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MitraClip is an effective treatment method for severe mitral regurgitation in high-risk populations in terms of reducing morbidity and frequency of hospitalizations. Efficacy and safety of MitraClip device in elderly population have been established, yet there are only 2 case reports of MitraClip implantation in the younger patients, who generally tend to have less surgical risk (Gorenflo et al.; Joffe et al., 2016). We describe a 19-year-old patient with severe mitral regurgitation with prior mitral valve annuloplasty and received MitraClip implantation due to high-surgical risk.

Coronary artery fistulas are rare anomalies that often become symptomatic with age. They are typically diagnosed incidentally during coronary angiography. The chief nonsurgical treatment is transcatheter coil embolization. We evaluated the outcomes of this procedure in 17 symptomatic patients who had 22 fistulas in total. The 9 men and 8 women (mean age, 52 +/- 16.5 yr; range, 27-74 yr) presented at 4 Turkish hospitals from October 2008 through March 2015. Three patients had multiple fistulas. Twelve fistulas originated from the right coronary artery and 10 from the left coronary artery, draining into the pulmonary artery in 18 instances. We evaluated results post-procedurally and after 2 to 5 months, defining angiographic success as a flow better than Thrombolysis in Myocardial Infarction grade 2 in the treated artery. Twenty-one of the 22 procedures immediately produced the targeted flow. We observed 2 minor and no major complications. On follow-up, 3 symptomatic patients under-went successful repeat treatment of one fistula each. We found that transcatheter coil embolization afforded good success rates with few complications in closing coronary artery fistulas. We share our experience to add to the data on treating patients with coronary artery fistulas, and to raise awareness among clinicians., NA

It is of clinical importance to determine creatinine clearance and adjust doses of prescribed drugs accordingly in patients with heart failure to prevent untoward effects. There is a scarcity of studies in the literature investigating this issue particularly in patients with heart failure, in whom many have impaired kidney function. The purpose of this study was to determine the degree of awareness of medication prescription as to creatinine clearance in patients hospitalized with heart failure. Patients hospitalized with a diagnosis of heart failure were retrospectively evaluated. Among screened charts, patients with left ventricular ejection fraction

WOS: 000374722700029, PubMed: 26164686, Objectives: Diabetes mellitus is an independent and strong risk factor for development of atrial fibrillation (AF). Electrophysiologic and electromechanical abnormalities are associated with a higher risk of AF. In this study we aimed to determine the correlation of atrial conduction abnormalities between the surface electrocardiographic and tissue Doppler echocardiographic measurements in type 2 diabetes mellitus (T2DM) patients. Methods: A total of 88 consecutive T2DM patients and 49 age-, gender-, and body mass index-matched healthy volunteers were included in the present study. Baseline characteristics were recorded and 24 hour ambulatory blood pressure monitoring, transthoracic echocardiography, and 12-lead surface electrocardiography were performed for all study participants. Atrial electromechanical delay (EMD) intervals were measured. Results: Maximum P-wave duration and P-wave dispersion (Pd) were significantly higher in patients with T2DM (105.7 +/- 10.2 ms vs. 102.2 +/- 7.5 ms, p = 0.02; 40.6 +/- 7.6 ms vs. 33.6 +/- 5.9 ms, p < 0.001, respectively). Interatrial, intraatrial, and intraleft atrial EMD were significantly higher in the T2DM patients when compared with the controls (16.5 +/- 7.8 ms vs.11.2 +/- 4.4 ms, p < 0.001; 9.0 +/- 7.3 ms vs. 6.0 +/- 3.8 ms, p = 0.002, and 7.4 +/- 5.2 ms vs. 5.1 +/- 3.2 ms, p = 0.002 respectively). Correlation analysis showed a positive correlation between interatrial EMD and Pd (r = 0.429, p < 0.001) and left atrial volume (r = 0.428,p < 0.001). Conclusions: In this study, there was significant EMD and Pd in patients with T2DM as compared with healthy volunteers. Additionally, interatrial EMD was correlated with Pd and left atrial volume index. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

The study aimed to examine the association between thoracic periaortic fat tissue volume and the long-term incidence of major adverse cardiovascular events.This retrospective cohort study included 433 consecutive patients (372 male and 61 female). Periaortic fat tissue volume was measured via electrocardiogram-gated 64-multidetector computed tomography. The patients were evaluated on an average 3 years of follow-up for major adverse cardiovascular events. The patients were divided into groups according to the presence of major adverse cardiovascular events.Major adverse cardiovascular events were noted in 44 (10.2 %) patients during follow-up. Periaortic fat tissue volume was significantly higher in the major adverse cardiovascular events (+) group (35.4 ± 26.1 cm(3) vs. 24.1 ± 14.9 cm(3), P = 0.001). The logistic regression model showed that periaortic fat tissue volume (hazard ratio: 1.03; 95 % CI: 1.01-1.05; P = 0.001), the glomerular filtration rate (hazard ratio: 0.98; 95 % CI: 0.96-0.99; P = 0.03), and male gender (hazard ratio: 4.76; 95 % CI: 1.08-20.90; P = 0.04) were independent predictors of major adverse cardiovascular events.Thoracic periaortic fat tissue volume may be considered a useful new parameter for predicting major adverse cardiovascular events.

ObJectIVe: Renal artery stenosis (RAS) is emerging one of the cause of chronic renal failure and end-stage renal disease. The vast majority of cases in elderly are due to atherosclerotic disease. The prevalence of RAS in several population studies varies considerably. The study aimed to examine the frequency and risk factors of atherosclerotic critical RAS in patients with coronary artery disease.

To evaluate thoracic periaortic adipose tissue (TAT) burden in patients with type 2 diabetes mellitus (DM) in comparison with controls and in relation to cardiovascular risk factors. A total of 93 patients with type 2 DM (mean (standard deviation; SD) age: 56.7 (11.2) years, 71.0 % were men) and 85 nondiabetic control subjects (mean (SD) age: 54.6 (10.9) years, 58.8 % were men) who were admitted to Mevlana University hospital between January 2011 and June 2013 and underwent multidetector computed tomography for any reason were included in this retrospective cohort study. Patient and control groups were compared in terms of demographic characteristics, anthropometrics, and laboratory findings. TAT volume was evaluated in both groups, while correlates of TAT were determined via linear regression analysis among patients. In patients with type 2 DM, TAT volume (40.1 (23.9) versus 16.9 (7.7) cm3, p

Impaired sleep quality is frequently associated with hypertension.The present study aims to examine self-reported sleep quality of patients with white coat hypertension. A total of 74 subjects who were evaluated in a cardiology outpatient clinic, including 39 normotensive subjects and 35 patients with white coat hypertension between the ages of 20 and 65 were included in this study. Patients with elevated office blood pressure (≥140/90 mm Hg) and normal 24-h and daytime ambulatory blood pressure (

The objective of this study was to investigate the relationship of echocardiographic epicardial fat thickness (EFT) and neutrophil to lymphocyte ratio (NLR) with different types of non-valvular atrial fibrillation (AF) in a clinical setting. A total of 197 consecutive patients were enrolled in the study. Seventy-one patients had paroxysmal non-valvular AF, 63 patients had persistent/permanent non-valvular AF, and 63 patients had sinus rhythm (control group). EFT was measured with echocardiography, while NLR was measured by dividing neutrophil count by lymphocyte count. EFT was significantly higher in patients with paroxysmal non-valvular AF compared with those in the sinus rhythm group (6.6 ± 0.7 vs. 5.0 ± 0.9 mm, p0.001). Persistent/permanent non-valvular AF patients had a significantly larger EFT compared with those with paroxysmal AF (8.3 ± 1.1 vs. 6.6 ± 0.7 mm, p0.001). EFT had a significant relationship with paroxysmal non-valvular AF (odds ratio 4.672, 95 % CI 2.329-9.371, p0.001) and persistent/permanent non-valvular AF (OR 24.276, 95% CI 9.285-63.474, p0.001). NLR was significantly higher in those with paroxysmal non-valvular AF compared with those in the sinus rhythm group (2.5 ± 0.6 vs. 1.8 ± 0.4, p0.001). Persistent/permanent non-valvular AF patients had a significantly larger NLR when compared with paroxysmal non-valvular AF patients (3.4 ± 0.6, vs. 2.5 ± 0.6, p0.001). NLR (2.1) had a significant relationship with non-valvular AF (OR 11.313, 95% CI 3.025-42.306, b 2.426, p0.001). EFT and NLR are highly associated with types of non-valvular AF independent of traditional risk factors. EFT measured by echocardiography and NLR appears to be related to the duration and severity of AF.

In this study, we sought to assess the incidence and predictors of radial artery occlusion (RAO), which is a significant complication of transradial cardiac catheterization. We prospectively evaluated the results of 106 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) via the transradial approach (TRA). At the 3(rd) h of intervention, the radial artery was checked by palpation; color doppler ultrasonography was performed at the 24(th) h. Fluoroscopy duration, procedure success, and complications of the radial artery were recorded. The procedure was successfully completed in all patients. RAO was detected in eight female and two male patients. In terms of RAO, there was a statistically significant difference between males and females (p=0.019). Other parameters did not show a significant correlation with RAO. Altough did not have any effect on procedural success, eight patients developed transient radial artery spasm. Gender was not associated with radial arterial spasms (p=0.19). TRA in the diagnosis and treatment of coronary artery disease has shown high procedural success and low complication rates; it addition, it presents a low economic burden. It should be used widely and be involved in the routine cardiology residency program.

Especially in spring and winter months many people use excessive dose topical or systemic decongestant agents to relief the allergic or infectious nasal congestive symptoms without physicians\' prescription. Although these agents bring some symptomatic benefits, sometimes serious adverse cardiac events reported at all drug users, especially who had known cardiac disease. These agents may cause slightly elevation of blood pressure in hypertensive patients, can trigger mortal arrhythmias like ventricular tachycardia, can also trigger myocardial infarction patients with known coronary artery disease or normal coronary artery and may cause decompensation of heart failure. In conclusion all these decongestant agents give only symptomatic relief and they don\'t treat flu and allergic disease. For this reason if the symptoms are mild or moderate not using these agents will be more wisely.

Background: The 12-lead surface electrocardiogram (ECG) is a useful tool to predict both atrial and ventricular arrhythmias via P-wave and QT measurements and its derivatives. Polycythemia vera (PV) is a chronic myeloproliferative disorder associated with cardiovascular events. The aim of this study was to assess ECG findings of patients with PV.Method and materials: Sixty patients with PV (34 male, mean age 58±11 years) and 60 age and gender-matched healthy volunteers were enrolled into the study. From the 12-lead surface ECG, P-wave and both conventional QT measurements and transmyocardial repolarization parameters (Tpeak-Tend interval (Tp-Te) and derivatives) were evaluated digitally by two experienced cardiologists. In addition, a novel parameter, Pi was calculated digitally as the standard deviation of the P-wave duration across the 12 ECG leads.Results: QT duration and corrected QT interval were significantly longer in the PV group compared to healthy controls (pp-Te was longer and the Tp-Te/QT ratio was significantly higher in the PV group compared to the controls. P-wave analyses showed that all P-wave parameters including Pmax, Pmin, P dispersion, and Pi were significantly prolonged in PV patients compared to the controls. The increase of both Tp-Te and P max in the PV group was independent of age, BMI, diabetes and hypertension, gender, systolic blood pressure, hemoglobin, hematocrit, left atrial dimension, left ventricular end-diastolic diameter and early deceleration time in a univariate analysis of co-variance model (F=11.097, p=0.001 and F=31.537, p=0.0001, respectively).Conclusion: The present study demonstrated that PV may be associated with electrocardiographic abnormalities of both atrium and ventricle.

WOS: 000301065000001, PubMed: 22211096, Background: The 12-lead surface electrocardiogram (ECG) is a useful tool to predict both atrial and ventricular arrhythmias via P-wave and QT measurements and its derivatives. Polycythemia vera (PV) is a chronic myeloproliferative disorder associated with cardiovascular events. The aim of this study was to assess ECG findings of patients with PV. Method and materials: Sixty patients with PV (34 male, mean age 58 +/- 11 years) and 60 age and gender-matched healthy volunteers were enrolled into the study. From the 12-lead surface ECG, P-wave and both conventional QT measurements and transmyocardial repolarization parameters (T-peak-T-end interval (T-p-T-e) and derivatives) were evaluated digitally by two experienced cardiologists. In addition, a novel parameter, Pi was calculated digitally as the standard deviation of the P-wave duration across the 12 ECG leads. Results: QT duration and corrected QT interval were significantly longer in the PV group compared to healthy controls (p

Aims: The aim of this study was to evaluate myocardial performance index (MPI) which reflects the combined systolic and diastolic performance of the ventricles by tissue Doppler imaging (TDI) in patients with polycythemia vera (PV). Method and Materials: Twenty-eight patients with PV (17 men; mean age 60 ± 9 years) and 30 age-matched healthy subjects were prospectively evaluated. The diagnosis of PV was performed according to the World Health Organization (WHO) criteria. Left ventricular (LV) systolic and diastolic functions were assessed by conventional echocardiography and TDI. MPI of both the LV and right ventricles (RV) were measured by TDI method. Results: The LV MPI was significantly higher in PV group than in the controls (0.61 ± 0.16 vs. 0.49 ± 0.05; P = 0.001). Also, the RV MPI was impaired in patients with PV compared to the control subjects (0.51 ± 0.11 vs. 0.43 ± 0.09; P = 0.005). RV late A filling velocity (Am) and RV isovolumetric relaxation time were significantly higher in the PV group compared to healthy subjects (P = 0.03 and 0.05, respectively). In logistic regression models, PV was determined as an independent predictor of impaired MPI (odds ratio: 3.7; CI 95%, 1.2–7.5). In addition, pulmonary arterial pressure was significantly elevated in patients with PV compared to the controls (P = 0.02). Conclusion: This study demonstrated that biventricular MPI is impaired in patients with PV. (Echocardiography 2011;28:948-954)

CD40 ligand is a thromboinflammatory molecule that predicts cardiovascular events. Platelets constitute the major source of soluble CD40 ligands (sCD40L), which has been shown to influence platelet activation. The main aim of this study was to evaluate sCD40L levels in patients with acute pulmonary embolism (PE). Sixty-five PE patients (32 males, mean age 58 ± 12 years) and 29 healthy controls (15 males, mean age 56 ± 14 years) were enrolled in the study. sCD40L levels were evaluated at the enrollment by ELISA method. Multislice detected pulmonary computed tomography was performed on all patients with a suspected diagnosis of PE. In addition, echocardiography was performed to evaluate right ventricular (RV) dysfunction. There was no statistically significant difference between the two groups regarding demographic features. sCD40L levels were significantly higher in acute PE group compared to healthy controls (5.3 ng/ml and 1.4 ng/ml, respectively; p < 0.001). sCD40L levels of patients with and without RV dysfunction were similar. Correlation analysis between echocardiographic findings and sCD40L levels did not show significant difference. The present study demonstrated a role of sCD40L in pathogenesis of PE for the first time. Further studies are needed to clarify a predictive and prognostic value of sCD40L levels in acute PE patients.

WOS: 000292520000003, PubMed: 21698055, Background: The mechanisms of the increased cardiac and vascular events in patients with OSA are not well understood. Arousal which is an important component of OSA was associated with increased sympathetic activation and electrocardiographic changes which prone to arrhythmias. We planned to examine the association among arousal, circulating Lp-PLA2 and total antioxidant capacity in male patients with OSA. Methods: Fifty male patients with newly diagnosed OSA were enrolled the study. A full-night polysomnography was performed and arousal index was obtained. Lp-PLA2 concentrations were measured in serum samples with the PLAC Test. Total antioxidant capacity in patients was determined with Antioxidant Assay Kit. Results: Arousal was positively correlated with LP-PLA2 levels (r=0.43, p=0.002) and was negatively correlated with total antioxidant capacity (r= -0.29, p=0.04). Elevated LP-PLA2 levels and decreased total antioxidant activities were found in the highest arousal quartile compared with the lowest and 2nd quartiles (p=0.02, p=0.05, respectively). LP-PLA2 was an independently predictor of arousal index in regression model (beta=0.357, p=0.002) Conclusions: This study demonstrated a moderate linear relationship between arousal and LP-PLA2 levels. Also, total antioxidant capacities were decreased in the higher arousal index. Based on the study result, the patients with higher arousal index may be prone to vascular events., Bilim Drug Company Ltd., The authors acknowledge to Bilim Drug Company Ltd. for the financial support for the LP-PLA2 and total antioxidant capacity assay kits. Also, the authors acknowledge to sleep laboratory staff for their contributions to the study.

Background: The mechanisms of the increased cardiac and vascular events in patients with OSA are not well understood. Arousal which is an important component of OSA was associated with increased sympathetic activation and electrocardiographic changes which prone to arrhythmias. We planned to examine the association among arousal, circulating Lp-PLA2 and total antioxidant capacity in male patients with OSA.Methods: Fifty male patients with newly diagnosed OSA were enrolled the study. A full-night polysomnography was performed and arousal index was obtained. Lp-PLA2 concentrations were measured in serum samples with the PLAC Test. Total antioxidant capacity in patients was determined with Antioxidant Assay Kit.Results: Arousal was positively correlated with LP-PLA2 levels (r=0.43, p=0.002) and was negatively correlated with total antioxidant capacity (r= -0.29, p=0.04). Elevated LP-PLA2 levels and decreased total antioxidant activities were found in the highest arousal quartile compared with the lowest and 2nd quartiles (p=0.02, p=0.05, respectively). LP-PLA2 was an independently predictor of arousal index in regression model (β=0.357, p=0.002)Conclusions: This study demonstrated a moderate linear relationship between arousal and LP-PLA2 levels. Also, total antioxidant capacities were decreased in the higher arousal index. Based on the study result, the patients with higher arousal index may be prone to vascular events.

Incidence of post-infarction left ventricular (LV) thrombus is reduced by modern methods of revascularization and treatment with intensive antithrombotic agents. LV thrombus may be an important cause of morbidity and mortality due to relatively high risk of embolization. Therefore, the diagnosis and appropriate management is crucial. The paper introduces a successful treatment of massive, mobile LV thrombus originating from the apical aneurysm and extending to the left ventricular outflow tract.

Atrial remodeling is an important part of cardiac remodeling after acute myocardial infarction (AMI). The aim of this study was to evaluate the effect of spironolactone on atria in patients with preserved left ventricular (LV) functions after AMI by using two-dimensional and tissue Doppler imaging techniques (TDI).The study consisted of 110 patients with AMI, successfully revascularized with percutaneous coronary intervention, ejection fraction greater than or equal to 40%, and Killip class I-II. Patients were randomized into two groups: conventional therapy (n=55) and additional spironolactone of 25 mg/day with standard conventional therapy (n=55). Echocardiography was performed in the first 48-72 h of AMI and during 6 months of follow-up. Left atrial volume index and emptying fraction were obtained. The peak regional atrial contraction velocity, the time between the onset of p-wave on the monitor ECG and the onset, peak, and the end (TE) of the atrial contraction wave on the tissue Doppler technique curve were measured.The left atrial volume index and left atrium (LA) dimensions did not significantly change in either group. In the spironolactone group, left atrial emptying fraction increased compared with both baseline value (from 53.0 ± 0.16 to 57.0 ± 0.13 P=0.011) and conventional therapy group (from 50.0 ± 0.17 to 47.0 ± 0.16, P=0.013). The atrial contraction velocity did not change but the LA-TE, interatrial septum-TE, and right atrium-TE were prolonged in the conventional therapy group.Additional spironolactone therapy provided a little benefit on LA remodeling and atrial electromechanic properties in patients with AMI and preserved LV functions.

Cardiotoxicity that results from lithium overdose is uncommon and electrocardiographic (ECG) changes are rarely reported. However, some authors have specifically reported the occurrence of ischemic ECG changes due to a lithium overdose. This article describes a case that is demonstrating ECG changes that mimic inferior myocardial infarction during the course of chronic lithium treatment and showing QTc prolongation in this patient. The patients’ ECG changes were partially recovered after hemodialysis. Ann Noninvasive Electrocardiol 2010;15(3):289–292

Angiographic detection of critical stenosis of left main coronary artery (LMCA) dramatically alters the patient's treatment approach. Therefore it should be examined further. This image of the LMCA may be due to sharp angulation, catheter-induced spasm or the relative stenosis due to ectatic LMCA. Operators can be avoided unnecessary revascularization procedures with further investigation. We report the image of angiographically severe stenosis of the LMCA due to a sharp angulation.

Associations between metabolic syndrome (MS) and major depressive disorder (MDD) are well documented although the underlying biological mechanisms for this relationship are less studied. Paraoxonase (PON1) is a high-density lipoprotein (HDL)-associated enzyme, with demonstrated evidence of strong antioxidant activity. Oxidative stress has been implicated in the pathophysiology of MS and MDD. PON1 activity has been studied to some extent in patients with MS and less in MDD. The aim of this study was to compare serum PON1 activity in patients with MS and MDD, MS without MDD, and normal control groups in the context of the biological mechanism of the association between MS and MDD. In this case-control study, 67 patients with MS and 25 healthy controls from the hospital–university staff were recruited. All patients and healthy controls were assessed by a semi-structured psychiatric interview. Patients with MDD were diagnosed according to the DSM-IV criteria for MDD. Serum PON1 activity was determined with a spectrophotometric method, and the activity was compared between patients with MS and MDD, with MS but without MDD, and control groups. Serum PON1 activity levels were lower in patients with MS and MDD group compared to those in the patients with MS and without MDD group and control group (69.5 ± 24.2, 84.3 ± 34.6, and 97.1 ± 40.8 U/ml, p = 0.03, respectively). Post hoc analysis showed that PON1 activity was statically significantly lower in the MS with MDD group than in the control group (p = 0.02). Impaired PON1 activity, in the context of enhanced oxidative stress, could be one of the possible underlying biological mechanisms of the MS–MDD association.

Objective: Heart rate recovery (HHR) after exercise is a function of vagal reactivation. This study aimed to evaluate HHR index in patients with erectile dysfunction. Methods: Men over the age of 18 years who were diagnosed with erectile dysfunction were included in the study. Ninety patients with erectile dysfunction (mean age=56.1±8.3 years) and 50 healthy subjects as controls (mean age=53.1±10.4 years) were compared. The erectile status of patients was evaluated using the sexual health inventory for men questionnaire. Basal electrocardiography, echocardiography, and treadmill exercise testing were performed in all patients and controls. The HHR index was defined as the reduction in heart rate from the rate at peak exercise to the rate at the first minute (HRR1), second minute (HRR2), third minute (HRR3), and fifth minute (HRR5) after terminating exercise stress testing. An independent sample t-test, Pearson correlation coefficient test, linear multivariate regression analysis, and receiver operating characteristic curve analysis were used for statistical assessment. Results: All HHR indices were found to be significantly decreased in patients with erectile dysfunction (p

[1] Petta S, Argano C, Colomba D, Camma C, Marco VD, Cabibi D, et al. Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease: association with the severity of liver disease. J Hepatol 2015;62: 928–933. [2] Chiang JK, Koo M, Kuo TB, Fu CH. Association between cardiovascular autonomic functions and time to death in patients with terminal hepatocellular carcinoma. J Pain Symptom Manage 2010;39:673–679. [3] Liu YC, Hung CS, Wu YW, Lee YC, Lin YH, Lin C, et al. Influence of non-alcoholic fatty liver disease on autonomic changes evaluated by the time domain, frequency domain, and symbolic dynamics of heart rate variability. PLoS One 2013;8:e61803. [4] Zhou Q, Zhang L, Wang K, Xu X, Ji M, Zhang F, et al. Effect of interconnection between cervical vagus trunk, epicardial fat pad on sinus node function, and atrial fibrillation. Pacing Clin Electrophysiol 2014;37:356–363. [5] Carnevali L, Graiani G, Rossi S, Al Banchaabouchi M, Macchi E, Quaini F, et al. Signs of cardiac autonomic imbalance and proarrhythmic remodeling in FTO deficient mice. PLoS One 2014;9:e95499. http://dx.doi.org/10.1371/ journal.pone.0095499. [6] Balcioglu AS, Cicek D, Akinci S, Eldem HO, Bal UA, Okyay K, et al. Arrhythmogenic evidence for epicardial adipose tissue: heart rate variability and turbulence are influenced by epicardial fat thickness. Pacing Clin Electrophysiol 2015;38:99–106.

This paper reports a very rare and an original case of a severe coarctation of aorta (CoA) that incidentally diagnosed at breastfeeding young women who presented with acute coronary syndrome. CoA is a complex congenital malformation and accounts for 5-10 % of all congenital heart disease. It is usually diagnosed in childhood with significant symptoms but many asymptomatic patients remain undiagnosed until adulthood. Also CoA is one of the reasons of secondary hypertension and premature coronary artery disease., Bu yazıda oldukça nadir rastlanan ve orjinal bir vaka olan akut koroner senrom ile başvuran genç kadında rastlantısal olarak tanı konan ciddi aort koarktasyonu sunulmuştur. Aort koarktasyonu kompleks bir doğumsal anomalidir ve tüm doğumsal kalp hastalıklarının %5-10'nu oluşturmaktadır. Sıklıkla çocukluk çağında ciddi belirtiler nedeniyle tanı konur ancak belirti vermeyen hastalar yetişkin çağa kadar tanı alamayabilirler. Ayrıca aort koaktasyonu sekonder hipertansiyon ve erken koroner arter hastalığı nedenlerinden biridir

Previous studies have clearly shown that epicardial adipose tissue (EAT) mass is associated with increased incidence of coronary artery disease. In the present study, the relationship between the EAT volume measured by cardiac multislice computerized tomography (MSCT) and cardiovascular risk was investigated in patients with type 2 diabetes mellitus. Ninety type 2 diabetic patients and 62 healthy controls were included in the study. We examined metabolic and anthropometric parameters including body mass index (BMI), fasting glucose and serum lipids and EAT volume of patients in comparison to those of control subjects. EAT volume was higher in Type 2 diabetic patients compared to control group (172.75 ± 64.85 cm3 and 68.94 ± 37.74 cm3, respectively) (p

ObjectiveTo evaluate thoracic periaortic adipose tissue (TAT) volume in patients with subclinical hypothyroidism (SH) in comparison with controls and in relation to cardiovascular risk factors.MethodsThe study population consisted of 28 newly diagnosed SH patients (mean (s.d.) age: 37.3 (±11.4) years, 85.7% were females) and 37 healthy volunteers (mean (s.d.) age: 35.3 (±10.7) years, 81.5% were females). Comparisons between patient and control groups used demographic characteristics, anthropometrics, and laboratory findings. All participants underwent thoracic radiographic assessment in the supine position, using an eight-slice multidetector computed tomography scanner and TAT volume was measured.ResultsThe TAT volume was determined to be 27.2 (±12.7) cm3in the SH group and 16.3 (±8.1) cm3in the control group, and the difference was statistically significant (PPr=0.572;PP=0.383) or concomitant smoking status (P=0.426).ConclusionsOur findings indicate that SH patients have significantly higher TAT values than controls and that increased TAT levels correlate with increased TSH levels.

Negative pressure pulmonary edema (NPPE) is defined as fluid transudation into the pulmonary interstitium which occurs as a result of elevated negative intrathoracic pressure caused by the upper respiratory tract obstruction and strong inspiratory effort. NPPE is usually seen during emergence from general anesthesia in the early post-operative period especially after upper respiratory tract surgery. We present a case of a 37-year-old male patient who underwent septoplasty operation and developed NPPE which could not diagnosed and progressed to acute subendocardial myocardial infarction.

Extraintestinal manifestations are well described in inflammatory bowel disease. A 63 year-old male was admitted to our clinic with the complaint of dyspnea and dry cough. Echocardiography revealed minimal pericardial effusion. He was prescribed ibuprofen 600 mg twice on a daily basis. Four days later, he was admitted to the hospital due to palpitations, chest pain and increased dyspnea. From the medical history results, it was clear that the patient had ulcerative colitis and did not have medical treatment for the last sixth months. He was treated with oral prednisolone and mesalamine. Within six days, his bowel symptoms as well as his cardiac symptoms improved for the better, and the patient was discharged in good condition on day six after his admission to hospital. Pericardial effusion was completely resolved. Ulcerative colitis, which may not be detected as an underlying cause, should be considered in pericardial effusion cases as differential diagnosis. Key words: Pericardial Effusion; Ulcerative Colitis; Corticosteroid Theraphy., İnflamatuar barsak hastalıklarında barsak dışı belirtiler iyi tanımlanmasına rağmen kardiyak tutulum nadiren bildirilmiştir. 63 yaşında erkek hasta nefes darlığı ve kuru öksürük şikayeti ile kardiyoloji polikliniğine başvurdu. Ekokardiyografide minimal perikardiyal effüzyon vardı. Günde iki kez 600 mg İbuprofen reçete edildi. Hasta çarpıntı, göğüs ağrısı ve nefes darlığında artma olması üzerine dört gün sonra hastaneye başvurdu. Kardiyoloji servisine yatırıldı. Tıbbi hikayesinde ülseratif kolit tanısı olduğu ve altı aydır tedavi almadığı belirlendi. Tekrar yapılan ekokardiyografide effüzyonun arttığı ve sağ atriyuma bası olduğu tespit edildi. Oral prednizolon ve mesalamin ile tedavi edildi. Altı gün içinde göğüs belirtilerine ilaveten barsak belirtileri düzeldi ve hastaneye başvurduktan altı gün sonra iyi durumda taburcu edildi. Bu sürede perikardiyal effüzyon tamamen gerilemişti. Nedeni tespit edilemeyen perikardiyal effüzyon vakalarında ayırıcı tanıda ülseratif kolit mutlaka düşünülmelidir. Anahtar kelimeler: Perikardiyal Effüzyon; Ülseratif Kolit; Kortikosteroid Tedavisi.

These original images were encountered during interventional procedures. Awareness about the abnormalities that they depict is important to identify them. We present an original image of the coronary sinus lead. The lead was placed in the posterolateral branch of the coronary sinus during cardiac resynchronization therapy combined with implantation of an implantable cardioverter-defibrillator. We observed that the lead achieved a heart shape in the left anterior oblique position (Fig. 1). We would like to dedicate this image to all physicians who are devoted to their work. Fig. 1 The fluoroscopic image showing the heart-shaped coronary sinus lead in the left anterior oblique position.

Background We investigated the relationship between peripheral neuropathy and parameters of arterial stiffness and carotid intima media thickness (CIMT) in patients with type 2 diabetes mellitus (T2DM). Material/Methods The study included 161 patients (80 females and 81 males), 69 of whom had peripheral neuropathy. All patients underwent 24-h blood pressure monitoring, and arterial stiffness parameters were measured. The CIMT was measured using B-mode ultrasonography and patients also underwent transthoracic echocardiographic examination. Results Patients with peripheral neuropathy, compared with those without it, were older (54.68±8.35 years vs. 51.04±7.89 years; p=0.005) and had T2DM for longer periods (60 vs. 36 months; p=0.004). Glycated hemoglobin (HbA1c) values (8.55±1.85 mg/dL vs. 7.30±1.51 mg/dL; p

We investigated the relationship between epicardial fat volume (EFV) measured by multislice computed tomography (MDCT) and long-term major adverse cardiac events (MACEs). Consecutive patients (n = 564) were enrolled in this retrospective study. Patients were divided into tertiles according to EFV. Patients were followed up for an average of 18 months. Patients in each tertile were similar in terms of gender and risk factors. Patients with greater EFV in the third group were more likely to be overweight ( P = .001) and older ( P = .001). High-density lipoprotein cholesterol levels were relatively lower in the third tertile (45 ± 9, 45 ± 11, and 43 ± 9 mg/dL, respectively; P = .018). The third group had a significantly higher rate of myocardial infarction (0.6%, 1.1%, and 3.7%, respectively; P = .043). The incidence of MACEs during the follow-up period was highest in the third group 15.9% (4.1%, 7.7%, and 15.9%, respectively; P = .001). Epicardial fat volume measured by MDCT was associated with increased long-term cardiovascular risk.

Endothelial dysfunction plays a major role in erectile dysfunction (ED). Uric acid (UA) is a marker of endothelial dysfunction. We hypothesized that increased UA levels may be associated with ED and aimed to investigate whether there is a relationship between, UA and ED in hypertensive patients.A total of 200 hypertensive patients who have a normal treadmill exercise test were divided into two groups based on the Sexual Health Inventory for Men (SHIM) test (21 defined as ED n = 110, and ≥ 21 defined as normal erectile function n = 90). The differences between the ED and normal erectile function groups were compared and determinants of ED were analyzed.The prevalence of ED was found to be 55.0%. Office blood pressure level was comparable between groups. UA levels were significantly increased in the ED group (6.20 ± 1.56 vs 5.44 ± 1.32, p = 0.01). In a regression model, age [odds ratio (95% confidence interval): 1.08 (1.04-1.14), p = 0.001], smoking [odds ratio: 2.33 (1.04-5.20), p = 0.04] and UA [odds ratio: 1.76 (1.28-2.41), p = 0.04] were independent determinants of ED. An UA level of5.2 mg/dl had 76.2% sensitivity, 43.7% specificity, 62.9% positive and 59.4% negative predictive value for determining ED.UA is an independent determinant of ED irrespective of blood pressure control and questioning erectile function for hypertensive patients with increased UA levels may be recommended.

With constantly evolving technology and an ever-increasing number of patients with pacemakers, clinicians will encounter various pacemaker malfunctions in their practice. While some of these issues can be solved even by using only the pacemaker׳s mode settings, others require re-intervention; neglecting a pacemaker׳s malfunction without full investigation threatens the patient׳s life. In this report, we describe a patient with a dual-chamber pacemaker with neglected or unresolved dyssynchronization that occurred 2 years after implantation.

Murat, Bektas/0000-0002-6564-7185; Yuksel, Murat/0000-0003-2636-5211 WOS: 000377435200008 PubMed: 25589093 Infection is one of the most devastating outcomes of cardiovascular implantable electronic device (CIED) implantation and is related to significant morbidity and mortality. In our country, there is no evaluation about CIED infection. Therefore, our aim was to investigate clinical characteristics and outcome of patients who had infection related to CIED implantation or replacement. The study included 144 consecutive patients with CIED infection treated at 11 major hospitals in Turkey from 2005 to 2014 retrospectively. We analyzed the medical files of all patients hospitalized with the diagnosis of CIED infection. Inclusion criteria were definite infection related to CIED implantation, replacement, or revision. Generator pocket infection, with or without bacteremia, was the most common clinical presentation, followed by CIED-related endocarditis. Coagulase-negative staphylococci and Staphylococcus aureus were the leading causative agents of CIED infection. Multivariate analysis showed that infective endocarditis and ejection fraction were the strongest predictors of in-hospital mortality.

Reoperative coronary artery bypass grafting (redo CABG)operation is associated with a high rate of mortality up to11.4%. It has been estimated that 10-20% of patients withhistory of coronary artery bypass grafting (CABG) operationneed redo CABG operation within 10 years. Due tohigh operation risk percutaneous coronary interventionshave emerged as the preferred treatment for the patientswith a history of CABG operation and presenting withacute coronary syndrome. Here, we reported percutaneouscoronary intervention in a patient needed redo CABGoperation. J Clin Exp Invest 2013; 4 (3): 380-382Key words: Acute coronary syndrome, redo CABG operation,percutaneous coronary intervention.