Objective: Therapeutic hypothermia improves neurologic prognosis after cardiac arrest. The aim of this study was to report clinical experience with intravascular method of cooling in patients with cardiac arrest resulting from ST-segment elevation myocardial infarction (STEMI).
Methods: Thirteen patients (11 male, 2 famele; mean age was 39.6±9.4 years) who had undergone mild therapeutic hypothermia (MTH) by intravascular cooling after cardiac arrest due to STEMI were included. Clinical, demographic, and procedural data were analyzed. Neurologic outcome was assessed by Cerebral Performance Category (CPC) score.
Results: Anterior STEMI was observed in 9 patients. One patient died of cardiogenic shock complicating STEMI. Mean cardiopulmonary resuscitation (CPR) duration and door-toinvasive cooling were 32.9±20.1 and 286.1±182.3 minutes, respectively. Precooling Glasgow Coma Scale score was 3 in 9 subjects. Twelve patients were discharged, 11 with CPC scores of 1 at 1-year follow-up. No major complication related to procedure was observed.
Conclusion: In comatose survivors of STEMI, therapeutic hypothermia by intravascular method is a feasible and safe treatment modality.

Objective: Prosthetic valve endocarditis (PVE) is associated with increased mortality and morbidity. Information regarding the long-term outcome of PVE is scarce in Turkey. The aim of this study was to evaluate long-term mortality rates of PVE and identify predictors of mortality in these patients.
Methods: From January 2008 through August 2013, 44 patients (25 male, 19 female; mean age 49.3±12.1 years) who received a definitive diagnosis of PVE enrolled in the study. Median follow-up period was 23 months. Survival status was assessed for each patient by reviewing charts and making contact by phone. Cox regression analysis was used to evaluate outcome predictors.
Results: The mitral valve was the most commonly affected valve and Staphylococcus aureus the most prevalent microorganism. Fourteen patients (32%) underwent surgery, 7 of whom underwent early surgery. Overall mortality and in-hospital mortality rates were 39% (n=17) and 25% (n=11), respectively. In multivariate analysis, NYHA classification >2 (hazard ratio [HR] 3.7; 95% confidence interval [CI], 1.16–11.8; p=0.03), early-onset PVE (HR 4.23; 95% CI, 1.1–16.42; p=0.04), vegetation size ≥10 mm (HR 3.94; 95% CI, 1.1–14.75; p=0.04), and heart failure (HR 4.18; 95% CI, 1.36–12.8; p=0.01) were found to be independent predictors of mortality.
Conclusion: Our findings suggest that PVE is associated with increased long-term mortality rates. Poor functional status, early-onset PVE, heart failure, and vegetation size are independent predictors of survival in patients with PVE.

Objective: Ascending aortic aneurysms (AAA) are a leading cause of morbidity and mortality. Nevertheless, their effects on global cardiac functions are yet to be fully understood. Myocardial performance index (MPI) has been widely used to quantitatively assess myocardial functions. The aim of this study was to evaluate left ventricular (LV) functions in patients with AAA using tissue Doppler (TD) echocardiography and MPI in addition to conventional echocardiographic methods.
Methods: Fifty patients with AAA (33 men, 17 woman; mean age 55.5±7.90 years) were included, and 106 patients without aortic dilatation (mean age 54.1±8.18 years) were included as the control group. LV systolic and diastolic functions were analyzed using 2-dimensional, M-mode, and TD echocardiography.
Results: Patients with AAA had significantly higher MPI (0.5±0.04 vs 0.4±0.05, p<0.001), TD-MPI (0.5±0.02 vs 0.4±0.03, p<0.001), and reduced aortic elasticity, as indicated by reduced aortic distensibility (AD) (1.7±1.27 vs 3.1±1.25, p<0.001). Multivariate linear regression analysis showed that TD-MPI was independently correlated with reduced aortic distensibility (B=-0.006, p=0.019, 95% confidence interval,-0.011 to -0.001).
Conclusion: MPI and TD-MPI indicated impairment of global cardiac functions in patients with AAA, which may be attributed to reduced aortic elasticity.

Objective: Chronic kidney disease (CKD) is considered to be one of the most common risk factors for cardiovascular diseases. Glomerular filtration rate (GFR) is the best method of testing level of kidney function and determining stage of kidney disease. The aim of this study was to examine the impact of renal function on severity of coronary heart disease (CHD).
Methods: The present study included 918 patients undergoing elective coronary angiography. GFR was evaluated by simplified Modification of Diet in Renal Disease (MDRD) formula (mL/min/1.73 m2). The extent and severity of CHD were evaluated according to SYNTAX score.
Results: According to SYNTAX score, 416 patients had normal coronary arteries or nonsignificant CHD (control group), 267 had mild CHD (SYNTAX score: 1–22), 129 had moderate CHD (SYNTAX score: 23–32), and 106 had severe CHD (SYNTAX score: ≥33). Estimated GFR values (median [25th– 75th percentiles]) were 99.00 (83.00–116.00) in the control group, 85.00 (73.00–101.00) in the mild CHD group, 87.00 (73.25–101.75) in the moderate CHD group, and 81.00 (65.00–101.00) in the severe CHD group. According to Spearman’s rank correlation analysis, a negative correlation found between MDRD and SYNTAX score was statistically significant (p<0.001, r=-0.268).
Conclusion: Renal function is an important predictor of presence and severity of angiographic CHD in patients without severe renal impairment. Negative correlation between MDRD and SYNTAX score was determined. This simple biochemical test can be used in determining risk of cardiovascular disease aside from other risk factors during routine clinical practice.

Objective: Thyroid disease is a common endocrine disease with important effects on the cardiovascular system. As an adaptive response to myocardial ischemia, coronary collateral circulation (CCC) plays an important role in obstructive coronary artery disease (CAD). The association between serum thyroid hormone levels and development of CCC was investigated in the present study.
Methods: In total, 430 consecutive patients who underwent coronary angiography procedure and had documented total occlusion in at least 1 major coronary artery were investigated retrospectively. Degree of CCC was classified according to Cohen-Rentrop method. Serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were assessed by the chemiluminescence immunoassay technique.
Results: In spite of diabetes mellitus (p=0.019), smoking (p<0.001), and TSH (p<0.001), FT3 (p<0.001), FT4 (p=0.015), and subclinical hypothyroidism (SCH) (p<0.001) ratios were significantly different between groups. In regression analysis, SCH (p=0.024), DM (p=0.021), smoking (p<0.001), and heart failure (p=0.029) were independent predictors of poor CCC development in multivariate model 1. When regression analyses were performed based on multivariate model 2, TSH (p<0.001), FT3 (p<0.001), heart failure (p=0.022), smoking (p<0.001), and hyperlipidemia (HPL) (p=0.046) were independent predictors of poor CCC development.
Conclusion: In addition to traditional risk factors, SCH, higher serum TSH, and lower FT3 levels were associated with development of poor CCC in patients with obstructive CAD.

Objective: The present study was designed to evaluate clinical practice of cardiovascular (CV) risk management and the influence of follow-up on risk profile among hypertensive patients.
Methods: Of the 1023 patients enrolled in the cross-sectional phase, data from 397 high-risk patients (mean [SD] age, 59.2 [11.5] years; 62.5% female) who had attended at least 1 follow- up visit within 9 months of (longitudinal phase) enrollment were included in the present non-interventional study of CV risk factors, 10-year coronary heart disease (CHD) risk estimate, risk level, and risk management.
Results: Ten-year CHD risk (p<0.001), and percentages of patients with high risk (20.7 vs 13.4%) and very high risk (19.6 vs 6.6%) significantly decreased upon follow-up (p<0.001). Significant reductions in systolic and diastolic blood pressure (BP), and low-density lipoprotein (LDL) cholesterol (p<0.001 for each), and an increase in high-density lipoprotein (HDL) cholesterol (p=0.007) were associated with a positive shift in risk grouping (42.8%). The shift toward lower-risk grouping was more prominent in patients with diabetes (5.5% vs 41.1%) and metabolic syndrome (19.2% vs 34.2%; p<0.001 for each). Achievement of target BP significantly improved upon follow-up, particularly in lower-risk groups (p<0.001).
Conclusion: Results indicate better CV risk management in hypertensive patients, with a pronounced decrease in 10- year CV risk estimate and a switch to lower-risk grouping, particularly in patients with diabetes mellitus and metabolic syndrome, associated with close follow-up.

Cor triatriatum sinister is a rare congenital cardiac pathology, representing only 0.1% of congenital cardiac anomalies, and often associated with other cardiac defects. In classic cor triatriatum sinister, the pulmonary venous chamber receives all pulmonary veins and drains into the left atrium through a variable-sized orifice. The case of a 4-month-old male patient who had subtotal cor triatriatum sinister associated with right and left upper anomalous pulmonary venous return is presented.

Echocardiography revealed systemic artery to pulmonary venous fistula, a rare vascular anomaly, in a 20-month-old girl, and multislice computed tomography angiography (CTA) was performed to rule out congenital heart disease. Normal bronchial connection and pulmonary vasculature were observed in the lung. The fistula drained through the left inferior pulmonary vein to the left atrium leading to a left-to-left shunt. Percutaneous intervention was performed in 2 stages using Amplatzer vascular plugs to close successfully.

Transcatheter aortic-valve implantation (TAVI) is a reliable alternative to surgical aortic-valve replacement in inoperable or high-risk patients. However, this evolving therapy is associated with a wide range of potential complications— some specific to TAVI, some often fatal. Prevention, early recognition, and taking essential precautions will significantly improve results. The case of an 85-year-old woman with balloon rupture during valvuloplasty in TAVI, a very rare and potentially fatal complication, is presented.

A 56-year-old female patient hospitalized with diagnosis of acute coronary syndrome underwent early coronary intervention. Anticoagulant and antithrombotic treatment was administered, including acetylsalicylic acid, clopidogrel, and heparin in periprocedural period. Severe back pain and rapidly progressing paraplegia developed in early period of follow-up. The patient underwent surgery immediately after diagnosis of spontaneous spinal epidural hematoma (SSEH) causing pressure, and decompression was performed. The patient rapidly improved without recurrence through early diagnosis and early surgical intervention. A common problem encountered by interventional cardiologists is back pain in patients who have undergone interventions in the femoral region and have lain in the same position for an extended period. Clinical onset of SSEH includes similar complaints, a fact of which cardiologists should be aware. Early diagnosis and early intervention may provide a good outcome, as is reported in the present case.

Takotsubo cardiomyopathy (TCM) is an unusual form of acute cardiomyopathy showing left ventricular apical ballooning. Patients with hypotension should undergo urgent echocardiography to determine if left ventricular outflow tract (LVOT) obstruction is present. This complication has been described in 10–25% of all TCM patients. That some patients do not survive an acute TCM event underscores the importance of prompt recognition and targeted management of dynamic LVOT obstruction. Described in the present report is the case of a TCM patient with cardiogenic shock, the hemodynamics of which worsened after inotropic agents were administered, alleviated after serum fluid and beta-blocker treatment.

A case of long-standing persistent atrial fibrillation (LPAF) that underwent hybrid treatment combining transvenous cryothermal and radiofrequency (RF) energy is described in the present report. Complex fractionated atrial electrogram (CFAE) maps before and after cryoablation revealed not only pulmonary vein isolation (PVI), but also a large antral ablation of CFAEs. Following cryoablation, a severe reduction in remote left atrial CFAE area was observed.

Heart failure is a progressive disease. A considerable number of patients eventually reach an advanced or terminal phase, in spite of developments in diagnostic procedure, alternative treatments that can slow progression, management, and follow-up. In addition to palliative care of patients in the terminal phase, accurate recognition of advanced disease is vital in the determination of therapeutic options. Overall management of patients with heart failure requires the collaboration of professionals from multiple disciplines. Still, patients with advanced heart failure should be managed by a “heart team,” as indicated by guidelines; communication and collaboration among cardiologists, cardiovascular surgeons, and other medical staff responsible for patient care is necessary. While our country has physicians experienced in the management of patients with advanced heart failure, these professionals are not distributed evenly across the country, and equitable access to therapeutic options is not provided. Hence, progress has yet to be made regarding appropriate referrals and patient circulation. The aims of the present consensus report are to strengthen the connection between certified, experienced centers and those that care for patients irrespective of disease phase and healthcare staff, as well as to raise awareness and provide information regarding conditions in Turkey.

red cell distribution width and contrast-induced nephropathy in patients underwent primary percutaneous coronary intervention
red cell distribution width and contrast-induced nephropathy in patients underwent primary percutaneous coronary intervention
red cell distribution width and contrast-induced nephropathy in patients underwent primary percutaneous coronary intervention

red cell distribution width and contrast-induced nephropathy in patients underwent primary percutaneous coronary intervention

The abstract of the article is in the Full Text

The abstract of the article is in the Full Text