Objective: This study is an examination of 1) overall mortality trend in the Turkish Adult Risk Factor (TARF) study stratified by sex and place of residence, and 2) brief report on main aspects of the 2016 survey.
Methods: The period of last 18 years was divided into 2 for trend analysis of data. Required information on deaths was obtained. Baseline age ≥40 years at the beginning of each period was the inclusion criterion. Cox regression analyses were performed.
Results: Among over 2500 participants in each, deaths were recorded in 281 and 334 individuals in Periods 1 and 2, respectively, and baseline mean age was 54.6 years and 56.4 years, respectively, in each period. Age-adjusted hazard ratio for mortality in Period 2 remained virtually the same for rural males, rose to borderline significance for urban males and rural females (p=0.06, p=0.09), and increased 1.72-fold for urban females (p=0.006), as compared to Period 1. Whereas males gained an average of 3.8 years of survival in the later period compared with the earlier period, females gained only 1.8 years. This narrowed the difference in mean age at death in favor of women from 2.5 years to 0.5 year. Of 1144 participants to be surveyed in the TARF 2016, 48 were lost to follow-up, 695 were examined, and 39 participants were ascertained to be deceased. In 362 cases, verbal information was obtained regarding health status.
Conclusion: Gain in survival in Turkish women has distinctly stagnated compared with men, and hazard of death has risen significantly for women and urban residents in the past decade, suggesting interaction between female sex and urban residence. Both phenomena require recognition and adoption of appropriate measures.

Objective: The aim of this study was to evaluate the adherence to recommendations for secondary prevention and the achievement of treatment targets for the control of risk factors in patients with established coronary heart disease (CHD) who were followed-up at various healthcare facilities in Turkey.
Methods: According to the protocol of the international Survey of Risk Factor Management study, questionnaire forms were completed and demographic, anthropometric, and laboratory data of CHD patients who were followed-up at a total of 15 selected primary, secondary, and tertiary healthcare centers were recorded.
Results: Among a total of 724 CHD patients (69.8% male; mean age: 63.3±10.7 years) included in the study, 18.4% were current smokers, only 19.1% had normal body mass index, and 22.1% had waist circumference below the limit of abdominal obesity. Physical activity was insufficient in 53% of the patients, 47.3% had low high-density lipoprotein cholesterol value, 46% had triglyceride level above 150 mg/dL, and 67% had glycated hemoglobin value of 6.5% or above. Of all the patients, 88.1% were using antiplatelet drugs, 71.4% were using beta-blockers, 55.7% were using statins, and 41.9% were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Blood pressure was under control in 56.7% of the hypertensive patients using antihypertensive drugs, and the proportion of diabetic patients who reached glycemic control targets using antidiabetic drugs was 35.9%. Low-density lipoprotein cholesterol was below 70 mg/dL in 12.2% of the patients using statins.
Conclusion: According to the data obtained, among Turkish CHD patients, the control rate of cardiovascular risk factors is low, and implementation of the recommendations regarding lifestyle modification and medication use for secondary prevention in the current guidelines are insufficient.

Objective: Extracorporeal shock wave lithotripsy (ESWL) is a safe and effective treatment for urinary tract calculi. While serious side effects are rare, transient cardiac arrhythmias may occur. New electrocardiographic (ECG) parameters, such as P wave dispersion (PWD), QT dispersion (QTd), T peak to T end (Tp-e) interval, Tp-e interval/QT ratio, and Tp-e interval/corrected QT ratio have been defined to help predict atrial and ventricular arrhythmias. However, effect of ESWL on these ECG parameters has not been previously investigated. The present study was an examination of the effect of ESWL on ECG parameters.
Methods: Total of 40 consecutive patients who underwent ESWL were prospectively enrolled in the study. Pre-procedure ECG parameters were compared with post-procedure ECG parameters.
Results: PWD values were significantly longer on post-procedure ECG compared with pre-procedure ECG (p=0.017). Corrected QT duration and QTd were significantly longer on post-procedure ECG compared with pre-procedure ECG (p=0.046 and p=0.008, respectively). In addition, Tp-e interval, Tp-e interval/QT ratio, and Tp-e interval/QTc ratio were significantly longer post procedure (p=0.035, p=0.045, and p=0.022, respectively). In univariate correlation analysis, duration of procedure was significantly correlated with post-procedure PWD, QTc, and QTD values.
Conclusion: Clinical use of ECG parameters may be helpful in monitoring of patients receiving ungated ESWL in order to detect cardiac dysrhythmia.

Objective: The aim of the present study was to assess the efficacy and safety of tolvaptan for severe hyponatremia (SH) in hypervolemic heart failure (HF) patients within daily clinical practice.
Methods: We restrospectively reviewed our database on tolvaptan as an add-on treatment in hypervolemic patients admitted to our clinic due to deterioration of HF and having hyponatremia resistant to standard therapy. Severe hyponatremia was defined as serum sodium concentration ≤125 mEq/L. The database included demographic, clinical, laboratory, and echocardiographic findings on admission, and numerous outcome measures for oral tolvaptan treatment were used to assess its efficacy and safety.
Results: The study group consisted of 56 hypervolemic HF patients with severe hyponatremia (25 female and 31 male) with mean age of 66 years. All patients received a single dose of tolvaptan 15 mg daily for an average of 3.2 days due to severe hyponatremia. Sodium and potassium concentrations, fluid intake, and urine volume increased (p<0.0001, p=0.037, p<0.0001, and p<0.0001, respectively), whereas furosemide dosage, body weight, heart rate, systolic and diastolic blood pressure, and New York Heart Association class decreased significantly in response to tolvaptan treatment, without a rise in serum creatinine or urea concentrations (p<0.0001, p<0.0001, p=0.001, p<0.049, p<0.009 ve p=0.001, respectively).
Conclusion: In this retrospective, single-centered study conducted in a small group of Turkish patients, short-term treatment with low-dose tolvaptan added to standard therapy of hypervolemic HF patients with severe hyponatremia was well tolerated with a low rate of major side effects and was effective in correcting severe hyponatremia.

Objective: Determining optimal timing for surgery in asymptomatic mitral regurgitation (MR) remains a challenge. The aim of this study was to evaluate subclinical changes in left ventricular (LV) systolic functions using velocity vector imaging (VVI) during follow-up of patients with chronic mitral regurgitation (MR).
Methods: A total of 54 patients (mean age: 57.9±8 years; 55% male) with moderate-to-severe MR and normal LV ejection fraction (EF), and 30 healthy controls (mean age: 56±6.5 years; 55% male) were evaluated using conventional echocardiography and VVI at baseline.
Results: At the end of 12 months, measurements of 45 MR patients were repeated. There was no significant change in LV dimensions or EF on follow-up. LV peak systolic strain and strain rate (SR) were decreased in patients with MR compared with controls (strain: 16.29±3.30 to 23.4±1.9; p=0.0001 and SR: 0.93±0.39 to 4.9±0.6; p=0.0001) at baseline. Impairment was more significant on follow-up. (strain: 13.76±2.68 and SR: 0.27±0.14; p=0.0001).
Conclusion: VVI-derived strain imaging might be used in the assessment of subclinical LV dysfunction and its progression during follow-up of patients with chronic MR especially in the decision of optimal timing for surgery.

Objective: Pulmonary arterial hypertension (PAH) is a rare disease. Although muscle strength, exercise capacity, quality of life, and activities of daily living of patients with PAH are affected, it is not known how they are affected by disease severity. The purpose of the present study was to investigate effects of disease severity on upper extremity muscle strength, exercise capacity, and performance of activities of daily living in patients with PAH.
Methods: Twenty-five patients with disease severity classified according to the New York Heart Association (NYHA) as functional class II (n=14) or class III (n=11) were included in the study. Upper-extremity exercise capacity and limitations in performing activities of daily living were assessed with 6-minute pegboard and ring test (6PBRT) and the Milliken activities of daily living scale (MAS), respectively. Shoulder flexion, elbow extension, elbow flexion muscle strength, and handgrip
strength were measured with dynamometer.
Results: There were no significant differences in age, gender, body mass index, or mean pulmonary artery pressure between groups (p>0.05). The 6PBRT, MAS, and elbow flexion (right) and grip strength (right and left) results were significantly lower in NYHA III group than in NYHA II group (p=0.004, p=0.002, p=0.043, p=0.002 and p=0.003, respectively). There was no significant difference in shoulder flexion, elbow flexion (left), or elbow extension between groups (p>0.05).
Conclusion: Results suggest that upper extremity exercise capacity, elbow flexion muscle strength (right), and handgrip strength decrease and that limitations in activities of daily living grow as disease severity increases in patients with PAH. When planning rehabilitation programs, disease severity should be considered and evaluations and treatments for the upper extremities should be included.

Electrical storm (ES) is not a rare clinical entity. Sympathetic hyperactivity may play critical role in development and continuation of ES. Some recent reports have demonstrated that catheter-based renal sympathetic denervation (RSD) may reduce sympathetic activation and have a potential role in reducing arrhythmic burden. A 46-year-old man was admitted to clinic with frequent implantable cardioverter defibrillator shocks and ES related to catecholaminergic polymorphic ventricular tachycardia (VT). Tachycardia was unresponsive to administration of beta-blockers, verapamil, and flecainide. Catheter ablation failed to suppress initial premature ventricular contractions. Based on aggravating effects of sympathetic system in clinical tachycardia, decision was made to perform RSD. After the procedure, sinus rhythm was achieved and no polymorphic VT was detected. Sustained monomorphic VT with right ventricular origin was successfully ablated via endocardial radiofrequency ablation. This new treatment modality may be a potential alternative method for patients in whom other ablative strategies have been unsuccessful.

Familial hypertrophic cardiomyopathy is a genetically heterogeneous disease with variable clinical features that is inherited as autosomal dominant with variable penetrance. Recent developments in genetics of hereditary cardiomyopathy have not only enlightened many points about pathogenesis, but have also provided great benefit to diagnostic approaches of clinicians. Heterozygous mutation of c3691-3692insTTCA in MYBPC3 gene was identified in a pediatric patient with diagnosis of hypertrophic cardiomyopathy at clinic. Hypertrophy was observed in sister and father of the patient in echocardiography screening, and it was subsequently determined that they also had same mutation. This mutation has not previously been defined and reported previously in the literature as cause of hypertrophic cardiomyopathy.

Carpenter syndrome (Acrocephalopolysyndactyly type 2, OMIM 201000) is a rarely seen autosomal recessive disorder. In addition to abnormalities such as acrocephaly, craniosynostosis, facial asymmetry, polydactyly and syndactyly, obesity, hypogonadism, mental retardation, and corneal opacity, it may frequently be accompanied by congenital heart diseases such as ventricular septal defect, patent ductus arteriosus and pulmonary stenosis. Double outlet right ventricle is a defect in which both major arteries originate in the morphological right ventricle. To the best of our knowledge, this is the first report in the literature of double outlet right ventricle disease in combination with Carpenter syndrome.

Neurofibromatosis type I (NF1) is a rare genetic disease caused by mutations in the NF1 gene, which encodes the tumor suppressor neurofibromin. Precapillary pulmonary hypertension is a severe complication of NF1, initially described in patients with advanced parenchymal lung disease, which may complicate the course of NF1. Presently described is a case of neurofibromatosis complicated by pulmonary hypertension.

Endovascular aneurysm repair (EVAR) of abdominal aorta is a valuable treatment option in selected patients with abdominal aortic aneurysm. Renal artery occlusion is a serious complication after EVAR and may progress to permanent renal injury requiring hemodialysis. In this report, case of unexpected renal artery occlusion after EVAR treated with renal artery stenting in the late postoperative period is described.

Kounis syndrome (KS) is defined as concurrent acute coronary syndrome and allergic or hypersensitivity reactions. Despite being increasingly reported, it is still an underdiagnosed entity. Several medications are already known to result in KS. Amoxicillin/clavulanic acid is a frequently used antibiotic, and its use has been linked with KS. The aim of the present report was to draw attention to rare clinical manifestation of KS following peroral amoxicillin/clavulanate use.

Although evident improvement has occurred in the diagnosis and treatment of cardiovascular disease (CVD), it is still the most important cause of mortality worldwide. The majority of the CVDs are multifactorial and polygenic. Therefore, it is logical to use genomics, proteomics, lipidomics, and metabolomics together for diagnosis and effective treatment of CVD. “Genome” is the combination of the words “gene” and “chromosome,” and includes all protein-coding genes and intergenic spaces (as well as intragenic regions, or introns, within genes) in an organism. Proteins that are synthesized in a cell, tissue, or organism are all called proteomes. Proteomics is the study of proteomes. The analysis of the lipodome, or all lipids synthesized in the organism, as well as lipid-derived mediators, and the functions of these mediators in biological systems, is the field of lipidomics. The metabolome is the complete set of low-molecular-weight metabolites and molecules in a human or any living organism. Metabolomic is the systematic analysis of small molecules and metabolites in human or animal biological fluids. The number of biomarkers used for the purpose of evaluating the risk of cardiovascular events is very limited and many of them are old. The drugs that were produced 30 years ago are still used in treatment. Development of -omics science plays an important role in the search for new biological markers that can be used in the diagnosis of CVD and there is a growing need for advancement of these branches of genetics. The recognition and internalization of -omics by clinicians is a time-consuming process, but will be more important in the near future.