Clinical Presentation, Electrocardiographic Findings, and Factors Related to the Hospitalization In Mad-Honey Intoxication.

Objectives: Mad-honey intoxication (MHI) often presents with all kinds of bradyarrhythmias. Despite numerous publications focused on clinical findings, we aim to evaluate poor prognostic implications, ischemia likely electrocardiography (ECG) changes, and detailed ECG findings of MHI in the largest series. Methods: This is a retrospective single-center study of 117 MHI patients admitted to emergency service. Results: The study had 26 (22.2%) females (median 52.5 years) and 91 (77.8%) males (median 51.0 years). Fifty-six (47.9%) patients had ischemia likely changes on ECG. Multivariate model demonstrated that beta-blocker usage (odds ratio (OR): 52.871; 95% confidence interval (CI): 3.618-772.554 (p=0.004)), atrioventricular junctional rhythm (AVJR) (OR: 5.319; 95%CI: 1.090-25.949 (p=0.039)), and quantity of mad-honey consumption (OR: 1.035; 95% CI: 1.008-1.063 (p=0.011)) are predictors of hospitalization. ROC curve analysis showed cutoff value of mad-honey consumption quantity 24.79 g had 57% sensitivity and 68% specificity for predicting hospitalization (AUC: 0.7, 95% CI: 0.55-0.816, p=0.027). In addition, all hospitalized cases were male. Conclusion: Our study has shown that male gender, AVJR, the quantity of mad-honey consumption, and beta-blocker usage are high-risk criteria for hospitalization in MHI patients. Furthermore, ischemia likely ECG changes is often observed with MHI even independently from hypotension or bradycardia.

Assessment of myocardial performance index in hypertensive patients with or without hyperuricaemia.

BACKGROUND: Myocardial performance index (MPI) is impaired in patients with hypertension. Uric acid is biologically active and can stimulate oxidative stress, endothelial dysfunction, inflammation, and vasoconstriction. Hyperuricaemia may provide a negative contribution to impaired MPI in hypertension. AIM: The study was designed to assess the MPI in hypertensive patients with or without hyperuricaemia. METHODS: A total of 96 consecutive hypertensive patients were divided into two groups according to levels of serum uric acid (SUA); 49 normouricaemic patients (defined as SUA < 7.0 mg/dL in men and < 6.0 mg/dL in women) and 47 hyperuricaemic patients. SUA levels and other biochemistry parameters were determined by a standard analytical technique. All patients were evaluated by two-dimensional and Doppler echocardiography. RESULTS: The two groups were similar according to age, body mass index, and smoking status. Mean MPI value (0.498 ± 0.06 vs. 0.410 ± 0.05, p < 0.001) was significantly higher in the hyperuricaemic group than the normouricaemic individuals and positively correlated with the mean value of SUA levels (r = 0.51, p < 0.001). CONCLUSIONS: Our study demonstrated that high SUA levels were significantly associated with impaired MPI in hypertensive patients. SUA may suggest a valuable laboratory finding in assessing the risk of developing subclinical impaired left ventricular global function.

[Evaluation of transfer parameters in patients admitted to our hospital with ST-elevation myocardial infarction]. / ST-yükselmeli miyokart enfarktüsü ile basvuran hastalarin transfer parametrelerinin degerlendirilmesi.

OBJECTIVE: Acute coronary syndrom (ACS) is a common disease that causes severe morbidity and mortality. The most important aspect of ST-elevation myocardial infarction (STEMI) as a subgroup of ACS treatment is the rapid reperfusion of arteries. Successful results depend not only on the experience of the center but also on the rapidity in which reperfusion is achieved. In our study, the transfer parameters were evaluated in patients who were admitted to our hospital with STEMI. METHODS: Two hundred consecutive patients (160 males, 40 females) who underwent primary percutaneous coronary intervention (PCI) for acute STEMI between January 2011 and March 2013 were included in our study. Transfer parameters of symptom-to-reperfusion treatment, clinical characteristics, and laboratory parameters were recorded. RESULTS: Thirty-six patients were admitted to our hospital with ambulances; 70 patients were admitted to centers without PCI capability, with a mean transfer time to our hospital of 73.9±12.5 min. Median pain-to-first medical contact time was 105 min (range: 5-600 min), and average first medical contact-to-balloon time was 115.5 min (range: 20-414 min). Total pain-to-balloon time in females was significantly higher than males (246 min [range: 70-840 min], 195 min [range: 45-684 min], respectively, p=0.032). Mean pain-to-balloon time was significantly lower in patients delivered to the hospital by ambulance than in patients admitted to emergency departments independently (185 min [range: 45-439 min], 248 min [range: 65-840 min], respectively, p=0.017). CONCLUSION: In this study, our hospital door-to-balloon time was found compatible with the target specified in the European Society of Cardiology and American College of Cardiology STEMI guidelines; however, first medical contact-to-balloon time was found to be above that advised by the current guidelines.

Early experience of percutaneous paravalvular leak closure using a novel Occlutech occluder.

AIMS: Paravalvular regurgitation is an important complication of mitral valve replacement. Although surgical repair is mostly recommended, it is associated with significant morbidity. On the other hand, percutaneous closure is a less invasive alternative approach. Percutaneous approaches to treatment of paravalvular prosthetic regurgitation have emerged recently. One of them is the Occlutech Paravalvular Leak Device. The aim of this study was to evaluate early and midterm outcomes of percutaneous paravalvular leak closure utilising a novel occluder. METHODS AND RESULTS: Twenty-one consecutive symptomatic patients who had moderate or severe paravalvular prosthetic regurgitation on transoesophageal echocardiography were included in the study. All the patients were clinically evaluated and found inoperable for surgery. They underwent transapical repair with the Occlutech Paravalvular Leak Device. The patients were followed for 17±5 months. Attempts were made to rectify 41 defects in 21 patients with 100% success. Mean procedure time was 76±40 min and fluoro-scopy time was 44±37 min. Early post-procedural outcome was uneventful in all cases, with ≥1 grade reduction in regurgitation in all of the patients. There was no mortality during hospital stay. There was one case of haemothorax in one patient and one case of pneumothorax in another. Post-implantation 90-day follow-up data were obtained for 19 patients, and 12-month data were obtained for 12 patients. No deaths due to any cause, stroke or surgery for prosthetic impingement, worsening or relapse of paravalvular leak during follow-up were recorded. One patient underwent reintervention and was treated successfully with the same occluder 11 months after the index procedure. CONCLUSIONS: The novel Occlutech Paravalvular Leak Device, which was designed specifically for mitral and aortic paravalvular regurgitation, is an additional, useful tool in the device armamentarium for the treatment of PVL.

Clinical Characteristics and Outcome of Cardiovascular Implantable Electronic Device Infections in Turkey.

Infection is one of the most devastating outcomes of cardiovascular implantable electronic device (CIED) implantation and is related to significant morbidity and mortality. In our country, there is no evaluation about CIED infection. Therefore, our aim was to investigate clinical characteristics and outcome of patients who had infection related to CIED implantation or replacement. The study included 144 consecutive patients with CIED infection treated at 11 major hospitals in Turkey from 2005 to 2014 retrospectively. We analyzed the medical files of all patients hospitalized with the diagnosis of CIED infection. Inclusion criteria were definite infection related to CIED implantation, replacement, or revision. Generator pocket infection, with or without bacteremia, was the most common clinical presentation, followed by CIED-related endocarditis. Coagulase-negative staphylococci and Staphylococcus aureus were the leading causative agents of CIED infection. Multivariate analysis showed that infective endocarditis and ejection fraction were the strongest predictors of in-hospital mortality.

Total atrial conduction time evaluated with tissue Doppler imaging increases in hypertensive patients with hyperuricemia.

BACKGROUND: Serum uric acid (SUA) is an independent predictor of cardiovascular events in patients with hypertension. Total atrial conduction time (TACT) is a novel echocardiographic parameter used to identify the presence of electrical and structural atrial remodeling. We hypothesized that elevated SUA levels may be associated with prolonged TACT. METHODS: A total of 50 consecutive hyperuricemic (defined as SUA>7 mg/dl for men and >6.0 mg/dl for women) patients who had hypertension were included in the study. A total of 42 normouricemic patients were also recruited consecutively as the control group. All patients were evaluated by two-dimensional echocardiography and TACT was estimated by measuring the time delay between the onset of the P-wave of ECG and peak A'-wave on the tissue Doppler imaging (TDI) of the left atrial lateral wall (PA-TDI duration). RESULTS: There were no significant differences between the two groups according to age, sex, left ventricular systolic function, left atrial diameter, and systolic and diastolic blood pressure values. PA-TDI duration was found to be significantly increased in the hyperuricemic group (112.3±14.7 vs. 92±12.7 ms; P<0.001) and positively correlated with the mean value of SUA levels (r=0.48, P<0.001). CONCLUSION: TACT increases in patients with hyperuricemia. Certainly, larger studies in different populations should further examine this potential association.

Effects of ivabradine therapy on heart failure biomarkers.

BACKGROUND: Heart rate (HR) reduction is associated with improved outcomes in patients with heart failure (HF) and biomarkers can be a valuable diagnostic tool in HF management. The primary aim of our study was to evaluate the short-term (6 months) effect of ivabradine on N-terminal pro B-type natriuretic peptide (NT-proBNP), CA-125, and cystatin-C values in systolic HF outpatients, and secondary aim was to determine the relationship between baseline HR and the NT-proBNP, CA-125, cystatin-C, and clinical status variation with ivabradine therapy. METHODS: Ninety-eight patients (mean age: 65.81 ± 10.20 years; 33 men), left ventricular ejection fraction < 35% with Simpson method, New York Heart Association (NYHA) class II-III, sinus rhythm and resting HR > 70/min, optimally treated before the study were included. Among them, two matched groups were formed: the ivabradine group and the control group. Patients received ivabradine with an average (range of 10-15) mg/day during 6 months of follow-up. Blood samples for NT-proBNP, CA-125, and cystatin-C were taken at baseline and at the end of a 6-month follow-up in both groups. RESULTS: There was a significant decrease in NYHA class in the ivabradine group (2.67 ± ± 0.47 vs. 1.85 ± 0.61, p < 0.001). When ivabradine and control groups were compared, a significant difference was also found in NHYA class 6 months later (p = 0.013). A significant decrease was found in HR in the ivabradine and control groups (84.10 ± 8.76 vs. 68.36 ± ± 8.32 bpm, p = 0.001; 84.51 ± 10 vs. 80.40 ± 8.3 bpm, p = 0.001). When both groups were compared, a significant difference was also found in HR after 6 months (p = 0.001). A significant decrease was found in cystatin-C (2.10 ± 0.73 vs. 1.50 ± 0.44 mg/L, p < 0.001), CA-125 (30.09 ± 21.08 vs. 13.22 ± 8.51 U/mL, p < 0.001), and NT-proBNP (1,353.02 ± 1,453.77 vs. 717.81 ± 834.76 pg/mL, p < 0.001) in the ivabradine group. When ivabradine and control groups were compared after 6 months, a significant decrease was found in all HF parameters (respectively; cystatin-C: p = 0.001, CA-125: p = 0.001, NT-proBNP: p = 0.001). Creatinine level was significantly decreased and glomerular filtration rate (GFR) was significantly increased in the ivabradine group (1.02 ± 0.26 vs. 0.86 ± 0.17, creatinine: p = 0.001; 79.26 ± 18.58 vs. 92.48 ± 19.88, GFR: p = 0.001). There was no significant correlation between NYHA classes (before and after ivabradine therapy) and biochemical markers, or HR. CONCLUSIONS: In the outpatients with systolic HF, persistent resting HF > 70/min with optimal medical therapy, the NT-proBNP, CA-125, and cystatin-C reductions were obtained with ivabradine treatment. Measurement of NT-proBNP, CA-125, and cystatin-C may prove to be useful in biomarker panels evaluating ivabradine therapy response in HF patients.

Predictors of anticoagulant treatment in patients with nonvalvular atrial fibrillation: results from atrial fibrillation in Turkey: epidemiologic registry.

The aim of the study was to assess the factors associated with the anticoagulation treatment in patients with atrial fibrillation (AF). A total of 2242 consecutive patients who had been admitted with AF on their electrocardiogram were included in the study. After excluding valvular AF, 1745 patients with nonvalvular AF were analyzed. Mean CHA2DS2-VASc score [cardiac failure, hypertension, age ≥ 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 -74 and sex category (female)], frequency of persistent/permanent AF, hypertension, diabetes mellitus (DM), stroke history, body mass index, and left atrial diameter were significantly higher in patients receiving anticoagulant therapy. Stroke history, persistent/permanent AF, hypertension, DM, age, heart failure, and left atrial diameter were independent predictors of warfarin prescription. Labile international normalized ratio was the only independent negative predictor of effective treatment with warfarin. In this study, we demonstrated that stroke history, persistent/permanent AF, hypertension, DM, and left atrial diameter were positive predictors, whereas advanced age and heart failure were negative predictors of oral anticoagulant use in patients with nonvalvular AF.

Association of omentin Val109Asp polymorphism with coronary artery disease.

OBJECTIVE: Coronary artery disease (CAD) is the most important morbidity and mortality disease in the world. It is also one of the leading causes of death in Turkey. Omentin, a recently found adipocytokine, is reported to regulate insulin sensitivity. It has anti-inflammatory properties and is inversely associated with CAD. Omentin gene polymorphism in patients with CAD has not been studied yet. The aim of this study is to investigate the relationship between omentin Val109Asp polymorphism and CAD. METHODS: This is an observational study on genetic association. 157 consecutive patients who had undergone coronary angiography were included in the study. Seventy-five of them had CAD and the rest serves the control group. Val109Asp polymorphism was analyzed and compared. Chi-square test was used in comparison of genotype frequencies, whereas ANOVA and chi-square tests were used in comparison of clinical characteristics according to the genotypes. RESULTS: There was no significant difference between CAD patients and control subjects regarding omentin Val109Asp polymorphism. However, a 2.5 fold increase in Val/Val (homozygous mutant) genotype was detected in patients with CAD. The OR (80% Cl) for Val/Val genotype was 3.46 (1.14-10.49). CONCLUSION: Although no significant difference was detected regarding omentin Val109Asp polymorphism, Val/Val genotype frequency was found to be more in patient group than control group. In conclusion, it may be speculated that Val/Val genotype increases the tendency for CAD, but this experiment should done with larger population to clarify this issue.

The impact of central blood pressure levels on the relationship between oscillometric and central blood pressure measurements: a multicenter invasive study.

The aim of this study was to investigate impact of central blood pressure (BP) levels and sex on the difference between central and upper arm oscillometric BP values. Oscillometric arterial BP measurements of 675 patients were simultaneously compared with values measured from the ascending aorta. The patients were divided into 3 groups according to systolic BP levels. The upper arm oscillometric device overestimated systolic BP (SBP) at low and medium BP levels but it underestimated SBP at high BP level. As for the effect of sex on differences in central and oscillometric BP, SBP was overestimated to a lesser degree in women than in men at low BP levels, but it was more highly underestimated in women than in men at high BP levels. The difference between oscillometric upper arm BP and aortic BP was directly affected by the patient's central BP level. In addition, the difference between central and oscillometric BP was also affected by sex factor.

The relationship between acute coronary syndrome and sildenafil.

Sildenafil is a drug used for male erectile dysfunction. Sildenafil's fatal cardiac effects except due to hypotension with simultaneous nitrate use have not been reported.We reported in this case a 70-year-old man admitted to the emergency service with chest pain, which occurs in an hour after sildenafil use. Electrocardiogram showed inferoposterior ST-segment elevation. In angiography, total circumflex artery occlusion has been seen.

Heart rate variability and heart rate recovery in patients with type 1 diabetes mellitus.

OBJECTIVE: Patients with diabetes mellitus (DM) are at an increased risk of sudden cardiac death (SCD) partly explained by cardiac autonomic neuropathy (CAN). There have been fewer studies to evaluate CAN using heart rate variability (HRV) and heart rate recovery (HRR) in patients with type 2 DM.To our knowledge, there has been no study to investigate the association between HRR, HRV and type 1 DM. The purpose of this study was to examine the changes in HRR and HRV measurements in type 1 diabetic patients. METHODS: The study population consisted of 35 consecutive patients with type 1 diabetes and 35 sex- and age-matched non-diabetic controls. We performed electrocardiography, echocardiography, Holter analysis, exercise stress test, routine biochemical tests including haemoglobin Ale, high-sensitivity C-reactive protein and evaluated the clinical characteristics. HRR was calculated by subtracting the heart rate values at the first minute of the recovery phase from the peak heart rate. Abnormal HRR was defined as HRR < or = 18 beats.The HRV analysis was performed in both time domain and frequency domain. RESULTS: In HRV analysis, type 1 diabetic patients had significantly lower time domain [SDNN (P=0.041), SDANN (P=0.016), r-MSSD (P<0.001), pNN50 (P<0.001)] and frequency domain [total power (P=0.002), VLF (P<0.001), LF (P<0.001), HF (P=0.001), LF/HF (P=0.034)] HRV parameters as compared to controls. In logistic regression analysis, the HRR (OR 0.927, 95% CI 0.872 to 0.985, P= 0.014), METs (OR 0.562, 95% CI 0.355 to 0.890, P= 0.014), pNN50 (OR 0.729, 95% CI 0.566 to 0.941, P= 0.015) and HF (OR 0.952, 95% CI 0.911 to 0.994, P= 0.027) were independently associated with type 1 DM. CONCLUSION: The results of this study showed that HRV parameters and HRR were significantly reduced in patients with type 1 versus healthy controls. We found that HRV parameters correlated with HRR in type 1 diabetic patients. There is a relationship between CAN and inflammation and also, there may be a relationship between CAN and intensive glycaemic control according to this study.

Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER study.

OBJECTIVES: Although atrial fibrillation (AF) is one of the most common rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. STUDY DESIGN: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency departments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. RESULTS: The mean age of the patients was determined as 66.8 ± 12.3 years with female patients representing 60% of the study population. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co-morbidity in patients with AF. While a stroke or transient ischemic attack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspirin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. CONCLUSION: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

Relation of Nickel Allergy with in-Stent Restenosis in Patients Treated with Cobalt Chromium Stents.

BACKGROUND: In-stent restenosis (ISR) is the major limitation of percutaneous coronary stenting procedure. The elements like nickel, chromate and molybdenum are known to cause contact allergy. Hypersensitivity reaction, against these metal ions, may be one of the reasons of ISR. Cobalt chromium coronary stents, which are increasingly being used in percutaneous coronary interventions, have more nickel amount than the stainless steel stents. OBJECTIVE: We aimed to investigate the association between nickel hypersensitivity reaction and ISR in patients treated with cobalt chromium coronary stents. METHODS: Epicutaneous patch tests for nickel were applied to 31 patients who had undergone elective cobalt chromium coronary stent implantation and had ISR in control angiogram. Thirty patients, without ISR, were included as the control group. Patch test results and other clinical variables were compared. RESULTS: There was no statistically significant difference of the mean age, sex, body mass index, rate of hypercholesterolemia, diabetes, hypertension and smoking between the patients with and without ISR. All other lesion characteristics were similar in the 2 groups. According to the patch test results, 7 patients had nickel contact allergy. All of these patients were in the ISR group, which was statistically significant (p<0.006). CONCLUSION: Patients treated with cobalt chromium coronary stents and had ISR were found to have significantly more nickel allergy than the control group. Nickel allergy may play role in restenosis pathophysiology.

Heart rate recovery index in patients with psoriasis.

OBJECTIVES: In clinical practice, autonomic functions are indirectly investigated with heart rate recovery (HRR) index measurements. Our aim was to evaluate the HRR index in patients with psoriasis, which is a systemic inflammatory disease. STUDY DESIGN: The study population included 39 psoriasis patients (18 female, mean age 48±15 years) and 40 control group (18 female, mean age 44±9 years) healthy individuals. The severity of psoriasis was calculated using the psoriasis area and severity index (PASI). None of the study patients had a PASI score >50. All of the participants underwent treadmill exercise testing using the Bruce protocol. RESULTS: According to basic clinical and demographic characteristics, both groups were similar with regard to age, body mass index, and fasting glucose and cholesterol levels. No significant differences were observed in the systolic or diastolic blood pressures or resting heart rates between the two groups. All patients and control-group participants had sinus rhythm and normal 12-lead ECG results at rest. All subjects completed the exercise tests to exhaustion without rhythm abnormalities, ischemic changes, or other complications. The maximal heart rate and metabolic equivalents achieved during the exercise stress test (EST) were similar in the psoriasis and control group (163±16 vs. 170±16, p=0.07; 9.8±0.9 vs. 10.1±1.0, p=0.24, respectively). The 1st, 3rd, and 5th minute HRR indices of patients with psoriasis were similar to those of the control group (HRR1: 30±12, 32±18, p=0.71; HRR3: 57±13, 64±17, p=0.10; HRR5: 64±15, 68±16, p=0.46, respectively). CONCLUSION: The HRR index, which is calculated by an EST and associated with autonomic nervous system function, is not effected in mild to moderate psoriasis patients.

Relation between indices of end-organ damage and mean platelet volume in hypertensive patients.

Mean platelet volume (MPV) has been recognized as an independent risk factor of hypertension. Hypertensive end-organ damage worsens the prognosis in hypertensive patients. We aimed to investigate the relationship between MPV levels and subclinical end-organ damage in hypertensive patients. One hundred and sixteen hypertensive patients (81 women, 35 men, with a mean age of 53 ± 11) were included in the study. There was no correlation between MPV and left-ventricular mass index (LVMI) (r = 0.145; P = 0.14) or albuminuria (r = 0.009; P = 0.93). Among the individuals that had grade I and grade II retinopathy, MPV levels (8.3 ± 2 fL, 8.2 ± 1.3 fL; P = 0.28) were similar either. We concluded that there was no correlation between MPV and markers of end-organ damage in hypertensive patients.

The relationship between mean platelet volume with metabolic syndrome in obese individuals.

The metabolic syndrome is closely associated with atherosclerotic risk factors and increased mortality. Mean platelet volume (MPV) is an indicator of platelet activation which also shows a close relationship with cardiovascular risk factors, such as diabetes mellitus, hypertension, hypercholesterolemia, obesity, metabolic syndrome. The aim of this study was to investigate the correlates of metabolic syndrome, its components and MPV adjusted for obesity in a large population study. A total of 2298 individuals with a mean age of 50 (age range 18-92) were interviewed. Nine hundred and twenty obese participants, who had BMI 30 kg/m² or more, further evaluated for the presence of metabolic syndrome. Five hundred and thirteen [396 women (70.2%)] had metabolic syndrome and the rest 407 individuals [324 women (79.6%)] served as the control group. The BMI, SBP, DBP, waist circumference, fasting plasma glucose, visceral fat, total cholesterol, high-density lipoprotein-cholesterol, and triglyceride was higher significantly in metabolic syndrome group (P = 0.002 for BMI and P < 0.001 for the others). No significant difference was observed between groups regarding low-density lipoprotein cholesterol, white blood cells, platelet counts, MPV, hematocrit and hemoglobin (P > 0.05 for all). The presence of metabolic syndrome and its components do not constitute a difference in MPV values in obese patients with a BMI 30 kg/m² or more.