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Background/Objectives Coronary microvascular dysfunction (CMD) is a common disorder, leading to symptoms similar to obstructive coronary artery disease and bears important prognostic implications. Local inflammation is suggested to promote development of CMD. Epicardial adipose tissue (EAT) is a local visceral fat depot surrounding the heart and the coronary arteries, modifying the inflammatory environment of the heart. We compared EAT in patients with and without CMD. Methods We retrospectively included consecutive patients undergoing diagnostic coronary angiography as well as transthoracic echocardiography between March and October 2016. EAT thickness was defined as space between the epicardial wall of the myocardium and the visceral layer of the pericardium and EAT index was calculated as EAT thickness/body surface area. Logistic regression analysis was used to determine the association of EAT index with the presence of CMD. Results Overall, 399 patients (mean age 60.2 ± 14.0 years, 46% male) were included. EAT thickness was significantly higher in patients with CMD compared to patients without CMD (EAT thickness 4.4 ± 1.8 vs. 4.9 ± 2.4 mm, p = 0,048 for patients without and with CMD, respectively). In univariate regression analysis, EAT index was associated with a 30% higher frequency of CMD (odds ratio [95% confidence interval]: 1.30 [1.001–1.69], p = 0.049). Effect sizes remained stable upon adjustment for body mass index (BMI, 1.30 [1.003–1.70], p = 0.048), but were attenuated when ancillary adjusting for age and gender (1.17 [0.90–1.54, p = 0.25). The effect was more pronounced in patients >65 years of age and independent of BMI and sex (1.85 [1.14–3.00], p = 0.013). Conclusion EAT thickness is independently associated with CMD and can differentiate between patients with and without CMD especially in older age groups. Our results support the hypothesis that modulation of local inflammation by epicardial fat is involved in the development of CMD.

To investigate the association between epicardial and pericoronary adipose tissue thicknesses measured with computed tomography (CT) and severity of COVID-19 infection.We recruited 504 patients admitted with RT-PCR-proven diagnosis of COVID-19 infection and underwent simultaneous Chest CT scanning. Epicardial adipose tissue thickness (EAT) and pericardial adipose tissue thickness (PCAT) were measured by CT. Comparisons were performed between ICU admitting and non-ICU admitting patients were performed.Of 504 patients, 423 patients were hospitalised in normal wards or followed as outpatient, and 81 patients were admitted to ICU. EAT and PCAT were significantly increased in ICU patients (5.98[5.06-7.13] mm vs. 8.05[6.90-9.89] mm,We found that both increased EAT and PCAT were associated with the severity of COVID-19 infection defined as the need for ICU admission.

Amaç: Bu çalışmada, bir grup seçkin sporcudaki tam kan viskozitesi ile sol ventriküler yeniden şekillenme arasında olası ilişki değerlendirilmiştir.Gereç ve Yöntemler: Bu çalışma seçkin atletlerin (65 futbolcu, 12 basketbolcu) katılımı ile gerçekleştirildi. Sol ventrikül kütlesi, transtorasik ekokardiyografi ile hesaplandı. Tam kan viskozitesinin hesaplanması hematokriti ve toplam plazma protein konsantrasyonunu kullanan formüller aracılığıyla hem yüksek kesme hızı (HSR= 208/s) hem de düşük kesme hızında (LSR= 0.5/s) gerçekleştirildi. Sol ventrikül kütle indeksi 115 g/m2 üzeri olması sol ventrikül hipertrofisi olarak tanımlandı, Katılımcıların tam kan viskoziteleri ve klinik özellikleri sol ventrikül hipertrofisi olup olmamasına göre karşılaştırıldı. Bulgular: Çalışmaya katılan 24 sporcuda sol ventrikül hipertrofisi mevcut idi. Tam kan viskozitesi hem yüksek kesme hızında (sol ventrikül hipertrofisi olmayan grup için HSR tam kan viskozitesi=17,4±0,89 cP karşın hipertrofi olan grup HSR tam kan viskozitesi= 17,95±0,78 cP; p= 0,011), hem de düşük kesme hızında (sol ventrikül hipertrofisi olmayan grup için HSR tam kan viskozitesi=63,7±18,9 cP karşın hipertrofi olan grup LSR tam kan viskozitesi= 76,36±16,35 cP; p=0,006) sol ventrikül hipertrofisi olan sporcu grubunda anlamlı şekilde daha yüksekti. Çoklu değişkenli lojistik regresyon analizinde tam kan viskozitesi düşük ve yüksek kesme değerleri için ayrı ayrı ayrı modellere alındı. Tam kan viskozitesi hem düşük kesme hızında (OR=1,057, %95 CI: 1,017-1,098; p=0,005), hem de yüksek kesme hızında (OR=2,885, %95 CI: 1,319-6,313; p=0,008) sol ventrikül hipertrofisi ile ilişki bulundu. Sonuç: Seçkin sporcularda gözlenen sol ventrikül hipertrofisinde tam kan viskozitesinin muhtemel bir rolü olabilir.

OBJECTIVES Elucidation of the underlying mechanisms of angiogenesis and arteriogenesis in coronary collateral formation is necessary for new therapies. Pleiotrophin is a secreted multifunctional cytokine and associated with the formation of functional cardiovascular neovascularization in a series of experimental animal models. We aimed to evaluate the serum levels of pleiotrophin in patients with chronic total coronary artery occlusion and poor or good collateral development. METHODS We included 88 consecutive patients (mean age of the entire population: 63.7±12.1 years, 68 male patients) with stable angina pectoris who underwent coronary angiography and had chronic total occlusion in at least one major coronary artery. Collateral grading was performed according to the Rentrop classification. After grading, patients were divided into poor collateral circulation (Rentrop grade 0 and 1) and good collateral circulation (Rentrop grades 2 and 3) groups. Serum pleiotrophin levels were measured using a commercial human ELISA kit. RESULTS Fifty-eight patients had good and 30 patients had poor coronary collaterals. The good collateral group had higher serum pleiotrophin levels than the poor collateral group (690.1±187.9 vs. 415.3±165.9 ng/ml, P

BACKGROUND The myocardial performance index (MPI) is a comprehensive measure of global systolic and diastolic function of the ventricle, and it has an inverse correlation with maximal oxygen consumption. In this study, the potential association between left ventricle MPI and biochemical biomarkers (including iron, homocysteine, and lipids) in elite athletes was investigated. MATERIAL AND METHODS This cross-sectional observational study consisted of 80 young male elite soccer and basketball players (age: 18-34 years) examined for a seasonal medical check-up. Cardiological examinations and transthoracic echocardiography of these athletes were performed and blood samples were analyzed according to standard laboratory protocols. Tissue Doppler recording was acquired from the mitral annulus using apical 4-chamber view and then the tissue Doppler-derived MPI was computed. RESULTS Athletes were separated into 2 groups based on MPI values (MPI ≤0.40 and MPI >0.40), and baseline demographic, clinical, and biochemical variables of the study participants were compared between these 2 groups. Serum triglyceride, high-density lipoprotein, total cholesterol, homocysteine levels, and iron parameters did not significantly differ between groups, while low-density lipoprotein level was significantly lower in the MPI ≤0.40 group (103.8±26.0 mg/dl vs. 116.8±30.2 mg/dl; p=0.043). Correlation analysis and multivariate linear regression analysis demonstrated a significant association between low-density lipoprotein and MPI. CONCLUSIONS In this study, various biochemical markers were evaluated for possible association with left ventricle MPI as a surrogate of cardiac performance. Among these biomarkers, only low-density lipoprotein was significantly associated with MPI in elite athletes.

Background Electrocardiography (ECG) is frequently used in preparticipation evaluation of competitive athletes. Repolarization heterogeneities on ECG is a well-known indicator for malignant ventricular arrhythmias and sudden cardiac death. We aimed to investigate the effect of iron and homocysteine levels on arrhythmogenic indicators, T peak-to-end (Tp-e) interval, and Tp-e/QT ratio in elite athletes. Methods A total of 72 players (48 football and 24 basketball) with a mean age of 25.4 ± 5.0 years were included to the analysis. Blood biochemistry, homocysteine level, and iron parameters (transferrin saturation and serum iron) were obtained by standard methods. Duration of QRS, QT interval, and Tp-e interval were measured manually on the precordial leads and Tp-e/QT ratio was calculated. Results Baseline demographic and clinical characteristics of the study population were compared in two groups according to the median value of Tp-e/QT = 0.219. Both iron and transferrin saturations were higher in the above median group (P = 0.001 and P = 0.002, respectively), however, homocysteine levels were not statistically different among two groups (P = 0.405). In correlation analysis, both serum iron and transferrin saturation were significantly correlated with Tp-e interval (r = 0.368; P = 0.001 and r = 0.394; P = 0.00, respectively) and Tp-e/QT ratio (r = 0.357; P = 0.002 and r = 0.372; P = 0.001, respectively). Multiple stepwise regression analysis revealed that transferrin saturation was an independent predictor of Tp-e interval and Tp-e/QT ratio (β = 0.325; P = 0.002 and β = 0.372; P = 0.001, respectively). Conclusion This study showed an independent relationship between iron status and Tp-e interval and Tp-e/QT ratios of elite sport players which were also not correlated with serum homocysteine levels.

Objective: Aortic stiffness and chronic kidney disease share common risk factors. Increased aortic stiffness is a predictor of lower estimated glomerular filtration rate (eGFR) at lower levels of renal functions. We aimed to investigate the association between invasively measured central aortic pulsatility (AP) as an indicator of aortic stiffness and eGFR in a population with coronary artery disease and without overt renal disease. Methods: This study had a cross-sectional design. Data were retrospectively collected. We evaluated 72 patients (44 males and 28 females; mean age 59.0±10.3 years) with coronary artery disease. eGFR was calculated with dividing the Cockcroft–Gault formula by body surface area. Direct measurements of aortic blood pressures were utilized to calculate pulse pressure and AP. Multiple linear regression analysis was performed to test the relationship between eGFR and AP, independent from potential confounders. Results: eGFR was significantly correlated with age (r=0.489, p0.71 had 84% sensitivity and 72% specificity in predicting eGFR of

OBJECTIVE Exaggerated blood pressure response to exercise is a risk factor for the development of future hypertension. In this study, we aimed to investigate the association between homocysteine, epicardial fat thickness, nonalcoholic hepatic steatosis, and exaggerated blood pressure response to exercise. PARTICIPANTS AND METHODS We included 44 normotensive and 40 patients with exaggerated blood pressure response to exercise who have normal resting blood pressure and without a previous diagnosis of hypertension. All patients underwent treadmill exercise test and clinical, ultrasonographic, and echocardiographic evaluation. Exaggerated blood pressure response to exercise is defined as peak exercise systolic blood pressure of at least 210 mmHg in men and at least 190 mmHg in women. Homocysteine and other biochemical parameters were determined with standardized automated laboratory tests. RESULTS Mean age of all participants is 47.9±8.5 years, and 36 of 84 participants were female. The frequency of diabetes mellitus in both groups was similar (P=0.250). Homeostasis model assessment index-insulin resistance had a statistically insignificant trend to be higher in a patient with exercise hypertension (P=0.058). The nonalcoholic fatty liver was more frequent in patients with exercise hypertension (13.6 vs. 47.5%, P=0.002). Epicardial fat thickness was increased in patients with exercise hypertension (5.5±1.5 vs. 7.3±1.1 mm; P=0.001). However, homocysteine levels did not significantly differ between normotensive and exercise hypertensive patients [12.3 μmol/l (5.7-16.9 μmol/l) vs. 13 μmol/l (5.9-28.3 μmol/l); P=0.883]. CONCLUSION In our study, homocysteine levels were not associated with exaggerated blood pressure response to exercise; however, fatty liver and epicardial fat thickness as visceral adiposity-related cardiometabolic risk factors were significantly related with exaggerated blood pressure response to exercise in patients without a previous diagnosis of hypertension.

OBJECTIVE: Treadmill exercise stress testing for identifying patients with a higher likelihood of coronary artery disease (CAD) before elective coronary angiography is recommended in the current guidelines. In this study, we aimed to evaluate the changes in the hematological parameters before and after exercise stress test in relation with the presence of CAD. METHODS: A total of 113 patients with chest pain who underwent treadmill exercise testing and coronary angiography were included in this study. RESULTS: Neutrophil count (4.38±0.99 vs 5.19±0.93, P

There is little data regarding the diagnostic ability of neutrophil–lymphocyte ratio (NLR) in acute coronary syndrome. Therefore, we aimed to assess the predictive value of NLR in the discrimination of troponin-positive patients. We enrolled 244 patients (mean age 61.3 ± 11.7 years, 70.5% male) who presented to the emergency service with acute chest pain. Patients were divided into 2 groups based upon the troponin positivity in the 12- to 24-hour follow-up. The admission NLR was significantly higher in the troponin-positive group (5.49 ± 4.01 vs 2.40 ± 1.36, P < .001). A cutoff point of 2.80 for NLR measured on admission had 79% sensitivity and 73% specificity in predicting follow-up troponin positivity. After multivariate analysis, admission NLR and glucose levels remained significant predictors of follow-up troponin positivity. In conclusion, NLR may be an early diagnostic marker in emergency service for discriminating patients who will have a positive troponin test in the follow-up.

Background Obstructive sleep apnea (OSA) has been shown to be associated with atrial fibrillation (AF). Prolongation of inter- and intraatrial conduction times during sinus rhythm has also been shown to be related to AF generation. Nasal continuous positive airway pressure (CPAP) is an effective treatment modality of OSA. Methods Twenty-four OSA patients diagnosed through polysomnography and 18 controls were included in the study. The basal inter- and intraatrial electromechanic delays prior to onset of the therapy were measured using tissue Doppler imaging. P-wave dispersion (Pd) was calculated on the basis of 12-lead electrocardiography. Same measurements were performed in OSA patients 6 months after the initiation of the therapy. Results Interatrial (39.2 ± 8 vs. 21.1 ± 2.8 ms, P < 0.001), left intraatrial (20.5 ± 7.2 vs. 11.1 ± 2 ms, P = 0.003), and right intraatrial electromechanical delays (20.7 ± 11 vs. 10 ± 2.6 ms, P < 0.001) prior to CPAP therapy were found to be significantly greater in OSA group as compared with the controls. Pd was also greater in the OSA group as compared with the controls (44 ± 7 vs. 28.5 ± 4 ms, P < 0.001). However, significant improvement has been noted after 6 months of CPAP therapy in interatrial (P < 0.0001), left intraatrial (P = 0.002), and right intraatrial electromechanical delays (P < 0.0001) as well as in Pd (P < 0.0001) as compared to baseline values in patients with OSA. Conclusion Our findings suggested that CPAP therapy provides more homogenous conduction through atria in patients with OSA. This effect may translate into decreased risk for AF associated with OSA.

OBJECTIVE latrogenic femoral pseudoaneurysm is a well-known vascular access site complication. Many invasive and noninvasive techniques have been proposed for the management of this relatively common complication. In this study, we aimed to evaluate efficiency and safety of stethoscope-guided compression as a novel noninvasive technique in the femoral pseudoaneurysm treatment. METHODS AND RESULTS We prospectively included 29 consecutive patients with the diagnosis of femoral pseudoaneurysm who underwent coronary angiography. Patients with a clinical suspicion of femoral pseudoaneurysm were referred to colour Doppler ultrasound evaluation. The adult (large) side of the stethoscope was used to determine the location where the bruit was best heard. Then compression with the paediatric (small) side of the stethoscope was applied until the bruit could no longer be heard and compression was maintained for at least two sessions. Once the bruit disappeared, a 12-hour bed rest with external elastic compression was advised to the patients, in order to prevent disintegration of newly formed thrombosis. Mean pseudoaneurysm size was 1.7 +/- 0.4 cmx 3.0 +/- 0.9 cm and the mean duration of compression was 36.2 +/- 8.5 minutes.Twenty-six (89.6%) of these 29 patients were successfully treated with stethoscope-guided compression. In 18 patients (62%), the pseuodoaneurysms were successfully closed after 2 sessions of 15-minute compression. No severe complication was observed. CONCLUSION Stethoscope-guided compression of femoral pseudoaneurysms is a safe and effective novel technique which requires less equipment and expertise than other contemporary methods.

BACKGROUND: Electrocardiography (ECG) is frequently used in preparticipation evaluation of competitive athletes. Repolarization heterogeneities on ECG is a well‐known indicator for malignant ventricular arrhythmias and sudden cardiac death. We aimed to investigate the effect of iron and homocysteine levels on arrhythmogenic indicators, T peak‐to‐end (Tp‐e) interval, and Tp‐e/QT ratio in elite athletes. METHODS: A total of 72 players (48 football and 24 basketball) with a mean age of 25.4 ± 5.0 years were included to the analysis. Blood biochemistry, homocysteine level, and iron parameters (transferrin saturation and serum iron) were obtained by standard methods. Duration of QRS, QT interval, and Tp‐e interval were measured manually on the precordial leads and Tp‐e/QT ratio was calculated. RESULTS: Baseline demographic and clinical characteristics of the study population were compared in two groups according to the median value of Tp‐e/QT = 0.219. Both iron and transferrin saturations were higher in the above median group (P = 0.001 and P = 0.002, respectively), however, homocysteine levels were not statistically different among two groups (P = 0.405). In correlation analysis, both serum iron and transferrin saturation were significantly correlated with Tp‐e interval (r = 0.368; P = 0.001 and r = 0.394; P = 0.00, respectively) and Tp‐e/QT ratio (r = 0.357; P = 0.002 and r = 0.372; P = 0.001, respectively). Multiple stepwise regression analysis revealed that transferrin saturation was an independent predictor of Tp‐e interval and Tp‐e/QT ratio (β = 0.325; P = 0.002 and β = 0.372; P = 0.001, respectively). CONCLUSION: This study showed an independent relationship between iron status and Tp‐e interval and Tp‐e/QT ratios of elite sport players which were also not correlated with serum homocysteine levels.

Objective: Polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk, including ischemic stroke. Prolonged atrial electromechanical interval (EMI) is related to increased atrial fibrillation (AF) risk. The aim of the study is to evaluate atrial EMI and electrocardiographic P-wave indices related to increased AF risk in patients with PCOS. Methods: Forty PCOS patients diagnosed on the basis of the Rotterdam criteria and 20 age-matched controls were prospectively included. patients with atrioventricular or intraventricular conduction abnormalities, dysrhythmia or taking antiarrhythmic drugs, atherosclerotic heart disease, cardiomyopathies, valvular lesions, pericardial disease, a history of pulmonary emboli or pulmonary hypertension, and abnormal thyroid function were excluded. Intra and interatrial EMI were measured by tissue Doppler imaging and P-wave dispersion (Pd) was calculated on 12-lead electrocardiography (ECG). The Isovolumetric relaxation time was the interval between the aortic valve closure artifact at the end of the LV outflow envelope and the mitral valve opening artifact at the beginning of the mitral E wave. Results: Patients with PCOS had significantly higher interatrial [38 (24-65) ms vs. 16 (9-19) ms p

We report a case of coronary artery perforation during diagnostic coronary angiography. No cardiac biomarker elevation was observed. However, the patient suffered acute pericarditis which was treated conservatively.

Agiz yoluyla kisa surede asiri su alimi ciddi norolojik ve kardiyak semptomlara yol acabilir ve su zehirlenmesi olarak adlandirilir. Bu durum psikiyatrik hastalarda siklikla gorulmektedir ancak intihar amacli asiri su alimi oldukca enderdir. Bu olgu sunumunda intihar amacli asiri su aliminin yol actigi elektrolit dengesizligine bagli ventrikuler fibrilasyon gelisen 51 yasindaki hastayi sunuyoruz. Hasta acil klinigimize bilinc degisikligi ve ajitasyon ile basvurdu. Hasta hipertansifti ve norolojik muayenesinde lateralizasyon bulgusu yoktu. Hastanede takibi esnasinda ventrikuler aritmi kardiyopulmoner arrest ve tonik klonik nobet gozlendi. Kan biyokimyasinda hastanin 4 saat icerisinde 12 litre su icmesiyle uyumlu olan hiponatremi ve hipokalemi mevcuttu. Elektrolit bozuklugunun duzeltilmesinden sonra ventrikuler aritmi ve nobet tekrarlamadi. Hasta psikiyatrik degerlendirmeye yonlendirildi ve antidepresan tedavi ile taburcu edildi. Su zehirlenmesi sizofreni gibi psikiyatrik bozukluklarda iyi bilinse de intihar dusuncesi olan depresif hastalarda daha once bildirilmemistir. Bu nadir durumun klinik sunumuna olan farkindalik potansiyel olarak olumcul seyredebilen komplikasyonlari onleyebilir.

Dear Editor,We read with great interest the article by Uyanik et al., entitled “Delayed ST-Segment Elevation Due to Electrical Injury Mimicking Acute Myocardial Infarction,” which was published recently in this journal. This case report was mentioning a young patient admitted with late-onset chest pain and ST-segment elevation following ele-ctrical injury (1). Although the case was presented precisely, some points merit further highlighting.Abnormal electrocardiography (ECG) may be found in approxi-mately 31% of patients following an electric shock (2). Non-specific ST-segment changes and sinus tachycardia are the most commonly reported ECG findings; QT prolongation, bundle branch block, atrial and ventricular fibrillation, and atrial and ventricular premature con-tractions are also detected. As referred to in this case report, ST-seg-ment elevation with or without myocardial involvement may follow electrical injury.In a clinical setting, ST-segment elevation on ECG may be related with many conditions, such as myocardial infarction, early repolariza -tion, electrolyte imbalance, and pericarditis. In this case, myocardial infarction may easily be excluded, since cardiac biomarkers are nor-mal and ST elevation is not consistent with myocardial infarction. In this case, ECG shows diffuse and concave ST elevation (elevated at the J point) with the exception of V1 and aVR. In acute myocardial infarction, ST elevation is also accompanied by reciprocal ST depres-sions. In the case of early repolarization, ST elevation is most often present in the mid- to lateral chest leads (V3-V6), and the majority of subjects with early repolarization has no ST deviations in the limb leads. So, early repolarization would be excluded in this patient, who has pronounced ST elevation on D2, D3, and aVF.Zeana describes a 65-year-old electrocuted subject who experi-enced precordial pain, serous enzymes of negative myocardial necro -sis, and ST elevation during 2 weeks of hospitalization (3). These fin-dings suggest the possibility of widespread pericardial involvement. In the case presented by Uyanik et al., pericardial involvement seems to be the most possible cause of ST changes in the admission ECG. This ECG shows us sinus bradycardia with diffuse concave ST elevati-on except for V1 and aVR. ST depression in V1 and aVR is also a typical finding for acute pericarditis. Late-onset chest pain also supports this condition. However, addition of a follow-up ECG of the patient to the report would be more valuable for confirmation of this diagnosis. In our opinion, pericarditis deserves discussion as a possible diagnosis in the aforementioned case.

OBJECTIVE The quantitative parameters which are used to assess the severity of aortic regurgitation (AR) provide the most accurate information whereas these parameters are difficult and time-consuming. The aim of this study was to get a practical parameter to use in daily practice for assessing the severity of aortic regurgitation. METHODS The study was an observational cohort study on diagnostic accuracy of severity of aortic regurgitation. Thirty-seven patients with aortic regurgitation determined by quantitative parameters (18 patients with severe aortic regurgitation and 19 patients with moderate aortic regurgitation) were included in this study. Each patient's diastolic flow pattern in the descending aorta was examined by pulsed wave Doppler. Systolic and diastolic flow time-velocity integral (TVI), TVI time, systolic and diastolic TVI ratio in the descending aorta were evaluated. In addition to these parameters, dP/dt, peak acceleration time and end-diastolic flow velocity in the diastolic flow were determined. We investigated whether there a significant difference between two groups or not. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off values of echocardiographic parameters which were used to identify the severity of aortic regurgitation. RESULTS The study population was composed of 16 female and 21 male patients. Their mean age was 46.5 years. The mean diastolic flow TVI of patients who had moderate and severe aortic regurgitation was found 10.1 cm and 18.6 cm, respectively (p

Fractional flow reserve (FFR) assessment is widely used to determine significance of intermediate coronary lesions. Previously, components of the metabolic syndrome (MS) which may affect FFR validity were not tested cumulatively. In this study, we investigate the possible effect of MS on FFR assessment.We retrospectively evaluated 178 consecutive patients who had undergone FFR assessment. Thirty-two patients were excluded. All of the coronary lesions were in the left anterior descending artery. They were evaluated with quantitative coronary angiography (QCA). In 105 patients the MS was present and 41 patients were without the MS. According to the severity of the coronary lesions in QCA, patients were divided into three groups: 40-50%, 51-60% and 61-70% lesions. FFR measurements were compared in each group with respect to MS presence. Coronary artery lesions were accepted as haemodynamically significant if FFRor = 0.80. Age of the population, lesion length, lesion diameter and adenosine dosage performed during FFR assessment were not different between patients with MS or without MS. When the lesions were divided into three categories according to the severity of the luminal narrowing expressed in stenosis percentages as 40-50, 51-60, and more than 61%, the observed FFR values decreased with advancing lesion category (P = 0.04). However, observed FFR values did not differ between the patients with MS and without MS in each category (P = 0.88). After exclusion of the diabetic patients, FFR values still did not differ between the patients with MS and without MS in each category (P = 0.78).Presence of the metabolic syndrome has no significant effect on FFR assessment. This study provides additional data for the reliability of FFR in patients with MS.

A 36-year-old female patient was admitted to our clinic with chronic atypical chest and back pain. She had a history of 3-day hospitalization in the intensive care unit after a severe blunt chest trauma in a car accident 25 years ago. She had no clear evidence of bloody pericardial effusion or pericardial intervention. The heart was observed to have regular rhythm without any murmur, rub, or gallop. Lung fields were clear. Electrocardiography demonstrated sinus rhythm along with non-specific ST-T wave …

Video 1: Transtorasik ekokardiyografi apikal dort bosluk goruntulemede mitral kapak posteriyor yaprakciginin ekojenitesi artmis kitle imaji izlenmektedir Video 2: Transtorasik ekokardiyografi apikal dort bosluk renkli Doppler goruntulemede mitral kapakta ileri duzeyde mitral yetersizligi izlenmektedir Video 3-5: Midozefagial goruntulemede mitral kapak posteriyor yaprakciginin ekojenitesi artmis kitle imaji izlenmektedir Video 6: Midozefagial renkli Doppler goruntulemede mitral kapakta ileri duzeyde ekzantrik mitral yetersizligi izlenmektedir

OBJECTIVES An increased circulating monocyte count has been found to be related to good collateral development in patients with stable coronary artery disease. Our aim in this study was to determine any possible relationship between the levels of circulating monocyte subsets and coronary collateral development. METHODS Patients who had greater than 95% stenosis of at least one major coronary artery in their first coronary angiogram were included consecutively in this study. Collateral development was graded as good and poor according to the Cohen-Rentrop method. Blood samples were subjected to cytometric analysis for the determination of monocyte subsets, CD14++CD16- and CD14+CD16+ monocytes. RESULTS Out of 105 patients, 55 had good and 50 had poor coronary collateral development. When the baseline characteristics were compared, the monocyte count was significantly higher in the good collateral group (517±151 vs. 396±109/mm3, P

a b s t r a c t Background and purpose: Coronary collateral circulation (CCC) has been demonstrated to be impaired in patients with type 2 diabetes mellitus which is characterized by insulin resistance. In this study, our purpose was to find out a possible relationship between CCC and non-alcoholic fatty liver disease (NAFLD), which is also characterized by insulin resistance, in non-diabetic patients with severe coronary artery disease. Methods: One hundred and fifty-one consecutive non-diabetic patients with stable angina pectoris who were found to have >95% stenosis of at least one major coronary artery were enrolled. Abdominal ultra- sonography (USG) was performed after coronary angiography to determine the presence or absence of NAFLD. Results: According to Cohen-Rentrop method, 81 (53.7%) patients had good and 70 (46.3%) patients had poor collateral development. NAFLD was present in 98 patients (64.9% of study population) and more prevalent in patients with poor collateral development (58 of 70 patients (82.9%) vs. 40 of 81 patients (49.4%), p < 0.001). Mean Rentrop collateral score was significantly lower in patients with NAFLD (1.2 ± 1.2 vs. 2.1 ± 0.9, p < 0.001). Shorter angina time, metabolic syndrome, presence of insulin resistance, less severe coronary artery disease, and female sex were also associated with poor collateral development. When the logistic regression analysis was performed using these factors, NAFLD was still significantly related to poor collateral development. Conclusions: Presence of NAFLD is associated with poor coronary collateral development in non-diabetic patients with severe coronary artery disease independent from other variables, especially metabolic syndrome and insulin resistance. Which mechanisms play role in this association is needed to be cleared with further studies.

Objective: Polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk, including ischemic stroke. Prolonged atrial electromechanical interval (EMI) is related to increased atrial fibrillation (AF) risk. The aim of the study is to evaluate atrial EMI and electrocardiographic P-wave indices related to increased AF risk in patients with PCOS. Methods: Forty patients with PCOS and 20 age-matched controls were included. Intra and interatrial EMI were measured by tissue Doppler imaging and P-wave dispersion (Pd) was calculated on 12-lead electrocardiography (ECG). Results: Patients with PCOS had significantly higher interatrial [38 (24-65) ms vs. 16 (9-19) ms p

Objective: Renal dysfunction is associated with increased cardiovascular morbidity and mortality. The alteration in renal function as a marker of mortality in pulmonary thromboembolism (PTE) has not been studied extensively. Methods: Four hundred four consecutive patients diagnosed with non-high-risk PTE (without cardiogenic shock or blood pressure

Angiosarcoma is the most common primary cardiac malignancy with a poor prognosis. In this report, we describe a 28-year-old male patient presenting with symptoms and findings of myocardial ischaemia who has been finally diagnosed with cardiac angiosarcoma.

The American Journal of Cardiology MARCH 13e16, 2014 10 IN AND C The incidence of the coronary artery anomalies ranges between 0.3-1%. Although coronary artery anomalies are present at birth, relatively few of them become symptomatic during childhood. The majority of anomalies are identified as incidental findings during coronary arteriography or at autopsy. However, some may become evident with angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure and even, sudden death. In this study, rate and pattern of congenital coronary artery anomalies in adult patients undergoing coronary angiography (CA) in a high volume tertiary medical center were reported. Among the 52 887 coronary angiographies performed between 2003 and 2009. 555 (390 male, 165 female) cases of coronary artery anomalies (1.05%) were identified. The mean age of patients with coronary artery anomaly was 52 13 years. Detailed description of coronary artery anomalies in our CA series is presented in Table 1. Atherosclerotic coronary artery disease accompanied to congenital coronary anomaly in (47.6 %) of cases. Myocardial bridges were the most common coronary artery anomaly and detected in 297 (53.5 %) patients. In 195 of cases (35%) anomalous origin or anomalous course of coronary arteries was present. Among them, anomalous origin of circumflex artery from the right coronary sinus was the most common form (n1⁄486, 15.5% of all cases). The second most common pattern regarding anomalous origin was the origin of right coronary artery from the left coronary sinus (n1⁄434, 6.1% of all cases). The rate of separate ostia of the left circumflex and left anterior descending coronary arteries from left coronary sinus or in other words, absence of left main coronary artery in our series was 2.5 % (n1⁄414). Although the absence of left main coronary artery is thought to be higher, this anomaly might not be specified by operator due to its benign course or inadequate imaging during procedure. Coronary artery fistulae were detected in 57 (10.2%) cases and congenital coronary aneurysm was present in 6 (1.1%) cases. The recognition of coronary artery anomalies shortens the duration of coronary angiography and mitigates the radiation exposure for both the operators and the patients. Also, it is important to know if there is any anomaly in origin or in course of coronary arteries before cardiac surgery to avoid complications.

Purpose: In this study, we aimed to evaluate efficiency and safety of stethoscope guided compression as a novel noninvasive technique in the femoral pseudoaneurysm treatment. Methods and results: We prospectively included 29 consecutive patients with diagnosis of femoral pseudoaneurysm who underwent coronary angiography. Patients with clinical suspicion of femoral pseudoaneurysm were referred to color Doppler ultrasound evaluation. Adult side of the stethoscope was used to determine location of bruit. Then, compression with pediatric side of stethoscope was applied until bruit could not be heard and compression was maintained for at least two sessions. Once bruit disappeared, 12- hour bed rest with external elastic compression was advised, in order to prevent disintegration of newly formed thrombosis. Mean pseudoaneurysm size was 1.7±0.4 cm × 3.0±0.9 cm and mean duration of compression was 36.2±8.5 minutes. Twenty-six (89.6%) of these 29 patients were successfully treated with stethoscope guided compression. In 18 patients (62%), pseuodoaneurysms were successfully closed after 2 sessions of 15-minute compression. Only one patient experienced mild vagal reaction. ![Figure][1] Figure 1 Conclusion: Stethoscope guided compression of femoral pseudoaneurysms is a safe and effective novel technique which require less equipment and expertise than other contemporary methods. [1]: pending:yes

Non-compaction cardiomyopathy is described by the spongy appearance of myocardium and this condition frequently exists with other cardiac or extracardiac abnormalities. However, coexistence of non-compaction cardiomyopathy with congenital intrahepatic porto-systemic shunt was not reported previously. Here we presented a 22-year-old male patient with Type 1 congenital intrahepatic porto-systemic shunt and non-compaction cardiomyopathy.

PP-181 Obstructive sleep apnea (OSA) is a common medical condition that is affecting approximately 5% to 15% of the population. Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. OSA has been shown to be associated with AF. Electrophysiological and