The anatomical relationship between the axillary artery and vein investigated by radial coronary angiography.

AIMS: To reduce the risk of inadvertent arterial puncture and bleeding, we aimed to define a safe puncture site by demonstrating the relation of the axillary artery and vein. METHODS: The anatomical course and relation as well as crossover sites of the axillary artery and vein, the presence of small arterial bridges over the axillary vein, and validation of commonly preferred axillary venous puncture sites were determined by simultaneous ipsilateral venography in patients (n  =  111; 80 men, age 60 ± 10 years) who underwent coronary angiography by radial artery access. RESULTS: The axillary vein was detected at the first costa-clavicular intersection in 62% and at the second anterior and third posterior costal intersection in 60% of the patients. Small arterial bridges over the axillary vein were observed in 77% of the patients and more frequently in females and body mass index ≥25 kg/m2 (P  =  0.034 and P  =  0.03, respectively). The axillary artery crossed the vein in 24% of the patients and almost always within the region close to the first costa-clavicular intersection site. CONCLUSION: Our study demonstrated a high crossover rate (24%) of axillary artery and vein and a high degree of variation in the course of axillary vein. Small arterial bridges over the axillary vein were observed in 77% of the patients.

Effect of acute sleep deprivation on left atrial mechanics assessed by three-dimensional echocardiography.

BACKGROUND: Although sleep deprivation (SD) affects cardiovascular system in many ways, physio-pathological changes in cardiac chamber volume and function have not been described well. The aim of the present study was to investigate the effect of SD on left atrial (LA) and ventricular function with three-dimensional (3D) echocardiography. METHODS: Thirty-two healthy individuals (12 females, mean age 33.25 ± 8.18) were evaluated. Echocardiographic examination was performed once after a night of regular sleep and a night of sleep debt. Beside conventional parameters, 3D phasic volumes and function were measured using a commercially available 3D echocardiography system and offline analysis software. RESULTS: Mean sleep duration of the study group was 8.15 ± 2.19 h in the day of regular sleep and 2.56 ± 2.25 h in the day of sleep deprivation. There was a significant prolongation in deceleration time (180.83 ± 15.34 vs. 166.44 ± 26.12; p = 0.044) and increase in E/e' (6.95 ± 1.26 vs. 6.38 ± 0.85; p = 0.005). Among 3D measurements, the difference in left ventricular ejection fraction (EF), LA EF, LA reservoir function and LA active EF were not significant. Mean LA passive EF of the individuals was significantly lower after night shift (24.10 ± 7.66 vs. 31.49 ± 7.75; p = 0.006). CONCLUSION: Acute SD is associated with a reduction in LA passive emptying function in healthy adults. 3D-derived indices were sufficient to show subclinical diastolic dysfunction according to impairment in passive phase of LA ejection. Prospective large-scale studies are needed to enlighten this issue.

Effect of acute sleep deprivation on heart rate recovery in healthy young adults.

BACKGROUND: Sleep deprivation (SD) is known to be associated with increased incidence of adverse cardiovascular events, but underlying pathophysiological mechanism has not been clearly demonstrated. Autonomic nervous system plays an important role in the regulation of cardiovascular function, and impairment in this system is associated with increased cardiovascular mortality. The aim of the current study was to investigate the effect of acute SD on autonomic regulation of cardiac function by determining heart rate recovery (HRR). METHODS: Twenty-one healthy security officers and nine nurses (mean age 33.25 ± 8.18) were evaluated. Treadmill exercise test was applied once after a night with regular sleep and once after a night shift in hospital. The HRR was calculated as the reduction in heart rate from peak exercise to the 30th second (HRR30), 1st minute (HRR1), 2nd minute (HRR2), 3rd minute (HRR3), and 5th minute (HRR5). The change in blood pressure (BP) measurements was also determined. RESULTS: Exercise capacity of individuals with SD was significantly lower (10.96 ± 1.01 vs. 11.71 ± 1.30 metabolic equivalent task (MET)s; p = 0.002), and peak systolic BP was significantly higher (173.8 ± 16.3 vs. 166.2 ± 9.9; p = 0.019). There was a signicant difference in HRR30 (12.74 ± 6.19 vs. 17.66 ± 5.46; p = 0.003) and HRR1 (31 ± 6.49 vs. 36.10 ± 7.78; p = 0.004). The ratio of these indices to peak HR was also significantly lower with SD (HRR%30 8.04 ± 4.26 vs. 10.19 ± 3.21; p = 0.025 and HRR%1: 18.66 ± 4.43 vs. 20.98 ± 4.72; p = 0.013). The difference in other indices of HRR was not significant. CONCLUSION: Our findings suggest that SD blunts cardiovascular autonomic response, and consequences of this relation might be more pronounced in subjects who are exposed to sleeplessness regularly or in subjects with baseline cardiovascular disease.

Giant Purulent Pericarditis with Cardiac Tamponade Due to Streptococcus intermedius Rapidly Progressing to Constriction.

Purulent pericardial effusion, although rare, is a life-threatening condition usually produced by the extension of a nearby bacterial infection locus or by blood dissemination in the immune-suppressed subjects or in the course of cardiothoracic surgery. Because clinical features of purulent pericardial effusion are often nonspecific, it can cause delay in diagnosis. Therefore, a high index of suspicion is required for timely diagnosis and management. Herein, we describe a case of giant purulent pericardial effusion due to Streptococcus intermedius with the history of bronchiectasis and pneumonia, which was successfully treated with pericardiocentesis via parasternal approach, appropriate antibiotics, and pericardiectomy.

The effect of urgent blood pressure reduction on left atrial strain in patients with hypertensive attack : Blood pressure lowering affects LA strain.

BACKGROUND: Left atrial (LA) strain is a robust measure of LA function and is a useful parameter to assess left ventricular filling pressure. While initially considered as a "load-independent" parameter of LA function, later studies have found that acute changes in LA preload may affect LA reservoir and contractile strains. Acute alterations in blood pressure (BP) induces a change in left ventricular (LV) filling pressure without imposing a volume load, thus providing an opportunity to assess the effects of the change in LA afterload on LA mechanics. This study aims to understand the effect of acute BP changes on LA strain. METHODS: A total of 40 patients admitted to the emergency department with hypertensive urgency were included. All patients underwent a comprehensive echocardiographic examination including measurement of LA reservoir, conduit and contractile strains. A repeat set of measurements were obtained after BP lowering. RESULTS: Average drop in mean BP following intervention was 18.1 ± 5.4%. LV end-systolic and end-diastolic volumes, as well as maximum and minimum LA volumes were decreased significantly after BP reduction. The absolute increases in reservoir and contractile strains were 2.3 ± 4.7% (7.9% ± 13.8% relative to baseline) and 2.5 ± 3.3% (13.5 ± 19.0% relative to baseline), respectively, with both changes being statistically significant (p = 0.003 for reservoir and p < 0.001 for contractile strains). There were no significant changes in conduit strain after BP intervention (p = 0.79). The change in both LA reservoir and contractile strains were more evident in those with a previous diagnosis of hypertension and those with a smaller degree of change in mean BP after intervention. CONCLUSION: In patients with an acute hypertension, lowering BP leads to an acute improvement in LA reservoir and contractile strains. Thus, acute changes in systemic BP should be considered when LA mechanics are evaluated.

The association between the configuration of tricuspid annular plane systolic excursion and right atrial contractile strain.

BACKGROUND: In the descending arm of tricuspid annular plane systolic excursion (TAPSE), there is notch formation that corresponds to the contractile phase of the atrial strain curve. Theoretically, this notch formation stands for atrial contraction. AIMS: We aim to characterize notch formation on TAPSE, predictors of its existence, and its relationship with the right ventricle and right atrial strain (RAS) parameters. METHODS: Retrospectively selected 240 patients were investigated for the determinants of notch formation on TAPSE and the relationship between RAS and TAPSE. RAS was analyzed using 2D speckle tracking in a dedicated mode for atrial analysis and reported separately for the reservoir, conduit, and contractile phases. RESULTS: 71.7% ( n = 172) of patients had notch formation on TAPSE and 70.4% (n = 169) had a normal value of right atrial contractile strain (RASct). Most patients with notch formation also had preserved RASct (95.9%; P <0.001). In multivariable analysis, RASct (odds ratio [OR], 1.45; 95% confidence interval [CI]: 1.13-1.77; P = 0.020) remained significant with notch formation. Receiver operator characteristic (ROC) analysis demonstrated that a RASct of -19% was a cut-off for the presence of notch formation. ROC area was 0.897 (95% CI 0.844-0.951; P <0.001). CONCLUSIONS: The changes in TAPSE configuration reflect the changes in the atrial contractile phase. The descending arm of TAPSE indicates RASct as to whether it is preserved or not. Notch formation persists if RASct is above -19%. So, an easier, more applicable, and more effortless tool, TAPSE, can be used as an indicator of the atrial contractile phase by its configuration in daily routine.

Prognostic value of TAPSE/PASP ratio in right ventricular failure after left ventricular assist device implantation: Experience from a tertiary center.

Background: In this study, we aimed to investigate the prognostic value of the tricuspid annular plane systolic excursion (TAPSE)/ pulmonary arterial systolic pressure (PASP) ratio in right ventricular failure patients undergoing left ventricular assist device implantation. Methods: Between February 2013 and February 2020, a total of 75 heart failure patients (65 males, 10 females; median age: 54 years; range, 21 to 66 years) were retrospectively analyzed. The prognostic value of TAPSE/PASP ratio was assessed using the multivariate Cox regression models and confirmed using the Kaplan-Meier analyses. Results: Forty-one (55.4%) patients had an ischemic heart failure etiology. The indication for assist device implantation was bridge to transplant in 64 (85.3%) patients. The overall survival rates at one, three, and five years following left ventricular assist device implantation were 82.7%, 68%, and 49.3%, respectively. Right ventricular failure was observed in 24 (32%) patients during follow-up. In the multivariate analysis, TAPSE/PASP was found to be independently associated with postoperative right ventricular failure (HR: 1.63; 95% CI: 1.49-2.23). A TAPSE/PASP of 0.34 mm/mmHg was found to be the most accurate predictor value, with lower ratios correlating with right ventricular failure. The Kaplan-Meier analysis showed a better overall survival using a TAPSE/PASP ≥ of 0.34 mm/mmHg (p<0.001). Conclusion: A lower TAPSE/PASP ratio, particularly lower values than 0.34 mm/mmHg, strongly predicts right ventricular failure after left ventricular assist device implantation in patients with advanced heart failure.

Alterations in right ventricular mechanics in patients with Behcet's disease.

Manifest myocardial involvement is somewhat rare in patients with Behcet's disease (BD), although echocardiographic studies suggest that subclinical alterations in left ventricular (LV) contractility is rather common. Data on right ventricular (RV) involvement in BD is rather scarce. This study aims to determine whether RV systolic performance is affected in BD patients, and to understand the clinical and echocardiographic correlates of RV contractility in these patients. Forty-five patients who fulfilled criteria for BD and 45 age and gender matched controls were enrolled. All participants underwent a comprehensive echocardiographic examination, including deformation imaging, to characterize RV mechanics. Conventional morphologic and echocardiographic indicators of RV morphology and function were not different between groups, but RV apical strain and RV free wall strain (FWS) were significantly lower in BD patients as compared to the controls (P < 0.001 and P = 0.02, respectively). The only significant correlates of FWS were tricuspid regurgitation velocity and related indices in healthy controls, while FWS correlated with LV global longitudinal strain (GLS), morphologic measures of left and right atria and ventricles, and with conventional measures of right ventricular contractility. The relationship between FWS and GLS remained statistically significant after adjusting for other clinical and echocardiographic parameters (ß = 0.379, P = 0.01). In patients with BD, there is a subclinical alteration in RV contractility and the degree of alteration in the RV systolic performance paralleled that of LV. Thus, present results support the presence of RV involvement in these patients.

Surgical results of chronic thromboembolic pulmonary endarterectomy in our recently developed program.

BACKGROUND: In this case series, we aimed to present our diagnostic workup, surgical management, and results of the patients who underwent pulmonary endarterectomy. METHODS: In this case series, a total of 26 patients (8 males, 18 females; median age: 58 years; range, 34 to 67 years) who were evaluated by a multidisciplinary team and were diagnosed with chronic thromboembolic pulmonary hypertension who underwent pulmonary endarterectomy in our clinic between November 2015 and December 2019 were included. Pulmonary endarterectomy procedure was performed in all cases under cardiopulmonary bypass and total circulatory arrest. The results of the procedures were analyzed retrospectively. RESULTS: Perioperative complications were observed in seven patients (26.9%) and in-hospital mortality rate caused by perioperative complications was 15.38%. At one-year of postoperative follow-up, the mean systolic pulmonary artery pressure decreased from 78±22 mmHg to 41±20 mmHg, pulmonary vascular resistance decreased from 698±10 dyn·s·cm-5 to 235±10 dyn·s·cm-5, 6-min walk distance increased from 345±10 m to 460±10 m and, arterial oxygen saturation increased from 85±3.5% to 95±4%. New York Heart Association functional class improvement from Class III-IV to Class I-II was observed in most patients, and one-year mortality rate was 19.23%. CONCLUSION: We suggest that patients diagnosed chronic thromboembolic pulmonary hypertension should be referred to cardiac surgery centers for pulmonary thromboendarterectomy, early before irreversible arteriopathy occurs.

[Consensus Report from Turkish Society of Cardiology: COVID-19 and Cardiovascular Diseases. What cardiologists should know. (25th March 2020)]. / Türk Kardiyoloji Dernegi Uzlasi Raporu: COVID-19 Pandemisi ve Kardiyovasküler Hastaliklar Konusunda Bilinmesi Gerekenler (25 Mart 2020).

In December 2019, in the city of Wuhan, in the Hubei province of China, treatment-resistant cases of pneumonia emerged and spread rapidly for reasons unknown. A new strain of coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) was identified and caused the first pandemic of the 21st century. The virus was officially detected in our country on March 11, 2020, and the number of cases increased rapidly; the virus was isolated in 670 patients within 10 days. The rapid increase in the number of patients has required our physicians to learn to protect both the public and themselves when treating patients with this highly infectious disease. The group most affected by the outbreak and with the highest mortality rate is elderly patients with known cardiovascular disease. Therefore, it is necessary for cardiology specialists to take an active role in combating the epidemic. The aim of this article is to make a brief assessment of current information regarding the management of cardiovascular patients affected by COVID-19 and to provide practical suggestions to cardiology specialists about problems and questions they have frequently encountered.

[Turkish Cardiology Association Consensus Report: COVID-19 Pandemic and Cardiovascular Diseases (May 13, 2020)]. / Türk Kardiyoloji Dernegi Uzlasi Raporu: COVID-19 Pandemisi ve Kardiyovasküler Hastaliklar Konusunda Bilinmesi Gerekenler (13 Mayis 2020).

In December 2019, in the city of Wuhan, in the Hubei province of China, treatment-resistant cases of pneumonia emerged and spread rapidly for reasons unknown. A new strain of coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) was identified and caused the first pandemic of the 21st century. The virus was officially detected in our country on March 11, 2020, and the number of cases increased rapidly; the virus was isolated in 670 patients within 10 days. The rapid increase in the number of patients has required our physicians to learn to protect both the public and themselves when treating patients with this highly infectious disease. The group most affected by the outbreak and with the highest mortality rate is elderly patients with known cardiovascular disease. Therefore, it is necessary for cardiology specialists to take an active role in combating the epidemic. The aim of this article is to make a brief assessment of current information regarding the management of cardiovascular patients affected by COVID-19 and to provide practical suggestions to cardiology specialists about problems and questions they have frequently encountered.