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Natriuretic peptides are widely used in all types of heart failure. Previously, we defined heart failure with non-reduced ejection fraction as patients with heart failure symptoms and/or signs and who have left ventricular ejection fraction > 40%.1 For the diagnosis of heart failure with preserved ejection fraction, the presence of raised natriuretic peptides is one of the major components of the diagnosis, and raised natriuretic peptides make the diagnosis more likely in patients with heart failure with mildly reduced ejection fraction.2 The majority of the existing studies have described the utility of natriuretic peptides in patients with heart failure with reduced ejection fraction, but there is not enough data on natriuretic peptides in heart failure patients with heart failure with non-reduced ejection fraction. Despite the insufficient information regarding the usage of natriuretic peptides in heart failure with non-reduced ejection fraction, it is obvious that there is an unmet need to guide how to use natriuretic peptides in these patients. The main goal of this article is to discuss the role of natriuretic peptides in diagnosis, prognosis, and guidance of heart failure treatment in patients with heart failure with non-reduced ejection fraction. The present review discusses the role of natriuretic peptides in heart failure with non-reduced ejection fraction focusing on: the characteristics of natriuretic peptides, primary prevention of heart failure, diagnosis of heart failure with non-reduced ejection fraction in different patient characteristics and co-morbidities, prognosis of heart failure, monitoring of heart failure treatment and, how to use in worsening heart failure. [ABSTRACT FROM AUTHOR]

The article focuses on hypertension is one of the major cardiovascular risk factors, closely related to the major cardiovascular, neurological, and renal adverse events. Topics include the resistant hypertension (RHT) has characterized by uncontrolled blood pressure (BP) despite intensive treatment, the higher risk has not limited only to cardiovascular events, and the documented that effective control of high BP in patients with RHT provides a significant decrease.

In endocrine diseases, hormonal changes, electrolyte abnormalities, and the deterioration of heart structure can lead to various arrhythmias. In diabetic patients, hypoglycemia, hyperglycemia, and hypokalemia can trigger arrhythmias, and diabetic cardiomyopathy can also cause electrical and structural remodeling to form substrates for arrhythmias. The risk of atrial fibrillation (AF) increases in hyperthyroidism; however, the prevalence of ventricular arrhythmias in hypothyroidism is higher. Besides AF and ventricular tachycardias, bradycardias and atrioventricular blocks can also be seen in pheochromocytoma due to the desensitization of adrenergic cardiovascular receptors. The correction of metabolic and electrolyte disturbances in patients with adrenal cortex disease should be the main approach in the prevention and treatment of arrhythmias. Early initiation of treatment in patients with acromegaly seems to decrease the development of cardiac remodeling and ventricular arrhythmia. Early and late after depolarizations due to hypercalcemia in hyperparathyroidism can lead to life-threatening ventricular arrhythmias. This elegant position paper provides important recommendations regarding prevention and treatment of arrhythmias for specific endocrine disorders. [ABSTRACT FROM AUTHOR]

In endocrine diseases, hormonal changes, electrolyte abnormalities, and the deterioration of heart structure can lead to various arrhythmias. In diabetic patients, hypoglycemia, hyperglycemia, and hypokalemia can trigger arrhythmias, and diabetic cardiomyopathy can also cause electrical and structural remodeling to form substrates for arrhythmias. The risk of atrial fibrillation (AF) increases in hyperthyroidism; however, the prevalence of ventricular arrhythmias in hypothyroidism is higher. Besides AF and ventricular tachycardias, bradycardias and atrioventricular blocks can also be seen in pheochromocytoma due to the desensitization of adrenergic cardiovascular receptors. The correction of metabolic and electrolyte disturbances in patients with adrenal cortex disease should be the main approach in the prevention and treatment of arrhythmias. Early initiation of treatment in patients with acromegaly seems to decrease the development of cardiac remodeling and ventricular arrhythmia. Early and late after depolarizations due to hypercalcemia in hyperparathyroidism can lead to life-threatening ventricular arrhythmias. This elegant position paper provides important recommendations regarding prevention and treatment of arrhythmias for specific endocrine disorders. [ABSTRACT FROM AUTHOR]

The article focuses on a position paper and narrative review from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists (TURCOSACT) regarding obstructive sleep apnea and its relationship with cardiovascular disease. It also addresses urinary angiotensinogen as a potential marker for prognosis in heart failure, a composite risk stratification index for acute pulmonary embolism, and other case reports and letters.

The article discusses the management of arrhythmia-induced cardiomyopathy (AIC), a form of cardiomyopathy characterized by left ventricular (LV) systolic dysfunction. Topics discussed include the association between AIC and heart failure (HF), the causes, clinical features and diagnosis of AIC, and the management of AIC in children and adults with congenital heart disease.

The article presents the discussion on evaluating the safety and effectiveness of using dTRA (distal transradial access). Topics include comparing the efficacy and safety of Catheter ablation (CA) combined with left atrial appendage closure (LAAC) and CA; and evaluating the relationship between LEAD anatomic and clinical features and various sitting patterns.

The article discusses the research study conducted that examines the causes of Arrhythmias accompanied with acute coronary syndromes (ACSs) and how to manage and treat challenging cases of arrhythmias in patients. Topics discussed include how to determine patients at risk for arrhythmias, direct current cardioversion (DCC) and catheter ablation, and atrial fibrillation.

Obstructive sleep apnea is common in adults with cardiovascular disease. Accumulating evidence suggests an association between obstructive sleep apnea and cardiovascular disease independent of the traditionally recognized cardiovascular disease risk factors. Observational studies indicate that obstructive sleep apnea is a risk factor for development of cardiovascular disease and that alleviation of obstructive events with positive airway pressure may improve cardiovascular disease outcomes. However, recent randomized controlled trials have not supported the beneficial effect of positive airway pressure in cardiac populations with concomitant obstructive sleep apnea. Some evidence suggests that the relationship between obstructive sleep apnea and traditionally recognized cardiovascular disease risk factors is bidirectional, suggesting that patients with cardiovascular disease may also develop obstructive sleep apnea and that efficient treatment of cardiovascular disease may improve obstructive sleep apnea. Recent data also indicate that the apnea-hypopnea index, which is commonly used as a diagnostic measure of obstructive sleep apnea severity, has limited value as a prognostic measure for cardiovascular disease outcomes. Novel markers of obstructive sleep apnea-associated hypoxic burden and cardiac autonomic response seem to be strong predictors of adverse cardiovascular disease outcomes and response to treatment of obstructive sleep apnea. This narrative review and position paper from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to update the current evidence about the relationship between obstructive sleep apnea and cardiovascular disease and, consequently, raise awareness for health professionals who deal with cardiovascular and respiratory diseases to improve the ability to direct resources at patients most likely to benefit from treatment of obstructive sleep apnea and optimize treatment of the coexisting cardiovascular diseases. Moreover, the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to contribute to strengthening the efforts of the International Collaboration of Sleep Apnea Cardiovascular Trialists in this context. [ABSTRACT FROM AUTHOR]

Stereotactic ablative body radiotherapy (SABR) allows the administration of ablative doses of radiation in a focused form with a low probability of side effects and is widely used for cancer treatment. However, in the recent years its usefulness in benign cardiac pathology is being studied. In this study, we aimed to guide the cardiologist in SABR and its applications in treatment of refractory ventricular tachycardia. In this review, we analyzed published literature on PubMed and MEDLINE with papers published in the past 5 years. We included papers in the English language with information about indications, radiotherapy plan, doses and fractionations, and outcomes. All citations were evaluated for relevant content and validation. [ABSTRACT FROM AUTHOR]

Up to 20% of patients with chronic kidney disease have atrial fibrillation, and 40%-50% of atrial fibrillation patients suffer from chronic kidney disease. The 2 diseases share several risk factors and frequently coincide with each other. Both entities are associated with a prothrombotic state, which contributes to increased thromboembolic risk. Atrial fibrillation patients with chronic kidney disease have elevated risk of stroke, major bleeding, and mortality. Clinical risk scores, including CHA2DS2-VASc score, HAS-BLED score, or ORBIT score have a limited value in adverse clinical outcome risk stratification in patients with severe chronic kidney disease. However, the inclusion of renal function in the R(2)-CHA2DS2-VASc score does not improve significantly thromboembolic risk prediction in atrial fibrillation. There is growing evidence suggesting that biomarkers, including N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin, cystatin C, or growth differentiation factor-15, might be helpful in the assessment of thromboembolic, bleeding, and/or mortality risk in atrial fibrillation patients with chronic kidney disease. The first-choice anticoagulant therapy is based on direct oral anticoagulants in this subgroup. The highest risk of adverse events is observed in end-stage renal disease, and in Europe, in contrast to the USA, solely warfarin is recommended in such atrial fibrillation patients. Treatment of atrial fibrillation patients with chronic kidney disease should be closely monitored with the selection of right anticoagulant agents at the appropriate dose. The current review paper summarizes available evidence and the challenges of the management of atrial fibrillation patients with chronic kidney disease with practical implications. [ABSTRACT FROM AUTHOR]

The article focuses on a document on management of arrhythmias in patients with acute coronary syndromes (ACS), by the author, published in several journals such as 'Eurointervention" during European Society of Cardiology (ESC) Congress in Barcelona, Spain. Topics discussed include invasive approaches for treatment of arrhythmia, ways to identify ACS patients at risk of arrhythmia, and recommendations for management of ventricular arrhythmias and acute care.

An introduction to the periodical is presented which discusses several articles within the issue on topics which include evaluation processes for the assessment of the article, social policy related to the research papers published in the journal, and techno-medicine.

Mitral paravalvular leaks (PVLs) commonly occur in patients with prosthetic valves. Paravalvular defects may be clinically inconsequential and may aggravate hemolysis or cause heart failure through regurgitation. Accordingly, patients may eventually require intervention such as redo surgery or a transcatheter closure of the defects. The introduction of purpose-specific closure devices and new steerable catheters has opened a new frontier for the transcatheter PVL closure. This mode of treatment is an initial therapy in most centers with experienced structural heart team. However, head-to-head data comparing two treatment modalities (surgery and transcatheter closure) are limited, and the world-wide experience is based on nonrandomized studies. Multimodality imaging, including three-dimensional transesophageal echocardiography, facilitates the delineation of mitral PVLs and provides essential data that aids the communication between the members of the structural heart team. In the near future, the success of interventional therapies will most probably increase in patients with mitral PVLs with the introduction of hybrid imaging modalities (echocardiography, cardiac computed tomography, and fluoroscopy). In conclusion, this paper summarizes the etiopathogenesis, clinical characteristics, diagnosis, and treatment of mitral PVLs. [ABSTRACT FROM AUTHOR]

Objective: To identify "genuine" publications from Turkey's institutions since 1992 that have cumulatively contributed the most to global cardiovascular medicine. Methods: Based on data from the Web of Science, 146 publications from Turkey were identified having received =50 citations as of late July, 2017. Papers with more than a minor share by international authors were excluded. Results: Hundred and ten primary authors generated 147 medical papers which received =50 (interquartile range, 54; 86) citations. These articles corresponded in quality to the top 12% global papers. Half of the articles were published from 2002 to late 2007, with a median exposure period of 12 years. Peak performance was reached in 2004-'07, with a mean of 15-20 papers annually, which then regressed to five papers in 2008-'13, representing an estimated 50% decline. Cardiology generated 105 articles (20 in collaboration with other branches), cardiovascular surgery generated 27 articles, and pediatric cardiology generated 5 articles. Publications arose from 26 medical faculties, Gülhane Military Academy, and 9 hospitals not which were not academically affiliated. The performance of many related Turkish institutions was disappointing. Conclusion: Turkey's contribution to cardiovascular medicine has further declined slightly in the current assessment, particularly since 2007. To prevent a further gap in Turkey's contribution to the field, an undelayed return is needed by building an environment that allows focusing on research with a potential to contribute to medicine. [ABSTRACT FROM AUTHOR]

Myocardial ischemia resulting from psychological stress [mental stress-induced myocardial ischemia (MSIMI)] refers to the condition wherein psychosocial and psychological stimulations cause myocardial ischemia in patients with coronary heart disease, which is different from druginduced myocardial ischemia. Therefore, this condition often escapes diagnosis, portends clinical risk, and affects the quality of life of MSIMI survivors. MSIMI is closely related to the poor prognosis of cardiovascular diseases, especially in young women, according to recent randomized, controlled trials (RCTs) on MSIMI. These RCTs involved different sample sizes, interventional measures, and detection techniques. Moreover, differences exist regarding the prevalence rate, distribution characteristics, possible pathogenesis, and clinical significance. Nevertheless, currently, the diagnostic criteria, pathogenesis, and treatment of MSIMI are still in the clinical exploration stage. Hence, considering recent RCTs, this paper summarizes the research status of MSIMI from the aspects of pathogenesis, diagnosis, and treatment strategies to provide a theoretical basis for the follow-up diagnostic methods and treatment guidelines for MSIMI. [ABSTRACT FROM AUTHOR]

The co-existence of atrial fibrillation (AF) and acute heart failure (AHF) is frequently reported and can exacerbate either or both of them. Their combination leads to increased morbidity and mortality. Although there has been a lack of studies on the prevalence and significance, as well as the treatment, of AF in patients with AHF, a position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association has recently reviewed the latest evidence on AF in the setting of AHF. The purpose of this paper is to briefly overview the crucial aspects of this consensus document. [ABSTRACT FROM AUTHOR]

Supraventricular arrhythmias are frequent, and symptomatic patients often need medical therapy or catheter ablation. The recently published 2019 European Society of Cardiology (ESC) Guidelines for the management of patients with supraventricular tachycardia (SVT) give a comprehensive overview of current developments in the field and provides recommendations for the management of adults with SVT. In this paper, we briefly summarized major new recommendations and significant changes from the former ESC guideline published 16 years ago. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is an uncommon disorder that may be hereditable, idiopathic or associated with conditions like drug exposure, connective tissue disease, HIV infection or congenital heart disease. Familial disease are usually due to mutations in the bone morphogenic protein receptor type 2 (BMPR2), activin-like kinase-type 1 (ALK1) and endoglin (ENG). Functional and structural changes in the pulmonary vasculature lead to increased pulmonary vascular resistance. Vascular remodeling involves endothelial dysfunction, activation of fibroblasts and smooth muscle cells and recruitment of circulating progenitor cells. Vasoconstriction has also been shown to affect the remodeling process. Genetics, cellular and molecular basis of PAH are discussed in the paper. [ABSTRACT FROM AUTHOR]

Left ventricular functions are among the most important predictors of prognosis in cases with coronary artery disease. Cases with moderate or high degree of left ventricular function are at high risk of death and correct evaluation of myocardial viability is clinically important while they are under medical therapy. In a considerably high percent of these patients, significant improvements occur in left ventricular functions after successful revascularization. In both left ventricular function and viability assessment there are many invasive and non-invasive (echocardiography, nuclear imaging, computerized tomography, magnetic resonance imaging, etc.) diagnostic methods. Here in this paper we will discuss solely role of echocardiography in the assessment of viability in patients with left ventricular dysfunction. [ABSTRACT FROM AUTHOR]

Although various cardiac monitoring methods were developed to detect subclinical arrhythmias, guidelines do not address in detail the management of subclinical atrial fibrillation and tachyarrhythmias. The European Heart Rhythm Association recently published a consensus document that addresses the clinical importance, implications, and management of device-detected subclinical atrial tachyarrhythmias. This paper comprehensively reviews the diagnostic tools to detect subclinical atrial arrhythmias and discusses the pathophysiologic link between devicedetected subclinical atrial fibrillation and stroke. In this invited review, in the light of this paper and current scientific data, we aimed to summarize how to manage subclinical atrial arrhythmias. [ABSTRACT FROM AUTHOR]

The recently published consensus document by the European Heart Rhythm Association presents a patient-tailored pharmacological antiarrhythmic treatment approach targeting the arrhythmia mechanism. This document comprehensively reviews the indications, side effects, and contraindications of antiarrhythmic drugs. In this paper, we reviewed novel treatment concepts offered by the consensus document. [ABSTRACT FROM AUTHOR]

Anemia associated with heart failure is a frequent condition, which may lead to heart function deterioration by the activation of neuro-hormonal mechanisms. Therefore, a vicious circle is present in the relationship of heart failure and anemia. The consequence is reflected upon the patients' survival, quality of life, and hospital readmissions. Anemia and iron deficiency should be correctly diagnosed and treated in patients with heart failure. The etiology is multifactorial but certainly not fully understood. There is data suggesting that the following factors can cause anemia alone or in combination: iron deficiency, inflammation, erythropoietin levels, prescribed medication, hemodilution, and medullar dysfunction. There is data suggesting the association among iron deficiency, inflammation, erythropoietin levels, prescribed medication, hemodilution, and medullar dysfunction. The main pathophysiologic mechanisms, with the strongest evidence-based medicine data, are iron deficiency and inflammation. In clinical practice, the etiology of anemia needs thorough evaluation for determining the best possible therapeutic course. In this context, we must correctly treat the patients' diseases; according with the current guidelines we have now only one intravenous iron drug. This paper is focused on data about anemia in heart failure, from prevalence to optimal treatment, controversies, and challenges. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Perturbative decline in cardiovascular publications in recent years in Turkey" by Altan Onat in a 2013 issue, along with reply of the author.

This Almanac highlights recent papers on congenital heart disease in the major cardiac journals. Over 100 articles are cited. Subheadings are used to group relevant papers and allow readers to focus on their areas of interest, but are not meant to be comprehensive for all aspects of congenital cardiac disease. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) includes a range of disorders characterized by excess accumulation of triglycerides within the liver. While simple steatosis may be clinically stable, non-alcoholic steatohepatitis (NASH) can be progressive. Inflammation is believed to be the driving force behind NASH and the progression to fibrosis and subsequent cirrhosis. NAFLD is globally considered a significant health concern not only because of its incidence but also because of its economic impact. The fact that NAFLD is associated with cardiovascular disease is widely recognized, as well as the fact that NAFLD patient mortality rises when such an association is present. In particular, NAFLD is associated with coronary and carotid atherosclerosis, endothelial dysfunction and arterial rigidity, ventricles function, valves morphology, congestive heart failure, and arrhythmias (especially atrial fibrillation). Additionally, the hypercoagulability status in NAFLD patient may be suggested by the presence of inflammatory and coagulation markers. In order to differentiate between milder forms and the more severe ones that necessitate aggressive therapy, individualized risk scores may be used. This narrative review will analyze and interpret the papers published in PubMed in the last 16 years, in an attempt to expand our understanding of the NASH as a possible cardiovascular risk factor. [ABSTRACT FROM AUTHOR]

Objective: Heart rate recovery (HRR) is a recognised marker used in clinical practice for assessing the risk of sudden cardiac death. Physical exercise leads to an improvement in HRR and has a proven beneficial effect on erection quality (EQ) related to the activity of the autonomic nervous system in men with ischaemic heart disease (IHD). This paper evaluates the relationship between HRR and EQ in patients with IHD and erectile dysfunction (ED) who underwent cardiac rehabilitation. Methods: The main analysis was based on the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman correlation coefficient, Pearson's chi-square test, chi-square test, with the Yates correction and (if possible) parametric tests were used. This prospective, non-randomised intervention study included 124 men with IHD and ED [International Index of Erectile Function (IIEF-5) scores of ≤21]. Of these, 89 patients underwent a 6-month cardiac rehabilitation phase III programme, whereas 35 did not. The results of the participants' total IIEF-5 scores and their HRR, demographic and clinical data were analysed. Results: The results of the 89 rehabilitated patients (mean age: 60.44±9.29 years) and 35 controls (mean age: 61.43±8.81 years) were analysed. In the rehabilitated patients, the mean baseline IIEF-5 score was 13.15±5.76 (95% CI: 11.93-14.36) and HRR was 16.49±7.68/min (95% CI: 14.88- 18.11). After cardiac rehabilitation, the parameters of ED and HRR improved significantly and were significantly higher than those of the controls; the mean IIEF-5 score of the rehabilitated group increased to 15.36±6.51 (95% CI: 13.99-16.73), while HRR increased to 21.40±7.25/min (95% CI: 19.88-22.93). A significant correlation was found between ΔHRR and ΔEQ (r=0.409791) as a result of the 6-month cardiac training programme Conclusion: Cardiac rehabilitation assessed by HRR has a sizable effect on autonomic balance in patients with IHD and ED, which plays a significant role in the mechanism of erection improvement. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a progressive disorder associated with impaired quality of life, high morbidity, mortality and frequent hospitalization and affects millions of people from all around the world. Despite further improvements in HF therapy, mortality and morbidity remains to be very high. The life-long treatment, frequent hospitalization, and sophisticated and very expensive device therapies for HF also leads a substantial economic burden on the health care system. Therefore, implementation of evidence-based guideline-recommended therapy is very important to overcome its worse clinical outcomes. However, HF therapy is a long process that has many drawbacks and sometimes HF guidelines cannot answers to every question which rises in everyday clinical practice. In this paper, commonly encountered questions, overlooked points, controversial issues, management strategies in grey zone and problems arising during follow up of a HF patient in real life clinical practice have been addressed in the form of expert opinions based on the available data in the literature. [ABSTRACT FROM AUTHOR]

In this paper, we reviewed the atrial fibrillation screening strategies in a stepwise manner and discussed the uncertainties in the assessment of the need for anticoagulation in light of the recently published European Heart Rhythm Association consensus document. We reviewed not only the methods and tools but also the role of health care professionals and patient organizations in addition to cost-effectiveness issues. [ABSTRACT FROM AUTHOR]

The article reports that the possible pathophysiological mechanisms of fragmented QRS (f-QRS) in patients with novel coronavirus disease (COVID-19). We thank the authors for their interest and thoughtful comments on our study. We would like to answer some questions that the authors wonder about our paper. First, in our study, we did not have a hypothesis that f-QRS occurred due to SARS-CoV-2.

Abnormal prolongation and shortening of the electrocardiographic QT interval duration, which occur in the hereditary forms of long and short QT syndromes, are associated with an increased risk of ventricular arrhythmias and sudden cardiac death. Even within the normal range, these altered durations are associated with an increased mortality risk in the general population. While extreme prolongation or reduction of the QT interval predisposes patients to malignant ventricular arrhythmias and sudden cardiac death, the precise dose-response relationship between the QT interval and cardiovascular disease mortality is still unknown. This paper describes the need for more standardized methods for measuring and reporting the QT interval and the need for more precise assessments of the risk associated with QT interval variation. [ABSTRACT FROM AUTHOR]

Objective: Prosthetic vascular access is the other choice when the superficial venous system is inadequate to perform a simple radio-cephalic and brachio-cephalic fistula. Methods: This paper reports the outcomes of a prospective cohort study of 54 patients who underwent either saphenous vein (SVI Group, n=29) or PTFE graft (PTFE Group, n=25) interposition surgery for prosthetic hemodialysis access. All patients were evaluated via color Doppler ultrasonography during preoperative course and superficial venous systems of these patients were found inadequate to perform simple radial/ brachial artery-cephalic vein anastomosis. Follow-up was performed for every 6-months period. Kaplan-Meier analysis and Log Rank test was used for estimation and comparison of the patency. Results: In SVI group access failure was observed in 5 of 29 patients (17.2%). In PTFE group, access failure was observed in 13 of the 25 patients (52%). Primary patency rate was 93% in 12th month and 82% in 24th month in SVI group while it was 88% in 12th month and 56% in 24th month in PTFE group. According to the Kaplan-Meier method, mean time of primary patency was significantly higher in SVI group when compared to PTFE group (33.03±1.32 months vs. 28.16±1.91 months, Log Rank chi-square value: 7.01, df:1, p=0.008). Secondary patency rate was 96% in 12th month and 93% in 24th month for SVI group while 96% in 12th month and 84% in 24th month for PTFE group. According to the Kaplan-Meier method, mean time of secondary patency was significantly higher in SVI group when compared to PTFE group (34.27±0.95 months vs. 31.16±1.40 months, Log Rank chi-square value: 7.33, df:1, p=0.007). Conclusion: Autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due its higher primary and secondary patency, lower complication rate and cost when compared with PTFE grafts. (Anadolu Kardiyol Derg 2014; 14: 542-6) [ABSTRACT FROM AUTHOR]

The use of implantable devices in management of cardiac diseases is increasing as a result of improvements in technology of permanent pacemaker and implantable cardioverter defibrillators. Device related infections are also rising accordingly and have become an important clinical problem. Accurate diagnosis and optimal management of these infections is challenging, necessitating complete removal of the device and prolonged antibiotic therapy. In this regard, a multidisciplinary approach is required with the essential support of microbiology and imaging modalities. This paper highlights the current literature on the pathogenesis, risk factors, diagnosis and management of device related infections. [ABSTRACT FROM AUTHOR]

Extracorporeal life support (ECLS) is instituted for the management of life threatening pulmonary or cardiac failure (or both), when no other form of treatment has been or is likely to be successful. It has being used in developed countries for many years. ECLS has come into practice for a while in Turkey, in order to ECLS recommendations. However, most of them are postcardiotomy cases. However, this therapeutic option has more indications including its reason that brought it into practice. All equipment of the system has being changed with the developing technology. The aim of this paper is to point out this modality, to introduce equipment, and to give information about organization and management to bring this therapeutic option in Turkey in order. [ABSTRACT FROM AUTHOR]

Extracorporeal life support (ECLS) is instituted for the management of life threatening pulmonary or cardiac failure (or both), when no other form of treatment has been or is likely to be successful. It has being used in developed countries for many years. ECLS has come into practice for a while in Turkey, in order to ECLS recommendations. However, most of them are postcardiotomy cases. However, this therapeutic option has more indications including its reason that brought it into practice. All equipment of the system has being changed with the developing technology. The aim of this paper is to point out this modality, to introduce equipment, and to give information about organization and management to bring this therapeutic option in Turkey in order. [ABSTRACT FROM AUTHOR]

Objective: The mortality of right heart thrombi (RHT) associated with pulmonary embolism (PE) is increased about three to four times. The most devastating scenario is fragmentation of RHT and occurrence of recurrent PE. The reports regarding the management of RHT complicated with PE are very scarce in the current literature. Therefore, we report a single-center experience in this paper. Methods: From January 2006 to December 2011, data of all patients diagnosed with acute PE were analyzed retrospectively. Of the 312 acute PE cases confirmed with computed tomography, total 35 patients who were diagnosed with concomitant RHT (prevalence of 11%) by echocardiography were recruited. After excluding of six patients with metastatic malignancy a total 29 patients were accepted eligible for the analysis. In addition, catheter -induced thrombus (type B) were not included to the study. The difference between categorical variables was analyzed with Chi-square test and continuous variables were analyzed with Mann-Whitney U test. A p value of <0.05 was considered statistically significant. Results: Overall mortality was high (34%) in study population: among undergoing surgery-100%, therapy with thrombolytics -18%, and heparin -27%. Troponin levels were found significantly higher in died patients than that in survived patients (p=0.03). There was no significant difference regarding to clinical and echocardiographic characteristics of patients received heparin versus thrombolytic except for shock index (p=0.02). In addition, patients treated with heparin had increased duration of hospitalization compared to subjects treated with thrombolytic (median: 8 vs 3 days p<0.01). Conclusion: Despite of the low incidence of RHT, a mortal course is still an important problem during PE. The decision on treatment modality should be performed based on the hemodynamic parameters, laboratory findings, and bleeding risk of the patients. [ABSTRACT FROM AUTHOR]

With the recent technological developments, computed tomography is becoming more important in the diagnosis of cardiovascular diseases. However, potential complications of the radiation dose used during the test have led debates. In the current situation, the data about undesirable effects of radiation dose used in cardiac computed tomography is not clear. In this paper, we reviewed the data about computed tomography and the risk of radiation. In order to reduce the risk of radiation due to computed tomography, the test should be performed with proper indication and in suitable patients. Besides, recently developed radiation dose reduction technologies and patient specific protocols have significantly reduced the radiation exposure. The clinicians should be well informed about the radiation reduction techniques and aware of the technical capabilities in their hospital. [ABSTRACT FROM AUTHOR]

Objective: Cardiovascular diseases (CVD) are the largest cause of morbidity and mortality in Turkey and in the World. Heart of Balçova Project is a community- based health promotion project that aims to reduce CVD incidence and prevalence through risk factor modification in the individual and population level. This paper presents results of the baseline survey that aimed to define CVD risk factors and risk of developing coronary heart disease (CHD) in the Balçova population. Methods: The study population included 36,187 people over 30 years of age residing in Balçova in 2007. Individuals were interviewed at their homes. Anthropometrics and blood pressure were measured and in total 12914 fasting blood samples were collected for lipid and glucose analyses. CHD risk was estimated using Framingham risk equation. Student's t test, Chi-square for trend test and ANOVA were used to compare mean levels and percentages of risk factors between age groups and gender. Results: In total 5552 men and 10528 women participated in the study. Smoking prevalence was 38.6% in men and 26.8% in women. The prevalence of obesity was 29.4% among men and 44.2% among women and obesity prevalence increased until the age group 75 years old. While 14.6% of men and 12.6% of women had diabetes, 39.8% of men and 41.8% of women had hypertension. The prevalence of high total cholesterol was 56.0% in men and 50.6% in women. Men had a higher risk of developing CHD compared to women in the following 10 years (13.4% vs 2.5%). Conclusion: The prevalence of preventable risk factors for CHD is very high in Balçova population. Community-based interventions should be planned and implemented targeting both the high-risk individuals and whole population. [ABSTRACT FROM AUTHOR]

An interview with medical personnel Navin C. Nanda is presented. When asked about his life history he refers to his birthplace Kenya where his father worked as a physician. Nanda discusses his medical career development and informs that he completed his medical studies at Seth G.S Medical College of Bombay University. He comments on his first published medical research paper related to hyperglycemia after myocardial infarction and its relationship to diabetes mellitus.

Arterial blood pressure fluctuates with a pattern that follows a circadian rhythm, with a peak in the early morning hours and a trough during nighttime. Nocturnal dipping of arterial blood pressure is part of this normal circadian pattern, and its absence, which is called non-dipping is associated with more severe end-organ damage and increased risk of cardiovascular events, especially in hypertensive patients. Although pathologic mechanisms are still unclear, it has been suggested that non-dippers show impairment in the autonomic system functions that include abnormal parasympathetic and sympathetic activities. Several studies have examined the role of the autonomic nervous system in the non-dipping phenomenon. In this paper, we aimed to review the studies evaluating the relationship between circadian arterial blood pressure pattern and indices of cardiac autonomic functions. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is a clinical syndrome that is often diagnosed late and is associated with a progressive clinical deterioration and death. However, over the past ten years there has been a dramatic increase in the number of effective therapies. Identification of dysfunctional pathways in the pulmonary circulation provided novel therapeutic targets with the goal of reducing pulmonary vascular resistance and death from right ventricular failure. Treatment strategies are determined according to current guidelines. Pulmonary artery vasoreactivity, functional class and response to treatment are important concepts for initiation of medical therapy. With the availability of medications that target different pathologic processes, combination therapy has become a frequently used therapeutic option in PAH. In this paper, we aimed to review the therapeutic algorithms in pulmonary hypertension based on current guidelines. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is an uncommon disorder that may be hereditable, idiopathic or associated with conditions like drug exposure, connective tissue disease, HIV infection or congenital heart disease. Familial disease are usually due to mutations in the bone morphogenic protein receptor type 2 (BMPR2), activin-like kinase-type 1 (ALK1) and endoglin (ENG). Functional and structural changes in the pulmonary vasculature lead to increased pulmonary vascular resistance. Vascular remodeling involves endothelial dysfunction, activation of fibroblasts and smooth muscle cells and recruitment of circulating progenitor cells. Vasoconstriction has also been shown to affect the remodeling process. Genetics, cellular and molecular basis of PAH are discussed in the paper. [ABSTRACT FROM AUTHOR]

Health is considered as important due to its impacts on individuals' lives. Although individual health level is determined partly by the accessibility of the services and their quality, there are many other factors that may influence an individual's health condition, which are mainly social determinants. Since there are many factors that determine health conditions of the individuals, it would be wrong to hold someone totally responsible for her health condition on the basis of her life-style; such as prudency. Indeed, before deciding about whether the patient was prudent or not; first, we have to look at those determinants of health, and investigate whether there is an effective intervention to avoid those determinants. Furthermore, life-styles of the individuals, which are thought to be the personal choices, are just one of the relatively less effective factors that may influence a person's health and also the autonomy of those choices is controversial. In our paper, we will endeavor to develop an argument showing that since health is one of our primary goods that needs to be protected as one of our basic human rights, and since the health status of individuals are not determined only by their personal choices, we claim that it would be unfair to consider accessing healthcare as something removable or limitable based on conditions other than medical criteria. [ABSTRACT FROM AUTHOR]

Acute heart failure syndrome is a heterogeneous group, which requires distinct therapeutic approaches. Diuretics and/or vasodilators for patients with high blood pressure and inotropic agents for patients with low left ventricular ejection fraction and evidence of hypoperfusion are kept in the forefront. Early initiation of therapy along with accurate and early diagnosis in acute heart failure reduces mortality and morbidity significantly. Therefore, it is critically important to develop algorithms, which could easily be followed by all physicians. In this paper, in parallelism with heart failure guidelines and utilizing data of the clinical studies, performed by colleagues of our country in this area, therapeutic algorithms compatible with the conditions of our country are suggested for distinct clinical presentations of acute heart failure. [ABSTRACT FROM AUTHOR]

Left ventricular functions are among the most important predictors of prognosis in cases with coronary artery disease. Cases with moderate or high degree of left ventricular function are at high risk of death and correct evaluation of myocardial viability is clinically important while they are under medical therapy. In a considerably high percent of these patients, significant improvements occur in left ventricular functions after successful revascularization. In both left ventricular function and viability assessment there are many invasive and non-invasive (echocardiography, nuclear imaging, computerized tomography, magnetic resonance imaging, etc.) diagnostic methods. Here in this paper we will discuss solely role of echocardiography in the assessment of viability in patients with left ventricular dysfunction. [ABSTRACT FROM AUTHOR]

Major cardiovascular events cause about 80% of the total mortality in diabetic patients. It has been shown that diabetic patients have hyperactive platelets. It may be expected that aspirin, through its antiplatelet action, could change the risk for vascular events in people with diabetes. However, some data suggest that aspirin may be less effective than expected in preventing cardiovascular events in patients with diabetes. In this paper, we review the aspirin use in diabetics with respect to cardiovascular endpoints. [ABSTRACT FROM AUTHOR]

Major cardiovascular events cause about 80% of the total mortality in diabetic patients. It has been shown that diabetic patients have hyperactive platelets. It may be expected that aspirin, through its antiplatelet action, could change the risk for vascular events in people with diabetes. However, some data suggest that aspirin may be less effective than expected in preventing cardiovascular events in patients with diabetes. In this paper, we review the aspirin use in diabetics with respect to cardiovascular endpoints. [ABSTRACT FROM AUTHOR]

Electrocardiographically detected left ventricular hypertrophy (LVH) and echocardiographically detected left ventricular hypertrophy are independent predictors of cardiovascular risk, both are defined as cardiac target organ damage in hypertensive patients. However, in clinical practice the preference is given to echocardiography and the discrepant electrocardiographic (ECG) findings are underestimated or even neglected in clinical decision-making. The aim of this opinion paper was to present a view on the relation between the increased left ventricular mass and discrepant ECG findings in hypertensive patients. The concept of the "relative voltage deficit" in hypertension and in LVH assessment is presented. The current knowledge on the structural and electrical remodeling in LVH is discussed in the context of changes of active and passive electrical properties of myocardium, underlying the changes in QRS amplitude in LVH. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Body surface potential mapping (BSPM) is essentially recommended for detecting and evaluating abnormalities of cardiac electric field specific for various stages of ischemic state of myocardium caused by coronary artery disease (CAD). In this regard, a goal of the present paper was to summarize the BSPM results, which were gathered in our laboratory for several years from the patients with CAD. METHODS: In a group of 110 patients (mean age: 48.4+/-6.2 years) with angiographically documented critical single-vessel (SVD) coronary artery disease among them 52 patients with left anterior descending artery (LAD) involvement, 40 patients with right coronary artery (RCA) and 18 patients with left circumflex artery (Cx) lesions, without any specific ischemic changes on standard resting 12-lead electrocardiogram (ECG), isointegral and departure ST-T maps were recorded using Fukuda Denshi (Tokyo, Japan) 87-electrode system for BSPM. RESULTS: Significant decrease of the minimum values of ST-T maps was found only in patients with LAD involvement. Typical distribution of the negative potential was found on ST-T map for each of LAD, RCA and Cx stenosis. Overall sensitivity of abnormal distribution of ST-T maps was 55.5% for the SVD group. In 21/96 of the SVD patients in whom exercise test was performed, the result was negative. Generally, in 12 of these 21 patients, the abnormal ST-T maps were observed (57.1%). The RCA lesion group had abnormal ST-T maps in 75% of the patients with negative exercise test. The corresponding ratios were 71.4% for LAD, and only 16.7% for Cx patients. CONCLUSION: ST-T resting maps are of some value in diagnosing stable ischemic heart disease. [ABSTRACT FROM AUTHOR]