After effective antiretroviral therapy, the survival of patients infected with HIV has increased substantially. Currently, cardiovascular disease (CVD) is an important cause of death among HIV infected patients in developed countries. Even in the setting of viral suppression, HIV infected patients without major CVD risk factors had 1,5-2 fold greater risk of MI. The pathophysiology of CVD in HIV infected patients is complex and involves a combination of HIV infection itself, antiretroviral drug effects and traditional risk factors. HIV-infected patients are more likely to have high-risk plaques. The tools used for assessing risk of CVD in the general population have not been validated for HIV infected patients and generally underestimate the severity of disease in HIV+ patient. Statins have wide immunomodulatory effects, and their use in the HIV-infected population may be of particular benefit. When selecting a statin to reach target LDL-C levels, potential drug interactions with antiretroviral drugs must be considered. Ongoing studies is expected to define optimal approaches to statin treatment in this population. Strategies to prevent CVD in HIV-infected individuals needs for a multidisciplinary approach.

Objective: Ceramide, the backbone of sphingolipids, is the key component affecting atherosclerotic changes through its important second-messenger role. Previous studies have demonstrated protective role of AMP-activated protein kinase (AMPK) genes in regulating atherosclerosis and hypertension. Ceramide synthase 5 (LASS5 or CERS5) gene has function in de novo synthesis of ceramide, and has indirect effect on AMPK gene. Aim of the present study was to identify role of LASS5 gene in atherosclerosis.
Methods: LASS5 gene-specific small interfering RNA (siRNA)-mediated gene silencing was performed in human umbilical vein endothelial cells (HUVEC) and differential expression of LASS5, AMPK-alpha and AMPK-alpha target genes were analyzed. HUVEC cells were then treated with AMPK activator in order to examine relationship of change in gene expression levels to AMPK activity.
Results: Novel physiological function of LASS5 was identified. Downregulation of LASS5 was found to attenuate ceramide production and increase expression of some AMPK target genes in HUVEC.
Conclusion: This is the first study to demonstrate that LASS5 was involved in negative regulation of atherosclerosis-related genes, such as AMPK-alpha. These preliminary findings provide insight into molecular mechanism of atherosclerosis and are important for development of potential therapeutic agents in the treatment of atherosclerosis.

Objective: Aim of the present study was to determine effects of high-dose versus low-dose intravenous (IV) bolus tirofiban on angiographic measures, ST resolution, enzymatic infarct size, and clinical outcomes in patients with acute coronary syndrome (ACS) who were undergoing percutaneous coronary intervention (PCI) and received current pharmacoinvasive therapy.
Methods: Acute coronary syndrome patients (n=271, 85.6% male; mean age: 57.9±12.6 years) from between 2009 and 2015 who received IV tirofiban therapy following PCI were retrospectively analyzed. All patients had received maintenance tirofiban infusion (0.15 μg/kg/min) after bolus dose and 600 mg clopidogrel. Percentage of patients undergoing drug eluting stent implantation procedure was 33.5%. Tirofiban was administered to all patients in bailout situation or for thrombotic complication after PCI.

Results: High-dose IV bolus group (25 μg/kg; n=140) was associated with greater ST segment resolution (66% vs. 50%, p=0.013) and reduced peak troponin release [12.4 ng/dL (range: 6.5–21.5 ng/dL) vs. 16.4 ng/dL (range: 10.1–27.4 ng/dL), p=0.001] compared with low-dose bolus group (10 μg/kg, n=131). Cardiovascular event rates were similar between groups at in-hospital, 1-month, and 6-month follow-up (p=1.000, 1.000, and 0.287, respectively). Percentage of patients with post-procedural Thrombolysis in Myocardial Infarction (TIMI) grade III flow, major, and minor bleeding were similar (p=0.085, 1.000, and 0.965, respectively).

Conclusion: Use of high-dose IV bolus tirofiban in addition to aspirin and high-dose clopidogrel improves ST segment resolution, reduces infarct size, and does not increase bleeding events in patients with ACS undergoing PCI compared with low-dose bolus. Angiographic measures and clinical endpoints were similar between groups.

Objective: Data from EUROASPIRE-IV Turkey report investigating risk factors and adherence to guidelines in patients hospitalized for coronary artery disease are presented and results are compared with those of EUROASPIRE-III Turkey and EUROASPIRE-IV Europe.
Methods: Study was performed in 24 European countries, including Turkey (17centers).Patients (18–80years old)hospitalized for coronary (index)event during preceding 3 years were identified from hospital records and interviewed ≥6 months later. Patient information regarding index event was acquired from hospital records. Anamnesis was obtained during the interview, and physical examination and laboratory analyses were performed. Results: Median age at the index coronary event was 58.8 years, and it was significantly decreased compared with last EUROASPIRE-III study (60.5 years),which was conducted at the same centers 6 years earlier (p=0.017). Of all patients, 19.3% were under 50 years of age and mean age was lower than that of EUROASPIRE-IV Europe (62.5years).Comparing EUROASPIRE-IV Turkey with EUROASPIRE-IIITurkey, rate of smokers increased to 25.5% from 23.1% (p=0.499), obesity increased to 40.7% from 35.5% (p=0.211), total cholesterol level increased to 49.6% from 48.3% (p=0.767),and diabetes rate increased to 39.7% from 33.6% (p=0.139), however none of the differences reached a level of statistical significance.Only 11.7%of the smokers quit after coronary event. Rates for these factors were lower in EUROASPIRE-IVEurope (16%for smoking, 37.6%for obesity, and 26.8%for diabetes). Conclusion: EUROASPIRE-IVTurkey data revealed that secondary prevention was unsatisfactory and had progressed unfavorably compared with last EUROASPIRE study, some risk factors were more uncontrolled than overall European average, and coronary artery events at young age remain an important problem.

Objective: Dyslipidemia is a major complication of antiretroviral treatment. Aim of the present study was to screen baseline lipid levels and cardiovascular disease risk in HIV-positive patients and analyze change in those parameters after initiation of antiretroviral treatment (ART).
Methods: HIV-positive patients who presented at our clinic between April 2011 and August 2012 were included. Study included 19 female (22.1%) and 67 male (77.9%) patients (mean age 39.5±10.3 years). Blood pressure, smoking habit, alcohol consumption, serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), glucose level, and antiretroviral treatment status data were reviewed retrospectively. Changes in lipid profile and lifetime risk for atherosclerotic cardiovascular disease (ASCVD) according to the American College of Cardiology guidelines were compared with baseline data and analyzed.
Results: At baseline, 13 (15.1%) patients were already receiving ART and 73 (84.9%) patients were treatment-naive or had stopped therapy ≥3 months prior to enrollment. At last visit, 73 (84.9%) patients were taking ART. Results of baseline and final visit TC levels were 175.5 mg/dL (range: 90–346 mg/dL) and 196.5 mg/dL (range: 104–317 mg/dL), respectively (p=0.001). HDL levels were 40 mg/dL (range: 21–81 mg/dL) and 35 mg/dL (range: 10–75 mg/dL; p=0.001), and LDL levels were 101.5 mg/dL (range: 32–191 mg/dL) and 120.5 mg/dL (range: 32–250 mg/dL; p<0.001). TG levels were 145.5 mg/dL (range: 43–2580 mg/dL and 152.5 mg/dL (range: 67–884 mg/dL; p=0.102). Baseline ASCVD risk score was 46% (range: 5–69%) while last visit ASCVD risk score was 50% (range: 5-69%; p<0.001).
Conclusion: HIV infection has adverse effects on lipid profiles and cardiovascular risk of HIV-positive patients. Therefore, patients should be closely monitored for lifestyle interventions and lipid-lowering agents.

Objectives: Aim of the present study was to investigate correlation between left atrial (LA) deformation parameters assessed using 2-dimensional (2D) speckle tracking echocardiography (STE) and complexity of coronary artery disease according to SYNTAX score (SXscore) in patients with stable coronary artery disease (SCAD).
Study design: Total of 60 moderate-risk SCAD patients (40 men, 20 women) who underwent coronary angiography and 30 healthy controls were included. Measurements of conventional echocardiographic parameters as well as peak LA strain during ventricular systole (LA-RES), peak LA strain during atrial systole (LA-PUMP), peak LA strain rate during ventricular systole (LA-SRS), peak LA strain rate during early diastole (LA-SRE), and peak LA strain rate during atrial systole (LA-SRA) were obtained.
Results: Patients were categorized into 2 groups: low SXscore of <20 (Group I) and high SXscore of ≥20 (Group II). Left ventricular (LV) diastolic functions were significantly impaired and LV filling pressure was significantly higher in high SXscore group. LA-RES (Control Group: 42.3±7.9, Group I: 36.4±8.2, Group II: 27.5±8.1; p<0.001) and LA-PUMP (Control Group: 17.6±3.4, Group I: 15.7±2.5, Group II: 13.1±3.2; p<0.001) were significantly lower in high SXscore group compared with low SXscore group. There was no statistical difference in LA-SRS, LA-SRE, or LA-SRA between the 3 groups. Correlation analysis indicated negative correlation between SXscore level and LA-RES function (r=-0.49; p<0.001).
Conclusion: 2D-STE-based LA deformation parameters are significantly impaired in patients with SCAD who have high SXscore. In addition, evaluation of LA-RES and LA-PUMP functions might be useful in estimating severity of disease in patients with SCAD.

Objective: We re-examined children who had previously been declared eligible to participate in competitive sports activities for cardiac disorders, using cardiac investigation protocol.
Methods: Total of 250 children (224 males [89.6%], and 26 females [10.4%]) between the ages of 8 and 17 years who had just started or were already engaged in sports activities were included in the study. Participants had detailed physical examination evaluated by a pediatric cardiologist. Those with findings suggesting cardiac disorder in their history and/or physical examinations, and/or 12-channel electrocardiography (ECG) were examined with echocardiography (ECHO), 24-hour Holter monitoring, and exercise test.
Results: Mean duration of participation in sports activities was 13 months. Among all, 10.4% of the children had abnormalities on ECG. ECHO demonstrated cardiomyopathy in 1, mitral valve prolapse in 2, tricuspid insufficiency in 2, and mitral insufficiency in 1 participant. Holter monitoring revealed non-sustained ventricular tachycardia attacks in 1, and supraventricular tachycardia in another child. Three were ultimately disqualified from partaking in competitive sports.
Conclusion: Sports and medical communities must work together to establish study protocols to prevent sudden death related to sports and to make these activities safer for athletes. Pediatric cardiology consultation for young athletes before they start sports activities is needed.

Bioresorbable vascular scaffold (BVS) stents have been proposed recently as an elegant technique for treatment of coronary artery disease. However, perspective that these “dissolvable” stents will replace conventional metallic stents in broad spectrum of clinical conditions and patient categories in the near future has been moderated by non-negligible incidence of stent thrombosis (ST). Mechanical factors, such as strut thickness and malapposition have been implicated in increased risk of BVS ST. Presently described is case of immediate partial BVS ST in a young male related to technical procedural problem, rather than mechanical problem. Glycoprotein IIb/IIIa inhibitors associated with anticoagulation resulted in complete resolution of thrombus and facilitated successful patient outcome.

Gemcitabine is a chemotherapy drug. It is a nucleoside analogue that is usually well tolerated by patients, with myelosuppression (especially thrombocytopenia) as dose-limiting side effect. Other mild to moderate side effects include alopecia, vomiting, nausea, rash, and fever. Coronary ischemia is the most common cardiotoxic effect of gemcitabine, which is due to its antimetabolites. While underlying cause of coronary ischemia following use of gemcitabine is uncertain, endothelial dysfunction and coronary thrombosis are potential explanations. To our knowledge, there are few published case reports of adverse cardiovascular side effects associated with gemcitabine. Presently described is case of acute inferior myocardial infarction in a female patient caused by gemcitabine.

Spontaneous echocardiographic contrast is defined as a phenomenon of discrete reflections appearing in the cardiac chambers or great vessels. It has been associated with several conditions leading to microbubble formation or low blood flow. This is a report of a neonate with spontaneous echocardiographic contrast related to patent ductus venosus.

Although heart failure is managed medically most of the time, heart transplantation is still last resort for selected end-stage heart failure patients with noncompaction cardiomyopathy. Presently described for the first time is case of pediatric patient with noncompaction cardiomyopathy who was initially referred to our hospital for heart transplant but underwent PDA repair and improved clinically without need for heart transplant.

Middle aortic syndrome (MAS) follows a course with distal thoracic and abdominal aorta stenosis. It is a rare disease that is usually diagnosed after the first decade of life. Clinical reflection of MAS is often in the form of hypertension and claudication in the lower extremities. Its etiology is unclear, but is known to be associated with congenital or acquired diseases. This pathology, which is accompanied by malignant hypertension, often does not respond to medical treatment. In patients with MAS, surgical treatment is first line recommendation to prevent complications such as hypertension, heart failure, intracranial bleeding, or aortic rupture. In order to draw attention to this disease, presently described is case of high blood pressure detected during routine examination of a child who had no complaint, and discovery of long-segment stenosis in the abdominal aorta identified with echocardiography and conventional angiography.

Presently described is successful cesarean delivery in a pregnancy superimposed on long-term bosentan treatment in an Eisenmenger syndrome patient with cor triatriatum sinistrum, double-orifice mitral valve, and large ventricular septal defect resulting in single functioning ventricle with double outlets. Cesarean delivery was performed at 27th week of gestation without maternal or fetal morbidity. The infant had no congenital cardiovascular abnormality or any probable teratogenic effect of bosentan treatment during pregnancy.

Maternal tachyarrhythmia is a common complication during pregnancy due to hormonal changes that enhance pre-existing arrhythmias or induce new arrhythmias in the presence of congenital heart defects in pregnant females. Presence of tachyarrhythmia during pregnancy poses risk to the mother and fetus, calling for proper treatment with medications. Use of antiarrhythmic drugs in cases of maternal tachyarrhythmia must give due consideration of potential teratogenic side effects. Utilization of antiarrhythmic drugs during pregnancy has been well studied; some result in minimal fetal harm or none at all. New techniques, such as cardiac ablation, have also been implemented with minimal or no radiation exposure to the fetus or mother. Pregnant women with tachyarrhythmia have been successfully treated with little to no impact on the developing fetus as result of increasing experience with antiarrhythmic drugs and progress of new procedural techniques.