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Introduction:Glomerular hyperfiltration is related to several clinical conditions, such as prediabetes and prehypertension, and associated with poor prognosis in long-term follow-up. This study aims to elucidate the relationship between glomerular hyperfiltration and short-term prognosis in patients with STsegment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI).Methods:A total of 1.402 patients (24% women, n=338) who had been diagnosed with STEMI and treated by primary PCI were enrolled in the present study. Glomerular hyperfiltration was defined an estimated glomerular filtration rate (GFR) above the 95th percentile based on age- and sex-specific distributions, and a low-filtration rate was defined as an estimated GFR below the 5th percentile. GFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration equation. The major adverse cardiovascular events (MACE) considered in this work included acute stent thrombosis, re-infarction, cardiogenic shock, and cardiac death within 30 days.Results:MACE was observed in 178 patients (12.6%). High and low GFRs led to higher risks of developing major cardiovascular events [odds ratio (OR): 1.92, 95% confidence interval (CI): 1.19-3.08, p

Introduction: To investigate the predictive accuracy of the CHA2 DS2 -VASc-HSF score in predicting the one-year mortality and major adverse cardiac and cerebrovascular events (MACCEs) in patients with non-STelevation acute coronary syndrome (NSTE-ACS). Patients and Methods: In this retrospective study, the study cohort was divided in to two groups based on the median CHA2 DS2 -VASc-HSF score: low-risk group (≤ 4 points) and high-risk group (> 4 points). Results: We enrolled 394 patients with NSTE-ACS (mean age: 58.7 ± 11.8 years). The CHA2 DS2 -VASc-HSF score independently predicted the coronary artery disease (CAD) severity (p< 0.01), one-year mortality (p< 0.01), and MACCEs (p< 0.01). The Global Registry for Acute Coronary Events (GRACE) risk score (GRS 1.0) independently predicted the CAD severity (p< 0.01), whereas the revised GRACE 2.0 risk score (GRS 2.0) independently predicted the one-year mortality (p< 0.01) and MACCEs (p< 0.01). The diagnostic performance of CHA2 DS2 -VASc-HSF was similar to GRS 2.0 in predicting the one-year mortality and MACCEs [area under the curve (AUC), 0.75 and 0.69 vs. 0.78 and 0.67; p= 0.41, p= 0.38, respectively) and better than GRS 1.0 for the CAD severity (AUC, 0.85 vs. 0.79; p= 0.03). The Kaplan-Meier curves displayed significantly higher one-year mortality and MACCEs in the high-risk group (p< 0.01) compared with the low-risk group (p< 0.01). Conclusion: The predictive accuracy of CHA2 DS2 -VASc-HSF is comparable to that of GRS 2.0 in determining the long-term cardiovascular outcomes; thus, it could be considered as a predictive model for patients with NSTE-ACS., Giriş: Bu çalışmada esas olarak modifiye CHA2 DS2 -VASc-HSF skorunun ST-yükselmesiz akut koroner sendromlu (STYz-AKS) hastalarda bir yıllık mortalite ve majör advers kardiyak ve serebrovasküler olayları (MACCEs) öngörüp öngörmediğini araştırmayı amaçladık. Hastalar ve Yöntem: Hastane kayıtları kullanılarak tasarlanmış bu retrospektif çalışmada, çalışma popülasyonu ortanca CHA2 DS2 -VASc-HSF skoruna göre düşük (≤ 4 puan) ve yüksek riskli (> 4 puan) olarak iki gruba ayrılmıştır. Bulgular: Çalışmaya ortalama 58.7 ± 11.8 yaşında olan 394 STYz-AKS hastası dahil edilmiştir. CHA2 DS2 - VASc-HSF skoru, koroner arter hastalığı (KAH) yaygınlığının, bir yıllık mortalitenin ve MACCEs’in bağımsız öngördürücüsü olarak bulunmuştur (sırasıyla, p< 0.01, p< 0.01, p< 0.01). Ayrıca “The Global Registry for Acute Coronary Events (GRACE)” 1.0 risk skorunun KAH yaygınlığı için (p< 0.01), güncellenmiş GRACE 2.0 risk skorunun ise bir yıllık mortalite ve MACCEs için bağımsız öngördürücü olduğunu saptadık (sırasıyla, p< 0.01, p< 0.01). CHA2 DS2 -VASc-HSF ve GRACE 2.0 risk skorlarının bir yıllık mortalite ve MACCEs’i öngörmede tanısal performanları istatistiksel olarak birbirine benzer iken [eğri altında kalan alan (AUC)= 0.75 ve 0.69 vs. 0.78 ve 0.67; sırasıyla, p= 0.41, p= 0.38), CHA2 DS2 -VASc-HSF KAH şiddetini öngörmede GRACE 1.0 risk skorundan daha iyi performans sergiledi (AUCs= 0.85 vs. 0.79; p= 0.03). Kaplan-Meier eğrisi CHA2 DS2 -VASc-HSF skoru > 4 puan olan hastalarda düşük riskli hastalara göre bir yıllık mortalite ve MACCEs’in istatistiksel olarak anlamlı derecede daha yüksek olduğunu gösterdi (sırasıyla, p< 0.01, p< 0.01). Sonuç: CHA2 DS2 -VASc-HSF’nin uzun dönem kardiyovasküler sonuçları öngörmedeki doğruluğu GRACE 2.0 ile kıyaslanabilir düzeyde olup klinik uygulamada STYz-AKS hastaları için bir tahmin modeli olarak düşünülebilir.

BACKGROUND This study aimed to investigate the predictive value of the newly defined C-reactive protein (CRP)-toalbumin ratio (CAR) in determining the extent and severity of coronary artery disease (CAD) in comparison with the other inflammatory markers such as neutrophil-tolymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), in patients with non-ST-elevated myocardial infarction (NSTEMI). PATIENTS AND METHODS This study is retrospectively designed and includes 205 patients with NSTEMI with a mean age of 56.6± 11.4 years. The study cohort was subdivided into two groups according to Synergy Between Percutaneous Coronary Intervention with Taxus and cardiac surgery score (SS) as low (

Background: The presence of intracoronary thrombus is associated with increased ischaemic complications in patients with NSTEMI. High thrombus burden is an independent predictor of major adverse ca...

Introduction:Non-ST-segment elevation myocardial infarction (NSTEMI) is a condition that constitutes a large part of acute coronary syndromes and has a high mortality rate with diffuse vascular disease. The aim of this study was to examine the association between monocyte to high-density lipoprotein cholesterol ratio (MHR) and thrombus burden, which is indicative of inflammation and cardiovascular endpoints in patients with NSTEMI.Methods:We retrospectively evaluated 205 consecutive patients who underwent coronary angiography for NSTEMI in our tertiary center. Complete blood count and biochemical analysis were performed using blood samples. Angiographic thrombus burden was classified as previously described by thrombolysis in the myocardial infarction (TIMI) study group.Results:Patients with high thrombus burden had higher monocyte count, MHR and platelet count compared to the group with low thrombus burden. TIMI and Syntax scores were also higher in the high thrombus burden group. Multiple logistic regression analysis revealed that TIMI and MHR values were independently related to high thrombus burden. [Odds ratio (OR): 1.678 (1.120-2.515) p=0.012) and OR: 1.432 (1.102- 1.861), p=0.007) respectively].Conclusion:In our study, we found that MHR was closely related to thrombus burden in patients with NSTEMI. With further studies, MHR may be a helpful parameter for risk scoring informing long-term morbidity and mortality.

Introduction:Transcatheter aortic valve implantation (TAVI) has been widely used in patients with high-risk aortic valve stenosis. Frailty is a parameter that significantly affects prognosis in cardiovascular diseases. In the clinic, the identification and validation of simple and inexpensive frailty evaluation methods are important. Our aim is to determine the importance of a simple and inexpensive clinical evaluation tool that can be used in patients with TAVI by examining the correlation between the “clinical frailty scale (CFS)” and “the psoas muscle area (PMA)”, which is a quantitative indicator of fraility.Methods:CFS was determined by clinical evaluation of 61 patients who underwent TAVI and PMA was calculated by computed tomography scan.Results:A significant correlation was found between the CFS and PMA values of the patients in the correlation analysis (r=-0.970, p

Objective: To assess outcomes of Syrian refugees undergoing coronary artery bypass surgery in a tertiary hospital in Turkey. Methods: We sought for in-hospital mortality and one year all-cause mortality as the main outcomes. We reviewed records of 67 Syrian and 427 Turkish patients undergoing isolated coronary bypass surgery between 2015 January and 2017 January retrospectively. Results: History of coronary, peripheral and carotid artery diseases and obesity were more frequent in Syrian patients. C-reactive protein levels were higher in Syrian patients whereas lipid profiles and systolic functions of the 2 groups were similar. Syrian patients more frequently presented with the acute coronary syndrome (26.9% versus 15.5%, p

The neutrophil to lymphocyte ratio (NLR), has been proposed as potential indicator of cardiovascular events. Our aim was to determine the relationship between NLR and development of myocardial injury after non-cardiac surgery (MINS).This observational cohort study included 255 consecutive noncardiac surgery patients aged ≥45 years. Electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels of the patients were obtained for a period of 3 days postoperatively.MINS was detected in 30 (11.8%) patients using the cut-off level of ≥14 ng/L for hscTnT. In the MINS group NLR (3.79 ± 0.7 vs. 2.69 ± 0.6, p 0.000) values were higher than non-NLR group. The NLR to be independently associated with the development of MINS (OR: 11.690; CI: 4.619-29.585, p 0.000).NLR seems to be a simple, easy and cheap tool to predict the development of MINS in patient undergoing non-cardiac surgery.

Initial presentation in almost half of the patients with chronic ischemic heart disease (IHD) is chronic stable angina. Despite recent improvements in diagnosis and treatment, IHD still appears to be the most important cause of morbidity and mortality in our country and industrialized countries. The main aim of the treatment of chronic stable angina is to increase life expectancy and to improve quality of life by reducing the frequency and severity of angina. Beta-blockers, calcium channel blockers and nitrates constitute the main stones of anti-ischemic and antianginal treatment; new antianginal agents should be considered in patients with resistant angina despite usage of traditional agents. It is essential to add lifestyle modifications to pharmacological treatment and patients should be informed firmly. Even though revascularization therapy has not been shown to be superior to the optimal medical therapy in prognosis and mortality in chronic stabil angina, it reduces angina and necessity to anti-anginal medications and improves exercise capacity and quality of life in patients who are symptomatic despite optimal medical therapy. In this review, we summarized the current approach to chronic stable angina in the light of the American College of Cardiology and European Society of Cardiology guidelines for the diagnosis and assessment of chronic stable angina.

A 52-year-old man complaining of persistent recurring chest pain at night underwent coronary angiogram at another institution. Normal coronaries were observed and he was discharged with muscle spasmolytic prescription. Since symptoms had continued, 24-hour Holter monitoring was ordered at our facility and results revealed huge ST elevation and polymorphic ventricular tachycardia. Cold pressor test performed in catheterization laboratory also resulted in ventricular tachycardia. Nifedipine was prescribed and follow-up Holter monitoring revealed no further vasospastic episodes. Utility of 24-hour Holter rhythm monitoring and cold pressor test in patients with recurrent chest pain at night is demonstrated in this report.

Totally subcutaneous intravascular portacath provide safe and reliable vascular access and is widely utilized for venous access for long-term parenteral administration of medications. Catheter fracture and/or embolization of the catheter fragment in to the heart and or pulmonary artery is a rare and potentially serious complication. When it occurs, a prompt surgical or percutaneous extraction of the embolized foreign body is necessary. We present an asymptomatic case of metastatic colon adenocarcinoma in a patient who had fragmentation of catheter from the connection of the port and migration to left pulmonary arteries. We successfully removed the 10-cm long and 6-Fr diameter fractured catheter segment from the left pulmonary artery via the right femoral vein using a snare catheter with triple loop without complication. Post-procedure course was uneventful and the nature of the vascular access made early ambulation possible. Compared to surgery, percutaneous approach is a less invasive, safe, reliable and effective technique. Therefore, we suggest that percutaneous transcatheter technique for retrieval of embolized or broken catheter fragments should be considered as the first-choice treatment.

Serum cholesterols play an important role in pathophysiology and prognosis of acute thrombotic diseases. The aim of the present study was to investigate the prognostic value of serum lipid parameters in acute pulmonary embolism (APE).From January 2008 to January 2014 a total of 275 patients who were hospitalised with a diagnosis of APE were retrospectively screened. Clinical data, laboratory parameters, serum cholesterol levels were recorded and pulmonary embolism severity index (PESI) scores were calculated. Mortality rate at 30 days was investigated as the clinical outcome.In our study population, 24 patients (8.7%) died within 30 days. Serum total cholesterol, LDL-C, HDL-C and triglyceride levels were significantly lower in deceased patients when compared to the survived patients (3.1 ± 0.6 vs. 4.7 ± 1.2 mmol/L, p0.01; 1.8 ± 0.9 vs. 2.9 ± 0.9 mmol/L, p0.01; 0.9 ± 0.3 vs. 1.2 ± 0.3 mmol/L, p0.01; 1.4 ± 0.7 vs. 1.7 ± 0.6 mmol/L, p = 0.04, respectively). In multivariate regression analysis; PESI scores (OR: 1.06 95% CI: 1.01-1.11, p0.01), right ventricular diameter (OR: 11.31 95% CI: 3.25-52.64, p0.01), total cholesterol (OR: 1.09 95% CI: 1.02-1.17, p0.01), LDL-C (OR: 1.06 95% CI: 1.01-1.12, p = 0.02), HDL-C (OR: 1.21 95% CI: 1.04-1.41, p0.01) and triglyceride (OR: 1.03 95% CI: 1.01-1.05, p0.01) levels were independently correlated with mortality.Serum total cholesterol, LDL-C, HDL-C and triglyceride levels, obtained within the first 24hours of hospital admission, may have prognostic value in patients with APE.

Objectives New-onset atrial fibrillation (NOAF) during hospitalization is considered a frequent complication associated with worse outcomes in the setting of ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the association of admission serum laboratory parameters, neutrophil to lymphocyte ratio (NLR), and monocyte to high-density lipoprotein ratio (MHR) with NOAF in STEMI patients treated with a primary percutaneous coronary intervention (PCI). Patients and methods A total of 621 patients who were hospitalized with a diagnosis of STEMI and treated with primary PCI were retrospectively enrolled in the study. NOAF during index hospitalization and overall mortality were reported as the clinical outcomes. Results In our study population, 40 (6.4%) patients developed NOAF during index hospitalization. Monocyte counts, mean platelet volume (MPV), red cell distribution width (RDW), NLR, MHR, C-reactive protein (CRP), creatinine, glucose, and uric acid levels were higher in the NOAF+ group compared with the NOAF- group. In multivariate regression analysis, age, left-ventricular ejection fraction, left atrial volumes, admission heart rate, multivessel disease, increased levels of CRP, MPV, RDW, uric acid, NLR, and MHR independently predicted NOAF. In addition, NOAF was found to be an independent predictor of overall mortality in the study population. Conclusion For the first time in the literature, admission serum levels of MPV, RDW, uric acid, NLR, and MHR were found to be correlated independently with NOAF after primary PCI.

Monocyte count to high-density lipoprotein ratio (MHR) has recently emerged as an indicator of inflammation and oxidative stress in the literature. We aimed to investigate the prognostic value of MHR in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI).A total of 513 patients who were hospitalized with diagnosis of acute ST-segment elevation myocardial infarction and treated with primary PCI were retrospectively enrolled in the study. Demographic and clinical data, admission laboratory parameters, and MHR values were recorded. Inhospital major adverse cardiac events (MACE) and mortality were reported as the clinical outcomes.Twenty-six patients (5%) died, and MACE was observed in 86 patients (17%) during hospital follow-up. Patients were categorized in 3 groups according to tertiles of admission MHR. The rates of inhospital mortality and MACE were significantly higher in tertile 3 group compared to tertile 1 group (10% vs 1%, 27% vs 11%; P.01 and P.01). In multivariate regression analysis, age, sex, presence of Killip 3 or 4, left ventricular ejection fraction, troponin I, C-reactive protein, and increased MHR levels (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P.01) independently predicted inhospital mortality; age, presence of Killip 3 or 4, troponin I, and increased MHR levels (odds ratio, 1.02; 95% confidence interval, 1.01-1.04; P.01) independently predicted MACE.Admission MHR values were found to be independently correlated with inhospital MACE and mortality after primary PCI.

Introduction. Usage of the Perclose ProGlide® (PP: Abbott Laboratories, Chicago, IL, USA) closure device is becoming increasingly prevalent during percutaneous endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI). The respective conditions treated via these procedures, abdominal aortic aneurysm and aortic valve stenosis, share risk factors but are two different physiopathological problems. Aim. Our aim was to compare the complication and success rates of PP closure device use in patients undergoing EVAR and TAVI. Materials and Methods. A total of 74 patients, including 58 undergoing TAVI and 16 undergoing EVAR, were analysed in our study. Results. Of the TAVI patients treated using the PP closure device, two (3.4%) had access to site-related bleeding complications and two (3.4%) experienced device failure. Of the EVAR patients who received the PP closure device, three (18.8%) had bleeding complications and three (18.8%) experienced device failure. Conclusion. Due to the underlying diffuse aortic wall pathology, the success rate of PP closure device use was lower and the complication rate of PP closure device was higher in the EVAR group versus the TAVI group.

Background Blood pressure variability (BPV) is a novel parameter related to adverse cardiovascular findings and events, especially in hypertensive patients. The aim of the present study was to investigate the relationship between short-term BPV and ascending aortic dilatation (AAD). Hypothesis Hypertensive patients with AAD may exhibit higher short-term BPV compared to hypertensive patients with normal diameter ascending aorta and BPV may be correlated with aortic sizes. Methods Seventy-six hypertensive patients with AAD and 181 hypertensive patients with a normal-diameter ascending aorta were retrospectively enrolled in the study. Clinical data, echocardiographic characteristics, and 24-hour ambulatory blood pressure monitoring characteristics were compared between the 2 groups. Standard deviation (SD) and Δ of BP were used as parameters of BPV. Results Although 24-hour mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were similar between the 2 groups, the SD of SBP and SD of DBP values were significantly higher in AAD patients (17.2 ± 6.8 vs 13.8 ± 3.5, P < 0.01; and 12.1 ± 5.1 vs 10.7 ± 3.1, P = 0.02, respectively). Daytime SD of SBP values were higher in AAD patients, whereas nighttime SD of SBP values did not differ between groups. In multivariate linear regression analysis, 24-hour SD of SBP, 24-hour Δ SBP, daytime SD of SBP, daytime Δ SBP, and left ventricular mass index were independently correlated with aortic size index. Conclusions Our study revealed higher levels of short-term BPV in hypertensive patients with AAD. This conclusion warrants further study.

WOS: 000343527100008 PubMed ID: 24525047 Background: It has been shown that left ventricular diastolic dysfunction (LVDD) develops in patients with metabolic syndrome (MetS). However, there is not sufficient evidence in the literature to determine whether this condition is due to increase in blood pressure, which is frequently encountered in MetS. The purpose of this study was to test the hypothesis whether LVDD in MetS is independent from the presence of hypertension. Methods: A total of 60 patients diagnosed with MetS and 30 healthy people, who were age- and gender-matched with the patient group, were included in the study as the control group. In the study group, 30 of the patients were normotensive whereas the other 30 had hypertension. Conventional echocardiographic examinations and tissue Doppler imaging were performed besides measurements of demographic and biochemical parameters. Results: In the hypertensive MetS group, early diastolic filling flow (E), early diastolic mitral annular velocity (E'), and E/A ratio were significantly lower compared to the control group. Late diastolic filling flow (A), deceleration time (DT), late diastolic mitral annular velocity (A'), and E/E' ratio were higher in the hypertensive MetS group than the control group. In the normotensive MetS group, E, E', and E/A ratio were also lower compared to the control group whereas DT, A', and E/E' ratio were higher. Conclusion: These findings support the idea that LVDD may develop in patients with MetS even in the absence of hypertension. In addition, co-existence of hypertension with MetS contributes to further worsening of diastolic functions. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

BACKGROUND: Acute pulmonary embolism (PE) is a serious clinical disease characterized by a high mortality rate. The aim of this study was to assess the prognostic value of international normalized ratio (INR) in acute PE patients not on anticoagulant therapy. METHODS: The study included 244 hospitalized acute PE patients who were not receiving previous anticoagulant therapy. Based on their 30‐day mortality, patients were categorized as survivors or non‐survivors. INR was measured during the patients’ admission, on the same day as the diagnosis of PE but before anticoagulation started. RESULTS: Thirty‐day mortality occurred in 39 patients (16%). INR was higher in non‐survivors than in survivors (1.3±0.4 vs 1.1±0.3, P=.003). In multivariate analysis, INR (HR: 3.303, 95% CI: 1.210–9.016, P=.020) was independently associated with 30‐day mortality from PE. Inclusion of INR in a model with simplified pulmonary embolism severity index (sPESI) score improved the area under the receiver operating characteristics (ROC) curve from 0.736 (95% CI: 0.659‐0.814) to 0.775 (95% CI: 0.701‐0.849) (P=.028). Also, the addition of INR to sPESI score enhanced the net reclassification improvement (NRI=8.8%, P

OBJECTIVES Galectin-3 is a marker associated with myocardial fibrosis and left ventricular myocardial index (LVMI). Myocardial fibrosis and LVMI have been reported in many studies to be associated with microvolt T-wave alternans (MTWA) positivity. In this study, galectin-3 levels of normotensive individuals and sustained systolic-diastolic hypertensive patients were compared and the association between galectin-3 levels and ambulatory ECG-based MTWA was investigated. METHODS A total of 184 individuals were included in the study, among whom, 43 were normotensive and 141 had sustained systolic-diastolic hypertension without cardiovascular or chronic renal failure. Galectin-3, MTWA, and LVMI were evaluated in all participants. Galectin-3 levels of hypertensive and normotensive participants were compared. The association between galectin-3, MTWA, LVMI, and estimated glomerular filtration rate (eGFR) was investigated in hypertensive patients. RESULTS LVMI and galectin-3 levels were higher among hypertensive patients compared with normotensives (94.9±26.8 vs. 76.4±22.9 g/m, 7.325±2.123 vs. 5.233±1.506 ng/ml; P

Cigarette smoking increases the oxidative stress mediated vascular dysfunction in young adults. We aimed to investigate the relation between the oxidative stress indices and coronary artery disease (CAD) severity in young patients presenting with acute myocardial infarction (AMI).Young patients (aged 〈 35 years) who were admitted consecutively to our hospital with a diagnosis of AMI were included in the study. Age matched healthy subjects were selected as controls. Oxidative stress indices including lipid hydroperoxide (LOOH), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase (PON) and arylesterase (ARE) activities were measured in serum. CAD severity was assessed by calculating the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Study) score. We analyzed the association between the oxidative indices and CAD severity.Forty two young patients were admitted to the hospital with AMI (age 32.4 ± 2.6 years; 39 males, 3 females). Current and heavy smoking was commonly observed among the patients (79%). All patients underwent emergency coronary angiography. Twenty-eight healthy subjects were selected as controls. Patients had significantly higher OSI and TOS levels (median, interquartile range) [0.44 (0.26-1.75) vs 0.25 (0.22-0.30), p0.001 and 6.0 (4.4-20.8) vs 4.1 (3.7-4.6), p0.001], respectively, and lower TAS and LOOH levels [1.6 ± 0.1 vs 1.7 ± 0.1, p = 0.02 and 3.0 ± 0.8 vs 3.6 ± 0.4, p = 0.001], respectively, compared to the control group. CAD severity correlated positively with OSI (r = 0.508, p = 0.001) and TOS levels (r = 0.471, p = 0.002). Subjects with an intermediate to high SYNTAX score (≥ 22) demonstrated significantly higher OSI (median, interquartile range) [0.40 (0.34-1.75) vs 0.34 (0.26-0.68), p = 0.01] and TOS [6.9 (4.4-20.8) vs 5.8 (4.5-11.4), p = 0.01] levels compared to subjects with low SYNTAX score.Oxidative stress is an important contributor to CAD severity among young smokers. Elevated OSI and TOS levels reflect disease severity and vascular damage related to heavy smoking in early onset CAD.

Aim: Aortic knob width (AKW) and calcification (AKC) were shown to be associated with atherosclerosis. We aimed to evaluate the relationship between AKW, AKC, and the extensivity of lower extremity arterial disease (LEAD).Material and Methods: AKW and AKC were assessed in patients with LEAD who underwent conventional or CT angiography. Characteristics of patients were retrospectively reviewed.Results: AKC was observed in 79 (42.2%) of 187 patients. Patients with AKC were older compared to those without (63.7±9.4 vs 60.2±8.9; p:0.009). Smoking was more frequent in patients with AKC whereas the frequency of coronary artery disease, hypertension (HT), dyslipidemia (DL), diabetes mellitus (DM) were similar. AKW was greater in patients with AKC (37.6±2.7 mm vs 36.7±2.4 mm; p: 0.013). Patients with AKC had higher TASC II class (2.8 ±0.9 vs 2.4±0.9; p:0.001). Patients were divided into low (A,B)(n:81) and high (C,D)(n:106) TASC II groups. Male patients were more common in both groups albeit statistical difference (%93.8 vs %82.1; p:0.017). DM, HT, and AKC were more common in high TASC II group. AKW was greater in high TASC II group (38.0±2.5 vs 35.8±1.9, p:0.001). HT [OR: 5,956 (2.800-12.671); p:0.001], AKW [OR: 1,583 (1.302-1.926); p:0.001] and AKC [OR: 2,540 (1.185-5.441); p: 0.017] were predictors for high TASC II class in multivariate logistic regression. In ROC analysis, AKW greater than 36.5 mm had 72.6% sensitivity and 69.1% specificity [AUC: 0.766, p:0.01, 95% CI (0.698–0.834)] to predict high TASC II class.Conclusion: AKW and AKC, easily assessed with plain chest radiograph, are related to extensivity of LEAD.Keywords: Atherosclerosis; aortic knob; lower extremity arterial disease; peripheral arterial disease; vascular calcification.

A 61-year-old man underwent successful percutaneous revascularization of both lower limbs with multiple stent implantations. Paralysis of right lower limb was noticed after completion of procedure when transferring the patient from angiography table. Since hematoma compressing lumbosacral neural plexus could be a fatal complication, computed tomography (CT) image was taken. CT showed bulge of distended bladder compressing stent struts. Following placement of Foley catheter, condition improved and he was subsequently discharged uneventfully.

A 47-year-old man presented to the outpatient clinic complaining of dyspnea. Physical examination was unremarkable. Electrocardiogram was normal. Chest x-ray showed distortion of the right cardiac silhouette by a large mass (Figure A). Transthoracic echocardiogram showed significant compression of the right atrium due to a large mass measuring 10x10 cm (Figure B, C). Positron emission tomography/computed tomography (PET/CT) displayed increased heterogeneous F-18 fluorodeoxyglucose (FDG) uptake with standardized uptake value (SUV) max 8.6 and hypometabolic areas, suggesting presence of necrotic tissue (Figure D). A 15x15x15-cm and 890-g giant mass with capsule invasion was successfully resected with partial pericardiectomy. Intrapericardial, intravascular, and lung invasion were not observed. Histopathological examination revealed type B1 thymoma, according to World Health Organization classification. Chemotherapy was administered. Control PET/CT performed on fourth postoperative month showed no increased FDG uptake in surgical or other sites. Thymomas and lymphomas comprise the majority of anterior mediastinal masses. While frequently asymptomatic, they may present with chest pain, dyspnea, or vena cava syndrome, depending on the dissemination of the tumor. In addition to displaying the anatomy of the tumor, PET/CT shows heterogeneous metabolic activity of the thymoma. Resection remains the first option when a tumor aggressively invades the cardiac and vascular structures, or causes significant compression, as in the present case. 353

A relationship exists between exposure to high altitude and increased coagulability. Mean platelet volume is a parameter of platelet functions and may be a marker for increased platelet aggregability. The aim of this study was to compare the mean platelet volumes and platelet counts in patients who experienced an acute coronary event at moderately high altitude and at sea altitude. Four hundred and one patients who experienced an acute coronary event were enrolled, of them 211 were born and had been living at the sea level, while 190 were born and had been living at high altitude (at least 2,000 m above the sea level). Patients were compared regarding the mean platelet volumes and platelet counts. The mean platelet volumes were significantly higher in patients living in high altitude (P = 0.001). No statistically significant differences were found among the groups regarding the platelet counts. As a result, this increased MPV values in highlanders who experienced an acute coronary event may reflect increased platelet aggregability.

Background Electrocution injury (EI) is a major problem in developing countries. The aim of this study is to investigate the effect of EI on electrocardiographic (ECG) parameters. Methods A total of 43 patients hospitalized with diagnosis of EI were prospectively enrolled. Admission ECGs were compared with follow-up ECGs obtained one month after the event. Results Maximum P wave duration (Pmax), minimum P wave duration (Pmin), P wave dispersion (PWD), PR interval, QRS complex duration, corrected QT duration (QTc), QT dispersion (QTD), T peak to T end (Tp-e) interval were longer and Tp-e interval/QT and Tp-e interval/QTc ratios were higher on admission ECGs compared to follow-up ECGs. Frontal QRS-T angle and frequency of patients with fragmented QRS were also higher on admission ECGs. Conclusion Our study revealed that EI causes significant deterioration of admission ECG parameters. The clinical use of these parameters in prediction of arrhythmias after EI warrants further studies.

Received: December 18, 2010 Accepted: June 6, 2011 Correspondence: Kazim Serhan Ozcan, M.D. Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi Kardiyoloji Klinigi, 34726 Uskudar, Istanbul, Turkey. Tel: +90 216 545 47 36 e-mail: serhandr@gmail.com ©2012 Turkish League Against Rheumatism. All rights reserved. Romatoid artrit (RA) toplumun yaklasik %1’inde gorulen, nedeni bilinmeyen, multisistem tutulumlu kronik bir hastaliktir. Hastaligin tipik ozelligi genellikle periferik eklemleri simetrik dagilimli olarak tutan persistan inflamatuar sinovittir. Romatoid artritin sistemik tutulumlari perikardit, plorit, vaskulit, tuzak noropatisi, interstisyel akciger hastaligi, Sjogren ve Felty sendromlaridir. Hastalarin yaklasik %50’sinde RA’nin perikardi etkiledigi, ekokardiyografik ve postmortem calismalarda gosterilmistir. Buna ragmen, kardiyak tamponad RA’nin nadir bir komplikasyonudur. Bu yazida, cerrahi olarak tedavi edilmis olan kardiyak tamponada neden olan lokule perikardiyal effuzyonlu 61 yasinda bir kadin hasta sunuldu. Anahtar sozcukler: Kardiyak tamponad; perikardiyal effuzyon; perikard; romatoid artrit. Rheumatoid arthritis (RA) is a chronic multisystem disease of unknown cause which affects approximately 1% of the population. The typical characteristic of RA is persistent inflammatory synovitis which usually involves peripheral joints in a symmetric distribution. Systemic involvements of RA include pericarditis, pleuritis, vasculitis, entrapment neuropathy, interstitial lung disease and Sjogren and Felty syndromes. Echocardiographic and postmortem studies have shown that RA affects pericardium in nearly 50% of the patients. However, cardiac tamponade is a rare complication of RA. In this report, we present a surgically-treated 61-year-old female patient with cardiac tamponade secondary to loculated pericardial effusion.

Atherosclerotic plaques tend to involve arterial localizations in which blood flow is not laminar due to arterial bends and bifurcations. A 49-year-old man was admitted to hospital with breathlessness and was subsequently diagnosed with left ventricular failure. Coronary angiography revealed three-vessel coronary artery disease and an anomalous extra left anterior descending artery taking off from the right sinus of Valsalva and spared from atherosclerosis. The absence of side branches and the relative lack of bends in arterial geometry were considered to be the cause of resistance to atherosclerosis. The present case identifies local flow conditions as an important factor determining the genesis of atherosclerosis in arterial segments.

Background: Demographic and clinical characteristics and angiographic findings of Turkish patients with coronary artery fistula have been investigated in this study and diagnostic tests and treatment methods used in these patients have also been evaluated in detail. Methods: We have examined the cardiac catheterization laboratory database retrospectively between March 2006 and July 2010. Among 49,567 patients, we have noted 60 patients diagnosed as coronary artery fistula. After coronary angiographic images were evaluated by two invasive cardiologists, 54 patients who had clear evidence of vessel of origin and drainage were included in the study. Results: A total of 54 (0.1%) patients with coronary artery fistula were noted. Mean age was 56.7 ± 10.7 years; 42 out of 54 patients had accompanying cardiac disorders. Patients’ complaints were directly associated with the presence of the fistula. Chest pain was the admission symptom in all of the patients with isolated coronary artery fistula. Six patients had coexistent congenital anomalies. Myocardial infarction with ST segment elevation occurred in 11 of the patients. In contrast to the previous reports, the most common artery of origin of the fistula was left anterior descending artery (50.8%) and pulmonary artery was found to be the most frequent region of the fistula drainage by 53.7%. Conclusions: Our findings suggest that large fistulas originating from the proximal segments of coronary arteries may increase the likelihood of atherosclerosis and myocardial infarction even in asymptomatic patients with no evidence of ischemia in noninvasive tests and no dilatation of cardiac chambers, and should therefore be closed.