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Subclinical atherosclerosis may be seen at an early age of ankylosing spondylitis (AS). Syndecan 1 (S1) expression is increased in response to proinflammatory cytokine and inflammation. High S1 may reduce carotid atherosclerosis progression. We aimed to investigate the relationship between S1 levels and subclinical atherosclerosis in patients with AS.Fifty-eight patients diagnosed with AS and 58 age-, sex-, and body mass index-matched controls were included in the study. S1 level and carotid intima-media thickness (cIMT) were evaluated using appropriate methods.AS patients' cIMT (0.53 ± 0.1 vs 0.45 ± 0.1 mm, p = .008), S1 (6.0 [1.7-149.2] vs 5.5 [1.0-29.8] ng/ml, p = .020), CRP (C-reactive protein) (2.1 [0.1-19.7] vs 1.1 [0.3-9.6] mg/dl, p = .012), fibrinogen (330.2 ± 87.0 vs 278.0 ± 54.5 mg/dl, p .001) values were significantly higher than the values of the control group. There was a negative correlation between cIMT and CRP (p = .034), age (p .001), disease duration (p = .005), BASDAI (p = .048) and fibrinogen (p = .009) in AS patients. There was a negative correlation between cIMT and S1 (p = .029). In multivariate analysis, an independent relationship was found between cIMT and age (β = 0.611, p .001) and syndecan (β = -0.196, p = .046).S1 level may rise in AS patients to suppress the inverse effects of proinflammatory cytokines and inflammation. A negative relationship between the cIMT values of AS patients and S1 level may reveal that S1 has a protective effect on the development of atherosclerosis in AS patients, independent of disease activity.

SUMMARY OBJECTIVE: Different parameters on electrocardiograms (ECG) have been investigated to predict arrhythmia and mortality in patients with acute pulmonary embolism (APE). The acute effect of thrombolytic therapy (TT) on these parameters has not been investigated yet. METHODS: We examined the data of 83 patients who were evaluated as high-risk APE and discharged from the hospital after TT. First, the high-risk APE patients’ ECGs were compared with healthy control subjects (n = 55). After their admission and 24 hours later, the ECGs of patients with APE were compared. Heart rate, P-wave morphology, QRS duration, QT distance, Tp-e, and the index of cardiac electrophysiological balance (iCEB) were analyzed. RESULTS: Although P maximum was not different between the groups’ ECGs, heart rate, QT, QTc (corrected QT) interval, Tp-e intervals, Tp-e/QT ratio, and P wave dispersion were significantly higher in the APE group ( P values < 0.031). iCEB or iCEBc (corrected iCEB) values were lower in APE group ( P < 0.001). After TT, we determined a decrease in heart rate, Tp-e interval, and Tp-e/QT ratio ( P < 0.001). Although we detected a decrease in the QT and QTc interval and QT dispersion (QTd), QTd had no statistical significance (respectively P -value 0.013, 0.029, and 0.096). The iCEB and iCEBc levels were lower after TT ( P -value was 0.035 and 0.044 respectively). CONCLUSION: The QT, QTc, Tp-e interval, Tp-e/QTc ratio, iCEB, and iCEBc values significantly decreased after TT. It may be thought that effective TT causes partial improvement in ventricular repolarization in an early period. RESUMO OBJETIVO: Diferentes parâmetros de eletrocardiograma (ECG) têm sido investigados para predizer mortalidade e arritmia em pacientes com embolia pulmonar aguda (EPA). O efeito agudo da terapia trombolítica (TT) nesses parâmetros ainda não foi investigado. MÉTODOS: Examinamos os dados de 83 pacientes avaliados com EPA de alto risco e que receberam alta hospitalar após TT. Primeiramente, comparamos os ECGs dos pacientes com EPA de alto risco com os de indivíduos saudáveis (n = 55). Os ECGs dos pacientes com EPA foram comparados logo após a internação e 24 horas mais tarde. A frequência cardíaca, a morfologia da onda P, a duração do QRS, o intervalo QT, Tp-e e o índice de equilíbrio eletrofisiológico cardíaco (iCEB) foram analisados. RESULTADOS: Embora o valor máximo de P não tenha sido diferente entre os grupos no ECG, a frequência cardíaca, QT, intervalo QTc (QT corrigido), intervalos Tpe, razão TP-e/QT e dispersão da onda P foram significativamente mais elevados no grupo de EPA (valores de P < 0,031). Os valores do iCEB ou iCEBc (iCEB corrigido) foram inferiores no grupo de APE (P < 0,001). Após a TT, observamos uma diminuição da frequência cardíaca, do intervalo TP-e e da razão TP-e/QT ( P < 0,001). Apesar de termos observado uma diminuição do intervalo QT e QTc e da dispersão do QT (QTd), o valor de QTd não apresentou uma diferença estatisticamente significativa (respectivamente, valor de P 0,013, 0,029 e 0,096). Os níveis do iCEB e iCEBc foram menores após a TT (valor de P 0,035 e 0,044, respectivamente). CONCLUSÃO: Os valores de QT, QTc, intervalo Tp-e, razão Tp-e/QTc, iCEB e iCEBc diminuíram significativamente após TT. Pode-se concluir que a TT eficaz causa uma melhora parcial da repolarização ventricular no período inicial.

Introduction:Coronary tortuosity (CT) is a common anatomical finding during coronary angiography (CA); however, its aetiology and clinical importance have not been clearly defined. We aimed to evaluate the effect of the presence or severity of CT and effect of the sigma-shaped right coronary artery (RCA) on the exercise stress test (EST).Methods:The study included 175 patients who underwent CA due to cardiac symptoms and positive EST and had no obstructive coronary artery disease in a single centre between 2017 and 2018 June. The patients were divided into two groups: Group 1, patients with CT (n=88), and group 2, patients without CT (n=87). The patients were also categorised as low and moderate-to-high risk based on Duke treadmill score (DTS).Results:The running distance and DTS were lower, and the rate of sigma-shaped RCA was higher in the CT group (p

SUMMARY OBJECTIVE Recent studies have linked malnutrition with undesirable outcomes in cardiovascular diseases. However, the underlying mechanism is unknown. Contrast-induced acute kidney injury (CI-AKI) increased cardiovascular mortality after percutaneous coronary intervention (PCI). This study hypothesizes that prognostic nutritional index (PNI) plays a role in the development of CI-AKI in patients with acute coronary syndrome undergoing emergency PCI. METHODS This study enrolled 551 patients. PNI was determined as 10× serum albumin (g/dL)+0.005×total lymphocyte count (mm3). CI-AKI was characterized as the increase in serum creatinine ≥0.3 mg/dL level within 48 h after PCI. Patients were classified as either CI-AKI (+) or CI-AKI (−). RESULTS CI-AKI has occurred in 72 of 551 patients (13.1%). PNI was significantly lower in the CI-AKI (+) group than in the CI-AKI (-) group (44.4±6.6 versus 47.2±5.8, p

It has been shown that transmitral A-wave (TMAW) is affected in paroxysmal atrial fibrillation (PAF), and decreased left atrial contractions cause a decrease in the TMAW velocity. The relationship between TMAW acceleration time (TMAW-AccT) and PAF is unknown. In this study, the predictive value of TMAW-AccT for PAF was investigated.Seventy PAF patients (mean age: 57.8 ± 11.0 years) and 70 control patients (mean age: 58.1 ± 10.5 years) were included in the study. Transthoracic echocardiography was performed in sinus rhythm in all patients. For TMAW-AccT, the time between the basal point of the A-wave and the highest point reached was measured.Transmitral A-wave -AccT was significantly longer in the PAF group than the control group (TMAW-AccT; 88.5 ± 18.1 vs 77.2 ± 16.4 ms, P = .000, respectively). The left atrial diameter and the left atrial volume index were similar between the groups (P = .07, P = .18, respectively). According to a multivariate logistic regression analysis, the TMAW-AccT (OR: 1.02, 95% confidence interval 1.02-1.07, P .001) was a predictor of PAF. A receiver operating characteristic curve analysis showed a cutoff value of TMAW-AccT of82 ms (sensitivity: 65.7%, specificity: 64.3%, positive predictive value: 64.8%, negative predictive value: 65.2%).Transmitral A-wave-AccT can be used as an early marker in detecting PAF without dilated left atrium.

Amac: QT intervali / QRS suresi olarak hesaplanan kardiyak elektrofizyolojik denge indeksi (iCEB), malign ventrikuler aritmileri ongormek icin yeni bir gosterge olarak tanimlanmistir. Burada, koroner kollateral dolasim (KKD) derecesinin; iCEB ve Tp-e / QT orani ile iliskisini arastirmayi amacladik. Hastalar ve Yontem: Kronik total okluzyon (KTO) tanisi olan 44 hasta ile benzer yas ve cinsiyet dagiliminda 55 saglikli kisi calismaya alindi. KTO hastalari, iyi (n = 24) ve zayif (n = 20) kollateral grubu olarak siniflandirildi. Tum hastalarin 12-lead standart elektrokardiyogrami (EKG) kaydedildi ve Tp-e araligi, QT araligi, QRS suresi, Tp-e/QT orani ve QT/QRS oranlari olculdu. Bulgular: Ortalama Tp-e araligi ve Tp-e/QT orani gruplar arasinda benzerdi. Ayrica, gruplar arasinda iCEB veya iCEBc degerleri benzer izlendi. Alt grup analizinde, KKD derecesi ile Tp-e/QT orani, Tp-e suresi ve QT/QRS oranini iceren EKG parametreleri arasinda bir iliski saptanmadi. Sonuc: KTO'lu hastalarda iCEB ve Tp-e/QT orani ile KKD gelisiminin derecesi arasinda anlamli bir iliski saptanmadi.

BACKGROUND: Atrial fibrillation (AF) prevalence in patients with acute myocardial infarction (MI) ranges from 3% to 25%. However demographic, clinical, and angiographic characteristics of AF patients who admitted with de novo MI are unclear. The aim of this study was to investigate the prevalence of patients presenting with de novo MI with AF. METHODS: The study was performed as a sub-study of the MINOCA-TR (Myocardial Infarction with Non-obstructive Coronary Arteries in Turkish Population) Registry, a multicenter, cross-sectional, observational, all-comer registry. MI patients without a known history of stable coronary artery disease and/or prior coronary revascularization were enrolled in the study. Patients were divided into AF and Non-AF groups according to presenting cardiac rhythm. RESULTS: A total of 1793 patients were screened and 1626 were included in the study. The mean age was 61.5 (12.5) years. 70.7% of patients were men. The prevalence of AF was 3.1% (51 patients). AF patients were older [73.4 (9.4) vs. 61.0 (12.4) years, p

Aim: The prevalence of atrial fibrillation (AF) in patients with myocardial infarction (MI) ranges widely and has been reported to be as high as 21%. However, the demographic, clinical, and angiographic characteristics of AF patients with de novo MI is unclear. The aim of this study was to investigate the prevalence of patients presenting with de novo MI with AF. Methods: The study was performed as a sub-study of the MINOCA-TR (Myocardial Infarction with Non-obstructive Coronary Arteries in Turkish Population) Registry, a multicenter, cross-sectional, observational, all-comer registry. MI patients without a known history of stable coronary artery disease and/or prior coronary revascularization were enrolled in the study. Patients were divided into AF and Non-AF groups according to their presenting cardiac rhythm. Results: A total of 1793 patients were screened and 1626 were included in the study. Mean age was 61.5 (12.5) years. 70.7% of patients were men. Prevalence of AF was 3.1% (51 patients). AF patients were older [73.4 (9.4) vs. 61.0 (12.4) years, p

Eventhough acute carotid stent thrombosis is a rare complication of carotid arterystenting (CAS), it can cause fatal thromboembolic events. There are limitednumbers of techniques that can be applied during such emergencies. In thisstudy, we report a case in which the sandwich technique was successfullyperformed in the acute in-stent thrombosis. Conclusively, in-proceduralin-stent thrombosis following CAS must be rapidly evaluated and treated,allowing the efficient prevention of catastrophic events. Thus, sandwich stenttechnique is a rapid and efficient method for treating acute in-stentthrombosis., Akutkarotis arter stent (KAS) trombozu nadir bir komplikasyon olmasına rağmen fataltromboembolik olaylara neden olabilir. Akut olaylarda uygulanabilecek sınırlısayıda teknik olmakla birlikte bu olgu bildirimizde akut KAS trombozunda başarılıbir şekilde uygulanan “sandviç stent tekniğini” sunmaktayız. Prosedürel akutKAS trombozu hızlı ve etkin bir şekilde değerlendirilerek tedavi edilmesigereken bir durumdur. Bu olgumuzda kullandığımız teknik böyle katastrofikdurumlarla başetmede hızlı ve güvenli alternatif bir yöntem olarakkullanılabilir.

Amac: QRS suresine bolunmus QT intervali olarak hesaplanan, kardiyak elektrofizyolojik denge indeksi (iCEB), malign ventrikuler aritmileri ongormek icin yeni bir risk belirleyicisi olarak tanimlanmistir. iCEB'nin artmis seviyeleri torsades de pointes (TdP) ve azalan iCEB duzeylerinin ise torsades de pointes olmayan ventrikuler tasikardi veya ventrikuler fibrilasyona neden oldugunu ongormektedir. Bu calismanin amaci koroner ektazisi (KAE) olan hastalarda iCEB kullanilarak, bu hastalardaki aritmojenik riski degerlendirmektir. Yontemler: Vaka kontrolu olarak tasarlanan calismamiza poliklinigimize basvuran 130 hasta dahil edildi. Izole KAE'si olan 75 hasta (calisma grubu) ve 55 saglikli birey (kontrol grubu) calismaya dahil edildi. Her iki gruba da 12 adet standart elektrokardiyografi cekildi. Tp-Te intervali, QT intervali, QRS intervali, Tp-Te / QT orani ve QT / QRS oranlari (iCEB) kaydedilerek gruplar arasinda karsilastirma yapildi. Bulgular: Tp-e intervalleri ve Tp-e / QT orani calisma grubunda anlamli olarak daha yuksek saptandi (p=0,001). Ayrica iCEB'in, calisma grubunda sayisal olarak daha yuksek olma egilimi oldugu bulunmustur, ancak gruplar arasinda istatistiksel olarak anlamli bir fark bulunamamistir (p=0,118). Tp-e ve Tpe / QT orani, iki veya uc damar KAE'si olan hastalarda, tek damar ektazisi olanlardan daha yuksekti (Tp-e icin p≤0,024 ve Tpe/QT orani icin p=0,028). iCEB, etkilenen koroner arter sayisi ile daha yuksek bulunmasina ragmen, gruplar arasinda istatistiksel olarak fark saptanmadi. Sonuc: Bulgularimiz, KAE hastalarinin saglikli kontrollere gore daha yuksek Tp-Te ve Tp-Te / QT degerlerine sahip oldugunu gostermektedir. KAE'li bireyler icin iCEB kullanilarak artmis aritmojenik riski gostermek icin daha fazla calismaya ihtiyacimiz vardir.

Background: Vasculopathy is a major cause of mortality and morbidity in Behcet’s Disease (BD). Subclinical atherosclerosis can even be detected in the early stage of BD. Soluble tumor necrosis factor-like (TNF) weak inducer of apoptosis (TWEAK) is known as a good marker of the inflammation in vascular tree. The aim of this study is to examine the relationship between carotid artery intima-media thickness (cIMT) and serum TWEAK levels in patients with BD. Materials and Methods: In line with International BD Study Group criteria, 48 BD, and 30 controls were included in our study. Disease activity was evaluated according to BD current activity form (BDCAF). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lipid parameters, serum TWEAK levels, and cIMT were measured. Results: Disease activity score of BD patients was found as 2 (range 0–7). cIMT, serum TWEAK, CRP and ESR levels of BD patients were significantly higher comparing to cIMT (0.62 ± 0.13 mm vs. 0.43 ± 0.09 mm, p < 0.001), serum TWEAK (667.5 ± 130.6 vs. 603.4 ± 89.6 pg/ml, p = 0.015), CRP (3.9 ± 4.3 vs. 1.4 ± 1.0 mg/dl, p < 0.001) and ESR (10.2 ± 10.0 vs. 5.6 ± 3.7 mm/h, p = 0.005) levels of the control group. There was a positive correlation between serum TWEAK level and disease activity (r = 0.251, p = 0.030) and cIMT (r = 0.463, p < 0.001). Our study also revealed an independent correlation between cIMT and serum TWEAK levels (beta = 0.354, p < 0.001). Conclusion: Increased serum TWEAK levels can play a part in the development of atherosclerotic heart disease in BD. Due to their liability to atherosclerosis, patients with BD must followed closely.

PubMed ID: 27436495, Familial Mediterranean fever (FMF) is a disease characterized by chronic inflammation. Atherogenic index of plasma (AIP) is a logarithmic value of the triglyceride to high-density lipoprotein cholesterol ratio and it is a good marker for atherosclerotic heart disease and cardiac risk. In this study, we investigated subclinical atherosclerosis and cardiac risks in patients with FMF. Patients with FMF (78 men and 84 women) and healthy controls (74 men and 82 women) were included in this study. The AIP values of the patients were calculated and carotid intima-media thicknesses (cIMTs) were measured. The cIMT (P

cure, erkan/0000-0001-7807-135X; Cure, Medine Cumhur/0000-0001-9253-6459; Aydogan Baykara, Rabia/0000-0003-0542-266X WOS: 000399025700011 PubMed: 27431747 Behcet's disease (BD) is a systemic vasculitis characterized by cardiovascular complications. Early diagnosis of these complications can reduce morbidity and mortality. Carotid artery intima-media thickness (cIMT) and the logarithmic value of triglyceride to high density lipoprotein ratio (atherogenic index of plasma, AIP) are good markers of atherosclerosis. the purpose of this study was to investigate whether AIP is a predictive marker of subclinical atherosclerosis in BD patients. A total of 84 BD patients (60 male, 24 female) and 84 healthy control individuals (58 male, 26 female) were included in this study. cIMT measurements were made, and AIP values were calculated. cIMT (p < 0.001) and AIP (p < 0.001) values of the BD patients were higher than those of the control group. A strong independent relationship was found between the AIP value and cIMT (beta = 0.232, p = 0.018). in the subgroup analysis, the cIMT and AIP values of male BD patients were higher than those of female BD patients. Increased AIP and cIMT values can be a good marker for subclinical atherosclerosis in BD patients, especially in male BD patients.

Cure, Medine Cumhur/0000-0001-9253-6459; cure, erkan/0000-0001-7807-135X; Balta, Sevket/0000-0002-6657-7334 WOS: 000374792900009 PubMed: 26941246 Behcet's disease (BD) is a vasculitic and inflammatory disease causing endothelial dysfunction. Irisin is a metabolic hormone related to insulin resistance and endothelial functions. in this study, we investigated the relationship between irisin and carotid intima-media thickness (cIMT), which is a marker of atherosclerosis in patients with BD. 48 patients with BD and 50 healthy individuals were enrolled in the study. Disease severity was evaluated by BD current activity form. Irisin, glucose, insulin, C reactive protein, erythrocyte sedimentation rate and lipid panel were examined in all patients. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was used to calculate insulin resistance. A simple and inexpensive cIMT test was used as indicator of atherosclerosis. cIMT was 0.62 (0.45-1.05) mm in the patients, while it was 0.38 (0.25-0.65) mm in the control group (p

In patients with spontaneous circulation after cardiopulmonary resuscitation, therapeutic hypothermia is defined as the reduction of body temperature to 32-34 ° C within the first 4-6 hours for neuroprotective purposes and to be maintained at this level for 12-24 hours after reaching the target temperature. Therapeutic hypothermia has been practiced since the 1940s. The aim of therapeutic hypothermia is to reduce cerebral edema, convulsive activity, metabolic demand and associated complications by providing low body heat. Therapeutic hypothermia is applied to increase life expectancy and quality of life. In out-of-hospital cardiac arrest, should be performed in comatose patients where initial rhythm is ventricular fibrillation and spontaneous circulation is returned. Herein, we present a 44 years old patient who had an aborted sudden cardiac death due to acute myocardial infarction and performing cardiopulmonary resuscitation for 30 minutes and discharged after 6 days with a successful therapeutic hypothermia., Kardiyopulmoner resisütasyon sonrası spontan dolaşım sağlanan hastalarda, nöroprotektif amaçlı ilk 4-6 saat içinde vücut ısısının 32-34 °C’ye kadar indirildiği ve hedef ısıya ulaştıktan sonra 12-24 saat bu düzeyde tutulmasına terapötik hipotermi denir. Terapötik hipotermi 1940’lardan bu yana uygulanmaktadır. Terapötik hipoterminin amacı, düşük vücut ısısı sağlayarak serebral ödem, konvülziyon aktivitesi, metabolik talebi ve bunlarla ilgili gelişecek komplikasyonları azaltmaktır. Terapötik hipotermi yaşam beklentisi ve hayat kalitesini artırmak için uygulanır. Hastane dışı kardiyak arrestlerde başlangıç ritmin ventriküler fibrilasyon olduğu ve spontan dolaşımın geri döndüğü komatöz hastalarda yapılmalıdır. Burada, akut miyokard enfarktüsü nedeniyle ani kardiyak ölümle sonuçlanan ve 30 dakika süreyle kardiyopulmoner resisütasyon uygulanan ve 6 gün sonra başarılı bir terapötik hipotermi sonrası taburcu edilen 44 yaşında bir hasta sunuyoruz.

Ankylosing spondylitis (AS) is associated with an increased risk of atherosclerotic cardiovascular disease (ACD). The atherogenic index of plasma (AIP), which is the logarithmic transformation of the plasma triglyceride (TG) level to the high-density lipoprotein level (HDL) ratio, has been suggested to be a novel marker in the identification of atherosclerosis risk. Therefore, this study aims to determine if the AIP can act as an accurate marker for the detection of subclinical atherosclerosis. Fifty-two male patients with AS and 52 age-, gender-, and body mass index (BMI)-matched healthy control subjects were included in the study. For each patient, AIP and total cholesterol (TC)/HDL values were calculated and carotid artery intima-media thickness (cIMT) was measured. The mean (SD) cIMT and median (range) AIP values for AS patients were higher than that of the healthy control subjects (0.60 ± 0.18 vs. 0.51 ± 0.10, p = 0.003 and 0.23 [− 0.32 to 0.85] vs. 0.09 [− 0.53 to 0.49], p = 0.007, respectively). A positive correlation was found between the patients’ cIMT and AIP values (r = 0.307, p = 0.002) and TC/HDL values (r = 0.241, p = 0.014). Regression analysis revealed an independent association between the subclinical atherosclerosis and AIP (beta [β] = 0.309, p = 0.002). There were no independent correlations between subclinical atherosclerosis and TC (β = 0.245, p = 0.065), TG (β = 0.185, p = 0.515), HDL (β = 0.198, p = 0.231), TC/HDL (β = 0.032, p = 0.862), and low-density lipoprotein (LDL) (β = 0.151, p = 0.246). A strong and independent correlation exists between AIP and cIMT values. Therefore, the AIP could serve as a better marker than the TC/HDL ratio for the detection of subclinical atherosclerosis in AS patients.

Takotsubo cardiomyopathy (TCMP) is characterised by a temporary aneurysm of the left ventricular apex in individuals without significant stenosis of the coronary arteries. It is extremely rare to see it combined with a thrombus. In this case report, we present a 57-year-old female patient with TCMP in whom apical thrombus was treated with short-term warfarin use.

In athletes, left ventricular hypertrophy is a physiological response upon routine active sports. If the hypertrophic cardiomyopathy is not diagnosed and treated, it can lead to sudden deaths in athletes. Not so much data is known whether or not it is favorable to use of Tp-e values in order to reflect the arrhythmia risks in asymptomatic elite cyclists. The aim of this study is to examine the risks of regular bike sport on potential arrhythmia in healthy active elite cyclists and veterans by using non-invasive cardiac tests. Study groups were: healthy volunteers (group 1, n=28, mean age 35.8±4.6), active cyclists (group 2, n=27, mean age 21±3.0), veteran cyclists (group 3, n=27, mean age 29.5±7.1 yr). All groups were underwent cardiological examinations, 12 derivation ECG records, transthoracic echocardiography investigations. Tp-e interval, Tp-e dispersion, corrected Tp-e interval, QT interval and Tp-e/QT ratio were calculated from ECG records. Tp-e intervals were measured with Tangent method, corrected Tp-e interval were measured with Bazett formula. Mean Tp-e interval results were as follows according to groups 1, 2, 3; 75.0±9.3, 88.1±7.0, 83.2±8.8 ms, respectively. The Tp-e interval, cTp-e interval, Tp- dispersion, QT interval, and SLI values were significantly higher in active cyclists than the veteran cyclists and the control group (p

Systemic lupus erythematosus (SLE) is characterized by chronic inflammation. Plasma atherogenic index (PAI) is a valuable marker for the cardiovascular disease and cardiac risk. The aim of this study was to evaluate the role and clinical use of PAI in atherosclerosis and the cardiac risk in SLE patients.We included 56 female SLE patients who were selected according to the American College of Rheumatology (1997) diagnosis criteria. Furthermore, we selected age-and body mass index (BMI)-matched 56 female healthy individuals. PAI was measured as a logarithmic value of triglyceride to high-density cholesterol ratio. We used carotid intima media thickness (cIMT) as an inflammatory marker because of its widespread use. The lipid and other biochemical parameters of patient and control groups were examined.The PAI and cIMT values of SLE patients were 0.04±0.23 and 0.78±0.18 mm, respectively. Besides, for the control group, the PAI value was -0.09±0.20 and cIMT value was 0.50±0.15 mm (p=0.002, p0.001; respectively). There was a strong correlation between cIMT and PAI (r=0.273, p=0.003). According to the multiple logistic regression analysis, we found that PAI value is an independent factor for cIMT in SLE patients (odds ratio: 2.6, 95 % confidence interval; 1.506-4.374; p=0.029).We determined that PAI can be used as an independent indicator for subclinical atherosclerosis in SLE patients.Sistemik lupus eritematozus (SLE), kronik inflamasyon ile karakterize bir hastalıktır. Plazma aterojenik indeks (PAI), kardiyovasküler hastalık ve kardiyak risk için değerli bir belirteçtir. Bu çalışmanın amacı PAI’in SLE hastalarında aterosklerozu ve kardiyak riski değerlendirmekteki rolü ve klinik kullanılabilirliliğini araştırmaktır.Amerikan Romatoloji Koleji (1997) tanı kriterlerine göre değerlendirilen 56 kadın SLE hastası dahil edildi. Ayrıca yaş ve vucüt kitle indeksi uyumlu 56 kadın sağlıklı kişi seçildi. PAI, trigliserit’in yüksek yoğunluklu kolesterole oranı logartimik ölçümüdür. Karotis intima medya kalınlığı (KIMK) inflamatuvar belirteç olarak yaygın olarak kullanıldığından, bu işareti bu çalışmada kullandık. Hasta ve kontrol gruplarının lipid ve diğer biyokimyasal parametreleri incelendi.Hasta grubunda PAI 0,04±0,23, KIMK 0,78±0,18 mm, kontrol grubunda PAI −0,09±0,20, KIMK 0,50±0,15 mm olduğu tespit edildi. Hasta grubunda PAI ve KIMK’ın kontrol grubuna kıyasla yüksek olduğu görüldü (sırasıyla p=0,002, p0,001). SLE hastaları içerisine KIMK ile PAI arasında pozitif korelasyon olduğu görüldü (r=0,273, p=0,003). Multipl logistik regresyon analize göre PAI, KIMK için bağımsız risk faktörü olarak değerlendirildi (Olasılık oranı: 2,6, Güven aralığı %95 1,506–4,374, p=0,029).Bu çalışma bize PAI’nın SLE hastalarında subklinik aterosklerozun değerlendirilmesinde kullanılabilecek bağımsız bir belirteç olabileceğini düşündürdü.

Familial Mediterranean fever (FMF) is a disease characterized by chronic inflammation. Atherogenic index of plasma (AIP) is a logarithmic value of the triglyceride to high-density lipoprotein cholesterol ratio and it is a good marker for atherosclerotic heart disease and cardiac risk. In this study, we investigated subclinical atherosclerosis and cardiac risks in patients with FMF. Patients with FMF (78 men and 84 women) and healthy controls (74 men and 82 women) were included in this study. The AIP values of the patients were calculated and carotid intima-media thicknesses (cIMTs) were measured. The cIMT ( P.001) and AIP ( P.001) values of patients with FMF were higher than the values of the control group. There was a positive correlation between cIMT and AIP values ( r = .304, P.001). In regression analysis, we detected an independent relationship between cIMT and AIP (β = .248, P = .001). Atherogenic index of plasma may be highly correlated with the subclinical atherosclerosis. Particularly, male patients with FMF may have a high cardiac risk.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology. A major cause of morbidity and mortality in SLE is accelerated atherosclerosis. Endothelial-specific molecule 1 (endocan) is a potential predictor of vascular events and is expressed in response to inflammatory cytokines in endothelial cells. We investigated the relationship between endocan and carotid intima–media thickness (cIMT) as a marker of early atherosclerosis. We included 44 women with SLE and 44 healthy women as controls. Disease severity of SLE was evaluated using the SLE Disease Activity Index. Endocan, C-reactive protein, erythrocyte sedimentation rate (ESR), and lipid panel were measured. The cIMT was 0.70 (range: 0.45-1.20) mm in patients with SLE and 0.40 (0.25-0.60) mm in controls ( P < .001). Endocan value was 1.6 ± 0.9 ng/mL in controls and 2.2 ± 1.0 ng/mL in patients with SLE ( P = .014). Endocan levels were positively correlated with cIMT ( r = .469, P < .001), body mass index ( r = .373, P = .013), and ESR ( r = .393, P = .008). Endocan level may be associated with subclinical atherosclerosis in SLE. Consequently, endocan levels may be a promising clinical tool for patients with SLE as a guide for preventive strategy.

The neutrophil to lymphocyte ratio (NLR) predicts cardiovascular events. The aim of this study was to determine whether NLR improved the positive predictive value (PPV) of dobutamine stress echocardiography (DSE) in patients with stable coronary artery disease (CAD). We conducted a retrospective review of laboratory and DSE data from the medical records of 1,012 patients who were divided into two groups according to the presence of ischemia and further subdivided into three groups according to the extent of ischemia (nonischemic segments, 1-3 ischemic segments, or > 3 ischemic segments). NLRs were compared among these groups. NLRs increased in patients with ischemia and correlated with the number of ischemic segments (P < 0.001). The optimal cutoff value of NLR determined using receiver operating characteristic analysis was > 2.04, and the diagnostic value of NLR for discriminating patients with ≥ 50% coronary stenosis in at least one of the coronary arteries from those without significant CAD was high [area under the curve (AUC) = 0.671, standard error = 0.052, P < 0.001, 95% confidence interval (CI) = 0.569-0.773)]. An NLR cutoff value of > 2.04 predicted CAD presence with significant stenosis (62.10% sensitivity and 64.10% specificity). PPV of DSE for a significant coronary artery lesion identified using coronary angiography was 73.8% (95% CI = 75.1-88.5, P < 0.001, AUC = 0.818). On including a cut-off value of > 2.04 for NLR in this multivariable predictive model, the AUC value slightly increased to 0.905 (95% CI = 85.4-95.6) and PPV of DSE increased from 73.8% to 92.6%. NLR improved PPV of DSE for patients with stable CAD.

Background The aim of this study was to examine the Tpeak-Tend (Tpe/corrected Tpe) interval, which is an indicator of transmural myocardial repolarization, measured non-invasively via electrocardiogram in patients with acute pulmonary embolism (PE), and to investigate the relationship with 30-day mortality and morbidity. Methods The study included 272 patients diagnosed with acute PE, comprising 154 females and 118 males, with a mean age of 63.1 ± 16.8 years. Tpe/cTpe intervals were calculated from the electrocardiograms with a computer program after using a ruler or vernier caliper manual measuring tool to obtain highly sensitive measurements. The relationship between the electrocardiogram values and 30-days mortality and morbidity were measured. Results The study group was divided into three groups according to cTpe intervals: Group 1, < 113 ms; Group 2, 113–133 ms; and Group 3, > 133 ms. White blood cell count and troponin T levels, corrected QT intervals with QRS complex durations, percentage of right ventricle dilatation with right/left-ventricular ratio, 30-day death, and combinations of these values were seen at a higher rate in Group 3 patients compared to the other groups. Kaplan–Meier analysis showed that the cTpe interval measured at > 126 ms could be used as a cut-off value in the prediction of mortality and morbidity. The cTpe cut-off values of 126 ms had sensivity, specificity, negative predictive value, and positive predictive value of 80.56 %, 59.32 %, 95.2 %, and 23.2 %, respectively. Conclusions cTpe interval could be a useful method in early risk stratification in patients with acute PE.

Background: Doppler pulmonary venous flow velocities (PVFV) pattern are useful parameters in assessing the left ventricular diastolic functions. Both mitral stenosis (MS) and aortic stenosis (AS) lead to diastolic dysfunction. We compared PVFV and left ventricular diastolic and ejection time (ET) in patients with moderate MS and AS. Methods: Forty-three patients with moderate MS (group 1), 65 patients with moderate AS (group 2), and 33 healthy subjects as controls (group 3) were included in this study. After obtaining standard measurements echocardiographically, diastolic period (DP), ET, the ratio of the DP to the ET (DP/ET), isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), peak systolic flow velocity (PS), peak antegrade diastolic flow velocity (PD), peak reversal flow velocity at atrial contraction (PRA), the ratio of the peak systolic to the diastolic flow velocity (PS/PD), deceleration time of the antegrade diastolic flow (PDDT), and pressure half time of the peak antegrade diastolic flow velocity (PDPHT) were measured. Mitral valve area (MVA), aortic valve area (AVA), systolic pulmonary artery pressure (PAP), peak and mean gradients were calculated with standard formulas. Results: In univariate analysis, MVA was correlated with PDPHT and PDDT (r = −0.41; p < 0.01, r = −0.36; p < 0.05, respectively), also it was correlated with DP/ET (r = −0.57; p < 0.001). Mitral peak and mean diastolic gradient were correlated with PS/PD (r = −0.43; p < 0.01, r = −0.36; p < 0.05, respectively) and DP/ET (r = 0.51; p < 0.01, r = 0.46; p < 0.01, respectively). AVA was only correlated with DP/ET (r = 0.38; p < 0.05). Aortic peak and mean systolic gradient were correlated with PS/PD (r = −0.29; p < 0.05, r = −0.27; p < 0.05, respectively) and DP/ET (r = −0.38; p < 0.01, r = −0.40; p < 0.01, respectively). In the same analysis, PAP in patients in group 1 and 2 was correlated with PS/PD (r = −0.42; p < 0.01 and r = −0.40; p < 0.01, respectively) and also it was correlated with PD (r = 0.37; p < 0.05 and r = 0.27; p < 0.05, respectively) in both groups. Conclusion: Moderate MS and AS similarly affect the PVFV, and PS/PD correlates with hemodynamics similarly both in MS and AS. Nevertheless, PDDT and PDPHT correlate with solely MVA. IRT higher in AS than MS, though DP/ET and ICT higher in MS than AS, and DP/ET relates with the severity of both MS and AS.

Background: Pure mitral stenosis (MS) affects left-ventricular performance as a result of myocardial and functional factors. We planned this study to evaluate the effect of MS on right- and left-ventricular functions using Doppler tissue imaging (DTI). Methods: A total of 46 patients with an established diagnosis of MS (mean age: 41 ± 11 years), and 40 age-matched healthy individuals (mean age: 40 ± 9 years) were included in this study. Echocardiography equipped with DTI function was performed on each participant. The mitral valve area was measured. Myocardial velocities were recorded at 4 different sites (septum, lateral, anterior, and inferior) of the left ventricle, and the right-ventricular free wall annulus by DTI. The positive systolic velocity when the mitral and tricuspid ring moved toward the cardiac apex, and 2 negative diastolic velocities when the mitral annulus moved toward the base away from the apex (1 during the early phase of diastole and another in the late phase of diastole [A m ]) were measured. The early diastolic velocity/A m ratio was calculated for each wall. The mean of systolic and diastolic myocardial velocities of the left ventricle was calculated. Patients with pure MS were compared with healthy participants, and the relationship of DTI variables with mitral valve area was evaluated. Results: The myocardial velocities of the left ventricle indicating left-ventricular function were found to be significantly lower in patients with pure MS. Right-ventricular annulus velocities, on the other hand, were similar in both groups. A significant positive correlation could be established between mitral valve area and mean positive systolic velocity, A m of the left ventricle, and right-ventricular A m ( r = 0.50, P r = 0.48, P =.001; r = 0.45, P =.002, respectively), whereas a significant negative correlation ( r = −0.42, P =.004) was established for right-ventricular early diastolic velocity/A m ratio. Conclusion: This first study where pure MS was evaluated by DTI shows that MS affects left-ventricular performance on long axis. The results indicate that the decrease in left-ventricular performance is caused by both functional and myocardial factors. (J Am Soc Echocardiogr 2002;15:1472-8.)

The previous studies relating to the effect of the Valsalva maneuver on P wave do not provide detailed information. In those studies, the parameters related to P wave duration during the release phase of the Valsalva maneuver were evaluated. The authors evaluated P wave amplitude as well as P wave duration during the strain phase of the Valsalva maneuver. Thirty- seven normal subjects and 36 patients with paroxysmal atrial fibrillation (PAF) were included in the study. Twelve-lead surface electrocardiography (ECG) was obtained from all the patients before and during the strain phase of the Valsalva maneuver. The authors evaluated the para meters related to both P wave duration and P wave amplitude. The highest P wave voltage was expressed as the P wave amplitude maximum (P amp max), the lowest P wave voltage as the P wave amplitude minimum (P amp min), and the P wave amplitude dispersion (P amp dispersion) as "the P amp max — the P amp min." Also, the maximum P wave duration was expressed as the P maximum (P max), the minimum P wave duration as the P minimum (P min), and the P wave dispersion as "the maximum P wave duration (P max) — the minimum P wave duration (P min)." All these parameters were measured before and during the strain phase of the Valsalva maneuver. P max, P dispersion, P amp max, and P amp dispersion were higher in patients with PAF compared to those of normal subjects before the Valsalva maneuver. In normal subjects, P max, P wave dispersion, P amp max, and P amp dispersion values were significantly higher in the strain phase of the Valsalva maneuver than before (p

Postmenopausal hormone replacement therapy (HRT) has usually been evaluated the relationship with atherosclerotic disease, whereas its effect on direct cardiac functions hasn't been investigated in detail. This study was planned to investigate the long-term effects of HRT on cardiac functions and exercise performance.Thirty-six postmenopausal women (mean age: 51 +/- 4 years, 39-60 years) were prospectively analyzed with pulsed wave Doppler echocardiography and symptom-limited exercise stress test before HRT (oral 0.625 mg conjugated estrogen and 2.5 mg medroxyprogesteron acetate/day), and at the third and the sixth months. The effect of HRT on left ventricular ejection fraction (EF), early filling velocity (E wave) and late filling velocity (A wave), E wave deceleration time (EDT), E/A ratio, myocardial performance index (MPI), exercise duration and METS changes were examined.HRT did not significantly alter the left ventricular EF. At the third month of HRT, there was an insignificant increase in E wave, EDT, and E/A ratio, whereas an insignificant decrease was noted in MPI (P0.05). However, at the sixth month of HRT, these changes became significant (68 +/- 12 vs. 75 +/- 13 cm/s, P0.01; 171 +/- 24 vs. 184 +/- 14 ms, P0.01; 1.01 +/- 0.23 vs. 1.11 +/- 0.27, P0.01, and 44 +/- 9 vs. 39 +/- 8%, P0.001, respectively). On the other hand, exercise duration and exercise METS values showed significant improvements at the third month of HRT (423 +/- 104 vs. 482 +/- 104 s, P0.001; 8.2 +/- 1.7 vs. 9.1 +/- 2 METS, P0.001). These improvements also continued at the sixth month of HRT. In conclusion, postmenopausal HRT leads to a progressive improvement on left ventricular function parameters, and in parallel, in exercise performance.

The diagnosis of right ventricular myocardial infarction (RVMI) accompanied by acute inferior myocardial infarction (MI) is still a problem that we encounter. This study was designed to find out the usefulness both of peak myocardial systolic velocity (Sm) and of the myocardial performance index (MPI) of the right ventricle measured by pulsed-wave tissue Doppler imaging (TDI) in assessing right ventricular function.Sixty patients who experienced a first acute inferior MI (mean [+/- SD] age, 57 +/- 9 years) were prospectively assessed. An ST-segment elevation ofor= 0.1 mV in V(4)-V(6)R lead derivations was defined as an RVMI. From the echocardiographic apical four-chamber view, the Sm, the peak early diastolic velocity, peak late diastolic velocity, the ejection time, the isovolumetric relaxation time, and the contraction time of the right ventricle were recorded at the level of the tricuspid annulus by using TDI. Then, the MPI was calculated. The patients were classified into the following three groups, according to the localization of the infarct-related artery (IRA) detected using coronary angiography: group I, proximal right coronary artery; group II, distal right coronary artery; and group III, circumflex coronary artery.RVMIs were detected in sixteen patients, and the IRA in 27 patients was the proximal right coronary artery. The right ventricular Sm was observed to be significantly low in patients with RVMIs and those in group I compared to those without RVMIs and those in groups II and III (10.9 +/- 1.3 vs 14.3 +/- 3.2 cm/s, respectively [p0.001]; 11.5 +/- 2.5 vs 15.1 +/- 3 cm/s, respectively; and 14.9 +/- 2.6 cm/s, respectively [p0.001]). In the diagnosis of RVMI, the values for sensitivity, specificity, negative predictive value, and positive predictive value of Sm12 cm/s were 81%, 82%, 92%, and 62% respectively, and in the diagnosis of the proximal right coronary artery as the IRA, those values were 63%, 88%, 74%, and 81%, respectively. The MPI was high in the same patient groups (0.83 +/- 0.12 vs 0.57 +/- 0.11 in those patients without RVMI, respectively, [p0.001]; 0.74 +/- 0.13 vs 0.56 +/- 0.15 in group II and 0.54 +/- 0.07 in group III, respectively [p0.001]). The sensitivity, specificity, negative predictive value, and positive predictive value of an MPI of0.70 in the diagnosis of RVMI were calculated as 94%, 80%, 97%, and 63%, respectively, and in the diagnosis of the proximal right coronary artery as the IRA, those values were 78%, 91%, 83%, and 88% respectively.An Sm12 cm/s and an MPI0.70 obtained by TDI may define RVMI concomitant with acute inferior MI, and the IRA.

WOS: 000175545800001, PubMed: 12041885, It is known that the QT interval is longer in women than men. Estrogen is reported to account for the QT interval prolongation in several studies conducted with hormone replacement therapy (HRT) in postmenopausal women. Along with this, there are conflicting data as regards the effects of HRT on QT interval and dispersion. Moreover, there is no evidence about the effect of HRT on exercise QT parameters. We compared QT parameters obtained from Surface electrocardiograms during resting and peak exercise before and after 6 months of HRT consisting of estrogen Plus progesterone in healthy postmenopausal women. Twenty-four healthy postmenopausal women were given 0.625 mg/day conjugated estrogens and 2.5 mg/clay medroxyprogesterone acetate for 6 months. Exercise stress testing using the Bruce protocol was performed before and after HRT. QT maximum, minimum, dispersion and corrected QT maximum, minimum and dispersion were calculated during testing and peak exercise. HRT resulted in a significant increase in estradiol plasma levels from 24+/-10 pg/mL to 117+/-66 pg/mL (P

Electrocardiogram (ECG) is widely used in the diagnosis of myocardial infarction (MI). It mostly gives important hints to detect the infarct-related artery (IRA). The changes in the morphology and in the position of the heart cause changes in ECG as well. Though ECG is used for the diagnosis of MI, it is not sufficient on its own in detecting the location of the underlying lesion. The pathologies changing the morphology of the heart, such as the atrial septal defect (ASD), increase the margin of error of ECG. We report a rare case; falsely positive ECG for anteroseptal MI in patient with ASD admitted with acute coronary syndrome. Coronary angiography revealed right coronary artery (RCA) lesion in the patient with acute MI who was found to have ST elevation in both precordial and inferior derivations. As a potential cause of mismatch between IRA and infarct location at ECG, echocardiography showed right ventricle dilatation related with cribriform ASD. It was percutaneously closed at 30 days after MI. Therefore, when observed a mismatch between IRA and infarct location at ECG, a detailed examination should be performed to determine potential causes of the mismatch.