Objective: This study aimed to examine the overall and coronary mortality in the 2014 Turkish Adult Risk Factor Study survey, and the distribution of cumulative mortality and incident coronary heart disease (CHD) across 7 geographic regions.
Methods: Information on mode of death was appropriately obtained. Information collected from survivors was based on history, examination of the cardiovascular system and the Minnesota coding of electrocardiograms. Cox regression analyses were performed.
Results: Of the 1.323 participants to be surveyed, 87 were lost to follow-up, 753 examined, and 35 ascertained as deceased. In 448 subjects, verbal information alone was obtained regarding health status. Nineteen deaths were of coronary and cerebrovascular origin. Cumulative 24-year assessment of the entire cohort in the age bracket 45–74 years disclosed high coronary mortality, at 7.3 per 1000 personyears in men and 3.8 in women, and recorded a limited decline of 18% since the year 2000. Age-adjusted Cox regression analysis, comprising 614 deaths and 482 incident CHD over a follow-up of 9.6 years, revealed higher mortality rates in the Mediterranean region and in men in the Black Sea and Marmara regions. The age-adjusted CHD incidence was significantly higher in males of the Mediterranean and females of the Southeast regions. An estimated 400–420.000 incident CHD cases develop currently each year in Turkey.
Conclusion: The generally high age-adjusted overall mortality in Turkey displays significant differences across geographic regions. Age-adjusted CHD incidence is not regressing sufficiently, and is especially high among men of the Mediterranean and women of the Southeast regions.

Objective: The inflammatory process plays an important role in the development of cardiovascular complications in patients with obstructive sleep apnea syndrome (OSAS). YKL-40/chitinase 3–like protein 1 is a novel biomarker of systemic inflammation. This study aimed to investigate whether carotid intima-media thickness (CIMT), a useful marker for early atherosclerosis, is associated with serum YKL–40/chitinase 3–like protein 1 levels in patients with normotensive and nondiabetic OSAS.
Methods: The study included 40 OSAS patients and 40 agesex- and body mass index-matched healthy controls. Serum YKL–40 levels were detected by enzyme-linked immunosorbent assay. CIMT was measured by B-mode ultrasound.
Results: The patients with OSAS had significantly increased CIMT and higher YKL–40 and high sensitivity C-reactive protein (hsCRP) levels than those of the controls. CIMT was strongly correlated with serum YKL–40 levels (r=0.694, p<0.001), hsCRP (r=0.622, p<0.001), age (r=0.525, p=0.001), and weakly correlated with apnea-hypopnea index (AHI) (r=0.365, p=0.021) and the percentage of recording time spent (PRTS) of oxygen saturation <90% (r=0.488, p=0.001). Moreover, it was detected that serum YKL-40 levels were strongly correlated with AHI (r=0.617, p<0.001), and weakly correlated with SaO2 <90% of PRTS (r=0.394, p=0.012) and hsCRP (r=0.486, p=0.001). In multiple regression analyses, age and serum levels of YKL–40 and hsCRP were found to be independent predictors of CIMT.
Conclusion: In patients with OSAS, CIMT was increased. This increase was associated with serum YKL–40 level. Increased serum level of YKL–40 may be an early predictor of atherosclerosis development in patients with OSAS.

Objective: There are various studies showing the cardiovascular benefits of the Mediterranean diet (MD), but, to the best of our knowledge, this is the first study which aimed to investigate the relation between adherence to the MD and severity of coronary artery disease (CAD).
Methods: The study was a single centre, cross-sectional prospective study which included 200 consecutive patients (131 men [65.5%] and 69 women [34.5%], mean age 57±9) who were diagnosed with CAD by coronary angiography between January 2012 and April 2013. A food frequency questionnaire was administered to the patients. Compliance to the MD was evaluated by the MD score (MDS), which collects prominent diet characteristics under 10 main titles. Each patient’s angiographic data was examined by a cardiologist, and Gensini scores (GS) were then calculated to evaluate the extensiveness of coronary atherosclerosis.
Results: Forty-four percent of patients were in the third category of body mass index (BMI) (≥30 kg/m2) and 17.5% were in the first category (BMI <25 kg/m2). Education levels were markedly low, with 78% of the patients having fewer than six years in education. Most patients had low physical activity levels (55.5%). Frequency of metabolic syndrome was prominent (79%). The median (25–75 percentiles) of GS was found to be 21.25 (7–44.75) and the MD score was 4 (3–5). A negative correlation was found between compliance to the MD and GS (r=-0.380, p<0.001).
Conclusion: This study found that in patients with CAD, compliance with the traditional MD is related to decreased severity of coronary atherosclerosis.

Objective: In recent years, there has been an increase in clinical situations requiring extraction of leads of implanted cardiac devices. This study aimed to evaluate the Evolution® Mechanical Dilator Sheath system, presently in use in our clinic for lead extraction procedures.
Methods: Lead extraction procedures carried out on 20 pa-tients (14 men, 6 women; mean age 61±19; range 23 to 85 years) between 2008 and 2013 using the Evolution system were retrospectively evaluated. Procedural success, and ma¬jor and minor complications were determined according to previously published guidelines.
Results: Mean duration of the lead implantation was 97±65 months (8-204). Fifteen (75%) patients had undergone pace-maker implantation and 5 (25%) had been implanted with a defbrillator. A total of 35 leads were removed from the pa¬tients. Seventeen (49%) were ventricular and 12 (34%) were atrial leads. Five (14%) were defbrillator coils and one of them a coronary sinus lead. Indications for lead extraction were device infection in 18 (90%) and lead dysfunction in 2 (10%) patients. Complete procedural success was 95%. Failure occurred in 1 patient. The major complication rate was 5% and minor complications were seen in 25% of the patients. No case of procedure –related mortality was seen.
Conclusion: In this single centre study, it was shown that ex-traction of pacemaker and defbrillator leads of longer postimplantation duration may be successfully carried out using the Evolution system. However, due to potentially serious complications it is advised that extraction be done by an experienced operator in centres with cardiovascular surgery facilities.

Objective: Atrioventricular nodal reentrant tachycardia (AVNRT) attacks is one of the common arrhythmias adversely affecting quality of life. The Umea 22 (U22) is a questionnaire developed for the assessment of symptoms associated with supraventricular tachycardia (SVT), and it is found to be effective in evaluation of quality of life after radiofrequency ablation. Using this questionnaire, the study aimed to assess quality of life among Turkish patients with ANRT before and after the successful RFA.
Methods: The study was conducted between January 2011 and September 2013, and included 57 patients who had undergone RFA due to AVNRT. The U22 questionnaire was administered pre-procedure and at 6 months post-procedure. The participants were asked to report on their general wellbeing, arrhythmia effects on their wellbeing, and intensity of discomfort associated with episodes. They were asked to provide a score from 1 to 10 in order to determine to severity of discomfort, and the quantity of symptoms was then assessed according to the visual analogue scale (VAS).
Results: Patients’ general wellbeing (7.5±2.3 vs. 8.7±1.8, p<0.001), the effects of arrhythmia episodes on general wellbeing (8.1±1.7 vs. 1.0±2.1, p<0.001), frequency of symptoms (2.8±0.8 vs. 0.4±0.9, p<0.001) and duration of symptoms were reduced significantly after RFA. The rate of drug use among patients also decreased after RFA (70% vs. 23%, p=0.017).
Conclusion: Treatment success was high in patients undergoing RFA due to AVNRT according to the U22 quality of life questionnaire. General and arrhythmia-associated quality of life had improved significantly by the 6th month post-procedure.

Objective: Long-term exposure to physical, chemical, ergo-nomic and psychosocial environmental factors may lead to occupational cardiovascular diseases in metal sector wurkers. The objective of this study is to determine knowledge levels among metal sector workers regarding occupational and cardiovascular risk factors.
Methods: The study was conducted between 2nd and 6th June 2014 with the participation of 82 workers. All were working in a medium-sized workplace in the metal industry. Data were collected by means of a questionnaire, which included socio-demographic characteristics and occupational cardiovascular risk factors, and a scale developed by Arıkan et al. to measure knowledge levels of risk factors for cardiovascular diseases (CARRF-KL).
Results: The mean age of workers was 39.97±8.44. Of the participants, 58.5% stated that they had known cardiac disease risk factors. The mean CARRF-KL score was found to be 18.65±4.04. The percentage of workers stating that they had no knowledge on the occupational risks for such diseases was 79.3%, while 19.5% of them stated that job stress caused cardiac diseases. One individual (1.2%) stated that one of the chemi¬cal solvents used in the working environment was a risk factor.
Conclusion: Although knowledge level among metal industry em¬ployees regarding cardiovascular risk factors was above average, it was understood that they had not adequate informa¬tion on occupational risk factors. Prolonged exposure to environmental factors without taking necessary measures constitutes a risk for cardiovascular disease. The elaboration of this information is important with respect to preventive cardiology.

Summary: Presence of a persistent left superior vena cava (PLSVC) is generally clinically asymptomatic and discovered incidentally during central venous catheterization. However, PLSVC may cause technical difficulties during cardiac device implantation. An 82-year-old man with heart failure symptoms and an ejection fraction (EF) of 20% was scheduled for resynchronization therapy-defibrillator device (CRT-D) implantation. A PLSVC draining via a dilated coronary sinus into an enlarged right atrium was diagnosed. First, an active-fixation right ventricular lead was inserted into the right atrium through the PLSVC. The stylet was preshaped to facilitate its passage to the right ventricular apex. An atrial lead was positioned on the right atrium free wall, and an overthe- wire coronary sinus lead deployed to a stable position. CRT-D implantation procedure was successfully completed.

Primary cardiac sarcoma is an uncommon entity and is related with poor long-term survival. Presented here is an unusual case of right atrial leiomyosarcoma which almost completely occluded both the right atrium and ventricle and destroyed the tricuspid valve. Multimodality imaging was used to characterize the mass and guide surgical management. A combination of two radical surgical excisions and both radiation and chemotherapy resulted in a better longterm outcome. The patient was one of the longest survivors

Coronary artery steal syndromes may occur following coronary artery bypass grafting as a result of the presence of large side-branches arising from the internal mammary artery (IMA). Coil embolization, Amplatzer Vascular Plug and graft stents are all used for the treatment of such syndromes. The literature contains limited data on the long-term success of these treatment methods. There is no large series regarding occluded IMA side branches causing coronary steal phenomena, and data on long-term followup of this treatment method is also very limited. This report presented two cases and their treatment, and reviewed the advantages and disadvantages of treatment methods and the factors that affect successful treatment

A 58-year-old man whose right superficial femoral artery had been stented 2 weeks previously presented at the emergency service complaining of right leg pain of 2 days’ duration. Angiography revealed a radiopaque foreign body distal to the stent. It was removed with a snare. Due to sudden disappearance of the popliteal artery pulse seventytwo hours after the procedure, an urgent control angiogram was performed, which showed a large thrombus occluding the superficial femoral artery. Surgery revealed a second larger radiolucent foreign body causing the thrombus. This was recognized as the distal tip and shaft of the peripheral self-expandable stent catheter used in the initial procedure. This report discusses preventive measures to be taken against this complication.

Haemophilia is a congenital coagulation defect brought about by the deficiency or lack of coagulation factor IX. The prevalence of coronary artery disease and acute coronary syndrome (ACS) is lower among haemophiliacs than in the normal population. However, with the administration of factor concentrate, average life expectancy can now extend to as long as 70 years in patients with haemophilia, and this in turn is leading to an increase in the prevalence of cardiac diseases among this population. Data regarding a treatment protocol for ACS and percutaneous coronary intervention (PCI) in patients with congenital coagulation defects is limited. We report a 41-year-old male patient with haemophilia B who presented with a non-ST elevation myocardial infarction, and on whom PCI was performed following monitoring of factor IX levels. The patient had no cardiovascular risk factor except smoking.

The complication rate of radiofrequency catheter ablation varies depending on patient characteristics and treatment, and has been reported to be approximately 3%. Esophageal irritation is one significant complication of catheter ablation, and its most common result is atrioesophageal fistulae. However, rarely, unexpected complications and clinical variants occur due to irritation of the vagal nerve or peri-esophageal tissue without fistula formation. In this case report, attention is drawn to this rare complication in two cases, one of which occurred after paraseptal-epicardial accessory pathway ablation, and the other after atrial fibrillation ablation. Both were symptomatic with severe gag reflex

Cardiac sarcoidosis is an underdiagnosed condition that may be present in as many as 25% of patients with systemic sarcoidosis. It is associated with significant morbidity and mortality in affected individuals. The presentation of cardiac involvement in sarcoidosis includes sudden death in the absence of preceding symptoms, conduction disturbances, ventricular arrhythmias, and heart failure. A scarcity of randomized data and a lack of prospective trials underlies the contention between experts on the most appropriate strategies for diagnosis and therapy. This review focuses on the electrophysiological sequelae of the disease, with an emphasis on current diagnostic guidelines, multimodality imaging for early detection, and the role of various therapeutic interventions. Multicentre collaboration is necessary to address the numerous unanswered questions pertaining to management of this disease.

Hypertension is a common and important public health problem in Turkey and worldwide. Recommendations on the diagnosis and treatment of hypertension have been presented in many nationally and internationally agreed European and American guidelines. However, there are differences among these guidelines, and some of the recommendations are not consistent with clinical practice in our country. Consensus report preparation, with the participation of relevant associations, was considered necessary to merge recommendations by evaluating hypertension guidelines from the perspective of Turkey and to create a joint approach in the diagnosis and treatment of hypertension in adults. For this purpose, it was aimed to prepare a practical text in Turkey in which all physicians dealing with hypertensive patients, from family practitioners in primary care to specialists in tertiary care, could come to agreement on common concepts, and which would be used as a basic reference guideline. Considering health care practices and sociocultural structure in Turkey, this report aimed to enhance awareness on hypertension, provide a common basis for different definitions and values as well as therapeutic options in various guidelines, and establish a practical reference guide to improve clinical practices in Turkey. This report is not a document describing hypertension in every aspect, but a reference, including basic recommendations with outlines. Care was taken to ensure that recommendations were evidencebased and valid for a majority of patients in clinical practice. However, it should be kept in mind that an approach assessment should be made on an individual basis for each patient.