The Relationship between Frontal QRS-T Angle and Vitamin D Deficiency.

Background and Objectives: A deficiency in serum 25-hydroxyvitamin D levels is associated with a number of cardiovascular situations, such as high blood pressure, heart failure, atherosclerotic heart disease, and peripheral artery disease. The frontal QRS-T angle has recently been proposed as a marker of ventricular repolarization. A wider frontal QRS-T angle has been positively correlated with adverse cardiac events. The objective of our study was to examine the association between serum 25-hydroxyvitamin D level and the frontal QRS-T angle. Materials and Methods: A total of 173 consecutive patients aged 18-60 years undergoing routine cardiology check-up evaluation, and not receiving concurrent vitamin D treatment were included in the study. Patients were classified in three groups, depending on their vitamin D levels, and categorized as follows: Group 1-deficient (<20 ng/mL), Group 2-insufficient (20-29 ng/mL), or Group 3-optimal (≥30 ng/mL). The frontal QRS-T angle was determined using the automated reports generated by the electrocardiography machine. Results: The average age of participants was 45.8 (±12.2) years, and 55.5% of participants were female (p < 0.001). Individuals with low vitamin D concentrations exhibited a wider frontal QRS-T angle. It was determined that vitamin D level is an independent predictive factor for the frontal QRS-T angle. Conclusions: As the levels of 25-hydroxyvitamin D decrease, repolarization time assessed by frontal QRS-T angle is widened. Our findings indicate that lower concentrations of vitamin D may increase the susceptibility to ventricular arrhythmia.

Baseline Characteristics of a Patient Cohort and Predictors of In-hospital MORtality in CORonary Care Units (MORCOR-TURK) Trial in Türkiye.

OBJECTIVE: The MORtality in CORonary Care Units in Türkiye (MORCOR-TURK) trial is a national registry evaluating predictors and rates of in-hospital mortality in coronary care unit (CCU) patients in Türkiye. This report describes the baseline demographic characteristics of patients recruited for the MORCOR-TURK trial. METHODS: The study is a multicenter, cross-sectional, prospective national registry that included 50 centers capable of 24-hour CCU service, selected from all seven geographic regions of Türkiye. All consecutive patients admitted to CCUs with cardiovascular emergencies between September 1-30, 2022, were prospectively enrolled. Baseline demographic characteristics, admission diagnoses, laboratory data, and cardiovascular risk factors were recorded. RESULTS: A total of 3,157 patients with a mean age of 65 years (range: 56-73) and 2,087 (66.1%) males were included in the analysis. Patients with arterial hypertension [1,864 patients (59%)], diabetes mellitus (DM) [1,184 (37.5%)], hyperlipidemia [1,120 (35.5%)], and smoking [1,093 (34.6%)] were noted. Non-ST elevation myocardial infarction (NSTEMI) was the leading cause of admission [1,187 patients (37.6%)], followed by ST elevation myocardial infarction (STEMI) in 742 patients (23.5%). Other frequent diagnoses included decompensated heart failure (HF) [339 patients (10.7%)] and arrhythmia [272 patients (8.6%)], respectively. Atrial fibrillation (AF) was the most common pathological rhythm [442 patients (14%)], and chest pain was the most common primary complaint [2,173 patients (68.8%)]. CONCLUSION: The most common admission diagnosis was acute coronary syndrome (ACS), particularly NSTEMI. Hypertension and DM were found to be the two leading risk factors, and AF was the most commonly seen pathological rhythm in all hospitalized patients. These findings may be useful in understanding the characteristics of patients admitted to CCUs and thus in taking precautions to decrease CCU admissions.

Rationale, Design, and Methodology of the MORCOR-TURK Trial: Predictors of In-hospital MORtality in CORonary Care Patients in Turkey.

BACKGROUND: Coronary care units are sophisticated clinics established to reduce deaths due to acute cardiovascular events. Current data on coronary care unit mortality rates and predictors of mortality in Turkey are very limited. The MORtality predictors in CORonary care units in TURKey (MORCOR-TURK) trial was designed to provide information on the mortality rates and predictors in patients followed in coronary care units in Turkey. METHODS: The MORCOR-TURK trial will be a national, observational, multicenter, and noninterventional study conducted in Turkey. The study population will include coronary care unit patients from 50 centers selected from all regions in Turkey. All consecutive patients admitted to coronary care units with cardiovascular diagnoses between 1 and 30 September 2022 will be prospectively enrolled. All data will be collected at one point in time, and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT05296694). In the first step of the study, admission diagnoses, demographic characteristics, basic clinical and laboratory data, and in-hospital management will be assessed. At the end of the first step, the predictors and rates of in-hospital mortality will be documented. The second step will be in cohort design, and discharged patients will be followed up till 1 year. Predictors of short- and long-term mortality will be assessed. Moreover, a new coronary care unit mortality score will be generated with data acquired from this cohort. RESULTS: The short-term outcomes of the study are planned to be shared by early 2023. CONCLUSION: The MORCOR-TURK trial will be the largest and most comprehensive study in Turkey evaluating the rates and predictors of in-hospital mortality of patients admitted to coronary care units.

Electrophysiological characteristics of epicardial atrial tachycardias and endocardial breakthrough site targeting for ablation: a single center experience.

BACKGROUND: Despite being increasingly observed in daily practice, epicardial atrial tachycardias (Epi AT) have not been extensively characterized. In the present study, we retrospectively characterize electrophysiological properties, electroanatomic ablation targeting, and outcomes of this ablation strategy. METHODS: Patients who underwent scar-based macro-reentrant left atrial tachycardia mapping and ablation patients with at least one Epi AT, which had a complete endocardial map, were selected for the inclusion. Based on current electroanatomical knowledge, Epi ATs were classified based by utilization of following epicardial structures: Bachmann's bundle, septopulmonary bundle, vein of Marshall. Endocardial breakthrough (EB) sites were analyzed as well as entrainment parameters. EB site was targeted for initial ablation. RESULTS: Among seventy-eight patients undergoing scar-based macro-reentrant left atrial tachycardia ablation, fourteen (17.8%) patients met the inclusion criteria for Epi AT and were included in the study. Sixteen Epi ATs were mapped, four utilizing Bachmann's bundle, five utilizing septopulmonary bundle, and seven utilizing vein of Marshall. Fractionated, low amplitude signals were present at EB sites. Rf terminated the tachycardia in ten patients; activation changed in five patients and in one patient atrial fibrillation ensued. During the follow-up, there were three recurrences. CONCLUSIONS: Epicardial left atrial tachycardias are a distinct type of macro-reentrant tachycardias that can be characterized by activation and entrainment mapping, without need for epicardial access. Endocardial breakthrough site ablation reliably terminates these tachycardias with good long-term success.

Radiofrequency catheter ablation of supraventricular tachycardia in patient with deep brain stimulator.

Safety of radiofrequency ablation in patients with deep brain stimulation systems is not known. We report a patient with a deep brain stimulator who has undergone radiofrequency ablation.

Impact of drug interactions with direct oral anticoagulants on mortality in elderly with atrial fibrillation during the COVID-19 pandemic.

Objective: To evaluate the effect of drug interactions with chronic direct oral anticoagulants (DOAC) on mortality in older atrial fibrillation (AF) patients during the Coronavirus disease 2019(COVID-19) pandemic. Methods: We followed a total of 601 elderly patients (65 years of age) from the NOEL-Drug Registry cohort who were referred to a tertiary outpatient clinic between 9 March 2020 and 1 March 2021. We recorded clinical characteristics and medications for the last 3 months. In addition, all drug interactions were identified using Lexicomp®. Finally, we recorded retrospectively all death events, COVID-19 diagnosis, and relevant deaths from the database at the end of the study. According to logistic regression, we performed propensity score (PS) matching to reduce potential bias. Factors associated with total mortality in the 12 months were analyzed using multivariable Cox proportion hazard analysis. Results: The mean age [standard deviation (SD)] was 74.5 (±6.9), and the male/female ratio was 337/264. The prevalence of total mortality was 16.9% (n = 102). A total of 4472 drugs were analyzed for DOAC interaction. 81.8% of older AF patients were not at risk in terms of potential interaction. In the Cox proportional hazard model after PS-matching, previous DOAC use with class X interaction was associated with significantly higher mortality risk (adjusted hazard ratio: 2.745, 95% confidence interval: 1.465-5.172, p = 0.004). Conclusions: Our study showed that while most co-medications do not have significant interactions with DOACs, few serious drug interactions contribute to mortality in elderly patients with AF during the pandemic.

Introducción: Evaluar el efecto de las interacciones farmacológicas con anticoagulantes orales directos (ACOD) crónicos sobre la mortalidad en pacientes mayores con fibrilación auricular (FA) durante la pandemia de la enfermedad por coronavirus 2019 (COVID-19). Métodos: Seguimos a un total de 601 pacientes ancianos (65 años) de la cohorte NOEL-Drug Registry que fueron remitidos a una consulta externa de tercer nivel entre el 9 de marzo de 2020 y el 1 de marzo de 2021. Registramos las características clínicas y los medicamentos durante los últimos tres meses. Además, todas las interacciones medicamentosas se identificaron utilizando Lexicomp®. Finalmente, registramos retrospectivamente todos los eventos de muerte, el diagnóstico de COVID-19 y las muertes relevantes de la base de datos al final del estudio. De acuerdo con la regresión logística, realizamos un emparejamiento por puntaje de propensión (PP) para reducir el posible sesgo. Los factores asociados con la mortalidad total en los 12 meses se analizaron mediante análisis de riesgo de proporción de Cox multivariable. Resultados: La edad media (desviación estándar [DE]) fue de 74,5 (± 6,9) y la relación hombre/mujer, de 337/264. La prevalencia de mortalidad total fue del 16,9% (n = 102). Se analizaron un total de 4.472 fármacos para determinar la interacción con ACOD. El 81,8% de los pacientes mayores con FA no estaban en riesgo en términos de interacción potencial. En el modelo de riesgos proporcionales de Cox después del emparejamiento por PP, el uso previo de ACOD con interacción X clase se asoció con un riesgo de mortalidad significativamente mayor (índice de riesgo ajustado: 2,745; intervalo de confianza del 95%: 1,465-5,172; p = 0,004). Conclusión: Nuestro estudio mostró que, si bien la mayoría de los medicamentos concomitantes no tienen interacciones significativas con los ACOD, pocas interacciones farmacológicas graves contribuyen a la mortalidad en pacientes de edad avanzada con fibrilación auricular durante la pandemia.

Impact of drug interactions with direct oral anticoagulants on mortality in elderly with atrial fibrillation during the COVID-19 pandemic

Objective: To evaluate the effect of drug interactions with chronic direct oral anticoagulants (DOAC) on mortality in older atrial fibrillation (AF) patients during the Coronavirus disease 2019(COVID-19) pandemic.MethodsWe followed a total of 601 elderly patients (65 years of age) from the NOEL-Drug Registry cohort who were referred to a tertiary outpatient clinic between 9 March 2020 and 1 March 2021. We recorded clinical characteristics and medications for the last 3 months. In addition, all drug interactions were identified using Lexicomp®. Finally, we recorded retrospectively all death events, COVID-19 diagnosis, and relevant deaths from the database at the end of the study. According to logistic regression, we performed propensity score (PS) matching to reduce potential bias. Factors associated with total mortality in the 12 months were analyzed using multivariable Cox proportion hazard analysis.ResultsThe mean age [standard deviation (SD)] was 74.5 (±6.9), and the male/female ratio was 337/264. The prevalence of total mortality was 16.9% (n=102). A total of 4472 drugs were analyzed for DOAC interaction. 81.8% of older AF patients were not at risk in terms of potential interaction. In the Cox proportional hazard model after PS-matching, previous DOAC use with class X interaction was associated with significantly higher mortality risk (adjusted hazard ratio: 2.745, 95% confidence interval: 1.465–5.172, p=0.004).ConclusionsOur study showed that while most co-medications do not have significant interactions with DOACs, few serious drug interactions contribute to mortality in elderly patients with AF during the pandemic. (AU)

Introducción: Evaluar el efecto de las interacciones farmacológicas con anticoagulantes orales directos (ACOD) crónicos sobre la mortalidad en pacientes mayores con fibrilación auricular (FA) durante la pandemia de la enfermedad por coronavirus 2019 (COVID-19).MétodosSeguimos a un total de 601 pacientes ancianos (65años) de la cohorte NOEL-Drug Registry que fueron remitidos a una consulta externa de tercer nivel entre el 9 de marzo de 2020 y el 1 de marzo de 2021. Registramos las características clínicas y los medicamentos durante los últimos tres meses. Además, todas las interacciones medicamentosas se identificaron utilizando Lexicomp®. Finalmente, registramos retrospectivamente todos los eventos de muerte, el diagnóstico de COVID-19 y las muertes relevantes de la base de datos al final del estudio. De acuerdo con la regresión logística, realizamos un emparejamiento por puntaje de propensión (PP) para reducir el posible sesgo. Los factores asociados con la mortalidad total en los 12 meses se analizaron mediante análisis de riesgo de proporción de Cox multivariable.ResultadosLa edad media (desviación estándar [DE]) fue de 74,5 (±6,9) y la relación hombre/mujer, de 337/264. La prevalencia de mortalidad total fue del 16,9% (n=102). Se analizaron un total de 4.472 fármacos para determinar la interacción con ACOD. El 81,8% de los pacientes mayores con FA no estaban en riesgo en términos de interacción potencial. En el modelo de riesgos proporcionales de Cox después del emparejamiento por PP, el uso previo de ACOD con interacción X clase se asoció con un riesgo de mortalidad significativamente mayor (índice de riesgo ajustado: 2,745; intervalo de confianza del 95%: 1,465-5,172; p=0,004). (AU)

Impact of drug interactions with direct oral anticoagulants on mortality in elderly with atrial fibrillation during the COVID-19 pandemic.

OBJECTIVE: To evaluate the effect of drug interactions with chronic direct oral anticoagulants (DOAC) on mortality in older atrial fibrillation (AF) patients during the Coronavirus disease 2019(COVID-19) pandemic. METHODS: We followed a total of 601 elderly patients (65 years of age) from the NOEL-Drug Registry cohort who were referred to a tertiary outpatient clinic between 9 March 2020 and 1 March 2021. We recorded clinical characteristics and medications for the last 3 months. In addition, all drug interactions were identified using Lexicomp®. Finally, we recorded retrospectively all death events, COVID-19 diagnosis, and relevant deaths from the database at the end of the study. According to logistic regression, we performed propensity score (PS) matching to reduce potential bias. Factors associated with total mortality in the 12 months were analyzed using multivariable Cox proportion hazard analysis. RESULTS: The mean age [standard deviation (SD)] was 74.5 (±6.9), and the male/female ratio was 337/264. The prevalence of total mortality was 16.9% (n=102). A total of 4472 drugs were analyzed for DOAC interaction. 81.8% of older AF patients were not at risk in terms of potential interaction. In the Cox proportional hazard model after PS-matching, previous DOAC use with class X interaction was associated with significantly higher mortality risk (adjusted hazard ratio: 2.745, 95% confidence interval: 1.465-5.172, p=0.004). CONCLUSIONS: Our study showed that while most co-medications do not have significant interactions with DOACs, few serious drug interactions contribute to mortality in elderly patients with AF during the pandemic.

Predictive outcomes of APACHE II and expanded SAPS II mortality scoring systems in coronary care unit.

OBJECTIVE: We investigated the predictive values of the expanded Simplified Acute Physiology Score (SAPS) II and Acute Physiologic Score and Chronic Health Evaluation (APACHE) II score in predicting in-hospital mortality in coronary care unit (CCU) patients. METHODS: In this study, expanded SAPS II and APACHE II scores were calculated in the CCU of a single-center tertiary hospital. Patients admitted to CCU with any cardivascular indication were included in the study. Both scores were calculated according to previously determined criteria. Calibration and discrimination abilities of the scores in predicting in-hospital mortality were tested with Hosmer-Lemeshow goodness-of-fit C chi-square and receiver operating characteristics (ROC) curve analyses. RESULTS: A total of 871 patients were included in the analysis. The goodness-of-fit C chi-square test showed that both scores have a good performance in predicting survivors and nonsurvivors in CCU. Expanded SAPS II score has a sensitivity of 80% and a specificity of 91.8% with the cut-off value of 5.55, while APACHE II has a sensitivity of 75.9% and a specificity of 87.4% with the cut-off value of 16.5 in predicting mortality. CONCLUSION: Expanded SAPS II and APACHE II scores have good ability to predict in-hospital mortality in CCU patients. Therefore, they can be used as a tool to predict short-term mortality in cardiovascular emergencies.

Effects of 3 months of treatment with empagliflozin on left ventricle global longitudinal strain and myocardial mechano-energetic effiency.

PURPOSE: Sodium glucose transporter-2 (SGLT-2) inhibitors are employed in the treatment of cardiovascular diseases such as heart failure and coronary artery disease. In the present study, we aimed to investigate how Empagliflozin in SGLT 2 inhibitors affects cardiac contraction and pump efficiency in patients who have Diabetes Mellitus (DM) without cardiovascular disease. METHODS: The conventional echocardiographic records and biochemical values ​​of 62 patients who had DM without a history of cardiovascular disease were evaluated before using Empagliflozin. The myocardial mechano-energetic (MME) activity and index, and global longitudinal strain (GLS) were also calculated. After 3 months of Empagliflozin use, the tests were repeated and compared with previous data. A p < .05 was considered statistically significant. RESULTS: Left ventricular GLS and MME efficiency were found to be significantly higher after treatment (-17.71 ± 2.12, -19.15 ± .71; p < .001 and 62.14 ± 18.21, 72.24 ± 26.57; p: .019). CONCLUSION: An increase was detected in left ventricular longitudinal strain and MME efficiency after using Empagliflozin for 3 months in patients with DM. This result suggests that Empagliflozin improves left ventricular pump efficiency and contraction.

Evaluation of inflammation markers in mitral valve prolapse.

OBJECTIVE: Mitral valve prolapse (MVP) is the most common cause of mitral regurgitation in developed countries. The role of inflammation in the pathogenesis of MVP is still not clear. In this study, we aimed to investigate how inflammatory markers such as monocyte/high-density lipoprotein ratio (MHR), lymphocyte/monocyte ratio (LMR), neutrophil/lymphocyte ratio (NLR), and platelet/neutrophil ratio (PLR) are affected in MVP patients. METHODS: In this retrospective study, we included 461 patients with MVP and 459 normal echocardiographic patients, matched with gender and age. Inflammatory markers and all variables were compared between the two groups. RESULTS: There were no statistically significant differences in age, sex, or body mass index between the two groups. Neutrophil counts (4,960 [3,900-6,780]. 4,200 [3,800-5,600], p < 0.001), NLR (2.488 [1.72-4.51], 1.857 [1.49-2.38], p < 0.001), MHR (14.9 [11.9-18.6], 12.2 [9.4-17.3], p = 0.003), PLR (122.4 [85-171], 104.4 [85-130], p < 0.001), and CRP (0.71 ± 0.50, 0.67 ± 0.33 p < 0.001) were significantly higher, and LMR (3.75 [2.75-5.09], 4.06 [3.12-4.83] p = 0.016) was significantly lower in the MVP group than the control group, respectively. In logistic regression analysis, NLR (odds ratio [OR]: 1.058 [1.047-1.072]; p < 0.001), LMR (OR: 1.560 [1.211-2.522]; p = 0.027), and PLR (OR: 1.015 [1.012-1.019]; p = 0.003) were found to be independent predictors for MVP presence. CONCLUSIONS: These parameters can be used as a simple, low-cost, practical tool to detect inflammation in MVP.

OBJETIVO: El prolapso de la válvula mitral (MVP) es la causa más común de insuficiencia mitral en los países desarrollados. El papel de la inflamación en la patogenia del MVP aún no está claro. En este estudio, nuestro objetivo fue investigar cómo los marcadores inflamatorios como la proporción monocitos/HDL (MHR), la proporción linfocitos/monocitos (LMR), la proporción neutrófilos/linfocitos (NLR) y la proporción plaquetas/neutrófilos (PLR) se ven afectados en pacientes con MVP. MÉTODOS: En este estudio retrospectivo, incluimos a 461 pacientes con PVM y 459 pacientes ecocardiográficos normales, emparejados por sexo y edad. Se compararon los marcadores inflamatorios y todas las variables entre los dos grupos. RESULTADOS: No hubo diferencias estadísticamente significativas en edad, sexo o índice de masa corporal entre los dos grupos. El recuento de neutrófilos (4,960 [3,900-6,780], 4,200 [3,800-5,600], p < 0.001), NLR (2.488 [1.72-4.51], 1,857 [1.49-2.38], p < 0.001), MHR (14.9 [11.9-18.6]), (12.2 [9.4-17.3], p = 0.003), PLR (122.4 [85-171], 104.4 [85-130], p < 0.001) y PCR (0.71 ± 0.50, 0.67 ± 0.33 p < 0.001) fueron significativamente mayores y LMR (3.75 [2.75-5.09], 4.06 [3.12-4.83] p = 0.016) fue significativamente menor en el grupo MVP que en el grupo de control, respectivamente. En el análisis de regresión logística; NLR (OR: 1.058 [1.047-1.072]; p < 0.001), LMR (OR: 1.560 [1.211-2.522]; p = 0.027) y PLR (OR: 1.015 [1.012-1.019]; p = 0.003) se encontraron como predictores independientes para la presencia de MVP. CONCLUSIONES: Estos parámetros pueden utilizarse como una herramienta sencilla, práctica y de bajo costo para detectar la inflamación en el PVM.

Obstructive sleep apnea is associated with depressed myocardial mechanoenergetics.

PURPOSE: To evaluate the association between the myocardial mechanoenergetic efficiency index (MEEi) and the Apnea-Hypopnea Index (AHI) in the initial phase of obstructive sleep apnea (OSA) diagnosis. METHODS: In this cohort study, we included a total of 382 eligible participants without cardiovascular disease in a tertiary outpatient clinic between January 2013 and January 2015. We recorded demographic, clinical, polysomnographic and echocardiographic variables of the patients. In addition, myocardial mechanoenergetic efficiency (MEE) and MEEi were calculated by an echocardiography-derived validated measurement. RESULTS: The mean (±SD) age of the participants was 48.47 ± 12.13, and male/female ratio was 287/95. Comparing with non-OSA, MEEi was significantly lower in OSA patients at all stages (0.35 ± 0.08 vs. 0.42 ± 0.05; p < .001). MEEi was negatively correlated with hypertension (r = -0.518, p < .001), body mass index (r = -0.382, p < .001), AHI (r = -0.656, p < .001), total apne (r = -0.525, p < .001), hypopnea (r = -0.415, p < .001), systolic pulmonary pressure (r = -0.318, p < .001), relative wall thickness (RWT; r = -0.415, p < .001), and positive correlated with left ventricular ejection fraction (r = 0.586, p < .001). According to multiple linear regression analysis AHI (ß = -0.625, p < .001), total apnea (ß = -0.402, p = .001), hypopnea (ß = -0.395, p = .001), LV ejection fraction (ß = 0.478, p < .001) and RWT (ß = -0.279, p < .001) have an independent relationship with MEEi. CONCLUSIONS: MEEi was lower in OSA patients. A reduced MEEi may reflect a disturbance in energy use of the myocardium. Consequently, our results may provide insight into the mechanisms leading to structural cardiac diseases in OSA patients.

Effects of new drug interaction index on drug adherence in older patients with hypertension.

OBJECTIVE: Hypertension is a challenging problem in the older population because of poor drug adherence (DA). We aimed to determine the DA and examine the drug interaction index (DII) on DA in older patients with hypertension. METHODS: In this cross-sectional, observational study, we enrolled 418 eligible patients aged ≥ 65 years between 1 February 2020 and 30 September 2020 in a tertiary hospital outpatient cardiology clinic. We prepared a questionnaire to record sociodemographic characteristics, morbidities, and drugs used by the population. The Morisky Medication Adherence Scale-8 (MMAS-8) was used for DA assessment. We identified drug interactions using the Lexicomp application. We calculated the DII from a ratio of clinically relevant interaction to total interaction. Descriptive tests and multiple linear regression analyses were performed to find independent factors on DA. RESULTS: The mean age (± standard deviation [SD]) was 72.91 (±6.47), and 272/146 were female/male in the study population. The most frequent comorbid disease was diabetes mellitus (23.5%). The percentage of patients having polypharmacy was 39.5, and the mean daily drug (±SD) use was 4.27 (±2.57). The most prescribed antihypertensive drugs were thiazide/derivates (29.8%) and angiotensin receptor blockers (24.8%). The mean MMAS-8 (±SD) was 4.55±0.98, and 321 (76.8%) participants had a poor DA. A total of 33.4% of patients had significant drug interaction. The mean DII (±SD) was 0.345±0.017. The area under the receiver operating characteristic (ROC) curve for DII was 0.616 (95% confidence interval [CI]: 0.547-0.686). CONCLUSION: We defined a new index for drug interaction intensity. Furthermore, the DII may be a useful tool to study aspects of DA in older patients with hypertension.

Novel Drug Interaction index and Risk of Mortality in Older Patients With Atrial Fibrillation Receiving Non Vitamin K Oral Anticoagulants (NOEL Drug).

Drug interactions with novel oral anticoagulants (NOACs) may decrease their advantages. We aimed to explore the drug interaction rates with NOACs and impacts of drug interaction index (DII) on mortality among older patients with atrial fibrillation (AF). In this retrospective cohort study, we enrolled 704 eligible patients aged 65≤ with AF between January 1, 2018 and December 30, 2019 in a tertiary outpatient cardiology clinic. We recorded demographic, clinical characteristics, and medications for the last 3 months. At the end of the evaluation visit (March 1, 2020), death events and dates were recorded. All medications were checked for drug interactions using Lexicomp® software. Each drug interaction was annotated according to risk grade. Moreover, we determined a new index ratio of C/D/X classes to total interactions called DII. The mean age was 75.19 ± 7.13 and 398 (56%) were male. Death events were observed in 106 (15%) patients. A total of 9883 drugs were analyzed for drug interactions. The majority of drug interactions were in class A (80.7%). Clinically relevant interactions were 14.6% (Class C/D/X). The area under receiver operating characteristic curve was 0.704 (95% confidence interval: 0.653-0.754) and 0.167 cutoff value (68.9% sensitivity and 80.2% specificity [3.11 positive likelihood ratio]) for DII to predict mortality. This study showed an overview of the NOACs interactions in older patients with AF. Additionally, the inappropriate NOAC dose and DII showed an association with mortality. NOAC treatment should be guided by drug interaction applications to reduce mortality.

Normal echocardiographic measurements in a Turkish population: The Healthy Heart ECHO-TR Trial.

OBJECTIVE: Normal reference values for the cardiac chambers are widely based on cohorts from European or American populations. In this study, we aimed to obtain normal echocardiographic measurements of healthy Turkish volunteers to reveal the age, gender, and geographical region dependent differences between Turkish populations and other populations. METHODS: Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination. Blood biochemical parameters were also obtained for all patients on admission. The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used to assess the echocardiographic cardiac chamber quantification. RESULTS: The study included 1154 volunteers (men: 609; women: 545), with a mean age of 33.5±11 years. Compared to men, women had a smaller body surface area, lower blood pressure and heart rate, lower hemoglobin, total cholesterol, lower low-density lipoprotein (LDL) levels, and higher high density lipoprotein (HDL) levels. Cardiac chambers were also smaller in women and their size varied with age. When we compared the regions in Turkey, the lowest values of left cardiac chamber indices were seen in the Marmara region and the highest values were observed in the Mediterranean region. Regarding the right cardiac indices, the Mediterranean region reported the lowest values, while the Black Sea region and the Eastern Anatolia region reported the highest values. CONCLUSION: This is the first study that evaluates the normal echocardiographic reference values for a healthy Turkish population. These results may provide important reference values that could be useful in routine clinical practice as well as in further clinical trials. (.

The association of plasma oxidative status and inflammation with the development of atrial fibrillation in patients presenting with ST elevation myocardial infarction.

Atrial fibrillation (AF) is the most common supraventricular arrhythmia following ST elevation myocardial infarction (STEMI). Oxidative stress and inflammation may cause structural and electrical remodeling in the atria making these critical processes in the pathology of AF. In this study, we aimed to evaluate the association between total oxidative status (TOS), total antioxidative capacity (TAC) and high-sensitivity C-reactive protein (hs-CRP) in the development of AF in patients presenting with STEMI. This prospective cohort study consisted of 346 patients with STEMI. Serum TAC and TOS were assessed by Erel's method. Patients were divided into two groups: those with and those without AF. Predictors of AF were determined by multivariate regression analysis. In the present study, 9.5% of patients developed AF. In the patients with AF, plasma TOS and oxidative stress index (OSI) values were significantly higher and plasma TAC levels were significantly lower compared to those without AF (p = .003, p = .002, p < .0001, respectively). Multivariate regression analysis results showed that, female gender (Odds ratio [OR] = 3.07; 95% Confidence Interval [CI] = 1.26-7.47; p = .01), left atrial diameter (OR =1.28; 95% CI =1.12-1.47; p < .0001), hs-CRP (OR =1.02; 95% CI =1.00-1.03; p = .001) and OSI (OR =1.10; 95% CI =1.04-1.18; p = .001) were associated with the development of AF in patients presenting with STEMI. The main finding of this study is that oxidative stress and inflammation parameters were associated with the development of AF in patients presenting with STEMI. Other independent predictors of AF were female gender, left atrial diameter and hs-CRP.

Efficacy of XP-endo finisher and TRUShape 3D conforming file compared to conventional and ultrasonic irrigation in removing calcium hydroxide.

The aim of this study was to compare the efficacy of the XP-endo Finisher and TRUShape 3D Conforming File to conventional and ultrasonic irrigation techniques for removing calcium hydroxide from artificially created grooves on root canals. The study used 32 human mandibular premolar teeth, which were decoronated and instrumented up to ProTaper Universal F5 (Dentsply Maillefer; Ballagiues, Switzerland). The teeth were split longitudinally, two standardised grooves were prepared in the apical and coronal portions and filled with calcium hydroxide. Each tooth was reassembled with wax. The samples were stored at 100% humidity at 37°C for 1 week, after which the specimens were grouped and irrigated using needle irrigation, ultrasonic irrigation, XP-endo Finisher via continuous irrigation or TRUShape 3D Conforming File via continuous irrigation. Two calibrated observers scored the amount of calcium hydroxide remaining, and the data were statistically analysed using the Kruskal-Wallis and Mann-Whitney U-tests, (P < 0.05). Needle irrigation had the poorest scores (P < .001), while the XP-endo Finisher, TRUShape 3D Conforming File via continuous irrigation and ultrasonic irrigation groups had similar results in removing calcium hydroxide.

The effect of fixed-dose combination of valsartan and amlodipine on nighttime blood pressure in patients with non-dipper hypertension.

OBJECTIVE: Failure to decrease blood pressure (BP) during the night is associated with higher cardiovascular (CV) morbidity and mortality. There is strong evidence that fixed-dose combinations (FDCs) of antihypertensive agents are associated with significant improvement and non-significant adverse effects. The aim of the present study was to evaluate whether FDC affected nocturnal BP favorably in patients with uncontrolled, non-dipper hypertension (HT). METHODS: All non-dipper hypertensives were either newly diagnosed with stage 2-3 HT or had HT uncontrolled with monotherapy. Patients (n=195) were consecutively assigned to 4 treatment groups: FDC of valsartan/amlodipine (160/5 mg), free-drug combination of valsartan 160 mg and amlodipine 5 mg, amlodipine 10 mg, and valsartan 320 mg. Ambulatory blood pressure monitoring (ABPM) was repeated at 4th and 8th week. RESULTS: Average 24-h (24-hour) and nocturnal BP were similar among the groups at baseline evaluation, and had significantly decreased by the fourth week of treatment. However, BP continued to decrease only slightly between the 4th and 8th weeks in the valsartan and amlodipine monotherapy groups, but continued to decrease significantly in both combination groups. After 4 weeks, day-night BP difference and day-night BP % change were significantly elevated in the combination and valsartan groups. Between the 4th and 8th weeks, however, day-night BP difference and day-night BP % change continued to rise only in the FDC group, nearly reducing to baseline levels in the free-drug combination and valsartan groups. An additional 2.2 mmHg decrease was observed in the FDC group, compared to the free-drug combination group. CONCLUSION: In non-dipper HT, FDC of valsartan and amlodipine improved diurnal-nocturnal ratio of BP and provided 24-h coverage.