Objective: Peripheral neuropathy is an important potential side effect of statin use. This study was an investigation of the incidence of peripheral neuropathy in patients taking atorvastatin or rosuvastatin for hypercholesterolemia and the relationship to the dose and duration of the treatment.
Methods: In all, 50 patients using a statin treatment and 50 healthy controls matched for age and gender who had never taken a statin were included in the study. Polyneuropathy was assessed with a neurological examination and electroneuromyography (ENMG).
Results: While no polyneuropathy was detected in the control group, polyneuropathy was seen in 33 (66%) of the patients in the statin group (p<0.01). There was no significant difference between the 2 statin groups in the results of the neurological examination or the ENMG findings regarding the incidence of polyneuropathy (p=0.288 and p=0.720, respectively). Neuropathy was observed in a neurological examination performed within the first year in 50% of the rosuvastatin users and 18% of those taking atorvastatin. The severity of the polyneuropathy increased with the duration of the treatment in the atorvastatin group (p=0.030).
Conclusion: This study revealed an increased risk of peripheral neuropathy with long-term statin use (>1 year). Electrodiagnostic changes have been detected in motor and sensory nerves in nerve conduction studies of patients on long-term statin treatment. The assessment of neurological symptoms, like tingling, numbness, pain and tremor in the hands and feet, and unsteadiness during walking associated with peripheral neuropathy may be useful in the follow-up of the patients on long-term statin treatment. Early detection of peripheral neuropathy and changing hypercholesterolemia treatment may prevent permanent nerve damage.

Objective: Atrial structural remodeling has been suggested to contribute to atrial fibrillation (AF) recurrence following direct-current cardioversion (DCCV). The role of several inflammatory and extracellular matrix turnover markers in AF recurrence following DCCV has been investigated. However, data on the impact of galectin-3, which is known to play a role in various fibrotic conditions, including cardiac fibrosis are lacking. The aim of this study was to demonstrate the predictive role of serum galectin-3 levels in AF recurrence following successful DCCV.
Methods: A total of 90 persistent AF patients who were sche-duled for DCCV were prospectively enrolled. Serum samples were assayed to determine pre-DCCV galectin-3 levels using the enzyme-linked immunosorbent assay method. Patients were followed up for 3 months for AF recurrence.
Results: Of 90 persistent AF patients (mean age: 55.33±7.94 years; 53.33% male) who underwent successful DCCV, 28 (31.11%) experienced early AF recurrence within 3 months. Patients with AF recurrence had a greater left atrial volume index (LAVI) (33.35± 2.45 mL/m2 vs. 29.21±3.08 mL/m2; p<0.001) and serum galectin-3 levels were higher (0.88 ng/mL [min-max: 0.52–1.32] vs. 0.60 ng/mL [min-max: 0.38–0.91]; p<0.001). In multivariate analysis, the number of DCCV attempts (hazard ratio [HR]: 1.879, 95% confidence interval [CI]: 1.052–3.355; p=0.033), LAVI (HR: 1.180, 95% CI: 1.028–1.354; p=0.018), and serum galectin-3 level (HR: 11.933, 95% CI: 1.220–116.701; p=0.033) were found to be independently associated with early AF recurrence following successful DCCV.
Conclusion: Circulating levels of galectin-3 may have an association with early AF recurrence following DCCV.

Objective: Ventricular repolarization (VR) markers may predict ventricular arrhythmias and cardiac arrest. The aim of this study was to investigate the acute effects of a hemodialysis (HD) session and HD adequacy on VR markers in HD patients.
Methods: This cross-sectional study was conducted at 2 university hospitals with 83 patients and VR markers were measured before and after an HD session: QT, QTc, QT minimum, QT maximum, dispersion of QT (QTd), T-peak to T-end (Tp-e) interval, and Tp-e/QT. Kt/V measurements calculated using the second generation Daugirdas formula were used to indicate dialysis adequacy. The patients were divided into 2 groups according to the Kt/V value. Group 1 patients had a Kt/V of ≤1.6 with a standard dialysis dose, and Group 2 comprised those with a measurement of >1.6 with a high dialysis dose.
Results: There were 36 patients in Group 1 and 47 patients in Group 2. There were statistically significantly more female patients in Group 2 (p=0.016). After an HD session, heart rate increased, blood pressure decreased, and the QT, QTc, QT maximum, QTd, Tp-e interval, and Tp-e/QT were prolonged (p<0.05). The VR markers measured were similar in the 2 groups. VR markers were not significantly different in diabetic patients.
Conclusion: HD may be a risk factor for cardiac arrest because of prolonged VR parameters, independent of HD adequacy. A high dialysis dose may not always be best for the heart.

Objective: Although the long-term prognosis of myopericarditis is good, recurrence continues to be a problem. In addition, there are concerns regarding the safety of the empirical use of anti-inflammatory drugs. This study was an investigation of the clinical outcomes of young patients with uncomplicated myopericarditis, the majority of whom received both nonsteroidal anti-inflammatory drugs and colchicine.
Methods: Patients aged 18 to 40 years who were admitted between May 2015 and May 2018 due to myopericarditis and had normal left ventricular function were included in the study. The primary outcome of the research was analysis of major adverse cardiac events (MACEs): all-cause mortality, myopericarditis recurrence, development of significant arrhythmia, heart failure, and cardiac tamponade. A total of 60 patients were included in the study. The median duration of follow-up was 19 months.
Results: A MACE occurred in 11.7% of the patients. None of the patients experienced heart failure, significant arrhythmia, cardiac tamponade, or all-cause mortality. Recurrence of myopericarditis was the only MACE observed. Most patients were treated with both nonsteroidal anti-inflammatory drugs and colchicine (96% and 95% of the patients, respectively). Univariate cox regression analysis indicated that only the maximum in-hospital C-reactive protein (CRP) level was associated with recurrence (hazard ratio: 1.01, 95% confidence interval: 1.01–1.02; p=0.04).
Conclusion: The intermediate-term prognosis of myopericarditis patients was excellent in terms of mortality. However, recurrence remains a challenge. The role of CRP, particularly in recurrence, should be explored further.

Objective: The mucopolysaccharidoses (MPS) are an important group of lysosomal storage diseases. Commonly reported cardiac involvement includes mitral leaflet thickening and accompanying prolapsus, regurgitation, and rarely, stenosis. The aim of this study was to evaluate cardiac involvement in patients with MPS type VI.
Methods: The study included a total of 13 children with MPS type VI who were admitted to a single pediatric department between 2016 and 2018. Cardiac status was evaluated prospectively with clinical findings, electrocardiography, and echocardiography. The age of the patients (8 boys, 5 girls) ranged between 2 and 14 years (median: 9 years).
Results: No arrhythmia was observed in any patient. Thickening of the mitral valve with or without regurgitation and prolapsus was the most common lesion seen. Additional involvement of the aortic valve was detected in 12 (92.3%) patients, and additional involvement of the tricuspid valve in 4 (30.8%). Isolated septal hypertrophy was found in 2 patients, and congestive heart failure in another.
Conclusion: Cardiac involvement is frequent in MPS. Mitral valve deformation is the most frequent finding. An echocardiographic examination should be performed periodically even if the patient has no clinical signs of cardiac disease, and any cardiac involvement should be kept under control with medical treatment.

Objective: Since the first World Symposium on Pulmonary Hypertension (WSPH; Geneva, 1973), pulmonary hypertension (PH) has been defined as a mean pulmonary artery pressure (mPAP) ≥25 mm Hg measured at right heart catheterization (RHC) while at rest in the supine position. At the 6th WSPH congress (Nice, 2018), a new proposal was presented defining pre-capillary PH as mPAP >20 mm Hg, with pulmonary arterial wedge pressure (PAWP) <15 mm Hg, and pulmonary vascular resistance (PVR) >3 WU. The aim of this study was to investigate the impact of the new definition of PH on the number of pre-capillary PH patients.
Methods: The results of RHC performed with various clinical indications between 2017 and 2018 were analyzed. The 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) and the 6th WSPH congress PH definitions were used to identify PH patients.
Results: Fifty-eight RHC procedures were performed in our hospital in a 1-year period. Most were performed with a suspicion of PH (n=52). The remainder (n=6) were performed with indications of valvular heart disease or left heart disease. There were 40 females (69%) and 18 males (31%). The mean age was 53.3±16.6 years. The RHC results revealed a mean PAP of 36.4±16.4 mm Hg, PAWP of 12.6±3.9 mm Hg, and PVR of 4.9±4.4 WU. Forty-three of 58 patients (74.1%) were classified as pre-capillary PH according to the ESC/ERS PH guideline, whereas 50 of 58 patients (86.2%) had pre-capillary PH according to the new WSPH definition.
Conclusion: The results of this study indicated that the impact of the new definition of PH on the number of pre-capillary PH patients identified was greater than the predicted <10%.

Objective: Few studies have directly assessed suboptimal management of dyslipidemia in Turkey. This study was conducted to assess patients’ understanding and perceptions of high cholesterol as well as physicians’ knowledge and awareness of lipid management strategies.
Methods: This was a multicenter, observational study (ClinicalTrials.gov identifier: NCT02608645). Consecutive patients admitted to the participating cardiology clinics who were at least 18 years of age and who had been classified in a secondary prevention (SP) group or a high-risk primary prevention (PP) group were enrolled. The study population included 1868 patients from 40 sites in Turkey. Two-thirds (67.5%) of the patients in the SP group had been prescribed a statin, whereas only 30.1% of the PP group patients received statin therapy (p<0.001).
Results: It was determined that 18% of the SP patients and 10.6% of the PP patients had a low-density lipoprotein cholesterol level at the recommended level (p<0.001). A patient survey revealed that almost half of the patients in the PP and in the SP groups were aware that their cholesterol levels were high. Negative information about statin treatment disseminated by media programs was the most common reason (9.4%) given for treatment discontinuation.
Conclusion: Perceptions, knowledge and compliance with the guidelines for PP and SP patients in real-life practice have increased, but it remains far below the desired level. Patients and physicians should have more information about the treatment of hyperlipidemia. More accurate media programming could help to prevent the dissemination of misinformation.

A coronary artery aneurysm is a challenging cli-nical situation due to the lack of sufficient evidence from randomized controlled studies and the lack of consensus on a management strategy. The present case is a description of the exclusion of a middle segment aneurysm of the left circumflex coronary artery using a PK Papyrus covered stent (Biotronik, AG, Bulach, Switzerland). The final images were favorable.

Paraplegia after percutaneous iliac angioplasty is very rare, and is typically associated with spinal cord ischemia (SCI). Presently described is a case of SCI and paraplegia developing after bilateral iliac stenting. This complication may be caused by a change in spinal blood flow in patients with diffuse atherosclerosis, and should be kept in mind.

Cardiac implantable electronic devices (CIEDs) are widely used in current practice. Analyzing the electrocardiographic patterns of these devices and having knowledge of artifacts is crucial to appropriate CIED management. A 32-year-old female patient presented at the device clinic for a routine follow-up visit. A dual-chamber pacemaker had been implanted 12 years previously for sinus node dysfunction. An initial 12-lead electrocardiogram (ECG) prompted concern due to a cyclical pattern of multiple, rapid pacing stimulus artifacts. Device interrogation revealed normal overall pacemaker function. Turning the pace gain function of the ECG machine off failed to eliminate the artifact. On review of the past medical history, the patient was found to have a prior diagnosis of congenital central hypoventilation syndrome and pulmonary hypertension, for which she underwent insertion of a diaphragmatic pacemaker. Interrogation of the diaphragmatic pacemaker revealed that the programmed parameters correlated with the frequency of the artifact noted on the ECG. In cardiac pacing, a single stimulus artifact of sufficient threshold can enable myocardial capture. Capturing diaphragmatic pacing, however, requires a train of multiple stimuli above the threshold. Thus, an understanding of the pacing configurations of various electrical devices that can potentially interfere with CIEDs is crucial to appropriate patient management.

Pulmonary valvular stenosis is a rare valvular disease; it accounts for 7% to 12% of all patients with congenital heart disease. Patients with mild or moderate pulmonary stenosis (PS) are usually asymptomatic and the stenosis is often detected incidentally with echocardiography performed for another reason. Severe PS typically presents with symptoms related to increased right ventricular pressure and right heart failure. Valvular heart diseases are associated with increased morbidity and mortality in pregnancy due to cardiovascular alterations that occur during the gestational period, such as increased extracellular volume, a faster heart rate, and decreased venous return due to compression of the vena cava inferior by the enlarged uterus. While mild or moderate PS can be well tolerated in pregnancy, severe PS can lead to maternal and fetal perinatal complications. Presently described is the case of a pregnant patient with severe PS who successfully underwent balloon valvuloplasty in the third trimester.