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Protein-C deficiency causes a thrombophilic environment in circulation. Although venous thromboembolism is the most common presentation, arterial events are rare. A 45 year-old woman with protein-C deficiency presented with multiple thromboembolic events including bilateral renal infarct and inferior ST-elevation myocardial infarction 3-days after coronary angiography via femoral approach which were normal coronary arteries. Computed tomographic angiography and transesophageal echocardioraphy displayed multiple thrombi sources including left atrium, left subclavian artery, sinus valsalva and descending aorta. Unfractionated-heparin and tissue plasminogen activator infusion were given. Although regression in ST-segment elevation and chest pain, no reduction in sizes of left atrial and aortic thrombus was observed by imaging modality. The patient refused surgical removal of thrombi, then warfarin therapy was planned. In patients with congenital thrombophilia and history of thromboembolism, anticoagulant treatment should be carefully managed during percutaneous diagnostic and interventional treatments and they should be performed by radial approach without interruption of anticoagulants.

Prosthetic valve thrombosis (PVT) is a life-threatening valve dysfunction. In asymptomatic cases, as well as certain symptomatic patients with PVT, the results of the first-line imaging tool, transthoracic echocardiography, may be inconclusive in terms of illustrating the thrombus, which is necessary in order to select the proper treatment option. Hence, a differential diagnosis based on clinical presentation may be challenging, and multimodality imaging, including echocardiography, cine fluoroscopy, and cardiac computed tomography, is usually required to distinguish between PVT and other prosthesis-related pathologies, such as pannus, vegetation, and prosthesis-patient mismatch.

Aim: We sought to determine the relationship between presence of atrial fibrillation (AF) and serum biomarkers, including native thiol (antioxidant), disulphide/native thiol ratio, Hs-CRP and high-sensitivity Troponin-I (Hs-TnI) in hypertrophic cardiomyopathy (HCM). Materials & methods: We enrolled consecutive 121 HCM outpatients without AF and 40 HCM outpatients with AF. A 12-lead electrocardiogram, transthoracic echocardiography and 24/48-h ambulatory rhythm monitoring were performed for all patients. Fasting venous blood samples were taken from all study patients to measure serum thiol-disulphide homeostasis, Hs-CRP and Hs-TnI. Results: Serum-native thiol was lower and disulphide/native thiol ratio was more oxidized in HCM patients with AF (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.

Three-dimensional transesophageal echocardiography (3D-TEE) provides detailed images of prosthetic valve thrombosis (PVT). However, data regarding PVT localization patterns based on 3D-TEE and their association with clinical findings among various bileaflet mitral prosthetic valve brands is lacking. The locations of thrombi were classified into 4 groups according to hinge and annulus involvement based on 3D-TEE: ring-like PVT involving entire mitral annulus (type-1), PVT involving peri-hinge(s) region and extends through some part of the annulus (type-2), PVT involving mitral annulus without involving hinge(s) region (type-3), and PVT involving only (peri)hinge(s) area (type-4). This study was conducted in 265 patients (male: 71, mean age: 46.3 +/- 12.7 years) with mitral PVT, including 150 St Jude Medical (SJM), 65 Carbomedics, 29 Medtronic ATS open-pivot, and 21 Sorin bileaflet mechanical valves. There was a significant difference in most common PVT localization patterns between different prosthetic valves (type-1 for Carbomedics and Sorin; type-2 for SJM and type-3 for ATS valves; p < 0.001). Additionally, PVT involving only (peri)hinge region(s) (type-4) was mostly observed in patients with SJM valves (18%). (Peri)hinge(s) area involvement was observed in the majority of study patients (78.1%). In patients who presented with thromboembolism, the most common PVT localization pattern was type-1 (53%). Increased age, low international normalized ratio on admission, PVT with a mobile part > 2 mm, type-1 and type-4 PVT were associated with thromboembolic events. In conclusion, thrombus can be displayed in distinct locations in several types of bileaflet mechanical valves due to different design, hinge and pivot mechanisms, which can be complicated with thromboembolic events. WOS:000638473800001 2-s2.0-85104240753 PubMed: 33835319

Ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction (AMI) with an associated mortality that ranges from 41% to 80%. The treatment consists of supplemental oxygenation, afterload reduction, intraaortic balloon pump, and surgical repair. In selected patients, extracorporeal membrane oxygenation (ECMO) and/or percutaneous closure of the defect can be considered if anatomically appropriate. Echocardiography evaluates the morphology and location of the defect, anatomical concerns for percutaneous closure, and accompanying pathologies. We present a 48-year-old man with inferior myocardial infarction and basal VSR who was not a candidate for percutaneous closure. Surgery was planned, but he died from extensive subarachnoid and intracranial hemorrhage.

The mitral-aortic intervalvular fibrosa (MAIVF) is a fibrous, avascular region between the anterior leaflet of the mitral valve and noncoronary cusp of the aortic valve. This makes MAIVF vulnerable to injury and infection; thus pseudoaneurysm may develop. The pseudoaneurysm can cause compression to coronary arteries which causes angina or pulmonary artery resulting in pulmonary hypertension. We presented the pseudoaneurysm of MAIVF causing compression of superior vena cava and right atrium which was visualized by two- and three-dimensional transesophageal echocardiography and cardiac computed tomography.

Subvalvular pannus formation is a rare but clinically important complication with prosthetic valves. Transthoracic echocardiography still plays a role in the initial assessment of mechanical aortic valve dysfunction. But evaluation with transesophageal echocardiography is more useful. Subvalvular area may be a blind spot of echocardiography due to acoustic shadowing. The case presented herein underlines the significant role of transgastric plane and three-dimensional TEE in the assessment of subvalvular pannus formation in mechanical aortic valves.

BACKGROUND The aim of this study was to explore the role of oxidative stress index (OSI), myeloperoxidase (MPO), and catalase (CAT) activity in cardiac allograft vasculopathy (CAV) in heart transplant recipients (HTRs). METHODS The study enrolled a median age of 41 ± 9 years 47 recipients. The HTx patients were divided into two groups based on the presence CAV as follows: CAV(+) and CAV(-) group. Also, CAV(+) group were divided into two groups as mild/moderate to severe CAV. The OSI, MPO, and CAT activity were analyzed in both groups. RESULTS The mean total antioxidant capacity (0.79 ± 0.46 vs 1.03 ± 0.33 μmol H2 O2 equiv/L) P = .043 was significantly lower and OSI, MPO, CAT activity were significantly higher in CAV(+) group (63 ± 38 vs 20 ± 16 arbitrary unit, P = .001; 398 ± 242 vs 139 ± 112 μg/L, P = .001; 51 ± 42 vs 26 ± 23 pmol/mg protein, P = .013, respectively). Also, mean OSI (38 ± 41 vs 93 ± 75, P = .05) were significantly higher in severe CAV(+) group. Recipient age, male gender, and low density lipoprotein-cholesterol were significantly higher in CAV(+) group. There was a moderate correlation between the CAV grade and OSI, MPO, and CAT levels in univariate analysis (r = .560, P = .002; r = .643, P = .007; r = .681, P = .001, respectively). CONCLUSION An increase in the serum level of OSI, MPO, and CAT was associated with CAV in HTRs.

Arterial hypertension is one of the physical complications of chronic lead exposure. Hypertension has effects on aortic elastic properties. The aim of this study was to evaluate the aortic elastic properties in workers occupationally exposed to lead. Forty-one workers who were exposed to lead and 39 healthy controls were included in the study. All patients underwent transthoracic echocardiography for detecting aortic elastic parameters. There were no differences in baseline characteristics between the lead-exposure group and controls. Aortic strain (9.4% ± 4.5% vs 12.4% ± 4.2%, P = .004) and aortic distensibility (0.45 ± 0.21 cm(2) /dyn vs 0.55 ± 0.20 cm(2) /dyn, P = .046) were decreased in patients with lead exposure compared with controls. There was a negative significant weak correlation between aortic strain and (r = -0.294, P = .008) lead levels. There was no significant correlation between aortic distensibility and any other echocardiographic parameters. This study suggests that chronic exposure to lead is related to impairment of aortic elasticity parameters.

Objective: Effects of various conditions on coronary artery dimensions is an important research topic, and data regarding effect of aortic valvular diseases are limited. Aim of the present study was to investigate effects of aortic regurgitation (AR) and aortic stenosis (AS) on coronary artery dimensions. Methods: Coronary dimensions of 95 patients (35 with isolated AR, 30 with isolated AS, and 30 without any valvular disease) were calculated. Patients with severe coronary artery disease and concurrent moderate to severe additional valvular disease were excluded. Mean diameter of major coronary arteries was determined using quantitative coronary angiography. Results: The 3 study groups were similar in terms of baseline characteristics. Diameter of left main coronary artery was found to be greater in AR group than AS group (2.66+-0.57 mm/m2 vs 2.36+-0.49 mm/m2; p=0.015). Mean diameter of left anterior descending and left circumflex arteries were found to be similar in AR and AS groups, and greater than control group. Mean diameter of right coronary artery was found to be greater in AR group compared with controls; however, no significant difference was found in same measurement between AS group and controls. Conclusion: Present study findings indicate that coronary dimensions in AR group tend to be greater than AS group. Further studies investigating factors that affect coronary dimensions would be beneficial in order to demonstrate mechanisms and differences in AR and AS groups.

PubMed ID: 28238569, Objective No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies. Methods Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared. Results Of the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8 ± 9.8 vs. 68.7 ± 11.4 years, p

Atrial fibrillation (AF) is a common cardiac arrhythmia. Dabigatran etixalate (DE) is one of the new oral anticoagulant drugs being used in nonvalvular AF (NVAF). There is no adequate real world data in different populations about DE. The aim of this registry was to evaluate the efficacy and safety of DE Consecutive NVAF patients treated with warfarin or both DE doses were enrolled during 18 months study period. The patients were re-evaluated at regular 6-month intervals during the follow-up period. During the follow-up period outcomes were documented according to RELY methodology A total of 555 patients were analyzed. There was no significant difference in ischemic stroke rates (p = 0.73), death rates (p = 0.15) and MI rates (p = 0.56) between groups. The rate of major bleeding was significantly higher in warfarin and dabigatran 150 mg group than dabigatran 110 mg (p

Introduction Epistaxis and hypertension are frequent conditions in the adult population. Masked hypertension is defined as a clinical condition in which a patient's office blood pressure level is

WOS: 000365693900004 PubMed: 26507385 Objectives: The crucial role of twisting motion on both left ventricular (LV) contraction and relaxation has been clearly identified. However, the reports studying the association between LV torsion and loading conditions have revealed conflicting outcomes. Previously normal saline infusion was shown to increase LV rotation. Our aim was to test this phenomenon after volume depletion in healthy volunteer blood donors. Design: A total of 26 healthy male volunteers were included in the study. LV end-diastolic and end-systolic diameter, LV ejection fraction, LV diastolic parameters, LV apical and basal rotation and peak systolic LV torsion were measured by speckle-tracking echocardiography before and after 450 mL blood donation. Results: Blood donation led to a significant decrease in end-diastolic LV internal diameter (48.7 +/- 0.4 versus 46.4 +/- 0.4mm; p

One of the major complications of arsenic on human health is hypertension. Arsenic-related hypertension and negative effects of arsenic on arterial system such as oxidative stress and vasoconstriction/vasorelaxation imbalance may lead to impair aortic elasticity. The aim of this study was to evaluate the effects of arsenic on aortic elasticity parameters including aortic strain and distensibility. One hundred twelve (112) workers were occupationally exposed to arsenic and 60 healthy control subjects were enroled. All patients underwent transthoracic echocardiography for detecting aortic strain and aortic distensibility. There were no differences in baseline demographic and echocardiographic characteristics between the groups. Aortic strain (10.3±3.9 vs 12.1±2.7%, P=0.001) and aortic distensibility (0.45±0.17 vs 0.54±0.15 cm2 per dyn, P=0.001) were decreased in arsenic-exposure group compared with controls. Urinary arsenic level was found to be negatively and significantly correlated with aortic strain (r=-0.306, P=0.001) and aortic distensibility (r=-0.259, P=0.006). Duration of arsenic exposure was also found to be negatively and significantly correlated with aortic strain (r=-0.386, P

Objective: The aim of this study was to assess exercise heart rate recovery (HRR) indices in mercury-exposed individuals when evaluating their cardiac autonomic function. Subjects and Methods: Twenty-eight mercury-exposed individuals and 28 healthy controls were enrolled. All the subjects underwent exercise testing and transthoracic echocardiography. The HRR indices were calculated by subtracting the first- (HRR1), second- (HRR2) and third-minute (HRR3) heart rates from the maximal heart rate. The two groups were evaluated in terms of exercise test parameters, especially HRR, and a correlation analysis was performed between blood, 24-hour urine and hair mercury levels and the test parameters. Results: The mercury-exposed and control groups were similar in age (37.2 ± 6.6 vs. 36.9 ± 9.0 years), had an identical gender distribution (16 females and 12 males) and similar left ventricular ejection fractions (65.5 ± 3.1 vs. 65.4 ± 3.1%). The mean HRR1 [25.6 ± 6.5 vs. 30.3 ± 8.2 beats per min (bpm); p = 0.009], HRR2 (43.5 ± 5.3 vs. 47.8 ± 5.5 bpm; p = 0.010) and HRR3 (56.8 ± 5.1 vs. 59.4 ± 6.3 bpm; p = 0.016) values were significantly lower in the mercury-exposed group than in the healthy controls. However, there were no significant correlations between blood, urine and hair mercury levels and exercise test parameters. Conclusions: Mercury-exposed individuals had lower HRR indices than normal subjects. In these individuals, mercury exposure measurements did not show correlations with the exercise test parameters, but age did show a negative correlation with these parameters. Therefore, cardiac autonomic functions might be involved in cases of mercury exposure.

Objectives Epicardial adipose tissue (EAT) and atrial electromechanical delay (AEMD) have been shown to be closely linked with atrial fibrillation. In this study, we aimed to investigate the relationship between EAT and AEMD. Methods Ninety-six patients were included in this study. Echocardiographic measurements were performed, and laboratory parameters were recorded. Patients were divided into two groups according to their inter-AEMD values. Patients with an inter-AEMD value of

BACKGROUND: Arsenic exposure is associated with various cardiovascular diseases. The aim of the present study was to assess cardiac autonomic function via heart rate response to exercise and recovery period of treadmill testing in arsenic‐exposed workers. METHODS: Sixty‐five (65) occupationally arsenic‐exposed workers and 35 healthy controls were enrolled. Blood and urinary arsenic levels were analyzed and symptom limited maximal treadmill exercise test were performed. Chronotropic response to exercise including age‐predicted maximal heart rate (APMHR), heart rate reserve (HR (reserve)), age‐predicted HR (reserve) (APHR (reserve)) and adjusted HR (reserve) and 1st‐, 2nd‐and 3rd‐min heart rate recovery (HRR) indices were calculated. RESULTS: Baseline clinical and echocardiographic parameters, exercise test duration, resting and maximal heart rate, peak exercise capacity, HR (reserve), APMHR, APHR (reserve), and adjusted HR (reserve) were found to be similar between groups. HRR (1) (22.0 ± 4.3 vs. 24.3 ± 3.1 bpm, p = .003) and HRR (2) (43.2 ± 6.2 vs. 46.7 ± 6.4 bpm, p = .012) were significantly lower in arsenic‐exposed workers compared to controls. Blood and urinary arsenic levels negatively correlated with HRR (1) (r = −.477, p

Purpose: In this study, we aimed to investigate the relationship between saphenous vein graft disease (SVGD) and neutrophil-to-lympocyte ratio (NLR) with other possible confounding factors. Methods: A total of 120 patients were enrolled into the present study. Of all participants, 40 patients were with SVGD and 80 of them were with patent SVG. Results: The NLR, white blood cell (WBC) count, age of SVG, red cell distribution width (RDW), and mean platelet volume were significantly higher in the SVGD group. In regression analysis, NLR, WBC, RDW, and age of SVG remained as independent predictors of SVGD. Conclusion: To our knowledge, we showed for the first time that NLR is independently associated with SVGD. It can be easily used in this era, because it is easily available, widely used, and relatively cheap. Besides NLR, WBC count, SVG age, and RDW can also be used to predict SVGD.

Colorectal neoplasm (CRN) and coronary heart disease (CHD) share common risk factors. We aimed to assess the risk for CRN in patients who are at high risk for developing CHD determined by measurements, which are independent from the risk factors for CRN. This study was conducted on individuals who underwent total colonoscopic examination and were without history of CHD. Two-hundred thirty-five subjects (82 with CRN and 153 with normal colonoscopic findings) participated in the study. Colorectal carcinoma (CRC) was defined as the presence of adenocarcinoma. We measured carotid intima media thickness (CIMT), flow-mediated dilation (FMD), and calculated Framingham risk score (FRS) for all participants. An increased CIMT (≥1.0 mm), a decreased FMD ( 20%) were defined as high risks for developing CHD. The risk and the prevalence of CRN were analyzed in relation to the risk for developing CHD. The ratio of the patients with overall-CRN and CRC was significantly higher in individuals who are at high risk for developing CHD compared with individuals who are at low risk for developing CHD by each 3 risk estimation method (P

Colorectal neoplasm (CRN) and coronary heart disease (CHD) share commonrisk factors. High prevalence of CRN have been shown in patients with overt CHD. But itis not obvious whether patients at high risk for CHD have increased risk for CRN. Weaimed to assess the risk for CRN in patients at high risk for CHD defined by independentmethods from risk factors of CRN.

We have read with much interest the article by Lamberts et al. [(1)][1], who reported on oral anticoagulation (OAC) and antiplatelets in atrial fibrillation (AF) patients after myocardial infarction (MI) and coronary intervention, and who concluded that OAC and clopidogrel were equal or better on