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Carotid artery stenosis (CAS), mainly caused by carotid atherosclerosis, is related to ischemic stroke. We investigated whether C-reactive protein (CRP) to albumin ratio (CAR) was associated with increased severity of carotid stenosis in patients undergoing carotid angiography. A total of 269 patients who were undergoing carotid angiography were included in this study. The patients were divided into 2 groups with respect to the severe CAS: group 1 (stenosis < 70%, n = 189) or group II (stenosis ≥ 70%, n = 80). C-reactive protein to albumin ratio was higher in group II compared to group I (0.56 ± 0.25 vs 0.14 ± 0.01, P < .001). The CAR (odds ratio [OR]: 1.051, 95%CI: 1.027-1.076, P < .001), neutrophil to lymphocyte ratio (NLR), and total cholesterol levels were independent predictors of severe CAS. The area under the receiver operating characteristic curve (area under the curve) for the CAR to predict severe CAS was 0.798 (95% CI: 0.741-0.854, P < .001). C-reactive to protein albumin ratio was an independent risk factor of severe CAS. Therefore, CAR might be considered a potential index in the severity of carotid artery disease.

Introduction: Atrial fibrillation (AF) is the most common arrhythmia with a prevalence that increases by aging. AF causes morbidity and mortality due to thromboembolic events. In developing countries, the use of new generation medications can be delayed. Objective: We evaluated nonvalvular AF patients without effective oral anticoagulation (OAC) when non- vitamin K antagonists (NOACs) were mostly unavailable in Turkey before 2012–2013. The results were compared with what would happen if NOAC was available in use. Patients and Methods: Two-hundred and five patients in AF with adequate information were detected 123 of these patients were nonvalvular AF, (92 patients in these 123 ones were not taking OAC or on ineffective INR range) were included in the study. Results: Thirty-one (25.2%) of these patients were already on effective warfarin therapy. Ninety-two (74.8%) patients were not on warfarin therapy or on out of effective therapeutic range. About 52.2% of participants were female. The mean age was 70.62 ± 11.8 years. Eighteen (19.5%) patients had a recurrent stroke. Conclusion: OACs are recommended for patients with high stroke risk according to CHA2DS2-VASc score. OAC therapy significantly decreases mortality, morbidity, and also especially stroke risk. The only OAC therapy was warfarin over the decades until NOACs have been found. In our study, if NOACs could be available before 2012 in Turkey, 74.8% of our cohort would be under the effective anticoagulation and 19.5% of patients may have avoided from stroke. This is important for patients' lives and also for their costs.

Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not much is known about the etiologies of aortic aneurysm. Recently, in hypertensive (HT) patients, blood...

Objective Bleeding is one of the most important causes of mortality in patients with acute coronary syndrome (ACS). This study therefore aimed to investigate bleeding risk in patients with ACS who were scheduled to receive dual antiplatelet therapy (DAPT) in Turkey. Methods This was a multicentre, observational, cross-sectional cohort study. The study population included 963 patients with ACS from 12 centres in Turkey. We used the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score to predict the bleeding risk for all the patients. The patients were divided into high (>= 25) or low (= 25). Compared with the male patients, the female patients had higher PRECISE-DAPT scores (28.2 +/- 15.7 vs 18.4 +/- 13.6,P < .001). Among the females, the rate of patients with a PRECISE-DAPT score >= 25 was 53%, while among the male patients, the score occurred at a rate of 22%. The female patients had lower haemoglobin (Hb) levels than the male patients (12.1 +/- 1.7 vs 13.8 +/- 1.9,P < .001) and lower creatinine clearance (70.7 +/- 27.5 vs 88.7 +/- 26.3,P < .001). The in-hospital bleeding rates were higher among the patients with high PRECISE-DAPT scores than among those who did not have high scores. Furthermore, the patients with high PRECISE-DAPT scores had a higher in-hospital mortality rate compared with those with low PRECISE-DAPT scores (1% vs 0%,P = .11). Conclusions The mean PRECISE-DAPT score was high among the patients with ACS in this study, indicating that the bleeding tendency was high. This study showed that the PRECISE-DAPT score may help physicians determine the type and duration of DAPT, especially in patients with ACS in Turkey.

Aim Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. Methods Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. Results A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity andE/Aratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular laterale ', septale ', and septals ' were higher in younger subjects and in females.E/e ' ratio was increased progressively with advancing decades. Right ventriculare ' ands ' were decreased buta ' was increased with increasing age. Septale ' lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. TheE/e ' ratio greater than 15 (and also 13) was not found. Conclusion This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials. WOS:000560812700001 2-s2.0-85089593434 PubMed: 32815581

Background: Epicardial adipose tissue (EAT) has been shown to be associated with diabetes mellitus (DM), hyper- tension (HT), coronary artery calcification, and atherosclerotic disease. Mitral annular calcification (MAC) is also associated with atherosclerosis. The purpose of this study was to assess the relationship between EAT and severe MAC. Material/Methods: The study enrolled 102 patients who had severe MAC and 107 patients who did not have MAC, as determined by echocardiographic examination. EAT was measured by transthoracic echocardiography. The parasternal long-axis view was used to measure the maximal EAT thickness. Results: Patients with severe MAC were older (p

Şafak, Özgen (Balikesir Author), Objective: To evaluate the efficacy of the monocyte/lymphocyte, platelet/lymphocyte, and HDULDL ratios as markers of the severity of coronary artery ectasia(CE). Study Design: Cross-sectional study. Place and Duration of Study: Department of Cardiology, Izmir Katip Celebi University and Balikesir University, Turkey, from January 2017 to October 2018. Methodology: A total of 7,923 coronary angiographs were retrospectively scanned. Inclusion criteria was >1.5 times dilatated of native coronary artery segment. Exclusion criteria was

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

Wegener's granulomatosis (granulomatosis with polyangiitis) is a form of vasculitis of small-to-medium-sized vessels and associated with diffuse anti-neutrophil cytoplasmic antibodies (cANCA). Cardiac involvement is not uncommon with 6–25% of unselected patients and up to 44% of patients with severe renal involvement. We report a 23-year-old man with Wegener's cardiomyopathy with 25% ejection fraction. The overall mortality rate of Wegener's granulomatosis with cardiac involvement has been reported to be between 15 and 45%. So it is important to keep in mind that cardiac examination is a must to detect if cardiac involvement is present.

WOS: 000429775000020, PubMed ID: 28301907, Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important factor for ensuring efficacy and safety in nonvalvular atrial fibrillation (NVAF). There are controversial results regarding NOAC adherence in real-world data and there are no data about NOAC adherence in Turkish population. This study investigated the NOAC adherence based on self-report, factors affecting nonadherence, and the relation of the adherence level with efficacy and safety outcomes. This multicenter cross-sectional study included 2738 patients (59% female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more than 3 months with >30 days of supply between September 1, 2015, and February 28, 2016. To measure the adherence level, an 8-item Morisky Medication Adherence Scale was used. The mean age of the patients was 70 +/- 10 years. Of the 2738 patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A total of 630 (23%) patients had high medication adherence, 712 (26%) moderate adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6% vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%, P = .004) bleeding rates. The adherence to NOAC was found to be quite low in Turkey. Nonadherence is associated with bleeding and thromboembolic cardiovascular events. Age, taking NOAC twice a day, and the additional noncardiac diseases, depression, and dementia were the independent factors affecting poor medication adherence.

PubMed ID: 28238569, Objective No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies. Methods Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared. Results Of the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8 ± 9.8 vs. 68.7 ± 11.4 years, p

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

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

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

Transcatheter aortic valve implantation (TAVI) is a novel method for patients with severe aortic stenosis at high surgical risk. Although short- and medium-term outcomes after TAVI are encouraging, long-term data on valve function and clinical outcomes are limited. Hence, our case can make a contribution to literature. An 80-year-old patient with severe aortic stenosis underwent TAVI in our clinic in October 2015. After 5 months, she admitted to our emergency department with severe dyspnea. Her symptoms were started within 2 days and getting worse day by day. Echocardiography revealed us a severe aortic regurgitation due to dislocation of the valve to the left ventricular outflow tract side. After diagnosis, aortic regurgitation was treated by valve-in-valve technique. TAVI may provide an alternative therapeutic approach to ineligible or poor surgical candidates of degenerative aortic stenosis. However, this technique also has some complications such as mortality, atrioventricular (AV) block, stroke, and coronary obstruction. Valve embolization is an another rare complication of this procedure and usually can be prevented by careful preprocedure annulus measurements, stable lead positioning for rapid pacing, optimal valve positioning, full balloon inflation at the time of valve deployment, and complete balloon deflation before stopping rapid pacing. At this point, our case became important for the complication literature with its time, about 5 months. Because it is the more recently used technique, we need much more time to detect the usefulness and complications of TAVI and learn how to avoid these complications.

OBJECTIVE This study investigated the effect of coronary artery disease (CAD) severity, distribution and left ventricular ejection fraction (LVEF) on acute ventricular pacing threshold and lead impedance at the time of pacemaker implantation. METHODS One hundred and thirty-two patients who received a ventricular pacemaker or internal cardioverter-defibrilator (ICD) lead in our institution between 2007-2010 were included in this observational study. Patients were divided into ICD and anti-bradycardic pacemaker (PM) groups. Groups were compared for ventricular stimulation threshold, lead impedance and LVEF. Later, groups were sub-grouped according to the severity and distribution of CAD and subgroups were compared in both groups for ventricular stimulation threshold, lead impedance. Quantitative data of groups were compared by means of independent samples t-test. RESULTS Ventricular pacing thresholds were found significantly higher ICD group compared with PM group (p

Congenital anomalies of the coronary arteries are an uncommon but important cause of chest pain and sudden cardiac death. The incidence of coronary artery anomalies has been reported between 0.6 to 1.3% in angiography and 0.3% in autopsy. The anomalous origin of left and right coronary arteries from a single coronary ostium in the right sinus of Valsalva is extremely rare and accounts for a small fraction of these anomalies with reported prevalence of 0.017% to 0.03% according to angiographic studies. We report a case of 52-year-old woman, suffering from chest pain, with an anomalous common origin of all coronary arteries from the right sinus of Valsalva.