Turkish Real Life Atrial Fibrillation in Clinical Practice: TRAFFIC Study.

BACKGROUND: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and is associated with an increased risk of thromboembolism, ischemic stroke, impaired quality of life, and mortality. The latest research that shows the prevalence and incidence of AF patients in Türkiye was the Turkish Adults' Heart Disease and Risk Factors study, which included 3,450 patients and collected data until 2006/07.The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study is planned to present current prevalence data, reveal the reflection of new treatment and risk approaches in our country, and develop new prediction models in terms of outcomes. METHODS: The TRAFFIC study is a national, prospective, multicenter, observational registry. The study aims to collect data from at least 1900 patients diagnosed with atrial fibrillation, with the participation of 40 centers from Türkiye. The following data will be collected from patients: baseline demographic characteristics, medical history, vital signs, symptoms of AF, ECG and echocardiographic findings, CHADS2-VASC2 and HAS-BLED (1-year risk of major bleeding) risk scores, interventional treatments, antithrombotic and antiarrhythmic medications, or other medications used by the patients. For patients who use warfarin, international normalized ratio levels will be monitored. Follow-up data will be collected at 6, 12, 18, and 24 months. Primary endpoints are defined as systemic embolism or major safety endpoints (major bleeding, clinically relevant nonmajor bleeding, and minor bleeding as defined by the International Society on Thrombosis and Hemostasis). The main secondary endpoints include major adverse cardiovascular events (systemic embolism, myocardial infarction, and cardiovascular death), all-cause mortality, and hospitalizations due to all causes or specific reasons. RESULTS: The results of the 12-month follow-up of the study are planned to be shared by the end of 2023. CONCLUSION: The TRAFFIC study will reveal the prevalence and incidence, demographic characteristics, and risk profiles of AF patients in Türkiye. Additionally, it will provide insights into how current treatments are reflected in this population. Furthermore, risk prediction modeling and risk scoring can be conducted for patients with AF.

Evaluation of the Early Effects of Childhood Asthma and Its Treatment on Cardiac Function as Revealed by Two-Dimensional Speckle-Tracking Echocardiography.

There is minimal information available regarding the early effects of bronchial asthma (BA) and its treatment on cardiac function in children. We used two-dimensional speckle-tracking echocardiography (2D-STE) to evaluate cardiac function before and after the treatment of childhood BA. We enrolled 44 children with moderate and severe BA who had not been treated over the preceding 3 months or who were newly diagnosed. All children received the same treatment (that recommended by the Global Initiative for Asthma [GINA] in 2017). All children also underwent transthoracic 2D-STE before treatment and 6 months later. Clinical data were compared before and after treatment. After treatment, significant increases were evident in right ventricular (RV) systolic and diastolic strain, as well as the systolic strain rate. Before and after treatment, the RV global longitudinal systolic strains were - 22.8 ± 3.6 and - 25.1 ± 4.5, respectively (p = 0.036); the RV global longitudinal diastolic strains were - 18.5 ± 6.0 and - 21.5 ± 5.2, respectively (p = 0.038); and the RV systolic strain rates were - 1.26 ± 0.4 and - 1.12 ± 0.3, respectively (p = 0.025). After treatment, significant increases were observed in the right atrial (RA) peak longitudinal strain and strain rate. Before and after treatment, the RA peak atrial longitudinal strains were 32.5 ± 10.8 and 44.7 ± 11.2, respectively (p = 0.042) and the RA longitudinal strain rates were - 1.6 ± 0.3 and - 2.0 ± 0.5, respectively (p = 0.041). RV and RA subclinical dysfunction may develop in children with early-stage BA. However, asthma treatment appears to improve such dysfunction. In children with BA, clinical and subclinical changes in cardiac functions can be easily detected via 2D-STE.

Acute Effects of Red Bull Energy Drinks on Atrial Electromechanical Function in Healthy Young Adults.

Energy drinks (EDs) are widely consumed by adolescents and young adults. Almost all kinds of arrhythmias have been reported following EDs consumption, most of which is atrial fibrillation (AF). Atrial conduction time prolongation and heterogeneous sinusal impulses propagation to the atriums are the key electrophysiological mechanisms leading AF. We aimed to evaluate the acute effects of Red Bull ED ingestion on atrial electromechanical conduction times in healthy young adults. After a 12-hour fasting, 54 healthy young adults consumed 330 mL of Red Bull ED. Atrial electromechanical coupling (PA), intra-atrial electromechanical delay (intra-AEMD), and interatrial electromechanical delay (inter-AEMD) were measured at baseline and 2-hour after Red Bull ED ingestion by echocardiographic tissue-Doppler imaging (TDI) method. PA-lateral (49.7 ± 11.2 vs 54.1 ± 11.0 msn, p = 0.001) and PA-septal (40.8 ± 9.1 vs 43.7 ± 10.5 msn, p = 0.032) times were statistically significantly prolonged after Red Bull ED ingestion. There was also a statistically significant increase in the duration of inter-AEMD (14.4 ± 10.6 vs 18.1 ± 8.5 msn, p = 0.010) after ED ingestion. It was showed that even a single can of ED can acutely increase atrial electromechanical conduction times in young adults. These findings may be the cause of ED-associated AF.

Assessment of the relationship between coronary flow rates and myocardial perfusion abnormality in patients with nonobstructive coronary artery disease: an observational study in cardiac syndrome X and coronary slow flow.

OBJECTIVES: In this study, we evaluated and compared the level of myocardial ischaemia caused by cardiac syndrome X (CSX) and coronary slow flow (CSF) with single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), and determined if changes in the level of myocardial ischaemia exist in CSF and CSX cases according to thrombolysis in myocardial infarction frame count (TFC). MATERIALS AND METHODS: The study population consisted of 66 patients with CSF and 78 angiographically normal patients (36 of them with CSX and 42 of them healthy controls). The coronary flow rates of all patients were documented using TFC. Subsequently, all patients were evaluated with SPECT-MPI and categorized into the following groups according to their results: patients with CSF, patients with CSX, and patients with normal coronary arteries. Finally, we investigated whether a relationship existed between the SPECT-MPI and TFC results from these three groups. RESULTS: All ischaemia scores for MPI were significantly higher in the CSF group than in the CSX and control groups (P < 0.05). TFC was significantly associated with the severity of ischaemia in the CSF patients. There was a significant positive correlation between the summon difference score (SDS) and mean TFC value (P < 0.05) as well as between the SDS and each individual coronary TFC value in the CSF patients (P < 0.05). The number of vessels involved in CSF was positively correlated with the SDS. CONCLUSION: CSF is associated with more severe myocardial ischaemia than CSX. The level of myocardial ischaemia on SPECT-MPI was correlated with the TFC and the number of affected coronary vessels in patients with CSF. These results suggest that CSF is a more serious clinical entity than CSX, and that the clinical severity of CSF appears to increase as the coronary flow rate decreases.

Does contrast media volume affect long-term survival in patients with chronic kidney disease?

INTRODUCTION: The aim of this study was to investigate the relationships between survival and related features in patients with chronic kidney disease undergoing cardiac catheterization and coronary angiography. MATERIAL AND METHODS: Three hundred and seven consecutive patients with an estimated glomerular filtration rate (e-GFR) less than 60 ml/min/1.73 m2 undergoing coronary angiography were enrolled in the study. The study population was pursued with a median follow-up duration of 41.5 months. RESULTS: In the Cox proportional hazards regression model, age (HR = 1.047, 95% CI: 1.011-1.084, p = 0.01), contrast media volume (HR = 1.004, 95% CI: 1.001-1.007, p = 0.008), angiotensin II receptor blocker (ARB) use (HR = 0.485, 95% CI: 0.261-0.901, p = 0.02), and e-GFR (HR = 0.978, 95% CI: 0.940-1.016, p = 0.04) were found to be independent predictors of long-term all-cause mortality. The survival analysis showed that the long-term all-cause mortality rate was higher in patients using contrast media volume greater than 140 ml compared to patients given less than or equal to 140 ml during the coronary angiography (3.6% vs. 11.6% log-rank, p = 0.001). CONCLUSIONS: In patients with chronic kidney disease undergoing cardiac catheterization, age, contrast media volume, e-GFR and low ARB use were found to be independent predictors of long-term all-cause mortality. Contrast media volume used > 140 ml was independently associated with long-term all-cause mortality compared to less than or equal to 140 ml during cardiac catheterization.

Aspirin resistance in patients with impaired renal functions.

BACKGROUND: Cardiovascular diseases (CVD) are the leading cause of death in patients with chronic kidney diseases (CKD). Aspirin resistance (AR) worsens prognosis in CVD. AIM: The aim of this study was to detect AR prevalence in this patient group. METHODS: The 203 patients (mean age 61.84 ± 11.51 years, 128 [63.1%] male) with stable coronary artery disease included in the study were grouped into four study groups according to their estimated glomerular filtration rate (eGFR) values. Multiplate test was used to determine AR. Platelet aggregation results were presented as aggregation unit (AU) × min and values over 300 AU × min were accepted as AR. RESULTS: 61 (30.04%) patients in the whole study population were found to have AR. Differences were detected between AR ratios and multiplate values of the patient groups (p = 0.006 and p = 0.002). AR ratio was highest in patient group 4 (eGFR < 30 mL/min/1.73 m²) and/or on chronic haemodialysis therapy, whereas there was little difference among the other three groups. In multivariate analysis, while AR status was independently related to female sex (OR = 2.31,CI 1.14-4.65, p = 0.019) and mean platelet volume (MPV) (OR = 1.68, CI 1.21-2.33, p = 0.002), multiplate test results were independently related to MPV (b = 0.265, p < 0.0001) and eGFR (b = -0.165, p = 0.025). CONCLUSIONS: The AR ratio was found to be high in severe CKD patients, especially haemodialysis patients, but not in mild and moderate CKD patients. This increased AR ratio in severe CKD patients may affect the prognosis in patients who already have an increased risk for cardiovascular complications.