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Cardiac autonomic neuropathy is a frequent complication of type 2 diabetes mellitus. Cardiac autonomic neuropathy, in which sympathetic tone predominates over parasympathetic activity, increases both cardiovascular morbidity and mortality and unfortunately has no definitive treatment. Sodium-glucose cotransporter-2 inhibitors have been suggested to reduce sympathetic nervous system activity, based on the results from previous studies. In this study, we aimed to investigate the effect of 24-week treatment with dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, on cardiac autonomic function measures in patients with type 2 diabetes mellitus and cardiac autonomic neuropathy.Dapagliflozin 10 mg/day (n=42) or non-sodium-glucose cotransporter-2 inhibitor oral antidiabetic(s) (n=38) was added to the treatment of patients whose glycemic control could not be achieved with existing treatments. The patients with definite or confirmed cardiac autonomic neuropathy diagnosed by cardiovascular autonomic reflex tests underwent 24-hour Holter-electrocardiogram recordings to obtain heart rate variability and heart rate turbulence parameters before starting additional medication and after a 24-week treatment period.In-group analyses showed that dapagliflozin 10 mg/day for 24 weeks improved heart rate variability and heart rate turbulence parameters and decreased the frequency of ventricular premature beats relative to their baseline values. No such findings were observed in the control group despite similar glycemic control. Comparisons between dapagliflozin group and the control group showed that these effects of dapagliflozin were significantly better than non-sodium-glucose cotransporter-2 inhibitor oral antidiabetics.Dapagliflozin improves measures of cardiac autonomic function compared to the control group in type 2 diabetic patients with cardiac autonomic neuropathy. This intergroup benefit, demonstrated for the first time, may be promising for the regression of cardiac autonomic neuropathy with sodium-glucose cotransporter-2 inhibitors.

Objective: This study aimed to evaluate whether neutrophil/lymphocyte (N/L) ratio assists in the diagnosis of coronary artery disease (CAD) in patients with suspected diaphragmatic attenuation artifact (DAA) on myocardial perfusion SPECT (MP-SPECT). Material and Methods: A total of 255 patients undergoing coronary angiography between 2015-2020 due to unclear DAA of the inferior wall on MP-SPECT were included in this retrospective study. Patients were divided into two groups (CAD and non-CAD) according to angiographic images. Significant CAD was defined as ≥50% stenosis of coronary arteries feeding the inferior wall. White blood cell count, biochemical parameters, and risk factors for CAD were compared between the two groups. Results: There was no statistically significant difference between the two groups in terms of age (p = 0.055), gender (p = 0.482), and body mass index (p = 0.305). N/L ratio (OR = 1.397 p = 0.002 95% Cl = 1.128-1.732) and left ventricle ejection fraction (OR = 0.896 p = 0.023 95% Cl = 0.815-0.985) were independent risk factors for CAD in multivariate binary logistic regression analysis. Receiver Operating Characteristic (ROC) curve analysis showed that a cut-off value of ≥2 for N/L ratio predicted the presence of CAD (sensitivity=63.5%, specificity=60.7%, AUC=0.668, 95% CI=0.596 – 0.740, p

Cardiac autonomic neuropathy is a serious microvascular complication of type 2 diabetes mellitus that affects a significant portion of patients. Due to decreased parasympathetic activity, the sympathetic nervous system becomes dominant, causing several problems that lead to increased cardiovascular morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors have been shown to reduce sympathetic nervous system activity previously. This is a promising finding for restoring the impaired sympathovagal balance in cardiac autonomic neuropathy. The aim of this study is to evaluate the effect of at least 6 months of sodium-glucose cotransporter-2 inhibitor treatment on sympathetic nervous system activity with sympathetic activity index and heart rate variability parameters in patients with type 2 diabetes mellitus.Holter-electrocardiogram recordings of 50 patients who were using an sodiumglucose cotransporter-2 inhibitor (empagliflozin or dapagliflozin) for at least 6 months and 50 patients who did not were analyzed retrospectively. The sympathetic activity index and heart rate variability parameters of these 2 groups, which were similar in terms of age, gender, hemoglobin A1c, and duration of diabetes, were compared.The ratio of low-frequency to high-frequency power reflecting the sympathovagal balance [-1.495 (-2.165/-1.196) vs. -1.224 (-1.619/-0.863), P=.008] and sympathetic activity index [1.44 (1.06/2.76) vs. 2.47 (1.42/3.68), P=.009] was lower in the sodiumglucose cotransporter-2 inhibitor group than in the control group. In addition, the sympathetic activity index was correlated with the ratio of low-frequency to high-frequency power (r=0.418, P.001).Sodium-glucose cotransporter-2 inhibitor treatment for at least 6 months was found to result in lower values of sympathetic activity index and the ratio of low-frequency to high-frequency power in patients with type 2 diabetes mellitus. These findings indicate lower sympathetic nervous system activity, which supports the sympathoinhibitor effects of sodiumglucose cotransporter-2 inhibitors.

Background/aim: Radiofrequency catheter ablation (RFA) is the most effective method of supraventricular tachycardia therapy. Recurrent supraventricular tachycardia causes systolic dysfunction and dilated cardiomyopathy. The aim of this study was to evaluate the long-term alterations of atrial and ventricular functions after RFAof typical atrioventricular nodal reentrant tachycardia (AVNRT). Materials and methods: This cross-sectional study included 55 consecutive patients with symptomatic drug-resistant AVNRT who had had an invasive electrophysiology study and RFA. Speckle-tracking?based echocardiographic assessment was performed shortly before and 1 year after the operation. Left ventricle (LV) and right ventricle (RV) peak systolic strain (PSS) and atrial strain measurements were performed. Results: RFA successfully eliminatedtachyarrhythmia in all patients. LV apical 4-chamber PSS ?20.8% (?24.7 to ?16.0) vs. ?22.8% (?26.6 to ?17.0, P < 0.001), LV apical 2-chamber PSS ?21.5% (?26.8 to ?10.1) vs. ?22.0% (?27.8 to ?13.7, P < 0.001), LV global PSS ?20.4% (?26.4 to ?14.4) vs. ?23.0% (?27.1 to ?2.3, P < 0.001), RV global PSS ?26.0% (?30.0 to ?18.0) vs. ?26.5% (?32.1 to ?19.7, P < 0.001), and peak left atrial longitudinal strain 41.0% (19.0?71.8) vs. 54.0% (25.6?82.0, P < 0.001) were significantly improved 1 year after RFA. Conclusion: RFA of AVNRT not only provides relief of palpitations but also improves cardiac functions.

Objective Thromboembolic events such as acute coronary syndrome related prosthetic heart valve thrombosis, pulmonary artery embolism and renal artery embolism are a rare condition but a major cause of morbidity and mortality. In this study we discussed low-dose thrombolytic therapy, in patients with thromboembolic events in the intensive care unit.Methods The study was performed on 12 consecutive patients [8 female; 50.3±16.0 (35–95) years] with acute thromboembolism including acute coronary syndrome related prosthetic heart valve thrombosis, acute pulmonary embolism and acute renal embolism who were treated with low-dose (25 mg) and slow infusion (6 hours) of t-PA. We evaluated mainly in-hospital safety and also effectiveness.Total treatment episodes was 1.66±0.88 (1-4) times.Results All thromboembolic events have been successfully treated with low-dose (25 mg) and slow infusion (6 hours) of t-PA. The success criteria were clinically improvement and radiologically lysis. None of the patients had ischemic stroke, intracranial hemorrhage, embolism (peripheral and recurrence of coronary artery embolism), bleeding requiring transfusion. The most frequent in-hospital complication was a gum bleeding without need for transfusion (two patients).Conclusions In our case series low-dose (25 mg) and slow infusion (6 hours) of t-PA have been performed successfully for thromboembolic events including acute coronary syndrome related prosthetic heart valve thrombosis, pulmonary embolism and renal embolism in patients with in the intensive care unit. Safety is promising and if efficacy will be proved; this method may be a valuable alternative to standard fibrinolytic regimen.

Doxorubicin is an anthracycline chemotherapeutic agent that causes cardiomyopathy as a side effect. Here, we aimed to investigate the effects of linagliptin and bisoprolol on the management of doxorubicin-induced cardiomyopathy in rats. Wistar rats were divided into six groups (n = 8). Group I received saline for 4 weeks; group II received 1 mg/kg bisoprolol for 8 weeks; group III received 3 mg/kg linagliptin for 8 weeks; group IV received 1.25 mg/kg doxorubicin for 4 weeks for the induction of cardiomyopathy; group V received 1.25 mg/kg doxorubicin for 4 weeks plus 1 mg/kg bisoprolol for 8 weeks; and group VI received 1.25 mg/kg doxorubicin for 4 weeks plus 3 mg/kg linagliptin for 8 weeks. Electrocardiography and isometric mechanography were conducted to measure ventricular contractile responses. Myocardial tissue and serum samples were analyzed for oxidative and cardiotoxic markers by ELISA. Electrocardiography revealed that QRS, QT and Tp intervals were longer in group IV than group I. Doxorubicin caused a significant decrease in ventricular contraction, which was significantly prevented by bisoprolol. Doxorubicin resulted in myocardial fiber disorganization and disruption, but bisoprolol or linagliptin improved this myocardial damage. Glutathione peroxidase was significantly decreased in groups IV and V. Bisoprolol or linagliptin treatment attenuated the significant doxorubicin-mediated increase in malondialdehyde. Doxorubicin and linagliptin provided significant elevations in CK-MB activity and troponin-I levels. Doxorubicin resulted in pronounced oxidative stress. The beneficial effects of bisoprolol and linagliptin on myocardial functional, histopathological and biochemical changes could be related to the attenuation of oxidative load.

ObjectivesArterial stiffness is associated with major adverse cardiovascular events. The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with abdominal aortic aneurysm (AAA).MethodsThis observational and cross-sectional study involved 59 subjects with AAA and 32 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument.ResultsMean abdominal aortic diameter of AAA patients and controls were 43.88 ± 9.28 mm and 20.43 ± 3.14 mm, consecutively. Baseline clinical characteristics of the patients and controls were similar for age, presence of hypertension, diabetes, dyslipidemia, coronary artery disease and smoking. Left ventricle ejection fraction and Left ventricle mass index (LVMI) were similar between groups. CAVI was significantly higher in patients with AAA than controls (9.74 ± 1.50 vs. 7.60 ± 1.07, p 8.3 had a sensitivity 89.8% and a specificity of 78.1% for predicting the presence of AAA in ROC analysis (area under curve = 0.897, 95%CI = 0.816–0.951, p ConclusionCAVI is increased in patients with AAA. Increased arterial stiffness may be a mechanical link between AAA, coronary artery disease and peripheral artery disease or a common mechanism effects the arterial stiffness, coronary artery disease, peripheral artery disease and AAA. Therefore, CAVI may be used as a valuable marker for risk stratification for the development of AAA in susceptible patients.

BACKGROUND Endothelial dysfunction (ED) is associated with high cardiovascular disease burden in hemodialysis (HD) patients. Vasohibin-1, an endothelium-derived angiogenesis inhibitor, is essential for endothelial cell survival, therefore it may be a promising marker of ED. We aimed to investigate whether vasohibin-1 levels are associated with ED markers in HD patients. METHODS Fifty HD patients and 30 healthy controls were included in the study. As markers of ED, endothelium-dependent flow-mediated dilatation (FMD), carotid intima-media thickness (CIMT), and pulse wave velocity (PWV) were examined. Serum vasohibin-1 levels were measured with ELISA. RESULTS Serum vasohibin-1 levels were low (387.7 ± 115.7 vs 450.1 ± 140.1 P = .02), FMDs' were impaired (6.65 ± 2.50 vs 10.95 ± 2.86 P

Objectives Radiocontrast agents (RCA) allergy occurs in 0.04 % – 0.22 % of patients. However, the risk of allergic reaction increases as 16 % to 35 % in patients with prior RCA allergy. Herein we reported our experience in patients with a prior history of RCA induced anaphylaxis who underwent coronary angiography (CAG) and intervention.Methods This retrospective study included 11 patients with prior history of RCA anaphylaxis who underwent CAG and / or intervention at our clinic between May 2016 and September 2019. The mean age of the patients was 61.8±8.99 years, 8 (72.7 %) were female, 9 (81.8 %) had hypertension, 6 (54.5 %) – diabetes mellitus, 11 (100 %) – dyslipidemia, 8 (72.7 %) patients were current smokers, 4 had prior history RCA allergy after i.v. RCA administration in contrast enhanced computed tomography and 7 patients experienced RCA allergy after CAG. All patients had prior severe anaphylaxis reaction. All patients were pretreated with intravenous feniramin maleat 45.5 mg and methylprednizolone 80 mg one hour before the procedure and dexametazon 8 mg after the procedure.Results CAG and intervention was successfully completed in all patients. Two patients had breakthrough RCA induced anaphylaxis, theyhad urticarial, itching, dyspnea and chest tightness, angioedema during coronary artery stenting. Additional dose of i.v. methylpredinisolene 80 mg, salbutamol nebulae and i.v. adrenalin 1 mg administration rapidly stabilize the patients. All patients were successfully treated and uneventfully discharged after percutaneous coronary intervention.Conclusion Management of patients with prior RCA adverse drug reaction may be complex. However when CAG and / or intervention is required in such patients it may be safely performed with premedication.

Environmental, genetic, oxidative and biochemical factors play an important role in the atherosclerotic process. We investigated the association of serum fibroblast growth factor (FGF-23), klotho, fetuin-A, osteoprotegerin (OPG), osteopontin (OPN) and high-sensitive-CRP (Hs-CRP) markers with coronary artery disease and whether one was superior to others or not. A study group of 52 patients with coronary artery disease (CAD) and a control group of 30 patients with angiographically normal epicardial coronary arteries were included in the study. Serum FGF-23, klotho, fetuin-A, OPN, OPG and Hs-CRP marker levels were studied. Patients with CAD were classified in two groups as low (SYNTAX ≤22

Introduction: Dietary herbal products taken together with prescription medicines may have harmful effects. In this study, we evaluated the use of dietary herbal supplements and identified factors that predict the concomitant use of these supplements in patients taking drugs prescribed for chronic cardiovascular diseases. Methods: We performed a cross-sectional study with 343 patients with cardiovascular diseases. Data regarding the sociodemographic status, medical condition, number of prescription drugs, and use of herbal supplements were collected using a self-administered questionnaire. Results: Regular use of dietary herbal supplements was reported by 82.5% of patients. The most commonly consumed herbal supplement was garlic (71.2%), followed by onion (67.1%), and walnut (63.6%). Consumption of herbal supplements was commonly observed in patients with hypertension (53.6%). Among the patients in the study, 21.3% patients reported consumption of herbal supplements to the physician. Results of multivariable analysis showed that body mass index (odds ratio [OR] = 0.890, 95% confidence interval [CI] = 0.826-0.960), heart failure (OR = 0.325, 95% CI = 0.142-0.742), coronary artery disease (OR = 0.162, 95% CI = 0.069-0.379), smoking (OR = 3.852, 95% CI = 1.194-12.433), hypertension (OR = 10.584, 95% CI = 4.648-24.103), and dysrhythmia (OR = 9.339, 95% CI = 2.035-42.853) were associated with the use of dietary herbal supplements. Conclusions: Our results showed that dietary herbal supplements were commonly used by patients with chronic cardiovascular diseases. Therefore, understanding the interactions between the herbal supplements and drugs is necessary for minimizing adverse reactions.

Introduction:Radiofrequencycatheter ablation therapy has been used to treat arrhythmia such assupraventricular and/or ventricular tachycardia. Increased waist circumferenceis important in assessing central obesity and may be an important factor forradiation injury. Therefore, this article describes the association betweenwaist circumference and fluoroscopic exposure time during cardiacradiofrequency catheter ablation procedures for symptomatic drug-resistanttachycardia.Patientsand Methods: From August 2011 to March 2015, 214 (136 women, 78 men)consecutive patients with symptomatic drug-resistant atrioventricular nodalre-entrant tachycardia (174 patients), atrioventricular re-entrant tachycardia(12 patients), Wolf-Parkinson-White syndrome (5 patients), atrial tachycardia(8 patients), atrial flutter (7 patients), right ventricular outflow tracttachycardia (5 patients), and atrial fibrillation (3 patients) underwent aninvasive electrophysiological study and radiofrequency catheter ablation. Thefluoroscopic exposure time, radiofrequency catheter ablation time, and waistcircumference were measured during the electrophysiological study.Results: Althoughage was significantly higher in women than in men, body weight, body height,waist circumference, and radiofrequency catheter ablation time weresignificantly higher in men than in women. There was a correlation betweenwaist circumference and fluoroscopic exposure time (p= 0.04, r= 0.13).Conclusion: The study showed thatthere was a positive correlation between waist circumference and fluoroscopicexposure time in patients with antiarrhythmic drug-refractory tachycardia whounderwent radiofrequency catheter ablation. This finding could help preventradiation injury, especially increased waist circumference duringradiofrequency catheter ablation., Giriş: Radyofrekans kateter ablasyon tedavisi supraventriküler ve/veyaventriküler aritmilerin tedavisinde kullanılmaktadır. Artmış bel çevresisantral obeziteyi değerlendirmede önemli bir yöntemdir, aynı zamanda radyasyonhasarı için de önemli bir faktör olabilir. Bu nedenle bu makale semptomatikilaca dirençli taşikardi nedeni ile yapılan kardiyak radyofrekans kateterablasyonu sırasındaki floroskopi maruziyet süresi ile bel çevresi arasındakiilişkiyi irdelemektedir.Hastalar ve Yöntem: Ağustos 2011 ila Mart 2015tarihleri arasında semptomatik ilaca dirençli; atriyoventriküler nodalre-entran taşikardi (174 hasta), atriyoventriküler re-entran taşikardi (12hasta), Wolf Parkinson White sendromu (5 hasta), atriyal taşikardi (8 hasta),atriyal flutter (7 hasta), sağ ventriküler çıkış yolu taşikardisi (5 hasta),atriyal fibrilasyon (3 hasta) nedenleri ile invaziv elektrofizyolojik çalışmave radyofrekans ablasyon uygulanan 214 (136 kadın, 78 erkek) ardışık hastaçalışmaya dahil edildi. Floroskopi maruziyet süresi, radyofrekans ablasyonzamanı ve bel çevresi işlem sırasında ölçüldü.Bulgular: Kadınların yaşı anlamlı olarak erkeklerden yüksek olsada vücut ağrılığı, boy, bel çevresi ve radyofrekans ablasyon süresi erkeklerdekadınlara göre daha anlamlı olarak yüksekti. Bel çevresi ile floroskopimaruziyet süresi arasında bir korelasyon mevcuttu (p= 0.04, r= 0.13).Sonuç: Çalışmamız göstermiştirki,antiaritmik ilaç dirençli taşikardi nedenli radyofrekans kateter ablasyonuygulanan hastalarda floroskopi maruziyet süresi ile bel çevresi arasındapozitif bir korelasyon mevcuttur. Bu bulgu özellikle artmış bel çevresi olan hastalardaradyofrekans kateter ablasyon sırasında radyasyon hasarını önlemek için faydalıolabilir.

Objective Renin angiotensinogen system (RAS) inhibitors, ramipril and sacubitril/valsartan are frequently used in the treatment of cardiovascular diseases. Although they are known as contraindicated during pregnancy in hypertensive women, there is not any outcome of their safety in male fertility after exposure to ramipril or sacubitril/valsartan. In this study, we aimed to evaluate the effects of ramipril and sacubitril/valsartan to highlight their safety in the male fertility in normotensive and hypertensive rats. Methods Adult male normotensive and dexamethasone-induced hypertensive rats were treated with sacubitril/valsartan, ramipril and saline for 18 days. Arterial blood pressures were verified using carotid artery cannulation. Male fertility parameters, including the testis weights, histopathologic scoring of the testis, sperm count, sperm motility, morphology, and serum testosterone levels, were analyzed in treated and nontreated normotensive/hypertensive rats. Results Sacubitril/valsartan or ramipril treatments did not reveal a significant difference in sperm production, testicular morphology, and radioimmunoassay of serum testosterone levels compared to the control group. However, sperm motility was significantly reduced in rats under RAS inhibition. Conclusion This finding was likely mediated by the identification of Ang receptors in the tails of rat sperm given that Ang receptors may play a role in the modulation of sperm motility. Identification of RAS-related proteins involved in sperm motility may help to explain their roles in motility. Our data provide general safety evidence for the male fertilization ability after paternal sacubitril/valsartan and ramipril exposure.

Introduction: Transcatheter aortic valve implantation (TAVI) is more reliable than surgical valve replacement for high-risk or inoperable aortic stenosis patients. In this study, we aimed to investigate the effects of different femoral access methods on the development of vascular complications and contrast-induced nephropathy (CIN) after transfemoral (TF)-TAVI. Patients and Methods: In total, 110 patients (aged 78.9 ± 12.2 years; 55 females) who underwent aortic valve replacement by TF-TAVI between June 2013 and April 2015 were included in the study. CIN was defined as an absolute increase in serum creatinine level of > 0.5 mg/dL or a relative increase of > 25% within 48-72 h after TF-TAVI. The patients were classified into two groups according to the femoral access methods: surgical cut-down (SCD) and vascular closure device (VCD) groups. Results: The amount of contrast medium (CM; p< 0.001) and the incidence of CIN (p= 0.038) were higher in the VCD group. Baseline glomerular filtration rate (GFR), baseline creatinine, Mehran score and CM were determined as the predictive factors of CIN development. Receiver operating characteristic analysis revealed that CM, which may predict the development of CIN, was determined as 178.5 mL, and GFR, which may predict the development of CIN, was determined as 48.9 mL/dk/1.73 m2. Conclusion: It may be preferred to perform the femoral arterial procedure using the SCD method instead of VCD in TAVI patients whose GFR is < 48.9; the use of CM may increase due to various reasons.

Endocan is a soluble proteoglycan, secreted by human vascular endothelial cells. Endocan is a marker for vascular pathologies and an important mediator of angiogenesis, strongly associated with inflammation, vascular endothelial dysfunction, and atherosclerosis. The relationship between coronary artery ectasia (CAE) and endocan has not been evaluated. We aimed to investigate this association. Fifty-four patients with isolated CAE without coronary stenosis and 30 controls with normal coronary angiogram were included in this study. Endocan plasma concentrations were measured using an enzyme-linked immunosorbent assay. Patients with isolated CAE had significantly higher levels of endocan compared to the controls (18.9 ± 7.3 vs 15.6 ± 3.6 ng/mL; P = .007). There was a significant correlation between endocan levels and severity of isolated CAE according to the Markis classification ( r = −.593, P < .001). Plasma endocan levels may reflect the presence and severity of isolated CAE, suggesting that endocan may be involved in pathogenesis of isolated CAE.

Objectives The aim of this study is to evaluate the association of venous thromboembolism with arterial stiffness by cardio-ankle vascular index method. Method We included 52 patients with a documented lower extremity venous thromboembolism within the last six months and 52 healthy subjects to this cross sectional observational study. Results Cardio-ankle vascular index (8.58 ± 1.60 versus 7.05 ± 1.44, p 7.8 had a sensitivity of 82.7% and a specificity of 80.8% for predicting venous thromboembolism (area under curve = 0.789, 95% confidence interval = 0.698–0.863, p Conclusion We found that arterial stiffness was increased in patients with venous thromboembolism which highlights the fact that arterial and venous circulation is in continuum and an insult may affect both of these circuits.

WOS: 000392195800004, PubMed ID: 27723665, Objective: Data regarding stroke prevention strategies in non-valvular atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs). This study aimed to evaluate real-life stroke prevention strategies for NVAF patients in the era of non-VKA oral anticoagulants (NOACs). Methods: We established a cross-sectional, multicenter, nationwide registry of NVAF patients. All consecutive atrial fibrillation (AF) patients and without mechanical heart valves or rheumatic mitral stenosis (but including those with any degree of mitral regurgitation) were enrolled in the ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study; ClinicalTrials. gov identifier NCT02344901) in Turkey. Base-line demographic data, medical history, and medications prescribed for NVAF treatment were collected. Univariate analyses were performed for continuous variables, and the chi-square test was used for categorical variables. Results: In total, 6273 patients from 29 provinces of Turkey were enrolled in the study between February and May 2015, with the contribution of 83 investigators. The mean age was 69.6 +/- 10.7 years; 56% of the patients were females, and one-fifth of the patients had at least one comorbid disease, the most common being hypertension (69%). The mean CHA(2)DS(2)-VASc and HAS-BLED scores were 3.3 +/- 1.6 and 1.6 +/- 1.1, respectively. The rate of oral anticoagulant (OAC) therapy use was 72% (37% NOAC and 35% VKA). Conclusion: The RAMSES study showed a higher prevalence of OAC use among NVAF patients than that reported in previous studies. Although NOACs were preferred over VKAs in daily cardiology practice, there is a need for improved OAC therapies for NVAF patients.

Summary Objective The level of right ventricular (RV) systolic function has prognostic importance in right ventricular ST-segment elevation myocardial infarction (RV-STEMI). This study aimed to evaluate the changes in RV systolic function in patients with RV-STEMI according to the revascularisation method used for their management. Methods The first group consisted of 132 patients who received primary percutaneous coronary intervention (PPCI). The 78 patients who had received thrombolytic therapy (TT) in external centres before referral to our centre for PCI within three to 12 hours of RV-STEMI were included in the second group. All patients were evaluated by conventional and two-dimensional speckle-tracking echocardiography. Results There were 172 male patients and their mean age was 63.7 ± 11.8 years. There were no significant differences between the two groups with regard to right ventricular systolic parameters at admission and at the one-month follow-up visit. The echocardiographic changes between admission and the one-month follow up were investigated for the patients included in the study groups. Mean values of each parameter observed at the one-month follow up were significantly increased compared to those at admission within each group. Conclusion Our study demonstrated that PCI within three to 12 hours following TT provided similar benefits on right ventricular systolic function compared to PPCI in patients with RV-STEMI.

Many techniques, methods and closure devices have been developed in order to reduce vascular complications that occur after coronary and peripheral interventions. The aim of the present study was to identify which method i.e. ultrasound (US) guidance or traditional access technique, is better for common femoral artery cannulation.The study included 939 patients, who were assigned to either the US-guided cannulation group (n = 449) or manual technique group (n = 490). The procedure time, first pass success rate, inadvertent venous puncture rate and complications developing within the first 7 days of the procedure were compared between the two groups.No differences were found between the two groups regarding basic characteristics and antiplatelet and anticoagulant therapy administered during and up to 24 hours before the procedure. Arterial puncture attempts (p0.001), inadvertent venous entry (p = 0.02), and total procedure time (p = 0.012) were significantly lower in the US-guided group compared to the manual technique group. Furthermore, the first pass success rate was significantly higher in the US-guided group compared to the manual technique group (p0.001). The US-guided group had significantly lower pain levels (p0.001), hematomas (p0.001) and arteriovenous fistulas (p = 0.011) than the manual technique group.US-guided common femoral artery cannulation yields both higher access rates at first attempt and a shorter access time, and lower pain and complication rates.

Background: Thrombolysis is an effective treatment strategy for prosthetic valve thrombosis (PVT). Recombinant tissue-type plasminogen activator (rt-PA) is widely used as a thrombolytic agent. Infusion of rt-PA may trigger the production of anti–tissue plasminogen activator (tPA) antibodies (ATAs). We aimed to evaluate the possible relationship between ATA levels and PVT formation, and the role of baseline ATA levels on outcomes of thrombolytic therapy in patients with PVT. Methods: This prospective, single-center cohort study included 28 patients with PVT undergoing thrombolysis and 31 controls with normal prostheses. Plasma samples were collected from patients with PVT at baseline and at 15th, 30th, 90th, and 180th days after thrombolysis and from controls at baseline only. The ATA levels were assessed in human plasma by an enzyme-linked immunosorbent assay. Results: Baseline ATA-immunoglobulin (Ig) G and IgM were significantly higher in patients with PVT than in controls. The levels of IgM and IgG peaked at 15th and 30th days after rt-PA infusion, respectively. Subtherapeutic international normalized ratio and baseline ATA-IgM were independent predictors of PVT. Thrombolysis failed in 6 patients (21%) in whom baseline IgM levels were significantly higher than successfully lysed patients. Rethrombosis occurred in 9 patients (32%) in whom baseline IgG levels were significantly higher than those without rethrombosis. There was a moderate positive correlation between baseline and 15th-day IgM levels and the dose of rt-PA needed for successful lysis. Conclusion: The ATA levels tended to be higher in patients with PVT at the time of initial diagnosis compared to controls without PVT. In addition, such patients with PVT and high ATA levels may be at high risk for failed thrombolysis or rethrombosis.

Introduction: Less-invasive procedures have gained more widespread adoption among cardiovascular surgeons as a result of continuous advances in the field of cardiac surgical techniques. It has now become clear that even smaller incisions may provide adequate exposure in certain cardiac surgical procedures without compromising the surgeon’s view of the surgical field. Furthermore, a limited incision offers the advantage of cosmetic outcomes, hence an improved quality-of-life after the operation. Herein, we report our experience regarding the use of partial upper sternotomy with limited skin incision for isolated or combined aortic valve operations. Patients and Methods: A total of 34 patients underwent aortic valve surgery via partial J-shaped upper sternotomy in two separate centers between January 2013 and December 2014. Sixteen patients (47%) underwent an isolated aortic valve replacement, while 18 patients (53%) underwent a modified Bentall procedure. Descriptive data included demographic and clinical outcome parameters. Results: Mean age was 54 ± 14 years (range: 19 to 82 years) and there were 11 females (32%). The average duration of surgery was 6.8 ± 1.8 hours, ranging from 4 to 10 hours. Early mortality occurred in 1 patient. Two patients had wound infection and they were re-hospitalized for wound care. Conclusion: Our preliminary result regarding the use of partial upper ministernotomy is encouraging. The technique allows adequate exposure during aortic valve surgery, even in procedures involving the proximal ascending aorta. Further studies are warranted to test the safety and efficacy of this approach.

OBJECTIVE: Transradial approach (TRA) for coronary angiography is a popular alternative approach to transfemoral coronary angiography due to the infrequent occurrence of access site complications such as bleeding, hematoma and pseudoaneursym formation. However, not all patients are suitable for TRA. This study aimed to determine the predictors of radial artery diameter in patients who are candidates for TRA. METHODS: The study included 222 consecutive patients who underwent TRA due to suspected stable coronary artery disease. Radial artery diameter was evaluated prior to the procedure using B-mode ultrasonography. RESULTS: Radial artery diameter was correlated with wrist circumference (r=0.539, p

The aim of this study was to investigate the midterm effects of transradial coronary angiography (TRCAG) on the radial and brachial artery diameter, the vasodilator characteristics, as well as to assess the factors determining functional recovery. This study included 136 consecutive patients who underwent TRCAG. The radial artery was evaluated with ultrasonography before and 1 month after the procedure. The basal right radial artery diameter (2.97 ± 0.46 vs. 2.82 ± 0.51, p

Objectives Arterial stiffness is associated with major adverse cardiovascular events. Chronic venous insufficiency (CVI) is severe form of chronic venous disease (CVD). The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with CVI. Methods This observational and cross-sectional study involved 87 subjects with CVI and 86 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument. Results High density lipoprotein cholesterol (HDL) was significantly lower in patients with CVI than controls (46.83 ± 9.25 mg/dl vs 51.33 ± 11.13 mg/dl, p = 0.004). Body mass index (BMI) was significantly higher in CVI patients than controls (28.53 ± 4.10 kg/m2 vs 26.37 ± 5.16 kg/m2, p = 0.003). Ankle brachial index (ABI) was significantly lower in patients with CVI compared to controls (1.08 ± 0.08 vs 1.14 ± 0.11, p 7.9 had a sensitivity 64.4% and a specificity of 94.7% for predicting the presence of CVI in ROC analysis (area under curve = 0.791, 95% CI = 0.723–0.849, p Conclusion CAVI is independently increased in CVI patients. Therefore CVI may be accepted a form of vascular sclerosis and vascular system should be evaluated in continuum not isolated.

Introduction: Stress imaging tests are recommended in patients with positive exercise electrocardiography (EECG) and intermediate pretest probability. However the role of coronary computed tomography angiography (CCTA) in young women with intermediate pretest probability and positive EECG is under debate. The aim of this study was to assess the diagnostic value of CCTA in young women patients with low-intermediate pretest probability and positive EECG results. Patients and Methods: From a retrospective registry of 67 young women with positive EECG between January 2011 and January 2014 were included in this study. Of these 67 patients 32 patients underwent CCTA and 35 patients underwent MPS after EECG. Results: There were no statistically significant differences between groups in demographic variables, or cardiovascular risk profile. The exercise test was positive in all patients. Both groups were similar for exercise capacity and Duke treadmill score. Blood chemistry of the patients were similar. The median pre-test probability of obstructive coronary artery disease (CAD) was lower in CCTA group 28% (15-45%) than in MPS group (15-50) (p= 0.045). Overall 3 patients in the CCTA and 7 patients in the MPS group had significant lesions. All patients in the CCTA positive group had significant CAD, while 3 out of 7 patients with positive MPS findings had significant CAD in coronary angiography. Conclusion: CCTA may be a valuable alternative of stress imaging tests in women patients with low-intermediate pretest probability and positive EECG.

Hepatit Cvirüsü (HCV) tedavisinde peginterferon (Peg-IFN)2b ve ribavirin tedavisi konvansiyonel interferon veribavirin tedavisinden daha etkilidir. Peg-IFN ve ribavirin tedavisinin önemlietkilerinin yanında ateş, halsizlik, heyecan, huzursuzluk, nötropeni ve trombositopenigibi bir çok yan etki görülebilir. Ayrıca kardiyak aritmiler ve senkop gibinadir olaylar da Peg-IFNtedavisine bağlı gelişebilir. Bizler bu çalışmada Peg-IFN ve ribavirin tedavisi sırasında presenkop atağı vereenteran taşikardilerin en sık formu olan atriyoventriküler nodal reenterantaşikardi gelişen bir yoğun bakım hastasını sunuyoruz., Thetreatment of hepatitis C virus (HCV) with peginterferon (Peg-IFN) α2b andribavirin is more effective than with conventional interferon and ribavirin.Despite the important effects of Peg-IFN and ribavirin therapy, many sideeffects, such as fever, fatigue, anxiety, irritability, neutropenia andthrombocytopenia, may be observed. In addition, cardiac arrhythmias and syncopeare rare consequences of Peg-IFN therapy. In this study, we report an intensivecare unit patient who developed atrioventricular nodal reentrant tachycardia(AVNRT), which is the most common type of reentrant supraventriculartachycardia, and presyncopal attack during Peg-IFN and ribavirin therapy.

The circulatory system is a complex system containing the heart and vessels. This system, originating from extraembryonic mesoderm, is the first functioning system of the embryo. The formation of the angioblast and primitive placental circulation starts at the beginning of the third week. Plasticity is defined as the ability of a mature cell to differentiate into different cell types. Haematopoietic stem cells can transform into neural, heart muscle, skeletal muscle and liver cells, while the bone marrow stromal cells can transform into heart and skeletal muscle cells. The identification of vessels as artery, venous or capillary is closely related to remodelling. Arteries express ephrin-B2 and D114, while veins express ephrin-B4 and neuropilin-2. With the guidance of these genes, the identification of arteries and veins has started. Besides genes, physical factors, including hemodynamic and cardiac output regulations, affect vessel branching. Flow-mediated vascular plasticity is a crucial link between the genetic and epigenetic factors. The arterial and venous differentiations are controlled by hemodynamic factors. In conclusion, blood flow is important for the formation of a vascular tree and activates arterial markers, including ephrin-B2 and neuropilin-1.

Objective: The ambulatory arterial stiffness index has been proposed as an indicator of arterial stiffness. The aim of this study was to test the hypothesis that increased ambulatory arterial stiffness index might be related with impaired left atrial function in hypertensive diabetic patients with no previous history of cardiovascular disease. Methods: Inclusion criteria included office systolic BP> 130 mm Hg or diastolic BP> 80 mm Hg and absence of secondary causes of HT, whereas exclusion criteria LV ejection fraction

Background Recently, the role of osteoprotegerin (OPG) in the pathogenesis of heart failure through different mechanisms has received much attention. Subclinical changes in left ventricular (LV) function can be identified using quantification of myocardial strain, and global longitudinal strain (GLS) is a superior predictor of outcomes than ejection fraction. We hypothesized that increased OPG levels could predict subclinical LV systolic dysfunction in treated diabetic hypertensive patients with preserved LV ejection fraction. Methods The study was composed of 86 diabetic hypertensive and 30 nondiabetic hypertensive patients. All patients underwent echocardiography and venous blood samples were taken for determination of OPG. The relation between OPG levels and LV GLS was investigated using 2-dimensional speckle tracking echocardiography. Results Diabetic hypertensive patients had higher diastolic peak early/early diastolic tissue velocity and lower systolic tissue velocity, GLS, GLS rate systolic, and GLS rate early diastolic than nondiabetic hypertensive patients ( P = 0.009, P = 0.049, P P = 0.004, and P 18.5 and ≤ 18.5). The patients with GLS ≤ 18.5 had higher diastolic blood pressure (mm Hg; P = 0.048), OPG (pmol/L; P P = 0.042) values than those with GLS > 18.5. In multivariate logistic regression analysis, OPG was found to be an independent predictor of impaired GLS ( P = 0.001). Receiver operating characteristic curve analysis revealed that OPG values of > 6.45 (pmol/L) identified the patients with GLS ≤ 18.5. Conclusions Plasma OPG values could predict subclinical LV systolic dysfunction in diabetic hypertensive patients.

OBJECTIVE It is important to know the elapsed symptom-to-door (StD) time between the emergence of ST-elevation myocardial infarction (STEMI) symptoms and admission to the hospital in terms of the selection of appropriate treatment and prognosis. In this study, we aimed to assess the relationship between serum C-reactive protein (CRP) and StD time after STEMI. METHODS 436 of the patients admitted to our center with STEMI between August 2012-February 2013 (338 male, mean age, 63.9±12.8) were included in this prospective-observational cohort study. Blood samples were obtained from laboratory results of the first reference period. Patients were divided into four groups according to the duration of StD time [0-1. hour; group 1 (G1), 1-3. hour; group 2 (G2), 3-6. hour; group 3 (G3), 6-12. hour; group 4 (G4)]. Statistical analysis was performed via chi-squre test, ANOVA test, Pearson's correlation analysis and receiver operator charecteristic (ROC) analysis. RESULTS As the time progressed, an increase in CRP levels was observed. The difference among the means of the G1-G3 (p=0.002), G1-G4 (p

OBJECTIVE The relationship between silent neuronal injury (SNI) and arterial stiffness assessed by cardio-ankle vascular index (CAVI) has not been evaluated in patients treated with coronary angiography and intervention due to acute coronary syndrome (ACS). The aim of this study is to evaluate the value of CAVI in prediction of SNI after percutaneous coronary angiography and intervention in patients presented with ACS. METHODS Eighty-three consecutive patients presented with ACS, who underwent percutaneous coronary angiography and intervention, were included in this prospective observational study on diagnostic accuracy. Neuron specific enolase (NSE) was studied before and 18 hour after the coronary angiography and intervention. CAVI was measured by VaSera-1000 instrument. Clinical and echocardiographic characteristics were analyzed and independent predictors of SNI were evaluated. Chi-square, Student t-test, Mann-Whithney U test, correlation analysis and logistic regression analysis was used for statistical analysis. RESULTS NSE levels significantly increased after cardiac catheterization (9.82±3.22 mg/dL vs. 13.15±8.55 mg/dL, p

We investigated the relationship between peripheral artery disease complexity and coronary artery disease complexity in patients with peripheral artery disease. A total of 449 patients were enrolled. SYNTAX score, a marker of coronary artery disease complexity, was assessed by dedicated computer software and complexity of peripheral artery disease was determined by Trans Atlantic Inter-Society Consensus II classification. The SYNTAX score of patients with minimal peripheral artery disease, Trans Atlantic Inter-Society Consensus A, Trans Atlantic Inter-Society Consensus B, Trans Atlantic Inter-Society Consensus C and Trans Atlantic Inter-Society Consensus D were 5 (11), 12.5 (13.25), 20 (14), 20.5 (19) and 27.5 (19), respectively (values in brackets represent the interquartile range). SYNTAX score and Trans Atlantic Inter-Society Consensus class was moderately correlated (r = 0.495, p

Introduction: Stroke is one of the leading causes of permanent disability and death. Stroke is generally associated with ischemia and carotid artery stenosis is the reason in nearly one third of the cases. The aim of the present study was to investigate the short and mid term results of carotid artery stenting (KAS) procedures performed in high risk patients due to carotid artery disease who were admitted to cardiology clinic of our institution. Patients and Methods: The study group consisted of 14 consecutive high risk patients in whom KAS was performed in the cardiology clinic of our institution due to atherosclerotic carotid artery disease between October 2011 and October 2013. Procedural success, in-hospital and out-hospital stroke, myocardial infarction and all causes of mortality were evaluated. Results: Angiographic success was achieved in all patients. In-hospital and out-hospital acure coronary syndrome was not observed. One patient developed permanent stroke 24 hours after the procedure. This stroke was related with non-intervened carotid artery. This patient died 32 days after the procedure. Procedure related stroke or death was not occurred in any of the patients. Conclusion: KAS is a safe procedure in high risk patients for appropriately equipped experienced operators.

Polycystic ovary syndrome (PCOS) is closely related to increased cardiovascular risk in women of reproductive age. Atrial conduction abnormalities in these patients have not been investigated in terms of atrial electromechanical delay measured by tissue Doppler imaging (TDI) as an early predictor of atrial fibrillation development. The aim of this study was to evaluate whether TDI-derived atrial conduction time is prolonged in PCOS. The study included 51 patients with PCOS and 48 age-matched healthy controls. P-wave dispersion (PWD) was calculated on the 12-lead surface electrocardiogram. Systolic and diastolic left ventricular (LV) functions, atrial electromechanical coupling, intraatrial and interatrial electromechanical delays were measured with conventional echocardiography and TDI. PWD was higher in PCOS women (50.45 ± 3.7 vs 34.73 ± 6.7 ms, p = 0.008). Interatrial and intraatrial electromechanical delay were found longer in patients with PCOS compared to controls (41.9 ± 9.0 vs 22.2 ± 6.6 ms, p

The aim of this study is to evaluate the incidence and predictors of silent neuronal injury (SNI) after coronary angiography (CAG) and intervention by serial measurement of serum neuron-specific enolase (NSE) in patients presented with acute coronary syndrome (ACS). Ninety-eight consecutive patients presented with ACS and underwent CAG and intervention were included in the study. The NSE levels significantly increased after CAG and intervention compared to baseline levels (22.03 ± 27.70 and 10.08 ± 3.15 consecutively). Left ventricular ejection fraction in the SNI+ group was significantly lower than that in the SNI− group (43.71% ± 12.51%, 50.84% ± 9.34%, P = .002). Maximal creatinine kinase myocardial band, troponin I, and SYNTAX score of the SNI+ group were significantly higher than those of the SNI− group (103.83 ± 99.22, 51.92 ± 78.33, P = .006; 50.04 ± 66.18, 19.18 ± 30.50, P = .002; 103.83 ± 99.22, 51.92 ± 78.33, P = .006; and 50.04 ± 66.18, 19.18 ± 30.50, P = .002 successively). SYNTAX score and performing percutaneous coronary intervention were the independent predictors of SNI ( P = .009, odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.014-1.107, P = .036, OR = 4.262, 95% CI = 1.097-16.56). Percutaneous coronary intervention and coronary artery lesion complexity may increase the risk of SNI in patients with ACS.