BACKGROUND:Contrast medium used in coronary angiography may cause changes in the electrophysiological properties of the myocardium, which may lead to some changes in the electrocardiography (ECG). Frontal plane QRS-T (fQRS-T) angle, which can be easily calculated from surface ECG, is an indicator of ventricular repolarization heterogeneity and predictive of arrhythmia. AIMS:The aim of our study was to investigate the effect of contrast medium use on the fQRS-T angle in patients undergoing elective coronary angiography with the diagnosis of stable angina pectoris. METHODS:Our study included 343 patients diagnosed with stable angina pectoris who underwent elective coronary angiography. Demographic data and risk factors of all patients were recorded at admission. The frontal plane QRS-T angle was calculated from routine ECG recordings of patients included in the study before and after coronary angiography and the change was recorded. The amount of contrast agent used was also noted for each patient. RESULTS:The mean age of the patients included in the study was 57.03 ± 9.10, and 185 (53.9 %) were male. The change in fQRS-T angle was statistically significant after the use of contrast media (30.04 ± 30.76 vs 33.87 ± 32.6, p value <0.001). CONCLUSIONS:In our study, although there was a statistically significant increase in the fQRS-T angle of the patients after contrast material, it did not exceed the pathological limit and no life-threatening ventricular arrhythmia was observed.

OBJECTIVE:Coronary artery disease is the leading cause of death worldwide. Vascular endothelial growth factor is known to induce endothelial cell migration and proliferation, increase vascular permeability, and modulate thrombogenicity. The aim of this study is to investigate the relationship between the VEGF insertion/deletion (I/D) variant (rs35569394) and coronary artery disease susceptibility in the Turkish population. METHODS:A total of 206 subjects, including 106 coronary artery disease patients and 100 controls, were included in this study. The VEGF I/D variant was genotyped using the polymerase chain reaction method. RESULTS:The frequency of the I/I, I/D, and D/D genotypes was 35.84 versus 37%, 33.97 versus 36%, and 30.19 versus 27% in patients and the control group, respectively. VEGF I/D genotype and allele distribution were not statistically significant between coronary artery disease patients and controls (p>0.05). There was no significant difference between VEGF I/D genotype distribution and patient characteristics including age, gender, disease duration, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, history of hypertension, history of diabetes mellitus, and smoking (p>0.05). CONCLUSION:This study suggests that the VEGF I/D variant is not a predisposing factor to coronary artery disease disease in a Turkish sample.

The complete genome sequence was determined for prototype parakeet/Netherlands/449/75 strain of avian paramyxovirus (APMV) serotype 3. The genome is 16,272 nucleotides (nt) in length, consisting of six non-overlapping genes in the order of 3'-N-P/V/W-M-F-HN-L-5', with intergenic regions of 31-63nt. APMV-3 genome follows the "rule of six" and is the largest among the avian paramyxoviruses reported to date, with a trailer region of 707nt, the longest in the family Paramyxoviridae. The cleavage site of F protein, A-R-P-R-G-R downward arrowL, does not conform to the preferred cleavage site of the ubiquitous cellular protease furin. Therefore, exogenous protease was needed for replication in vitro. Alignment and phylogenetic analysis of the predicted amino acid sequences of strain Netherlands proteins with the cognate proteins of viruses of all of the five genera of family Paramyxoviridae showed that APMV-3 strain Netherlands is more closely related to APMV-1 than APMV-6.

Introduction: Transradial coronary angiography (TRA) is associated with a lower incidence of bleeding rate and access site complications and is associated with better outcomes compared to transfemoral angiography. However, radial artery spasm (RAS) is an important limitation of TRA procedures. Little is known regarding the relationship of serum vasodilator and inflammatory markers with RAS. Therefore, the present study aimed to investigate the association between serum adropin level and RAS in patients undergoing TRA. Methods: From February 2020 to January 2021, 39 consecutive patients who underwent elective daiagnostic TRA and experienced RAS during the procedure, and 42 age and sex matched controls who did not experience RAS were prospectively included into the study. The groups were compared regarding serum adropin levels and inflammatory markers. Results: Although adropin levels were found to be lower in the RAS group, this difference was not statistically significant between the the patients with RAS and controls (14.9 vs. 16.1, P=0.105). However, inflammatory parameters monocyte count and MHR (monocyte/HDL cholesterol ratio) were found to be statistically significantly higher in the RAS group compared to controls (P=0.001 and P=0.010, respectively). Moreover, a significant positive correlation was found between the monocyte count and RAS (r:0.360, P<0.001), and between MHR and RAS (r:0.288, P=0.009). Furthermore, multivariate analysis demonstrated that monocyte count (OR:1.671, 95%CI:1.312-2.094, P=0.001) and MHR (OR:1.116, 95%CI:1.054-1.448, P=0.022) were found to be independent predictors of RAS. Conclusion: Serum vasodilator and inflammatory markers may be useful in the prediction of RAS in patients undergoing TRA procedures.

What is known and Objective Although restoration of sinus rhythm is the integral part of the atrial fibrillation (Af) management, recurrence frequency of Af is high after cardioversion. However, little is known about the association of electrocardiography (ECG) parameters with Af recurrence after restoration of sinus rhythm. The present study aimed to investigate whether frontal plane QRS-T (fQRST) angle, as a marker of ventricular repolarization heterogeneity, predicts Af recurrence after successful pharmacological cardioversion. Methods One hundred and sixty-five paroxysmal Af patients with an acute Af episode who underwent successful pharmacological cardioversion with intravenous amiodarone infusion were included into the study. Patients were divided into two groups according to presence or absence of in-hospital Af recurrence. The association between fQRST angle and Af recurrence was investigated. Results and discussion Af recurrence was observed in 42 (25.4%) patients. The mean fQRST angle was significantly higher in patients with Af recurrence compared to those without Af recurrence (90 +/- 45.8 vs. 51 +/- 38.2, p < 0.001). Also, Af recurrence was more frequent in patients who had fQRST angle >90, compared to patients with fQRST angle <= 90 (54.1% vs. 13.7%, p < 0.001). Moreover, ROC curve analysis demonstrated that an increased fQRST angle >92.5 predicted in-hospital Af recurrence with a sensitivity of 76.2% and a specificity of 81.4% (AUC:0.728, p < 0.001). Furthermore, multivariate analysis demonstrated that fQRST angle was an independent predictor of in-hospital Af recurrence after successful pharmacological cardioversion (OR: 1.892, 95% CI: 1.361-2.917, p < 0.001). What is new and conclusion As a parameter that can be easily calculated from automated ECG recordings, fQRST angle may be useful in the prediction of early Af recurrence after successful pharmacological cardioversion with amiodarone.

BACKGROUND:Increased left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH) are independent predictors of adverse cardiovascular events. However, little is known regarding the association between coronary circulation and LVMI. We aimed to investigate the association between coronary dominance and LVMI, and to demonstrate the impact of coronary dominance pattern on the emergence of LVH.METHODS:In total, 367 consecutive patients without known cardiovascular disease and significant obstructive coronary artery disease who underwent diagnostic coronary angiography were prospectively included in the study. Patients were divided into three groups according to coronary dominance pattern. Patients with right dominance (RD), co-dominance (CD) and left dominance (LD) patterns were compared regarding echocardiographically detected LVMI. Additionally, the association between coronary dominance pattern and LVH was investigated.RESULTS:The frequency of RD, CD and LD patterns was 70.3%, 19.1% and 10.6%, respectively. LVMI was significantly higher in patients with CD pattern compared with those with RD and LD patterns (P < .001, for both comparisons). LVH was present in 71 (19.3%) patients. Importantly, the CD pattern was more frequent in patients with LVH compared with those without LVH (P < .001). No significant difference was found between women and men regarding the type of coronary dominance pattern. However, while the presence of CD pattern was found to be an independent predictor of LVH in women (OR:1.221, 95%CI:1.048-1.872, P < .001), no association was observed between coronary dominance pattern and LVH in men.CONCLUSIONS:Coronary dominance pattern may significantly affect the LVMI, and it may be useful in the further risk stratification of female patients.

Objective Frontal plane QRS-T (fQRS-T) angle is a marker of ventricular repolarization heterogeneity and increased fQRS-T angle is associated with arrhythmias, adverse events and mortality. However, little is known about the importance and usefulness of fQRS-T angle in hypertensive patients. The present study aimed to investigate the association between blood pressure (BP) levels and fQRS-T angle. The main goal was to demonstrate whether BP lowering has a favorable effect on fQRS-T angle in hypertensive patients. Methods This study included 392 newly diagnosed hypertensive patients who underwent antihypertensive therapy. Responders and nonresponders to antihypertensive therapy were compared regarding baseline and post-treatment fQRS-T angle. fQRS-T angle was calculated as the absolute difference between QRS and T wave axes that were obtained from electrocardiography. Response to treatment was defined as achieving BP levels <140/90 mmHg. Results At the 1-month follow-up visit, responders had significantly lower fQRS-T angle compared to nonresponders despite the similar baseline fQRS-T angle (baseline: 57° ± 18.2° vs.56.6° ± 16.3°; P = 0.819, at 1 month: 36.9° ± 13.7 vs.53.5° ± 15.6°; P < 0.001). Moreover, after 3 months of antihypertensive treatment, both responders at 1 month and 3 months had significantly lower fQRS-T angle compared to nonresponders (34.8° ± 13.3° vs. 35.4° ± 12.9° vs. 52.3° ± 13.9°; P < 0.001). Furthermore, a significant moderate positive correlation was observed between systolic BP and fQRS-T angle (r:0.797; P < 0.001), and between diastolic BP and fQRS-T angle (r:0.761; P < 0.001). Conclusion In the present study, a significant decrease in fQRS-T angle was observed following BP lowering throughout the study period. Therefore, fQRS-T angle may be useful in the monitoring of antihypertensive treatment.

Background: Coronary artery disease (CAD) is the leading cause of mortality in hypertensive patients. Systematic Coronary Risk Evaluation (SCORE) is the preferred scoring system to predict future fatal cardiovascular events in hypertensive patients. However, the relationship between SCORE and coronary atherosclerosis is not well described. We aimed to investigate whether SCORE has a relationship with CAD severity in hypertensive patients, even in the absence of high risk features. Material and methods: Four hundred and fifty-two hypertensive patients who underwent elective coronary angiography and defined as low or moderate risk according to SCORE were included into the study. Patients were divided into two groups. Patients with a SCORE < 1% were defined as low risk group, and patients with a SCORE ≥ 1% and < 5% were defined as moderate risk group. The groups were compared regarding CAD severity. Results: The frequency of stenotic CAD and multivessel disease, and mean SYNTAX score, were significantly higher in SCORE ≥ 1%, and < 5% group compared to patients with SCORE < 1%. Correlation analysis revealed a significant positive moderate correlation between SCORE and SYNTAX score (Pearson’s r: 0.679, p < 0.001). ROC curve analysis demonstrated that a SCORE ≥ 3% predicted SYNTAX score > 22 with a sensitivity of 75% and a specificity of 86.5% (AUC: 0.879, p < 0.001). Furthermore, multivariate analysis demonstrated that SCORE was an independent predictor of stenotic CAD (OR: 1.616, p < 0.001), multivessel disease (OR: 1.913, p < 0.001), and SYNTAX score > 22. (OR: 1.817, p < 0.001). Conclusion: Our results suggest that SCORE is associated with CAD severity in hypertensive patients even in the absence of high risk features. The SCORE system may be useful in further risk stratification of hypertensive patients with moderate risk features and suspected CAD.

Results from studies on the relationship between restless legs syndrome (RLS) and coronary artery disease (CAD) are conflicting. Some studies associate RLS with CAD by heart rate variability, blood pressure variability, and other autonomic, neuronal reasons, while other studies do not support these observations. The aim of this study was to investigate the prevalence of RLS in patients undergoing coronary angiography for CAD and to assess RLS prevalence with severity of CAD. After inclusion and exclusion criteria were applied, enrolled patients with less than 50% coronary artery stenosis by angiography (0–49%) were assigned to group 1, and patients with 50% or more coronary artery stenosis were assigned to group 2. Patients were diagnosed with RLS if they met all five essential criteria of the International RLS study group. RLS prevalence and other comorbidities were compared between the two groups. Of 126 patients, 74 men (59%), mean age 64.0 ± 8.7 years, mean BMI 29.6 kg/m2, 47 (37%) were assigned to group 1 (no or nonobstructive CAD) and 79 (63%) were assigned to group 2 (obstructive CAD). No significant differences were found between the groups in terms of mean age, BMI, gender, or prevalence of hypertension, hypercholesterolemia, and DM. The prevalence of RLS in group 2 (29%) was significantly higher than in group 1 (15%), p = 0.013. These results suggest that prevalence of RLS is associated with CAD and with CAD severity. We conjecture that RLS may be related to vascular endothelial dysfunction in cardiovascular disease.

Aim: Non-dipper hypertension (NDHT) is associated with increased cardiovascular mortality. Lots of different electrocardiographic parameters can be used for this purpose. Some electrocardiographic repolarization parameters and some particular parameters obtained from 24 hours holter recordings frequently were used. The aim of this study was to evaluate ventricular arrhythmia risk by using most of this electrocardiographic parameters in patients with dipper hypertension (DHT) and NDHT.Material and methods: 220 patients with hypertension were included this study. Patients were divided into two groups as DHT and NDHT according to the 24 hours ambulatory blood pressure monitoring. Two groups were compared with electrocardiography and echocardiography parameters and also were compared with heart rate variability (HRV) and heart rate turbulence (HRT) parameters.Results: There were no significant differences between DHT and NDHT groups with regard to demographic and laboratory datas. Also echocardiography parameters normally distributed and have no significant differences between two groups. There were no significant differences between DHT and NDHT groups with regard to left ventricular mass index (p=0.280). Although QT, QT dispersion, HRV and HRT parameters differences were not statistically significant , results were in favour of DHT in terms of ventricular arrhythmia risk. Conclusion: When hypertensive patients having no statistically significant differences in terms of left ventricular diamaters and left ventricular mass between them were divided as DHT and NDHT; there were no statistically significant differences between two groups with regard to electrocardiographic ventricular arrhythmia parameters although results were in favour of DHT.

Background: Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease. Objective: In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease. Methods: This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant. Results: Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden. Conclusions: Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias.

Amaç: Ayak bileği-kol basınç indeksi (AKİ), noninvaziv ve ucuz bir metod olup yaşlı popülasyonda periferik arter hastalığının (PAH) tanımlanması için kullanılır. PAH’nın bir göstergesi olarak AKİ, koroner arter hastalığını (KAH) tahmin etmek için yaygın bir şekilde kullanılmaktadır. Eritrosit dağılım genişliği (EDG) dolaşımdaki eritrositlerin boyutlarındaki değişkenliğin bir ölçüsüdür. EDG’deki artışlar hem kararlı hem de kararsız haldeki KAH ile ilişkilidir. Bu çalışmada, kararlı anjina pektoris (KAP) hastalarında EDG ve AKİ belirteçlerinin SYNTAX skoru (SS) kullanılarak koroner lezyon şiddeti üzerine prediktif bilgi sağlayıp sağlayamayacağını araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya 109 KAP hastası dahil edildi. Hastalar önce 40 hasta normal koroner arterler ve 69 hasta KAH grubuna ayrılarak değerlendirildi. Sonrasında KAH hasta grubu, KAH şiddetini anjiyografik olarak derecelendiren SS’na göre iki ayrı alt gruba (SS 1-22 (n=32) ve SS gt;22 (n=37) ayrılarak incelendi. p lt;0.05 anlamlı kabul edildi. Bulgular: Çok değişkenli regresyon analizi EDG ve AKİ’nin KAH varlığının bağımsız birer prediktörü olduğunu gösterdi (sırasıyla; OR: 6,209, p= 0,001 ve OR: -2,342, p lt;0,001). Fakat aynı analiz AKİ’nin KAH şiddetini öngörmede EDG’den daha iyi olduğunu gösterdi (sırasıyla; OR: 1,568, p= 0,215 ve OR: -1,540, p lt;0,001). Sonuçlar: Koroner arter hastalığı varlığında EDG’nin anlamlı derecede arttığı, AKİ’nin anlamlı derecede azaldığı görülmüştür. KAH varlığını öngörmede EDG ve AKİ’nin kullanışlı birer değişken olduğu tespit edilmiştir. AKİ, KAH’ın şiddetini tahmin etmede EDG'den daha güçlü bir öngördürücüdür.

Coronary artery perforation (CAP) is a rare, but potentially mortal possible complication of percutaneous coronary intervention. There are several treatment options for this complication, including prolonged balloon dilatation, use of a coronary stent graft, and bypass surgery. In this case report, a 65-year-old female patient who was admitted to the catheter laboratory with a diagnosis of acute coronary syndrome, was presented. Coronary angiography revealed total occlusion in the mid segment of the right coronary artery and a drug-eluting stent was implanted under 12 atm of pressure following pre-dilatation with a perfusion balloon. In order to perform defragmentation of the thrombus shifted into the proximal stent segment, post-dilatation was performed with a stent balloon (4-6 atm). After post-dilatation, an Ellis Class II perforation developed. In order to control the bleeding, a coronary stent graft was implanted at the perforation area. The rupture was sealed. Control coronary angiography 40 days later indicated that the stent graft was patent, but an arteriovenous fistula (AVF) draining to the right ventricle was detected. To the best of our knowledge, this is the first case of AVF seen as a late complication of CAP treated with a stent graft.

Summary Introduction: Previous studies have predicted an independent relationship between red cell distribution width (RDW) and the risk of death and cardiovascular events in patients with coronary artery disease (CAD). The aim of this study was to investigate the relationship between RDW and extensiveness of CAD in patients with diabetes mellitus (DM). Methods: Two hundred and thirty-three diabetic patients who underwent coronary angiographies at our centre in 2010 were included in the study. All of the angiograms were re-evaluated and Gensini scores were calculated. Triple-vessel disease wasdiagnosed in the presence of stenosis > 50% in all three coronary artery systems. Result: RDW was significantly higher in diabetic CAD patients (p < 0.001). Patients with CAD who had a RDW value above the cut-off point also had higher Gensini scores, higher percentages of obstructive CAD and triple-vessel disease (p ≤ 0.001 for all). According to the cut-off values calculated using ROC analysis, RDW > 13.25% had a high diagnostic accuracy for predicting CAD. RDW was also positively correlated with Gensini score, obstructive CAD and triple-vessel disease (r < 0.468 and p < 0.001 for all). Conclusion: RDW values were found to be increased in the diabetic CAD population. Higher RDW values were related to more extensive and complex coronary lesions in patients with DM.

Background and Objectives: Systemic inflammation has an important role in the initiation of atherosclerosis, which is associated with arterial stiffness (AS).Aortic flow propagation velocity (APV) is a new echocardiographic parameter of aortic stiffness.The relationship between systemic inflammation and AS has not yet been described in patients with familial Mediterranean fever (FMF).We aimed to investigate the early markers of AS in patients with FMF by measuring APV and carotid intima-media thickness (CIMT).Subjects and Methods: Sixty-one FMF patients (43 women; mean age 27.3±6.7 years) in an attack-free period and 57 healthy individuals (36 women; mean age 28.8±7.1 years) were included in this study.The individuals with atherosclerotic risk factors were excluded from the study.The flow propagation velocity of the descending aorta and CIMT were measured to assess AS.Results: APV was significantly lower (60.2±16.5 vs. 89.5±11.6 cm/sec, p<0.001) and CIMT was significantly higher (0.49±0.09 vs. 0.40±0.10mm, p<0.001) in the FMF group compared to the control group.There were significant correlations between APV and mean CIMT (r=-0.424,p<0.001), erythrocyte sedimentation rate (ESR) (r=-0.198,p=0.032), and left ventricle ejection fraction (r=0.201,p=0.029).APV and the ESR were independent predictors of FMF in logistic regression analysis (OR=-0.900,95% CI=0.865-0.936,p<0.001 and OR=-1.078,95% CI=1.024-1.135,p=0.004, respectively).Mean CIMT and LVEF were independent factors associated with APV in linear regression analysis (β=-0.423,p<0.001 and β=0.199, p=0.017, respectively) Conclusion: We demonstrated that APV was lower in FMF patients and is related to CIMT.According to our results, APV may be an independent predictor of FMF. (

Objective: Psoriasis is a chronic inflammatory disorder, which affects around 1%-3% of the human population worldwide. Cardiovascular events are the leading cause of morbidity and mortality in patients with psoriasis. Some studies have reported that psoriasis is related to increased arrhythmias. The Tp-e interval and Tp-e/QT ratio have been accepted as new markers for the assessment of myocardial repolarization and ventricular arrhythmogenesis. The aim of this study was to assess ventricular repolarization in patients with psoriasis using Tp-e interval and Tp-e/QT ratio. Methods: The study population consisted of 74 patients with psoriasis and 74 healthy volunteers. The diagnosis of psoriasis was based on a clinical or histopathological examination of all patients. QT interval, corrected QT (QTc), QT dispersion (QTd), Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups. Results: According to the electrocardiographic parameters, QT and QTc intervals and QTd were significantly higher in patients with psoriasis than in control subjects (p<0.001; p<0.001; p=0.014; respectively). The Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were significantly higher in patients with psoriasis than in control subjects [93 +/- 13 milliseconds (ms) vs. 98 +/- 14 ms, p=0.040; 104 +/- 17 ms vs. 111 +/- 17 ms, p=0.008; 0.23 +/- 0.03 vs. 0.25 +/- 0.03, p<0.001; respectively]. Additionally, the CRP value was an independent predictor of an increased Tp-e/QT ratio (beta=0.537, p<0.001). Conclusion: Our study revealed that ventricular repolarization features were impaired in patients with psoriasis. Therefore, these patients should be more closely screened for ventricular arrhythmias.

Background: Familial Mediterranean fever (FMF) is a chronic, recurrent auto-inflammatory disease characterised by self-terminating attacks of fever and sterile polyserositis. The main cause of death in auto-inflammatory diseases is cardiovascular events. Additionally, auto-inflammatory diseases have potential effects on the myocardial repolarisation parameters, including the T-wave peak-to-end (Tp-Te) interval, cTp-Te interval (corrected Tp-Te) and the cTp-Te/QT ratio. The aim of this study was to analyse the efficacy of myocardial repolarisation alterations in anticipation of cardiovascular risks in patients with FMF.Methods: This study included 66 patients with FMF and 58 healthy control subjects. Tp-Te and cTp-Te intervals and the cTp-Te/QT ratio were measured from the 12-lead electrocardiogram.Results: In electrocardiographic parameters, analysis of QT, QT dispersion, corrected QT (QTc) and QTc dispersion were similar between the groups. The Tp-Te and cTp-Te intervals and Tp-Te/QT and cTp-Te/QT ratios were significantly prolonged in FMF patients. Multivariate linear regression analyses indicated that erythrocyte sedimentation rate was an independent predictor of a prolonged cTp-Te interval.Conclusions: Our study revealed that when compared with control subjects, Tp-Te and cTp-Te intervals and cTp-Te/QT ratio were increased in FMF patients.