Background Heart failure (HF) is a leading cause of hospitalization and mortality worldwide and places a great economic burden on healthcare systems. Identification of prognostic factors in HF patients is of great importance to establish optimal management strategies and to avoid unnecessary invasive and costly procedures in end-stage patients. Objectives In the current study, we aimed to investigate the association between diastolic strain parameters including E/e’ SR, and short-term outcomes in advanced HF patients. Methods The population study included 116 advanced HF with reduced ejection fraction (HFrEF) patients. Clinical, laboratory, and echocardiographic evaluations of the patients were performed within the first 24 hours of hospital admission. Patients were followed for one month and any re-hospitalization due to worsening of HF symptoms and any mortality was recorded. The level of significance adopted in the statistical analysis was 5%. Results E/e’ SR was significantly higher in the patient group compared to the control group (p=0.001). During one-month follow-up, 13.8% of patients died and 37.1% of patients were rehospitalized. Serum NT-ProBNP (p=0.034) and E/e’ SR (p=0.033) were found to be independent predictors of mortality and ACEİ use (p=0.027) and apical 3C strain (p=0.011) were found to be independent predictors of rehospitalization in the patient group. Conclusion Findings of the current prospective study demonstrate that E/e’ SR measured by speckle tracking echocardiography is an independent and sensitive predictor of short-term mortality in advanced HFrEF patients and may have a role in the identification of end-stage HFrEF patients.

Background: The aim of the present study was to investigate the association between diastolic global longitudinal strain (GLS) rateand mortality, re-hospitalization as well as hospitalization period in heart failure (HF) patients. Methods:Clinical, laboratory and echocardiographic parameters within the first 24 hours for 116 patients with ejection fraction (EF) ≤ 40% and Class 3 to Class 4 symptoms of New York Heart Association who were hospitalized in the cardiology clinic of our hospital were reviewed.Fiftyeight individuals without any diagnosis for cardiac failure were included as the control group. Echocardiographic measurements, tissue Doppler and diastolicstrain rate (SR) were reviewed. The N-terminal pro-brainnatriuretic peptide (ProBNP)level was analysed in addition to standard biochemical and hematological parameters. Results: The diastolic E strain rate and E/E’SR was statistically significant in patients with mortality within one month (p<0.05). These two parameters were statistically significant also in patients with one-month mortality (p <0.005).When looked under the guidance of these findings, E strain rate and E / E ’SR are a predictive parameter for one month mortality in HF patients. Conclusion: The E strain rate and E/E’SR are superior parameters than other tissue doppler parameters to predict the prognosis and the mortality in patients with heart failure. E/E’SR is a superior indicator for diastolic function of thre left ventricle when compared to other tissue doppler parameters.

Resumo Fundamento A insuficiência cardíaca é uma das principais causas de hospitalização e mortalidade em todo o mundo e representa um grande fardo económico para os sistemas de saúde. A identificação de fatores prognósticos em pacientes com IC é de grande importância para estabelecer estratégias de manejo ideais e evitar procedimentos invasivos e dispendiosos desnecessários em pacientes em estágio terminal. Objetivos No presente estudo, nosso objetivo foi investigar a associação entre parâmetros de strain diastólico, incluindo E/e’ SR, e resultados de curto prazo em pacientes com IC avançada. Métodos O estudo populacional incluiu 116 pacientes com insuficiência cardíaca avançada com fração de ejeção reduzida (ICFEr) avançada. Avaliações clínicas, laboratoriais e ecocardiográficas dos pacientes foram realizadas nas primeiras 24 horas de internação. Os pacientes foram acompanhados por um mês e qualquer reinternação por piora dos sintomas de IC e qualquer mortalidade foi registrada. O nível de significância adotado na análise estatística foi de 5%. Resultados A E/e’ SR foi significativamente maior no grupo de pacientes em comparação ao grupo controle (p=0,001). Durante o acompanhamento de um mês, 13,8% dos pacientes morreram e 37,1% dos pacientes foram reinternados. NT-ProBNP sérico (p=0,034) e E/e’ SR (p=0,033) foram considerados preditores independentes de mortalidade e o uso de IECA (p=0,027) e strain 3C apical (p=0,011) foram considerados independentes preditores de reinternação no grupo de pacientes. Conclusão Os resultados do presente estudo prospectivo demonstram que a E/e’ SR medida pela ecocardiografia com speckle tracking é um preditor independente e sensível de mortalidade em curto prazo em pacientes com ICFEr avançada e pode ter um papel na identificação de pacientes com ICFEr em estágio terminal.

OBJECTIVE:Recent studies have linked malnutrition with undesirable outcomes in cardiovascular diseases. However, the underlying mechanism is unknown. Contrast-induced acute kidney injury (CI-AKI) increased cardiovascular mortality after percutaneous coronary intervention (PCI). This study hypothesizes that prognostic nutritional index (PNI) plays a role in the development of CI-AKI in patients with acute coronary syndrome undergoing emergency PCI.METHODS:This study enrolled 551 patients. PNI was determined as 10× serum albumin (g/dL)+0.005×total lymphocyte count (mm3). CI-AKI was characterized as the increase in serum creatinine ≥0.3 mg/dL level within 48 h after PCI. Patients were classified as either CI-AKI (+) or CI-AKI (-).RESULTS:CI-AKI has occurred in 72 of 551 patients (13.1%). PNI was significantly lower in the CI-AKI (+) group than in the CI-AKI (-) group (44.4±6.6 versus 47.2±5.8, p<0.001, respectively). Multivariate logistic regression analysis showed that PNI [odds ratio, OR: 1.631, 95% confidence interval (CI): 1.168-2.308, p=0.02] and estimated glomerular filtration rate (OR: 3.26, 95%CI 1.733-6.143, p<0.001) were independent risk factors for CI-AKI.CONCLUSIONS:PNI is an independent risk factor for CI-AKI. The development of CI-AKI may be the mechanism responsible for the relationship between poor nutritional status and adverse cardiac events.

Aim: The CHA(2)DS(2)-VASc (heart failure, hypertension, age >75, diabetes mellitus, stroke history, vascular disease, 65-74 age range, gender) and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history, labile INR, elderly, drugs/alcohol) are scoring system for using to estimate stroke and bleeding development in cases with atrial fibrillation. We aim to evaluate the relationship between the implantable cardioverter defibrillator (ICD) therapies and CHAIDSi-VASc and HAS-BLED scores. Methods: 398 patients were included in this retrospective study after reviewing the data of the patients above the age of 18 who had ICD implantation for any reason between 2014-2019 and who were found to have at least two pacemaker check-ups with 6-month intervals. CHA(2)DS(2)-VASc and HAS-BLED scores were calculated during the device implantation and last control visit date. Results: 148 of the patients received ICD therapy (appropriate shock [n = 1181 and in appropriate therapy In = 301) and 250 of them did not receive any therapy. It was observed that the CHA(2)DS(2)-VASc and HAS-BLED scores were similar in the groups receiving and not receiving therapy (respectively, p = 0.64 and p = 0.60). CHA(2)DS(2)-VASc and HAS-BLED scores were similar in patients with appropriate shock or not (respectively p = 0.89 and p = 0.85) with median follow-up period 5.5 years. Multivariate regression analysis showed that reduced ejection fraction, presence of single-chamber ICD, lapsing of a long time after the implantation were independent risk factors for ICD device therapies (p < 0.05). Conclusions: CHA(2)DS(2)-VASc and HAS-BLED scores are not associated with device-based ICD therapies.

Vasospastic angina is a type of angina pectoris, usually associated with transient ST-segment elevation, usually spontaneously or with nitrates. Sometimes we present with chest pain clinic, sometimes with more severe pictures and cardiac arrest. The impact of environmental factors on the triggering of the disease should not be ignored. In most patients, symptoms can be controlled by medical treatment. The main backbone of medical treatment is calcium channel blockers and vasodilator drugs. In this article, we aimed to describe our patient with a resistant coronary osteal spasm.

It has been shown that transmitral A‐wave (TMAW) is affected in paroxysmal atrial fibrillation (PAF), and decreased left atrial contractions cause a decrease in the TMAW velocity. The relationship between TMAW acceleration time (TMAW‐AccT) and PAF is unknown. In this study, the predictive value of TMAW‐AccT for PAF was investigated.

It is of clinical importance to determine creatinine clearance and adjust doses of prescribed drugs accordingly in patients with heart failure to prevent untoward effects. There is a scarcity of studies in the literature investigating this issue particularly in patients with heart failure, in whom many have impaired kidney function. The purpose of this study was to determine the degree of awareness of medication prescription as to creatinine clearance in patients hospitalized with heart failure. Patients hospitalized with a diagnosis of heart failure were retrospectively evaluated. Among screened charts, patients with left ventricular ejection fraction <40% and an estimated glomerular filtration rate (eGFR) of ≤50 mL/min were included in the analysis. The medications and respective doses prescribed at discharge were recorded. Medications requiring renal dose adjustment were determined and evaluated for appropriate dosing according to eGFR. A total of 388 patients with concomitant heart failure and renal dysfunction were included in the study. The total number of prescribed medications was 2808 and 48.3% (1357 medications) required renal dose adjustment. Of the 1357 medications, 12.6% (171 medications) were found to be inappropriately prescribed according to eGFR. The most common inappropriately prescribed medications were famotidine, metformin, perindopril, and ramipril. A significant portion of medications used in heart failure requires dose adjustment. Our results showed that in a typical cohort of patients with heart failure, many drugs are prescribed at inappropriately high doses according to creatinine clearance. Awareness should be increased among physicians caring for patients with heart failure to prevent adverse events related to medications.

There is controversial data regarding the relationship between uric acid (UA) and coronary artery disease and cardiovascular events. Despite the deleterious effects of hyperuricemia on endothelial function, the effect of UA on myocardial ischemia has not been previously studied. We aimed to investigate the relationship between UA and myocardial ischemia that was identified using dobutamine stress echocardiography (DSE). In this retrospective study, the laboratory and DSE reports of 548 patients were reviewed. The patients were divided into two groups based on the presence of ischemia and further subdivided into three groups according to the extent of ischemia (none, ischemia in 1–3 segments, ischemia in >3 segments). Serum UA levels were compared. Determinants of ischemia were assessed using a regression model. UA was increased in patients with ischemia and was correlated with the number of ischemic segments (p < 0.001). A cutoff value of UA > 5 mg/dl had 63.9 % sensitivity, 62.0 % specificity, 42.5 % positive predictive value (PPV), and 79.6 % negative predictive value for ischemia. When the positive DSE exams were further sorted according to the UA cutoff, the PPV of DSE increased from 80.2 to 94.0 %. Uric acid (odds ratio 1.51; 95 % CI 1.14–1.99), diabetes mellitus, HDL and glomerular filtration rate were found to be independent determinants of myocardial ischemia in DSE. Increased UA is associated with both the presence and extent of DSE-identified myocardial ischemia. A UA cutoff may be a good method to improve the PPV of DSE.

Takotsubo cardiomyopathy (TCMP) is characterised by a temporary aneurysm of the left ventricular apex in individuals without significant stenosis of the coronary arteries. It is extremely rare to see it combined with a thrombus. In this case report, we present a 57-year-old female patient with TCMP in whom apical thrombus was treated with short-term warfarin use.

INTRODUCTION: Low grade inflammation plays an important role in the several development process of coronary artery disease. The soluble urokinase plasminogen activator receptor (suPAR) and chitinase 3-like protein 1 (YKL-40) are the new potential biomarkers of inflammation. We intended to test the hypothesis whether the inflammatory biomarker YKL-40 alone or in combination with suPAR could be the new diagnostic biomarkers for acute myocardial infarction (AMI). METHODS: Fifty-five patients with AMI and seventy control subjects were included in the study. The diagnosis of AMI was based on the current 3rd standard universal definition criteria. Serum YKL-40 and suPAR levels were measured at the first and second days of AMI by using ELISA method. RESULTS: Serum YKL-40 levels were significantly higher in the first (69.10±16.58 ng/mL) and second day (60.64±16.01 ng/mL) of AMI patients than those of the control subjects (37.11±4.30 ng/mL) (p DISCUSSION AND CONCLUSION: Serum suPAR and YKL-40 can be considered strong inflammatory markers of AMI. We concluded that serum suPAR and YKL-40 levels at the first day and second day of AMI could be used as an clinically useful marker for diagnosis of AMI.

Primary malignant melanomas of uterine cervix are quite rarely seen neoplasms, and long-life prognosis of patients with this disease is poor. Immunohistochemical methods and exclusion of other primary melanoma sites are used to confirm the diagnosis. As with other melanomas, cervix malignant melanomas may also cause cardiac metastases. Cardiac metastases are among rarely seen but more commonly encountered cases, compared to primary cardiac tumors. Here, we present a case of biatrial cardiac metastases in a 73-year-old patient with uterine cervix malignant melanomas. The patient underwent echocardiography, cardiac magnetic resonance imaging, and computed tomography. Our report shows the importance of advanced diagnostic techniques, such as cardiac magnetic resonance, not only for the detection of cardiac masses, but for a better anatomic definition and tissue characterization. Although the cases of malignant melanomas leading to multiple cardiac metastasis were reported in literature, the metastatic concurrence of malignant melanomas in both right and left atriums is quite rarely encountered as metastatic malignant melanomas. Also, another intriguing point in our case is that the primary lesion of our case was stemmed from uterine cervix, but not skin.

The neutrophil to lymphocyte ratio (NLR) predicts cardiovascular events. The aim of this study was to determine whether NLR improved the positive predictive value (PPV) of dobutamine stress echocardiography (DSE) in patients with stable coronary artery disease (CAD). We conducted a retrospective review of laboratory and DSE data from the medical records of 1,012 patients who were divided into two groups according to the presence of ischemia and further subdivided into three groups according to the extent of ischemia (nonischemic segments, 1-3 ischemic segments, or > 3 ischemic segments). NLRs were compared among these groups. NLRs increased in patients with ischemia and correlated with the number of ischemic segments (P < 0.001). The optimal cutoff value of NLR determined using receiver operating characteristic analysis was > 2.04, and the diagnostic value of NLR for discriminating patients with ≥ 50% coronary stenosis in at least one of the coronary arteries from those without significant CAD was high [area under the curve (AUC) = 0.671, standard error = 0.052, P < 0.001, 95% confidence interval (CI) = 0.569-0.773)]. An NLR cutoff value of > 2.04 predicted CAD presence with significant stenosis (62.10% sensitivity and 64.10% specificity). PPV of DSE for a significant coronary artery lesion identified using coronary angiography was 73.8% (95% CI = 75.1-88.5, P < 0.001, AUC = 0.818). On including a cut-off value of > 2.04 for NLR in this multivariable predictive model, the AUC value slightly increased to 0.905 (95% CI = 85.4-95.6) and PPV of DSE increased from 73.8% to 92.6%. NLR improved PPV of DSE for patients with stable CAD.

With constantly evolving technology and an ever-increasing number of patients with pacemakers, clinicians will encounter various pacemaker malfunctions in their practice. While some of these issues can be solved even by using only the pacemaker׳s mode settings, others require re-intervention; neglecting a pacemaker׳s malfunction without full investigation threatens the patient׳s life. In this report, we describe a patient with a dual-chamber pacemaker with neglected or unresolved dyssynchronization that occurred 2 years after implantation.

The aim of this study was to examine the Tpeak-Tend (Tpe/corrected Tpe) interval, which is an indicator of transmural myocardial repolarization, measured non-invasively via electrocardiogram in patients with acute pulmonary embolism (PE), and to investigate the relationship with 30-day mortality and morbidity.