AIMS:The Türkiye Heart Failure (TURK-HF) registry aims to identify the sociodemographic and clinical characteristics, management strategies, and outcomes of patients with heart failure (HF) and to assess the implementation of evidence-based HF therapies in Türkiye. METHODS:The TURK-HF registry is a national, multicenter, prospective, observational study of unselected patients with HF regardless of ejection fraction. A total of 46 investigators from 38 centers in 22 cities across Türkiye participated in the registry. The study investigators will gain access to the electronic case report form via www.turkhf.com website using their usernames and passwords. The baseline assessment of the patients will include sociodemographic data, primary care access information, frailty assessment, health-related quality of life questionnaire, HF-related information, medical history and comorbidities, physical examination findings, electrocardiographic and echocardiographic data, H2FPEF score calculation, laboratory results, and medical and device-based HF therapies. The management strategies and potential complications of patients hospitalized with acute HF will be systematically documented. Follow-up data will be collected at regular outpatient visits every 6 months with a margin of error of 1 month. The clinical endpoints of the TURK-HF registry were cardiovascular or all-cause mortality, HF-related hospitalizations, clinician-interpreted outcomes, patient-reported outcomes, and surrogate endpoints, either alone or in combination. The TURK-HF registry was registered at ClinicalTrials.gov (ID: NCT06707220). CONCLUSION:The TURK-HF registry offers comprehensive and distinctive insights into contemporary HF clinical characteristics, diagnostic methods, treatments, and outcomes. This registry has the potential to influence implementation strategies, clinical research, and public policies across Türkiye.

OBJECTIVE:The main objective of this study is to determine the incidence and predictors of clinical outcomes in patients with AF treated with factor Xa inhibitors in a real-world setting. METHODS:The present study was a multicentre and observational study that included patients with AF who were treated with factor Xa inhibitors. The primary outcome was the composite of ischemic stroke, TIA, systemic embolism, major bleeding, and all-cause mortality. RESULTS:A total of 1162 patients from 26 cardiology centers were included in this study, with a median age of 72 years. During the median 12-month follow-up period, the primary outcome occurred in 195 patients (16.8%). Treatment with rivaroxaban compared with apixaban and edoxaban showed a lower rate of ischemic stroke, TIA, and/or systemic embolism (2.2% vs. 4.7% vs. 6.5%, respectively, p = 0.014). The major bleeding rate was similar between all three factor Xa inhibitors. The all-cause mortality rate in the rivaroxaban group was lower compared with the apixaban and edoxaban groups (9.8% vs. 15.1% vs. 12.4%, respectively, p = 0.042). Overall, the frequency of primary outcome was 13.8%, 19.6%, and 20.6% for patients treated with rivaroxaban, apixaban, and edoxaban, respectively (p = 0.019). Older age, male sex, low body weight, high bleeding risk, heart failure, hypertension, liver failure, and treatment with apixaban 2.5 mg b.i.d. were independently associated with the development of primary outcome. CONCLUSION:The follow-up data from the ANATOLIA-AF study provides detailed data about the incidence and independent predictors of adverse clinical outcomes in patients with AF treated with factor Xa inhibitor treatment.

Introduction:Hypertension is a significant public health concern and a contributor to cardiovascular conditions. Although physicians are essential in preventing and managing hypertension, limited research has been conducted on their own awareness of the condition. Aim:We aimed to examine the prevalence and awareness of hypertension among doctors in Turkey and identify relevant demographic and behavioral risk factors. Material and methods:A cross-sectional study was carried out with 178 physicians aged 25 to 64, randomly chosen from 35 healthcare institutions in 24 cities across Turkey. Data collection involved a structured questionnaire that examined hypertension awareness, sociodemographic details, and cardiovascular risk factors, complemented by standardized blood pressure assessments and body measurements. Hypertension was identified based on a systolic blood pressure of ≥ 140 mm Hg and/or a diastolic pressure of ≥ 90 mm Hg, self-reported diagnosis, or the use of antihypertensive drugs. Results:The overall prevalence of hypertension was 15.7%, with a significantly higher rate among males (20.2%) than females (7.8%) (p = 0.03). Age was a strong predictor, as individuals over 40 years had a markedly higher hypertension prevalence (27.9%) compared to those under 40 (4.3%) (p < 0.001). Body mass index (BMI), smoking, and physical inactivity were also significantly associated with hypertension. Among hypertensive doctors, awareness was 78.5%, though it did not show significant differences based on gender, BMI, or comorbidities. Conclusions:Despite relatively high awareness levels, hypertension remains prevalent among medical professionals, particularly in older and male doctors. Targeted strategies, such as routine screenings and lifestyle intervention programs, are essential to improve hypertension prevention and management in this population.

OBJECTIVE:Atherosclerosis, a major contributor to coronary artery disease (CAD), is characterized by chronic arterial inflammation. Pentraxin 3 (PTX-3), a biomarker of inflammation, serves as an indicator of both atherosclerosis and the progression of CAD. The aim of this study was to investigate the association between PTX-3 levels and the presence and severity of CAD, as determined by coronary computed tomography angiography (CCTA). METHOD:In this study, 94 participants (54 with CAD and 40 controls) underwent CCTA and coronary artery calcium scoring (CACS) using computed tomography. PTX-3 levels were measured using the enzyme-linked immunosorbent assay (ELISA) method. CAD patients were categorized based on CCTA findings and further subdivided into three groups according to their CACS: Group I (CACS < 100), Group II (CACS 100-299), and Group III (CACS ≥ 300). RESULTS:Serum PTX-3 levels were significantly higher in the CAD group. A PTX3 cut-off value of 5.80 ng/mL predicted CAD with 68% sensitivity and 66% specificity. A strong positive correlation was observed between CACS and PTX-3 levels (r = 0.521, P < 0.001). In high-risk patients with a CACS ≥ 300, PTX-3 levels were significantly higher than those in low- and intermediate-risk groups a CACS < 300. However, no significant difference in PTX-3 levels was observed between the normal coronary group and the low- and intermediate-risk groups. Furthermore, no correlation was found between the degree of coronary artery stenosis and PTX-3 levels. CONCLUSION:Pentraxin 3 might serve as a valuable biomarker for the diagnosis and severity of CAD.

Background/Objectives: As an endocrine organ, adipose tissue produces adipokines that influence coronary artery disease (CAD). The objective of this study was to assess the potential value of CTRP5 and chemerin in differentiating coronary computed tomography angiography (CCTA)-confirmed coronary artery disease (CAD) versus non-CAD. Secondarily, within the CCTA-confirmed CAD group, the aim was to investigate the relationship between the severity and extent of CAD, as determined by coronary artery calcium score (CACS), and the levels of CTRP5 and chemerin. Methods: Consecutive individuals with chest pain underwent CCTA to evaluate coronary artery anatomy and were divided into two groups. The CCTA-confirmed CAD group included patients with any atherosclerotic plaque (soft, mixed, or calcified) regardless of calcification, while the non-CAD group consisted of individuals without plaques on CCTA, with zero CACS, and without ischemia on stress ECG. Secondarily, in the CCTA-confirmed CAD group, the severity and extent of CAD were evaluated using CACS. Blood samples were collected and stored at −80 °C for analysis of CTRP5 and chemerin levels via ELISA. Results: Serum CTRP5 and chemerin levels were significantly higher in the CAD group compared to the non-CAD group (221.83 ± 103.81 vs. 149.35 ± 50.99 ng/mL, p = 0.003 and 105.02 ± 35.62 vs. 86.07 ± 19.47 ng/mL, p = 0.005, respectively). Receiver operating characteristic (ROC) analysis showed that a CTRP5 cutoff of 172.30 ng/mL had 70% sensitivity and 73% specificity for identifying CAD, while a chemerin cutoff of 90.46 ng/mL had 61% sensitivity and 62% specificity. A strong positive correlation was observed between CTRP5 and chemerin, but neither adipokine showed a correlation with the Agatston score, a measure of CAD severity and extent, nor with coronary artery stenosis as determined by CCTA. Conclusions: CTRP5 and chemerin were significantly elevated in the CCTA-confirmed CAD group compared to the non-CAD group, with CTRP5 showing greater sensitivity and specificity. However, neither adipokine was linked to CAD severity and extent, differing from findings based on invasive coronary angiography (ICA). CTRP5 may serve as a promising “all-or-none biomarker” for CAD presence.

OBJECTIVE:Post-authorization safety study focusing on the safety of edoxaban treatment in Türkiye with a prospective design has not been performed yet. The Evaluation of Treatment safety in patients with Atrial Fibrillation on edoxaban therapy in real-life in TüRkiye (ETAF-TR) study is designed to evaluate the safety and effectiveness of edoxaban treatment in atrial fibrillation (AF). The baseline results of the ETAF-TR study describe the demographic, clinical, and laboratory characteristics of the study population. METHOD:The ETAF-TR study (NCT04594915) is a prospective, national, multicentre, observational, post-authorization safety study conducted in 50 outpatient cardiology clinics. RESULTS:Overall, 1,053 patients with AF treated with edoxaban for stroke prevention were enrolled in the study between August 2020 and May 2022. The mean age of the study population was 70.1+-11.3 years, and 59.0% of the patients were female. Mean CHA2DS2-VASc and HAS-BLED scores were 3.5 and 1.6, respectively. Of the 1053 patients, 843 (80.1%) received standard dose edoxaban and 210 (19.9%) received reduced dose edoxaban. Of the 1053 patients, 38 patients (3.6%) had off-label usage of edoxaban therapy. Among the remaining 1015 patients, 834 (82.2%) received the appropriate dose of edoxaban, and 181 (17.8%) received an inappropriate dose of edoxaban according to the summary of product characteristics (SmPC) criteria. CONCLUSION:Edoxaban has been used wide spectrum of patients with AF in daily routine practice with a good overall adherence to the SmPC. As the biggest national pharmacovigilance study to date, the ETAF-TR Study will provide detailed insight into the safety of edoxaban treatment. *ETAF-TR Investigators Eyüp Avcı, Çağatay Önal, Ferit Böyük, Salih Kılıç, Serhat Çalışkan, Özkan Vural, Nurullah Çetin, Eren Ozan Bakır, Turgay Işık, Özcan Başaran, Oğuzhan Çelik, Nijad Bakhshaliyev, Ufuk Eryılmaz, Mustafa Çalışkan, Ömer Faruk Baycan, Adem Atıcı, Aysu Oktay, Sinan İnci, Mehmet Erdoğan, Ender Özgün Çakmak, Özge Turgay Yıldırım, Mehmet Ballı, Fazilet Ertürk Sağ, Nihat Söylemez, Fatma Köksal, Mahmut Yılmaz, Veysel Özgür Barış, Şahin Dost, Serhat Sığırcı, Şahin Topuz, Ataç Çelik, Erkan Borazan, Ömer Taşbulak, Gökhan Demirci, Mustafa Ali Yavaş, Demet Menekşe Gerede Uludağ, İrem Müge Akbulut Koyuncu, Mehmet Emre Özerdem, Mustafa Yenerçağ, Deniz Elçik, Bahadır Kırılmaz, Uğur Küçük, Ebru Özpelit, Zeynep Kumral, Turhan Turan, Selim Kul, Veysel Yavuz, Kamil Tülüce, Selcen Yakar Tülüce, Burcu Yağmur, Anar Mammadli, Ersin Sarıçam, Ramazan Düz, Müjgan Tek, Mustafa Kurşun.

PURPOSE: The purpose of this study was to evaluate prediabetic patients for microvascular changes using optical coherence tomography-angiography (OCT-A) and compare with diabetic patients and healthy controls. METHODS: OCT-A images of 60 eyes of 30 patients with diabetes mellitus (DM), 72 eyes of 36 prediabetic patients, and 108 eyes of 54 healthy controls were retrospectively evaluated and compared in this study. A swept-source OCTA (Triton, Topcon) instrument was used for collecting OCT-A images. Duration of the diabetic or prediabetic period, glycated hemoglobin, fasting blood glucose level, postprandial glucose (PPG) level, high-density lipoprotein, low-density lipoprotein, triglyceride, and creatinine values of all participants were recorded. RESULTS: Microaneurysm, nonperfusion areas, perifoveal capillary disruption, and capillary network disorganization were detected in both prediabetics and diabetics but statistically more common in diabetic patients. Neovascularization and intraretinal microvascular anomalies were detected only in diabetic patients. CONCLUSIONS: OCT-A seemed to be effective in detecting microvascular changes in diabetic patients. More importantly, results showed us that in prediabetic patients, microvascular changes can be seen before the onset of DM and before or concurrently with neurodegenerative changes.

Aims We aimed to determine the use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and to identify clinical factors associated with their use in patients with heart failure (HF) in a real-life setting. Methods Real-world data on Empagliflozin and Dapagliflozin use in patients with HEART failure: The RED-HEART study is a multicentre, cross-sectional and observational study that included HF patients in the outpatient setting regardless of ejection fraction from 19 cardiology centres between August 2023 and December 2023. Results The study population consisted of 1923 patients with HF, predominantly men (61.2%), with a median age of 66 (range: 19-101) years. Overall, 925 patients (48.1%) were receiving SGLT2is. Among the study population, 22.1% had HF with preserved ejection fraction, 21.5% had HF with mildly reduced ejection fraction, 56.4% had HF with reduced ejection fraction and the use of SGLT2is was 42.0%, 47.9% and 50.6% in each group, respectively (P = 0.012). The use of SGLT2is was 76.6% in patients with HF and diabetes, 19.8% in patients with HF and chronic kidney disease and 26.8% in patients without diabetes and chronic kidney disease (P < 0.001). Higher education level [odds ratio (OR): 1.80; 95% confidence interval (CI): 1.06-3.05; P = 0.027], higher household income (OR: 3.46; 95% CI: 1.27-9.42; P = 0.015), New York Heart Association functional class IV (OR: 2.72; 95% CI: 1.16-6.35; P = 0.021), diabetes (OR: 9.42; 95% CI: 6.72-13.20; P < 0.001), the use of angiotensin receptor-neprilysin inhibitors (ARNis) (OR: 4.09; 95% CI: 2.39-7.01; P < 0.001), the use of mineralocorticoid receptor antagonists (MRAs) (OR: 2.02; 95% CI: 1.49-2.75; P < 0.001), the use of loop diuretics (OR: 1.62; 95% CI: 1.18-2.22; P = 0.003) and the use of thiazide diuretics (OR: 1.72; 95% CI: 1.30-2.29; P < 0.001) were independently associated with the use of SGLT2is. Conversely, atrial fibrillation (OR: 0.63; 95% CI: 0.45-0.88; P = 0.008), chronic kidney disease (OR: 0.53; 95% CI: 0.37-0.76; P = 0.001), the use of dihydropyridine calcium channel blockers (OR: 0.68; 95% CI: 0.48-0.98; P = 0.042) and the use of statins (OR: 0.67; 95% CI: 0.49-0.91; P = 0.010) were independently associated with the non-use of SGLT2is. Conclusions The RED-HEART study provided comprehensive real-world data about implementing SGLT2is in patients with HF. These results suggest that there is a need for organized action and close collaboration between healthcare providers to improve the implementation of SGLT2is, especially in patients with HF with preserved ejection fraction and chronic kidney disease.

OBJECTIVE:Oral anticoagulant therapy is the cornerstone of atrial fibrillation management to prevent stroke and systemic embolism. However, there is limited real-world information regarding stroke and systemic embolism prevention strategies in patients with atrial fibrillation. The aim of the ROTA study is to obtain the real-world data of anticoagulant treatment patterns in patients with atrial fibrillation. METHODS:The ROTA study is a prospective, multicenter, and observational study that included 2597 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January 2021 and May 2021. RESULTS:The median age of the study population was 72 years (range: 22-98 years) and 57.4% were female. The median CHA2DS2-VASc and HAS-BLED scores were 4 (range: 0-9) and 1 (range: 0-6), respectively. Vitamin K antagonists and direct oral anticoagulants were used in 15.9% and 79.4% of patients, respectively. The mean time in therapeutic range was 52.9% for patients receiving vitamin K antagonists, and 76% of those patients had an inadequate time in therapeutic range with <70%. The most common prescribed direct oral anticoagulants were rivaroxaban (38.1%), apixaban (25.5%), and edoxaban (11.2%). The rate of overuse of vitamin K antagonists and direct oral anticoagulants was high (76.1%) in patients with low stroke risk, and more than one-fourth of patients on direct oral anticoagulant therapy were receiving a reduced dose of direct oral anticoagulants. Among patients who were on direct oral anticoagulant treatment, patients with apixaban treatment were older, had higher CHA2DS2-VASc and HAS-BLED scores, and had lower creatinine clearance than the patients receiving other direct oral anticoagulants. CONCLUSIONS:The ROTA study provides important real-world information about anticoagulant treatment patterns in patients with atrial fibrillation.time in therapeutic range with <70%.

Purpose Inappropriate dosing of direct oral anticoagulants is associated with an increased risk of stroke, systemic embolism, major bleeding, cardiovascular hospitalization, and death in patients with atrial fibrillation. The main goal of the study was to determine the prevalence and associated factors of inappropriate dosing of direct oral anticoagulants in real-life settings.Methods This study was a multicenter, cross-sectional, observational study that included 2004 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January and May 2021. The main criteria for inappropriate direct oral anticoagulant dosing were defined according to the recommendations of the European Heart Rhythm Association.Results The median age of the study population was 72 years and 58% were women. Nine-hundred and eighty-seven patients were prescribed rivaroxaban, 658 apixaban, 239 edoxaban, and 120 dabigatran. A total of 498 patients (24.9%) did not receive the appropriate dose of direct oral anticoagulants. In a logistic regression model, advanced age, presence of chronic kidney disease and permanent atrial fibrillation, prescription of reduced doses of direct oral anticoagulants or edoxaban treatment, concomitant use of amiodarone treatment, and non-use of statin treatment were significantly associated with potentially inappropriate dosing of direct oral anticoagulants.Conclusion The study demonstrated that the prevalence of inappropriate direct oral anticoagulant dosing according to the European Heart Rhythm Association recommendations was 24.9% in patients with atrial fibrillation. Several demographic and clinical factors were associated with the inappropriate prescription of direct oral anticoagulants.

OBJECTIVE This study aimed to evaluate whether the addition of heart rate-corrected QT inter- val prolongation to the Global Registry of Acute Coronary Events risk score improves the pre- dictive value for early mortality in patients with non-ST segment elevation acute coronary syndrome. METHODS We retrospectively screened our database for consecutive non-ST-segment eleva- tion acute coronary syndrome patients between January 2017 and July 2019. The demographic and clinical parameters were acquired via chart review. All electrocardiograms were reviewed by 2 physicians. QT interval was measured using the tangent method. Early mortality was defined as all-cause death observed during the hospital stay or within 30 days after discharge. RESULTS The final study population consisted of 283 patients, there were 17 early deaths. Ten of 59 patients with prolonged corrected QT intervals died (16.9%, P < .001). Both the Global Registry of Acute Coronary Events risk score (odds ratio: 1.032; 95% CI: 1.012-1.053; P = .002) and corrected QT interval (odds ratio: 1.026; 95% CI: 1.007-1.045; P = 0.007) independently predicted early mortality. The area under value was 0.769 (95% CI: 0.674-0.863, P < .001) for the corrected QT interval and 0.780 (95% CI:0.681-0.878; P < .001) for the Global Registry of Acute Coronary Events risk score alone. However, when the corrected QT interval and the Global Registry of Acute Coronary Events risk score were combined, it was found to be 0.808 (95% CI: 0.713-0.904, P < .001). CONCLUSION This study is the first to report that prolonged corrected QT and the Global Registry of Acute Coronary Events risk score independently predict early mortality and a combina- tion of these 2 factors may improve the predictive value for early mortality in patients with ST-segment elevation acute coronary syndrome.

Objectives: SMYRNA-HF study is a prospective multicenter registry study to determine the profiles of patients with heart failure (HF) in Turkey. This study aimed to present the baseline characteristics of preliminary cohort by comparing them according to different HF phenotypes. Methods: The first SMYRNA-HF cohort included outpatients with HF from 9 centers. Patients were classified into three HF phenotypes as HF with reduced ejection fraction (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF) as recommended by guidelines. Results: Overall, 298 patients were included in this preliminary analysis that 57% of the patients were classified as having HFrEF, 33.3% as having HFpEF, and 9.7% as having HFmrEF. Female gender was more common in HFpEF (p = 0.003). Age, frequency of diabetes mellitus, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker, use of beta-blocker, use of daily loop diuretic, heart rate, blood urea nitrogen levels, lipid profiles, hemoglobin, white blood cell, platelet levels were similar among three HF phenotypes. Body mass index (BMI) (p < 0.001), frequency of hypertension (HT) (p < 0.001), and atrial fibrillation (AF) (p = 0.015) were higher in HFpEF. Ischemic etiology (p < 0.001) was less frequent in HFpEF. Use of mineralocorticoid receptor antagonist was higher in HFrEF (p < 0.001). Conclusions: Our study presented the baseline characteristics of outpatients with HF in Turkey. There were significant differences among HF phenotypes in terms of gender, BMI, frequency of HT, AF, and ischemic etiology. Treatment implementations seem to follow the guidelines. Although the rates are low, new treatment approaches recommended in the most recent guidelines seem to enter clinical practice.

BACKGROUNDThis study aimed to assess the safety and tolerability of nebivolol in hypertensive patients with coronary artery disease and left ventricular ejection fraction ≥ 40% in a Turkish cohort.METHODSA total of 1015 hypertensive patients and coronary artery disease with left ventricular ejection fraction ≥ 40% were analyzed from 29 different centers in Turkey. Primary outcomes were the mean change in blood pressure and heart rate. Secondary outcomes were to assess the rate of reaching targeted blood pressure (<130/80 mmHg) and heart rate (<60 bpm) and the changes in the clinical symptoms (angina and dyspnea). Adverse clinical events and clinical outcomes including cardiovascular mortality, cardiovascular hospital admissions, or acute cardiac event were recorded.RESULTSThe mean age of the study population was 60.3 ± 11.5 years (male: 54.2%). During a mean follow-up of 6 months, the mean change in blood pressure was -11.2 ± 23.5/-5.1 ± 13.5 mmHg, and the resting heart rate was -12.1 ± 3.5 bpm. Target blood pressure and heart rate were achieved in 76.5% and 37.7% of patients. Angina and functional classifications were improved by at least 1 or more categories in 31% and 23.2% of patients. No serious adverse events related to nebivolol were reported. The most common cardiovascular side effect was symptomatic hypotension (4.2%). The discontinuation rate was 1.7%. Cardiovascular hospital admission rate was 5% and hospitalization due to heart failure was 1.9% during 6 months' follow-up. Cardiovascular mortality rate was 0.1%.CONCLUSIONNebivolol was well tolerated and safe for achieving blood pressure and heart rate control in hypertensive patients with coronary artery disease and heart failure with preserved or mildly reduced ejection fraction.

Miyokard Kontraktil Hücreleri ve Fizyolojisi Hülya DİP Ventriküler Kontraksiyon ve Relaksasyon Mekanikleri Mustafa DURAN Kalp Boşluklarının Anatomisi Burhan GENCER Kalp Kapaklarının Anatomisi Kemal KARAARSLAN Koroner Dolaşım Anatomisi Mustafa KARABACAK Kalbin İleti Sistemi Anatomisi Muhammet Cihat ÇELİK Kardiyak Anamnez Özgür KIRBAŞ Göğüs Ağrısı Mustafa KURŞUN Dispne, Ortopne, Paroksismal Noktürnal Dispne Turgay ASLAN Çarpıntı, Senkop, Baş Dönmesi Filiz ÇELEBİ Siyanoz, Ödem, Asit, Venöz Dolgunluk Melike POLAT Öksürük, Hemoptizi, Halsizlik ve Yorgunluk Hakan SÜYGÜN Diğer Nadir Görülen Semptomlar Bihter ŞENTÜRK İnspeksiyon; Deri, Cilt, Baş-Boyun, Ekstremiteler, Göğüs ve Abdomenin Genel Görünümü Oğuzhan YILDIRIM Kan Basıncı Ölçümü Cihan ALTIN Venöz Sistem Muayenesi İlker GÜL Nabız Muayenesi Serdal BAŞTUĞ Ekstremite Muayenesi Gürkan KARACA Prekordiyum Muayenesi Enes ÇON Kardiyak Oskültasyonun Genel Prensipleri Gizem ÇABUK Kalp Seslerinin ve Üfürümlerinin Fizyolojisi ve Oluşum Mekanizması Kutluhan Eren HAZIR Cenk SARI Kalp Üfürümlerinin Derecelendirilmesi ve Sınıflandırılması Ahmet PEYNİRCİ Temel Kalp Sesleri Nazile BİLGİN DOĞAN Ek Kalp Sesleri Murat Can GÜNEY Prostetik Kalp Kapak Sesleri Can Ramazan ÖNCEL Sistolik Üfürümler Ersin Çağrı ŞİMŞEK Diyastolik Üfürümler Sümeyye Fatma ÖZER Devamlı Üfürümler Cemal KÖSEOĞLU Fizyolojik ve Masum Üfürümler Mehmet MUŞTU Dinamik Oskültasyon Gülhan YÜKSEL EKG Çekim Tekniği, İlk Değerlendirme ve Temel Prensipler Ömer Faruk ÇİÇEK Kalbin Elektriksel Aksının Değerlendirilmesi Sıtkı DOĞAN Normal Elektrokardiyografi Yavuz UĞURLU Anormal Elektrokardiyogram Elif ERGÜL Sinüs Düğüm Kaynaklı Aritmiler Ahmet KASAPKARA Atriyal Aritmiler Uğur ARSLANTAŞ Atrıyoventriküler Nodal Disritmiler Büşra ULUN Ventriküler Aritmiler Mehmet Fatih KARAKAŞ Preeksitasyon Sendromları Şenol TAYYAR Kardiyak Kanalopatiler Haluk Furkan ŞAHAN Elektrolit Bozukluklarının Elektrokardiyografiye Etkileri Abdullah ÖZÇELİK İlaçların EKG Üzerine Etkisi Bayram Ali UYSAL İskemik Kalp Hastalıklarında Saptanan Elektrokardiyografik Anormallikler Sefa TATAR Perikardiyal Hastalıklarda Saptanan EKG Anormallikleri Serkan SİVRİ Kalp Yetersizliklerinde Saptanan Elektrokardiyografik Anormallikler İbrahim Halil ÖZDEMİR Normal Telekardiyografi Özellikleri ve Değerlendirme Ahmet Lütfü SERTDEMİR Kardiyovasküler Hastalıklarda Göğüs Radyografisi (Telekardiyogram) Şahin AVŞAR Çocuklarda Kardiyak Fizik Muayene Şeyma ERTEM

BACKGROUND:The aim of this study was to detect the optimal values for Age, Body Mass Index (BMI) and HOMA-IR of obese patients prior to surgery that results in a maximal decrease of visceral fat mass 6 months after bariatric surgery.METHOD:In this study, 33 experimental set-ups were designed. This study was approved by Baskent University Medical and Health Sciences Research Board (Approval number: KA16/281). The study data consisted of 40 obese patients who lost weight through the bariatric surgery between February 2015 and December 2016. The values of BMI, Age and HOMA for the obese patients who lost weight through the bariatric surgery were evaluated in three categories and at three levels; the response variable was determined as the Change in Epicardial Fat Thickness (ΔEFT).RESULTS:As a result of CCD analysis, the optimum ΔEFT = 2.571 was determined when Age = 30.52, BMI = 45.30, and HOMA = 34.62. As a result of the BBD analysis, the optimum ΔEFT = 3.756 was determined, when Age = 38.36, BMI = 63.18, and HOMA = 14.95. The optimum ΔEFT was modeled with Contour and Response Surface plots.CONCLUSION:Based on the two surface response models used in our study, the maximal decrease of visceral fat mass as assessed by measuring echography images of epicardial fat thickness can be obtained by bariatric surgery of persons who are between 31 and 38 year old, have a BMI between 45 and 63 kg/m2 and have a HOMA-IR 34 between 15 and 35. Central Composite Design and a Box-Behnken Design of suitable patient data predicted 35 optimal settings of independent variables for the maximal clinical response of an intervention.

Background: Many factors were blamed for the worse prognosis in COVID-19. Heart failure patients are thought to be under increased risk because of either immune-compromised basal status or possible interaction of viral infection with on-going medications, such as the Renin-Angiotensin-Aldosterone system (RAAS) blockers. Sacubitril is a neprilysin inhibitor and its' combination with valsartan is recommended as a novel medication for heart failure. Case Report: A 71 years of age female with end-stage heart failure was hospitalized for COVID-19 pneumonia. She was under sacubitril/valsartan combination for the heart failure, and at the end of the first week of hospitalization, clinical and laboratory parameters recovered uneventfully. Sacubitril/valsartan therapy was continued without complications during the in-hospital course. Conclusion: Specific therapies for heart failure should not be withdrawn in COVID-19. To our knowledge, this is the first case report documenting the clinical progress of a COVID-19 pneumonia patient who was already under sacubitril/valsartan treatment.

OBJECTIVEThe D-SPIRIT registry is designed to investigate the safety and effectiveness of dabigatran etexilate in patients with atrial fibrillation in routine clinical practice.METHODSD-SPIRIT is the first national, multicenter, prospective, observational, postmarketing registry that investigates the usage of dabigatran in real life. A total of 326 noveloral anticoagulant-eligible patients with atrial fibrillation who have been taking dabigatran etexilate therapy for stroke prevention at least 6 months from 9 different centers were enrolled into the registry. Patients were followed up for 2 years to evaluate the effectiveness and safety of the treatment. All adverse clinical events including bleeding, thromboembolic events, stroke, systemic embolism, transient ischemic attack, myocardial infarction, and all-cause death were recorded.RESULTSThe mean age was 71.1±9.6 years, and 57.4% of the study participants were female. The mean CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack [TIA], vascular disease, age 65-74 years, sex category) score was 3.4±1.6. The cumulative adverse clinical events rate was 6.30% per year. The rate for embolic events including TIA, ischemic stroke, and peripheral embolism was 1.26% per year. The rate for major bleeding was 2.20% per year, and the mortality rate was 0.94% per year.CONCLUSIONThis registry obtained an important overview of the current safety and effectiveness of the dabigatran etexilate in Turkey. Our results indicate similar rates of thromboembolic and bleeding events with pivotal phase 3 trial and other real-life registries. However, rate of undertreatment usage of dabigatran etexilate in real life was found to be considerable.

Objective: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey. Methods: The ARNi-TR is a multicenter, nonintervention al, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control. Results: N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARNi. Conclusion: The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.