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Aim To investigate the relationship between malnutrition and follow-up cardiovascular (CV) events in non-ST-segment elevation myocardial infarction (NSTEMI).Material and methods A retrospective study was performed on 298 patients with NSTEMI. The baseline geriatric nutritionalrisk index (GNRI) was calculated at the first visit. The patients were divided into three groups accordingto the GNRI: >98, no-risk; 92 to ≤98, low risk; 82 to Results Follow-up data showed that MTH risk group had significantly higher incidence of repeat PCI and all-cause mortality compared to other groups (p0.05). The mean GNRI was 84.6 in patients needing repeat PCI and99.8 in patients who did not require repeat PCI (pConclusion GNRI value may have a potential role for the prediction of repeat PCI in patients with NSTEMI.

Background and objective: We aimed to investigate biochemical factors affecting coronary collateral circulation development in an elderly population aged 75 years and over. Material and methods: The study group consisted of patients with a prior coronary angiography for stable coronary artery disease (CAD). Patients with total occlusion of at least one vessel were included in the study. Enrolled patients were divided into two groups, good collateral (GC; n = 73) and bad collateral (BC; n = 55), in accordance with the Cohen-Rentop's classification system. Results: In comparison to the GC group, bilirubin levels were significantly lower (p < 0.001), and fasting plasma glucose (FPG) levels were significantly higher in the BC group (p = 0.026). Low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the BC group when compared to the GC group (p = 0.002 and p < 0.001, respectively). Backward elimination stepwise logistic regression analysis identified bilirubin and FPG as variables that strongly predicted the presence of a well-developed coronary collateral circulation and a poorly developed coronary collateral circulation, respectively. Conclusion: Bilirubin and FPG were seemed as the most important factors affecting coronary collateral circulation development in patients with stable CAD who were older than 75 years.

Aim: The most significant clinical association of interatrial block (IAB) was found with increased risk of atrial fibrillation and ischemic stroke. In this study, we sought to evaluate P wave duration and interatrial block in patients presented with acute ST-segment-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Materials and Methods: We performed a retrospective analysis of patients presented with acute STEMI who underwent emergent PCI. Follow-up electrocardiograms were obtained from electronic database system. Echocardiographic data were also obtained from electronic patient records. Electrocardiographic measurements were performed using SEMA Workstation 3.8.1 (Schiller AG). Results: Primary analysis included 200 consecutive patients with STEMI. However, there were 20 in-hospital deaths and 83 patients were lost to follow-up. Remaining 97 patients (80 male, 17 female) were included in the final analysis. Mean age was 57.0212.18 years. There were 48 patients with anterior STEMI and 49 patients with inferior STEMI. Mean duration of follow-up was 11 months and ECGs at the end of the follow up revealed that the frequency of partial and advanced IAB were 13.2% and 7.7% respectively. Statistical analysis showed that neither P wave duration nor IAB showed significant association with the infarct related artery lesion localization. Also, the degree of systolic dysfunction was not associated with IAB. Only male gender and left atrial diameter had significant positive correlation with P wave duration. Conclusion: IAB was not rare in patients with a history of acute coronary syndrome. The infarct related artery does not seem to have a significant correlation with interatrial conduction.

PURPOSE: The geriatric nutritional risk index (GNRI) is a simple and objective nutritional assessment tool for elderly patients. Lower GNRI values are associated with a worse prognosis in heart failure with reduced ejection fraction (HFrEF). Our aim is to investigate the relationship between malnutrition and follow-up cardiovascular (CV) events in HFrEF. METHODS: A retrospective study was performed on 362 patients with HFrEF. The baseline GNRI was calculated at the first visit. The patients were divided into three groups according to the GNRI: >98, no-risk group; 92 to 0.05). Mean GNRI value was 83.3 in NVAF patients and 101.1 in patients without NVAF (p

New-generation oral anticoagulants (NOACs) are now preferred as a first-line treatment in the management of atrial fibrillation for prevention of thromboembolic complications. Mean platelet volume (MPV), one of the indicators of increased platelet activity, is also associated with an increased stroke risk in atrial fibrillation patients. The aim of this study was to evaluate changes in MPV, platelet distribution width (PDW) and plateletcrit following use of NOACs. The study included 116 patients with non-valvular atrial fibrillation without previous NOAC use. Complete blood counts, biochemical analyses and echocardiography were performed for all patients. No significant differences were observed in MPV or other platelet indices at 6 months compared to baseline. Our results indicate that MPV and other platelet indices are not affected by NOAC use in non-valvular atrial fibrillation patients.Neue orale Antikoagulanzien (NOAC) werden mittlerweile für die Erstlinientherapie bei Vorhofflimmern zur Prävention thromboembolischer Komplikationen bevorzugt eingesetzt. Das mittlere Thrombozytenvolumen („mean platelet volume“ [MPV]), ein Indikator der erhöhten Thrombozytenaktivität, ist auch mit einem erhöhten Schlaganfallrisiko bei Patienten mit Vorhofflimmern assoziiert. Ziel der vorliegenden Studie war es, Veränderungen im MPV, der Thrombozytenverteilungsbreite und dem Thrombokrit nach Einsatz von NOAC zu untersuchen. Eingeschlossen wurden 116 Patienten mit nichtvalvulärem Vorhofflimmern ohne vorherige NOAC-Einnahme. Bei allen Patienten wurden große Blutbilder erstellt, zudem wurden biochemische Analysen und eine Echokardiographie durchgeführt. Im Vergleich zur Ausgangsmessung fanden sich nach 6 Monaten keine signifikanten Unterschiede im MPV oder in anderen Thrombozytenparametern. Unsere Ergebnisse zeigen, dass das MPV und andere Thrombozytenparameter bei Patienten mit nichtvalvulärem Vorhofflimmern nicht durch eine NOAC-Einnahme beeinträchtigt sind.

Background Graves' disease has a multitude of effects on the cardiovascular system. In the detection of subclinical left ventricular dysfunction, speckle-tracking echocardiography is more useful than conventional echocardiography. The aim of the present study was to compare the longitudinal global strain values and venous blood concentration of (tissue inhibitor of metalloproteinase-1) TIMP-1, a regulator of the extracellular matrix, among hyperthyroid patients with Graves' disease, euthyroid patients with Graves' disease and healthy control subjects. Materials and methods The study enrolled 40 hyperthyroid patients with newly diagnosed Graves' disease, 40 patients with Graves' disease who were euthyroid for at least 6 months and 40 control subjects with normal thyroid function. Participants underwent conventional echocardiography and speckle-tracking echocardiography to obtain segmental and global longitudinal strain values. In addition, the serum TIMP-1 value was assessed in the venous blood samples of the participants. Results The hyperthyroid Graves' patients showed greater serum TIMP-1 levels versus the control group and the euthyroid Graves' group. Compared to the control group, the TIMP-1 level was also significantly higher in the euthyroid Graves' group. Lower GLS (global longitudinal strain) average and GLS2C, GLS3C, GLS4C values were observed in both the hyperthyroid and euthyroid Graves' patients compared to the control group. The euthyroid Graves' patients and hyperthyroid Graves' patients had similar GLS values. The serum TIMP-1 level was negatively correlated with global strain values. Conclusion Graves' disease coexists with impaired segmental and global longitudinal strain and increased TIMP-1 levels. This coexistence seems to be independent of serum thyroid hormone levels.

OBJECTIVE Worldwide, over 200 million people are diagnosed with lower extremity arterial disease (LEAD). LEAD significantly increases the risk of death and amputation of the lower limb. A new classification system (WIfI) has been proposed to initially assess all patients with ischemic rest pain or wounds and also predicts 1-year amputation risk. Elabela is a bioactive peptide and a part of the apelinergic system, which has beneficial effects on body fluid homeostasis and cardiovascular health. We aimed to investigate serum Elabela levels in LEAD. METHODS A total of 119 subjects were enrolled in this cross-sectional study, 60 of whom were in the LEAD group and 59 in the control group. All participants underwent physical examination and routine biochemical tests, including serum Elabela levels. Additionally, the LEAD group was divided into subgroups according to the Rutherford classification, ankle-brachial index (ABI) values, and WIfI risk scores. RESULTS Serum low-density lipoprotein, Elabela, and high-sensitivity C-reactive protein (Hs-CRP) levels were statistically higher in the LEAD group (p=0.002, p

Objective: Studies have shown that hypercholesterolemia can induce ventricular vulnerability to fibrillation, and statin therapy exerts antiarrhythmic effects. In the present study, we investigated the relationship between arrhythmogenic substrate and familial hypercholesterolemia (FH) with regard to statin therapy. Methods: We evaluated 46 statin-naive patients (41±12 years) with FH, and 46 healthy subjects (40±8 years) prospectively. Electrocardiography (ECG) of patients were compared before and after 6 months of intensive statin therapy and with control groups. The ECG parameters were calculated by two experienced cardiologists who blinded to each other’s findings. Results: There were no significant differences found between groups’ baseline characteristics. Total cholesterol (343±49 mg/ dL vs. 161±12 mg/dL; p

Objective. This study was designed to investigate the effects of Desert Dust Storms and Climatological Factors on Mortality and Morbidity of Cardiovascular Diseases admitted to emergency department in Gaziantep. Method. Hospital records, obtained between September 01, 2009 and January 31, 2014, from four state hospitals in Gaziantep, Turkey, were compared to meteorological and climatological data. Statistical analysis was performed by Statistical Package for the Social Science (SPSS) for windows version 24.0. Results. 168,467 patients were included in this study. 83% of the patients had chest pain and 17% of patients had cardiac failure (CF). An increase in inpatient hospitalization due to CF was observed and corresponded to the duration of dust storms measured by number of days. However, there was no significant increase in emergency department (ED) presentations. There was no significant association of cardiac related mortality and coinciding presence of a dust storm or higher recorded temperature. The association of increases in temperature levels and the presence of dust storms with “acute coronary syndrome- (ACS-) related emergency service presentations, inpatient hospitalization, and mortality” were statistically significant. The relationship between the increase in PM10 levels due to causes unrelated to dust storms and the outpatient application, admission, and mortality due to heart failure was not significant. The increase in particle matter 10 (PM) levels due to causes outside the dust storm caused a significant increase in outpatient application, hospitalization, and mortality originated from ACS. Conclusion. Increased number of dust storms resulted in a higher prevalence of mortality due to ACS while mortality due to heart failure remained unchanged. Admission, hospitalization, and mortality due to chest pain both dependent and independent of ACS were increased by the presence of dust storms, PM10 elevation, and maximum temperature.

BACKGROUND AND AIMS Few studies have shown the direct effect of familial hypercholesterolemia (FH) on myocardial systolic function. Studies focused on heterozygote FH patients but not homozygote ones, and they did not perform genetic analyses. We aimed to evaluate all types of patients with FH using the potentially more sensitive speckle tracking echocardiography (STE) technique to identify early left ventricular (LV) dysfunction. METHODS Genetic analyses of patients with FH were conducted for LDL-receptor, PCSK9, and ApoB100. Nine homozygote, two compound heterozygote, and 82 heterozygote FH patients and 85 healthy subjects were prospectively studied. Longitudinal and circumferential strain measurements and conventional echocardiography findings were obtained. RESULTS LV ejection fractions were similar for all (homozygote, heterozygote, and control) groups. The LV average longitudinal strain (aLS) and average circumferential strain (aCS) levels were significantly reduced in the homozygote and heterozygote groups when compared with the controls (for aLS, P = .008 (

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is a major cause of morbidity and mortality. The upregulation of TRP channels is believed to mediate the progression of electrical remodelling and the arrhythmogenesis of the diseased heart. However, there is limited data about the contribution of the TRP channels to development of AF. The aim of this study was to investigate leukocyte TRP channels gene expressions in non-valvular atrial fibrillation (NVAF) patients. The study included 47 NVAF patients and 47 sex and age matched controls. mRNA was extracted from blood samples, and real-time polymerase chain reaction was performed for gene expressions by using a dynamic array system. Low levels of TRP channel expressions in the controls were markedly potentiated in NVAF group. We observed marked increases in MCOLN1 (TRPML1), MCOLN2 (TRPML2), MCOLN3 (TRPML3), TRPA1, TRPM1, TRPM2, TRPM3, TRPM4, TRPM5, TRPM6, TRPM7, TRPM8, TRPC1, TRPC2, TRPC3, TRPC4, TRPC5, TRPC6, TRPC7, TRPV1, TRPV2, TRPV3, TRPV4, TRPV5, TRPV6, and PKD2 (TRPP2) gene expressions in NVAF patients (P PKD1 (TRPP1) gene expression. This is the first study to provide evidence that elevated gene expressions of TRP channels are associated with the pathogenesis of NVAF.

Abstract. Background: The aim of this study was to compare the simultaneous double-protection method (proximal balloon plus distal filter) with distal-filter protection or proximal-balloon protection alone in asymptomatic patients during carotid artery stenting. Patients and methods: 119 consecutive patients were investigated for carotid artery stentings in the extracranial internal carotid artery with the use of distal filters (n = 41, 34.4 %), proximal balloon (MoMa) protection (n = 40, 33.6 %) or double protection (n = 38, 31.9 %). Magnetic resonance imaging (MRI) was performed on all patients before the procedure, and control diffusion-weighted MRI (DW-MRI) was obtained within 24–48 h after the procedure. Procedural data, complications, success rate, major adverse cardiovascular events, and MRI findings were collected. Results: New cerebral high-intensity (HI) lesions were observed in 47 (39.4 %) patients. HI lesions were observed in 22 (53.6 %), 15 (37.5 %), and 10 (26.3 %) of the patients with distal filters, proximal protection, and double protection, respectively (p = 0.004). The average number of HI lesions on DW-MRI was 1.80 in the distal-filter group, 0.90 in the proximal-balloon group, and 0.55 in the double-protection group (p < 0.001). Procedure and fluoroscopy times were slightly longer in the double-protection group compared to the distal- or proximal-protection groups (p = 0.001). Conclusions: The double (proximal plus distal) cerebral embolic protection technique is safe and effective for minimizing the risk of cerebral embolization, even in patients with asymptomatic carotid artery stenosis, despite slightly longer procedure and fluoroscopy times.

Objective The purpose of this study was to investigate the influence of electrical stimulation transmitted through the body during electroconvulsive therapy on traditional and relatively new ventricular repolarization parameters (Rate corrected QT interval (QTc), QT dispersion (QTd), rate corrected JT interval (JTc), JT dispersion (JTd), T-peak to T-end interval (Tp-e) and Tp-e/QTc ratio) under propofol anaesthesia. Methods Twenty-two patients (aged 18–50 years) who were each scheduled for ECT for major depression, bipolar disorder or schizophrenia enrolled to the study. Electrocardiography (ECG) recordings were obtained before anaesthesia and within 3–5 min after electrical stimulus of ECT for measurements. QTc, QTd, JTc, JTd, Tp-e and Tp-e/QTc were measured as repolarization indices. Results The study included twenty-two patients, 9(40.9%) females and 13(59.1%) males, and the mean age accounted for 33.57 ± 9.95 years. The comparison of the measured parameters before and after ECT, which were not statistically different, were as follows: QTc (416.52 ± 46.64 vs 430.00 ± 34.00msn; p = 0.18), JTc (308.09 ± 25.09 vs 315.47 ± 26.89msn; p = 0.30), QTd (22.27 ± 11.51 vs 20.45 ± 9.9msn; p = 0.52) and JTd (22.72 ± 11.2 vs 17.72 ± 10.20msn; p = 0.06). Also, no significant difference was detected at the following parameters Tp-e (80.0 ± 13.45 vs 78.63 ± 15.21msn; p = 0.65) and Tp-e/QTc ratio (0.19 ± 0.03 vs 0.18 ± 0.07; p = 0.08). On the other hand, HR showed a significant increase after ECT at 88.13 ± 13.74 vs 93.0 ± 15.2 bpm; p = 0.03. Conclusion QTc, QTd, JTc, JTd, Tp-e interval and Tp-e/QTc ratio, which are thought to be potential repolarisation markers for ventricular arrhythmias, did not demonstrate significant change within 3–5 min of electrical stimulation during ECT.

A 2-year-old girl presented with severe abdominal pain due to a giant iliac artery aneurysm. We embolized the internal iliac artery with microcoils and then eliminated the aneurysmal sac using a BeGraft peripheral stent without any complications. To the best of our knowledge, there are no previous reports of a transcatheter giant iliac artery intervention.

Atrial fibrillation (AF) is an arrhythmia caused by disorganized electrical activity in the atria, and it is an important cause of mortality and morbidity. There is a limited data about Rho/Rho-kinase (ROCK) pathway contribute to AF development. The aim of the present study was to elucidate leukocyte RHO/ROCK gene expressions in patients with non-valvular AF (NVAF). A total of 37 NVAF patients and 47 age and sex-matched controls were included in this study. mRNA was extracted from leukocytes, and real-time polymerase chain reaction was used for gene expression analysis. A marked increase in ROCK1 and ROCK2 gene expressions in patients with NVAF was observed (P

Objective The aim of this study was to determine the relationship of left atrial appendage (LAA) mechanics assessed using 2-dimensional (2D)-strain analysis of the gray scale images obtained during transesophageal echocardiography (TEE) to the conventional LAA functional parameters, CHA2DS2-VASc score, and the presence of spontaneous echo contrast (SEC) and/or LAA thrombus in patients with non-valvular atrial fibrillation (AF). Methods The study included 126 patients with AF and 30 controls with a sinus rhythm who were referred for TEE. The global, medial, lateral and apical LAA longitudinal 2D-strain of all patients and the CHA2DS2-VASc score of AF patients were evaluated. Results The global, medial, lateral, and apical LAA longitudinal 2D-strain results of AF patients were significantly lower than those of the controls and revealed moderate but significant correlations with LAA flow velocity and LAA area change. Patients with a CHA2DS2-VASc score of 0 or 1 had the highest LAA 2D-strain values and the results revealed that the LAAemptying velocity and LAA lateral and medial 2D-strain values were independent correlates of CHA2DS2-VASc score. SEC was detected in 84 patients, of whom, 42 had dense SEC and 27 had thrombus in the LAA. Multivariate analysis indicated that LAA emptying velocity, LAA area change, and LAA medial 2D-strain were independently associated with the presence of dense SEC/thrombus. In ROC analysis, cut-off values for global, medial, apical, and lateral 2D-strain for the presence of dense SEC/ thrombus were 6.0% p=0.011), 8.0% (p=0.032), 6.0% (p=0.033), and 5.4% (p=0.004), respectively. Conclusion Global and regional LAA mechanics were significantly related to conventional LAA functional parameters and to the presence of LAA-dense SEC/thrombus in patients with AF and may be useful as complementary data for estimating future thromboembolism.

Objective: Obesity is associated with cardiovascular risk factors and is a major predictor of cardiovascular disease and mortality. This global burden affects myocardial function by inducing structural and functional alterations. Although subclinical left ventricular (LV) dysfunction is known in obese subjects, there is not sufficient information about overweight people. The aim of the present study was to evaluate subclinical LV dysfunction in overweight people with three-dimensional speckle-tracking echocardiography (3D-STE). Methods: One hundred eighteen consecutive patients between 18 and 80 years old were enrolled into the study. Patients were divided into three groups according to body mass index (BMI): normal (BMI: 18.5–24.9 kg/m2) (n=35), overweight (BMI: 25–29.9 kg/m2) (n=43), and obese (BMI ≥30 kg/m2) (n=40). 3D-STE was performed, and global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were measured. 3D-STE results were compared between the groups. Results: The mean age of the patients was 60.97±8.94 years, and 55.1% of the patient population were male. Mean GCS was −13.5, GLS was −11.9, GRS was 32.3, and GAS was −22. As BMI increased, GCS and all other strain parameters were significantly worse [p

The relationship between contrast-induced nephropathy (CIN) and oxidative mechanisms is well documented. Our aim was to demonstrate the possible relationship between CIN and serum bilirubin as an antioxidant molecule. This retrospective study included 359 patients with peripheral artery disease (PAD) who underwent peripheral diagnostic angiography; 179 developed CIN after the intervention and another 180 were the control group, matched for age, gender, and cardiovascular risk factors. Baseline, 48- to 72-hour, and 30-day laboratory values, major adverse cardiovascular events, and dialysis requirements were recorded. Patients with CIN had significantly higher levels of uric acid, red cell distribution width, and neutrophil-to-lymphocyte ratio (NLR) but lower total bilirubin compared to the control patients ( P < .05). Multivariate logistic regression analysis showed that diabetes mellitus, left ventricular ejection fraction, uric acid, NLR, and total bilirubin levels were independent predictors of CIN development ( P = .01, P = .001, P = .001, P = .01, and P = .001, respectively). This study demonstrated that decreased total bilirubin was associated with CIN development after the administration of radiocontrast agents in patients with PAD.

Once accepted as a benign phenomenon, electrocardiographic early repolarization pattern is now considered to have significant clinical importance. Haissaguerre et al. (1) were first to describe the possible association between early repolarization pattern and idiopathic ventricular fibrillation. Since then, numerous studies have documented the clinical association between early repolarization pattern and future arrhythmic events. Due to different definitions, the prevalence of early repolarization pattern varies widely between 2% and 31% (2). The 2015 European Society of Cardiology Guidelines for the management of ventricular arrhythmias and the prevention of sudden cardiac death recommend that early repolarization syndrome (ERS) should be diagnosed only in patients with early repolarization pattern on electrocardiography (ECG) and a history of resuscitated cardiac arrest or a documented episode of ventricular fibrillation and/or polymorphic ventricular tachycardia (3). Also, due to lack of clear evidence, the panel experts could not make recommendations for the management.

Objective: Endothelial dysfunction (ED) is a condition that involves increased oxidative stress and decreased total antioxidant status (TAS) levels. Systemic lupus erythematosus (SLE) is also associated with ED. We aimed to determine the association between serum TAS and ED as assessed by flow-mediated dilation (FMD) in patients with SLE. Methods: Thirty-four patients with stable SLE who were not undergoing any treatment and 39 healthy volunteers without any overt cardiovascular disease were included in this cross-sectional study. Doppler ultrasound was used to measure FMD to assess ED in the study groups. Serum TAS levels were measured using a TAS kit. High-sensitivity C-reactive protein (hs-CRP) and anticardiolipin antibody (aCLA) levels were also measured to assess the inflammatory state. The SLE group further was divided into 2 groups according to presence or absence of aCLA. SLE disease activity was assessed using the SLE disease activity index (SLEDAI). Regression analysis was used to define independent predictors. Results: The mean TAS levels were significantly lower in patients with SLE than in controls (1.60±0.11 versus 1.73±0.15 mmol/L, p

Abstract. Background: The aim of this study was to assess the periprocedural and one-year outcomes of two different cerebral protection systems used during carotid artery stenting (CAS). Patients and methods: We enrolled 90 consecutive patients with carotid artery stenosis who underwent CAS with a proximal flow blockage protection system (mean age 69.7 ± 8) or distal protection with a filter (mean age 70.8 ± 7). Results: CAS was performed successively on 89 patients (99 %). Adverse events were defined as major stroke, minor stroke, transient ischemic attack (TIA), myocardial infarction, and death. Two strokes, one TIA, one death, and one myocardial infarction were observed in-hospital. There were no significant differences in safety or benefits between the proximal flow blockage embolic protection system (n = 45) and the distal filter protection system (n = 45) in terms of clinically apparent cerebral embolism, TIA, death, or myocardial infarction during the periprocedural stage or during the one-year follow-up period. Conclusions: Although it has been shown that the proximal flow blockage cerebral protection system decreases the risk of silent cerebral embolism, it has no advantage over the distal filter protection system in terms of adverse cerebrovascular or cardiac events during the periprocedural stage or during the long-term follow-up period.

Carbon monoxide (CO) poisoning could cause significant cardiac injury. This study aimed to evaluate patients with CO poisoning by using speckle tracking echocardiography (STE), a potentially more sensitive technique, to identify left systolic ventricular dysfunction for the first time in the literature. Seventy-two patients who were exposed to CO poisoning were studied. Blood collection and echocardiography were performed at admission and after patients’ discharge on days 10–15 (mean 12 days). Global longitudinal strain (GLS) and global circumferential strain (GCS) were calculated using STE. In order to find the normal strain levels and to compare it to the patient with CO poisoning, 35 healthy subjects were included in the study. Left ventricular ejection fraction was analyzed according to Simpson’s method. Patients were divided into two groups based on their LVEF values. LVEF

Presently described is a case of subacute subclavian artery thrombosis treated with rheolytic thrombectomy, using the AngioJet system and direct stenting, in addition to double antiembolic filter protection of both the vertebral and brachial arteries.

The relationship between bilirubin levels and peripheral artery disease has been documented. Our aim was to demonstrate the possible relationship between serum bilirubin levels and abdominal aortic aneurysms (AAAs). The study included 219 patients, 110 had a previous diagnosis of AAA and 109 patients were normal controls. Only patients with AAAs which had a size of 40 to 54 mm were included in the study. Baseline laboratory values and 2 computerized tomographic measurements 12 months apart were recorded. Patients with AAA had significantly higher white blood cell (WBC) counts and neutrophil–lymphocyte ratio (NLR) but lower total and direct bilirubin levels compared with the control patients ( P < .05). Multivariate logistic regression analysis showed that WBC, NLR, and total and direct bilirubin levels were independent predictors of the presence of an AAA ( P = .03, P = .001, P = .001, and P = .001, respectively). White blood cells and total bilirubin level were independent predictors of a rapidly enlarging AAA (>10 mm/y, P = .002 and P < .001, respectively). This study demonstrated that increased WBC and decreased total bilirubin levels were independent predictors of an AAA, especially the subgroup in which the AAA was rapidly expanding.

Lower extremity arterial disease (LEAD) is a well-established risk factor for concomitant coronary artery disease (CAD). There are no published data combining all three lower limb arterial segments (aortoiliac, femoropopliteal and below the knee vessels) in order to estimate CAD severity in LEAD patients. Herein has been derived a new scoring system for this purpose, which uses the wellknown TASC II classification, Syntax score and, for the first time in medical literature, a Syntax II score.The study population consisted of 178 patients who underwent lower limb and coronary diagnostic angiography for assessment of LEAD and CAD at the same session. Syntax and Syntax II scores were calculated. TASC II classifications of the lower limb arteries were done. A new scoring system, called "Total Peripheral Score" (TPS), for lower limbs was also calculated.A positive correlation was found between TPS and Syntax score and a less prominent positive correlation between TPS and Syntax II score (p0.001). A cut-off value of '6' for the new score was found for estimating high risk subgorup of CAD (Syntax score32; p0.001). Critical femoropopliteal arterial segment stenosis was the most predictive lower limb arterial zone for presence of severe CAD (Syntax score32; p = 0.011).Taking into account all lower limb arterial segments for predicting CAD during lower limb arterial angiography was recommended. A TPS of more than '6' is the practical cut-off value for estimating severe CAD. Femoropopliteal arterial critical stenosis is the most predictive arterial zone for estimating severe CAD.

Left ventricular aneurysms are seen rarely in primary percutaneous coronary interventional era. True aneurysms are usually localized to apex of the ventricle and it\'s very rare to develop in the inferior wall. In this paper, we presented a true left ventricle aneurysm, localized at the basal inferior wall which is developed in the course of subacute inferior myocardial infarction of a 74-years-old man. Aneurysm is detected during left ventriculography. The true ventricular aneurysm and consequent severe mitral regurgitation caused by tethering of mitral aparatus are confirmed with transthoracic echocardiography., Sol ventrikül anevrizmaları primer perkütan koroner girişim çağında nadir görülmektedir. Gerçek anevrizmalar genellikle ventrikülün apeksine yerleşiktir ve inferiyor duvarda yerleşimi çok nadirdir. Bu yazıda 74 yaşında bir erkek hastada akut inferior myokart enfarktüsü seyrinde gelişen bazal inferiyor yerleşimli gerçek anevrizma olgusu sunduk. Anevrizma sol ventrikülografi ile tespit edildi. Anevrizma ve yol açtığı ileri mitral yetersizliği ekokardiyografi ile doğrulandı

BACKGROUND AND OBJECTIVES Subintimal angioplasty is a common treatment choice for chronic total occlusions (CTO) in the iliac and femoropopliteal arteries. This article describes the technical aspects and early outcomes of two different re-entry devices and comparison with manual re-entry technique. SUBJECTS AND METHODS A retrospective review of 61 patients (re-entry group) treated with Outback or Pioneer Plus catheters was carried out. A matched cohort of patients (n=62) who underwent lower extremity interventions without the use of re-entry devices (manual re-entry group) were also analyzed (overall 123 patients were analyzed). Procedural success, procedural durations, patency estimates, ankle-brachial indices, and complications were analyzed. RESULTS Sixty-one patients underwent Outback or Pioneer Plus guided subintimal recanalization. After the procedure, ankle-brachial indices significantly increased in all patients during follow-up. Primary patency for the entire cohort was 83% in the first month. When the re-entry device group was compared with manual re-entry group, no difference was found with respect to success, complication, and patencies between the two groups during follow-up. However, procedure duration and the amount of contrast agent used was significantly decreased in re-entry groups (p

Objectives Proximal cerebral protection devices have been developed as an alternative to filter protection devices for reducing neurological complications during carotid artery stenting (CAS). The aim of the present study was to evaluate the frequency of silent cerebral embolism after CAS using different cerebral embolic protection devices and the impact of silent cerebral embolism on neurocognitive function. Methods One hundred consecutive patients who underwent CAS were enrolled. The patients were randomized to either proximal balloon occlusion or filter protection. Neurocognitive tests were performed before and six months after CAS. Cerebral embolisms were evaluated with diffusion-weighted magnetic resonance imaging (DW-MRI). Results The number and volume of new ischemic lesions found with DW-MRI were higher in the filter protection group than in the proximal balloon occlusion group. According to our definition, nine (21%) patients in the balloon occlusion group and 16 (36%) patients in the filter protection group showed neurocognitive decline, and ten (23%) patients in the balloon occlusion group and four (9%) patients in the filter protection group showed neurocognitive improvement (NS). Regarding the group of patients with new cerebral ischemic lesions on DW-MRI, neurocognitive decline occurred in 14 (31%) of 45 patients with DW-MRI lesions and 11 (26%) of 43 patients without DW-MRI lesions (NS). Conclusion Neurocognitive outcome after CAS is unpredictable; both neurocognitive decline and improvement can occur. In this study, the proximal balloon occlusion system significantly decreased cerebral microemboli during CAS compared to filter protection. Cerebral microembolism was not found to be associated with neurocognitive decline.

WOS: 000329046500011, PubMed ID: 23857994, Transoesophageal echocardiography (TEE) and venous intracardiac echocardiography (ICE) are traditionally used to visualize the interatrial septum (IAS) and the tenting effect of the fossa ovalis in patients undergoing percutaneous balloon mitral valvuloplasty (PBMV). The aim of the present study was to assess the comparative efficacy and safety of arterial (intra-aortic) ICE and venous ICE, compared with TEE (traditional approach), in the patients undergoing PBMV. TEE, aortic ICE, and venous ICE were consecutively performed in 50 patients (40 9 years, 86 female). The images of intracardiac structures were obtained from both aortic and right atrial loci. The IAS was visualized using TEE, aortic ICE, and venous ICE. The mean mitral valve area was 1.14 0.2 cm(2), and the mean left atrial volume index was 57.5 12 mL/m(2). The mean size of the visualized septal length was 48 5 mm by TEE, 51 5 mm by aortic ICE, and 33 6 mm by venous ICE. The BlandAltman test indicated that the 95 limits of agreement for the measurement of septal diameter ranged from 11.0 to 5.9 mm (mean 2.5 mm) between TEE and aortic ICE, 2.8 to 33.5 mm (mean 15.3 mm) between TEE and venous ICE, and 36.6 to 0.8 mm (mean 17.9 mm) between venous and aortic ICE. Standard venous ICE generally tended to yield smaller values compared with TEE and aortic ICE for the measurement of septal length. Furthermore, the view of fossa ovalis and tenting effect was optimal in 11 patients on venous ICE; however, the fossa ovalis and tip of the needle were well visualized in all patients on aortic ICE (P 0.001). There were no major complications with the use of aortic ICE. Aortic ICE is a superior alternative to venous ICE and facilitates trans-septal puncture in patients with mitral stenosis.

Spontaneous coronary artery dissection (SCAD) is a rare and uncommon case of sudden cardiac death and acute coronary syndrome. Herein, we present a 13-year-old boy with chest pain who was diagnosed with acute ST-segment elevation myocardial infarction associated with SCAD, possibly caused by the consumption of an energy drink, which has not been reported previously in the pediatric age group. On coronary angiography, the left anterior descending artery showed extensive dissection from the distal part of the vessel. Based on the morphology of the vessel with a dissection and TIMI flow grade III, it was decided to manage this patient conservatively with close follow-up. The aim of this report is to highlight the risks associated with the consumption of caffeinated energy drinks in children.

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEY, WOS: 000329858400063, …, Turkish Soc Cardiol

Işık, Turgay (Balikesir Author), One of the major concerns remaining in the treatment with stenting is the occurrence of stent thrombosis (ST). We reviewed 1960 consecutive patients (mean age 56 +/- 11.6 years, 84.6% males) treated with primary coronary stenting for ST elevation myocardial infarction between 2003 and 2008. All clinical, angiographic, and follow-up data were retrospectively collected. The data when the patient had angina pectoris was obtained from medical record. Early ST was observed in 89 (4.5%) patients. We identified 86 patients with early ST and known date and time of symptom onset. In these patients (mean age 59.2 +/- 13.9, 83.7% males), symptoms occurred mostly at night time (00.00-6.00 am) and during winter months but the day of the week effect was not presence. In conclusion, occurrences of early ST throughout the week were equally distributed, but early ST was more likely to occur in the winter months and night hours.

Background. Sarcoidosis is an inflammatory granulomatous disease of unknown etiology that involves multiple organ systems. Many studies have shown a strong relationship between inflammation and atherosclerosis. The aim of this study is to investigate the relationship between elastic properties of the aorta and the duration of the disease in patients with sarcoidosis. Method. The study population included 52 patients with sarcoidosis (22 men, mean age = 42.7 +/- 10.7 years, and mean disease duration = 38.8 +/- 10.8 months) and 50 healthy control subjects (18 men, and mean age = 42.0 +/- 8.0 years). Aortic stiffness (beta) index, aortic strain (AoS) and aortic distensibility (AoD) were calculated from the aortic diameters measured by transthoracic echocardiography and blood pressure obtained by sphygmomanometer. Cardiac functions were determined by using routine echocardiographic evaluation consist of standard two-dimensional and conventional Doppler and tissue Doppler imaging. Results. The conventional echocardiographic parameters were similar between patients and controls. There were significant differences between the control and the patient groups in beta index (1.63 +/- 0.55 vs 2.44 +/- 1.54, p = 0.001), AoS (15.61 +/- 5.69 vs 10.93 +/- 4.11%, p < 0.001) and AoD (6.35 +/- 2.64 vs 4.66 +/- 1.98, 10(-6) cm(2)/dyn, p = 0.001). There were statistically significant negative correlations between the disease duration and AoD (r = -0.46, p = 0.01) and AoS (r = -0.44, p = 0.002), whereas there was a positive correlation between the disease duration and beta index (r = 0.37, p = 0.01). In multivariate analysis, disease duration was significantly related with AoD, AoS and beta index (respectively, RR = 3.28, p = 0.002; RR = 3.03, p = 0.004; RR = 2.39, p = 0.02). Conclusion. We observed that elastic properties of the aorta alter in patients with sarcoidosis. We also have demonstrated a statistically significant correlation between aortic elastic properties and the disease duration.