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Introduction: Endovascular aortic repair (EVAR) is commonly used for abdominal aortic aneurysms, but its mortality rate remains high. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, which measures hemoglobin, albumin, lymphocyte, and platelet levels, provides prognostic value by reflecting the nutritional status and systemic inflammation. This study aimed to explore the relationship between the HALP score upon admission and long-term mortality in patients with EVAR. Methods: Consecutive patients with EVAR at our tertiary center from October 2010 to August 2021 were retrospectively analyzed. HALP scores were calculated using the following formula: hemoglobin (g/L) × albumin (g/L) × lymphocyte count (/L)/platelet count (/L). In-hospital and long-term mortality data were extracted. Receiver operating characteristic curve analysis identified predictors of in-hospital mortality. Multivariate Cox regression analysis was performed to examine determinants of long-term mortality. Results: Among the 162 participants (mean age: 69.4±8.2 years, 90.1% male), the HALP score was the most significant predictor of in-hospital mortality (area under the curve: 0.752, 95% confidence interval: 0.674-0.830; p

Objective: This single-center study aimed to assess the incidence and predictors of carotid artery Xact stent fractures (SF) and their impact on in-stent restenosis (ISR) during long-term follow-up. Methods: A cohort of 108 patients (97 males, median age 69.4±8 months) who underwent Xact stent placement for internal carotid artery stenosis between 2013 and 2021 and were diagnosed with SFs through fluoroscopy in 2022 were included. SFs were categorized as types I-V based on fracture characteristics. Follow-up included duplex ultrasound examinations to assess stent patency. Results: The average follow-up duration was 49.2±24.3 months, with ISR observed in 10 patients. Twenty-three SFs (21.3%) were identified: type I (5 patients), type II (7 patients), type III (3 patients), type IV (6 patients), and type V (2 patients). Calcification and stent length significantly predicted SFs (p

Background:Heart failure (HF) is a common condition that affects 1-3% of the general population. Its prevalence exhibits notable international and intranational disparities, partly explained by socioeconomic status, religion, ethnic diversity, and geographic factors. A comprehensive understanding of the epidemiological symptoms of HF in different regions of Türkiye has yet to be revealed.Aims:To examine epidemiological data from 2016 to 2022, focusing on crucial patient characteristics and geographical regions, to determine the incidence and prevalence of HF in Türkiye across seven diverse geographical regions.Study Design:A nationwide population-based retrospective cohort study.Methods:The comprehensive National Electronic Database of the Turkish Ministry of Health was used in this study to obtain data that covers the whole Turkish population from January 1, 2016, to December 31, 2022. The International Classification of Diseases-10 (ICD-10) codes were used to identify adults with HF (n = 2,701,099) and associated comorbidities. Türkiye is divided into seven geographically distinct regions. Epidemiological characteristics and survival data of these regions were analyzed separately. All-cause mortality was set as the primary outcome.Results:In , the total estimated prevalence of adult patients with HF is 2.939%, ranging from 2.442% in Southeastern Anatolia to 4.382% in the Black Sea Region. Except for the Eastern Anatolia Region, the three most often reported comorbidities were hypertension, dyslipidemia, and anxiety disorders. The rates of prescribing guideline-directed medical therapy (GDMT) for HF and other medications varied significantly. GDMT prescription rates were lowest in the Eastern Anatolia Region (82.6% for beta-blockers, 48.7% for RASi, 31.8% for mineralocorticoid receptor antagonists, and 9.4% for SGLT2i). The Mediterranean and Aegean regions had the highest median N-terminal brain natriuretic peptide (NT-proBNP) levels of 1,990,0 pg/ml (518.0-6,636,0) and 1,441,0 pg/ml (363.0-5,000,0), respectively. From 2016 to 2022, 915,897 (33.9%) of 2,701,099 patients died. The Eastern Anatolia Region had the lowest all-cause mortality rate of 26.5%, whereas the Black Sea Region had the highest all-cause mortality rate of 35.3%.Conclusion:Our real-world analysis revealed geographic disparities in HF characteristics, such as decreased mortality in socioeconomically challenged regions. Higher stress susceptibility in developed regions may increase the likelihood of adverse outcomes.

Background: Systemic immune-inflammatory index (platelet count × neutrophil–lymphocyte ratio) is a new marker that predicts adverse clinical outcomes in coronary artery diseases. Our aim was to investigate the relationship between the systemic immune-inflammatory index and residual SYNTAX score in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods: In this retrospective study, 518 consecutive patients who underwent primary percutaneous coronary intervention (PCI) with the diagnosis of ST-segment elevation myocardial infarction were analyzed. The severity of coronary artery diseases was determined by residual SYNTAX score. In the receiver operating characteristic curve analysis, systemic immune-inflammatory index with an optimal threshold value of 1025.1 could detect the presence of a high residual SYNTAX score; the patients were divided into 2 groups as low (326) and high (192) according to the threshold value. In addition, binary multiple logistic regression analysis methods were used to evaluate independent predictors of high residual SYNTAX score. Results: In binary multiple logistic regression analysis, systemic immune-inflammatory index [odds ratio = 6.910; 95% CI = 4.203-11.360; P

Background and Objectives: Diagnosis of myocarditis remains a challenge in clinical practice; however, magnetic resonance imaging (CMRI) can ease the diagnostic approach by providing various parameters. The prevalence of right ventricular involvement in acute myocarditis is suggested to be more frequent than previously hypothesized. In this study, we sought to investigate subclinical RV involvement in patients with acute myocarditis and preserved RV ejection fraction (EF), using CMRI RV speckle-tracking imaging. Materials and Methods: CMRI of 27 patients with acute myocarditis (nine females, age 35.1 ± 12.2 y) was retrospectively analyzed. A control group consisting of CMRI images of 27 healthy individuals was included. Results: No significant differences were found regarding left ventricle (LV) and atrium dimensions. LV ejection fraction was significantly different between groups (56.6 ± 10.6 vs. 62.1 ± 2.6, p < 0.05). No significant differences were present between parameters used for conventional assessment of RV. However, RV strain absolute values were significantly lower in the acute myocarditis group in comparison with that of the control group (18.4 ± 5.4 vs. 21.8 ± 2.8, p = 0.018). Conclusions: Subclinical RV dysfunction detected by CMR-derived strain may be present in patients with acute myocarditis even with preserved RVEF.

Purpose: The present study sought to investigate the association between Cardiac magnetic resonance (CMR) imaging parameters including late gadolinium enhancement (LGE), total left ventricular mass (TLVM), mitral regurgitation, and left atrial (LA) volume, with atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM). patients. Materials and Methods: Consecutive 122 patients with the diagnosis of HCM and together with having 48-hour Holter monitoring were included in the present work. Two experienced observers evaluated all CMR images. The correlation between AF and CMR parameters including TLVM, LA volume, the presence and extent of LGE, mitral regurgitation, and the maximum left ventricular thickness were evaluated. Results: Between the LA volume and AF, a significant correlation was observed. Additionally, TLVM was also associated with AF. The logistic multivariate analysis assessing TLVM, LA volume, and the extent of LGE revealed that only the left atrial volume was the independent predictor. Significant correlations were observed between the existence and extent of LGE, TLVM, mitral regurgitation and LA volume. Conclusion: The presence of LGE was positively correlated with LA volume. LA volume appears to be the most important independent predictor of AF in HCM patients.

Background: In patients with essential hypertension, fragmented QRS has been associated with many remodeling components that might lead to adverse cardiovascular effects. This study aimed to evaluate the relationship between fragmented QRS and adverse events and its potential long-term prognostic value. Methods: The patients with essential hypertension were divided into two groups accord- ing to the presence of fragmented QRS: fragmented QRS (+) and fragmented QRS (−). During long-term follow-up, the relationship of fragmented QRS to coronary artery dis-ease, congestive heart failure, stroke, cardiovascular death, all-cause death, and major adverse cardiovascular and cerebrovascular events was evaluated. Results: The study group included 542 patients with essential hypertension. Fragmented QRS on ECG was observed in 224 (41.3%) patients. Considering the incidence rates at the end of 5.6 +- 1.3 years' follow-up, the total incidence rate of major adverse cardiovascular and cerebrovascular events (P

Objective:Percutaneous coronary intervention (PCI) has become the treatment method for patients presenting with ST elevation myocardial infarction (STEMI). One of the well-known complications of PCI is no-reflow. Studies demonstrated a relationship between endothelial dysfunction and disturbed vascular flow due to angulation of vascular tree. Although the relationship between hemodynamic alterations and coronary angulation is evident, there is a lack of detailed analysis in terms of hemodynamic changes between vascular geometry and coronary no-reflow. We aimed to elucidate the relationship between vascular geometry and coronary no-reflow.Method:We reviewed PCI database of our hospital and enrolled a total of 120 patients with STEMI, who developed no-reflow following PCI, and sex and age matched 80 patients with normal flow. For each group, demographic and clinical characteristics, laboratory values and two dimensional quantitative coronary angiography measurements were evaluated.Results:Patients with no-reflow had a higher prevalence of hypertension and diabetes mellitus. In addition, serum C-reactive protein levels were higher in patients with no-reflow compared to patients with normal flow (p

Background/aim: Effective management of heart failure involves evidence-based use of multiple medications and their combinations. Furthermore, dosage escalation of the recommended medications is advised. In cases of advanced heart failure, long-term mechanical assistance devices or heart transplantation surgery may be necessary. Socio-economic disparities create unequal opportunities for people to access these treatments. The study aimed to analyze and compare medical and advanced heart failure treatments recommended by guidelines across various regions in Türkiye. Materials and methods: About 85 million citizens medical treatment records were utilized between January 1, 2016, and December 31, 2022. Medical and heart replacement treatment opportunities for heart failure in Türkiye were evaluated in the general population and across different geographical regions. Results: According to this study, beta-blockers were the most commonly prescribed medication for heart failure in Türkiye. This was followed by angiotensin-converting enzyme inhibitors at 44% and mineralocorticoid receptor antagonists at 38.9%. However, only 0.6% of patients used angiotensin receptor blocker-neprilysin inhibitors. Despite the high incidence of diabetes mellitus among heart failure patients, only 11% used sodium-glucose cotransporter two inhibitors. The study also found that using an implantable cardioverter defibrillator (ICD) was 0.8%, and cardiac resynchronization therapy (CRT) was 0.3% among all intracardiac device treatments. Heart replacement therapies, cardiac transplantation surgery, and long-term left ventricle-assisted device (LVAD) surgery had very low rates. Conclusion: The use of guideline-directed medical therapy is not optimal in Türkiye and varies across different geographical regions. It is a fact that heart transplant or LVAD surgery, CRT, and ICD implantation rates in Türkiye are significantly lower than those in developed countries, regardless of geographical region. [ABSTRACT FROM AUTHOR]

Background and Objectives: Diagnosis of myocarditis remains a challenge in clinical practice; however, magnetic resonance imaging (CMRI) can ease the diagnostic approach by providing various parameters. The prevalence of right ventricular involvement in acute myocarditis is suggested to be more frequent than previously hypothesized. In this study, we sought to investigate subclinical RV involvement in patients with acute myocarditis and preserved RV ejection fraction (EF), using CMRI RV speckle-tracking imaging. Materials and Methods: CMRI of 27 patients with acute myocarditis (nine females, age 35.1 ± 12.2 y) was retrospectively analyzed. A control group consisting of CMRI images of 27 healthy individuals was included. Results: No significant differences were found regarding left ventricle (LV) and atrium dimensions. LV ejection fraction was significantly different between groups (56.6 ± 10.6 vs. 62.1 ± 2.6, p < 0.05). No significant differences were present between parameters used for conventional assessment of RV. However, RV strain absolute values were significantly lower in the acute myocarditis group in comparison with that of the control group (18.4 ± 5.4 vs. 21.8 ± 2.8, p = 0.018). Conclusions: Subclinical RV dysfunction detected by CMR-derived strain may be present in patients with acute myocarditis even with preserved RVEF. [ABSTRACT FROM AUTHOR]

Aim:Attention deficit hyperactivity disorder (ADHD) is the most neurodevelopmental disorder in childhood, which causes repetitive trauma and extremity injuries. Oppositional defiant disorder (ODD) and conduct disorder (CD) are the most comorbid conditions of ADHD. Our study investigated the correlation between extremity trauma and ADHD’s subgroups in pediatric trauma patients and comparison with the control group. Our aim was to detect high-risk patients in pediatric extremity injuries and to prevent possible extremity injuries with early diagnosis.Materials and Methods:Between September 2018 and February 2019, 60 pediatric patients with extremity injuries (group 1) and non-traumatic reasons (group 2) were included in this prospective study consecutively. Patients were evaluated with the Conner’s Parent Rating Scale and Strength and Difficulties Questionnaire for ADHD subgroups, ODD and CD. Patients who received an initial diagnosis were evaluated by the Child and Adolescent Psychiatry Department of Trakya University Medical Hospital.Results:Patients who were diagnosed as ADHD were significantly higher in the trauma group (p=0.042), but no statistical significance was found in any subgroups of ADHD, ODD and CD.Conclusion:Our results were in accordance with the vast majority of current literature in which ADHD was found to be significantly higher in the trauma group. ADHD must be considered in pediatric trauma patients to prevent possible extremity injuries.

Objective:Rheumatic heart disease is the deposition of immune complexes which cause malfunction of the heart valves. Percutaneous mitral balloon valvuloplasty (PMBV) is an established treatment option in patients with symptomatic moderate or severe rheumatic mitral valve disease, but PMBV is not a preferred option in mitral stenosis (MS) patients with moderate mitral regurgitation (MR) due to the risk of severe MR. The aim of this study was to evaluate the safety and feasibility of PMBV in symptomatic MS patients with moderate MR by comparing the post-procedural parameters with those of MS patients with mild or no MR.Method:Among 104 patients with symptomatic MS, 10 patients with moderate MR were classified as group 2 while 94 patients who had mild or none MR were classified as group 1 in the present work. All patients underwent PMBV and pre- and post-procedural mitral valve area, MRs were recorded and cardiovascular events and complications were assessed in 30 days.Results:The only difference in both groups before and after the procedure was the severity of the MR. Cardiovascular death was not observed for both groups in 30 days. In group 1, there were 3 patients and in group 2, there was 1 patient who developed severe MR after PMBV. All patients who had post-procedural severe MR required mitral valve replacement in 30 days due to severe MR in group 1. The composite complication rate was similar between the groups.Conclusion:PMBV might be an alternative treatment option for selected patients having significant MS with moderate MR.

Objective: A strong correlation exists between myocardial fibrosis and heart failure (HF). Myocardial fibrosis can be detected by cardiac magnetic resonance (CMR), which is a crucial noninvasive imaging method with high specificity and sensitivity. Matrix metalloproteinases (MMPs) are primary proteases responsible for the degradation of extracellular matrix (ECM) components, and they play a vital role in maintaining the balance between anabolism and catabolism of ECM. This study aims to investigate the correlation between cardiac fibrosis detected on CMR and serum MMP-9 levels in patients with HF. Methods: We enrolled 53 patients (age: ≥18 years) with left ventricular ejection fraction (LVEF) ≤40%, who received CMR because of various indications. All patients were divided into two groups-with cardiac fibrosis (n=32) and without cardiac fibrosis (n=21)-detected by CMR with late-Gadolinium. Both groups were then compared according to MMP-9 levels. Results: MMP-9 levels were significantly higher in patients with cardiac fibrosis than those without fibrosis (p

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Introduction: Endovascular aortic repair (EVAR) is commonly used for abdominal aortic aneurysms, but its mortality rate remains high. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, which measures hemoglobin, albumin, lymphocyte, and platelet levels, provides prognostic value by reflecting the nutritional status and systemic inflammation. This study aimed to explore the relationship between the HALP score upon admission and long-term mortality in patients with EVAR. Methods: Consecutive patients with EVAR at our tertiary center from October 2010 to August 2021 were retrospectively analyzed. HALP scores were calculated using the following formula: hemoglobin (g/L) x albumin (g/L) x lymphocyte count (/L)/platelet count (/L). In-hospital and long-term mortality data were extracted. Receiver operating characteristic curve analysis identified predictors of in-hospital mortality. Multivariate Cox regression analysis was performed to examine determinants of long-term mortality. Results: Among the 162 participants (mean age: 69.4±8.2 years, 90.1% male), the HALP score was the most significant predictor of in-hospital mortality (area under the curve: 0.752, 95% confidence interval: 0.674-0.830; p<0.001). Multivariate Cox regression analysis revealed HALP (p=0.001) and C-reactive protein (p=0.004) as independent determinants of long-term mortality. Conclusion: This study is the first to investigate the association between the HALP score and in-hospital and long-term mortality in EVAR patients. The HALP score is a robust prognostic tool compared with its components and other parameters in this patient population. [ABSTRACT FROM AUTHOR]

Copyright of Bezmialem Science is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Right ventricular (RV) dysfunction in acute pulmonary embolism (APE) has been associated with increased mortality and morbidity. The aim of the present study was to assess the timing and magnitude of regional RV functions using speckle-tracking echocardiography (STE) and their relationship to early hospital mortality in patients with APE. Methods: One hundred forty-two patients were prospectively studied at the onset of an acute episode and after a median follow-up period of 30 days. Their clinical and laboratory characteristics were recorded. For all patients, conventional two-dimensional echocardiography and STE were performed within 24 h after the diagnosis of APE. Results: Twenty-eight (19.7%) patients died during the hospitalization follow-up. Patients who died during hospitalization were older and had higher high sensitivity cardiac troponin T levels, and a higher percentage of patients had simplified Pulmonary Embolism Severity Indexes. In STE analyses, they had lower RV free wall peak longitudinal systolic strain (PLSS) and higher RV peak systolic strain dispersion indexes. The time to PLSS difference between RV free wall and LV lateral was longer in patients who died during hospitalization than in those who survived, and this was an independent predictor of early hospital mortality with 85.7% sensitivity and 75.0% specificity in patients with APE. Conclusion: APE was associated with RV electromechanical delay and dispersion. Electromechanical delay index might be useful to predict early hospital mortality in patients with APE.

Objective: Aortic stenosis (AS) is the most common valvular heart disease requiring intervention, particularly in developed countries. Transcatheter aortic valve replacement (TAVR) is indicated for patients with a high surgical risk and a post-procedural survival expectancy of more than 12 months. Over the years, the TAVR method has emerged as a significant treatment option for patients with symptomatic severe AS and has begun to be implemented in our country as well. The objective of this study was to evaluate the short and long-term outcomes of patients undergoing TAVR at our center, as well as to assess our institution's experience with the TAVR procedure. Methods: This retrospective, single-center analysis included 16 consecutive patients with symptomatic AS who underwent TAVR between March 2022 and February 2024. All patients included in the study underwent implantation of a balloon-expandable TAVR valve. In the study, the demographic characteristics of patients preoperatively and during post-procedural follow-ups, their clinical status preoperatively and postoperatively, and echocardiographic findings were evaluated and compared. Results: The mean age of the entire population was 78.3 ± 8.7 years, and 50% were women. Transfemoral access was used in 93.8% of patients. Implantation success was achieved in all cases. During the TAVI procedure, 12.5% of patients required permanent pacemaker implantation. The mean length of hospital stay for the entire cohort was 4.5±2.3 days. There wasn't show in-hospital deaths occurred before hospital discharge. During the follow-up, it was observed that 3 patients died from all-cause mortality. The mean follow-up duration of the study was 552 days, with the longest follow-up being 666 days. The significant improvement was noted in all echocardiographic parameters and functional capacity. No cases with moderate or severe aortic regurgitation, necessitating additional procedures. Conclusion: Our center results with TAVR over a 2-year span consistent with broader studies. Despite some procedure-related complications, advancements in devices and techniques are expected to reduce these, enhancing outcomes with increased procedural experience. With medicine favoring less invasive approaches, TAVR is poised to become a more prevalent alternative to surgery across diverse patient cohorts. [ABSTRACT FROM AUTHOR]

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Copyright of Cumhuriyet Medical Journal is the property of Cumhuriyet Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)