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Background Post-cardiac injury syndrome (PCIS) is a clinical entity caused by immune reactions against antigens released after primary or secondary cardiac damage. This condition, which has been reported to occur generally after cardiac perforation, may also occur after epicardial ablation of ventricular arrhythmias. Case summary We report a case of a 33-year-old Male who developed chest pain accompanied by electrocardiogram (ECG) changes—extensive ST segment elevation in V1–V6 leads after an initially uncomplicated ventricular tachycardia CA procedure by epicardial approach. After examination and investigations, including transthoracic echocardiography (TTE), invasive coronary angiography (ICA), he was diagnosed with regional pericarditis, which occurred even though the ablation was uneventful. Furthermore, the diagnosis was difficult due to the absence of pericardial effusion on TTE and the unique ECG with changes that can be confused with acute coronary syndrome (ACS), findings that are not characteristic of pericarditis. The most important factor that made our case interesting was the improvement of the complaints and ECG findings after the removal of the epicardial catheter. The patient was discharged after a certain period of TTE and ECG follow-up. Discussion Regional pericarditis after ablation is a relatively rare PCIS. Coronary events should definitely be considered in the differential diagnosis. It is important to confirm the diagnosis with non-invasive and, if necessary, invasive imaging methods and to perform treatments and interventions for the underlying cause.

Background: Although the prevalence of coronary artery anomalies (CAA) is due to accidental and rare discoveries, it varies between different countries or geographies. CAA are rare congenital disorders having various clinical definitions. Its prevalence varies in angiographic and autopsy series in adult populations and is approximately 1% in average. While the incidence ranges from 0.2% to 5.64% in coronary angiographic (CAG) studies, it is around 0.3% in autopsy series. We aimed to estimate the frequency of CAA in our patient population. Methods: The coronary angiographic data of 4099 consecutive adult patients, who underwent CAG between January 2019 and December 2020, were analyzed and retrospectively studied. Results: The mean age of the total patients who underwent CAG was 61.59 ± 13.67 years (range, 18-98 years). CAA were found in 76 patients (1.85% incidence), origin and course anomaly in 62 patients (81.6%), and coronary artery termination anomaly in 14 patients (18.4%). Separate exits of the left anterior descending (LAD) and left circumflex (LCX) coronary artery from the left sinus of Valsalva (LSV) were the most common anomalies (36.84%). Coronary artery fistulas were seen in 14 (18.42%) patients. Abnormal origin of left circumflex artery (LCX) from the right coronary artery (RCA) or right sinus valsalva (RSV) was seen in 13 (17.11%) patients. Outflow anomalies from the contralateral coronary sinus were detected in 10 (13.16%) patients. Conclusion: The incidence and pattern of CAA in our patient population showed similarity with previous studies. Physicians should be aware of CAA that may be associated with potentially serious cardiac incidents, because recognition of these CAA is important for the decision of treatment procedures.

Single coronary artery(SCA) anomaly is a rare anomaly where the right and left coronary arteries arise from a single ostium in the sinus valsalva and feed the whole heart. Although asymptomatic in most cases, it can cause angina, syncope, myocardial infarction and sudden cardiac death. It is essential to diagnose it especially in terms of the risk of encountering clinical pictures such as sudden death at a young age and its association with other congenital anomalies. In this report, we present a patient with a SCA anomaly. During an emergency conventional angiography, a right coronary artery(RCA) arising from the left main coronary artery(LMCA) originating from a single ostium was detected in the aorta.

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

Single coronary artery(SCA) anomaly is a rare anomaly where the right and left coronary arteries arise from a single ostium in the sinus valsalva and feed the whole heart. Although asymptomatic in most cases, it can cause angina, syncope, myocardial infarction and sudden cardiac death. It is essential to diagnose it especially in terms of the risk of encountering clinical pictures such as sudden death at a young age and its association with other congenital anomalies. In this report, we present a patient with a SCA anomaly. During an emergency conventional angiography, a right coronary artery(RCA) arising from the left main coronary artery(LMCA) originating from a single ostium was detected in the aorta.

Ekstrakranial karotid arter anevrizmalari oldukca nadirdir. Tum periferal arter anevrizmalarinin %0.4-4’unu olusturmaktadir. Anevrizmalarin norolojik komplikasyonlarindan kacinmak icin kesin tedavi gerekmektedir. Altmis yedi yasinda erkek hasta, uc ay once efor sirasinda ortaya cikan gogus agrisi sikayeti ile hastanemiz kardiyoloji poliklinigine basvuruyor. Olguya yapilan efor testinin pozitif cikti ve koroner anjiyografide koroner arterlerde darlik saptandi. Karotis Doppler ultrasonografide, sol internal karotid arterde %80 darliga neden olan plak vardi. Dort damar bypass karari alindi ve ayni senasta sol karotid endarterektomi yapildi. Operasyonu takiben iki gun sonra hastanin boynunda sislik ve morarma goruldu. Yapilan kontrol Doppler ultrasonografide sol internal karotid arterde anevrizma gelistigi izlendi. Ilk operasyonu takiben bir hafta sonra tekrar opere edildi ve safen ven greft interpozisyonu ile uc uca anastamoz yapildi. Alti aylik Doppler ultrasonografi kontrolleri ile takibi alindi.

WOS: 000450866100008, PubMed ID: 29737876, Background: Atherosclerosis is a disease of the arterial wall with predilection to some sites on others. MicroRNAs (miRNAs) are a class of the non-coding RNAs regulating the target gene expression at post-transcriptional level. Different miRNAs were found at distinct stages of plaque development and expression of miRNAs' might play an important role in the local behaviour of atherosclerotic plaques. Objective: We aimed to investigate and compare mirR-221/222 expression levels in tissues and in circulation in patients with and without overt atherosclerosis. Methods: RNA was isolated from 40 tissues as 20 tissue samples from coronary artery atherosclerotic plaques (CAAP) and internal mammary arteries (IMA), obtained from same individual) and 80 blood (44 patients with atherosclerosis and 36 healthy subjects) samples. MiR-221/222 expression levels were measured using real time PCR. Results: Expression levels of miR-221 was significantly increased in CAAP compared with completely atherosclerosis-free IMA tissues with a 8.94 times fold-change (p = 0.015). The miR-221 expression in tissue samples was significantly different in patients with hypercholesterolemia (p = 0.010), hypertension (p = 0.018) and family history of CAD (p = 0.033) versus not. Expression of miR-222 was not statistically significant between the two tissue samples overall. Conclusions: MiR-221 may be a potential biomarker for local atherosclerotic behavior, Research Council of Cumhuriyet University Sivas [T-641]; TUBITAK, Turkey [214S031], This study was supported by the Research Council of Cumhuriyet University (Project No: T-641) Sivas and TUBITAK (Project No: 214S031), Turkey.

In this study, we compared the patients who underwent coronary angiography (CAG), followed by revascularization by coronary artery stent implantation according to the CAG results without any evidence of ischemia with myocardial perfusion scintigraphy (MPS), and the patients who underwent revascularization by coronary artery stent implantation following the detection of ischemia in MPS before CAG in terms of the mortality and hospitalization due to acute coronary syndrome (ACS). Between January 2009 and January 2016, a total of 407 patients (52% males, 48% females; mean age: 66 ± 9 years; range: 40–85 years) who underwent CAG following diagnosis of stable angina and underwent coronary artery stenting were retrospectively analyzed. The patients were divided into two groups: Group 1 (n = 200) included those who had MPS before CAG and in whom ischemia was detected and stent was implanted, and Group 2 (n = 207) included those who had stent implantation according to the CAG results without prior MPS. The mean follow-up was 40 ± 18 months. Although there was no significant difference in the mortality rates between the groups, the rate of hospitalization due to ACS was significantly lower in Group 1 (P = 0.112 vs.P = 0.022, respectively). According to the multivariate Cox-regression analysis, demonstration of ischemia in MPS before revascularization, statin use, clopidogrel use, and higher high-density lipoprotein cholesterol levels were found to be associated with a reduced risk of ACS-related hospitalization, whereas the presence of diabetes mellitus and smoking was found to be associated with an increased risk of ACS-related hospitalization.

WOS: 000405499200008, PubMed ID: 27714730, Background: An understanding of the left main coronary artery (LMCA) anatomy is important for accurate diagnosis and therapy. We aimed to investigate LMCA anatomy via 128-multisliced coronary computed-tomography-angiography (CCTA) in patients with normal LMCA. Materials and methods: A total of 201 CCTA studies were included in this study. Anatomical features of LMCA including cross-sectional areas of the LMCA ostial, LMCA distal, left anterior descending artery (LAD) ostial and left circumflex artery (LCX) ostial, and degree of tapering and LMCA bifurcation angles (BA) in the form of LMCA-LCX BA, LMCA-LAD BA, LAD-LCX BA at end-diastole and end-systole. Results: The mean age was 55 +/- 11; 55.7% of patients were males. Right coronary artery was dominant in 173 (86.1%) patients. Mean LMCA length was 10.0 +/- 4.5 mm. The mean values of LMCA ostial, LMCA distal, LAD ostial and LCX ostial areas were 18.2 +/- 5.1 mm2, 13.2 +/- 4.0 mm2, 9.0 +/- 3.2 mm(2) and 7.6 +/- +/- 2.8 mm(2), respectively. LMCA ostial-distal area, LMCA distal-LAD ostial area and LMCA distal-LCX ostial area ratios were = 1.44 -< 1.69 in 47 (23.4%), 53 (26.4%), 47 (23.4%) patients, respectively, and were = 1.69 -< 1.96 in 19 (9.5%), 24 (11.9%), 40 (19.9%) patients respectively. Systolic motion modifies LMCA BAs; systolic motion begets an increment of LMCA-LAD angle in 72.6% of patients and decrement of LAD-LCX angle in 75.6% of patients. Patients with T-shaped LAD-LCX BA was shown to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher diastolic-to-systolic range (DSR) of LAD-LCX BA compared to patients with Y-shaped LAD-LCX BA. Conclusions: LMCA with T-shaped distal BA was found to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher DSR of distal BA compared to patients with Y-shaped distal BA. These findings may provide useful information for LMCA bifurcation stenting or designing dedicated stents for LMCA.

PURPOSE Transradial and transulnar artery approaches are commonly used for percutaneous interventions, with considerably low risk of developing hand ischemia, for reasons that have not been fully understood. The aim of this study was to evaluate the changes in the diameter, peak systolic flow velocity (PSV), and volume flow (VF) of the radial (RA) and ulnar artery (UA) during unilateral reciprocal temporary occlusion. METHODS A total of 204 extremity arteries of 102 consecutive patients were evaluated using Doppler ultrasonography. At the level of the wrist, RA and UA were consecutively compressed for 60 seconds. The diameter, PSV, and VF parameters of both arteries were evaluated during unilateral reciprocal compression. RESULTS Compared with the baseline values, the median (interquartile range) increases in diameter, PSV, and VF were 0.2 (0.1-0.3) mm, 6.8 (1.7-17.5) cm/s, and 1.9 (0.8-10) ml/min, respectively, for RA, and 0.1 (0.1-0.3) mm, 9.4 (2.6-18.0) cm/s, and 10.0 (0.0-20.0) ml/min, respectively, for UA during reciprocal compression (p < 0.001 for all). CONCLUSIONS Reciprocal compression significantly increased the diameter, PSV, and VF of both arteries during reciprocal compression. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:197-203, 2017.

WOS: 000394509600007, PubMed ID: 28265209, Length of stay is the primary driver of heart-failure hospitalization costs. Because cancer antigen 125 has been associated with poor morbidity and mortality rates in heart failure, we investigated the relationship between admission cancer antigen 125 levels and lengths of stay in heart-failure patients. A total of 267 consecutive patients (184 men, 83 women) with acute decompensated heart failure were evaluated prospectively. The median length of stay was 4 days, and the patients were classified into 2 groups: those with lengths of stay 4 days. Patients with longer lengths of stay had a significantly higher cancer antigen 125 level of 114 U/mL (range, 9-298 U/mL) than did those with a shorter length of stay (19 U/mL; range; 3-68) (P < 0.001). The optimal cutoff level of cancer antigen 125 in the prediction of length of stay was > 48 U/mL, with a specificity of 95.8% and a sensitivity of 96% (area under the curve, 0.979; 95% confidence interval [CI], 0.953-0.992). In the multivariate logistic regression model, cancer antigen 125 > 48 U/mL on admission (odds ratio=4.562; 95% CI, 1.826-11.398; P=0.001), sodium level (P< 0.001), creatinine level (P=0.009), and atrial fibrillation (P=0.015) were also associated with a longer length of stay after adjustment for variables found to be statistically significant in univariate analysis and correlated with cancer antigen 125 level. In addition, it appears that in a cohort of patients with acute decompensated heart failure, cancer antigen 125 is independently associated with prolonged length of stay.

WOS: 000389047200012, PubMed ID: 28105338, Matrix metalloproteinase (MMP)-3 and MMP-9 polymorphisms are characterized by plaque stability in coronary arteries. The aim of the current study was to investigate the 5A/6A polymorphism in the MMP-3 gene and C/T polymorphism in the MMP-9 gene in patients with coronary artery disease (CAD). The study population consisted of 400 patients who underwent coronary angiography. There were two groups consisting of 200 consecutive patients with CAD, presenting with stable angina pectoris, and 200 consecutive patients exhibiting normal coronary arteries. Two single nucleotide polymorphisms in the MMP gene, MMP-3 and MMP-9, were detected using a polymerase chain reaction-restriction fragment length polymorphism assay. Mean age, gender distribution, smoking status, presence of diabetes mellitus and hypercholesterolemia were identified to be similar between the groups. One hundred and twenty seven (63.5%) patients had hypertension in the CAD group, whereas only 55 (27.5%) patients had hypertension in the control group (P< 0.001). No significant difference in frequency of alleles and genotypes of MMP-9 C -> T between the CAD and control groups was identified. The 5A allele frequency of MMP-3 in the CAD group was significantly higher when compared with the control group (P< 0.001; odds ratio=2.18). The genotype frequency of MMP-3 5A/5A in the CAD group was significantly higher when compared with the controls (P=0.005). When compared with the homozygous wild-type (6A/6A) genotype of the MMP-3 gene, the cumulative frequency of heterozygote and homozygote genotypes of the MMP-3 gene was significantly higher in the CAD compared with the control group (P, Research Council of Cumhuriyet University (Sivas, Turkey) [F-340], The present study was supported by the Research Council of Cumhuriyet University (Sivas, Turkey; CUBAP project no. F-340).

WOS: 000400680200010, PubMed ID: 27460050, The current study aimed to evaluate the influence of regular annual influenza vaccinations on cardiovascular (CV) death and heart failure-related hospitalizations (HFrH) in stable outpatients with heart failure with reduced ejection fraction. The Turkish research team-HF (TREAT-HF) is a network undertaking multicenter, observational cohort studies in HF. This study is a subgroup analysis of TREAT-HF outpatient cohorts who completed a questionnaire on influenza vaccination status and for whom follow-up data were available. A total of 656 patients with available follow-up data for CV death and HFrH including recurrent hospitalization were included in the study. Patients were classified into two groups: those who received regular influenza vaccination (40 %) and those who did not receive vaccination. During a mean follow-up of 15 +/- 6 months, 113 (18 %) patients had CV death and 471 (72 %) patients had at least one HFrH. The CV death rate was similar in both groups of patients (16 vs. 19 %, p = 0.37), whereas, HFrH and recurrent HFrH were significantly less frequently encountered in patients who received regular influenza vaccination than in those who did not receive vaccination (43 vs. 92 % and 16 vs. 66 %, p < 0.001, respectively). In a multivariate Cox proportional hazards model - in addition to a few clinical factors - vaccination status (HR = 0.30, 95 % CI = 0.17-0.51, p < 0.001) and graduation from university (HR = 0.35, 95 % CI = 0.17-0.72, p = 0.004) remained independently associated with the risk of recurrent HFrH. Regular influenza vaccination does not influence CV deaths; however, it decreases HFrH including recurrent episodes of HFrH in outpatients with heart failure with reduced ejection fraction.

WOS: 000375063100015, PubMed ID: 26947364, Background: There are several studies evaluating the cardiac effects of carbon monoxide (CO) poisoning during the acute period; however, the number of studies evaluating the long-term cardiac effects is limited. Objective: The present study aimed to evaluate the effects of blood carboxyhemoglobin (COHb) levels, elevated due to CO poisoning on the long-term development of acute myocardial infarction (AMI). Methods: This cross-sectional cohort study included a total of 1013 consecutive patients who presented to the emergency department (ED) due to CO poisoning, between January 2005 and December 2007. The diagnosis of CO poisoning was made according to the medical history and a COHb level of greater than 5%. In terms of AMI development, the patients were followed up for an average of 56 months. Results: At the end of follow-up, 100 (10%) of 1013 patients experienced AMI. Carboxyhemoglobin levels at the time of poisoning were higher among those who were diagnosed with AMI compared to those who were not (55% +/- 6% vs 30% +/- 7%; P < .001). Using a multivariate Cox proportional hazards model with forward stepwise method, age, COHb level, CO exposure time, and smoking remained associated with an increased risk of AMI after adjustment for the variables found to be statistically significant in a univariate analysis. According to a receiver operating characteristic curve analysis, the optimal cutoff value of COHb used to predict the development of AMI was found to be greater than 45%, with 98% sensitivity and 94.1% specificity. Conclusion: In patients presenting to the ED with CO poisoning, COHb levels can be helpful for risk stratification in the long-term development of AMI. (C) 2016 Elsevier Inc. All rights reserved.

WOS: 000392195800004, PubMed ID: 27723665, Objective: Data regarding stroke prevention strategies in non-valvular atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs). This study aimed to evaluate real-life stroke prevention strategies for NVAF patients in the era of non-VKA oral anticoagulants (NOACs). Methods: We established a cross-sectional, multicenter, nationwide registry of NVAF patients. All consecutive atrial fibrillation (AF) patients and without mechanical heart valves or rheumatic mitral stenosis (but including those with any degree of mitral regurgitation) were enrolled in the ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study; ClinicalTrials. gov identifier NCT02344901) in Turkey. Base-line demographic data, medical history, and medications prescribed for NVAF treatment were collected. Univariate analyses were performed for continuous variables, and the chi-square test was used for categorical variables. Results: In total, 6273 patients from 29 provinces of Turkey were enrolled in the study between February and May 2015, with the contribution of 83 investigators. The mean age was 69.6 +/- 10.7 years; 56% of the patients were females, and one-fifth of the patients had at least one comorbid disease, the most common being hypertension (69%). The mean CHA(2)DS(2)-VASc and HAS-BLED scores were 3.3 +/- 1.6 and 1.6 +/- 1.1, respectively. The rate of oral anticoagulant (OAC) therapy use was 72% (37% NOAC and 35% VKA). Conclusion: The RAMSES study showed a higher prevalence of OAC use among NVAF patients than that reported in previous studies. Although NOACs were preferred over VKAs in daily cardiology practice, there is a need for improved OAC therapies for NVAF patients.

WOS: 000374033100024, PubMed ID: 30039119, A 32 year old female patient presented to the cardiology clinic with an atypical chest pain. Her history revealed no other condition than Leopard syndrome which was diagnosed on her birth. On her coronary CT angiography, LMCA originated from the right coronary sinus and had a prepulmonic course. The purpose of this article is to present this patient with Leopard syndrome accompanied by left coronary artery outlet and coronary sinus abnormality.

WOS: 000429775000020, PubMed ID: 28301907, Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important factor for ensuring efficacy and safety in nonvalvular atrial fibrillation (NVAF). There are controversial results regarding NOAC adherence in real-world data and there are no data about NOAC adherence in Turkish population. This study investigated the NOAC adherence based on self-report, factors affecting nonadherence, and the relation of the adherence level with efficacy and safety outcomes. This multicenter cross-sectional study included 2738 patients (59% female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more than 3 months with >30 days of supply between September 1, 2015, and February 28, 2016. To measure the adherence level, an 8-item Morisky Medication Adherence Scale was used. The mean age of the patients was 70 +/- 10 years. Of the 2738 patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A total of 630 (23%) patients had high medication adherence, 712 (26%) moderate adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6% vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%, P = .004) bleeding rates. The adherence to NOAC was found to be quite low in Turkey. Nonadherence is associated with bleeding and thromboembolic cardiovascular events. Age, taking NOAC twice a day, and the additional noncardiac diseases, depression, and dementia were the independent factors affecting poor medication adherence.

Persistan sol süperiorvena kava nadir fakat önemli bir vasküler anomalidir. Sol süperior kardinal veninregrese olmayıp innominate vene uzanması ile oluşur. Sıklıkla izole olarakgörülür. Fakat atriyal septal defekt, bikuspit aortik kapak, aort koarktasyonu,koroner sinüs anomalileri veya kortriatrium gibi diğer kardiyovasküleranomalilerle ilişkili olabilir. Nefes darlığı ve atipik göğüs ağrısı şikayeti ile bizebaşvuran, ekokardiyografide sol persistan superior vena kava (PSSVK) olduğusaptanan olguya, ajitesalin kontrast ekokardiyografi yapıldı ve PSSVK anomalisi dogrulandı. İlave anomaliyönünden ileri tetkik amaçlı koroner bilgisayarlı tomografi (BT) anjiyografiincelemesi yapıldı. PSSVK’nın sol atriuma açıldığı ve koroner sinüsün patentolduğu izlendi. Olguyu literatür ve radyolojik görüntüler ışığında sunmayı amaçladık., Persistentleft superior vena cava is a rare but important vascular abnormality. It occurswhen the left superior cardinal vein does not regress and reaches innominatevein. It often present as an isolated condition. However, it might beassociated to cardiovascular anomalies such as atrial septal defect, bicuspidaortic valve, aortic coarctation, coronary sinus anomalies or cor triatrium. Apatient presenting with shortness of breath and atypical chest pain hadbeen diagnosed with left persistent superior vena cava (LPSVC) onechocardiography. Agitated salin contrast echocardiography was performed andthe LPSVC confirmed. Coronary CT angiography was performed in order to checkfor additional anomalies. It was seen that the LPSVC opens to the left atriumand the coronary sinus was patent. We aimed to present this case in the lightof literature and radiological images.

Anomalous origin of the coronary artery is a rare anomaly and does not generally lead to myocardial infarction and ventricular tachycardia. We report an uncommon case of anomalous origin of the right coronary artery originating from the left sinus of Valsalva with ventricular tachycardia and myocardial ischemia. A 42-year-old male was transferred from an external facility due to syncope and documented episodes of ventricular tachycardia preceding syncope. MPS showed small ischemic area in the inferior wall. Coronary CT angiography confirmed that RCA was originating from the left coronary aortic sinus with a separate ostium from the LMCA and coursing between the aorta and the pulmonary trunk. After consulting with cardiothoracic surgeons, the decision to perform corrective surgery was made. A successful correction surgery was performed by the surgeons, and the patient was asymptomatic after surgery.

Amaç: Periferik arter hastalığının tedavisi farklı tedaviseçeneklerine sahiptir. Son zamanlarda hibrid tedavi yöntemi (endovaskülertedavi artı cerrahi) alt ekstremite arter hastalığı tedavisindekullanılmaktadır. Bu çalışmada iliyakarter ve infrainguinal periferik arter hastalığında hibrid tedaviincelenmiştir.Gereç ve Yöntemler: Bu çalışma Ocak 2010 ile Ağustos2015 yılları arasında tıkayıcı iliyak arter hastalığı olan ve endovaskülertedavi yapılan 76 hastayı içermektedir. 56 hastaya sadece iliyak arterendovasküler tedavi uygulanırken, 20 hastaya iliyak arter endovasküler tedaviyeilave infrainguinal vasküler cerrahi uygulanmıştır. Bulgular: Yirmi hibrid tedavi kolunda, iliyakarter lezyon uzunluğu 31,0 ± 7,6 mm idi. Yedi hasta TASC-II A iliyak artersınıfında iken, 13 hasta TASC-II B iliyak sınıfında idi. Femoropopliteal lezyonlara göre 8 hasta TASC-IIC, 12 hasta TASC-II D. Bir hasta postoperatif dönem öldü, bir hastada greft tıkanıklığıgelişti ve kateter yöntemi ile tedavi edildi. Takipte bir hastada iliyak arterstent tıkanıklığı gelişti. Bir yıllık takipte ayak bileği/ kol sistolik basınçoranı 0,91 ± 0,20 idi. Sonuçlar: Hibrid tedavi iliyak arter veinfrainguinal arter hastalığını içeren çoklu alt ekstremite arter hastalığında uygunbir tekniktir. Bu teknik daha az komplikasyon oranlı açıklık oranına sahiptir.&nbsp, Aim: The treatment of peripheral arterial disease hasencompassed different therapy options. Hybrid therapy method (endovasculartreatment plus surgery) has recently been used in lower extremity arterial disease.This study has examined hybrid therapy practice in iliac and infrainguinalarterial disease. Materials and Methods: This study included 76 patientswith occlusive iliac artery disease and performed iliac artery endovasculartreatment from January 2010 to August 2015. While 56 patients underwent onlyiliac artery stenting, 20 of 76 patients underwent additionally infrainguinalvascular surgery (hybrid therapy). Results: In 20 hybrid patients group, iliac artery lesionlength was 31.0 ± 7.6 mm. Seven patients had TASC-II A iliac artery class,while 13 patients had TASC-II B class. According to femoropopliteal lesions,eight patients had TASC-II C, while 12 patients had TASC-II D. One patient died in postoperative period.Graft stenosis developed in one patient, which was resolved through cathetertherapy. In the one-year follow-up, in one patient, iliac stent restenosisdeveloped. ABI was 0.91 ± 0.20. Conclusion: Hybrid therapy is a feasibleoption for multilevel lower extremity artery disease, including iliac arterydisease and TASC-II C or D femoropopliteal disease. This technique hasfavorable patency with lower complication rates.

In this study, we investigated the relationship between the mean platelet volume (MPV) with mortality and heart failure (HF)-related hospitalization in stable chronic HF outpatients with reduced ejection fraction (HFrEF) and with sinus rhythm (SR).This retrospective cohort study included 197 consecutive stable chronic HFrEF outpatients with SR, who were admitted to our cardiology outpatient clinics for examination between January 2014 and January 2015. According to the receiver-operating characteristic curve analysis, the optimal cut-off value of MPV to predict HF-related hospitalization was9.1 fL. Patients were classified into two categories according to threshold MPV levels, as group I with MPV ≤ 9.1 fL and group II with MPV9.1 fL.The mean age of patients was 65 ± 13 years. The mean follow-up duration was 10 ± 3 months, and 44 patients (22%) succumbed to cardiovascular (CV) death. The rate of CV mortality was similar between the two groups (21% vs. 24%, p = 0.649). However, the rate of patients who experienced HF-related hospitalization was lower in group I compared with group II (41% vs. 87%, p0.001, respectively). Univariate analysis demonstrated associations of many clinical factors in addition to increased MPV9.1 fL with HF-related hospitalization; however, In the multivariate Cox proportional-hazards model, only increased MPV9.1 fL (HR: 2.895, 95% CI: 1.774-4.724, p0.001), systolic pulmonary artery pressure level (HR: 1.018, 95% CI: 1.001-1.036, p = 0.048) and pre-admission beta blocker use (HR: 0.517, 95% CI: 0.305-0.877, p = 0.014) remained associated with a risk of HF-related hospitalization.The mean platelet volume might be a useful parameter for risk stratification with regard to HF-related hospitalization in HFrEF outpatients with SR.

Amaç: Periferik arter hastalığının tedavisi farklı tedavi seçeneklerine sahiptir. Son zamanlarda hibrid tedavi yöntemi (endovasküler tedavi artı cerrahi) alt ekstremite arter hastalığı tedavisinde kullanılmaktadır. Bu çalışmada iliyak arter ve infrainguinal periferik arter hastalığında hibrid tedavi incelenmiştir.Gereç ve Yöntemler: Bu çalışma Ocak 2010 ile Ağustos 2015 yılları arasında tıkayıcı iliyak arter hastalığı olan ve endovasküler tedavi yapılan 76 hastayı içermektedir. 56 hastaya sadece iliyak arter endovasküler tedavi uygulanırken, 20 hastaya iliyak arter endovasküler tedaviye ilave infrainguinal vasküler cerrahi uygulanmıştır. Bulgular: Yirmi hibrid tedavi kolunda, iliyak arter lezyon uzunluğu 31,0 ± 7,6 mm idi. Yedi hasta TASC-II A iliyak arter sınıfında iken, 13 hasta TASC-II B iliyak sınıfında idi. Femoropopliteal lezyonlara göre 8 hasta TASC-II C, 12 hasta TASC-II D. Bir hasta postoperatif dönem öldü, bir hastada greft tıkanıklığı gelişti ve kateter yöntemi ile tedavi edildi. Takipte bir hastada iliyak arter stent tıkanıklığı gelişti. Bir yıllık takipte ayak bileği/ kol sistolik basınç oranı 0,91 ± 0,20 idi. Sonuçlar: Hibrid tedavi iliyak arter ve infrainguinal arter hastalığını içeren çoklu alt ekstremite arter hastalığında uygun bir tekniktir. Bu teknik daha az komplikasyon oranlı açıklık oranına sahiptir, Aim: The treatment of peripheral arterial disease has encompassed different therapy options. Hybrid therapy method (endovascular treatment plus surgery) has recently been used in lower extremity arterial disease. This study has examined hybrid therapy practice in iliac and infrainguinal arterial disease. Materials and Methods: This study included 76 patients with occlusive iliac artery disease and performed iliac artery endovascular treatment from January 2010 to August 2015. While 56 patients underwent only iliac artery stenting, 20 of 76 patients underwent additionally infrainguinal vascular surgery (hybrid therapy). Results: In 20 hybrid patients group, iliac artery lesion length was 31.0 ± 7.6 mm. Seven patients had TASC-II A iliac artery class, while 13 patients had TASC-II B class. According to femoropopliteal lesions, eight patients had TASC-II C, while 12 patients had TASC-II D. One patient died in postoperative period. Graft stenosis developed in one patient, which was resolved through catheter therapy. In the one-year follow-up, in one patient, iliac stent restenosis developed, ABI was 0.91 ± 0.20. Conclusion: Hybrid therapy is a feasible option for multilevel lower extremity artery disease, including iliac artery disease and TASC-II C or D femoropopliteal disease. This technique has favorable patency with lower complication rates

WOS: 000396440200005, PubMed ID: 28106016, Objective: Gender is an important feature in the management of atrial fibrillation (AF). This study investigated gender-related differences in patients with AF in Turkey. Methods: As a part of RAMSES (ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey, NCT02344901) study, information of the patients with AF who successively applied to the hospital was analyzed. This cross-sectional, multi-center, nationwide observational study enrolled 6264 non-valvular AF (NVAF) outpatients (55.9% women) from Turkey. Results: Compared with men, women with NVAF were older (71 years [range: 65-78 years] vs. 70 years [range: 62-77 years]; p= 1 [male], >= 2 [female]) had not received any anticogulant therapy. Conclusion: Although women with NVAF receive better treatment than men, anticoagulation therapy is suboptimal in large proportion of men and women, with underuse in high-risk patients and overuse in low-risk patients. There is an urgent need to improve optimization of anticoagulation in patients with NVAF.

WOS: 000397928500009, PubMed ID: 28099589, Background: According to common belief, most myocardial infarctions (MIs) are due to the rupture of nonsevere, vulnerable plaques with < 70% obstruction. Data from recent trials challenge this belief, suggesting that the risk of coronary occlusion is, in fact, much higher after severe stenosis. The aim of this study was to investigate whether or not acute ST-elevation MIs result from high-grade stenoses by evaluating the presence of coronary collateral circulation (CCC). Methods: We retrospectively included 207 consecutive patients who had undergone primary percutaneous coronary intervention for acute ST-elevation MI. Collateral blood flow distal to the culprit lesion was assessed by two investigators using the Rentrop scoring system. Results: Out of the 207 patients included in the study, 153 (73.9%) had coronary collateral vessels (Rentrop 1-3). The Rentrop scores were 0, 1, 2, and 3 in 54 (26.1%), 50 (24.2%), 51 (24.6%), and 52 (25.1%) patients, respectively. Triglycerides, mean platelet volume (MPV), white cell (WBC) count, and neutrophil count were significantly lower in the group with good collateral vessels (p = 0.013, p = 0.002, p = 0.003, and p = 0.021, respectively). Conclusion: More than 70% of the patients with acute MI had CCC with Rentrop scores of 1-3 during primary coronary angiography. This shows that most cases of acute MI in our study originated from underlying high-grade stenoses, challenging the common believe. Higher serum triglycerides levels, greater MPV, and increased WBC and neutrophil counts were independently associated with impaired development of collateral vessels.

WOS: 000403533000007, PubMed ID: 27849190, Objective: Angiographic assessment of stenosis has limited predictive value for functionally significant lesions compared with fractional flow reserve (FFR). The recently developed angiographic DILEMMA score, which consists of minimal lumen diameter (MLD), lesion length (LL) and Bypass Angioplasty Revascularization Investigation (BARI) Myocardial Jeopardy Index (MJI) was found to have diagnostic value in predicting FFR 0.80 group and 103 lesions in FFR

PubMed ID: 28238569, Objective No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies. Methods Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared. Results Of the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8 ± 9.8 vs. 68.7 ± 11.4 years, p

WOS: 000393268700003, PubMed ID: 27654487, Aim: We aimed to evaluate the effect of echocardiographically demonstrated right ventricular dysfunction (RVD) on time in therapeutic range (TTR) in heart failure (HF) patients receiving warfarin therapy. Methods:A total of 893 consecutive HF patients were included and classified into 4 different subgroups: HF with preserved ejection fraction (HFpEF) without RVD (n = 373), HF with reduced EF (HFrEF) without RVD (n = 215), HFpEF with RVD (n = 106) and HFrEF with RVD (n = 199). Groups were compared according to baseline, demographic and clinical data and the characteristics of warfarin therapy. Results: Presence of RVD yielded lower median TTR values both in HFpEF and HFrEF patients. RVD, current smoking, New York Heart Association functional class III/IV, hypertension, diabetes mellitus, pulmonary disease, prior transient ischemic attack or stroke, chronic kidney disease (CKD) stage 4/5 and CKD stage 3 were found to be independent predictors of poor anticoagulation control in multivariate logistic regression analysis. Conclusions: The present study demonstrated that presence of RVD in HF increases the risk for poor anticoagulation. (C) 2016 S. Karger AG, Basel

Testicular cancer is the most common solid tumor among young men. Regimens containing cisplatin and bleomycin in combination with etoposide are used for treatment of non-seminomatous germ cell testicular tumors. Cancer patients are at increased risk of thrombosis. Epidemiological studies have identified chemotherapy as an additional risk factor for a hypercoagulability state and thrombosis. The risk is more pronounced with cisplatin-containing chemotherapy. Thromboprophylaxis with LMWH during chemotherapy has demonstrated to give substantial risk reduction of thromboembolic events. We present a case of acute myocardial infraction during combined chemotherapy with bleomycin, etoposide and cisplatin for testicular cancer under thromboprophylaxis with nadroparin. Emergency coronary angiography revealed total occlusion of the right coronary artery by a thrombus which was successfully removed by aspiration.

WOS: 000367930400001, PubMed ID: 26839721, A considerable percentage of electrical injuries occur as a result of work activities. Electrical injury can lead to various cardiovascular disorders: acute myocardial necrosis, myocardial ischemia, heart failure, arrhythmias, hemorrhagic pericarditis, acute hypertension with peripheral vasospasm, and anomalous, nonspecific ECG alterations. Ventricular fibrillation is the most common arrhythmia resulting from electrical injury and is the leading cause of death in electrical (especially low voltage alternating current) injury cases. Asystole, premature ventricular contractions, ventricular tachycardia, conduction disorders (various degrees of heart blocks, bundle-brunch blocks), supraventricular tachycardia, and atrial fibrillation are the other arrhythmic complications of electrical injury. Complete atrioventricular block has rarely been reported and permanent pacemaker was required for the treatment in some of these cases. Herein, we present a case of reversible complete atrioventricular block due to low voltage electrical injury in a young electrical technician.

Transradial and transulnar artery approaches are commonly used for percutaneous interventions, with considerably low risk of developing hand ischemia, for reasons that have not been fully understood. The aim of this study was to evaluate the changes in the diameter, peak systolic flow velocity (PSV), and volume flow (VF) of the radial (RA) and ulnar artery (UA) during unilateral reciprocal temporary occlusion.A total of 204 extremity arteries of 102 consecutive patients were evaluated using Doppler ultrasonography. At the level of the wrist, RA and UA were consecutively compressed for 60 seconds. The diameter, PSV, and VF parameters of both arteries were evaluated during unilateral reciprocal compression.Compared with the baseline values, the median (interquartile range) increases in diameter, PSV, and VF were 0.2 (0.1-0.3) mm, 6.8 (1.7-17.5) cm/s, and 1.9 (0.8-10) ml/min, respectively, for RA, and 0.1 (0.1-0.3) mm, 9.4 (2.6-18.0) cm/s, and 10.0 (0.0-20.0) ml/min, respectively, for UA during reciprocal compression (p0.001 for all).Reciprocal compression significantly increased the diameter, PSV, and VF of both arteries during reciprocal compression. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:197-203, 2017.

WOS: 000392631500004, PubMed ID: 27665329, Objective: New York Heart Association (NYHA) classification predicts prognosis for heart failure (HF) patients. Socioeconomic status (SES) has the potential to affect treatment strategy and disease course. The present objective was to investigate whether SES of Turkish HF patients affected NYHA classification. Methods: Turkish research team-HF (TREAT-HF) is a questionnaire study with 52 questions, the purpose of which is to aid in the assessment of various qualities of HF patients. The 2013 TREAT-HF cohort included 503 patients from 11 centers in Turkey. Patients were divided into 2 groups according to NYHA functional classification: I-II, a better functional classification, or III-IV, a poorer functional classification. In addition, patients were analyzed according to gender. Results: Evaluated were NYHA functional classifications of 459 (326 males and 133 females) patients with a mean age of 59.7 +/- 14.07 years and a mean ejection fraction (EF) of 31.7 +/- 9.22%. Total monthly family income level of >= 1000 TL, younger age, higher EF, and male gender were independently associated with better NYHA functional classification. In addition to EF, regular weight control was found to be independently associated with better NYHA classification for females, while younger age and income of >= 1000 TL were independently associated with better NYHA classification for males. Conclusion: The present results demonstrated that SES was associated with NYHA functional classification in a cohort of Turkish HF patients.

The clinical significance of unligated major left internal mammary artery (LIMA)-side branches (SB) remains controversial in patients with previous coronary artery bypass graft (CABG) surgery. The aim of this study was to investigate the clinical significance of unligated major LIMA-SB by using exercise myocardial perfusion imaging (MPI) with single-photon emission tomography.We conducted a retrospective analysis of 2819 consecutive patients who underwent diagnostic angiography. There were 407 CABG patients with LIMA graft. The demographic, laboratory, pre-angiographic stress test and angiographic data of these patients were collected. A subgroup of patients with unligated major LIMA-SB who were referred to angiography with the diagnosis of stable angina pectoris and positive exercise MPI was identified and divided into two groups for comparison: anterior wall vs non-anterior wall ischemia groups.Among 407 patients with LIMA graft, 112 (27.5%) patients were found to have unligated major LIMA-SB. In a subgroup of patients (n=45) with positive exercise MPI and patent LAD-LIMA system with unligated major LIMA-SB, the median values of diameter and length of unligated major LIMA-SB were statistically higher in anterior wall ischemia group (n=24) compared to non-anterior wall ischemia group (1.8mm vs 0.6mm, P0.001 and 17.0cm vs 8.0cm, P0.001, respectively). The cut-off values of unligated major LIMA-SB length and diameter were 11cm and 1.3mm respectively. Unligated major LIMA-SB with a length of ≥11.0cm and a diameter of1.3cm had 95.8% of sensitivity and 100% of specificity for predicting anterior wall ischemia on exercise MPI. In patients with anterior wall ischemia, summed stress score and summed difference score were improved after percutaneous coil embolization of large unligated major LIMA-SB with ≥11.0cm length and1.3mm diameter.Large unligated major LIMA-SB with ≥11.0cm length and1.3mm diameter seems to be a potential source of ischemia in CABG patients. We suggest that exercise MPI might be a first option noninvasive test in evaluating the clinical significance of unligated major LIMA-SB and the effectiveness of embolization therapy.

WOS: 000380806300010, PubMed ID: 27182772, Background Nonvalvular atrial fibrillation (NVAF) frequently coexists with coronary artery disease (CAD). However, the optimal antithrombotic strategy for patients with concomitant CAD and NVAF is controversial. The aim of this study is to assess the prevalence of CAD with NVAF and to determine antithrombotic treatment options in patients with or without a history of CAD. Methods ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey (RAMSES study) was a cross-sectional, multicenter, nationwide observational study carried out in NVAF patients. We studied the clinical data of 6264 Turkish patients participating in the RAMSES study. Demographic properties and antithrombotic therapies were recorded and compared between patients with and without CAD. Results CAD was present in 1828 (29.2%) of patients with NVAF. Most of the NVAF patients with CAD were men (58%) and comorbid diseases were significantly more common in patients with CAD. Although patients with CAD had higher CHA(2)DS(2)VASc scores than those without disease (4.1 +/- 1.5 vs. 2.9 +/- 1.5; P=0.001), they had lower use of oral anticoagulant (OAC) therapy (66.1 vs. 74.4%, P=0.01). Among OAC drugs, warfarin was the preferred medication in patients with CAD (35.4 vs. 30.6%, P=0.01), whereas nonvitamin K antagonist oral anticoagulants were preferred in patients without CAD (40 vs. 34.3%, P=0.01). Patients with CAD required nearly three-fold higher antiplatelet treatment compared with patients without CAD (57.8 vs. 21.4%, P

WOS: 000398921700008, PubMed ID: 27646643, To evaluate the abnormalities and variations of the arterial system of upper extremities and superficial palmar arch with computed tomography angiography and to guide the clinician during this procedure. A total of 156 upper extremities of 78 cases were retrospectively analyzed using computed tomography angiography. The study was approved by the local ethics committee of the hospital. From the analysis of the computed tomography angiography images, the following information was recorded; the diameters and abnormalities of radial, ulnar and brachial arteries in both upper extremities, the presence of atherosclerotic changes or stenosis in these arteries, whether the superficial palmar arch was complete or incomplete, and arterial dominance. Also, the computed tomography angiography classification of superficial palmar arch distribution and anatomic configuration was performed. The mean baseline diameters of the radial, ulnar and brachial arteries of the cases were; 2.8 +/- 0.6, 2.5 +/- 0.7, and 4.7 +/- 0.6 mm, respectively. A complete superficial palmar arch was observed in 69.2 % of the right hands and 70.5 % of the left hands. For the superficial palmar arches on the right side, the radial artery was dominant in two and the ulnar artery was dominant in 47 with the remaining showing codominance. On the left side, the radial artery was dominant in one hand, with the ulnar artery being dominant in 49 cases, and in 28 cases, there was codominance. In the superficial palmar arch classification, four of the arches (A-D) were defined as complete and the remaining three (E-G) as incomplete. The current study clarified different variations in palmar circulation and forearm arteries to aid the surgeon during trans-radial or trans-ulnar catheterization, hemodialysis, or coronary artery bypass grafting.

We aimed to differentiate ischemic heart failure (HF) from non-ischemic HF in patients presenting with non-acute onset exertional dyspnea using technetium-99m methoxyisobutylisonitrile gated single photon emission tomography ((99m)Tc-MIBI gSPET) imaging.One hundred and seventy nine consecutive patients with exertional dyspnea without concomitant chest pain referred to (99m)Tc-MIBI gSPET imaging were included in this study. All patients had a newly diagnosed HF with reduced ejection fraction (HFrEF). Imaging findings were compared between ischemic HF and non-ischemic HF groups.Of the 179 patients, 127 had ischemic HF and 52 had non-ischemic HF. There was no difference between ischemic and non-ischemic groups in terms of age, gender, body mass index, any smoking history, diabetes mellitus, history of hypertension and hyperlipidemia. Global dysfunction of left ventricle was more common in non-ischemic HF group than ischemic HF group (82.7% vs 41.7% respectively, P0.001). Presence of severe (3+/4+) ischemia and large perfusion defect were higher in ischemic HF group compared to non-ischemic HF group (45.7% vs 15.4%, P0.001 and 23.6% vs 3.8%, P=0.003, respectively). Summed stress score (SSS), summed rest score and summed difference score were higher in ischemic HF group compared to non-ischemic HF group (P0.001, P0.001, and P=0.021, respectively). In multivariate analysis, absence of global dysfunction (P0.001, OR=10.338, 95%CI: 3.937-27.405) and SSS (P0.001, OR=1.208, 95%CI: 1.090-1.339) were the independent predictors of ischemic HF. Absence of global dysfunction had 58.3% sensitivity and 86.7% specificity for diagnosis of ischemic HF at gSPET imaging in patients presenting with newly diagnosed HF and exertional dyspnea without concomitant chest pain (AUC=0.705, 95%CI: 0.632-0.771, P0.001), whereas SSS8 had 65.4% sensitivity and 75.0% specificity (AUC=0.732, 95%CI: 0.661-0.795, P0.001).Absence of global dysfunction and SSS on SPET imaging were the independent predictors of ischemic etiology of HF presenting with dyspnea without concomitant chest pain. These findings had a low sensitivity, but acceptable specificity.

WOS: 000371271400047, PubMed ID: 26800138, …