The relationship between sarcopenia and one-year mortality in patients with critical limb ischemia undergoing endovascular therapy below the knee.

OBJECTIVE: Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). Patients with CLI have poor long-term prognosis. The aim of this study was to investigate the value of sarcopenia in terms of 1-year mortality in patients with below-the-knee lesions who underwent endovascular treatment for CLI. METHODS: A total of 190 patients with critical limb ischemia who underwent endovascular treatment (EVT) for below-the-knee (BTK) lesions were enrolled in this study. Sarcopenia was defined using the psoas muscle index (PMI). PMI was obtained by calculating the average psoas muscle area (APMA) of the left and right psoas muscles at the third lumbar vertebra level and dividing by the square of the height (cm2/m2). The primary endpoint of the study was 1-year mortality and the secondary endpoint was 1-year amputation. Patients were divided into 2 groups according to presence of sarcopenia. RESULTS: We detected sarcopenia in 64 patients. The mean age, height, and EF were higher in sarcopenia group. The psoas muscle area, weight, psoas muscle index, body-mass index, albumin level, and GFR were lower in sarcopenia group. The incidence of amputation (11.9% vs 29.7%, p = 0.003) and mortality (15.1% vs 35.9%, p = 0.001) were higher in patients with sarcopenia. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of amputation and mortality. The survival curve for 1-year using the sarcopenia was analyzed using the Kaplan-Meier method, and statistical analysis was performed with the log-rank test. The presence of sarcopenia, glomerular filtration rate level, and low ejection fraction were found to be independent predictors of mortality. CONCLUSIONS: Sarcopenia was associated with 1-year mortality in patients with CLI undergoing EVT for BTK lesions. Also, patients with sacropenia had higher 1-year amputation rates. Sarcopenia may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.

Association Between CRP/Albumin Ratio and Long-Term Mortality in Patients With cHronIc Limb-Threatening Ischemia Undergoing EndovaScular Therapy Below The Knee: The ACHILES-BTK Registry.

BACKGROUND: Chronic limb-threatening ischemia (CLTI), which presents with ischemic rest pain, ulceration, or gangrene, is a complex form of peripheral artery disease that can cause mortality and amputation. C-reactive protein (CRP), an inflammatory marker, indicates vascular inflammation resulting from the cytokine-dependent inflammatory process in the arterial wall, and arterial atherosclerosis resulting from the inflammation. Lower albumin levels are also associated with peripheral artery disease. We investigated the association between CRP/Albumin ratio (CAR) and long-term mortality in patients with CLTI. METHODS: A total of 172 patients who underwent endovascular treatment (EVT) for below the knee (BTK) lesions were enrolled in this study. Patients with acute infection requiring antibiotic therapy, chronic inflammatory disease, end-stage liver disease, malignancy were excluded from the study. Besides, patients with pre-follow-up intervention to the same vascular bed were also excluded from the study. The primary endpoint of the study was all-cause mortality. Patients were divided into 2 groups according to mortality. RESULTS: A total of 70 patients (40.6%) died during 32 ± 21 months of follow-up in the present study. The major amputation rate was 21.5%. The mortality (+) group was older and had higher rates of congestive heart failure, chronic kidney disease, history of stroke, and CRP levels. Moreover, statin and ACE inhibitor/angiotensin receptor blocker (ACE/ARB) use, GFR, and albumin levels were lower in the mortality (+) group. CAR was significantly higher in the mortality (+) group when comparing both groups (3.25 [1.46 - 7.86] vs. 9.75 [4.5 - 17.71], P < 0.001). CAR, congestive heart failure, chronic kidney disease, history of stroke, ACE/ARB, or statin use were independent predictors of all-cause mortality in multivariable Cox regression analysis. CONCLUSIONS: CAR was associated with mortality in CLTI patients undergoing EVT for BTK lesions. CAR may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.

The Effect of Recanalization of a Chronic Total Coronary Occlusion on Atrial Conduction Velocities.

BACKGROUND: P-wave duration and P-wave dispersion (PWD) give information about inhomogeneous and discontinuous atrial conduction, which are believed to be the leading electrophysiological causes of atrial fibrillation. The aim of this study was to investigate the effect of percutaneous chronic total occlusion (CTO) revascularization on P-wave duration and PWD in electrocardiography (ECG). MATERIALS AND METHODS: We enrolled 98 consecutive patients with sinus rhythm who underwent percutaneous coronary interventions (PCIs) for CTO. The maximum (Pmax) and minimum P-wave duration and PWD were measured before CTO interventions and at the first and sixth months after the procedure. RESULTS: There was no significant differences between the successful and failed CTO PCI groups in pre-procedural demographic, clinical, laboratory, angiographic data, and ECG parameters. Pmax values and PWD at 1 month and 6 months after successful CTO PCI were statistically lower than those at baseline (p < 0.001), while there was no significant change in the failed CTO PCI group. PWD values were significantly lower at 6 months of follow-up, regardless of the target vessel (p = 0.010, p < 0.001, p < 0.001; for left anterior descending, circumflex and right coronary artery, respectively). Compared to pre-CTO values in all Rentrop classes, PWD values were significantly lower at the sixth month. CONCLUSIONS: This study demonstrated that Pmax and PWD, which are risk factors for atrial arrhythmias, significantly reduced within 1 and 6 months after successful CTO PCI irrespective of the target vessel.

Evaluation of early electrocardiographic changes after successful percutaneous stent implantation to isolated coarctation of aorta.

BACKGROUND: Coarctation of aorta (CoA) is a congenital obstructive lesion characterized by narrowing of the aorta in which concludes as increase in afterload. Percutaneous stent implantation to CoA is a treatment of choice in older children and adults. Pathology related to CoA mainly caused by increased afterload and left ventricular hypertrophy. Electrocardiographic (ECG) findings are also related to left ventricular hypertrophy (LVH). Evidence shows that, in variety of diseases, the correction of the pathology might normalize ECG findings and ventricular dysfunction related to increase in afterload. Therefore the aim of this study was to compare the pre- and postprocedural ECG findings of the patients who underwent percutaneous intervention for isolated CoA. METHODS: After exclusion criterion was applied, 30 patients were included into study, retrospectively. ECG records before the procedure and 3 months after the procedure of the patients were evaluated. The parameters related to LVH, ventricular and atrial conduction were evaluated and compared between pre- and post-procedural ECG records. RESULTS: The findings showed that parameters of atrial conduction including P wave maximum duration (p < 0.001) and p wave dispersion (p < 0.001) were significantly decreased after stent implantation. Additionally, ventricular repolarization parameters including QT duration (p = 0.039), Tpe interval (p < 0.001), Tpe / QT (p = 0.038) and Tpe / QTc (p = 0.003) were significantly decreased after stent implantation. Sokolow-Lyon criteria (p < 0.003) and voltage in selected leads were significantly decreased after intervention. CONCLUSION: Percutaneous intervention to CoA might regress LVH parameters in ECG and improve atrial and ventricular repolarization in ECG, which might lead to decreased event of atrial and ventricular arrhythmias in patients with isolated CoA.

Relation between aortic knob width and subclinical left ventricular dysfunction in hypertensive patients.

BACKGROUND: The assessment of left ventricular (LV) structure and function is important in the evaluation of hypertensive heart disease, as it provides information on the cardiovascular morbidity and mortality. Aortic knob width (AKW) is a measurement of radiographic structure formed by the foreshortened aortic arch and a portion of the descending aorta. The main aim of this study was to investigate the relation between AKW on the routine chest radiography and subclinical LV dysfunction in hypertensive patients. PATIENTS AND METHODS: A total of 144 patients with hypertension admitted to the cardiology outpatients clinic were enrolled consecutively. The patients were divided into two groups according to tissue Doppler-derived myocardial performance index (MPI): subclinical LV dysfunction group (abnormal MPI ≥ 0.5, n = 85) and absence of subclinical LV dysfunction group (normal MPI< 0.5, n = 59). RESULTS: Patients with subclinical LV dysfunction were older (60 ± 8 vs. 54 ± 8, p = 0.001). Left ventricular mass index (LVMI) (96 ± 27 vs. 74 ± 24, p < 0.001) and prevalence of LV hypertrophy (28 vs. 8%, p = 0.011) were significantly different between two groups. Patients with subclinical LV dysfunction had higher AKW (42 ± 6 vs. 34 ± 5, p < 0.001) compared with patients without subclinical LV dysfunction. There was a significant correlation between MPI and AKW (r = 0.7, p < 0.001). Multiple logistic regression analysis showed that AKW (ß = 0.617, p = 0.001) and posterior wall thickness (PWth) (ß = 1.189, p = 0.021) were independently associated with subclinical LV dysfunction. Analysis using the Receiver Operating Characteristic (ROC) curve has demonstrated that aortic knob of 37 mm constitutes the cutoff value for the presence of subclinical LV dysfunction with 85.9% sensitivity and 86.4% specificity (The Area under the Curve ± Standard Error (AUC±SE) = 0.916 ± 0.024, p < 0.001). CONCLUSION: AKW may provide important predictive information on subclinical LV dysfunction in patients with hypertension.

Naples prognostic score as a predictor of mortality in surgical aortic valve replacement.

Aim: Investigating the impact of nutritional and inflammatory status, assessed by the Naples-Prognostic-Score (NPS), on postoperative mortality in 173 older adults undergoing surgical aortic valve replacement(SAVR) for aortic stenosis(AS).Methods: Retrospective study calculating NPS from neutrophils/lymphocytes, lymphocytes/monocytes, total cholesterol and serum albumin.Results: Mean age was 69.39 ± 6.153 with 45.1% females. The post-operative mortality was 23.7% over a follow-up period of 50 ± 31 months. The 1-month mortality rate is 2.89%. High NPS significantly associated with increased mortality; multivariate logistic regression confirmed its independence (odds-ratio:3.494, 95% confidence-interval:1.555-7.849, p = 0.002). NPS cutoff of 2 showed 73.2% sensitivity, 56.8% specificity and area-under-the-curve of 0.758 for predicting all-cause mortality. Kaplan-Meier analysis supported lower NPS correlating with better survival.Conclusion: NPS independently predicts postoperative mortality in SAVR patients.

[Box: see text].

Prognostic Nutritional Index as a New Prediction Tool for All-Cause Mortality in Patients with Chronic Limb-Threatening Ischemia Undergoing Endovascular Therapy.

Objectives: Chronic Limb-Threatening Ischemia (CLTI) represents a complex manifestation of peripheral artery disease distinguished by symptoms such as ischemic rest pain, non-healing ulcers on the lower limb or foot, and the development of gangrene. CLTI is associated with a high risk of limb amputation, decreased quality of life, and substantial morbidity and mortality. The Prognostic Nutritional Index (PNI), which is calculated using albumin and lymphocyte levels, reflects the immunological and nutritional status. The objective of this study was to investigate the correlation between PNI levels and mortality among patients diagnosed with CLTI who underwent endovascular therapy. Methods: Individuals diagnosed with CLTI who received endovascular therapy below the knee in our tertiary care center were enrolled in this retrospective study. The patients were divided into two groups: survivors and non-survivors. Logistic regression analyses were performed to detect independent predictors of mortality and using Cox regression model, we assessed the relationship between PNI and mortality. Survival curves were estimated using the Kaplan-Meier method. Results: The study comprised 113 patients diagnosed with PAD who underwent EVT. The non-survivor group (42 patients) was older (62.9±10.9 vs. 67.7±9.9, p=0.045) and had a higher prevalence of chronic renal failure (22.5% vs. 42.9%, p=0.023) and congestive heart failure (8.5% vs. 21.4%, p:0.049) than the survivor group (71 patients). The median PNI value was lower in the non-survivor group than in the survivor group (35.9±5 vs 38.2±4.4, p=0.012). Cox regression analyses showed that Low PNI was associated with increased mortality (HR=0.931, CI=0.872-0.995, p=0.035). PNI cut-off of 37.009 showed 64.3% sensitivity, 64.8% specificity, and AUC of 0.642 for predicting all-cause mortality. Kaplan-Meier analysis supported higher PNI correlating with better survival. Conclusion: The Prognostic Nutritional Index was independently associated with mortality among individuals diagnosed with Chronic Limb-Threatening Ischemia.

Clinical Outcomes of Double-Kissing Crush or Double-Kissing Culotte in Nonleft Main Bifurcation Lesions: The ROUTE Trial.

BACKGROUND: Double-kissing (DK) crush and DK culotte are the recommended 2-stent strategies in true coronary bifurcation lesions. However, it is a matter of curiosity about which of the DK crush and DK culotte stenting techniques will have superior results. We aimed to compare the clinical outcomes of DK crush and DK culotte stenting in nonleft main coronary artery bifurcation. METHODS: Consecutive patients who received DK crush or DK culotte technique for de novo true nonleft main coronary artery bifurcation lesion were categorized according to which treatment they received. The primary end point of the study was target lesion failure as a composite end point of target lesion revascularization, target vessel myocardial infarction, and cardiac death. Secondary end points were all-cause death and definite stent thrombosis. RESULTS: A total of 202 patients were categorized as DK crush (101 patients) or DK culotte (101 patients) techniques. The target lesion failure had occurred frequently in the DK crush (10.9%) compared with the DK culotte (3.0%; P=0.028) that was mainly driven by increased target lesion revascularization (9.9% in the DK crush versus 3.0% in the DK culotte; P=0.045). The number of patients with target vessel myocardial infarction (3.0% in the DK crush versus 2.0% in the DK culotte; P=0.651) and cardiac death (1.0% in the DK crush versus 0.0% in the DK culotte; P=0.315) was higher in the DK crush. There were no differences in terms of definite stent thrombosis and all-cause death between groups. CONCLUSIONS: In the present analysis, DK culotte was associated with lower 1-year target lesion failure rates compared with DK crush in true nonleft main coronary artery bifurcations. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04789161.

Frequency and predictors of no-reflow phenomenon in patients with COVID-19 presenting with ST-segment elevation myocardial infarction.

OBJECTIVES: Thrombotic process is triggered in the course of Coronavirus disease-2019 (COVID-19), which is a global pandemic, and both arterial and venous systems are affected. ST-elevation myocardial infarction (STEMI) that may develop in these patients may cause more complicated results with the effect of thrombosis burden. Our aim in this study is to determine the frequency of no-reflow phenomenon in COVID-19 patients with STEMI and to determine the factors that predict this complication. METHODS: In this study, which is a single-centre, retrospective and observational, a total of 126 patients who underwent primary percutaneous coronary intervention (pPCI) in our centre due to STEMI between 11 March 2020 and 10 January 2021 were evaluated. Patients were divided into two groups according to the presence of COVID-19 infection. RESULTS: While 62 patients were in the COVID-19 (+) group, 64 patients were evaluated in the COVID-19 (-) group. When the two groups are compared, C-reactive protein, D-dimer, ferritin and neutrophil-lymphocyte ratio (NLR) were significantly higher, and the lymphocyte count was significantly lower in the COVID-19 (+) group. No-reflow was numerically higher in patients with COVID-19. In multivariable analysis, D-dimer and NLR were found to be independent predictors of no-reflow phenomenon in COVID-19 patients. CONCLUSIONS: Although the no-reflow phenomenon was numerically higher in COVID-19 patients who underwent pPCI due to STEMI compared to the non-COVID group, no statistical difference was found in our study. However, NLR and D-dimer have been identified as independent predictors of no-reflow development risk in COVID-19 patients.

Fragmented QRS complex may predict long-term mortality after isolated surgical aortic valve replacement in patients with severe aortic stenosis.

OBJECTIVES: Fragmented QRS (fQRS), related to myocardial fibrosis, is an important prognostic marker of cardiovascular events and mortality. Aortic stenosis (AS), the most frequent valvular heart disease in developed countries, causes myocardial fibrosis due to ventricular pressure overload. The current study aimed to investigate whether fQRS is associated with long-term mortality after isolated surgical aortic valve replacement (SAVR) in patients with severe AS. METHODS: A total of 289 patients who underwent SAVR for severe AS between May 2009 and January 2020 with interpretable electrocardiogram were included. Patients were divided into 2 groups according to the presence of fQRS. Kaplan-Meier survival analyses were used to detect cumulative survival rates. Univariable and multivariable Cox proportional hazards models were used to determine the predictors of all-cause mortality. RESULTS: fQRS occurred in 126 (43.5%) patients. A total of 59 (20.4%) patients died over a follow-up period of 54 ± 32 months. All-cause mortality was higher in the fQRS group (23 [14.1%] vs 36 [28.6], log-rank test P = 0.002) in the long term. The presence of fQRS [hazard ratio (HR): 1.802, confidence interval (CI): 1.035-3.135, P = 0.037], electrocardiographic left ventricular strain (HR: 1.836, CI: 1.036-3.254, P = 0.038) and history of stroke or transient ischaemic attack (HR: 3.130, CI: 1.528-6.412, P = 0.002) were independent predictors of all-cause mortality in the multivariable Cox regression model. CONCLUSIONS: fQRS is associated with a 1.8-fold increase in long-term mortality in patients undergoing isolated SAVR for severe AS. Detecting fQRS in electrocardiograms may provide prognostic information about the long-term outcomes.

Plateletcrit may predict no-reflow after saphenous vein graft interventions in patients with non-ST elevation myocardial infarction.

Saphenous vein graft (SVG) percutaneous coronary interventions (PCIs) are procedures with potential complications such as distal embolization, slow or no-reflow phenomenon. Platelets are the main factors in development of thrombus and no-reflow phenomenon. There have been multiple studies that identified the association between plateletcrit (PCT) and cardiovascular outcomes. The aim of the study was to investigate whether PCT can predict the development of no-reflow in patients with non-ST elevation myocardial infarction (NSTEMI) undergoing PCI for SVG disease. A total of 181 patients who underwent PCI for SVG disease with NSTEMI were included retrospectively. Platelet indices on admission were recorded. Patients were divided into two groups according to the development of no-reflow during the procedure: no-reflow (n = 32; 18%) and normal reflow (n = 149; 82%). PCT and platelet count were higher in the no-reflow group (0.254 vs. 0.224, P = 0.020; 265.4 vs. 233, P = 0.011, respectively). The PCT cut-off value for predicting no-reflow was calculated as 0.230 by ROC curve analysis with 68.8% sensitivity and 51.0% specificity. Multivariate logistic regression analysis showed that PCT was an independent predictor of no-reflow (odds ratio: 5.091, confidence interval: 1.356-19.116, P = 0.016). PCT may be useful in identifying patients at risk for developing no-reflow in patient with NSTEMI undergoing SVG PCI.

A new biomarker that predicts ventricular arrhythmia in patients with ischemic dilated cardiomyopathy: Galectin-3.

INTRODUCTION: Ventricular arrhythmias are caused by scar tissue in patients with ischemic dilated cardiomyopathy. The gold standard imaging technique for detecting scar tissue is magnetic resonance imaging (MRI). However, MRI is not feasible for use as a screening test, and also cannot be used in patients who have received an implantable cardioverter-defibrillator (ICD). In this study, we aimed to assess the association between levels of galectin-3 (Gal-3), which is known to be secreted by scar tissue, and the history of ventricular arrhythmias in patients with ischemic dilated cardiomyopathy who received an ICD. METHODS: Nineteen healthy controls and 32 patients who had previously undergone VVI-ICD implantation due to ischemic dilated cardiomyopathy were enrolled in the study. Patients were divided into three groups: the first group including patients who had received no ICD therapies, the second including patients with arrhythmia requiring therapies with no arrhythmia storm, and the third including patients who had arrhythmia storm. We assessed the association between Gal-3 levels and the history of ventricular arrhythmias in these patients. RESULTS: Gal-3 levels were significantly higher in the patient groups than in the control group (p<0.01). Gal-3 levels of patients with arrhythmias requiring ICD therapies were significantly higher than in patients with ICD not requiring therapies (p=0.02). They were also higher in patients with a history of arrhythmia storm than in patients without shocks (p=0.05). Receiver operating curve analysis showed with 84% sensitivity and 75% specificity that Gal-3 levels over 7 ng/ml indicated ventricular arrhythmia that required therapies. CONCLUSION: Gal-3 may be used to further improve risk stratification in patients with ischemic cardiomyopathy who are more prone to developing life-threatening arrhythmias.

Effect of prognostic nutritional index on short-term survival after transcatheter aortic valve implantation.

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) is a good alternative to surgical aortic valve replacement (SAVR) in severe aortic stenosis patients who are at intermediate or high risk, or other cases that are considered unsuitable for SAVR. TAVI is most often performed on elderly patients, and although conventional risk scores include a number of comorbidities, they do not take into account functional decline specific to elderly patients. The prognostic nutritional index (PNI), which is a simple and effective parameter for both nutritional and inflammatory status, reflects functional decline in the elderly. The aim of this study was to determine the effect of the PNI on short-term survival after TAVI. METHODS: The PNI values of 302 patients who underwent TAVI were analyzed. The study population was divided into 2 groups according to a PNI cut-off value: PNI >43.37 (n=213; 70%) and PNI <43.37 (n=89; 30%). RESULTS: Patients with a lower PNI score had a significantly higher mortality rate in the initial 30-day period following the procedure than patients with a higher PNI score (3.3% vs. 31.5%; p<0.001). Major vascular complications and cardiac tamponade were significantly more frequent in the lower PNI group. The cut-off value of the PNI for 30-day survival was 43.37, with 94.3% specificity and 73.4% sensitivity and the negative predictive value of the PNI was 96.7%. The PNI score was found to be an independent risk factor for 30-day mortality after TAVI. CONCLUSION: A higher PNI score was associated with short-term survival and fewer post-TAVI complications.

CHA2DS2-VASc score as a predictor of no-reflow phenomenon after saphenous vein graft percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes.

BACKGROUND: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) is associated with an increased risk of complications, particularly no­reflow phenomenon and distal embolization due to low patency rates. The CHA2DS2­VASc score is a clinical risk stratification tool used to predict thromboembolism events especially in patients with nonvalvular atrial fibrillation. AIM: The aim of this study was to investigate the relationship between the CHA2DS2­VASc score and no­reflow phenomenon after SVG PCI in patients with non-ST­segment elevation acute coronary syndromes (NSTE­ACS). METHODS: In this study, we included 268 patients diagnosed with NSTE­ACS who underwent PCI for SVG disease in our tertiary cardiovascular center. Patients were divided into 2 groups: group 1 without no­­reflow phenomenon (n = 190) and group 2 with no­reflow phenomenon (n = 78) following the intervention, and then compared based on CHA2DS2­VASc scores. RESULTS: The CHA2DS2­VASc score (P <0.001) was significantly higher in group 2, even though no significant difference regarding atrial fibrillation was observed between the study groups. The CHA2DS2­VASc score (P <0.001), degenerated saphenous vein graft (P = 0.006), and intraluminal thrombus (P <0.001) were found to be independent predictors of no­reflow phenomenon. Receiver operating characteristics analysis showed that a CHA2DS2­VASc score of 4 predicted no­reflow phenomenon with 67.9% sensitivity and 69.3% specificity. CONCLUSIONS: Our findings suggest that the CHA2DS2­VASc score can be an independent predictor of no­reflow phenomenon in patients undergoing SVG interventions. As a simple and easy­to­calculate score, it might be a useful assessment tool to predict no­reflow phenomenon before SVG interventions in patients with NSTE­ACS.

Characterization, epidemiological profile and risk factors for clinical outcome of infective endocarditis from a tertiary care centre in Turkey.

Background: We aimed to investigate the clinical, laboratory, microbiological characteristics of IE in a single tertiary care centre in Turkey and to identify the factors associated with in-hospital mortality. Methods: A total of 155 consecutive adult patients (≥18 years) admitted to our single tertiary care hospital between 2009 and 2019 with definite infective endocarditis were retrospectively included in the study. Results: The mean age of the patients was 58 years. Among 155 endocarditis episodes, 60% involved prosthetic valves, 35.5% had native valve endocarditis (NVE) and 4.5% were device related. Prosthetic valve disease was the most frequent predisposing valve lesion followed by degenerative valvular disease. Vegetations were detected in 103 (66.5%) patients by transthoracic echocardiography and in 145 (93%) patients by transoesophageal echocardiography. The most commonly affected valve was the mitral valve in 84 (54.2%) patients, followed by 67 (43.2%) aortic valve. Staphylococci were the most frequent causative microorganisms isolated in both NVE (31.8%), prosthetic valve endocarditis (38.9%) and device related IE cases. At least one complication was present in 70 patients (45.2%). One hundred and eight patients underwent surgical therapy (69.7%). Age, syncope, heart failure, perforation, septic shock, renal failure, high red cell distribution width, atrial fibrillation, hypocalcaemia, pulmonary hypertension were associated with high mortality. Conclusions: We identified a 10-year presentation of IE in a referral centre in Turkey. Likely other series, we observed more staphylococcus endocarditis with the aging of the population. Surgery was associated with higher in-hospital survival. Age, syncope, perforation, septic shock were independent predictors of mortality.

Successful percutaneous treatment of coronary steal syndrome with the amplatzer vascular plug 4 and coil embolization.

The left internal mammary artery (LIMA) is widely used in coronary artery bypass grafting surgery due to its long term perfect patency rates. However, coronary steal syndrome can occur because of unligated LIMA side branches and it causes blood flow from coronary artery to LIMA. Even though the optimal therapy of coronary steal syndrome is still controversial, some percutaneous and surgical treatment modalities can be used in the treatment of steal phenomenon for relieving angina and resolving ischemia. It was demonstrated that percutaneous treatments such as the use of gelatin sponge particles or drug-eluting stents with covered stent, and coil and vascular plug embolization were used to treat this phenomenon successfully. Several studies revealed that these percutaneous treatments can reduce the ischemic area and results in prevention of blood flow from coronary artery to LIMA side branches. Supporting these findings, we herein present a 48-year-old male patient with objective ischemia with coronary steal syndrome treated successfully with the Amplatzer vascular plug (AVP) 4 and coil embolization in the same procedure. To the best of our knowledge, the combined therapy has not been described in the literature yet. Supporting the literature findings, successful treatment of LIMA side branches in our case with two different percutaneous modalities results in improvement of coronary flow and a reduced ischemic area and angina.

Evaluation of the Tp-Te interval, Tp-Te/QTc ratio, and QT dispersion in patients with Turner syndrome.

OBJECTIVE: To evaluate ventricular repolarization parameters using the interval from the peak to the end of the T wave (Tp-Te), together with QT and corrected QT (QTc) intervals, QT dispersion (QTd), and Tp-Te/QTc ratio in patients with Turner syndrome (pwTS) and to compare the results with those from healthy controls. METHODS: In total, 38 patients previously diagnosed with Turner syndrome (TS) and 35 healthy girls (controls) were included in our cross-sectional study. Twelve-lead electrocardiography (ECG) and echocardiography after a 30-min rest were performed. The QT, QTc, QTd, Tp-Te interval, and Tp-Te/QTc ratio were determined. RESULTS: No differences in age or sex were observed between the groups. QT intervals were similar in both groups [pwTS: 354.76±25.33 ms, controls (C): 353.29±17.51 ms, p=0.775]. pwTS had significantly longer QTc and QTd than controls (411.87±22.66 ms vs. 392.06±13.21 ms, p<0.001 and 40.31±2.02 ms vs. 37.54±1.83 ms, p<0.001, respectively). Similarly, the Tp-Te interval and Tp Te/QTc ratio were significantly longer in pwTS than in controls (71.89±3.39 ms vs. 65.34±2.88 ms, p<0.001 and 0.17±0.01 vs. 0.16±0.01, p=0.01). CONCLUSION: As pwTS have longer QTc, QTd, Tp-Te interval, and Tp-Te/QTc ratio, an annual follow-up with ECG can provide awareness and even prevent sudden death in them. Also avoiding the use of drugs that makes repolarization anomaly and having knowledge about the side effects of these drugs are essential in pwTS.

Coronary microvascular dysfunction equivalent to left main coronary artery disease.

Coronary microvascular dysfunction, also known as cardiac syndrome X, is a clinical syndrome presenting with typical angina and evidence of myocardial ischemia in the absence of flow-limiting stenosis on coronary angiography. Of patients undergoing coronary angiography due to suspected myocardial ischemia, 50% are found to have normal or near-normal coronary arteries. Described in this case report is a patient who developed hypotension and ST segment depressions during treadmill exercise test. Left main coronary artery or multivessel disease was suspected. Coronary angiography was normal, but coronary flow reserve measurement revealed severe microvascular dysfunction.

Potential contribution of virtual histology plaque composition to hemodynamic-morphologic dissociation in patients with non-ST elevation acute coronary syndrome.

OBJECTIVE: Histologic plaque characteristics may influence the hemodynamic effect generated by physiologically significant unstable coronary lesions where plaque content and surface related factors are expected to contribute to the maximum translesional pressure drop. In this study, we aimed to identify local lesion specific virtual histological characteristics that may potentially affect hemodynamic outcome measures. METHODS: Forty-eight consecutive patients with non-ST-elevation acute coronary syndrome (NSTEACS) having paired hemodynamic and morphological data were enrolled. A dual sensor guide-wire was used for the assessment of fractional flow reserve (FFR) and stenosis resistance (HSR) in the culprit vessel. Virtual histology intravascular ultrasound imaging was performed after obtaining hemodynamic data. RESULTS: In a hemodynamically significant lesion subset (FFR<0.75 [n=34]), after controlling for lesion length, MLA and coronary artery compliance, FFR correlated with necrotic core (NC) area (r=-0.423, p=0.028) at MLA and NC volume (r=-0.497, p=0.008) and dense calcium (DC) volume (r=-0.332, p=0.03) across the entire lesion segment. Likewise, NC (r=-0.544, p=0.005) and DC (r=0.376, p=0.03) areas at MLA and NC (r=0.545, p=0.005) and DC (r=0.576, p=0.003) volumes across the entire lesion segment were associated with HSR in the hemodynamically significant lesion group (HSR>0.80 [n=33]). However, no correlation has been observed between intracoronary hemodynamic end-points and plaque components in hemodynamically insignificant lesions. CONCLUSIONS: This study demonstrated that for a given coronary stenosis geometry and arterial compliance, plaque composition may influence hemodynamic outcome measures in functionally significant stenoses in patients with NSTEACS.