Objectives: Detection of extent and severity of atherosclerosis using easy, non-invasive methods is of great importance. Atherosclerotic burden may be evaluated with the Gensini scoring system (GSS). Carotis intima media thickness (CIMT), plasma asymmetric dimethyl arginine (ADMA) level, and endothelial dysfunction are well known surrogate markers of atherosclerosis. The aim of this study was to evaluate the relationship between atherosclerotic burden determined by the GSS, and ADMA, CIMT and endothelial function.
Study design: Consecutive patients who had undergone coronary angiography were evaluated. 50 patients with acute coronary syndrome (ACS), 50 patients with stable coronary artery disease (SCA), and 50 patients with normal coronary arteries (NCA) were included. All subjects’ GSS, ADMA, CIMT and endothelial functions were evaluated and compared.
Results: GSS was higher in ACS than SCA (75.4 vs 54.9; p<0.001). CIMT was higher in ACS and SCA in compared to NCA (0.98, 0.96, 0.78 mm respectively; p<0.001). Endothelium derived vasodilatory response (EDVR) was decreased in ACS and SCA in compared to NCA (3.5±2.1%, 3.3±1.8%, 7.2±3.5% respectively; p<0.001). Plasma ADMA concentration was higher in ACS and SCA in compared to NCA (0.928, 0.992, 0.475 μmol/l respectively; p<0.001). There was a weak positive correlation between GSS and plasma ADMA levels (r=0.293; p=0.002), an intermediate positive correlation between GSS and CIMT (r=0.508; p<0.001), and an intermediate negative correlations between GSS and EDVR (r= -0.662; p<0.001).
Conclusion: This study showed that CIMT, ADMA concentration and endothelial dysfunction were significantly associated with CAD. However, only the GSS was significantly different between ACS and SCA groups.

Objectives: We aimed to observe the effect of cardiac rehabilitation (CR) on left ventricular diastolic function in patients with acute myocardial infarction (AMI) and revascularization by percutaneous coronary intervention (PCI).
Study design: 82 patients were enrolled the study; 42 who were participating in a CR program, and 40 who did not maintain the program as a control group. Measurements of mitral inflow included the peak early filling (E-wave) and late diastolic filling (A-wave) velocities, the E/A ratio, deceleration time (DT) of early filling velocity and mitral A-wave duration. The early diastolic annular velocity has been expressed as e’ with PW tissue Doppler imaging. The mitral inflow E velocity to tissue Doppler e’ (E/e’) was calculated and isovolumic relaxation time (IVRT) was measured. Measurements of pulmonary venous waveforms included peak systolic (S) velocity, peak anterograde diastolic (D) velocity and the time difference between the duration of the atrial reversal (Ar) and mitral Awave duration (Ar-A).
Results: E/A and septal e’ were better with the CR group than the control group. (p=0.048 vs p=0.006 respectively). The difference between E/e’ measurements were not statistically significant (p=0.138). The left ventricular diastolic function of patients were partially improved with cardiac rehabilitation. There was no association between infarct-related artery (IRA) and diastolic functional measurements of the left ventricle in the individuals. Only hypertension was found significantly associated with E/A (p=0.000).
Conclusion: CR improves septal e’ and E/A significantly in patients with AMI and revascularized successfully by PCI, especially in those with hypertension.

Objectives: The goal of the study was to determine the effect of decreased preload on right ventricular systolic function, as measured by new and old echocardiographic parameters in chronic renal failure (CRF) patients.
Study design: A total of 30 CRF patients (mean age 48 ± 15 years and 19 female) undergoing hemodialysis were included in the study. Echocardiography was used to determine left ventricular ejection fraction (LVEF), left atrial volume, right atrial area, right ventricular end-diastolic area, systolic pulmonary artery pressure, right ventricular fractional area change (RV FAC), right ventricular myocardial performance index (Tei index), right ventricular tissue Doppler S' (RV S') velocity, isovolumic myocardial acceleration (IVA), tricuspid annular plane systolic excursion (TAPSE) and right ventricular outflow tract systolic excursion (RVOT SE) before and after hemodialysis.
Results: The RV S' velocity and RVOT SE parameters which are indicators of right ventricular systolic function did not change significantly after hemodialysis (p=0.919, p=0.186). However, the RV FAC, Tei index, IVA and TAPSE values were significantly increased (p<0.001 for all). TAPSE was found to be the only parameter that had a positive correlation with the amount of fluid removed (p=0.041 and r=0.375).
Conclusions: Although RV S' velocity and RVOT SE, was found to be independent of preload, RV FAC, Tei index, IVA and TAPSE values were depend on the preload. In addition, TAPSE correlated with the amount of fluid removed.

Objectives: Fragmented QRS (fQRS) as a predictor of cardiac events in coronary artery disease has previously been reported. In this study, we hypothesized that presence of fQRS on a 12-lead electrocardiogram (ECG) on admission would be predictive of adverse outcomes in non-ST elevated myocardial infarction (NSTEMI).
Study design: A total of 149 NSTEMI patients (112 male, 37 female) were retrospectively analyzed. The fQRS pattern was defined as the presence of an additional R’, notching in the nadir of the S wave, fragmentation of the RS or QS complexes in 2 contiguous leads corresponding to a major coronary artery territory. The relationship between presence of fQRS on admission on a 12-lead ECG, and primary end points [cardiovascular death (CVD)] and secondary end points (re-infarction, repeat target vessel revascularization [percutaneous/surgical]) were assessed. The median follow-up time was 18 (13-24) months.
Results: Other than age, there were no significant differences in baseline characteristics and laboratory findings for patients in the fQRS and non-fQRS groups. The patients in the fQRS group were older [64 years vs 59 years, p=0.048]. CVD and re-infarction were significantly higher in the fQRS group in the median 18-month follow-up (26.1% vs 8.7%, p=0.005; 23.9% vs 10.7%, p=0.035, respectively). By a multivariate regression analysis in all 149 patients, age ≥65 years and the presence of fQRS in a 12-lead ECG on admission were found to be powerful independent predictors of cardiovascular mortality (HR: 4.91, 95% CI: 1.60-15.03, p=0.005; HR: 2.77, 95% CI: 1.02-7.50, p=0.044, respectively).
Conclusion: Presence of fQRS on a 12-lead ECG on admission is associated with increased long-term mortality in patients with NSTEMI.

Objectives: Hypertension is a common comorbidity in patients with type 2 diabetes. Management of hypertension is of paramount importance in reducing macro and microvascular complications of diabetes. The aim of this study is to determine the rate of blood pressure control (<140/85 mmHg) in diabetic patients with hypertension, and to evaluate the prescribing pattern of antihypertensive medications.
Study design: This was a prospective, cross-sectional, observational study conducted in a tertiary centre in Turkey. Of 707 patients with diabetes, 500 hypertensive patients were evaluated to determine control of hypertension and treatment attitudes. Logistic regression analysis was used to evaluate the likelihood of prescription of each class of antihypertensive medications for the presence of macro and microvascular complications.
Results: Most of the patients (95%) were on antihypertensive therapy. Only 41% achieved target blood pressure values (<140/85 mmHg). Renin angiotensin system (RAS) blockers were the most frequently (82.4%) prescribed antihypertensive agents, and a combination of RAS blockers and diuretics were the most commonly preferred combination therapy. Most of the patients were on 1 antihypertensive drug or a combination of 2 drugs (39.5% and 44.7%, respectively). Patients with coronary artery disease were more likely to receive beta blockers (Odds ratio=3.6, 95% confidence interval=2.3-5.6; p<0.001).
Conclusion: Although most of the diabetic hypertensive patients were on hypertensive therapy, more than half had uncontrolled blood pressure.

Objectives: Stiffness index beta (SIB), aortic strain (AS) and distensibility (AD) are the parameters used to assess elasticity of the aorta, and can be measured by non-invasive method such as echocardiography. In this study, we aimed to analyse the effects of Maraş powder and smoking on aortic stiffness by comparing young individuals.
Study design: The study included 90 male subjects aged 18-40 years. 30 subjects were Maras powder users (mean age; 32±2), 30 were smokers (mean age: 28±2) and 30 were healthy volunteers (mean age: 29±2). After detailed physical examination, all subjects underwent transthoracic echocardiography. Systolic and diastolic diameters of the aorta were measured from the ascending aorta at modified parasternal long axis views by M-mode echocardiography. AS, AD, and SIB were calculated using standard formulae. Group parameters were then compared to each other.
Results: There was no significant difference between the groups in terms of demographic and clinical features, including blood pressures, lipid profile and serum creatinine (p>0.05). Although AS and AD were lower, and SIB was higher in the Maraş powder and smoking groups compared to the control group, the difference between groups was not statistically significant (for AS: 17.61±2.22, 17.75±1.93, 18.48±2.02 respectively, for AD: 9.03±1.12, 9.14±0.96, 9.9±1.12, respectively, for SIB: 2.72±1.07, 2.59±0.88, 2.37±0.71 respectively, for all p>0.05).
Conclusion: Our study revealed that smoking and Maraş powder did not lead to a significant change in elasticity of the aorta in individuals under the age of 40.

Percutaneous mitral balloon valvuloplasty (PMBV) is the primary treatment in mitral stenosis patients with appropriate valve anatomy with no contraindications present. Pericardial effusion, cardiac tamponade and thrombus formation are rare but serious complications of this procedure. In the literature, the mortality rate associated with PMBV has been reported as 1%. The presence of intracardiac thrombus is a contraindication for PMBV. However, thrombus formation during the process is a very rare condition. In this case, we present a patient with rheumatic mitral stenosis, with both pericardial effusion and intracardiac thrombus, after laseration at the base of the left atrium during the valvuloplasty procedure.

We report a 57-year-old patient with acute anterior wall infarction with a history of a coronary baypass graft operation in 2007. He also had concurrent left arm cyanosis and severe pain. He had received diagnosis of pancreatic adenocarcinoma one month previously and had had his first chemotherapy in the previous week with gemcitabine and 5-fluorouracil. After the angiography, a giant thrombus was detected in the proximal left subclavian artery, deteriorating the flows of both left internal mammarian artery (LIMA) to left anterior descending (LAD) coronary artery graft, as well as the left brachial artery. The proximal subclavian artery was stented and good flow was achieved. Through the LIMA, the distal part of LAD, which was totally obstructed with probable distal thrombus embolization, was reached and a percutaneous balloon angioplasty performed. However, the no-reflow phenomenon was observed in distal LAD. A Fogarty traction of thrombus was performed successfully for the revascularization of the left arm. Approximately 30 minutes after the procedure, both angina and ST segment elevation in ECG were resolved under unfractioned heparin and nitroglycerin infusion. However, the patient died due to sepsis seven days after admission to hospital. In the literature, there are only a few previous reports on this rare clinical entity. The eitology, presentation, and the possible management strategies of this clinical entity is presented in this report.

Although aortocaval fistula is mostly encountered as a complication of abdominal aortic aneurysms, it may also arise as a complication of lumbar disc surgery. Great arteriovenous shunts especially may lead to high-output heart failure in due time. In this paper, we aim to present a case of high-output heart failure secondary to aortocaval fistule caused by lumbar disc surgery.

In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treated by percutaneous closure of the rupture using the retrograde approach. The procedure was performed successfully within 26 minutes. We think this approach may be used in future instead of the antegrade approach.

We report a case of thrombus treated with thrombolytic therapy in a patient with normal cardiac functions and Takayasu arteritis. A 27-year-old man with a history of Takayasu arteritis was admitted to our out-patient clinic with a complaint of both right and left foot pain and weakness. In a Doppler ultrasound examination, a subtotal thrombotic occlusion was found in the bilateral popliteal arteries. A transthoracic echocardiography revealed a left ventricular apical thrombus, although both cardiac functions and heart dimensions were normal. Surgical excision was recommended to avoid further embolization, but this was refused by the patient. We decided to perform thrombolytic treatment. The thrombus in the left ventricle was fully resolved by the third day. Perfusion in both feet also returned to normal.

Costello syndrome is a rare syndrome characterized by failure to thrive, short stature, mental motor retardation, characteristic facial features, macrocephaly, a short neck, loose soft skin with deep palmar and plantar creases, and hypertrichosis. Cardiac involvement is seen in almost two thirds of patients, and is a determinant for the prognosis of Costello syndrome. The most common cardiac anomalies are pulmonary stenosis, hypertrophic cardiomyopathy, atrial septal defect, ventricular septal defect and arrhytmia. In this report, we present a 14-month-old female pediatric patient with hypertrophic cardiomyopathy, clinically and genetically diagnosed with Costello syndrome. The report also contains a review of recent related literature.

Heart failure is a clinical picture that occurs when the heart is unable to provide sufficient blood to the tissues and organs due to low performance. In end-stage heart failure, quality of life and survival rates are affected adversely. Heart transplantation is still the best method of treatment in many end-stage heart failure patients who remain symptomatic despite guideline-directed medical therapy. The current situation of heart transplantation in Turkey is discussed in this review.