Objective: Arterial stiffness parameters including pulse wave velocity (PWV) and augmentation index (AIx) are associated with increased risk of cardiovascular disease. A close relationship has been demonstrated between vitamin D deficiency and cardiovascular disease. The aim of the present study was to investigate effects of vitamin D deficiency and supplementation on arterial stiffness parameters in patients with normal cardiac functions.
Methods: Study population consisted of 45 patients with vitamin D deficiency and normal cardiac functions. Median age (interquartile range) was 45.0 (12.00) years, and 33 patients were female. Patients were treated with oral administration of vitamin D3. Arterial stiffness parameters were evaluated using Mobil-O-Graph arteriograph system, which detected signals from the brachial artery before and after treatment.
Results: Vitamin D levels significantly increased after treatment (9.0 [6.00] nmol/L vs 29.0 [11.50] nmol/L, p<0.001). No significant difference was observed among conventional echocardiographic parameters before or after treatment. Post-treatment PVW and AIx were significantly lower than baseline measurements (6.8 [1.55] m/s vs 6.4 [1.30] m/s, p<0.001 and 23.0 [22.00]% vs 31.0 [14.50]%, p<0.001, respectively). Baseline vitamin D levels significantly correlated with PWV (r=-0.352, p=0.018). Posttreatment vitamin D levels also significantly correlated with posttreatment PWV (r=-0.442, p=0.002) and AIx (r=-0.419, p=0.004). Multivariate linear regression analysis revealed no independent predictor of baseline log-transformed PWV.
Conclusion: Vitamin D supplementation has beneficial effects on arterial stiffness. Arterial stiffness parameters may aid in the assessment of cardiovascular risk in patients with vitamin D deficiency.

Objective: In this study, the associations between pulmonary artery stiffness (PAS) and aortic stiffness, left ventricular diastolic parameters, and left ventricular mass (LVM) index in moderate to severe obstructive sleep apnea syndrome (OSAS) patients without coexisting disorders were investigated.
Methods: A total of 66 non-diabetic, non-hypertensive, and non-smoking volunteers were enrolled. Participants were categorized by apnea-hypopnea index (AHI; event/hour). The control group was defined as no OSAS: AHI<5 (n=35), and OSAS group had moderate to severe OSAS: AHI>15 (n=31). Echocardiographic and biochemical tests, including measurement of C-reactive protein (CRP), were performed. PAS (kHz/s) was calculated by dividing the maximal frequency shift of the pulmonary flow by the acceleration time.
Results: PAS (kHz/s), obtained by echocardiography, was statistically significantly higher in the OSAS group than the control group (28±5 vs 18±4, p<0.001), and was positively correlated with AHI, CRP, aortic stiffness index, E/E’, and LVM index (p=0.034, p=0.039, p<0.001, p=0.040, and p<0.001, respectively), and negatively correlated with aortic strain (AS), aortic distensibility (AD), E/A, E’/A’, and E’ (p<0.001). Regression analyses indicated that CRP and PAS are independent predictors of aortic stiffness (p<0.05). E/A and LVM index were independent predictors of PAS (p=0.002 and p=0.001, respectively).
Conclusion: Increased PAS is associated with aortic stiffness, left ventricular diastolic function, and increased LVM index. PAS may be a more effective indicator of aortic stiffness in OSAS patients than CRP.

Objective: Pre- and postoperative changes in echocardiographic parameters and results of 6-minute walking test (6-MWT) were investigated in the present study.
Methods: Seventy-six patients (32 males, 44 females; mean age 45.9±15.1 years) were included. Before and after surgery, 6-MWT and echocardiography were performed. Changes in postoperative parameters were compared to basal walking test and other basal parameters.
Results: Distance covered in 6-MWT significantly increased after surgery (p<0.001). Significant decrease in right ventricular diameter and pressure, and significant increase in left ventricular diameter were also observed. While changes in ejection fraction (EF) were not significant, significant reduction in systolic pulmonary artery pressure (sPAP) and tricuspid regurgitation were observed. No statistically significant correlation was observed between baseline 6-MWT results and echocardiographic parameters.
Conclusion: The present study was the first to investigate the correlation between baseline 6-MWT results and right ventricular echocardiographic parameters. Myocardial performance index (MPI) and TAPSE were important parameters in followup after pulmonary endarterectomy. Improvement in quality of life parameters was also important.

Objective: The present study compared heart rate variability (HRV) parameters in patients with coronary artery ectasia (CAE) and coronary artery disease (CAD).
Methods: The study population consisted of 60 consecutive patients with CAE (14 women; mean age 51.63±7.44 years), 60 consecutive patients with CA (15 women; mean age 53.67±9.31 years), and 59 healthy individuals (13 women; mean age 52.85±8.19 years). Electrocardiograms, 24-hour Holter analyses, and routine biochemical tests were performed, and clinical characteristics were evaluated. Coronary angiography images were analyzed. Time-domain HRV parameters, including the standard deviation (SD) of normal-to-normal intervals (SDNN) and the root mean square of difference in successive normal-tonormal intervals (RMSSD) were evaluated, as were frequencydomain HRV parameters including low-frequency (LF), very lowfrequency (VLF), high-frequency (HF), the proportion derived by dividing low- and high-frequency (LF/HF), and total power (TP).
Results: SDNN was lower in both the CAE and CAD groups, compared to the healthy group (140.85±44.21, 96.51±31.28, and 181.05±48.67, respectively). A significant difference in RMSSD values among the groups was determined (p=0.004). Significantly decreased VLF and HF values were found in the CAE group, compared with the healthy group (VLF p<0.001; HF, p=0.007). TP, VLF, and HF values were significantly lower (p<0.001, p<0.001, and p<0.001, respectively), but LF and LF/ HF values were significantly higher (p<0.001 for both) in the CAD group than in the healthy group. TP values were significantly higher (p<0.001), and LF and LF/HF values were lower in the CAE group, compared with the CAD group (p<0.001 for both).
Conclusion: A decrease in vagal modulation or an increase in sympathetic activity of cardiac function, assessed by HRV analysis, is worse in patients with CAD than in patients with CAE.

Objective: Levoatriocardinal vein (LACV) is a rare cardiac pathology that represents a connection between the pulmonary venous and cardinal systems. The aim of the present study was to discuss morphological and clinical characteristics, as well as diagnostic methods, of experience with LACV.
Methods: Records of 11 patients (4 male, 7 female; mean age 79±1.83 days; range 1-390 days) diagnosed with LACV between 2010 and 2014 were retrospectively reviewed. Presence of LACV was confirmed with echocardiography. The primary obstructive lesion associated with cardiac defects and the integrity of the interatrial septum was identified in each patient with left-sided obstruction.
Results: Mean weight was 4.4±0.4 kg (range: 2–8). Age at presentation was under 1 year in 82% of patients. Nine patients had left-sided obstruction, and 2 had normal intracardiac anatomy and pulmonary venous return. In patients with left-sided obstruction, LACV was initially demonstrated with echocardiographic evaluation, performed in apical 4-chamber, high parasternal, and subcostal views. Atrial septum was restrictive or intact in patients with left-sided obstructions. LACV originated directly from the left atrium in all patients.
Conclusion: Levoatriocardinal vein is an extremely rare cardiac pathology, presenting almost exclusively in patients with left-sided obstructive lesions. In patients with left-sided obstructions, LACV must be kept in mind. It may also present in patients with normal intracardiac anatomy and pulmonary venous return.

Objective: The aim of the present assessment was to identify “genuine” medical papers generated by Turkey’s institutions that have contributed most to cardiovascular medicine.
Methods: Based on Web of Science data, 160 papers were identified as having received 40 or more citations as of late July 2015. Papers with more than minor contribution from international authors were excluded.
Results: A total of 127 primary authors generated 160 papers, each receiving ≥40 (95% confidence interval 40–165) citations. These papers corresponded in quality to the global top 15% and were estimated to represent a global share of 3 per mille. Half were published between 2001 and 2006, with a median exposure period of 10.4 years. An estimated 9 of these papers have been produced in Turkey annually since around the turn of the century. Cardiology generated 120 articles, cardiovascular surgery 35, and pediatric cardiology 6. These papers originated from only 28 medical faculties, Gülhane Military Medical Academy (GATA), and 9 hospitals that are not academically affiliated. A majority of related Turkish institutions have shown disappointing performance.
Conclusion: The present assessment demonstrates that the unsatisfactory performance of Turkey’s contribution to cardiovascular medicine has further regressed, if slightly, particularly since 2006. Unless a wide-scale concerted effort is made to build an environment focused on research with a potential to contribute, Turkey’s gap in the field is likely to widen.

Summary– Cardiac valve injury, a condition that can follow blunt thoracic trauma, has a wide range of clinical presentations, depending on the structures involved. Post-traumatic tricuspid regurgitation is relatively rare, caused by increase in intrathoracic pressure when the tricuspid valve leaflets close, leading to rupture of the chordae tendineae. A case of severe tricuspid regurgitation due to chordal rupture presenting with atrial flutter following a motorbike accident is described in the present report.

Summary– Aortopulmonary window is a rare anomaly, a communication between the ascending aorta and the main pulmonary artery. Prognosis in the absence of correction is poor, with mortality of around 40% in the first year of life. A case of aortopulmonary window without pulmonary vascular disease in adulthood is described in the present report.

Summary– Anticoagulation with warfarin is the main treatment of intracardiac thrombus. While novel oral anticoagulants (NOACs) have been approved by the US Food and Drug Administration (FDA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF), they are not indicated for resolution of intracardiac thrombus. The case of a 60-year-old woman with left ventricular (LV) thrombus secondary to hypertrophic cardiomyopathy and AF is described in the present report. Indications for oral anticoagulation were AF and LV thrombus. Thrombus was dissolved after 1 month of apixaban treatment. To the best of our knowledge, this is the first report that describes the resolution of LV thrombus with apixaban treatment in a patient with hypertrophic cardiomyopathy.

Single ventricle is a rare congenital heart dis-ease, typically diagnosed with dyspnea and cyanosis. The number of patients who reach adulthood without having un-dergone surgical treatment is limited due to poor prognosis. While some reports in the literature, describe patients who have reached the 2nd and 3rd decades of life, it is very interesting that the case of the patient who has lived the longest with unoperated single ventricle is reported in Turkey.

Summary– Dedicator of cytokinesis 8 protein (DOCK8) deficiency is an autosomal recessive, inherited form of hyper-immunoglobulin E (hyper-IgE) syndrome, characterized by persistent cutaneous viral infections, elevated IgE, eosinophilia, and allergic manifestations. The case of a 10-year-old boy who presented with giant aortic aneurysm between the aortic root and iliac bifurcation is described in the present report. Aortic aneurysm of this size has not yet been reported.

Summary– While trisomy 21 is a common genetic disorder in singletons, the incidence among identical twins is very rare, occurring in approximately 1–2 per 1000 twin gestations. Trisomy 21 is associated with high incidence of congenital heart defects, and commonly occurs with ventricular septal defects (VSDs). Physiologic burden of VSDs depends on prevalence of anatomic and other circulatory factors. A case of identical twins with trisomy 21 and large VSDs is described in the present report. Though genetically identical, phenotypes varied significantly. One twin was managed medically, while the other developed more significant heart failure, requiring operative repair.

We read the article ” Epicardial fat thickness as associated with left ventricular myocardial performance in patients with newly diagnosed hypertension” by Börekçi et al.(1) The authors aimed to investigate the relationship between epicardial fat thickness(EFT) and tissue Doppler myocardial performance index (TD-MPI), which incorporates both systolic and diastolic left ventricular (LV) function, in newly diagnosed hypertension (HT) patients.They concluded that TD-MPI was independently associated with EFT in patients with newly diagnosed HT. EFT may be used as a predictor of impaired LV global functions in patients with normal left ventricular ejection fraction (LVEF) and newly diagnosed HT. Thanks to the authors for their good contribution of the present study, which is successfully designed and well-documented.

Objective: Epicardial fat thickness (EFth) is associated with both left ventricular hypertrophy (LVH) and diastolic dysfunction. However, the effect of EFth on myocardial performance is not known. The aim of this study was to investigate the relationship between EFth and tissue Doppler myocardial per- formance index (TD-MPI), which incorporates both systolic and diastolic left ventricular (LV) function, in newly diagnosed hypertension (HT) patients.
Methods: A total of 314 consecutive, newly diagnosed HT patients were prospectively included (mean age: 51.9±1.7 years). EFth was measured perpendicularly on the free wall of the right ventricle at the end of the systole in 2 echocardiographic views (parasternal short and long axis). Myocardial performance index (MPI) was calculated using tissue Doppler (TD) echocar- diography. Patients were divided into 2 groups according to median TD-MPI levels (TD-MPIlow and TD-MPIhigh). Results: EFth values of the TD-MPIhigh group were higher than those of the TD-MPIlow group (p<0.05). Patients in the TD-MPIhigh group also had higher age, body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), left ventricular mass index (LVMI), E/A ratio, and aortic dis- tensibility, compared with the TD-MPIlow group (p<0.05 for all). Multivariate linear regression analysis showed that TD-MPI was independently associated with age (β=0.089, p=0.012), LVMI (β=0.090, p=0.05), E/A (β=-0.118, p=0.005), and EFth (β=0.432, p<0.001). Conclusion: TD-MPI was independently associated with EFth in patients with newly diagnosed HT. EFth may be used as a predictor of impaired LV global functions in patients with normal left ventricular ejection fraction (LVEF) and newly diagnosed HT.