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Objective: The neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and uric acid (UA) are inflammatory markers in cardiovascular disease. However, there are not enough data on infarct-related artery (IRA) patency in ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the association of NLR, PLR, and UA with IRA patency before percutaneous coronary intervention (PCI) in STEMI. Methods: The study was designed as a retrospective study. Three hundred and twenty-four consecutive patients with STEMI were divided into two groups according to pre-PCI Thrombolysis in Myocardial Infarction flow grade (TIMI). Patients with a TIMI flow grade of into the spontaneous reperfusion (SR) group, while patients with TIMI flow grade of 0, 1 and 2 were placed into the non-SR group. The χ2 and independentsamples t-test, Mann-Whitney U test, multivariate logistic regression analysis, and receiver-operator characteristic (ROC) curve analysis were used for the statistical analysis. Results: PLR, NLR, and UA values in the SR group were lower than in the non-SR group (p190, UA>5.75 mg/dL, and NLR>4.2 predicted non-SR. The sensitivity and specificity of the association between low IRA TIMI flow grade and PLR were 88% and 84%, 72% and 66% for UA, and 74% and 44% for NLR, respectively. Conclusion: We determined that PLR and UA are novel predictors of IRA patency before PCI. We suggest that PLR and UA may be used in riskstratifying STEMI. (Anatol J Cardiol 2015; 15: 648-56)

PMID: 25537998 Abstract: Objective: The aim of this study was to evaluate the relationship between atrial electromechanical delay (EMD) measured with tissue Doppler imaging (TDI) and left atrial (LA) mechanical functions in patients with ischemic stroke and compare them with healthy controls. Methods: Thirty patients with ischemic stroke were enrolled into this cross-sectional, observational study. The control group consisted of 35 age- and gender-matched apparently healthy individuals patients. Acute cerebral infarcts of probable embolic origin were diagnosed via imaging and were confirmed by a neurologist. Echocardiographically, time intervals from the beginning of P wave to beginning of A wave from the lateral and septal mitral and right ventricular tricuspid annuli in TDI were recorded. The differences between these intervals gave the mechanical delays (inter- and intra-atrial). Left atrial (LA) volumes were measured using the biplane area-length method, and LA mechanical function parameters were calculated. Statistical analysis was performed using student s t-test, chi-squared test, and Pearson s test. Results: The laboratory and clinical characteristics were similar in the two groups. Increased left atrial EMD (21.36±10.38 ms versus 11.74±6.06 ms, p

cagliyan, caglar/0000-0002-2529-4995; Kaya, Hasan/0000-0003-3923-4026 WOS: 000350492000007 PubMed: 23742948 The aim of the study was to assess the factors associated with the anticoagulation treatment in patients with atrial fibrillation (AF). A total of 2242 consecutive patients who had been admitted with AF on their electrocardiogram were included in the study. After excluding valvular AF, 1745 patients with nonvalvular AF were analyzed. Mean CHA2DS2-VASc score [cardiac failure, hypertension, age >= 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 -74 and sex category (female)], frequency of persistent/permanent AF, hypertension, diabetes mellitus (DM), stroke history, body mass index, and left atrial diameter were significantly higher in patients receiving anticoagulant therapy. Stroke history, persistent/permanent AF, hypertension, DM, age, heart failure, and left atrial diameter were independent predictors of warfarin prescription. Labile international normalized ratio was the only independent negative predictor of effective treatment with warfarin. In this study, we demonstrated that stroke history, persistent/permanent AF, hypertension, DM, and left atrial diameter were positive predictors, whereas advanced age and heart failure were negative predictors of oral anticoagulant use in patients with nonvalvular AF.

Genetic mutations resulting in a hypercoagulable state are well-defined risk factors for venous thrombosis. However, there are few cases of arterial thrombosis, including coronary thrombosis, in patients with such genetic mutations described in the literature.

Background/aim: The thrombolysis in myocardial infarction (TIMI) risk score (TRS), and the TIMI risk index (TRI) have been reported in coronary artery disease patients. We investigated whether admission TRI is associated with no-reflow (NRF) in patients undergoing primary percutaneous coronary intervention (p-PCI). Materials and methods: ST-segment elevation myocardial infarction (STEMI) patients treated with p-PCI were included in the study. TRI was calculated on admission using specified variables. We defined the angiographic NRF phenomenon as a coronary TIMI flow grade of ≤2 after the vessel was recanalized or a TIMI flow grade of 3 together with a final myocardial blush grade (MBG) of

The aim of this study was to evaluate the relationship between hematologic indices and the Global Registry of Acute Coronary Events (GRACE) score in patients with ST-segment elevation myocardial infarction (STEMI). A total of 800 patients who consecutively and retrospectively presented with STEMI within 12 hours of symptom onset. After accounting for exclusion criteria, a total of 379 patients remained in the study. We enrolled 379 patients with STEMI (mean age 61.7 ± 13.6 years; men 73%). Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), and monocyte count were associated with increased worse GRACE risk score ( P = .008, P = .012, P = .005, P = .022, respectively). In multivariate linear regression analysis, NLR, PLR, RDW, and monocyte count were found to be independent predictors of GRACE risk score. We demonstrate for the first time that PLR, RDW, and monocyte were associated with the GRACE score in patients with STEMI.

Background: Arterial stiffness (AS), the term describes the rigidity of arterial walls, and its hemodynamic results have been shown to be associated with increase in future cardiovascular events. Women with pre-eclampsia in their past pregnancies have a higher risk of developing cardiovascular disease later in life. The goal of this study was to assess AS using a non-invasive and simple oscillometric method in pregnant women with and without pre-eclampsia. Methods: Ninety pregnant women, forty-five of which had pre-eclampsia, were included in the study. The vascular measurements were performed with a Mobil-O-Graph 24h PWA Monitor, an automatic oscillometric device. Statistical analysis was performed using the Chi-square, independent sample t-test or the Mann-Whitney U test, Pearson correlation, and linear regression tests. Results: All the vascular function parameters were significantly higher in the patients with pre-eclampsia. The pulse wave velocity (PWV) values found in the pre-eclampsia group were positively correlated with gestational age, maternal age, glucose level, creatinine level, augmentation index, and central blood pressure. Using linear regression analysis, the PWV values were confirmed to be positively correlated with gestational age, maternal age, and central systolic blood pressure. The women with severe pre-eclampsia had significantly higher blood pressures, PWV values, augmentation indices, and cardiac outputs when compared with the patients with mild pre-eclampsia. Conclusion: Oscillometric PWV measurement is already accepted as the most reproducible quick, simple, and inexpensive non-invasive method for the assessment of large artery stiffness. It can be applied to evaluate the AS and also aid in detecting future cardiovascular risk of patients with pre-eclampsia. © 2014 Informa Healthcare USA, Inc.

Amaç: Bu çalışmada kliniğimizdeki romatizmal mitral darlıklı (MD) erişkin hastalara uygulanan perkütan mitral balon valvüloplastinin (PMBV) erken dönem klinik, ekokardiyografik ve hemodinamik sonuçlarını değerlendirmeyi amaçladık. Yöntemler: Kliniğimizde Ocak 2010-Ekim 2014 tarihleri arasında orta ya da ciddi MD nedeniyle PMBV uygulanan 53 hasta (49 kadın, 5 erkek; ortalama yaş 38±11 yıl) geriye dönük olarak değerlendirildi. İşlem başarısı, işlem sonrası mitral kapak alanının (MKA) >1,5 cm2 olması ve 3. derece mitral yetersizlik (MY) olmaması olarak kabul edildi. Bulgular: Toplam 53 hastadan 48’inde (%91) PMBV işlemi uygulanabildi ve tamamlanabilen tüm işlemler başarılı oldu. Hastalardan 3’üne kapak geçilememesi, 1’ine membranöz obstrüktif vena kava, 1’ine de septostomi yapılamaması nedeniyle PMBV uygulanamadı. Başarılı PMBV uygulanan 2 hastaya ortalama 14 ay sonra semptomatik orta-ciddi MD nedeniyle mitral kapak replasmanı yapıldı. Ortalama 13±8 ay boyunca izlenen hastalarda atrial fibrilasyon gelişmesi veya embolik komplikasyonlar izlenmedi. Sonuç: Perkütan mitral balon valvüloplasti işlemi deneyimli merkezlerde yüksek başarı ve düşük komplikasyon oranları ile etkin ve güvenli bir tedavi yaklaşımıdır. Objective: We sought to analyze short-term clinical, echocardiographic, and hemodynamic consequences of percutaneous mitral balloon valvuloplasty (PMBV) in the treatment of rheumatic mitral stenosis (MS) in our clinic. Methods: We retrospectively reviewed 53 patients (49 females, 5 males; mean age 38±11 years) who underwent PMBV for moderate or severe MS between January 2010 and October 2014. Procedural success was defined as the reaching a mitral valve area (MVA) >1.5 cm2 and absence of grade 3 mitral regurgitation. Results: We were able to perform PMBV in 48 of 53 patients (91%) and all the procedures that were completed were successful. PMBV couldn’t be performed in 3 patients due to inability to pass the mitral valve, 1 patient due to membranous obstructive vena cava and 1 patient due inability to perform septostomi. Two patients who underwent successful PMBV became symptomatic after an average of 14 months follow-up and mitral valve replacement was performed due to moderate-to-severe MS. Patients were followed for an average of 13 ± 8 months and atrial fibrillation development or embolic complications were not observed. Conclusion: Percutaneous mitral balloon valvuloplasty procedure is a safe and effective treatment approach with high success and low complication rates in experienced centers.

Avcı, Eyüp (Balikesir Author), Contrast-induced nephropathy (CIN) is acute kidney failure that occurs after exposure to contrast agent. There is no sensitive biomarker to predict the development of CIN. In a retrospective study, we investigated the predictive value of the fibrinogen to albumin ratio (FAR) to determine the risk of CIN in patients (N = 246) who underwent carotid angiography. Contrast-induced nephropathy was defined as a 0.5 mg/dL or 25% increase in serum creatinine levels 48 to 72 hours following exposure to a radiocontrast agent. Patients were grouped according to whether they developed CIN or not, that is, CIN(-) and CIN(+) groups, respectively. Contrast-induced nephropathy developed in 39 (15.8%) of all the patients. The fibrinogen levels, neutrophil to lymphocyte ratio (NLR), and FAR in the CIN (+) group were higher than in the CIN (-) group (P < .001). Multivariate analysis showed that age, diabetes, NLR, platelet-lymphocyte ratio, and FAR were independent risk factors for CIN. The area under the curve (AUC) of FAR was 0.800 for the prediction of CIN, and the best cutoff value was 57.4 with sensitivity, specificity, positive predictive value, and negative predictive value of 74.4%, 60.8%, 26.4%, and 92.7%, respectively. The FAR may be useful as a predictor of CIN.

Woven coronary artery is a rare congenital anomaly with an unknown etiology. A 53-year-old male presented with exertional chest pain and dyspnea for six months. Electrocardiogram and transthoracic echocardiography were in normal range. Dobutamine stress echocardiography revealed reversible ischemia in the inferior wall. Right coronary angiography showed an 80% stenosis before the sinoatrial branch and a twisting course of the right coronary artery lumen after it divided into multiple thin channels. Left coronary angiogram revealed noncritical lesions. A diagnosis of woven right coronary artery was considered, and he was discharged with medical therapy.

ST elevation myocardial infarction is a clinic situation usually presents with total occlusion in the coronary artery. The electrocardiography (ECG) at the presentation helps us to diagnose, to guess the occluded coronary artery and to assess the treatment. However, sometimes the ECG could not be enough to guess the occluded coronary artery. Left anterior descending (LAD) coronary artery occlusion resulting in inferior ST-segment elevation without anterior ST-segment elevation is an extremely rare finding. In this study, we presented a case who admitted to the emergency department with a typically chest pain and inferior ST-segment elevation without anterior ST-segment elevation ECG pattern but a total occlusion in LAD in the coronary angiography. J Clin Exp Invest 2013; 4 (4): 525-528, ST elevasyonlu miyokard infarktüsü genellikle koroner arterde tam tıkanma sonucu oluşan klinik bir durumdur. Başvuru anında çekilen elektrokardiyografi tanı koymak, lokalizasyonun yerini tahmin etmek ve tedaviyi yönlendirmek için bize yardımcı olan en önemli araçtır. Fakat bazen elektrokardiyografi lokalizasyonun yerini tahmin etmek için yeterli olmayabilir. Anterior ST segment elevasyonu olmadan inferior derivasyonlarda ST segment elevasyonu olup da sol ön inen arter darlığı saptanması oldukça nadir bir durumdur. Bu çalışmada acil servise tipik göğüs ağrısı ile gelen, elektrokardiyografide anterior derivasyonlarda ST segment elevasyonu olmadan inferior derivasyonlarda ST segment elevasyonu olan, koroner anjiyografisinde sol ön inen arterde ciddi darlık saptadığımız bir olgu nadir görülmesi nedeniyle sunuldu.

Introduction: Ankylosing spondylitis is a chronic infl ammatory disease which may be associated with cardiovascular complications. The aim of the study was to investigate aortic elastic properties and serum asymetric dimethylarginine (ADMA) levels in patients with ankylosing spondylitis without any cardiac involvement. Patients and Methods: Fifty-fi ve ankylosing spondylitis patients and 30 age/gender matched healthy subjects were enrolled into this study. Fasting glucose, serum lipids, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ADMA were studied. Aortic strain, distensibility and stiffness index were calculated from aortic diameters measured by transthoracic echocardiography and simultaneous blood pressure measurements. Results: ESR and CRP were higher in patients group. Serum ADMA levels were also higher in ankylosing spondylitis than in controls (0.76 ± 0.19 vs. 0.55 ± 0.12, p< 0.001). In subgroup analysis, ADMA was signifi cantly lower in anti-TNF-alfa treatment group than conventional treatment group (0.68 ± 0.15 vs. 0.87 ± 0.18, p< 0.001). Mean aortic strain and distensibility were lower and stiffness index was higher in ankylosing spondylitis group than controls. No correlation between ADMA and aortic elastic properties was observed. In ankylosing spondylitis group, a negative signifi cant correlation was found between duration of ankylosing spondylitis and aortic strain and distensibility. Conclusion: Our study suggest that patients with ankylosing spondylitis without cardiac involvement, aortic elasticity was impaired and ADMA levels were increased, while there was no signifi cant correlation between aortic elastic properties and ADMA levels., Giriş: Ankilozan spondilit kronik infl amatuvar bir hastalık olup, kardiyovasküler komplikasyonlarla ilişkili olabilmektedir. Bu çalışmada amacımız, kardiyak tutulum olmayan ankilozan spondilit hastalarında aortun elastik özellikleri ile serum asimetrik dimetilarjinin (ADMA) düzeylerinin araştırılmasıdır. Hastalar ve Yöntem: Elli beş ankilozan spondilit hastasıyla benzer yaş ve cinsiyette 30 sağlıklı birey çalışmaya alındı. Açlık glukoz, serum lipidleri, C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH) ve ADMA düzeyleri çalışıldı. Aortik strain, distensibilite ve sertlik indeksi transtorasik ekokardiyografi de aort çapı ölçümleri ve eş zamanlı kan basıncı ölçümleriyle hesaplandı. Bulgular: Ankilozan spondilit grubunda ESH ve CRP düzeyleri yüksekti. Serum ADMA düzeyleri ankilozan spondilit grubunda kontrol grubuna göre anlamlı olarak yüksekti (0.76 ± 0.19 ve 0.55 ± 0.12, p< 0.001). Alt grup analizinde, anti-TNF-alfa tedavisi alan grupta konvansiyonel tedavi grubuna göre daha düşük ADMA düzeyi ölçüldü (0.68 ± 0.15 ve 0.87 ± 0.18, p< 0.001). Ortalama aortik strain ve distensibilite değerleri ankilozan spondilit grubunda daha düşük iken, sertlik indeksi daha yüksek saptandı. Korelasyon analizinde ADMA düzeyleri ile aortun elastik özellikleri arasında ilişki izlenmezken, ankilozan spondilit grubunda hastalık süresi ile aortik strain ve distensibilite arasında ters yönde anlamlı korelasyon izlendi. Sonuç: Çalışmamızda elde ettiğimiz sonuçlar kardiyak tutulumun olmadığı ankilozan spondilit hastalarında aortik elastisitenin bozulduğunu ve ADMA düzeylerinin arttığını göstermektedir. Ayrıca, aortun elastik özellikleri ile ADMA düzeyleri arasında anlamlı ilişki saptanamamıştır.

WOS: 000324268900016, PubMed: 23677730, Background: AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) is a prospective, multicenter study designed with the aim of describing the prevalence and epidemiology of AF practice in Turkey. This study aims to evaluate stroke risk in non-valvular atrial fibrillation (AF) and anticoagulant drug utilization within conformity to AF guidelines. Methods: Patients were recruited in 17 referral hospitals reflecting all the population of 7 geographical regions of Turkey. 2242 consecutive patients who had been admitted with AF on ECG were included in the study. 1745 of these patients, who had non-valvular AF, were included in the statistical evaluation. Stroke risk was evaluated with the CHA(2)DS(2)-VASc score. Results: The average age of participants was determined to be 69.2 +/- 11.5 years (56% female). Persistent-permanent AF was found to be the most common type of non-valvular AF (78%). The most common comorbid disorder was hypertension (73%). It was found that oral anticoagulant therapy was used by 40% of all patients, 37% of whom had effective INR (2.0-3.0). Upon multivariate analysis, age was found to be the only independent predictor of stroke among the variables' effects on thromboembolic events that created CHA2DS2-VASc abbreviations (OR 1.026, p < 0.001). Conclusions: These results suggest that stroke risk scores should be thoroughly heeded based on guidelines, and that anticoagulation must be applied according to their guidance.

Acute cardiac tamponade requires urgent diagnosis andtreatment. We report a case of a 43-year-old man whowas receiving warfarin treatment for 8 months followingmitral valve replacement. The patient had complaint ofdyspnea and fatigue for a few days. Cardiac tamponadewas diagnosed, and the INR at that time was 10.4. Urgentpericardiocentesis were undertaken and 1400 ml of pericardialblood was drained. Following surgery the patient’srecovery was uneventful. An intravenous vitamin K injectionand fresh frozen plasma transfusion were administeredto reverse the patient’s over-anticoagulated state.The final pathology revealed chronic inflammation andthere was no malignancy, and no bacteria or mycobacteriumwere seen. Emergency physicians should rememberthat over-anticoagulation with warfarin may contribute tocertain complications, including hemopericardium, andthat strict control of target INR should be the goal for patientswho require continuous warfarin treatment. J ClinExp Invest 2013; 4 (2): 229-233Key words: Hemopericardium, tamponade, oral anticoagulation,warfarin, echocardiography

Atrial fibrillation (AF) is an important health problem in Turkey. However, no prospective, multicenter, large trial reflecting national data has been published so far. Therefore, the aim of this study was to follow, analyze and evaluate patients with AF in a large multicenter nation-wide trial.Two thousand three hundred consecutive patients with AF in their electrocardiogram, reflecting all the population of seven geographical regions of Turkey will be included in the study. The patients will be followed up for two years and death, transient ischemic attack, stroke, systemic thromboembolism, major bleeding, hospitalization will be recorded as the primary end-point.Will be available at the end of the study; preliminary results will be due December 2012.General risk profile of patients with AF, frequency of anticoagulation, frequency of effective treatment and risks of bleeding will be evaluated according to the current guidelines. Major adverse events and their independent predictors will be determined.AMAÇ: Atriyal fibrilasyon (AF) ülkemiz için önemli bir sağlık sorunudur. Ülkemizde ileriye dönük, çok merkezli ve ülke epidemiyolojisini yansıtan ölçekte herhangi bir çalışma mevcut değildir. Bu çalışmayla ülkemizde çok merkezli bir çalışmada AF hastalarının epidemiyolojik verilerinin öne dönük olarak analizi, takibi ve değerlendirilmesi amaçlandı. YÖNTEMLER: Ülkemizden yedi coğrafi bölgeye ait nüfusu yansıtacak şekilde elektrokardiyografisinde en az bir defa AF atağı tespit edilmiş olan ardışık 2300 hasta çalışmaya alınacaktır. Hastalar ikinci yılın sonunda majör kardiyak sonlanım noktaları (ölüm, geçici iskemik atak, inme, sistemik tromboembolizm, major kanama ve hastane yatışı) açısından değerlendirilecektir. BULGULAR: Çalışma sonunda elde edilecektir. İlk bulguların Aralık 2012 tarihinde elde edilmesi planlanmaktadır. SONUÇ: AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) çalışması ile kılavuzların önerileri doğrultusunda ülkemizdeki AF hastalarının genel risk profili, oral antikoagülan tedavi kullanım sıklığı, tedavi alan hastalarda hedef INR değerlerine ulaşılıp ulaşılmadığı ve hastaların kanama riskleri belirlenecektir. Çalışma sonunda ülkemizde AF’li hastalarda majör istenmeyen olay sıklığı ve bu olayların bağımsız belirteçleri de belirlenecektir.

This study was aimed to investigate sensitivity and specificity of QT dispersion (QTd) as a predictor of hypertensive response to peak exercise stress testing (EST). Fifty-nine patients were divided in to two groups (32 patients with exaggerated blood pressure response (EBPR) to EST group and 27 patients for normotensive group) and the EST was monitored. The QTd and corrected QT (QTc) intervals were still found to be significant predictors of EBPR (P0.05). In receiver operating characteristic (ROC) analysis, a level of QTd ≥ 40 predicted EBPR with 84% sensitivity and 74% specificity. According to the present data, QTd might be an important predictive marker for EBPR.

Like any other foreign bodies, implanted cardiac devices can become infected. Staphylococcus aureus and coagulase-negative Staphilococci are the most common causes of infections of pacemaker and defibrillator systems. In this case an implantable cardioverter defibrillator pocket infection caused by an extremely rare microorganism, Klebsiella pneumonia, is presented.

PMID: 24164991 Objectives: Pulmonary hypertension (PH) is composed of a heterogeneous group of disorders marked by increased pulmonary artery resistance leading to right heart failure, with high mortality. Evidence is increasing to propose that inflammation plays a significant role in the pathophysiological mechanism. Increased prevalence of PH in patients with systemic inflammatory diseases is already known. Herein, we sought to evaluate the association between neutrophil to lymphocyte ratio (N/L ratio) and pulmonary arterial hypertension (PAH). Study design: Twenty-five patients with PAH and 25 controls were evaluated. Baseline clinical and echocardiographic variables were obtained. Complete blood counts in all patients and controls were reviewed retrospectively. Results: The N/L ratio was higher in patients with PAH compared to healthy volunteers (p=0.05). A cut-off value of 1.65 for N/L ratio predicted the presence of PAH with 72% sensitivity and 69% specificity. After multivariate analysis, only N/L ratio remained a significant predictor of PAH. Conclusion: We showed for the first time that N/L ratio was significantly increased in patients with PAH compared to controls. Amaç: Pulmoner hipertansiyon (PH) sağ ventrikül yetersizliği ve yüksek mortalite ile seyreden artmış pulmoner arter direnci ile kendini gösteren heterojen bir hastalık grubundan oluşur. Son zamanlarda patofizyolojik mekanizmada enflamasyonun merkezi bir rolü olduğu ile ilgili kanıtlar artmaktadır. Sistemik enflamatuvar hastalıklarda PH prevalansının artmış olduğu zaten bilinmektedir. Bu çalışmada, nötrofil/lenfosit oranı (N/L oranı) ile pulmoner arter hipertansiyonu (PAH) arasındaki ilişki değerlendirildi. Çalışma planı: Pulmoner arter hipertansiyonu bulunan 25 hasta ve sağlıklı 25 gönüllüden oluşan kontrol grubu değerlendirildi. Bazal klinik ve ekokardiyografik bulgular kaydedildi. Tüm hasta ve kontrol grubunun tam kan sayımları geriye dönük olarak değerlendirildi. Bulgular: Nötrofil/lenfosit oranı kontrol grubuna göre PAH’lı hastalarda daha yüksekti (p=0.05). N/L oranının 1.65 eşik değeri PAH varlığını %72 duyarlılık ve %69 özgüllük ile öngörmekteydi. Çok değişkenli analizden sonra sadece N/L oranının PAH’ın anlamlı öngördürücüsü olarak kaldığı saptandı. Sonuç: Nötrofil/lenfosit oranının kontrol grubuna göre PAH’lı hastalarda daha yüksek olduğu gösterildi.

Amaç: Atriyum fibrilasyonu (AF) klinik pratiğimizde en sık rastlanan ritm bozukluğu olup ülkemizde bu konuda yapılmış çok merkezli bir epidemiyolojik çalışma bulunmamaktadır. Bu çalışmanın amacı ülkemizde ilk kez yapılmış olan çok merkezli, ileriye dönük Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) çalışmasının kayıtlarından yararlanarak AF’ye klinik yönden yaklaşımımızı değerlendirmektir. Çalışma planı: Ülkemizde nüfus dağılımı göz önünde bulundurularak 17 ayrı üçüncü basamak merkezden, elektrokardiyografisinde en az bir defa AF atağı tespit edilmiş olan ardışık 2242 hasta çalışmaya alındı. Acil polikliniğine başvuran ya da yatmakta olan hastalar çalışmadan dışlandı. Hastaların epidemiyolojik verileri ve uygulanan tedaviler değerlendirildi. Bulgular: Çalışma popülasyonunu oluşturan hastaların %60’ı kadındı, hastaların ortalama yaşı 66.8±12.3 yıl olarak saptandı. Türk nüfusunda en sık görülen AF tipi non-valvular AF (%78) olup, AF’li hastaların %81’i ısrarcı-kalıcı AF’li idi. AF’ye en sık eşlik eden komorbid durum hipertansiyon (%67) olarak bulundu. Hastaların %15.3’ünde inme, geçici iskemik atak ve sistemik tromboemboli hikayesi mevcut iken kanama öyküsü hastaların %11.2’sinde kaydedildi. Çalışma süresinde hastaların %50’si warfarin, %53’ü de aspirin kullanıyordu. Oral antikoagülan ilaç kullanan hastaların %41.3’ünde etkin INR düzeyi saptandı. Oral antikoagülan ilaç kullanmamanın en sık nedeni (%69) hekim ihmali olarak saptandı. Sonuç: Bu veriler klinik pratiğimizde özellikle AF’li hastaların antitrombotik tedavileri konusunda daha dikkatli olunması gerektiğini göstermektedir. Objectives: Although atrial fibrillation (AF) is one of the most com- mon rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Tur- key: Epidemiologic Registry (AFTER) study. Study design: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency depart- ments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. Results: The mean age of the patients was determined as 66.8±12.3 years with female patients representing 60% of the study popula- tion. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co- morbidity in patients with AF. While a stroke or transient ischemic at- tack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspi- rin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. Conclusion: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

This case report describes a unique form of a complex congenital anomaly; ventricular septal defect associated with patent ductus arterious and coarctation of aorta in a 21-year-old patient with a multimodality approach.

Objective: The aim of this study is to investigate the relationship between serum thyroid hormone levels that are within the normal range and the presence and severity of coronary artery disease (CAD) in patients referred for coronary angiography. Methods: In this observational study, we enrolled 119 consecutive patients (77 men, mean age 60.7±13.8 years) who underwent coronary angiography. Blood samples were tested for thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) concentrations. Additionally, risk factors, clinical characteristics and angiographic results were obtained. The patients were separated into two groups according to the Gensini score as those with mild or severe atherosclerosis. Statistical analysis was performed using the Chi-square, Mann-Whitney U, correlation and logistic regression tests, and ROC analysis. Results: FT3 levels were significantly lower in subjects with CAD (4.0±0.7 vs. 4.6±0.6 pmol/L; p

A 55-year-old female patient was admitted with chest pain for 8 hours. She has no risk factors for coronary artery disease. There were no significant pathological findings on physical examination. ST-segment elevation in lead V 1-6 were observed on electrocardiogram. Coronary angiography revealed the left anterior descending artery originating from the left sinus valsalva alone and coursing normally. It was totally occluded after diagonal branch (Fig. 1A). Percutaneous transluminal coronary angioplasty and stenting were performed successfully (Fig. 1B). By a left Amplatz catheter, a coronary ostium, was cannuled at the left anterior surface of the ascending aorta, 2-3 cm above the sinotubuler junction. It was divided into two branches, as circumflex coronary artery (Cx) and right coronary artery (RCA), after intercrossing the front side of the aorta (Fig. 2). There were non-critical lesions in RCA and non-critical and critical lesions in the mid and distal part of Cx (Fig. 2B). Fig. 1 Fig. 2 The incidence of coronary anomaly in the large case series is about % 1,3.1) In Yamanaka's classification1) only the left main coronary artery and RCA anomalies has been listed as coronary anomalies originate from the aorta. We didn't find any reported coronary anomaly case, similar to our case in the literature.2),3) We report an association of RCA and Cx with single ostium originate from high left anterior aorta case. This case may find a different place in the classification of coronary anomalies originating from the ascending aorta.

A 33-year-old female presented with the typical angina symptoms of dyspnea on exertion. Five years prior, the patient had been diagnosed with familial hypercholesterolemia, as had her living siblings (a brother and a sister). The patient's family history included 2 brothers and 2 sisters that died in childhood due to unknown etiology. Although she was being treated with 80 mg atorvastatin and 10 mg ezetimibe, her total cholesterol level was 607 mg/dL, her low density lipoprotein (LDL) level was 555 mg/dL, her high density lipoprotein (HDL) level was 26 mg/dL, and her triglyceride level was 126 mg/dL. Monthly LDL apheresis was started as an adjunct to drug therapy.1) On physical examination, she had xanthelasma and plantar xanthomas. Cardiac examination revealed sinus tachycardia of 120 bpm, blood pressure of 110/75 mm Hg, and grade 3/6 systolic ejection murmur that was most prominent over the second intercostal space on the right sternal border. Electrocardiography showed ST depressions in the inferolateral derivations. Transthoracic echocardiography revealed normal left ventricular systolic function, mild hypertrophy of the left ventricle, and calcified aortic stenosis with a peak gradient of 95 mm Hg and a mean gradient of 62 mm Hg (Figs. 1 and ​and2).2). Fluoroscopic examination revealed severe calcification of the aortic root (Fig. 3). Coronary angiography demonstrated a 90% narrowing in the osteal part of the left main coronary artery (Fig. 4, arrows) and 80% in the proximal right coronary artery (Fig. 5, arrow). The patient was referred for surgery.2) Intraoperatively, extensive calcifications of the whole aortic root (porcelain aorta) required a modified Bentall procedure with a mechanical valve conduit.3) The left anterior descending artery was bypassed using the left internal mammary artery, the right coronary artery using the right internal mammary artery, and both diagonal and OM using sequential saphenous veins. Despite inotropic and intraaortic balloon pump support, the patient died during the early postoperative period due to prolonged cardiopulmonary bypass and heart failure. Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5

Women with valvular heart disease have an increased risk of adverse outcomes in pregnancy; however, with appropriate evaluation and treatment, most women can successfully bear healthy children. During pregnancy, pulmonary stenosis is generally well tolerated in the absence of other haemodynamically significant lesions. We present a case of a multiparous woman,who is pregnant with her sixth child, with a severe pulmonary stenosis. She presented with exertional chest pain and dyspnea. She was managed successfully with balloon valvuloplasty.

The aim of this study was to investigate the predictors of warfarin use in patients with non-valvular atrial fibrillation (AF). This study was the first to be conducted in a Turkish population. Materials and methods: Patients who presented to our outpatient clinic with the diagnosis of AF between September 2008 and October 2009 were enrolled. The patients were classified according to the CHADS2 risk scoring system recommended by the AHA/ACC/ESC guidelines for the classification of stroke risk in non-valvular AF patients. The probable variables influencing the use of warfarin were determined as age, sex, income level, healthcare coverage, lifestyle, place of residence, classification of AF, hypertension, diabetes mellitus, coronary artery disease, thyrotoxicosis, cardiac insufficiency, left ventricular dysfunction, stroke risk stratification, and history of stroke or systemic embolism (SE). Results: Among the 570 patients enrolled in the study, 144 were excluded because of insufficient patient information or refusal to participate, while 101 patients were excluded due to valvular AF. Thus, the evaluation was based on 325 patients (133 males and 192 females; mean age: 65 ± 10). According to the CHADS2 scoring, 62.2% of the patients were at high risk, 26.8% were at moderate risk, and 11.1% were at low risk. Only 19.7% of the patients were on warfarin treatment. In the logistic regression analysis, a history of stroke or SE, high income level, and the presence of persistent and permanent AF were found to be positive predictors of warfarin use, while advanced age was a negative predictor of warfarin use. Conclusion: This study demonstrated that a history of stroke or SE, high income level, presence of persistent and permanent AF, and advanced age are independent predictors of warfarin use in non-valvular AF patients.

We report a case of the giant thrombus on atrial lead of a patient who has a DDD dual-chamber permanent pacemaker.

We aimed to evaluate the success and safety of percutaneous mitral balloon valvuloplasty (PMBV) and its mid-term clinical and echocardiographic results in patients with symptomatic mitral stenosis, including those having a high echo score (9 to 11).This prospective study included 57 consecutive patients (9 men, 48 women; mean age 41+/-9 years) who underwent PMBV with the Inoue technique for symptomatic (NYHA class II-IV) mitral stenosis (valve area1.5 cm2). The patients were divided into two groups according to the echo scores ofor=8 (group 1, n=25) and8 (group 2, n=32). Clinical and echocardiographic evaluations were performed before and after 24-48 hours of PMBV and during the follow-up period, including restenosis and major cardiovascular events.Patients in group 2 had significantly higher rates of atrial fibrillation (53.1% vs. 16%; p=0.006) and functional capacity of NYHA class III-IV (90.7% vs. 56%; p=0.01). Procedural success rates were 96% (n=24) and 90.6% (n=29) in group 1 and 2, respectively. Failure occurred in one patient (4%) in group 1, and in three patients (9.4%) in group 2. One patient in group 1 developed severe mitral stenosis resulting in valve replacement. In group 2, two patients developed hemopericardium. After the procedure, there was a two-fold increase from 1.0+/-0.1 cm2 to 2.0+/-0.2 cm2 in the mean valve area, being more prominent in group 1 (group 1: from 1.1+/-0.1 cm2 to 2.1+/-0.1 cm2; group 2: from 0.9+/-0.1 cm2 to 1.8+/-0.1 cm2; p0.001). In-hospital mortality or embolic events did not occur, nor did restenosis or major cardiovascular events during a mean follow-up of 21+/-13 months.Our results show that PMBV can be performed successfully in patients having a low (or=8) or higher (9-11) echo score, with satisfactory hemodynamic and symptomatic improvements.

Oral anticoagulant therapy has been shown to decrease the risk for vascular complications in patients with atrial fibrillation (AF). We evaluated the frequency of oral anticoagulant use in patients with AF, whether oral anticoagulant use was associated with effective INR values, and the reasons for not including an anticoagulant in the treatment.The study included 426 consecutive patients (256 women, 170 men; mean age 66+/-11 years) who presented with a diagnosis of AF between October 2007 and November 2008. The patients were inquired about whether they were using warfarin and/or aspirin and the reasons for not taking an oral anticoagulant. The INR levels were measured in those receiving warfarin.Permanent AF was present in 72.8%, and paroxysmal AF was present in 27.2%. Patients = or75 years of age accounted for 32.4%. The risk for stroke was high in 69.3%, moderate in 21.8%, and low in 8.9%, hypertension being the most frequent risk factor (66.7%). Inquiry about medications showed that 107 patients (25.1%) were taking aspirin and warfarin, 21 patients (4.9%) and 237 patients (55.6%) were taking warfarin and aspirin alone, respectively, while 61 patients (14.3%) used none. The incidence of oral anticoagulant use was 30.1%, being significantly low in patients = or75 years of age (p=0.0001), and having hypertension (p=0.023) or coronary artery disease (p=0.004). Effective INR values recommended by the guidelines were attained in 47.7% (n=61) of patients receiving warfarin. Sex, age, clinical risk factors, and socioeconomic parameters were not associated with achievement of target INR values. The most frequent reason for not starting anticoagulant treatment was the low tendency of physicians to prescribe the drug (74.3%), followed by the presence of contraindications (9.8%).The most important factor for inadequate oral anticoagulant use especially in patients having a high risk for stroke is the low incidence of prescription of the drug by the physicians, suggesting low influence of the guidelines on the clinical practice.

We evaluated the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for further risk stratification of intermediate-risk patients with non-ST elevation acute coronary syndromes (NSTE-ACS).The study included 137 intermediate-risk patients (85 men, 52 women; mean age 62+/-11 years) with ACS, based on the TIMI risk score (scores 3 to 5). Serum NT-proBNP levels were measured 12 hours after the last anginal episode. The patients were divided into four groups according to the following NT-proBNP quartiles: 17-310 pg/ml (n=34), 313-688 pg/ml (n=35), 724-2,407 pg/ml (n=34), and 2,575-24,737 pg/ml (n=34). Primary endpoint of the study was mortality. The mean follow-up was 21.8+/-7.1 months.There were 27 deaths (19.7%), 14 of which were in the 4th quartile (4th vs 1st, 2nd, and 3rd quartiles: p=0.02, p=0.01, and p0.01, respectively). The first three quartiles did not differ significantly in this respect. In Kaplan-Meier analysis, patients in the 4th quartile had the lowest cumulative survival (log rank test, 4th vs 1st, 2nd, and 3rd quartiles: p=0.041, p=0.026, and p=0.009, respectively). NT-proBNP level was significantly higher in nonsurvivors than in survivors (p=0.01). In univariate analysis, mortality was also associated with the TIMI risk score, ejection fraction, and age. Patients who died were older (65.6+/-11.9 years vs 60.7+/-11.0 years; p=0.048) and had a lower ejection fraction (46.3+/-11% vs 54.1+/-9.8%; p0.001) than patients who survived. Mortality rates corresponding to TIMI risk scores of 3, 4, and 5 were 25.9%, 29.6%, and 44.4%, respectively (p=0.58 for TIMI 3 vs 4; p=0.001 for TIMI 3 vs 5; p=0.013 for TIMI 4 vs 5). Cox proportional hazards regression analysis showed that only TIMI risk score was an independent predictor of mortality (hazard ratio 2.3, 95% confidence interval 1.4-3.8, p=0.001).NT-proBNP has an additive predictive value over TIMI risk score in predicting long-term mortality in intermediate-risk patients with ACS.

Background Inflammation is one of the key mechanism in the development and progression of coronary artery disease. Myocardial bridging (MB) increases the tendency for development of atherosclerosis. The role of inflammation on the development of atherosclerosis in the MB is not clear. In this study, we investigated the existence of inflammation in the patients who have atherosclerotic plaque in the bridged segment. Methods This study included 40 patients (group I) presented with stable angina pectoris and detected MB in LAD on coronary angiography and 30 control subjects (group II) with normal coronary angiogram. Patients in group I were divided into two subgroups based on the findings on intravascular ultrasound (IVUS): group IA included 25 patients without atherosclerotic lesion in any coronary artery and group IB included 15 patients with atherosclerotic lesion in addition to MB in bridged segment of LAD. High-sensitivity C-reactive protein (hs-CRP) levels were compared between group I and II and group IA and IB. Results IVUS showed an atherosclerotic involvement with the proximal segment of MB in 15 patients (=group IB). No plaques were seen in other coronary arteries, in distal of MB or in the bridged segment. With regards to the level of hs-CRP, while no difference was established between group I and group II (1.7±0.4 mg/L vs 1.9±0.6 mg/L, p >0.05), hs-CRP was significantly higher in group IB than in group IA (3.2±0.3 mg/L vs 1.5±0.2 mg/L, p =0.001) and control group (3.2±0.3 mg/L vs 1.9±0.6 mg/L, p =0.03). A significant positive correlation was detected between the hs-CRP and the percentage of atherosclerotic stenosis on IVUS in group IB ( R =0.639, p =0.01). Conclusions These results indicate the presence of a low grade inflammation in patients with atherosclerotic lesion in bridged segment.

PP-048 The neutrophil/lymphocyte ratio (NLR) is an inexpensive, readily available and reliable inflammatory marker which has a predictor value in different cardiovascular disorders. Functional capacity is one of the most important prognostic factor in patients with heart failure. In this study, we

J Clin Exp Invest www.jceionline.org Vol 4, No 2, June 2013 1 Dicle University Medicine Faculty, Department of Cardiology, Diyarbakir, Turkey 2 Izmir University, Medical Park Hospital, Department of Cardiology, Izmir, Turkey Correspondence: Faruk Ertas, Dicle University Medicine Faculty, Department of Cardiology, Diyarbakir, Turkey Email: farukertas@hotmail.com Received: 12.04.2013, Accepted: 22.04.2013 Copyright © JCEI / Journal of Clinical and Experimental Investigations 2013, All rights reserved JCEI / 2013; 4 (2): 242-243 Journal of Clinical and Experimental Investigations doi: 10.5799/ahinjs.01.2013.02.0276

Coronary artery anomalies are uncommon and often asymptomatic. A double right coronary artery (RCA) is an extremely rare coronary artery anomaly, and only a few cases of double RCA have been reported. We report on an atherosclerotic double RCA that appeared after primary percutaneous intervention in a patient with an acute inferior myocardial infarction. This is the second case in the literature in which coronary arteries can be accepted as a double RCA, which were hidden by a total atherosclerotic occlusion in the proximal part of the RCA.

A left atrial (LA) free-floating myxoma is a rare disorder, which has an embolic potential and may also cause sudden death because of the occlusion of the mitral orifice. A 77-year-old female patient presented with an episode of dizziness and syncope on exertion. For the last 2 months prior to the …