Predictors of Future Atrial Fibrillation Development in Patients with Hypertrophic Cardiomyopathy: A Prospective Follow-Up Study.

BACKGROUND: We evaluated whether left atrial (LA) phasic functions, P-wave dispersion (PWD), and plasma NT-proBNP levels could predict future development of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). METHODS: Seventy patients with HCM were evaluated. The LA phasic functions including the LA total emptying volume (LATEV), LA total emptying fraction (LATEF), LA active emptying volume (LAAEV), LA active emptying fraction (LAAEF), LA passive emptying volume (LAPEV), and LA passive emptying fraction (LAPEF) were evaluated. P-wave dispersion was calculated. Plasma NT-proBNP levels were measured on the same day with echocardiographic study. RESULTS: Patients were followed up 53.09 ± 1.87 months. Patients who developed AF (n = 18) had significantly higher PWD values, NT-proBNP levels, LAVI, E/E' av, and resting LVOT gradients and significantly lower LATEF and LAAEF. In multivariate analysis, LATEF (P = 0.002), LAAEF (P = 0.007), logNT-proBNP level (P = 0.022), and PWD (P = 0.018) were associated with AF development. The results of receiver operating characteristic analysis revealed that a LATEF cutoff value 49% with 72% sensitivity and 81% specificity, a LAAEF cutoff value of 36% with 72% sensitivity and 71% specificity, and an NT-proBNP cutoff value of 720 pg/mL predicted future AF development with 72% sensitivity and 60% specificity. A PWD cutoff value of 47.5 msecond predicted future AF development with 78% sensitivity and 72% specificity. CONCLUSION: In patients with HCM, LA phasic functions, PWD, and NT-proBNP levels predict future development of AF. Assessment of LA phasic functions during routine echocardiographic evaluation and measuring NT-proBNP levels and PWD values of patients with HCM during daily practice may provide important data in predicting those at high risk of AF occurrence.

Quality of life of patients with atrial septal defect following percutaneous closure.

INTRODUCTION: Quality of life has become an important outcome measure in addition to mortality and morbidity in patients with congenital heart disease. Atrial septal defect is a common congenital heart disease, and transcatheter atrial septal defect closure has become an accepted treatment modality. The aim of this study is to assess the quality of life of patients with atrial septal defect who underwent percutaneous closure. MATERIALS AND METHODS: We examined the quality of life of 69 patients with atrial septal defect and 69 healthy controls matched according to age, sex, educational level, and economic, marital, and employment status. Quality of life was investigated using the Turkish version of Short Form-36. RESULTS: The mean age of the patients was 39.7 ± 14.2 and 26% were male. The quality of life assessment was performed at a mean follow-up time of 18.0 ± 13.8 months after the intervention. The mean scores of the domains of the Short Form-36, namely, physical functioning, role functioning, social functioning, mental health, vitality, pain, and general health, were similar in patients with atrial septal defect who underwent percutaneous closure and the control group. CONCLUSION: Adult patients who underwent percutaneous atrial septal defect closure perceive their quality of life to be as good as their healthy counterparts.

Percutaneous closure of perimembranous ventricular septal defects associated with septal aneurysm in adults.

OBJECTIVE: Percutaneous closure of perimembranous ventricular septal defects (pmVSD) has become an accepted alternative to surgical closure in selected cases. However, closure of pmVSDs associated with septal aneurysm is more challenging. We report our experience of device closure of pmVSDs associated with septal aneurysm. METHODS: Between 2008 and 2012, percutaneous closure of pmVSD associated with septal aneurysm was attempted in 11 adult patients in our institution. The patients were followed up at 1, 3, 6, and 12 months after the procedure. RESULTS: Mean age of the patients (64% male, 36% female) was 36.2±1.3 years. Diameter of the left and right ventricular openings of the aneurysm measured by ventriculography was 13.5±5.6 mm and 5.9±2.2 mm, respectively. The defect was occluded with Amplatzer pmVSD Occluder in 4 patients, Amplatzer Muscular Ventricular Septal Defect Occluder in 4 patients, Amplatzer Duct Occluder I in 1 patient, and Amplatzer Duct Occluder II in 2 patients (AGA Medical Corp., Plymouth, MN, USA). The procedure was succesfull in all patients. Mean follow-up time was 22±1.9 months. There was no device- or procedure-related complications at the acute setting or mid-term follow-up. CONCLUSION: Percutaneous closure of pmVSDs associated with aneurysm is more challenging than that of simple defects. The selection of the device type and size should be made according to the configuration and size of the aneurysm and defect.

Frequency of angina and quality of life in outpatients with stable coronary artery disease in Turkey: insights from the PULSE study.

OBJECTIVE: Cardiologists' approach to angina in outpatients with stable coronary artery disease (CAD) is unclear. Therefore, we analysed data from the national multicentre, observational PULSE study to evaluate the frequency of angina, clinical variables affecting angina frequency and the impact of frequent angina on quality of life (QoL) in outpatients with stable CAD managed by cardiologists in secondary and tertiary health-care centres in Turkey. METHODS AND RESULTS: Adult outpatients with stable CAD in sinus rhythm were included. Data were collected at a single study visit from 83 centres. Patients were divided into five categories according to angina attack frequency. QoL was measured by the MacNew heart disease health-related QoL Questionnaire. The mean (standard deviation; SD) age of all patients (n = 2661) was 61.2 (10.2) years. Of 2,661 patients, 48.7% had no anginal attacks while 16.5% had minimal, 14.5% occasional, 12.2% regular and 8.1% frequent attacks. Angina attack frequency correlated positively with female sex, heart rate, the severity of angina. Emotional, physical, social, and global scores of QoL tended to decrease across angina attack frequency categories. Short- and long-acting nitrates, ivabradine were significantly more preferred in patients with higher frequency of angina attacks rather than beta blockers and calcium channel blockers. CONCLUSIONS: Insufficient angina control in outpatients with stable CAD requires reassessment of medical approach since it has a negative impact on QoL. The social and economic consequences of this burden should be sought on a national basis.

The incidence of chronic thromboembolic pulmonary hypertension secondary to acute pulmonary thromboembolism.

INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is a curable and partially preventable complication, with a substantial incidence, leading to severe morbidity and mortality. The aim of the present study was to find out the incidence of CTEPH secondary to acute pulmonary thromboembolism (PTE) using non-invasive procedures such as ventilation/perfusion (V/Q) scintigraphy and pulmonary multidetector CT (MDCT) angiography in determining the diagnosis of CTEPH. MATERIALS AND METHODS: The study included a total of 99 patients diagnosed with initial PTE between January 2010 and December 2012. The patients who received anticoagulant therapy at least for three months underwent transthoracic echocardiography (TTE) (n= 85). Thirty one patients with a SPAP value > 30 mmHg and/or an evidence of right ventricular dysfunction in TTE underwent MDCT pulmonary angiography and V/Q scintigraphy. The patients with an evidence of residual chronic thromboembolic signs in MDCT pulmonary angiography and/or segmental perfusion defect(s) in V/Q scintigraphy underwent right heart catheterization (RHC) (n= 7). The mean PAP was measured, and a vasoreactivity test was performed. During RHC, a non-contrast medium was delivered to the pulmonary arteries for pulmonary arteriography imaging. RESULTS: Among patients diagnosed with PTE, 44 were male and 55 were female. The mean age was 60 ± 17 years. Of these patients, 63.6% had history of at least one additional disease and at least one risk factor for PTE. During diagnosis, 24 subjects were considered having massive, 61 submassive and 14 non-massive PTE. Nineteen (19.1%) patients received thrombolythic therapy. Other 80 (80.8%) patients received standard anticoagulant therapy with an INR value within the therapeutic range. In 79.8% of patients, thromboembolism was bilateral, and it was unilateral in 21.8%. After a minimum of 1 year, and maximum of 2 years follow up five subjects (5.5%) were diagnosed with CTEPH. The univariate analysis showed no association between the development of CTEPH and factors like; age, etiologic risk factors for PTE, receiving thrombolytic treatment, prevalence and type of PTE. CONCLUSION: Potentially preventabl complication of pulmonary embolism; CTEPH, had a substantial incidence during follow-up.

[A case of occurring hemodynamic deterioration and ST-segment elevation during transcatheter aortic valve implantation]. / Kateter yoluyla aort kapagi yerlestirilmesi sirasinda hemodinamik bozukluk ve ST-segment yükselmesi gelisen bir olgu.

Transcatheter aortic valve implantation is becoming increasingly popular as an alternative treatment technique for symptomatic patients with severe aortic stenosis, who are at high risk for surgery. However, with this revolutionary treatment modality, some fatal complications have also emerged. One of these fatal complications is the occlusion of the left main coronary artery at the time of procedure. In this case report, we report a case of a transcatheter aortic valve implantation complicated by acute left main trunk subtotal occlusion and hemodynamic collapse, which was successfully recovered by balloon angioplasty and stent implantation.

Heart Failure Awareness Survey in a Turkish Population: HFAS-TR.

OBJECTIVE: Heart failure is a leading cause of death and the most common diagnosis leading to hospitalization. Its awareness is lower than that of other cardiovascular diseases, both in the general population and among patients with heart failure (HF). This study aimed to establish the current level of knowledge about HF in patients with HF with reduced ejection fraction (HFrEF) and mildly reduced ejection fraction (HFmrEF) in Türkiye. METHODS: This questionnaire-based survey study is multicenter, conducted across 34 centers from December 2021 to July 2022. We performed a survey consisting of two sets of questions focusing on individual characteristics of the patients and HF-related knowledge. RESULTS: The study included a total of 2,307 outpatient HF patients, comprising 70.5% males and 29.5% females with a mean age of 64.58 ± 13 (56-74) years and a mean body mass index value of 32.5 ± 10 kg/m2. HFrEF and HFmrEF were determined in 74.7% and 25.3% of patients, respectively. Thirty percent of the patients were unaware that they had HF. While 28.7% of the patients thought that they had sufficient information about HF, 71.3% believed they lacked adequate knowledge. In the study, 25.2% of the participants identified dyspnea, 22% identified tiredness, and 25.4% identified leg edema as the most common symptoms of HF. Only 27.4% of patients recognized all three typical symptoms of HF. CONCLUSION: We found that the study population's knowledge about HF symptoms and the nature of the disease was poor. Educational and awareness activities are necessary to optimize outcomes and benefits.

Obstruction of superior vena cava flow during transcatheter atrial septal defect closure with the Atriasept ASD occluder.

In this paper, we describe a patient with a large secundum atrial septal defect ASD (26 mm) with adequate rims that were suitable for percutaneous closure. While closing this ASD, the superior vena cava (SVC) was occluded with the right atrial disc of the Atriasept ASD occluder (Cardia) and thus the device was retrieved before its release. After retrieval of this device, an Amplatzer ASD occluder was successfully implanted without disturbing the caval flow.

Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER study.

OBJECTIVES: Although atrial fibrillation (AF) is one of the most common rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. STUDY DESIGN: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency departments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. RESULTS: The mean age of the patients was determined as 66.8 ± 12.3 years with female patients representing 60% of the study population. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co-morbidity in patients with AF. While a stroke or transient ischemic attack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspirin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. CONCLUSION: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

[Heart failure prevalence and predictors in Turkey: HAPPY study]. / Türkiye'deki kalp yetersizligi prevalansi ve öngördürücüleri: HAPPY çalismasi

OBJECTIVES: The aim of this study was to determine the prevalence of heart failure (HF) in adult residents of Turkey based on echocardiography and N-terminal B type natriuretic factor. STUDY DESIGN: 4650 randomly selected residents aged ≥ 35 years were enrolled. Height, weight, waist and hip circumference, and blood pressure measurements were taken, and a 12-lead ECG was performed. Advanced age, hypertension (HT), diabetes mellitus (DM), obesity, and chronic renal failure (CRF) were assessed. History of any heart disease, any abnormal ECG, or an NT-proBNP ≥ 120 pg/mL was accepted as echocardiography indication. Patients with systolic and/or diastolic dysfunction, or NT-proBNP ≥ 2000 pg/mL were classified as having HF if their functional capacity was NYHA ≥ Class II, and were classified as having asymptomatic left ventricular dysfunction (ASVD) if their functional capacity was NYHA

Comparison of DDD versus VVIR pacing modes in elderly patients with atrioventricular block.

OBJECTIVES: Dual-chamber pacing is believed to have an advantage over single-chamber ventricular pacing. The aim of this study was to determine whether elderly patients who have implanted pacemakers for complete atrioventricular block gain significant benefits from dual-chamber (DDD) pacemakers compared with single chamber ventricular (VVIR) pacemakers. STUDY DESIGN: This study was designed as a randomized, two-period crossover study-each pacing mode was maintained for 1 month. Thirty patients (16 men, mean age 68.87 ± 6.89 years) with implanted DDD pacemakers were submitted to a standard protocol, which included an interview, pacemaker syndrome assessment, health related quality of life (HRQoL) questionnaires assessed by an SF-36 test, 6-minute walk test (6MWT), and transthoracic echocardiographic examinations. All of these parameters were obtained on both DDD and VVIR mode pacing. Paired data were compared. RESULTS: HRQoL scores were similar, and 6MWT results did not differ between the two groups. VVIR pacing elicited significant enlargement of the left atrium and impaired left ventricular diastolic functions as compared with DDD pacing. Two patients reported subclinical pacemaker syndrome, but this was not statistically significant. CONCLUSION: Our study revealed that in active elderly patients with complete heart block, DDD pacing and VVIR pacing yielded similar improvements in QoL and exercise performance. However, after a short follow-up period, we noted that VVIR pacing caused significant left atrial enlargement and impaired left ventricular diastolic functions.

The Role of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) in Atrial Fibrillation: Treatment Management Based on Patient and Drug Characteristics.

Data from Turkey revealed that atrial fibrillation patient percentage under adequate anti- coagulation in Turkey is less than that in other countries due to multiple parameters such as treatment adherence problems, failure to follow guideline recommendations, negative perspective on the use of new drugs, drug costs, and payment conditions. The aim of this article is to provide physicians with a compiled resource that focuses on the differences between non-vitamin K antagonist oral anticoagulants and heterogeneity of atrial fibrilla- tion patients by reviewing the global and national data from a multidisciplinary perspective and provide guidance on the choice of non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients. A gastroenterologist, 2 neurologists, and 11 cardiologists from university and training and research hospitals in Turkey who are experienced in atrial fibrillation and non-vitamin K antagonist oral anticoagulant treatments gathered in 3 separate meetings to identify the review topics and evaluate the outcomes of the systematic literature search. Based on the pharmacological characteristics, clinical studies, and real-world data compari- sons, it has been revealed that non-vitamin K antagonist oral anticoagulants are not similar. Thromboembolism and bleeding risks, renal and hepatic functions, coexisting conditions, and concomitant drug usage have been shown to affect the levels of benefits gained from non-vitamin K antagonist oral anticoagulant in atrial fibrillation patients. Although Turkish patients with atrial fibrillation have been observed to be younger, they are more likely to have coexisting cardiovascular conditions compared to the atrial fibrillation patients in other countries. Selection of an appropriate non-vitamin K antagonist oral anticoagulant in line with the available evidence and recent guidelines will provide substantial benefits to atrial fibrillation patients.

Evaluation of demographic, clinical, and aetiological data of patients admitted to cardiology clinics and diagnosed with left ventricular hypertrophy in Turkish population (LVH-TR).

BACKGROUND: Left ventricular hypertrophy (LVH) is potentially modifiable cardiovascular risk factor often overlooked in clinical practice. For this reason, we planned to LVH-TR (Left Ventricular Hypertrophy in Turkish Population) trial to determine the aetiological causes and demographic characteristics of LVH patients. METHODS: Our study was a multicentre, national, observational study and included 886 patients who applied to the cardiology clinics in 22 centres between February 2020 and August 2021. In the initial evaluation, the Fabry disease (FD) and cardiac amyloidosis (CA) algorithm was followed in patients whose definitive etiologic cause(s) could not be identified. RESULTS: The most common aetiological causes of LVH in our study were hypertension with a rate of 56.6%, heart valve disease with 8.2%, and hypertrophic cardiomyopathy with 7.5%. Athlete's heart was detected in eight patients, LV non-compaction was detected in four patients. The rate of LVH of unknown cause was 18.8%. FD was suspected in 143 patients, and CA was suspected in 16 patients. There were 43 (4.85%) patients with low α-galactosidase A enzyme levels. GLA gene mutation analysis was positive in 1.58% of all patients, and these patients were diagnosed with FD, and 15 (1.69%) patients were diagnosed with CA by endomyocardial biopsy method. CONCLUSION: In the aetiology of LVH, the rate of LVH of unknown cause was high. FD and CA should be considered primarily in this patient group. Early diagnosis of the disease by following the schemes leading to FD and CA was essential in starting treatment before the progression of the disease.

Impact of a mass media campaign to increase public awareness of hypertension.

OBJECTIVES: We evaluated the effect of a nationwide media campaign on hypertension awareness in the population, which was implemented with the aim of spreading key messages related to optimal blood pressure levels and encouraging blood pressure measurements. STUDY DESIGN: A nationwide project called "12/8 Awareness Campaign" was implemented between October 2005 and January 2006 using all available mass and outdoor media aiming to improve the knowledge of people on normal blood pressure values and to encourage regular blood pressure measurements. Four survey questions to inquire the level of awareness related to optimal blood pressure levels, hypertension, and hypertension-related disease conditions were directed via face-to-face interviews to two separate samples representing the general Turkish population before (n=1716) and after (n=1725) the campaign, respectively. The answers of the pre- and post-campaign individuals were compared. RESULTS: After the campaign, the percentage of participants who did not know their blood pressure levels decreased from 54.8% to 47.8%, the percentage of those who checked their blood pressure within the past two months increased from 34.3% to 39.6%, and the percentage of those who were aware of the optimal blood pressure levels rose from 51.8% to 58.6% (p<0.001). CONCLUSION: The campaign contributed significantly to the awareness of hypertension in general population, which is highly encouraging for future efforts for early detection of hypertension and prevention of related morbidity and mortality.

Demographic, Clinical, and Angiographic Characteristics of Atrial Fibrillation Patients Suffering From de novo Acute Myocardial Infarction: A Subgroup Analysis of the MINOCA-TR Study Population.

BACKGROUND: Atrial fibrillation (AF) prevalence in patients with acute myocardial infarction (MI) ranges from 3% to 25%. However demographic, clinical, and angiographic characteristics of AF patients who admitted with de novo MI are unclear. The aim of this study was to investigate the prevalence of patients presenting with de novo MI with AF. METHODS: The study was performed as a sub-study of the MINOCA-TR (Myocardial Infarction with Non-obstructive Coronary Arteries in Turkish Population) Registry, a multicenter, cross-sectional, observational, all-comer registry. MI patients without a known history of stable coronary artery disease and/or prior coronary revascularization were enrolled in the study. Patients were divided into AF and Non-AF groups according to presenting cardiac rhythm. RESULTS: A total of 1793 patients were screened and 1626 were included in the study. The mean age was 61.5 (12.5) years. 70.7% of patients were men. The prevalence of AF was 3.1% (51 patients). AF patients were older [73.4 (9.4) vs. 61.0 (12.4) years, p<0.001] than non-AF patients. The proportion of women to men in the AF group was also higher than in the non-AF group (43.1% vs. 28.7%, p=0.027). Only 1 out of every 5 AF patients (10 patients, 19.6%) was using oral anticoagulants (OAC). CONCLUSIONS: AF prevalence in patients presenting with de novo MI was lower than previous studies that issued on AF prevalence in MI cohorts. The majority of AF patients did not have any knowledge of their arrhythmia and were not undergoing OAC therapy at admission, emphasizing the vital role of successful diagnostic strategies, patient education, and implementations for guideline adaptation.

[EUROASPIRE III: a comparison between Turkey and Europe]. / EUROASPIRE III: Türkiye ile Avrupa'nin karsilastirilmasi.

OBJECTIVES: The EUROASPIRE III survey was conducted in 2006-2007 in 22 countries in Europe (76 centers) to describe risk factors, lifestyle and therapeutic management of patients with coronary heart disease (CHD), compliance with current guidelines, and to document changes over time. This study aimed to assess the results of the EUROASPIRE III survey in terms of differences between Turkey and other European countries. STUDY DESIGN: The results of the EUROASPIRE III survey were compared with those of 17 centers from Turkey. Consecutive patients with a diagnosis of CHD (669 medical records, 23.8% women) were identified retrospectively, of which 338 patients (50.5%) were followed-up, interviewed, and examined at least six months after the index event (acute coronary syndrome or interventional procedure). RESULTS: Compared to the EUROASPIRE III data, recordings from Turkey's centers at discharge on classical risk factors did not exhibit remarkable differences; however, data on weight, height, waist circumference, lipid profile, glucose, and HbA1c measurements were more incomplete. In comparison to Europe population, the most important differences were observed in the higher rates of the following: young patients with myocardial infarction (>50 years, 20% vs. 12.7%), persistence in smoking (23.1% vs. 17.2%), immobility, low HDL-cholesterol (50.2% vs. 36.7%), insufficient follow-up by physicians after the index event (12% vs. 2.2%-except Turkey), and insufficient patient education. CONCLUSION: The data from the Turkey arm of the survey show that efforts for cardiovascular disease prevention fall short of the targets, similar to Europe.

[Preferences regarding invasive diagnostic procedures in patients aged 70 years or over presenting with acute coronary syndrome and relationship with short-term mortality]. / Akut koroner sendrom ile basvuran 70 yas ve üzeri hastalarda invaziv tanisal yöntem tercihleri ve bunun erken dönem mortalite ile iliskisi.

OBJECTIVES: We prospectively classified patients presenting with acute coronary syndrome (ACS) into two age groups, <70 years and ≥70 years, and investigated the frequency of cardiac catheterization, the predictors of cardiac catheterization in the older patient population, and determined early mortality in patients treated with or without cardiac catheterization. STUDY DESIGN: The study included 1,101 patients admitted with ACS. The patients were prospectively classified in two age groups, <70 years (n=762; mean age 55±9 years) and ≥70 years (n=339; mean age 76±5 years). Data on demographic characteristics, clinical and laboratory findings, and the presence or absence of cardiac catheterization were recorded. The predictors of cardiac catheterization were assessed in the overall patient group and in those ≥70 years of age, and 30-day mortality rates were determined. RESULTS: Compared with the older group, in younger patients cardiac catheterization was more frequent (74.4% vs. 50.7%, p=0.0001) and earlier (p=0.023), and decision for percutaneous coronary intervention was more common (52.7% vs. 40.7%, p=0.010), whereas coronary bypass grafting was performed more frequently in the older group (43% vs. 31.2%, p=0.010). Overall 30-day mortality rates showed significant differences in both groups between patients treated with or without cardiac catheterization (<70 years: 3.7% vs. 18.3%, p<0.0001; ≥70 years: 5.6% vs. 21%, p<0.0001). Logistic regression analysis showed the following as significant predictors of cardiac catheterization in patients ≥70 years of age: heart failure (OR: 3.853, p=0.017), systolic blood pressure <100 mmHg (OR: 3.602, p=0.008), creatinine clearance <60 ml/min (OR: 2.761, p=0.001), and ST-segment elevation ≥1 mm on the electrocardiogram (OR: 2.817, p=0.0001). CONCLUSION: Invasive diagnostic and therapeutic strategies are implemented less frequently in elderly patients. These procedures, which offer obvious mortality benefit, should be considered in elderly patients after meticulous risk evaluation.

[Percutaneous closure of ventricular septal defects in adult patients: our initial experience]. / Eriskinlerdeki ventriküler septal defektlerin perkütan kapatilmasinda ilk deneyimlerimiz.

OBJECTIVES: We evaluated our initial experience with percutaneous closure of ventricular septal defects (VSD) in adult patients. STUDY DESIGN: Percutaneous closure of VSDs in adult patients was launched in 2007 in our center. This study included the first five patients (3 women, 2 men; mean age 32.6 years; range 17 to 44 years) with a perimembranous (n=4) or muscular (n=1) VSD. Before percutaneous intervention, all the patients were assessed by transthoracic (TTE) and, when necessary, transesophageal (TEE) echocardiography, heart catheterization, and ventriculography. Percutaneous closure was performed under fluoroscopy and TEE or TTE guidance using the Amplatzer device (perimembranous asymmetric VSD occluder in perimembranous VSDs and muscular VSD occluder in muscular VSD). RESULTS: The mean VSD diameter was 7.4 mm (range 5 to 11 mm) by echocardiography, and 8.2 mm (range 6 to 11 mm) by ventriculography. The mean left ventricular end-diastolic diameter was 47.2 mm, and the mean distance between the VSD and the aorta was 5.6 mm. Percutaneous closure was successful in all the patients. Ventriculography obtained immediately after the procedure showed minimal passage from the interventricular septum in three patients, but there was no passage on control TTE examination on the first day after the procedure. Aortic, tricuspid, and mitral valves showed normal function. No rhythm problems were seen. All the patients were discharged within one or two days after the procedure. CONCLUSION: Percutaneous closure of VSDs has become a good alternative to surgical repair in recent years, with high success rates and low morbidity. The results of percutaneous closure of VSDs are also successful in adult patients.

Additive prognostic value of NT-proBNP over TIMI risk score in intermediate-risk patients with acute coronary syndrome.

OBJECTIVES: We evaluated the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for further risk stratification of intermediate-risk patients with non-ST elevation acute coronary syndromes (NSTE-ACS). STUDY DESIGN: The study included 137 intermediate-risk patients (85 men, 52 women; mean age 62+/-11 years) with ACS, based on the TIMI risk score (scores 3 to 5). Serum NT-proBNP levels were measured 12 hours after the last anginal episode. The patients were divided into four groups according to the following NT-proBNP quartiles: 17-310 pg/ml (n=34), 313-688 pg/ml (n=35), 724-2,407 pg/ml (n=34), and 2,575-24,737 pg/ml (n=34). Primary endpoint of the study was mortality. The mean follow-up was 21.8+/-7.1 months. RESULTS: There were 27 deaths (19.7%), 14 of which were in the 4th quartile (4th vs 1st, 2nd, and 3rd quartiles: p=0.02, p=0.01, and p<0.01, respectively). The first three quartiles did not differ significantly in this respect. In Kaplan-Meier analysis, patients in the 4th quartile had the lowest cumulative survival (log rank test, 4th vs 1st, 2nd, and 3rd quartiles: p=0.041, p=0.026, and p=0.009, respectively). NT-proBNP level was significantly higher in nonsurvivors than in survivors (p=0.01). In univariate analysis, mortality was also associated with the TIMI risk score, ejection fraction, and age. Patients who died were older (65.6+/-11.9 years vs 60.7+/-11.0 years; p=0.048) and had a lower ejection fraction (46.3+/-11% vs 54.1+/-9.8%; p<0.001) than patients who survived. Mortality rates corresponding to TIMI risk scores of 3, 4, and 5 were 25.9%, 29.6%, and 44.4%, respectively (p=0.58 for TIMI 3 vs 4; p=0.001 for TIMI 3 vs 5; p=0.013 for TIMI 4 vs 5). Cox proportional hazards regression analysis showed that only TIMI risk score was an independent predictor of mortality (hazard ratio 2.3, 95% confidence interval 1.4-3.8, p=0.001). CONCLUSION: NT-proBNP has an additive predictive value over TIMI risk score in predicting long-term mortality in intermediate-risk patients with ACS.

[The efficiency and safety of balloon valvuloplasty in patients with mitral stenosis and a high echo score: mid- and short-term clinical and echocardiographic results]. / Mitral darligi olan ve eko skoru yüksek hastalarda balon valvüloplastinin etkinlik ve güvenilirligi: Erken-orta dönem klinik ve ekokardiyografik sonuçlar.

OBJECTIVES: We aimed to evaluate the success and safety of percutaneous mitral balloon valvuloplasty (PMBV) and its mid-term clinical and echocardiographic results in patients with symptomatic mitral stenosis, including those having a high echo score (9 to 11). STUDY DESIGN: This prospective study included 57 consecutive patients (9 men, 48 women; mean age 41+/-9 years) who underwent PMBV with the Inoue technique for symptomatic (NYHA class II-IV) mitral stenosis (valve area <1.5 cm2). The patients were divided into two groups according to the echo scores of 8 (group 2, n=32). Clinical and echocardiographic evaluations were performed before and after 24-48 hours of PMBV and during the follow-up period, including restenosis and major cardiovascular events. RESULTS: Patients in group 2 had significantly higher rates of atrial fibrillation (53.1% vs. 16%; p=0.006) and functional capacity of NYHA class III-IV (90.7% vs. 56%; p=0.01). Procedural success rates were 96% (n=24) and 90.6% (n=29) in group 1 and 2, respectively. Failure occurred in one patient (4%) in group 1, and in three patients (9.4%) in group 2. One patient in group 1 developed severe mitral stenosis resulting in valve replacement. In group 2, two patients developed hemopericardium. After the procedure, there was a two-fold increase from 1.0+/-0.1 cm2 to 2.0+/-0.2 cm2 in the mean valve area, being more prominent in group 1 (group 1: from 1.1+/-0.1 cm2 to 2.1+/-0.1 cm2; group 2: from 0.9+/-0.1 cm2 to 1.8+/-0.1 cm2; p<0.001). In-hospital mortality or embolic events did not occur, nor did restenosis or major cardiovascular events during a mean follow-up of 21+/-13 months. CONCLUSION: Our results show that PMBV can be performed successfully in patients having a low (