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Aims There is an increasing trend evaluating the role of non-pulmonary vein (PV) triggers to improve ablation outcomes in persistent atrial fibrillation (AF) as pulmonary vein isolation (PVI) strategy alone has modest outcomes. We investigated the long-term safety and efficacy of left atrial appendage isolation (LAAi) in addition to PVI using cryoballoon (CB) in persistent AF. Methods and results In this multicentre retrospective analysis, we included a total of 193 persistent AF patients (mean age: 60 ± 11 years, 50.3% females) who underwent PVI and LAAi using CB. Baseline and follow-up data including electrocardiography (ECG), 24 h Holter ECGs, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as the detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a median follow-up of 55 (36.5–60.0) months, 85 (67.9%) patients with PVI + LAAi were in sinus rhythm after the index procedure. Ischaemic stroke/transient ischemic attack occurred in 14 (7.2%) patients at a median of 24 (2–53) months following catheter ablation. Multivariate regression analysis revealed heart failure with preserved ejection fraction [hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.04–5.02; P = 0.038], male gender (HR 0.53, 95% CI 0.29–0.96; P = 0.037), and LA area (HR 1.04, 95% CI 0.53–1.32; P = 0.023) as independent predictors of ATa recurrence. Conclusion Our findings demonstrated that the LAAi + PVI strategy using CB had acceptable long-term outcomes in patients with persistent AF. Systemic thrombo-embolic events are an important concern throughout the follow-up, which were mostly observed in case of non-adherence to anticoagulants.

Objectives: Vitamin D plays a pivotal role in cardiovascular system and its deficiency is related to various of cardiovascular disorders. We investigated the association between serum vitamin D level and coronary artery ectasia formation. Methods: Our study included 45 patients with coronary artery ectasia and 55 patients with normal coronary artery. Vitamin D and parathyroid hormone levels were obtained before coronary angiography. Results: Baseline characteristic features were similar between groups. The Vitamin D levels and serum calcium levels were significantly lower in the coronary artery ectasia group compare to control group (respectively; 15.6 ng/ml vs. 12.0 ng/ml; p=0.002 and 9,52 vs. 9.0; p

Since its recognition in December 2019 as a cause of pneumonia, SARS-CoV-2 infection has rapidly spread globally, causing a pandemic. Although it is an infectious disease, several distinct manifestations have been described in the setting of COVID-19, which result from the immune perturbations caused by this new Coronavirus. The heart is frequently involved in COVID-19 and is associated with severe outcomes. Pericarditis is rarely reported in COVID-19 patients and no reports on its treatment and outcome are available so far. Herein, we present a 33-year-old man with COVID-19-related pericarditis (COVID-19-RP) who was unresponsive to colchicine and nonsteroidal anti-inflammatory drugs, but was successfully treated with the IL-1R antagonist anakinra.

Background: Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stage renal disease. Methods: Patients included were between 18 and 85 years of age and were receiving hemodialysis for at least 6 months. High sensitive cardiac troponin T (hs-cTnT) levels were studied in blood samples taken at the beginning and end of HD. Two-dimensional speckle tracking strain imaging was used to evaluate myocardial contractility. Results: Seventy patients (50.7 ± 16.9 years of age, 27 women) were included in study. The mean volume of ultrafiltration was 3260 ± 990 mL. A significant increase in circulating hs-cTnT levels was observed, as well as a prominent decrease in left ventricular global longitudinal strain (GLS) after HD (52.4 ± 40.2 ng/L vs. 66.8 ± 48.5 ng/L, p < 0.001 and 20.1 ± 3.6% vs. 16.8 ± 3.8% p < 0.001, respectively). Moreover, ultrafiltration rate and GLS were found as the strongest independent variables in relation to the relative increase in hs-cTnT. Conclusions: Hemodialysis can cause a significant increase in hsTnT. This can jeopardize the accuracy of clinical diagnoses based on hs-TnT measurements. GLS may be used as a determinant of this hs-TnT increase. The influence of HD on the cardiovascular system should be kept in mind to prevent unnecessary interventions.

Background The left atrium (LA) is the main contributor of left ventricular (LV) filling. LA volume and volume index are routinely evaluated during echocardiographic assessment as having prognostic value in a wide range of cardiovascular pathologies. Yet, LA volume is easily affected by volume status. Thus, a non-invasive novel parameter such as indices of LA longitudinal strain (LS) have been proposed as alternative measurements. LA strain was shown to be associated with LV filling pressures and it has been suggested to provide prognostic information in patients with heart failure, atrial fibrillation, ischemic and valvular heart diseases. Nevertheless the acute effect of hemodynamic changes on LA LS indices is not well-established due to lack of evidence in healthy subjects and patient populations. The aim of this study is to evaluate the LA mechanics and change in echocardiographic methods used for assessment of LA by examining the end stage kidney patients before and after the hemodialysis (HD). Methods Patients between 18 and 85 years of age, receiving HD for at least 6 months were included. The echocardiographic images were obtained before and after HD. 2D speckle tracking strain analysis was performed for LA in 45 patients. Reference points for analysis are set on the "P" waves. LA reservoir, conduit and contraction phase LS were calculated. The changes in echocardiographic methods before and after hemodialysis were examined. Correlation between volume depletion and change in echocardiographic parameters were calculated. Results 45 patients (47.7 ± 14.7 years of age, 19 women) were included in study. The mean volume of ultrafiltration was 2755.12 ± 845.5 ml . The chamber sizes of LA are decreased after hemodialysis (LA diameter; 4.9 ± 0.8 cm vs. 4.4 ± 0.5 cm p Conclusion LA contraction LS is a volume independent measurement obtained by 2D speckle tracking. Assessment of LA mechanics with echocardiography would be an easy and repeatable assessment which can guide to describe the cardiac pathophysiology and hemodynamics better. Moreover defining novel volume independent parameters for evaluation of LA would contribute to clinical perspectives of the patients.

Objective Ultrafiltration rate is one of the major determinants of adverse outcomes in patients undergoing hemodialysis (HD) therapy. Previous studies have focused on the impact of HD on right ventricular (RV) peak strain values. However, the influence of HD on the temporal characteristics of deformation has not been reported yet. The aim of the present study was to evaluate the impact of high ultrafiltration rate (HUR) on RV mechanical dyssynchrony. Methods Echocardiographic images focused on the RV and left ventricle (LV) were obtained from 60 patients (49.2+-17.3 years, 22 female) before and after HD. Patients were divided into two groups according to ultrafiltration rate. Changes in echocardiographic parameters with HD were examined. Two-dimensional speckle-tracking strain analysis was used to assess deformation. Mechanical dispersion was measured as the standard deviation of time to peak longitudinal strain of six segments for RV and 18 segments for LV. Results The average ultrafiltrated volume and ultrafiltration rate were 3000.1+-1007.9 mL and 11.4+-2.9 mL/kg/h, respectively. Global longitudinal strain (GLS) of the RV and LV decreased after HD in both groups. A significant difference was observed in RV mechanical dispersion with HD for patients in the high ultrafiltration group. A mild statistically insignificant increase in LV mechanical dispersion was also observed after HD. Conclusion HUR has a substantial impact on LV and RV GLS and RV dyssynchrony. Ultrafiltration rates and volumes should be kept as low as possible to achieve hemodynamic stability and tolerability.

Background/aim The aim of this study was to investigate the importance of preprocedural uric acid (UA) level in predicting fractional flow reserve (FFR) results of intermediate coronary lesions in patients with stable coronary artery disease undergoing coronary angiography. Materials and methods We retrospectively analyzed 293 patients who underwent FFR measurement to determine the significance of intermediate coronary stenosis detected by conventional coronary angiography. Patients were divided into 2 groups: Group 1 (n = 127) included patients with FFR of 0.80 (hemodynamically nonsignificant lesions). Uric acid levels were assessed in both groups with the enzymatic colorimetric method by clinical chemistry autoanalyzer. Results The mean UA level was significantly higher in patients whose FFR indicated hemodynamically significant coronary lesions (UA: 5.43 ± 1.29 mg/dL in Group 1 vs. 4.51 ± 1.34 mg/dL in Group 2, P < 0.001). Conclusion Elevated UA levels are associated with hemodynamically significant coronary lesions measured with FFR. Uric acid may be used as a predictor of hemodynamically compromised coronary lesions before FFR procedures.

Giriş: Kan dolaşımında bulunan monosit sayısı yeni aterosklerotik plak oluşumundaöngörücüdür. Bununla birlikte yüksek dansiteli lipoprotein kolesterol (HDL)düzeyleri ile ateroskleroz arasında güçlü bir negatif ilişki vardır. Buçalışmada, monosit sayısı/HDL oranıyla koroner arter hastalığı ciddiyetiarasındaki ilişkiyi değerlendirmeyi amaçladık.Hastalar veYöntem: Koroner anjiyografi yapılan toplam 760 hasta çalışmayadahil edildi. Koroner ateroskleroz ciddiyeti Gensini skorlama sistemikullanılarak değerlendirildi ve hastalar Gensini skorlarına göre yüksek (>20) ve düşük (< 20) olarak iki gruba ayrıldı. Bazal karakteristik özelliklerve laboratuvar parametreleri kaydedilerek yüksek ve düşük Gensini skoru olanhastalar arasında karşılaştırıldı.Bulgular: Hipertansiyon, diabetes mellitus, hiperlipidemi, ileri yaş ve sigaraiçiciliği yüksek Gensini skoru olan hastalarda daha fazlaydı. Açlık kan şekeri,kreatinin düzeyleri ve monosit/HDL oranı düşük Gensini skoru olan hastalardayüksek Gensini skoru olanlara kıyasla daha düşüktü. Lojistik regresyonanalizinde ileri yaş, açlık kan şekeri, hiperlipidemi, aile öyküsü ve erkekcinsiyetin yüksek Gensini skoru için bağımsız parametreler olduğu gözlendi.Monosit/HDL oranının, Gensini skoruyla korele olduğu (p< 0.001) ancak bukorelasyonun çok zayıf olduğu tespit edildi (Spearman’s Rho: 0.159).Sonuç: Monosit/HDL oranı ile Gensini skoruyla eldeedilen ateroskleroz yaygınlığı arasında zayıf da olsa bir ilişki izlenmiştir.Ancak Monosit/HDL oranı ve aterosklerotik kalp hastalığı arasındaki ilişkiyibelirlemek için daha fazla klinik çalışmaya ihtiyaç vardır., Introduction:Circulatingmonocyte count is predictive of new atherosclerotic plaque development. Inaddition, there is a strong inverse relationship between high-densitylipoprotein (HDL) cholesterol and atherosclerosis. We aimed to investigate therelationship between the monocyte/HDL cholesterol ratio and severity ofcoronary artery disease.Patientsand Methods: A total of 760 patients who underwent coronaryangiography were included in the study. The severity of coronaryatherosclerosis was calculated by the Gensini score, and the patients weregrouped as having low (< 20) and high (> 20) Gensini scores. Baselinecharacteristics and laboratory parameters were recorded and compared betweenpatients with low and high Gensini scores. Results: Hypertension,diabetes mellitus, hyperlipidaemia, advanced age and smoking were more commonin patients with a high Gensini score. Fasting blood glucose levels, creatininelevels and monocyte/HDL cholesterol ratio were significantly lower in patientswith a low Gensini score than in those with a high Gensini score. Logisticregression analysis revealed that older age, fasting blood glucose levels,hyperlipidaemia, family history of coronary artery disease and male gender wereindependent predictors of a high Gensini score. We observed a correlationbetween the monocyte/HDL cholesterol ratio and Gensini score (p< 0.001).However, this correlation was weak (Spearman’s rho = 0.159).Conclusion: We observed a positive but weak correlationbetween the monocyte/HDL cholesterol; ratio and increased coronaryatherosclerotic burden, as calculated by Gensini scoring. Further studies arerequired to demonstrate the relationship between the monocyte/HDL cholesterolratio and atherosclerotic cardiovascular disease.

Objective Previous studies have suggested that there is a relationship between coronary artery disease (CAD) and parathyroid hormone (PTH) levels. Here, we aimed to evaluate the association between PTH levels and severity of CAD. Methods Patients were divided into two groups based on their serum PTH values. Patients with PTH levels ≤72 pg/mL were accepted as Group 1 (n=568) and >72 pg/mL as Group 2 (n=87). Gensini score system and >50% stenosis in any coronary artery with conventional coronary angiography were used to determine the extensiveness of CAD. This study was designed as a prospective and cross-sectional study. Results Baseline characteristics except for age, gender, and blood pressure were similar between groups. Mean serum PTH levels of the entire cohort was 43.4±29.5 pg/mL. Median Gensini score was 19.5 in Group 1 and 14.5 in Group 2 (p=0.75). On the other hand, PTH levels were weakly correlated with Gensini score (Spearman's Rho=0.11, p=0.003). Additionally, we did not observe a statistically significant difference between PTH levels and the number of stenotic vessels (p=0.14). This study was designed as a prospective and cross-sectional study. Conclusion There is no association between serum PTH levels and extensiveness of CAD.

Coronary artery anomalies are rare and mostly silent in clinical practice. First manifestation of this congenital abnormality can be devastating as syncope, acute coronary syndrome, and sudden cardiac death. Herein we report a case with coronary artery anomaly complicated with ST segment myocardial infarction in both inferior and anterior walls simultaneously diagnosed during primary percutaneous coronary intervention.

Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.

Background and Objectives: Genetic predisposition is an important risk factor for coronary artery disease (CAD). In this study, we aimed to evaluate the impact of rs10757274 and rs2383206 polymorphisms in chromosome 9p21 on presence and severity of CAD in a Turkish population. Subjects and Methods: A total of 646 patients who underwent coronary angiography were included in this study. Coronary vessel score and Gensini score were calculated to assess the angiographic severity of CAD. Alleles of AA, AG, and GG were determined for rs10757274 (polymorphism-1) and rs2383206 (polymorphism-2) polymorphisms located in chromosome 9p21 from the blood samples. Results: There was a significant difference between the alleles in polymorphism-1 in the presence of coronary artery disease (38.9% in AA, 48.0% in GG and 56.4% in AG, p=0.017). However, there was no difference between the alleles in polymorphism-2. According to vessel scores, there was a significant difference between the alleles in polymorphism-1 (AA 0.71 +/- 1.04, GG 0.88 +/- 1.07, AG 1.06 +/- 1.12, p=0.018). In polymorphism-2, vessel scores did not show a difference between the alleles. In polymorphism-1, there was a significant difference in Gensini score (p=0.041). Gensini scores did not differ between the alleles in polymorphism-2 (p>0.05 for all). In multivariate analyses, none of the alleles was an independent factor for presence of CAD. Conclusion: The presence of rs10757274 polymorphism including AG allele in chromosome 9p21 was related to CAD. However, this relationship was not independent of other cardiovascular risk factors.

A B S T R A C T S the leading disease, follow by arrhythmia, then congestive heart failure. Congestive heart failure was diagnosed in 19,6% cases. Congenital heart diseases was diagnosed in 5,9% of studied population. The most diagnosed pathology was isolated ventricular septal defect and tetralogy of Fallot. Post-rheumatic valvulopathies and congenital heart diseases are the first aetiological factor of congestive heart failure in young. Results: Patients with severe hypertension, congestive heart failure, symptomatic arrhythmias were admitted for more investigations and proper care. After the compensation drug treatment, patient needed surgery, underwent surgical procedure. The hospital mortality rate was 0,2%. The poor compliance and limited finances gives the follow-up difficult. Conclusion: This study confirms that rheumatic heart disease still accounts for a major proportion of all cardiovascular diseases in children and young adults in African countries. Rapid urbanization and transition from agrarian life to the wage-earning economy of city life continue to fuel increases in average blood pressure levels and prevalence of hypertension.