Objective: Aortic stenosis (AS) is a progressive disease, and valve replacement—the only treatment option—should be performed after it becomes symptomatic and before irreversible myocardial damages develop. Surgical valve replacement is recommended in patients with very severe AS (VSAS), even if they are asymptomatic. However, there is no detailed study on the effect of transcatheter aortic valve implantation (TAVI) in patients with VSAS. Our aim in this study is to show the feasibility and safety of TAVI in symptomatic patients with VSAS.
Methods: A total of 505 consecutive patients with symptomatic AD who underwent TAVI in our center were retrospectively studied. The mean age of the patients was 77.8±7.6 years, and 56.4% of them were women. The patients were divided into 2 groups: a group with VSAS (n=134 patients) and a group with high-gradient AS (HGAS) (n=371 patients).
Results: Female sex, left ventricular ejection fraction, small left ventricle, hypertrophic left ventricle were more common in the group with VSAS; on the other hand, histories of coronary artery disease bypass surgery, myocardial infarction, and atrial fibrillation were less frequent. Predilatation and Edwards SAPIEN 3 were less used in the group with VSAS. There was no statistical difference in major complications and in-hospital mortality (group with VSAS: 5 patients, group with HGAS: 16 patients; p=0.769) according to the Valve Academic Research Consortium-2 criteria. There was a significant difference between the 2 groups in favor of the group with VSAS on the Cox regression model survival curve (p<0.001).
Conclusion: In this study, it has been shown that TAVI can be feasible and safe in symptomatic VSAS, with acceptable complications and higher survival rates. Currently, further randomized studies are required to perform TAVI in patients with asymptomatic VSAS currently indicated for surgical aortic valve replacement.

Objective: Iatrogenic aortic dissection (IAD) during coronary interventions is a rare but fatal complication. There is not enough experience and trial on this subject. In this study, we report our IAD cases and their acute, short-term, and long-term results.
Methods: In this study, we screened 6,096 coronary angiographies performed in our center between February 2016 and February 2019. Ascending aortic dissection developed in 8 patients. A total of 7 patients had computed tomographic angiography images after the event and during the follow-up. We performed 1-month and 1-year follow-up examinations.
Results: The incidence of IAD was 0.13%. The female sex ratio was as 63%. A total of 37% of the patients had presented with acute coronary syndrome. In 37% of the patients, dissection occured while support catheter use, but in the remaining patients, dissections developed owing to hydraulic pressure. Regardless of the Dunning staging, 7 patients were followed-up with medical treatment, and 1 patient with decreased coronary flow was referred to emergency coronary bypass surgery. Regression was in the first tomography in 4 patients and observed in the control tomography in the remaining patients with medical treatment. The in-hospital 1-month and 1-year mortality rates were 0%.
Conclusion: IAD is a fatal disease, and conservative follow-up is suggested due to lack of clear management recommendations. The findings in our study showed that medical treatment is the first choice for the hemodynamically stable patients when dissection is sealed by stenting; however, surgical treatment is required in patients with the decreased coronary flow.

Objective: Inflammation plays a crucial role in the pathogenesis and clinical outcome of atherosclerosis. Among the various inflammatory factors, antimicrobial peptides, such as alpha-defensins, seem to contribute to the development and progression of atherosclerosis. The aim of this study was to evaluate the plasma levels of human neutrophil peptide-1, -2, and -3 (HNP1–3) in patients with acute myocardial infarction (AMI) and to assess its relationship with the severity of coronary artery disease.
Methods: Plasma HNP1–3 levels in patients with AMI and controls with angiographically normal coronary arteries were measured by solid-phase enzyme-linked immunosorbent assay. In the patient group, coronary artery disease severity was assessed using the SYNergy between percutaneous intervention with TAXus and cardiac surgery score (SS).
Results: HNP1–3 levels were significantly higher in the group with AMI than in the controls (6.5±5.8 ng/mL vs. 2.8±2.5 ng/mL, p<0.001). The receiver operator characteristic (ROC) analysis yielded a cut-off value of 3.13 ng/mL for differentiating patients with AMI from the controls (area under the curve: 0.739, 95% confidence interval: 0.629–0.831, p<0.001). HNP1–3 levels in the high SS tertile (≥33) were slightly but statistically nonsignificantly higher than that in the low (≤22) and intermediate SS tertiles (high SS: 7.0±6.1 ng/mL, intermediate SS: 5.9±6.2 ng/mL, low SS: 5.3±3.8 ng/mL; p=0.639).
Conclusion: Patients with AMI had higher plasma HNP1–3 levels than the controls, but this did not show a significant correlation with angiographic disease severity. The nonsignificant trend toward higher SS in patients with higher HNP1–3 levels warrants future studies on larger populations.

Objective: Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot that plays an important role in coronary atherosclerosis. In this study, our aim was to investigate the relationship between long-term major adverse cardiovascular events (MACEs) and EAT volume detected by coronary computed tomography angiography (CCTA) in patients with Type 2 diabetes mellitus (T2-DM) without previous coronary events.
Methods: A total of 127 patients with diabetes who underwent CCTA between 2012 and 2014 were enrolled retrospectively. The study population was divided into 2 groups according to whether they experienced or did not experience MACE, which was defined as cardiac death, non-fatal myocardial infarction or unstable angina requiring hospitalization, coronary revascularizations (percutaneous coronary intervention or coronary artery bypass grafting surgery), heart failure, peripheral arterial disease, or ischemic stroke. In both groups, EAT volumes were measured by CCTA.
Results: During 60±7 months follow-up period, 22 participants experienced MACEs. Data were evaluated with univariate and multivariate analyses and receiver operating characteristic (ROC) analysis. Age, male sex, coronary artery disease, hemoglobin A1c, glucose, creatinine, C- reactive protein, and cholesterol levels were found to be associated with MACE. EAT volume (odds ratio [OR]: 1.027; 95% confidence interval [CI]: 1.010‒1.044, p=0.002) and low-density lipoprotein (OR: 1.015; 95% CI: 1.000‒1.030, p=0.050) were found to be independent predictors for MACE. ROC analysis indicated that EAT volumes >123.2 mL had a 72.7% sensitivity and a 77.1% specificity for predicting long-term MACE in patients with T2-DM (area under the curve: 0.820; 95% CI: 0.733–0.908).
Conclusion: EAT volume is an independent predictor of long-term MACE in patients with T2-DM without previous coronary events. EAT volume may be used additionally in risk stratification for MACE besides the well-known vascular risk factors in patients with T2-DM.

Objective: Sudden cardiac death (SCD) is one of the causes of death among patients infected with human immunodeficiency virus (HIV). The T peak to T end interval (Tp-e interval) is a parameter that is used in the prediction of SCD. The aim of this study was to investigate the difference in Tp-e interval and Tp: QT and Tp: corrected QT interval (QTc) ratios between patients infected with HIV and healthy individuals as well as in other factors affecting patients infected with HIV.
Methods: A total of 83 patients infected with HIV with negative HIV ribonucleic acid (RNA) levels who were receiving antiretroviral therapy (ART) and 83 healthy individuals were included in this study. All the participants underwent electrocardiography, their Tp-e and QT intervals were measured, and QTc intervals and Tp-e: QT and Tp-e: QTc ratios were calculated. In addition, in the patients infected with HIV, CD4 and CD8 T-cell count and HIV RNA levels were measured.
Results: The Tp-e interval was found to be longer and the Tp-e: QT and Tp-e: QTc ratios were found to be higher in patients infected with HIV. Nadir CD4 was observed to be an independent predictor of Tp-e interval (p=0.014, β=‒0.28). Furthermore, correlation analysis revealed a negative correlation of the nadir CD4 level and CD4: CD8 ratio with Tp-e interval and Tp-e: QT ratio.
Conclusion: Low nadir CD4 and a reversed CD4: CD8 ratio in patients infected with HIV receiving ART were found to be associated with a prolonged Tp-e interval and increased Tp-e: QT and Tp-e: QTc ratios. Thus, more attention should be taken in terms of SCD in patients infected with HIV, especially in those with low nadir CD4 and reversed CD4: CD8 ratio.

Objective: The objective of this study is to determine the impact of applying lifestyle intervention in the form of a continuous care model (CCM) on reducing dietary sodium intake and blood pressure (BP) in patients with hypertension.
Methods: This randomized controlled trial was conducted in a 2-group design on a total of 50 patients who were hypertensive (experimental and control) as a pre‒post test study. A healthy lifestyle (emphasizing physical activity and heart-healthy diet) in the form of CCM, which considers the patient as an active agent in the health process, was conducted in the experimental group over a period of 4 months. The mean BP value and dietary sodium intake in both groups were measured at the beginning and the end of the study.
Results: The mean sodium intake, the mean systolic BP, and the mean diastolic BP decreased to 2.42±0.73 mm Hg (from 3.12±0.79), 128.4±13.04 mm Hg (from 144.20±13.12), and 79.4±8.93 mm Hg (from 89±9.12), respectively, after the intervention in the experimental group (p=0.021, p<0.001, and p=0.011, respectively).
Conclusion: Applying lifestyle intervention in the form of CCM may be recommended to reduce dietary sodium intake and mean systolic and diastolic BP in patients who are hypertensive. Considering the fact that lifestyle modifications are quite important regardless of the use of antihypertensive drugs, lifestyle intervention in the form of CCM is recommended to improve patient’s adherence to dietary restrictions and consequently, treatment outcomes in patients who are hypertensive.

Summary– Ventricular septal rupture (VSR) is an ominous mechanical complication of acute myocardial infarction (MI) accompanied with a poor prognosis. Transcatheter closure (TCC) of VSR has been proposed as an alternative approach for surgery. This study presents a 79-year-old man with diabetes mellitus, hypertension, dyslipidemia, and chronic stable angina with 3-vessel coronary artery disease, who had refused a coronary artery bypass graft. He complained of orthopnea and dyspnea of New York Heart Association (NYHA) function class III after the recent neglected inferior MI. Transthoracic echocardiography revealed moderate left ventricular (LV) systolic dysfunction, true aneurysm formation at the base of the inferoseptal wall, as well as a large-sized (12 mm) VSR at the posterior aspect of basal inferoseptal segment with significant left to right shunt and a peak systolic gradient of 50 mm Hg at the VSR site. Given the high risk profile for surgery and patient refusal, he was a candidate for TCC of VSR and staged multi-vessel percutaneous coronary intervention (PCI). A 30 mm Figulla atrial septal defect (ASD) occluder device was chosen and successfully deployed at the VSR site with minimal residual shunt. A month later, successful multi-vessel PCI was performed with good procedural and clinical outcomes on the 6-month follow-up.

Summary– Symptomatic aortic aneurysms can manifest in different clinical settings, such as acute coronary syndrome (ACS), acute heart failure, a shock that is mostly due to the complications related to dissection or rupture of the aneurysm. In these clinical settings, the diagnosis can be established with the help of medical history, physical examination, and promptly performed imaging tests. However, the diagnosis of an asymptomatic aortic aneurysm is usually incidental. Thus, it is very rare to find a case of ACS with intact aortic aneurysm and without obstructive coronary artery disease. In this paper, we report a successfully treated male patient aged 41 years with intact ascending aortic aneurysm who presented with ACS and was diagnosed with the help of bedside echocardiographic assessment.

Summary– Pacemakers are lifesaving devices that are being implanted with various indications, such as sinus node disease, atrioventricular block, and cardiac resynchronization therapy. Impedance measurement is one of the integral tests by which electrical resistance in pacing lead is tested. In this paper, we report an interesting observation of sudden impedance rise after ventricular tachycardia ablation with transmural lesions, which subsequently normalized without any need for intervention. The clinical implication of our findings is that careful observation might be indicated instead of lead replacement in case of a sudden surge in epicardial lead impedance after endocardial ablation owing that the impedance surge might be reversible.