Objectives Patients with rheumatoid arthritis (RA) are known to be at increased cardiovascular risk. Etanercept is a tumor necrosis factor α (TNF-α) blocking agent that has been successfully used in the treatment of RA. We sought to assess the effects of etanercept on cardiac functions and lipid profile in RA patients without overt cardiac disease. Methods Sixteen patients with active RA were recruited to the study prospectively. Etanercept was administered subcutaneously twice a week for 6 months. Clinical and laboratory predictors of RA activity and lipid profile were evaluated at baseline and at 6 months. The systolic and diastolic function parameters of the left ventricle were obtained by echocardiographic examination and included mitral inflow Doppler and tissue Doppler imaging. Results Sixteen patients (13 women; median age, 48 years [range, 27–69 years]) completed the study. Patients’ 28-item Disease Activity Score and Health Assessment Questionnaire scores were significantly reduced by treatment (6.35 to 4.45 [ P < 0.001] and 2.0 to 0.75 [ P = 0.005], respectively). Diastolic dysfunction was detected in 6 patients (37.5%) (3 in grade 1 and 3 in grade 2) by mitral inflow Doppler and the tissue Doppler parameters before the treatment. No significant change in diastolic dysfunction was observed during follow-up (6/16 to 5/16, P = 0.164). In addition, there were also no significant differences in the left ventricular ejection fraction (65.8–66.9, P = 0.168) and lipid profiles after 6 months of etanercept treatment. Conclusions Etanercept treatment was safe for use as regards cardiac functions and lipid profiles and effective on RA parameters during 6-month follow-up in patients with active RA.

Background: We aimed to evaluate clinical effects of additional heart rate control by ivabradine on life quality score and 6-minute walking test in patients with previously implanted biventricular cardiac resynchronization therapy defibrillator (CRT-D) with ischemic heart failure under regular treatment.Methods: Fifteen men and 14 women with a median age of 63 years (range, 48-79 years) were studied. Twenty-one patients were in New York Heart Association class II (8 patients were in class III), CRT-D implanted previously, and with resting heart rates greater than 70 beats per minute with sinus rhythm despite conventional medication. Patients were given 2.5- to 7.5-mg ivabradine orally twice a day, and drug dosage was titrated to decrease the patients' average heart rate to 70 beats per minute. Before and 3 months after ivabradine treatment, all patients underwent extensive clinical, echocardiographic, and laboratory evaluation.Results: Ivabradine treatment produced dose-dependent reductions in heart rate at rest and at peak exercise (91.9 +/- 6.3 to 71.7 +/- 4.8 and 114.4 +/- 7.6 to 96.8 +/- 4.8; P = 0.001 and P = 0.001, respectively). There were also significant improvements in life quality score (52.4 +/- 9.5 to 37.9 +/- 7.8; P = 0.001) and 6-minute walking distance (278.7 +/- 85.8 to 373.3 +/- 94.0; P = 0.001) of patients. All patients with New York Heart Association class III became class II after 3 months of ivabradine treatment.Conclusion: Heart rate reduction in a short-term period by ivabradine produced significant improvements in exercise capacity and life quality in patients with CRT-D and conventional therapy.

OBJECTIVE T-wave peak to end interval (TPE) is a measure of repolarization dispersion, which has been reported as a major arrhythmogenic factor post acute myocardial infarction. The aim of our study was to investigate the changes in TPE in this patient population with regard to peri-procedural intracoronary ECG findings. PATIENTS AND METHODS Forty-four patients (34 male and mean age of 54.9 ± 10.9 years) with acute STEMI were included. Intracoronary ECG was performed during primary PCI. TPE indices were calculated before and after the procedure. Measurement of the intracoronary ST-segment was carried out before and just after coronary blood flow was established in the infarct related artery. Intracoronary ST-segment resolution (IC-STR) was defined as ≥ 1 mm compared to baseline. RESULTS There was no difference with respect to baseline characteristics when patients with IC-STR were compared with patients without IC-STR. TPE values decreased significantly after primary PCI in patients with IC-STR (80.9 ± 22.8 ms vs. 65.8 ± 14.4 ms; p < 0.001) whereas they did not change significantly after PCI in patients without IC-STR (79.2 ± 20.9 ms vs. 68.5 ± 16.3 ms; p = 0.18). CONCLUSIONS TPE measured from surface ECG recordings is significantly reduced in STEMI patients with successful reperfusion after primary PCI, as determined by IC-ECG recordings.

OBJECTIVES:Sarcoidosis is an inflammatory granulomatous disease of unknown cause that involves multiple organ systems. Myocardial involvement is usually associated with poor prognosis, but diagnosis of cardiac sarcoidosis is frequently difficult. The aim of this study was to investigate the atrial conduction time in patients with sarcoidosis by using high-usefulness tissue Doppler echocardiography.METHODS:The study population included 49 patients with sarcoidosis (19 men; mean age, 40.5 ± 9.8 years; mean disease duration, 35.7 ± 15.3 months) and 45 healthy control subjects (17 men; mean age, 40.7 ± 7.2 years). From the 12-lead electrocardiogram, P wave dispersion (PWD) was calculated. The timing of atrial contractions (PA) was measured as the intervals between the onset of P wave on electrocardiogram and the beginning of A-wave on TDI, and atrial electromechanical delay (EMD) was calculated from the lateral (PA lateral) and septal (PA septal) mitral annulus and lateral tricuspid annulus (PA tricuspid).RESULTS:Both PA lateral and PA septal were significantly longer in patients with sarcoidosis than control subjects (67.9 ± 16.1 vs 56.3 ± 13.1, P < 0.001; and 54.8 ± 15.2 vs 45.1 ± 14.2 ms, P = 0.002, respectively). Intra-atrial (PA septal-PA tricuspid) and interatrial (PA lateral-PA tricuspid) EMD were significantly higher in sarcoidosis groups (12.6 ± 7.5 vs 8.0 ± 7.1, P = 0.003; and 25.7 ± 9.8 vs 19.3 ± 7.7 ms, P = 0.001, respectively). Similarly, maximum P-wave duration and PWD were significantly longer in patients with sarcoidosis than control subjects (105.2 ± 11.8 vs 96.7 ± 15.4, P = 0.004 and 24.7 ± 5.6 vs 19.7 ± 7.1 ms, P = 0.001, respectively). There were significant positive correlations between the disease duration and interatrial EMD (r = 0.56, P < 0.001) and intra-atrial EMD (r = 0.66, P < 0.001). Positive correlation also was present between the disease duration and PWD (r = .62, P < 0.001).CONCLUSIONS:Atrial EMD was found prolonged in patients with sarcoidosis. We also have demonstrated that PWD, interatrial and intra-atrial EMD were significantly correlated with disease duration. This study calls attention to measurement of atrial conduction time that may be clinically helpful in the recognition of cardiac involvement.

Preintervention thrombus burden in the infarct-related artery is an independent predictor of no-reflow and adverse outcomes in coronary artery disease. The role of D-dimers in the acute phase of ST-elevated myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) has not been fully elucidated. We aimed to investigate the predictive value of serum D-dimer levels on the outcome of patients with STEMI.

Traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), stroke and cerebrovascular disease (CVD) are identified as risk factors for hypopituitarism. Pituitary dysfunction after TBI, SAH, and CVD may present in the acute phase or later in the course of the event. Chronic hypopituitarism, particularly growth hormone (GH) deficiency is related to the increased cardiovascular morbidity and mortality. In patients with serious ventricular arrhythmias, who need cardiopulmonary resuscitation, brain tissue is exposed to short-term severe ischemia and hypoxia. However, there are no data in the literature regarding pituitary dysfunction after ventricular arrhythmias.

We aimed to elucidate the relationship between mild-to-moderate renal impairment and the development of coronary collateral vessels (CCV) in patients with acute coronary syndrome (ACS).

INTRODUCTION:Some reports have shown increased platelet aggregation and activation in patients with pulmonary artery hypertension (PAH). Mean platelet volume (MPV) is a simple and easy method of assessing platelet function. We aimed to investigate the mean platelet volume levels in patients with atrial septal defect (ASD) and the association between MPV levels and pulmonary artery hypertension. METHOD:One hundred and forty consecutive patients (42 males and mean age 35 +/- 9 y) and forty healthy controls (15 males and mean age 35 +/- 4 y) were enrolled in the study between December 2008 and February 2011. RESULTS:The ASD group demonstrated a significantly higher right ventricular size and pulmonary artery pressure than the control group (42 +/- 4 mm vs. 36 +/- 3 mm and 43 +/- 12 mmHg vs. 32 +/- 11 mmHg; P < 0.001 and P < 0.001, respectively). MPV levels were higher in the ASD group than the control group (9.3 +/- 1.2 fl vs. 8.6 +/- 0.8 fl, P < 0.001). There was a significant, positive correlation between MPV and systolic pulmonary artery pressure (PAP) (r = 0.542 and P < 0.001) in the ASD group. MPV was also significantly correlated with right ventricular size but not ASD diameter in the ASD group (r = 0.441, P < 0.001 and r = 0.126, P = 0.268, respectively). In receiver operating characteristics curve analysis, the cut-off value of MPV levels was > 8.7 fl and had 82% sensitivity and 63% specificity in predicting pulmonary artery hypertension. CONCLUSION:In the present study, we found that MPV levels, an indicator of platelet activation, were significantly higher in patients with ASD and correlated with systolic pulmonary artery pressure and right ventricular diameter.

Introduction Contrast-induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. Although the incidence of CIN is quite low in the general population, CIN incidence is significantly increased in patients with diabetes mellitus (DM). Objectives We compared the efficacy of prophylactic use consisting of a saline infusion or a sodium bicarbonate infusion for the prevention of CIN in patients with DM. Materials and Methods A total of 195 DM patients who had unselected renal function were randomized into 2 groups: 101 patients were assigned to saline infusion, and 94 patients were assigned to bicarbonate infusion. The primary end point was the maximum increase in the serum creatinine (SCr) level, whereas the secondary end point was the development of CIN after the procedure. Results The maximum increase in SCr levels was significantly lower in the saline group than in the bicarbonate group: −0.03 mg/dL (IQR, −0.09 to 0.10 mg/dL) versus 0.02 mg/dL (IQR, −0.09 to 0.13 mg/dL) ( P = 0.014). The rate of CIN was significantly lower in the saline group than in the bicarbonate group (5.9% vs 16%, P = 0.024). In the subset of study participants with a baseline creatinine clearance of less than 60 mL/min, the maximum increase in SCr levels was significantly lower, −0.08 mg/dL (IQR, −0.13 to −0.04 mg/dL), in the saline group than in the bicarbonate group, 0.03 mg/dL (IQR, −0.13 to 0.12 mg/dL) ( P = 0.004). Conclusions The use of prophylactic hydration with isotonic saline before coronary procedures may decrease SCr levels and reduce the incidence of CIN in patients with DM with unselected renal functions to a greater extent than sodium bicarbonate can.

Aim: The most important sequel of acute rheumatic fever is mitral stenosis (MS) in long term. Longitudinal tissue Doppler derived strain and strain rate (SR) imag-ing is a novel technique that evaluates global and regional left ventricular systolic functions with high sensitivity. The aim of the study was to assess the effects of percutaneous mitral balloon valvuloplasty Background: Pregnancy can cause life-threatening complications in women with mitral stenosis. Frequently there is an urgent need to increase the mitral valve area mechanically. Balloon Mitral Valvuloplasty (BMV) has been performed safely during pregnancy withgood results. However, few reports evaluated the long-term clinical and echographic outcome in populations of pregnant women undergoing BMV. Methods: From January 1990 to December 2011, 88 pregnant women aged 29, 2 5, 44 years (Range 18-43 years) at mean gestational duration 27.6 weeks underwent BMV. They were subsequently followed by a medical interview, clinical and echographic evaluations during a mean follow-up of 157 75,8 months. Results: The procedure was successful in 82 procedures (93,2%). Immediately after valvuloplasty, the patients showed clinical, hemodynamic and echographic improvement, the 2-dimensional mitral valve area increased from 1,08 ± 0,21 cm 2 to 2,1 ± 0,37 cm 2 (P < 0.0001) and the transmitral gradient decreased from 22,5 ± 8,6 to 5,6 ± 3,4mmHg (P < 0.0001). One patient developed severe mitral regurgitation requiring urgent surgical correction. During the procedure there were no maternal or fetal complications. All patients had uneventful pregnancy and 89,5% had normal delivery. The mean gestational age at delivery time was 38 ± 5,1 weeks. There was no stillborn and one fetal death. Ata mean follow-up of 157 ± 75,8 month, there a significant decrease inmean mitral valve area 1,6 ± 0,4 cm 2 (p=0.005) and restenosis in 29 pa- (34,1%)with of a BMV in cases. Conclusion: For pregnant women with severe mitral stenosis, BMV has provides good immediate results without significant maternal risk or fetal morbidity or mor- tality and a favorable long-term outcome.

We read with interest the article by Raposeiras-Roubin et al dealing with the incidence, clinical predictors, and outcomes of contrast-induced nephropathy (CIN) after coronary angiography in patients with myocardial infarction (MI). As mentioned by the authors, the rise in serum creatinine (SCr) may occur in patients with acute MI due to the nature of the disease. Hemodynamic instability and pump failure are most plausible explanations for SCr increase and acute kidney injury in the setting of acute MI. However, the authors also emphasized that the use of medications was left to the direction of cardiologists according to their clinical protocols based on the international treatment guidelines. So, it is obvious that some patients had new initiations of medications including angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs), which may increase SCr even in populations with normal renal function. In spite of hydration protocols, the reason for why the authors found a very high CIN rate (27.7%) according to their definition ( 25% SCr increase from baseline to 72 hours) may be the new use of ACEI or ARB. Likewise, most studies demonstrate higher CIN ratio in patients with MI undergoing coronary angiography. We think that initiation of medications such as ACEI and ARB are contributory factors of higher CIN rate according to the current CIN definitions in patients with MI besides hemodynamic instability. We believe that new cutoff values of SCr increase may be necessary for the definition of CIN in subgroups of patients who received ACEI or ARB on the day of contrast exposure.

Background: We aimed to investigate the effects of brachytherapy, drug-eluting stent (DES) and bare metal stent (BMS) applications in the treatment of coronary artery disease, on five-year clinical outcomes and mortality.

Aim: Contrast-induced nephropathy (CIN) is a serious complication occurring after the administration of contrast materials to patients at risk of acute renal injury. Nebivolol is a third generation beta blocker which has anti-apoptotic and anti-oxidant properties. In addition, it has vasodilatator effect via increasing nitric oxide level. So, the aim of the study was to compare the effectiveness of prophylactic nebivolol use versus pretreatment with N-Acetylcysteine (NAC) for prevention of CIN after coronary angiography. Patients and methods: We prospectively enrolled 99 patients who were scheduled for elective coronary angiography procedure and whose baseline creatinin levels between 1.2 and 1.7 mg/dl. Patients were divided into three groups. Group I (NAC group) consisted of the patients received NAC plus hydration, group II (nebivolol group) nebivolol plus hydration and, group III (hydration group) only hydration. In group II, patients received oral nebivolol (5 mg/dose, n = 33) once a day for total 3 doses before coronary angiography, starting two days before angiography and continuing at the morning of angiography day. CIN was defined as an increase of ≥0.5 mg/dl or an increase of >25% in serum creatinine over baseline at 2-day or 5-day after coronary angiography in the first definition. Results: Treatment groups were similar with respect to baseline clinical characteristics. Serum creatinine levels at 2-day and 5-day were not significantly different in the three groups (p=0.96 and p=0.79, respectively). CIN occurred in 18.2% (6/33) of patients in group I, 24.2% (8/33) in group II, and 24.2% (8/33) in group III (p=0.79). Also, the incidence of CIN in diabetic patients was not different in the three treatment groups (p=0.16). Although the incidence of CIN was not different in the three groups (p=0.30), in the diabetic subgroup, CIN occurred in 20% (2/10) of patients taking nebivolol, none of patients taking NAC and 55.6% (5/9) of patients administered only hydration (p=0.01). Conclusion: Both nebivolol and NAC which was added to hydration theraphy didn't reduced the risk of CIN in patients with reduced renal function undergoing elective coronary angiography. This study demonstrated the protective effect of NAC on CIN in only diabetic patients.

Abstract Background. We aimed to determine the status of the autonomic nervous system in patients with autosomal-dominant polycystic kidney disease (ADPKD) who were normotensive and had normal renal function. Methods. A total of 28 normotensive ADPKD patients with normal renal function and 30 healthy control subjects consented to participate in the study. Heart rate recovery (HRR) indices were defined as the reduction in heart rate from the rate at peak exercise to the rate at the 1st, 2nd, 3rd and 5th minutes after the cessation of the exercise stress test; these results were indicated HRR1, HRR2, HRR3 and HRR5, respectively. Results. The 1st- and 2nd-minute HRR indices of patients with ADPKD were significantly lower than those of the healthy control group (27.1±7.9 vs 32.0±7.9; p=0.023 and 46.9±11.5 vs 53.0±9.0; p=0.029, respectively). Similarly, HRR indices after the 3rd and 5th minutes of the recovery period were significantly lower in patients with ADPKD when compared with indices in the control group (56.7±12.0 vs 65.1±11.2; p=0.008 and 62.5±13.8 vs 76.6±15.5; p =0.001, respectively). Conclusion. Impaired HRR index is associated with normotensive early-stage ADPKD patients. Increased renal ischemia and activation of the renin–angiotensin–aldosterone system (RAAS) may contribute to impairment in the autonomic nervous system in these patients before the development of hypertension. Even if ADPKD patients are normotensive, there appears to be an association with autonomic dysfunction and polycystic kidney disease.