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Objective: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey. Methods: The ARNi-TR is a multicenter, nonintervention al, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control. Results: N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p

We report the case of a 52-year-old female diagnosed with Brugada syndrome (BrS) scheduled to undergo right total knee arthroplasty. General anaesthesia was induced and maintained with thiopental intravenous sodium + remifentanil and sevoflurane + remifentanil infusion, respectively. Rocuronium bromide was used as the muscle relaxant. The defibrillator was ready for use with the electrodes on the patient. Sugammadex was used for muscle relaxant antagonization. Postoperative analgesia was provided by intermittent morphine HCL via an epidural catheter, intravenous patient-controlled analgesia (Meperidine), and intravenous tenoxicam. The patient was discharged on the 6th day without any problem. Anaesthetic management of patients with BrS is challenging for anaesthesiologists, because fatal cardiac arrhythmias can be triggered by many drugs commonly used in the perioperative period such as bupivacaine, lidocaine, neostigmine, propofol, succinylcholine, ketamine, and tramadol. In these cases, a detailed preoperative evaluation including family history, avoidance of drugs triggering arrhythmia, taking precautions against arrhythmia, and using the agents that are reported to be safe are essential for patient safety.

Introduction. Although cardiac function appears normal in patients with cirrhosis at rest, cardiac function deteriorates in these patients under stress conditions. Decreased cardiac function against stress may be due to coronary microvascular dysfunction in these patients. In this study, we aimed to evaluate coronary microvascular dysfunction in patients with cirrhosis by measuring coronary flow reserve (CFR) by transthoracic echocardiography. Materials and methods. Thirty-eight patients with cirrhosis and 32 healthy subjects (as control group) were examined. In addition to standard two-dimesional (2D) and Doppler echocardiography, coronary flow velocity was measured by pulsed-wave Doppler from the middle to the distal part of the left anterior descending artery at the beginning and after dipyridamole infusion in the hyperemic state. CFR was measured as the ratio of hyperemic peak diastolic flow rate to basal peak diastolic flow rate. Results. CFR was significantly lower in the cirrhosis group than in the control group (2.01 ± 0.31 and 2.84 ± 0.62; p Conclusions. Impaired CFR in patients with cirrhosis promotes coronary microvascular dysfunction. The coronary microvascular dysfunction can potentially contribute to the development of cirrhotic cardiomyopathy.

Amaç: Yüksek kan basıncının karotis arterler üzerinde istenmeyen etkilere yol açtığı iyi bilinmesine ragmen bu etkinin hangi değerden itibaren başladığı net değildir. Bu çalışmanın amacı bunu değerlendirmektir. Yöntem: Çalışma kesitsel planlandı ve toplam 308 birey dahil edildi. Sistolik kan basıncı (SKB) 0.05) ancak grup 3 ile 1 arasında anlamlı fark vardı (p135,5 mmHg olmasının%78,2 sensitivite, %74,6 spesifite, DKB>86,5 mmHg olmasının %79,3 sensitivite ve %71,6 spesifite ile karotis distensibilitesini etkilemeye başladığı bulundu. Benzer olarak SKB>137,5 mmHg olmasının %80,4 sensitivite, %73,1 spesifite, DKB>88,5 mmHg olmasının ise %79,1 sensitivite ve %73,8spesifite ile karotis elastisitesini etkilemeye başladığı gösterildi. Sonuç: Karotis distensibilitesi ve elastisitesi kan basıncının artışı ile azalmaktadır. Yüksek-normal kan basıncına sahip bireylerde belirli bir kan basıncı değerinden sonra karotis hasarı başlıyor olabilir.

Objectives: SMYRNA-HF study is a prospective multicenter registry study to determine the profiles of patients with heart failure (HF) in Turkey. This study aimed to present the baseline characteristics of preliminary cohort by comparing them according to different HF phenotypes. Methods: The first SMYRNA-HF cohort included outpatients with HF from 9 centers. Patients were classified into three HF phenotypes as HF with reduced ejection fraction (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF) as recommended by guidelines. Results: Overall, 298 patients were included in this preliminary analysis that 57% of the patients were classified as having HFrEF, 33.3% as having HFpEF, and 9.7% as having HFmrEF. Female gender was more common in HFpEF (p = 0.003). Age, frequency of diabetes mellitus, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker, use of beta-blocker, use of daily loop diuretic, heart rate, blood urea nitrogen levels, lipid profiles, hemoglobin, white blood cell, platelet levels were similar among three HF phenotypes. Body mass index (BMI) (p < 0.001), frequency of hypertension (HT) (p < 0.001), and atrial fibrillation (AF) (p = 0.015) were higher in HFpEF. Ischemic etiology (p < 0.001) was less frequent in HFpEF. Use of mineralocorticoid receptor antagonist was higher in HFrEF (p < 0.001). Conclusions: Our study presented the baseline characteristics of outpatients with HF in Turkey. There were significant differences among HF phenotypes in terms of gender, BMI, frequency of HT, AF, and ischemic etiology. Treatment implementations seem to follow the guidelines. Although the rates are low, new treatment approaches recommended in the most recent guidelines seem to enter clinical practice.

Although it is well known that obesity increases the risk of atherosclerosis in carotid arteries, it is not clear whether this risk changes after obesity surgery. The aim of this study was to investigate whether weight reduction with a laparoscopic sleeve gastrectomy (LSG) has any effect on distensibility and elasticity which show subclinical atherosclerosis in the carotid arteries of obese individuals. This prospective study included 130 patients (body mass index (BMI) 48.21 ± 6.97 kg/m2) who underwent LSG. The patients were followed up for 1 year. Comparisons were made of the distensibiliy and elasticity values calculated preoperatively and at 1, 3, 6, and 12 months, postoperatively. There was a statistically significant increase in distensibility and elasticity values from baseline to 1, 3, 6, and 12 months postoperatively (p

Background: The aim of our study was to determine the optimization of the change in epicardial fat thickness in obese patients who underwent bariatric surgery with Central Composite (CCD) and Box-Behnken Experimental design (BBD). Methods: Response Surface Methods are used to see the sensitivity of the assessment criterion to changes in design variables, and even to obtain the necessary correlations experimentally. Response surface methods are evaluated in two different ways as CCD and BBD design. In this study, 33 experimental designs were designed. The study data consisted of 40 obese patients who lost weight by bariatric surgery between February 2015 and December 2016. Body Mass Index (BMI), Age and HOMA values were evaluated in 3 categories and 3 levels, and response variable was the change in Epicardial Fat Thickness (ΔEFT). Results: As a result of CCD analysis, Age = 30.52, BMI = 45.30, HOMA = 34.62, the optimum ΔEFT = 2.571. As a result of BBD analysis, Age = 38.36, BMI = 63.18, HOMA = 14.95, the optimum ΔEFT = 3.756. Optimum ΔEFT is modeled with Contour and Response surface graphics. Conclusion: According to the results of the analysis, it was found that BBD analysis for optimum ΔEFT was more positive than CCD and optimum age, BMI and HOMA combinations were determined to reach maximum ΔEFT.

Amaç: Diyabet (D) ve prediyabette (PD) vasküler yapıların ve gözün etkilenmesi bilinen bir komplikasyondur. Çalışmamızda PD ve D hastalarında damarsal yapılardaki değişiklikleri karotis intima-media kalınlığı (KIMK) ve epikardiyal yağ kalınlığı (EYK) ölçerek ateroskleroz gelişim riski açısından, gözde ise optik koherens tomografi anjiografi (OKTA) kullanarak retinal ve koroidal vasküler değişiklikler açısından sunmayı amaçladık.Gereç ve Yöntem: Çalışmamızda Mayıs 2017- Haziran 2017 tarih aralığındaki laboratuar verilerine göre prediyabet ve diyabet tanısı alan hastalarda KIMK, EYK ölçümü ile ateroskleroz riski ve OKTA tekniği ile retinal ve koroidal vasküler değişiklikler; 19 prediyabetik, 12 diyabetik olguda, hastaların yaşı ve cinsiyeti benzer olan 31 normal kan şekeri seviyesine sahip bilinen koroner arter hastalığı olmayan kontrol (K) grubu ile karşılaştırılarak kaydedildi.Bulgular: Diyabetik 12 hasta (7 kadın, 5 erkek, ortalama yaş 54.2±6.2), PD 19 hasta (ortalama yaş 51±8.6, 11 kadın, 8 erkek) ve 31 K grubu (ortalama yaş 50,9±11.2, 18 kadın, 13 erkek) çalışmaya dahil edilmiştir. KIMK en yüksek diyabetli hastalarda, daha sonra PD ve en az miktarda kontrol hastalarında bulunmuştur. EYK'de gruplar arası farklılık ayırtedilmedi. OKTA verilerine göre en sık bulgu non-perfüzyon, FAZ (foveal avaskuler zon) erozyonu ve venöz göllenme olup en fazla diyabetli hastalarda, sonra PD ve en az K grubunda izlenmiştir.Sonuç: Subklinik aterosklerozun belirteçleri olan KIMK ve EFT’ye ek olarak retinal vasküler hastalıkların OKTA ile girişimsel olmayan yöntemlerle değerlendirmesinde glukoz metabolizması bozukluğu olan hastaların risk değerlendirilmesinde katkı sağlayacaktır., Aim: It is a well-known complication that diabetes (DM) and prediabetes (PD) affectsvascular structures and eye. In our study we aim to find out the atherosclerotic changes in patients with PD and DM by using carotis intima-media thickness (CIMT), epicardial fat thickness (EFT) and rusing optical coherence tomography angiography (OCTA).Materials and Methods: Between May 2017- June 2017 consecutive 19 patients with PD and 12 patients with D were enrolled into the study. They compared with age sex matched control (C) group consisted of 31 individuals who have normal blood glucose levels. Patients with coronary artery disease was excluded. Measurements of CIMT, EFT and retinal and choroidal vascular changes by using OCTA technique obtained from our study group were recorded and compared with each other.Results: Twelve patients with D (5 male,7 female, mean age 54.2±6.2), 19 patients with PD (8 male, 11 female, mean age 51±8.6) and 31 C group (13 male, 18 female, mean age 50.9±11.2) were included in the study. The highest value of CIMT was found in patients wih D following by patients with PD and control group had the lowest values. There was no difference between groups in EFT. The most common findings in OCTA were non-perfussion, FAZ (foveal avascular zone) erosion and venous pooling. Similarly these findings were more frequent in patient DM following by patients with PD.Conclusion: Non invasive measurement of CIMT, EFT and retinal vascular changes detected by OCTA are useful and feasible tools for the assessment of subclinical atheroscleoris in patients with glucose metabolism disorders.

Cardiovascular disease (CVD) is one of the leading causes of mortality in obese patients. We aimed to investigate the influence of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on carotid intima media thickness (CIMT) and epicardial fat thickness (EFT) which are the independent predictors of subclinical atherosclerosis.Patients were recruited for standard indications. A total of 105 patients (79 women and 26 men) with the mean age of 43.61 ± 12.42 were prospectively enrolled. On B-mode duplex ultrasound; the mean CIMT at the far wall of both left and right common carotid arteries were measured. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Delta (Δ) values were obtained by subtracting sixth month values from the baseline values. Body mass index (BMI) was significantly reduced from 46.95 ± 7.54 to 33.54 ± 6.41 kg/m2 (p 0.001) in sixth months after LSG. Both EFT and CIMT were significantly decreased after surgery (8.68 ± 1.95 mm vs. 7.41 ± 1.87 mm; p 0.001 and 0.74 ± 0.13 mm vs. 0.67 ± 0.11 mm; p 0.001 respectively). A significant correlation between ΔEFT and ΔBMI (r = 0.431, p 0.001) was shown. ΔCIMT is significantly correlated with ΔEFT, ΔBMI and Δ systolic blood pressure (r = 0.310, r = 0.285 and r = 0.231 respectively, p 0.05 for all). In multivariate stepwise linear regression analysis; among variables only ΔBMI was the independent predictor of ΔEFT (β = 153, p = 0.001).Early atherosclerotic structural changes may be reversed or improved by sustained weight loss after LSG in asymptomatic obese patients.

Aim Gestational hypertension (GHT) is a common disorder of pregnancy characterized by new onset hypertension without the presence of detectable proteinuria after 20 weeks of gestation. Epicardial fat thickness (EFT) and carotid intima media thickness (CIMT) are suggested as new predictors of subclinical atherosclerosis. Although the relationship between these parameters and essential hypertension has been demonstrated, this association in patients with GHT is still unknown. We aimed to investigate CIMT and EFT in patients with GHT. Methods A total of 90 patients (44 GHT and 46 controls) were enrolled. Patients with diabetes mellitus, chronic hypertension and cardiovascular disease (CVD) were excluded. In the third trimester, the mean CIMT at the far wall of both left and right common carotid arteries was measured on B-mode duplex ultrasound. EFT was measured on the free wall of the right ventricle at the end systole in the parasternal long-axis view by standard transthorasic 2D echocardiography. Results Unlike the mean CIMT (0.52 ± 0.13 mm vs 0.47 ± 0.11 mm; P = 0.078), the mean EFT was significantly higher in the GHT group compared to the controls (5.31 ± 1.68 mm vs 4.17 ± 1.16 mm; P = 0.002). In multivariate logistic regression analysis, among the most pertinent clinical variables, only EFT is an independent determinant of GHT (OR: 2.903; 95% confidence interval [CI]: 1.454-5.796; P = 0.003). In receiver operating characteristic (ROC) analysis, EFT >5.5 mm had 82.6% specificity and 52.3% sensitivity in predicting a diagnosis of GHT (ROC area under curve: 0.689, 95% CI: 0.577-0.802, P = 0.002). Conclusion Maternal EFT may be higher in pregnant women with GHT in comparison with those of controls.

Background The aim of this study was to detect the optimal values for Age, Body Mass Index (BMI) and HOMA-IR of obese patients prior to surgery that results in a maximal decrease of visceral fat mass 6 months after bariatric surgery. Method In this study, 33 experimental set-ups were designed. This study was approved by Baskent University Medical and Health Sciences Research Board (Approval number: KA16/281). The study data consisted of 40 obese patients who lost weight through the bariatric surgery between February 2015 and December 2016. The values of BMI, Age and HOMA for the obese patients who lost weight through the bariatric surgery were evaluated in three categories and at three levels; the response variable was determined as the Change in Epicardial Fat Thickness (ΔEFT). Results As a result of CCD analysis, the optimum ΔEFT = 2.571 was determined when Age = 30.52, BMI = 45.30, and HOMA = 34.62. As a result of the BBD analysis, the optimum ΔEFT = 3.756 was determined, when Age = 38.36, BMI = 63.18, and HOMA = 14.95. The optimum ΔEFT was modeled with Contour and Response Surface plots. Conclusion Based on the two surface response models used in our study, the maximal decrease of visceral fat mass as assessed by measuring echography images of epicardial fat thickness can be obtained by bariatric surgery of persons who are between 31 and 38 year old, have a BMI between 45 and 63 kg/m2 and have a HOMA-IR 34 between 15 and 35. Central Composite Design and a Box-Behnken Design of suitable patient data predicted 35 optimal settings of independent variables for the maximal clinical response of an intervention.

Since asthma and atherosclerosis may share similar pathophysiological mechanism, this study is planned to investigate whether epicardial fat thickness (EFT), carotid and femoral intima media thicknesses, which are markers of subclinical atherosclerosis, are increased in patients with asthma.The study was designed as a cross-sectional study. A total of 154 participants (83 patients with asthma and 71 healthy volunteers) were enrolled into the study. Epicardial fat, carotid, and femoral intima media thicknesses were measured and recorded in both groups. The statistical difference between the two groups was examined.Both carotid and femoral intima media thicknesses were significantly higher in patients with asthma compared to control group (5.52 ± 0.4 mm vs. 5.36 ± 0.4 mm; p = 0.038 and 5.64 ± 0.4 mm vs. 5.46 ± 0.5 mm; p = 0.036, respectively). However, there was not a significant difference in EFT between the groups [5.9 mm (5.3-6.6; IQR = 1.3) vs. 5.6 mm (4.7-6.5; IQR = 1.8); p = 0.1]. On comparison of control group and asthma subgroups (mild, moderate, and severe), there was a statistically significant difference among these four groups in terms of carotid and femoral intima media thicknesses (p = 0.002 and p0.001, respectively). Subgroup analyses showed that this difference was mainly due to patients with severe asthma.Carotid and femoral intima media thicknesses in asthmatic patients were found to be increased compared to the normal population. As a result, the risk of subclinical atherosclerosis in asthmatic patients may be high.

Objective: Myocardial infarction is a leading cause of morbidity and mortality. Fibrinolytic administration is still a life-saving choice in ST-segment elevated myocardial infarction (STEMI), but the rate of successful reperfusion can be inconsistent. Failed reperfusion adds additional clinical risks to rescue percutaneous coronary intervention for STEMI patients. The interval between the peak of the T wave and the end of the T wave (Tpe) and the ratio of Tpe and a corrected measurement of the time from the start of the Q wave to the end of the T wave (Tpe/QTc ratio) are relatively new electrocardiogram (ECG) indices and have not yet been tested in STEMI patients treated with fibrinolytic agents. Methods: A total of 177 STEMI patients (mean age: 60.5+-11.1 years; 138 men and 39 women) were enrolled in this retrospective study to evaluate ECG parameters. The Tpe interval and the Tpe/QTc ratio at baseline and at the 90th minute following the administration of fibrinolytic therapy were analyzed. The clinical and ECG findings of successful and failed reperfusion groups were compared. Results: Successful reperfusion was achieved in 119 patients (67.2%). The average Tpe interval on the admission ECG was shorter (91.7 vs. 100.9 milliseconds [ms]) (p

Objective: Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases. The impact of AF on in-hospital outcomes in acute decompensated heart failure (ADHF) is controversial. The aim of this study is to determine the prevalence of AF among hospitalized patients with ADHF and describe the clinical characteristics and in-hospital outcomes of these patients with and without AF. Methods: We examined the multicenter, observational data from the real-life data of hospitalized patients with HF: Journey HF-TR study in Turkey that studied the clinical characteristics and in-hospital outcomes of hospitalized patients with ADHF between September 2015 and September 2016. Results: Of the 1,606 patients hospitalized with ADHF, 626 (39%) had a history of AF or developed new-onset AF during hospitalization. The patients with AF were older (71+-12 vs. 65+-13 years; p

Introduction Pericardium is a fibroserous sac surrounding the heart and the roots of the great vessels. Pericardial agenesis which is a rare condition can be complete or partial and the most common form is absence of left hemipericardium. Pericardial agenesis is often an incidental finding, as it is usually asymptomatic. Moreover patients presenting with symptoms can be missed diagnosed, because it can be difficult to visualise the pericardium clearly with imaging modalities. Herein we present a misdiagnosed pericardial agenesis case. Case Report A 49 years old male was admit to our cardiology clinic for confirmation, and follow-up of a previous diagnosis of right ventricular cardiomyopathy (CMP). He had been previously diagnosed based on transthoracic and transesophageal echocardiography findings 13 years ago. Since then he had been attending routine follow-ups, he had also underwent several imagining modalities even cardiac magnetic resonance (CMR) to confirm the diagnosis of right ventricular CMP. No arrhythmia had been detected in Holter monitoring. He had no dyspnea, or other specific signs and symptoms. His medical and family histories were otherwise unremarkable. A 12-lead electrocardiogram (ECG) showed normal sinus rhythm without having specific abnormalities. The chest X-ray revealed laevorotation of the heart (Fig A). The transthoracic echocardiography showed a laterally displaced left ventricle (LV) apex, and an enlarged right ventricle (RV) with normal systolic function (Fig B). Coronary computed tomography angiography (CCTA) revealed normal coronary arteries, leftward displacement of the heart with mild RV dilatation. The pericardium was only visible around right atrium (Fig C). CMR demonstrated mild RV dilatation (end-diastolic volume 167ml) with reasonable systolic function (EF 50%), normal LV dimensions with normal systolic function (Fig D). The absence of pericardium at both left and right sides, except around right atrium, was confirmed, whereas there was no additional finding such as wall motion abnormality. Therefore the patient was diagnosed with partial pericardial agenesis and scheduled for follow-ups. Conclusion The pericardial agenesis which is a rare disorder is generally benign. Although MRI is believed to be the gold standard technique, it might not be able to delineate entire pericardium, because of various artefacts or paucity of surrounding fat. Therefore physicians should be aware of the indirect signs on various imaging modalities like excessive laevorotation of the heart, as direct recognition can be tricky, and the patient can be easily missed and/or misdiagnosed. Our patient was asymptomatic. His pericardial defect was almost total and this abnormality hadn’t been recognized in his previous CMR or echocardiograpy, leading to a misdiagnosis of CMP. Complete or unilateral absence of the pericardium is considered to be benign, surgical pericardioplasty may only be considered for highly symptomatic patients. Abstract 498 Figure.

Amaç: Obstrüktif Uyku Apne Sendromu (OUAS) saptanan hastalarda vasküler endoteliyel işlev bozukluğu ve preaterosklerozis;brakial arter akım aracılı vazodilatasyon (BAAV), karotis arter intima-media kalınlığı (KIMK), mean platelet volume (MPV) veepikardiyal yağ dokusu (EYD) ölçümü yapılarak değerlendirildi. OUAS hastaları Apne-hipopne indekslerine (AHI) göre gruplaraayrılarak kıyaslandı.Hastalar ve Yöntem:Hastanemize uyku bozukluğu nedeni ile başvuran ve polisomniografi ile yapılan değerlendirmede AHİ değeri5 ve üstünde bulunan, hiperlipidemi, hipertansiyon, diyabetes mellitus ve bilinen kalp-damar hastalığı olmayan, yaşları 30-70arası, kadın ve erkeklerden oluşan hastalar çalışmaya dahil edildi. Bu hastalar AHI derecelerine göre hafif-orta ve şiddetli şeklindegruplandırıldı. Preateroskleroz KIMK, EYD kalınlığı ve MPV ile vasküler fonksiyon ve endotel hücre vazodilatasyonu ise BAEF bakılarak değerlendirildi. İstatistik olarak iki grup arasındaki farklılıklar değerlendirilmek istendiğinde parametrik test ön şartlarınısağladığı durumda “Student’s t Test”; sağlamadığında ise “Mann Whitney–U testi” kullanıldı.Bulgular: 23 hastanın 16 tanesi erkek, 7 tanesi kadındır. Yaş ortalaması 46,309,51 (31-65 yaş arası). Hastalar AHI indekslerinegöre (hafif:5-15, orta:16-30, şiddetli 30) olarak gruplandırıldığında karşılaştırma için kullanılan parametrelerde anlamlı farklılık saptanmadı.Sonuç: OUAS hastalarında kardiyovasküler riskin arttığı bilinmektedir. Çalışmamızda bu hastalarda hastalığın şiddeti ile preateroskleroz ve endotel fonksiyonun bozulması arasında bağlantı bulunmamıştır., Purpose: To investigate endothelial dysfunction and pre-atherosclerosis in patients with Obstructive Sleep Apnea Syndrome(OSAS) by using several parameters including Brachial Artery Flow-Mediated Vasodilation (BAFMV), Carotid Intima-MediaThickness (CIMT), Mean Platelet Volume (MPV) and Epicardial Fat Thickness (EFT). Patients with OSAS were classified accordingto the Apnea-Hypopnea Index (AHI).Patients and Methods: OSAS patients who have 5 or more AHI score were enrolled in the study. Patients with hypertension,hyperlipidemia, diabetes mellitus and cardiovascular diseases were excluded. Patients were classified as mild (5-10), moderate(16-30) and severe (30) according to AHI. These groups were compared to each other in terms of endothelial dysfunction andpre-atherosclerosis markers including BAFMV, CIMT, MPV and EFT. Groups were compared statistically by using either Student’sT-Test or Mann Whitney–U test.Results: Our study population consists of 23 patients with OSAS (16 male, 7 female) with the mean age of 46.309.51 yearsranging from 31-65 years. There were no significant differences in all parameters between the mild (5-10), moderate (16-30) andsevere (30) groups according to AHI.Conclusion: It is well known that patients with OSAS have an increased cardiovascular risk. In our study, no differences were shownbetween the progression of the disease and endothelial dysfunction and pre-atherosclerosis markers.

Background: Pulmonary hypertension (PH) is present in a sig- nificant proportion of patients with end stage renal disease (ESRD) and is of prognostic importance. Data on the effect of renal transplant on PH is very limited. In this study, the aim was to examine the effect of renal transplant on systolic pul- monary artery pressure (SPAP) determined by Doppler echocardiography. Methods: Analysis was performed on the records of 500 con- secutive patients who underwent renal transplant at our cen- ter between the years 1999 to 2008. The prevalence of PH in the preoperative assessment period was established. Patients were diagnosed as having PH when measured SPAP values were > 35 mm Hg. Results: Pulmonary hypertension was detected in 85 of the 500 (17%) patients under pre-transplant evaluation. At post-transplant follow up Doppler echocardiographic exam- ination was performed on 50 of the 85 patients. After exclu- sion of 8 cases (1 due to massive pulmonary thromboem- boli; 7 due to graft failure requiring dialysis therapy) analy- ses were performed on 42 patients who had undergone both pre- and post-transplant echocardiographic examination. Mean SPAP at pre-transplant evaluation was 45.9 ± 8.8 mm Hg and in 6 (14.3%) cases SPAP was above 50 mm Hg. Compared to pre-transplant values, a significant decrease was observed in mean SPAP values in an average of 53 months of postoperative follow up (41.8 ± 7.4 mm Hg vs. 45.9 ± 8.8 mm Hg, p < 0.0001). Conclusion: These findings indicate that patients with ESRD accompanied by PH may benefit from renal transplant. Further research is required for more concrete conclusions to be drawn on this subject.

OBJECTIVES Exaggerated blood pressure response (EBPR) to exercise tests is an additional cardiovascular risk factor and predictor of future development of hypertension. However, there are conflicting data on the diagnostic threshold of EBPR and its clinical importance in kidney disease. The aim of this study was to investigate vascular inflammation and subclinical nephropathy in otherwise healthy volunteers with EBPR. PATIENTS AND METHODS The study included 170 middle-aged, healthy volunteers (mean age: 43.3±6.9; range: 35-65 years: 100 men and 70 women). Participants performed a treadmill exercise test until they reached their age-adjusted maximum heart rate and were divided into EBPR and normal/physiological blood pressure response groups. Before exercise tests, serum high sensitive C-reactive protein (hs-CRP) and urine albumin-to-creatinine ratio were measured to evaluate vascular inflammation and subclinical nephropathy, respectively. Anthropometrical measurements, fasting serum glucose, fasting lipid profile, and the full blood count of participants were also evaluated. RESULTS EBPR was detected in 31 (18.2%) participants. Hs-CRP levels (1.03 vs. 0.46 mg/l) (P

OBJECTIVE There are various cardiovascular abnormalities in end-stage liver disease (ESLD). In these patients, left ventricular (LV) systolic function is normal at rest but deteriorates during stress. This deterioration may be due to subclinical myocardial dysfunction. This study evaluated global LV and right ventricular (RV) functions using 2-dimensional (2D) speckle tracking in patients with ESLD. METHODS Forty liver transplant candidates with ESLD and 26 healthy individuals were included in the study. All of the patients underwent conventional echocardiographic measurement. Longitudinal, circumferential, and radial strain measurements, as well as apical and parasternal short-axis image recordings were obtained. All 2D strain measurements were measured with offline analysis using velocity vector imaging (VVI) software. RESULTS In the apical 4- and 2-chamber measurements, the LV mean longitudinal strain was significantly lower in the patient group compared with that of the control group (-16.0±3.2% versus -17.6±2.2%, -16.7±3.3% versus -18.7 ±2.1 ± 2.1 %; p=0.002, respectively). The LV mean circumfe-rential strain did not differ between groups. The LV mean radial strain and RV longitudinal strain were significantly lower in the patient group (45.4±10.7 vs. 52.7±10.8%; p=0.01 and -19.2±3.5% versus -21.5±3.6%; p=0.03, respectively). CONCLUSION Subclinical impairment of global LV and RV systolic functions was determined in liver transplantation candidates using VVI. This deterioration was detected in longitudinal and radial deformation rather than circumferential deformation mechanics, which is consistent with early-stage LV myocardial dysfunction.

Patients with vitamin D deficiency (VDD) have potential to have increased cardiovascular morbidity and mortality. In this study, we aimed to discover the findings of early atherosclerosis in patients with VDD by measuring carotid intima-media thickness (CIMT) and epicardial fat thickness (EFT).The study population includes 52 patients with VDD (n = 30 [57% female], mean ± SD age 54.28 ± 8.77 years, mean ± SD serum 25-hydroxyvitamin D (25 [OH] D) 11 ± 2.4 ng/mL) and 82 participants for control group (n = 52 [63.4% female], mean ± SD age 56.40 ± 7.90 years, mean ± SD serum (25 [OH] D) 53 ± 4.2 ng/mL) who have no cardiovascular disease. Carotid intima-media thickness was assessed by using ultrasonography, and EFT was measured on the free wall of the right ventricle at end diastole from the parasternal long-axis views by standard transthoracic 2-dimensional echocardiography.Both CIMT and EFT were significantly higher in patients with VDD compared with controls (0.75 ± 0.16 mm vs 0.68 ± 0.21 mm, P0.05, and 0.66 ± 0.15 cm vs 0.56 ± 0.15 cm, P0.001).Patients with VDD seem to have increased CIMT and EFT, which are predictors of atherosclerotic process. Further studies are needed to confirm these results.

Aim: In this paper, itis aimed to investigate red blood celldistribution width (RDW), mean platelet volume (MPV) and coronary arterycalcium scores (CACS) in patients with and without coronary artery disease(CAD) detected by coronary computed tomography angiography (CCTA).Materials and Methods: Clinicalrecords of 172 patients who underwent CCTA due to the presence of angina-likesymptoms were retrospectively investigated. Clinical characteristics, riskfactors for CAD, CACS and biochemical parameters including RDW and MPV wererecorded.Results: Mean MPV (7.95 ±1.57 fL vs.7.12±1.26 fL, p, Amaç: Bu çalışmada, koroner bilgisayarlıtomografik anjiyografi (KBTA) ile saptanan koroner arter hastalığı (KAH) vekoroner arter kalsiyum skorunun (KAKS) kırmızı kan hücresi dağılım genişliği(RDW) ve ortalama trombosit hacmi (MPV) arasındaki ilişkinin değerlendirilmesi amaçlandı.Gereç ve Yöntem: Anjina veya benzeri semptomlar nedeniyle 64 kesitli KBTA uygulanan 172hastanın tıbbi kayıtları geriye dönük olarak incelendi. Hastaların kliniközellikleri, risk faktörleri, KAKS’ı da içeren KBTA sonuçları, RDW, MPVdeğerlerini de içeren biyokimyasal ve hematolojik parametreleri kaydedildi.Bulgular: Çalışma popülasyonu KBTA sonuçlarına göre KAH (n=85) ve normal koronerarter (NKA) (n=87) olmak üzere iki gruba ayrıldı. Ortalama RDW (%15,36±1,15’ekarşı %14,37±2,01; p

Background: The study was planned to assess potential differences in hypertension prevalance and hypertension related demographic properties in a urban area with relatively higher income and cultural population compared to national average. Methods: Field work was done by educated personel at Karşıyaka Municipality Building by one by one interviewing poll, blood pressure measurement, rhythm and body composition analysis in February 2014. Hypertension was defined as average systolic blood pressure ≥140 mmHg or average diastolic blood pressure ≥90 mmHg. Results: Out of total 1417 (627 males and 790 females) people enrolled, 780 people hypertensive(prevalence 55%). Hypertension prevalence in middle age group( age 35-65) was 46%, in geriatric age group(age>65) %79. 216 out of 780 hypertensive (27.7%) people were not aware of their disease. Ratio of people under antihypertensive treatment was 69.4% and ratio of people under control was 34.7%, whereas control rate was 50.1% in 541 patients who were aware of their diseases.Conclusions: Hypertension prevalances in our study were similar to PatenT2 trial prevalances, which were 46 % for middle age group and 78% for geriatric age group. Compared to PatenT 2 data, rate of hypertension awareness (54.7% vs 72.3%) and rate of being under treatment (47.5% vs 69.4%) were higher. Rate of controlled hypertension was a little big higher (28.7 % vs 34.7% )in our group, whereas control rates in aware and treated groups were similar (53.9 % and 50.1 %) in both study. Keywords: Hypertension, Prevalance, Awareness, Treatment

Aim: Elevated red blood cell distribution width (RDW) and mean platelet volume (MPV) levels which are closely associated with chronic inflammation and platelet aggregation are suggested as independent predictors of obesity and cardiovascular diseases. However influence of significant weight loss following bariatric surgery on these parameters is unknown. Therefore we aimed to find out the effect of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on RDW and MPV levels. Methods: The medical data of 98 morbid obese subjects (25 male, 73 female) who were operated between February 2015 and June 2017 according to indications of bariatric surgery in current guidelines including body mass index (BMI) >40 kg/m 2 or BMI= 35-40 kg/ m 2 with additional comorbidities were recorded. The difference between baseline and values at one year was expressed as a delta (Δ). Results: The mean age of our study population was 41.89±11.99 years and mean weight loss in one year after LSG was 45.41±13.13 kg (36.5%). BMI decreased from 46.60±7.11 kg/m 2 to 29.58±4.63 kg/m 2 . Compared to the baseline, significant decreases in RDW (14.61±1.69 % vs. 13.71±2.10 %; p

Different surgical procedures have been used in the management of chronic subdural hematoma (CSDH). Nowadays treatment with burr hole is more preferable than craniotomy in most clinics. We present two cases of CSDH, which caused neurological deficits. In both cases cortical membranectomy was performed following craniotomy. After this procedure, significant improvement was observed in patients neurological deficits. We recommend that craniotomy and subtotal membranectomy may be a more adequate choice in such cases. This report underlined that craniotomy is still an acceptable, safe, efficient and even a better procedure in selected patients with CSDH.

The association of obesity with atrial fibrillation (AF) and with ventricular arrhythmias is well documented. The aim of this study was to investigate whether weight reduction by a laparoscopic sleeve gastrectomy has any effect on P wave dispersion (PWD), a predictor of AF, and corrected QT interval dispersion (CQTD), a marker of ventricular arrhythmias, in obese individuals. In a prospective study, a total of 114 patients (79 females, 35 males) who underwent laparoscopic sleeve gastrectomy were examined. The patients were followed 1 year. PWD and CQTD values before and 3rd, 6th, and 12th months after the surgery were calculated and compared. There was a statistically significant decline in body mass index (BMI), PWD, and CQTD values among baseline, 3rd, 6th, and 12th months (p

Background: Renal artery stenosis can cause renovascular hypertension manifesting clinically as high blood pressure. Objectives: In this study, we determined the efficiency of non-contrast magnetic resonance angiography (NC-MRA) using the inflow inversion recovery (inhance) method in the evaluation of renal arteries of hypertensive patients. Patients and Methods: Three-dimensional (3D) contrast-enhanced magnetic resonance angiography (CE-MRA) and NC-MRA were used to prospectively evaluate 66 patients diagnosed with hypertension. 3D CE-MRA and digital substractional angiography served as the gold standards. Image quality, number of main/accessory renal arteries, and main renal artery diameters were assessed. Statistical analyses were based on paired-t tests and intra-class correlation coefficients. Results: Of the 126 main renal and 12 accessory renal arteries reviewed in this study, NC-MRA overall image quality was good or excellent in more than 89.5%. An image quality of 94% was recorded for both left and right sides with CE-MRA. The differences between the 3D CE-MRA and NC-MRA readings for the renal artery ostium and proximal, medial, and distal segment diameters were not significant (P > 0.05). Inter-reader agreement regarding all segments was excellent. 3D CE-MRA was superior to NC-MRA in assessing accessory renal arteries (detection ratio using NC-MRA: 7/12, 58%). Conclusion: NC-MRA using the inhance method to image the anatomy of the renal artery provides an alternative to CE-MRA in patients with hypertension.

Gestational hypertension (GHT) is a common disorder of pregnancy characterized by new onset hypertension without the presence of detectable proteinuria after 20 weeks of gestation. Epicardial fat thickness (EFT) and carotid intima media thickness (CIMT) are suggested as new predictors of subclinical atherosclerosis. Although the relationship between these parameters and essential hypertension has been demonstrated, this association in patients with GHT is still unknown. We aimed to investigate CIMT and EFT in patients with GHT.A total of 90 patients (44 GHT and 46 controls) were enrolled. Patients with diabetes mellitus, chronic hypertension and cardiovascular disease (CVD) were excluded. In the third trimester, the mean CIMT at the far wall of both left and right common carotid arteries was measured on B-mode duplex ultrasound. EFT was measured on the free wall of the right ventricle at the end systole in the parasternal long-axis view by standard transthorasic 2D echocardiography.Unlike the mean CIMT (0.52 ± 0.13 mm vs 0.47 ± 0.11 mm; P = 0.078), the mean EFT was significantly higher in the GHT group compared to the controls (5.31 ± 1.68 mm vs 4.17 ± 1.16 mm; P = 0.002). In multivariate logistic regression analysis, among the most pertinent clinical variables, only EFT is an independent determinant of GHT (OR: 2.903; 95% confidence interval [CI]: 1.454-5.796; P = 0.003). In receiver operating characteristic (ROC) analysis, EFT5.5 mm had 82.6% specificity and 52.3% sensitivity in predicting a diagnosis of GHT (ROC area under curve: 0.689, 95% CI: 0.577-0.802, P = 0.002).Maternal EFT may be higher in pregnant women with GHT in comparison with those of controls.

Coronary slow flow (CSF) may be a reflection of a systemic slow-flow phenomenon in the coronary arterial tree. In this study, the CSF group consisted of 24 men (77.4%) and 7 women (22.5%). An age- and gender-matched normal coronary artery (control) group was composed of 21 men (72.4%) and 8 women (27.5%). Retinal arteriovenous circulation time was measured using fundus fluorescein angiography as a part of the microcirculation and the circulation time between the antecubital vein and the retina as a part of the systemic circulation in patients with CSF and controls with normal coronary arteries. The mean arm-retina circulation time was 19.0 ± 5.7 seconds in the CSF group and 14.1 ± 3.1 seconds in the control group (p

Objective: The aim of this study was to investigate the relationship between oxidative/antioxidative stress markers and the diagnosis and complexity of coronary artery disease (CAD) in patients with stable CAD. Methods: A total of 145 patients were enrolled in the study. Based on coronary angiography results, the patients were categorized into 2 groups: those without CAD (Group 1) and those with CAD (Group 2). The patients in Group 2 were also categorized into low score and moderate/high score groups according to their SYNTAX score. The serum malondialdehyde (MDA) and total antioxidant capacity (TAOC) levels of Group 1 and Group 2 were compared. Finally, MDA and TAOC levels were compared between the moderate/high-risk and low-risk groups formed according to SYNTAX score. Results: There was a significant difference with respect to both serum TAOC and MDA levels between Group 1 and Group 2 (p=0.036 and p=0.029, respectively). The groups with a SYNTAX score 1-22 and with a SYNTAX score >22 were not significantly different with respect to serum TAOC or MDA level (p=0.582 and p=0.85, respectively). Conclusion: The serum MDA level was significantly higher and the TAOC level was significantly lower in patients with stable CAD compared to those without; however, these molecule levels failed to predict disease complexity in patients with stable CAD.

Impaired fasting glucose (IFG) and impaired glucose intolerance (IGT) are predictors of cardiovascular disease (CVD). We tested the hypothesis that epicardial fat thickness (EFT) and carotid intima–media thickness (cIMT), as markers of early atherosclerosis, are increased in patients with prediabetes. We prospectively enrolled 246 patients (162 with prediabetes and 84 controls). Prediabetes was defined according to American Diabetes Association criteria, and patients were divided into 3 groups: group 1—IFG, group 2—IGT, and group 3—IFG + IGT. Both cIMT and EFT were significantly greater in patients with prediabetes compared with controls (0.81 ± 0.20 mm vs 0.68 ± 0.16 mm, P < .001 and 7.0 ± 2.0 mm vs 5.6 ± 1.6 mm, P < .001, respectively). This difference was mainly attributed to patients with IGT. Age, waist circumference, and 2-hour glucose independently predicted cIMT, while 2-hour glucose was the only independent predictor of EFT in multivariate analysis among other relevant parameters for cIMT and EFT. The cIMT and EFT (measured noninvasively) could be useful indicators of CVD risk in these patients. In order to prove this hypothesis, long-term prospective studies with greater patient numbers are required.

Aim: Obesity is a disease that reduces the quality and duration of life and its prevalence is also increasing in the elderly population.In this study, we aimed to investigate the results of early and midterm weight loss and treatment of concomitant diseases and evaluate the safety and efficacy of bariatric surgery in patients aged 60 years and older who underwent Laparoscopic Sleeve Gastrectomy (LSG) in our clinic. Material and Methods: We retrospectively evaluated 28 morbid obese patients ≥60 years oldwho underwent LSG between September 2014 and January 2018.Data reviewed included age, sex, preoperative weight and body mass index (BMI), comorbid conditions, early or delayed complications, mortality, length of follow-up, weight lost, BMI points lost, and effects on obesity-related comorbid conditions. Results: Of 28 patients included in the study there were 22 (78.6%) females and 6 (21.4%) males. The average age of patients was 63.4±3.39.Preoperative mean BMI was 48.4±7.0kg/m2.Average follow-up period 20.67 month. Postoperative median BMI was,36.24kg/m2 in the 6th month, 33.47kg/m2 in the 1st year and 31.17kg/m2 in the 2nd year.Present comorbid conditions included 23 (82.1%) hypertension, 16 (57.1%) diabetes mellitus and 3 (10.7%) obstructive sleep apnea. All of patients reported resolution or improvement in comorbid conditions.No mortality was observed in patients. Conclusion: Outcomes and complication rates of bariatric surgery in patients aged 60 years and older are low and acceptable. The results of our study support bariatric surgery in elderly patients. However, detailed information should be provided about the slightly increased risks and the possibility of less satisfactory outcome.

Introduction Pulmonary hypertension (PHT) has been reported to occur in a considerable proportion of patients with end-stage renal disease (ESRD). It is a progressive condition of the pulmonary circulation that poses prognostic importance. In this study, we sought to investigate the prevalence and the predictors of PHT among ESRD patients undergoing renal transplantation. Patients and methods We retrospectively evaluated the records, clinical and demographic data as well as laboratory results of 500 adult patients who underwent renal transplantation at our institution. A comprehensive Doppler echocardiographic examination was performed in all patients as part of the preoperative assessment. Systolic pulmonary artery pressure (SPAP) was calculated using Bernoulli equation; a value of >30 mm Hg was accepted as PHT. Results The mean age of the study population was 31.6 ± 10.2 years. The mean duration of dialysis was 40 months; 432 patients (86.4%) were on hemodialysis (HD) and 68 (13.6%) on peritoneal dialysis (PD). PHT was detected in 85 (17%) patients with a mean SPAP of 46.7 ± 8.7 mm Hg (range = 35–75 mm Hg). The mean age, sex, and laboratory variables were similar between patients with versus without PHT (P > .05 for all). The mean duration of dialysis therapy was longer in the PHT group than those subjects with normal SPAP (50.8 vs 38.5 months; P = .008). Concerning the type of dialysis, the ratio of patients having PHT was higher in the HD compared with the PD group (18.8% vs 5.9%; P = .008). The prevalence of chronic obstructive pulmonary artery disease, asthma, smoking, hypertension, and diabetes mellitus did not differ between patients with versus without PHT (P > .05 for all). Conclusion The findings of this study revealed that PHT was a common clinical condition among patients with ESRD evaluated for renal transplantation. The time on renal replacement therapy particularly HD as the treatment was associated with greater prevalences. Since it may be of prognostic importance in patients undergoing renal transplantation, a careful preoperative assessment including a comprehensive Doppler echocardiographic examination is needed to identify PHT.

Background Mitral annular calcification (MAC) has been shown to be associated with atherosclerosis, and is a predictor of cardiovascular events. Coronary flow reserve (CFR) determined by transthoracic echocardiography has been introduced as a reliable indicator for coronary microvascular function. In this study we sought to investigate CFR in patients with and without MAC. Methods Seventy patients (mean age, 68.2±6.6 years) who were free of coronary artery disease or diabetes mellitus were involved; 35 patients with MAC constituted the experimental group while 35 patients without MAC served as controls. Using transthoracic Doppler echocardiography coronary peak flow velocities were measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak flow velocities. Results The clinical and demographic characteristics including age, sex, and traditional coronary risk factors did not differ between the groups ( P >.05). The mean value of CFR was significantly lower in participants with mitral annular calcification than it was in controls (2.25±0.41 vs. 2.64±0.57; P β =−0.40, P =.004), smoking ( β =−0.36, P =.007), and C-reactive protein levels ( β =−0.28, P =.04) as the independent variables significantly associated with CFR. Conclusions Our results demonstrate that CFR is impaired in patients with mitral annular calcification suggesting that coronary microvascular-endothelial dysfunction, an early finding of atherosclerosis, is present in these patients.

Background Cardiovascular disease (CVD) is the most common cause of death in patients with end-stage renal disease (ESRD) as well as in renal transplant recipients (RTR). In this study we sought to evaluate the prevalence and the types of CVD in patients with ESRD undergoing renal transplantation. Patients and Methods The data of 500 consecutive patients with ESRD undergoing renal transplantation were evaluated retrospectively. Demographic findings, clinical variables, and laboratory results including invasive and noninvasive cardiologic tests were recorded. Results The mean age of patients was 31.6 ± 10.2 years, of whom 133 (26.6%) were female. The prevalence of major atherosclerotic risk was as follows: hypertension 62.2%, diabetes mellitus 3.4%, smoking 26.4%, dyslipidemia 13.2%, and family history of atherosclerosis 9.8%. Treadmill exercise test was performed on 139 subjects, and myocardial perfusion scintigraphy on 73. Coronary artery disease was identified in 16 of 42 cases (38.1%) who had undergone angiography. Eight patients underwent percutaneous coronary intervention, and coronary bypass surgery was performed on 4 cases prior to renal transplantation. On echocardiographic examination mean ejection fraction was 51.9 ± 7.1%, and wall motion abnormality was detected in 15% of cases. The most prevalent valvular disease was mitral regurgitation (45.8%) followed by tricuspid regurgitation (30.6%). Conclusion The findings of this study indicate that CVD and atherosclerotic risk factors are common in patients with ESRD undergoing renal transplantion. With regard to the prognostic significance, pretransplantation identification of these conditions is of paramount importance. As a result, improved detection of occult CV disorders results in the possiblity of improved outcomes following renal transplantation.

Introduction The incidence of coronary artery anomalies (CAAs) varies from 0.2% to 8.4%. Knowledge of such anatomical variations is important as coronary procedures are regularly performed these days. We aimed to find the coronary dominance pattern, intermediate artery (IMA) frequency and CAA incidence in our clinic, and compare them to those in the literature. Methods The medical reports of 5,548 patients who had undergone coronary angiography (CAG) between 2005 and 2009 were retrospectively investigated. Dominance pattern and presence of IMA and CAA were recorded. CAAs were described using two different classifications: Angelini and Khatami's classification, and a new modified classification that was derived from Angelini and Khatami's classification. Some procedural details and clinical features of the patients with CAA were also investigated. Results Coronary dominance pattern was: 81.6% right coronary artery, 12.2% circumflex artery and 6.2% co-dominant. IMA was present in 613 (11.0%) patients. The incidences of overall anomaly were 2.7% and 1.4%, according to the different classifications. Absent left main coronary artery, which was the most common anomaly in the present study, was found in 51 (0.9%) patients. Incidences of myocardial bridge, coronary arteriovenous fistulae and aneurysms were 1.1%, 0.2% and 0.3%, respectively. Conclusion CAAs are generally asymptomatic, isolated lesions. Some may lead to anginal symptoms, myocardial infarction or sudden death. We found that CAA was associated with increased radiation and contrast exposure in patients who underwent CAG. This risk could be reduced if appropriate catheters were designed and training programmes on ostial cannulation were developed.

Aim Paclitaxel and carboplatin are frequently used chemotherapy drugs in the treatment of gynecologic malignancies. Little is known about their effects on left ventricular mechanical and coronary microvascular functions. Methods Thirty consecutive patients were prospectively enrolled. Patients underwent transthoracic echocardiography (TTE) before and after chemotherapy, to evaluate left ventricular mechanical functions and coronary flow reserve (CFR). A comprehensive TTE, tissue Doppler and two-dimensional (2D) strain imaging were performed and coronary flow velocity was measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak flow velocities. Mitral annular velocities by tissue Doppler, peak strain, and systolic strain rate by velocity vector imaging (VVI) were measured. Baseline measurements were compared with healthy controls (n = 26). Results No patient developed heart failure (HF) symptoms, no significant change occurred in left ventricular ejection fraction or cardiac output and no significant difference was observed in CFR after chemotherapy. Baseline mean longitudinal peak strain and systolic stain rate were similar between patients and controls: −17.5 ± 2.6% versus −17.6 ± 2.2% (P = NS) and −1.04 ± 0.14/sec versus −1.05 ± 0.12/sec (P = NS). Peak strain and systolic strain rate decreased significantly after chemotherapy (from −17.5 ± 2.6% to −16.2 ± 2.5%, P