Introduction: Erectile dysfunction (ED) and cardiovascular (CV) diseases share common risk factors and ED has been accepted as an early manifestation of CV disease. Exercise stress testing (EST) is used to evaluate CV functions in men with ED. Low exercise workload, a slower heart rate recovery (HRR) after exercise, and inability to increase heart rate during EST (chronotropic incompetence) are independent negative predictors of adverse CV outcomes. Aim: To assess the association among EST parameters, ED, and testosterone levels. Methods: The study population consisted of 41 patients with ED and 40 controls. All participants underwent treadmill EST to assess cardiac autonomic functions. HRR indices were calculated by subtracting 1st (HRR1), 2nd (HRR2), and 3rd (HRR3) minute heart rates during the recovery period from maximal heart rate. Total exercise duration, exercise capacity and chronotropic response, and plasma testosterone levels were evaluated. Erectile functions were evaluated with the Sexual Health Inventory for Men. Patients were divided into subgroups according to severity and duration of ED. Main Outcome Measures: Mean HRR1 (30.6 +/- 11.9 vs 36.9 +/- 9.9; P=.01), HRR2 (44.9 +/- 12.4 vs 54.9 +/- 7.8; P<.001), and HRR3 (50.1 +/- 11.7 vs 63.0 +/- 7.9; P<.001) were significantly lower in the ED than in the control group. Total exercise duration (9.4 +/- 1.9 vs 10.9 +/- 1.7 minutes; P<.001), exercise capacity (12.5 +/- 1.9 vs 13.6 +/- 1.4 metabolic equivalents; P=.004), and chronotropic response (0.88 +/- 0.1 vs 1.0 +/- 0.1; P<.001) were worse in the ED group. However, we found no association between severity and duration of ED and EST parameters. In addition, serum testosterone levels were significantly correlated with HRR1 (r=0.36, P=.02) in men with ED. Conclusion: Our data suggested that cardiac autonomic functions are impaired in patients with ED. A weak correlation between cardiac autonomic dysfunction and low testosterone levels in patients with ED was noted. However, further studies are needed to elucidate the prognostic significance and clinical implications of impaired autonomic functions and testosterone replacement therapy in patients with ED. Copyright (C) 2017, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.

Thromboembolic complications are the most important outcomes of atrial fibrillation (AF). New oral anticoagulants (NOACs) have been presented to protect non-valvular AF patients from thromboembolic complications. In this study, we aimed to evaluate effectiveness and safety of NOACs and also reveal prescribing habits of physicians, retrospectively. NOACs and their effectiveness and safety retrospectively. Patients with non-valvular AF using either rivaroxaban or dabigatran were included in the study in five different tertiary centers. Patients were identified by scanning their medication reports. Appropriate patients were called and face-to-face interviews were done. Followups were carried out on the phone. 183 out of 201 identified patients, taking rivaroxaban and dabigatran, were reached. General clinical characteristics were not significantly different between drug groups. Vascular disease and persistent AF were significantly higher in the rivaroxaban group. The rate of low dose medication in the dabigatran group was higher compared to the rivaroxaban group. Average age of the patients taking low dose medication were prominently higher in both groups. Between high and low dose users of the dabigatran group, creatinine clearance (CrCl) were not differed. Among rivaroxaban group, CrCl of the low dose users were lower than of the high dose users. However, among low-dose-prescribed patients, only 6 out of 38 patients had a CrCl value in the range of 30-49 ml/min, revealing that remaining 32 patients were receiving inappropriately low rivaroxaban dose. The rate of all-cause mortality, thromboembolism and bleeding complications were not statistically significant between the medication groups. While prescribing NOAC for non-valvular AF patients, physicians seem to consider patients’ ages rather than CrCl values. In terms of protecting from thromboembolism, rivaroxaban and dabigatran seem to be equally effective and safe.

Gurkan Acar, Karacasu, Turkey Constantina Aggeli, Athens, Greece Tolga Aksu, Kocaeli, Turkey N. Al-Naamani, Boston, Mass., USA Joseph S. Alpert, Tucson, Ariz., USA Giuseppe Andò, Messina, Italy Aristidis Androulakis, Athens, Greece Dimitrios Angouras, Athens, Greece Patrick Antoun, Jacksonville, Fla., USA Yaron Arbel, Tel Aviv, Israel Wilbert S. Aronow, Valhalla, N.Y., USA S. Aydin, Elazig, Turkey Juan Badimon, New York, N.Y., USA Maciej Banach, Lodz, Poland John Barbetseas, Athens, Greece Kristen Barthel, Boulder, Colo., USA Alban-Elouen Baruteau, New York, N.Y., USA Melissa Bates, Iowa City, Iowa, USA Javier Beaumont, Pamplona, Spain Stephanie Benjamin, Northridge, Calif., USA Alexandre Benjo, New Orleans, La., USA Evgeny Berdyshev, Chicago, Ill., USA A. Berezin, Zaporozhye, Ukraine E. Bershad, Houston, Tex., USA Sanjeev Bhattacharyya, London, UK Michael Böhm, Homburg/Saar, Germany Harisios Boudoulas, Athens, Greece Konstantinos D. Boudoulas, Columbus, Ohio, USA Ryan Boudreau, Iowa City, Iowa, USA Alberto Bouzas-Mosquera, A Coruña, Spain Sorin Brener, Brooklyn, N.Y., USA Frank Breuckmann, Arnsberg, Germany Adam S. Budzikowski, Brooklyn, N.Y., USA L. Maximilian Buja, Houston, Tex., USA John W. Calvert, Atlanta, Ga., USA Paul Chai, New York, N.Y., USA Robert D. Chait, West Palm Beach, Fla., USA Shaoliang Chen, Nanjing, China Yi Chu, Iowa City, Iowa, USA

Objectives: Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias and cardiovascular mortality. We aimed to evaluate ventricular repolarization indexes in patients with prehypertension and new diagnosed hypertension. Materials: Our study population consisted of 95 subjects: 28 healthy volunteers with normotensive, 35 subjects with prehypertension, and 32 patients with newly diagnosed hypertension (HT). Tp-e interval and Tp-e/QT ratio were measured from a 12-lead electrocardiogram, and the Tp-e interval corrected for heart rate. These parameters were compared among groups. Results: Age, gender distribution, heart rate and lipit levels were similar, between of the study groups (P > 0.05). Corrected QT dispersion, corrected Tp-e interval and Tp-e/QT ratio were significantly increased in patients with HT when compared with normotensive and prehypertension subjects (P < 0.001, P = 0.001, P = 0.001 respectively). Conclusion: Tp-e interval and Tp-e/QT ratio were increased in HT patients with respect to normotensive subjects. These parameters were similar normotensive and prehypertensive subjects. Our results may contribute to pathophysiological mechanisms of increased prevalence of ventricular arrhythmias and cardiovascular mortality risk by indicating increased ventricular repolarization heterogeneity in hypertension patients.

Amaç: Bariatrik cerrahi tedavi hızlı bir şekilde kilo kaybında çok etkili olmaktadır. Bu çalışmamızda obezite cerrahisi öncesi ve sonrasında biyokimyasal ve ekokardiyografik olarak kardiyak fonksiyonları inceledik.Gereç ve Yöntem: Çalışmamıza prospektif olarak Genel cerrahi polikliniğinde bariatrik cerrahiye (laparoskopik sleeve gastrektomi) uygun olarak değerlendirilen, 23-55 yaş arası, morbit obez ( VKİ 47.8 ± 7.3 kg/m2 ) olan 30 (22 kadın ve 8 erkek ) hasta alınmıştır. Hastaların fizik muayene ve biyokimyasal testleri yapıldı. Bariatrik cerrahi öncesi ve 6 ay sonrası konvensiyonal ve doku doppler ekokardiyografi parametreleri, sol ve sağ ventrikül fonksiyonları, miyokard performans indeksleri (MPI), sol ve sağ atriyal volüm endeksleri ölçüldü.Bulgular: VKİ cerrahi öncesi 47.8 ±7.3 kg/m2 iken 6 ay sonunda 34.1±7.1 kg/m2 ölçüldü (p<0.001). Kalp hızı (p= 0.020) ve sistolik (p = 0.003) ve diyastolik kan basıncı (p = 0.009) ve plasma açlık glukoz (p<0.001) değerleri iki grup arasında anlamlı düşük bulundu. Sol ventrikül diyastol sonu çapı, sol ventrikül kitlesi, Triküspit E/A oranı ve sol atrium volüm indeksi anlamlı olarak farklı idi (sırasıyla p= 0.026, p= 0.010, p<0.001, p= 0.006 ). Sol ventrikül septal MPI (0.44±0.06 ; 0.40±0.06, p=0.05) ve sağ ventrikül MPI anlamlı şekilde düştüğü gözlendi (0.43±0.08 ; 0.35±0.05, p<0.001). Sonuç: Kilo kaybının morbid obez hastalarda kardiyak fonksiyonları iyileştirdiğini düşündürmektedir. Bulgularımız hastaların sistolik ve diyastolik fonsiyonlarında olumsuz değişme olmadığını, ayrıca myokard performans indeksinin iyileştiği sonucunu ortaya koymuştur.

Miyokardiyal kas bandi basitce epikardiyal koroner arterin intramural seyir gosteren kisminin sistol sirasinda daralmasidir. Kas bandi iyi seyirli olmasina ragmen, akut koroner sendrom, aritmi ve ani kadiyak olum gibi semptomlara neden olabilir. Bu yazida sol on inen arterin orta kismindaki kas bandi ile iliskili tipik efor anginasi olan bir hastayi sunduk.

To evaluate the efficacy and safety of the new oral anticoagulants of rivaroxaban and dabigatrane etexilate in daily clinical practice in Turkey.

OBJECTIVE:In Turkey, a type of smokeless tobacco called Maras powder (MP) is widely used in the south-eastern region. Smokeless tobacco is found in preparations for chewing and for absorption by the nasal and oral mucosae. The purpose of this study was to investigate whether MP damages intra- and inter-atrial conduction delay and left atrial (LA) mechanical function as much as cigarette smoking.METHOD:A total of 150 chronic MP users (50 males, 32.5 ± 5.4 years), smokers (50 males, 32.1 ± 6.0 years) and controls (50 males, 30.1 ± 5.8 years) were included in the study. LA volumes were measured echocardiographically according to the biplane area-length method. Atrial electromechanical coupling was measured with tissue Doppler imaging and LA mechanical function parameters were calculated.RESULTS:The LA passive emptying fraction was significantly decreased and LA active emptying volume (LAAEV) was significantly increased in the MP group (p = 0.012 and p = 0.024, respectively), and the LA active emptying fraction (LAAEF) was significantly increased in the smokers (p = 0.003). There was a positive correlation between the amount of MP used and smoking (pack years) with LAAEV and LAAEF (r = 0.26, p = 0.009 and r = 0.25, p = 0.013, respectively). Lateral atrial electromechanical intervals (PA) were significantly higher in MP users, and the septal mitral PA was statistically higher in the smokers (p = 0.05 and p = 0.04, respectively).CONCLUSION:We suggest that atrial electromechanical coupling intervals were prolonged and LA mechanical function was impaired in MP users and smokers, but there was no significant difference between the MP users and smokers. These findings may be markers of subclinical cardiac involvement and tendency for atrial fibrillation.

Behcet Hastaligi, kronik sistemik inflamatuvar bir hastaliktir. Kardiyak tutulum, ozellikle koroner embolizasyon Behcet Hastaligi’nin oldukca nadir bir bulgusudur. Bu yazida, tekrarlayan miyokard infarktusu meydana gelen bir Behcet olgusunu sunduk.

J. Dawn Abbott, Providence, R.I., USA Gurkan Acar, Karacasu, Turkey Muhammet A. Adyn, Hamburg, Germany Constantina Aggeli, Athens, Greece Pierfrancesco Agostoni, Utrecht, Netherlands Piergiuseppe Agostoni, Milano, Italy Cary W. Akins, Boston, Mass., USA Zehra Ilke Akyildiz, Izmir, Turkey Dimitrios Alexopoulos, Patras, Greece Joseph S. Alpert, Tucson, Ariz., USA Y. Al-tonbary, Mansoura, Egypt Charlotte Andersson, Gentofte, Denmark Shin-ichi Ando, Fukuoka, Japan George K. Andrikopoulos, Thrakomakedones, Greece Dimitrios Angouras, Athens, Greece Yaron Arbel, Tel Aviv, Israel Hossein Ardehali, Chicago, Ill., USA C. Arnott, Sydney, N.S.W., Australia Wilbert S. Aronow, Valhalla, N.Y., USA Giuseppe Asciutto, Malmö, Sweden Dan Atar, Oslo, Norway Vasilios Athyros, Thessaloniki, Greece Juan Badimon, New York, N.Y., USA Leora Balsam, New York, N.Y., USA Sevket Balta, Eskisehir, Turkey Cengiz Basar, Duzce, Turkey Jeroen Bax, Leiden, Netherlands Javier Beaumont, Pamplona, Spain J. Belsey, Sudbury, UK John F. Beltrame, Adelaide, S.A., Australia Pedro Beraldo de Andrade, São Paulo, Brazil E. Bershad, Houston, Tex., USA Reinaldo B. Bestetti, São José do Rio Preto, Brazil Jacek Bialkowski, Zabrze, Poland Peter Block, Atlanta, Ga., USA Michael Böhm, Homburg/Saar, Germany Harisios Boudoulas, Athens, Greece Konstantinos D. Boudoulas, Columbus, Ohio, USA Natale Daniele Brunetti, Foggia, Italy Andrzej Budaj, Warsaw, Poland Adam S. Budzikowski, Brooklyn, N.Y., USA L. Maximilian Buja, Houston, Tex., USA Thilo Burkard, Basel, Switzerland Larry M. Bush, Atlantis, Uganda Sebastian Buss, Heidelberg, Germany

BACKGROUND Bipolar disorder (BD) is a chronic mental illness that is associated with substantial functional impairment, morbidity and mortality. Lithium is still considered as a first-line therapy in BD. In this study, systolic and diastolic function parameters were measured with echocardiography in BD during lithium therapy and compared to those of a control group. METHODS Thirty BD under lithium therapy and controls were included in our study. Blood samples were taken 12 hours after receiving the last dose of lithium treatment, in the meantime echocardiography were performed. Left ventricular systolic and diastolic function was assessed by conventional echocardiography and tissue Doppler imaging. Serum lithium level correlation between diastolic function parameters was measured. RESULTS Baseline demographic and laboratory results did not differ significantly between the groups. Left ventricular ejection fraction (LVEF) (66.7 ± 7.1% vs 66.7 ± 4.9%), E/A ratio (1.14 ± 0.41 vs 1.28 ± 0.29), and isovolumetric relaxation time (IVRT) (77.8 ± 14.5 cm/sec vs 75.9 ± 17.7cm/sec) measured with conventional echocardiography showed no significant difference between the two groups. Em (14.8 ± 5.2 cm/sec vs 15 ± 4.6 cm/sec), Am (12.7 ± 4.0 cm/sec vs 11.1.0 ± 2.4 cm/sec) and E/Em (5.5 ± 1.8 vs 5.9 ± 2.4) measured with tissue Doppler echocardiography showed no significant difference between the two groups. Serum lithium levels were not correlated with LVEF, mitral inflow E velocity, mitral inflow A velocity, E/A ratio, deceleration time (DT), IVRT, or E/Em ratio. CONCLUSION Left ventricular systolic and diastolic functions were preserved in BD during lithium therapy.

Objective: In heart failure (HF) patients, functional capacity has been demonstrated to be a marker of poor prognosis, independent of left ventricular ejection fraction (EF). Lymphocyte count is currently recognized in certain risk stratification scores for chronic HF, and severe HF is associated with lymphocytopenia. However, no data exists on the association between lymphocyte count and functional capacity in patients with stable HF. This study aimed to assess the relationship between lymphocyte count and New York Heart Association (NYHA) functional capacity in systolic HF outpatients.Methods: The Turkish Research Team-HF (TREAT-HF) is a network which undertakes multi-center observational studies in HF. Data on 392 HF reduced ejection fraction (HFREF) patients from 8 HF centers are presented here. The patients were divided into two groups and compared: Group 1 comprised stable HFREF patients with mild symptoms NYHA Class (I-II), while Group 2 consisted of patients with NYHA Class III-IV symptoms.Results: Patient mean age was 60 +/- 14 years. Lymphocyte count was lower in patients with NYHA functional classes III and IV than in patients with NYHA functional classes I and II, 0.9 [0.6-1.5] x1000 versus 1.5 [0.7-2.2] x1000, p<0.001). In multivariate logistic regression analysis, lymphocyte count OR: 0.602, 95% CI: 0.375-0.967, p=0.036), advanced age, male gender, presence of hypertension, EF, left atrium size, systolic pulmonary artery pressure, neutrophil and basophil counts, creatinine level, and diuretic usage were associated with poor NYHA functional class in systolic HF outpatients.Conclusion: The present study demonstrated that in stable HFREF outpatients, lymphocytopenia was strongly associated with poor NYHA function, independent of coronary heart disease risk factors.

INTRODUCTION:Slow coronary flow (SCF) is described as the slow passage of contrast to distal coronaries despite anatomically normal coronary arteries. It has been shown that increased serum prolidase activity (SPA) correlates with collagen turnover. Increased collagen turnover might be associated with the development of atherosclerotic plaques.AIM:To investigate the relationship between serum prolidase activity and slow coronary flow.MATERIAL AND METHODS:This cross-sectional study included 40 SCF patients (mean age: 55.0 ±9.5 years, 20 females) and 40 controls (mean age: 53.9 ±8.2 years, 21 females) with normal coronary anatomy and normal coronary flow. The Thrombolysis in Myocardial Infarction (TIMI) frame-count (TFC) method was used for SCF diagnosis. Serum prolidase activity was measured spectrophotometrically, and the relevant parameters were compared between the groups.RESULTS:There were no statistically significant differences between the SCF and control groups in terms of basic demographic, clinical, and laboratory data. However, the SPA was significantly higher in the SCF group compared to the control (702.7 ±13.8 and 683.9 ±13.2 respectively, p<0.001). Serum prolidase activity was significantly correlated with the mean TFC (r=0.463, p<0.001). The overall findings of this study support the predictive accuracy of the serum prolidase activity in our cohort, with a statistically significant ROC value of 681.3.CONCLUSIONS:Our study showed that SPA was increased in SCF patients. The activity of this enzyme was significantly correlated with the mean TFC.