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© 2022, The Author(s), under exclusive licence to Springer Nature Switzerland AG.Background: Transcatheter aortic valve implantation (TAVI) is currently the treatment of choice for the majority of patients at moderate or high surgical risk. However, some complications occur frequently with this procedure. In this study, we aimed to assess whether the cusp-overlap view (COP) technique may be associated with a reduced incidence of some of these complications compared with the classical three-cusp view (TCV) technique. Methods: In this single-center, retrospective study we investigated; technical success, postprocedural permanent pacemaker implantation (PPMI), new-onset stroke, pericardial tamponade, arrhythmia development, acute renal failure, major bleeding, major vascular complications, procedure-related coronary obstruction, new-onset left bundle branch block (LBBB), paravalvular leak, peri-procedural myocardial infarction (MI), day of hospitalization, death, and major adverse cardiac and cerebrovascular events (MACCE) were determined as the clinical endpoints. Results: A total of 281 consecutive patients who met the study criteria and underwent elective or emergency transfemoral TAVI using the self-expandable CoreValve Evolut valve were included. 176 consecutive patients implanted with the classical TCV technique and 105 consecutive patients implanted with the COP technique were compared. Compared with the TCV group, patients in the COP group had lower PPMI (3.8% vs. 10.8%, p = 0.039), in-hospital mortality (1.9% vs. 8.5%, p = 0.018), and 1-year death (4.8% versus 18.8%, p = 0.001), and MACCE rates (12.4% vs 31.3%, p < 0.001). Conclusion: The COP technique may help to reduce the conduction disturbances, PPMI requirement and complication rates that may develop following TAVI. In addition, it is an interesting result that it reduces mortality and MACCE rates in long-term follow-ups.

Objective: Fibrinogen plasma level rises in the event of inflammatory cases. It is known that there is a powerful intercourse between fibrinogen level and plasma viscosity. Albumin plasma level dropes during the inflammatory cases. The aim of this work determine significance of fibrinogen albumin ratio (FAR) as a indicator emphases the burden of atherosclerosis. Method: The study included 83 patients diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) between January and September 2015. The definition of NSTEMI was made according to “Definition of Third Universal Myocardial Infarction” guidelines published on 2013 by European Society of Cardiology. Burden of atherosclerosis was evaluated by Syntax score (SS) and Gensini Score. Patients were seperated two groups as medium-high SS (n=23) and low SS (n=60). FAR levels were compared. Results: FAR was 80.71 ± 30.3 in low SS group and 120 ± 49.72 in the mid-high SS group respectively (p

We aimed to compare the long-term follow-up results of patients with atrial fibrillation (AF) who use vitamin K antagonist (VKA) with effective time in therapeutic range (TTR) and non-vitamin K antagonist oral anticoagulants (NOACs).A total of 1140 patients were followed at 35 different centers for five years. During the follow-up period, the INR values were studied at least 4 times a year and the TTR values were calculated according to the Roosendaal method. The effective TTR level was accepted as60% as recommended by the guidelines. There were 254 patients in the effective TTR group and 886 patients in the NOACs group. Ischemic cerebrovascular disease/ transient ischemic attack (CVD/TIA), hemorrhagic CVD, and mortality were considered primary endpoints based on one-year and five-year follow-ups.Ischemic CVD/TIA (3.9% vs. 6.2%; P = 0.17) and hemorrhagic CVD (0.4% vs. 0.5%, P = 0.69), the one-year mortality rate (7.1% vs. 8.1%; P = 0.59), five-year mortality rates (24% vs. 26.3%; P = 0.46) were not different between the effective TTR and NOACs groups during the follow-up respectively. The CHA2DS2-VASC score was similar between warfarin with the effective TTR group and NOACs group (3 [2-4] vs. 3 [2-4]; P = 0.17, respectively]. Additionally, survival free-time did not differ between the warfarin with effective TTR group and each NOAC in the Kaplan-Meier analysis (dabigatran, P = 0.59; rivaroxaban, P = 0.34; apixaban, P = 0.26; and edoxaban, P = 0.14).There was no significant difference in primary outcomes between the effective TTR and NOAC groups in AF patients.

Amaç: Transkateter aort kapak replasmanının (TAVR) cerrahiye uygun olmayan, yüksek riskli semptomatik şiddetli aort darlığı (AS) olan hastalar için etkili bir tedavi yöntemidir. TAVR’da cinsiyete bağlı farklılıklar hala tartışılmaktadır. Bu çalışma ile kliniğimizde TAVR uygulanan hastalarda cinsiyetin klinik sonuçlar üzerine etkisini araştırmayı amaçladık.Yöntemler: Ocak 2015 ile Ocak 2022 tarihleri arasında TAVR yapılan ardışık 270 hasta çalışmaya dahil edildi. AS’yi değerlendirmek için hastanın tıbbi öyküsünün yanı sıra transtorasik veya transözofageal ekokardiyografi ve bilgisayarlı toraks tomografisi bulguları incelendi. Semptomatik, yüksek riskli şiddetli aort darlığı tespit edilen hastalara kendiliğinden genişleyebilen Evolute-R cihazlarıyla işlem yapıldı. Hastalar taburculuk sonrası ilk bir yıl takip edildi. Takipler klinik ziyaretler ve telefon görüşmeleriyle gerçekleşti.Bulgular: Hastane içi mortalite (%5.4’e karşı %7.4 ; p=0.507), bir yıllık takipte ölüm (%14.9'e karşı %.13.1, p=0.681) ve bir yıllık takipte majör advers kardiyovasküler ve serebrovasküler olaylar (MACCE) (%26.4'e karşı %23.8, p=0.627) oranları açısından kadın ve erkek cinsiyetleri arasında istatistiksel olarak anlamlı farklılık saptanmadı. Bir yıllık mortalite ve MACCE oranlarını içeren sağkalım analizi Kaplan-Meier eğrileri kullanıldı. Buna göre her iki cinsiyet arasında mortalite ve MACCE açısından istatistiksel olarak anlamlı farklılık saptanmadı ( sırasıyla; p= 0.910; p =0.889).Sonuç: TAVR yapılan hasta grubumuzda her iki cinsiyet arasında klinik sonlanımlar açısından önemli bir farklılık saptayamadık. Son yıllarda cihaz ve prosedürle ilişkili gelişmelerle cinsiyetin klinik sonuçlar üzerine etkisi azaltılmıştır., Aim: Transcatheter aortic valve replacement (TAVR) is an effective treatment modality for patients with high-risk symptomatic severe aortic stenosis (AS) who are not suitable for surgery. Gender-related differences in TAVR are still deliberated, thus in this study we aimed to investigate the effect of gender on clinical outcomes in patients who underwent TAVR in our clinic.Methods: 270 consecutive patients who underwent TAVR between January 2015 and January 2022 were included in the study. In addition to the patient's medical history, transthoracic or transesophageal echocardiography and computed tomography findings were examined to evaluate AS. Patients with symptomatic, high-risk severe aortic stenosis were treated with self-expanding Evolute-R devices. The patients were followed up for the first year after discharge. Follow-up was done by clinical visits and phone calls.Results: In-hospital mortality (5.4% vs. 7.4%; p=0.507), death at one-year follow-up (14.9% vs. 13.1%, p=0.681), and major adverse cardiovascular and cerebrovascular events (MACCE) at one-year follow-up (26.4% versus 23.8%, p =0.627) rates, there was no statistically significant difference between male and female genders. Kaplan Meier curves were used for survival analysis, including one-year mortality and MACCE rates. Accordingly, no statistically significant difference was found between the two genders in terms of mortality and MACCE (respectively; p= 0.910; p=0.889).Conclusion: In our patient group who underwent TAVR, we could not detect a significant difference in clinical outcomes between both genders. In recent years, the effect of gender on clinical outcomes may decrease with device and procedural developments.

Although transcatheter aortic valve replacement (TAVR) is safe and effective, mortality and bleeding events post procedure are important. The present study investigated the changes in hematologic parameters to evaluate whether they predict mortality or major bleeding. We enrolled 248 consecutive patients (44.8% male; mean age 79.0 ± 6.4 years) undergoing TAVR. In addition to demographic and clinical examination, blood parameters were recorded before TAVR, at discharge, 1 month and 1 year. Hemoglobin levels before TAVR 12.1 ± 1.8 g/dL, 10.8 ± 1.7 g/dL at discharge, 11.7 ± 1.7 g/dL at first month, 11.8 ± 1.4 g/dL at first year (Hemoglobin values compared with pre-TAVR, P < .001, P = .019, P = .047, respectively). Mean platelet volume (MPV) before TAVR 8.72 ± 1.71 fL, 8.16 ± 1.46 fL at discharge, 8.09 ± 1.44 fL at first month, 7.94 ± 1.18 fL at first year (MPV values compared with pre-TAVR, P < .001, P < .001, P < .001, respectively). Other hematologic parameters were also evaluated. Hemoglobin, platelet count, MPV, and red cell distribution width before the procedure, at discharge, and at the first year did not predict mortality and major bleeding in receiver operating characteristic analysis. After multivariate Cox regression analysis, hematologic parameters were not independent predictors of in-hospital mortality, major bleeding, and death at 1 year after TAVR.

The aim of this study was to investigate the frequency of oral anticoagulant drugs and time in therapeutic range in patients receiving warfarin in addition to the epi-demiological trial of non-valvular atrial fibrillation previously conducted in Turkey (The Atrial Fibrillation: Epidemiological Registry trial). Furthermore, the prevalence of major adverse events and mortality rates of the patients were evaluated during the long-term follow-up period.We created a national data registry for non-valvular atrial fibrillation patients, reflecting all geographic regions by population density. In that context, the study included all consecutive atrial fibrillation patients older than 18 years of age who were admitted to the cardiology outpatient clinic except for patients those with prosthetic heart valvesand rheumatic mitral valve stenosis.This study included 2592 patients from 35 different centers. The mean age was 68.7 ± 11.1 years, and 55.5% of the patients were female. The most common comorbid diseases were chronic kidney disease (69%) and hypertension (65.5%). The time in ther- apeutic range rate in the general population was 40%, and the mortality rate at 5-year follow-up was 29.4%.The Atrial Fibrillation: Epidemiological Registry 2 study showed higher use of anticoagulant in non-valvular atrial fibrillation patients than in previous national stud-ies. Furthermore, this study demonstrated that most of the non-valvular atrial fibrilla- tion patients are in the high-risk group and the time in therapeutic range rates are still low in Turkey. As a result, this is a significant reason for switching from warfarin to non-K vitamin-dependent new oral anticoagulant treatments.

Kawasaki disease is usually self-limited, but it can lead to aneurysm, stenosis, thrombosis, and myocardial infarction in the coronary arteries. The most important complication of Kawasaki disease is coronary artery aneurysm. Coronary artery aneurysm or ectasia may be seen in 15–25% of patients who do not receive treatment. It develops in 5% of children who receive intravenous immunoglobulin at the appropriate time. Acute myocardial infarction is the most important cause of morbidity and mortality in Kawasaki patients with giant aneurysms. We present a 10-year-old girl who had a history of giant aneurysm in the coronary arteries and underwent percutaneous coronary intervention due to anterior myocardial infarction.

The objective of this study is to assess the prognostic effects of T ranscatheter aortic valve replacement (TAVR) on the patients with different degrees of left ventricular systolic (LVS) function and severe symptomatic aortic stenosis. Also examines the prognostic association of LV remodelling after TAVR.Patients stratified into four subgroups with respect to baseline LV ejection fraction (LVEF) (LVEF25%, LVEF 25%-40%, LVEF 41%-49% and LVEF ≥ 50%). We compared the baseline characteristics and temporal changes in echocardiographic parameters of the patients after TAVR, and determined all-cause mortality (ACM) in a follow-up period of mean 20.7 ± 15.8 months (up to 84). There were 495 patients at 8 centres. ACM was similar in all groups (28.1%, 29.5%, 22.5% and 24.1% respectively;This study shows that TAVR is beneficial in the whole range of LVS function, irrespective of the baseline EF. Early recovery in LVEF after TAVR is critical for survival, however, it seems to be more eye catching in the patients with advanced heart failure with reduced EF.

Kawasaki disease is usually self-limited, but it can lead to aneurysm, stenosis, thrombosis, and myocardial infarction in the coronary arteries. The most important complication of Kawasaki disease is coronary artery aneurysm. Coronary artery aneurysm or ectasia may be seen in 15-25% of patients who do not receive treatment. It develops in 5% of children who receive intravenous immunoglobulin at the appropriate time. Acute myocardial infarction is the most important cause of morbidity and mortality in Kawasaki patients with giant aneurysms. We present a 10-year-old girl who had a history of giant aneurysm in the coronary arteries and underwent percutaneous coronary intervention due to anterior myocardial infarction.

WOS:000614539900006 PMID: 33371718 The present study aimed to examine the association of C-reactive protein to albumin ratio (CAR) with short-term major adverse cardiac events (MACEs) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). We included 539 STEMI patient treated with pPCI in this study. Patients were divided into 2 groups according to MACE development. Patients with MACE had higher CAR than those without (1.18 [0.29-1.99] vs 0.21 [0.09-0.49], P < .001). Multivariate analysis showed that The Global Record for Acute Coronary Events score, Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score, glucose and CAR (odds ratio:1.326, 95% CI: 1.212-1452, P < .001) were independent predictors of MACE. The CAR may be proven useful for risk stratification in STEMI patients undergoing pPCI

Background: Heart failure (HF) is an important public health problem. We aimed to investigate the predictors of long-term hospitalization in Turkish HF population. Materials and Methods: Journey-HF-TR study is a multicenter, cross-sectional, noninvasive, and observational study that was conducted in intensive care unit (ICU), coronary care unit (CCU), and cardiology wards in seven geographical regions of Turkey. In this subgroup analysis, patients were classified as two groups according to inhospital stay called the patient with the shorter length of stay (S-LOS) (inhospital stay

PMID:30930444 A 19-year-old man was admitted due to sudden onset and progressively increasing shortness of breath, cough, nausea, and vomiting. The patient had undergone aortic and mitral valve replacement with mechanical prosthesis for the treatment of infective endocarditis 4 years ago.

Introduction: This study was undertaken to examine the role of hematological parameters in predicting the severity of hypertension in pre-eclamptic women. Patients and Methods: Two hundred sixty-one pre-eclamptic women and fifty-one women with normal pregnancy were included in the study. The severity of preeclampsia was classified as mild or severe. Results: Compared to post-delivery period, pre-eclamptic females had lower platelet count, raised mean platelet volume and raised neutrophil lymphocyte ratio (p< 0.001, p< 0.001, p< 0.001, respectively). Multiple linear regression analysis showed an independent correlation between the severity of hypertension and mean platelet volume as well as the neutrophil lymphocyte ratio (β= 0.25, p< 0.001; β= 0.31, p< 0.001, respectively). Conclusion: Both mean platelet volume and neutrophil lymphocyte ratio emerged as independent predictors of the severity of hypertension in preeclampsia.

Objective: The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) have been reported in patients with coronary artery disease (CAD). In this study, we sought to evaluate the association between TRI and the extent and severity of CAD evaluated by SYNTAX score (SS) and Gensini score in patients with ST elevation myocardial infarction (STEMI). Methods: A total of 290 patients with STEMI were included in the study. GRS and TRI were calculated on admission using specified variables. The extent and severity of CAD were evaluated using the SS and Gensini scores. The patients were divided into low (TRI ⩽19), intermediate (TRI 19–30), and high (TRI ⩾30) risk groups. A Pearson correlation analysis was used for the relationship between TRI, GRS, Gensini score and SS. Results: There were significant differences in the mean age ( p < 0.001), admission heart rate ( p < 0.001), admission systolic blood pressure ( p = 0.009), SS ( p < 0.001), GRS ( p < 0.001) and in-hospital major adverse cardiac events (MACE) in all patients between the low, intermediate and high TRI risk groups. There was a positive significant correlation between TRI and SS ( r = 0.24, p < 0.001), Gensini score ( r = 0.18, p = 0.002), GRS ( r = 0.74, p = 0.001) and in-hospital MACE ( r = 0.29, p < 0.001). Conclusion: TRI is significantly related to SS and Gensini score in predicting the extent and severity of CAD in patients with STEMI.

Objective: We aimed to assess relationship between the severity of coronary atherosclerosis assessed by SYNTAX score (SS) and neutrophil to lymphocyte ratio (NLR) in patients with ST elevation myocardial infarction (STEMI. Methods: After accounting for exclusion criteria, a total of 291 patient with STEMI in whom primary percutaneous coronary intervention was performed were retrospectively included (216 male, 75 female; mean age 61.6+14.0 years). Total and differential leukocyte counts and other biochemical markers were measured at admission. Patients were categorized into tertiles on the basis of SS. Monitoring for major adverse cardiac events (MACEs) was performed during the in hospital follow-up period. Results: The SS high group leukocyte (p=0.009), neutrophil (p=0.008), NLR (p=0.048), peak troponin (p, Amaç: Biz bu çalışmada STEMİ hastalarında nötrofil lenfosit oranı (NLO) ve Syntax skoru (SS) ile değerlendirilen koroner aterosklerozun şiddeti arasındaki ilişkiyi ST yükselmeli miyokard infarktüsü (STEMİ)\'ünde değerlendirmeyi amaçladık. Yöntemler: Dışlama kriterleri sonrası primer perkütan koroner girişim uygulanan geriye dönük olarak toplamda 291 STEMI hastası çalışmaya alındı. (216 erkek,75 kadın, ortalama yaş 61,6±14,0 yıl). Toplam ve diferensiyel lökosit sayımı ve diğer biyokimyasal belirteçler hasta kabulünde alındı. Hastalar SS göre üç tertile ayrıldı. Majör istenmeyen kardiyak olaylar (MİKO) için izleme hastanede yatış döneminde yapıldı Bulgular: SSyüksek grup, lökosit (p=0,009), nötrofil (p=0,008), NLO (p=0,048), zirve troponin (p

Objective: We aimed to investigate short term effects of oral and infusion dosages of amiodarone on thyroid function. Methods: A hundred and fifty-five prospectively consecutive patients with a diagnosis of atrial or ventricular arrhythmias admitted to our clinic whom amiodarone were applied enrolled to our study. 134 patients received 16 mg/kg amiodarone iv infusion for 24 hours and oral 500p100 mg/day amiodarone as the maintenance dose for one month. 21 patients received only oral 500p100 mg/day amiodarone dose for one month. Follow up visit was performed in the first month of amiodarone therapy. Results: In this study 68% of patients were male and the average age of the patients was 62.8p13.5. The indications for amiodarone treatment were atrial fibrillation (41%), ventricular tachycardia (41%), and preoperative (5%), supraventricular tachycardia (5%), atrial flutter (5%), and ventricular fibrillation (3%). At the first month of follow up 83% of patients were in euthyroid state, 17% of the patients had amiodarone induced thyroid dysfunction (TD), 5% of patients had subclinical hyperthyroidism, 5% of patients had manifest hypothyroidism, 7% of patients had subclinical hyperthyroidism, and 1% of the patients developed overt hyperthyroidism. Conclusion: In this study we showed that amiodarone can cause adverse effects on thyroid function in a short time of period. For this reason patients should be followed in the first, third, sixth and twelfth months of amiodarone therapy and thyroid function should be evaluated. J Clin Exp Invest 2014; 5 (2): 280-285

Background: The aim of this study was to perform a multicenter, prospective investigation regarding the epidemiology, the current effectiveness of therapeutic anticoagulation, and the risk of thromboembolism in patients with valvular atrial fibrillation (AF) based on the records of the Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. Methods: Patients were selected from a total of 2,242 consecutive admissions that presented with AF diagnosed via electrocardiogram. Those diagnosed with non-valvular AF were excluded from the AFTER study population, which left 497 patients with valvular AF for analysis. Results: The etiology of valvular AF in patients was either attributed to rheumatic mitral valve stenosis (n = 217) or possessing a prosthetic heart valve (n = 280). Out of all the patients with valvular AF, 83.1% were taking warfarin for anticoagulation. Only 36.1% demonstrated a therapeutic international normalized ratio (INR), and among those patients it was found that 19.1% exhibited a labile INR. Multivariate analysis revealed that age was the only independent predictor of thromboembolic events in patients with valvular AF. Conclusions: Many valvular AF patients are not maintained at therapeutic INR levels, which poses a threat to patient health as they age and are at greater risk for thromboembolism.

Annual Meeting of the European-Society-of-Cardiology (ESC) -- AUG 30-SEP 03, 2014 -- -- Barcelona, SPAIN, WOS: 000343001305230, …, European Soc Cardiol

The aim of the study is to investigate the association between the severity of rheumatic mitral valvular disease (RMVD) and the neutrophil–lymphocyte ratio (NLR). A total of 227 patients were enrolled in the study and divided into 3 groups. Patients in group 1 had rheumatic mitral stenosis (RMS), those in group 2 had RMVD without stenosis, and those in group 3 served as the control group. Group 1 was further divided into 2 groups, severe mitral stenosis (MS) and mild to moderate MS. The NLR was significantly higher in patients with severe MS when compared to those with mild to moderate MS ( P = .002) while lymphocyte count was lower ( P = .034). Using a cutoff level of 2.56, the NLR predicted severe RMS with a sensitivity of 75% and specificity of 74%. In conclusion, as an inexpensive, simple, and accessible marker of inflammation, the NLR may be useful in predicting the presence and severity of MS in patients with RMVD.

Inflammation has recently emerged in the pathogenesis of several cardiovascular disorders, including arrhythmias. The neutrophil–lymphocyte ratio (NLR) is a simple marker for the assessment of inflammatory status. Therefore, we aimed to investigate the relationship between the NLR and the ventricular premature contraction (VPC) existence. Patients aged between 18 and 40 years who were referred to the cardiology clinic were enrolled in the study. All patients’ complete blood counts and 24-hour Holter recordings were analyzed. The NLR was higher within the VPC group compared to the control group ( P < .001). According to the NLR tertiles, VPCs were more common in the higher NLR tertile ( P < .001). A cutoff point of 1.80 for the NLR had 71% sensitivity and 60% specificity in predicting VPC in apparently healthy individuals. After multivariate analysis, only the NLR remained significant predictor of presence of VPC. In conclusion, the NLR is independently and significantly associated with VPC existence.

The objective of this study was to investigate the relationship of echocardiographic epicardial fat thickness (EFT) and neutrophil to lymphocyte ratio (NLR) with different types of non-valvular atrial fibrillation (AF) in a clinical setting. A total of 197 consecutive patients were enrolled in the study. Seventy-one patients had paroxysmal non-valvular AF, 63 patients had persistent/permanent non-valvular AF, and 63 patients had sinus rhythm (control group). EFT was measured with echocardiography, while NLR was measured by dividing neutrophil count by lymphocyte count. EFT was significantly higher in patients with paroxysmal non-valvular AF compared with those in the sinus rhythm group (6.6 ± 0.7 vs. 5.0 ± 0.9 mm, p0.001). Persistent/permanent non-valvular AF patients had a significantly larger EFT compared with those with paroxysmal AF (8.3 ± 1.1 vs. 6.6 ± 0.7 mm, p0.001). EFT had a significant relationship with paroxysmal non-valvular AF (odds ratio 4.672, 95 % CI 2.329-9.371, p0.001) and persistent/permanent non-valvular AF (OR 24.276, 95% CI 9.285-63.474, p0.001). NLR was significantly higher in those with paroxysmal non-valvular AF compared with those in the sinus rhythm group (2.5 ± 0.6 vs. 1.8 ± 0.4, p0.001). Persistent/permanent non-valvular AF patients had a significantly larger NLR when compared with paroxysmal non-valvular AF patients (3.4 ± 0.6, vs. 2.5 ± 0.6, p0.001). NLR (2.1) had a significant relationship with non-valvular AF (OR 11.313, 95% CI 3.025-42.306, b 2.426, p0.001). EFT and NLR are highly associated with types of non-valvular AF independent of traditional risk factors. EFT measured by echocardiography and NLR appears to be related to the duration and severity of AF.

Objectives: Our aim was to evaluate whether more thanone observer or fractional flow reserve has the same resultsin assessing coronary lesion severity in intermediatelesions.Methods: Our hospital’s database was searched for fractionalflow reserve procedures and then these patient’slesions were assessed visually by three experienced interventionalcardiologist.Results: 8 of 46 patients were (17.4%) female and 38 of 46were (82,6%) male. Average age was 61±11 years (Male:60±11 / Female: 70±7 years). One observer could onlydetect 66.7% of severe lesions and 76.2% of non-severelesions. When two observers agreed about lesion severity,true detection of severe lesions was (max) 76.7%, andtrue detection of non-severe lesions was (max) 66.7%, soa decrease in true detection of non-severe lesions wasobserved. When one of the observers called a lesion “severe”and the lesion was assumed as “severe”, detectionof a severe lesion was 83.3% (p=0.017); if all of the observersagreed that the lesion was “non-severe” then truedetection of a non-severe lesion was 90.5% (p

Objective: The aim of the study was to determine theclinical characteristics, comorbidities, responsible diseasesand in-hospital mortality of patients who received atemporary pacemakerMethods: Our study included 545 patients who received atemporary pacemaker due to various causes during theirhospitalization between January 2008 and May 2012.Results: Of the 545 patients whose records werescanned retrospectively in our study, 235 (43%) were femaleand 310 (57%) were male. Average age of patientswas 70±14.2 years (20,100). Leading cause for receivingpacemaker was third degree atrioventricular block (178patients, 32.6%).Other causes were bradycardia or asystoleduring procedures such as coronary angiography,catheterization etc. (101 patients, 18.5%), symptomaticsinus bradycardia (70 patients, 12.8%), pacemaker endof life (During procedure, 65 patients, 11.9%). Temporarypacemaker implantation due to drugs, hyperpotasemiaand both was 6.2% (34 patients), 3.6% (20 patients) and1.1% (6 patients) respectively. Eight patients used drugsfor committing suicide. While the top responsible drugsfor pacemaker implantation were digoxin, beta blockersand calcium channel blockers, only one patient was usinga noncardiac drug (oxcarbamazepin). Half of the patientshad coronary artery disease (276 patients, 51%). 101 patients(18.5%) received a temporary pacemaker due toblock in the course of myocardial infarction. 85 patientsdied during their hospitalization (15.5%).Conclusıon: Although causes for temporary pacemakerimplantation has changed over time, myocardial infarctionwith block still remains fatal even a temporary pacemakeris inserted. J Clin Exp Invest 2013; 4 (2): 180-183Key words: Temporary cardiac pacemaker, mortality,acute myocardial infarction, atrioventricular conductionblock.

Objective: We aimed to evaluate our clinical experienceand short-term results of percutaneous closure of secundumtype atrial septal defects (ASD) in adults.Methods: We studied 71 patients (49 female, 22 male,mean age 35±14 years) undergoing percutaneous closureof ASD between January 2010-October 2012 in ourclinic. All procedures were performed under sedoanalgesiawithout balloon sizing. Clinical characteristics of patients,properties of percutaneous closure intervention,complications and short-term results are evaluated.Results: Defect diameter measured by transesophagealechocardiographic examination was 19.8±6.4 mm. Devicesize used for percutaneous closure was 24.7±6.7mm. Procedure was successfully performed in 67 patients(94%). Four patients were referred for surgery because ofprocedural failure. During procedure, a patient developedtransient 2nd degree AV block, and another developeddevice thrombosis. Residual shunt was detected in threepatients at first day control echocardiographic examination.In the follow-up of 13±8 months, no residual shunt,embolic or arrhythmic complications were observed.Conclusion: Percutaneous closure of secundum ASD isa safe and effective method with high success and lowcomplication rates in experienced centers. J Clin Exp Invest2013; 4 (1): 67-72Key words: Secundum atrial septal defect, percutaneousclosure, sedoanalgesia, transesophageal echocardiography

Objective: To investigate the predictive value of serum nitrate (nitrogen oxide: NOx) levels in the detection of peripheral and mesenteric ischaemia durations.Methods: Rats were sacrificed for determining the basal serum values of NOx in Group I without any intervention. The superior mesenteric artery was clamped in Groups II and III and blood samples were taken at 120 minutes in Group II and at 360 minutes in Group III. The right common femoral artery was clamped in Groups IV and V and blood samples were taken at 120 minutes in Group IV and at 360 minutes in Group V.Results: The peak values of NOx were obtained in Group II and Group IV. NOx levels were reduced in advanced periods of ischaemia. In the other words, the NOx levels were significantly higher at two hours of ischaemia (p

Objective: Carotid artery stenting (CAS) is being applied more frequently as an alternative mode of treatment to carotid endarterectomy. We aimed to present the short-term clinical outcomes of the patients admitted to our clinic with a diagnosis of carotid artery disease and revascularized by CAS. Methods: The study was retrospective and a single-centered study. Between June 2013-January 2016 the patients with an indication for carotid artery intervention and accepted CAS procedure were included in the study. Clinical characteristics and procedural data of the patients were obtained by scanning patient files. After discharge, hospital records were scanned and patients were called to learn whether or not patients were alive and that they have suffered a recent stroke. Results: We included 82 patients that meet the inclusion criteria in the study. 59% of patients were male with a mean age of 68±9 years. 56% of patients were symptomatic. In all patients, stents were used. 85% of patients distal embolic protection devices and 15% MOMA were used. 64 right, 18 left, and two bilateral carotid arteries were stented with a total of 82 patient of 84 successful CAS. Due to residual stenosis a second stent was implanted only in one patient. One patient experienced a partial muscle weakening in upper extremity due to an air embolism and 2 patients received opac material which recovered spontaneously in 24 hours. Conclusion: CAS is being successfully applied with a very low risk of complications in experienced centers. Short-term clinical results of CAS are quite satisfactory. Key words: stroke, carotid artery stenosis, carotid artery stenting, clinical outcomes

Previous studies show that serum fibrinogen levels are established risk factors for coronary artery disease (CAD) and that serum albumin levels are of a higher specificity and sensitivity in ST-elevation myocardial infarction (STEMI). In this study, we sought to evaluate the association between fibrinogen to albumin ratio (FAR) and the extent and severity of CAD evaluated by TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries (SYNTAX) Score (SS) in patients with STEMI.A total of 278 patients with STEMI were included in the study. FAR was calculated using specified variables. The extent and severity of CAD were evaluated using the SS. The patients were divided into low- (SS22) and high- (SS ≥22) risk groups. A Spearman rank correlation coefficient analysis was used for the relationship between FAR and SS. The cutoff points for sensitivity and specificity of FAR in predicting SS were estimated by performing a receiver operator characteristic curve analysis.There were significant differences in the mean age (P=.016), admission serum albumin (P=.041), serum fibrinogen (P.001), FAR (P.001), and SS risk groups. Positive correlation was detected between FAR and SS (r=0.458, P.001). A cutoff level of87 FAR predicted SS (sensitivity, 70%; specificity, 70%), and an area under the curve of 0.758 serum fibrinogen and albumin level was an independent predictor for SS in patients with STEMI (b=0.039; 95% confidence interval, 0.016-0.062; P=.001 and b=-6.906; 95% confidence interval, -12.284 to -1.527; P=.013, respectively).In the present study, we showed that FAR is significantly related to SS in predicting the severity of CAD in patients with STEMI.

Objectives: In this study, we aimed to compare the effectsof infarct localization in patients with ST ElevatedMyocardial Infarction (STEMI) on the right ventricular(RV) functions by using advanced echocardiographicmethods.Materials and methods: A total of 89 patients withSTEMI were included into the study and patients weredivided to three groups as anterior, isolated-inferior andinferior+RV MI groups. In addition to standard echocardiographicmesurements, RV tissue doppler, RV EjectionFraction (RVEF), Myocardial performance index (MPI)and TAPSE measurements of all patients were performedbetween 24-72 hours after the event.Results: Compared to groups, RV functions in inferior MIwith RV involvement group were deteriorated. Tricuspidannular plane systolic excursion (TAPSE) value for theinferior MI with RV involvement (19±1mm) group werelower than those for Inferior MI group without RV involvement(23±1mm) and anterior MI (23±1mm) (p

OBJECTIVES Neurally mediated syncope is defined as a transient loss of blood flow to the brain, resulting in vasodilatation, bradycardia, or both. The pathophysiologic mechanisms of neurally mediated syncope are not clear. In this study, we investigated carotid artery elasticity parameters in patients with neurally mediated syncope. METHODS The study was conducted on 41 patients who were examined by the tilt table test. Group 1 constituted of 21 patients who had a positive response to the tilt table test. Clinical and hemodynamic parameters were compared with patients in a negative tilt table test group (group 2). The systolic and diastolic diameters of the carotid arteries, carotid distensibility, carotid strain, carotid stiffness index, and carotid elastic modulus of the left carotid arteries were calculated by a high-resolution ultrasound device. RESULTS No differences in hemodynamic variables or clinical parameters were detected between the groups. Carotid distensibility (mean ± SD, 1.6 ± 0.6 versus 2.2 ± 0.8 cm(2) × dyne(-1) × 10(-6); P = .044) and strain (6.8% ± 1.7% versus 8.2% ± 1.9%; P = .026) were lower in group 1 than in group 2. The carotid elastic modulus (0.88 ± 0.33 versus 0.74 ± 0.25 cm(2) × dyne(-1) × 10(-6); P = .002) and stiffness index (6.7 ± 0.4 versus 6.2 ± 0.5; P = .038) were higher in group 1. CONCLUSIONS In this study, we concluded that elastic properties of the carotid artery are impaired in patients with neurally mediated syncope. This finding suggests that impaired carotid arterial elasticity may be a factor in the pathophysiologic mechanisms of neurally mediated syncope.

The aim of this study is to investigate the association between neutrophil to lymphocyte ratio (NLR) and severity of coronary atherosclerosis. A total of 172 patients undergoing coronary angiography were included in the study. Control group consisted of patients with normal coronary arteries. Patients with coronary stenosis were divided into 2 groups by use of Gensini scores. The NLR was higher in severe atherosclerosis group compared with mild atherosclerosis and control groups ( P < .001). In correlation analysis, NLR showed significant correlation with Gensini score. A cutoff value of 2.5 for NLR predicted severe atherosclerosis with a sensitivity and specificity of 62% and 69%, respectively. After multivariate analysis, high levels of NLR were independent predictors of severe atherosclerosis together with glucose and high-density lipoprotein. Our study suggests that the NLR is a predictor of severe atherosclerosis that may be useful for cardiac risk stratification in patients with coronary artery disease.

Epicardial fat has been proposed as a new cardiometabolic risk factor. Although epicardial fat thickness (EFT) is associated with hypertension, the relationship between diurnal blood pressure profiles and EFT is still unknown. The purpose of this study is to investigate the association between the echocardiographic EFT and diurnal blood pressure profiles in hypertensive patients.After the ambulatory blood pressures of 123 patients were monitored, they were divided into three groups according to the clinical diagnoses: 41 patients (33.3%) were in the normotensive group, 40 patients (32.5%) were in the dipper hypertensive group and 42 patients (34.1%) were in the non-dipper hypertensive group. All participants underwent transthoracic echocardiography and ambulatory blood pressure monitoring to measure the EFT and blood pressure responses.The mean EFT measurements of the dipper group were significantly higher than the normotensive group (6.5 ± 0.6 vs 5.8 ± 0.6; p0.0001). On the other hand, the mean EFTs of the non-dipper group were also significantly higher than the dipper group (7.4 ± 0.7 vs 6.5 ± 0.6, p0.0001). An EFT of ≥ 7 mm predicted the non-dipper profile in hypertensive patients with 74% sensitivity and 71% specificity (receiving operator characteristic area under the curve: 0.826, 95% CI 0.738-0.913; p0.0001). EFT was associated with both dipper (OR 8.9, 95% CI 3.03-26.3; p0.0001) and non-dipper blood pressure profiles (OR 12.3, 95% CI 1.75-86.31; p0.0001), and this relationship was also independent from all the risk factors.Echocardiographic EFT assessment is independently associated with impaired diurnal blood pressure profiles in the hypertensive individuals. Thus, the echocardiographic assessment of the EFT may be helpful in cardiometabolic risk stratification and therapeutic interventions.

Epicardial fat tissue is a visceral fat depot with anatomical and functional contiguity to the myocardium and coronary arteries. The objective of this study was to evaluate the association between epicardial fat thickness (EFT) and cardiac changes in healthy female subjects. The study population consisted of ninety-six consecutive healthy female (mean age 31.1 ± 6.7 years) who underwent transthoracic echocardiography. EFT was measured by echocardiography. Subjects were divided into two groups according to the EFT; EFT6 mm and EFT ≥ 6 mm. The cardiac structural changes, increased left atrial volume indices (LAVI) (41.2 ± 9.9 vs. 52.6 ± 12.5, p = 0.001) and left ventricular mass indices (LVMI) (129.6 ± 32.1 vs. 155.6 ± 31.6 p0.05), were observed in patients with increased EFT. Myocardial tei index (MTI), which was used to evaluate both systolic and diastolic functions, was higher with increased EFT (0.44 ± 0.07 vs. 0.48 ± 0.08, p = 0.02). The correlation analysis revealed significant correlation between EFT and each of LAVI (r = 0.312, p = 0.002), LVMI (r = 0.301, p = 0.003), body mass index (BMI) (r = 0.8, p0.001), and MTI (r = 0.27, p = 0.005). Multivariate regression analysis demonstrated that EFT was associated with BMI (t = 5.28, p = 0.001), MTI (r = 2.39, p = 0.019), LVMI (r = 2.16, p = 0.01), and LAVI (r = 3.21, p = 0.002). In conclusion, EFT is an important predictor of cardiac alterations in women who are prone to obesity.

PubMedID: 26789488 We conducted this study to determine demographic details, and clinical presentations in patients with peripartum cardiomyopathy (PPCMP) of Turkish origin. The study population consisted of 58 patients with PPCMP treated at 3 major hospitals in Turkey, retrospectively. In this study, demographic details and initial echocardiographic data were recorded and long-term clinical status was evaluated. The mean age for the patient cohort was 31.47 ± 6.31 years. Thirty-eight patients (73.1%) were multigravida and seven patients had multifetal pregnancy (13.7%). The mean follow-up left ventricular (LV) ejection fraction increased from 31 ± 7 to 38 ± 19. A minority of patients were defined as improvers according to our pre-specified criteria. The average survival period after diagnosis of PPCMP was 20.66 ± 14.44 months. Initial values for LV end-diastolic diameter and urea were higher in the deceased patients compared with the surviving patients, respectively. Twenty-eight (48%) patients with PPCMP showed improvement in the follow-up period. Of the 58 PPCMP patients, 9 (15%) died during a mean follow-up of 32 ± 22 months. © 2016 Informa UK Limited, trading as Taylor & Francis Group.

INTRODUCTION The thrombolysis in myocardial infarction (TIMI) risk score is calculated as the sum of independent predictors of mortality and ischemic events in ST elevation acute myocardial infarction (STEMI). Several studies show that the neutrophil to lymphocyte ratio (NLR) is a prognostic inflammatory marker. In preliminary studies, platelet to lymphocyte ratio (PLR) has been proposed as a pro-thrombotic marker. The relationship between NLR, PLR and TIMI risk score for STEMI has never been studied. AIM To evaluate the association between TIMI-STEMI risk score and NLR, PLR and other biochemical indices in STEMI. MATERIAL AND METHODS In this retrospective study, we evaluated 390 patients who presented with STEMI within 12 h of symptom onset. Patients were grouped according to low and high TIMI risk scores. RESULTS We enrolled 390 patients (mean age 61.9 ±13.6 years; 73% were men). The NLR, platelet distribution width (PDW) and uric acid level (UA) were significantly associated with a high TIMI-STEMI risk score (p = 0.016, p = 0.008, p = 0.030, respectively), but PLR was not associated with a high TIMI-STEMI risk score. Left ventricular ejection fraction was an independent predictor of TIMI-STEMI risk score. A cut-off point of TIMI-STEMI score of > 4 predicted in-hospital mortality (sensitivity 75%, specificity 70%, p < 0.001). We found that NLR, PDW, and UA level were associated with TIMI-STEMI risk score. CONCLUSIONS Neutrophil to lymphocyte ratio, PDW and UA level are convenient, inexpensive and reproducible biomarkers for STEMI prognosis before primary angioplasty when these indicators are combined with the TIMI-STEMI risk score. We believe that these significant findings can guide further clinical practice.

Objective: The aim of the study was to determine the clinical characteristics, comorbidities, responsible dis­eases and in-hospital mortality of patients who received a temporary pacemaker Methods: Our study included 545 patients who received a temporary pacemaker due to various causes during their hospitalization between January 2008 and May 2012. Results: Of the 545 patients whose records were scanned retrospectively in our study, 235 (43%) were fe­male and 310 (57%) were male. Average age of patients was 70±14.2 years (20,100). Leading cause for receiving pacemaker was third degree atrioventricular block (178 patients, 32.6%).Other causes were bradycardia or asys­tole during procedures such as coronary angiography, catheterization etc. (101 patients, 18.5%), symptomatic sinus bradycardia (70 patients, 12.8%), pacemaker end of life (During procedure, 65 patients, 11.9%). Temporary pacemaker implantation due to drugs, hyperpotasemia and both was 6.2% (34 patients), 3.6% (20 patients) and 1.1% (6 patients) respectively. Eight patients used drugs for committing suicide. While the top responsible drugs for pacemaker implantation were digoxin, beta blockers and calcium channel blockers, only one patient was using a noncardiac drug (oxcarbamazepin). Half of the patients had coronary artery disease (276 patients, 51%). 101 pa­tients (18.5%) received a temporary pacemaker due to block in the course of myocardial infarction. 85 patients died during their hospitalization (15.5%). Conclusıon: Although causes for temporary pacemaker implantation has changed over time, myocardial infarction with block still remains fatal even a temporary pacemaker is inserted. J Clin Exp Invest 2013; 4 (2): 180-183, Amaç: Geçici kalp pili implante edilen hastaların klinik özellikleri, komorbiditeleri, altta yatan hastalıkları ve hastane içi mortalitelerinin belirlenmesi amaçlanmıştır. Yöntemler: Çalışmamıza değişik sebeplerle geçici kalp pili takılması gerekli olan, Ocak 2008-Mayıs 2012 tarihleri arasında hastanemizde yatırılarak takip edilen 545 hasta dahil edilmiştir. Bulgular: Çalışmamızda geriye dönük olarak taranan 545 hastadan 235’i kadın (%43) ve 310’u erkekti (%57). Hastaların yaş ortalaması 70±14,2 (aralığı, 20-100) olarak hesaplandı. En sık kalp pili takılma sebebi olarak atriyoventriküler tam blok (178 hasta, %32,6) saptandı. Bunu koroner anjiografi, kateter vb. işlemler sırasında gelişen bradikardi, asistol (101 hasta, %18,5), semptomatik sinüs bradikardisi (70 hasta, %12,8), kalp pili ömrünün bitmesi (kalp pili değişim işlemi sırasında,65 hasta, %11,9) gibi nedenler izledi. İlaca ve hiperpotasemiye bağlı olarak sırasıyla 34 ve 20 hastaya (%6,2,%3,6), her iki nedene bağlı 6 hastaya (%1,1) geçici kalp pili implantasyonu yapılmıştı. 8 hastada intihar amaçlı ilaç içimi gözlendi. En sık geçici kalp pili takılmasına gerek duyulan ilaçlar digoksin, B blokerler ve kalsiyum kanal blokerleri olurken; sadece 1 hastada direkt kardiyak endikasyonla kullanılmayan ilaç saptandı (okskarbamazepin). Hastaların yaklaşık yarısında koroner arter hastalığı saptandı (276 hasta, %51). 101 hastada (%18,5) miyokart enfarktüsüne bağlı blok nedeniyle geçici kalp pili implantasyonu yapılmıştı. Hastaların 85 tanesi hastanede yatışı sırasında eksitus olmuştu (%15,5). Sonuç: Geçici kalp pili takılma nedenleri zaman içerisinde değişiklik göstermesine rağmen, geçici kalp pili takılsa bile, miyokart enfarktüsü sırasında blok gelişimi oldukça ölümcül seyretmektedir.

A 69-year-old male patient chronic smoker with a past history of hypertension, myocardial infarction was admitted with complaints orthopnea. Examina­tion revealed a blood pressure of 150/100 mmHg, pulse 114/min, tachypnea, jugular venous disten­tion. Extensive bilateral crackles over both lung fields. The findings were consistent with the diagno­sis of acute pulmonary edema. Chest radiography and tomography revealed a spherical mass in the middle lobe of the right lung, obscuring the right side of the cardiac silhouette (Fig. 1). Echocardiographic evaluation showed preserved left ventricular systol­ic function with ejection fraction of 60%, and signs of restrictive type of diastolic dysfunction (E/A=4.8, DT 100 msec). An increase in diuretic dose result­ed in improvement in the patient\'s symptoms and A repeat radiograph and tomography (Fig. 2) after successful treatment of the acute pulmonary edema showed complete resolution of the opacity consis­tent with the diagnosis of “pseudotumor” or “vanish­ing tumor” or “phantom tumor” of the lung. Phantom tumor is generally believed to occur in patients with systolic dysfunction (1). Phantom tumor of the lung refers to the accumulation of fluid in the interlobar spaces as a result of congestive heart failure, giving the radiological appearance of a neoplasm. Rapid radiological improvement in response to treatment for heart failure is a classical feature of this clini­cal entity. Although phantom tumor is generally be­lieved to occur in patients with systolic dysfunctio, in our case, its appearance was secondary to diastolic dysfunction. We presented phantom tumor of the lung in a patient with preserved left ventricular sys­tolic function. J Clin Exp Invest 2013; 4 (2): 242-243

Aim. To present a case referred to our clinic with severe right ear pain but without any abnormal finding during otological examination and diagnosed as myocardial infarction and also to draw attention to otalgia which can occur secondary to myocardial infarction.Case Report. An 87-year-old female admitted with right ear pain lasting for nearly 12 hours and sweating on the head and neck region. On otolaryngologic examination, any pathological finding was not encountered. Her electrocardiogram revealed findings consistent with myocardial infarction. Her troponin values were 0.175 ng/L at 1 hour, and 0.574 ng/L at 3 hours. The patient was diagnosed as non-ST MI, and her required initial therapies were performed. On cardiac angiography, very severe coronary artery stenosis was detected, and surgical treatment was recommended for the patient. The patient who rejected surgical treatment was discharged with prescription of medical treatment.Conclusion. Especially in elderly patients with complaints of ear pain but without any abnormal finding on otoscopic examination, cardiac pathologies should be conceived.

Implantable cardioverter defi brillators are widely used for primary and secondary prevention from sudden death. These devices terminate attacks of ventricular tachycardia and ventricular fi brillation by applying direct current shock, if it necessary. Despite these benefi cal effects, inappropriate shocks are important side effects of implantable cardioverter defi brillators. Inappropriate implantable cardioverter defi brillator shocks impair life quality by causing pain and psychological side-effects, and even induce new arrhytmias. In this paper we present a case of inappropriate implantable cardioverter defi brillator shock due to tremor.

Paravalvular leak (PVL) is a common complication after surgical valve replacement. Most PVLs remain clinically silent; however, some may require reoperation due to symptomatic PVL. Surgical closure of PVL remains the most common therapy for these defects; however, redo surgery has some disadvantages, including a high recurrence rate as well as high morbidity and mortality rates. Percutaneous closure of PVLs has emerged as an alternative to surgical closure. A 42-year-old male patient underwent a second percutaneous closure due to residual mitral paravalvular leak. During the procedure, the closure device embolized in the descending aorta. The device was captured with a snare and successfully retrieved, and then PVL was successfully occluded with another device.