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Objective: We aimed to assess the real-world label adherence of non-vitamin K antagonist oral anticoagulant (NOAC) dosing patterns, including apixaban, edoxaban, and rivaroxaban, in Turkish patients with atrial fibrillation., Methods: This was an observational, prospective, cross-sectional, multicenter study. Patients with atrial fibrillation (AF) who were prescribed NOACs within the last 4 months were recruited from 34 cardiology clinics in Türkiye. Baseline data were initially collected, and patient awareness was evaluated at 3-4 weeks., Results: A total of 903 patients were enrolled in the study. The mean age was 72.84 ± 10.17 years. We found that 140 (15.5%), 721 (79.8%), and 42 patients (4.7%) were prescribed off-label low, on-label, and off-label high dosing, respectively. The age of the patients in the on-label group was significantly lower than that of those in the off-label low and off-label high groups (both P < 0.001). Female patients were more frequently observed in the off-label high group (P = 0.019). The body mass index values of the patients in the off-label high-dose group were significantly lower than those in the other groups (P < 0.001). The perception of income levels also revealed significant differences between the groups (P = 0.010). Furthermore, the HAS-BLED scores (the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol Concomitantly) were significantly lower in the on-label group than in the other groups (P < 0.001). Similarly, the CHA2DS2-VASc [the Congestive Heart Failure, Hypertension, Age ≥75 (Doubled), Diabetes, Stroke (Doubled), Vascular Disease, Age 65-74, and Sex Category (Female)] scores were significantly lower in the on-label group than in the off-label group (P < 0.001)., Conclusion: The clinical impact off-label NOAC prescriptions may vary. Therefore, raising clinician awareness about proper NOAC dosing could aid in improve the outcomes.

Introduction: Cardiomyopathy due to myocardial iron deposition is the leading cause of death in transfusion- dependent beta-thalassemia major (β-TM) patients. Although cardiac T2* magnetic resonance imaging (MRI) can be used for the early detection of cardiac iron level before the onset of symptoms associated with iron overload, this expensive method is not widely available in many hospitals. Frontal QRS-T angle is a novel marker of myocardial repolarization and is associated with adverse cardiac outcomes. We aimed to investigate the relationship between cardiac iron load and f(QRS-T) angle in patients with β-TM., Methods: The study included 95 β-TM patients. Cardiac T2* values under 20 were considered to indicate cardiac iron overload. The patients were divided into two groups according to the presence or absence of cardiac involvement. Laboratory and electrocardiography parameters, including frontal plane QRS-T angle, were compared between the two groups., Results: Cardiac involvement was detected in 33 (34%) patients. Multivariate analysis showed that frontal QRS-T angle independently predicted cardiac involvement (p < 0.001). An f(QRS-T) angle of ≥ 24.5° had a sensitivity of 78.8% and a specificity of 79% in detecting the presence of cardiac involvement. In addition, a negative correlation was found between cardiac T2* MRI value and f(QRS-T) angle., Conclusions: A widening f(QRS-T) angle could be considered a surrogate marker of MRI T2* to detect cardiac iron overload. Therefore, calculating the f(QRS-T) angle in thalassemia patients is an inexpensive and simple method for detecting the presence of cardiac involvement, especially when cardiac T2* values cannot be determined or monitored., Competing Interests: The authors report no conflict of interest. However, the authors are responsible for the content and writing of the paper.

Background: The newly described bendopnea in heart failure (HF) is associated with increased cardiac filling pressures. The aim of the study was to show the effect of bendopnea follow-up on reaching optimal medical treatment doses in HF., Methods: A total of 413 patients were screened, and we included 203 patients with HF who were previously evaluated for bendopnea. Demographic data, presence or absence of bendopnea, medical history, laboratory findings, and medical treatments were evaluated. Optimal medical therapy target doses at baseline and 3rd month were compared in groups with and without bendopnea., Results: On admission, 64 patients (31.5%) had bendopnea. The rate of patients with bendopnea decreased in the 3rd month (n=42, 20.7%). The proportion of patients who used at least 50% of the recommended medical treatment dose on admission and in the 3rd month was compared; angiotensin-converting enzyme inhibitor /angiotensin receptor blockers use increased from 40.6% to 71.9% in those with bendopnea ( P =0.013), from 56.1% to 81.3% in those without bendopnea ( P <0.001) and beta-blockers use increased from 28.2% to 60.9% in those with bendopnea ( P =0.042), from 31.6% to 69.8% in those without bendopnea ( P <0.001). However, aldosterone antagonists use decreased from 70.3% to 67.2% in those with bendopnea ( P =0.961), from 68.4 % to 64.1% in those without bendopnea ( P =0.334). Bendopnea was independently effective in achieving ACE-I/ARB target doses (OR: 0.359, CI 95%: 0.151-0.854, P =0.020)., Conclusion: Bendopnea follow-up in HF patients can provide a significant improvement in reaching the recommended treatment target doses., (© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: We aimed to determine whether there is a relationship between the systemic immune-inflammation (SII) index and the recurrence of atrial fibrillation (AF) after successful direct current cardioversion (DCCV). Methods: The study included 99 patients with persistent AF who underwent successful cardioversion between 2015 and 2020. Results: In multiple regression analyses, the SII index was found to be a better independent predictor of AF recurrence after successful DCCV (p < 0.001). The cut-off value of SII (563) was associated with 96.9% sensitivity and 55.2% specificity to predict AF recurrence after DCCV. Conclusion: As a simple biomarker, SII index is an independent parameter for predicting AF recurrence after successful DCCV in patients with persistent AF. Also, SII levels can predict AF recurrence better than neutrophil-to-lymphocyte ratio.

Objective: Hyperuricemia is associated with poor outcomes in chronic heart failure (HF). We aimed to evaluate whether uric acid (UA) alone or in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a good predictor of all-cause mortality, HF hospitalization, and the composite endpoint of HF hospitalization or all-cause mortality in chronic HF., Methods: UA and NT-proBNP levels were evaluated retrospectively in 861 chronic HF patients with a left ventricular ejection fraction of ≤50%. The patients were compared by dividing them into 4 groups according to the cut-off values of UA and NT-proBNP., Results: Serum UA concentrations were ≥ 7.0 mg/dL in 46.5% of the subjects. With a median follow-up of 30 months, 201 (23.3%) patients died and 308 (35.8%) patients were hospitalized during the study. The all-cause mortality rate was higher in the hyperuricemic group than that of the normouricemic group (p < 0.001). A multivariate Cox regression model revealed that UA and NT-proBNP were independent predictors of all-cause mortality (HR: 1.105, 95% CI: 1.019-1.198, p = 0.016 and HR: 3.743, CI: 2.647-5.292, p < 0.001, respectively). Patients were divided into 4 groups based on UA (≥ 7 and < 7 mg/dL) and NT-proBNP (≥ 2279 and < 2279 ng/L) levels. All-cause mortality, HF hospitalization, and the composite endpoint of HF hospitalization or all-cause mortality rates were higher in the group with high UA and NT-proBNP levels (p < 0.001, p < 0.001, p < 0.001, respectively)., Conclusion: Hyperuricemia alone is an independent predictor of all-cause mortality in chronic HF. However, the combination of UA and NT-proBNP appears to be a stronger predictor of poor outcomes., Competing Interests: Conflict of interest No conflict of interest was declared by the authors., (Copyright © 2022 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.)

Objective: Inflammatory processes play an important role in cardiac valve calcification and ossification. The aim of this study was to investigate the relationship between the neutrophil-lymphocyte ratio (NLR) and degenerative aortic stenosis (AS)., Methods: A total of 220 patients with AS and 158 healthy individuals who were a control group were included in the study. The NLR was calculated by dividing the number of neutrophils by number of lymphocytes in peripheral blood samples., Results: The study group consisted of 220 AS patients (mild/ moderate group: n=110; severe group: n=110) and 157 healthy controls. Both the mild/moderate AS group (p<0.001) and the severe AS group (p<0.001) had a significantly higher NLR compared with the control group. The NLR in the severe AS group was significantly higher than that of the mild/moderate AS group (p<0.001). The groups were similar with respect to other baseline characteristics. A receiver operating characteristic curve analysis yielded a strong predictive ability of NLR for the presence of AS (Area under the curve=0.930; 95% CI [confidence interval], 0.898-0.963; p<0.001). A cut-off value of 2.310 for NLR had a sensitivity and specificity of 80.4% and 92.4%, respectively, for the presence of AS. In multivariate logistic regression analysis, NLR (Odds ratio: 43.8; 95% CI, 14.7-130.7) was the only independent predictor of AS., Conclusion: The discriminative performance of NLR for AS is high. NLR is strongly and independently associated with AS.

Objective: This retrospective study sought to research the adequacy of the follow-up and optimization of cardiac implantable electronic devices (CIEDs) performed by industry representatives., Methods: A total of 403 consecutive patients (35% females; median age, 67 years; age range 18-97 years) with either pacemakers (n=246), implantable cardioverter-defibrillators (ICDs), (n=117) or cardiac resynchronization therapy with defibrillator (CRT-D) (n=40) applied to our hospital's outpatient pacemaker clinic for follow-up. These patients had been followed up by industry representatives alone until September 2013 and then by a cardiologist who is dealing with cardiac electrophysiology and has a knowledge of CIED follow-up., Results: It was ascertained that 117 (47.6%) of 246 patients with pacemakers had a programming error. Forty-three (36.8%) of 117 patients were symptomatic, and after reprogramming, all symptoms diminished partially or completely during the follow-up. Moreover, 30 (25.6%) of 117 patients with ICDs had a programming error. Furthermore, 6 (15%) of 40 patients with CRT-Ds had a programming error. To conclude, when all patients with CIEDs were assessed together, it was ascertained that 153 (38%) of 403 patients had programming errors., Conclusion: The prevalence of inappropriate programming of CIEDs by industry representatives was quite higher than expected. Therefore, our study strongly demonstrates that CIED follow-up should not be allowed to be performed entirely by manufacturers' representatives alone.

Background and Objectives: Non-calcified carotid plaques are more unstable than calcified plaques, and they are associated with a higher risk of rupture, thromboembolism, and consequently, stroke. The purpose of the present study is to compare calcified and non-calcified plaques that cause intermediate carotid artery stenosis with respect to neutrophil/lymphocyte ratio (NLR)., Subjects and Methods: A total number of 139 asymptomatic patients with 50-70% stenosis of the carotid artery were included in this study. Carotid Doppler ultrasound imaging and computed tomography angiography were performed to divide the carotid artery plaques into two groups as calcified and non-calcified. Patients included in the calcified (n=73) and non-calcified (n=66) plaque groups were compared with respect to total neutrophil count, lymphocyte count and NLR., Results: Total lymphocyte count was statistically significantly lower in the non-calcified plaque group compared to the calcified plaque group (total lymphocyte count in non-calcified/calcified plaque groups [10 3 /mm 3 ]: 2.1/2.3, respectively) (p=0.002). NLR was statistically significantly higher in the non-calcified plaque group compared to the calcified plaque group (NLR in non-calcified/calcified plaque groups: 2.6/2.1, respectively) (p<0.001). The cut-off value for NLR was found to be >2.54. Multivariate regression analysis showed that NLR was independently associated with non-calcified carotid artery plaques (odds ratio 5.686, 95% CI 2.498-12.944, p<0.001)., Conclusions: NLR is increased in the presence of non-calcified carotid artery plaques that cause asymptomatic intermediate stenosis. Increased NLR can be used as a marker to assess the risk of rupture of non-calcified carotid artery plaques., Competing Interests: The authors have no financial conflicts of interest.

Objective: This study aimed to evaluate the association between the history of stroke/transient ischemic attack (TIA) and inter- and intra-atrial electromechanical delay (EMD) in patients with paroxysmal atrial fibrillation (PAF)., Methods: Patients diagnosed with PAF were included in this retrospective study. Patients who had a history of stroke or TIA were defined as the symptomatic group, whereas those who did not have such a history were defined as the asymptomatic group. On the basis of the transthoracic echocardiographic records, atrial electromechanical coupling (time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the A' wave interval with tissue Doppler echocardiography) and intra- and interatrial EMD were measured., Results: In this study, 160 patients were included, 52 of whom were symptomatic. While the intra-left atrial EMD was 68.2±6.1 ms in the symptomatic group, it was found to be 50.8±6.5 ms in the asymptomatic group (p<0.001). Interatrial EMD was 91.3±5.0 ms in the symptomatic group, whereas it was 71.5±7.0 ms in the asymptomatic group (p<0.001). In multiple logistic regression analysis, intra-left atrial [odds ratio (OR): 1.417, 95% confidence interval (CI): 1.193-1.684, p<0.001] and interatrial EMDs (OR: 1.398, 95% CI: 1.177-1.661, p<0.001) were found to be independently associated with the presence of stroke/TIA., Conclusion: Prolonged inter- and intra-left atrial EMDs in patients with PAF is associated with stroke/TIA. Evaluating this parameter in addition to the CHA2DS2-VASc score in patients with PAF may be helpful in identifying patients who are at a high risk of stroke/TIA.

Background: The aim of this study was to assess the short and long-term effects of carotid artery stenting (CAS) procedure on blood pressure (BP) through ambulatory BP monitoring., Methods: One hundred fifty three patients who underwent CAS for primary or secondary protection from December 2010 to September 2013 were enrolled to our study. The BP levels of total of 123 patients were monitored for 1 year. Thereafter, the pre-procedure levels of BP were compared with BP levels at the 24-hour and the first year intervals after the procedure., Results: Systolic and diastolic BP levels at the 24-hour and the first year intervals after CAS were significantly lower than the pre-procedure BP levels. The mean 24-hour systolic BP was 113 ± 13 mmHg and diastolic BP was 63 ± 8 mmHg, both of which were significantly lower (p < 0.001 and p < 0.001 respectively), while the pre-procedure mean systolic BP was 133 ± 10 mmHg and the mean diastolic BP was 75 ± 9 mmHg. Moreover, the mean first-year systolic BP was 125 ± 10 mmHg with a decline of 8 ± 8 mmHg and mean diastolic BP was 71 ± 8 mmHg with a decline of 4 ± 7 mmHg, both of which were again significantly lower compared to the pre-procedure levels (p < 0.001 and p < 0.001 respectively)., Conclusions: The results of our study suggested that systolic and diastolic BP levels diminished after CAS. Additionally, BP reduction continued even 1 year after the CAS.

Background and Objectives: Celiac disease (CD) is a chronic autoimmune disorder induced by dietary gluten intake by individuals who are genetically sensitive. Many studies report an increased risk of cardiovascular diseases in such patients. The aim of this study is to assess aortic elasticity properties in patients with CD that may be associated with an increased risk of cardiovascular disease., Subjects and Methods: Eighty-one patients diagnosed with CD by antibody test and biopsy and 63 healthy volunteers were included in this prospective study. Electrocardiographic and echocardiographic examinations were performed., Results: The CD group did not have any differences in the conventional echocardiographic parameters compared to the healthy individuals. However, patients in the CD group had an increased aortic stiffness beta index (4.3±2.3 vs. 3.6±1.6, p=0.010), increased pressure strain elastic modulus (33.6±17.0 kPa vs. 28.5±16.7 kPa, p=0.037), decreased aortic distensibility (7.0±3.0×10(-6) cm(2)/dyn vs. 8.2±3.6×10(-6) cm(2)/dyn, p=0.037), and similar aortic strain (17.9±7.7 vs. 16.0±5.5, p=0.070) compared to the control group. Patients with CD were found to have an elevated neutrophil/lymphocyte ratio compared to the control group (2.54±0.63 vs. 2.24±0.63, p=0.012). However, gluten-free diet and neutrophil/lymphocyte ratio were not found to be associated with aortic elasticity., Conclusion: Patients with CD had increased aortic stiffness and decreased aortic distensibility. Gluten-free diet enabled the patients with CD to have a reduction in the inflammatory parameters whereas the absence of a significant difference in the elastic properties of the aorta may suggest that the risk of cardiovascular disease persists in this patient group despite a gluten-free diet.

Objective: An increased neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical prognosis in patients with cardiovascular disease. In this study, we aimed to investigate if there was a correlation between NLR and the risk of stroke in patients with intermediate carotid artery stenosis., Methods: A total of 254 patients with a 50%-70% stenosis in the carotid artery, 115 of whom were symptomatic and 139 of whom were asymptomatic, were included in the study. Patients with a history of ischemic cerebrovascular event with or without sequelae, transient ischemic attack, and amaurosis fugax in the last 1-6 months were included in the symptomatic group of the study. The symptomatic and asymptomatic groups were compared in terms of total neutrophil count, lymphocyte count, and NLR., Results: The total white blood cell count (WBC), neutrophil count, and NLR were found to be higher and the lymphocyte count was found to be lower in the symptomatic patients than those in the asymptomatic patients (symptomatic/asymptomatic, respectively, WBC [10(3)/mm(3)]: 9.0/8.2, neutrophil count [10(3)/mm(3)]: 6.1/5.0, NLR: 3.08/2.2, lymphocyte count [10(3)/mm(3)]: 1.9/2.2) (P < .001). The cutoff value for NLR was found to be 2.6 or higher. In the multivariate regression analysis, an NLR value of 2.6 or higher was shown to be an independent variable for carotid artery stenosis to become symptomatic., Conclusions: NLR is increased in symptomatic intermediate carotid artery stenosis. An increased NLR value is an independent variable for carotid artery plaques to become symptomatic., (Published by Elsevier Inc.)

Transcatheter aortic valve implantation (TAVI) is considered an alternative therapy in high-risk patients with severe aortic stenosis (AS). However, this minimally invasive procedure carries potential complications, such as valve embolization at time of TAVI. We present a case of balloon-expandable aortic valve embolization which was managed nonsurgically. Valve embolization was managed conservatively, as the patient refused open heart surgery for definitive treatment. The patient was transferred to the intensive care unit in stable hemodynamic condition and discharged 1 week following the procedure.

Background: There is some evidence suggesting increased risk of atrial fibrillation (AF) in patients with celiac disease (CD). Impaired left atrial function plays a significant role in the development of AF. This study aimed at assessing the electrical and mechanical functions of the left atrium in patients with CD., Methods: A total of 71 patients with biopsy-proven, antibody-positive CD and 52 age-matched healthy controls were included in this prospective study. P-wave dispersion (PWD) was measured to assess the electrical functions of the left atrium through the use of surface electrocardiography. A tissue Doppler echocardiography was performed to determine the atrial conduction and electromechanical delay (EMD) time. To evaluate the mechanical functions of the left atrium, maximum, minimum, and presystolic atrial volumes were estimated to calculate the contractile, conduit, and reservoir functions., Results: In terms of transthoracic echocardiographic parameters, CD and control subjects were not significantly different. However, as compared to controls, patients with CD had significantly increased PWD (median 52 ms [interquartile range 46-58 ms] vs. 38 [36-40], P < 0.001). Also, significantly higher interatrial (49 ms [32-60] vs. 26 ms [22-28], P < 0.001), intra-left atrial (26 ms [17-44] vs. 14 ms [12-18], P < 0.001), and intra-right atrial (15 ms [8-22] vs. 10 ms [8-14], P < 0.001) EMD was found among CD subjects than controls. Despite an increase in the left atrial volume in patients with CD, conduit and reservoir functions were comparable., Conclusions: Although atrial mechanical functions are preserved in patients with CD, a slower electrical conduction was found, suggesting an increased risk of AF in this group of patients., (© 2015, Wiley Periodicals, Inc.)

Objective: The aim of this trial was to investigate the impact of corrected balloon occlusive diameter (cBOD) on successful performance of percutaneous atrial septal defect (ASD) closure., Methods: The trial comprised 86 patients (60 female, 26 male; mean age 36.5±14.3) on whom percutaneous ASD closure was performed. Patients were evaluated using transesophageal echocardiography (TEE). Relation of the defect to surrounding tissues and size of rims was also investigated. Balloon sizing was performed intraoperatively on all patients. Size of device was ascertained according to both durability of rims and whether or not they formed significant indentation, both of which determine cBOD., Results: The ASD closure device was successfully implanted in 84 (97.5%) patients. Mean maximum defect size was 17.4±5.9 mm, and mean color flow diameter was 16.8±5.4 mm. Mean maximum defect size at the moment of loss of shunt flow was 18.4±5.9 mm with TEE, and 18.8±6.1 mm with fluoroscopy. Mean size of Amplatzer occluder device was 20.0±6.5 mm. Device embolization was observed in 2 patients. However, no death occurred during or after the procedure., Conclusion: Percutaneous secundum ASD closure is a safe and effective treatment modality in experienced centers. Utilizing corrected balloon occlusive diameter may be of benefit in deciding the size of ASD occluder device.

Background: The frequency of patent foramen ovale (PFO) is greater in patients who have had a stroke and transient ischemic attack (TIA) than that in the general population. However, it is not well defined, which PFO would cause stroke or TIA. In this trial, we aimed to evaluate whether there was a difference regarding morphologic features of PFO in patients who were symptomatic (cryptogenic stroke or history of TIA) or asymptomatic according to the neurologic findings., Methods: Symptomatic patients with PFO and cryptogenic stroke or TIA and asymptomatic patients with PFO who were symptomatic in terms of neurologic findings as well as patients without any neurologic symptoms in whom PFO was diagnosed incidentally by transesophageal echocardiography were enrolled to this retrospective study on the condition that they were aged younger than 55 years. Not only the clinical and demographic characteristics of 2 groups were compared but also their morphological features were assessed. The morphologic features of PFO that were assessed included the length and height of tunnel, atrial septal excursion distance, thickness of septum primum, and thickness of septum secundum., Results: One hundred fifty-six patients, 64 of whom were symptomatic, were enrolled to this study. The height of PFO (median, 3.0 [interquartile range, 2.0-3.8]mm versus 2.0 [2.0-2.0]mm, P < .001), thickness of septum secundum (5.0 [5.0-7.0] versus 3.0 [2.0-3.0], P < .001), and septal excursion distance (7.0 [6.0-10.5] versus 4.0 [4.0-5.0], P < .001) were found to be greater in the symptomatic group than those in the asymptomatic group. There was no significant difference regarding the length of tunnel and thickness of septum primum. The ratio of length to height of PFO tunnel was less in the symptomatic group (3.0 [3.0-3.23] versus 5.0 [4.0-6.25], P < .001)., Conclusions: Our findings appear to indicate that a higher PFO tunnel, relatively greater interatrial septal mobility, thicker septum pellucidum, and the presence of an atrial septal aneurysm may help identifying the subjects at the age of or younger than 55 years with PFO who are at greater risk for cryptogenic stroke or TIA., (Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Celiac disease (CD) is an immune-mediated enteropathy involving the small intestines. Genetic and environmental risk factors as well as autoimmunity have been linked to its etiology. Studies have shown that coronary artery disease, autoimmune myocarditis, arrhythmias and premature atherosclerosis are more prevalent in individuals with CD compared to individuals without the disease. In this case report a young male patient with CD presented with acute myocardial infarction with spontaneous coronary artery dissections of two vessels. To the best of our knowledge, this is the first case report of spontaneous multi-vessel coronary artery dissection in a patient with CD.

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

Objective: Systemic sclerosis (SSc) is an autoimmune connective tissue disorder characterized by fibrosis. The prognosis of the disease is bad when clinically symptomatic cardiac dysfunction is occurred, therefore early detection of cardiac dysfunction is important in patients with SSc. The aim of this study was to investigate the frequency of fQRS in superficial electrocardiography in cardiacally asymptomatic patients with SSc and its relation to the systolic pulmonary artery pressure (sPAP)., Methods: This study included 31 cardiacally asymptomatic patients with SSc (23 females, 40.4±9.2 years) and 41 healthy volunteers as the control (31 females, 38.2±11.8 years). The ECGs with 12 derivations and transthoracic echocardiographies of the patients were evaluated. The presence of fQRS in the superficial ECG, and its relation to systolic pulmonary artery pressure (sPAP) were investigated., Results: The mean sPAP value in the SSc group was observed to be higher than that of the control group (26 mm Hg and 20 mm Hg, respectively, p<0.001). The presence of fQRS in the SSc group was more frequent than the control group (55% and 10%, respectively, p<0.001). In SSc patients presence of fQRS become relevant with ≥24 mm Hg sPAP by 88% sensitivity and 79% specificity., Conclusion: In our study, the presence of fQRS in SSc patients, were more frequent than in the normal population. Since pulmonary hypertension is the primary cause of mortality in patients with SSc, the correlation of fQRS with sPAP should also be considered.

Objective: Beta-thalassemia major (TM) is a genetic hemoglobin disorder causing chronic hemolytic anemia. Since cardiac insufficiency and arrhythmias are the primary causes of mortality in such patients, monitoring of cardiac iron load is important in management of the disorder. The purpose of this study was to investigate the importance of fragmented QRS (fQRS) and its relation to the cardiac T2* value for the evaluation of cardiac iron load in TM patients., Methods: This retrospective study included 103 TM patients. The patients' T2* values, measured by cardiac MRI and 12-lead surface ECGs, were interpreted. The cardiac T2* values under 20 were considered as cardiac iron overload. The relationship between the cardiac T2* value and fQRS in ECG was investigated., Results: The median age of the patients was 22.6 ± 6.6 years. All patients were on regular blood transfusions and iron chelators. The patients had no risk factors for coronary artery disease. In 50 (48%) patients fQRS was detected, and in 37 (74%) of these the T2* values were low. 86% of patients with cardiac involvement (37) had fQRS, but 22% of patients with non-involvement (13) had fQRS (p < 0.001)., Conclusion: Since cardiac involvement is the primary cause of mortality in TM patients, the early diagnosis of cardiac dysfunction is of vital importance. The search for fQRS in the ECGs of these patients, particularly when cardiac T2* values cannot be determined and followed, is a non-expensive and easy-to-attain method for therapy management.

Percutaneous mitral balloon valvuloplasty (PMBV) is the primary treatment in mitral stenosis patients with appropriate valve anatomy with no contraindications present. Pericardial effusion, cardiac tamponade and thrombus formation are rare but serious complications of this procedure. In the literature, the mortality rate associated with PMBV has been reported as 1%. The presence of intracardiac thrombus is a contraindication for PMBV. However, thrombus formation during the process is a very rare condition. In this case, we present a patient with rheumatic mitral stenosis, with both pericardial effusion and intracardiac thrombus, after laseration at the base of the left atrium during the valvuloplasty procedure.

Objectives: The effectiveness of carotid artery stenting (CAS) for primary and secondary prevention of ischemic stroke has been demonstrated. The aim of our study was the clinical and radiological evaluation of the reliability of the CAS procedure over a two-year follow-up period., Study Design: This study included 120 patients (mean age, 68 (48-86) years) admitted to our hospital between December 2010 and March 2013 for whom CAS was decided in the neurology, cardiovascular surgery and cardiology council. Symptomatic cases with more than 50% stenosis by angiography and asymptomatic patients with stenosis of more than 70% were included in the study. 80% of the asymptomatic patients were those detected during the screening before the coronary bypass surgery., Results: The success rate of the procedure was found as 97.5%. No mortality or myocardial infarction was observed in any of the patients in whom CAS was applied successfully. In 1 symptomatic patient (0.8%), ischemic cerebrovascular event with sequelae was observed 24 hours after the procedure. In total, transient ischemic attack was observed in 2 patients (1.7%) 6 and 11 months after the procedure. Asymptomatic restenosis was detected in 3 patients (2.5% of the total, with 2 in the asymptomatic and 1 in the symptomatic group). Symptomatic restenosis was not observed. None of the patients experienced hyperperfusion syndrome., Conclusion: We believe the CAS procedure can be performed safely in symptomatic and asymptomatic patients with low complication and high success rates.