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Objective: Physiologic studies have shown that atrium has an active role in venous blood return from lower extremity. In this context we investigated the association between AF and chronic venous disease (CVD). Methods: In this observational study we included 392 AF patients which were divided into two groups (chronic AF, 218 (56%)) and non-chronic. AF, 174 (44%)). These two groups were compared in terms of CVD after matching conventional risk factors for CVD. Results: CEAP classification was different between chronic and non-chronic patients (C0–C2: 72% vs 47%; C3–C6: 28% vs 53% <0.001). Chronic AF patients had also higher rate of venous reflux on Doppler ultrasound (38% vs 16% P < 0.05). There was a correlation between AF duration, right atrial volume index and CEAP classification respectively (rho:0.314 p < 0.001), (rho:0.258, p < 0.001). Conclusion: Prevalence of CVD is higher in patients with chronic AF. In addition, atrial volume is directly correlated with CVD. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether there is any difference between radiographic axial spondyloarthritis (r-axSpA), also termed ankylosing spondylitis (AS), and non-radiographic (nr-) axSpA, with respect to subclinial myocardial dysfunction using speckle tracking echocardiography (STE). Methods: This was a cross-sectional case control study. We included 72 patients with AS, 38 patients with nr-axSpA, and 56 age-matched healthy subjects. Patients with cardiac disease and cardiac risk factors affecting STE were excluded. The disease burden evaluated by the BASDAI, BASFI, BAS-G, and ASAS-HI scores were comparable in both the r- and nr-axSpA groups. A detailed echocardiographic examination including the M-mode, Doppler, and STE was applied to whole study population. Results: Duration of the disease, the use of an anti-TNFa agent, and CRP levels were higher in patients with AS. Although the AS, nr-axSpA, and control groups had similar ejection fraction values (59±5.2, 60±4.6, 60±4.6, respectively, and p=0.499), the global longitudinal peak systolic strain (GLS) (20.5±3.3, 21.1±3.5, and 22.3±2.4, respectively, and p<0.05) was different between the groups. In a post-hoc analysis, GLS was not different between the nr-axSpA and control groups, and it was significantly lower in patients with AS. In the univariate analysis, peripheral arthritis (p=0.035) and age (p=0.032) were correlated with GLS. A multivariate regression analysis demonstrated that peripheral arthritis (p=0.009) was the only independent GLS predictor. Conclusion: Subclinical myocardial dysfunction as assessed by GLS was present in AS, but not in nr-ax- SpA patients. Thus, GLS could be used as a differentiating factor between radiographic and nr-axSpA patients. [ABSTRACT FROM AUTHOR]

Atrial septal defect (ASD) is also responsible for 30-33% of adult defects. Transcatheter treatment is the first-line treatment for secundum ASD treatment, If defect is appropriate. A 36-year-old ASD patient that had a successful transcatheter closure. The occluder embolization became, within the first 24 hours after procedure, to the aortic arcus. It is known that the devices with embolism are taken by snare and biopsy catheter, but differently, this case involving surgical removal after retraction to femoral artery by another ASD occluder device. Hybrid approach should always be mindful when removing embolized device with high success rate, using dif ferent methods. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to determine the clinical features of patients with recurrent pericardial effusion. We also aimed to evaluate the clinical course and the outcomes of the patients with recurrent pericardial effusion who underwent percutaneous and surgical interventions. Method: 22 patients with recurrent massive pericardial effusion were retrospectively evaluated. We recorded the primary etiologies of effusion, laboratory parameters, and time of the recurrence of effusion, type of the pericardial drainage and also one year mortality of the patients after pericardial drainage. Results: Mean age of the patients was 60±16 and 64% were male. The most common cause was malignancy (31%) followed by idiopathic (27%), postcardiotomy syndrome (13,5%), renal failure(13,5%), autoimmune disease (10%), and heart failure (5%). Median recurrent time was 46 days (interquartile range 16-78 days). The characteristics of the pericardial fluid at initial intervention consist of 59.5% serohaemorrhagic, 27% serous and 13,5% hemorrhagic pericardial effusion . Majority of patients (73%) underwent subxiphoid tube drainage and the remaining patients (27%) underwent percutaneous pericardiocentesis in first intervention. 9 (40.9%) patients died in one year follow up. Of the dead patients, 55.5% had malignity, 22.2% had postcardiotomy syndrome and 22.2% had renal failure. Conclusions: The most common cause of death and recurrent pericardial effusion was malignancy. Idiopathic recurrent pericarditis, autoimmune disease and congestive heart failure are the most benign pathology in which the patients had no mortality in a 1 year follow up period. [ABSTRACT FROM AUTHOR]

The PRECISE-DAPT (predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy) score is recommended for predicting out-of-hospital bleeding after percutaneous coronary intervention (PCI). However, its long-term prediction remains unclear. We investigated the performance of this score in predicting long-term outcomes in patients with the acute coronary syndrome (ACS). We divided retrospectively enrolled patients (n = 1071) into two groups according to their PRECISE-DAPT scores: low < 25 and high ≥ 25. Bleeding was assessed using the Bleeding Academic Research Consortium criteria. The ischemic endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). During follow-up (median 7.3 years), MACCE (55 vs 35%, P<.001) and major bleeding (9 vs 4%, P =.002) rates were greater in the high score group. The PRECISE-DAPT score was an independent predictor of MACCE in multivariate analysis (Hazard ratio [HR]: 1.028, 95% confidence interval [CI]: 1.016–1.039, P <.001). Also, the PRECISE-DAPT score predicted all-cause mortality (HR: 2.115, 95% CI: 1.508–2.965, P <.001) at long-term follow-up. The PRECISE-DAPT score may be useful for predicting MACCE at long-term follow-up in addition to the risk of bleeding. [ABSTRACT FROM AUTHOR]

Cardiac hydatid cyst is a rare manifestation of Echinococcus infestation. It is mainly located in left ventricle followed by right ventricle, left atrium, pericardium, pulmonary artery in case of heart involvement. Herein we report a hydatid cyst in atrioventricular sulcus which is an unusual and rare location for cardiac hydatid cyst as demonstrated by three dimensional transthoracic and cardiac magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Objective: CHA2DS2-VASc [congestive heart failure / left ventricular dysfunction, hypertension, age≥75 years (doubled), diabetes, stroke (doubled) - vascular disease, 65-74 years of age, and female sex ]is a validated , straightforward and practical stratification of thromboembolic risk score for non-valvular atrial fibrillation (NVAF). However it is usually used for stroke. In this trial we aim to compare the CHA2DS2-VASc score between patients with and without AF suffering from peripheral arterial embolism (PAE). Materials and Methods: We retrospectively evaluated the data registries of 150 patients who admitted to hospital due to PAE between January 2011- December 2016. CHA2DS2-VASc score was calculated for each patient Results: Atrial fibrillation was detected 59% of patients. Patients with AF were elder, more often female gender, hypertension, heart failure, hyperlipidemia, stroke and transient ischemic attack (p<0.05). The rate of prior PAE was similar between two groups (p>0.05). Patients with AF had higher CHA2DS2-VASc score then those without AF (5.1±1.7 vs 3.5±1.8 p<0.001). The rate of the patients with a CHA2DS2-VASc score 1-3 was higher in non-AF group (41% vs 23% p=0.017). However the rate of the patients with a CHA2DS2-VASc score score 7-9 was higher in AF group (28% vs 6% p<0.001). In-hospital mortality was similar between groups (14% vs 7% p=0.235). Conclusion: Although AF patients had higher thromboembolic risk level based on CHA2DS2-VASc score. The rate of prior PAE rate was similar between AF and non-AF groups. [ABSTRACT FROM AUTHOR]

Background: Thromboembolic complication is directly related to CHA2DS2-VASc score in patients with non-valvular atrial fibrillation (NVAF). In this study we compared the CHA2DS2-VASc score and in-hospital mortality between NVAF patients with non-cerebral thromboembolism and those with stroke. Methods: We retrospectively reviewed medical records of 213 patients with NVAF who experienced stroke and 115 patients with NVAF who experienced non-cerebral thromboembolism between 2010 and 2015. In all patients, CHA2DS2-VASc score before the event was calculated. Results: The mean CHA2DS2-VASc score was similar in patients with stroke (4.52±1.66) and those with non-cerebral thromboembolism (4.29±2.02) (p=0.196). In-hospital mortality rate was similar between the groups (19% vs. 17%, p=0.756). The rates of coronary artery disease (52% vs. 38%, p=0.014), prior transient ischemic attack (16% vs. 5%, p=0.001), and prior non-cerebral thromboembolism (18% vs. 3%, p<0.001) were higher in patients with non-cerebral thromboembolism. Warfarin (55% vs. 14% p<0.001) and antiplatelet use (56% vs. 40%, p=0.004) was more common in the non-cerebral embolism group, while non-vitamin K antagonist oral anticoagulant (NOAC) use was more common in the stroke group (15% vs. 7% p=0.026). Conclusions: The patients with stroke had similar CHA2DS2-VASc score and in-hospital mortality compared to patients with non-cerebral thromboembolism. [ABSTRACT FROM AUTHOR]

Objectives The aim of the present study was to retrospectively evaluate the prevalence of concurrent coronary artery disease in patients who underwent surgery due to severe valvular heart disease. The study also investigated the association of coronary artery disease with the type of valvular heart disease. Materials and methods A total of 241 patients (123 females [51%]), who had underwent single valvular heart surgery, were included in the study. The patients who underwent valve replacement surgery were divided into four groups: patients with severe mitral stenosis (MS), patients with severe mitral regurgitation (MR), patients with severe aortic regurgitation (AR), and patients with severe aortic stenosis (AS). Age, DM, HT, history of smoking, and LDL values were recorded as the risk factors for CAD. Results Coronary artery disease was detected in 26.4% of patients with mitral stenosis and 57.7% of patients with aortic stenosis. Of the patients with mitral insufficiency, 41.9% had CAD, and 44.4% of the patients with aortic insufficiency had CAD. Conclusion The comparison of MS and AS groups revealed significantly higher prevalence of CAD in the AS group. There was no statistically significant difference between the MR and AR groups in terms of the prevalence of CAD. The comparison of MS and MR groups revealed significantly higher prevalence of CAD in the MR group. Furthermore, the comparison of these groups in terms of the extensiveness of the coronary artery disease revealed significantly higher Gensini score in the MR group. [ABSTRACT FROM AUTHOR]

Considering the increasing use of the transcatheter aortic valve implantation (TAVI) procedure, the relationship of contrast-induced nephropathy (CIN) with post-TAVI mortality has become important. The Mehran score was developed to detect the risk of CIN development after cardiac intervention. We aimed to compare the role of the modified Mehran score, which can be calculated pre-procedure, in predicting CIN development and compare it with the original Mehran score. We retrospectively collected data from TAVI procedures at our institution between December 2016 and June 2021; of 171 patients, 44 (25.7%) had CIN. We found no association between contrast media volume and CIN (387 ± 120 vs 418 ± 139 mL, P =.303). High and very high modified Mehran score and preoperative C-reactive protein (CRP) level were independent risk factors for CIN development after TAVI procedure. The area under curve (AUC) was.686 with 95% CI:.591-.780 and P <.001, and also, with a cut-off point of >7.5 points, there was 79.5% sensitivity and 63.0% specificity; otherwise, with a cut-off point of >9.5 points, there was 54.5% sensitivity and 71.7% specificity, for the modified Mehran score. The modified Mehran score comes into prominence compared with the original Mehran score since it can be calculated pre-procedure. [ABSTRACT FROM AUTHOR]

Introduction: It is well known that chronic hepatitis B virus infection (CHBV) can be associated with cirrhosis and hepatocellular carcinoma but it can also be associated with extra‐hepatic effects, of which cardiac manifestations are the one of the least known. There is a limited amount of data about myocardial dysfunction in CHBV and insufficient data of strain echocardiography in CHBV. The aim of this study was to detect early myocardial dysfunction in CHBV using strain echocardiography. Method: This prospective study included 40 CHBV patients without anti‐viral treatment, 40 CHBV patients under anti‐viral treatment, and 40 healthy volunteers as control group from 2017 October to 2018 May. The patients in all groups were aged 30–60 years, with no co‐morbid diseases. Any patients with pathologies that would cause myocardial dysfunction were excluded from the study. All patients were evaluated with transthoracic two‐dimensional (2D), tissue Doppler, and strain echocardiography. Results: The mean age and gender distribution were similar in all groups (P = 0.677). A statistically significant difference was determined between the groups in respect of the global circumferential strain and global longitudinal strain values (P < 0.01). The difference in the mean lateral s′ was of statistical significance between the CHBV patients and the control group (P = 0.035). No statistically significant difference was determined in respect of the other echocardiographic parameters. Conclusion: As it is a chronic necro‐inflammatory period, chronic HBV can affect myocardial functions. Traditional echocardiographic parameters may not be useful in the detection of early myocardial dysfunction. The results of this study showed that strain echocardiography may be more valuable in early myocardial dysfunction rather than routine 2D echocardiography in CHBV patients. [ABSTRACT FROM AUTHOR]

Systemic venous anomalies without other congenital heart defects are usually asymptomatic and often found incidentally during a vascular intervention or other surgery. A 60-year-old man with DDD cardiac permanent pacemaker was admitted to the emergency department with syncope and total atrioventricular block due to end-of-life of the permanent pacemaker. The lead of the transient pacemaker could not be advanced via transfemoral access to the right ventricle. Venography revealed that the left-sided inferior vena cava drained into the persistent left superior vena cava, and both continued with the coronary sinus. To avoid unexpected events, venography should be performed to detect venous congenital anomalies during transient or persistent pacemaker implantation. [ABSTRACT FROM AUTHOR]

This study investigated the diagnostic performance of point-of-care ultrasound (POCUS) for acute kidney injury (AKI) etiological subgroups in emergency department (ED) patients. Multi-organ POCUS including kidney, bladder, inferior vena cava (IVC), lung and cardiac examinations were used to identify five AKI subgroups: hypovolemia, reduced cardiac output, systemic vasodilatation and renal vasomodulation, renal and post-renal. One hundred sixty-five AKI patients were included in the study. The most diagnostic parameter in the post-renal group was the presence of any hydronephrosis, with a sensitivity of 93.3% (95% confidence interval [CI]: 68.1-99.8) and specificity of 85.9% (95% CI: 79.3-91.1). For the reduced cardiac output group, the most diagnostic parameter was IVC maximum diameter >17 mm with a sensitivity of 100% (95% CI: 83.2-100) and specificity of 70.2% (95% CI: 61.6-77.7). For the hypovolemia group, the most diagnostic parameter was IVC maximum diameter ≤17.9 mm with a sensitivity of 81.2% (95% CI: 71.2-88.8) and specificity of 56.5% (95% CI: 44-68.4). For the systemic vasodilatation and renal vasomodulation group, the most diagnostic parameter was diffuse ascites with a sensitivity of 56.3% (95% CI: 29.9-80.2) and specificity of 89.9% (95% CI: 83.8-94.2). None of the parameters were significant for the renal group. We concluded that multi-organ POCUS is of diagnostic value for AKI subgroups. [ABSTRACT FROM AUTHOR]

Background: Hyperparathyroidism (PHP) is the most common cause of hypercalcemia in outpatients. It is characterized by many cardiac complications including chronic cardiac arrhythmia, hypertrophy, and diastolic insufficiency. However, there are insufficient data about the cardiac systolic function in PHP. Data regarding the positive effects of surgical treatment on cardiac complications are limited and inadequate. The aim of this study was to evaluate the postoperative changes in the left ventricle functions of patients with PHP using strain echocardiography (STE) instead of traditional echocardiographic evaluation. Methods: This prospective study included 29 patients with PHP. Detailed echocardiographic evaluations were made including conventional and STE‚ ventricle function preoperatively and at 6 months after surgery. Then, preoperative and postoperative STE changes, global longitudinal (GLS) and circumferential strain (GCS), were compared. Patients with recurrent surgery, poor echogenicity, and comorbid conditions affecting STE were excluded. Results: No significant change was determined in ejection fraction in the period from preoperative to 6 months postoperative (P >.05). The GLS value increased from 18.53 ± 3.06 to 20.25 ± 3.89, to a statistically significant level (P =.004). The other echocardiographic parameters remained unchanged for the same patients. Conclusion: Despite normal 2D echocardiography data, it was determined that the GLS values deteriorated preoperatively and improved by the 6th postoperative month. The detection of early disorders in PHP that cannot be detected on 2D echocardiography, even in asymptomatic patients, may suggest a new treatment indication. For asymptomatic PHP patients, strain echocardiography may be more valuable than 2D echocardiographic evaluation to determine myocardial dysfunction. The recent literature is insufficient, and there is a need for further, more extensive studies with longer follow‐up periods. [ABSTRACT FROM AUTHOR]

Objective: Cardiac fibrosis is an important contributor to adverse left ventricular (LV) remodeling and arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Galectin-3 (Gal-3) is a novel marker of cardiac fibrosis and inflammation. In this study, we investigated Gal-3 levels in patients with HCM and controls and assessed the relationship between Gal-3 level and echocardiographic indices using strain echocardiography in patients with HCM. Methods: Forty patients with HCM in sinus rhythm and 35 healthy controls were prospectively enrolled in this case-control study. The HCM diagnosis was based on two-dimensional echocardiographic demonstration of a hypertrophied and non-dilated left ventricle (LV) with a wall thickness ≥15 mm in one or more LV myocardial segments in the absence of any cardiac or systemic disease capable of inducing LV hypertrophy. Patients with one of the followings were excluded: coronary artery disease, atrial fibrillation episodes on 24-h Holter electrocardiogram (ECG) monitoring, history of an invasive intervention to alleviate an LV outflow (LVOT) obstruction, inadequate image quality, renal disease, diabetes mellitus, hyperlipidemia, liver cirrhosis, and pulmonary fibrosis. Global LV longitudinal, circumferential strain and strain rates, peak torsion, and LV mass index (LVMI) of all subjects were assessed by echocardiography. Gal-3 levels were measured in all subjects. Results: Left ventricular global longitudinal strain (-13.37±4.6% vs. -18.93±2.5%, p<0.001) and strain rate (0.66±0.22 s-1 vs. 1.08±0.14 s-1, respectively; p<0.001) values were lower in patients with HCM than in controls. Gal-3 levels were significantly higher in patients with HCM than in controls (16.9±6.64ng/mL vs. 13.21±3.42ng/mL, p=0.005). Gal-3 levels were associated with the thickness of the interventricular septum (r=0.444, p=0.004) and LVMI (r=0.365, p=0.021); however, they were not associated with LV global longitudinal strain (p=0.42) or strain rate (p=0.28). Conclusion: Gal-3 levels increased and were correlated with the degree of LV hypertrophy in patients with HCM. Gal-3 is not a good marker of decreased myocardial LV diastolic and systolic functions in these patients. [ABSTRACT FROM AUTHOR]

Our aim was to evaluate the acute cardiac toxicity of adjuvant trastuzumab treatment and its possible relation to changes in oxidative stress. Electrocardiographic and echocardiographic tissue Doppler imaging (TDI) parameters, activity of antioxidant enzymes (superoxide dismutase; SOD), and products of oxidative stress (malondialdehyde; MDA) were analyzed in 30 patients with early-stage breast cancer who had adjuvant trastuzumab treatment. There was a significant prolongation of QT interval after trastuzumab treatment. There was also a significant decrease in left ventricular ejection fraction (LVEF), TDI-derived S’ parameters, and SOD enzyme activity and increase in MDA levels after trastuzumab infusion. There was a positive correlation between changes in SOD activity and LVEF and a negative correlation between changes in MDA levels and LVEF. This study demonstrated a correlation between decreases in LVEF and increases in products of the oxidative stress in patients who had adjuvant trastuzumab treatment. [ABSTRACT FROM PUBLISHER]

Objectives: The aim of the present study was to retrospectively evaluate the prevalence of concurrent coronary artery disease in patients who underwent surgery due to severe valvular heart disease. The study also investigated the association of coronary artery disease with the type of valvular heart disease.Materials and Methods: A total of 241 patients (123 females [51%]), who had underwent single valvular heart surgery, were included in the study. The patients who underwent valve replacement surgery were divided into four groups: patients with severe mitral stenosis (MS), patients with severe mitral regurgitation (MR), patients with severe aortic regurgitation (AR), and patients with severe aortic stenosis (AS). Age, DM, HT, history of smoking, and LDL values were recorded as the risk factors for CAD.Results: Coronary artery disease was detected in 26.4% of patients with mitral stenosis and 57.7% of patients with aortic stenosis. Of the patients with mitral insufficiency, 41.9% had CAD, and 44.4% of the patients with aortic insufficiency had CAD.Conclusion: The comparison of MS and AS groups revealed significantly higher prevalence of CAD in the AS group. There was no statistically significant difference between the MR and AR groups in terms of the prevalence of CAD. The comparison of MS and MR groups revealed significantly higher prevalence of CAD in the MR group. Furthermore, the comparison of these groups in terms of the extensiveness of the coronary artery disease revealed significantly higher Gensini score in the MR group. [ABSTRACT FROM AUTHOR]