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The purpose of this subgroup analysis is to investigate and analyze the venous leg symptoms including sense of coldness and sign of ecchymosis in patients with or without peripheral varicose veins (PVVs) from VEIN-TURKEY study population. A total of 600 patients, who were enrolled to VEIN-TURKEY study recently, were included in this subgroup analysis. Patients were examined clinically for the presence and severity of PVV and varicocele. Patients were asked to answer the VEINES-Sym questionnaire consisting of 10 parts and questions about ecchymosis and coldness in their legs. Frequency of symptoms present in the VEINES-Sym instrument, coldness (16.6%, 6.5%, P = .002, respectively), and ecchymosis (16.6%, 2.7%, P < .001, respectively) were significantly higher in patients with PVV compared to patients without PVV. Mean score of each symptom was significantly lower in PVV (+) patients including scores of ecchymosis and coldness. Total VEINES-Sym score was also correlated with the scores of ecchymosis (r = 0.18, P < .001) and coldness (r = 0.35, P < .001). Logistic regression analysis revealed that heavy legs, aching legs, night cramps, and ecchymosis are significantly and independently associated with PVV. In conclusion, sign of ecchymosis and coldness are significantly higher in patients with PVV compared to patients without PVV in a population recruited from the urology clinics. In clinical evaluation, presence or sign of ecchymosis and coldness in legs should be considered to be compatible with PVV in the absence of trauma, hematologic pathologies including antiplatelet treatment, and arterial stenosis or obstruction. Vascular and Molecular Cardiology Society The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Vascular and Molecular Cardiology Society. WOS:000532776900001 32356471 Q3

Kilic, Suleyman Sirri (isu author) Objective The aim of this study is to evaluate chronic venous disease symptoms by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire in varicocele patients. Material and methods The study was designed as a prospective, case controlled study and conducted in four hospitals from Turkey. A total of 600 patients who admitted to urology outpatient clinic were enrolled to the study. After the exclusion of 44 patients who do not match the inclusion criteria, the remaining 556 patients were examined for the presence and grade of varicocele and subsequently examined clinically for the presence of chronic venous disease findings. Finally, patients were asked to answer the VEINES-Sym questionnaire consisting of 10 items. All patients' demographic parameters, cardiovascular risk factors, other co-morbid diseases and drug usage were noted. Results Patients were classified into two groups: varicocele (+) group (n=269) and varicocele (-) group (n=287). VEINES-Sym scores of varicocele patients were lower compared to patients without varicocele (41.415.21, 43.19 +/- 3.22, respectively, p

WOS: 000374730800002, PubMed ID: 27105588, Background: The perioperative use of antithrombotic therapy is associated with increased bleeding risk after cardiac implantable electronic device (CIED) implantation. Topical application of tranexamic acid (TXA) is effective in reducing bleeding complications after various surgical operations. However, there is no information regarding local TXA application during CIED procedures. The purpose of our study was to evaluate bleeding complications rates during CIED implantation with and without topical TXA use in patients receiving antithrombotic treatment. Methods: We conducted a retrospective analysis of consecutive patients undergoing CIED implantation while receiving warfarin or dual antiplatelet (DAPT) or warfarin plus DAPT treatment. Study population was classified in two groups according to presence or absence of topical TXA use during CIED implantation. Pocket hematoma (PH), major bleeding complications (MBC) and thromboembolic events occuring within 90 days were compared. Results: A total of 135 consecutive patients were identified and included in the analysis. The mean age was 60 +/- 11 years old. Topical TXA application during implantation was reported in 52 patients (TXA group). The remaining 83 patients were assigned to the control group. PH occurred in 7.7 % patients in the TXA group and 26.5 % patients in the control group (P = 0.013). The MBC was reported in 5.8 % patients in the TXA and 20.5 % patients in control group (P = 0.024). Univariate logistic regression analysis identified age, history of recent stent implantation, periprocedural spironolactone use, periprocedural warfarin use, perioperative warfarin plus DAPT use, cardiac resynchronization therapy, and topical TXA application during CIED implantation as predicting factors of PH. Multivariate analysis showed that perioperative warfarin plus DAPT use (OR = 10.874, 95 % CI: 2.496-47.365, P = 0.001) and topical TXA application during CIED procedure (OR = 0.059, 95 % CI: 0.012-0.300, P = 0.001) were independent predictors of PH. Perioperative warfarin plus DAPT use and topical TXA application were also found to be independent predictors of MBC in multivariate analyses. No thromboembolic complications was recorded in the study group. Conclusion: The present study demonstrated that the topical TXA application during CIED implantation is associated with reduced PH and MBC in patients with high bleeding risk.

Characteristics of patients with pocket hematoma and/or major bleeding complications. Table S2. Baseline characteristics according to MBC. Table S3. Procedure related characteristics according to MBC. Table S4. Univariate and multivariate predictors of MBC. (DOCX 28 kb)

FUNDAMENTO: O levosimendan, um sensibilizador de cálcio, aumenta a sensibilidade do coração para o cálcio, aumentando assim a contratilidade miocárdica, sem aumento do cálcio intracelular. Recentemente foi demonstrado que o levosimendan era benéfico na melhoria da função renal. No entanto, fica por determinar que o efeito benéfico esteja relacionado em forma diferencial ao status renal durante o evento-índice. OBJETIVO: O objetivo do presente estudo foi determinar se o levosimendan pode melhorar o resultado renal em pacientes com insuficiência cardíaca aguda descompensada com e sem agravamento da função renal. MÉTODOS: Quarenta e cinco pacientes consecutivos que tiveram uma taxa de filtração glomerular reduzida e pelo menos dois dados consecutivos quanto à função renal, antes da administração de levosimendan, foram incluídos no estudo. Os pacientes foram classificados em dois grupos, com e sem agravamento da função renal com base no aumento da creatinina sérica > 0,3 mg/dL. RESULTADOS: Uma melhoria significativa foi observada na função renal em pacientes com agravamento da função renal (creatinina sérica de 1,4 ± 0,16 a 1,21 ± 0,23 mg/dL, p = 0,001 e taxa de filtração glomerular de 48,9 ± 15 a 59,3 ± 21,8 mL/min/m², p = 0,011), apesar de que não houve melhoria significativa em aqueles sem agravamento da função renal (creatinina sérica de 1,29 ± 0,33 a 1,37 ± 0,66 mg/dL, p = 0,240 e taxa de filtração glomerular de 53,7 ± 17,6 a 52,9 ± 21,4 mL/min/m², p = 0,850). CONCLUSÃO: O levosimendan parece proporcionar um efeito de realce renal em pacientes com severa insuficiência cardíaca sistólica descompensada aguda e agravamento da função renal. Considerar esse efeito diferencial poderia contribuir a obter resultados renais benéficos. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0)

Introduction: Smoking has been known to cause various adverse cardiovascular reactions. Our study was conducted to demonstrate the chronic effects of smoking on baroregulatory function by using heart rate turbulence (HRT) parameters among asymptomatic smokers. Materials and Methods: Sixty four smokers with histories of incessant smoking for at least one year (group 1) and 30 non-smokers (group 2) were enrolled in this study. Addiction of smoking was graded according to the modified Fagerström test for nicotine dependence (m-FNDT). Each smoker was conferred a nicotine dependence index (NDI) according to the m-FNDT. The values of HRT (TO: Turbulence onset, TS: Turbulence slope) were compared between two groups along with basic clinical, echocardiographic and Holter parameters. And the relationship between HRT and m-FDT was analyzed. Results: There was no significant difference the basic clinical and echocardiographic features (p> 0.05). The mean value of TO was higher significantly (p< 0.05) in group 1 than group 2, the mean values of TS was not different significantly between the two groups. The value of NDI was positively correlated with the value of TO (p< 0.05). Conclusion: Smoking impaired baroregulatory function especially in TO, even in asymptomatic smokers., Giriş: Sigaranın kardiyovasküler sisteme olan zararlı etkileri bilinmektedir. Çalışmamızın amacı sigara içiminin baroregülatuvar mekanizmaya olan etkilerini, kalp hızı türbülansını kullanarak normal kişilerle karşılaştırmaktır. Materyal ve Metod: En az bir yıldır sigara içme öyküsü olan asemptomatik 64 kişi grup 1 olarak kabul edildi. Aynı klinik özelliklere sahip asemptomatik sigara alışkanlığı olmayan 30 kişi grup 2 olarak düzenlendi. Çalışmaya alınan grup 1'deki sigara içicilerinin nikotin bağımlılık indeksi (NBİ) modifiye-Fagerström Nikotin bağımlılık testi (m-FNBT) kullanılarak hesaplandı. Tüm gruplardaki hastalara 24 saatlik elektrokardiyografi Holter takılarak, tamamının HRT (TO, total onset ve TS, total slope) ile bazal ekokardiyografik parametreleri hesaplandı. Bulgular: Gruplar arasında taşıdıkları demografik, klinik ve ekokardiyografik özellikler açısından istatistiksel olarak anlamlı bir fark saptanmadı (p> 0.05). Grup 1'de ortalama TO değeri anlamlı olarak yüksek iken (p< 0.05), ortalama TS değerleri arasında iki grup arasında istatistiksel olarak anlamlı bir fark saptanmadı (p> 0.05). Grup 1'de hesaplanan NBİ değeri ile ortalama TO arasında pozitif korelasyon saptandı (p< 0.05). Sonuç: Kronik sigara içicisi olanlarda, aynı özelliklere sahip içmeyen gruba oranla baroregülatuvar mekanizmada (özellikle TO) bozulma olduğu saptandı

Ventricular mural aneurysms especially in the left ventricle represent an increased risk for life-threatening arrhythmias. We present a case of ventricular tachycardia originating from an inferobasal left ventricular aneurysm. A 25-year-old male patient presented with complaints of palpitation, breathlessness, and dizziness of two-hour onset. The electrocardiogram showed wide-QRS tachycardia at which time his blood pressure was 80/40 mmHg. The patient suddenly developed collapse and ventricular tachycardia was diagnosed on the monitor, and he returned to sinus rhythm following successful cardioversion. He remained stable during hospitalization. The electrocardiogram was in sinus rhythm with right bundle branch block and small Q waves in inferior leads. He had an eight-year history of surgery for ventricular septal defect closure, during which a ventricular aneurysm was detected but left untreated. Echocardiographic examination showed a dyskinetic aneurysmal region extending from the inferobasal segment to the posterior wall of the left ventricle. Coronary arteries were normal on angiography, and ventriculography confirmed the aneurysm. Electrophysiologic study was recommended, but the patient refused any treatment. He remained asymptomatic during 18 months of follow-up.

FUNDAMENTO: La levosimendana es un nuevo agente inotropico que aumenta la contractibilidad cardiaca sin aumentar la captacion celular de calcio, de forma de no causar sobrecarga de calcio y arritmias relacionadas. En pacientes con insuficiencia cardiaca (IC), la duracion prolongada del QRS esta asociada a un aumento en el riesgo de mortalidad y muerte subita cardiaca. Cambios estructurales en el ventriculo izquierdo pueden llevar a la contraccion asincrona, causando atraso de conduccion y un QRS prolongado en el ECG de superficie. OBJETIVO: EL objetivo del presente estudio fue comparar los efectos agudos de levosimendana y dobutamina en la duracion del QRS en pacientes con IC grave y ritmo sinusal. METODOS: 60 pacientes consecutivos con IC isquemica fueron incluidos en el estudio y randomizados en dos grupos para infusion de levosimendana (n=37) o dobutamina (n=23). 67,2 % eran hombres; la media de la edad era 66,4±9,2 para todos los pacientes. La duracion basal del QRS en los grupos levosimendana y dobutamina fue 120,44±23,82 vs. 116,59±13,80 respectivamente. La fraccion de eyeccion del ventriculo izquierdo (FEVI) estaba disminuida en ambos grupos (23,15±8,3 vs. 24,56±7,5). RESULTADOS: En el grupo levosimendana, la duracion del QRS disminuyo del valor basal para 116,47±24,56 ms (p=0,006), en cuanto no hubo diferencia significativa en el grupo dobutamina (p=0,605). Ambos medicamentos causaron un aumento en la FEVI, pero este fue significativo apenas en el grupo levosimendana (27,95±8,9 p=0,003 vs. 26,67±7,6, p=0,315). CONCLUSION: El estudio sugiere que la administracion de levosimendana, pero no de dobutamina, acorta la duracion del QRS en el ECG de superficie, posiblemente por causar una contraccion colectiva en las fibras del musculo del ventriculo izquierdo. La base molecular de ese efecto aun precisa ser aclarada.

WOS: 000269807700004, PubMed ID: 19654563, Aim The aim of this study was to evaluate the myocardial viability in nondiabetic patients with chronic coronary artery disease (CCAD) or past myocardial infarction (MI), using thallium-201 infusion myocardial perfusion single-photon emission computed tomography (MPSPECT) imaging after oral glucose application (Glu + Tl-201-infusion). Materials and methods In this study, 33 nondiabetic patients (three female, 30 male, mean age: 55.24 +/- 11 years, range: 33-77 years) with MI history or known CCAD were included. Rest/redistribution/24 h-late-MPSPECT imaging was performed for all patients. In all patients in whom fixed perfusion defect was observed on any wall of the left ventriculi, after 24 h-late-MPSPECT imaging, 75g oral glucose was given. Thirty minutes later, 1 mCi thallium-201 in 100 ml of physiological saline solution was applied in a period of 20 min by slow infusion. After infusion at the 10th minute, MPSPECT imaging was performed. Perfusion was evaluated visually for a total of 3432 segments with the 26-segment 5-point scoring technique. Scoring measured perfusion as 0=no perfusion defect, 1=mildly reduced, 2=moderately reduced, 3=severely reduced, and 4=absent uptake. Scores '0 and 1' were considered normal and scores '2-4' were considered abnormal. Results For serum insulin levels measured after glucose application, a significant increase was determined, according to the period before glucose application (P= 90% narrowing. In rest images, in segments with segmental scores of 3 and 4, when the total reversibility ratio was evaluated, this ratio was calculated to be 0.7% for redistribution images and 4.5% for 24 h-late-M PSPECT. The highest total reversibility ratio in these segments was detected with Glu + Tl-201-infusion images to be 10.3%. When we evaluated the patients with respect to the MI history time, the highest segmental perfusion improvement was detected in patients with 0-3 months of MI history. Conclusion We conclude that in nondiabetic patients who are known to have CCAD or past MI history, Glu + (TI)-T-201-infusion is an easily applicable method that gives better results for the evaluation of myocardial viability. Nucl Med Commun 30:779-788 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

WOS: 000272359300008, PubMed ID: 19669399, Atrial fibrillation (AF) is the most frequently encountered chronic arrhythmia associated with significant morbidity. It is generally encountered in the elderly, and will presumably become more prevalent in the future due to the increasing proportion of the elderly in the population. Major studies on AF have demonstrated no significant difference between rhythm and rate control in terms of mortality. However, young population with new-onset or lone AF, or patients in whom the maintenance of sinus rhythm is a must (due to recurrent thromboembolic events etc.) still gives rise to significant concerns related to the obligatory long-term prophylaxis. The long-term administration of the currently available conventional agents (amiodarone, dofetilide, sotalol, propafenone,flecainide etc.) is considered as a 'double edged sword' due to the presence of life-threatening adverse effects including pro-arrhythmia and organ toxicity associated with these agents. Several molecules are being developed for the management of AF. However, only a few novel agents confer promising results with respect to safety and efficacy issues in the major studies. Dronedarone is an amiodarone analogue without iodine moiety in its structure, and is similar to amiodarone with regard to its structural and electrophysiological properties. Dronedarone is largely denuded of the potentially life-threatening adverse effects of anti-arrhythmics. Major clinical studies have demonstrated both rhythm and rate-controlling efficacy of dronedarone compared to placebo without any serious adverse effects in patients with AF. However, the ANDROMEDA trial, a large scale study including patients hospitalized for symptomatic congestive heart failure (with severely depressed left ventricular systolic functions) was prematurely terminated due to the increased mortality in the dronedarone arm compared to placebo indicating a lack of safety in this group of patients. Conversely, the recently published ATHENA study (including more than 4,600 high risk patients, but excluding those with severe heart failure) demonstrated a significant reduction in cardiovascular hospitalizations and cardiovascular mortality with dronedarone compared to placebo. In contrast, the DIONYSOS study, comparing dronedarone with amiodarone, demonstrated better safety, but lower efficacy of dronedarone for the maintenance of sinus rhythm in patients with AF. Further clinical trials (including head to head comparison with other conventional anti-arrhythmics) are still required to determine the place of dronedarone in the management of AF. The present review focuses on basic and clinical aspects of dronedarone, a novel agent for the management of AF.

WOS: 000251425300006, PubMed ID: 17952581, Background Levosimendan is a relatively new cardiac inotropic agent with calcium sensitizing activity. This study was conducted to investigate the effects of levosimendan (L) and dobutamine (D) on renal function in patients hospitalized with decompensated heart failure (HF). Method The present study included 88 consecutive patients hospitalized with acutely decompensated HF (New York Heart Association (NYHA) Class 3-4) requiring inotropic therapy. Patients were randomized 2:1 to either L or D for intravenous inotropic support. Diuretic therapy was kept constant during infusions. Renal function values, including serum creatinine (CR), blood urea nitrogen, 24-h urinary output levels and calculated glomerular filtration rate (GFR) were measured just prior to and 24 h after the infusions in all patients, and 48 and 72 h after the infusions in every second patient in both groups. The pre and post-infusion values of renal function and left ventricular ejection fraction (LVEF) were evaluated. Results LVEF increased significantly in both groups. Those in L showed a significant improvement in calculated GFR after 24 h, whereas those in D showed no significant change (median in change in L:+15.3%, median change in D: -1.33%). Furthermore, in the L group a significant improvement was observed in calculated GFR after 72 h compared to baseline levels, whereas in D no significant change (median change in L:+45.45%, median change in D: +0.09%) was seen. Both agents improved 24-h urinary output. Conclusion Levosimendan seems to provide beneficial effects in terms of improvement in renal function compared to dobutamine in patients with heart failure who require inotropic therapy.

WOS: 000250983000007, PubMed ID: 17182136, Background: Herbal products have been widely used by many patients with cardiovascular problems solely expecting benefit out of them. Since, it is important to consider patients' needs and believes to prevent breaking off the relationship of patients and physicians, we conducted a survey on patients admitted to our outpatient Cardiology department. Methods: A questionnaire was prepared including 49 questions. After giving informed consent, 310 participants were enrolled into our survey. Participants were asked about disease states, use of herbal products and their tendencies. Results: There were 169 male ( mean age: 54.7 +/- 13.3 years) and 141 female participants ( mean age: 56.2 +/- 14.7 years). 54.5% ( n= 169) had hypertension ( HT), 48.7% ( n= 151) had coronary artery disease ( CAD). Among all participants, 38.7% ( n= 120) stated that they have used herbals in part of their lives. Presence of dyslipidemia was associated with herbal use. Three fourths of herbal users ( 73.3%, n= 88) stated that they thought they benefited some extent from the use of herbals, and 25% ( n= 30) of herbal users stated that they did not take their medicine regularly. Herbal users more frequently agreed the statement " herbals are beneficial when added to medicine" compared to nonusers ( 20.8% vs. 15.8%, p

WOS: 000251636700015, PubMed ID: 18029333, Myocardial performance index (MPI) has been regarded as an important parameter in the evaluation of ventricular systolic function in congestive heart failure. This study was designed to investigate the relationship between the ratio of isovolumic contraction time/left ventricular ejection time (IVCT/LVET), MPI, and LV systolic function. A total of 43 patients (patient group) with LV ejection fractions (LVEFs) = 55%. LVEF was measured in all cases by 2-dimensional echocardiography via the modified Simpson method. Isovolumic relaxation time (IVRT), IVCT, LVET, ratio of IVCT/LVET, and MPI ([IVRT+IVCT]/LVET) were measured via Doppler echocardiography. The mean value for lVCT was found to be significantly higher (P

QT interval dispersion reflects regional variations in ventricular repolarization and cardiac electrical instability. Previous studies have showed that QT interval dispersion changes during episodes of myocardial ischemia. Slow coronary flow (SCF) in epicardial coronary arteries is a rare and unique angiographic finding. Whether this pattern of flow is associated with electrocardiographic abnormalities is unknown. Therefore, this study was designed to investigate whether SCF results in electrocardiographic (ECG) changes compared to normal coronary flow. For this aim 24 patients with angiographically proven SCF who had no obstructive coronary lesion (group I) and 25 patients without coronary artery disease (group II) were included in the study. Both groups underwent a routine standard 12-lead surface electrocardiogram recorded at 50 mm/s during rest. QT dispersion (QTd), corrected QT (QTc), and corrected QT dispersion (QTcd) were calculated. Distributions of sex, age, body mass index (BMI), and cardiac risk factors were similar in the 2 groups. Mean heart rate was similar in the 2 groups (74 ±8 vs 77 ± 7 p > 0.05). Mean QRS interval durations were similar in the groups (92 ±7 vs 90 ±6 ms p > 0.005). In group I, QTd, QTcd, and QTc, were significantly higher than in group II (QTd: 73 ±14 vs 40 ±14; QTcd: 71 ±15 vs 42 ±9; QTc: 414 ±14 vs 388 ±13, respectively p

Coronary artery anomalies occur in less than 1% of patients who undergo coronary angiography and they account for 1% to 2% of all cases of congenital heart disease. The most commonly encountered anomaly, the circumflex artery originating from the right coronary artery or the right sinus of Valsalva, is usually well tolerated. The patient in the case presented here was found to have a left anterior descending artery arising from the right sinus of Valsalva-a situation that is very rarely encountered. ©2007 Health Communications Inc.

WOS: 000244518100023, PubMed ID: 17276973, Myocyte necrosis has been considered to play a fundamental role in the pathophysiology of congestive heart failure (CHF), which has usually evolved as a consequence of depletion of compensatory mechanisms and contractile reserve of myocardium. Elevated levels of creatine kinase MB (CK-MB) and troponin I (Tn-I) have been regarded as biochemical markers of myocyte necrosis. This study was planned to investigate the specificity and sensitivity of Tn-I and CK-MB in CHF and to examine the correlation of these markers with disease severity. A total of 104 patients (38 female, 66 male; mean age, 66 y [range, 36-89]) with symptoms and signs of heart failure on admission and with a reduced left ventricular ejection fraction (EF; by transthoracic echocardiography) were labeled "the patient group," and 58 patients (40 female, 18 male; mean age, 61 y [range, 34-77]) with no signs or symptoms of CHF and with a normal EF detected by transthoracic echocardiography were included in the study as "the control group." Left ventricular EFs, end-diastolic diameters, and end-systolic diameters of patients in both groups were measured. Blood samples were drawn from all patients in both groups on admission, so that levels of CK-MB and Tn-I could be measured. All patients in both groups also underwent coronary angiography. Conditions leading to elevation of CK-MB or Tn-I were considered exclusion criteria. The 2 groups failed to show any significant differences in terms of mean age and the presence of coronary artery disease, hypertension, or diabetes mellitus (P >.05). Mean EF in the patient group was lower than that in the control group (P .05). The mean EF in group 2 was significantly lower than that in group I and in the control group (P .05), but group 2 had significantly higher mean values of CK-MB and Tn-I than were noted in the control group (P

WOS: 000234323900007, PubMed ID: 16374140, Background Coronary artery bypass grafting has been performed for a long period utilizing saphenous vein grafts, the fate of which might be crucial to prognosis following the operation. Metabolic syndrome, on the other hand, has become an increasingly important part of cardiovascular practice. We examined whether there was any negative effect of metabolic syndrome on saphenous vein graft patency in a relatively short term (

WOS: 000235317400009, PubMed ID: 16435071, Background: Statins are life saving drugs in cardiovascular practice. However, they still are underprescribed in many situations despite their well-established benefits. Adherence may be improved by increased comprehension of the patients. Methods: Patients enrolled into a previous survey were randomized into two groups as those, who were informed comprehensively (Group 1) and those not (Group 2). 202 patients, all of whom were on secondary prevention, were contacted after median 15 months of follow up and evaluated whether they continued the statins, and reached targets. Results: 102 out of 202 patients were those enrolled into Group 1, and 100 of them were those enrolled into Group 2. In Group 1, 62.7% of patients were on continuous statin therapy during period betweeen initial and secondary contact, whereas, only 46% of patients in Group 2 were on continuous statin therapy (p = 0.017). Being well-informed about statin increased the likelihood of being on continuous statin therapy after median of 15 months by 1.977 folds. Concerning targets, 64.7% of those in Group 1 reached the targets, whereas, 43% of those in Group 2 reached the targets (p = 0.002). Being well-informed about statin increased the likelihood of having suggested targets by ATP III after median of 15 months by 2.430 folds. Conclusion: Providing patients with comprehensive knowledge about statins, even in patients, who were already on statin therapy, seems not only to improve adherence but also increase the percentage of those reaching targets.

WOS: 000233222200004, PubMed ID: 16255750, Objective: We investigated whether mobile telephones affect the function of implantable cardioverter defibrillators (ICDs). Background: It is well known that electromagnetic fields can affect medical devices. Methods: The study included 43 patients with ventricular tachycardia and/or fibrillation treated with transvenous pectoral ICDs. Testing was done under continuous electrocardiograph monitoring under supervision of an ICD programmer. Initially, each patient was tested during spontaneous rhythm. Then the ICD was programmed to a pace rhythm higher than the patient's heart rate, and the tests were repeated at paced rhythm. In 7 patients, tests were performed during the implantation procedure as well. In 3 of the patients, only a single defibrillation zone was active. The other 40 patients had one or more active ventricular tachycardia zones. Two mobile phones (both GSM 900 MHz) were positioned 50 cm away from the implanted device in opposite directions and switched on. Communication was established between these phones, two investigators had a 20-second conversation, and then the phones were switched off. The same procedure was repeated at 30, 20, and 10 cm away from the implantation site, respectively. Finally, the procedure was performed-with the antennae of both phones touching the device pocket. In the above-mentioned 7 cases where testing was done during implantation of the ICD, a call was made from one phone to the other, ringing occurred for 5 seconds, and then two investigators conversed while the device was implanted. Results: There was no change in the function of the ICDs during any of the phone testing procedures. In 5 cases, artifacts were noted on the surface lectrocardiographic (ECG) screen of the programmer during the tests, but no such changes were observed on the simultaneous intracardiac ECGs. Conclusion: The results of the study suggest that mobile phones have no effects on ICD function.

Slow coronary flow (SCF) in a normal-appearing coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. The aim of the study was to evaluate echocardiographic features in patients with SCF. Thirty-four patients with angiographically proven SCF (group I) and 25 patients with normal coronary flow (group II) were enrolled in the study. The diagnosis of SCF was made with use of the “TIMI frame count (TFC)” method. All patients underwent complete transthoracic echocardiographic examination (M-mode, 2-dimensional [2-D], and Doppler parameters such as color, continuous, pulsed wave). There were no significant differences with respect to systolic parameters between the 2 groups; in spite of these, group I showed impaired left ventricular diastolic patterns compared to group II. Group I patients had higher peak late diastolic filling velocities due to enhanced atrial systole (A), lower peak (E/A) diastolic filling velocity ratios, and longer isovolumetric relaxation times compared with group II, and these were statistically significant (p

The Thrombolysis in Myocardial Infarction (TIMI) frame count is a simple clinical tool for assessing quantitative indexes of coronary blood flow. This measurement has been significantly correlated with flow velocity measured with a flow-wire by several investigators during baseline conditions or hyperemia. In this study we aimed to evaluate the coronary flow in patients with isolated coronary artery ectasia by means of the TIMI frame count and to compare the results with those of patients with angiographically normal coronary arteries. The study population consisted of 37 patients with coronary artery ectasia only in the right coronary artery (RCA). The control group consisted of 31 patients with angiographically proven normal coronary arteries. Coronary artery ectasia was defined as nonobstructive lesions of the coronary arteries with a luminal dilatation 1.5-fold or more of the adjacent normal coronary segments. The TIMI frame count was determined for each major coronary artery in each patient according to the methods first described by Gibson et al. The TIMI frame count of RCA in the study group was significantly higher than in that of the control group (51 +/- 17 vs 25 +/- 8, P < 0.0001). The TIMI frame counts of the study group for the left anterior descending and left circumflex coronary artery were also significantly higher than those of the control group (corrected TIMI frame count for LAD = 42 +/- 11 vs 24 +/- 7, P < 0.001; TIMI frame count for LCx = 44 +/- 15 vs 25 +/- 9, P < 0.001). In patients with coronary artery ectasia, the TIMI frame count of the RCA was higher than that of the left anterior descending and left circumflex coronary artery (51 +/- 17 vs 42 +/- 11 and 44 +/- 15, respectively, P < 0.05). We have shown increased TIMI frame counts in patients with isolated coronary artery ectasia and suggest that the pathophysiological mechanism of coronary artery ectasia is not a focal disease. TIMI frame counts can be regarded as an index of the severity of impaired coronary flow in patients with coronary artery ectasia.

Aortic valve calcification (AVC) is correlated with atherosclerotic risk factors; however, its significance remains largely unknown. The aim of this study was to investigate whether AVC detected by transthoracic echocardiography can be a useful marker for the identification of significant coronary artery disease (CAD), particularly in elderly patients. The study included 432 consecutive patients with suspected CAD who were admitted for the first time for coronary angiography. Two-dimensional transthoracic echocardiography and selective coronary angiography were performed in all patients. Aortic valve calcification was defined as bright dense echoes of > 1 mm on one or more cusps and decreased mobility of the involved cusp. Aortic valve calcification was detected in 64 of the 337 patients with significant CAD, but only in 9 of 95 cases with normal or mildly stenotic coronary arteries (19% vs 9%, p < 0.001). The severity of coronary artery disease (defined as the number of obstructed vessels) was not related to the presence of AVC (p > 0.05). Stepwise multiple logistic regression analysis of the study patients revealed only age (p = 0.003, odds ratio = 1.56) and AVC (p < 0.001, odds ratio = 2.03) as independent predictors of CAD. When the study population was divided into two groups as those below (n = 338) and above (n = 94) 75 years old, AVC failed to be a predictor of CAD in those > 75 years old (p > 0.05, odds ratio = 0.8) while it remained the most significant predictor of CAD (p < 0.001, odds ratio = 2.19 in patients aged < 75 years. In conclusion, detection of AVC by transthoracic echocardiography may be a useful noninvasive marker for identification of significant CAD in patients younger than 75 years old. Its clinical usefulness is limited in elderly patients.

Atrial fibrillation (AF) is the most common arrhythmia encountered in acute medical practice. One-third of hospitalizations for cardiac rhythm disturbances are attributed to AF, with increasing rates in the past decade. Significant morbidity and mortality, including 15% to 20% of all ischemic strokes and 20% of all strokes, result from AF. The overall mortality rate for patients with AF is approximately double that for patients in normal sinus rhythm. Atrial flutter (AFL) has many clinical aspects that are similar to AF, AF and AFL have same management strategies in emergency settings. The major goals of treatment include alleviation of the associated symptoms and/or hemodynamic disturbance, reduction of the risk of systemic thromboembolism, reduction in hospital length of stay. The very large scaled AFFIRM and AF-CHF clinical trials compared rate and rhythm control (cardioversion), but did not explore the optimal management for recent-onset AF/AFL patients presenting to the emergency department (ED) with in 48 hours of symptoms. Although international standard guidelines are available, AF treatment in ED is still heterogeneous in terms of the management strategy (rate or rhythm) chosen. National based guidelines or consensus documents specific to ED management of AF has recently been developed and published in order to solve this problem. Aim of this review is to give detailed information for ED team about echocardiographic criterias supporting cardioversion (CV) of AF, CV procedure itself and new antiarrhythmic and oral anticoagulant drugs by adhering to the guidelines.Keywords: Cardioversion, recent-onset atrial fibrillation, flutter, emergency ÖzetAtriyal fibrilasyon, akut tıbbi uygulamada karşılaşılan en sık aritmidir. Kalp ritm bozuklukları nedeniyle hastaneye yatanların üçte birinde neden AF olup son on yılda sıklığı giderek artmaktadır. AF belirgin mortalite ve morbiditeye neden olmaktadır. Tüm iskemik inmelerin %15-%20’si ve tüm inmelerin %20’si AF nedenlidir. AF’si olan hastalarda genel ölüm oranı, normal sinus ritmi olanlara göre yaklaşık iki kat fazladır. Atriyal flutter (AFL)’in AF’e benzer birçok klinik yönleri bulnumaktadır, acil durumlarda AF ve AFL aynı tedavi stratejilerine sahiptir. Tedavinin başlıca hedefleri, ilgili semptom ve/veya hemodinamik bozukluğun azaltılması, sistemik tromboembolik riskin azaltılması ve hastanede kalış süresinin kısaltılmasını içermektedir. Çok büyük ölçekli AFFIRM ve AF-CHF çalışmaları, hız ve ritim kontrolü (kardiyoversiyon) stratejilerini kıyasladı, fakat, semptom başlangıcının 48 saati içerisinde acile servise(AS) başvuran, yeni başlangıçlı AF/AFL hastalarında optimal tedavi yöntemini açığa kavuşturamadı. Uluslararası standart kılavuzlar bulunmasına rağmen AS’de AF tedavisi, seçilen tedavi stratejisi (hız veya ritim) yönünden hala heterojendir. Son zamanlarda bu sorunu çözmek amacıyla, AS’de AF tedavisine yönelik ulusal kaynaklı kılavuzlar ve konsensüs belgeleri geliştirilmiş ve yayınlanmıştır. Bu derlemenin amacı, AS ekibine, kılavuzlara bağlı kalınarak kardiyoversiyonu destekleyen ekokardiyografik parametreler, kardiyoversiyon işleminin kendisi ve yeni antiaritmik ve antikoagulan ilaçlar hakkında ayrıntılı bilgi sunmaktır.Anahtar sözcükler: Kardiyoversiyon, atrial fibrilasyon, flutter, acil, Atriyal fibrilasyon, akut tıbbi uygulamada karşılaşılan en sık aritmidir. Kalp ritm bozuklukları nedeniyle hastaneye yatanların üçte birinde neden AF olup son on yılda sıklığı giderek artmaktadır. AF belirgin mortalite ve morbiditeye neden olmaktadır. Tüm iskemik inmelerin %15%20’si ve tüm inmelerin %20’si AF nedenlidir. AF’si olan hastalarda genel ölüm oranı, normal sinus ritmi olanlara göre yaklaşık iki kat fazladır. Atriyal flutter (AFL)’in AF’e benzer birçok klinik yönleri bulnumaktadır, acil durumlarda AF ve AFL aynı tedavi stratejilerine sahiptir. Tedavinin başlıca hedefleri, ilgili semptom ve/veya hemodinamik bozukluğun azaltılması, sistemik tromboembolik riskin azaltılması ve hastanede kalış süresinin kısaltılmasını içermektedir. Çok büyük ölçekli AFFIRM ve AF-CHF çalışmaları, hız ve ritim kontrolü (kardiyoversiyon) stratejilerini kıyasladı, fakat, semptom başlangıcının 48 saati içerisinde acile servise(AS) başvuran, yeni başlangıçlı AF/AFL hastalarında optimal tedavi yöntemini açığa kavuşturamadı. Uluslararası standart kılavuzlar bulunmasına rağmen AS’de AF tedavisi, seçilen tedavi stratejisi (hız veya ritim) yönünden hala heterojendir. Son zamanlarda bu sorunu çözmek amacıyla, AS’de AF tedavisine yönelik ulusal kaynaklı kılavuzlar ve konsensüs belgeleri geliştirilmiş ve yayınlanmıştır. Bu derlemenin amacı, AS ekibine, kılavuzlara bağlı kalınarak kardiyoversiyonu destekleyen ekokardiyografik parametreler, kardiyoversiyon işleminin kendisi ve yeni antiaritmik ve antikoagulan ilaçlar hakkında ayrıntılı bilgi sunmaktır.

The purposes of this study are to evaluate the clinical usefulness of maximum QTc and QTc dispersion determination in aortic stenosis, and to compare the effects of maximum QTc and QTc dispersion on the risk of syncope in aortic stenosis. The QT interval dispersion has long been known to be a marker of dispersion of ventricular repolarization and, hence, electrical instability. Additionally, it has been shown that these patients have a propensity to ventricular tachyarrhythmic syncope. The study included 86 patients with aortic stenosis who underwent left-heart catheterization and coronary angiography during investigation of syncope and 30 healthy subjects. The patients were characterized with regard to the presence or absence of a history of syncope and the severity of aortic stenosis (the degree of peak transvalvular gradient). In addition, QT max and QT dispersion measurements were corrected for heart rate according to Bazett's formula. The QTc max and QTc dispersion were greater in patients with aortic stenosis than in the healthy subjects (477 ±49 ms vs 370 ±22 ms, p < 0.001; 60 ± 13 ms vs 38 ± 1 ms, p < 0.001). Similarly, the QTc max and QTc dispersion were greater in the patients with a history of syncope than in the patients with no history of syncope (493 ±48 ms vs 459 ±4 ms, p < 0.001; 68 ±12 ms vs 53 ± 10 ms, p < 0.001). In addition, both parameters were greater in the patients with a high transvalvular gradient than in the patients with a low transvalvular gradient (489 ±49 ms vs 451 ±39 ms, p < 0.001; 65 ± 12 ms vs 50 ±9 ms, p < 0.001). Multivari ate logistic regression analysis showed that only a increased QTc dispersion had significant value for the risk of syncope in aortic stenosis. An increased QTc dispersion caused a 10.4% increase in the occurrence of syncope in aortic stenosis. These results suggest that high values of QTc dispersion are sensitive noninvasive markers to determine the risk for syncope in aortic stenosis.

The present study assessed and compared the diagnostic accuracy of thallium-201 (Tl-201) exercise myocardial single photon emission computerised tomography (SPECT) and dobutamine stress echocardiography (DSE) for detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). Study population consisted of 26 consecutive patients with permanent LBBB who were suffering from chest pain. Patients (8 women, 18 men mean age = 57+/-8 years) were studied with DSE, Tl-201 SPECT and coronary angiography (CAG). Three different approaches for diagnosis of CAD were used to identify CAD in left arterial descending (LAD) coronary artery territories in scintigraphic studies: (1) Approach A (conventional approach): involvement of septal, and/or anterior, and/or apical wall. (2) Approach B: involvement of anterior and septal wall irrespective of apical wall. (3) Approach C: involvement of septum, anterior and apical wall. DSE gave a sensitivity of 91%, specificity of 92% and accuracy of 92% for diagnosis of CAD in the LAD coronary artery territory. Tl-201 SPECT (conventional approach) gave a sensitivity of 100%, specificity of 42% and diagnostic accuracy of 69% for diagnosis of CAD in the LAD coronary artery territory. Sensitivity, specificity and diagnostic accuracy of approach C were 33, 85 and 57% respectively. The specificity of Tl-201 SPECT significantly increased in approach C when compared with approach A and B (p < 0.02). However sensitivity of the Tl-201 SPECT with approach C showed significant decrease when compared with DSE and approach A and B (p < 0.005). Specificity of DSE for diagnosis of CAD in LAD were significantly higher than those of Tl-201 SPECT regarding the approach A and B (p < 0.01). In conclusion the use of DSE for diagnosis of CAD in patients with LBBB seems to be more suitable than Tl-201 SPECT.

WOS: 000288462900006, PubMed ID: 20682610, Impairment of endothelial functions has been shown to occur after acute and chronic exposure to passive smoking (PS), as assessed by flow-mediated dilatation (FMD) of the brachial artery. A total of 61 participants, 30 male and 31 female, mean ages 26 (18-36) were enrolled in the study. All were clinically well and nonsmokers. All participants stayed for 30 minutes in the smoking room. Carbon monoxide (CO) level was 7.42 +/- 0.98 ppm (4.71-10.50). Mean carboxyhemoglobin (COHb) levels of participants were significantly elevated after PS. Mean FMD was 18.6% +/- 9% and decreased to 12.4% +/- 7% after PS (P < .001). In the current study, with more number of participants at lower CO concentrations (7.42 ppm) and with smaller increase in COHb (51%) significant reduction (33%, P < .001) in FMD was observed.

Chronic renal failure patients on maintenance hemodialysis (HD) have a number of ECG abnormalities and cardiac arrhythmias. Clinical and experimental data have shown that increased QT dispersion is associated with severe ventricular arrhythmias and sudden cardiac death. Therefore, the aim of this study was to investigate whether the uremic patients receiving long-term HD have increased QTc interval and/or QTc dispersion compared to normal subjects and to evaluate the effect of electrolyte changes between the predialysis and postdialysis phases on these parameters. Forty patients with end-stage renal failure on long-term HD (22 men, 18 women, mean age 44 years) were included in this study. Serum concentrations of K+, Na+, Ca++, Mg++, Cl-, phosphate, urea, creati nine, HCO3-, and arterial blood gases (PO2, PCO2), together with blood pH, were monitored and QTc intervals and QTc dispersion were measured from 12-lead ECG in predialysis and postdialysis phases. The hemodialyzed patients had an increased predial ysis QTc maximum interval and QTc dispersion compared to normal subjects (480 ±51 vs 310 ±38 msec, p < 0.001 and 61 ±17 vs 42 ±14 msec, p < 0.001, respectively). Both QTc maximum interval and QTc dispersion increased significantly at the end of the HD (480 ± 51 vs 505 ±49 msec p< 0.001 and 61 ± 17 vs 86 ± 18 msec, p< 0.001, respec tively). The serum K+(5.3 ±0.56 vs 3.36 ±0.41 mEq/L, p < 0.001), phosphate (7.19 ± 1.62 vs 3.81 ± 1.02 mg/dL, p ++(2.21 ±0.18 vs 2.47 ±0.24 mg/dL, p < 0.001), HCO3-(15.5 ±3.2 vs 20.1 ±3.4 mmol/L, p< 0.001) concentrations and pH (7.27 ± 1.1 vs 7.43 ± 1.2, p < 0.001) significantly increased after HD compared to predialysis values. There was significant correlation between the QT dispersion increase and serum electrolyte changes (K+, Ca++, and pH levels) (p < 0.05). The association between serum electrolyte changes, acid-base status and QT measurements might provide new insights into the evaluation of the ionic bases involved in inhomogeneous ventricular repolarization.

Background: Previous studies have reported controversial results regarding the effectiveness of systemic thrombolysis in preventing left ventricular (LV) thrombus after acute myocardial infarction (MI). Hypothesis: This study was performed to evaluate the influences of thrombolysis, and particularly successful reperfusion, on the incidence of LV thrombus formation after acute anterior MI. Methods: in all, 191 patients suffering from a first attack of acute anterior MI were prospectively evaluated by two‐dimensional echocardiography and coronary angiography, performed at the end of the first week and within the first two weeks of MI, respectively. Of these, 98 who presented within 12 h of onset of symptoms received intravenous streptokinase (1.5 million IU), while the remaining 93 patients who, either because of contraindications or late admission, did not receive thrombolytic treatment served as control group. All patients received aspirin and full‐dose anticoagulation with intravenous heparin. Successful reperfusion in the streptokinase group was assessed by enzymatic and electrocardiographic evidence. Results: The overall incidence of LV thrombi was 24.6% (47/191). When all patients were evaluated, no statistically significant difference was found between the frequency of LV thrombi in the patients who had thrombolysis (22.4%) and those who did not (26.8%), despite a trend toward the formation of fewer thrombi in the initial group (p > 0.05). However, the patients who had successful reperfusion with streptokinase (n = 64) had significantly reduced incidence of LV thrombi compared with those who did not receive thrombolytic therapy (20 vs. 26.8%, p < 0.05). Stepwise multivariate analysis suggested that LV abnormal wall motion score (p = 0.01) and presence of LV aneurysm were independent predictors of LV thrombus formation in patients with acute anterior MI. Conclusion: Not all patients who received streptokinase for acute anterior MI, but only those with successful reperfusion had reduced incidence of LV thrombi. The favorable effects of thrombolysis on LV thrombus formation are probably due to the preservation of global LV systolic function.

Mechanical alternans, an ominous sign of terminal systolic heart failure, could be indirectly shown by Doppler analysis. On the other hand, Levosimendan, a novel agent, improves contractility in patients with HF. We searched the effect of L versus dobutamin onto Doppler alternans in patients with systolic HF. We found that Levosimendan improves beta-to-beat alteration in patients with systolic HF, demonstrated by pulsed Doppler compared to dobutamin. © 2007 Elsevier Ireland Ltd. All rights reserved., Yilmaz, M.B.; Cumhuriyet University Faculty of Medicine, Department of Cardiology, Sivas, Turkey; email: cardioceptor@gmail.com

WOS: 000323683500013, PubMed ID: 23267239, Coronary collaterals (CCs) serve as alternative conduits for blood flow in obstructive coronary artery disease. We investigated the association of various components of blood pressure (BP) parameters with the the degree of coronary collateralization. Patients (n = 245) who underwent coronary angiography were included. Intraarterial BP in the ascending aorta was determined using a standard fluid-filled system. Readings of the conventional peripheral pressure were measured using a manual sphygmomanometer. All blood samples were drawn at admission, before coronary angiography. A total of 65 patients were found to have adequate CC development. Central diastolic BP and peripheral diastolic BP were found to be lower in the group with adequate CC. In multivariate logistic regression model, central diastolic BP and Gensini score were found to be independent predictors of adequate CC. In conclusion, low central diastolic BP in the case of severe coronary stenosis may be an important stimulus for adequate CC development.

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEY, WOS: 000329858401055, …, Turkish Soc Cardiol

WOS: 000323324400012, PubMed ID: 23728224, Objective: Renal dysfunction commonly accompanies the course of cardiac disorders and strongly associates with increased morbidity and mortality. Elevated central venous pressure is related to worsening renal function in patients with heart failure. However, predictors of worsening renal function in mitral stenosis-whose pathophysiologic process is similar to heart failure with regard to right heart dysfunction-are unknown. This study aimed to evaluate whether clinical and echocardiographic parameters might predict worsening renal function in patients with mild-to-moderate mitral stenosis. Methods: The current study has a prospective cohort design. Sixty consecutive patients (9 male, 51 female, mean age 50 +/- 13 years) with mild-to- moderate mitral stenosis were followed up for 34 +/- 13 months (range 1-60) and their renal functions were monitored. Worsening renal function was defined as a decline in glomerular filtration rate of >= 20% on follow-up. In order to presence or absence of worsening renal functions, study patients divided into two groups. Statistical analysis was performed using the Chi-square, Independent samples t / Mann-Whitney U tests, univariate and multivariate Cox proportional hazards analyses, receiver operating characteristic (ROC) and Kaplan-Meier curve analyses. Results: Worsening renal function was observed in 14 patients (23%). In univariate analysis, male gender, mean pulmonary artery pressure (mPAP), peak tricuspid regurgitation velocity, systolic pulmonary artery pressure, digitalis and antiplatelet usage, right atrial size, and TEI index were determined to be predictors of worsening renal function. In a multivariate Cox proportional hazards model, mPAP (HR=1.136, 95% CI: 1.058-1.220, p21 mmHg, and those who did not have, in terms of worsening renal function (p=0.006), and the difference between the groups increased after 30 months of follow-up. Conclusion: Elevated mean pulmonary artery pressure at the time of initial evaluation, in patients with mild-to-moderate mitral stenosis, might help to predict worsening renal function.

WOS: 000322171400012, PubMed ID: 22994845, Platelet abnormalities in diabetes mellitus (DM) and atrial fibrillation (AF) may underline the etiology of a prothrombotic state in these conditions. Increased mean platelet volume (MPV) is a marker of abnormal platelet function and activation. We aimed to investigate the possible association of chronic AF with MPV in patients who have type 2 DM. Patients who had type 2 DM with either chronic (>= 6 months) AF or normal sinus rhythm (NSR) were included in the study. A total of 162 patients (aged 38-89 years) were divided into 2 groups according to the presence of either AF or NSR. Group 1 consisted of 81 diabetic patients with AF, and group 2 consisted of 81 diabetic patients with NSR. The two groups were not significantly different in terms of age, and gender, as well as in hypertension, smoking, history of coronary artery disease, previous cerebrovascular accidents, microalbuminuria, retinopathy, duration of DM, body mass index, hemoglobin A(1c), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (p > 0.05 for all variables). Although no significant difference was present between groups concerning platelet count; for patients with AF, MPV was higher compared with patients with NSR (9.0 +/- 0.2 fl vs. 8.4 +/- 0.2 fl; p = 0.001). Furthermore, no significant difference was noted between groups regarding routine medications received by patients. In multivariate logistic regression analysis, MPV was the only variable independently related to AF (OR = 2.659; 95% CI, 1.286-5.498; p = 0.008). Consequently, it is concluded that AF is associated with increased MPV in patients with type 2 DM, suggesting the presence of tentatively related processes leading to reciprocal interaction.

(2016). Effects of right ventricular systolic functions and COPD on cancer antigen-125 levels which are associated with atrial fibrillation in patients with heart failure? Acta Cardiologica: Vol. 71, No. 4, pp. 503-503.

WOS: 000305811600012, PubMed ID: 22386346, Background: Increased gamma-glutamyl transferase (GGT) level is associated with increased oxidative stress, all-cause mortality, the development of cardiovascular disease, and metabolic syndrome. However, its role in acute pulmonary embolism (PE) is unknown. In this study, we aimed to investigate the relationship between GGT and early mortality in patients with acute PE. Methods: A total of 127 consecutive patients with confirmed PE were evaluated. The optimal cutoff value of GGT to predict early mortality was measured as more than 55 IU/L with 94.4% sensitivity and 66.1% specificity. Patients with acute PE were categorized prospectively as having no increased (group I) or increased (group II) GGT based on a cutoff value. Results: Of these 127 patients, 18 patients (14.2%) died during follow-up. Among these 18 patients, 1 (1.4%) patient was in group I, and 17 (30.9%) patients were in group II (P < .001). gamma-Glutamyl transferase level on admission, presence of shock, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, main pulmonary artery involvement, troponin I, alanine aminotransferase, alkaline phosphatase, and creatinine levels were found to have prognostic significance in univariate analysis. In the multivariate Cox proportional hazards model, GGT level on admission (hazard ratio [HR], 1.015; P = .017), presence of shock (HR, 15.124; P = .005), age (HR, 1.107; P = .010), and heart rate (HR, 1.101; P = .032) remained associated with an increased risk of acute PE-related early mortality after the adjustment of other potential confounders. Conclusions: We have shown that a high GGT level is associated with worse hemodynamic parameters, and it seems that GGT helps risk stratification in patients with acute PE. (C) 2012 Elsevier Inc. All rights reserved.

WOS: 000303845000005, PubMed ID: 21996616, BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressively debilitating disease limiting patients' survival. The prognosis of COPD worsens with the addition of right ventricular (RV) failure. Red cell distribution width (RDW) is a measure of variability in the size of circulating erythrocytes, and is a powerful predictor of outcomes in patients with both chronic and acute left heart failure. Here we attempted to test whether RDW could provide an early marker of RV failure in patients with COPD. METHODS: Thirty-nine consecutive patients with COPD were enrolled in the study. All patients had at least 10 years' history of COPD, and all were treated appropriately. Thirty-nine age-matched and sex-matched individuals were enrolled for comparison. Red cell distribution width was obtained in all patients before transthoracic echocardiography. Right ventricular parameters were evaluated, and RV failure was identified via lateral tricuspid annulus longitudinal motion and systolic-tissue Doppler velocity, using transthoracic echocardiography. RESULTS: Patients with COPD had significantly higher RDW values compared with control subjects (patients with COPD, mean +/- SD, 16.1 +/- 2.5; range, 12.3 to 23.3; control subjects, mean +/- SD, 13.6 +/- 1.3; range, 11.7 to 18.3; P < .001). In multivariable logistic regression, the presence of high RDW was the only parameter independently predicting RV failure in patients with COPD (odds ratio, 2.098; P = .017). Levels of RDW, obtained before echocardiography, predicted the presence of RV failure with a sensitivity of 70% and specificity of 93.1%, with a cutoff value of >17.7. CONCLUSION: Red cell distribution width may be used to identify COPD patients with RV failure. Cite this article: Sincer, I., Zorlu, A., Yilmaz, M. B., Dogan, O. T., Ege, M. R., Amioglu, G., Aydin, G., Ardic, I., & Tandogan, I. (2012, MAY/JUNE). Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease. Heart & Lung, 41(3), 238-243. doi:10.1016/j.hrtlng.2011.07.011.

WOS: 000299522300022, PubMed ID: 21956582, …

WOS: 000303508600007, PubMed ID: 22139027, Heart failure (HF) is one of the most common and leading cause of death worldwide. Clinical trials provide evidence that the development of atrial fibrillation (AF) is a marker of poor prognosis in patients with HF. Furthermore, elevated D-dimer level is associated with increased cardiovascular mortality independent of AF in HF patients. We investigated whether plasma D-dimer levels in patients with hospitalized systolic HF could predict development of AF. A total of 150 consecutive patients with sinus rhythm who admitted to the emergency department with hospitalized systolic HF were evaluated. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission. Atrial fibrillation developed in 31 (20.7%) patients during follow-up period of 6.3 +/- A 5 months. Patients who developed atrial fibrillation had significantly increased levels of D-dimer [608 (339-1,022) ng/ml versus 1,100 (608-2,599) ng/ml, P = 0.001]. Optimal cut-off level of D-dimer to predict development of AF was found to be > 792 ng/ml. D-dimer > 792 ng/ml, right ventricular dilatation, age, systolic pulmonary pressure, left atrium size, moderate to severe tricuspid regurgitation, and beta blocker usage were found to have prognostic significance in univariate analysis. In multivariate Cox proportional-hazards model, D-dimer levels > 792 ng/ml (HR = 3.019, P = 0.006), and right ventricular dilatation (HR = 8.676, P = 0.003) were associated with an increased risk of new-onset AF. In conclusion, D-dimer could predict development of AF in patients with hospitalized systolic HF.

WOS: 000301403100018, PubMed ID: 22139722, Background: Without appropriate control measures, contrast-induced nephropathy (CIN) incidence has been claimed to be overestimated. Purpose: To evaluate the relationship and the difference between differential serum creatinine (DsCr), which is currently surrogating as a marker of GIN, and measured differential GFR values as a control measure (DGFR) in hospitalized patients. Material and Methods: GFR was measured two times by Tc-99m DTPA, before and 48 h after contrast media (CM), along with sCr and BUN in 35 inpatients (22 men, 13 women, mean age +/- SD = 61 +/- 14) with no known chronic kidney disease. Results: Relationship was moderate between GFR and sCr (R = 0.50, P < 0.01) in the study population. Pre-CM vs. post-CM values of GFR, sCr and BUN were not statistically different as (mean +/- SD); 78 +/- 36 vs. 73 +/- 35 mL/min/1.73m(2), 0.95 +/- 0.26 vs. 0.94 +/- 0.26 mg/dl and 21 +/- 16 vs. 19 +/- 13 mg/dl, respectively, in the study group. According to basal GFR values, 14 patients (40%) seemed carrying risk of GIN (GFR < 60 mymin/1.73m2) in whom only two had sCr >1.5 mg/dl. Twenty-five patients (71%) had discordant results in relation to Ds Cr and DGFR and two of them had GIN according to classical definition of Ds Cr, although having basal sCr

WOS: 000298900400023, PubMed ID: 21958741, Red cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 +/- 15 years. The mean follow-up duration was 11 +/- 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p 14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p.= 0.012) and the presence of shock (hazard ratio 9.354, p

Amaç: Kardiyorenal anemi sendromu kalp yetersizliği (KY) hastalarında tanımlanmıştır. Renal bozukluğun ve aneminin ayrı ayrı etkileri daha önce ortaya konmuş olsa da, böbrek, kemik iliği ve kalp arasındaki karmaşık etkileşim, hastalığı daha hafif olan kişilerde karar verme işlemini nispeten verimsiz kılar. Bu çalışmada, tahmini glomerül filtrasyon hızı (eGFR) ve hemoglobin (Hb) çarpımının KY hastalarında sonlanımı öngörmedeki rolünü araştırmayı amaçladık. Çalışma planı: Çalışmaya, akut dekompanse sistolik KY tanısıyla hastaneye yatırılıp taburcu edilen ardışık 148 hasta (89 erkek, 59 kadın; ort. yaş 68±10) alındı. Taburcu edilirken Hb düzeyleri ölçüldü, böbrek fonksiyonu MDRD (Modification of Diet in Renal Disease) formülü ile belirlendi. eGFRxHb çarpımı hesaplanarak, ROC (alıcı işletim karakteristiği) analiziyle kesim değeri çıkarıldı. Hastaların 34 aya varan takipleri (ort. 8.2±5.5 ay) sonrasında eGFRxHb çarpımı değerinin ölüm üzerindeki etkisi araştırıldı. Bulgular: Hasta grubunda ortalama Hb 12.7±2 gr/dl, ortalama kreatinin 105±46 ?mol/l ve ortalama eGFR 61±23 ml/dk/1.73 m2 bulundu. Seksen iki hastada (%55.4) eGFR, Objectives: Cardiorenal anemia syndrome is defined in patients with heart failure (HF). Although individual influ- ences of renal impairment and anemia were shown pre- viously, complex interaction between the kidney, bone marrow, and the heart renders decision making relatively inefficient in patients with milder forms of these diseases. We aimed to investigate whether product of estimated glo- merular filtration rate (eGFR) and hemoglobin (Hb) pre- dicts outcomes in patients with HF. Study design: The study included 148 consecutive pa- tients (89 males, 59 females; mean age 68±10 years) who were hospitalized with acutely decompensated systolic HF and discharged alive. Discharge Hb levels were measured. Renal function was estimated via the MDRD (Modification of Diet in Renal Disease) formula. The eGFR x Hb product was derived, and cut-off was defined using the ROC (re- ceiver operating characteristic) analysis. The influence of eGFR x Hb product on mortality was analyzed after a fol- low-up period of up to 34 months (mean 8.2±5.5 months). Results: The mean Hb was 12.7±2 g/dl, the mean creati- nine was 105±46 μmol/l, and the mean eGFR was 61±23 ml/min/1.73 m2. Eighty-two patients (55.4%) had an eGFR of

C pneumoniae (C. pneumoniae), a human respiratory pathogen, is the bacterium most often found to be associated with coronary heart disease. C. pneumoniae has been associated with atherosclerotic disease by seroepidemiologic analysis and by demonstration of the organism in atherosclerotic lesions by polymerase chain reaction. Recently, the presence of chlamydial deoxyribonucleic acid (DNA) was reported in peripheral blood mononuclear cells of patients with coronary artery disease. We aimed to investigate the effects of percutaneous transluminal coronary angioplasty on C. pneumoniae DNA detection in circulating white blood cells.

WOS: 000303508600004, PubMed ID: 21901368, D-dimer is a fibrin degradation product, and is implicated in pathologies of cardiovascular system. Thrombosis within the vascular system in relation with inflammation and stasis might be associated with poor prognosis in patients with systolic heart failure (HF). In this study we aimed to investigate for relationship between d-dimer levels and cardiovascular mortality in patients with systolic HF. A total of 174 consecutive patients with hospitalized systolic HF were evaluated. All hospitalized patients were obtained d-dimer levels within the first 24 h following admission after obtaining informed consent. Patients were followed up for cardiovascular mortality and 40 (23%) patients died. d-dimer levels were higher among those who died compared to those who survived (2727 +/- A 2569 (710-4438) versus. 1029 +/- A 1319 (303-1061) ng/ml, P < 0.001). Optimal cut-off level of d-dimer to predict cardiovascular mortality was found to be > 1435 ng/ml. D-dimer levels were negatively correlated with ejection fraction, positively correlated with left atrium size and left ventricular diastolic diameter. D-dimer > 1435 ng/ml, age, diabetes mellitus, presence of atrial fibrillation, and creatinine level were found to have prognostic significance in univariate analyses. In multivariate Cox proportional-hazards model, d-dimer > 1435 ng/ml (HR = 3.250, 95% CI 1.647-6.414, P = 0.001), creatinine level (HR = 1.269, 95% CI 1.008-1.599, P = 0.043), and presence of atrial fibrillation (HR = 2.159, 95% CI 1.047-4.452, P = 0.037) remained associated with an increased risk of death after adjustment for variables found to be statistically significant in univariate analysis and correlated with d-dimer level. In conclusion, d-dimer measurement could help risk stratification in patients with systolic HF.

Levosimendan, a calcium sensitizer, increases the sensitivity of the heart to calcium, thus increasing myocardial contractility without a rise in intracellular calcium. It was recently shown that levosimendan is beneficial in improving renal function. However, it remains to be established that the beneficial effect is differentially related to renal status during index event.The purpose of the current study was to determine whether levosimendan could improve renal outcome in acute decompensated heart failure patients with and without worsening renal function.Forty-five consecutive patients who had a reduced glomerular filtration rate and had at least two consecutive data regarding renal function prior to administration of levosimendan were enrolled in the study. Patients were classified into two groups as those with and without worsening renal function based on an increase in serum creatinine0.3 mg/dL.A significant improvement was noted in renal function in patients with worsening renal function (serum creatinine from 1.4 ± 0.16 to 1.21 ± 0.23 mg/dL, p=0.001 and glomerular filtration rate level from 48.9 ± 15 to 59.3 ± 21.8 mL/min/m², p=0.011), while there was no significant improvement in those without worsening renal function (serum creatinine from 1.29 ± 0.33 to 1.37 ± 0.66 mg/dL, p=0.240 and glomerular filtration rate level from 53.7 ± 17.6 to 52.9 ± 21.4 mL/min/m², p=0.850).Levosimendan appears to provide a renal-enhancing effect in patients with severe, acute decompensated systolic heart failure and worsening renal function. Consideration of this differential effect might help obtain beneficial renal outcomes.

WOS: 000295899700024, PubMed ID: 21804472, …

WOS: 000296230200011, PubMed ID: 21968258, Objectives: We aimed to evaluate echocardiography-guided hemodynamic determinants of quality of life (QoL) via the Medical Outcomes Study Short Form (SF-36) questionnaire in patients with mild to moderate mitral stenosis (MS). Methods: Eighty consecutive patients with rheumatic MS, who were admitted to the outpatient department, were enrolled into the study upon obtaining informed consent. Forty age-sex-matched healthy individuals were enrolled as a control group. Results: All subscale scores and total SF-36 scores were significantly lower in the patient group representing a worse QoL. In multivariable logistic regression analysis, only mean pulmonary artery pressure (OR 1.138, 95% CI 1.049-1.234, p = 0.002) was found to be an independent predictor of poor QoL in patients with mild to moderate MS. Conclusion: During follow-up of MS patients before intervention, physicians should consider that mean pulmonary artery pressure is the main factor which influences the patients' QoL. In patients with MS, it seems that referral to intervention should consider components and derivatives of QoL. Copyright (C) 2011 S. Karger AG, Basel