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

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

Background : Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality. In the current prospective study, we addressed the impact of RA on left atrial (LA) function and electrical remodelling. Further, we tried to demonstrate the effects of infliximab, an anti-TNF-alpha agent, on echocardiographical LA abnormality in RA patients with preserved left ventricular (LV) ejection fraction. Methods : We compared 38 female RA patients without clinical evidence of heart disease and 30 female controls without RA and clinical evidence of heart disease. Further, we compared RA patients receiving infliximab and increasing doses of prednisolone over a three-month period. At baseline and post treatment, this study assessed (1) LA and LV parameters using conventional and speckle tracking echocardiography (STE), and (2) electrocardiographic P-wave changes. Results : The values of C-reactive protein (CRP), isovolumic relaxation time (IVRT), A wave, and deceleration time (DT) were significantly higher in RA patients compared to the control group (p < 0.05), whereas E/E' and E/A values were found to be lower (p < 0.05) in RA patients. E/E' values were lower in prednisolone- compared to infliximab-treated patients (p < 0.05). After three months of infliximab and prednisolone treatment, CRP and disease activity score (DAS 28) values decreased in both groups (p < 0.05), and Duke activity status index (DASI) increased (p < 0.05). Maximal left atrial volume index (LAVImax), pre-contraction left atrial volume index (LAVIpreA) and maximum P wave (Pmax) of the RA patients were higher compared to the control group (p < 0.05), whereas LA global strain was found to be lower (p < 0.05). There was no difference in Pmax values between groups before and after the treatment period. E/E', LAVImax and LAVIpreA values of infliximab-treated patients decreased and LA global strain increased after three months of therapy compared to baseline (p < 0.05). At baseline in both treatment groups, E/E' and LA global late diastolic strain rate were lower in prednisolone- compared to infliximab-treated patients (p < 0.05). Conclusion : There was echocardiographic LA abnormality in these RA patients. In this patient group there was also a meaningful increase in maximum P wave assessed by electrocardiography. Infliximab therapy for a period of three months improved LA abnormality.

Objectives: Dual antiplatelet therapy (DAPT), consisting of clopidogrel and aspirin, is the main-stay treatment of acute coronary syndromes (ACS). However, major adverse cardiovascular events may occur even in patients undergoing DAPT, and this has been related to the variable pharmacodynamic efficacy of these drugs, especially clopidogrel. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are novel inflammatory markers for cardiovascular risk stratification, which may reflect an inflammatory state and thus high on-treatment platelet reactivity (HPR). Methods: We investigated the usefulness of PLR and NLR in predicting HPR in clopidogrel-treated patients with ACS. A total of 244 patients were enrolled in this study, and 43 of them were nonresponsive to clopidogrel. Results: Logistic regression analysis indicated that PLR was significantly associated with HPR (P < 0.001). Using a cutoff level of 331, PLR predicted HPR with a sensitivity of 73% and a specificity of 69% (odds ratio: 376.15, 95% confidence interval = 37.813–3741.728 P < 0.001, receiver operating characteristic curve: 0.885). Conclusions: We suggest that more attention should be paid to the PLR values of these patients on admission to identify individuals who may not benefit from clopidogrel during the course of ACS.

Objective: heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided. Methods: this is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM. Results: there were 1054 patients with a mean age of 63.3±13.3 years and with a median follow-up period of 16 (7-17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p, NA

Purpose. The purposes of this study are to assess the acute effects of iodixanol, an iso-osmolar contrast media, on pulmonary functions and to evaluate the body composition in order to find out its role in causing this deterioration. Methods. 35 male and 25 female patients undergoing diagnostic coronary angiography (CA) were enrolled in the study. Before CA, all patients’ body compositions were evaluated by measuring their body mass indexes (BMIs) and waist-to-hip ratios (WHRs). Total body waters (TBWs), fat masses (FMs), fat-free masses (FFMs), and basal metabolism rates (BMRs) were measured via bioimpedance analysis. The CA was performed via radial artery route using iodixanol in every patient. The pulmonary function tests of these patients were performed before, during, and 2 hours after the CA. FEV1∆, FEF25–75%∆, and FVC∆ parameters were calculated by subtracting the measured baseline value from the measurement after the CA. Results. Angiography caused significant reduction in forced expiratory volume in 1 sec (FEV1, from 94.17 ± 18.83 to 84.45 ± 18.31, p<0.0001), forced vital capacity (FVC, from 96.57 ± 15.82 to 88.31 ± 17.96, p<0.0001), and forced expiratory flow at 25–75% (FEF25–75% from 82.54 ± 24.26 to 72.11 ± 25.41, p=0.001) and remained lower after 2 h after CA in male patients, respectively. FEV1 values were 103.40 ± 17.79 to 94.96 ± 17.063 (p=0.004); FVC values were 107.20 ± 19.03 to 99.08 ± 20.56 (p=0.009); and FEF25–75% values were 83.92 ± 24.30 to 73.24 ± 20.45 (p=0.005) before and after CA and remained lower after 2 h after CA in female patients, respectively. FEV1/FVC ratio remained unchanged. FEF25–75%∆ was statistically correlated with FFM, TBW, and WHR (p<0.05; r=−0.344, r=−0.347, and r=0.357, resp.), and FVC∆ was correlated with WHR in male patients (p=0.018, r=397). Conclusions. Our data suggested that diagnostic CA using iodixanol, an iso-osmolar contrast media, leads significant impairment in respiratory functions. Due to the persistence of these reductions even 2 hours after CA, ventilatory functions should be considered especially in patients whose body compositions or hydration levels are not within the desired physiological range.

Kocayigit, Ibrahim/0000-0001-8295-9837; WOS:000473278000005 PubMed ID: 31264653 Objective: It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. Methods: All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). Results: Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were over-represented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. Conclusion: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.

We present the case of a 54-year-old male patient with Loeffler endocarditis. It is a rare disorder characterized by fibrous thickening of the endocardium leading to apical obliteration and restrictive cardiomyopathy resulting in heart failure, thromboembolic events or atrial fibrillation. To the best of our knowledge, this is the first case reporting the electrical silence of the right ventricular (RV) apex caused by fibrothrombotic thickening of this area. Under these circumstances RV apical implantation of an implantable cardioverter defibrillator (ICD) or pacemaker electrode may lead to unsuccessful stimulation of these devices.

Background/aim: We investigated whether obstructive sleep apnea syndrome (OSAS) has any impact on pulmonary artery distensibility (PAD) and right ventricular (RV) function. Materials and methods: Subjects were categorized according to apnea?hypopnea index (AHI) as follows: controls (n = 17 and AHI < 5), mild-to-moderate OSAS (n = 22 and AHI = 5?30), and severe OSAS (n = 29 and AHI > 30). All subjects underwent transthoracic echocardiography a er polysomnography to assess PAD and RV function. PAD was recorded as M-Mode trace of the right pulmonary artery and was de ned as (PAmax ?PAmin/PAmin) × 100. S? was measured by means of TDI of the lateral annulus of the RV using apical four-chamber view. Results: Patients with severe OSAS demonstrated impaired RV longitudinal systolic function (S?) compared to the other groups (P < 0.05). Impaired pulmonary vasculature elastic properties as re ected by decreased PAD were more prevalent in severe OSAS (26.2 < 5.7%) compared to the controls (29.9 &pm; 4.6%; P < 0.05) and mild-to-moderate OSAS (29.0 &pm; 4.1%; P < 0.05). An inverse relation between PAD (P < 0.05), RV myocardial performance index (MPI) (P < 0.05), and AHI was demonstrated. S? also correlated with PAD (P < 0.05). Conclusion: PAD is a signi cant tool to evaluate pulmonary vasculature sti ening and is well correlated with disease severity in OSAS. Further, impaired PAD may lead to RV systolic dysfunction.

The purpose of the present study was to evaluate how obstructive sleep apnoea (OSA) influences left ventricular (LV) torsion and whether nasal continuous positive airway pressure (CPAP) therapy has any impact on LV torsion in OSA patients with established cardiovascular risk factors.LV torsion was assessed by two-dimensional speckle tracking echocardiography (STE) in 162 participants without overt cardiovascular disease. The participants were categorized according to the apnoea-hypopnea index (AHI) as controls and mild, moderate and severe OSA patients. Forty-three patients with AHI greater than 30 were enrolled to receive CPAP therapy for 24 weeks. Twenty-eight patients received CPAP therapy effectively (compliance: 65%). After completion of CPAP therapy, STE was repeated to evaluate LV torsion.LV torsion was decreased in the severe OSA group compared to mild and moderate OSA but was similar to controls as a result of predominant decrease in apical rotation. AHI had no correlation with LV torsion in moderate OSA but a significant and mild negative correlation with LV torsion in severe OSA. When adjusted for potential confounding variables such as left ventricular mass index, diastolic dysfunction and the presence of hypertension, AHI and E/E' remained significant predictors of LV torsion in OSA patients. LV apical rotation tended to increase after effective CPAP therapy. On the other hand, LV basal rotation decreased significantly.LV torsion was altered in OSA patients with varying degrees according to the disease severity. Furthermore, there was no significant change of torsion after 24 weeks of CPAP therapy.

Obstructive sleep apnea (OSA) is a common syndrome in patients with metabolic syndrome (MetS). Epicardial fat thickness (EFT), an indicator of visceral adiposity, is a novel parameter for studying patients with OSA. Our aim was to investigate the effects of continuous positive airway pressure therapy (CPAP) therapy on EFT.A total of 162 subjects (68 women and 94 men) were included and divided into three groups: Group I: Apnea-hypopnea index (AHI) 5 (n = 45), Group II: AHI 5-15 (n = 22), and Group III: AHI 15 (n = 95). All participants underwent full-night polysomnography and transthoracic echocardiography. There were 28 symptomatic patients with AHI 15 who received compliant CPAP therapy for 24 weeks.MetS was more frequent, and systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose were higher in Group III compared with I (p 0.05). High-density lipoprotein (HDL) levels were lower in Group III compared with I (p 0.05). Triglyceride levels and waist circumference were higher in Group III compared with I and II (p 0.05). EFT was higher in Group III compared with I and higher in Group II compared with I (p 0.05). EFT was predicted by MetS and AHI. After CPAP therapy high-sensitive C-reactive protein (hsCRP) and EFT were reduced (p 0.05).EFT was significantly higher in patients with AHI 15 and predicted by MetS and AHI. CPAP therapy reduced hsCRP levels and EFT.

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

Objective: Obstructive sleep apnea (OSA) is associated with thromboembolic events. Compromised left atrial appendage (LAA) function due to left ventricular (LV) performance abnormality, often present in patients with OSA, may play an important role. The purpose of this study is to evaluate LV and LAA mechanical functions during sinus rhythm (SR) in patients with OSA. Methods: LV and LAA functions were assessed in 43 OSA patients and compared with that of 20 control patients in SR. Tissue Doppler velocities of the LAA apex and emptying velocities (EV) of LAA were obtained on parasternal short-axis view. Results: The baseline clinical characteristics were similar except for AHI (apnea-hypopnea index), minimal SaO2, mean SaO2, hypertension, and body-surface area. Most of the LV echocardiographic parameters significantly deteriorated in OSA patients in comparison with those in the control group. LAA EV, LAA systolic relaxation velocity (SM), LAA early-diastolic velocity (EM), LAA contraction velocity (AM), left atrial (LA) minimum volume index, LA ejection fraction, LA conduit volume index, and LA reservoir volume index were lower in OSA patients compared with those in the control group (p

Objectives This study investigated the effects of infliximab, a monoclonal antibody against TNFα, on myocardial deformation and aortic elasticity in patients with rheumatoid arthritis (RA), and the association of aortic elasticity with myocardial deformation. Study design 38 female rheumatoid arthritis (RA) patients and 30 healthy controls were included in the study. Twenty patients received infliximab and 18 patients received prednisolone. Left ventricular (LV) longitudinal, circumferential and radial strain, systolic strain rate and early diastolic strain rate using speckle-tracking echocardiography, and aortic elasticity using M-mode echocardiography were assessed at baseline and post-treatment. Results LV systolic longitudinal basal-, mid-, and apical strain, systolic mid- and apical strain rate, basal-, mid- and apical early strain rate, circumferential systolic apical strain and systolic strain rate were reduced in RA patients compared to controls. Compared to baseline, infliximab treatment increased aortic strain, aortic distensibility and decreased aortic s index. No significant aortic elastic changes were observed with prednisolone treatment. Longitudinal basal- and apical strain, basal-, mid- and apical systolic and diastolic strain rates, circumferential basal systolic strain, radial mid- and apical strain and apical strain rate were increased following infliximab treatment. Infliximab treatment improves aortic elasticity in parallel to myocardial deformation, but no significant association was observed following prednisolone treatment. Conclusion Myocardial deformation is impaired in RA patients and is related to aortic stiffness. Chronic inhibition of TNFα improves LV deformation in association with aortic elasticity.

BACKGROUND AND PURPOSE To investigate an association between left atrial (LA) structural and P wave dispersion (PWD) during sinus rhythm, and electrical remodeling in cryptogenic stroke (CS) patients. METHODS Forty CS patients and 40 age- and sex-matched healthy controls were enrolled. P wave calculations were based on 12-lead electrocardiography (ECG) at a 50-mm/s-paper speed with an amplitude of 10 mm/mV. Difference between the maximum and minimum P wave duration was the P wave dispersion (PWD=Pmax-Pmin). LA deformation was evaluated by speckle tracking echocardiography within 3 days of the acute event. RESULTS PWD was 30.1±7.0 ms and 27.4±3.5 ms in CS and control group (P=0.02), whereas LA maximum volume index [LAVImax] was 20.4±4.5 mL/m(2) and 19.9±2.4 mL/m(2) in CS and control group, respectively (P = 0.04). While global peak LA strain was [pLA-S] (LA reservoir function) 41.4 ± 6.3% and 44.5 ± 7.1% in CS and control group, (P = 0.04), global peak late diastolic strain rate values [pLA-SRa] (LA pump function) were 2.5 ± 0.4% and 2.9 ± 0.5% in CS and control group, respectively (P = 0.001). A mild and a strong negative correlation between global pLA-S and LAVImax (r=-0.49; P

PMID = 28867012