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SUMMARY OBJECTIVE Recent studies have linked malnutrition with undesirable outcomes in cardiovascular diseases. However, the underlying mechanism is unknown. Contrast-induced acute kidney injury (CI-AKI) increased cardiovascular mortality after percutaneous coronary intervention (PCI). This study hypothesizes that prognostic nutritional index (PNI) plays a role in the development of CI-AKI in patients with acute coronary syndrome undergoing emergency PCI. METHODS This study enrolled 551 patients. PNI was determined as 10× serum albumin (g/dL)+0.005×total lymphocyte count (mm3). CI-AKI was characterized as the increase in serum creatinine ≥0.3 mg/dL level within 48 h after PCI. Patients were classified as either CI-AKI (+) or CI-AKI (−). RESULTS CI-AKI has occurred in 72 of 551 patients (13.1%). PNI was significantly lower in the CI-AKI (+) group than in the CI-AKI (-) group (44.4±6.6 versus 47.2±5.8, p

WOS: 000353933700006, PubMed: 25995662, Background/Aims: Poor sleep quality (SQ) is associated with increased cardiovascular mortality and morbidity. Additionally, asymmetric dimethylarginine (ADMA) is an independent predictor of cardiovascular mortality and morbidity. However, no sufficient data regarding the relationship between ADMA levels and SQ have been reported. The goal of the current study was to evaluate the association between SQ and ADMA levels in normotensive patients with type 2 diabetes mellitus. Methods: The study participants consisted of 78 normotensive type 2 diabetics. The SQ of all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients with a global PSQI score > 5 were defined as "poor sleepers." Factors associated with poor SQ were analyzed using a multiple regression model. Serum ADMA levels were measured using high performance liquid chromatography. Results: The median ADMA levels of the poor sleepers were increased compared with patients defined as good sleepers (5.5 [4.2 to 6.6] vs. 4.4 [2.9 to 5.4], p < 0.01, respectively). However, the L-arginine/ADMA ratio was decreased in poor sleepers (p < 0.01). Global PSQI scores were positively correlated with ADMA levels (p < 0.01) and negatively correlated with the L-arginine/ADMA ratio (p = 0.02). ADMA levels were correlated with sleep latency (p < 0.01) and sleep efficiency (p = 0.01). Logistic regression analysis showed that ADMA levels (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16 to 2.44; p = 0.01) and body mass index (OR, 1.15; 95% CI, 1.01 to 1.31; p = 0.04) were associated with poor SQ independently of glomerular filtration rate, sex, age, duration of diabetes, hemoglobin A1c, total cholesterol, and systolic blood pressure. Conclusions: Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus., Selcuk University Scientific Research Projects FundSelcuk University, This project was supported by Selcuk University Scientific Research Projects Fund.

Takotsubo cardiomyopathy (TCMP) is characterised by a temporary aneurysm of the left ventricular apex in individuals without significant stenosis of the coronary arteries. It is extremely rare to see it combined with a thrombus. In this case report, we present a 57-year-old female patient with TCMP in whom apical thrombus was treated with short-term warfarin use.

Background & objectives: Relationship of trace elements with obesity and diabetes is complex, alterations in their metabolism can be induced by the diseases and their complications. To study the role of the trace elements in diabetes and obesity, serum trace elements levels (Cr, Se, Fe, Zn, Cu and Mn) were measured in obese women with or without diabetes as well as healthy women. Further, correlation between serum trace elements levels and glucose, insulin, homeostasis model assessment (HOMA-IR), glycated haemoglobin (HbA 1 c), body mass index (BMI), waist circumferences, waist -to -hip ratio and high-sensitivity C-reactive protein(hsCRP) were also determined in these women. Methods: This study was performed with morbidly obese (BMI >40 kg/m 2 women with diabetes (n=41), without diabetes (n=45) and 50 healthly non obese women. Anthropometric measurements were taken and levels of serum Zn, Cr, Fe Cu and Mn were determined. Biochemical parameters included serum glucose, insulin, lipids, haemoglobin, hsCRP and HbA1C. Results: The levels of Zn (P

Background: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (Pd) might be a useful marker in predicting PAF in patients with acute ischemic stroke.Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared.Results: Maximum P-wave duration (p=0.002), Pd (pd was the only independent predictor of PAF. The cut-off value of Pd for the detection of PAF was 57.5 milliseconds (msc). Area under the curve was 0.80 (pConclusion: Pd on a single 12-lead ECG obtained within 24 hours of an acute ischemic stroke might help to predict PAF and reduce the risk of recurrent strokes.

Introduction Erectile dysfunction (ED) is a frequent complaint of elderly subjects and is closely associated with endothelial dysfunction and cardiovascular disease (CVD). Uric acid is also associated with endothelial dysfunction, oxidative stress, and CVD, raising the hypothesis that an increased serum uric acid might predict ED in patients who are at risk for coronary artery disease (CAD). Aim This study aims to evaluate the association of serum uric acid levels with presence and severity of ED in patients presenting with chest pain of presumed cardiac origin. Methods This is a cross-sectional study of 312 adult male patients with suspected CAD who underwent exercise stress test (EST) for workup of chest pain and completed a sexual health inventory for men survey form to determine the presence and severity of ED. Routine serum biochemistry (and uric acid levels) were measured. Logistic regression analysis was used to assess risk factors for ED. Main Outcome Measures The short version of the International Index of Erectile Function questionnaire diagnosed ED (cutoff score ≤ 21). Serum uric acid levels were determined. Patients with chest pain of suspected cardiac origin underwent an EST. Results One hundred forty-nine of 312 (47.7%) male subjects had ED by survey criteria. Patients with ED were older and had more frequent CAD, hypertension, diabetes and impaired renal function, and also had significantly higher levels of uric acid, fibrinogen, glucose, C-reactive protein, triglycerides compared with patients without ED. Uric acid levels were associated with ED by univariate analysis (odds ratio=1.36, P = 0.002); however, this association was not observed in multivariate analysis adjusted for estimated glomerular filtration rate. Conclusion Subjects presenting with chest pain of presumed cardiac origin are more likely to have ED if they have elevated uric acid levels. Solak Y, Akilli H, Kayrak M, Aribas A, Gaipov A, Turk S, Perez-Pozo SE, Covic A, McFann K, Johnson RJ, and Kanbay M. Uric Acid level and erectile dysfunction in patients with coronary artery disease. J Sex Med 2014;11:165–172.

WOS: 000324268900016, PubMed: 23677730, Background: AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) is a prospective, multicenter study designed with the aim of describing the prevalence and epidemiology of AF practice in Turkey. This study aims to evaluate stroke risk in non-valvular atrial fibrillation (AF) and anticoagulant drug utilization within conformity to AF guidelines. Methods: Patients were recruited in 17 referral hospitals reflecting all the population of 7 geographical regions of Turkey. 2242 consecutive patients who had been admitted with AF on ECG were included in the study. 1745 of these patients, who had non-valvular AF, were included in the statistical evaluation. Stroke risk was evaluated with the CHA(2)DS(2)-VASc score. Results: The average age of participants was determined to be 69.2 +/- 11.5 years (56% female). Persistent-permanent AF was found to be the most common type of non-valvular AF (78%). The most common comorbid disorder was hypertension (73%). It was found that oral anticoagulant therapy was used by 40% of all patients, 37% of whom had effective INR (2.0-3.0). Upon multivariate analysis, age was found to be the only independent predictor of stroke among the variables' effects on thromboembolic events that created CHA2DS2-VASc abbreviations (OR 1.026, p < 0.001). Conclusions: These results suggest that stroke risk scores should be thoroughly heeded based on guidelines, and that anticoagulation must be applied according to their guidance.

Amaç: Atriyum fibrilasyonu (AF) klinik pratiğimizde en sık rastlanan ritm bozukluğu olup ülkemizde bu konuda yapılmış çok merkezli bir epidemiyolojik çalışma bulunmamaktadır. Bu çalışmanın amacı ülkemizde ilk kez yapılmış olan çok merkezli, ileriye dönük Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) çalışmasının kayıtlarından yararlanarak AF’ye klinik yönden yaklaşımımızı değerlendirmektir. Çalışma planı: Ülkemizde nüfus dağılımı göz önünde bulundurularak 17 ayrı üçüncü basamak merkezden, elektrokardiyografisinde en az bir defa AF atağı tespit edilmiş olan ardışık 2242 hasta çalışmaya alındı. Acil polikliniğine başvuran ya da yatmakta olan hastalar çalışmadan dışlandı. Hastaların epidemiyolojik verileri ve uygulanan tedaviler değerlendirildi. Bulgular: Çalışma popülasyonunu oluşturan hastaların %60’ı kadındı, hastaların ortalama yaşı 66.8±12.3 yıl olarak saptandı. Türk nüfusunda en sık görülen AF tipi non-valvular AF (%78) olup, AF’li hastaların %81’i ısrarcı-kalıcı AF’li idi. AF’ye en sık eşlik eden komorbid durum hipertansiyon (%67) olarak bulundu. Hastaların %15.3’ünde inme, geçici iskemik atak ve sistemik tromboemboli hikayesi mevcut iken kanama öyküsü hastaların %11.2’sinde kaydedildi. Çalışma süresinde hastaların %50’si warfarin, %53’ü de aspirin kullanıyordu. Oral antikoagülan ilaç kullanan hastaların %41.3’ünde etkin INR düzeyi saptandı. Oral antikoagülan ilaç kullanmamanın en sık nedeni (%69) hekim ihmali olarak saptandı. Sonuç: Bu veriler klinik pratiğimizde özellikle AF’li hastaların antitrombotik tedavileri konusunda daha dikkatli olunması gerektiğini göstermektedir. Objectives: Although atrial fibrillation (AF) is one of the most com- mon rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Tur- key: Epidemiologic Registry (AFTER) study. Study design: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency depart- ments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. Results: The mean age of the patients was determined as 66.8±12.3 years with female patients representing 60% of the study popula- tion. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co- morbidity in patients with AF. While a stroke or transient ischemic at- tack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspi- rin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. Conclusion: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

WOS: 000292694700012, PubMed: 21757938, Objective: In this study, our aim was to evaluate the effect of a higher dose of atorvastatin on the recurrence rate of atrial fibrillation (AF) after electrical cardioversion (EC) in addition to antiarrhythmic therapy. Subjects and Methods: 48 patients with persistent AF were included in this study. The patients were randomized to an atorvastatin 40-mg treatment group and a control group. Atorvastatin was started 3 weeks before EC and was continued for 2 months after EC. EC was performed using biphasic shocks after 3 weeks of treatment with the orally administered anticoagulant warfarin. Lipid and inflammatory parameters (high-sensitivity C-reactive protein, white blood cell count and fibrinogen level) were evaluated at the baseline and before EC. The endpoint of this study was electrocardiographically confirmed recurrence of AF of >10 min. Results: There were no significant differences in baseline characteristics and lipid and inflammatory marker levels between the treatment and control groups. Total cholesterol and low-density lipoprotein levels were significantly decreased in patients taking atorvastatin for 2 months compared with baseline values (174 +/- 31 vs. 129 +/- 25 mg/dl, p = 0.001, and 112 +/- 23 vs. 62 +/- 20 mg/dl, p = 0.001, respectively), while no significant change occurred in control patients (168 +/- 26 vs. 182 +/- 29 mg/dl, p = 0.07, and 99 +/- 18 vs. 108 +/- 26 mg/dl, p = 0.1, respectively). At the end of the 2-month follow-up period, 9 patients (20.5%) experienced AF recurrence, and there was no significant difference in AF recurrence rate between the treatment and control groups (26 vs. 13%; p = 0.2). Conclusion: Atorvastatin therapy prior to EC does not prevent the recurrence of arrhythmia in patients with persistent AF who are receiving antiarrhythmic therapy. Copyright (C) 2011 S. Karger AG, Basel

Background Pulmonary hypertension (PH) caused by chronic obstructive lung disease (COLD) essentially involves the right heart. Also left ventricular (LV) systolic and diastolic functions may be affected. Objectives The aim of this study was to investigate the effect of on LV diastolic function in patients with COLD. Methods A total of 47 patients with COLD and 20 controls were included in this study. All patients underwent Doppler echocardiography, tissue Doppler imaging examinations and right cardiac catheterization. The patients were divided into 2 subgroups according to mean pulmonary arterial pressure (mPAP): patients without PH (group1, n = 25) and with PH (group 2, n = 22). The following measurements were taken: peak velocity of early diastolic filling (E), peak late filling with atrial contraction (A), E/A ratio, deceleration time (DT) of E, isovolumic relaxation time (IVRT), early (Em) and late (Am) diastolic mitral lateral annulus velocity. Results Mitral E/A < 1 and Em < 8 cm/sec were higher in group 2 than in group 1 and the control group. There were significant correlations between mPAP and both mitral E/A (r:− 0.60) and Em (r:− 0.45). In multivariate model, mPAP was not found to be significant on mitral E/A ratio < 1, but there was a significant effect on mitral Em < 8 cm/sec (odds ratio [OR]:1.14, P < 0.05). Conclusion This study shows that LV diastolic dysfunction in COLD is closely correlated to PH levels. Although increased mPAP may affect the mitral E/A ratio, it seems to have no effect on mitral E/A < 1, whereas it has an independent effect on Em < 8 cm/sec. Copyright © 2010 Wiley Periodicals, Inc.

OP-037 Beta blockers and diuretics are frequently associated with erectile dysfunction (ED). However, the definitive mechanisms of ED secondary to these drugs are still unclear. Uric acid is a novel marker of atherosclerosis and endothelial dysfunction. Also, endothelial dysfunction plays a major