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Left ventricle (LV), right ventricular (RV) structural and functional changes occurs in advanced heart failure (HF). Assessment of RV function is important as it has prognostic significance in prognosis. RV functions, depending on the underlying cause of ischemic cardiomyopathy (ICMP) or nonischemic cardiomyopathy(NICMP) are affected by different levels. Patients with clinical sign of HF and echocardiographic parameters as LVEF ≤ % 35 and LV end diastolic diameter (LVEDD) ≥ 55 mm, sinus rhythm (SR), clear image quality, absence or mild valve insufficiency were included in the study. The study consisted of 20 ICMP and 24 NICMP patients with LVEF 5.5 cm), non severe valve disease and SR. RV and LV volume, diameter and function are assessed by echocardiography. Patients have similar basic characteristics. LV functions were evaluated by two-dimensional(2D) echocardiography, transmitral flow Doppler and tissue Doppler echocardiography and the analysis revealed similar results in both groups. RV longitudinal diameter in ICMP was significantly lower when compared to the NICMP(6.80 ± 0.83 cm, 7.4 ± 1.03 cm; p=0.03). Mean RVEF was comparable between groups and %59 in NICMP while 62% in ICMP. There were no significant differences between groups regarding RV transtricuspid flow Doppler parameters. In tissue Doppler parameters, lateral annulus Sm velocity which reflects RV systolic function was lower in ICMP than NICMP (0.09 ± 0.02 cm/sn vs 0.11 ± 0.018 cm/sn; p = 0.004). TAPSE assessed by M-mode echocardiography was significantly lower in ICMP group than NICMP(1.98 ± 0.39, 2.28 ± 0.33; p = 0.009). The present study show that RV function was significantly decreased in ICMP when compared to NICMP.

Background: Fractional flow reserve (FFR) is an interventional diagnostic method, based on intracoronary pressure measurement, used for the assessment of the severity of coronary artery stenoses. Aim: Our study aimed to compare visual measurements made by multiple observers with FFR measurement in the assessment of angiographically moderate coronary artery stenosis. Methods: The angiographic images of moderate coronary artery lesions of 359 patients enrolled in the study were interpreted independently by three interventional cardiologists assigned as observers (O1, O2, O3). Results: In FFR, 37.9% were haemodynamically significant, while 62.1% were insignificant. 40.3% of the lesions were considered severe by O1, 39.9% by O2, and 44.4% by O3. When we compare the FFR results to the observers’ decisions about lesion severity, the serious lesion percentages of all three observers were different both from each other and from the FFR result, at a statistically significant level (respectively, p < 0.001, p < 0.001). The kappa analysis performed to check the agreement between the observers’ decisions and FFR revealed significant difference between FFR results and the decisions made by all observers (p < 0.001). The kappa agreement analysis performed by matching observers’ decisions in pairs revealed a good agreement between O1 and O2 and a moderate agreement between O2 and O3 as well as O1 and O3, although there was still a significant disagreement between all pairs of observers (p < 0.001). Conclusions: Visual assessment, even when performed by experienced interventional cardiologists, does not yield similar results with FFR procedure in the process of determination of the functional importance of moderately severe coronary artery stenoses.

Background: The SYNTAX score is an angiographic score that predicts coronary artery disease (CAD) complexity. It has been shown to be useful for decision making about percutaneous coronary intervention or coronary artery bypass grafting among patients with CAD. Higher SYNTAX scores are indicative of more complex disease. Chronic obstructive pulmonary disease (COPD) is characterised by limitation of airflow. Measurement of forced expiratory volume in one second (FEV1) in spirometry is used for diagnosis and to determine the severity of the disease. Aim: To evaluate the relationship between FEV1 and SYNTAX score in patients with COPD. Methods: Seventy-eight patients with a previous diagnosis of COPD and 48 patients without COPD were enrolled. Spirometry and coronary angiography were performed in all patients. SYNTAX score was calculated and compared between the two groups. The correlation between FEV1 and SYNTAX score was analysed. Results: SYNTAX score was higher in patients with COPD than in patients without COPD (23.22 ± 12.10 vs. 17.92 ± 11.21, respectively; p = 0.013). Multivariate analysis demonstrated that COPD was independently predictive for intermediate and high SYNTAX score (odds ratio 4.833; 95% confidence interval 2.228–10.485; p < 0.001). Mean FEV1 (% predicted) was 64.7 ± 11.4 and negatively correlated with SYNTAX score in COPD group (r = –0.266 and p = 0.018). The receiver operating characteristic analysis yielded a cutoff value of 65.5 for the FEV1 to predict SYNTAX score ≥ 23, with sensitivity and specificity being 78.6% and 70%, respectively. Conclusions: COPD is a predictor of higher SYNTAX scores. FEV1 is associated with more severe and complex CAD.

Transcatheter aortic valve implantation (TAVI) was introduced as an alternative treatment for patients with severe symptomatic aortic stenosis for whom surgery would be high-risk. Prosthetic aortic valve endocarditis is a serious complication of surgical AVR (SAVR) with high morbidity and mortality. According to recent cases, post-TAVI prosthetic valve endocarditis (PVE) seems to occur very rarely. We present the case of a 75-year-old woman who underwent TAVI (Edwards Saphien XT) with an uneventful postoperative stay. She was diagnosed with endocarditis using three dimensional (3D) echocardiography on the TAVI device 7 months later and she subsequently underwent surgical aortic valve replacement. Little experience of the interpretation of transoesophageal echocardiography (TEE) and the clinical course and effectiveness of treatment strategies in post-TAVI endocarditis exists. We report a case of PVE in a TAVI patient which was diagnosed with three-dimensional transoesophageal echocardiography (3DTEE).

Objective: The high incidence of non-organ specific autoantibodies in patients with mitral valve prolapse (MVP) may suggest an association between MVP and autoimmune diseases. A higher incidence of MVP in patients with chronic lymphocytic thyroiditis and Graves' disease has been demonstrated in various studies. In particular, an increased incidence of MVP in patients with auto- immune thyroid disease characterized with hyperthyroidism may suggest an association between MVP and thyroid functions. To the best of our knowledge, there is a lack of literature regarding the evaluation of autoimmune thyroid diseases in patients with MVP. This study primarily aimed to evaluate the autoimmune thyroid disease using thyroid ultrasonography and autoimmune thyroid antibodies in patients with MVP. Materials and Methods: Thyroid function tests, thyroid autoimmune antibodies, and thyroid ultrasonographic examination were evaluated in 30 patients with MVP (19 females and 11 males; mean age: 29.6±9.3 years) and 30 healthy volunteers (19 females and 11 males; mean age: 27.6±7.5 years). Results: Two groups were similar in terms of demographical and clinical characteristics. Evaluation of the thyroid functions, auto- immune thyroid antibodies, and thyroid ultrasonography revealed no statistically significant difference between the study groups. Conclusion: The results of the study suggest no association between MVP and autoimmune thyroid diseases. This requires further clarification with large-scaled studies.

Introduction: Prior studies have reported a differential mortality effect of the time of admission (weekdays vs. weekends, regular hours vs. off hours) in patients with ST elevation myocardial infarction (STEMI). However, these studies did not evaluate the relationship between the admission hours and mortality risk at admission. Patients and Methods: A total of 228 patients presenting with reperfusion eligible acute STEMI between January 2006 and March 2009 were enrolled in this study. With respect to admission hours, patients were divided into 4 groups: night (between 24.00 and 05.59 hours), morning (between 06.00 and 11.59 hours), afternoon (between 12.00 and 17.59 hours) and evening (between 18.00 and 23.59 hours)]. The relationship between admission hours and in hospital mortality risk were examined using the TIMI risk index (TRI) [heart rate x (age/10)2 /systolic blood pressure]. Results: Patients in different groups of admission hours were not significantly different in terms of age, heart rate, systolic blood pressure, Killip class > 1 or time to infarction. TRI, a predictor of in-hospital mortality, was also not significantly different between these groups defined using 6-hour time intervals (p: 0.69). Conclusion: Time of admission did not significantly affect the mortality risk at presentation in patients with STEMI. Healthcare providers should continue to work to enhance the healthcare system during regular and off-hours and to reduce existing disparities in cardiac care through multifaceted initiatives aiming to improve the timely delivery of evidence-based therapies.

Background: Aortic stenosis increases with age. According to guidelines, left ventricular systolic dysfunction is an indication for aortic valve replacement, even in asymptomatic patients. There is no clear data on the application of transcatheter aortic valve implantation (TAVI), which is a method showing continuous improvement in recent years, in patients with reduced ejection fraction (REF) having a poor prognosis for surgical aortic valve replacement. We therefore aimed to investigate the effect of TAVI on left ventricular ejection fraction (LVEF) and also its efficacy and safety in patients with REF. Methods and results: The study included 104 patients who underwent transfemoral TAVI in our clinic. The patients were divided into two groups: LVEF ≤ 45% (REF group, n = 28) and LVEF > 45% (preserved ejection fraction [PEF] group, n = 76). Follow-up measure­ments were performed at baseline, discharge, 1st, 6th and 12th months. No statistical difference was found between the groups with respect to complications and mortality rates. A statistically significant difference was detected in LVEF after TAVI, either in all patients (53.9 ± 14.6, 57.0 ± 11.4, 59.4 ± 8.4, 60.4 ± 6.8, 63.2 ± 3.9, respectively, at baseline, discharge, 1st, 6th and 12th months, p < 0.001) or in the groups separately. A statistically significant increase in LVEF (p < 0.001) was determined at discharge, 1st, 6th and 12th months, whereas LVEF increased in all follow-ups of the PEF group, however this elevation reached a statistical significance only at the 1st month (p = 0.04). Conclusions: Our study has shown the positive effect of TAVI on LVEF and its effective and safe applicability in patients with REF.

Background/aim: Electrophysiological changes are observed following mechanical stretches due to pressure overload in patients with severe aortic stenosis (AS). The electrical instability occurs after depolarization and dispersion of repolarization. The aim of this study was to evaluate changes in ventricular repolarization following transcatheter aortic valve implantation (TAVI). Materials and methods: The study population included 100 consecutive patients with severe AS that underwent TAVI. Electrocardiography (ECG) was performed at baseline, immediately after TAVI, and 1 week after TAVI. Results: The mean age of the patients was 78.2 ± 7.2 years. Thirty-four (34%) of the patients were male and 66 (66%) were female. Compared to the baseline, mean QT dispersion (QTd) immediately after TAVI and 1 week after TAVI decreased significantly (82.8 ± 26.5, 75.6 ± 25.2, and 65.8 ± 28.3, respectively, P < 0.001). Likewise, compared to the baseline, mean corrected QTd (QTcd) immediately after TAVI and 1 week after TAVI decreased significantly (84.7 ± 25.2, 76.7 ± 30.8, and 69.1 ± 31.4, respectively, P < 0.001). Conclusion: QTd is indicative of heterogeneity of ventricular refractoriness and is prolonged in patients with AS. Following TAVI, a decrease in QTd might reduce the risk of ventricular arrhythmia in patients with severe AS.

Background: Previous studies have shown an association between paraoxonase (PON) activity and the presence and severity of coronary atherosclerosis. Aim: To demonstrate any association between serum PON activity and the presence and severity of coronary artery calcification (CAC). Methods: A total of 156 consecutive patients having the suspicion of coronary atherosclerosis or needing risk stratification for cardiovascular events were included in the present study. Peripheral venous blood samples of all participants to measure serum PON activity were collected before undergoing multidetector computed tomography, which was used to determine the presence and quantity of CAC. Results: Serum PON-1 levels were lower in the CAC group compared to the no CAC group (60 [35–96] U/L vs. 291 [230–371] U/L, respectively, p < 0.001). There was a significant negative correlation between total CAC score and PON (r2 = 0.335, p < 0.001). In multivariate analysis, the significant and independent predictors of the presence of CAC were male sex, high-sensitive C-reactive protein, and PON. Similarly, increased PON was significantly and independently associated with freedom from CAC. In receiver operating characteristics analysis, PON level < 197 U/L had 87% sensitivity, 91% specificity, 93% positive predictive value, and 85% negative predictive value in predicting CAC. Conclusions: Diminished serum PON activity is significantly and independently associated with the presence and severity of CAC, and vice versa.

Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Its incidence increases with age. AF is classified into subtypes according to the duration and/or able to provide sinus rhytym. İnitially, patients should be evaluated for rhythm or rate control for appropriate treatment. Second stage of strategy aimed to investigate the feasibility of anticoagulation therapy. Recently, due to the progress made in treatment with rhythm control and anticoagulation therapy, either American or European guidelines have been renovated. These developments have taken place in the newly published guide. In this article, the current change in the management of AF is discussed., Atriyal fibrilasyon (AF) klinik pratikte en sık görülen disritmi olup insidansı yaşla birlikte artış göstermektedir. Sinüs ritminini sağlayabilmeye ve oluşum süresine göre AF sınıflandırılmaktadır. Tedavi, ilk olarak hastaların ritm kontrolü veya hız kontrolü açısından uygunluğunun değerlendirilmesiyle başlar. Strateji belirlendikten sonra ikinci aşamada antikoagülan tedavinin gerekliliği araştırılır. Son zamanlarda hem ritm kontrolü hem de antikoagülan tedavide kaydedilen gelişmeler gerek Amerikan gerekse Avrupa kılavuzlarının birbiri ardına yenilenmesini gerekli kılmıştır. Bu gelişmeler yeni yayınlanan kılavuzlarda yerini almış olup bu yazıda atriyal fibrilasyon tedavisinde yaşanan bu güncel değişimler ele alınmıştır.

Transcatheter aortic valve replacement can be an effective, reliable treatment for severe aortic stenosis in surgically high-risk or ineligible patients. However, various sequelae like coronary artery obstruction can occur, not only in the long term, but also immediately after the procedure. We present the case of a 78-year-old woman whose left main coronary artery became obstructed with calculus 2 hours after the transfemoral implantation of an Edwards Sapien XT aortic valve. Despite percutaneous coronary intervention in that artery, the patient died. This case reminds us that early recognition of acute coronary obstruction and prompt intervention are crucial in patients with aortic stenosis who have undergone transcatheter aortic valve replacement.

Background Remote ischemic postconditioning (RIPC) decreases infarct size and prevents left ventricular (LV) remodeling in patients with myocardial infarction. However, there is no study that evaluates the effect of RIPC on LV mechanics assessed by speckle tracking echocardiography. Therefore, we aimed to test the effects of RIPC on LV deformation parameters such as strain, strain rate, rotation, and twist in healthy subjects. Methods The study group consisted of 22 healthy subjects. To test the effects of RIPC, 3 cycles of reperfusion followed by ischemia (each lasting 10 or 30 seconds) were applied immediately after 20 minutes of nondominant arm ischemia. Transthoracic echocardiography (TTE) was obtained at baseline and repeated 30 minutes after the completion of these cycles. In TTE images, apical 4-3-2 chamber longitudinal strain (LS)/strain rate, basal and apical circumferential strain/strain rate, and rotational parameters, such as basal rotation, apical rotation, and LV twist, were recorded. Results Apical 4-3-2 chamber LS and apical circumferential strain/strain rate measurements were comparable before and after RIPC, whereas basal circumferential strain was significantly decreased after RIPC (−23 ± 3.4 vs. −18.9 ± 6.9, P = 0.017). After RIPC, apical rotation was significantly increased (11.6 ± 3.7 vs. 16.7 ± 4.0, P

Introduction Transcatheter aortic valve implantation is a promising alternative to high risk surgical aortic valve replacement. The procedure is mainly indicated in patients with severe symptomatic aortic stenosis who cannot undergo surgery or who are at very high surgical risk. Aim Description early results of our single-center experience with balloon expandable aortic valve implantation. Material and methods Between July 2011 and August 2012, we screened in total 75 consecutive patients with severe aortic stenosis and high risk for surgery. Twenty-one of them were found ineligible for transcatheter aortic valve implantation (TAVI) because of various reasons, and finally we treated a total of 54 patients with symptomatic severe aortic stenosis (AS) who could not be treated by open heart surgery (inoperable) because of high-risk criteria. The average age of the patients was 77.4 ±7.1; 27.8% were male and 72.2% were female. The number of patients in NYHA class II was 7 while the number of patients in class III and class IV was 47. Results The average mortality score of patients according to the STS scoring system was 8.5%. Pre-implantation mean and maximal aortic valve gradients were measured as 53.2 ±14.1 mm Hg and 85.5 ±18.9 mm Hg, respectively. Post-implantation mean and maximal aortic valve gradients were 9.0 ±3.0 and 18.2 ±5.6, respectively (p < 0.0001). The left ventricular ejection fraction was calculated as 54.7 ±14.4% before the operation and 58.0 ±11.1% after the operation (p < 0.0001). The duration of discharge after the operation was 5.29 days, and a statistically significant correlation between the duration of discharge after the operation and STS was found (r = 0385, p = 0.004). Conclusions We consider that with decreasing cost and increasing treatment experience, TAVI will be used more frequently in broader indications. Our experience with TAVI using the Edwards-Sapien XT (Edwards Lifesciences, Irvine, CA) devices suggests that this is an effective and relatively safe procedure for the treatment of severe aortic stenosis in suitable patients.

Background and Aim: Hepcidin has been shown to be an acute phase reactant, induced by infection and inflammation. Ongoing inflammation was shown in rheumatic valve disease (RVD). In this study we want to investigate whether there is a relationship between inflammation and impaired iron metabolism and the role of hepcidin on serum iron levels. Methods and Results: Fourty-six patients with RVD and 34 healthy individuals were included in the study. Serum hepcidin, high-sensitive C-reactive protein (hs-CRP), hemoglobin, hematocrit, iron, iron-binding capacity, ferritin levels were measured. Serum hepcidin levels were significantly increased in patients with RVD than in control group (316 ± 121 ng/mL vs 435 ± 126 ng/mL; P < .001). Serum hs-CRP levels were no significantly higher in the patient group in than in the control group (3.9 ± 3.6 mg/L vs 3.5 ± 3.7 mg/L; P = .521). Conclusion: Hepcidin levels are decreased independently from hs-CRP levels as a compensatory mechanism to increase the iron absorption in response to decreased serum iron levels in patients with RVD.

Celiac is predominantly a disease of the small intestine characterized by chronic malabsorption in genetically susceptible individuals who ingest grains containing gluten, such as wheat, barley, and rye. In the present study, we evaluate left ventricular function in patients with celiac disease by using strain and strain rate echocardiography imaging. Materials and methods: Twenty celiac patients and 20 healthy controls were included in this study. Left ventricle systolic and diastolic functions were evaluated with standard 2-dimension, M-mode, conventional Doppler echocardiography. Strain and strain rate parameters were obtained for 8 segments of the left ventricle. Results: There were no significant differences between patients and controls regarding left ventricle function as assessed by 2-dimensional, M-mode, conventional Doppler. Differences between strain rate values did not reach statistical significance, but when strain and average strain values were taken into consideration, statistically significant differences were found between the groups. Conclusion: We determined the subclinical effect of celiac disease on left ventricular systolic function by using strain echocardiography imaging for the first time in the literature. We showed that evaluation of the cardiac involvement in celiac patients by sophisticated echocardiography techniques is essential.

Valvular heart diseases cause serious health problems in Turkey as well as in Western countries. According to a study conducted in Turkey, aortic stenosis (AS) is second after mitral valve disease among all valvular heart diseases. AS is frequently observed in elderly patients who have several cardiovascular risk factors and comorbidities. In symptomatic severe AS, surgical aortic valve replacement (AVR) is a definitive treatment. However, in elderly patients with left ventricular dysfunction and comorbidities, the risk of operative morbidity and mortality increases and outweighs the gain obtained from AVR surgery. As a result, almost one-third of the patients with serious AS are considered ineligible for surgery. Transcatheter aortic valve implantation (TAVI) is an effective treatment in patients with symptomatic severe AS who have high risk for conventional surgery. Since being performed for the first time in 2002, with a procedure success rate reported as 95% and a mortality rate of 5%, TAVI has become a promising method. Assessment of vascular anatomy, aortic annular diameter, and left ventricular function may be useful for the appropriate selection of patients and may reduce the risk of complications. Cardiac imaging methods including 2D and 3D echocardiography and multidetector computed tomography are critical during the evaluation of suitable patients for TAVI as well as during and after the procedure. In this review, we describe the role of echocardiography methods in clinical practice for TAVI procedure in its entirety, i.e. from patient selection to guidance during the procedure, and subsequent monitoring.

Background Abnormal nocturnal blood pressure (BP) profile has been linked to microvascular function and autonomic dysfunction. However, no data were available regarding nocturnal BP profile in coronary slow flow (CSF). Aim The aim was to investigate any association between CSF and abnormal BP response in normotensive patients. Methods Consecutive 45 patients with CSF and 45 patients with normal blood flow during coronary angiography underwent 24-hour ambulatory BP monitoring. Hemodynamic parameters including 24-hour, daytime and nighttime systolic/diastolic/mean/pulse pressures, and BP % changes were obtained. Dippers, nondippers, and reverse dippers were determined. Results Baseline characteristics of both groups were well matched except for TIMI (Thrombosis in Myocardial Infarction) frame counts for all major epicardial coronary arteries. No statistical significance was detected regarding to hemodynamic parameters obtained by 24-hour ambulatory BP monitoring. The prevalence of nondippers was higher in CSF patients compared with controls (51.1% vs 28.9%, respectively). In univariate analysis, systolic BP change (%), 24-hour diastolic BP, diastolic BP change (%), 24-hour mean BP, mean BP change (%), nondipper/reverse dipper, and separately nondipper status were found to be significant predictors for CSF. However, in multivariate logistic regression analysis, systolic BP change (%) (odds ratio [OR], 0.934; 95% confidence interval [CI], 0.874–0.998; P = 0.045), nondipper/reverse dipper status (OR, 0.505; 95% CI, 0.265–0.962; P = 0.038), and separately nondipper status (OR, 0.317; 95% CI, 0.126–0.797; P = 0.015) were found to be significant predictors for CSF. Conclusion The frequency of nondippers was higher in slow flow, and there was a significant association between CSF and abnormal nocturnal BP profile in normotensives.

Aim In our study, we aimed to evaluate left ventricular function in patients with Sjogren syndrome (SS) using tissue Doppler echocardiography (TDE) and myocardial performance index (MPI) in addition to conventional echocardiographic methods. Methods We evaluated 50 patients with SS and 48 healthy volunteers with similar demographic characteristics. Systolic and diastolic functions of the left ventricle were analyzed with standard two-dimensional (2D) echocardiography, M-mode echocardiography, pulsed-wave (PW) Doppler and tissue Doppler imaging. Results Septal part of the mitral annulus PW TDE showed that systolic myocardial wave (Sm), early diastolic myocardial wave (Em), late diastolic myocardial wave (Am) and Em/Am ratios are significantly lower, and myocardial isovolumetric relaxation time (IVRTm) and MPI values are significantly higher in patients with SS. Lateral site of the mitral annulus PW TDE showed that Em, Sm and Em/Am ratios are significantly lower, and IVRTm and MPI values are significantly higher in patients with SS compared with healthy controls. Conclusion In this study, it was shown that both left ventricle systolic and diastolic functions of patients with SS were disturbed.

Introduction and Aim: Sarcoidosis increases inhomogeneity in ventricular repolarization due to the presence of sarcoid granuloma, which significantly correlates with ventricular fibrillation. Various studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (T-peak to T-end [Tpe] interval) may correspond to the transmural dispersion of repolarization and that increased Tpe interval and Tpe/QT ratio are associated with malignant ventricular arrhythmias. The present study hypothesized that QT and Tpe intervals are significantly prolonged in sarcoidosis patients without apparent cardiac involvement. Methods: The study population consisted of 54 patients (37 female; mean age 43.4±10.6 years) under follow-up for sarcoidosis and 56 healthy subjects (37 female; mean age 42.4±8.6 years). Results: There was no statistically significant difference between the groups in maximum QT interval, QT dispersion or corrected QT (QTc) interval, but QTc dispersion and Tpe interval were significantly prolonged in the sarcoidosis group compared to the control group (QTc dispersion 59.9±22.5 and 44.4±23.8, respectively, p=0.001; Tpe interval 79.4±9.3 and 70.7±7.03, respectively, p

There is an established relationship between depression/anxiety disorders and cardiovascular morbidity and mortality which has been previously documented. However, there has been no study evaluating coronary slow flow in association with depression and anxiety.A total of consecutive 90 patients were included in the study. All patients completed scoring scales for depression [Hamilton Rating Scale for Depression (HAMD)] and anxiety (STAI-1, State anxiety subscale of State-Trait Anxiety Inventory; STAI-2, Trait anxiety subscale of State-Trait Anxiety Inventory). Thereafter, they underwent selective coronary angiography and 2 groups were formed: coronary slow flow (n = 42), and normal coronary flow (n = 48). The two groups had comparable baseline characteristics. However, significant differences were found between coronary slow flow and normal coronary flow groups regarding depression (13.1 ± 8.2 and 6.9 ± 6.7, p0.001 for HAMD, respectively) and anxiety (46.2 ± 15.0 vs. 32.6 ± 9.9, p0.001 for STAI-1 and 51.0 ± 16.7 vs. 43.0 ± 10.7, p = 0.009 for STAI-2, respectively) scores. There were also significant positive correlations between depression/anxiety scores and TIMI frame counts of all major epicardial coronary arteries. In addition, after adjustment for smoking, hypertension, scoring scales, and the presence of depressive mood, all scoring scales and depressive mood were found to be independent risk factors for coronary slow flow in multivariable logistic regression analysis.Significant association was found among coronary slow flow, depression/anxiety scores and depressive mood.Anxiety; Coronary slow flow; Depression; Scale.

Objective: Chronic obstructive pulmonary disease (COPD) is a risk factor for cardiovascular disease (CVD). Carotid intima-media thickness (CIMT) is the sign of subclinical atherosclerosis. Therefore, the aim of this study was to evaluate whether CIMT measurement is related with significant coronary artery disease (CAD) in patients with COPD, similar to those without COPD. Methods: One hundred and eight patients with previously diagnosed COPD and 78 patients without COPD who underwent coronary angiography (CAG) were enrolled in this prospective cross-sectional study. Carotid artery ultrasonography was performed on all patients after coronary angiography by another operator who was blind to the CAG results. The patients were divided into four subgroups as follows: group 1: COPD (-) and CAD (-); group 2: COPD (-) and CAD (+); group 3: COPD (+) and CAD (+); and group 4: COPD (+) and CAD (-). Patients with previous coronary revascularization, carotid artery disease, and lung disease other than COPD were not enrolled in this study. The student’s t-test, chi-square analysis, multiple logistic regression analysis, and receiver operating characteristic (ROC) curve were used for statistical analysis. Results: CIMT was found to be highest in patients with both significant CAD and COPD (group 3) (p1.25 mm to predict CAD was 12.4. The area under the ROC curve for a cut-off value of 1.25 mm for CIMT to predict CAD in COPD patients was calculated as 0.913, with a sensitivity of 89.7% and specificity of 86.7%. Conclusion: CIMT has a predictive value for the presence of CAD in patients with COPD. Further studies are needed to validate our results. (Anatol J Cardiol 2016; 16: 601-7)

BACKGROUND: It is well known that right ventricular (RV) dysfunction occurs early before clinical systemic congestion in patients with mitral stenosis (MS). Therefore, we aimed to evaluate the role of two-dimensional (2D) strain imaging in the assessment of subclinical RV dysfunction. METHODS: Fifty-nine patients with isolated MS (mild and moderate) and 31 healthy control subjects constituted the study population. RV peak longitudinal strain (RV-LS) and strain rate (RV-LSr) measurements were obtained from apical four-chamber view. RESULTS: There were no significant differences in left ventricular ejection fraction (LV-EF) and RV fractional area change between control and MS groups. RV strain (23.5 ± 7.2 vs. 18.63 ± 6.3, P = 0.001) and RV strain rate (1.72 ± 0.54 vs. 1.37 ± 0.66, P = 0.01) measurements were significantly lower in patients with MS than the control group. However, RV strain and strain rate measurements were comparable between MS subgroups. Correlation analysis revealed that there was poor correlation between RV-LS/LSr and mean-maximum gradients and echoscore but moderate correlation between RV-LS and RV-Sr in systolic pulmonary artery pressure and planimetric mitral valve area. CONCLUSION: We demonstrated that patients with MS had lower RV functions using 2D strain imaging and this is independent from severity of MS. In the detection of subclinical RV dysfunction in patients with MS, 2D strain imaging appears to be useful. (Echocardiography, 2012;00:1-6).

Electrocardiography (ECG) may be a practical guiding tool for prognostic infarct sizing in ST elevation acute myocardial infarction (STEAMI). In this study, we sought to find a relation between the infarct size and the change in the QRS axis after thrombolytic therapy.Patients with STEAMI who received thrombolytic therapy were selected retrospectively. The mean QRS axes of two ECGs (before and 90 minutes after thrombolytic therapy) were calculated. Creatinine kinase MB (CKMB) was used as the marker of infarct size.We did not detect any correlation between infarct size and change in the QRS axis with respect to any myocardial infarction MI localizations (p=0.80). However, in the isolated inferior MI group, there was a good correlation between CKMB and change in the QRS axis (r=-0.52 p=0.049).The change in the QRS axis is rarely emphasized, providing a practical and promising tool for evaluating both the efficiency of the thrombolytic therapy and prognostic infarct sizing.Elektrokardiyografi (EKG) ST yükselmeli akut miyokard infarktüsü (STYAMİ) ile gelen hastalarda prognostik infarkt genişliğini belirlemede pratik ve yönlendirici bir araç olabilir. Bu çalışma ile infarkt genişliği ile trombolitik tedavi sonrası QRS aks değişim miktarı arasında bir ilişki olup olmadığını bulmaya çalıştık.Bu çalışmada trombolitik tedavi alan STYAMİ hastaları retrospektif olarak seçildi. İki EKG’de (trombolitik tedavi öncesindeki ve tedavi sonrası 90. dakikadaki) ortalama QRS aksı bir formül yardımıyla hesaplandı. İnfarkt genişliğini belirlemede belirteç olarak kreatinin kinaz MB (CKMB) kullanıldı.Tüm Mİ altgrupları gözönüne alındığında infarkt genişliği ile QRS aksı değişimi arasında korelasyon saptamadık (p=0.80). Sadece izole inferior Mİ grubunda CKMB ile QRS aksı değişimi arasında iyi derece korelasyon saptadık (r=−0.52 p=0.049).QRS aksı değişimi, trombolitik tedavinin etkinliğinin değerlendirilmesinde ve prognostik infarkt genişliğinin belirlenmesinde çok vurgulanmamış, pratik ve gelecek vadeden bir araç gibi gözükmektedir.

OBJECTIVE: There is no data related to right ventricular functions in mild mitral stenosis patients with normal pulmonary pressure. Therefore, in the present study we investigated right wntricular functions in mild mitral stenosis patints who had visually normal right ventricul by tissue Doppler imaging.METHODS: The study population consisted of 42 rhuematic mild mitral stenosis patients and 31 age-sex matched controls. All patients underwent conventional echocardiography and tissue Doppler imaging. Isovolumetric myocardial accelearation, myocardial performance index and peak sistolic velocities were calculated from the tissue Doppler parameters. RESULTS: The study grops were comparable regarding age, sex, systolic pulmonary artery pressure, systolic-diastolic blood pressure and heart rate. When compared to the control group patients with mitral stenosis had significabtly lower values of isovolumetric myocardial acceleration p: 0,001 , myocardial performance index p: 0,014 and peak systolic velocity p: 0,001 . Within the tisstue Doppler parameters, isovolumetric myocardial acceleration was the most closely correlated parameter with the mitral valve area r: 0.59; p: 0,0001 CONCLUSION: Rheumatic mild mitral stenosis patients with visually normal right ventricle had impaired right ventricular function assessed by tissue Doppler imaging. This impaired function might be related to the rheumatismal myocardial involvement rather than abnormalities in the pulmonary vasculatories., AMAÇ: Romatiznal hafif mitral darlıklı hastalarda, pulmoner arter basıncı normalken sağ ventrikül fonksiyonları ile ilgili veri yoktur. Biz bu çalışmamızda görsel ve boyutsal olarak normal sağ ventriküle sahip hafif mitral darlığı hastalarında sağ ventrikül fonksiyonlarını doku Doppler ile değerlendirmeyi planladıkYÖNTEMLER: Çalışmaya 42 romatizmal hafif mitral darlıklı hasta ve 31 yaş ve cinsiyet eşleşmiş kontrol grubu alındı. Hastalara konvensiyonel ve doku Doppler ekokrdiyografi yapıldı. Doku Doppler parametlerinden izovolümetrik miyokardiyal akselarasyon, miyokard performans indeksi ve tepe sistolik velosite hesaplandı. BULGULAR: Her iki grupta yaş ortalaması, cinsiyet, sistolik pulmoner arter basıcı sistolik ve diyastolik kan basıncı ve kalp hızı değerleri benzerdi. Doku Doppler parametrelerinden izovolümetrik miyokardiyal akselarasyon p: 0,001 , miyokard performans indeksi p: 0,014 ve tepe sistolik velosite p: 0,001 anlamlı olarak hasta grubunda düşük saptandı. İzovolümetrik miyokardiyal akselarasyon doku Doppler parametrelerinden arasında mitral kapak alanı ile en iyi korele olan paramatre olarak bulundu r: 0.59; p: 0,0001 SONUÇ: Görsel ve boyutsal olarak normal sağ ventriküle sahip romatizmal hafif mitral darlığı hastalarında doku Doopler ile değerlendirilen sağ ventrikül fonksiyonları bozulmuştur. Sağ ventrikül fonksiyonlarındaki bu bozukluk pulmoner vaskülatürdeki değişikliklerden çok sağ ventrikülün romatizmal tutulumuna bağlı olabilir.

It has been demonstrated that platelet activation occurs in patients with aortic stenosis. However, no study has assessed platelet activation in patients with a normally functioning bicuspid aortic valve (BAV). Therefore, we aimed to investigate relationship between platelet activation assessed by mean platelet volume (MPV) and normally functioning BAV.Thirty-nine patients with isolated BAV and 25 age- and gender-matched healthy participants were included in the study. Patients with more than mild aortic regurgitation and aortic velocity2 m/s were excluded from the study. For the entire study population, MPV was measured using an automatic blood counter.Compared to control group, MPV value was significantly higher in patients with BAV (8.6 ± 1.0 vs 8.0 ± 0.8, p: .01). In the correlation analysis, there was a significant correlation between MPV measures with aortic stiffness (r: .32 and p: .01) and aortic elastic modulus (r: .37 and p: .003).Our study results indicate that BAV is associated with elevated MPV values.

Objectives: Although there have been a considerable number of reports about BNP levels in patients with mitral stenosis (MS), the relationship between the brain natriuretic peptid (BNP) level and the severity of MS is not investigated extensively in patients with sinus rhythm. In this study we aimed to evaluate plasma BNP levels in patients with MS and to determine the relation of BNP levels with the anatomic and physiological severity of MS.Materials and methods: Ninety six patients with isolated rheumatic MS and 40 healthy control subjects (group 1) constituted the study population. The patients with MS were classified as those with mild MS (45 patients, group 2), moderate MS (31 patients, group 3) and severe MS (20 patients, group 4). All subjects underwent a detailed echocardiography and venous blood was drawn for BNP levels.Results: Patients with MS had significantly higher BNP levels than control subjects. In addition, the analysis with respect of the severity of MS showed that BNP levels increased significantly from group 1 through to group 4. In correlation analysis, while there was a good correlation between BNP levels with planimetric mitral valve area and pulmonary artery pressure, there was moderate correlation between BNP levels with left atrial diameter, mean and maximum gradients.Conclusion: We demonstrated that plasma BNP levels were correlated with echocardiographic parameters showing the severity of the MS. Natriuretic peptides might be useful in the clinical and echocardiographic evaluation of MS patients as an indicator of disease severity

BACKGROUND Coronary artery ectasia (CAE) is characterized by an abnormal dilatation of the coronary arteries. The most common cause of CAE is atherosclerosis but other possible etiologies include congenital abnormalities and inflammatory and connective tissue disease. Earlier studies have documented the association of CAE with the presence of aneurysms in other vascular beds. However, cardiac venous system in patients with isolated CAE has not been studied earlier. In this study, we aimed to assess coronary venous vessels by antegrade coronary venous angiography in patients with isolated CAE. METHODS Twenty-four patients with isolated CAE without significant stenosis and 21 age-matched and sex-matched controls without CAE were included in this study. The anatomy of the coronary venous system was imaged in a left anterior oblique view at an angle of 45° by antegrade coronary angiography. RESULTS Patients with isolated CAE had significantly larger coronary veins compared with control individuals with angiographically normal coronary arteries (coronary sinus ostium: 10.1 ± 1.0 vs. 8.5 ± 2.2 mm, respectively, P=0.003; coronary sinus mid level: 7.9 ± 1.4 vs. 6.5 ± 1.6, respectively, P=0.003; great cardiac vein: 5.6 ± 1.0 vs. 4.3 ± 0.8, respectively, P=0.001; middle cardiac vein: 3.9 ± 1.3 vs. 3.7 ± 1.4, respectively, P=0.52; posterior or lateral vein: 3.2 ± 1.1 vs. 2.4 ± 0.7, respectively, P=0.016). CONCLUSION We have shown for the first time a significant dilatation in the coronary veins in patients with isolated CAE, suggesting the presence of a more extensive vascular destruction in the coronary circulation.

The aim of this study was to investigate the effect of sevoflurane and desflurane on cardiac arrhythmias in adult patients who will be anesthetized. A total of 40 patients who were in the ASA I–II group and who were to undergo elective surgery were included in the study. No pre-medication was administered to the patients. They were monitored with the Holter equipment at preoperative 24 hours, and also at postoperative 24 hours on condition that Holter monitoring will begin before induction. Following routine monitoring, the patients were randomly divided into two equal groups; group one was given sevoflurane and group two was given desflurane. In this study, desflurane and sevoflurane resulted in both a significant prolongation of QT and QTc and a significant increase in QT and QTc dispersion when compared with the basal values. In the sevoflurane group, there was no significant increase in postoperative ventricular arrhythmia, compared to that during the preoperative period. However, this increase was significant in the desflurane group (p = 0.009). Sevoflurane and desflurane result in an increase in QT dispersion. Postoperative rhythmic control should carefully be monitored, especially in the desflurane group.

Background: Metabolic syndrome (MS) has been reported to be associated with an increased risk of atrial fibrillation (AF). The aim of this study was to investigate P-wave dispersion (PWD) in patients with MS. Methods: The study population included 66 patients with MS (21 men, 45 women; mean age, 49.7 ± 9.1 years) and 63 control subjects without MS (26 men, 37 women; mean age, 47.0 ± 10.6 years). The diagnosis of MS was based on the National Cholesterol Education Program Adult Treatment Panel III criteria. A 12-lead electrocardiogram was recorded for each subject. The difference between maximum and minimum P-wave duration was calculated and defined as PWD. An echocardiographic examination was also performed for each subject. Results: Maximum P-wave duration and PWD were found to be significantly higher in patients with MS compared with the control subjects (Maximum P-wave duration: 113.5 ± 9.7 ms vs 101.0 ± 8.1 ms, PWD: 37.8 ± 7.6 vs 23.3 ± 5.9, respectively, P < 0.001 for both). However, there was no statistically significant difference between two groups regarding minimum P-wave duration (75.6 ± 6.9 ms vs 77.6 ± 7.8 ms, respectively, P = 0.18). In addition, PWD was positively correlated with age, body mass index, waist circumference, systolic and diastolic blood pressure, triglyceride level, deceleration time, isovolumetric relaxation time and negatively correlated with high-density lipoprotein cholesterol level and early-to-late diastolic velocity ratio. Conclusion: We have shown that patients with MS have higher PWD, indicating increased risk for AF, compared to the control subjects without MS.

OBJECTIVES The metabolic syndrome (MS) is highly prevalent in patients with acute myocardial infarction. It has been shown that MS is associated with poor in-hospital outcome and long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of MS on the infarct-related artery patency in patients treated with thrombolytic therapy for acute myocardial infarction. METHODS We retrospectively analyzed 116 patients who were admitted to our clinics with acute ST elevation myocardial infarction and received thrombolytic therapy within 12 h of chest pain. MS was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. The flow in the infarct-related artery was analyzed according to the thrombolysis in myocardial infarction (TIMI) flow grade and corrected TIMI frame count. RESULTS MS was present in 55.2% of patients. The proportion of patients with MS who achieved TIMI grade 3 f low after thrombolysis was significantly lower than that of patients without MS (41.5 vs. 58.5%, P < 0.001). Moreover, corrected TIMI frame counts were significantly higher inpatients with MS (58.3+/-34.8 vs. 44.7+/-28.1, P =0.02). On multivariate logistic regression analysis MS was the only independent predictor of TIMI flow less than 3 (P =0.03,odds ratio = 3.545, 95% confidence interval: 1.064-11.808). CONCLUSION We have shown for the first time that patients with MS have lower rates of TIMI grade 3 flow and higher corrected TIMI frame counts after thrombolytic therapy for acute myocardial infarction.

Ventricular septal defect associated with infundibular pulmonary stenosis is a relatively uncommon congenital cardiac defect. We report the first case of a patient with perimembranous small ventricular septal defect and infundibular stenosis suffered from pulmonary valve endocarditis and septic pulmonary embolism.

Background Chronic increased afterload due to severe aortic stenosis (AS) results in com-pensatory concentric left ventricular (LV) hypertrophy and LV dysfunction. These in turn cause remodeling of the left heart. The aim of this study was to investigate the acute effect of transcatheter aortic valve implantation (TAVI) on left atrial (LA) mechanics and LV diastolic function. Methods The study consisted of a total of 35 consecutive patients (mean age was 77.7 ± 5.0 years, 25 female) undergoing TAVI. All TAVI procedures have been performed under the transesophageal echocardiography (TEE) guidance. Before and 24 h after TAVI, all patients underwent transthoracic echocardiography (TTE) and mitral inflow velocities with pulsed-wave (PW) Doppler including early filling wave (E), late diastolic filling wave (A), and E/A ratio were obtained. LV diastolic function was also explored by pulsed tissue Doppler imaging (TDI). Early (E') and late (A') diastolic annular velocities, E'/A' ratio and E/E' ratio were obtained. In addition, during the procedure before and minutes after the valve implantation, the left atrial appendage-peak antegrade flow velocity (LAA-PAFV) was measured and recorded with TEE. Results Compared with baseline, the mean mitral E, septal E' and E'/A' ratio increased significantly after TAVI. In addition, the LAA-PAFV increased significantly within minutes of TAVI (32.45 ± 10.7 cm/s vs. 47.6 ± 12.6 cm/s, p Conclusions TAVI improves LV diastolic function and LA performance immediately.

OBJECTIVE: Cardiac surgery may be performed in patients with hematologic disorders, but carries an increased risk of morbidity. This series describes an experience of transcatheter aortic valve implantation (TAVI) in patients with hematologic malignancies, and highlights the technical considerations to be kept in mind. METHODS: Between June 2011 and April 2014, 133 consecutive high-risk patients with symptomatic severe aortic stenosis were treated with TAVI at our centre. Based on consensus among the local heart team, five patients with hematologic malignancies (myelodysplastic syndrome [2],chronic lymphocytic leukemia [2], Hodgkin lymphoma [1]) were considered high risk for surgery (Logistic EUROSCORE 17.2+-14.0% and STS score 5.8+-4.3%). Serial echocardiographic and clinical follow-ups were done pre- and post-procedure, at discharge, and at 1, 3, 6 and 12 months. RESULTS: Our procedural success rate was 80%. Two heart valves were implanted in one patient due to aortic embolization of the previous valve. Perforation of the right ventricle and cardiac tamponade occurred in the same patient. Mean blood transfusion requirement was 1.0+-1.4 U (range: 0 to 3 U). Mean aortic valve gradient was reduced from baseline to 9.2+-3.27 mmHg, and the effective orifice area was significantly increased to 1.96+-0.29 cm2. Paravalvular aortic regurgitation (AR) was absent-mild in all the patients. CONCLUSION: This present series demonstrates that TAVI with a balloon-expandable valve can be performed safely and effectively and is technically feasible in high-risk patients with hematologic malignancies.

Aim: Metabolic syndrome is defined as a clinical entity characterized by insulin resistance, abdominal obesity, glucose intolerance or diabetes mellitus, dyslipidemia and hypertension. In the present study, we aimed to evaluate right ventricular function in metabolic syndrome patients with tissue Doppler echocardiography.Material and Method: The study population consisted of 28 metabolic syndrome patients and sex-age matched 30 control subjects. All the study population underwent echocardiography and right ventricular function was assessed by tissue echocardiography. Results: The mean age of the metabolic syndrome patients was 48±6.7 and control group was 46±8.3 and there was no statistical significant difference. When compared to the control group, right ventricular function assessed by tissue doppler was found to be significantly lower in metabolic syndrome patients (10.3±2.4 vs 16.4±3.6; p, Amaç: Metabolik sendrom, insülin direnciyle başlayan abdominal obezite, glukoz intoleransı veya diabetes mellitus, dislipidemi, hipertansiyon gibi aterosklerotik risk faktörlerini içeren klinik bir durum olarak tanımlanır. Bu çalışmamızda metabolik sendromlu hastalarda sağ ventrikül fonksiyonları doku Doppler ekokardiyografi ile değerlendirmeyi amaçladık.Gereç ve Yöntem: Çalışmamıza 28 metabolik sendrom hastası ve hastalar ile yaş ve cinsiyet açısından eşitlenmiş 30 kontrol dahil edilmiştir. Tüm çalışma grubuna ekokardiyografi yapılmış olup sol ventrikül fonksiyonları normal olan hastalarda sağ ventrikül fonksiyonları doku Doppler ile değerlendirilmiştir.Bulgular: Metabolik sendrom hastalarının ortalama yaşı 48±6.7 olup kontrol grubunun yaş ortalaması ise 46±8.3’dü ve aralarındaki fark istatistiksel anlamlı değildi. Sağ ventrikül doku doppler sistolik dalga (Sm) değerleri metabolik sendrom hastalarında kontrol grubu ile karşılaştırıldığında anlamlı düşük saptandı (10.3±2.4 vs 16.4±3.6; p

Sarcoidosis is a multi-systemic granulomatous disease of unknown etiology. The present study has been designed to evaluate the importance of diastolic dysfunction with left atrial volume index (LAVi) and left ventricular mass index (LVMi) in determining subclinical cardiac involvement in subjects with stage I–II pulmonary sarcoidosis. A total of 54 patients under follow-up for sarcoidosis without cardiac involvement and 56 healthy subjects were included in the study. The echocardiographic assessment of the patients revealed no significant difference between the two groups regarding left ventricular end-systolic and end-diastolic diameters, ejection fraction (LVEF) and annular velocity determined by tissue Doppler evaluation. The LVEF calculated was 61.8 ± 7.8 % in the sarcoidosis group versus 64.1 ± 2.7 % in the control group (p = 0.04). Left ventricular interventricular septum thickness, posterior wall thickness, and relative wall thickness were significantly higher in the sarcoidosis group compared to the control group (p

Patients with asymptomatic severe aortic stenosis (AS) constitute a heterogeneous group which includes not only certain cases who are at high risk of sudden death and valve-related heart failure, but also those at low risk for these events. Degenerative AS, which includes a majority of patients with AS, is characterized by stricture of the valve, increased arterial stiffness, and diverse left ventricular response to the valvular plus arterial vascular load. In addition to using traditional primary parameters, the severity of AS and the total left ventricular load should be assessed using new measures such as energy loss index and valvulo-arterial impedance. Natriuretic peptide levels and global longitudinal strain imaging may also be used as secondary parameters to obtain information about left ventricular systolic function, although these parameters do not correlate with the severity of AS. Exercise stress testing and exercise echocardiography are also beneficial when assessing the patient if they are symptomatic, and for determining valvular and left ventricular contractile reserves. The aim of this review was to emphasize the importance of risk stratifications in asymptomatic severe AS cases, and to assess the severity of AS using not only conventional methods but also new methods on which much emphasis has been placed during recent years.

Objectives: The aim of this single-center study was to assess the incidence and predictors of in-hospital access site complications related to transcatheter aortic valve implantation (TAVI) performed with new delivery systems in our hospital which has the largest case series in Turkey. Materials and method: We performed successful TAVI with the Edwards Sapien XT valve to 127 (46 male) patients via a transfemoral (121), trans-subclavian (5) and transapical (1) approach. Access site complications were defined according to the Valve Academic Research Consortium (VARC) end-point definitions. Results: Vascular complications occurred in 10.1% of patients. There was negative correlation between vascular complications and diameter of the common femoral artery (r = − 0.301, p=0.004), external iliac artery (r = − 0.327, p=0.004) and common iliac artery (r = − 0.324, p=0.004), but positive correlation between diabetes (r =0.240, p=0.008), sheath to femoral artery ratio (SFAR), sheath to external iliac artery ratio (SEIAR), procedure time, discharge time and the Society of Thoracic Surgeons (STS) score (respectively; r=0.339, 0.001, 0.527, 0.361, 0.289, p=0.003, 0.001, 0.001, 0.001, 0.002). The incidence of vascular complications was significantly higher in patients with diabetes and a high STS score. VARC bleeding complications occurred in 11.7 % of patients. The learning curve pointing out the importance of experience was significantly important in decreasing both bleeding and vascular complications. Conclusions: In this study, we demonstrated that major vascular complications related to TAVI decrease with the use of smaller delivery systems and experience and increase with high-risk scores (STS) and the presence of diabetes. In addition, VARC major vascular complications, observed mostly in patients with diabete mellitus (DM) and high STS scores, were associated with vascular diameters. These results further underline the importance of experience and a multidisciplinary team in patient selection and management for TAVI.

In this case presentation, the transcatheter aortic valve implantation (TAVI) intervention successfully performed on a 76-year-old male patient with severe degenerative aortic stenosis and diagnosed with myelodysplastic syndrome (MDS) is discussed. This case presentation represents the first case on the treatment of severe aortic stenosis on a patient with myelodysplastic syndrome through the use of the TAVI method and may form an alternative to surgery in patients with severe aortic stenosis who have a known haematological disease. For a successful procedure, the patient must be evaluated in cooperation with the haematology clinic and all necessary precautions regarding bleeding and infection complications of the patient must be taken prior to the procedure.

Pulmonary hypertension (PH) is common in patients with severe aortic stenosis (AS). The prognostic effect of PH in high-risk patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown. The aim of this study was to examine the feasibility of TAVI in patients with PH and to determine the effect of TAVI on PH.TAVI was performed in 70 patients (mean age, 77.6 years; 51 females and 19 males) between July 2011 and December 2012, in our hospital. The patients were divided into three groups based on their systolic pulmonary artery pressure (sPAP) values. Group 1 comprised patients with sPAP values40 mmHg; group 2 included patients with sPAP values ranging from 40 to 59 mmHg; and group 3 included patients with sPAP values60 mmHg. Seventy percent of the patients were in groups 2 and 3. After TAVI, the sPAP values of the patients in groups 2 and 3 were significantly decreased (47.4 ± 4.6 and 36.6 ± 6.3, P0.001 and 64.5 ± 4.7 and 43.2 ± 9.2, P0.001, respectively). However, this reduction was sustained for 6 months in group 2 (P = 0.006), whereas the reduction lost its statistical significance (P = 0.07) after 1 month in group 3 (64.5 ± 4.7 and 40.8 ± 8.0, P = 0.001). Significant differences between the sPAP values in all three groups before the procedure were sustained after TAVI (P ≤ 0.001) and after the 1st month (P = 0.02); however, no statistically significant difference was observed after the 6th month (P = 0.06).In this study, we demonstrated that TAVI could be reliably and successfully performed in PH patients with severe AS and that TAVI results in a permanent and significant reduction in sPAP.

The rootstock potential of 21 bottle gourds (Lagenaria siceraria) collected from the Mediterranean region (Turkey) was investigated for watermelon with regard to plant growth, yield, and fruit quality. The Crimson Tide watermelon cultivar was used as a scion and 2 commercial rootstocks (L. siceraria) were also used for comparison. In greenhouse conditions, the survival rate of grafted plants and the effect of rootstocks on plant growth were determined. The grafted plants were planted under low tunnels in early spring and the effects of the rootstocks on early yield, total yield, and fruit quality were evaluated. The survival rates of the grafted plants varied from 83% to 100%. Survival rates of those with commercial rootstocks and local rootstocks were similar. Plants grafted onto 20-02, 31-09, 31-43, 35-01, and 46-03 were more vigorous than ungrafted control plants. Compared to the control plants, grafted plants had 37% to 80% higher plant dry weight. All of the grafted plants except CT/Macis produced a higher yield than the control plants. The plants grafted onto 6 of the local rootstocks had significantly greater total yields than those grafted onto the commercial rootstocks. Among the local bottle gourd landraces tested, the 01-16, 07-45, 20-06, 31-09, 31-15, and 46-03 were found to be promising genotypes with regard to total yield. Early yield was not significantly affected by rootstock. The quality parameters of the fruits harvested from the grafted and control plants were found to be similar except for a limited number of graft combinations. It was concluded that germplasm from Turkish bottle gourds has a high rootstock potential for watermelon with regard to the investigated parameters.