Serum vaspin levels and carotid intima media thickness in pre dialysis patients.

BACKGROUND AND OBJECTIVE: Vaspin is a molecule belonging to adipokine family which is associated with insulin resistance and obesity in humans. Several studies have evaluated the serum levels of vaspin in various conditions including coronary artery disease and chronic hemodialysis patients. To our best knowledge, serum vaspin levels have not yet been studied in pre dialysis patients. Carotid intima-media thickness (CIMT) is a noninvasive procedure used to diagnose the extent of carotid atherosclerotic vascular disease. The objective of this study is to evaluate serum vaspin levels in pre dialysis patients and their relationships with glomerular filtration rate and CIMT levels. METHODS: A total of twenty-five pre dialysis patients (14 female and 11 male) and 22 healthy controls (8 female and 14 male) were included in the study. CIMT was measured through B-mode ultrasonography. RESULTS: Serum vaspin levels were significantly lower (p<0.05) and CIMT levels were significantly higher (p<0.001) in pre dialysis patients than in control subjects. Serum vaspin levels were found to be significantly correlated with glomerular filtration rate (r=0.42, p<0.001) and CIMT (r=-0.47, p<0.05) in pre dialysis patients. CONCLUSIONS: This is the first report to describe the correlation between serum vaspin levels and CIMT in pre dialysis patients. We concluded that serum vaspin levels were decreased in pre dialysis patients compared to the control subjects. In addition, serum vaspin levels were found to be significantly correlated with glomerular filtration rate and CIMT. This article is protected by copyright. All rights reserved.

Platelet-to-Lymphocyte Ratio May Predict the Severity of Calcific Aortic Stenosis.

BACKGROUND: Platelet-to-lymphocyte ratio (PLR) is an emerging inflammatory indicator which is closely associated with adverse cardiovascular events. Therefore, we aimed to investigate the relationship between PLR and the severity of calcific aortic stenosis (AS). MATERIAL AND METHODS: The study was designed as a retrospective study. A total of 86 consecutive patients with calcific AS were divided into two groups as mild-to-moderate AS and severe AS according to the transaortic mean pressure gradient. PLR levels were calculated from the complete blood count (CBC). RESULTS: Platelet to lymphocyte ratio was significantly higher in severe and mild-to-moderate AS groups when compared to the control subjects (151±31.2, p<0.001, 138±28.8 vs. 126±26.5, p=0.008, respectively). In the subgroup analysis of AS patients, PLR was found to be higher in the severe AS group compared to mild-to-moderate group (p<0.001). A significant correlation was found between PLR and transaortic mean pressure gradient in patients with AS (r=0.421, p<0.001). CONCLUSIONS: Our study results demonstrated that increased PLR correlates with the severity of calcific AS.

Effect of short-term treatment with levosimendan on oxidative stress in renal tissues of rats.

The aim of this study is to evaluate the influences of short-term treatment with levosimendan (chemical formula: C14H12N6O) on oxidative stress and some trace element levels in renal tissues of healthy rats. A total of 20 male Wistar-albino rats were randomly divided into two groups, each consisting of 10 rats. Animals in the first group were not treated with levosimendan and served as control. Animals in the second group were injected intraperitoneally with 12 µg/kg levosimendan and served as levosimendan group. Animals in both the groups were killed 3 days after the treatment, and their kidneys were harvested for the determination of tissue oxidant/antioxidant statues and trace element levels in renal tissues. The tissue malondialdehyde level was significantly (p < 0.001) lower in levosimendan group than in controls. The protective enzyme activities such as superoxide dismutase, catalase, and glutathione peroxidase and antioxidant glutathione level were significantly (p < 0.001) higher in levosimendan group than in controls. It was concluded that levosimendan reduced oxidative stress by avoiding lipid peroxidation and production of reactive oxygen species, and overactivating and/or increasing the protective antioxidant enzyme levels in renal tissues of rats. It is supposed that this experimental study provides beneficial data for clinicians in the management of renal tissue damage related to obstruction and/or ischemia.

A novel echocardiographic method for the detection of subclinical atherosclerosis in newly diagnosed, untreated type 2 diabetes.

BACKGROUND: Diabetes accelerates the natural process of atherosclerosis and is a predictor for progression of atherosclerotic lesions. To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Recently, it has been shown that the color M-mode-derived propagation velocity of the descending thoracic aorta (aortic velocity propagation [AVP]) was associated with coronary and carotid atherosclerosis. METHODS: Carotid intima-media thickness (CIMT) and AVP were measured in 72 patients with newly diagnosed type 2 diabetes and 44 healthy people. Individuals who had previously used oral hypoglycemic agents or insulin treatment or had a history of hyperlipidemia, cigarette smoking, hypertension, and cardiovascular disease were excluded from this study. RESULTS: Compared with control group, patients with type 2 diabetes had significantly lower AVP (39.9 ± 6.5 vs. 58.4 ± 6.7 cm/sec, P < 0.001) and higher CIMT (1.1 ± 0.1 vs. 0.95 ± 0.12 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r = -0.835, P < 0.001), AVP and fasting plasma glucose (r = -0.796, P < 0.001)), AVP and HbA1 c (r = -0918 P < 0.001). CONCLUSIONS: Diabetes mellitus may be associated with subclinical atherosclerosis assessed by measurement of AVP and CIMT. These simple methods might improve patient selection for primary prevention atherosclerotic progression.

Is atrial electromechanical coupling delayed in patients with secundum atrial septal defect?

BACKGROUND: There is no available published information about the atrial electromechanical coupling time (AEMCT) in patients with atrial septal defect (ASD). The aim of this study was to investigate the relationship between ASD and AEMCT obtained by tissue Doppler imaging (TDI). METHODS: A total of 35 patients with ASD and 22 healthy controls were included in the study. The time intervals from the onset of the P-wave on the surface electrocardiogram to the beginning of the late diastolic A-wave (PA) representing AEMCT were obtained from the lateral mitral annulus, septal mitral annulus, and right ventricular (RV) tricuspid annulus, and named PA-lateral, PA-septal, and PA-tricuspid, respectively. The difference between PA-septal and PA-tricuspid, PA-lateral and PA-septal, and PA-lateral and PA-tricuspid were defined as intra-right AEMCT, intra-left AEMCT, and inter- AEMCT, respectively. RESULTS: PA-tricuspid, PA-septal, and PA-lateral values were longer in patients with ASD when compared with the controls, but did not reach statistical significance (39.9 ± 19.1 vs. 37.2 ± 15.5, P = 0.952; 49.6 ± 14.0 vs. 45.4 ± 11.1, P = 0.826 and 60.3 ± 16.3 vs. 59.7 ± 12.5, P = 0.437, respectively). There were no significant differences between the ASD and control groups in terms of inter-atrial, intra-right atrial, and intra-left AEMCT (21.3 ± 2.3 vs. 20.8 ± 4.6, P = 0.957; 9.7 ± 3.3 vs. 6.9 ± 1.3, P = 0.723 and 13.6 ± 4.7 vs. 10.9 ± 4.5, P = 0.518, respectively). Furthermore, ASD diameter and total septum length did not correlate with AEMCT. CONCLUSION: Both intra- and inter-AEMCT were not increased in patients with ASD than control subjects. In addition, we found no association between the ASD diameter and indices of AEMCT in patients with ASD.

Increased risk of atrial and ventricular arrhythmia in long-lasting psoriasis patients.

BACKGROUND: Several reports have demonstrated an association between psoriasis and cardiovascular diseases. P wave dispersion (PWD) is the most important electrocardiographic (ECG) markers used to evaluate the risk of atrial arrhythmias. QT dispersion (QTD) can be used to assess homogeneity of cardiac repolarization and may be a risk for ventricular arrhythmias. AIM: To search PWD and QTD in patients with psoriasis. METHODS: Ninety-four outpatient psoriasis patients and 51 healthy people were evaluated by physical examination, 12-lead ECG, and transthoracic echocardiography. Severity of the psoriasis was evaluated by psoriasis area and severity index (PASI). RESULTS: Mean disease duration was 129.4 ± 83.9 (range, 3-360) months and PASI ranged from 0 to 34.0 (mean ± SD; 7.6 ± 6.7). Compared to control group, psoriatic patients had significantly shorter Pmax and Pmin durations, longer QTcmax, and greater PWD and QTcD. Transmitral deceleration time (DT) and isovolumetric relaxation time (IVRT) were significantly longer among psoriasis patients. QTcD and PWD were significantly correlated with disease duration (r = 0.693, P < 0.001, and r = 0.368, P = 0.003, resp.). CONCLUSIONS: In this study, we found that both PWD and QTcD are increased in psoriasis patients compared to healthy subjects. In addition, they had longer DT and IVRT.

[A case of idiopathic ventricular tachycardia in a 14-year-old obese patient due to golden berry fruit extract pills for weight loss]. / Zayiflama amaciyla altin çilek meyve özü hapi kullanan 14 yasinda obez hastada gelisen bir idiyopatik ventriküler tasikardi olgusu.

Several studies have determined an association between obesity and increased risk of cardiac arrhythmia. Currently, due to the increased frequency of obesity, food-, plant-, and drug-based therapies for weight loss have gained great attention. A 14-year-old female patient presented with complaints of palpitation of one-hour onset. Blood pressure was 110/70 mmHg and peripheral pulses were present. She had been using golden berry extract pill three times a day for 10 days. The electrocardiogram showed nonsustained monomorphic ventricular tachycardia (VT). Echocardiographic examination and cardiac magnetic resonance imaging (MRI) were normal. She returned to sinus rhythm following amiodarone infusion. She refused the electrophysiologic study, which plays a vital role in the diagnosis and establishment of the appropriate therapy. Although there was no decrease in body mass index (BMI) of the patient during the two-year follow-up, she had no complaint or evidence of VT on intermittent rhythm Holter studies. This case suggests the primary role of golden berry extract use in the development of VT, rather than obesity.

Clinical and echocardiographic follow-up in pregnant patients with valvular heart disease.

OBJECTIVES: Pregnancy associated cardiovascular changes may result in a significant hemodynamic burden and can lead to morbidity and even mortality in women with cardiac disease. The present study aimed to evaluate clinical and echocardiographic follow-up in pregnant patients with valvular heart disease (VHD). STUDY DESIGN: The medical records of pregnant patients diagnosed with VHD from January 2004 to January 2011 were screened. Demographic characteristics including history of cardiac intervention performed during pregnancy, pulmonary edema, and maternal and fetal mortality, and cesarean section (C/S) history were collected from the hospital database and clinical records of the cardiology and obstetrics departments. The echocardiographic examination was carried out at presentation, 3rd trimester, and 1 month after delivery. The outcomes evaluated were cardiac intervention, pulmonary edema, and both fetal and maternal mortality during pregnancy and C/S. RESULTS: We evaluated the outcomes of 884 pregnant patients with VHD. Adverse clinical outcomes including death, pulmonary edema, and valvular interventions were frequent among patients with severe VHD, whereas no adverse clinical outcome was observed in patients with mild-moderate VHD (n=49, 5.5% vs. n=0, 0%, p<0.001). In patients with severe VHD, clinical outcomes were frequent among patients with valve stenosis, but lower among patients with regurgitation [death 4 (0.45%) vs. 0 (0%); pulmonary edema (15 (1.7%) vs. 13 (1.5%); valvular intervention 11 (1.2%) vs. 6 (0.7%); respectively). CONCLUSION: Valvular heart disease is associated with fetal/maternal morbidity and mortality. Pregnant with severe VHD constitute a high-risk group in which life-threatening complications are likely to occur in the course of pregnancy.

Analysis of the influences of short-term levosimendan exposure on oxidant/antioxidant status and trace-element levels in the physiological status of the thoracic aorta of rats.

The objective of this study was to evaluate the effect of levosimendan (chemical formula C14H12N6O) exposure on oxidant/antioxidant status and trace-element levels in the thoracic aorta of rats. Eighteen male Wistar albino rats were randomly divided into two groups of eight animals each. Group 1 was not exposed to levosimendan and served as a control. Levosimendan (12 µg/kg) diluted in 10 ml 0.5 % dextrose was administered intraperitoneally to group 2. Animals of both groups were killed after 3 days, and their thoracic aortae were harvested for determination of changes in tissue oxidant/antioxidant status and trace-element levels. The animals in both groups were killed 72 h after levosimendan exposure, and thoracic aortae were harvested for determination of the lipid peroxidation product MDA and antioxidant GSH levels and the activities of antioxidant enzymes such as SOD, GSH-Px and CAT. It was found that MDA, GSH and CAT enzyme levels increased in thoracic aortae of rats after levosimendan administration. SOD and CA enzyme activities and the level of antioxidant GSH decreased in thoracic aortae of rats after levosimendan treatment. Pb, Cd and Fe levels of thoracic aortae were significantly higher (P < 0.001) and Mg, Mn, Zn and Cu were significantly lower (P < 0.001) in the levosimendan group compared to the control group. These results suggest that short-term levosimendan treatment caused an increase in free radical production and a decrease in antioxidant enzyme activity in thoracic aortae of levosimendan-treated rats. It also causes a decrease or increase in many mineral levels of the thoracic aorta, which is an undesirable condition for normal pharmacological function.

Frequency of pulmonary hypertension in patients with COPD due to biomass smoke and tobacco smoke.

OBJECTIVES: Pulmonary hypertension (PH) is a common and well established complication of chronic obstructive pulmonary disease (COPD). Its presence is associated with decreased survival. This study was designed to investigate the PH frequency and its relations in hospitalized tobacco and biomass related COPD patients. METHODS AND RESULTS: The study was a retrospective review of inpatients with COPD defined as a history of tobacco or biomass smoking, Pulmonary function tests (PFT) within stable status, an echocardiogram within stable status. PH was defined as systolic pulmonary artery pressure (sPAP) >35 mmHg. Of the 694 individuals, 600 had suitable aspects for inclusion of study. All Females were biomass exposer and males were tobacco smoker. The Prevalence of PH was found more frequent in females than males. It was more prominent in moderate level COPD cases (56,2% and 37,5%, P<0,002). Both groups had airflow limitation, hypercapnia and hypoxemia, but no differences were found in terms of PaCO(2) and PaO2. However, FEV1 % was lower in males than females (p<0,005). On the other hand, FVC % was lower in the females compared with the males (p < 0.02). When analyzing the influence of PFT and demographic parameters on PH in separate COPD level groups, the results a bit varied among the groups. CONCLUSION: Our study demonstrated that PH frequency is higher in female COPD cases due to biomass smoke than in male COPD cases due to tobacco smoke. The influence of FVC % on the risk of a person having PH increased with increasing COPD level.

Dream anxiety is an emotional trigger for acute myocardial infarction.

OBJECTIVE: The aim of the present study was to investigate the relationship between nightmares and acute myocardial infarction (AMI) occurring during sleep, and also to evaluate the influence of several related factors. METHOD: The sample comprised AMI patients who had been admitted to the coronary care unit. The patients were grouped into two categories; the asleep-AMI group consisted of 36 patients who had the onset of symptoms of AMI during sleep, and the awake-AMI group included 183 patients who had AMI while they were awake. The sleep quality and dream anxiety for the 1-month interval before AMI were assessed with Pittsburgh Sleep Quality Index (PSQI) and Van Dream Anxiety Scale (VDAS), respectively. RESULTS: Asleep-AMI patients reported significantly poorer subjective sleep quality, significantly higher global PSQI scores, and displayed significantly higher nightmare frequency, difficulty in falling asleep after a nightmare, higher autonomic hyperactivity, dream recall frequency, daytime anxiety, psychological problems, and higher global dream anxiety scores than awake-AMI patients. CONCLUSION: The present study suggests that sleep anxiety and related emotions are associated with AMI during sleep.

The effects of perindopril on QT duration and dispersion in patients with coronary slow flow.

Coronary slow flow (CSF) is characterized by delayed opacification of coronary arteries in the absence epicardial occlusive disease. QT duration and dispersion have been reported to be longer in patients with CSF. ACE inhibitors may improve CSF through positive effects on endothelial function. The study included 32 patients having CSF and 25 subjects having normal coronary arteries in coronary angiography. The patients were evaluated with 12-leads electrocardiography and echocardiography before and 3 months after treatment with perindopril. Compared to the control group, maximum corrected QT duration (QTcmax) (432.0 ± 28.9 vs. 407.0 ± 39.1 ms, p = 0.008) and QT dispersion (QTcD) (64.0 ± 16.5 vs. 37.3 ± 12.1 ms, p < 0.001), mitral inflow deceleration time (DT) (251.3 ± 49.4 vs. 218.8 ± 44.5 ms, p = 0.013), and isovolumetric relaxation time (IVRT) (115.8 ± 18.4 vs. 107.2 ± 22.9 ms, p < 0.001) were significantly longer and E/A ratio 0.85 ± 0.2 vs. 1.1 ± 0.3, p = 0.004) was lower in patients with CSF. QTcmax (to 407.0 ± 28.0 ms, p = 0.001), QTcD (to 44.5 ± 11.4 ms, p < 0.001), DT (to 221.6 ± 37.7 ms, p < 0.001) and IVRT (to 103.8 ± 16.1 ms, p < 0.001) were significantly decreased and E/A ratio (to 0.98 ± 0.3, p < 0.001) was significantly increased after treatment with perindopril. Coronary slow may be associated with prolonged QT interval and increased QT dispersion and impaired diastolic filling. Perindopril may be helpful in restoration of these findings.

[Regional distribution of all-cause mortality and coronary disease incidence in Turkey: findings of Turkish Adult Risk Factor survey 2010]. / Türkiye'de ölüm ve koroner hastalik insidansinin bölgesel dagilimlari: TEKHARF 2010 taramasi sonuçlari

OBJECTIVES: We analyzed the distribution of cumulative all-cause and cardiovascular mortality and incident coronary heart disease (CHD) across the seven geographic regions of Turkey and presented overall and coronary mortality findings of the 2010 survey of the Turkish Adult Risk Factor Study. STUDY DESIGN: A total of 1406 participants were surveyed. Information on the mode of death was obtained from first-degree relatives and/or health personnel of local heath offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiography. RESULTS: Of the surveyed participants, 686 were examined; information on health status was obtained in 577 subjects, and 32 participants (14 women, 18 men; mean age 72.3±15.6 years) were ascertained to have died. The total duration of follow-up was 2,520 person-years. Nineteen deaths were of coronary (n=16) or cerebrovascular (n=3) origin. Cumulative 20-year assessment of the entire cohort for the age bracket of 45-74 years disclosed a high coronary mortality rate, being 7.4 and 4.1 per 1000 person-years in men and women, respectively, and representing a limited decline after year 2000. Age-adjusted Cox regression analysis comprising 433 deaths and 506 incident CHD cases over a 7.3-year follow-up showed similar mortality rates across the regions, and a significantly high CHD incidence in males of the Black Sea and Marmara regions and in females of the Southeast Anatolia. Currently, 480,000 incident CHD cases are estimated yearly in Turkey. CONCLUSION: The high age-adjusted overall mortality in Turkey shows nonsignificant differences across geographic regions, whereas the age-adjusted CHD incidence is high in the Black Sea and Marmara regions.

[Procedural success and short- and mid-term results of percutaneous closure of persistent arterial duct with the Amplatzer Duct Occluder II]. / Duktus arteriyozus açikliginin Amplatzer Duct Occluder II ile perkütan kapatilmasinda islem basarisi ve kisa-orta dönem takip sonuçlari

OBJECTIVES: We evaluated the effectiveness and reliability of percutaneous closure of persistent arterial duct (PAD) with the Amplatzer Duct Occluder II (ADO II), together with short- and mid-term results. STUDY DESIGN: The study included 16 patients (10 girls, 6 boys; median age 6 years; range 5 months to 12 years) who underwent percutaneous PAD closure with the ADO II device. The ductus diameter was less than 6 mm in all the cases. According to the Krichenko classification, 10 patients had type A, five patients had type E, and one patient had residual PAD. The patients were assessed by aortography and echocardiography. The mean follow-up was 13.9 months (range 2 to 23 months). RESULTS: Closure of PAD was successfully performed via the arterial approach in all the patients. The median ductus waist diameter was 3 mm (range 2 to 5 mm), the median device waist diameter was 4 mm (range 3 to 6 mm), and the waist length was 4 or 6 mm. The mean fluoroscopy time and the mean procedure time were 10.6 min (range 4 to 39 min) and 30 min (range 18 to 80 min), respectively. Immediate aortography following the procedure showed shunt only through the device lumen. No residual shunt or increases in aortic and left pulmonary flow velocities were observed in echocardiographic examinations. No complications occurred during the procedure and follow-up. CONCLUSION: In all the cases, the ADO II device was found effective and reliable for closure of PADs of less than 6 mm.

Noninvasive assessment of atherosclerosis in patients with isolated hypertension.

BACKGROUND: Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been used to assess endothelial dysfunction. An impaired FMD response may reflect a vascular phenotype prone to atherosclerosis. The thickness of the common carotid intima-media (CIMT) as measured by ultrasound represents a marker of structural atherosclerosis. Recently, it has been shown that color M-mode propagation velocity measured along the origin of descending thoracic aorta (AVP) may reflect atherosclerosis. In this study, the effects of isolated hypertension on these atherosclerosis markers are investigated. METHODS: Fifty patients with newly diagnosed hypertension and forty healthy people were enrolled. Patients were evaluated with transthoracic echocardiography. Diastolic functions were evaluated by transmitral filling parameters of deceleration time (DT), E/A ratio, and isovolumetric relaxation time (IVRT). Carotid intima-media thickness, FMD, and AVP were measured. RESULTS: Age, gender, and BMI of both groups were similar. Compared to control group CIMT, DT and IVRT values were significantly higher, and FMD and AVP values were significantly lower in hypertensive patients. There were significant correlations between AVP and CIMT (r =-0.699, P < 0.001), AVP and FMD (r = 0.400, P < 0.001), and FMD and CIMT (r =-0.600, P < 0.001). Carotid intima-media thickness, AVP, and FMD were significantly correlated with systolic and diastolic blood pressures and DT and IVRT. CONCLUSIONS: In patients with isolated hypertension, AVP and FMD decrease and CIMT increases. In addition, CIMT is inversely correlated with AVP and FMD, and AVP is directly correlated with FMD.

Incremental diagnostic value of color M-mode propagation velocity of the descending thoracic aorta to exercise electrocardiography.

OBJECTIVES: Exercise electrocardiography test (EET) has limited sensitivity and specificity. Recently, color M-mode-derived propagation velocity of the descending thoracic aorta (APV) has been shown to be associated with coronary artery disease (CAD). We evaluated the incremental value of APV for better prediction of CAD in EET-positive patients. STUDY DESIGN: Color M-mode APV was measured in 342 patients undergoing EET for chest pain and an intermediate likelihood of CAD. Coronary angiography was performed in 199 patients having a positive EET. RESULTS: The mean APV was 44.5 ± 20.8 cm/sec in patients with a positive EET compared to 63.5 ± 19.6 cm/sec in those with a normal test. Significant CAD was detected in 134 patients (67.3%), involving one vessel (n=41), two vessels (n=52), and three vessels (n=41). Patients with CAD had significantly lower APV values compared to patients with normal coronary arteries (33.8 ± 13.2 vs. 66.6 ± 15.6 cm/sec, p<0.001). An APV value of ≤ 41 cm/sec predicted CAD with 85.1% sensitivity and 93.8% specificity. An APV of >61 cm/sec had 94% specificity for the estimation of normal coronary arteries. A threshold of >41 cm/sec and a threshold of >61 cm/sec would have avoided unnecessary coronary angiography in 30.7% (61/199) and 21.6% (43/199) of patients with a positive EET but high APV values, with negative predictive values of 75.3% and 84.3%, respectively. In correlation analysis, APV was significantly correlated with Duke treadmill score (r=0.587, p<0.001) and the number of coronary vessels involved (r=-0.767, p<0.001), but not with any of the echocardiographic parameters. CONCLUSION: Measurement of APV may improve diagnostic value of EET and may be specifically valuable to exclude false positive EET results, leading the physician to other noninvasive tests for further evaluation of CAD probability.

[Clinical and laboratory features of patients with pericardial effusion]. / Perikart efüzyonu olan hastalarin klinik ve laboratuvar özellikleri.

OBJECTIVES: We reviewed patients who were diagnosed to have pericardial effusion (PE) over a four-year period to determine the causes of PE, clinical and laboratory features, and treatment modalities. STUDY DESIGN: Medical records of 136 patients (81 women, 55 men; mean age 55.8±18.7 years; range 8 to 90 years) admitted to our department with PE from August 2005 to August 2009 were reviewed. The diagnosis of PE was made by transthoracic echocardiography. Medical history, physical examination, electrocardiography, echocardiography, and laboratory findings and treatment methods were recorded. RESULTS: The most frequent complaint was dyspnea (86.8%) and the most common physical examination finding was jugular venous distension (47.1%). The most common electrocardiographic and echocardiographic findings were tachycardia (47.8%) and mild PE (<1 cm) (63.2%), respectively. Chronic renal failure and malignant diseases were the primary causes of PE (25% and 22.8% respectively), followed by idiopathic cases (14%). Pericardial tamponade was detected in 34 patients (25%), of which the majority had malignant diseases (53%). Thirty-eight patients (27.9%) underwent interventional treatment (pericardiocentesis in 27, surgical drainage in 11), while 98 patients (72.1%) were followed-up with medical treatment. Mortality occurred in three patients with pericardial tamponade. CONCLUSION: The most common causes of PE in our cases were chronic renal failure and malignancies. The incidence of malignant PE is on the incline owing to increased life expectancy. Echocardiography is the primary imaging modality for the evaluation of PE.

Current clinical practice of cardiac resynchronization therapy in Turkey: Reflections from Cardiac Resynchronization Therapy Survey-II.

OBJECTIVE: Cardiac resynchronization therapy (CRT) has been shown to reduce mortality in selected patients with heart failure with reduced ejection fraction (HFrEF). CRT Survey-II was a snapshot survey to assess current clinical practice with regard to CRT. Herein, we aimed to compare Turkish data with other countries of European Society of Cardiology (ESC). METHODS: The survey was conducted between October 2015 and December 2016 in 42 ESC member countries. All consecutive patients who underwent a de novo CRT implantation or a CRT upgrade were eligible. RESULTS: A total of 288 centers included 11,088 patients. From Turkey, 16 centers recruited 424 patients representing 12.9% of all implantations. Compared to the entire cohort, Turkish patients were younger with a lower proportion of men and a higher proportion with ischemic etiology. Electrocardiography (ECG) showed sinus rhythm in 81.5%, a QRS duration of <130 ms in 10.1%, and ≥150 ms in 63.8% of patients. Left bundle branch block (LBBB) was more common. Median left ventricular ejection fraction (LVEF) was 25%, lower than in the overall ESC cohort, but NYHA class was more often II. Most common indication for CRT implantation was HF with a wide QRS (70.8%). Almost 98.3% of devices implanted were CRT-D, in contrast to the overall cohort. Fluoroscopy time was longer, but duration of overall procedure was shorter. LV lead implantation was unsuccessful in 2.6% patients. Periprocedural complication rate was 6.3%. The most common complication was bleeding. Remote monitoring was less utilized. CONCLUSION: These are the first observational data reflecting the current CRT practice in Turkey and comparing it with other countries of Europe. Findings of this study may help detect gaps and provide insights for improvement.

The effects of trimetazidine on p-wave duration and dispersion in heart failure patients.

BACKGROUND: P-wave duration and dispersion (PWD) have been shown to be noninvasive predictors for development of atrial fibrillation. Thus, it may be possible to attenuate atrial fibrillation risk through normalization of P-wave duration and dispersion. Trimetazidine, a metabolic modulator, has been reported to improve cardiac function in heart failure (HF) patients. METHODS: Thirty-six HF patients being treated with angiotensin inhibitors, carvedilol, spironolactone, and furosemide were prescribed trimetazidine, 20 mg three times a day. Electrocardiographic and echocardiographic examinations were obtained before and 6 months after addition of trimetazidine in HF patients and 36 healthy control group patients having normal echocardiographic examination. RESULTS: Maximum P-wave duration (Pmax) (106.7 +/- 15.8 vs. 91.7 +/- 12.7 ms) and PWD (57.2 +/- 15.4 vs. 37.9 +/- 16.7 ms) were significantly longer in HF patients compared to the control group. There were significant correlations of Pmax and PWD with left atrial diameter (r = 0.508, P = < 0.001 and r = 0.315, P = 0.029), left ventricular ejection fraction (LVEF) (r = 0.401, p = 0.005 and r = 0.396, P = 0.005), deceleration time (r = 0.296, P = 0.032 and r = 0.312, P = 0.035), and isovolumetric relaxation time (r = 0.265, P = 0.038 and r = 0.322, P = 0.015). There were significant improvements in LVEF (32.7 +/- 6.5% to 37.2 +/- 5.5%, P = 0.036), left atrial diameter (41.5 +/- 6.7 to 40.3 +/- 6.1 mm, P < 0.001), and Pmax (106.7 +/- 15.8 to 102.2 +/- 11.5 ms, P = 0.006) and PWD (57.2 +/- 15.4 to 48.9 +/- 10.1 ms, P < 0.001) during follow-up. CONCLUSIONS: Trimetazidine added to optimal medical therapy in HF may improve Pmax and PWD in association with improved left ventricular function. Longer-term and larger studies are necessary to evaluate whether these findings may have clinical implications on prevention of atrial fibrillation.

QTc dispersion in hyperthyroidism and its association with pulmonary hypertension.

BACKGROUND: Several studies have reported that hyperthyroidism is associated with prolonged QT interval corrected by the heart rate (QTc) and pulmonary hypertension (PHT). METHODS: Forty-seven patients with newly diagnosed overt hyperthyroidism and 20 healthy people were enrolled in the study. Transthoracic echocardiography, 12-lead surface electrocardiogram, and thyroid hormone levels were studied at the time of enrollment and after achievement of euthyroid state with propylthiouracil treatment. RESULTS: Baseline clinical characteristics were similar. However, heart rate (90.5+/-19.6 vs 79.2+/-13.7 bpm, P = 0.024), pulmonary artery systolic pressure (PASP) (26.0+/-12.0 vs 10.6+/-4.0 mmHg, P < 0.001), E deceleration time (DT) (191.8+/-25.6 vs 177.0+/-10.7 ms, P = 0.016), isovolumetric relaxation time (IVRT) (91.38+/-12.3 vs 79.6+/-10.5 ms, P < 0.001), and QTc dispersion (QTcD) (50.3+/-17.2 vs 38.9+/-11.6 ms, P = 0.009) were significantly higher in hyperthyroid patients compared to control group. Heart rate (to 74.1+/-13.8, P < 0.001), QTcD (to 37.3+/-10.1 ms, P < 0.001), DT (to 185.3+/-19.7 ms, P = 0.008), IVRT (to 88.6+/-10.3 ms, P = 0.056), and PASP (23.1+/-10.1 mmHg P < 0.001) were significantly decreased after achievement of euthyroid state. Although PHT was present in 16 patients before treatment only six patients still had PHT during euyhyroid state. Compared to patients with normal PASP, QTcD was significantly longer in patients with PHT (56.5+/-15.8 vs 37.9+/-12.8 mmHg P < 0.001). There were also significant correlations between QTcD and presence of PHT (r = 0.516, P < 0.001) and PASP (r = 0.401, P = 0.009). CONCLUSIONS: Hyperthyroidism is a reversible cause of PHT and diastolic dysfunction. Increased QTcD observed in hyperthyroidism may be associated with PHT and diastolic dysfunction. These abnormal findings in hyperthyroidism often normalize with the achievement of euthyroid state.