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This recent Turkish Myocardial Infarction registry reported that guidelines are largely implemented in patients with acute myocardial infarction (MI) in Turkey. We aimed to obtain up-to-date information for short- and midterm outcomes of acute MI. Fifty centers were selected using probability sampling, and all consecutive patients with acute MI admitted to these centers (between November 1 and 16, 2018) were enrolled. Among 1930 (mean age 62 ± 13 years, 26% female) patients, 1195 (62%) had non-ST segment elevation myocardial infarction (NSTEMI) and 735 (38%) had ST segment elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) was performed in 94.4% of patients with STEMI and 60.2% of those with NSTEMI. Periprocedural mortality occurred in 4 (0.3%) patients. In-hospital mortality was significantly higher in STEMI than in patients with NSTEMI (5.4% vs 2.9%, respectively; P = .006). However, the risk became slightly higher in the NSTEMI group at 1 year. Women with STEMI had a significantly higher in-hospital mortality compared with men (11.2% vs 3.8%; P < .001); this persisted at follow-up. In conclusion, PCI is performed in Turkey with a low risk of complications in patients with acute MI. Compared with a previous registry, in-hospital mortality decreased by 50% within 20 years; however, the risk remains too high for women with STEMI.

Amaç: Ürik asit, insanlarda pürin metabolizması sonucunda meydana gelen son üründür ve pek çok çalışmada kardiyovasküler hastalıklar ile ilişkisi incelenmiştir. Ancak, iskemik ve dilate kardiyomiyopati hastalarında serum ürik asit seviyelerinin değerlendirildiği çalışmalar sınırlıdır. Çalışmamızın amacı, iskemik (İKMP) ve dilate kardiyomiyopati (DKMP) hastalarında serum ürik asit seviyelerini karşılaştırmaktır.Materyal ve Metod: Bu çalışmaya kliniğimizde Ocak 2016 ile Haziran 2018 tarihleri arasında düşük ejeksiyonfraksiyonlu kalp yetersizliği nedeniyle yatmış olan 115 hasta ve yaş-cinsiyet eşleştirmesi yapılan 55 kontrol hastası alındı. DEFKY’li hastalar İKMP olanlar (n=69) ve DKMP olan hastalar (n=46) olarak iki gruba ayrıldı.Bulgular: İKMP ve DKMP grupları arasında; cinsiyet, vücut kitle indeksi, kullanılan ilaçlar ve aritmi görülme sıklığı açısından anlamlı bir farklılık saptanmadı. Ancak, İKMP grubunda yaş, hipertansiyon, hiperlipidemi, koroner arter hastalığı (KAH) varlığı, ailede KAH öyküsü ve sigara içiciliği sıklığı anlamlı olarak daha fazla idi. Her iki grup, laboratuvar özellikleri açısından karşılaştırıldıklarında; İKMP grubunda ürik asit değerinin anlamlı olarak daha yüksek olduğu saptandı (6.9 ± 1.9’a karşın 6.3 ± 1.2, p=0.029). Sonuç: Çalışmamızda, İKMP’li kalp yetersizliği hastalarında serum ürik asit düzeyinin DKMP‘li kalp yetersizliği hastalarına göre anlamlı olarak yüksek olduğu tespit edildi.

Background The pregnancy process is characterized by several changes in the cardiovascular system, especially in left ventricle (LV) systolic and diastolic function. Tissue Doppler imaging (TDI) is a useful tool to evaluate global LV function. This study investigated changes in LV functions using TDI in third-trimester pregnant women. Methods A total of 86 consecutive third-trimester healthy pregnant women and 40 age-matched nonpregnant healthy women (control group) were enrolled in this cross-sectional study. LV diameter, standard Doppler and tissue Doppler parameters, and myocardial performance index (MPI) were measured for all patients. Results There was no significant difference in baseline characteristics between the pregnant and control groups. However, the cardiac chamber diameter was larger, the Am velocity was higher, and the E velocity, Em velocity, and E/A ratio were lower in the pregnant group. In addition, the MPI was significantly higher in the pregnant group compared to the control group (0.57 +/- 0.11 vs 0.42 +/- 0.02, P < .001). Correlation analysis showed that gestational week was positively correlated with the MPI (r = .407, P = .003). Conclusions Detailed assessment of cardiac function is important during pregnancy. We demonstrated that pregnancy was associated with a significantly increased MPI, as well as structural and functional changes.

BACKGROUND Pregnancy affects the cardiovascular system, particularly the cardiac conduction system, thereby increasing the susceptibility of patients towards arrhythmia. QT interval results in ventricular arrhythmias, predominantly polymorphic ventricular tachycardia. The present study was planned to investigate the relationship between a gestational week and QT dispersion in cesarean section patients undergoing spinal anaesthesia. METHODS The study included 40 patients between the ages of 18 and 45 who had no symptoms of anaemia and undergoing elective cesarean section. The patients were separated into two groups based on the gestational week as Group I

Background: Transradial approach (TRA) has increasingly become the default strategy for cardiac catheterisation. However, TRA can result in several complications; radial artery occlusion (RAO) is the most unwilling complication. Unfractionated heparin (UFH) is an effective therapy in preventing RAO. The goal of this study was to evaluate whether weight-adjusted high dose UFH reduces the rate of RAO after diagnostic cardiac catheterisation compared to weight-adjusted standard dose UFH. Methods: A total of 1215 patients screened and after exclusion criteria, 686 consecutive patients were enrolled. 100 IU/kg UFH (high dose UFH group) and 50 IU/kg UFH (standard dose UFH group) were given the patients undergoing diagnostic cardiac catheterisation. RAO was evaluated with vascular Doppler ultrasonography at 10 days after cardiac catheterisation. Results: Among 686 patients undergoing diagnostic cardiac catheterisation, RAO was detected in 36 (5.2%) patients. There was no significant difference with respect to baseline characteristics and co-morbid diseases between high dose UFH group and standard dose UFH group. RAO was significantly higher in standard dose UFH group than high dose UFH group (7.9% vs. 3.0%, p = .004). Multivariate logistic regression analysis was demonstrated that age (OR: 0.958, 95% CI: 0.924-0.993, p = .019) and standard dose heparin (OR: 2.811, 95% CI: 1.347-5.866, p = .006) were independent factor for RAO. Conclusions: High dose UFH was independently associated with a lower rate of RAO. Given that RAO nearly affects about 10% patient underwent TRA, prefer to high dose UFH may be a reasonable choice for RAO prevention.

OBJECTIVE: This study aimed to evaluate the safety of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) during daily clinical practice. METHODS: This was a prospective study conducted between January 01, 2016, and April 01, 2017, in patients aged ≥18 years with a diagnosis of NVAF. We performed the study in 9 clinical centers from different regions of Turkey, and the mean follow-up period was 12+2 months. We investigated major and minor bleeding events of DOAC. RESULTS: A total of 1807 patients with NVAF were enrolled. The mean age of the patients was 73.6±10.2 years, CHA2DS2-VASc score was 3.6±1.4, and HAS-BLED score was 2±1.2. The most frequently prescribed DOAC was dabigatran 110 mg bid in 409 (22.6%) patients. The patients on apixaban 2.5 mg bid were older (p

Objective: Acute coronary syndrome (ACS) is a leading cause of death worldwide. There is great interest in defining the risk factors and underlying mechanisms of ACS among young people. The microbiota and its metabolites have recently become a popular research topic, yet there is still no study that investigated microbiota-generated metabolites as a possible risk factor in young patients with ACS. In this study, we aimed to investigate the relationship between microbiota-generated metabolites and ACS in young people. Methods: This study included 44 young patients with ACS (

Several laboratory parameters have been used to assess inflammatory process and determine cardiovascular risk. The C-reactive protein to albumin ratio (CAR) is a novel marker of inflammation and its clinical importance has not been clearly elucidated in coronary artery disease (CAD). We compared the diagnostic value of CAR with other inflammatory parameters in detecting significant CAD. Patients (n = 421) with stable angina pectoris who underwent coronary angiography for the suspected CAD were included. Neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio, uric acid, monocyte to high-density cholesterol (HDL-C) ratio, mean platelet volume to lymphocyte ratio (MPVLR), and platelet to mean corpuscular volume (MCV) ratio were measured. Patients with significant CAD had a significantly higher NLR ( P = .043), MLR ( P = .004), uric acid ( P < .001), monocyte to HDL-C ratio ( P = .004), and CAR ( P < .001) compared to patients without significant CAD. However, MPVLR and platelet to MCV ratio weren’t different between 2 groups. The area under the curve (AUC) of CAR was the highest AUC among all inflammatory parameters for predicting significant CAD. Multivariate analysis showed that age (odds ratio [OR]: 1.046, 95% confidence interval [CI], 1.020-1.072, P < .001) and CAR (OR: 1.175, 95% CI, 1.126-1.226, P < .001) were the only independent predictors of significant CAD. In conclusion, CAR had the strongest diagnostic value in detecting significant CAD among the inflammatory parameters evaluated in this study.

What is known and objective Propofol is a most commonly used anaesthetic drug for conscious sedation in outpatient procedures. Previous studies have shown that propofol may affect ventricular repolarization based on QT and Tp-e intervals. Frontal QRS-T angle is a marker of ventricular depolarization and repolarization difference. However, there is no study investigating the effect of propofol on frontal QRS-T angle. In this study, we aimed to investigate the effect of propofol on frontal QRS-T angle in patients undergoing colonoscopy procedure. Method A total of 56 patients (53.5% females) who underwent colonoscopy procedure were included in this study. All patients underwent 12-lead surface electrocardiograms (ECGs) just before colonoscopy and 15 minutes after colonoscopy. QT interval, QTc interval, Tp-e interval, Tp-e/QT, Tp-e/QTc and frontal QRS-T angle were calculated from 12-lead ECGs. Results and discussion The frontal QRS-T angle was significantly increased 15 minutes after colonoscopy compared to basal value (36.2 ± 24.3 vs. 29.5 ± 23.6, P = .003). In addition, repolarization parameters including QT, QTc and Tp-e intervals were significantly prolonged at 15 minutes after colonoscopy compared to basal value, except Tp-e/QT and Tp-e/QTc. Significant ventricular or supraventricular arrhythmias were not observed in any patient during the procedure. What is new and conclusion In this study, we found that propofol administration increased the frontal QRS-T angle in patients undergoing colonoscopy procedure. Given that a prolonged frontal QRS-T angle is associated with ventricular arrhythmias, it may be safer to monitor those patients receiving propofol during colonoscopy procedures.

BACKGROUND Contrast-induced nephropathy (CIN) following cardiac catheterization remains a considerable clinic challenge. Volume status is very important in the development of CIN. It can be assessed noninvasively by measuring inferior vena cava (IVC) diameters. The aim of this study was to assess whether IVC can be used for prediction of CIN in patient undergoing cardiac catheterization. METHODS A total of 269 patients undergoing cardiac catheterization were prospectively enrolled in this study. IVC inspiratory and expiratory diameters were measured by transthoracic echocardiography. Caval index was calculated as the percentage decrease in the IVC diameter during respiration. CIN was defined as a ≥0.5 mg/dL and/or a ≥25% increase in serum creatinine within 72 hour post-procedure. RESULTS Contrast-induced nephropathy developed in 46 (17.1%) patients after cardiac catheterization. Caval index was significantly higher in patients with CIN than in patients without CIN (47% [40-64] vs 35% [26-50], P

Objective: Previous studies showed that myocardialrepolarization markers are prolonged in hypertensive patients with leftventricular hypertrophy (LVH) compared to patients with non-LVH. Frontal QRS-Tangle, angle between the QRS and T wave axes, is novel marker of myocardialrepolarization. The aim of our study is to investigate the relationship betweenfrontal QRS-T angle and LVH in hypertensive patients. Material and Method: A total 187 hypertensive patients were included our study. Frontal QRS-T angle was obtained from the automatic reports of the ECG machine. LVH was defined as left ventricular mass index (LVMI) > 115 g/m2 in men and 95 g/m2 in women. Results: Patients with LVH had significantly longer QT dispersion (p=0.028), corrected QT dispersion (p=0.010), Tp-e interval (p = 0.045) and wider frontal QRS-T angle (p, Amaç: Önceki çalışmalarda sol ventrikülhipertrofisi (SVH) bulunan hipertansif hastalarda, SVH bulunmayan hastalaragöre miyokardiyal repolarizasyon belirteçlerinin uzamış olduğu gösterilmiştir.Ortalama QRS ve T dalgası eksenleri arasındaki açı olarak tanımlanan frontalQRS-T açısı da miyokard repolarizasyonunun yeni bir göstergesidir. Çalışmamızınamacı, hipertansif hastalarda frontal QRS-T açısı ile SVH arasındaki ilişkiyiincelemektir.Gereç ve Yöntem: Çalışmamıza toplam187 hipertansif hasta dâhil edildi. Frontal QRS-T açısı, EKG cihazının otomatikraporlarından elde edildi. Sol ventrikül kitle indeksinin (SVKİ) erkeklerde> 115 g/m2, kadınlarda > 95 g/m2 olması SVH olaraktanımlandı.Bulgular: SVH bulunanhastalarda, SVH bulunmayan hastalara göre QT dispersiyonu (p = 0,028),düzeltilmiş QT dispersiyonu (p = 0,010)ve Tp-e aralığı (p = 0,045) daha uzun, frontal QRS-T açısı (p < 0,001) isedaha genişti. Korelasyon analizinde, SVKİ QT dispersiyonu (r= 0,150, p= 0,041),düzeltilmiş QT dispersiyonu (r= 0,167, p= 0,022), Tp-e aralığı (r= 0,160, p= 0,046) ve frontal QRS-T açısı (r= 0,360, p < 0,001)ile pozitif bir şekilde korele idi. Çok değişkenli analizle, frontal QRS-Taçısı SVH'nin tek bağımsız prediktörü olarak bulundu (OR: 1,04, 95% CI: 1,02-1,06,p < 0,001). ROC curve analizinde frontal QRS-T açısının SVH'yi göstermedekien iyi kesme değeri 28o idi. Bu kesme değer, SVH'yi %70,5sensitivite ve %54,5 spesifite ile öngördü.Sonuç: Frontal QRS-T açısı, basit, ucuz ve12 derivasyonlu yüzey elektrokardiyografiden kolaylıkla elde edilebilen birparametredir. Bu açı, hipertansif hastalarda SVH'nin basit bir göstergesiolarak kullanılabilir.

Objective There is a close link between major depressive disorder (MDD) and cardiovascular disease (CVD). Increasing oxidative stress, changes in hypothalamic-pituitary-adrenal axis and platelet clotting cascade may lead to subclinical myocardial damage in MDD patients without overt CVD. The aim of the study was to investigate whether MDD is associated with fragmented QRS (fQRS) on electrocardiogram (ECG) which may reflect myocardial fibrosis/scarring and ischaemia. Methods and results A total of 66 MDD patients without overt CVD and 35 age- and sex-matched control subjects were enrolled in this study. Twelve-lead surface ECGs were analysed for the presence of fQRS and echocardiographic examination was performed for each individual. Multivariate logistic regression analysis was used to assess the relationship between MDD and fQRS. The baseline characteristics in terms of age, gender, body mass index and cardiovascular risk factors were comparable in the groups (all P values0.05). Left ventricular ejection fraction, left ventricular wall thickness and diastolic blood pressure were also similar in the two groups. The presence of fQRS was more prevalent (P 0.001) and SBP values (P = 0.007) were higher in patients with MDD compared to controls. Moreover, multivariate binary logistic regression analysis indicated the recurrent MDD as the only independent predictor of fQRS on ECG (beta =0.196, 95% CI 0.046 - 0.827, P = 0.014). Conclusion The presence of fQRS on the ECG is associated with MDD, and may be a beneficial tool for detecting subclinical cardiac damage in this population.

Introduction: Structural and electrophysiological changes play a critical role in the development of atrial fibrillation (AF). Although the pathophysiology of paroxysmal AF (PAF) has not been fully elucidated, oxidative stress (OS) and DNA damage appear to be important triggers. Thus far, no studies have investigated the relationships among total oxidant status (TOS), DNA damage, and PAF. The goal of this study was to assess TOS and DNA damage in patients with PAF. Methods: This cross-sectional study included 56 patients with PAF and 31 healthy controls. OS was assessed based on TOS, total antioxidant capacity (TAC), and oxidative stress index (OSI). The level of DNA damage was assessed using 8-hydroxy-2′-deoxyguanosine (8-OHdG). Results: There were no significant differences between the groups in terms of baseline characteristics. However, patients with PAF had significantly higher high-sensitivity C-reactive protein (p=0.018), TOS (p=0.001), OSI (p=0.001), and 8-OHdG (p=0.019) levels, compared with the control group. Multivariate logistic regression analysis showed that serum TOS level (odds ratio: 1.608; 95% confidence interval [CI]: 1.188-2.176, p=0.002) was the only independent predictor of PAF. TOS ≥12.2 predicted PAF with a sensitivity of 82% and specificity of 76% (AUC: 0.785, 95% CI: 0.687-0.883, p

Background and aims Carotid artery stenting (CAS) is an accepted treatment modality for carotid artery disease. However, CAS is associated with periprocedural embolic events, and the effect of balloon post-dilatation has not been sufficiently investigated in large studies. We assessed the effect of post-dilatation on periprocedural outcomes during CAS. Methods The study included 128 patients who underwent CAS. The patients were divided into groups according to whether post-dilatation was (post-dilatation [+], group 1) or was not (post dilatation [−], group 2) performed after stent deployment. Major adverse events were defined as death, minor or major stroke, and transient ischemic attack at 30 days. Silent ischemia was assessed using diffusion-weighted magnetic resonance imaging. Results No significant between-group differences were found in baseline characteristics, comorbid diseases, or lesion characteristics. The degree of stenosis and procedure duration was greater in group 1 than in group 2. The rate of major adverse events at 30 days was similar between the two groups (5.1% vs. 4.3%, p = 0.844). The silent ischemia rate and number of high-intensity signals were higher in group 1 than in group 2 (45.8% vs. 26.1%, p = 0.020 and 1.01 [1.2] vs. 0.42 [0.79], p = 0.002). Multivariate analysis revealed that post-dilatation was associated with a 2.4-fold increase in silent ischemia (95% confidence interval: 1.15–5.20, p = 0.020). Conclusions Although post-dilatation was not associated with an increase in major adverse events, it significantly increased the incidence of periprocedural silent ischemia. Therefore, post-dilation should be performed only in cases with severe residual stenosis after CAS.

Objectives: In this study, we aimed to investigate the effects of spinal anesthesia on the QT interval in patients with term and post-term pregnancy that were scheduled for elective cesarean sectio...

BackgroundStroke therapy options have focused on limiting the infarct volume. Neutrophil to lymphocyte ratio (NLR) can be valuable to detect the patients that required intensive treatment at early stage by predicting infarct volume. The aim of this study is to evaluate the relationship between NLR and infarct volume according to the stroke territory, and to determine the prognostic value of NLR for predicting 3-month mortality in acute ischemic stroke (AIS) patients.MethodsA total of 107 patients with AIS were enrolled and followed up 3months in terms of mortality. Study population was divided into two groups according to the stroke territory: anterior circulating stroke (ACS) and posterior circulating stroke (PCS). All patients underwent magnetic resonance imaging. The complete blood count and venous blood samples were obtained from the patients on admission to the emergency department.ResultsThere were no difference between ACS and PCS groups regarding baseline characteristics and co-morbid diseases. Also, C-reactive protein and NLR were similar between two groups. In correlation analyses, infarct volume was significantly correlated with CRP and NLR in ACS (r=0.350, p=0.001 and r=0.482, p0.001, respectively), but not correlated with infarct volume in PCS. Also, NLR was correlated with NIHHS in only ACS group (r=0.326, p=0.002). Multivariate analysis showed that NLR was the only independent predictor of 3-month mortality (OR 1.186, 95% CI 1.032-1.363, p=0.016).ConclusionNLR is significantly correlated with ACS infarct volume, but not with PCS infarct volume in AIS. Also, NLR was an independent predictor of 3-month mortality in AIS patient.

The simultaneous occurrence of acute ST-segment elevation myocardial infarction and acute ischemic stroke is an uncommon and complex clinical presentation. Although the medical treatment of both diseases is similar, data regarding optimal reperfusion therapy are limited. Nevertheless, use of tissue plasminogen activator may be a reasonable strategy for treatment of both diseases. We present a rare case of coexisting thrombosis of the coronary artery and mid cerebral artery that was managed successfully with tissue plasminogen activator thrombolytic therapy. (C) 2018 Elsevier Inc. All rights reserved.

WOS: 000361477800003 PubMed: 25968094 BackgroundSerum uric acid (SUA) is an independent predictor of cardiovascular events in patients with hypertension. Total atrial conduction time (TACT) is a novel echocardiographic parameter used to identify the presence of electrical and structural atrial remodeling. We hypothesized that elevated SUA levels may be associated with prolonged TACT.MethodsA total of 50 consecutive hyperuricemic (defined as SUA>7mg/dl for men and >6.0mg/dl for women) patients who had hypertension were included in the study. A total of 42 normouricemic patients were also recruited consecutively as the control group. All patients were evaluated by two-dimensional echocardiography and TACT was estimated by measuring the time delay between the onset of the P-wave of ECG and peak A'-wave on the tissue Doppler imaging (TDI) of the left atrial lateral wall (PA-TDI duration).ResultsThere were no significant differences between the two groups according to age, sex, left ventricular systolic function, left atrial diameter, and systolic and diastolic blood pressure values. PA-TDI duration was found to be significantly increased in the hyperuricemic group (112.314.7 vs. 92 +/- 12.7ms; P

Background The predictive value of exercise treadmill testing (ETT) remains inadequate in diagnosing patients with suspected coronary artery disease (CAD) and needs to be improved. Objective The aim of this study was to investigate whether the presence of FQRS on 12-lead ECG would increase the PPV of ETT in patients with an intermediate likelihood of CAD. Methods fQRS, defined as the presence of notched R or S waves without accompanying typical bundle branch block or the existence of an additional wave-like RSR’ pattern in the original QRS complex (with a duration of

WOS: 000354291600010 PubMed: 25704186 Introduction: Both inferior vena cava (IVC) diameter and the degree of inspiratory collapse are used in the estimation of right atrial pressure. Aim: The purpose of this study is to evaluate the utility of IVC diameter, using echocardiography as a marker of volume overload and the relationship between these parameters and N-terminal pro-B natriuretic peptide (NT-proBNP) in patients with systolic heart failure (HF). Methods: We included 136 consecutive patients with systolic HF (left ventricular ejection fraction, = 50%

Background and objectives: No-reflow (NR) phenomenon is defined as insufficient myocardial perfusion in coronary circulation in the absence of angiographic evidence of mechanical obstruction. The primary mechanisms of the NR occurrence are thought to be high platelet activity and thrombus burden. Soluble CD40 ligand (sCD40L), which is released into the plasma following platelet activation, accelerates the inflammatory process and causes further platelet activation. The aim of our study is to investigate the relationship between the NR phenomenon and sCD40L level in patients with ST-elevation myocardial infarction (STEMI). Methods: A total of 81 acute STEMI patients undergoing primary percutaneous coronary intervention and 40 healthy participants were included in this study. Acute STEMI patients were classified into two groups: 41 patients with the NR phenomenon (NR group) and 40 patients without the NR phenomenon (non-NR group). The serum sCD40L level was measured for all groups. Results: The serum sCD40L level was significantly higher in the NR group than in non-NR and control groups (379 &plusmn, 20 pg/mL, 200 &plusmn, 15 pg/mL and 108 &plusmn, 6.53 pg/mL, respectively, p &lt, 0.001). Univariate regression analysis demonstrated that male sex, age, Gensini score and sCD40L level were the possible factors affecting the occurrence of the NR phenomenon. In multivariate regression analysis, age (odds ratio [OR], 1.091, 95% confidence interval [CI], 1.023&ndash, 1.163, 0.008) and serum sCD40L (OR, 1.016, 95% CI, 1.008&ndash, 1.024, 0.001) remained the independent predictor of the presence of NR. Conclusions: Our study showed that serum sCD40L level was an independent predictor of the NR phenomenon occurrence.

Dear Editor,We read with a great interest the article by Mahfouz et al. recently published in your journal [1]. In this study, the authors found that fragmented QRS (fQRS) is frequent and an indepe...

A patient with a history of intracranial hemorrhage who was hospitalized due to massive pulmonary thromboembolism (PTE) was presented. A 59-year-old female patient had an intracranial hemorrhage while under anticoagulant therapy due to PTE after a knee operation. Therefore, the anticoagulant therapy was discontinued. Forty-seven days after the cessation of the anticoagulant treatment, the patient was admitted to the emergency department with a complaint of acute dyspnea and presyncope. Transthoracic echocardiography showed signs of right ventricular overload. Contrast-enhanced thorax computed tomography showed saddle-like filling defects in the level of pulmonary trunk bifurcation to the extension of both the main pulmonary arteries. The patient was admitted with a massive PTE. Fibrinolytic treatment could not be given due to the history of hemorrhagic stroke while under heparin infusion therapy. The patient dyspnea did not resolve, so pulmonary angiography and thrombus aspiration was planned. The patient's clinical status had improved after the thrombus aspiration. After the thrombus aspiration, bemiparin treatment was given via effective anti-factor Xa level. Due to lower extremity Doppler ultrasonography showing subacute- chronic thrombosis on the right popliteal vein, inferior vena cava filter was inserted. When thrombolytic therapy cannot be given to patients with a high risk bleeding, the embolectomy and/or aspiration of pulmonary thrombus may be an appropriate treatment option. In such patients, for anticoagulant therapy, unfractioned heparin with close aPTT follow-up or low molecular weight heparin therapy with antifactor Xa follow-up can be used.

Cardiac syndrome X (CSX) is characterized by the presence of myocardial ischemia in the absence of coronary artery stenosis on angiograms. Its relation to oxidative stress and inflammation is well known. There are no data on thiols and their relation with inflammation in CSX. The aim of this study was to investigate thiol levels and thiol/disulfide homeostasis in CSX patients.Fifty consecutive patients who had documented myocardial ischemia and normal coronary angiogram (CSX group), and 45 age-matched and sex-matched consecutive patients who had normal coronary angiogram without myocardial ischemia (control group) were enrolled in this study. C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), native thiol, total thiol, and disulfide levels were measured and disulfide/thiol ratios were calculated in all patients.Demographic, clinical, basic laboratory, and echocardiographic characteristics were similar in the two groups (P0.05). Serum total thiol, native thiol, and disulfide levels decreased significantly in the CSX group compared with the control group (P0.001). CRP and NLR increased significantly in the CSX group compared with the control group (P0.001). Although disulfide/native thiol levels increased in the CSX group, this reduction did not reach statistical significance (5.8 vs. 5.5, P0.05). The reduction of thiols was correlated negatively with CRP and NLR (P0.001). Although univariate logistic regression analyses showed that serum total and native thiol levels, CRP and NLR were independent predictors for CSX estimation, stepwise multivariate logistic regression analysis showed only total thiol levels as an independent predictor for CSX (odds ratio=0.966, 95% confidence interval: 0.950-0.982, P0.001). Also, receiver operating characteristic curve analysis showed that serum total thiol values of 338.4 or below could predict the CSX with 86% sensitivity and 84% specificity (area under curve=0.903; 95% confidence interval: 0.842-0.965).Serum total thiol levels decreased significantly in CSX and this reduction independently predicted CSX with strong sensitivity and specificity. This suggests that the reduction in thiols along with increased inflammation may play a pathophysiological role in the development of CSX.

WOS: 000390164900004 PubMed: 27160174 Background: Myocardial performance index (MPI) is impaired in patients with hypertension. Uric acid is biologically active and can stimulate oxidative stress, endothelial dysfunction, inflammation, and vasoconstriction. Hyperuricaemia may provide a negative contribution to impaired MPI in hypertension. Aim: The study was designed to assess the MPI in hypertensive patients with or without hyperuricaemia. Methods: A total of 96 consecutive hypertensive patients were divided into two groups according to levels of serum uric acid (SUA); 49 normouricaemic patients (defined as SUA < 7.0 mg/dL in men and < 6.0 mg/dL in women) and 47 hyperuricaemic patients. SUA levels and other biochemistry parameters were determined by a standard analytical technique. All patients were evaluated by two-dimensional and Doppler echocardiography. Results: The two groups were similar according to age, body mass index, and smoking status. Mean MPI value (0.498 +/- 0.06 vs. 0.410 +/- 0.05, p < 0.001) was significantly higher in the hyperuricaemic group than the normouricaemic individuals and positively correlated with the mean value of SUA levels (r = 0.51, p < 0.001). Conclusions: Our study demonstrated that high SUA levels were significantly associated with impaired MPI in hypertensive patients. SUA may suggest a valuable laboratory finding in assessing the risk of developing subclinical impaired left ventricular global function.

Statins may exert pleiotropic effects in coronary artery disease (CAD), diabetes mellitus, and familial hypercholesterolemia. We evaluated the effects of statins on the neutrophil–lymphocyte ratio (NLR) and mean platelet volume (MPV) in 261 consecutive patients with hypercholesterolemia having CAD or at high cardiovascular (CV) risk and 50 healthy participants who were retrospectively included in this study. Patients were treated with 10 to 80 mg atorvastatin or 10 to 40 mg rosuvastatin for 24 weeks according to baseline levels of cholesterol, triglycerides, and CV risk. Baseline NLR and MPV were significantly higher in patients with CAD or at high risk compared to the control group (1.89 [0.37-6.78]) vs 1.44 [0.75-2.41], P < .001 and 8.8 [6.27-18.6] vs 8.45 [6-11] fL, P = .038, respectively). The NLR, MPV, and lipid parameters were also compared in the patient group after statin treatment for 24 weeks. Lipid levels decreased but the NLR and MPV did not change significantly after the statin therapy. Further studies are needed to clarify the effect of statin therapy on NLR and MPV in patients with CAD or at high CV risk.

WOS: 000359919000001 PubMed: 26200613 The goal of this study was to evaluate the preejection time (PEP)-derived myocardial performance index (MPI) in hypertensive (HT) patients with sinus rhythm and its relationship to the classic Tei index. One hundred five patients were enrolled in the study (65 HT and 40 control subjects). The mean age of all patients was 50.5 +/- 15 years and 60% were female. Echocardiography was performed on all patients. MPI was measured with the classic Tei method (MPI-Tei index) and the PEP-derived MPI method by using tissue Doppler echocardiography. Although the MPI-Tei index is defined as the ratio of isovolumetric contraction time (IVCT) along with isovolumetric relaxation time (IVRT) to ejection time (ET), PEP-derived MPI is defined as the ratio of PEP and IVRT to ET. We compared echocardiographic data between the HT group and the control group. MPI-Tei index and the PEP-derived MPI values were higher in the HT group compared with controls (0.52 +/- 0.10 vs 0.39 +/- 0.07, P < 0.001, and 0.51 +/- 0.09 vs 0.39 +/- 0.07). PEP-derived MPI was strongly correlated with the MPI-Tei index (r = 0.945, P < 0.001). Our study determined that the PEP-derived MPI might be used in the evaluation of left ventricular function in patients with HT, similar to the classic MPI-Tei index.

Objectives Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) appears to be involved in atherosclerotic plaque vulnerability and rupture. In this study, we aimed to evaluate the utility of serum LOX-1 levels in the diagnosis and assessment of left ventricular systolic HF and LOX-1's relationship with serum pro-brain natriuretic peptide (NT-proBNP). Design and settings This was a cross-sectional study of all eligible patients admitted to the department of cardiology of the University Hospital between July 2011 and April 2012. Methods Fifty-five patients with a diagnosis of systolic heart failure and 25 patients without systolic HF were enrolled in this study. Serum C-reactive protein, NT-proBNP, and LOX-1 were studied. Results Serum LOX-1 and NT-proBNP levels were significantly higher in the heart failure group and showed a positive correlation with NT-proBNP and negative correlations with left ventricular ejection fraction (EF). In addition, LOX-1 levels in patients with ischaemic cardiomyopathy were significantly higher, while they were similar in patients with dilated cardiomyopathy compared to control subjects. Conclusion Our study demonstrates the utility of the serum LOX-1 levels in the diagnosis of left ventricular systolic heart failure. LOX-1 may have a place in the diagnosis of heart failure, in particular in patients with ischaemic cardiomyopathy.