Background/Objectives: Immune checkpoint inhibitor (ICI)-associated cardiovascular adverse events are relatively uncommon; they can be life-threatening, particularly when involving malignant ventricular arrhythmias. Electrocardiographic markers such as P-wave dispersion (PWD), QT dispersion (QTd), T-peak to T-end (Tp-e) interval, and Tp-e/QT and Tp-e/QTc ratios have been linked to an elevated risk of both atrial and ventricular arrhythmias and sudden cardiac death across various cardiac conditions. Monitoring these parameters may aid in identifying the risk of arrhythmogenic events in cancer patients undergoing ICI therapy. Methods: This retrospective cohort study analyzed 42 patients with cancer who received ICI therapy and had serial 12-lead electrocardiograms (ECGs) performed at baseline and at three-month intervals during the first year of treatment, from May 2022 to November 2023. ECG parameters including PWD, QTd, Tp-e interval, and Tp-e/QT and Tp-e/QTc ratios were measured and compared between baseline and follow-up time points. Results: The median follow-up duration was 5.3 months (range: 0.5-18.9 months). No statistically significant differences were observed in any of the ECG parameters between baseline and subsequent measurements (p > 0.05). One patient developed atrial fibrillation during the third month of treatment. Additionally, one patient exhibited a left anterior fascicular block, and another experienced frequent ventricular extrasystoles. No malignant ventricular arrhythmias were reported throughout the study period. Conclusions: This study found no significant changes in electrocardiographic markers associated with arrhythmia risk during ICI treatment. Larger, multicenter, prospective studies with extended follow-up are warranted to further elucidate the cardiovascular safety profile of ICIs.

Aim: Ramadan fasting (RF) can affect the health status of patients with coronary artery disease or risk factors. The aim of this study is to evaluate echocardiographic functions and tei index according to ramadan fasting status in patients followed for clinically existing coronary artery disease. Material and Method: This single-centre, cross-sectional study included 49 patients who were being followed up with a diagnosis of coronary artery disease. The patients were separated into 2 groups as those who were fasting during the month of Ramadan (RF (+), n=24) and those who were not (RF (-), n=25). Detailed echocardiographic evaluations were made. Analyses of the study data were performed using MedCalc software. Results: The demographic and echocardiographic characteristics of the patients in both groups were similar at the start of the study. When the fasting and non-fasting groups were compared separately, a statistically significant decrease was determined in the tei index value in the ramadan fasting (+) group after 1 month of fasting (0.44±0.14 vs. 0.40±0.12) (p: 0.025). Conclusion: In this study, the effects of RF on cardiac functions were investigated in patients with coronary artery disease and a previous stent procedure. The results of the echocardiographic evaluation after one month of fasting showed a statistically significant decrease in the tei index in the patient group fasting for Ramadan. This finding demonstrated positive effects of RF on cardiac functions.

Abstract Aims: Ramadan fasting (RF) can affect the health status of patients with cardiovascular disease or risk factors. The aim of this study was to evaluate echocardiographic functions according to RF status in patients being followed up for clinically present coronary artery disease. Methods This single-centre, cross-sectional study included 49 patients who were being followed up with a diagnosis of coronary artery disease and had undergone stent placement at least 1 year previously. The patients were separated into 2 groups as those who were fasting during the month of Ramadan (RF (+), n = 24) and those who were not (RF (-), n = 25). Detailed echocardiographic evaluations were made. Analyses of the study data were performed using MedCalc software. Results The demographic and echocardiographic characteristics of the patients in both groups were similar at the start of the study. When all the patients were evaluated together, there were seen to be no significant changes in the echocardiographic diameter measurements, tissue doppler evaluations, tei index values, and global longitudinal strain values throughout the fasting month. When the fasting and non-fasting groups were compared separately, a statistically significant decrease was determined in the tei index value in the RF (+) group after 1 month of fasting (0.44 ± 0.14 vs. 0.40 ± 0.12) (p:0.025). Conclusions In this study, the effects of RF on cardiac functions were investigated in patients with coronary artery disease and a previous stent procedure. The results of the echocardiograph evaluation after one month of fasting showed a statistically significant decrease in the Tei index in the patient group fasting for Ramadan. This finding demonstrated positive effects of RF on cardiac functions.

Objectives: The primary aim of this study was to investigate the potential relationship between non-alcoholic fatty liver disease (NAFLD) and contrast-induced nephropathy (CIN) in patients with non-ST-elevation myocardial infarction (NSTEMI). As a secondary goal, we aimed to explore the impact of NAFLD on short-term adverse events and coronary artery disease (CAD) severity in patients with NSTEMI. Methods: Three hundred and seven NSTEMI patients were included in this study. Laboratory analyses of these patients were performed before the procedure and 48–72 h after the procedure, and all patients underwent pre-procedure 2-dimensional transthoracic echocardiography and pre-discharge abdominal ultrasonography. The NAFLD (-) and (+) groups were compared statistically in terms of CIN, major cardiovascular-cerebrovascular adverse events (MACCE), and coronary artery severity (assessed by syntax score). Results: The mean age of the 307 consecutive patients included in the study was 61.58±12.39 (min-max: 26–94). The rates of CIN (primary objective) and MACCE and syntax scores (secondary objective) were comparable in both groups. Conclusion: In patients with NSTEMI, there was no relationship between NAFLD and CIN and short-term MACCE. Furthermore, NAFLD may not have an impact on the CAD severity in such patients. Based on these results, NAFLD is not a risk factor for CIN, short-term mortality, or CAD severity in NSTEMI patients.

BackgroundImmune checkpoint inhibitors (ICI) are generally associated with rare cardiac side effects, yet instances like myocarditis can be fatal. Therefore, detecting and managing left ventricular dysfunction early in ICI therapy is vital.ObjectivesThis study aims to evaluate whether left ventricular global longitudinal strain (LV GLS) is a predictor for early detection of cardiac dysfunction in patients receving ICI.MethodsThis retrospective cohort study included 44 cancer patients who received ICI therapy and underwent pre- and post- treatment assessments of left ventricular ejection fraction (LVEF) and LV GLS between May 2022 and November 2023. Retrospective comparisons and evaluations were conducted on pre-treatment and 3-month interval LVEF and LV GLS measurements during the first year of treatment.ResultsThe median follow-up duration was 5.3 months (0.5-18.9). No statistically significant difference between baseline and subsequent time points was observed in LVEF and LV GLS values (p>0.05). At the 3-month evaluation, a notable decrease in LVEF and LV GLS was observed in two patients. One patient with reduced LVEF and LV GLS succumbed to myocarditis, and another experienced sudden death of unknown etiology. The other two patients had decreased LV GLS with normal LVEF. Subsequent follow-ups of the patients exhibiting decreased LV GLS alone revealed no further decline in LVEF or LV GLS.ConclusionIn our study, a reduction in LV GLS did not demonstrate a significant role in the early prediction of ICI-related myocarditis or cardiac dysfunction. Further validation through multicenter, large-scale, prospective studies with extended follow-up periods is needed to confirm these findings.

Objectives: The aim of this retrospective study was to evaluate the effects of bringing low-density lipoprotein cholesterol (LDL-C) values to levels in line with guideline recommendations on long-term mortality in patients with a known history of coronary artery disease (CAD), undergoing transcatheter aortic valve implantation (TAVI), and long-term pre-treatment with statins. Methods: This is a retrospective and observational study of patients undergoing TAVI at a tertiary heart center with a history of CAD and long-term statin therapy. Ninety-nine patients were included in the study. The relationship between LDL-C levels in accordance with the guidelines and 5-year mortality was determined by regression analysis. Results: When the study population was divided into 2 groups with and without 5-year mortality, LDL-C values were found to be significantly higher in the mortality group (120 mg/dL vs. 93.9 mg/dL, p < 0.001). Parameters associated with the development of 5-year mortality were evaluated with univariate and multivariate logistic regression analysis. LDL-C ≥ 100 mg/dL (OR: 6.59, 95% CI: 2.17-20.01) and LDL-C ≥ 70 mg/dL (OR:3.88, 95% CI: 1.16-12.93) parameters were determined as independent predictors of mortality independent of other parameters. Conclusions: The most important result obtained in this study is that achieving the LDL-C level targets specified in the guidelines significantly reduces the in-hospital and 5-year mortality rates in patients with a previous history of CAD and statin use and undergoing TAVI. Although all patients included in the study used statins, the mortality rate was significantly higher in patients who did not reach the target LDL-C value.

Vascular inflammation has a pivotal role in the progression of atherosclerosis and major cardiovascular events (MACE). However, there is limited data concerning to role of changes in inflammatory markers in predicting MACE. In the current study, it was investigated whether the difference between high sensitive C-Reactive Protein (hs-CRP) and systemic immune-inflammatory index values (Δhs CRP and ΔSII) measured before and after the procedure and residual SYNTAX score (rSS) in stable coronary artery patients underwent percutaneous coronary intervention (PCI) could predict MACE. 203 patients (mean age: 62.11±9.20, 75% male) were included in the study. Before the first procedure and at the 1st month after the procedure(s), their blood was drawn. rSS was calculated. MACE was determined as cardiovascular mortality, target vessel revascularization non-fatal myocardial infarction, and ischemic stroke. MACE was observed in 20 patients (9.9%). Of these patients, 3 (1.5%) had cardiovascular mortality, 3 (1.5%) had a non-fatal myocardial infarction, 12 (5.9%) had target vessel revascularization due to unstable angina, and the remaining 2 (1.0%) had an ischemic stroke. The area under the curve (AUC) to predict MACE diagnosis was 0.548 for ΔSII and 0.647 for Δhs-CRP and 0.766 for rSS. In multiple regression analysis, only rSS > 4 was an independent predictor for MACE (HR=3.41, 95% CI: 1.39-8.35, p=0.007). The change in SII and hs-CRP after PCI was found to be insufficient to predict MACE, while rSS was the only independent predictor for MACE. [Med-Science 2023; 12(2.000): 536-41]

Previous reports indicate that microwave-induced hyperthermia can impair learning and memory. Here, we report that preexposure to a single 20-min period of hyperthermia can produce thermal tolerance and, thereby, attenuate future physiological and behavioral reactions to heating. Because endogenous opioids have been implicated in thermoregulation and reactions to microwave exposure, we also determined how opioid receptor antagonism might modulate these effects. In an initial experiment, rats were exposed daily, over 5 successive days, to 600-MHz microwaves (at a whole-body specific absorption rate of 9.3 W/kg) or sham exposed. In animals exposed to microwaves, thermal tolerance was evidenced by declining rectal temperatures over time. Temperature reductions following microwave exposure were prominent after a single previous exposure. Therefore, in a second study, a single hyperthermic episode was used to induce thermal tolerance. On Day 1, rats were either exposed, over a 20-min period, to 600-MHz microwaves (at a whole-body specific absorption rate of 9.3 W/kg) or sham exposed. Just prior to radiation/sham-radiation treatment, rats received either saline or naltrexone (0.1 or 10 mg/kg, intraperitoneally (i.p.)). The following day (Day 2), rats were either microwave or sham exposed and tested on a task which measures the relative time subjects explore a familiar versus a novel stimulus object. Normothermic rats spend significantly more time in contact with new environmental components and less time with familiar objects. Brain (dura) and rectal temperatures were recorded on both days of the study. Microwave exposure produced a reliable hyperthermia which was significantly lower (on Day 2) in rats receiving repeated treatments (tolerant group). On the behavioral test, rats exposed only once to microwave-induced hyperthermia (nontolerant group) exhibited significantly different patterns of object discrimination than did tolerant or sham-exposed animals. Sham-exposed and tolerant animals showed a distinct preference for the new object whereas the nontolerant animals did not. Naltrexone (10 mg/kg) antagonized the hyperthermia-induced disruption of the object discrimination task (in nontolerant rats) and produced patterns of object exploration that were similar to those of sham-irradiated and thermal-tolerant rats, suggesting that endogenous opioids play a role in the organism’s response to heating. Taken together, these data are consistent with the conclusions that 1) microwave-induced hyperthermia can cause a dose-dependent disruption of the normal discrimination between new and familiar objects, 2) physiological reactions to a single hyperthermic episode can produce a thermotolerance that expresses itself in both reduced levels of hyperthermia and attenuated behavioral disruptions following microwave exposure, and 3) opioid antagonism can partially reverse some of the behavioral effects of microwave-induced hyperthermia.

Objective: The aim of this study was to investigate whether there is subtle cardiac dysfunction in patients with chronic venous insufficiency. Methods: Age and sex matched 56 patients with a score of C3 and above in the Clinical, Etiological, Anatomical, Pathophysiological classification and 56 healthy volunteers were included in the study. All subjects were evaluated by detailed echocardiographic examination, including two-dimensional strain echocardiographic analysis by speckle tracking method. Results: Mitral E wave deceleration time (EDT), E and A wave velocity, E/e' ratio for left ventricle, tricuspid EDT, E/e’ ratio for right ventricle and systolic pulmonary artery pressure were found high as significant statistically in patients groups (p < 0.05). But no any statistically significant difference was observed in other parameters between two groups. Conclusions: There may be an increase in diastolic filling pressures in patients with chronic venous insufficiency due to the increased preload in the supine position. This condition seems to be clinically important in patients at high risk for heart failure due to the presumption of the early treatment of chronic venous insufficiency may reduce the risk of heart failure evolvement.

Objective The aim of the study was to investigate the effect of invasive treatment for chronic venous insufficiency (CVI) on cardiac hemodynamics. Methods Fifty three patients diagnosed with saphenofemoral junction or great saphenous vein insufficiency in a level above C3 according to Clinical-Etiology-Anatomy-Pathophysiology classification were included in the study. All the patients underwent 2D echocardiography before and 3 months after the invasive treatment. Results In postinvasive treatment echocardiographic assessment, significant decreases in right ventricular end-diastolic diameter ( p = 0.006), TAPSE ( p = 0.006), tricuspid E wave velocity ( p = 0.004), tricuspid E/A ratio ( p < 0.001), sPAB ( p = 0.017), tricuspid lateral s' wave velocity ( p = 0.004), and right ventricular free wall longitudinal strain rate ( p = 0.011) were observed. Conclusions The invasive treatment of superficial venous insufficiency of the lower extremities may lead to reduction in the increased venous return in the supine position subclinically.

Aim: Warfarin , a vitamin K antagonist, is the only approved oral agent to provide anticoagulation in patients with metallic prosthetic valves. Since effectively initiating and maintaining anticoagulation is challenging due to various factors , those patients undergo frequent periodic INR testing. The aim of this study was to investigate the effect of the timing of warfarin ingestion on the stability of anticoagulation. Materials and Methods: A total of 60 patients with metallic prosthetic valves were included in the study. First, all the patients were informed to take warfarin between 19:30 and 20:00 during the first month, then to take warfarin between 09:30 and 10:00 during the second month. All the patients underwent INR monitoring once every 15 days during the follow-up period. The time in therapeutic range (TTR) values for the first month and second month ( referred to as ‘first TTR’ and ‘second TTR’, respectively) were calculated separately using the Rosendaal method. Results: The mean age ( ± SD) of the patients was 59.6 ± 9.6 years and 36.7% (n=22) were male. There was no significant difference between the first TTR and second TTR values of the patients (66.23 ± 40.7% vs 64.12 ± 41.13%, p=0.783). The mean INR value in the first month was found to be significantly lower than in the second month (2.73 ± 0.53 vs 3.06 ± 0.47, p=0.001). Conclusion:.The study results showed that the timing of warfarin ingestion did not affect the stability of anticoagulation although taking the warfarin in the morning provided higher INR values.

OBJECTIVE:The systemic immune inflammatory index (SII) has prognostic value in cardiovascular diseases. The aim of current study was to investigate whether or not left atrial appendage (LAA) thrombus could be predicted by SII in patients with non-valvular atrial fibrillation. METHOD:The study included 525 patients newly diagnosed with non-valvular atrial fibrillation, who had not previously had anticoagulant treatment (50.7% male, mean age 62.94±10.79 years). All patients underwent transoesophageal echocardiography. RESULTS:LAA thrombus was observed in 86 patients (16.4%). In the ROC curve SII had a good diagnostic power in predicting LAA thrombus (AUC: 0.760, 95% CI: 0.703-0.818, P<0.001). In the multivariate regression analysis, diabetes (Hazard ratio: 2.264, 95% CI: 1.169-4.389, P=0.015), LAA emptying rate of <20 cm/s (Hazard ratio: 59.347, 95% CI: 25.397-138.680, P<0.001), and SII value of >750 (Hazard ratio: 4.291, 95% CI: 2.144-8.586 P<0.001) were determined as independent predictors for LAA thrombus. A poor correlation was found between SII and the CHADS2 VASc score (r=0.239, P<0.001) Conclusion. The SII, a practical and easily obtained test, can be used as a predictor of LAA thrombus in patients with non-valvular atrial fibrillation, and to decide on the anticoagulant treatment.

OBJECTIVE:MicroRNAs have been explored as potential biomarkers for many pathological processes including coronary artery disease. In this study, we aimed to compare the circulating levels of selected atherosclerosis-associated miRNAs in patients with a history of early-onset coronary artery disease with that of age- and sex-matched healthy controls and older patients with late-onset coronary artery disease.METHODS:Study population consisted of 30 patients with early onset coronary artery disease, 31 age- and sex-matched healthy controls, and 30 patients with late-onset coronary artery disease. Plasma levels of 13 microRNAs (endothelial cell-related miR-126, -92a/b; vascular smooth muscle cell-related miR-145; inflammation-related miR-16, -21, -125b, -146a/b, -147b, -150, -155; lipometabolism-related miR-27b, -122, -370) were evaluated by using real-time polymerase chain reaction.RESULTS:In patients with early onset coronary artery disease, plasma expressions of the lipometabolism-related miR-27b, miR-122; inflammation-related miR-125b, miR-146a/b, miR-147b, miR-150, miR-155; and VSMC-related miR-145 were significantly downregulated and endothelial cell-related miR-126 was significantly upregulated compared to age- and sexmatched healthy controls. Circulating microRNA profile of patients with early onset coronary artery disease was also different from that of older patients with late-onset coronary artery disease. Plasma levels of miR-21, miR-27b, miR-122, miR-125b, miR-146b, miR-147b, and miR-155 were lower and plasma levels of miR-16 and miR-92a were higher in patients with early onset coronary artery disease compared to older patients with late-onset coronary artery disease.CONCLUSION:MicroRNAs are promising biomarkers for early onset coronary artery disease.

The aim of this study was to investigate the relationship between the residual SYNTAX score (rSS) and recovery of left ventricular function after percutaneous coronary intervention (PCI) in stable symptomatic patients. Overall, 81 patients (mean age: 62.3 ± 9.1 years, 72.8

Depression, and anxiety are considered to be linked with hypertension. In our study, we planned to investigate association between depression /anxiety and hypertension (HT) in young patients . A cross sectional study was conducted .The study group consisted of 175 patients under 45 years of age with a mean arterial blood pressure above 130/80 in 24-hour ambulatory blood pressure monitoring. The control group consisted of 125 volunteer health workers under 45 years of age with a mean arterial blood pressure below 130/80 in 24-hour ambulatory blood pressure monitoring. All the participants were requested to answer the questions of 'Hospital Anxiety Depression Scale' (HADS). A score of above 10 was defined as depression or anxiety based on the chosen scale. In the study group ,the mean age was 38.15±4.62 years and the ratio of male was 45 % where as in the control group ,the mean age was 38.44±4.63 years and the ratio of male was %46. (P:0.537 for mean age, P:0.866 for the ratio of male ). The active smoking rate and the body mass index (BMI) value were significantly higher in the study group (p:0.005 and p: 0.029 respectively). The study group had the higher median anxiety score and depression score (p<0.001). Body mass index (BMI) (HR: 1.102, CI:1.014-1.199, p:0.023) HADS anxiety and depression scores above 10 (HR: 21.989, CI: 8.280-58.397, p:<0.001 and HR: 29.087, CI: 8.579–98.624, p<0.001 respectively) were associated with HT. In our study, the presence of depression/anxiety determined by HADS score and high BMI values were found to be associated with hypertension in patients under 45 years of age.

Aim: The mortality of chronic systolic heart failure has been decreased thanks to state-of-the-art therapy.However, the mortality rate is still high in acute heart failure (AHF).Our study was planned to investigate the mortality rates and predictors of mortality in AHF. Material and Method:A single-center retrospective study was conducted on 805 patients hospitalized due to AHF between March 2009 and June 2013.The patients were separated into two main groups: the decompensated heart failure group (DHF), which comprised the patients with signs of right heart failure with or without pulmonary edema (722 patients -89.7%), and the acute pulmonary edema group (PE) presenting only with pulmonary edema (83 patients -10.3%).The two groups were compared for the patient-related variables.The survival analysis of the groups based on the etiology was performed.Finally, the independent predictors for 2-year mortality in AHF were investigated. Results:The 2-year mortality rate was higher in DHF than in PE (51.4% vs. 31.6%p<0.001).The mortality rates of ischemic cardiomyopathy, nonischemic cardiomyopathy, and heart failure with preserved ejection fraction (HFpEF) were 52.8%, 39.6%, and 47.3%, respectively (p=0.389).Advanced age, previous cerebrovascular diseases, anemia, hyponatremia, hypoalbuminemia, lower left ventricular ejection fraction (LVEF), and lower systolic blood pressure predicted increased 2-year mortality independently.In contrast, usage of beta-blockers during hospitalization predicted reduced 2year mortality independently. Conclusion:Mortality rate was similar between different heart failure types.Various laboratory and clinical parameters predict mortality, whereas beta-blockers and ACE inhibitors reduce mortality.