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Rosacea may contribute to the development of cardiovascular (CV) diseases by causing endothelial dysfunction (ED), which is known to be the initial step of atherosclerosis, due to its inflammatory features.This study aimed to assess ED in rosacea patients using the flow-mediated dilatation (=dilation) (FMD) method.Seventy-three rosacea patients and 73 age, gender-matched healthy volunteers were enrolled. Individuals with cardiac risk factors, pregnant, and lactating women were excluded. Demographic, clinical data and anthropometric measurements were recorded. FMD measurement was performed ultrasonographically by a cardiologist. Systolic and diastolic blood pressures (BP) were measured and hemogram, erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), and fasting blood glucose values were assessed.The FMD value was statistically lower in rosacea patients compared with healthy controls (p = 0.000). Metabolic syndrome, systolic and diastolic BPs, and plasma NLR were higher in the rosacea group (p = 0.009, p = 0.000, p = 0.000, p = 0.000, respectively). According to the multivariate linear regression analysis, rosacea type significantly predicted FMD.Rosacea is not only a disease limited to the skin, but it may also have systemic involvement. A significant difference was found between FMD values measured in between the case and control groups, suggesting rosacea may have an atherogenic effect. Possible cardiac risks should be considered in rosacea patients, and further evaluation could be warranted.

An accurate diagnosis of pulmonary hypertension (PH) is crucial to ensure that patients receive timely treatment. One of the used imaging models to detect pulmonary hypertension is the X-ray. Therefore, a new automated PH-type classification model has been presented to depict the separation ability of deep learning for PH types. We retrospectively enrolled 6642 images of patients with PH and the control group. A new X-ray image dataset was collected from a multicentre in this work. A transfer learning-based image classification model has been presented in classifying PH types. Our proposed model was applied to the collected dataset, and this dataset contains six categories (five PH and a non-PH). The presented deep feature engineering (computer vision) model attained 86.14% accuracy on this dataset. According to the extracted ROC curve, the average area under the curve rate has been calculated at 0.945. Therefore, we believe that our proposed model can easily separate PH and non-PH X-ray images.

SUMMARY OBJECTIVE: The purpose of this study was to explore the efficacy of the triglyceride glucose (TyG) index on in-hospital mortality in nondiabetic coronavirus disease 2019 (COVID-19) patients with myocardial injury. METHODS: This was a retrospective study, which included 218 nondiabetic COVID-19 patients who had myocardial injury. The TyG index was derived using the following equation: log [serum triglycerides (mg/dL) ×fasting blood glucose (mg/dL)/2]. RESULTS: Overall, 49 (22.4%) patients died during hospitalization. Patients who did not survive had a higher TyG index than survivors. In multivariate Cox regression analysis, it was found that the TyG index was independently associated with in-hospital death. A TyG index cutoff value greater than 4.97 was predicted in-hospital death in nondiabetic COVID-19 patients with myocardial damage, with 82% sensitivity and 66% specificity. A pairwise evaluation of receiver operating characteristic (ROC) curves demonstrated that the TyG index (AUC: 0.786) had higher discriminatory performance than both triglyceride (AUC: 0.738) and fasting blood glucose (AUC: 0.660) in predicting in-hospital mortality among these patients. CONCLUSIONS: The TyG index might be used to identify high-risk nondiabetic COVID-19 patients with myocardial damage.

PURPOSE: We investigated the efficacy and safety of hydroxychloroquine for empirical treatment of outpatients with confirmed COVID-19. METHODS: In this prospective, single-center study, we enrolled ambulatory outpatients with COVID-19 confirmed by a molecular method who received hydroxychloroquine. The patients were divided into low- and moderate-risk groups based on the Tisdale risk score for drug-associated QT prolongation, and the QT interval was corrected for heart rate using the Bazett formula (QTc). The QTc interval was measured by electrocardiography both pretreatment (QTc1) and 4 h after the administration of hydroxychloroquine (QTc2). The difference between the QTc1 and QTc2 intervals was defined as the ΔQTc. The QTc1 and QTc2 intervals and ΔQTc values were compared between the two risk groups. RESULTS: The median and interquartile range (IQR) age of the patients was 47.0 (36.2-62) years, and there were 78 men and 74 women. The median (IQR) QTc1 interval lengthened from 425.0 (407.2-425.0) to 430.0 (QTc2; 412.0-443.0) milliseconds (ms). However, this was not considered an increased risk of ventricular tachycardia associated with a prolonged QTc interval requiring drug discontinuation, because none of the patients had a ΔQTc of >60 ms or a QTc2 of >500 ms. Moreover, the median (quartiles; minimum-maximum) ΔQTc value was higher in patients in the moderate-risk group than those in the low-risk group (10.0 [-4.0-18.0; -75.0-51.0] vs. 7.0 [-10.5-23.5; -53.0-59.0 ms]) (p = 0.996). Clinical improvement was noted in 91.4% of the patients, the exceptions being 13 patients who presented with non-serious adverse drug reactions or who had severe COVID-19 and were hospitalized. Adverse effects related to hydroxychloroquine were non-serious and occurred in 52.8% (n = 80) of the patients. CONCLUSIONS: Our findings show that hydroxychloroquine is safe for COVID-19 and not associated with a risk of ventricular arrhythmia due to drug-induced QTc interval prolongation. Additionally, hydroxychloroquine was well tolerated, and there were no drug-related non-serious adverse events leading to treatment discontinuation in the majority of patients who were stable and did not require hospitalization.

OBJECTIVE To analyse the correlation of overactive bladder (OAB) and severity of coronary artery disease (CAD) by using Gensini score in postmenopausal women. STUDY DESIGN Observational correlation study design. PLACE AND DURATION OF STUDY Haseki Training and Research Hospital, Istanbul, Turkey, from January 2016 to January 2018. METHODOLOGY Female patients in postmenopausal status, who had undergone coronary angiography due to CAD in tertiary academic care centre cardiology unit, were enrolled in the study. The Gensini score of each patient was calculated by two different cardiologists and the average score was taken. All participants filled the OAB-V8 questionnaire (Validated Turkish form). The participants were separated into two groups according to the severity OAB symptoms. Patients with OAB-V8 score ≥8, were included into OAB Group and patients with OAB-V8 score

Introduction: To investigate the predictive accuracy of the CHA2 DS2 -VASc-HSF score in predicting the one-year mortality and major adverse cardiac and cerebrovascular events (MACCEs) in patients with non-STelevation acute coronary syndrome (NSTE-ACS). Patients and Methods: In this retrospective study, the study cohort was divided in to two groups based on the median CHA2 DS2 -VASc-HSF score: low-risk group (≤ 4 points) and high-risk group (> 4 points). Results: We enrolled 394 patients with NSTE-ACS (mean age: 58.7 ± 11.8 years). The CHA2 DS2 -VASc-HSF score independently predicted the coronary artery disease (CAD) severity (p< 0.01), one-year mortality (p< 0.01), and MACCEs (p< 0.01). The Global Registry for Acute Coronary Events (GRACE) risk score (GRS 1.0) independently predicted the CAD severity (p< 0.01), whereas the revised GRACE 2.0 risk score (GRS 2.0) independently predicted the one-year mortality (p< 0.01) and MACCEs (p< 0.01). The diagnostic performance of CHA2 DS2 -VASc-HSF was similar to GRS 2.0 in predicting the one-year mortality and MACCEs [area under the curve (AUC), 0.75 and 0.69 vs. 0.78 and 0.67; p= 0.41, p= 0.38, respectively) and better than GRS 1.0 for the CAD severity (AUC, 0.85 vs. 0.79; p= 0.03). The Kaplan-Meier curves displayed significantly higher one-year mortality and MACCEs in the high-risk group (p< 0.01) compared with the low-risk group (p< 0.01). Conclusion: The predictive accuracy of CHA2 DS2 -VASc-HSF is comparable to that of GRS 2.0 in determining the long-term cardiovascular outcomes; thus, it could be considered as a predictive model for patients with NSTE-ACS., Giriş: Bu çalışmada esas olarak modifiye CHA2 DS2 -VASc-HSF skorunun ST-yükselmesiz akut koroner sendromlu (STYz-AKS) hastalarda bir yıllık mortalite ve majör advers kardiyak ve serebrovasküler olayları (MACCEs) öngörüp öngörmediğini araştırmayı amaçladık. Hastalar ve Yöntem: Hastane kayıtları kullanılarak tasarlanmış bu retrospektif çalışmada, çalışma popülasyonu ortanca CHA2 DS2 -VASc-HSF skoruna göre düşük (≤ 4 puan) ve yüksek riskli (> 4 puan) olarak iki gruba ayrılmıştır. Bulgular: Çalışmaya ortalama 58.7 ± 11.8 yaşında olan 394 STYz-AKS hastası dahil edilmiştir. CHA2 DS2 - VASc-HSF skoru, koroner arter hastalığı (KAH) yaygınlığının, bir yıllık mortalitenin ve MACCEs’in bağımsız öngördürücüsü olarak bulunmuştur (sırasıyla, p< 0.01, p< 0.01, p< 0.01). Ayrıca “The Global Registry for Acute Coronary Events (GRACE)” 1.0 risk skorunun KAH yaygınlığı için (p< 0.01), güncellenmiş GRACE 2.0 risk skorunun ise bir yıllık mortalite ve MACCEs için bağımsız öngördürücü olduğunu saptadık (sırasıyla, p< 0.01, p< 0.01). CHA2 DS2 -VASc-HSF ve GRACE 2.0 risk skorlarının bir yıllık mortalite ve MACCEs’i öngörmede tanısal performanları istatistiksel olarak birbirine benzer iken [eğri altında kalan alan (AUC)= 0.75 ve 0.69 vs. 0.78 ve 0.67; sırasıyla, p= 0.41, p= 0.38), CHA2 DS2 -VASc-HSF KAH şiddetini öngörmede GRACE 1.0 risk skorundan daha iyi performans sergiledi (AUCs= 0.85 vs. 0.79; p= 0.03). Kaplan-Meier eğrisi CHA2 DS2 -VASc-HSF skoru > 4 puan olan hastalarda düşük riskli hastalara göre bir yıllık mortalite ve MACCEs’in istatistiksel olarak anlamlı derecede daha yüksek olduğunu gösterdi (sırasıyla, p< 0.01, p< 0.01). Sonuç: CHA2 DS2 -VASc-HSF’nin uzun dönem kardiyovasküler sonuçları öngörmedeki doğruluğu GRACE 2.0 ile kıyaslanabilir düzeyde olup klinik uygulamada STYz-AKS hastaları için bir tahmin modeli olarak düşünülebilir.

OBJECTIVE To investigate whether inflammation based scores including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) predict the slow flow (SF)/no-reflow (NR) phenomenon comparatively in patients with non-ST-elevated Myocardial Infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). METHODS Current study is retrospective designed and includes 426 NSTEMI patients (mean age of 56.8 ± 11.4 years). The patients were grouped into non slow flow/no-reflow and slow flow/no-reflow groups according to postintervention thrombolysis in myocardial infarction flow grade. RESULTS The slow flow/no-reflow group had significantly higher MHR and lower LMR values than the non slow flow/no-reflow group (P

Background and objectives: In this study, we aimed to evaluate whether the systemic immune-inflammation index (SII) has a prognostic value for major adverse cardiac events (MACEs), including stroke, re-hospitalization, and short-term all-cause mortality at 6 months, in aortic stenosis (AS) patients who underwent transcatheter aortic valve implantation (TAVI). Materials and Methods: A total of 120 patients who underwent TAVI due to severe AS were retrospectively included in our study. The main outcome of the study was MACEs and short-term all-cause mortality at 6 months. Results: The SII was found to be higher in TAVI patients who developed MACEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the SII (HR: 1.002, 95%CI: 1.001–1.003, p &lt, 0.01) was an independent predictor of MACEs in AS patients after TAVI. The optimal value of the SII for MACEs in AS patients following TAVI was &gt, 1.056 with 94% sensitivity and 96% specificity (AUC (the area under the curve): 0.960, p &lt, 0.01). We noted that the AUC value of SII in predicting MACEs was significantly higher than the AUC value of the C-reactive protein (AUC: 0.960 vs. AUC: 0.714, respectively). Conclusions: This is the first study to show that high pre-procedural SII may have a predictive value for MACEs and short-term mortality in AS patients undergoing TAVI.

Insulin resistance is one of the most important risk factors that accelerate atherosclerosis. The goal of this study is to investigate the relationship between the triglyceride glucose (TyG) index and functional vessel disease measured using pulse wave velocity (PWV), in a nondiabetic asymptomatic Turkish population. Nondiabetic, healthy patients (n = 1095) with no previous history of coronary heart disease were enrolled. Functional vessel disease was detected by measuring PWV. The TyG index was calculated using the following equation: log [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The study population was divided into 2 groups based on their TyG index. The high TyG index group had higher PWV, corrected PWV, left ventricular mass index, body mass index, rates of hypertension, and was predominately male. Age, gender, blood urea nitrogen level, and TyG index were detected as independent risk factors of PWV in linear regression analysis. Triglyceride glucose index and age were also independent risk factors of the corrected PWV in logistic regression analysis. These findings show a relationship between TyG index and subclinical vessel disease, even in patients without a history of atherosclerotic cardiovascular disease or diabetes.

Background/aim: arterial stiffness, known as a predictor of early vascular aging, was defined as the main determinant of cardiovascular mortality and morbidity. However, the relationship between lipid profile and increased arterial stiffness is not clear. The aim of this study is to investigate the relationship between lipid profiles and increased arterial stiffness in patients with early vascular aging syndrome. Materials and methods: a total of 1582 participants -504 (31.8%) of were male and the mean age was 52.8 +/- 14.2 years- were included in the study . Patients who applied to the hospital for various reasons and who had undergone 24-h blood pressure Holter monitoring were included in this study. Patients were divided into four groups according to pulse wave velocity (PWV) quartiles (Q1 (8.8)). Results: we found that in the highest PWV group, patients had higher systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, blood urea nitrogen (BUN), creatinine, urinary albumin excretion (UAE), uric acid(UA), total cholesterol (TC), low-density lipoprotein ( LDL-C), triglycerid (TG), and non-high-density lipoprotein (HDL-C ) levels. Additionally, diabetes mellitus (dm), age, non-HDL-C, and TG/ HDL-C levels were detected as independent risk factors of increased PWV in ordinal logistic regression analysis. Conclusion: our study demonstrates that lipid parameters are strongly correlated with increased PWVvalue and early vascular aging. In daily clinical practice, TG\HDL-C ratio, known as atherogenic index, might be used routinely for predicted of early vascular aging and subclinical atherosclerosis., NA

Introduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n=64) and it was unsuccessful in 29% of cases (n=26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were significantly elevated in the unsuccessful CTO PCI group. Pre-PCI ECG parameters showed no significant difference. Irrespective of the target vessel revascularization, we observed that PWD and P-max values were significantly lower in the 12th months follow-up. In all Rentrop classes, PWD values were significantly decreased at 12th months follow-up in comparison to the pre-CTO PCI values. Conclusion: This study has determined that PWD and P-max, which are both risk factors for atrial arrhythmias, are significantly reduced within 12th months after successful CTO PCI regardless of the target vessel.

Introduction Early vascular aging syndrome (EVAS) is defined as increased arterial stiffness compared to age and sex matched patients, EVAS is measured by pulse wave velocity (PWV). Aim In our study we aim to identify in patients with high risk of EVAS using the CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores. Methods The CHADS2, CHA2DS2-VASc-HS and CHADS2VASC scoring systems are advised to determine management strategies in patients with nonvalvular atrial fibrillation. As they contain similar risk factors for the development or presence of EVAS, we believed that this risk scoring system could also be used to predict EVAS. This study was designed as a retrospective observational study. 2108 consecutive patients who had undergone 24-h blood pressure monitoring and measured PWV levels were included in the study. The patients were divided into the two groups according to corrected Pwv values. Results CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores were positively correlated with PWV values (r =0.251, p < 0.001; r = 0.457, p < 0.001; and r = 0.385, p < 0.001, respectively). CHA2DS2-VASc-HS score was statistically better than CHA2DS2, CHA2DS2-VASc score to predict early vascular aging syndrome (p < 0.001). For the prediction of EVAS, the cut-off value of CHA2DS2-VASc-HS score was >= 1.5 with a sensitivity of 49% and a specificity of 50 % (AUC 0.605; 95% [CI] 0.58-0.63) in the ROC curve analyses. Conclusions The CHA2DS2-VASc-HS scoring system might be used in daily clinical practice to calculate the total risk assessment of EVAS. This score is relatively simple to use and time-saving technique.

Introduction:Transcatheter aortic valve implantation (TAVI) has been widely used in patients with high-risk aortic valve stenosis. Frailty is a parameter that significantly affects prognosis in cardiovascular diseases. In the clinic, the identification and validation of simple and inexpensive frailty evaluation methods are important. Our aim is to determine the importance of a simple and inexpensive clinical evaluation tool that can be used in patients with TAVI by examining the correlation between the “clinical frailty scale (CFS)” and “the psoas muscle area (PMA)”, which is a quantitative indicator of fraility.Methods:CFS was determined by clinical evaluation of 61 patients who underwent TAVI and PMA was calculated by computed tomography scan.Results:A significant correlation was found between the CFS and PMA values of the patients in the correlation analysis (r=-0.970, p

Background/aim This study investigated whether baseline serum level of C-reactive protein (CRP)/albumin ratio is associated with infarct localization, number of vascular lesions, and in-hospital mortality in patients undergoing primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI). Methods The study population consisted of 116 patients diagnosed with STEMI. The CRP/albumin ratio at first admission, cardiac troponin-I (cTnI), PCI results, and clinical outcomes were recorded. Results The mean CRP/albumin ratio, cTnI level, and mean number of vascular lesions were significantly higher in non-survivors than in survivors (p = 0.006, p = 0.004, and p = 0.007, respectively). Multivariate logistic regression analysis demonstrated that the CRP/albumin ratio and number of coronary artery lesions were independent predictors of mortality in STEMI patients. According to these analyses, the presence of ? 2 vessel lesions was the most important predictor of mortality, with an odds ratio of 2.009 (95% confidence interval: 1.191?3.387, p = 0.009). Conclusion This study demonstrates the potential utility of the CRP/albumin ratio for predicting the clinical outcome of patients with STEMI. In addition, the presence of ? 2 vascular lesions contributed to a 2-fold increase in mortality rate in STEMI patients.

Objective: To assess outcomes of Syrian refugees undergoing coronary artery bypass surgery in a tertiary hospital in Turkey. Methods: We sought for in-hospital mortality and one year all-cause mortality as the main outcomes. We reviewed records of 67 Syrian and 427 Turkish patients undergoing isolated coronary bypass surgery between 2015 January and 2017 January retrospectively. Results: History of coronary, peripheral and carotid artery diseases and obesity were more frequent in Syrian patients. C-reactive protein levels were higher in Syrian patients whereas lipid profiles and systolic functions of the 2 groups were similar. Syrian patients more frequently presented with the acute coronary syndrome (26.9% versus 15.5%, p

The neutrophil to lymphocyte ratio (NLR), has been proposed as potential indicator of cardiovascular events. Our aim was to determine the relationship between NLR and development of myocardial injury after non-cardiac surgery (MINS).This observational cohort study included 255 consecutive noncardiac surgery patients aged ≥45 years. Electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels of the patients were obtained for a period of 3 days postoperatively.MINS was detected in 30 (11.8%) patients using the cut-off level of ≥14 ng/L for hscTnT. In the MINS group NLR (3.79 ± 0.7 vs. 2.69 ± 0.6, p 0.000) values were higher than non-NLR group. The NLR to be independently associated with the development of MINS (OR: 11.690; CI: 4.619-29.585, p 0.000).NLR seems to be a simple, easy and cheap tool to predict the development of MINS in patient undergoing non-cardiac surgery.

Initial presentation in almost half of the patients with chronic ischemic heart disease (IHD) is chronic stable angina. Despite recent improvements in diagnosis and treatment, IHD still appears to be the most important cause of morbidity and mortality in our country and industrialized countries. The main aim of the treatment of chronic stable angina is to increase life expectancy and to improve quality of life by reducing the frequency and severity of angina. Beta-blockers, calcium channel blockers and nitrates constitute the main stones of anti-ischemic and antianginal treatment; new antianginal agents should be considered in patients with resistant angina despite usage of traditional agents. It is essential to add lifestyle modifications to pharmacological treatment and patients should be informed firmly. Even though revascularization therapy has not been shown to be superior to the optimal medical therapy in prognosis and mortality in chronic stabil angina, it reduces angina and necessity to anti-anginal medications and improves exercise capacity and quality of life in patients who are symptomatic despite optimal medical therapy. In this review, we summarized the current approach to chronic stable angina in the light of the American College of Cardiology and European Society of Cardiology guidelines for the diagnosis and assessment of chronic stable angina.

A 52-year-old man complaining of persistent recurring chest pain at night underwent coronary angiogram at another institution. Normal coronaries were observed and he was discharged with muscle spasmolytic prescription. Since symptoms had continued, 24-hour Holter monitoring was ordered at our facility and results revealed huge ST elevation and polymorphic ventricular tachycardia. Cold pressor test performed in catheterization laboratory also resulted in ventricular tachycardia. Nifedipine was prescribed and follow-up Holter monitoring revealed no further vasospastic episodes. Utility of 24-hour Holter rhythm monitoring and cold pressor test in patients with recurrent chest pain at night is demonstrated in this report.

Totally subcutaneous intravascular portacath provide safe and reliable vascular access and is widely utilized for venous access for long-term parenteral administration of medications. Catheter fracture and/or embolization of the catheter fragment in to the heart and or pulmonary artery is a rare and potentially serious complication. When it occurs, a prompt surgical or percutaneous extraction of the embolized foreign body is necessary. We present an asymptomatic case of metastatic colon adenocarcinoma in a patient who had fragmentation of catheter from the connection of the port and migration to left pulmonary arteries. We successfully removed the 10-cm long and 6-Fr diameter fractured catheter segment from the left pulmonary artery via the right femoral vein using a snare catheter with triple loop without complication. Post-procedure course was uneventful and the nature of the vascular access made early ambulation possible. Compared to surgery, percutaneous approach is a less invasive, safe, reliable and effective technique. Therefore, we suggest that percutaneous transcatheter technique for retrieval of embolized or broken catheter fragments should be considered as the first-choice treatment.

Ticagrelor is believed to be a more potent and faster antiplatelet agent compared with clopidogrel and may result in lower ischemic outcomes in patients with acute coronary syndrome. However, the best strategy of switching from ticagrelor to clopidogrel is unclear. Current guidelines advocate clopidogrel bridging with a 600 mg loading dose (LD). This study aimed to compare the safety and feasibility of switching protocols from ticagrelor to clopidogrel 600 mg or 300 mg LD in patients with unstable angina pectoris (USAP). One hundred and eighty patients with USAP undergoing adhoc percutaneous coronary intervention (PCI) received preprocedural ticagrelor 180 mg/daily. The decision to switch antiplatelet therapy to clopidogrel with either 300 mg LD or 600 mg LD at 12 h was left to the discretion of the treating physician. The primary outcome was a composite of an efficacy endpoint major adverse cardiac and cerebrovascular events (MACCEs) and a safety endpoint Bleeding Academic Research Consortium scale (BARC) (≥1). There were no differences in our composite clinical endpoint of MACCE between the two strategies, with one event occurring in each group. One patient in each group had myocardial infarction due to stent thrombosis, and the patient in the 300 mg switching group died due to stent thrombosis. No difference between the two arms was observed in terms of BARC bleeding criteria. This study showed that among USAP patients undergoing PCI, switching to clopidogrel with 300 mg LD showed no significant difference compared to 600 mg clopidogrel LD. Ticagrelor LD in ad hoc PCI and de-escalation to clopidogrel with 300 mg LD could translate to lower costs for patients with USAP without compromising safety and efficacy.

The prognostic value of malnutrition in elderly patients with non-ST-elevated myocardial infarction (NSTEMI) is not fully understood. Nutritional characteristics were evaluated by novel Controlling Nutritional status (CONUT), the prognostic nutritional index (PNI) and the geriatric nutritional risk index (GNRI) scores. The impact of these scores on major outcomes in 253 NSTEMI patients over 60 years and older were assessed. Compared to those with good nutritional status, malnourished patients had more major adverse cardiac and cerebrovascular events (MACCEs) at 1-year follow up. Multivariable cox regression analysis revealed that CONUT (hazard ratio = 1.372, p &lt, 0.01) was independent predictor of MACCEs, whereas PNI (p = 0.44) and GNRI (p = 0.52) were not. The discriminating power of the CONUT (AUC: 0.79) was adequate and significantly superior to both the PNI (AUC: 0.68) and the GNRI (AUC: 0.60), with a p-value for both &lt, 0.01. Patients with elevated CONUT exhibited the highest event rate for all-cause mortality and MACCEs in survival analysis (p &lt, 0.01). We conclude that malnutrition is strongly associated with adverse outcomes in older patients with NSTEMI. In fact, the CONUT score adequately predicts one-year MACCEs among elderly NSTEMI patients who achieve complete revascularization after coronary intervention.

Acute mesenteric ischaemia (AMI) is an emergency condition that requires urgent diagnosis. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been studied as inflammatory biomarkers in atherosclerosis, but data regarding AMI are lacking. The study population included patients with AMI (n = 46) versus age and sex-matched healthy controls (n = 46). Computed multidetector tomographic angiography was performed to diagnose AMI. NLR and PLR were calculated using complete blood count. C-reactive protein (CRP) levels were also analyzed. Neutrophil levels and lymphocytes were significantly higher in patients with AMI than in the control individuals (P 0.001 and P = 0.43, respectively). NLR levels were significantly higher in patients with AMI compared with that in the control individuals (P 0.001). Platelet levels did not reach statistical significance between the groups (P = 0.709). However, patients with AMI had significantly higher PLR levels than the control group (P = 0.039). CRP levels on admission were higher in patients with AMI in comparison with control individuals. There was also a positive correlation between NLR and CRP (r = 0.548, P 0.001), and between PLR and CRP (r = 0.528, P 0.001). NLR level greater than 4.5, measured on admission, yielded an area under the curve value of 0.790 (95% confidence interval 0.681-0.799, sensitivity 77%, specificity 72%), and PLR level of greater than 157 yielded an area under the curve value of 0.604 (95% confidence interval 0.486-0.722, sensitivity 59%, specificity 65%). Patients with AMI had increased NLR, PLR, and CRP levels compared with controls. Increased NLR and PLR was an independent predictor of AMI.

Background: Vasodilatory function of radial artery (RA) declines following the transradial catheterization. However, it is uncertain whether impaired vasodilatory function develops in every patient. The aim of this study was to investigate the incidence and predictive factors of impaired vasodilatory function following transradial procedures. Methods: Consecutive patients undergoing elective transradial procedures were prospectively enrolled. Ultrasound examination of RA was recorded just before and 1 week after the procedure. RA diameters and flow velocities were measured at baseline, after flow mediated vasodilation (FMD) and after nitrate mediated vasodilation (NMD). Results: Fifty-one patients were included (62 ± 11 years, 55% male, 41% hypertensive, 20% diabetic, 65% with coronary artery disease). Overall FMD and NMD were significantly impaired after 1 week. However, deterioration of FMD and NMD was observed in 67% and 71% of patients, respectively. Absolute change in FMD was significantly different in patients using a renin– angiotensin system (RAS) inhibitor compared to those who were not (1.9 ± 12.9 vs. –7.7 ± ± 12.7%, respectively, p = 0.025). Additionally, there was a moderate but significant correlation between baseline RA diameter and absolute change in NMD (r = 0.419, p < 0.001). RAS blockade was independently associated with protection against FMD deterioration (OR 0.241, 95% CI 0.066–0.883, p = 0.032), whereas RA diameter (OR 0.079, 95% CI 0.009–0.720, p = 0.024) and procedure time (OR 1.156, 95% CI 0.989–1.350, p = 0.068) were associated with NMD deterioration, although the latter had borderline significance. Conclusions: Vasodilatory function of RA gets impaired in most patients following transradial procedures. RAS blockade seems to exert a protective role against deteriorating endothelium- dependent vasodilation, whereas smaller RA diameter and potentially longer procedure time are associated with impaired endothelium-independent vasodilation.

Right atrioventricular valve is historically named as tricuspid valve. However, cases depicting multi-leaflet morphology of the right atrioventricular valve were reported. Accessory leaflet of the tricuspid valve is a rare entity and associated with congenital cardiac anomalies. We present an accessory tricuspid valve in a patient with isolated persistent left superior vena cava.

Introduction. Usage of the Perclose ProGlide® (PP: Abbott Laboratories, Chicago, IL, USA) closure device is becoming increasingly prevalent during percutaneous endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI). The respective conditions treated via these procedures, abdominal aortic aneurysm and aortic valve stenosis, share risk factors but are two different physiopathological problems. Aim. Our aim was to compare the complication and success rates of PP closure device use in patients undergoing EVAR and TAVI. Materials and Methods. A total of 74 patients, including 58 undergoing TAVI and 16 undergoing EVAR, were analysed in our study. Results. Of the TAVI patients treated using the PP closure device, two (3.4%) had access to site-related bleeding complications and two (3.4%) experienced device failure. Of the EVAR patients who received the PP closure device, three (18.8%) had bleeding complications and three (18.8%) experienced device failure. Conclusion. Due to the underlying diffuse aortic wall pathology, the success rate of PP closure device use was lower and the complication rate of PP closure device was higher in the EVAR group versus the TAVI group.

Background and Aim. Long hospital days in intensive care unit (ICU) due to life-threatening diseases are increasing in the world. The primary goal in ICU is to decrease length of stay in order to improve the quality of medical care and reduce cost. The aim of our study is to identify and categorize the factors associated with prolonged stays in ICU.Materials and Method. We retrospectively analyzed 3925 patients. We obtained the patients’ demographic, clinical, diagnostic, and physiologic variables; mortality; lengths of stay by examining the intensive care unit database records.Results. The mean age of the study was 61.6 ± 18.9 years. The average length of stay in intensive care unit was 10.2 ± 25.2 days. The most common cause of hospitalization was because of multiple diseases (19.5%). The length of stay was positively correlated with urea, creatinine, and sodium. It was negatively correlated with uric acid and hematocrit levels. Length of stay was significantly higher in patients not operated on than in patients operated on (p<0.001).Conclusion. Our study showed a significantly increased length of stay in patients with cardiovascular system diseases, multiple diseases, nervous system diseases, and cerebrovascular diseases. Moreover we showed that when urea, creatinine, and sodium values increase, in parallel the length of stay increases.

SummaryVorapaxar, a novel antiplatelet thrombin PAR-1 inhibitor, has been evaluated in the successful TRA2P trial and the failed TRACER trial. The drug is currently approved for post myocardial infarction and peripheral artery disease indications with concomitant use of clopidogrel and/or aspirin. The FDA ruled that the vorapaxar safety profile is acceptable. However, both trials revealed excess diplopia (double vision) usually reversible after vorapaxar. The diplopia risk appears to be small (about 1 extra case per 1,000 treated subjects), but real. Overall, there were 10 placebo and 34 vorapaxar diplopia cases (p=0.018) consistent for TRACER (2 vs 13 cases; p=0.010) and for TRA2P (8 vs 21 cases; p=0.018). Hence, we review the FDA-confirmed evidence and discuss potential causes and implications of such a surprising adverse association, which may be related to off-target PAR receptor mismodulation in the eye.

Background: Pulmonary embolism (PE) is a life-threatening event with a broad presentation spectrum ranging from asymptomatic cases to sudden cardiac arrest. It is unclear if right atrial emboli cause PE in patients with atrial fibrillation (AF) or if mild PE itself increases right cardiac pressure provoking AF. Objective: To determine the incidence and predictors of asymptomatic PE in patients undergoing AF ablation. Method and Results: Patients (n = 93) were screened and those with previous or current symptomatic PE or venous thromboembolism, pulmonary hypertension, increased right heart pressures detected on echocardiography, a history of stroke, transient ischemic attack, coagulopathy or cancer and inappropriate contrast for the evaluation of pulmonary arterial tree were excluded. The remaining AF patients (n = 71) underwent guided ablation controlled with 3-dimensional, left atrial and pulmonary venous computed tomography. The asymptomatic PE was defined by using the modified Miller score by 2 independent assessors in 6 patients. Univariate logistic regression showed that age (OR: 1.094, 95% CI 1.007-1.188, p = 0.033), diabetes (OR: 12.000, 95% CI 1.902-75.716, p = 0.008), CHA2DS2-VASc score (OR: 2.800, 95% CI 1.304-6.013, p = 0.008), and pulmonary artery diameter (OR: 1.221, 95% CI 1.033-1.444, p = 0.019) were significantly associated with PE. However, multivariate analysis revealed that the CHA2DS2-VASc score (p = 0.047) remained the exclusive significant predictor for asymptomatic PE. Conclusion: The incidence of random asymptomatic PE in AF patients is high (>8%). The CHA2DS2-VASc score can predict silent PE. Since patients with a high CHA2DS2-VASc score are already anticoagulated, our results do not change clinical practice but are noteworthy in terms of the cause-effect relationship between AF and PE.

Depression is associated with poor prognosis for cardiovascular disease (CVD) including mortality. Among multiple mechanisms linking depression and CVD, changes in platelet reactivity are known to be one of the major confounders of such adverse association. However, there are very limited data in children. Thus, we evaluated some conventional hemostatic indices including whole blood platelet aggregation in patients with documented pediatric depression and compared these data with those obtained from healthy children. The pediatric patients fulfilled criteria for major depression with a minimum score of 19 on the 21-item Beck Depression Inventory Scale. Plasma fibrinogen, D-dimer, platelet count, mean platelet volume, and platelet aggregation induced by ADP and collagen were measured in 67 pediatric patients with depression and matched by age and sex with 78 healthy controls. As expected, the depressed children had significantly higher BECK scales (P = 0.001) compared with the normal subjects. Platelet aggregation induced by ADP and collagen (P = 0.0001 for both) was significantly higher in depressed children. BECK scale scores correlated significantly with platelet aggregation induced by ADP (r = 0.3, P = 0.001) and collagen (r = 0.4, P = 0.01). In contrast, platelet counts, fibrinogen, D-dimer, mean platelet volume, and antithrombin-III levels were almost identical between both groups. Children with depression exhibit mostly intact hemostatic parameters, with the exception of significantly higher platelet activity when compared with healthy controls. These data match well with prior evidence from depressed adults supporting the hypothesis that platelets participate in the pathogenesis of depression. However, beyond pure assessment of platelet activity, other elements including serotonin content and cell receptor changes in pediatric depression should be elucidated before randomized trial(s) can be justified.

Background and Aim. Psoas muscle area (PMA) can reflect the status of skeletal muscle in the whole body. It has been also reported that decreased PMA was associated with postoperative mortality or morbidity after several surgical procedures. In this study, we aimed to investigate the relation between PMA and mortality in all age groups in intensive care unit (UNIT). Materials and Method. The study consists of 362 consecutive patients. The demographic characteristics of patients, indications for ICU hospitalization, laboratory parameters, and clinical parameters consist of mortality and length of stay, and surgery history was obtained from intensive care archive records. Results. The mean age was 61.2±18.2 years, and the percentage of female was 33.3%. The mean duration of stay was 10.3±24.4 days. Exitus ratio, partial healing, and healing were 25%, 70%, and 5%, respectively. The mean right, left, and total PMA were 8.7±3.6, 8.9±3.4, and 17.6±6.9, respectively. The left and total PMA averages of the nonoperation patients were statistically significantly lower (p=0.021 p=0.043). The mean PMA between the ex and recovered patients were statistically significantly lower (p=0.001, p=0.001, p<0.001). Dyspnoea, renal insufficiency, COPD, transfusion rate, operation rate, ventilator needy, and mean duration of hospitalization were statistically significant higher in patients with exitus. There is a significant difference in operation types, anesthesia type, and clinic rates. Conclusion. Our data suggest that sarcopenia can be used to risk stratification in ICU patients. Future studies may use this technique to individualize postoperative interventions that may reduce the risk for an adverse discharge disposition related to critical illness, such as early mobilization, optimized nutritional support, and reduction of sedation and opioid dose.