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DergiPark: 1020979 tmsj Aims: Peripartum cardiomyopathy is a rarely seen pregnancy-related myocardial disorder. The diagnosis is usually challenging and is made by exclusion. We aimed to present the recovery of a patient with peripartum cardiomyopathy as a result of a successful treatment plan. Case Report: A 26-year-old female patient with type-2 diabetes mellitus presented to the cardiology department of Trakya University School of Medicine. The patient experienced dyspnea and edema after delivery at 37 weeks of gestation. After the results of the blood tests, further cardiac examinations were deemed necessary. The echocardiogram revealed a low ejection fraction, indicating heart failure. The patient was recommended to halt breastfeeding and bromocriptine treatment was started. The patient was discharged one week later and kept under follow-up. Conclusion: Peripartum cardiomyopathy is a rare disease and therefore not easy to diagnose, but with appropriate treatment plans and frequent follow-ups, patients have high chances of full recovery.

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes.This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as65 years old, 65-75 yo, 75-84 yo and85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups.A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p0.05).Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.A delírium gyakran jelentkezik intenzív osztályon ápolt betegek körében, és rossz prognózissal társul. A de­lírium intenzív osztályos ellátása leginkább általános és palliatív intenzív osztályos adatokon alapul. Ebben a vizsgálatban azt a célt tûztük ki, hogy megállapítsuk a delí­rium incidenciáját és sajátosságait coronaria intenzív osztályon (CICU), továbbá megállapítsuk prognózisát, életkori eloszlását és a betegkimenetre gyakorolt hatását.A vizsgálatba egy tercier egyetemi kórház CICU-ján 2017. augusztus 1. és 2018. augusztus 1. között ápolt betegeit vontuk be. Részletesen tanulmányoztuk a betegdokumentációkat, rögzítettük a demográfiai, klinikai és laboratóriumi paramétereket. A delírium diagnózisát pszichiáter konzulens erôsítette meg. A betegeket két csoportra osztottuk (delírium vs. delíriummentesség), megállapítottuk a két csoportba kerülô betegek sajátosságait a vizsgálat kezdetén, és prognózisukat a kórházi ápolás és az utánkövetés során. Életkori sajátosságok alapján négy csoportba osztottuk a pácienseket:65 éves, 65–75 éves, 75–84 éves és85 éves, és a különbözô életkori csoportok között összehasonlítottuk a delí­rium incidenciáját, sajátosságait és prognózisát.1108, különbözô indikációk miatt intenzív osztályon ápolt beteget vontunk be a vizsgálatba (átlagos életkor: 64,4 ± 13,9 év; 66% férfi). Az összes beteg 11,1%-a esetében alakult ki delírium a CICU-n. A delí­riumban szenvedô betegek idôsebbek voltak, több kísérô betegségben szenvedtek, magasabb volt a szervezetük gyulladásos szintje, és magasabb volt a mortalitásuk is a kórházi ápolás során, mint azok esetében, akiknél nem alakult ki delírium (p0,05). A delirálók csoportjában az átlagosan 9 hónapos utánkövetés során szignifikánsan magasabb volt a kórházi újrafelvétel, az ismételt infarktus, a kognitív diszfunkció, a pszichiátriai kezelés szükségessége és a mortalitás is (p0,05). Az életkori alcsoportok szerinti felosztásban a delirálók csoportjában az életkor elôrehaladtával szignifikánsan nôtt a delírium és a mortalitás incidenciája egyaránt (p0,05).Amennyiben a coronaria intenzív osztályon ápolt betegnél delírium alakul ki, megnô a morbiditás és mortalitás incidenciája a kórházi ápolás alatt és az utánkövetés során is. A delírium gyakrabban fordul elô geriátriai betegek és társbetegségekkel küzdôk körében, és rosszabb prognózissal társul. A delírium mielôbbi felismerése érdekében a nagy kockázatú betegeket szorosan után kell követni.

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Congenital absence of the pericardium is not a common condition in daily practice. There are no obvious and clear symptoms. This condition, which is diagnosed incidentally, may cause some complications when not diagnosed. Therefore, imaging techniques, such as echocardiography, are essential. In this article, we present a rare case of pericardial agenesis.

WOS: 000455438000004, PubMed ID: 30079702, Background: The use of warfarin and aspirin in combination is restricted to limited patients under relevant guidelines. Aims: To evaluate the prevalence of the inappropriate combination of aspirin and warfarin therapy in daily practice and its risks. Study Design: Cross-sectional study. Methods: The awareness, efficacy, safety, and time in the therapeutic range of warfarin in the Turkish population study is a multi-center observational study that includes 4987 patients using warfarin for any reason between January 1, 2014, and December 31, 2014. To determine the prevalence of inappropriate combination use in daily practice, all patients who had a history of atherosclerotic disease (ischemic heart disease, peripheral artery disease) or cerebrovascular disease (n=1498) were excluded. The data of 3489 patients were analyzed. We defined inappropriate combination as all patients who received aspirin and warfarin regardless of the indication for warfarin use, under the direction of the European Society of Cardiology guideline recommendation. Results: The mean age of patients was 59.2 +/- 13.8 years (41.8% male). The prevalence of the inappropriate use of warfarin and aspirin combination was 20.0%. The prevalence of combination therapy in patients with a primary indication for mechanical heart valve, non-valvular atrial fibrillation, and other reasons was 20.5%, 18.7%, and 21.0%, respectively. Multivariate logistic regression analysis revealed that age (odds ratio, 1.009; 95% confidence interval, 1.002-1.015; p=0.010), heart failure (odds ratio, 1.765; 95% confidence interval, 1.448-2.151; p

OBJECTIVE: This study aimed to evaluate the safety of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) during daily clinical practice. METHODS: This was a prospective study conducted between January 01, 2016, and April 01, 2017, in patients aged ≥18 years with a diagnosis of NVAF. We performed the study in 9 clinical centers from different regions of Turkey, and the mean follow-up period was 12+2 months. We investigated major and minor bleeding events of DOAC. RESULTS: A total of 1807 patients with NVAF were enrolled. The mean age of the patients was 73.6±10.2 years, CHA2DS2-VASc score was 3.6±1.4, and HAS-BLED score was 2±1.2. The most frequently prescribed DOAC was dabigatran 110 mg bid in 409 (22.6%) patients. The patients on apixaban 2.5 mg bid were older (p

Background and objectives: Mortality may increase in hypouricemia as well as inhyperuricemia. We assessed the predictive value of low serum uric acid (SUA) levels on the risk of overall mortality or a composite endpoint of death and nonfatal events. Materials and Methods: In 1013 community-based middle-aged adults, free of uncontrolled diabetes and coronary heart disease at baseline, the association of sex-specific SUA tertiles with defined outcomes was evaluated prospectively by logistic regression, stratified to gender and presence of type-2 diabetes, using recent criteria. Results: Totally, 43 deaths and additional incident nonfatal events in 157 cases were recorded at a median 3.4 years’ follow-up. Multivariable linear regression disclosed SUA to be significantly associated among non-diabetic individuals positively with creatinine, triglycerides, and body mass index in women further with fasted glucose. In multivariable-adjusted logistic regression analysis, sex-specifically dichotomized baseline uric acid (&lt, 5.1 and &lt, 4.1 mg/dL vs. higher values) significantly predicted the non-fatal events in the whole sample (relative risk (RR) 1.51 [95% confidence interval (CI) 1.02, 2.26]), as well as in men, while composite endpoint in the whole sample tended to rise (RR 1.38). Compared with the intermediate one, the top and bottom SUA tertiles combined tended to confer mortality risk (RR 2.40 [95% CI 0.89, 6.51]). Adverse outcomes in diabetic women were predicted by tertiles 2 and 3. Conclusions: Inverse association of SUA with adverse outcomes, especially in men, is consistent with the involvement of uric acid mass in autoimmune activation. The positive association of uric acid with adverse outcomes in diabetic women is likely mediated by concomitant high-density lipoprotein dysfunction.

DergiPark: 1020978 tmsj Aims: We aimed to present a heart failure patient with a hydatid cyst of the lung, mimicking a phantom tumor. Case Report: A 71-year-old male patient pre- sented to the cardiology department of Trakya University School of Medicine with increasing shortness of breath and cough. His hospital admission complaints, heart failure history, and chest radiology results were consistent with a phantom tumor of the lung secondary to congestive heart failure. The patient was given diuretics; however, there was no evidence of resolution or change in the size of the observed cystic lesion. A hydatid cyst as a differential diagnosis was consid- ered, and subsequent questioning of the patient revealed animal contacts. The patient was offered the option of surgical removal of the cyst, which he declined due to the high mortality risk. The patient was prescribed 400 mg of albendazole and was advised to have regular check-ups. In the long term, he showed no further signs and symptoms of hydatid cyst. The hydatid cyst was neither removed nor disappeared, and it continued to be visible on radiological follow-up examinations. Conclusion: Due to the similarities present in admission complaints and chest examinations, it is challenging to differentiate hydatid cyst of the lung in heart failure patients. Physicians should be aware of the hydatid cyst in the differential diagnosis of pleural cysts and consider patients’ occupation and residency in order to not overlook zoonotic diseases.

DergiPark: 1020973 tmsj Aims: This study aims to evaluate the genetics, clinical characteristics, and functional abnormalities of patients diagnosed with hypertrophic cardiomyopathy in Trakya University Hospital. Methods: This retrospective study was conducted with patients who were diagnosed with hypertrophic cardiomyopathy between November 2009 - November 2019 in Trakya University Hospital. The data were obtained from the hospital’s database. Patients’ data (regarding age, gender, ge- netics, transthoracic echocardiogram findings, medications, types of hypertrophic cardiomyopathy, and first diagnoses) were examined. Numbers, percentages, means, and standard deviations were used as descriptive statistics. Results: Eleven patients with hypertrophic cardiomyopathy were evaluated. Five (45.45%) were female and 6 (54.54%) were male. The mean age of the female patients was 58.20 ± 8.57 years. The most common type of hypertrophic cardiomyopathy was found to be asymmetrical septal cardiomyopathy [7 (63.63%)]. Three (27.27%) patients presented with hypertension. There were gene mutations in three patients. Among these three patients, two (18.18%) patients have MYBPC3, and one (9.09%) patient has TTN gene mutations. Conclusion: Hypertrophic car- diomyopathy is usually accompanied by comorbidities such as arrhythmias, myocardial infarction, coronary artery disease. Therefore, these patients must be paid attention to in these matters.

DergiPark: 700196 tmsj Aims: Coronary artery anomalies are rare diseases among the population. These anomalies, which are usually noticed by chance, can remain silent for many years without symptoms. We aimed to present a patient with a coronary artery anomaly withouthaving any symptoms for many years. Case Report: A 73-year-old female patient presented to the Department of Cardiologyof the Trakya University School of Medicine. The patient stated that she had chest pain that decreased with rest and increasedwith exercise for the last 2 months. After the cardiac examination of the patient, imaging procedures were deemed necessary.After imaging, the patient was diagnosed with a single coronary artery anomaly. The patient was recommended to have surgery,but she refused. Upon this, the patient was discharged on condition that she was kept under frequent follow-up. Conclusion:Coronary artery anomalies have reached higher rates of diagnosis thanks to increased imaging technologies in recent years. Ifthese congenital diseases that can even cause death are noticed early, there are various treatment options. First of all, medicaltreatment is preferred, and surgery is recommended in patients with no response to the medical treatment. This disease, whichis closely related to the patient's life, should be carefully evaluated by the doctors. Keywords: Coronary arteries, cardiac anomaly,angiography

Objectives The prognostic effects of poor nutritional status and cardiac cachexia on coronary artery disease (CAD) are not clearly understood. A well-accepted nutritional status parameter, the prognostic nutritional index (PNI), which was first demonstrated to be valuable in patients with cancer and those undergoing gastrointestinal surgery, was introduced to patients requiring coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the prognostic value of PNI in patients with CAD undergoing CABG. Methods We evaluated the in-hospital and long-term (3-y) prognostic effect of PNI on 644 patients with CAD undergoing CABG. Baseline characteristics and outcomes were compared among the patients by PNI and categorized accordingly: Q1, Q2, Q3, and Q4. Results Patients with lower PNI had significantly higher in-hospital and long-term mortality. Patients with lower PNI levels (Q1) had higher in-hospital mortality and had 12 times higher mortality rates than those with higher PNI levels (Q4). The higher PNI group had the lower rates and was used as the reference. Long-term mortality was higher in patients with lower PNI (Q1)—4.9 times higher than in the higher PNI group (Q4). In-hospital and long-term mortality rates were similar in the non-lower PNI groups (Q2–4). Conclusion The present study demonstrated that PNI, calculated based on serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients undergoing CABG.

Combýnatýon of atrialseptal defect and mitral stenosis is defined as Lutembacher syndrome. Mitral stenosis is mostly acquired (rheumatic heart disease), as congenital mitral stenosis is very rare. The percutaneous interventions for mitral stenosis have become widespread,. The ASD may become either congenital or iatrogenic. Theco-existence of spontaneous or iatrogenic atrial septa ldefect and acquired mitral stenosis is known as acquired Lutembacher Syndrome. Here, we report a case of acquired Lutembacher Syndrome.

Keskin, Muhammed/0000-0002-4938-0097; Cinier, Goksel/0000-0001-5064-1816; Guvenc, Tolga Sinan/0000-0002-6738-266X WOS: 000430070500012 PubMed: 28401800 The prognostic impact of nutritional status in patients with pulmonary embolism (PE) is poorly understood. A well-accepted nutritional status parameter, prognostic nutritional index (PNI), which was first demonstrated to be valuable in patients with cancer and gastrointestinal surgery, was introduced to patients with PE. Our aim was to evaluate the predictive value of PNI in outcomes of patients with PE. We evaluated the in-hospital and long-term (53.8 +/- 5.4 months) prognostic impact of PNI on 251 patients with PE. During a median follow-up of 53.8 +/- 5.4 months, 27 (11.6%) patients died in hospital course and 31 (13.4%) died in out-of-hospital course. The patients with lower PNI had significantly higher in-hospital and long-term mortality. The Cox proportional hazard analyses showed that PNI was associated with an increased risk of all-cause death for both unadjusted model and adjusted for all covariates. Our study demonstrated that PNI, calculated based on serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients with PE.

Introduction: It is well known that the tendency toward thrombosis is increased in cancer patients. The increase in cancer procoagulant and tissue factor levels, endothelial damage, and stasis due to compression are among the most accused causes of thrombosis in cancer patients. Hypereosinophilia is a rare condition that causes endothelial damage leading to thrombosis. Case Presentation: We present a 64-year-old male patient with cardiac involvement of hypereosinophilia which developed in the T-cell lymphoma ground resulting in a fatal cardioembolic stroke. Despite normal left ventricular (LV) contractions, almost half of the ventricular volume was full of thrombus in this case. Conclusion: Hypereosinophilia is a rare cause of thrombus formation in the left ventricle in patients with preserved ejection fraction. However, hypereosinophilic cardiac involvement can lead to rapid, progressive, life-threatening complications.

Background: The Glasgow prognostic score (GPS), which is obtained from a combination of C-reactive protein (CRP) and serum albumin level, predicts poor prognoses in many cancer types. Systemic inflammation also plays an important role in pathogenesis of cardiovascular diseases. In this study, we aimed to investigate the effect of inflammation-based GPS on in-hospital and long-term outcomes in patients hospitalized in intensive cardiovascular care unit (ICCU). Methods: A total of 1004 consecutive patients admitted to ICCU were included in the study, and patients were divided into three groups based on albumin and CRP values as GPS 0, 1, and 2. Patients’ demographic, clinic, and laboratory findings were recorded. In-hospital and one-year mortality rates were compared between groups. Results: Mortality occurred in 109 (10.8%) patients in in-hospital period, 82 (8.1%) patients during follow-up period, and thus, cumulative mortality occurred in 191 (19.0%) patients. Patients with a high GPS score had a higher rate of comorbidities and represented increased inflammatory evidence. In the multivariate regression model there was independent association with in-hospital mortality in GPS 1 patients compared to GPS 0 patients (Odds ratio, (OR), 5.52, 95% CI: 1.2–16.91, p = 0.025) and in GPS 2 patients compared to GPS 0 patients (OR, 7.01, 95% CI: 1.39–35.15, p = 0.018). A higher GPS score was also associated with a prolonged ICCU and hospital stay, and increased re-hospitalization in the follow-up period. Conclusion: Inflammation based GPS is a practical tool in the prediction of worse prognosis both in in-hospital and one-year follow-up periods in ICCU patients.

Background and objectives: Despite being within the normal reference range, changes in thyroid stimulating hormone (TSH) levels have negative effects on the cardiovascular system. The majority of patients admitted to hospital with acute coronary syndrome (ACS) are euthyroid. The aim of this study was to investigate the effect of TSH level on the prognosis of in-hospital and follow-up periods of euthyroid ACS patients. Materials and Methods: A total of 629 patients with acute coronary syndrome without thyroid dysfunction were included in the study. TSH levels of patients were 0.3–5.33 uIU/mL. Patients were divided into three TSH tertiles: TSH level between (1) 0.3 uIU/mL and &lt, 0.90 uIU/mL (n = 209), (2) 0.90 uIU/mL and &lt, 1.60 uIU/mL (n = 210), and (3) 1.60 uIU/mL and 5.33 uIU/mL (n = 210). Demographic, clinical laboratory, and angiographic characteristics were compared between groups in terms of in-hospital and follow-up prognosis. Results: Mean age was 63.42 ± 12.5, and 73.9% were male. There was significant difference between tertiles in terms of TSH level at admission (p &lt, 0.001), the severity of coronary artery disease (p = 0.024), in-hospital mortality (p &lt, 0.001), in-hospital major hemorrhage (p = 0.005), total adverse clinical event (p = 0.03), follow-up mortality (p = 0.022), and total mortality (p &lt, 0.001). In multivariate logistic regression analysis, the high–normal TSH tertile was found to be cumulative mortality increasing factor (OR = 6.307, 95%, CI: 1.769–22.480, p = 0.005) during the 6-month follow-up period after hospitalization and discharge. Conclusions: High–normal TSH tertile during hospital admission in euthyroid ACS patients is an independent predictor of total mortality during the 6-month follow-up period after hospitalization and discharge.

OBJECTIVE Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. METHODS The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: ≥50%). RESULTS A total of 1098 patients (male, 47.5%; mean age, 83.5+-3.1 years) aged ≥80 years and 4596 patients (male, 50.2 %; mean age, 71.1+-4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8% for patients who were ≥80 years and 27.1% for patients 65-79 years old. For patients aged ≥80 years with HF, the prevalence rate was 67% for hypertension (HT), 25.6% for diabetes mellitus (DM), 54.3% for coronary artery disease (CAD), and 42.3% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p

Acute coronary syndromes generally result from the atherosclerotic plaque rupture or chronic stenosis. However, they may also be caused by vasospasm resulting from vasoactive peptides released from the endothelium around the plaques. The frequency of coronary vasospasm or variant angina may actually be higher than originally thought. Variant angina is a clinical condition that generally occurs after a triggering event and resolves spontaneously or after nitrate treatment, usually within 5 minutes. Clinical manifestations have also been reported to occur after coronary spasm due to a transient increase in the arterial tonus on the background of coronary plaques (1, 2). The male-to-female ratio is 5 to 1 (3). A normal electrocardiogram (ECG) recorded during chest pain may obscure a three-vessel vasospasm. Multi-vessel spasms are known to increase the risk of death, and therefore, angiography or provocative tests have been recommended (4, 5). An early and correct diagnosis may allow proper management with medications.

Background and objectives: Cranial magnetic resonance imaging findings of patients considered to be cryptogenic stroke may be useful in determining the clinical and prognostic significance of arrhythmias, such as atrial premature beats and atrial run attacks, that are frequently encountered in rhythm Holter analysis. This study was conducted to investigate the relationship between short atrial runs and frequent premature atrial contractions detected in Holter monitors and infarct distributions in cranial magnetic resonance imaging of patients diagnosed with cryptogenic stroke. Materials and Methods: We enrolled the patients with acute ischemic stroke whose etiology were undetermined. We divided the patients in two groups according to diffusion-weighted magnetic resonance imaging as single or multiple vascular territory acute infarcts. The demographic, clinical, laboratory, echocardiographic, and rhythm Holter analyses were compared. Results: The study investigated 106 patients diagnosed with cryptogenic stroke. Acute cerebral infarctions were detected in 31% of the investigated patients in multiple territories and in 69% in a single territory. In multivariate logistic regression analysis, the total premature atrial contraction count (OR = 1.002, 95% CI: 1.001&ndash, 1.004, p = 0.001) and short atrial run count (OR = 1.086, 95% CI: 1.021&ndash, 1.155, p = 0.008) were found as independent variables that could distinguish between infarctions in a single or in multiple vascular territories. Conclusions: Rhythm Holter monitoring of patients with infarcts detected in multiple vascular territories showed significantly higher premature atrial contractions and short atrial run attacks. More effort should be devoted to the identification of cardioembolic etiology in cryptogenic stroke patients with concurrent acute infarcts in the multiple vascular territories of the brain.

ObjectiveApelin is a novel adipocytokine with a significant role in ischemia/reperfusion injury that is synthesized and secreted in myocardial cells and coronary endothelium. There is debate on its value for the diagnosis and prognosis of myocardial infarction. We aimed to investigate plasma apelin level in patients with acute ST segment elevation (STEMI) and non-ST segment elevation (NSTEMI) myocardial infarction and its relationship with left ventricular function and prognostic parameters.MethodsForty-one patients with STEMI, 21 patients with NSTEMI and 10 patients as control group with normal coronary angiograms were included. Plasma apelin level at presentation was investigated regarding its relationship with other diagnostic and prognostic parameters.ResultsApelin level was significantly higher in acute myocardial infarction (0.31 ± 0.56 ng/mL) compared to control group (0.08 ± 0.05 ng/mL) (p 0.05). No correlation was found between apelin and NT-proBNP, hsCRP, troponin, ejection fraction (EF) and Killip score (p > 0.05). A positive correlation was found between apelin and TIMI, GRACE and Gensini scores (p ConclusionApelin level was found to be high in acute myocardial infarction. With its inotropic and vasodilator effects, apelin was thought to have a protective role against severe ischemia.

Introduction: The aim of the study was to evaluate whether serum thyroid-stimulating hormone (TSH) within the normal range in euthyroid subjects (having normal free triiodothyronine (fT3) and thyroxine (fT4)) is related to the risk of overall mortality or a composite endpoint of death and nonfatal events. Material and methods: In 614 middle-aged adult hospital screenees, free of uncontrolled diabetes at baseline, the association of sex-specific TSH tertiles with death was prospectively assessed using Cox regression, with the composite endpoint assessed using logistic regression in adjusted analyses, stratified by gender. Results: In total, 64 deaths and additional incident nonfatal events in 141 cases were recorded at a mean 7.55 years' follow-up. Multivariable linear regression revealed TSH to be significantly associated among men with age (p = 0.006), but in women inversely with fT3 and fT4 (p < 0.001, and p = 0.024 respectively). In logistic regression analysis, adjusted for age, fT3, fT4, systolic blood pressure and serum total cholesterol, sex-specific baseline TSH tertiles were associated in men neither with the risk of death nor with composite endpoint. In contrast, in women, the highest compared with the bottom TSH tertile predicted the risk of composite endpoint (relative risk: 2.02, 95% CI: 1.07-3.82) and, much more strongly, the mortality risk, independently of fT4 increments. Conclusions: The significant association of higher range of normal serum TSH in euthyroid middle-aged adults with the risk of death and nonfatal adverse outcomes in women alone cannot be accounted for by the action of thyroid hormone and is consistent with involvement of TSH in the pro-inflammatory state.

Background : Topical beta-blockers have a well-established role in the treatment of glaucoma. We aimed to investigate the outcome of patients who developed symptomatic atrioventricular (AV) block induced by topical beta-blockers. Methods : All patients admitted or discharged from our institution, the Siyami Ersek Training and Research Hospital, between January 2009 and January 2013 with a diagnosis of AV block were included in the study. Subjects using ophthalmic beta-blockers were recruited and followed for permanent pacemaker requirement during hospitalisation and for three months after discontinuation of the drug. A permanent pacemaker was implanted in patients in whom AV block persisted beyond 72 hours or recurred during the follow-up period. Results : A total of 1 122 patients were hospitalised with a diagnosis of AV block and a permanent pacemaker was implanted in 946 cases (84.3%) during the study period. Thirteen patients using ophthalmic beta-blockers for the treatment of glaucoma and no other rate-limiting drugs were included in the study. On electrocardiography, eight patients had complete AV block and five had high-degree AV block. The ophthalmic beta-blockers used were timolol in seven patients (55%), betaxolol in four (30%), and cartelol in two cases (15%). The mean duration of ophthalmic beta-blocker treatment was 30.1 ± 15.9 months. After drug discontinuation, in 10 patients the block persisted and a permanent pacemaker was implanted. During follow up, one more patient required pacemaker implantation. Therefore in total, pacemakers were implanted in 11 out of 13 patients (84.6%). The pacemaker implantation rate did not differ according to the type of topical beta-blocker used (p = 0.37). The presence of infra-nodal block on electrocardiography was associated with higher rates of pacemaker implantation. Conclusion : Our results indicate that topical beta-blockers for the treatment of glaucoma may cause severe conduction abnormalities and when AV block occurs, pacemaker implantation is required in a high percentage of the patients.

OBJECTIVE Iron deficiency (ID) is the most common nutritional deficiency, and iron metabolism becomes further deteriorated in the presence of certain conditions, such as heart failure (HF). Atrial fibrillation (AF) has many similarities to HF, including a chronic inflammatory pathophysiology; however, the prevalence of ID and other hematinic deficiencies in AF patients have not been determined. METHODS In this study, the prevalence of iron (serum ferritin