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WOS: 000433285000010, PubMed ID: 28968197, Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once-or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1: 1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 +/- 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.

We investigated the relationship between atrial fibrillation (AF) and contrast-induced nephropathy (CIN) in patients with non-ST-segment elevation myocardial infarction (NSTEMI); 1045 consecutive patients undergoing percutaneous coronary interventions were enrolled. Risk factors for CIN were investigated. Baseline characteristics, except oral anticoagulant use, were similar between patients with and without AF. Patients with CIN show higher presence of diabetes mellitus (DM), coronary artery bypass graft surgery history, Mehran score, baseline creatinine levels, baseline glomerular filtration rate (GFR), peak troponin levels, left ventricular ejection fraction (LVEF), and presence of AF ( P < .05). In multivariate logistic regression analyses, the presence of DM (odds ratio [OR], 2.333; 95% confidence interval [CI], 1.222-4.457; P = .010), Mehran score (OR, 1.269; 95% CI, 1.152-1.398; P < .001), baseline GFR (OR, 0,954; 95% CI, 0.944-0.964 P < .001), left anterior descending artery originated infarction (OR, 1.594; 95% CI, 1.061-2.398; P = .025), LVEF value (OR, 0.956; 95% CI, 0.926-0.986; P = .005), and the presence of AF (OR, 3.830; 95% CI, 1.239-11.839; P = .020) were independent predictors of CIN. Atrial fibrillation can be related to CIN development in patients with NSTEMI.

Background We aimed to evaluate whether heart rate variability (HRV) could predict prolonged asystole before head-up tilt table test (HUTT) by comparing time domain HRV parameters of patients with type 2B vasovagal syncope (VVS) and patients with other types of VVS. Methods Ninety-eight patients who examined with 24-hour Holter electrocardiogram monitoring before HUTT and diagnosed with VVS were enrolled. Patients were divided into two groups in accordance with their VVS type as group 1 (n = 43) consisting of patients with type 2B VVS and group 2 (n = 57) consisting of patients with other types of VVS. Time domain HRV parameters (SDNN, SDANN, SDNN index, RMSSD, pNN50) of two groups were compared. ROC curve analysis was performed to predict best cutoff values that could prognosticate occurrence of prolonged asystole during HUTT. Results SDNN, SDANN, SDNN index values were significantly longer for group 1 compared to group 2 (P = 0.009, P = 0.006, P = 0.004; respectively). While a SDNN cutoff value of ≥151 ms predicted occurrence of type 2B VVS before HUTT with 69% sensitivity and 56% specificity, a SDANN value of ≥164 ms had 47% sensitivity and 87% specificity and a SDNN index value of ≥102 ms showed 40% sensitivity and 85% specificity. Conclusions In our study, we tried to demonstrate prediction of prolonged asystole by analyzing HRV parameters before HUTT. We found out that time domain HRV parameters were longer in patients with type 2B VVS than patients with other types of VVS. Our results need to be supported by extensive studies.

IntroductionQuality of life has become an important outcome measure in addition to mortality and morbidity in patients with congenital heart disease. Atrial septal defect is a common congenital heart disease, and transcatheter atrial septal defect closure has become an accepted treatment modality. The aim of this study is to assess the quality of life of patients with atrial septal defect who underwent percutaneous closure.Materials and methodsWe examined the quality of life of 69 patients with atrial septal defect and 69 healthy controls matched according to age, sex, educational level, and economic, marital, and employment status. Quality of life was investigated using the Turkish version of Short Form-36.ResultsThe mean age of the patients was 39.7 ± 14.2 and 26% were male. The quality of life assessment was performed at a mean follow-up time of 18.0 ± 13.8 months after the intervention. The mean scores of the domains of the Short Form-36, namely, physical functioning, role functioning, social functioning, mental health, vitality, pain, and general health, were similar in patients with atrial septal defect who underwent percutaneous closure and the control group.ConclusionAdult patients who underwent percutaneous atrial septal defect closure perceive their quality of life to be as good as their healthy counterparts.

WOS: 000396901400006, PubMed ID: 27488754, Objective: The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. Methods: The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Results: Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001). Conclusion: These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patients, Working Group on Heart Failure of the Turkish Society of Cardiology, This study had been designed, supported and conducted by the Working Group on Heart Failure of the Turkish Society of Cardiology.

research, Amaç: Kardiyologlar birçok riskli hastanın teşhis, tedavi ve girişimsel tedavisiyle uğraşmaktadırlar. Bu çalışmada Türkiye'deki mevcut "malpraktis" sisteminin kardiyologların tanı ve tedavi yaklaşımlarını nasıl etkilediğini ve önerdiğimiz yeni hasta tazminat sistemine yaklaşımlarını inceledik.Yöntemler: Bu kesitsel çalışmada Türk sağlık sisteminin farklı seviyelerinde çalışan kardiyologların mesleki risk algılarının uygulamalarına etkisini araştırma amacıyla 24 soruluk bir anketi asistan, uzman ve öğretim üyelerine elektronik posta, basılı evrak ve cep telefonu mesajı ile gönderildi.Bulgular: Ankete toplam 253 kardiyolog cevap verdi. Bunların 29'una (%11.6) geçmişte malpraktis talepleri için dava açılmıştı. Dava edilen kardiyologların 2'sine (%6.9) maddi tazminat talebinde bulunuldu, 1'ine (%3.4) ihmal nedeniyle hapis cezası verildi. Bunun yanında 132 (%52.8) kardiyolog "malpraktis" korkusu nedeni ile pratiklerinde değişiklik yaptıklarını bildirmekteydi. Ayrıca 232 (%92.8) kardiyolog önerdiğimiz hasta tazminat sistemini tercihe değer buluyordu. Kardiyologların %78.8'i bilgisayarlı tomografik anjiyografi (BTA) veya perfüzyon sintigrafisi, %71.6'sı koroner anjiyografi, %20'si stent implantasyonu, %83.2'si ise yüksek riskli hastalardan kaçınma kararlarında malpraktisten kaçınmanın etkili olduğu kanaatindeydi.Sonuç: "Malpraktis" korkusu kardiyologlarda yüksek oranlarda gereksiz test isteme, girişim yapma veya yüksek riskli hastalardan kaçınma eğilimi yaratmaktadır. Önerdiğimiz yeni "malpraktis" sistemi çalışmaya katılan kardiyologların büyük çoğunluğu tarafından mevcut sisteme tercih edilir bulunmuştur, Objective: Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists’ diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system.Methods: The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message.Results: A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients.Conclusion: The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system

Gölcük, Şükriye Ebru (Balikesir Author), "Objective: Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists' diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system. Methods: The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message. Results: A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients. Conclusion: The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.", Amaç: Kardiyologlar birçok riskli hastanın teşhis, tedavi ve girişimsel tedavisiyle uğraşmaktadırlar. Bu çalışmada Türkiye’deki mevcut “malpraktis” sisteminin kardiyologların tanı ve tedavi yaklaşımlarını nasıl etkilediğini ve önerdiğimiz yeni hasta tazminat sistemine yaklaşımlarını inceledik. Yöntemler: Bu kesitsel çalışmada Türk sağlık sisteminin farklı seviyelerinde çalışan kardiyologların mesleki risk algılarının uygulamalarına etkisini araştırma amacıyla 24 soruluk bir anketi asistan, uzman ve öğretim üyelerine elektronik posta, basılı evrak ve cep telefonu mesajı ile gönderildi. Bulgular: Ankete toplam 253 kardiyolog cevap verdi. Bunların 29’una (%11.6) geçmişte malpraktis talepleri için dava açılmıştı. Dava edilen kardiyologların 2’sine (%6.9) maddi tazminat talebinde bulunuldu, 1’ine (%3.4) ihmal nedeniyle hapis cezası verildi. Bunun yanında 132 (%52.8) kardiyolog “malpraktis” korkusu nedeni ile pratiklerinde değişiklik yaptıklarını bildirmekteydi. Ayrıca 232 (%92.8) kardiyolog önerdiğimiz hasta tazminat sistemini tercihe değer buluyordu. Kardiyologların %78.8’i bilgisayarlı tomografik anjiyografi (BTA) veya perfüzyon sintigrafisi, %71.6’sı koroner anjiyografi, %20 ’si stent implantasyonu, %83.2’si ise yüksek riskli hastalardan kaçınma kararlarında malpraktisten kaçınmanın etkili olduğu kanaatindeydi. Sonuç: “Malpraktis” korkusu kardiyologlarda yüksek oranlarda gereksiz test isteme, girişim yapma veya yüksek riskli hastalardan kaçınma eğilimi yaratmaktadır. Önerdiğimiz yeni “malpraktis” sistemi çalışmaya katılan kardiyologların büyük çoğunluğu tarafından mevcut sisteme tercih edilir bulunmuştur., Cardiovascular Academy Society of Turkey

Objectives: This study was aimed to evaluate our clinical experiences and investigate results of percutaneous clo-sure of secundum atrial septal defects (ASD) in our clinic. Results: We retrospectively included 70 patients (19 male, 51 female) undergoing percutaneous ASD closure proce-dure with mean age of 36±14.8 (17-75) in our clinic between March 2008 and January 2010. Defect diameter meas-ured by transesophageal echocardiography was 19.7±6.3 mm (6-32 mm). Device size used for percutaneous closure of ASD was 23.7±6.2 (12-36). Devices used for percutaneous closure were nitinol-based devices including Amplatzer (64.7%), Cardiofix (26.7%) and biodegredable BioStar (8.6%). The percutaneous closure procedure was successful at 68 of 70 (97%) patients. In 2 patients procedure failed. Failure reason was device embolization in one patient and device strut fracture in other; so these 2 patients referred to surgery. During follow up 2 more patients also referred to surgery because of device embolization in first day control. In 3 patients (4.2%) supraventricular arrythmias that are converted to sinus by cardioversion are observed. Mean follow up interval was 18.6±9.6 months (1-44) and during this period peripheral vascular complications, cerebrovascular accidents, thrombus on devices, device erosion or death is not observed. Conclusion: Percutaneous closure of secundum ASD which started to replace surgical treatment of ASD in last dec-ades is safe and effective method in short to mid-term period. However because of potentially serious complication risks it should be performed in special centers by operators who are experienced in treating structural heart diseases., Amaç: Bu çalışmada, kliniğimizde perkütan yolla atrial septal defekt (ASD) kapatılması işlemi uygulanan hastalara ait klinik deneyimimizin ve sonuçlarının değerlendirilmesi amaçlanmıştır. Bulgular: Çalışmaya kliniğimizde, Mart 2008-Ocak 2010 tarihleri arasında perkütan yolla ASD kapatılması işlemi uy-gulanan ortalama yaşı 36±14,8 olan (17-75) yıl olan 70 hasta (19 erkek, 51 kadın) retrospektif olarak alındı. Hastala-rın transözofajial ekokardiyografi ölçümlerinde ASD çapı 19,7±6,3 mm (6-32 mm) olarak ölçüldü. Perkütan kapatma-da kullanılan cihaz çapları 23,7±6,2 (12-36) olarak saptandı. ASD kapatma cihazı olarak nitinol bazlı cihazlardan Amplatzer %64,7, Cardiofix %26,7 oranında ve biodegredable BioStar %8,6 oranında kullanıldı. Yetmiş hastadan 68\'inde (%97) işlem başarılı oldu. Bir hastada işlem esnasında cihaz embolisi, 1 hastada ise cihazda strut kırığı ol-ması nedeniyle hastalar cerrahiye verildi. Takipte 2 hastada 1. gün kontrolünde cihaz embolizasyonu saptandı. Üç hastada (%4,2) kardiyoversiyon ile sinus ritmine çevrilen supraventriküler aritmi izlendi. Hastalar ortalama 18,6±9,6 ay (1 ay- 44 ay) boyunca izlendi. Takipte hastalarda cihaz üzerinde thrombüs, cihaz erozyonu, periferik vasküler komplikasyon, serebro vasküler olay veya ölüm izlenmedi. Sonuç: Sekundum ASD\'lerin perkütan kapatılması son yıllarda cerrahinin yerini almaya başlayan kısa ve orta vadede güvenli, etkin bir tedavi şeklidir. İşlemin potansiyel ciddi olabilecek komplikasyonları nedeniyle yapısal kalp hastalıkla-rının tedavisinde uzmanlaşmış; tecrübeli merkezlerde yapılması hususuna dikkat edilmelidir.

Amac: Karotis stentlemede restenoz ve uzun donem so­nuclarla ilgili veriler sinirlidir. Bu calismanin amaci semp­tomatik agir karotis arter darlikli hastalarda stentleme isleminin klinik sonuclara ve restenoz oranlarina etkisini arastirmaktir. Gerec ve yontem: Calismaya Kalp Damar Cerrahisi, Kardiyoloji ve Noroloji ortak konseyinde stent implantas­yonu karari alinan 20 hasta (yas ortalamasi 68±7 yil, 11\'i erkek) alindi. Hastalar perioperatif (ilk 30 gun ) ve birinci yil sonunda hem klinik hem de Doppler ultrasonografi ile degerlendirilerek kardiyovaskuler olay sikligi ve restenoz oranlari degerlendirildi. Izlemde karotis Doppler ultraso­nografi ile %50 ve uzeri darliga karsilik gelen instent zirve akim hizinin ≥224 cm/sn olmasi restenoz olarak kabul edildi. Bulgular: Hastalarda ek hastalik olarak 14\'unde koroner arter hastaligi, 3\'unde periferik arter hastaligi, 2\'sinde kro­nik bobrek yetmezligi, 2\'sinde ise kalp yetersizligi mevcut­tu. Islemde kullanilan stentlerin capi 6 ile 8 mm arasinda, stent uzunlugu ise 30 ile 40 mm idi. Bes (%25) hastaya predilatasyon yapilirken, postdilatasyon 19(%95) hastaya uygulandi. Postdilatasyon sonrasi hicbir hastada ≥%30 reziduel darlik izlenmedi. Islem basarisi %100\'du. Islem sonrasi periprosedurel olay kapsaminda 1(%5) hastada gecici iskemik atak gelisti. Otuz gunluk ve bir yillik takip­lerde inme, miyokard infarktusu veya olum gorulmedi. Hicbir hastada restenoz izlenmedi. Diyabet ve kalp yeter­sizligi restenoz ongordurucu faktorleri olarak saptandi. Sonuc: Karotis arter stentleme iyi secilmis olgularda kisa donemde etkin ve guvenilir bir yontemdir. Restenoz karo­tis arter darliginda islem basarisini etkileyen kisitlayici bir faktor olarak gorunmemektedir.

Introduction : The presence of patent foramen ovale (PFO) is considered a possible cause for cryptogenic stroke. The mechanism underlying the ischaemic neurological events in the presence of PFO has not been firmly established. The purpose of this study was to compare: (1) the mean platelet volume levels in PFO patients with and without a cryptogenic stroke, and (2) pre- and post-procedural mean platelet volumes (MPV) in patients undergoing percutaneous PFO closure. Methods : Sixteen PFO patients undergoing percutaneous closure to prevent recurrent ischaemic events and 15 asymptomatic patients with PFO were enrolled in the study. Mean platelet volume was compared between patients with and without a history of stroke. We also compared pre- and postprocedural MPV levels in patients undergoing percutaneous PFO closure. Results : Mean platelet volume, which is a marker for platelet activity, was similar in PFO patients with and without stroke (9.34 ± 1.64 vs 9.1 ± 1.34 fl; p = 0.526). Interestingly, MPV decreased significantly after percutaneous closure compared to pre-procedural levels (9.34 ± 1.64 vs 8.3 ± 1.12 fl; p = 0.001). Conclusion : Our findings suggest interatrial communication through a PFO may be related to increased MPV and increased platelet activity.

OBJECTIVE Indications for pacing, pacing modes, and demographics of patients who underwent pacemaker implantation between two different time periods were compared in this study. METHODS Pacemaker registry of our cardiology department was used to evaluate these changes from 1986 to 2007 (First period: 1986-1996, second period: 1997-2007) retrospectively. RESULTS Registry revealed 776 implantations in the first and 874 implantations in the second period. The percentages of first implantation were 89% and 70.1% respectively. Nearly 50% of the patients in both periods were female. Main indications for pacing were atrioventricular (AV) block, sick sinus syndrome (SSS) and slow ventricular rate during atrial fibrillation in both periods. Implantation of VVI-AAI pacemakers have decreased (77.8%/1.5% to 51%/0.3%, p=0.05) and implantation of DDD-VDD pacemakers have increased (19.3%/1.3% to 42.3%/6.3%, p=0.05) during the second period compared to the first period. Permanent pacemaker implantation for SSS has decreased significantly from 31.1% in the first period to 12.0% (p=0.05) in the second period. Implantation for AV block has increased significantly from 63.3% to 79.7% (p=0.05) in the second period. CONCLUSION Our data revealed temporal changes in pacemaker implantation practice during last twenty years in the cardiology department of a teaching hospital. Implantation of VVI-AAI pacemakers have decreased significantly during the second period. Permanent pacemaker implantation for AV block has also decreased during the last period.

Objective: The aim of the study was to determine the clinical characteristics, comorbidities, responsible dis­eases and in-hospital mortality of patients who received a temporary pacemaker Methods: Our study included 545 patients who received a temporary pacemaker due to various causes during their hospitalization between January 2008 and May 2012. Results: Of the 545 patients whose records were scanned retrospectively in our study, 235 (43%) were fe­male and 310 (57%) were male. Average age of patients was 70±14.2 years (20,100). Leading cause for receiving pacemaker was third degree atrioventricular block (178 patients, 32.6%).Other causes were bradycardia or asys­tole during procedures such as coronary angiography, catheterization etc. (101 patients, 18.5%), symptomatic sinus bradycardia (70 patients, 12.8%), pacemaker end of life (During procedure, 65 patients, 11.9%). Temporary pacemaker implantation due to drugs, hyperpotasemia and both was 6.2% (34 patients), 3.6% (20 patients) and 1.1% (6 patients) respectively. Eight patients used drugs for committing suicide. While the top responsible drugs for pacemaker implantation were digoxin, beta blockers and calcium channel blockers, only one patient was using a noncardiac drug (oxcarbamazepin). Half of the patients had coronary artery disease (276 patients, 51%). 101 pa­tients (18.5%) received a temporary pacemaker due to block in the course of myocardial infarction. 85 patients died during their hospitalization (15.5%). Conclusıon: Although causes for temporary pacemaker implantation has changed over time, myocardial infarction with block still remains fatal even a temporary pacemaker is inserted. J Clin Exp Invest 2013; 4 (2): 180-183, Amaç: Geçici kalp pili implante edilen hastaların klinik özellikleri, komorbiditeleri, altta yatan hastalıkları ve hastane içi mortalitelerinin belirlenmesi amaçlanmıştır. Yöntemler: Çalışmamıza değişik sebeplerle geçici kalp pili takılması gerekli olan, Ocak 2008-Mayıs 2012 tarihleri arasında hastanemizde yatırılarak takip edilen 545 hasta dahil edilmiştir. Bulgular: Çalışmamızda geriye dönük olarak taranan 545 hastadan 235’i kadın (%43) ve 310’u erkekti (%57). Hastaların yaş ortalaması 70±14,2 (aralığı, 20-100) olarak hesaplandı. En sık kalp pili takılma sebebi olarak atriyoventriküler tam blok (178 hasta, %32,6) saptandı. Bunu koroner anjiografi, kateter vb. işlemler sırasında gelişen bradikardi, asistol (101 hasta, %18,5), semptomatik sinüs bradikardisi (70 hasta, %12,8), kalp pili ömrünün bitmesi (kalp pili değişim işlemi sırasında,65 hasta, %11,9) gibi nedenler izledi. İlaca ve hiperpotasemiye bağlı olarak sırasıyla 34 ve 20 hastaya (%6,2,%3,6), her iki nedene bağlı 6 hastaya (%1,1) geçici kalp pili implantasyonu yapılmıştı. 8 hastada intihar amaçlı ilaç içimi gözlendi. En sık geçici kalp pili takılmasına gerek duyulan ilaçlar digoksin, B blokerler ve kalsiyum kanal blokerleri olurken; sadece 1 hastada direkt kardiyak endikasyonla kullanılmayan ilaç saptandı (okskarbamazepin). Hastaların yaklaşık yarısında koroner arter hastalığı saptandı (276 hasta, %51). 101 hastada (%18,5) miyokart enfarktüsüne bağlı blok nedeniyle geçici kalp pili implantasyonu yapılmıştı. Hastaların 85 tanesi hastanede yatışı sırasında eksitus olmuştu (%15,5). Sonuç: Geçici kalp pili takılma nedenleri zaman içerisinde değişiklik göstermesine rağmen, geçici kalp pili takılsa bile, miyokart enfarktüsü sırasında blok gelişimi oldukça ölümcül seyretmektedir.

BACKGROUND: We aimed to evaluate whether heart rate variability (HRV) could predict prolonged asystole before head‐up tilt table test (HUTT) by comparing time domain HRV parameters of patients with type 2B vasovagal syncope (VVS) and patients with other types of VVS. METHODS: Ninety‐eight patients who examined with 24‐hour Holter electrocardiogram monitoring before HUTT and diagnosed with VVS were enrolled. Patients were divided into two groups in accordance with their VVS type as group 1 (n = 43) consisting of patients with type 2B VVS and group 2 (n = 57) consisting of patients with other types of VVS. Time domain HRV parameters (SDNN, SDANN, SDNN index, RMSSD, pNN50) of two groups were compared. ROC curve analysis was performed to predict best cutoff values that could prognosticate occurrence of prolonged asystole during HUTT. RESULTS: SDNN, SDANN, SDNN index values were significantly longer for group 1 compared to group 2 (P = 0.009, P = 0.006, P = 0.004; respectively). While a SDNN cutoff value of ≥151 ms predicted occurrence of type 2B VVS before HUTT with 69% sensitivity and 56% specificity, a SDANN value of ≥164 ms had 47% sensitivity and 87% specificity and a SDNN index value of ≥102 ms showed 40% sensitivity and 85% specificity. CONCLUSIONS: In our study, we tried to demonstrate prediction of prolonged asystole by analyzing HRV parameters before HUTT. We found out that time domain HRV parameters were longer in patients with type 2B VVS than patients with other types of VVS. Our results need to be supported by extensive studies.

Summary Introduction The presence of patent foramen ovale (PFO) is considered a possible cause for cryptogenic stroke. The mechanism underlying the ischaemic neurological events in the presence of PFO has not been firmly established. The purpose of this study was to compare: (1) the mean platelet volume levels in PFO patients with and without a cryptogenic stroke, and (2) pre- and post-procedural mean platelet volumes (MPV) in patients undergoing percutaneous PFO closure. Methods Sixteen PFO patients undergoing percutaneous closure to prevent recurrent ischaemic events and 15 asymptomatic patients with PFO were enrolled in the study. Mean platelet volume was compared between patients with and without a history of stroke. We also compared pre- and postprocedural MPV levels in patients undergoing percutaneous PFO closure. Results Mean platelet volume, which is a marker for platelet activity, was similar in PFO patients with and without stroke (9.34 ± 1.64 vs 9.1 ± 1.34 fl; p = 0.526). Interestingly, MPV decreased significantly after percutaneous closure compared to pre-procedural levels (9.34 ± 1.64 vs 8.3 ± 1.12 fl; p = 0.001). Conclusion Our findings suggest interatrial communication through a PFO may be related to increased MPV and increased platelet activity.

We aimed to evaluate the success and safety of percutaneous mitral balloon valvuloplasty (PMBV) and its mid-term clinical and echocardiographic results in patients with symptomatic mitral stenosis, including those having a high echo score (9 to 11).This prospective study included 57 consecutive patients (9 men, 48 women; mean age 41+/-9 years) who underwent PMBV with the Inoue technique for symptomatic (NYHA class II-IV) mitral stenosis (valve area1.5 cm2). The patients were divided into two groups according to the echo scores ofor=8 (group 1, n=25) and8 (group 2, n=32). Clinical and echocardiographic evaluations were performed before and after 24-48 hours of PMBV and during the follow-up period, including restenosis and major cardiovascular events.Patients in group 2 had significantly higher rates of atrial fibrillation (53.1% vs. 16%; p=0.006) and functional capacity of NYHA class III-IV (90.7% vs. 56%; p=0.01). Procedural success rates were 96% (n=24) and 90.6% (n=29) in group 1 and 2, respectively. Failure occurred in one patient (4%) in group 1, and in three patients (9.4%) in group 2. One patient in group 1 developed severe mitral stenosis resulting in valve replacement. In group 2, two patients developed hemopericardium. After the procedure, there was a two-fold increase from 1.0+/-0.1 cm2 to 2.0+/-0.2 cm2 in the mean valve area, being more prominent in group 1 (group 1: from 1.1+/-0.1 cm2 to 2.1+/-0.1 cm2; group 2: from 0.9+/-0.1 cm2 to 1.8+/-0.1 cm2; p0.001). In-hospital mortality or embolic events did not occur, nor did restenosis or major cardiovascular events during a mean follow-up of 21+/-13 months.Our results show that PMBV can be performed successfully in patients having a low (or=8) or higher (9-11) echo score, with satisfactory hemodynamic and symptomatic improvements.

Congenital anomalies of the coronary arteries are an uncommon but important cause of chest pain and sudden cardiac death. The incidence of coronary artery anomalies has been reported between 0.6 to 1.3% in angiography and 0.3% in autopsy. The anomalous origin of left and right coronary arteries from a single coronary ostium in the right sinus of Valsalva is extremely rare and accounts for a small fraction of these anomalies with reported prevalence of 0.017% to 0.03% according to angiographic studies. We report a case of 52-year-old woman, suffering from chest pain, with an anomalous common origin of all coronary arteries from the right sinus of Valsalva.