Objective: The aim of the study was to describe the acute cardiotoxic effects of anthracycline chemotherapy in echocardiographic strain and electrocardiographic repolarization parameters in patients with breast cancer.

Methods: A total of 35 consecutive patients (all females, mean age: 48.9 ± 11.8 years) who received chemotherapy due to breast cancer were prospectively included. Pre-treatment (T0) and third month (T2) 2-dimensional strain echocardiography and electrocardiography were performed. Additionally, within 3 hours of the first dose of chemotherapy (T1), additional elec-trocardiographic images were obtained. All mechanical and electrical parameters from different time intervals (T0, T1, and T2) were compared with each other.

Results: In the acute period after treatment, electrocardiographic repolarization parameters were prolonged and this prolongation continued to the third month (QT corrected with Bazett formula [440.10 ± 27.63 (T0), 468.00 ± 38.98 (T1), 467.86 ± 35.09 (T2)], QT dispersion
[49.85  ± 19.52 (T0), 69.54 ± 16.06 (T1), 57.63 ± 14.42 (T2)], and T-wave peak-to-end interval [94.00 ± 45.46 (T0), 131.20 ± 17.79 (T1), 120.00 ± 18.32 (T2)]; P <.001). There
was no significant change in global longitudinal strain values before and after treatment (global
longitudinal strain avg: −21 ± 7.1%; P =.8). However, there were significant reductions in strain parameters including circumferential and radial strain, and torsion (−17.2 ± 3.5 to -13 ± 2.84; P  < .001, 45.1 ± 8.3 to 35.6 ± 10; P <.001, and 12.1 ± 3.5 to 7.7 ± 2.1; P <.001, respectively).

Conclusion: Both the electrical and mechanical functions of the heart can be impaired acutely extending to 3 months after anthracycline chemotherapy. Therefore, cardiotoxicity should be evaluated early both electrically and mechanically after chemotherapy.

Objective: Acute myocarditis mimics acute coronary syndrome due to its clinical course and presentation. This study aimed to evaluate left ventricular longitudinal and circumferential functions during the acute phase and late phase of acute myocarditis with preserved left ventricular ejection fraction using 2-dimensional speckle tracking echocardiography.

Methods: Forty-one consecutive acute myocarditis patients with preserved left ventricular ejection fraction confirmed by cardiac magnetic resonance imaging underwent 2-dimensional speckle tracking echocardiography within the first week of hospital admission. Findings were compared with age and sex-matched 40 healthy controls. Left ventricular mechanics of the study group were reevaluated by 2-dimensional speckle tracking echocardiography during followup (23.85 ± 6.65 months later).

Results: Myocardial lesions with late gadolinium enhancement on cardiac magnetic resonance imaging were mostly localized in the subepicardial layer (91.40%) and commonly observed in the inferolateral wall (42.94%). Consistent with the cardiac magnetic resonance imaging findings, 2-dimensional speckle tracking echocardiography showed the localization of the involved myocardial segments with prominent impairment in global longitudinal peak systolic strain and global circumferential strain of the inferolateral wall of the left ventricle. In the acute phase, global longitudinal peak systolic strain (−17.32 ± 2.02 vs −20.59 ± 2.38) and global circumferential strain (−22.33 ± 2.27 vs −24.85 ± 3.19) were found to be lower in patients with acute myocarditis compared to healthy controls (both P <.001). While global circumferential strain was improved in the late phase compared with the acute phase (from −22.28 ± 2.32 to −22.90 ± 2.65; P =.003), global longitudinal peak systolic strain was not significantly changed during follow-up (from −17.30 ± 2.09 to –17.62 ± 2.19; P =.072).

Conclusion: Subtle left ventricular systolic function impairment can be detected by the
2-dimensional speckle tracking echocardiography technique in patients with acute myocarditis with preserved left ventricular ejection fraction and improvement in circumferential function could be observed during follow-up.

Objective: Abnormal iron handling complicates pulmonary hypertension and causes functional limitation and poor outcomes. Although preliminary results in group 1 pulmonary hypertension patients support the use of iron replacement, whether this applies to other PH subgroups is not known.

Methods: A total of 58 patients with an established diagnosis of group 1 or 4 pulmonary hypertension, who had serum ferritin of <100 ng/mL or 100-300 ng/mL in combination with a transferrin saturation <20% and received 500-1000 mg of ferric carboxymaltose, were included in the study. The change in ferritin levels and transferrin saturation was calculated at 12- and 24-week follow-up. A six-minute walk test is undertaken at the first, 12-week, and 24-week follow-up visits.

Results: In group 1 pulmonary hypertension patients, ferritin levels increased from 14 ng/mL to 133 and 90 ng/mL at 12- and 24-week, respectively (P <.001 for both). In group 4 pulmonary hypertension patients, ferritin levels increased from 22.1 ng/mL to 145 and 88.9 ng/mL at 12 and 24 weeks, respectively (P <.001 for both). The 6-minute walk test distances were 356, 412, and 350 m in group 1 pulmonary hypertension patients and 260, 315, and 290 m in group 4 pulmonary hypertension patients. Although the difference between baseline and 12-week 6-minute walk test was significant in both groups (P <.001 for both), this difference was lost at 24-week.

Conclusion: Our study indicates that there is no difference in response to iron replacement in patients with group 1 and group 4 pulmonary hypertension patients, in terms of treatment success and functional status.

Objective: Atrial fibrillation is the most common arrhythmia observed in the clinical practice. Pulmonary vein isolation is a well established treatment option for atrial fibrillation but is limited by recurrence. Previous studies have demonstrated that abnormal P wave indices were associated with adverse atrial remodeling and its role in predicting atrial fibrillation recurrence. In the present study, we aimed to evaluate the place of a novel index as we named P wave duration-t o-amplitude ratio in predicting the recurrence of atrial fibrillation.

Methods: Patients who underwent pulmonary vein isolation for symptomatic drug-resistant atrial fibrillation between January 2016 and March 2018 were retrospectively screened. A total of 111 patients were enrolled in the current study. P wave indices of the patients were calculated by precisely measuring the electrocardiogram traces recorded with an electrophysiology recording system.

Results: While P wave duration (129 ± 18.4 vs. 109 ± 15.7 ms, P <.001), P wave duration-to-amplitude ratio (1072.7 ± 528.3 vs. 626.9 ± 368 ms/mV, P <.001), P wave peak time (65 ± 12 vs. 54 ± 10 ms, P <.001), and P wave dispersion (49 ± 14.1 vs. 27.9 ± 17 ms, P =.001) values were significantly higher in the atrial fibrillation recurrence (+) group, the P wave amplitude (0.12 ± 0.05 vs. 0.18 ± 0.02 mV, P <.001) value was found to be lower. A P wave duration-t o-amplitude ratio value of >830 ms/mV has 61.8% sensitivity and 88.4% specificity for the prediction of the atrial fibrillation recurrence (area of under the curve [AUC], 0.727).

Conclusion: P wave duration-to-amplitude ratio, which may be considered as an indicator of the temporal and electrical propagation of the P wave in the atria, can predict atrial fibrillation ablation recurrence.

Objective: Acute myocardial infarction constitutes one of the leading reasons for cardiac mortality. Therefore, early identification of high-risk patients provides better prognostic accuracy. This study aimed to investigate the prognostic significance of novel inflammatory biomarkers such as neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and prognostic nutritional index in acute myocardial infarction patients treated with percutaneous coronary intervention and to compare their predictive abilities with each other.

Methods: A total of 828 acute myocardial infarction patients treated with percutaneous coronary intervention were retrospectively analyzed. The inflammatory indices, such as neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and prognostic nutritional index, were calculated by admission blood tests. The study population was divided into 2 groups according to the occurrence of major adverse cardiac events, which were defined as all-cause mortality, non-fatal myocardial infarction, and cerebrovascular events.

Results: Multivariate Cox regression analysis determined prognostic nutritional index as an inde-pendent predictor of major adverse cardiac event and all-cause mortality (hazard ratio: 1.05,
95% CI: 1.02-1.07, P <.001 for major adverse cardiac event and hazard ratio: 1.05, 95% CI: 1.02-1.09, P =.002 for all-cause mortality). Receiver operating characteristic curves revealed that the predictive value of prognostic nutritional index with both regard to major adverse cardiac event and all-cause mortality was better than the systemic immune-inflammation index and neutrophil-to-lymphocyte ratio (by DeLong method, area under curvePNI vs. area
under curveSII z test = 2.66, P =.008; area under curvePNI vs. area under curveNLR z test = 2.8, P =.006; area under curvePNI vs. area under curveSII z test = 2.58, P =.009; area under curvePNI vs. area under curveNLR z test = 3.28, P =.001; respectively).

Conclusions: Prognostic nutritional index was demonstrated as an independent predictor of major adverse cardiac events and all-cause mortality and a more powerful prognostic index than other novel inflammatory biomarkers in acute myocardial infarction patients treated with percutaneous coronary intervention.

Objective: The Performance Measure for Activities of Daily Living-8 (PMADL-8) for patients with congestive heart failure is an International Classification of Functioning, Disability, and Health-based Activities of Daily Living (ICF) questionnaire to evaluate disease-specific functional limitations in chronic heart failure (CHF). The purpose of this study was to investigate the reliability and validity of the Turkish version of the PMADL-8 in CHF patients.

Methods: In this study, 50 patients with CHF were included. Test–retest reliability of the PMADL-8 was assessed by intraclass correlation coefficient and Cronbach’s alpha was calculated for internal consistency. Correlation coefficients between the PMADL-8 and New York Heart Association (NYHA) functional class, Chronic Heart Failure Questionnaire (CHQ), Nottingham Health Profile (NHP) were analyzed for construct validity.

Results: The Cronbach’s alpha value of the PMADL-8 test and retest scores were recorded as 0.996, indicating that the scale is highly reliable. Test–retest reliability results of the PMADL-8 (mean intraclass correlation coefficient = 0.996) were excellent. The PMADL-8 score was moderately correlated with the NHP total score (r = 0.629, P <.001) and NHP physical abilities score (r = 0.517, P <.001). The PMADL-8 score was weakly correlated with the NYHA functional class (r = 0.385, P <.006), CHQ dyspnea (r = −0.475, P <.001), CHQ fatigue (r = −0.340, P =.016), and total score (r = −0.367, P =.009).

Conclusion: The Turkish version of PMADL-8 is a reliable and valid assessment tool that could be used to determine activity limitations in CHF. The PMADL-8 is also useful for health professionals during the ICF evaluation of CHF patients.

The human cardiovascular system is a product of evolution that occurred over hundreds of thousands of years. During its long history, cardiovascular design has been shaped and reshaped by developing adaptations to the hemodynamic challenges it faced at every step. Although being momentarily beneficial for dealing with the problem they were first devised for, the evolutionary changes were built upon one another and culminated in the current scheme which may not necessarily be the ultimate or an immaculate design. Therefore, the analysis of the cardiovascular evolution provides a fascinating opportunity to spot the possible weak points of our cardiovascular system, to better understand the disease pathophysiology, and to formulate treatment alternatives. In this regard, this review tries to summarize the teleonomy of cardio-vascular evolution from a hemodynamic perspective.

A 61-year-old male presented to emergency department with symptoms of shortness of breath, palpitations, and night sweats. We performed bedside transthoracic echocardiography which showed shunt from the left ventricle to the right atrium in systole with color Doppler examination. Gerbode-type ventricular septal defect and an image of a fibrillar, mobile mass compatible with vegetation was observed just above the tricuspid valve. We performed trans-esophageal echocardiography which showed vegetations on the aortic valve noncoronary cusp. Two sets of blood cultures were positive for Streptococcus sanguinis. The patient was evaluated by the heart team and an operation decision was made for the patient. The patient underwent surgery after 2 weeks of antibiotic theraphy. In the surgery, the Gerbode-type ventricular septal defect was closed with a polytetrafluoroethylene patch. Tricuspid annuloplasty was performed with De Vega technique. Mechanical aortic valve was implanted. Postoperative transthoracic echocardiography showed no residual shunt.

Emery–Dreifuss muscular dystrophy is one of a group of muscular dystrophies caused by a deficiency in genes encoding nuclear proteins (emerin, lamin A/C, nesprin). It progresses with joint contractures, muscular dystrophy, and cardiac involvement. Cardiac findings include dilated cardiomyopathy, conduction defects, and an associated increased risk of sudden cardiac death. We report the case of a young boy, aged 16, with lamin A/C gene mutation and dilated cardio-myopathy. From the patient’s history, it was learned that his father and sister also had dilated cardiomyopathy and both died of heart failure. Cardiac resynchronization therapy implantation was planned in the follow-up of the patient due to progressive left ventricular dysfunction and left ventricular dyssynchrony. But the family did not accept this treatment option. The patient was placed on the heart transplant list. While waiting for a suitable donor, he died as a result of sudden cardiac arrest while he was being treated in the intensive care unit.

Non-ischemic dilated cardiomyopathy is the most common subgroup of heart failure in young adults. Several metabolic defects could be the underlying etiology in these young heart failure patients. However, most cases are considered idiopathic. Primary carnitine deficiency is an overlooked inherited metabolic disease causing cardiomyopathy in these patients. Oral carnitine replacement therapy could prevent primary carnitine deficiency patients from progressing to advanced heart failure and life-threatening arrhythmias. In this case report, we present an index primary carnitine deficiency case and his brother’s diagnosis and successful treatment period to draw attention to primary carnitine deficiency as a treatable cause of heart failure in young adults.