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Cardiac hepatopathy has generally been used to describe any liver damage caused by cardiac disorders in the absence of other possible causes of liver damage. Although there is no consensus on the terminology used, cardiac hepatopathy can be examined as congestive hepatopathy (CH) and acute cardiogenic liver injury (ACLI). CH is caused by passive venous congestion of the liver that generally occurs in the setting of chronic cardiac conditions such as chronic HF, constrictive pericarditis, tricuspid regurgitation, or right-sided heart failure (HF) of any cause, and ACLI is most commonly associated with acute cardiocirculatory failure resulting from acute myocardial infarction, acute decompensated HF, or myocarditis. Histologically, CH is characterized by sinusoidal dilation, replacement of hepatocytes with red blood cells extravasating from the sinusoids, and necrosis/apoptosis of zone 3 of the Rappaport acinus, and it could progress to cirrhosis in advanced cases. In ACLI, however, massive necrosis of zone 3 is the main histological finding. Primary laboratory findings of CH are elevated serum cholestasis markers including bilirubin, alkaline phosphatase, and γ-glutamyl-transpeptidase levels, whereas those of ACLI are a striking elevation in transaminase and lactate dehydrogenase levels. Both CH and ACLI have a prognostic value for identifying cardiovascular events and mortality and have some special implications in the management of patients undergoing ventricular assist device implantation or cardiac transplantation. There is no specific treatment for CH or ACLI other than treatment of the underlying cardiac disorder.

Aim: Tp-e/QT ratio is a novel marker of ventricular repolarization. The aim of the study is to evaluate the Tp-e interval and Tp-e/QT ratio before and after radiofrequency ablation (RFA) for patients with frequent premature ventricular complexes (PVCs). Patients & methods: The study included 151 consecutive patients who underwent RFA for treatment of symptomatic frequent PVCs. Results: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio (all p < 0.001) were significantly different before and after RFA. After the procedure, mean left ventricular ejection fraction of the population were significantly increased than before RFA (p < 0.001). There was a significant correlation between preprocedural Tp-e/QTc ratio and PVC burden in patients (p = 0.023). Conclusion: Our study shows that PVCs may have a negative effect on ventricular repolarization.

Objective: To develop and validate a scale to measure fear of activity in patients with coronary artery disease. Design: Psychometric study. Setting: Outpatient cardiology clinics. Participants: The scale was applied to patients who had myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention within the last 12 months (N=250). Interventions: A scale for fear of activity in patients with coronary artery disease (Fact-CAD) was created through semistructured focus group interviews with patients. Face and content validity of Fact-CAD was verified. Main Outcome Measures: Psychometric analysis included model fit, unidimensionality, reliability, local dependency, differential item functioning, and external construct validity. Analyses were performed using the Rasch Analysis Model. Results: Fact-CAD scale was a reliable (high Person Separation Index of 0.89) and valid (unidimensional, no misfit, local independency supported, no residual correlations) measure of fear of activity. Three items showed differential item functioning according to employment status, marital status, and angina pectoris, which were not assigned as real item bias by experts and remained in the model. Conclusion: Fact-CAD was supported by Rasch analysis as a psychometrically valid scale to evaluate fear of activity in patients with coronary artery disease. (C) 2019 by the American Congress of Rehabilitation Medicine WOS:000520949900011 2-s2.0-85073748647 PubMed: 31562874

Aim: This study aims to assess the predictive role of the preprocedural circulating monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) on the occurrence of stent restenosis (SR) in patients with stable and unstable angina pectoris undergoing successful bare-metal stenting (BMS). Patients & methods: Between February 2008 and June 2014, a total of 831 patients with stable and unstable angina pectoris who underwent successful BMS were retrospectively analyzed. Demographic and clinical characteristics of the patients were recorded. Left ventricular ejection fraction and laboratory data were also noted. Results: In the receiver operating characteristics curve analysis, MHR >14 had 71% sensitivity and 69% specificity in predicting SR. Conclusion: Our study results show that preprocedural MHR is an independent predictor of SR in this patient population.

Contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PPCI) is associated with adverse short- and long-term outcomes. The aim of this study was to evaluate the predictive value of gamma-glutamyl transferase (GGT) for risk of CIN in patients with ST-segment elevation myocardial infarction who underwent PPCI. A total of 473 patients were enrolled in the study. A relative increase in serum creatinine ≥25%, or an absolute increase ≥0.5 mg/dl, from the baseline within 72 hours of contrast exposure was defined as CIN. Patients were divided into 3 groups according to GGT tertiles (tertile 1, GGT19 U/L; tertile 2, GGT 19 to 33 U/L; and tertile 3, GGT33 U/L) on admission. Demographics, clinical risk factors, laboratory parameters, CIN incidence, and other inhospital clinical outcomes were compared among GGT tertiles. CIN incidence was significantly higher in tertile 3 (29%) compared with tertiles 1 (11%) and 2 (11%, p0.001). Inhospital death incidence was significantly increased across tertiles (from tertile 1 to tertiles 2 and 3, 1%, 4%, and 5%, respectively, p0.05). In receiver operating characteristic analysis, a threshold value of GGT26.5 U/L had 70% sensitivity and 60% specificity for CIN. After including variables found significant in univariate analysis, the presence of diabetes mellitus (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.22 to 2.31, p0.001), C-reactive protein (for each 1 mg/L increase; OR 1.01, 95% CI 1.00 to 1.02, p = 0.007), contrast volume (for each 1-ml increase; OR 1.01, 95% CI 1.00 to 1.02, p = 0.012), and GGT26.5 U/L (OR 2.59, 95% CI 1.48 to 4.53, p0.001) were found as independent associates of CIN in multivariate regression analysis. Each 1 U/L increase in GGT was also associated with CIN risk (OR 1.04, 95% CI 1.03 to 1.06, p0.001). In conclusion, GGT on admission was a significant and independent predictor of CIN after PPCI in patients with ST-segment elevation myocardial infarction.

Background: The risk of syncope and sudden cardiac death due to ventricular arrhythmias increased in patients with aortic stenosis (AS). Recently, it was shown that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio can be novel indicators for prediction of ventricular arrhythmias and mortality. We aimed to investigate the association between AS and ventricular repolarization using Tp-e interval and Tp-e/QT ratio. Methods: Totally, 105 patients with AS and 60 control subjects were enrolled to this study. The severity of AS was defined by transthoracic echocardiographic examination. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured from the 12-lead electrocardiogram. Results: Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly increased in parallel to the severity of AS (P < 0.001, P = 0.001, and P = 0.001, respectively). Also, it was shown that Tp-e/QTc ratio had significant positive correlation with mean aortic gradient (r = 0.192, P = 0.049). In multivariate logistic regression analysis, Tp-e/QTc ratio and left ventricular mass were found to be independent predictors of severe AS (P = 0.03 and P = 0.04, respectively). Conclusions: Our study showed that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were increased in patients with severe AS. Tp-e/QTc ratio and left ventricular mass were found as independent predictors of severe AS. Ann Noninvasive Electrocardiol 2015;00(0):1-7 aortic stenosis; Tp-e interval; Tp-e/QT ratio

AEMD and Vitamin D Deficiency Objectives Limited data are available regarding cardiac arrhythmias in vitamin D (VitD) deficiency. Therefore, we aimed to assess whether atrial electromechanical delay (AEMD) measured by tissue Doppler imaging (TDI), which is an indicator for atrial fibrillation (AF) development, is prolonged in patients with VitD deficiency as compared to the control group. The effect of vitD replacement on AEMD was also evaluated. Methods In this prospective study a total of 28 VitD-deficient and 56 age-, gender-, and BMI-matched VitD-sufficient healthy participants were enrolled. P-wave dispersion (PWd) was calculated on the 12-lead electrocardiogram. Both intra- and inter-AEMD were calculated by TDI. Measurements were performed at baseline in both groups and were repeated after 6-month replacement therapy in subjects with vitD deficiency. Results PWd and inter- and left intra-AEMD were significantly prolonged in patients with VitD deficiency compared to the control group (P 0.05) following replacement therapy. Conclusion PWd and left intra- and inter-AEMD are increased in patients with VitD deficiency. The serum 25(OH)D level was found as an independent predictor for AEMD in patients with VitD deficiency. Also a significant decrement was observed in inter-AEMD following vitD replacement therapy. Studies with longer follow-up are needed to investigate whether vitD-deficient patients with prolonged AEMD develop clinical arrhythmia and vitD replacement reduces the risk of atrial arrhythmias.

Objective: Electrical storm (ES) is a life-threatening pathology that requires immediate and effective treatment due to increased morbidity and mortality. Catheter ablation (CA) is an effective therapeutic option, particularly in patients with drug resistant ventricular arrhythmia episodes. These procedures should only be performed in highly specialized and experienced centers. Here we aimed to assess safety and efficacy of CA in a relatively large cohort with ES in our tertiary center hospital. Methods: A total of 44 patients (90.9% male; mean age: 59.7±10.3 years) with ischemic cardiomyopathy undergoing CA for drug-refractory ES were prospectively evaluated. Procedures were performed using non-contact and electro-anatomic mapping systems. Long-term follow-up analysis addressed the predictors of ES recurrence and cardiac mortality. Results: Acute success rates for clinical and non-clinical VTs were 90.8% and 55.5%, respectively. A mean follow-up at 28±11 months revealed cardiac mortality in 8 (18%) patients, 39 (88.6%) patients were free from the ES, and 24 (55%) patients remained free from both ES and paroxysmal VT episodes. In multivariate regression analysis, recurrence of ES (OR=3.11, 95% CI: 1.65-4.62, p=0.001), LVEF, and serum creatinine were found as independent predictors of cardiac mortality. In addition, substrate based ablation, implantation of ICD for secondary prophylaxis, LVEF, and serum creatinine were good predictors of ES recurrence. Conclusion: Catheter ablation for ventricular arrhythmias in the course of ES in patients with ischemic cardiomyopathy is safe with an acceptable success rate. (Anatol J Cardiol 2016; 16: 159-64)

Monocyte to high density lipoprotein cholesterol ratio (MHR) is generally understood to be a candidate marker of inflammation and oxidative stress. Therefore, we aimed to assess the association between MHR and aortic elastic properties in hypertensive patients.A total of 114 newly-diagnosed untreated patients with hypertension and 71 healthy subjects were enrolled. Aortic stiffness index, aortic strain and aortic distensibility were measured by using echocardiography.Patients with hypertension had a significantly higher MHR compared to the control group (p0.001). Also, aortic stiffness index (p0.001) was significantly higher and aortic distensibility (p0.001) was lower in the hypertensive group. There was a positive correlation of MHR with aortic stiffness index (r = 0.294, p0.001) and negative correlation with aortic distensibility (r = -0.281, p0.001). In addition, MHR and high sensitivity C-reactive protein have a positive correlation (r = 0.30, p0.001). Furthermore, MHR was found to be an independent predictor of aortic distensibility and aortic stiffness index.In patients with newly-diagnosed untreated essential hypertension, higher MHR was significantly associated with impaired aortic elastic properties.

Objectives Vitamin D (VitD) deficiency affects the cardiovascular system via endocrine, paracrine, and autocrine pathways. Limited data are available regarding cardiac autonomic dysfunction in VitD deficiency. The aim of this study was to assess the cardiac autonomic functions by using heart rate recovery index (HRRI) and heart rate variability (HRV) in apparently healthy subjects with VitD deficiency. Methods A total of 24 VitD deficient and 50 age-, gender-, and body mass index–matched VitD sufficient healthy participants who admitted to outpatient clinics at a tertiary centre were enrolled. All study participants underwent Treadmill exercise test and 24-hour Holter recording to assess cardiac autonomic functions. HRRIs were calculated by subtracting first, second, and third minute heart rates during recovery period from maximal heart rate. Results Mean HRR1 (28.0 ± 8.3 vs 42.8 ± 6.4, P < 0.001), HRR2 (41.1 ± 11.2 vs 60.8 ± 10.4, P < 0.001), and HRR3 (44.9 ± 13.3 vs 65.9 ± 9.8, P < 0.001) were significantly higher in VitD sufficient group compared to VitD deficient group. HRV parameters as, SDNN (P = 0.040), SDANN (P < 0.001), RMSSD (P < 0.001), PNN50 (P < 0.001), and HF (P < 0.001) were significantly decreased in patients with VitD deficiency; but LF (P < 0.001) and LF/HF (P = 0.003) were significantly higher in VitD deficient group. Serum 25(OH)D level was positively correlated with HRRIs (P < 0.001), PNN50, RMSSD, SDANN, and HFnu; negatively correlated with LFnu and LF/HF (P < 0.05). Also, multivariate linear regression analysis showed that serum 25(OH)D level was significantly associated with HRRIs and HRV parameters (P < 0.001). Conclusion Our study results suggest that cardiac autonomic functions are impaired in patients with VitD deficiency despite the absence of overt cardiac involvement and symptoms. Further studies are needed to elucidate the prognostic significance and clinical implications of impaired autonomic functions in patients with VitD deficiency.

Increased circulating D-dimer levels have been correlated with adverse outcomes in various clinical conditions. To our knowledge, the association of on-admission D-dimer and in-hospital mortality in infective endocarditis (IE) has not been investigated. We hypothesized that increased on-admission D-dimer levels would correlate with adverse outcomes when prospectively studied in patients with IE.In this prospective study, a total of 157 consecutive patients with the definite IE diagnosis met the inclusion criteria and underwent testing for on-admission D-dimer and CRP assays. The outcome measure was in-hospital death from any cause.In-hospital mortality occurred in 40 (26%) patients. Increased levels of plasma D-dimer (5.1 ± 1.7 vs 1.9 ± 0.8, p0.001), CRP [45(13-98) vs 12(5-28), p0.001] were found in dead patients compared with those survived. In addition to S. aureus infection, increased leukocyte count, end-stage renal disease, LVEF50%, vegetation size of10mm, perivalvular abscess, on-admission D-dimer (HR: 1.32; 95% CI: 1.24-1.40; p0.001) and CRP (HR: 1.18; 95% CI: 1.09-1.36; p=0.001) levels were significantly associated with in-hospital mortality. Furthermore, the sensitivity and specificity of D-dimer ≥ 4.2mg/L in predicting in-hospital death in IE were 86% and 85%, respectively. Moreover, the sensitivity and specificity of CRP levels ≥ 13.6 mg/L were 72% and 69%, respectively.Our findings suggest that on-admission D-dimer level may be a simple, available and valuable biomarker that allows us to identify high-risk IE patients for in-hospital mortality. D-dimer ≥ 4.2mg/L, CRP ≥ 13.6 mg/L were independently associated with IE related in-hospital death.

Early morning blood pressure surge (MBPS) is a risk factor for cardiovascular events (CVEs), but the relationship with uric acid is not well understood. The authors aimed to determine the association between MBPS and increased uric acid and the effect of elevated MBPS and uric acid combination on CVEs. A total of 921 patients underwent 24-hour ambulatory blood pressure monitoring and were followed for a median of 40 months. During this period, 103 (11.2%) CVEs occurred. There was a significant relationship between increasing quartiles of serum uric acid level and increasing values of MBPS (P

Background Fragmented QRS complex (fQRS) is associated with worse outcomes in several cardiovascular conditions. However, alterations in fQRS in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and association of fQRS with myocardial blush grade (MBG) has not been investigated until now. In this study, we aimed to investigate the association of MBG after primary PCI with evolution of fQRS. Methods Our study consisted of 401 consecutive patients with STEMI who underwent primary PCI. Patients were categorized into two subgroups according to persistence or new-onset of fQRS (Group 1) and absence or resolution of fQRS (Group 2) at 48 hours after primary PCI. The evolution of fQRS on pre- and post-PCI ECG and their relation with myocardial reperfusion parameters were investigated. Results Patients in group 1 showed older age, higher rate of smoking, lower HDL-cholesterol, lower LVEF, higher angina-to-door time, higher TIMI frame count, and high rate of patients with MBG

Background Fragmented QRS complex (fQRS) is associated with cardiovascular outcomes in various patient populations. Although there were clinical studies investigating the association of fQRS with arrhythmic events in patients with systolic heart failure, the results were conflicting regarding the association of implantable cardioverter defibrillator (ICD) shocks and fQRS. In this study, we aimed to evaluate the association between the presence and extent of fQRS with appropriate ICD shocks and/or all-cause mortality. Methods A total of 215 patients (age: 58.2 ± 11.6 years, 72.5 % male) with the diagnosis of left ventricular systolic heart failure in whom ICD had been implanted for primary prophylaxis were enrolled. Standard ECG evaluation revealed fQRS complex in 123 patients (57.2 %). The phenomenon of fQRS was defined as deflections at the beginning of the QRS complex, on top of the R wave, or in the nadir of the S wave similar to the definition in CAD. Results At mean 23.5 ± 12.1 months follow-up, all-cause mortality was observed in 45 (20.9 %) patients and 111 (51.6 %) patients experienced appropriate ICD shocks. Median number of ECG leads with fQRS were higher in patients with appropriate ICD shocks (3 [2–6] vs 1 [0–2], P < 0.001, respectively). The presence of fQRS (HR: 6.64, 95 % CI: 3.54–12.4, P < 0.001) and the number of leads with fQRS (HR: 1.35, 95% CI: 1.22–1.67) were found as independent predictors of appropriate ICD shocks. Additionally, there was a negative correlation between left ventricular ejection fraction and the number of leads with fQRS (r = −0.434, P < 0.001). Rates of all-cause mortality did not differ between the fQRS(+) (29 [24 % ]) and fQRS(−) (16 [17 % ]) groups (P = 0.27). Conclusion Our findings suggest that the presence and extent of fQRS complex on standard 12-lead ECG predicts appropriate ICD shocks in patients with left ventricular systolic heart failure who underwent ICD implantation for primary prophylaxis.

Subvalvular apparatus preservation is an important concept in mitral valve replacement (MVR) surgery that is performed to remedy mitral regurgitation. In this study, we sought to determine the effects of papillary muscle repositioning (PMR) on clinical outcomes and echocardiographic left ventricular function in rheumatic mitral stenosis patients who had normal left ventricular systolic function. We prospectively assigned 115 patients who were scheduled for MVR surgery with mechanical prosthesis to either PMR or MVR-only groups. Functional class and echocardiographic variables were evaluated at baseline and at early and late postoperative follow-up examinations. All values were compared between the 2 groups. The PMR group consisted of 48 patients and the MVR-only group of 67 patients. The 2 groups’ baseline characteristics and surgery-related factors (including perioperative mortality) were similar. During the 18-month follow-up, all echocardiographic variables showed a consistent improvement in the PMR group; the mean left ventricular ejection fraction deteriorated significantly in the MVR-only group. Comparison during follow-up of the magnitude of longitudinal changes revealed that decreases in left ventricular end-diastolic and end-systolic diameters and in left ventricular sphericity indices, and increases in left ventricular ejection fractions, were significantly higher in the PMR group than in the MVR-only group. This study suggests that, in patients with rheumatic mitral stenosis and preserved left ventricular systolic function, the addition of papillary muscle repositioning to valve replacement with a mechanical prosthesis improves left ventricular dimensions, ejection fraction, and sphericity index at the 18-month follow-up with no substantial undesirable effect on the surgery-related factors.

Objectives The association of QRS duration (QRSd) with ventricular dyssynchrony is well-known in systolic heart failure (HF). However, there are no data regarding the relationship between QRSd and atrial dyssynchrony in patients with HF. We aimed to investigate the association of QRSd with intra-atrial and inter-atrial dyssynchrony in patients with systolic HF by using color tissue Doppler imaging (TDI). Methods The study consisted of 70 systolic HF patients and 35 healthy controls. According to QRSd, HF patients were categorized into 2 subgroups as narrow QRS (n = 35) and wide QRS (n = 35) groups. Time intervals between the onset of P-wave and the onset of A-wave on color TDI from the right atrium (P-RA), inter-atrial septum (P-IAS) and left atrium (P-LA) were measured. Atrial dyssynchrony was defined as differences between P-RA and P-IAS (RA dyssynchrony), between P-LA and P-IAS (LA dyssynchrony) and between P-RA and P-LA (inter-atrial dyssynchrony). Results In patients with either HF groups, we observed significant impairment in intra-atrial and inter-atrial synchronicity compared with the controls (P

Serum uric acid (SUA) level is known as a significant predictor for cardiovascular diseases, partly through increased inflammatory response and smooth muscle cell proliferation. Inflammation and smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relation between SUA and ISR has not been studied. The aim of the present study was to investigate the predictive value of preprocedural SUA on the development of ISR in patients who undergo coronary bare-metal stent implantation. Clinical, biochemical, and angiographic data from 708 consecutive patients (mean age 60.3 ± 9.3 years, 71% men) who had undergone bare-metal stent implantation and additional control coronary angiography for stable or unstable angina pectoris were analyzed. Patients were divided into tertiles on the basis of preprocedural SUA levels. Stent restenosis was observed in 54 patients (23%) in the lowest tertile, in 79 (34%) in the middle tertile, and in 109 (46%) in the highest tertile (p0.001). Using multiple logistic regression analysis, diabetes mellitus, smoking, high-density lipoprotein cholesterol, stent length, C-reactive protein level, and preprocedural SUA level emerged as independent predictors of ISR. On receiver-operating characteristics curve analysis, SUA level5.5 mg/dl had 75% sensitivity and 71% specificity (area under the curve 0.784, p0.001) in predicting ISR. In conclusion, higher preprocedural SUA is a powerful and independent predictor of bare-metal stent restenosis in patients with stable and unstable angina pectoris.

Background The neutrophil-to-lymphocyte ratio is an independent predictor of worse prognosis in both infectious and cardiovascular disease. We hypothesized that an increased neutrophil-to-lymphocyte ratio at admission would predict in-hospital unfavourable outcomes in patients with infective endocarditis (IE). Methods We retrospectively analyzed clinical, laboratory, and echocardiographic data in a total of 121 consecutive adult patients (64 men; mean age, 54.7 ± 14.2 years) with definite IE. Results Among all patients, the prespecified clinical outcomes were experienced in 46 patients (38%). In-hospital mortality and central nervous system (CNS) events occurred in 29 (24%) and 21 patients (17%), respectively. The neutrophil-to-lymphocyte ratio at admission was found to be significantly higher for either composite end point. On using multiple Cox regression analysis, vegetation size ≥ 10 mm, end-stage renal disease, Staphylococcus aureus infection, low hemoglobin level, increased C-reactive protein (CRP) level, and high neutrophil-to-lymphocyte ratio at admission emerged as independent predictors of in-hospital unfavourable outcomes. In the receiver operating characteristics (ROC) curve analysis, a neutrophil-to-lymphocyte ratio > 7.1 had 80% sensitivity and 83% specificity in predicting adverse outcomes. Conclusion High neutrophil-to-lymphocyte ratio at admission is an independent predictor of in-hospital mortality and CNS events in patients with IE. However, prospective validation of these findings is required.

BACKGROUND: Hypertension (HT) is one of the main conditions associated with left ventricular (LV) diastolic dysfunction. Epicardial fat tissue (EFT) serves as a source of a plenty of proinflammatory cytokines and is associated with increased cardiovascular events. The aim of the current study was to evaluate the relation among echocardiographically measured EFT thickness, systemic inflammation, and LV diastolic dysfunction in patients with essential HT. PATIENTS AND METHODS: The study included 135 newly diagnosed and untreated hypertensive outpatients. On the basis of conventional Doppler and tissue Doppler imaging-derived parameters, patients were divided into two groups: 60 patients with normal diastolic function and 75 patients with LV diastolic dysfunction. EFT thickness was measured from the parasternal long-axis view at end-systole and high-sensitivity C-reactive protein (hs-CRP) was assessed using the latex-enhanced immunoturbidimetric method. RESULTS: In patients with LV diastolic dysfunction, EFT thickness was significantly increased compared with the normal diastolic function group (7.9 ± 1.7 vs. 6.3 ± 1.5 mm; P < 0.001, respectively). Serum hs-CRP level was also significantly higher in the LV diastolic dysfunction group (P < 0.001) and was correlated with EFT thickness (r = 0.442, P < 0.001). In stepwise multivariate logistic regression analysis, EFT thickness (odds ratio 1.27, 95% confidence interval 1.12-1.43; P = 0.006) and hs-CRP level (odds ratio 1.42, 95% confidence interval 1.18-1.72; P = 0.003) emerged as independent positive predictors of LV diastolic dysfunction. CONCLUSION: In patients with newly diagnosed and untreated essential HT, increased EFT thickness and hs-CRP level are significantly related to impaired LV diastolic function independent from other factors, including age, waist circumference, and 24-h systolic blood pressure.

Objectives Left ventricular (LV) synchronous contraction is impaired in patients with hypertension (HT). The deleterious effects of HT on cardiovascular system are more evident in patients with nondipper HT than dippers. In this study, we aimed to investigate the effect of nondipping HT on LV systolic synchronicity compared with dippers and controls. Methods One hundred patients with newly diagnosed essential HT and 50 normotensive subjects were enrolled in this study. The hypertensive patients were assigned 2 groups comprising 55 dippers and 45 nondippers. Each subject underwent a comprehensive transthoracic echocardiographic examination. The evaluation of systolic dyssynchrony was performed by tissue synchronization imaging, and the time to regional peak systolic tissue velocity (Ts) in LV was measured on the basis of 12 segmental models. The standard deviation (SD) of the 12 LV segments (Ts-SD-12) and maximal difference in Ts between any two of the 12 LV segments (Ts-12) were calculated. Results Compared with the control group, the synchronicity indexes were significantly prolonged in the hypertensive patients. Furthermore, Ts-SD-12 and Ts-12 values were found to be significantly impaired in patients with nondipper HT, compared with dippers: Ts-SD-12 (38.1 ± 18.7 vs. 31.8 ± 15.4, P ≤ 0.001); Ts-12 (123.0 ± 50.6 vs. 98.4 ± 42.3, P ≤ 0.001). Stepwise multivariate logistic regression analysis revealed a significant negative association between LV dyssynchrony indices and percentage decline in BP level from day to night. Conclusion Synchronous systolic contraction of LV is found to be significantly impaired in patients with nondipping circadian pattern of HT compared with dippers and the controls.

Introduction: We hypothesized that the red cell distribution width (RDW) would predict the outcome of surgical revascularization of patients with coronary artery disease.Materials and Methods: Ninety four patients with severe coronary artery disease who underwent coronary artery bypass grafting were included in this study. A total of 94 patients were divided into tertiles based on their preprocedural RDW (mean RDW: tertile 1, 12.68 ± 0.60; tertile 2: 13.64 ± 0.49; tertile 3, 16.47 ± 2.04).Results: There were a total of 18 (19.1%) deaths over a mean follow-up of 51 months. Patients with a high RDW showed the highest mortality (34%) as compared to patients with medium (10%) and low RDW (13%). In multivariable regression modeling, RDW > 14.6 was a significant independent predictor of five year outcome in mortality.Conclusion: In conclusion, elevated preprocedural RDW in patients undergoing coronary artery bypass grafting is associated with increased risk of long-term mortality.

Red cell distribution width (RDW) is a strong prognostic marker for systolic left heart failure regardless of the anemia status, and heart rate variability (HRV) is negatively associated with mortality and sudden cardiac death in patients with systolic left heart failure. Their relationship has not been investigated in the previous literature.One hundred eighty four patients who had been previously diagnosed with systolic left heart failure (with ischemic or non-ischemic etiology) were retrospectively enrolled in our study. Patients underwent 24-h electrocardiographic monitoring, and blood samples for RDW and other variables were analyzed. Study population was grouped into tertiles of RDW (Tertile 1: 13.4 ± 1.4%, Tertile 2: 14.6 ± 1.4%, and Tertile 3: 17.1 ± 1.2%).Most of the characteristics of patients were similar among RDW tertiles. Standard deviation of all normal RR intervals (SDNN), standard deviation of the averages of RR intervals in all 5-min segments (SDANN) and root-mean square of difference of successive RR intervals (RMSSD) values significantly differed among groups (p0.001). The highest RDW tertile had the lowest HRV values, and Pearson correlation analysis yielded a negative correlation between HRV parameters and RDW (for SDNN, SDANN, RMSSD; r = 0.373, 0.340, 0.362, respectively, p0.001 for all). In stepwise multivariate analysis HRV was independently associated with RDW.The HRV parameters were independently associated with RDW in patients with systolic left heart failure.

Myocardial clefts are defined as narrow, deep blood-filled invaginations within the left ventricular myocardium. They occur in hypertrophic cardiomyopathy patients with different frequency and represent a distinctive morphological expression of hypertrophic cardiomyopathy. Although two-dimensional transthoracic echocardiography is able to detect myocardial clefts in some cases, cardiovascular magnetic resonance imaging with its high spatial resolution can detect myocardial clefts not visualized with echocardiography. In this report, we represent multimodality imaging of a septal myocardial cleft in a hypertrophic cardiomyopathy patient.

Aim: To determine the association of monocyte count-to-high-density lipoprotein (HDL)-cholesterol ratio, a recently emerged inflammatory marker, with abdominal aortic aneurysm (AAA) size. Patients & methods: A total of 120 asymptomatic AAA subjects (99 male, mean age: 67.1 ± 10.2 years) were enrolled into the study. All data were compared between patients with low and high admission monocyte/HDL ratio. Multivariate linear regression analysis was performed to study the relationship between different variables and AAA size. Results: Compared to patients with below-median monocyte/HDL ratio, aneurysm diameter was significantly higher in above-median monocyte/HDL ratio group (54.3 ± 10.6 mm vs 62.0 ± 12.4 mm, p < 0.001, respectively). Hypertension, coronary artery disease, monocyte/HDL ratio and C-reactive protein were independently associated with AAA diameter. Conclusion: Monocyte/HDL ratio is independently associated with AAA size.

Objective Thyroid hormones have both direct and indirect effects on thermogenesis such as modulating vascular smooth muscle cell proliferation. However, the influence of more subtle changes in thyroid hormones on coronary atherosclerosis remains a matter of speculation. Smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relationship between free thyroxine (fT4) and ISR has not been studied. In the present study, we aimed to assess the role of preprocedural serum fT4 level on the development of ISR in patients undergoing coronary bare metal stent (BMS) implantation. Materials and methods We enrolled and analyzed clinical, biochemical, and angiographic data from 705 consecutive patients without a history of primary thyroid disease [mean age 60.3 ± 9.3 years, 505 (72%) male]; all patients had undergone BMS implantation and further control coronary angiography owing to stable or unstable angina pectoris. Patients were divided into 3 tertiles based on preprocedural serum fT4 levels. Results ISR was observed in 53 (23%) patients in the lowest tertile, 82 (35%) patients in the second tertile, and 107 (46%) patients in the highest fT4 tertile (p < 0.001). Using multiple logistic regression analysis, five characteristics emerged as independent predictors of ISR: diabetes mellitus, smoking, HDL-cholesterol, stent length, and preprocedural serum fT4 level. In receiver operating characteristics curve analysis, fT4 level > 1.23 mg/dL had 70% sensitivity and 73% specificity (AUC: 0.75, p < 0.001) in predicting ISR. Conclusion Higher preprocedural serum fT4 is a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris.

Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) has been suggested as a simple method to identify unfavorable cardiovascular outcomes in the general population. The effect of the TG/HDL-C ratio on essential hypertensive patients is unclear. About 900 consecutive essential hypertensive patients (mean age 52.9 +/- 12.6 years, 54.2% male) who visited our outpatient hypertension clinic were analyzed. Participants were divided into quartiles based on baseline TG/HDL-C ratio and medical records were obtained periodically for the occurrence of fatal events and composite major adverse cardiovascular events (MACEs) including transient ischemic attack, stroke, aortic dissection, acute coronary syndrome, and death. Participants were followed for a median of 40 months (interquartile range, 35-44 months). Overall, a higher quartile of TG/HDL-C ratio at baseline was significantly linked with higher incidence of fatal and nonfatal cardiovascular events. Using multivariate Cox regression analysis, plasma TG/HDL-C ratio was independently associated with increased risk of fatal events (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.13-1.37; P

Background: It has been shown that psychological status is associated with the likelihood of atrial fibrillation (AF). Prolongation of the duration of atrial electromechanical delay (AEMD) is known to be a precursor for AF development. Aim: Therefore, we aimed to evaluate AEMD in patients with anxiety disorder. Methods: In this prospective study, a total of 82 anxiety disorder and 80 healthy subjects were enrolled. Symptoms of anxiety were evaluated by using the Hamilton Anxiety Rating Scale (HAM-A). P-wave dispersion (PWD) was measured on a 12-lead electrocardiogram. Both intra- and inter-AEMD were measured with tissue Doppler imaging. Results: Basal characteristics were similar between the two groups. PWD, inter- and right intra-AEMD were significantly prolonged in patients with anxiety disorders, compared to the control group (p < 0.05). In the correlation analysis, HAM-A was significantly and moderately correlated with right intra- and inter-AEMD, and PWD. Conclusions: Patients suffering from anxiety disorders are characterised by prolonged AEMD, which can provide significant contributions to evaluate the risk for AF development in this group.

Aim: Recently, lymphocyte-to-monocyte ratio (LMR) has emerged as a new indirect marker of inflammation which is associated with adverse outcomes in oncology and cardiovascular diseases. The aim of the study was to evaluate the relationship between LMR and slow coronary flow (SCF). Patients & methods: A total of 100 consecutive patients with SCF and 100 consecutive patients with normal coronary flow were enrolled in this study. Results: LMR was significantly lower in patients with SCF than in patients with normal coronary flow (p < 0.001). Also, LMR was negatively correlated with neutrophil-to-lymphocyte ratio and CRP levels (p < 0.001 and p = 0.005). LMR was found to be significantly and independently associated with SCF (p = 0.033). Conclusion: LMR was negatively correlated with serum C-reactive protein and neutrophil-to-lymphocyte ratio levels.

Background and aim Chronic kidney disease (CKD) and cardiovascular disease are closely interrelated and the presence of one condition synergistically affects the prognosis of the other, in a negative manner. There are surprisingly very few data on the relationship between baseline coronary artery disease (CAD) severity and subsequent decline in kidney function. We aimed to evaluate for the first time whether baseline coronary artery lesion severity predicts the decline in kidney function. Materials and methods The study population was derived from a series of consecutive patients presenting with stable angina pectoris or angina equivalents, who underwent coronary angiography. SYNTAX score for each patient was calculated to define severity of CAD. Change in kidney function was defined by calculating the rates of change in eGFR. Results Among the 823 patients included in our study, the mean age was 59.2 ± 10.7 years, 78.4% were males, and 32% had diabetes. The mean baseline eGFR was 87.3 ± 24.9 ml/min/1.73 m2 and the median Syntax score was 14 (IQR = 10–20). The median length of follow-up was 2.75 years (IQR = 2.42–3.50). The mean yearly change for eGFR in the entire study population was 4.06 (95% CI: 3.59–4.51) ml/min/1.73 m2. A higher Syntax score was associated with a significantly faster decline in eGFR in all (unadjusted and adjusted) models. During the follow-up, 103 patients developed CKD. A higher Syntax score, analyzed both as continuous and categorical variable, was associated with incident CKD in all models. Conclusion We have demonstrated for the first time that severity of CAD is an independent risk factor for the decline in kidney function. Studies are needed to highlight the potential mechanisms regarding the association between severity of CAD and decline in kidney function.

Uric acid (UA) is independently associated with the emergence of hypertension. Nocturnal nondipping pattern of hypertension is associated with a greater risk of cardiovascular, renal, and cerebrovascular complications than dippers. The aim of the present study was to evaluate the relationship between the circadian blood pressure rhythm and UA level in patients with newly diagnosed essential hypertension. The study included 112 essential hypertensive patients and 50 healthy controls. The hypertensive patients were divided into two groups according to the results of 24-hour ambulatory blood pressure monitoring, including 60 dippers (35 men, 25 women; mean age, 52.6±15.8 years) and 52 nondippers (29 men, 23 women; mean age, 55.9±13.2 years). Nondippers had significantly higher serum UA levels than the dippers and controls (5.8±0.8, 5.1±0.9 and 4.2±0.9 mg/dL, respectively; P

Amac: Metabolik sendromda aortik sertlikte artis olmasi beklenmektedir. Calismamizda metabolik sendrom (MetS)\'lu hastalarda aortik sertlik ve bununla iliskili ekokardiyografik ve biyokimyasal parametreleri saptamayi amacladik. Gerec ve yontem: Calismaya guncellenmis ATP III kriterlerine gore MetS tanisi alan ardisik 46 hasta (25 erkek, ortalama yas 47.3±6.6 yil) ve 44 kontrol (18 erkek, ortalama yas 46.0±6.1yil) hastasi alindi. M-mode ekokardiyografi ile aortik strain, distensibilite ve sertlik indeksi hesaplandi. Ekokardiyografik olarak diastolik parametrelerin olcumu yapildi. Bulgular: Ekokardiyografik parametrelerden sol ventrikul kitle indeksi, deselerasyon zamani (DZ), izovolumetrik relaksasyon zamani (IVRZ) MetS\'lu hastalarda kontrol grubuna kiyasla yuksek ve mitral E/A orani ise dusuk saptandi. MetS\'lu hastalarda kontrol grubuna kiyasla aortik distensibilite anlamli dusuk (10.4±3.5\'e cm2.dyn-1.10-6 karsilik 12.7±3.4 cm2.dyn-1.10-6, p=0.002), sertlik indeksi ise anlamli yuksek saptandi (6.5±2.0\'e karsilik 3.2±0.8, p

Objectives: In this study, we evaluated aortic stiffnessand echocardiographic and laboratory factors affectingaortic stiffness in patients with metabolic syndrome(MetS).Materials and methods: Forty-six patients (25 male,mean age 47.3±6.5 years) with the diagnosis of MetS accordingto the Adult Treatment Panel III Final Report criteriawere included. Forty-four age and gender matchedhealthy subjects (18 male, mean age 46.0±6.1 years)were recruited as the control group. Aortic strain, distensibilityand stiffness index were calculated by M-modeechocardiography and diastolic parameters were measured.Results: Left ventricular mass index (LVMI), decelerationtime (DT), isovolumic relaxation time (IVRT) wereincreased and mitral E/A ratio was decreased in patientswith MetS compared to controls. In the MetS patients,aortic distensibility was significantly decreased (10.4±3.5cm2.dyn-1.10-6 vs. 12.7±3.4 cm2.dyn-1.10-6, p=0.002),and ASI was significantly increased (6.5±2.0 vs. 3.2±0.8,p

OBJECTIVES We aimed to determine the in-hospital mortality and clinical outcome of patients older than 75 years who were admitted to our high-volume tertiary center with ST-elevation myocardial infarction (STEMI) and treated with primary percutaneous intervention (PCI). STUDY DESIGN Our study included patients over 75 years old who were admitted with STEMI and underwent primary PCI at our center between January 2008 and September 2011. We retrospectively collected data from our hospital records for 1165 patients with STEMI. We found 186 patients that were eligible for our study. We defined major adverse cardiovascular events (MACE) as in-hospital mortality, repeated target vessel revascularization, and reinfarction. RESULTS The mean age of the patients was 79.7±4.4 years and the mean pain-balloon inflation time was 4.7±2.3 hours. The procedure success rate was 71.5%. In-hospital mortality and MACE occurred in 20.4% and 25.8% of patients, respectively. Twenty patients had cardiogenic shock at admission. Patients with cardiogenic shock had significantly more MACE than the rest of the study population (76.5% vs. 17.5%, p

OBJECTIVES Epicardial fat tissue is a type of visceral adipose tissue that functions as a metabolically active endocrine organ. Most components of metabolic syndrome (MetS), especially visceral obesity, are associated with a low-grade systemic inflammatory state. In this study, we aimed to assess the relationship between echocardiographic epicardial fat thickness (EFT), MetS, the components of MetS, and high sensitivity C-reactive protein (hs-CRP) levels in patients with MetS. STUDY DESIGN Forty-six patients (25 males, mean age 47.3±6.5 years) with the diagnosis of MetS (according to the Adult Treatment Panel III update criteria) but without clinical coronary artery disease, and 44 age and gender matched healthy volunteers (18 males, mean age 46.0±6.1 years) were included in the study. EFT, which was measured by transthoracic echocardiography, as well as clinical and biochemical parameters were compared between the two groups. RESULTS Waist circumference, total and LDL-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressure levels, hs-CRP, and uric acid levels were significantly higher in patients with MetS. EFT was also significantly increased in patients with MetS (8.7±0.2 mm vs. 4.8±0.1 mm, p

Izole tek koroner arter anomalili (TKAA) olgular; klinik ozellikleri, anjiyografik bulgulari ve tedavi yontemleri arastirilmak uzere geriye donuk degerlendirildi. Ekim 2005 ve Ekim 2008 tarihleri arasinda Turkiye Yuksek Ihtisas Hastanesi Kardiyoloji Kliniginde 27.714 hastaya tanisal amacli yapilan koroner anjiyografi (KAG) kayitlari incelendi ve TKAA tanili 10 hasta calismaya dahil edildi. Hastalarin yas ortalamalari 60±13, (dagilim 33–77 yil ) idi, hastalardan 4’ u erkek (%40), 6’ si kadindi (%60) (yas ortalamasi sirasiyla 49±14,5 yil; dagilim 33–68 yil ve 67±8 yil; dagilim 60–77 yil). Hastalarin basvuru sirasindaki klinik ve demografik ozellikleri ve uygulanan tedavi yontemleri kaydedildi ve KAG kayitlari izlenerek modifiye Lipton siniflandirmasina gore siniflandirildi. Calismaya alinan kardiyak kateterizasyon yapilmis 27.714 hastanin 10 tanesinde TKAA tespit edilmistir. Hastalardan 9 (%90) tanesinde tek koroner arter sag sinus valsalvadan orjin alirken, 1 hastada (%10) tek koroner arter sol sinus valsalvadan orjin almisti. Hastalarin 4’ unde (%40) ciddi aterosklerotik kalp hastaligi mevcuttu ve bu hastalarin 2’ sine koroner baypas cerrahisi uygulandi. Diger hastalar medikal takibe alindi. Tek koroner arter anomalileri nadir anomaliler olmasina ragmen ozellikle KAG isleminin sik yapildigi buyuk merkezlerde insidental olarak daha sik saptanirlar. Bircok olgu klinik olarak iyi seyirlidir ve medikal izlem yeterlidir. Fakat tedavi planlanirken; klinik semptomlar, aterosklerotik kalp hastaligi varligi, koroner anomalinin tipi dikkate alinmalidir.

BACKGROUND: The risk of syncope and sudden cardiac death due to ventricular arrhythmias increased in patients with aortic stenosis (AS). Recently, it was shown that Tp‐e interval, Tp‐e/QT, and Tp‐e/QTc ratio can be novel indicators for prediction of ventricular arrhythmias and mortality. We aimed to investigate the association between AS and ventricular repolarization using Tp‐e interval and Tp‐e/QT ratio. METHODS: Totally, 105 patients with AS and 60 control subjects were enrolled to this study. The severity of AS was defined by transthoracic echocardiographic examination. Tp‐e interval, Tp‐e/QT, and Tp‐e/QTc ratios were measured from the 12‐lead electrocardiogram. RESULTS: Tp‐e interval, Tp‐e/QT, and Tp‐e/QTc ratios were significantly increased in parallel to the severity of AS (P < 0.001, P = 0.001, and P = 0.001, respectively). Also, it was shown that Tp‐e/QTc ratio had significant positive correlation with mean aortic gradient (r = 0.192, P = 0.049). In multivariate logistic regression analysis, Tp‐e/QTc ratio and left ventricular mass were found to be independent predictors of severe AS (P = 0.03 and P = 0.04, respectively). CONCLUSIONS: Our study showed that Tp‐e interval, Tp‐e/QT, and Tp‐e/QTc ratios were increased in patients with severe AS. Tp‐e/QTc ratio and left ventricular mass were found as independent predictors of severe AS.

Blood pressure (BP) usually increases upon awakening-a physiological mechanism called morning BP surge (MBPS). BP values above the MBPS threshold are associated with target organ damage, including left ventricular hypertrophy and proteinuria. Despite these data, there have been no studies that have investigated the association between elevated MBPS and the development of incident chronic kidney disease (CKD). In this study, patients with essential hypertension were included and underwent ambulatory BP measurements and MBPS. Patients were followed for a median of 3.33 years. In total, 622 patients were enrolled. The mean age of patients was 57.6 +/- 12.4 years, 54.0% were men, 16.7% had diabetes, and 10.6% had prevalent cardiovascular disease. During follow-up, 32 patients developed CKD. Higher MBPS, analyzed both as continuous and categorical variables, was associated with incident CKD in all models. Elevated MBPS is associated with kidney function deterioration and the development of CKD. Studies are needed to further examine underlying mechanisms regarding MBPS and these renal outcomes. (c) 2015 Wiley Periodicals, Inc.

Background: Previous studies proposed that both inflammation, oxidative stress, and impaired endothelial dysfunction have a significant role in occurrence of slow coronary flow (SCF). monocyte-to-high density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress, which have been studied only in patients with chronic kidney disease. Hypothesis: We aimed to assess the relationship between MHR and SCF. Methods: Patients who had angiographically normal coronary arteries were enrolled in this retrospective study (n = 253 as SCF group and n = 176 as control group). Patients who had corrected thrombolysis in myocardial infarction frame counts (cTFCs) above the normal cutoffs were defined as with SCF. Results: The MHR and high-sensitivity C-reactive protein (hsCRP) were significantly higher in the SCF group. In correlation analysis, MHR has a significantly positive correlation with cTFC and serum hsCRP levels ( P < .001). In multivariate logistic regression analysis, MHR was found as independently associated with the presence of SCF (odds ratio: 1.24, P < .001). Conclusion: Higher MHR which indicates an enhanced inflammation and oxidative stress was significantly and independently associated with the presence of SCF. Besides, MHR was positively correlated with serum hsCRP level as a conventional marker for systemic inflammation.

Serum uric acid (UA) is independently associated with hypertension and blood pressure (BP) variability (BPV) is associated with cardiovascular events and mortality in hypertensive patients. The aim of the present study was to assess the association of serum UA with BPV in 300 untreated essential hypertension patients (mean age 57.3±13.6 years). BPV was quantified as the standard deviation (SD) of the 24-hour, daytime, and nighttime mean values obtained by using ambulatory BP monitoring. In correlation analysis, log UA values were found to be positively correlated with 24-hour systolic BPV and nighttime systolic and diastolic BPV (Pearson coefficients of 0.246, 0.280, and 0.353, respectively; P

Atherosclerosis plays an important role in saphenous vein graft disease (SVGD). Previous trials showed that inflammatory blood cells play a role in this process. The platelet to lymphocyte ratio (PLR) has been proposed as a novel predictor for cardiovascular risk and indicator of atherosclerosis. The aim of this study was to assess the relationship between SVGD and PLR. A total of 220 patients with SVG were enrolled (n = 87 with SVGD and n = 133 with patent SVG). A ≥50% stenosis within the SVG was defined as clinically significant. Median PLR ( P < .001) and mean platelet volume (MPV; P = .043) were significantly higher in patients with SVGD. Also, PLR showed significantly positive correlation with age of SVG ( P < .05). Median age of SVGs was also higher in the SVGD group ( P = .025). In multivariate logistic regression analyses, the PLR and MPV were independent predictors of SVGD. Using a cutoff level of 106.3, the PLR predicted SVGD with a sensitivity of 87.4% and a specificity of 80.3%. To the best of our knowledge, this study showed, for the first time, that PLR was independently associated with SVGD. Both PLR and MPV might predict SVGD.

Limited data are available regarding cardiac arrhythmias in vitamin D (VitD) deficiency. Therefore, we aimed to assess whether atrial electromechanical delay (AEMD) measured by tissue Doppler imaging (TDI), which is an indicator for atrial fibrillation (AF) development, is prolonged in patients with VitD deficiency as compared to the control group. The effect of vitD replacement on AEMD was also evaluated.In this prospective study a total of 28 VitD-deficient and 56 age-, gender-, and BMI-matched VitD-sufficient healthy participants were enrolled. P-wave dispersion (PWd) was calculated on the 12-lead electrocardiogram. Both intra- and inter-AEMD were calculated by TDI. Measurements were performed at baseline in both groups and were repeated after 6-month replacement therapy in subjects with vitD deficiency.PWd and inter- and left intra-AEMD were significantly prolonged in patients with VitD deficiency compared to the control group (P0.001). While serum 25(OH)D levels were significantly and negatively correlated with left intra-AEMD (r = -0.657, P0.001), there was a positive correlation between serum 25(OH)D level and PWd (r = 0.523, P0.001). The serum 25(OH)D level was found as the independent predictor of the both left intra- and inter-AEMD in the multivariate linear regression analysis (β:-0.552, P0.001 and β:-0.555, P0.001, respectively). The serum 25(OH)D level was significantly increased after replacement therapy. While inter-AEMD was significantly decreased (P = 0.013), there was no change in PWD and left and right intra-AEMD (P0.05) following replacement therapy.PWd and left intra- and inter-AEMD are increased in patients with VitD deficiency. The serum 25(OH)D level was found as an independent predictor for AEMD in patients with VitD deficiency. Also a significant decrement was observed in inter-AEMD following vitD replacement therapy. Studies with longer follow-up are needed to investigate whether vitD-deficient patients with prolonged AEMD develop clinical arrhythmia and vitD replacement reduces the risk of atrial arrhythmias.

BACKGROUND: Fragmented QRS complex (fQRS) is associated with cardiovascular outcomes in various patient populations. Although there were clinical studies investigating the association of fQRS with arrhythmic events in patients with systolic heart failure, the results were conflicting regarding the association of implantable cardioverter defibrillator (ICD) shocks and fQRS. In this study, we aimed to evaluate the association between the presence and extent of fQRS with appropriate ICD shocks and/or all‐cause mortality. METHODS: A total of 215 patients (age: 58.2 ± 11.6 years, 72.5 % male) with the diagnosis of left ventricular systolic heart failure in whom ICD had been implanted for primary prophylaxis were enrolled. Standard ECG evaluation revealed fQRS complex in 123 patients (57.2 %). The phenomenon of fQRS was defined as deflections at the beginning of the QRS complex, on top of the R wave, or in the nadir of the S wave similar to the definition in CAD. RESULTS: At mean 23.5 ± 12.1 months follow‐up, all‐cause mortality was observed in 45 (20.9 %) patients and 111 (51.6 %) patients experienced appropriate ICD shocks. Median number of ECG leads with fQRS were higher in patients with appropriate ICD shocks (3 [2–6] vs 1 [0–2], P < 0.001, respectively). The presence of fQRS (HR: 6.64, 95 % CI: 3.54–12.4, P < 0.001) and the number of leads with fQRS (HR: 1.35, 95% CI: 1.22–1.67) were found as independent predictors of appropriate ICD shocks. Additionally, there was a negative correlation between left ventricular ejection fraction and the number of leads with fQRS (r = −0.434, P < 0.001). Rates of all‐cause mortality did not differ between the fQRS(+) (29 [24 % ]) and fQRS(−) (16 [17 % ]) groups (P = 0.27). CONCLUSION: Our findings suggest that the presence and extent of fQRS complex on standard 12‐lead ECG predicts appropriate ICD shocks in patients with left ventricular systolic heart failure who underwent ICD implantation for primary prophylaxis.

Previous studies showed that renal dysfunction was associated with both a reduction in serum high-density lipoprotein (HDL) cholesterol concentration and increased circulating monocyte count. We aimed to investigate the effect of circulating monocyte to serum HDL cholesterol ratio (M/H ratio) on fatal and composite cardiovascular events, in an observational cohort study of chronic kidney disease (CKD) patients. A total of 340 subjects with stage 1–5 CKD were followed for a mean follow-up period of 33 (range 2–44) months and assessed for fatal and nonfatal CV events. M/H ratio was calculated for all patients. All-cause mortality and CVE were also analyzed in relation to M/H ratio. Monocyte/HDL cholesterol ratio was negatively correlated with estimated glomerular filtration rate (eGFR) (r = −0.43, P