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Left ventricular apical thrombusThe study population included 378 patients (mean age: 56.5 ± 12.3 years, male: 318) presenting with AMI between January 2016 and January 2020. Primary percutaneous coronary intervention procedure was performed in all patients. Initial echocardiogram was performed within 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and 12th months. Patients were divided into two groups according to the presence of LVAT on echocardiography.The incidence of the LVAT was 8.5% (High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneurysm may be used for LVAT risk prediction among patients presenting with AMI.

OBJECTIVE: This study aimed to evaluate the acute effect of cryoballoon ablation (CB-A) on electrocardiographic parameters that have been suggested to reflect heterogeneity in atrial conduction and ventricular repolarization. METHODS: A total of 67 patients (52.6±13.2 years, 43 men) without any exclusion criteria who had undergone CB-A for atrial fibrillation (AF) between January 01, 2015, and December 31, 2018, constituted our study population. Electrographic recordings obtained before and after the ablation procedure on the same day were retrospectively evaluated for the P-wave dispersion, QTc dispersion, Tp-Te interval, and Tp-Te/QT ratio. The pre- and post-ablation values were tested for significant differences. The association of the possible CB-A-related changes in these parameters with AF recurrence during follow-up was evaluated. RESULTS: P dispersion (30.1±6.8 vs. 35.9±9.4 ms, p

Atrial arrhythmias are well-known complications of atrial septal defect (ASD), and associated with substantial morbidity. After ASD closure, right atrial and ventricular enlargement regresses, however, the risk of atrial arrhythmia development continues. In this study, we aimed to investigate the relationship between the Crochetage sign, which is a possible reflection of heterogeneous ventricular depolarization due to long-term hemodynamic overload, and the development of late atrial arrhythmia after ASD closure.This retrospective study included a total of 314 patients (mean age: 39.5 (30-50) years; male: 115) who underwent percutaneous device closure for secundum ASD. The study population was divided into two groups according to the presence or absence of the Crochetage sign. The Crochetage sign was defined as an M-shaped or bifid pattern notch on the R wave in one or more inferior limb leads. Cox-regression analysis was performed to determine independent predictors of late atrial arrhythmia development.Fifty-seven patients (18.1%) presented with late atrial arrhythmia. Of these 57 patients, 30 developed new-onset atrial fibrillation/atrial flutter (AF/AFL), and 27 patients with pre-procedure paroxysmal AF/AFL had a recurrence of AF/AFL during follow-up. History of paroxysmal AF/AFL before the procedure (HR: 4.78; 95% CI 2,52-9.05; p0.001), the presence of Crochetage sign (HR: 3.90; 95% CI 2.05-7.76; p0.001), and older age at the time of ASD closure (HR: 1.03; 95% CI 1.01-1.06; p = 0.002) were found as independent predictors for late atrial arrhythmia.The presence of Crochetage sign may be used to predict the risk of late atrial arrhythmia development after transcatheter ASD closure.

The CHA2DS2-VASc score predicts stroke and mortality risk in several cardiovascular diseases regardless of atrial fibrillation. In this study, we aimed to investigate the ability of CHA2DS2-VASc score to predict in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS). The study population included 558 patients undergoing CAS. The patients were stratified into three groups based on their CHA2DS2-VASc scores [low (≤ 2, n = 123), moderate (3–5, n = 355) and high (6–8, n = 80)]. In-hospital and 3-year outcomes were compared between the groups. In-hospital rates of ipsilateral and major strokes and death were significantly different between the groups (1.6% vs. 3.9% vs. 16.2%; 1.6% vs. 4.5% vs. 16.2%; 0.8% vs. 3.1% vs. 13.8%, p

The growing problem of endocardial lead infections and lead malfunctions has increased interest in percutaneous lead-removal technology. Transvenous lead extraction (TLE) via simple manual traction (SMT) is the first-line therapy. When SMT is not successful, TLE from the femoral vein using a gooseneck snare (GS) with a radiofrequency ablation catheter (RFAC) may be an alternative option. The aim of our study was to evaluate the success rate of transvenous extraction of chronically implanted leads via the femoral approach using a GS with RFCA in cases of failure with SMT.The study included 94 consecutive patients who were referred for lead extraction due to pocket erosion and infection (71 patients) and to lead malfunction (23 patients). Initially, SMT was attempted for all patients. If SMT was not successful, patients underwent TLE using a GS with RFAC.Leads were extracted successfully with SMT in 34 patients (54 leads), while 60 patients (83 leads) underwent TLE using a GS with RFAC. The mean indwelling time of the leads was longer in the femoral approach with GS (87.5 ± 37.9 vs. 31.3 ± 25.8 months; p 0.001). The procedural success rate was 96.7% in the femoral approach with GS. A preceding implantation lead duration of51 months predicted an unsuccessful SMT necessitating alternative TLE using a GS with RFAC with 86% sensitivity and 78% specificity (p 0.001).Transvenous lead extraction via the femoral approach using GS with RFAC may be an alternative approach to SMT with a high success rate, especially when the indwelling time of the leads is long.HINTERGRUND: Das zunehmende Problem der Infektion endokardialer Elektroden und von Elektrodenfehlfunktionen hat zu einem vermehrten Interesse an Verfahren zur perkutanen Elektrodenentfernung geführt. Die transvenöse Elektrodenextraktion (TLE) mittel simpler manueller Traktion (SMT) ist die Therapie der ersten Wahl. Wenn dieser Ansatz nicht gelingt, kann die TLE über die V. femoralis mit einer Gänsehalsschlinge (GS) und einem Radiofrequenzablationskatheter (RFAC) eine Alternativoption sein. Ziel dieser Studie war es, die Erfolgsrate der TLE von vor längerer Zeit implantierten Elektroden über einen femoralen Zugang mithilfe einer GS und eines RFAC in Fällen zu ermitteln, in denen die SMT nicht erfolgreich war.In die Studie wurden 94 konsekutive Patienten einbezogen, die aufgrund einer Taschenerosion oder -infektion (71 Patienten) oder wegen Elektrodenfehlfunktion (23 Patienten) zur Elektrodenextraktion überwiesen worden waren. Zuerst wurde bei allen Patienten die SMT versucht. Bei erfolgloser SMT wurde bei den Patienten die TLE mithilfe einer GS und eines RFAC angewendet.Mit SMT wurden die Elektroden bei 34 Patienten (54 Elektroden) erfolgreich entfernt, während bei 60 Patienten (83 Elektroden) eine TLE unter Einsatz einer GS und eines RFAC erfolgte. Beim femoralen Zugang mit GS bestand eine längere mittlere Liegezeit der Elektroden (87,5 ± 37,9 vs. 31,3 ± 25,8 Monate; p 0,001). Dabei betrug die prozedurale Erfolgsrate 96,7% beim femoralen Zugang mit GS. Lag die vorangegangene Elektrodenimplantation51 Monate zurück, war dies ein Prädiktor für den Misserfolg der SMT, somit wurde als Alternative eine TLE unter Verwendung einer GS und eines RFAC mit 86% Sensitivität und 78% Spezifität (p 0,001) erforderlich.Die TLE über einen femoralen Zugang mithilfe einer GS und eines RFAC kann ein alternativer Ansatz zur SMT mit einer hohen Erfolgsrate sein, insbesondere bei langer Elektrodenliegedauer.

Data is scarce regarding the relation between P wave indices and new onset atrial fibrillation (NOAF) after trans-catheter aortic valve replacement (TAVR).The present study aimed to find out certain characteristics of P wave that may predict NOAF after TAVR procedure.Patients with severe calcific aortic stenosis who had undergone TAVR procedure between 2013 and 2019 in two centers were investigated. P wave abnormalities that have been resumed to reflect impaired atrial conduction; partial and advanced inter atrial block (IAB), P-wave terminal force in lead V1, P wave dispersion, reduced amplitude of P- wave in lead I, P wave peak time in D2 and V1 were evaluated on pre- procedural 12 derivation surface electrocardiography (ECG). The relationship between these parameters and incidence of NOAF during index hospitalization was evaluated.A total of 227 consecutive patients (median age 79 [74-83]; 134 [59%] female) were included in the study. NOAF occurred in 46 (20.3%) patients. P wave duration, P wave dispersion, number of patients with partial and advanced IAB, left atrium diameter, STS score were higher in NOAF patients. Use of general anesthesia and history of prior open heart surgery were also more frequent in NOAF group. In multivariable logistic regression analysis; advanced IAB (OR 6.413 [2.555-16.095] p 0.01), P wave dispersion (OR 3.544 [1.431-8.780] p = 0.006) and use of general anesthesia (OR 2.736 [1.225-6.109] p = 0.014) were independent predictors of NOAF.Among P wave abnormalities evaluated on pre-procedural 12-derivation surface ECG, advanced IAB and P wave dispersion may predict NOAF after TAVR procedure.

BACKGROUND There is limited data regarding the effect of idiopathic premature ventricular complexes (PVC) on myocardial repolarisation. Most of PVC's originate from right and left ventricular outflow tracts (RVOT and LVOT). AIM The aim of this study is to evaluate the acute effect of outflow tract PVC ablation on electrocardiographic repolarisation markers. METHODS A total of 180 patients (49.2 ± 13.6 years, 74 male) without any exclusion criteria who had undergone outflow tract PVC ablation between 1 January 2015 and 1 November 2018 constituted our study population. Electrocardiographic recordings that had been obtained before and after ablation procedure on the same day were retrospectively evaluated for the QTc dispersion, Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio. Significance of difference between pre- and postablation values was tested. RESULTS There was no significant difference regarding QTc dispersion between pre- and post-ablation state (36.5 ± 20.9 vs. 35.3 ± 16.4 ms, p: NS). However, Tp-e and Tp-e/QT values in all lateral precordial derivations were observed to decrease significantly after PVC ablation (in the respective order on derivation V5: 104.0 ± 21.6 ms vs. 91.1 ± 14.8 ms, p

Takotsubo syndrome (TS) is an acute but transient heart failure syndrome and it is very uncommon for TS to present with syncope and complete atrioventricular (AV) block. In this report, we discuss a case of TS complicated by a third-degree AV block presented to the emergency department with syncope and requiring permanent pacemaker implantation. A 53-year-old female was admitted to our emergency department with complaints of syncopal episodes and chest pain. Due to ongoing chest pain, electrocardiography (ECG) findings and segmentary wall motion abnormality on the transthoracic echocardiography (TTE), she was immediately transferred to the cardiac catheterization laboratory. Coronary angiogram revealed normal coronary arteries and left ventriculography demonstrated apical ballooning and hypokinesis of the apex. Once the diagnosis of TS was established, the patient was transferred to the coronary intensive care unit (CICU). Initial ECG at CICU demonstrated complete AV block with a heart rate of 35 beats/min. On the third day of hospitalization, repeat TTE showed improved left ventricular functions with an ejection fraction of 50%. During the follow-up period in CICU, complete AV block persisted and the rhythm did not return to normal sinus rhythm after six days of monitorization. An electrophysiological study demonstrated supra-hisian atrioventricular block and atrioventricular dissociation. On the seventh day of hospitalization, TTE demonstrated recovered ventricular functions with an ejection fraction of 65%, and a dual pacemaker was then implanted. Her third-month followup was uneventful and TTE showed normal left ventricular functions but pacemaker interrogation revealed 99% of ventricular pacing. This case report demonstrated that the decision to implant a permanent pacemaker in such patients should be considered on a case-by-case basis, and an electrophysiological study could be valuable on this decision.

Right ventricular (RV) perforation is a rare but life-threatening complication of pericardiocentesis and is usually treated surgically. We presented a case of RV free wall perforation, which occurred during pericardiocentesis and tried to be closed percutaneously with the Amplatzer vascular plug-III (AVP-III) device. The occluder device sealed the perforation, but it was in an insecure position; therefore, the patient underwent surgical repair. As an AVP-III device, with a middle disk thicker than the RV myocardium, it may cause the RV myocardium to stretch outwards, so it should not be used for the treatment of RV perforation by the transcatheter way.

Objective: We intended to report our institutional experience with ventricular tachycardia (VT) ablation in patients with structural heart disease. Patients and Methods: A total of 36 consecutive patients (31 male, age: 62.8 ± 13.2 years) who had undergone VT ablation in our institution between 01.01.2017 and 01.05.2019 were included in the analysis. Results: A total of 27 patients with the diagnosis of ischemic cardiomyopathy and 9 patients with the diagnosis of nonischemic cardiomyopathy had undergone VT ablation. VT ablation was successful in 32 (88.9%) patients. There were no major procedural complications; however, one patient with ischemic cardiomyopathy died 48 hours after the procedure because of post-ablation cardiogenic shock. Another patient with unsuccessful VT ablation died during hospitalization due to electrical storm. Endocardial ablation was performed in 23 (63.9%) patients and epicardial or combined endocardial and epicardial ablation was performed in 13 (36.1%) patients. Substrate ablation was the dominant strategy in 29 (80.6%) patients whereas activation mapping and isthmus ablation was performed in 7 (19.4%) patients. Conclusion: Our experience confirms the effectiveness and safety of VT ablation in patients with structural heart disease who are resistant to medical therapy and/or who receive recurrent implantable cardioverter-defibrillator shocks.

Colchicine may prevent both recurrent serositis attacks and secondary amyloidosis in familial Mediterranean fever (FMF). Furthermore, colchicine may decrease the frequency of atrial fibrillation in some groups of patients without FMF. However, there is no study that evaluates the effect of colchicine on arrhythmogenic electrocardiographic indices in FMF. In this study, we evaluated the impact of 1 year of colchicine treatment on atrial and ventricular arrhythmogenic electrocardiographic (ECG) parameters in newly diagnosed FMF patients.We enrolled 28 newly diagnosed FMF (20 female, mean age 31.4 ± 8.2 years) patients who fulfilled the modified Tel Hashomer criteria. Electrocardiographic, demographic and laboratory parameters were obtained at the first visit and at the end of the 1‑year colchicine treatment. Herein, we assessed P wave dispersion (Pd) for atrial arrhythmia risk and peak-to-end interval of T wave (Tp-E), Tp-E/QT, Tp-E/QTc values for ventricular arrhythmia risk.Colchicine treatment significantly decreased Tp-E and Tp-E/QT values (p = 0.02 and p = 0.01, respectively) by the end of the 1‑year treatment. However, Pd values did not change with treatment.Colchicine treatment may have a favourable effect on ventricular repolarisation indices that relate to ventricular arrhythmia and sudden death.ZIEL DER ARBEIT: Mit Colchizin lassen sich möglicherweise sowohl rezidivierende Serositisschübe als auch die sekundäre Amyloidose bei familiärem Mittelmeerfieber (FMF) verhindern. Außerdem kann Colchizin die Häufigkeit von Vorhofflimmern bei einigen Gruppen von Patienten ohne FMF senken. Jedoch liegt bisher keine Studie zur Wirkung von Colchizin auf arrhythmogene elektrokardiographische (EKG-)Hinweise bei FMF vor. In der vorliegenden Studie untersuchten die Autoren den Einfluss einer einjährigen Colchizinbehandlung auf atriale und ventrikuläre arrhythmogene EKG-Parameter bei Patienten mit neu diagnostiziertem FMF.Dazu wurden 28 Patienten mit neu diagnostiziertem FMF (20 w., Durchschnittsalter: 31,4 ± 8,2 Jahre) in die Studie einbezogen, die die modifizierten Tel-Hashomer-Kriterien erfüllten. Elektrokardiographische, demografische und Laborparameter wurden bei der Erstvorstellung und am Ende der einjährigen Behandlung mit Colchizin erhoben. Dabei wurde die P‑Wellen-Dispersion (Pd) hinsichtlich des Risikos atrialer Arrhythmien und das Intervall zwischen Spitze und Ende der T‑Welle („peak-to-end interval of T wave“, Tp-E) sowie das Verhältnis von Tp-E zum QT-Intervall (Tp-E/QT) und zum frequenzkorrigierten QT-Intervall (Tp-E/QTc) hinsichtlich des Risikos ventrikulärer Arrhythmien untersucht.Unter Colchizinbehandlung erwiesen sich der Tp-E- und der Tp-E/QT-Wert am Ende der einjährigen Therapie als signifikant niedriger (p = 0,02 bzw. p = 0,01). Allerdings veränderten sich die Pd-Werte unter der Therapie nicht.Colchizin hat möglicherweise positive Wirkungen auf ventrikuläre Repolarisationsparameter, die in Zusammenhang mit ventrikulären Arrhythmien und plötzlichem Herztod stehen.

Bidirectional ventricular tachycardia (BVT) is a rare arrhythmia that is generally observed in patients with catecholaminergic ventricular tachycardia or digoxin overdose. Herein, we present a case of BVT and electrical storm (ES) in an acute ischemic heart failure patient that is typically induced by hypokalemia. The patient was in invasive mechanical ventilator (MV) support and hypokalemia was related to acute respiratory alkalosis and that caused refractory hypokalemia despite intravenous (IV) potassium replacement. We also discuss our approach to solve refractory hypokalemia caused by respiratory alkalosis.

Objective: In the present study we aimed to demonstrate clinical characteristics, predictors of procedural success and long term recurrence of atrial tachyarrhythmia patients undergoing catheter ablation (CA). Patients and Methods: Consecutive patients who had undergone CA due to an atrial tachyarrhythmia in a single centre arrhythmia unit between 2012 – 2020 were screened. Predictors of procedural success and recurrence were analysed by logistic regression. Results: Study population consisted of 299 consecutive patients (95 [31.8 %] atrial tachycardia, 204 [68.2 %] atrial flutter cases);163 ( 54.5 % ) were male; median age was 54 ( IQR; 42-64). Median follow up was 330 (IQR; 90 – 810) days. Atrial flutter patients were older and had more co-morbidities. Acute procedural success rate was 82.1 % vs. 77.0 % (p= 0.313) and recurrence was 9.3 % vs. 21.6 % (p=0.022) in atrial tachycardia (AT) and atrial flutter (AFL) cases respectively. History of valvular or congenital heart disease surgery, left atrium diameter and age were found to be independent predictors of failed ablation, recurrence and post-procedural atrial fibrillation. Conclusion: Age, left atrium diameter, valvular or congenital heart disease surgery are independent predictors for acute procedural success, recurrence and post-procedural atrial fibrillation in AT and AFL patients who undergo catheter ablation.

Ventricular arrhythmias (VAs) continue even after left ventricular assist device (LVAD) implantation. The effect of LVAD on VAs is controversial. We investigated electrophysiologic changes after LVAD and its effects on VAs development. A total of 107 implantable cardioverter-defibrillator (ICD) patients, with LVAD, were included in this study. Electrocardiographic parameters including QRS duration (between the beginning of the QRS complex and the end of the S wave), QT duration (between the first deflection of the QRS complex and the end of the T wave) corrected QT (QTc), QTc dispersion, fragmented QRS (F-QRS), and ICD recordings before, and post-LVAD first year were analyzed. All sustained VAs were classified as polymorphic ventricular tachycardia (PVT) or monomorphic VT (MVT). The QRS, QT, QTc durations, and QTc dispersion had decreased significantly after LVAD implantation (p0.001 for all). Also MVT increased significantly from 28.9% to 49.5% (p = 0.019) whereas PVT decreased from 27.1% to 4.67% (p = 0.04) compared to pre-LVAD period. A strong correlation was found between QT shortening and the decrease in PVT occurrence. Besides, the increase in the F-QRS after LVAD was associated with post-LVAD de nova MVT development. Finally, F-QRS before LVAD was found as an independent predictor of post-LVAD late VAs in multivariate analysis. Pre-existing or newly developed F-QRS was associated with post-LVAD late VAs, and it may be used to determine the risk of VAs after LVAD implantation.

Background Coronary artery bypass grafting (CABG) remains the gold standard treatment for mutivessel and left main coronary artery disease (CAD). Saphenous vein graft (SVG) patency is still a problem in CAD patients after CABG surgery. The Dual Antiplatelet Treatment (DAPT) score is a clinical prediction tool that predicts ischaemic and bleeding risk in CAD patients. The aim of this study is to investigate the relationship between DAPT score and SVG patency in CABG patients. Method This retrospective study enrolled a total of 398 patients (68 female; mean age 65.8 +/- 9.1 years) with a history of CABG surgery. The study population was divided into two subgroups according to SVG patency. The DAPT score was calculated for each patients and compared between the two groups. Results Coronary angiography revealed SVG disease in 212 patients and SVG patency in 186 patients. The rates of diabetes mellitus and hypertension, red cell distribution width values, DAPT Score, time interval after CABG and number of SVGs were significantly higher while LVEF was significantly lower in patients with SVG disease. The presence of diabetes mellitus, high DAPT score, long time interval after CABG and high number of SVGs were found to be independent predictors of SVG patency. DAPT score above 2.5 predicted SVG disease with a sensitivity of 77.1% and a specificity of 87.1% (AUC: 0.873; 95%CI: 0.823-0.924; p < 0.001). Conclusion The DAPT score may provide useful information for SVG patency in CABG patients. Patients with high DAPT score should be followed up closely for SGV occlusion. DAPT score may be useful prior to CABG in determining the duration of dual anti-platelet therapy and in encouraging the use of arterial grafts with better patency. WOS:000642132800001 2-s2.0-85104816621 PubMed: 33880976

Background: Inflammatory mechanisms play an important role in both atherosclerosis and stroke. There are several inflammatory peripheral blood count markers associated with carotid artery stenosis degree, symptomatic carotid artery lesions and carotid artery stent restenosis that reported in previous studies. However, the prognostic role of the blood cell counts and their ratios in predicting in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS) has not been comprehensively investigated. Systemic immune-inflammation index (SII) proved its' efficiency in patients with solid tumors and its' role was rarely examined in cardiovascular disorders and stroke. The current study evaluated the effect of this novel risk index on in-hospital and long-term outcomes in a large patient population who underwent CAS. Method: A total of 732 patients with carotid artery stenosis who underwent CAS were enrolled to the study. SII was calculated using the following formula: neutrophil-to-lymphocyte ratio pound total platelet count in the peripheral blood (per mm3) and the patients were stratified accordingly: T1, T2 and T3. In-hospital and 5-year outcomes were compared between the tertiles of SII. Results: During the hospitalization, major stroke, ipsilateral stoke, myocardial infarction, death and major adverse cardiovascular events (MACE) rates were significantly higher in high SII level (T3) compared to SII levels (T1 and 2). In longterm outcomes, ipsilateral stroke, major stroke, transient ischemic attack, death, and MACE were significantly higher in the patients with higher SII level (T3). The 5-year Kaplan-Meier overall survival for T1, T2, and T3 were 97.5%, 96.7% and 86.0% respectively. In-hospital and 5-year regression analyses demonstrated that high SII was independently associated with MACE and mortality. Conclusion: SII was independently associated with in-hospital and long-term clinical outcomes in patients undergoing CAS. Immune and inflammation status, as assessed easily and quickly using SII, has a good discriminative value in these patients. WOS:000686903400007 2-s2.0-85109196298 PubMed: 34242858

The new coronavirus disease (COVID-19) has spread rapidly all over the world and caused anxiety disorders. Recent studies have also shown that the prevalence of depression and anxiety increased during the COVID-19 outbreak. We aimed to evaluate the anxiety and depression levels during the pandemic and identify the effect of pandemic-related stress on blood pressure (BP) control in primary hypertensive patients.A total of 142 patients with primary hypertension (HT) who continued to use the same antihypertensive drugs before and during the pandemic were included in the study. Twenty-four -hour Ambulatory Blood Pressure Monitoring (ABPM) and the Hospital Anxiety and Depression Scale (HADS) questionnaire were applied to patients. We retrospectively reviewed 24-h ABPM records of the same patients for the year before the pandemic.Daytime, nighttime and 24 -hour-systolic blood pressure (SBP) levels as well as daytime, nighttime, and 24- hour-diastolic blood pressure (DBP) levels , were significantly elevated during the COVID-19 outbreak compared to the pre-pandemic period (p0.001). Higher HADS-A scores (HADS-A ≥7) were significantly associated with much greater increase in BP compared to the patients with lower HADS-A scores.Psychological stress due to the COVID-19 outbreak led to worsening of the regulation of BP in controlled hypertensive patients whose antihypertensive treatments did not change.Yeni koronavirüs hastalığı (COVID-19) tüm dünyada hızlı bir şekilde yayılarak anksiyete bozukluğuna sebep olmuştur. Yakın zamanlı çalışmalar, COVID-19 salgını sırasında depresyon ve anksiyete prevalansında artış olduğunu göstermiştir. Biz bu çalışmamızda primer hipertansif hastalarda, pandemi sırasında anksiyete ve depresyon düzeylerini değerlendirmeyi ve pandemiye bağlı stresin kan basıncı kontrolü üzerindeki etkisini belirlemeyi amaçladık.Pandemi öncesinde ve sırasında aynı antihipertansif ilaçları kullanmaya devam eden toplam 142 primer hipertansiyon hastası çalışmaya dahil edildi. Bu hastalara 24 saatlik Ambulatuar Kan Basıncı Monitorizasyonu (AKBM) yapıldı ve Hastane Anksiyete ve Depresyon Ölçeği (HADS) anketi uygulandı. Pandemiden önceki son 1 yıl için aynı hastaların 24 saatlik AKBM kayıtlarını geriye dönük olarak incelendi.Gündüz, gece ve 24 saat sistolik kan basıncı ile gündüz, gece ve 24 saat diyastolik kan basıncı, COVID-19 salgını sırasında pandemi öncesi döneme kıyasla önemli ölçüde yükseldi (p0.001). Daha yüksek HADS-A skorları (HADS-A 7), daha düşük HADS-A skoruna sahip hastalara kıyasla kan basıncında çok daha fazla artışla anlamlı şekilde ilişkilendirildi.COVID-19 salgınına bağlı psikolojik stres, antihipertansif tedavileri değişmeyen kontrollü hipertansif hastalarda kan basıncı regülasyonun bozulmasına sebep olmuştur.

BACKGROUND AND AIM OF THE STUDY Chronic severe aortic regurgitation (AR) is associated with progressive accumulation of interstitial fibrosis and disruption of myocardial structure. After aortic valve replacement (AVR), the negative remodeling process reverses, and left ventricular ejection fraction (LVEF) improves but not in all patients. In this study, we aimed to investigate the association of fragmented QRS (F-QRS), which is a possible marker of myocardial fibrosis, with postoperative left ventricular (LV) systolic dysfunction. METHODS A total of 147 consecutive patients with AVR were included in this study. F-QRS was identified by the presence of various RSR' patterns (QRS duration

Patients and medical staff expose to significant radiation during electro-physiological (EP) procedures. There are few data regarding the leading factors of longer fluoroscopy time and higher scattered radiation in a laboratory giving EP training during those interventions.The patients' recordings that underwent EP procedure in a single centre arrhythmia unit from February 2019 to January 2020 were examined. Prospectively collected data regarding procedure duration, fluoroscopy time and total air kerma, demographic characteristics of the patients, type of procedure, success of ablation and the use of electro anatomic mapping were retrospectively evaluated. Predictors of total air kerma were analysed with linear regression analysis.Study population consisted of 437 patients with a median age of 47 (39-56); 184 (42.1%) were male. Median fluoroscopy time was 768 (420-1320) seconds and median cumulative air kerma was 369 (191-750) mGy. Fluoroscopy time and cumulative air kerma were significantly lower in diagnostic EP studies compared to other procedures. There was no difference in terms of total air kerma between the procedures other than the diagnostic EP study. In multivariable linear regression analysis; body surface area, fluoroscopy time, not using the electro-anatomical mapping, unsuccessful ablation and atrial flutter ablation were predictors of total air kerma in EP studies performed by trainees.Scattered radiation during EP procedures performed by in-training operators is related with some factors. Awareness about those may help to effort reducing the harmful effect of ionising radiation.

Background The Synergy between Percutaneous Coronary Intervention (SYNTAX) score, has been used to estimate the extent and complexity of coronary artery disease (CAD). The H2FPEF score enables robust discrimination of heart failure with preserved ejection fraction (HFpEF) from non-cardiac aetiologies of dyspnea. In the present study, we aimed to investigate the relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction (NSTEMI). Method Two hundred eighty two consecutive patients with NSTEMI who underwent coronary angiographic examination were enrolled in this study. The H2FPEF score was calculated for each patient on admission. All patients underwent coronary angiography within 2 days following their admission. The SYNTAX scoring system was used to evaluate the severity and extent of CAD. Results The mean H2FPEF Score [3(2-4) vs 1(0.5-1.5),p < .001] and the frequencies of diabetes mellitus, hypertension and, atrial fibrillation were significantly higher and LVEF was significantly lower in patients with high SYNTAX score. High H2FPEF Score (OR: 3.61, 95%CI: 2.64-4.93;p = .001) and low left ventricular ejection fraction (OR: 0.94, 95%CI: 0.89-0.98;p = .013) were found to be independent associates for high SYNTAX score. H2FPEF Score above a cut-off level of 2.5 predicted high SYNTAX score with a sensitivity of 80% and a specificity of 82.5% (AUC: 0.890; 95%CI: 0.848-0.931;p < .001). There was a significant and moderate positive correlation between H2FPEF and SYNTAX Scores (r = 0.694,p < .001). Conclusion High H2FPEF score may be associated with high SYNTAX score and may be used to estimate the extent and complexity of CAD in NSTEMI patients. WOS:000551601900001 2-s2.0-85088531958 PubMed: 32703101

Background Transvenous lead extraction may become a complicated process and special sheath systems used for extraction may not be available in the laboratory. Transvenous lead extraction from femoral vein by using ablation catheter and snare may be an alternative and cost-effective method to transvenous lead extraction with specialized lead extraction sheaths. The aim of the present study is to evaluate the factors that may be associated with the use of transfemoral technique during extraction of chronically implanted leads. Methods We retrospectively analyzed consecutive patients who underwent transvenous extraction of pacemaker, cardiac resynchronization therapy (CRT) and intracardiac defibrillator (ICD) leads in our institution in between 01.01.2016 and 01.01.2019. The indications for lead extraction were based on the European Heart Rhythm Association recommendations. Manual traction was applied to all leads at the beginning of each case. If manual traction was not successful, a subclavian approach by using locking stylet (Liberator Universal Locking Stylet, Cook Medical) or femoral approach was used. Femoral approach was performed using the flexible 13F long sheath and a second sheath for ablation catheter. Ablation catheter was wrapped around the lead and the tip of the ablation catheter was caught with gooseneck snare. Downward traction was applied on the body of the lead by using ablation catheter and gooseneck snare complex to release either end of the lead. Results A total of 160 leads in 94 patients were extracted during the time interval between 01.01.2016 and 01.01.2019. The indications for extraction were cardiac device related pocket erosion and infection in 71 (75.6%) and lead failure in the 23 (24.4%) cases. Extracted system was ICD in 48 (51.1%), CRT in 9 (9.6%) and pacemaker in 37 (39.3%) cases. The median time from the preceding procedure was 62.5 (IQR:32.3- 95.3) months. Lead extraction was performed by manual traction in 35 (37.2%) patients, by locking stylet method in 7 (7.4%) and by femoral approach in 52 (55.3%) patients. Clinical success was achieved in 93 (98.9%) cases and all of the patients discharged uneventfully without a major complication as death, cardiac avulsion or tear requiring pericardiocentesis or emergent surgery. Procedural success with femoral approach was achieved in 51/52 (98%) patients (99 leads). Ordinal regression revealed the time from the preceding procedure as the only parameter that was significantly associated with the usage of femoral approach (OR:1.065 ( 95% CI 1.039-1.100) p Conclusion Based on our experience, transfemoral approach by using ablation catheter and gooseneck snare seems to be an effective and safe method for chronically implanted lead extraction. It may be particularly be useful when manual traction is unsuccessful and special toolkids are not available for extraction.

Background There is significant interpatient variability regarding the timing of the earliest local activation relative to surface QRS during premature ventricular complex (PVC) ablation. The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs. Methods Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 01/07/2018 and 01/07/2019 constituted our study population. Catheter-induced PVCs were generated at the site with presumptive PVC origin according to the ECG criteria during the procedure of PVC ablation. Five PVCs were induced by mechanical stimulation in separate points, and the time interval between the beginning of EGM at catheter tracing and the beginning of the QRS complex of each catheter-induced PVC was noted. The mode of five time intervals (Cath EGM-ECG) was used in the analysis. The time interval between the beginning of local EGM of clinical PVCs at the earliest site and the beginning of the QRS complex of clinical PVCs (PVC earliest EGM-ECG) was also noted. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG. Results Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG (Table 1). A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population (Figure 1). Conclusion The results of the present study indicate that catheter-induced PVCs generated at the site of the presumptive source of origin of clinical PVCs may guide the timing of the earliest site during clinical PVC ablation. Further studies are required to validate our results and test the predictive value of Cath EGM- ECG interval for long-term success of PVC ablation. Table 1 PVC earliest EGM-ECG < Cath EGM- ECG PVC earliest EGM-ECG ≥ Cath EGM- ECG Ablation successful (n:52) 9 (17.3%) 43 (82.7%) Ablation not successful (n:11) 11 (100.0%) 0 (0%) Outcome of ablation in general patient population according to the relationship between PVC earliest EGM-ECG and Cath EGM- ECG Abstract Figure 1

There is not a widely accepted optimal rate of stent opening in patients underwent carotid artery stenting. In this study we evaluated the effect of carotid stent opening rate (CSOR) without performing post-dilation on in-hospital and long-term outcomes.A total of 825 patient patients underwent carotid artery stenting without post-dilation enrolled to the study. The patients divided into two groups according to their final CSOR (50% ≤ Post-stent deployment (SD)80% and 80% ≤ Post-SD ≤ 100%). In-hospital and 3-year outcomes were compared between the groups.During hospitalization, the rate of ipsilateral stroke, major stroke and transient ischemic attacks were similar between the groups (respectively; 6.2% vs. 4.1, P = 0.190; 1.5% vs. 1.8, P = 0.811; 1.5% vs. 1.9%, P = 0.683). The 3-year Kaplan-Meier overall survival rates for the first and second groups were 87.6% and 84.4%, respectively (log rank test P = 0.426). The 3-year Kaplan-Meier overall cumulative ipsilateral stroke rates for the first and second groups were 88.0% and 88.6%, respectively (log rank test P = 0.409) CONCLUSION: Our study demonstrated that a CSOR higher than 50% without performing a post-dilation might be an effective therapeutic approach since there was not a significant difference regarding outcomes between the patients with a 50% ≤ Post-SD80% and 80% ≤ Post-SD ≤ 100%. The need for post-stent balloon dilation might have been eliminated due to subsequent stent self-expansion.

The aim of present study is to evaluate the predictive value of QTc dispersion, Tp-Te interval and Tp-Te/QT ratio for idiopathic monomorphic outflow tract ventricular tachycardia (VT) occurrence in patients with frequent idiopathic outflow tract premature ventricular complexes (PVCs).A total of 180 patients (49.2 ± 13.6 years, 74 male) who had undergone outflow tract PVC ablation between 01 January 2015 and 01 November 2018 constituted our study population. Patients with isolated outflow tract PVC without any VT recording on Holter recordings and without any inducible VT at EPS were classified as isolated PVC group. Patients with any episode of VT that has the same morphology with outflow tract PVC were classified as nonsustained or sustained VT groups based on the duration of VT episode. QTc dispersion, Tp-Te and Tp-Te/QT ratio values were calculated and compared between groups.There were 116 patients with isolated PVC, 35 patients with nonsustained VT and 29 patients with sustained VT. QTc dispersion, Tp-Te and Tp-Te/QT ratio values were significantly lower in patients with isolated PVC compared to patients with nonsustained or sustained VT episodes. Tpeak to Tend interval greater than 110.5 msec on derivation V6 predicted VT occurrence with 93.8% sensitivity and 82.8% specificity. Tpeak to Tend/QT interval greater than 0.27 on derivation V6 predicted VT occurrence with 93.8% sensitivity and 0.81% specificity.Tp-Te interval and Tp-Te/QT ratio on derivation V6 may aid in prediction of presence of outflow tract VT in clinical practice.

Malignant ventricular arrhythmias are challenging to manage, requiring a multidisciplinary approach. The mechanism, which triggers ventricular fibrillation (VF) associated with ventricular extrasystoles has not been clarified yet, however, abolishing ventricular extrasystoles may stop ventricular fibrillation in these patients. By this case presentation, we aimed to present a successful treatment of an electrical storm (ES), which developed after an acute myocardial infarction, by catheter ablation.

Aortic prosthetic vascular graft infections (PVGI) are rare complications of the aortic surgery, with an incidence of 0.5%-6%. Although rare, they carry mortality rates as high as 25%-88%. Improvement in diagnostic imaging modalities in the last two decades, together with early diagnosis, aortic PVGI associated mortality was reduced. These imaging methods include transesophageal echocardiography (TEE), computed tomography angiography (CTA), and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). In this case report, we focus mainly on three imaging modalities as TEE, CTA, and 18F-FDG PET/CT and showed their role in the assessment of aortic PVGI.

Introduction: Percutaneous endovascular methods have emerged to the contemporary revascularization choice in patients with infrapopliteal (IP) arterial disease. However, restenosis remains to be the Achilles' heel of this minimally invasive revascularization techniques. We aimed to analyze the association between preprocedural (neutrophil to lymphocyte ratio) Neutrophil-to-Lymphocyte ratio (NLR) and subsequent patency in a cohort of patients with symptomatic IP disease undergoing balloon angioplasty. Methods: All patients primarily treated with angioplasty of at least one IP artery causing severe symptoms or critical limb ischemia (CLI) (Rutherford category 1–6) between January 2014 and August 2015 were analyzed. The baseline demographic, clinical, and angiographic features admission laboratory test results were obtained from hospital files and computer records. NLR was calculated as the preprocedural ratio of neutrophils to lymphocytes. Results: The study population involved 42 (43.8%) CLI patients and 52 (54.2%) claudicants. The most frequent target vessel was the posterior tibial artery. Primary patency at 1 month was 81.9% and 62.7% at 6 months. NLR (odds ratio: 0.04, P = 0.03) independently predicted patency at 1 month but did not have a role on arterial patency after 1 month. Only smoking (odds ratio: 4.8, P = 0.01) associated with patency at 6 months. Conclusion: Preprocedural NLR was an independent risk factor for IP arterial patency at short-term. It may be used as a risk factor for subsequent amputation or recurrent interventions.

Introduction ST segment elevation (STE) in the standard 12‑lead surface electrocardiography (ECG) is a well-known finding in patients with metastatic cardiac tumors. It is important to identify the specific characteristics of STE among those patients to prevent unnecessary aggressive treatments. In the present study, we aimed to demonstrate the ECG characteristics of patients with metastatic cardiac tumors who has STE. Material and methods Medical literature was searched from Pubmed database with key words “metastatic cardiac tumors” or “cardiac tumors” and “ST segment elevation” or “ST elevation”. In addition, remaining articles were explored using the references of case reports which were obtained during former screening (snowball procedure). Results Thirty six of 46 case reports were included and ECG characteristics of each case were evaluated. Convex- shaped STE was observed in all patients and it showed a specific coronary territory in 35 of 36 patients (97.2%). Pathologic Q wave and/or loss of R wave progression were observed in only one patient. T wave inversion following STE was detected in 34 patients (94.4%). STE evolution was absent in 32 of 36 patients while the information regarding STE evolution were not provided in the remaining cases. Conclusion STE due to tumor invasion has certain characteristics which could help clinicians in the differential diagnosis.

Aim Current literature lacks a definitive threshold of idiopathic premature ventricular complex (PVC) burden for predicting cardiomyopathy (CMP). The main objective of the present study was to evaluate relationship between the PVC burden and left ventricular ejection fraction (LVEF). Method This multicenter, cross‐sectional study included 341 consecutive patients with more than 1,000 idiopathic PVC in 24 hr of Holter monitoring admitted to the cardiology clinics between January 2019 and May 2019 in the nineteen different centers. The primary outcome was the LVEF measured during the echocardiographic examination. Result Overall, the median age was 50 (38–60) and 139 (49.4%) were female. Percentage of median PVC burden was 9% (IQR: 4%–17.4%). Median LVEF was found 60% (55–65). We used proportional odds logistic regression method to examine the relationship between continuous LVEF and candidate predictors. Increase in PVC burden (%) (regression coefficient (RE) −0.644 and 95% CI −1.063, –0.225, p

Background The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs. Methods Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 1 July 2018 and 1 July 2019 constituted our study population. The time interval between the beginning of the EGM and the beginning of the QRS of each catheter-induced PVC (Cath EGM-ECG) and the time interval between the beginning of the EGM of clinical PVCs at the earliest site and the beginning of the QRS of clinical PVCs (PVC earliest EGM-ECG) were noted for each patient. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG. Results Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG. A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population. Conclusion Cath EGM-ECG seems to serve as a reliable guide for finding the optimal timing of the earliest site for successful PVC ablation.

Early diagnosis of non-ST elevation acute coronary syndrome (NSTE-ACS) and prediction of the severity of current coronary artery disease (CAD) play a major role in patient prognosis. Electrocardiography has a unique value in the diagnosis and provides prognostic information on patients with NSTE-ACS. In the present study, we aimed to examine the relationship between P wave peak time (PWPT) and the severity of CAD in patients with NSTE-ACS.A total of 132 consecutive patients (female: 35.6%; mean age: 60.1 ± 11.6 years) who were diagnosed with NSTE-ACS were evaluated retrospectively. Gensini scores (GSs) were used to define the angiographic characteristics of the coronary atherosclerotic lesions. The patients were divided into two groups according to the GS. The PWPT was defined as the duration between the beginning and the peak of the P wave, and R wave peak time (RWPT) was defined as the duration between the beginning of the QRS complex and the peak of the R wave.There were 59 (44.6%) patients in the high-GS group (GS ≥25 ) and 73 (55.3%) patients in the low-GS group (GS25 ). Presence of diabetes mellitus, low left ventricular ejection fraction, and high RWPT and PWPT were identified as predictors of a high GS in the study population. There was no significant difference between the area under the curves of PWPT and RWPT for predicting the severity of CAD (0.663 vs. 0.623, respectively; p = 0.573).The present study found that both PWPT and RWPT on admission electrocardiography were associated with the severity and complexity of CAD in patients with NSTE-ACS.HINTERGRUND: Die frühe Diagnose eines akuten Koronarsyndroms ohne ST-Hebung („non-ST elevation acute coronary syndrome“ [NSTE-ACS]) und die Vorhersage des Schweregrads einer bestehenden koronaren Herzkrankheit (KHK) sind von wesentlicher Bedeutung für die Prognose des Patienten. Das Elektrokardiogramm (EKG) hat einen herausgehobenen diagnostischen Wert und liefert prognostische Informationen zu Patienten mit NSTE-ACS. In der vorliegenden Studie wurde die Beziehung zwischen der Zeit bis zum P‑Wellen-Gipfel („P wave peak time“ [PWPT]) und dem Schweregrad der KHK bei Patienten mit NSTE-ACS untersucht.Insgesamt 132 konsekutiv eingeschlossene Patienten (weiblich: 35,6 %; Durchschnittsalter: 60,1 ± 11,6 Jahre) mit Diagnose einer NSTE-ACS wurden retrospektiv betrachtet. Anhand des Gensini-Scores (GS) wurden die angiographischen Eigenschaften der koronaren atherosklerotischen Läsionen definiert. Gemäß dem GS wurden die Patienten in zwei Gruppen eingeteilt. Die PWPT war als die Zeitdauer vom Beginn bis zum Gipfel der P‑Welle definiert, und die Zeit bis zum R‑Wellen-Gipfel („R wave peak time“ [RWPT]) als die Dauer vom Beginn des QRS-Komplexes bis zum Gipfel der R‑Welle.Die Gruppe mit hohem GS (GS ≥25) umfasste 59 (44,6 %) Patienten, die Gruppe mit niedrigem GS (GS25) umfasste 73 (55,3 %) Patienten. Das Vorliegen eines Diabetes mellitus, eine geringe linksventrikuläre Ejektionsfraktion und eine hohe RWPT sowie PWPT wurden als Prädiktoren eines hohen GS in der Studienpopulation identifiziert. Es fand sich kein signifikanter Unterschied zwischen den Flächen unter den Kurven von PWPT und RWPT für die Vorhersage des KHK-Schweregrads (0,663 vs. 0,623; p = 0,573).In der vorliegenden Studie war sowohl die PWPT als auch die RWPT im Aufnahme-EKG mit dem Schweregrad und der Kompliziertheit der KHK bei Patienten mit NSTE-ACS assoziiert.

The aim of this study was to evaluate and compare the subfoveal choroidal thickness (SFCT) and peripapillary retinal nerve fiber layer thickness (pRNFLT) in patients with microvascular angina (MA), coronary slow flow phenomenon (CSFP) and healthy controls.Thirty-two consecutive patients with MA, 35 consecutive patients with CSFP and 40 age and sex-matched controls were enrolled. SFCT, average pRNFLT and four quadrants of pRNFLT were measured by spectral domain- optical coherence tomography (SD-OCT).The mean SCFT in patients with CSFP (267.57 ± 30.61 μm) was significantly thinner than those of patients with MA (288.84 ± 28.25 μm) and control (291.21 ± 31.75 μm) (p = 0.002) while SFCT of patients with MA were similar with those of controls. Patients with CSFP had thinner superior and inferior pRNFLT compared to patients with MA and controls (p0.001 and p = 0.005, respectively) while there were no significant differences in average pRNFLT, nasal and temporal quadrant of pRNFLTs among three groups. In the multivariate linear regression analyses, the presence of CSFP was found negatively correlated with SFCT and superior pRNFLT.Patients with CSFP had thinner SFCT, superior and inferior quadrants of pRNFLT proposing the presence of a generalized endothelial dysfunction and increased microvascular resistance in these patients.

Background Inflammation and malnutrition play a critical role in the outcomes of patients undergoing carotid artery stenting (CAS). Prognostic nutritional index (PNI) is commonly utilized to evaluate the peri-operative immune-nutritional status of patients undergoing colorectal cancer surgery and is independently associated with survival. We assessed the association between immune-nutritional status, indexed by PNI, and outcomes in CAS patients. Methods A total of 615 patients hospitalized for CAS in a tertiary heart center were enrolled in the study. PNI was calculated using the following formula: 10× serum albumin value (g/dL) + 0.005 × total lymphocyte count in the peripheral blood (per mm3). In-hospital and 5-year outcomes (ipsilateral stroke, major stroke, transient ischemic attack, myocardial infarction, and mortality) were compared between the tertiles of PNI. Results In-hospital outcomes were similar between the groups except the increased mortality in decreasing tertiles of PNI. During a mean follow-up duration of 51.1 months, the lower PNI tertile was related to unfavorable outcomes. After adjusting for multi-model Cox regression analysis, PNI persisted as an independent prognostic factor for mortality and major stroke. Conclusion PNI was independently associated with long-term mortality and major stroke in CAS patients. Malnutrition and inflammation, which can be assessed easily and quickly using PNI, have an important prognostic value in the patients undergoing CAS.

Introduction: Cardiac myxomas are the most common primary intracardiac tumors. Although myxomas are histologically benign, they are potentially dangerous due to potential risk of systemic and cerebral embolism. In this study, we aimed to investigate the potential predictors of embolism in patients with left atrial myxoma. Methods: This single-center retrospective study enrolled 93 patients (mean age: 52.9 ± 15.3 years, female: 70 [75.3%]) with left atrial myxomas between 2014 and 2018. The patients were classified into two groups (embolic vs nonembolic) to investigate possible predictors of embolism. Demographic, laboratory, and echocardiographic parameters were recorded into a dataset and compared between patients with and without embolism. Results: The study population was composed of 13 (14%) patients in embolic (11 cerebrovascular and 2 peripheral) and 80 (86%) patients in nonembolic group. Demographic and laboratory parameters were similar between the groups. Tumor sizes were significantly higher in the embolic group than in the nonembolic group (5.59 ± 1.08 vs 4.29 ± 0.61; P = 0.001). By multivariate analysis, increased tumor size, increased left atrial diameter, and the presence of atrial fibrillation and irregular tumor surface were identified as independent predictors of embolism. In ROC curve analyses, tumor size above 4.6 cm predicted embolism with a sensitivity of 77% and a specificity of 73% (AUC: 0.858; 95% CI: 0.752–0.964; P

Background: Epicardial fat reflects abdominal visceral adiposity and visceral fat plays an important role in the development of an unfavorable metabolic and atherosclerosis risk profile. Intracoronary thrombus burden is an important factor affecting the success of the procedure particularly in patients undergoing percutaneous coronary intervention (PCI). Therefore, determining the factors predicting thrombus burden has great importance in predicting adverse cardiovascular events as well as determining the most appropriate treatment strategy to prevent failure in PCI. Aim: The aim of the current study was to evaluate the relationship between Epicardial adipose thickness (EAT) and thrombus burden in the patients with ST-elevation myocardial infarction (STEMI) who undergo primary PCI (pPCI). Methods: The study was prospective and included patients (n=156) who were referred to Kosuyolu Research and Education hospital with STEMI between 2016 and 2017. Thrombus burden was scored as follows: 0 (no thrombus), 1 (possible thrombus), 2 (definite thrombus 2xreference vessel diameter), and 5 (complete vessel occlusion). According to thrombus grade the patients were grouped as low thrombus burden (grades 0-3) and high thrombus burden (grades 4 and 5). EAT, identified as an echo-free space between the myocardium and visceral pericardium, was measured perpendicularly, on the free wall of the right ventricle at both parasternal long- and short-axis views at end-diastole in three cardiac cycles. Results: Fifty-one subjects were in the low thrombus burden group and 105 in the high thrombus burden group. There were no differences in the two groups for LVEF, smoking status, family history of coronary artery disease (CAD), diabetes mellitus (DM), hypertension (HT), and hypercholesterolemia and for total cholesterol, triglyceride, GFR, LDL-C and HDL-C. In multivariate logistic regression analysis the EAT (odds ratio: 2.53, 95% CI: 1.76-3.67; p < .001) was found as an independent predictor of high thrombus burden. Conclusions: The present study showed that EAT was an independent predictor of coronary thrombus burden in STEMI.