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Objectives: The modified Glasgow Prognostic Score (mGPS) is one type of inflammation-based index; it includes data on elevated C-reactive protein and reduced albumin content. The predictive value of mGPS for outcomes is investigated in various diseases such as cancer, heart failure, myocardial infarction, acute pulmonary embolism, and inflammatory bowel diseases. This study aimed to evaluate the link between mGPS and the severity and complexity of peripheral arterial disease (PAD) as determined by the Transatlantic Intercommunal Consensus Document (TASC-II) classification and the prediction value of mGPS for procedural success in patients undergoing endovascular treatment (EVT)., Methods: Our study included 203 consecutive patients receiving EVT for atherosclerotic obstruction of aortoiliac, femoro-popliteal, and below-knee arteries between January 2019 and February 2020. The lesion characteristics were determined according to categories in the TASC-II. Operational failure is the inability to position the guidewire through the occluded lesion following percutaneous intervention or achieve distal perfusion following EVT., Results: In our study, we observed 136 patients (%6) with TASC A-B lesions and 67 patients (%33) with TASC C-D lesions. EVT was performed on the femoro-popliteal artery in 59.4% of the patients, on the aortoiliac artery in 30.7%, and on the below-the-knee artery in 9.9%. mGPS was an independent predictor of severe PAD (OR: 17.943, 95% CI: 5.120-62.882; p < .001) and procedural success (odds ratio: 0.004; 95% CI: 0.001-0.099; p < .001). Additionally, we identified age and the presence of a TASC D lesion as independent predictors of interventional success (OR: 0.938, 95% CI: 0.819-0.979; p : .034; OR: 0.104, 95% CI: 0.107-0.643; p : .015, respectively)., Conclusion: We determined that mGPS independently predicts PAD complexity and severity based on TASC-II classification; the EVT success rate is lower in patients with high mGPS., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Past studies have shown that non-dipper hypertensive patients have more frequent subclinical left ventricular (LV) systolic dysfunction compared to dippers. Many different parameters have been examined to predict subclinical LV dysfunction. The role of osteoprotegerin (OPG) in the pathogenesis of heart failure and LV systolic dysfunction through different mechanisms had well described. In the present study, we hypothesized that increased OPG levels could predict subclinical LV systolic dysfunction in non-dipper hypertensive patients., Patients and Methods: Hypertensive patients were divided into two groups according to the results of ambulatory blood pressure (BP) monitoring. Non-dipper patients were subsequently divided into two further groups (normal LV function and impaired LV function) according to LV global longitudinal strain (GLS)., Results: A total of 103 hypertensive patients (51 dippers, 52 non-dippers) were included in the study. In the non-dipper group, LV GLS was normal in 21 patients and impaired in 31 patients. Based on the results of the multivariate logistic regression test, it was determined that OPG levels (OR: 2.413, 95% CI: 1.284-4.535, P  = 0.006) and LVMI (OR: 1.086, 95% CI: 1.013-1.165, P  = 0.021) were independently associated with impaired GLS., Conclusion: Higher OPG values were associated with subclinical LV systolic dysfunction in non-dipper hypertensive patients. It could be used for the early diagnosis of subclinical LV systolic dysfunction, which would allow for strategies to be designed to reduce the cardiovascular event rate in this patient population., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The association between hypertensive retinopathy and left atrial (LA) impairment is unknown. Accordingly, it was aimed to investigate the possible relationship between hypertensive retinopathy and LA phasic functions by means of two-dimensional speckle-tracking echocardiography (2D-STE)., Methods: A total of 124 hypertensive patients and 27 control subjects were included in the study. LA reservoir strain (LA S-S ), LA conduit strain (LA S-E ), and LA booster strain (LA S-A ) parameters were used to evaluate LA myocardial functions., Results: Hypertensive patients (with and without retinopathy) displayed an obvious reduction in the LA reservoir strain (LA S-S ) , and LA conduit strain (LA S-E ). Moreover, further impairment in LA reservoir and conduit strain was found in patients with hypertensive retinopathy than in the isolated hypertensive patients. There were no significant differences in LA booster strain (LA S-A ) among the three groups. Impaired LA S-S (OR: 0.764, CI: 0.657-0.888, and p < 0.001), LA S-E (OR: 0.754, CI: 0.634-0.897, and p = 0.001), and hypertension (HT) duration (OR: 2.345, CI: 1.568-3.507, and p < 0.001) were shown to be independent predictors of hypertensive retinopathy., Conclusion: Impaired LA reservoir and conduit strain may be used to predict hypertensive patients at higher risk of developing hypertensive retinopathy, and to determine which patients should be followed more closely for hypertensive retinopathy., (© 2022 Wiley Periodicals LLC.)

Myocardial injury (MI) is not unusual after transcatheter aortic valve replacement (TAVR). To determine precipitating factors and prognostic outcomes of MI after TAVR, we retrospectively investigated relationships between MI after TAVR and aortic root dimensions, baseline patient characteristics, echocardiographic findings, and procedural features. Of 474 patients who underwent transfemoral TAVR for severe aortic stenosis in our tertiary center from June 2011 through June 2018, 188 (mean age, 77.7 ± 7.7 yr; 96 women [51%]) met the study inclusion criteria. Patients were divided into postprocedural MI (PMI) (n=74) and no-PMI (n=114) groups, in accordance with high-sensitivity troponin T levels. We found that MI risk was associated with older age (odds ratio [OR]=1.054; 95% CI, 1.013-1.098; P=0.01), transcatheter heart valve type (OR=10.207; 95% CI, 2.861-36.463; P=0.001), distances from the aortic annulus to the right coronary artery ostium (OR=0.853; 95% CI, 0.731-0.995; P=0.04) and the left main coronary artery ostium (OR=0.747; 95% CI, 0.616-0.906; P=0.003), and baseline glomerular filtration rate (OR=0.985; 95% CI, 0.970-1.000; P=0.04). Moreover, the PMI group had a longer time to hospital discharge (P=0.001) and a higher permanent pacemaker implantation rate (P=0.04) than did the no-PMI group. Our findings may enable better estimation of which patients are at higher risk of MI after TAVR and thus improve the planning and course of clinical care., (© 2022 by the Texas Heart® Institute, Houston.)

Objective: Hyponatremia is a prognostic marker for specific pathologies. However, the association between contrast-induced nephropathy (CIN) and post-procedural hyponatremia has not been explored. Our study aims to evaluate the association between hyponatremia developing after contrast media administration and CIN., Material and Methods: A total number of 236 patients who required nephrology consultation before coronary angiography (CAG) or percutaneous coronary intervention (PCI) because of the high risk for contrast nephropathy, were included. Serum sodium levels were measured at admission and within three consecutive days after contrast media administration., Results: Hyponatremia was observed in 141patients (59.7%) following angiography. CIN was developed in 149 (63.4%) patients. Among the patients who developed hyponatremia, ejection fraction, serum haemoglobin level and serum albumin level were low whereas, contrast media volume and percentage of the diabetes mellitus were higher. Also, length of hospital stay, percentage of CIN, renal replacement requirement and mortality rate were higher in patients with hyponatremia. In univariable analysis to evaluate the risk factors for CIN, being female gender, age, diabetes mellitus, serum albumin concentration, haemoglobin level, contrast media volume and hyponatremia were associated with development of CIN. Multivariable logistic regression analysis revealed that advanced age, serum albumin concentration and hyponatremia were independent predictors of CIN., Conclusion: Post-procedural hyponatremia was an independent risk factor for CIN in CAG or PCI patients.

Ventricular arrhythmias (VAs) continue even after left ventricular assist device (LVAD) implantation. The effect of LVAD on VAs is controversial. We investigated electrophysiologic changes after LVAD and its effects on VAs development. A total of 107 implantable cardioverter-defibrillator (ICD) patients, with LVAD, were included in this study. Electrocardiographic parameters including QRS duration (between the beginning of the QRS complex and the end of the S wave), QT duration (between the first deflection of the QRS complex and the end of the T wave) corrected QT (QTc), QTc dispersion, fragmented QRS (F-QRS), and ICD recordings before, and post-LVAD first year were analyzed. All sustained VAs were classified as polymorphic ventricular tachycardia (PVT) or monomorphic VT (MVT). The QRS, QT, QTc durations, and QTc dispersion had decreased significantly after LVAD implantation (p < 0.001 for all). Also MVT increased significantly from 28.9% to 49.5% (p = 0.019) whereas PVT decreased from 27.1% to 4.67% (p = 0.04) compared to pre-LVAD period. A strong correlation was found between QT shortening and the decrease in PVT occurrence. Besides, the increase in the F-QRS after LVAD was associated with post-LVAD de nova MVT development. Finally, F-QRS before LVAD was found as an independent predictor of post-LVAD late VAs in multivariate analysis. Pre-existing or newly developed F-QRS was associated with post-LVAD late VAs, and it may be used to determine the risk of VAs after LVAD implantation., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © ASAIO 2021.)

Background: Echocardiography is generally used in our daily practice to detect cardiovascular complications in COVID-19 patients and for etiological research in the case of worsened clinical status. Many echocardiographic parameters have been the subject of investigation in previous studies on COVID-19. Recently, the right ventricle early inflow-outflow (RVEIO) index has been identified as a possible and indirect marker of the severity of tricuspid regurgitation and right ventricular dysfunction in pulmonary embolism. In this study, we aimed to investigate the relationship between the severity of pneumonia in COVID-19 patients and the RVEIO index., Methods: A total of 54 patients diagnosed with COVID-19 pneumonia were enrolled in this study. Our study population was separated into two groups as severe pneumonia and nonsevere pneumonia based on computed tomography imaging., Results: Saturation O 2 , C-reactive protein, D-dimer, deceleration time, tricuspid annular plane systolic excursion, tricuspid lateral annular systolic velocity, and RVEIO index values were found to be significantly different between severe and nonsevere pneumonia groups. The result of the multivariate logistic regression test revealed that saturation O2, D-dimer, Sm, and RVEIO index were the independent predictive parameters for severe pneumonia. Receiver operating characteristic curve analysis demonstrated that RVEIO index >4.2 predicted severe pneumonia with 77% sensitivity and 79% specificity., Conclusion: The RVEIO index can be used as a bedside, noninvasive, easily accessible, and useful marker to identify the COVID-19 patient group with widespread pneumonia and, therefore high risk of complications, morbidity, and mortality., (© 2021 Wiley Periodicals LLC.)

Objective: Left atrial (LA) function is an important predictor of adverse cardiovascular outcomes in patients with hypertension (HT). Therefore, recognition of subtle LA dysfunction in the early stages of HT is essential for controlling modifiable variables. Several electrocardiographic and echocardiographic parameters have been studied to show early LA dysfunction. The goal of this study was to investigate the relationship between newly defined morphology-voltage-P wave duration electrocardiography (MVP ECG) score and early LA dysfunction in hypertensive patients., Materials and Methods: Eighty-nine hypertensive patients were included in this study. Based on speckle tracking echocardiography results, the patients were divided into two groups: 67 patients with normal LA function were included in Group 1, and 22 patients with abnormal LA function in Group 2., Results: Age, diabetes mellitus history, duration of HT history, left ventricular mass index, E/Em, and MVP ECG score values were statistically significant between the two groups. Based on the results of the multivariate logistic regression test, duration of HT history, E/Em, and MVP ECG score were determined as independent predictive parameters for early LA dysfunction in hypertensive patients., Conclusion: In conclusion, MVP ECG score assessment could be a novel approach to detect early LA dysfunction in hypertensive patients.

A 48-year-old male patient was admitted to our outpatient clinic with complaints of shortness of breath. He also had a holo-diastolic murmur at the right sternal border and an apical impulse being displaced laterally and inferiorly. Transthoracic echocardiography showed a severe aortic regurgitation without aortic valve stenosis and a mildly dilated left ventricle accompanied by an ejection fraction of 55%. The aortic regurgitation jet was eccentric and there were significant holodiastolic flow reversals in the descending thoracic aorta. Surgical management was advised for this patient because of symptomatic severe aortic regurgitation. Then, the patient underwent preoperative coronary angiography through the right femoral artery route. The left coronary ostium could be engaged with a 6 Fr Judkins left diagnostic catheter; however, the catheter jumped through the ascending aorta. Afterwards, the catheter was engaged and again jumped through the ascending aorta. Engagement and jumping cycles observed between successive systole to diastole. In our opinion, this catheter movement is explained by wide pulse pressure, like the severe characteristic physical findings of severe aortic regurgitation. Further studies are needed to understand whether this catheter movement is angiographically evidence of severe aortic regurgitation., (© 2019 The Author(s).)

Background: Atrial arrhythmias are well-known complications of atrial septal defect (ASD), and associated with substantial morbidity. After ASD closure, right atrial and ventricular enlargement regresses, however, the risk of atrial arrhythmia development continues. In this study, we aimed to investigate the relationship between the Crochetage sign, which is a possible reflection of heterogeneous ventricular depolarization due to long-term hemodynamic overload, and the development of late atrial arrhythmia after ASD closure., Methods: This retrospective study included a total of 314 patients (mean age: 39.5 (30-50) years; male: 115) who underwent percutaneous device closure for secundum ASD. The study population was divided into two groups according to the presence or absence of the Crochetage sign. The Crochetage sign was defined as an M-shaped or bifid pattern notch on the R wave in one or more inferior limb leads. Cox-regression analysis was performed to determine independent predictors of late atrial arrhythmia development., Result: Fifty-seven patients (18.1%) presented with late atrial arrhythmia. Of these 57 patients, 30 developed new-onset atrial fibrillation/atrial flutter (AF/AFL), and 27 patients with pre-procedure paroxysmal AF/AFL had a recurrence of AF/AFL during follow-up. History of paroxysmal AF/AFL before the procedure (HR: 4.78; 95% CI 2,52-9.05; p < 0.001), the presence of Crochetage sign (HR: 3.90; 95% CI 2.05-7.76; p < 0.001), and older age at the time of ASD closure (HR: 1.03; 95% CI 1.01-1.06; p = 0.002) were found as independent predictors for late atrial arrhythmia., Conclusion: The presence of Crochetage sign may be used to predict the risk of late atrial arrhythmia development after transcatheter ASD closure., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest with this work., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background and Aim of the Study: Chronic severe aortic regurgitation (AR) is associated with progressive accumulation of interstitial fibrosis and disruption of myocardial structure. After aortic valve replacement (AVR), the negative remodeling process reverses, and left ventricular ejection fraction (LVEF) improves but not in all patients. In this study, we aimed to investigate the association of fragmented QRS (F-QRS), which is a possible marker of myocardial fibrosis, with postoperative left ventricular (LV) systolic dysfunction., Methods: A total of 147 consecutive patients with AVR were included in this study. F-QRS was identified by the presence of various RSR' patterns (QRS duration <120 ms) such as additional R wave (R prime)or notching of the R or S wave in at least two consecutive leads. Patients were compared in two groups based on the presence or absence of F-QRS. A logistic regression model was used to determine independent predictors of postoperative LV systolic dysfunction (LVEF <50%)., Results: Patients with F-QRS were associated with poor recovery of LV systolic function after AVR compared to the patients without F-QRS, regardless of preoperative LVEF (p = .008). F-QRS was found to be an independent predictor of postoperative LV systolic dysfunction (LVEF <50%). Lower preoperative LVEF and increased LV end diastolic diameter index were also found as independent risk factors for postoperative LV systolic dysfunction., Conclusions: As a possible marker of myocardial fibrosis, F-QRS was associated with postoperative LV systolic dysfunction. Therefore, as a simple and convenient clinical parameter, F-QRS may be used to predict poor recovery of LVEF after AVR., (© 2021 Wiley Periodicals LLC.)

Objective: The new coronavirus disease (COVID-19) has spread rapidly all over the world and caused anxiety disorders. Recent studies have also shown that the prevalence of depression and anxiety increased during the COVID-19 outbreak. We aimed to evaluate the anxiety and depression levels during the pandemic and identify the effect of pandemic-related stress on blood pressure (BP) control in primary hypertensive patients., Method: A total of 142 patients with primary hypertension (HT) who continued to use the same antihypertensive drugs before and during the pandemic were included in the study. Twenty-four -hour Ambulatory Blood Pressure Monitoring (ABPM) and the Hospital Anxiety and Depression Scale (HADS) questionnaire were applied to patients. We retrospectively reviewed 24-h ABPM records of the same patients for the year before the pandemic., Results: Daytime, nighttime and 24 -hour-systolic blood pressure (SBP) levels as well as daytime, nighttime, and 24- hour-diastolic blood pressure (DBP) levels , were significantly elevated during the COVID-19 outbreak compared to the pre-pandemic period (p<0.001). Higher HADS-A scores (HADS-A ≥7) were significantly associated with much greater increase in BP compared to the patients with lower HADS-A scores., Conclusion: Psychological stress due to the COVID-19 outbreak led to worsening of the regulation of BP in controlled hypertensive patients whose antihypertensive treatments did not change., Competing Interests: Conflict of interest: One of the authors of this article (Mustafa Caliskan) is an Editorial Board Member of this journal and was excluded from all evaluation steps. The other authors declare that they have no conflict of interest., (© Copyright Istanbul Medeniyet University Faculty of Medicine.)

Right ventricular (RV) perforation is a rare but life-threatening complication of pericardiocentesis and is usually treated surgically. We presented a case of RV free wall perforation, which occurred during pericardiocentesis and tried to be closed percutaneously with the Amplatzer vascular plug-III (AVP-III) device. The occluder device sealed the perforation, but it was in an insecure position; therefore, the patient underwent surgical repair. As an AVP-III device, with a middle disk thicker than the RV myocardium, it may cause the RV myocardium to stretch outwards, so it should not be used for the treatment of RV perforation by the transcatheter way., (© 2020 Wiley Periodicals LLC.)

Objective: Acute decompensated heart failure (ADHF) is a life-threatening medical condition and more than 30% of patients hospitalized for ADHF develop acute kidney injury (AKI), which increases the rate of both mortality and morbidity. Previous research has indicated that several biomar- kers may help to predict the development of AKI. The aim of this study was to investigate the relationship between lactate level at the time of admission and AKI in ADHF patients., Methods: A total of 154 consecutive ADHF patients were prospectively enrolled from June 2018 to December 2018, and after applying the exclusion criteria, a total of 91 patients were included in the study. The patients were divided into 2 groups: those with and without AKI., Results: There were 63 patients in the group without AKI and 28 patients in the group with AKI. The AKI group had a higher percentage of a history of chronic kidney disease (CKD), a higher creatinine level, lower glomerular filtration rate level, lower bicarbonate level, higher lactate level, and a lower left ventricular ejection fraction compared with the non-AKI group (p<0.05 for all parameters). Multiple logistic regression analysis determined that CKD history (odds ratio [OR]: 4.003, 95% confidence interval [CI]: 1.295-12.371; p=0.016) and lactate level (OR: 1.545, 95% CI: 1.222-1.954; p<0.001) were independent predictive parameters for developing AKI., Conclusion: An elevated lactate level may help to make an early diagnosis of AKI, an important concern in ADHF.

Background: A presystolic wave (PSW) is commonly seen on Doppler examination of the left ventricular outflow tract (LVOT), and the possible mechanism for PSW is considered to be left ventricular stiffness and impaired LV compliance. We aimed to compare the relationship between PSW and dipper, nondipper hypertension., Patients and Methods: A total of 83 patients were included in the study. The participating patients were divided into two groups as 42 patients with dipper hypertension and 41 patients with nondipper hypertension based on the results of ambulatory blood pressure monitoring., Results: Left ventricular mass index (91.6 ± 12.9 vs. 106.1 ± 7.9, P < 0.001) and E/Em (7.4 [6.6-8.3] vs. 10 [8-12], P < 0.001) were significantly higher, and Em (9.9 ± 2.7 vs. 7.9 ± 3.4, P = 0.004) was significantly lower in the nondipper group compared with dipper group. And also, the PSW was found to be higher in the nondipper group. The nondipper group had markedly increased frequencies of PSW compared with the dipper group (68 vs. 38%, respectively, P = 0.008). In the multivariate logistic regression test, E/Em [odds ratio (OR) 1.464, 95% confidence interval (CI): 1.113-1.926, P = 0.006] and the presence of PSW (OR 3.115, 95% CI: 1.061-9.143, P = 0.039) were determined as independent predictive parameters for nondipper hypertension., Conclusion: The presence of PSW on transthoracic echocardiography suggests that we may come across nondipper hypertension and a high risk of end-organ damage. PSW may be used as a useful parameter in risk stratification in hypertensive patients.

An 89-year-old female patient presented to our cardiology outpatient clinic complaining of shortness of breath and back pain. Chest X-ray demonstrated a widened mediastinum. Transthoracic echocardiography showed an ascending aortic aneurysm and the modified apical 5-chamber view showed that left atrium was compressed between the ascending and descending aortas. Color Doppler turbulence was also seen in the compressed area. A contrast-enhanced chest computed tomography scan in axial and coronal planes showed that left atrium and pulmonary veins were compressed by ascending and descending aortic aneurysms. Herein, we illustrated this rare condition diagnosed by transthoracic echocardiography in combination with computed tomography.

Background: Ulcerative colitis is a chronic idiopathic inflammatory bowel disease of the colon that is characterized by a relapsing and remitting course. Previous studies have shown that arterial stiffness, carotid intima media thickness, atrial electromechanical delay, and global longitudinal strain suggested subclinical cardiovascular disorders in ulcerative colitis patients. The aims of our study was to evaluate the left atrial function of patients with ulcerative colitis by using speckle tracking echocardiography, and to assess the relationship between echocardiographic variables and the extent of the disease., Methods: We recruited 51 outpatients with ulcerative colitis in remission phase and 52 healthy volunteers. The ulcerative colitis patients were evaluated by for the extent of the disease by endoscopy at the initial diagnosis., Results: E/E m , left atrial volume, and left atrial stiffness index were higher, and peak atrial longitudinal strain was lower in pancolitis than in non-pancolitis patients. In the multivariate logistic regression test, peak atrial longitudinal strain and E/E m were found to be independent predictors for pancolitis., Conclusion: Early detection of myocardial abnormalities by conventional echocardiography and speckle tracking echocardiography, which is a simple and non-invasive technique, may be useful for giving insights to the extent of the disease in ulcerative colitis patients., (© 2019 Wiley Periodicals, Inc.)

Introduction: Ear lobe crease (ELC) was first described in 1973 as a physical examination finding indicating significant coronary artery disease (CAD). Several studies have been carried out in relation to this finding, and it has been shown that it is a marker of intima-media thickness, carotid artery disease, and CAD. We aimed to investigate the relationship between earlobe crease, which is a simple physical examination finding, and GRACE score as a risk estimation index in acute coronary syndromes without ST-segment elevation (NSTE-ACS) patients. Methods: 360 patients (mean age 62.2 years, 70% male) were included in our study. Patients were divided into two groups of GRACE scores ≤ 109 and >109, 167 patients were enrolled in group 1, and193 cases in group 2. Results: The group 2 patients were older, had higher systolic blood pressure (SBP) levels, a higher rate of hypertension, higher glucose levels, lower creatinine clearance levels, higher initial and peak troponin levels, lower hemoglobin levels, lower left ventricular ejection fraction (LVEF) and higher Gensini scores than the patients in group 1. The higher GRACE score group had markedly increased frequencies of ELC compared to the lower GRACE score group (80.8% vs. 24.5%, respectively, P < 0.001). Conclusion: The presence of ELC may predict moderate to high risk group of patients with NSTEACS., (© 2020 The Author(s).)

Aortic prosthetic vascular graft infections (PVGI) are rare complications of the aortic surgery, with an incidence of 0.5%-6%. Although rare, they carry mortality rates as high as 25%-88%. Improvement in diagnostic imaging modalities in the last two decades, together with early diagnosis, aortic PVGI associated mortality was reduced. These imaging methods include transesophageal echocardiography (TEE), computed tomography angiography (CTA), and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). In this case report, we focus mainly on three imaging modalities as TEE, CTA, and 18F-FDG PET/CT and showed their role in the assessment of aortic PVGI., (© 2019 Wiley Periodicals, Inc.)

In this study, we aimed to investigate the predictive value of early systolic lengthening duration in differentiating myocardial ischemia from scar tissue in patients with chronic coronary total occlusion. A total of 69 patients were included in the study. The participating patients were divided into two groups as 35 patients with ischemia and 34 patients with scar tissue based on the results of the myocardial perfusion scintigraphy. In the scar group compared to the ischemia group; LVEF, GLS, SRS', and the duration of early systolic lengthening were significantly lower; whereas, EDV, ESV, and WMSI were significantly higher in the scar group compared to the ischemia group. In the multivariate logistic regression test, LVEF (OR 1.150, 95% CI 1.044-1.268, p = 0.005) and duration of early systolic lengthening (OR 1.021, 95% CI 1.004-1.039, p = 0.016) were determined as independent predictive parameters for ischemia detected by myocardial perfusion scintigraphy. Duration of early systolic lengthening obtained by speckle tracking echocardiography in patients with chronic total occlusion lesions may be useful in differentiating ischemia from scar tissue detected in myocardial perfusion scintigraphy. Prolonged duration of early systolic lengthening in patients with chronic total occlusion lesions was related to the presence of ischemia detected by myocardial perfusion scintigraphy.

Coronary artery bifurcation disease of a saphenous vein graft (SVG) is extremely rare. SVG disease remains a challenging lesion to treat because of increased morbidity and mortality with repeated coronary artery bypass graft (CABG) surgery, a high rate of periprocedural complications, and in-stent restenosis or occlusion requiring repeat revascularization with percutaneous coronary intervention. Presently described is use of the simultaneous kissing stent technique to treat inverted Y SVG bifurcation disease in a patient with a prior CABG and new-onset acute coronary syndrome.

A 91-year-old female patient was admitted to hospital for evaluation of transcatheter aortic valve implantation. A chest radiography showed a hiatal hernia, and the stomach and duodenum appeared in the thoracic cavity. The descending aorta was pushed by the stomach and duodenum., Competing Interests: The authors declare no conflict of interest related to this article., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

In this study, our objective was to evaluate right ventricular functions with speckle-tracking and conventional echocardiographic methods in patients with acute inferior myocardial infarction and to investigate the correlation between the echocardiographic parameters and the prediction of the proximal RCA lesions. 77 patients were included in this study. Patients with a RCA occluded proximal to the right ventricular branch were assigned to Group 1 and patients with an RCA occlusion distal to the right ventricle branch were assigned to Group 2. All echocardiographic examinations were carried out within 24 h after PTCA, which was performed for the treatment of inferior myocardial infarction. RV TAPSE, RV TDI Sm, FAC, RV-FW strain, RV-FW SRE', RV-FW SRA' and RV E/Em which were statistically significant in univariate analysis were evaluated with the help of the multivariate logistic regression analysis. In the multivariate logistic regression test; RV-FW strain (OR 0.751, 95% CI 0.592-0.954, p = 0.019) and RV E/Em (OR 0.442, 95% CI 0.252-0.776, p = 0.004) were determined as the independent predictive parameters for proximal RCA occlusion. In the ROC analysis, RV-FW strain > - 14.75% predicted the proximal RCA occlusion with 83% sensitivity and 61% specificity (AUC = 0.81, p < 0.001) and RV E/Em > 6.25 with 68% sensitivity and 80% specificity (AUC = 0.79, p < 0.001). In this study, we demonstrated that decreased RV FW strain and increased RV E/Em were predictive parameters for the presence of the proximal RCA in patients with acute inferior MI.

Malignant ventricular arrhythmias are challenging to manage, requiring a multidisciplinary approach. The mechanism, which triggers ventricular fibrillation (VF) associated with ventricular extrasystoles has not been clarified yet, however, abolishing ventricular extrasystoles may stop ventricular fibrillation in these patients. By this case presentation, we aimed to present a successful treatment of an electrical storm (ES), which developed after an acute myocardial infarction, by catheter ablation., (Copyright © 2018. Published by Elsevier Inc.)

A 42-year-old female patient was referred our clinic for investigation of a history of acute retinal artery occlusion. Transthoracic echocardiography showed a cyst-like, mobile formation on posterior mitral valve leaflet. 2D and real time 3D transesophageal echocardiography showed a flexible circular mobile structure which was attached to posterior mitral valve leaflet. Echocardiographic appearance and morphological characteristics were suggestive of accessory mitral valve tissue., (© 2018, Wiley Periodicals, Inc.)

Carotid artery stenting is a method used in the treatment of extracranial carotid artery stenosis that is becoming increasingly more common. Acute carotid thrombosis following CAS is a very rare and devastating complication that can be lethal for the patient unless treated immediately. We report a case of acute carotid stent thrombosis occurring immediately after emergent revascularization, and that was treated with intraarterial tissue plasminogen activator and intravenous tirofiban infusion.

A 71-year-old male with a medical history of hypertension was admitted to emergency department with hypertensive pulmonary edema. The patient appeared anxious and diaphoretic, and physical examination revealed tachypnea, crepitant rales in the both lungs and a systolic ejection murmur at the right sternal border, radiating to the both carotid arteries. The electrocardiography showed sinus tachycardia with indications of left ventricle hypertrophy Before the aortic valve surgery, transesophageal echocardiography (TEE) was performed for detailed evaluation of the aortic valve. Two-dimensional TEE showed mild tricuspid valve regurgitation and only two of three leaflets of the tricuspid valve at a time., (© 2017, Wiley Periodicals, Inc.)

An 83-year-old male patient presented to the outpatient clinic with complaint of swelling at right antecubital area. Ultrasonographic examination of the right upper extremity revealed a mass lesion within the right cephalic vein, which was consistent with thrombus. A computed tomography (CT) venography showed contrast enhancement in cephalic vein at distal arm and an aneurysmatic thrombus area displaying regular borders with a size of 28*30 mm; there was no contrast enhancement at more proximal levels at the cephalic vein., (© 2017, Wiley Periodicals, Inc.)

A 28-year-old man was admitted to our emergency service with a shortness of breath and palpitation. On admission, his blood pressure was high and he was in hypertensive pulmonary edema. His physical examination showed rales in both lungs and pansystolic murmur at mitral focus. His medical history included aortic valve replacement (AVR) because of native aortic valve infective endocarditis. Transthoracic echocardiography (TTE) showed normal functional aortic valve. Color flow imaging demonstrated severe mitral regurgitation with posterior eccentric jet. To examine in detail, transesophageal echocardiography (TEE) and three-dimensional (3D) echocardiography were performed. TEE disclosed a separation in the subaortic curtain leading to severe mitral regurgitation from the left ventricle to the left atrium. In addition to severe mitral regurgitation with posterior eccentric jet, 26-mm-long pouch was seen in mitral-aortic intervalvular fibrosa (MAIVF) at 120° TEE view. This pouch was separated from the mitral anterior leaflet junction releasing the mitral anterior leaflet and causing prolapse and chorda rupture in the A2 scallop of the mitral anterior leaflet. The MAIVF connects the anterior mitral leaflet to the posterior portion of the aortic annulus. The separation of the MAIVF represents a complication of the aortic valve replacement., (© 2017, Wiley Periodicals, Inc.)

Forty-five-year-old male patient presented with chest pain and dyspnea lasting for three weeks. Transthoracic echocardiography demonstrated a huge right sinus of Valsalva aneurysm. Contrast-enhanced cardiac computed tomography was performed and revealed three large unruptured sinus of Valsalva aneurysms., (© 2017, Wiley Periodicals, Inc.)