OBJECTIVE:The use of cardiac implantable electronic devices has increased in recent years. It has also brought some issues. Among these, the complications of cardiac implantable electronic devices infection and pocket hematoma are difficult to manage. It can be fatal with the contribution of patient-related risk factors. In this study, we aimed to find mortality rates in patients who developed cardiac implantable electronic devices infection and pocket hematoma over 5 years. We also investigated the risk factors affecting mortality in patients with cardiac implantable electronic devices. METHODS:A total of 288 cardiac implantable electronic devices patients were evaluated. Demographic details, history, and clinical data of all patients were recorded. Cardiac implantable electronic devices infection was defined according to the modified Duke criteria. The national registry was used to ascertain the mortality status of the patients. The patients were divided into two groups (exitus and survival groups). In addition, the pocket hematoma was defined as significant bleeding at the pocket site after cardiac implantable electronic devices placement. RESULTS:The cardiac implantable electronic devices infection was similar in both groups (p=0.919), and the pocket hematoma was higher in the exitus group (p=0.019). The exitus group had higher usage of P2Y12 inhibitors (p≤0.001) and novel oral anticoagulants (p=0.031). The Cox regression analysis, including mortality-related factors, revealed that renal failure is the most significant risk factor for mortality. Renal failure was linked to a 2.78-fold higher risk of death. CONCLUSION:No correlation was observed between cardiac implantable electronic devices infection and mortality, whereas pocket hematoma was associated with mortality. Furthermore, renal failure was the cause of the highest mortality rate in patients with cardiac implantable electronic devices.

Aim. Epicardial adipose tissue (EAT) is a layer between the myocardium and the epicardium, similar to the intra-abdominal adipose tissue. Many cardiovascular diseases have been associated with increased EAT. Limited proof exists that EAT contributes to ventricular extrasystoles (VES). In this study, we aimed to examine the role of EAT on VES.Material and methods. 266 subjects were included in this prospective study between April 2022 and March 2023. They underwent a 12‑lead electrocardiogram, 24‑hour Holter monitoring, and echocardiography. The subjects were divided into two groups: the VES Group (n=134) (>60 VES / hr) and the non-VES Group (n=132) (<10 VES / hr) group. In addition, severe VES were defined as ≥10.000 VES / 24‑hr. EAT and other variables were compared between the non-VES and VES groups. Logistic regression analysis was performed to find the factors affecting VES, and an ROC analysis was used to determine the cut-off values of the variables.Results. EAT was higher in the VES group (p<0.001). In pairwise comparisons, higher EAT in the VES group was independent of ventricular frequency (p=0.552). Variables affecting the presence of VES were left ventricular mass index (p=0.031), QT dispersion (p=0.010), and EAT (p<0.001). The EAT predicted the presence of VES at a cut-off value of 4.05 with a sensitivity of 54.5 % and a specificity of 81.3 %.Conclusion. This research indicated that increased EAT might be an independent predictor of VES.

BACKGROUND: Coronary microvascular dysfunction (CMD) is a common occurrence in individuals with insulin resistance (IR). Homeostatic model assessment for insulin resistance (HOMA-IR) is a widely used surrogate marker of IR, although recent studies suggest triglyceride-glucose (TyG) index is a superior marker of IR that had a better accuracy to predict type 2 diabetes or cardiovascular outcomes than HOMA-IR. OBJECTIVES: We aimed to assess the accuracy and usefulness of TyG index and HOMA-IR for predicting CMD as assessed with echocardiographic coronary flow reserve (CFR) measurement. METHODS: All cases included in the institutional CFR registry were retrospectively reviewed, and 656 cases without epicardial coronary artery disease and without major risk factors for atherosclerosis were included. A CFR <= 2.0 was defined as CMD. RESULTS: TyG index was available in all cases, while HOMA-IR was available in 398 cases. Both TyG index and HOMA-IR were associated with CMD on univariate analyses, while after adjustment for potential confounders HOMA-IR (odds ratio [OR]:1.38, 95% confidence interval [CI]:1.14-1.67, p = 0.001) but not TyG index (OR:1.48, 95% CI:0.82-2.67, p = 0.19) was associated with CMD. The predictive accuracy of HOMA-IR (c-statistic:0.63, 95% CI:0.54-0.72, p = 0.003) was higher than TyG index(c-statistic:0.55, 95% CI:0.47-0.63, p = 0.13), although the difference was not statistically significant (DeLong p = 0.23). There was strong evidence favoring a true difference between CMD vs. non-CMD groups for HOMA-IR (BF 10 :3507) but not for TyG index(BF10:0.66). CONCLUSIONS: HOMA-IR, but not TyG index, is closely associated with CMD. (c) 2024 National Lipid Association. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Aim: The internet is a popular and continually utilized platform to gain medical knowledge for patients and health professionals. This research aimed to evaluate the accuracy and quality of videos for premature ventricular contraction (PVC) on YouTube. Material and method: The keyword "premature ventricular contraction" was inputted into the YouTube search engine. The 60 most watched videos on YouTube were analyzed. Six of these were excluded from the study. A total of 54 patients were included in the study. General characteristics of the videos were recorded. Two specialist physicians reviewed all videos. GQS, DISCERN, and JAMA scoring systems were used to test the video quality and reliability. Video quality was divided into three groups according to the GQS score. Video characteristics were compared between quality groups. Results: 37% of the videos posted were from doctors, and the most frequently seen content was related to general information about PVCs, accounting for 70.4%. There were 24 high-quality videos. The number of video comments (p=0.006), daily view rate (p=0.001), JAMA (p=

Background and Objectives: Smokeless tobacco (ST) use has recently become an alternative to cigarettes, and it has been concluded that ST is at least as harmful as cigarettes. ST use is thought to play a role in the pathogenesis of arrhythmia by affecting ventricular repolarization. In this study, we aimed to examine the relationships of Maras powder (MP), one of the ST varieties, with epicardial fat thickness and new ventricular repolarization parameters, which have not previously been described. Materials and Methods: A total of 289 male individuals were included in this study between April 2022 and December 2022. Three groups, 97 MP users, 97 smokers, and 95 healthy (non-tobacco), were compared according to electrocardiographic and echocardiographic data. Electrocardiograms (ECG) were evaluated with a magnifying glass by two expert cardiologists at a speed of 50 m/s. Epicardial fat thickness (EFT) was measured by echocardiography in the parasternal short- and long-axis images. A model was created with variables that could affect epicardial fat thickness. Results: There were no differences between the groups regarding body mass index (p = 0.672) and age (p = 0.306). The low-density lipoprotein value was higher in the MP user group (p = 0.003). The QT interval was similar between groups. Tp-e (p = 0.022), cTp-e (p = 0.013), Tp-e/QT (p =0.005), and Tp-e/cQT (p = 0.012) were higher in the MP user group. While the Tp-e/QT ratio did not affect EFT, MP predicted the epicardial fat thickness (p < 0.001, B = 0.522, 95%CI 0.272–0.773). Conclusions: Maras powder may play a role in ventricular arrhythmia by affecting EFT and causing an increase in the Tp-e interval.

OBJECTIVE:The current study investigated the contribution of the dissertations produced in the field of cardiology to the scientific literature and the factors affecting the publication process.METHODS:The study included 1049 cardiology dissertations archived in the national thesis center database between January 2010 and December 2017. The titles (English and Turkish), abstracts, and author names of cardiology dissertations were searched in Google Academic, TR Directory, and PubMed Central databases. In addition to their publication rates, the subject of the cardiology dissertations, the type of research, the type of institution, the academic title of the cardiology dissertation advisors, the duration of publication, the index of the published journals, and the quartile ranking of the Science Citation Index and Science Citation Index Expanded journals were examined.RESULTS:Among the reviewed 1049 cardiology dissertations 42.7% (n = 448) were published in a journal. The publication rate of cardiology dissertations among male authors was 43.5% and among female authors 40.1%. The cardiology dissertations were published at the highest rate after the 60th month. Among the published cardiology dissertations, 63.4% (n = 284) appeared in journals indexed by the Science Citation Index and Science Citation Index Expanded. There was no statistically significant relationship between the academic titles of cardiology dissertation advisors and the quartile ranking of Science Citation Index and Science Citation Index Expanded journals (P = 0.072).CONCLUSIONS:There were difficulties in transforming into a publication of dissertations in the field of cardiology to gain an academic identity. Incentives should be created to increase the desire and motivation of the residents.

BACKGROUND:Atrial fibrillation (AF) is one of the most common heart rhythm disorders. Identification and early treatment of AF risk factors can improve mortality and morbidity rates. This study aimed to compare the renal venous stasis index (RVSI) and intra-renal venous flow (IRVF) patterns evaluated by intra-renal Doppler ultrasonography in patients with AF and sinus rhythm (SR). MATERIAL AND METHODS:A total of 68 patients, 34 with AF (lasting >12 months AF) and 34 with SR (no previous diagnosis of AF and no AF attack in 24-h Holter monitoring) were included in the study. The RVSI was calculated, and the IRVF patterns were determined using intra-renal Doppler ultrasonography. High RVSI was defined as >0.12 RVSI. In addition, echocardiography and a 6-min walk test were performed. A model including diabetes mellitus, hypertension, creatine, Pro-BNP, left ventricular ejection fraction, presence of AF, and systolic pulmonary artery pressure was created to evaluate the effects of variables on high RVSI. RESULTS:The RVSI value was significantly higher in patients with AF than in those with SR (P=0.004). The SR group exhibited a higher prevalence of the continuous flow pattern, which is one of the IRVF patterns (P=0.015). In contrast, the biphasic flow pattern was observed more frequently in patients with AF (P=0.003). The presence of AF was found to predict the high RVSI (P=0.002, OR=14.134, 95% CI 2.083-71.277). CONCLUSIONS:The presence of AF may affect the IRVF and cause an increase in RVSI.

Background: Atrial fibrillation (AF) is the most common rhythm disorder in the elderly. The AF can cause life-threatening thromboembolic complications. Therefore, there is a need to determine the risk factors of AF. In this study, we aimed to examine the association of markers of malnutrition with AF in individuals aged 75 years and older and to find the factors that may affect mortality. Methods: In this prospective study, 358 consecutive individuals aged 75 years and older presenting to the cardiology outpatient clinic were included. All participants were divided into AF and sinus rhythm (SR) groups. In addition, a questionnaire and scoring system were used to assess malnutrition status. Information was obtained from all patients through outpatient clinic visits or telephone interviews for one year. Death from any cause was considered as the endpoint. Results: AF was observed in 71 (19.8%) patients. Death was higher in patients with AF (p < 0.001), high CONUT score (p = 0.018), and GLIM malnutrition (p = 0.018). GLIM malnutrition caused a 2.8-fold increase in the development of AF. Conclusions: Screening for malnutrition in the elderly is essential. According to GLIM criteria, malnutrition may play a role in the development of AF and increase one-year mortality in the elderly.

Aim: Hemogram, biochemistry, serum electrolyte, and inflammatory marker levels are altered in patients with acute myocardial infarction. When diagnosing and monitoring patients with acute myocardial infarction using cardiac-specific biomarkers, the levels of these markers should also be under control. We looked into the diagnostic and therapeutic value of hemogram, biochemistry, inflammatory markers, and electrolyte levels in acute myocardial infarction patients. Material Method: It is a descriptive epidemiological study. Within the scope of the study, all patients aged 18 years and over and diagnosed with acute myocardial infarction in the Emergency Department and Cardiology Department of Kahramanmaraş Sütçü İmam University Faculty of Medicine Hospital between 01.01.2020 - 31.07.2022 were included retrospectively. Hemogram, biochemistry, serum electrolyte and inflammatory marker levels were investigated in acute myocardial infarction patients. Results: Leukocyte, neutrophil, procalcitonin and C-reactive protein values were significantly higher in patients with acute myocardial infarction. Although platelet/lymphocyte ratios were high, no significance was found. In patients with acute myocardial infarction, glucose values measured at the time of stress were found to be high (hyperglycaemia). When we analysed the serum lactate levels of patients with acute myocardial infarction, it was found to be significantly higher. Conclusion: In patients with acute myocardial infarction, hemogram, biochemistry, serum electrolyte and inflammatory marker levels are altered. The levels of these markers should also be controlled during the diagnosis and follow-up of acute myocardial infarction patients with cardiac specific biomarkers. We believe that hemogram, biochemistry, inflammatory markers and electrolyte levels may contribute to the prediction of early serious complications in patients with acute myocardial infarction.

Coronary artery disease (CAD) involves a complex atherosclerotic process, and many factors play a role in this process. Although there are studies evaluating the development and severity of CAD with trace elements in the blood, there is no study evaluating coronary flow to our knowledge. This study aimed to evaluate the relationship between coronary flow and trace elements after percutaneous intervention in ST-elevation myocardial infarction (STEMI). This study included 126 consecutive patients who presented to the emergency department with STEMI between May 2023 and August 2023. Thrombolysis in myocardial infarction (TIMI) flow grades were calculated after primary percutaneous coronary intervention, and patients were categorized into two groups: low TIMI flow grade and normal TIMI flow grade. The diagnosis of STEMI was defined according to European acute coronary syndrome (ACS) guidelines. Demographic and clinical data were recorded. After coronary angiography, blood tests for trace elements were obtained in addition to routine laboratory parameters. All variables were compared between the two groups. There was no significant difference between low and normal TIMI flow grade groups regarding age and gender. Killip score (p=0.004) and tirofiban (p<0.001) use were higher in the low TIMI flow grade group. Serum copper, high-density lipoprotein, low-density lipoprotein, diabetes mellitus, hypertension, and platelet variables were included in binary logistic regression analysis; low serum copper (p=0.014, OR=1.023, Cl=1.005-1.042) was found to be a risk factor for low TIMI flow grade. Regarding the outcomes of this research, we found that serum copper levels are an important risk factor for low TIMI flow grade in STEMI.

Journal of Cardiovascular ElectrophysiologyVolume 34, Issue 1 p. 241-245 EP ROUNDS Multiple wide QRS tachycardias in the same individual with ischemic cardiomyopathy Elif Hande Ozcan Cetin MD, Elif Hande Ozcan Cetin MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorAhmet Korkmaz MD, Ahmet Korkmaz MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorMeryem Kara MD, Meryem Kara MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorIdriz Merovci MD, Idriz Merovci MD orcid.org/0000-0003-4483-8158 Department of Cardiology, University Clinical Center of Kosovo, Prishtina, KosovoSearch for more papers by this authorKemal Gocer MD, Kemal Gocer MD Department of Cardiology, Kahramanmaraş Sütçü Imam University, Kahramanamaras, TurkeySearch for more papers by this authorEkrem Aksu MD, Ekrem Aksu MD Department of Cardiology, Kahramanmaraş Sütçü Imam University, Kahramanamaras, TurkeySearch for more papers by this authorSuhaib Abusaif MD, Suhaib Abusaif MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorOzan Oguz MD, Ozan Oguz MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorOzcan Ozeke MD, Corresponding Author Ozcan Ozeke MD [email protected] orcid.org/0000-0002-4770-8159 @ozcanozeke Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey Correspondence Ozcan Ozeke, MD, Sağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Kardiyoloji Klinigi, Bilkent, Ankara 06800, Turkey. Email: [email protected]Search for more papers by this authorSerkan Cay MD, Serkan Cay MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorFirat Ozcan MD, Firat Ozcan MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorDursun Aras MD, Dursun Aras MD Department of Cardiology, İstanbul Medipol University, İstanbul, TurkeySearch for more papers by this authorSerkan Topaloglu MD, Serkan Topaloglu MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this author Elif Hande Ozcan Cetin MD, Elif Hande Ozcan Cetin MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorAhmet Korkmaz MD, Ahmet Korkmaz MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorMeryem Kara MD, Meryem Kara MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorIdriz Merovci MD, Idriz Merovci MD orcid.org/0000-0003-4483-8158 Department of Cardiology, University Clinical Center of Kosovo, Prishtina, KosovoSearch for more papers by this authorKemal Gocer MD, Kemal Gocer MD Department of Cardiology, Kahramanmaraş Sütçü Imam University, Kahramanamaras, TurkeySearch for more papers by this authorEkrem Aksu MD, Ekrem Aksu MD Department of Cardiology, Kahramanmaraş Sütçü Imam University, Kahramanamaras, TurkeySearch for more papers by this authorSuhaib Abusaif MD, Suhaib Abusaif MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorOzan Oguz MD, Ozan Oguz MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorOzcan Ozeke MD, Corresponding Author Ozcan Ozeke MD [email protected] orcid.org/0000-0002-4770-8159 @ozcanozeke Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey Correspondence Ozcan Ozeke, MD, Sağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Kardiyoloji Klinigi, Bilkent, Ankara 06800, Turkey. Email: [email protected]Search for more papers by this authorSerkan Cay MD, Serkan Cay MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorFirat Ozcan MD, Firat Ozcan MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this authorDursun Aras MD, Dursun Aras MD Department of Cardiology, İstanbul Medipol University, İstanbul, TurkeySearch for more papers by this authorSerkan Topaloglu MD, Serkan Topaloglu MD Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, TurkeySearch for more papers by this author First published: 13 December 2022 https://doi.org/10.1111/jce.15776 Disclosures: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat REFERENCES 1Aslan AO, Merovci I, Tunçez A, et al. Widening of the QRS complex during the wide complex tachycardia: what is the mechanism. J Cardiovasc Electrophysiol. 2022; 33(7): 1605-1608. 10.1111/jce.15567 PubMedWeb of Science®Google Scholar 2Klein GJ, Guiraudon GM, Kerr CR, et al. “Nodoventricular” accessory pathway: evidence for a distinct accessory atrioventricular pathway with atrioventricular node-like properties. 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Alternating narrow and wide complex tachycardia. Pacing Clin Electrophysiol. 2002; 25(1): 103-104. 10.1046/j.1460-9592.2002.t01-1-00103.x PubMedWeb of Science®Google Scholar 15Ravindran BK, Pavri BB, Greenspon AJ, Ho RT. Tachycardia during bradycardia: what is the mechanism. J Cardiovasc Electrophysiol. 2003; 14(8): 894-896. 10.1046/j.1540-8167.2003.03037.x PubMedWeb of Science®Google Scholar 16Tomcsanyi J, Somloi M, Bozsik B, Rohla M. Wide and narrow QRS complex tachycardia with identical heart rates: what is the mechanism. Pacing Clin Electrophysiol. 2005; 28(6): 568-570. 10.1111/j.1540-8159.2005.09568.x PubMedWeb of Science®Google Scholar 17Back Sternick E, Bagchi A, Lokhandwala Y, Wellens HJ. Two tachycardias, wide and narrow-more than a coincidence. J Cardiovasc Electrophysiol. 2020; 31(6): 1553-1556. 10.1111/jce.14486 PubMedWeb of Science®Google Scholar 18Karimli E, Kara M, Korkmaz A, et al. Dual 1:2 tachycardia: what is the mechanism. 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Aim: Generalized anxiety disorder (GAD) is a subtype of anxiety disorder that differs in symptoms and clinical findings. There is excessive and pervasive worry about everyday life conditions, physical performance in GAD. Changes in ventricular repolarization may play a role and interact with this process. Therefore, this study aimed to investigate whether ventricular repolarization parameters interact with the level of GAD and highlight for followed-up treatment. Material and Methods: One hundred eighteen patients (non-smoker, non-alcoholic) without a previous psychiatric disease who were newly diagnosed with GAD were included in this study between March 2021 and February 2022. One hundred twenty healthy individuals who did not have any psychiatric or organic disorder and whose Hamilton Anxiety Rating Scale (HAM-A) score was below five were taken as the control group. A 12-lead ECG was taken at enrolment. The ventricular repolarization parameters were calculated. Results: The individuals participating in the study were divided into two groups: GAD and control groups. There was no statistically significant difference between the two groups regarding demographic characteristics. The TG level (p=0.049) was higher than in the GAD group. Six parameters, including age, gender, TG, Tpeak-Tend interval (Tp-e), QT dispersion, and heart rate were entered into logistic regression analysis. QT dispersion (OR: 1.122; 95%Cl:1.0811.165;p<0.001) and heart rate (OR: 1.039; 95%Cl:1.002-1.076;p<0.037) were found to be independent predictors of GAD. Discussion: QT dispersion associated with ventricular arrhythmia is a simple test that should be closely monitored in patients with GAD and is an important criterion for establishing treatment protocol including drug and physical exercise.

Background: Cardiac autonomic neuropathy is a frequent complication of type 2 diabetes mellitus. Cardiac autonomic neuropathy, in which sympathetic tone predominates over parasympathetic activity, increases both cardiovascular morbidity and mortality and unfortunately has no definitive treatment. Sodium-glucose cotransporter-2 inhibitors have been suggested to reduce sympathetic nervous system activity, based on the results from previous studies. In this study, we aimed to investigate the effect of 24-week treatment with dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, on cardiac autonomic function measures in patients with type 2 diabetes mellitus and cardiac autonomic neuropathy. Methods: Dapagliflozin 10 mg/day (n=42) or non-sodium-glucose cotransporter-2 inhibitor oral antidiabetic(s) (n=38) was added to the treatment of patients whose glycemic control could not be achieved with existing treatments. The patients with definite or confirmed cardiac autonomic neuropathy diagnosed by cardiovascular autonomic reflex tests underwent 24-hour Holter-electrocardiogram recordings to obtain heart rate variability and heart rate turbulence parameters before starting additional medication and after a 24-week treatment period. Results: In-group analyses showed that dapagliflozin 10 mg/day for 24 weeks improved heart rate variability and heart rate turbulence parameters and decreased the frequency of ventricular premature beats relative to their baseline values. No such findings were observed in the control group despite similar glycemic control. Comparisons between dapagliflozin group and the control group showed that these effects of dapagliflozin were significantly better than non-sodium-glucose cotransporter-2 inhibitor oral antidiabetics. Conclusion: Dapagliflozin improves measures of cardiac autonomic function compared to the control group in type 2 diabetic patients with cardiac autonomic neuropathy. This intergroup benefit, demonstrated for the first time, may be promising for the regression of cardiac autonomic neuropathy with sodium-glucose cotransporter-2 inhibitors.

Objective: This study aimed to evaluate whether neutrophil/lymphocyte (N/L) ratio assists in the diagnosis of coronary artery disease (CAD) in patients with suspected diaphragmatic attenuation artifact (DAA) on myocardial perfusion SPECT (MP-SPECT). Material and Methods: A total of 255 patients undergoing coronary angiography between 2015-2020 due to unclear DAA of the inferior wall on MP-SPECT were included in this retrospective study. Patients were divided into two groups (CAD and non-CAD) according to angiographic images. Significant CAD was defined as ≥50% stenosis of coronary arteries feeding the inferior wall. White blood cell count, biochemical parameters, and risk factors for CAD were compared between the two groups. Results: There was no statistically significant difference between the two groups in terms of age (p = 0.055), gender (p = 0.482), and body mass index (p = 0.305). N/L ratio (OR = 1.397 p = 0.002 95% Cl = 1.128-1.732) and left ventricle ejection fraction (OR = 0.896 p = 0.023 95% Cl = 0.815-0.985) were independent risk factors for CAD in multivariate binary logistic regression analysis. Receiver Operating Characteristic (ROC) curve analysis showed that a cut-off value of ≥2 for N/L ratio predicted the presence of CAD (sensitivity=63.5%, specificity=60.7%, AUC=0.668, 95% CI=0.596 – 0.740, p<0.001). Conclusion: N/L ratio is a simple and accessible test and may increase the diagnostic accuracy of MP-SPECT for CAD in patients with suspicious diaphragmatic attenuation on MP-SPECT.

Introduction: The non-invasive approach has become the first choice for the acute non-ST elevation myocardial infarction-acute coronary syndrome (NSTEMI-ACS) during the Coronavirus Disease-2019 (COVID-19) pandemic. However, most of these patients require interventional treatment. In this study, the possible role of hematological inflammatory markers in differentiating medium-high risk NSTEMI-ACS patients according to the GRACE risk classification in need of interventional treatment was investigated. Patients and Methods: Patients who underwent coronary angiography with the diagnosis of NSTEMI-ACS in a tertiary cardiology clinic between January 2018 and December 2019 were included in the study, which was designed as a retrospective cohort study. NSTEMI-ACS patients (n= 276), except for patients with exclusion criteria (n= 32), were divided into two groups as those in need of invasive treatment (n= 217) and medical treatment (n= 59) according to the results of coronary angiography. The hematological inflammatory markers were compared between groups. Results: Neutrophil to lymphocyte ratio (NLR) (AUC: 0.637, 95% CI: 0.563-0.712, p= 0.001) and systemic immune-inflammation index (SII) (AUC: 0.622, 95% CI: 0.545-0.699, p= 0.004) predicted the requirement of interventional treatment in NSTEMI-ACS. Conclusion: It is unclear whether the NLR and SII elevation, which may be a predictor of the need for invasive treatment, is a cause or a consequence of the pathophysiological process in patients with NSTEMI-ACS. However, elevated NLR and SII values can help distinguish NSTEMI-ACS patients who need invasive treatment during the COVID-19 pandemic. The results of this study, show the need for large-sized studies to determine the ideal cut-off point of NLR and SII levels in determining the treatment strategy for NSTEMI-ACS.

Background/Aim: Hypertension is well defined in preeclamptic individuals and those with a history of preeclampsia. However, the relationship between blood pressure pattern and fragmented QRS on electrocardiography (ECG) has not been elucidated in normotensive patients with a history of preeclampsia. This study aimed to investigate the frequency of non-dipper blood pressure (BP) patterns in normotensive individuals with a history of preeclampsia and to evaluate the relevance of this pattern to fragmented QRS (fQRS). Methods: Sixty-three normotensive (office BP measurement) patients with a history of preeclampsia were included in this study between August 2020 and January 2021. These individuals underwent 24-hour ambulatory BP monitoring. The patients were divided into two groups as dipper and non-dipper, according to their BP patterns. The two groups were compared in terms of echocardiographic parameters, laboratory values, and QRS fragmentation on ECG. Results: Left ventricular diastolic dysfunction (LVDD) diagnosed by echocardiography (P= 0.015) and fQRS on ECG (P=0.002) were significantly higher in the non-dipper group than in the dipper group. Tricuspid regurgitation velocity (P=0.004) and average E/e' ratio (P

Ventricular lead perforation (VLP) is a rare and life-threatening complication of permanent pacemakers. Generally, VLP emerges in acute and subacute periods after cardiac electronic devices are implanted. Late VLP is unexpected and occurs less frequently. There is an uncertain approach to the treatment of VLPs. Collaboration with cardiovascular surgeons is recommended. Herein, we present two cases of cardiac perforations who were successfully managed. One of them was admitted with cardiac tamponade four years after dual-chamber pacemaker (DCP) implantation, and the right ventricular lead was successfully removed with an open surgical method. The other was admitted with cardiac tamponade two weeks after DCP implantation. Ventricular lead was extracted by a simple traction method without surgical support and successfully re-implanted in the correct location.

Environmental, genetic, oxidative and biochemical factors play an important role in the atherosclerotic process. We investigated the association of serum fibroblast growth factor (FGF-23), klotho, fetuin-A, osteoprotegerin (OPG), osteopontin (OPN) and high-sensitive-CRP (Hs-CRP) markers with coronary artery disease and whether one was superior to others or not. A study group of 52 patients with coronary artery disease (CAD) and a control group of 30 patients with angiographically normal epicardial coronary arteries were included in the study. Serum FGF-23, klotho, fetuin-A, OPN, OPG and Hs-CRP marker levels were studied. Patients with CAD were classified in two groups as low (SYNTAX <= 22, n = 29) and moderate-high (SYNTAX >= 23, n = 23) according to anatomic SYNTAX score. FGF-23 (p = .033), klotho (p < .001), fetuin-A (p = .005) and OPG (p = .001) serum marker levels were significantly lower in CAD patients than the control group. Serum levels of FGF-23 (p = .012), klotho (p = .001), fetuin-A (p = .015) and OPG (p = 0.002) were significantly different between SYNTAX tertiles and control group. Klotho (p = .025, odd ratio (OR) = 0.542, 95% confidence interval (CI): 0.317-0.926) and HT (p = .004, OR = 34.598, 95%CI:1.054-1135.657) were the independent predictors of CAD presence. Serum klotho levels of 91.48 pmol/L predicts the presence of CAD with 60% sensitivity and 96.55% specificity (p < .001, area under curve = 0.864, 95% CI = 0.768, 0.931). We found that serum klotho level is an independent predictor of presence, extent and severity of CAD.

OBJECTIVE: Patients with chronic kidney disease (CKD) have increased risk for cardiac arrhythmias. Other than comorbidities like diabetes mellitus and cardiovascular disease, factors like acidosis, uremia and electrolyte imbalance may contribute to this risk. The aim of this study was to evaluate electrocardiography (ECG) measurements of ventricular repolarization and search for related clinical features like serum electrolytes that may indicate a risk for arrhythmias in patients with pre-dialytic CKD. MATERIAL and METHODS: The study included 107 patients with stage 3-5 CKD and 49 healthy individuals. ECG parameters; QT, QTc, Tp-e, Tp-e/QT and Tp-e/QTc were measured on ECG recordings from all participants. Clinical features and serum electrolyte values were recorded. RESULTS: Mean QTc of patients were higher than healthy controls (p=0.008). We found positive correlations with QTc measurements and serum magnesium and phosphorus levels. We demonstrated that Tp-e, Tp-e/QT and Tp-e/QTc were negatively correlated with potassium levels (p=0.023, 0.042, 0.013). Regression for clinical features revealed no other relation for these correlations. CONCLUSION: Measuring ECG parameters may help to identify additional risk factors for arrhythmogenesis. We found increased QTc measurements in pre-dialytic CKD patients who were younger than in previous studies. Tp-e, Tp-e/QT and Tp-e/QTc were negatively correlated with serum potassium. Electrolyte imbalances like hypokalemia might unravel the susceptibility for arrhythmias in CKD patients.

Unconventional sites are being used for pacing in patients with inaccessible right ventricle like single ventricle, atresia of tricuspid valve and in anomalous venous drainage. Here we report a case in which the right ventricle could not be accessed due to the bioprosthesis. A 65-year-old woman with history of TVR and CABG was admitted to our emergency depertmant with syncope. In physcial examination results are: blood pressure 70/40 mmHg, pulse rate 35/min, electrocardiogram (ECG): Atrial fibrillation and heart rate 38 bpm (figure 1), peripheral pulses were palpable. We learned that the patient was treated with digoxin furosemide and rivaroxaban. we implemented temporary pacemaker because the hemodynamics of the patient was unstable and we followed up the patient during the 72 hours. At the end of the third day her ECG rhythm was AF and heart rate was 35 bpm. We decided to implement permanent pacemaker. We decided treated with epicardial pacing via coronary sinüs, because the patient had history of TVR. Coronary sinus was cannulated and occlusive CS angiogram was performed (figure 2). There was posterolateral side branch which could be targeted for lead implantation. However, the proksimal part of the side brunch was angeled and small. Therefore middle cardiac vein was targeted. A 0,014'' guidewire was positioned into the middle cardiac vein and CS pacing lead was advanced over it. The lead was stable and there was not diaphragmatic stimulation. Pacing threshold impedance and R wave amplitude were within normal ranges.(figure3).