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Background: Atrial fibrillation (AF) remains the most common arrhythmia following mitral valve surgery. Although numerous clinical and laboratory indicators and possible mechanisms of postoperative AF (PoAF) have been described, the role of microvascular dysfunction in pathogenesis has not been assessed. We aimed to evaluate the association between microvascular dysfunction and PoAF in patients undergoing isolated mitral valve replacement. Methods: 188 patients undergoing mitral valve replacement were included in this retrospective study. Demographic characteristics of the patients were recorded. Angiographic assessment of microvascular perfusion was performed using the myocardial blush grading technique for each patient. Univariate and multivariate logistic regression analyses were utilized to determine predictors of PoAF. Results: Of 188 patients (56.69 ± 8.9 years, 39.4% male) who underwent mitral valve replacement, 64 (34%) patients developed PoAF. In the PoAF group, a lower basal hemoglobin level (12.64 ± 0.89 vs. 14.46 ± 0.91 g/dL; p < 0.001), a higher left atrial diameter [5.9 (5.2–6.47) vs. 4.9 (4.5–5.8) cm; p < 0.001], and a lower total blush score (TBS) (8.33 ± 0.84 vs. 8.9 ± 0.31; p < 0.001) were detected. Multivariate logistic regression analysis revealed that preoperative LA diameter (OR:2.057; 95% CI: 1.166–3.63; p = 0.013), preoperative hemoglobin (OR:0.12; 95% CI: 0.058–0.245; p < 0.001), and abnormal TBS (OR:15.1; 95% CI: 1.602–142.339; p = 0.018) were independent predictors of PoAF. Conclusions: Our findings demonstrated that TBS at the preoperative period was an independent predictor of PoAF in patients undergoing isolated mitral valve replacement.

Akut koroner total oklüzyon kestiriminde yeni gelişimli atriyoventriküler blok varlığının rolü: nadir bir STYzME olgusu

Aim: Inflammation has an important role in the development of atherosclerosis. The risk of atherosclerosis and its complications is higher for patients with diseases such as systemic lupus erythematosus and rheumatoid arthritis in whom inflammatory activity is higher than for healthy individuals. However, several studies have shown conflicting results in patients with scleroderma. In this study, carotid intima-media thickness (CIMT) was compared in patients with scleroderma and a control group. Methods: Thirty patients diagnosed with scleroderma (mean age 51.3 ± 11.8 years) and 30 healthy volunteers were included in the study. The groups were similar regarding age, gender, and risk factors for atherosclerosis. Results: There was no statistically significant difference between the groups in terms of age, gender, lipid level, hypertension, and diabetes mellitus prevalence (p>0.05). The mean CIMT (scleroderma group: 0.070±0.011, control group: 0.048±0.008, p, Amaç: Enflamasyon ateroskleroz gelişiminde önemli bir role sahiptir. Enflamatuvar aktivitenin yüksek olduğu sistemik lupus eritematozus ve romatoid artrit gibi hastalıkları olan hastalarda ateroskleroz ve ateroskleroza bağlı gelişebilecek komplikasyon riski sağlıklı bireylere göre daha yüksektir. Bununla birlikte, birkaç çalışma sklerodermalı hastalarda çelişkili sonuçlar göstermiştir. Bu çalışmada karotis intima-media kalınlığı (KİMK) kullanılarak sklerodermalı hastalar ve kontrol grubu karşılaştırıldı. Yöntemler: Çalışmaya skleroderma tanısı konan 30 hasta (ortalama yaş 51.3 ± 11.8 yıl) ve 30 sağlıklı gönüllü dahil edildi. Gruplar yaş, cinsiyet ve ateroskleroz için risk faktörleri açısından benzerdi. Bulgular: Gruplar arasında yaş, cinsiyet, lipid düzeyi, hipertansiyon ve diabetes mellitus prevalansı açısından istatistiksel olarak anlamlı fark yoktu (p>0.05). Ortalama KİMK (skleroderma grubu: 0.070±0.011, kontrol grubu: 0.048±0.008, p

Coronary artery ectasia (CAE) is associated with increased risk of mortality, equivalent to that of patients with obstructive coronary artery disease (CAD). Considering the role of inflammation in the pathogenesis of CAE, we aimed to investigate whether there is an association between systemic immune-inflammation index (SII) and isolated CAE. The study population included 510 patients of which 170 patients with isolated CAE, 170 patients with obstructive CAD and 170 patients with normal coronary angiograms (NCA). The severity of CAE was determined according to the Markis classification. Patients with isolated CAE had significantly higher SII values compared to those with obstructive CAD and NCA [median 550 IQR (404-821), median 526 IQR (383-661), and median 433 IQR (330-555), respectively

BACKGROUND Left atrial scar is an important entity in the atrial fibrillation substrate. P wave dispersion (PWD) is an indicator of slow and inhomogeneous conduction in the atria. In this study, we aim to investigate the relation between PWD and left atrial scars identified by electroanatomical mapping. METHODS Patients who had an electroanatomical map obtained during sinus rhythm as well as at least one electrocardiogram in sinus rhythm prior to the procedure were included in the study. Left atrial scar (defined as

Cardioneuroablation is one of the emerging therapies in vasovagal syncope. In this study, we present a simple method of cardioneuroablation performed via a rightsided approach, targeting anterior-right and right-inferior ganglionated plexi, along with procedural and follow-up data.Patients who had underwent cardioneuroablation between March 2018 and September 2019 with vasovagal syncope in 2 clinics were enrolled in the study. All patients underwent radio-anatomically guided radiofrequency ablation targeting anterior-right ganglionated plexi and right-inferior ganglionated plexi. Syncope and symptom burden, 24-hour ambulatory electrocardiogram data at presentation, and at follow-up were assessed along with procedural data.A total of 23 patients underwent modified right-sided cardioneuroablation. Mean basal cycle length decreased significantly from 862.3 ± 174.5 ms at the beginning of the procedure 695.8 ± 152.1 ms following the final radiofrequency ablation (P.001). Mean 24-hour ambulatory heart rate increased significantly from 66.4 ± 10.7 bpm at baseline to 80 ± 7.6 bpm at follow-up (P.001). Only 1 patient had 1 episode of syncope following the procedure at the mean follow-up period of 10 ± 2.9 months. The same patient had recurrent presyncope.The right-sided cardioneuroablation approach was found to be an effective treatment for vasovagal syncope and may be regarded as a default initial cardioneuroablation technique.

Aims: An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction, which is estimated with an algorithm by the recent ASE/EACVI guideline. In this study, we sought to determine the efficacy of the LA global longitudinal strain to estimate the elevated LV filling pressure. Methods and Results: Consecutive patients who underwent left ventricular catheterization between January 2016 and December 2018 were included. Transthoracic echocardiography was performed within 24hrs before the catheterization. The LV filling pressure was estimated using echo parameters based on the 2016 ASE/EACVI algorithm. Moreover, to evaluate left atrial function, the LA GLS was measured using 2D speckle tracking echocardiography on four chamber-view (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to mean left atrial pressure (LAP) was used as a reference, and >12 mm Hg was defined as elevated.71 patients (mean age of 63.2±9.75, 70.4% male) underwent left heart catheterization. Invasive LV filling pressure was defined as elevated in 41 (57.8%) and normal in 30 patients (42.2%). 9(12.7%) patients of 71 were defined as indeterminate based on the 2016 algorithm. Using the ROC method, the accuracy of the algorithm was found as AUC:0.75 with 77% specificity and 70% sensitivity. The accuracy of 25.5 % cut point of LASr was found as AUC:0.79 with 77% specificity and 80% sensitivity for estimating LAP.Conclusions: LASr with higher sensitivity may add an incremental value to estimate LV filling pressure, and hence may be used for HFpEF diagnosis.

Nonalcoholic fatty liver disease (NAFLD) is the most common liver pathology in the developed world. Nonalcoholic fatty liver disease is associated with a higher risk of cardiovascular disease. We investigated the impact of ranolazine on liver tests in patients with NAFLD and coronary artery disease (CAD). Patients who had established CAD and NAFLD (as assessed by raised serum transaminase activity, sonographic criteria, and the absence of any other obvious liver disease) were allocated to “on ranolazine” (n = 40) or “not on ranolazine” (n = 35) groups. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured in all patients at baseline and at the end of the study. After 6 months of ranolazine treatment, both ALT and AST activities were significantly lower in patients in the “on ranolazine” group compared with “not on ranolazine” patients (change from baseline: ALT, −11.0 ± 1.7 IU/L, P < .001; AST, −5.2 ± 1.9 IU/L, P =.009). In conclusion, the present study showed that treatment with ranolazine for 6 months led to a significant reduction in the activities of both serum aminotransferases in patients with stable CAD and NAFLD.

Treatment of the lesions located in the popliteal artery and superficial femoral artery are potentially clinical challenge because of the long length of lesions, high- calcium content in the vessel wall and inside the plaques, and individual dynamic forces found within these vessels. Intraluminal or subintimal recanalization of the vessel lumen is achieved mostly by ipsilateral antegrade or contralateral retrograde femoral approach in the treatment of total occlusion of the superficial femoral artery. In the event of failure, retrograde access into the popliteal artery is considered as an essentially different method. In our case report, we aimed to present rescue retrograde popliteal intervention following an unsuccessful antegrade approach which resulted in an unexpected atherothrombotic complication that occurred in the common iliac artery of the contralateral site., Yüzeyel femoral ve popliteal arterlerdeki ciddi lezyonların tedavisinde lezyonların uzunluğu, lokalizasyonu ve plak yapısındaki ya da damar duvarındaki yüksek kalsiyum içeriği nedeniyle uygulanacak strateji her vakada bireysel farklılık göstermektedir. Yüzeyel femoral arter okluzyonlarının tedavisinde ipsilateral antegrad ya da kontralateral retrograd yaklaşım sık kullanılmakla birlikte özellikle bu tedavi seçeneklerinin başarılı olmadığı durumlarda retrograd popliteal girişim de alternatif olarak kullanılabilmektedir. Bu vaka sunumunda, antegrad yaklaşımın başarısız olması üzerine popliteal arter yoluyla retrograd yaklaşımın başarılı bir şekilde uygulandığı ancak işlem sonrası karşı taraf ana iliak arterde gerçekleşen beklenmedik aterotrombotik komplikasyon ve başarılı çözümü takdim edilmiştir.

Pacemakers are lifesaving devices that are being implanted with various indications, such as sinus node disease, atrioventricular block, and cardiac resynchronization therapy. Impedance measurement is one of the integral tests by which electrical resistance in pacing lead is tested. In this paper, we report an interesting observation of sudden impedance rise after ventricular tachycardia ablation with transmural lesions, which subsequently normalized without any need for intervention. The clinical implication of our findings is that careful observation might be indicated instead of lead replacement in case of a sudden surge in epicardial lead impedance after endocardial ablation owing that the impedance surge might be reversible.

A 63-year-old man with active COVID-19 infection and a history of coronary artery bypass grafting presented with acute thrombotic occlusion of saphenous venous graft which was anastomosed to the left anterior descending artery. Initial antegrade approach, complicated by a small leakage in the distal left anterior descending artery, was later converted to a retrograde approach via occluded saphenous vein graft. After successful stenting, TIMI 3 flow was achieved.

The relationship between coronary tortuosity (CorT) and tissue-level myocardial perfusion is not clear. We investigated tissue perfusion in myocardial territories supplied by tortuous coronary arteries. Among patients who had undergone coronary angiography, patients with reported CorT, those with ≥1 coronary artery were included in the study group (100 patients). The control group included patients with normal coronary arteries (100 patients). Thrombolysis In Myocardial Infarction frame count (TFC) and myocardial blush grade (MBG) were calculated for each coronary artery. Mean TFC was significantly higher in tortuous right coronary artery (RCA), left anterior descending (LAD) artery, and circumflex (Cx) artery compared to their non-tortuous counterparts (28.81 ± 6.463 vs 21.94 ± 3.328, P = .009; 43.28 ± 5.698 vs 36.17 ± 3.875, P = .006; 29.35 ± 4.111 vs 23.821 ± 2.639; P < .001, respectively). Mean MBG was also significantly lower in tortuous RCA, LAD, and Cx, compared to their normal counterparts (2.78 ± 0.417 vs 2.98 ± 0.155, P < .001; 2.74 ± 0.483 vs 2.97 ± 0.164, P < .001; 2.92 ± 0.277 vs 2.99 ± 0.110, P < .001, respectively). For each tortuous coronary artery, TFC was similar for every MBG category. Tortuous coronary arteries have higher TFC and lower MBG, suggesting impaired epicardial and microvascular coronary flow, when compared to normal coronary arteries.

The purpose of this study is to investigate incidence of gastrointestinal symptoms and complications in patients who underwent high-power short-duration (HPSD), posterior left atrial wall isolation during atrial fibrillation ablation and thereafter have received gastrointestinal prophylactic regimen consisting of sucralfate, proton-pump inhibitor and colchicine. Patients were followed and assessed at baseline, up until 6th month following the procedures.Among 115 patients who were included, 5 patients (4.3%) reported gastrointestinal symptoms at follow-up. No complications were diagnosed during the follow-up. In conclusion, the HPSD along with prophylactic regimen has been associated with low incidence of gastrointestinal adverse events.

Objectives:Thrombus by the activated platelets and reduced blood flow of myocardium as a result of the thrombus lies under the pathophysiology of acute myocardial infarction (MI). Mean platelet volume (MPV) is known to increase by the activation and rapid turnover of the platelets. This parameter has been shown to increase in acute MI and high levels are associated with poor prognosis. Trials comparing the MPV in ST elevated and non-ST elevated myocardial infarction (MI) patients are so rare in the literature. We aimed to search for the difference in MPV in these 2 types of acute MI.Materials and Methods:We retrospectively searched for the patients followed up because of acute MI in our coronary intensive care unit. MPV was routinely worked up from the admission complete blood count analysis. Patients were compared in two groups as ST elevation MI and non-ST elevation MI.Results:As a result, 356 elligible patients were included in our trial (203 were non-ST elevation patients, 153 were ST elevation patients). Mean patient age was 63 and 29% were female. MPV in non-ST elevation group was significantly higher than ST elevation MI group (10.5±1.2 vs 10.1±1.2, p=0.001).Conclusion:We concluded that MPV, a parameter of platelet reactivity, was significantly higher in patients with non-ST elevated MI. Chronic underlying atherosclerosis, comorbidities and activated platelets probably playing more central role in pathophysiology of this acute MI type may explain these results. In non-ST elevation MI, urgent and appropriate antiaggregant therapy, as explained in the guidelines is as important as it is in ST elevated MI, we believe our results may be important for reminding this issue.

WOS: 000478731100013, PubMed: 31237119, Background. Fenofibrate, a peroxisome proliferator-activated receptor-alpha (PPAR alpha) agonist, is used to treat patients with hypercholesterolemia and hypertriglyceridemia in order to reduce the risk of development of the atherosclerotic cardiovascular disease. However, it exerts pleiotropic effects beyond correcting atherogenic dyslipidemia to treat hypercholesterolemia. Objectives. The aim of this study was to investigate the potential effects of fenofibrate on endothelial function by analyzing the serum nitric oxide (NO) levels in patients with hypertriglyceridemia. Material and methods. Lipid profiles and serum NO levels were assessed in 56 healthy adults aged 29 to 84 years, before and after 12 weeks of fenofibrate (250 mg/d; n = 30) or placebo (n = 26). Appropriate dietary suggestions for hypertriglyceridemia were made for all patients. This study was randomized, double-blind and placebo-controlled in design. Results. Total cholesterol, low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) and triglyceride levels significantly decreased; high-density lipoprotein (HDL) and NO levels significantly increased after 12 weeks of fenofibrate therapy. We observed a statistically significant correlation between the increase in serum NO levels and decrease in serum triglyceride levels (r = -0.42, p = 0.02) in the fenofibrate group. Conclusions. The positive effect of short-term fenofibrate treatments on vascular endothelial functions in patients with hypertriglyceridemia has been demonstrated by increasing the serum NO levels. Agents such as fenofibrate targeting PPAR alpha-associated signaling pathways show promise as an alternative treatment of vascular dysfunction related to advanced age and hyperlipidemia., Association of Turkish Clinical Vascular Biology

PURPOSE An elevated left ventricular (LV) filling pressure is the main finding in heart failure patients with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines. In this study, we sought to determine the efficacy of the LV global longitudinal strain (GLS) in predicting an elevated LV filling pressure. METHODS AND RESULTS A total of 73 prospectively selected patients undergoing LV catheterization (mean age 63.19 ± 9.64, 69% male) participated in this study. Using the algorithm, the LV filling pressure was estimated using the echocardiographic parameters obtained within 24 hours before catheterization. The LV GLS was measured using an automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to the mean left atrial pressure (LAP) was used as a reference, and a LAP of >12 mm Hg was defined as elevated. Invasive LV filling pressure was elevated in 43 patients (59%) and normal in 30 patients (41%). Nine of 73 (12%) patients were defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS determined the elevated LAP (AUC =0.79; specificity, 73%; sensitivity, 84%) with better sensitivity compared to that by the algorithm (AUC =0.76; specificity, 77%; sensitivity, 72%). CONCLUSIONS We demonstrated that LV GLS was an independent predictor of elevated LAP as the E/e' ratio and TR jet velocity and may be used as a major criterion for the diagnosis of HFpEF.

Systemic immune-inflammation index (SII), on the basis of lymphocyte, neutrophil and platelet counts had been published to be a good prognostic factor in coronary artery disease. Nevertheless, the prognostic value of Systemic immune-inflammation index (SII) in a condition of no-reflow phenomenon (NRP) remains inconsistent, we evaluated the SII as a simple calculated tool for predicting the NRP among patients with STEMI who underwent primary percutaneus coronary intervention (PCI).510 consecutive acute STEMI patients who underwent primary PCI within 12 h from symptom onset from October 2015 to January 2020 were enrolled in our study. The receiver-operating characteristic (ROC) curve was used to determine the cut-off value of SII to predict the no-reflow. Multivariate stepwise logistic regression, including covariates found to have a significant association with NRP in univariate analysis, was used to identify independent predictors of no-reflow.A ROC curve analysis showed that the best cut-off value of SII for predicting no-reflow was 1028, with sensitivity and specificity of 79% and 70, respectively (AUC, 0.839; 95% CI 0.797-0.881). An ROC curve comparison analysis was performed to compare the SII with NLR and PLR. Multivariate analysis revealed that SII ≥1028 value (OR = 6.622, 95% confidence interval (CI): 3.802-11.627,SII levels are independently associated with the NRP in patients undergoing primary PCI for acute STEMI. High SII may be a promising indicator for the prediction of NRP in these patients.

Purpose: An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline. In this study, we sought to determine the efficacy of LV global longitudinal strain (GLS) to estimate the elevated LV filling pressure. Methods and Results: 73 prospectively selected patients undergoing left ventricular catheterization (mean age 63.19±9.64, 68.5% male) participated in this study. Using the algorithm, the LV filling pressure was estimated with the echo parameters obtained within 24hrs before the catheterization. The LV GLS was measured using the automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to mean left atrial pressure (LAP) was used as a reference, and >12 mm Hg was defined as elevated. The invasive LV filling pressure was elevated in 43 (58.9%) and normal in 30 patients (41.1%). In 9 (12.3%) patients of 73 are defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS estimated the LV filling pressure (AUC=0.79, 73% specificity, 84% sensitivity) with higher sensitivity compared with the algorithm (AUC=0.76, 77% specificity, 72% sensitivity). Conclusions: We confirmed that the LV GLS is feasible and reproducible in estimating LV filling pressure. In addition, LV GLS highly predicts elevated LAP as E/e’ and TR jet velocity and may be used as major criteria for the diagnosis of HFpEF

Background: Acute Stanford type A aortic dissection (ATAAD) is a life-threatening medical emergency. The aim of this study was to investigate the clinical significance of the prognostic nutritional index (PNI) as a novel inflammatory marker for ATAAD patients undergoing surgical repair. Methods: We retrospectively examined the medical records of 151 ATAAD patients who treated surgically. Patients were divided into two groups (survival and death) and these groups were compared with respect to clinical and laboratory parameters. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Logistic regression analyses were performed to identify the risk factors of in-hospital mortality. Results: The mean age of the study cohort was 61 ± 12 years, 99 (65.6%) were males, and 35 (23.2%) patients died during the hospital stay. The PNI levels were significantly lower in death group compared with survival group (32.80 ± 4.90 vs. 37.94 ± 5.42, p Conclusion: Lower PNI values are independently associated with in-hospital mortality in ATAAD. The PNI may be a useful tool for predicting the early mortality of ATAAD patients after surgical repair.

Introduction Certain arrythmias, particularly of ventricular origin, necessitate deep lesions in order to achieve clinical success. The introduction of irrigated-tip radiofrequency (RF) catheters has allowed creation of deeper lesions and has decreased char formation. Although normal saline has been used as a standard solution, recent observations have suggested less ionic solutions may increase lesion depth. In this in-vitro study we aimed to characterize lesions created by irrigated-tip RF catheters using standard normal saline(NS), half-normal saline (HNS), and HNS-%2.5Dextrose (HNS-DEX/2) combination solutions. METHODS Bovine myocardium was placed firstly in ringer-lactate bath. Using irrigated-tip RF catheter ablation lesions were created serially using 30, 40, 50, 60, 70Watts with NS, HNS and HNS-DEX/2 as irrigation solutions. Lesion depths, steam pops and impedance drops were measured. Subsequently the experiment was repeated in normal saline bath. RESULTS Both HNS-DEX/2 and HNS irrigation solutions increase lesion depths when compared to normal saline (Table 1, Figure 1). Steam pops were more common and earlier with HNS-DEX/2 and HNS. DISCUSSION AND CONCLUSION Our findings suggest that less ionic irrigation solutions lead to increased lesion depths using similar RF power. If confirmed in-vivo, HNS and, particularly, HNS-DEX/2 as irrigation solution may increase ablation success for intramural/deep myocardial arrhythmic foci. Additionally, studies to assess safety of this strategy are necessary as intuitively deeper lesions may lead to more complications. Table 1 Irrigation Solution/Bath solution 30W/30ml(Lesion depth mm)(Impedance drop) 40W/30ml(Lesion depth mm)(Impedance drop) 50W/30ml(Lesion depth mm)(Impedance drop) 60W/30ml(Lesion depth mm)(Impedance drop) 70W/30ml(Lesion depth mm)(Impedance drop) HNS+%2.5D / Ringer Lactate 470->61 4.583->63 5.074->62SP+(32s) 6.080->66SP+(27s) 7.577->65SP+(26s) HNS/ Ringer Lactate 3.590->65 4.580->63SP+(34s) 5.073->59SP+(33s) 5.580->56SP+(28s) 6.583->64SP+(22s) NS/ Ringer Lactate 3.077->60 472->59 4.576->61 5.081->56 674->55 SP+(30s) HNS+%2.5D/Normal saline 3.573->67 598->63 5.573->58SP+(28s) 697->76SP+(26s) 7.570->58SP (25s) HNS/Normal saline 3.563->58 4.066->52 4.567->52 5.575->52 788->60SP+(28s) NS/Normal saline 2.566->58 3.063->52 4.073->58 5.077->55 5.568->44 Lesions created by irrigated tip radiofrequency catheter with bovine myocardium Abstract Figure 1

Purpose of review Herein, we provide a review of the recent literature on the epidemiological and pathophysiological relationship between hypertension (HTN) and diabetes mellitus, along with prognostic implications and current treatment concepts. Recent findings Diabetes mellitus affects ∼10% of US adults. The prevalence of HTN in adults with diabetes mellitus was 76.3% or 66.0% based on the definitions used by guidelines. There exist differences among major society guidelines regarding the definition of HTN and target blood pressure (BP) levels. Recent basic and clinical research studies have shed light on pathophysiologic and genetic links between HTN and diabetes mellitus. Randomized controlled trials over the past 5 years have confirmed the favorable BP and cardiovascular risk reduction by antidiabetic agents. Summary HTN and diabetes mellitus are 'silent killers' with rising global prevalence. The development of HTN and diabetes mellitus tracks each other over time. The coexistence of both clinical entities synergistically contributes to micro- and macro-vasculopathy along with cardiovascular and all-cause mortality. Various shared mechanisms underlie the pathophysiological relationship between HTN and diabetes mellitus. Moreover, BP reduction with lifestyle interventions and antihypertensive agents is a primary target for reducing cardiovascular risk among patients with HTN and diabetes mellitus.

Interventional cardiologists encounter a wide range of lesions that cannot be angiographically distinguished from fixed atherosclerotic obstructive disease. In this case report, we document vasospasm at multiple sites in the coronary territory in a patient presenting with acute coronary syndrome. A 61-year-old woman was referred to our hospital with typical chest pain lasting approximately 1 h. After performing the left coronary artery angiography, a severe tubular stenosis was detected in circumflex (Cx) artery. Diffuse spasm was observed in the right coronary artery (RCA) and it resolved after intracoronary administration of nitroglycerin. After performing left system angiography again, severe stenosis in Cx artery was also completely resolved. Our finding is of clinical importance in that it is more likely to simulate a constant coronary stenosis than would have spasm occurred proximally. The clinical importance of our report is that a catheter-induced vasospasm (CIV) may simulate fixed coronary stenosis, not always osteally and in some instances at multiple sites. Awareness of this phenomenon and liberal use of nitroglycerin in any patient with discrete luminal narrowing, even when an ostial "lesion" is not present, can help to avoid misinterpreting CIV as an atherosclerotic lesion.

OBJECTIVE Although patients with prosthetic heart valves have an increased risk of clinically overt cerebrovascular events, evidence for the risk of silent cerebral infarction (SCI) is scarce. Serum neuron-specific enolase (NSE) is suggested to be a valid biomarker that allows for the quantification of the degree of neuronal injury. We aimed to assess whether NSE is elevated as a marker of recent SCI in patients with a prosthetic mitral valve. METHODS We measured the NSE levels in 103 patients with a prosthetic mitral valve (PMV), admitted to our outpatient clinics for routine evaluation. International normalized ratio (INR) and time in target therapeutic range (TTR) were noted as anticoagulation quality measures. RESULTS Most of the patients were females (58%), and a mean age was 65 years. NSE values of >12 ng/mL, suggesting a recent SCI, was detected in 25 patients (24%). NSE was negatively correlated with admission INR (r=-0.307, p=0.002). Multivariate analyses demonstrated subtherapeutic INR (INR

OBJECTIVE In daily clinical practice, we encounter ST segment elevation myocardial infarction (STEMI) patients loaded with clopidogrel upon admission to primary angioplasty. These patients are loaded with ticagrelor, if there is no contraindication. This study aimed to compare the level of injury between STEMI patients who were first loaded with clopidogrel and the ones first loaded with ticagrelor. Although patients were switched from clopidogrel to ticagrelor at the first hour of angioplasty, antiplatelet action may still be lower than the others. METHODS This study included STEMI patients with angina onset of ≤3 h and who had primary angioplasty to proximal segment of one coronary artery. All patients had total thrombotic occlusion at the proximal segment. Δtroponin level (6th-hour troponin-admission troponin) was calculated to compare the level of myocardial injury. RESULTS A total of 105 patients were included; 52 were loaded with ticagrelor and 53 with clopidogrel first and switched to ticagrelor. Baseline characteristics were similar in the two groups, except from type B2 lesions being more common in the ticagrelor-loaded group. Δtroponin levels were significantly higher in the clopidogrel-loaded group compared with the ticagrelor-loaded group (p=0.013). Major bleeding and in-hospital MACE rates were similar in both groups. CONCLUSION In STEMI patients, the degree of troponin rise was more prominent in clopidogrel-loaded patients, despite the switch to ticagrelor in the first hour of intervention. Clopidogrel is slow and modest, and variable platelet inhibition may continue to be a negative factor for protection from myocardial injury, even after switching to ticagrelor.

Diabetes mellitus (DM) has become a public health problem worldwide, and it has large implications for cardiovascular disease (CVD). In this article, we discuss the etiology and pathophysiology of CVD in DM including the effects of abnormal glucose homeostasis, genetic factors, epigenetics, apoptosis, common pathophysiological mechanisms shared by both DM and CVD, and contributions of other comorbidities. We then cover the pathogenesis of both atherosclerotic disease and cardiomyopathy in relation to DM. Finally, we discuss the prevention of heart disease in DM with a focus on hypertension and dyslipidemia management, weight loss, lifestyle changes, antiplatelet therapy, and glycemic control.

Entrapment of equipment during coronary angiography is an uncommon but serious complication of invasive coronary procedures. Percutaneous extraction of trapped material is the accepted method of treatment. This case report is a description of the extraction of a diagnostic catheter retained as a result of collapsing into an O-shape in the right common iliac artery while trying to engage the tip of the catheter with the right coronary ostium. This rationale and unique wire-balloon method, requiring no specifically designed device, can be simply and safely performed in similar cases.

WOS: 000474629300005, PubMed: 32082875, Background: This study aims to compare three different tricuspid annuloplasty techniques using suture, ring, and band. Methods: Between January 2010 and December 2015, a total of 231 consecutive patients (78 males, 153 females; mean age 50.3 +/- 15.9 years; range, 34 to 66 years) who underwent tricuspid valve annuloplasty using three different techniques were retrospectively analyzed. Tricuspid valve repair was performed with de Vega a nnuloplasty technique (n=62, 26.8%), flexible ring (n=76, 32.9%) or Teflon strip (n=93, 40.3%). Postoperative data including vital signs, echocardiographic reports, functional status, and the rate of re-do surgeries were recorded. Results: Cardiopulmonary bypass times were statistically significantly shorter in the de Vega annuloplasty group (p< 0.001). There was no significant difference among the groups in terms of the in-hospital mortality. Late postoperative tricuspid regurgitation grades, systolic pulmonary artery pressure, and right atrial diameters showed significant improvements, compared to baseline, in ring and strip annuloplasty groups. Conclusion: Our study results demonstrate that suture-based approaches should be avoided. Instead of performing routine tricuspid ring annuloplasty, Teflon strip annuloplasty may be considered an alternative method in most cases, particularly due to controversy in selection of true ring size and high cost of this surgical material in the real-life setting.