Search

Unstable angina is common in ischemic heart diseases. Patients with unstable angina undergo coronary angiography to detect lesions that may require treatment. Coronary angiography can be performed through several ways of arterial access. Radial access is the most commonly used method. We report a 71 year old male patient who presented with chest pain due to unstabil angina pectoris. Coronary angiograhy was perfomed by a new technique, transpalmar access through superficial palmar branch of the ulnar artery. The patient was treated successfully with percutaneous coronary intervention of the left anterior descending artery. In our case, transpalmar approach was performed for the first time in Turkey.

AIM The aim of this study is to identify the predictors of angiographic no-reflow development in patients who underwent primary percutaneous coronary intervention and to investigate the long-term (median follow-up time=59 months) clinical endpoints. PATIENTS AND METHODS We retrospectively evaluated 3205 patients (824 females, mean age: 58.6 years) with acute myocardial infarction (ST-segment elevation myocardial infarction) admitted within the first 12 h of chest pain and treated with primary percutaneous coronary intervention between January 2006 and January 2010. The patients were divided into angiographic no-reflow [final Thrombolysis In Myocardial Infarction (TIMI)

Objective Mitral valve prolapse (MVP) is a heart valve anomaly that affects a considerable segment of the population. Studies of patients with isolated MVP have shown that aortic distensibility decreased as the aortic diameter increased. The aim of this study was to compare evaluations of aortic distensibility in MVP patients using both applanation tonometry and the conventional echocardiographic examination. Methods A total of 36 consecutive patients with MVP (16 male and 20 female) and 23 healthy controls (11 male and 12 female) were included in this study. The difference in aortic diameter and distensibility was examined using echocardiography and pulse wave velocity (PWV) was measured with applanation tonometry. Results According to the echocardiographic measurements, the aortic distensibility was lower in the MVP patients than in the control group (6.2±4.0 cm².dyn⁻¹.10⁻⁶ vs. 10.0±5.2 cm². dyn⁻¹.10⁻⁶; p=0.02). The PWV measured with applanation tonometry was significantly higher in the MVP patients than in the control group (9.0±2.4 m/s vs. 7.2±1.4 m/s; p=0.006). Conclusion The results of this study showed that aortic distensibility was reduced in patients with isolated MVP compared with a healthy control group. There was a moderate negative correlation between the results of both methods.

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:Thepurpose of this study was to evaluate left ventricular myocardial mechanicsusing 2-dimensional speckle tracking echocardiography (2D-STE) during normal,uncomplicated pregancy and postpartum term.Patientsand Methods: In this prospective, longitudinal study, 86 healthypregnant women who underwent serial 2 dimensional echocardiographic evaluationduring each trimester (trimester one 8-12 weeks; trimester two 20-24 weeks,trimester three 32-36 weeks, and postpartum 10-14 weeks). Two-dimensional STEwas performed to measure global left ventricular longitudinal, circumferential,and radial strain (GLS, GCS, and GRS, respectively).Results: GLS showeda decrease during pregnancy (for first trimester 21.0 ± 2.1%; for secondtrimester 19.9 ± 1.8%; for third trimester 18.2 ± 2.1; for postpartum 19.1 ±1.4, p< 0.001). GCS was significantly reduced during pregnancy (p= 0.033)and peaked as the same value in the first trimester. GRS remained unchangedthroughout the pregnancy and labor (p= 0.033).Conclusion: This study gives normalranges of 2D indices in pregnancy. 2D STE demonstrated that LV longitudinal andcircumferantial strain are significantly reduced, whereas radial strainremained unchanged., Giriş: Bu çalışmanın amacı sağlıklı gebelerde, gebelik süresince ve sonrasında solventrikül fonksiyonlarındaki değişimi “iki boyutlu speckle trackingekokardiyografi (STE)” yöntemi ile araştırmaktır.Hastalar veYöntem: Çalışmaya 86 sağlıklı gebe dahil edilmiş ve gebeliğinbirinci trimester 8-12 hafta, ikinci trimester 20-24 hafta, üçüncü trimester32-36 hafta ve postpartum 10-14. haftada 2 boyutlu ekokardiyografi ilekayıtları alınmıştır. Sol ventrikül global longitüdinal strain (SV-GLS), solventrikül global radiyal strain (SV-GRS), sol ventrikül global sirkumferansiyelstrain (SV-GCS) değerleri not edilmiştir. Bulgular: SV-GLS birinci trimester için -%21.0 ± 2.1; ikinci. trimester için -%19.9 ±1.8; üçüncü trimester için -%18.2 ± 2.1; postpartum -%19.1 ± 1.4, p< 0.001).SV-GCS gebelik boyunca anlamlı olarak azalırken (p= 0.033), post partum dönemde1.ci trimesterde bulunan değerlerine yükseldi. SV-GRS değerlerinde gebelikboyunca değişiklikler istatistiksel olarak anlamlı bulunmadı (p= 0.103).Sonuç: Bu çalışmada STE iledeğerlendirilen, SV-GLS ve SV-GCS ile mekanik fonksiyonlarının anlamlı birşekilde değiştiğini ve SV-GRS’de bir değişim olmadığını saptadık.

PubMed: 28623012 Objectives Coronary no-reflow (NR) following primary percutaneous coronary intervention (pPCI) is associated with worsened prognosis in patients with ST segment elevation myocardial infarction (STEMI). Despite rapid developments in cardiovascular area; there are limited data regarding prediction of NR before pPCI. P wave duration and dispersion (PWD, PWDIS respectively) have been studied in STEMI patients and found to be associated with reperfusion success; however none of them has been found to predict NR before PCI. In our study we aimed to evaluate whether PWD, PWDIS and a novel parameter P wave peak time (PWPT) could predict NR development in STEMI patients. Method Fifty six patients who were admitted with anterior STEMI constituted study populations. The diagnosis and treatment of STEMI was made on the basis of current guidelines. P wave parameters including PWD, PWDIS and PWPT were calculated from electrocardiograms that were obtained on admission and 60 min after pPCI. Results Patients were divided into two groups according to the development of NR. We observed that PWPT that were obtained from D2 (PWPTD2) and V1 (PWPTV1) leads were longer in NR group than reflow group. There were significant correlations between PWPT and reperfusion parameters regarding percent of ST segment resolution, peak CKMB level and TIMI frame count of infarct related artery. Preprocedural PWPTD2 was found to be an independent predictor of NR development. Conclusion In our study we observed that PWPT could be a useful parameter in the assessment of reperfusion success and prediction of NR development. © 2017 Elsevier Inc.

Giriş: Açlık dışıkalıntı kolesterolün artması, artmış düşük dansiteli lipoprotein kolesterol(LDL-C) gibi iskemik kardiyovasküler hastalıklar için artmış risk ileilişkilidir. Çalışmamızın amacı, ilk kez akut koroner sendrom (AKS) ile gelenhastalarda kalıntı kolesterol ve akut koroner sendromun arasındaki ilişkiyiaraştırmaktır. Hastalar ve Yöntem:İlk kez akut koroner sendrom ile başvuran 226 hasta ve normal koroner arterolarak sonuçlanmış 192 elektif koroner anjiyografi hastasında, diğer lipitprofili parametrelerinin yanı sıra, açlık dışı kalıntı kolesterolün artankonsantrasyonlarını karşılaştırdık. Bulgular: AKShastaları kontrol grubu ile karşılaştırıldığında erkek cinsiyet fazla, dahagenç ve daha fazla oranda diabetes mellitus mevcuttu (tümü için p< 0.001).AKS hastalarında glukoz ve beyaz kan hücresi düzeyleri de daha yüksekti.Kalıntı kolesterol, LDL-C değerine benzer şekilde, AKS grubunda istatistikselolarak kontrol grubu ile karşılaştırıldığında daha yüksekti (p< 0.001). Tekdeğişkenli ve çok değişkenli ikili lojistik regresyon analizinde yüksek kankalıntı kolesterolü, yüksek kan LDL-C değerleri ve düşük kan HDL-C değerleriile akut koroner sendromlar arasında anlamlı bir ilişki mevcuttu. Sonuç: Çalışmamız,yüksek kan LDL-C seviyelerinde olduğu gibi artmış kalıntı kolesteroldüzeylerinin artmış ilk kez yaşanılan AKS riski ile ilişkili olduğunugöstermiştir. AKS hastalarında LDL-C düzeylerinin düşürülmesinin yanı sırakalıntı kolesterol düzeylerinin düşürülmesi üzerine daha fazla çalışmayapılmalı ve odaklanılmalıdır., Introduction: Thisstudy aimed to investigate the association between remnant cholesterol andacute coronary syndrome (ACS) and its predictive value for acute coronarysyndrome occurring for the first time. Patients and Methods:We compared increasing concentrations of non-fasting remnant cholesterol asidefrom other lipid profile parameters to investigate this association in 226patients with ACS for the first time and 192 elective coronary angiographypatients with normal coronary arteries. Results: Patientswith ACS were mostly males and were younger than those in the control group;moreover, they had higher percentage of diabetes mellitus (for all p

Objective: The aim of this study is to assess the prevalence of polypharmacy, inappropriate drug use, and drug-drug interactions (DDIs) in elderly patients presenting at outpatient cardiology clinics in Turkey. Methods: The EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study will be an observational, real-world, multicenter study conducted to evaluate DDIs and polypharmacy in elderly cardiac outpatients. All consecutive patients (aged ?65 years) admitted to outpatient cardiology clinics between July 30, 2018 and July 30, 2019 who provide written, informed consent will be enrolled. A total of approximately 5000 patients are to be enrolled in this non-interventional study. All of the data will be collected at one point in time and current clinical practice will be evaluated (ClinicalTrials.gov NCT03370523). Results: Patient demographics, comorbid disease characteristics, laboratory test results, and details of medication use will be collected using self-reports and medical records. The severity of comorbid disease will be recorded and scored according to Charlson Comorbidity Index (CCI) and patients will be divided into 3 groups: mild, those with a CCI score of 1–2; moderate, those with a CCI score of 3–4; and severe, those with a CCI score of ?5. Polypharmacy will be defined as the use of 5 or more medications at one time. DDIs will be determined using the Lexicomp Online drug interaction screening tool and potentially inappropriate medications will be defined based on the 2015 update of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Severe drug interactions will be defined as those in category D or X. Conclusion: EPIC will be the first large-scale study in Turkey to evaluate polypharmacy, potentially inappropriate medications, and DDIs in elderly cardiac outpatients in a real-world clinical setting. Amaç: Türkiye’deki kardiyoloji polikliniklerine başvuran yaşlı hastalarda polifarmasi prevalansını, uygunsuz ilaç kullanımını ve ilaç-ilaç etkileşimlerini (İİE) değerlendirmek. Yöntemler: EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) çalışması kardiyoloji polikliniklerine başvuran yaşlı hastalarda polifarmasi ve İİE’nin değerlendirileceği, gerçek yaşam verilerini aktaran, çok merkezli ve gözlemsel bir çalışma olarak tasarlandı. Çalışmaya; 30 Temmuz 2018 ve 30 Temmuz 2019 tarihleri arasında farklı kardiyoloji polikliniklerine başvuran, aydınlatılmış onam formunu imzalayan, 65 yaş ve üzeri, kadın ve erkek, ardışık 5000 hastanın dahil edilmesi planlandı. Hastalarla ilgili tüm verilerin tek bir ziyarette alınması ve verilerin değerlendirilmesi planlandı (ClinicalTrials.gov numarası NCT03370523). Bulgular: Hastalara ait demografik veriler, komorbid hastalık durumları, laboratuvar test sonuçları ve ilaç bilgileri hasta beyanları ve medikal kayıtlar yoluyla toplanacaktır. Komorbid hastalıklar kaydedilecek ve komorbid hastalıkların ciddiyeti Charlson komorbidite indeksi’ne (CKİ) göre hastalar 3 gruba ayrılacaktır: CKİ skoru 1–2 olanlar hafif, CKİ skoru 3–4 olanlar orta, CKİ skoru ?5 olanlar ciddi. Polifarmasi aynı hastanın bir kerede 5 ve üzeri ilaç kullanması olarak tanımlanacaktır. İİE Lexicomp® çevrimiçi ilaç etkileşimi tarama aracı ile kontrol edilecek, potansiyel uygunsuz ilaç kullanımı 2015 Beers kriterlerine göre tanımlanacaktır. D ve X kategorisindeki etkileşimler ciddi ilaç etkileşimi olarak sınıflandırılacaktır. Sonuç: EPIC çalışması kardiyoloji polikliniklerine başvuran yaşlı hastalarda polifarmasi, İİE ve potansiyel uygunsuz ilaç kullanımı konularında gerçek yaşam verilerini ayrıntılı olarak aktaran ilk büyük çaplı çalışma olacaktır. WOS:000475438700008 2-s2.0-85068799852 PubMed: 31311898

Background: Rehospitalizations with acute coronary syndromes (ACSs) have declined over the last years, but there is a remaining need for potential further reduction of rehospitalization after ACS to determine the most predominant predictors that can guide strategies to reduce re-hospitalizations burden. Aim: This multi-center study aimed to evaluate the demographic, clinical characteristics, and medications of rehospitalized patients who suffered a new cardiac event in 12 months after admission due to ACS. Material and Methods: Patients age >18 years who have been hospitalized between November 1 2017, and April 1 2018, for ACS within12 months before the readmission for a new acute coronary event were enrolled. Results: The present study included a total of 628 (65.9% from Turkey) consecutive patients rehospitalized with ACS (ST-elevation myocardial infarction [STEMI], 23.0%; ACS without ST-elevation [NSTE-ACS], 76.9%) from 15 different countries. The majority of the rehospitalized patients were men (67.9%), and the mean age was 63.1 ± 12.53 years. 406 (64.6%) had typical, 209 (33.2%) of patients had atypical chest pain and 13 (2.07%) had not any chest pain complaint during readmission. 304 (48.41%) of patients were discharged from hospital earlier than 3 days and 107 (17.04%) of patients stayed more than 7 days. The subcategories of first index diagnosis were 227 (36.1%) STEMI; 401 (63.8%) NSTE-ACS. The mean time from index discharge to rehospitalization was 189.25 ± 118 days. 248 (39.4%) patients were re-hospitalized more than once after index discharge. The most common risk factors were diabetes mellitus (471, 75.0%). 175 (27.87%) of patients stopped taking medication before re-hospitalization. Most of the patients (69.4%) had multivessel disease. Conclusion: Several factors identify patients at higher risk of rehospitalization with ACS. Understanding and preventing these causes can prevent rehospitalization and improve their outcome.

WOS: 000392195800004, PubMed ID: 27723665, Objective: Data regarding stroke prevention strategies in non-valvular atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs). This study aimed to evaluate real-life stroke prevention strategies for NVAF patients in the era of non-VKA oral anticoagulants (NOACs). Methods: We established a cross-sectional, multicenter, nationwide registry of NVAF patients. All consecutive atrial fibrillation (AF) patients and without mechanical heart valves or rheumatic mitral stenosis (but including those with any degree of mitral regurgitation) were enrolled in the ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study; ClinicalTrials. gov identifier NCT02344901) in Turkey. Base-line demographic data, medical history, and medications prescribed for NVAF treatment were collected. Univariate analyses were performed for continuous variables, and the chi-square test was used for categorical variables. Results: In total, 6273 patients from 29 provinces of Turkey were enrolled in the study between February and May 2015, with the contribution of 83 investigators. The mean age was 69.6 +/- 10.7 years; 56% of the patients were females, and one-fifth of the patients had at least one comorbid disease, the most common being hypertension (69%). The mean CHA(2)DS(2)-VASc and HAS-BLED scores were 3.3 +/- 1.6 and 1.6 +/- 1.1, respectively. The rate of oral anticoagulant (OAC) therapy use was 72% (37% NOAC and 35% VKA). Conclusion: The RAMSES study showed a higher prevalence of OAC use among NVAF patients than that reported in previous studies. Although NOACs were preferred over VKAs in daily cardiology practice, there is a need for improved OAC therapies for NVAF patients.

Objective: The aim of this study was to determine the role of leftsided mechanical parameters in postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). Methods: Ninety patients with coronary artery disease and normal left ventricular (LV) function in sinus rhythm were enrolled in the study. Preoperative LV and left atrial (LA) mechanics were evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE), including strain and rotation parameters, and volume indices. Patients were monitored in order to detect POAF during the postoperative period. Results: Twenty-three of 90 patients (25.6%) developed POAF. Age (p70 pg/ml, OR 22.377, CI 3.286–152.381, p

OBJECTIVES We aimed to determine the effects of normal pregnancy on left atrial (LA) mechanics using 2-dimensional speckle-tracking echocardiography. METHODS A total of 47 healthy women with singleton pregnancies were prospectively enrolled in this study. A total of 4 visits, including each trimester and postpartum at 6 months, were planned. Echocardiographic studies were performed with a Vivid 7 device equipped with a 2.5-MHz transducer (GE Vingmed Ultrasound AS, Horten, Norway). RESULTS Although the LA reservoir phase strain showed a gradual decrease from the first trimester to the third trimester during pregnancy, the measurements in the postpartum period were found to return to initial levels (mean ± SD: first trimester, 40.3% ± 11.7%; second trimester, 37.5% ± 12.9%; third trimester, 33.5% ± 9.0%; postpartum, 42.1% ± 11.1%; P < .001). The LA pump function strain was also parallel to the LA reservoir strain and gradually decreased from the first trimester to the third trimester during pregnancy, and it was observed that rose to the initial level in the postpartum period (first trimester, 16.7% ± 7.4%; second trimester, 14.8% ± 5.5%; third trimester, 12.7% ± 4.3%; postpartum, 15.8% ± 5.5%; P < .001). CONCLUSIONS We prospectively determined normal reference values for LA deformation parameters using speckle-tracking echocardiography in each trimester and the postpartum period in healthy pregnancy. These reference values may help identify subclinical LA dysfunction in several cardiovascular or systemic conditions. According to this study, these parameters decreased toward the third trimester during pregnancy and recovered in the postpartum period.

Incomplete stent expansion and inadequate apposition predispose to stent thrombosis following percutaneous coronary intervention. Recent studies have shown that increasing the duration of balloon inflation during stent employment was beneficial. Thus, the balloon inflation time required for optimal stent expansion and apposition in patients receiving second-generation drug-eluting stents (DES) were determined using optical coherence tomography (OCT). Between April 2014 and March 2015, 38 patients (28 men, 10 women; mean age 60.5 ± 11.4 years) with stable angina pectoris due to single significant de novo coronary artery stenosis were prospectively enrolled. All patients were administered aspirin and clopidogrel and received weight-adjusted intravenous unfractionated heparin. Images of basal lesions were obtained using the C7XR LightLab Dragonfly OCT catheter. Expansion and apposition parameters improved with increasing duration of balloon inflation (30 s or 60 s) with nominal pressure (12 atm). Mean lesion length was 19.8 ± 7.6 mm. Mean stent diameter and length were 2.8 ± 0.36 mm and 24.9 ± 7.6 mm, respectively. With deployment of a stent at nominal pressure with conventional duration, inadequate stent expansion and malapposition frequently occurred as detected by OCT; however, a balloon inflation duration of 60 s markedly improved stent expansion and apposition parameters without significant complications.

WOS: 000444701600011 PubMed ID: 28707026 New-onset atrial fibrillation (NOAF), a common complication of acute ST-segment elevation myocardial infarction (STEMI), is associated with a poor prognosis. Several clinical and laboratory parameters are reported to be associated with NOAF in patients with STEMI. The aim of the present study was to evaluate the predictive value of plasma BaEurotype natriuretic peptide (BNP) levels for NOAF development and long-term prognosis in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). We retrospectively enrolled 1,928 patients with STEMI who underwent pPCI. After applying exclusion criteria, 1,057 patients were retained in the final study population. Patients with NOAF were compared with patients without NOAF in the entire study population and in a matched group. Patients with NOAF had a significantly higher average plasma BNP level (161 pg/ml, range: 72.3-432) than patients without NOAF in the study population (70.7 pg/ml, range: 70-129; p < 0.001) and in the matched group (104.6 pg/ml, range: 47.2-234.5; p = 0.014). Furthermore, the plasma BNP level was found to be an independent predictor of NOAF development (odds ratio [OR]: 1.003; 95% confidence interval [CI]: 1.000-1.005; p = 0.034) and mortality in the long-term follow-up (OR: 1.004; 95% CI: 1.002-1.006; p < 0.001). The present study found that a high plasma BNP level was significantly associated with NOAF development in STEMI patients, and was an independent predictor of NOAF development and all-cause mortality during long-term follow-up, regardless of other NOAF risk factors.

Objective: T-peak–T-end (TPE) interval, which represents the dispersion of repolarization, is defined as the interval between the peak and end of the T-wave, and is associated with increased malignant ventricular arrhythmia and sudden cardiac death (SCD) in patients with ST elevation myocardial infarction (STEMI). Although prolonged TPE interval is associated with poor short- and long-term outcomes, even in patients with STEMI treated with successful primary percutaneous coronary intervention (pPCI), clinical, angiographic, and laboratory parameters that affect TPE remain to be elucidated. The aim of our study was to evaluate the potential relationship between prolonged TPE interval and reperfusion success using ST segment resolution (STR) in patients with STEMI undergoing pPCI. Methods: In the current study, 218 consecutive patients with STEMI who underwent pPCI were enrolled; after exclusion, 164 patients were included in the study population. Results: Patients were divided into two groups according to the presence of complete (STR%≥70) or incomplete (STR%

Sarcoidosis is a systemic inflammatory disease with unknown etiology involving several organs. Myocardial involvement, pericarditis, severe rhythm abnormalities, and heart valve disease due to papillary muscle dysfunction are some of the cardiac manifestations. Conventional echocardiographic methods remain insufficient for the determination of subclinical myocardial dysfunction in patients with sarcoidosis. In our study, we investigated the impact of sarcoidosis on bi-ventricular and atrial functions using two-dimensional (2D) speckle tracking echocardiography (STE). Forty patients with sarcoidosis and 20 age and sex-matched controls were recruited into study. All subjects underwent a transthoracic echocardiography for the evaluation of ventricular and atrial functions with 2D STE. Left ventricular (LV) dimensions, LV ejection fraction, and right ventricular (RV) systolic velocity were similar between the two groups. Left atrial (LA) diameter was significantly higher in sarcoidosis patients than controls. Eighteen (45 %) patients in the sarcoidosis group and 1 (5 %) patient in the control group had LV diastolic dysfunction. LV global longitudinal, radial, circumferential strain, twist, untwists, and RV global longitudinal strain values were significantly lower in sarcoidosis patients compared to controls. LA and RA reservoir functions were also significantly lower in sarcoidosis patients than controls. Although impaired LV diastolic function was detected using conventional parameters, only novel advanced echocardiographic modalities demonstrated impaired bi-ventricular and atrial mechanical functions in patients with sarcoidosis.

Coronary no-reflow (NR) is observed in nearly half of ST segment elevation myocardial infarction (STEMI) patients who undergo a primary percutaneous coronary intervention (pPCI) despite epicardial coronary vessel patency. Several methods used to define NR include thrombolysis in myocardial infarction grade, corrected thrombolysis in myocardial infarction frame count, myocardial blush grade, ST-segment resolution, contrast echocardiography, and MRI. The aim of our study was to evaluate the relationship between NR and R-wave peak time (RWPT) measured from infarct-related artery leads METHOD: We enrolled 282 consecutive STEMI patients treated with pPCI in Kafkas University Hospital from January 2014 to January 2015. After exclusion, the remaining 233 patients were included in the study population RESULTS: Patients were divided into two groups according to the development of NR. We observed that increased preprocedural (31 (27-37) vs 27 (21-30) p

Left ventricular aneurysm (LVA) is rare but potentially fatal complication of myocardial infarction. It has been strictly defined as a distinct area of abnormal left ventricular diastolic contour with systolic dyskinesia or paradoxical bulging. It may be asymptomatic. However, complications including thromboembolism, heart failure, valvular regurgitation, arrhythmia, and rarely rupture may be the initial presentation. Diagnosis may be established by transthoracic echocardiography, left ventriculography, computed tomographic angiography, and cardiac magnetic resonance imaging. Here, we report a case of uncommonly located LVA in an adult patient with normal coronary arteries, which was diagnosed with multimodality imaging. © 2017, Wiley Periodicals, Inc.

Objectives: Aim of the present study was to investigate correlation between left atrial (LA) deformation parameters assessed using 2-dimensional (2D) speckle tracking echocardiography (STE) and complexity of coronary artery disease according to SYNTAX score (SXscore) in patients with stable coronary artery disease (SCAD). Study design: Total of 60 moderate-risk SCAD patients (40 men, 20 women) who underwent coronary angiography and 30 healthy controls were included. Measurements of conventional echocardiographic parameters as well as peak LA strain during ventricular systole (LA-RES), peak LA strain during atrial systole (LA-PUMP), peak LA strain rate during ventricular systole (LA-SRS), peak LA strain rate during early diastole (LA-SRE), and peak LA strain rate during atrial systole (LA-SRA) were obtained. Results: Patients were categorized into 2 groups: low SXscore of

WOS: 000396440200005, PubMed ID: 28106016, Objective: Gender is an important feature in the management of atrial fibrillation (AF). This study investigated gender-related differences in patients with AF in Turkey. Methods: As a part of RAMSES (ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey, NCT02344901) study, information of the patients with AF who successively applied to the hospital was analyzed. This cross-sectional, multi-center, nationwide observational study enrolled 6264 non-valvular AF (NVAF) outpatients (55.9% women) from Turkey. Results: Compared with men, women with NVAF were older (71 years [range: 65-78 years] vs. 70 years [range: 62-77 years]; p= 1 [male], >= 2 [female]) had not received any anticogulant therapy. Conclusion: Although women with NVAF receive better treatment than men, anticoagulation therapy is suboptimal in large proportion of men and women, with underuse in high-risk patients and overuse in low-risk patients. There is an urgent need to improve optimization of anticoagulation in patients with NVAF.

PubMed ID: 28238569, Objective No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies. Methods Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared. Results Of the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8 ± 9.8 vs. 68.7 ± 11.4 years, p

A 56-year-old male patient was admitted to our clinic due to persistent fever despite the use of antibiotics for 2 weeks, chest pain, and presyncope. His medical history revealed that the patient underwent modified Bentall-De Bono procedure 2 months ago due to ascending aortic aneurysm and severe aortic insufficiency. Transthoracic apical 5 chamber view showed that mobile vegetation prolapsed into the left ventricular outflow tract during ventricular diastole and that mechanical prosthetic valve was superior to the aortic annulus. Transesophageal echocardiography revealed normal aortic mechanical prosthetic valve function; however, the valve was positioned more superior to the annular plane and a dense vegetation was observed. Moreover, a complete dehiscence of the prosthetic valve was attached to aortic annulus with a single stitch in an area between noncoronary sinus and left coronary sinus. Dense thrombus formation was observed in the perivalvular region. Many cases with prosthetic valve endocarditis and partial dehiscence as its complication have been reported in the literature. However, to the best of our knowledge, there is no reported case of complete dehiscence secondary to infective endocarditis following complete ascending aortic graft and prosthetic aortic valve replacement (modified Bentall-De Bono procedure).

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.

WOS: 000380806300010, PubMed ID: 27182772, Background Nonvalvular atrial fibrillation (NVAF) frequently coexists with coronary artery disease (CAD). However, the optimal antithrombotic strategy for patients with concomitant CAD and NVAF is controversial. The aim of this study is to assess the prevalence of CAD with NVAF and to determine antithrombotic treatment options in patients with or without a history of CAD. Methods ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey (RAMSES study) was a cross-sectional, multicenter, nationwide observational study carried out in NVAF patients. We studied the clinical data of 6264 Turkish patients participating in the RAMSES study. Demographic properties and antithrombotic therapies were recorded and compared between patients with and without CAD. Results CAD was present in 1828 (29.2%) of patients with NVAF. Most of the NVAF patients with CAD were men (58%) and comorbid diseases were significantly more common in patients with CAD. Although patients with CAD had higher CHA(2)DS(2)VASc scores than those without disease (4.1 +/- 1.5 vs. 2.9 +/- 1.5; P=0.001), they had lower use of oral anticoagulant (OAC) therapy (66.1 vs. 74.4%, P=0.01). Among OAC drugs, warfarin was the preferred medication in patients with CAD (35.4 vs. 30.6%, P=0.01), whereas nonvitamin K antagonist oral anticoagulants were preferred in patients without CAD (40 vs. 34.3%, P=0.01). Patients with CAD required nearly three-fold higher antiplatelet treatment compared with patients without CAD (57.8 vs. 21.4%, P

WOS: 000386930500018, PubMed ID: 27671101, What is known and objectiveAlthough inappropriate use of digoxin has been described in various populations, a real-world evaluation of patterns of digoxin prescription has not been well studied in patients with atrial fibrillation (AF). The aim of this study was to identify prevalence, indications and appropriateness of digoxin use in the general population of patients with non-valvular AF (NVAF) in Turkey. MethodsWe included and classified patients from the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke prevention strategies in Turkey) study, a prospective registry including 6273 patients with NVAF, on the basis of digoxin use. After excluding the data of 73 patients whose medical history about digoxin use or left ventricle function was absent, 6200 patients were included for the final analysis. Digoxin use was considered inappropriate if patients did not have left ventricular systolic dysfunction or symptomatic heart failure (HF). Results and discussionDigoxin was used in 1274 (20.5%) patients. Patients treated with digoxin were older (71.4 9.8 years vs. 69.2 +/- 10.9 years, P < 0.001), more likely to be female (58.8% vs. 55.9%, P = 0.019) and had more common comorbidities such as HF (40.2% vs. 17.4%), diabetes (26.4% vs. 21.1%), coronary artery disease (35.3 vs. 27.6%) and persistent/permanent AF (93.4% vs. 78.4%; P < 0.001 for each comparison). Of the 1274 patients, the indication of digoxin use was considered inappropriate in 762 (59.8%). What is new and conclusionOur findings show that nearly one-fifth of the patients with NVAF were on digoxin therapy and nearly 60% of these patients were receiving digoxin with inappropriate indications in a real-world setting.

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

A 47 year-old man with dyslipidaemia was admitted with acute ST-elevation myocardial infarction of the inferior wall with total occlusion of the right coronary artery (RCA). After the administration of medical treatment, thrombus aspiration was applied to the vessel and a 3.0 × 28 mm bare stent was deployed to the RCA at 18 atm. After the intervention (PCI), coronary angiography (CAG) revealed TIMI flow 3 (Figs. 1A, C). The patient’s clinical status had improved. Six months later, he was admitted to our hospital complaining of atypical chest pain. After an abnormal exercise treadmill stress test, we performed control CAG which showed a coronary artery aneurysm at the stented site without restenosis (Figs. 1B, D). Optical coherence tomography (OCT) demonstrated the presence of an aneurysm without intramural thrombus and disruption of the neointima extending into the aneurysm. Other side of stent struts were well apposed and covered by neointimal tissue proli feration (Fig. 2). This case report demonstrates that dyslipidaemia and a high thrombus burden are common risk factors for aneurysm. Moreover, it supports the mechanisms for coronary artery aneurysm which have been speculated upon by Yoshikawa et al. (J Am Coll Cardiol Intv, 2010; 3:1300–1302). OCT yields novel insights into the processes of re-endothelialisation and neointimal formation following coronary intervention. Additionally, it can be used to determine coronary abnormalities, such as coronary artery aneurysm after stent implantation.