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Aim:Transradial access (TRA) for coronary intervention is increasingly used in current clinical practice. The aim of the present study was to evaluate the hypothesis that cutaneous analgesia before TRA for coronary intervention at a puncture site 30 minutes before puncture can reduce patient discomfort and the incidence of radial artery spasm (RAS).Methods:Patients (n=104) undergoing planned coronary interventions using TRA were prospectively randomized to receive either 1 mL of 1% lidocaine subcutaneously (n=52) (control group) or subcutaneous lidocaine plus 5% lidocaine cream (n=52) cutaneously 30 minutes before puncture (treatment group). The primary endpoint was angiographically or clinically confirmed RAS. Secondary endpoints were the occurrence of patient discomfort in the forearm during the procedure and access-site crossover to the femoral artery. Patient discomfort was quantified with a visual analogue scale (VAS) score.Results:Fifty-two patients in the treatment group (60.5±9.4 years of age and 16 female) and 52 patients in the control group (60.4±9.7 years of age and 16 female) were included in the final analysis. Radial artery spasm occurrence decreased in the treatment group compared to the control group (26.9% vs 9.6%; p=0.04) accompanied by a VAS score of 3.7±1.8 in the treatment group and 4.9±2.0 in the control group; p=0.02. The access site crossover rate did not differ between the groups (7.6% vs 21.1%; p=0.09).Conclusion:Cutaneous analgesia before TRA for coronary interventions is associated with a substantial reduction in the RAS and the procedure-related level of patient discomfort.

Introduction:Leftventricular (LV) rotation and twist play important roles in LV contraction andrelaxation. Systolic function is usually preserved with aging, but diastolicfunction deteriorates. The aim of this study was to establish a reference valuefor LV twist and examine the effect of aging on it.Patientsand Methods: We enrolled 75 healthy subjects who were divided intotwo groups according to age: < 40 and > 40 years. LV rotation and twistwere assessed with two-dimensional speckle tracking imaging at the basal andapical levels of the parasternal short axis. LV twist was defined as an apicalrotation relative to the baseline. Exclusion criteria included a history ofischemic and valvular disease, arrhythmia, use of a pacemaker, and systolicdysfunction.Results: Peak Awave velocity (70.6 ± 13.7 vs. 57.7 ± 10.6, p< 0.001) and E/E’ratio (7.7 ±2.2 vs. 6.1 ± 1.3, p< 0.001) were higher and peak E wave velocity (52.4 ± 16vs. 76.8 ± 11, p< 0.001) and E/A ratio (0.75 vs. 1.34, p< 0.001) werelower in old patients than in young patients. There was an increase in apicalrotation (4.4 ± 2.9° vs. 3.3 ± 2.4°, p= 0.075) and a decrease in basal rotation(−4.1 ± 2.7° vs. −5.2 ± 3.7°, p= 0.185) in old patients, but these changesindicated no significant difference. With aging, the twist increased (8.6 ±3.3° vs. 8.5 ± 4.1°, p= 0.890), but not significantly. LV apical rotation (5 ±3.2 vs. 2.4 ± 1.1, p= 0.004) and twist (9.4 ± 3.4 vs. 6.9 ± 2.4, p= 0.64)decreased in the old group with an increasing degree of LV diastolicdysfunction.Conclusion: LV twist slightly increasedwith age, but this effect was reversed with increased diastolic dysfunctioneven in the presence of normal systolic function., Giriş: Sol ventrikül (LV) rotasyon ve büküm hareketi kasılma vegevşemede önemli rol oynamaktadır. Yaşlanma ile LV sistolik fonksiyonlarıkorunsada diyastolik fonksiyonlar genellikle bozulur. Bu çalışmanın amacı, LVbüküm için bir referans değeri saptamak ve yaşlanmanın büküm üzerindeetkilerini incelemekti.Hastalar ve Yöntem: Çalışmaya 75 sağlıklı kişidahil edildi; katılımcılar 40 yaş üstü ve 40 yaş altı olarak iki gruba ayrıldı.LV rotasyon ve büküm parasternal kısa eksen bazal ve apikal seviyelerinde 2D-STIile değerlendirildi. LV büküm hareketi apikal ve bazal rotasyonun görecelitoplamı olarak tanımlandı. İskemik ve kapak hastalığı, aritmi, kalp pili vesistolik disfonksiyon öyküsü dışlama kriterleri olarak tanımlandı.Bulgular: Yaşlılarda gençlere kıyasla pik A dalga hızı (70.6 ±13.7 vs. 57.7 ± 10.6, p< 0.001), E/E’ oranı (7.7 ± 2.23 vs. 6.09 ± 1.3,p< 0.001) daha yüksek, pik E dalga hızı (52.4 ± 16 vs. 76.75 ± 11, p

Introduction Percutaneous endovascular therapy is an accepted and preferred procedure for symptomatic subclavian artery disease. However, the technical feasibility and effectiveness of treating chronic total occlusion of the subclavian artery with this approach is uncertain. We aimed to evaluate the initial and mid-term results of endovascular therapy for patients with symptomatic chronic total occlusion of the left subclavian artery. Methods Consecutive patients who underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery between January 2010 and February 2014 were included. Results Overall, 16 patients (10 male, 6 female; mean age 56 ± 13 years) underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery. 6 (37.5%) had arm claudication, 8 (50.0%) had vertebrobasilar insufficiency and 2 (12.5%) had coronary steal. 18 balloon-expandable stents were implanted in 15 patients. Central luminal passage was not achieved in one patient because of the subintimal position of the guidewire (procedural success rate 93.8%). There were no procedure-related complications. Mean preprocedural and postprocedural systolic blood pressure differences between the upper extremities were 37 ± 13 (range 25-60) mmHg and 11 ± 9 (range 5-38) mmHg, respectively; the improvement was statistically significant. Outpatient follow-up revealed one asymptomatic restenosis at two years. The patency rate at two years was 93.3%. Conclusion Balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery is safe and effective, with good acute success rate and mid-term patency. Prospective randomised studies on larger patient populations would provide more precise results.

Background: Patients with non-ST-elevation acute coronary syndrome are heterogeneous in terms of clinical presentation and immediate- and long-term risk of death or non-fatal ischemic events. The aim of the present study was to evaluate the relationship between the Global Registry of Acute Coronary Events (GRACE) score and severity of coronary artery disease angiographically evaluated by Gensini score in patients with non-ST-elevation acute coronary syndrome. Methods: A total of 245 patients with non-ST-elevation acute coronary syndrome were enrolled to the study. Based on the GRACE risk score classification system, the patients were divided into low- (n = 97, 39.6%), intermediate- (n = 84, 343%), and high- (n = 64, 26.1%) risk groups. All patients underwent coronary angiography within five days after admission. Results: The Gensini scores were 26 +/- 29 in the low-risk group, 29 +/- 19 in the intermediate-risk group, and 38 +/- 23 in the high-risk group (p = 0.016). The low-risk group was significantly different from the high-risk group (p = 0.013), and the difference from the intermediate-risk group almost reached significance. Normal, noncritical, one and two, or multivessel disease were identified in 15 (6.1%), 31 (12.7%), 75 (30.6%), and 124 (50.6%) patients, respectively. The prevalence of multivessel disease was 28% in the low-risk group, 30% in the intermediate-risk group, and 42% in the high-risk group. The high-risk group was significantly different from the low-risk group (p < 0.01). Conclusion: Our study demonstrates that the GRACE score has significant value for assessing the severity and extent of coronary artery stenosis in patients with non-ST-elevation acute coronary syndrome. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Objective: The aim of this study was to evaluate the left (LV) and right (RV) ventricular function in euthyroid Hashimoto's thyroiditis (eHT) patients. Subjects and Methods: Forty-five patients diagnosed with eHT and 45 age- and gender-matched control subjects were enrolled in this study. Echocardiographic parameters reflecting RV and LV functions such as chamber dimensions, ejection fraction, fractional shortening, conventional and tissue Doppler-derived early and late filling velocities (E, A, E', A'), isovolumic relaxation (IVRT) and contraction (IVCT) times, ejection time (ET), deceleration time (DT), Tei index, pulmonary acceleration time (PAcT) and tricuspid annular plane systolic excursion (TAPSE) of patients with eHT were compared to those of control subjects using the paired-samples t test or Wilcoxon signed-rank test. Results: Regarding the LV function, compared to the controls patients with eHT had a higher LV-Tei index (0.6 ± 0.2 vs. 0.4 ± 0.1, p < 0.001), higher DT (p < 0.001) and IVRT (p < 0.001) values, and higher E/E' ratios (p = 0.04). In contrast, the peak E wave velocity (p = 0.02), E/A ratio (p = 0.01) and ET (p = 0.02) were significantly lower in the eHT group than amongst the controls. The RV, Tei index (0.40 ± 0.11 vs. 0.28 ± 0.07, p < 0.001), TAPSE (2.0 ± 0.3 vs. 2.2 ± 0.2 mm, p < 0.001), PAcT (124.3 ± 22.6 vs. 149.4 ± 18.3 ms, p < 0.001), A' (p = 0.007) and IVCT (p = 0.001) were significantly higher in patients with eHT than the controls. However, the tricuspid E/A ratio (p = 0.01), E' (p = 0.03) and E'/A' ratio (p = 0.001) were significantly lower in the eHT patients than the control group. Conclusions: This study demonstrated that both RV and LV functions were impaired in patients with eHT.

Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels.Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were ) who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure.Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in patients group during followup. Decrease in brain natriuretic peptide levels after closure were statistically significant ( versus , ).Conclusion. Brain Natriuretic Peptide levels are elevated in patients with ventricular septal defects as compared to controls. Percutaneous closure of Ventricular Septal Defect with Amplatzer occluders decreases the BNP levels.

A B S T R A C T Background: CHA2DS2-VASc score is the most widely preferred method for prediction of stroke risk in patients with atrial fibrillation. We hypothesized that CHA2DS2-VASc score may represent atrial remodeling status, and therefore echocardiographic evaluation of left atrial electromechanical remodeling can be used to identify patients with high risk. Methods: A total of 65 patients who had documented diagnosis of paroxysmal atrial fibrillation (PAF) were divided into three risk groups according to the CHA2DS2-VASc score: patients with low risk (score = 0, group 1), with moderate risk (score = 1, group 2), and with high risk score (score 2, group 3). We compared groups according to atrial electromechanical intervals and left atrium mechanical functions. Results: Atrial electromechanical intervals including inter-atrial and intra-atrial electromechanical delay were not different between groups. However, parameters reflecting atrial mechanical functions including LA phasic volumes (Vmax, Vmin and Vp) were significantly higher in groups 2 and 3 compared with group 1. Likewise, LA passive emptying volume (LATEV) in the groups 2 and 3 was significantly higher than low-risk group (14.12 8.13 ml/m 2 , 22.36 8.78 ml/m 2 , 22.89 7.23 ml/m 2 , p: 0.031). Univariate analysis demonstrated that Vmax, Vmin and Vp were significantly correlated with CHA2DS2-VASc score (r = 0.428, r = 0.456, r = 0.451 and p < 0.001). Also, LATEV (r = 0.397, p = 0.016) and LA active emptying volume (LAAEV) (r = 0.281, p = 0.023) were positively correlated with CHA2DS2-VASc score. In the ROC analysis, Vmin 11 ml/m 2 has the highest predictive value for CHA2DS2-VASc score 2 (88% sensitivity and 89% specificity; ROC area 0.88, p < 0.001, CI [0.76–0.99]). Conclusion: Echocardiographic evaluation of left atrial electromechanical function might represent a useful method to identify patients with high risk.

Objective : This study is aimed at analyzing the demographic and clinical characteristics, as well as the hematological.biochemical parameters of patients who admitted to the hospital with the diagnosis of mad honey poisoning. Materials and Methods : A total of 16 patients who were admitted with mad honey intoxication symptoms and treated in Emergency Department of Sakarya Education and Research Hospital between January 2009 and December 2012 were included in the study. Demographic and clinical characteristics of the patients and hematological, biochemical parameters were obtained from hospital records. Heart rate, systolic and diastolic blood pressure on admission and at discharge were obtained retrospectively. Results : Sixteen patients (10 males and 6 females, mean age 58.5 ± 10 years, range between 41 and 79) were included in our study. Heart rate was 42± 6 beats/min, systolic blood pressure was 73 ± 19 mmHg, and diastolic blood pressure was 45 ± 17 mmHg on admission. In the evaluation of the patients' heart rhythms on admission to the emergency room, nine (56.3%) patients had sinus bradycardia, three (18.8%) patients had nodal rhythm, two (12.5%) patients had first degree atrioventricular block, and two (12.5%) patients had atrial fibrillation. Atropine 1.1 ± 0.4 mg and saline 1125 ± 465 ml were used to treat patients. Patients were discharged with a stable condition after an average 27.7 ±7.2 h of follow.up. Heart rate was 75 ± 8 beats/min, systolic blood pressure was 132 ± 7 mmHg, and diastolic blood pressure was 82 ± 6 mmHg at discharge. Mortality was not observed. Hematological and biochemical parameters measured at the time of admission were within normal ranges. Conclusion : Mad honey poisoning should be considered in previously healthy patients with unexplained symptoms of bradycardia, hypotension, and cardiac dysrhythmias. Therefore, diet history should carefully be obtained from the patients admitted with bradycardia and hypotension, and mad honey intoxication should also be considered in the differential diagnosis, as well as primary cardiac, neurologic, and metabolic disorders. Mad honey poisoning may be presented with life.threatening symptoms without any hematological and biochemical disorder. Key words : clinical and laboratory findings, mad honey, poisoning

The correlation between plasma D-dimer level and reperfusion has not been clarified yet in thrombolytic therapy applied for acute myocardial infarction patients. The aim of this study was to investigate whether there is a relationship between reperfusion and fibrinolytic activity in acute myocardial infarction patients treated with thrombolytic therapy. Fibrinolytic activity was reflected by plasma D-dimer levels. During the study period, 186 patients were initially analyzed. But 18 of these patients were excluded from the study because they were not suitable for study criteria. Blood was collected from 168 acute myocardial infarction patients within first 6 h. Intravenous tissue plasminogen activator (100 mg) or streptokinase (1,500,000 U) was applied to patients. Mean age of the patients was 58 (28-86) years and majority was men (86%). The number of anterior, inferior, and lateral myocardial infarction patients were 76 (45.2%), 85 (50.6%), and seven (4.2%), respectively. The mean time from symptom onset to thrombolytic application was 134 (95-212) min. Reperfusion occurred in 115 (68.5%) patients. D-dimer levels were markedly high after thrombolytic therapy versus before (155 mg/dl, 362 mg/dl, P

Background: Stent implantation has evolved as an important therapeutic strategy for aortic coarctation. Aim: This study aimed to present the experience of aortic coarctation stenting using the Cheatham-Platinum stent by an Adult Interventional Cardiology Team. Material and methods: The data of 11 patients (ages were between 15 to 58 years) who underwent aortic coarctation stent implantation between 2008 and 2011 for moderate to severe native aortic coarctation were retrospectively collected. Results: Average systolic blood pressure was 175 ±35 mm Hg, and mean diastolic blood pressure was 115 ±15 mm Hg. Pressure gradient proximal and distal to aortic coarctation was 55.5 ±17.7 before the stenting. The invasive gradient decreased below 10 mm Hg in all patients. There were no complications except in one patient whose subclavian artery was occluded without any clinical finding. One patient had a totally occluded lesion, needing perforation for acquired interruption using a 0.35 inch hydrophilic wire under the supporting balloon. There was no aneurysm or restenosis at follow-up. Left ventricular functions completely recovered within 1 month in all patients. Conclusions: Stenting using the Cheatham-Platinum stent, either covered or bare, is safe in moderate to severe native aortic coarctation and provides an excellent transcoarctation gradient and clinical hypertension and left ventricular functional relief in adult patients.

Background.We have known that patients with renal insufficiency (creatinine level) have increased mortality for coronary artery disease. In this study, the relationship between admission creatinine level and one year mortality are evaluated in patients with acute myocardial infarction (AMI).Method. 160 AMI patients (127 men and 33 women with a mean age of 59 ± 13) were enrolled in the study. Serum creatinine levels were measured within 12 hours of AMI. The patients were divided into two groups according to admission serum creatinine level. (1) elevated group (serum creatinine > 1.3 mg/dL) and (2) normal group (≤1.3 mg/dL). One year mortality rates were evaluated.Results. Elevated serum creatinine is observed in the 27 patients (16.9%). The mean creatinine level is 1.78 ± 7 mg/dL in the elevated group and 0.9 ± 0.18 mg/dL in the normal group (P<0.0001). The mortality rate of the elevated group (n=7, 25.9%) is higher than that of the normal group (n=9, 6.8%). A significant increase in one year mortality is also observed (P=002) 60.Conclusion. The mildly elevated admission serum creatinine levels are markedly increased to one year mortality in patients with AMI.