Search

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.

Objective: Ventricular arrhythmias following acute coronary syndrome (ACS) range from benign to life-threatening fatal arrhythmias. Tpeak-end (Tp-e) interval has been shown to be an important parameter in the assessment of repolarization dispersion. We aimed to evaluate the relationship between SYNTAX and Global Registry of Acute Coronary Events (GRACE) risk score calculated on admission and Tp-e interval and Tp-e/QTc ratio. Methods: A total of 421 patients were included in the study. The patients were divided into 2 groups as low SYNTAX score (=22) and moderate and high risk SYNTAX score (>22). According to the GRACE risk score, the patients were divided into 2 groups; high-risk patients =140 and <140 low-risk patients. Results: In the group with SYNTAX score >22, the Tp-e interval (p<0.001) and Tp-e/QTc ratio (p<0.001) was found to be significantly higher than in the group with a SYNTAX score =22. Tp-e interval (p<0.001) and Tp-e/QTc ratio (p=0.002) was higher in patients with GRACE risk score =140 compared with patients with a GRACE risk score <140. The correlation between Tp-e interval and Tp-e/QTc ratio and SYNTAX score (r=0.489; p<0.001) and GRACE risk score (r=0.274; p<0.001) were found to be significant. A significant and independent correlation was found between the SYNTAX score and Tp-e/QTc ratio (ß=0.385; p<0.001). Conclusion: Tp-e interval and Tp-e/QT ratio increased in patients with severe coronary artery disease assessed with SYNTAX score. Tp-e interval and Tp-e/QT ratio increased in patients with a high GRACE risk score. [ABSTRACT FROM AUTHOR]

Although late gadolinium enhancement on cardiac magnetic resonance imaging remains the reference standard for scar assessment, it does not provide quantitative information about the extent of pathophysiological changes within the scar tissue. T1 mapping and extracellular volume (ECV) mapping are steadily becoming diagnostic and prognostically useful tests for in vivo myocardial histology, influencing clinical decisionmaking. Quantitative native T1 maps (acquired without a contrast agent) represent the longitudinal relaxation time within the myocardium and changes with myocardial extracellular water (edema, focal, or diffuse fibrosis), fat, iron, and amyloid protein content. Post-contrast ECV maps estimate the size of the extracellular space and have sensitivity in the identification of interstitial disease. Both pre- and post-contrast T1 mapping are emerging as comprehensive tools for the assessment of numerous conditions including ischemic scarring that occurs post myocardial infarction (MI). This review outlines the current evidence and potential future role of T1 mapping in MI. We conclude by highlighting some of the remaining challenges such as quality control, standardization of image acquisition for clinical practice, and automated methods for quantifying infarct size, area at risk, and myocardial salvage post MI. [ABSTRACT FROM AUTHOR]

Objective: To determine the values of microvolt T-wave alternans (MTWA) in children and adolescents with Eisenmenger syndrome (ES) and controls. Methods: Thirteen were included in the study. After analyzing the 24-h ECG recordings, MTWA was considered using three leads (V5, V1, and aVF). Right heart catheterization and 6-minute walk test (6-MWD) were applied to the patients and pro-brain natriuretic peptide levels were assessed; echocardiographic parameters were obtained from both the groups and the results were compared. Results: The MTWA value in lead V5 was 81.08±10.73 µV in the patient group (63.50±18.78 µV in the control group), in lead V1 was 75.00±16.86 µV (73.94±16.77 µV in the control group), and in lead aVF was 73.77±17.81 µV (72.61±16.21 µV in the control group). Comparison of MTWA values between patients and controls revealed that only lead V5 values were statistically different in the ES group. The 6-MWD scores significantly correlated with lead V5. Right atrial volume and right ventricular fractional area change were significantly correlated with lead V1. The Tei index was significantly correlated with lead aVF. Conclusion: The MTWA lead V5 value was significantly higher in children with ES than in controls and was also correlated with decreased exercise tolerance. [ABSTRACT FROM AUTHOR]

Objective: Coronary slow flow phenomenon (CSFP) is characterized by the decreased rate of contrast progression in epicardial coronary arteries in the absence of significant coronary stenosis. Mounting evidence has showed a significant association between inflammation and CSFP severity. This study aimed to evaluate possible associations between interleukin-1 receptor antagonist (IL-1ra) gene variable number tandem repeat (VNTR), IL-1β -511 single nucleotide (SNP), and IL-1β+3954 SNP mutations with CSFP. Methods: Forty-eight patients with CSFP and 62 controls with angiographically normal coronary arteries were prospectively enrolled in the study. Genotypes were assessed using the polymerase chain reaction (PCR)-based restriction fragment length polymorphism (PCR-RFLP) technique. Results: Homozygote genotype for allele 2 of+3954 C>T 2/2 genotype was significantly more frequent in patients with CSFP than in the control group, whereas 1/2 genotype was more frequent in the control group (35.4% versus 14.5% for 2/2 genotype and 25% versus 35.5% for 1/2 genotype in CSFP and control groups, respectively, X²=6.6, p=0.04). The allelic frequency of allele 2 of this polymorphism was significantly higher in the CSFP group than in the control group (47.9% versus 28.6% in the control group, X²=5.6, p=0.02). However, there was no significant difference with regard to genotype or allelic frequencies of IL-1ra VNTR or IL-1β-511 SNP polymorphisms between patients with CSFP and controls. Conclusion: IL-1β+3954 SNP mutations are significantly more common in patients with CSFP. It may suggest that the tendency for inflammation may contribute to the presence of this phenomenon. [ABSTRACT FROM AUTHOR]

Objective: Psoriasis is a chronic inflammatory disorder, which affects around 1%-3% of the human population worldwide. Cardiovascular events are the leading cause of morbidity and mortality in patients with psoriasis. Some studies have reported that psoriasis is related to increased arrhythmias. The Tp-e interval and Tp-e/QT ratio have been accepted as new markers for the assessment of myocardial repolarization and ventricular arrhythmogenesis. The aim of this study was to assess ventricular repolarization in patients with psoriasis using Tp-e interval and Tp-e/QT ratio. Methods: The study population consisted of 74 patients with psoriasis and 74 healthy volunteers. The diagnosis of psoriasis was based on a clinical or histopathological examination of all patients. QT interval, corrected QT (QTc), QT dispersion (QTd), Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups. Results: According to the electrocardiographic parameters, QT and QTc intervals and QTd were significantly higher in patients with psoriasis than in control subjects (p<0.001; p<0.001; p=0.014; respectively). The Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were significantly higher in patients with psoriasis than in control subjects [93±13 milliseconds (ms) vs. 98±14 ms, p=0.040; 104±17 ms vs. 111±17 ms, p=0.008; 0.23±0.03 vs. 0.25±0.03, p<0.001; respectively]. Additionally, the CRP value was an independent predictor of an increased Tp-e/QT ratio (ß=0.537, p< 0.001). Conclusion: Our study revealed that ventricular repolarization features were impaired in patients with psoriasis. Therefore, these patients should be more closely screened for ventricular arrhythmias. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the acute phase (pre- and in-hospital) antithrombotic management patterns (AMPs) and in-hospital outcomes for patients hospitalized with an acute coronary syndrome (ACS). Methods: In total, 1034 patients [514 patients with ST-segment elevation myocardial infarction (STEMI) and 520 with unstable angina/non-STEMI (UA/NSTEMI)] hospitalized for ACS within 24 h of symptom onset were included in this multicenter prospective registry study conducted at 34 hospitals across Turkey. Patient characteristics, index event description, pre- and in-hospital AMPs, and clinical outcomes were evaluated. Results: Majority (89.1%) of patients did not receive pre-hospital treatment. Overall 87.9% patients with STEMI and 55.6% patients with NSTEMI underwent percutaneous coronary intervention and dual antiplatelet therapy (DAPT) was based mainly on acetylsalicylic acid (ASA) and clopidogrel during hospitalization (99.8% and 98.2%, respectively). DAPT use at discharge was 98.4% and 86.8%, respectively. The percentage of patients with STEMI who received pre-hospital care, in-hospital cardiac catheterization, and pre and/or in-hospital triple antiplatelet therapy was higher than that of patients with UA/NSTEMI. In addition, higher rate of in-hospital hemorrhagic (2.3% vs. 0.8%) and cardiac ischemic (1.2% vs. 0.4% for MI and 1.6% vs. 0.8% for recurrent ischemia) complications and earlier induction of pre and/or in-hospital antiplatelet therapy and cardiac catheterization were also noted in patients with STEMI than in those with UA/NSTEMI. Conclusion: Our findings revealed in-hospital and at-discharge management to be mainly based on DAPT in patients with ACS. Interventional strategies were used in the majority of patients with STEMI, while the usage and timing of immediate pre-hospital ECG from symptom onset should be improved in these patients. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "Evaluation of right ventricular functions in patients with nasal polyposis: an observational study" by E. Simşek and colleagues that was published in a 2013 issue is presented and a response from the author for the same is also presented.

The author comments on a study entitled "Evaluation of myocardial function in pediatric patients with the transposition of great arteries after arterial switch operation," by T. Oner and colleagues. The study examined the myocardial function of pediatric patients who underwent arterial switch operation (ASO). The use of tissue Doppler echocardiography as an effectively method for post-operative assessment of ASO patients was also mentioned.

Objective: Polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk, including ischemic stroke. Prolonged atrial electromechanical interval (EMI) is related to increased atrial fibrillation (AF) risk. The aim of the study is to evaluate atrial EMI and electrocar-diographic P-wave indices related to increased AF risk in patients with PCOS. Methods: Forty PCOS patients diagnosed on the basis of the Rotterdam criteria and 20 age-matched controls were prospectively included. patients with atrioventricular or intraventricular conduction abnormalities, dysrhythmia or taking antiarrhythmic drugs, atherosclerotic heart disease, cardiomyopathies, valvular lesions, pericardial disease, a history of pulmonary emboli or pulmonary hypertension, and abnormal thyroid function were excluded. Intra and interatrial EMI were measured by tissue Doppler imaging and P-wave dispersion (Pd) was calculated on 12-lead electrocardiography (ECG). The Isovolumetric relaxation time was the interval between the aortic valve closure artifact at the end of the LV outflow envelope and the mitral valve opening artifact at the beginning of the mitral E wave. Results: Patients with PCOS had significantly higher interatrial [38 (24-65) ms vs. 16 (9-19) ms p<0.001], left-sided intra-atrial (14.8±6.1 vs. 7±1.7 ms, p<0.001), and right-sided intra-atrial (22.3±8.1 vs. 8.6±3.6 ms, p<0.001) EMI compared with the control group. Pd was significantly greater in the PCOS group compared with control group [45 (27-60) ms vs. 30 (26-38) ms, p<0.001]. Echocardiographic parameters of atrial EMI were significantly correlated with body mass index, Pd, and isovolumetric relaxation time in patients with PCOS. Conclusion: PCOS is associated with prolonged inter- and intra-atrial conduction times, which are related to increased AF risk. [ABSTRACT FROM AUTHOR]

Objective: Obstructive sleep apnea (OSA) is associated with thromboembolic events. Compromised left atrial appendage (LAA) function due to left ventricular (LV) performance abnormality, often present in patients with OSA, may play an important role. The purpose of this study is to evaluate LV and LAA mechanical functions during sinus rhythm (SR) in patients with OSA. Methods: LV and LAA functions were assessed in 43 OSA patients and compared with that of 20 control patients in SR. Tissue Doppler velocities of the LAA apex and emptying velocities (EV) of LAA were obtained on parasternal short-axis view. Results: The baseline clinical characteristics were similar except for AHI (apnea-hypopnea index), minimal SaO2, mean SaO2, hypertension, and body-surface area. Most of the LV echocardiographic parameters significantly deteriorated in OSA patients in comparison with those in the control group. LAA EV, LAA systolic relaxation velocity (SM), LAA early-diastolic velocity (EM), LAA contraction velocity (AM), left atrial (LA) minimum volume index, LA ejection fraction, LA conduit volume index, and LA reservoir volume index were lower in OSA patients compared with those in the control group (p<0.05). LAA AM was negatively correlated with AHI and the ratio of peak early diastolic flow velocity (E) to early-diastolic (E') and positively correlated with LA conduit volume (p<0.05). Multiple predictors for LAA AM were AHI, presence of diastolic dysfunction, and E/E' values (p<0.05). Conclusion: LAA mechanical function is significantly depressed in patients with OSA and SR. LAA dysfunction may predispose these patients to thromboembolic events. The evaluation of LAA mechanical function by tissue Doppler study using transthoracic echocardiography (TTE) may become an alternative for routine work-up in OSA patients. [ABSTRACT FROM AUTHOR]

Objective: There are still contradictory data in the literature whether patients with acromegaly are under risk in terms of atherosclerotic heart disease. Increased arterial stiffness develops before atherosclerosis and is evaluated to be a risk factor for atherosclerosis. Mean platelet volume (MPV) is currently gaining interest as a new independent cardiovascular risk factor. There are contrasting views about arterial stiffness in patients with acromegaly. There is no report in literature studying MPV in acromegaly patients. The aim of this study was to evaluate MPV and arterial stiffness in patients with acromegaly. Methods: This study was designed as an observational cross-sectional, case-controlled study. Twenty-eight patients with acromegaly and 22 healthy volunteers were recruited for the study. The arteriography device Mobil-O-Graph® (IEM GmbH. Stolberg, Germany) which can perform oscillometric measurements was used to measure arterial stiffness. The Mann-Whitney U test, Student's t-test, Spearman's nonparametric correlation analysis and the chi-square test were used to statistical analyze. Results: Aortic pulse wave velocity (PWV) value was found to be 6.41±2.12 m/s in the patient group with active acromegaly and 5.24±1.04 m/s in the healthy control group. The difference was statistically significant (p=0.03). The mean MPV value was found to be 9.68±1.11 in the patient group with active acromegaly and 8.53±1.18 in the healthy control group. There was a statistically significant difference between the two groups (p=0.004). In patients with acromegaly, a positive correlation was found between MPV and IGF-1 level (p=0.021, r=0.434). Conclusion: We determined an increase in aortic PWV and MPV in patients with acromegaly. In conclusion, evaluation of MPV and arterial stiffness in future studies could be beneficial in determining the risks for cardiovascular disease in patients with acromegaly. [ABSTRACT FROM AUTHOR]

Objective: Objective of this study was to investigate the correlation between P wave dispersion and left ventricular diastolic function, which are associated with the increased cardiovascular events in patients with dipper and non-dipper HT. Methods: Eighty sex and age matched patients with dipper and non-dipper HT, and 40 control subject were included in this observational cross-sectional study. P wave dispersion was measured through electrocardiography obtained during the admission. The left ventricule LV ejection fraction was measured using the modified Simpson's rule by echocardiography. In addition, diastolic parameters including E/A rate, deceleration time (DT) and isovolumetric relaxation time (IVRT) were recorded. Independent samples Bonferroni, Scheffe and Tamhane tests and correlation test (Spearman and Pearson) were used for statistical analysis. Results: P wave dispersion was found to be significantly increased in the non-dipper than in the dipper group (56.0±5.6 vs. 49.1±5.3, p<0.001). Pmax duration was found significantly higher (115.1±5.6 vs. 111.1±5.8, p=0.003) and Pmin duration significantly lower (59.0±5.6 vs. 62.3±5.3, p=0.009) in the non-dippers. Correlation analysis demonstrated presence of moderate but significant correlation between P-wave dispersion and left ventricular mass index (r=0.412, p=0.011), IVRT (r=0.290 p=0.009), DT (r=0.210, p=0.052) and interventricular septum thickness (r=0.230 p=0.04). Conclusion: P wave dispersion and P Max were found to be significantly increased and P min significantly decreased in the non-dipper HT patients compared to the dipper HT patients. P-wave dispersion is associated with left ventricular dysfunction in non-dipper and dipper HT. [ABSTRACT FROM AUTHOR]

Objective: There are few data regarding clinical characteristics, laboratory parameters, electrocardiographic and echocardiographic findings in takotsubo cardiomyopathy patients presenting with QT prolongation. Aim of this study was to investigate the differences in these parameters between takotsubo cardiomyopathy patients presenting with and those without QT prolongation. Methods: We performed an observational retrospective study. One hundred five patients were enrolled from the takotsubo cardiomyopathy registry database and divided according to the presence of QT prolongation. Fifty patients presented with QT prolongation (QT group) and 55 did not (NQT group). Statistical analysis was performed using Student's t-test or Mann-Whitney U test and chi-square test. Results: QT group had higher prevalence of dyspnea (66 versus 40%, p=0.008) and cardiogenic shock (46 versus 24%, p=0.016) than NQT group. QT group had higher prevalence of ST elevation (82 versus 64%, p=0.036), T wave inversion (96 versus 58%, p=0.001), ventricular tachycardia/ ventricular fibrillation (8 versus 0%, p=0.032) and classic ballooning pattern (92 versus 66%, p=0.003), but lower left ventricular ejection fraction (mean, 39.2 versus 43.5%, p=0.005). In addition, QT group had significant higher hs-C-reactive protein (median, 6.6 versus 1.7 mg/L, p=0.023), creatine kinase-MB (median, 18.6 versus 7.6 ng/mL, p=0.032) and NT-pro-brain natriuretic peptide levels (median, 3637 versus 2145 pg/mL, p=0.044). QT group required more frequent use of inotropics (46 versus 24%, p=0.016) and diuretics (58 versus 38%, p=0.042) than NQT group. Conclusion: The clinical features of takotsubo cardiomyopathy are different according to the presence of QT prolongation. The QT group was lesser likely to have preserved cardiovascular reserve and more likely to require hemodynamic support than the NQT group despite the entire prognosis of takotsubo cardiomyopathy is excellent regardless of QT prolongation. [ABSTRACT FROM AUTHOR]

Objective: Clopidogrel therapy is the standard of care in patients with acute coronary syndrome (ACS) and stent implantation. However, concern arises because 25% of subjects are nonresponders to clopidogrel. As this nonresponsiveness is associated with increased adverse outcome, detection of these subjects in daily practice is important in order to withhold a more aggressive therapy and closer follow up. In this study we aimed to evaluate the relation between mean platelet volume (MPV) which is an indicator of platelet activation and clopidogrel nonresponsiveness. Methods: The study was planned as a prospective cohort study. A total of 185 patients who had been on clopidogrel therapy for any acute coronary syndrome were enrolled in this study. Clopidogrel responsiveness was analyzed by Multiplate MP-0120 device by using the method of whole blood aggregometry. Blood samples were drawn 3.5 days after clopidogrel loading dose. The amount of ADP induced platelet aggregation was assessed as area under curve (AUC), and a cut-off value of 500, above which the patient is considered as clopidogrel nonresponder, was used. MPV was analyzed from the blood which were sampled at the admission of the patient by using automatic hemocounter. Independent sample t-test, ROC analyses and logistic regression analsis were used in statistical analysis. Results: Among the 185 patients analyzed 41 were found to be clopidogrel nonresponder (22.1%). Mean MPV was found to be significantly higher in nonresponders compared to responders (8.7±0.82 fL vs. 8.1±0.83 fL, p<0.001). A cut-off value of 8.3 fL for MPV was detected in prediction of clopidogrel nonresponsiveness with a sensitivity of 76.6% and specificity of 68.3% (OR: 6.4; 95% CI 2.9-14.1, AUC: 0.70, p<0.001). Conclusion: This study showed that MPV can be used as a predictor of clopidogrel resistance in patients with ACS. [ABSTRACT FROM AUTHOR]

The article focuses on a study that was conducted to analyze the effect of Nebivolol, a beta- blocker, on P wave dispersion (PD) and duration in patients with Behçet's disease (BD). It mentions the procedure where Behçet's patients were administered 5mg Nebivolol for three months and the effect was evaluated with electrocardiography for baseline and after 3-month therapy. It reveals the result which confirms that the drug causes decrease in maximum PD in patients with BD.

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

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

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

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

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

The article presents a case study of two-and-a-half-female patient with cardiac arrest (CA) during an operation for inguinal hernia (IH) and syndactyly. Topics discussed include diagnosis of Timothy syndrome (TS) by electrocardiography (ECG)-Holter findings, implantation of an epicardial dual-chamber implantable cardioverter defibrillator (EDCICD), and starting the treatment with beta-blocker propranolol.

The article presents a case study of a 66-year-old man who was admitted to our emergency department due to severe chest pain with a history of hypertension and diabetes mellitus. It mentions use of electrocardiography and catheterization which revealed occluded proximal right coronary artery and a critical thrombotic lesion on the left circumflex artery. It also discusses diagnosis of subacute thrombosis in stents in different vessels after cessation of ticagrelor therapy.

The article presents case study of a 78-year-old man, who had lung cancer with no history of chemotherapy and radiotherapy was admitted to an emergency department with complaints of chest pain, cough, dyspnea, and wheezing. Echocardiography revealed pericardial effusion, and pericardial puncture fluid culture yielded non-fermentative, gram-negative bacteria identified as S. maltophilia. The patient was diagnosed with bacterial pericarditis.

The article discusses why cardiac resynchronization therapy with defibrillator (CRT-D) is preferred over cardiac resynchronization therapy with pacemaker (CRT-P) in CRT-indicated patient. Topics discussed include CRT-D demonstrating advantages over implantable cardioverter defibrillator (ICD) in terms of morbidity, symptom reduction, and survival; pacing site-dependent arrhythmia, and possibility of device-related tachyarrhythmia to occur due to device-related arrhythmia.

A letter to the editor as well as response from the authors including A.Tanındı and colleagues regarding the article "Epicardial adipose tissue thickness is associated with myocardial infarction and impaired coronary perfusion" published in previous issue is presented.

A letter to the editor in response to the article "Home blood pressure is the predictor of subclinical target organ damage like ambulatory blood pressure monitoring in untreated hypertensive patients" by A. Her and colleagues in a 2014 issue is presented along with the author's response.

A letter to the editor is presented in response to the article ""Association of P wave dispersion and left ventricular diastolic dysfunction in non-dipper and dipper hypertensive patients" by A.R. Tosu and others published in April 2014 issue, along with the reply of the authors to the same.

A letter to the editor is presented in response to the article related to association between scar size and characteristics on T-wave alternans in postmyocardial infarction patients by Kivanç Yalm, Ebru Gölcük published in the 2014 issue along with reply of authors' to the same.

The article discusses correlation of doppler ultrasonography and hypertensive target organ damage. Topics include recent advances in ultrasonography, identification of renal arterial stenosis by renal doppler ultrasonography, arterial lesions associated with hypertension, evaluation of atherosclerosis in the various organs by ultrasonography, and correlation of glomerulosclerosis and arteriolosclerosis evaluated by renal biopsy.

A letter to the editor is presented in response to the article "Effect of nebivolol on endothelial dysfunction in patients with Behçet's disease (BD); a prospective single-arm controlled study" by Akkaya H and colleagues in the 2013 issue and also presents a response by the author of the article in the same issue.

A diagnostic puzzle related to finding the right diagnosis for the presence of hyperechogenic mass on interatrial septum as revealed by transthoracic echocardiography in a 47-year-old female patient who was taken to hospital due to atrial arrhythmia.

A response from the author of the article "Renal dysfunction as a marker of increased mortality in patients with pulmonary thrombembolism" in the 2016 issue is presented.

The article presents a case study on a 62-year old male patient, who has been on hemodialysis through a left sided atrio-ventricular (AV) radial fistula for 8 years, with an indication for the implantable cardioverter defribillator (ICD) implantation. The authors recommend the implantation of a rhythm device on the side of the AV fistula in young patients with old AV fistula because of expected requiements for a new AV access.