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Objective Myocardial injury related to percutaneous coronary interventions (PCI) might adversely affect the prognosis of patients with coronary artery disease. Our study aimed to investigate the effects of long-term statin usage on myocardial injury related to elective PCI. Methods In our study, total 102 patients were included and evaluated in 3 groups based on the statin usage before PCI, "potent statin" group (n=26), "weak statin" group (n=23), and "statin free" group (n=53). The occurrence of the procedural complications was identified (n=31). The myocardial injury was determined by serial high-sensitivity troponin T (hsTnT) testing at 0th, 2nd, 4th, and 12th hour of the procedure. Results The increase in hsTnT values in the 2nd and 4th hour was significantly lower in the potent statin group than in the other 2 groups (p=0.008 and p=0.009, respectively). In patients with procedural complications, the increase in hsTnT levels at the 2nd, 4th, and 12th hour were also lower in the potent statin group (p=0.032, p=0.019, and p=0.006, respectively). Also, in patients with procedural complications, hsTnT levels exceeding the myocardial infarction limit at the 4th and 12th hour were lower in the potent statin group (p=0.039 and p=0.006, respectively). Conclusion These results show that elective PCI related myocardial injury was less frequent in patients who were using high-dose statins. This result was more pronounced in patients who developed complications during the procedure.

OBJECTIVE: Gamma-glutamyl transferase (GGT) to albumin ratio (GAR) has been shown to be helpful to diagnose and determine the severity of coronary artery disease (CAD). Coronary computed tomography angiography (CCTA) is a guide recommended non-invasive test that provides information about the presence, severity, and morphology of coronary plaques. In this study, our main aim was to investigate the relationship between the presence, morphology, and severity of coronary plaques detected via CCTA and GAR in patients with low to moderate risk for undiagnosed CAD. METHODS: Nine hundred and sixty six patients were included who underwent CCTA. The severity of CAD and plaque morphology were investigated. CT-adapted Leaman score (CT-LeSc) was calculated to determine the extent of the CAD. The study population was further evaluated in three groups according to tertiles of GAR. RESULTS: Atherosclerotic plaques were more common in the male gender and older patients with conventional cardiovascular risk factors. GAR was significantly lower in patients with normal CCTA than in patients with a non-obstructive plaque or obstructive plaque on CCTA. Patients in upper GAR tertiles had a higher coronary calcium score (CACS) and CT-LeSc. GAR was one of the independent predictors to predict severe stenotic plaque and high CACS. CONCLUSION: GAR can independently predict the presence, extent, and severity of CAD determined by CT-LeSc. We believe as a cheap, safe, and widely available tool, GAR would be useful in the diagnosis of CAD.

WOS: 000453084600010, PubMed ID: 30391989, Objective: Smoking is one of the most important public health problems and preventable causes of mortality in Turkey. Major healthcare policies have been implemented to combat this problem over the past 10 years. The aim of this study was to conduct a systematic review and meta-analysis of epidemiological studies performed in the country in the last 15 years to determine the prevalence of smoking in Turkey. Methods: Ovid Medline, the Web of Science Core Collection, and the Turkish Academic Network and Information Center (ULAKBIM), as well as the websites of the Ministry of Health and the Turkish Statistical Institute were searched for the appropriate epidemiological studies. Studies included in the analysis were evaluated by a self-developed bias score regarding their potential to represent Turkey and standardization of measurements. The meta-analysis and meta-regression analysis were performed using a random effects model. Results: Ten epidemiological studies (n=122383) that included data about smoking were found. Eight of them (all with low bias score) included separate data about the smoking habit of women (n=49524) and men (n=37684). The smoking prevalence was determined to be 30.5% for the whole group, 15.7% for women, and 46.1% for men, when occasional smokers were included. Although the change observed in crude prevalence values over time was not statistically significant, when the data of the 3 studies that gave prevalence values according to age categories were standardized according to age, the incidence of smoking between 2003 and 2012 decreased 6.8% (20.2%) when occasional smokers were included and 8.4% (26.3%) when they are excluded. Conclusion: Despite implementation of major healthcare policies and some success in decreasing rate of smoking, one-third of the Turkish population aged over 15 years and nearly half of the men are smokers. It is essential to continue and to strengthen measures to combat smoking.

Many studies have revealed a role of YKL-40 as a new inflammatory biomarker in angiogenesis, inflammation, atherosclerosis and cardiovascular events. Thus, the aim of this study was to investigate the association of serum YKL-40 level with coronary collateral development and SYNTAX score in patients with stable coronary artery disease.A total of 165 patients who had ≥90% stenosis in at least one major coronary artery were prospectively enrolled in the study. Collateral degree was graded according to Rentrop-Cohen classification. Patients with grade 2 or 3 collateral degree were included in good collateral group and patients with grade 0 or 1 collateral degree were included in poor collateral group. The patients were also classified according to SYNTAX criteria, those with low (≤22) and those with high (22) SYNTAX score.Serum YKL-40 and hs-CRP levels were significantly lower in good collateral group. Furthermore, YKL-40 level showed significant positive correlations with SYNTAX score (r=0.486, p0.001) and hs-CRP level (r=0.340, p0.001). In multivariate regression analysis, serum YKL-40 (odds ratio: 0.928; 95% confidence interval: 0.917-0.940; p0.001), duration of ischemic symptom and total occlusion were independent predictors of good collateral development. In ROC curve analysis, a YKL-40 value cut-off point of ≥168.5 predicted the high SYNTAX score with a sensitivity of 81.0% and specificity of 72.4%.Increased serum YKL-40 level was related with poor collateral development and high SYNTAX score. According to these findings YKL-40 can be used as a predictor of good collateral development and high SYNTAX score.

The Turkish Hypertension Consensus Report was prepared for the first time in 2015 to adapt the European and American international guidelines to our clinical practice and to create a practical report that could be a basic reference for all physicians dealing with hypertensive patients. This report, which was prepared by a committee with representation from 5 leading hypertension associations, has been accepted and is widely used. New clinical studies in hypertension literature and updated international guidelines since 2015 have demanded an update of the Turkish Hypertension Consensus Report as well. In this updated 2019 report, blood pressure levels were classified as Normal, Elevated, Stage 1, and Stage 2 hypertension. A new section was added for secondary hypertension. It was specified that drug treatment may be initiated with any 1 or a combination of 4 groups of drugs (diuretics, calcium channel blockers, angiotensin-converting enzyme [ACE] inhibitors, and angiotensin receptor blockers [ARBs]), except a combination of an ACE inhibitor and an ARB. It was emphasized that beta-blockers may be a first choice for hypertension treatment in diseases such as atrial fibrillation, heart failure, and coronary artery disease. The initial recommendation for hypertension treatment is a combination therapy in patients with a blood pressure level >= 150/90 mmHg. Target blood pressure values were redefined according to age and the presence of comorbidities. The hypertension treatment algorithm was renewed; it is proposed that drug therapy can also be initiated with a risk-based approach for the group with an elevated blood pressure (systolic blood pressure: 120-139 mmHg, diastolic blood pressure: 80-89 mmHg). The threshold clinic systolic blood pressure level was reduced from 160 mmHg to >= 150 mmHg for the initiation of drug therapy in individuals 80 years of age or more. The section on the treatment of special groups has now been expanded to include pregnancy and lactation. As in the previous report, in this update, practical recommendations for the most common cases seen in the clinic were the goal, rather than a comprehensive report that addresses all aspects of hypertension. This report has evidence-based recommendations for most patients; however, it should be kept in mind that there may be differences from 1 patient to another and that physicians should take an individualized approach according to a good clinical evaluation.

Objective Diabetes mellitus (DM) is a serious public health problem. Despite various epidemiological studies reporting prevalence of DM in Turkey, there is no meta-analysis or systematic review evaluating these studies as a whole and assessing temporal changes in the prevalence of DM. In this meta-analysis, the studies that have been conducted in the last 15 years and which provide information on the prevalence of DM in our country are examined. Methods Epidemiological studies on cardiovascular risk factors in adult Turkish population that had been conducted within the last 15 years and having the capacity of either representating or potentially representing the country, were searched through Ovid, Medline and Web of Science Core Collection the Turkish Academic Network and Information Center (ULAKBIM) databases. Additionally, websites of Ministry of Health and related societies were investigated for additional studies. Random effects model was used in meta-analysis of low bias risk studies. Meta-regression was performed to evaluate the temporal change in DM prevalence. Results There were 8 studies which provided information with regard to DM prevalence (n=84656). Four of these studies (n=56853) had low bias risk and four had high bias risk (n=27803). When compared with low bias risk studies, those with high bias risk had very large variation of DM prevalence (between 4% to 15%). Meta-analysis of the low bias risk group yielded a crude DM prevalence of 13.5% (95% CI: 11.6-15.5%) in the whole group, 14.2% (95% CI: 12.3-16.2%) in females, 12.6% (95% CI: 10.5-14.9%) in males. In meta-regression analysis of low bias risk group, mean age difference among the studies and the time period in which the study was undertaken were partially able to explain the inter-study heterogeneity (R2 values were 52% and 78%). Conclusion This meta-analysis shows that DM is a highly prevalent public health problem in our country. Contrary to studies, which compare the recent studies with previous ones and report an increasing prevalence of DM, the present meta-analysis-despite its limitations-provides findings that the temporal increase of DM prevalence is at least paused over time. This situation underlines the need for new studies.

Objective The incidence of metabolic syndrome varies greatly in developed and developing countries. In the last 10 to 15 years, important studies have been performed examining the incidence of metabolic syndrome in Turkey. This article is a meta-analysis of the studies that investigated the incidence of metabolic syndrome this country. Methods Epidemiological studies from the last 15 years that provided information about the incidence of metabolic syndrome in Turkey were screened in the Ovid Medline, the Web of Science Core Collection, and the Turkish Academic Network and Information Center (ULAKBIM) databases. In addition, web pages of the Ministry of Health, the Turkish Statistical Institute, and the associations of the related medical discipilnes were screened for appropriate studies. A bias tool that is developed by our team was used to categorize the included studies as having low- or high risk of bias. A random effects model was used in the meta-analysis. Linear and nonlinear meta-regression analyses were performed to evaluate heterogeneity and temporal variations in prevalence rates. Results Four studies (n=34893) were identified that provided information about the status of metabolic syndrome in Turkey using the Adult Treatment Panel III definition. There was excellent interobserver agreement regarding the selection of studies and the scoring of the selected research with respect to bias. The metaanalysis revealed a prevalence of 32.9% (95% confidence interval [CI]: 30.2-35) overall, 38.3% (95% CI: 35.8-40.8) in women, and 26.8% (95% CI: 23.4-30.3) in men. Two studies (n=8568) provided data according to the International Diabetes Federation definition of metabolic syndrome. The random effects model used in the metaanalysis of these studies demonstrated a prevalence of metabolic syndrome of 43.3% (95% CI: 41.9-44.7) overall, 50.4% (95% CI: 49.0-51.9) in women, and 35.4% (95% CI: 32.5-38.5) in men. Conclusion In Turkey, the incidence of metabolic syndrome is 1 in every 4 men, and 1 in every 3 women. The rate is particularly high among women. Studies designed to prevent the development of metabolic syndrome are needed.

Background: High-sensitive cardiac troponin (hsTn) levels can be elevated due to non-pathological events such as strenuous exercise. However, the effect of statins on circulating hsTnT levels with moderate exercise is uncertain. Therefore, we evaluated the impact of statins on hsTnT level with moderate exercise. Methods: We enrolled a total of 56 patients: 26 statin users and 30 non-users. All patients were shown to have no coronary artery disease before participating in the study. Participants performed a fixed-protocol moderate level exercise. HsTnT levels were measured before and 4 h after the exercise. Participants were also grouped based on their hsTnT levels, as proposed in the recent European Society of Cardiology guideline (0-1 hour algorithm) for acute coronary syndromes without persistent ST-segment elevation. Results: Statin users showed a significant increase in serum hsTnT levels with moderate exercise (p = .004), whereas the control group showed a modest increase without statistical significance (p = .664). The percentage of patients whose hsTnT levels exceeded the rule-out limits for non-ST-segment myocardial infarction diagnosis (according to the 0-1 algorithm) after moderate exercise varied significantly between groups (p = .024). Conclusions: Statin therapy can cause a significant increase in hsTnT levels after moderate exercise. This increase can jeopardise the accuracy of clinical diagnoses based on the newly implemented algorithms. The awareness of these adverse effects of statins, mainly used by patients with high risk of coronary events, can prevent misdiagnosis or unnecessary hospitalisations.

Objective Failure to select the optimal left ventricular (LV) segment for lead implantation is one of the most important causes of unresponsiveness to the cardiac resynchronization therapy (CRT). In our study, we aimed to investigate the echocardiographic and clinical benefits of LV lead implantation guided by an intraoperative 12-lead surface electrocardiogram (ECG) in patients with multiple target veins. Methods We included 80 [42 (62.5%) male] heart failure patients who successfully underwent CRT defibrillator (CRT-D) implantation. Patients were divided into two groups. In group 1, LV lead was positioned at the site with the shortest biventricular-paced (BiV-paced) QRS duration (QRSd), as intraprocedurally measured using surface ECG. In group 2 (control), we included patients who underwent the standard unguided CRT. ECG, echocardiogram, and functional status were evaluated before and 6 months after CRT implantation in all patients. Results In group 1, BiV-paced QRSd measurements were successfully performed in 112 of 120 coronary sinus branches during CRT and an LV lead was successfully placed at the optimal site in all patients. Compared with group 2, group 1 had a significantly higher rate (85% vs. 50%, p=0.02) of response (>15% reduction in LV end-systolic volume) to CRT as well as a shorter QRSd (p

Objective: Obesity is the most important epidemic of the 21st century and its incidence is increasing steadily in Turkey. The aim of this study was to assess the current status and temporal change in the prevalence of obesity in Turkey with a systematic review and meta-analysis of epidemiological studies conducted in the last 15 years.

Objective: Dyslipidemias, primarily hypercholesterolemia, are independent and strong predictors of cardiovascular (CV) events. The frequency of dyslipidemia is very important in terms of determining CV prevention policies. In order to determine the up-to-date frequency of CV risk factors in Turkey, a meta-analysis of the epidemiologic studies carried out in the last 15 years was performed. This article presents the results on the dyslipidemia data including hypercholesterolemia principally.

Although cardiovascular protective action of bilirubin has been attributed to its antioxidant effect, there was scarce data regarding the anti-inflammatory properties. Herein, we aimed to assess the relationship between serum total bilirubin level and severity of coronary artery disease (CAD) in association with the direct inflammatory marker such as C-reactive protein (CRP), the other indirect markers included in inflammation process such as neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) in patients with stable CAD.Angiographic data of 1501 patients were analyzed in this retrospective cross-sectional study. Patients were categorized according to Gensini scores as control, mild CAD and severe CAD groups. The association of clinical and laboratory parameters with the severity of CAD were determined by multivariable linear regression analysis.Total bilirubin level in the control group was significantly higher than those of the other groups. After multivariable linear regression analysis total bilirubin [β=-3.131 (-4.481, -1.782), p0.001] was significantly associated with the severity of CAD. Futhermore, there was a moderate and significant inverse correlation between serum total bilirubin level and the severity of CAD (r=-0.173, p0.001), CRP (r=-0.112, p0.001), NLR (r=-0.070, p=0.026) and RDW (r=-0.074, p=0.027).Serum total bilirubin level was independently and inversely associated with the severity of coronary atherosclerosis in patients with stable CAD. In addition, total bilirubin level was inversely correlated with CRP, NLR and RDW. These results suggest that besides its already known effect on the oxidative stress, higher serum total bilirubin level may exhibit an anti-inflammatory effect in the coronary atherosclerotic process.

Prasugrel, a third generation P2Y12 receptor inhibitor, is more powerful than clopidogrel. TRITON-TIMI 38 trial compared the effectiveness of prasugrel with clopidogrel in patients with STEMI and NSTEMI. This paper examined the main TRITON-TIMI 38 trial and subgroup analyses of the trial to determine patient subgroups in which prasugrel is superior to clopidogrel in preventing clinical events without an additional increase in bleeding risk. In such patients, one might expect to derive optimal benefit from prasugrel without a significant increase in bleeding.

A 54-year-old man underwent percutaneous coronary intervention (PCI) and two stents were placed on left anterior coronary artery and circumflex artery. Low molecular weight heparin (LMWH) together with ticagrelor 90 mg twice a day and acetylsalicylic acid (Aspirin) were started after PCI due to high risk of stent thrombosis. On the fourth day of patient's follow-up in the intensive care unit (ICU), bloody secretion was started from endotracheal tube. Hemoglobin dropping, bilateral infiltration on the chest X-ray and bleeding from lung were diagnosed as diffuse alveolar hemorrhage (DAH). Apart from LMWH and antiplatelet therapies with aspirin and ticagrelor, there were no other identified risk factors for DAH. As far as we know, our report is the first case of DAH caused by LMWH and dual anti-platelet therapy including ticagrelor.

Background Currently, there is not enough echocardiographic information regarding aging-associated changes in the octogenarian population. We aimed to characterize echocardiographic measures of structure and function among a group of healthy octogenarians. Methods Approximately 350 octogenarians, residing in nursing homes, were screened in Ankara, Turkey. According to inclusion criteria, 40 octogenarians were enrolled. These subjects underwent conventional and tissue Doppler echocardiography according to the guidelines of the American Society of Echocardiography (ASE). The population was also separated into various groups according to gender, body mass index (BMI

OBJECTIVE Metabolic syndrome (MS) is defined by a cluster of interdependent physiological, biochemical, and clinical risk factors and linked to a state of chronic inflammation. YKL-40 is known as an inflammatory glycoprotein, which is secreted by various cell lines during inflammation. Thus, we aimed to assess the association of serum YKL-40 levels with the presence and severity of MS. METHODS In this prospective cross-sectional study, a total of 177 consecutive patients [n=114 MS present and n=63 MS absent] were enrolled. MS was defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Serum YKL-40 and hs-CRP levels were measured for all participants. RESULTS Serum YKL-40, hs-CRP and white blood cell count (WBC) were significantly higher in the MS present group (p

Background Device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) are both associated with short- and long-term complications. Our knowledge of the complication rates of ASD and PFO closure is limited. Our objective was to review the peri-procedural and long-term complications of ASD and PFO closure. Methods Medline, EMBASE, and Scopus databases were searched between 1973 and 2012. A total of 28,142 patients from 203 case series were included. Of these 203 articles, 111 were reporting ASD closure, 61 were reporting PFO closure, and 31 were reporting both. Pooled incidence rates of cardiac complications were calculated separately for peri-procedural and at follow-up. Results Peri-procedural major complications were reported from 0% to 9.4%, with a pooled estimate rate of 1.4% (95% CI: 1.3–1.6%). It was 1.6% (95% CI: 1.4–1.8%) in ASD group, 1.1% (95% CI: 0.9–1.3%) in PFO group, and 1.3% (95% CI: 0.9–1.9%) in ASD/PFO group. The most common major complication was the device embolization requiring surgery. Peri-procedural minor complications were reported with a pooled estimate rate of 1.4% (95% CI: 1.2–1.7%). It was 1.6% (95% CI: 1.2–2.1%) in ASD group, 1.3% (95% CI: 1.0–1.7%) in PFO group, and 1.5% (95% CI: 1.1–1.2.1%) in ASD/PFO group. The most frequent major complications at follow-up were cerebrovascular events [1.3% (95% CI: 1.1–1.6%)] and device thrombosis [1.2% (95% CI: 1.0–1.4%)]. Both were more frequent in PFO group. Conclusion Device closure of ASD and PFO are associated with non-negligible serious complications, both in early and long-term. © 2013 Wiley Periodicals, Inc.

In this study, we aimed to evaluate the relationship between TIMI myocardial perfusion (TMP) grade, as an indicator of myocardial reperfusion, and fragmented QRS (fQRS) in standard 12-lead electrocardiogram. Also, we evaluate fQRS is an additional indicator of myocardial reperfusion. One hundred patients admitted with first STEMI to Coronary Intensive Care Unit and who were used thrombolytic therapy was included in this retrospective study. Standard 12-lead electrocardiogram records of patients simultaneous with coronary angiography (second day) were assessed and analysed for the presence of fQRS. Also, coronary angiography images were analyzed to identify the infarct related artery, TIMI grade of infarct related artery and TMP grade of infarct related artery. The patients with fQRS demonstrated a significantly lower TMP grade, TIMI grade and ejection fraction compared with the non-fQRS patients (P = 0.004, P = 0.003, P = 0.02 respectively). The patients with inadequate myocardial reperfusion demonstrated a significantly higher fQRS compared with the adequate myocardial reperfusion patients. (56.9% versus 23.5%, P = 0.002 respectively). On correlation analysis, there was a significant negative correlation between fQRS and left ventricular ejection fraction (r = -232, P = 0.02) TMP grade and adequate myocardial reperfusion (TMP 3) showed significant negative correlation with fQRS (r = -0.370, P = 0.000; r = -0.318, P = 0.001 respectively). Presence of fragmented QRS in STEMI patients was associated with inadequate myocardial reperfusion and it can be used as a simple, noninvasive parameter to evaluate myocardial reperfusion.

Prasugrel, a third generation P2Y12 receptor inhibitor, is more powerful than clopidogrel. TRITON-TIMI 38 trial compared the effectiveness of prasugrel with clopidogrel in patients with STEMI and NSTEMI. This paper examined the main TRITON-TIMI 38 trial and subgroup analyses of the trial to determine patient subgroups in which prasugrel is superior to clopidogrel in preventing clinical events without an additional increase in bleeding risk. In such patients, one might expect to derive optimal benefit from prasugrel without a significant increase in bleeding.

Pre-infarction angina reduces myocardial infarct size by preventing the myocardium from being subjected to ischemia reperfusion (I/R) injury. Ischemic preconditioning is the proposed mechanism for this effect. Sphingosine 1 phosphate (S1P) activates ischemic preconditioning pathways and may play a role in the presence of cardioprotective effects of pre-infarction angina. Therefore, we evaluated the relationship between pre-infarction angina and serum S1P levels.Between May 2011 and January 2012, 79 patients with acute myocardial infarction were included in the study. In addition to taking routine medical histories, all of the patients were questioned as to whether or not they had pre-infarction angina. We determined patients serum levels of S1P at admission and discharge, and peak creatine kinase MB and troponin levels were also measured in the pre-infarction angina positive and negative groups.Of the 79 patients included in the study, 36 had pre-infarction angina and 43 had not. Baseline characteristics were similar between the groups. The median level of serum S1P in patients with pre-infarction angina was significantly higher than in those without pre-infarction angina both at admission and discharge [0.54 (0.14-1.35) vs. 0.26 (0.12-0.62) p = 0.014/0.51 (0.20-1.81) vs. 0.30 (0.13-0.68) p = 0.010]. Serum high sensitive troponin levels were significantly lower in patients with pre-infarction angina [0.97 (0.39-3.07) vs. 2.56 (0.9-6.51) p = 0.034]. Serum S1P levels both at admission and discharge tended to be higher in patients with more angina episodes, but the differences between these subgroups were not statistically significant.Patients who experienced pre-infarction angina had higher serum S1P levels than patients without pre-infarction angina. This study supported our hypothesis that the cardioprotective effects of pre-infarction angina may in part be mediated by S1P.Ischemic preconditioning; Pre-infarction angina; Sphingosine 1 phosphate.

OBJECTIVES The EURIKA study (The European Study on Cardiovascular Risk Prevention and Management in Daily Practice), which covers 12 European countries including our country, aimed to describe the management of cardiovascular risk factors in the daily practice and to detect areas of improvement. We evaluated our country-based data on the methods used by physicians to manage cardiovascular risk factors and the results of patients who participated in this study. STUDY DESIGN The EURIKA study recruited 663 patients (mean age 59.4±7.6 years; 47.2% males) and 67 physicians (55 men, 12 women; mean age 40.7±8.6 years) from Turkey. Risk factor definition and treatment goals were based on the 2007 European guidelines on cardiovascular disease prevention. Blood samples were analyzed in a central laboratory. The 10-year risk for fatal cardiovascular disease was estimated based on the SCORE system. RESULTS About one-third (34.8%) of the doctors did not use any cardiovascular disease guidelines. Only 48.5% used cardiovascular risk calculation. The most common (74%) reason for not using risk calculation was stated as having limited time. The rates of reaching target total/LDL cholesterol, blood pressure, and HbA1c levels were 30.4%, 32.1%, and 26% in treated dyslipidemics, hypertensives, and diabetics, respectively. Hypertension, diabetes, dyslipidemia, and smoking accounted for 59.4% of attributable cardiovascular risk. Lack of control of these risk factors accounted for 31.8% of cardiovascular risk. CONCLUSION Only half of our doctors use cardiovascular risk calculation, and therapeutic guidelines are not adequately used. Moreover, the control rates of risk factors in primary prevention are low.

Cardiac myxomas are the most common primary benign tumors of the heart and appears particularly in the left atrium. Myxomas exhibit a wide spectrum of symptoms from asymptomatic to very serious according to the localisation of the tumours. Only 5% of these tumours occur in the right and left ventricles. We report an unusual case of a 21-year-old woman with a leukemia in remission, in whom routine transthorasic echocardiographic examination demonstrated an incidental left ventricular mass. The patient underwent successful resection of the left ventricular mass under cardiopulmonary bypass through the left atrial approach. Histopathologic examination was diagnostic for myxoma. In this case, the presentation of the mass was atypical for two reasons: the tumour was a cardiac myxoma in the left ventricular localisation and in a patient with leukemia in remission.

In the era of early and invasive therapeutic approaches, myocardial rupture has become an uncommon complication of myocardial infarction. We report an uncommon complication following inferior myocardial infarction with both left ventricular and right ventricular rupture and subsequent communication via a shared pseudoaneurysm. (Echocardiography 2010;27:E83-E86)

Background The prevalence of smoking is high in Turkey. However, there are no data available evaluating the differences between smokers and nonsmokers according to their sex in patients with acute myocardial infarction (AMI) in Turkey. Hypothesis The aim of the study was to determine the prevalence of smoking and its relationship to age, localization, and extension of coronary heart disease (CHD), and other risk factors in Turkish men and women with first AMI. Methods This study included, 1502 patients with first AMI from 3 different cities in Turkey. The baseline characteristics and traditional risk factors for CHD, Coronary angiographic results, and in-hospital outcome were recorded. Results The proportion of male smokers was significantly higher than that of women (68% vs 18%, P < 0.001). Smokers were younger by almost a decade than nonsmokers (P < 0.001). Male nonsmokers were younger than females; however, the mean age of first AMI was similar in male and female smokers. In both genders, prevalence of hypertension and diabetes mellitus was significantly lower in smokers than in nonsmokers (P < 0.001). Smokers had less multivessel disease and less comorbidity as compared to nonsmokers. Although the in-hospital mortality rate was lower in smokers, smoking status was not an independent predictor of mortality. Conclusions Smoking, by decreasing the age of first AMI in women, offsets the age difference in first AMI between men and women. The mean age of first AMI is lower in Turkey than most European countries due to a high percentage of smoking. Copyright © 2010 Wiley Periodicals, Inc.

Myocardial injury and acute coronary syndrome have been rarely associated with amoxicillin/clavulanic acid intake. The responsible pathogenetic mechanism is described by an amplified mast cell degranulation inducing coronary artery spasm and/or acute myocardial infarction in susceptible individuals which is called Kounis syndrome. We report here a case of Kounis syndrome presented with acute coronary syndrome due to amoxicillin/clavulanic acid use. All other etiologies, including ischemic reinfarction were appropriately ruled out. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

Diabetic patients tend to have more extensive and diffuse coronary artery disease (CAD) that may contribute to the less favorable outcomes in them. The aim of this study was to elucidate the predictors of the angiographic severity and extent of CAD in patients with diabetes.A total of 203 diabetic patients (116 men; mean age, 61.9+/-10.8) who were referred for a first coronary angiogram were included. The extent and severity of CAD was assessed in several ways. The first was a simple classification in one-vessel, two-vessel, and three-vessel disease scoring system. The total numbers of segments withor = 20 andor = 50% stenosis were calculated as CASS 20 and CASS 50 scores, respectively. Hamsten and Gensini scores were also calculated.Of the 203 patients included in the study, 175 (86.2%) had CAD. Multivariate ordinal logistic regression analysis showed that age (Wald 5.741, P=0.017), glomerular filtration rate (Wald 5.032, P=0.025), previous myocardial infarction (Wald 10.955, P=0.001), and family history of CAD (Wald 7.236, P=0.007) were independent predictors of the severity of CAD, as assessed by the clinical zero-vessel to three-vessel disease scoring system. On stepwise multiple linear regression analysis, glomerular filtration rate was an independent predictor of the CASS 20 (r=-0.221, P=0.004), CASS 50 (r=-0.239, P=0.005), Gensini (r=-0.328, P0.001), and Hamsten (r=-0.320, P0.001) scores. Previous myocardial infarction was an independent predictor of the CASS 50 (r=0.355, P0.001), Gensini (r=0.350, P0.001), and Hamsten (0.256, P0.001) scores. Age and sex were independent predictors for the CASS 50 (r=0.174, P=0.039; r=0.172, P=0.016, respectively) and Hamsten (r=0.212, P=0.011; r=0.244, P=0.001, respectively) scores.Renal function is one of the most important factors associated with the extent and severity of coronary atherosclerosis, whereas classical coronary risk factors and the degree of metabolic control were not associated with the severity of coronary atherosclerosis in diabetic patients.

Erol, Cetin/0000-0001-7396-3818 WOS: 000244821400009 PubMed: 17279356 Objective The prescribing pattern of drugs used for treating hypertension changes over time in response to changes in recommended guidelines and innovations in drug formulations, among others. In addition, the classes of antihypertensive drugs used vary among the countries. The aim of this study was to investigate the practice of antihypertensive medications in primary care units in Turkey. Methods TURKSAHA is a cross-sectional screening study conducted in 1000 primary care units considered to be representative of primary care in Turkey, with the purpose of defining the demographic characteristics, clinical features, rate of blood pressure control achieved and the antihypertensive drugs prescribed for the hypertensive patients treated in these centers. In this analysis, we investigated the agents used in the treatment regimen. Results Of the 16,270 patients considered to be eligible for inclusion in the study, 15,187 (93.3%) were on an antihypertensive treatment, and 1083 (6.7%) were receiving no treatment. Patients who received treatment but whose antihypertensive medication was not specified (2290 patients) were subsequently excluded, and the trial was carried out with the remaining 12,897 patients. The mean age of the patients was 60 +/- 11 years (60.2% female). Of the 12,897 patients, 75.7% were receiving monotherapy, 19.7% two drugs, 4.1% three drugs and 0.5% four or more drugs. The rate of successful blood pressure control (< 140/90 mmHg; for diabetics < 130/80 mm Hg) in relation to the number of drugs received was 26.3, 25.9, 24.5 and 26.2%, respectively. Among the patients receiving monotherapy, the most frequently used antihypertensive drug class was angiotensin-converting enzyme inhibitors (30.1%), followed by beta-blockers (20.6%), calcium-channel blockers (17.9%), diuretics (15.4%) and angiotensin-receptor blockers (14%). Conclusion As in other European countries, the rate of successful blood pressure control was low among hypertensive patients receiving treatment, and despite the inadequacy of monotherapy to control blood pressure, many of the patients continued this treatment regimen. Consistent with the global trend, the most frequently prescribed anti-hypertensives were angiotensin blockers.

Objective: As an indicator of variability in circulating erythrocyte size, red cell distribution width (RDW) is linked to chronic inflammation. The association of rheumatic heart valve stenosis and inflammation is also well-known. This study aimed to assess the relationship between RDW and presence and severity of rheumatic mitral valve stenosis (RMVS). Methods: A total of 417 consecutive patients with RMVS, and 81 age- and -gender matched healthy control subjects were included in the study between February 2009 and April 2014. Transthoracic echocardiography and demographic characteristics were recorded for all participants. Results: Baseline characteristics were similar in the two groups. However, median RDW was significantly higher in patients with RMVS compared to control group (14.4% [11.3- 19.6] vs. 13.6% [11.6-18.1], p

Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.

To evaluate the right ventricular function in patients with obstructive sleep apnea syndrome (OSAS) independent from systemic hypertension (HT) and to determine the association between OSAS severity and right ventricular dysfunction.The study population included 77 consecutive subjects; 20 of these patients had OSAS, 20 of them had HT, but did not have OSAS, 16 patients, who constituted the study group, had both disorders, and 21 subjects without any of these two disorders represented the control group. Right ventricular function was assessed by echocardiography: standard two-dimensional, M-Mode, and conventional Doppler as well as tissue Doppler imaging. None of the patients had a previous history of cardiac disease. The diagnosis of OSAS was based on an apnea- hipopnea index of 5 or higher in polysomnography.Tricuspid inflow velocities and tissue Doppler derived tricuspid annular diastolic velocities were significantly different in the patient groups (OSAS, HT, OSAS + HT) compared to the control group. Tricuspid annular plane systolic excursion (TAPSE) (18.3 +/- 3.2, 18.4 +/- 2.5, 20.1 +/- 2.1, and 20.7 +/- 2.5 mm, respectively, P = 0.024) and peak systolic myocardial velocity at tricuspid lateral annulus (S-vel) (12.2 +/- 1.5, 10.9 +/- 0.9, 11.2 +/- 1.1, and 13.1 +/- 2.1 cm/s, respectively, P0.001) were significantly lower in patient groups compared to those of the study group. Tissue Doppler derived myocardial performance index (MPI) of the right ventricle was significantly impaired in the patient groups compared to the control group (0.34 +/- 0.06, 0.44 +/- 0.06, 0.45 +/- 0.07, and 0.41 +/- 0.06, respectively, P0.001). With regard to these right ventricular functional parameters, there was no significant difference between OSAS and the other patient groups (HT and OSAS + HT). There were significant correlations both between OSAS severity and the right ventricular functions, and between diastolic and systolic parameters of the right ventricle (r = -0.45, P0.05).Both right ventricular systolic and diastolic functions are impaired in patients having OSAS with or without HT. Right ventricular MPI was found to be the parameter most closely related with OSAS severity and the right ventricular subclinical dysfunction.

Aspirin non-responsiveness has been described as having a normal closure time (CT) by platelet function analyzer (PFA)-100 assay despite confirmed treatment with aspirin. There is no standard definition of aspirin non-responsiveness by PFA-100, with a variety of cut-off values having been used. We proposed an alternative definition of aspirin non-responsiveness by PFA-100 assay.One hundred eighty-four patients with diagnosis of stable coronary artery disease or diabetes mellitus were included in the study. Blood samples were drawn before and after the 7 days of aspirin therapy. An individual was labelled as aspirin non-responder if his/her post-aspirin CT was not 2SD above his/her baseline CT, where SD was calculated from the baseline CTs of the study population. Aspirin non-responsiveness was also defined as having a normal post-aspirin CT (or =193 s) regardless of pre-aspirin CT.The baseline CT ranged 82-187 s (mean 129.1 +/- 27.5, median 128 s) in the study population. At the end of 1 week of aspirin administration, CT increased to a mean of 260.7 +/- 63.6 s (range 102-301). According to our definition, 28 (15.2%) of 184 patients were aspirin non-responders. Univariate analysis indicated that aspirin non-responsiveness was closely associated with gender (P = 0.012) diabetes (P = 0.006), smoking (P = 0.0496) and hypertension (P = 0.021). Multivariate analysis identified diabetes (P = 0.016) as the only significant independent predictor for the presence of aspirin non-responsiveness. Thirty-four of 184 patients (18.5%) classified as aspirin non-responders according to the second criteria. Seven patients with prolongation of post-aspirin CT more than 2SD were classified as aspirin non-responders by the second criteria. Only 1 patient without prolongation of CT more than 2SD was classified as aspirin responsive by the second criteria.Definition of aspirin non-responsiveness as post-aspirin CTsor =193 s might overestimate the prevalence of aspirin non-responsiveness. Nevertheless, definition of aspirin non-responsiveness by PFA-100 must be standardized and its utility as a predictor of cardiovascular events needs to be further investigated.

OBJECTIVE The role of systemic and chronic inflammatory processes in the pathophysiology of rheumatic heart valve disease is well known. The neutrophil-to-lymphocyte ratio (NLR) was shown to be an indicator of systemic inflammation. In this study, we aimed to investigate relationship between NLR as a marker of systemic inflammation and rheumatic mitral valve stenosis (RMVS). METHODS This is a retrospective study. Among patients who underwent transthoracic echocardiography between January 2008-March 2013, 314 patients with RMVS were included retrospectively in the study. The control group included 57 healthy persons who underwent transthoracic echocardiography during the study period. Basal characteristics and NLR were compared between the two groups. Independent predictors of RMVS were determined by logistic regression analysis. RESULTS Basal characteristics were similar among the groups (age, 50.2 ± 14.2 vs. 49.2 ± 13.0, p=0.60). The NLR was significantly higher in patients with RMVS [2.9 (0.6-13.0) vs. 2.1 (0.7-5.8), p

Coronary collateral vessels can provide a perfusion reserve in case of increased myocardial oxygen demand. Development of coronary collateral vessels (CCV) is triggered by the pressure gradient between the coronary bed of arteries caused by an obstruction and myocardial ischemia. Myocardial hypoxia can facilitate development of CCVs. There is a chronic hypoxemia in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the effect of COPD on CCVs. The study included 98 patients with COPD who underwent coronary angiography. Those patients in whom coronary angiography is normal or severity of coronary artery stenosis in thought not to be sufficient for the development of CCVs (

Doppler tissue imaging (DTI) has been proposed as a tool for the evaluation of diastolic function. Controversy exists regarding whether DTI measurements are influenced by preload. Changes in the circulating volume associated with hemodialysis result in preload reduction. To determine the influence of preload reduction on DTI and standard pulsed-Doppler transmitral diastolic velocities, 30 patients (mean age 41 +/- 14) with chronic renal insufficiency without overt heart disease were studied by DTI and standard pulsed Doppler before and after hemodialysis. From the apical window, DTI sample volume was placed at the lateral and septal mitral annulus and at the midsegment of lateral and septal myocardial wall of the left ventricle. Peak early diastolic annular and myocardial, and peak late diastolic annular and myocardial velocities were measured. Transmitral peak early and late diastolic velocities were also recorded by standard pulsed Doppler. The peak velocity of early diastolic mitral flow decreased from 100 +/- 30 to 85 +/- 34 cm/s (P < 0.001) after hemodialysis. Hemodialysis elicited marked reduction in early diastolic lateral mitral annular and midlateral myocardial velocities (6.9 +/- 3.2 to 6.3 +/- 2.9 cm/s, P < 0.04 and 6.7 +/- 0.3 to 5.5 +/- 2 cm/s, P < 0.001, respectively). Early diastolic, septal mitral annular, and midseptal myocardial velocities were also significantly decreased (5.8 +/- 2.8 to 4.6 +/- 2 cm/s, P < 0.006 and 6.2 +/- 2 to 5.1 +/- 1 cm/s, P < 0.008, respectively). Late diastolic mitral annular and myocardial velocities did not change. It is concluded that early diastolic mitral annular and myocardial velocities are affected by acute preload reduction. It is necessary to consider preload when diastolic function is assessed by DTI.

Platelets of diabetic patients have been reported to be less sensitive to aspirin. The aim of this study is to compare a medium (300 mg) and low (100 mg) dose of aspirin on platelet function in diabetic patients.We have included one hundred and two patients with type 2 diabetes mellitus. Platelet function was measured as closure time (CT) with the Platelet Function Analyzer (PFA)-100 before the administration of aspirin. Initially the patients were given 100 mg aspirin once daily for seven days, and then the measurements were repeated. If the CT exceeded the upper limit of 300 s, the study was terminated. If not, the patients continued the aspirin therapy with a dose of 300 mg daily for another seven days, and the CTs were measured again.After taking 100 mg aspirin, the CT significantly increased from 126+/-29 s to 256+/-66 s (p0.001). In 68 of 102 (67%) patients, the CT increased to 300 s. In the remaining 34 patients, the baseline CT was 113+/-29, and increased to 170+/-45 s after 100 mg aspirin (p0.001). In these patients, there was a further increase in the CT from 170+/-45 to 229+/-75 s following 300 mg aspirin (p0.001). On average, the CT was increased by 60% and 39% following ingestion of 100 and 300 mg aspirin, respectively. CT300 s were obtained in 15 (44%) of 34 patients after 300 mg aspirin.Although, a daily dose of 100 mg aspirin effectively inhibited platelet function in a majority of diabetics, a considerable proportion of patients showed a greater platelet inhibition with the use of 300 mg aspirin. The PFA-100 closure time may be used to separate those patients who require a higher dose of aspirin to achieve desired antiplatelet effect.

The aims of this study were to evaluate the diagnostic value of intracoronary electrocardiogram (ECG) and presence of angina pectoris during percutaneous coronary interventions in the prediction of myocardial viability assessed by low-dose dobutamine echocardiography (LDDE). Seventy-one patients (60 men; mean age, 54 +/- 11 years) with recent Q-wave MI and angiographically documented regional wall motion abnormality in the presence of a significant (>/= 70%) nonocclusive stenosis of the infarct-related vessel who were referred for angioplasty were prospectively included in the study. The intracoronary ECG was recorded using coronary angioplasty guidewire. Significant ST segment elevation was defined as a new or worsening ST segment elevation of >/= 0.1 mV at 80 msec after the J-point. Angina pectoris was noted as present or absent during balloon inflation. All patients underwent LDDE for viability assessment. Significant ST segment elevation in the intracoronary ECG and chest pain were observed in 56 (78.9%) and 49 (69%) of the 71 patients. Viability was present on LDDE in 52 (92.9%) of 56 patients with and 3 (20%) of 15 without ST segment elevation. Viability was detected in 45 (91.8%) of 49 patients with and 10 (45.4%) of 22 without angina pectoris during balloon occlusion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ST segment elevation for viability were 94.5%, 75%, 92.9%, 80%, and 90.1%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of angina pectoris for viability were 81.8%, 75%, 91.8%, 54.5%, and 80.3%, respectively. The present study demonstrated that a simple assessment of ST segment elevation in the intracoronary ECG or angina pectoris during coronary angioplasty can be used to assess myocardial viability identified by LDDE in patients with previous MI.

Background: The ventricular late potential (VLP) detected using the technique of signal average electrocardiography (SAECG) interacts with several factors, primarily time. Method: In this study, we examined the interaction, over time, of VLP with the initial ischemic burden and enzyme levels in acute myocardial infarction. Patients diagnosed as having acute myocardial infarction were included in the study. On the first day, the patients underwent enzyme analysis and electrocardiography (ECG) follow-up every 6 hours. A 24-hour ambulatory ECG was performed on the seventh day in order to determine the ischemic burden. SAECG findings (TQRS, RMS, LAS were obtained on the seventh day, in the first and third months. The study was continued with the patients who did not require angioplasty as decided with angiographic evaluation in the first month. Results: The study included 30 patients with acute myocardial infarction (mean age 51 ± 12, 28 males and 2 females). The initial mean CK-MB levels and the mean ischemic burden were 98 ± 31 U/L and 44 ± 96 minutes. The TQRS (ms), LAS (ms), and RMS (μV) values (mean ± SD) obtained at day 7, month 1, and month 3 are 97 ± 12, 96 ± 9, 103 ± 11, P = 0.01; 31 ± 10, 31 ± 11, 32 ± 10, P = 0.46; 43 ± 28, 41 ± 26, 33 ± 25, P = 0.01, respectively. We observed that the TQRS and RMS values changed significantly with time, but these levels of significance disappeared when adjusted for the initial ischemic burden and CK-MB levels (P = 0.06; P = 0.53). The VLP frequency was 33% at day 7 and 23% at month 3. Unlike the CK-MB level, the initial ischemic burden was significantly different between the patients with and without VLP at month 3 (150.85 ± 149.28, 12.34 ± 26.48, P = 0.001). When tested together with age and gender, it was found that the high initial ischemic burden increased the possibility of VLP (OR: 24, Cl: 2.09–279.52, P = 0.01) at month 3. Conclusion: SAECG findings in patients with myocardial infarction changed with time; however, this change occurred depending on the initial ischemic burden and CK-MB levels. Of these, only the initial ischemic burden, especially in high levels, was a determinant for the presence of VLP in the late period of myocardial infarction. A.N.E. 2002;7(3):242–246

The cardiovascular system is involved in 5% of the cases of Behçet's disease. Thrombophlebitis. aneurysm in arteries, pericarditis, myocarditis, valvular disease, ventricular arrhythmia, and conduction system disorders may occur. A case of Behçet's disease with complete proximal atrioventricular block is presented.

We hypothesized that the change in aortic elastic properties could directly be shown with color Doppler tissue imaging (CDTI), that these findings could be related to aortic stiffness and distensibility and that, through these, coronary artery disease (CAD) could be predicted. One hundred and twenty six patients (group I: 83 with CAD, mean age 54+/-10 years, 18 female, 65 male; group II: 43 without CAD, mean age 53+/-10 years, 27 female, 16 male) having been evaluated for coronary artery disease by angiography were examined by echocardiography. Arterial pressure was measured immediately before echocardiographic evaluation. Internal aortic systolic and diastolic diameters by M-mode echocardiography and aortic upper wall tissue velocities (Aortic S, E, A, m/sec) by CDTI were measured 3 cm above the aortic valve. Lateral mitral annulus tissue velocities (Annulus S, E, A, m/sec) were also recorded. Aortic distensibility (cm2 x dynes(-1)) and aortic stiffness index were calculated using formulas. In the statistical analyses, CAD risk factors and left ventricular ejection fraction were used for adjustment. Aortic stiffness (2.79+/-3.49 vs 1.62+/-1.31, P=0.03), distensibility (1.55+/-1.46 vs 2.37+/-3.08, P=0.04), and aortic S velocity (0.057+/-0.016 vs 0.064+/-0.015, P=0.02) differed significantly between groups I and II. After adjustment, while aortic stiffness and S velocity were still statistically different (P=0.04; P=0.03 respectively), the significance of the difference in aortic distensibility disappeared (P=0.051). Aortic stiffness and aortic S velocity (0.06 m/sec

A 53-year-old female patient was admitted with dyspnea and fatigue. On transthoracic echocardiography, systolic pulmonary artery pressure (PAP) was measured as 90 mmHg, and right heart catheterization revealed pulmonary arterial hypertension. Pulmonary angiography demonstrated bilateral pulmonary artery stenosis, and the diagnosis was determined as Takayasu arteritis. Balloon angioplasty was performed under corticosteroid and immunosuppressive treatment. In this case report, we describe a patient in whom bilateral pulmonary artery stenosis developed due to Takayasu arteritis, and we discuss the patient in light of the current literature.