Prediction of New-Onset Atrial Fibrillation in Transcatheter Aortic Valve Implantation.

Background: This study investigates the association between prolonged total atrial conduction time and the development of new-onset atrial fibrillation (AF) following transcatheter aortic valve implantation (TAVI). Methods: We enrolled 307 patients who underwent TAVI. Total atrial conduction time was calculated as the time between the onset of the P wave on the electrocardiography and the peak of the a' wave velocity (PA-TDI duration) on tissue Doppler imaging echocardiography. Results: A total of 263 patients were analyzed after excluding 44 with pre-existing AF. Of these 263 patients, 47 (17.8%) experienced new-onset AF after the TAVI procedure. The new-onset AF group had an older median age (80.6 vs. 77.5 years) and a higher incidence of paravalvular aortic regurgitation than those without AF (none 29.8%, mild 46.8%, moderate 23.4%). The new-onset AF group had increased end-systolic diameter (35.0 vs. 31.7 mm, p = 0.03), left atrial diameter (44.7 vs. 41.9 mm, p = 0.049), and PA-TDI duration (137.0 vs. 125.4 ms, p = 0.009). Older age, the presence of paravalvular aortic regurgitation, and prolonged PA-TDI duration were independently associated with new-onset AF in multivariate analysis. The optimal cut-off value for PA-TDI duration was 123.5 ms. Conclusions: AF in patients treated with TAVI may pose significant risks for morbidity and mortality. PA-TDI duration, a readily available echocardiographic parameter, can detect patients with a high risk of new-onset AF.

Bidirectionality of LF when the movie makes you sad: Effects of negative emotions on heart rate variability among patients with major depression.

OBJECTIVES: Heart rate variability (HRV) reflects the capacity to adapt to internal and environmental changes. Decreased HRV may indicate inadequate adaptive capacity. This study aims to investigate the relationship between the heart and brain's adaptive abilities, both at rest and when negative emotions are stimulated in depression. SUBJECTS AND METHODS: The study included 30 patients (20 female, 10 male) with major depression (mean age = 29.8 ± 7.8) and 30 healthy controls, all of whom had similar characteristics in terms of age and gender, selected through convenience sampling. The patients were drug-free at the time of the assessment. Holter recordings were obtained while subjects watched videos stimulating anger, fear, sadness, and a neutral video, and at rest, HRV parameters were calculated. To control for interindividual variability and account for paired sampling, linear mixed effects models were employed. RESULTS: Watching the 'sadness video' led to an increase in low frequency band (LF) [LF change (Control vs depression); Difference:-620.80 df:107 t:-2.093 P:0.039] and LF/high frequency band ratio (LF/HF) [LF/HF change (control vs depression group); Difference:-1.718 df:105 t:-2.374 P:0.020] in the depression group. The video led to a decrease in LF and LF/HF in the controls. Although the differences between the conditions and interactions with the group were significant, the effects were independent of depression severity. CONCLUSION: In depression, brain's regulatory effect on the heart differed from controls in the sadness condition, possibly due to increased arousal levels in subjects with depression and their inability to suppress sympathetic activity when a state of sadness is stimulated.

Unlocking Promising Therapies: Drug-Eluting Stents in Medically Refractory Angina Patients With Myocardial Bridging.

Myocardial bridging (MB) is a congenital variation in which a coronary artery segment tunnels through the myocardium instead of following its usual epicardial route. Although MB is usually diagnosed incidentally and has a good long-term prognosis, it can lead to complications such as angina, myocardial infarction, arrhythmias, and sudden death. This study aimed to evaluate the outcomes of drug-eluting stent (DES) implantation in patients with MB and medically refractory angina. The study included 12 patients with significant MB who did not respond to maximal medical therapy and underwent DES implantation. The patients were followed up for a mean duration of 33 months. The procedural success rate was 92%, with only 1 patient experiencing acute coronary artery rupture during the procedure. During the follow-up period, none of the patients reported angina symptoms, required additional percutaneous coronary intervention, or developed stent thrombosis. One patient (8.3%) died from a non-cardiac cause. The procedure demonstrates a high procedural success rate and leads to favorable long-term outcomes, including the absence of angina symptoms and the avoidance of stent-related complications. In conclusion, this study suggests that DES implantation can serve as an effective treatment option for selected patients with medically refractory angina and significant MB.

Role of echocardiography on early diagnosis of atrial remodelling and fibrosis in elite athletes.

There is emerging data indicating that long-standing vigorous exercise may be associated with atrial structural remodelling. This remodelling process is may be the cause of the increasing frequency of atrial arrythmias in athletes. Early diagnosis of atrial remodelling by atrial imaging could have a role in management of atrial arrythmias in elite athletes. In this study we aimed to diagnose early phases of atrial remodelling in elite athletes. Two groups of athletes including professional weight lifters (n = 33), professional marathoners (n = 32) and sedentary participants (n = 30) were enrolled. We also studied patients who received cardiotoxic chemotherapy (n = 10) for comparison. Serum TGF-beta level as a marker of fibrosis was measured. Both left atrial (LA) 3D volume and strain values were analysed. There was a positive correlation between serum TGF-beta levels and LA volumes and negative correlation between TGF-beta levels and strain values. TGF-beta levels were higher among chemotherapy and weight lifter groups, compared to control and marathoner groups [mean 0.57 ± 0.3 and 0.55 ± 0.2 vs. 0.45 ± 0.2 and 0.47 ± 0.2, respectively, p = 0.005]. LA volumes were higher among chemotherapy and weight lifter groups [median 33 (26-38) and 31 (23-36) respectively, p = 0.005], and strain values were lower in these two groups [mean 20.3 ± 2.5 and 24.6 ± 4.5, respectively, p < 0.005] compared to control and marathoner groups. Total exercise volume was higher in weight lifter group compared to marathoners [13,780 (2496-36,400) vs. 4732 (780-44928), respectively, p = 0.001]. There wasn't any difference between any group regarding left ventricular systolic and diastolic functions. Vigorous exercise causes atrial remodelling and fibrosis in elite athletes. Strength exercise carries higher risk for atrial fibrosis than endurance exercise. Burden of exercise is correlated with the severity of cardiac fibrosis. Echocardiographic evaluation of the left atrium and TGF-beta levels may help to detect subclinical cardiac remodelling and fibrosis.

Sarcopenia and anthracycline cardiotoxicity in patients with cancer.

BACKGROUND: Several studies have suggested that sarcopenia is associated with an increased treatment toxicity in patients with cancer. The aim of this study is to evaluate the relationship between sarcopenia and anthracycline-related cardiotoxicity. METHODS: Patients who received anthracycline-based chemotherapy between 2014 and 2018 and had baseline abdominal CT and baseline and follow-up echocardiography after anthracycline treatment were included. European Society of Cardiology ejection fraction criteria and American Society of Echocardiography diastolic dysfunction criteria were used for definition of cardiotoxicity. Sarcopenia was defined on the basis of skeletal muscle index (SMI) and psoas muscle index (PMI) calculated on CT images at L3 and L4 vertebra levels. RESULTS: A total of 166 patients (75 men and 91 women) were included. Sarcopenia was determined in 33 patients (19.9%) according to L3-SMI, in 17 patients (10.2%) according to L4-SMI and in 45 patients (27.1%) according to PMI. 27 patients (16.3%) developed cardiotoxicity. PMI and L3-SMI were significantly associated with an increased risk of cardiotoxicity (L3-SMI: HR=3.27, 95% CI 1.32 to 8.11, p=0.01; PMI: HR=3.71, 95% CI 1.58 to 8.73, p=0.003). CONCLUSIONS: This is the first study demonstrating a significant association between CT-diagnosed sarcopenia and anthracycline-related cardiotoxicity. Routine CT scans performed for cancer staging may help clinicians identify high-risk patients in whom closer follow-up or cardioprotective measures should be considered.

Breast artery calcification as an opportunistic predictor of cardiovascular disease.

BACKGROUND: Atherosclerotic cardiovascular disease is still the leading cause of mortality for women. Breast cancer screening with mammography is recommended in all women aged over 40 years. AIMS: Whether breast artery calcification (BAC) is associated with cardiovascular disease is not clear. We aimed to evaluate the association between BAC and the presence of coronary atherosclerosis determined by CT. METHODS: All patients who underwent both mammography and coronary CT angiography between January 2010 and December 2016 were screened, and patients with a duration of less than 12 months between CT and mammography were included. RESULTS: A total of 320 women were included and BAC was detected in 47 (14.6%) patients. BAC was correlated with age and CT coronary calcium score. Both the frequency of critical coronary artery stenosis (34% vs 10.6%; p = 0.001) and CT coronary calcium score (5.5 vs 0; p = 0.001) was significantly higher in patients with BAC. The absence of BAC was a strong predictor of the absence of significant coronary artery disease (p = 0.001). BAC was independently associated with all-cause mortality after excluding patients with breast cancer (HR: 5.32; p = 0.013). CONCLUSION: Breast artery calcification is associated with coronary calcium score and significant coronary stenosis. A high BAC score is related to increased mortality.

Percutaneous interventions of coronary artery fistulas: a single-center experience.

Introduction: Coronary artery fistula (CAF) is a congenital communication between the coronary artery and other vascular structures or cardiac chambers. Percutaneous CAF closure is an emerging alternative to surgery, but long-term outcome data are limited. Aim: To review our center's experience with percutaneous CAF closure methods. Material and methods: Patients who were admitted to our department and underwent percutaneous coronary artery fistula intervention between January 2002 and April 2022 due to presence of CAF-related symptoms or complications were retrospectively analyzed. Data were obtained retrospectively from the hospital electronic database. Results: A total of 39 patient were included. Mean age was 57.3 ±12.5 years and 23 (59%) patients were male. The most common symptom was angina (69.2%) and 51.2% of the patients were under treatment with at least one anti-anginal agent at admission. The right coronary artery (n = 19) and left anterior descending artery (n = 19) were the most common sites of CAF origin, and the pulmonary artery (n = 22) was the main drainage site. Coil embolization was performed most frequently and occlusion via cyanoacrylate in 3 patients and detachable balloon angioplasty in 1 patient were preferred. Percutaneous occlusion was achieved in 34 cases, 2 of the 5 failed cases underwent surgical occlusion, and remaining patients were treated with anti-anginal drugs. Complications occurred in 6 (15.3%) patients and all of the patients recovered without sequelae. Conclusions: Coronary artery fistulas may present with different symptoms or complications and there are several techniques for percutaneous occlusion. Percutaneous closure of CAF is feasible and safe in anatomically suitable vessels, with good results at follow-up.

Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach.

OBJECTIVE: The aim of this study is to analyze the low-density lipoprotein cholesterol-lowering therapies in secondary prevention patients by analyzing their plasma low-density lipoprotein cholesterol levels, current treatment, considering their inadequate response to medications (as defined in current guidelines), and the requirement for a protein convertase subtilisin/kexin type 9 inhibitor. METHODS: Delphi panel is used to seek expert consensus of experienced 12 cardiologists. A questionnaire consisting of 6 main questions is used to reflect the opinion of the expert panelists on the practices of low-density lipoprotein cholesterol-lowering therapies of patients with high and very high cardiovascular risk. Patients with atherosclerotic cardiovascular disease are covered in this present analysis. RESULTS: According to expert opinion data, 18.6% of the patient population with atherosclerotic cardiovascular disease is estimated to have experienced recurrent vascular events. The current treatment of the patient population is 39.7% on high dose, 36.9% on low/moderate dose of statin, 13.1% on maximum tolerated dose statin+ezetimibe, and 1.2% on maximum tolerated dose statin+ezetimibe+protein convertase subtilisin/kexin type 9 inhibitor. The percentage of atherosclerotic cardiovascular disease patients with inadequate treatment response is estimated to be 20.2% in those using "maximum tolerated dose statin+ezetimibe." The proportion of patients who will need to be treated with a protein convertase subtilisin/kexin type 9 inhibitor increases as their low-density lipoprotein cholesterol levels rises from 9.1% in 70-99 mg/dL to 50.8% in ≥160 mg/dL for these patients. CONCLUSION: According to expert opinion, although a substantial proportion of patients with secondary prevention have not achieved low-density lipoprotein cholesterol goals, the use of protein convertase subtilisin/kexin type 9 inhibitors is very low. Since the questionnaire subject to panel discussion did not include any question elaborating the issue, the discrepancy between the recommendation of the related guidelines and Turkish practice needs further studies for the explanation.

Evaluation of atrial fibrosis in atrial fibrillation patients with three different methods.

BACKGROUND: The presence of atrial fibrosis has already been known as a risk factor for atrial fibrillation (AF) development. We aimed to evaluate atrial fibrosis with previously defined three different methods, which were cardiac magnetic resonance imaging (C-MRI), echocardiographic strain imaging, and biomarkers and show the relationship between these methods in patients with AF scheduled for cryoballoon ablation. METHODS: A total of 30 patients were enrolled. Atrial T1 relaxation durations were measured using C-MRI before the procedure of atrial fibrillation catheter ablation. Fibroblast growth factor-21 (FGF-21) and fibroblast growth factor-23 (FGF-23) levels were measured at serum derived from the femoral artery (Peripheral FGF 21 and 23) and left atrium blood samples (Central FGF 21 and 23) before catheter ablation. Preprocedural transthoracic echocardiography was performed. The median follow-up duration for atrial tachyarrhythmia (ATa) recurrence was 13 (12-18 months) months. RESULTS: The mean ages of the study group were 55.23 ± 12.37 years, and there were 17 (56.7%) female patients in study population. There were negative correlations between post contrast T1 relaxation durations of both posterior and posterosuperior atrium, and central FGF-23 (r: - 0.561; p = 0.003; r:-0.624; p = 0.001; Posterior T1 vs. central FGF-23 levels and Posterosuperior T1 vs central FGF-23 levels, respectively). The positive correlations were observed between postcontrast posterior T1 relaxation durations and left ventricle ejection fraction (r:0.671; p = 0.001); left atrial emptying fraction (r:0.482; p = 0.013); peak atrial longitudinal strain (r:0.605; p = 0.001), and peak atrial contraction strain (r:0.604; p = 0.001). Also negative correlation was observed between postcontrast posterior T1 relaxation durations, and left atrial volume index (r: - 0.467; p = 0.016).

Correlation of vascular risk age with pulse wave velocity in young patients with low absolute cardiovascular risk.

OBJECTIVE: The systematic coronary risk evaluation (SCORE) estimates the 10-year risk of fatal cardiovascular disease (CVD), and its application is recommended. The absolute risk of CVD, independent of risk factors, is relatively low in young individuals. Expressing the risk as their "risk age" may aid in understanding the risk. This study aimed to demonstrate a possible correlation between vascular risk age, SCORE risk value, and the level of subclinical atherosclerosis evaluated using a pulse wave velocity (PWV) device. METHODS: This work was designed to be a cross-sectional study. The SCORE 10-year fatal CVD risk and vascular risk age were calculated for patients below the age of 50 years and without any previous diagnosis of atherosclerotic disease or equivalents. The PWV of each patient was measured non-invasively using a PWV device. RESULTS: The study population included a total of 300 patients with a mean age of 35.1±9.5 years. The mean PWV and mean vascular age of the entire study population were 6.3±1.3 m/s and 44.3±5.5 years, respectively, and the median 10-year risk of fatal CVD score was 0.4 (0.04-2.74). There was a positive correlation between PWV and the 10-year risk of fatal CVD (r=0.613; P<0.001) and vascular risk age (r=0.684; P<0.001). CONCLUSION: Despite their young age and low to moderate 10-year risk of fatal CVD (<1%-5%) according to the SCORE chart, patients with a high vascular risk age were found to have high PWV values. These results show that calculations of vascular risk age might be used to assess the risk of fatal CVD in young patients and correlate with subclinical atherosclerosis.

Assessment of Diastolic Function and Thiol-Disulphide Homeostasis in Arsenic-Exposed Workers.

OBJECTIVES: Exposure to arsenic is associated with various cardiovascular diseases. The imbalance between antioxidant and oxidant homeostasis plays a crucial role in the cardiovascular effects of arsenic. The aim of this study was to investigate the effect of arsenic exposure on diastolic function by measuring thiol and disulphide in arsenic-exposed workers. METHODS AND RESULTS: A total of 107 male arsenic-exposed workers and 36 healthy subjects were enrolled. Mitral inflow velocity and parameters of diastolic function were measured. As oxidative stress indicators, total thiol, native thiol, disulphide, and their percent ratios were determined. The mean age was 39.1 ± 9.5 years in the arsenic-exposed group and 37.4 ± 9.6 years in the controls. The median blood arsenic level was 42 µg/dL in the arsenic-exposed group and 3.75 µg/dL in the controls. E-wave, E/A ratio, and e' wave were lower and left atrial diameter, A-wave, average E/e' ratio, and tricuspid regurgitation velocity were higher in the arsenic-exposed group. Native and total thiol concentrations were lower, and disulphide/native and disulphide/total thiol ratios were higher in the arsenic-exposed group. Fourteen (13.1%) workers had diastolic dysfunction, 26 (24.3%) had indeterminate, and 67 (62.6%) had normal diastolic function, compared to 1 (2.8%), 2 (5.6%), and 33 (97.7%) in the control group, respectively. In regression analysis, disulphide/native thiol ratio (p < 0.001) and blood arsenic level (p < 0.001) predicted increased average E/e' ratio in the arsenic-exposed group. CONCLUSIONS: This study showed strong associations among arsenic exposure, oxidative stress, and diastolic function, and revealed the influence of arsenic exposure on diastolic dysfunction through oxidative stress.

Cholesterol efflux promoting function of high-density lipoproteins in calcific aortic valve stenosis.

Background and aims: Cholesterol efflux capacity is a functional property of high-density lipoproteins (HDL) reflecting the efficiency of the atheroprotective reverse cholesterol transport process in humans. Its relationship with calcific aortic valve stenosis (CAVS) has not been fully assessed yet. Methods: We evaluated HDL-CEC in a patient population with varying degrees of aortic valvular calcific disease, assessed using echocardiography and cardiac computed tomography. Measurement of biomarkers that reflect osteogenic and tissue remodeling, along with dietary and gut microbiota-derived metabolites were performed. Results: Patients with moderate-severe CAVS had significantly lower HDL-CEC compared to both control and aortic sclerosis subjects (mean: 6.09%, 7.32% and 7.26%, respectively). HDL-CEC displayed negative correlations with peak aortic jet velocity and aortic valve calcium score, indexes of CAVS severity (ρ = -0.298, p = 0.002 and ρ = -0.358, p = 0.005, respectively). In multivariable regression model, HDL-CEC had independent association with aortic valve calcium score (B: -0.053, SE: 0.014, p < 0.001), GFR (B: -0.034, SE: 0.012, p = 0.007), as well as with levels of total cholesterol (B: 0.018, SE: 0.005, p = 0.002). Conclusion: These results indicate an impairment of HDL-CEC in moderate-severe CAVS and may contribute to identify potential novel targets for CAVS management.

Four-Dimensional Echocardiographic Evaluation of Left Ventricular Systolic Functions in Patients with Chronic Myeloid Leukaemia Receiving Tyrosine Kinase Inhibitors.

Tyrosine kinase inhibitors (TKIs) are established treatment for haematological malignancies. However, cardiac adverse effects, including the reduction in left ventricular ejection fraction and symptomatic heart failure remain clinical problems. The purpose of this study was to evaluate the left ventricular systolic functions in patients with chronic myeloid leukaemia receiving TKIs. A cross-sectional and observational study was conducted of 37 patients with chronic myeloid leukaemia receiving dasatinib or nilotinib after imatinib failure. Left ventricular systolic functions were evaluated using four-dimensional speckle tracking echocardiography derived global longitudinal (GLS), circumferential (GCS), radial (GRS), and area (GAS) strain indices. Mean ejection fraction, stroke volume, cardiac output and left ventricular mass index were similar between control and patient groups and within normal limits. GLS (- 16.7% vs - 20.8%, p < 0.001), GCS (- 13.0% vs - 15.6%, p = 0.002), and GAS (- 26.2% vs - 31.0, p < 0.001) values were significantly higher in the patient population than those of the controls. Dasatinib and nilotinib groups did not show differences regarding strain indices. In multivariate regression analysis, only the usage of dasatinib or nilotinib was found to be an independent risk factor for diminished GAS (ß = 4.406, p = 0.016), GLS (ß = 3.797, p = 0.001), and GCS (ß = 2.404, p = 0.040). Although imatinib, nilotinib, and dasatinib seem to be clinically safe in terms of cardiac function, monitoring of systolic functions using strain imaging, and long-term observation of patients may provide early detection of the possible cardiac toxicity.

Association of dietary and gut microbiota-related metabolites with calcific aortic stenosis.

BACKGROUND: Histopathological changes in calcific aortic stenosis (CAS) resemble changes in coronary atherosclerosis. Concerning recent evidence on dietary and gut microbiota-related metabolites representing players in atherosclerosis, we aimed to investigate the link between dietary and gut microbiota-derived metabolites and CAS. METHODS: We consecutively recruited eligible subjects with moderate-severe CAS (n = 60), aortic sclerosis (ASc) (n = 49) and age and gender-matched control subjects (n = 48) in May 2016-December 2016. Plasma dietary and gut microbiota-related metabolite levels, namely choline, betaine, and trimethylamine N-oxide (TMAO), were measured using ultra-performance liquid chromatography-tandem mass spectroscopy method. Histopathological examinations were performed in patients that underwent aortic valve surgery. RESULTS: Prevalence of traditional cardiovascular risk factors or co-morbidities did not differ among groups (all p > 0.05). CAS patients had higher plasma choline levels compared to both control (p < 0.001) and ASc (p = 0.006). Plasma betaine and TMAO levels were similar (both p > 0.05). Compared to the lowest quartile choline levels (<11.15 µM), patients with the highest quartile choline levels (≥14.98 µM) had higher aortic valvular (p < 0.001) and mitral annular (p = 0.013) calcification scores. Plasma choline levels were independently associated with aortic peak flow velocity (B ± SE:0.165 ± 0.060, p = 0.009). Choline levels were elevated in subjects who had aortic valves with denser lymphocyte infiltration (p < 0.001), neovascularization (p = 0.011), osseous metaplasia (p = 0.004), more severe tissue remodelling (p = 0.002) and calcification (p = 0.002). CONCLUSION: We found a significant association between choline levels and CAS presence and severity depicted on imaging modalities and histopathological examinations. Our study may open new horizons for prevention of CAS.

Consensus Report on Diagnosis, Treatment and Prevention of Infective Endocarditis by Turkish Society of Cardiovascular Surgery (TSCVS), Turkish Society of Clinical Microbiology and Infectious Diseases (KLIMIK), Turkish Society of Cardiology (TSC), Turkish Society of Nuclear Medicine (TSNM), Turkish Society of Radiology (TSR), Turkish Dental Association (TDA) and Federation of Turkish Pathology Societies (TURKPATH) Cardiovascular System Study Group.

Infective endocarditis (IE) is rare, but associated with significant morbidity and mortality rates. Estimates of the incidence of IE in Turkey are compromised by the absence of population-based prospective studies. Due to the frequent presence of predisposing cardiac conditions and higher rates of nosocomial bacteremia in highrisk groups, the incidence of IE is expected to be higher in Turkey. Additionally, while IE generally affects older people in developed countries, it still affects young people in Turkey. In order to reduce the mortality and morbidity, it is critical to diagnose the IE to determine the causative agent and to start treatment rapidly. However, most of the patients cannot be diagnosed in their first visits, about half of them can be diagnosed after three months, and the disease often goes unnoticed. In patients diagnosed with IE, the rate of identification of causative organisms is significantly lower in Turkey than in developed countries. Furthermore, most of the centers do not perform some essential microbiological diagnostic tests as a routine practice. Some antimicrobials that are recommended as the first-line of treatment for IE, particularly antistaphylococcal penicillins, are not available in Turkey. These problems necessitate reviewing the epidemiological, laboratory, and clinical characteristics of IE in our country, as well as the current information about its diagnosis, treatment, and prevention together with local data. Physicians can follow patients with IE in many specialties. Diagnosis and treatment processes of IE should be standardized at every stage so that management of IE, a setting in which many physicians are involved, can always be in line with current recommendations. Study Group for Infective Endocarditis and Other Cardiovascular Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist organizations to establish a consensus report on the diagnosis, treatment, and prevention of IE in the light of current information and local data in Turkey.

Role of femoral artery ultrasound imaging in cardiovascular event risk prediction in a primary prevention cohort at a medium-term follow-up.

BACKGROUND: Cardiovascular (CV) disease prevention guidelines have addressed how imaging may influence CV risk determined by established risk score systems in primary prevention. Nevertheless, data are lacking regarding the use of femoral artery ultrasonography for CV risk modification. Herein, we hypothesized that femoral artery plaque and its characteristics, as well as femoral intima-media thickness (fIMT) measurements, may predict major adverse cardiovascular events (MACE). METHODS: Subjects free from documented CV disease who were scheduled for coronary computed tomographic angiography at our institution from September 2016-June 2017 were included. IMT measurements and plaque assessment were performed at femoral and carotid arteries. Coronary artery calcium score (CACS) was recorded. Patients were followed-up for MACE. RESULTS: A total of 215 subjects (mean age: 54.85 years, 47.91% male) were eligible. Median number of CV risk factors was 3. Median 10-year atherosclerotic CV disease risk based on Pooled Cohort Equation (PCE) equation was 6.3%. At a median follow-up of 24 months, 9 subjects (4.19%) had MACE. Patients who experienced MACE at follow-up were older (p=0.047), more of male gender (p=0.015), had higher serum creatinine levels despite being within reference limits (p=0.031) and PCE equation risk score (p=0.011). In patients who experienced MACE at follow-up, distal (p=0.027), bifurcation (p=0.007), and proximal carotid IMT (p=0.030) and fIMT (p=0.015) were increased. Surface irregularities and ulceration in femoral artery plaques were more common (p=0.001) and CACS was higher (p<0.001). When adjusted for other subclinical atherosclerosis imaging markers, femoral artery plaque surface irregularities and ulceration and only coronary calcification (without concomitant carotid or femoral atherosclerosis) were found to be independent predictors of MACE at follow-up (both p=0.004). CONCLUSIONS: Our data emphasize that baseline ultrasonographic assessment of the femoral arteries to define plaque characteristics may provide prognostic information for predicting MACE in a primary prevention cohort.

All-trans Retinoic Acid-Induced Isolated Myocarditis: A Case Report and Review of the Literature.

All-trans retinoic acid (ATRA) is the mainstay of treatment in patients with acute promyelocytic leukemia. Despite being effective, it can lead to cardiac complications either as a component of ATRA syndrome or an isolated form denominated as ATRA-induced isolated perimyocarditis. We present a case of this complication and review the literature. (Level of Difficulty: Intermediate.).