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OBJECTIVE: To evaluate postgraduate training period, social life and problems of cardiology residents in Turkey by using a questionnaire form and to compare with the core curriculum of European Society of Cardiology for general cardiology. METHODS: Overall, 529 residents of cardiology ages in range of 24-35 years (mean age: 26.5±2.0 years, 81.4% male) participated as volunteers in this cross-sectional survey study. An 86-item questionnaire form was used to evaluate the education process, capacity of knowledge and skill and social effectiveness level of participants. The questionnaire were composed both closed- and open-ended questions. The questionnaire form was filled in with the face-to-face communication method. The data of survey were compared with the core curriculum of European Society of Cardiology for general cardiology training period. Chi-square or Fischer exact test was used for statistical analysis. RESULTS: The participants were working in various university hospitals (70.3%) and training-research (state) hospitals in 31 different provinces in Turkey (40.8% in Marmara region). They visited 40±10 outpatients and 10±5 hospitalized pts daily in the clinics. The 3-5 residents worked at the clinic on night shifts and mostly (89%) 8 or more night shifts per month were held in their first training years. During first three-years of training 76% of residents have performed echocardiography, 40.8%-transesophageal echocardiography and 10% - intraoperative echocardiography. The 84.3% of them evaluated exercise tests, 76.4%-Holter electrocardiography and 53.3%-tilt-table tests. The rate of residents working in coronary angiography laboratories was 54.3%. The 53.7% of residents performed coronary angiography and 64%-only in the 4th year of their training. The number of coronary angiography performance was under expected when compared with European Society of Cardiology curriculum. The 18.5% of residents were participated as assistant researcher in an international multi-center study and only 10% had an article published in national journals (4.3% published in Science Citation Index). The 30.6% considered the cardiology training period in their centers to be insufficient, whereas 37.4% found it partially sufficient and 31.9% sufficient. Only 32.9% of participants could dedicate time for social activities. CONCLUSION: According to the referred core curriculum of ESC for general cardiology the training of cardiology residents in non-invasive applications is adequate however coronary angiography applications are slightly insufficient in Turkey. In addition, the number of publications per capita is quiet low. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association of pulse pressure (PP) with mortality and major adverse cardiac events (MACE) in one-year period after anterior ST-elevation myocardial infarction (A-STEMI)., Methods: A total of 261 consecutive patients whose blood pressure was measured with the aid of a catheter before primary percutaneous coronary intervention (PPCI) between August 2016 and February 2017 were included in the study. The patients were divided into three groups according to pulse pressure (PP) (Group 1, PP<35 mmHg; Group 2, 35≤PP≤50 mmHg; Group 3, PP>50 mmHg)., Results: The mean age of the patients was 63.4±14.1 years, and 206 of them were male. The groups were similar in terms of age and diastolic blood pressure (DBP). The ratio of female patients in Group 1 was higher, and their systolic blood pressure (SBP) was lower than those from the other groups (P=0.005 vs. P=0.042). The rates of MACE and mortality were higher in Group 1. The predictive PP values were calculated to be 42.5 mmHg for development of MACE and 41.5 mmHg for mortality. One-year survival ratio was worse in Group 1 than in the others according to Kaplan-Meier analysis (P<0.001)., Conclusion: The values of PP which was measured intra-aortically in patients with A-STEMI were associated with mortality and MACE in the one-year follow-up period.

Objective: To evaluate the predictive value of mean perfusion pressure (mPP) in the development of acute kidney injury (AKIN) after transcatheter aortic valve implantation (TAVI)., Methods: One hundred and forty seven consecutive patients with aortic stenosis (AS) were evaluated for this study and 133 of them were included. Mean arterial pressure (mAP) and central venous pressure (CVP) were used to calculate mPP before TAVI procedure (mPP = mAP-CVP). The occurrence of AKIN was evaluated with AKIN classification according to the Valve Academic Research Consortium-2 recommendations. The patients were divided into two groups according to the receiver operating characteristic (ROC) analysis of their mPP levels (high-risk group and low-risk group)., Results: The AKIN prevalence was 22.6% in this study population. Baseline serum creatinine level, glomerular filtration rate, amount of contrast medium, and the level of mPP were determined as predictive factors for the development of AKIN., Conclusion: The occurrence of AKIN is associated with increased morbidity and mortality rates in patients with TAVI. In addition to the amount of contrast medium and basal kidney functions, our study showed that lower mPP was strongly associated with development of AKIN after TAVI.

Congenital ventricular diverticulum is a rare and usually asymptomatic cardiac malformation which can cause major complications such as systemic thromboembolism, infective endocarditis, cardiac rupture, heart failure, arrhythmia and sudden death. We present a case with multiple congenital left ventricular diverticulum admitted to hospital with sudden onset right-sided hemiplegia and dysarthria.

Aim: Inflammation is a critical participant in mediating all stages of cardiovascular disease. Studies related with chitotriosidase that was recently found to be relevant to arterial inflammation. In this study we evaluated activity of serum chitotriosidase in acute coronary syndrome patients and its relationship with cardiovascular events, cardiac enzymes and inflammatory indicators., Methods: We prospectively analyzed consecutive 30 patients with ST-segment elevation myocardial infarction, 30 patients with non ST-segment elevation myocardial infarction, 30 patients with unstable angina pectroris who were admitted to our intensive care unit and 30 healthy people (average age 56.86±10.44 years, 81 male) between Jaunary and June 2010. Details of baseline clinical characteristics, biochemical values, receiving treatment and basal ECG findings were recorded. Data of patients with coronary angiography were evaluated., Results: Cut off value of chitotriosidase was calculated 82.00 mmol·ml-1·h-1, with 83 percent sensitivity and 72 percent spesificity. The activity of chitotriosidase in acute coronary syndrome group was 88.85±23.08 mmol·ml-1 ·h-1, where as the control group was 68.47±28.44 mmol·ml-1·h-1, respectively p=0.001).The highest activity of chitotriosidase (96.11±19.77 mmol·ml-1·h-1) was found in ST-segment elevation myocardial infarction group and the minimal activity of chitotriosidase was in the control group (68.47±28.44 mmol·ml-1·h-1) (p= 0.001). The activity of chitotriosidase in ST-segment elevation myocardial infarction and non ST-segment elevation myocardial infarction groups were significantly higher than control group (p=0.001 and p=0.045). When acute coronary syndrome groups compared to control; a positive correlation was found between chitotriosidase activity and hs-CRP (r=0.21, p= 0.046), troponin T (r=0.25, p=0.016), creatine kinase-MB (r=0.20, p=0.059)., Conclusion: The activity of chitotriosidase is increased in acute coronary syndrome patients. Chitotriosidase is higher in ST-segment elevation myocardial infaction group than non ST-segment elevation myocardial infarction and unstable angina pectoris group.

Objective: To evaluate postgraduate training period, social life and problems of cardiology residents in Turkey by using a questionnaire form and to compare with the core curriculum of European Society of Cardiology for general cardiology., Methods: Overall, 529 residents of cardiology ages in range of 24-35 years (mean age: 26.5±2.0 years, 81.4% male) participated as volunteers in this cross-sectional survey study. An 86-item questionnaire form was used to evaluate the education process, capacity of knowledge and skill and social effectiveness level of participants. The questionnaire were composed both closed- and open-ended questions. The questionnaire form was filled in with the face-to-face communication method. The data of survey were compared with the core curriculum of European Society of Cardiology for general cardiology training period. Chi-square or Fischer exact test was used for statistical analysis., Results: The participants were working in various university hospitals (70.3%) and training-research (state) hospitals in 31 different provinces in Turkey (40.8% in Marmara region). They visited 40±10 outpatients and 10±5 hospitalized pts daily in the clinics. The 3-5 residents worked at the clinic on night shifts and mostly (89%) 8 or more night shifts per month were held in their first training years. During first three-years of training 76% of residents have performed echocardiography, 40.8%-transesophageal echocardiography and 10% - intraoperative echocardiography. The 84.3% of them evaluated exercise tests, 76.4%-Holter electrocardiography and 53.3%-tilt-table tests. The rate of residents working in coronary angiography laboratories was 54.3%. The 53.7% of residents performed coronary angiography and 64%-only in the 4th year of their training. The number of coronary angiography performance was under expected when compared with European Society of Cardiology curriculum. The 18.5% of residents were participated as assistant researcher in an international multi-center study and only 10% had an article published in national journals (4.3% published in Science Citation Index). The 30.6% considered the cardiology training period in their centers to be insufficient, whereas 37.4% found it partially sufficient and 31.9% sufficient. Only 32.9% of participants could dedicate time for social activities., Conclusion: According to the referred core curriculum of ESC for general cardiology the training of cardiology residents in non-invasive applications is adequate however coronary angiography applications are slightly insufficient in Turkey. In addition, the number of publications per capita is quiet low.

Pneumopericardium is defined by the presence of air in the pericardial sac. We present a 61-year-old cachectic woman who developed pneumopericardium after pericardiocentesis. She presented with complaints of fatigue and shortness of breath. The chest X-ray showed an increased cardiothoracic ratio, and echocardiographic examination showed a marked pericardial effusion. Pericardiocentesis was performed and a total of 860 ml hemorrhagic pericardial fluid was aspirated. At the end of the first week after removal of the catheter, control chest radiography showed air-fluid levels in the pericardial cavity, and echocardiography revealed dense air bubbles in the decreased pericardial effusion. As the patient was hemodynamically stable, she was monitored on medical treatment. However, five days later, pericardiocentesis was repeated due to a significant increase in the pericardial effusion despite decreased amount of air. As no etiologic factor could be elicited, a connective tissue disease was considered and a corticosteroid was added to her treatment, which resulted in a rapid decline in the pericardial effusion on follow-up chest radiography and echocardiography. She was discharged on steroid therapy.

A 34-year-old pregnant woman presented to the emergency department with the complaints of palpitations at 32 weeks gestation. The diagnosis of right ventricular outflow tract ventricular tachycardia (VT) was made. Intravenous 5 mg of metoprolol and 25 mg of diltiazem did not terminate the VT. Ten milligrams of adenosine were administered. Within 10 s of adenosine administration, sustained VT converted to repetitive monomorphic VT and within 30 s to normal sinus rhythm. The mother and the foetus tolerated the medications well. Non-stress test for the assessment of the foetal well-being was normal.