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Seyis, Sabri (isu author) Gunay, Seyda (isu author) Rencuzoglu, Ibrahim (isu author) Objective: To investigate the usefulness of PLR in predicting severity and complexity of coronary atherosclerosis as assessed by the SXscore in patients with Non ST elevation myocardial infarction NSTEMI who underwent nonurgent coronary angiography (CA). Background: In NSTEMI patients, there is a debate whether early angiography and revascularization is beneficial compared with a more conservative approach. Platelet to lymphocyte ratio (PLR) is a new prognostic marker that gives idea about inflammation and aggregation pathways and may predict coronary atherosclerotic burden. PLR can be used to select patients who should go under angiography earlier due to excessive ischemic load. Methods: We retrospectively evaluated 111 consecutive patients who presented with NSTEMI and underwent non-urgent coronary angiography between July 2016 and March 2017. The PLR was calculated as the ratio of the platelet count to the lymphocyte count. The Syntax scores SX of all patients were calculated. A low SX score was defined as ? 22, an intermediate score as 23 to 32, and a high score as ? 33. Results: 92 patients (82.8%) had low SX scores (? 22), 19 patients (17.1%) had intermediate to high SX scores (? 23). Patients in the intermediate to high SX score group had significantly higher PLR 263 (219-366) vs. 117 (82-144.5) p

Objective: To evaluate the role of CHA2DS2-VASc score in predicting the intracoronary thrombus burden in patients with ST-Elevation Myocardial Infarction (STEMI). Background: High intracoronary thrombus burden is associated with reduced procedural success, larger infarct size, and mortality after Primary Percutaneous Coronary Intervention (PPCI). Prediction of thrombus burden before PPCI might be useful by enabling the detection of patients at risk for these complications. Methods: We retrospectively evaluated 164 consecutive patients who presented with STEMI within 12 h after the onset of chest pain between January 2015 and June 2016. PPCI was performed within 1 h after admission. Thrombus burden was graded according to Thrombolysis in Myocardial Infarction (TIMI) thrombus score. The patients were stratified into low (grades 1, 2 and 3) and high thrombus burden groups (grades 4 and 5). CHA2DS2-VASc score was calculated for each patient. Results: Thrombus burden was low in 94 (57%) patients and high in 70 (43%) patients. CHA2DS2-VASc score was higher in patients with high thrombus burden compared to patients with low thrombus burden (4.41 +/- 1.7 vs. 1.47 +/- 1.1, p2 to predict high thrombus burden was 0.925, with a sensitivity of 91% and a specificity of 82%. Conclusion: CHA2DS2-VASc score is a simple tool that predicts thrombus burden in STEMI patients undergoing PPCI. WOS:000416221500062

Background: Persistent Left Superior Vena Cava (PLSVC) is a rare congenital anomaly which is typically asymptomatic and discovered incidentally during device implantation. Methods: In this case, we present challenges and techniques of Cardiac Resynchronization Therapy (CRT) in a patient with PLSVC. Results: After evaluating the exact anatomy of PLSVC and Coronary Sinus (CS), we chose the appropriate approach and equipment's. By using a J shaped stylet, a guide wire and inner sub-selection catheter, we performed implantation successfully. Conclusion: In most cases of PLSVC, successful cardiac device implantation is possible with increasing operator experience, cardiac imaging and appropriate tools. WOS:000416221500032 Q4

Hamidi, Mehmet (Balikesir Author), Objective: This study aimed to determine the differences in terms of demographic characteristics and preferred stroke prevention strategies for patients with non-valvular atrial fibrillation living in seven geographical regions of Turkey.Methods: In total, 6273 patients were enrolled to this prospective, observational RAMSES study. The patients were divided into seven groups based on the geographical region of residence.Results: In terms of the geographical distribution of the overall Turkish population, the highest number of patients were enrolled from Marmara (1677, 26.7%). All demographic characteristics were significantly different among regions. Preferred oral anticoagulants (OACs) also differed between geographical regions; non-vitamin K OACs were preceded by warfarin in East Anatolia, Aegean, Southeast Anatolia, and Black Sea. Nearly one-third of the patients (28%) did not receive any OAC therapy. However, the number of patients not receiving any OAC therapy was higher in Southeast Anatolia (51.1%) and East Anatolia (46.8%) compared with other geographical regions of Turkey. Inappropriate use of OACs was also more common in East and Southeast Anatolia.Conclusion: This study was the first to show that the demographic differences among the geographical regions may result in different preferences of stroke prevention strategies in Turkey. OACs are still under- or inappropriately utilized, particularly in the eastern provinces of Turkey.

WOS: 000402283900004, PubMed ID: 28407216, BackgroundThe data regarding stroke prevention strategies in nonvalvular atrial fibrillation (NVAF) are limited especially in patients with renal impairment (RI). We sought to evaluate management dilemmas in patients with concurrent NVAF and RI in RAMSES (ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies inTurkey) study. MethodsWe conducted a prospective, multicenter, nation-wide registry in NVAF patients in outpatient cardiology clinics. All consecutive patients with NVAF were enrolled in RAMSES study (ClinicalTrials.gov identifier NCT02344901). The baseline data were collected. Glomerular filtration rate (GFR) was estimated by Cockcroft-Gault equation. ResultsA total number of 6273 patients from 29 provinces of Turkey with the contribution of 83 investigators were enrolled to the study. Of the study population, 1964(33%) patients had RI which was defined as GFR < 60 mL/min. Patients with RI had significantly higher CHA(2)DS(2)VASc and HAS-BLED scores compared to those without RI (39 15 vs. 29 +/- 15, and 20 +/- 1 vs. 14 +/- 1; P < 0001). Prior history of major bleeding (69% vs. 41%, P < 0001) and stroke (162% vs. 118%, P < 0001) was significantly higher among individuals with concomitant RI and NVAF. Although RI patients had a higher risk for thromboembolism, number of the patients who did not receive any anticoagulant therapy was higher in patients with RI than without RI (301 vs. 264%, P = 0003). ConclusionRAMSES study showed that one-third of the patients with NVAF had RI in the real-world setting. Although it is mandatory in most of the patients with concomitant NVAF and RI, nearly one-third of these patients did not receive any anticoagulant therapy.

WOS: 000394997800003, PubMed ID: 27848065, The definition of non-valvular atrial fibrillation (NVAF) is controversial. We aimed to assess the impact of valvular heart disease on stroke prevention strategies in NVAF patients. The RAMSES study was a multicenter and cross-sectional study conducted on NVAF patients (ClinicalTrials.gov identifier NCT02344901). The study population was divided into patients with significant valvular disease (SVD) and non-significant valvular disease (NSVD), whether they had at least one moderate valvular disease or not. Patients with a mechanical prosthetic valve and mitral stenosis were excluded. Baseline characteristics and oral anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF, there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant valvular disease was mitral regurgitation (58.1%), followed by aortic regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had higher CHA(2)DS(2)VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0; 5.0), p < 0.001] and HAS-BLED [2.0 (1.0; 2.0) vs. 2.0 (1.0; 2.0), p = 0.004] scores compared to patients with NSVD. Overall, 2763 (71.2%) of NSVD and 1515 (73.8%) of SVD patients were on OAC therapy (p = 0.035). When the patients with SVD were analyzed separately, the mean CHA(2)DS(2)VASc and HAS-BLED scores were higher in patients with mitral regurgitation compared to patients with aortic regurgitation and aortic stenosis [4.0 (3.0; 5.0), 3.0 (2.0; 4.0), 3.0 (2.0; 4.0) p < 0.001 and 2.0 (1.0; 3.0), 1.0 (1.0; 2.0), 1.0 (0.0; 2.0) p < 0.001, respectively]. In patients with SVD, 65.7% of mitral regurgitation, 82.6% of aortic regurgitation and 88.0% of aortic stenosis patients were on OAC therapy. One out of three NVAF patients had at least one moderate valvular heart disease with the predominance of mitral regurgitation. Patients with SVD were at greater risk of stroke and bleeding compared to patients with NSVD. Although patients with mitral regurgitation should be given more aggressive anticoagulant therapy due to their higher risk of stroke, they are undertreated compared to patients with aortic valve diseases.

WOS: 000384041400052, PubMed ID: 27583892, This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance 50mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of

WOS: 000375095000005 PubMed ID: 27138310 Objective: Atrial fibrillation is the most common arrhythmia and is associated with a five-fold increased risk of thromboembolic events. Vitamin K antagonists (VKAs) have been the mainstay of oral anticoagulant prophylaxis and the data on stroke prevention strategies are limited to VKA era. The purpose of this study is to evaluate the use of VKA, non-Vitamin K antagonist oral anticoagulants (NOAC), and antiplatelet agents in patients with non-valvular atrial fibrillation (NVAF). Methods: The ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey (RAMSES) is an observational, multicenter, prospective study of patients with NVAF. The study targeted enrollment of 7835 patients from 68 sites in Turkey. All the data will be collected at one point in time and current clinical practice will be evaluated. (ClinicalTrials.gov number NCT02344901). Results: Baseline characteristics of patients, antithrombotic therapies, transition to NOACs and rate/rhythm control strategies will be evaluated. Conclusion: The RAMSES registry will be the largest study in Turkish NVAF patients. The study will provide insights into real-world problems and anticoagulant treatment in patients with NVAF.

Capsaicin is the active component of chili peppers, which has been shown to possess several beneficial effects. Currently, the best-known medical use of capsaicin is as a topical painkiller. Drug-induced myocardial infarction is not a common phenomenon and the underlying mechanism has been related with coronary spasm in the majority of cases. We present a 29-year-old man who experienced coronary vasospasm and acute myocardial infarction (AMI) which were possibly induced by the use of a topical capsaicin patch to relieve lumbago. He presented with chest pain of one hour onset. The electrocardiogram showed ST-segment elevation in the leads II, III, and aVF, consistent with inferior wall AMI. Echocardiography confirmed inferior hypokinesia. Urgent coronary angiography showed normal right and left coronary arteries. Since he had no cardiac risk factors for coronary artery disease, nor a history of recent emotional or physical stress, or ingestion of any illicit substance, the vasospasm and subsequent AMI was attributed to the use of the capsaicin patch for six days. Upon institution of appropriate treatment and removal of the patch, no new anginal attacks or ischemic episodes were seen within a follow-up of one month. This is the first case report of AMI induced by the use of a topical capsaicin patch., Kapsaisin, yararlı birçok etkisi olduğu gösterilen acı kırmızıbiberin aktif bileşenidir. Günümüzde topikal ağrıkesici olarak kullanılmaktadır. İlaç kullanımı ile ilişkili miyokart enfarktüsü sık görülen bir durum değildir ve olguların çoğunda altta yatan mekanizma koroner vazospazm ileilişkilidir. Bu yazıda, bel ağrısını dindirmek için topikal kapsaisin yaması kullandığı sırada koroner vazospazm ve sonrasında akut miyokart enfarktüsü (AME) geçiren 29 yaşında bir erkek hasta sunuldu. Göğüs ağrısı başladıktan bir saat sonra başvuran hastanın elektrokardiyogramında, II, III, ve aVF derivasyonlarında inferiyor duvar enfarktüsü ile uyumlu ST-segment yükselmesi izlendi. Ekokardiyografik incelemede inferiyor hipokinezi görüldü. Acil koroner anjiyografide hastanın sağ ve sol koroner arterleri normal bulundu. Hastada koroner arter hastalığı için hiçbir risk faktörü, yakın zamanda yaşanmış duygusal veya fiziksel sıkıntı veya herhangi bir yasak madde alımı gibi bir durum olmadığından, vazospazm ve sonrasındaki AME, altı gündür kullanmakta olduğu kapsaisin yamasına bağlandı. Uygun tedaviye başlanması ve yamanın çıkarılması sonrasında, hastada bir aylık takip süresi içinde herhangi bir anjina atağı veya iskemik epizot görülmedi. Sunulan olgu, topikal kapsaisin yamasına bağlı olarak AME geliştiği bildirilen ilk olgudur.

Background. We aimed to investigate the effects of continuous positive airway pressure (CPAP) treatment on electrocardiography (ECG), premature ventricular contraction load on 24-hour Holter recordings, and implantable cardioverter defibrillator (ICD) shocks in patients with obstructive sleep apnea syndrome (OSAS) and heart failure. Methods. Patients with heart failure and ICD and patients with newly diagnosed OSAS were divided into two groups according to CPAP treatment. To compare the impact of CPAP on ECG parameters, both baseline and 6-month ECG, 24-hour Holter ECG, ambulatory blood pressure monitoring, echocardiography, polysomnography, and laboratory parameters were collected. Results. CPAP treatment significantly reduced the frequency of premature ventricular contractions, T-peak to T-end, corrected QT, corrected QT dispersion, and T-peak to T-end/corrected QT ratio in the study group (p .001 for all). Although the baseline NT-pro-BNP levels were similar between study and control groups, after six months, the NT-pro-BNP levels of the study group were significantly lower than that of the control group (39.18 ± 7.57 versus 46.11 ± 7.65; p Conclusions. CPAP treatment in patients with heart failure and ICD and in patients with newly diagnosed OSAS may have beneficial effects on premature ventricular contractions and electrocardiographic arrhythmia indices and NT-pro-BNP levels. However, these results are needed to be clarified with further studies.

Amaç: İmplante edilen kardiyoverter defibrilatörler (İKD) uygun hastalarda ani ölüm riskini azaltmaktadır. Ancak İKD şokları ile artmış morbidite ve mortalite arasında ilişki olduğu düşünülmektedir. Çalışmamızda son zamanlarda kardiyak olayları öngörmede sıklıkla kullanılan ekokardiyografik bir ölçüm olan Tei indeksinin İKD şokları ile ilişkisini inceledik. Yöntem: Uygun endikasyonla İKD implante edilen hastaların retrospektif olarak bazal özellikleri ve iki yıllık cihaz takipleri incelendi. İKD şoku alanlar ve İKD şoku almayanlar olarak iki grup oluşturuldu. Bu gruplar bazal özellikleri ve Tei indeksi açısından karşılaştırıldı. Bulgular: Çalışma popülasyonumuzdaki kalp yetersizliği hastalarının İKD implantasyonunu takip eden iki yıl içerisinde hiç şok almayanlara göre ortalama Tei indeksleri anlamlı şekilde daha yüksek saptandı (0.70±0.10 vs 0.56±0.10, p

Seyis, Sabri (isu author) Background Despite advances in reperfusion strategies, medical therapy, and emergent surgery, cardiac rupture (CR) is still a major lethal complication. Numerous parameters have been found to be associated with CR development after a primary percutaneous coronary intervention (pPCI). SYNTAX Score (SS) and SYNTAX Score II (SSII) have been studied in ST-segment elevation myocardial infarction (STEMI) patients, and higher scores have been associated with higher mortality. However, the relationship between CR and SSII is unclear. This study investigates the possible relationship between CR and SS, SSII in STEMI patients treated with pPCI. Patients and methods We enrolled 1663 consecutive STEMI patients treated with pPCI, who were divided into two groups according to CR development and compared with each other. Patients were further stratified into the three groups according to their SSII values. Results In this study, 33 (1.98%) patients developed CR. Both SS and SSII of those with CR were significantly higher than those without (19.27±4.0 vs. 16.40±4.55; P