The Relationship of Systolic Pulmonary Artery Pressure with Perioperative Mortality and Morbidity in Patients Undergoing Non-Cardiac Surgery: A Single-Center Experience.

OBJECTIVE: Pulmonary hypertension (PH) is associated with adverse perioperative events in patients undergoing non-cardiac surgery. In this study, we aimed to investigate the relationship between systolic pulmonary artery pressure (sPAP), evaluated by transthoracic echocardiography (TTE) before surgery, and perioperative mortality and morbidity in patients who underwent non-cardiac surgery in our center. METHODS: Of the 3425 retrospectively screened patients who underwent non-cardiac surgery, 3049 patients whose estimated sPAP values were previously determined by TTE were included in the study. Patients were classified into 3 groups according to their estimated sPAP levels. sPAP <35 mmHg formed group 1, 35-39 mmHg group 2, and ≥ 40 mmHg group 3. All demographic and perioperative data obtained from the database of our institute were compared in three groups. RESULTS: Of the 3049 patients enrolled in the study, 2406 (78.9%) were in group 1, 259 (8.5%) in group 2, and 384 (12.6%) in group 3. Thirty-day all-cause mortality was observed in 82 (2.7%) patients, cardiac mortality occurred in 9 patients (0.3%). In the group with sPAP ≥40 mmHg, cardiac mortality was 0.5% and all-cause mortality was 7.3%. Thirty-day all-cause mortality, acute pulmonary edema, and acute renal failure were significantly higher in group 3 than in the other groups. Cardiac mortality did not differ significantly between the groups. Age, sPAP value, and chronic obstructive pulmonary disease history were revealed as independent predictors of all-cause mortality in multivariate logistic regression analysis. CONCLUSION: In conclusion, increased sPAP is associated with adverse postoperative outcomes. The evaluation of sPAP with TTE before non-cardiac surgery in patients whose clinical features and examination findings suggest PH may contribute to preoperative risk assessment.

Evaluation of Aortic Elasticity Parameters Measured by Transthoracic Echocardiography in a Normotensive Population: A Single-Center Study.

OBJECTIVE: Impaired arterial elastic features is one of the earliest manifestations of atherosclerosis in the vessel wall and is associated with the development of cardiovascular disease and increased mortality and morbidity. In this study, we aimed to investigate the mean values of aortic elasticity parameters in a normotensive population with transthoracic echocardiography and to evaluate these values in different age groups and their relationship with other risk factors. METHODS: This retrospective study included 405 subjects who met the inclusion criteria among 2880 individuals screened between 2020 and 2022. The study population was divided into 5 groups according to their age. Aortic elasticity parameters (aortic strain, aortic stiffness index, and aortic distensibility) were calculated from the associated formulas by measurements made from the ascending aorta in the parasternal long axis. RESULTS: In 405 subjects (mean age 42.18 ± 10.39, 54.3% female), the mean aortic strain value was 15.14 ± 3.56%, the mean aortic stiffness index was 3.24 ± 1.05, and the mean aortic distensibility was 7.48 ± 2.36 cm2/dyn1/103. It was observed that aortic strain and distensibility values significantly decreased with increasing age groups, while aortic stiffness significantly increased. All 3 aortic elasticity parameters were strongly correlated to age. In the multivariate linear regression analysis, age was found to be an independent factor for all aortic elasticity parameters. CONCLUSION: Aortic elasticity parameters can be evaluated with transthoracic echocardiography in daily practice. Comparing these measurements with normal values in similar age groups may help to detect patients with increased cardiovascular risk in the early period, regardless of the other risk factors.

Relationship between the triglyceride-glucose index and the SYNTAX score 2 in patients with non-ST elevation myocardial infarction.

We evaluated if admissiontriglyceride-glucose index (TyG index) correlated with the anatomical synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score 2 in non-ST elevation myocardial infarction (NSTEMI), nondiabetic patients. Methods: SYNTAX score 2 (SSII) was retrospectively evaluated in 260 nondiabetic patients hospitalized with NSTEMI who underwent coronary angiography. The TyG index was calculated using the following equation: log [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. We stratified patients according to tertiles of SSII (≤21.5, 21.5-30.6, and ≥30.6). These score ranges were defined as SSII low, SSII mid, and SSII high, respectively. Results: The average age of the patients was 57.2 ± 10.9 years; 135 patients (52.2%) were males. The average TyG index was 8.68 ± 0.12, and SSII was 18.9 ± 9.9. A moderate correlation was found between TyG index and SSII (r = 0.347; P < 0.001) and TyG index was independent risk factors for SSII high [odds ratio (OR), 6.0; 95% CI, 2.7-17.0; P < 0.001]. Conclusion: In nondiabetic patients with NSTEMI, TyG index correlated with the SSII.

Effects of iron deficiency on left ventricular functions in young women regardless of anemia: A speckle tracking echocardiography study.

BACKGROUND: Iron deficiency is one of the most common metabolic disorders worldwide and affects multiple organs and systems including the cardiovascular (CV) system. Iron deficiency can cause structural and functional changes in the myocardium. The aim of the study is to evaluate left ventricular (LV) functions in patients with low ferritin levels without anemia by two-dimensional "speckle tracking" echocardiography (2D STE). METHODS: We studied 90 participants (all female) that were divided into two groups according to ferritin levels (49 patients with ferritin levels <30 ng/mL, 41 age-matched controls with >30 ng/mL). Patients with anemia (hemoglobin level <12 g/dL), known CV disease, diabetes mellitus, low ejection fraction (<55%), active infection, high ferritin levels (>200 ng/mL) were excluded. All patients were evaluated by transthoracic echocardiography. In addition to conventional echocardiographic parameters and Doppler measurements, LV global longitudinal strain (GLS) and strain rate (GLSR) were obtained by 2D STE. RESULTS: Mean ferritin level was 18.96 ± 7.29 ng/mL in low ferritin group, and was 61.22 ± 26.14 ng/mL in control group. There were no significant differences according to conventional and Doppler echocardiographic parameters between the groups. LV GLS and GLSR values were significantly lower in low ferritin group comparing with control group (17.31% ± 1.56 and 18.96% ± 1.53, p < 0.001; 0.64 ± 0.13 1/s and 0.81 ± 0.13 1/s, p < 0.001, respectively). There was a significant positive correlation between ferritin levels and LV GLS and GLSR values in study group (r = 0.482, p < 0.001; r = 0.387, p < 0.001, respectively). Ferritin level was also detected as an independent risk factor for GLS value < -18% in logistic regression analysis. In ROC curve analysis, the area under the curve for predicting GLS < -18% was 0.801 (p < 0.001, 95% CI 0.70-0.89) and the threshold of ferritin value was 28.5 ng/mL (sensitivity 76.1%, specificity 77.3%). DISCUSSION: Low ferritin levels can cause subclinical LV systolic dysfunction in patients without anemia. STE provides detailed information about LV functions. With larger studies, these patients should be followed more closely and considered for iron replacement treatment before developing anemia.

Evaluation of pulmonary arterial stiffness and comparison with right ventricular functions in patients with cirrhosis preparing for liver transplantation.

OBJECTIVE: Pulmonary complications are common in patients with liver cirrhosis. Devolopment of pulmonary hypertension (PH) is associated with a poor prognosis in these patients. Pulmonary arterial stiffness (PAS) is considered an early sign of pulmonary vascular remodeling. The aim of this study is to investigate PAS and compare it with right ventricular (RV) functions in patients with cirrhosis who are scheduled for liver transplantation. METHODS: The study included 52 cirrhosis patients (mean age 51.01 ± 12.18 years, male gender 76.9%) who were prepared for liver transplantation and 59 age and sex matched (mean age 51.28 ± 13.63 years, male gender 62.7%) healthy individuals. Patients with left ventricular ejection fraction (LVEF) less than 55%, ischemic heart disease, more than mild valvular heart disease, chronic pulmonary disease, congenital heart disease, rheumatic disease, moderate to high echocardiographic PH probability, rhythm or conduction disorders on electrocardiography were excluded from the study. In addition to conventional echocardiographic parameters, PAS value, pulmonary vascular resistance (PVR) and RV ejection efficiency was calculated by the related formulas with transthoracic echocardiography (TTE). RESULTS: Demographic characteristics and cardiovascular risk factors of the groups were similar. PAS, PVR, and sPAP values were found to be significantly higher in the patient group (20.52 ± 6.52 and 13.73 ± 2.05; 1.43 ± 0.15 and 1.27 ± 0.14; 27.69 ± 3.91 and 23.37 ± 3.81 p < 0.001, respectively). RV FAC and RV Ee were significantly lower and RV MPI was significantly higher in the patient group (45.31 ± 3.85 and 49.66 ± 3.62, p < 0.001; 1.69 ± 0.35 and 1.85 ± 0.23, p = 0.005; 0.39 ± 0.07 and 0.33 ± 0.09, p = 0.001, respectively). PAS was significantly correlated with RV FAC and MPI (r = -0.423, p < 0.001; r = 0.301, p = 0.001, respectively). CONCLUSIONS: Increased PAS in cirrhosis patients may be associated with early pulmonary vascular involvement. Evaluation of RV functions is important to determine the prognosis in these patients. FAC, MPI, and RV Ee measurements instead of TAPSE or RV S' may be more useful in demonstrating subclinical dysfunction. The correlation of PAS with RV FAC and MPI may indicate that RV subclinical dysfunction is associated with early pulmonary vascular remodeling in patients with liver cirrhosis.

Relationship Between Fasting Glucose, HbA1c Levels, and the SYNTAX Score 2 in Patients With Non-ST-Elevation Myocardial Infarction.

We evaluated if admission glycosylated hemoglobin (HbA1c) and fasting glucose levels are correlated with the severity of coronary artery disease (CAD) in non-ST-elevation myocardial infarction (NSTEMI), nondiabetic, patients. Coronary artery disease severity, according to the anatomical synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery (SYNTAX) score 2 (SSII), was retrospectively evaluated in 359 nondiabetic patients hospitalized with NSTEMI who underwent coronary angiography. Glucose intolerance was assessed by serum fasting glucose and HbA1c levels. We stratified patients according to tertiles of SSII (≤21.5, 21.5-30.6, and ≥30.6). These score ranges were defined as SSII low, SSII mid, and SSII high, respectively. The average age of the patients was 57.1 ± 10.9 years; 189 (52.1%) patients were males. The average fasting glucose was 114 ± 52 mg/dL, HbA1c was 5.8% ± 0.9%, and SSII was 18.9 ± 10.3. A stronger correlation was found between HbA1c and SSII than fasting glucose and SSII (r1 = 0.901, P < .001, r2 = 0.378, P < .001, respectively), and HbA1c level and hypertension were independent risk factors for SSII high (odds ratio [OR]: 2.2 (95% CI: 0.5-9.0, P < .001; OR: 1.1 (1.0-1.3), P = .007, respectively). In conclusion, in nondiabetic patients with NSTEMI, HbA1c levels correlated with CAD severity as measured by the SSII.

The Triglyceride-Glucose Index, a Predictor of Insulin Resistance, Is Associated With Subclinical Atherosclerosis.

Insulin resistance is one of the most important risk factors that accelerate atherosclerosis. The goal of this study is to investigate the relationship between the triglyceride glucose (TyG) index and functional vessel disease measured using pulse wave velocity (PWV), in a nondiabetic asymptomatic Turkish population. Nondiabetic, healthy patients (n = 1095) with no previous history of coronary heart disease were enrolled. Functional vessel disease was detected by measuring PWV. The TyG index was calculated using the following equation: log [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The study population was divided into 2 groups based on their TyG index. The high TyG index group had higher PWV, corrected PWV, left ventricular mass index, body mass index, rates of hypertension, and was predominately male. Age, gender, blood urea nitrogen level, and TyG index were detected as independent risk factors of PWV in linear regression analysis. Triglyceride glucose index and age were also independent risk factors of the corrected PWV in logistic regression analysis. These findings show a relationship between TyG index and subclinical vessel disease, even in patients without a history of atherosclerotic cardiovascular disease or diabetes.

Role of dyslipidemia in early vascular aging syndrome

Background/aim: Arterial stiffness, known as a predictor of early vascular aging, was defined as the main determinant of cardiovascular mortality and morbidity. However, the relationship between lipid profile and increased arterial stiffness is not clear. The aim of this study is to investigate the relationship between lipid profiles and increased arterial stiffness in patients with early vascular aging syndrome. Materials and methods: A total of 1582 participants ­504 (31.8%) of were male and the mean age was 52.8 ±14.2 years­ were included in the study . Patients who applied to the hospital for various reasons and who had undergone 24-h blood pressure Holter monitoring were included in this study. Patients were divided into four groups according to pulse wave velocity (PWV) quartiles (Q1 (<6.3), Q2 (6.3­7.4), Q3 (7.5­8.8), Q4 (>8.8)). Results: We found that in the highest PWV group, patients had higher systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, blood urea nitrogen (BUN), creatinine, urinary albumin excretion (UAE), uric acid(UA), total cholesterol (TC), low-density lipoprotein ( LDL-C), triglycerid (TG), and non- high-density lipoprotein (HDL-C ) levels. Additionally, diabetes mellitus (dm), age, non-HDL-C, and TG/ HDL-C levels were detected as independent risk factors of increased PWV in ordinal logistic regression analysis. Conclusion: Our study demonstrates that lipid parameters are strongly correlated with increased PWVvalue and early vascular aging. In daily clinical practice, TG\HDL-C ratio, known as atherogenic index, might be used routinely for predicted of early vascular aging and subclinical atherosclerosis.

Mitral annular calcification and its severity predict high risk for cardio-embolic stroke in elderly patients with first diagnosed atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia worldwide and a large proportion of patients with AF are older than 75 years of age. Mitral annular calcification (MAC), which is usually observed in advanced age, is associated with increased risk of AF and cardio-embolic stroke in the general population. OBJECTIVES: This study was performed to assess whether presence of MAC and its severity predict cardio-embolic stroke in elderly patients with first diagnosed AF. METHODS: In this cross-sectional study, 72 elderly patients suffering from acute cardio-embolic stroke with first diagnosed AF and 79 elderly control group patients with first diagnosed AF and without stroke were investigated. A parasternal short-axis view at the level of the mitral annulus was used for MAC measurements. The severity of MAC was measured from the anterior to posterior edge at its greatest width. RESULTS: MAC thicknesses were significantly higher in the stroke group. ROC curve analysis showed that a cut point of 2.5 mm for the value of MAC thickness exhibited 68.1% sensitivity and 77.2% specificity for detecting cardio-embolic stroke in elderly patients with AF. In multivariate logistic regression analysis, MAC thickness (OR = 1.173, 95% CI 1.083-1.270; p < 0.001) was found to be independent predictor of cardio-embolic stroke in elderly patients with AF. CONCLUSION: MAC thickness may provide useful information for the relevant risk evaluation of elderly patients with AF. Pre-stroke MAC presence and its severity appear to have better clinical value for predicting cardio-embolic stroke in elderly patients with AF, independent from traditional risk factors for stroke.

Understanding Vascular Age: Are Clinical scoring systems useful for Early Vascular Aging Syndrome Prediction ?

INTRODUCTION: Early vascular aging syndrome (EVAS) is defined as increased arterial stiffness compared to age and sex matched patients, EVAS is measured by pulse wave velocity (PWV). AIM: In our study we aim to identify in patients with high risk of EVAS using the CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores. METHODS: The CHADS2, CHA2DS2-VASc-HS and CHADS2VASC scoring systems are advised to determine management strategies in patients with nonvalvular atrial fibrillation. As they contain similar risk factors for the development or presence of EVAS, we believed that this risk scoring system could also be used to predict EVAS. This study was designed as a retrospective observational study. 2108 consecutive patients who had undergone 24-h blood pressure monitoring and measured PWV levels were included in the study. The patients were divided into the two groups according to corrected Pwv values. RESULTS: CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores were positively correlated with PWV values (r =0.251, p < 0.001; r = 0.457, p < 0.001; and r = 0.385, p < 0.001, respectively). CHA2DS2-VASc-HS score was statistically better than CHA2DS2, CHA2DS2-VASc score to predict early vascular aging syndrome (p < 0.001). For the prediction of EVAS, the cut-off value of CHA2DS2-VASc-HS score was ≥ 1.5 with a sensitivity of 49% and a specificity of 50 % (AUC 0.605; 95% [CI] 0.58-0.63) in the ROC curve analyses. CONCLUSIONS: The CHA2DS2-VASc-HS scoring system might be used in daily clinical practice to calculate the total risk assessment of EVAS. This score is relatively simple to use and time-saving technique.

The mid-term effects on quality of life and foot functions following pilon fracture.

BACKGROUND: Although pilon fractures are uncommon, they are of importance to orthopaedic surgeons because of the difficulty of treatment. Poor outcomes and high complication rates are seen despite various surgical methods. This study aims to examine the changes affecting the quality of life and foot functions in patients applied with open reduction and internal fixation (ORIF) for a pilon fracture. METHODS: In this study, a total of 45 patients treated with ORIF for a pilon fracture in our clinic between January 2010 and December 2016 were evaluated with AOFAS and SF-12 in a total of 10 categories according to demographic data, fracture classification and surgical technique. In addition to functional values, patient records were examined regarding complications, including infection, soft-tissue defect, malalignment, non-union, arthrosis and Sudeck atrophy. In patients with AOFAS <85 and low SF-12 scores, variables were examined and the relationship with complications was evaluated. RESULTS: The mean follow-up period was 3.7 years (range 2 to 7). The AOFAS value was determined to fall to <85 when the Ruedi Allgower classification increased (p=0.010), when AO classification increased (p=0.020), when there was a concomitant lateral malleolar fracture (p=0.028), and when the status was non-anatomic according to the Ovadia Bell criteria (p=0.031). The SF-12 PCS value was observed to decrease when the Ruedi Allgower classification increased (p=0.018) and when the status was non-anatomic according to the Ovadia Bell criteria (p=0.012). A correlation was determined between the SF-12 PCS and the AOFAS values (p=0.000). CONCLUSION: The reasons for the failure of ORIF in tibia pilon fractures were found to be Ruedi 3 classification, concomitant lateral malleolar fracture, and non-anatomic surgical reduction. Failure in foot functions has a direct effect on quality of life in both the short and mid term.

Acute hyperglycemia and contrast-induced nephropathy in patients with non-ST elevation myocardial infarction.

Acute hyperglycemia and contrast-induced nephropathy (CIN) are frequently observed in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI), and both are associated with an increased mortality rate. We investigated the possible association between acute hyperglycemia and CIN in patients with NSTEMI undergoing PCI. MATERIALS AND METHODS: We retrospectively enrolled 281(149, 53% men) NSTEMI patients undergoing PCI. For each patient, plasma glucose levels were secreened at hospital admission. Acute hyperglycemia was defined as glucose levels > 198 mg/dl. CIN was defined as an increase in serum creatinine 25% or 0.5 mg/dl from baseline in the first 48-72 hours. RESULTS: Overall, 44 (15.7%) patients had acute hyperglycemia. Patients with acute hyperglycemia had higher incidence of CIN than those without acute hyperglycemia (29.5 vs 5.1%, P < 0.001). Also, in-hospital mortality, length of hospital stay, major bleeding, requirement of mechanical ventilation and dialysis were observed significantly higher in patients with hyperglycemia. Patients were then reallocated to two groups according to the presence or absence of CIN. Overall, 25 cases (8.9%) of CIN were diagnosed. Diabetes mellitus, weight, age, glucose level and estimated glomerular filtration rate (eGFR) were detected as independent risk factors of CIN. Additionally, admission glucose levels were significantly correlated with creatinine levels after PCI, eGFR and contrast volume/eGFR ratio. CONCLUSION: In NSTEMI patients undergoing primary PCI, acute hyperglycemia may be associated with an increased risk for CIN and in-hospital mortality and morbidity.

The relationship between diurnal blood pressure abnormalities and target organ damage in normotensive subjects. Which is more important? Increased blood pressure levels or circadian blood pressure abnormalities.

Objective: Circadian blood pressure (CBP) abnormalities are well-known risk factors for many diseases such as cardiovascular, cerebrovascular, and chronic kidney disease. The object of this study was to evaluate the relationship between abnormalities in CBP rhythm and target organ damage (TOD) in normotensive non-dipper (non-DP) subjects.Methods: The 24-h ambulatory BP monitoring (ABPM) and echocardiography were performed and urinary albumin excretion (UAE) was measured in 127 normotensive dipper (DP) (42 males, 85 females) and 337 (89 males, 248 females) normotensive non-DP subjects.Results: When we compared DP and non-DP subjects; Pulse wave velocity (PWV) (7.12 ± 1.72 vs 7.57 ± 1.87 m/s, p = 0.02), the percentile of corrected PWV (cPWV) (7.1 vs. 20.2, p= 0.001) and the percentile of corrected augmentation index (cAIx) (23.5 vs. 33.9, p = 0.03), left ventricle mass index (LVMI) (78.00 ± 23.27 vs. 95.59 ± 18.29 g/m2, p = 0.01), relative wall thickness (RWT)(0.36 ± 0.13 vs 0.46 ± 0.09, p = 0.01), percentile of proteinuria (8.6 vs 29.2%, p = 0.00) were higher in non-DP group. In the correlation analyses, the PWV, LVMI, RWT were negatively correlated with the rate of systolic fall in nighttime (%)(-0.15, p = 0.01 vs. -0.23, p = 0.02 vs. -0.27, p = 0.00). It was observed that cPWV, cAIx, and UAE were independently associated with age and non-DP status (NDS), in logistic regression analysis.Conclusions: Our results suggested that normotensive persons with CBP abnormalities had TOD. In light of the data of this article, non-dipper status is detected in the early period and if the provision of diurnal blood pressure rhythm may reduce the incidence of future adverse events in nondipper normotensive subjects.

CHA2DS2-VASC Score Predicts Risk of Contrast-Induced Nephropathy in Non-ST Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Interventions.

BACKROUND: The CHA2DS2-VASC score, used for embolic risk stratification in atrial fibrillation, has been reported recently to predict adverse clinical outcomes in patients with coronary artery disease. We investigated the correlation between the CHA2DS2-VASC score and contrast-induced nephropathy (CIN) in patients with non-ST elevation myocardial infarction (NSTEMI) who underwent percutaneous coronary intervention (PCI). METHODS: We retrospectively enrolled 363 (191; 52.6% men) NSTEMI patients undergoing PCI. The CHA2 DS2-VASC score was calculated for each patient, and the study population was divided into 2 groups: CHA2DS2-VASC score <2 group (low score; n = 259, 71.3%) and CHA2DS2-VASC score ≥2 group (high score; n = 104, 28.6%). Patients were then reallocated to 2 groups according to the presence or absence of CIN. CIN was defined as a rise in serum creatinine >0.5 mg/dL or >25% increase in baseline within 72 h after PCI. RESULTS: Overall, 56 cases (15.4%) of CIN were diagnosed. When patients with a CHA2DS2-VASC score of <2 were compared with those with a CHA2DS2-VASC score of ≥2, patients with a high score had a higher frequency of CIN (33) 31.7% versus (23) 8.9%; p < 0.001. Also patients with CIN had higher CHADS2 VASC score (3.94 ± 1.13 vs. 1.68 ± 0.46, p < 0.001). Additionally, in-hospital mortality, length of hospital stay, major bleeding, requirement of mechanical ventilation, and dialysis were observed significantly higher in patients with CHA2DS2-VASC score of ≥2 (p = 0.001, p = 0.002, p = 0.006, p = 0.001, p = 0.001, respectively). In receiver operating characteristic curve analysis, the area under the curve for predicting CIN was 0.702 (p < 0.001, 95% CI 0.617-0.787) and cutoff value was 2.5 (sensitivity 58.9%, specificity 76.9%) for the number of CHA2DS2-VASC score. CONCLUSION: In NSTEMI patients undergoing PCI, CHADS2 VASC score is associated with an increased risk for CIN and in-hospital morbidity and mortality.

Reference pulse wave velocity values in a healthy, normotensive Turkish population.

OBJECTIVE: Pulse wave velocity (PWV) is the primary determiner of arterial stiffness. In daily practice, the normal range of arterial stiffness is based on large multi-center studies conducted in the USA, Europe, Asia, and Australia. The goal of this study was to identify the reference values of brachial PWV in a healthy, normotensive Turkish population with no cardiovascular risk factors. METHODS: This retrospective study involved healthy, adult Turkish participants from Ankara. A total of 353 consecutive, normotensive individuals were enrolled in the study between September 2017 and January 2018 according to strict inclusion criteria, Normal PWV and 95% confidence interval values were acquired for 353 patients (mean age: 55.03±15.38 years; range: 20-95 years) who were divided into 6 age groups. RESULTS: The mean PWV was 7.75±1.89 m/s (range: 4.25- 15.90 m/s). The PWV had a positive linear correlation with age (r2=0.94; p=0.00). The PWV increased gradually by an average of 5% to 9% with each decade of life until the age of 50 years, after which the average PWV increased by 16%. CONCLUSION: To the best of our knowledge, this study is the first to define PWV reference values via brachial measurement in a healthy, normotensive Turkish population. These data provide important information for daily clinical practice in Turkey.

Anterior myocardial infarction in a patient with isolated left ventricular non-compaction.

We presented a 55-year-old male patient with isolated left ventricular non-compaction who was admitted to our emergency department for chest pain and exertional dyspnoea. He was hospitalised due to anterior myocardial infarction, and during his assessment, isolated left ventricular non-compaction was diagnosed.

Hyperhomocysteinemia Predicts the Severity of Coronary Artery Disease as Determined by the SYNTAX Score in Patients with Acute Coronary Syndrome.

BACKGROUND: Hyperhomocysteinemia is a known risk factor for acute coronary syndrome (ACS) and is related with the severity of coronary artery disease (CAD). Previous studies have used less quantifiable scoring systems for assessing the severity of CAD. Therefore, we aimed to assess the relationship between homocysteine levels and SYNTAX score (SXscore), which is currently more widely used to grade the severity of CAD. METHODS: A total of 503 patients with adiagnosis of ACS were examined angiographically with SXscore. The patients were divided into three groups according to SXscore; Group 1 a low SXscore (≤ 22), Group 2 a moderate SXscore (23-32), and Group 3 a high SXscore (≥ 33). RESULTS: Plasma homocysteine levels were 16.3 ± 6.2 nmol/mL in Group 1, 18.1 ± 9.6 nmol/mL in Group 2, and 19.9 ± 9.5 nmol/mL in Group 3. Homocysteine levels were significantly higher in Group 2, and Group 3 compared to Group 1 (p = 0.023 and 0.007, respectively). In the correlation analysis, homocysteine levels were correlated with SXscore (r: 0.166, p < 0.01). CONCLUSIONS: Serum homocysteine levels on admission were associated with an increased severity of CAD in the patients with ACS.

The relationship between lymphocyte-to-monocyte ratio and saphenous vein graft patency in patients with coronary artery bypass graft.

AIM: A lower lymphocyte count and a high monocyte count give important clues about the prognosis of various cardiovascular diseases. We hypothesized that lymphocyte-to-monocyte ratio (LMR) was associated with the saphenous vein graft disease (SVGD) in patients with coronary artery bypass graft (CABG). PATIENTS & METHODS: A total of 218 patients with previous history of CABG surgery, who underwent coronary angiography due to stable angina symptoms, were investigated, retrospectively. RESULTS: LMR levels were significantly lower in the SVGD group. Multiple logistic regression analyses showed that LMR levels were independent predictors of SVGD (OR: 0.648; 95% CI: 0.469-0.894; p = 0.008). CONCLUSION: Our results suggested that LMR levels may provide useful information for the relevant risk evaluation of SVGD in CABG patients.

Percutaneous treatment of a superior mesenteric artery pseudoaneurysm and arteriovenous fistula with coil embolization: a case report.

Visceral artery pseudoaneurysm and arteriovenous fistula following penetrating abdominal injuries is a rarely observed complication. Presently described is the case of a 44-year-old male admitted to the hospital after having previously experienced penetrating abdominal trauma. The patient had developed a pseudoaneurysm in the superior mesenteric artery and an arteriovenous fistula between the superior mesenteric artery and vein following surgery. The patient underwent successful coil embolization procedure and he was discharged 1 day after intervention.