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Objective: Epicardial adipose tissue (EAT) has been found to be associatedwith the diastolic dysfunction in recent years, but this relationship has notbeen fully elucidated. Echocardiography is a non-invasive, simple, costeffective and accessible approach to assess EAT thickness, which can be performed easily.The aim of this study was to evaluate the effectiveness of EAT on prediction ofdiastolic dysfunction. Materialsand Methods: A total of 138patients without any cardiovascular,inflammatory, autoimmune and cancer disease, were enrolled. Our study was performed in the Cardiology clinic ofSakarya University Training and Research Hospital between May 2019 and December2019. Subjects were divided into two groups, those with and withoutdiastolic dysfunctions. Conventional echocardiography parametersand tissue Doppler imaging (TDI) were performed to evaluate left ventricularfunctions. EAT thickness on the free wallof the right ventricle in parasternal long-axis view were measured usingtransthoracic echocardiography.Results: Incomparison with the non- diastolicdysfunction group, patients with diastolic dysfunction hadsignificantly higher epicardial fat thickness (5.98±1.52 mm vs 4.32±1.03 mm; p

The prevalence of coronary artery disease is increasing in young adults. We evaluated the outcomes of different types of acute coronary syndrome in 917 patients undergoing coronary angiography aged ≤45 years. Male sex, smoking, dyslipidemia were the most important risk factors. ST-elevation myocardial infarction (STEMI; 54.8%) predominated. The STEMI patients had higher risk of hospital mortality (3.6% vs 0.6%; P = .004) and major adverse cardiac and cerebrovascular events (MACCE; 13.8% vs 3.3%; P < .001, hazard ratio [HR], 4.65; 95% CI, 2.45-8.82). Presentation heart rate, blood pressure, heart failure, shock, arrhythmia, ejection fraction (EF), diabetes, contrast-induced nephropathy (CIN), and elevated troponin were associated with hospital mortality and MACCE. But only heart failure (HR, 5.816; 95% CI, 2.254-15.008) and CIN (HR, 6.241; 95% CI, 2.340-16.641) were independent risk factors for hospital MACCE. There was no difference in long-term mortality between the 2 groups, but non-STEMI patients had higher risk for MACCE after 3 years (14.4% vs 9.9%, P = .033). Although shock (HR, 0.814; 95% CI, 0.699-0.930), Killip class ≥2 (HR, 0.121; 95% CI, 0.071-0.170), CIN (HR, 0.323; 95% CI, 0.265-0.380), and EF (HR, 0.917; 95% CI, 0.854-0.984) were independent predictors of hospital death, only EF was the independent predictor of long-term mortality (HR, 0.897; 95% CI, 0.852-0.944).

Objective: The primary aim of this study was to investigate the role of platelet-lymphocyte ratio (PLR) to predict bleeding risk in nonvalvular atrial fibrillation (NVAF). Secondary aim was to determine the possible relation between PLR and thromboembolic and bleeding risk scores. Tertiary aim was to evaluate the predictive value of PLR for the patients in the therapeutic international normalized ratio (INR) range. Method: PLR was calculated from the complete blood count of 228 patients who were under warfarin management for NVAF. The patients were called and it was questioned whether they had experienced the bleeding event within six months after measurement of the PLR values. Correspondence/Yazışma Adresi: Kahraman Cosansu, Deparment of Cardiology, Sakarya University, Education and Research Hospital Sakarya, Turkey, 54100 e-mail: kahraman141@gmail.com DOI: 10.5798/dicletip.705814 Results: Bleeding event was observed in 48 patients after the PLR was calculated. It was found significantly correlation between PLR and CHA2DVAS2C (p165,9 was determined significant indicator for bleeding (p 165,9 değeri kanama için önemli bir gösterge olarak belirlendi (p

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

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

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Amaç:Literatürdekoroner kollateral dolaşımın (KKD) derecesi ile D vitamini seviyesi arasındamuhtemel bir ilişki olabileceğine dair yayınlar mevcuttur. Bu çalışmanın amacıkronik total oklüzyon (KTO) nedeniyle perkütan koroner girişim yapılanhastalarda hem Rentrop hem de Werner sınıflandırmasına göre KKD ile D vitaminiseviyesi arasında bir ilişki olup olmadığının araştırılmasıdır. Materyal-Metot:Mevcutçalışma tek-merkezli, retrospektif kohort çalışmasıdır. KTO işlemi içinhastaneye yatırılan ardışık 101 hasta çalışmaya alınmıştır. Hastalar KKDderecesine göre hem Rentrop hem de Werner sınıflandırmasına göre üçer grubaayrılmıştır. Her bir grup 25(OH)VitD3 seviyesine göre birbiriylekıyaslanmıştır. Bulgular:HastalarRentrop sınıflandırmasına göre üçgruba ayrıldığında gruplar arasında25(OH)VitD3 seviyesi açısından fark saptanmamıştır [Rentrop 1: 15,7ng/ml (7,0-77,0 ng/ml), Rentrop 2: 16,9 ng/ml (7,0-71,3), Rentrop 3: 16,6 ng/ml(7,0-28,7), p=0,925]. Hastalar Werner sınıflandırmasına göre tekrar üç gruba sınıflandırıldığındayine gruplar arasında 25(OH)VitD3 seviyesi açısından farksaptanmamıştır [Werner 0: 19,6 ng/ml (7,0-77,0 ng/ml), Werner 1: 16,6 ng/ml(7,0-71,3), Werner 2: 17,0 ng/ml (7,0-28,3), p=0,411]. Sonuç: Çalışma sonucuna göre 25(OH)VitD3 seviyesi ile KKD derecesi arasında klinikpratikte bire bir ilişki olmadığı kanaatindeyiz., Objective:Therehave been studies which revealed a possible relation with the grade of coronarycollateral circulation (CCC) and the level of Vitamin D in the literature. Theobjective of this study was to assess whether there is a correlation betweenthe grade of CCC and the level of Vitamin D according to both Rentrop andWerner classifications in patients with coronary chronic total occlusion (CTO)who underwent percutaneous coronary intervention. Material-Method:Thepresent study is a single-centre, retrospective cohort study. A total of 101consecutive patients, who were hospitalized to undergo coronary CTO procedure,were enrolled in the study. The patients were classified into 3 groups withregard to the grade of CCC according to both Rentrop and Werner classifications.These groups were compared with each other according to the 25(OH)VitD3 levels.Results:Therewas no significant difference among 3 groups with regard to 25(OH)VitD3 levelswhen the patients were classified according to the Rentrop classification[Rentrop 1: 15.7 ng/ml (7.0-77.0 ng/ml), Rentrop 2: 16.9 ng/ml (7.0-71.3),Rentrop 3: 16.6 ng/ml (7.0-28.7), p=0.925]. Moreover, there was no significantdifference among 3 groups with regard to 25(OH)VitD3 levels when thepatients were classified according to the Werner classification. [Werner 0:19.6 ng/ml (7.0-77.0 ng/ml), Werner 1: 16.6 ng/ml (7.0-71.3), Werner 2: 17.0ng/ml (7.0-28.3), p=0.411].Conclusion:Wedeem that there may not be a direct correlation (one-to-one relationship)between the level of 25(OH)VitD3 and the grade of CCC in clinicalpractice.

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

Background: The aim of this study was to investigate the ability of a new index, namely the left ventricular internal dimension at end-diastole/mitral valve E-point septal separation (LVIDd/EPSS), to predict the left ventricular (LV) systolic function and to compare its performance with that of the EPSS index and to investigate the correlation between the LVIDd/EPSS and the left ventricular ejection fraction (LVEF). Methods: The current study recruited 142 patients who presented to the Cardiology Clinic of Sakarya University Education and Research Hospital and were followed for heart failure (HF).M-mode measurements of the EPSS and the LVIDd were recorded in the parasternal long-axis view. Results: Totally, 142 HF patients with midrange ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) were enrolled in the study. There was a significantly correlation both between the EF and the EPSS and between the EF and the LVIDd/EPSS (P0.05). The receiver operating characteristic curve analysis showed that the LVIDd/EPSS predicted advanced HF with 87% sensitivity and 72% specificity, using a cutoff value of 3.35,and it predicted the HFrEF (EF

Kocayigit, Ibrahim/0000-0001-8295-9837; WOS:000473278000005 PubMed ID: 31264653 Objective: It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. Methods: All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). Results: Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were over-represented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. Conclusion: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.

Purpose: Direct oral anticoagulants (DOACs) have many advantages over warfarin regarding periprocedural management for dental extractions. They avoid the need to assess and possibly adjust warfarin therapy to achieve appropriate hemostatic status before and after extraction. The present study evaluated the real-life data regarding quality of life (QoL) and burden for patients with atrial fibrillation receiving long-term treatment with warfarin or DOACs during periprocedural management for dental extraction. Patients and Methods: We implemented a multicenter study. The sample was composed of 205 patients who had been receiving long-term anticoagulation treatment with warfarin (n = 133) or DOACs (n = 72). The Duke Anticoagulation Satisfaction Scale (DASS) was used to assess the QoL. Periprocedural management for dental extraction was recorded using the questions designed by us. Results: Warfarin created a significantly greater burden for patients during periprocedural management for dental extraction compared with DOACs. The DASS results showed that the QoL of patients was significantly better for the DOAC group than for the warfarin group (score, 75.19 ± 18.52 and 90.12 ± 17.28, respectively; P =.0001). Of the patients in the DOAC group, 45 had used warfarin as their previous therapy and had undergone another tooth extraction while using warfarin. Of these patients, 91.1% chose DOACs as their anticoagulant of choice for dental extraction. Conclusion: The present findings suggest that DOACs have many advantages compared with warfarin regarding the reported QoL and periprocedural management of dental extraction. © 2018 American Association of Oral and Maxillofacial Surgeons

The negative impact of atrial fibrillation (AF) on health-related quality of life has been extensively documented. The aim of this study was to compare the Hospital Anxiety and Depression Scale (HADS) scores of patients with non-valvular AF during warfarin administration and after switching to novel oral anticoagulants (NOACs). The study comprised 100 consecutive patients on warfarin treatment between July 2018 and January 2019 for whom a transition to NOACs was planned. All patients completed the HADS at the start of the study and at least 3 months after that date. The mean value of HADS-A (5.9 ± 2.1 vs. 4.4 ± 1.6, p

Objective: This study assessed whether high levels of iodide administered during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) differentially influenced thyroid function compared to PCI for non-complex coronary lesions. Subjects and Methods: A total of 615 patients were enrolled in the study; 205 underwent elective PCI for CTO lesions (Group I) and 410 underwent elective PCI for non-complex lesions including non-CTO, non-bifurcation, non-calcified, and non-tortuous lesions (Group II). Patients were monitored for development of incidental thyroid dysfunction between 1 and 6 months after PCI. Results: The patients in Group I were administered a median of 255 mL of contrast medium during PCI for CTO; a median of 80 mL was administered to the patients in Group II during non-complex PCI (p =0.001). Ten (5.4%) of the 186 euthyroid patients in Group I and 19 (5%) of the 379 eu­thyroid patients in Group II developed subclinical hyper­thyroidism (p = 0.854). However, 7 (50%) of the 14 subclinical hyperthyroid patients in Group I and only 3 (12%) of the 25 subclinical hyperthyroid patients in Group II developed overt hyperthyroidism (p = 0.019). Conclusion: In euthyroid patients, PCI for coronary CTO lesions did not increase the risk for subclinical hyperthyroidism when compared to PCI for non-complex coronary lesions. However, in patients with subclinical hyperthyroidism at baseline, PCI for coronary CTO lesions significantly increased the development of overt hyperthyroidism when compared to PCI for non-complex coronary lesions.

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

BACKGROUND: Atrial fibrillation is one of the most common abnormal heart rhythms. Neutrophil‐lymphocyte ratio (NLR) has emerged as a potential marker for the level of inflammation in cardiac disorders. HYPOTHESIS: NLR might be associated with thrombosis and bleeding risk scores and might predict cardioembolic risk in nonvalvular atrial fibrillation (NVAF) patients within the therapeutic international normalized ratio (INR). METHODS: We enrolled 272 patients taking warfarin for NVAF and classified them into 2 groups: Group A consisted of patients (n = 132) whose time in therapeutic range (TTR) was ≥65%, and Group B comprised patients (n = 139) whose TTR was

Background: Assessing the monocyte to high-density lipoprotein ratio (MHR) is a new tool for predicting inflamation, which plays a major role in atherosclerosis. Myocardial bridge (MB) is thought to be a benign condition with development of atherosclerosis, particularly at the proximal segment of the brigde. Objective: To evaluate the relationhip between MHR and the presence of MB. Methods: We consecutively scanned patients referred for coronary angiography between January 2013- December 2016, and a total of 160 patients who had a MB and normal coronary artery were enrolled in the study. The patients’ angiographic, demographic and clinic characteristics of the patients were reviewed from medical records. Monocytes and HDL-cholesterols were measured via complete blood count. MHR was calculated as the ratio of the absolute monocyte count to the HDL-cholesterol value. MHR values were divided into three tertiles as follows: lower (8.25 ± 1.61), moderate (13.11 ± 1.46), and higher (21.21 ± 4.30) tertile. A p-value of < 0.05 was considered significant. Results: MHR was significantly higher in the MB group compared to the control group with normal coronary arteries. We found the frequency of MB (p = 0.002) to increase as the MHR tertiles rose. The Monocyte-HDL ratio with a cut-point of 13.35 had 59% sensitivity and 65.0% specificity (ROC area under curve: 0.687, 95% CI: 0.606-0.769, p < 0.001) in accurately predicting a MB diagnosis. In the multivariate analysis, MHR (p = 0.013) was found to be a significant independent predictor of the presence of MB, after adjusting for other risk factors. Conclusion: The present study revealed a significant correlation between MHR and MB. Resumo Fundamento: A avaliação da razão de monócitos para lipoproteínas de alta densidade (MHR, sigla em inglês) é uma nova ferramenta para se prever o processo inflamatório, o qual desempenha um papel importante na aterosclerose. A ponte miocárdica (PM) é considerada uma condição benigna com desenvolvimento de arteriosclerose, particularmente no segmento proximal da ponte. Objetivo: Avaliar a relação entre a MHR e a presença de PM. Métodos: Examinamos concecutivamente pacientes encaminhados para angiografia coronariana entre janeiro de 2013 e dezembro de 2016, e um total de 160 pacientes, uma parcela dos quais com PM, e outra com artérias coronárias normais, foram incluídos no estudo. As características angiográficas, demográficas e clínicas dos pacientes foram revisadas a partir de registros médicos. Monócitos e colesteróis HDL foram medidos através de hemograma completo. A MHR foi calculada como a razão entre a contagem absoluta de monócitos e o valor do colesterol HDL. Os valores de MHR foram divididos em três tercis, da seguinte forma: tercil inferior (8,25 ± 1,61); tercil moderado (13,11 ± 1,46); e tercil superior (21,21 ± 4,30). Considerou-se significativo um valor de p < 0,05. Resultados: A MHR foi significativamente maior no grupo com PM, em comparação com grupo controle com artérias coronárias normais. Verificamos que a prevalência de PM (p=0,002) aumentou à medida que se elevavam os tercis de MHR. A razão monócitos-colesterol HDL com ponto de corte de 13,35 apresentou sensibilidade de 59% e especificidade de 65,0% (área ROC sob a curva: 0,687, IC95%: 0,606-0,769, p < 0,001) na predição acurada do diagnóstico de PM. Na análise multivariada, a MHR (p = 0,013) mostrou-se um preditor independente significativo da presença de PM, após ajustes para outros fatores de risco. Conclusão: O presente estudo revelou uma correlação significativa entre MHR e PM.

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

Giriş: Bu makalenin amacı akıllı telefon kullanılan dönemde çalışma ve çalışmadışı saatleri (ÇDS)’nde akut ST-elevasyonlu miyokart infarktüsü (STEMİ)’nünortalama tanı süresini belirlemektir. Ayrıca uygulama varlığı ve yokluğundaÇDS’deki tanı zamanları arasında önemli farklılık olup olmadığına bakılacaktır.Hastalar veYöntem: Bu retrospektif çalışmaya Ocak 2013-Nisan 2014tarihlerinde STEMİ tanısı konup primer perkütan koroner girişim (PKG) içintransfer edilen 174 hasta alındı. Bu periyotta, hastanede ÇDS’de akıllı telefonkullanılmaktaydı. Ayrıca Ocak 2012-Kasım 2012 tarihlerinde ÇDS’de kardiyoloğunacile çağırılması veya hastane bilgisayarından kardiyoloğa elektronik posta ileelektrokardiyografi gönderilmesi yoluyla STEMİ tanısı konan 58 hasta alındı.Bulgular: Uygulamanın kullanılmaya başlanılması sonrası çalışma sırasında hastalarıntanı süresi ortalama 7.9 ± 1.7 dakikaydı. ÇDS’de STEMİ tanısı ortalama 8.2 ±1.4 dakika olarak saptandı. Çalışma ve ÇDS arasında tanı zamanlarında farkgörülmedi (p= 0.143). Uygulamanın kullanılmaya başlanması öncesi ÇDS’de STEMİtanı süresi 18.0 ± 3.1 dakikaydı. ÇDS’de uygulama başlangıcı öncesi ve sonrasıarasında STEMİ tanı süresi açısından anlamlı fark saptandı (p< 0.001).Sonuç: Akıllı telefonuygulamalarının özellikle PKG yapılamayan merkezlerde ÇDS’de kullanılması STEMİtedavisindeki gecikmeyi azaltarak kısa ve uzun dönem klinik sonuçlarda iyileşmesağlayabilir., Introduction:Thisstudy aimed to determine the mean time for diagnosis of acute ST-segmentelevation myocardial infarction (STEMI) for both working hours (WHs) andnon-WHs (NWHs) during the period that a smartphone application was in use toaid the speed of diagnosis and any significant difference in diagnosis timesduring NWHs with and without use of the application.Patientsand Methods: In this retrospective study, 174 patients who had beendiagnosed with STEMI and transferred for primary percutaneous coronaryintervention between January 2013 and April 2014 were recruited. During thisperiod, the hospital used a smartphone application to aid diagnosis duringNWHs. In addition, 58 patients who were diagnosed with STEMI during NWHsbetween January 2012 and November 2012, either by a cardiologist called to theemergency department or an electrocardiography being sent to the cardiologist’se-mail from a hospital computer, were enrolled.Results: After thesmartphone application was used, patients were diagnosed in a mean time of 7.9± 1.7 min during WHs, whereas STEMI was diagnosed in a mean time of 8.2 ± 1.4min during NWHs. There was no statistically significant difference in diagnosistimes between WHs and NWHs (p= 0.143). However, before the application wasused, the mean time for the diagnosis of STEMI was 18.0 ± 3.1 min during NWHs,and consequently, there was a significant difference in STEMI diagnosis timesduring NWHs before and after the application began to be used (p< 0.001).Conclusion: The application ofsmartphones, especially during NWHs at non-percutaneous coronaryintervention-capable centres, can significantly reduce delays in STEMItreatment, which can result in improved short- and long-term clinical outcomes.

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

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

The aim of this study was to investigate the association of serum hyaluronidase and nitric oxide (NO) levels with arterial stiffness in patients with hypertension (HT) and diabetes mellitus (DM). A total of 101 patients with diagnosis of DM and HT were enrolled in this study. The patients were divided into three groups as follows: only hypertensive (I), only diabetic (II) and both diabetic and hypertensive (III). Serum hyaluronidase levels were negatively correlated with aortic strain (AS) and aortic distensibility (AOD) in all groups, whereas a significant positive correlation was noted between serum hyaluronidase levels and aortic strain index (ASI) (all p-values0.05). There was a significant negative correlation between serum hyaluronidase and NO levels in all patients (p0.001). When the correlation between serum hyaluronidase and serum NO levels was investigated in the individual patient groups, a negative correlation was found in groups I, II and III (p = 0.017, p0.001 and p0.001, respectively). A significant relationship between plasma hyaluronidase level and parameters of aortic stiffness was found in patients with HT and/or DM. We suggest that the pathophysiological mechanisms responsible for the development of arterial stiffness in subjects with impaired endothelial function may involve pathological changes in the HA metabolism.

Wstep: Urokortyna 1 (UCN1) ma dzialanie kardiostymulujące, diuretyczne i natriuretyczne, a jej ekspresja zwieksza sie w niewydolności serca (HF). Cel: Celem niniejszego badania byly: ocena stezen UCN1 u chorych z HF, ocena związku UCN1 z roznymi parametrami klinicznymi oraz ocena przydatności UCN1 jako wskaźnika diagnostycznego HF w porownaniu z peptydem natriuretycznym typu B (pro-BNP). Metody: Autorzy zmierzyli stezenia UCN1 i pro-BNP w surowicy u 90 kolejnych pacjentow ze skurczową HF (frakcja wyrzutowa lewej komory [LVEF] ≤ 45%) i u 90 zdrowych osob stanowiących grupe kontrolną. Do pomiaru stezen UCN1 i pro-BNP w surowicy uzyto metody ELISA. W celu określenia LVEF i ciśnienia skurczowego w tetnicy plucnej (PASP) przeprowadzono przezprzelykowe badanie echokardiograficzne. Ponadto oszacowano filtracje klebuszkową (GFR), stosując wzor Cockcrofta-Gaulta. Wyniki: Stezenie UCN1 bylo wyzsze u chorych z HF (391,5 [357,0–482,0] pg/ml; p < 0,001). Stwierdzono dodatnią korelacje stezenia UCN1 z klasą NYHA (r = 0,89; p < 0,001) i PASP (r = 0,39; p < 0,001) oraz ujemną korelacje z LVEF (r = –0,46; p < 0,001) i GFR (r = –0,21; p = 0,046). Zanotowano rowniez istotną dodatnią zaleznośc miedzy stezeniami pro-BNP i UCN1 (p < 0,001; r = 0,96). W celu oceny wartości parametrow w diagnozowaniu HF wyznaczono krzywe ROC i obliczono pole pod krzywą (AUC), ktore wynosilo 0,99 (95% CI 0,98–1,00; p < 0,001) w przypadku stezenia UCN1 oraz 1,00 (p < 0,001) w przypadku stezenia pro-BNP. Wnioski: Stezenie UCN1 zwieksza sie w miare nasilania sie HF i dysfunkcji lewej komory. Parametr ten moze byc stosowany jako diagnostyczny biomarker w skurczowej HF, jednak znaczenie pomiaru UCN1 jako badania uzupelniającego u pacjentow, u ktorych wykonano oznaczenie pro-BNP, jest wątpliwe.

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

OP-020 THE RELATIONSHIP BETWEEN LYMPHOCYTE/NEUTROPHIL RATIO, MEAN PLATELET VOLUME, AND RED CELL DISTRIBUTION WIDTH AND LONG TERM CARDIOVASCULAR EVENTS IN PATIENTS WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION FOLLOWING MYOCARDIAL INFARCTION H.A. Barman, H.A. Cakmak, B. Ikitimur, A.S. Ertugrul, M. Uyar, K. Cosansu, B. Karadag, V.A. Vural. Department of Cardiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey; Department of Public Health, Selcuk University Meram Medical Faculty, Konya, Turkey; Department of Cardiology, Seka Goverment Hospital, Kocaeli, Turkey

Introduction Kidney transplantation is the treatment of choice for most patients with end-stage renal disease (ESRD). Strategies to increase donor organ availability and to prolong the transplanted kidney9s survival have become priorities in kidney transplantation. Standard immunosuppressive therapy consists of initial treatment and maintenance regimes to prevent rejection and short courses of more intensive immunosuppressive therapy to treat episodes of acute rejection. Immunosuppressive drugs may cause electrocardiographic changes as increased QT interval (QTc) which is associated with a variety of cardiac diseases and sudden death. The aim of our study is to compare the effect of two different calcineurin inhibitors (cyclosporine A and tacrolimus), azatiopirin and everolimus on QT interval in renal transplant patients. Method A total of 98 patients were assigned into the study (51 Tacrolimus, 23 cyclosporine A, 15 everolimus and 9 azatiopirin). The mean time after transplantation was 18 months. QT dispersion was calculated according to Bazzet9s formula from the 12 leads electrocardiography. The corrected QT (QTc) values from pretransplant ECGs and the follow-up ECGs (at least 6 months) were compared. Results There were no significant differences between groups with respect to pretransplantation QT times (p≥0.05). QT times were increased after transplantation for all patient groups. Patients receiving cyclosporine A, azatiopirin and everolimus had statistically significantly increased QTc times than patients on tacrolimus (p=0.042). Discussion We showed that QT interval was affected by all immunosuppressive drugs. However, QTc interval prolongation was less prominent in patients on tacrolimus in comparison to other drugs. QTc prolongation is an independent predictor of mortality in patients with ESRD who are candidates for renal transplantation. We revealed that tacrolimus is the safest drug with respect to QT prolongation in renal transplant patients. Tacrolimus should be considered as a drug of choice in patients developing QT prolongation during the course of immunosuppressive treatment.

Introduction Kidney transplantation is the treatment of choice for most patients with end-stage renal disease (ESRD). Strategies to increase donor organ availability and to prolong the transplanted kidney9s survival have become priorities in kidney transplantation. Standard immunosuppressive therapy consists of initial treatment and maintenance protocols to prevent rejection and short courses of more intensive immunosuppressive therapy to treat episodes of acute rejection. The effects of this drugs on electrocardiographic findings are not well known. An increased corrected QT interval (QTc) is associated with a variety of cardiac diseases and predicts sudden death. The PR interval reflects the time of the electrical impulse conducting from the sinus node through the AV node and entering the ventricles. The PR interval is therefore a good estimate of AV node function. The aim of our study is to investigate the effect of two different calcineurin inhibitors (cyclosporine A and tacrolimus) on QT and PR interval in renal transplant patients. Methods In this study, renal transplant patients receiving immunosuppressive drugs were evaluated to investigate the post-transplantation alterations in QTc and PR interval. A total of 74 patients were assigned into the study (51 patients on Tacrolimus and 23 patients on cyclosporine A). The mean time after transplantation was 18 months. QT dispersion was calculated according to Bazzet9s formula from the 12 leads electrocardiography. The corrected QT (QTc) and PR interval values from the follow-up ECG (at least 6 months) were compared with pretransplant ECGs. Results Statistically significant increase in QTc times were observed in both groups receiving tacrolimus and cyclosporine (p=0.022 and p=0.005, respectively). Although PR intervals were significantly shortened in patients receiving tacrolimus (p 0.05). Discussion Past studies investigating the effects of immunosuppressive drugs on electrocardiographic findings generally focused on QT intervals. However, PR interval was also analysed in our study. We showed that QT interval was effected by tacrolimus and cyclosporine A. Moreover we found that tacrolimus also shortens PR interval. Shortening in PR interval may be related to increases in heart rate. Another explanation for this shortening may be activation of a pre-existing accessory pathway due to AV blockage induced by tacrolimus. QTc prolongation is known to be an independent predictor of mortality in renal transplantation candidates with end stage renal disease. Taking this into consideration, all renal transplant patients must be closely followed with ECGs.