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Aim: We sought to determine the relationship between presence of atrial fibrillation (AF) and serum biomarkers, including native thiol (antioxidant), disulphide/native thiol ratio, Hs-CRP and high-sensitivity Troponin-I (Hs-TnI) in hypertrophic cardiomyopathy (HCM). Materials & methods: We enrolled consecutive 121 HCM outpatients without AF and 40 HCM outpatients with AF. A 12-lead electrocardiogram, transthoracic echocardiography and 24/48-h ambulatory rhythm monitoring were performed for all patients. Fasting venous blood samples were taken from all study patients to measure serum thiol-disulphide homeostasis, Hs-CRP and Hs-TnI. Results: Serum-native thiol was lower and disulphide/native thiol ratio was more oxidized in HCM patients with AF (p

Objective:In this study, we investigated the correlation between coronary lesion complexity as characterized by syntax score (SS) with circulating adiponectin and adipocyte-fatty acid binding protein (A-FABP4) concentrations in the presence of stable coronary artery disease affecting three coronary vessels (three-vessel stable CAD).Methods:The study groups consisted of 41 control subjects (28 males and 13 females, non-CAD group) and 115 affected subjects (79 males and 36 females, three-vessel stable CAD group). We divided into tertiles the three-vessel stable CAD group according to SS and estimated circulating concentrations of adiponectin and A-FABP4.Results:We did not find any correlation between the coronary lesion complexity with either the adiponectin and/or A-FABP4. We found lower the A-FABP4 of the non-CAD group than those of the groups with three-vessel stable CAD (pConclusion:Adiponectin is not a suitable parameter for demonstrating the existence of CAD or predicting coronary lesion complexity. A-FABP4 is more useful for the proof of the presence of CAD but A-FABP4 are not correlated with the severity of CAD.

Background: The aim of this study was to investigate whether there is a relationship between coronary collateral circulation (CCC) and contrast associated nephropathy (CAN) in very elderly patients. Methods: Patients aged 90 years or older with at least one major occlusion of the coronary artery proximal or mid-section were included in the study. CCC was graded according to the Rentrop classification. CAN was defined as an increase in blood creatinine value of 25% or more on the second day after coronary angiography. Results: Thirty-six patients who met the study criteria were included in the study. In the study group, CAN developed in 12 patients (CAN (+) group), 24 patients did not develop CAN (CAN (&minus, ) group). The creatinine levels before coronary angiography were 1.05 &plusmn, 0.12 in the CAN (&minus, ) group and 1.22 &plusmn, 0.14 in the CAN (+) group. Baseline creatinine values were significantly higher in the CAN (+) group (p = 0.001). The contrast agent used in the CAN (+) group was significantly higher (p = 0.001). In the CAN (+) group, nine patients (43%) had poor collateral circulation, whereas only three patients (20%) had well-developed collateral circulation. In a logistic regression analysis, the collateral class was not a risk factor for CAN, whereas contrast agent volume and basal creatinine were independent predictors of CAN. Conclusion: We found that CCC grade was not associated with the development of CAN in very old patients, but the amount of contrast agent and pre-procedure creatinine values were independent variables in the development of CAN.

Kadı, Hasan (Balikesir Author), Objective: Tricuspid regurgitation is a common finding in healthy subjects. This finding may associate with patent foramen ovale that it is relatively common in the community. No study was found investigating the association between tricuspid regurgitation and patent foramen ovale. The aim of this study was to evaluate the association between tricuspid regurgitation and patent foramen ovale in healthy young subjects. Material and Methods: Eighty-eight subjects were included in the study. Subjects who had evidence of cardiovascular or other systemic disease were excluded from the study. Detection of tricuspid regurgitation was performed with color flow Doppler. The tricuspid regurgitation jet length and area were measured using color Doppler images. The tricuspid regurgitation jet peak velocity and duration were measured with continuous wave Doppler modality. Study subjects were divided into two groups according to whether patent foramen ovale was present [PFO (+) group and PFO (-) group]. Results: There were 23 subjects in the PFO (+) group and 65 subjects in the PFO (-) group. Tricuspid regurgitation flow was pansystolic in 70% of subjects in the PFO (+) group and 8% of subjects in the PFO (-) group (p, Amaç:Sağlıklı bireylerde triküspid yetersizliği sık rastlanan bir bulgudur. Bu bulgu toplumda göreceli olarak sık görülen patent foramen ovale ile ilişkili olabilir. Patent foramen ovale ve triküspid yetersizliğini araştıran herhangi bir yayına rastlamadık. Çalışmamızın amacı, sağlıklı genç erişkinlerde patent foramen ovale ve triküspid yetersizliği arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntemler: Sağlıklı 88 birey çalışmaya alındı. Kardiyovasküler veya başka bir sistemik hastalığı olanlar çalışmaya alınmadı. Triküspid yetersizliği renkli Doppler ekokardiyografi ile saptandı. Triküspid yetersizlik akımının uzunluğu ve alanı renkli Doppler görüntülerden elde edildi. Triküspid yetersizlik akımının zirve hızı ve süresi devamlı Doppler spektral görüntülerden ölçüldü. Çalışma vakaları patent foramen ovale olup olmadığına göre PFO (+) grup ve PFO (-) grup olmak üzere 2 gruba ayrıldı. Bulgular: Çalışma kriterlerine uyan 88 vakanın 23'ü PFO (+) grupta ve 65'i PFO (-) grupta idi. Triküspid yetersizlik akımı PFO (+) gruptaki vakaların %70'inde pansistolik iken bu oran PFO (-) grupta %8 idi. Patent foramen ovalenin saptanmasında pansistolik triküspid yetersizliğinin özgüllüğünü %92 ve duyarlılığını %70 olarak bulduk. Sonuç: Çalışmamızın bulguları sağlıklı genç erişkinlerde pansistolik triküspid yetersizliğinin patent foramen ovale ile ilişkili olabileceğini göstermektedir.

Introduction: The aim of this study was to determine the factors associated with postoperative atrial fibrillation (AF) in patients with left atrial (LA) myxoma. Methods: Thirty-six consecutive patients with LA myxoma (10 men, mean age: 49.3 ± 15.7 years), who were operated on between March 2010 and July 2012, were included in this retrospective study. Pre-operative electrocardiograms and echocardiographic examinations of each patient were reviewed. Results: Postoperative AF developed in 10 patients, whereas there was no evidence of paroxysmal AF after resection of the LA myxoma in the remaining 26 patients. The patients who developed AF postoperatively were significantly older than those who did not develop AF (median: 61.5 vs 46 years; p = 0.009). Among the electrocardiographic parameters, only P-wave dispersion differed significantly between postoperative AF and non-AF patients (median: 57.6 vs 39.8 ms, p = 0.004). Logistic regression analysis revealed P-wave dispersion (OR: 1.11, 95% CI: 1.003-1.224, p = 0.043) and age (OR: 1.13, 95% CI: 1.001-1.278, p = 0.048) as independent predictors of postoperative AF in our cohort of patients. Conclusions: P-wave dispersion is a simple and useful parameter for the prediction of postoperative AF in patients with LA myxoma.

Introduction: Although carotid artery stenting (CAS) is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. The aim of this study was to investigate QT durations on 12-lead surface electrocardiography after CAS. Patients and Methods: Patients (29 male, 12 female) that are suitable for CAS, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled to our study. 12-lead surface electrocardiography recordings were obtained at the beginning, immediately after and at the 24 hour of the procedure. QT maximum, minimum and dispersion durations were analyzed by double blinded observers. Three distinct corrected QT intervals were determined according to Bazett’s formula. Results were statistically analyzed using Friedman and Wilcoxon tests. Results: The QT maximum and dispersion values were significantly decreased immediately after the procedure and continued with low levels at 24 hour recordings, respectively (455±44/58±11, 440±46/37±10, and 450±44/48±10 ms, p value

Summary Introduction Cilostazol is a PDE3 inhibitor and used to treat peripheral arterial disease. There are few reports on the influence of cilostazol on heart. Aims The aim of this study was to assess this effect on right ventricular function and pulmonary artery pressure. Methods Forty patients with normal left and right ventricular ejection fraction and mild or moderate pulmonary artery hypertension were enrolled in the study. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tissue Doppler imaging (TDI), and two-dimensional speckle-tracking echocardiography (2D-STE) before and after oral administration of cilostazol. Also pulmonary artery pressure assessed before and after administration of cilostazol. Results After cilostazol administration, there were significant increases in the TAPSE (1.9 ± 0.3 cm vs. 2.2 ± 0.3 cm, P

Objectives: We aimed to investigate the relationship between the platelet-lymphocyte ratio (PLR) and coronary collateral circulation (CCC) in patients with stable angina pectoris (SAP) and chronic total occlusion (CTO). Methods: A total of 294 patients with both SAP and CTO were classified according to their Rentrop collateral grades as either poor (Rentrop grades/0-1) or good (Rentrop grades/2-3). Results: The PLR values were significantly higher in patients with poor CCC than in those with good CCC (156.8 + 30.7 vs 132.1 + 24.4, P < 0.001). In regression analysis, PLR (unit = 10) [odds ratio 1.48, 95% confidence interval (CI) 1.33 -1.65; P < 0.001] and high-sensitivity C-reactive protein were found to be the independent predictors of poor CCC. In receiver operator characteristic curve analysis, optimal cut-off value of PLR to predict poor CCC was found as 138.1, with 76% sensitivity and 65% specificity. Conclusion: PLR may be an important, simple, and cost effective tool predicting the degree of collateralization in patients with SAP and CTO.

Primary percutaneous coronary intervention (P-PCI) is the gold standard treatment for acute coronary syndromes. Plasma levels of catecholamines and other vasopressors are elevated during acute myocardial infarction (AMI) and coronary vasoconstriction is frequent. We aimed to compare the reference vessel diameter (RVD) of the infarct-related artery (IRA) during primary PCI and after an average of 3 days.Coronary angiography (CAG) was performed on 58 patients with acute ST-segment elevation myocardial infarction (STEMI) and TIMI 3 flow after P-PCI (43 men, 15 women; mean age, 55.5 ± 10 years). TIMI 3 flow was achieved either by simple balloon dilatation and/or thrombus aspiration. Lesion length, RVD, minimal lumen diameter (MLD), mean vessel diameter (meanD), and area of stenosis were compared during P-PCI and follow-up CAG.RVD, MLD, and meanD values were significantly higher during the follow-up CAG than after P-PCI (RVD 2.7 ± 0.7 mm vs. 2.9 ± 0.7 mm, p = 0.001; MLD 1.5 ± 0.5 mm vs. 1.7 ± 0.4 mm, p = 0.002; meanD 2.2 ± 0.5 mm vs. 2.4 ± 0.5 mm, p = 0.001). Area of stenosis values were significantly lower during the follow-up CAG than after primary PCI (69.5 ± 16.5 % vs. 62.1 ± 15 %, p = 0.001). Lesion lengths were not statistically significant during the follow-up CAG and primary PCI (lesion length 24.0 ± 10.8 mm vs. 22.1 ± 8.8 mm, p 0.05).This study showed that RVD was higher at the follow-up CAG a few days after AMI in patients who had TIMI 3 flow after P-PCI with simple balloon dilatation and/or thrombus aspiration. A delay of a few days for stent implantation in P-PCI allows for larger-diameter stent use and may help to reduce stent thrombosis and restenosis rates.

Introduction: In this study, we investigated the effects of frequent and unnecessary change in medication to control of blood pressure. Also we investigated the role of the regular use of drugs in the treatment of hypertension. Patients and Methods: Nine hundred hypertensive patients (509 males and 391 females; mean age 62.4 ± 12.1 years) were evaluated retrospectively. Only the patients taking anti-hypertensives for at least six months were included. Patients' records were examined in terms of anti-hypertensive treatment. Intra-group exchange and use of regularly in anti-hypertensive drugs were investigated. Effects of the change in blood pressure and patient compliance were investigated. Results: When intra-group drug change was examined, rates of drug changes were as follows; angiotensin receptor blocker group, 62.3%; angiotensin converting enzyme group, 55.1%; betablockers group, 39.9%; calcium channel blocker group, 20.9%. While the ratio of non-compliance was 28.7% in the patient group with drug change, it was only 9.3% in the group without change in treatment. Average blood pressure difference was found 6.1 ± 7.6 mmHg and 7.6 ± 7.5 mmHg respectively (p < 0.001). The average number of drug usage with and without change of antihypertensive drug were 2.5 ± 0.87 and 2.2 ± 0.89 (p < 0.001) respectively. Conclusion: In patients under angiotensin converting enzyme inhibitors and angiotensin receptor blocker treatments, intra-group change of medication is common. Frequent intra-group change of anti-hypertensive drugs has negative effects on blood pressure control.

Background Primary percutaneous coronary intervention (PPCI) is the standard treatment in patients with ST-segment elevation myocardial infarction (STEMI). Thrombectomy devices are used to remove thrombus or to prevent embolization of thrombus and plaque during PPCI. QT dispersion (the difference between maximal and minimal QT interval calculated on a standard 12-lead electrocardiogram) represents the regional nonuniformity of ventricular repolarization. It may reflect early coronary reperfusion in reducing electrophysiological instability by decreasing QT dispersion in the recovery phase after acute STEMI. Hypothesis Our aim was to show whether an additional effect of thrombectomy on reducing QT dispersion will be seen in patients undergoing PPCI for STEMI. Methods The study population included 80 consecutive patients who were admitted to the hospital within 12 hours after the onset of acute STEMI and angiographic evidence of intraluminal thrombus in the infarct-related artery. Patients with atrial fibrillation or flutter, intraventricular conduction abnormalities, pre-excitation, cardiogenic shock, cardiomyopathy, ventricular hypertrophy, and severe valvular heart disease were excluded from the study. Results There were no significant differences between groups regarding gender, age, cardiovascular risk factors, and time from symptom onset to treatment, except for smoking, which was much higher in the PPCI plus thrombectomy group. Infarct-related artery distribution (left anterior descending artery [LAD] to non-LAD), and neither the rate of balloon predilatation nor stent implantation were different between groups. Successful coronary patency was achieved in each case. QT interval measurements were similar between groups at admission. However, at 24 hours, QT and QTc dispersions were less in the PPCI plus thrombectomy group (41 ± 9 vs 33 ± 7 ms, P

Objective Although carotid stenting is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. Heart rate variability (HRV) is an established tool for the asessment of autonumic functions. In this study, our aim was to investigate the relation between the alterations in autonomic functions and HRV by Holter monitoring parameters. Methods Patients (19 male, 8 female) that are suitable for carotid artery stenting, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled to our study. Short-term HRV analysis recordings were obtained at the beginning, and after the procedure. The square root of the mean squared differences of successive NN intervals (RMSSD), total frequency, low frequency (LF), high frequency (HF), normalized units LF (LFnu), normalized units HF (HFnu), LF/HF ratios were analyzed. Results were statistically analysed by using Wilcoxon test. Results Total frequency did not show any significant changes after the procedure (1101 ± 829, 981 ± 855). While RMSSD and HFnu values significantly increased respectively (23 ± 12/33 ± 22, and 22 ± 10/35 ± 10, p < 0.05) after the procedure, HF values increased nonsignificantly after the procedure (82 ± 92/92 ± 108). LF, LFnu, and LF/HF values were significantly decreased after the procedure. (228 ± 166/112 ± 100, 70 ± 15/55 ± 18, 4 ± 2.5/2.1 ± 2, respectively, p < 0.05) Conclusions While RMSSD and HF are used as markers of vagal activity, LF is a marker of sympathetic modulation and LF/HF ratio shows sympathovagal balance. In our study, we showed that carotid artery stenting is associated with increase in parasympathetic activation, and this finding is demonstrated by HRV parameters.

Coronary perforation is a rare complication of percutaneous coronary intervention. A 60-year-old male patient with a diagnosis of hepatocellular carcinoma was admitted to our hospital with crescendo anginal attacks. Coronary angiogram revealed significant stenosis in distal left main coronary artery (LMCA). After implanting a 4.0×18 mm coronary stent from LMCA to left anterior descending artery (LAD), coronary angiography showed a perforation in the proximal part of the LAD and a plaque shift to the osteum of circumflex artery (Cx), causing 60% stenosis. Rupture was sealed by implantation of a polytetrafluoroethylene (PTFE) coated stent in proximal LAD. Due to ongoing chest pain and electrocardiographic ischemic changes, a 3.5×18 mm coronary stent was implanted in Cx. Unfortunately, another perforation occurred in Cx. The PTFE coated stent was not flexible enough to advance from the former LMCA to LAD stent to the Cx artery, and another 3.5×18 mm coronary stent was deployed in Cx artery successfully. Although control angiography showed complete sealing of the rupture, echocardiography showed a large pericardial effusion compressing the right side of the heart. Autotransfusion was done to stabilize the hemodynamic status. One-week later, coronary angiography did not show any contrast agent extravasation. In this case, we present double coronary perforations of the LAD and Cx arteries, and successful treatment with both covered and conventional stents and autotransfusion.

Introduction: In the developed countries, stroke is the third most common cause of death. There are many data indicating that stents reduce the risk of embolism but there are few publications assessing whether different stent designs can influence the peripro cedural complications. Aim: To determine the effects of open- and closed-cell stent designs on 1-month results of carotid artery stenting (CAS). Material and methods: The study group consisted of 290 consecutive patients (216 men and 74 women, mean age 66.6 ±8.7 years). Neuroprotection with a distal protection device was used in all cases. The patients were divided into two groups: the opencell stent group ( n = 144) and the closed-cell stent group ( n = 138). Major adverse cardiac and cerebrovascular events (MACCE) described as myocardial infarction, stroke and death within 1 month were recorded and analysed subsequently. Periprocedural hypoten sion and transient cerebral ischaemia at 1 month after the CAS procedure were also assessed. Results: We treated 290 carotid stenoses and stents were implanted in all patients. Fifteen patients (5.5%) were treated by staged CAS due to bilateral carotid artery disease. The technical success rate was 97.2%. There was no difference in the MACCE and tran sient cerebral ischaemia rate at 1 month between the two groups ( p = 0.44 and p = 0.94, respectively). The incidence of ischaemic stroke was lower in the closed-cell stent group (2.77% vs. 0%; p = 0.04). The periprocedural rate of hypotension was higher in the closed-cell stent group (2.1% vs. 7.2%; p = 0.04). Conclusions: Closed-cell stents are associated with a low rate of ischaemic stroke. We think that closed-cell stents may be pre ferred in patients at high risk of embolism.

Objectives: We evaluated clinical practice in cardiovascular risk management and related patient compliance among Turkish hypertensive patients. Study design: This noninterventional, observational study included 1023 patients (620 women, 403 men; mean age 58.4±10.6 years) with essential hypertension, from 50 centers across Turkey. Patients were evaluated at a cross-sectional phase and a follow-up phase of nine months. Data obtained at the cross-sectional phase included patient demographics, medical and past history, cardiovascular risk status, and current practice patterns regarding cardiovascular risk management. Results: The mean duration of hypertension was 8.1±7.1 years. The mean body mass index was 30.3±5.2 kg/m 2 and systolic and diastolic blood pressures (BP) were 147.8±22.4 and 88.9±12.5 mmHg, respectively. Ten-year coronary heart disease risk and risk level were significantly higher in males, and significantly increased in the presence of diabetes, metabolic syndrome, and renal disease and/or microalbuminuria (p

Clinical and demographic characteristics of the groups such as age, gender body mass index, systolic and diastolic blood pressure showed no statistically significant differences between both groups. Although there was no difference in QTd values between groups at baseline (43,28 ± 12,55 msec in the positive ETT group, and 40,28 ± 11,08 msec in the control group, p=NS), peak exercise QTd was much higher in the positive ETT group than the control group (57,40 ± 13,70 msec and 28,23 ± 5,05 msec, respectively, p< 0.01). Since QTd greater than 60 msec related to ischemia has been previously reported, ETT positive patients were reevaluated in two different subgroups with QTd ? 60 msec (34 patients), and QTd < 60 msec(32 patients). The sum of ST depression were much more in the QTd ? 60 msec group (7,22 ± 0,74 vs 4,40 ± 1,78; t: -8,458, p, Amaç: Pozitif egzersiz testi ile birlikte angina ya da angina benzeri göğüs ağrısı ve normal koroner anjiografi ile karakterize kardiyak sendrom X'in (KSX) gerçek nedeni tartışmalıdır. QT dispersiyonu (QTd) ölçümü miyokard heterojenitesini gösteren invazif olmayan bir yöntemdir. İskemik miyokardın iskemik olmayan miyokardla repolarizasyon süresi farkı QTd'de uzamaya yol açar. Bu çalışmanın amacı KSX'li hastalarda QTd ölçümü ile etyolojik bir faktör olarak iskemi varlığının araştırılmasıdır. Yöntem: Stabil angina pektorisi olan 105 hasta çalışmaya dahil edildi. Toplam 105 hastanın 66'sı (38 kadın, 28 erkek, ortalama yaş: 48,08±10,21) pozitif egzersiz testi ve normal koroner anjiografi ile KSX olarak teşhis edildi. 39 hastadan oluşan kontrol grubu (24 kadın, 15 erkek, ortalama yaş: 50,84±11,34) ise negatif egzersiz testi ve normal koroner anjiografiye sahipti. QT intervali istirahat ve zirve egzersiz sırasında alınan standart 12 derivasyonlu elektrokardiyografi üzerinden ölçüldü. QTd maksimum

BACKGROUND Advanced atrioventricular block is a frequent complication in patients with inferior acute myocardial infarction (AMI); in patients in hospital, it often occurs concurrently with other complications and is associated with high mortality. Very little information is available about early and late advanced atrioventricular block in inferior AMI. We hypothesized that the time of appearance of advanced atrioventricular block characterized by poor response to atropine requiring temporary pacemaker therapy may affect the prognosis of patients with inferior AMI. METHODS We studied 51 patients with inferior AMI and advanced atrioventricular block characterized by poor response to atropine requiring temporary pacemaker therapy. According to pre-established electrocardiographic criteria and the time of appearance of the advanced atrioventricular block, patients were divided into two groups: an early block group consisting of 30 patients who developed advanced atrioventricular block during the first 24 h of inferior AMI, and a late block group consisting of 21 patients who developed advanced atrioventricular block after the first 24 h of chest pain. RESULTS The groups were similar regarding age, coronary risk factors, frequency of right ventricular infarction, QRS score, atrial and ventricular rates, the time of return to first-degree atrioventricular block, cardiac arrhythmias, heart failure and mortality. The early advanced atrioventricular block group included a greater number of men than did the late group (P = 0.017). CONCLUSION These data suggest that the time of appearance of advanced atrioventricular block does not affect the prognosis of hospital patients with inferior AMI.

OBJECTIVE The aim of this study was to evaluate the relation between blood gamma-glutamyltransferase (GGT) levels and coronary collateral circulation in patients with chronic total occlusion (CTO). METHODS Two hundred twenty-two patients with chronic stable coronary artery disease (CAD) and CTO were included in this cross-sectional, observational study. Coronary collaterals were graded from 0 to 3 according to the Rentrop method. Patients with grade 0-1 collateral development were regarded as poor collateral group (n=66) while patients with grade 2-3 collateral development were regarded as good collateral group (n=156). Statistical analysis was performed using independent samples t, Mann-Whitney U and Chi-square tests, logistic regression and receiver operator curve analysis. RESULTS The poor coronary collateral group had significantly higher levels of serum GGT compared to the good collateral group (p

The influence of plasma adiponectin levels on myocardial contractile function has not been fully examined. We aimed to investigate the relationship between three-directional systolic function and plasma adiponectin levels in asymptomatic hypertensive patients using two- dimensional speckle-tracking echocardiography. The study population consisted of 78 patients with hypertension and 40 healthy controls. Longitudinal strain was significantly reduced in all patients, including those without LV hypertrophy (p = 0.009). In multiple-regression analysis, plasma adiponectin levels (β = −0.273, p = 0.008) and LV mass index (β = 0.458, p

OBJECTIVE No data exist on the functional relevance of collateral vessels in patients undergoing percutaneous coronary intervention (PCI). Also, the subtle effects of improved collateral flow on right ventricular (RV) function are difficult to assess. However, novel echocardiographic approaches like tissue-Doppler imaging (TDI) and two-dimensional speckle-tracking echocardiography (2DSTE) can quantify RV regional myocardial function. We hypothesized that these techniques may help delineate revascularization therapy-induced changes in regional RV contractility that escape clinical routine studies. METHODS This study was a prospective registry of consecutive patients undergoing PCI for a collateral supplying artery. All included patients underwent standard echocardiography with TDI and 2DSTE to assess RV function before successful PCI and it was repeated after 24 hours and 1 month. RESULTS There were no significant changes in either the RV systolic myocardial velocities, or the tricuspid annular plane systolic excursion values. However, RV free wall longitudinal strain/systolic strain rate values showed a significant increase 24 hours after PCI when compared to baseline (-25.9 +/- 6.8% vs. -21.5 +/- 6.6%, P < 0.001 and -2.18 +/- 0.40/s vs. -1.64 +/- 0.41/s, P < 0.001, respectively). Also, the improvement of RV function was further suggested by the tendency of RV isovolumic acceleration to be higher when compared with baseline at 1 month of follow-up (2.49 +/- 0.7 m/s2 vs. 2.1 5 +/- 0.6 m/s2, P = 0.056). CONCLUSION Both TDI-derived isovolumic acceleration and 2DSTE-derived strain/strain rate produced a similar picture with respect to the change in RV contractile function. However, 2DSTE indicated a much more pronounced and earlier improvement of systolic function; therefore, 2DSTE could be included in future studies that involve functional relevance of collateral vessels.

Coronary subclavian steal syndrome refers to decreased or reversed internal mammary artery flow, which causes angina related to severe subclavian steno-occlusive disease in patients with in situ internal mammary-to-coronary artery graft. We present a 48-year-old man with cerebrovascular and peripheral artery disease and the first case in the literature of a saphenous vein graft-coronary-subclavian unidirectional steal syndrome.

The concurrence of acute coronary syndrome with allergy or hypersensitivity as well as with anaphylactic or anaphylactoid reactions is increasingly encountered in daily clinical practice. There are several reports associating mast cell activation with acute cardiovascular events in adults. This was first described by Kounis as 'allergic angina syndrome',progressing to 'allergic myocardial infarction'. The main mechanism proposed is the vasospasm of coronary arteries. We present a case of a 28-year-old man who was admitted to our hospital with thoracic pain and dyspnoea. The symptoms recurred after simultaneous use of 1 g amoxicillin/clavulanic acid orally and 1 g ampicillin/sulbactam parenterally for tonsillitis the night before presentation and on the morning of admission.

Although carotid artery stenting (CAS) is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. And, autonomic functions influence P-wave durations. In this study, our aim was to investigate P-wave durations on 12-lead surface electrocardiography after CAS.Patients (19 male, 8 female) who are suitable for CAS, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled in our study. 12-lead surface electrocardiography recordings were obtained at the beginning, immediately after and at the 24 h of the procedure. P-wave maximum, minimum and dispersion durations were analyzed by double-blinded observers. Results were statistically analysed using Friedman and Wilcoxon tests.The P maximum and P dispersion values were significantly increased immediately after the procedure and continued with high levels at 24-h recordings, respectively (128 ± 10/19 ± 7, 143 ± 14/37 ± 11, and 137 ± 11/30 ± 7 ms, p value0.05). The P minimum value was significantly decreased immediately after the procedure (109 ± 11/105 ± 10 ms, p value0.05). At 24-h recordings, a nonsignificant increase occured in P minimum values (106 ± 8 ms).P maximum and dispersion durations were significantly increased after the CAS and continued with high levels at 24-h recordings, which may be associated with the alterations in autonomic functions via augmented parasympathetic activity by vagally mediated stimulus. Overall, these findings suggest that decline in cardiovascular activity is prolonged at least 24 h after CAS.

Background: The purpose of this article is to investigate the functional relevance of coronary collateral circulation and estimate the quality of the distal run-offs in patients with coronary chronic total occlusion (CTO). Methods: We analyzed the 267 consecutive patients who underwent PCI for CTO. In 119 patients, the distal portion of total occlusion was filled with ipsilateral collateral connections (ipsilateral group), and in 103 patients, it was filled with contralateral collateral connections (contralateral group). The target vessel diameter and dilatation rates of the groups were evaluated and compared for the echocardiographic parameters. Results: The principal finding in this study is that mean value of the target vessel diameter beyond occlusion was significant higher in the contralateral group than in the ipsilateral group (p

Aim: The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).Materials and Methods: We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.Results: The 2 groups were not significantly different with respect to demographic and operative data (P > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (P < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (P < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (P = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.Conclusion: Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.

PP-190 The aim of the present study was to analyze anterolateral papillary muscle longitudinal strain (ALPM-St), posteromedial papillary muscle longitudinal strain (PMPM-St), anterolateral papillary muscle time to peak longitudinal strain (ALPM-time), posteromedial papillary muscle time to peak