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Increased neutrophil gelatinase-associated lipocalin (NGAL) levels are associated with toxic or ischemic renal injury.This study aimed to assess the usefulness of serial NGAL measurements with a point-of-care assay in patients with left ventricular systolic dysfunction (LVSD) for earlier detection of contrast-induced nephropathy (CIN).A total of 84 patients with LVSD patients referred for coronary angiography were consecutively enrolled in the study. The study population was divided into two groups as the CIN and the non-CIN groups according to the CIN's determination. The serum creatinine levels were calculated 24 h before the procedure and at the 48th and 72nd h after the cardiac catheterization. The plasma NGAL concentration was measured before and at 4 and 24 h after the cardiac catheterization.Baseline and serial NGAL levels were significantly higher in patients with CIN compared to the patients without CIN. NGAL 24th h levels after the index procedure were found to be an independent and significant predictor of CIN in multivariate analysis.Serial point-of-care NGAL measurements might help earlier detection of CIN in patients with heart failure after coronary angiography.

Resumo Fundamento A doença valvar mitral reumatismal (DVMR) é a apresentação mais comum das doenças cardíacas reumáticas (DCR). Os processos de inflamação e fibrose também têm papéis significativos em sua patogênese. Estudos recentes demonstram que os tióis e o tiol-dissulfeto são marcadores de stress oxidativo inéditos e promissores. Objetivos O objetivo deste estudo foi avaliar diferenças entre os níveis de tiol sérico e de tiol-dissulfeto em pacientes com DVMR e no grupo de controle. Métodos Noventa e dois pacientes com DVMR foram cadastrados no estudo. Cinquenta e quatro sujeitos saudáveis, e com correspondência de sexo e idade em relação ao grupo de estudo, também foram incluídos no estudo como um grupo de controle. Foram investigados os níveis de tiol nos pacientes com DVMR e o grupo de controle. Os p-valores menores que 0,05 foram considerados estatisticamente significativos. Resultados Os pacientes com DVMR apresentaram pressão sistólica da artéria pulmonar (PSAP) e níveis de diâmetro do átrio esquerdo (AE) mais altos que os do grupo de controle. Os níveis de tiol nativo (407±83 μmol/L vs. 297±65 μmol/L, p

Glucocorticoids are among the most prescribed drugs globally due to their potent anti-inflammatory and immunosuppressive properties. Although they have positive effects on the treatment of various disease states; long-term administration is associated with high blood pressure, insulin resistance, and susceptibility to type 2 diabetes. The heart attempts to cope with increased blood pressure and a decrease in glucose utilization by developing pathological cardiac remodeling. However, in this process, cardiac fibrosis formation and deterioration in heart structure and functions occur. Galectin-3, a member of the β-galactoside binding lectins, is consistently associated with inflammation and fibrosis in the pathogenesis of various disease states including insulin resistance and heart failure. Galectin-3 expression is markedly increased in activated macrophages and a subset of activated fibroblasts and vascular cells. Also, failing and remodeling myocardium show increased Gal-3 expression and elevated Gal-3 levels are related to heart failure severity and prognosis. Furthermore, Gal-3-related pathways are recently suggested as therapeutic targets both pharmacologically and genetically to increase insulin sensitivity in vivo. The objective of this review is to provide a summary of our current understanding of the role of glucocorticoid-associated insulin resistance, which is important for some cardiac events, and the potential role of galectin in this pathophysiological process.

Aim: We aimed to investigate the association between whole blood viscosity (WBV) and nondipping pattern in patients with essential hypertension. Materials & methods: A total of consecutive 530 patients who had been evaluated by ambulatory blood pressure monitoring were included. WBV was estimated by using hematocrit and plasma total protein levels for both WBV in low shear rate (0.5 s-1) and WBV in high shear rate (208 s-1) according to the de Simone’s formula. Results: In the multivariate analysis, low shear rate and high shear rate of WBV were associated independently with nondipping pattern in patients with essential hypertension. Conclusion: As a simple, inexpensive and noninvasive tool, WBV seems to be a significant predictor of nondipping hypertension.

OBJECTIVES Elucidation of the underlying mechanisms of angiogenesis and arteriogenesis in coronary collateral formation is necessary for new therapies. Pleiotrophin is a secreted multifunctional cytokine and associated with the formation of functional cardiovascular neovascularization in a series of experimental animal models. We aimed to evaluate the serum levels of pleiotrophin in patients with chronic total coronary artery occlusion and poor or good collateral development. METHODS We included 88 consecutive patients (mean age of the entire population: 63.7±12.1 years, 68 male patients) with stable angina pectoris who underwent coronary angiography and had chronic total occlusion in at least one major coronary artery. Collateral grading was performed according to the Rentrop classification. After grading, patients were divided into poor collateral circulation (Rentrop grade 0 and 1) and good collateral circulation (Rentrop grades 2 and 3) groups. Serum pleiotrophin levels were measured using a commercial human ELISA kit. RESULTS Fifty-eight patients had good and 30 patients had poor coronary collaterals. The good collateral group had higher serum pleiotrophin levels than the poor collateral group (690.1±187.9 vs. 415.3±165.9 ng/ml, P

Recently fragmented QRS (fQRS) on electrocardiography (ECG) has been introduced as a predictor of myocardial scarring and myocardial ischemia in coronary artery disease (CAD).The aim of this study was to investigate the relationship between fQRS and fractional flow reserve (FFR) results in patients with the intermediate degree of coronary artery stenosis.A total of 301 consecutive patients who underwent coronary angiography (CAG) and FFR measurement for intermediate coronary artery stenosis were included in the study. The study patients were divided into two groups: the low FFR group (FFR value of ≤0.80) and normal FFR (FFR value of0.80) group. Both groups were compared in terms of the presence of fQRS.Of 301 patients, fQRS was detected in 128 (42.5%) and low FFR was detected in 115 (38.2%). In the low FFR group, fQRS was significantly higher (P0.001). Multivariate analysis showed that fQRS was an independent predictor of myocardial ischemia in patients with intermediate coronary stenosis (OR=7.202, CI 95%, 4.195-12.367; p0.001). The presence of fQRS had 70% sensitivity and 74% specificity for the prediction of FFR≤0.80.In clinical practice, the presence of fQRS on ECG is associated with myocardial ischemia in patients with intermediate coronary stenosis.

Purpose Monocyte-high density lipoprotein ratio (MHR) has recently emerged as a marker of inflammation and oxidative stress in the cardiovascular disease. We aimed to investigate whether baseline MHR is associated with functional significance of intermediate coronary artery lesions. Methods Three hundred and one consecutive patients, 215 males and 86 females, who underwent fractional flow reserve (FFR) measurement for angiographically intermediate coronary stenosis (40–70% in quantitative coronary analysis) in the left anterior descending coronary artery were enrolled into the study. An FFR value of ≤ 0.80 was accepted for hemodynamic significance. Results Of the 301 patients, 115 (38.2%) exhibited significant functional stenosis (FFR ≤ 0.80) in the FFR measurement. Patients with hemodynamically significant lesions had higher MHR values (11.6 ± 3.3 vs. 12.6 ± 2.5 p = 0.003).In stepwise multivariate logistic regression analysis, total cholesterol (OR = 1.008, 95% CI = 1.002–1.013, p Conclusions Increased MHR values were associated with functional significance of angiographically intermediate coronary artery stenosis.

Junctional tachycardias(JT) are rare supraventriculartachyarrhythmias observed mainly in infants and children. JT is rare in adultpatients, and it is associated with poor outcomes. In general, these supraventricular tachycardiasrespond insufficiently to pharmacological treatment. In this report, we present the case of a 72-year-old patient withincessant tachyarrhythmia in whom cryoablation of the para-Hisian ectopic focuswas successfully performed., Junctional taşikardiler (JT), çoğunlukla bebeklerde ve çocuklarda görülen nadir görülen supraventriküler taşiaritmidir. JT erişkin hastalarda nadirdir ve kötü sonuçlarla ilişkilidir. Genel olarak, bu supraventriküler taşikardiler farmakolojik tedaviye yetersiz cevap verirler. Bu yazıda, para-hisian ektopik odağının kriyoablasyonunun başarıyla yapıldığı, sürekli taşiaritmili 72 yaşında bir olguyu sunuyoruz.

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia and is a major cause of embolic stroke. In patients with hereditary bleeding disorders such as haemophilia, management of AF particularly anticoagulation can be quite challenging. Left atrial appendage (LAA) closure is an emerging option in AF patients who are not eligible for oral anticoagulation therapy because of contraindications or high bleeding risk. Case summary A 67-year-old man with permanent AF and haemophilia was referred for further evaluation of our cardiology clinic by his primary haematologist. The CHA2DS2-VASc score was estimated to be 3 and the HAS-BLED score was 3. Due to high risk of bleeding, we decided to perform percutaneous LAA closure instead of oral anticoagulation. Pre-procedural cardiac computerized tomography angiography and transoesophageal echocardiography were performed for measurements of LAA dimensions and exclude LAA thrombus. Percutaneous LAA occlusion was performed using a 28-mm AmplatzerTM AmuletTM device. The final result was excellent without significant residual leak, pericardial effusion, and embolic complication. Clopidogrel 75 mg/day and aspirin 81 mg/day for 1 month with adequate FVIII prophylaxis and then only aspirin 81 mg/day for 2 months were recommended. No antiplatelet was given after 3 months. The patient did not report any thrombotic or haemorrhagic adverse events and there were no complications related to implanted device after 1 year of follow-up. Discussion In patients with hereditary bleeding disorders such as haemophilia, management of AF particularly anticoagulation can be quite challenging. In this report, we present a case of percutaneous LAA occlusion using AmplatzerTM AmuletTM device in a patient who has haemophilia and permanent AF. LAA closure has the potential to be more cost effective as compared to oral anticoagulation therapy due to lesser necessity of clotting factor infusion.

Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or who are unsuitable candidates for open-heart surgery. However, concerns exist over treating patients who have undergone previous mitral valve surgery due to the potential interference between the mitral prosthetic valve or ring and the TAVI device. In this case report, we present a case in which a patient with symptomatic severe aortic stenosis and previous mechanical mitral valve replacement was successfully treated with TAVI using a Portico valve, which is under-researched. J Teh Univ Heart Ctr 2019;14(2):85-89 This paper should be cited as: Korkmaz A, Gürsoy HT, İleri M, Uçar Elalmış Ö, Güray Ü. Transcatheter Self-expandable Aortic Valve (Portico) Implantation in a Patient with Previous Mitral Valve Replacement: A Case Report. J Teh Univ Heart Ctr 2019;14(2):85-89.

WOS: 000400680200010, PubMed ID: 27460050, The current study aimed to evaluate the influence of regular annual influenza vaccinations on cardiovascular (CV) death and heart failure-related hospitalizations (HFrH) in stable outpatients with heart failure with reduced ejection fraction. The Turkish research team-HF (TREAT-HF) is a network undertaking multicenter, observational cohort studies in HF. This study is a subgroup analysis of TREAT-HF outpatient cohorts who completed a questionnaire on influenza vaccination status and for whom follow-up data were available. A total of 656 patients with available follow-up data for CV death and HFrH including recurrent hospitalization were included in the study. Patients were classified into two groups: those who received regular influenza vaccination (40 %) and those who did not receive vaccination. During a mean follow-up of 15 +/- 6 months, 113 (18 %) patients had CV death and 471 (72 %) patients had at least one HFrH. The CV death rate was similar in both groups of patients (16 vs. 19 %, p = 0.37), whereas, HFrH and recurrent HFrH were significantly less frequently encountered in patients who received regular influenza vaccination than in those who did not receive vaccination (43 vs. 92 % and 16 vs. 66 %, p < 0.001, respectively). In a multivariate Cox proportional hazards model - in addition to a few clinical factors - vaccination status (HR = 0.30, 95 % CI = 0.17-0.51, p < 0.001) and graduation from university (HR = 0.35, 95 % CI = 0.17-0.72, p = 0.004) remained independently associated with the risk of recurrent HFrH. Regular influenza vaccination does not influence CV deaths; however, it decreases HFrH including recurrent episodes of HFrH in outpatients with heart failure with reduced ejection fraction.

BACKGROUND Acute heart failure is a heterogenous syndrome defined by a number of factors, such as its physiopathology, clinical picture, time of onset, and relation to acute coronary syndrome. Acute cardiogenic pulmonary edema (ACPE) constitutes approximately 10-20% of acute heart failure syndromes, and it is the most dramatic symptom of left heart failure. Platelet to lymphocyte ratio (PLR) is a relatively novel inflammatory marker that can be utilized for prognosis in various disease processes. OBJECTIVE In this study, we investigated the value of the PLR for the prediction of mortality in patients with ACPE. METHODS A total of 115 patients hospitalized with a diagnosis of ACPE were included in this study. The patients were divided into tertile groups according to their PLR values: high (PLR > 194.97), medium (98.3-194.97), and low tertile (PLR

INTRODUCTION[|]Contrast-induced nephropathy (CIN) is a common complication of diagnostic or interventional procedures that may arise from administration of intravascular contrast media. Recent studies have reported the thiol-disulfide ratio as a novel oxidative stress marker. Therefore, we investigated the role of thiol levels in predicting CIN in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (PCI).[¤]METHODS[|]A total of 302 patients were enrolled in the study. CIN was defined as an increase in serum creatinine concentration ≥0.5 mg/dL compared with the admission value or a >25% relative rise during the first 48–72 hours after the procedure. To evaluate the relationship between thiol levels and CIN, the patients were divided into a CIN group and a non-CIN group.[¤]RESULTS[|]CIN occurred in 44 (15%) patients. Native thiol (274.8+-84.7 μmol/L vs. 220.8+-97.1 μmol/L, p=0.001) and total thiol (305.4+-89.7 μmol/L vs. 260.1+-102.1 μmol/L, p=0.009) levels were higher in patients within the non-CIN group. Disulfide (15.8+-6.6 μmol/L vs. 19.6+-8.4 μmol/L, p=0.002) levels, and mean disulfide/total thiol ratios (8.4+-3.7 vs. 5.9+-3.1, p=0.001) were higher in patients with CIN (+) group. In univariate analysis, the initial native thiol, total thiol, disulfide levels, and disulfide/total thiol ratio were found to have prognostic significance in the development of CIN. In the multivariate regression analysis, only the disulfide/total thiol ratio (OR=1.190; 95% CI: 1.090–1.300; p=0.001) was significantly and independently associated with CIN. The cutoff value of the disulfide/total thiol ratio to predict CIN on admission in patients with STEMI who underwent primary PCI was 7, with a sensitivity of 68.2% and a specificity of 79.8%.[¤]DISCUSSION AND CONCLUSION[|]Our results suggest that thiol/disulfide homeostasis could be a good biochemical risk marker for CIN in STEMI patients who underwent primary PCI.[¤]

Objective: Aortic stiffness and chronic kidney disease share common risk factors. Increased aortic stiffness is a predictor of lower estimated glomerular filtration rate (eGFR) at lower levels of renal functions. We aimed to investigate the association between invasively measured central aortic pulsatility (AP) as an indicator of aortic stiffness and eGFR in a population with coronary artery disease and without overt renal disease. Methods: This study had a cross-sectional design. Data were retrospectively collected. We evaluated 72 patients (44 males and 28 females; mean age 59.0±10.3 years) with coronary artery disease. eGFR was calculated with dividing the Cockcroft–Gault formula by body surface area. Direct measurements of aortic blood pressures were utilized to calculate pulse pressure and AP. Multiple linear regression analysis was performed to test the relationship between eGFR and AP, independent from potential confounders. Results: eGFR was significantly correlated with age (r=0.489, p0.71 had 84% sensitivity and 72% specificity in predicting eGFR of

The sclerotic lesions of the aortic valve share common features with atherosclerosis. An anti-inflammatory protein, adiponectin, seems to have a protective effect on the cardiovascular system. The goal of our study is to determine adiponectin levels in patients with aortic sclerosis and to compare these values with the control group with similar age and cardiovascular risk profile.Sixty-eight patients with aortic sclerosis and 40 controls were included. Serum adiponectin levels were measured by solid-phase enzyme-linked immunosorbent assay.There were no significant differences regarding age, sex and other cardiovascular risk factors between groups. Also, mean body mass index values were similar. The rate of mitral annular calcification and left ventricular hypertrophy were significantly higher in patients with aortic sclerosis. Among laboratory variables, high-sensitive C-reactive protein (hsCRP) levels were significantly higher in patients with aortic sclerosis than in those without (4.0 ± 2.9 vs. 2.9 ± 2.3 mg/dl, P = 0.04). Adiponectin levels were found to be significantly lower in aortic sclerosis group than in controls (9.7 ± 4.4 vs. 11.7 ± 4.9 μg/ml, P = 0.034). In the whole group, adiponectin levels were significantly correlated with BMI (r = -0.22, P = 0.02), white blood cell count (r = -0.2, P = 0.03), hsCRP (r = -0.25, P = 0.008), total cholesterol (r = -0.18, P = 0.05), high-density lipoprotein (HDL) cholesterol (r = 0.31, P = 0.001) and triglyceride (r = -0.36, P 0.001).In patients with aortic sclerosis, serum adiponectin levels were significantly lower compared with those with normal aortic valves. Our findings suggested that adiponectin might play a role in the progression of degenerative aortic valve disease.

Background and aim: Infective endocarditis (IE) is associated with increased mortality and morbidity. In this study, we aimed to evaluate the role of troponin levels in predicting long-term survival in patients with IE. Methods: A retrospective analysis of the medical database of Yuksek Ihtisas Education and Research Hospital was performed to reach the patients that received the diagnosis of definite IE according to Duke criteria. Out of 84 definite IE cases, 48 patients (mean age 45.6±17.3, 39.6% female) that had troponin T levels measured upon hospital admission were included. The survival status of the study subjects was assessed during a follow-up period of 1 year. Results: A total of 20 (41.7%) patients died during the follow-up. Baseline median troponin T levels were significantly higher in fatal cases (0.08 [0.02-0.24] ng/ml vs. 0.02 [0.01-0.04] ng/ml p=0.003). The optimal troponin T level to detect mortality was 0.05 ng/ml according to receiver operating characteristic curve (area under the curve 0.75, 95% Confidence Interval (CI) [0.61-0.9], p=0.003) with 70% sensitivity and 79% specificity. Patient with elevated troponin levels were older, were more likely to be male and tended to have enterococcal infection. These patients had also higher creatinine levels and increased systolic pulmonary pressures. In the multivariate Cox regression analysis, renal failure (hazards ratio (HR) 8.23, CI 95% 2.53-26.9, p

Background: Platelet activation appears to play an important role in thromboembolic com­plications of infective endocarditis (IE). Mean platelet volume (MPV) is a potentially useful marker of platelet activity and a quick and easy determinant of thrombotic risk. Hence the aim of this study was to investigate the baseline platelet volume indices (MPV and platelet distribution width [PDW]) in IE patients who developed embolic events in the follow-up period and who did not. Methods: The study group consisted of 76 consecutive patients (female: 55, male: 21, mean age: 26 years old, ranged: 8–64 years) with definite IE according to Duke Criteria. Thirty four healthy subjects, who were age and gender adjusted, served as the control group. The mean duration of hospital stay was 44 days. Results: Among the IE patients, 13 (13/76, 17.1%) had major embolic events. Significantly larger vegetations were observed in patients with embolic events as compared to non-embolic group (1.4 vs. 1.0 cm, p = 0.03). MPV at hospital admission was higher in patients who had embolic events in the follow-up period compared to both those who did not and the control subjects (10.62 ± 1.13 vs. 9.25 ± 0.97 and 8.93 ± 0.82 fL, p < 0.001, respectively). Similarly, the patients with embolic events had increased PDW compared to the non-embolic ones and the control group (16.31 ± 2.42 vs. 14.35 ± 1.97 and 14.04 ± 1.82%, p < 0.001, respectively). Conclusions: The present study demonstrated that IE patients with embolic events had in­creased MPV and PDW values, compared to non-embolics. Future prospective studies with standardized measurements may clarify the clinical role of platelet volume indices in thrombo­embolic complications of IE.

OBJECTIVE Exaggerated blood pressure response to exercise is a risk factor for the development of future hypertension. In this study, we aimed to investigate the association between homocysteine, epicardial fat thickness, nonalcoholic hepatic steatosis, and exaggerated blood pressure response to exercise. PARTICIPANTS AND METHODS We included 44 normotensive and 40 patients with exaggerated blood pressure response to exercise who have normal resting blood pressure and without a previous diagnosis of hypertension. All patients underwent treadmill exercise test and clinical, ultrasonographic, and echocardiographic evaluation. Exaggerated blood pressure response to exercise is defined as peak exercise systolic blood pressure of at least 210 mmHg in men and at least 190 mmHg in women. Homocysteine and other biochemical parameters were determined with standardized automated laboratory tests. RESULTS Mean age of all participants is 47.9±8.5 years, and 36 of 84 participants were female. The frequency of diabetes mellitus in both groups was similar (P=0.250). Homeostasis model assessment index-insulin resistance had a statistically insignificant trend to be higher in a patient with exercise hypertension (P=0.058). The nonalcoholic fatty liver was more frequent in patients with exercise hypertension (13.6 vs. 47.5%, P=0.002). Epicardial fat thickness was increased in patients with exercise hypertension (5.5±1.5 vs. 7.3±1.1 mm; P=0.001). However, homocysteine levels did not significantly differ between normotensive and exercise hypertensive patients [12.3 μmol/l (5.7-16.9 μmol/l) vs. 13 μmol/l (5.9-28.3 μmol/l); P=0.883]. CONCLUSION In our study, homocysteine levels were not associated with exaggerated blood pressure response to exercise; however, fatty liver and epicardial fat thickness as visceral adiposity-related cardiometabolic risk factors were significantly related with exaggerated blood pressure response to exercise in patients without a previous diagnosis of hypertension.

Summary Background Dual antiplatelet therapy (DAPT), aspirin plus a P2Y12 inhibitor, is the standard antithrombotic treatment following acute coronary syndromes. The factor Xa inhibitor rivaroxaban reduced mortality and ischaemic events when added to DAPT, but caused increased bleeding. The safety of a dual pathway antithrombotic therapy approach combining low-dose rivaroxaban (in place of aspirin) with a P2Y12 inhibitor has not been assesssed in acute coronary syndromes. We aimed to assess rivaroxaban 2·5 mg twice daily versus aspirin 100 mg daily, in addition to clopidogrel or ticagrelor (chosen at investigator discretion before randomisation), for patients with acute coronary syndromes started within 10 days after presentation and continued for 6–12 months. Methods In this double-blind, multicentre, randomised trial (GEMINI-ACS-1) done at 371 clinical centres in 21 countries, eligible patients were older than 18 years with unstable angina, non-ST segment elevation myocardial infarction (NSTEMI) or ST segment elevation myocardial infarction (STEMI), with positive cardiac biomarkers and either ischaemic electrocardiographic changes or an atherosclerotic culprit lesion identified during angiography. Participants were randomly assigned (1:1) within 10 days after admission for the index acute coronary syndromes event to either aspirin or rivaroxaban based on a computer-generated randomisation schedule. Randomisation was balanced by using randomly permuted blocks with size of four and was stratified based on the background P2Y12 inhibitor (clopidogrel or ticagrelor) intended to be used at the time of randomisation. Investigators and patients were masked to treatment assignment. Patients received a minimum of 180 days of double-blind treatment with rivaroxaban 2·5 mg twice daily or aspirin 100 mg daily. The choice of clopidogrel or ticagrelor during trial conduct was not randomised and was based on investigator preference. The primary endpoint was thrombolysis in myocardial infarction (TIMI) clinically significant bleeding not related to coronary artery bypass grafting (CABG; major, minor, or requiring medical attention) up to day 390. Primary analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT02293395. Findings Between April 22, 2015, and Oct 14, 2016, 3037 patients with acute coronary syndromes were randomly assigned; 1518 to receive aspirin and 1519 to receive rivaroxaban. 1704 patients (56%) were in the ticagrelor and 1333 (44%) in the clopidogrel strata. Median duration of treatment was 291 days (IQR 239–354). TIMI non-CABG clinically significant bleeding was similar with rivaroxaban versus aspirin therapy (total 154 patients [5%]; 80 participants [5%] of 1519 vs 74 participants [5%] of 1518; HR 1·09 [95% CI 0·80–1·50]; p=0·5840). Interpretation A dual pathway antithrombotic therapy approach combining low-dose rivaroxaban with a P2Y12 inhibitor for the treatment of patients with acute coronary syndromes had similar risk of clinically significant bleeding as aspirin and a P2Y12 inhibitor. A larger, adequately powered trial would be required to definitively assess the efficacy and safety of this approach. Funding Janssen Research & Development and Bayer AG.

OBJECTIVE: Treadmill exercise stress testing for identifying patients with a higher likelihood of coronary artery disease (CAD) before elective coronary angiography is recommended in the current guidelines. In this study, we aimed to evaluate the changes in the hematological parameters before and after exercise stress test in relation with the presence of CAD. METHODS: A total of 113 patients with chest pain who underwent treadmill exercise testing and coronary angiography were included in this study. RESULTS: Neutrophil count (4.38±0.99 vs 5.19±0.93, P

Objectives: To detect the prevalence of alternative herbal medicine and nutritional complementary product intake in patients admitted to outpatient cardiology clinics and to determine demographic characteristics, comorbidities and medical properties of those patients. Study design: Patients admitted to outpatient cardiology clinics between June 2011 and March 2012 were given questionnaires involving age, gender, education, occupation, chronic illness, medication, herbs, nutritional complementary products, the index purpose and motivation for using herbs and nutritional complementary products. The data of those questionnaires were analyzed. Results: A total of 454 questionnaires were collected. The mean age was 49+-13 and 48% of the participants were female. Of those patients, 12% had diabetes, 34% had hypertension, 26% had coronary artery disease, 7% had heart failure, 58% had chronic illness, 49% had cardiovascular disease, and 57% had history of drug intake. Including vitamins and minerals, there were 75 (16%) patients taking alternative and complementary medicine. When vitamins and minerals were excluded, 56 (12%) patients were using at least one product, while 24 (5%) patients were using more than one. Garlic (n=33), flaxseed (n=13), ginger (n=12), omega 3 (n=12), and turmeric (n=11) were the most popular products. Of those 56 patients, 32% were using alternative medicine for hypertension and 23% for hyperlipidemia treatment, while 20% were using those products to be healthier in general. Alternative medicine was more prominent in females (p=0.04), and older patients (p=0.004). Education level, drug intake, and the presence of chronic illnesses, hypertension and cardiovascular disease were significantly higher in those patients. Conclusion: Alternative and complementary products were common in patients admitted to outpatient cardiology clinics. Female gender, advanced age, higher education level, drug intake, and having a chronic illness were predisposing factors.

Background: Adiponectin, an adipose tissue derived cytokine, is known to have antiatherogenic and anti-inflammatory effects on endothelial cells and macrophages. Calcific aortic valve disease has a similar physiopathology to atherosclerosis. Aim: To investigate the relationship between adiponectin and calcific aortic valve disease. Methods: The study group consisted of 58 patients with calcific aortic stenosis and 24 healthy controls. Aortic stenosis patients were divided into three groups according to their valvular areas: mild (n = 11), moderate (n = 25), and severe (n = 22). Serum adiponectin levels and other biochemical parameters were measured. Results: The aortic stenosis and control group were similar in terms of age, gender and cardiovascular risk factors. Adiponectin median values did not differ significantly between two groups (2.19 μg/mL [1.43–3.18], 1.79 μg/mL [1.34–3.42] aortic stenosis and control group, respectively; p = 0.7). Aortic stenosis patients were divided into three groups according to their valvular area as mild, moderate and severe. There were no differences when we compared adiponectin levels among those groups (mild: 2.10 μg/mL [1.47–3.31], moderate: 2.13 μg/mL [1.44–2.91], severe: 2.65 μg/mL [1.28–3.43]; p = 0.67). Age (r = 0.26, p = 0.045) and aspartate aminotransferase (r = 0.28, p = 0.04) had positive correlations with adiponectin; while white blood cell count (r = –0.32, p = 0.015), fasting blood glucose (r = –0.29, p = 0.03), haemoglobin (r = –0.27, p = 0.04) and triglyceride levels (r = –0.41, p = 0.002) had negative correlations. Conclusions: In our study, we did not find a relationship between adiponectin levels and calcific aortic valve disease.

Bilateral subconjunctival haemorrhage and facial petechia are common clinical finding, characteristically present in numerous disease especially systemic diseases; in the setting of infection or trauma; or in patients who are otherwise healthy. To our knowledge this feature has previously been described in one patient after cardioversion [1]. But in this case we wish to draw attention to this finding observed on a patient suffering defibrillation.

Background: We aimed to investigate the clinical features associated with development of coronary collateral circulation (CCC) in patients with acute non-ST-elevation myocardial infarction (NSTEMI) and to develop a scoring model for predicting poor collateralization at hospital admission. Methods: The study enrolled 224 consecutive patients with NSTEMI admitted to our coronary care unit. Patients were divided into poor (grade 0 and 1) and good (grade 2 and 3) CCC groups. Results: In logistic regression analysis, presence of diabetes mellitus, total white blood cell (WBC) and neutrophil counts and neutrophil to lymphocyte ratio (NLR) were found as independent positive predictors of poor CCC, whereas older age (>= 70 years) emerged as a negative indicator. The final scoring model was based on 5 variables which were significant at p < 0.05 level following multivariate analysis. Presence of diabetes mellitus, and elevated total WBC (>= 7.85 x 10(3)/mu L) and neutrophil counts (>= 6.25 x 10(3)/mu L) were assigned with 2 points; high NLR (>= 4.5) with 1 point and older age (>= 70 years old) with -1 point. Among 30 patients with risk score = 4; out of whom, 130 (with a 93.5% positive predictive value) had poor collateralization. Sensitivity and specificity of the model in predicting poor collateralization in patients with scores = 4 were 99.2% (130/131) and +76.3 (29/38), respectively. Conclusions: This study represents the first prediction model for degree of coronary collateralization in patients with acute NSTEMI.

Collaterals, which develop in response to ischemic stimuli derived from coronary artery disease (CAD), contribute to reduction of infarct size, left ventricular dysfunction, and mortality. However, there is considerable variation among patients with coronary heart disease regarding the extent of coronary collateral development (CCD). In this study, we aimed to investigate the association of the degree of platelet activation via mean platelet volume (MPV) with coronary collateral circulation. Therefore, 210 patients who underwent coronary angiography and had coronary stenosis ≥50 % in at least one coronary artery were included in the study. Clinical information and analyses of blood samples were obtained from a review of the patients' chart. Blood samples for MPV were analyzed by K3 EDTA and collateral vessels were graded according to the Rentrop classification. In the study group, 150 of the 210 patients were found to have inadequate CCD. Although there was no difference between the two groups with regard to platelet count, MPV levels were significantly higher in the patients who had inadequate CCD (11.3 ± 1.0 fl vs. 9.5 ± 1.5 fl, p 0.001). Furthermore, the Gensini score was significantly lower in patients who had inadequate CCD (45 ± 46 vs. 91 ± 35, p 0.001). MPV, Gensini score, age, female gender, total cholesterol, red cell distribution width, triglyceride, and fasting glucose levels were found to have univariate association with poor CCD. In multivariate logistic regression model, MPV (OR = 2.45, p 0.001) and Gensini score (OR = 0.98, p 0.001) were found to be the independent predictors of impaired CCD. In receiver operator characteristic curve analysis, optimal cut-off value of MPV to predict inadequate CCD was found as9.6 fl, with 96% sensitivity and 84.7% positive predictive value. In conclusion, we can say that MPV is an important, simple, effortless, and cost effective tool and can be useful in predicting the CCD in patients with significant CAD.

Isolated systolic hypertension (ISH) is generally encountered in elderly patients and there are scarce data regarding the renin-angiotensin-aldosterone system (RAAS) activity in patients with ISH. We aimed to determine the plasma renin activity (PRA), plasma aldosterone levels (PAL) and aldosterone/PRA ratio (PAL/PRA) in patients (age50 years) with ISH and to compare these values with patients with essential hypertension (EH) as well as subjects with normal blood pressure values (control) who have similar age and cardiovascular risk profile.Consecutively, 42 untreated ISH patients, 30 patients with EH and 29 normal subjects were included in the study. Parameters were presented as median (interquartile range).There were no significant differences regarding age, gender and other cardiovascular risk factors among groups. As expected, systolic, diastolic blood pressure and pulse pressure values were significantly different among groups. Besides, PRA values were found to be significantly lower in patients with ISH (0.4 [0.2-1.1] ng/ml/h) compared with the EH (0.95 [0.5-2.6] ng/ml/h, p =0.024) and control (1.3 [0.7-2.1] ng/ml/h, p =0.001) groups. Although, PAL were similar among groups, PAL/PRA ratio was significantly higher in ISH group (134.1 [73-224]) compared with those with EH (42.2 [35-84], p0.001) and the control group (53.3 [30-106], p =0.001). No significant difference was present with respect to PAL/PRA ratio between EH and control groups.Our findings suggested that in patients with ISH, despite lower PRA levels, PAL/PRA ratio is significantly higher compared with the patients with EH and subjects with normal blood pressure. Since higher PAL/PRA levels is an indicator of relative aldosterone excess, medications blocking RAAS activity including aldosterone antagonists may have useful cardiovascular consequences in addition to their antihypertensive effects in ISH.

Epicardial adipose tissue (EAT) is related to the presence of coronary artery disease (CAD). Increased γ-glutamyltransferase (GGT) activity is associated with atherosclerosis. We assessed the relationship between EAT and serum GGT activity in addition to cardiovascular risk factors in patients with stable anginal symptoms. Consecutive patients (n = 120) who underwent coronary angiography were included. Epicardial adipose tissue thickness was measured by echocardiography. Serum GGT activity was measured by enzymatic colorimetric assay. Epicardial adipose tissue thickness and serum GGT activity were higher in patients with CAD (n = 83). Patients with metabolic syndrome (n = 83) were found to have higher EAT thickness. Serum GGT activity was independently associated with EAT values. In conclusion, echocardiographic EAT was significantly higher in patients with CAD and serum GGT activity correlated with EAT thickness.

Aim: In mitral stenosis (MS), left atrial (LA) compliance plays a crucial role in the occurrence of symptoms and pulmonary arterial hypertension and can alter pulmonary venous flows (PVF). The aim of present study is to compare LA compliance (net atrioventricular compliance-Cn) and PVF velocities in patients with different functional status despite similar mitral valve area (MVA). Additionally, the relationships of the same variables with each other and other echocardiographic parameters showing the hemodynamic severity of mitral stenosis were investigated. Methods: Thirty-one patients with moderate to severe mitral stenosis were studied. The patients were divided into two groups according to their NYHA functional classes (FC). The patients with lower FC (NYHA FC1 and FC2) were included in Group I(n = 15), and those with FC ≥ 3 included in Group II (n = 16). All patients underwent comprehensive transthoracic and transesophageal echo Doppler examination. Results: Despite similar LA size, MVA, and transmitral diastolic pressure gradients, systolic pulmonary artery pressure (SPAP) was significantly higher and LA compliance was significantly lower in Group II as compared to group I. Also, systolic PVF velocity (PVs), diastolic PVF velocity (PVd), and PVs/PVd ratio were significantly lower in Group II as compared to Group I. In whole group, significant positive correlations between LA compliance and PVs (r = 0.38, P = 0.035), as well as PVd (r = 0.40, P = 0.023) and, significant negative correlation between LA compliance and SPAP (r =– 0.36, P = 0.047) were noted. Conclusion: Our findings suggested that in patients with MS, when there is inconsistency between symptomatic status and conventional echocardiographic variables, simple and noninvasive Doppler parameters, LA compliance, and PVF could be measured before cardiac catheterization for more accurate and complete evaluation of patients. (ECHOCARDIOGRAPHY, Volume 26, November 2009)

WOS: 000257946700009, PubMed ID: 17705053, Background: Acute coronary syndromes, characterized by the rupture of unstable plaque and the subsequent thrombotic process involving platelets, have been increasing in relative frequency. The central role of platelet activation has long been noticed in this pathophysiology; hence, many therapies have been directed against it. In this study, we have aimed to search prospectively the value of mean platelet volume (MPV), which is a simple and accurate measure of the functional status of platelets, in patients hospitalized with diagnosis of acute coronary syndromes (ACS). Materials and methods: A total of 216 consecutive patients (156 male, 60 female) hospitalized with the diagnosis of non-ST segment elevation (NSTE) ACS within the first 24 h of their chest pain were enrolled. One hundred and twenty patients, matched according to sex and age, with stable coronary heart disease (CHD) (85 male, 35 female) were enrolled as a control group. Patients were classified into two group: those with unstable angina (USAP, n = 105) and those with non-ST segment elevation myocardial infarction (NSTEMI, n = 111). Results: MPVs were 10.4 +/- 0.6 fL, 10 +/- 0.7 fL, 8.9 +/- 0.7 fL consecutively for NSTEMI, USAP and stable CHD with significant differences. Patients with ischemic attacks in the first day of hospitalization accompanied by > 0.05 mV ST segment shift had significantly higher MPV compared to those without such attacks (P = 0.001). Multivariable logistic regression analysis yielded that MPV (P = 0.016), platelet count (P < 0.001), and the presence of > 0.05 mV ST segment depression at admission (P = 0.002) were independent predictors of development of NSTEMI in patients presenting with NSTE ACS. Conclusion: In patients presenting with NSTE ACS, higher MPV, though there are overlaps among subgroups, indicates not only more risk of having NSTEMI but also ischemic complications.

Systolic heart failure (SHF) is associated with increased morbidity and mortality. Beta-blockers (BB) were shown to provide mortality benefit in patients with SHF, and currently indicated in all stages of patients with SHF. We evaluated the factors influencing the prescription of BBs at discharge in patients hospitalised with HF. Hospital discharge records of consecutive 1418 patients (996 men, 422 women) with a mean age of 57 +/- 15 years, hospitalised and treated for SHF (EF < 45%), were retrospectively reviewed. Mean age of female (n = 422) and male patients (n = 996) was similar (58 +/- 15 years vs. 58 +/- 14 years, p = 0.654). Mean EF was 33 +/- 7%, and not different for each sex (p = 0.288). BBs were present in 47.4% of patients at hospital discharge, and female patients were more frequently prescribed than men (51.7% vs. 45.7%, p = 0.036). Patients who were prescribed BBs at discharge were younger than those who were not (p = 0.034). Patients who were prescribed BBs at discharge had significantly higher EF than those who were not (p = 0.019). Older patients were prescribed low-dose BBs. Besides, creatinine level was significantly higher in the group who were prescribed low-dose BBs than those who were prescribed high dose. However, EF was significantly lower in the group, who were prescribed low-dose BBs than in those prescribed moderate-high dose (33 +/- 7% vs. 35 +/- 7%, p = 0.023). There exist several factors associated with underuse of this highly recommended medication in patients with HF.

Objective: Polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk, including ischemic stroke. Prolonged atrial electromechanical interval (EMI) is related to increased atrial fibrillation (AF) risk. The aim of the study is to evaluate atrial EMI and electrocardiographic P-wave indices related to increased AF risk in patients with PCOS. Methods: Forty PCOS patients diagnosed on the basis of the Rotterdam criteria and 20 age-matched controls were prospectively included. patients with atrioventricular or intraventricular conduction abnormalities, dysrhythmia or taking antiarrhythmic drugs, atherosclerotic heart disease, cardiomyopathies, valvular lesions, pericardial disease, a history of pulmonary emboli or pulmonary hypertension, and abnormal thyroid function were excluded. Intra and interatrial EMI were measured by tissue Doppler imaging and P-wave dispersion (Pd) was calculated on 12-lead electrocardiography (ECG). The Isovolumetric relaxation time was the interval between the aortic valve closure artifact at the end of the LV outflow envelope and the mitral valve opening artifact at the beginning of the mitral E wave. Results: Patients with PCOS had significantly higher interatrial [38 (24-65) ms vs. 16 (9-19) ms p

Background Despite the advances in medical and interventional treatment modalities, some patients develop epicardial coronary artery reperfusion but not myocardial reperfusion after primary percutaneous coronary intervention (PCI), known as no-reflow. The goal of this study was to evaluate the safety and efficacy of intracoronary epinephrine in reversing refractory no-reflow during primary PCI. Methods A total of 248 consecutive STEMI patients who had undergone primary PCI were retrospectively evaluated. Among those, 12 patients which received intracoronary epinephrine to treat a refractory no-reflow phenomenon were evaluated. Refractory no-reflow was defined as persistent TIMI flow grade (TFG) ≤2 despite intracoronary administration of at least one other pharmacologic intervention. TFG, TIMI frame count (TFC), and TIMI myocardial perfusion grade (TMPG) were recorded before and after intracoronary epinephrine administration. Results A mean of 333 ± 123 mcg of intracoronary epinephrine was administered. No-reflow was successfully reversed with complete restoration of TIMI 3 flow in 9 of 12 patients (75%). TFG improved from 1.33 ± 0.49 prior to epinephrine to 2.66 ± 0.65 after the treatment (p

A Rare Cause of Resistant Hypertension: Idiopathic Retroperitoneal Fibrosis A 48 year-old lady presented with resistant hypertension and impaired renal function. Detailed evaluation with laboratory analyses and imaging modalities led the diagnosis of retroperitoneal fibrosis with a consequent hydronephrosis. Following one-month treatment with the combination of steroid therapy and nephrostomy catheter insertion, fibrous tissue was regressed and the patient’s blood pressure was under control without further complication.

WOS: 000357192400004, Objectives: This study aims to evaluate left and right ventricular functions at rest by pulsed-wave Doppler and tissue Doppler echocardiography methods in patients with Behcet's disease (BD) without overt cardiovascular disease, and compare with age and sex matched subjects. Patients and methods: Fifty-four patients with BD (12 males, 42 females; mean age 35+/-8 years; range 18 to 51 years) without cardiovascular symptoms, and 36 age-matched controls (12 males, 24 females; mean age 33+/-5 years; range 18 to 47 years) were included. Cardiac functions were evaluated by conventional and tissue Doppler echocardiography. Results: Although conventional indices of left ventricular systolic function were similar in both groups, mitral annular systolic velocity was lower (p

WOS: 000242209100008, PubMed ID: 16943646, Background: Atrial fibrillation (AF) is a frequent arrhythmia, associated with morbidity and mortality. It is identified by two types on surface electrocardiogram as fine and coarse AF. We aimed to search the association of subtypes of AF with clinical parameters. Methods: Eight hundred and eleven consecutive patients, who had AF attack which lasted longer than 24 h or more, were evaluated along with clinical and laboratory data. Results: Coarse AF was noticed in 51.7% (n = 419), and fine AF in 48.3% (n = 392). Sex was associated with subtype of AF such that coarse AF was present in 46.5% of male patients, but in 56.1% of female patients (p = 0.009). Coarse AF was present in 85.3% of patients with mitral stenosis, whereas it was present in 35.3% of patients with normal heart valve (p < 0.001).). Patients having fine AF were significantly older than those having coarse AF (64 +/- 12, 57 +/- 13 years, p < 0.001). 19.6% of those with coarse AF had history of cerebrovascular event (CVE), whereas 13.5% of those with fine AF had history of CVE (p = 0.021). After controlling for age in the multivariable logistic regression analysis, presence of coarse AF (B = 1.585, p = 0.031) was found to be independently associated with the history of CVE. Conclusion: AF is identified by two morphological forms on the surface electrocardiogram. These two forms were found to be associated with different clinical parameters, acting on vascular endpoints differently. Copyright (c) 2007 S. Karger AG, Basel.

WOS: 000236020200010, PubMed ID: 16490428, Development of coronary collaterals (CCs) is triggered by the gradient between arteries due to obstruction and myocardial ischemia. Presence of CCs that feed the jeopardized myocardial area may limit the infarct size after coronary occlusion and may even provide a survival benefit. However, some patients develop good CCs, whereas others do not. The metabolic syndrome (MS) has been identified as a secondary target to decrease cardiovascular risk, although the effect of MS on development of CCs has not been investigated. We prospectively enrolled 596 consecutive patients (337 men and 259 women; mean age 56 +/- 8 years) who underwent coronary angiography at our center and were found to have total occlusion of the right coronary artery. Patients were then classified as having good CCs (Rentrop's grades 2 to 3) or poor CCs (Rentrop's grades 0 to 1). There were significant differences in terms of body mass index (kilograms of body weight divided by square meters of height), glucose levels, triglyceride levels, and years with angina pectoris between those with good and poor CCs. Prevalences of diabetes mellitus were 27.1% among patients with good CCs and 44% among those with poor CCs (p

WOS: 000234323900007, PubMed ID: 16374140, Background Coronary artery bypass grafting has been performed for a long period utilizing saphenous vein grafts, the fate of which might be crucial to prognosis following the operation. Metabolic syndrome, on the other hand, has become an increasingly important part of cardiovascular practice. We examined whether there was any negative effect of metabolic syndrome on saphenous vein graft patency in a relatively short term (