Objectives: We analyzed all-cause and coronary mortality data of the Turkish Adult Risk Factor Study cohort in Marmara and Central Anatolia regions, surveyed in 2011, and overall performance of long-term (21 years) follow-up of participants.
Study design: A total of 1,588 participants with an age range of 45 to 74 years were surveyed. Information on the mode of death was obtained from first-degree relatives and/or personnel of local health offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiograms. Loss to follow-up was defined as the lack of physical examination for at least eight years.
Results: Of the surveyed participants, 854 were examined, information on health status was obtained in 606 subjects, 46 individuals (28 men, 18 women) were ascertained to have died, and 82 subjects were lost to follow-up. A total of 2,800 person-years were added to follow-up. Nineteen deaths were attributed to coronary heart disease (CHD) and five deaths to cerebrovascular events. Overall mortality was estimated as 10.9 per 1000 person-years. In the age bracket of 45-74 years, overall annual all-cause mortality and CHD mortality were 12.8 and 5.5 per mille, respectively. Based on the total loss to follow-up (31.2%) during the past two decades, an annual loss to follow-up may be derived as 19.3 for every 1000 participants. This loss was nearly twice as high in participants living in big cities compared to those in smaller towns and rural areas.
Conclusion: A trend to slight reduction in coronary mortality, though not in overall mortality, before the age 75 years is noted in Turks. Annual loss to follow-up amounts to 2% of the participants.

Objectives: We aimed to evaluate left atrial (LA) volumes and phasic functions in heart failure patients with preserved or low ejection fractions.
Study design: The study consisted of 59 patients (36 men, 23 women; mean age 63.8 years) with heart failure accompanied by low (n=26) or preserved (n=33) ejection fractions. Two-dimensional echocardiographic LA volumes (maximal, minimal and pre-contraction volumes) were obtained and LA phasic functions (reservoir, conduit, and pumping functions) were calculated. The findings were compared with those of age- and sex-matched 30 controls (20 men, 10 women; mean age 60.3 years) without heart failure.
Results: All LA volumes were found to be significantly increased in both groups with heart failure compared with controls. Left atrial reservoir and pumping functions were significantly lower in patients with preserved ejection fraction than in those with low ejection fraction (p=0.02 and p=0.009, respectively). Left atrial conduit function was significantly lower in heart failure patients with low ejection fraction than in those with preserved ejection fraction (p=0.005). Compared with controls, heart failure patients with either low or preserved ejection fractions exhibited significantly decreased LA phasic functions (p<0.001).
Conclusion: Our results demonstrate that, compared to subjects without heart failure, all phasic LA functions are impaired in heart failure patients with either low or preserved ejection fraction. However, impairment in LA reservoir and pumping functions is more prominent in heart failure patients with preserved ejection fraction.

Objectives: We aimed to assess the use and reporting-quality of multivariate logistic regression analysis (MVLRA) in articles published in two Turkish cardiology journals.
Study design: We reviewed all original articles published in two Turkish cardiology journals (the Anatolian Journal of Cardiology and Archives of the Turkish Society of Cardiology) between January 2010 and August 2011. The articles that used MVLRA were analyzed comprehensively based on 10 predefined criteria.
Results: A total of 212 articles were reviewed, of which MVLRA was used in 33 (15.6%). Twenty-nine articles (%87.9) properly included the main components of the MVRLA, namely, odds ratios, 95% confidence intervals, and p values. However, none of the articles reported MVRLA-related data such as the modeling type, validation, goodness-fit, multicollinearity and interaction tests. There were severe reporting flaws and faults as to the ratio of the total number of events or sample size to the number of independent variables included into the MVLRA model, the use of fitness procedures, and how the independent variables were selected.
Conclusion: Our results indicate that MVLRA has become a standard statistical method in the Turkish cardiology literature. However, overall reporting of MVLRA data still has seriously inadequate and inaccurate aspects.

Objectives: The EURIKA study (The European Study on Cardiovascular Risk Prevention and Management in Daily Practice), which covers 12 European countries including our country, aimed to describe the management of cardiovascular risk factors in the daily practice and to detect areas of improvement. We evaluated our country-based data on the methods used by physicians to manage cardiovascular risk factors and the results of patients who participated in this study.
Study design: The EURIKA study recruited 663 patients (mean age 59.4±7.6 years; 47.2% males) and 67 physicians (55 men, 12 women; mean age 40.7±8.6 years) from Turkey. Risk factor definition and treatment goals were based on the 2007 European guidelines on cardiovascular disease prevention. Blood samples were analyzed in a central laboratory. The 10-year risk for fatal cardiovascular disease was estimated based on the SCORE system.
Results: About one-third (34.8%) of the doctors did not use any cardiovascular disease guidelines. Only 48.5% used cardiovascular risk calculation. The most common (74%) reason for not using risk calculation was stated as having limited time. The rates of reaching target total/LDL cholesterol, blood pressure, and HbA1c levels were 30.4%, 32.1%, and 26% in treated dyslipidemics, hypertensives, and diabetics, respectively. Hypertension, diabetes, dyslipidemia, and smoking accounted for 59.4% of attributable cardiovascular risk. Lack of control of these risk factors accounted for 31.8% of cardiovascular risk.
Conclusion: Only half of our doctors use cardiovascular risk calculation, and therapeutic guidelines are not adequately used. Moreover, the control rates of risk factors in primary prevention are low.

Introduction: Aortic stiffness (AS) is a strong predictor of cardiovascular events. In spite of clinical importance, value of AS in patients who have coronary stenosis and undergo percutaneous coronary interventions (PCI) was unknown.Our hypothesis is that AS may give additional information about coronary hemodynamic status. In this study,we investigated the effect of coronary stenosis on AS.
Methods: Totally 107 patients were included in the study. Patients were divided into three groups. Thirty-nine patients who had significant lesion (≥50%) in coronary artery were included the ‘critical group’. The ‘non-critical group’ consisted of 38 patients with non-significant lesion (0-50%). The control group was made up of 30 patients with normal angiogram. AS was measured with carotid-femoral-aortic by pulse-wave-velocity (PWV) method. (m/s)

Results: PWV values were similar in control and non-critical group (5.7±1.1vs.5.8±1.1,p=0.6) However, PWV in critical group was significantly higher than other groups (p<0.0001). After PCI, 24.4% decrease in PWV was shown. In PCI group, PWV after PCI was significantly lower than baseline (9.4±2.2vs.7.1±2.0, p<0.0001).
Multiple logistic regression analysis showed that PWV is predictive factor for significant stenosis (Exp(B): 3.960 CI: 2.014-7.786).

There was significant but weak correlation between AS and age (r=.412,p=0.01) and blood pressure (r=.342,p<0.01)

Conclusion: The significant coronary stenosis is associated with high AS levels. Successful PCI procedures decrease AS levels. Our results suggest that AS may give additional information about coronary hemodynamic status.

Objectives: We aimed to investigate the relationship between plasma asymmetric dimethylarginine (ADMA) levels and heart rate variability (HRV) in diabetic patients.
Study design: The study included 100 patients (44 men, 56 women) with type 2 diabetes mellitus. The patients were divided into two groups based on the use of oral antidiabetics (n=67; mean age 54.6±7.8 years) or insulin (n=33; mean age 51.6±8.8 years). Plasma ADMA levels were measured and HRV parameters were calculated from 24-hour Holter EKG recordings. The findings were compared with those of a control group consisting of 42 nondiabetic individuals (mean age 52.8±6.2 years).
Results: Compared to the control group, plasma ADMA levels were significantly higher (p=0.007) and all HRV parameters were significantly reduced in both diabetic groups. However, ADMA levels and HRV parameters were similar in the two diabetic groups (p>0.05). Correlation analysis showed no significant relationship between plasma ADMA levels and HRV parameters.
Conclusion: Our findings show that plasma ADMA levels are increased and HRV is reduced in diabetic patients, indicating that these patients have both endothelial dysfunction and autonomic dysfunction, but plasma ADMA levels cannot be used to evaluate autonomic dysfunction.

Brugada syndrome is a genetic disease characterized by persistent or transient ST elevation in the right precordial electrocardiogram (ECG) leads with or without right bundle branch block. It represents an increased risk for sudden cardiac death despite a structurally normal heart. Brugada-type ECG can be unmasked and induced by several circumstances. We report on a 24-year-old male patient who experienced a syncopal episode and manifested Brugada type 1 ECG during a febrile state. His ECG changed to normal after treatment of fever. A single-chamber ICD was implanted to the patient because of syncope, fever-induced type I Brugada ECG pattern, and ventricular fibrillation during ajmaline challenge.

Transradial approach for percutaneous interventions has emerged as an alternative to transfemoral access which is known to be more associated with vascular local complications. However, lack of guiding-catheter support via the radial access is one of the problems encountering the operators. Many solutions have been proposed to overcome this problem. We report on a 62-year-old man with tight stenosis of the distal part of the right coronary artery. He underwent coronary angiography and then percutaneous angioplasty via the right radial artery. During the procedure, attempts to advance a stent beyond a tortuosity at the level of the second segment failed due to lack of support of the 6-Fr Judkins right 4 guiding catheter, even with the buddy wire technique. Then, switching to a 5-Fr Judkins right 4 guiding catheter allowed safe deep engagement and resulted in successful advancement and deployment of the stent.

Totally implanted port devices play an important role in acute and chronic medical care of patients with various conditions and are widely used for infusion of fluids, medications, blood or other blood products, and for monitoring hemodynamic parameters. Embolization of a part of port devices is a rare but potentially serious complication of port catheter placement. We report distal embolization of a catheter fragment of a PORT-A-CATH device into the main pulmonary artery and right ventricle and its successful percutaneous retrieval in a patient with metastatic lung cancer, who was also found to have thoracic inlet syndrome or pinch-off syndrome.

Dextrocardia with situs inversus is an uncommon congenital condition in which the major visceral organs are reversed. The clinical diagnosis and electrocardiographic localization of myocardial infarctions in these patients remain a great challenge unless dextrocardia is recognized. A 50-year-old male with known dextrocardia and situs inversus presented with acute chest pain radiating to the right arm. The reversed normalized electrocardiogram showed acute anterior myocardial infarction and cardiac catheterization showed a proximal occlusion of the left anterior descending artery. He underwent coronary angioplasty with stenting, resulting in relief of chest pain and improvement in his clinical condition.

Nerium oleander is a plant native only in the Mediterranean region, but it can also be cultivated worldwide, particularly in warm areas. Biologically active oleander compounds may be used for therapeutic purposes. However, when used for self-medication, it may cause serious problems including death. We present a 30-year-old otherwise healthy man who developed complete atrioventricular block after taking a syrup of N. oleander leaves for self-medication to relive hemorrhoidal complaints. The patient was treated by oral administration of charcoal combined with sodium sulfate as well as electrolyte solutions and transient use of an external cardiac pacemaker. The atrioventricular block reverted to sinus rhythm in 30 hours and he was discharged in good hemodynamic status and general condition.

Penetrating injuries to the myocardium are rare but potentially lethal. We present a 22-year-old asymptomatic male patient with a pellet lodged in the myocardium as a result of a gunshot that took place three years before. His medical history was otherwise unremarkable. The chest X-ray showed multiple pellets within the thorax. Computed tomography of the chest demonstrated many pellets in the anterior chest wall, while a few lodging within the lung tissue and one within the myocardium. Transthoracic echocardiography showed a pellet within the left ventricular myocardium presenting as an acoustic shadowing. Thickening of the adjacent pericardium was also noted. There were no signs of constrictive pericarditis or regional wall motion abnormality. Holter monitoring and treadmill exercise test did not show any abnormal finding. The patient was included in a periodic follow-up program.

Over the last decade, several technologies have been developed for percutaneous repair of the mitral valve for patients with severe mitral regurgitation (MR) and at high-risk for the traditional open-heart mitral valve repair or replacement. Among them, MitraClip has emerged as the only clinically safe and effective method for percutaneous mitral valve repair. It is adapted from the surgical technique that was initially described by Dr. Alfieri and his group by placement of a suture approximating the edges of the mitral leaflets at the origin of the MR jet, leading to creation of so-called bow-tie or double orifice with significant reduction in the MR jet. Here, we review the details of the technology, its procedural perspective as well as currently available data for its safety and effectiveness on a case-based report.

Turkey’s institutions were evaluated with respect to publication output in cardiovascular medicine in 2011, based on data of the Web of Knowledge. Only articles in full-text and reviews appearing in source publications covered by Science Citation Index CD Edition were included. A fractional count system was used for items published jointly with a foreign center or a noncardiological Turkish institution. Turkey’s publications decreased to 101 in 2011 from 121 of the previous year, as her share of world publication decreased from 6.1 to 5.1 per mille, representing a drop below the 2001 level. Eighty-one articles originated from adult cardiology. The median impact factor was 1.67, similar to that of the previous year, half of the publications appearing in periodicals with an impact factor of 1.33 to 3.52. The front-runner institutions of highest productivity, apart from the TARF Study, were Kartal Koşuyolu and Türkiye Yüksek İhtisas Hospitals as well as S. Demirel and Cumhuriyet universities and Gülhane Military Medical Academy. Bells are ringing for authorities to undertake serious measures in realization that Turkey’s medical research activity is on the road to drastic decline.

intercoronary continuity is a rare variant for of coronary circulation. Its prevalence and clinical significance has not been fully understood yet.