Objective: A prospective study to compare the mean blood pressure and mean weight of subjects with congestive heart failure (CHF) in the month before Ramadan, during the month of Ramadan, and in each of the two months following Ramadan to determine if fasting has any effect on health. Methods: Patients were given a blood pressure meter and weighing scale and instructed to take daily measurements. Data were transmitted wirelessly from the devices to a simple home gateway for automatic onward transmission to the data server without intervention from the subject. Subsets of data for blood pressure and weight were created for each of the months before Ramadan, during the month of Ramadan, and the two months following Ramadan for 2025 and 2026. The mean and standard deviation were determined for each patient, and comparison between successive months was performed for the cohort mean and standard deviation using t- test. Paired t -tests were performed for subgroups containing only patients participating in successive periods. Results: There was significant variation in the mean of an individual and in the mean of a cohort; however, the mean was consistent across the period with the value for the t- test between successive periods being greater than 0.25 (CI: 0.05). The value for the paired t- test was greater than 0.22 (CI: 0.05) for all periods except between post-Ramadan and 2 months post-Ramadan when the value was 0.10 (CI: 0.05), and some subjects were seen to exhibit significant changes. Conclusions: The t- test and paired t- test values show that there were no statistically significant differences between cohort means and paired comparisons for blood pressure and weight for all months, indicating there are no effects on health in patients with CHF due to fasting if appropriately clinically managed.

Access to hospital care for congestive heart failure (CHF) patients is often costly and delayed, worsening outcomes. Remote patient monitoring provides a solution by continuously tracking health indicators and supporting timely clinical decisions. For this approach to be effective, data must be presented in a clear, actionable format rather than raw streams that disrupt workflow. This study applies a User-Centered Design methodology to develop intuitive visualizations of daily blood pressure and weight data for CHF patients. Through three iterative cycles of requirement definition, visualization development, and evaluation, the design was refined to meet clinicians’ needs. The final visualizations proved highly effective, enhancing efficiency, usability, and clinical decision-making.

Aim: This study aimed to identify predictors of 10-year survival in patients undergoing early Transcatheter Aortic Valve Replacement (TAVR) with the first-generation CoreValve system, providing insights from a pioneering single-center experience in Turkey.Material and Methods: We retrospectively analyzed high-risk patients who underwent TAVR between April 2012 and March 2013. Baseline clinical characteristics and echocardiographic parameters were compared between survivors and non-survivors over a 10-year follow-up period. Survival analysis was performed using Kaplan-Meier curves, and Cox regression models were utilized to identify independent predictors of survival.Results: The cohort included patients with a mean age of 77.1 ± 7.7 years. The Kaplan–Meier analysis estimated the median survival time at 62 months (95% CI: 33–127), with a mean survival time of 71.6 months (95% CI: 43.9–99.3). Survivors exhibited significantly lower left ventricular (LV) end-diastolic diameter, LV mass index, and LV diastolic-systolic diameter difference compared to non-survivors. In univariate analysis, STS score, pulmonary artery pressure (PAP), LV hypertrophy pattern, LV diameter difference, and LV mass index emerged as potential predictors of long-term survival. STS score and LV diameter difference were independent predictors.Conclusion: In this study, both STS score and LV diastolic-systolic diameter difference were identified as independent predictors of 10-year survival following TAVR. These findings emphasize the critical role of precise patient evaluation and underscore the potential value of personalized procedural strategies to optimize long-term outcomes in TAVR patients

Background and Objectives: An atrial high-rate episode (AHRE) is defined according to the European Society of Cardiology (ESC) guidelines as a heart rate of ≥175 bpm lasting at least 5 min. This study aimed to evaluate whether neuron-specific enolase (NSE) levels, an indicator of neurological impact, could serve as a surrogate biomarker for silent neurological ischemia in patients with atrial high-rate episodes (AHREs). Materials and Methods: Patients with AHRE detected in a pacemaker analysis and a control group without any arrhythmias were included. Patients with AHRE were divided into subgroups according to AHRE duration—Group 1: AHRE < 5 min, Group 2: AHRE ≥ 5 min–<1 h, Group 3: AHRE ≥ 1 h–<24 h, Group 4: AHRE ≥ 24 h. Neuron-specific enolase (NSE) levels were measured using a double-antibody enzyme-linked immunosorbent assay (ELISA) with a sensitivity of 0.05 ng/mL. Imaging techniques were not employed in this study, and NSE was used as an indirect measure of potential neurological impact. Results: There were 160 patients, including 80 (50.0%) in the AHRE group and 80 (50.0%) in the control group. According to AHRE duration, there were 24 (30.0%) patients in Group 1, 33 (41.2%) in Group 2, 19 (23.8%) in Group 3, and 4 (5.0%) in Group 4. Patients with AHRE had statistically significant differences in age, sPAP, transmitral E/A ratio, and NSE levels. The mean NSE levels of all groups were significantly different (p < 0.001). A correlation analysis in patients with AHRE showed a very strong positive correlation between AHRE duration and NSE values as well as correlations with age, virtual CHA2DS2-VASc score, and LA diameter. NSE levels were positively correlated with AHRE duration and LA diameter. AHRE duration was an independent predictor of elevated NSE levels. Conclusions: It was shown that AHRE is associated with silent neurological ischemia and that NSE levels can be used to demonstrate these neurological effects. Future studies can contribute to the development of more effective treatment strategies based on these findings by investigating the neurological effects of AHRE in more detail.

INTRODUCTION:Infective endocarditis is defined as an infection of the endothelial surfaces in the heart (valves and endocardium), prosthetic heart valves, and intracardiac devices (such as pacemaker leads and ventricular assist devices). Due to diagnostic challenges, determining the true incidence of infective endocarditis is difficult. Despite advancements in diagnosis and treatment, incidence and mortality rates have not decreased. In this study, we evaluated the clinical and laboratory parameters of patients with infective endocarditis followed in our hospital between 2005 and 2018 and assessed their relationship with in-hospital and one-year mortality. METHODS:This study retrospectively analysed 145 patients aged ≥18 years who were diagnosed with infective endocarditis and followed in our hospital between 2005 and 2018. Data were analysed using IBM SPSS V23. Statistical analyses included the Shapiro-Wilk test, T-test, Mann-Whitney U test, and Chi-square test. RESULTS:The average age of the patients was 53 (18-86), and 52.4% (n = 76) were male. In 34% (n = 37) of our patients, the predisposing factor for infective endocarditis was rheumatic valve disease. In-hospital mortality was 31.7%, and one-year mortality was 40.6%. A statistically significant difference in in-hospital mortality was found between combination therapy (23%) and medical therapy (40.8%). Mitral valve involvement was the most common, occurring in 48.3% of patients. Staphylococci were the most frequently isolated microorganisms in blood cultures (41.4%). Heart failure was the most common complication and was associated with the highest mortality rate (23.4%). NYHA was an independent predictor of in-hospital mortality. CONCLUSION:In our study, surgical intervention, i.e. combination therapy, applied after two weeks of antibiotic treatment, was found to be more effective. Early combination therapy may be life-saving.

BACKGROUND Atrial high-rate episode (AHRE) is defined according to the European Society of Cardiology (ESC) guidelines as a heart rate of ≥175 bpm lasting at least 5 minutes. This study aimed to investigate whether neuron-specific enolase (NSE) levels, an indicator of silent neurological ischemia, could be used as an effective biomarker to demonstrate silent neurological ischemia in patients with detected AHRE and to examine factors associated with AHRE. METHODS Patients with AHRE detected in pacemaker analysis and a control group without any arrhythmias were included. Patients with AHRE were divided into subgroups according to AHRE duration: Group 1: AHRE <5 minutes, Group 2: AHRE ≥5 minutes - <1 hour, Group 3: AHRE ≥1 hour - <24 hours, Group 4: AHRE ≥24 hours. Neuron-specific enolase (NSE) levels of the patients were measured. RESULTS There were 160 patients, including 80 (50.0%) in the AHRE group and 80 (50.0%) in the control group. According to AHRE duration, there were 24 (30.0%) patients in Group 1, 33 (41.2%) in Group 2, 19 (23.8%) in Group 3, and 4 (5.0%) in Group 4. Patients with AHRE had statistically significant differences in age, sPAP, transmitral E/A ratio and NSE levels. The mean NSE levels of all groups were significantly different (p<0.001). Correlation analysis in patients with AHRE showed a very strong positive correlation between AHRE duration and NSE values as well as correlations with age, CHA2DS2-VASc score and LA diameter. NSE levels were positively correlated with AHRE duration and LA diameter. AHRE duration was an independent predictor of elevated NSE levels. CONCLUSION It was shown that AHRE is associated with silent neurological ischemia and that NSE levels can be used to demonstrate these neurological effects. Future studies can contribute to the development of more effective treatment strategies based on these findings by investigating the neurological effects of AHRE in more detail.

Background and Objectives: Hypertension is typically classified into two main groups, “dipper” and “non-dipper”, based on nocturnal blood pressure decline. The coronary artery calcium score (CACS) is an essential biomarker used to assess the presence and severity of coronary artery disease (CAD). This study aims to demonstrate the relationship between CACS and hypertensive patients with moderate-to-high cardiovascular disease (CVD) risk classified as either dipper or non-dipper. Participants and Methods: A total of 167 patients with moderate-to-high CVD risk were divided into two subgroups: 95 patients with dipper hypertension (HT) and 72 with non-dipper hypertension. CACS was measured using coronary computed tomography angiography. Results: In the dipper HT group, there were 60 females (63.2%) and 35 males (36.8%), whereas the non-dipper HT group included 28 females (38.9%) and 44 males (61.1%) (p = 0.002). The mean age was 57 in the dipper HT group and 62 in the non-dipper HT group (p = 0.011). The mean CACS was 93 in the non-dipper HT group and 10 in the dipper HT group (p < 0.001). A history of coronary artery disease was more common in the non-dipper HT group (p = 0.003). Smoking prevalence was higher in the non-dipper HT group (31 patients, 43.1%) compared to the dipper HT group (25 patients, 26.3%) (p = 0.023). Correlation analysis showed that CACS was positively correlated with age, BMI, and HbA1c and negatively correlated with eGFR. Higher CACS values were also observed in males and patients with a history of coronary artery disease, diabetes mellitus, and hyperlipidemia. In univariate analysis, age, male sex, smoking, CAD, CACS, and elevated creatinine were identified as significant risk factors for non-dipper HT (p < 0.05). However, in multivariate analysis, only CACS emerged as a significant independent risk factor (p = 0.001), while other variables were not significant (p > 0.05). The area under the curve (AUC) for CACS was 0.759, indicating statistically significant and excellent discriminative capability (p < 0.001, 95% CI: 0.680–0.839). Conclusions: It was concluded that non-dipper hypertension is associated with higher CACS and indicates a higher cardiovascular risk for this group.

Background: Atrial fibrillation (AF) is strongly associated with an increased risk of ischemic events.Anticoagulation focuses on reducing the risk of embolism.Guideline recommended CHA 2 DS 2 -VASc scoring system is most widely used; however, different scoring systems do exist.Thus, we sought to assess the impact of anticoagulant treatment and different scoring systems on the development of stroke, myocardial infarction, and allcause mortality in patients with nonvalvular AF. Methods:The present study was designed as a prospective cohort study.The enrollment of the patients was conducted between August 1, 2015, and January 1, 2016.The followup period was defined as the time from enrollment to the end of April 1, 2017, which also provided at least 12 months of prospective follow-up for each patient.Results: A total of 1807 patients with AF were enrolled.During the follow-up, 2.7% (48) of patients had stroke, 0.8% ( 14) had myocardial infarction, and 7.5% (136) died.The anticoagulation and risk factors in AF (ATRIA) score had a better accuracy for the prediction of stroke compared to other scoring systems (0.729, 95% CI, 0.708-0.750,P < .05).Patients under low-dose rivaroxaban treatment had significantly worse survival (logrank P < .001).Age, CHA 2 DS 2 -VASc score, R 2 CHADS 2 score, ATRIA score, chronic heart failure, prior stroke, and being under low-dose rivaroxaban treatment were independent predictors of clinical endpoint (P < .001). Conclusion:Low-dose rivaroxaban treatment was independently and strongly associated with the combined clinical endpoint.Furthermore, the ATRIA score proved to be a stronger predictor of stroke in the Turkish population.

Introduction: Suppression of Tumorigenicity 2 (ST2), a member of the interleukin-1 (IL-1) superfamily, is recognized as an important biomarker in inflammatory responses and cardiovascular diseases. Elevated serum levels of sST2 have prognostic value, particularly in cases of cardiac stress such as heart failure and acute pulmonary embolism (APE). We aimed to assess ST2 levels as a potential biomarker for right heart dysfunction in APE patients, particularly in the context of its limited predictive value for mortality and risk stratification. Methods: Patients diagnosed with APE confirmed via computed tomography pulmonary angiography (CTPA) were enrolled in this study. To ensure the specificity of sST2 elevation to APE, patients with other conditions known to cause elevated sST2 levels were excluded. Results: After pre-clinical evaluation, 66 patients diagnosed with APE who met the study criteria, and 62 healthy subjects in the control group, were included in this study. sST2 levels were positively correlated with APE. Conclusions: In patients diagnosed with APE, sST2 levels had high sensitivity. sST2 levels are elevated in APE and are associated with right ventricular dysfunction, but do not independently predict mortality or risk stratification based on Pulmonary Embolism Severity Index (PESI) scores.

ÖzGünümüzde tüm toplumlarda mortalitenin en önemli sebebi kardiyovasküler hastalıklar olmaya devam etmektedir

Noncompaction cardiomyopathy is a rare type of cardiomyopathy that can result in left ventricular failure, thromboembolic events, tachyarrhythmias, and sudden cardiac death. It is a congenital cardiomyopathy in which deep trabeculations and cavities in the left ventricle are formed due to the cessation of the development of myocardial tissue in the intrauterine period. Ebstein's anomaly is a congenital anomaly characterized by apical displacement of the tricuspid valve septal leaflet. Although the association of noncompaction cardiomyopathy and ebstein is a rare disease, there are cases described in the literature. A 23-year-old male patient, who presented with palpitations and fatigue, was diagnosed with noncompaction cardiomyopathy and ebstein anomaly. After the diagnosis, the patient is followed closely without complications with appropriate medical follow-up. Congenital heart diseases can be seen alone or in association with other cardiac malformations. When there are suspicious findings in a patient with ebstein's anomaly, it may be associated with noncompaction cardiomyopathy, and screening with echocardiographic and cardiac MRI should be considered.

Thrombotic coronary artery occlusions usually manifest as acute coronary syndrome with cardiogenic shock, acute pulmonary edema, cardiac arrest, fatal arrhythmias, or sudden cardiac death. Although it usually occurs based on atherosclerosis, it can also occur without atherosclerosis. There is no predictor of coronary artery thrombosis clinically and no consensus regarding the optimal treatment. In the current literature, treatment options include emergency coronary artery bypass grafting, entrapment of thrombus in vessel wall with stent implantation, intracoronary thrombolysis, glycoprotein IIb/IIIa inhibitors, anticoagulation with heparin, and thrombus aspiration as reperfusion strategies. Here, we reviewed a new treatment strategy based on the literature, and a case series with successful results in hemodynamically stable patients with low-dose slow infusion tissue plasminogen activator (tPA) for thrombotic coronary artery occlusions that allow coronary flow was reported. Prospective randomized studies and common consensus are needed on low-dose, slow-infusion tissue plasminogen activator treatment regimen and optimal treatment management for thrombotic coronary artery occlusions.

In December 2019, several cases of pneumonia of unknown origin were reported in the city of Wuhan, province of Hubei, China. The pathogen was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease was named coronavirus disease 2019 (COVID-19). Acute phase reactans (APRs) are critical in the early diagnosis, treatment, and for monitoring the progression of COVID-19. Seventy two patients were included in the study and infections confirmed by real-time reverse transcription polymerase chain reaction. Clinical parameters, the level of APFs and D-dimer were assessed and results were retrived from the patients' medical records. Chest computed tomography (CT) findings were described for each patient and they were divided into two groups, with or without COVID-19 pneumonia. The correlation between APRs and CT findings and the patients' prognosis were evaluated. Twenty eight (38.8%) of the 72 patients were female and 44 (61.2%) were male. The most common symptom was cough (43%) and the most common associated chronic disease was hypertension (12.5%). Thirty (41.6%) patients had completely normal chest CT, while 42 (58.4%) patients had typical findings in terms of COVID-19 pneumonia. C reactive protein (CRP), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), ferritin, procalcitonin and D-Dimer levels were statistically significantly higher in patients with pneumonia than in those without pneumonia and these parameters were also statistically significantly higher in patients with severe illness. In conclusion, CRP, LDH, ESR, ferritin, and D-Dimer were associated with severe COVID-19 pneumonia. These biomarkers can be used to evaluate the prognosis to predict the clinical course of disease, allowing a proper management and treatment of the patients.

Galectin-3 is an inflammation biomarker associated with atrial remodeling which plays a role in the development of atrial fibrillation (AF). Atrial high-rate episode (AHRE) is related to development of clinically documented AF and stroke. The present study aimed to determine the relationship between the presence of AHRE and the coronary sinus (CS) serum sampling of galectin-3 levels in the long-term follow-up of cardiac resynchronization therapy (CRT) patients. A total of 108 consecutive CRT patients were included prospectively in the study. AHREs were defined as atrial tachyarrhythmia episodes lasting at least 6 min with atrial rate >190 beats/min detected by cardiac implantable electronic device. CS blood samples were drawn from the CS guiding catheter to perform galectin-3 measurements. Galectin-3 levels were measured via ELISA. During a mean follow-up 12.6±4.9 months, AHRE was observed in 31 (28.7%) patients and not observed in 77 (72.3%) patients. CS galectin-3 levels were significantly higher in patients with AHRE than those without AHRE (18.09±2.62 vs 13.17±3.17, respectively, p<0.001). Moreover, CS galectin-3 levels showed significant positive correlation with percent of time spent in total AHRE (r=0.436, p<0.001). Multivariate logistic regression analysis demonstrated that left atrium (LA) volume and CS galectin-3 levels were significant and independent predictors for AHRE (OR=1.127, 95% CI: 1.045 to 1.216; p=0.002, OR=1.799, 95% CI: 1.388 to 2.330; p<0.001, respectively). In this study, we determined that high CS galectin-3 levels were a predictor for the development of AHRE in CRT patients.

The basic components of energy drinks include caffeine, guarana, taurine, ginseng, and sugar. The excessive consumption of energy drinks has been associated with cardiovascular events such as tachycardia and myocardial infarction in the literature. We herein describe a 24-year-old man admitted to the emergency department. The patient’s medical history and family history were unremarkable. It was, however, learned that he had consumed 8 to 10 cans of energy drinks per day (3.5–4 Lit/d) in the 2-week period leading to the hospital admission. Physical examination revealed bilateral diffuse rales and 2+ pretibial edema. Echocardiography showed a left ventricular ejection fraction of 25% with global left ventricular hypokinesia and dilated left ventricular dimensions. Coronary angiography demonstrated normal coronary arteries. On cardiac magnetic resonance imaging, the left ventricle was dilated, and the systolic function was reduced. No pathological enhancement was observed. This case report and many previous studies support a possible link between caffeinated energy drinks and cardiovascular events.

OBJECTIVE:This study aimed to evaluate the safety of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) during daily clinical practice.METHODS:This was a prospective study conducted between January 01, 2016, and April 01, 2017, in patients aged ≥18 years with a diagnosis of NVAF. We performed the study in 9 clinical centers from different regions of Turkey, and the mean follow-up period was 12+2 months. We investigated major and minor bleeding events of DOAC.RESULTS:A total of 1807 patients with NVAF were enrolled. The mean age of the patients was 73.6±10.2 years, CHA2DS2-VASc score was 3.6±1.4, and HAS-BLED score was 2±1.2. The most frequently prescribed DOAC was dabigatran 110 mg bid in 409 (22.6%) patients. The patients on apixaban 2.5 mg bid were older (p<0.001). Patients on rivaroxaban 15 mg od also had a higher prevalence of chronic renal failure, 46 (16.7%) patients. A total of 205 (11.4%) bleeding events were observed; among these, 34 (1.9%) patients had major bleeding and 171 (9.4%) patients had minor bleeding. The major and minor bleeding events were 2/273 (0.7%) and 30/273 (10.9%) in patients receiving dabigatran 150 mg bid, 13/409 (3%) and 44/409 (10.7%) in patients receiving dabigatran 110 mg bid, 4/385 (1%) and 42/385 (10.9%) in patients receiving rivaroxaban 20 mg od, 8/276 (2.9%) and 27/276 (9.7%) in patients receiving rivaroxaban 15 mg od, 3/308 (0.9%) and 14/308 (4.5%) in patients receiving apixaban 5 mg bid, 4/156 (2.5%) and 14/156 (9%) in patients receiving apixaban 2.5 mg bid, respectively. The total bleeding events were 17 (5.6%) in patients receiving apixaban 5 mg, less than those receiving other DOACs. On multivariate analyses, rivaroxaban 20 mg od (p=0.002), ATRIA and HAS-BLED scores, and peripheral artery disease were independent indicators of bleeding. The most frequent location of major bleeding was the gastrointestinal system (GIS) [17 (0.9%) patients], and the most frequent location of minor bleeding was the gingiva [45 (2.5%) patients].CONCLUSION:This study showed that similar results as the previous real-life study; however, we had some different results, such as the GIS tract bleeding was more frequent in patients receiving dabigatran 110 mg bid. The major and intracranial bleeding events were similar for different DOACs; and among DOACs, only rivaroxaban 20 mg od was associated with a high risk of bleeding.

Abstract Introduction Cardiac resynchronization therapy (CRT) is a device‐based method of treatment which decreases morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). This study was aimed to investigate the effects of CRT on hemodynamic and arterial stiffness parameters evaluated by noninvasive method, and determine whether there is a correlation between the changes after CRT in these parameters and the clinical response to CRT or not. Methods The study included 46 patients with HFrEF who were planned to undergo CRT implantation. Before the CRT implantation, clinical and demographic data were recorded from all patients. Hemodynamic and arterial stiffness parameters were measured oscillometrically by an arteriograph before CRT implantation. The patients were re‐evaluated minimum three months after CRT; the above‐mentioned parameters were measured again and compared to the pre‐CRT period. Results Compared to the period before CRT, mean systolic blood pressure (SBP) (116.8 ± 19.1 mm Hg vs 127.7 ± 20.9 mm Hg, P = .005), central SBP (cSBP) (106.2 ± 17.3 mm Hg vs 116.8 ± 18.7 mm Hg, P = .015), cardiac output (CO) (4.6 ± 0.8 lt/min vs 5.1 ± 0.8 lt/min, P = .002), stroke volume (65.6 ± 16.3 mL vs 72.0 ± 14.9 mL), and pulse wave velocity (PWV) (10 ± 1.6 m/sec vs 10.4 ± 1.8 m/sec, P = .004) increased significantly in post‐CRT period. In addition, the same parameters were significantly increased post‐CRT period in patients with clinical response. However, there was not any similar increase in nonresponder patients. Conclusion This study demonstrated that SBP, CO, and PWV increased significantly after CRT. The modest increases in these parameters were observed to be associated with positive clinical outcomes.

DOI: 10.14744/ejmi.2020.24126 EJMI 2021;5(1):27–32

BACKGROUND:We evaluated the efficacy of a new method in identifying peri-device leak (PDL) using morphology of the thrombus formed inside the left atrial appendage (LAA) as seen on follow-up transesophageal echo (TEE).METHOD:A total of 291 consecutive patients undergoing Watchman procedure were included in this analysis. TEE was performed at 45 days postprocedure. Based on the presence of the thrombus inside the LAA behind the device, patients were grouped as (1) white (W) group: LAA completely filled with thrombus (n = 101), 2) nonwhite (NW) group: LAA completely black or mixed (part black and part white; n = 190). Follow-up TEE was repeated at 6 and 12 months.RESULTS:Baseline characteristics were comparable between groups except the device size, number of patients with chicken-wing morphology, and prevalence of left atrial "smoke" that were significantly higher in the NW group. Detection of black appearance was comparable between the pre-coil closure image and the NW population (26/36 [72.2%] vs 99/154 [64.3%], p = .37). After adjusting for clinically relevant covariates, NW appearance of the LAA was associated with the presence of significant leak (odds ratio: 47.96, 95% confidence interval: 2.91-790.2, p < .001). The 11 patients with mixed appearance at the 6-month TEE remained unchanged (part black and part white) at the 12-month TEE. LAA appearance was white in all 36 patients following coil closure.CONCLUSION:Our findings demonstrated white and nonwhite appearance of the appendage on TEE to be reliable markers of complete closure and leak respectively, following LAA occlusion with the Watchman device.