Prognostic Value of Nutritional Indexes in Evaluating the 1-Year Results after Implantation of the Carillon Mitral Contour System.

Background: The prognostic importance of nutritional indexes has been shown in some diseases. We aimed to examine the prognostic value of these indexes in patients implanted with the Carillon Mitral Contour System (CMCS). Methods: Fifty-four patients who underwent successful CMCS implantation were evaluated. Prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI) and controlling nutritional status (CONUT) scores were calculated. The relationships between these indexes and 1-year clinical outcomes including all-cause mortality and re-hospitalization due to heart failure were investigated. Results: In Kaplan-Meier analysis, 1-year all-cause mortality rates were significantly higher in the patients with low PNI and GNRI and high CONUT scores (52.0% vs. 0%, p < 0.001; 54.2% vs. 0%, p < 0.001; 52.4%, 6.1%, p < 0.001; respectively). For the composite endpoint, a significant difference was observed between those below and above the cut-off values (70.0% vs. 16.7%, p < 0.001; 75.0% vs. 23.3%, p < 0.001; 66.7% vs. 20.8%, p < 0.001, respectively). In multivariate Cox regression analysis, GNRI was determined to be an independent predictor of 1-year all-cause mortality [hazard ratio: 0.707; 95% confidence interval: 0.510-0.979; p = 0.037]. Conclusions: Nutritional indexes have prognostic value in predicting 1-year all-cause mortality in severe functional mitral regurgitation patients undergoing CMCS implantation. In particular, GNRI can guide the selection of patients who will benefit from CMCS.

Caseous calcification of the mitral annulus; scary image during robotic surgery.

Caseous calcification of the mitral annulus (CCMA) is a very rare form of mitral annular calcification (MAC). CCMA accounts for 0.63% of all cases and 0.06-0.07% of the total population and usually seen in elderly and female patients. It mostly affects the posterior leaflet of the mitral valve. The pathogenesis of CCMA remains unclear. Hypercholesterolemia and the dissolution of lipid-laden macrophages may be implicated in liquefaction necrosis. CCMA is composed of a mixture of calcium, fatty acid, and cholesterol. The name "caseous" comes from the cheese-like or toothpaste-like consistency of the mass. Cardiac magnetic resonance imaging may help in differentiating MAC from CCMA and should perform. The first treatment option should be conservative treatment because of surgical complications of the procedure. We presented a case report which is about CCMA with preoperative and intraoperative robotic images.

The Value of Frontal Planar QRS-T Angle in Patients without Angiographically Apparent Atherosclerosis.

OBJECTIVE: The present study was undertaken to investigate the prognostic value of the frontal planar QRS-T angle in patients without angiographically apparent coronary atherosclerosis. SUBJECTS AND METHODS: Three hundred and seven patients with normal coronary arteries on coronary angiography were included. The absolute difference between the frontal QRS- and T-wave axes was defined as the frontal planar QRS-T angle, and patients were divided into 3 subgroups based on the frontal planar QRS-T angle (<45, 45-90, and >90°). Demographic, clinical, laboratory, and angiographic data were compared between groups. Based on the regression analysis results, patients were recategorized into 4 groups according to their luminal calibers of left main coronary artery (LMCA) and history of hypertension (HT) (nonhypertensive LMCA ≤4.13 mm, nonhypertensive LMCA >4.13 mm, hypertensive LMCA ≤4.13 mm, and hypertensive LMCA >4.13 mm). RESULTS: The median value of the frontal planar QRS-T angle of all participants was 38°. Subjects with the widest frontal planar QRS-T angle were older (p = 0.027), were hypertensive (p = 0.001), and had higher corrected QT values (p = 0.001). Patients with the widest frontal planar QRS-T angle had larger LMCA and left anterior descending coronary artery diameters compared to subjects with a normal and borderline frontal QRS-T angle (p = 0.004 and p = 0.028, respectively). Corrected QT, HT, and LMCA diameter were found as independent predictors of the frontal planar QRS-T angle. Subjects with HT and a larger luminal caliber of LMCA had the widest frontal planar QRS-T angle. CONCLUSION: Patients with a history of HT and a larger luminal caliber of LMCA had the widest frontal planar QRS-T angle. Since HT-induced electrophysiological changes are still not well established and we observed that changes in the luminal caliber of coronary arteries are associated with an abnormal frontal QRS-T angle, the frontal QRS-T angle could serve as a marker of ventricular repolarization heterogeneity in hypertensive patients in addition to keeping track of arrhythmic events, even before overt disease.

The effect of age on right ventricular diastolic function in healthy subjects undergoing treadmill exercise test.

OBJECTIVE: There is an increasing interest for the value of right ventricle (RV) in predicting exercise tolerance and prognosis in cardiovascular disease. However, there is relatively few data evaluating the effect of age on RV diastolic filling velocities during rest or exercise in healthy subjects. METHODS: A total of 54 healthy subjects were enrolled in this study. Patients were divided into 2 groups according to their age: Group 1 (≤45-years-old) and Group 2 (>45-years-old). A treadmill exercise test was performed using modified Bruce protocol. Conventional pulsed-wave Doppler and tissue Doppler velocities were obtained both at rest and immediately after the end of exercise, respectively. RESULTS: In the overall analysis, tricuspid flow Doppler analysis showed a significant increase in A-wave velocity, less marked rise in E-wave velocity, decreased E/A ratio and decreased E-wave deceleration time (EDT) with exercise. Tissue Doppler analysis revealed increased Aa velocity, decreased in Ea/Aa ratio and IVRT. No significant change was observed in Ea velocity and E/Ea ratio with exercise. Although diastolic velocities changed significantly with exercise, systolic velocities did not. Cardiac response to exercise differed slightly in the older subjects compared to younger ones. The older subjects were more likely to have a reduced mean rate of RV filling for the second half of diastole from baseline to peak exercise. CONCLUSION: To distinguish normal physiological changes due to aging from those of pathologic conditions may provide benefits while evaluating patients with known or suspected cardiovascular disease.

Increased serum uric acid levels are correlated with decreased left atrial appendage peak flow velocity in patients with atrial fibrillation.

OBJECTIVE: We aimed to examine the relationship between serum uric acid levels and left atrial appendage (LAA) peak flow velocity, an indicator of the mechanical functions of the LAA, and atrial fibrillation (AF). SUBJECTS AND METHODS: Transesophageal echocardiography was performed before cardioversion in 153 patients with AF. The patients were categorized into 2 groups based on their LAA blood flow velocity. Group 1 included 87 patients with a low LAA flow velocity (<35 cm/s), and group 2 comprised 66 patients with a normal LAA flow velocity (≥35 cm/s). The χ(2) and Student's t tests were used to compare categorical and quantitative data between the groups. Linear regression analyses were performed to demonstrate the independent association between serum uric acid levels and LAA peak flow velocity. RESULTS: The LAA blood flow velocity was 24.62 ± 5.90 cm/s in group 1 and 49.28 ± 13.72 cm/s in group 2, respectively (p < 0.001). The serum uric acid levels were 6.88 ± 1.85 mg/dl in group 1 and 5.97 ± 1.51 mg/dl in group 2, and the difference was statistically significant (p = 0.001). There was a negative correlation between serum uric acid levels and LAA blood flow velocity (r = -0.216, p = 0.007). Multivariate regression analysis showed that serum uric acid levels, age and gender differences were significant predictors of the LAA peak flow velocity. CONCLUSIONS: High serum uric acid levels were associated with a low contractile function of the LAA and could provide additional prognostic information on future thromboembolic events in patients with AF.

Elasticity properties of pulmonary artery in patients with bicuspid aortic valve.

OBJECTIVE: Although the vascular complications of bicuspid aortic valve (BAV) disease cause significant morbidity and mortality, the role of pulmonary artery in this pathogenesis is less understood. We aimed to assess the elastic properties of pulmonary artery with echocardiography in patients with BAV. MATERIAL AND METHODS: Thirty patients with BAV (26 males) were enrolled in this study. The presence of aortic stenosis was accepted as exclusion criteria. Thirty-two healthy subjects (27 males) with no any history of cardiovascular disease comprised the control group. In all patients, maximal frequency shift (MFS) and acceleration time (AcT) of the pulmonary artery flow trace were measured echocardiographically in parasternal short-axis view. Subsequently, pulmonary artery stiffness (PAS) was calculated by using the following formula PAS (kHz/sec) = MFS/AcT. RESULTS: There were no significant differences in baseline demographic characteristics of the study population. Aortic strain and aortic distensibility index were lower, and aortic stiffness index (SI) higher, in patients with BAV. The PAS was significantly increased in patients with BAV compared with control subjects with tricuspid aortic valve (11.08 ± 2.27 vs. 7.11 ± 1.54, P < 0.001). There was a significant correlation between aortic diameters, aortic elasticity indexes, and PAS. Multivariate linear regression analysis, the only significant independent factor affecting the PAS was SI (ß = 0.547, P < 0.001). CONCLUSION: We demonstrated that elastic properties of pulmonary artery tend to be impaired as in the aorta in patients with BAV disease.

Mitral-Tricuspid Regurgitation Change After Transcatheter Aortic Valve Implantation and Its Effect on Mortality and Hospitalization.

OBJECTIVE: Moderate to severe mitral regurgitation (MR) and tricuspid regurgitation (TR) are present in approximately 20-60% of patients undergoing transcatheter aortic valve implantation (TAVI). This study aims to evaluate the impact of TAVI on MR and TR, pulmonary hypertension, and reverse cardiac remodeling in these patients.  Methods: Out of 240 patients who underwent TAVI, 79 who met the inclusion and exclusion criteria were analyzed. RESULTS: In our study, 46.8% (n = 37) of the patients were male. Nineteen (24.1%) patients died within two years. Before TAVI, 34 (43%) patients had moderate-to-severe MR, which decreased to 18 (22.7%) after the procedure (P < 0.05). Similarly, the number of patients with moderate-to-severe TR decreased from 26 (32.9%) before TAVI to 12 (15%) after the procedure (P < 0.05). Of the patients, 50.6% (n = 40) did not require hospitalization after the procedure, while 25 were hospitalized once, 12 twice, and 2 three times. The mean systolic pulmonary artery pressure (sPAP) values of the patients decreased from 44.30 ± 14.42 mmHg before the procedure to 39.09 ± 11.77 mmHg after the procedure (Z=-3.506, P < 0.001). No correlation was found between changes in MR and TR grades after TAVI and mortality or hospitalization during follow-up. Furthermore, there was no statistically significant difference in tricuspid annular plane systolic excursion (TAPSE), free wall annular S' velocity, left atrial volume (LAV), or LAV index (LAVI) before and after TAVI.  Conclusion: There was a significant decrease in moderate-to-severe MR and TR after TAVI; however, this did not impact hospitalization or mortality rates. Additionally, no significant differences were observed in right ventricular systolic function or in LAV and LAVI before and after TAVI.

Endovascular Repair of Ruptured Aortic Aneurysm: A Single-Center Experience.

OBJECTIVE: Aortic rupture is a rare and catastrophic emergency. Prompt diagnosis and treatment are the primary determinants of mortality. During follow-up, the majority of patients who have been effectively treated die from hypovolemic shock and multiorgan failure. This article describes the clinical and procedural details of sixteen patients with ruptured aortic aneurysms treated endovascularly. In addition, it discusses the main factors contributing to the mortality of these patients. METHOD: Patients who underwent endovascular treatment for acute aortic rupture at our center from October 2016 to March 2023 were included in this retrospective study. RESULTS: A total of 16 patients underwent endovascular aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) for acute aortic rupture. The patients' mean age was 73.06 years (range: 52-92), and 15 of them were male. The ruptures occurred in the abdominal aortic aneurysm in ten patients, in thoracic aortic aneurysm in three patients, in the isolated iliac artery aneurysm in two patients, and there was one case of non-aneurysmal aortic rupture. In our series, patients who presented with an impending, self-limited rupture and stable hemodynamic status had good prognostic outcomes. However, eight patients died due to multiorgan failure, hemorrhagic shock, disseminated intravascular coagulopathy, renal failure, or abdominal compartment syndrome. These patients generally had poor admission vital signs and low hemoglobin values. The most critical determinants for the success of the procedure are promptly stopping the bleeding, avoiding general anesthesia, and opting for blood product replacement instead of fluid replacement. CONCLUSION: Each patient with ruptured aortic aneurysm should be managed according to the patient's hemodynamics at presentation, the size of the aneurysm, the suitability for percutaneous procedure, logistical factors, and the operator-center's experience.

[Retrieval of embolized coronary stent: combination of various approaches]. / Embolize olan bir koroner stentin çikarilmasi: Degisik yaklasimlarin kombinasyonu.

Device embolization is a potentially serious complication of percutaneous vascular interventions. Various devices and techniques can be used for the retrieval procedure. Herein, we report the retrieval of a stent that slipped off the balloon in the left main coronary artery and then embolized to the right femoral artery in a 77-year-old male. The stent could not be retrieved by snare, but was removed from the coronary tree via a balloon advanced inside it. The stent then embolized into the right femoral artery. Using a balloon catheter advanced through the stent and then via a biopsy forceps advanced over a femoro-femoral wire loop, we were able to remove the stent from the patient. In conclusion, there is no proven standard method for the retrieval of embolized material. Different techniques and devices can be used depending on the creativity of the operator as well as the individual situation of the case.

Endovascular Therapy of Aortic Rupture Secondary to a Psoas Abscess.

Secondary infection of the aorta is a sporadic and life-threatening disease. It is usually caused by infection and abscess in an adjacent structure. The most common mechanism for secondary aortic infection is a psoas abscess eroding the aortic wall, which rarely results in non-aneurysmal aortic rupture. Primary treatment is surgical aortic reconstruction, but the risk of emergency surgical treatment is high. Endovascular aortic stent-graft implantation can be lifesaving in this setting by stopping the bleeding. However, the crucial question of durability and late infections remains unanswered and warrants long-term antibiotic treatment and follow-up. In this report, we present a case of primary psoas abscess, which resulted in non-aneurysmal aortic rupture and its endovascular treatment.

Statin adherence in patients with high cardiovascular risk: a cross-sectional study.

OBJECTIVES: Statin adherence is an essential problem although lifetime medication is recommended especially in patients with high cardiovascular risk. The importance of perceived risk as a predictor of adherence among cardiology patients has not been fully explored. This study aimed to test the importance of perceived risk as a predictor of statin adherence amongst hypercholesterolemic patients to identify predictors associated with poor adherence. METHODS: This cross-sectional study was conducted at cardiology outpatient clinics of the University hospital in Ankara, Turkey. A total of 327 consecutive patients with high CV risk were recruited. Self-reported Morisky Green Levine Medication Adherence Scale was used to assess statin adherence. RESULTS: Of the patients studied, 34.5% had concerns about side effects. Also, the mean age was 63.85 ± 11.29 years, 66.1% were men, 32.4% applied non-drug alternative therapies, 53.2% had a Mediterranean-style diet and 20.8% checked their lipid values irregularly. Participants reported 50.2% high, 30% moderate, and 19.9% low statin medication adherence. Low-density lipoprotein cholesterol (LDL-C), Total Cholesterol (TC), Triglyceride (TG) and high-density lipoprotein (HDL) control rates were 44.6%, 74.3%, 61.5% and 41.6%. On multiple logistic regression, concern about side effects was associated with a statistically significant quadruple elevation of odds of non-adherence. Also, being male, former smokers, not having complementary interventions, having regular visits, being educated for more than 5 years, having low depressive symptom scores, living in a rural, being never or former smokers, employee were significant predictors of high medication adherence scores. CONCLUSION: Approximately half of the patients reported high medication adherence. Proper strategies to improve adherence would include patient education efforts focused on patients with concerns about side effects and those who are female, less educated, current smokers, interested in complementary interventions, have irregular follow-up visits, and have depressive symptoms. Brief medication adherence scales may facilitate the assessment of patients' adherence.

Atrial and ventricular arrhythmia predictors with electrocardiographic parameters in myocardial infarction with non-obstructive coronary artery disease (MINOCA).

BACKGROUND: The clinical importance and recognition of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasing. Nevertheless, no studies are investigating the risk of atrial fibrillation and ventricular arrhythmia in MINOCA patients. This study aimed to determine the risk of arrhythmia with electrocardiographic predictors in MINOCA patients. METHODS: In this study, patients diagnosed with MINOCA and stable out-patients without significant lesions in their coronary arteries were compared. Morphology-voltage-Pwave duration electrocardiography (MPV ECG) score was used to determine atrial arrhythmia risk. QT interval and QT dispersion Tpeak-Tend time and Tpeak-Tend/QT interval were used to determine ventricular arrhythmia risk. RESULTS: A total of 155 patients were included in our study. Seventy-seven of these patients were in the MINOCA group. There was no statistically significant difference between the two groups in MPV ECG score (1.95 ± 1.03 vs 1.68 ± 1.14, p = 0.128). P-wave voltage, P-wave morphology and P-wave duration, which are components of the MPV ECG score, were not statistically significantly different. The QRS complex duration (90.21 ± 14.87 vs 82.99 ± 21.59 ms, p = 0.017), ST interval (271.95 ± 45.91 vs 302.31 ± 38.40 ms, p < 0.001), corrected QT interval (438.17 ± 43.80 vs 421.41 ± 28.39, p = 0.005) and QT dispersion (60.75 ± 22.77 vs 34.19 ± 12.95, p < 0.001) were statistically significantly higher in the MINOCA group. The Tpeak-Tend (89.53 ± 32.16 vs 65.22 ± 18.11, p < 0.001), Tpeak-Tend/QT interval (0.2306 ± 0.0813 vs 0.1676 ± 0.0470, p < 0.001) and Tpeak-Tend/corrected QT interval (0.2043 ± 0.6997 vs 0.1551 ± 0.4310, p < 0.001) ratios were also significantly higher in patients with MINOCA. CONCLUSIONS: In the MINOCA patients, there was no increase in the risk of atrial fibrillation based on ECG predictors. However, it was shown that there could be a significant increase in the risk of ventricular arrhythmia. We believe this study could be helpful for specific recommendations concerning duration of hospitalisation and follow up in MINOCA patients.

Evaluation of the Transcatheter Aortic Valve Replacement Results in Patients with Borderline Aortic Annulus and the Impact of Under- or Oversizing the Valve.

BACKGROUND: Optimal valve sizing provides improved results in transcatheter aortic valve replacement. Operators hesitate about the valve size when the annulus measurements fall into borderline area. Our purpose was to compare the results of borderline versus non-borderline annulus and to understand the impact of valve type and under or oversizing. METHODS: Data from 338 consecutive transcatheter aortic valve replacement procedures were analyzed. The study population was divided into 2 groups as 'borderline annulus' and 'non-borderline annulus.' Balloon expandable valves already have a grey zone definition. Similar to balloon expandable valves, annulus sizes that are within 15% above or below the upper or lower limit of a particular self-expandable valve size are defined as the 'borderline annulus' for self-expandable valves. The borderline annulus group was also divided into 2 subgroups according to the smaller or larger valve selection as 'undersizing' and 'oversizing.' Comparisons were made regarding the paravalvular leakage and residual transvalvular gradient. RESULTS: Of these 338 patients, 102 (30.1%) had a borderline and 226 (69.9%) had a non-borderline annulus. Both the transvalvular gradient (17.81 ± 7.15 vs. 14.44 ± 6.27) and the frequency of paravalvular leakage (for mild, mild to moderate, and moderate, 40.2%, 11.8%, and 2.9% vs., 18.8%, 6.7%, and 0.4%, respectively) were significantly higher in the borderline annulus than the non-borderline annulus group (P <.001). There were no significant differences between the groups balloon expandable versus self-expandable valves and oversizing versus undersizing regarding the transvalvular gradient and paravalvular leakage in patients with borderline annulus (P >.05). CONCLUSION: Regardless of the valve type and oversizing or undersizing, borderline annulus is related to significantly higher transvalvular gradient and paravalvular leakage when compared to the non-borderline annulus in transcatheter aortic valve replacement.

The Definition of Sarcomeric and Non-Sarcomeric Gene Mutations in Hypertrophic Cardiomyopathy Patients: A Multicenter Diagnostic Study Across Türkiye.

BACKGROUND: Hypertrophic cardiomyopathy is a common genetic heart disease and up to 40%-60% of patients have mutations in cardiac sarcomere protein genes. This genetic diagnosis study aimed to detect pathogenic or likely pathogenic sarcomeric and non-sarcomeric gene mutations and to confirm a final molecular diagnosis in patients diagnosed with hypertrophic cardiomyopathy. METHODS: A total of 392 patients with hypertrophic cardiomyopathy were included in this nationwide multicenter study conducted at 23 centers across Türkiye. All samples were analyzed with a 17-gene hypertrophic cardiomyopathy panel using next-generation sequencing technology. The gene panel includes ACTC1, DES, FLNC, GLA, LAMP2, MYBPC3, MYH7, MYL2, MYL3, PLN, PRKAG2, PTPN11, TNNC1, TNNI3, TNNT2, TPM1, and TTR genes. RESULTS: The next-generation sequencing panel identified positive genetic variants (variants of unknown significance, likely pathogenic or pathogenic) in 12 genes for 121 of 392 samples, including sarcomeric gene mutations in 30.4% (119/392) of samples tested, galactosidase alpha variants in 0.5% (2/392) of samples and TTR variant in 0.025% (1/392). The likely pathogenic or pathogenic variants identified in 69 (57.0%) of 121 positive samples yielded a confirmed molecular diagnosis. The diagnostic yield was 17.1% (15.8% for hypertrophic cardiomyopathy variants) for hypertrophic cardiomyopathy and hypertrophic cardiomyopathy phenocopies and 0.5% for Fabry disease. CONCLUSIONS: Our study showed that the distribution of genetic mutations, the prevalence of Fabry disease, and TTR amyloidosis in the Turkish population diagnosed with hypertrophic cardiomyopathy were similar to the other populations, but the percentage of sarcomeric gene mutations was slightly lower.

The impact of mitral stenosis on left atrial function assessed by two-dimensional speckle tracking echocardiography.

AIMS: The aim of this study is to investigate the effect of mitral stenosis (MS) on left atrial (LA) function using two-dimensional speckle tracking echocardiography (2DSTE). METHODS AND RESULTS: The study subjects consisted of 52 patients with asymptomatic MS and 52 control subjects. LA function was assessed using prototype speckle tracking software and manual tracking method. Maximal LA volume (LAVmax) and minimal LA volume (LAVmin) and LA volume before atrial contraction (LAVpre-a) were measured. Using these volumes, LA reservoir, conduit and booster pump fuction parameters were calculated. Indexed LAVmax, LAVmin, and LAVpre-a measurements via speckle tracking were highly correlated with manual tracing methods in both groups. Expansion index (67.8 ± 36.4 vs. 148.3 ± 44.2), diastolic emptying index (37.7 ± 12.9 vs. 58.0 ± 8.5), passive emptying (37.3 ± 14.1 vs. 70.4 ± 10.4) and passive emptying index (13.3 ± 6.3 vs. 41.3 ± 10.6) were decreased significantly in MS patients (P < 0.001). In contrast active emptying index (62.6 ± 4.1 vs. 29.5 ± 10.1) increased in MS group (P < 0.001) while active emptying (28.1 ± 13.0 vs. 28.3 ± 6.9) remained same among both groups. CONCLUSIONS: This is the first study relating LA volumes and function assessed by 2DSTE to MS. 2D speckle tracking analysis of LA volume is relatively easy and provides more detailed information regarding the changes in LA volumes during the cardiac cycle.

The Relationship Between Sexual Activity and Heart Rate Variability in Menopausal Women.

BACKGROUND: Menopause is an important life stage for women, which can bring along sex- ual and cardiac problems. Increased heart rate variability is an indicator of parasympa- thetic activity and is associated with mental and physical health and life expectancy. This study aimed to evaluate the effect of sexual activity (only penile-vaginal intercourse but not masturbation or non-coital sex with a partner) on heart rate variability in healthy menopausal women. METHODS: We evaluated 130 menopausal patients aged 45-60 years, without chronic dis- ease. The average weekly sexual activity numbers remembered in the last 1 year were questioned. The patients were divided into 2 groups according to the presence of sexual activity. The sexually active group was divided into subgroups as 1 per week and 2 or more per week. Menopause Rating Scale was applied for menopausal symptoms. Heart rate variability was analyzed from the 24-hour electrocardiography Holter recording. RESULTS: Heart rate variability parameters were higher in the sexually active group than in the sexually inactive group (mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording: P = .004; root mean square of differences between adjacent normal RR intervals, expressed in ms: P=.001; number of NN intervals exceeding 50 milliseconds: P = .011; percentage of adjacent RR intervals with a difference of duration >50 ms: P = .009; low frequency: P = .011; high fre- quency: P=.008, low frequency/high frequency: P=.018). When assessed by multiple linear regression analysis by adjusting for age, body mass index, and menopause dura- tion, the variables mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording, root mean square of differences between adjacent normal RR intervals, expressed in ms, and low frequency were inde- pendently associated with the number of sexual activities per week (B = 2.89 ± 1.02, 95% CI = 0.866-4.91, P = .005; B = 4.57 ± 1.83, 95% CI = 0.94-8.2, P = .014; and B = 1174.9 ± 592.2, 95% CI = 2.9-2346.9, P = .049, respectively). CONCLUSION: In healthy menopausal women, continued sexual activity with penile-vagi- nal intercourse is associated with better health outcomes on cardiac autonomic function through higher heart rate variability, an index of parasympathetic activity.

Comprehensive assessment of Mahaim accessory pathways' anatomic distribution.

OBJECTIVE: To present the authors' experience of Mahaim-type accessory pathways (MAPs), focusing on anatomic localizations. METHODS: Data from consecutive patients who underwent electrophysiological study (EPS) for MAP ablation in two tertiary centres, between January 1998 and June 2020, were retrospectively analysed. RESULTS: Of the 55 included patients, 27 (49.1%) were male, and the overall mean age was 29.5 ± 11.6 years (range, 12-66 years). MAPs were ablated at the tricuspid annulus in 43 patients (78.2%), mitral annulus in four patients (7.3%), paraseptal region in three patients (5.5%), and right ventricle mid-apical region in five patients (9.1%). Among 49 patients who planned for ablation therapy, the success rate was 91.8% (45 patients). CONCLUSION: MAPs were most often ablated at the lateral aspect of the tricuspid annuli, sometimes at other sides of the tricuspid and mitral annuli, and infrequently in the right ventricle. The M potential mapping technique is likely to be a useful target for ablation of MAPs.

Percutaneous closure of a postero-medial mitral paravalvular leak: the triple telescopic system.

Paravalvular leaks (PVLs) still remain as a serious complication of heart valve surgery. The reported incidence of PVL is ∼ 3-12.5% and most of them become clinically manifest as worsening heart failure, hemolysis, and arrhythmias within the first 6 months. Surgical intervention is recommended for symptomatic patients, but high-operative risk associated with the repeat procedures frequently prohibits the redo surgery for the older patients with multiple severe comorbidities. In view of the limitations of surgery, percutaneous closure techniques have been applied to PVLs with considerable achievement. However, the technique is still challenging due to the lack of specifically engineered instruments for the procedure and requires considerable operator expertise. In this case report, we presented a case of posteromedial mitral PVL, which was successfully closed using an innovative telescopic catheter system involving three different catheters.

Circadian variation of acute st segment elevation myocardial infarction by anatomic location in a Turkish cohort.

BACKGROUND: To evaluate the relationship between site of infarction (anterior vs. inferior) and circadian variation in patients with ST segment elevation myocardial infarction (STEMI) in a Turkish cohort. MATERIAL/METHODS: This restrospective study enrolled 465 patients (407 male, mean age 65±7 years) with STEMI. Patients were then categorised into 4 6-hour increments according to the time of day during which the symptoms began (12:00 AM-06:00 AM, 06:00 AM-12:00 PM; 12:00 PM-06:00 PM and 06:00 PM-12:00 AM hours). Characteristics of patients by site of infarction (anterior vs. inferior) were compared. RESULTS: The frequency of onset of acute anterior MI as determined by onset of pain demonstrated significant circadian variation among the 4 time periods, demonstrating bimodal peaks (afternoon and morning) and a trough between 06:00 PM to 06:00 AM. The incidence of occurrence of MI between 06:00 AM to 06:00 PM was 4.50 times that of the average frequency of the remaining 12 hours of the day. The frequency of onset of acute inferior MI as determined by onset of pain exhibited significant circadian variation among the 4 time periods, demonstrating bimodal peaks (midnight to 06:00 AM and 06:00 AM to noon) and a trough between noon to midnight. The incidence of occurrence of MI between midnight to noon was 4.25 times that of the average frequency of the remaining 12 hours of the day. CONCLUSIONS: Different circadian periodicity in the time of onset of STEMI was found regarding infarction site in a Turkish cohort. This may be related to genetic and/or demographic characteristics of the Turkish population.