Search

Objective In this study, we aimed to report early outcomes of catheter-directed thrombolysis (CDT) with alteplase in patients with subacute limb ischemia and to assess whether there is a link between malnutrition (determined by Controlling Nutritional Status [CONUT] score) and response to thrombolysis and bleeding. Methods This was a retrospective study conducted between 2007 and 2020 with 118 patients with Rutherford class 3 (34.7%), class 4 (40.7%), and class 5 (24.6%) symptoms owing to infraaortic subacute thrombotic occlusion who were treated with catheter-directed thrombolysis. Results Immediate technical success (Thrombolysis in Myocardial Infarction [TIMI] grade 2/3) was achieved in 56%, overall technical success after all adjunctive procedures was seen in 83.9%. Clinical success was obtained in 74.5% within 30 days. Major bleeding occurred in 11.8%. When we excluded access site hematomas, the rate of major bleeding was 5.1%. In-hospital mortality rate was 5.1%, and the amputation rate within 30 days was 12.7%. Any-degree malnutrition was detected in 48.3% according to CONUT score (≥2). Any-degree malnutrition was associated with failed thrombolysis and bleeding. The CONUT score predicted insufficient lytic response even after adjustment for confounding factors; however, serum C-reactive protein or neutrophil/lenfosit ratio did not. Other predictors of immediate technical failure after thrombolysis were symptom duration, Rutherford class 4/5 symptoms, and worsened distal runoff. Conclusion In patients with subacute limb ischemia, CDT combined with adjunctive interventions was effective in many patients at the expense of a substantial risk of bleeding and death. Malnutrition was associated with insufficient lytic response and bleeding. Physicians should be aware of malnutrition and consider the nutritional status of patients with limb ischemia when selecting appropriate treatment.

Giriş-amaç: Vagal reaktivasyon normal olarak egzersiz sonrası toparlanmanın erken döneminde meydana gelir. Normal vagal reaktivasyonun yokluğunda, kalp hızı toparlanması (HRR) zayıflar. Kalp hızı türbülansı (HRT), ventriküler ektopiden sonra arteriyel kan basıncındaki bozulmalara verilen otonomik yanıtın bir göstergesidir. HRR ve HRT'nin (türbülans başlangıcı (TO) ve türbülans eğimi (TS)) prognostik rolü iyi bilinmektedir. Bu çalışmada, egzersiz testi sırasında ventriküler ektopi sıklığı ve iskemik ST-segment değişikliği varlığı ile bu parametreler arasında bir ilişki olup olmadığını araştırmayı amaçladık. Yöntemler: Koroner arter hastalığı ya da kalp yetmezliği olmayan 1550 hastadan 100'ünde (%6,4) ezgersiz sonrası toparlanma sırasında ventriküler ektopi vardı. Bu hastalarda ventriküler ektopi sıklığı, egzersiz sonrası 1. dakikadaki HRR indeksi, TO ve TS değerlerini ölçtük. Bulgular: Hastaların %35'inde TO, %17'sinde TS ve %10'unda HRR anormaldi ve TO daha önce bozulmuştu. Hastalar iskemik ST-segment değişikliklerine göre (negatif ve pozitif) gruplandırıldığında; yaş, maksimum METs, egzersiz süresi, TO, TS, TS normal/anormal, HRR, HRR normal/anormal, egzersiz veya toparlanma sırasında ventriküler ektopi sayısı, maksimum kalp hızı ve bazal kalp hızı gruplar arasında benzerdi. Egzersiz testi pozitif olanlarda TO anormal olma eğilimindeydi (p=0.07). HRR ile TS arasında hafif derecede anlamlı bir korelasyon gözlendi (r=0.21, p=0.036). Toparlanma sürecindeki ventriküler ektopi sayısı, egzersiz sırasındaki ventriküler ektopi sayısı ile korele idi. Ayrıca TS, kalp hızı TO ve HRR ile koreleydi. Sonuç: Düşük-orta riskli bireylerde, toparlanmanın 1. dakikasındaki HRR ve HRT’nin, otonomik fonksiyonun farklı yönlerini yansıtıyor olabilirler ve bunlar, egzersiz testi sırasındaki iskemik ST-segment değişikliği varlığı ve ventriküler ektopi sıklığı ile ilişkili değildi.

Protein-C deficiency causes a thrombophilic environment in circulation. Although venous thromboembolism is the most common presentation, arterial events are rare. A 45 year-old woman with protein-C deficiency presented with multiple thromboembolic events including bilateral renal infarct and inferior ST-elevation myocardial infarction 3-days after coronary angiography via femoral approach which were normal coronary arteries. Computed tomographic angiography and transesophageal echocardioraphy displayed multiple thrombi sources including left atrium, left subclavian artery, sinus valsalva and descending aorta. Unfractionated-heparin and tissue plasminogen activator infusion were given. Although regression in ST-segment elevation and chest pain, no reduction in sizes of left atrial and aortic thrombus was observed by imaging modality. The patient refused surgical removal of thrombi, then warfarin therapy was planned. In patients with congenital thrombophilia and history of thromboembolism, anticoagulant treatment should be carefully managed during percutaneous diagnostic and interventional treatments and they should be performed by radial approach without interruption of anticoagulants.

BACKGROUND There is limited data regarding the effect of idiopathic premature ventricular complexes (PVC) on myocardial repolarisation. Most of PVC's originate from right and left ventricular outflow tracts (RVOT and LVOT). AIM The aim of this study is to evaluate the acute effect of outflow tract PVC ablation on electrocardiographic repolarisation markers. METHODS A total of 180 patients (49.2 ± 13.6 years, 74 male) without any exclusion criteria who had undergone outflow tract PVC ablation between 1 January 2015 and 1 November 2018 constituted our study population. Electrocardiographic recordings that had been obtained before and after ablation procedure on the same day were retrospectively evaluated for the QTc dispersion, Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio. Significance of difference between pre- and postablation values was tested. RESULTS There was no significant difference regarding QTc dispersion between pre- and post-ablation state (36.5 ± 20.9 vs. 35.3 ± 16.4 ms, p: NS). However, Tp-e and Tp-e/QT values in all lateral precordial derivations were observed to decrease significantly after PVC ablation (in the respective order on derivation V5: 104.0 ± 21.6 ms vs. 91.1 ± 14.8 ms, p

Aim: We sought to determine the relationship between presence of atrial fibrillation (AF) and serum biomarkers, including native thiol (antioxidant), disulphide/native thiol ratio, Hs-CRP and high-sensitivity Troponin-I (Hs-TnI) in hypertrophic cardiomyopathy (HCM). Materials & methods: We enrolled consecutive 121 HCM outpatients without AF and 40 HCM outpatients with AF. A 12-lead electrocardiogram, transthoracic echocardiography and 24/48-h ambulatory rhythm monitoring were performed for all patients. Fasting venous blood samples were taken from all study patients to measure serum thiol-disulphide homeostasis, Hs-CRP and Hs-TnI. Results: Serum-native thiol was lower and disulphide/native thiol ratio was more oxidized in HCM patients with AF (p

In addition to the genetic complexity of hypertrophic cardiomyopathy (HCM), there must be other disease-modifying factors that contribute to its highly variable clinical and phenotypic expression. The authors aimed to investigate serum thiol/disulphide homeostasis as a proxy for oxidative stress using a novel automated assay in patients with HCM.This cross-sectional study was conducted on 119 patients with HCM and 52 without HCM. The methods used to measure dynamic thiol/disulphide homeostasis as calorimetric and duplex quantities were developed in 2014.Median serum native thiol levels were significantly lower in patients with HCM than in those without (312.5 μmol/L [285-370 μmol/L] vs 421 μmol/L [349-469.5 μmol/L]; p 0.001). Serum total thiol levels and disulphide levels were considerably lower than those in the control group ([844.68 ± 195.99 μmol/L vs 1158.92 ± 243.97 μmol/L; p 0.001], [259.13 ± 65.66 μmol/L vs 375.02 ± 79.99 μmol/L; p 0.001], respectively). Serum disulphide/native thiol ratios and disulphide/total thiol ratios were significantly lower in HCM patients than in controls (0.80 ± 0.09 vs 0.92 ± 0.05; p 0.001 and 0.31 [0.30-0.32] vs 0.32 [0.32-0.33]; p 0.001). Finally, reduced thiol ratios were higher and oxidized thiol ratios were significantly lower in patients with HCM than in controls.Despite the fact that antioxidant capacity was impaired, the extracellular environment remained in a reducing state by keeping serum disulphide/native thiol ratios low. Therefore, the authors speculate that HCM may behave similarly to tumours with respect to serum thiol-disulphide levels.HINTERGRUND: Neben der genetischen Komplexität der hypertrophen Kardiomyopathie (HCM) muss es weitere krankheitsmodifizierende Faktoren geben, die zur hoch variablen klinischen und phänotypischen Ausprägung der Erkrankung beitragen. Ziel der vorliegenden Arbeit war es, die Thiol/Disulfid-Homöostase im Serum als einen Surrogatparameter für oxidativen Stress bei Patienten mit HCM zu untersuchen; dabei kam ein neuartiger automatisierter Assay zum Einsatz.In diese Querschnittstudie wurden 119 Patienten mit und 52 Patienten ohne HCM eingeschlossen. Die Verfahren zur Messung der dynamischen Thiol/Disulfid-Homöostase als kalorimetrische und Duplex-Mengen wurden 2014 entwickelt.Die medianen Serumkonzentrationen von nativem Thiol waren bei Patienten mit HCM signifikant niedriger als bei Patienten ohne die Erkrankung: 312,5 μmol/l (285–370 μmol/l) vs. 421 μmol/l (349–469,5 μmol/l); p 0,001. Die Gesamtthiol- und Disulfidkonzentrationen im Serum waren erheblich niedriger als in der Kontrollgruppe: 844,68 ± 195,99 μmol/l vs. 1158,92 ± 243,97 μmol/l; p 0,001; 259,13 ± 65,66 μmol/l vs. 375,02 ± 79,99 μmol/l; p 0,001. Das Verhältnis von Disulfiden zu nativem Thiol und von Disulfiden zu Gesamtthiol war bei Patienten mit HCM signifikant niedriger als in der Kontrollgruppe: 0,80 ± 0,09 vs. 0,92 ± 0,05; p 0,001; 0,31 (0,30–0,32) vs. 0,32 (0,32–0,33); p 0,001. Zudem war das Verhältnis reduzierter Thiole bei Patienten mit HCM höher als in der Kontrollgruppe, das Verhältnis oxidierter Thiole dagegen niedriger.Obwohl die antioxidative Kapazität beeinträchtigt war, blieb das extrazelluläre Milieu in einem reduzierten Zustand, indem die Verhältnisse von Disulfiden zu nativem Thiol im Serum niedrig gehalten wurden. Daher vermuten wir, dass sich die HCM in Bezug auf Thiol‑/Disulfidspiegel im Serum ähnlich verhält wie Tumoren.

OBJECTIVE: Endovascular therapy (EVT) has increasingly been used even after the development of new techniques and technologies. EVT has displayed durable early and mid-term outcomes for infrarenal aorta occlusions (IAO). Nonetheless, little is known regarding their long-term outcomes and predictors of restenosis. METHODS: A total of 55 consecutive patients (age, 58.8±6.97 years; 67.2% male; 42% critical limb ischemia) from a single-center database, undergoing EVT for IAO disease between January 2011 and March 2019 were retrospectively analyzed. The outcome measures were primary patency rate and amputation free survival calculated by the Kaplan–Meier method. Independent predictors of restenosis were assessed by Cox proportional hazard regression model. RESULTS: In 49 patients (89.1%), technical success was achieved. In total, 190 stents (65 self-expandable stents, 60 balloon-expandable stents) were implanted. During the follow up of 34.5±28 months, 7 patients experienced loss of patency. Primary patency rates were 96%, 82%, and 75% at 1, 3, and 5 years, respectively, and amputation free survival rates were 100%, 90%, and 82% at 1, 3, and 5 years, respectively. CONCLUSION: In this study, five-year outcomes of primary patency and amputation free survival for EVT of infrarenal aorta total occlusive lesions were favorable. None of the demographic, lesion, and device factors were independently associated with loss of primary patency.

Three-dimensional transesophageal echocardiography (3D-TEE) provides detailed images of prosthetic valve thrombosis (PVT). However, data regarding PVT localization patterns based on 3D-TEE and their association with clinical findings among various bileaflet mitral prosthetic valve brands is lacking. The locations of thrombi were classified into 4 groups according to hinge and annulus involvement based on 3D-TEE: ring-like PVT involving entire mitral annulus (type-1), PVT involving peri-hinge(s) region and extends through some part of the annulus (type-2), PVT involving mitral annulus without involving hinge(s) region (type-3), and PVT involving only (peri)hinge(s) area (type-4). This study was conducted in 265 patients (male: 71, mean age: 46.3 +/- 12.7 years) with mitral PVT, including 150 St Jude Medical (SJM), 65 Carbomedics, 29 Medtronic ATS open-pivot, and 21 Sorin bileaflet mechanical valves. There was a significant difference in most common PVT localization patterns between different prosthetic valves (type-1 for Carbomedics and Sorin; type-2 for SJM and type-3 for ATS valves; p < 0.001). Additionally, PVT involving only (peri)hinge region(s) (type-4) was mostly observed in patients with SJM valves (18%). (Peri)hinge(s) area involvement was observed in the majority of study patients (78.1%). In patients who presented with thromboembolism, the most common PVT localization pattern was type-1 (53%). Increased age, low international normalized ratio on admission, PVT with a mobile part > 2 mm, type-1 and type-4 PVT were associated with thromboembolic events. In conclusion, thrombus can be displayed in distinct locations in several types of bileaflet mechanical valves due to different design, hinge and pivot mechanisms, which can be complicated with thromboembolic events. WOS:000638473800001 2-s2.0-85104240753 PubMed: 33835319

Spontaneous and simultaneous multivessel coronary artery spasm may present with multisite myocardial ischemia, atrioventricular block, acute lung edema, cardiogenic shock, or ventricular fibrillation. In a case of syncope caused by vasospasm, the underlying mechanism may be complex, such as atrioventricular block and/or ventricular arrhythmia. Dual implantable cardioverter defibrillator (ICD) placement should be considered along with optimal medical treatment. This report is a description of a 57-year-old male patient who was admitted to the hospital with chest pain followed by loss of consciousness. As the patient had bradycardia, a diffuse spasm, and life-threatening ventricular arrhythmia during ischemic episodes, a dual ICD device was implanted. ICD treatment may be a good option in cases with a diffuse spasm that is hard to control with medical treatment due to the risk of life-threatening ventricular arrhythmia.

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

We presented a 77-year-old man with hypertrophic obstructive cardiomyopathy applied with flail tricuspid leaflet and severe tricuspid regurgitation leading to right heart failure 2 months after the failed septal ablation. The ruptured anterior tricuspid papillary muscle resulted from infarction of the base of anterior papillary muscle of the right ventricle (RV) confirmed by magnetic resonance imaging. As the septomarginal band is frequently lit up by intracoronary contrast that particular attention should be paid to the RV papillary muscles. And, if the papillary muscles or the RV free wall is brightened, then the use of that septal artery should be avoided.

Ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction (AMI) with an associated mortality that ranges from 41% to 80%. The treatment consists of supplemental oxygenation, afterload reduction, intraaortic balloon pump, and surgical repair. In selected patients, extracorporeal membrane oxygenation (ECMO) and/or percutaneous closure of the defect can be considered if anatomically appropriate. Echocardiography evaluates the morphology and location of the defect, anatomical concerns for percutaneous closure, and accompanying pathologies. We present a 48-year-old man with inferior myocardial infarction and basal VSR who was not a candidate for percutaneous closure. Surgery was planned, but he died from extensive subarachnoid and intracranial hemorrhage.

Background: Epicardial fat reflects abdominal visceral adiposity and visceral fat plays an important role in the development of an unfavorable metabolic and atherosclerosis risk profile. Intracoronary thrombus burden is an important factor affecting the success of the procedure particularly in patients undergoing percutaneous coronary intervention (PCI). Therefore, determining the factors predicting thrombus burden has great importance in predicting adverse cardiovascular events as well as determining the most appropriate treatment strategy to prevent failure in PCI. Aim: The aim of the current study was to evaluate the relationship between Epicardial adipose thickness (EAT) and thrombus burden in the patients with ST-elevation myocardial infarction (STEMI) who undergo primary PCI (pPCI). Methods: The study was prospective and included patients (n=156) who were referred to Kosuyolu Research and Education hospital with STEMI between 2016 and 2017. Thrombus burden was scored as follows: 0 (no thrombus), 1 (possible thrombus), 2 (definite thrombus 2xreference vessel diameter), and 5 (complete vessel occlusion). According to thrombus grade the patients were grouped as low thrombus burden (grades 0-3) and high thrombus burden (grades 4 and 5). EAT, identified as an echo-free space between the myocardium and visceral pericardium, was measured perpendicularly, on the free wall of the right ventricle at both parasternal long- and short-axis views at end-diastole in three cardiac cycles. Results: Fifty-one subjects were in the low thrombus burden group and 105 in the high thrombus burden group. There were no differences in the two groups for LVEF, smoking status, family history of coronary artery disease (CAD), diabetes mellitus (DM), hypertension (HT), and hypercholesterolemia and for total cholesterol, triglyceride, GFR, LDL-C and HDL-C. In multivariate logistic regression analysis the EAT (odds ratio: 2.53, 95% CI: 1.76-3.67; p < .001) was found as an independent predictor of high thrombus burden. Conclusions: The present study showed that EAT was an independent predictor of coronary thrombus burden in STEMI.

Primary tricuspid valve regurgitation may be encountered in daily practice as a result of multiple etiologies. Described herein are the cases of 2 patients with severe primary tricuspid regurgitation. The underlying mechanism was posterior leaflet prolapse due to spontaneous chordae rupture in 1 case, and iatrogenic posterior leaflet tissue loss during removal of a permanent pacemaker in the other. Transthoracic and transesophageal echocardiography, which permit assessment of the tricuspid valve with multilevel imaging, are the techniques of choice for accurate detection and understanding of the etiology, the severity of valve regurgitation, and the determination of treatment options, in addition to providing assistance with timing and guidance during intervention. Three-dimensional echocardiography offers the ability to visualize the entire tricuspid valve and to identify which leaflets are affected by the pathology.

Objective. The aim of the study was to determine an association between the plasma YKL-40 level and echocardiographic left ventricle systolic and diastolic function parameters in patients with acute myocardial infarction.Subjects and Methods. The study included 46 patients with acute myocardial infarction. Serum brain natriuretic protein (BNP) and YKL-40 levels were analyzed on admission and after one month. Left ventricle systolic and diastolic functions and Tei index were computed by transthoracic echocardiography.Results. Plasma YKL-40 was significantly higher in patients with acute myocardial infarction (AMI) (101.7 μg/L versus 34 μg/L, resp.,p<0.001) and remained higher than in healthy subjects after one month. The levels of YKL-40 on admission were correlated with log BNP on admission (r=0.41,p=0.004), Tei index (r=0.44,p=0.002), left atrium volume index (r=0.32,p=0.02), and mitral septal annular E/e′ (r=0.44,p=0.003). Death was more frequently observed in patients with plasma YKL-40 above the median value than in those with plasma YKL-40 below the median value (p=0.001; OR = 13.6 (2.5–72.3)).Conclusion. YKL-40 elevations in patients with AMI remain at least one month and are associated with serum BNP elevations, diastolic dysfunction, and long-term increased overall mortality. It has prognostic importance in patients with AMI.

Objective: To test the potential role of heart-type fatty acid-binding protein (H-FABP) in detecting increased perioperative cardiac risk in comparison with cardiac troponin I (cTnI) in the early postoperative period. Subjects and Methods: Sixty-seven patients who had clinical risk factors and underwent elective intermediate - or high-risk noncardiac surgery were included in this study. Serum specimens were analyzed for H-FABP and cTnI levels before and at 8 h after surgery. None of the patients had chest pain; 27 had a history of ischemic heart disease, 3 of heart failure, 5 of cerebrovascular diseases, 40 of diabetes and 46 of hypertension. Results: The mean duration of the operations was 2.33 ± 1.27 h (range 1-6). In the postoperative period, 27 (40.3%) patients had increased H-FABP levels (≥7.5 ng/ml); the median preoperative serum H-FABP level was 0.13 ng/ml (0.1 µg/l during the postoperative period. Correlation analysis revealed that the presence of diabetes was associated with an increased H-FABP level (r = 0.30, p = 0.01). Of the 27 patients with H-FABP ≥7.5 ng/ml, 21 (87%) had diabetes. There was no significant correlation with other clinical risk factors, type or duration of surgery. Conclusion: The H-FABP levels significantly increased in the postoperative period. Most patients with increased postoperative H-FABP levels were diabetic. High H-FABP levels could alert clinicians to increased perioperative cardiovascular risk and could prevent underdiagnosis, especially in diabetic patients.

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

Objectives: Familial Mediterranean fever (FMF) is an au- tosomal recessive disorder and the most frequent periodic syndrome characterized by recurrent attacks of polyserositis. Heart-type fatty acid-binding protein (h-FABP) is an intracellu- lar molecule engaged in the transport of fatty acids through the myocardial cytoplasm and a rapid marker of myocardial injury. FMF is an autoinflammatory disease characterized by ongo- ing inflammatory activity. Inflammation also plays an important role in the development and progression of atherosclerosis in some rheumatic diseases. We aimed to investigate markers of atherosclerosis in patients with FMF by the measurement of serum h-FABP and malondialdehyde levels (MDA). Study design: Forty consecutive patients with FMF and twenty healthy volunteers were selected to participate in the study. The diagnosis of FMF was based on Tel-Hashomer criteria. Serum h-FABP and MDA levels were determined to examine the association. Results: The mean h-FABP level in FMF patients was sig- nificantly higher than the normal population (4.89±0.83 vs. 3.06±2.13 ng/ml, p

OBJECTIVES Thymosin beta4 (Tβ4) has been shown to have an important role in healing of damaged tissues and promoting cardiomyocyte survival in acute coronary syndromes. We evaluated endogenous Tβ4 levels in patients presenting with ST-elevation acute myocardial infarction (STEMI) before and after successful primary percutaneous coronary intervention (PCI). STUDY DESIGN The study included 24 consecutive patients (7 females, 17 males; mean age 55.0±10.9 years) who underwent successful primary PCI for STEMI and 24 age- and sex-matched healthy controls (13 females, 11 males; mean age 57.5±11.7 years) with angiographically normal coronary arteries. To determine Tβ4 levels, blood samples were obtained from STEMI patients on admission and 48 hours after successful PCI, and from controls immediately after coronary angiography. RESULTS Compared to controls, baseline levels of high-density lipoprotein cholesterol (46.2±8.9 vs. 34.2±7.2 mg/dl, p

Sweet's syndrome is characterized by skin lesions and fever. One of the rare extracutaneous manifestations of Sweet's syndrome is cardiovascular involvement including coronary artery occlusion. In this article, we present a case of acute myocardial infarction associated with exacerbation of Sweet's syndrome. Coronary angiography has demonstrated normal left coronary arterial system and the occlusion of distal right coronary artery. The patient underwent successful balloon angioplasty and subsequent coronary artery stenting. The presence of coronary ectasia, aneurysm and coronary occlusion of right coronary artery caused us to hypothesize that the coronary involvement including ectasia, aneurysm and occlusion might be associated with hyperreactive inflammatory response secondary to exacerbations of Sweet's syndrome.

There are many studies demonstrating deteriorated ventricle and endothelium functions in familial Mediterranean fever (FMF) patients. As FMF is an autoinflammatory disease with an ongoing inflammatory activity and inflammation plays an important role in the development and progression of atherosclerosis in some of the rheumatic diseases, we aimed to investigate the early markers of atherosclerosis in patients with FMF by the measurements of serum paraoxonase-1 (PON-1) activity, mean platelet volume (MPV) and malondialdehyde (MDA) level.This study is a cross-sectional, observational study. Forty consecutive patients with FMF and twenty healthy volunteers were selected to form the study population. The diagnosis of FMF was based on Tel-Hashomer criteria. Serum PON-1 activity, MPV and MDA level were determined to examine their association with FMF. Student's t-test, Mann-Whitney U test, Pearson correlation analysis were used for statistical analysis.The mean PON-1 activity in FMF patients was significantly lower than in the healthy population (141.46±38.29 vs. 179.62±10.73 U/l, p0.01). Serum MDA levels were the same between the groups (1.08±0.66 vs. 1.08±0.33 nmol/mL, p=0.99). MPV was higher in FMF patients than in the control l group (8.87±0.99 vs. 8.22±0.45 fl, p=0.04). PON, MPV and MDA levels were the same in FMF patients with acute attack and attack -free period.Our results show that PON-1 activity is lower in patients with FMF. Reduced PON-1 activity and increased MPV, independent of the oxidative stress status of these patients, may lead to increased atherosclerotic propensity in FMF.AMAÇ: Ailevi Akdeniz Ateşi (AAA) hastalarında bozulmuş ventrikül ve endotel fonksiyonlarını gösteren pek çok çalışma bulunmaktadır. AAA devamlı enflamatuvar aktivite ile seyreden bir otoenflamatuvar hastalık olduğundan ve bazı romatizmal hastalıklarda enflamasyon ateroskleroz gelişimi ve ilerlemesinde önemli rol oynadığından, AAA hastalarında serum paraoksonaz-1 (PON-1) aktivitesi, ortalama trombosit hacmi (OTH) ve malondialdehit (MDA) seviyesi ölçerek aterosklerozun erken belirteçlerini araştırmayı amaçladık. YÖNTEM: Bu çalışma kesitsel ve gözlemsel bir çalışmadır. Kırk AAA'lı hasta ve yirmi sağlıklı gönüllü çalışma topluluğunu oluşturmak için seçildi. AAA tanısı Tel-Hashomer kriterlerine göre konuldu. AAA, MDA seviyesi, OTH ve PON-1 aktivitesi arasındaki ilişkiyi araştırmak için serum PON-1 aktivitesi ve MDA seviyesi ve OTH ölçüldü. İstatistiksel analiz için Student’s t-testi, Mann-Whitney U testi, Pearson korelasyon analizi kullanıldı. BULGULAR: AAA hastalarında ortalama PON-1 aktivitesi normal bireylere göre önemli olarak daha düşüktü (141.46±38.29 karşın 179.62±10.73 U/L, p0.01). Gruplar arasında serum MDA seviyeleri aynıydı (1.08±0.66 karşın 1.08±0.33 nmol/mL, p=0.99). OTH normal bireylere göre önemli olarak daha yüksekti (8.87±0.99 vs. 8.22±0.45 fl, p=0.04). AAA hastalarında akut atak sırasında ve ataksız dönemlerde PON-1 aktivitesi, MDA seviyeleri ve OTH aynıydı. SONUÇ: Sonuçlar göstermektedir ki AAA hastalarında PON-1 aktivitesi düşüktür. Azalmış PON-1 aktivitesi ve artmış OTH bu hastalarda, oksidatif stres durumundan bağımsız olarak, AAA'de artmış ateroskleroz yatkınlığına işaret ediyor olabilir.

Prinzmetal-variant angina is a syndrome of chest pain caused by myocardial ischemia secondary to reversible coronary artery vasospasm, which may occur in angiographically normal and diseased coronary arteries. It typically occurs at rest and is accompanied by transient ST-segment elevation. Although the underlying pathophysiology is not well established, coronary spasm secondary to increased serotonergic activity as well as increased sympathetic activity may prevail. Coronary artery spasm can be invoked by antimigraine therapy and also by drugs having serotonergic activity such as ergonovine and ergotamine. Prinzmetal-variant angina may be complicated with acute myocardial infarction, ventricular arrhythmias as well as sudden cardiac death. We report a case of 48-year old woman presenting with chest pain and diffuse ST-segment elevation on electrocardiography during an episode of angina, while she was taking zolmitriptan 5 mg/d and citalopram 20 mg/d for migraine and depression, respectively. Coronary angiography (performed because of prolonged angina and presence of diffuse ST-segment elevation on electrocardiography) revealed that diffuse narrowing of left anterior descending coronary artery alleviated after intracoronary nitrate therapy. The most likely cause of myocardial infarction was coronary artery spasm because of the possible increased serotonergic activity secondary to concomitant use of zolmitriptan and citalopram.

Platelets are important source of inflammatory mediators. Platelets could initiate an inflammatory response during ST-elevation myocardial infarction (STEMI). Thrombus aspiration is a popular technique to remove thrombus in STEMI. In our study, we evaluated the effects of manual thrombus aspiration

Inthelastdecadesseveralinvestigatorshavesuggestedtheassociationofandrogenswithhypertension. Recently, some studies have shown that the incidence of cardiovascular diseases is increased in men with low testosterone levels, suggesting a protective role of androgens. Hypertension is one of the mostcommonproblemsinpregnancythatcomplicates5-10 %ofpregnancies.Anincreaseofmorbidity wasobservedinbabiesfrompregnantwomenwithhypertension.However,thepathogenesisremains unclearandthislimitstheabilitytopreventandtreatthispathology.Thebeneficialeffectsofandrogens for vascular system are associated with their ability to cause vasorelaxation. Inhuman vessels, this non genomiceffectofandrogensappeartobeduetoactivationoflargeconductancecalcium-activatedpotassiumchannels(BKCa)andvoltagegatedpotassiumchannels(KV)whichisinducedbycGMPincrease andaconsequentactivationofcGMP-dependentproteinkinase(PKG).Ontheotherhand,thegenomic effects of androgens concerning ionic channels are almost unknown. Our previous studies suggested that androgens increase the expression of BKCa channels and decrease expression of L-type calcium channels (LTCC). The aim of this work was to analyze the genomic effects of androgens on theexpressionofotherproteinsinvolvedintheregulationofvascularcontractility,suchassolubleguanylate cyclase (sGC), the natriuretic peptide receptor-A (NPRA) and PKG. This study also aimed to compare the expression levels of these proteins in human umbilical artery (HUA) from normotensive andhypertensivepregnantwomen.ToachievethesegoalsrealtimePCRwasperformedusingsmooth