Predictors of the right ventricular perforation caused by active-fixation pacing and defibrillator leads: A single-centre experience.

INTRODUCTION: Active-fixation leads have been associated with higher incidence of cardiac perforation. Large series specifically evaluating radiographic predictors of right ventricular (RV) lead perforation are lacking. METHODS: We conducted a retrospective observational study including 1691 consecutive patients implanted with an active fixation pacing and defibrillator lead at our institution between January 2015 and January 2021. Fourteen patients who had clinically relevant RV perforation caused by pacemaker and implantable cardioverter-defibrillator leads were included in the study. RESULTS: Univariate and multivariate analyses were used to identify predictors of RV perforation. In multivariate analysis, lead slack score (odds ratio [OR]: 3.694, 95% confidence interval [CI]: 1.066-12.807; p = .039), change in lead slack height (OR: 1.218, 95% CI: 1.011-1.467; p = .038) and width (OR: 1.253, 95% CI: 1.120-1.402; p = .001), left ventricular ejection fraction (OR: 0.995, 95% CI: 0.910-1.088; p = .032) were independent predictors of RV perforation. CONCLUSION: Fluoroscopic predictors of RV perforation associated with RV lead can be easily determined during implantation. Identification of these predictors may prevent the sequelae of RV perforation associated with active-fixation leads.

The effect of adjuvant Mitomycin C during vitrectomy on functional and anatomical outcomes in patients with severe diabetic tractional retinal detachment.

PURPOSE: To evaluate the effect of adjuvant Mitomycin C (MMC) use on the anatomical and functional success of vitreoretinal surgery (VRS) in severe diabetic tractional retinal detachment (dTRD) patients. METHODS: A retrospective analysis of consecutive patients undergoing VRS due to severe dTRD was conducted. Patients were categorized into those who received 20 µg/0.1 mL MMC via MMC sandwich method (Group 1) and those who did not (Group 2). Demographics, surgical characteristics, visual outcomes, and complications that may related to MMC were analyzed. RESULTS: A total of 25 eyes were included, 13 in Group 1 and 12 in Group 2. No statistical difference was observed in baseline characteristics between the groups. The mean best-corrected visual acuity was 1.90 ± 0.43 logMAR and 1.93 ± 0.41 logMAR preoperatively and 1.60 ± 0.78 logMAR and 1.56 ± 0.78 logMAR postoperatively in Groups 1 and 2, respectively (p = 0.154). The postoperative mean intraocular pressure was 16.23 ± 2.55 mmHg and 13.08 ± 4.94 mmHg in Groups 1 and 2, respectively (p = 0.225). The rate of re-surgery was significantly lower in Group 1 (0% vs. 41.7% in Group 2, p = 0.015). Retina was attached in all patients at the last visit. No MMC-related complication was recorded. CONCLUSION: Intraoperative adjuvant MMC application for severe dTRD significantly reduces re-surgery rates with good anatomical and functional outcomes safely.

Prognostic value of non-alcoholic fatty liver disease fibrosis score in patients undergoing cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) has been shown to predict cardiac events in several patient populations. However, the relationship between NFS and response to CRT has not been investigated. The aim of the study was to investigate the predictive role of NFS in the assessment of response after CRT. METHODS: Three hundred thirty-six patients with heart failure undergoing CRT were prospectively studied. Liver fibrosis were assessed according to the non-alcoholic fatty liver disease fibrosis score (NFS), which includes age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase /alanine aminotransferase ratio, platelets, and albumin. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at six months at follow-up. RESULTS: Two hundred thirty-eight patients (71%) had CRT response after 6 months of follow-up. Receiver-operator characteristic curve analysis showed NFS cutoff value of < -1.12 for predicting CRT response with a sensitivity of 70.4% and a specificity of 52.9%. The patients were also divided into four groups according to the quartiles of NFS. The proportion of response to CRT was increased with lower level of NFS value. Multivariate logistic regression analysis demonstrated the NFS score < -1.12 and LVIDs were independent predictors of the CRT response. In the second model of analysis which included NFS, quartiles demonstrated that fourth NFS quartile and LVIDs were independent predictors of CRT response. CONCLUSION: Liver fibrosis assessed by NFS can provide valuable information to predict reverse remodeling in patients undergoing CRT. The present study supports monitoring of NFS to improve preoperative risk stratification of these patients.

Severe anterior persistent fetal vasculature: the role of anterior retinal elongation on prognosis.

PURPOSE: This study aims to investigate surgical outcomes of eyes with severe anterior persistent fetal vasculature (PFV) and the role of associated anatomical anomalies on prognosis. METHODS: This is a retrospective, comparative case series of 32 eyes of 31 patients who underwent vitreoretinal surgery for severe anterior PFV, defined as fibrovascular tissue totally covering the back of cataractous lens. Based on the degree of anterior retinal elongations, cases were classified as follows: group 1, eyes with well-developed pars plana and minor/no abnormalities (n = 11, 34%); group 2, eyes with partially developed pars plana and broad-based elongations (n = 9, 28%); and group 3, eyes with no visible pars plana and fibrovascular membrane having 360° continuity with peripheral retina (n = 12, 38%). Complications and functional and anatomical outcomes were investigated. RESULTS: The median surgical age was 2 (1-12) months. The median follow-up was 26 (6-120) months. Seventy-three percent in group 1 achieved finger counting or better vision with a single surgery and without any pupillary/retinal complication. Groups 2 and 3 required 2.1 ± 0.9 and 2.6 ± 1.2 surgeries on average. Pupillary obliteration and RD occurred in 33% and 22% in group 2 and 58% and 67% in group 3. Retina remained attached after silicone oil removal in 89% of group 2 and 25% of group 3. Phthisis developed in 50% in group 3. CONCLUSION: Peripheral retinal anomalies are common in severe anterior PFV and have a major impact on prognosis. Prognosis is favorable in cases with mild-to-moderate anomalies with appropriate management of possible retinal tears. In eyes with 360° retinal elongations, severe fibrous proliferation and eventual eye loss are common.

Bicuspid aortic valve caused subaortic stenosis with bulging of valve calcification through subaortic area in a young patient.

Bicuspid aortic valve is the most common congenital cause for the development of aortic valve calcification and stenosis. Calcification cause valvular stenosis or valvular insufficiency due to coaptation failure. We report a unique case of calcification of bicuspid valve was extending to left ventricular outflow tract and attached to interventricular septum which caused subvalvular stenosis.

Acute Myocardial Infarction Due to Myocardial Bridge Treated With Surgery: a Case Report.

Myocardial bridging is congenital anomaly characterized by segment of epicardial coronary arteries passing through the myocardium. Various ischemic conditions are related with this pathology. We report a case of myocardial bridging that was complicated with acute anterior myocardial infarction and a review of the literature. The patient was treated successfully with coronary bypass graft surgery after unsuccessful percutaneous intervention.

Volumetric changes within hippocampal subfields in Alzheimer's disease continuum.

Neurodegeneration in Alzheimer's disease continuum (ADC) starts from the transentorhinal cortex and progresses within hippocampal circuitry following the connectivity of its subfields transsynaptically. We aimed to track volumetric changes of the hippocampal subfields by comparing three stages of the ADC. MRI data of 15 patients diagnosed with Alzheimer's disease dementia (ADD), 15 patients with amnestic mild cognitive impairment (MCI), and 15 individuals with subjective cognitive impairment (SCI) were analyzed. The hippocampal formation was subdivided into CA1, CA3, subiculum (SUB), and dentate gyrus (DG) using FreeSurfer and volumetric values were obtained. The volumetric values were analyzed with ANCOVA and intracranial volume was selected as a covariate. ANCOVA results of the hippocampal subfields displayed statistically significant differences among the three groups in bilateral CA1, SUB, and DG volumes (Right CA1: F = 7.316, p = 0.002; left CA1: F = 6.768, p = 0.003; right SUB: F = 9.390, p < 0.001; left SUB: F = 5.925, p = 0.005; right DG: F = 9.469, p < 0.001; left DG: F = 9.354, p < 0.001), while CA3 volumes were not significantly different among the groups. Post hoc comparisons revealed that volume reductions in bilateral CA1, DG, and SUB were present in ADD compared to both MCI and SCI groups. No significant volumetric changes were found between the SCI and MCI groups. While our results are generally consistent with the literature in terms of the CA1 and SUB findings, they additionally point to the importance of the significant volume loss in DG and the resilience of the CA3 sector.

Assessment of Cardiovascular Surgery Requirements in Children and Adolescents Admitted With Chest Pain To A Pediatric Emergency Clinic.

INTRODUCTION: Chest pain in children and adolescents is an important symptom in the pediatric emergency clinic. The aim of this study is to assess the characteristics of chest pain and cardiovascular surgery in the pediatric population. MATERIALS AND METHODS: There were 352 children who presented with chest pain to the pediatric emergency department between December 2007 and February 2017. These children were included in this study, which is a retrospective observational study. RESULTS: Among the 352 patients, six patients (1.7%) underwent cardiovascular surgery. Forty-eight patients (13.6%) were diagnosed with cardiac disease, and the most common cardiac causes were myocarditis and pericarditis. CONCLUSION: Only six patients (1.7%) who were admitted to the emergency department with chest pain needed cardiovascular surgery. The chest pain in children required less surgery, and mortality and morbidity were lower compared with adult cardiac chest pain.

Selective angiography through radiofrequency catheter during ablation of premature ventricular contractions originating from aortic cusp: A single-centre experience.

INTRODUCTION: Intraprocedural coronary angiography is recommeded in patients undergoing ablation in aortic cusps to assess the relation of catheter tip and coronary ostia. In this report, we present our experience in selective coronary angiography through the radiofrequency catheter during premature ventricular contraction (PVC) ablation. METHODS AND RESULTS: We prospectively recruited 43 consecutive patients who underwent PVC ablation in the aortic cusps between March 2018 and April 2021. We performed coronary angiography through the contact force (CF)-sensing ablation catheter at the ablation site. Successful ablation was achieved in 38 (88%) of patients. No technical problems occurred after the contrast injection and ablation parameters were within the normal values, without any change of impedance and CF-sensing values and neither electrogram signal quality after contrast injection. No complications occurred during the procedure, hospital stay, and during one-year follow-up (15.3 ± 3.1 months). CONCLUSION: Selective coronary angiography through the CF-sensing ablation catheter to assess the relation between the ablation site and the coronary ostia is feasible and no minor or major complications occurred in our experience.

Usefulness of novel Martin/Hopkins and Sampson equations over Friedewald equation in cardiology outpatients: A CVSCORE-TR substudy.

BACKGROUND AND AIMS: The Friedewald equation (LDL-Cf) is known to produce inaccurate estimations of low-density lipoprotein cholesterol (LDL-C) when triglycerides are high (>400 mg/dL) or LDL-C is low (<70 mg/dL). The Martin/Hopkins (LDL-Cmh) and Sampson (LDL-Cs) equations were developed to overcome these limitations, but few data are available to assess whether these equations offer incremental usefulness over LDL-Cf. Our aim was to understand whether there was any incremental usefulness of novel equations on decisions regarding patient management. METHODS: Four thousand one hundred and ninety-six cardiology patients who were included in a multicentre registry database were analysed. Each patient was assigned to a cardiovascular risk class using the SCORE (Systematic COronary Risk Evaluation) algorithm, and relevant European guidelines were used to assess LDL-C targets. RESULTS: Compared with LDL-Cmh and LDL-Cs, LDL-Cf was able to correctly identify 96.9%-98.08% of patients as within or outside the LDL-C target, respectively, and 1.95%-2.8% of patients were falsely identified as being within the LDL-C target. Kappa coefficients for agreement between LDL-Cf vs LDL-Cmh and LDL-Cf vs LDL-Cs were 0.868 and 0.918 (P < .001). For patients not on cholesterol-lowering drugs, the decision to initiate treatment would be different in 1.2%-1.8% of cases if LDL-Cs or LDL-Cmh were used, respectively. For those already on cholesterol-lowering drugs, decisions regarding treatment intensification would be different in 1.5%-2.4% of cases if LDL-Cs or LDL-Cmh were used. CONCLUSIONS: In most cardiology outpatients, the Friedewald equation has excellent agreement with the novel Martin/Hopkins and Sampson equations, and treatment decisions should not change in most patients.

Bleeding risk in patients with acute coronary syndrome in a Turkish population: Results from the Turkish Acute Coronary Syndrome Registry (TACSER) study.

OBJECTIVE: Bleeding is one of the most important causes of mortality in patients with acute coronary syndrome (ACS). This study therefore aimed to investigate bleeding risk in patients with ACS who were scheduled to receive dual antiplatelet therapy (DAPT) in Turkey. METHODS: This was a multicentre, observational, cross-sectional cohort study. The study population included 963 patients with ACS from 12 centres in Turkey. We used the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score to predict the bleeding risk for all the patients. The patients were divided into high (≥25) or low (˂25) bleeding risk groups based on their PRECISE-DAPT scores. RESULTS: The mean PRECISE-DAPT score was 21.9. Overall, 32.2% of the patients had high PRECISE-DAPT scores (≥25). Compared with the male patients, the female patients had higher PRECISE-DAPT scores (28.2 ± 15.7 vs 18.4 ± 13.6, P Ë‚ .001). Among the females, the rate of patients with a PRECISE-DAPT score ≥25 was 53%, while among the male patients, the score occurred at a rate of 22%. The female patients had lower haemoglobin (Hb) levels than the male patients (12.1 ± 1.7 vs 13.8 ± 1.9, P Ë‚ .001) and lower creatinine clearance (70.7 ± 27.5 vs 88.7 ± 26.3, P Ë‚ .001). The in-hospital bleeding rates were higher among the patients with high PRECISE-DAPT scores than among those who did not have high scores. Furthermore, the patients with high PRECISE-DAPT scores had a higher in-hospital mortality rate compared with those with low PRECISE-DAPT scores (1% vs 0%, P = .11). CONCLUSIONS: The mean PRECISE-DAPT score was high among the patients with ACS in this study, indicating that the bleeding tendency was high. This study showed that the PRECISE-DAPT score may help physicians determine the type and duration of DAPT, especially in patients with ACS in Turkey.

Systolic aortic root motion predicts response to cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is recommended for patients with advanced chronic heart failure. Systolic aortic root motion (SARM) has been investigated in dilated cardiomyopathy patients and found that heart failure patients had reduced SARM. We aimed to investigate the relationship between SARM and response to CRT. METHODS: Fifty-six patients with advanced heart failure, wide QRS complex, and LVEF ≤35% were included. Transthoracic echocardiography was performed before, and repeated at 6 months in follow-up. Systolic aortic root motion was measured in each patient before the device implantation. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months follow-up. RESULTS: Forty patients (71%) had CRT response after 6 months of follow-up. In multivariate analysis, significant associates of response to CRT was evaluated adjusting for functional capacity, etiology of cardiomyopathy, QRS duration, baseline left ventricular dimensions/volumes and SARM. SARM was the only predictor of response to CRT (OR 1.818, 95% CI, 1.101-3.003, P = .019). CONCLUSIONS: SARM predicts non-response to CRT and may help in the selection of CRT candidates.

The Relationship between Nesfatin-1 Levels and SYNTAX Score in Patients with Non-ST Segment Elevation Myocardial Infarction.

OBJECTIVE: Nesfatin-1 is a novel anorectic neuropeptide with potent metabolic regulatory effects. It regulates blood pressure, heart rate, cardiomyocyte metabolism and permeability. SYNTAX score, which is an angiographic scoring system, defines the grade and complexity of coronary artery disease (CAD). We aimed to evaluate the relationship between nesfatin-1 level and severity of CAD according to the SYNTAX score in patients with non-ST segment elevation myocardial infarction (NSTEMI). METHODS: A total of 109 subjects were enrolled into the study, of whom 80 underwent coronary angiography (CA) with the diagnosis of NSTEMI and 29 had normal coronary arteries detected in CA. NSTEMI patients were divided into 2 groups: low SYNTAX score (< 32) (45 patients) and high SYNTAX score (≥ 32) (35 patients). RESULTS: The NSTEMI patients with a high SYNTAX score (score ≥ 32) had a lower serum nesfatin-1 level (62 pg/ml; 39-98) compared to the NSTEMI patients with a low SYNTAX score (score < 32) (138 pg/ml; 65-286) and the control group (392 pg/ml; 178-1320). There was also a negative correlation between serum nesfatin-1 level and SYNTAX score (r = -0.594, p < 0.001). A lower serum level of nesfatin-1 (odds ratio = 0.116; 95% confidence interval: 0.138- 0.094; p < 0.001) was an independent predictor for high SYNTAX score in the NSTEMI patients after multiple linear regression analysis. CONCLUSIONS: Serum nesfatin-1 level was lower in the high SYNTAX group than in the low SYNTAX group in patients with NSTEMI. Nesfatin-1could have a role in the pathogenesis of atherosclerotic burden in patients with NSTEMI.

The short-term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation.

BACKGROUND: The autonomic nervous system (ANS) is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation (AF), whereas the presence of AF can activate and alter the ANS. The catheter ablation of AF (AFCA) may cause the cardiac ANS dysfunction, whereas restoration of sinus rhythm or sympathovagal imbalance by AFCA can reverse this process. Our principal goal was to investigate the short-term effect of AFCA on ANS functions evaluated by noninvasive chronotropic (CI), resting heart rate (RHR), and heart rate recovery (HRR) indices. METHOD: A total of 45 patients were enrolled with symptomatic, drug refractory paroxysmal AF undergoing first cryoballoon (CB) pulmonary vein antrum isolation (PVAI) with one 28-mm CB using single 3-minute freeze techniques without bonus applications. All patients underwent symptom-limited exercise treadmill testing to evaluate noninvasive parameters of ANS before PVAI. For those patients who remained in sinus rhythm, an additional exercise test was repeated after 1 and 3 months after discharge. RESULTS: The autonomic CI and RHR/HRR indices were impaired after PVAI and persisted post-PVAI 3 months. However, these parameters were not different in patients with and without recurrence. CONCLUSION: This study demonstrated that the successful AFCA might concurrently impair the ANS parameters. The autonomic imbalance between the sympathetic and parasympathetic activity after AFCA could either become antiarrhythmic and/or proarrhythmic based on which of the two components was going to prevail after successful AFCA. The impaired ANS balance after PVAI might also be another hypothetical mechanism for AF recurrence particularly in the absence of PV reconnection.

The relationship between fragmented QRS and functional significance of coronary lesions.

BACKGROUND: Recently fragmented QRS (fQRS) on electrocardiography (ECG) has been introduced as a predictor of myocardial scarring and myocardial ischemia in coronary artery disease (CAD). OBJECTIVE: The aim of this study was to investigate the relationship between fQRS and fractional flow reserve (FFR) results in patients with the intermediate degree of coronary artery stenosis. METHODS: A total of 301 consecutive patients who underwent coronary angiography (CAG) and FFR measurement for intermediate coronary artery stenosis were included in the study. The study patients were divided into two groups: the low FFR group (FFR value of ≤0.80) and normal FFR (FFR value of >0.80) group. Both groups were compared in terms of the presence of fQRS. RESULTS: Of 301 patients, fQRS was detected in 128 (42.5%) and low FFR was detected in 115 (38.2%). In the low FFR group, fQRS was significantly higher (P<0.001). Multivariate analysis showed that fQRS was an independent predictor of myocardial ischemia in patients with intermediate coronary stenosis (OR=7.202, CI 95%, 4.195-12.367; p<0.001). The presence of fQRS had 70% sensitivity and 74% specificity for the prediction of FFR≤0.80. CONCLUSION: In clinical practice, the presence of fQRS on ECG is associated with myocardial ischemia in patients with intermediate coronary stenosis.

ALCAPA Syndrome and Atrial Septal Defect In a 68-Year-Old Woman: An Extremely Rare Congenital Association.

Anomalous left coronary artery arising from the pulmonary artery (ALCAPA) has been generally reported as an isolated lesion that is also called Bland-White-Garland syndrome. Herein we report a case of ALCAPA syndrome with an atrial septal defect in a 68-year-old woman. She had been asymptomatic until the age of 68. Echocardiographic examination revealed atrial septal defect, and coronary angiography showed that the left main coronary artery originated from the pulmonary artery and intensive collateral connections between the right and left coronary artery. In this case, it would appear that ALCAPA is associated with atrial septal defect.

Predictors of Impaired Reperfusion after Percutaneous Coronary Intervention in Patients with In-Hospital Acute Stent Thrombosis: A Retrospective Analyses of 5 Years of Data.

BACKGROUND: Acute stent thrombosis (STh) is a rare complication of percutaneous coronary intervention (PCI) and is associated with a high-risk of reperfusion failure. However, data focusing on risk factors of reperfusion failure in patients undergoing repeat PCI for treatment of STh remains inadequate. METHODS: A total of 8815 patients who underwent PCI with stent implantation from January 2009 to December 2013 were retrospectively reviewed. Among those cases, patients that presented with acute STh and underwent a repeat PCI for acute STh were identified. RESULTS: There were 108 patients who underwent repeat PCI for the treatment of in-hospital acute STh that were retrospectively analyzed. Of these study subjects, 21 (25%) had thrombolysis in myocardial infarction (TIMI) flow < 3 after repeat PCI. The median value of pain-to-balloon time was 40 minutes in the TIMI < 3 group, 35 minutes in the TIMI = 3 group (p < 0.001), and the first PCI-to-stent thrombosis time was also longer in the TIMI < 3 group (10 hours vs. 2.5 hours, p = 0.001). When patients were evaluated according to PCI time, the percentage of patients with TIMI < 3 was significantly higher in the night period compared to the daytime period (46.4% vs. 17.5 %, p = 0.002). In the multivariable logistic regression analysis, stent length [odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.008-1.38] and pain-to- balloon time (OR = 1.28, 95% CI, 1.06-1.54) were the only independent predictors of failed reperfusion. CONCLUSIONS: Baseline stent length and pain-to-balloon time were associated with reperfusion failure in PCI for STh. Moreover, TIMI flow grade showed a circadian variation.

The Association between CHA2DS2-VASc Score and Mortality in Patients with Heart Failure with Reduced Ejection Fraction.

BACKGROUND: Heart failure (HF) is associated with significant mortality and morbidity. Therefore, identifying high-risk patients may optimize treatment for HF patients and reduce adverse events. The aim of this study was to assess the role of the CHA2DS2-VASc score to predict mortality in patients with reduced left ventricular ejection fraction (LVEF). METHODS: A total of 106 patients with reduced LVEF were enrolled in this study. All patients completed a one-year follow-up, and a CHA2DS2-VASc score was calculated for each patient. RESULTS: Twenty-one patients (19.8%) died during the 1-year follow-up. We found that baseline functional status, CHA2DS2-VASc score, brain natriuretic peptide, blood urea and hemoglobin levels were associated with mortality. In the multivariate analysis, CHA2DS2-VASc score and functional capacity were the only predictors of 1-year mortality. CONCLUSIONS: Use of the CHA2DS2-VASc score appears to be feasible for risk stratification and mortality prediction in patients with reduced LVEF.

Gamma-glutamyl transferase predicts recurrences of atrial fibrillation after catheter ablation.

BACKGROUND: Catheter ablation is a popular therapy of atrial fibrillation (AF). Gamma-glutamyl transferase (GGT) is known as a marker of oxidative stress. The objective of this study was to ascertain the relationship between levels of GGT and recurrence of AF after catheter ablation. METHODS: A total of 102 paroxysmal AF patients who underwent cryoballoon catheter ablation were enrolled. Serum samples were obtained to evaluate GGT levels before catheter ablation. Cox regression analysis was used to estimate the predictors of AF recurrence. RESULTS: Mean age of the cohort was 49.9 ± 11.7 and 63% of the patients were male. After a mean follow-up of 20 months, 19 (23%) patients had AF recurrences. The baseline GGT levels were significantly higher in patients who had AF recurrence [27 U/L (17-36) vs 18 U/L (13-22), P = 0.002]. The optimal cut-off value of GGT to predict AF recurrence was 23.5 U/L according to receiver operating characteristic curve analysis (area under the curve 0.72, P = 0.002). In the multivariable Cox regression analysis, baseline GGT > 23.5 was the only independent predictor of AF recurrence (hazard ratio (HR) 4.47, 95% confidence interval [1.66-12.09], P = 0.003). CONCLUSIONS: Our results indicate that elevated GGT is associated with AF recurrence. A simple measurement of GGT may help us to identify high-risk patients undergoing catheter ablation for AF.

Reversed shunting in CREST syndrome.

The patent foramen ovale (PFO) is one of the most common congenital defects and may as well stand for "potential for opening" in addition to patent foramen ovale. Although patients are usually asymptomatic because the defect is flap-like and does not permit significant left-to-right shunting, the pathological conditions that result in cardiac rotation or higher than normal right atrial pressures can reverse the normal left atrial to right atrial pressure gradient and cause a right-to-left shunt through a PFO. Pulmonary complications of systemic sclerosis (SSc) are common, and are the leading cause of SSc-related death. The most common pulmonary manifestations of SSc are pulmonary hypertension (PAH), interstitial lung disease, and any combination thereof. Compared with the idiopathic form of PAH (IPAH), patients with SSc-associated PAH have a threefold increased risk of death and may receive a diagnosis late in the course of disease because of insidious onset and the high prevalence of cardiac, musculoskeletal, and pulmonary parenchymal comorbidities. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:390-391, 2016.