The effect of contrast agents on the anticoagulant properties of oral factor Xa inhibitors.

BACKGROUND: Contrast agents may affect the anticoagulant properties of novel oral anticoagulants. PURPOSE: To evaluate the effect of iohexol as a contrast agent on the anticoagulant activity of oral factor Xa inhibitors. MATERIAL AND METHODS: The study included 65 individuals who underwent contrast computed tomography(CT). Group 1 comprised 20 patients using rivaroxaban, Group 2, 20 patients using apixaban, and Group 3, 20 patients using edoxaban. Group 4 was the control group of five healthy volunteers. Iohexol (60 mL) was used as a contrast agent. Blood samples of 2 mL were withdrawn into two tubes at 4 h after the drug dose and 1 h after the contrast CT (CT was performed 3 h after the drug was taken) from all the patients, and for the control group, at any time before and 1 h after contrast CT. The anticoagulant properties of rivaroxaban, apixaban, and edoxaban were evaluated using anti-factor Xa levels. RESULTS: The anti-factor Xa level was increased after using the contrast agent in the rivaroxaban group (0.66 ± 0.32 U/mL vs. 0.67 ± 0.32 U/mL; P = 0.01) and the edoxaban group (0.74 ± 0.35 U/mL vs. 0.76 ± 0.36 U/mL; P = 0.006). No significant difference was observed in the apixaban group (0.66 ± 0.33 U/mL vs. 0.66 ± 0.32 U/mL; P = 0.21) and control group (0.02 ± 0.01 U/mL vs. 0.03 ± 0.01 U/mL; P = 0.33). CONCLUSION: The anticoagulant properties of rivaroxaban and edoxaban tended to increase significantly, but there was no statistically significant difference in the anticoagulant properties of apixaban after the administration of contrast agent. To determine whether the small laboratory difference has a clinical effect, there is a need for larger clinical trials (NCT04611386).

The predictive value of hemoglobin to creatinine ratio for contrast-induced nephropathy in percutaneous coronary interventions.

OBJECTIVES: Hemoglobin and creatinine levels are important factors for contrast induced nephropathy (CIN) development. Our aim in this study is to investigate the predictive value of hemoglobin to creatinine ratio for CIN development in patients with percutaneous coronary intervention (PCI). METHODS: A total of 500 patients who underwent PCI in our clinic were evaluated prospectively in terms of CIN. Hemoglobin to creatinine ratio is calculated as baseline hemoglobin/baseline serum creatinine value. glomerular filtration rate (GFR) was calculated with Cockcroft-Gault formula. The definition of CIN includes absolute (≥0.5 mg/dL) or relative increase (≥25%) in serum creatinine at 48-72 h after exposure to a contrast agent compared to baseline serum creatinine values. RESULTS: CIN was detected in 13.8% (69 patients) of 500 patients. In multivariate lineer regression analysis, hemoglobin to creatinine ratio (beta: -0.227, p=0.03) and ejection fraction (EF) (beta: -0.161, p<0.001), contrast amount used (beta: 0.231, p<0.001) were found to be significant predictors for the development of CIN. In receiver operating characteristics (ROC) analysis; AUC=0.730 (0.66-0.79) for hemoglobin to creatinine ratio, p<0.001, AUC=0.694 (0.62-0.76) for EF, p<0.001 and AUC=0.731 (0.67-0.78) for contrast amount used p<0.001. CONCLUSIONS: Hemoglobin to creatinine ratio, EF and contrast amount used were independent predictors for CIN development in patients with PCI (NCT04703049).

The value of atrial electromechanical delay in predicting atrial fibrillation development after coronary artery bypass surgery.

OBJECTIVE: Predicting postoperative atrial fibrillation (PoAF) in the preoperative period will provide a serious advantage in preventing the morbidity and mortality associated with this arrhythmia and in planning the treatment. In this study, we investigated the value of atrial electromechanical delay (AEMD) in predicting the development of PoAF. METHODS: A total of 93 patients who underwent isolated coronary artery bypass grafting (CABG) operation were included in this prospective study. Patients' demographic characteristics, laboratory parameters, echocardiographic data, and AEMD durations that could be measured by the co-use of electrocardiography and echocardiography were recorded. The patients at sinus rhythm during the postoperative period were identified as "Group 1", and those who developed PoAF were identified as "Group 2". RESULTS: PoAF incidence was 26.88% (n = 25). Left ventricle (LV) lateral AEMD, LV medial AEMD, right ventricle lateral AEMD, and left atrium (LA) lateral AEMD durations of Group 2 were significantly higher than Group 1 (p < 0.001, p = 0.004, p = 0.004, p < 0.001; respectively). In Univariate Logistic Regression Analysis, the age, hypertension, LA maximum volume, LA lateral AEMD and pulmonary artery pressure were significantly associated with PoAF development (p = 0.01, p = 0.004, p = 0.004, p = 0.001, p = 0.01; respectively). However, only LA lateral AEMD was found as an independent predictive factor for the development of PoAF in the Multivariate Logistic Regression Analysis (OR:1.03, 95% CI:1.001-1.06, p = 0.04). AUC was .741 for LA lateral AEMD in ROC Curve Analysis (95% CI: .633-.849, p < 0.001). CONCLUSIONS: The development of PoAF can be predicted by AEMD durations measured in the preoperative period in patients undergoing isolated CABG.

The way to a patient's heart is through their esophagus: A case of esophago-pericardial fistula.

Here in we present a 74-year-old case of esophago-pericardial fistula with pericardial effusion and pneumopericardium. Bone-related esophageal trauma was the cause of the esophago-pericardial fistula. The esophago-pericardial fistula was diagnosed with echocardiography, computerized tomography (CT) and endoscopy. Pericardiocentesis was performed for drainage the pericardial effusion. The esophago-pericardial fistula was treated with covered self-expandable esophageal stent.

Thoracic endograft placement using a transfemoral snare in a patient with angled aortic arch.

OBJECTIVE: In complex anatomical challenges, endovascular endograft implantation to the thoracic aorta may not be performed. Various techniques have been put forward for endograft therapy. In this report, we present the effect of femoral snare support for a patient with an aortic arch angle. METHOD: Thoracic endovascular aneurysm repair (TEVAR) was used for treating a 60-year-old male patient who suffered from severe angulation in the arcus aorta and aneurysmal enlargement of the left subclavian artery and descending aorta. The endovascular graft could not be advanced into the aortic arch with the guidewire because of the aortic arch angle. Therefore, the TEVAR graft distal end was caught with the snare advanced from the femoral artery, and the TEVAR graft was advanced into the aortic arch. CONCLUSION AND RESULT: The femoral snare technique is a simple and successful method for endograft implantation of the aortic arch disease without the risk of heart trauma, especially in cases with aortic arch tortuosity.

The predictive value of the combined systolic-diastolic index for atrial fibrillation after coronary artery bypass surgery.

OBJECTIVE: Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is a factor that causes an increase in mortality and morbidity. Therefore, predicting post-CABG AF development is important for treatment management. In this study, we investigated the value of the ratio E/(Ea × Sa) as a combined systolic-diastolic index in predicting post-CABG AF development. METHODS: This prospective study included 102 patients who underwent only isolated coronary bypass. Preoperative demographic features, biochemical, and hematological parameters, and the electrocardiographic data of all patients were recorded. The E/(Ea × Sa) indices were calculated from the echocardiographic measurements. Those who retained their postoperative sinus rhythm were defined as group 1, and those who developed AF were defined as group 2. RESULTS: Group 2 had significantly higher lateral (group 1:1.14 ± 0.61 vs. group 2:1.47 ± 0.87; P = .02), medial (group 1:1.61 ± 0.70 vs. group 2:1.99 ± 0.91; P = .02), and mean (group 1:1.30 ± 0.58 vs. group 2:1.62 ± 0.74; P = .001) E/(Ea × Sa) indices than group 1. In the univariate analysis, age, CHA2 DS2 -VASc score, sPAP, IABP use, and mean E/(EaxSa) index were found to be significant predictors of post-CABG AF development. However, only the mean E/(EaxSa) index was found to be a significant predictor of post-CABG AF development in the multivariate analysis (OR: 2.19 95% CI 1.01-5.96; P = .045). CONCLUSIONS: The combined systolic-diastolic index predicted the development of post-CABG AF.

A novel index combining diastolic and systolic tissue Doppler parameters for predicting cardiac resynchronization therapy response.

OBJECTIVE: Identification of patients who are nonresponders to cardiac resynchronization therapy (CRT) with the use of simple and objective parameters may be helpful in tailoring treatment. The aim of this study is to investigate whether E/(Ea × Sa) could be a predictor of CRT nonresponders (E = early diastolic transmitral velocity, Ea = early diastolic mitral annular velocity, Sa = systolic mitral annular velocity). METHODS: In total, 53 heart failure patients were evaluated for this study, and 33 patients were included according to the study criteria. Before and 6 months after CRT-D(CRT with a defibrillator) implantation, E, Ea, and Sa were determined at the medial and lateral mitral annular sites, and the average values were obtained. E/(Ea × Sa) was calculated (medial, lateral, average). The patients were followed for 6 months to monitor their CRT response. A responder was defined as a patient with a reduction in end-systolic volume of ≥15% and an increase in 6-minute walking distance of 50 m. RESULTS: At a 6-month follow-up, 24 (72.7%) of the 33 patients responded to CRT. At the 6-month follow-up, in the responder group, the E/Ea ratio, lateral mitral, and average E/(Ea × Sa) indices were significantly reduced (P < .01 for all). The baseline lateral mitral, medial mitral, and average E/(Ea × Sa) indices were significantly lower in the responder group than in the nonresponder group (P ≤ .01 for all). The receiver operating characteristic analysis showed that all the E/(Ea × Sa) indices predict the CRT nonresponder patients. The AUC values were 0.89 (lateral E/(Ea × Sa)), 0.85 (average E/(Ea × Sa)), and 0.77 (medial E/(Ea × Sa)) (P ≤ .01 for all). CONCLUSION: We found that the E/(Ea × Sa) index is a novel predictor of CRT nonresponder patients.

The effect of thyroid functions on contrast-induced nephropathy in patients undergoing coronary angiography and percutaneous coronary intervention.

OBJECTIVE: To investigate the effects of thyroidism on the development of contrast-induced nephropathy in patients undergoing coronary angiography and percutaneous coronary intervention. METHODS: The prospective, observational study was conducted at Trakya University Faculty of Medicine, Edirne, Turkey, from October 1, 2016, to October 1, 201 7, and comprised patients with hypothyroidism, hyperthyroidism and euthyroid patients. Thyroid and renal functions were evaluated from blood samples taken before the procedure. The definition of contrast-induced nephropathy included absolute (0.5 mg/dL) or relative increase (25%) in serum creatinine 48-72 h after exposure to a contrast agent compared with baseline serum creatinine values. SPSS 10 was used for data analysis. RESULTS: Of the 162 patients, 58(35.8%) had hypothyroidism, 47(29%) hyperthyroidism and 57(35.2%) euthyroid. Contrast-induced nephropathy was significantly higher in hypothyroid and hyperthyroid subjects compared to euthyroid group (p<0.001 each). Univariate analysis showed contrast volume, procedure, albumin value, hypothyroidism and hyperthyroidism to be independent predictors of contrast-induced nephropathy (p<0.05 each), but multivariate analysis only showed hypothyroidism and the hyperthyroidism as the independent predictors (p<0.01 each). CONCLUSIONS: Contrast-induced nephropathy rate was increased in patients with malfunctioning thyroid, Hypothyroidism and hyperthyroidism were found to be independent predictors of contrast-induced nephropathy.

Hourglass-shaped right ventricle and localized constrictive pericarditis.

Constrictive pericarditis is characterized by thick pericardial fibrosis and frequent calcification that progressively impairs diastolic filling of the heart. The diagnosis of constrictive pericarditis has been challenging even though multiple diagnostic modalities have been developed. The diagnosis of constructive pericarditis is especially difficult in localized constrictive pericarditis which is extremely rare. We report a case of localized constrictive pericarditis with a 3D multislice cardiac computed tomography (CT) finding of the constrictive band causing strangulation and hourglass shaping of the right ventricle.

A Novel Index Combining Diastolic and Systolic Tissue Doppler Parameters for Prediction of Atrial Fibrillation Recurrence.

OBJECTIVE: Identification of patients at risk for atrial fibrillation (AF) recurrence with using simple and objective parameters may be helpful in tailoring the treatment. In this study, we investigated whether E/(Ea×Sa) and Ea/(Aa×Sa) could be a predictor of AF recurrence after cardioversion. (E = early diastolic transmitral velocity, Ea = early diastolic mitral annular velocity, Aa = late diastolic mitral annular velocity, Sa = systolic mitral annular velocity). METHODS: In total, 127 patients with persistent AF were evaluated for this study and 73 patients were included according to the study criteria. Sinus rhythm (SR) was achieved for 70 patients after electrical direct-current cardioversion. E, Sa, Ea, and Aa were determined at mitral medial and lateral site and average values obtained. E/(Ea×Sa) and Ea/(Aa×Sa) were calculated (medial, lateral, average). Heart rate and rhythm were followed with an electrocardiography (ECG) monitor and 12-lead ECG at first week and first month. RESULTS: At one month, 53 patients (75.7%) were in SR, whereas 17 patients (24.3%) reverted to AF. According to precardioversion E/(Ea×Sa) lateral, E/(Ea×Sa) medial, E/(Ea×Sa) average (P ≤ 0.01 for all the indices), 24-hour echocardiographic evaluation E/(Ea×Sa) lateral, E/(Ea×Sa) medial, E/(Ea×Sa) average, Ea/(Aa×Sa) lateral, Ea/(Aa×Sa) medial, and Ea/(Aa×Sa) average (P ≤ 0.01 for all the indices), indices were significantly higher in the AF recurrence group than in the SR group. Furthermore, the ROC analysis showed that all the E/(Ea×Sa) and Ea/(Aa×Sa) parameters predict the AF recurrence. The AUC values range from 70% to 81% (P ≤ 0.01 for all the parameters). In subgroup analysis of the patients, precardioversion mitral medial E/Ea ratio was between 8 and 15, and the ROC analysis showed that the novel indices predict the AF recurrence. The AUC values range from 72% to 86% (P ≤ 0.02 for all the parameters). CONCLUSIONS: We found that E/(Ea×Sa) and Ea/(Aa×Sa) indices are novel predictors of AF recurrence.

[Levels of awareness of occupational and general cardiovascular risk factors among metal industry employees]. / Metal sektörü çalisanlarinin mesleki ve genel kardiyovasküler risk faktörleri bilgi düzeyleri.

OBJECTIVE: Long-term exposure to physical, chemical, ergonomic and psychosocial environmental factors may lead to occupational cardiovascular disease in metal industry employees. This study aimed to determine levels of knowledge levels regarding occupational and cardiovascular risk factors among metal industry employees. METHODS: The study was conducted between 2nd and 6th June 2014 with the participation of 82 employees. All were working in a medium-sized workplace in the metal industry. Data were collected by means of a questionnaire, which included socio-demographic characteristics and occupational cardiovascular risk factors, and a scale developed by Arikan et al. to measure awareness levels of risk factors for cardiovascular diseases (CARRF-KL). RESULTS: The mean age of employees was 39.97±8.44. Of the participants, 58.5% stated that they had knowledge on cardiac disease risk factors. The mean CARRF-KL score was found to be 18.65±4.04. The percentage of employees stating that they had no knowledge on the occupational risks for such diseases was 79.3%, while 19.5% stated that job stress caused cardiac diseases. One individual (1.2%) stated that one of the chemical solvents used in the working environment was a risk factor. CONCLUSION: Although awareness among metal industry employees of cardiovascular risk factors was above average, it was determined that they do not have adequate information on occupational risk factors. Prolonged and unprotected levels exposure to environmental factors constitute a risk for cardiovascular disease. This information is important for the development of preventive cardiology.

The REDUCED (a RandomisED stUdy Comparing standard systemic anticoagulation thErapy to low Dose intracoronary anticoagulation therapy for elective percutaneous coronary intervention) trial. A novel pharmacologic regime for elective percutaneous coronary intervention.

AIM: This study tried to determine the efficacy and safety of low-dose intracoronary unfractionated heparin (UFH) in elective percutaneous coronary intervention (PCI). METHODS: Two-hundred patients who underwent elective PCI of an uncomplicated lesion were included into the study. The patients were assigned to either a control group (70-100 IU/kg intravenous UFH) or a low-dose intracoronary UFH (1,000 IU intracoronary UFH) group. RESULTS: At 30 days, the primary end point (composite of death, myocardial infarction, or urgent target vessel revascularization) was similar in both groups [intracoronary UFH group, 1.0%; control group, 2.0%; odds ratio; 0.49 (95% CI: 0.04 - 5.54), P = 0.56]. Post-procedural myocardial injury (according to CK-MB, P = 0.91; according to Tn I, P = 0.81) and bleeding events (based on TIMI criteria, P = 0.33; based on STEEPLE criteria, P = 0.20) were similar in the control and intracoronary groups. The primary end point at 6 months was also similar between the two groups (P = 0.33). Moreover, the health care cost at 30 days of follow-up was lower in the intracoronary group than in the control group (1,016 ± 54 $/patient vs 1,110 ± 102 $/patient, P < 0.001). CONCLUSION: This pilot study suggests that elective PCI could be safely performed with low-dose intracoronary UFH in the treatment of uncomplicated lesions and at a lower cost as compared to standard systemic anticoagulation.These results should be confirmed by further studies.

Safety and efficacy results of percutaneous renal stent implantation in patients with acute coronary syndrome with ectatic and aneurysmatic coronary arteries.

BACKGROUND: For the treatment of stenotic lesions developing in dilated coronary arteries, it is difficult to find an appropriately sized coronary stent given that the vessel diameter is too large. This poses a greater problem, especially in patients who require urgent intervention, such as acute coronary syndrome. OBJECTIVE: We aimed to evaluate the efficacy and safety of renal stents implanted in ectatic/aneurysmatic coronary arteries in such patients. METHODS: In total, 18 patients (renal stent group) who underwent renal stent implantation in ectatic/aneurysmatic coronary arteries requiring percutaneous coronary intervention (PCI) and 45 patients who underwent large-sized bare-metal coronary stent (BMCS) implantation (BMCS group) at our center were included in the study. The primary endpoints were MACE (myocardial infarction and cardiovascular mortality), and the secondary endpoints were restenosis and all-cause mortality. RESULTS: In the study patients with a mean follow-up of 25.3 ± 14.6 months (1-48 months), the control coronary angiography duration was 24.6 ± 14.8 months for the renal stent group and 22.8 ± 15.7 months for the BMCS group (p = 0.06). The MACE was observed in 2 (11.1%) patients in the renal stent group and 4 (8.9%) patients in the BMCS group (HR: 1.39 (0.24-7.82), p = 0.70). The secondary composite outcome was identified in 4 (22.2%) patients in the renal stent group and 6 (13.7%) patients in the BMCS group (HR: 1.93 (0.53-6.91), p = 0.31). No significant differences in primary and secondary outcomes were noted between the groups. CONCLUSION: Renal stents used during PCI in patients with acute coronary syndrome with ectatic/aneurysmatic coronary arteries have similar efficacy, and mid-term follow-up results those noted for BMCS. These findings support that renal stents can be used in ectatic and aneurysmatic coronary arteries when necessary. CLINICAL TRIAL REGISTRATION: This study has been registered on ClinicalTrials.gov (NCT05410678).

Should an Inoue balloon larger than suggested by guidelines be used for percutaneous balloon mitral valvuloplasty?

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the immediate and long-term results of single inflation using a larger balloon size in patients with symptomatic rheumatic mitral stenosis (MS) METHODS: Among a study population of 231 patients with MS, percutaneous balloon mitral valvuloplasty (PBMV) was performed using the Inoue balloon technique. The ideal balloon size was measured according to the patients' height. Patients were allocated at random to two groups: a stepwise method was used in 115 patients (group 1), and a single-inflation method (with +2 mm larger balloon size) in 116 patients (group 2). Follow up was scheduled at six-month intervals for the first year, and annually thereafter. Patients were followed up until 2009. RESULTS: The mitral valve area (MVA) was increased from pre-PBMV values of 1.2 +/- 0.3 cm2 and 1.1 +/- 0.21 cm2 in groups 1 and 2, respectively, to post-PBMV values of 1.9 +/- 0.34 cm2 and 2.0 +/- 0.28 cm2 in groups 1 and 2, respectively; the increase in MVA for each group was statistically significant (p < 0.01) The mean transmitral pressure gradient (MMG) was decreased from pre-PBMV values of 14.1 +/- 5.5 mmHg and 13.2 +/- 5.9 mmHg in groups 1 and 2, respectively, to post-PBMV values of 5.9 +/- 2.3 mmHg and 5 +/- 2.5 mmHg in groups 1 and 2, respectively. One patient in group 2 underwent surgery due to severe mitral regurgitation. The procedure time was significantly shorter in group 2 (32 +/- 11.5 min versus 25 +/- 11 min; p < 0.001). The mean follow up duration was 49.5 +/- 19.2 months (range: 24-84 months). At the last follow up examination, the MVA was shown to be significantly larger in group 2 than in group 1 (1.65 +/- 0.3 versus 1.42 +/- 0.34 cm2; p = 0.02), while the MMG was lower (9 +/- 3.6 versus 6.7 +/- 3 mmHg; p = 0.017). CONCLUSION: The study results suggested that using a +2 mm larger balloon size with single overinflation may represent an alternative and effective therapy, with a shorter procedure time.

Evaluation of atrial electromechanic delay and left atrial mechanical functions in the patients with secundum type atrial septal defect.

AIM: The aim of our study was to evaluate atrial electromechanical delay (AEMD) and left atrial mechanical functions (LAMF) in the patients with secundum-type atrial septal defect (ASD). METHOD: We included 72 patients with secundum type ASD in the study group and 35 gender and age-matched healthy volunteers for the control group. Maximal, minimal, and presystolic LA volumes were measured by modified Simpson method and indexed to the body surface area (BSA). Inter-AEMD, right and left intra-AEMD were measured from the lateral and septal mitral annulus and tricuspid annulus using tissue Doppler imaging (TDI). RESULTS: The age, gender, systolic and diastolic blood pressure, heart rate (HR), BSA, and body mass index (BMI) parameters were not significantly different between the groups. Left atrial active and total emptying fractions and conduit volumes were significantly lower in the patients with ASD compared with the control group (P = 0.006, P = 0.001, and P = 0.032, respectively). Total emptying volume was increased in patients with ASD (P = 0.021). Passive emptying volume and fraction and active emptying volumes were not different significantly between the groups (P > 0.05). The left intraatrial, right intraatrial, and inter-AEMDs were significantly longer in the ASD group (P = 0.032, P = 0.013, and P = 0.003, respectively). CONCLUSION: The left atrial reservoir and contractile pump functions are reduced; the left intraatrial, right intraatrial, and inter-AEMDs are increased in the patients with ASD.

A novel echocardiographic predictor of atrial fibrillation recurrence: L-wave.

Diastolic dysfunction leads to atrial fibrillation (AF) by increasing left atrial pressure and also increases recurrence rate after cardioversion. So, L-wave, which is associated with severe diastolic dysfunction, could predict recurrent AF after cardioversion. The aim of this study was to investigate predictive value of L-wave for AF recurrence at first month after electrical cardioversion. A total of 127 patients with persistent AF were evaluated for this study and finally 73 patients were included according to the study criteria. Echocardiographic examinations were performed for all patients before and at 24th hour after electrical cardioversion. Heart rates and rhythms were followed with electrocardiography monitor and 12-lead ECG at first week and first month. Seventy patients achieved sinus rhythm (SR) after cardioversion and 3 patients who did not go into SR excluded from the study. Patients were divided into 2 groups according to having (group 1) or not having (group 2) L-wave on echocardiography. Twenty-two patients (6 men, 16 women) had L-wave and 48 patients (19 men, 29 women) did not have L-wave. Duration of AF was longer in group 1 as compared to group 2 (P = 0.03). Mean heart rate was lower in group 1 than in group 2 (P < 0.001). Duration of AF and presence of L-wave were significant parameters for AF recurrence in univariate analysis, however, presence of L-wave was the only significant parameter for AF recurrence in multivariate analysis. Ten patients in group 1 (45.5%) and 7 patients (14.6%) in group 2 (P = 0.005) had AF recurrence at the end of first month after cardioversion. L-wave did predict AF recurrence with 59% sensitivity, 77% specificity, 45% positive predictive value, and 85% negative predictive value at 1 month. Echocardiographic L-wave could predict the AF recurrence.

In vitro evaluation of anticoagulant therapy management when urgent percutaneous coronary intervention is required in rivaroxaban-treated patients.

We investigated in vitro the management of intraprocedural anticoagulation in patients requiring immediate percutaneous coronary intervention (PCI) while using regular direct oral anticoagulants (DOACs). Twenty-five patients taking 20 mg of rivaroxaban once daily comprised the study group, while five healthy volunteers included the control group. In the study group, a beginning (24 h after the last rivaroxaban dose) examination was performed. Then, the effects of basal and four different anticoagulant doses (50 IU/kg unfractionated heparin (UFH), 100 IU/kg UFH, 0.5 mg/kg enoxaparin, and 1 mg/kg enoxaparin) on coagulation parameters were investigated at the 4th and 12th h following rivaroxaban intake. The effects of four different anticoagulant doses were evaluated in the control group. The anticoagulant activity was assessed mainly by anti-factor Xa (anti-Xa) levels. Beginning anti-Xa levels were significantly higher in the study group than in the control group (0.69 ± 0.77 IU/mL vs. 0.20 ± 0.14 IU/mL; p < 0.05). The study group's 4th and 12th-h anti-Xa levels were significantly higher than the beginning level (1.96 ± 1.35 IU/mL vs. 0.69 ± 0.77 IU/mL; p < 0.001 and 0.94 ± 1.21 IU/mL vs. 0.69 ± 0.77 IU/mL; p < 0.05, respectively). Anti-Xa levels increased significantly in the study group with the addition of UFH and enoxaparin doses at the 4th and 12th h than the beginning (p < 0.001 at all doses). The safest anti-Xa level (from 0.94 ± 1.21 to 2.00 ± 1.02 IU/mL) was achieved 12 h after rivaroxaban with 0.5 mg/kg enoxaparin. Anticoagulant activity was sufficient for urgent PCI at the 4th h after rivaroxaban treatment, and additional anticoagulant administration may not be required at this time. Twelve hours after taking rivaroxaban, administering 0.5 mg/kg of enoxaparin may provide adequate and safe anticoagulant activity for immediate PCI. This experimental study result should confirm with clinical trials (NCT05541757).

The prognostic significance of a fragmented QRS complex after primary percutaneous coronary intervention.

Fragmented QRS (fQRS) may occur due to non-homogeneous activation of ischemic ventricles. We want to investigate the prognostic significance of a fQRS complex in a patient who had undergone primary percutaneous coronary intervention (PCI). Eighty-five patients with no history of coronary artery disease who underwent primary PCI were included in the study. Of these patients, 34 who were found to have a fQRS at the 48th hour after primary PCI were defined as group 1, and 51 who were found not to have a fQRS were defined as group 2. Both groups were monitored for adverse cardiac events. At 6.6 ± 2.3 months of follow-up, major adverse cardiac events (MACE) was found significantly higher in the fQRS group [group 1:10 (29.4%) vs. group 2:3 (5.9%); p:0.003]. In multivariate Cox regression analysis; the duration of chest pain (HR:1.02, CI:1.004-1.05; p = 0.03) and fQRS at 48th hour (HR 7.16, CI 3.17-20.11; p = 0.006) were predictors of MACE. In the group 2, event-free survival rate was found significantly higher; however, Q wave and QRS distortion were found to be insignificant with regard to demonstrating event-free survival. Compared to both Q wave and QRS distortion, fQRS showed high sensitivity and specificity in demonstrating MACE (sensitivity 0.77; specificity 0.67; AUC 0.71 (0.57-0.86); p 0.01). fQRS had 73% sensitivity and 49% specificity and Q wave had 58% sensitivity and 85% specificity for demonstrating the presence of scar on myocardial perfusion scintigraphy with ROC curve analysis. The presence of a fQRS at the 48th hour is a significant predictor of MACE in patients with ST elevation myocardial infarction who have undergone primary PCI. (ClinicalTrials.gov number: NCT01136837).

Left ventricular hemangioma.

Primary cardiac tumors of the ventricles are very uncommon. Cardiac hemangiomas are extremely rare primary benign cardiac tumors that are often asymptomatic and are typically diagnosed incidentally during an echocardiographic examination. We report the case of a 27-year-old male who was referred to our hospital complaining of atypical chest pain over the last three months. The pain was unrelated to exercise, and consisted of 1-2 minutes of ongoing, stinging chest pain followed by 2-3 seconds of ongoing palpitations. His physical examination was unremarkable, his blood pressure was 130/80 mmHg, his ECG was sinus rhythm, and his heart rate was 82 beats/min. A transthoracic echocardiogram revealed a mobile 1.20x1.28 cm mass in the left ventricular cavity at the antero-lateral wall. Subsequent coronary angiography was performed to determine the vascular supply for the mass, and showed late opacification of a well-vascularized left ventricle mass from the second diagonal artery. Surgery was performed and the mass was complete resected. The pathological and histological examination of the resected mass showed that it was a hemangioma. The patient was discharged 5 days after surgery without symptoms.

The Predictive Value of the Left Atrial Kinetic Energy for Atrial Fibrillation Recurrence.

Background and aim Determining which patients will experience recurrence of atrial fibrillation (AF) is crucial for treatment modification. This study aimed to investigate the predictive value of left atrial kinetic energy (LAKE) in AF recurrence. Materials and methods A total of 120 consecutive patients who achieved sinus rhythm (SR) with electrical direct current cardioversion and met the inclusion criteria were included in the study. Transthoracic echocardiography (TTE) and LAKE values were calculated on the first day after cardioversion. Rhythm control was performed with 12-lead electrocardiography in the first-month follow-up. Results While 81 (67.5%) patients were in SR at one month, AF recurrence was detected in 39 (32.5%) patients. In the AF group, AF duration, cardioversion energy, number of diabetic patients, left atrium (LA) diameter, LA pre-mitral A wave volume, LA minimum volume, and pulmonary artery pressure values were significantly higher than in the SR group, while mitral A wave velocity and LAKE values were significantly lower. In multivariate regression analysis, AF duration (OR: 1.54; 95% CI: 1.22 - 1.93; p < 0.001), LA diameter (OR: 1.33; 95% CI: 1.10 - 1.61; p = 0.002), and LAKE (OR: 0.96; 95% CI: 0.94 - 0.99; p = 0.007) were determined to be independent predictors of AF recurrence at one month. Conclusions LA diameter, AF duration, and LAKE were found to be significant predictors of AF recurrence after cardioversion.