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Background: Coronary artery perforation (CAP) is an infrequent and life-threatening complication of percutaneous coronary intervention (PCI), requiring prompt intervention. There is insufficient data about the prognosis and management of CAP in patients with acute coronary syndrome (ACS). The aim of this study was to investigate the management of CAP in patients with ACS. Methods: The results of 25 patients with CAP were retrospectively analyzed. Results: Of the 25 patients, 14 patients (56%) had ACS. According to the Ellis classification, the grade of perforation was type-I in 8 (32%) patients, type-II in 6 (24%) patients and type-III in 11 (44%) patients. Prolonged balloon inflation was performed to 20 (80%) cases of CAP. It successfully sealed the perforation in three cases of type-I, five cases of type-II CAP and in seven cases of type-III CAP. Seven patients underwent covered stent implantation. Emergent CABG was required in two patients with type-III CAP. In-hospital mortality was not observed in the patients. Conclusion: The outcomes of CAP in patients with ACS were similar to patients with stable coronary disease. The continuation of anti-platelet agents after the successful management of CAP may be encouraged in these patients.

Background: Chronic obstructive pulmonary disease (COPD) is not only characterized by chronic airflow limitation, but is also a systemic disease. There is no information about alterations in right ventricle (RV) functions precipitated by systemic manifestations of COPD. Objectives: We aimed to evaluate the relationship between the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index that evaluates systemic manifestations of COPD and RV functions by means of 2-dimensional speckle-tracking echocardiography (2D-STE) in COPD patients. Methods: The study involved 135 COPD patients and 37 control subjects. All patients underwent 2D-STE, pulmonary function tests and 6-min walk tests, and were divided into quartiles according to their calculated BODE index score. Results: COPD patients had impaired RV and left-ventricle diastolic functions compared to controls. There was a decreasing trend from quartile 1 (Q1) to Q4 in RV functional parameters, i.e. RV free wall strain (RVFW-S, p < 0.001), tricuspid annular plane systolic excursion (p < 0.001), systolic myocardial velocity (p < 0.001), RV fractional area change (p < 0.001), RV myocardial performance index (p < 0.001) and pulmonary artery systolic pressure (p < 0.001). The transmitral Doppler E wave/lateral mitral annular tissue Doppler E wave ratio was similar in the 4 BODE index quartiles (p = 0.159). Multivariate analysis was performed to find independent predictors of decreased RVFW-S (≤19.06), and the BODE index (in quartiles; OR 4.61 and 95% CI 1.85-11.63) was found to be an independent predictor. In a partial correlation analysis adjusted for forced expiratory volume in 1s % predicted, RVFW-S was correlated with the 6-min walk distance (r = 0.498). Conclusion: The BODE index, which can be easily evaluated in office settings, may provide information about reduced RV functions as well as guiding treatment and helping to predict prognosis in COPD patients.

Objectives: Typical atrioventricular nodal reentrant tachycardia (AVNRT) can be cured with slow pathway ablation. This study was designed to assess the alterations in atrial and ventricular functioning using speckle tracking echocardiography in consecutive patients with typical AVNRT who underwent slow pathway radiofrequency (RF) ablation. Study design: Included in this study were 23 consecutive patients with symptomatic drug-resistant typical (slow-fast) AVNRT, all of whom underwent an invasive electrophysiology study and RF ablation. Patients underwent transthoracic echocardiographic evaluation 24 hours before and 24 hours after the ablation procedure. Results: AVNRT was induced during the electrophysiological study, and RF ablation successfully eliminated tachyarrhythmia in 23 (100%) patients. The atrial-His (A-H) interval was decreased in the post-ablation period compared to the pre-ablation period without the occurrence of immediate conduction disturbances. Peak left atrial longitudinal strain during the reservoir phase was increased in the post-ablation period compared to the pre-ablation period (48.24+-16.45 vs. 38.07+-15.72, p

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular morbidity and mortality. Increased arterial stiffness is associated with the presence and severity of cardiovascular disease. The cardio-ankle vascular index (CAVI) is a new method for assessment of arterial stiffness that is not influenced by blood pressure at the time of measurement and is significantly correlated with the presence and severity of cardiovascular disease. The aim of the present study was to evaluate whether there is an association between the spirometric severity of COPD, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, with arterial stiffness as assessed by CAVI. We enrolled 123 patients with COPD (102 men) followed up by the chest medicine outpatient clinics and 35 healthy subjects (26 men). All patients were assessed with spirometry, CAVI, and clinical history. Patients with COPD had significantly increased CAVI values compared with control subjects (10.37 ± 2.26 vs. 6.74 ± 1.42, p

OBJECTIVE 24-h ambulatory blood pressure monitoring (24-h ABPM) is a better predictor of cardiovascular events (CVEs) than spot blood pressure (BP) measurements in hypertensive diabetic patients. In this patient group, the underlying mechanism of the relationship between a nondipper pattern determined with 24-h ABPM and increased incidence of CVE is unknown. Cardioankle vascular index (CAVI) is a new index of the overall arterial stiffness from the aorta to the ankle. The objective of the present study was to evaluate the relationship between a dipper/nondipper pattern and arterial stiffness in hypertensive diabetic patients using the CAVI method. METHODS We enrolled 99 hypertensive patients with type-2 diabetes mellitus. 24-h ABPM and CAVI measurements were performed for all patients. The relationship between a dipper/nondipper pattern and CAVI measurements was analyzed. RESULTS Sixty-three (63.6%) patients had a nondipper pattern. In univariate analysis, CAVI, mean arterial pressure (MAP)-asleep, overall diastolic BP, overall systolic BP, duration of hypertension, and statin use were significantly higher among patients with a nondipper pattern than that in dippers. Multivariate linear regression analyses showed that the difference between MAP-asleep and MAP-awake was associated independently with CAVI (β coefficient=0.514, P

Background— Prosthetic valve thrombosis during pregnancy is life-threatening for mother and fetus, and the treatment of this complication is unclear. Cardiac surgery in pregnancy is associated with very high maternal and fetal mortality and morbidity. Thrombolytic therapy has rarely been used in these patients. The aim of this study is to evaluate the safety and efficacy of low-dose (25 mg), slow infusion (6 hours) of tissue-type plasminogen activator for the treatment of prosthetic valve thrombosis in pregnant women. Methods and Results— Between 2004 and 2012, tissue-type plasminogen activator was administered to 24 consecutive women in 25 pregnancies with 28 prosthetic valve thrombosis episodes (obstructive, n=15; nonobstructive, n=13). Mean age of the patients was 29±6 years. Thrombolytic therapy sessions were performed under transesophageal echocardiography guidance. The mean dose of tissue-type plasminogen activator used was 48.7±29.5 mg (range, 25–100mg). All episodes resulted in complete thrombus lysis after thrombolytic therapy. One patient had placental hemorrhage with preterm live birth at the 30th week, and 1 patient had minor bleeding. Conclusions— Low-dose, slow infusion of tissue-type plasminogen activator with repeated doses as needed is an effective therapy with an excellent thrombolytic success rate for the treatment of prosthetic valve thrombosis in pregnant women. This protocol also seems to be safer than cardiac surgery or any alternative medical strategies published to date. Thrombolytic therapy should be considered first-line therapy in pregnant patients with prosthetic valve thrombosis.

Introduction: We aimed to investigate the role of electrocardiography (ECG) findings in determining infarct related coronary arteries of patients hospitalized with a diagnosis of acute inferior myocardial infarction (AIMI). Patients and Methods: The first ECG records taken on admission to hospital and demographic characteristics of 132 patients, who were followed with the diagnosis of AIMI (mean age, 57.3 ± 11, 118 men) in our center between January 2004-January 2009, were evaluated. Results: When coronary angiography were evaluated, it was detected that the infarct-related coronary artery (IRCA) was the right coronary artery (RCA) in 70.4% of all patients, whereas it was circumflex artery (Cx) in 29.6% respectively. It was detected that DIII-ST elevation was higher than DII (94.6% sensivity, and 75.9% specifity, p= 0.001) and there was st depression in aVL and DI leads in cases which IRCA was RCA (88.2% sensivity and 75.2% specifity, p= 0.011). Although ST depression in aVL lead was higher than st depression in DI in cases which RCA was IRCA, this finding was defined statistically significant (%95.7 sensivity; %73.6 specifity; p= 0.016). RCA was the IRCA significantly in patients with inferior wall MI accompanied by right ventricular myocardial infarction (p= 0.005). Although Cx was observed as the culprit artery in cases which was accompanied by posterior wall infarction, no statistically finding was detected (p= 0.3). ST-depression was detected in V1-2 leads in ECG of patients whose culprit artery was Cx (%84.6 sensitivity, %36.3 specificity, p= 0.009). Conclusion: The findings based on surface ECG of the patients who underwent AIMI shows that IRCA can be predicted., Giriş: Akut inferiyor miyokart enfarktüsü (AİME) tanısıyla hastaneye yatırılan olguların enfarktüsten sorumlu koroner arterlerinin belirlenmesinde elektrokardiyografi (EKG) bulgularının önemini araştırdık. Hastalar ve Yöntem: Merkezimizde Ocak 2004-Ocak 2009 tarihleri arasında AİME tanısı ile takip edilen 132 hastanın (ortalama yaş; 57.3 ± 11, 118 erkek); hastaneye başvuru sırasında çekilen ilk EKG kayıtları ve demografik özellikleri retrospektif olarak değerlendirildi. Bulgular: Koroner anjiyografi tetkikleri değerlendirildiğinde; olguların %70.4'ünde enfarktüsten sorumlu koroner arterin (ESKA) sağ koroner arter (RCA), %29.6'sında sirkumfleks arter (Cx) olduğu saptandı. Sorumlu arterin RCA olduğu olgularda; DIII derivasyonundaki ST segment yükselmesinin, DII derivasyonundan daha fazla olduğu (%94.6 duyarlılık, %75.9 özgüllük, p= 0.001),aVL ve DI derivasyonlarının her ikisinde de ST segment çökmesinin bulunduğu saptandı (%88.2 duyarlılık, %75.2 özgüllük, p= 0.011). Sorumlu arterin RCA olduğu olgulara aVL derivasyonundaki ST segment çökmesinin, DI derivasyonundaki ST segment çökmesinden daha fazla olmasının istatistiksel olarak anlamlı olduğu belirlendi (%95.7 duyarlılık, %73.6 özgüllük p= 0.016). İnferiyor yüz enfarktüse, sağ ventrikül miyokart enfarktüsünün eşlik ettiği hastalarda sorumlu arter anlamlı olarak RCA idi (p= 0.005). Posterior duvar infarktüsünün eşlik ettiği olgularda sorumlu arterin daha çok Cx olduğu gözlense de bu durum istatistiksel olarak anlamlı değildi (p= 0.3). Sorumlu arterin Cx olduğu olguların EKG'lerinde V1-2 derivasyonlarında ST segment çökmesi saptandı (%84.6 duyarlılık, %36.3 özgüllük p= 0.009). Sonuç: AİME geçiren olguların yüzey EKG'lerinden elde edilen bulgular, enfarktüsten sorumlu koroner arterin tahmin edilebileceğini göstermektedir.

Introduction: Radiofrequency ablation of tachyarrhythmia is effective in the treatment of tachycardia. In this study, we evaluated the results of radiofrequency catheter ablation of tachyarrhythmia. Patients and Methods: From December 2010 to January 2012, 114 consecutive patients with symptomatic drug-resistant typical slow-fast atrioventricular nodal reentrant tachycardia, 17 patients with atrioventricular reentrant tachycardia (five Wolf Parkinson White syndrome), eight patients with atrial tachycardia, seven patients with atrial flutter, five patients with right ventricular outflow tract tachycardia and three patients with atrial fibrillation underwent an invasive electrophysiology study and radiofrequency ablation. Results: The 154 patients (age: 39.1 ± 17.2 years, body mass index: 24.3 ± 5.2 kg/m2, waist/ hip ratio: 0.88 ± 5.2, systolic blood pressure: 128.3 ± 22.4 mmHg, diastolic blood pressure: 75.30 ± 9.0 mmHg, resting heart rate: 76.10 ± 8.2 beat/minute) with tachycardia (89 women, 65 men) were ablated. Procedure and fluoroscopy times were 57.5 ± 19.0 and 14.4 ± 4.1 minute respectively. The mean follow up period was 10.2 ± 4.3 months. During follow up period three patients with atrioventricular nodal reentrant tachycardia, two patients with atrioventricular reentrant tachycardia, one patient with right ventricular outflow tract tachycardia and one patient with atrial fibrillation had recurrence. Conclusion: The transvenous radiofrequency ablation therapy is a safe and effective approach for the treatment of tachyarrhythmia under experienced hands.

Introduction: Atrioventricular nodal reentrant tachycardia is the most common regular supraventricular arrhythmia in humans. This study investigated the admission hemoglobin levels and gender differences in transvenous radiofrequency ablation therapy for the treatment of the slow pathway of atrioventricular nodal reentrant tachycardia. Patients and Methods: Nineteen consecutive patients with symptomatic drug-resistant typical slow-fast atrioventricular nodal reentrant tachycardia underwent an invasive electrophysiology study and performed radiofrequency ablation of slow conduction pathway within atrioventricular node. Blood samples were taken between 08.30 and 09.30 a.m. from the antecubital vein for complete blood count. Results: Nineteen consecutive patients with slow-fast atrioventricular nodal reentrant tachycardia (12 female, 7 male) were ablated. Mean admission hemoglobin and hematocrit (%) levels were significantly increased in male patients as compared with female patients (15.38 ± 1.21 mg/dL, 12.72 ± 1.36 mg/dL, p < 0.001; 45.41 ± 3.26, 37.90 ± 2.88, p < 0.001 respectively). There was not gender differences in the radiation exposure time, fluoroscopy time, complication rate (0%) and acute success rate (100%). Conclusion: There was not gender differences in the radiation exposure time, fluoroscopy time, complication rate and acute success rate at the transvenous radiofrequency ablation therapy for the treatment of atrioventricular nodal reentrant tachycardia. Mean admission hemoglobin and hematocrit levels were significantly decreased in female patients as compared with male patients.

Objectives The aim of this prospective study was to identify the most effective and safest regimen among different thrombolytic treatment strategies. Background The best treatment strategies for prosthetic valve thrombosis have been controversial. Methods Transesophageal echocardiography–guided thrombolytic treatment was administered to 182 consecutive patients with prosthetic valve thrombosis in 220 different episodes (156 women; mean age, 43.2 ± 13.06 years) between 1993 and 2009 at a single center. These regimens chronologically included rapid (Group I), slow (Group II) streptokinase, high-dose (100 mg) tissue plasminogen activator (t-PA) (Group III), a half-dose (50 mg) and slow infusion (6 h) of t-PA without bolus (Group IV), and a low dose (25 mg) and slow infusion (6 h) of t-PA without bolus (Group V). The endpoints were thrombolytic success, in-hospital mortality, and nonfatal complication rates. Results The overall success rate in the whole series was 83.2%; it did not differ significantly among Groups I through V (68.8%, 85.4%, 75%, 81.5%, and 85.5%, respectively; p = 0.46). The overall complication rate in the whole series was 18.6%. Although the overall complication rate was similar among Groups I through IV (37.5%, 24.4 %, 33.3%, and 29.6%, respectively; p > 0.05 for each comparison), it was significantly lower in Group V (10.5%, p Conclusions Low-dose slow infusion of t-PA repeated as needed without a bolus provides effective and safe thrombolysis in patients with prosthetic valve thrombosis. (Comparison of Different TRansesophageal Echocardiography Guided thrOmbolytic Regimens for prosthetIc vAlve Thrombosis; NCT01451320 )

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.

Objectives: Arterial stiffness and epicardial fat thickness (EFT) are associated with coronary artery disease (CAD). The cardio-ankle vascular index (CAVI) is a novel marker of arterial stiffness. The SYNTAX score (SS) reflects the complexity of CAD. We aimed to evaluate the relation of EFT and CAVI with CAD complexity in nondiabetic patients. Method: We enrolled 121 patients undergoing coronary angiography. In all patients, CAVI and EFT were determined. SS were calculated. The relationship between EFT, CAVI and SS was analyzed. Results: CAVI and EFT were significantly correlated with SS (r = 0.537, p < 0.001, and r = 0.629, p < 0.001, respectively) and found to be independent predictors of intermediate-high SS. For the prediction of intermediate-high SS, receiver-operating characteristic curve analysis revealed a cutoff value of 5 mm for EFT (area under the curve, AUC = 0.851, 95% confidence interval, CI, 0.775–0.910) with a specificity of 92.2% and a sensitivity of 77.4% and 8.6 for CAVI (AUC = 0.877, 95% CI 0.805–0.929) with a specificity of 68.9% and a sensitivity of 93.5%. Conclusion: CAD complexity is associated with adverse cardiovascular events. It can be predicted noninvasively with EFT and CAVI in nondiabetic patients with suspected CAD. Thus, patients at high risk for cardiovascular events may be detected early and managed with appropriate treatment strategies.

Giriş: Bening prostathiperplazisi (BPH), yaşlı erkeklerde en sık görülen hastalıktır. BPH’ninateroskleroz ile ilişkisi bilinmesine karşın; subklinik ateroskleroz ileilişkisi henüz değerlendirilmemiştir. Bizim çalışmamızın amacı, bu ilişkininkarotis intima media kalınlığı (KİMK) kullanılarak araştırılmasıydı.Hastalarve Yöntem: Çalışmaya, 50-65 yaş arasında50 BPH hastası ve BPH’si olmayan 50 erkek hasta kontrol deneği dahil edildi.Alt ürüner sistem semptomları (AÜSS)’nın değerlendirilmesinde kullanılan,uluslararası prostat semptom skoruna (IPSS) göre, hastalar hafif-orta AÜSS (IPSS < 20, n= 33hasta) ve ciddi AÜSS (IPSS ≥ 20, n= 17 hasta) gruplarına ayrıldı. KİMK ve diğerparametreler açısından gruplar karşılaştırıldı.Bulgular: Kontrol grubuyla karşılaştırıldığında, BPH grubunda KİMKönemli düzeyde yüksekti (sırasıyla, 0.73 ± 0.2 vs. 0.97 ± 0.3, p< 0.001).Ayrıca, yalnızca hastaları kapsayan alt grup analizinde, hafif-orta AÜSSgrubuna göre ciddi AÜSS grubunda da CIMT önemli düzeyde yüksekti (sırasıyla,0.84 ± 0.2 vs. 1.22 ± 0.3, p, Introduction:Benign prostatic hyperplasia (BPH) is the most common disorder in elderly men.Although the relationship between atherosclerosis and BPH is known, theassociation between subclinical atherosclerosis and BPH has not yet beeninvestigated. The aim of our study was to assess this relationship usingcarotid intima-media thickness (CIMT).Patientsand Methods: Fifty patients with BPH and 50 controlsubjects without BPH of ages 50-65 years were enrolled. According to theinternational prostate symptom score (IPSS), which is used for the evaluationof LUTS, patients were divided into mild-moderate (IPSS< 20 point, n= 33patients) and severe groups (IPSS ≥ 20 point, n= 17 patients). CIMT wasevaluated using ultrasonography. The relationship between CIMT and other parameterswere analysed.Results:CIMT was significantly higher in BPH group (p=0.02). In addition, it was significantly higher in severe LUTS group insubgroup analyses, which included only patients (1.22 ± 0.3 vs. 0.84 ± 0.2,p< 0.001). There was a positive correlation between CIMT and IPSS (r= 0.745,p< 0.001). CIMT and HDL cholesterol were found to be independent predictorsof BPH in multivariate analysis.Conclusion:Subclinical atherosclerosis and BPH may sharecommon aetiopathogenic factors. Therefore, BPH and lower urinary tract symptomsmay be indicators of atherosclerotic burden in men of the same age group.

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

In the present study, we aimed to evaluate temporal changes in heart-type fatty acid-binding protein (h-FABP) and myocardial performance index (Tei index) following administration of 5-fluorouracil (5-FU), a chemotherapeutic agent associated with myocardial ischemia induced by coronary vasospasm. Thirty-two patients with cancer receiving their first 5-FU-based chemotherapy were included in the study. Prior to chemotherapy and 24 hours after the initiation of chemotherapy, all patients underwent a comprehensive echocardiographic examination. Blood samples were taken for h-FABP and troponin I (TnI) measurements at different time points during the first 24 hours of 5-FU administration. Postinfusion echocardiography revealed worsening in Tei index (0.37 ± 0.08 vs 0.43 ± 0.07, P < .001). Clinically overt cardiotoxicity was evident in 4 (12.5%) of our patient population. Heart-type fatty acid binding protein and TnI levels were within normal ranges at all time points. Our results suggest that ischemia coronary vasospasm due to 5-FU cardiotoxicity should be reviewed. Furthermore, Tei index might be a sensitive indicator of occult 5-FU cardiotoxicity.

Background. Atrial fibrillation (AF) frequently accompanies heart failure (HF), and causes exacerbation of symptoms and treatment failure in such patients. Vitamin D was recently suggested to be an important mediator of cardiovascular disease, including HF. Objectives. The aim of this study was to evaluate the relationship between vitamin D deficiency and AF in patients with chronic HF. Material and Methods. The study included 180 chronic HF patients that were divided into 2 groups based on having sinus rhythm [AF (–) group] or chronic AF [AF (+) group]. Vitamin D status was assessed via measurement of the serum 25-hydroxyvitamin D (25[OH]D) concentration. Results. Mean age of the patients was 66 ± 8.7 years and 53.9% were male. There weren’t any significant differences in age, gender, body mass index, etiology or chronic HF stage between the 2 groups. The vitamin D level in the AF (+) group was significantly lower than in the AF (–) group (11.05 ng/mL vs. 20 ng/mL, p < 0.001) and the parathyroid hormone level was significantly higher in the AF (+) group (76.7 vs. 55 pq mL, p

Background: GRACE risk score (GS) is a scoring system which has a prognostic significance in patients with non-ST segment elevation myocardial infarction (non-STEMI). Objective: The present study aimed to determine whether end-systolic or end-diastolic epicardial fat thickness (EFT) is more closely associated with high-risk non-STEMI patients according to the GS. Methods: We evaluated 207 patients who had non-STEMI beginning from October 2012 to February 2013, and 162 of them were included in the study (115 males, mean age: 66.6 ± 12.8 years). End-systolic and end-diastolic EFTs were measured with echocardiographic methods. Patients with high in-hospital GS were categorized as the H-GS group (in hospital GS > 140), while other patients were categorized as the low-to-moderate risk group (LM-GS). Results: Systolic and diastolic blood pressures of H-GS patients were lower than those of LM-GS patients, and the average heart rate was higher in this group. End-systolic EFT and end-diastolic EFT were significantly higher in the H-GS group. The echocardiographic assessment of right and left ventricles showed significantly decreased ejection fraction in both ventricles in the H-GS group. The highest correlation was found between GS and end-diastolic EFT (r = 0.438). Conclusion: End-systolic and end-diastolic EFTs were found to be increased in the H-GS group. However, end-diastolic EFT and GS had better correlation than end-systolic EFT and GS. Resumo Fundamento: O escore de risco GRACE (SG) é um sistema com significado prognóstico para pacientes com infarto do miocárdio sem supradesnivelamento do segmento ST (IMSSST). Objetivo: Determinar se a espessura da gordura epicárdica (EGE) ao final da sístole ou da diástole é mais associada com pacientes de IMSSST de alto risco de acordo com o SG. Métodos: Este estudo avaliou 207 pacientes com IMSSST desde outubro de 2012 a fevereiro de 2013, sendo 162 deles incluídos no estudo (115 homens, idade média: 66,6 ± 12,8 anos). Mediu-se a EGE ao final da sístole e da diástole com métodos ecocardiográficos. Pacientes com alto SG intra-hospitalar (SG > 140) foram classificados como grupo SG-A, enquanto os outros foram classificados como grupo de risco baixo-a-moderado (grupo SG-BM). Resultados: As pressões arteriais sistólica e diastólica dos pacientes SG-A foram mais baixas do que as dos pacientes SG-BM, sendo a frequência cardíaca média mais alta nesse grupo. A EGE ao final da sístole e a EGE ao final da diástole foram significativamente mais altas no grupo SG-A. A avaliação ecocardiográfica dos ventrículos direito e esquerdo mostrou fração de ejeção significativamente reduzida em ambos os ventrículos no grupo SG-A. Observou-se maior correlação entre SG e EGE ao final da diástole (r = 0,438). Conclusão: A EGE ao final da sístole e a EGE ao final da diástole mostraram-se aumentadas no grupo SG-A. Entretanto, a EGE ao final da diástole apresentou melhor correlação com o SG do que a EGE ao final da sístole.

Introduction: We aimed to develop a classification method to discriminate ventricular septal defect and atrial septal defect by using severalhemodynamic parameters.Patients and Methods: Forty three patients (30 atrial septal defect, 13 ventricular septal defect; 26 female, 17 male) with documentedhemodynamic parameters via cardiac catheterization are included to study. Such parameters as blood pressure values of different areas,gender, age and Qp/Qs ratios are used for classification. Parameters, we used in classification are determined by divergence analysismethod. Those parameters are; i) pulmonary artery diastolic pressure, ii) Qp/Qs ratio, iii) right atrium pressure, iv) age, v) pulmonary arterysystolic pressure, vi) left ventricular sistolic pressure, vii) aorta mean pressure, viii) left ventricular diastolic pressure, ix) aorta diastolicpressure, x) aorta systolic pressure. Those parameters detected from our study population, are uploaded to multi-layered artificial neuralnetwork and the network was trained by genetic algorithm.Results: Trained cluster consists of 14 factors (7 atrial septal defect and 7 ventricular septal defect). Overall success ratio is 79.2%, andwith a proper instruction of artificial neural network this ratio increases up to 89%.Conclusion: Parameters, belonging to artificial neural network, which are needed to be detected by the investigator in classical methods,can easily be detected with the help of genetic algorithms. During the instruction of artificial neural network by genetic algorithms, boththe topology of network and factors of network can be determined. During the test stage, elements, not included in instruction cluster, areassumed as in test cluster, and as a result of this study, we observed that multi-layered artificial neural network can be instructed properly,and neural network is a successful method for aimed classification.

Assesment of large arterial stiffness is increasingly used in clinal settings. Although there are several invasive and non-invasive methods such as carotid-femoral pulse wave velocity (PWV) and augmentation index (AI), researchers and clinicians still face problems in selecting the best methodology for their specific use. PWV, which is defined as the velocity of the arterial pulse for moving along the vessel wall, plays an important clinical role in defining patients under high cardiovascular risk and it is inversely correlated with arterial elasticity and relative arterial com - pliance. PWV along the aorta can be measured by using two ultrasound or pressure sensitive trans - ducers fixed transcutaneously over the course of a pair of arteries separated by a known distance: the femoral and right common carotid arteries. PWV is calculated from measurements of pulse transit time and the distance, according to the following formula: PWV (m/s)= distance (m)/tran - sit time (s). AI is defined as Dp/pp (where Dp is the difference between the late systolic peak and the mid-systolic peak and pp is the amplitude of the pulse pressure wave). Central blood pressure and pulse pressure, the AI and PWV, which are often used incorrectly as interchangeable indexes of arterial stiffness, increase with age, hypertension, diabetes mellitus and hyperlipidemia, and are associated with target organ damage such as left ventricular hypertrophy, microalbuminuria, carotid intima-media thickness and endothelial dysfunction. Althouhg the carotid-femoral (aortic) PWV is the gold standard test for assessing central arterial stiffness, the AI reflects stiffness of the systemic arterial tree. This paper summaries the advantages and disadvantages of PWV and AI in the assess - ment of arterial stiffness.

Transcatheter aortic valve implantation is an alternative therapy for surgery in patients with aortic stenosis having high risk for surgery. Transcatheter aortic valve implantation may be performed through transfemoral, transaortic and transapical approaches. General anesthesia is generally required for transapical and transaortic approaches while epidural anesthesia is enough for the transfemoral approach. Although transfemoral access is suitable for most cases, patients having severe vascular tortuosity are candidates for the transapical approach. However, the approach for patients having vascular tortuosity along with poor respiratory capacity contraindicated for general anesthesia is controversial. Vascular complications that significantly increase patient morbidity and mortality are common in transfemoral transcatheter aortic valve implantation and generally associated with severe ilio-femoral tortuosities, severe calcification, porcelain aorta, and significant atheroma of the femoral and iliac vessels. But the effect of tortuosity alone was not evaluated well and complications were generally associated with vascular calcification. Stiff wires were commonly used in endovascular procedures. The vascular tortuosity can be straightened with stiff wires but the accordion effect, pseudo obstruction and vascular injury may also be observed. Herein we present a case of severe aortic stenosis successfully treated with transfemoral aortic valve implantation despite severe femoral, iliac and aortic tortuosity having severe chronic obstructive pulmonary disease.

Objectives: The aim of this study was to evaluate real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) in the assessment of mitral paravalvular leakage curtaining surgery with a Dacron patch. Methods: RT-3D TEE was used before and after the operation. Results: Repairing a mitral paravalvular leak with Dacron patch curtaining was a useful, simple and new technique with promising feasibility and durability. Conclusions: In selected patients in whom the mitral paravalvular defect is relatively large, and may thus not be suitable for closing with primary suture, Dacron patch curtaining may be feasible for repair guided with RT-3D TEE; both are described for the first time.

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.

Introduction:We aimed to evaluate the importance of theEuroSCORE-II (ES-II) risk-scoring system in predicting the development of acuteischemic heart failure (AIHF) after acute anterior ST segment elevationmyocardial infarction (A-STEMI).Patientsand Methods: A total of 261 patients (206 male; mean age,63.5 ± 14.2 years) admitted to our centre with A-STEMI between April 2012 andJanuary 2013 were included in the study. The patients were divided into twogroups according to their clinical findings and were prospectively followedduring the hospitalisation period for the development of cardiac morbidity andmortality. These groups were the AIHF group (n= 69) and non-AIHF group (n=192). For the diagnosis of AIHF, we considered the recommendations of theEuropean Society of Cardiology Guidelines on Heart Failure and the Framinghamcriteria.Results: Accordingto our results, the morbidity and mortality rates were higher in the AIHFgroup. Symptom-to-balloon time, ejection fraction (EF), glomerular filtrationrate (gfr), no-reflow phenomenon, left main coronary artery disease and ES-II,which are the predictors of the development of AIHF, were determined vialogistic regression analysis. ROC analysis revealed that symptom-to-balloontime > 209.5 min, EF < 36.5%, gfr < 68.5 mg/dL/1.73 m2 andES-II > 4.9% were the cut-off values in the development of AIHF.Conclusion: Patients with A-STEMI complicatedby AIHF have significantly high mortality rates. With the pre-estimation of thedevelopment of AIHF, complication rates can be reduced. For this purpose, ES-IIscore > 4.9% can be used as a predictor of AIHF after A-STEMI., Giriş:Akut anterior ST yükselmeli miyokart infarktüsü(A-STEMİ) sonrası akut iskemik kalp yetersizliği (AİKY) gelişimini öngörmedeEuroSCORE-II skorlama sisteminin önemini değerlendirmeyi amaçladık. Hastalarve Yöntem: Çalışmaya Nisan 2012-Ocak2013 tarihleri arasında merkezimize A-STEMİ nedeniyle kabul edilen 261 hasta(206 erkek, ortalama yaş 63.5 ± 14.2) dahil edildi. Hastalar klinik bulgularınagöre iki farklı gruba ayrıldı ve hastanede yatış periyodu süresince kardiyakmorbidite ve mortalite gelişimi bakımından prospektif olarak takip edildi. Bu gruplarAİKY grubu ((n= 69) ve non-AİKY grupları (n= 192) idi. AİKY tanısı koyabilmekiçin Avrupa Kardiyoloji Cemiyeti kalp yetersizliği klavuzu ve Framinghamkriterleri göz önünde bulunduruldu.Bulgular:Çalışmamız sonuçlarına göre AİKY grubunda morbiditeve mortalite daha yüksekti. Regresyon analizleri sonuçlarına göre semptom-balonzamanı, ejeksiyon fraksiyonu, no-reflow fenomeni, sol ana koroner hastalığı, üçdamar koroner arter hastalığı, SYNTAX skoru ve ES-II’nin AİKY gelişimininprediktörleri oldukları belirlendi. ROC analizlerinin sonuçlarına goresemptom-kapı zamanının > 229.5 dakika, EF < %36.5, SYNTAX skoru >27.75 ve EsII > %4.9 değerlerinin AİKY gelişimini öngördürebilecek sınırdeğerler oldukları belirlendi.Sonuç: AİKY gelişen A-STEMİ’li hastalarda mortaliteoranları artmaktadır. AİKY gelişiminin önceden öngörülmesi kardiyakkomplikasyonları azaltabilir. Bu amaçla Es-II’nin > %4.9 olması A-STEMİsonrası AİKY gelişimim öngördürücüsü olarak kullanılabilir.

Background— Distinguishing pannus and thrombus in patients with prosthetic valve dysfunction is essential for the selection of proper treatment. We have investigated the utility of 64-slice multidetector computed tomography (MDCT) in distinguishing between pannus and thrombus, the latter amenable to thrombolysis. Methods and Results— Sixty-two (23 men, mean age 44±14 years) patients with suspected mechanical prosthetic valve dysfunction assessed by transesophageal echocardiography were included in this prospective observational trial. Subsequently, MDCT was performed before any treatment was started. Periprosthetic masses were detected by MDCT in 46 patients, and their attenuation values were measured as Hounsfield Units (HU). Patients underwent thrombolysis unless contraindicated, and those with a contraindication or failed thrombolysis underwent surgery. A mass which was completely lysed or surgically detected as a clot was classified as thrombus, whereas a mass which was surgically detected as tissue overgrowth was classified as pannus. A definitive diagnosis could be achieved in 37 patients with 39 MDCT masses (22 thrombus and 17 pannus). The mean attenuation value of 22 thrombotic masses was significantly lower than that in 17 pannus (87±59 versus 322±122; P P P =0.007). Conclusions— Sixty-four slice MDCT is helpful in identifying masses amenable to thrombolysis in patients with prosthetic valve dysfunction. A high (HU≥145) attenuation suggests pannus overgrowth, whereas a lower value is associated with thrombus formation. A higher attenuation (HU>90) is associated with reduced lysis rates.

Background: The outcomes of thrombolytic therapy (TT) in elderly patients with prosthetic valve thrombosis (PVT) have not been evaluated previously. We investigated the outcomes of low-dose and slow infusion TT strategies in elderly patients with PVT. Methods: Twenty-seven (19 female) patients aged ≥65 years (median: 70 years, range: 65-82 years) were treated with repeated TT agents for PVT. The TT regimens included 24-hour infusion of 1.5 million units of streptokinase in 2 patients, 6-hour infusion of 25 mg recombinant tissue plasminogen activator (t-PA) in 12 patients, and 25-hour infusion of 25 mg t-PA in 13 patients. Treatment success and adverse event rates were assessed. Results: The initial and cumulative success rates were 40.7% and 85.2%, respectively. Adverse events occurred in 6 (22.2%) patients including 4 (14.8%) major (1 death, 1 rethrombosis, and 2 failed TT) and 2 (7.4%) minor (1 transient ischemic attack and 1 access site hematoma) events. Higher thrombus burden (thrombus area ≥1.1 cm2 by receiver operating characteristics analysis, sensitivity: 83.3%, specificity: 85%, area under the curve: 0.86, P = .008) and New York Heart Association class (0% vs 15.4% vs 25% vs 100% for classes I-IV, respectively, P = .02) predicted adverse events. By multiple variable analysis, thrombus area was the only independent predictor of adverse events (odds ratio: 13.8, 95% confidence interval: 1.02-185, P = .04). Conclusion: Slow infusion of low doses of TT agents (mostly t-PA) with repetition is successful and safe in elderly patients with PVT. However, excessive thrombus burden may predict adverse events.

The aim of this study was to evaluate the oxidant-antioxidant balance in patients with abdominal aortic aneurysms (AAA). Forty-two consecutive patients with AAA and 46 control subjects were included. Total oxidant status (TOS) and total antioxidant status (TAS) levels were measured and the oxidative stress index (OSI) value determined. Serum TOS and OSI values in patients with AAA were higher than those in the controls (p2O2 equivalent/L for TOS was associated with 86% sensitivity and 83% specificity and a cut-off value of 1.77 for OSI was associated with 86% sensitivity and 81% specificity for predicting AAA. Systemic oxidative imbalance develops in patients with AAA, particularly as a result of an increase in TOS.

Heparin gibi antikoagulan ilac kullanan hastalar bu ilaclara bagli ciddi komplikasyonlarla karsilasabilirler. Burada kronik bobrek yetersizligi olan bir hastada gelisen bukkal mukoza hematomu olgusu sunulmaktadir

Background Myocardial contusion is a rare complication of blunt chest trauma. Transient conduction and rhythm problems, right ventricular dysfunction, or pulmonary embolism may occur after chest trauma, but these complications almost always occur early in the post-operative period. Objectives The objective is to describe a case illustrating that trauma may induce high-grade atrioventricular block. Case Report We report the case of a patient who developed delayed onset of complete atrioventricular block after transient complete atrioventricular block and alternating bundle branch block secondary to blunt chest trauma. Conclusion Even with an injury that does not seem to be caused by direct penetrating trauma to the heart, maybe every trauma patient needs an electrocardiographic evaluation. It is important to note that myocardial healing is a continuous process after trauma, and additional pathology may be revealed later in the course of healing from myocardial contusion.

Cardiac tamponade is a life-threatening condition requiring urgent intervention. It may either be drained surgically or percutaneously. Percutaneous drainage of pericardial effusion bears the risk of laceration and perforation of the myocardium and the coronary vessels, air embolism, pneumothorax, dysrhythmias, puncture of the peritoneal cavity and abdominal viscera, internal mammary artery fistula, acute pulmonary edema, and purulent pericarditis. Here, we report an easy and safe approach for pericardiocentesis under the guidance of agitated saline contrast injection through a Seldinger needle before inserting guidewire and catheter. This cheap, easy, feasible, and comfortable method of injection of agitated saline contrast before the insertion of guidewire and catheter may prevent the undesired complications.

Ventricular septal rupture and ventricular pseudoaneurysm formation are rare complications of acute myocardial infarction. Immediate intervention is mandatory in these circumstances. Our case is a unique presentation of an anterior myocardial infarction in an 85-year-old male, complicated by ventricular septal rupture and ventricular pseudoaneurysm formation.

Coarctation of the aorta is a rare congenital anomaly usually accompanying bicuspid aortic valve. Adult patients with aortic coarctation can be managed either with surgery or percutaneously. Here we present a case of percutaneously treated aortic coarctation complicated with infective endocarditis of the aortic valve, thoracic aortitis, and thoracic mycotic aneurysm.

BACKGROUND Conduction disturbances including type 2 second-degree atrioventricular block (Mobitz II) and third-degree atrioventricular block following blunt chest trauma are probably rare. Moreover, the pathophysiological mechanisms responsible for this rare dysrhythmia following trauma are not well understood yet. In this study, it was aimed to identify the frequency of this dysrhythmia associated with trauma. METHODS Two hundred and fifty-three consecutive Mobitz II block and third-degree atrioventricular block patients admitted to the Emergency Department of Internal Medicine between January 2012 and March 2013 were evaluated. Only four patients with Mobitz II block and third-degree atrioventricular block associated with trauma were enrolled into the present study. The level of atrioventricular block was defined according to electrocardiographic characteristics. RESULTS Only four (mean age: 40.2±19.7 years, two male) of 253 patients were associated with trauma. All patients had normal coronary arteries in coronary angiography or multislice computed tomography. Permanent pacemaker was performed in two patients with third-degree atrioventricular block. None of the patients had coronary artery disease or hypertension. CONCLUSION Rare clinical cases in the literature confirm that blunt chest trauma can cause conduction defects, which are usually transient. However, patients with blunt chest trauma must need an electrocardiographic evaluation for atrioventricular block upon admission and in the follow-up period.

AMAÇ: Künt göğüs travmasını takiben tip 2 ikinci derece atriyoventriküler blok (Mobitz II) ve üçüncü derece atriyoventriküler blok iletim bozuklukları oldukça nadirdir. Dahası, travmayı takiben oluşan bu disritmilerden sorumlu patofizyolojik mekanizmalar henüz tam olarak anlaşılamamıştır. Biz travma ile ilişkili bu disritmilerin sıklığını tespit etmeyi amaçladık. GEREÇ VE YÖNTEM: Acil servise başvuran ardışık Mobitz II ve üçüncü derece atriyoventriküler bloklu 253 hasta, Ocak 2012 ile Mart 2013 tarihleri arasında değerlendirildi. Mobitz II ve üçüncü derece atriyoventriküler blok ve travma ile ilişkili sadece dört hasta mevcut çalışmaya alındı. Atriyoventriküler blok düzeyi elektrokardiyografik özelliklere göre tanımlandı. BULGULAR: 253 hastanın sadece dördü (ortalama yaş: 40.2±19.7 yıl, iki erkek) travma ile ilişkili bulundu. Tüm hastaların koroner anjiyografi veya çok kesitli bilgisayarlı tomografi ile koroner arterleri normal saptandı. Kalıcı kalp pili üçüncü derece atriyoventriküler bloğu olan iki hastaya takıldı. Hastaların hiçbirinde koroner arter hastalığı ve hipertansiyon yoktu. TARTIŞMA: Literatürde künt göğüs travmasına bağlı iletim kusurları nadir görülen klinik olgulardır ve genellikle geçici olmaktadır. Bu nedenle künt göğüs travması olan hastaların başvuru sırasında ve takiplerde atriyoventriküler blok açısından elektrokardiyografik değerlendirilmesi gerekir., BACKGROUND: Conduction disturbances including type 2 second-degree atrioventricular block (Mobitz II) and third-degree atrioventricular block following blunt chest trauma are probably rare. Moreover, the pathophysiological mechanisms responsible for this rare dysrhythmia following trauma are not well understood yet. In this study, it was aimed to identify the frequency of this dysrhythmia associated with trauma.METHODS: Two hundred and fifty-three consecutive Mobitz II block and third-degree atrioventricular block patients admitted to the Emergency Department of Internal Medicine between January 2012 and March 2013 were evaluated. Only four patients with Mobitz II block and third-degree atrioventricular block associated with trauma were enrolled into the present study. The level of atrioventricular block was defined according to electrocardiographic characteristics.RESULTS: Only four (mean age: 40.2±19.7 years, two male) of 253 patients were associated with trauma. All patients had normal coronary arteries in coronary angiography or multislice computed tomography. Permanent pacemaker was performed in two patients with third-degree atrioventricular block. None of the patients had coronary artery disease or hypertension.CONCLUSION: Rare clinical cases in the literature confirm that blunt chest trauma can cause conduction defects, which are usually transient. However, patients with blunt chest trauma must need an electrocardiographic evaluation for atrioventricular block upon admission and in the follow-up period

WOS: 000352651800008, PubMed: 25662695, The Ceraflex atrial septal defect occluder is an alternative device to the Amplatzer septal occluder with some structural innovations including flexible connection, increased flexibility, and minimized amount of implant material. We evaluated the efficiency and safety of the Ceraflex septal occluder device in percutaneous closure of secundum atrial septal defects. This was a prospective, nonrandomized, multicenter study of patients undergoing transcatheter closure for an atrial septal defect with the Ceraflex and the Amplatzer septal occluder devices. A clinical evaluation and follow-up transthoracic echocardiography were performed at 1, 6, and 12 months. Between 2010 and 2014, 125 patients underwent atrial septal defect closure with the Ceraflex septal occluder (n = 58) and the Amplatzer septal occluder (n = 67) under transesophageal echocardiography guidance. Patient characteristics, the stretched size of the defect, device size, and fluoroscopy time were similar between the groups. The immediate and follow-up complete occlusion rates for both groups were 100%. There was no device embolization, procedure-related stroke, or pericardial effusion. The Ceraflex septal occluder is a safe and efficient device for closure of secundum atrial septal defects with no procedural complications. The Ceraflex has similar outcomes when compared with the Amplatzer septal occluder device. The advantage of the Ceraflex septal occluder device is that it can be deployed without the tension of the delivery catheter.

Background Mitral annular calcification (MAC) is a common echocardiographic finding in clinical practice and is associated with cardiovascular risk factors and atherosclerosis. However, data regarding left ventricular (LV) functions are lacking. We aimed to evaluate the relationship between MAC and LV mechanical functions with the utility of two-dimensional speckle tracking echocardiography (2DSTE). Methods The study involved 91 patients with MAC and 48 control subjects. Mitral annular thickness of 1–2 mm was reported as mild, 2–5 mm as moderate, and >5 mm as severe MAC. All patients underwent 2D echocardiography. Results MAC was observed in 91 (65.5%) patients. Of LV diastolic parameters, E/Em ratio, LAVI, LV mass index, and t-LV UR were increased. Of LV systolic parameters, GLS and Sm were decreased, whereas Ar, Ar-rate systole, peak LV twist, peak LV twist rate, LV-tor, and MPI were increased, which were all correlated with presence and severity of MAC. Multivariate linear regression analysis showed that LV mass index (β = 0.225, P = 0.012), t-LV UR (β = 0.370, P

OBJECTIVE This study was designed to investigate the effects of dipper and nondipper patterns on global longitudinal systolic functions of left ventricle (LV) by means of two-dimensional speckle tracking echocardiography in treated hypertensive diabetic patients with preserved left ventricular ejection fraction. PATIENTS AND METHODS We enrolled 86 hypertensive diabetic patients. Twenty-four hour ambulatory blood pressure monitoring and echocardiography were performed in each patient. The relationship between dipper/nondipper patterns and global longitudinal strain (GLS) was analyzed. RESULTS Fifty-one (59.3%) patients had a nondipper pattern. GLS and average global longitudinal strain rate systolic (GLSRs) were significantly decreased (-17.8±1.5, -19.6±1.9; P

Backround. The aim of this study was to evaluate the changes in perioperative oxidant-antioxidant balance in ONCABG.Methods. Twenty-three patients were included in this study. Serum total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) values were assessed preoperatively, at 20 minutes after aortic clamping and at 30 minutes, 6 hours, and 48 hours after declamping (reperfusion). The patients were divided into 2 groups according to the median aortic cross clamping (XC) time: group 1 (XC time < 42 minutes) and group 2 (XC time ≥ 42 minutes).Results. TOS and OSI values of whole patients at 30 minutes after reperfusion were higher than preoperative values (P=0.045,P=0.015), while perioperative TAS levels of the patients were similar to the preoperative levels (P=0.173). XC time was correlated with TOS levels at 30 minutes after reperfusion (r=0.43,P=0.041). In group 2, TOS and OSI values at 30 minutes after reperfusion were higher than preoperative values (P=0.023,P=0.048), whereas a significant difference was not found in group 1 (P=0.601,P=0.327).Conclusions. Oxidative imbalance and increase in TOS at reperfusion in ONCABG may be associated with XC time.

Background QT dispersion (QTd) is a predictor of ventricular arrhythmia. Ventricular arrhythmia is an important factor influencing morbidity and mortality in patients with aortic stenosis. Surgical aortic valve replacement reduced the QTd in this patients group. However, the effect of transcatheter aortic valve implantation (TAVI) on QTd in patients with aortic stenosis is unknown. The aim of this study was to investigate the effect of TAVI on QTd in patients with aortic stenosis. Methods Patients with severe aortic stenosis, who were not candidates for surgical aortic valve replacement due to contraindications or high surgical risk, were included in the study. All patients underwent electrocardiographic and echocardiographic evaluation before, and at the 6th month after TAVI, computed QTd and left ventricular mass index (LVMI). Results A total 30 patients were admitted to the study (mean age 83.2 ± 1.0 years, female 21 and male 9, mean valve area 0.7 ± 3 mm2). Edwards SAPIEN heart valves, 23 mm (21 patients) and 26 mm (9 patients), by the transfemoral approach were used in the TAVI procedures. All TAVI procedures were successful. Both QTd and LVMI at the 6th month after TAVI were significantly reduced compared with baseline values of QTd and LVMI before TAVI (73.8 ± 4 ms vs. 68 ± 2 ms, P = 0.001 and 198 ± 51 g/m2 vs. 184 ± 40 g/m2, P = 0.04, respectively). There was a significant correlation between QTd and LVMI (r = 0.646, P < 0.001). Conclusions QTd, which malign ventricular arrhythmia marker, and LVMI were significantly reduced after TAVI procedure. TAVI may decrease the possibility of ventricular arrhythmia in patients with aortic stenosis.

Background Right ventricular (RV) function is known to be impaired in the presence of metabolic syndrome (MetS). Epicardial adipose tissue is a metabolically active organ that generates various bioactive molecules, which might affect cardiac function and morphology. Thus, we hypothesized that RV dysfunction in patients with MetS may be related to increased epicardial fat thickness (EFT) in these patients. In patients with MetS, we aimed to assess the relation of EFT with RV function using two-dimensional speckle tracking echocardiography (2DSTE)-derived strain and strain rate imaging. Methods The study involved 76 subjects with MetS and 61 subjects without MetS. Biventricular structure and function together with EFT were evaluated by conventional echocardiography. RV free and septal walls strain (RVFW-S & RVSW-S), systolic and early diastolic strain rates (RVSRs & RVSRe) were evaluated by 2DSTE. Results Epicardial fat thickness was significantly higher in subjects with MetS (6.45 ± 1.48 mm vs. 5.49 ± 1.05 mm, P

The aim of this study is to evaluate the efficacy and safety of two doses of heparin, a low dose (2500 IU) and a standard dose (5000 IU) in patients who underwent transradial coronary angiography (TRCAG).A total of 459 consecutive patients were included in the present study, 217 in the 2500-IU heparin group and 242 in the 5000-IU heparin group. Radial artery patency was evaluated one month after the TRCAG with Doppler ultrasonography.The RAO was observed in 15 (3.3%) patients. The RAO was significantly higher in 2500 IU heparin group than 5000 IU heparin group (5.5% vs 1.2% p=0.010, respectively). Female gender (Odds ratio (OR)=66.135, p=0.002, 95% confidence interval (CI)=4.584-954.131), sheath removal time (OR=1.496, p0.001, 95% CI=1.254-1.784) and administration of 2500 IU heparin (OR=9.758, p=0.034, 95% CI=1.195-79.695) were the independent predictors of RAO in multivariate regression analysis. While the presence of hypertension was independently associated with radial artery patency in multivariate regression analysis (OR=0.022, p=0.005, 95% CI=0.002-0.307).The patients in the standard dose heparin group had lower RAO rates compared to low dose group in this study. This suggests that using the current technique, standard dose of heparin is still required for transradial diagnostic angiography.

Atrial flutter (AFL) is a common arrhythmia which may decrease cardiac output and may cause embolic events. Direct current (DC) cardioversion, medical cardioversion and radiofrequency (RF) ablation are therapeutic options, but over all RF ablation therapy has the longest event free period. Although development of AFL after myocardial infarction is quite common it may spontaneously recover or results in atrial fibrillation. Herein we report a patient with medical and electrical cardioversion resistant AFL which developed in the early post-myocardial infarction period causing hemodynamic instability, who was successfully treated with RF catheter ablation.