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Objectives: We hypothesized that long-term morbidity and mortality can be identified by the presence of comorbidities in patients with carotid artery stenosis. In our study we aimed to investigate the relationship between clinical characteristics, laboratory findings and long-term prognosis in carotid artery stenosis patients after stenting Patients and Methods: We retrospectively enrolled 212 patients whom underwent carotid artery stenting (CAS) between January 2010 and December 2012 at Kartal-Kosuyolu Training and Research Hospital. CAS was performed in symptomatic patients with >60% stenosis and in asymptomatic patients with >80% stenosis of extracranial carotid artery. Symptoms were defined by an ipsilateral cerebral or ocular minor or major ischemic event within the past 6 months. Results: Mean age of study population was 67.4 ± 7.9 years and 158 patients (74.5%) were male. In the follow-up period 18 patients had MI, 18 patients had major stroke, 23 patients had transient ischemic attack. Twenty-one patients (9.9%) died from cerebral-cardiovascular causes. All MACCE was found in 64 patients (30.2%). Multivariate analysis revealed that age (OR: 1.09, 95% CI: 1.02-1.17, p = 0.05), heart failure (OR: 3.78, 95% CI: 1.48-9.62, p = 0.005), creatinine (OR: 3.54, 95% CI: 1.16-10.82, p=0.026) and neutrophil-lymphocyte ratio (OR: 2.88, 95% CI: 1.90-4.36, p < 0.0001) were independent predictors of the MACCE. Conclusion: Although, the short-term risk of patients undergoing CAS dominated by lesion-related factors, pre-existing comorbidities may be even more important for the long-term event. Age, heart failure, creatinine and neutrophil-lymphocyte ratio were found as the most important risk factors of MACCE.

Introduction Periprocedural myocardial necrosis, which can range from a low level elevation of cardiac biomarkers to a large myocardial infarction (MI), is a common complication after percutaneous coronary intervention (PCI). Aim We hypothesized that insulin-like growth factor-1 (IGF-1) levels may play a protective role in myocardial injury after coronary stent placement and aimed to investigate the relationship between IGF-1 levels and plaque characteristics assessed by optical coherence tomography (OCT). Material and methods Between May 2015 and December 2015 we prospectively enrolled 74 patients with stable angina pectoris in whom single de novo coronary artery stenosis was present. PCI was performed according to standard methods. OCT was applied to all patients. TnT was analyzed at admission, before PCI and at 6, 12, 24 and 48 h after PCI. Serum IGF-1 was measured prior to PCI. Results A total of 25 (33.7%) patients had periprocedural myocardial injury or type 4a myocardial infarction, and 49 (66.2%) patients had no events. IGF-1 level and reference intimal thickness, medial thickness, and plaque fibrous cap thickness in OCT had strong correlations (r = 0.88, 0.80 and 0.88 respectively, p < 0.001). IGF-1 was an independent predictor of periprocedural myocardial injury or type 4a MI in univariate (OR = 0.929, 95% CI: 0.895-0.964, p < 0.001) and multivariate regression analysis (OR = 0.757, 95% CI: 0.575-0.998, p = 0.04). Based on ROC analysis, the best cut-off value of IGF-1 for predicting periprocedural myocardial injury or type 4a myocardial infarction was 144.5 ng/ml, with a maximum sensitivity of 88% and specificity of 77.6% (AUC = 0.80, 95% CI: 0.69-0.88, p < 0.0001). Conclusions The results from this study indicate that low IGF-1 levels are associated with plaque instability assessed by OCT. Low IGF-1 levels may identify patients who are at increased risk for periprocedural myocardial injury/infarction.

Introduction: The aim of this study was to use speckle-tracking echocardiography (STE) for identifying subclinical global systolic function abnormalities in chronic asymptomatic alcoholic patients with a normal ejection fraction. Patients and Methods: We included 30 healthy subjects (age 34.8 ± 5.8 years) and 75 asymptomatic alcoholic patients (age 39.8 ± 6.5 years) and divided them into two groups according to their total lifetime dose of ethanol (TLDE): group I (TLDE < 15 kg ethanol/kg body weight) and group II (TLDE ≥ 15 kg ethanol/kg body weight). In the two-dimensional (2D)-STE analysis, the left ventricular (LV) global longitudinal strain (G-LS), longitudinal global strain rate in systole (G-SRsys), longitudinal global strain rate in early diastole (G-SRearly) and longitudinal global strain rate in late diastole (G-SRlate) values were obtained. Results: Alcoholic patients had larger end-systolic and end-diastolic dimensions, thicker interventricular septal and posterior wall and higher LV mass index. However, there were no differences in the end-systolic and end-diastolic dimensions and LV mass index among them. The ejection fraction did not differ between the groups. The G-LS values were lower in alcoholic patients (p< 0.001). G-LS was found to be significantly lower among alcoholic patients, although the LV mass index and LV dimensions remained unchanged. Although G-SRsys was lower in alcoholic patients compared with that in controls (p= 0.03), there were no differences in the G-SRearly and G-SRlate values. There was a significant correlation between G-LS values and TLDE (r= 0.49, p< 0.001). Conclusion: To the best of our knowledge, this is the first study demonstrating the presence of early functional abnormalities of longitudinal systolic function by 2D-STE in chronic alcoholic patients. These functional mechanics have a parallel impairment with the increase in alcohol consumption.

Hepatit Cvirüsü (HCV) tedavisinde peginterferon (Peg-IFN)2b ve ribavirin tedavisi konvansiyonel interferon veribavirin tedavisinden daha etkilidir. Peg-IFN ve ribavirin tedavisinin önemlietkilerinin yanında ateş, halsizlik, heyecan, huzursuzluk, nötropeni ve trombositopenigibi bir çok yan etki görülebilir. Ayrıca kardiyak aritmiler ve senkop gibinadir olaylar da Peg-IFNtedavisine bağlı gelişebilir. Bizler bu çalışmada Peg-IFN ve ribavirin tedavisi sırasında presenkop atağı vereenteran taşikardilerin en sık formu olan atriyoventriküler nodal reenterantaşikardi gelişen bir yoğun bakım hastasını sunuyoruz., Thetreatment of hepatitis C virus (HCV) with peginterferon (Peg-IFN) α2b andribavirin is more effective than with conventional interferon and ribavirin.Despite the important effects of Peg-IFN and ribavirin therapy, many sideeffects, such as fever, fatigue, anxiety, irritability, neutropenia andthrombocytopenia, may be observed. In addition, cardiac arrhythmias and syncopeare rare consequences of Peg-IFN therapy. In this study, we report an intensivecare unit patient who developed atrioventricular nodal reentrant tachycardia(AVNRT), which is the most common type of reentrant supraventriculartachycardia, and presyncopal attack during Peg-IFN and ribavirin therapy.

Introduction and objectives Two-dimensional speckle-tracking echocardiography is a novel tool to assess myocardial function. The purpose of this study was to evaluate left ventricular myocardial strain and rotation parameters by two-dimensional speckle-tracking echocardiography in a large group of healthy adults across a wide age range to establish their reference values and to assess the influence of age, sex, and hemodynamic factors. Methods Transthoracic echocardiograms were acquired in 247 healthy volunteers (139 women, 44 years [standard deviation, 16 years old] (range, 18-80 years). We measured longitudinal, circumferential, and radial peak systolic strain values, and left ventricular rotation and twist. Results Average values of global longitudinal, radial, and circumferential strain were -21.5% (standard deviation, 2.0%), 40.1% (standard deviation, 11.8%) and -22.2% (standard deviation, 3.4%), respectively. Longitudinal strain was significantly more negative in women, whereas radial and circumferential strain and rotational parameters were similar in both sexes. Accordingly, lower limits of normality for the strain components were -16.9% in men and -18.5% in women for longitudinal strain, and -15.4% for circumferential and 24.6% for radial strain, irrespective of sex. Longitudinal strain values were more negative at the base than at apical segments. Mean rotational values were -6.9 ° (standard deviation, 3.5 °) for the base, 13.0 ° (standard deviation, 6.5 °) for apical rotation, and 20.0 ° (standard deviation, 7.3 °) for net twist. Conclusions We report the comprehensive assessment of normal myocardial deformation and rotational mechanics in a large cohort of healthy volunteers. We found that women have more negative longitudinal strain, accounting for their higher left ventricular ejection fraction. Availability of reference values for these parameters may foster their implementation in the clinical routine. Full English text available from: www.revespcardiol.org/en. © 2013 Sociedad Española de Cardiología. Published by Elsevier España, S.L. All rights reserved.

Polycystic ovary syndrome (PCOS) is closely related to increased cardiovascular risk in women of reproductive age. Atrial conduction abnormalities in these patients have not been investigated in terms of atrial electromechanical delay measured by tissue Doppler imaging (TDI) as an early predictor of atrial fibrillation development. The aim of this study was to evaluate whether TDI-derived atrial conduction time is prolonged in PCOS. The study included 51 patients with PCOS and 48 age-matched healthy controls. P-wave dispersion (PWD) was calculated on the 12-lead surface electrocardiogram. Systolic and diastolic left ventricular (LV) functions, atrial electromechanical coupling, intraatrial and interatrial electromechanical delays were measured with conventional echocardiography and TDI. PWD was higher in PCOS women (50.45 ± 3.7 vs 34.73 ± 6.7 ms, p = 0.008). Interatrial and intraatrial electromechanical delay were found longer in patients with PCOS compared to controls (41.9 ± 9.0 vs 22.2 ± 6.6 ms, p

Background Although a treadmill exercise stress testing (EST) is often the first-line screening procedure for subjects with an intermediate probability of coronary artery disease (CAD), one limitation of this test is the high rate of inconclusive tests that result from borderline exercise-induced ST changes. The carotid intima media thickness (CIMT) correlates well with atherosclerosis. The purpose of this study was to evaluate the clinical usefulness of performing CIMT measurements in patients with an inconclusive EST. Methods Symptomatic patients without history of vascular disease and with inconclusive EST result were included. Inconclusive results were defined as the presence of horizontal or downsloping ST-segment depression between 0.5 and 0.9 mm or 1.0 and 1.4 mm upsloping ST-segment depression. After inconclusive EST regarding electrocardiographic changes, the measurements of the CIMT and myocardial perfusion imaging study (MPS) were performed in all patients. The CIMT was measured at the posterior wall of the common carotid artery. The diagnosis of CAD was based on the presence of reversible perfusion defects on exercise MPS. Results A total of 87 patients (57 men) with a mean age of 58.9 ± 7.2 years were enrolled. The MPS was positive in 18 patients. The CIMT in patients with positive MPS was significantly greater than in patients with negative MPS. The CIMT was 0.82 ± 0.33 mm in patients with positive MPS and 0.63 ± 0.21 mm in patients with negative MPS (p = 0.004). Receiver operating characteristic curve analyses revealed that the greatest specificity was obtained when the cut-off value of CIMT was set at 0.66 mm (sensitivity 39%; specificity 72.5%; positive predictive value 27%; negative predictive value 82%). Conclusion In patients with inconclusive electrocardiographic changes during EST, CIMT was a useful measurement to prevent alternative more expensive and invasive tests. Additionally, mean CIMT is useful for screening patients with an inconclusive EST result to exclude CAD.

Nonalcoholic fatty liver disease (NAFLD) encompasses a disease spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). We aimed to evaluate left ventricular (LV) systolic function using two-dimensional speckle-tracking echocardiography (2D-STE) in patients with NAFLD and to investigate whether any changes exist among the subgroups of NAFLD.We included 55 NAFLD patients and 21 healthy controls. The diagnosis of NAFLD was made on the basis of liver biopsy. After the patients were categorized into groups according to their histopathological analysis (simple steatosis, borderline NASH, and definitive NASH), all patients underwent echocardiography. In the 2D-STE analysis of the LV global longitudinal strain (G-LS), strain rate in systole (G-SRsys), strain rate in early diastole (G-SRearly), and strain rate in late diastole (G-SRlate) values were obtained.G-LS and G-SRsys values were lower in the NAFLD group. Although there was a significant difference in the G-LS between controls and simple steatosis, borderline NASH, and definitive NASH, no significant differences were found between NAFLD groups. To investigate whether impaired LV systolic dysfunction, determined using 2D-STE, is the consequence of NAFLD components, we included a subgroup. A total of 11 patients with NAFLD who were normotensive, nondiabetic, nonobese, and had a normal lipid profile and low homeostasis model assessment of insulin resistance (HOMA-IR) values were included. Echocardiographic abnormalities in systolic function were not different between this subgroup of NAFLD and healthy individuals.Patients with NAFLD and its subgroups have evidence of subclinical myocardial dysfunction in relation to the presence of insulin resistance. 2D-STE could not be used for differentiation of the NAFLD subgroups.

Objectives: The SYNTAX score (SXscore) has emerged as a reproducible angiographic tool to quantify the extent of coronary artery disease based on the location and complexity of each lesion. The aim of this study was to evaluate whether the SXscore is an independent predictor of long-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 2993 patients with acute STEMI who underwent primary PCI were stratified into the 4 groups according to the SXscore quartiles; quartile 1(Q1, SXscore ≤ 9, n = 819), Q2 (9 < SXscore < 16, n = 715), Q3 (16 ≤ SXscore < 20, n = 710), and Q4 (SXscore ≥ 20, n = 749). Results: There were significant differences among the quartiles with respect to age, basal creatinine and glucose levels, and the incidences of diabetes mellitus, Killip ≥2, and anemia. From Q1 to Q4, there were increasing rates of culprit left anterior descending lesion ( P < .001), multivessel disease ( P < .001), chronic total occlusion ( P < .001), and proximal lesion localization ( P < .001). At long-term follow-up, all-cause mortality, nonfatal myocardial infarction, stroke, rehospitalization due to heart failure, and the need of revascularization were significantly more frequent among the patients in the highest SXscore quartile. In multivariate analysis, after including the SXscore as a numerical variable into the model, every point of increase was determined as an independent predictor for long-term mortality (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = .008) and for overall major adverse cardiac events (MACEs; HR 1.02, 95% CI 1.01-1.04, P < .001). Conclusion: The SXscore is an independent predictor of both in-hospital and long-term mortality and MACE in patients with acute STEMI undergoing primary PCI.

Objectives: Typical atrioventricular nodal reentrant tachycardia (AVNRT) can be cured with slow pathway ablation. This study was designed to assess the alterations in atrial and ventricular functioning using speckle tracking echocardiography in consecutive patients with typical AVNRT who underwent slow pathway radiofrequency (RF) ablation. Study design: Included in this study were 23 consecutive patients with symptomatic drug-resistant typical (slow-fast) AVNRT, all of whom underwent an invasive electrophysiology study and RF ablation. Patients underwent transthoracic echocardiographic evaluation 24 hours before and 24 hours after the ablation procedure. Results: AVNRT was induced during the electrophysiological study, and RF ablation successfully eliminated tachyarrhythmia in 23 (100%) patients. The atrial-His (A-H) interval was decreased in the post-ablation period compared to the pre-ablation period without the occurrence of immediate conduction disturbances. Peak left atrial longitudinal strain during the reservoir phase was increased in the post-ablation period compared to the pre-ablation period (48.24+-16.45 vs. 38.07+-15.72, p

Background: We aimed to evaluate the role of B-type natriuretic peptide (BNP) in assessing severity of coronary artery disease by SYNTAX score (SS) II in a prospective study among ST elevation acute coronary syndrome (ACS) patients. Methods: One thousand and six patients with ST elevation myocardial infarction (STEMI) who admitted for primary percutaneous intervention were included. The patients were divided into two groups according to SS II values (≤32 and >32). The independent predictors of high SS II were investigated, and the best cutoff value of BNP, high-sensitivity C-reactive protein (hs-CRP), peak troponin I, and hemoglobin level in predicting high SS II was determined.Results: There was a positive correlation between BNP, white blood cell, hs-CRP, fasting blood glucose, peak troponin I, and SS I. SS II and hemoglobin were negative, but other parameters were positively correlated. High SS II group independent predictors of hypertension, diabetes mellitus, smoking, multivessel disease, high Killip class, BNP, peak troponin I, hemoglobin, and hs-CRP levels were found in STEMI patients. The value of BNP >87.15 pg/ml with 59% sensitivity and 77% specificity (area under the curve [AUC]: 0.722 [95% confidence interval [CI]: 0.689–0.756], P < 0.001), hs-CRP >10.85 mg/dl with 64% sensitivity and 64% specificity (AUC: 0.685 [95% CI: 0.65–0.72], P < 0.001), peak troponin I >77.83 ng/mL with 68% sensitivity and 63% specificity (AUC: 0.704 [95% CI 0.67–0.738], P < 0.001), and hemoglobin >16.75 g/dL with 4% sensitivity and 97% specificity (AUC: 0.345 [95% CI: 0.309–0.382] P < 0.001) independently predicted high SS II group. Conclusion: Serum BNP level was independently associated with the severity of coronary atherosclerosis in patients with ACS together with multivessel disease, left ventricular ejection fraction, hs-CRP, and troponin. Therefore, BNP assessment gives additional prognostic information for early risk stratification of patients with ACS.

Background: During coronary artery bypass grafting (CABG), one of the most important complications related to the internal mammary artery (IMA) is perioperative spasm. Nebivolol causes endothelium-dependent vascular relaxation by increasing nitric oxide (NO) release and prevents endothelial dysfunction in long-term use. In our study, we measured the effect of a third generation beta blocker, nebivolol, on the flow dynamics of IMA grafts. Methods: We recruited 90 hypertensive patients undergoing isolated CABG operation, who were divided into three groups and each group included 30 patients: Group 1 patients were under antihypertensive treatment other than beta-blockers (angiontensin-converting enzyme [ACE] inhibitors, calcium channel blockers or diuretics; monotherapy or combination therapy), Group 2 received metoprolol (50 mg/day) and Group 3 received nebivolol (5 mg/day). These antihypertensive therapies were given for at least one week before the operation and continued thereafter. IMA blood flow volume was measured for one minute just before cardiopulmonary bypass (measurement A) and before left internal mammary artery (LIMA)-left anterior descending (LAD) artery anastomosis (measurement B) in the three groups. Cardiac output measurements were also achieved simultaneously. Results: The measurement A results were 56.3 ± 36.2, 54.6 ± 28.1 and 66.8 ± 34.2 mL/min in Groups 1, 2 and 3, respectively (p0.05). While the cardiac outputs were similar within the three groups, the IMA free flow volume was higher in the nebivolol group after local papaverine use. Conclusion: Nebivolol might represent a good choice in hypertensive patients undergoing cardiac surgery by preventing perioperative myocardial hypoperfusion which increases early morbidity and mortality.

Although very high gradient levels were measured during the evaluation of ventricular septal defect (VSD) in daily practice, these measurements are generally interpreted as erroneous and thus neglected. Our aim was to assess the features of VSD’s having erroneous interventricular pressure gradients by echocardiography. A 46 patients were enrolled in the study. The patients with higher Doppler-derived interventricular gradient than brachial systolic blood pressure were compared with patients with lower gradient (group 1, n = 26; group 2, n = 20, respectively) in terms of echocardiographic characteristics of VSD. No significant relations were observed in systolic and diastolic blood pressure and interventricular synchronicity between two groups (117.1 ± 6.7 vs 110.2 ± 6.3 mmHg, p = 0.145; 74.7 ± 4.3 vs 73.2 ± 4.9 mmHg, p = 0.32; 31.2 ± 5.5 vs 33.2 ± 4.9 msn, p = 0.29, respectively). Left ventricular end-diastolic and end-systolic diameters were greater in group 2 (46.6 ± 3.5 vs 49.5 ± 4.5, p = 0.022; 30.3 ± 2.5 vs 32.9 ± 3.2, p = 0.004, respectively). Doppler-derived interventricular pressure gradients were significantly higher in group 1 (144.4 ± 13.6 vs 75.7 ± 5.1 mmHg, p

Primary percutaneous coronary intervention (P-PCI) is the gold standard treatment for acute coronary syndromes. Plasma levels of catecholamines and other vasopressors are elevated during acute myocardial infarction (AMI) and coronary vasoconstriction is frequent. We aimed to compare the reference vessel diameter (RVD) of the infarct-related artery (IRA) during primary PCI and after an average of 3 days.Coronary angiography (CAG) was performed on 58 patients with acute ST-segment elevation myocardial infarction (STEMI) and TIMI 3 flow after P-PCI (43 men, 15 women; mean age, 55.5 ± 10 years). TIMI 3 flow was achieved either by simple balloon dilatation and/or thrombus aspiration. Lesion length, RVD, minimal lumen diameter (MLD), mean vessel diameter (meanD), and area of stenosis were compared during P-PCI and follow-up CAG.RVD, MLD, and meanD values were significantly higher during the follow-up CAG than after P-PCI (RVD 2.7 ± 0.7 mm vs. 2.9 ± 0.7 mm, p = 0.001; MLD 1.5 ± 0.5 mm vs. 1.7 ± 0.4 mm, p = 0.002; meanD 2.2 ± 0.5 mm vs. 2.4 ± 0.5 mm, p = 0.001). Area of stenosis values were significantly lower during the follow-up CAG than after primary PCI (69.5 ± 16.5 % vs. 62.1 ± 15 %, p = 0.001). Lesion lengths were not statistically significant during the follow-up CAG and primary PCI (lesion length 24.0 ± 10.8 mm vs. 22.1 ± 8.8 mm, p 0.05).This study showed that RVD was higher at the follow-up CAG a few days after AMI in patients who had TIMI 3 flow after P-PCI with simple balloon dilatation and/or thrombus aspiration. A delay of a few days for stent implantation in P-PCI allows for larger-diameter stent use and may help to reduce stent thrombosis and restenosis rates.

We report a case of cyst was initially labeled as left ventricular noncompaction cardiomyopathy. An accurate diagnosis is essential to establish the most effective treatment strategy. In particular, echocardiographic examination assists in identifying the correct diagnosis. In this case, two-dimensional and three-dimensional echocardiography and computed tomography were used for definitive diagnosis of cardiac hydatid cyst.

Carotid artery stenosis is the major cause of the stroke associated with ischemic origin and carries increased mortality and morbidity. Since carotid artery endarterectomy (CEA) was first performed in 1950, in conjunction with the advanced technology and increased experience under the guidance of randomized controlled trials, balloon angioplasty and carotid artery stenting, which have similar mortality and morbidity, have become comparable with CEA. Determining the optimal treatment option for each patient is the most important issue in carotid artery stenosis. Today, there have been improvements in technology and recent advances in the cardiovascular sciences. Moreover, there is increased experience, increased attention to patient selection, and a team approach to find the most suitable treatment for the patient. In this review, we briefly discuss the current treatment approaches for carotid artery stenosis under the guidance of the modern studies.

WOS: 000384729500007, PubMed ID: 27319275, Background: Vasculogenic erectile dysfunction is a harbinger of vascular disease. Comprehensive cardiac workup is accepted to be beneficial in men with this condition, especially those with otherwise unrecognized cardiovascular disease. We aimed to evaluate the role of two-dimensional speckle-tracking echocardiography (2D-STE) for noninvasive evaluation in patients with documented arteriogenic erectile dysfunction. Methods: 64 consecutive men with Doppler proven erectile dysfunction of more than 3 months of duration were recruited. Patients divided into 2 groups according to mean peak systolic velocity (PSV). Patients with PSV < 20 cm/sn constituted Group 1 and patients with PSV >= 20 cm/sn constituted Group 2. All underwent echocardiography and were compared. According to the 2D-STE analysis for the left atrium (LA); strain during ventricular systole (LARes), during late diastole (LA-Pump), strain rate during ventricular contraction (LA-SRs), during passive ventricular filling (LA-SRe), during active atrial contraction (LASRa) values and for LV; global longitudinal strain (GLS), strain rate in systole (GSRs), strain rate in early diastole (GSRe), and strain rate in late diastole (GSRa) values were obtained. Results: Beside diastolic parameters, LA-Res and LA-Pump were found to be significantly different between groups. GLS and GSR values were lower in Group 1. Moreover, correlation analysis revealed a significant correlation of GLS values with PSV (r = -0.4, P = .001). Conclusion: Myocardial deformation parameters by 2D-STE are valuable for detection of subclinical cardiovascular dysfunction in men with arteriogenic erectile dysfunction. This noninvasive method may be used as an emerging prognostic marker for risk stratification. Copyright (C) 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Objective: To evaluate whether a complete analysis of electrocardiograms (ECGs) taken before hip fracture surgery could provide prognostic data regarding in-hospital perioperative cardiovascular complications (PCVCs). Methods: Elderly patients who underwent surgery using a proximal femoral nail due to peritrochanteric fracture between 2009 and 2013 were retrospectively evaluated. Patients’ 12-lead preoperative ECGs were analyzed and corrected QT intervals (QTcs) were calculated. Following analysis, ECGs with atrial fibrillation, left or right bundle branch block, ventricular premature beats, Q-waves, ventricular strain, sinus bradycardia or tachycardia were designated as abnormal. The relationship between observed ECG abnormalities and calculated QTc interval, and the development of in-hospital PCVC was evaluated. Results: In total, 190 male and 232 female patients were included in the study. Two hundred nineteen (51.9%) patients had a fractured right hip and 203 (48.1%) had a fractured left hip. ECGs of 133 patients were abnormal. Seventeen patients (4.02%) died and 62 patients (14.6%) developed PCVCs. There was a statistically significant increase (P=0.0183) in PCVC as perioperative cardiac risk factors increased. Of the abnormal ECG changes, only atrial fibrillation, paced rhythm and ventricular strain were found to be related to PCVCs (P

Varenicline (Champix, Chantix) has been available for use in smoking cessation since 2006. This drug has been associated with adverse cardiovascular events. Potential mechanisms for this association include modulation of parasymphathetic output from the brainstem to the heart, release of catecholamines and prothrombotic effect. We report the case of a 30-year-old man with no known cardiac disease, who developed thrombotic occlusion of left anterior descending artery and presented with acute coronary syndrome secondary to treatment with varenicline. The Naranjo probability scale indicates that varenicline was the probable cause of the myocardial infarction.

This letter to the editor reports on a case of third-generation oral contraceptive pill use associated with spontaneous coronary dissection of the left coronary artery and proximal thrombotic occlusion of the right coronary artery (RCA).

Although the effects of chronic alcoholism on left ventricular (LV) systolic function are well established, diastolic impairment has been evaluated partially. In addition, there are scarce data available about the relation of LV diastolic function to either or both duration and quantity of drinking among alcoholics. The aim of the study was to evaluate the left atrial (LA) function in chronic asymptomatic alcoholic patients by using two-dimensional speckle-tracking echocardiography (2D-STE). We enrolled 30 healthy subjects (age 34.8 ± 5.8 years) and 75 asymptomatic male alcoholics (age 39.8 ± 6.5 years) divided into two groups, according to total lifetime dose of ethanol: group I

Peripartum cardiomyopathy (PPCM) is a rare form of dilated cardiomyopathy that is associated with high maternal morbidity and mortality. Onset is usually between the last month of pregnancy and up to the fifth month postpartum. PPCM usually presents with signs and symptoms of heart failure and rarely with thromboembolic complications. The true incidence of thromboemboli in PPCM is unknown. Herein we report an unusual case of PPCM in a previously healthy woman who presented with recurrent transient ischemic attacks due to thrombus in the left ventricle. Resumo: A miocardiopatia periparto (MPP) é uma forma rara de miocardiopatia dilatada, associada a elevada mortalidade e morbilidade materna. A doença manifesta-se habitualmente entre o último mês de gravidez até ao 5.° mês depois do parto. A MPP apresenta-se habitualmente com sinais e sintomas de insuficiência cardíaca e, raramente, com complicações tromboembólicas. A verdadeira incidência de tromboembolismo na MPP não é conhecida. Apresentamos um caso, pouco habitual, de MPP em mulher previamente saudável que se apresentou com acidentes isquémicos transitórios recorrentes, devido à presença de trombo no ventrículo esquerdo. Keywords: Peripartum cardiomyopathy, Transient ischemic attacks, Transthoracic echocardiography, Palavras-chave: Miocardiopartia periparto, Acidente isquémico transitório, Ecocardiografia transtorácica

Background: The aim of this study was to determine right ventricular (RV) and right atrial (RA) deformation assessed by two-dimensional echocardiographic and three-dimensional echocardiographic (3DE) imaging in patients with prediabetes and type 2 diabetes mellitus. Methods: This cross-sectional study included 47 untreated normotensive subjects with prediabetes, 57 recently diagnosed normotensive patients with diabetes, and 54 healthy controls of similar sex and age distributions. All subjects underwent laboratory analyses and complete two-dimensional echocardiographic and 3DE examinations. Results: Three-dimensional echocardiographic RV end-diastolic volume index gradually decreased from controls across patients with diabetes to those with diabetes (69 ± 10 vs 63 ± 8 vs 58 ± 8mL/m2, P < .001), whereas 3DE RV end-systolic volume index was higher in controls compared with patients with diabetes and those with diabetes (25 ± 4 vs 23 ± 4vs 22 ± 4mL/m2, P < .001). However, there was no difference in 3DE RV ejection fraction among the three groups (63 ± 4% vs 62 ± 4% vs 61 ± 5%, P = .063). RV and RA global strain and systolic and early diastolic strain rates were decreased in patients with prediabetes and in those with diabetes compared with controls, whereas RV and RA late diastolic strain rates were increased in these patients. Multivariate regression analysis showed that RV global strain was associated with glycated hemoglobin, independent of left ventricular parameters. Conclusions: RV and RA myocardial deformation and function obtained by 3DE and two-dimensional echocardiographic strain, even in normal ranges, were decreased in patients with prediabetes and in those with diabetes compared with controls. The long-term parameter of glucose control was correlated with the right heart mechanics.

The clinical and angiographic predictors of coronary artery aneurysm (CAA) formation in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are not clear. This study aims to assess the predictors of CAA formation after primary PCI. 3,428 patients who underwent PCI for STEMI were enrolled. The average period of follow-up was mean 48 months (range 35–56 months) after PCI. During this time, 1,304 patients were underwent follow-up coronary angiography. CAA was detected in 21 patients (1.6 %). CAA occurred at the segment of stent implantation in all patients. The clinical and angiographic data were compared between patients with CAA group (n = 21) and without CAA group (n = 1,283). Patients who developed CAA had longer reperfusion time, higher high-sensitiviy C-reactive protein (hs-CRP) levels and neutrophil to lymphocyte ratio than those who had without CAA. Angiographically, CAA developed proximally located lesions and lesion length was significantly greater in patients with CAA than without CAA. Statin and beta-blocker discontinuation were found higher in stent-associated CAA. Every 1 mg/l increase in hs-CRP and implantation of drug eluting stent (DES) were independent predictor of CAA formation after STEMI. Baseline elevated inflammation status and DES implantation in the setting of STEMI may predict the CAA formation.

PP-234 Bicuspid aortic valve (BAV) is the result of abnormal aortic leaflet formation during valvulogenesis. Recently, it has been shown that BAV is associated with abnormal aortic stiffness, which has a negative impact on left ventricular (LV) diastolic function. The purpose of this study was to

The presence of the metabolic syndrome is a strong predictor for the presence of NASH (non-alcoholic steatohepatitis) in patients with NAFLD (non-alcoholic fatty liver disease). In the present study, we assessed LA (left atrial) deformation parameters in patients with NAFLD using 2D-STE (speckle tracking echocardiography) and to investigate if any changes exist between subgroups of the NAFLD. A total of 55 NAFLD patients and 21 healthy controls were included in the study. The diagnosis of NAFLD was based on liver biopsy. After patients were categorized into groups according to histopathological analysis (simple steatosis, borderline NASH, definitive NASH), all patients underwent echocardiography with Doppler examination. In the 2D-STE analysis of the left atrium, LA-Res (peak LA strain during ventricular systole), LA-Pump (peak LA strain during atrial systole), LA-SRS (peak LA strain rate during ventricular systole), LA-SRE (peak LA strain rate during early diastole) and LA-SRA (peak LA strain rate during atrial systole) were obtained. LA-Res, LA-Pump and LA-SRA were lower in the NAFLD group than in the control group. LA-Res was found to be significantly lower in NAFLD subgroups compared with healthy subjects (43.9±14.2 in healthy controls compared with 31.4±8.3 with simple steatosis, 32.8±12.8 with borderline NASH and 33.8±9.0 with definitive NASH). LA-Pump was significantly lower in the NAFLD group (18.2±3.1 in healthy controls compared with 13.3±4.7 with borderline NASH and 14.4±4.7 with definitive NASH). There were significant differences in LA-SRA between healthy controls compared with simple steatosis and borderline NASH (−1.56±0.36 compared with 1.14±0.38 and 1.24±0.32 respectively). Correlation analysis showed significant correlation of LA-Res values with E (early diastolic peak velocity)/Em (early diastolic mitral annular velocity) ratio (r=−0.50, P≤0.001), with LAVI (LA volume index; r=−0.45, P≤0.001) and with Vp (propagation velocity; r=0.39, P≤0.001). 2D-STE-based LA deformation parameters are impaired in patients with NAFLD with normal systolic function. Although LA-Res and pump function parameters might be useful in estimating LV (left ventricular) filling pressure in the NAFLD patient group, it could not be used for differentiating the subgroups.

To the Editor We read with interest Plonczak et al ’s1 article depicting the two-vessel spontaneous coronary artery dissection (SCAD) as a cause of acute coronary syndrome (ACS). SCAD is uncommon, accounting for 0.1–0.28% of all patients with ACS or sudden cardiac …

The aim of this study was to compare the right ventricular (RV) structure and diastolic function between normotensive and non-diabetic subjects with metabolic syndrome (MS), and new diagnosed diabetic and hypertensive patients. Study included 89 normotensive and non-diabetic subjects with MS which was defined by the presence ≥3 ATP-NCEP-III criteria, 45 diabetic and 117 hypertensive patients, as well as 76 controls with no MS criteria, matched for age and sex. All subjects underwent laboratory blood tests and complete two-dimensional echocardiography including pulsed and tissue Doppler. RV free wall thickness was similar between MS and diabetic patients, but significantly lower than in hypertensive patients (4.6 ± 0.8 versus 4.3 ± 0.7 versus 4.9 ± 0.9 mm; p 0.01). Tricuspid E/e' ratio was similar between observed groups (5.3 ± 1.2 versus 5.2 ± 1.1 versus 5.7 ± 1.2, p 0.05). RV systolic function evaluated by tissue Doppler (st) was similar between MS and diabetic participants, but still worse than in hypertensive patients (13.1 ± 2.2 versus 13.5 ± 2.5 versus 12.5 ± 2.4, p 0.05). Global RV function estimated by Tei index was similar among MS and diabetic patients, and most impaired in hypertensive patients (0.47 ± 0.09 versus 0.45 ± 0.08 versus 0.52 ± 0.1, p 0.01). Increased fasting glucose level, abdominal obesity and hypertension were independent predictors of biventricular hypertrophy, diastolic dysfunction and global dysfunction in whole population. RV structure and function gradually deteriorated from diabetic patients, across MS subject, to hypertensive patients. Normotensive and non-diabetic subjects with MS had similar level of RV impairment as diabetic patients which emphasize the synergic effects of MS components on cardiac damage.

YouTube has become a useful resource for knowledge and is widely used by medical students as an e-learning source. The purpose of this study was to assess the videos relating electrocardiogram (ECG) on YouTube.YouTube was searched on May 28, 2013 for the search terms "AF ecg" for atrial fibrillation, "AVNRT" for atrioventricular nodal reentrant tachycardia, "AVRT" for atrioventricular reentrant tachycardia, "AV block or heart block" for atrioventricular block, "LBBB, RBBB" for bundle branch block, "left anterior fascicular block or left posterior fascicular block" for fascicular blocks, "VT ecg" for ventricular tachycardia, "long QT" and "Brugada ecg". Non-English language, unrelated and non-educational videos were excluded. Remaining videos were assessed for usefulness, source and characteristics. Usefulness was assessed with using a checklist developed by the authors.One hundred nineteen videos were included in the analysis. Sources of the videos were as follows: individuals n=70, 58.8%, universities/hospitals n=10, 8.4% and medical organizations n=3, 2.5%, health ads n=10 8.4%, health websites n=26, 21.8%. Fifty-six (47.1%) videos were classified as very useful and 16 (13.4%) videos were misleading. 90% of the videos uploaded by universities/hospitals were grouped as very useful videos, the same ratio was 45% for the individual uploads. There were statistically significant differences in ECG diagnosis among the groups (for very useful, useful and misleading, p0.001, 0.02 and 0.008, respectively). The ratio of the misleading information in ventricular tachycardia videos was found to be 42.9%.YouTube has a substantial amount of videos on ECG with a wide diversity from useful to misleading content. The lack of quality content relating to ECG on YouTube necessitates that videos should be selected with utmost care.

Aluminium (Al) is the third most prevalent element, representing approximately 8% of total mineral components in the earth's crust (1). Chronic exposure to Al is mainly encountered at particular work places, for example, in foundries or in the Al powder industry, as an occupational exposure. In case of occupational Al exposure, inhalation is the main route of uptake. Chronic exposure to Al is associated with skeletal, neurological, hematological and lung changes. Studies regarding the Al powder industry showed that long-term inhalative exposure to Al can induce pulmonary fibrosis (2). Although there is only one report about ventricular tachycardia as a cardiac manifestation in occupationally exposed persons (3), in this report, we presented a case that had Mobitz type I second-degree atrioventricular block and nonsustained ventricular tachycardia. To our knowledge, this is the first report in chronic poisoning.

Mini-Abstract We present a 74-year-old man with a history of hypertension presented to the emergency room with shortness of breath and dizziness. A resting electrocardiogram showed 2:1 atrioventricular block with a wide QRS duration and a rhythm of 35 beats/min. Transthoracic echocardiography was performed and color flow Doppler, color M-mode, and continuous-wave Doppler recordings of the transmitral flow revealed retrograde flow into the left atrium after the blocked P-wave, which indicate holodiastolic mitral regurgitation.

Background Recent European Association of Echocardiography and American Society of Echocardiography guidelines on three-dimensional echocardiography state that normal values of left ventricular (LV) parameters for age and body size remain to be established. Methods In 226 consecutive healthy subjects (125 women; age range, 18–76 years), comprehensive three-dimensional echocardiographic analyses of LV parameters were performed, and values were compared with those obtained by conventional echocardiography. Results Upper reference values (mean + 2 SDs) for three-dimensional LV end-diastolic and end-systolic volumes were 85 and 34 mL/m 2 in men and 72 and 28 mL/m 2 in women, respectively. Indexing LV volumes to body surface area did not eliminate gender differences. Lower reference values (mean − 2 SDs) for ejection fraction were 54% in men and 57% in women and for stroke volume were 25 and 24 mL/m 2 , respectively. Upper reference values for LV mass were 97 g/m 2 in men and 90 g/m 2 in women and for end-diastolic sphericity index were 0.49 and 0.48, respectively. Significant age dependency of LV parameters was identified and reported across age groups. Three-dimensional echocardiographic LV volumes were larger, ejection fraction was similar, and LV stroke volume and mass were significantly smaller in comparison with the corresponding values obtained by conventional echocardiography. Conclusions The investigators report a comprehensive analysis of LV geometry and function using three-dimensional echocardiography in a relatively large cohort of healthy Caucasian subjects with a wide age range. These may serve to establish age-specific and gender-specific reference ranges, which are crucial for the routine implementation of three-dimensional echocardiography to detect LV remodeling and dysfunction in clinical practice.

Currently, nonalcoholic fatty liver disease (NAFLD) itself has been accepted as an atherosclerotic risk factor and related to increased cardiovascular disease risk. In this study, we aimed to investigate the relationship of epicardial fat thickness (EFT), a parameter associated with atherosclerosis in recent years, with carotid artery intima-media thickness (C-IMT), another parameter of subclinical atherosclerosis.We investigated 57 patients with biopsy-proven NAFLD and 30 age-matched and sex-matched controls. EFT was obtained by transthoracic echocardiography and C-IMT was evaluated by an ultrasonographic measurement using a linear type B-mode probe.EFT and C-IMT were significantly higher in NAFLD patients compared with the controls (EFT: 0.58 ± 0.18 vs. 0.36 ± 0.17 cm, P0.001 and C-IMT: 0.64 ± 0.1 vs. 0.52 ± 0.1 mm, P0.001, respectively). We found a statistically significant correlation between EFT and BMI, C-IMT, waist circumference, homeostasis model assessment of insulin resistance, and nonalcoholic steatohepatitis scores in both groups. Stepwise regression analysis showed that C-IMT (β=0.36, t=2.86, P=0.006) and waist circumference (β=0.3, t=2.44, P=0.018), in the order they entered into the model, were independent predictors of EFT in patients with NAFLD.Our findings indicate that EFT and C-IMT were significantly higher in patients with NAFLD compared with the controls and waist circumference and C-IMT are independent predictors for EFT in patients with NAFLD.

Summary Objectives Connective tissue diseases involve characteristic inflammatory lesions in the cardiovascular system, in addition to other systems. The involvement of the cardiovascular system in the course of connective tissue diseases may result in serious morbidity and mortality. Pulse wave velocity which is an indicator of arterial dilatation capacity may predict cardiovascular risk of patients. Pulse wave velocity is inversely proportional to arterial dilatation capacity. Decreased dilatation capacity leads to a reduction in arterial blood pressure and flow dynamics and impairment in coronary perfusion. Methods In our study, we examined pulse wave velocity in frequent chronic inflammatory rheumatologic diseases: rheumatoid arthritis, systemic lupus erythematosus, and Behcet's disease. A total of 98 subjects participated in our study including 24 patients with newly diagnosed rheumatoid arthritis (4 males, 20 females; mean age 42.5 ± 11.5 years), 22 patients with newly diagnosed systemic lupus erythematosus (1 male, 21 females; mean age 35.8 ± 11.1 years), 33 patients with newly diagnosed Behcet's disease (26 males, 7 females; mean age 32.7 ± 8.0 years), and 19 healthy subjects in the control group (10 males, 9 females; mean age 36.2 ± 15.0 years). Aorta pulse wave velocity was determined by Complior Colson (Createch Industrie, Garges les Gonesses, France) device which allowed for pulse wave recording and automated measurement. Results Pulse wave velocity was higher in rheumatoid arthritis, systemic lupus erythematosus, and Behcet's disease groups compared to the control group. When all variables were included in the regression analysis only age was found to affect pulse wave velocity independently. Conclusion Pulse wave velocity was found to be high in chronic inflammatory connective tissue diseases compared to the control group. However, no difference was found between groups. Age was determined as the most important independent variable in the regression analysis.

It is well-known that collateral circulation is important in preserving ventricular functions, especially in coronary artery disease with total occlusion. The conus branch is distinct in having notable capacity of angiogenesis and arteriogenesis. We intend to emphasize the clinical importance of the conus branch by presenting two cases in which it supplied the distal regions of total occlusion.

Trastuzumab is a monoclonal antibody used for the treatment of metastatic breast carcinoma in women whose tumors overexpress the human epidermal growth factor receptor-2. Although trastuzumab is generally well tolerated, cardiac toxicity has occurred as a rare but potentially serious complication that limits its use in some patients. In this study, we detected new-onset mitral regurgitation in trastuzumab-treated patients. To our knowledge, there is no report or survey on new-onset mitral regurgitation during this treatment. We discussed the possible reasons for this newly described side effect of the drug in the light of left ventricular longitudinal global strain and papillary muscle dyssynchrony of the patient by detecting two-dimensional speckle tracking echocardiography.

The diagnostic administration of contrast agents has been increased recently in various fields, including coronary angiography, but reports of coronary artery spasm caused by contrast agents are rare. However, myocardial infarction following administration of nonionic contrast agents has not been reported, as far as we are aware. Herein, we described a case of acute anterior myocardial infarction induced by the contrast agent iopromide (Ultravist). We also discussed the possible reasons for this situation.

Non-ionic agents have pharmacological side effects, such as seizure, alteration of cerebral function, confusion, short-term memory loss, mental aberrations and ophthalmoplegia. In this report, we present two cases that developed contrast-induced encephalopathy following coronary angioplasty by the non-ionic contrast agent, iopromide (Ultravist® ). As a result, we concluded that iopromide-induced encephalopathy may occur during angioplasty in patients with no particular predispositions. In addition to that, contrast-induced encephalopathy should be considered as a new-onset neurological disorder.

In this report, we present a case of an 84-year-old woman treated with a low-dose prolonged infusion of tissue plasminogen activator (tPA) for a free-floating thrombus in the right atrium.

We report on a patient who developed cardiogenic shock caused by dynamic left ventricular outflow tract (LVOT) obstruction following percutaneous coronary intervention for anteroseptal acute myocardial infarction.

Amyloidosis is a clinical disorder caused by extracellular and or intracellular deposition of insoluble abnormal amyloid fibrils that alter the normal function of tissues. Amyloid A amyloidosis is the most common form of systemic amyloidosis worldwide The heart may be affected in systemic AL amyloidosis, but also more rarely in A amyloidosis. In this report, we presented a patient with A-type amyloid heart disease who had dynamic left ventricular outflow tract obstruction mimicking hypertrophic obstructive cardiomyopathy. We also investigated left ventricular torsion, untwisting rate and left ventricular longitudinal global strain by two-dimensional speckle tracking echocardiography.

1 Department of Cardiology, Kosuyolu Heart Center, Kartal, Istanbul, Turkey 1 Kartal Kosuyolu Yuksek Ihtisas Egitim ve Arastirma Hastanesi, Kardiyoloji Klinigi, Istanbul, Turkiye 2 Department of Cardiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey 2 Bakirkoy Dr. Sadi Konuk Egitim ve Arastirma Hastanesi, Kardiyoloji Klinigi, Istanbul, Turkiye Left Circumfl ex and Left Anterior Descending Coronary Artery Supplying the Left Ventricular Apex-Double Protection

We present a case of isolated prolapse of the tricuspid anterior leaflet in an asymptomatic 34-year-old man who was referred to our hospital for a routine check up. We performed two-and three-dimensional transoesophageal echocardiography (TEE). We found three-dimensional TEE a useful, non-invasive tool that can provide additional information to two-dimensional echocardiography in the assessment of tricuspid valve prolapse.