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Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not much is known about the etiologies of aortic aneurysm. Recently, in hypertensive (HT) patients, blood...

Introduction: Coronary angiography is a principle diagnostic and therapeutic procedure in modern cardiology practice. The transradial access for cardiac catheterization has overtaken the transfemoral approach because of many advantages. However, some patients suffer radial pain after the procedure. Unfortunately, this complication has been poorly evaluated in previous studies. The present study aimed to determine the prevalence of radial pain after transradial coronary angiography and investigate factors that influence post-procedural pain. Methods: This is a cross-sectional study in which a total of 100 consecutive patients who underwent elective transradial coronary angiography ± percutaneous coronary intervention between January 2015–2016 were evaluated. The patients were asked about presence of disturbing pain in the forearm especially wrist region after the procedure. Verbal rating scale was used to evaluate pain assessment. The patients were divided as early pain group (two hours after the procedure) and prolonged pain group (one month after the procedure) and analysis was performed. Results: A total of 55 patients suffered from pain in the early phase (after two hours), and 26 of patients had prolonged pain at one month after the radial intervention. Independent pain predictors in the early pain group were male operator (p = 0.004, OR = 3.386, 95% CI: 1.484–7.725) and experience of operator (OR = 4.147, 95% CI: 1.637–10.506, p = 0.003). On the other hand, the younger age of patients (OR = 0.955, 95% CI: 0.915–0.966, p = 0.032) and experience of operator (OR = 3.947, 95% CI: 1.547–10.047, p = 0.004) were the independent predictors of prolonged radial pain. Conclusion: Pain after radial coronary angiography is not uncommon. Experience, operator gender, and age of the patients were independent predictors of pain after transradial coronary angiography.

In patients with severe aortic stenosis, the data about the incidence of acquired thrombocytopenia according to the use of balloon-expandable or self-expandable valves are limited. We investigated the relationship between the post-transcatheter aortic valve replacement (TAVR) thrombocytopenia and the balloon-expandable or self-expandable valves. A total of 127 consecutive patients who underwent TAVR were retrospectively analyzed. Among the study population, 61 (48%) patients underwent TAVR with the balloon-expandable valve and the 66 (52%) patients with the self-expandable valve. Procedural success did not differ between the groups ( P = .575). The access site complications and in-hospital mortality were the same across the groups ( P = .225 and P = .466). However, paravalvular (PV) leaks were significantly higher in the self-expandable valve group ( P = .007). Among all, 65 patients experienced thrombocytopenia, which was more frequent in the self-expandable valve group (63.6 vs 37.7%, P = .005). In multivariate analyses, admission platelet count, PV leak, and self-expandable valve deployment were the predictors of thrombocytopenia ( P = .001, P = .002, and P = .021, respectively). The present study showed a higher incidence of acquired thrombocytopenia in the self-expandable valve group. Although the procedural success was similar between the groups, postprocedural PV leaks were more common in the self-expandable valve group.

Objective Non high density lipoprotein cholesterol (non HDL-C) covers all aterojenic lipoproteins and correlates with C reactive protein (CRP) which is reliable marker of inflammation. CRP is related to poor angiographic coronary collateral circulation (CCC). We aimed to show whether non HDL-C is associated with CCC.Methods Patients who underwent coronary angiography for stable coronary artery disease and at least one epicardial coronary artery occluded in the proximal or middle region were included in the study. Accrording to the Rentrop scoring system Rentrop 0 and 1 were considered to be poor CCC, and Rentrop 2 and 3 were considered to be good CCC. Non-HDL-C was calculated by subtracting HDL-C from total cholesterol (TC).Results 84 patients were included in the study. While 44 patients (52%) had good CCC, 40 patients (48%) had poor CCC. TC was found to be higher in the poor CCC group than in the good CCC group (224.3 ± 35.6 vs 179.2 ± 25.5 p = 0.000). HDL-C levels were found to be lower in the poor CCC group than in the good CCC group (37.3 ± 9.8 vs 44.1 ± 8.6 p = 0.001). Non-HDL-C cholesterol levels were higher in the group with poor CCC (185.7 ± 39.2 vs 132.8 ± 28.1 p = 0.000). CRP levels were found to be higher in the poor CCC group (3.73 ± 2.5 vs 1.67 ± 1.4 p = 0,000).Conclusion Non-HDL-C is independent predictors of poor CCC.

Background Previous studies proposed that inflammation, oxidative stress, and impaired endothelial dysfunction have a crucial role in occurrence of saphenous vein graft (SVG) disease (SVGD). The aim of this study was to assess the relationship between monocyte-to-high-density lipoprotein cholesterol (HDL-C) ratio (MHR) and serum albumin (SA) level as readily available inflammatory and oxidative stress markers with the presence of SVGD in patients with a coronary bypass. Methods In this retrospective cross-sectional study, a total of 257 patients (n = 112 SVGD [+] [mean age was 65.3 ± 8.4 years, 75.0% males] and n = 145 SVGD [−] [mean age was 66.5 ± 10.1 years, 74.5% males]) were enrolled. At least one SVG with ≥ 50% stenosis was defined as SVGD. Independent predictors of SVGD were determined by logistic regression analysis. Results White blood cell, neutrophil, monocyte, the age of SVG, and MHR were significantly higher, whereas SA level was significantly lower in patients with SVGD. In regression analysis, neutrophil, age of SVG, SA (odds ratio [OR]: 0.232 [0.156–0.370], p Conclusion Consequently, to the best of our knowledge, this is the first study showing a significant and independent association between SA and MHR with SVGD.

Graphical abstract, Highlights • A post-MI ventricular septal defect is a complication of ST-elevation MI. • Iatrogenic tricuspid regurgitations have not been reported after percutaneous closure. • Care should be taken with the degree of tricuspid regurgitation to prevent iatrogenic tricuspid injury.

Presently described is a case in which the tip of the delivery catheter system (nose cone) has been broken during catheter removal after valve deployment in a femoral transcatheter aortic valve replacement procedure and the successful management of this rare complication.

We assessed the prognostic value of the platelet to lymphocyte ratio (PLR) on in-hospital and long-term major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in a large prospective study. Patients (n = 1938) admitted with acute STEMI within 12 hours of symptom onset and who underwent pPCI between January 2010 and January 2015 were followed up for 31.6 ± 16.2 months. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, nonfatal myocardial infarction, and mortality were higher in the third PLR tertile group. A PLR in the third tertile had 2.4-fold increased risk of in-hospital MACE and 2.8-fold risk of long-term MACE. The PLR was significantly and positively correlated with peak creatine kinase MB (CK-MB) levels (r = 0.562, P < .001) and Gensini score (r = 0.408, P < .001). Kaplan-Meier analysis of long-term MACE-free survival revealed a higher occurrence of MACE in the third PLR tertile group compared to the other tertiles. In conclusion, the PLR may be a marker of inflammatory and prothrombotic status and predicted in-hospital and long-term MACE in a population with STEMI.

The objective of this study was to evaluate right ventricular systolic and diastolic functions with the use of conventional and tissue Doppler echocardiography in patients with slow coronary flow (SCF).Patients who were detected to have SCF but otherwise normal epicardial coronary arteries between October 2010 and July 2011 were included in our study. The control group was selected from the patients with normal coronary arteries but no SCF. All patients underwent echocardiography to evaluate left and right cardiac functions with conventional methods and tissue Doppler imaging. The study consisted of 86 patients [59 (68.6%) males, mean age: 54 +/- 10 years) with SCF. Sixty-six subjects [42 (63.6%) males, mean age: 55 +/- 8 years] with normal coronary arteries without SCF constituted the control group.Tissue Doppler findings of left ventricular systolic and diastolic functions were significantly disturbed in the SCF group (myocardial performance index: 0.37+/- 0.02 vs. 0.28 +/- 0.02, P0.001; E/A ratio: 0.9 +/-0.1 vs. 1.1 0.1, P0.001). However, when the right ventricular functions were considered, no significant difference was observed between the 2 groups (myocardial performance index: 0.25 +/- 0.10 vs. 0.25 +/- 0.10, P = 0.9; E/A ratio: 0.50 +/- 0.06 vs. 0.50 +/- 0.08, P= 0.3; TAPSE: 26.2 +/- 2.2 vs. 25.9 +/- 2.2, P = 0.6).Preserved right ventricular diastolic and systolic functions in contrast to the impaired left ventricular functions in patients with SCF was the main finding of our study. The exact mechanisms of this new finding should be investigated by further studies.

Background: Adiponectin, an adipose tissue derived cytokine, is known to have antiatherogenic and anti-inflammatory effects on endothelial cells and macrophages. Calcific aortic valve disease has a similar physiopathology to atherosclerosis. Aim: To investigate the relationship between adiponectin and calcific aortic valve disease. Methods: The study group consisted of 58 patients with calcific aortic stenosis and 24 healthy controls. Aortic stenosis patients were divided into three groups according to their valvular areas: mild (n = 11), moderate (n = 25), and severe (n = 22). Serum adiponectin levels and other biochemical parameters were measured. Results: The aortic stenosis and control group were similar in terms of age, gender and cardiovascular risk factors. Adiponectin median values did not differ significantly between two groups (2.19 μg/mL [1.43–3.18], 1.79 μg/mL [1.34–3.42] aortic stenosis and control group, respectively; p = 0.7). Aortic stenosis patients were divided into three groups according to their valvular area as mild, moderate and severe. There were no differences when we compared adiponectin levels among those groups (mild: 2.10 μg/mL [1.47–3.31], moderate: 2.13 μg/mL [1.44–2.91], severe: 2.65 μg/mL [1.28–3.43]; p = 0.67). Age (r = 0.26, p = 0.045) and aspartate aminotransferase (r = 0.28, p = 0.04) had positive correlations with adiponectin; while white blood cell count (r = –0.32, p = 0.015), fasting blood glucose (r = –0.29, p = 0.03), haemoglobin (r = –0.27, p = 0.04) and triglyceride levels (r = –0.41, p = 0.002) had negative correlations. Conclusions: In our study, we did not find a relationship between adiponectin levels and calcific aortic valve disease.

Aim: We aimed to investigate whether baseline monocyte to high-density lipoprotein cholesterol ratio (MHR), an easily available inflammatory and oxidative stress marker, is associated with SYNTAX score. Patients & methods: In this cross-sectional study, n = 1229 consecutive patients with coronary artery disease were classified into two groups, low SYNTAX score (≤22) and high SYNTAX score (≥23). Results: MHRs were significantly higher in patients with high SYNTAX score (p < 0.05). In multivariate regression analysis, MHR remained as independent predictor of high SYNTAX score together with C-reactive protein (CRP), hypertension and diabetes mellitus. In correlation analysis, MHR showed significant positive correlations with SYNTAX score (r = 0.371, p < 0.001) and CRP level (r = 0.336, p < 0.001). Conclusion: This study suggests MHR is independently associated with burden of coronary atherosclerosis.

Collaterals, which develop in response to ischemic stimuli derived from coronary artery disease (CAD), contribute to reduction of infarct size, left ventricular dysfunction, and mortality. However, there is considerable variation among patients with coronary heart disease regarding the extent of coronary collateral development (CCD). In this study, we aimed to investigate the association of the degree of platelet activation via mean platelet volume (MPV) with coronary collateral circulation. Therefore, 210 patients who underwent coronary angiography and had coronary stenosis ≥50 % in at least one coronary artery were included in the study. Clinical information and analyses of blood samples were obtained from a review of the patients' chart. Blood samples for MPV were analyzed by K3 EDTA and collateral vessels were graded according to the Rentrop classification. In the study group, 150 of the 210 patients were found to have inadequate CCD. Although there was no difference between the two groups with regard to platelet count, MPV levels were significantly higher in the patients who had inadequate CCD (11.3 ± 1.0 fl vs. 9.5 ± 1.5 fl, p 0.001). Furthermore, the Gensini score was significantly lower in patients who had inadequate CCD (45 ± 46 vs. 91 ± 35, p 0.001). MPV, Gensini score, age, female gender, total cholesterol, red cell distribution width, triglyceride, and fasting glucose levels were found to have univariate association with poor CCD. In multivariate logistic regression model, MPV (OR = 2.45, p 0.001) and Gensini score (OR = 0.98, p 0.001) were found to be the independent predictors of impaired CCD. In receiver operator characteristic curve analysis, optimal cut-off value of MPV to predict inadequate CCD was found as9.6 fl, with 96% sensitivity and 84.7% positive predictive value. In conclusion, we can say that MPV is an important, simple, effortless, and cost effective tool and can be useful in predicting the CCD in patients with significant CAD.

Epicardial adipose tissue (EAT) is related to the presence of coronary artery disease (CAD). Increased γ-glutamyltransferase (GGT) activity is associated with atherosclerosis. We assessed the relationship between EAT and serum GGT activity in addition to cardiovascular risk factors in patients with stable anginal symptoms. Consecutive patients (n = 120) who underwent coronary angiography were included. Epicardial adipose tissue thickness was measured by echocardiography. Serum GGT activity was measured by enzymatic colorimetric assay. Epicardial adipose tissue thickness and serum GGT activity were higher in patients with CAD (n = 83). Patients with metabolic syndrome (n = 83) were found to have higher EAT thickness. Serum GGT activity was independently associated with EAT values. In conclusion, echocardiographic EAT was significantly higher in patients with CAD and serum GGT activity correlated with EAT thickness.

The intrinsic atrial vulnerability is proposed as one of the mechanisms of paroxysmal atrial fibrillation (PAF) in Wolff-Parkinson-White (WPW) syndrome. In this study, we examined the early changes in atrial refractoriness and intra- and inter-atrial conduction times after radiofrequency (RF) catheter ablation of accessory pathway (AP).Twenty-four consecutive patients with WPW syndrome and documented AV reciprocating tachycardia but without history of PAF (fourteen male, mean age 39 +/- 9.5 years) and 27 control subjects (six female, mean age 51.4 +/- 10.1 years) with AV nodal reentrant tachycardia (AVNRT) who underwent ablation of the slow AV nodal pathways were enrolled into the study. Regional atrial effective refractory periods (AERPs), AERP dispersion, and intra- and inter-atrial conduction times were obtained before and 30 min after ablation and were compared between two groups. In the study group, patients with and without inducible AF were also compared regarding these parameters.In the study group, AERPs in higher right atrium and right posterolateral atrium were significantly increased, and AERP dispersion, intra-atrial, and inter-atrial conduction times were significantly decreased after ablation; AERP in distal coronary sinus was unchanged. In control group, no significant difference was observed in these parameters. Inducibility of AF was significantly reduced following ablation of AP in the study group (from seven to zero of 24 patients, p = 0.016). Comparison between patients with (n = 7) and without (n = 17) AF revealed that left atrium diameter was larger, AERPs in the right posterolateral atrium before and after ablation, and ERP of AP were shorter in AF group.In WPW syndrome patients, RF catheter ablation of AP results in an 'immediate' decrease in atrial vulnerability. Since inducibility of AF becomes more difficult in this less vulnerable atrium, the AP itself may play an important role in the development of AF.

WOS: 000257946700009, PubMed ID: 17705053, Background: Acute coronary syndromes, characterized by the rupture of unstable plaque and the subsequent thrombotic process involving platelets, have been increasing in relative frequency. The central role of platelet activation has long been noticed in this pathophysiology; hence, many therapies have been directed against it. In this study, we have aimed to search prospectively the value of mean platelet volume (MPV), which is a simple and accurate measure of the functional status of platelets, in patients hospitalized with diagnosis of acute coronary syndromes (ACS). Materials and methods: A total of 216 consecutive patients (156 male, 60 female) hospitalized with the diagnosis of non-ST segment elevation (NSTE) ACS within the first 24 h of their chest pain were enrolled. One hundred and twenty patients, matched according to sex and age, with stable coronary heart disease (CHD) (85 male, 35 female) were enrolled as a control group. Patients were classified into two group: those with unstable angina (USAP, n = 105) and those with non-ST segment elevation myocardial infarction (NSTEMI, n = 111). Results: MPVs were 10.4 +/- 0.6 fL, 10 +/- 0.7 fL, 8.9 +/- 0.7 fL consecutively for NSTEMI, USAP and stable CHD with significant differences. Patients with ischemic attacks in the first day of hospitalization accompanied by > 0.05 mV ST segment shift had significantly higher MPV compared to those without such attacks (P = 0.001). Multivariable logistic regression analysis yielded that MPV (P = 0.016), platelet count (P < 0.001), and the presence of > 0.05 mV ST segment depression at admission (P = 0.002) were independent predictors of development of NSTEMI in patients presenting with NSTE ACS. Conclusion: In patients presenting with NSTE ACS, higher MPV, though there are overlaps among subgroups, indicates not only more risk of having NSTEMI but also ischemic complications.

Anticoagulation treatment can prevent systemic embolism in patients with mitral stenosis (MS) and atrial fibrillation (AF), but this treatment is under debate if patients are in sinus rhythm. The authors aimed to determine the hemostatic changes in patients with MS and sinus rhythm. Forty-six patients (28 in sinus rhythm and 18 in AF) with mitral stenosis were enrolled in this study. They studied systemic venous fibrinogen, D-dimer, antithrombin-III, tissue plasminogen activator (tPA), plasminogen activator inhibitor-I (PAI-I), von Willebrand factor (vWF), and platelet factor 4 (PF 4) in these patients. The patients were first classified according to their rhythm as sinusal and AF, and then according to the presence of left atrial spontaneous echo contrast (LASEC). Fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly greater in patients with MS and sinus rhythm or atrial fibrillation compared to the control group (p

Background We aimed to investigate the usefulness of monocyte to HDL cholesterol ratio (MHR) in predicting coronary artery disease severity and future major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS). Methods 2661 patient with ACS were enrolled and followed up during median 31.6 months. Results MHR were significantly positively correlated with neutrophil to lymphocyte ratio (r=0.438), CRP (r=0.394), Gensini (r=0.407), and SYNTAX score (r=0.333). During in-hospital and long-term follow-up, MACE, stent thrombosis, non-fatal MI, and mortality occurred more frequently in the third tertile group. Kaplan-Meier analysis revealed the higher occurrence of MACE in the third tertile group compared with other tertiles. Adjusting for other factors, a MHR value in the third tertile group was determined as an independent predictor of in-hospital and long-term MACE. Conclusions MHR as a novel inflammation-based marker seemed to be an independent predictor of severity of coronary artery disease and future cardiovascular events in patients with ACS. MHR may utilise the identification of patients who are at higher risk for MACE and individualisation of targeted therapy.

Every catheter laboratory is equipped with an X-ray system designed to provide fluoroscopic imaging of the heart. Although cardiac catheters are well visualized in all X-ray imaging, the soft tissue of myocardium is not. Therefore the imaging of the cardiac chambers is indirect through relation to the cardiac silhouette. However, fluoroscopy can be used to detect complications from the invasive procedures in the cardiac catheterization laboratory, such as cardiac tamponade where the excursion of the cardiac silhouette decreases, and visceral and parietal pericardium are seen separated by the blood of accumulation in the pericardial cavity. Even if a transthoracic or intracardiac echocardiography guidance is immediately available, early fluoroscopic detection of tamponade should be remembered during the invasive procedures in the cardiac catheterization laboratory.

Recent studies have suggested ABO blood type locus as an inherited predictor of thrombosis, cardiovascular risk factors, myocardial infarction. However, data is scarce about the impact of non-O blood groups on prognosis in patients with ST-elevation myocardial infarction (STEMI). Therefore, we aimed to evaluate the prognostic importance of non-O blood groups in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) METHODS: 1835 consecutive patients who were admitted with acute STEMI between 2010 and 2015 were included and followed-up for a median of 35.6months.The prevalence of hyperlipidemia, total cholesterol, LDL, peak CKMB and no-reflow as well as hospitalization duration were higher in patients with non-O blood groups. Gensini score did not differ between groups. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, non-fatal MI, and mortality were higher in non-O blood groups. In multivariate logistic regression analysis, non-0 blood groups were demonstrated to be independent predictors of in-hospital (OR:2.085 %CI: 1.328-3.274 p=0.001) and long term MACE (OR:2.257 %CI: 1.325-3.759 p0.001). Kaplan-Meier analysis according to the long-term MACE free survival revealed a higher occurrence of MACE in non-O blood group compared with O blood group (p0.001, Chi-square: 22.810).Non-O blood groups were determined to be significant prognostic indicators of short- and long-term cardiovascular adverse events and mortality in patients with STEMI undergoing pPCI. In conjunction with other prognostic factors, evaluation of this parameter may improve the risk categorization and tailoring the individual therapy and follow-up in STEMI patient population.

WOS: 000236020200010, PubMed ID: 16490428, Development of coronary collaterals (CCs) is triggered by the gradient between arteries due to obstruction and myocardial ischemia. Presence of CCs that feed the jeopardized myocardial area may limit the infarct size after coronary occlusion and may even provide a survival benefit. However, some patients develop good CCs, whereas others do not. The metabolic syndrome (MS) has been identified as a secondary target to decrease cardiovascular risk, although the effect of MS on development of CCs has not been investigated. We prospectively enrolled 596 consecutive patients (337 men and 259 women; mean age 56 +/- 8 years) who underwent coronary angiography at our center and were found to have total occlusion of the right coronary artery. Patients were then classified as having good CCs (Rentrop's grades 2 to 3) or poor CCs (Rentrop's grades 0 to 1). There were significant differences in terms of body mass index (kilograms of body weight divided by square meters of height), glucose levels, triglyceride levels, and years with angina pectoris between those with good and poor CCs. Prevalences of diabetes mellitus were 27.1% among patients with good CCs and 44% among those with poor CCs (p

To assess the diagnostic importance of serum-solubilized adhesion molecules, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, sE-selectin and sP-selectin in aortocoronary saphenous vein graft disease.The study population was composed of two groups consisting of 41 patients with saphenous vein graft stenosis (stenosis group) and 43 patients without saphenous vein graft stenosis (no-stenosis group) based on the results of coronary angiography. All patients underwent coronary artery bypass graft operation involving the use of at least one saphenous vein graft for bypass. At the time of cardiac catheterization, it had been more than 1 year since the operation.Serum level of sP-selectin was significantly higher in the stenosis group than in the no-stenosis group (72.9+/-21.7 versus 48.7+/-18.6 ng/ml, P0.001). No differences were found between the two groups with respect to serum levels of sE-selectin, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. Multivariate analysis revealed that only serum levels of sP-selectin, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were independently correlated with the stenosis of saphenous vein grafts. A cutoff value of serum sP-selectin57.5 ng/ml yields a specificity of 79.5%, a sensitivity of 73.3% and a positive predictive value of 80.5% for saphenous vein graft stenosis.In this study, sP-selectin level was found to be significantly higher in the group that had late aortocoronary saphenous vein bypass graft disease. This result suggests that platelet activation may play a causal role in late graft disease.

Aortic stenosis is one of the most commonly encountered valvular pathology requiring surgery in developed countries. There are similarities between risk factors for coronary atherosclerosis and the development of aortic stenosis. We designed a retrospective study, evaluated the lipid profile and previous echocardiographic recordings of patients with aortic stenosis, and searched the association of rate of progression and lipid profile.The annual rates of progression in the peak and mean aortic gradients were 8.5 +/- 3.2 and 6.7 +/- 2.2 mm Hg/year, respectively. We classified the annual rate of progression of peak aortic gradient into 2 groups, group 1 with10 mm Hg ("slow progressors") and group 2 withor =10 mm Hg annual rate of progression ("fast progressors"). The annual rate of progression in group 1 was significantly higher than that in group 2, both in peak and mean aortic gradients (12 +/- 2 mm Hg and 6.4 +/- 1.6 mm Hg; 9 +/- 1.3 mm Hg and 5.2 +/- 1.1 mmHg; P.001 for both). There was a highly significant difference between group 1 and group 2 for total cholesterol/high-density lipoprotein (HDL) cholesterol level ratio (7.1 +/- 1.4 vs 5.2 +/- 1.3, P.001). There was a significant correlation between annual rate of progression in peak gradient and total cholesterol/HDL cholesterol level ratio (r = 0.399, P =.009). Smoking (P =.024, Beta = 0.26), presence of coronary heart disease (P =.011, Beta = 0.31), and total cholesterol/HDL cholesterol level ratio (P =.004, Beta = 1.98) were independently predictive of fast progression of the peak aortic gradient in the regression analysis.In a small group of patients from Turkey with aortic stenosis, there seems to be an association between the rate of progression and total cholesterol/HDL cholesterol level ratio, with fast progression occurring in the group with higher ratios.

Objective - Dilated cardiomyopathy has been associated with left ventricular thrombosis, which leads to substantial morbidity and mortality as a site for peripheral emboli.There are some studies on patients with dilated cardiomyopathy showing altered haemostasis and platelet behaviour despite sinus rhythm. Mean platelet volume, which is the most accurate and simple estimate of platelet reactivity, may be associated with the development of left ventricular thrombosis. Methods and results - We prospectively enrolled 48 consecutive patients with dilated cardiomyopathy and sinus rhythm with left ventricular thrombosis and compared them with an age-sex-matched control group having dilated cardiomyopathy without left ventricular thrombosis.We found that in patients with left ventricular thrombosis mean platelet volume is significantly higher than those without (9.5 ′ 0.8 vs. 8.7 ′ 0.6, p < 0.001). Conclusions - Mean platelet volume is increased in patients with dilated cardiomyopathy and sinus rhythm having left ventricular thrombosis. This might be reflecting a causal relationship, which in turn requires further study to establish the role of antiplatelet agents both in prevention and in treatment.

We report a case of coronary artery perforation during diagnostic coronary angiography. No cardiac biomarker elevation was observed. However, the patient suffered acute pericarditis which was treated conservatively.

Agiz yoluyla kisa surede asiri su alimi ciddi norolojik ve kardiyak semptomlara yol acabilir ve su zehirlenmesi olarak adlandirilir. Bu durum psikiyatrik hastalarda siklikla gorulmektedir ancak intihar amacli asiri su alimi oldukca enderdir. Bu olgu sunumunda intihar amacli asiri su aliminin yol actigi elektrolit dengesizligine bagli ventrikuler fibrilasyon gelisen 51 yasindaki hastayi sunuyoruz. Hasta acil klinigimize bilinc degisikligi ve ajitasyon ile basvurdu. Hasta hipertansifti ve norolojik muayenesinde lateralizasyon bulgusu yoktu. Hastanede takibi esnasinda ventrikuler aritmi kardiyopulmoner arrest ve tonik klonik nobet gozlendi. Kan biyokimyasinda hastanin 4 saat icerisinde 12 litre su icmesiyle uyumlu olan hiponatremi ve hipokalemi mevcuttu. Elektrolit bozuklugunun duzeltilmesinden sonra ventrikuler aritmi ve nobet tekrarlamadi. Hasta psikiyatrik degerlendirmeye yonlendirildi ve antidepresan tedavi ile taburcu edildi. Su zehirlenmesi sizofreni gibi psikiyatrik bozukluklarda iyi bilinse de intihar dusuncesi olan depresif hastalarda daha once bildirilmemistir. Bu nadir durumun klinik sunumuna olan farkindalik potansiyel olarak olumcul seyredebilen komplikasyonlari onleyebilir.

Myocardial staining is a complication of coronary angiography or intervention procedures and consists of extravasations of contrast material into the myocardium. The powerful injection of contrast (myocardial staining) is caused by the improper positioning of the angiography or guiding catheter and can lead to refractory ventricular tachyarrhythmias and occasionally cardiac death. It results in small puffs of dye extravasating into pericoronary space (epicardial or myocardial).We presented an interesting image of a massive myocardial staining and dense coronary and thebesian venous opacification during complicated right coronary angiography. This case illustrates the value of careful manipulation and positioning of the coronary catheter during coronary angiogram.

WOS: 000357192400004, Objectives: This study aims to evaluate left and right ventricular functions at rest by pulsed-wave Doppler and tissue Doppler echocardiography methods in patients with Behcet's disease (BD) without overt cardiovascular disease, and compare with age and sex matched subjects. Patients and methods: Fifty-four patients with BD (12 males, 42 females; mean age 35+/-8 years; range 18 to 51 years) without cardiovascular symptoms, and 36 age-matched controls (12 males, 24 females; mean age 33+/-5 years; range 18 to 47 years) were included. Cardiac functions were evaluated by conventional and tissue Doppler echocardiography. Results: Although conventional indices of left ventricular systolic function were similar in both groups, mitral annular systolic velocity was lower (p

Uhl's anomaly is a rare congenital hypoplasia of the right ventricular (RV) myocardium. It can be seen together with some other congenital anomalies. Here we first report a 16-year-old male patient with Uhl's anomaly which appears with cardiac tamponade.

The object of our study was to compare the value of exercise stress testing with simultaneous dobutamine stress echocardiography and technetium-99m isonitrile singlephoton emission computed tomography for the diagnosis of coronary artery disease. Sixty-nine patients with either suspected or proven coronary artery disease underwent simultaneous dobutamine technetium-99m isonitrile singlephoton emission computed tomography and stress echocardiography, and treadmill exercise electrocardiography. Dobutamine echocardiography and technetium-99m isonitrile single-photon emission computed tomography revealed a higher overall sensitivity than exercise testing (94 vs 60% P

WOS: 000325595600018, PubMed: 23778004, Background: In this study, a novel echocardiographic parameter in the evaluation of the presence of coronary artery disease (CAD) and aortic stiffness, aortic propagation velocity, was measured and compared with other conventional aortic stiffness parameters such as aortic strain and aortic distensibility. Also, the relation between aortic propagation velocity and carotid intima media thickness was evaluated. Method and results: A total of 51 patients with CAD and 42 patients with normal coronary arteries as a non-CAD group were included in the study. Aortic propagation velocity was significantly lower in the CAD group (p < 0.001). A statistically significant relation was detected between aortic propagation velocity and the maximum, mean, and overall carotid intima media thickness values for right and left carotid arteries (p < 0.001). There was a statistically significant relation between aortic propagation velocity, aortic strain, and aortic distensibility (r = 0.556, p < 0.001 and r = 0.483, p < 0.001 respectively). Conclusion: Aortic propagation velocity is a novel and simple echocardiographic parameter of aortic stiffness which is feasible for non invasive cardiovascular risk stratification and selection of high risk individuals for CAD. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Atrial myxomas are rare tumors. They occur in less clinical history. In her neurological examination, no than 0.05% of the population, but they constitute persisting deficit was noticed. She was, then, conapproximately 50% of primary cardiac neoplasms [1]. sulted to the neurology department for differential They are true neoplasms thought to be derived from diagnosis of severe headache. At her contrast-enpluripotential subendocardial mesenchymal cells [2]. hanced computerized tomographic examination of the These tumors present with systemic embolization in cranium, she was noticed to have many commaup to 45% of cases [3,4], with the cerebral circulation shaped enhancing lesions one of which was a giant being involved in one-half of these instances [5]. aneurysm on the left side. She was, then, referred to Cerebral ischemia resulting from direct tumor emthe neurosurgery department on an urgent basis. bolization is the most common neurological preFollowing her hospitalisation in the neurosurgery sentation [6]. Other rare neurological manifestations department, she underwent cerebral angiography in include parenchymal brain metastasis [7], intracerebrwhich there were multiple fusiform aneurysms on al hemorrhage [5] and oncotic aneurysm formation both carotid artery territories, one of which was a [1,8]. With rare exceptions, neurological symptoms giant aneurysm on the left middle cerebral artery related to atrial myxomas occur before or at the time artery locus (Fig. 1) of primary tumor diagnosis. We describe a patient Treatment with coil embolization of the aneurysm who presented with transient neurological symptoms was decided due to localisation of the giant 25 years after complete resection of left atrial myxaneurysm. Before the procedure, since she was oma as initial finding of late recurrence. known to have resection of myxoma, an echocardiogA 38-year-old woman was admitted to our raphy was performed and a mass lesion originating emergency department with chief complaints of from the posterior wall of the left atrium with severe headache and episodes of right sided weakmultiple, mobile, papillary extensions towards mitral ness. She was normotensive having 115/75 mmHg valve was noted (Fig. 2). Following coil embolization systolic /diastolic blood pressures and known to have of the giant aneurysm, she was referred to our left atrial myxoma resection 25 years ago in her department and operated successfully for the mass lesion. Pathology confirmed our diagnosis and the diagnosis for the late recurrence of the myxoma at the first site was established. She has been followed up *Corresponding author. SSK Bloklari 70 /7 06170, Yenimahalle /Anby our clinic uneventfully for both recurrence and kara, Turkey. Tel.: 190-312-346-9401. E-mail address: cardioceptor@ttnet.net.tr (M.B. Yilmaz). progression or regression of cerebral aneurysms.

The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). Despite the improvement in P-wave dispersion after percutaneous mitral balloon valvuloplasty (PMBV), the changes in echocardiographic parameters related to AF risk are unknown. In this study we aimed to investigate the acute effect of PMBV on atrial electromechanical delay (EMD) assessed by tissue Doppler echocardiography in addition to electrocardiographic parameters. This single-center study consisted of 30 patients with moderate or severe MS (23 females and seven males, aged 36.5 ± 8.5 years, with a mean MVA of 1.1 ± 0.2 cm2) who underwent successful PMBV without complication at our clinic and 20 healthy volunteers from hospital staff as a control group (16 females and four males, aged 35.4 ± 6 years). We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated after PMBV within 72 h of the procedure. The P-wave dispersion was calculated from12-lead ECG. Interatrial and intra-atrial EMDs were measured by tissue Doppler echocardiography. These ECG and echocardiographic parameters after PMBV were compared with previous values. The maximum P-wave duration (138 ± 15 vs. 101 ± 6 ms, p

There is no doubt that appropriate use of thrombolytic drugs improves survival in patients with acute myocardial infarction. Streptokinase, one of the most commonly used thrombolytic drugs in large clinical trials, is not fibrin-specific and brings about a lytic state with potential for bleeding. We report a case of spontaneous rectus muscle hematoma following streptokinase therapy for acute myocardial infarction and review the relevant literature. To our knowledge, this is the first case reported in the literature. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

This report presents a case of a left hemitruncus and tetralogy of Fallot. The diagnosis was first made by means of echocardiography and confirmed with cardiac catheterization thereafter. To the authors' knowledge, this patient is the fourth-longest-term survivor so far reported in the medical literature. A significant improvement has been observed after surgical correction of the anomaly, and the patient was free of symptoms at the 6-mo follow-up examination.

WOS: 000265432300009, PubMed ID: 18413331, In this study, factors leading to the failure of internal mammary artery grafting was investigated among patients with coronary bypass. In all, 1323 patients were evaluated. It was found that lower grade diameter stenosis in the native vessel during postoperative angiogram and wall motion score index independently affected the fate of internal mammary artery as a graft. Grafting with internal mammary artery to native vessels with lower grade stenosis and to myocardium with poor wall score might not be a rational approach.

Objective: To determine whether QT dispersion (QTd), a noninvasive electrocardiographic parameter of ventricular tachyarrhythmia risk assessment, is changed by implantable cardioverter-defibrillator (ICD) shocks delivered during implantation process, to analyze the duration of these changes, and to further evaluate the effect of amiodarone on these parameters. Methods: Twenty-six consecutive patients who are scheduled to undergo ICD implantation for aborted sudden cardiac death or documented symptomatic sustained ventricular tachycardia were enrolled into the study. A simultaneous 12-lead electrocardiogram (ECG) was recorded after the ICD implantation just before starting the testing shock when the patients were under general anesthesia (baseline record) and at 1st, 5th, 10th, 15th, 20th, 25th, and 30th minutes after the successful shocks. RR interval, QT interval, corrected QT interval (QTc), QTd, and corrected QTd (QTcd) were all measured and calculated on ECG. Results: At 1st minute after the successful shock, an abrupt increase (from 67.0 ± 13.8 ms to 94.8±21 ms, P < 0.0001) was observed in QTcd, which was followed by a gradual return to the preshock values at 20th minute. Analysis of patients with and without long-term oral amiodarone treatment showed that in amiodarone-pretreated patients QTcd returned to the baseline value earlier than in patients without amiodarone treatment (15 minutes vs 20 minutes, respectively). Conclusions: ICD shocks cause an increase in QTcd lasting for up to 20th minute, which may predominate in some important clinical problems like electrical storm. Amiodarone, with the desirable effect on QTcd, may reduce the proarrhythmic effects of ICD shocks.

Background Isolated ventricular non-compaction (IVNC) is a rare disorder characterized by prominent trabecular meshwork and deep recesses. We retrospectively assessed the clinical characteristics and natural course of IVNC in adults diagnosed at our hospital. Methods and Results Sixty-seven adult patients (44 male, mean age 41 ± 18 years) with the diagnosis of IVNC were evaluated in this retrospective cohort. Its prevalence was found to be .14%. Forty-seven patients (70%) had class I/II functional capacity. Fifty-seven patients (85%) had electrocardiographic abnormalities, and the most common one was left ventricular (LV) hypertrophy (25%). LV systolic function was depressed in 44 patients (66%), with a median ejection fraction (EF) of 35% (range: 20%–48%) at diagnosis. Multiple regression analysis revealed that age at initial presentation, the total number of affected segments, and the ratio of non-compaction/compaction (NC/C) were the independent predictors of LV systolic dysfunction. Familial occurrence of IVNC was 33%. During a mean follow-up of 30 months (range: 9–50 months), major complications including ventricular tachycardia, heart failure requiring hospitalization, and cerebrovascular events were observed in 36%, 34%, and 9% of the patients, respectively. Ten patients (15%) with IVNC died in this study. LVEF at initial presentation and functional capacity at last visit were found to be independent predictors of mortality. Conclusion This study suggests that IVNC is a form of cardiomyopathy with higher prevalence and relatively better prognosis than previously reported. Age at initial presentation, ratio of NC/C, and number of affected segments seem to be major determinants of LV systolic dysfunction, while initial LVEF and last functional capacity predict mortality in this cohort.

WOS: 000237777700003, PubMed ID: 16498244, Background. Aortic stenosis (AS) and atrial fibrillation (AF) are commonly encountered in clinical practice. Natriuretic peptides (NP) are endogenous cardiac hormones, which have been shown to increase in patients with heart failure, and valvular or congenital heart disease. We aimed to determine the association between atrial NP (ANP) and late postoperative AF after surgery for AS along with temporal changes in plasma ANP levels and left atrial (LA) volumes. Methods: 22 patients (16 males/6 females, mean age: 61 years) with symptomatic AS and 8 healthy volunteers (5 males/3 females) were enrolled into our study. All the patients studied underwent transthoracic echocardiography, which was repeated during the follow-up. N-terminal ANP (N-ANP) was studied initially and at the 2-month follow-up. Postoperatively, the patients were followed up for 12 months for AF attacks. Results: Patients with AS had significantly higher levels of N-ANP, left ventricular (LV) end-diastolic pressure, E/A ratio, LV mass and LA volumes compared to the controls. Patients with postoperative AF attacks were significantly older, had higher N-ANP levels and LV end-diastolic pressure in addition to higher LA volumes and longer symptom duration compared to patients without AF. Age at the time of operation (p = 0.011) and N-ANP at the 2nd month (p = 0.047) were found to be independent predictors for late AF attacks during follow-up in regression analysis. Besides, N-ANP (p < 0.001) at the 2-month follow-up independently predicted impaired LA remodeling. Conclusion:ANP might be an important factor to identify AS patients at risk for late postoperative AF attacks. Copyright (c) 2006 S. Karger AG, Basel

Gunumuzde neredeyse tum kalici kalp pili elek- trotlari transvenoz yolla takilmaktadir. Metalik trikuspit protezi mevcudiyeti mutlak kon- trendikasyon olmasa da, transvenoz endokardiyal elektrot yerlestirilmesini komplike edebilmektedir. Bu gibi durumlarda epikardiyal elektrod yerlestir- ilmesi bir secenektir. Epikardiyal elektrot yerlestir- ilmesi torakotomi gerektirir ve daha once toratoko- tomi oykusu olan hastalarda komplikasyon riski yuksektir.Kalici kalp pilllerinin ekstrakardiyak uyari yapmasi iyi bilinen durumlardir ancak pek- toral kas uyarimi oldukca nadirdir. Bu yazida epikardiyal kalici kalp pili elektrodu disfonksiyonuna bagli pektoral kas stimulasyonu olan, trikuspit kapak protezli hastada alternatif bir yontem olarak koroner sinus yoluyla uyarimi sunulmustur.