Objective: The SYNTAX score (SS) is not just a measure of the severity of coronary artery disease, but also complexity. The aim of this study was to evaluate the relationship between the SS and myocardial viability/non-viability assessed by positron emission tomography (PET) in patients with ischemic cardiomyopathy (IC).
Methods: A total of 107 IC patients who had undergone PET were enrolled in the study. The patients were divided into two groups according to the presence or absence of viable myocardium. SS was analyzed from recorded conventional coronary angiographies.
Results: Patients with a non-viable myocardium (n=21; 19.6%) had a significantly higher SS compared to those with a viable myocardium (17.6±3.7 vs. 14.1±5.2, respectively; p=0.004). Point-biserial correlation coefficient analysis indicated that the presence of myocardial non-viability was mildly correlated with a higher SS (rpb=-0.28, p=0.004). In multivariate logistic regression analysis, the SS was identified as the sole independent predictor of myocardial non-viability (odds ratio [OR]: 1.164, 95% confidence interval [CI]: 1.044–1.297; p =0.006]. Receiver operating characteristic analysis revealed a cutoff point of 16 for predicting a non-viable myocardium (area under curve: 0.71, 95% CI: 0.61–0.82) with a sensitivity of 76.2% and a specificity of 61.6%.
Conclusion: The results of the present study indicates that a high SS is associated with the presence of a non-viable myocardium in IC patients.

Objective: The aim of this study was to assess the validity of automated quantitative and semiquantitative visual analysis of total perfusion deficit (TPD) using the IQ SPECT gamma camera system compared to conventional coronary angiographically detected significant coronary artery disease (CAD).
Methods: The study included patients with suspected CAD who underwent myocardial perfusion single photon emission computed tomography and conventional coronary angiography. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) (semiquantitative visual analysis results) were assessed using a 5-point scale in a standard 17-segment model, and TPD (stress, rest, and ischemic TPD) was quantified using automated software.
Results: In all, 84 patients (Group 1, those who underwent revascularization) had significant coronary artery lesions, and 81 (Group 2) had non-significant lesions. The median interquartile range values were: stress-TPD (sTPD): 16 (3.5– 33.5) vs 9.2 (2–17.9), rest-TPD: 9.4 (2.2–18.8) vs 4 (1–11), and 6.9 (1.9–14.1) vs 3.4 (1–6.1) for ischemic-TPD (iTPD) in Group 1 and Group 2, respectively. To detect ischemia, the optimal cut-off points were 9.5 (sensitivity: 75%, specificity; 60%) for sTPD, and 4.5 (sensitivity: 56%, specificity: 73%) for iTPD. There were significant correlations between quantitative and semi-quantitative methods in detection of significant coronary artery disease (sTPD-SSS: r=0.954, sTPD-SDS: r=0.746, iTPD-SSS: r=0.654, iTPD-SDS: r=0.759; p<0.05 for all).
Conclusion: The quantitative analysis and summed stress scores produced by the IQ SPECT system appear to be a useful and valid method to detect significant CAD.

Objective: Depression and anxiety disorders are frequently found in combination with obstructive coronary artery disease. Coronary artery ectasia (CAE) is an atypical form of coronary artery disease, the etiology of which has not yet been clearly defined. The aim of this study was to assess the existence of a relationship between anxiety/depression and CAE.
Methods: A CAE group (n=41; mean age: 58.9±9.0 years) and a control group (n=42; mean age: 58.0±9.6 years) were compared. The anxiety and depression status of patients was evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire.
Results: Age, sex, ejection fraction, and cardiovascular risk factor data were similar in both groups. The serum Creactive protein (CRP) and uric acid levels as well as the leukocyte count were significantly higher in the CAE group (p<0.05). The HADS anxiety score was higher in the CAE group, but without statistical significance (p=0.23). The HADS depression score and total HADS score was significantly higher in the CAE group (p<0.001 and p<0.001). The total HADS score and the HADS depression score were correlated with the serum CRP level (r=0.489; p<0.001 and r=0.543; p<0.001, respectively), whereas the anxiety score was not correlated with CRP (r=0.85; p=0.23).
Conclusion: The depression score, CRP, and uric acid levels were greater in patients with isolated CAE compared with those of patients with normal coronaries. The anxiety score did not demonstrate a relationship to CAE; however, there was an association between the depression score and CRP, which is an inflammatory marker.

Objective: Pulse wave velocity (PWV) is the primary determiner of arterial stiffness. In daily practice, the normal range of arterial stiffness is based on large multi-center studies conducted in the USA, Europe, Asia, and Australia. The goal of this study was to identify the reference values of brachial PWV in a healthy, normotensive Turkish population with no cardiovascular risk factors.
Methods: This retrospective study involved healthy, adult Turkish participants from Ankara. A total of 353 consecutive, normotensive individuals were enrolled in the study between September 2017 and January 2018 according to strict inclusion criteria, Normal PWV and 95% confidence interval values were acquired for 353 patients (mean age: 55.03±15.38 years; range: 20–95 years) who were divided into 6 age groups.
Results: The mean PWV was 7.75±1.89 m/s (range: 4.25– 15.90 m/s). The PWV had a positive linear correlation with age (r2=0.94; p=0.00). The PWV increased gradually by an average of 5% to 9% with each decade of life until the age of 50 years, after which the average PWV increased by 16%.
Conclusion: To the best of our knowledge, this study is the first to define PWV reference values via brachial measurement in a healthy, normotensive Turkish population. These data provide important information for daily clinical practice in Turkey.

Objective: This study is a comparison of the electrocardiogram (ECG) findings of detainees and convicts who participated in a hunger strike recorded at the end of the strike and 2 months later.
Methods: A total of 81 male detainees and convicts (mean age 41±9.4 years) who participated in a hunger strike between September 2012 and November 2012 were included in this study. The mean duration of the fast was 45±9.6 days. Measurements of blood pressure, body weight, and serum electrolytes (sodium, potassium, calcium) obtained on the last day of the hunger strike and 2 months later were compared, as well as 12-lead ECG readings obtained at the same intervals, which were scanned and transferred to a high-resolution electronic format and evaluated.
Results: The mean weight loss for the 81 patients during the hunger strike was 6±3.7 kg. Early repolarization (ER) (inferior: 10, lateral: 5, inferolateral: 1) was detected in 16 (19.7%) ECGs taken on the last day of fasting, and in 4 (4.9%) (inferior: 3, lateral: 1) of those measured 2 months after the strike (p<0.001). A significant difference was observed in the PR interval (157±75 ms vs. 153±23 ms; p=0.035) and QRS duration (95±73 vs. 92±11; p=0.001), whereas there was no significant difference in heart rate (p=0.068). Additionally, there was no significant difference in terms of electrolyte levels between the last day of the hunger strike and 2 months after its conclusion.
Conclusion: This is the first time long-term lack of nutrition was demonstrated to be associated with ER.

Objective: An association between ventricular repolarization parameters (VRPs) and ventricular arrhythmias has been demonstrated in previous studies. However, there are limited data related to a relationship between synthetic cannabinoids (SCs) and VRPs. The aim of this study was to analyze the acute effects of SCs on VRPs using electrocardiogram (ECG) measurements of the T-peak to T-end interval (Tp-e), Tp-e/QT ratio, and Tp-e/corrected QT (QTc) ratio.
Methods: The present study included 58 patients who were admitted to the emergency department who used SCs (SC +) between 2014 and 2016, and 50 healthy control subjects (SC -). The QT and QTc intervals, Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured from a 12-lead ECG. These parameters were compared between groups and correlation analysis was performed.
Results: The Tp-e and QTc intervals were significantly higher in SC + patients when compared with the SC- group (92.2±10.0, 77.4 ±9.3, p<0.001; 434.5±30.8, 410.9±27.3, p<0.001, respectively). Tp-e/QT and Tp-e/QTc ratios were greater in SC + patients in comparison with SC – participants (0.26±0.02, 0.22±0.02, p<0.001; 0.21±0.02, 0.18±0.02, p<0.001, respectively). Significant correlations were found between the use of SCs and the Tp-e interval (r=0.610; p<0.001), Tp-e/QT (r=0.655; p<0.001) and Tp-e/ QTc ratios (r=0.437; p<0.001).
Conclusion: The Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were greater in subjects who used SCs. Therefore, SC users might have an increased risk of ventricular arrhythmia.

Objective: The aim of this study is to assess the prevalence of polypharmacy, inappropriate drug use, and drug-drug interactions (DDIs) in elderly patients presenting at outpatient cardiology clinics in Turkey.
Methods: The EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study will be an observational, real-world, multicenter study conducted to evaluate DDIs and polypharmacy in elderly cardiac outpatients. All consecutive patients (aged ≥65 years) admitted to outpatient cardiology clinics between July 30, 2018 and July 30, 2019 who provide written, informed consent will be enrolled. A total of approximately 5000 patients are to be enrolled in this non-interventional study. All of the data will be collected at one point in time and current clinical practice will be evaluated (ClinicalTrials.gov NCT03370523).
Results: Patient demographics, comorbid disease characteristics, laboratory test results, and details of medication use will be collected using self-reports and medical records. The severity of comorbid disease will be recorded and scored according to Charlson Comorbidity Index (CCI) and patients will be divided into 3 groups: mild, those with a CCI score of 1–2; moderate, those with a CCI score of 3–4; and severe, those with a CCI score of ≥5. Polypharmacy will be defined as the use of 5 or more medications at one time. DDIs will be determined using the Lexicomp Online drug interaction screening tool and potentially inappropriate medications will be defined based on the 2015 update of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Severe drug interactions will be defined as those in category D or X.
Conclusion: EPIC will be the first large-scale study in Turkey to evaluate polypharmacy, potentially inappropriate medications, and DDIs in elderly cardiac outpatients in a real-world clinical setting.

Transaxillary access is an alternative to femoral access in patients with iliofemoral occlusion for transcatheter aortic valve implantation (TAVI). A Multilayer Flow Modulator (MLFM) stent is frequently used in patients with a complex thoracic and abdominal aortic aneurysm. The MLFM stent is particularly used in cases where large arteries, such as the renal or celiac artery, feed from the aneurysmal sac. To the best of our knowledge, there is no prior report in the literature of a TAVI case with a pre-existing MLFM stent. Presently described are 2 TAVI cases, one with thoracoabdominal MLFM stents, and the second with occluded bilateral carotid and iliac arteries.

Angiography is still the workhorse imaging approach for the vast majority of percutaneous coronary revascularization (PCR) cases. However, the limitations of angiographic guidance for coronary procedures have been well established. This case report demonstrates how 3-dimensional optical coherence tomography (3D OCT) can change the treatment strategy, which, had only the angiography results been considered, seemed to be straightforward. A 67-year-old male patient presented with non-ST-elevation myocardial infarction. A coronary angiogram revealed a tight lesion of the proximal left anterior descending artery (LAD). Angiographically, the vessel ostium appeared not to be involved. To clarify the disease border and determine the right stenting strategy, 3D OCT was performed. Measurements revealed heavy disease of the LAD, ranging from the ostium to the left main coronary artery (LMCA). It was decided to proceed with a provisional stenting strategy of the LMCA and the LAD. After postdilatation, the angiography revealed a good result for the LAD, but significant pinching of the ostium of the LCx. The kissing balloon technique was then applied at the LAD/LCx bifurcation. The final OCT examination documented a well-expanded stent without areas of malapposition and an open LCx ostium without significant narrowing. Intracoronary images obtained using OCT add significant information to what is provided by angiography alone, thereby improving the interpretation of angiographic images and the planning of the PCR procedure.

Patients with Behçet’s disease are at risk for iatrogenic aneurysms after interventions. Presently described is the case of a 55-year-old male with multiple pseudoaneurysms occurring in the late period after a coronary angiography procedure performed via the radial artery. There was no previous diagnosis of vasculitis. Behçet’s disease was revealed to be the underlying pathology.

This case report illustrates the follow-up of a 57-year-old female with a type B aortic dissection (AD) under dabigatran treatment. The patient had been operated on 8 years earlier due to type A AD. The aortic valve was repaired and a 26-mm polyester fiber graft was applied to the ascending aorta and the aortic arch. In computerized tomography scans taken after the procedure, a dissection flap extending from the descending aorta to the iliac arteries was seen, but the patient was asymptomatic and no further surgery was performed. The patient was subsequently diagnosed with atrial fibrillation. A CHA₂DS₂VASc score of 3 was recorded and dabigatran treatment was initiated. The aortic aneurysm and dissection were followed up via computed tomography and echocardiography at regular intervals, and at 6 months no progression was seen. No thromboembolic or hemorrhagic events were observed. To our knowledge, this is the first case report of dabigatran treatment for a patient with a type B AD. Based on this case, the use of dabigatran would appear to be safe in a patient with an uncomplicated type B AD, but the results of this case need to be confirmed with extended follow-up and additional patients.