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Aim: Although the transforearm approach is considered a safe and effective option for percutaneous coronary intervention, the different characteristics of the radial and ulnar arteries deserve attention. This study aimed to evaluate radial (RA) and ulnar artery (UA) diameter and blood flow parameters changes after catheterization., Material and Method: A total of 328 patients were enrolled. Their artery (171 RA and 157 UA) diameter and flow parameters [peak systolic velocity (PSV), end-diastolic volume (EDV) and pulsatility index (PI)] were evaluated before and after catheterisation., Results: After RA catheterization, the diameters and PSV decreased in the RA (from 2.71±0.66 to 2.47±0.51, p=0.007; from 44.7±8.3 to 33.9±9.5, p=0.021) and increased in the UA (from 2.49±0.83 to 2.59±0.58, p=0.033; from 48.3±11.9 to 59.6±11.0, p.

Background: Atrial fibrillation (AF) is the most common etiology of acute ischemic stroke (AIS). In recent years, epicardial fat tissue (EFT) has been found to be associated with the presence and chronicity of AF. However, the potential association between EFT and AIS in AF patients has not been fully elucidated. The aim of this study was to evaluate the effectiveness of EFT on prediction of AIS in patients with AF., Methods: This cross-sectional study has included 80 AF patients with AIS and 80 age-gender matched AF controls without AIS. Echocardiographic evaluations were performed in the first three days after hospitalization between July 2019 and December 2019 in Sakarya University Education and Research Hospital. Echocardiographic measurement of EFT was conducted according to previously published methods., Results: In comparison with the control group, AF patients with AIS had significantly higher epicardial fat thickness (8.55 ± 1.08 vs 5.90 ± 1.35 mm; P < 0.0001). The multivariate regression analysis indicated that EFT independently predicts AIS in patients with AF., Conclusions: The present study showed that, EFT is an independent predictor for the development of acute ischemic stroke in patients with AF., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The transulnar approach (TUA) has been considered both as primary access and as a secondary access site after transradial access (TRA) failure for coronary invasive procedures. However, there is little evidence supporting the use of the TUA as the first approach to diagnostic coronary angiography (CAG) or interventions. Patients (n = 587) who underwent CAG and/or angioplasty (292 patients via TRA, 295 patients via TUA) were included. The primary end points of the study were major adverse cardiac events and major vascular events (hematoma, vascular occlusion, vasospasm), and secondary end points included angiographic success, crossover rate, and angiographic procedural times. The mean age was 60 ± 21 years. The composite primary end points occurred in 34 (11.6%) patients in the TRA and 22 (7.4%) patients in the TUA arm ( P < .001). More arterial occlusion and more arterial spasm than in the TUA and similar urgent target vessel revascularization were observed in the TRA group in 48 hours. Based on previous studies and our clinical experience, we speculated that the TUA performed by an experienced operator has equal status with the TRA for coronary catheterization, especially in patients with a palpable ulnar pulse.

Background: The aim of this study was to investigate the ability of a new index, namely the left ventricular internal dimension at end-diastole/mitral valve E-point septal separation (LVIDd/EPSS), to predict the left ventricular (LV) systolic function and to compare its performance with that of the EPSS index and to investigate the correlation between the LVIDd/EPSS and the left ventricular ejection fraction (LVEF). Methods: The current study recruited 142 patients who presented to the Cardiology Clinic of Sakarya University Education and Research Hospital and were followed for heart failure (HF).M-mode measurements of the EPSS and the LVIDd were recorded in the parasternal long-axis view. Results: Totally, 142 HF patients with midrange ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) were enrolled in the study. There was a significantly correlation both between the EF and the EPSS and between the EF and the LVIDd/EPSS (P<0.001). In both HFmrEF and HFrEF groups, the correlation between the LVIDd/EPSS and the EF was more significant than was the correlation between the EPSS and the EF (P<0.001). The results of the linear regression analysis indicated that the LVIDd/EPSS was an independent predictor of the HFmrEF and the HFrEF (P<0.001). In the patients with EPSS≤12, there was a significant association between the EF and the LVIDd/EPSS (P<0.001) but not between the EF and the EPSS(P>0.05). The receiver operating characteristic curve analysis showed that the LVIDd/EPSS predicted advanced HF with 87% sensitivity and 72% specificity, using a cutoff value of 3.35,and it predicted the HFrEF (EF<40%) with 84% sensitivity and 81% specificity, using a cutoff value of 3.75. Conclusion: The LVIDd/EPSS may allow certain clinicians, especially beginners and emergency department physicians, to assess the LVEF when other methods are not available or questionable., (Copyright © 2015 Tehran Heart Center, Tehran University of Medical Sciences.)

Background: Assessing the monocyte to high-density lipoprotein ratio (MHR) is a new tool for predicting inflamation, which plays a major role in atherosclerosis. Myocardial bridge (MB) is thought to be a benign condition with development of atherosclerosis, particularly at the proximal segment of the brigde., Objective: To evaluate the relationhip between MHR and the presence of MB., Methods: We consecutively scanned patients referred for coronary angiography between January 2013- December 2016, and a total of 160 patients who had a MB and normal coronary artery were enrolled in the study. The patients' angiographic, demographic and clinic characteristics of the patients were reviewed from medical records. Monocytes and HDL-cholesterols were measured via complete blood count. MHR was calculated as the ratio of the absolute monocyte count to the HDL-cholesterol value. MHR values were divided into three tertiles as follows: lower (8.25 ± 1.61), moderate (13.11 ± 1.46), and higher (21.21 ± 4.30) tertile. A p-value of < 0.05 was considered significant., Results: MHR was significantly higher in the MB group compared to the control group with normal coronary arteries. We found the frequency of MB (p = 0.002) to increase as the MHR tertiles rose. The Monocyte-HDL ratio with a cut-point of 13.35 had 59% sensitivity and 65.0% specificity (ROC area under curve: 0.687, 95% CI: 0.606-0.769, p < 0.001) in accurately predicting a MB diagnosis. In the multivariate analysis, MHR (p = 0.013) was found to be a significant independent predictor of the presence of MB, after adjusting for other risk factors., Conclusion: The present study revealed a significant correlation between MHR and MB.

Introduction: Direct stenting (DS) is associated with improved markers of reperfusion during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). However, data evaluating its impact in small vessel coronary artery disease (CAD) are lacking., Aim: To compare DS and conventional stenting (CS) for small vessel CAD on clinical outcomes of patients with STEMI undergoing PPCI., Material and Methods: A cohort of 616 STEMI patients treated with DS (202 patients) or CS (414 patients) in small vessel (≤ 2.75 mm) lesions was retrospectively analyzed. The primary endpoint was to compare the occurrence of major adverse cardiac events (MACE) between groups during 2-year follow-up. The secondary end points included in-hospital target lesion revascularization (TLR) and in-hospital death., Results: The primary end-point, MACEs, occurred in 9.2% in the DS group and 12.3% in the CS group ( p > 0.05). The rates of TLR, myocardial infarction (MI) and target vessel revascularization (TVR) were not significantly different between groups ( p > 0.05). The stent thrombosis (ST) rate was significantly lower in the DS group (1.0% vs. 4.2%, p = 0.04) at 2 years. However, DS was not found to be an independent predictor of ST in multivariate analysis. There were no significant differences in in-hospital rates of death and TLR. The DS compared to CS resulted in greater rates of postprocedural TIMI grade 3 flow, and lower risk of edge dissection. The procedure time, radiation exposure and contrast administration were found to be significantly lower in the DS group., Conclusions: In selected patients with STEMI undergoing PPCI for small vessel CAD, DS is not only safe and feasible but also reduces ST rates, contrast load, and procedural and radiation exposure time., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2019 Termedia Sp. z o. o.)

Background: Atrial fibrillation is one of the most common abnormal heart rhythms. Neutrophil-lymphocyte ratio (NLR) has emerged as a potential marker for the level of inflammation in cardiac disorders., Hypothesis: NLR might be associated with thrombosis and bleeding risk scores and might predict cardioembolic risk in nonvalvular atrial fibrillation (NVAF) patients within the therapeutic international normalized ratio (INR)., Methods: We enrolled 272 patients taking warfarin for NVAF and classified them into 2 groups: Group A consisted of patients (n = 132) whose time in therapeutic range (TTR) was ≥65%, and Group B comprised patients (n = 139) whose TTR was <65%., Results: NLR values were higher in group B than in group A (P < 0.0001). Patients classified as high risk according to CHA 2 DS 2 -VASc score had significantly higher NLR levels (P = 0.002) than those classified as low and intermediate risk. Furthermore, NLR levels were significantly correlated with CHA 2 DS 2 -VASc and HAS-BLED scores (P < 0.001 and P < 0.0001, respectively). NLR predicted patients within therapeutic INR range (TTR ≥65%) with sensitivity of 81% and specificity of 71% in a receiver operator characteristic curve analysis, using a cutoff value of 2.17. Area under the curve for NLR was 0.81 (P < 0.0001)., Conclusions: To our knowledge, this is the first study showing correlation of NLR with both CHA 2 DS 2 -VASc and HAS-BLED risk scores. NLR might represent a useful marker to identify patients with high risks of stroke and bleeding and may have predictive value in identifying patients within the therapeutic INR range., (© 2018 Wiley Periodicals, Inc.)

Background: Sudden cardiac deaths due to arrhythmias are thought to be an important cause of mortality in patients with renal transplants. Exposure to immunosuppressive drugs may lead to QT or PR interval abnormalities which may consequently cause arrhythmias. Our study investigated the long term impact of four different immunosuppressive drugs on PR and corrected QT intervals (QTc) in renal transplant patients, Methods: The study population consisted of 98 kidney transplant recipients. Study patients were receiving immunosuppressive management with tacrolimus, cyclosporine A, everolimus or azathioprine according to the local protocols. QTc and PR intervals obtained from the most recent post-transplant electrocardiograms were compared with the pre-transplant intervals dated before the transplantation procedure., Results: Post-transplant QTc intervals had prolonged significantly in comparison to the pre-transplant QTc intervals in all groups. However, there were no significant differences between the immunosuppressive agents with regard to post-transplant QTc interval prolongation (p > 0.05). There were no significant differences between the groups with regard to the pre and post-transplant PR interval changes (p > 0.05)., Conclusions: QT interval prolongation, a marker of risk for arrhythmias and sudden death, is highly prevalent among kidney transplant patients receiving different classes of immunosuppressive drugs., (© 2014 Wiley Periodicals, Inc.)

The aim of this study was to investigate the association of serum hyaluronidase and nitric oxide (NO) levels with arterial stiffness in patients with hypertension (HT) and diabetes mellitus (DM). A total of 101 patients with diagnosis of DM and HT were enrolled in this study. The patients were divided into three groups as follows: only hypertensive (I), only diabetic (II) and both diabetic and hypertensive (III). Serum hyaluronidase levels were negatively correlated with aortic strain (AS) and aortic distensibility (AOD) in all groups, whereas a significant positive correlation was noted between serum hyaluronidase levels and aortic strain index (ASI) (all p-values < 0.05). There was a significant negative correlation between serum hyaluronidase and NO levels in all patients (p < 0.001). When the correlation between serum hyaluronidase and serum NO levels was investigated in the individual patient groups, a negative correlation was found in groups I, II and III (p = 0.017, p < 0.001 and p < 0.001, respectively). A significant relationship between plasma hyaluronidase level and parameters of aortic stiffness was found in patients with HT and/or DM. We suggest that the pathophysiological mechanisms responsible for the development of arterial stiffness in subjects with impaired endothelial function may involve pathological changes in the HA metabolism.

Background: Urocortin 1 (UCN1) has cardiostimulatory, vasodilatory, diuretic and natriuretic effects, and its expression increases in heart failure (HF)., Aim: To determine UCN1 levels in patients with HF, to evaluate UCN1's relationship with various clinical parameters, and to assess UCN1 as a diagnostic marker in HF, compared to pro-B-type natriuretic peptide (pro-BNP)., Methods: We investigated serum levels of UCN1 and pro-BNP in 90 consecutive patients with systolic HF (left ventricular ejection fraction [LVEF] ≤ 45%) and 90 healthy controls. Serum UCN1 and pro-BNP levels were measured using the ELISA method. Transthoracic echocardiography was performed to determine LVEF and pulmonary artery systolic pressure (PASP). Glomerular filtration rate (GFR) was estimated using the Cockcroft-Gault formula., Results: UCN1 level was higher in HF patients (391.5 [357.0-482.0] pg/mL, p < 0.001). UCN1 was positively related with NYHA class (r = 0.89, p < 0.001), and PASP (r = 0.39, p < 0.001); and negatively related with LVEF (r = -0.46, p < 0.001), and GFR (r = -0.21, p = 0.046). A significant positive correlation was found between pro-BNP and UCN1 levels (p < 0.001, r = 0.96). Receiver operating characteristic (ROC) curves yielded an area under the curve (AUC) of 0.99 (95% CI 0.98-1.00,p < 0.001) for UCN1 and 1.00 (p < 0.001) for pro-BNP in the diagnosis of HF., Conclusions: UCN1 increases with worsening HF and left ventricular dysfunction. It may be used as a diagnostic biomarker in systolic HF, but the incremental value of measuring UCN1 in patients tested for pro-BNP is questionable.

Background: Apelin is a novel endogenous peptide with inotropic and vasodilatory properties., Aim: To investigate the role of apelin in the prognosis of acute coronary syndromes (ACS) and to assess the relationship between apelin and other diagnostic and prognostic markers., Methods: Seventy-six patients with ACS (mean age 62.1 ± 10 years) were evaluated in terms of their plasma apelin-36 concentrations, ejection fraction (EF), high sensitivity C-reactive protein (hsCRP), creatine kinase (CK), CK-MB and troponin I levels. The study group consisted of 35 ST elevation myocardial infarction (STEMI) and 41 non-ST elevation (NSTE) ACS patients. Patients were followed up for one year for cardiovascular outcomes., Results: There was no significant relationship between apelin and TIMI, GRACE, GENSINI scores, hsCRP and EF in STEMI and NSTE-ACS groups (p > 0.05). Apelin showed positive correlations with CK, CK-MB and troponin I in patients with NSTE-ACS, but a negative correlation in patients with STEMI (p < 0.05). There were no statistically significant differences between patients reaching the composite end point at one year with regard to apelin levels., Conclusions: Apelin was positively correlated with cardiac biomarkers in patients with NSTE-ACS but negatively correlated in patients with STEMI. In STEMI, generally larger amounts of myocardial cells are subjected to infarction compared to NSTE-ACS, which may explain why apelin levels decrease with increasing CK, CK-MB and troponin levels in STEMI patients.

Introduction: Atherosclerosis is a systemic disorder. It is a frequent leading cause of coronary artery disease (CAD). Similarly, atherosclerotic vascular alterations could lead to testicular arterial blood flow reduction and impairment of testicular function with age. Inhibin-B has been validated as a valuable serum marker of testicular functions and its correlation with testicular volume was shown in some studies done before. The purpose of this study is to investigate the association between serum inhibin-B levels and CAD in elderly men., Material and Methods: Between March 2009 and March 2010, fifty-two 50-80-year-old consecutive patients with Gensini score over 20 and ejection fraction (EF) > 50% were included in the study as the CAD group. Fifty healthy men without any cardiac disease history were recruited as the control group. All patients in the CAD group who had indications for coronary artery angiography underwent selective coronary artery angiography., Results: Inhibin-B, total testosterone and testicular volume levels were found to be significantly lower in the CAD group in comparison with the control group (p = 0.004, p < 0.0001, and p = 0.001 respectively)., Conclusions: In this study, although no correlation was found in CAD patients between Gensini score and inhibin-B or testicular volume, inhibin-B levels and testicular volume were significantly lower in patients with CAD than in healthy men. In order to fully assess the relationship between serum inhibin-B levels and CAD, multi-centered prospective and longitudinal studies must be done in elderly male patients.