Objective: Impaired arterial elastic features is one of the earliest manifestations of atherosclerosis in the vessel wall and is associated with the development of cardiovascular disease and increased mortality and morbidity. In this study, we aimed to investigate the mean values of aortic elasticity parameters in a normotensive population with transthoracic echocardiography and to evaluate these values in different age groups and their relationship with other risk factors.

Methods: This retrospective study included 405 subjects who met the inclusion criteria among 2880 individuals screened between 2020 and 2022. The study population was divided into 5 groups according to their age. Aortic elasticity parameters (aortic strain, aortic stiffness index, and aortic distensibility) were calculated from the associated formulas by measurements made from the ascending aorta in the parasternal long axis.

Results: In 405 subjects (mean age 42.18 ± 10.39, 54.3% female), the mean aortic strain value was 15.14 ± 3.56%, the mean aortic stiffness index was 3.24 ± 1.05, and the mean aortic distensibility was 7.48 ± 2.36 cm2/dyn1/103. It was observed that aortic strain and distensibility values significantly decreased with increasing age groups, while aortic stiffness significantly increased. All 3 aortic elasticity parameters were strongly correlated to age. In the multivariate linear regression analysis, age was found to be an independent factor for all aortic elasticity parameters.

Conclusion: Aortic elasticity parameters can be evaluated with transthoracic echocardiography in daily practice. Comparing these measurements with normal values in similar age groups may help to detect patients with increased cardiovascular risk in the early period, regardless of the other risk factors.

Objective: Resistant hypertension is associated with increased mortality and morbidity. The optimal medical therapy is not fully elucidated in resistant hypertension. There are relatively few studies in the literature on the treatment of resistant hypertension. In this study, we compared the effectiveness of nebivolol 5 mg, a third generation beta-blocker, with spironolactone 25 mg in patients with resistant hypertension.

Methods: A total of 81 patients with resistant hypertension were included in the study. The spironolactone group was composed of 38 patients while the nebivolol group was composed of
43 patients. Resistant hypertension was defined as having office blood pressure ≥ 140/90 mmHg while the patients were under 3 or more antihypertensive agents treatment which included diuretic agents. Office and ambulatory blood pressure at basal and after 8 weeks of treatment were recorded.

Results: Office systolic blood pressure and diastolic blood pressure in 24-hour ambulatory blood  pressure monitoring were significantly lower when compared to basal values in both nebivolol and spironolactone groups. The decrease in 24-hour mean systolic and diastolic blood pressure in nebivolol group was 14.9 ± 19.8 mmHg and 9.3 ± 12.7 mmHg compared to 19.5 ± 16.4 mmHg and 13.7 ± 10.8 mmHg in the spironolactone group, respectively. The decrease in 24-hour mean systolic and diastolic blood pressure was not significantly different
between the nebivolol and spironolactone groups (P = 0.338 and P = 0.153).

Conclusion: Nebivolol is an effective treatment option for resistant hypertension and the antihypertensive effect of nebivolol is similar to low-dose spironolactone.

Objective: Our aim in this study was to show the relationship between long-term all-cause mortality and thyroid functions in the elderly patient group that underwent primary percuta-neous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction.

Methods: Two-hundred seventy patients over 65 years of age who underwent primary percutaneous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction were analyzed retrospectively. After applying the exclusion criteria, 198 patients were included in the study. The patients were divided into 2 groups according to their out-of-hospital mortality status. Angiographic, laboratory, echocardiographic, and electrocardiographic data were analyzed.

Results: The mean age of 198 patients in the study was 72.5 ± 6.6 years, and the median follow-up time was 101.7 months. Age was higher in the deceased group (70.4 ± 5.4 vs. 74.5 ± 6.9, P < 0.001). In multivariate analysis, age (odds ratio: 1.59, P = 0.003), insulin (odds ratio: 2.561, P = 0.016), angina balloon time (odds ratio: 1.134, P = 0.002), number of serious stenoses (odds ratio: 1.702, P = 0.003), creatinine (odds ratio: 3.043, P < 0.001), and fT4 (odds ratio: 2.026, P = 0.026) were determined as independent predictors of mortality. The fT4 level was correlated with the uric acid level (R: 0.182, P = 0.02) and the fT3 level was correlated with albumin (R: –0.253, P = 0.001) and creatinine (R: –0.224, P = 0.003) levels. A fT4 level cutoff value of 0.99 ng/mL had a sensitivity of 76%, a specificity of 54%, and an area under the curve of 0.675 in predicting mortality. In Kaplan–Meier analysis, fT4 elevation was strongly associated with mortality (P = 0.01).

Conclusion: In our study, subclinical values in thyroid functions were found to be associated with increased mortality, apart from known factors in elderly patients who underwent primary PTCA with the diagnosis of ST-segment elevation myocardial infarction.

Objective: Different results have been obtained in studies on the effect of anesthesia type applied during transcatheter aortic valve implantation on in-hospital outcomes. In this study, we aimed to investigate the association of the type of anesthesia with the lenght of stay in the intensive care unit and the need for inotropes in patients undergoing transcatheter aortic valve implantation.

Methods: A total of 140 patients who underwent transcatheter aortic valve implantation between January 2016 and January 2022 were retrospectively analyzed. The patients were divided into 2 groups as deep sedation and general anesthesia according to the type of anesthesia.

Results: The mean age of all patients was 78.5 ± 8.6 years, and 69 of the patients (49.3%) were female. Length of stay in intensive care unit, midazolam dosage, use of inotropic agents, and procedural hypotension were significantly lower in the deep sedation group than in the general anesthesia group [(1[1-2] vs. 1[1-2.5] days, P = 0.03), (2.1 ± 0.4 mg/kg vs. 2.3 ± 05, P = 0.02), (39 (37.9%) vs. 22 (59.5%), P = 0.02), (41 (39.8%) vs. 25 (67.6%), P = 0.004)]. General anesthesia was associated with increased use of inotropic agents during transcatheter aortic valve implantation compared to deep sedation (odds ratio = 2.93 95% CI = 1.18-7.30, P = 0.02).

Conclusion: The use of inotropes is less in transcatheter aortic valve implantation procedures performed under deep sedation and length of stay in intensive care unit is shorter.

Objective: Atrial fibrillation is the most common arrhythmia following coronary artery bypass graft surgery. The relationship between impaired lung function and atrial fibrillation has been described previously. We aimed to evaluate the prognostic influence of small airway function on predicting postoperative atrial fibrillation undergoing isolated coronary artery bypass graft surgery (CABG).

Methods: We retrospectively analyzed 283 patients who underwent isolated CABG at our institution between January 2020 and August 2020. The patients were divided into 2 groups according to the development of postoperative atrial fibrillation. Demographic characteristics of the patients were recorded; spirometry was performed for each patient before surgery. Small airway function was determined by forced mid-expiratory flow (forced expiratory flow 25%-75%) values measured by spirometry. Propensity score matching was applied to ensure a balanced distribution of demographic data between the 2 groups.

Results: The frequency of postoperative atrial fibrillation was 30.7% in our patient population. After propensity matching, forced expiratory volume in 1 second/forced vital capacity %
[80.6 (73.8-87.8) vs. 76.3 (66.7-81.6), P = 0.006] and forced expiratory flow 25%-75% (87.4 ± 14.2 vs. 75.2 ± 15.8, P = 0.001) were significantly lower in postoperative atrial fibrillation group. In multivariate analysis, white blood cell count, left ventricular ejection fraction, cross-clamp time, and forced expiratory flow 25%-75% were found to be independent predictors of postoperative atrial fibrillation development after isolated CABG. In the receiver operating characteristic curve analysis, forced expiratory flow 25%-75% with an optimal threshold value of 81% could detect the presence of postoperative atrial fibrillation with 63.8% sensitivity and 70.1% specificity.

Conclusion: Our study demonstrated that small airway obstruction, as indicated by forced expiratory flow 25%-75% in spirometry, can be a simple predictive tool for the development of postoperative atrial fibrillation in patients undergoing isolated CABG.

Objective: The objective of this study is to assess and compare the accuracy of old and new versions of the European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE and SCORE2) American Heart Association/American College of Cardiology Pooled Cohort Risk Assessment Evaluation (PCE) in predicting long-term cardiovascular events in patients with hypertension.

Methods: This retrospective study consisted of 788 patients diagnosed with hypertension between 2009 and 2018. The absolute risk for 10-year cardiovascular events was calculated with SCORE, SCORE2, SCORE-OP, and PCE systems based on patients’ data obtained on the date of hypertension diagnosis. The study group was followed for the occurrence of major adverse cardiac and cerebrovascular events. The differences between observed and predicted risk calculated using SCORE, SCORE2, and PCE systems and their prognostic value were assessed.

Results: The mean age of the 788 patients included in the study, of whom 426 (54.1%) were female, was 54 ± 9 years. During a mean follow-up of 6 years, 173 (22.0%) patients experienced a major adverse cardiac and cerebrovascular event. In predicting the occurrence of major adverse cardiac and cerebrovascular events in hypertension patients over the long-term, PCE had a predictive power comparable and slightly superior to “SCORE2—SCORE-OP (AUC 0.732 vs. 0.724, respectively)” whereas SCORE (AUC 0.689) was inferior to “SCORE2–SCORE-OP.”

Conclusion: In this study, the Pooled Cohort Risk Assessment Equation risk-scoring system was superior to the old and new versions of Systematic Coronary Risk Evaluation risk system in predicting the cardiovascular and cerebrovascular events that developed in patients with hypertension.

Coronary vasospasm is characterized by transient and reversible vasoconstriction that can cause myocardial ischemia. Patients with acute coronary syndrome may present to the emergency department with various clinical features, including mortal arrhythmias and cardiac arrest. Coronary angiography was performed in a 61-year-old male patient with the diagnosis of acute coronary syndrome due to recurrent angina attacks and dynamic changes in electrocardiography. In the patient whose critical stenosis was not detected in the first imaging, angina attack developed before the procedure was terminated. On control imaging, we detected total occlusion of the left anterior descending artery due to coronary vasospasm. After the administration of intracoronary nitroglycerin, the total occlusion of the left anterior descending artery due to vasospasm completely resolved and the angina attack relieved. It is uncommon for total stenosis to develop immediately after the coronary angiography observes open coronary arteries. However, if total stenosis is detected in patients with recurrent angina attacks without risk factors, intracoronary nitroglycerin can be administered to appropriate patients before intervention.

A total of 1492 outpatients with suspected coronary artery disease and who underwent computed tomography-derived fractional flow reserve analysis were examined. To investigate the effects of vessel morphology such as lumen diameter or volume on computed tomography-derived fractional flow reserve, nearly the same or subthreshold values affecting computed tomography-derived fractional flow reserve hemodynamics vessels were compared. Case 1 and 2 present almost the same vessel length (case 1 vs. case 2; 135.0 mm vs. 133.6 mm), low-attenuation plaque volume (0 mm3 vs. 0 mm3), intermediate attenuation plaque volume (12.5 mm3 vs. 35.5 mm3), and calcified plaque volume (4.7 mm3 vs. 0 mm3) in the right coronary artery. However, lumen volume (877.8 mm3 vs. 2443.7 mm3) and distal computed tomography-derived fractional flow reserve (0.79 vs. 0.96) were markedly different between the 2 patients. Computed tomography-derived fractional flow reserve depends not only on vessel length or plaque characteristics but also on lumen volume or vessel morphology.

Infection of cardiac implantable electronic devices is one of the most dangerous complications, and the main treatment approach is the removal of cardiac implantable electronic device from the body. We present a case of successful lead removal of implantable cardioverter-defibrillator infection at which right ventricular lead had giant vegetation material. We performed percutaneous debulking of giant right ventricular lead vegetation by percutaneous approach under the realtime intracardiac echocardiography visualization because of the high risk of pulmonary artery embolization of giant infectious material and poor lung and general condition of the patient.