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Background/Aim: Oxidative stress status in obstructive sleep apnea syndrome (OSAS) is well discussed in the literature. Oxidative stress levels increase, and antioxidant system activi-ty decreases in OSAS patients. However, the change in oxidative stress status in positional (pOSAS) and non-positional (npOSAS) OSAS has not been adequately examined. The aim of this study was to compare OSAS patients’ polysomnographic (PSG) parameters and oxidative stress capacities with the structural and functional properties of the upper respiratory tract. Methods: This study was designed as prospective case-control study and patients were divided into three groups as control, pOSAS and npOSAS according to their PSG findings. Ear nose throat examinations including rhinomanometry test and oxidative stress blood parameter tests were conducted to all patients. Variables among the groups were compared. Results: All PSG parameters were significantly worse in the OSAS groups than the control group (P

It is of clinical importance to determine creatinine clearance and adjust doses of prescribed drugs accordingly in patients with heart failure to prevent untoward effects. There is a scarcity of studies in the literature investigating this issue particularly in patients with heart failure, in whom many have impaired kidney function. The purpose of this study was to determine the degree of awareness of medication prescription as to creatinine clearance in patients hospitalized with heart failure. Patients hospitalized with a diagnosis of heart failure were retrospectively evaluated. Among screened charts, patients with left ventricular ejection fraction

Background Cardiovascular diseases, among which atherosclerotic heart disease, are known to be one of the most important mortality and morbidity causes in patients with rheumatoid arthritis (RA). Ischemia modified albumin (IMA) is a potential marker that can be used to assess atherosclerosis-related myocardial ischemia. Another frequently used marker for the assessment of atherosclerotic lesions is the carotid intima media thickness (CIMT). Aim To evaluate the role that IMA has on atherosclerosis development and its clinical usability in patients with RA, by assessing the values of IMA and CIMT. Methods and materials Our prospective study was conducted between June 2012 and March 2013 at the Rheumatology Department of Necmettin Erbakan Meram Medical School, Turkey. Fifty-two RA patients, diagnosed according to the 1987 criteria of the American College of Rheumatology, and an age- and sex-matched control group of 46 healthy subjects were included in this study. Results No significant difference was detected between the groups with respect to age, sex and body mass index. In the patient group the IMA and CIMT values were found to be 0.37 ± 0.12 absorbance units (ABSU) and 0.80 ± 0.22 mm, respectively, while in the control group they were 0.31 ± 0.11 ABSU and 0.51 ± 0.18 mm, respectively. The IMA and CIMT values were significantly higher in the patient group (P = 0.022 and P < 0.0001, respectively). A positive correlation was found between IMA, CIMT and Disease Activity Score of 28 joints (P = 0.016 and P = 0.002, respectively). Conclusion Since the values of IMA were higher in the patient group compared to controls and because of its correlation with CIMT, we suggest the use of IMA as an early marker of atherosclerosis in RA patients.

Amaç: Özellikle proksimal darlığı olan koroner arterhastalarında veya ciddi miyokardiyal hipertrofisi olan hastalarda antegradkardiyoplejinin homojen olmayan dağılımı ciddi bir problemdir. Bu prospektifrandomize çalışmada, kombine antegrad-retrograd kardiyoplejinin sadece antegradtekniğe kıyasla erken dönemde daha iyi miyokardiyal koruma sağlaması ve daha iyilaboratuar sonuçları ile ilişkisi değerlendirilmiştir. Gereç ve Yöntemler: Koroner bypass cerrahisi uygulanan 60 hasta (45 (%75)erkek, 15 (%25) kadın) çalışmaya dahil edilmiştir ve iki grupta incelenmiştir:Grup 1’de 30 hastaya aort kökünden antegrad ve koroner sinusten retrograd yollakombine kardiyopleji; Grup 2’de ise 30 hastaya aort kökünden antegradkardiyopleji verildi. Preoperatif, intraoperatif ve postoperative altıncı gündealınan kan örneklerinden CK-MB, TpI, TNF- α, IL-1, IMA, ICAM-1 ve BNP parametreleriçalışıldı. Hastalar preoperative olarak ve postoperative altıncı gündetranstorasik ekokardiyografi ile değerlendirildi. Bulgular: Postoperatif ortalama EF düşüşü Grup 1’de Grup 2’yekıyasla istatistiksel olarak anlamlı şekilde daha az oldu (4.13 ± 9.09 ve 8.90± 10.76, sırayla Grup 1 ve Grup 2, p=0.046). TNF- α seviyelerindeki değişiminbüyüklüğü kıyaslandığında Grup 2’deki artışın daha fazla olduğu bulunmuştur(p=0.047).Sonuçlar: Antegrad ve retrograd kardiyoplejinin birlikteuygulanmasının, erken postoperatif dönemde tek başına antegrad kardiyoplejiyegöre daha iyi miyokardiyal koruma sağlayabileceği sonucuna vardık., Aim: Nonhomogeneous distribution of antegrade cardioplegiaespecially in cases with severe myocardial hypertrophy or proximal stenosis ofcoronary arteries may be a serious problem. This prospective randomized studywas designed to determine whether combined antegrade–retrograde cardioplegiaprovides improved myocardial protection in the early period and is associatedwith better laboratory results compared with antegrade technique alone.Material and Methods: A total of 60 patients who underwent coronary arterybypass grafting surgery, 45 (75%) males and 15 (25%) females, were included inthe study as 2 groups: In Group 1, 30 patients were given the combinedcardioplegia solution antegrade via the aortic root and retrograde via thecoronary sinus, in Group 2, 30 patients were given only antegrade cardioplegiasolution via the aortic root. The CK-MB, TpI, TNF- α, IL-1, IMA, ICAM-1, andBNP parameters were studied in the blood samples which were takenpreoperatively, intraoperatively and postoperative sixth day. The patients wereevaluated preoperatively and on the sixth postoperative day using transthoracicechocardiography.Results: The postoperative mean EF decrease was significantlylower in Group 1 compared to Group 2 (4.13 ± 9.09 vs 8.90 ± 10.76 in Group 1vs. Group 2, respectively, p=0.046). When the change in TNF-α levels werecompared between groups 1 and 2, the magnitude of increase in TNF-α wassignificantly higher in Group 2 (p=0.047).Conclusion: We concluded that co-administration of antegrade andretrograde cardioplegia may provide improved myocardial protection compared toantegrade cardioplegia method alone in the early postoperative period.

The constriction of vessels due to atherosclerotic lesions causes hypoxia/ischemia and oxidative changes resulting in transformation of free albumin to ischemia-modified albumin (IMA) in the circulation and increased carotid intima–media thickness (cIMT). We investigated the reliability of IMA increase in evaluating atherosclerosis in patients with familial Mediterranean fever (FMF) compared with cIMT. Patients with FMF (n = 58) diagnosed by the Tel-Hashomer criteria in attack-free period and 38 healthy people were included in the study. Patient demographics as well as the clinical and laboratory characteristics of the healthy controls and patients with FMF were noted. The IMA levels and cIMT in patients with FMF were 0.30 ± 0.09 absorbance units (ABSUs) and 1.12 ± 0.27 mm, respectively, and in the control group, IMA levels and cIMT were 0.25 ± 0.07 ABSU and 0.74 ± 0.26 mm, respectively. The IMA levels and cIMT were significantly higher in patients with FMF than in controls ( P = .020 and P < .0001, respectively). The IMA values showed positive correlation with cIMT in patients with FMF( r = .302, P = .041). Our results reveal that IMA—an oxidative stress marker—may be an indicator of atherosclerosis in patients with FMF. This finding deserves further investigation.

WOS: 000353933700006, PubMed: 25995662, Background/Aims: Poor sleep quality (SQ) is associated with increased cardiovascular mortality and morbidity. Additionally, asymmetric dimethylarginine (ADMA) is an independent predictor of cardiovascular mortality and morbidity. However, no sufficient data regarding the relationship between ADMA levels and SQ have been reported. The goal of the current study was to evaluate the association between SQ and ADMA levels in normotensive patients with type 2 diabetes mellitus. Methods: The study participants consisted of 78 normotensive type 2 diabetics. The SQ of all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients with a global PSQI score > 5 were defined as "poor sleepers." Factors associated with poor SQ were analyzed using a multiple regression model. Serum ADMA levels were measured using high performance liquid chromatography. Results: The median ADMA levels of the poor sleepers were increased compared with patients defined as good sleepers (5.5 [4.2 to 6.6] vs. 4.4 [2.9 to 5.4], p < 0.01, respectively). However, the L-arginine/ADMA ratio was decreased in poor sleepers (p < 0.01). Global PSQI scores were positively correlated with ADMA levels (p < 0.01) and negatively correlated with the L-arginine/ADMA ratio (p = 0.02). ADMA levels were correlated with sleep latency (p < 0.01) and sleep efficiency (p = 0.01). Logistic regression analysis showed that ADMA levels (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16 to 2.44; p = 0.01) and body mass index (OR, 1.15; 95% CI, 1.01 to 1.31; p = 0.04) were associated with poor SQ independently of glomerular filtration rate, sex, age, duration of diabetes, hemoglobin A1c, total cholesterol, and systolic blood pressure. Conclusions: Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus., Selcuk University Scientific Research Projects FundSelcuk University, This project was supported by Selcuk University Scientific Research Projects Fund.

Systemic lupus erythematosus (SLE) is a major cause of cardiovascular mortality and morbidity associated with early atherosclerosis. Carotid intima-media thickness (CIMT) is one of the early markers of atherosclerosis. Oxidative stress plays an important role in pathophysiologic mechanisms of SLE. Ischemia modified albumin (IMA) and total oxidant status (TOS) have been associated with oxidative stress in several diseases. In our study we aimed to investigate the relationship between serum IMA and TOS levels with CIMT in patients with SLE and to compare these with control group values. In our study, 60 SLE patients diagnosed according to the American College of Rheumatology (ACR) criteria and 35 healthy controls were included. Serum IMA levels were measured by manually spectrophotometric method. Increased serum TOS and IMA levels and CIMT were found in patients with SLE when compared with control group (p 0.05). Our results suggest that serum levels of IMA and TOS increase in SLE. However lack of association between the tested parameters suggests that further researches are needed.

Takotsubo cardiomyopathy (TCMP) is characterised by a temporary aneurysm of the left ventricular apex in individuals without significant stenosis of the coronary arteries. It is extremely rare to see it combined with a thrombus. In this case report, we present a 57-year-old female patient with TCMP in whom apical thrombus was treated with short-term warfarin use.

Impaired sleep quality is frequently associated with hypertension.The present study aims to examine self-reported sleep quality of patients with white coat hypertension. A total of 74 subjects who were evaluated in a cardiology outpatient clinic, including 39 normotensive subjects and 35 patients with white coat hypertension between the ages of 20 and 65 were included in this study. Patients with elevated office blood pressure (≥140/90 mm Hg) and normal 24-h and daytime ambulatory blood pressure (

The aim of our study was to evaluate serum paraoxonase (PON1), total antioxidant status (TAS), total oxidant status (TOS), and ischemia-modified albumin (IMA) levels in patients with prediabetes, diabetes, and in healthy control subjects. The subjects were aged between 20 and 60 years. Forty diabetic subjects (mean age 46.6 ± 9.7 years), 39 prediabetic subjects (mean age 44.0 ± 9.3 years) and 24 healthy control subjects (mean age 43.7 ± 9.7 years). Lipid profile, PON1, TAS, TOS and IMA levels were measured. The serum TOS and IMA levels in diabetes were significantly higher than those of the control subjects (P = 0.024 and P = 0.012, respectively), while the serum PON1 levels of the diabetes patients were significantly lower than those of the control subjects (P = 0.039). The serum TOS levels of the diabetes patients were significantly higher than those of the subjects with prediabetes (P = 0.013). There were no significant differences between the serum IMA and PON1 levels of the prediabetes and diabetes groups (P = 0.075 and P = 0.110, respectively). The serum TAS levels of the three groups were similar. The present study demonstrated that in diabetes there is greater oxidative stress. Patients with type 2 diabetes had higher TOS and IMA levels, but lower PON1 values, than controls. There were no differences in oxidative stress markers between prediabetic patients and healthy subjects.

To evaluate the accuracy of cardiac computed tomography (CT) parameters and pulmonary artery (PA) obstruction (OS) scores in determining the echocardiographic right ventricular dysfunction (RVD) in hemodynamically stable patients with acute pulmonary embolism (PE). A total of 120 patients with acute PE were included in the study. Right ventricle/left ventricle ratio (RV/LV); PA axial diameter; superior vena cava (SVC) axial diameter; and Ghanima, Miller, Qanadli, and Mastora obstruction scores were obtained using CT. RVD was assessed by echocardiography. The patients were divided into two groups based on the presence or absence of RVD. RV/LV ratio, SVC axial diameter, PA axial diameter, and Miller, Qanadli, and Mastora scores were significantly increased in the RVD group. Multivariate logistic regression analysis showed that RV/LV ratio [OR 6.36 (2.02–279.46 95 % CI), p = 0.01] and PA axial diameter [OR 5.02 (1.02–1.26 95 % CI), p = 0.03] were independent predictors of echocardiographic RVD. Predictive values of these parameters were improved when combined with other intragroup cutoff values. A cutoff value for the RV/LV ratio of >1.08 had 81.43 % sensitivity, 52.08 % specificity, 71.3 PPV, and 65.8 NPV for prediction of RVD. Tomographic axial diameters enable more accurate predictions of RVD than OS scores do.

Background Red cell distribution width (RDW) is a measure of erythrocyte size variability and has been shown as an independent predictor of mortality. The aim of this article was to evaluate the association of RDW with endothelial dysfunction in patients with chronic kidney disease (CKD). Methods Patients with 1 to 5 stages of CKD were included in the study. Endothelial function was assessed with flow-mediated dilatation (FMD). Estimated glomerular filtration rate (eGFR) and carotid intima media thickness (CIMT) were determined. Clinicode-mographic characteristics, biochemical values, complete blood counts, ferritin, C-reactive protein (CRP) and cholesterol levels were recorded. Spearman's correlation was used to determine correlates of RDW. Multivariate linear regression model was used to assess independent associates of FMD. Results Overall, 367 patients with CKD 1 to 5 were included in the study. RDW showed a significant increase from stage 1 to stage 5 CKD. Median RDW was 13.5. Patients with RDW values higher than median had significantly lower hemoglobin, eGFR and FMD values and higher CIMT and CRP values compared with patients who had RDW values below median. RDW showed a significant positive correlation with the presence of diabetes mellitus, CIMT and CRP, whereas a significant negative correlation with eGFR, ferritin and FMD. Multivariate analysis showed independent predictors of FMD as RDW, presence of diabetes, hemoglobin, eGFR, CRP, and serum albumin. Conclusions Multivariate regression model revealed RDW as a significant predictor of FMD independent of major confounding factors, such as diabetes, inflammation, anemia and kidney function in CKD.

Recent studies have reported that a novel cardiac biomarker, heart-type fatty acid-binding protein (h-FABP), significantly predicts mortality inpatients with pulmonary embolism (PE) at intermediate risk. The aim of this study was to evaluate the effect of thrombolytic therapy on prognosis of the intermediate risk acute PE patients with elevated levels of h-FABP. This is non-interventional, prospective, and single-center cohort study where 80 patients (mean age 62 ± 17 years, 32 men) with confirmed acute PE were included. Only patients with PE at intermediate risk (echocardiographic signs of right ventricular overload but without evidence for hypotension or shock) were included in the study. h-FABP and other biomarkers were measured upon admission to the emergency department. Thrombolytic (Thrl) therapy was administered at the physician’s discretion. Of the included 80 patients, 24 were h-FABP positive (30 %). 14 patients (58 %) with positive h-FABP had clinical deterioration during the hospital course and required inotropic support and 12 of these patients died. However, of 56 patients with negative test, only 7 patients worsened or needed inotropic support and five patients died during the hospital stay. Mortality of patients with PE at intermediate risk was 21 %. The 30-day mortality rate was significantly higher in h-FABP(+) patients compared to h-FABP(−) patients (9 vs. 50 %, p < 0.001). Multivariate analysis revealed h-FABP as the only 30 day mortality predictor (HR 7.81, CI 1.59–38.34, p = 0.01). However, thrl therapy did dot affect the survival of these high-risk patients. Despite, h-FABP was successful to predict 30-days mortality in patients with PE at intermediate risk; it is suggested to be failed in determining the patients who will benefit from thrl therapy.

Aim: Mean corpuscular volume (MCV) is a measure of size of red blood cells. Recently a few studies showed an association of macrocytosis with all-cause mortality. We aimed to assess the relationship of MCV with cardiovascular (CV) morbidity and mortality in patients with chronic kidney disease (CKD), and the effect of MCV on endothelial function. Methods: This is an observational cohort study with a prospectively maintained cohort of patients with stage 1–5 CKD. Estimated glomerular filtration rate (eGFR), flow mediated dilatation (FMD) and laboratory values were measured at baseline. Multivariate linear and Cox regression analyses were used to predict independent associations of FMD and composite CV events, respectively. Results: A total of 309 patients were included in the study. In contrast to anaemia MCV did not show a significant change among CKD groups. MCV was an independent predictor of FMD in addition to serum haemoglobin, CRP, diabetes, systolic blood pressure (SBP) and eGFR. Median MCV value was 85 fl. Kaplan–Meier analysis showed that at 38 months the survival rate was 97.6% in the group with MCV < 85 compared to 81.6% in the arm with MCV ≥ 85 (P < 0.001, log-rank test). Cox regression analysis showed MCV as a predictor of composite CV events independent of major confounding factors. Conclusion: This is the first study in the literature showing an independent association of MCV and FMD. Our results also determined MCV as an independent predictor of composite CV events independent of anaemia, inflammation, diabetes and eGFR in patients with CKD.

Background Epicardial fat thickness (EFT), an indicator of visceral obesity, and leptin are 2 novel markers for studying the obstructive sleep apnea (OSA) population. This study aimed to investigate the effects of gender on leptin levels and EFT, and the relation with OSA severity. Methods A total of 149 patients with OSA (female/male 55/94 and mean age 50.8 ± 9.2 years) and 50 control patients (female/male 24/26 and mean age 48.9 ± 8.8 years) were included in the study. The study population was divided into 4 groups according to apnea/hypopnea index (AHI) as control (AHI 0.05). EFT was thicker in the severe OSA group than in the control and mild OSA groups among women, whereas EFT was not changed according to OSA severity among males (P > 0.05). Conclusion Leptin and EFT may be a valuable parameter in the evaluation of OSA severity in women than in men.

Background Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance encountered in clinical practice and is associated with impaired quality of life. Data from the previous studies have shown that sleep quality (SQ), as a component of life quality, may also deteriorate in patients with AF. However, it remains unclear; we do not know whether SQ improves after sinus rhythm is maintained. Therefore, we aimed to examine the relationship between SQ and AF, as well as the effects of sinus rhythm restoration with direct current cardioversion (DCC) on SQ among patients with persistent AF. Methods One hundred fifty-three patients with a diagnosis of nonvalvular AF and 150 age-matched control subjects with sinus rhythm were recruited. SQ was assessed using the Pittsburgh Sleep Quality Index (PSQI). The study was designed with two stages. First, the difference in SQ between AF patients and age-matched controls was examined. Patients with global PSQI scores greater than 5 were defined as “poor sleepers.” Thus, a higher global PSQI score indicated worsened SQ. Predictors of poor SQ were also analyzed using a regression model. Second, the effect of rhythm control on SQ was studied in patients with AF who were eligible for DCC. Of the 65 patients with persistent AF, 54 patients with successful cardioversion were followed for 6 months. The remaining 11 patients, whose cardioversion was unsuccessful, were not followed. After 6 months of follow-up, the PSQI scores of patients with sinus rhythm maintenance (n = 39) and patients with AF recurrence (n = 15) were reassessed. Changes in global PSQI scores (baseline vs after 6 months) were analyzed. Results The PSQI scores were significantly higher in the AF group compared to the control group (9.4 ± 4.6 vs 5.8 ± 4.1, P = 0.001, respectively). The prevalence of poor sleepers was significantly higher in the AF group (76%) than in the control group (45%) (P < 0.001 by the χ2 test). Multivariate logistic regression analysis showed that AF (odds ratio [OR]: 3.36, 95% confidence interval [CI]: 2.00–5.55), age (OR: 1.02, 95% CI: 1.00–1.04), and diabetes mellitus (OR:1.79, 95% CI: 1.03–3.14) were independent predictors of poor SQ. In the second stage, the effect of rhythm control on the SQ of the 54 patients with successful DCC was analyzed. PSQI scores improved significantly between baseline and the 6 months in sinus rhythm maintenance group (8.7 ± 4.1 vs 7.2 ± 3.8, P < 0.001, respectively). However, in the AF recurrence group, the change in global PSQI scores between baseline and the sixth month was not statistically significant (9.8 ± 4.5 vs 9.2 ± 4.2, P = 0.56, respectively). Conclusion Patients with AF have shorter sleep duration and poor SQ. Maintenance of sinus rhythm after DCC may have a favorable effect on the SQ of patients with AF. Nevertheless, AF is an independent predictor of poor SQ.

OBJECTIVE: Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage. There are currently no available data on this imaging method with regard to assessing right ventricular involvement in anterior myocardial infarction. Therefore, we aimed to evaluate right ventricular regional functions using a derived strain and strain rate imaging tissue Doppler method in patients who were successfully treated for their first anterior myocardial infarction. METHODS: The patient group was composed of 44 patients who had experienced their first anterior myocardial infarction and had undergone successful percutaneous coronary intervention. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained. RESULTS: The right ventricular myocardial velocities of the patient group were significantly decreased with respect to all three velocities in the control group. The strain and strain rate values of the right mid and apical ventricular segments in the patient group were significantly lower than those of the control group (excluding the right ventricular basal strain and strain rate). In addition, changes in the right ventricular mean strain and strain rate values were significant. CONCLUSION: Right ventricular involvement following anterior myocardial infarction can be assessed using tissue Doppler based strain and strain rate. © 2013 CLINICS.

Background: Cigarette smoking is associated with increased rates of coronary artery disease and acute myocardial infarction (MI). Paradoxically, smokers had lower mortality after MI. The purpose of this study was to evaluate the effect of chronic smoking on myocardial performance index (MPI) in middle-aged men after an acute MI. Material and methods: A total of 429 patients (325 smokers vs. 104 nonsmokers) presenting with acute ST elevation MI were enrolled in this study. Thrombolysis in myocardial infarction (TIMI) flow of the infarct related artery was measured before and after the primary percutaneous coronary intervention (PCI), and Gensini score was also calculated. Conventional echocardiography and tissue Doppler echocardiography (TDI) were performed within 48–72 hours after onset of chest pain. Peak early (Em) and late (Am) diastolic velocities, peak systolic (Sm) mitral annular velocities and time intervals were recorded with TDI. The MPI, ratio of Em/Am, and E/Em were calculated. Results: Baseline demographic and angiographic characteristics such as Gensini score, pre and, post PCI TIMI flow were similar in 2 groups. In contrast, LV MPI was preserved among smokers (0.59 ± 0.15 vs. 0.66 ± 0.14, P = 0.01), and Em/Am values were also higher in smokers (0.84 ± 0.28 vs. 0.75 ± 0.31, P = 0.01). Independent predictors of impaired MPI (≥0.60) were determined as nonsmoking status (odds ratio 2.940, 95% CI 0.98–5.83, P = 0.05), left anterior descending artery stenosis (odds ratio 3.196, 95% CI 1.73–5.91 P = 0.001), and, age (odds ratio 1.12, 95% CI 1.03–1.22, P = 0.01). Conclusions: Despite similar demographic and angiographic characteristics, smoker males had a paradoxically better MPI after acute MI.

WOS: 000338109400011, PubMed: 24818625, Objective: Masked hypertension is a clinical condition, the importance of which is agreed in recent years and which is characterized by increased cardiovascular mortality and morbidity and is thought to be important endothelial dysfunction in the pathophysiology. Plasma total homocysteine levels are accepted as a major independent biomarker for endothelial dysfunction and/or a contributor to hypertension and coronary artery disease. In this study, we aimed to measure the level of serum homocysteine and to evaluate the relationship between the parameters of ambulatory blood pressure monitoring in patients with masked hypertension. Methods: This cross-sectional observational study included 37 subjects with normal blood pressure, 30 with masked-hypertension and 27 patients with obvious hypertension. Masked hypertension (MHT) was defined as office blood pressure = 135/85 mm Hg. Homocysteine levels of the subjects were measured by using HPLC system with fluorescent detector. Lipid parameters were measured by routine methods. Mann-Whitney U test was used for statistical analysis. Results: In the analysis of homocysteine, it was observed that there was no difference between the control group and patients with masked hypertension. Patients with high blood pressure showed higher homocysteine levels when compared to masked hypertension (p=0.02). Homocysteine levels showed a weak positive correlation with average systolic blood pressure (r=0.335, p=0.043). Homocysteine levels were higher in smokers than non-smokers. compared with non-smokers group in all participants (p=0.036). Conclusion: We have reached the opinion that in the individuals with no obvious health problems but with masked hypertension, homocysteine levels may not have any significant effect upon high blood pressure levels., Coordinatorship of Scientific Research Projects [09202067], The approval was received from the Ethics Committee (Ethics Committee no: 197, date: 05.29.2009) and ethical values have been abided during the study. Chemical substances, commercial kit and colons and various consumables that are necessary for the research were met by the Selcuk University Coordinatorship of Scientific Research Projects and this Project was supported with the Project number 09202067 by Coordinatorship of Scientific Research Projects.

A 72-year-old female patient with respiratory distress and chest pain was referred for echocardiography after which a severe aortic stenosis was diagnosed. From clinical perspective an AVR would have carried too much risk in this case, therefore TAVI with transapical approach via left anterior thoracotomy was the treatment of choice. In this case report, we describe our experience with this new procedure in our country.

Alt ekstremite derin ven trombozuna bagli olusan akut, masif pulmoner emboli tanisi konmus 76 yasinda erkek hastada ciddi kardiyovaskuler ve solunumsal instabilite gelisti. Takiben hastaya iki saat sureyle streptokinaz infuzyonu verildi. Trombolitik tedavi sonrasi hemodinamik kararsizligin devam etmesi uzerine, spiral bilgisayarli tomografi cekildi. Bilgisayarli tomografi, masif pulmoner embolinin sebat ettigini gosterdi. Literatur verileri isiginda hastaya cerrahi pulmoner embolektomi onerildi; ancak hasta cerrahiyi reddetti. Bunun uzerine hastaya iki saat sureyle intravenoz rekombinant doku tipi plazminojen aktivatoru verildi. Tedavi sonrasinda hastanin klinik durumu ve radyolojik bulgulari belirgin olarak duzeldi. Hasta efektif antikoagulan tedavi ile taburcu edildi. Anah tar soz cuk ler: Bilgisayar tomografi; pulmoner emboli; trombolitik tedavi. A 76-year-old male patient diagnosed with acute, massive pulmonary embolism due to deep vein thrombosis of a lower extremity developed significant cardiovascular and respiratory instability. Subsequently, streptokinase infusion was administered over two hours. Spiral computed tomography was performed due to the persistent hemodynamic instability following the thrombolytic therapy. Computed tomography showed persistent massive pulmonary embolism. In the light of literature data, the patient was recommended for surgical pulmonary embolectomy, however he refused surgery. Therefore, he was administered intravenous recombinant tissue type plasminogen activator over two hours. Clinic status of the patient and radiological findings were significantly improved following therapy. The patient was discharged with effective anticoagulant therapy.

P-wave parameters including P-wave dispersion (P d) have been examined in general population to predict development of atrial fibrillation (AF). But data on end-stage renal disease (ESRD) population are limited. P index (Pi) and interatrial block (IAB) as novel parameters may more accurately predict AF and have not been previously investigated in ESRD patients. We aimed to evaluate these novel ECG parameters in ESRD patients. Eighty-six HD, 47 CAPD, and 43 age- and gender-matched control subjects were enrolled in the study. P-wave duration was measured in all 12-leads of the surface ECG. The standard deviation of the P-wave duration across the 12 ECG leads was accepted as a Pi. P-wave duration above and equal to 110 ms was defined as IAB. All P-wave parameters were evaluated digitally by two observers. Pi was found to be significantly different among the groups in ANOVA. In post hoc analysis, P i was increased in HD group compared with the control group (p = 0.01). Also, P i tended to increase in CAPD group compared with controls (p = 0.06). The effect of ESRD on P i was independent of age, gender, and systolic blood pressure in univariate covariant analysis. The prevalence of IAB was 61, 55, and 32 % in patients with HD, CAPD, and controls, respectively (p = 0.001). P d was significantly higher in HD group compared with healthy controls. However, Pd values of CAPD patients did not show significant difference compared with controls. The present study demonstrated that IAB frequency and Pi were increased in patients with ESRD.

WOS: 000301065000001, PubMed: 22211096, Background: The 12-lead surface electrocardiogram (ECG) is a useful tool to predict both atrial and ventricular arrhythmias via P-wave and QT measurements and its derivatives. Polycythemia vera (PV) is a chronic myeloproliferative disorder associated with cardiovascular events. The aim of this study was to assess ECG findings of patients with PV. Method and materials: Sixty patients with PV (34 male, mean age 58 +/- 11 years) and 60 age and gender-matched healthy volunteers were enrolled into the study. From the 12-lead surface ECG, P-wave and both conventional QT measurements and transmyocardial repolarization parameters (T-peak-T-end interval (T-p-T-e) and derivatives) were evaluated digitally by two experienced cardiologists. In addition, a novel parameter, Pi was calculated digitally as the standard deviation of the P-wave duration across the 12 ECG leads. Results: QT duration and corrected QT interval were significantly longer in the PV group compared to healthy controls (p

WOS: 000309036000005, PubMed: 22825896, Background: Doxorubicin is a chemotherapeutic agent used in a wide spectrum of cancers. However, cardiotoxic effects have limited its clinical use. The early detection of doxorubicin-induced cardiotoxicity is crucial. The purpose of our study was to assess values of Doppler and tissue Doppler imaging (TDI) -derived myocardial performance index (MPI) in adult cancer patients receiving doxorubicin treatment. Methods: A total of 45 patients underwent echocardiographic examinations before any doxorubicin had been administered and then after doxorubicin. Doppler and TDI-derived MPI of left ventricular (LV) were determined in the evaluation of cardiotoxicity. Additionally, TDI-derived MPI of right ventricular (RV) was determined. Results: All patients underwent control echocardiographic examination after mean 5 +/- 1.7 months. The LV MPI obtained by both Doppler and TDI were increased after doxorubicin treatment (0.56 +/- 0.11, 0.61 +/- 0.10, p = 0,005 vs 0.51 +/- 0.09, 0.59 +/- 0.09, p = 0.001, respectively). There was no correlation between Doppler-derived MPI and cumulative doxorubicin dose (coefficient of correlation 0.11, p = 0.6). TDI-derived MPI was correlated with cumulative doxorubicin dose (coefficient of correlation 0.35, p = 0.015), but this correlation is weak (r = 0.38). The study population was divided into two groups according to doxorubicin dose (below and above 300 mg level). There was a moderate correlation between TDI-derived MPI and less than 300 mg of doxorubicin dose (coefficient of correlation 0.51, p = 0.028). However, Doppler-derived MPI was not correlated with less than 300 mg of doxorubicin dose (coefficient of correlation 0.38, p = 0.123). Also, there was no significant change in the TDI-derived RV-MPI (0.49 +/- 0.14, 0.50 +/- 0.12, p = 0.56). Conclusions: TDI-derived MPI is a useful parameter and an early indicator compared with Doppler-derived MPI in the detection of cardiotoxicity during the early stages. Also, doxorubicin administration does not affect RV function. (Cardiol J 2012; 19,4: 363-368)

High dose statin medication in acute coronary syndrome cases is a therapy which lowers mortality and morbidity rates. Interleukin-6 (IL-6) is produced in higher amounts in acute myocardial infarction (MI) and facilitates myocardial damage. However, secretion of nitric oxide (NO) is depleted. We aimed to compare the effects of conventional dose (10-40 mg/day) and aggressive dose (80 mg/day) atorvastatin medications on IL-6 and NO levels in patients with primary percutaneous transluminal coronary angioplasty (PTCA) intervention after acute MI. 50 patients (8 females, 42 males) with the diagnosis of acute MI with ST segment elevation enrolled to the study. Primary PTCA intervention was performed on these patients and consequently either conventional dose (10 to 40 mg/day) or aggressive dose (80 mg/day) atorvastatin medications were given to the patients. Three months later, plasma IL-6 and NO levels were determined and alterations in the groups were evaluated. IL-6 levels decreased from 24.34 ± 12.04 to 11.40 ± 5.79 pg/ml and from 29.62 ± 17.38 to 12.51 ± 8.95 pg/ ml in conventional dose and aggressive dose regimens respectively (p

Aims: The aim of this study was to evaluate myocardial performance index (MPI) which reflects the combined systolic and diastolic performance of the ventricles by tissue Doppler imaging (TDI) in patients with polycythemia vera (PV). Method and Materials: Twenty-eight patients with PV (17 men; mean age 60 ± 9 years) and 30 age-matched healthy subjects were prospectively evaluated. The diagnosis of PV was performed according to the World Health Organization (WHO) criteria. Left ventricular (LV) systolic and diastolic functions were assessed by conventional echocardiography and TDI. MPI of both the LV and right ventricles (RV) were measured by TDI method. Results: The LV MPI was significantly higher in PV group than in the controls (0.61 ± 0.16 vs. 0.49 ± 0.05; P = 0.001). Also, the RV MPI was impaired in patients with PV compared to the control subjects (0.51 ± 0.11 vs. 0.43 ± 0.09; P = 0.005). RV late A filling velocity (Am) and RV isovolumetric relaxation time were significantly higher in the PV group compared to healthy subjects (P = 0.03 and 0.05, respectively). In logistic regression models, PV was determined as an independent predictor of impaired MPI (odds ratio: 3.7; CI 95%, 1.2–7.5). In addition, pulmonary arterial pressure was significantly elevated in patients with PV compared to the controls (P = 0.02). Conclusion: This study demonstrated that biventricular MPI is impaired in patients with PV. (Echocardiography 2011;28:948-954)

CD40 ligand is a thromboinflammatory molecule that predicts cardiovascular events. Platelets constitute the major source of soluble CD40 ligands (sCD40L), which has been shown to influence platelet activation. The main aim of this study was to evaluate sCD40L levels in patients with acute pulmonary embolism (PE). Sixty-five PE patients (32 males, mean age 58 ± 12 years) and 29 healthy controls (15 males, mean age 56 ± 14 years) were enrolled in the study. sCD40L levels were evaluated at the enrollment by ELISA method. Multislice detected pulmonary computed tomography was performed on all patients with a suspected diagnosis of PE. In addition, echocardiography was performed to evaluate right ventricular (RV) dysfunction. There was no statistically significant difference between the two groups regarding demographic features. sCD40L levels were significantly higher in acute PE group compared to healthy controls (5.3 ng/ml and 1.4 ng/ml, respectively; p < 0.001). sCD40L levels of patients with and without RV dysfunction were similar. Correlation analysis between echocardiographic findings and sCD40L levels did not show significant difference. The present study demonstrated a role of sCD40L in pathogenesis of PE for the first time. Further studies are needed to clarify a predictive and prognostic value of sCD40L levels in acute PE patients.

WOS: 000292520000003, PubMed: 21698055, Background: The mechanisms of the increased cardiac and vascular events in patients with OSA are not well understood. Arousal which is an important component of OSA was associated with increased sympathetic activation and electrocardiographic changes which prone to arrhythmias. We planned to examine the association among arousal, circulating Lp-PLA2 and total antioxidant capacity in male patients with OSA. Methods: Fifty male patients with newly diagnosed OSA were enrolled the study. A full-night polysomnography was performed and arousal index was obtained. Lp-PLA2 concentrations were measured in serum samples with the PLAC Test. Total antioxidant capacity in patients was determined with Antioxidant Assay Kit. Results: Arousal was positively correlated with LP-PLA2 levels (r=0.43, p=0.002) and was negatively correlated with total antioxidant capacity (r= -0.29, p=0.04). Elevated LP-PLA2 levels and decreased total antioxidant activities were found in the highest arousal quartile compared with the lowest and 2nd quartiles (p=0.02, p=0.05, respectively). LP-PLA2 was an independently predictor of arousal index in regression model (beta=0.357, p=0.002) Conclusions: This study demonstrated a moderate linear relationship between arousal and LP-PLA2 levels. Also, total antioxidant capacities were decreased in the higher arousal index. Based on the study result, the patients with higher arousal index may be prone to vascular events., Bilim Drug Company Ltd., The authors acknowledge to Bilim Drug Company Ltd. for the financial support for the LP-PLA2 and total antioxidant capacity assay kits. Also, the authors acknowledge to sleep laboratory staff for their contributions to the study.

Atrial remodeling is an important part of cardiac remodeling after acute myocardial infarction (AMI). The aim of this study was to evaluate the effect of spironolactone on atria in patients with preserved left ventricular (LV) functions after AMI by using two-dimensional and tissue Doppler imaging techniques (TDI).The study consisted of 110 patients with AMI, successfully revascularized with percutaneous coronary intervention, ejection fraction greater than or equal to 40%, and Killip class I-II. Patients were randomized into two groups: conventional therapy (n=55) and additional spironolactone of 25 mg/day with standard conventional therapy (n=55). Echocardiography was performed in the first 48-72 h of AMI and during 6 months of follow-up. Left atrial volume index and emptying fraction were obtained. The peak regional atrial contraction velocity, the time between the onset of p-wave on the monitor ECG and the onset, peak, and the end (TE) of the atrial contraction wave on the tissue Doppler technique curve were measured.The left atrial volume index and left atrium (LA) dimensions did not significantly change in either group. In the spironolactone group, left atrial emptying fraction increased compared with both baseline value (from 53.0 ± 0.16 to 57.0 ± 0.13 P=0.011) and conventional therapy group (from 50.0 ± 0.17 to 47.0 ± 0.16, P=0.013). The atrial contraction velocity did not change but the LA-TE, interatrial septum-TE, and right atrium-TE were prolonged in the conventional therapy group.Additional spironolactone therapy provided a little benefit on LA remodeling and atrial electromechanic properties in patients with AMI and preserved LV functions.

Cardiotoxicity that results from lithium overdose is uncommon and electrocardiographic (ECG) changes are rarely reported. However, some authors have specifically reported the occurrence of ischemic ECG changes due to a lithium overdose. This article describes a case that is demonstrating ECG changes that mimic inferior myocardial infarction during the course of chronic lithium treatment and showing QTc prolongation in this patient. The patients’ ECG changes were partially recovered after hemodialysis. Ann Noninvasive Electrocardiol 2010;15(3):289–292

WOS: 000278211900020, PubMed: 20453387, Background: The exaggerated blood pressure response to exercise (EBPR) is an independent predictor of hypertension. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide inhibitor and higher plasma levels of ADMA are related to increased cardiovascular risk. The aim of this study is to identify the relationship between ADMA and EBPR. Methods and Results: A total of 66 patients (36 with EBPR and 30 as controls) were enrolled in the study. EBPR is defined as blood pressure (BP) measurements >= 200/100 mmHg during the treadmill test. All the subjects underwent 24-h ambulatory BP monitoring. L-arginine and ADMA levels were measured using a high performance lipid chromatography technique. The serum ADMA levels were increased in the EBPR group compared to the healthy controls (4.0 +/- 1.4 vs 2.6 +/- 1.1 mu mol/L respectively, P=0.001), but L-arginine levels were similar in the 2 groups (P=0.19). The serum ADMA levels were detected as an independent predictor of EBPR (odds ratio 2.28; 95% confidence interval 1.22-4.24; P=0.002). Conclusions: Serum ADMA levels might play a role in EBPR to exercise. (Circ J 2010; 74: 1135-1141)

Prognosis of cases of myocardial infarction with normal coronary arteries (MINCA) is known to be better than acute myocardial infarction cases with obstructive coronary lesions. A MINCA case causing ventricular septal rupture is rare. Herein, we present a 70-year-old female MINCA case which caused ventricular septal rupture which is a fatal complication of acute myocardial infarction. Learning objective: Acute myocardial infarction, whether it is atherosclerotic or non atherosclerotic, has a high mortality rate when complicated with ventricular septal rupture. Complications of acute myocardial infarction should be observed cautiously and specific risk factors for ventricular septal rupture need to be investigated.>

BACKGROUND The aim of the present study was to evaluate left ventricle (LV) systolic and diastolic function, using tissue Doppler echocardiography (TDE) and color M-mode flow propagation velocity, in relation to blood glucose status in normotensive patients with type 2 diabetes mellitus (T2DM) who had no clinical evidence of heart disease. METHODS Seventy-two patients with T2DM (mean age 49.1 +/- 9.8 years) without symptoms, signs or history of heart disease and hypertension, and 50 ages matched healthy controls (mean age 46.1 +/- 9.8 years) had echocardiography. Systolic and diastolic LV functions were detected by using conventional echocardiography, TDE and mitral color M-mode flow propagation velocity (V(E)). Fasting blood glucose level (FBG) after 8 hours since eating a meal, postprandial blood glucose level (PPG), and HbA(1C) level were determined. The association of FBG, PPG and HbA(1C) with the echocardiographic parameters was investigated. RESULTS It was detected that although systolic functions of two groups were similar, diastolic functions were significantly impaired in diabetics. No relation of FBG and PPG with systolic and diastolic functions was determined. However, HbA(1C) was found to be related to diastolic parameters such as E/A, Em/Am, V(E) and E/V(E) (beta=-0.314, P = < 0.05; beta=-0.230, P < 0.05; beta=-0.602, P < 0.001, beta= 0.387, P < 0.005, respectively). In addition to HbA(1C), LV, diastolic functions were also correlated with age and diabetes duration. CONCLUSION Diastolic LV dysfunction may develop even in absence of ischemia, hypertension, and LVH in T2DM. FBG and PPG have no effect on LV functions, but HbA(1C) levels may affect diastolic parameters.

Background:The purpose of this study was to examine the effects of exercise on maximum QTc interval (QTcmax) and QTc dispersion (QTcd) in diabetic patients without clinically evident heart disease. Methods: Seventy-six diabetic patients who had no coronary artery disease or hypertension (group I; mean age 48 ± 9 years old) and 40 healthy volunteers (group II; mean age 46 ± 13 years old) were enrolled in the study. Cases with clinically evident heart disease were excluded from the study. Resting 12-lead electrocardiogram (ECG) and maximal treadmill exercise test (according to Bruce protocol) were performed in all cases. The QTcmax interval was determined at rest (RQTcmax) and during peak exercise (PQTcmax). Also, the QTcd was measured at rest (RQTcd) and during peak exercise (PQTcd). Autonomic neuropathy was assessed by measuring the heart rate variability (HRV). Results: There was no significant difference between clinical characteristics of two groups. In group I, HRV parameters were significantly lower than group II. RQTcd, PQTcd, RQTcmax, and PQTcmax were significantly longer in group I (56 ± 16 vs 34 ± 11; P 0.05), and no significant difference was present between RQTcd and PQTcd (56 ± 16 vs 62 ± 22; P > 0.05, respectively). Conclusion: Exercise does not affect QTcd in patients with diabetes mellitus and without clinically evident heart disease.

Associations between metabolic syndrome (MS) and major depressive disorder (MDD) are well documented although the underlying biological mechanisms for this relationship are less studied. Paraoxonase (PON1) is a high-density lipoprotein (HDL)-associated enzyme, with demonstrated evidence of strong antioxidant activity. Oxidative stress has been implicated in the pathophysiology of MS and MDD. PON1 activity has been studied to some extent in patients with MS and less in MDD. The aim of this study was to compare serum PON1 activity in patients with MS and MDD, MS without MDD, and normal control groups in the context of the biological mechanism of the association between MS and MDD. In this case-control study, 67 patients with MS and 25 healthy controls from the hospital–university staff were recruited. All patients and healthy controls were assessed by a semi-structured psychiatric interview. Patients with MDD were diagnosed according to the DSM-IV criteria for MDD. Serum PON1 activity was determined with a spectrophotometric method, and the activity was compared between patients with MS and MDD, with MS but without MDD, and control groups. Serum PON1 activity levels were lower in patients with MS and MDD group compared to those in the patients with MS and without MDD group and control group (69.5 ± 24.2, 84.3 ± 34.6, and 97.1 ± 40.8 U/ml, p = 0.03, respectively). Post hoc analysis showed that PON1 activity was statically significantly lower in the MS with MDD group than in the control group (p = 0.02). Impaired PON1 activity, in the context of enhanced oxidative stress, could be one of the possible underlying biological mechanisms of the MS–MDD association.

A 43-year-old male patient was admitted to coronary intensive care unit with the diagnosis of acute inferolateral myocardial infarction and with a picture of cardiogenic shock. In physical examination, systolic blood pressure was 50 mmHg and diastolic blood pressure could not be taken. The patient was diagnosed with cardiogenic shock and was started on saline, dopamine and dobutamine infusion. His blood pressure did not increase although the dosage of positive inotropic agents was increased. A cardiac tamponade revealed with urgent echocardiographic evaluation and pericardiocentesis was carried out. Blood pressure returned to normal range within hours after pericardiosentesis. Echocardiographic examination performed on the second day of AMI on the asymptomatic patient revealed thrombosed myocardial rupture. The patient was referred to emergency surgery with the diagnosis of three-vessel disease and myocardial rupture according to urgent angiography. In the operation, the ruptured region in the ventricle free wall was primarily repaired. By-pass surgery was performed with saphenous vein graft to the LAD and CV-OM1 coronary arteries. Key words: Free wall rupture, acute myocardial infarction, treatment.

The deleterious effects of cardiac iron load on the ventricular repolarization were demonstrated in beta-thalassemia major (βTM), but little is known about the P wave measurements, an independent risk factor for development of atrial fibrillation (AF). We aimed to examine relationship between P-wave parameters and iron loading using cardiac T2* Magnetic Resonance Imaging (MRI) in asymptomatic β-TM patients. The study involved 22 β-TM patients and 22 age- and gender-matched healthy controls. Although P-wave parameters were within normal limits, P max, P min, and Pi were significantly prolonged in the β-TM group compared to the healthy controls (p=0.005, p=0.01, and p=0.03, respectively). Pd was found similar between groups (p=0.46). The prevalence of partial IAB was increased in patients with β-TM (p=0.001) and complete IAB was detected only in one patient. P-wave parameters of patients with cardiac T2* =20 msec were comparable in patients with β-TM. There was no correlation between P-wave parameters and cardiac T2*MRI values. The present study demonstrated that P-wave measurements were slightly affected in β-TM patients with preserved LV functions and this influence was not related with cardiac T2*MRI values. We concluded that the effect of β-TM on the AF development is still controversial.

The neutrophil to lymphocyte ratio (NLR) predicts cardiovascular events. The aim of this study was to determine whether NLR improved the positive predictive value (PPV) of dobutamine stress echocardiography (DSE) in patients with stable coronary artery disease (CAD). We conducted a retrospective review of laboratory and DSE data from the medical records of 1,012 patients who were divided into two groups according to the presence of ischemia and further subdivided into three groups according to the extent of ischemia (nonischemic segments, 1-3 ischemic segments, or > 3 ischemic segments). NLRs were compared among these groups. NLRs increased in patients with ischemia and correlated with the number of ischemic segments (P < 0.001). The optimal cutoff value of NLR determined using receiver operating characteristic analysis was > 2.04, and the diagnostic value of NLR for discriminating patients with ≥ 50% coronary stenosis in at least one of the coronary arteries from those without significant CAD was high [area under the curve (AUC) = 0.671, standard error = 0.052, P < 0.001, 95% confidence interval (CI) = 0.569-0.773)]. An NLR cutoff value of > 2.04 predicted CAD presence with significant stenosis (62.10% sensitivity and 64.10% specificity). PPV of DSE for a significant coronary artery lesion identified using coronary angiography was 73.8% (95% CI = 75.1-88.5, P < 0.001, AUC = 0.818). On including a cut-off value of > 2.04 for NLR in this multivariable predictive model, the AUC value slightly increased to 0.905 (95% CI = 85.4-95.6) and PPV of DSE increased from 73.8% to 92.6%. NLR improved PPV of DSE for patients with stable CAD.

Background The aim of this study was to examine the Tpeak-Tend (Tpe/corrected Tpe) interval, which is an indicator of transmural myocardial repolarization, measured non-invasively via electrocardiogram in patients with acute pulmonary embolism (PE), and to investigate the relationship with 30-day mortality and morbidity. Methods The study included 272 patients diagnosed with acute PE, comprising 154 females and 118 males, with a mean age of 63.1 ± 16.8 years. Tpe/cTpe intervals were calculated from the electrocardiograms with a computer program after using a ruler or vernier caliper manual measuring tool to obtain highly sensitive measurements. The relationship between the electrocardiogram values and 30-days mortality and morbidity were measured. Results The study group was divided into three groups according to cTpe intervals: Group 1, < 113 ms; Group 2, 113–133 ms; and Group 3, > 133 ms. White blood cell count and troponin T levels, corrected QT intervals with QRS complex durations, percentage of right ventricle dilatation with right/left-ventricular ratio, 30-day death, and combinations of these values were seen at a higher rate in Group 3 patients compared to the other groups. Kaplan–Meier analysis showed that the cTpe interval measured at > 126 ms could be used as a cut-off value in the prediction of mortality and morbidity. The cTpe cut-off values of 126 ms had sensivity, specificity, negative predictive value, and positive predictive value of 80.56 %, 59.32 %, 95.2 %, and 23.2 %, respectively. Conclusions cTpe interval could be a useful method in early risk stratification in patients with acute PE.