Frontal Plane QRS-T Angle as a Marker of Cardiac Iron Overload in Patients with Beta Thalassemia Major.

Introduction: Cardiomyopathy due to myocardial iron deposition is the leading cause of death in transfusion- dependent beta-thalassemia major (ß-TM) patients. Although cardiac T2* magnetic resonance imaging (MRI) can be used for the early detection of cardiac iron level before the onset of symptoms associated with iron overload, this expensive method is not widely available in many hospitals. Frontal QRS-T angle is a novel marker of myocardial repolarization and is associated with adverse cardiac outcomes. We aimed to investigate the relationship between cardiac iron load and f(QRS-T) angle in patients with ß-TM. Methods: The study included 95 ß-TM patients. Cardiac T2* values under 20 were considered to indicate cardiac iron overload. The patients were divided into two groups according to the presence or absence of cardiac involvement. Laboratory and electrocardiography parameters, including frontal plane QRS-T angle, were compared between the two groups. Results: Cardiac involvement was detected in 33 (34%) patients. Multivariate analysis showed that frontal QRS-T angle independently predicted cardiac involvement (p < 0.001). An f(QRS-T) angle of ≥ 24.5° had a sensitivity of 78.8% and a specificity of 79% in detecting the presence of cardiac involvement. In addition, a negative correlation was found between cardiac T2* MRI value and f(QRS-T) angle. Conclusions: A widening f(QRS-T) angle could be considered a surrogate marker of MRI T2* to detect cardiac iron overload. Therefore, calculating the f(QRS-T) angle in thalassemia patients is an inexpensive and simple method for detecting the presence of cardiac involvement, especially when cardiac T2* values cannot be determined or monitored.

Usefulness of the systemic immune-inflammation index in predicting atrial fibrillation recurrence after direct current cardioversion.

Background: We aimed to determine whether there is a relationship between the systemic immune-inflammation (SII) index and the recurrence of atrial fibrillation (AF) after successful direct current cardioversion (DCCV). Methods: The study included 99 patients with persistent AF who underwent successful cardioversion between 2015 and 2020. Results: In multiple regression analyses, the SII index was found to be a better independent predictor of AF recurrence after successful DCCV (p < 0.001). The cut-off value of SII (563) was associated with 96.9% sensitivity and 55.2% specificity to predict AF recurrence after DCCV. Conclusion: As a simple biomarker, SII index is an independent parameter for predicting AF recurrence after successful DCCV in patients with persistent AF. Also, SII levels can predict AF recurrence better than neutrophil-to-lymphocyte ratio.

Asymptomatic Cerebral Emboli Following Carotid Artery Stenting: A Diffusion-Weighted MRI Study

BACKGROUND: Silent cranial embolism due to carotid artery stenting has been demonstrated to cause dementia, cognitive decline, and even ischemic stroke. The purpose of this study was to compare the periprocedural asymptomatic cranial embolism rates of different stent designs used for extracranial carotid stenosis with diffusion-weighted magnetic resonance imaging. METHODS: A total of 507 consecutive patients who underwent carotid artery stenting at our center from December 2010 to June 2020 (mean age, 66.4 ± 9.5) were analyzed retrospectively. The patients were divided into 3 groups as open-cell stent (334 patients), closed-cell stent (102 patients), and hybrid-cell stent (71 patients) groups. Diffusionweighted magnetic resonance imaging was performed for the patients before and after carotid artery stenting and compared. The diffusion limitations of 3 stent groups on cranial diffusion-weighted magnetic resonance imaging were compared with one another. RESULTS: Periprocedural asymptomatic same-side microembolism, which was the primary endpoint of our study, was detected in 58 (17.4%) patients in the open-cell stent group, 6 (5.9%) patients in the closed-cell group, and 8 (11.3%) patients in the hybrid cell group, and overall in 72 (14.2%) patients. On diffusion-weighted magnetic resonance imaging, periprocedural asymptomatic same-side cranial embolism was found to be statistically significantly higher in the open-cell group compared to the other two groups (P=.011). CONCLUSIONS: The result of this study showed us that the rate of same-side cranial embolism detected on cranial diffusion-weighted magnetic resonance imaging after carotid artery stenting performed with open-cell stent was higher than those of the carotid artery stenting procedure performed with closed-cell and hybrid-cell stents.

Supraventricular arrhythmia in mitral valve prolapse : Predictive value of P-wave dispersion and atrial conduction time.

BACKGROUND: The incidence of supraventricular arrhythmia (SVA) is high in patients with mitral valve prolapse (MVP). The purpose of our study was to determine the role of parameters showing atrial conduction heterogeneity such as P­wave dispersion (PWD) and atrial electromechanical delay (AEMD) in predicting the development of SVA in MVP patients. METHODS: A total of 76 patients with MVP (56 female, 20 male) were included in the study. The patients were divided into two groups according to the presence or absence of SVA: 36 patients were allocated to the non-SVA group and 40 patients to the SVA group. Heart rate variability (HRV), PWD, and AEMD values were determined and compared. RESULTS: The PWD was found to be higher in the SVA group. Interatrial EMD was 32.00 ms (25.00-35.00) in patients with SVA while it was 18.00 ms in patients without SVA (11.00-23.75); the intra-atrial EMD was 17.0 ms (10.00-20.00) in patients with SVA whereas it was 10.00 ms (4.00-14.00) in patients without SVA. Lower HRV was found in the SVA group. CONCLUSION: In the SVA group, PWD and AEMD were increased while HRV values were decreased. Noninvasive parameters may help predict the presence and incidence of SVA during the follow-up of this group of patients.

Six-year outcomes of carotid artery stenting performed with multidisciplinary management in a single center.

OBJECTIVE: This study aimed to evaluate the first 30-day results of clinical, periprocedural asymptomatic cranial embolism, and long-term restenosis of the multidisciplinary conducted and evaluated carotid artery stenting (CAS) procedure in our patient group with real-life data. METHODS: A total of 610 patients who were subjected to consecutive CAS procedures in our center between December 2010 and February 2019 were clinically and radiologically followed up for a mean duration of 6 years. Of the 610 patients, 274 (45%) were symptomatic for carotid artery stenosis, whereas 336 (55%) were identified as asymptomatic. As embolism protection methods, distal protection, proximal protection, and double (distal + proximal) protection was used in 52%, 43%, and 0.3% of patients, respectively. RESULTS: The success rate of the CAS procedure was 96%. Procedure-related death was reported in 4 (0.6%) patients who successfully underwent the CAS procedure. Moreover, acute carotid artery stent thrombosis, hyperperfusion syndrome, periprocedural major stroke, and periprocedural minor stroke was observed in 4 (0.6%), 2 (0.3%), 2 (0.3%), and 12 (1.9%) patients, respectively. The total clinical complication rates during the first 30 periprocedural days were 1.6% (10 patients) and 3.1% (19 patients) in the asymptomatic and symptomatic groups, respectively. On cranial magnetic resonance imaging performed, asymptomatic ipsilateral cranial microembolism, asymptomatic contralateral cranial microembolism, and bilateral asymptomatic cranial microembolism was detected in 61 (11.6%), 20 (3.8%), 23 (4.4%) patients, respectively. Asymptomatic restenosis was observed in 24 (3.9%) patients. CONCLUSION: The CAS procedure is a reliable treatment option applicable with acceptable complication and success rates as outlined in the guidelines, when performed following a multidisciplinary evaluation, in the treatment of symptomatic and asymptomatic carotid artery stenosis, including high-risk patient groups.

Transcatheter aortic valve implantation through the brachial artery.

Transcatheter aortic valve implantation (TAVI) has been increasingly used in patients with severe aortic stenosis. The femoral artery is the most commonly used entry site for TAVI; however, other entry sites were also reported as transapical, transaortic, transaxillary/subclavian, and transcarotid in patients with occlusive peripheral arterial disease. In this report, a case of TAVI procedure through the brachial artery is presented.

Increased Intima-Media Thickness of the Ascending Aorta May Predict Neurological Complications Associated with TAVI.

OBJECTIVES: Neurological complications associated with transcatheter aortic valve implantation (TAVI) are important due to its morbidity and mortality risks. The purpose of this study was to investigate the importance of the features of the aortic valve and ascending aorta to predict the neurological complications associated with TAVI. METHODS: The patients for whom the heart team decided to perform TAVI were included in the study. In order to assess possible neurological complications, cerebral diffusionweighted magnetic resonance imaging(MRI) was performed pre- and post-operatively. The diameter of the patients' aortic root and ascending aorta, aortic valve scores, intima media thickness of the ascending aorta were measured from their transesophageal echocardiography records. RESULTS: A total of 108 patients constituted the study population. 31 patients were found to develop a new lesion (MR+) detected on MRI after TAVI, while 76 patients did not have any new lesions (MR-). The groups did not have any significant differences in their aortic valve features and scores. However, AA-IMT was found to be higher in the MR+ group (1.8mm [1.6-2.3] vs 1.4mm [1.2-1.8] interquartile range). The multivariate logistic regression analysis conducted to detect new lesions revealed that AA-IMT led to a significantly increased risk. CONCLUSION: The features of the ascending are more important than the demographic characteristics of patients and features of the native valve in predicting new lesions on MRI scans and thus neurological events after TAVI.

Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population: ECHO-DOP-TR Trial.

AIM: Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. METHODS: Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. RESULTS: A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity and E/A ratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular lateral e', septal e', and septal s' were higher in younger subjects and in females. E/e' ratio was increased progressively with advancing decades. Right ventricular e' and s' were decreased but a' was increased with increasing age. Septal e' lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. The E/e' ratio greater than 15 (and also 13) was not found. CONCLUSION: This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials.

Visceral fat index: a novel predictor for coronary collateral circulation.

Objective This study was designed to investigate the role of visceral adiposity along with other clinical parameters in predicting poor coronary collateral circulation (CCC) among patients with severe obstructive coronary artery disease (CAD). Subjects and methods A total of 135 patients with severe obstructive CAD and good (n = 70) or poor (n = 65) CCC were included. Data on angiographically detected CCC, the quality criteria for CCC (Rentrop scores) and visceral fat index (VFI) obtained via bioelectrical impedance were compared between good and poor CCC groups. Independent predictors of poor CCC, the correlation between VFI and Rentrop score and the role of VFI in the identification of CCC were analyzed. Results A significant negative correlation was noted between VFI and Rentrop scores (r = -0.668, < 0.001). The presence of hypertension (OR 4.244, 95% CI 1.184 to 15.211, p = 0.026) and higher VFI (OR 1.955, 95% CI 1.342 to 2.848, p < 0.001) were shown to be independent predictors of an increased risk for poor CCC. ROC analysis revealed a VFI > 9 (AUC [area under the curve] (95% CI): 0.898 (0.834-0.943), p < 0.0001) to be a potential predictor of poor CCC with a sensitivity of 95.38% and specificity of 85.71%. Conclusion In conclusion, our findings revealed comorbid hypertension and higher VFI to significantly predict the risk of poor CCC in patients with severe obstructive CAD.

Visceral fat index: a novel predictor for coronary collateral circulation

ABSTRACT Objective This study was designed to investigate the role of visceral adiposity along with other clinical parameters in predicting poor coronary collateral circulation (CCC) among patients with severe obstructive coronary artery disease (CAD). Subjects and methods A total of 135 patients with severe obstructive CAD and good (n = 70) or poor (n = 65) CCC were included. Data on angiographically detected CCC, the quality criteria for CCC (Rentrop scores) and visceral fat index (VFI) obtained via bioelectrical impedance were compared between good and poor CCC groups. Independent predictors of poor CCC, the correlation between VFI and Rentrop score and the role of VFI in the identification of CCC were analyzed. Results A significant negative correlation was noted between VFI and Rentrop scores (r = -0.668, < 0.001). The presence of hypertension (OR 4.244, 95% CI 1.184 to 15.211, p = 0.026) and higher VFI (OR 1.955, 95% CI 1.342 to 2.848, p < 0.001) were shown to be independent predictors of an increased risk for poor CCC. ROC analysis revealed a VFI > 9 (AUC [area under the curve] (95% CI): 0.898 (0.834-0.943), p < 0.0001) to be a potential predictor of poor CCC with a sensitivity of 95.38% and specificity of 85.71%. Conclusion In conclusion, our findings revealed comorbid hypertension and higher VFI to significantly predict the risk of poor CCC in patients with severe obstructive CAD.

A novel biomarker for prediction of atrial fibrillation susceptibility in patients with celiac disease.

BACKGROUND: Celiac disease (CD), a serious autoimmune disorder that occurs in people who are genetically predisposed, is induced by dietary gluten intake and affects primarily the small intestine. Many studies have identified an increased risk of cardiovascular problems in patients with CD. Moreover, these patients are susceptible to certain liver diseases, as well as fibrosis. OBJECTIVE: The aim of this study was to assess the presence of fibrosis using the De Ritis ratio, determining its effect on the electromechanical features of the left atrium and its susceptibility to atrial fibrillation (AF) in patients with CD. METHODS: A total of 97 patients diagnosed with CD by antibody test and biopsy were included in this prospective study. Two groups were created from these patients, a fibrosis-prone (FP) group and a non-fibrosis-prone (NFP) group, according to the cut-off value, as defined in previously published reports, for the AST/ALT ratio. Electrocardiographic and echocardiographic examinations were performed as part of the study. RESULTS: There were no differences in the baseline characteristics and conventional echocardiographic parameters of the defined groups. However, the patients in the FP group, as compared to those in the NFP group, had significantly increased PWD (56.68±6.48 ms vs. 37.49±6.22 ms, P<0.001). Additionally, significantly higher interatrial (60.50±13.05 ms vs. 29.40±11.55 ms, P<0.001), intra-left atrial (44.18±14.12 ms vs. 21.02±11.99 ms, P<0.001), and intra-right atrial (15.61±8.91 ms vs. 8.38±4.50 ms, P<0.001) EMD was found among the patients in the FP group compared to that of the NFP group. CONCLUSION: It is believed that the susceptibility to AF cited in previous studies may be related to fibrosis. Our study is the first to examine the possible effects of fibrosis on AF susceptibility in patients with CD, whereby we propose a new biomarker for prediction of AF susceptibility of these patients.

Assessment of the association between the personality traits of young patients with acute coronary syndrome and the severity of coronary artery disease.

OBJECTIVE: The role of psychosocial risk factors is becoming increasingly important in the etiology of acute coronary syndrome (ACS). The purpose of this study was to assess an association between the personality types of young patients with ACS and the prevalence and severity of coronary artery disease (CAD). METHODS: Patients younger than 45 years of age who presented with ACS and who underwent coronary angiography in the period from 2012 to 2016 were included in the study. The coronary angiography records of the patients were examined and their Gensini score (GS) was calculated; GS ≥20 was considered to be severe CAD. The Eysenck Personality Questionnaire-Revised Short Form scales were used to measure psychoticism, extraversion, lying, and neuroticism. RESULTS: A total of 139 patients were included in the study. The median psychoticism score of patients with GS <20 was found to be significantly higher than that of patients with GS ≥20 [1.0 (25th and 75th percentile: 0.0-2.0) vs. 1.0 (25th and 75th percentile: 0.0-1.0); p=0.015]. The median psychoticism score was 1.0 (25th and 75th percentile: 1.0-2.0) in the unstable angina pectoris group, 0.5 (25th and 75th percentile: 0.0-1.0) in the ST segment elevation myocardial infarction group, and 1.0 (25th and 75th percentile: 0.0-1.0) in the non-ST segment elevation myocardial infarction group (p=0.004). CONCLUSION: The presence of psychoticism characteristics in patients who present with ACS is associated with less severe CAD.

The association between apelin gene polymorphism and coronary artery disease in young patients with acute obstructive coronary syndrome.

OBJECTIVE: The purpose of this study was to evaluate the association between V103V, 6140AG, TGA-Stop-TAA Stop, and 6016CA polymorphisms of the apelin (APLN) gene detected for the first time among young patients with acute coronary syndrome (ACS) and coronary artery disease (CAD). METHODS: This was a prospective cross-sectional study. The study population was divided into 2 groups. The first group included 132 patients who were found to have critical lesions in their coronary arteries, while the control group consisted of 41 patients who were found to have normal coronary arteries or non-critical atherosclerotic lesions. RESULTS: Among the gene polymorphisms, V103V was found to be more common in the critical CAD patients with the GG genotype compared with the control group (67.4% vs. 46.3%). On the other hand, the GT genotype was more common in the control group (53.7% vs. 32.6%). Univariate and multivariate logistic regression analysis revealed that the GG genotype of V103V was an independent predictor for the presence of critical CAD (odds ratio: 2.397; 95% confidence interval, 1.174-4.892; p=0.016). CONCLUSION: In cases of V103V polymorphism of the APLN gene, patients with the GG genotype were at a greater risk for the presence of atherosclerotic critical lesions compared with the control group.