The Effect of Uric Acid and Albumin Ratio in Undergoing Lower Extremity Endovascular Interventions For Peripheral Arterial Disease Related Contrast Induced Nephropathy.

BACKROUND: Among patients undergoing percutaneous vascular intervention, contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality.Serum uric acid/albumin ratio (UAR) has emerged as a new marker associated with poor cardiovascular outcomes. We aimed to evaluate the relationship between UAR and CIN occurrence in patients treated for peripheral artery disease. METHODS: Patients underwent percutaneous intervention due to peripheral artery disease were enrolled. The primary endpoint was development of contrast related nephropathy. Patients were divided into two groups according to the CIN occurrence. RESULTS: 663 patients were enrolled and mean age was 62±10 years. After the intervention, 45 patients had CIN and 618 patients did not have CIN. Logistic regression analysis were performed to define the parameters of CIN. Male gender, diabetes, uric acid /albumin ratio, contrast volume, presence of coronary artery disease and CRP levels were found significant in univariate analysis. However, only UAR was found significant in multivariate analysis (OR 95% CI: 3.426 (1.059-11.079), (p=0.040)).Therefore ,it is the only independent predictor for occurrence of CIN. CONCLUSION: UAR is a reliable scoring system, which predicts CIN in such patient group. This score is not only cost-effective also simple, which can be easily applied into the clinical practice.

Can we predict bleeding at admission in Crimean-Congo hemorrhagic fever?

BACKGROUND: In Crimean-Congo hemorrhagic fever, bleeding has a significant impact on the prognosis of the disease. In our study, we aimed to identify independent risk factors for the development of bleeding in Crimean-Congo hemorrhagic fever and to contribute to the management of the disease. METHODS: Cases with a definitive diagnosis of Crimean-Congo hemorrhagic fever were divided into two groups: those who developed bleeding and those who did not. Demographic, clinical and laboratory parameters were subjected to logistic regression analysis in terms of risk factors for bleeding development. Cut-off values for numerical variables were determined by receiver operating characteristics. RESULTS: A total of 74 patients diagnosed with CCHF were included in the study. Bleeding occurred in at least one defined focus in 21 patients. In the multivariate logistic regression model, procalcitonin, days from symptom onset to admission, platelet count, and d-dimer were identified as independent risk factors for bleeding development. Procalcitonin had the most significant effect, with an approximately 5.3-fold increase in bleeding risk for each unit increase in its level. For discriminate bleeding, LDH and ferritin exhibited the highest sensitivity, while procalcitonin showed the highest specificity. CONCLUSION: This study demonstrates the potential use of specific clinical and laboratory variables to predict bleeding development in CCHF patients. Procalcitonin elevation and the time from symptom onset to hospital admission have a significant effect in predicting bleeding.

The effect of preemptive retrolaminar block on lumbar spinal decompression surgery.

PURPOSE: Spinal decompression surgery causes severe pain. Retrolaminar block (RLB) is block, which is done by infiltration of local anesthetic to block spinal nerves between the lamina and superior costotransversospinalis muscle. The primary aim of this study is to evaluate the effectiveness of RLB on postoperative analgesia in patients undergoing spinal surgery. Secondary aims are effects on additional anesthetic and analgesic consumption. METHODS: The sixty (60) patients who underwent lumbar spinal surgery between May 2020 and May 2021 under general anesthesia with or without applied preemptive RLB for postoperative analgesia were included in this prospective observational study. Group I received ultrasound-guided preemptive RLB. In Group II, no intervention was performed. Postoperative VAS scores were compared in groups as primary outcome, perioperative additional anesthetic and analgesic needs were compared as secondary outcome. RESULTS: There was a significant difference between the groups in favor of the RLB group in terms of postoperative VAS scores at rest [1.33 (0.33-3.509)] and movement [2.40 (1.20-4.00)] (p < 0.001). Perioperative sevoflurane consumption was significantly low in block group (p < 0.001). Postoperative tramadol consumption was lower in Group I compared with Group II [Group 1: 200 (100-300); Group 2: 37.5 (0-200); p < 0.001]. CONCLUSION: Preemptive RLB may be used to reduce patients' pain in lumbar decompression surgery as well as to be part of a multimodal analgesia and anesthesia regimen to reduce anesthetic and analgesic drug consumption. Trial registration numberClinicalTrials.gov (No. NCT04209907).

A single center study of the efficacy and safety of Pro-Glide used for closure in thoracic endovascular aortic repair in patients with previous groin intervention.

BACKGROUND: This study aimed to evaluate the efficacy and safety of Pro-Glide, a suture-mediated vascular closure device, regarding technical success and complications in patients who had undergone aortic intervention and had previous groin intervention (PGI). METHODS: One hundred and thirty-five patients who underwent percutaneous thoracic endovascular aortic repair via the femoral artery and were closed with the Pro-Glide device were analyzed retrospectively. PGI was defined as a history of open surgical access to the femoral artery or wide sheath (>18 F) placement due to endovascular or valvular intervention. The patients were divided into two groups 38 cases with PGI and 97 cases without PGI. RESULTS: The overall success rate of closure of the femoral artery with Pro-Glide was not statistically significant between the two groups (93.8% vs 92.1%, p = .711). Sheath sizes were compared between the groups and PGI (+) group had significantly higher sheath sizes compared to PGI (-) group (24.3 ± 1.1 F vs 23.8 ± 1.0 F, p = .011). Three patients in the PGI (+) group and six patients in the PGI (-) group experienced technical failure of the percutaneous femoral approach. Femoral complications were seen after the procedures in four patients in the PGI (+) group and four in the PGI (-) group. The PGI (+) group had a higher complication rate when compared to the PGI (-) group; however, this was not statistically significant (p = .181). CONCLUSION: The present study was conducted on a significantly larger sample compared to previous studies and the findings suggest that the Pro-Glide vascular closure device is a safe option for patients with a history of PGI and may not be considered as a contraindication.

Total, free, and bioavailable 25-hydroxyvitamin D levels in patients with periodontitis (stage III): a case-control study.

OBJECTIVE: The aim of this study was to investigate the relationship between total, free and bioavailable 25-hydroxyvitamin D levels, and periodontitis. MATERIALS AND METHODS: Thirty-nine patients with periodontitis diagnosis and 44 healthy participants were included in this study. 25-Hydroxyvitamin D, vitamin D-binding protein, procalcitonin, and albumin levels were measured from the serum samples obtained. Free and bioavailable 25-hydroxyvitamin D levels were calculated. Total, free, and bioavailable 25-hydroxyvitamin D levels were compared between the healthy control and periodontitis groups. The association of total 25 (OH)D levels with periodontitis was tested through univariate analysis and multivariate logistic regression. RESULTS: Total 25-hydroxyvitamin D, bioavailable 25-hydroxyvitamin D, and free 25-hydroxyvitamin D levels were significantly lower in the periodontitis group than in the healthy control group (p < 0.001). In the logistic regression analysis, a significant correlation was observed between total 25-hydroxyvitamin D and periodontitis (p<0.001). CONCLUSION: Our study shows that there is a relationship between total, free and bioavailable 25-hydroxyvitamin D levels and periodontitis. In addition, it has been shown that the determination of free and bioavailable 25-hydroxyvitamin D levels does not provide additional advantages in terms of the relationship between periodontitis and vitamin D. CLINICAL RELEVANCE: In this case-control study, we examined the relationship between total, free and bioavailable 25-hydroxyvitamin D and periodontitis. We found lower total, free, and bioavailable 25-hydroxyvitamin D levels in periodontitis patients. It was also found that vitamin D-binding protein may be an important biomarker in the identification of various forms of periodontal disease. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT05343273.

The association of left atrial mechanics with left ventricular morphology in patients with hypertrophic cardiomyopathy: a cardiac magnetic resonance study.

Purpose: Hypertrophic cardiomyopathy (HCM) is related with structural and pathologic changes in the left atrium (LA) and left ventricle (LV). The aim of this study was to explore the association between LA mechanics and LV characteristics in patients with HCM using cardiac magnetic resonance feature tracking (CMR-FT). Material and methods: A total of 76 patients with HCM and 26 healthy controls were included in the study. The parameters including the extent of LV late gadolinium enhancement (LGE-%) and the LV early diastolic longitudinal strain rate (edLSR) were assessed for LV. LA conduit, booster, and reservoir functions were assessed by LA fractional volumes and strain analyses using CMR-FT. HCM patients were classified as HCM patients without LGE, with mild LGE-% (0% < LGE-% l 10%), and prominent LGE-% (10% < LGE-%). Results: HCM patients had worse LA functions compared with the controls (p < 0.05). The majority of LA functional indices were more impaired in HCM patients with regard to LGE. LA volumes were higher in HCM patients with prominent LGE-% compared with HCM patients with mild LGE-% (p < 0.05). However, only a minority of LA functional parameters differed between the 2 groups. LA strain parameters showed weak to modest correlations with LV LGE-% and LV edLSR. Conclusions: LV characteristics, to some extent, influence LA mechanics, but they might not be the only factor inducing LA dysfunction in patients with HCM.

Efficacy and Safety of Trastuzumab Emtansine in Her2 Positive Metastatic Breast Cancer: Real-World Experience.

AIM: The aim of this study is to evaluate the efficacy and toxicity of trastuzumab emtansine (T-DM1) in cases with metastatic breast cancer (mBC) in different lines of treatment. METHOD: Retrospective analysis of T-DM1 results of human epidermal growth factor receptor 2 (Her2) positive 414 cases with mBC from 31 centers in Turkey. FINDINGS: Except 2, all of the cases were female with a median age of 47. T-DM1 had been used as second-line therapy in 37.7% of the cases and the median number of T-DM1 cycles was 9. Progression-free survival (PFS) and overall survival (OS) times were different according to the line of treatment. The median OS was found as 43, 41, 46, 23 and 17 months for 1st, 2nd, 3rd, 4th and 5th line, respectively (p = 0.032) while the median PFS was found as 37, 12, 8, 8 and 8 months, respectively (p = 0.0001). Treatment was well tolerated by the patients. The most common grade 3-4 adverse effects were thrombocytopenia (2.7%) and increased serum gamma-glutamyl transferase (2%). DISCUSSION: The best of our knowledge this is the largest real-life experience about the safety and efficacy of T-DM1 use in cases with mBC after progression of Her2 targeted treatment. This study suggests and supports that T-DM1 is more effective in earlier lines of treatment and is a reliable option for mBC.

The predictive value of CHADS2 score for subclinical cerebral ischemia after carotid artery stenting (from the PREVENT-CAS trial).

BACKGROUND: Carotid artery stenting (CAS) is being increasingly used as an alternative revascularization procedure to carotid endarterectomy; however, subclinical ischemic cerebral lesions after CAS remain as a matter of concern. Hence, we aimed to assess the clinical utility of the CHADS2 score in predicting subclinical ischemic events after CAS. METHODS: We prospectively evaluated 107 patients (mean age: 70.4 ± 6.6 years, male:77) who underwent CAS for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after CAS were excluded. The presence of new hyperintense lesion on diffusion-weighted imaging (DWI) without any neurological findings was considered as silent ischemia. Patients were classified into two groups as DWI-positive and DWI-negative patients. RESULTS: Among study population, 28 patients (26.2%) had subclinical embolism. The DWI-positive group had a significantly higher CHADS2 scores, older age, more frequent history of stroke, higher proportion of type III aortic arch, and longer fluoroscopy time than the DWI-negative group. Increased CHADS2 score was identified as one of the independent predictors of silent embolism (OR = 5.584; 95%CI: 1.516-20.566; p = .010), and CHADS2 score higher than 2.5 predicted subclinical cerebral ischemia with a sensitivity of 72% and a specificity of 71% (AUC: 0.793; 95% CI: 0.696 - 0.890; p < .001). CONCLUSIONS: CHADS2 score was able to predict the risk of periprocedural subclinical ischemic events in CAS and might be of clinical value in the management of patients with carotid artery stenosis.

Impacting Water Droplets Can Alleviate Dust from Slanted Hydrophobic Surfaces.

Water droplet impacting on a slanted dusty hydrophobic surface is examined in relation to dust mitigation from surfaces. Impacting droplet characteristics including droplet spreading/retraction rates, slipping length, and rebound heights are analyzed via high-speed recording and a tracker program. The environmental dust characteristics in terms of size, shape, elemental composition, and surface free energy are evaluated by adopting the analytical methods. The findings reveal that the dynamic characteristics of the impacting droplet on the slanted hydrophobic surface are significantly influenced by the dust particles. The maximum droplet spreading over the dusty surface becomes smaller than that of the nondusty surface. The presence of the dust particles on the slanted hydrophobic surface increases energy dissipation, and the water droplet slipping length over the surface becomes less than that corresponding to the nondusty surface. Impacting droplet fluid infuses over the dust particle surface, which enables mitigation of dust from the surface to the droplet fluid. A dust-mitigated area on the slanted surface is larger than that corresponding to the horizontal surface; in which case, the area ratio becomes almost six-fold, which slightly reduces with increasing Weber number. The optical transmittance of the dust-mitigated surface by the impacting droplet remains high.

Fever of unknown origin (FUO) on a land on cross-roads between Asia and Europa; a multicentre study from Turkey.

AIMS: The differential diagnosis of Fever of Unknown Origin (FUO) is still a major clinical challenge despite the advances in diagnostic procedures. In this multicentre study, we aimed to reveal FUO aetiology and factors influencing the final diagnosis of FUO in Turkey. METHODS: A total of 214 patients with FUO between the years 2015 and 2019 from 13 tertiary training and research hospitals were retrospectively evaluated. RESULTS: The etiologic distribution of FUO was infections (44.9%), malignancies (15.42%), autoimmune/inflammatory (11.68%) diseases, miscellaneous diseases (8.41%) and undiagnosed cases (19.62%). Brucellosis (10.25%), extrapulmonary tuberculosis (6.54%) and infective endocarditis (6.54%) were the most frequent three infective causes. Solid malignancies (7.1%) and lymphoma (5.6%), adult-onset still's disease (6.07%) and thyroiditis (5.14%) were other frequent diseases. The aetiological spectrum did not differ in elderly people (P < .05). Infections were less frequent in Western (34.62%) compared with Eastern regions of Turkey (60.71%) (P < .001, OR: 0.31, 95% Cl: 0.19 to 0.60). The ratio of undiagnosed aetiology was significantly higher in elderly people (p: 0.046, OR: 2.34, 95% Cl: 1.00 to 5.48) and significantly lower in Western Turkey (P: .004, OR: 3.07, 95% Cl: 1.39 to 6.71). CONCLUSIONS: Brucellosis, extrapulmonary tuberculosis and infective endocarditis remain to be the most frequent infective causes of FUO in Turkey. Solid tumours and lymphomas, AOSD and thyroiditis are the other common diseases. The aetiological spectrum did not differ in elderly people, on the other hand, infections were more common in Eastern Turkey. A considerable amount of aetiology remained undiagnosed despite the state-of-the-art technology in healthcare services.

Clinical efficacy and safety of the PRO-glide device as a sUture-mediated ClosurE in Thoracic EndoVascular Aortic Repair in patients with previous groin intervention (from the PRODUCE-TEVAR Trial).

BACKGROUND: While the percutaneous approach is increasingly preferred, suture-mediated closure devices have been put into clinical practice to close the femoral artery during procedures requiring a large-sized introducer. However, scar in the groin is considered a contraindication or an exclusion criterion for percutaneous procedures. The aim of our study was to investigate the outcomes and safety of Pro-Glide device as suture-mediated closure device in patients who underwent thoracic endovascular aortic repair with percutaneous femoral access ≥22 F who had previous groin intervention. METHODS: A total of 73 patients who underwent endovascular repair with percutaneous femoral access were retrospectively included in the study. Previous groin intervention was defined as history of open surgical access or large sheath insertion (>18 F) to femoral artery because of endovascular or valvular intervention. Patients were divided into two groups as who had previous groin intervention PGI (+) and had not PGI (-). RESULTS: A total of 73 patients [60 male (82.2%)] were included in the study. Seventeen patients had PGI, and 56 did not. When groups were compared in terms of sheath sizes, a significantly higher sheath sizes were used in PGI (+) patients (24.5 ± 1.1 F vs. 23.8 ± 0.9 F, p = 0.005). The overall success rate in the femoral approach with pre-close technique was statistically insignificant between two groups (94.1% vs. 96.4%, p = 0.55). One patient in PGI (+) group and two patients in PGI (-) had technical failure for percutaneous femoral approach. One patient (5.9%) in PGI (+) group and one patient (1.8%) in PGI (-) group had femoral complications after the procedures; however, there was no significant difference between the groups in terms of complications (5.9% vs. 1.8%, p = 0.13). CONCLUSION: Pro-Glide device may be a safe and less invasive method for femoral access in patients with PGI and might not be considered as a contraindication for patients with history of PGI.

Comparison between PeRcutanEous and surgical femoral aCcess for endovascuLar aOrtic repair in patientS with typE III aortic Dissection (PRECLOSE Trial).

OBJECTIVES: Aortic dissections are cardiovascular events with high mortality and morbidity rates. Management might be either with medical or interventional approach. Recently, thoracic endovascular intervention (TEVAR) becomes the first treatment of choice because of its better results and lower rates of complications in patients with type III aortic dissections. The intervention might be performed via femoral artery either with percutaneous or with surgical approach. Because of large sheath insertion to femoral artery, Pre-close technique is described in literature. The aim of this study was to investigate and compare the outcomes and safety of 'Pre-close technique' to surgical approach in patients with type III aortic dissections who underwent TEVAR with femoral access ≥22 F. METHODS: A total of 96 patients whom had type III aortic dissection and was performed TEVAR were retrospectively included in the study. Fifty-six patients had TEVAR with percutaneous approach and these patients are named as P-TEVAR group, and 40 patients had TEVAR with surgical approach and these patients are named as S-TEVAR group. Pre- and post-procedural data with complications and procedural data during TEVAR were evaluated for both groups and compared in between. RESULTS: The main finding was that there was no significant difference between S-TEVAR and P-TEVAR groups in terms of complications and technical success. Operating room time was significantly decreased in P-TEVAR group (P < 0.001). Overall success rate for femoral approach in patients with Pre-close technique was 94.6% and was 100% for surgical approach. P-TEVAR group had post-operative complications in three patients and S-TEVAR group had in four patients. CONCLUSIONS: Total percutaneous approach with Pre-close technique using Pro-Glide device is a safe and feasible method of femoral access in patients with type III aortic dissections.

Prognostic influence of objective nutritional indexes on mortality after surgical aortic valve replacement in elderly patients with severe aortic stenosis (from the nutrition-SAVR trial).

AIM: Several scoring systems, such as controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI), have been previously described to show nutritional status. In the present study, we aimed to investigate the value of these scoring systems in predicting in-hospital and long-term mortality in patients undergoing surgical aortic valve replacement (SAVR). METHODS: PNI, GNRI, and CONUT were determined using the receiver operator characteristics curve analysis in 150 consecutive elderly patients (age: 70 (66-74) years, male: 78) who underwent SAVR due to degenerative severe aortic stenosis (AS). Patients were divided into two groups according to cutoff values from these indexes. RESULTS: During the 50 ± 31 months follow-up period, a total of 36 (24%) patients died. 30-day mortality, 1-year mortality, and total mortality were significantly higher in lower PNI, lower GNRI, and higher CONUT groups. PNI cutoff value was 49.2, GNRI cutoff value was 102.5, and CONUT cutoff value was 1.5. PNI ≤ 49.2, GNRI ≤ 102.5, and CONUT > 1.5 values were found to be independent predictors of total mortality even after risk adjustment. In addition, in the mortality group, PNI (53.7 ± 5.9 vs. 47.4 ± 6.3; p < .001) and GNRI (108 ± 10 vs. 99 ± 6.3); p < .001) were significantly lower, while CONUT score (1 [0-2] vs. 2 [0.2-3]; p < .001) was significantly higher. CONCLUSION: Objective nutritional indexes including CONUT score, PNI, and GNRI are important prognostic factors and those indexes should be part of frailty assessment in patients with severe AS.

Detection of a rare cause of pulmonary hypertension by multimodality imaging: Left ventricular endomyocardial fibrosis.

Endomyocardial fibrosis (EMF), a restrictive cardiomyopathy characterized by subendocardial fibrosis, is commonly seen in tropical and subtropical regions. EMF involving the left ventricle presents with severe pulmonary hypertension (PH) and is a rare cause of PH in non-tropical areas. Multimodality imaging is important for accurate diagnosis, especially cardiac magnetic resonance imaging which is the cornerstone. Herein, we report the case of a patient who presented with heart failure symptoms and severe PH, and in whom EMF was diagnosed by multimodality imaging.

Sliding Water Droplet on Oil Impregnated Surface and Dust Particle Mitigation.

Self-cleaning of surfaces becomes challenging for energy harvesting devices because of the requirements of high optical transmittance of device surfaces. Surface texturing towards hydrophobizing can improve the self-cleaning ability of surfaces, yet lowers the optical transmittance. Introducing optical matching fluid, such as silicon oil, over the hydrophobized surface improves the optical transmittance. However, self-cleaning ability, such as dust mitigation, of the oil-impregnated hydrophobic surfaces needs to be investigated. Hence, solution crystallization of the polycarbonate surface towards creating hydrophobic texture is considered and silicon oil impregnation of the crystallized surface is explored for improved optical transmittance and self-cleaning ability. The condition for silicon oil spreading over the solution treated surface is assessed and silicon oil and water infusions on the dust particles are evaluated. The movement of the water droplet over the silicon oil-impregnated sample is examined utilizing the high-speed facility and the tracker program. The effect of oil film thickness and the tilting angle of the surface on the sliding droplet velocity is estimated for two droplet volumes. The mechanism for the dust particle mitigation from the oil film surface by the sliding water droplet is analyzed. The findings reveal that silicon oil impregnation of the crystallized sample surface improves the optical transmittance significantly. The sliding velocity of the water droplet over the thick film (~700 µm) remains higher than that of the small thickness oil film (~50 µm), which is attributed to the large interfacial resistance created between the moving droplet and the oil on the crystallized surface. The environmental dust particles can be mitigated from the oil film surface by the sliding water droplet. The droplet fluid infusion over the dust particle enables to reorient the particle inside the droplet fluid. As the dust particle settles at the trailing edge of the droplet, the sliding velocity decays on the oil-impregnated sample.

Prevalence of Anxiety and Relationship of Anxiety with Coping Styles and Related Factors in Healthcare Workers During COVID-19 Pandemic.

BACKGROUND: The aim is to investigate anxiety prevalence among the healthcare workers during COVID-19 pandemic and the also relationship of "significant clinical anxiety" with coping styles and the related factors. SUBJECTS AND METHODS: An online questionnaire was performed to evaluate the anxiety responses of 544 healthcare workers, the adopted coping styles and the related factors during COVID-19 pandemic. The questionnaire included the subsections of sociodemographic data, other clinical data and the items on exposure to social media, Generalized Anxiety Disorder-7 (GAD-7) Scale and Coping Styles Scale Brief Form. RESULTS: Minimal, mild, moderate and severe anxiety were present in 214 (39.3%), 191 (35.1%), 95 (17.5%) and 44 (8.1%) participants, respectively. GAD-7 score was ≥10 in 139 (25.6%) of the participants indicating "significant clinical anxiety". Being female and a nurse were associated with significant clinical anxiety. In addition, the parameters such as "concern about COVID-19, concern about infect COVID-19 to relatives, unwillingness to work, frequency of social media use about COVID-19, sleep disturbances and experiencing somatic symptoms" were observed to be extremely significantly more common in the healthcare workers with "significant clinical anxiety" than those without that mental condition. The regression analysis revealed that higher adoption of using emotional social support, one of the emotional focused coping styles and behavioral disengagement, one of the ineffektive focused coping styles are considered to be predictor of significant clinical anxiety. Whereas, positive reinterpretation, one of the emotional focused coping styles was a predictor in reduction of significant clinical anxiety. Also more frequent exposure to social media and sleep disturbances were the predictors of significant clinical anxiety in the healthcare staff. CONCLUSION: Our results have emphasized the factors that should be taken into account and application of coping styles that may be functional in protecting mental health of the healthcare workers in their struggle against a huge disaster affecting worldwide societies.

The Effect of Recanalization of a Chronic Total Coronary Occlusion on Atrial Conduction Velocities.

BACKGROUND: P-wave duration and P-wave dispersion (PWD) give information about inhomogeneous and discontinuous atrial conduction, which are believed to be the leading electrophysiological causes of atrial fibrillation. The aim of this study was to investigate the effect of percutaneous chronic total occlusion (CTO) revascularization on P-wave duration and PWD in electrocardiography (ECG). MATERIALS AND METHODS: We enrolled 98 consecutive patients with sinus rhythm who underwent percutaneous coronary interventions (PCIs) for CTO. The maximum (Pmax) and minimum P-wave duration and PWD were measured before CTO interventions and at the first and sixth months after the procedure. RESULTS: There was no significant differences between the successful and failed CTO PCI groups in pre-procedural demographic, clinical, laboratory, angiographic data, and ECG parameters. Pmax values and PWD at 1 month and 6 months after successful CTO PCI were statistically lower than those at baseline (p < 0.001), while there was no significant change in the failed CTO PCI group. PWD values were significantly lower at 6 months of follow-up, regardless of the target vessel (p = 0.010, p < 0.001, p < 0.001; for left anterior descending, circumflex and right coronary artery, respectively). Compared to pre-CTO values in all Rentrop classes, PWD values were significantly lower at the sixth month. CONCLUSIONS: This study demonstrated that Pmax and PWD, which are risk factors for atrial arrhythmias, significantly reduced within 1 and 6 months after successful CTO PCI irrespective of the target vessel.

Effect of lung resection on electrocardiography.

BACKGROUND: Post-operative changes in electrocardiography (ECG) after lung surgery have been investigated in prior researches. We have limited data about benign physiologic changes in ECG after lung surgery, specifically after lung resection. The aim of our study was to investigate relationship in between lung resection with minimally invasive robotic or video-assisted thoracoscopic surgery (VATS) and its effect on ECG after lung resection. METHODS: After exclusion criteria had been applied, a total of 133 patients were enrolled in the present study. Operational information such as amount of resected segment and side of resection was recorded. Lung resections were divided into two groups. One group included surgeries with lung resections <3 segments and other group included surgeries with segmentectomy ≥3 segments. Pre-operative and postoperative (in between 2nd and 3rd months) ECG data of the patients were compared. The location of resected segments as left-sided and right-sided resections were noted to compare the ECG changes for sub-analysis. RESULTS: Among 133 patients, 101 patients were male (75.9%). There was no significant difference between parameters including ventricular rate, P wave, QRS wave and T wave axis in degrees, PR, QRS, QT and QTc durations, Tpe interval, ratio of Tpe interval to QT and QTc interval and fQRSTa. There was significant difference between before and after resection in terms of degree of QRS axis (before resection =37.3 ± 52.7 vs. after resection = 26.2 ± 55.7, P = .026). Sub-analysis regarding to amount of resected segments, there was no significant difference identified in terms of QRS axis in degrees between before and after resection for patients who underwent lung resection <3 segments (p = .885). However, there was significant difference in QRS axis in degrees for patients who underwent lung resection ≥3 segments (before resection = 47.3 ± 57.5 vs. after resection = 23.7 ± 66.2, P = .010). There was significant rightward axial change after left-sided lung resections (before resection =32.0 ± 52.4 vs. after resection = 49.4 ± 47.1, P = .005) and leftward axial change after right-sided lung resection (before resection = 41.7 ± 53.0 vs. after resection = 7.1 ± 55.2, P < .001). CONCLUSION: Understanding and recognition of possible ECG changes are crucial during post-operative follow-up of the patients who underwent lung resection. These changes might be benign changes, which are related to anatomical and geometrical changes within thoracic cavity.

Evaluation of early electrocardiographic changes after successful percutaneous stent implantation to isolated coarctation of aorta.

BACKGROUND: Coarctation of aorta (CoA) is a congenital obstructive lesion characterized by narrowing of the aorta in which concludes as increase in afterload. Percutaneous stent implantation to CoA is a treatment of choice in older children and adults. Pathology related to CoA mainly caused by increased afterload and left ventricular hypertrophy. Electrocardiographic (ECG) findings are also related to left ventricular hypertrophy (LVH). Evidence shows that, in variety of diseases, the correction of the pathology might normalize ECG findings and ventricular dysfunction related to increase in afterload. Therefore the aim of this study was to compare the pre- and postprocedural ECG findings of the patients who underwent percutaneous intervention for isolated CoA. METHODS: After exclusion criterion was applied, 30 patients were included into study, retrospectively. ECG records before the procedure and 3 months after the procedure of the patients were evaluated. The parameters related to LVH, ventricular and atrial conduction were evaluated and compared between pre- and post-procedural ECG records. RESULTS: The findings showed that parameters of atrial conduction including P wave maximum duration (p < 0.001) and p wave dispersion (p < 0.001) were significantly decreased after stent implantation. Additionally, ventricular repolarization parameters including QT duration (p = 0.039), Tpe interval (p < 0.001), Tpe / QT (p = 0.038) and Tpe / QTc (p = 0.003) were significantly decreased after stent implantation. Sokolow-Lyon criteria (p < 0.003) and voltage in selected leads were significantly decreased after intervention. CONCLUSION: Percutaneous intervention to CoA might regress LVH parameters in ECG and improve atrial and ventricular repolarization in ECG, which might lead to decreased event of atrial and ventricular arrhythmias in patients with isolated CoA.

The effect of cardiac rehabilitation on blood pressure, and on left atrial and ventricular functions in hypertensive patients.

PURPOSE: Hypertension is associated with left ventricular (LV) hypertrophy, impaired LV relaxation, and left atrial (LA) enlargement. Cardiac rehabilitation (CR) improves clinical outcomes in a broad spectrum of cardiac disease. The aim of our study was to determine the effect of CR on blood pressure (BP), and on LA and LV functions in hypertensive patients. METHODS: Thirty consecutive hypertensive patients who would undergo CR program, and 38 hypertensive patients who refused to undergo CR program were included. All patients underwent ambulatory BP monitoring and transthoracic echocardiography, which were repeated after completion of the CR program, or 12 weeks later in the control group. LA and LV functions were assessed by both speckle tracking and 3-dimensional echocardiography. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were assessed before and after CR. RESULTS: Although initial ambulatory BP values and NT-proBNP levels were similar between the groups, daily, day-time, and night-time BP and NT-proBNP were significantly lower in the CR group after rehabilitation. LA reservoir strain and LV global longitudinal strain of the CR group significantly increased after CR while no significant increase was observed in controls. CONCLUSION: CR improves LA and LV strain while lowering BP and should be encouraged in routine management of hypertensive patients.