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Introduction: This study aimed to investigate pre-procedural (Neutrophil to Lymphocyte Ratio) (NLR) in patients with (Left Main Coronary Artery) (LMCA) disease and to identify a relevant NLR value related to mortality after percutaneous intervention in unprotected LMCA disease. Patients and Methods: Seventy-one patients diagnosed with unprotected LMCA disease were divided into two groups according to their mortality rates: survivors (n= 56, 78%) and non-survivors (n= 15, 22%). The mean follow-up duration was 26.0 ± 24.8 months, and all-cause mortality was considered as an endpoint. Results: The non-survivor group had higher NLR values [3.23 (2.31-4.01) vs. 5.82 (2.92-14.99), p= 0.026] compared to the survivor-group. ROC analysis revealed an NLR cut-off value of 5.24 for predicting all-cause mortality. During follow-up, the group with high NLR values was associated with a significantly higher rate of all-cause mortality rate [6 (10.5%) vs. 9 (64.3%), p< 0.001] compared to the low NLR group. In multivariate analysis, the NLR (OR= 1.695; 95% CI= 1.124-2.556; p= 0.012) was found to be independent predictors of mortality. Conclusion: NLR is the independent predictor of all-cause mortality in unprotected LMCA disease. As far as we know, this study is the first study investigating the prognostic value of NLR in patients with unprotected LMCA disease stenting.

Introduction: Cerebral embolism after carotid artery stenting (CAS) remains a matter of concern in frailty patients. The prognostic nutrition index (PNI), which provides an objective assessment of nutritional status, is a useful prognostic indicator in cardiovascular diseases. We aim to determine the value of pre-procedural PNI in predicting cerebral embolism including stroke, transient ischemic attack (TIA), and silent new ischemic cerebral lesions (SNICLs). Patients and Methods: We retrospectively evaluated 138 patients (mean age= 70.6 ± 6.7 years, male= 99) who underwent CAS. Inclusion criteria were as follows: i) availability of all medical records including albumin value and lymphocyte count, ii) having cranial imaging after CAS, iii) having symptomatic carotid stenosis 50-99% or asymptomatic carotid stenosis ≥60-99%. The study population was divided into two subgroups according to the presence of cerebral embolism as cerebral embolism (+) cerebral embolism (-) groups. Results: Among the study population, 22 patients (16%) had at least 1 SNICL, seven patients (5.0%) had an ischemic stroke, and five patients (3.6%) had TIA. The cerebral embolism (+) group had a significantly lower PNI, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the cerebral embolism (-) group. Low PNI was identified as one of the independent predictors of cerebral embolism (OR= 0.808; 95% CI= 0.670-0.975; p= 0.026), and PNI lower than 44.7 predicted cerebral embolism with a sensitivity of 70.6% and a specificity of 61.1% (AUC= 0.739; 95% CI= 0.651 to 0.827; p< 0.001). Conclusion: The current data suggest that PNI is an independent prognostic factor for cerebral embolic complications after CAS procedures.

Rheumatoid arthritis (RA) is related to cardiovascular disease and results in increased mortality rates. Ischemia, autonomic nervous system dysfunction, impaired cardiac ionic currents, and genetic predisposition may be the underlying mechanisms. Proarrhythmic ventricular electrophysiological remodeling detected on the basis of Tp‑e interval, Tp-e/QT, and Tp-e/QTc ratios plays a key role in the prognosis. Our aim was to assess proarrhythmic ventricular electrophysiological remodeling in patients with RA, a well-known chronic inflammatory disorder. A total of 163 patients with RA and 47 patients as a control group were included in this retrospective study. Proarrhythmic ventricular electrophysiological remodeling markers were evaluated in both groups along with baseline demographic and clinical variables. Patients using medication or with chronic disorders that can affect ventricular repolarization markers were excluded. The patients with RA had prolonged Tp‑e interval (66 ms [44–80]; 80 ms [78–96], p

Background: Infective endocarditis (IE) is a heterogenous infection that affects the endothelial surface of the intracardiac structures and other implanted intracardiac devices. We aimed to compare demographical characteristics, causative microorganisms, treatment, and prognosis of prosthetic and native valve endocarditis diagnosed in two separate hospitals. Material and methods: Between 2010 and 2020, patients admitted with the diagnosis of IE were retrospectively included in our multicenter study. Patients' demographic and epidemiological data, clinical characteristics, infected intracardiac structure and sort of valve, culprit microorganisms, laboratory findings, treatment manifestations and in-hospital outcomes with a period of 6 months were obtained from an electronic medical record system. Results: A total of 173 consecutive patients had diagnosed IE, 60.1% (104 patients) of them native valve endocarditis (NVE) and 39.8 % (69 patients) of them prosthetic valve endocarditis (PVE). Baseline demographic properties were not different except hypertension and atrial fibrillation. Patients with prior hypertension were 25% (26 patients) in NVE; 39.1% (27 patients) in PVE and the difference was statistically significant. Septic shock was significantly higher in the PVE group than the NVE group (7.4% versus 1%; P = .036), and also recurrent endocarditis occurred more frequently in the PVE group than the NVE group (8.8% versus 1%; P = .016). Conclusion: In our study, although we detected higher mean age, HT, RDW and atrial fibrillation rates compared with NVE, we did not detect a significant difference in mortality and morbidity.

Pulmonary arterial hypertension (PAH) is a severe, life-threatening disorder despite the availability of specific drug therapy. A lack of endogenous prostacyclin secondary to downregulation of prostacyclin synthase in PAH may contribute to vascular pathologies. Therefore, prostacyclin and its analogs including inhaled iloprost may decrease pulmonary arterial pressure and ventricular pressure.Here, we studied that acute effects of iloprost used in pulmonary vasoreactivity testing on the intracardiac conduction system in patients with PAH. A total of 35 (15 idiopathic PAH, 20 congenital heart disease) patients with PAH were included in this prospective study. Patients were divided into two groups: 22 patients with negative pulmonary vasoreactivity in group 1 and 13 with positive pulmonary vasoreactivity in group 2. Electrophysiological parameters including basic cycle length, atrium-His (AH) interval, His-ventricle (HV) interval, PR interval, QT interval, QRS duration, Wenckebach period, and sinus node recovery time (SNRT) were evaluated before and after pulmonary vasoreactivity testing in both groups.The AH interval (81 [74-93]; 80 [65.5-88], p = 0.019) and SNRT (907.7 ± 263.4; 854.0 ± 288.04, p = 0.027) was significantly decreased after pulmonary vasoreactivity testing. Mean right atrium pressure was found to be correlated with baseline AH (r = 0.371, p = 0.031) and SNRT (r = 0.353, p = 0.037).Inhaled iloprost can improve cardiovascular performance in the presence of PAH, primarily through a reduction in right ventricular afterload and interventricular pressure. Decreased pressure on the interventricular septum and ventricles leads to conduction system normalization including of the AH interval and SNRT due to resolution of inflammation and edema.HINTERGRUND: Die pulmonalarterielle Hypertonie (PAH) ist eine schwere, lebensbedrohliche Erkrankung trotz spezifischer medikamentöser Behandlung. Ein Mangel an endogenem Prostazyklin infolge einer Herabregulierung der Prostazyklinsynthase bei PAH kann zu Gefäßerkrankungen beitragen. Daher können Prostazyklin und seine Analoga einschließlich des inhalativen Iloprost den pulmonalarteriellen Druck und den Ventrikeldruck senken.In der vorliegenden Studie wurden die akuten Wirkungen von dem zur Prüfung der pulmonalen Vasoreaktivität eingesetzten Iloprost auf das intrakardiale Erregungsleitungssystem bei Patienten mit PAH untersucht. In die prospektive Studie wurden 35 Patienten mit PAH (15 mit idiopathischer PAH, 20 mit kongenitaler Herzerkrankung) eingeschlossen. Die Patienten wurden in 2 Gruppen eingeteilt: 22 Patienten mit negativer pulmonaler Vasoreaktivität in Gruppe 1 und 13 mit positiver pulmonaler Vasoreaktivität in Gruppe 2. Vor und nach der Prüfung der pulmonalen Vasoreaktivität wurden elektrophysiologische Parameter einschließlich grundlegender Zyklusdauer, Atrium-His(AH)-Intervall, His-Ventrikel(HV)-Intervall, PR-Intervall, QT-Intervall, QRS-Dauer, Wenckebach-Periode und Sinusknotenerholungszeit (SKEZ) in beiden Gruppen gemessen.Das AH-Intervall (81 [74–93]; 80 [65,5–88], p = 0,019) und die SKEZ (907,7 ± 263,4; 854,0 ± 288,04; p = 0,027) waren nach Prüfung der pulmonalen Vasoreaktivität signifikant erniedrigt. Der mittlere Druck im rechten Vorhof erwies sich als mit dem Ausgangs-AH-Intervall korreliert (r = 0,371; p = 0,031) und SKEZ (r = 0,353; p = 0,037).Inhalatives Iloprost kann die kardiovaskuläre Leistung bei Vorliegen einer PAH verbessern, in erster Linie durch eine Reduktion der rechtsventrikulären Nachlast und des interventrikulären Drucks. Ein verminderter Druck auf das Interventrikularseptum und die Ventrikel führt zur Normalisierung des Erregungsleitungssystems einschließlich des AH-Intervalls und der SKEZ aufgrund der Rückbildung von entzündlichen Veränderungen und Ödemen.

SUMMARY BACKGROUND: Percutaneous mitral balloon valvuloplasty and mitral valve replacement have been the treatment options for mitral stenosis for several years, however, studies that compare these two modalities are very rare in the literature. ObjectIve: In this article, we aim to investigate the comparison of clinical results of percutaneous mitral balloon valvuloplasty and mitral valve replacement. Methods: 527 patients with rheumatic mitral stenosis, treated with percutaneous mitral balloon valvuloplasty or mitral valve replacement (276 patients with percutaneous mitral balloon valvuloplasty and 251 patients with mitral valve replacement) from 1991 to 2012 were evaluated. The demographic characteristics, clinical, echocardiographic and catheterization data of patients were evaluated retrospectively. The results of early and late clinical follow-up of patients after percutaneous mitral balloon valvuloplasty and mitral valve replacement were also evaluated. Results: The mean follow-up time of the percutaneous mitral balloon valvuloplasty group was 4.7 years and, for the mitral valve replacement-group, it was 5.45 years. The hospital stay of the percutaneous mitral balloon valvuloplasty group was shorter than that of the mitral valve replacement group (2.02 days vs 10.62 days, p

Endomyocardial fibrosis (EMF), a restrictive cardiomyopathy characterized by subendocardial fibrosis, is commonly seen in tropical and subtropical regions. EMF involving the left ventricle presents with severe pulmonary hypertension (PH) and is a rare cause of PH in non-tropical areas. Multimodality imaging is important for accurate diagnosis, especially cardiac magnetic resonance imaging which is the cornerstone. Herein, we report the case of a patient who presented with heart failure symptoms and severe PH, and in whom EMF was diagnosed by multimodality imaging.

Background: Percutaneous mitral balloon valvuloplasty (PMBV) has been established as an effective and safe treatment modality for symptomatic patients with severe rheumatic mitral stenosis. While Wilkin Score (WS) ≤ 8 are associated with higher rates of procedural success and lower rates of restenosis, higher WS are associated with lower rates of procedural success and higher rates of restenosis. It is well known that platelets have substantial role in thromboembolic complications of rheumatic mitral stenosis and various studies showed that increased platelet (PLT) activity in rheumatic mitral stenosis. The aim of this study was to assess the usefulness of PLT indices as a predictor of restenosis in patients who underwent PMBV. Methods: We retrospectively enrolled 178 consecutive patients who underwent PMBV. Patients were classified into the two groups. Study group (n=21) included patients whom we performed redo PMBV during their follow-up as a result of mitral restenosis following previous PMBV (index procedure) and control group (n=157) included patients whom did not undergo a redo PMBV. PLT indices including PLT count, Platelecrit and mean platelet volume values were evaluated in these groups. Results: In study group, PLT count (210 ± 49 vs. 241 ± 62, p=0.010), PCT [0.203 (0.173-0.230) vs. 0.260 (0.243-0.290), p

The neutrophil to lymphocyte ratio (NLR) predicts adverse clinical outcomes in several cardiovascular diseases. Our aim was to investigate the association of residual SYNTAX score (rSS) with the NLR in patients (n = 613) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Patients were divided into 2 groups: group 1 with low NLR (2.59). Coronary artery disease severity was calculated for both groups besides baseline clinical and demographic variables. Receiver operating characteristic curve analysis demonstrated that NLR with a cutoff value of 2.59 had good predictive value for increased rSS (area under the curve = 0.707, 95% CI: 0.661-0.752, P < .001). The median rSS value of group 2 was higher (2.0 [0-6.0]; 4.0 [0-10.0], P < .001) compared with group 1; the number of patients with high rSS was also higher in group 2 (26 [9.7%]; 107 [31.0%], P < .001). In multivariate logistic regression analysis, the NLR (odds ratio = 3.933; 95% CI: 2.419-6.393; P < .001) was an independent predictor of high rSS. Additionally, there was a positive correlation between NLR and rSS (r = 0.216, P < .001). In conclusion, higher NLR was an independent predictor of increased rSS in patients with STEMI.

Radiofrequency catheter ablation (RFCA) procedure is performed for many tachyarrhythmias. We performed successful RFCA in a 5-year-old child for supraventricular tachyarrhythmia and Wolff-Parkinson-White syndrome. Acute circumflex artery (CxA) occlusion occurred due to RFCA. After percutaneous balloon angioplasty was performed into the CxA, the patient was treated with systemic steroid to resolve myocardial edema. To the best of our knowledge, systemic steroid was used first time for acute coronary artery injury related myocardial ischemia.

OBJECTIVE The influence of the Ramadan fasting on blood pressure (BP) in patients taking diuretics therapy has not been addressed specifically yet. The aim of this study was to examine the effect of long Ramadan fasting on BP with ambulatory BP monitoring in hypertensive patients using diuretics. METHODS This prospective, observational study was done on 129 hypertensive patients and was carried out in two groups: 73 treated hypertensive patients were assigned to the diuretic group and 56 treated hypertensive patients were allocated to the non-diuretic group. Twenty-four-hour ambulatory BP monitoring was performed during and after Ramadan. Mean overall, daytime and nighttime BP were measured and compared in both groups. The differences in mean SBP and DBP were recorded between the two monitoring periods. RESULTS In diuretic group, 24-h SBP decreased from 128.2 ± 17.9 to 119.3 ± 9.5 mmHg during Ramadan (8.9 units; P < 0.001). DBP decreased from 79.4 ± 10.9 to 75.3 ± 7.6 mmHg (4.1 units; P < 0.001). On the other hand, SBP and DBP were lower insignificantly in the non-diuretic group. The reduction in SBP was significantly higher in the diuretic group (overall: P = 0.005, daytime: P = 0.011, nighttime: P = 0.022). Thiazide-like diuretics lowered BP more than thiazide-type diuretic despite an insignificant difference. CONCLUSION This study suggested that Ramadan fasting might cause significant reductions in mean SBP and DBP measurements in patients using diuretics. Despite decreasing in BP, diuretics generally well tolerated and can be safe in well-controlled hypertensive patients during Ramadan fasting.

Objectives The aim of our study was to evaluate the usefulness of systemic immune-inflammation index (SII) at admission in predicting in-hospital mortality in patients with infective endocarditis. Methods 133 definite IE patients (≥18 years) according to modified Duke criteria, treated in our tertiary care hospital between December 2009 and May 2019, were retrospectively analysed. Symptoms, comorbidities, predisposing valvular diseases, prosthetic valve, device, history of injectable drug use, blood culture results, echocardiography findings, and complications were collected. We calculated the SII as follows: SII = platelet count × neutrophil count/lymphocyte count at admission. Results The median age of the patients was 56 (40–66) years. Prosthetic valve disease was the most frequent predisposing valve lesion. Staphylococcus species were the most common microorganisms. The most frequent complication was in-hospital mortality (22%) followed by renal failure. Older population, syncope, increased inflammatory markers, high systolic pulmonary artery pressure (PAPs), heart failure, renal failure, and septic shock were associated with high mortality. However age, syncope, hypocalcemia, not going to surgery, and SII were independent predictors of in-hospital mortality. According to receiver operating characteristic curve analysis, the optimal SII cut-off value for predicting mortality was 2314 (area under the curve 0.641; P = 0.019). Conclusion We demonstrated that high SII levels are independently associated with in-hospital mortality. The SII may be a promising prognostic predictor for patients with infective endocarditis.

Right atrial appendage (RAA) aneurysm is a rare congenital cardiac abnormality thought to be caused by dysplasia of the muscular wall of the RA and RAA. Structural, contractile, or electrical atrial changes are associated with the onset and progression of atrial fibrillation. The RAA aneurysm can have various symptoms, such as thromboembolic complications. Diagnosis of RAA aneurysm greatly depends on imaging modalities, among which echocardiography is the most widely used one. Echocardiography is very effective in discovering the aneurysm, distinguishing it from other abnormalities such as pericardial cysts, Ebstein's anomaly and cor triatriatum, and detecting intracardiac thrombosis or blood flow limitations. Cardiac magnetic resonance imaging and computed tomography are important complementary examinations. They may provide more details on the neighboring structures of the aneurysm, especially when echocardiographic images are suboptimal.

Introduction: Contrast-induced nephropathy (CIN) is one of the most important causes for increased mortality rates in ST-segment elevation myocardial infarction (STEMI) patients. In our study, we aimed to investigate the impact of serum osmolarity on CIN in patients with STMEI who were undergoing percutaneous coronary intervention. Patients and Methods: A total of 163 consecutive patients with STEMI were enrolled in this study. The patients were divided into two groups; patients without CIN were assigned to group 1 and patients with CIN were assigned to group 2. The baseline clinical, laboratory and demographic features, including the serum osmolarity, were compared for both groups. Results: A total of 144 patients without CIN comprised group 1, while 22 patients with CIN comprised group 2. The serum osmolarity level [289.06 (284.75-292.39), 291.71 (289.69-295.72); p= 0.004] was higher in patients with CIN. Additionally, age (OR: 1.097, CI: 1.033-1.164; p= 0.002) and serum osmolarity (OR:1.117, CI: 1.008-1.238; p= 0.035) were found to be independent predictors of CIN. Conclusion: Higher serum osmolarity is related with CIN in STEMI patients who are undergoing percutaneous coronary intervention. This could cause increased adverse clinical outcomes, even if the underlying coronary artery disease is treated successfully.

Background It is well known that approximately 20% of patients who undergo cardiac surgery experience weight loss in postoperative period. However, there is a lack of data on postoperative consequences of malnutrition. This study aimed to investigate the relationship between nutritional status and long-term outcomes in patients undergoing isolated coronary artery bypass grafting (CABG). Material and methods A total of 586 patients who underwent isolated CABG in our center between January 2015 and March 2016 were included in this study. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of all-cause death, non-fatal myocardial infarction (MI), and stroke. Patients were divided into two groups based on their MACCE outcomes. Prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and controlling nutritional status (CONUT) scores were used to show the nutritional status. Results The mean follow-up time of the whole study group was 38.08 ± 13.4 months. The follow-up time was 39 ± 13 months in patients with mortality, while it was 20 ± 15 months in those without mortality. The PNI and GNRI values were lower in patients with major adverse cardiac and cerebrovascular events (MACCE) compared to patients without MACCE. The median CONUT score was higher in patients with MACCE. Conclusion Our study showed that nutritional indices including PNI, CONUT, and GNRI were associated with long-term MACCE and mortality in patients who underwent isolated CABG. The use of these scores in order to predict prognosis in patients treated with CABG seems to be an applicable method in clinical practice.

Resumo Fundamento A insuficiência cardíaca com fração de ejeção reduzida (ICFEr) é uma doença de alta prevalência que requer hospitalizações repetidas e causa morbimortalidade significativa. Portanto, o reconhecimento precoce de preditores de resultados desfavoráveis é essencial para o manejo do paciente. Objetivo O objetivo do presente estudo é investigar a relação entre realce tardio pelo gadolínio (RTG) detectado por ressonância magnética cardíaca (RMC) e os parâmetros de repolarização, como o intervalo QT corrigido (QTc), intervalo Tp-e, ângulo QRS-T frontal detectado pelo eletrocardiograma (ECG) de 12 derivações na ICFEr. Método Neste estudo observacional, retrospectivo, de centro único, foram incluídos 97 pacientes consecutivos com ICFEr submetidos à RMC. A população do estudo foi dividida em dois grupos, de acordo com a presença de RTG. Foram registradas medidas ecocardiográficas e de RMC e características demográficas. Os intervalos QTc, intervalos Tp-e, e ângulos QRS-T frontais foram calculados a partir do ECG. Um valor de p

Objectives Vascular calcification is a well-known phenomenon and affects coronary and carotid arteries as well as other arterial beds. Presence of arterial calcification is associated with major adverse events in patients undergoing percutaneous coronary artery or carotid artery intervention. Even though there is a clear association between worse outcome and coronary-carotid calcification, there is no research that interrogated the relationship between iliac arterial calcification and clinical outcomes because of lack of data. Therefore, in this study, we aimed to investigate the impact of iliac arterial calcification on procedure success rates and long-term outcomes among patients undergoing endovascular intervention. Methods The records of 453 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into two groups based on the presence or absence of heavy calcification of iliac arteries. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed. Results According to our study, the rate of restenosis following endovascular intervention at 6 and 12 months were similar between two groups. On the other hand, long-term restenosis was significantly higher in patients with heavy calcification of iliac arteries as compared to patients with low calcification on iliac arteries (32.2% vs. 12.8%, p < 0.05). Conclusions Our data showed that there was a strong association between heavy calcification of iliac arteries and long-term restenosis in patients undergoing endovascular intervention.

Objective To compare surgical risk scores including Euroscore II, STS and Logistic Euroscore for their predictive ability about postoperative atrial fibrillation (POAF). Study design Prospective cohort study. Place and duration of study Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital and Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, from June to December 2018. Methodology One hundred and four patients, undergoing isolated coronary artery bypass grafting operation, were enrolled. Surgical risk scores, clinical, laboratory and echocardiographic parameters were compared between POAF-positive and POAF-negative groups Results: Of the 104 patients included, 23 (22.1%) patients developed atrial fibrillation postoperatively. Peripheral artery disease, carotid artery disease, current smoking, cardiopulmonary bypass time, left atrial diameter, and Syntax II score were found to be associated with POAF. Among these, peripheral artery disease and cardiopulmonary bypass time were independently related with POAF. Euroscore II (p = 0.005), STS (p = 0.026) and Logistic Euroscore (p = 0.032) were all statistically higher in POAF developing patients. In terms of ROC analysis, area under the curve was higher in Euroscore II (0.697) than STS and Logistic Euroscore (0.658 and 0.652, respectively). Conclusion Euroscore II, STS and Logistic Euroscore were all associated with POAF development. However, Euroscore II could be a better option for the prediction of POAF.

Bu olguda atrial tasikardi ve aort koarktasyonunun birlikte goruldugu nadir bir olguyu sunduk. Tanisi henuz koyulmamis aort koarktasyonu olan yetiskinler genellikle asemptomatiktir ya da hipertansiyonla gelebilirler. Kirk bes yasinda kadin hasta acil servise akut baslangicli supraventrikuler tasikardi ile basvurdu. Atrial tasikardi ablasyonu yapilirken hastada aort koarktasyonu oldugu teshis edildi. Radyofrekans kateter ablasyonu ve koarktasyon segmentine stent implantasyonu basarili bir sekilde gerceklestirildi. Direncli hipertansiyonu ve kardiyak ufurumu olan genc bir hastada aort koarktasyonu olabilecegi akla gelmelidir.

Introduction: Imbalance between pro- and anti-inflammatory cytokines secreted from visceral adipose tissue (VAT) contributes to the pathogenesis of certain cardiovascular and metabolic disorders, including insulin resistance. Epicardial adipose tissue (EAT) is a form of VAT mainly concentrated along the coronary arteries. It has been shown in various studies that EAT thickness is positively correlated with cardiovascular disease. Due to its high worldwide prevalence, prevention and management of type 2 diabetes (T2D) has become a major public health challenge. Metformin, the most widely prescribed drug to treat T2D, has favorable effects on VAT and body weight. As metformin decreases VAT mass, in this prospective study we analyzed the possible positive effect of metformin on EAT mass, which is organ-specific VAT, and body mass index (BMI). Methods: Subjects were selected from patients admitted to the internal medicine outpatient clinic. Newly diagnosed T2D patients treated with metformin monotherapy were analyzed and 40 patients were included. EAT thickness in the included patients was measured echocardiographically. BMI and EAT thickness were analyzed at the beginning (BMI0 and EAT0) and after three months of metformin monotherapy (BMI3 and EAT3). Results: There was a statistically significant decrease in EAT thickness after three months of metformin monotherapy (EAT0=5.07±1.33 mm vs. EAT3=4.76±1.32 mm; p

Background Coronary artery disease (CAD) causes electrical heterogeneity on ventricular myocardium and ventricular arrhythmia due to myocardial ischemia linked to ventricular repolarization abnormalities. Objective Our aim is to investigate the impact of increased level of CAD spectrum and severity on ventricular repolarization via Tp-e interval, Tp-e/QT and Tp-e/QTc ratios. Methods 127 patients with normal coronary artery (group 1), 129 patients with stable CAD (group 2) and 121 patients with acute coronary syndrome (group 3) were enrolled. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were evaluated as well as baseline demographic and clinical parameters. Kruskal-Wallis one-way ANOVA test was used for comparing quantitative variables with abnormal distribution while One-Way ANOVA test was used for comparing the means between groups with normal distribution. Tukey HSD and Welch tests were used for subgroups analyses with normal distribution. Spearman analysis was used to evaluate the correlation between clinical variables and repolarization markers. A p-value < 0.05 was considered statistically significant. Results Tp-e interval [66(50-83), 71(59-82) and 76(64-86); group 1,2 and 3 respectively, p

The goal of the present work was to examine associations between COVID-19 pneumonia severity and pulmonary artery diameter. A total of 101 patients with COVID-19 were included in this retrospective observational study. The patients were divided into three groups based on the CT images: 41 patients with mild pneumonia, group 2 had 39 patients with moderate pneumonia, and group 3 had 21 patients with severe pneumonia. Furthermore, the diameter of the main pulmonary artery was calculated as well as ascending aorta, right and left pulmonary artery diameters. Laboratory analysis results were also compared. Analyses show an increased main pulmonary artery diameter is associated with poorer prognosis for patients with COVID-19 pneumonia. Further studies are needed into the mechanisms between severe hypoxemia, increased inflammation, and vascular resistance and higher numbers of thromboembolic events.Ziel der vorliegenden Arbeit war es, Zusammenhänge zwischen dem Schweregrad der COVID-19-Pneumonie und dem Durchmesser der Pulmonalarterie zu untersuchen. Insgesamt 101 Patienten mit COVID-19 wurden in diese retrospektive Beobachtungsstudie eingeschlossen. Die Patienten wurden auf Basis der Computertomographie(CT)-Bilder in 3 Gruppen eingeteilt: 41 Patienten mit leichter Pneumonie, in Gruppe 2 waren 39 Patienten mit mittelschwerer Pneumonie, und Gruppe 3 umfasste 21 Patienten mit schwerer Pneumonie. Darüber hinaus wurde der Durchmesser der Hauptpulmonalarterie sowie der aufsteigenden Aorta, der rechten und linken Pulmonalarterie berechnet. Auch die Ergebnisse der Laboranalysen wurden verglichen. Die Analysen zeigen, dass ein erhöhter Durchmesser der Hauptpulmonalarterie mit einer schlechteren Prognose für Patienten mit COVID-19-Pneumonie assoziiert ist. Weitere Studien sind erforderlich, um die Mechanismen zwischen schwerer Hypoxämie, erhöhter Entzündung und Gefäßwiderstand und höheren thromboembolischen Ereignissen zu untersuchen.

Background: Cardiac rehabilitation (CR) is associated with improved clinical outcomes in a broad spectrum of cardiac disease. The beneficial effect of CR has been proven in patients with ischemic heart diseases. Post-operative atrial fibrillation (AF) and atrial arrhythmias are common complications following coronary artery bypass grafting (CABG) surgery. The aim of this study was to evaluate the effect of CR on atrial conductions in patients who underwent isolated CABG surgery. Methods: After the exclusion criterion was applied 545 patients were included in the study, retrospectively. One group (Rehab +) included patients who participated in CR program and the other group (Rehab -) included patients who did not want to or could not be participated in CR program after isolated CABG surgery. ECG parameters of Pmax, Pmin and P wave dispersion (PWD) of both groups were compared. Results: All parameters including heart rate, PR interval, Pmax, Pmin and PWD were significantly changed in rehab (+) group after CABG surgery. There was significant change in rehab (+) group when compared to rehab (-) group in terms of parameters of Pmax (P

Background: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) is associated with an increased risk of complications, particularly no‑reflow phenomenon and distal embolization due to low patency rates. The CHA2DS2‑VASc score is a clinical risk stratification tool used to predict thromboembolism events especially in patients with nonvalvular atrial fibrillation. Aims: The aim of this study was to investigate the relationship between the CHA2DS2‑VASc score and no‑reflow phenomenon after SVG PCI in patients with non–ST‑segment elevation acute coronary syndromes (NSTE‑ACS). Methods: In this study, we included 268 patients diagnosed with NSTE‑ACS who underwent PCI for SVG disease in our tertiary cardiovascular center. Patients were divided into 2 groups: group 1 without no‑‑reflow phenomenon (n = 190) and group 2 with no‑reflow phenomenon (n = 78) following the intervention, and then compared based on CHA2DS2‑VASc scores. Results: The CHA2DS2‑VASc score (P < 0.001) was significantly higher in group 2, even though no significant difference regarding atrial fibrillation was observed between the study groups. The CHA2DS2‑VASc score (P < 0.001), degenerated saphenous vein graft (P = 0.006), and intraluminal thrombus (P < 0.001) were found to be independent predictors of no‑reflow phenomenon. Receiver operating characteristics analysis showed that a CHA2DS2‑VASc score of 4 predicted no‑reflow phenomenon with 67.9% sensitivity and 69.3% specificity. Conclusions: Our findings suggest that the CHA2DS2‑VASc score can be an independent predictor of no‑reflow phenomenon in patients undergoing SVG interventions. As a simple and easy‑to‑calculate score, it might be a useful assessment tool to predict no‑reflow phenomenon before SVG interventions in patients with NSTE‑ACS.

Background: The aim of this study was to evaluate the effect of cardiac rehabilitation on electrocardiographic changes in patients undergoing isolated coronary artery bypass grafting. Methods: Between January 2016 and July 2019, a total of 625 patients (485 males, 140 females; mean age: 59.6 years; range, 50.6 to 68.6 years) who underwent isolated coronary artery bypass grafting and survived were retrospectively analyzed. The patients were divided into two groups according to the participation in the cardiac rehabilitation program as follows: the Rehab(+) group (n=363) and the Rehab(-) group (n=262). Electrocardiographic parameters of both groups were compared. Results: There was a significant decrease in the electrocardiographic findings of heart rate (p Conclusion: Cardiac rehabilitation program after coronary artery bypass grafting decreases ventricular repolarization indices of electrocardiography. Based on these changes, postoperative cardiac rehabilitation program may reduce the risk of ventricular arrhythmia and sudden cardiac death during follow-up.

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

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NCI-2019-0309.R2

Objective The optimal treatment modality for left main coronary artery (LMCA) disease is still controversial. The aim of this study was to investigate long-term prognostic determinants of percutaneous coronary intervention (PCI) for LMCA disease and the role of coronary artery disease (CAD) severity in this population. Methods A total of 60 consecutive patients who underwent LMCA PCI were enrolled in this study. Baseline demographic and clinical variables were recorded, as well as the SYNTAX score (SS), SS II, and residual SS (rSS). The primary endpoints of the study were all-cause death, non procedural myocardial infarction (MI), and stroke. The patients were then divided into 2 groups: patients without a composite endpoint (Group 1) and those with a composite endpoint (Group 2). Results Of the 60 patients, 15 (25%) were female and the mean age was 59.8±14.7 years. The median follow-up time was 25 months (range: 12-33 months). A primary composite endpoint was observed in 16 patients (26.7%): mortality occurred in 10 patients (16.7%), 4 (6.6%) experienced MI, and stroke was seen in 2 patients (3.3%). Target vessel revascularization was performed in 3 patients (5%). The mean SYNTAX score (Group 1: 19.9±9.8; Group 2: 26.8±12.2; p=0.029), SS II PCI (Group 1: 27.7 [range: 17.7-36.8]; Group 2: 34.2 [range: 27.9-55.2]; p=0.030) and rSS (Group 1: 0 [range: 0-5]; Group 2: 12.5 [range: 3.5-22.5]; p=0.001) were higher in patients with a composite endpoint. Additionally, creatinine (odds ratio [OR]: 13.098; 95% confidence interval [CI]: 1.471-116.620; p=0.021), non-postdilatation (OR: 8.340; 95% CI: 1.230-56.570; p=0.030), and rSS (OR: 1.157; 95% CI: 1.024-1.307; p=0.019) were independent predictors of a primary composite endpoint. Conclusion CAD severity has prognostic value for mortality, MI, and stroke in patients who undergo unprotected LMCA PCI. An increased initial SS and post-procedural rSS were related to adverse cardiovascular outcomes. The rSS was also an independent predictor of major adverse cardiac and cerebrovascular events and mortality.

The left internal mammary artery (LIMA) is widely used in coronary artery bypass grafting surgery due to its long term perfect patency rates. However, coronary steal syndrome can occur because of unligated LIMA side branches and it causes blood flow from coronary artery to LIMA. Even though the optimal therapy of coronary steal syndrome is still controversial, some percutaneous and surgical treatment modalities can be used in the treatment of steal phenomenon for relieving angina and resolving ischemia. It was demonstrated that percutaneous treatments such as the use of gelatin sponge particles or drug-eluting stents with covered stent, and coil and vascular plug embolization were used to treat this phenomenon successfully. Several studies revealed that these percutaneous treatments can reduce the ischemic area and results in prevention of blood flow from coronary artery to LIMA side branches. Supporting these findings, we herein present a 48-year-old male patient with objective ischemia with coronary steal syndrome treated successfully with the Amplatzer vascular plug (AVP) 4 and coil embolization in the same procedure. To the best of our knowledge, the combined therapy has not been described in the literature yet. Supporting the literature findings, successful treatment of LIMA side branches in our case with two different percutaneous modalities results in improvement of coronary flow and a reduced ischemic area and angina.

OBJECTIVES We aimed to associate a coronary artery disease (CAD) presence and severity with endothelial dysfunction (ED), carotid intima media thickness (CIMT) and Tissue Factor Pathway Inhibitor (TFPI). BACKGROUND ED has a central role in atherosclerosis. CIMT and TFPI activity are also related with atherosclerosis and CAD. METHODS In our prospective observational study, 50 patients had CAD and 30 had normal coronary arteries. Endothelial function was evaluated by endothelium-dependent flow-mediated dilatation (FMD) and nitroglycerine-mediated dilatation (NMD) measurements. CIMT and Serum TFPI levels were also measured. RESULTS TFPI was a statistically significant determinant between the two groups with an increased level in CAD (+) group (84.9 ± 19.3 vs 70.2 ± 14.7, p = 0.001). There was a positive correlation between CIMT and Gensini (r = 0.34, p = 0.014). There was a strong negative correlation between Gensini and FMD-NMD, statistically significant (FMD: r = -0.715, p < 0.001; NMD: r = -0.718, p < 0.001). CONCLUSION We observed that ED, increased CIMT and TFPI levels were associated with CAD. Additionally, increased CIMT measurements and decreased FMD and NMD values had a positive correlation with GSS (Tab. 4, Fig. 6, Ref. 50).

Iatrogenic aortic valve injury after mitral valve surgery is a well-known but rare complication. Herein, we report a 62-year-old male patient who underwent mitral valve replacement surgery 12 years ago and developed moderate to severe aortic regurgitation immediately after surgery.

Objective: To evaluate the prognostic value of C-reactive protein to albumin ratio (CAR) in patients with severe aortic valve stenosis undergoing surgical aortic valve replacement (AVR). Methods: Four hundred seventy-six patients with severe degenerative aortic stenosis who underwent successful isolated surgical AVR were enrolled. Hospitalization due to heart failure, surgical aortic reoperation, paravalvular leakage rates, and long-term mortality were evaluated in the whole study group. The participants were divided into two groups, as 443 patients without mortality (group 1) and 33 patients with mortality (group 2) during the follow-up time. Results: CAR was lower in patients without mortality than in those with mortality during the follow-up time (0.84 [0.03-23.43] vs. 2.50 [0.22-26.55], respectively, P

Introduction Behcet’s disease (BD) is a chronic, multisystemic disease characterised by vascular involvement. Acute and chronic inflammatory processes associated with BD may cause endothelial dysfunction, which can then lead to a subsequent increase of arterial stiffness and altered pressure wave reflections. The aim of this study was to evaluate the pulse wave velocity (PWV) measurements in patients with inactive BD and control subjects. Methods We studied 50 patients with inactive BD and 49 healthy control subjects without known cardiovascular disease. Carotid-femoral PWV was determined in all subjects by the same expert research clinician using Complior device (Colson, Paris, France). Results Mean disease duration was 3.23±2.31 years. Patients with BD (mean age 36.04±9.94 years) had significantly higher PWV levels compared to controls (9.57±1.88 vs. 8.47±1.13 m / s; p=0,003). PWV was found to be positively correlated with age, systolic, diastolic, mean blood pressure, waist, and waist / hip ratio. Conclusion In our study we demonstrated that patients with BD exhibit significantly increased arterial stiffness assessed by increased carotid-femoral PWV compared to healthy control subjects.

Background: This study aimed to examine the value of prognostic nutritional index (PNI) as a predictor of outcomes in patients with heart failure and preserved ejection fraction (HFpEF).Met...

Background: We aimed to investigate the clinical, laboratory, microbiological characteristics of IE in a single tertiary care centre in Turkey and to identify the factors associated with in...