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Aim: Cardiac resynchronization therapy (CRT) is a reliable treatment modality in patients with systolic dysfunction. However, not every patient appears to benefit from CRT. The systemic immune inflammation index (SII) is closely linked to the poor prognosis of various cardiovascular disorders. However, there is no study investigating whether SII has predictive value in determining response to CRT in dilated cardiomyopathy patients. Therefore, we intend to investigate the association between SII and response to CRT. Methods: A total of 220 patients (mean age 61.2±10.8 years; 120 men) implanted with CRT were involved in this study. Echocardiographic and laboratory measurements were evaluated prior to CRT. Response to CRT was determined as a≥ 15% decrease in left ventricular end-systolic volume at one-year follow-up. Results: Patients grouped as CRT responders and non-responders. Of these, 143 (64.6%) were considered to be CRT responders, while the remaining 77 (33.4%) were non-responders. Female sex (OR: 3.823, CI: 1.568-9.324 p=0.003), QRS duration (OR: 1.224, CI: 1.158-1.335 p825 estimated no response to CRT with 80% sensitivity and 75% specificity. Conclusions: SII was associated with unresponsiveness to CRT. Therefore, it may be used to determine optimal patient selection for CRT implantation in routine clinical practice. Amaç: Kardiyak resenkronizasyon tedavisi (KRT), sistolik disfonksiyonu olan hastalarda güvenilir bir tedavi yöntemidir. Ancak, KRT'nin faydası belli hasta grupları ile sınırlıdır. Sistemik immün inflamatuvar indeks (SII), çeşitli kardiyovasküler bozuklukların kötü prognozu ile ilişkilidir. Bununla birlikte, dilate kardiyomiyopati hastalarında SII'nin KRT'ye yanıtı belirlemede prediktif değeri olup olmadığını araştıran bir çalışma bulunmamaktadır. Bu nedenle, bu çalışmada SII ile KRT'ye yanıt arasındaki ilişkiyi araştırmak amaçlandı. Yöntemler: Bu çalışmaya KRT implante edilen toplam 220 hasta (ortalama yaş 61,2±10,8 yıl; 120 erkek) dahil edildi. KRT öncesi ekokardiyografi ve laboratuvar ölçümleri değerlendirildi. KRT'ye yanıt, bir yıllık takipte sol ventrikül sistol sonu hacminde ≥ %15 azalma olarak belirlendi. Bulgular: Hastalar, KRT'ye yanıt verenler ve yanıt vermeyenler olarak gruplandırıldı. Bunlardan 143'ü (%64,6) KRT'ye yanıt veren olarak kabul edilirken, kalan 77'si (%33,4) yanıt vermeyendi. Kadın cinsiyet (OR: 3.823, CI: 1.568-9.324 p=0.003), QRS süresi (OR: 1.224, CI: 1.158-1.335 p825'lik bir sınır değeri, %80 duyarlılık ve %75 özgüllük ile KRT'ye yanıt olmadığını öngördürmüştür. Sonuç: Bu çalışmada SII’nin KRT'ye yanıtsızlığı öngördüğü gösterilmiştir. Bu nedenle SII rutin klinik uygulamada KRT implantasyonu için optimal hasta seçimini belirlemede kullanılabilir.

Giriş ve Amaç: Bu çalışmada merkezimizde transkateter aortik kapak implantasyonu (TAVİ) uygulanan hastaların erken ve geç dönem klinik ve ekokardiyografik takip sonuçları değerlendirildi.Hastalar ve Yöntem: 2011-2013 yılları arasında kliniğimizde ciddi aort darlığı (AD) nedeni ile TAVİ uygulanan 48 hastanın erken ve geç dönem sonuçları değerlendirildi. Tüm hastalara transfemoral yaklaşım ile CoreValve biyoprotez kapak yerleştirildi ve hastalar 17,4±15,3 ay takip edildi.Bulgular: Hastaların (24’ü kadın, ortalama yaş 77,4±8,1) işlem öncesi ortalama aortic kapak alanı (AVA) 0,7±0,2 cm2, ortalama aortik kapak gradiyenti (MnG) 55,4±19,8 mmHg, fonksiyonel sınıfı New York Kalp Cemiyeti (NYHA)’ne göre 2,5±0,4 iken, TAVİ işlemini takiben AVA, MnG ve fonksiyonel sınıflamalarında anlamlı düzelme görüldü. İşlem başarısı %87,5 olup, hastalara ortalama 1,5±0,5 kapak implante edildi. 1 hastada kapak implantasyonu sonrası hemodinamiyi bozan ileri paravalvüler AY geliştiği için cerrahi aort kapak replasmanı yapıldı. İşlemde 3 hastada AV tam blok, 2 hastada koroner obstrüksiyona bağlı ventriküler taşikardi; işlem sonrası erken dönemde ise 3 hastada geçici iskemik atak, 2 hastada minör kanama gelişti. 3 hasta işlemde gelişen kalp tamponadı nedeniyle, 1 hasta işlem sonrası 28. gün enfeksiyon ve sepsis nedeniyle, 2 hasta kompleks ventriküler artimiye bağlı kardiyak arrestten, 2 hasta da 1. ve 4. aylarda kalp dışı nedenlerden hayatını kaybetti. İşlemin 3 yıllık yaşam süresi %75 bulundu.Sonuç: Cerrahi riski yüksek veya opere edilemeyecek olan semptomatik AD hastalarında, cerrahiye alternatif bir tedavi yöntemi olarak klinik pratiğe girmiş olan TAVİ işlemi, erken ve geç dönem sonuçları itibariyle başarılı ve güvenilir bir yöntemdir., Background: The early and late term results of who underwent transcatheter aortic valve implantation (TAVI) in our center were evaluated in this study.Patients and Methods: The early and late term results of 48 patients with severe aortic stenosis who underwent the TAVI procedure in our clinic between 2011 and 2013 years were evaluated. All of our patients were implanted with CoreValve bioprosthetic valves through the transfemoral approach and followed-up for 17.4±15.3 months.Results: Before the procedure, the mean aortic valve area (AVA) was 0.7±0.2cm2, the mean valvular gradients (MnG) were 55.4±19.8 mmHg and the mean functional class was 2.5±0.4. Following the TAVI procedure the AVA, MnG and functional class were improved, significantly. The technical success rate was %87.5, and mean 1.5±0.5 valves was implanted in all patients. Surgical AVR was required for 1 patient because of severe paravalvular leakage. At the procedure, in 3 patients third degree atrioventricular (AV) block and in 2 patient coronary occlusion were developed. The patients with third degree AV block was required permanent pacemaker. In the early term after TAVI in 3 patients transient ischemic attack and in 2 patients minors hemoragy were developed. 3 patient was dead of cardiac tamponade in the procedure, 1 patient was dead from infections and sepsis postoperative 28th days, 2 patients were dead from cardiac arrest because of complex ventricular arrythmia, 2 patients were dead of noncardiac reasons on the 1st and 4th months, respectively. In this study 3 years survi of TAVI procedure was %75.Conclusion: In the patients with high surgery risk or inoperable aortic stenosis TAVI is a rather safe and successful method in the early and late terms as an alternative therapy to surgery.

Introduction: Slow coronary flow (SCF) is an angiographic phenomenon characterized by delayed opacification of epicardial coronary arteries without an obstructive coronary disease. Serum soluble urokinase-type plasminogen activator receptor (suPAR) levels seem closely related to atherosclerosis due to increased inflammation and prothrombotic state. We studied whether circulating suPAR is related to SCF. Material and methods: The present study was cross-sectional and observational. It included 75 individuals who underwent coronary angiography with suspected CAD and had angiographically normal coronary arteries of varying coronary flow rates. The relationship between suPAR, C-reactive protein (CRP) and SCF was investigated. Forty patients with isolated SCF (mean age: 46.0 ±4.14 years) and 35 age- and gender-matched control participants with normal coronary flow (NCF) and normal coronary arteries (NCA) (mean age: 46.0 ±5.7 years) were included in the study. We used logistic regression analysis to determine the predictors of SCF. Results: The clinical characteristics were not statistically significantly different between SCF and NCA groups. Serum suPAR level was significantly higher in the SCF group than the control group (2.5–5.4 ng/ml vs. 0.1–1.4 ng/ml; p < 0.001). Also the serum CRP level was higher in the CSF group than the control group (1.57 ±0.43 mg/l vs. 0.53 ±0.23 mg/l; p < 0.001). Conclusions: This study revealed significantly increased serum suPAR levels in patients with SCF. Although we cannot draw conclusions on the underlying pathological process of SCF, we believe that these findings may be pioneering for further studies investigating the specific roles of circulating suPAR in the SCF phenomenon in the coronary vasculature.

Giriş:Bu çalışmanın amacı, kardiyak sendrom X (KSX)hastalarında monositin HDL kolesterole oranı (MHO)’nı ve kolay kullanılabilirinflamatuvar göstericileri araştırmaktır.Hastalarve Yöntem: Çalışmaya 50’si KSX ve 50’sinormal koroner arterlere sahip toplam 100 hasta dahil edilmiştir.Bulgular:Total beyaz küre sayısı, nötrofil sayısı, monositsayısı, lenfosit sayısı, nötrofil/lenfosit oranı, C-reaktif protein, hsCRP veMHO KSX grubunda artmıştır (p< 0.05), ancak HDL kolesterol CSX hastalarındakontrol grubuna göre azalmıştır (p< 0.05). Korelasyon analizindeMHO’nun hsCRP (r= 0.375, p< 0.001) veCRP (r= 0.403, p< 0.001) ile pozitif yönde korelasyon olduğugösterilmiştir. Multivariate logisticregresyon analizinde MHO’nun KSX hastalığını göstermede bağımsız bir göstergeolduğu bulundu [odds ratio: 1.250, 95% confidence interval (CI): 1.240-1.461,p< 0.001]. Sınır değeri 90.6 alırsak, MHO bu oran ile KSX hastalığınınvarlığını %78 duyarlılık ve %70 özgüllükle göstermektedir. Sonuç: Çalışmamızda MHO KSX hastalarınıgöstermede ciddi ve bağımsız bir gösterge olduğu gösterilmiştir., Introduction:The aim of this study was to investigate an easilyavailable inflammatory marker and monocyte-to-high-density lipoproteincholesterol ratio (MHR) in patients with cardiac syndrome X (CSX). Patientsand Methods: The study population included 100 patients ofwhich 50 had CSX (CSX group) and 50 had normal coronary angiograms (controlgroup).Results: Totalwhite blood cell (WBC) count, monocyte count, neutrophil count, NLR,high-sensitivity C-reactive protein (hs-CRP), C-reactive protein (CRP) and MHRwere higher in the CSX group (p< 0.05), whereas high-density lipoproteincholesterol (HDL-C) level was significantly lower in the CSX group as comparedwith that in the control group (p< 0.05). In the correlation analysis, MHRrevealed a significantly positive correlation with hs-CRP (r= 0.375, p

WOS: 000358183300002

Dear editor We read with great interest the article entitled “P-wave and QT dispersion in patients with conversion disorder” by Izci et al1 in Therapeutics and Clinical Risk Management. In this well designed research, Izci et al studied QT dispersion (QTd) and P-wave dispersion (Pd) in patients with conversion disorder (CD). In conclusion, they reported that corrected QT (QTc) and QTd values were significantly altered in patients with CD when compared to healthy controls, but that there was no significant difference in terms of Pd. It has been postulated that the relationship between somatoform disorders and CD is related to altered autonomic functions.2 These changes may affect the refractory period and conduction velocity of the heart. In line with these assumptions, heterogeneity in the duration of the ventricular repolarization phase leading to arrhythmias may also be seen in patients with CD. As in this study, QTd is the most frequently used parameter to detect ventricular inhomogeneity. However, reproducibility of QT interval measurements is low in both manual and automatic measurements and interobserver and intraobserver variability of QTd is very high.3,4 Quantifying the inhomogeneity of the myocardium, transmural dispersion of repolarization (TDR) has also been used since the beginning of the 2000s in addition to QTd.5 There are three types of myocyte, ie, endocardial, epicardial, and midmyocardial M cells, each having different electrophysiological properties in the ventricular myocardium. Mid-myocardial M cells have typically the longest repolarization phase. The repolarization phase of the midmyocardial M cells continues until the end of the T-wave. However, the repolarization phase of the epicardial cells ends at the peak of the T-wave. The time between the peak and end of the T-wave is known as the Tp-e interval, and is an index of the TDR.5 In addition, the Tp-e/QT ratio has also been used as an electrical dispersion index for the myocardium, showing arrhythmic risk. The role of the TDR in evaluation of arrhythmic risk has been demonstrated in coronary artery disease and in the Brugada, short QT, and long QT syndromes. Previously, we showed that the Tp-e interval was increased in patients with obstructive sleep apnea.6 On the other hand, the basic electrophysiological characteristics of the atrium that predispose to atrial arrhythmias are prolongation of intra-atrial and interatrial conduction times and heterogeneous propagation of sinus impulses. Pd is an accepted marker of atrial depolarization heterogeneity and the altered propagation of sinus impulses found to be associated with increased risk of atrial fibrillation. Although prolonged Pd values were found to be correlated with atrial fibrillation, it is controversial whether Pd is related to heterogeneity of atrial conduction or to other factors. Furthermore, reproducibility of P-wave measurements is low in both manual and automatic measurements and interobserver and intraobserver variability is very high. Atrial electromechanical coupling (AEC) can be assessed by electrocardiography-integrated tissue Doppler imaging and provides a means to determine the atrial mechanical and electrical event. Analysis of AEC by tissue Doppler imaging allows precise analysis of AEC between different regions. Moreover, measurement of AEC may suggest an inhomogeneous propagation of sinus impulses in different cardiac sites. Autonomic dysregulation and altered sympathovagal balance, as in somatoform disorders, may account for heterogeneity in atrial conduction properties. Measurement of AEC has been done in patients with psoriasis, ankylosing spondylitis, hyperthyroidism, end-stage renal disease, and hypertension.7–9 Regarding these observations, autonomic imbalance may cause atrial depolarization and sinus impulse propagation abnormalities leading to altered AEC. Our opinion is that, if AEC intervals had been measured in this study, they may have been found to be altered in patients with CD. Further, regarding the forementioned observations, if Izci et al had measured the Tp-e interval and Tp-e/QT ratio in their study, they might have found an increased TDR in their patients with CD. Considering all the data about Pd, AEC, QTd, and TDR, their study might have revealed the effects of CD on electrical heterogeneity of the myocardium more completely in many respects.

Background The role of inflammation in fibrotic and calcific processes of atherosclerosis and aortic stenosis (AS) is similar. Furthermore, a relationship between systemic inflammation and heart failure has been well demonstrated. Recently, neutrophil/lymphocyte ratio (NLR) has been proposed as a predictive marker of systemic inflammation. We investigated the association of NLR with the severity of calcific AS and left ventricular (LV) systolic dysfunction in patients with severe calcific AS. Methods A total of 96 patients with calcific AS were included in this retrospective study from 2011 to 2013. The severity of AS was graded according to the transaortic mean pressure gradient. The patients were divided into 3 groups as mild-to-moderate AS, severe AS with normal left ventricular ejection fraction (LVEF), and severe AS with reduced LVEF (mean gradient >40 mmHg and LVEF