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Objective: The aim of this study was to assess the clinical characteristics of patients with heart failure and preserved ejection fraction (HFpEF) and atrial fibrillation (AF) and compare them with those of HFpEF patients without AF. Methods: This study was a sub-group analysis of a multicenter, observational, and cross-sectional registry conducted in Turkey (ClinicalTrials.gov identifier: NCT03026114). Patients with HFpEF were divided into 2 groups: HFpEF with AF and HFpEF with sinus rhythm (SR), and the clinical characteristics of the groups were compared. Results: In a total of 819 HFpEF patients (median age: 67 years; 58% women), 313 (38.2%) had AF. Compared to the patients with SR, those with AF were older (70 years vs 66 years; p

WOS: 000392195800004, PubMed ID: 27723665, Objective: Data regarding stroke prevention strategies in non-valvular atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs). This study aimed to evaluate real-life stroke prevention strategies for NVAF patients in the era of non-VKA oral anticoagulants (NOACs). Methods: We established a cross-sectional, multicenter, nationwide registry of NVAF patients. All consecutive atrial fibrillation (AF) patients and without mechanical heart valves or rheumatic mitral stenosis (but including those with any degree of mitral regurgitation) were enrolled in the ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study; ClinicalTrials. gov identifier NCT02344901) in Turkey. Base-line demographic data, medical history, and medications prescribed for NVAF treatment were collected. Univariate analyses were performed for continuous variables, and the chi-square test was used for categorical variables. Results: In total, 6273 patients from 29 provinces of Turkey were enrolled in the study between February and May 2015, with the contribution of 83 investigators. The mean age was 69.6 +/- 10.7 years; 56% of the patients were females, and one-fifth of the patients had at least one comorbid disease, the most common being hypertension (69%). The mean CHA(2)DS(2)-VASc and HAS-BLED scores were 3.3 +/- 1.6 and 1.6 +/- 1.1, respectively. The rate of oral anticoagulant (OAC) therapy use was 72% (37% NOAC and 35% VKA). Conclusion: The RAMSES study showed a higher prevalence of OAC use among NVAF patients than that reported in previous studies. Although NOACs were preferred over VKAs in daily cardiology practice, there is a need for improved OAC therapies for NVAF patients.

Background: To determine and compare the demographic characteristics, clinical profile and management of patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) in a Turkish cohort. Methods: The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is an observational and multicenter study conducted in Turkey. Consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had HFmrEF or HFpEF were included (NCT03026114). Results: The study population included 1065 (mean age of 67.1 ± 10.6 years, 54% women) patients from 12 sites in Turkey. Among participants, 246 (23.1%) had HFmrEF and 819 (76.9%) had HFpEF. Compared to patients with HFpEF, those with HFmrEF were more likely to be male (57.7 vs 42.2%; p < 0.001), had higher N-terminal pro-B-type natriuretic peptide levels (853 vs 528 pg/ml, p < 0.001), were more likely to have ECG abnormalities (72.4 vs 53.5%, p < 0.001) and hospitalization history for heart failure (28 vs 18.6%; p = 0.002). HFmrEF patients were more likely to use ?-blockers (69.9 vs 55.2%, p < 0.001), aldosterone receptor antagonists (24 vs 14.7%, p = 0.001), statins (37 vs 23%, p < .001), and loop diuretics (39.8 vs 30.5%, p = 0.006) compared to patients with HFpEF. Conclusions: The results of APOLLON study support that the basic characteristics and etiology of HFmrEF are significantly different from HFpEF. This registry also showed that the patients with HFmrEF and HFpEF were younger but undertreated in Turkey compared to patients in western countries. © 2018 European Federation of Internal Medicine 2-s2.0-85056506589 PubMed: 30446354

Mert, Kadir Ugur/0000-0002-1331-5365; Agus, Hicaz Zencirkiran/0000-0002-5882-0525; WOS: 000468584800003 PubMed ID: 31062760 Objective: This study aimed to examine gender-based differences in epidemiology, clinical characteristics, and management of consecutive patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Methods: The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is a multicenter, cross-sectional, and observational study. Consecutive patients with HFmrEF or HFpEF who were admitted to the cardiology clinics were included (NCT03026114). Herein, we performed a post-hoc analysis of data from the APOLLON trial. Results: The study population included 1065 (mean age of 67.1 +/- 10.6 years, 54% women) patients from 11 sites in Turkey. Compared with men, women were older (68 years vs. 67 years, p

Mert, Kadir Ugur/0000-0002-1331-5365; OZLEK, BULENT/0000-0001-5429-1323 WOS: 000472227200010 PubMed: 30865367 Objectives: To compare real-world characteristics and management of individuals aged 80 and older with heart failure (HF) and mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) derived from a large cohort of survey and to compare them with those younger than 80 from the same survey. Methods: This is an observational, multicentre and cross-sectional study conducted in Turkey (NCT03026114). Consecutive 1065 (mean age of 67.1 +/- 10.6 years) patients admitted to the cardiology outpatient units with HFmrEF and HFpEF were included. Results: Participants aged 80 and older (n = 123, 11.5%) were more likely to be female (66.7% vs 52.5%, P = 0.003), had a higher prevalence of atrial fibrillation (49.6% vs 34%, P = 0.001), and anaemia (46.3% vs 33.4%, P = 0.005) than those who were younger than 80. N-terminal pro B-type natriuretic peptide levels were higher in those aged 80 and older than in those younger than 80 (1037 vs 550 pg/ml, P < 0.001). The prescription rates of HF medications (including in ACE-Is/ARBs, beta-blockers, MRAs, digoxin, ivabradine and diuretics) were similar (P > 0.05) in both groups. Octogenarians did not significantly differ from younger patients in the prevalence of HFmrEF (24.4% vs 22.9%) and HFpEF (75.6% vs 77.1%). Coronary artery disease was associated with HFmrEF (P < 0.05), whereas atrial fibrillation was associated with HFpEF (P < 0.05) in octogenarians. Conclusions: This study revealed that nearly 12% of the individuals with HFmrEF and HFpEF in this real-world sample were aged 80 and older. Participants aged 80 and older are more likely to be female and have more comorbidities than those who were younger than 80. However, HF medication profiles were similar in both groups. This study also showed that associated factors with HFmrEF and HFpEF were differ in octogenarians.

WOS: 000353933700006, PubMed: 25995662, Background/Aims: Poor sleep quality (SQ) is associated with increased cardiovascular mortality and morbidity. Additionally, asymmetric dimethylarginine (ADMA) is an independent predictor of cardiovascular mortality and morbidity. However, no sufficient data regarding the relationship between ADMA levels and SQ have been reported. The goal of the current study was to evaluate the association between SQ and ADMA levels in normotensive patients with type 2 diabetes mellitus. Methods: The study participants consisted of 78 normotensive type 2 diabetics. The SQ of all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients with a global PSQI score > 5 were defined as "poor sleepers." Factors associated with poor SQ were analyzed using a multiple regression model. Serum ADMA levels were measured using high performance liquid chromatography. Results: The median ADMA levels of the poor sleepers were increased compared with patients defined as good sleepers (5.5 [4.2 to 6.6] vs. 4.4 [2.9 to 5.4], p < 0.01, respectively). However, the L-arginine/ADMA ratio was decreased in poor sleepers (p < 0.01). Global PSQI scores were positively correlated with ADMA levels (p < 0.01) and negatively correlated with the L-arginine/ADMA ratio (p = 0.02). ADMA levels were correlated with sleep latency (p < 0.01) and sleep efficiency (p = 0.01). Logistic regression analysis showed that ADMA levels (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16 to 2.44; p = 0.01) and body mass index (OR, 1.15; 95% CI, 1.01 to 1.31; p = 0.04) were associated with poor SQ independently of glomerular filtration rate, sex, age, duration of diabetes, hemoglobin A1c, total cholesterol, and systolic blood pressure. Conclusions: Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus., Selcuk University Scientific Research Projects FundSelcuk University, This project was supported by Selcuk University Scientific Research Projects Fund.

Mert, Kadir Ugur/0000-0002-1331-5365; BASARAN, OZCAN/0000-0002-6384-6455 WOS: 000435197000006 PubMed: 29724973 Objective: Although almost half of chronic heart failure (HF) patients have mid-range (HFmrEF) and preserved left-ventricular ejection fraction (HFpEF), no studies have been carried out with these patients in our country. This study aims to determine the demographic characteristics and current status of the clinical background of HFmrEF and HFpEF patients in a multicenter trial. Methods: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejectiON fraction (APOLLON) trial will be an observational, multicenter, and noninterventional study conducted in Turkey. The study population will include 1065 patients from 12 sites in Turkey. All data will be collected at one point in time and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT03026114). Results: We will enroll all consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had New York Heart Association class II, III, or IV HF, elevated brain natriuretic peptide levels within the last 30 days, and an left ventricular ejection fraction (LVEF) of at least 40%. Patients fulfilling the exclusion criteria will not be included in the study. Patients will be stratified into two categories according to LVEF: mid-range EF (HFmrEF, LVEF 40%-49%) and preserved EF (HFpEF, LVEF >= 50%). Regional quota sampling will be performed to ensure that the sample was representative of the Turkish population. Demographic, lifestyle, medical, and therapeutic data will be collected by this specific survey. Conclusion: The APOLLON trial will be the largest and most comprehensive study in Turkey evaluating HF patients with a LVEF >= 40% and will also be the first study to specifically analyze the recently designated HFmrEF category.

Developing technological infrastructure has enabled the development of computer based biomedical systems as in many areas in the field of medicine. One of these systems are biomedical imaging systems. Many studies are being conducted for a new image processing techniques to improve the performance of this systems. Noise reduction is one of the important steps in biomedical image processing. In this study, noise reduction was performed to emphasize coronary arteries on x-ray heart angiography images. For this purpose, the original angiography images were smoothed using non-local averages. Thus, insignificant groups of pixels in the image described as noise has been removed. Then, the boundaries of coronary arteries are sharpened with first and second derivatives of image based combined enhancement method. It is seen that the mean square error values obtained by the proposed method are more successful when compared with the noise reduction results obtained using the Wiener filter. These results show that the non-local means method can be used as a successful pre-processing method for noise reduction in angiography images.

In this study, we sought to assess the incidence and predictors of radial artery occlusion (RAO), which is a significant complication of transradial cardiac catheterization. We prospectively evaluated the results of 106 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) via the transradial approach (TRA). At the 3(rd) h of intervention, the radial artery was checked by palpation; color doppler ultrasonography was performed at the 24(th) h. Fluoroscopy duration, procedure success, and complications of the radial artery were recorded. The procedure was successfully completed in all patients. RAO was detected in eight female and two male patients. In terms of RAO, there was a statistically significant difference between males and females (p=0.019). Other parameters did not show a significant correlation with RAO. Altough did not have any effect on procedural success, eight patients developed transient radial artery spasm. Gender was not associated with radial arterial spasms (p=0.19). TRA in the diagnosis and treatment of coronary artery disease has shown high procedural success and low complication rates; it addition, it presents a low economic burden. It should be used widely and be involved in the routine cardiology residency program.

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

WOS: 000396440200005, PubMed ID: 28106016, Objective: Gender is an important feature in the management of atrial fibrillation (AF). This study investigated gender-related differences in patients with AF in Turkey. Methods: As a part of RAMSES (ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey, NCT02344901) study, information of the patients with AF who successively applied to the hospital was analyzed. This cross-sectional, multi-center, nationwide observational study enrolled 6264 non-valvular AF (NVAF) outpatients (55.9% women) from Turkey. Results: Compared with men, women with NVAF were older (71 years [range: 65-78 years] vs. 70 years [range: 62-77 years]; p= 1 [male], >= 2 [female]) had not received any anticogulant therapy. Conclusion: Although women with NVAF receive better treatment than men, anticoagulation therapy is suboptimal in large proportion of men and women, with underuse in high-risk patients and overuse in low-risk patients. There is an urgent need to improve optimization of anticoagulation in patients with NVAF.

WOS: 000380806300010, PubMed ID: 27182772, Background Nonvalvular atrial fibrillation (NVAF) frequently coexists with coronary artery disease (CAD). However, the optimal antithrombotic strategy for patients with concomitant CAD and NVAF is controversial. The aim of this study is to assess the prevalence of CAD with NVAF and to determine antithrombotic treatment options in patients with or without a history of CAD. Methods ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey (RAMSES study) was a cross-sectional, multicenter, nationwide observational study carried out in NVAF patients. We studied the clinical data of 6264 Turkish patients participating in the RAMSES study. Demographic properties and antithrombotic therapies were recorded and compared between patients with and without CAD. Results CAD was present in 1828 (29.2%) of patients with NVAF. Most of the NVAF patients with CAD were men (58%) and comorbid diseases were significantly more common in patients with CAD. Although patients with CAD had higher CHA(2)DS(2)VASc scores than those without disease (4.1 +/- 1.5 vs. 2.9 +/- 1.5; P=0.001), they had lower use of oral anticoagulant (OAC) therapy (66.1 vs. 74.4%, P=0.01). Among OAC drugs, warfarin was the preferred medication in patients with CAD (35.4 vs. 30.6%, P=0.01), whereas nonvitamin K antagonist oral anticoagulants were preferred in patients without CAD (40 vs. 34.3%, P=0.01). Patients with CAD required nearly three-fold higher antiplatelet treatment compared with patients without CAD (57.8 vs. 21.4%, P

WOS: 000301065000003, PubMed: 22211098, Background: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (P-d) might be a useful marker in predicting PAF in patients with acute ischemic stroke. Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared. Results: Maximum P-wave duration (p=0.002), P-d (p

WOS: 000386930500018, PubMed ID: 27671101, What is known and objectiveAlthough inappropriate use of digoxin has been described in various populations, a real-world evaluation of patterns of digoxin prescription has not been well studied in patients with atrial fibrillation (AF). The aim of this study was to identify prevalence, indications and appropriateness of digoxin use in the general population of patients with non-valvular AF (NVAF) in Turkey. MethodsWe included and classified patients from the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke prevention strategies in Turkey) study, a prospective registry including 6273 patients with NVAF, on the basis of digoxin use. After excluding the data of 73 patients whose medical history about digoxin use or left ventricle function was absent, 6200 patients were included for the final analysis. Digoxin use was considered inappropriate if patients did not have left ventricular systolic dysfunction or symptomatic heart failure (HF). Results and discussionDigoxin was used in 1274 (20.5%) patients. Patients treated with digoxin were older (71.4 9.8 years vs. 69.2 +/- 10.9 years, P < 0.001), more likely to be female (58.8% vs. 55.9%, P = 0.019) and had more common comorbidities such as HF (40.2% vs. 17.4%), diabetes (26.4% vs. 21.1%), coronary artery disease (35.3 vs. 27.6%) and persistent/permanent AF (93.4% vs. 78.4%; P < 0.001 for each comparison). Of the 1274 patients, the indication of digoxin use was considered inappropriate in 762 (59.8%). What is new and conclusionOur findings show that nearly one-fifth of the patients with NVAF were on digoxin therapy and nearly 60% of these patients were receiving digoxin with inappropriate indications in a real-world setting.

Extraintestinal manifestations are well described in inflammatory bowel disease. A 63 year-old male was admitted to our clinic with the complaint of dyspnea and dry cough. Echocardiography revealed minimal pericardial effusion. He was prescribed ibuprofen 600 mg twice on a daily basis. Four days later, he was admitted to the hospital due to palpitations, chest pain and increased dyspnea. From the medical history results, it was clear that the patient had ulcerative colitis and did not have medical treatment for the last sixth months. He was treated with oral prednisolone and mesalamine. Within six days, his bowel symptoms as well as his cardiac symptoms improved for the better, and the patient was discharged in good condition on day six after his admission to hospital. Pericardial effusion was completely resolved. Ulcerative colitis, which may not be detected as an underlying cause, should be considered in pericardial effusion cases as differential diagnosis. Key words: Pericardial Effusion; Ulcerative Colitis; Corticosteroid Theraphy., İnflamatuar barsak hastalıklarında barsak dışı belirtiler iyi tanımlanmasına rağmen kardiyak tutulum nadiren bildirilmiştir. 63 yaşında erkek hasta nefes darlığı ve kuru öksürük şikayeti ile kardiyoloji polikliniğine başvurdu. Ekokardiyografide minimal perikardiyal effüzyon vardı. Günde iki kez 600 mg İbuprofen reçete edildi. Hasta çarpıntı, göğüs ağrısı ve nefes darlığında artma olması üzerine dört gün sonra hastaneye başvurdu. Kardiyoloji servisine yatırıldı. Tıbbi hikayesinde ülseratif kolit tanısı olduğu ve altı aydır tedavi almadığı belirlendi. Tekrar yapılan ekokardiyografide effüzyonun arttığı ve sağ atriyuma bası olduğu tespit edildi. Oral prednizolon ve mesalamin ile tedavi edildi. Altı gün içinde göğüs belirtilerine ilaveten barsak belirtileri düzeldi ve hastaneye başvurduktan altı gün sonra iyi durumda taburcu edildi. Bu sürede perikardiyal effüzyon tamamen gerilemişti. Nedeni tespit edilemeyen perikardiyal effüzyon vakalarında ayırıcı tanıda ülseratif kolit mutlaka düşünülmelidir. Anahtar kelimeler: Perikardiyal Effüzyon; Ülseratif Kolit; Kortikosteroid Tedavisi.

Although exaggerated blood pressure responses (EBPR) to exercise have been related to future hypertension and masked hypertension (MHT), the relationship between exercise capacity and MHT remains unclear. A sedentary life style has been related to increased cardiovascular mortality, diabetes mellitus (DM), and hypertension. In this study, we aimed to examine the relationship between exercise capacity and MHT in sedentary patients with DM.This study included 85 sedentary and normotensive patients with DM. Each patient's daily physical activity level was assessed according to the INTERHEART study. All patients underwent an exercise treadmill test, and exercise duration and capacity were recorded. Blood pressure (BP) was recorded during all exercise stages and BP values ≥ 200/110 mmHg were accepted as EBPR. MHT was diagnosed in patients having an office BP140/90 mmHg and a daytime ambulatory BP135/85 mmHg. Patients were divided into two groups according to their ambulatory BP monitoring (MHT and normotensive group).The prevalence of MHT was 28.2%. Exercise duration and capacity were lower in the MHT group than in the normotensive group (p0.05) and were negatively correlated with age, HbA1c, mean daytime BP, and mean 24 hour BP. Peak exercise systolic BP and the frequency of EBPR were both increased in the MHT group (25.0% and 8.1%, respectively, p=0.03). According to a multivariate regression, exercise capacity (OR: 0.61, CI95%: 0.39-0.95, p=0.03), EBPR (OR: 9.45, CI95%: 1.72-16.90, p=0.01), and the duration of DM (OR: 0.84, CI95%: 0.71-0.96, p=0.03) were predictors of MHT.Exercise capacity, EBPR, and the duration of DM were predictors of MHT in sedentary subjects with DM.

An increased prevalence of masked hypertension (MHT) has been demonstrated among patients with diabetes mellitus (DM). MHT appears to cause cardiovascular (CV) complications similar to clinically overt hypertension. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide inhibitor and higher plasma levels of ADMA are related to increased CV risk in both the general population and among patients with DM. The aim of this study was to evaluate the relationship between MHT and ADMA in diabetic patients.This study included DM patients (n = 131) with normal office blood pressure (140/90 mmHg). None of the participants were using antihypertensive medications. All participants utilized an ambulatory blood pressure monitor (ABPM) for 24 h. Serum ADMA and arginine levels were measured using the fluorescence detector high performance liquid chromatography method.The prevalence of MHT was 24.4% among the study subjects. ADMA levels were increased in the MHT group when compared with normotensive diabetics (6.2 ± 2.2 vs 4.2 ± 1.7 μmol/L p = 0.001, respectively). Furthermore, arginine/ADMA ratio was lower in the MHT group than among the normotensive group (29.9 ± 12.1 vs 46.0 ± 19.0 p = 0.001). In the multivariate logistic regression model, ADMA, BMI and HDL levels were found to be independent predictors of MHT Odds ratio: 1.63 (1.28-2.06), 1.19 (1.05-1.35), and 0.95 (0.90-0.99), respectively. The cut-off value of the ADMA was 4.34 μmol/L with a sensitivity, specificity, positive predictive value, and negative predictive value of 84.4%, 59.6%, of 40.3%, and 92.2%, respectively (AUC = 0.78).Serum ADMA may play a role in both the pathophysiology and screening of MHT in DM subjects.

We admitted a maintenance haemodialysis patient with hypotension and weakness. He had undergone cadaveric renal transplantation 19 years earlier. He had lost his kidney due to chronic allograft nephropathy 1 year after transplantation and returned to haemodialysis. He had hypotension, especially remarkable during haemodialysis. He also had hepatitis C but no cirrhosis. The patient denied a previous pulmonary tuberculosis. On physical examination, he was hypotensive (80/60 mmHg) but without peripheral oedema, neck vein distention or hepatomegaly. Heart sounds were weakly heard and there was no audible murmur or friction rub. Pericardial calcification was noticed on chest x-ray (Figure ​(Figure1).1). Echocardiography could not visualize the pericardium or heart. Only coarse calcification of the pericardium from the subphrenic angle, but no further detail, was visible. Subsequently, we performed computerized tomography of the pericardium (Figure ​(Figure2),2), which revealed a crescent-like calcification of the pericardium. There were calcific plaques on the right lower lobe of the pulmonary pleura as well. Fig. 1 Postero-anterior chest x-ray showing crescent-like pericardial calcification. Note also that calcification in the pleura overlying right lower lung. Fig. 2 Coronal section of computerized tomography of the chest depicting crescent-like calcification of the pericardium encasing heart and right lower pleural calcification. The presence of pericardial calcification strongly suggests constrictive pericarditis (CP) in patients with symptoms and signs of heart failure. A myriad of disease states can cause pericardial calcification. In the Western world, the most common cause is idiopathic. However, in the developing countries, tuberculosis remains an important cause. Plain chest radiographs can display calcification. Echocardiography may confirm the diagnosis, showing a thickened pericardium and calcification in some cases. However, normal echocardiography does not rule out CP. Transoesophageal echocardiography is more sensitive; however, the gold standard for diagnosis is invasive haemodynamic evaluation. Patients with CP may present with two types of complaints: those related to fluid overload, ranging from peripheral oedema to anasarca; and those related to a diminished cardiac output response to exertion, such as fatiguibility and dyspnoea. These symptoms may be masked in haemodialysis patients due to ultrafiltration and close volume regulation. Conflict of interest statement. None declared.