Search

Abstract This study evaluated the management of dyslipidemia in Turkey with the goal of understanding current diagnosis and treatment patterns, as well as identifying unmet needs in achieving effective low-density lipoprotein cholesterol (LDL-C) targets. Using a Delphi panel consisting of nine expert cardiologists, the study reveals key gaps in dyslipidemia management, particularly in the underutilization of combination therapies, such as statins and PCSK9 inhibitors, which are crucial for achieving LDL-C targets in high-risk patients. The findings indicate that while many patients with very high cardiovascular risk are diagnosed, a significant proportion do not receive optimal treatment to reach LDL-C levels recommended by European guidelines. Addressing these gaps could lead to more effective management of dyslipidemia and reduce the burden of cardiovascular disease in Turkey. The study’s insights provide critical recommendations for clinicians and policymakers to improve clinical practice and health outcomes through more aggressive lipid-lowering strategies.

The aim of this study was to investigate the patient characteristics and laboratory parameters for COVID-19 non-survivors as well as to find risk factors for major bleeding complications. For this retrospective study, the data of patients who died with COVID-19 in our intensive care unit were collected in the period of March 20 - April 30, 2020. D-dimer, platelet count, C-reactive protein (CRP), troponin, and international normalized ratio (INR) levels were recorded on the 1st, 5th, and 10th days of hospitalization in order to investigate the possible correlation of laboratory parameter changes with in-hospital events. A total of 161 non-survivors patients with COVID-19 were included in the study. The median age was 69.8±10.9 years, and 95 (59%) of the population were male. Lung-related complications were the most common in-hospital complications. Patients with COVID-19 had in-hospital complications such as major bleeding (39%), hemoptysis (14%), disseminated intravascular coagulation (13%), liver failure (21%), ARDS (85%), acute kidney injury (40%), and myocardial injury (70%). A multiple logistics regression analysis determined that age, hypertension, diabetes mellitus, use of acetylsalicylic acid (ASA) or low molecular weight heparin (LMWH), hemoglobin, D-dimer, INR, and acute kidney injury were independent predictors of major bleeding. Our results showed that a high proportion of COVID-19 non-survivors suffered from major bleeding complications.

INTRODUCTION[|]Red cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) have been found to be associated with non-valvular atrial fibrillation (AF) and cardiovascular diseases. However, correlation of these parameters with presence of left atrial (LA) thrombus and/or spontaneous echo contrast (SEC) in patients with non-valvular AF has not been clarified. This study was an investigation of correlation of RDW, NLR, and clinical risk factors with LA thrombus and dense SEC in patients with non-valvular AF in the Turkish population.[¤]METHODS[|]The demographic, laboratory, and echocardiographic properties of 619 non-valvular AF patients who underwent transesophageal echocardiography (TEE) examination before direct current cardioversion (DCCV) or AF ablation treatment were retrospectively investigated. Complete blood count (CBC) and biochemical parameters were studied 6 to 12 hours before TEE examination. Left atrial stasis (LAS) markers were noted as presence of left atrial/left atrial appendage (LA/LAA) thrombus or dense spontaneous echo contrast (DSEC).[¤]RESULTS[|]Total of 325 (52%) patients with LAS were compared with 294 patients (48%) without LAS. In the LAS group, there were 274 (84%) patients with LA/LAA thrombus and 51 (16%) patients with DSEC. LAS (+) group, values for RDW (14.85+-1.48 vs. 13.77+-1.30; p6 months, and international normalized ratio

Background and Objectives: Vasovagal syncope (VVS) is the most common cause of syncope and has multiple pathophysiological mechanisms. Asymmetric dimethylarginine (ADMA) is the major inhibitor of nitric oxide (NO). In this study, we aimed to investigate the relationship between plasma ADMA levels and syncope during the head-up tilt (HUT) test. Materials and Methods: Overall, 97 patients were included in this study. They were above 18 years of age and were admitted to our clinic with the complaint of at least one episode of syncope consistent with VVS. The HUT test was performed in all patients. Patients were divided into the following two groups based on the HUT test results: group 1 included 57 patients with a positive HUT test and group 2 included 35 patients with a negative HUT test. Blood samples were taken before and immediately after the HUT test to measure ADMA levels. Results: No significant intergroup differences were observed concerning gender and age (female gender 68% vs 60%; mean age 24.85 ± 4.01 vs 25.62 ± 3.54 years, respectively, for groups 1 and 2). ADMA values were similar between groups 1 and 2 before the HUT test [ADMA of 958 (544−1418) vs 951 (519−1269); p = 0.794]. In the negative HUT group, no significant differences were observed in ADMA levels before and after the HUT test [ADMA of 951 (519−1269) vs 951 (519−1566); p = 0.764]. However, in the positive HUT group, ADMA levels were significantly decreased following the HUT test [pretest ADMA of 958 (544−1418) vs post-test ADMA of 115 (67−198); p < 0.001]. Conclusion: ADMA levels significantly decreased after the HUT test in patients with VVS.

Left ventricular noncompaction (LVNC) is a genetically heterogenous form of cardiomyopathy which may remain undiagnosed till adulthood due to the late presentation of typical symptoms such as dyspnea, congestion, ventricular arrhythmias and thromboembolism. Symptomatic bradycardia secondary to persistent sinus node dysfunction is very rare. Coexistent cardiac defects are common in children however in adults the disease is usually in isolated form. Here, we present a case of twenty-three year-old female LVNC patient with patent ductus arteriosus, bicuspid aortic valve and persistent sinus node dysfunction who presented with dizziness as the first manifestation of the disease.

Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most common coronary anomaly. It is thought to be of no clinical relevance unless cardiac surgery is performed. We report a 53-year-old patient with aberrant circumflex coronary artery origin from the right aortic sinus of Valsalva which was first suspected from transthoracic 2D and transesophageal 3D echocardiographic views and confirmed by coronary CT angiography. The patient did not receive further diagnostic or therapeutic options. Therefore, we recommended medical therapy with optimal treatment of his cardiovascular risk factors together with regular clinical follow up.

Abstract Fistula from left internal mammary artery (LIMA) to pulmonary artery (PA) is rarely encountered in daily practice. In recent years, endovascular therapy options have emerged for the treatment of fistula formations and replaced with surgery. A 53-year-old man admitted to our outpatient clinic with symptoms of typical angina and shortness of breath despite optimal medical therapy. In his relevant history, he had a coronary artery bypass graft (CABG) operation in 2009 in which his LIMA was anastomosed to left anterior descending (LAD) and ramus artery sequentially. Coronary angiography including selective imaging of LIMA demonstrated a fistula formation originating from the proximal portion of the LIMA and draining to PA. After successful closure of fistula with transcatheter coil embolization, the patient was discharged without any complication and symptom. In conclusion, although LIMA to PA fistula is an infrequent clinical condition, it should be considered as a potential cause of persistent angina after CABG operation. Treatment options include conservative medical therapy, surgical ligation and endovascular interventions. The best therapy should be individualised for each patient in respect to patient’s symptoms, surgical compatibility and anatomy of fistula.

Objectives:Right heart catheterization (RHC) is a gold standard method for diagnosis, also monitors the level of the disease, the prognosis, and the response to the therapy in patients with pulmonary arterial hypertension (PAH). Cardiac power output (CPO) is the product of flow and pressure. Aim of this study was to evaluate right ventricular cardiac power output (RVCPO) in PAH patients as a prognostic factor. Materials and methods: Demographic characteristics, functional class, RHC findings, echocardiographic data, PAH-specific medical treatment usage of 105 treatment-naïve, newly diagnosed Group 1 PAH patients between September 2009 and June 2019 were reviewed. RVCPO (Watt) was calculated as a product of cardiac output (CO) and mean pulmonary artery pressure (mPAP), divided by a constant of 451. Results: RVCPO was lower in high-risk patients (0,25 ± 0,02 W for high risk, 0,42 ± 0,15 W for low risk, and 0,44 ± 0,10 W for intermediate-risk; p=0.04) in comparison with low and intermediate-risk patients. RVCPO showed very high correlation with mPAP while a low positive correlation with CO, and PVR. 0,44 W for RVCPO was found the most accurate predictor value for mortality in low and intermediate-risk patients by ROC analysis. Conclusion: RVCPO could be a promising hemodynamic parameter that represents cardiac pumping ability with PAH patients. RVCPO tends to increase with low and intermediate risk while decrease with high-risk and associated with mortality above 0,44 W with low and intermediate-risk patients. We suggest that RVCPO could be a beneficial hemodynamic tool to discriminate the patients at-risk among the low and intermediate-risk groups.

Introduction:To explore the prognostic importance for admission of C-reactive protein (CRP)/albumin ratio (CAR) in elderly patients aged 80 years over who presented with non-ST elevation myocardial infarction (non-STEMI).Methods:This retrospective, observational research was related to the clinical data of 528 elderly non-STEMI patients. The study population was categorized based on CAR tertiles as T1, T2, and T3 groups. The CAR was obtained by dividing CRP to albumin level. The main outcome of the research was the in-hospital mortality.Results:The in-hospital mortality rate during index hospitalization was 5% (n=27 patients). Cases included in the T3 tertile had significantly higher incidence of cardiopulmonary arrest, cardiac mortality, and all-cause mortality during the index hospitalization [(15% vs 4% vs 0.5%), (10% vs 1% vs 0%), and (13% vs 2% vs 0%), respectively, p1 on admission, revascularization, and CAR (odds ratio: 1.47, 95% confidence intervals: 1.23-1.75, p1.12 predicted in-hospital mortality with a sensitivity of 85% and specificity of 77% (area under the curve: 0.813, p

Aim:Despite advances in-stent technology, in-stent restenosis (ISR) is still a major problem following percutaneous coronary intervention (PCI) and its reasons have not been fully revealed. In the presented study, we investigated the effect of admission blood glucose (ABG), fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) levels on coronary ISR patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI in five-year follow-up.Methods:From 2.900 patients who underwent coronary stent implantation for STEMI from January 2008 through December 2012 were retrospectively analyzed through the hospital digital recording system. Of these, 264 patients who underwent control coronary angiography during the five-year follow-up were included in the study. Patients were divided into two main group ISR and non-ISR; were divided into two subgroups diabetic and non-diabetic groups were compared with HbA1c, ABG, FBG and angiographic parameters.Results:There were 127 patients in the ISR group (diabetic: 36 non-diabetic: 91) and 137 patients in the non-ISR group (diabetic: 43 non-diabetic: 94). Regardless of the patients diabetes status, no significant difference was found between the groups with and without ISR in terms of HbA1c, FBG and ABG. A significant relationship was found between the baseline HbA1c value and having ISR only in the diabetic subgroup (p=0.01).Conclusion:This study results showed that in diabetic STEMI patients who underwent primary PCI, higher HbA1c levels were associated with higher ISR rates, but not with FBG and ABG levels.

OBJECTIVE: Monocyte to high-density lipoprotein ratio (MHR) has recently been postulated as a novel parameter related to adverse cardiovascular outcomes. In this study, we aimed to investigate the correlation of MHR with stent restenosis (SR) rates after the primary percutaneous coronary intervention (PCI) and bare-metal stent (BMS) implantation. METHODS: In this study, patients who had undergone primary PCI for STEMI and had a control angiogram during follow-up were retrospectively recruited. Patients were categorized according to admission MHR tertiles, clinical and angiographic data were compared. In addition, predictors of SR were evaluated with logistic regression analysis. RESULTS: A total number of 448 patients (240 patients with SR and 208 patients without SR) were included in this study. Patients were categorized into three groups according to tertiles of admission MHR. During a follow-up period of median 12 months, the rate of SR was significantly higher in patients with higher MHR levels (45% in tertile 1, 54% in tertile 2 and 62% in tertile 3, p

Background: High-intensity statin (HIS) therapy is widely recommended for secondary prevention after an acute myocardial infarction (AMI). The 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidemia guidelines have lowered the target low-density lipoprotein cholesterol (LDL-C) level, which necessitates a more frequent use of nonstatin therapies. Objectives: The objectives of the study were to investigate the rate of LDL-C target attainment for secondary prevention in AMI patients. Methods: This retrospective investigation included 1360 patients diagnosed with AMI in a tertiary heart center. Lipid parameters were collected within 24 h of admission and within 1 year after discharge. The medications used were retrieved from medical records, and the lowest LDL-C levels after statin treatment were used to assess the effectiveness of the therapy. LDL-C target attainment was defined according to the 2016 ESC/EAS dyslipidemia guidelines as an LDL-C level of < 70 mg/dL and a ≥ 50% reduction from baseline. In addition, the rate of LDL-C target attainment according to the 2019 ESC/EAS guidelines was defined as an LDL-C level of < 55 mg/dL and a ≥ 50% reduction from baseline. Results: In total, 502 (36.9%) and 247 (18.2%) patients reached the LDL-C targets according to the 2016 and 2019 ESC/EAS guidelines, respectively. The admission LDL-C levels were significantly lower and HIS treatment was used more frequently in patients who subsequently attained the LDL-C goal. Remarkably, 461 (34%) patients failed to reach the LDL-C goals despite HIS treatment. Only 27 (1.9%) patients were prescribed ezetimibe. Conclusion: The rate of LDL-C goal attainment in AMI patients was low, which indicates the need for combination statin and non-statin lipid-lowering therapies.

INTRODUCTION[|]Pathological studies have suggested that local inflammation, particularly eosinophilic infiltration of the adventitia, could be related to nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD). However, the role of systemic inflammation in the pathogenesis of NA-SCAD remains unknown. Our aim was to investigate systemic inflammatory activation in patients with an acute coronary syndrome (ACS) secondary to NA-SCAD.[¤]METHODS[|]The institutional electronic medical database was reviewed, and 22 patients with NA-SCAD-ACS were identified after the review. Furthermore, 30 random patients with CAD-ACS and 30 random subjects without any history of CAD or ACS with demographic and clinical characteristics similar to those of NA-SCAD-ACS patients were identified from the institutional database to be included in the study. [¤]RESULTS[|]Patients with NA-SCAD-ACS and those with CAD-ACS both had higher white blood cell and neutrophil counts than controls. Neutrophil–lymphocyte ratio (NLR) and C-reactive protein (CRP) levels were only significantly higher in the NA-SCAD-ACS group [2.01 (1.54–6.17) for NLR and 0.70 (0.13–2.70) for CRP] than in the controls [1.55 (1.27–2.13), p=0.03 for NLR and 0.15 (0.10–0.43), p=0.049 for CRP]; however, there were no differences between the NA-SCAD-ACS and CAD-ACS groups [1.91 (1.41–2.78) for NLR and 0.41 (0.09–1.10) for CRP, p>0.05 for both comparisons] regarding all tested parameters.[¤]DISCUSSION AND CONCLUSION[|]The degree of inflammatory activation in NA-SCAD-ACS patients was similar to, or even greater than, that in CAD-ACS patients; thus, suggesting a role of inflammation in the pathophysiology of NA-SCAD-ACS.[¤]

Objective: Lifelong statin treatment is recommended in patients with cardiovascular diseases, but drug adherence is a significant problem. The aim of this study was to investigate factors related to statin discontinuation in high-risk patients with coronary artery disease (CAD) diagnosed by coronary angiography. Methods: A total of 300 consecutive patients who were followed-up with a diagnosis of CAD were recruited. Patients were categorized as statin adherent or statin non-adherent (patients interrupting statin therapy >30 days). Study participants completed a questionnaire regarding demographic characteristics, medical history, knowledge of statin treatment, and factors related to statin discontinuation. Results: In all, 160 patients (53.3%) were found to be statin adherent. Of those, 122 patients had suffered myocardial infarction, and atorvastatin was the most prescribed statin on discharge. Among the study population, 26% were illiterate and 55% had graduated from primary school. Only 39 cases (13%) cases had a low-density lipoprotein-cholesterol level

Idiopathic ascending aortitis is an insidious disease most often encountered during an evaluation for other cardiovascular and connective tissue diseases. To the best of our knowledge, admission to an emergency department with chest pain due to idiopathic ascending aortitis has not been reported before. Herein, the case of a 46-year-old man with chest and back pain symptoms that were discovered to be secondary solely to idiopathic ascending aortitis is described.

Objective: Extracorporeal shock wave lithotripsy (ESWL) is a safe and effective treatment for urinary tract calculi. While serious side effects are rare, transient cardiac arrhythmias may occur. New electrocardiographic (ECG) parameters, such as P wave dispersion (PWD), QT dispersion (QTd), T peak to T end (Tp-e) interval, Tp-e interval/QT ratio, and Tp-e interval/corrected QT ratio have been defined to help predict atrial and ventricular arrhythmias. However, effect of ESWL on these ECG parameters has not been previously investigated. The present study was an examination of the effect of ESWL on ECG parameters. Methods: Total of 40 consecutive patients who underwent ESWL were prospectively enrolled in the study. Pre-procedure ECG parameters were compared with post-procedure ECG parameters. Results: PWD values were significantly longer on post-procedure ECG compared with pre-procedure ECG (p=0.017). Corrected QT duration and QTd were significantly longer on post-procedure ECG compared with pre-procedure ECG (p=0.046 and p=0.008, respectively). In addition, Tp-e interval, Tp-e interval/QT ratio, and Tp-e interval/QTc ratio were significantly longer post procedure (p=0.035, p=0.045, and p=0.022, respectively). In univariate correlation analysis, duration of procedure was significantly correlated with post-procedure PWD, QTc, and QTD values. Conclusion: Clinical use of ECG parameters may be helpful in monitoring of patients receiving ungated ESWL in order to detect cardiac dysrhythmia.

It is rare for ventricular tachycardia arising from the right ventricle to originate in the tricuspid annulus, and the clinical presentation and cardiac abnormalities associated with this type of arrhythmia have not been clearly established. This report describes a case of biventricular noncompaction presenting with ventricular arrhythmia originating in the tricuspid annulus and successfully treated with radiofrequency ablation.

Objectives: Previous studies have shown the association between various hematological parameters and cardiovascular diseases, and their prognostic value. In this study, we compared red cell distribution width (RDW), neutrophil lymphocyte ratio (NLR) and mean platelet volume (MPV) measurements among patients with poor coronary collateral circulation (CCC) and well-developed CCC. Study design: 326 patients with stable coronary artery disease (CAD) were evaluated retrospectively. CCC was graded by using the Rentrop classification. The poor CCC group included patients with Rentrop 0-1 CCC, and the good CCC group included Rentrop 2-3 CCC. Results: There were 171 subjects (84% male; mean age 56.6+-10.4 years) in the poor CCC group, and 155 subjects (89% male; mean age 57.6+-9.7 years) in the good CCC group. The total number of vessels with >95% stenosis (1.1+-0.5 vs. 1.0+-0.4; p=0.64) and Gensini scores (84.4+-38.8 vs. 83.3+-37.4; p=0.83) was not higher in the poor CCC group compared to the good CCC group. RDW was significantly higher in the poor CCC group compared to the good CCC group (14.19+-1.36% vs. 13.89+-1.19%; p=0.04). In multivariate logistic regression analysis, elevated levels of RDW and LDL were found to be independent predictors of poor CCC (OR 1.73, 95% CI: 1.30-2.29, p=0.01 and OR 1.01 95% CI 1.002-1.02; p=0.02, respectively). Conclusion: In the present study, poor CCC was found to be independently correlated with RDW, but not with any other hematological parameters in patients with stable CAD.

Objectives: The prognostic importance of red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) in cardiovascular diseases has been shown. Ascending aortic dilatation (AAD) is a common cardiovascular disease and is associated with aortic wall inflammation and cystic degeneration. In this study, we aimed to investigate the relationship between serum levels of RDW, NLR and the presence of AAD. Study design: Two-hundred consecutive patients with AAD diagnosed by transthoracic echocardiography were prospectively recruited and were compared to 170 age-gendermatched subjects with normal aortic diameters. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW and NLR counts, as well as mean corpuscular volume (MCV). If possible, results of CBC tests within the previous two years were also included and the averages were used. Results: RDW [median 13.9, interquartile range (IQR) 1.40 vs. median 13.3, IQR 1.05%, p=0.01], NLR (median 2.04, IQR 1.09 vs. median 1.78, IQR 0.90, p=0.01) and high-sensitive Creactive protein (hs-CRP) (median 0.60, IQR 0.80 vs. median 0.44, IQR 0.68 mg/L, p=0.01) levels were significantly higher in the AAD group compared to the control group. In univariate correlation analysis, ascending aortic diameters were correlated with RDW levels (r=0.31, p=0.01), NLR levels (r=0.15, p=0.01) and hs-CRP levels (r=0.12, p=0.03). In multivariate logistic regression analysis, increased levels of RDW and hs- CRP remained as the independent correlates of AAD in the study population. Receiver operating characteristic (ROC) curve analysis revealed that a RDW measurement higher than >13.8% predicted AAD with a sensitivity of 49.5% and a specificity of 82.8% (area under the curve [AUC] 0.681, p=0.01). Conclusion: In patients with AAD, RDW and hs-CRP levels are increased, which may indicate the role of inflammation in the pathogenesis of AAD.

Objectives: The genetic risk factors that contribute to the risk of developing aortic dissection (AD) have been studied. We assessed the association of endothelial nitric oxide synthase (eNOS) gene polymorphism with AD. Study design: Patients who underwent surgery with the diagnosis of AD and survived after the operation in our center between May 2007 and June 2011 were recruited retrospectively. The eNOS intron 4a/b polymorphism was determined by polymerase chain reaction (PCR) using oligonucleotide primers (sense: 5'-AGGCCCTATGGTAGTGCCTTT-3'; antisense: 5'-TCTCTTAGTGCTGTGGTCAC-3') that flank the region of the 27 bp VNTR in intron 4. Results: Thirty-nine patients (88%) had type A AD, while the remainder (12%) had type B AD. The distribution of eNOS4 a/b gene polymorphism differed significantly from the control group, with higher frequencies of eNOS 4a/a and 4a/b genotypes in the AD group (χ2=7.16, p=0.03). Conclusion: In this study, the distribution of eNOS genotypes differed between the AD and control groups; however, this polymorphism was not found to be an independent factor for the development of AD.

Abstract Background: The relationship between psychiatric illness and heart disease has been frequently discussed in the literature. The aim of the present study was to investigate the relationship between anxiety, depression and overall psychological distress, and coronary slow flow (CSF). Methods: In total, 44 patients with CSF and a control group of 50 patients with normal coronary arteries (NCA) were prospectively recruited. Clinical data, admission laboratory parameters, and echocardiographic and angiographic characteristics were recorded. Symptom Checklist 90 Revised (SCL-90-R), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scales were administered to each patient. Results: The groups were comparable with respect to age, sex, and atherosclerotic risk factors. In the CSF group, BAI score, BDI score, and general symptom index were significantly higher than controls (13 [18.7] vs. 7.5 [7], p = 0.01; 11 [14.7] vs. 6.5 [7], p = 0.01; 1.76 [0.81] vs. 1.1[0.24], p = 0.01; respectively). Patients with CSF in more than one vessel had the highest test scores. In univariate correlation analysis, mean thrombolysis in myocardial infarction (TIMI) frame counts were positively correlated with BAI (r = 0.56, p = 0.01), BDI (r = 0.47, p = 0.01), and general symptom index (r = 0.65, p = 0.01). The psychiatric tests were not correlated with risk factors for atherosclerosis. Conclusion: Our study revealed higher rates of depression, anxiety, and overall psychological distress in patients with CSF. This conclusion warrants further studies.