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Background: Atrial fibrillation (AF) is strongly associated with an increased risk of ischemic events. Anticoagulation focuses on reducing the risk of embolism. Guideline recommended CHA2DS2-VASc scoring system is most widely used; however, different scoring systems do exist. Thus, we sought to assess the impact of anticoagulant treatment and different scoring systems on the development of stroke, myocardial infarction, and all-cause mortality in patients with nonvalvular AF., Methods: The present study was designed as a prospective cohort study. The enrollment of the patients was conducted between August 1, 2015, and January 1, 2016. The follow-up period was defined as the time from enrollment to the end of April 1, 2017, which also provided at least 12 months of prospective follow-up for each patient., Results: A total of 1807 patients with AF were enrolled. During the follow-up, 2.7% (48) of patients had stroke, 0.8% (14) had myocardial infarction, and 7.5% (136) died. The anticoagulation and risk factors in AF (ATRIA) score had a better accuracy for the prediction of stroke compared to other scoring systems (0.729, 95% CI, 0.708-0.750, P <.05). Patients under low-dose rivaroxaban treatment had significantly worse survival (logrank P <.001). Age, CHA2DS2-VASc score, R2CHADS2 score, ATRIA score, chronic heart failure, prior stroke, and being under low-dose rivaroxaban treatment were independent predictors of clinical endpoint (P <.001)., Conclusion: Low-dose rivaroxaban treatment was independently and strongly associated with the combined clinical endpoint. Furthermore, the ATRIA score proved to be a stronger predictor of stroke in the Turkish population.

This recent Turkish Myocardial Infarction registry reported that guidelines are largely implemented in patients with acute myocardial infarction (MI) in Turkey. We aimed to obtain up-to-date information for short- and midterm outcomes of acute MI. Fifty centers were selected using probability sampling, and all consecutive patients with acute MI admitted to these centers (between November 1 and 16, 2018) were enrolled. Among 1930 (mean age 62 ± 13 years, 26% female) patients, 1195 (62%) had non-ST segment elevation myocardial infarction (NSTEMI) and 735 (38%) had ST segment elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) was performed in 94.4% of patients with STEMI and 60.2% of those with NSTEMI. Periprocedural mortality occurred in 4 (0.3%) patients. In-hospital mortality was significantly higher in STEMI than in patients with NSTEMI (5.4% vs 2.9%, respectively; P = .006). However, the risk became slightly higher in the NSTEMI group at 1 year. Women with STEMI had a significantly higher in-hospital mortality compared with men (11.2% vs 3.8%; P < .001); this persisted at follow-up. In conclusion, PCI is performed in Turkey with a low risk of complications in patients with acute MI. Compared with a previous registry, in-hospital mortality decreased by 50% within 20 years; however, the risk remains too high for women with STEMI.

Background: Transradial approach (TRA) has increasingly become the default strategy for cardiac catheterisation. However, TRA can result in several complications; radial artery occlusion (RAO) is the most unwilling complication. Unfractionated heparin (UFH) is an effective therapy in preventing RAO. The goal of this study was to evaluate whether weight-adjusted high dose UFH reduces the rate of RAO after diagnostic cardiac catheterisation compared to weight-adjusted standard dose UFH., Methods: A total of 1215 patients screened and after exclusion criteria, 686 consecutive patients were enrolled. 100 IU/kg UFH (high dose UFH group) and 50 IU/kg UFH (standard dose UFH group) were given the patients undergoing diagnostic cardiac catheterisation. RAO was evaluated with vascular Doppler ultrasonography at 10 days after cardiac catheterisation., Results: Among 686 patients undergoing diagnostic cardiac catheterisation, RAO was detected in 36 (5.2%) patients. There was no significant difference with respect to baseline characteristics and co-morbid diseases between high dose UFH group and standard dose UFH group. RAO was significantly higher in standard dose UFH group than high dose UFH group (7.9% vs. 3.0%, p  = .004). Multivariate logistic regression analysis was demonstrated that age (OR: 0.958, 95% CI: 0.924-0.993, p  = .019) and standard dose heparin (OR: 2.811, 95% CI: 1.347-5.866, p  = .006) were independent factor for RAO., Conclusions: High dose UFH was independently associated with a lower rate of RAO. Given that RAO nearly affects about 10% patient underwent TRA, prefer to high dose UFH may be a reasonable choice for RAO prevention.

Background: Anemia is a common health problem worldwide and is associated with a poor prognosis for cardiovascular diseases. It can alter myocardial depolarization and repolarization by affecting the generation and propagation of electrical impulses. The frontal QRS-T angle is a novel marker of the absolute difference between myocardial depolarization and repolarization. This study investigated the effects of anemia on the frontal QRS-T angle., Methods: The study included 66 anemic subjects with no cardiac disorders, and 50 age- and gender-matched controls. Twelve-lead electrocardiography (ECG) was obtained for all subjects, and the frontal QRS-T angle was calculated based on the automatic report of the ECG machine., Results: Subjects with anemia had a significantly higher frontal QRS-T angle than subjects without anemia (28.9±14.1 vs. 22.5±11.8, P=0.011). In correlation analysis, the frontal QRS-T angle was positively correlated with the Body Mass Index (BMI; r=0.287, P=0.002), left ventricular mass (LVM; r=0.264, P=0.004), and heart rate (r=0.275, P=0.003) and negatively correlated with the hemoglobin level (r=-0.349, P<0.001). Multivariate regression analysis showed that the hemoglobin level (β=-0.254, tβ=-2.805, P=0.006), BMI (β=0.240, t=2.770, P=0.007), and LVM (β=0.201, t=2.303, P=0.023) were independently associated with the frontal QRS-T angle., Conclusions: The hemoglobin level was found to be an independent predictor of the frontal QRS-T angle.

Introduction: Structural and electrophysiological changes play a critical role in the development of atrial fibrillation (AF). Although the pathophysiology of paroxysmal AF (PAF) has not been fully elucidated, oxidative stress (OS) and DNA damage appear to be important triggers. Thus far, no studies have investigated the relationships among total oxidant status (TOS), DNA damage, and PAF. The goal of this study was to assess TOS and DNA damage in patients with PAF., Methods: This cross-sectional study included 56 patients with PAF and 31 healthy controls. OS was assessed based on TOS, total antioxidant capacity (TAC), and oxidative stress index (OSI). The level of DNA damage was assessed using 8-hydroxy-2'-deoxyguanosine (8-OHdG)., Results: There were no significant differences between the groups in terms of baseline characteristics. However, patients with PAF had significantly higher high-sensitivity C-reactive protein (p=0.018), TOS (p=0.001), OSI (p=0.001), and 8-OHdG (p=0.019) levels, compared with the control group. Multivariate logistic regression analysis showed that serum TOS level (odds ratio: 1.608; 95% confidence interval [CI]: 1.188-2.176, p=0.002) was the only independent predictor of PAF. TOS ≥12.2 predicted PAF with a sensitivity of 82% and specificity of 76% (AUC: 0.785, 95% CI: 0.687-0.883, p<0.001)., Conclusion: We found that TOS and DNA damage were significantly greater in patients with PAF than in the control group. Therefore, we propose that TOS and DNA damage can be used to detect patients at higher risk of AF., (Copyright © 2020 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: In this study, we aimed to investigate the effects of spinal anesthesia on the QT interval in patients with term and post-term pregnancy that were scheduled for elective cesarean section. Materials and methods: Forty pregnant women scheduled for elective cesarean section under spinal anesthesia were assigned into two groups: Post-term group (Group P) ( n  = 20) and Term group (Group T) ( n  = 20). After entering the operation room, standard monitoring [electrocardiography (ECG), noninvasive blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation] was performed. The patient was placed in the sitting position and spinal anesthesia was performed with a median approach at the L3-L4a level using a 25G Quincke-type spinal needle. After cerebrospinal fluid was viewed, 12.5 mg (2.5 mL) hyperbaric bupivacaine was administered intrathecally over 1 min. Other ECG records were made at min 1 (T1), 5 (T2), and 10 (T3) after the induction of spinal anesthesia and after skin closure (T4). QT and QT dispersion were measured from ECG. Heart rate-corrected QT (QTc) and QT dispersion (QTcd) values were calculated using the Bazett formula. Results: Demographic characteristics of the patients were similar in both groups. Postoperative QTc, QTd, and QTcd values were significantly increased in Group P compared to those in Group T ( p  < .05). Conclusion: Spinal anesthesia led to increased postoperative QTc, QTd, and QTcd values in the patients with a gestational age of ≥42 weeks who underwent cesarean section. Accordingly, it is advisable to perform postoperative strict cardiac monitoring particularly in post-term pregnant women undergoing spinal anesthesia.

Objective: Acute coronary syndrome (ACS) is a leading cause of death worldwide. There is great interest in defining the risk factors and underlying mechanisms of ACS among young people. The microbiota and its metabolites have recently become a popular research topic, yet there is still no study that investigated microbiota-generated metabolites as a possible risk factor in young patients with ACS. In this study, we aimed to investigate the relationship between microbiota-generated metabolites and ACS in young people., Methods: This study included 44 young patients with ACS (<50 years of age), 39 elderly patients with ACS, and 44 patients with normal coronary arteries. Inflammatory parameters and serum trimethylamine N-oxide (TMAO) and choline levels were measured in all patients., Results: Young patients with ACS had significantly higher levels of TMAO and choline compared to the control and elderly ACS groups. Also, elderly patients with ACS had a significantly higher level of TMAO than the control group. Linear regression analysis was performed to determine the independent predictors of TMAO. Two regression models were involved. The first model included young ACS and control groups, while the second model included young and elderly ACS groups. In the first model, we found that young ACS (ß=0.399, p=0.004) and smoking ACS (ß=0.211, p=0.046) were significantly associated with TMAO level. In the second model, young ACS was significantly associated with TMAO level (ß=0.230, p=0.035)., Conclusion: In this study, we have shown that young ACS was significantly associated with increased TMAO level.

Several laboratory parameters have been used to assess inflammatory process and determine cardiovascular risk. The C-reactive protein to albumin ratio (CAR) is a novel marker of inflammation and its clinical importance has not been clearly elucidated in coronary artery disease (CAD). We compared the diagnostic value of CAR with other inflammatory parameters in detecting significant CAD. Patients (n = 421) with stable angina pectoris who underwent coronary angiography for the suspected CAD were included. Neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio, uric acid, monocyte to high-density cholesterol (HDL-C) ratio, mean platelet volume to lymphocyte ratio (MPVLR), and platelet to mean corpuscular volume (MCV) ratio were measured. Patients with significant CAD had a significantly higher NLR ( P = .043), MLR ( P = .004), uric acid ( P < .001), monocyte to HDL-C ratio ( P = .004), and CAR ( P < .001) compared to patients without significant CAD. However, MPVLR and platelet to MCV ratio weren't different between 2 groups. The area under the curve (AUC) of CAR was the highest AUC among all inflammatory parameters for predicting significant CAD. Multivariate analysis showed that age (odds ratio [OR]: 1.046, 95% confidence interval [CI], 1.020-1.072, P < .001) and CAR (OR: 1.175, 95% CI, 1.126-1.226, P < .001) were the only independent predictors of significant CAD. In conclusion, CAR had the strongest diagnostic value in detecting significant CAD among the inflammatory parameters evaluated in this study.

What Is Known and Objective: Propofol is a most commonly used anaesthetic drug for conscious sedation in outpatient procedures. Previous studies have shown that propofol may affect ventricular repolarization based on QT and Tp-e intervals. Frontal QRS-T angle is a marker of ventricular depolarization and repolarization difference. However, there is no study investigating the effect of propofol on frontal QRS-T angle. In this study, we aimed to investigate the effect of propofol on frontal QRS-T angle in patients undergoing colonoscopy procedure., Method: A total of 56 patients (53.5% females) who underwent colonoscopy procedure were included in this study. All patients underwent 12-lead surface electrocardiograms (ECGs) just before colonoscopy and 15 minutes after colonoscopy. QT interval, QTc interval, Tp-e interval, Tp-e/QT, Tp-e/QTc and frontal QRS-T angle were calculated from 12-lead ECGs., Results and Discussion: The frontal QRS-T angle was significantly increased 15 minutes after colonoscopy compared to basal value (36.2 ± 24.3 vs. 29.5 ± 23.6, P = .003). In addition, repolarization parameters including QT, QTc and Tp-e intervals were significantly prolonged at 15 minutes after colonoscopy compared to basal value, except Tp-e/QT and Tp-e/QTc. Significant ventricular or supraventricular arrhythmias were not observed in any patient during the procedure., What Is New and Conclusion: In this study, we found that propofol administration increased the frontal QRS-T angle in patients undergoing colonoscopy procedure. Given that a prolonged frontal QRS-T angle is associated with ventricular arrhythmias, it may be safer to monitor those patients receiving propofol during colonoscopy procedures., (© 2019 John Wiley & Sons Ltd.)

Background: The pregnancy process is characterized by several changes in the cardiovascular system, especially in left ventricle (LV) systolic and diastolic function. Tissue Doppler imaging (TDI) is a useful tool to evaluate global LV function. This study investigated changes in LV functions using TDI in third-trimester pregnant women., Methods: A total of 86 consecutive third-trimester healthy pregnant women and 40 age-matched nonpregnant healthy women (control group) were enrolled in this cross-sectional study. LV diameter, standard Doppler and tissue Doppler parameters, and myocardial performance index (MPI) were measured for all patients., Results: There was no significant difference in baseline characteristics between the pregnant and control groups. However, the cardiac chamber diameter was larger, the Am velocity was higher, and the E velocity, Em velocity, and E/A ratio were lower in the pregnant group. In addition, the MPI was significantly higher in the pregnant group compared to the control group (0.57 ± 0.11 vs 0.42 ± 0.02, P < .001). Correlation analysis showed that gestational week was positively correlated with the MPI (r = .407, P = .003)., Conclusions: Detailed assessment of cardiac function is important during pregnancy. We demonstrated that pregnancy was associated with a significantly increased MPI, as well as structural and functional changes., (© 2019 Wiley Periodicals, Inc.)

Background and Aims: Carotid artery stenting (CAS) is an accepted treatment modality for carotid artery disease. However, CAS is associated with periprocedural embolic events, and the effect of balloon post-dilatation has not been sufficiently investigated in large studies. We assessed the effect of post-dilatation on periprocedural outcomes during CAS., Methods: The study included 128 patients who underwent CAS. The patients were divided into groups according to whether post-dilatation was (post-dilatation [+], group 1) or was not (post dilatation [-], group 2) performed after stent deployment. Major adverse events were defined as death, minor or major stroke, and transient ischemic attack at 30 days. Silent ischemia was assessed using diffusion-weighted magnetic resonance imaging., Results: No significant between-group differences were found in baseline characteristics, comorbid diseases, or lesion characteristics. The degree of stenosis and procedure duration was greater in group 1 than in group 2. The rate of major adverse events at 30 days was similar between the two groups (5.1% vs. 4.3%, p = 0.844). The silent ischemia rate and number of high-intensity signals were higher in group 1 than in group 2 (45.8% vs. 26.1%, p = 0.020 and 1.01 [1.2] vs. 0.42 [0.79], p = 0.002). Multivariate analysis revealed that post-dilatation was associated with a 2.4-fold increase in silent ischemia (95% confidence interval: 1.15-5.20, p = 0.020)., Conclusions: Although post-dilatation was not associated with an increase in major adverse events, it significantly increased the incidence of periprocedural silent ischemia. Therefore, post-dilation should be performed only in cases with severe residual stenosis after CAS., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background and objectives : No-reflow (NR) phenomenon is defined as insufficient myocardial perfusion in coronary circulation in the absence of angiographic evidence of mechanical obstruction. The primary mechanisms of the NR occurrence are thought to be high platelet activity and thrombus burden. Soluble CD40 ligand (sCD40L), which is released into the plasma following platelet activation, accelerates the inflammatory process and causes further platelet activation. The aim of our study is to investigate the relationship between the NR phenomenon and sCD40L level in patients with ST-elevation myocardial infarction (STEMI). Methods: A total of 81 acute STEMI patients undergoing primary percutaneous coronary intervention and 40 healthy participants were included in this study. Acute STEMI patients were classified into two groups: 41 patients with the NR phenomenon (NR group) and 40 patients without the NR phenomenon (non-NR group). The serum sCD40L level was measured for all groups. Results: The serum sCD40L level was significantly higher in the NR group than in non-NR and control groups (379 ± 20 pg/mL, 200 ± 15 pg/mL and 108 ± 6.53 pg/mL, respectively; p < 0.001). Univariate regression analysis demonstrated that male sex, age, Gensini score and sCD40L level were the possible factors affecting the occurrence of the NR phenomenon. In multivariate regression analysis, age (odds ratio [OR], 1.091; 95% confidence interval [CI], 1.023-1.163; p < 0.008) and serum sCD40L (OR, 1.016; 95% CI, 1.008-1.024; p < 0.001) remained the independent predictor of the presence of NR. Conclusions: Our study showed that serum sCD40L level was an independent predictor of the NR phenomenon occurrence., Competing Interests: The authors declare no conflicts of interest.

The simultaneous occurrence of acute ST-segment elevation myocardial infarction and acute ischemic stroke is an uncommon and complex clinical presentation. Although the medical treatment of both diseases is similar, data regarding optimal reperfusion therapy are limited. Nevertheless, use of tissue plasminogen activator may be a reasonable strategy for treatment of both diseases. We present a rare case of coexisting thrombosis of the coronary artery and mid cerebral artery that was managed successfully with tissue plasminogen activator thrombolytic therapy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Stroke therapy options have focused on limiting the infarct volume. Neutrophil to lymphocyte ratio (NLR) can be valuable to detect the patients that required intensive treatment at early stage by predicting infarct volume. The aim of this study is to evaluate the relationship between NLR and infarct volume according to the stroke territory, and to determine the prognostic value of NLR for predicting 3-month mortality in acute ischemic stroke (AIS) patients., Methods: A total of 107 patients with AIS were enrolled and followed up 3 months in terms of mortality. Study population was divided into two groups according to the stroke territory: anterior circulating stroke (ACS) and posterior circulating stroke (PCS). All patients underwent magnetic resonance imaging. The complete blood count and venous blood samples were obtained from the patients on admission to the emergency department., Results: There were no difference between ACS and PCS groups regarding baseline characteristics and co-morbid diseases. Also, C-reactive protein and NLR were similar between two groups. In correlation analyses, infarct volume was significantly correlated with CRP and NLR in ACS (r = 0.350, p = 0.001 and r = 0.482, p ≤ 0.001, respectively), but not correlated with infarct volume in PCS. Also, NLR was correlated with NIHHS in only ACS group (r = 0.326, p = 0.002). Multivariate analysis showed that NLR was the only independent predictor of 3-month mortality (OR 1.186, 95% CI 1.032-1.363, p = 0.016)., Conclusion: NLR is significantly correlated with ACS infarct volume, but not with PCS infarct volume in AIS. Also, NLR was an independent predictor of 3-month mortality in AIS patient.

Background: Contrast-induced nephropathy (CIN) following cardiac catheterization remains a considerable clinic challenge. Volume status is very important in the development of CIN. It can be assessed noninvasively by measuring inferior vena cava (IVC) diameters. The aim of this study was to assess whether IVC can be used for prediction of CIN in patient undergoing cardiac catheterization., Methods: A total of 269 patients undergoing cardiac catheterization were prospectively enrolled in this study. IVC inspiratory and expiratory diameters were measured by transthoracic echocardiography. Caval index was calculated as the percentage decrease in the IVC diameter during respiration. CIN was defined as a ≥0.5 mg/dL and/or a ≥25% increase in serum creatinine within 72 hour post-procedure., Results: Contrast-induced nephropathy developed in 46 (17.1%) patients after cardiac catheterization. Caval index was significantly higher in patients with CIN than in patients without CIN (47% [40-64] vs 35% [26-50], P < 0.001). In addition, the used contrast volume (145 [90-217] vs 70 [60-100], P < 0.001) and the frequency of percutaneous coronary intervention (50% vs 17.9%, P < 0.001) were significantly higher in patients with CIN than in patients without CIN. In receiver operating characteristic (ROC) curve analysis, caval index ≥ 41% predicted CIN with a specificity of 69% and sensitivity of 72%. Multivariate analysis indicated that caval index ≥ 41% was an independent predictor of post-procedural CIN development (OR: 3.367, 95% CI: 1.574-7.203, P = 0.002)., Conclusions: Caval index, a simple and noninvasive echocardiographic marker, is an independent predictor of post-procedural CIN development in patients undergoing cardiac catheterization., (© 2018 Wiley Periodicals, Inc.)

Objective There is a close link between major depressive disorder (MDD) and cardiovascular disease (CVD). Increasing oxidative stress, changes in hypothalamic-pituitary-adrenal axis and platelet clotting cascade may lead to subclinical myocardial damage in MDD patients without overt CVD. The aim of the study was to investigate whether MDD is associated with fragmented QRS (fQRS) on electrocardiogram (ECG) which may reflect myocardial fibrosis/scarring and ischaemia. Methods and results A total of 66 MDD patients without overt CVD and 35 age- and sex-matched control subjects were enrolled in this study. Twelve-lead surface ECGs were analysed for the presence of fQRS and echocardiographic examination was performed for each individual. Multivariate logistic regression analysis was used to assess the relationship between MDD and fQRS. The baseline characteristics in terms of age, gender, body mass index and cardiovascular risk factors were comparable in the groups (all P values >0.05). Left ventricular ejection fraction, left ventricular wall thickness and diastolic blood pressure were also similar in the two groups. The presence of fQRS was more prevalent (P < 0.001) and SBP values (P = 0.007) were higher in patients with MDD compared to controls. Moreover, multivariate binary logistic regression analysis indicated the recurrent MDD as the only independent predictor of fQRS on ECG (beta =0.196, 95% CI 0.046 - 0.827, P = 0.014). Conclusion The presence of fQRS on the ECG is associated with MDD, and may be a beneficial tool for detecting subclinical cardiac damage in this population.

Statins may exert pleiotropic effects in coronary artery disease (CAD), diabetes mellitus, and familial hypercholesterolemia. We evaluated the effects of statins on the neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) in 261 consecutive patients with hypercholesterolemia having CAD or at high cardiovascular (CV) risk and 50 healthy participants who were retrospectively included in this study. Patients were treated with 10 to 80 mg atorvastatin or 10 to 40 mg rosuvastatin for 24 weeks according to baseline levels of cholesterol, triglycerides, and CV risk. Baseline NLR and MPV were significantly higher in patients with CAD or at high risk compared to the control group (1.89 [0.37-6.78]) vs 1.44 [0.75-2.41], P < .001 and 8.8 [6.27-18.6] vs 8.45 [6-11] fL, P = .038, respectively). The NLR, MPV, and lipid parameters were also compared in the patient group after statin treatment for 24 weeks. Lipid levels decreased but the NLR and MPV did not change significantly after the statin therapy. Further studies are needed to clarify the effect of statin therapy on NLR and MPV in patients with CAD or at high CV risk., (© The Author(s) 2015.)

Objectives: Cardiac syndrome X (CSX) is characterized by the presence of myocardial ischemia in the absence of coronary artery stenosis on angiograms. Its relation to oxidative stress and inflammation is well known. There are no data on thiols and their relation with inflammation in CSX. The aim of this study was to investigate thiol levels and thiol/disulfide homeostasis in CSX patients., Materials and Methods: Fifty consecutive patients who had documented myocardial ischemia and normal coronary angiogram (CSX group), and 45 age-matched and sex-matched consecutive patients who had normal coronary angiogram without myocardial ischemia (control group) were enrolled in this study. C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), native thiol, total thiol, and disulfide levels were measured and disulfide/thiol ratios were calculated in all patients., Results: Demographic, clinical, basic laboratory, and echocardiographic characteristics were similar in the two groups (P>0.05). Serum total thiol, native thiol, and disulfide levels decreased significantly in the CSX group compared with the control group (P<0.001). CRP and NLR increased significantly in the CSX group compared with the control group (P<0.001). Although disulfide/native thiol levels increased in the CSX group, this reduction did not reach statistical significance (5.8 vs. 5.5, P>0.05). The reduction of thiols was correlated negatively with CRP and NLR (P<0.001). Although univariate logistic regression analyses showed that serum total and native thiol levels, CRP and NLR were independent predictors for CSX estimation, stepwise multivariate logistic regression analysis showed only total thiol levels as an independent predictor for CSX (odds ratio=0.966, 95% confidence interval: 0.950-0.982, P<0.001). Also, receiver operating characteristic curve analysis showed that serum total thiol values of 338.4 or below could predict the CSX with 86% sensitivity and 84% specificity (area under curve=0.903; 95% confidence interval: 0.842-0.965)., Conclusion: Serum total thiol levels decreased significantly in CSX and this reduction independently predicted CSX with strong sensitivity and specificity. This suggests that the reduction in thiols along with increased inflammation may play a pathophysiological role in the development of CSX.

Objectives: Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) appears to be involved in atherosclerotic plaque vulnerability and rupture. In this study, we aimed to evaluate the utility of serum LOX-1 levels in the diagnosis and assessment of left ventricular systolic HF and LOX-1’s relationship with serum pro-brain natriuretic peptide (NT-proBNP)., Design and Settings: This was a cross-sectional study of all eligible patients admitted to the department of cardiology of the University Hospital between July 2011 and April 2012., Methods: Fifty-five patients with a diagnosis of systolic heart failure and 25 patients without systolic HF were enrolled in this study. Serum C-reactive protein, NT-proBNP, and LOX-1 were studied., Results: Serum LOX-1 and NT-proBNP levels were significantly higher in the heart failure group and showed a positive correlation with NT-proBNP and negative correlations with left ventricular ejection fraction (EF). In addition, LOX-1 levels in patients with ischaemic cardiomyopathy were significantly higher, while they were similar in patients with dilated cardiomyopathy compared to control subjects., Conclusion: Our study demonstrates the utility of the serum LOX-1 levels in the diagnosis of left ventricular systolic heart failure. LOX-1 may have a place in the diagnosis of heart failure, in particular in patients with ischaemic cardiomyopathy.

Background: The predictive value of exercise treadmill testing (ETT) remains inadequate in diagnosing patients with suspected coronary artery disease (CAD) and needs to be improved., Objective: The aim of this study was to investigate whether the presence of FQRS on 12-lead ECG would increase the PPV of ETT in patients with an intermediate likelihood of CAD., Methods: fQRS, defined as the presence of notched R or S waves without accompanying typical bundle branch block or the existence of an additional wave-like RSR' pattern in the original QRS complex (with a duration of <120 ms), was assessed in 95 patients with positive ETT. Coronary angiogram (CA) was performed in all patients, divided into two groups as the significant CAD group and nonsignificant CAD group according to coronary artery lesions. The differences between the groups in terms of the presence of fQRS and clinical characteristics were investigated., Results: The mean age of patients was 51.3 ± 11.3 years, and 74 of them were males (77.9%). FQRS was present in 47 (49.5%) patients, and significant CAD was demonstrated in 51 subjects (53.7%) among the enrolled subjects. fQRS was more prevalent in the significant CAD group compared to nonsignificant CAD group (P < 0.001). The presence of FQRS increased the PPV of positive ETT from 53.7% to 85.1%. In addition, FQRS was associated with the increased risk of significant CAD in multivariate analysis (OR = 2.839, P < 0.001)., Conclusion: In clinical practice, the presence of fQRS in patients with positive ETT may support clinicians during the decision-making process with regard to the referral for a coronary angiography., (© 2015 Wiley Periodicals, Inc.)

Background: Myocardial performance index (MPI) is impaired in patients with hypertension. Uric acid is biologically active and can stimulate oxidative stress, endothelial dysfunction, inflammation, and vasoconstriction. Hyperuricaemia may provide a negative contribution to impaired MPI in hypertension., Aim: The study was designed to assess the MPI in hypertensive patients with or without hyperuricaemia., Methods: A total of 96 consecutive hypertensive patients were divided into two groups according to levels of serum uric acid (SUA); 49 normouricaemic patients (defined as SUA < 7.0 mg/dL in men and < 6.0 mg/dL in women) and 47 hyperuricaemic patients. SUA levels and other biochemistry parameters were determined by a standard analytical technique. All patients were evaluated by two-dimensional and Doppler echocardiography., Results: The two groups were similar according to age, body mass index, and smoking status. Mean MPI value (0.498 ± 0.06 vs. 0.410 ± 0.05, p < 0.001) was significantly higher in the hyperuricaemic group than the normouricaemic individuals and positively correlated with the mean value of SUA levels (r = 0.51, p < 0.001)., Conclusions: Our study demonstrated that high SUA levels were significantly associated with impaired MPI in hypertensive patients. SUA may suggest a valuable laboratory finding in assessing the risk of developing subclinical impaired left ventricular global function.

Background: Serum uric acid (SUA) is an independent predictor of cardiovascular events in patients with hypertension. Total atrial conduction time (TACT) is a novel echocardiographic parameter used to identify the presence of electrical and structural atrial remodeling. We hypothesized that elevated SUA levels may be associated with prolonged TACT., Methods: A total of 50 consecutive hyperuricemic (defined as SUA>7 mg/dl for men and >6.0 mg/dl for women) patients who had hypertension were included in the study. A total of 42 normouricemic patients were also recruited consecutively as the control group. All patients were evaluated by two-dimensional echocardiography and TACT was estimated by measuring the time delay between the onset of the P-wave of ECG and peak A'-wave on the tissue Doppler imaging (TDI) of the left atrial lateral wall (PA-TDI duration)., Results: There were no significant differences between the two groups according to age, sex, left ventricular systolic function, left atrial diameter, and systolic and diastolic blood pressure values. PA-TDI duration was found to be significantly increased in the hyperuricemic group (112.3±14.7 vs. 92±12.7 ms; P<0.001) and positively correlated with the mean value of SUA levels (r=0.48, P<0.001)., Conclusion: TACT increases in patients with hyperuricemia. Certainly, larger studies in different populations should further examine this potential association.

Objective: Cardiotrophin-1 (CT-1) is closely associated with many cardiovascular diseases, such as hypertension, myocardial infarction (MI), and heart failure, and exhibits a cardioprotective effect in ischemia-reperfusion injury. The aim of this study was to evaluate the relationship between CT-1 and Troponin-I (Tn-I) in off-pump coronary artery bypass (OPCAB) grafting on the beating heart., Methods: Seventy-eight patients (mean age 60.8 ± 9.7 years, 79.5% male) undergoing elective OPCAB surgery were included in this study undertaken between July 1, 2012 and July 1, 2013 in the Department of Cardiology and Cardiac Surgery, University School of Medicine Hospital. Venous blood samples were collected 5 minutes before OPCAB surgery and 6 hours after surgery. Plasma CT-1 levels were measured using the ELISA method., Results: Compared to the preoperative period, Tn-I and CT-1 values were higher in the postoperative period [0.255 ng/mL (0.030-0.430) versus 0.045 ng/mL (0.005-0.090), P &lt; .001; and 33.7 pg/mL (15.8-98.5) versus 8.7 pg/mL (0.68-25.4), P &lt; .001]. There was also an elevation in white blood cells, aspartate aminotransferase, creatine kinase (CK), and creatine kinase MB (CK-MB) values, as well as a decrease in hemoglobin values (P &lt; .001). When a correlation analysis for postoperative CT-1 was performed, there was a significant positive correlation between postoperative CK, CK-MB, and Tn-I levels (r = 0.250, P &lt; .027; r = 0.270, P = .017; and r = 0.241, P &lt; .034)., Conclusion: CT-1 was found to be associated with Tn-I, which is used to detect myocardial damage after OPCAB surgery. CT-1 may also be used to detect myocardial damage.

The goal of this study was to evaluate the preejection time (PEP)-derived myocardial performance index (MPI) in hypertensive (HT) patients with sinus rhythm and its relationship to the classic Tei index. One hundred five patients were enrolled in the study (65 HT and 40 control subjects). The mean age of all patients was 50.5 ± 15 years and 60% were female. Echocardiography was performed on all patients. MPI was measured with the classic Tei method (MPI-Tei index) and the PEP-derived MPI method by using tissue Doppler echocardiography. Although the MPI-Tei index is defined as the ratio of isovolumetric contraction time (IVCT) along with isovolumetric relaxation time (IVRT) to ejection time (ET), PEP-derived MPI is defined as the ratio of PEP and IVRT to ET. We compared echocardiographic data between the HT group and the control group. MPI-Tei index and the PEP-derived MPI values were higher in the HT group compared with controls (0.52 ± 0.10 vs 0.39 ± 0.07, P < 0.001, and 0.51 ± 0.09 vs 0.39 ± 0.07). PEP-derived MPI was strongly correlated with the MPI-Tei index (r = 0.945, P < 0.001). Our study determined that the PEP-derived MPI might be used in the evaluation of left ventricular function in patients with HT, similar to the classic MPI-Tei index.

Introduction: Both inferior vena cava (IVC) diameter and the degree of inspiratory collapse are used in the estimation of right atrial pressure., Aim: The purpose of this study is to evaluate the utility of IVC diameter, using echocardiography as a marker of volume overload and the relationship between these parameters and N-terminal pro-B natriuretic peptide (NT-proBNP) in patients with systolic heart failure (HF)., Methods: We included 136 consecutive patients with systolic HF (left ventricular ejection fraction, <50%), including 80 patients with acutely decompensated HF and 56 patients with compensated HF as well as 50 subjects without a diagnosis of HF. All patients underwent transthoracic echocardiography to assess both their IVC diameters and the degree of inspiratory collapse (≥50%, <50%, and no change [absence] groups); NT-proBNP levels were measured, and these data were compared between the 2 groups., Results: Inferior vena cava diameter and NT-proBNP were significantly higher among the patients with HF than among the control subjects (21.7 ± 2.6 vs 14.5 ± 1.6 mm, P < .001 and 4789 [330-35000] vs 171 [21-476], P < .001). The mean IVC diameter was higher among the patients with decompensated HF than among the patients with compensated HF (23.2 ± 2.1 vs 19.7 ± 1.9 mm, P < .001). The values of NT-proBNP were associated with different collapsibility of IVC subgroups among HF patients. The NT-proBNP levels were 2760 (330-27336), 5400 (665-27210), and 16806 (1786-35000), regarding the collapsibility of the IVC subgroups: greater than or equal to 50%, less than 50%, and absence groups, P < .001, respectively, among HF patients. There was a significant positive correlation between IVC diameter and NT-proBNP (r = 0.884, P < .001). A cut off value of an IVC diameter greater than or equal to 20.5 mm predicted a diagnosis of compensated HF with a sensitivity of 90% and a specificity of 73%., Conclusions: Inferior vena cava diameter correlated significantly with NT-proBNP in patients with HF. Inferior vena cava diameter may be a useful variable in determining a patient's volume status in the setting of HF and may also enable clinicians to distinguish patients with decompensated HF from those with compensated HF., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: This study evaluated the response to electrical cardioversion (EC) and the effect on the myocardial performance index (MPI) in patients with persistent and long-standing persistent atrial fibrillation (AF)., Methods: We enrolled 103 patients (mean age 69.6 ± 8.9 years, 40.7% males) with a diagnosis of persistent and long-standing persistent AF. EC was applied to all patients after one g of amiodarone administration. Echocardiographic findings before EC were compared in patients with successful versus unsuccessful cardioversions and in patients with maintained sinus rhythm (SR) versus those with AF recurrence at the end of the first month. We also compared echocardiographic data before EC versus at the end of the first month in the same patients with maintained SR., Results: SR was achieved in 72.8% of patients and was continued at the end of the first month in 69.3% of the patients. The MPI value of all patients was found to be 0.73 ± 0.21. The size of the left atrium was determined to be an independent predictor of the maintenance of SR at 1 month. In subgroup analyses, when we compared echocardiographic findings before EC and at the end of the first month in patients with maintained SR, the MPI (0.66 ± 0.14 vs 0.56 ± 0.09, p < 0.001) values were significantly decreased., Conclusions: Our study is the first to show impairment of the MPI, which is an indicator of systolic and diastolic function, in patients with persistent and long-standing persistent AF and improvement of the MPI after successful EC.

During pregnancy, infective endocarditis (IE) is quite rare but has a high mortality rate in terms of the mother and the fetus. In this article, a 24-year-old patient with a history of mitral valve prolapse (MVP) who was hospitalized due to IE and treated successfully is presented. On echocardiography, severe mitral valve prolapse, severe mitral regurgitation, and vegetation on the posterior leaflet of mitral valve were observed. Streptococcus mitis was subsequently isolated from four sets of blood cultures. The patient was diagnosed with IE. After 6 weeks of antibiotic therapy, the patient was cured completely without surgical treatment. At 40-weeks of pregnancy, the patient gave birth via a normal vaginal delivery. There were no problems with the 3,800-gram baby born. In current guidelines, there is very limited advice on treatment options for patients who develop IE during pregnancy. Therefore, evaluation of patient-based treatment options would be appropriate. In addition, IE prophylaxis for MVP is not recommended in current guidelines. However, in MVP patients with mitral regurgitation, prior to procedures associated with a high risk of infective endocarditis, IE prophylaxis may be rational.