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Data regarding the possible role of heparanase (HPA) in the occurrence of left atrial/left atrial appendage (LA/LAA) thrombus in patients with atrial fibrillation (AF) is lacking. The goal of the present study was to assess the association between plasma levels of HPA and LA/LAA thrombus in AF.A total of 687 patients with nonvalvular AF (NVAF) without anticoagulation therapy were included from January 2016 to June 2019. Serum HPA analysis was performed with a commercially available human ELISA kit. Logistic regression models were used to test for association.Serum HPA levels were significantly higher in patients with LA/LAA thrombus than in those without LA/LAA thrombus (270.8 [193.4 ± 353.2] pg/mL vs 150.3 [125.2 ± 208.4] pg/mL; P 0.001). In multivariate analysis, serum HPA remained a significantly independent predictor of LA/LAA thrombus (odds ratio 1.674, 95% confidence interval [CI] 1.339-2.289, P 0.001). In the receiver operating characteristic (ROC) curve analysis, HPA showed a predictive value with an area under the curve (AUC) of 0.757 (95% CI 0.652-0.810, P 0.001). The optimal cutoff level for HPA predicting LA/LAA thrombus was 210.7 pg/mL, with a sensitivity of 74.3% and a specificity of 64.8%.An elevated HPA level was associated with the presence of LA/LAA thrombus in patients with AF. HPA might portend the risk for the prothrombotic state in AF patients.HINTERGRUND: Es fehlen Daten zur möglichen Rolle von Heparanase (HPA) beim Auftreten eines Thrombus linksatrial oder im linken Herzohr (LA/LAA) bei Patienten mit Vorhofflimmern (VF). Ziel der vorliegenden Studie war es, den Zusammenhang zwischen den Plasmaspiegel von HPA und einem LA/LAA-Thrombus bei VF zu untersuchen.Von Januar 2016 bis Juni 2019 wurden in die Studie 687 Patienten mit nichtvalvulärem VF (NVVF) ohne Antikoagulationstherapie einbezogen. Eine Serum-HPA-Analyse erfolgte mit einem kommerziell erhältlichen humanen ELISA-Kit. Logistische Regressionsmodelle wurden zur Prüfung des Zusammenhangs eingesetzt.Die Serum-HPA-Spiegel waren bei Patienten mit LA/LAA-Thrombus signifikant höher als bei Patienten ohne LA/LAA-Thrombus (270,8 [193,4 ± 353,2] pg/ml vs. 150,3 [125,2 ± 208,4] pg/ml; p 0,001). In der multivariaten Analyse blieb die Serum-HPA ein signifikant unabhängiger Prädiktor eines LA/LAA-Thrombus (Odds Ratio 1,674; 95 %-Konfidenzintervall, 95 %-KI: 1,339–2,289; p 0,001). In der Receiver-Operating-Characteristic(ROC)-Kurvenanalyse zeigte sich für HPA ein prädiktiver Wert mit einem Areal unter der Kurve (AUC) von 0,757 (95 %-KI: 0,652–0,810; p 0,001). Der optimale Grenzwert für HPA zur Vorhersage eines LA/LAA-Thrombus betrug 210,7 pg/ml, mit einer Sensitivität von 74,3 % und einer Spezifität von 64,8 %.Ein erhöhter HPA-Spiegel ging mit dem Vorliegen eines LA/LAA-Thrombus bei Patienten mit VF einher. Der HPA-Wert könnte ein Hinweis auf das Risiko eines prothrombotischen Zustands bei VF-Patienten sein.

Objective: Acute decompensated heart failure (ADHF) is a life-threatening medical condition and more than 30% of patients hospitalized for ADHF develop acute kidney injury (AKI), which increases the rate of both mortality and morbidity. Previous research has indicated that several biomar- kers may help to predict the development of AKI. The aim of this study was to investigate the relationship between lactate level at the time of admission and AKI in ADHF patients. Methods: A total of 154 consecutive ADHF patients were prospectively enrolled from June 2018 to December 2018, and after applying the exclusion criteria, a total of 91 patients were included in the study. The patients were divided into 2 groups: those with and without AKI. Results: There were 63 patients in the group without AKI and 28 patients in the group with AKI. The AKI group had a higher percentage of a history of chronic kidney disease (CKD), a higher creatinine level, lower glomerular filtration rate level, lower bicarbonate level, higher lactate level, and a lower left ventricular ejection fraction compared with the non-AKI group (p

Introduction: Ear lobe crease (ELC) was first described in 1973 as a physical examination finding indicating significant coronary artery disease (CAD). Several studies have been carried out in relation to this finding, and it has been shown that it is a marker of intima-media thickness, carotid artery disease, and CAD. We aimed to investigate the relationship between earlobe crease, which is a simple physical examination finding, and GRACE score as a risk estimation index in acute coronary syndromes without ST-segment elevation (NSTE-ACS) patients. Methods: 360 patients (mean age 62.2 years, 70% male) were included in our study. Patients were divided into two groups of GRACE scores ≤ 109 and >109, 167 patients were enrolled in group 1, and193 cases in group 2. Results: The group 2 patients were older, had higher systolic blood pressure (SBP) levels, a higher rate of hypertension, higher glucose levels, lower creatinine clearance levels, higher initial and peak troponin levels, lower hemoglobin levels, lower left ventricular ejection fraction (LVEF) and higher Gensini scores than the patients in group 1. The higher GRACE score group had markedly increased frequencies of ELC compared to the lower GRACE score group (80.8% vs. 24.5%, respectively, P < 0.001). Conclusion: The presence of ELC may predict moderate to high risk group of patients with NSTEACS.

Introduction: Hypertriglyceridemia is known as an independent risk factor for coronary artery disease (CAD). Fenofibrate that is used for the treatment of hypertriglyceridemia can prevent cardiovascular events in patients with CAD. However, there is little information regarding the vascular effects of fenofibrate on arterial wall stiffness in patients with hypertriglyceridemia and without CAD, diabetes mellitus (DT), and hypertension (HT). The objective of this study is to evaluate the effects of fenofibrate treatment on the arterial stiffness in the patients with pure hypertriglyceridemia. Patients and Methods: We included 37 patients with hypertriglyceridemia without CAD, HT, and DT in this study. We performed pre- and post-treament physical examination of the patients and took their blood samples. Patients were allocated fenofibrate for a duration of 168 ± 14 days for its administration. We assessed arterial stiffness by aortic pulse wave velocity (PWV) using a SphygmoCor device. Importantly, we estimated central arterial pressure waveform parameters by radial artery applanation tonometry and used augmentation index (AIx) as a measure of wave reflections. Results: Fenofibrate treatment resulted in significantly greater reductions in total cholesterol (201.3 ± 61.0 mg/dL vs. 270.0 ± 93.4 mg/dL), triglycerides (261.3 ± 234.3 mg/dL vs. 704.7 ± 338.7 mg/dL), and the C/H levels (5.3 ± 2.6 vs. 7.2 ± 1.9, respectively) as compared with the pretreatment levels (p< 0.001). There was a tendency of high-sensitivity C-reactive protein (hs-CRP) to decline after fenofibrate treatment as change in hs-CRP was significant (0.47 ± 0.41 mg/dL vs. 0.32 ± 0.31 mg/dL respectively, p< 0.01). AIx remained unchanged from the pretreatment levels (24.2% ± 12.4% vs. 22.0% ± 11.4%, respectively, p> 0.05). There was a significant reduction in PWV after fenofibrate treatment (11.3 ± 2.9 m/s vs. 9.2 ± 2.2 m/s, p= 0.001). Conclusion: Fenofibrate treatment appears to effectively improve the arterial wall stiffness in the patients with pure hypertriglyceridemia.

Purpose Acute pulmonary embolism (APE) is a life-threating cardiothoracic thromboembolic emergency in which right ventricle dysfunction (RVD) is a major concern. In the present study, we examined the hepatic veins (HVs) blood flow with pulsed-wave spectral Doppler ultrasonography to determine its relationship with the simplified pulmonary embolism severity index (sPESI) and the patient's RVD status. Methods We divided the 243 patients who met the inclusion criteria into two groups based on both their sPESI scores and their RVD status. Transthoracic echocardiography was performed to evaluate the RVD and the HVs within 1 hour after patient admission. The liver was evaluated using subcostal and intercostal echocardiographic windows in grayscale B-mode, and HVs were assessed using color and spectral Doppler assessment though the same echocardiographic windows. Result A cut-off value of the systolic reverse flow velocity-time integral (SrVTI) = 2.2 cm carried a sensitivity and specificity of 84.29% and 74.89%, respectively, for the prediction of sPESI ≥ 1. A SrVTI cut-off value of 2.1 cm yielded a sensitivity and specificity of 83.03% and 73.91%, respectively, for the prediction of RVD. Conclusion HV Doppler assessment could be a useful method for anticipating the sPESI and the presence of RVD in patients with APE. In addition, it may provide information regarding the hemodynamic impact of APE.

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±0.2cm 2 , 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 Acute pulmonary embolism (APE) is a cardiothoracic thromboembolic emergency at risk of life-threatening. Several risk graduation algorithms may be applied to delineate short-term mortality in patients with APE. In this study, we aim to depict the relationship between the right ventricular early inflow-outflow (RVEIO) index, which is a Doppler-based parameter, and the pulmonary embolism severity index(PESI) in acute pulmonary embolism. METHODS In the presented study, a total of 160 patients who were diagnosed with APE using pulmonary computed tomography angiography or ventilation/perfusion scintigraphy were comprised. Patients were separated to 2 groups based on the simplified PESI (sPESI): sPESI

IntroductionThe non-O phenotype of the ABO genotype has been linked with an increased risk of cardiovascular disease. Atrioventricular (AV) block (AVB) is defined as retardation or cessation in the route of an electrical impulse passing from the atria to the ventricles because of an anatomical or functional disruption in the conduction system. We aimed to interpret the association between blood group status and high-grade atrioventricular block (HAVB).Material and methodsThis study was implemented as a retrospective review of the recorded data of patients diagnosed with high-grade AV block and a control group. The study population consisted of 640 patients with HAVB and 570 control subjects.ResultsPresence of non-O blood group (p < 0.001) was significantly more prevalent in HAVB patients than in the control subjects. Blood group type was the sole independent predictor of HAVB in multiple regression analysis (p < 0.001, OR = 1.35, 95% CI: 1.08–1.57). Also, third-degree AVB had a higher incidence in the non-O blood subgroup and also non-O blood group was a predictor of third-degree AVB (p < 0.001, OR = 1.39, 95% CI: 1.13–1.69).The incidence of HAVB did not distinguish between the two Rh (D) groups. Rh (D) status did not have an impact on HAVB.ConclusionsThis is the first study that has evaluated the potential relationship between HAVB and ABO blood groups. The main finding of this report is that patients with non-O blood group types have a higher risk for development of HAVB compared with O blood group patients.

In this study, we aimed to investigate the predictive value of early systolic lengthening duration in differentiating myocardial ischemia from scar tissue in patients with chronic coronary total occlusion. A total of 69 patients were included in the study. The participating patients were divided into two groups as 35 patients with ischemia and 34 patients with scar tissue based on the results of the myocardial perfusion scintigraphy. In the scar group compared to the ischemia group; LVEF, GLS, SRS', and the duration of early systolic lengthening were significantly lower; whereas, EDV, ESV, and WMSI were significantly higher in the scar group compared to the ischemia group. In the multivariate logistic regression test, LVEF (OR 1.150, 95% CI 1.044-1.268, p = 0.005) and duration of early systolic lengthening (OR 1.021, 95% CI 1.004-1.039, p = 0.016) were determined as independent predictive parameters for ischemia detected by myocardial perfusion scintigraphy. Duration of early systolic lengthening obtained by speckle tracking echocardiography in patients with chronic total occlusion lesions may be useful in differentiating ischemia from scar tissue detected in myocardial perfusion scintigraphy. Prolonged duration of early systolic lengthening in patients with chronic total occlusion lesions was related to the presence of ischemia detected by myocardial perfusion scintigraphy.

OBJECTIVE Left atrial (LA) function is an important predictor of adverse cardiovascular outcomes in patients with hypertension (HT). Therefore, recognition of subtle LA dysfunction in the early stages of HT is essential for controlling modifiable variables. Several electrocardiographic and echocardiographic parameters have been studied to show early LA dysfunction. The goal of this study was to investigate the relationship between newly defined morphology-voltage-P wave duration electrocardiography (MVP ECG) score and early LA dysfunction in hypertensive patients. MATERIALS AND METHODS Eighty-nine hypertensive patients were included in this study. Based on speckle tracking echocardiography results, the patients were divided into two groups: 67 patients with normal LA function were included in Group 1, and 22 patients with abnormal LA function in Group 2. RESULTS Age, diabetes mellitus history, duration of HT history, left ventricular mass index, E/Em, and MVP ECG score values were statistically significant between the two groups. Based on the results of the multivariate logistic regression test, duration of HT history, E/Em, and MVP ECG score were determined as independent predictive parameters for early LA dysfunction in hypertensive patients. CONCLUSION In conclusion, MVP ECG score assessment could be a novel approach to detect early LA dysfunction in hypertensive patients.

OBJECTIVE: Endovascular therapy (EVT) has increasingly been used even after the development of new techniques and technologies. EVT has displayed durable early and mid-term outcomes for infrarenal aorta occlusions (IAO). Nonetheless, little is known regarding their long-term outcomes and predictors of restenosis. METHODS: A total of 55 consecutive patients (age, 58.8±6.97 years; 67.2% male; 42% critical limb ischemia) from a single-center database, undergoing EVT for IAO disease between January 2011 and March 2019 were retrospectively analyzed. The outcome measures were primary patency rate and amputation free survival calculated by the Kaplan–Meier method. Independent predictors of restenosis were assessed by Cox proportional hazard regression model. RESULTS: In 49 patients (89.1%), technical success was achieved. In total, 190 stents (65 self-expandable stents, 60 balloon-expandable stents) were implanted. During the follow up of 34.5±28 months, 7 patients experienced loss of patency. Primary patency rates were 96%, 82%, and 75% at 1, 3, and 5 years, respectively, and amputation free survival rates were 100%, 90%, and 82% at 1, 3, and 5 years, respectively. CONCLUSION: In this study, five-year outcomes of primary patency and amputation free survival for EVT of infrarenal aorta total occlusive lesions were favorable. None of the demographic, lesion, and device factors were independently associated with loss of primary patency.

PURPOSE Acute pulmonary embolism is a life-threatening cardiothoracic emergency leading to right ventricle systolic and diastolic dysfunction. In the present study, we investigated the right ventricle diastolic function and its predictive value in patients with acute pulmonary embolism. MATERIAL AND METHODS Were prospectively recruited in this study 621 patients diagnosed with acute pulmonary embolism between December 2015 and June 2019. Among them, 173 were excluded, leaving 448 patients for follow-up. Transthoracic echocardiography was performed for the evaluation of the right ventricle systolic and diastolic indices. At 30-day follow-up, the patients were allocated either into the benign or in the complicated clinical course group. RESULTS The group with complicated clinical course had higher value of pulmonary artery systolic pressure (PASP), right/left ventricle diameter ratio, E-wave velocity, E/A ratio, A' wave velocity, E/E' ratio, and time interval between E and E' waves (P

Femoral artery aneurysm (FAA) is a rare peripheral vascular aneurysm that can lead to thrombosis, embolism and fatal rupture in untreated cases. The clinical presentation of FAA varies from the finding of an asymptomatic mass on routine physical examination to acutelimb-threatening ischemia. Presently, a case of FAA that caused deep vein thrombosis and compartment syndrome has been described. Although the current treatment method recommended for FAA is an open surgical procedure, in this case, an endovascular intervention was performed due to high risk of surgical mortality.

Introduction:Thepurpose of this study was to evaluate left ventricular myocardial mechanicsusing 2-dimensional speckle tracking echocardiography (2D-STE) during normal,uncomplicated pregancy and postpartum term.Patientsand Methods: In this prospective, longitudinal study, 86 healthypregnant women who underwent serial 2 dimensional echocardiographic evaluationduring each trimester (trimester one 8-12 weeks; trimester two 20-24 weeks,trimester three 32-36 weeks, and postpartum 10-14 weeks). Two-dimensional STEwas performed to measure global left ventricular longitudinal, circumferential,and radial strain (GLS, GCS, and GRS, respectively).Results: GLS showeda decrease during pregnancy (for first trimester 21.0 ± 2.1%; for secondtrimester 19.9 ± 1.8%; for third trimester 18.2 ± 2.1; for postpartum 19.1 ±1.4, p< 0.001). GCS was significantly reduced during pregnancy (p= 0.033)and peaked as the same value in the first trimester. GRS remained unchangedthroughout the pregnancy and labor (p= 0.033).Conclusion: This study gives normalranges of 2D indices in pregnancy. 2D STE demonstrated that LV longitudinal andcircumferantial strain are significantly reduced, whereas radial strainremained unchanged., Giriş: Bu çalışmanın amacı sağlıklı gebelerde, gebelik süresince ve sonrasında solventrikül fonksiyonlarındaki değişimi “iki boyutlu speckle trackingekokardiyografi (STE)” yöntemi ile araştırmaktır.Hastalar veYöntem: Çalışmaya 86 sağlıklı gebe dahil edilmiş ve gebeliğinbirinci trimester 8-12 hafta, ikinci trimester 20-24 hafta, üçüncü trimester32-36 hafta ve postpartum 10-14. haftada 2 boyutlu ekokardiyografi ilekayıtları alınmıştır. Sol ventrikül global longitüdinal strain (SV-GLS), solventrikül global radiyal strain (SV-GRS), sol ventrikül global sirkumferansiyelstrain (SV-GCS) değerleri not edilmiştir. Bulgular: SV-GLS birinci trimester için -%21.0 ± 2.1; ikinci. trimester için -%19.9 ±1.8; üçüncü trimester için -%18.2 ± 2.1; postpartum -%19.1 ± 1.4, p< 0.001).SV-GCS gebelik boyunca anlamlı olarak azalırken (p= 0.033), post partum dönemde1.ci trimesterde bulunan değerlerine yükseldi. SV-GRS değerlerinde gebelikboyunca değişiklikler istatistiksel olarak anlamlı bulunmadı (p= 0.103).Sonuç: Bu çalışmada STE iledeğerlendirilen, SV-GLS ve SV-GCS ile mekanik fonksiyonlarının anlamlı birşekilde değiştiğini ve SV-GRS’de bir değişim olmadığını saptadık.

Background and aim: The objective of this study was to assess the potential role of mitral regurgitation (MR) in the release of copeptin in heart failure patients with reduced ejection fraction (HFrEF). Methods: The study included 63 patients of whom 33 had functional mild MR (Group 1) and 30 had functional severe MR (Group 2). The functional class of both groups was New York Heart Association (NYHA) Class III. Blood samples for the determination of plasma copeptin and B-type natriuretic peptide (BNP) levels were obtained on the same day with the echo-cardiographic examination. Standard echocardiographic studies were performed. Results: Copeptin and BNP levels showed a substantial agreement in the whole study group (Kappa level: 0.607, p < 0.0001). Also, copeptin and BNP showed a strong correlation and were both increased and significantly higher in Group 2 than in Group 1 (p < 0.001 and p < 0.05, respectively). Left ventricular global longitudinal strain and left ventricular ejection fraction values were similar in both groups. The study population were divided into two subgroups on the basis of copeptin median level (6.4 ng/mL), and the prevalence of severe MR was significantly higher in the above-median-copeptin subgroup. A linear regression analysis showed that the presence of severe MR was the only independent predictor of high circulating plasma copeptin level (OR 7.5, 95% CI 2.8–12.1; p = 0.002). Conclusions: Severe MR is an independent predictor of elevated plasma copeptin level in HFREF irrespective of systolic function.

Introduction: Recentstudies have shown a significant association between left atrial (LA) globallongitudinal strain (GLS) and the progression of atrial fibrillation (AF) withsignificantly decreased LA GLS in patients with paroxysmal AF. Significantlyhigher levels of serum galectin-3 have also been found in patients with non-valvularAF. This study aimed to examine the relationship of the early stage of atrialfibrosis and reduced atrial deformation with serum galectin-3 concentration inmiddle-aged patients with a first episode of non-valvular AF.Patients and Methods:Thisstudy prospectively enrolled 34 patients who were admitted to our emergencydepartment and required either a medical or electrical cardioversion due to thefirst episode of AF, without any structural or coronary heart disease and withnormal LA size. Additionally, 31 control subjects were also enrolled. Thediameter, volume, and mechanical function of LA, including strain (S) andstrain rate (SR), and serum galectin-3 levels were measured.Results: Theaverage age was 48.5 ± 10.4 years. Galectin-3 values were not significantlydifferent between the AF and control groups (r= 0.42; p= 0.51) and were foundto correlate inversely with peak negative SR on apical four chamber (r= −0.31,p= 0.02) and two chamber (r= −0.25, p= 0.04) views. In comparison to the controlgroup, the AF group had significantly lower values of peak systolic S on fourchamber view (p= 0.037), peak late diastolic S (p= 0.04), peak positive SR onapical four-chamber view (p= 0.04), and peak late negative SR on apical fourchamber (p= 0.03) and two-chamber (p= 0.02) views.Conclusion: Middle-aged patients withthe first episode of AF and normal LA sizes had reduced LA reservoir and activeatrial functions. Although beginning signs of LA functional remodeling wereshown on S and SR imaging, these were not completely reflected by serumgalectin-3 levels., Giriş: Biz bu çalışmada ilk atak non-valvular atriyal fibrilasyon (AF)’lu ortayaşlı hasta grubunda serum galectin konsantrasyonu ile AF erken evresiarasındaki ilişkiyi araştırdık.Hastalar veYöntem: Bu çalışmaya acil servisimize ilk atak AF ile başvuran,medikal ya da elektriki kardiyoversiyon yapılmış, yapısal ya da koroner kalphastalığı olmayan normal LA boyuta sahip 34 hasta ve 31 kontrol hastasıprospektif olarak dahil edildi. Ekokardiyografik bulgular kayıt altına alındıve serum galectin düzeyleri ekokardiyografi öncesi alınan kan örneklerindenölçüldü.Bulgular: Hastaların ortalama yaşı 48.5 ± 10.4 yıldı. Galectin değerleri arasında AFve kontrol grubu arasında anlamlı fark saptanmadı (r= 0.42 ; p= 0.51) ve apikaldört boşluk (r= -0.31, p= 0.02) ve iki boşluk görüntüden (r= -0.25 , p= 0.04)pik negatif SR ile negatif korele bulundu. Kontrol grubu ilekarşılaştırıldığında, AF grubunda dört boşluk görüntüden pik sistolik strain(p= 0.037), pik geç diastolik strain (p= 0.04), pik positif SR (p= 0.04) ve pikgeç negatif SR apikal dört (p= 0.03) ve iki boşluk (p= 0.02) görüntüdendeğerleri anlamlı olarak daha düşük olarak bulunmuştur.Sonuç: İlk atak AF’li orta yaşlıve normal LA boyutuna sahip hastalarda LA rezervuar ve aktif atriyalfonksiyonlar azalmıştır. Strain ve SR görüntüleme ile gösterilmiş LAfonksiyonel remodeling belirtileri başlamış olmasına rağmen bu durum serumgalectin düzeyleri ile tam olarak gösterilememiştir.

Pericardial effusion (PE) is a common clinical condition that can develop as a result of systemic or cardiac diseases. Here, we report the results of cytology for patients who underwent pericardiocentesis for PE. The study comprised 283 patients who underwent primary percutaneous pericardiocentesis between 2007 and 2016. The mean age of the patients was 60.0 ± 16.6 years; 162 (57.2%) were male and 121 (42.8%) were female. The presence of reactive mesothelial cells, acute and chronic inflammatory cells, and/or blood without evidence of malignant cells was considered as benign. The presence of malignant cells with/without reactive mesothelial cells, inflammatory cells, and/or blood was considered as malignant. The vast majority of PE specimens (219 cases; 77.4%) were classified as benign. Only 20 cases (7.1%) were classified as atypical, and malignant cells were present in the PE specimens of 44 cases (15.5%). The most common diagnosis was benign PE. The most commonly encountered malignancy was lung cancer. The rate of malignancy was 1.9% in the serous group and 24% in the hemorrhagic group, which was statistically significant. Benign PE was the most frequent cytological diagnosis in our study. Chronic nonspecific pericarditis was the most frequent type of pericarditis in the benign PE group, while lung adenocarcinoma was the most frequent malignancy in the malignant PE group. The rate of malignancy was significantly higher in the hemorrhagic group than in the serous group.

We compared direct stenting (DS) with conventional stenting (CS) – i.e., stenting after predilation – during primary percutaneous coronary intervention (P-PCI) in terms of procedural results and long-term mortality in patients with ST-elevated myocardial infarction (STEMI). We retrospectively analyzed 2306 patients (mean age 59 years, 22% female) who underwent P‑PCI within 12 h of symptom onset. Patients were then followed up prospectively for clinical events. Patients were divided into a DS group (n = 597) and a CS group (n = 1709). The CS group was further divided into a CS-1 group (baseline thrombolysis in myocardial infarction [TIMI] flow grade ≥ 1) and a CS-2 group (baseline TIMI flow grade 0). Main outcome measures were postprocedural myocardial reperfusion and all-cause mortality in long-term follow-up. Patients in the DS group had a higher percentage of final TIMI-3 flow, myocardial blush grade 3 and complete ST-segment resolution, better left ventricular ejection fraction, and a lower incidence of distal embolization compared with CS patients. In-hospital (1.5 vs. 4.6%, respectively, p = 0.001) and long-term all-cause mortality (8.8 vs. 17.0%, respectively, p < 0.001) were significantly lower in the DS group than in the CS group. Kaplan–Meier survival analysis showed similar survival rates in the DS and CS-1 groups (log-rank p = 0.40), but significantly worse survival in the CS-2 group than in the other groups (log-rank p < 0.001). After adjusting for risk factors, DS was not found to be a predictor of long-term mortality. DS in P‑PCI was associated with better postprocedural angiographic results and long-term survival. However, the DS group had similar in-hospital and long-term mortality to matched patients in the CS group.

Endocan is a recently introduced marker of endothelial dysfunction and is also associated with inflammation and atherosclerosis. To date, the relationship between cardiac syndrome X (CSX) and endocan has not been studied. The objective of this study was to compare the serum endocan levels of patients with CSX with those of control subjects. In this study, 50 patients were included in the CSX group and 28 patients in the control group. Patients with pathological conditions that could potentially influence endothelial functions were excluded. Endocan serum concentrations were measured using an enzyme-linked immunosorbent assay. The mean endocan level of the CSX group was significantly higher than that of the control group (3051.3 ± 1900.5 ng/l vs. 2088.1 ± 522.2 ng/l; p = 0.002). There was no difference between the two groups in terms of age, gender, hypertension, diabetes mellitus, dyslipidemia, and smoking status. In receiver operating characteristic (ROC) curve analysis, endocan levels greater than 2072 ng/l had a 72% sensitivity and 54% specificity (p = 0.002) for accurately predicting a diagnosis of CSX. The results of this study suggest that patients with CSX have higher endocan levels. Therefore, endocan may be valuable in helping uncover the underlying pathogenesis of CSX.

Carotid artery stenting is a method used in the treatment of extracranial carotid artery stenosis that is becoming increasingly more common. Acute carotid thrombosis following CAS is a very rare and devastating complication that can be lethal for the patient unless treated immediately. We report a case of acute carotid stent thrombosis occurring immediately after emergent revascularization, and that was treated with intraarterial tissue plasminogen activator and intravenous tirofiban infusion.

Objective Cardiac masses comprise a category that includes benign, malignant, and nontumoral mass lesions. The present study aims to share the findings relating to cardiac masses observed at our tertiary cardiology hospital in Turkey. Methods The records of patients who presented with cardiac masses and underwent surgery at our institute between 2006 and 2015, and whose tissue samples were sent to a pathology laboratory, were retrospectively reviewed in a consecutive manner. Results The study included 228 patients with an average age of 52.5 ± 17.3 years. Of the study's subjects, 95 (41.7%) were male and 133 (58.3%) female. The most commonly observed mass was myxoma in 68 patients (29.8%), of whom 20 (29.4%) were male and 48 (70.6%) female. The second most frequently detected mass was pannus, with 38 cases (16.7%) - 10 (26.3%) in males and 28 (73.7%) in females. The third most common cardiac mass was thrombus (16.2%), with 18 cases of thrombi in men (48.6%) and 19 (51.4%) in women. Conclusion The most commonly observed cardiac mass was myxoma and most were localized in the left atrium. The second most frequently detected mass was pannus, which was mostly found on mitral mechanical prosthetic valves. Thrombi were the third most prevalent mass and were commonly localized in the right atrium.

BACKGROUND/AIM The aim of this study was to evaluate if the modified ACEF (age, creatinine, and ejection fraction) score is a predictor of major adverse cardiac and cerebrovascular events during 1 year of follow-up in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS We retrospectively enrolled 1632 consecutive patients who were admitted to our emergency department diagnosed with STEMI within 12 h of chest pain and treated with primary PCI. The modified ACEF score, determined with a simplified scoring system, was calculated. The patients were grouped into tertiles according to this score (group I mACEF 1.37) . The clinical and angiographic data were compared among the tertiles. RESULTS In patients with the highest mACEF tertile, out-of-hospital cardiac arrest (1.3%, 1.8%, and 4.1% consecutively; P = 0.003), Killip class ≥ II (P < 0.001), and cardiogenic shock were more common and ejection fraction was lower (P < 0.001). Moreover, in the 1-year follow-up, there was a statistically significant difference between cardiac mortality, target vessel revascularization, stroke, reinfarction, and major adverse cardiac and cerebrovascular events of the groups, while the rates of stent thrombosis were similar. CONCLUSION The modified ACEF score is a predictor of cardiac mortality and morbidity during 1-year follow-up.

In this study, our objective was to evaluate right ventricular functions with speckle-tracking and conventional echocardiographic methods in patients with acute inferior myocardial infarction and to investigate the correlation between the echocardiographic parameters and the prediction of the proximal RCA lesions. 77 patients were included in this study. Patients with a RCA occluded proximal to the right ventricular branch were assigned to Group 1 and patients with an RCA occlusion distal to the right ventricle branch were assigned to Group 2. All echocardiographic examinations were carried out within 24 h after PTCA, which was performed for the treatment of inferior myocardial infarction. RV TAPSE, RV TDI Sm, FAC, RV-FW strain, RV-FW SRE', RV-FW SRA' and RV E/Em which were statistically significant in univariate analysis were evaluated with the help of the multivariate logistic regression analysis. In the multivariate logistic regression test; RV-FW strain (OR 0.751, 95% CI 0.592-0.954, p = 0.019) and RV E/Em (OR 0.442, 95% CI 0.252-0.776, p = 0.004) were determined as the independent predictive parameters for proximal RCA occlusion. In the ROC analysis, RV-FW strain - 14.75% predicted the proximal RCA occlusion with 83% sensitivity and 61% specificity (AUC = 0.81, p 0.001) and RV E/Em 6.25 with 68% sensitivity and 80% specificity (AUC = 0.79, p 0.001). In this study, we demonstrated that decreased RV FW strain and increased RV E/Em were predictive parameters for the presence of the proximal RCA in patients with acute inferior MI.

Introduction:Copeptinis known to be increased in cardiac heart failure. The role of copeptin inpatients with severe mitral regurgitation has not been assessed in patientswith preserved ejection fraction. The objective of this study is to evaluatethe role of severe mitral regurgitation caused by degenerative mitral diseasein copeptin release.Patientsand Methods: 39 patients with degenerative mitral regurgitation (DMRgroup) and 30 control subjects (control group) were included in the study. Theclinical and echocardiographic findings were recorded. Blood samples wereobtained in 15 min before echocardiographic examination for determination ofplasma copeptin. Global left ventricular longitudinal and circumferentialstrains were evaluated by applying 2D speckle-tracking imaging.Results: There wasno statistical difference among copeptin levels of all groups (median valuesare for DMR:10.7 (9.0-17.1); control group:13.2 (10.6-20.7; p= 0.42). GCSTR andGLSTR were significantly lower in the DMR group (-19.2 ± 5.5 vs. -23.8 ± 5.3;p= 0.002 and -17.1 ± 4.3 vs. -19.9 ± 2.4 p= 0.002 respectively). LAV (83.7 ±38.8 vs. 34.1 ± 7.5 p= 0.0001), E/e’ (9.6 ± 4.0 vs. 6.0 ± 1.4; p= 0.0001), andE/A (1.79 ± 0.5 vs. 0.9 ± 0.24 p= 0.0001) ratios were significantly higher inthe DMR group.Conclusion: Our study demonstrated thatthere is no significant change in serum copeptin concentrations in severemitral regurgitation due to degenerative mitral disease. This can be attachedto the filling changes of left atrium, atrial stretch receptors, and increasedstroke volume., Giriş: Kopeptinin kalp yetersizliğinde yükseldiği bilinmektedir.Korunmuş ejeksiyon fraksiyonlu ileri mitral yetersizliği olan hastalardakopeptinin rolü bilinmemektedir. Bu çalışmanın amacı kopeptin salınımındadejeneratif mitral hastalığa bağlı ileri mitral yetersizlikliğinin rolünüdeğerlendirmektir.Hastalar ve Yöntem: Dejeneratif ileri mitralyetersizliği olan 39 hasta (DMR grubu) ve 30 kontrol deneği (kontrol grubu)çalışmaya alındı. Klinik ve ekokardiyografik bulgular kayıt altına alındı.Plasma kopeptin düzeyini belirlemek için ekokardiyografik incelemeden 15 dakikaönce kan örnekleri alındı. Global sol ventriküler longitudinal vesirkumferensiyal değerlendirme 2D specle tracking görüntüleme ile yapıldı.Bulgular: Gruplar arasında kopeptin düzeyleri açısından anlamlıfark yoktu (median değerleri DMR: 10.7 (9.0-17.1); kontrol grup:13.2(10.6-20.7) (p= 0.42)). GCSTR ve GLSTR değerleri DMR grubunda control grubunagöre daha düşüktü ( -19.2 ± 5.5 vs. -23.8 ± 5.3; p= 0.002 ve -17.1 ± 4.3 vs.-19.9 ± 2.4 p= 0.002 sırasıyla). LAV (83.7 ± 38.8 vs. 34.1 ± 7.5 p= 0.0001),E/e’ (9.6 ± 4.0 vs. 6.0 ± 1.4; p= 0.0001) ve E/A (1.79 ± 0.5 vs. 0.9 ± 0.24 p=0.0001) oranları DMR grubunda anlamlı olarak yüksekti.Sonuç: Bizim çalışmamız;dejeneratif mitral hastalığa bağlı ileri mitral yetersizliğinde kontrol grubunagöre kopeptin düzeylerinde anlamlı değişiklik olmadığını göstermiştir. Bu bulgusol atriyal dolum değişiklikleri, atriyal stretch reseptörleri ve artmış strokevolüm ile ilişkilidir.

Objective: Bicuspid aortic valve (BAV) is a complex developmental anomaly caused by abnormal aortic leaflet formation during valvulogenesis. The present study is an assessment of the effects of BAV disease on the ascending aorta and pulmonary artery (PA), and an evaluation of the consequences for systolic and diastolic functioning of the left and right ventricles. Methods: Total of 66 patients were eligible for inclusion. Pulmonary artery maximum diameter (PAD) was obtained 1 cm distal to the pulmonary annulus. Using pulsed-wave tissue Doppler imaging, left ventricular (LV) early diastolic velocity (E′) measurement was obtained at the annulus with placement of sample volume. Right ventricle (RV) peak global strain rate during systole (RV-SRS), early diastole (RV-SRE), and late diastole (RV-SRA) were calculated. Results: In this study, 40.9% (n=27) of patients were female and average age was 35±11years. RV-SRS values (β=-.781, t=-2.723; p=0.010) and log-LV tissue Doppler imaging E’ (β=2.996, t=-5.405; p=

Objectives: Aim of the present study was to investigate correlation between left atrial (LA) deformation parameters assessed using 2-dimensional (2D) speckle tracking echocardiography (STE) and complexity of coronary artery disease according to SYNTAX score (SXscore) in patients with stable coronary artery disease (SCAD). Study design: Total of 60 moderate-risk SCAD patients (40 men, 20 women) who underwent coronary angiography and 30 healthy controls were included. Measurements of conventional echocardiographic parameters as well as peak LA strain during ventricular systole (LA-RES), peak LA strain during atrial systole (LA-PUMP), peak LA strain rate during ventricular systole (LA-SRS), peak LA strain rate during early diastole (LA-SRE), and peak LA strain rate during atrial systole (LA-SRA) were obtained. Results: Patients were categorized into 2 groups: low SXscore of

Background No gold standard exists for grading tricuspid regurgitation (TR) severity. We developed a simple parameter, the right ventricular (RV) early inflow-outflow (RVEIO) index, using the early diastolic filling velocity and RV outflow velocity integrated over the systolic ejection period. We hypothesized that this index would help identify severe TR in clinical practice. Methods We obtained data from routine transthoracic echocardiograms. All records reporting moderate (n=395) or severe (n=395) TR were reanalyzed to measure vena contracta (VC) width, TR jet area, effective regurgitant orifice (EROA) derived with the proximal isovelocity surface area method, RVEIO index, and right-sided chamber volumes. Results Significant linear trends were demonstrated for right atrial volume index, end-diastolic volume index, E-wave velocity, RV velocity time integral, TR jet area, VC width, and EROA with increasing TR severity. Independent predictors of severe RT included RVEIO index ≥ 10, VC width ≥ 0.7 cm, TR jet area>10 cm2, and EROA ≥ 0.4 cm2. Conclusion RVEIO index is a useful, simple, accurate, and independent predictor of severe TR that adds incrementally to traditional methods of quantifying TR severity. Accurate quantification and classification of TR severity is critical for clinical decision-making and management; therefore, the incorporation of RVEIO index into the integrative approach to grading TR severity should be considered.

Fundamento: The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy. Objectives: To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method. Methods: 64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging. Results: Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation. Conclusions: Measuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR. Resumo Fundamento: O papel da função do músculo papilar na regurgitação mitral grave com fração de ejeção do ventrículo esquerdo preservada e reduzida e o método de escolha para avaliar PM ainda são objetos de controvérsia. Objetivos: Avaliar e comparar a função dos músculos papilares entre pacientes com insuficiência mitral funcional e degenerativa pelo método free strain. Métodos: 64 pacientes com insuficiência mitral grave - 39 pacientes com insuficiência mitral degenerativa grave (grupo IMD) e 25 com insuficiência mitral funcional grave (grupo IMF) - e 30 indivíduos controle (grupo controle) foram incluídos no estudo. A função dos músculos papilares foi avaliada pelo método free strain a partir de imagens apicais quatro-câmaras do músculo papilar anterolateral (MPA) e imagens apicais três-câmaras do músculo papilar posteromedial (MPP). Strains circunferenciais e longitudinais globais do ventrículo esquerdo foram avaliados por meio de imagens bidimensionais a partir do rastreamento de conjunto de pontos de cinza (speckle tracking). Resultados: O strain longitudinal global do ventrículo esquerdo (grupo IMD, -17 [-14,2/-20]; grupo IMF, -9 [-7/-10,7]; grupo controle, -20 [-18/-21] p < 0,001); strain circunferencial global do ventrículo esquerdo (grupo IMD, -20 [-14,5/-22,7]; grupo IMF, -10 [-7/-12]; grupo controle, -23 [-21/-27,5] p < 0,001) e strains de músculos papilares (MPP; grupo IMD, -30,5 [-24/-46,7]; grupo IMF, -18 [-12/-30]; grupo controle; -43 [-34,5/-39,5] p < 0,001; MPA; grupo IMD, (-35 [-23,5/-43]; grupo IMF, -20 [-13,5/-26]; grupo controle, -40 [-32,5/-48] p < 0,001) mostraram-se significativamente diferentes nos grupos. MPA e MPP mostraram-se altamente correlacionados com a FEVE (p < 0,001, p < 0,00; respectivamente), SLG (p < 0,001, p < 0,001; respectivamente) e SCG (p < 0,001, p < 0,001; respectivamente) do VE entre todos os grupos. Não foi encontrada correlação entre os strains de músculos papilares e área eficaz do orifício (AEO) nos grupos de insuficiência mitral grave. Conclusões: A medição do strain longitudinal de músculos papilares pelo método free strain é prática e aplicável. A disfunção dos músculos papilares tem um papel pequeno em IM grave devido a causas degenerativas e funcionais, e a função dos músculos papilares, em general, parece seguir a função ventricular esquerda. O MPP é o MP mais afetado na insuficiência mitral em ambos os grupos, IMD e IMF.

Objective: The present study was designed to determine the effects of tirofiban (Tiro) infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing PCI. Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), while the most effective timing of administration is still under investigation. Methods: A total of 1242 patients (83.0% males, mean (standard deviation; SD) age: 54.7 (10.9) years) with STEMI who underwent primary PCI were included in this retrospective non-randomized study in four groups, composed of no tirofiban infusion [Tiro (-); n=248], tirofiban infusion before PCI (pre-Tiro; n=720), tirofiban infusion during PCI (peri-Tiro; n=50), and tirofiban infusion after PCI (post-Tiro; n=224). In all Tiro (+) patients, bolus administration of Tiro (10 pg/kg) was followed by infusion (0.15 pg/kg/min) for a mean (SD) duration of 22.4±6.8 hours. Results: The pre-PCI Tiro group was associated with the highest percentage of patients with TIMI 3 flow (99.4%; p75% ST-segment resolution (78.1%; p

A 91-year-old female patient was admitted to hospital for evaluation of transcatheter aortic valve implantation. A chest radiography showed a hiatal hernia, and the stomach and duodenum appeared in the thoracic cavity. The descending aorta was pushed by the stomach and duodenum.

A 42-year-old female patient was referred our clinic for investigation of a history of acute retinal artery occlusion. Transthoracic echocardiography showed a cyst-like, mobile formation on posterior mitral valve leaflet. 2D and real time 3D transesophageal echocardiography showed a flexible circular mobile structure which was attached to posterior mitral valve leaflet. Echocardiographic appearance and morphological characteristics were suggestive of accessory mitral valve tissue.