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Cardiomyopathy, which is shortly defined as a disease of the myocardium, has a broad definition that includes many different diagnoses. Recent advances in cardiac imaging techniques, including basic and advanced echocardiography, computed tomography, nuclear medicine, and cardiac magnetic resonance, allow for a more accurate evaluation of volumes and thickness of cardiac chambers, systolic and diastolic function of the ventricules, and tissue structure. Multimodality imaging often provides the first clinical suspicion for specific etiologies, especially when the medical and family history is unclear, by identification of red flags of underlying systemic diseases. In this review, we aimed to evaluate the role of multimodality imaging in diagnosis of cardiomyopathies with key images and discussed the effects of genetics on the diagnostic, prognostic, and therapeutic guidance of cardiomyopathies.

There is an increasing incidence of diagnosing both congenital and acquired heart valve diseases in women during pregnancy. Factors such as elevated rates of pregnancy, older maternal age, and coexisting conditions like diabetes, hypertension, and obesity contribute significantly to the symptomatic manifestation and detection of valvular heart diseases in women planning for pregnancy. Pregnancy induces cardiovascular changes across the maternal physiology, posing a heightened risk of morbidity and mortality, especially in women afflicted with valvular heart diseases. In this article, we present a case of a 25-year-old patient who underwent mitral ring annuloplasty surgery at the age of 9. Her echocardiography revealed a mismatch of the mitral ring during a follow-up examination at the age of 20. Despite neglecting further follow-ups, the patient became pregnant and presented to us at the 6th week of pregnancy. She underwent evaluations at the 6th, 10th, and 22nd weeks of pregnancy, as well as before delivery. Following the resumption of follow-up appointments, intervention planning was initiated during the postpartum period. This case exemplifies successful management, resulting in a healthy delivery after navigating through the pregnancy.

Ankylosing spondylitis is a complex chronic disease that starts from the spine and sacroiliac joint, causes joint stiffness, and affects the quality of life. Aortic dilatation, aortic valve insufficiency, and heart block due to conduction system involvement are the leading accompanying cardiac pathologies. In this case report, we aimed to show a rare cardiac involvement of left atrial calcification, pericardial involvement, and formation of a calcified inflammatory mass that might be misdiagnosed as vegetation on the mitral valve in a late-stage ankylosing spondylitis patient, by using multimodality imaging and histopathological diagnosis.

Objective: Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists' diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system., Methods: The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message., Results: A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients., Conclusion: The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.

Objective: The aim of this study was to evaluate the adherence to recommendations for secondary prevention and the achievement of treatment targets for the control of risk factors in patients with established coronary heart disease (CHD) who were followed-up at various healthcare facilities in Turkey., Methods: According to the protocol of the international Survey of Risk Factor Management study, questionnaire forms were completed and demographic, anthropometric, and laboratory data of CHD patients who were followed-up at a total of 15 selected primary, secondary, and tertiary healthcare centers were recorded., Results: Among a total of 724 CHD patients (69.8% male; mean age: 63.3±10.7 years) included in the study, 18.4% were current smokers, only 19.1% had normal body mass index, and 22.1% had waist circumference below the limit of abdominal obesity. Physical activity was insufficient in 53% of the patients, 47.3% had low high-density lipoprotein cholesterol value, 46% had triglyceride level above 150 mg/dL, and 67% had glycated hemoglobin value of 6.5% or above. Of all the patients, 88.1% were using antiplatelet drugs, 71.4% were using beta-blockers, 55.7% were using statins, and 41.9% were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Blood pressure was under control in 56.7% of the hypertensive patients using antihypertensive drugs, and the proportion of diabetic patients who reached glycemic control targets using antidiabetic drugs was 35.9%. Low-density lipoprotein cholesterol was below 70 mg/dL in 12.2% of the patients using statins., Conclusion: According to the data obtained, among Turkish CHD patients, the control rate of cardiovascular risk factors is low, and implementation of the recommendations regarding lifestyle modification and medication use for secondary prevention in the current guidelines are insufficient.

Objective: Bicuspid aortic valve (BAV) is a complex developmental anomaly caused by abnormal aortic leaflet formation during valvulogenesis. The present study is an assessment of the effects of BAV disease on the ascending aorta and pulmonary artery (PA), and an evaluation of the consequences for systolic and diastolic functioning of the left and right ventricles., Methods: Total of 66 patients were eligible for inclusion. Pulmonary artery maximum diameter (PAD) was obtained 1 cm distal to the pulmonary annulus. Using pulsed-wave tissue Doppler imaging, left ventricular (LV) early diastolic velocity (E') measurement was obtained at the annulus with placement of sample volume. Right ventricle (RV) peak global strain rate during systole (RV-SRS), early diastole (RV-SRE), and late diastole (RV-SRA) were calculated., Results: In this study, 40.9% (n=27) of patients were female and average age was 35±11years. RV-SRS values (ß=-.781, t=-2.723; p=0.010) and log-LV tissue Doppler imaging E' (ß=-2.996, t=-5.405; p=<0.001) were negatively correlated, and log-PAD (ß=4.861, t=3.052; p=0.005) was positively and independently correlated with ascending aortic diameter., Conclusion: Ascending aorta diameter is positively correlated with PA diameter in BAV patients, and RV strain rate and LV diastolic parameters are affected before development of the valve disease.

Objective: Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with increased morbidity and mortality. Atrial fibrosis augments recurrence rate following AF catheter ablation. Osteopontin is a multifunctional molecule involved in several pathophysiological pathways, including fibrosis. Presently described is investigation of relationship between serum osteopontin level and AF recurrence after AF cryoablation., Methods: The study was designed to be prospective and observational; 60 patients with paroxysmal (n=47) and persistent (n=13) AF were included. Osteopontin level was measured both before and 6 months after AF ablation with cryoballoon., Results: Preprocedure and postprocedure osteopontin level did not differ between the 2 groups of AF patients (p=0.286, p=0.493, respectively). Postprocedure osteopontin level was significantly higher compared with preprocedure value (32.18 ng/mL vs 15.58 ng/mL; p=<0.001). Left atrial diameter, AF type, and preprocedure osteopontin level were related to AF recurrence (p≤0.05). An age-adjusted multivariate logistic regression analysis was conducted to determine independent predictors of AF recurrence. Among these, AF type (ß=2.211; p=0.004; odds ratio [OR]: 9.124; 95% confidence interval [CI]: 2.026-41.094) was found to be the most important factor related to AF recurrence. Preprocedure osteopontin level also predicted AF recurrence independently (ß=0.059; p=0.048; OR: 1.061; 95% CI 1.001-1.125)., Conclusion: Study results revealed persistency of AF and high preprocedure osteopontin level independently predicted AF recurrence in patients undergoing cryoballoon AF ablation. Association of a biochemical marker with AF recurrence might be beneficial to selection of appropriate patients for cryoballoon procedure and assessment of long-term procedural success.

Takotsubo cardiomyopathy (TTC), also known as left ventricular apical ballooning syndrome or stress cardiomyopathy, is characterized by transient left ventricular systolic dysfunction and the absence of obstructive lesion in the epicardial coronary arteries. The most common presentation is acute substernal chest pain, although occasionally dyspnea and syncope, and rarely shock with ST-segment elevation and elevated cardiac biomarkers have been observed. Inverted (reverse) TTC is a rare pattern characterized hypokinesis of the basal and midventricular segments. Presently described was case of a 27-year-old woman with ventricular fibrillation following endoscopic nasal sinus surgery.

Pericardiocentesis is a life-saving procedure performed in cardiac tamponade cases occurring in infective, inflammatory or malignancy conditions, or following percutaneous coronary intervention, cardiac device implantation or catheter ablation. In spite of advanced imaging methods, a substantial risk of complication persists. Emergent surgical intervention may be required, in particular during advancement of the catheter into the heart chambers or in cases of wall rupture. Furthermore, in all these cases, patients have a high risk of surgery because of existing comorbidities. This case presents a patient suspected of tuberculous pericarditis who underwent diagnostic pericardiocentesis complicated by right ventricular puncture. The catheter in the right ventricle was withdrawn via a second catheter placed in the pericardial cavity. Spontaneous blood control was established, and with no increase in pericardial effusion surgical intervention was not required. This method can be applied in certain conditions, including cardiac injury caused by pericardiocentesis or intracardiac manipulations, thus eliminating the need for high-risk surgical intervention.

Objectives: To identify the cut-off values for waist circumference (WC) that may best predict cardiometabolic risk associated with insulin resistance in adult Turkish men and women., Study Design: A total of 1,039 non-diabetic subjects (592 females, 447 males; mean age 40.2+/-12.8 years) aged = or >18 years were enrolled. Insulin resistance was assessed with homeostasis model assessment of insulin resistance (HOMA-IR). The subjects were classified into quantiles based on the WC values and quantiles were compared with respect to the HOMA-IR levels. Receiver operating characteristic (ROC) analysis was used to identify the WC cut-off value that would best predict insulin resistance., Results: HOMA-IR values increased in parallel with increasing WC quantiles for both genders (p=0.001). The cut-off values for WC that showed the highest sensitivity and specificity to predict insulin resistance were 93 cm for men (91.6% and 51%, respectively) and 83 cm for women (91.1% and 34.8%, respectively)., Conclusion: Our results demonstrate that the cut-off values for WC that would best predict cardiometabolic risk associated with insulin resistance are 93 cm for men and 83 cm for women in Turkish adults. However, our findings also raise the question as to whether it is indeed necessary to define a WC cut-off value for the prediction of insulin resistance, because, regardless of the cut-off WC value taken into account, insulin resistance will be overlooked in a significant number of individuals with a WC below this cut-off value.