BACKGROUND Three-dimensional (3D) echocardiography and 3D strain parameters have been used for a comprehensive quantitative assessment of left ventricular (LV) myocardial dynamics. So far, there are no data on sacubitril/valsartan effects on cardiac functions and LV reverse remodeling using 3D echocardiography. This study aimed to evaluate the effects of sacubitril/valsartan on the LV functions using two-dimensional (2D) echocardiography, 3D echocardiography, and the 3D strain parameters. METHODS A single-center prospective cohort study which included 100 heart failure with reduced ejection fraction (HFrEF) patients with guidelines-approved indications for sacubitril/valsartan treatment. Patients received a short course (3-month) of sacubitril/valsartan. 3-month follow-up 2D, 3D echocardiographic parameters, and 3D strain were compared to baseline parameters. RESULTS The results of the study revealed a significant improvement in left ventricular dynamic functions at 3-month follow-up with an improvement in left ventricular systolic function (mean left ventricular ejection fraction (LVEF) increased from 27.65 ± 4.98% to 32.89 ± 6.03%, P<0.001). Comparison of HFrEF patients with ischemic and non-ischemic etiologies showed that echocardiographic parameters significantly improved in both groups after 3 months of sacubitril/valsartan treatment. There was no statistically significant difference between both groups regarding echocardiographic parameters at baseline and 3-month follow-up. CONCLUSIONS In a single-center prospective observational cohort study evaluating the effects of short-term (3-month course) sacubitril/valsartan treatment on LV dynamics assessed by 3D echocardiography and 3D strain, sacubitril/valsartan was associated with a significant improvement of LV systolic functions and reverse remodeling effects in both ischemic and non-ischemic HFrEF patients.

Amaç: Sakubitril/valsartan tedavisinin, enalaprile kıyasla düşük ejeksiyon fraksiyonlu kalp yetersizliği (DEF-KY) hastalarında hastaneye yatış ve mortalite riskini azalttığı ve yaşam kalitesini artırdığı gösterilmiştir, ancak bugüne kadar ülkemizde yapılmış, sakubitril/valsartanın klinik bulgulara ve laboratuvar sonuçlarına olan etkilerini gösteren çalışma bulunmamaktadır. Biz çalışmamızda, sakubitril/ valsartan tedavisinin kliniğe ve laboratuvar bulgularına olan etkilerini hem iskemik hem de non-iskemik DEF-KY hastalarında karşılaştırmalı olarak araştırmayı hedefledik. Gereç ve Yöntemler: Çalışmamıza, 18 yaşından büyük, KY kılavuzlarına göre sakubitril/valsartan tedavisi başlama endikasyonu olan hastalar dâhil edildi. Tüm hastalardan tedavi başlamadan önce ve tolere edilebilen maksimal doz sakubitril/valsartan tedavisinin 6. ayında olmak üzere iki kez ayrıntılı öykü alındı, tüm sistem fizik muayene yapıldı ve elektrokardiyogram çekildi. Venöz kanda sodyum (Na), potasyum (K), kreatinin ve NT-ProBNP düzeylerine bakıldı. Tedavi öncesi ve sonrası bulgular karşılaştırıldı. Bulgular: Çalışmaya başlangıçta 150 hasta katıldı. Bu hastalardan 19'u takip süresini tamamlayamadığı için çalışma dışı bırakıldı ve toplamda 71'i iskemik, 56'sı ise non-iskemik KY hastası olmak üzere 127 hasta (%27,6'sı kadın) çalışmaya dâhil edildi. Her iki grupta da sistolik ve diyastolik kan basıncı, dakikadaki kalp hızı, NT-proBNP ve Na düzeyi ve haftalık furosemid ihtiyacında istatistiksel olarak anlamlı azalma gözlendi. Glomerüler filtrasyon hızı (GFH)'nda anlamlı değişiklik olmazken, kreatinin ve potasyum (K) düzeylerinde istatistiksel olarak anlamlı artış tespit edildi. Sonuç: Bu çalışmanın sonuçları göstermiştir ki sakubitril/valsartan, hem iskemik hem de non-iskemik DEF-KY'de benzer etkiler yaratmakta, her iki grupta da hastaların laboratuvar ve klinik bulgularında belirgin düzelme, semptomlarında rahatlama, haftalık furosemid ihtiyacında azalma ve kalp hızında düşüş sağlamaktadır. Bununla birlikte, yan etkiler olarak semptomatik hipotansiyon, hiperpotasemi ve GFH düşüşü açısından dikkatli olunmalıdır.

Objective: It is not known whether direct-acting oral anticoagulants (DOACs), such as dabigatran, apixaban, and rivaroxaban increase the risk of bleeding complications during or after coronary catheterization. The aim of this study was to investigate the safety of uninterrupted DOAC treatment during diagnostic radial coronary angiography (CAG). Methods: This study included 160 patients who underwent diagnostic radial cardiac catheterization. The 60 patients in the group who were using a DOAC (apixaban, rivaroxaban, or dabigatran) were enrolled in a Group A. Post-procedure results from patients in Group A were compared with those of an age-and sex-matched control group (Group B) that included 100 patients who underwent radial CAG who did not use a DOAC. Results: There was no significant difference in the procedure and compression times, creatinine level, or presence of hypertension, diabetes mellitus, smoking, alcohol use, vascular disease, or congestive heart failure between the 2 groups. During the 1 -month follow-up period, only 1 radial occlusion was registered in the control group (Group B). There was no case of a large hematoma (> 5 cm or extending to the forearm), dissection, fistula, perforation, or compartment syndrome. Hematomas smaller than 5 cm were seen in 2 patients (1 in each group). No thrombotic events were observed during follow-up examinations. Conclusion: Performing radial CAG with uninterrupted DOAC treatment appears to carry no risk of increased early or short-term complications. The simple, uninterrupted DOAC strategy is comfortable, easy, and safe.

Background: Atherosclerotic cardiovascular disease influences young patients as well as the elderly. A large proportion of patients with coronary artery disease (CAD) have metabolic syndrome (MS), although the frequency and association of its different components are not clear. To the best of our knowledge, there is no any study about the prevalence of MS among young patients with ST-elevation myocardial infarction (STEMI). We sought to determine the prevalence of MS in patients below 46 years of age who presented with STEMI and underwent primary percutaneous coronary intervention. Methods: In the present prospective study, 141 consecutive patients with STEMI <46 years of age admitted to intensive coronary care unit. STEMI was defined according to the ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. All patients were grouped presence of MS. In the second step, the components of MS were analyzed, excluding patients with diabetes mellitus (DM). Results: The total prevalence of MS was 46.8% (n = 66). In MS group, the most frequent component of MS was low high-density lipoprotein (HDL) levels (84.8%), followed by elevated triglycerides (TGs) (78.1%). A total of 121 patients did not have DM and 51 (42.1%) of these patients presented with MS. Conclusions: The prevalence of MS in young patients with STEMI is high. Low HDL cholesterol (HDLc) concentrations and high TG levels are cardiovascular risk factors, regardless of low-density lipoprotein cholesterol levels and they are found too often in our study. These results highlight the need to implement preventative strategies for reducing overall cardiovascular risk in young patients as well as elderly.

The development of an aorto‐right ventricular fistula is a rare complication of cardiac surgery. The most common treatment is surgical closure of the fistula, but percutaneous closure of the fistula has become an attractive alternative option. We present a case of successful utilization of live/real time three/four‐dimensional transoesophageal echocardiography (3/4DTEE) to select the correct device size for percutaneous closure of an adult patient presenting with an aorto‐right ventricular (AO‐RV) fistula following aortic valve replacement. To the best of our knowledge, this is the first case in which 3/4DTEE was used to select the device size and guide percutaneous closure of an iatrogenic AO‐RV fistula.

Background:The classification of pulmonary stenosis (PS) severity based on the transpulmonary pressure gradient, which is affected by flow rate.Case Report: We report the first case of a pregnant patient with atrial septal defect (ASD) and pulmonary stenosis that was misclassified by conventional echocardiographic methods.Most importantly, threedimensional transoesophageal echocardiographic assessment of pulmonary stenosis changed the entire treatment strategy. Conclusion:The planimetric calculation of the pulmonary valve (PV) opening area using threedimensional transoesophageal echocardiographic may be helpful, especially in encounters with specialized conditions such as ASD and/or pregnancy, which can cause inaccurate recordings of the transvalvular peak gradient.

The newly developed three dimensional speckle-tracking echocardiography (3D-STE) technology provides quick and comprehensive quantitative assessment of biventricular myocardial dynamics. The impact of coronary slow flow phenomenon (CSFP) on biventricular functions has not been comprehensively evaluated using this new technology. Therefore, the aim of this study was to evaluate the effects of CSFP on biventricular systolic functions using 3D-STE. Forty patients with CSFP and otherwise normal coronary arteries (NCAs) and 40 age- and sex-matched controls with normal coronary angiograms (CAGs) were prospectively enrolled. Biventricular systolic function was evaluated by 3D-STE. Left ventricular (LV) global longitudinal, circumferential and radial strains, ejection fraction (EF) were significantly lower and LV end-systolic volume (ESV) was significantly higher in the CSFP group compared to the control group. There were no significant differences in LV mass, LV end-diastolic volume (EDV) or LV stroke volume (SV). Additionally, Right ventricular (RV) free wall, septal wall and global longitudinal strains, and RV EF were significantly lower in the CSFP group, but there were no significant differences in RV EDV, ESV and RV SV. The present study demonstrated that CSFP has a notable negative effect on not only 3D strain parameters but also biventricular EF. There was a strong correlation between the strain parameters of the affected vessel’s myocardial area and the TIMI frame count of same vessel.

Kounis syndrome (KS) is a rarely diagnosed condition which should always be kept in mind when an acute myocardial infarction (AMI) happens in the context of anaphylactic reactions. We report a case of a 31-year old female; 2 hours after the ingestion of the mushroom (Pleurotus ostreatus); she experienced nausea, stomachache, vomiting, dyspnea and chest pain. Electrocardiogram (ECG) showed an ST segment elevation in D1, AVL, precordial leads V1-V4. The blood analysis revealed high levels of CK-MB fraction and troponin T values. The diagnosis of Kounis syndrome was made in the catheterization laboratory via the complete resolution of angina, along with electrocardiographic changes that took place after intracoronary nitrate therapy and skin prick to prick test positivism with the mushroom. To the best of our knowledge, this is the first case of a type I variant of Kounis syndrome due to Pleurotus ostreatus allergy reported so far.

Functional mitral regurgitation may have different haemodynamic consequences, clinical implications and treatment options, such as surgical or percutaneous interventions or implanting a pacemaker. Here we present two cases with haemodynamically significant intermittent functional mitral regurgitation as the underlying mechanism of heart failure. The cases underline the importance of a high index of suspicion in patients with intermittent heart failure, and a careful analysis of echocardiographic images with simultaneous ECG, in order to delineate systolic and diastolic mitral regurgitation.

OBJECTIVESThe aim of this study was to retrospectively evaluate the morphologic and functional features of myocardial bridging (MB) and to investigate the impact of morphologic features on presence of atherosclerosis with multi-detector computed tomography (MDCT) coronary angiography.STUDY DESIGNThe study population consisted of 191 consecutive patients. Besides coronary lesions, morphologic features of the MB (depth, length and the distance of the tunneled artery from the left coronary ostium) were analyzed.RESULTSMDCT detected MB on left anterior descending artery in 41 patients (21.5%). The prevalence of atherosclerotic plaques proximal to the MB of LAD was 49% (20/41). There was a statistically significant correlation between percentage of systolic compression and depth of the tunneled segment (r=0.538, p<0.01). There was no relation between distance of the tunneled segment from the ostium and degree of systolic compression. No significant correlation was found between percentage of systolic compression and length of the tunneled segment (r=0.058, p=0.721). Morphologic features of MB were not related to the presence of CAD in proximal segments.CONCLUSIONMDCT coronary angiography depicts the morphologic and functional features of the MB in detail. The depth of MB segment was correlated with systolic compression of MB. There was no relationship between distance of the tunneled segment from the ostium and systolic compression.

BACKGROUND:While the effects of percutaneous mitral balloon valvuloplasty (PMBV) on left ventricular, right ventricular, left atrial and right atrial functions have been well demonstrated, the effects on coronary flow velocity remain unclear. The study aim was to evaluate the effects of PMBV on coronary flow velocity and flow velocity reserve in patients with mitral stenosis (MS).METHODS:A total of 32 symptomatic patients (22 females, 10 males; mean age 41.2 years) with moderate or severe isolated rheumatic MS (valve area <1.5 cm2) detected by planimetric methods was included in the study. The left anterior descending (LAD) artery flows were evaluated by coronary presets and pulsed-wave Doppler echocardiography. Hyperemic diastolic coronary flow velocities were evaluated under basal conditions and after intravenous dipyridamole, and the coronary flow velocity reserve was calculated. At seven days after PMBV the coronary flow velocity and flow velocity reserve were re-evaluated, and values obtained pre- and post-PMBV were compared.RESULTS:The pre- and post-PMBV basal diastolic flow velocities were 22.6 ± 5.1 cm/s and 33.0 ± 7.9 cm/s, respectively (p = 0.030), while hyperemic diastolic flow velocities were 45.8 ± 10.0 cm/s and 53.7 ± 11.5 cm/s, respectively (p = 0.003). The systolic and diastolic peak flow velocities were significantly increased compared to the pre-PMBV values, whereas there was no significant change in diastolic coronary flow velocity reserve (2.04 ± 0.55 versus 1.83 ± 0.28, p = 0.265).CONCLUSIONS:PMBV increases coronary flow in isolated MS without affecting coronary flow reserves. The low coronary flow velocities may be a reason for the subclinical left ventricular dysfunction that occurs in isolated MS.

BACKGROUND:At present, there are no definite criteria for selecting patients eligible for same-day discharge after percutaneous coronary interventions (PCI). With rapid ambulation and reduced vascular complication rates, transradial PCI have many features that favorably reduce costs and hospital stay. This study aimed to demonstrate the possibility of early ambulatory discharge following transradial percutaneous coronary interventions.METHODS:254 consecutive patients undergoing transradial PCI (elective, urgent, and emergent) at our center was observed during hospital stay. Patient demographics, angiographic characteristics, post-procedural complications, and timing of these post-procedural events were recorded.RESULTS:A total of 336 lesions were treated among 299 vessels with 277 stents. One hundred fifty-two (45.2%) lesions were Type C. There were 26 chronic total occlusions (CTO). One hundred fifty-five (61%) patients were discharged on the same day after the procedure. 24 complications (12.6%) occurred and were divided into three groups according to occurrence time. 13 (54.2%) occurred within the first 2 h and 11 (45.8%) occurred after the 24-hour period. No complications were observed between the 2nd and 24th hours.CONCLUSIONS:Same-day discharge with a 2-hour observation period is safe and feasible after successful transradial PCI in appropriate patients. Although a minor number of complications occurred, these did not occur between the 2nd and 24th hours. Same-day discharge after successful transradial PCI could be an alternative for better utilization of resources.

A 47-year-old soccer trainer was referred for a precordial murmur incidentally noted on routine physical examination. Cardiac auscultation revealed a grade 4/6 continuous murmur heard best on the left sternal border. No other sign was detected on physical examination. Chest X-ray and ECG showed no abnormalities. Transthoracic echocardiography …

BackgroundPotential interference between implanted cardiac devices and other medical instruments is an important concern. Therefore, we aimed to investigate the possible device interaction between implantable cardioverter defibrillators (ICDs) and external enhanced counterpulsation (EECP) treatment.MethodsTwenty‐one patients with an implanted ICD or cardiac resynchronization therapy with defibrillator (CRT‐D) were enrolled into the study. EECP had applied as two sessions of 5 minutes. Data from device interrogations before and after the first EECP session and during second EECP session were recorded and analyzed for signs of possible device interaction.ResultsThere was no sign of inappropriate sensing or noise during EECP session. There was no difference regarding electrode impedance, pacing, and sensing values before and after EECP. There was a statistically significant difference regarding heart rates during EECP therapy between rate response off and on modes (68.69 ± 5.92 beats/min and 90.32 ± 11.05 beats/min, respectively P = 0,001). In four patients with CRT‐D and unipolar left ventricular pacing, counterpulsation could not be done because of QRS sensing problems.ConclusionsEECP seems to be a safe treatment modality in patients with implanted ICD and CRT‐D devices. It should be kept in mind that in those patients with CRT‐D, rate responsive mode is on; inappropriate sinus tachycardia can be seen during EECP therapy. Also in patients with CRT‐D using a unipolar sensing mode, problems of QRS complex sensing by the EECP may occur and, therefore, this effects synchronization and success of EECP therapy.