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ÖZETAmaç: Potasyumun (K+) kardiyovasküler hastalıklardaki kritik rolü ve olumsuz kardiyak olayları önlemedenormokalemik durumu devam ettirmenin önemi her geçen gün daha iyi anlaşılmaktadır. Çalışmamızda, normalsınırlar içerisinde olmasına rağmen, serum potasyum düzeylerindeki değişkenlik oranı ile ST-yükselmelimiyokard enfarktüsü (STyME) hastalarında izlenen hastane içi majör kardiyak olaylar (MACE) arasındaki ilişkiyiaraştırmayı amaçladık.Gereç ve Yöntemler: 2013 – 2015 yılları arasında tersiyer merkezimize STyME tanısı ile başvuran toplam 419hasta retrospektif olarak dizayn edilen çalışmamıza dahil edildi. Hastaneye başvuru anında veya hastane içitakipleri sırasında normal değerlerin dışında K+ düzeyi saptanan hastalar çalışmaya alınmaz iken, hastaneyatışı boyunca en az 5 (beş) ardışık K+ değeri mevcut olan hastalar çalışmaya dahil edildi.Bulgular: Çok değişkenli regresyon analizinde, çalışma populasyonundaki serum K+ düzeylerinin değişkenlikoranı (OR: 7.84, 95%CI: 1.18-51.81, p=0.03) hastane içi olumsuz kardiyak olayların (MACE) bağımsız öngördürücüsüolarak saptandı. Serum K+ düzeylerinin değişkenlik oranı ? 0.57 (optimal kestirim değeri) olmasıhalinde, hastane içi olumsuz olayları % 46.2 duyarlılık ve % 84.9 özgüllükle öngörmekteydi. [area undercurve (AUC) 0.66, p=0.001].Sonuç: Çalışmamızın sonuçları, normal sınırlar içinde olsa dahi değişkenlik gösteren K+ düzeylerinin STyMEhastalarında hastane içi olumsuz olayların bağımsız bir öngördürücüsü olabileceğini göstermiştir. Bu nedenle,artmış oranda K+ düzeyi değişkenliği gösteren hastaların daha yakından takibi olumsuz kardiyak olaylarıen aza indirmek açısından büyük önem arz etmektedir.Anahtar kelimeler: Potasyum; ST-yükselmeli miyokard enfarktüsü; Majör olumsuz kardiyak olaylarABSTRACTObjective: The critical role of potassium (K+) in cardiovascular disease and, maintaining a normokalemicstate are increasingly being recognized to preclude adverse cardiac events. The main objective of our studywas to evaluate whether there is an association between the variability of serum potassium levels, evenwithin the normal range, and in-hospital major adverse cardiovascular events (MACE) in patients with STelevationmyocardial infarction (STEMI).Materials and Method: A total of 419 patients who were admitted to our tertiary heart center with a diagnosisof STEMI from May 2013 to May 2015 were included in this retrospective study. The patients whohave any serum K+ levels beyond the normal range on admission and during the in-hospital follow-up intervalwere excluded. The patients who had at least five consecutive serum K+ measurements during thein-hospital stay were included in the study.Results: In multivariable logistic regression analysis, the variability of serum K+ levels (OR: 7.84, 95%CI: 1.18-51.81, p=0.03) was found to be independently associated with MACE in the study population. The optimalcut-off value of the variability of serum K+ levels was ? 0.57 with a sensitivity of 46.2% and a specificity of84.9% [area under curve (AUC) 0.66, p=0.001].Conclusion: Our findings provide evidence that variability of serum K+ levels even within the normal rangemay be an independent predictor of MACE in STEMI patients. Therefore, close follow up of the patients witha high variability of serum K+ levels has utmost importance in order to minimize the risk of MACE.Keywords: Potassium; ST-elevation myocardial infarction; Major adverse cardiovascular events

Acute pulmonary embolism is a serious medical condition that has a substantial global impact. Inflammation plays a role in the pathophysiology and prognosis of acute pulmonary embolism (APE). The aim of the present study was to investigate the prognostic value of admission parameters for complete blood count (CBC) in APE.A total of 203 patients who were hospitalized with diagnosed APE were retrospectively enrolled in the study. Clinical data, PESI scores, admission CBC parameters, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were all recorded. The clinical outcomes of study subjects were determined by the reported patient 30-day mortality and long-term mortality.During a median follow-up period of 20 months [interquantile range 17], 34 subjects in the study population (17%) died. NLR and PLR levels were significantly higher in patients who died within the 30 days (n = 14) [9.9 (5.5) vs. 4.5 (4.1), p = 0.01 and 280 (74) vs. 135 (75), p = 0.01, respectively] and during the long-term follow-up (n = 20) [8.4 (2.9) vs. 4.1 (3.8), p = 0.01 and 153 (117) vs. 133 (73), p = 0.03, respectively] when compared to the patients that survived. In Cox regression analysis, age, systolic blood pressure, systolic pulmonary arterial pressure, PESI scores (HR 1.02 95%CI 1.01-1.04, p = 0.01), elevated levels of NLR (HR 1.13 95%CI 1.04-1.23, p = 0.01) and PLR (HR 1.002 95%CI 1.001-1.004, p = 0.01) were independently correlated with total mortality.Admission NLR and PLR may have prognostic value in patients with APE.

AIMS: Fragmented QRS has emerged as a novel electrocardiographic parameter associated with adverse clinical events in various diseases. The aim of this study was to investigate the association of fQRS with in‐hospital and long‐term cardiovascular events in patients with ST‐segment elevation myocardial infarction (STEMI) and non‐ST segment elevation myocardial infarction (NSTEMI). METHODS AND RESULTS: We searched PubMed, Embase, Web of Science, and Cochrane Library up to October 2015 for eligible studies. We selected studies with fQRS defined with 12‐lead ECG during the index hospitalization of STEMI/NSTEMI. Primary outcomes were in‐hospital and long‐term cardiovascular events. In‐hospital mortality was significantly higher in fQRS (+) group (99/733; 13.5%) compared to fQRS (–) group (47/1293; 3.6%) (OR 4.03 95% CI 1.81–8.94; P = 0.0006). Long‐term mortality rate was higher in fQRS (+) group (89/473; 18.8%) compared to fQRS (–) group (54/1009; 5.3%) (OR 3.93 95% CI 1.92–8.05; P = 0.0002). In addition the frequency of long‐term MACE was higher in fQRS (+) group (46.9%) compared to fQRS (–) group (14.6%) (OR 5.13 95% CI 2.77–9.51; P < 0.00001) CONCLUSION: Presence of fQRS on admission ECG was found to be predictor of mortality, MACE, deterioration of LV function, and presence of multivessel disease in patients with STEMI and NSTEMI.

Amaç: Miyokard infarktüsünün (MI) akut fazında gelişen atriyal fibrilasyon (AF) hastane içi ve sonrasındauzun dönemdeki mortalitenin önemli göstergelerinden biridir. Bu çalışmanın amacı, primer perkütankoroner girişim uygulanmış akut anterior ST yükselmeli miyokard infarktüsü hastalarında MgSO4infüzyonunun en uzun p dalga süresi( Pmax ), en kısa p dalga süresi( Pmin ) , p dalga dispersiyonu (Pdd) vebunun AF ile ilişkisi üzerine etkisini araştırmak olarak belirlenmiştir.Metod: Çalışmaya akut anterior ST yükselmeli miyokard infarktüsü tanısıyla hastaneye yatırılan ve primerperkütan koroner girişim uygulanmış 55 hasta ( yaş ortalaması 55.1 ± 6.7 ) ile kontrol grubu olarak 47normal birey ( yaş ortalaması 54.1 ± 7.2 ) prospektif olarak alındı. Bütün hastaların demografik ve kliniközellikleri kaydedildi. Hasta grubunda Mg tedavisi uygulanan 25 hasta ile Mg tedavisi uygulanmayan 30hastanın, başvuru sırasında ve PKG sonrası 5.saatte elektrokardiyografileri çekilerek Pmax, Pmin ve Pddsüreleri ölçüldü.Bulgular: Akut MI hastalarında Pmax. ve Pdd, kontrol grubuna göre daha yüksek bulundu ( sırasıyla 118.7 ±6.3 msn vs. 107.1 ± 3.4 msn, p = 0.01 ve 40.5 ± 4.8 msn vs. 30.2 ± 3.3 msn; p = 0.01). Magnezyum tedavisialan hastaların PKG sonrası 5.saat EKG'sindeki Pmax. ve Pdd değerleri, başvuru EKG'sine görekarşılaştırıldığında anlamlı olarak daha düşük saptandı ( sırasıyla 121.4 ± 7.1 vs. 109.6 ± 4.1 msn, p= 0.01 ve41.3 ± 4.7 vs 30.7 ± 2.9 msn, p = 0.01). Magnezyum tedavisi almayan hastaların ise PKG sonrası 5.saat EKG'sindeki sadece Pmax değeri başvuru EKG' sine göre anlamlı olarak düşük bulundu (116.6 ± 4.7 vs 114.7 ± 4.2msn, p = 0.04). Tedavi sonrası Pdd azalışı, Mg (+) grupta Mg (-) gruba göre anlamlı olarak daha yükseksaptandı ( 10.6 ± 5.1 vs 2.1 ± 1.4 msn, p = 0.01).Sonuç: Akut anterior MI nedeniyle primer PKG uygulanan hastalarda Mg tedavisi Pdd' da belirgin azalmasağlamaktadır. Bu sonuç, özellikle AF gelişme riski yüksek olan hasta grubunda Mg tedavisinin yararlıolabileceğine işaret etmektedir., Backgrounds: Atrial fibrillation (AF) occuring in the acute phase of Myocardial Infarction (MI) is animportant predictor of in- hospital and long-term mortality. The aim of this study is to investigate the effect ofMgSO4 therapy on the maximum P wave duration(P max), minimum P wave duration (Pmin), P wavedispersion (PWD) and its relationship with AF in acute anterior ST-segment elevation myocardial infarction(STEMI) patients treated with primary percutaneous coronary interventions (PCI).Methods: Fifty-five patients (mean age 55.1 ± 6.7) who were hospitalized with diagnosis of STEMI and 47normal individuals (mean age 54.1 ± 7.2 years) were prospectively enrolled. Percutaneous coronaryintervention was performed to all MI patients with conventional methods. All patients' demografic andclinical features were recorded. In STEMI patients group, admission and fifth-hour electrocardiographicparameters (Pmax, Pmin, PWD) were measured in patients with Mg therapy(n=25) and patients without Mgtherapy(n=30).Results: Pmax and PWD values were higher in acute MI patients than the control group. (118.7 ± 6.3 msn vs.107.1 ± 3.4 msn, 40.5 ± 4.8 msn vs. 30.2 ± 3.3 msn; p = 0.01 and p = 0.01, respectively ). In Mg(+) group,Pmax and PWD values were significantly lower on fifth-hour ECGs compared to admission ECGs( 121.4 ±7.1 vs 109.6 ± 4.1 msn, 41.3 ± 4.7 vs 30.7 ± 2.9 msn, p = 0.01 and p = 0.01). In Mg(-) group , only Pmaxvalues were significantly lower on fifth-hour ECGs compared to admission ECGs(116.6 ± 4.7 vs 114.7 ± 4.2msn, p = 0.04). PWD decrease after treatment was significantly higher in Mg (+) group than Mg (-) group (10.6 ± 5.1 vs 2.1 ± 1.4 msn, p = 0.01).Conclusions: Mg treatment causes significant reduction in PWD values in patients with acute anterior STelevationMI after primary PCI. This result suggests that Mg treatment may be useful especially in high-riskpatients in terms of developing AF.

BackgroundSystemic inflammation is accepted as one of the pathophysiological mechanisms of atrial fibrillation (AF). The role of inflammation has been shown previously. Interleukin (IL) system is the main modulator of the inflammatory responses and genetic polymorphisms of IL-1 cluster genes are associated with increased risk for inflammatory diseases. ObjectivesTo investigate the association between polymorphisms of IL-1 cluster genes and lone AF. Subjects and MethodsDNA samples were collected from 70 proven lone AF patients and 70 healthy subjects. Genomic DNA was typed for the variable number of the tandem repeat (VNTR) IL-1 receptor antagonist (RN) gene polymorphism, IL-1B -511 C > T(rs16944) promoter polymorphism, and +3953 C > T(rs1143634) polymorphism in exon 5 by polymerase chain reaction. ResultsIn lone AF group the frequency of IL-1RN2/2 and IL-1RN1/2 genotypes were higher than in the control group (7.2% vs 4.3% and 48.5% vs 22.8%, respectively; (2) = 14.1; P = 0.028). The frequency of allele 2 was significantly higher in the lone AF group (32.1% vs 15.7%; (2) = 10.7; P = 0.005). Allele and genotype distribution of IL-1B -511 C > T and +3953 C > T polymorphisms were not statistically different between the groups. C-reactive protein (CRP) levels were higher in lone AF patients compared to the control group (median = 1.25, interquartile range [IQR] = 0.85 vs median = 1.08, IQR 0.46 mg/L, respectively; P = 0.02). In multivariate regression analysis, presence of allele 2 of IL-1 VNTR polymorphism and elevated plasma high-sensitive-CRP levels were the independent predictors of lone AF. ConclusionPresence of allele 2 of VNTR polymorphism of IL-1RN gene may cause increased risk for lone AF probably due to the inadequate limitation of inflammatory reactions.