Objective: Down syndrome is a genetic syndrome characterized with various dysmorphisms and congenital malformations such as congenital heart diseases. We aimed to evaluate the relationship between Down syndrome, hypothyroidism, and cardiac findings.

Methods: Thyroid hormone profiles and echocardiographic findings were evaluated. Patients with hypothyroidism and Down syndrome were named group 1; patients with hypothyroidism without Down syndrome group 2 and group 3 was control. The echocardiographic parameters (interventricular septum and left ventricular systolic, diastolic posterior wall thickness, left ventricular end-diastolic diameter, ejection fraction) were indexed to body surface area. Left ventricular mass index and relative wall thickness were calculated. Patients with relative wall thickness equal to or below 0.42 were classified as eccentric hypertrophy or normal geometry, while those over 0.42 as concentric remodeling or concentric hypertrophy.

Results: Thyroid stimulating hormone values of groups 1 and 2 were significantly higher than those of group 3. There were no significant differences for fT4 between the groups. Interventricular septum and left ventricular posterior wall end-diastolic and end-systolic thickness were significantly higher in group 1 than groups 2 and 3. There was no statistically significant difference in left ventricular mass index between groups 1 and 2. In terms of relative wall thickness, 16 out of 29 patients in group 1 were revealed as concentric remodeling, 12 as normal geometry, 1 patient as eccentric hypertrophy. In group 2, 6 patients were revealed as concentric remodeling, 14 as normal geometry. There was no statistically significant difference of left ventricular end-diastolic thickness between 3 groups.

Conclusion: Cardiac morphology and functions were significantly affected by hypothyroidism in patients with Down syndrome. Hypertrophy in Down syndrome may be caused by the cellular changes in myocardium.

Objective: This study aimed to compare the sympathetic nervous system activity of atrial fibrillation patients without structural heart disease and the normal population in terms of urinary metanephrine levels.

Methods: Our study was conducted with 40 paroxysmal or persistent patients without structural heart disease and CHA2DS2VASc score of 0 or 1 and 40 healthy controls. Laboratory parameters, demographic characteristics, and 24-hour urine metanephrine levels were compared between the 2 groups included in the study.

Results: Metanephrine value in urine was found to be significantly higher in the atrial fibrillation group (atrial fibrillation group 97.50 ± 17.19 µg/day vs. control group 74.27 ± 15.55 µg/day; P < 0.001). The body mass index of the atrial fibrillation group was found to be significantly higher than the control group (atrial fibrillation group 27.26 ± 2.97 kg/m2 vs. control group 24.05 ± 2.24 kg/m2; P < 0.001). In multivariate linear regression analysis, body mass index (beta: 0.266, P =.02) and urinary metanephrine level (beta: 0.522, P = 0.002) were found to be independent risk factors. According to receiver operating characteristic analysis, it was determined that urinary metanephrine value (area under the curve = 0.834, P < 0.001) and body mass index (area under the curve = 0.803, P < 0.001) predicted the development of atrial fibrillation.

Conclusion: Our study found that urinary metanephrine levels were higher in patients with atrial fibrillation without structural heart disease than those without atrial fibrillation, and metanephrine values predicted the development of atrial fibrillation.

Objective: Acute heart failure remains at high risk of mortality despite recent advances in the management and treatment of heart failure. Recently, C-reactive protein to albumin ratio has been shown to predict all-cause mortality in heart failure with reduced ejection fraction. The association between C-reactive protein to albumin ratio and in-hospital mortality in patients with acute heart failure regardless of the left ventricular ejection fraction remains unknown.

Methods: In this retrospective, single-center cohort study, we included 374 hospitalized patients with acute decompensated heart failure. We calculated C-reactive protein to albumin ratio and evaluated the relationship between the values and in-hospital mortality.

Results: During hospitalization duration of 10 [6-17] days, need for hemodialysis/ultrafiltration, acute ischemic hepatitis, coagulopathy, ventricular tachycardia, invasive mechanical ventilation, and shock were more prevalent in the high C-reactive protein to albumin ratio (≥0.78) group compared to low C-reactive protein to albumin ratio (<0.78) group. Mortality was higher in the high C-reactive protein to albumin ratio group in comparison to the low C-reactive protein to albumin ratio group (36.7% vs. 12%; P < 0.001). C-reactive protein to albumin ratio was independently and significantly associated with in-hospital mortality (hazard ratio = 1.69, 95% CI: 1.02-2.82; P = 0.042) by multivariate Cox proportional hazard analysis. In receiver operating characteristic analysis, C-reactive protein to albumin ratio was able to predict in-hospital mortality (area under the curve value for in-hospital mortality was 0.72; P < 0.001).

Conclusion: Admission C-reactive protein to albumin ratio was associated with increased all-cause mortality in hospitalized patients with acute decompensated heart failure.

Objective: Beneficial effects of transaortic valve implantation on left ventricular hemodynamics and prognosis of patients have been demonstrated. Although left ventricular systolic and diastolic function following transaortic valve implantation procedure have been examined in previous studies, 4-dimensional echocardiographic parameters have not been extensively studied, especially in patients with preserved ejection fraction aortic stenosis. In our study, we planned to evaluate the effect of transaortic valve implantation on myocardial deformation using 4-dimensional echocardiography.

Methods: A total of 60 consecutive patients who underwent transaortic valve implantation for severe aortic stenosis with preserved ejection fraction were prospectively enrolled in the study. Standard 2-dimensional echocardiography and 4-dimensional echocardiography were performed in all patients before and 6 months after the transaortic valve implantation procedure.

Results: Six months after valve implantation, significant improvement was observed in global longitudinal strain (P < 0.001), spherical circumferential strain (P = 0.022), global radial strain (P = 0.008), and global area strain (P < 0.001). In the regression analysis, global area strain and absence of diabetes mellitus were determined as independent predictors to show a 10% increase in the left ventricular ejection fraction.

Conclusions: In patients with preserved ejection fraction who underwent transaortic valve implantation, left ventricle deformation parameters have improved after 6 months, especially by using 4-dimensional echocardiography. The use of 4-dimensional echocardiography should be more common in daily practice.

Objective: The appointment system has been developed and implemented to eliminate difficulties with queued admissions. To identify and eliminate admission gaps, this study examined the characteristics of patients who applied to the cardiology outpatient clinic via appointment and queue systems.

Methods: The study comprised 2135 cardiology outpatients. Patients were divided into 2 groups based on whether they used appointments (group 1) or the queue (group 2). Both groups’ and non-cardiac diagnosed patients’ demographic, clinical, and presentational variables were compared. Comparing patients’ characteristics by appointment-to-visit time was also done.

Results: There were 1088 female participants (51%). Female gender (54.8%) and individuals aged ≥ 18–64 (69.8%) years were significantly higher in group 1. While the rate of first admission (P = 0.003) patients was significantly higher in group 1, the rate of patients followed up (P = 0.003) and disabled (P = 0.011) was significantly higher in group 2. Patients’ rate with non-cardiac complaints was 40.2% in group 1, but it was significantly lower in group 2 at 22.2% than in group 1 (P = 0.001). Admissions to the emergency department within the last month were significantly higher in group 2 than group 1 (P = 0.021), this rate was significantly higher in favor of group 1 (P =.031) in patients with non-cardiac diagnoses. In addition, patients who requested a general examination and had no complaints were significantly higher in group 1 than in group 2 (P = 0.003). Comparing the post-examination diagnoses, it was shown that group 2 (76.3%) had a higher rate of cardiac diagnoses than group 1 (51.5%). The presence of cardiac-related complaints (P = 0.009) and appointment-to-visit time ≥ 15 days (P = 0.013) were found to be significant independent predictors of admission to the emergency department. The rates of patients with cardiac-related complaints (40.8%) and patients under follow-up (63%) were higher in the group with a gap of ≥ 15 days between appointment-to-visit time.

Conclusion: Prioritizing patients by complaints, clinical features, medical history, or cardiovascular risk factors can enhance appointment scheduling.

Objective: Oxidative stress is closely related to the development of atherosclerosis and acute coronary syndromes. In this study, we aimed to examine the relationship between hemogram indices and oxidative stress parameters in patients with ST-segment elevation myocardial infarction.

Methods: A single-centered, prospective, and cross-sectional study was performed in 61 patients with ST-segment elevation myocardial infarction. Before coronary angiography, in the blood samples taken from the peripheral vein, hemogram indices and oxidative stress parameters such as total oxidative status, total antioxidant status, and oxidative stress index were examined. We examined a total of 15 hemogram indices.

Results: Most of the study patients were male (78%), and the mean age was 59.3 ± 12.2 years. Mean corpuscular volume value was found to be negatively and moderately significantly correlated with total oxidative status and oxidative stress index values (r = −0.438, r = −0.490, P < 0.001). A negative and moderate significant correlation was found between mean corpuscular hemoglobin and total oxidative status and oxidative stress index values (r = −0.487, r = −0.433, P < 0.001). Red cell distribution width value was found to be positively and moderately correlated with total oxidative status (r = 0.537, P < 0.001). Red cell distribution width was also found to be moderately and statistically significantly correlated with oxidative stress index value (r = 0.410, P = 0.001). In receiver operating characteristic analysis, mean corpuscular volume, mean corpuscular hemoglobin, and red cell distribution width levels have been successful in predicting total oxidative status and oxidative stress index.

Conclusions: We conclude that mean corpuscular volume, mean corpuscular hemoglobin, and red cell distribution width levels predict oxidative stress in patients with ST-segment elevation myocardial infarction.

Organelles whose functions change as a result of molecular processes are involved in the pathogenesis of atherosclerosis, which is the main cause of coronary artery disease, in addition to molecular processes. Recently, the role of mitochondria in the pathogenesis of coronary artery disease has attracted the attention of researchers. Mitochondria is a cell organelle with its own genome that plays a regulatory role in aerobic respiration, energy production, and cell metabolism. The number of mitochondria in cells changes dynamically, and there are different numbers of mitochondria in every tissue and every cell, depending on their function and energy needs. Oxidative stress causes mitochondrial dysfunction by leading to alterations in the mitochondrial genome and mitochondrial biogenesis. The dysfunctional mitochondria population in the cardiovascular system is closely related to the coronary artery disease process and cell death mechanisms. It is thought that the altered mitochondria (dys)function accompanying the molecular changes in the atherosclerosis process will be among the new therapeutic targets of coronary artery disease in the near future.

This article presents the case of a 24-year-old woman with Poland syndrome who developed primary right atrial cardiac angiosarcoma. The patient presented to the hospital with dyspnea and chest pain, and imaging studies revealed a large mass attached to the right atrium. Urgent surgery was performed to remove the tumor, and the patient underwent adjuvant chemotherapy afterward. Follow-up exams showed no signs of the tumor or any complications from treatment. Poland syndrome is a rare congenital disorder characterized by the absence of unilateral large pectoral muscle, ipsilateral symbrachydactyly, and other malformations of the anterior chest wall and breast. Although the condition does not predispose patients to malignancy, different pathologies can be seen in these patients due to the unknown etiology of the syndrome. Primary right atrial cardiac angiosarcoma is a rare malignancy, and its coexistence with Poland syndrome has not been well established in the literature. This case report highlights the need to consider cardiac angiosarcoma as a possible diagnosis in patients with Poland syndrome who present with cardiac symptoms.

Renal artery stenosis is the leading cause of secondary hypertension. Percutaneous treatment options are safe and effective but can, in rare cases, entail possible complications such as renal subcapsular hematoma. Awareness of such complications will enable better management. Although post-intervention subcapsular hematomas are believed to occur secondary to wire perforation, in this report, we present 3 cases demonstrating reperfusion injury findings rather than wire perforation.

Pulmonary arterial hypertension is still a fatal disease persisting with poor prognosis, despite all the advances in treatment (new agents and new combination strategies) in recent years. Patients present with different symptoms which are not specific to the disease (dyspnea, angina, palpitation, and syncope). Angina may occur secondary to myocardial ischemia due to increased right ventricular afterload (oxygen supply and demand mismatch) or external compression on the left main coronary artery. Left main coronary artery compression is associated with post-exercise sudden cardiac death in pulmonary arterial hypertension patients. It should be kept in mind in the differential diagnosis of angina in patients with pulmonary arterial hypertension and should be treated immediately. Here, we report a pulmonary arterial hypertension patient associated with secundum-type atrial septal defect presented with ostial left main coronary artery compression caused by an enlarged pulmonary artery and treated with intravascular ultrasound-guided percutaneous coronary intervention.