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Purpose: The triglyceride-glucose index (TyG) is an important parameter that reflects insulin resistance and its use has increased recently. Its relationship with cardiovascular diseases has been shown in previous studies. Our aim was to investigate the association of residual SYNTAX score (rSS) with TyG index in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Materials and Methods: A total of 663 STEMI patients who underwent primary percutaneous coronary intervention were included in the study. The patients were divided into 2 groups according to the TyG index level as high and low. The cut-off value for the TyG index was determined as 9.61 by ROC analysis. Coronary artery disease severity was calculated for both groups besides baseline clinical and demographic variables. Results: A total of 281 patients were evaluated in the high TyG index group and 386 patients in the low TyG index group. A rSS above 8 was considered high. The proportion of patients with high rSS in the increased TyG index group was found to be significantly higher than in the other group [114 (40.6) vs. 54 (14.0)]. In addition, higher TyG index is determined to be the independent predictor of higher rSS in logistic regression analysis. Conclusion: High TyG index had a strong association with rSS and higher TyG index was an independent predictor of increased rSS in patients with STEMI

Aim: This work was designed to explore the role of the triglyceride-glucose (TyG) index in the prediction of long-term mortality in patients with lower extremity artery disease (LEAD) undergoing endovascular revascularization. Methods: The records of 723 patients with symptomatic LEAD undergoing endovascular revascularization between January 2016 and December 2021, with long-term follow-up until December 2021, were analyzed. Results: The rate of long-term mortality was significantly higher among patients with high TyG index than patients with low TyG index. Conclusion: The TyG index is an independent predictor of long-term mortality in patients with LEAD undergoing endovascular revascularization.

In our study, we aimed to assess the role of acceleration time (AT), ejection time (ET), and AT/ET ratio to distinguish between true and pseudo severe AS in patients with classical low flow-low gradient (LF-LG) aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF).Sixty-seven classical LF-LG AS with reduced LVEF patients who underwent dobutamine stress echocardiography (DSE) were included in the study. According to DSE results, all patients were divided into two groups; true AS and pseudo severe AS. Aortic valve calcium score was measured in patients with inconclusive DSE results. AT and other ejection dynamics (ET and AT/ET) were calculated by taking baseline echocardiographic records into account for all patients. The predictive power of AT and other ejection dynamics were evaluated to estimate true and pseudo severe AS.According to DSE results, out of 67 patients, 44 (65.7%) was diagnosed as true severe AS. There was a statistically significant relation between baseline AT and true AS [adjusted OR 4.47 (95% CI 1.93-10.4), p = 0.001]. The best cutoff value of AT was measured as 100 msec according to the Youden index. This value had a sensitivity value of 77%, specificity value of 87%, positive predictive value of 92%, and a negative predictive value of 67%.The measurement of AT can predict the DSE outcome and can be used for diagnostic purposes to distinguish between true and pseudo severe AS in classical LF-LG AS patients with reduced LVEF.

Sarcopenia is one of the most significant contributors to morbidity in patients with chronic liver disease. Serum myokines are potential biomarkers for detecting early sarcopenia. We aimed to investigate the relationship between serum myokines and cirrhosis-related mortality in the early stages of the disease.In total, 262 patients and 50 healthy controls were enrolled in this study, which was designed as a multicenter cross-sectional study. At the beginning of the study, sarcopenia was defined by computed tomography scans using the third lumbar vertebra skeletal muscle index. Serum myostatin, irisin, and follistatin levels, nutritional status of the patients, and muscle strength as measured by the handgrip test were recorded. Cirrhosis-related mortality and overall survival were evaluated in the fourth year of the study as the second checkpoint of cross-sectional analysis.A total of 145 (55.3%) patients were diagnosed with sarcopenia. Multivariate analysis revealed that low BMI, high levels of myostatin, and decreased irisin levels were independent predictors of sarcopenia. While serum irisin level was the most predictive parameter in terms of 4th-year cirrhosis-related mortality in the CHILD A group, serum myostatin levels were found more indicative in the CHILD BC group regardless of sarcopenia status ( Plt; 0.001).Serum myostatin levels predict sarcopenia in all stages of cirrhosis. Serum irisin levels can also be used as a potential biomarker to predict both treatable sarcopenia and cirrhosis-related mortality in CHILD A patients.

Transcatheter aortic valve implantation (TAVI) is a less invasive and safe therapeutic alternative in patients who are at very high surgical risk or in whom there are contraindications to open surgery. On the other hand, allocating transcatheter therapy to the adequate candidates and identifying a reliable and validated risk stratification tool for mortality prediction is still lacking. The C-reactive (CRP) to albumin ratio (CAR) is a novel inflammation-based prognostic tool and it is strongly associated with inflammation severity and mortality. In this study, we aimed to elucidate the predictive significance of CAR for mortality in patients who underwent TAVI.The records of 321 consecutive patients who underwent TAVI due to symptomatic aortic stenosis between 1 January 2015 and 31 December 2020 were analysed. Patients were divided into two groups based on the CAR values. For each group, all-cause, cardiovascular, and non-cardiovascular mortality occurring72 h after the index procedure and at maximum follow-up was documented.The mean follow-up time was 40 (22-63) months. A total of 180 (56.1%) patients died during long-term follow-up. According to our study, median CAR values were significantly higher among patients who died during follow-ups compared to survivors [1.13 (0.69-2.21) vs 3.56 (1.53-10.00),Our data showed that CAR is an independent predictor of long-term mortality in patients undergoing TAVI due to symptomatic aortic stenosis.

In this study, we aimed to investigate the prognostic value of C-reactive protein (CRP) to albumin ratio (CAR) for predicting restenosis in superficial femoral artery (SFA) lesions and its association with subsequent clinical outcomes in patients undergoing endovascular intervention.The records of 685 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into 2 groups, based on the CAR values. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed.According to our study, patients with high CAR values had higher rates of restenosis (30.2% vs. 10.3%, P 0.05) and mortality (31.3% vs. 12.9%, P 0.05). The rate of lower extremity amputations was also significantly higher in patients with high CAR values compared to those with low CAR values (9.1% vs. 3%, P 0.05). With respect to Receiver operating characteristic ROC curves of inflammatory markers, the area under the curve (AUC) value of CAR was statistically significant (AUC: 0.659; 95% confidence interval CI: 0.611-0.706; P 0.01).Our data showed that CAR is an independent predictor of restenosis and poor clinical outcomes in patients undergoing endovascular intervention.

Objective Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). Patients with CLI have poor long-term prognosis. The aim of this study was to investigate the value of sarcopenia in terms of 1-year mortality in patients with below-the-knee lesions who underwent endovascular treatment for CLI. Methods A total of 190 patients with critical limb ischemia who underwent endovascular treatment (EVT) for below-the-knee (BTK) lesions were enrolled in this study. Sarcopenia was defined using the psoas muscle index (PMI). PMI was obtained by calculating the average psoas muscle area (APMA) of the left and right psoas muscles at the third lumbar vertebra level and dividing by the square of the height (cm2/m2). The primary endpoint of the study was 1-year mortality and the secondary endpoint was 1-year amputation. Patients were divided into 2 groups according to presence of sarcopenia. Results We detected sarcopenia in 64 patients. The mean age, height, and EF were higher in sarcopenia group. The psoas muscle area, weight, psoas muscle index, body-mass index, albumin level, and GFR were lower in sarcopenia group. The incidence of amputation (11.9% vs 29.7%, p = 0.003) and mortality (15.1% vs 35.9%, p = 0.001) were higher in patients with sarcopenia. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of amputation and mortality. The survival curve for 1-year using the sarcopenia was analyzed using the Kaplan–Meier method, and statistical analysis was performed with the log-rank test. The presence of sarcopenia, glomerular filtration rate level, and low ejection fraction were found to be independent predictors of mortality. Conclusions Sarcopenia was associated with 1-year mortality in patients with CLI undergoing EVT for BTK lesions. Also, patients with sacropenia had higher 1-year amputation rates. Sarcopenia may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.

Amaç:, Bu çalışmada Hipertrofik kardiyomiyopati (HKMP) hastalarında geç kontrast tututulmu (GKT), toplam sol ventrikül kütlesi (TSVK), mitral yetersizlik ve sol atriyum (SA) hacmi dahil olmak üzere Kardiyak manyetik rezonans (KMR) görüntüleme parametreleri ile atriyal fibrilasyon (AF) arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem: Bu çalışmaya HKMP tanısı alan, KMR çekimi yapılmış ve 48 saatlik Holter monitorizasyonu olan ardışık 122 hasta dahil edilmiştir. KMR tecrübesine sahip Radyoloji ve Kardiyoloji uzman hekimleri tarafından KMR görüntüleri değerlendirilmiştir. TSVK, SA hacmi, GKT varlığı ve yaygınlığı, mitral yetersizliği ve maksimum sol ventrikül kalınlığını içeren KMR parametreleri ile AF arasındaki korelasyon değerlendirilmiştir. Bulgular: SA hacmi ve AF arasında anlamlı bir korelasyon gözlendi. Ek olarak TSVK, AF ile ilişkili bulundu. TSVK, SA hacmi ve GKT'nin kapsamını değerlendiren lojistik çok değişkenli analiz, yalnızca sol atriyal hacmin bağımsız öngörücü olduğunu ortaya koydu. GKT, TSVK, mitral yetersizlik ve SA hacminin varlığı ve yaygınlığı arasında anlamlı korelasyonlar gözlendi. Sonuç: GKT'nin varlığı, SA hacmi ile pozitif korelasyon gösterdi. SA hacmi, HKMP hastalarında AF'nin en önemli bağımsız belirleyicisi gibi görünmektedir.

The management of a solitary pulmonary nodule is a challenging issue in pulmonary disease. Although many factors have been defined as predictors for malignancy in solitary pulmonary nodules, the accurate diagnosis can only be established with the permanent histological diagnosis.We tried to clarify the possible predictors of malignancy in solitary pulmonary nodules in patients who had definitive histological diagnosis.We made a retrospective study to collect the data of patients with solitary pulmonary nodules who had histological diagnosis either before or after surgery. We made a statistical analysis of both the clinic and radiological features of these nodules with respect to malignancy both in contingency tables and with logistic regression analysis.We had a total of 223 patients with a radiological diagnosis of solitary pulmonary nodule. Age, smoking status and pack years of smoking, maximum standardized uptake value (SUVmax), and radiological features such as solid component, spiculation, pleural tag, lobulation, calcification, and higher density were significant predictors of malignancy in contingency tables. Age, smoking status and smoking (pack/year), SUVmax, and radiological features including spiculation, pleural tag, lobulation, calcification, and higher density were the significant predictors in univariate analysis. However, multivariate analysis revealed only SUVmax greater than 2.5 (p 0.0001), spiculation (p = 0.009), and age older than 61 years (p = 0.015) as the significant predictors for malignancy.Age, SUVmax, and spiculation are the independent predictors of malignancy in patients with solitary pulmonary nodules.

Introduction: Cerebral embolism after carotid artery stenting (CAS) remains a matter of concern in frailty patients. The prognostic nutrition index (PNI), which provides an objective assessment of nutritional status, is a useful prognostic indicator in cardiovascular diseases. We aim to determine the value of pre-procedural PNI in predicting cerebral embolism including stroke, transient ischemic attack (TIA), and silent new ischemic cerebral lesions (SNICLs). Patients and Methods: We retrospectively evaluated 138 patients (mean age= 70.6 ± 6.7 years, male= 99) who underwent CAS. Inclusion criteria were as follows: i) availability of all medical records including albumin value and lymphocyte count, ii) having cranial imaging after CAS, iii) having symptomatic carotid stenosis 50-99% or asymptomatic carotid stenosis ≥60-99%. The study population was divided into two subgroups according to the presence of cerebral embolism as cerebral embolism (+) cerebral embolism (-) groups. Results: Among the study population, 22 patients (16%) had at least 1 SNICL, seven patients (5.0%) had an ischemic stroke, and five patients (3.6%) had TIA. The cerebral embolism (+) group had a significantly lower PNI, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the cerebral embolism (-) group. Low PNI was identified as one of the independent predictors of cerebral embolism (OR= 0.808; 95% CI= 0.670-0.975; p= 0.026), and PNI lower than 44.7 predicted cerebral embolism with a sensitivity of 70.6% and a specificity of 61.1% (AUC= 0.739; 95% CI= 0.651 to 0.827; p< 0.001). Conclusion: The current data suggest that PNI is an independent prognostic factor for cerebral embolic complications after CAS procedures.

Background The prognostic value of C-reactive protein/albumin ratio (CAR) is of import in cardiovascular diseases. Our aim was to evaluate the impact of the CAR in patients with asymptomatic abdominal aortic aneurysm (AAA) undergoing endovascular aneurysm repair (EVAR). Material and Method We retrospectively evaluated 127 consecutive patients who underwent technically successful elective EVAR procedure between December 2014 and September 2020. The optimal CAR cut-off value was determined by using receiver operating characteristic (ROC) curve analysis. Based on the cut-off value, we investigated the association of CAR with long-term all-cause mortality. Results 32 (25.1%) of the patients experienced all-cause mortality during a mean 32.7 ± 21.7 months’ follow-up. In the group with mortality, CAR was significantly higher than in the survivor group (4.63 (2.60–11.88) versus 1.63 (0.72–3.24), p < 0.001). Kaplan–Meier curves showed a higher incidence of all-cause mortality in patients with high CAR compared to patients with low CAR (log-rank test, p < 0.001). Multivariable Cox regression analysis revealed that glucose ≥ 110 mg/dL (HR: 2.740; 95% CI: 1.354–5.542; p = 0.005), creatinine ≥ 0.99 mg/dL (HR: 2.957, 95% CI: 1.282–6.819, p = 0.011) and CAR > 2.05 (HR: 8.190, 95% CI: 1.899–35.320, p = 0.005) were the independent predictors of mortality. Conclusion CAR was associated with a significant increase in postoperative long-term mortality in patients who underwent EVAR. Preoperatively calculated CAR can be used as an important prognostic factor.

Purpose: Hypertrophic cardiomyopathy (HCM) is related with structural and pathologic changes in the left atrium (LA) and left ventricle (LV). The aim of this study was to explore the association between LA mechanics and LV charac-teristics in patients with HCM using cardiac magnetic resonance feature tracking (CMR-FT). Material and methods: A total of 76 patients with HCM and 26 healthy controls were included in the study. The pa-rameters including the extent of LV late gadolinium enhancement (LGE-%) and the LV early diastolic longitudinal strain rate (edLSR) were assessed for LV. LA conduit, booster, and reservoir functions were assessed by LA fractional volumes and strain analyses using CMR-FT. HCM patients were classified as HCM patients without LGE, with mild LGE-% (0% < LGE-% >= 10%), and prominent LGE-% (10% < LGE-%).Results: HCM patients had worse LA functions compared with the controls (p < 0.05). The majority of LA functional indices were more impaired in HCM patients with regard to LGE. LA volumes were higher in HCM patients with prominent LGE-% compared with HCM patients with mild LGE-% (p < 0.05). However, only a minority of LA functional parameters differed between the 2 groups. LA strain parameters showed weak to modest correlations with LV LGE-% and LV edLSR.Conclusions: LV characteristics, to some extent, influence LA mechanics, but they might not be the only factor induc-ing LA dysfunction in patients with HCM.

Saphenous venous graft to pulmonary artery fistula is a rare condition.Below we report a casewith saphenous venous graft to left pulmonary artery fistula presenting with coronary ischemia and right heart failure in the literature. 61 year-old male patient was admitted to our emergency department with exertional chest pain. He had previous history of coronary artery bypass graft (CABG) operation.The transthorasic echocardiogram displayed normal left ventricular ejection fraction (55%) .However, right ventricular systolic functional parameters were decreased, tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity were found as 13mm and 7 cm/sec,respectively. Coronary angiography represented critical stenosis in native coronary arteries.Left internal mammarian arterial graft (LIMA) to LAD remains to be patent. Aorto-CXA saphenous venous graft was also patent. Aorto-RCA and LAD septal sequential saphenous venous graft was patent in RCA course, a fistula from Aorto-RCA and LAD septal sequential venos graft to left pulmonary artery was observed. Coronary computed tomography clearly represented the fistula from venus graft to pulmonary artery. The patient was discussed by Heart Team and re-operation was decided, the patient declined the operation and he was discharged from the hospital under medical therapy. Acquired coronary artery fistulas mostly develop after CABG surgery ; moreover, they may be related to trauma ,neoplasmor infection.They may develop in various areas,there are several data reporting coronary artery fistulas from LIMA or saphenous grafts to pulmonary artery. To the best of our knowledge, this current case was the first case report demonstrating the saphenous venous graft fistulazation without venous aneurysm to pulmonary artery linked to right ventricle failure and coronary ischemia togetherness without any other underlying cause to explain the right heart failure.

Purpose We aimed to compare COVID-19 imaging findings of young adults (19–35 years of age) with those of children (0–18 years) and to correlate imaging findings of young adults with their laboratory tests. Materials and methods This retrospective study included Real Time-Polymerase Chain Reaction (RT-PCR) confirmed 130 young adults (mean age: 28.39 ± 4.77; 65 male, 65 female) and 36 children (mean age: 12.41 ± 4.51; 17 male, 19 female), between March and June 2020. COVID-19 related imaging findings on chest CT were examined in young adults and compared with children by the Mann-Whitney U, and Chi-square or Fisher's exact test. Laboratory examinations of young adults were assessed in terms of correlation with radiological findings by the Spearman's correlation analysis. Results Bilateral multiple distributions (p = 0.014), subpleural involvement, and pleural thickening (p = 0.004), GGOs with internal consolidations were more frequent in adults (p = 0.009). Infiltrations were significantly larger than 20 mm in young adults (p = 0.011). The rates of feeding vessel sign, vascular enlargement, and halo sign were significantly higher in young adults (p

Objective In this study, we aimed to determine the plasma proadrenomedullin (ProADM) levels in patients with rheumatic mitral stenosis (MS), to evaluate the relationship between ProADM levels and the echocardiographic parameters that represent the severity of stenosis and symptoms, and to compare the ProADM and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, which is a well-known marker for rheumatic MS. Methods Our study included 53 consecutive patients with isolated rheumatic MS and 45 volunteers with similar age and gender features. Patients with MS were divided into two groups based on the presence of an indication for intervention. Detailed echocardiographic examinations were performed on all participants, and blood samples were collected to detect the NT-proBNP and ProADM levels. Results NT-proBNP and ProADM levels were significantly higher in the rheumatic MS group compared with the control group. In rheumatic MS groups, patients with an indication for intervention had higher levels of NT-proBNP and ProADM compared with patients without an indication for intervention. Moreover, NT-proBNP and ProADM levels were found to be significantly correlated with echocardiographic parameters, which revealed the severity of stenosis in various degrees. Both parameters increased as the New York Heart Association (NYHA) class increased, and this increase had a statistical significance. Additionally, the cut-off values of both parameters (NT-proBNP: 119.9 pg/mL, ProADM: 6.15 nmol/L) could detect patients with an indication for intervention with high sensitivity and specificity rates. NT-proBNP was found to be slightly more effective in this regard. Conclusion The increased NT-proBNP and ProADM levels in patients with isolated rheumatic MS can help clinicians in distinguishing patients with an indication for intervention by providing additional information to echocardiography.

INTRODUCTION Aortic stenosis (AS) is the most common degenerative valvular heart disease that can affect left ventricular functions. Tp-e interval and Tp-e/QT ratio is a novel repolarization marker which is associated with adverse cardiovascular events in several cardiovascular diseases. In our study, our aim is to investigate the prognostic effect of Tp-e interval, Tp-e/QT and Tp-e/QTc ratios on mortality in patients who underwent successful surgical aortic valve replacement (AVR). METHODS A total of three hundred seventy-five patients undergoing successful surgical AVR were included in this study. Then, patients were divided into two groups according to mortality as group 1 without mortality (342 patients) and group 2 with mortality (33 patients). Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were calculated for both groups. RESULTS Tp-e interval (71 (63.7-77); 86 (84-88), p

Using the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) ratio as an index of right ventricular load adaptability, we aimed to evaluate early changes in right heart contractile function of patients with group 1 pulmonary artery hypertension (PAH) after sequential combination PAH-specific therapy.A total of 49 patients with group 1 PAH and 31 control participants were included in the study. The baseline clinical and echocardiographic data of the control and PAH group were compared. Subsequently, clinical and echocardiographic data of PAH patients before treatment and at 6 months after PAH-specific treatment were analyzed.A significant increase in the TAPSE/PASP ratio was found in patients at 6 months of PAH-specific treatment (0.25 ± 0.14; 0.33 ± 0.16, p 0.001). Right atrial pressure (8 mm Hg [5-10]; 5 mm Hg [3-8], p 0.001) and PASP (80.8 ± 30.6 mm Hg; 65.9 ± 25.7 mm Hg, p 0.001) were significantly lower after sequential combination PAH-specific therapy. Negative correlations were found between the TAPSE/PASP ratio and N‑terminal pro-B-type natriuretic peptide (r = -0.524, p 0.001), tricuspid regurgitation velocity (r = -0.749, p 0.001), right atrial area (r = -0.298, p = 0.037), and right atrial pressure (r = -0.463, p = 0.001).In patients with group 1 PAH, echocardiographic evaluation at the early stage of treatment (6 months) shows a significant improvement in the TAPSE/PASP ratio indicating right ventricular load adaptation. Comprehensive studies are needed on the routine use of the TAPSE/PASP ratio in the risk assessment of PAH patients.HINTERGRUND: Ziel der Arbeit war es, mit der Verwendung des Quotienten (TAPSE/PASP) der systolischen Exkursion der Trikuspidalringebene (TAPSE) zum pulmonalarteriellen systolischen Druck (PASP) – als Index für die rechtsventrikuläre Anpassungsfähigkeit an die Herzlast – früh auftretende Veränderungen der kontraktilen Funktion des rechten Herzens bei Betroffenen mit pulmonalarterieller Hypertonie (PAH) der Gruppe 1 nach sequenzieller PAH-spezifischer Kombinationstherapie zu beurteilen.In die vorliegende Studie wurden 49 Betroffene mit PAH der Gruppe 1 und 31 Teilnehmende als Kontrollen einbezogen. Dabei wurden die klinischen und echokardiographischen Ausgangsdaten der Kontroll- und der PAH-Gruppe verglichen. Anschließend wurden die klinischen und echokardiographischen Daten der PAH-Betroffenen vor der Behandlung und 6 Monate nach PAH-spezifischer Therapie ausgewertet.Bei PAH-Betroffenen fand sich beim Follow-up nach 6 Monaten ein signifikanter Anstieg beim TAPSE/PASP-Quotienten (0,25 ± 0,14; 0,33 ± 0,16; p 0,001). Der rechtsatriale Druck (8 mm Hg [5–10]; 5 mm Hg [3–8]; p 0,001) und PASP (80,8 ± 30,6 mm Hg; 65,9 ± 25,7 mm Hg; p 0,001) waren nach sequenzieller PAH-spezifischer Kombinationstherapie signifikant niedriger. Negative Korrelationen wurden festgestellt zwischen dem TAPSE/PASP-Quotienten und dem „N-terminal pro-B-type natriuretic peptide“ (NT-proBNP; r = −0,524; p 0,001), der trikuspidalen Regurgitationsgeschwindigkeit (r = −0,749; p 0,001), der rechtsatrialen Fläche (r = −0,298; p = 0,037) und dem rechtsatrialen Druck (r = −0,463; p = 0,001).Bei Betroffenen mit PAH der Gruppe 1 war bei der echokardiographischen Beurteilung in einem frühen Behandlungsstadium (nach 6 Monaten) eine signifikante Verbesserung des TAPSE/PASP-Quotienten festzustellen, was ein Zeichen einer rechtsventrikulären Anpassung an die Herzlast darstellt. Vergleichende Studien sind erforderlich, um den Routineeinsatz des TAPSE/PASP-Quotienten in der Risikoabschätzung von PAH-Betroffenen zu beurteilen.

Objective Long QT syndrome (LQTS) is an inherited cardiac ion channel disorder (channelopathy) that is characterized by prolonged QT intervals on the electrocardiography (ECG) and possess the risk of sudden cardiac death (SCD). Jervell-Lange Nielsen syndrome (JLNS) is a specific subtype of LQTS that is accompanied by congenital sensorineural hearing loss, inherited autosomal recessively, and higher risk of SCD. In this study, we aimed to investigate JLNS prevalence in deaf children attending special schools for hearing loss, located in our province. Methods An ECG screening program was conducted in 6 special schools for children with hearing loss in Istanbul and a total of 440 students between 6 and 18 years old were included. Corrected QT interval (QTc) was calculated using the Bazett formula. Notably, 51 students, detected with any abnormal finding on ECG, were invited to our center for a comprehensive examination. Results A total of 8 patients were found with a prolonged QT interval. JLNS was diagnosed in 4 (0.9%) patients. In addition, 2 students had already been diagnosed with JLNS at another center earlier. The other 2 students, being siblings, were newly diagnosed with JLNS; and appropriate treatment was initiated. Genetic testing revealed a pathological homozygous mutation in KCNQ1 gene. The younger sibling (Case 1), who possessed a QTc of greater than 500 ms and a history of syncope, which was very suspicious for SCD, was implanted an implantable cardioverter-defibrillator. Propranolol treatment was initiated for both siblings. Conclusion JLNS should be carefully considered and screened, especially in patients with a history of congenital deafness.

Purpose:Mitral stenosis (MS) is torelated for an extended period in patients with atrial septal defect (ASD) known as Lutembacher syndrome due to depressurizing effect. In a similar way, patients with patent foramen ovale (PFO) may have clinical benefits in severe MS. We aim to evaluate the clinical effects of PFO in rheumatic MS. Methods and Results:Transthoracic and transesophageal echocardiography records of the patients with symptomatic severe MS were screened for the period between 2008-2019 in a single center. Three-hundred-twenty symptomatic patients with severe MS were included and presence of PFO recorded. Left atrial appendix (LAA) thrombotic status was defined as clear, spontaneous echo contrast, and thrombus. Two different statistical models were used to determine the predictors of either smallest (mitral valve area) MVA at symptomatic presentation or more thrombogenic LAA. Thirty-four patients had PFO. Multivariable ordinary least square model demonstrated that increase in systolic pulmonary arterial pressure, ejection fraction and presence of PFO were associated with smaller MVA on presentation. Multivariable proportional odds logistic regression model demonstrated that advanced age, increased left atrial diameter, absence of PFO were associated with more thrombotic status whereas larger MVA was associated with decreased thrombotic status in LAA. Conclusion:Presence of PFO in severe MS results in two clinical benefits as i) being asymptomatic with smaller MVA and ii) having less LAA thrombosis probably caused by depressurizing effect on the left atrial pressure. Our study, could serve as an example for patient groups with expected symptomatic benefits from left atrium pressure offloading interventions.

Background Congenital coronary artery anomalies (CCAAs) have the potential for life-threatening complications, including malignant ventricular arrhythmias and sudden cardiac death (SCD). In this study, we aimed to evaluate the relationship between impaired repolarization parameters and poor cardiovascular clinical outcomes in patients with potentially serious CCAAs. Methods This retrospective study included 85 potentially serious CCAA patients (mean age: 54.7 ± 13.6 years; male:44) who were diagnosed with conventional and coronary computed tomography angiography (CCTA). All patients underwent transthoracic echocardiography and 12-lead surface electrocardiography. Cardiac events were defined as sustained ventricular tachycardia or fibrillation, syncope, cardiac arrest and SCD. Results The presence of interarterial course (IAC) was confirmed by CCTA in 37 (43.5%) patients. During a median follow-up time of 24 (18-50) months, a total of 11 (12.9%) patients experienced cardiac events. The presence of IAC was significantly more frequent and Tp-e interval, Tp-e/QTc ratio and frontal QRS/T angle (fQRSTa) were significantly greater in patients with poor clinical outcomes. Moreover, the presence of IAC, high Tp-e/QTc ratio and high fQRSTa were found to be independent predictors of poor clinical outcomes and decreased long-term cardiac event-free survival in these patients. A net reclassification index was +1.0 for the Tp-e/QTc ratio and +1.3 for fQRSTa which were confirmable for additional predictability of these repolarization abnormalities. Conclusion Impaired repolarization parameters, including wider fQRSTa, prolonged Tp-e interval, and increased Tp-e/QTc ratio, and IAC may be associated with poor cardiovascular clinical outcomes in potentially serious CCAA patients.

OBJECTIVE The study aimed to evaluate the influence of different degrees of multidetector computed tomography (MDCT)-based perimeter oversizing on incidence and severity of paravalvular aortic regurgitation (PAR) and conduction disturbances (CD) for the Portico device. METHODS We retrospectively analyzed 63 patients who underwent transcatheter aortic implantation (TAVI) in our center from March 2017 to June 2019. Patients were divided into two groups (group I, below %13.9; group II, above 13.9%) based on the degree of oversizing. Oversizing was calculated as (Device nominal perimeter / MDCT-derived annular perimeter - 1) * 100. Procedural and clinical data were evaluated by VARC-2 definitions. RESULTS Mild or greater PAR was present in 76.4% of patients in group I and 34.4% of patients in group II (P = 0.009). The rate of CD tended to be lower in the patient's group I (P = 0.034). A cutoff value of 13.9% was identified as having the best predictive value for mild or greater PAR. On multivariate analysis, a lower percentage of oversizing (odds ratio 6.38; %95 confidence interval 2.00 - 20.33; P = 0.002) emerged as the most powerful independent predictor of PAR, whereas the implantation depth and severe oversizing were independent predictors of CD (P = 0.003 and P = 0.029, respectively). We demonstrated that the optimal acceptable perimeter-based oversizing range appears to be between 10 - 15%. CONCLUSION Perimeter-based oversizing by MDCT inversely correlated with PAR after TAVI for Portico device, and its preoperative evaluation could help in predicting PAR and CD.

The coexistence of pannus and thrombus is not uncommon. Accurate diagnosis of the etiology of prosthetic valve dysfunction (PVD) is of utmost importance in guiding adequate and rational therapy. We present a case of PVD in which computed tomography played a decisive role in guiding treatment. (Level of Difficulty: Intermediate.), Central Illustration

Endomyocardial fibrosis (EMF), a restrictive cardiomyopathy characterized by subendocardial fibrosis, is commonly seen in tropical and subtropical regions. EMF involving the left ventricle presents with severe pulmonary hypertension (PH) and is a rare cause of PH in non-tropical areas. Multimodality imaging is important for accurate diagnosis, especially cardiac magnetic resonance imaging which is the cornerstone. Herein, we report the case of a patient who presented with heart failure symptoms and severe PH, and in whom EMF was diagnosed by multimodality imaging.

Introduction:In this study, we aimed to investigate the short-term stability and variability of cardiac troponin T (cTnI) in ethylenediamine tetraacetic acid (EDTA) whole blood, heparinized whole blood, and EDTA plasma.Methods:Thirteen patients with myocardial infarction were included. Venous blood samples (24 mL) from all patients were collected into vacuum tubes with EDTA and heparin (Becton Dickinson-USA), and analyses were performed on four different groups (one group for repeatability and three groups for stability).Results:There was no statistically significant difference in cTnI concentrations at baseline, 2, 4, 6, 12, 24, and 48 hours between the heparinized whole blood, EDTA whole blood, and EDTA plasma groups (group 2) (p>0.05). In the heparinized whole blood and EDTA plasma groups, there was a statistically significant difference between cTnI concentrations at baseline, 2, 4, 6, 12, 24, and 48 hours. In the EDTA whole blood group, there was no statistically significant difference between any time points.Conclusion:The interclass and intraclass correlation coefficients of the EDTA whole blood group were sufficiently high, which indicates better stability. EDTA whole blood samples are preferable for cTnI measurement because they are stable for 48 hours. EDTA-containing tubes are easy to find in clinical laboratories and do not need to be centrifuged, which saves time and effort.

Transcatheter device closure is a common treatment option of atrial septal defect. Mitral regurgitation has been reported with comorbid mitral valve prolapse and atrial septal defect. However there is no consensus regarding the pathogenesis of mitral regurgitation after closure. We are reporting a patient with functional mitral regurgitation associated with both an oversize closure device and wall motion abnormality after inferior myocardial infarction.

Amac: Doku Doppler kaynakli isovolumik akselerasyon (IVA) her iki ventrikulun sistolik fonksiyonunu on ve ard yukten etkilenmeden degerlendiren bir parametredir. Bu calismada asemptomatik aort darligi (AD) olan hastalarda, sol ventrikul sistolik disfonksiyonun IVA ile erken asamada tespiti amaclanmistir. Gerec ve Yontemler: Calismaya izole AD bulunan 75 hasta ve herhangi bir kapak hastaligi bulunmayan 30 hasta olmak uzere toplam 105 hasta dahil edildi. AD hastalari, transtorasik ekokardiyografi ile belirlenen aort kapak alani (AKA) ve aortik pik velositeye gore uc gruba (hafif, orta ve ileri) ayrildi. Konvansiyonel ekokardiyografi parametreleri, sistolik ve diyastolik doku Doppler parametreleri [isovolumik kontraksiyon esnasinda olusan pik miyokardiyal velosite (IVV), ejeksiyon fazinda olusan miyokardiyal velosite (Sm), erken diyastolik miyokardiyal velosite (e'), gec diyastolik miyokardiyal velosite (a'), akselarasyon zamani (AT)] tum hastalarda hesaplandi. IVA, IVV akim hizinin AT suresine bolunmesiyle elde edildi. Bulgular: Sistolik parametrelerden IVV (p