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Purpose In this study, we aimed to assess the effectiveness of malignancy stratification algorithms of the American College of Radiology (ACR) and European Thyroid Association (ETA) in the delineation of thyroid nodules using a database of nodules that were unequivocally diagnosed by means of histopathological examination and meticulously matched with the imaged nodules. Methods A total of 165 patients having 251 thyroid nodules with histopathologically proven definitive diagnoses during a 5-year period were included in this study. All patients had preoperatively undergone ultrasonography (US) examination, and US characteristics of the thyroid nodules were retrospectively analyzed and assigned in compliance with the thyroid imaging reporting and data system categories recommended by the ACR (ACR-TIRADS) and ETA (EU-TIRADS). The diagnostic effectiveness in the delineation of thyroid nodules and unnecessary fine-needle aspiration (FNAB) rates were evaluated. Results Overall, 189 nodules (75.30%) were diagnosed as benign, while 62 nodules (24.70%) were reported to be malignant based on histopathological assessment. Sensitivity and specificity rates were 71% and 75% for ACR-TIRADS and 73% and 80% for EU-TIRADS. The area under the curve values were 0.78 and 0.80 for ACR-TIRADS and EU-TIRADS, respectively. The unnecessary FNAB rates were 61% for ACR-TIRADS and 64% for EU-TIRADS as per the recommended criteria of each algorithm. Conclusion The diagnostic performance of both malignancy stratification systems was signified to be moderate and sufficient in a cohort of nodules with definite histopathological diagnosis. In light of our results, we demonstrated the strengths and weaknesses of the ACR- and EU-TIRADS for physicians who should be familiar with them for optimal management of thyroid nodules.

Objective. Left circumflex (LCx) artery originating from the right coronary arterial (RCA) system has been reported as the most common form of anomalous origination of a coronary artery from the opposite sinus (ACAOS). However, some studies claim that RCA originating from the left coronary sinus (LCS) is the most frequent form. The aim of this study was to determine the most common type of ACAOS in a single center.Materials and Methods. The database of the catheterization laboratory was retrospectively searched. All patients who were performed coronary angiography between 1999 and 2006 were included to registry. All examinations were carefully analyzed to determine the most frequent type of ACAOS.Results. We detected ACAOS in 35 cases (16 RCA originating from the LCS, 13 LCx from the RCS or the RCA, and 6 others) out of 5165 coronary angiograms. The most common form was RCA originating from LCS. Moreover, we revealed that 5 cases with RCA originating from the LCS were previously misdiagnosed and not reported as a coronary anomaly.Conclusions. RCA originating from the LCS was the most common form of ACAOS in our registry. The high change of misdiagnosis or underreporting of this anomaly could have biased the true prevalence.

Objective Heart fatty acid binding protein (HFABP) is a low-molecular-weight free protein that is abundant in the intracytoplasmic space of myocytes. Due to its unique features, serum HFABP levels may increase in myocardial ischaemia. The aim of this study was to evaluate the effect of myocardial ischaemia induced by dobutamine stress echocardiography (DSE) on serum HFABP levels. Methods and results A total of 30 consecutive patients with suspected myocardial ischaemia underwent DSE examination. HFABP levels were measured immediately before and 1 hour after DSE. HFABP rose significantly in individuals in the DSE positive group (1.66 ± 1.18 ng/ml vs 2.65 ± 1.34 ng/ml, P = 0.004), but remained unchanged in the DSE negative group (1.61 ± 0.77 ng/ml vs 1.85 ± 0.76 ng/ml, P = 0.066). Conclusion Serum HFABP levels increased significantly at 1 hour in the presence of ischaemia induced by DSE in patients with stable clinical coronary syndromes. No such increase was evident in the absence of ischaemia.

Natriuretic peptides have long been introduced into clinical practice. These biomarkers have certainly been shown to provide useful information in the diagnosis, prognosis and risk stratification in heart failure and also may have a role in the guidance of heart failure therapy. Although, there are some limitations in using of these markers such as lack of specificity, aging, renal dysfunction or obesity, among the huge number of candidates for heart failure biomarkers, only natriuretic peptides are currently widely used in daily clinical practice in heart failure. Recent heart failure guidelines recognize natriuretic peptides as an essential tool in the new diagnostic and therapeutic algorithms. Furthermore, natriuretic peptides are not only used in the diagnosis or prognosis of heart failure, but also these biomarkers are referred to have some potential role in primary prevention, cardio-oncology, advanced heart failure, assessment of response to cardiac resynchronization therapy, pulmonary arterial hypertension, acute coronary syndromes, atrial fibrillation and valvular heart disease. in this article, natriuretic peptides have been reviewed for their updated information and new recommendations in heart failure and also potential role of these biomarkers in the management of various clinical conditions have been addressed in the form of expert opinion based on the available data in the literature. (Anatol J Cardiol 2019: 21 Suppl 1; 1-40)

The approach to patients with an indication for oral anticoagulation (OAC) for atrial fibrillation (AF) who undergo coronary stenting and thus need dual antiplatelet therapy has long been debated. Dual antiplatelet therapy accompanied by OAC (so called "triple therapy") carries a high bleeding risk and thus should either be avoided or used for a limited period. The lack of relevant prospective randomised trial data have largely been overcome by the recently published PIONEER AF-PCI trial, the results of which will be summarized in this article.

PubMedID: 29512625 Objective: The goal of this study was to define clinical practice patterns for assessing stroke and bleeding risks and thromboprophylaxis in nonvalvular atrial fibrillation (NVAF) and to evaluate treatment outcomes and patient quality of life. Methods: A clinical surveillance study was conducted in 10 tertiary healthcare centers across Turkey. Therapeutic approaches and persistence with initial treatment were recorded at baseline, the 6th month, and the 12th month in NVAF patients. Results: Of 210 patients (57.1% male; mean age: 64.86±12.87 years), follow-up data were collected for 146 patients through phone interviews at the 6th month and 140 patients at the 12th month. At baseline, most patients had high CHADS2 score (?2: 48.3%) and CHA2DS2-VASc (?2: 78.7%) risk scores but a low HAS-BLED (0–2: 83.1%) score. Approximately two-thirds of the patients surveyed were using oral anticoagulants as an antithrombotic and one-third were using antiplatelet agents. The rate of persistence with initial treatment was approximately 86%. Bleeding was reported by 22.6% and 25.0% of patients at the 6th and 12th month, respectively. The proportion of patients with an INR of 2.0–3.0 was 41.8% at baseline, 65.7% at the 6th month, and 65.9% at the 12th month. The time in therapeutic range was 61.0% during 1 year of followup. The median EuroQol 5-dimensional health questionnaire (EQ-5D) score of the patients at baseline and the 12th month was 0.827 and 0.778, respectively (p

This is an editorial comment on the European Society of Cardiology Guidelines on atrial fibrillation that has been revised in 2016.

Ranolazin is indicated for the control of angina in patients with chronic stable coronary artery disease. Born as a "metabolic modulator", ranolazine is now considered to be a "late sodium current blocker". This review tries to summarize the mechanism of antianginal effects of ranolazine.

Background The pathophysiology of coronary artery ectasia (CAE) is still unknown. Inflammation and degradation of connective tissue may have a role in the development of coronary ectasia. In the present study, the authors examined neutrophil gelatinase-associated lipocalin (NGAL) levels in isolated CAE patients. Methods Thirty-five patients with isolated CAE (25 males; mean age, 59 ± 10 years) and 35 age- and sex-matched healty volunteers (22 males; mean age, 57 ± 11 years) who had been shown to have normal coronary arteries were included in the study. Basal characteristics were recorded. Serum NGAL levels were determined with an enzyme-linked immunosorbent assay kit. Results NGAL levels were significantly higher in the isolated CAE group than in the control group (65.1 ± 13 vs 53.7 ± 19 ng/mL; P = 0.006). There were also significant difference in NGAL levels according to the number of ectatic coronary arteries (58.1 ± 13, 70.9 ± 9, and 71.1 ± 11 ng/mL for 1, 2, and 3 arteries, respectively; P = 0.015). Level of NGAL was lowest in patients who have only 1 ectatic coronary artery. Conclusion Serum NGAL levels increased in patients with isolated CAE, and NGAL may play a crucial role in the development and/or progression of coronary artery ectasia.

Background: Heart rate variability (HRV) and heart rate turbulence are known to be disturbed and associated with excess mortality in heart failure. The aim of this study was to investigate whether losartan, when added on top of P-blocker and angiotensin-converting enzyme inhibitor (ACEI) therapy, could improve these indices in patients with systolic heart failure. Methods and Results: Seventy-seven patients (mean age 60.4 +/- 8.0, 80.5% male) with ischemic cardiomyopathy (mean ejection fraction 34.5 +/- 4.4%) and New York Heart Association Class II-III heart failure symptoms, already receiving a beta-blocker and an ACEI, were randomly assigned to either open-label losartan (losartan group) or no additional drug (control group) in a 2:1 ratio and the patients were followed for 12 weeks. The HRV and heart rate turbulence indices were calculated from 24-hour Holler recordings both at the beginning and at the end of follow-up. The baseline clinical characteristics, HRV, and heart rate turbulence indices were similar in the 2 groups. At 12 weeks of follow-up, all HRV parameters except pNN50 increased (SDNN: 113.2 +/- 34.2 versus 127.8 +/- 24.1, P = .001; SDANN: 101.5 +/- 31.7 versus 115.2 +/- 22.0, P =.001; triangular index: 29.9 +/- 11.1 versus 34.2 +/- 7.9, P =.008; RMSSD: 29.1 +/- 20.2 versus 34.3 +/- 23.0, P =.009; NN50: 5015.3 +/- 5554.9 versus 6446.7 +/- 6101.1, P =.024; NN50: 5.65 +/- 6.41 versus 7.24 +/- 6.99, P =.089; SDNNi: 45.1 +/- 13.3 versus 50.3 +/- 14.5, P =.004), turbulence onset decreased (-0.61 +/- 1.70 versus -1.24 +/- 1.31, P =.003) and turbulence slope increased (4.107 +/- 3.881 versus 5.940 +/- 4.281, P =.004) significantly in the losartan group as compared with controls. Conclusions: A 12-week-long losartan therapy significantly improved HRV and heart rate turbulence in patients with Class II-III heart failure and ischemic cardiomyopathy already on beta-blockers and ACEI.

The aim of this study was to disclose the release kinetics of heart fatty acid binding protein (HFABP) and myoglobin in acute myocardial infarction (AMI) reperfused by primary percutaneous coronary intervention (PPCI) and to determine the influence of the quality of coronary flow post PPCI on the release properties of these markers.Twenty-four patients with AMI who underwent successful PPCI and had no evidence of reocclusion within the first 120 minutes were studied. Serum myoglobin and HFABP levels at baseline and at 15, 30, 45, 60, 90 and 120 minutes after reperfusion were measured. Corrected TIMI frame count (CTFC) in the relevant vessel post PPCI was used to categorize patients in group I (CTFC21) and group 2 (CTFCor = 21). Biomarker ratios at each sampling point were calculated by dividing the serum level of the biomarker at the specific sampling time by its baseline level. Baseline myoglobin and HFABP levels rose significantly at 15 minutes (153 +/- 251.5 microg/L vs. 904.3 +/- 542.6 microg/L, 10.9 +/- 8 microg/L vs. 17.8 +/- 9.1 microg/L, both P0.0001) after successful PPCI. Group 2 patients tended to have higher biomarker ratios at each time point as compared to group I.Successful PPCI for AMI results in a significant increase of both HFABP and myoglobin levels within 15 minutes of vessel opening and the quality of flow in the infarction-related artery post PCI as evaluated by CTFC does not influence the release kinetics of these biomarkers.

Cardiac autonomic neuropathy (CAN) is an important complication of diabetes mellitus (DM) and confers an increased cardiovascular risk. The aim of this study was to disclose the place of heart rate (HR) variability and HR turbulence for the detection of CAN in patients with type 2 DM and no obvious heart disease. Ninety patients who were < 75 years old and had type 2 DM for >= 2 years were studied. CAN was diagnosed with a battery of cardiovascular reflex tests and the degree,of neuropathic involvement was graded by the Ewing score. Time-domain HR variability and HR turbulence parameters were assessed on 24-hour digital, Holter recordings. Thirty-five patients were found to have CAN. The clinical characteristics of patients with and without CAN were similar, except that the mean duration of DM and the number of patients using insulin were significantly increased in the group with CAN. All time-domain HR variability parameters were significantly lower in the group with CAN. Of the 2 HR turbulence parameters studied, turbulence onset was similar but turbulence slope was significantly lower in the group with CAN. The Ewing score significantly correlated negatively with all HR variability parameters and turbulence slope, and among all, turbulence slope was the most strongly correlated (r = -0.617, p < 0.01). Receiver-operating characteristics analysis revealed a sensitivity of 97% and a specificity of 71% at a turbulence slope cut-off value of 3.32 for the detection of CAN. In conclusion, time-domain HR variability and HR turbulence parameters, except turbulence, onset were found to be significantly depressed in patients with type 2 DM and CAN. Decreases in all these parameters were found to correlate significantly with degree of neuropathic involvement. The most strongly correlated parameter, turbulence slope, was found to be highly sensitive and specific for the detection of CAN at a cut-off value of 3.32. (c) 2007 Elsevier Inc. All rights reserved. (Am J Cardiol 2007;100:890-893)

Background and aim: The aim of this study was to evaluate the effect of statin treatment on P-wave morphology, dispersion, and tissue Doppler imaging-derived atrial conduction time (PA-TDI), which are known to be predictors of atrial fibrillation (AF). Methods: A total of 132 patients with guideline-directed statin indications but no clinical atrial tachyarrhythmias were studied. P-wave duration, P-wave dispersion, and P-wave amplitude on surface 12-lead electrocardiogram and PA-TDI were evaluated before and after three months of statin (either atrovastatin 10–40 mg/d or rosuvastatin 10–20 mg/d) treatment. Results: Total and low-density lipoprotein cholesterol were significantly reduced after statin therapy. P-wave dispersion significantly decreased from 39.6 ± 9.4 to 36.9 ± 9.6 ms. Statin treatment significantly decreased both the maximum (from 1.5 ± 0.36 to 1.45 ± 0.33 mV, p = 0.001) and the minimum (from 1.07 ± 0.28 to 1.04 ± 0.27 mV, p = 0.01) P-wave amplitude. The PA-TDI value was found to be significantly shorter after statin treatment (121.7 ± 18.7 vs. 118.7 ± 15.8 ms, p = 0.016) Conclusions: Short-term statin therapy was shown to significantly affect P-wave amplitude, P-wave dispersion, and atrial conduction time in a broad range of patients without any clinical atrial tachyarrhythmia.

Low energy internal cardioversion (ICV) is a relatively new method. This report describes the long-term follow-up results of a prospective randomized comparison of low energy ICV and transthoracic cardioversion (TT CV) in patients with persistent atrial fibrillation (AF). Fifty-two patients (mean age, 60.6 ± 10.1 years, 23 males) with persistent AF were randomly assigned to either TT (n = 26) or ICV (n = 26). The baseline characteristics of the 2 groups were similar. Transthoracic CV was performed under sedation with hand-held electrodes in the apex-anterior position and high energy (100-360 J) monophasic shocks. ICV was performed by a dedicated balloon-directed catheter utilizing truncated, biphasic shocks of low energy (1-15 J). Sinus rhythm (SR) was restored in 24/26 (92%) patients in the ICV group and in 22/26 (85%) patients in the TT CV group (P > 0.05). Immediate recurrence of AF (IRAF), defined as reappearance of AF within 2 minutes of successful CV, occurred in 5 patients (21%) in the ICV group and in 1 patient (4.5%) in the TT group (P > 0.05). Successfully cardioverted patients in whom no IRAF occurred were followed-up for 18 months under both warfarin and Class 1 or 3 antiarrhythmic drugs, as guided by the current ACC/AHA/ESC Guidelines. The rate of SR at 1, 3, 6, 12, and 18 months of follow-up was not significantly different between the 2 groups, and in an intention-to-treat analysis at 18 months, SR was present in 6 patients (23%) in the ICV group and in 10 patients (38%) in the TT group (P > 0.05). The majority of AF recurrences occurred within a month of successful CV in both groups (8/12 [67%] in the TT group and 15/18 [83%] in the ICV group, P > 0.05). The mortality, thromboembolic, and bleeding complication rates were similar in the 2 groups. In this prospective randomized comparison of TT and low energy ICV in patients with persistent AF, the 18-month rates of SR and major adverse clinical events were found to be similar.

Electrical cardioversion (CV) is used to restore sinus rhythm (SR) in patients with atrial fibrillation (AF). In this prospective randomized study, we compared two different methods of electrical CV, namely transthoracic (TT) and low-energy transvenous internal CV (ICV), in patients with persistent AF with respect to efficacy, safety and the magnitude of myocardial damage provoked by either method.Fifty-two patients with persistent AF were randomly assigned to either TT (n = 26) or ICV (n = 26). The baseline characteristics of the two treatment groups were similar. TT CV was performed under sedation with hand-held electrodes in the apex-anterior position and high-energy (100-360J) monophasic shocks. ICV was performed by a single catheter approach utilizing a special balloon-directed catheter with proximal and distal arrays of shock electrodes that were positioned in the right atrium and left pulmonary artery under fluoroscopy. Truncated, biphasic shocks of low energy (1-15 joules) were used. Cardiac troponin T (cTpnT), creatine kinase (CK) and CK-MB levels were assessed before and 24 hours after each procedure. SR was restored in 24/26 (92%) patients in the ICV and 22/26 (85%) patients in the TT CV groups (p0.05). The mean energy to achieve SR was significantly higher with the TT method (9.8 +/- 4.3 J vs. 246.4 +/- 73.6 J, p0.05). CV with either method caused no elevation in cTpnT levels. Total CK and CK-MB levels remained unchanged with ICV. On the other hand, TT CV resulted in a significant increase in total CK (51.8 +/- 30 vs. 156.5 +/- 255.3, p0.05) and a nonsignificant rise in CK-MB levels (14.7 +/- 7 vs. 17.3 +/- 1.1, p0.05).In this prospective randomized comparison, TT and ICV were found to be equally effective to restore SR in patients with persistent AF No evidence of myocardial damage was detected with either method.

In an attempt to determine the early and late outcomes of small vessel stenting, we retrospectively evaluated our database on 51 consecutive patients (41 males, mean age, 57.1 +/- 10.1 years) who underwent stenting of at least one significant lesion in a coronary artery with a reference vessel diameter (RVD)

OBJECTIVE It has been claimed that left ventricular (LV) systolic dysfunction impairs left atrial (LA) and left atrial appendage (LAA) functions. In this study, we compared the LA and LAA function parameters in patients with chronic nonvalvular atrial fibrillation (AF) with and without LV systolic dysfunction. METHODS AND RESULTS The study population consisted of 28 patients with chronic nonvalvularAF. Group I consisted of 12 patients with LV systolic dysfunction (mean age: 61 +/- 14 years; LV ejection fraction: 44 +/- 6%), group II of 16 patients with normal LV systolic function (mean age: 52 +/- 15 years; LV ejection fraction: 65 +/- 3%). LV ejection fraction (EF) was measured by echocardiography utilizing bi-plane area length method. The following LA and LAA transoesophageal echocardiography parameters were obtained: I) LA diameter, 2) LAA ejection velocity, 3) LAA filling velocity, 4) LAA ejection fraction, 5) pulmonary venous (PV) systolic velocity, 6) PV diastolic velocity, 7) PV systolic velocity/diastolic velocity ratio. The left atrium diameter was significantly larger in group I than in group 11 (4.7 +/- 0.7 cm vs. 3.8 +/- 0.6 cm, p < 0.05). The LAA ejection velocity and LAA ejection fraction were significantly lower in group I than in group 11 (22.6 +/- 15.5 cm/s vs 37.5 +/- 11.3 cm/s and 26.9 +/- 20.8% vs. 41.3 +/- 10.9%, p < 0.05 for both comparisons). The PV systolic velocity and PV systolic velocity/diastolic velocity ratio were significantly smaller in group I than in group II (26.2 +/- 14.8 cm/s vs. 51.5 +/- 22 cm/s and 0.7 +/- 0.6 vs. 1.2 +/- 0.5, p < 0.05 for both comparisons). Although decreased LAA filling and PV diastolic velocities were determined in group I, no significant difference existed between groups I and II. Thrombus and/or spontaneous echo contrast (SEC) in the LA and/or LAA were more frequent in group I (75% vs. 18%, p < 0.05). CONCLUSION These results indicate that LV systolic dysfunction impairs various LA and LA function parameters and is associated with an increased frequency of SEC and/or LA thrombus in patients with chronic nonvalvularAF.

Low-molecular-weight heparins (LMWH) of different types have yielded different results when used in the setting of unstable angina (UA) or non Q-wave myocardial in-farction (NQMI). We compared the safety and therapeutic efficacy of two different LMWHs, namely dalteparin (Dalt.) and enoxaparin (Enox.), in the acute phase (first 5 days) of UA or NQMI. One hundred and forty-two patients with UA/NQMI were randomly assigned to treatment with either Dalt. [120 IU/kg twice daily by subcutaneous (SC) injection] or Enox. [1 mg/kg twice daily by SC injection]. The occurrence of any one of death, myocardial infarction, or angina recurrence within 5 days of the first LMWH injection was the endpoint of the study. There were 69 patients in the Enox. group (53 males, 16 females, mean age : 60.3±11.9) and 73 patients in the Dalt. group (54 males, 19 females, mean age : 59.6 ±10.3). The baseline characteristics of the patients in the two groups were similar. There were no deaths in either group. Myocardial infarction occurred in two patients in the Dalt. group (4%). Angina recurrence was seen in 11 patients in the Enox. group (16%) and in 11 patients in the Dalt. group (15%). Overall, any of the events that made up the endpoint occurred in 11 (16%) and 14 (19%) patients in the Enox. and Dalt. groups, respectively (P>0.05). The time to occurrence of the first event, however, was significantly longer in the Enox. group (82.3±33.2 versus 37.6±23.4 hours, P=0.007). Thrombocytopenia and allergic reactions were not detected in any patient. Major bleeding was seen in 1 patient in the Enox. group. Minor bleeding occurred in 17 (25%) and 21 (29%) patients in the Enox. and Dalt. groups, respectively (P>0.05). Enoxaparin and dalteparin were found to be equally safe and effective for the early management of UA/NQMI, but enoxaparin appeared to delay the occurrence of MI or angina recurrence as compared to dalteparin in this setting.

In this report, an unusual case with a multiple plexiform type of coronary artery-to-left ventricular fistula and coexisting atherosclerotic involvement of the contralateral coronary artery is described and the pertinent literature is reviewed briefly.

Metoprolol is widely used to eliminate symptoms in patients with mitral valve prolapse (MVP), a condition associated with enhanced sympathetic tone. In this study, effects of metoprolol on heart rate variability (HRV) indices were investigated in symptomatic patients with MVP. Thirty-nine symptomatic patients with MVP (26 women, mean age 26 +/- 7 years) and 16 age- and gender-matched controls were studied. After a baseline 24-hour Holter evaluation in all subjects, patients with,MVP were started on metoprolol succinate therapy at a dose of 25 to 100 mg/d, and Holter analysis was repeated at the end of 3 months of metoprolol therapy. At the basal evaluation, all time-domain HRV indices with the exception of proportion of adjacent RR intervals differing by > 50 ms in the 24-hour recording were significantly lower in patients with MVP than controls (SD of all normal-to-normal [NN] intervals, p = 0.013; SD of average NN intervals calculated during 5-minute periods of the entire recording, p = 0.03; triangular index, p = 0.025; and square root of mean squared differences in successive NN intervals, p = 0.026). After metoprolol treatment, all HRV indices significantly improved compared with baseline (SD of all NN intervals, p = 0.028; SD of average NN intervals calculated during 5-minute periods of the entire recording, p = 0.043; triangular index, p = 0.004; square root of the mean squared differences in successive NN intervals, p = 0.021; and proportion of adjacent RR intervals differing by > 50 ms in the 24-hour recording, p = 0.014), and HRV indices after metoprolol treatment were similar to those of the control group (p > 0.05). In conclusion, metoprolol significantly improved impaired HRV parameters in symptomatic patients with MVP. (c) 2007 Elsevier Inc. All rights reserved.

The American Journal of Cardiology MARCH 26e29, 2015 11 IN AND C PP-111 A New Tool for Catheter Ablation: Lasso Electroporation Catheter. Omer Uz, Haluk Un, Ugur Kucuk, Hilal Olgun Kucuk, Ejder Kardesoglu, Zafer Isilak, Mehmet Uzun. Gulhane Military Medical Academy, Haydarpasa Hospital, Department Of Cardiology, Istanbul, Turkey; Siyami Ersek Thoracic and Cardiovascular Surgery Center Department of Cardiology, Istanbul, Turkey. Currently, radiofrequency (RF) energy is the most widely accepted and used method for arrythmia ablation. However, RF ablation has potential disadvantages such as endocardial disruption, charring, platelet activation and thrombus formation, Alternative energy sources have been proposed for catheter ablation. Cryoablation, microwave, laser and ultrasound may be able to create longer, deeper, and more controlled lesions. Irreversible electroporation is a nonthermal ablative tool that uses direct electrical pulses to create irreversible membrane pores and eventual cell death. At present there is no commercially avaiable cardiac eletroporation cathater. But limited animal studies utilizing modified standart ablation cathaters have been reported. Here we present design of a lasso electroporation cathater. Defibrillators are widely used to terminate life-threatening arrhythmias. If defibrillator shock-induced transmembrane potentials are large enough, they can cause irreversible tissue damage due to electroporation. We use 10-polar lasso cathater. Positive and negative poles of all electrode pairs were connected in parallel (Figure 1A). And we connected these poles to transcutaneous pacing patch. Direct current electricity transmitted to lasso cathater when we applied shock from defibrillator paddles to the transcutaneous pacing patch(Figure 1B). We test our cathater in saline solution. Whenever we applied shock, bubbles were seen around the electrode pairs which mean our lasso electroporation cathater is functioning properly(Figure 1C). To our knowledge this is the first lasso electroporation cathater reported in literature. We applied local ethic committee for further animal studies. Future studies will establish the efficacy of this new and promising technology.

In this study, we tried to disclose certain electrocardiogram (ECG) criteria that might be useful in the classification of posteroseptal accessory atrioventricular pathways as right and left in patien

Amaç: Atriyal fibrilasyon (AF) yönetimi toplam maliyetinin klinik uygulama ve kılavuzlar bazında hesaplanarak akut koroner sendrom, kalp yetersizliği, inme ve ilaça bağlı advers olaylar açısından maliyet verilerinin sağlanması. Yöntem: Bu maliyet analiz çalışması, AF hastalarında akut koroner sendrom, kalp yetersizliği, inme ve ilaca bağlı advers olaylar bazında toplam maliyetin, kendi klinik pratikleri ve ACCF/AHA/ESC kılavuzlarında yer alan öneriler doğrultusunda araştırıcılar tarafından doldurulan standart anket formları aracılığı ile hesaplanması yolu ile yürütüldü. Toplam tıbbi maliyet hesabına dahil edilen maliyet kalemleri tedavi, sağlık kaynakları kullanımı, tanısal testler ve konsültasyon kalemleri olarak belirlendi. Bulgular: Akut koroner sendrom için hesaplanan ortalama toplam maliyet, uzmanların günlük klinik pratiği yansıtan görüşlerine göre 5.478.43 TL iken kılavuzlar doğrultusunda 11.319.44 TL olarak hesaplandı. Kalp yetersizliği toplam maliyeti uzman görüşlerine göre 4.523.74 TL iken kılavuzlar doğrultusunda 2.925.86 TL olarak hesaplandı. İnme toplam maliyeti uzman görüşlerine göre 5.719.25 TL, kılavuzlara göre ise 7.931.18 TL olarak hesaplandı. İlaca bağlı advers olaylar içinde, yalnızca kardiyak advers olaylar için, uzman görüşleri doğrultusunda kılavuzlara göre daha yüksek maliyet tespit edildi (288.65 ve 150.99 TL). Sonuç: Atriyal fibrilasyon ve ilgili advers olayların yönetiminde klinik pratikte kullanılan tedavi algoritmalarını yansıtan bulgularımız, hastalıkları kontrol altına alınamayan hastaların sağlık ekonomisine getirdiği fazladan maliyet yüküne işaret etmektedir. Objective: To estimate total cost of atrial fibrillation (AF) management concerning acute coronary syndrome, heart failure, stroke and drug related adverse events with respect to clinical practice and available guidelines. Methods: This cost analysis study was based on identification of total costs related to management of acute coronary syndrome, heart failure, stroke and the drug related adverse events in patients with AF based on standardized questionnaire forms filled by experts according to their daily clinical practice and also to ACCF/AHA/ESC guidelines. Total cost included cost items related to treatment, healthcare resources utiliza- tion, and diagnostic test and consultations. Results: The yearly cost of acute coronary syndrome per patient was 5.478.43 TL according to expert's view reflecting real clinical practice whereas it was 11.319.44 TL when calculation was based on recommendations in the guidelines. The average total cost of heart failure was 4.523.74 TL according to expert's view whereas it was 2.925.86 TL based on guidelines. The average total cost of stroke was 5.719.25 TL accord- ing to expert's view but 7.931.18 TL based on guidelines. Among drug related adverse events, only those related to cardiac adverse events were estimated to be higher according to expert view as compared to guideline recommendations (288.65 vs. 150.99 TL). Conclusions: Reflecting the treatment algorithms in the management of AF and related adverse events, our findings seem to emphasize the extra burden on health economics posed by patients suffering from the uncontrolled disease.

Background . A major concern in evaluating dynamic cardiomyoplasty has been whether the synchronous stimulation of latissimus dorsi muscle is essential for benefit or not. We studied 10 patients to determine the efficacy of the systolic augmentation generated by the synchronous electrical stimulation of the latissimus dorsi muscle. Methods . Left ventricular ejection fraction, end-systolic and end-diastolic volume indexes, and stroke volume index obtained during resting, peak exercise, and recovery periods ("on" values) were compared with those obtained 1 week after cessation of electrical stimulus ("off" values). Double product and estimated total body oxygen consumption at peak exercise were also calculated and compared. Results . Higher ejection fractions (0.36 ± 0.07 versus 0.33 ± 0.06 at rest, 0.40 ± 0.07 versus 0.33 ± 0.07 peak exercise, and 0.37 ± 0.06 versus 0.31 ± 0.06 at recovery) and lower end-systolic volume indexes with relatively constant end-diastolic volume indexes were observed with the cardiomyostimulator on. Further, exercise response was better with the cardiomyostimulator on. Double product indirectly reflected better myocardial oxygen supply/demand ratio when on at peak exercise (17 ± 2.2 mm Hg × beats/min × 10 −3 for on versus 19 ± 2.6 mm Hg × beats/min × 10 −3 for off). Estimated total body oxygen consumption was improved at peak exercise when the cardiomyostimulator was functional (12 ± 2.7 mL · kg −1 · min −1 versus 11 ± 2.6 mL · kg −1 · min −1 ). Conclusions . Current data suggest a true systolic assist during synchronous contractions of the latissimus dorsi muscle. It is thought, therefore, that synchronous electrical stimulation is essential for maximum benefit and all the beneficial effect of cardiomyoplasty certainly cannot be attributed to simple wrapping itself.

Accessory mitral valve tissue is a rare finding in echocardiographic examinations. We report a case with an echocardiographically detected accessory mitral valve tissue which caused left ventricular outflow tract obstruction and was presumably responsible for a cerebrovascular accident.

OBJECTIVE Endothelial progenitor cells (EPC) have a regenerative role in the vascular system. In this study, we aimed to evaluate simultaneously the effects of EPC and inflammatory cells on the presence and the extent of coronary artery disease (CAD) and the grade of coronary collateral growth in patients with clinical suspicion of CAD. METHODS This study has a cross-sectional and observational design. We enrolled 112 eligible patients who underwent coronary angiography consecutively (mean age: 59±9 years). The association of circulating inflammatory cells and EPC (defined by CD34+KDR+ in the lymphocyte and monocyte gate) with the presence, severity and extent of CAD and the degree of collateral growth were investigated. Logistic regression analysis was used to define the predictors of collateral flow. RESULTS Of 112 patients 30 had normal coronary arteries (NCA, 27%, 55±9 years) and 82 had CAD (73%, 61±8 years). Among the patients with CAD, the percent degree of luminal stenosis was

A B S T R A C T S observed under four stages. Atrial fibrillation follow-ups before and after the operation were done with electrocardiography. Results: The atrial fibrillation development incidence in group II patients was significantly found less compared to group I. In both groups, the levels of NT-proBNP, checked in T1 on patients having atrial fibrillation, were found higher than the patients with sinus rhythm. The levels of NT-proBNP in T2, T3, T4 among group I were found meaningfully higher than group II. Conclusion: NT-proBNP levels’ and atrial fibrillation occurrence risk’s showing high correlation are important in the estimation of rhythm problems that could develop right after open heart surgeries. The interventions done beforehand and decreasing the risk of atrial fibrillation development in those patients are extremely important in reducing morbidity and mortality.

OBJECTIVE Autonomic dysfunction is an important marker of prognosis in congestive heart failure (CHF) and may determine the symptoms and progression of CHF. The aim of our study was to investigate whether preserved autonomic function assessed by heart rate variability (HRV) analyses is related to absence of CHF symptoms despite prominently reduced systolic function. METHODS The study had a cross-sectional observational design. Fifty patients with left ventricular ejection fraction (EF) below 40% were enrolled. The patients were divided into two groups according to their CHF symptomatic status as Group 1 (NYHA functional class I, asymptomatic group) and Group 2 (NYHA functional class ≥ II, symptomatic group). Plasma C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-proBNP) levels, echocardiographic parameters and HRV indices were measured while the patients were clinically stable in each group. Possible factors associated with the development of CHF symptoms were assessed by using multiple regression analysis. RESULTS Baseline clinical characteristics and left ventricular EF were similar in the two groups. Serum CRP (15 ± 21 vs 7 ± 18 mg/L, p=0.011) and NT-proBNP levels (1935 ± 1088 vs 1249 ± 1083 pg/mL, p=0.020) were significantly higher in symptomatic group. The HRV parameters (SDNN: 78 ± 57 vs 122 ± 42 ms, p=0.001; SDANN: 65 ± 55 vs 84 ± 38 ms, p=0.024; SDNNi: 36 ± 41 vs 70 ± 46 ms, p

Fractional flow reserve (FFR) is a method to determine the significance of a lesion. Although an FFR measurement of0.75 is accepted to show ischaemia, the effect of the location of the lesion on the coronary artery is not known. This study investigates the effect of lesion location on the FFR measurement.Ninety-nine eligible patients who had undergone FFR measurement of an intermediate lesion (40-70% stenosis) at the left anterior descending coronary artery (LAD) were included. The lesions proximal to the origin of the first diagonal branch were accepted as proximal lesions and the remaining lesions were accepted as distal.The patients were categorized according to the degree of the percent diameter stenosis (40-50%, 50-60%, and60%) and the reference vessel diameter (RVD) (or = 2.8 mm and2.8 mm). We compared the FFR measurements between proximal and distal lesions among different categories which were set according to anatomical features of the lesions.No significant difference was found between the FFR values of proximal and distal lesions with a similar percent diameter stenosis (0.86 +/- 0.08 vs. 0.83 +/- 0.08; 0.77 +/- 0.11 vs. 0.80 +/- 0.09; 0.75 +/- 0.07 vs. 0.77 +/- 0.08; P = 0.646).We did not find a difference between the FFR values of proximal and distal lesions with a similar RVD either (0.78 +/- 0.03 vs. 0.81 +/- 0.02; 0.84 +/- 0.03 vs. 0.81 +/- 0.01; P = 0.976). Major adverse cardiac event incidence was also similar for proximal and distal lesions (23% vs. 20%; P = 0.793).Fractional flow reserve can show the physiological significance of a stenosis independent of the anatomical location of the lesion on the coronary artery.

To investigate the effect of body mass index (BMI) on heart rate variability (HRV) and inflammatory parameters in patients with heart failure.We analyzed 55 consecutive patients (mean age, 63.5 +/- 12.8 years; male/female, 39/16) with symptomatic left ventricular systolic (ejection fraction45%) heart failure. The participants were classified into three categories according to BMI: lean (BMI25 kg/m2), overweight (BMI = 25-29.9 kg/m2) and obese (BMIor= 30 kg/m2). The cause of heart failure was mainly ischemic heart disease (75%) with mean ejection fraction 30 +/- 7%. Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein levels were measured, and time-domain HRV indices were determined on Holter electrocardiogram. The relationship between HRV indices and laboratory, inflammatory and echocardiographic parameters was investigated with correlation analysis.Age, sex, clinical characteristics (hypertension, diabetes mellitus, dyslipidemia, family history, smoking) were similar between groups. BMI was inversely correlated with NT-pro BNP levels (P = 0.001). HRV indices did not differ between groups. Correlation analysis demonstrated the relationship between HRV indices and fasting blood glucose (SDNN, SDANN, SDNNI, root mean square successive differences, VTI), C-reactive protein (SDANN, SDNNI, VTI), pulmonary artery pressure (SDNN, SDANN, VTI) levels.In systolic heart failure patients a higher BMI is associated with decreased NT-proBNP levels. Although HRV indices were not different between groups, inflammatory parameters, fasting blood glucose and pulmonary artery pressure were correlated with them.

Fractional flow reserve (FFR) is an invasive method to assess the functional significance of coronary stenoses. The value of FFR in diabetic patients is controversial because of microvascular dysfunction. The aim of this study is to investigate the effect of diabetes mellitus (DM) on FFR measurements.One hundred and twenty-one patients with an intermediate lesion who had undergone FFR measurement were included in the study. Lesion severity was determined by quantitative coronary angiography. The patients were divided into groups according to the presence (group 1) or absence (group 2) of DM. The patients were further categorized according to the degree of luminal narrowing caused by the lesion (40-50, 51-60, and60%) and reference vessel diameter (or = 2.8 and2.8 mm). FFR measurements were compared in each category.There was no difference between the FFR values of diabetic and nondiabetic patients who had coronary lesions with similar degree of luminal narrowing (0.87+/-0.08 vs. 0. 0.85+/-0.07; 0.81+/-0.08 vs. 0.82+/-0.10; 0.81+/-0.10 vs. 0.83+/-0.09, P = 0.957). In the analysis comparing FFR measurements in the categories set according to reference vessel diameter, we did not find a difference either (0.82+/-0.09 vs. 0.83+/-0.09; 0.84+/-0.09 vs. 0.82+/-0.09, P = 0.878). The DeltaFFR value, which is the difference between FFR values before and after adenosine administration, was also similar in diabetic and nondiabetic patients (8.4+/-6.0 vs. 8.4+/-5.5, P = 0.997).The presence of DM does not have a significant impact on FFR values in coronary stenoses of intermediate severity.

We sought to investigate the early and late effects of magnetic resonance imaging (MRI) on stent thrombosis and major adverse coronary events after coronary artery stent (CAS) implantation at a long-term follow-up period.Forty-three patients (28 men, mean age 63+/-10 years) who underwent CAS implantation before MRI examination were included. MRI was performed on a 1.5-T MR-system with a phased array multicoil. An average of 1.3 stents per patient were implanted (1-4 stents). More than one MRI was performed for two patients. Patients who underwent MRI within 8 weeks after the procedure were included in the early-term group (17 patients), and those who underwent MRI after 8 weeks were included in the late-term group (26 patients).Mean follow-up period was 36+/-15 months. There was no acute or subacute stent thrombosis. Late stent thrombosis that resulted in acute myocardial infarction was observed in a patient from the early group after an operation for prostate hyperplasia 5 months after MRI, and the patient underwent percutaneous coronary artery angioplasty. De-nova lesion was observed in four patients in the early group and two patients in the late group (P=0.14). In-stent restenosis was recorded in two patients in the early group and three patients in the late group (P=0.98). Composite major adverse cardiac events (acute coronary syndrome, myocardial infarction, death, and cerebrovascular event) were observed in seven of the early-group patients (41%), and in six of the late-group patients (23%) (P=0.20).MRI can be safely performed in patients with CAS implantation both in the early and late course, and is not associated with an increased risk of major adverse clinical cardiac events at long-term follow-up.

Isolated right ventricular myocardial infarction accounts for only 3% of all infarctions. It has previously been reported as a complication of percutaneous coronary intervention involving the right coronary artery secondary to occlusion of the right ventricular branch. In the present: report, a patient is described in whom isolated right ventricular myocardial infarction developed due to occlusion of the right ventricular branch of the right coronary artery in the absence of percutaneous intervention.

WOS: 000207610701378 …

OBJECTIVE Atrial fibrillation (AF) is known to be related with increased risk of thromboembolic events. Asymmetrical dimethylarginine (ADMA), which is an endogenous inhibitor of nitric oxide synthase (NOS), can cause endothelial dysfunction by decreasing nitric oxide (NO) and lead to increased risk of thrombosis. In the present study our aim was to compare plasma levels of ADMA in patients with acute onset ( 1 year) to determine the risk of thrombosis. METHOD 17 patients with the first detected attack of AF within the first 24 hours of presentation (group 1), 25 patients who had permanent chronic AF lasting at least 1 year or more (group II) and 18 healthy persons as the control group (group III) were included in the study. For each patient the plasma ADMA, L-arginine, symmetrical dimethylarginine (SDMA) concentrations were measured by high-performance liquid chromatography in venous blood samples collected before cardioversion. We compared the plasma ADMA, L-arginine and SDMA concentrations between the groups. RESULTS Plasma L-arginine (78.18 +/- 28.29 vs. 73.14 +/- 14.11 vs. 71.03 +/- 21.31, P = 0.549) and plasma SDMA concentrations (0.38 +/-0.18 vs. 0.42 +/- 0.21 vs. 0.32 +/- 0.24, P = 0.224) were similar in all groups. There was a significant difference between plasma ADMA concentrations (0.76 +/- 0.27 vs. 0.50 +/- 0.26 vs. 0.36 +/- 0.20, P < 0.001) among the groups. When we compared plasma ADMA levels between the subgroups, we also found a significant difference (P = 0.002 when comparing group I and group II, P < 0.001 when comparing of group I and group III, P = 0.042 when compareng of group II and group III). CONCLUSION ADMA levels in patients with acute onset AF were significantly increased when compared with patients with chronic AF and the healthy control group indicating the presence of endothelial dysfunction and a prothrombotic state even in a very early phase of AF.

Myocardial fractional flow reserve (FFR) is utilized to determine the hemodynamic significance of coronary stenoses. We sought to determine the effect, if any, of metoprolol on FFR in patients with coronary stenoses of intermediate severity.Eighteen patients (10 males, mean age, 59.4 +/- 7.7 years) with isolated, intermediate (30% to 70% narrowing on coronary angiogram) lesions on the proximal LAD and a preserved ejection fraction, underwent FFR measurement using a 0.014 inch pressurewire and intracoronary adenosine injection before and after intravenous metoprolol at a dose that achieved at least a 10% decrease in the heart rate. Heart rate dropped significantly with metoprolol. At the premetoprolol measurement, aortic pressure (Pa) remained essentially the same (105.7 +/- 11.5 versus 105.6 +/- 11.6 mmHg, P0.05) and distal coronary pressure (Pd) dropped significantly by 9% from 96.3 +/- 12.7 to 87.4 +/- 13.4 mmHg (P0.001) after adenosine injection yielding an FFR(1) of 0.83 +/- 0.07. At the postmetoprolol phase, Pa dropped nonsignificantly by 2% from 104.4 +/- 12.8 to 102.4 +/- 14.3 mmHg (P = 0.09) and Pd dropped significantly by 11% from 95.7 +/- 14.4 to 85.3 +/- 16.4 mmHg (P0.001) after adenosine injection, yielding an FFR(2) of 0.83 +/- 0.08, which was almost exactly the same as FFR(1) (P0.05).In this study, FFR was found not to be influenced by metoprolol treatment in patients with intermediate coronary stenoses and a preserved ejection fraction.

Objective The aim of this study was to investigate the heart rate variability (HRV) parameters in patients with neurally mediated reflex syncope. Methods Thirty-three patients (10 men, age range 16-50 years) who were scheduled to undergo head-upright tilt test (HUTT) with a typical history of vasovagal syncope (VVS) underwent 24-hour Holter monitoring in an attempt to study HRV parameters. Sixteen individuals without syncope and similar baseline characteristics made up the control group. Results Seventeen of the 33 syncopal patients showed HUTT positivity. All the time domain HRV parameters except the mean RR interval were higher in the HUTT (+) syncopal patients than in the negative responders. Although not statistically significant, the positive responders had higher NN50, pNN50, RMSSD and SDNNi values than the control group. HUTT (-) VVS patients had lower SDNN and SDANN values when compared with the control group. The other HRV parameters did not differ significantly between the HUTT (-) patients and the control group. Conclusion Increased parasympathetic tonus as reflected by significantly higher HRV parameters is associated with a greater frequency of HUTT positivity in patients with syncope and no organic heart disease.

Objective Although it is well established that plasma B-type natriuretic peptide (BNP) levels are higher in patients with acute coronary syndromes, the relationship between plasma BNP level and stable coronary artery disease is not clear. The aim of this study was to examine the relationship between plasma BNP levels and the extent of obstructive lesions on coronary angiography in stable coronary artery patients. Methods Plasma BNP concentrations were measured in 62 patients with a diagnosis of stable angina pectoris who had a left ventricular ejection fraction (LVEF) ≥ 45% on echocardlographic evaluation. Coronary angiography was performed for all patients, who were than divided into two groups according to the results of the angiography. Group I consisted of the patients who had a lesion leading to an obstruction of the lumen in any coronary artery by less than 50% or those who had normal coronary arteries. All other patients constituted group II. Results In group I (n = 26), the mean plasma BNP level was 64.8 ′ 29.5 pg/mL In group II (n = 36), it was 99.7 ′ 55.4 pg/ml. BNP was significantly higher in group II (P=0.007) than group I. The BNP concentration of the patients with one-vessel disease (n = 12), two-vessel disease (n = 16), and three-vessel disease (n=8) were 77.9 ′ 34.9 pg/ml, 109.3 ′ 67.9 pg/ml, 113.3 ′ 48.1 pg/ml consecutively. In this respect, the plasma BNP was significantly higher in the groups with more extended vessel disease (P=0.02). When we compared the patients according to involvement of left anterior descending artery (LAD), BNP levels were significantly higher in this group, (116.1 ′ 55.8pg/ml versus 64.1 ′ 30.2 pg/ml; P = 0.001). Conclusion Plasma levels of BNP were higher in patients who have stable coronary artery disease with preserved left ventricular systolic function. The level of increase in plasma BNP concentration was positively correlated with the extent of lesion and LAD involvement on coronary angiography.

OBJECTIVE Coronary stenoses of intermediate severity create difficulties in decision making when revascularization is concerned. Myocardial fractional flow reserve (mFFR), an accurate tool to identify physiological significance of individual coronary stenoses, may help solve this problem. METHODS AND RESULTS Fifty-eight intermediate (30-70%) coronary stenoses in 51 patients (mean age 54.4 +/- 8.9 years, 9 women) were left unrevascularized because of normal (> or = 0.75) mFFR findings and the patients were prospectively followed with regard to the occurrence of death, myocardial infarction and target vessel revascularization. The mean reference vessel diameter, percent stenosis and mFFR of the intermediate lesions were 3.3 +/- 0.3 mm, 46.8 +/- 9.2% and 0.86 +/- 0.05, respectively. Of the 58 intermediate lesions, 20 (34%) were associated with perfusion defects on thallium scan. Significant (> 70%) disease in addition to the one with the intermediate stenosis was present in I coronary artery in 24 (47%), and 2 coronary arteries in 6 (12%) patients and angioplasty of at least one significant stenosis was performed at the initial evaluation in 18 (35%) patients. Follow-up for a mean of 16.6 +/- 6.6 months disclosed no death or myocardial infarction. Target vessel revascularization was performed in 3 (6%) patients at a mean of 4 +/- 2.6 months. A control angiogram, which was performed in 12 of 18 patients who had undergone angioplasty at the initial evaluation revealed restenosis in 3 (25%) patients with no significant angiographic changes in the target intermediate stenoses. Anginal status was found to be significantly improved at follow-up. CONCLUSIONS In this study, we found that intermediate coronary stenoses with an mFFR > or = 0.75 have a favourable medium-term clinical outcome with respect to major cardiac adverse events when left unrevascularized based on mFFR findings.

Adenosine is a powerful direct coronary vasodilator with a very short half-life that has been shown to be effective in avoiding and reversing no reflow. We report an immediate successful recanalization of an occluded major side branch after stenting with acute intracoronary adenosine administration. The beneficial effect of adenosine may imply that the side branch occlusion (SBO) in this case could be due to spasm or distal embolization of the atherosclerotic debris ending up with no flow. We believe that adenosine could be helpful in at least some cases of SBO and therefore may be worth attempting.