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OBJECTIVE Chronic kidney disease (CKD) and diabetes mellitus (DM) are common comorbidities in heart failure (HF). Patients with HF are at a high risk of hyperkalemia, and are therefore undertreated with respect to disease-modifying therapies. The Turkish Research Team-Heart Failure (TREAT HF) data were analyzed for the evaluation of hyperkalemia in real-life clinical practice in HF patients with CKD or DM. METHODS The TREAT HF is a multicenter, national, observational registry. In this study, potassium levels of 1028 patients with HF were analyzed. Hyperkalemia is defined as blood potassium levels >5 mEq/L and evaluated based on the CKD, DM, HF medications, and New York Heart Association (NYHA) classes. RESULTS Overall, 14.3% of patients (n=147) were found to have hyperkalemia. Hyperkalemia was more prevalent in patients with estimated glomerular filtration rate (eGFR)

Background Carbohydrate antigen 125 (CA 125), known as a tumor marker for ovarian cancer, has been reported to increase and be associated with severity in heart failure and chronic obstructive pulmonary disease. Patients with pulmonary arterial hypertension may also die due to developing right heart failure. The aim of this study is to evaluate the prognostic role of CA-125 in PAH patients. Methods A total of 40 consecutive patients with PAH were evaluated prospectively. The mean age of patients was 52 ± 11 years (12% males, 88% females) with a median follow-up period of 16 months. Results After follow-up period, 12 out of 40 patients (30%) died. CA-125 levels were higher among those who died compared to those who survived [78.5 (11.0–292) vs. 27.5 (2.10–138) U/ml, p = 0.001]. The optimal cut-off value of CA-125 to predict mortality was found as 35.29 U/ml, with 85.7% specificity and 75% sensitivity. In multivariable Cox proportional-hazards model with forward stepwise method; CA-125 > 35.32 U/ml on admission (HR = 7.645, 95% CI: 1.356–43.121, p = 0.021), age (HR = 1.132, 95% CI: 1.040–1.233, p = 0.004), TAPSE (HR = 0.740, 95% CI: 0.549–0.998, p = 0.048) and uric acid (HR = 1.444, 95% CI: 1.022–2.042, p = 0.037) remained associated with an increased risk of death. Conclusion In this study, we showed for the first time that serum CA-125 values were an independent predictor for the long-term mortality in PAH patients.

Objectives This study examined the effects of sacubitril/valsartan on N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response. Background NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF). Methods Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline. Results In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p Conclusions In-hospital initiation of sacubitril/valsartan produced rapid reductions in NT-proBNP, statistically significant at discharge. A favorable NT-proBNP response over time was associated with a better prognosis and predicted by higher starting dose and predisposing clinical profile. (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event [TRANSITION]; NCT02661217)

OBJECTIVE: We aimed to compare the outcomes of chronic heart failure (HF) patients with reduced ejection fraction (CHFrEF) in the Turkish Research Team in HF (TREAT-HF) registry according to marital status with a specific focus on being the widowed (widow/widower) versus the married.METHODS: TREAT-HF is a network, enrolling CHFrEF with a follow up for HF-related hospitalization (HFrH) and all-cause mortality (ACM). In this cohort, the widowed patients were compared with patients who were married before and after propensity score (PS) matching analysis.RESULTS: There were 723 cHFrEF patients with a complete dataset, including reported marital status at baseline for this analysis. Out of 723 patients with HF, 37 “never-married” and “divorced” patients were excluded from the analysis. Then, out of 686 remaining patients with HF, who had at least one reported marriage in the database, widowed patients with HF (n=124) were compared with married patients (n=562). The mean follow up period was 21±12 months up to 48 months. The widowed patients had a higher risk of HFrH (p=0.047), although ACM remained similar compared to married patients (p=0.054). After PS matching, HFrH remained more frequent among the widowed compared with the married (p=0.039) although ACM yielded similar rates. Of note, it was shown that being a widower (p=0.419) was not linked to increased risk of HFrH during follow up contrary to being a widow (p=0.037) despite similar age, ejection fraction, creatinine, NYHA functional class distribution and a similar rate of life-saving medications.CONCLUSION: PS matching analysis yielded that the widowed had increased the risk for HFrH. Of note, widowers did not seem to have an increased risk for HFrH, contrary to widows. WOS:000619599000010 PubMed: 33623875

Purpose Hyperkalemia is increasingly prevalent and life-threatening condition in heart failure (HF). In clinical practice, hyperkalemia is also an important barrier to optimal application of RAASi. New potassium binders, sodium zirconium cyclosilicate and patiromer, were developed for the treatment of hyperkalemia. TREAT HF data were analyzed for the evaluation of potential clinical application of potassium binders in real life clinical care in HF patients. Methods TREAT HF is a network which undertakes multicenter, national, observational studies designed to evaluate HF patients' clinical characteristics and current treatment modalities. 1028 patients with the diagnosis of chronic HF, median age 64 years and median LVEF 30% who had potassium and GFR data were included in this analysis. In this patient population, 847 patients (82.6%) were receiving beta blockers, 739 (71.9%) were receiving ACE inhibitors or ARBs and 518 (50.4%) were receiving MRA. Patients with hyperkalemia (serum potassium ≥5.1 mEq/L) were considered candidate for potassium binders based on the criteria of HARMONIZE study. According to eGFR (mL/min) level, renal dysfunction was subclassified as: stage-1 (eGFR ≥90) (n=211), stage-2 (eGFR 60- Results In study population, median potassium level was 4.5 mEq/L, median creatinin level was 1.1 mg/dL and median eGFR was 65.5 mL/min. Overall, 82.9% of patients had normal serum potassium levels (≥3.5–5 mEq/l) and 14.3% of patients (n=147) were found to have hyperkalemia (≥5.1 mEq/L) and, hypokalemia was found in 2.8% of patients (n=30). Hyperkalemia was present in 10.9% (n=23) of patients with stage-1, 12.6% (n=50) of patients with stage-2, 17.0% (n=52) of patients with stage-3 and 19.5% (n=22) of patients with stage 4–5 renal dysfunction. In patients with eGFR Conclusions This study suggested that in real life clinical practice, 14.3% of HF patients have hyperkalemia and seem to be eligible for the treatment of potassium binders. The risk of hyperkalemia increases with advanced stages of renal dysfunction and the use of RAASi, showing an increased clinical need for potassium binders in HF patients with renal dysfunction and in those receiving RAASi. Funding Acknowledgement Type of funding source: None

Background Relationship between the frequency of occurrence of bendopnea during the daily life of heart failure (HF) outpatients and clinical outcomes has never been evaluated before. Methods Turkish Research Team-Heart Failure (TREAT-HF) is a network between HF centres, which undertakes multicentric observational studies in HF. Herein, the data including stable 573 HF patients with reduced ejection fraction out of seven HF centres were presented. A questionnaire was filled by the patients, with the question 'Do you experience shortness of breath while tying your shoelace?', assessing the presence and frequency of bendopnea. Results To the question related to bendopnea, 48% of the patients answered 'yes, every time', 31% answered 'yes, sometimes', and 21% answered 'No'. Patients were followed for an average of 24 +/- 14 months, and the patients who answered 'yes, every time' and 'yes, sometimes' to the bendopnea question were found having increased risk for both HF-related hospitalisations (HR:3.2,p < .001- HR:2.8,p = .005) and composite outcome consisting of 'HF-related hospitalisations and all-cause death in the multi-variate analysis (HR:3.1,p < .001- HR:3.0,p < .001). Kaplan Meier analysis for HF-related hospitalisation, all-cause death, and the composite of these were provided for these three groups, yielding significant and graded divergence curves with the best prognosis in 'no' group, with the moderate prognosis in 'sometimes' group, and with the worst prognosis in the 'every time' group. Conclusion For the first time in the literature, our study shows that the increased frequency of bendopnea occurrence in daily life is associated with poor outcomes in HF outpatients. WOS:000561035900001 2-s2.0-85089596091 PubMed: 32812491

In this study, we compared the patients who underwent coronary angiography (CAG), followed by revascularization by coronary artery stent implantation according to the CAG results without any evidence of ischemia with myocardial perfusion scintigraphy (MPS), and the patients who underwent revascularization by coronary artery stent implantation following the detection of ischemia in MPS before CAG in terms of the mortality and hospitalization due to acute coronary syndrome (ACS). Between January 2009 and January 2016, a total of 407 patients (52% males, 48% females; mean age: 66 ± 9 years; range: 40–85 years) who underwent CAG following diagnosis of stable angina and underwent coronary artery stenting were retrospectively analyzed. The patients were divided into two groups: Group 1 (n = 200) included those who had MPS before CAG and in whom ischemia was detected and stent was implanted, and Group 2 (n = 207) included those who had stent implantation according to the CAG results without prior MPS. The mean follow-up was 40 ± 18 months. Although there was no significant difference in the mortality rates between the groups, the rate of hospitalization due to ACS was significantly lower in Group 1 (P = 0.112 vs.P = 0.022, respectively). According to the multivariate Cox-regression analysis, demonstration of ischemia in MPS before revascularization, statin use, clopidogrel use, and higher high-density lipoprotein cholesterol levels were found to be associated with a reduced risk of ACS-related hospitalization, whereas the presence of diabetes mellitus and smoking was found to be associated with an increased risk of ACS-related hospitalization.

WOS: 000394509600007, PubMed ID: 28265209, Length of stay is the primary driver of heart-failure hospitalization costs. Because cancer antigen 125 has been associated with poor morbidity and mortality rates in heart failure, we investigated the relationship between admission cancer antigen 125 levels and lengths of stay in heart-failure patients. A total of 267 consecutive patients (184 men, 83 women) with acute decompensated heart failure were evaluated prospectively. The median length of stay was 4 days, and the patients were classified into 2 groups: those with lengths of stay 4 days. Patients with longer lengths of stay had a significantly higher cancer antigen 125 level of 114 U/mL (range, 9-298 U/mL) than did those with a shorter length of stay (19 U/mL; range; 3-68) (P < 0.001). The optimal cutoff level of cancer antigen 125 in the prediction of length of stay was > 48 U/mL, with a specificity of 95.8% and a sensitivity of 96% (area under the curve, 0.979; 95% confidence interval [CI], 0.953-0.992). In the multivariate logistic regression model, cancer antigen 125 > 48 U/mL on admission (odds ratio=4.562; 95% CI, 1.826-11.398; P=0.001), sodium level (P< 0.001), creatinine level (P=0.009), and atrial fibrillation (P=0.015) were also associated with a longer length of stay after adjustment for variables found to be statistically significant in univariate analysis and correlated with cancer antigen 125 level. In addition, it appears that in a cohort of patients with acute decompensated heart failure, cancer antigen 125 is independently associated with prolonged length of stay.

Background: Rehospitalizations with acute coronary syndromes (ACSs) have declined over the last years, but there is a remaining need for potential further reduction of rehospitalization after ACS to determine the most predominant predictors that can guide strategies to reduce re-hospitalizations burden. Aim: This multi-center study aimed to evaluate the demographic, clinical characteristics, and medications of rehospitalized patients who suffered a new cardiac event in 12 months after admission due to ACS. Material and Methods: Patients age >18 years who have been hospitalized between November 1 2017, and April 1 2018, for ACS within12 months before the readmission for a new acute coronary event were enrolled. Results: The present study included a total of 628 (65.9% from Turkey) consecutive patients rehospitalized with ACS (ST-elevation myocardial infarction [STEMI], 23.0%; ACS without ST-elevation [NSTE-ACS], 76.9%) from 15 different countries. The majority of the rehospitalized patients were men (67.9%), and the mean age was 63.1 ± 12.53 years. 406 (64.6%) had typical, 209 (33.2%) of patients had atypical chest pain and 13 (2.07%) had not any chest pain complaint during readmission. 304 (48.41%) of patients were discharged from hospital earlier than 3 days and 107 (17.04%) of patients stayed more than 7 days. The subcategories of first index diagnosis were 227 (36.1%) STEMI; 401 (63.8%) NSTE-ACS. The mean time from index discharge to rehospitalization was 189.25 ± 118 days. 248 (39.4%) patients were re-hospitalized more than once after index discharge. The most common risk factors were diabetes mellitus (471, 75.0%). 175 (27.87%) of patients stopped taking medication before re-hospitalization. Most of the patients (69.4%) had multivessel disease. Conclusion: Several factors identify patients at higher risk of rehospitalization with ACS. Understanding and preventing these causes can prevent rehospitalization and improve their outcome.

WOS: 000374033100024, PubMed ID: 30039119, A 32 year old female patient presented to the cardiology clinic with an atypical chest pain. Her history revealed no other condition than Leopard syndrome which was diagnosed on her birth. On her coronary CT angiography, LMCA originated from the right coronary sinus and had a prepulmonic course. The purpose of this article is to present this patient with Leopard syndrome accompanied by left coronary artery outlet and coronary sinus abnormality.

Objectives: Hyponatremia and atrial fibrillation (AF) have been established as strong predictors for worse clinical outcomes in patients with heart failure (HF). However, little is known about hyponatremia in relation to the occurrence of AF. This study aims to investigate the possible relationship between hyponatremia and AF in patients with chronic HF and reduced ejection fraction (HFrEF). Methods: Turkish research team-HF (TREAT-HF) is a network that has been undertaking multicenter, observational cohort studies on HF. A total of 880 patients who had plasma sodium measurement in TREAT-HF data set were included in this study. Hyponatremia was defined as a plasma sodium level of ≤135 mmol/L. The patients were classified into hyponatremia (n=213) or normonatremia (n=667) based on the sodium level. Results: The rate of AF was found to be 33.3% in patients with hyponatremia and 18.8% in patients with normonatremia (p

Background and objective: Prevalence of atrial fibrillation is higher in hemodialysis patients as compared to the general population. Atrial electromechanical delay is known as a significant predictor of atrial fibrillation. In this study, we aimed to reveal the relationship between atrial electromechanical delay and attacks of atrial fibrillation. Materials and methods: The study included 77 hemodialysis patients over 18 years of age giving written consent to participate in the study. The patients were divided into two groups based on the results of 24-h Holter Electrocardiogram (Holter ECG) as the ones having attacks of atrial fibrillation and the others without any attack of atrial fibrillation. Standard echocardiographic measurements were taken from all patients. Additionally, atrial conduction times were measured by tissue Doppler technique and atrial electromechanical delays were calculated. Results: Intra- and interatrial electromechanical delay were found as significantly lengthened in the group of patients with attacks of atrial fibrillation (p = 0.03 and p &lt, 0.001 respectively). The optimal cut-off time for interatrial electromechanical delay to predict atrial fibrillation was &gt, 21 ms with a specificity of 79.3% and a sensitivity of 73.7% (area under the curve 0.820, 95% confidence interval (CI), 0.716&ndash, 0.898). In the multivariate logistic regression model, interatrial electromechanical delay (odds ratio = 1.230, 95% CI, 1.104&ndash, 1.370, p &lt, 0.001) and hypertension (odds ratio = 4.525, 95% CI, 1.042&ndash, 19.651, p = 0.044) were also associated with atrial fibrillation after adjustment for variables found to be statistically significant in univariate analysis and correlated with interatrial electromechanical delay. Conclusions: Interatrial electromechanical delay is independently related with the attacks of atrial fibrillation detected on Holter ECG records in hemodialysis patients.

The number of patients diagnosed with heart failure (HF) is gradually increasing as a result of the increase in the elderly population. As the proportion of patients admitted to the emergency room with the diagnosis of acute heart failure increases, the opinion of cardiologists who are interested in heart failure has gained more importance in both the in-hospital management of these patients during the acute period and also in post-hospital management. The current review aimed to help the clinicians determine the course of patients with HF, beginning with the time of admission, according to the current guidelines and expert opinions.

In this study, we investigated the relationship between the mean platelet volume (MPV) with mortality and heart failure (HF)-related hospitalization in stable chronic HF outpatients with reduced ejection fraction (HFrEF) and with sinus rhythm (SR).This retrospective cohort study included 197 consecutive stable chronic HFrEF outpatients with SR, who were admitted to our cardiology outpatient clinics for examination between January 2014 and January 2015. According to the receiver-operating characteristic curve analysis, the optimal cut-off value of MPV to predict HF-related hospitalization was9.1 fL. Patients were classified into two categories according to threshold MPV levels, as group I with MPV ≤ 9.1 fL and group II with MPV9.1 fL.The mean age of patients was 65 ± 13 years. The mean follow-up duration was 10 ± 3 months, and 44 patients (22%) succumbed to cardiovascular (CV) death. The rate of CV mortality was similar between the two groups (21% vs. 24%, p = 0.649). However, the rate of patients who experienced HF-related hospitalization was lower in group I compared with group II (41% vs. 87%, p0.001, respectively). Univariate analysis demonstrated associations of many clinical factors in addition to increased MPV9.1 fL with HF-related hospitalization; however, In the multivariate Cox proportional-hazards model, only increased MPV9.1 fL (HR: 2.895, 95% CI: 1.774-4.724, p0.001), systolic pulmonary artery pressure level (HR: 1.018, 95% CI: 1.001-1.036, p = 0.048) and pre-admission beta blocker use (HR: 0.517, 95% CI: 0.305-0.877, p = 0.014) remained associated with a risk of HF-related hospitalization.The mean platelet volume might be a useful parameter for risk stratification with regard to HF-related hospitalization in HFrEF outpatients with SR.

WOS: 000403533000007, PubMed ID: 27849190, Objective: Angiographic assessment of stenosis has limited predictive value for functionally significant lesions compared with fractional flow reserve (FFR). The recently developed angiographic DILEMMA score, which consists of minimal lumen diameter (MLD), lesion length (LL) and Bypass Angioplasty Revascularization Investigation (BARI) Myocardial Jeopardy Index (MJI) was found to have diagnostic value in predicting FFR 0.80 group and 103 lesions in FFR

WOS: 000399748200003, PubMed ID: 27958615, Background: Heart failure (HF) is a fatal disease. Plasma osmolality with individual impacts of sodium, blood urea nitrogen (BUN), and glucose has not been studied prognostically in patients with HF. Aim: This study aims to investigate the impact of serum osmolality on clinical endpoints in HF patients. Methods: A total of 509 patients (383 males, 126 females) with HF with reduced ejection fraction in three HF centres were retrospectively analysed between January 2007 and December 2013. Follow-up data were completed for 496 patients. Plasma osmolality was calculated as (2 x Na) + (BUN/2.8) + (Glucose/18). Quartiles of plasma osmolality were produced, and the possible relationship between plasma osmolality and cardiovascular mortality was investigated. Results: The mean follow-up was 25 +/- 22 months. The mean age was 56.5 +/- 17.3 years with a mean EF of 26 +/- 8%. The mean levels of plasma osmolality were as follows in the quartiles: 1st % = 280 +/- 6, 2nd % = 288 +/- 1, 3rd % = 293 +/- 2 (95% confidence interval [ CI] 292.72-293.3), and 4th % = 301 +/- 5 mOsm/kg. The EF and B-type natriuretic peptide levels were similar in the four quartiles. Univariate and multivariate analyses in the Cox proportional hazard model revealed a significantly higher rate of mortality in the patients with hypo-osmolality. The Kaplan-Meier plot showed graded mortality curves with the 1st quartile having the worst prognosis, followed by the 4th quartile and the 2nd quartile, while the 3rd quartile was shown to have the best prognosis. Conclusions: Our study results suggest that normal plasma osmolality is between 275 and 295 mOsm/kg. However, being close to the upper limit of normal range (292-293 mOsm/kg) seems to be the optimal plasma osmolality level in terms of cardiovascular prognosis in patients with HF.

WOS: 000367930400001, PubMed ID: 26839721, A considerable percentage of electrical injuries occur as a result of work activities. Electrical injury can lead to various cardiovascular disorders: acute myocardial necrosis, myocardial ischemia, heart failure, arrhythmias, hemorrhagic pericarditis, acute hypertension with peripheral vasospasm, and anomalous, nonspecific ECG alterations. Ventricular fibrillation is the most common arrhythmia resulting from electrical injury and is the leading cause of death in electrical (especially low voltage alternating current) injury cases. Asystole, premature ventricular contractions, ventricular tachycardia, conduction disorders (various degrees of heart blocks, bundle-brunch blocks), supraventricular tachycardia, and atrial fibrillation are the other arrhythmic complications of electrical injury. Complete atrioventricular block has rarely been reported and permanent pacemaker was required for the treatment in some of these cases. Herein, we present a case of reversible complete atrioventricular block due to low voltage electrical injury in a young electrical technician.

WOS: 000392631500004, PubMed ID: 27665329, Objective: New York Heart Association (NYHA) classification predicts prognosis for heart failure (HF) patients. Socioeconomic status (SES) has the potential to affect treatment strategy and disease course. The present objective was to investigate whether SES of Turkish HF patients affected NYHA classification. Methods: Turkish research team-HF (TREAT-HF) is a questionnaire study with 52 questions, the purpose of which is to aid in the assessment of various qualities of HF patients. The 2013 TREAT-HF cohort included 503 patients from 11 centers in Turkey. Patients were divided into 2 groups according to NYHA functional classification: I-II, a better functional classification, or III-IV, a poorer functional classification. In addition, patients were analyzed according to gender. Results: Evaluated were NYHA functional classifications of 459 (326 males and 133 females) patients with a mean age of 59.7 +/- 14.07 years and a mean ejection fraction (EF) of 31.7 +/- 9.22%. Total monthly family income level of >= 1000 TL, younger age, higher EF, and male gender were independently associated with better NYHA functional classification. In addition to EF, regular weight control was found to be independently associated with better NYHA classification for females, while younger age and income of >= 1000 TL were independently associated with better NYHA classification for males. Conclusion: The present results demonstrated that SES was associated with NYHA functional classification in a cohort of Turkish HF patients.

Objectives. Resistant hypertension has unfavourable effects on cardiovascular and other systems. The aim of this study was to investigate the association of neutrophil/lymphocyte (N/L) ratio and resistant hypertension. Methods. A total of 140 patients were included in the study. Ambulatory 24-hour blood pressure monitoring, transthoracic echocardiography and blood sample analyzing were performed in all patients. There were 60 patients with resistant hypertension group (mean age=55.1±9.7 years) and 80 patients with non-resistant hypertension group (mean age=56.8±14.1 years). Results. Mean neutrophil levels were significantly higher in resistant hypertension group (71.7±6.1% vs. 65.9±5.4%, p

The clinical significance of unligated major left internal mammary artery (LIMA)-side branches (SB) remains controversial in patients with previous coronary artery bypass graft (CABG) surgery. The aim of this study was to investigate the clinical significance of unligated major LIMA-SB by using exercise myocardial perfusion imaging (MPI) with single-photon emission tomography.We conducted a retrospective analysis of 2819 consecutive patients who underwent diagnostic angiography. There were 407 CABG patients with LIMA graft. The demographic, laboratory, pre-angiographic stress test and angiographic data of these patients were collected. A subgroup of patients with unligated major LIMA-SB who were referred to angiography with the diagnosis of stable angina pectoris and positive exercise MPI was identified and divided into two groups for comparison: anterior wall vs non-anterior wall ischemia groups.Among 407 patients with LIMA graft, 112 (27.5%) patients were found to have unligated major LIMA-SB. In a subgroup of patients (n=45) with positive exercise MPI and patent LAD-LIMA system with unligated major LIMA-SB, the median values of diameter and length of unligated major LIMA-SB were statistically higher in anterior wall ischemia group (n=24) compared to non-anterior wall ischemia group (1.8mm vs 0.6mm, P0.001 and 17.0cm vs 8.0cm, P0.001, respectively). The cut-off values of unligated major LIMA-SB length and diameter were 11cm and 1.3mm respectively. Unligated major LIMA-SB with a length of ≥11.0cm and a diameter of1.3cm had 95.8% of sensitivity and 100% of specificity for predicting anterior wall ischemia on exercise MPI. In patients with anterior wall ischemia, summed stress score and summed difference score were improved after percutaneous coil embolization of large unligated major LIMA-SB with ≥11.0cm length and1.3mm diameter.Large unligated major LIMA-SB with ≥11.0cm length and1.3mm diameter seems to be a potential source of ischemia in CABG patients. We suggest that exercise MPI might be a first option noninvasive test in evaluating the clinical significance of unligated major LIMA-SB and the effectiveness of embolization therapy.

WOS: 000377193000003, PubMed ID: 26467374, Objective: Endothelial dysfunction, secondary to systemic inflammation and oxidative stress, is known to play a major role in the development and progression of atherosclerosis. It is hypothesized that the lower incidence of coronary artery disease in the premenopausal period in females when compared with males is associated with regular menstrual blood loss. We investigated whether regular blood donation (BD) is associated with improved endothelial function in healthy adult males. Methods: Fifty young healthy male volunteers volunteers with a mean age of 30 +/- 6 years without overt cardiovascular disease were enrolled to participate in serial consecutive BDs. Serum iron levels as oxidative stress parameters, flow-mediated dilatation (FMD) for endothelial function, 24-h mean diastolic blood pressure for peripheral vascular resistance identification, and high-sensitivity C-reactive protein (hs-CRP) levels as systemic inflammatory markers were evaluated before and after BD. This study used a prospective observational cohort design. Patients with cardiovascular and inflammatory diseases were excluded. Results: BD was found to improve FMD steadily and significantly when compared with the baseline (mean +/- SD: 9.9%+/- 3.8%, 10.44%+/- 3.9%, 10.65%+/- 3.9%, and 10.75 +/- 3.9%, respectively, p=0.15, p=0.02, p=0.006 as compared with the baseline). A steady decrease was identified in hs-CRP levels after serial BDs, although this decrease was not statistically significant in the all phases (2.96 +/- 3.3 mg/L, 2.26 +/- 1.5 mg/L, and 2.12 +/- 1.5 mg/L, respectively, p=0.829, p=0.558). The 24-h mean diastolic blood pressures were significantly lower in the chronic phase (77 +/- 9 mm Hg, 75 +/- 7 mm Hg, and 72 +/- 8 mm Hg, respectively, p=0.50, p=0.003), whereas there was no significant change in iron levels in the acute and chronic phases (66 +/- 32 mg/dL, 72 +/- 43 mg/dL, and 68 +/- 33 mg/dL, respectively, p=1.000, p=1.000). Conclusion: The results of the study indicate that regular BD improves endothelial function.

WOS: 000392631500001, PubMed ID: 27665326, Objective: The present objective was to determine frequency of Arginine389Glycine (Arg389Gly) and Cytochrome p450 2D6*10 (Cyp2D6*10) polymorphism in cases of heart failure-reduced ejection fraction (HFREF), and to evaluate the influence of the polymorphisms in response to beta-blocker (BB) therapy. Methods: A total of 206 HFREF patients and 90 healthy controls were prospectively enrolled. Genotypes for Arg389Gly and Cyp2D6*10 polymorphisms of the healthy controls and 162 of the 206 heart failure (HF) patients were measured, identified by polymerase-chain-reaction-and restriction-fragment-length-polymorphism analysis. HFREF patients and healthy controls were compared regarding Arg389Gly polymorphism. The HFREF patients were separated into 2 subgroups based on achievement of maximal target dose (MTD) of BB. Results: When comparing frequency of genotype distribution for Arg389Gly polymorphism in HFREF patients to the healthy controls, a statistically significant association was observed with CC genotype and Glisin-Glisin (GG) genotype (p

Atrial fibrillation is the most common rhythm disturbance in general population. We present a 19-year-old man who was admitted to emergency department with progressive weakness, intermittent nausea, vomiting, and palpitations for 1-2 hours. He stated that he had palpitations for the first time. His past history was notable for venlafaxine use for panic disorder. He was diagnosed with AF with rapid ventricular rate and admitted to coronary care unit. Medical cardioversion with amiodarone was attempted and normal sinus rhythm was restored. He had no additional problems during hospital stay and was discharged on anticoagulant therapy (warfarin sodium). Atrial fibrillation should be born in mind in cases presenting to emergency department with palpitations, chest pain, syncope, or weakness in order to provide early diagnosis and treatment for this important disorder causing many complications. [Med-Science 2016; 5(1.000): 275-9]

WOS: 000374730800002, PubMed ID: 27105588, Background: The perioperative use of antithrombotic therapy is associated with increased bleeding risk after cardiac implantable electronic device (CIED) implantation. Topical application of tranexamic acid (TXA) is effective in reducing bleeding complications after various surgical operations. However, there is no information regarding local TXA application during CIED procedures. The purpose of our study was to evaluate bleeding complications rates during CIED implantation with and without topical TXA use in patients receiving antithrombotic treatment. Methods: We conducted a retrospective analysis of consecutive patients undergoing CIED implantation while receiving warfarin or dual antiplatelet (DAPT) or warfarin plus DAPT treatment. Study population was classified in two groups according to presence or absence of topical TXA use during CIED implantation. Pocket hematoma (PH), major bleeding complications (MBC) and thromboembolic events occuring within 90 days were compared. Results: A total of 135 consecutive patients were identified and included in the analysis. The mean age was 60 +/- 11 years old. Topical TXA application during implantation was reported in 52 patients (TXA group). The remaining 83 patients were assigned to the control group. PH occurred in 7.7 % patients in the TXA group and 26.5 % patients in the control group (P = 0.013). The MBC was reported in 5.8 % patients in the TXA and 20.5 % patients in control group (P = 0.024). Univariate logistic regression analysis identified age, history of recent stent implantation, periprocedural spironolactone use, periprocedural warfarin use, perioperative warfarin plus DAPT use, cardiac resynchronization therapy, and topical TXA application during CIED implantation as predicting factors of PH. Multivariate analysis showed that perioperative warfarin plus DAPT use (OR = 10.874, 95 % CI: 2.496-47.365, P = 0.001) and topical TXA application during CIED procedure (OR = 0.059, 95 % CI: 0.012-0.300, P = 0.001) were independent predictors of PH. Perioperative warfarin plus DAPT use and topical TXA application were also found to be independent predictors of MBC in multivariate analyses. No thromboembolic complications was recorded in the study group. Conclusion: The present study demonstrated that the topical TXA application during CIED implantation is associated with reduced PH and MBC in patients with high bleeding risk.

Talidomid antiinflamatuar, antiangiogenetik ve immünomodulator etkilerinden dolayı günümüzde çeşitli hastalıklarda artan oranda kullanılmaktadır . Talidomidin sinüzal bradikardi yapabildiği ile ilgili çalışmalar mevcuttur. Sadece bir vakada ise talidomidle ilişkili atrioventriküler(AV) tam blok bildirilmiştir. Ancak şu ana kadar talidomid ile ilgili 2. Derece AV blok olgusu bildirilmemiştir. Burada, 50 yaşında, multipl myleom nedeniyle talidomid kullanmakta olan, acil servise senkop ile başvuran ve 2:1 AV blok saptanan bir hastayı sunmaktayız. Hastanın son 5 aydır 100 mg /gün talidomid kullandığı ve ilaç başlanmadan önceki elektrokardiyografilerinde anormal bir bulgu olmadığı görüldü. Başvuru anında hastanın kalp hızı 45-75/dk arasında değişmekteydi. Hastanın hipotansiyona eşlik eden senkobu olması nedeniyle geçici kalp pili implante edildi. Talidomid tedavisi sonlandırıldıktan 5 gün sonra hastanın kalp hızının 80/dk olduğu izlendi ve ertesi gün geçici pacemaker çıkarıldı. Geçici pacemaker çıkarıldıktan sonra yapılan ritm holterde anormal bulgu izlenmedi. Talidomid kullanan hastalarda yakın kardiyak ve elektrokardiyografik takip yapılmalıdır., Due to its anti-inflammatory, anti-angiogenic, and immunomodulatory effects, thalidomide is increasingly used in the treatment of various diseases. Previous studies have demonstrated that thalidomide may cause sinusal bradycardia. Thalidomide-associated complete atrioventricular block has been reported in only a single case, but there is no case of second-degree atrioventricular block associated with thalidomide in the literature. Here, we present the case of a 50-year-old patient who had been using thalidomide for multiple myeloma. The patient was admitted to the emergency service with syncope, and had second-degree (2:1) atrioventricular block. The patient was using thalidomide (100 mg/day) for the previous 5 months and had not had any abnormal findings in previous electrocardiographies. His heart rate on presentation was variable, from 45 to 75 bpm. He was treated with a temporary pacemaker because of hypotension and syncope. Five days after the completion of the thalidomide treatment, the patient's heart rate was 80 bpm. The following day, the pacemaker was removed and a Holter ECG did not show any abnormalities. Patients undergoing thalidomide treatment should be followed up for cardiac and electrocardiographic parameters.

WOS: 000382877100004, PubMed ID: 27708973, Objective: The aim of our study is to investigate the relationship between microalbuminuria and flow-mediated dilatation in familial Mediterranean fever (FMF) patients. Material and Methods: In our study, there were two groups consisting of 54 patients who were out of the attack period (43 of whom had no microalbuminuria and 11 of whom had microalbuminuria) and 40 healthy controls (M/F: 12/28). Results: There was no statistically difference between patient and control groups'age (25.06 +/- 8.07, 22.89 +/- 6.00 years, respectively). Flow-mediated dilatation (FMD) percentages were significantly different between the three groups (p=0.01). It was observed that there was a correlation between microalbuminuria and FMD percentage. Conclusion: Endothelial dysfunction and renal damage occurred as a result of low-grade chronic inflammation. Microalbuminuria, which is the indicator of renal damage and endothelial dysfunction, and FMD show that endothelial functions can be used in the following of early detection of renal damage and endothelial functions in FMF patients.

Characteristics of patients with pocket hematoma and/or major bleeding complications. Table S2. Baseline characteristics according to MBC. Table S3. Procedure related characteristics according to MBC. Table S4. Univariate and multivariate predictors of MBC. (DOCX 28 kb)

Amaç: Bu çalışmada Miyokard perfüzyon sintigrafisinde (MPS) iskemi saptanması sonucu Koroner anjiografi (KAG) yapılan hastalarda; KAG sonucuna göre invaziv müdahale gerektiren lezyon saptanan hastalarla invaziv müdahale gerektiren lezyon saptanmayan hastaların özelliklerinin karşılaştırılması ve MPS de anlamlı iskemisi olan hastalarda; KAG sonucuna gore müdahale gerektiren lezyon saptanmasını öngördüren (predikte eden) faktörlerin belirlenmesi amaçlandı. Gereç ve Yöntemler: Çalışmaya Ocak 2013-Ocak 2015 tarihleri arasında MPS çekilen ve MPS de iskemi saptanıp KAG yapılan 616 hasta dahil edildi. Hastalar KAG sonuçlarına invaziv müdahale gerektiren koroner arter lezyonu saptananlar (Grup I) ve saptanmayanlar (Grup II) olarak iki gruba ayrıldı. Bulgular: Hastaların ortalama yaşı 66±10 olup %33 ü kadın , % 67 si erkekti. Tüm parametreler; KAG'da müdahale gerektiren lezyon saptanması ile ilişkili olan parametrelerin belirlenmesi amaçlı tek değişkenli regresyon analizine dahil edildi. Tek değişkenli analizde; erkek cinsiyet, yaş, EF, orta-ciddi mitral regurjitasyon bulunması, Hemoglobin, keratin değerleri ve platelet sayısı KAG da müdahale gerektiren lezyon saptanması ile ilişkili bulunurken çok değişkenli analizde ise sadece erkek cinsiyet, yaş, EF ve hemoglobin ilişkili kaldı. Sonuç: Çalışmamızda MPS de iskemisi olan hastalarda ; erkek cinsiyet, daha genç yaş, daha yüksek EF ve hemoglobinin diğer faktörlerden bağımsız olarak KAG da müdahale gerektiren lezyon saptanması ile ilişkili olduğu gösterildi., Aim: This study aimed to compare the characteristics of patients with lesions requiring invasive intervention and patients with lesions that did not require invasive intervention according to the results of coronary angiography (CAG), which was conducted on these patients due to detected ischemia in the myocardial perfusion scintigraphy (MPS),and todetermine the predictive factors to detect lesions that require intervention according to the CAG results in patients who had significant ischemia in MPS. Materials and methods: This study included 616 patients who received CAG after detecting ischemia in MPS between January 2013 and January 2015. The patients were divided into two groups according to CAG results as patients with coronary artery lesions that require invasive intervention (Group I) and patients with coronary artery lesions that did not require invasive intervention (Group II). Results: The average age of patients was 66±10 and 33% of patients were female and 67% were male. All parameters were included into univariate regression analysis in order to determine the parameters related to detecting lesions requiring intervention in CAG. In the univariate analysis, male gender, age, EF, moderateto-severe MR, hemoglobin, creatinine levels, and platelet counts were related to detecting lesions requiring intervention in CAG. On the other hand, in the multivariate analysis, only male gender, age, EF,and hemoglobin level were found to be related. Conclusion: This study showed that male gender, younger age, higher EF, and hemoglobin values are related with detecting lesions requiring intervention in CAG independent from other factors in patients with ischemia in MPS.

Amaç: Nötrofil/lenfosit (N/L) oranı koroner arter hastalığı, akut miyokard infarktüsü ve kalp yetersizliği gibi kardiyovasküler hastalıkların prognozu ile ilişkilidir. Ancak implante edilebilen intrakardiyak defibrilatör cihazı (ICD) olan kalp yetersizliği (KY) hastalarında prognostik önemi bilinmemektedir. Bu çalışmada artmış N/L oranı ile ICD olan kalp yetersizliği hastalarında uygun ICD şoklama gelişimi arasındaki ilişkiyi göstermeyi amaçlamaktadır. Gereç ve Yöntem: Toplam ICD implante edilmiş KY olan 58 hasta çalışmaya dahil edildi. ROC eğrisi analizine göre: optimal N/L oranının ICD şoklamasını tahmin etmedeki ayırıcı değeri >2.54 bulundu ve duyarlılığı %59.3, özgüllüğü %87.1 di. Hastalar ayırıcı N/L değerine göre, düşük (grup I) ve yüksek (grup II) olarak iki gruba ayrıldı. Bulgular: Hastaların ortalama yaşı 60±10 di. ICD şoklama 27 (%47) hastada gözlendi. Bu 27 hastanın 11 (%29) tanesi Grup I de ve 16 (%80) tanesi Grup II (p, Aim: Neutrophil/lymphocyte (N/L) ratio is associated with prognosis in cardiovascular diseases such as coronary artery disease, acute myocardial infarction, and heart failure (HF). However, its prognostic significance in HF patients with implantable cardioverter defibrillator (ICD) is unknown. The aim of this study was to evaluate the association between N/L ratio and the development of appropriate ICD shock in HF patients with implante ICD. Material and Method: A total of 58 consecutive HF patients with implanted ICD were enrolled into the study. According to the receiver operator characteristics curve analysis: optimal cut-off value of N/L ratio to predict appropriate ICD shock was found as >2.54, with 59.3% sensitivity and 87.1% specificity. Patients were categorized into two as lower (group I) or higher (group II) N/L ratio according to cut-off value of >2.54. Results: Mean age of patients was 60±10 years. ICD shock was observed in 27 (47%) patients. Among these 27 patients 11 (29%) patient was in Group I and 16 (80%) were in Group II (p

WOS: 000376567100038, Due to its anti-inflammatory, anti-angiogenic, and immunomodulatory effects, thalidomide is increasingly used in the treatment of various diseases. Previous studies have demonstrated that thalidomide may cause sinusal bradycardia. Thalidomide-associated complete atrioventricular block has been reported in only a single case, but there is no case of second-degree atrioventricular block associated with thalidomide in the literature. Here, we present the case of a 50-year-old patient who had been using thalidomide for multiple myeloma. The patient was admitted to the emergency service with syncope, and had second-degree (2:1) atrioventricular block. The patient was using thalidomide (100 mg/day) for the previous 5 months and had not had any abnormal findings in previous electrocar-diographies. His heart rate on presentation was variable, from 45 to 75 bpm. He was treated with a temporary pacemaker because of hypotension and syncope. Five days after the completion of the thalidomide treatment, the patient's heart rate was 80 bpm. The following day, the pacemaker was removed and a Holter ECG did not show any abnormalities. Patients undergoing thalidomide treatment should be followed up for cardiac and electrocardiographic parameters.

WOS: 000376128200001, PubMed ID: 27242935, Endovascular stent graft implantation is a favorable method for complex aortic coarctation accompanied by patent ductus arteriosus. Herein, an 18-year-old woman with complex aortic coarctation and patent ductus arteriosus was successfully treated by endovascular thoracic stent graft via retroperitoneal approach. The reason for retroperitoneal iliac approach was small sized common femoral arteries which were not suitable for stent graft passage. This case is the first aortic coarctation plus patent ductus arteriosus case described in the literature which is treated by endovascular thoracic stent graft via retroperitoneal approach.

WOS: 000368271900006, PubMed ID: 26648276, CONTEXT AND OBJECTIVE: The location of embolism is associated with clinical findings and disease severity in cases of acute pulmonary embolism. The level of gamma-glutamyl transferase increases under oxidative stress-related conditions. In this study, we investigated whether gamma-glutamyl transferase levels could predict the location of pulmonary embolism. DESIGN AND SETTING: Hospital-based cross-sectional study at Cumhuriyet University, Sivas, Turkey. METHODS: 120 patients who were diagnosed with acute pulmonary embolism through computed tomography-assisted pulmonary angiography were evaluated. They were divided into two main groups (proximally and distally located), and subsequently into subgroups according to thrombus localization as follows: first group (thrombus in main pulmonary artery; n = 9); second group (thrombus in main pulmonary artery branches; n = 71); third group (thrombus in pulmonary artery segmental branches; n = 34); and fourth group (thrombus in pulmonary artery subsegmental branches; n = 8). RESULTS: Gamma-glutamyl transferase levels on admission, heart rate, oxygen saturation, right ventricular dilatation/ hypokinesia, pulmonary artery systolic pressure and cardiopulmonary resuscitation requirement showed prognostic significance in univariate analysis. The multivariate logistic regression model showed that gamma-glutamyl transferase level on admission (odds ratio, OR = 1.044; 95% confidence interval, CI: 1.011-1.079; P = 0.009) and pulmonary artery systolic pressure (OR = 1.063; 95% CI: 1.005-1.124; P = 0.033) remained independently associated with proximally localized thrombus in pulmonary artery. CONCLUSIONS: The findings revealed a significant association between increased existing embolism load in the pulmonary artery and increased serum gamma-glutamyl transferase levels.

Objective: Red cell distribution width (RDW) is associated with mortality in cardiopulmonary disorders such as coronary artery disease (CAD), acute coronary syndrome (ACS), heart failure, and acute pulmonary embolism. However, the little data that is available show the relationship between RDW and re-ACS after discharge in ACS patients. We aimed to investigate for relation between admission RDW and reACS related rehospitalization in ACS patients.Materials and Methods: A total of 400 consecutive patients with ACS were evaluated. In ROC curve analysis: optimal cut-off value of RDW to predict re-ACS was found as >14.0%, with 70% sensitivity and 62.5% specificity. Patients were categorized as having no increased (Group I) or increased (Group II) RDW based on a cut off value of 14.0%.Results: Mean age of patients was 63±12 years. Mean follow-up duration was 15±9 months and 80 patients rehospitalized with reACS. Among these 80 patients 24 (11%) patients belonged to Group I, and 56 (32%) patients were in Group II (p 14.0% on admission, presence of ST elevation MI, LV ejection fraction, and HDL cholesterol levels were found to have prognostic significance in univariate analysis. In multivariate Cox proportional-hazards model, only increased RDW > 14.0% on admission (HF=2.355, P=0.002), and previous ST elevation MI (HR: 1.906, P=0.024) remained associated with an increased risk of re-ACS. Furthermore, the mortality rate of the patients in the second group were significantly higher than those observed in the first group (4 (2%) vs 27 (15%), pConclusion: It seems RDW helps risk stratification in patients with ACS.