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Tam Metin / Full Text ESCI PMID: 34177289 WOS:000660311100004 Arterial stiffness is related to arteriolosclerotic diseases and is a marker of adverse cardiovascularevents. Mitral annular calcification (MAC) is progressive calcium deposition on the posterior and inferior mitral annulus and is associated with atherosclerotic cardiovascular diseases. Cardio-ankle vascular index (CAVI)is a measurement technique used to estimate the degree of arterial stiffness without effect from blood pressure. The aim of this study is to research arterial stiffness using CAVI in patients with MAC.Materials and Methods: The study was cross-sectional and observational and included 98 patients with MACconfirmed by echocardiography who referred to the cardiology clinics and met study inclusion criteria and 38controls without MAC. CAVI measurements were obtained by using the Vascular Screening System VaSeraVS-1000 (Fukuda Denshi, Tokyo, Japan) device.Results: The two groups were similar in terms of demographic characteristics, including age, sex, hypertension, coronary artery disease, body surface area, and smoking (P > .05). Left atrial volume index wassignificantly higher in patients with MAC compared with the control group (P < .001). Right arm CAVI, leftarm CAVI, and mean CAVI were significantly higher in the MAC group than the control group (P = .037, P= .005, and P = .014, respectively) and increased with MAC severity. There was a significant positive correlation between mean CAVI and MAC grade (r = 0.278, P = .001). Also, when ankle-brachial index (ABI) wasmeasured with CAVI, left and right extremity ABI values were significantly lower in patients with MAC (P =.017 and P = .005, respectively).Conclusion: CAVI increased in all patients with MAC and associated with increasing grade of calcification

Introduction: In this study, we aimed to investigate the relationship between autonomic dysfunction (AD) deter- mined according to the blood pressure (BP) and heart rate (HR) response in exercise treadmill test (ETT) prior to cryoballoon ablation (CBA), and the recurrence of atrial fibrillation (AF) after CBA in patients with paroxysmal AF. Patients and Methods: Seventy-six patients (mean age 53 ± 11 years, 61.8% male) with paroxysmal AF who underwent CBA were enrolled. Before CBA the ETT was performed by all patients. BP and HR responses in ETT were compared between patients with and without AF recurrence. Results: AD rate was significantly higher in the group with recurrence compared to the non-recurrent group (p< 0.001). In addition to AD, age, female gender, and lower exercise capacity were also associated with post-CBA AF recurrence (p> 0.05 for all). Examining AD parameters, systolic blood pressure at peak exercise (SBPpeak) (p< 0.001) and diastolic blood pressure at peak exercise (DBPpeak) (p< 0.001), slow heart rate recovery (HRR) (p< 0.001) were significantly higher in the recurrent group. Conclusion: AD may be associated with AF recurrence after CBA in patients with paroxysmal AF. SBPpeak, DBPpeak, and slow HRR appear to be predictors of AF recurrence after ablation. Giriş: Çalışmamızda lone atriyal fibrilasyonlu (AF) hastalarda, cryobalon ablasyon (CBA) öncesi yapılan egzersiz treadmil testinde (ETT) bakılan kan basıncı ve kalp hızı yanıtına göre tespit edilen otonomik disfonksiyon (OD) ile CBA sonrası AF rekürrensi arasındaki ilişkiyi değerlendirmeyi amaçladık. Hastalar ve Yöntem: Çalışmaya cryobalon ablasyon yapılan 76 hasta (ortalama yaş 53 ± %11, 61.8 erkek) alındı. CBA öncesi tüm hastalara ETT yapıldı. AF rekürrensi ablasyon sonrası üç, altı, dokuz ve 12. aylarda değerlendirildi ve kaydedildi. ETT deki kan basıncı ve kalp hızı yanıtı AF rekürrens görülen ve görülmeyen hastalarda karşılaştırıldı. Bulgular: OD oranı rekürrens olan grupta rekürrens olmayan gruba göre anlamlı olarak yüksek saptandı [17 (%89.5) vs. 19 (%33.3), p< 0.001]. OD dışında yaş, kadın cinsiyet, düşük egzersiz kapasitesi, CBA sonrası AF rekürrens ile ilişkili bulunmuştur (p> 0.05 for all ). OD parametreleri incelendiğinde, maksimum egzersizdeki sistolik kan basıncı (188.89 ± 28.13 vs 157.60 ± 28.82, p< 0.001), maksimum egzersizdeki diyastolik kan basıncı (87.47 ± 16.89 vs. 72.02 ± 15.43, p< 0.001), yavaş kalp hızı iyileşmesi [11 (%57.9) vs. 8 (%14), p< 0.001] CBA sonrası AF rekürrensi ile ilişkili bulunmuştur. Sonuç: OD lone AF’li hastalarda CBA sonrası AF rekürrensi ile ilişkili olabilir. Maksimum egzersizdeki sistolik kan basıncı, maksimum egzersizdeki diyastolik kan basıncı, yavaş kalp hızı iyileşmesi ablasyon sonrası AF rekürrens prediktörü olarak bulunmuştur.

Previous studies showed that subclinical abnormal left atrial (LA) function could be diagnosed with LA speckle tracking evaluation long before chamber enlargement. Osteoprotegerin (OPG) is a member of the tumor necrosis factor (TNF) receptor superfamily and was recently found to be an indicator for adverse cardiovascular outcomes and a risk factor for new onset atrial fibrillation. The authors hypothesized that OPG values could predict LA mechanical dysfunction and LA remodeling assessed by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension (HT) and diabetes mellitus (DM).A single center study was conducted including consecutive patients presenting to the authors' outpatient clinic. Enrolled patients needed to have been treated for HT and DM for at least 1 year.The study included 80 patients (mean age, 57.5 ± 8.3 years). Patients in the impaired LA strain group were older (p = 0.035), had lower low density lipoprotein (LDL) cholesterol (mg/dl) (p = 0.021), and higher OPG (pmol/l) (p = 0.004) values than patients in the normal LA strain group. Univariate logistic regression analysis demonstrated that age (p = 0.039), LDL cholesterol (mg/dl) (p = 0.025), and OPG (pmol/l) (p = 0.008) values were associated with impaired LA strain. Backward multivariate logistic regression analysis showed that LDL cholesterol (mg/dl) (OR: 0.982, CI 95% 0.964-0.999, p = 0.049) and OPG (pmol/l) (OR: 1.438, CI 95% 1.043-1.983, p = 0.027) were independently associated with impaired LA strain.In hypertensive and diabetic patients, higher OPG values were associated with impaired LA function assessed by 2D-STE. In this high-risk patient group, serum OPG can be used as a risk predictor for LA mechanical dysfunction.ZIELSETZUNG: Frühere Studien belegen, dass eine subklinisch gestörte linksatriale (LA) Funktion mithilfe der linksatrialen Speckle-tracking-Analyse lange vor einer Kammervergrößerung diagnostiziert werden kann. Osteoprotegerin (OPG) gehört zur Familie der Tumor-Nekrose-Faktor(TNF)-Rezeptor-Superfamilie und wurde vor Kurzem als Indikator eines ungünstigen kardiovaskulären Verlaufs und als Risikofaktor für neu auftretendes Vorhofflimmern identifiziert. Es wird postuliert, dass die OPG-Werte bei Patienten mit Hypertonie (HT) und Diabetes mellitus (DM) ein Prädiktor für mechanische LA-Dysfunktion und LA-Remodeling in der zweidimensionalen Speckle-tracking-Echokardiographie (2D-STE) sind.In eine Single-Center-Studie wurden konsekutiv Patienten eingeschlossen, die sich in der Klinik der Autoren ambulant vorstellten. Voraussetzung für den Einschluss war eine mindestens 1‑jährige Behandlung wegen HT und DM.Insgesamt 80 Patienten wurden in die Studie eingeschlossen (Durchschnittsalter 57,5 ± 8,3 Jahre). Die Patienten in der Gruppe mit gestörtem LA-Strain waren älter (p = 0,035), hatten einen niedrigeren Low-density-Lipoprotein(LDL)-Cholesterin-Spiegel (mg/dl; p = 0,021) und höhere OPG-Spiegel (pmol/l; p = 0,004) als Patienten in der Gruppe mit normalem LA-Strain. Eine univariate logistische Regressionsanalyse ergab, dass das Alter (p = 0,039), LDL-Cholesterin (mg/dl; p = 0,025) und OPG (pmol/l; p = 0,008) mit einem gestörten LA-Strain assoziiert waren. In einer rückwärts gerichteten multivariaten logistischen Regressionsanalyse waren LDL-Cholesterin (mg/dl; OR 0,982, 95%-Konfidenzintervall [KI] 0,964–0,999, p = 0,049) und OPG (pmol/l; OR 1,438, 95%-KI 1,043–1,983, p = 0,027) unabhängig mit einem gestörten LA-Strain assoziiert.Bei Patienten mit Hypertonie und Diabetes waren höhere OPG-Werte mit einer gestörten LA-Funktion in der 2D-STE assoziiert. In dieser Hochrisikogruppe kann der Serum-OPG-Spiegel als Risikoprädiktor der mechanischen LA-Dysfunktion genutzt werden.

Objectives Pulmonary hypertension (PHT) is one of the essential predictors of mortality in chronic obstructive pulmonary disease (COPD). It is thought that PHT is due to vasoconstriction secondary to hypoxia caused by airway obstruction in COPD patients; however, loss of capillary bed with emphysema, inflammation, and endothelial dysfunction may also play a role in the development of PHT. Epicardial adipose tissue (EAT) has a role as a metabolically active endocrine organ and secretes various proinflammatory cytokines. We hypothesized that EAT thickness in COPD patients might be associated with the systolic pulmonary arterial pressure (PAPs) level, and we aimed to test it. Methods The present study included 129 consecutive patients with the diagnosis of COPD. All patients underwent transthoracic echocardiographic evaluation. The relationship between PAPs and EAT thickness was evaluated. Results Positive correlations with PAPs were reported with age, EAT, white blood cell (WBC) and GOLD grade score (range 0.197-0.275, P values 0.026 to 0.002), negative correlations with body-mass index (BMI), hyperlipidemia, FEV1 (% predicted) and pO2 (range -0.216 to -0.340, P values .014 to

WOS: 000434104700038 PubMed ID: 29277286 Background: Radiofrequency catheter ablation (CA) is a common non-pharmacological treatment option for ventricular premature contractions (PVCs) originating from right ventricular outflow tract (RVOT). In this study, we aimed to investigate the relationship between recurrence after CA for RVOT-PVC and S-wave in lead 1 that was shown to be associated with RVOT depolarization. Methodology: A total of 104 patients who were referred to our clinic for CA for idiopathic RVOT-PVC between 2012 and 2015 years were enrolled. All ECG parameters were measured before and after the ablation procedure. Results: Ablation was successful in 100 patients (96,1%). These patients with successful ablation were followed for a mean duration of 1078 days. 13 patients (13%) had recurrence. Univariate logistic regression analysis revealed age (odds ratio: 1.916, p:0,012), presence of post-procedural S1 (odds ratio:1.040 p:0,028), post-procedural S1 area (oddsratio:1.023 p:0,041), AS] area (odds ratio:1.242 p:0,004) as predictors for recurrence. Multivariate logistic regression analysis detected age (odds ratio:1.053 p:0,032) and AS] area (odds ratio:0.701 p:0,009) as predictors for recurrence. Conclusion: Radiofrequency CA for RVOT-PVC can be performed with high procedural success and low complication rates. Age and Delta S1 area might be helpful for prediction of recurrence after CA. (C) 2017 Elsevier Inc. All rights reserved.

Introduction:Thereis limited knowledge about the use of bioresorbable scaffolds (BRSs) in longsegment coronary artery lesions. We aimed to evaluate the clinical outcomes ofBRS-BRS and drug eluting stents (DESs)-BRS overlapping applications.Patientsand Methods: Cross-sectional, single-center study between 2013 and2016 enrolled 97 patients and 100 lesions scheduled for BRS placement in longsegment lesions (> 28 mm). BRS-BRS overlap was performed in 30 patients and30 lesions, DES-BRS overlap was performed in 67 patients and 70 lesions. Acuteprocedural success and major adverse cardiac events (MACE) (death, stent thrombosis,and target lesion reintervention) were assessed.Results: Acuteprocedural success was 97.1% in the overall group. MACE was observed in 6patients (6.2%) in the entire group, 4 (5.9%) in the DES-BRS group, and 2(6.6%) in the BRS-BRS group.Conclusion: BRS use might be a safeand effective option for the treatment of long segment lesions. Both BRS-BRSoverlap and BRS-DES overlap may be performed with short overlap segment., Giriş: Uzun segment lezyonlarda biyoeriyebilen stentlerin (BRS) kullanımı ileilgili sınırlı bilgimiz olduğundan hem BRS-BRS hem de İlaç salınımlı metalstent (DES)-BRS overlap uygulanan hastaların klinik sonuçlarını değerlendirmeyiplanladık.Hastalar veYöntem: Tek merkezli, kesitsel planlanan; Ocak 2013-Haziran 2016tarihleri arasında uzun segment lezyonlara (> 28 mm) BRS yerleştirilmesiplanlanan 97 hasta ve 100 lezyon çalışmaya alındı. Otuz hasta ve 30 lezyondaBRS-BRS overlap uygulanırken , 67 hasta 70 lezyona DES-BRS overlap uygulandı.Akut işlem başarısı ve MACE (ölüm, stent trombozu, hedef damara yeniden girişim)değerlendirildi.Bulgular: Akut işlem başarısı %97.1 idi. Tüm hasta grubunda toplam MACE 6 (%6.2)hastada gelişirken, DES-BRS grubunda 4 (%5.9), BRS-BRS grubunda 2 (%6.6)hastada MACE gerçekleşti.Sonuç: Uzun segment lezyonlardaBRS kullanımı seçenek olarak değerlendirilebilinir. BRS-BRS veya BRS-DESoverlap yapacak şekilde yerleştiriken kısa segment overlap olacak şekildegerçekleştirilmelidir.

Introduction:Radiofrequencycatheter ablation therapy has been used to treat arrhythmia such assupraventricular and/or ventricular tachycardia. Increased waist circumferenceis important in assessing central obesity and may be an important factor forradiation injury. Therefore, this article describes the association betweenwaist circumference and fluoroscopic exposure time during cardiacradiofrequency catheter ablation procedures for symptomatic drug-resistanttachycardia.Patientsand Methods: From August 2011 to March 2015, 214 (136 women, 78 men)consecutive patients with symptomatic drug-resistant atrioventricular nodalre-entrant tachycardia (174 patients), atrioventricular re-entrant tachycardia(12 patients), Wolf-Parkinson-White syndrome (5 patients), atrial tachycardia(8 patients), atrial flutter (7 patients), right ventricular outflow tracttachycardia (5 patients), and atrial fibrillation (3 patients) underwent aninvasive electrophysiological study and radiofrequency catheter ablation. Thefluoroscopic exposure time, radiofrequency catheter ablation time, and waistcircumference were measured during the electrophysiological study.Results: Althoughage was significantly higher in women than in men, body weight, body height,waist circumference, and radiofrequency catheter ablation time weresignificantly higher in men than in women. There was a correlation betweenwaist circumference and fluoroscopic exposure time (p= 0.04, r= 0.13).Conclusion: The study showed thatthere was a positive correlation between waist circumference and fluoroscopicexposure time in patients with antiarrhythmic drug-refractory tachycardia whounderwent radiofrequency catheter ablation. This finding could help preventradiation injury, especially increased waist circumference duringradiofrequency catheter ablation., Giriş: Radyofrekans kateter ablasyon tedavisi supraventriküler ve/veyaventriküler aritmilerin tedavisinde kullanılmaktadır. Artmış bel çevresisantral obeziteyi değerlendirmede önemli bir yöntemdir, aynı zamanda radyasyonhasarı için de önemli bir faktör olabilir. Bu nedenle bu makale semptomatikilaca dirençli taşikardi nedeni ile yapılan kardiyak radyofrekans kateterablasyonu sırasındaki floroskopi maruziyet süresi ile bel çevresi arasındakiilişkiyi irdelemektedir.Hastalar ve Yöntem: Ağustos 2011 ila Mart 2015tarihleri arasında semptomatik ilaca dirençli; atriyoventriküler nodalre-entran taşikardi (174 hasta), atriyoventriküler re-entran taşikardi (12hasta), Wolf Parkinson White sendromu (5 hasta), atriyal taşikardi (8 hasta),atriyal flutter (7 hasta), sağ ventriküler çıkış yolu taşikardisi (5 hasta),atriyal fibrilasyon (3 hasta) nedenleri ile invaziv elektrofizyolojik çalışmave radyofrekans ablasyon uygulanan 214 (136 kadın, 78 erkek) ardışık hastaçalışmaya dahil edildi. Floroskopi maruziyet süresi, radyofrekans ablasyonzamanı ve bel çevresi işlem sırasında ölçüldü.Bulgular: Kadınların yaşı anlamlı olarak erkeklerden yüksek olsada vücut ağrılığı, boy, bel çevresi ve radyofrekans ablasyon süresi erkeklerdekadınlara göre daha anlamlı olarak yüksekti. Bel çevresi ile floroskopimaruziyet süresi arasında bir korelasyon mevcuttu (p= 0.04, r= 0.13).Sonuç: Çalışmamız göstermiştirki,antiaritmik ilaç dirençli taşikardi nedenli radyofrekans kateter ablasyonuygulanan hastalarda floroskopi maruziyet süresi ile bel çevresi arasındapozitif bir korelasyon mevcuttur. Bu bulgu özellikle artmış bel çevresi olan hastalardaradyofrekans kateter ablasyon sırasında radyasyon hasarını önlemek için faydalıolabilir.

Coronary artery fistulae, which are connections between coronary artery branches and cardiac chambers or major vessels, are usually congenital forms of coronary artery anomalies, but rarely may be acquired because of cardiac trauma, neovascularity in association with cardiac neoplasm, mural thrombus formation, or iatrogenic causes. Although half of the patients with coronary artery fistula remain asymptomatic, these fistulae may lead to angina, syncope, congestive heart failure, myocardial infarction, and sudden death. Here we present a case of coronary artery fistula between right coronary artery and left atrium through a large left atrial thrombus in a patient with rheumatic mitral stenosis. The diagnosis was confirmed using echocardiography, conventional and multislice computed tomography, and coronary angiography. To the best of our knowledge, this interesting and unique entity is the first to be reported in the present literature.

WOS: 000405215800001 PubMed ID: 28440067 Objectives: We aimed to evaluate the peri-procedural success of DESolve bio-resorbable scaffolds (BRSs) and analyzed real-life data about major cardiac events during 1-year follow-up. Background: There is little information about real-life data of DESolve BRS which is a novel stent technology offering various advantages over drug eluting stents and commonly used in daily cardiology practice. Methods: We conducted this single-center and non-randomized cross-sectional study from June 2015 through August 2016 in Medipol University Department of Cardiology and included 117 patients undergoing single or multivessel percutaneous coronary interventions (PCI) with novolimus-eluting BRS devices (152 scaffolds) (Elixir Medical Corporation). Study end points were acute device and procedural success, scaffold thrombosis and major adverse cardiac event (MACE) rates of DESolve BRS. Results: Device success was 96.7% and procedural success was 99.3%. We detected MACE rate as 0.9% while clinical-driven target lesion revascularization was performed in one patient. None of the patients experienced scaffold thrombosis or death. Peri-procedural complications were reported in three patients. Conclusions: High rates of successful scaffold implantations, low rates of peri-procedural complications, and major cardiac events in long-term suggest that DESolve scaffolds can safely and effectively be used in daily intervention practice by particularly experienced operators.

WOS: 000395790600005 PubMed ID: 27221959 Background: Myocardial injury induced by catheter ablation (CA) for atrial fibrillation (AF) leads to elevated biomarker levels. Aim: This prospective study examined levels of myocardial injury biomarkers (creatinine kinase [CK], myocardial bound for CK [CK-MB], and troponin I [TnI]) and their impact on AF recurrence following two different ablation strategies, namely: cryoballoon ablation (CBA) and radiofrequency ablation (RFA). We also aimed to evaluate the relationship between AF recurrence after CA and other clinical, echocardiographic and procedural parameters. Methods: We enrolled 98 patients with AF, 21% of whom had persistent AF and 79% had paroxysmal AF. 58% of patients underwent CBA, and 42% underwent RFA. CK, CK-MB, and TnI levels were measured before and 6 h after the procedure. Patients had follow-up visits three, six, and nine months after the index procedure. Biomarker levels were compared between the patients with and without AF recurrence. Results: Post-ablation CK (postCK), post-ablation CK-MB (postCKMB), and post-ablation TnI (postTnI) levels were significantly high in the CBA and RFA groups (p < 0.001 for all). TnI elevation (DTnI) was correlated with age (p = 0.033) and median temperature reached during ablation (p < 0.005) in the CBA group, while it was correlated with application time in the RFA group (p < 0.001). Multivariate analysis in the CBA group revealed age and left atrium diameter as positive independent predictors (p = 0.029 and p = 0.046), and DTnI as a negative independent predictor for AF recurrence (p = 0.001). Elevated cardiac biomarkers were not associated with AF recurrence in the RFA group (p > 0.05). Conclusions: The levels of all cardiac biomarkers were elevated after CBA and RFA. Elevated TnI levels after CBA were independent negative predictors of AF recurrence. Measurement of TnI levels after CBA may be useful for the prediction of better clinical outcome.

WOS: 000390471300070 PubMed ID: 27681252 Objective: The aim of the present study was to investigate the relationship between glomerular filtration rate (GFR) and acute post-scaffold recoil (PSR) in patients undergoing bioresorbable scaffold (BVS) implantation. Methods: We included 130 patients who underwent everolimus-eluting BVS device (Absorb BVS; Abbott Vascular, Santa Clara, CA, USA) or the novolimus-eluting BVS device (Elixir Medical Corporation) implantations for single or multi-vessel disease. Clinical, angiographic variables and procedural characteristics were defined and pre-procedural GFR was calculated for each patient. Post-procedural angiographic parameters of each patient were analyzed. Primary objective of the study was to evaluate the effect of GFR on angiographic outcomes after BVS implantation while secondary objective was to compare post-procedural angiographic results between the two BVS device groups. Results: Baseline clinical characteristics and angiographic parameters were similar between the two BVS groups. Post-procedural angiographic analysis revealed significantly lower PSR in the DESolve group than the Absorb group (0.10 +/- 0.04 vs. 0.13 +/- 0.05, p: 0.003). When PSR in the whole study population was evaluated, it was positively correlated with age, tortuosity, calcification and PBR as there was a negative correlation between GFR. Besides GFR were found to be independent predictors for PSR in all groups and the whole study population. Conclusion: In patients undergoing BVS implantation, pre-procedural low GFR is associated with increased post-procedural PSR. Calcification, age, PBR, dyslipidemia and tortuosity are other independent risk factors for PSR. DESolve has lower PSR when compared with Absorb.

Background Although response to cardiac resynchronization therapy (CRT) has been conventionally assessed with left ventricular volume reduction, ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]) are of critical importance associated with unfavorable outcomes even in the "superresponders" to therapy. We evaluated the predictors of VT/VF and the association of residual dyssynchrony during follow-up. Methods Ninety-five patients receiving CRT were followed-up for 9 ± 3 months. Post-CRT dyssynchrony was defined as a prolonged QRS duration (QRSd) for persistent electrical dyssynchrony (ED), and a Yu index ≥ 33 ms for persistent mechanical dyssynchrony. The first VT/VF episode, including nonsustained VT detected on device interrogation and/or appropriate antitachycardia pacing or shock for VT/VF, were the end points of the study. Results Forty-five patients who reached the study end points had significantly lower mean ΔQRS (baseline QRSd - post-CRT QRSd) values than those without VT/VF (-20.8 ± 28.9 ms vs -6.6 ± 30.7 ms, P = 0.022). Both the baseline and post-CRT QRSds, along with the Yu index values, were not different in two groups. Patients with VT/VF were statistically more likely to have persistent ED (38% vs 9%, P = 0.021). Kaplan-Meier curves showed that a negative ΔQRS was associated with a higher incidence of VT/VF during follow-up (P = 0.016). A multivariate Cox model revealed that QRS prolongation was an independent predictor of VT/VF after CRT (P = 0.029). Conclusions A negative ΔQRS, also called persistent ED, is associated with VT/VF. Narrowest possible QRSd might be a reliable goal of both implantation and optimization of devices to reduce arrhythmic events after CRT.

WOS: 000379196600009 Background. Ventricular ectopic beats (VEBs) are considered as benign ventricular arrhythmias in patients without structural heart disease. However, symptomatic frequent VEBs can adversely affect energy metabolism. The present study aimed to determine the effect of symptomatic frequent VEBs on energy expenditure, physical activity and sleep pattern. Methods. Thirty-seven patients with symptomatic frequent VEBs and no structural heart diseases were enrolled. Patients underwent simultaneous 24-hour-ambulatory Holter electrocardiogram monitoring and the BodyMedia armband device monitoring which measures energy expenditure. Data acquired from both devices were compared with the data acquired from healthy volunteers in the control group. Results. Total energy expenditure (TEE) was higher in the patient group than the control group (1470 353 kcal vs 1125 275 kcal, P < 0.001). Average metabolic equivalence (aMETs) (1.1 +/- 0.2 vs. 1.3 +/- 0.2, P = 0.028), physical activity duration (PAD) (0.35 vs. 0.48, P = 0.007) and sleep duration (SDN) (3.15 vs. 4.31, P = 0.004) were significantly lower in the patient group than control group. VEBs frequency was inversely correlated with only SDN (r = 0.374, P = 0.027). Conclusion. Total energy expenditure (TEE) is increased in patients with symptomatic frequent VEBs in comparison with healthy subjects while PAD, average metabolic equivalence (aMETs) and SDN are decreased. VEBs frequency was inversely correlated with SDN.

Objectives The aim of this study is to evaluate the association of venous thromboembolism with arterial stiffness by cardio-ankle vascular index method. Method We included 52 patients with a documented lower extremity venous thromboembolism within the last six months and 52 healthy subjects to this cross sectional observational study. Results Cardio-ankle vascular index (8.58 ± 1.60 versus 7.05 ± 1.44, p 7.8 had a sensitivity of 82.7% and a specificity of 80.8% for predicting venous thromboembolism (area under curve = 0.789, 95% confidence interval = 0.698–0.863, p Conclusion We found that arterial stiffness was increased in patients with venous thromboembolism which highlights the fact that arterial and venous circulation is in continuum and an insult may affect both of these circuits.

Summary Objective The level of right ventricular (RV) systolic function has prognostic importance in right ventricular ST-segment elevation myocardial infarction (RV-STEMI). This study aimed to evaluate the changes in RV systolic function in patients with RV-STEMI according to the revascularisation method used for their management. Methods The first group consisted of 132 patients who received primary percutaneous coronary intervention (PPCI). The 78 patients who had received thrombolytic therapy (TT) in external centres before referral to our centre for PCI within three to 12 hours of RV-STEMI were included in the second group. All patients were evaluated by conventional and two-dimensional speckle-tracking echocardiography. Results There were 172 male patients and their mean age was 63.7 ± 11.8 years. There were no significant differences between the two groups with regard to right ventricular systolic parameters at admission and at the one-month follow-up visit. The echocardiographic changes between admission and the one-month follow up were investigated for the patients included in the study groups. Mean values of each parameter observed at the one-month follow up were significantly increased compared to those at admission within each group. Conclusion Our study demonstrated that PCI within three to 12 hours following TT provided similar benefits on right ventricular systolic function compared to PPCI in patients with RV-STEMI.

WOS: 000444701600011 PubMed ID: 28707026 New-onset atrial fibrillation (NOAF), a common complication of acute ST-segment elevation myocardial infarction (STEMI), is associated with a poor prognosis. Several clinical and laboratory parameters are reported to be associated with NOAF in patients with STEMI. The aim of the present study was to evaluate the predictive value of plasma BaEurotype natriuretic peptide (BNP) levels for NOAF development and long-term prognosis in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). We retrospectively enrolled 1,928 patients with STEMI who underwent pPCI. After applying exclusion criteria, 1,057 patients were retained in the final study population. Patients with NOAF were compared with patients without NOAF in the entire study population and in a matched group. Patients with NOAF had a significantly higher average plasma BNP level (161 pg/ml, range: 72.3-432) than patients without NOAF in the study population (70.7 pg/ml, range: 70-129; p < 0.001) and in the matched group (104.6 pg/ml, range: 47.2-234.5; p = 0.014). Furthermore, the plasma BNP level was found to be an independent predictor of NOAF development (odds ratio [OR]: 1.003; 95% confidence interval [CI]: 1.000-1.005; p = 0.034) and mortality in the long-term follow-up (OR: 1.004; 95% CI: 1.002-1.006; p < 0.001). The present study found that a high plasma BNP level was significantly associated with NOAF development in STEMI patients, and was an independent predictor of NOAF development and all-cause mortality during long-term follow-up, regardless of other NOAF risk factors.

WOS: 000439342900001 PubMed ID: 29541904 SYNTAX score II (SS-II) has a powerful prognostic accuracy in patients with stable complex coronary artery disease who have undergone revascularization; however, there is limited data regarding the prognosis of patients with ST segment elevation myocardial infarction (STEMI). The aim of this study is to examine both the predictive performance of SS-II in determining in-hospital and long term mortality of STEMI patients and to compare SYNTAX score (SS) and TIMI risk score (TRS). Consecutive 1912 STEMI patients treated with primary percutaneous coronary intervention (p-PCI) retrospectively reviewed, and the remaining 1708 patients constituted the study population after exclusion. The patients were divided into three groups according to increased SS-II value: low (n:562; SS-II = 34.4). In-hospital and long term mortality rate from all causes (0 vs. 0.5 vs. 10.6% and 1.8 vs. 3.2 vs. 18.1% respectively, p

Objectives We aimed to test the left atrial (LA) mechanics and contraction synchrony by 2D strain imaging, in patients with Wolff–Parkinson–White (WPW) syndrome, before and after radiofrequency catheter ablation (RFCA). Methods Study population consisted of 25 patients with WPW scheduled for RFCA and 30 healthy controls. The peak LA strain at the end of the ventricular systole (LAs strain) and the LA strain with LA contraction (LAa Strain) were obtained. To assess LA dyssynchrony, septal versus lateral wall time-to-peak strain measurements were measured. Results There was no difference between the patients with WPW and control subjects with regard to peak LAs and LAa strain. Patients with WPW demonstrated higher global time-to-peak LAs and LAa strain values compared with the control group. Peak LAs strain and LAa strain values, measured before and after the RF ablation of the accessory pathway, were comparable (34.3 ± 3.92 vs. 34.6 ± 3.2, P = 0.816, 14.7 ± 2.8 vs. 15.3 ± 2.3, P = 0.052, respectively). Global time-to-peak LAs and LAa strain measurements were significantly shorter after the RFCA compared with the values obtained before the RFCA. However, septo-lateral times to peak LA strain differences were found to be comparable in both WPW versus control and pre- versus postablation groups. Conclusion LA mechanical function assessed by 2D strain imaging was comparable between patients with WPW and control subjects. Patients with WPW had more prominent LA dyssynchrony during atrial pump phase as compared with the controls, a condition which could not improve after successful elimination of the accessory pathway by RFCA.

Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients however data regarding left ventricle (LV) function in COPD is limited. We, in this study, aimed to evaluate the LV systolic function and its relation to BODE index in COPD patients with the utility of two-dimensional speckle tracking echocardiography (2D-STE). The study involved 125 COPD patients and 30 control subjects. All patients underwent 2D-echocardiography, pulmonary function tests and -minute walk tests. The patients were divided into four quartiles according to BODE index score. COPD patients had lower mitral annulus systolic velocity (Sm), average global longitudinal strain (GLS), average global longitudinal strain rate systolic (GLSRs), average GLSR early diastolic (GLSRe), average GLSR late diastolic (GLSRa), tricuspid annular plane systolic excursion (TAPSE) and peak systolic myocardial velocity (Sm-RV) (p0.001, p0.001, p0.001, p0.001, p0.001, p0.001 and p = 0.002 respectively) than control subjects. There were significant differences between BODE index quartiles in terms of Sm, average GLS and average GLSRs. Patients were divided into two groups according to median value of GLS (-18.6 and ≤ -18.6). BODE index quartiles were found to be independent predictors of decreased GLS in multivariate logistic regression analysis (p = 0.030). Increased BODE index was associated with impaired LV mechanics in patients with COPD.

OBJECTIVE: Transradial approach (TRA) for coronary angiography is a popular alternative approach to transfemoral coronary angiography due to the infrequent occurrence of access site complications such as bleeding, hematoma and pseudoaneursym formation. However, not all patients are suitable for TRA. This study aimed to determine the predictors of radial artery diameter in patients who are candidates for TRA. METHODS: The study included 222 consecutive patients who underwent TRA due to suspected stable coronary artery disease. Radial artery diameter was evaluated prior to the procedure using B-mode ultrasonography. RESULTS: Radial artery diameter was correlated with wrist circumference (r=0.539, p

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

SYNTAX score II (SS II) uses 2 anatomical and 6 clinical variables for the prediction of mortality after coronary artery bypass graft and percutaneous coronary intervention. The aim of this study was to investigate the relationship between glycated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial glucose (PPG), and SYNTAX Score (SS) and SS II in patients with type 2 diabetes mellitus and coronary artery disease (CAD). We enrolled 215 consecutive diabetic patients with stable angina pectoris who underwent coronary angiography. The SS II was calculated using a nomogram that was based on the findings of a previous study. There was a moderate correlation between HbA1c and SS ( r = .396, P < .001), but there was a good correlation between HbA1c and SS II ( r = .535, P < .001). There was also a weak correlation between FBG ( r = .270, P = .001), PPG ( r = .177, P = .027), and SS, but there was a weak–moderate correlation between FBG ( r = .341, P < .001), PPG ( r = .256, P = .001), and SS II. A better correlation has been detected between HbA1c and SS II compared to the correlation between HbA1c and SS.

Objectives Arterial stiffness is associated with major adverse cardiovascular events. Chronic venous insufficiency (CVI) is severe form of chronic venous disease (CVD). The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with CVI. Methods This observational and cross-sectional study involved 87 subjects with CVI and 86 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument. Results High density lipoprotein cholesterol (HDL) was significantly lower in patients with CVI than controls (46.83 ± 9.25 mg/dl vs 51.33 ± 11.13 mg/dl, p = 0.004). Body mass index (BMI) was significantly higher in CVI patients than controls (28.53 ± 4.10 kg/m2 vs 26.37 ± 5.16 kg/m2, p = 0.003). Ankle brachial index (ABI) was significantly lower in patients with CVI compared to controls (1.08 ± 0.08 vs 1.14 ± 0.11, p 7.9 had a sensitivity 64.4% and a specificity of 94.7% for predicting the presence of CVI in ROC analysis (area under curve = 0.791, 95% CI = 0.723–0.849, p Conclusion CAVI is independently increased in CVI patients. Therefore CVI may be accepted a form of vascular sclerosis and vascular system should be evaluated in continuum not isolated.

Introduction: Stress imaging tests are recommended in patients with positive exercise electrocardiography (EECG) and intermediate pretest probability. However the role of coronary computed tomography angiography (CCTA) in young women with intermediate pretest probability and positive EECG is under debate. The aim of this study was to assess the diagnostic value of CCTA in young women patients with low-intermediate pretest probability and positive EECG results. Patients and Methods: From a retrospective registry of 67 young women with positive EECG between January 2011 and January 2014 were included in this study. Of these 67 patients 32 patients underwent CCTA and 35 patients underwent MPS after EECG. Results: There were no statistically significant differences between groups in demographic variables, or cardiovascular risk profile. The exercise test was positive in all patients. Both groups were similar for exercise capacity and Duke treadmill score. Blood chemistry of the patients were similar. The median pre-test probability of obstructive coronary artery disease (CAD) was lower in CCTA group 28% (15-45%) than in MPS group (15-50) (p= 0.045). Overall 3 patients in the CCTA and 7 patients in the MPS group had significant lesions. All patients in the CCTA positive group had significant CAD, while 3 out of 7 patients with positive MPS findings had significant CAD in coronary angiography. Conclusion: CCTA may be a valuable alternative of stress imaging tests in women patients with low-intermediate pretest probability and positive EECG.

We aimed to investigate the association between aortic arch and coronary artery calcification (CAC). We postulated that low- and high-risk CAC scores could be predicted with the evaluation of standard chest radiography for aortic arch calcification (AAC).Consecutive patients who were referred for a multidetector computerized tomography (MDCT) examination were enrolled prospectively. All patients were scanned using a commercially available 64-slice MDCT scanner for the evaluation of CAC score. A four-point grading scale (0, 1, 2 and 3) was used to evaluate AAC on the standard posterior-anterior chest radiography images.The study group consisted of 248 patients. Median age of the study group was 52 (IQR: 10) years, and 165 (67 %) were male. AAC grades (r = 0.676, p0.0001) and age (r = 0.518, p0.0001) were significantly and positively correlated with CAC score. Presence of AAC was independently associated with the presence of CAC (OR: 11.20, 95 % CI 4.25 to 29.52). An AAC grade of ≥ 2 was the strongest independent predictor of a high-risk CAC score (OR: 27.42, 95 % CI 6.09 to 123.52). Receiver operating characteristics curve analysis yielded a strong predictive ability of AAC grades for a CAC score of ≥ 100 (AUC = 0.892, P0.0001), and ≥ 400 (AUC = 0.894, P0.0001). Absence of AAC had a sensitivity, specificity and accuracy of 90 %, 84 % and 89 %, respectively, for a CAC score of100. An AAC grade of ≥ 2 predicted a CAC score of ≥ 400 with a sensitivity, specificity and accuracy of 68 %, 98 % and 95 %, respectively.AAC is a strong and independent predictor of CAC. The discriminative performance of AAC is high in detecting patients with low- and high-risk CAC scores.Hintergrund: Um den Zusammenhang zwischen Aortenbogen‐ und Koronararteriensklerose (CAC) zu untersuchen postulierten wir, dass Low‐und High‐Risk‐CAC Scores durch die Auswertung von Standardröntgenaufnahmen des Thorax bezüglich Verkalkung des Aortenbogens (AAC) vorhergesagt werden können. Patienten und Methoden: Konsekutive für eine Multidetektor Computertomographie (MDCT) vorgestellte Patienten wurden prospektiv eingeschrieben. Alle Patienten wurden mit einem handelsüblichen 64‐Zeilen‐MDCT‐Scanner untersucht. Die Standard‐posterior‐anteriore Röntgenaufnahme des Thorax wurde verwendet, um AAC bewerten. Ergebnisse: Die Studiengruppe bestand aus 248 Patienten. Das mittlere Alter lag bei 52 (IQB: 10) Jahren, und 165 Patienten (67 %) waren männlich. AAC‐Typen (r = 0,676, p0,0001) und Alter (r = 0,518, p0,0001) waren signifikant und positiv mit dem CAC‐Score korreliert. Die Anwesenheit von AAC war unabhängig mit der Anwesenheit von CAC korreliert (OR: 11.20, 95 % CI 4,25 bis 29,52). Ein AAC Grad von ≥ 2 war der stärkste unabhängige Prädiktor für den Hochrisiko‐CAC‐Score (OR: 27.42, 95 % CI 6,09 bis 123,52). Die ROC Analyse ergab eine starke Vorhersagekraft von AAC‐Typen für einen CAC‐Score von ≥ 100 (AUC = 0,892, p0,0001) und ≥ 400 (AUC = 0,894, p0,0001). Fehlen von AAC hatte eine Sensitivität, Spezifität und Genauigkeit von 90 %, 84 % und 89 % für einen CAC‐Score von100. Ein AAC Grad von ≥ 2 sagte einen CACScore von ≥ 400 mit einer Sensitivität, Spezifität und Genauigkeit von 68 %, 98 % und 95 % voraus. Schlussfolgerungen: AAC ist ein starker und unabhängiger Prädiktor für CAC. AAC kann gut Patienten mit Low‐und High‐Risk‐CAC‐Scores diskriminieren.

Objective: The ambulatory arterial stiffness index has been proposed as an indicator of arterial stiffness. The aim of this study was to test the hypothesis that increased ambulatory arterial stiffness index might be related with impaired left atrial function in hypertensive diabetic patients with no previous history of cardiovascular disease. Methods: Inclusion criteria included office systolic BP> 130 mm Hg or diastolic BP> 80 mm Hg and absence of secondary causes of HT, whereas exclusion criteria LV ejection fraction

Background Recently, the role of osteoprotegerin (OPG) in the pathogenesis of heart failure through different mechanisms has received much attention. Subclinical changes in left ventricular (LV) function can be identified using quantification of myocardial strain, and global longitudinal strain (GLS) is a superior predictor of outcomes than ejection fraction. We hypothesized that increased OPG levels could predict subclinical LV systolic dysfunction in treated diabetic hypertensive patients with preserved LV ejection fraction. Methods The study was composed of 86 diabetic hypertensive and 30 nondiabetic hypertensive patients. All patients underwent echocardiography and venous blood samples were taken for determination of OPG. The relation between OPG levels and LV GLS was investigated using 2-dimensional speckle tracking echocardiography. Results Diabetic hypertensive patients had higher diastolic peak early/early diastolic tissue velocity and lower systolic tissue velocity, GLS, GLS rate systolic, and GLS rate early diastolic than nondiabetic hypertensive patients ( P = 0.009, P = 0.049, P P = 0.004, and P 18.5 and ≤ 18.5). The patients with GLS ≤ 18.5 had higher diastolic blood pressure (mm Hg; P = 0.048), OPG (pmol/L; P P = 0.042) values than those with GLS > 18.5. In multivariate logistic regression analysis, OPG was found to be an independent predictor of impaired GLS ( P = 0.001). Receiver operating characteristic curve analysis revealed that OPG values of > 6.45 (pmol/L) identified the patients with GLS ≤ 18.5. Conclusions Plasma OPG values could predict subclinical LV systolic dysfunction in diabetic hypertensive patients.

OBJECTIVE It is important to know the elapsed symptom-to-door (StD) time between the emergence of ST-elevation myocardial infarction (STEMI) symptoms and admission to the hospital in terms of the selection of appropriate treatment and prognosis. In this study, we aimed to assess the relationship between serum C-reactive protein (CRP) and StD time after STEMI. METHODS 436 of the patients admitted to our center with STEMI between August 2012-February 2013 (338 male, mean age, 63.9±12.8) were included in this prospective-observational cohort study. Blood samples were obtained from laboratory results of the first reference period. Patients were divided into four groups according to the duration of StD time [0-1. hour; group 1 (G1), 1-3. hour; group 2 (G2), 3-6. hour; group 3 (G3), 6-12. hour; group 4 (G4)]. Statistical analysis was performed via chi-squre test, ANOVA test, Pearson's correlation analysis and receiver operator charecteristic (ROC) analysis. RESULTS As the time progressed, an increase in CRP levels was observed. The difference among the means of the G1-G3 (p=0.002), G1-G4 (p

OBJECTIVE The relationship between silent neuronal injury (SNI) and arterial stiffness assessed by cardio-ankle vascular index (CAVI) has not been evaluated in patients treated with coronary angiography and intervention due to acute coronary syndrome (ACS). The aim of this study is to evaluate the value of CAVI in prediction of SNI after percutaneous coronary angiography and intervention in patients presented with ACS. METHODS Eighty-three consecutive patients presented with ACS, who underwent percutaneous coronary angiography and intervention, were included in this prospective observational study on diagnostic accuracy. Neuron specific enolase (NSE) was studied before and 18 hour after the coronary angiography and intervention. CAVI was measured by VaSera-1000 instrument. Clinical and echocardiographic characteristics were analyzed and independent predictors of SNI were evaluated. Chi-square, Student t-test, Mann-Whithney U test, correlation analysis and logistic regression analysis was used for statistical analysis. RESULTS NSE levels significantly increased after cardiac catheterization (9.82±3.22 mg/dL vs. 13.15±8.55 mg/dL, p

We investigated the relationship between peripheral artery disease complexity and coronary artery disease complexity in patients with peripheral artery disease. A total of 449 patients were enrolled. SYNTAX score, a marker of coronary artery disease complexity, was assessed by dedicated computer software and complexity of peripheral artery disease was determined by Trans Atlantic Inter-Society Consensus II classification. The SYNTAX score of patients with minimal peripheral artery disease, Trans Atlantic Inter-Society Consensus A, Trans Atlantic Inter-Society Consensus B, Trans Atlantic Inter-Society Consensus C and Trans Atlantic Inter-Society Consensus D were 5 (11), 12.5 (13.25), 20 (14), 20.5 (19) and 27.5 (19), respectively (values in brackets represent the interquartile range). SYNTAX score and Trans Atlantic Inter-Society Consensus class was moderately correlated (r = 0.495, p

Introduction: Stroke is one of the leading causes of permanent disability and death. Stroke is generally associated with ischemia and carotid artery stenosis is the reason in nearly one third of the cases. The aim of the present study was to investigate the short and mid term results of carotid artery stenting (KAS) procedures performed in high risk patients due to carotid artery disease who were admitted to cardiology clinic of our institution. Patients and Methods: The study group consisted of 14 consecutive high risk patients in whom KAS was performed in the cardiology clinic of our institution due to atherosclerotic carotid artery disease between October 2011 and October 2013. Procedural success, in-hospital and out-hospital stroke, myocardial infarction and all causes of mortality were evaluated. Results: Angiographic success was achieved in all patients. In-hospital and out-hospital acure coronary syndrome was not observed. One patient developed permanent stroke 24 hours after the procedure. This stroke was related with non-intervened carotid artery. This patient died 32 days after the procedure. Procedure related stroke or death was not occurred in any of the patients. Conclusion: KAS is a safe procedure in high risk patients for appropriately equipped experienced operators.

The aim of this study is to evaluate the incidence and predictors of silent neuronal injury (SNI) after coronary angiography (CAG) and intervention by serial measurement of serum neuron-specific enolase (NSE) in patients presented with acute coronary syndrome (ACS). Ninety-eight consecutive patients presented with ACS and underwent CAG and intervention were included in the study. The NSE levels significantly increased after CAG and intervention compared to baseline levels (22.03 ± 27.70 and 10.08 ± 3.15 consecutively). Left ventricular ejection fraction in the SNI+ group was significantly lower than that in the SNI− group (43.71% ± 12.51%, 50.84% ± 9.34%, P = .002). Maximal creatinine kinase myocardial band, troponin I, and SYNTAX score of the SNI+ group were significantly higher than those of the SNI− group (103.83 ± 99.22, 51.92 ± 78.33, P = .006; 50.04 ± 66.18, 19.18 ± 30.50, P = .002; 103.83 ± 99.22, 51.92 ± 78.33, P = .006; and 50.04 ± 66.18, 19.18 ± 30.50, P = .002 successively). SYNTAX score and performing percutaneous coronary intervention were the independent predictors of SNI ( P = .009, odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.014-1.107, P = .036, OR = 4.262, 95% CI = 1.097-16.56). Percutaneous coronary intervention and coronary artery lesion complexity may increase the risk of SNI in patients with ACS.

Background: Coronary artery perforation (CAP) is an infrequent and life-threatening complication of percutaneous coronary intervention (PCI), requiring prompt intervention. There is insufficient data about the prognosis and management of CAP in patients with acute coronary syndrome (ACS). The aim of this study was to investigate the management of CAP in patients with ACS. Methods: The results of 25 patients with CAP were retrospectively analyzed. Results: Of the 25 patients, 14 patients (56%) had ACS. According to the Ellis classification, the grade of perforation was type-I in 8 (32%) patients, type-II in 6 (24%) patients and type-III in 11 (44%) patients. Prolonged balloon inflation was performed to 20 (80%) cases of CAP. It successfully sealed the perforation in three cases of type-I, five cases of type-II CAP and in seven cases of type-III CAP. Seven patients underwent covered stent implantation. Emergent CABG was required in two patients with type-III CAP. In-hospital mortality was not observed in the patients. Conclusion: The outcomes of CAP in patients with ACS were similar to patients with stable coronary disease. The continuation of anti-platelet agents after the successful management of CAP may be encouraged in these patients.

Background: Chronic obstructive pulmonary disease (COPD) is not only characterized by chronic airflow limitation, but is also a systemic disease. There is no information about alterations in right ventricle (RV) functions precipitated by systemic manifestations of COPD. Objectives: We aimed to evaluate the relationship between the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index that evaluates systemic manifestations of COPD and RV functions by means of 2-dimensional speckle-tracking echocardiography (2D-STE) in COPD patients. Methods: The study involved 135 COPD patients and 37 control subjects. All patients underwent 2D-STE, pulmonary function tests and 6-min walk tests, and were divided into quartiles according to their calculated BODE index score. Results: COPD patients had impaired RV and left-ventricle diastolic functions compared to controls. There was a decreasing trend from quartile 1 (Q1) to Q4 in RV functional parameters, i.e. RV free wall strain (RVFW-S, p < 0.001), tricuspid annular plane systolic excursion (p < 0.001), systolic myocardial velocity (p < 0.001), RV fractional area change (p < 0.001), RV myocardial performance index (p < 0.001) and pulmonary artery systolic pressure (p < 0.001). The transmitral Doppler E wave/lateral mitral annular tissue Doppler E wave ratio was similar in the 4 BODE index quartiles (p = 0.159). Multivariate analysis was performed to find independent predictors of decreased RVFW-S (≤19.06), and the BODE index (in quartiles; OR 4.61 and 95% CI 1.85-11.63) was found to be an independent predictor. In a partial correlation analysis adjusted for forced expiratory volume in 1s % predicted, RVFW-S was correlated with the 6-min walk distance (r = 0.498). Conclusion: The BODE index, which can be easily evaluated in office settings, may provide information about reduced RV functions as well as guiding treatment and helping to predict prognosis in COPD patients.

Prosthetic valve dysfunction due to pannus formation is a rare but serious complication. Currently, limited data are available concerning the pathogenesis and immunohistochemical properties of pannus. The study aim was to investigate the morphological, histopathological and immunohistochemical characteristics of pannus formation in patients with prosthetic valve dysfunction.A total of 35 patients (10 males, 25 females; mean age 44 ± 16 years) who had undergone re-do valve surgery due to prosthetic valve obstruction was enrolled in the study. Immunohistochemical studies were aimed at evaluating the expression of alphasmooth muscle actin (α-SMA) and desmin in myofibroblasts and smooth muscle cells; epithelial membrane antigen (EMA) in epithelial cells; and CD34, Factor VIII and vascular endothelial growth factor (VEGF) in endothelial cells. Matrix metalloproteinases (MMPs) -2 and -9, and transforming growth factor-beta (TGF-β) were used to demonstrate cytokine release from macrophages, leukocytes, fibroblasts and myofibroblasts.Pannus appeared as a tough and thick tissue hyperplasia which began from outside the suture ring in the periannular region and extended to the inflow and outflow surfaces of the prosthetic valves. Histopathological analysis showed the pannus tissue to consist of chronic inflammatory cells (lymphocytes, plasma cells, macrophages and foreign body giant cells), spindle cells such as myofibroblasts, capillary blood vessels and endothelial cells laying down the lumens. Calcification was present in the pannus tissue of 19 explanted prostheses. Immunohistochemical studies revealed positive α-SMA expression in all patients, whereas 60.5% of patients were positive for desmin, 50% for EMA, 42.1% for VEGF, 39.5% for TBF-β, 42.1% for MMP-2, 86.8% for CD34, and 97.4% for Factor VIII. MMP-9 was negative in all patients.Pannus tissue appears to be formed as the result of a neointimal response in periannular regions of prosthetic valves that consist of periannular tissue migration, myofibroblast and extracellular matrix proliferation with vascular components. It is a chronic active process in which mediators such as TGF-β, VEGF and MMP-2 play roles in both matrix formation and degradation.

Giriş: Bening prostathiperplazisi (BPH), yaşlı erkeklerde en sık görülen hastalıktır. BPH’ninateroskleroz ile ilişkisi bilinmesine karşın; subklinik ateroskleroz ileilişkisi henüz değerlendirilmemiştir. Bizim çalışmamızın amacı, bu ilişkininkarotis intima media kalınlığı (KİMK) kullanılarak araştırılmasıydı.Hastalarve Yöntem: Çalışmaya, 50-65 yaş arasında50 BPH hastası ve BPH’si olmayan 50 erkek hasta kontrol deneği dahil edildi.Alt ürüner sistem semptomları (AÜSS)’nın değerlendirilmesinde kullanılan,uluslararası prostat semptom skoruna (IPSS) göre, hastalar hafif-orta AÜSS (IPSS < 20, n= 33hasta) ve ciddi AÜSS (IPSS ≥ 20, n= 17 hasta) gruplarına ayrıldı. KİMK ve diğerparametreler açısından gruplar karşılaştırıldı.Bulgular: Kontrol grubuyla karşılaştırıldığında, BPH grubunda KİMKönemli düzeyde yüksekti (sırasıyla, 0.73 ± 0.2 vs. 0.97 ± 0.3, p< 0.001).Ayrıca, yalnızca hastaları kapsayan alt grup analizinde, hafif-orta AÜSSgrubuna göre ciddi AÜSS grubunda da CIMT önemli düzeyde yüksekti (sırasıyla,0.84 ± 0.2 vs. 1.22 ± 0.3, p, Introduction:Benign prostatic hyperplasia (BPH) is the most common disorder in elderly men.Although the relationship between atherosclerosis and BPH is known, theassociation between subclinical atherosclerosis and BPH has not yet beeninvestigated. The aim of our study was to assess this relationship usingcarotid intima-media thickness (CIMT).Patientsand Methods: Fifty patients with BPH and 50 controlsubjects without BPH of ages 50-65 years were enrolled. According to theinternational prostate symptom score (IPSS), which is used for the evaluationof LUTS, patients were divided into mild-moderate (IPSS< 20 point, n= 33patients) and severe groups (IPSS ≥ 20 point, n= 17 patients). CIMT wasevaluated using ultrasonography. The relationship between CIMT and other parameterswere analysed.Results:CIMT was significantly higher in BPH group (p=0.02). In addition, it was significantly higher in severe LUTS group insubgroup analyses, which included only patients (1.22 ± 0.3 vs. 0.84 ± 0.2,p< 0.001). There was a positive correlation between CIMT and IPSS (r= 0.745,p< 0.001). CIMT and HDL cholesterol were found to be independent predictorsof BPH in multivariate analysis.Conclusion:Subclinical atherosclerosis and BPH may sharecommon aetiopathogenic factors. Therefore, BPH and lower urinary tract symptomsmay be indicators of atherosclerotic burden in men of the same age group.

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular morbidity and mortality. Increased arterial stiffness is associated with the presence and severity of cardiovascular disease. The cardio-ankle vascular index (CAVI) is a new method for assessment of arterial stiffness that is not influenced by blood pressure at the time of measurement and is significantly correlated with the presence and severity of cardiovascular disease. The aim of the present study was to evaluate whether there is an association between the spirometric severity of COPD, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, with arterial stiffness as assessed by CAVI. We enrolled 123 patients with COPD (102 men) followed up by the chest medicine outpatient clinics and 35 healthy subjects (26 men). All patients were assessed with spirometry, CAVI, and clinical history. Patients with COPD had significantly increased CAVI values compared with control subjects (10.37 ± 2.26 vs. 6.74 ± 1.42, p

OBJECTIVE 24-h ambulatory blood pressure monitoring (24-h ABPM) is a better predictor of cardiovascular events (CVEs) than spot blood pressure (BP) measurements in hypertensive diabetic patients. In this patient group, the underlying mechanism of the relationship between a nondipper pattern determined with 24-h ABPM and increased incidence of CVE is unknown. Cardioankle vascular index (CAVI) is a new index of the overall arterial stiffness from the aorta to the ankle. The objective of the present study was to evaluate the relationship between a dipper/nondipper pattern and arterial stiffness in hypertensive diabetic patients using the CAVI method. METHODS We enrolled 99 hypertensive patients with type-2 diabetes mellitus. 24-h ABPM and CAVI measurements were performed for all patients. The relationship between a dipper/nondipper pattern and CAVI measurements was analyzed. RESULTS Sixty-three (63.6%) patients had a nondipper pattern. In univariate analysis, CAVI, mean arterial pressure (MAP)-asleep, overall diastolic BP, overall systolic BP, duration of hypertension, and statin use were significantly higher among patients with a nondipper pattern than that in dippers. Multivariate linear regression analyses showed that the difference between MAP-asleep and MAP-awake was associated independently with CAVI (β coefficient=0.514, P

Introduction: Radiofrequency ablation of tachyarrhythmia is effective in the treatment of tachycardia. In this study, we evaluated the results of radiofrequency catheter ablation of tachyarrhythmia. Patients and Methods: From December 2010 to January 2012, 114 consecutive patients with symptomatic drug-resistant typical slow-fast atrioventricular nodal reentrant tachycardia, 17 patients with atrioventricular reentrant tachycardia (five Wolf Parkinson White syndrome), eight patients with atrial tachycardia, seven patients with atrial flutter, five patients with right ventricular outflow tract tachycardia and three patients with atrial fibrillation underwent an invasive electrophysiology study and radiofrequency ablation. Results: The 154 patients (age: 39.1 ± 17.2 years, body mass index: 24.3 ± 5.2 kg/m2, waist/ hip ratio: 0.88 ± 5.2, systolic blood pressure: 128.3 ± 22.4 mmHg, diastolic blood pressure: 75.30 ± 9.0 mmHg, resting heart rate: 76.10 ± 8.2 beat/minute) with tachycardia (89 women, 65 men) were ablated. Procedure and fluoroscopy times were 57.5 ± 19.0 and 14.4 ± 4.1 minute respectively. The mean follow up period was 10.2 ± 4.3 months. During follow up period three patients with atrioventricular nodal reentrant tachycardia, two patients with atrioventricular reentrant tachycardia, one patient with right ventricular outflow tract tachycardia and one patient with atrial fibrillation had recurrence. Conclusion: The transvenous radiofrequency ablation therapy is a safe and effective approach for the treatment of tachyarrhythmia under experienced hands.

Introduction: Atrioventricular nodal reentrant tachycardia is the most common regular supraventricular arrhythmia in humans. This study investigated the admission hemoglobin levels and gender differences in transvenous radiofrequency ablation therapy for the treatment of the slow pathway of atrioventricular nodal reentrant tachycardia. Patients and Methods: Nineteen consecutive patients with symptomatic drug-resistant typical slow-fast atrioventricular nodal reentrant tachycardia underwent an invasive electrophysiology study and performed radiofrequency ablation of slow conduction pathway within atrioventricular node. Blood samples were taken between 08.30 and 09.30 a.m. from the antecubital vein for complete blood count. Results: Nineteen consecutive patients with slow-fast atrioventricular nodal reentrant tachycardia (12 female, 7 male) were ablated. Mean admission hemoglobin and hematocrit (%) levels were significantly increased in male patients as compared with female patients (15.38 ± 1.21 mg/dL, 12.72 ± 1.36 mg/dL, p < 0.001; 45.41 ± 3.26, 37.90 ± 2.88, p < 0.001 respectively). There was not gender differences in the radiation exposure time, fluoroscopy time, complication rate (0%) and acute success rate (100%). Conclusion: There was not gender differences in the radiation exposure time, fluoroscopy time, complication rate and acute success rate at the transvenous radiofrequency ablation therapy for the treatment of atrioventricular nodal reentrant tachycardia. Mean admission hemoglobin and hematocrit levels were significantly decreased in female patients as compared with male patients.

Introduction: We aimed to investigate the role of electrocardiography (ECG) findings in determining infarct related coronary arteries of patients hospitalized with a diagnosis of acute inferior myocardial infarction (AIMI). Patients and Methods: The first ECG records taken on admission to hospital and demographic characteristics of 132 patients, who were followed with the diagnosis of AIMI (mean age, 57.3 ± 11, 118 men) in our center between January 2004-January 2009, were evaluated. Results: When coronary angiography were evaluated, it was detected that the infarct-related coronary artery (IRCA) was the right coronary artery (RCA) in 70.4% of all patients, whereas it was circumflex artery (Cx) in 29.6% respectively. It was detected that DIII-ST elevation was higher than DII (94.6% sensivity, and 75.9% specifity, p= 0.001) and there was st depression in aVL and DI leads in cases which IRCA was RCA (88.2% sensivity and 75.2% specifity, p= 0.011). Although ST depression in aVL lead was higher than st depression in DI in cases which RCA was IRCA, this finding was defined statistically significant (%95.7 sensivity; %73.6 specifity; p= 0.016). RCA was the IRCA significantly in patients with inferior wall MI accompanied by right ventricular myocardial infarction (p= 0.005). Although Cx was observed as the culprit artery in cases which was accompanied by posterior wall infarction, no statistically finding was detected (p= 0.3). ST-depression was detected in V1-2 leads in ECG of patients whose culprit artery was Cx (%84.6 sensitivity, %36.3 specificity, p= 0.009). Conclusion: The findings based on surface ECG of the patients who underwent AIMI shows that IRCA can be predicted., Giriş: Akut inferiyor miyokart enfarktüsü (AİME) tanısıyla hastaneye yatırılan olguların enfarktüsten sorumlu koroner arterlerinin belirlenmesinde elektrokardiyografi (EKG) bulgularının önemini araştırdık. Hastalar ve Yöntem: Merkezimizde Ocak 2004-Ocak 2009 tarihleri arasında AİME tanısı ile takip edilen 132 hastanın (ortalama yaş; 57.3 ± 11, 118 erkek); hastaneye başvuru sırasında çekilen ilk EKG kayıtları ve demografik özellikleri retrospektif olarak değerlendirildi. Bulgular: Koroner anjiyografi tetkikleri değerlendirildiğinde; olguların %70.4'ünde enfarktüsten sorumlu koroner arterin (ESKA) sağ koroner arter (RCA), %29.6'sında sirkumfleks arter (Cx) olduğu saptandı. Sorumlu arterin RCA olduğu olgularda; DIII derivasyonundaki ST segment yükselmesinin, DII derivasyonundan daha fazla olduğu (%94.6 duyarlılık, %75.9 özgüllük, p= 0.001),aVL ve DI derivasyonlarının her ikisinde de ST segment çökmesinin bulunduğu saptandı (%88.2 duyarlılık, %75.2 özgüllük, p= 0.011). Sorumlu arterin RCA olduğu olgulara aVL derivasyonundaki ST segment çökmesinin, DI derivasyonundaki ST segment çökmesinden daha fazla olmasının istatistiksel olarak anlamlı olduğu belirlendi (%95.7 duyarlılık, %73.6 özgüllük p= 0.016). İnferiyor yüz enfarktüse, sağ ventrikül miyokart enfarktüsünün eşlik ettiği hastalarda sorumlu arter anlamlı olarak RCA idi (p= 0.005). Posterior duvar infarktüsünün eşlik ettiği olgularda sorumlu arterin daha çok Cx olduğu gözlense de bu durum istatistiksel olarak anlamlı değildi (p= 0.3). Sorumlu arterin Cx olduğu olguların EKG'lerinde V1-2 derivasyonlarında ST segment çökmesi saptandı (%84.6 duyarlılık, %36.3 özgüllük p= 0.009). Sonuç: AİME geçiren olguların yüzey EKG'lerinden elde edilen bulgular, enfarktüsten sorumlu koroner arterin tahmin edilebileceğini göstermektedir.

Objectives The aim of this prospective study was to identify the most effective and safest regimen among different thrombolytic treatment strategies. Background The best treatment strategies for prosthetic valve thrombosis have been controversial. Methods Transesophageal echocardiography–guided thrombolytic treatment was administered to 182 consecutive patients with prosthetic valve thrombosis in 220 different episodes (156 women; mean age, 43.2 ± 13.06 years) between 1993 and 2009 at a single center. These regimens chronologically included rapid (Group I), slow (Group II) streptokinase, high-dose (100 mg) tissue plasminogen activator (t-PA) (Group III), a half-dose (50 mg) and slow infusion (6 h) of t-PA without bolus (Group IV), and a low dose (25 mg) and slow infusion (6 h) of t-PA without bolus (Group V). The endpoints were thrombolytic success, in-hospital mortality, and nonfatal complication rates. Results The overall success rate in the whole series was 83.2%; it did not differ significantly among Groups I through V (68.8%, 85.4%, 75%, 81.5%, and 85.5%, respectively; p = 0.46). The overall complication rate in the whole series was 18.6%. Although the overall complication rate was similar among Groups I through IV (37.5%, 24.4 %, 33.3%, and 29.6%, respectively; p > 0.05 for each comparison), it was significantly lower in Group V (10.5%, p Conclusions Low-dose slow infusion of t-PA repeated as needed without a bolus provides effective and safe thrombolysis in patients with prosthetic valve thrombosis. (Comparison of Different TRansesophageal Echocardiography Guided thrOmbolytic Regimens for prosthetIc vAlve Thrombosis; NCT01451320 )

Objectives: Arterial stiffness and epicardial fat thickness (EFT) are associated with coronary artery disease (CAD). The cardio-ankle vascular index (CAVI) is a novel marker of arterial stiffness. The SYNTAX score (SS) reflects the complexity of CAD. We aimed to evaluate the relation of EFT and CAVI with CAD complexity in nondiabetic patients. Method: We enrolled 121 patients undergoing coronary angiography. In all patients, CAVI and EFT were determined. SS were calculated. The relationship between EFT, CAVI and SS was analyzed. Results: CAVI and EFT were significantly correlated with SS (r = 0.537, p < 0.001, and r = 0.629, p < 0.001, respectively) and found to be independent predictors of intermediate-high SS. For the prediction of intermediate-high SS, receiver-operating characteristic curve analysis revealed a cutoff value of 5 mm for EFT (area under the curve, AUC = 0.851, 95% confidence interval, CI, 0.775–0.910) with a specificity of 92.2% and a sensitivity of 77.4% and 8.6 for CAVI (AUC = 0.877, 95% CI 0.805–0.929) with a specificity of 68.9% and a sensitivity of 93.5%. Conclusion: CAD complexity is associated with adverse cardiovascular events. It can be predicted noninvasively with EFT and CAVI in nondiabetic patients with suspected CAD. Thus, patients at high risk for cardiovascular events may be detected early and managed with appropriate treatment strategies.