Foetal cardiac function in third trimester pregnancies with reduced fetal movements.

The objective of our study was to investigate the possible relationship between poor perinatal outcome and foetal cardiac functions in pregnant women with reduced foetal movements (RFM). This cross-sectional study included 126 pregnant women with normal foetal movements (Group 1, Controls) and 42 pregnant women over 32 weeks gestation with RFM (Group 2). Group 2 was further divided into two subgroups according to their perinatal outcome: normal perinatal outcome (Group 2a) and poor perinatal outcome (Group 2b). Cardiotocography, the E/A ratio in both atrioventricular valves, myocardial performance index (MPI) and foetal tricuspid annular plane systolic excursion (f-TAPSE) were evaluated. Foetuses with poor perinatal outcome had a higher MPI (p = .003), higher tricuspid and mitral E/A (p < .001), and lower f-TAPSE values (p < .001). In regression analysis, f-TAPSE was the only parameter (p = .04) independently associated with poor perinatal outcome. In conclusion, examining f-TAPSE may predict adverse perinatal outcome in pregnancies with RFM.IMPACT STATEMENTWhat is already known on this subject? Reduced foetal movement (RFM) is associated with adverse pregnancy outcome. Cardiotocography, amniotic fluid assessment, estimated birthweight, foetal Doppler and formal foetal movement count (kick chart) are generally used in the clinical assessment of pregnancies with reduced foetal movements. These tests, we currently use to assess foetal wellbeing in women with reduced foetal movements, have limited sensitivity in predicting foetal compromise.What do the results of this study add? Foetal cardiac Doppler may potentially be used as an important adjunct to the conventional management of women with a perception of reduced foetal movements.What are the implications of these findings for clinical practice and/or further research? Foetal echocardiographic evaluation, such as f-TAPSE, may influence clinical practice by enabling improved risk stratification for poor perinatal outcome, thus allowing more timely definitive intervention. This could help to decrease the rate of stillbirth related to reduced foetal movements. The few established echocardiographically derived parameters, which can asses global right ventricle function, are not always easy to obtain, however, f-TAPSE is easily obtainable using ultrasound and it appears to be a clinically useful echocardiographic measurement of right ventricular function.

Cardiovascular risk unawareness is common in individuals admitting to cardiology outpatient clinics in Turkey: the CVSCORE-TR study.

OBJECTIVES: Cardiovascular "risk" is an abstract concept that is frequently misunderstood by the general public. However, correct estimation of one's own cardiovascular risk is important as risk unawareness is associated with noncompliance with interventions aimed to reduce risk burden. Knowing the prevalence and factors linked with an increased probability of risk unawareness are therefore important to develop strategies aimed to increase risk awareness. Aims. To study prevalence of risk unawareness and to understand risk markers associated with risk underestimation and overestimation. Design. A total of 1716 participants were enrolled to the study in 33 centers across Turkey. Relevant demographic and clinical data were collected by direct interview. Cardiovascular risk of the participants was calculated using SCORE risk charts. Results. Ten-year risk for a fatal cardiovascular event was calculated as low in 633 (36.8%), intermediate in 513 (29.9%) and high-very high in 570 (33.2%) participants, respectively. According to these findings, 34.6% (n = 593) of the participants estimated their risk correctly, whereas 22.7% (n = 390) of the participants overestimated and 42.7% (n = 733) of the participants underestimated their risk. Male gender was the sole factor that was associated with an increased risk of underestimation, while having hypertension, significant valve disease or atrial fibrillation was associated with increased odds for risk overestimation. Conclusions. Only one-thirds of the sample was aware of their calculated risk for cardiovascular mortality and risk underestimation was the most common mode of risk unawareness, prompting concerns on the possible impact of the latter on adherence to the strategies aimed to reduce cardiovascular risk.

Favorable electrocardiographic changes after substantial weight loss in patients with morbid obesity : Results of a prospective study.

BACKGROUND: Obese patients have an increased risk of arrhythmias and sudden death, even in the absence of structural heart disease and cardiac dysfunction. This study aimed to determine whether weight loss by bariatric surgery has an effect on arrhythmia-related electrocardiographic (ECG) variables in morbidly obese patients. METHODS: In this prospective study, the data of 48 patients were analyzed. All ECG variables that have the potential to predict ventricular arrhythmia were evaluated before surgery, and were compared with the 1­month and 6­month follow-up results. RESULTS: The mean body mass index was 45.74 ± 5.60 kg/m2 before surgery. There was a statistically significant decline in body mass index in the first and sixth month after surgery (39.26 ± 5.00 kg/m2 and 31.71 ± 4.49 kg/m2, respectively; p < 0.001). Furthermore, notable reduction was found in terms of heart rate measurements-QTc­d, JTc, JTc­d, Tp­e, TP-e/QT, TP-e/QTc-in the first month and sixth month compared with baseline (p < 0.001 for all comparisons). Several ECG variables, such as heart rate (r = 0.369, p = 0.001), QTc­d (r = 0.449, p = 0.001), JTc­d (r = 0.324, p = 0.002), Tp­e (r = 0.592, p = 0.001), Tp-e/QTc (r = 0.543, p = 0.001), Tp-e/JTc (r = 0.515, p = 0.001), exhibited a positive and significant correlation with weigh loss. Moreover, a negative and weakly significant correlation was found between the index of cardiac electrophysiological balance (r = -0.239, p = 0.004) and body mass index. CONCLUSION: Substantial weight loss following laparoscopic sleeve gastrectomy in obese patients is accompanied by a significant improvement in ventricular repolarization. Therefore, this effect may lead to a decrease in the incidence of lethal ventricular arrhythmia and sudden cardiac death.

Short- and mid-term effects of sleeve gastrectomy on left ventricular function with two-dimensional speckle tracking echocardiography in obese patients.

AIM: This study aimed to investigate left ventricular functions of obese patients with no known heart disease who underwent laparoscopic sleeve gastrectomy by speckle tracking echocardiography in their early and medium-term postoperative follow-up. PATIENTS AND METHOD: Thirty-seven obese patients (10 M, 27 F) without coronary artery disease or heart failure who had undergone LSG were included in the study. Apical four-, three-, and two-chamber images were analyzed longitudinally by conventional methods and speckle tracking echocardiography (STE) for left ventricle functions preoperatively, at the postoperative Month 1 and at the postoperative Month 6 (QLAB 6.0), using current software. RESULTS: No difference was found between standard echocardiography and Doppler parameters in terms of the 1-month versus 6-month follow-up values compared to baseline. Left ventricular STE longitudinal measurements demonstrated significantly higher longitudinal strain and strain velocity parameters in the follow-up values at Month 6 compared to the values at Month 1 and at baseline. Global longitudinal strain (GLS) was -17.48 ± 1.09% in 6-month follow-up, -16.16 ± 1.26% in 1-month follow-up, and -16.06 ± 1.25% at baseline (P < .001). A significant correlation was found between delta GLS, which represents patients' GLS change in 6 months, and delta weight, which represents patients' body weight change in 6 months. CONCLUSION: Obese patients who had undergone LSG were observed to have improved left ventricular function in the mid-term.

Impact of valvular heart disease on oral anticoagulant therapy in non-valvular atrial fibrillation: results from the RAMSES study.

The definition of non-valvular atrial fibrillation (NVAF) is controversial. We aimed to assess the impact of valvular heart disease on stroke prevention strategies in NVAF patients. The RAMSES study was a multicenter and cross-sectional study conducted on NVAF patients (ClinicalTrials.gov identifier NCT02344901). The study population was divided into patients with significant valvular disease (SVD) and non-significant valvular disease (NSVD), whether they had at least one moderate valvular disease or not. Patients with a mechanical prosthetic valve and mitral stenosis were excluded. Baseline characteristics and oral anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF, there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant valvular disease was mitral regurgitation (58.1%), followed by aortic regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had higher CHA2DS2VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0; 5.0), p < 0.001] and HAS-BLED [2.0 (1.0; 2.0) vs. 2.0 (1.0; 2.0), p = 0.004] scores compared to patients with NSVD. Overall, 2763 (71.2%) of NSVD and 1515 (73.8%) of SVD patients were on OAC therapy (p = 0.035). When the patients with SVD were analyzed separately, the mean CHA2DS2VASc and HAS-BLED scores were higher in patients with mitral regurgitation compared to patients with aortic regurgitation and aortic stenosis [4.0 (3.0; 5.0), 3.0 (2.0; 4.0), 3.0 (2.0; 4.0) p < 0.001 and 2.0 (1.0; 3.0), 1.0 (1.0; 2.0), 1.0 (0.0; 2.0) p < 0.001, respectively]. In patients with SVD, 65.7% of mitral regurgitation, 82.6% of aortic regurgitation and 88.0% of aortic stenosis patients were on OAC therapy. One out of three NVAF patients had at least one moderate valvular heart disease with the predominance of mitral regurgitation. Patients with SVD were at greater risk of stroke and bleeding compared to patients with NSVD. Although patients with mitral regurgitation should be given more aggressive anticoagulant therapy due to their higher risk of stroke, they are undertreated compared to patients with aortic valve diseases.

Assessment of Atrial Electromechanical Delay and Left Atrial Mechanical Functions in Patients with Ulcerative Colitis.

OBJECTIVE: Ulcerative colitis (UC) is a common inflammatory bowel disease causing systemic inflammation, which may also affect the cardiovascular system, as well as other organ systems. The aim of the current study was to evaluate left atrial (LA) mechanical functions and duration of atrial electromechanical delay (AEMD) with echocardiography in patients with UC. METHOD: A total of 91 patients, 45 with UC (Group 1) and 46 healthy individuals as control (Group 2) were included in the study. The demographic and laboratory data were recorded, and echocardiographic measurements were taken for all patients. RESULTS: In the evaluation of basal clinical and laboratory findings, no difference was detected between the two groups, except for white blood cell count (WBC) (8.26 ± 2.71 vs. 7.06 ± 1.70, P = 0.013) and high-sensitivity C-reactive protein (Hs-CRP; 3.4 ± 1.7 vs. 1.0 ± 0.8, P < 0.001). The echocardiographic assessment revealed that the diastolic parameters such as E-, E/A-, and E- waves decreased in the UC group when compared to the control group. LA mechanical functions were different between groups, except for left atrial (LA) maximal volume: LA minimum volume (22.2 ± 12.9 vs. 15.3 ± 4.7, P = 0.001), LA volume before atrial systole (29.9 ± 14.2 vs. 24.2 ± 4.9, P = 0.021), LA ejection fraction (27.4 ± 16.5 vs. 38.6 ± 10.1, P < 0.001), LA total emptying volume (17.9 ± 6.9 vs. 21.9 ± 5.9, P = 0.004), LA active emptying fraction (27.4 ± 16.5 vs. 38.6 ± 10.1, P < 0.001), LA active emptying volume (7.7 ± 3.6 vs. 9.4 ± 2.9, P = 0.013), LA passive emptying fraction (26.8 ± 10.2 vs. 33.2 ± 9.2, P = 0.002), and LA passive emptying volume (10.3 ± 4.9 vs. 12.5 ± 4.5, P = 0.029). There was a significant difference between the groups in terms of AEMD durations, except time interval from the onset of the P-wave on the surface ECG to the peak of the late diastolic wave (PA) of the tricuspid valve. The correlation analysis revealed that age and duration of disease were correlated with AEMD. CONCLUSION: The current study reported that LA volume and mechanical functions degenerated and AEMD increased in patients with UC when compared to the control group. These findings demonstrate that UC may have effects on LA electromechanical functions related to duration of disease.

Serum neutrophil gelatinase-associated lipocalin levels in patients with non-dipper hypertension.

PURPOSE: Neutrophil gelatinase-associated lipocalin (NGAL) is a protein belonging to the lipocalin superfamily and plays a role in atherosclerosis, renal injury and inflammation. The present study aimed to investigate serum NGAL concentrations in groups of patients with dipper and non-dipper hypertension (HT) and to characterize the relationship between NGAL concentration and circadian blood pressure in hypertensive patients. METHODS: A total of 41 (22 male, 19 female, mean age: 56.1 ±8.9 years) non-dipper HT patients, 40 (19 male, 21 female, mean age: 54.0 ±10.0 years) dipper HT patients and 42 age- and gender-matched healthy individuals were enrolled in the study. Dipper and non-dipper HT were diagnosed via ambulatory blood pressure monitoring. Serum NGAL concentrations were measured by enzyme-linked immunosorbent assay from blood samples obtained from patients. RESULTS: Serum NGAL concentrations were found to be significantly higher in the non-dipper and dipper HT patient groups in comparison with the control group (84.9 ±23.0 ng/ml and 62.1 ±17.8 vs. 46.6 ± 13.7 ng/ml, p <0.017, respectively). Moreover, serum NGAL concentrations were significantly higher in the non-dipper HT group in comparison with the dipper HT group (p<0.017). Serum NGAL concentration showed significant correlation with overall ambulatory BP levels both in non-dipper and dipper HP groups. CONCLUSION: Serum NGAL concentrations increased significantly in non-dipper HT patients in comparison with dipper HT patients and normotensive patients and show significant correlation with ambulatory BP levels. Serum NGAL concentration might be a useful marker in identifying HT patients with higher risk for cardiovascular mortality.

Exercise-Induced Repolarization Changes in Patients with Isolated Myocardial Bridging.

BACKGROUND: Although myocardial bridging (MB) is defined as an angiographic phenomenon with a benign course, it has also been associated with adverse cardiovascular events. The effects of exercise on myocardial repolarization in patients with MB were tested in this study, with Tp-e and Tp-e/QT repolarization indexes. MATERIAL AND METHODS: A total of 50 patients in whom isolated MB was diagnosed at coronary angiography (CAG) (Group I) and 48 patients with normal CAG results (Group II) were included in this study. The participants underwent treadmill exercise stress testing according to the Bruce protocol. QT dispersion (QTd) was defined as the minimum QT interval subtracted from the maximum. The Tp-e interval was defined as the difference between the QT and the QT peak time period. QTd and Tp-e intervals were calculated for all patients before and after exercise testing and differences between groups were compared. RESULTS: At peak exercise, QTd and cQTd showed a significant increase in comparison to baseline values in the group of patients with myocardial bridges. Significant increases were also found with exercise in the Tp-e, cTp-e durations and Tp-e/QT ratio of the MB patient group in comparison to the baseline values. On the other hand, significant differences in QTd, cQTd, Tp-e, cTp-e intervals, and Tp-e/QT ratio during peak exercise in comparison with baseline values were not detected in the control group (p>0.05). CONCLUSIONS: Significant increases in QTd, cQTd, Tp-e and cTp-e intervals and Tp-e/QT ratio were detected in the MB patients during exercise testing.

The Relationships between Atrial Electromechanical Delay and CHA2DS2-VASc Score in Patients Diagnosed with Paroxysmal AF.

AIM: This study aims to evaluate the relationship between atrial electromechanical delay (AEMD) times and CHA2DS2-VASc scores in patients diagnosed with paroxysmal atrial fibrillation (PAF). MATERIALS AND METHODS: The study included a total of 74 patients, 34 of whom were diagnosed with PAF and 40 were included in the control group. The CHA2DS2-VASc score was calculated for each patient. Additionally, blood samples were taken from all patients and transthoracic echocardiographic measurements were made. Left atrial mechanical functions and AEMD were calculated. RESULTS: Mean CHA2DS2-VASc score measured was 2.24 ± 1.53 in PAF group. There was no significant difference between the groups when the patients were evaluated for baseline characteristics and laboratory parameters (P > 0.05) The echocardiographic evaluation of LA mechanical functions showed that only LA minimum volume (19 ± 6.4 vs. 16.7 ± 4.6, P = 0.02) and LA presystolic volume (28.9 ± 7 vs. 25.1 ± 5.7, P = 0.01) were higher in the PAF group. When AEMD was compared between the groups; lateral PA, septal PA, tricuspid PA, Interatrial EMD, and intraatrial EMD were significantly extended compared to control group (P < 0.001) CHA2DS2-VASc score was correlated with Lateral atrial PA (P < 0.001, r = 0.524), Septal atrial PA (P < 0.001, r = 0.45), Interatrial EMD (P < 0.001, r = 0.54), and intraatrial EMD (P < 0.001, r = 0.51) times. CONCLUSION: The present study shows that AEMD times increase in patients with PAF compared to the control group. Furthermore, this study revealed a correlation between AEMD times and CHA2DS2-VASc score, as well showed that extended AEMD time may be associated with thromboembolism risk.

Assessment of atrial electromechanical delay and left atrial mechanical functions in patients with psoriasis vulgaris.

OBJECTIVES: Increased frequency of atrial fibrillation (AF) has been demonstrated in psoriasis cases. Prolongation of the duration of atrial electromechanical delay (AEMD) is a well-known characteristic of the atrium, which is vulnerable to AF. In the current study, our aims are to investigate AEMD durations and mechanical functions of the left atrium (LA) in patients with psoriasis. METHODS: A total of 90 patients, 45 with psoriasis vulgaris and 45 as the control group, were included in the study. Atrial electromechanical coupling (PA) and intra- and inter-atrial electromechanical delay (IA-AEMD) were measured with tissue Doppler echocardiography. P-wave dispersion (PWD) was calculated from the 12-lead electrocardiogram. The severity of the disease was evaluated by the Psoriasis Area and Severity Index. RESULTS: The durations of PA lateral and PA septal were significantly high in the psoriasis group when compared with the control group (47.7 ± 9.8 vs. 57.1 ± 8.4 msec, P < 0.001 and 38.6 ± 9.9 vs. 43.6 ± 8 msec, P = 0.016, respectively). The durations of IA-AEMD, intra-right electromechanical delay, and intra-left electromechanical delay in the psoriasis group were significantly prolonged compared with the control group (15.2 ± 4.1 vs. 21.7 ± 5.6 msec, P < 0.001; 6 ± 2.5 vs. 8.7 ± 2.7 msec, P < 0.001; and 9.1 ± 3.9 vs. 13.5 ± 5.2 msec, P < 0.001; respectively). PWD was significantly higher in patients with psoriasis vulgaris compared with controls (36.1 ± 7.9 vs. 40.2 ± 9.1 msec, P = 0.043). CONCLUSION: In the present study, we found prolongation in the durations of AEMD and PWD in the psoriasis group compared with the control group. These results might be an early predictor of AF and other arrhythmias.

The effects of successful percutaneous mitral balloon valvuloplasty on acute and intermediate term aortic stiffness.

AIM: The aim of this study was to evaluate the effects of percutaneous mitral balloon valvuloplasty (PMBV) on short- and intermediate-term aortic stiffness in patients with mitral stenosis. MATERIALS AND METHODS: This prospective study included 56 patients with critical mitral stenosis in normal sinus rhythm (68% female; mean age: 42 ± 11 years) and 37 healthy controls. Aortic stiffness was measured using transthoracic echocardiography before PMBV, and 24-48 hours and 1 year post procedure. RESULTS: Aortic strain and distensibility were significantly higher in the patients with mitral stenosis, both after PMBV and 1 year post procedure, whereas the aortic stiffness index (ASI) was significantly lower. There was also a significant decrease in mitral mean gradient (MMG) and systolic pulmonary artery pressure (sPAP) after PMBV, based on echocardiography and catheterization. Mitral valve area (MVA) significantly increased after PMBV. There was a significant correlation between change in ∆MVA and ∆MMG and aortic elastic properties. There was a significantly negative correlation between the ∆MVA and ∆∆ aortic stiffness (r = -0.62, P < 0.001), and a significantly positive correlation between ∆MMG and ∆ASI (r = 0.60, P < 0.001). CONCLUSION: Mitral valve stenosis was associated with impaired aortic stiffness and following PMBV, aortic stiffness decreased during both the acute period and the intermediate period.

P-Wave Dispersion and Atrial Electromechanical Delay in Patients with Preeclampsia.

OBJECTIVES: To investigate the duration of atrial electromechanical delay (EMD) and left atrial mechanical function in patients with preeclampsia. MATERIALS AND METHODS: This study included 26 pregnant women with preeclampsia and 24 age-matched pregnant women without preeclampsia (control group). Atrial electromechanical coupling (PA) and intra-atrial and interatrial EMD were measured using tissue Doppler echocardiography. P-wave dispersion (PWD) was measured via 12-lead electrocardiography. All data were analyzed using SPSS v.15.0 for Windows (SPSS, Inc., Chicago, Ill., USA). Differences in continuous variables between groups were examined using a nonparametric Mann-Whitney U test. Correlation analysis was performed using Spearman's coefficient of correlation. Categorical values were compared using a χ2 test. RESULTS: PA lateral and PA septal durations were significantly longer in the preeclampsia group than in the control group [74.6 ± 8.1 vs. 62.3 ± 5.3 ms (p < 0.001) and 59.7 ± 5.3 vs. 56.2 ± 4.9 ms (p = 0.005), respectively]. The duration of interatrial EMD and intra-atrial EMD in the preeclampsia group was significantly longer than in the control group [25.4 ± 4.6 vs. 13.2 ± 3.9 ms (p < 0.001) and 10.5 ± 1.9 vs. 7.1 ± 1.2 ms (p < 0.001), respectively]. PWD was significantly higher in patients with preeclampsia (43.1 ± 9.1 ms) than in the controls (37.6 ± 7.9 ms; p = 0.008). There was a significant correlation between PWD and interatrial EMD and intra-atrial EMD [r = 0.46 (p < 0.001) and r = 0.39 (p < 0.001), respectively]. CONCLUSION: The duration of atrial EMD and PWD was prolonged in patients with preeclampsia.

Determinants of iatrogenic femoral pseudoaneurysm after cardiac catheterization or percutaneous coronary intervention via the femoral artery.

OBJECTIVE: This study aimed to define the prevalence and predictors for pseudoaneurysm after coronary angiography, cardiac catheterization and percutaneous coronary interventions (PCIs) performed via the femoral artery. METHODS: The study included 8469 patients enrolled between January 2007 and December 2009 on whom cardiac catheterization, coronary and/or peripheral angiography and PCIs via the femoral artery were performed. All data, including clinical characteristics and complications, were obtained retrospectively from patient chart records. RESULTS: Pseudoaneurysm was detected in 65 (0.76%) patients. Pseudoaneurysm was ascertained more frequently in patients with a history of coronary artery disease (0.9% vs. 0.4%; p=0.012), in females than in males (1.4% vs. 0.5%; p<0.001), in patients older than 65 years (1.2% vs. 0.6%; p=0.002), in patients with a history of femoral artery intervention (1.2% vs. 0.6%; p=0.01), in hypertensives than in normotensives (1.3% vs. 0.5%; p<0.001), in patients taking low molecular weight heparin (1.0% vs. 0.2%; p<0.001), in patients taking clopidogrel (1.0% vs. 0.4%; p=0.007), and in patients with chronic renal disease (3.8% vs. 0.7%; p<0.001). There was no statistically significant trend (1.2% vs. 0.7%; p=0.053) towards more pseudoaneurysm formation in emergent interventions than in elective procedures. CONCLUSION: Patients with a higher risk of pseudoaneurysm development following intervention via the femoral artery should be specified and extra attention given during the intervention. These patients should be informed of the increased risk of this complication and its results, and should be under close follow-up concerning development of iatrogenic femoral pseudoaneurysm.

Early- and mid-term effects of percutaneous mitral balloon valvuloplasty on left atrial mechanical functions in mitral stenosis.

OBJECTIVES: The aim of the study was to evaluate left atrial (LA) mechanical functions in MS before and after percutaneous mitral balloon valvuloplasty (PMBV) and to follow it up in short- and mid-term. STUDY DESIGN: We carried out a prospective study of 49 patients with critical mitral stenosis (MS) who had normal sinus rhythm. LA mechanical functions were evaluated before and 24-48 h, 3 months, and 1 year after PMBV, which included LA passive emptying volume (LAPEV), LA active emptying volume (LAAEV), LA total emptying volume (LATEV), LA passive emptying fraction (LAPEF), LA active emptying fraction (LAAEF), LA total emptying fraction (LATEF), and conduit volume. RESULTS: The transthoracic echocardiography parameters of the MS patients before and 24-48 h, 3 months, and 1 year after PMBV were as follows: (a) mitral valve area 1.1 cm² (0.9-1.6); 2.2 cm² (1.8-2.8) (p<0.001); 2.2 cm² (1.7-2.9) (NS); 2.1 cm² (1.8-2.7) (p<0.001); (b) LAPEV 13 ml/m² (9-27); 11 ml/m² (8-19) (p<0.001); 10 ml/m² (7-19) (p<0.001); 10 ml/m² (6-18) (p<0.001); (c) LATEV 26 ml/m² (19-50); 21 ml/m² (16-40) (p<0.001); 20 ml/m² (15-36) (p<0.001); 19 ml/m² (15-34) (p<0.001); (d) Conduit volume 30 ml/m² (22-44); 33 ml/m² (26-46) (p<0.001); 34 ml/m² (30-42) (p<0.001); 36 ml/m² (31-42) (p<0.001), respectively. However, LAAEV, LAPEF, LAAEF, and LATEF were not altered after PMBV. CONCLUSION: The findings of this study demonstrated an improvement of LA mechanical functions, which continued to improve for 1 year, after successful treatment of MS by PMBV.

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

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

Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture.

UNLABELLED: Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. KEY WORDS: Chest pain; Coronary artery disease; Esophageal rupture; Misdiagnosis.

Effect of Aromatherapy on the Anxiety of Patients before Coronary angiography.

PURPOSE: This study aimed to assess the effect of aromatherapy administered before coronary angiography on anxiety levels and physiological parameters. MATERIAL AND METHOD: The study used a randomized controlled trial design. The study group consisted of a total of 96 individuals. The research data were collected using the descriptive information form, the State-Trait Anxiety Inventory (STAI), and the Physiological Parameters Assessment Form. RESULTS: The results of this study indicated a significant difference between the groups in terms of pain levels and mean STAI-I scores prior to coronary angiography. CONCLUSION: The results revealed that aromatherapy administered before angiography reduced the anxiety and pain levels of patients.

The effect of insulin resistance on the heart rate recovery in healthy individuals with a low-to-moderate cardiovascular disease risk profile.

The association between insulin resistance (IR) and heart rate recovery index (HRRI) has been reported previously, but the cardiovascular disease (CVD) risk profile of the subjects was unclear in these studies. Therefore, we evaluated the association between IR and HRRI in apparently healthy individuals without metabolic syndrome who had a low-to-moderate CVD risk profile. A total of 182 eligible subjects were retrospectively included in the study. The subjects were divided into two groups according to the homeostasis model assessment of IR (HOMA-IR) value. HOMA-IR ≥2.5 was defined as IR (+) group (92 subjects), and <2.5 as IR (-) group (88 subjects). HRRI-2 was found by subtracting the heart rate at the second minute in the post-exercise recovery period from the maximum heart rate. Abnormal HRRI was defined as HRRI-2 that is ≤42 beats. The mean age of the patients was 41.91 ± 8.64 and 49.4% of them were female. Abnormal HRRI rates were significantly higher in the IR (+) group (37.2% vs 18.2%; p = 0.004). A negative correlation was detected between HRRI-2 and HOMA-IR (r = -0.416; p < 0.001). HOMA-IR (Odds Ratio (OR) = 1.57; confidence interval (CI) = 1.10-2.23; p = 0.013) and maximum heart rate during exercise (OR = 0.95; CI = 0.91-0.99; p = 0.013) as independent variables of abnormal HRRI. The HOMA-IR value of 2.82 was identified as an effective cutoff point for the prediction of abnormal HRRI (area under the curve: 0.658; CI: 0.570-0.746; p = 0.001). In this study, it was shown that IR without metabolic syndrome reduces HRRI in healthy individuals with a low-to-moderate CVD risk profile.

Increased triglyceride-glucose index predicts contrast-induced nephropathy in non-diabetic NSTEMI patients: A prospective study.

The triglyceride-glucose (TyG) index is a new reliable marker of insulin resistance (IR) and has recently been reported to be associated with renal dysfunction and contrast-induced nephropathy (CIN). Our aim in this study is to investigate the relationship between the TyG index and CIN in non-diabetic non-ST elevation acute myocardial infarction (NSTEMI) patients. The study included 272 non-diabetic patients who applied with NSTEMI and underwent coronary angiography (CAG). Patient data were divided into quartiles according to the TyG index: Q1: TyG < 8.55; Q2: 8.55 ≤ TyG ≤ 8.87; Q3: 8.88 ≤ TyG ≤ 9.29; and Q4: TyG > 9.29. Baseline characteristics, laboratory measurements, angiography data, and the incidence of CIN were compared between the groups. CIN was observed in 18 (6.6%) patients in the study. The incidence of CIN was lowest in the Q1 group and highest in the Q4 group (1 (1.5%) in Q1; 3 (4.4%) in Q2; 5 (7.4%) in Q3; 9 (13.2%) in Q4; p = 0.040). TyG index was found to be an independent risk factor for the development of CIN in multivariate logistic regression analysis (odds ratio = 6.58; confidence interval (CI) = 2.12-20.40; p = 0.001). TyG index value of 9.17 was identified as an effective cut-off point for the prediction of CIN (Area under the curve: 0.712, CI: 0.590-0.834, p = 0.003), and it had a sensitivity of 61% and a specificity of 72%. The results of this study showed that a high TyG index increases the incidence of CIN after CAG in non-diabetic NSTEMI patients and is an independent risk factor for the development of CIN.

Value of increased CRP/albumin ratio in predicting embolic events in patients with infective endocarditis.

Background: The CRP/albumin ratio (CAR), a new inflammatory marker, is associated with adverse outcomes in various cardiovascular diseases. We evaluated the effectiveness of CAR in predicting embolic events in patients diagnosed with infective endocarditis (IE). Methods: A total of 145 patients with IE were included in the study and categorized into two groups according to the presence of embolic events. We retrospectively analyzed the patients' clinical, laboratory and echocardiographic data. Results: CRP (94.2 vs 63.3; p < 0.001) and CAR (25.8 vs 15.1; p < 0.001) values were significantly higher in patients who experienced embolic events. Multivariate analysis showed that a high CAR value (odds ratio: 1.030; 95% CI: 1.000-1.060; p = 0.041) was an independent predictor of embolic events in patients with IE. Conclusion: The CAR is a cheap and easily accessible marker that can predict the development of embolic events in patients diagnosed with IE.