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Background: Positive T wave in lead aVR (TaVR) has been associated with increased risk of adverse events in patients with various cardiovascular diseases., Objective: The purpose of this study was to investigate the prevalence and prognostic significance of positive TaVR in patients with hypertrophic cardiomyopathy (HCM)., Methods: This study investigated 421 consecutive patients with HCM (177 women; age 51.1 ± 14.9 years). Admission electrocardiogram was examined for the presence of a positive TaVR. The primary endpoint was defined as a composite of major arrhythmic events (MAEs), which included sudden cardiac death, sustained ventricular tachycardia or fibrillation, or appropriate implantable cardioverter-defibrillator therapy. Cardiovascular mortality and all-cause death were evaluated as secondary endpoints., Results: During median follow-up period of 6.0 years (interquartile range 4.0-11.6 years), 53 patients (12.6%) experienced the primary endpoint. On multivariable competing analysis, after adjusting for other confounding factors, the presence of positive TaVR was found to be an independent and strong predictor of the primary composite endpoint. Time-dependent receiver operating characteristic analysis, net reclassification index, and integrated discrimination improvement showed that the addition of positive TaVR to conventional HCM risk factors improved prediction of arrhythmic events. However, in subgroup analysis, a positive TaVR lost statistical significance in patients with apical HCM but remained significant in patients with all other hypertrophy patterns., Conclusion: Positive TaVR is associated with MAE in HCM patients, independent of and incremental to traditional risk factors., (Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

The relationship between atrial fibrillation and human immunodeficiency virus (HIV) infection was evaluated. Electro-echocardiographic methods can be used to predict the development of atrial fibrillation (AF). In this study, we aimed to investigate the atrial electromechanical delay (AEMD) parameters of HIV (+) patients. Forty-two HIV (+) patients and 40 HIV (-) healthy volunteers were prospectively enrolled in this study. The electromechanical properties of the subjects' atria were evaluated with tissue Doppler imaging. The left-AEMD, right-AEMD and inter-AEMD were increased in the HIV (+) patients relative to the controls (p=0.003, p<0.001, and p<0.001, respectively). The CD4 count was inversely correlated with the inter-AEMD (r=-0.428, p<0.001). The CD4 count was an independent predictor of the inter-AEMD (β=0.523, p=0.007). Our study demonstrated that both the inter- and intra-atrial electromechanical delays were prolonged in the patients with HIV. This non-invasive and simple technique may provide significant contributions to the assessment of the risk of atrial arrhythmia in patients with HIV., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Since some echocardiographic features play an important role in the assessment of the defect and safety of the procedure, the salient features of the anatomical variations seen in adults undergoing transcatheter device closure should be well known to prevent inadvertent adverse effect or complications. It has been reported that the valve of the inferior vena cava, Eustachian valve, could be mistaken as the atrial septum thus ending in a wrong diagnosis and causing inadvertent surgical or percutaneous closure of an Eustachian valve to interatrial septum. We present a concise article that brings out a practical issue encountered during device closure of atrial septal defects., (Copyright © 2017. Published by Elsevier B.V.)

Prediction of left main coronary artery (LMCA) or equivalent disease is important with regard to selecting the appropriate treatment strategy. The classical electrocardiographic pattern of LMCA disease includes ST elevation (STE) in lead aVR in the presence of extensive ST depression (most prominent in leads I, II, and V4-6) with the STE in aVR≥V1. Patients with these findings may potentially require early coronary angiography and coronary bypass surgery; therefore selected patients with these findings on exercise testing might benefit from more urgent or expedited angiography., (Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Background and Aim: Infective endocarditis (IE) is associated with increased mortality and morbidity. In this study, we aimed to evaluate the role of troponin levels in predicting long-term survival in patients with IE., Methods: A retrospective analysis of the medical database of Yuksek Ihtisas Education and Research Hospital was performed to reach the patients that received the diagnosis of definite IE according to Duke criteria. Out of 84 definite IE cases, 48 patients (mean age 45.6 ± 17.3, 39.6% female) that had troponin T levels measured upon hospital admission were included. The survival status of the study subjects was assessed during a follow-up period of 1 year., Results: A total of 20 (41.7%) patients died during the follow-up. Baseline median troponin T levels were significantly higher in fatal cases (0.08 [0.02-0.24] ng/ml vs. 0.02 [0.01-0.04] ng/ml p = 0.003). The optimal troponin T level to detect mortality was 0.05 ng/ml according to receiver operating characteristic curve (area under the curve 0.75, 95% Confidence Interval (CI) [0.61-0.9], p = 0.003) with 70% sensitivity and 79% specificity. Patient with elevated troponin levels were older, were more likely to be male and tended to have enterococcal infection. These patients had also higher creatinine levels and increased systolic pulmonary pressures. In the multivariate Cox regression analysis, renal failure (hazards ratio (HR) 8.23, CI 95% 2.53-26.9, p < 0.0001), heart failure (HR 4.48, CI 95% 1.73-11.61, p = 0.002) and troponin T ≥ 0.05 ng/ml (HR 3.11, CI 95% 1.13-8.56, p = 0.03) were associated with increased mortality rates., Conclusions: IE has poor outcome and baseline troponin T levels may predict long-term survival rates in these patients., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)