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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.

Objective In this study, we aimed to report early outcomes of catheter-directed thrombolysis (CDT) with alteplase in patients with subacute limb ischemia and to assess whether there is a link between malnutrition (determined by Controlling Nutritional Status [CONUT] score) and response to thrombolysis and bleeding. Methods This was a retrospective study conducted between 2007 and 2020 with 118 patients with Rutherford class 3 (34.7%), class 4 (40.7%), and class 5 (24.6%) symptoms owing to infraaortic subacute thrombotic occlusion who were treated with catheter-directed thrombolysis. Results Immediate technical success (Thrombolysis in Myocardial Infarction [TIMI] grade 2/3) was achieved in 56%, overall technical success after all adjunctive procedures was seen in 83.9%. Clinical success was obtained in 74.5% within 30 days. Major bleeding occurred in 11.8%. When we excluded access site hematomas, the rate of major bleeding was 5.1%. In-hospital mortality rate was 5.1%, and the amputation rate within 30 days was 12.7%. Any-degree malnutrition was detected in 48.3% according to CONUT score (≥2). Any-degree malnutrition was associated with failed thrombolysis and bleeding. The CONUT score predicted insufficient lytic response even after adjustment for confounding factors; however, serum C-reactive protein or neutrophil/lenfosit ratio did not. Other predictors of immediate technical failure after thrombolysis were symptom duration, Rutherford class 4/5 symptoms, and worsened distal runoff. Conclusion In patients with subacute limb ischemia, CDT combined with adjunctive interventions was effective in many patients at the expense of a substantial risk of bleeding and death. Malnutrition was associated with insufficient lytic response and bleeding. Physicians should be aware of malnutrition and consider the nutritional status of patients with limb ischemia when selecting appropriate treatment.

Background Carotid artery stenting (CAS) with a carotid protection device (CPD) has become the standard practice in patients with severe carotid stenosis and high surgical risk. However, the clinical efficacy and safety of CPDs are still controversial issues. We aimed to compare the clinical outcomes of the CAS without CPD with CAS combined with CPD. Methods This is a multicenter randomized prospective study registered with http://clinicaltrials.gov (NCT02781181). After the exclusion, 279 patients were enrolled (139 patients in the CAS with CPD group and 140 patients in the CAS without CPD group). The primary outcome was a combination of peri-procedural in-hospital transient ischemic attack (TIA), ipsilateral stroke, or death. The secondary outcome was new ischemic brain lesions on post-procedural diffusion-weighted magnetic resonance imaging (DW-MRI). Results Two patients died in CAS without CPD group, one patient died in CAS with CPD group. TIA was only seen in patients who underwent CAS under protection (n = 5). The combined primary outcome of TIA, ipsilateral stroke, and death rate was not different between groups (5.7% vs. 2.8%; p = 0.254). New defects were noted on the post-procedural DW-MRI in 28% of patients in the CPD group and 27% of patients in the no CPD group (p = 0.881). Conclusions This study suggests that CAS without CPD is not associated with higher rates of peri-procedural TIA, stroke, and death or new ischemic brain lesions on post-procedural DW-MRI compared to CAS with CPD in selected symptomatic and asymptomatic patients with significant carotid artery stenosis provided that there is no visible thrombus.

Carotid artery stenting has been a widely used interventional treatment method for the last 3 decades in the treatment of carotid artery stenosis. In the current literature, unlike major cardiovascular complications, less emphasis has been placed on carotid pseudoaneurysm (PA). A carotid artery PA can be caused by trauma, spontaneous infection, vasculitis, or it may be iatrogenic. However, the incidence of PA secondary to carotid stenting is extremely rare. Although it may be completely asymptomatic in rare instances, it usually progresses symptomatically (neck swelling, nerve compression, respiratory distress, hoarseness, dysphagia, and ischemic cerebrovascular events). Doppler ultrasound, contrast-enhanced computed tomography, and conventional angiography are the main diagnostic tools. Primary closure, including graft interposition, has been described as a surgical therapeutic option. An endovascular approach with placement of a covered or bare metal stent is an alternative treatment method to surgery.

Objective Peripheral arterial disease (PAD) is a global health problem and associated with poor outcomes. It causes increased arterial stiffness. The association of PAD with aortic arterial stiffness was investigated in previous studies. However, there is limited data regarding the effect of peripheral revascularization on arterial stiffness. The aim of our study is to investigate the effect of peripheral revascularization on aortic stiffness parameters in patients with symptomatic PAD. Methods A total of 48 patients with PAD who underwent peripheral revascularization were included in the study. Echocardiography was performed before and after the procedure, and aortic stiffness parameters were obtained by using aortic diameters and arterial blood pressure measurements. Results Post-procedural aortic strain (5.1 [1.3–14] vs. 6.3 [2.8–6.3], p = 0.009) and aortic distensibility (0.2 [0.0–0.9] vs. 0.3 [0.1–1.1], p = 0.001) measurements were significantly increased compared to pre-procedural values. Patients were also compared according to the lesion laterality, site and treatment methods. It was found that the change in aortic strain ( p = 0.031) and distensibility ( p = 0.043) were significantly higher in unilateral lesion compared to bilateral lesion. Also, the change in aortic strain ( p = 0.042) and distensibility ( p = 0.033) were significantly higher in iliac site lesion compared to superficial femoral artery (SFA) site lesion. Moreover, the change in aortic strain was significantly higher ( p = 0.013) in patients treated with stent compared to only balloon angioplasty. Conclusion Our study showed that successful percutaneous revascularization significantly reduced aortic stiffness in PAD. The change in aortic stiffness was significantly higher in unilateral lesions, iliac site lesions and stent-treated lesions.

In addition to the genetic complexity of hypertrophic cardiomyopathy (HCM), there must be other disease-modifying factors that contribute to its highly variable clinical and phenotypic expression. The authors aimed to investigate serum thiol/disulphide homeostasis as a proxy for oxidative stress using a novel automated assay in patients with HCM.This cross-sectional study was conducted on 119 patients with HCM and 52 without HCM. The methods used to measure dynamic thiol/disulphide homeostasis as calorimetric and duplex quantities were developed in 2014.Median serum native thiol levels were significantly lower in patients with HCM than in those without (312.5 μmol/L [285-370 μmol/L] vs 421 μmol/L [349-469.5 μmol/L]; p 0.001). Serum total thiol levels and disulphide levels were considerably lower than those in the control group ([844.68 ± 195.99 μmol/L vs 1158.92 ± 243.97 μmol/L; p 0.001], [259.13 ± 65.66 μmol/L vs 375.02 ± 79.99 μmol/L; p 0.001], respectively). Serum disulphide/native thiol ratios and disulphide/total thiol ratios were significantly lower in HCM patients than in controls (0.80 ± 0.09 vs 0.92 ± 0.05; p 0.001 and 0.31 [0.30-0.32] vs 0.32 [0.32-0.33]; p 0.001). Finally, reduced thiol ratios were higher and oxidized thiol ratios were significantly lower in patients with HCM than in controls.Despite the fact that antioxidant capacity was impaired, the extracellular environment remained in a reducing state by keeping serum disulphide/native thiol ratios low. Therefore, the authors speculate that HCM may behave similarly to tumours with respect to serum thiol-disulphide levels.HINTERGRUND: Neben der genetischen Komplexität der hypertrophen Kardiomyopathie (HCM) muss es weitere krankheitsmodifizierende Faktoren geben, die zur hoch variablen klinischen und phänotypischen Ausprägung der Erkrankung beitragen. Ziel der vorliegenden Arbeit war es, die Thiol/Disulfid-Homöostase im Serum als einen Surrogatparameter für oxidativen Stress bei Patienten mit HCM zu untersuchen; dabei kam ein neuartiger automatisierter Assay zum Einsatz.In diese Querschnittstudie wurden 119 Patienten mit und 52 Patienten ohne HCM eingeschlossen. Die Verfahren zur Messung der dynamischen Thiol/Disulfid-Homöostase als kalorimetrische und Duplex-Mengen wurden 2014 entwickelt.Die medianen Serumkonzentrationen von nativem Thiol waren bei Patienten mit HCM signifikant niedriger als bei Patienten ohne die Erkrankung: 312,5 μmol/l (285–370 μmol/l) vs. 421 μmol/l (349–469,5 μmol/l); p 0,001. Die Gesamtthiol- und Disulfidkonzentrationen im Serum waren erheblich niedriger als in der Kontrollgruppe: 844,68 ± 195,99 μmol/l vs. 1158,92 ± 243,97 μmol/l; p 0,001; 259,13 ± 65,66 μmol/l vs. 375,02 ± 79,99 μmol/l; p 0,001. Das Verhältnis von Disulfiden zu nativem Thiol und von Disulfiden zu Gesamtthiol war bei Patienten mit HCM signifikant niedriger als in der Kontrollgruppe: 0,80 ± 0,09 vs. 0,92 ± 0,05; p 0,001; 0,31 (0,30–0,32) vs. 0,32 (0,32–0,33); p 0,001. Zudem war das Verhältnis reduzierter Thiole bei Patienten mit HCM höher als in der Kontrollgruppe, das Verhältnis oxidierter Thiole dagegen niedriger.Obwohl die antioxidative Kapazität beeinträchtigt war, blieb das extrazelluläre Milieu in einem reduzierten Zustand, indem die Verhältnisse von Disulfiden zu nativem Thiol im Serum niedrig gehalten wurden. Daher vermuten wir, dass sich die HCM in Bezug auf Thiol‑/Disulfidspiegel im Serum ähnlich verhält wie Tumoren.

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.

We presented a 77-year-old man with hypertrophic obstructive cardiomyopathy applied with flail tricuspid leaflet and severe tricuspid regurgitation leading to right heart failure 2 months after the failed septal ablation. The ruptured anterior tricuspid papillary muscle resulted from infarction of the base of anterior papillary muscle of the right ventricle (RV) confirmed by magnetic resonance imaging. As the septomarginal band is frequently lit up by intracoronary contrast that particular attention should be paid to the RV papillary muscles. And, if the papillary muscles or the RV free wall is brightened, then the use of that septal artery should be avoided.

Ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction (AMI) with an associated mortality that ranges from 41% to 80%. The treatment consists of supplemental oxygenation, afterload reduction, intraaortic balloon pump, and surgical repair. In selected patients, extracorporeal membrane oxygenation (ECMO) and/or percutaneous closure of the defect can be considered if anatomically appropriate. Echocardiography evaluates the morphology and location of the defect, anatomical concerns for percutaneous closure, and accompanying pathologies. We present a 48-year-old man with inferior myocardial infarction and basal VSR who was not a candidate for percutaneous closure. Surgery was planned, but he died from extensive subarachnoid and intracranial hemorrhage.

Introduction: AF in patients with mitral stenosis (MS) causes significant morbidity and mortality. PMBV, which is a treatment of choice for patients with MS, is a highly successful procedure that provides significant improvement in symptoms and echocardiographic parameters. In this study we aimed to demonstrate the probable effects of PMBV on novel echocardiographic and electrocardiographic parameters that can predict the development of AF in 1-year period in patients with MS. Patients and Methods: Twenty-eight patients with moderate or severe rheumatic MS (mean age 37.6 ± 7.4 years; 14 (50%) males) were enrolled this study. All patients who were eligible for this procedure underwent comprehensive echocardiographic examinations with evaluation of ACT measured using tissue Doppler imaging (TDI) before PMBW and repeated at the end of the 1 year after successful PMBV. In addition, 12-lead ECGs were recorded for each patient 1 day before PMBV for the evaluation of baseline maximum and minimum P-wave duration and P-wave dispersion (PWD); this was repeated at the end of the 1 year after successful PMBV. Results: ACT (148.1 ± 20.5 vs 121.3 ± 20.5 p< 0.001), P-max (151.7 ± 15.8 vs 137.3 ± 15.6 p< 0.001) and PWD (84.7 ± 18.8 vs 71.1 ± 18.5 p< 0.001) were found to be significantly decreased after PMBV. A strong positive correlation was detected between ACT, P-max, PWD, LAVi ve PAPs before and after PMBV. In addition, there was a strong correlation between Δ values that were measured by subtracting the baseline measurements from the post-PMBV measurements. Accordingly, ΔACT was correlated with ΔP-max ve ΔPWD (r= 0.5 p= 0.007 and r= 0.55 p= 0.002, respectively). ΔACT, ΔP-max and ΔPWD correlated significantly with only ΔLAVi and ΔPAP in echocardiographic parameters. Conclusion: This study demonstrated that atrial conduction properties that have also been evaluated with ECG and TDI studies significantly correlate with other echocardiographic parameters in patients with MS. In addition, significant improvement occurred in these parameters at the end of the 1 year after PMBV. Further prospective investigations may provide useful data for the detection of the relation between atrial electromechanical characteristics and development of AF in patients with MS.

Objective:In this study, we investigated the correlation between coronary lesion complexity as characterized by syntax score (SS) with circulating adiponectin and adipocyte-fatty acid binding protein (A-FABP4) concentrations in the presence of stable coronary artery disease affecting three coronary vessels (three-vessel stable CAD).Methods:The study groups consisted of 41 control subjects (28 males and 13 females, non-CAD group) and 115 affected subjects (79 males and 36 females, three-vessel stable CAD group). We divided into tertiles the three-vessel stable CAD group according to SS and estimated circulating concentrations of adiponectin and A-FABP4.Results:We did not find any correlation between the coronary lesion complexity with either the adiponectin and/or A-FABP4. We found lower the A-FABP4 of the non-CAD group than those of the groups with three-vessel stable CAD (pConclusion:Adiponectin is not a suitable parameter for demonstrating the existence of CAD or predicting coronary lesion complexity. A-FABP4 is more useful for the proof of the presence of CAD but A-FABP4 are not correlated with the severity of CAD.

Transcatheter closure has become the leading approach for closure of most instances of patent ductus arteriosus. However, there are some complications associated with this procedure. We report a case involving the embolization of a device in the right pulmonary artery during placement. A 20-year-old woman was referred to our hospital for percutaneous transcatheter closure of patent ductus arteriosus. During the deployment of an Amplatzer duct occluder device, it was disconnected from the connector and became embolized in the lower branch of the right pulmonary artery. We could not grasp the device with a gooseneck snare. After various attempts, the device was captured and removed by a BiPal bioptome endomyocardial biopsy forceps. Based on our findings, we recommend that endomyocardial biopsy forceps should be considered as an alternative when such complications occur.

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.

Hypertrophic obstructive cardiomyopathy is an inheritable cardiac disease that typically manifests with an increased left ventricular outflow tract gradient. In most cases, basal septal hypertrophy and systolic anterior motion of the anterior mitral valve leaflet are the key components of the left ventricular outflow tract obstruction. The goal of septal reduction therapy, a widely accepted treatment modality, is to remove this obstruction. Although myectomy is a well-established and effective surgical technique for septal reduction therapy, transcoronary alcohol septal ablation is an alternative therapy for patients who decline to have surgery or who are not suited to a surgical intervention. A new septal reduction method has also been described in the literature. This case report describes the successful treatment of hypertrophic obstructive cardiomyopathy in a 57-year-old female using the new septal reduction technique.

Primary tricuspid valve regurgitation may be encountered in daily practice as a result of multiple etiologies. Described herein are the cases of 2 patients with severe primary tricuspid regurgitation. The underlying mechanism was posterior leaflet prolapse due to spontaneous chordae rupture in 1 case, and iatrogenic posterior leaflet tissue loss during removal of a permanent pacemaker in the other. Transthoracic and transesophageal echocardiography, which permit assessment of the tricuspid valve with multilevel imaging, are the techniques of choice for accurate detection and understanding of the etiology, the severity of valve regurgitation, and the determination of treatment options, in addition to providing assistance with timing and guidance during intervention. Three-dimensional echocardiography offers the ability to visualize the entire tricuspid valve and to identify which leaflets are affected by the pathology.

Objective. The aim of the study was to determine an association between the plasma YKL-40 level and echocardiographic left ventricle systolic and diastolic function parameters in patients with acute myocardial infarction.Subjects and Methods. The study included 46 patients with acute myocardial infarction. Serum brain natriuretic protein (BNP) and YKL-40 levels were analyzed on admission and after one month. Left ventricle systolic and diastolic functions and Tei index were computed by transthoracic echocardiography.Results. Plasma YKL-40 was significantly higher in patients with acute myocardial infarction (AMI) (101.7 μg/L versus 34 μg/L, resp.,p<0.001) and remained higher than in healthy subjects after one month. The levels of YKL-40 on admission were correlated with log BNP on admission (r=0.41,p=0.004), Tei index (r=0.44,p=0.002), left atrium volume index (r=0.32,p=0.02), and mitral septal annular E/e′ (r=0.44,p=0.003). Death was more frequently observed in patients with plasma YKL-40 above the median value than in those with plasma YKL-40 below the median value (p=0.001; OR = 13.6 (2.5–72.3)).Conclusion. YKL-40 elevations in patients with AMI remain at least one month and are associated with serum BNP elevations, diastolic dysfunction, and long-term increased overall mortality. It has prognostic importance in patients with AMI.

Summary Introduction Cilostazol is a PDE3 inhibitor and used to treat peripheral arterial disease. There are few reports on the influence of cilostazol on heart. Aims The aim of this study was to assess this effect on right ventricular function and pulmonary artery pressure. Methods Forty patients with normal left and right ventricular ejection fraction and mild or moderate pulmonary artery hypertension were enrolled in the study. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tissue Doppler imaging (TDI), and two-dimensional speckle-tracking echocardiography (2D-STE) before and after oral administration of cilostazol. Also pulmonary artery pressure assessed before and after administration of cilostazol. Results After cilostazol administration, there were significant increases in the TAPSE (1.9 ± 0.3 cm vs. 2.2 ± 0.3 cm, P

Hypoalbuminemia is associated with a poor prognosis in patients with end-stage renal disease, chronic ischemic heart disease, heart failure (HF), and stroke. We aimed to investigate its prognostic value in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by a primary percutaneous coronary intervention (p-PCI).We retrospectively enrolled 1706 patients with STEMI treated by p-PCI. We prospectively followed up the patients for a median duration of 40 months.On admission, hypoalbuminemia (3.5 g/dl) was present in 519 (30.4%) patients. The incidence of final TIMI grade 3 flow (84 vs. 91.4%, P0.001) was lower in the patients with hypoalbuminemia. In-hospital mortality (9.4 vs. 2%), HF (20.2 vs. 8.6%), and major bleeding (6 vs. 2.5%) rates were significantly higher in patients with hypoalbuminemia. However, in-hospital stroke and reinfarction rates were similar in both groups. At long-term follow-up (median duration: 42 months), all-cause mortality (23.3 vs. 8.4%, P0.001), reinfarction (11.6 vs. 7.7%, P=0.013), stroke (2.6 vs. 1.1%, P=0.031), and advanced HF (13.3 vs. 6.1%, P0.001) rates were significantly higher in patients with hypoalbuminemia. In the Cox proportional hazard model, hypoalbuminemia was determined as an independent predictor of long-term mortality [hazard ratio 2.98, 95% confidence interval 1.35-6.58, P=0.007) and development of advanced HF (hazard ratio 2.96, 95% confidence interval 1.44-6.08, P=0.003).Hypoalbuminemia on admission is a strong independent predictor for long-term mortality and development of advanced HF in patients with STEMI undergoing p-PCI.

OBJECTIVES We aimed to compare the efficacy of primary percutaneous coronary intervention (p-PCI) in patients >=80 versus =80 years. Post-procedural TIMI grade 3 flow was significantly less frequent in the age >=80 years patients (82.1% vs. 91.1%, p =80 years patient group. Overall rates of mortality (40% vs. 9.7%, p =80 years patient group. However, there was no difference between the two groups with respect to the reinfarction/revascularization rates. Analysis, using the Cox proportional hazards model, revealed that age >=80 to was an independent predictor of long-term mortality (hazard ratio 2.17, 95% CI 1.23-4.17, p=0.02). CONCLUSION Age is an independent predictor of mortality after p-PCI for STEMI. Although it seems to improve early outcomes, the efficacy of p-PCI at long-term follow-up is limited in elderly patients.

Objectives: Enhanced matrix metalloproteinase-8 (MMP-8) activity in the early post-myocardial infarction (MI) period has been related to early remodeling. However, it has been demonstrated that plasma MMP-8 level has a biphasic profle, and the relation between the late plasma levels and remodeling is unclear. We evaluated the plasma MMP-8 levels and its correlates 20±3 months after acute MI. Study design: 58 post-MI patients and 26 control subjects underwent quantitative single-photon emission computed tomography (SPECT) and echocardiography. The plasma MMP-8 levels were measured and its correlates were investigated. Results: The MMP-8 levels were signifcantly higher in post-MI patients [median 3.88 ng/ml, interquartile range (1.88-6.43) vs. 0.67 ng/ml (0.34-2.47); p

Objective: Mitral valve regurgitation (MR) is the second most common heart valve disease in Europe. Without intervention, prognosis of severe symptomatic MR is poor. Percutaneous edge-to-edge mitral valve repair with MitraClip is a promising mitral regurgitation treatment technique in select, high-surgical-risk patients. The present objective was to describe the experience of a single center with MitraClip use in a high-risk series in Turkey. Methods: Between May 2013 and September 2014, 28 high-surgical-risk patients with MR of at least grade 3+ and mean EuroSCORE of 26% underwent MitraClip implantation at our institution. In-hospital and follow-up safety and efficacy results are presented. Results: Mean patient age was 58 years, and 75% were male. Grade 3 or 4 MR was present in all patients, and was primarily the result of restrictive functional mitral regurgitation (in 89% of cases). Mean left ventricular ejection fraction (LVEF) was 27% and New York Heart Association (NYHA) classification was III or IV in 89% of the population. Acute procedural success was 89%, with 47% of patients receiving a single clip, 39% receiving 2 clips, and 14% receiving 3 clips. One periprocedural death occurred, and 2 deaths occurred during follow-up (mean: 13.9 months). After 1 year, more than 75% of patients had MR severity of ≤2+ and NYHA classification of I or II, but no significant change in left ventricular volume or systolic function. Significant improvement in 6-minute walk test and quality of life was also observed. Conclusion: Initial experience with the MitraClip system showed promising results in patients considered high-surgical-risk, particularly in those with end-stage heart failure.

Giriş: Nötrofil-lenfosit oranı (NLO) akut koroner sendromlarınfizyopatolojisi ile ilişkilidir. ST segment elevasyonlu miyokart infarktüsünde(STEMİ) gözlenen inflamatuvar süreç NLO’da artışa sebep olabilir. Çalışmamızda,STEMİ ile hastaneye başvuran hastalarda kardiyojenik şok (KŞ) gelişen vegelişmeyen gruplar arasında NLO’da fark olup olmadığı araştırıldı. Hastalarve Yöntem: Çalışmaya akut STEMİ ile başvurantoplam 203 hasta alındı. Yüz hasta KŞ grubunu oluşturdu. Yüz üç hastada isekomplikasyonsuz STEMİ mevcuttu. Tüm hastalardan rutin kan örnekleri alındı. NLOanalizi yapıldı.Bulgular: NLO gruplar arasında anlamlı olarak farklı bulundu (9.9± 7.9 vs. 6.2 ± 4.3, sırasıyla, p< 0.001).“Multiple logistic regression” analizi, KŞ’yle komplike STEMİ’nin şokizlenmeyen STEMİ hasta grubuna göre daha yüksek NLO değerlerine sahip olduğunugösterdi (β= 1.07, %95 CI 1.01-1.15, p= 0.03).Sonuç: Çalışmamızda hastaneye başvuruda ölçülen NLO’nun KŞ gelişen STEMİ hastalarında anlamlı olarakdaha yüksek olduğu bulundu. Artmış NLO oranı KŞ gelişecek hastaları predikteetmede kullanılabilir., Introduction: Neutrophilto lymphocyte ratio (NLR) is related to the pathogenesis of acute coronarysyndromes. The inflammatory process in ST-elevation myocardial infarction(STEMI) may cause an increase in NLR. In this study, we aimed to investigatewhether admission NLR is associated with STEMI complicated by cardiogenicshock.Patients and Methods: Thestudy population comprised patients who had presented with acute STEMI. Allpatients referred underwent routine blood tests, including common blood cellcounts, and NLR analysis.Results: STEMIshowed characteristics of cardiogenic shock in 100 patients and wasuncomplicated in 103 patients. NLR was significantly different between the twogroups (9.9 ± 7.9 vs. 6.2 ± 4.3, respectively, p< 0.001). Multiple logisticregression analyses showed that NLR was significantly associated with STEMIcomplicated by cardiogenic shock (β= 1.07, 95% CI 1.01-1.15, p= 0.03).Conclusion: Our results demonstrated thatadmission NLR was higher in patients with STEMI complicated by cardiogenicshock. To prove this relationship between NLR and cardiogenic shock, furtherinvestigations are needed.

Recently, longitudinal stent deformation (LSD) has been reported increasingly. Even though the reported cases included almost all stent designs, most cases were seen in the Element™ stent design (Boston Scientific, Natick, MA, USA). It is considered that stent design, lesion and procedural characteristics play a role in the etiology of LSD. Yet, the effect of LSD on long-term clinical outcomes has not been studied well. Element stents implanted between January 2013 and April 2015 in our hospital were examined retrospectively. Patients were grouped into two according to the presence of LSD, and their clinical, lesion and procedural characteristics were studied. Twenty-four LSD’s were detected in 1812 Element stents deployed in 1314 patients (1.83 % of PCI cases and 1.32 % of all Element stents). LMCA lesions (16.7 % vs 1.6 %, p < 0.001), complex lesions (75 % vs 35.1 %, p < 0.001), bifurcation lesions (37.5 % vs 18.3 %, p = 0.017), ostial lesions (33.3 % vs 12.8 %, p = 0.003), using of extra-support guiding catheter (54.2 % vs 22.3 %, p < 0.001) and extra-support guidewire (37.5 % vs 16.2 %, p = 0.005) were found to be more frequent in cases with LSD than in cases without it. In addition, the number of stents, stent inflation pressure and the use of post-dilatation were significantly different between the two groups. Two patients had an adverse event during the follow-up period. LSD is a rarely encountered complication, and is more common in complex lesions such as ostial, bifurcation and LMCA lesions. The use of extra-support guiding catheter, extra-support guidewires and low stent inflation pressure increases the occurrence of LSD. Nevertheless, with increased awareness of LSD and proper treatment, unwanted long-term outcomes can be successfully prevented.

BACKGROUND: Arrhythmogenic right ventricular dysplasia (ARVD) is characterized by progressive replacement of ventricular myocytes with variable amounts of fibrous and adipose tissue. 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, and Tp‐e/QTc ratio) in asymptomatic ARVD patients METHODS: We selected 27 patients with asymptomatic ARVD and 27 age‐ and gender‐match young, healthy volunteers. RESULTS: Tp‐e interval, Tp‐e/QT and Tp‐e/QTc ratio were also significantly higher in ARVD group compared to the control group (all P < 0.001). There were negative correlation between S global and Tp‐e, Tp‐e/QT, Tp‐e/QTc ration (r = −0.57, P = 0.02; r = −0.85, P = 0.02; r = −0.63, P < 0.01; respectively). There were also negative correlation between Sm global and Tp‐e, Tp‐e/QT, Tp‐e/QTc ration (r = −0.61, P < 0.01; r = −0.67, P < 0.01; r = −0.68, P < 0.01; respectively). Moreover, Em global were negative correlation between Tp‐e, Tp‐e/QT, and Tp‐e/QTc (r = − 0.64, P < 0.001, r = − 0.75, P < 0.01; r = −0,69, P < 0.01; respectively) CONCLUSION: In conclusion, we have presented strong evidence suggesting that Tp‐e interval, Tp‐e/QT ratio, and Tp‐e/QTc ratio were increased in asymptomatic ARVD patients.

Objectives We evaluated in-hospital results of primary percutaneous coronary intervention (PCI) in a high-volume tertiary center. Study design We retrospectively evaluated 1625 patients (1323 males, 302 females; mean age 56.0 ± 11.6 years) who underwent primary PCI for acute ST-elevation myocardial infarction between January 2006 and April 2008. All coronary angiography procedures were performed using the femoral artery route. In-hospital clinical and angiographic results were recorded. Results On admission, 23% of the patients had diabetes mellitus, 49.6% had anterior myocardial infarction, and 4.9% had cardiogenic shock. The mean duration of pain was 171.2 ± 121.2 minutes, and the mean door-to-balloon time was 31.6 ± 7.2 minutes. Infarct-related artery was the left anterior descending artery in 49.7%, multivessel disease was present in 40.9%, TIMI 2/3 flow was present in 23.6%, and high-grade thrombus was observed in 66.8%. Primary PCI involved balloon dilatation (5.7%) and stent implantation (94.3%). The incidence of angiographic no-reflow was 11.9%. The mean hospital stay was 5.2 ± 3.3 days. All-cause mortality occurred in 71 patients (4.4%). Other in-hospital events were reinfarction (1.4%), target vessel revascularization (1.9%), hemorrhagic/ischemic stroke (0.6%), stent thrombosis (1.2%), major bleeding (3.8%), blood transfusion (4.8%), heart failure (10.5%), atrial fibrillation (4%), and ventricular tachycardia (3.9%). Conclusion Primary PCI is an effective method in achieving complete revascularization of the infarct-related artery. Successful in-hospital results not only depend on the experience and equipment of the center, but also on how rapidly reperfusion is achieved.

Objectives: Plasma brain natriuretic peptide (BNP) lev- el increases with symptoms and severity of mitral regur- gitation (MR). We aimed to determine the relationship between plasma BNP levels and echocardiographic pa- rameters in patients with acute and chronic MR. Study design: The study included 55 patients (31 males, 24 females) with isolated moderate-to-severe MR. Of these, 31 patients had acute MR, and 24 patients had chronic MR. All the patients were assessed by transtho- racic, transesophageal and Doppler echocardiography and plasma BNP levels were determined. Results: Clinical characteristics and functional capacity were similar in the two groups. Patients with acute MR had significantly higher left ventricular (LV) ejection frac - tion (EF) (p=0.001), and significantly lower LV end-sys - tolic diameter (p=0.016), end-systolic volume (p=0.027), end-diastolic diameter (p=0.011), left atrial volume (LAV) (p=0.003), and plasma BNP levels (p=0.036). Effective regurgitation orifice area was also significantly higher in patients with acute MR (p=0.038). In multiple linear re- gression analysis, the natural logarithm of BNP was sig- nificantly correlated with E/Ea ratio (β=0.50, p=0.002) and LAV (β=0.38, p=0.015) in patients with acute MR, and with systolic pulmonary artery pressure (β=0.60, p=0.002) and EF (β=-0.36, p=0.039) in patients with chronic MR. Conclusion: Although the echocardiographic degree of MR was more pronounced in patients with acute MR, serum BNP levels tended to be lower in this group. Cor- relation of serum BNP with E/Ea and LAV in this group may be an important finding. OZET ABSTRACT

BACKGROUND Increased serum uric acid (UA) has been shown to directly promote oxidative stress. Recent studies point toward a role for oxidative stress in the pathogenesis of ascending aortic aneurysms (AscAAs). This study was designed to examine the relationship between serum UA concentrations, total antioxidant reductive capacity, and AscAAs. METHODS The serum UA concentrations, total antioxidant reductive capacity were compared in 60 patients with ascending aortic dilatation (ectasia group (3.8-4.3 cm), 34 patients; aneurysmal group (≥4.4 cm), 26 patients) vs. 30 control subjects. The patients were evaluated by a complete transthoracic echocardiographic examination including measurement of the aortic dimensions. RESULTS The serum UA concentration and total antioxidant reductive capacity were significantly higher in patients with AscAAs. In multiple linear regression analysis, hypertension and serum UA concentration were significantly associated with aortic dilatation (β = 0.3, P = 0.03; β = 0.15, P < 0.001, respectively). CONCLUSIONS In conclusion, we found that serum UA concentration and total antioxidant capacity (TAC) were significantly associated with aortic dilatation. The higher serum UA concentration may be responsible for the elevated serum antioxidant capacity that was observed among individuals with AscAA. Large-scale epidemiological studies conducted over several years are required to correlate the cross-sectional findings from this study with clinical outcome.

Aim: The effects of chronic aortic regurgitation (AR) on coronary blood flow of systolic/diastolic phase and phase and coronary reserve have been shown. Whereas thrombolysis in myocardial infarction (TIMI) frame count, which incorporates coronary blood flow and a higher TIMI frame count (TFC) is reflect disordered resistance vessel function, has not yet been evaluated in chronic AR. Method: 33 patients with isolated chronic AR diagnosed by echocardiography and angiography, and 22 control groups with no coronary or valvular disease who underwent angiography for atypical chest pain were included in our study. Coronary blood flow was measured using TFC. Result: Coronary blood flow, echocardiographic and demographic parameters were compared between the two groups. The mean TFC is found to be higher in AR patients when compared to the control group. (left anterior descending coronary artery (LAD) TFC, 43±7.3 vs. 30±5.9 frames/s, p

We describe the case of a 57-year-old woman referred to our emergency service with ruptured abdominal aneurysm. We placed a 34-mm Amplatzer sizing balloon II into the suprarenal level of aorta to immediately control the active massive bleeding and to get the patient out of hemorrhage shock into the stable condition. After the bleeding control, endovascular repair was successfully performed. This is the first case report, to our knowledge, of atrial septal defect (ASD) sizing balloon use for blocking the blood flow through aorta to control the bleeding. ASD sizing balloon has some different properties compared to aortic occlusion balloon catheter (AOBC). Due to availability of sheathless usage, ASD sizing balloon may be preferred over AOBC for some of patient groups with peripheral artery diseases and small femoral artery diameters. © 2014 Wiley Periodicals, Inc.

The molecular basis and pathophysiology of pulmonary hypertension (PH) are rapidly evolving areas. Recently discovered angiopoietins (Ang) constitute a family of growth factors, and whether they play a causal or protective role in pulmonary hypertension has not been fully elucidated. Since left heart disease probably represents the most frequent cause of PH, we sought to determine whether there was a relationship between serum Ang-1 levels and pulmonary hypertension caused by mitral stenosis (MS). The study population was composed of 49 patients with isolated MS. These patients were then divided into group 1 [31 patients with severe MS: mitral valve area (MVA)

Objective: Although several hypotheses have been suggested, the underlying mechanism of coronary slow flow phenomenon (CSFP) has not been well established yet. The aim of this study was to determine the roles of plasma apolipoprotein-B100 (Apo-B) and apolipoprotein-A1 (Apo-A1) in CSFP which have an atherogenic effect and anti-atherogenic effects respectively. Methods: The study consisted of 31 patients with CSFP (group 1), 28 normal subjects as control group(group 2) and 30 patients with coronary artery disease (CAD) (group 3) detected by coronary angiography. CSFP was diagnosed by the TIMI frame count method. Blood Apo-B, Apo-A1, Apo-B/Apo-A1 ratio, and demographic parameters were compared between the groups. Results: The Apo-B values were 93±25 mg/dL, 90±26 mg/dL, and 106±27 mg/dL in groups 1, 2 and 3, respectively (p=0.048 between group 1 and 3, p=0.041 between group 2 and 3, p= NS between group 1 and 2). TheApo-A1values were 127±14 mg/dL, 125±21 mg/dL and 106±27 mg/dL in groups 1, 2 and 3 respectively (p=0.028 between group 1 and 3, p=0.021 between group 2 and 3, p= NS between group 1 and 2). The apo-B/apo-A1 ratio were 0.73±0.18, 0.69±0.23 and 0.98±0.20 in groups 1, 2 and 3 respectively (p=0.017 between group 1 and 3, p=0.010 between group 2 and 3, p= NS between group 1 and 2). Conclusion: Although lower levels of plasma Apo-A1 and higher levels of Apo-B and the ratio of Apo-B to Apo-A1 are related with CAD, there is no relationship between these apolipoproteins and CSFP.

Primary myocardial involvement is common in systemic sclerosis (SSc). We evaluated the atrial and ventricular electromechanical characteristics by using tissue Doppler echocardiography in SSc patients with subclinical cardiac involvement. Twenty-seven consecutive patients (24 women; mean age +/- SD 49.9 +/- 11.3 years) presenting with SSc without pulmonary arterial hypertension or symptomatic heart failure were prospectively studied. Electrocardiographic P-wave dispersion (Pd), corrected QT dispersion (QTcd), interatrial, intra-atrial, interventricular, and intraventricular electromechanical delays were analyzed by tissue Doppler echocardiography, and brain natriuretic peptide levels were measured. Results were compared with 17 healthy controls. There was no difference in conventional and tissue Doppler parameters between the two groups. However, patients with SSc had higher mean Pd (mean [+/-SD] 46.8 +/- 15 and 36 +/- 8 ms, respectively, P = 0.004) and mean interatrial electromechanical delay time (DT) (mean [+/-SD] 32.2 +/- 9.2 and 24.7 +/- 9.7 ms, respectively, P = 0.01), mean electromechanical delay time for all segments (Mean Ts) (mean [+/-SD] 148.8 +/- 18.8 and 129.3 +/- 13.4 ms, respectively, P0.001), and intraventricular DT (mean [+/-SD] 27.6 +/- 12.5 and 16.2 +/- 7.2 ms, respectively, P0.001). Intraventricular DT was the only parameter that correlated significantly with the Mean Ts. Brain natriuretic peptide levels were within normal limits in both groups; however, they were higher in patients with SSc than in controls (mean [+/-SD] 37.5 +/- 28.5 and 23.1 +/- 16.0 pg/ml, respectively, P = 0.03). The evaluation of atrial and ventricular electromechanical parameters by using tissue Doppler echocardiography seems to be useful for detection of subclinical cardiac involvement in SSc patients with normal conventional echocardiographic findings.

Summary: Atrial fibrillation (AF) is known to be one of the most important complications of mitral stenosis (MS). It has been reported that autonomic nervous system (ANS) had an effect on AF development, heart rate variability (HRV) and heart rate recovery (HRR) were under the control of ANS, and their disorders were present in MS. We studied the effect of Valsartan on HRV and HRT, and thus its effect on ANS. Methods: Eleven patients (39±8 years, 10 females) with mild to moderate MS were included in the study. Sixteen volunteers (38±8 years, 14 females) matched for age and sex were selected for control group. All subjects underwent transthoracic echocardiography (TTE), symptom-limited treadmill test and 24 hour Holter monitorization.The patients were administered 160 mg of Valsartan daily for 14 weeks. TTE, treadmill test and Holter monitorization were repeated at the end of treatment period. In Holter monitorization, the time and frequency domain analysis of HRV and in exercise test, HRR at first and third minutes (HRR1 and HRR3) were examined. Results: Before Valsartan treatment, no significant difference was found in HRR and HRV parameters between the two groups. Systolic and diastolic blood pressure, and also HRR1values were significantly decreased after treatment of Valsartan (117±6 vs. 107±4 mmHg p

Objective: Left ventricular (LV) systolic functions are generally depressed in Mitral Stenosis (MS). Recovery of LV systolic functions demonstrated with 2D echocardiography in some patients by mitral balloon valvuloplasty (MBV). Systolic mitral annular velocity (S') by Tissue Doppler Imaging (TDI) predicts LV systolic function. We aimed to evaluate early effects of MBV on LV systolic function by TDI.Methods: Forty-eight consecutive patients included to the study (39 female, 36±10 years). A full transthoracic echocardiographic study (TTE) including left ventricular ejection fraction assessment by teicholz method and mitral annular color TDI assessment was performed 24 hours before and after MBV in all patients. MBV performed by Inoue technique under guidance of TTE. Analysis of mitral lateral annular S' wave velocity was performed immediately after echocardiographic examination. Results: MBV performed successfully in 43 patients (Group A), and severe mitral regurgitation developed in 5 patients(Group B). Mitral valve area, and S’ wave velocity increased, mean and maximum mitral gradient, and left atrial diameter, and systolic pulmonary artery pressure (PAP) were reduced significantly by MBV in group A patients (p

Left ventricular dyssynchrony and myocardial fibrosis are common findings in patients with nonischemic dilated cardiomyopathy (NDCM). The aim of this study was to investigate the association between myocardial fibrosis and intraventricular systolic dyssynchrony (DYS-sys) in patients with NDCM.Thirty-nine patients with NDCM and sinus rhythm were enrolled. Intraventricular DYS-sys was evaluated using Doppler tissue imaging, and cardiac fibrosis was assessed with cardiovascular magnetic resonance imaging with a 17-segment cardiac model. Each segment was graded on a 2-point scale (segmental fibrosis score): 0 = absence of late gadolinium enhancement, and 1 = presence of late gadolinium enhancement. A cardiac fibrosis index was calculated as 17/(17 - sum of fibrotic segments). Receiver operating characteristic analysis was performed to determine the utility of the cardiac fibrosis index to predict intraventricular systolic dyssynchrony.Patients with DYS-sys had larger left atrial size (P = .004) and left ventricular end-systolic (P = .028) and end-diastolic (P = .034) volumes and lower tricuspid annular Doppler tissue imaging peak systolic velocities (P = .037) compared with patients without DYS-sys. A cardiac fibrosis indexor = 1.4 predicted significant DYS-sys with 92% sensitivity and 60% specificity (area under the receiver operating characteristic curve, 0.703; 95% confidence interval, 0.512-0.893; P = .035). Patients with cardiac fibrosis indexesor = 1.4 (group 1) had larger left ventricular end-systolic (P = .044) and end-diastolic (P = .034) volumes than those with cardiac fibrosis indexes1.4 (group 2). Nine of 11 patients (82%) in group 1 and 6 of 28 patients (21%) in group 2 had significant DYS-sys (Pearson's chi(2) = 12.169, P.0001). Logistic regression analysis revealed that cardiac fibrosis indexor = 1.4 (odds ratio, 11.2; 95% confidence interval, 1.72-71.4; P = .012) was an independent predictor of DYS-sys.Patients with NDCM and prominent cardiac fibrosis have significant DYS-sys. The cardiac fibrosis index is a useful tool to predict DYS-sys.

Aim: We investigated the relationship between the severity of reciprocal ST depression and the extent of coronary artery disease in patients with inferior myocardial infarction. Method: Ninety-five consecutive patients (52 women 43 men, with a mean age of 54±5 years) who had acute inferior myocardial infarction were included in the study. Reciprocal changes in the ST segment were defined as ST depression of >1 mm in at least two out of four of the precordial leads V1–V4. All the patients had undergone coronary angiography within seven days of admission. The extension of coronary artery disease which was measured by Gensini and Reardon scores, was compared with the reciprocal changes on ECG recorded at the time of admission. Result: There was a significant correlation between reciprocal ST depression and disease extension (r=0.68 for Gensini score, r= 0.88 for Reardon score, p