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Introduction: Pathological Q waves are correlated with infarct size, and Q wave regression is associated with left ventricular ejection fraction improvement. There are limited data regarding the association between Q wave regression and clinical outcomes. Our main objective was to assess the association of pathological Q wave evolution after reperfusion with clinical outcomes after ST-elevation myocardial infarction (STEMI). Patients and Methods: Standard 12-lead electrocardiograms (ECGs) were recorded in 1553 patients, who presented to our hospital with chest pain and underwent primary percutaneous coronary intervention (p-PCI) with the diagnosis of STEMI and were retrospectively analyzed. ECGs were recorded before and 90 min after PCI, as well as at hospitalization discharge and 12 months of follow-up. The study population was divided into three groups as the Q wave regression group, the Q wave persistent group, and the non-Q wave MI group. Results: There were 502 (32%) patients with persistent Q waves (PQ group), 509 (33%) patients with Q wave regression (RQ group), and 542 (35%) patients with non-Q wave MI (NQ group). The degree of LVEF was significantly greater in the RQ group and NQ group than in the PQ group [(47.5 ± 10.1 vs. 49.2 ± 9.9) vs. 43.3 ± 10.5 respectively, p Conclusion: In a population of STEMI patients, persistent Q waves defined according to the classic ECG criteria after reperfusion were associated with high one-year mortality, and low LVEF, while Q wave regression was associated with significantly lower risk of events.

Background Sortilin was an important molecular protein involved in the pathogenesis of atherosclerosis. Besides, serum sortilin was associated with adverse cerebrovascular events. Atherosclerotic stenosis in the carotid artery is a major etiology for ischemic stroke. The risk of stroke in patients with intermediate carotid artery stenosis (CAS) was unknown. Hence, the aim of the present study was to evaluate the relationship between serum sortilin levels and stroke in patients with intermediate CAS. Methods A total of 195 intermediate CAS patients were included in this cross-sectional study. The patients were divided into two groups as symptomatic ( N = 95) and asymptomatic ( N = 100) patients. Patients with a transient ischemic attack (TIA), retinal ischemic event, or ischemic stroke resulting from the narrowed carotid artery were considered to be symptomatic. Serum sortilin concentrations were measured using the enzyme-linked immunosorbent assay. Results Serum sortilin level was significantly higher in the symptomatic group than in the severe asymptomatic group (1.53 ± 0.25 ng/mL vs 1.34 ± 0.19 ng/mL, p < 0.001). Besides, high serum sortilin levels (odds ratio = 4.91, 95% confidence intervals 1.24–19.51, p = 0.023) were identified as independent predictors of symptomatic carotid plaque. In the receiver operating characteristic curve analysis, serum sortilin levels higher than 1.34 ng/mL predicted stroke/TIA with a sensitivity of 66.3% and a specificity of 67% (AUC = 0.725, p < 0.001). Conclusions Serum sortilin level is increased in the presence of symptomatic intermediate CAS and may have clinical value in the management of patients with carotid artery disease.

Left ventricular apical thrombusThe study population included 378 patients (mean age: 56.5 ± 12.3 years, male: 318) presenting with AMI between January 2016 and January 2020. Primary percutaneous coronary intervention procedure was performed in all patients. Initial echocardiogram was performed within 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and 12th months. Patients were divided into two groups according to the presence of LVAT on echocardiography.The incidence of the LVAT was 8.5% (High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneurysm may be used for LVAT risk prediction among patients presenting with AMI.

The effect of malnutrition on outcomes after carotid artery stenting (CAS) is not well known. This study reports the relationship between malnutrition and post-procedure 30-day major adverse events (MAEs). A total of 978 patients hospitalized for CAS were enrolled in the study. Controlling nutritional status (CONUT) score, the nutritional risk index (NRI), and the prognostic nutritional index (PNI) were calculated. MAEs (myocardial infarction, stroke/transient ischemic attack and mortality) were compared. According to the CONUT score, NRI, and PNI, 9.4%, 41%, and 11.4% patients were moderately or severely malnourished, respectively; 74.8% were at least mildly malnourished by at least 1 score. Forty-seven patients (4.8%) had a post-procedure 30-day MAE. Continuous classifications of the indexes were independently associated with higher MAE. CONUT showed the highest predictive ability, whereas NRI had the lowest (C-index: CONUT, 0.701; NRI, 0.681; PNI, 0.688). According to categorical classification of indexes, only CONUT and PNI showed predictive ability for MAE. Malnutrition assessment could identify patients with CAS at elevated risk for MAE. CONUT, NRI, and PNI continuous scores were independent prognostic factors for the post-procedure 30-day MAE. According to our study, CONUT showed the highest predictive ability.

In this study, we investigated whether left atrial functions evaluated by speckle tracking echocardiography , classic echocardiographic and clinic parameters predict appropriate Implantable Cardioverter Defibrillator (ICD) shock in patients who underwent ICD implantation for hypertrophic cardiomyopathy.Totally 87 patients who received ICD implantation for primary or secondary prevention were included in the study. Patients' clinical, electrocardiographic, 2 dimen- sion classic, and speckle tracking echocardiographic data were collected. Left atrial functions were assessed by speckle tracking echocardiography. Left atrial strain just before mitral valve opening was taken as peak atrial longitudinal strain. Appropriate ICD therapy was defined as cardioversion or defibrillation due to ventricular tachycardia or fibrillation. Patients were divided into 2 groups as occurrence or absence of appropri- ate ICD therapy during follow-up (mean, 50.2 ± 9.3 months). Patients with an European Society of Cardiology (ESC) risk score6% were considered high-risk patients.A total of 24 (27.5 %) patients were observed to have an appropriate ICD therapy. In patients on whom appropriate ICD therapy was performed, a higher Sudden Cardiac Death risk Score and decreased peak atrial longitudinal strain and global longitudinal peak strain were observed. In patients with high ESC risk score (6%), in Cox regres- sion analysis, peak atrial longitudinal strain (odds ratio: 0.806, P = .008), Sudden Cardiac Death risk score (odds ratio: 1.114, P = .03) and global longitudinal peak strain (odds ratio: 1.263, P = .02) were found to be independent predictors of occurrence of appropriate ICD therapy.Easily measurable peak atrial longitudinal strain may provide additional information in predicting ventricular arrhythmias or deciding on prophylactic medical treatment to prevent ventricular arrhythmias or reduce the frequency of appropriate shock in high-risk patients with ICD implanted.

A previously healthy 68-year-old woman presented to the outpatient clinic with a 2-month history of palpitation. Physical examination and laboratory findings were unremarkable. Her electrocardiogram showed sinus tachycardia with a heart rate of 115 beats/m. Transthoracic echocardiography (TTE) showed a normal ejection fraction with a huge mass in the left atrium (Figure 1a). Transesophageal echocardiography (TEE) and cardiac magnetic resonance imaging (MRI) were performed for further evaluation. TEE revealed a hyperechogenic, well-demarcated mass in the left atrium, that was attached to the interatrial septum and adjacent to the left pulmonary veins (Figure 1b, 1c,1d). Cardiac MRI revealed a heterogeneous left atrial mass located on the fossa ovalis, 58x52x54 mm in size and markedly hyperintense on a STIR sequence (Figure 1e). These findings were suggestive of a benign cardiac tumour such as myxoma or hemangioma. A decision for surgery was made and coronary angiography was performed which showed that the branch of the circumflex artery supplied and surrounded the mass in the form of a net (Figure 1e). The patient underwent complete excision of the mass (Figure 2a, 2b). Histopathological examination revealed a nested architecture of epitelioid cells, the nests are round or oval in shape and invested by an fibrovascular stroma. Tumor cells had centrally and eccentrically located round nuclei and cytoplasm ranging from finely granular to eosiniphilic. At immunohistochemical staining, the nests were positive for chromogranin A, negative for cytokeratin (Figure 2c, 2d, 2e, 2f). A diagnosis of paraganglioma was made. After an uneventful postoperative course, she was discharged home on postoperative day 6. Cardiac paraganglioma is a very rare neuroendocrine tumour and accounts for less than 1% of primary cardiac tumours (1,2). Approximately 10% of paragangliomas may be malignant, complete surgical resection remains the first-line treatment (3).

The effect of physiological circulatory changes during pregnancy on hypertrophic cardiomyopathy (HCM) has been reported with limited data. This study aimed to provide information regarding outcomes of pregnant women with HCM and to identify predictors of major adverse cardiac event (MACE).A total of 45 pregnancies with HCM were retrospectively reviewed. The primary endpoint was a MACE that occurred within an 8‑week period after delivery, including maternal death, heart failure (HF), syncope, and malignant ventricular arrhythmias (VAs). Baseline and outcome data were analyzed for all patients. Patients with and without MACE were compared, and patients with obstructive HCM were compared with those who had non-obstructive HCM. The study population was divided into two subgroups of patients having or not having an implantable cardioverter defibrillator implantation (ICD).At least one MACE occurred in 11 patients (24.4%); six patients developed HF (13.3%), six had a ventricular tachyarrhythmia (13.3%), and two had syncope (4.4%). New York Heart Association functional class of ≥ II, presence of HF signs before pregnancy, increased left ventricular outflow tract (LVOT) gradient were significantly associated with MACE. Fatal VAs were seen during pregnancy in one of five HCM patients with ICD. In the ROC curve analysis, an LVOT gradient higher than 53.5 mm Hg predicted the presence of MACE with a sensitivity of 90.9% and a specificity of 73.5%. This study is the largest series in the literature representing pregnant women who had HCM and ICD.The current data suggest that HF and high LVOT gradients are important risk factors for the development of cardiac complications.HINTERGRUND: Über die Auswirkungen physiologischer Kreislaufveränderungen während der Schwangerschaft auf eine hypertrophe Kardiomyopathie (HCM) wurde bisher anhand begrenzt vorhandener Daten berichtet. Ziel der vorliegenden Studie war, Informationen über die Ergebnisse schwangerer Frauen mit HCM zu erhalten und Prädiktoren schwerer unerwünschter kardialer Ereignisse (MACE) zu identifizieren.Retrospektiv wurden dazu die Daten von 45 Schwangerschaften mit HCM ausgewertet. Primäerer Endpunkt war ein MACE, das innerhalb einer 8‑Wochen-Phase nach Entbindung auftrat, einschließlich Tod der Mutter, Herzinsuffizienz, Synkope und maligner ventrikulärer Arrhythmien (VA). Die Ausgangsdaten und die Daten des Ergebnisses im Verlauf wurden für sämtliche Patientinnen ausgewertet. Verglichen wurden einerseits Patientinnen mit und ohne MACE, andererseits Patientinnen mit obstruktiver HCM und mit nichtobstruktiver HCM. Die Studienpopulation wurde in 2 Subgruppen unterteilt: Bei den einen wurde ein implantierbarer Kardioverter-Defibrillator (ICD) implantiert, bei den anderen nicht.Bei 11 Patientinnen trat mindestens ein MACE auf (24,4 %); eine Herzinsuffizienz entwickelte sich bei 6 Patientinnen (13,3 %), ebenfalls bei 6 eine ventrikuläre Tachyarrhythmie (13,3 %), und bei 2 trat eine Synkope auf (4,4 %). Eine Funktionsklasse ≥ II gemäß New York Heart Association, das Vorliegen von Herzinsuffizienzsymptomen vor der Schwangerschaft und eine erhöhter linksventrikulärer Ausflusstrakt(LVOT)-Gradient waren signifikant mit MACE vergesellschaftet. Eine tödliche VA wurde während der Schwangerschaft bei einer von 5 HCM-Patientinnen mit ICD beobachtet. In der Receiver-Operator-Characteristic(ROC)-Kurven-Analyse war ein LVOT-Gradient über 53,5 mm Hg ein Prädiktor für das Vorliegen eines MACE mit einer Sensitivität von 90,9 % und einer Spezifität von 73,5 %. Die vorliegende Studie enthält die größte Serie schwangerer Frauen mit HCM und ICD in der Literatur.Den aktuellen Daten zufolge stellen Herzinsuffizienz und hohe LVOT-Gradienten entscheidende Risikofaktoren für das Auftreten kardialer Komplikationen dar.

High-grade intracoronary thrombus (ICT) burden leads to greater myocardial injury following anterior myocardial infarction (MI). The modified Glasgow prohgnostic score (mGPS) is a novel immune-inflammatory index, calculated by using C-reactive protein (CRP) and albumin levels, was shown to have prognostic value in heart diseases. The present study investigated the role of mGPS in predicting high grade ICT in patients with acute anterior MI admitted between February 2017 and March 2020. Blood samples were obtained at admission and mGPS was calculated. The ICT burden was evaluated visually from angiographic images. Patients were divided into 2 groups according to the ICT burden as high and low. A total of 1132 patients were enrolled: a mean age 61 ± 12.4 years and 370 males (32.7%). Serum albumin was lower, whereas mGPS and CRP were higher in high grade ICT group. CRP (odds ratio (OR): 1.404 95% CI: 1.312–1.502; P < .001), albumin (OR: .486; 95% CI: .301–.782 P < .001), and mGPS (0 vs ≥ 1) (OR: 7.391; 95% CI: 3.910–13.972; P < .001) were independent predictors of high-grade ICT burden in the left anterior descending coronary artery. The mGPS is a novel predictor of high-grade ICT burden and may be useful for risk stratification in patients with acute anterior MI.

Coverage of the left subclavian artery origin is required to achieve adequate proximal seal during up to 40% of TEVAR cases. The evidence regarding left subclavian artery revascularization in patients undergoing elective or emergent TEVAR with left subclavian artery coverage is weak, and there is ongoing debate whether revascularization should be performed routinely of selectively. Beyond this debate, there is a lack of data about left subclavian artery coverage during TEVAR in end-stage renal disease patients with a functional left upper limb atreriovenous fistula. We present the case of a patient with a left distal radiocephalic arteriovenous fistula who underwent emergent TEVAR with left subclavian artery coverage for ruptured type B aortic dissection. The arteriovenous fistula remains functional on a 3-month follow-up, and the patient did not develop symptoms related to posterior stroke, spinal cord ischemia, limb ischemia, or vertebrobasilar insufficiency.

Atherosclerosis is a chronic inflammatory vascular condition characterised by intimal thickening with cholesterol accumulation and macrophage foam cell infiltration causing plaque formation at the site of the injured vessel wall. This condition is a major contributor to carotid artery stenosis (CAS). Sortilin, a member of the mammalian vacuolar protein sorting 10 protein family, promotes uptake of low-density lipoprotein particles into macrophages with consequent foam cell formation independent of the low-density lipoprotein receptor, and thereby, accelerates atherosclerotic plaque formation and progression. We investigated the correlation between serum sortilin levels and the severity of extracranial CAS.The study included 149 patients who underwent carotid angiography for suspected carotid artery disease. The North American Symptomatic Carotid Endarterectomy Trial 2011 criteria were used to determine the degree of CAS. Serum sortilin concentrations were measured using the enzyme-linked immunosorbent assay.Serum sortilin levels were significantly higher in the severe CAS than in the non-severe CAS group (2.71 ± 0.71 ng/mL vs 1.63 ± 0.57 ng/mL, P .001). Receiver operating characteristic curve analysis showed that serum sortilin levels1.66 ng/mL predicted severe CAS with sensitivity of 83.49% and specificity of 56.76%.Current data suggest that prediction of severe CAS may serve as an atherosclerosis biomarker and significantly contribute to research on disease progression in atherosclerosis, as well as in other arterial diseases. Sortilin may be a potential therapeutic target owing to its role in the pathogenesis of atherosclerotic carotid artery disease.

Aim: Statins are one of the most important agents in the treatment of atherosclerotic peripheral arterial disease. We aim to compare high- and moderate-dose statin therapy in patients with lower extremity artery disease (LEAD) who have undergone percutaneous transluminal angioplasty (PTA). Patients and Methods: Ninety-four patients treated with PTA were selected consecutively and retrospectively and were divided into two groups according to the high- or moderate-dose statin treatments they were given. Groups were compared for the absence of restenosis and occlusion as primary patency and the need for reintervention in the treated arterial segment as secondary patency. All patients underwent computed tomography (CT) angiography or duplex scan one year after receiving PTA. Results: Coronary revascularization (p

This study evaluated the impact of the baseline estimated glomerular filtration rate (eGFR) on clinical and angiographic outcomes and long-term in-stent restenosis (ISR) rates in patients undergoing elective carotid artery stenting (CAS) procedures. Consecutive patients who underwent CAS were retrospectively enrolled (n = 456). At the end of 3 years of follow-up, patients who had died or were lost follow-up were excluded from the study and a final analysis was performed using data from the remaining 405 patients. The study population (n = 405) was divided into 3 tertiles based on the tertile values of the eGFR level (T1, T2, and T3); then, clinical and procedural characteristics and 3-year ISR rates were compared between the groups. An ISR of 50% was detected in 49 (12%) surviving patients. The 3-year ISR was higher among patients with the lowest eGFR values (T1) by 3.7 times (95% CI: 2.01-11.38) than that among patients with the highest eGFR values (T3). These significant relationships persisted following adjustment for confounders. A lower baseline eGFR level was significantly associated with an increased ISR rate. Decreased renal function may be a predictor of ISR after CAS using first-generation stents.

Background Coronary artery bypass grafting (CABG) remains the gold standard treatment for mutivessel and left main coronary artery disease (CAD). Saphenous vein graft (SVG) patency is still a problem in CAD patients after CABG surgery. The Dual Antiplatelet Treatment (DAPT) score is a clinical prediction tool that predicts ischaemic and bleeding risk in CAD patients. The aim of this study is to investigate the relationship between DAPT score and SVG patency in CABG patients. Method This retrospective study enrolled a total of 398 patients (68 female; mean age 65.8 +/- 9.1 years) with a history of CABG surgery. The study population was divided into two subgroups according to SVG patency. The DAPT score was calculated for each patients and compared between the two groups. Results Coronary angiography revealed SVG disease in 212 patients and SVG patency in 186 patients. The rates of diabetes mellitus and hypertension, red cell distribution width values, DAPT Score, time interval after CABG and number of SVGs were significantly higher while LVEF was significantly lower in patients with SVG disease. The presence of diabetes mellitus, high DAPT score, long time interval after CABG and high number of SVGs were found to be independent predictors of SVG patency. DAPT score above 2.5 predicted SVG disease with a sensitivity of 77.1% and a specificity of 87.1% (AUC: 0.873; 95%CI: 0.823-0.924; p < 0.001). Conclusion The DAPT score may provide useful information for SVG patency in CABG patients. Patients with high DAPT score should be followed up closely for SGV occlusion. DAPT score may be useful prior to CABG in determining the duration of dual anti-platelet therapy and in encouraging the use of arterial grafts with better patency. WOS:000642132800001 2-s2.0-85104816621 PubMed: 33880976

Femoral artery aneurysm (FAA) is a rare peripheral vascular aneurysm that can lead to thrombosis, embolism and fatal rupture in untreated cases. The clinical presentation of FAA varies from the finding of an asymptomatic mass on routine physical examination to acutelimb-threatening ischemia. Presently, a case of FAA that caused deep vein thrombosis and compartment syndrome has been described. Although the current treatment method recommended for FAA is an open surgical procedure, in this case, an endovascular intervention was performed due to high risk of surgical mortality.

Introduction: Percutaneous endovascular methods have emerged to the contemporary revascularization choice in patients with infrapopliteal (IP) arterial disease. However, restenosis remains to be the Achilles' heel of this minimally invasive revascularization techniques. We aimed to analyze the association between preprocedural (neutrophil to lymphocyte ratio) Neutrophil-to-Lymphocyte ratio (NLR) and subsequent patency in a cohort of patients with symptomatic IP disease undergoing balloon angioplasty. Methods: All patients primarily treated with angioplasty of at least one IP artery causing severe symptoms or critical limb ischemia (CLI) (Rutherford category 1–6) between January 2014 and August 2015 were analyzed. The baseline demographic, clinical, and angiographic features admission laboratory test results were obtained from hospital files and computer records. NLR was calculated as the preprocedural ratio of neutrophils to lymphocytes. Results: The study population involved 42 (43.8%) CLI patients and 52 (54.2%) claudicants. The most frequent target vessel was the posterior tibial artery. Primary patency at 1 month was 81.9% and 62.7% at 6 months. NLR (odds ratio: 0.04, P = 0.03) independently predicted patency at 1 month but did not have a role on arterial patency after 1 month. Only smoking (odds ratio: 4.8, P = 0.01) associated with patency at 6 months. Conclusion: Preprocedural NLR was an independent risk factor for IP arterial patency at short-term. It may be used as a risk factor for subsequent amputation or recurrent interventions.

Background and aim: The objective of this study was to assess the potential role of mitral regurgitation (MR) in the release of copeptin in heart failure patients with reduced ejection fraction (HFrEF). Methods: The study included 63 patients of whom 33 had functional mild MR (Group 1) and 30 had functional severe MR (Group 2). The functional class of both groups was New York Heart Association (NYHA) Class III. Blood samples for the determination of plasma copeptin and B-type natriuretic peptide (BNP) levels were obtained on the same day with the echo-cardiographic examination. Standard echocardiographic studies were performed. Results: Copeptin and BNP levels showed a substantial agreement in the whole study group (Kappa level: 0.607, p < 0.0001). Also, copeptin and BNP showed a strong correlation and were both increased and significantly higher in Group 2 than in Group 1 (p < 0.001 and p < 0.05, respectively). Left ventricular global longitudinal strain and left ventricular ejection fraction values were similar in both groups. The study population were divided into two subgroups on the basis of copeptin median level (6.4 ng/mL), and the prevalence of severe MR was significantly higher in the above-median-copeptin subgroup. A linear regression analysis showed that the presence of severe MR was the only independent predictor of high circulating plasma copeptin level (OR 7.5, 95% CI 2.8–12.1; p = 0.002). Conclusions: Severe MR is an independent predictor of elevated plasma copeptin level in HFREF irrespective of systolic function.

INTRODUCTION[|]Postoperative atrial fibrillation (POAF) is a frequent and serious complication after aorto-coronary bypass graft (ACBG) surgery which unfortunately increases morbidity and mortality. Postoperative stroke, hemodynamic instability, renal failure, infection, inotropic agent and coronary unit need are complications caused by POAF. Inflammation and oxidative stress are among several mechanisms contributing to the pathogenesis of POAF. Monocyte to HDL ratio (M/H ratio) is a newly defined parameter of both inflammation and oxidative stress. In this study we investigated M/H ratio in predicting POAF after ACBG surgery.[¤]METHODS[|]Total number of 311 patients who underwent ACBG surgery were included in our study. Blood samples were obtained from the patients after 12 hours of fasting for analysis of routine biochemistry and lipid panel in the morning of ACBG surgery. Patients were monitored for the occurrence of POAF continuously through hospitalization. [¤]RESULTS[|]POAF was demonstrated in 71 patients after ACBG operation. M/H ratio was significantly higher in POAF+ group compared to POAF – group (p< 0.001). Median age of POAF (+) patients is 62.0+-10.1 which was significantly higher than POAF (-) patients. Other atrial fibrillation risk factors such as hypertension, diabetes mellitus, smoking or alcohol consumption were similar between groups. Potassium level was statistically lower in POAF+ group compared to POAF- group. (p= 0,01)[¤]DISCUSSION AND CONCLUSION[|]M/H ratio is an indicator of inflammation and oxidative stress which both plays an important role in the pathogenesis of atrial fibrillation. M/H ratio was found be statistically higher in POAF + patients compared to POAF – patients.[¤]

Giriş: Kontrast madde nefropatisi (KMN) primer perkütan koroner girişim (p-PKG)uygulanan ST yükselmeli miyokart infarktüsü (STEMİ) hastalarda ciddi birkomplikasyondur. Monosit/yüksek dansiteli lipoprotein (HDL) oranı (MHR) sonzamanlarda inflamasyon ve oksidatif stres işaretleyici tanımlamıştır. Buçalışmanın amacı, p-PKG uygulanan hastalarda KMN riski için MHR öngörü değeriniaraştırmaktır.Hastalar veYöntem: STEMİ tanısı ile hastaneye yatırılan ve p-PKG uygulanan2120 hasta retrospektif olarak değerlendirildi. Kontrast maruziyeti sonrası 72saat içinde başlangıç serum kreatininde ≥ %25 göreceli artış veya ≥ 0.5 mg/dLmutlak artış olması KMN olarak tanımlandı. MHR acil servis başvurusundahesaplandı. KMN riski ile MHR arasındaki ilişki değerlendirildi.Bulgular: KMN insidansı (n= 139) %6.6 idi. Yaş (p= 0.001), bazal kreatinin (p, Introduction: Contrast-inducednephropathy (CIN) is a serious complication in patients with ST segmentelevation myocardial infarction (STEMI) undergoing primary percutaneouscoronary intervention (p-PCI). The monocyte to high-density lipoprotein (HDL)cholesterol ratio (MHR) has recently been defined as an inflammation andoxidative stress marker. The aim of this study was to evaluate the predictivevalue of MHR for risk of CIN in patients with ST who underwent p-PCI.Patients and Methods:Dataof a 2120 patients who were hospitalised with the diagnosis of STEMI andunderwent p-PCI were retrospectively evaluated. A relative increase in serumcreatinine levels of ≥ 25% or an absolute increase of ≥ 0.5 mg/dL from thebaseline within 72 h of contrast exposure was defined as CIN. MHR was calculatedon emergency admission. The risk of CIN was evaluated across MHR values.Results: Theincidence of CIN was 6.6% (n= 139). Age (p= 0.001), baseline creatinine levels(p< 0.001), DM (p< 0.001), HT (p< 0.001) and anaemia (p= 0.001) werehigher in patients with CIN. The patients were divided into 2 groups based onthe development of CIN. Peripheral monocyte count, HDL levels and MHR did notdiffer between the groups. After correction for all baseline confounders,neither peripheral monocyte count nor MHR were found to be independentpredictors of CIN development in our multivariate logistic regression analyses.Conclusion: Because MHR does not differmuch from that in stable patients at the early phase of infarction, it cannotbe a potential predictor of CIN development in patients with STEMI whounderwent p-PCI.

Objective: This study is a comparison of the electrocardiogram (ECG) findings of detainees and convicts who participated in a hunger strike recorded at the end of the strike and 2 months later. Methods: A total of 81 male detainees and convicts (mean age 41+-9.4 years) who participated in a hunger strike between September 2012 and November 2012 were included in this study. The mean duration of the fast was 45+-9.6 days. Measurements of blood pressure, body weight, and serum electrolytes (sodium, potassium, calcium) obtained on the last day of the hunger strike and 2 months later were compared, as well as 12-lead ECG readings obtained at the same intervals, which were scanned and transferred to a high-resolution electronic format and evaluated. Results: The mean weight loss for the 81 patients during the hunger strike was 6+-3.7 kg. Early repolarization (ER) (inferior: 10, lateral: 5, inferolateral: 1) was detected in 16 (19.7%) ECGs taken on the last day of fasting, and in 4 (4.9%) (inferior: 3, lateral: 1) of those measured 2 months after the strike (p

Background In addition to proinflammatory properties, eosinophils can stimulate platelet activation and enhance prothrombotic pathways. In this study, we aimed to investigate the association between the eosinophil percentage (EOS%) and major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods This study enrolled a total of 1,909 patients who were diagnosed with STEMI. Ventricular arrhythmia, reinfarction, the need for cardiopulmonary resuscitation, target vessel revascularization, congestive heart failure, and cardiovascular mortality during index hospitalization were defined as MACE. Results Three hundred and eighty patients (19.7%) reached the combined endpoint with MACE. The rates of inhospital mortality and MACE were significantly higher in low EOS% group as compared to high EOS% group (4% vs. 1.1%, p p p p Conclusions Low EOS% on admission may be associated with high inhospital MACE in STEMI patients. EOS% may be used as a novel biomarker for risk stratification of these patients.

Introduction: The aim of this study was to investigate an easily available inflammatory marker and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) in patients with cardiac syndrome X (CSX). Patients and Methods: The study population included 100 patients of which 50 had CSX (CSX group) and 50 had normal coronary angiograms (control group). Results: Total white blood cell (WBC) count, monocyte count, neutrophil count, NLR, high-sensitivity C-reactive protein (hs-CRP), C-reactive protein (CRP) and MHR were higher in the CSX group (p< 0.05), whereas high-density lipoprotein cholesterol (HDL-C) level was significantly lower in the CSX group as compared with that in the control group (p< 0.05). In the correlation analysis, MHR revealed a significantly positive correlation with hs-CRP (r= 0.375, p< 0.001) and CRP (r= 0.403, p< 0.001). In the multivariate logistic regression analysis, MHR was independently associated with the presence of CSX (odds ratio: 1.250, 95% confidence interval [CI]: 1.240-1.461, p< 0.001). Using a cut-off level of 90.6, pre-procedural MHR predicted the presence of slow coronary flow (SCF) with a sensitivity of 78% and specificity of 70%. Conclusion: In conclusion, our findings revealed that higher MHR levels were significantly and independently associated with the presence of CSX.

Drug-induced torsades de pointes (TdP) is a rare but potentially fatal adverse effect of commonly prescribed medications including cardiac and noncardiac drugs. Importantly, many drugs have been reported to cause the characteristic Brugada syndrome-linked electrocardiography (ECG) abnormalities and/or (fatal) ventricular tachyarrhythmias. Chlorpheniramine and propranolol have the arrhythmogenic effects reported previously. A review of literature revealed a large number of case reports of chlorpheniramine or propranolol use resulting in QTc prolongation, TdP, or both. However, we wish to report the case of a patient who was treated with a combination of chlorpheniramine and propranolol, whose ECG showed no QT prolongation but who suffered from cardiac arrest due to TdP.

The aim of this study was to investigate the midterm effects of transradial coronary angiography (TRCAG) on the radial and brachial artery diameter, the vasodilator characteristics, as well as to assess the factors determining functional recovery. This study included 136 consecutive patients who underwent TRCAG. The radial artery was evaluated with ultrasonography before and 1 month after the procedure. The basal right radial artery diameter (2.97 ± 0.46 vs. 2.82 ± 0.51, p

Objective: Slow coronary flow (SCF) phenomenon is described as the delayed opacification of the distal vasculature and angiographically normal coronary arteries. Considerable studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tpe) may correspond to the transmural dispersion of repolarization and that increased Tpe interval and Tpe/QT ratio are associated with malignant ventricular arrhythmias. In this study, we intended to evaluate ventricular repolarization in patients with SCF by using the Tpe interval and Tpe/QT ratio. Methods: The study population included 33 patients with angiographically proven SCF and 33 control patients with angiographically proven normal coronary arteries without associated SCF. Coronary flow rates of patients and the control group were documented by TIMI (Thrombolysis in Myocardial Infarction) frame count. From the electrocardiograms, Tpe interval and Tpe/QT ratio were calculated and compared between groups. Results: No statistically significant difference was found between the two groups in terms of basic characteristics. Mean Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio were prolonged in the study group compared to the control group (p

Background The chronic consumption of androgenic anabolic steroids has shown to cause atrial arrhythmias. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate repolarization dispersion measured from the 12-lead surface electrocardiogram (including Tp-e interval, Tp-e/QT ratio, and Tp-e/cQT ratio) in bodybuilders who are using anabolic androgenic steroids (AAS). Methods We selected a population of 33 competitive bodybuilders, including 15 actively using AAS for ≥ 2 years (users) and 18 who had never used AAS (nonusers), all men. Results QT, cQT, QTd, cQTd, JT, and cJT were significantly increased in AAS users bodybulders compared to the nonusers (all P < 0.001). Tp-e interval, Tp-e/QT ratio, and Tp-e/cQT ratio were also significantly higher in AAS user group compared to the nonuser group (all P < 0.001). QRS duration was not different between the groups. There were negative correlation between Em and Tp-e, Tp-e/QT ratio, Tp-e/cQT ration (r = −0.657, P < 0.01; r = −0.607, P = 0.02; r = −0.583, P = 0.02; respectively).There were also negative correlation between Sm and Tp-e, Tp-e/QT ratio, Tp-e/cQT ration (r = −0.681, P < 0.01; r = −0.549, P = 0.03; r = −0.544, P = 0.023; respectively). Conclusion In conclusion, we have presented a strong evidence suggesting that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were increased in AAS users, which suggest that there might be a link between AAS use and ventricular arrthymias and sudden death.

The bicuspid aortic valve is associated with disorders of the aortic wall, including coarctation of the aorta and aortic dissection. The histologic abnormality underlying aortic complications in bicuspid aortic valve is cystic medial necrosis. The elastic properties of the aorta are abnormal in bicuspid aortic valve. Here, we present a case of aortic thrombotic occlusion in a patient with a bicuspid aortic valve.

We report a case of Kounis syndrome (allergic angina) documented with normal coronary arteries on angiography and echocardiographically proved moderate mitral stenosis in a patient with severe chest pain and electrocardiographic ST-segment elevations but with normal troponin levels.

Background: Atrial fibrillation is the most common clinically significant arrhythmia. It is now established that atrial high-rate episodes are highly correlated with atrial fibrillation. Aims: To investigate the relation between diastolic electrocardiographic parameters and subclinical atrial fibrillation detected by cardiac implantable electronic devices. Study Design: Ccross-sectional study. Methods: A total of 203 patients who had a dual-chamber, rate-modulated pacing pacemaker implanted due to sinus node dysfunction were prospectively enrolled in this study. Atrial high-rate episodes were defined as any lasting more than 5 min with an atrial rate of ≥220 beats per minute during the previous year. Patient groups were categorized on the basis of pacemaker interrogation as the absence of atrial high-rate episodes [atrial high-rate episodes (-)] and the presence of atrial high-rate episodes [atrial high-rate episodes (+)]. Episodes related to atrial over sensing were excluded. Twelve-lead surface electrocardiography was independently analyzed by two experienced readers for the measurement of diastolic electrocardiography parameters. Results: Among 203 patients (mean age: 67.5±9.1, 60.1% male), 51 (25.1%) with atrial high-rate episodes were defined as group 1 and 152 (74.9%) without atrial high-rate episodes were defined as group 2. Both groups were similar in terms of demographic characteristics and cardiovascular risk factors. Tend-Q and Tend-P were significantly longer in group 2. PQ interval was statistically longer in group 1. Corrected QT interval was significantly longer in group 1. Diastolic electrocardiography index, heart rate and PQ and QT intervals were the only independent predictors of atrial high-rate episodes in patients with dual pacemakers in multivariate analysis. Conclusion: Abnormal diastolic electrocardiography parameters are powerful predisposing factors for the initiation of incident atrial fibrillation. Diastolic electrocardiography parameters and a novel diastolic index predict atrial high-rate episodes. Evaluating these parameters enables clinicians to identify patients who are at high risk and who may benefit from prophylactic treatment.

Background: Epicardial adipose tissue (EAT) is thought to be associated with the extension and severity of coronary artery disease (CAD), and echocardiographic measurement of EAT thickness is considered to be a possible cardiovascular risk indica­tor. The European Society of Cardiology Task Force recommends further non-invasive testing in patients with an intermediate pre-test probability (PTP) for the diagnosis of CAD. Aim: We sought to evaluate the clinical usefulness of performing EAT measurements in patients with a high-intermediate PTP. Methods: Patients referred to an outpatient clinic with stable chest pain symptoms, with PTP for CAD between 66% and 85%, were included in the study. Echocardiographic measurement of the EAT was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium. Single-photon emission computed tomography (SPECT) was performed in all patients. The diagnosis of CAD was based on the presence of reversible perfusion defects on SPECT. Results: A total of 126 patients (76 men, 60.3%) with a mean age of 65.3 ± 9.1 years were recruited. The EAT thickness was 7.3 ± 0.7 mm in patients with positive SPECT and 6.2 ± 0.6 mm in patients with negative SPECT (p < 0.001). Multivariable analysis revealed higher rates of positive SPECT in patients with higher EAT (odds ratio [OR] 9.80; 95% confidence interval [CI] 3.72–25.79; p < 0.001), and receiver operating characteristic curve analysis showed that the greatest specificity was obtained when the cut-off value of EAT thickness was 6.75 mm (sensitivity 76%; specificity 74%). Conclusions: In patients with high-intermediate PTP, EAT is a useful measurement that may assist in risk stratification.

Amac: Kontrast madde nefropatisi (CIN) uzamis hastanede yatis suresi, artmis kardiyovaskuler komplikasyonlar ve mortalite ile iliskilidir. Trombosit/lenfosit orani (PLR) tromboz ve inflamasyon arasindaki dengeyi gosteren potansiyel bir belirtec olarak tanimlanmis ve artan kardiyovaskuler morbidite ve mortalite ile iliskili bulunmustur. Biz bu calismada PLR’nin primer perkutan koroner girisim (pPCI) yapilan ST yukselmeli miyokard infarktusu (STEMI) hastalarda CIN gelisimini tahmin etmede bagimsiz bir risk faktoru olup olmadigi arastirdik. Gerec ve Yontemler: Kurumumuza akut STEMI ile basvuran ve pPCI yapilan 1348 hasta geriye donuk olarak degerlendirildi. Hastane dosya ve bilgisayar kayitlarindan veriler elde edildi. CIN gelisimi sonlanim noktasi olarak kabul edildi. Bulgular: 127 (%9.4) hastada CIN gelismisti. 16 hastaya renal replasman tedavisi uygulandi. Hastane ici mortalite orani %2,7(n = 37) bulunmustur. Hastalar CIN gelisimine gore iki gruba ayrildi. Yas (P = 0,001), bazal GFR (P < 0,001), grade 3 ve uzeri kronik bobrek hastaligi (P < 0,001), bazal kreatinin (P < 0,001), EF (P < 0,001), DM varligi (P < 0,001) gruplar arasinda farkli idi. Cok degiskenli analizlerde, PLR (odds ratio [OR] 1.012, %95 guven araligi [CI] 1,006-1,017, P < 0,001) CIN gelisimini bagimsiz olarak ongordu. Sonuclar: PLR, kolay ulasilabilir yaygin olarak kullanilan ve nispeten ucuz biyomarkerdir ve STEMI nedeniyle pPCI uygulanan hastalarda CIN gelisiminin bagimsiz bir belirleyicisidir.