Cardio-ankle brachial index is associated with prolonged Tp-e interval in patients with arterial hypertension.

AIM: The cardio-ankle vascular index (CAVI) is a marker of arterial stiffness, and elevated CAVI values have been reported to be associated with an increased risk of cardiovascular mortality and cardiac arrhythmia. This study aimed to evaluate the relationship between Tp-e interval and CAVI, which is associated with cardiac arrhythmia on electrocardiography (ECG). METHOD: The study included patients with hypertension whose blood pressure values were taken under control with optimal medical treatment. Arterial stiffness and CAVI were measured using the vascular scanning system VaSera VS-1000. The patients were divided into two groups as CAVI<9 and CAVI≥9. Ventricular repolarization markers QT and QTc intervals, Tp-e interval, and Tp-e/QT and Tp-e/QTc ratios were measured using 12­lead ECG. RESULTS: Tp-e interval (78.7 ± 10.3 vs. 63.6 ± 9.1, p < 0.001), Tp-e/QT ratio (0.018 ± 0.02 vs. 0.015 ± 0.02, p < 0.001), and Tp-e/QTc ratio (0.17 ± 0.02 vs. 0.14 ± 0.04, p = 0.025) were statistically significantly higher in the CAVI≥9 group compared to the CAVI<9 group. In the prediction of patients in the CAVI≥9 group, Tp-e interval had an area under the curve value of 0.862 (0.784-0.940, p < 0.001) at the cut-off point of >72.5 msec, indicating a statistically significant result. Left CAVI and right CAVI were found to be significantly correlated with Tp-e interval (r = -0.650, p < 0.001 and r = -0.663, p < 0.001, respectively). CONCLUSION: We found that elevated CAVI values were associated and positively correlated with prolonged Tp-e interval values in patients with hypertension. Patients with elevated CAVI values should be followed up closely to prevent cardiac arrhythmic events.

Effect of Sodium-Glucose Co-transporter-2 Inhibitors on Ventricular Repolarization Markers in Heart Failure with Reduced Ejection Fraction.

BACKGROUND AND AIM: Sodium-glucose co-transporter-2 (SGLT2) inhibitors added to optimal medical therapy have been shown to reduce the risk of cardiovascular death and recurrent heart failure (HF) hospitalization in HF patients. We aimed to evaluate the effect of SGLT2 inhibitors on the ventricular repolarization markers (VRM) in patients with HF with reduced ejection fraction (HFrEF). METHODS: 51 patients with HFrEF who had symptoms New York Heart Association (NYHA) class II-IV despite optimal medical treatment and were added SGLT2 inhibitors to their treatment were included in the study. Electrocardiography (ECG) and laboratory results obtained before the treatment and at the first-month follow-up visit were compared. QT, QTc (corrected by Bazett formula), QT dispersion (QTd), QTc dispersion (QTc-d), Tpeak to Tend (Tp-e) interval, Tp-e/QT, and Tp-e/QTc ratios were measured and defined as VRM. RESULTS: A significant decrease was observed in HR, QT, QTc intervals, and QTd compared to pre-treatment. While the mean Tp-e interval was 101.5 ± 11.7 ms before treatment, it decreased to 93.1 ± 12.7 ms after treatment (p < 0.001). There was a significant decrease in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels after treatment [2859 ± 681vs.1266 ± 763, respectively (p < 0.001)] and QTd, Tp-e interval, and Tp-e/QTc ratio was positively correlated with the change in NT-proBNP level. CONCLUSIONS: The addition of SGLT2 inhibitors to optimal medical therapy in HFrEF patients positively changes VRM (QT, QTc, QTd, Tp-e, and Tp-e/QTc).

Effects of sodium-glucose cotransporter-2 inhibitors on nutritional status in heart failure with reduced ejection fraction.

OBJECTIVE: This study aimed to evaluate the effects of sodium-glucose cotransporter-2 inhibitors on nutritional status in patients with heart failure with reduced ejection fraction. METHODS: The sodium-glucose cotransporter-2 inhibitor treatment was initiated in 153 patients with heart failure with reduced ejection fraction who were symptomatic despite optimal medical treatment and were followed up for 6 months. The Minnesota Living With Heart Failure Questionnaire scores, New York Heart Association functional class, NT-pro-BNP levels, and nutritional index scores of the patients were evaluated before sodium-glucose cotransporter-2 inhibitor treatment and at the 6-month follow-up. The nutritional status of the patients was evaluated with the COntrolling NUTritional Status score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index. RESULTS: After sodium-glucose cotransporter-2 inhibitor treatment, significant changes were observed in the mean scores of the three different nutritional indexes: COntrolling NUTritional Status (before: 2.76±2.43 vs. after: 1.12±1.23, p<0.001), Geriatric Nutritional Risk Index (before: 98.2±9.63 vs. after: 104.4±5.83, p<0.001), and Prognostic Nutritional Index (before: 37.9±4.63 vs. after: 42.9±3.83, p<0.001) scores. A significant decrease in the number of patients with malnutrition was observed according to the COntrolling NUTritional Status (before: 46.4% vs. after: 9.7%, p<0.001), Geriatric Nutritional Risk Index (before: 41.8% vs. after: 18.9%, p=0.006), and Prognostic Nutritional Index (before: 36.6% vs. after: 13.7%, p=0.007) scores. A significant functional improvement was observed in patients after sodium-glucose cotransporter-2 treatment: Minnesota Living With Heart Failure Questionnaire scores (before: 39.2±7.2 vs. after: 20.4±7.4, p<0.001), NT-pro-BNP levels (before: 2989±681 vs. after: 1236±760, p<0.001), and New York Heart Association class (before: class II-III: 95.5%; class IV: 4.5% vs. after: class II-III: 78%; class IV: 0%, p<0.001). CONCLUSION: In patients with heart failure with reduced ejection fraction who are symptomatic despite optimal medical treatment, the addition of an sodium-glucose cotransporter-2 inhibitor to treatment can significantly improve both the nutritional and functional statuses.

Evaluation of endothelial dysfunction with cardio-ankle vascular index measurements in patients with erectile dysfunction.

BACKGROUND: It has been reported that there is a relationship between erectile dysfunction and endothelial dysfunction. However, a practical and non-invasive method to clinically evaluate this relationship has not yet been determined. The cardio-ankle vascular index is a marker of arteriosclerosis that develops as a result of endothelial dysfunction. OBJECTIVE: To investigate the correlation between the cardio-ankle vascular index and the presence and severity of erectile dysfunction. MATERIALS/METHODS: This was a case-control study including 74 patients that presented to the urology department of our institution with erectile dysfunction (without cardiovascular risk factors) and 86 healthy individuals of similar age. The patients with erectile dysfunction and the control group were evaluated using the five-item version of the International Index of Erectile Function (IIEF-5). Cardio-ankle vascular index and ankle-brachial pressure index measurements were performed using the VaSera VS-1000 (Fukuda-Denshi Company, Ltd, Tokyo, Japan) device. RESULTS: The mean age was 59.8 ± 1.3 years for the erectile dysfunction group and 57.9 ± 1.1 years for the control group. The mean right (R)-cardio-ankle vascular index values of the erectile dysfunction and control groups were 9.20 ± 2.6 and 8.11 ± 1.8, respectively (p = 0.014), and their mean left (L)-cardio-ankle vascular index values were 9.08 ± 2.7 and 7.96 ± 1.2, respectively (p = 0.008). The mean International Index of Erectile Function score of the patients with erectile dysfunction was 10.1 ± 3.6. An inverse correlation was found between the R-cardio-ankle vascular index and L-cardio-ankle vascular index and the International Index of Erectile Function score (r = -0.411, p = 0.011, and r = -0.454, p < 0.001, respectively). DISCUSSION AND CONCLUSION: According to our findings, the cardio-ankle vascular index was higher in patients with erectile dysfunction than in healthy individuals.

The relationship between vitamin B12 levels and electrocardiographic ventricular repolarization markers.

Introduction: Background: it has been shown that vitamin B12 deficiency, which can cause hematological and neuropsychiatric disorders, may also be associated with cardiac autonomic dysfunction, heart rate variability, endothelial dysfunction, and a decrease in myocardial deformation. Aims: the aim of our study is to evaluate the relationship between vitamin B12 levels and electrocardiographic repolarization disorders, which are indicators of arrhythmogenic predisposition in healthy individuals. Methods: our study population consisted of 214 healthy adults. Considering the distribution of vitamin B12 levels and accepting 25 % and 75 % percentiles as the cut-off values, the participants were divided into 3 groups. Laboratory, echocardiography and electrocardiography (ECG) measurements were compared between three groups. ECG measurements were performed manually and Tpeak-Tend (Tp-e), Tp-e corrected (Tp-ec), QT and QT corrected (QTc) intervals were calculated. Results: the patients in Group 1 (vitamin B12 < 253 pg/ml) were found to have significantly higher QT and QTc dispersions, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios when compared to those in Group 2 (253 pg/ml < vitamin B12 > 436 pg/ml) and Group 3 (vitamin B12 > 436 pg/ml). On the other hand, a negative significant correlation was detected between vitamin B12 levels and Tp-e, Tp-e/QT, Tp-e/QTc ratios, QT and QTc dispersions. Conclusion: a low level of vitamin B12 in healthy individuals can be a significant indicator of arrhythmogenic susceptibility. A close follow-up of these subjects in terms of arrhythmogenic predisposition can be useful.

Introducción: Fundamento: se ha demostrado que la deficiencia de vitamina B12, que puede causar trastornos hematológicos y neuropsiquiátricos, también puede estar asociada con disfunción autonómica cardíaca, variabilidad de la frecuencia cardíaca, disfunción endotelial y disminución de la deformación miocárdica. Objetivos: el objetivo de nuestro estudio es evaluar la relación entre los niveles de vitamina B12 y los trastornos de repolarización electrocardiográfica que son indicadores de predisposición arritmogénica en individuos sanos. Métodos: la población del estudio fue de 214 adultos sanos. Considerando la distribución de los niveles de vitamina B12 y aceptando los percentiles del 25 % y 75 % como valores de corte, los participantes se dividieron en 3 grupos. Se compararon las mediciones de laboratorio, ecocardiografía y electrocardiografía (ECG) entre tres grupos. Las mediciones del ECG se realizaron manualmente y se calcularon los intervalos Tpeak-Tend (Tp-e), Tp-e corregido (Tp-ec), QT y QT corregido (QTc). Resultados: se encontró que los pacientes del grupo 1 (vitamina B12 < 253 pg/ml) tenían dispersiones QT y QTc, intervalo Tp-e, cocientes Tp-e/QT y Tp-e/QTc significativamente más altos cuando se compararon con los del grupo 2 (253 pg/ml < vitamina B12 > 436 pg/ml) y el grupo 3 (vitamina B12 > 436 pg/ml). Por otro lado, se detectó una correlación significativa negativa entre los niveles de vitamina B12 y las relaciones Tp-e, Tp-e/QT, Tp-e/QTc, dispersiones QT y QTc. Conclusión: el bajo nivel de vitamina B12 en los individuos sanos puede ser un indicador significativo de susceptibilidad arritmogénica. Un seguimiento estrecho de estos sujetos en términos de predisposición arritmogénica podría ser útil.

Evaluation of the cardio-ankle vascular index in COVID-19 patients.

OBJECTIVE: This study aimed to investigate the relationship and prognostic significance of cardio-ankle vascular index, which is a measure of arterial stiffness that can lead to endothelial dysfunction and poor cardiovascular issues in COVID-19 patients, with COVID-19. METHODS: The study included 115 patients, of which 65 patients in the case group with Real time reversetranscription-polymerasechainreaction test positive and diagnosed for COVID-19 and 50 volunteers in the control group. Patients with COVID-19 were classified as moderate/severe or mild COVID-19 in the subgroup analysis based on the severity of the disease. We investigated the relationship between cardio-ankle vascular index and COVID-19 by using the VaSera VS-1000 device to automatically measure each patient's cardio-ankle vascular index and ankle-brachial pressure index. RESULTS: The mean age of participants included in the study was 65.7±10.7 years. Patients and volunteers were statistically similar in terms of age, gender, comorbidities, Charlson comorbidity index scores, and body mass index values (p>0.05). The right-cardio-ankle vascular index value was 9.6±2.4 in the case group and 8.5±1.1 in the control group (p=0.004). The left-cardio-ankle vascular index value was 9.4±2.7 in the case group and 8.5±1.2 in the control group (p=0.01). The right-cardio-ankle vascular index value was 10.8±3.4 in the moderate/severe disease group and 8.8±0.9 in the mild disease group (p=0.008). The left-cardio-ankle vascular index value was 10.7±3.6 in the moderate/severe disease group and 8.5±1.5 in the mild disease group (p<0.001). The right-cardio-ankle vascular index and left-cardio-ankle vascular index values were found to be significantly higher in COVID-19 patients in our study. When receiver operating characteristic analysis was performed to distinguish moderate/severe COVID-19 patients from mild patients, right-cardio-ankle vascular index was area under the curve 0.757 (0.630-0.884), and left-cardio-ankle vascular index was area under the curve 0.782 (0.661-0.902). CONCLUSION: The right-cardio-ankle vascular index and left-cardio-ankle vascular index values increased in COVID-19 patients in our study, and this was thought to be prognostically significant.

YouTube as a Source of Information on Echocardiography: Content and Quality Analysis.

BACKGROUND: YouTube (YouTube, LLC, San Bruno, CA, USA) is an easily accessible and increasingly popular source of information on health-related issues. This study evaluated the scientific content and quality of English-language echocardiography videos posted to this Internet platform. METHODS: For this study, 583 videos were identified and evaluated following a YouTube search using the keyword 'echocardiography' in July 2020. A total of 92 videos were included in this study following the application of the study exclusion criteria. Both video quality and scientific content were evaluated based on the DISCERN score, global quality score, content score, and total quality score (TQS), which was calculated by adding the scores of the three aforementioned scoring systems. RESULTS: The median duration of the included videos was 315 seconds (interquartile range: 173-852 seconds). The median number of views was 33046 (interquartile range: 7445-89012). Twenty-four (26.08%), 43 (46.73%) and 25 (27.17%) videos, respectively, were stratified into the following three groups based on TQS values: group 1 (5-7 points), group 2 (8-11 points) and group 3 (12-14 points). The values of views (median: 45072), video duration (median: 474), power index (median: 80250) and popularity (median: 34) were significantly higher in group 3 than in the other groups. The duration that a video was online was statistically significantly higher in group 1. CONCLUSIONS: The results suggest that YouTube is an important tool for easily sharing health-related information and disseminating it to large audiences. It can be concluded from the growing interest in videos with scientific content and the high quality scores recorded that YouTube offers accurate and quality information about echocardiography.

Evaluation of Electrocardiographic Parameters and the Presence of Interatrial Block in Patients with Mad Honey Intoxication.

Mad honey intoxication (MHI) is a food-induced clinical condition that usually presents with cardiovascular symptoms and can lead to life-threatening arrhythmias if not diagnosed and treated early. No data exist in the literature on the presence of interatrial block (IAB) after food intoxication. In our study, we sought to investigate atrioventricular electrocardiography (ECG) parameters and determine the frequency of IAB in patients with MHI. In total, 76 patients diagnosed with MHI were included in our retrospective study. Twelve-lead ECGs were performed and participants were divided into two groups according to the presence of IAB in the reference ECG. The P maximum (Pmax), P minimum (Pmin), P dispersion (Pdisp), T peak to T end (Tp-Te) interval and QT dispersion (QTdisp) values were compared between the two groups. IAB was detected in 28 (35.5%) of 76 MHI patients included in the final analysis. Pmax duration (122 ± 8; p < 0.001) and PD (69 ± 11; p < 0.001) were significantly higher in the IAB ( +) group. During regression analysis, Pmax [odds ratio (OR) 1.158, 95% confidence interval (CI) 1.036-1.294; p = 0.010] and Pd (OR 1.086, 95% CI 1.001-1.017; p = 0.046) were independently associated with IAB. Pmax and Pd area under the receiver operating characteristic curve values for IAB prediction were 0.926 (95% CI 0.841-1,000; p < 0.001) and 0.872 (95% CI 0.765-0.974; p < 0.001), respectively. ECG changes are common in patients presenting with MHI. These patients need to be followed up clinically in terms of progression to arrhythmic events that may occur in the future.

Relationship between door-to-balloon time and clinical experience level of emergency department physicians.

BACKGROUND: This study aimed to investigate the relationship between the experience level of physicians initially making the clinical diagnosis of ST-segment elevation myocardial infarction in the emergency department and door-to-balloon time (DBT). MATERIAL AND METHODS: The study group comprised 522 patients with ST-elevation myocardial infarction who were immediately treated in the catheter laboratory. Information about DBT, the experience level of the physicians who initially clinically diagnosed the patients and clinical benefit parameters were collected. The experience level of the physicians was divided into three groups: medical practitioner (no emergency training; n = 351), assistant physician (undergoing emergency medicine training; n = 111) and emergency medicine specialist (n = 60). DBT was compared among these groups. RESULTS: The average DBT was 80.3 ± 83.2 minutes for medical practitioners, 77.5 ± 74.7 minutes for assistant physicians and 53.6 ± 28.1 minutes for emergency medicine specialists. The difference in DBT between the emergency medicine specialist group and others was statistically significant (P = .046). CONCLUSIONS: DBT decreased as the experience level of the emergency physician increased, but randomisation is required to determine the clinical benefit of this effect.

The effect of low iron storage without Anaemia on electrocardiography.

BACKGROUND: Low iron storage is a common health problem around the world. Although the association of low iron storage with cardiovascular events and various electrocardiographic parameters has been investigated, its association with fragmented QRS (fQRS), Tpeak-Tend (Tp-e) interval, Tp-e/QT and Tp-e/QTc ratios, which are important criteria for repolarization, has not been studied in adults. METHODS: A total of 201 female patients in the 18-50 age group with no history of chronic and cardiac disease or anaemia were included in the study. Patients were divided into 3 groups based on their ferritin levels. Twelve lead EKGs were obtained from each patient, and fQRS, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were calculated manually. RESULTS: A total of 201 female patients with an average age of 37 ± 9 were included in the study. Group 1 (ferritin<15 ng/mL) consisted of 79 (39.3%) patients, Group 2 (ferritin 15-30 ng/mL) consisted of 64 patients (31.8%) and Group 3 (ferritin≥30 ng/mL) consisted of 58 (28.9%) patients. Tp-e interval was significantly higher in Group 1 compared to Group 2 and 3 (p < 0.001). A similar relationship was also observed between Tp-e/QT, Tp-e/QTc and fQRS (p < 0.001). A moderate, negative relationship was found in the correlation analysis of Tp-e, Tp-e/QT, Tp-e/QTc and fQRS with ferritin value [r = -0.519 (p = 0.001), r = -0.485 (p = 0.001), r = -0.540 (p = 0.001) and r = -0.345 (p = 0.001), respectively]. CONCLUSION: As a result of the study, it was found that low iron storage may increase arrhythmogenic susceptibility through increased fragmented QRS presence, increased Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in healthy women of childbearing age.

Predictors and Clinical Outcomes of Crossover From Radial to Femoral Access During Primary Percutaneous Coronary Intervention.

Access site complications are more common with femoral access (FA) than radial access (RA). However, due to the higher rate of failure and crossover, door-to-balloon time (DBT) is prolonged by RA. Records of 3600 patients who underwent primary percutaneous coronary intervention (pPCI) between January 2016 and June 2019 were retrospectively reviewed. A total of 130 patients with crossover from RA to FA were identified and compared with the data of 501 patients who underwent pPCI with successful RA during 2018. Regression analysis was performed to determine the predictors of crossover. Crossover to the femoral approach occurred in 5.9% of our cases. Mean DBT was 17 minutes longer in the crossover group (61 ± 72 minutes vs 78 ± 79 minutes, P = .026). Female sex (odds ratio [OR]: 1.8; 95% CI, 0.99-3.46, P = .046) and anterior myocardial infarction (AntMI; OR: 0.52; 95% CI, 0.33-0.88, P = .007) were independent predictors of crossover. In-hospital mortality rates were significantly higher in the crossover group than in the radial success group (5.4% vs 1.8%, P = .020). Crossover to FA due to radial failure is associated with delayed DBT and increased rate of in-hospital mortality. Female sex and AntMI were primary predictors of crossover.

Association between Cardio-ankle Vascular Index and Contrast-induced Nephropathy.

OBJECTIVE: To investigate the relationship between cardio-ankle vascular index (CAVI), which is a marker of arteriosclerosis and the development of contrast-induced nephropathy (CIN). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Cardiology, Sakarya University Medical Faculty, from May to December 2019. METHODOLOGY: Between May and December 2019, demographic characteristics, CAVI measurements, and in-hospital clinical outcomes were compared among 66 patients, who developed CIN after coronary angiography (CAG) and an acute coronary syndrome (ACS) diagnosis, and 60 ACS patients without CIN. RESULTS: The frequency of CIN development in the study was 5.5%. In the CIN group, EF was lower (44.5 ± 10.6% vs. 49.3 ± 9.8%, p = 0.011) and GFR (mL/min/1.73 m2) at admission, was lower (60.3 ± 23.3 vs. 87.0 ± 21.5, p <0.001) than in the non-CIN group. CAVI values indicative of arterial stiffness (AS) were significantly higher in the CIN group. Mortality was not significantly higher in the CIN group (p = 0.099). CONCLUSION: AS is more common in ACS patients, who developed CIN after CAG. Older patients with low EF and low GFR, in whom AS is more common, should be intravenously hydrated and more closely monitored to prevent CIN development. Key Words: Contrast-induced nephropathy, Acute coronary syndrome, Cardio-ankle vascular index, Arterial stiffness.

Comparison of effects of thrombolytic therapy and primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction on in-hospital, six-month, and one-year mortality.

INTRODUCTION: This study aims to evaluate the effect of primary percutaneous coronary intervention (PCI) and thrombolytic therapy (TT) on the in-hospital adverse events, in-hospital and long-term mortality in patients over 65 years of age with acute ST-segment elevation myocardial infarction (STEMI). MATERIAL AND METHODS: A total of 111 retrospectively screened patients (73 males, mean age: 73.4 ±5.9 years) over 65 years of age with STEMI, who underwent TT or primary PCI, were included in the study. Patients' characteristics, in-hospital outcomes, and 6-month and 1-year mortalities were recorded. RESULTS: Our study was conducted with 111 patients over 65 years of age with STEMI (73 males, 38 females). Of the patients, 66 (59.5%) were treated with thrombolytics, and 45 (40.5%) patients underwent primary PCI. Door-to-needle time was 25.9 ±7.8 min in the TT group, whereas door-to-balloon time was 84.4 ±20.0 min in the PCI group. Time from symptom onset to hospital admission was 213.6 ±158.4 min in the thrombolytic group, and 166.8 ±112.8 min in the PCI group. Rescue PCI was performed in 7 (10.6%) patients in the TT group due to lack of reperfusion. Recurrent infarction was observed in 5 (7.6%) patients in the TT group and in 2 (4.4%) patients in the PCI group. Non-haemorrhagic stroke was observed in 1 (1.5%) patient in the thrombolytic-administered group and in 4 (8.9%) patients in the PCI group. No intracranial haemorrhage was observed in any patient. Major haemorrhage was observed in 4 (6.1%) patients in the TT group and in 4 (8.9%) patients in the PCI group. Six-month and 1-year mortalities were present in 15 (22.7%) patients and 19 patients in thrombolytic group, and 8 (17.8%) and 8 (17.8%) patients in the PCI group, respectively. Binary logistic regression analysis indicated that the patient's age was the only predictor for 1-year mortality (odds ratio (OR) = 1.1, 95% confidence interval (CI): 1.019-1.188, p = 0.015). CONCLUSIONS: Considering the in-hospital adverse outcomes, in-hospital mortality, and 6-month mortality rates, TT and primary PCI have similar effects in STEMI patients aged 65 years and over according to the results of our study. Although 1-year mortality was higher in the TT group, it was not statistically significant.

Lack of Variation in Inflammatory Hematological Parameters between Benign Nodular Goiter and Papillary Thyroid Cancer.

BACKGROUND: Inflammatory hematological parameters like the neutrophil/lymphocyte (N/L) ratio have been investigated in many cancer types and significant relationships found with prognosis, for example. The aim of this present study was to investigate the impact of hematological parameters notably on N/L ratio and mean platelet volume (MPV) in papillary thyroid cancer cases. MATERIALS AND METHODS: A total of 79 patients who underwent a thyroidectomy operation in Findikli, Goiter Research and Treatment Center during 2011- 2015 period were enrolled in the study, 41 with papillary thyroid cancer and 38 with benign goiter confirmed by pathological examination. We collected clinical and laboratory data for the patients from hospital records retrospectively. Blood samples taken at admission were assessed for parameters compared between the groups. RESULTS: No significant differences between papillary thyroid cancer and benign goiter groups were apparent in terms of age, the N/L ratio, MPV, white blood cell count (WBC), red blood cell count (RBC), hemoglobin, hematocrit, platelet, neutrophil, lymphocyte, red blood cell distribution width (RDW) and platelet crit (PCT) levels (>0.05). Only the level of platelet distribution width (PDW) significantly differed, being lower in the papillary cancer group (<0.05). CONCLUSIONS: No significant relationship between papillary thyroid cancer and inflammatory hematological parameters including in particular the N/L ratio and MPV. The relevance of the PDW values remains unclear.

Percutaneous Closure of an Aortic Prosthetic Paravalvular Leak with Device in a Patient Presenting with Heart Failure.

Paravalvular leaks (PVLs) are a well-recognized complication of prosthetic valve replacement. Perivalvular prosthetic regurgitation causes significant morbidity and is associated with high perioperative mortality if open surgical repair is required. PVLs manifest with symptoms of congestive heart failure, hemolysis, or in most cases, the combination of both. In recent years, the development of imaging and device techniques significantly shortened the duration of fluoroscopy and procedure success was achieved. Percutaneous transcatheter closure of PVLs with a specific device causes symptomatic improvement. We present a case of transcatheter closure of aortic paravalvular insufficiency with amplatzer duct occluder 2 device.

Spontaneous rectus sheath hematoma during rivaroxaban therapy.

Rivaroxaban is an oral anticoagulant agent that directly inhibits Factor Xa and interrupts both the intrinsic and extrinsic pathway of the coagulation cascade and is currently indicated for use in patients for atrial fibrillation and prophylaxis of deep venous thrombosis. The present case reports of spontaneous rectus sheath hematoma during rivaroxaban therapy for atrial fibrillation in a 75-year-old woman.

Relation between the GRACE score and severity of atherosclerosis in acute coronary syndrome.

BACKGROUND: Patients with non-ST-elevation acute coronary syndrome are heterogeneous in terms of clinical presentation and immediate- and long-term risk of death or non-fatal ischemic events. The aim of the present study was to evaluate the relationship between the Global Registry of Acute Coronary Events (GRACE) score and severity of coronary artery disease angiographically evaluated by Gensini score in patients with non-ST-elevation acute coronary syndrome. METHODS: A total of 245 patients with non-ST-elevation acute coronary syndrome were enrolled to the study. Based on the GRACE risk score classification system, the patients were divided into low- (n=97, 39.6%), intermediate- (n=84, 34.3%), and high- (n=64, 26.1%) risk groups. All patients underwent coronary angiography within five days after admission. RESULTS: The Gensini scores were 26±29 in the low-risk group, 29±19 in the intermediate-risk group, and 38±23 in the high-risk group (p=0.016). The low-risk group was significantly different from the high-risk group (p=0.013), and the difference from the intermediate-risk group almost reached significance. Normal, noncritical, one and two, or multivessel disease were identified in 15 (6.1%), 31 (12.7%), 75 (30.6%), and 124 (50.6%) patients, respectively. The prevalence of multivessel disease was 28% in the low-risk group, 30% in the intermediate-risk group, and 42% in the high-risk group. The high-risk group was significantly different from the low-risk group (p<0.01). CONCLUSION: Our study demonstrates that the GRACE score has significant value for assessing the severity and extent of coronary artery stenosis in patients with non-ST-elevation acute coronary syndrome.

Clopidogrel-induced spontaneous pectoral hematoma.

Clopidogrel is an oral antiplatelet agent used in the treatment of coronary artery disease, peripheral vascular disease and cerebrovascular disease. Gastrointestinal symptoms including nausea, diarrhea and constipation are the common side effects of this drug. Serious side effects like intracranial hemorrhage and severe neutropenia were also reported but spontaneous pectoral hematoma due to the clopidogrel has not been reported previously. We present a case of large spontaneous pectoral hematoma during clopidogrel therapy in an elderly woman.