OBJECTIVE:The aim of this study was to compare central blood pressure, central pulse pressure, and parameters like augmentation index and pulse wave velocity, which are used to evaluate arterial stiffness using an oscillometric method called arteriography, among hypertensive patients with and without concomitant ascending aortic aneurysms. METHODS:This research was conducted as a single-center and prospective study. A total of 83 patients were included in this study, including 44 consecutive patients with hypertension diagnosed and an ascending aortic diameter of 40 mm or more detected by 2D transthoracic echocardiography, and 39 controls with hypertension diagnosed and a normal ascending aortic diameter. RESULTS:E/e' ratio was found to be significantly higher in the aneurysm group (9.05±2.24 vs. 7.75±1.94, p<0.05). The difference between peripheral and central systolic blood pressures was found to be significantly lower in the aneurysm group compared to the control group (9.3±4.5 vs. 11.8±4.1, p<0.05, respectively). Among the examined arterial stiffness parameters, augmentation index values were significantly higher in the aneurysm group (27±8.7 vs. 22.7±9.6, p<0.05), while pulse wave velocity did not show a statistically significant difference between the groups (8.85±1.85 vs. 8.59±1.19, p>0.05, respectively). CONCLUSION:Our study suggests that a potential relationship between the development of ascending aortic aneurysm and elevated aortic stiffness in hypertensive patients.

Aim: Despite medical advancements, heart failure (HF) maintains high mortality rates. Our research delves into examining the relationship between the serum creatinine/albumin ratio and one-year mortality in patients with decompensated systolic HF. Methods: During the period from October 2014 to October 2015, we enrolled 80 patients (comprising 37 females) who had been diagnosed with acute systolic decompensated heart failure and had a left ventricular ejection fraction (LVEF) of ≤ 40%. These patients were divided into two cohorts depending on whether they experienced all-cause mortality within the span of one year. Results: Among the 80 participants, 31 (39%) experienced mortality within the first year. The average age of the deceased group was 69±14 years, with 38.7% (n=12) being female. In contrast, the surviving group had an average age of 66±12 years, with 51% (n=25) being female. The HF group with mortality exhibited significantly higher levels of serum creatinine-albumin ratio, urea, and creatinine values, along with a higher prevalence of pretibial edema (p

Objective: The comparison of complications after cardiac implantable electronic device procedures has not been studied adequately between both genders. Here, we examined the effect of gender on complications in the Southeast Anatolian Region of Turkey. Methods: A total of 1640 patients from 3 centers in the Southeast Anatolian Region of Turkey were randomly selected. We compared major adverse cardiac events (clinically significant hematoma, pericardial effusion or tamponade, pneumothorax, and device infection) between genders. Univariate and multivariate analyses were plotted to identify predictors of outcomes between both genders. Results: The overall rate of major adverse cardiac events was 3.8% (63 of 1640). Major adverse cardiac events occurred in 4.1% (40 of 983) of the men and 3.5% (23 of 657) in the women groups (P = .557). The most complications were device-related infection (2.1%) and pneumothorax (1.3%) in both genders. Single- and dual-chamber pacemakers were more implanted in women than in men (11.7% vs. 6.2% and 32.6% vs. 20.1%, respectively, P < .001). On the contrary, single- and dual-chamber implantable cardioverter defibrillators were more implanted in men than in women (38.1% vs. 19.6% and 8.5% vs. 4.1%, respectively, P <.001). Additionally, warfarin treatment and history of heart failure were found predictors of major adverse cardiac events in multivariable analysis. Conclusions: This small-scale, real-life patient data revealed no remarkable distinction in terms of complications between both genders. Multinational randomized large-scale cohort trials are required to support our results.

Monocyte to HDL cholesterol ratio (MHR), lymphocyte to monocyte ratio (LMR), and neutrophil to lymphocyte ratio (NLR) have been proposed as novel systemic inflammatory markers. The aim of this study was to explore the association between MHR, LMR and NLR with pulmonary arterial hypertension (PAH). The study is a single-center, retrospective Cross-sectional study. The study group consisted of 73 patients with PAH and the control group 77 participants without cardiac pathology as determined by echocardiography. On admission, blood sampling to calculate MHR, LMR, NLR, and detailed clinical data were obtained. According to the Pearson test, systolic pulmonary artery pressure (PAP) value Higher MHR, NLR and lower LMR that indicates an enhanced inflammation were significantly increased in patients with PAH when compared with controls. Compared to many other inflammatory markers, these markers are widely available. positively correlated with the MHR and NLR (r:.35, P < .001 and r:.33, P < .001, respectively), but negatively correlated with LMR (r: −.26, P = .001). After multivariate logistic regression analysis, MHR, LMR, and NLR remained as significant predictors of PAH (OR: 2.651, 95% CI: 1.227–5.755, P = .007; OR: 0.647, 95% CI:0.450–0.931, P = .005; OR: 1.350, 95% CI: 1.054–1.650 P = .030, respectively).

Background The incidence of postoperative complications following cardiac implantable electronic device (CIED) procedures in patients treated with antithrombotic drugs has not been studied sufficiently. Here we present a comparison of complications after CIED implantations. Methods Using an observational study design, the study included 1807 patients with a taking antiplatelet drugs (n: 1601), nonvitamin K anticoagulants (NOAC) (n: 136), and warfarin (n: 70) undergoing CIED surgery. Primary endpoint was accepted as cumulative events including composite of clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to device system. Secondary outcomes included each compenent of cumulative events. Multivariable analysis was performed to identify predictors of cumulative events. Results The overall cumulative event rate was 3.7% (67 of 1807). Cumulative events occured 3.1% (50 of 1601) in the antiplatelet, 5.1% (7 of 136) NOAC, and 14.3% (10 of 70) warfarin groups (p < 0.001). CSH occurred in 2 of 70 patients (2.9%) in the warfarin group, as compared with 5 of 1601 (0.3%) in the antiplatelet group (p: 0.032). However, no significant differences were found between NOAC and warfarin groups in terms of CSH (0.7% vs. 2.9% respectively, p: 0.267). Warfarin treatment was an independent predictor of cumulative events and increased 2.9-fold the risk of cumulative events. Major surgical complications were rare and did not differ significantly between the study groups. Conclusions The incidence and severity of complications may be lower in patients treated with periprocedurally antiplatelet or NOAC therapy when compared with warfarin therapy. Further randomized control studies are required to confirm our findings.

OBJECTIVE:We aimed to determine the relationship between LMR and MHR and in-hospital and long-term mortality in patients with ACS.METHODS:We retrospectively collected patients with ACS undergoing coronary angiography between January 2012 and December 2013.RESULTS:In total, 825 patients with a mean age of 62.4 ± 12.9 years (71.3% male) were enrolled in the study. Patients were divided into three tertiles based on MHR levels and LMR levels. In-hospital mortality of the patients was significantly higher amongst patients in the upper MHR tertile when compared with the lower and middle MHR tertile groups [30 (10.9%) vs 8 (2.9%) and 14 (5.1%); P < .001, P = .009, respectively]. Five-year mortality of the patients was significantly higher amongst patients in the upper MHR tertile when compared with the lower and middle MHR tertile groups [84 (30.5%) vs 48 (17.5%) and 57 (20.7%); P < .001, P = .005, respectively]. In-hospital mortality of the patients was significantly higher amongst patients in the lower LMR tertile when compared with the upper and middle LMR tertile groups [25 (9.1%) vs 10 (3.6%) and 17 (6.2%); P = .007, P = .130, respectively]. Five -year mortality of the patients was significantly higher amongst patients in the lower LMR tertile when compared with the upper and middle LMR tertile groups [77 (28.0%) vs 47 (17.1%) and 65 (23.6%); P = .001, P = .142, respectively].CONCLUSION:We have shown that high MHR and low LMR were significant and independent predictors of in-hospital and long-term mortality in patients with ACS.

In patients with unstable angina pectoris (UAP) or non-ST elevation myocardial infarction (NSTEMI), long-term mortality remains high despite improvements in the diagnosis and treatment. In this study, we investigated whether serum albumin level is a useful predictor of long-term mortality in patients with UAP/NSTEMI. Consecutive patients (n = 403) who were hospitalized with a diagnosis of UAP/NSTEMI were included in the study. Patients were divided into 2 groups based on the presence of hypoalbuminemia and the relationship between hypoalbuminemia and mortality was analyzed. Hypoalbuminemia was detected in 34% of the patients. The median follow-up period was 35 months (up to 45 months). Long-term mortality rate was 32% in the hypoalbuminemia group and 8.6% in the group with normal serum albumin levels (P< .001). On multivariate analysis, hypoalbuminemia, decreased left ventricular ejection fraction, and increased age were found to be independent predictors of mortality (P< .05). The cutoff value of 3.10 g/dL for serum albumin predicted mortality with a sensitivity of 74% and specificity of 67% (receiver-operating characteristic area under curve: 0.753, 95% CI: 0.685-0.822). All-cause long-term mortality rates were significantly increased in patients with hypoalbuminemia. On-admission albumin level was an independent predictor of mortality in patients with UAP/NSTEMI.

Introduction: Atherosclerosis is a chronic inflammatory process and inflammation is an important component of acute coronary syndrome (ACS). Platelet-to-lymphocyte ratio (PLR) is a useful parameter showing the degree of the inflammatory response. Aim: To explore the association between PLR and long-term mortality in patients with ACS. Material and methods: A total of 538 patients who had a diagnosis of ACS between January 2012 and August 2013 were followed up to 60 months. On admission, blood sampling to calculate PLR and detailed clinical data were obtained. Results: In total, 538 patients with a mean age of 61.5 +/- 13.1 years (69% male) were enrolled in the study. Median follow-up was 79 months (IQR: 74-83 months). Patients were divided into 3 tertiles based on PLR levels. Five-year mortality of the patients was significantly higher among patients in the upper PLR fertile when compared with the lower and middle PLR tertile groups (55 (30.7%) vs. 27 (15.0%) and 34 (19.0%); p < 0.001, p = 0.010 respectively). In the Cox regression analysis, a high level of PLR was an independent predictor of 5-year mortality (OR = 1.005, 95% CI: 1.001-1.008, p = 0.004). Kaplan-Meier analysis according to the long-term mortality-free survival revealed the higher occurrence of mortality in the third PLR tertile group compared to the first (p < 0.001) and second tertiles (p = 0.009). Conclusions: PLR, which is an easily calculated and universally available marker, may be useful in long-term risk classification of patients presenting with ACS.

OBJECTIVE:The neutrophil/lymphocyte ratio (NLR) has been evaluated as a new predictor of cardiovascular risk. Inflammation has been shown to be associated with various arrhythmias including supraventricular tachycardias (SVTs). In this study, we aimed to investigate the relation between NLR and SVT in patients with a documented atrial tachyarrhythmia. METHODS:The study used a retrospective cross-sectional design. Patients who had SVT but were otherwise healthy were included. The exclusion criteria included drug use (except antiarrhythmic agents), morbid obesity, acute or chronic infection, inflammatory diseases, systemic diseases, and cancer. Total and differential leukocyte counts and routine biochemical tests were performed before the ablation procedure. RESULTS:The study included 150 patients with SVT and 98 healthy controls. The biochemical and hematological parameters were comparable between the groups, except neutrophil and lymphocyte counts. The neutrophil count was significantly higher (4.7±1.5x103/µL versus 4.1±1.0x103/µL; p<0.001) and lymphocyte count was significantly lower (2.2±0.6x103/µL versus 2.5±0.6x103/µL; p=0.001) in the SVT group than in the control group. As a result, the SVT group had significantly higher NLR values than the control group (2.2±0.9 versus 1.7±0.5; p<0.001). In addition, NLR values were higher in patients in whom tachycardia was induced during an electrophysiological study (EPS) (2.3±0.9 versus 2.0±0.8; p=0.02). The association between NLR and SVT remained significant after multivariate analysis (odds ratio: 1.5, 95% confidence interval: 1.001-2.263, p=0.049). CONCLUSION:Our study indicated that NLR values were significantly higher in patients with documented SVT than in control subjects. Inducibility of SVT during EPS was associated with higher NLR values.

We conducted this study to determine demographic details, and clinical presentations in patients with peripartum cardiomyopathy (PPCMP) of Turkish origin. The study population consisted of 58 patients with PPCMP treated at 3 major hospitals in Turkey, retrospectively. In this study, demographic details and initial echocardiographic data were recorded and long-term clinical status was evaluated. The mean age for the patient cohort was 31.47 ± 6.31 years. Thirty-eight patients (73.1%) were multigravida and seven patients had multifetal pregnancy (13.7%). The mean follow-up left ventricular (LV) ejection fraction increased from 31 ± 7 to 38 ± 19. A minority of patients were defined as improvers according to our pre-specified criteria. The average survival period after diagnosis of PPCMP was 20.66 ± 14.44 months. Initial values for LV end-diastolic diameter and urea were higher in the deceased patients compared with the surviving patients, respectively. Twenty-eight (48%) patients with PPCMP showed improvement in the follow-up period. Of the 58 PPCMP patients, 9 (15%) died during a mean follow-up of 32 ± 22 months.

Rheumatic mitral valve stenosis (RMS) is a complication of rheumatic heart disease (RHD) and leads to significant morbidity and mortality. RHD is a chronic inflammatory and autoimmune disease that is associated with cytokine activities. The etiology of RMS is not fully understood yet. Interleukin (IL)-17 and IL-23 have a key role in development of the autoimmunity. The expression of these cytokines in RMS remains unclear. In this study, we investigated the serum levels of IL-17 and IL-23 in RMS patients compared to healthy subjects.A total of 35 patients admitted to cardiology outpatient clinic between December 2014 and May 2015 who were diagnosed with RMS formed the study group. Age- and gender-matched 35 healthy subjects were included as the control group. Statistical analyses were performed using SPSS 18.0 and P value <0.05 was considered as statistically significant.The patients with RMS had higher WBC count, hsCRP, systolic pulmonary artery pressure (PAPs), left atrial diameter (LAD), IL-17, and IL-23 levels compared to the control subjects. The levels of IL-17 (P = 0.012) and IL-23 (P = 0.004) were significantly higher in the RMS group. Correlation analysis revealed that IL-17 and IL-23 levels had a significant correlation with each other and with hsCRP and LAD.We demonstrated that serum levels of IL-17 and IL-23 are significantly higher in patients with RMS compared to those of healthy subjects. IL-17 and IL-23 expression may have a possible role in inflammatory processes that result in RMS development.

Objective: Stent restenosis (SR) is an important compli­cation of percutaneous coronary intervention. There are many studies explored the relation of eosinophils with SR, however, there is no data about relationship between eo­sinophil-lymphocyte ratio (ELR) and SR. In this study we aimed to investigate the relationship between the value of ELR on admission and SR. Methods: The study was included 314 patients who had been applied a coronary stent implantation and they were admitted to cardiology clinic with stabile angina and un­derwent repeat coronary angiography. The data obtained from patients were analyzed retrospectively. The patient group was consisted of 197 patients who were diagnosed as SR, and the control group was consisted of 117 pa­tients whose stents were patent angiographically. Results: The groups were similar in terms of age, gender, hypertension, diabetes mellitus, LDL-C, HDL-C, platelet count, platelet-lymphocyte ratio (PLR), hemoglobin and left ventricle ejection fraction (LVEF). White blood cell (WBC), neutrophil, eosinophil, C-reactive protein (CRP), ELR and neutrophil-lymphocyte ratio (NLR) on admission were higher in the SR group compared to the controls. All patients were categorized into two groups according to ELR values and SR was more frequent in the high ELR group compared to low ELR group. An ELR value of ≥0.745 predicted SR with 64% sensitivity and 61% specif­ity. Conclusion: In this study ELR was found statistically higher in SR patients compared to the controls. Accord­ing to our data ELR as an inexpensive and easy method, may contribute to determination of high risk patients and increased ELR can be used as a predictor of SR.

SLE is a chronic autoimmune disease that can affect almost every organ (1). Risk of cardiovascular diseases such as pericarditis, myocarditis, valvular heart disease, and myocardial infarction is increased in SLE, but the latter is observed rarely in childhood. An 11-year-old girl who had been followed-up at our pediatric nephrology clinic for SLE was admitted to our emergency room with chest pain followed by cardiac arrest. We detected 2–3 mm ST elevations in the DII, DIII, aVF, V5, and V6 leads of electrocardiography. Creatine kinase MB fraction (CKMB) was 7.75 ng/mL (range, 0.6–6.3) and troponin I level was 0.88 ng/mL (range, 0–0.04). Transthoracic echocardiography revealed areas of dyskinesia in the left ventricular apical region, paradoxical movement in the interventricular septum, and minimal aortic insufficiency. Coronary angiography revealed total occlusion of the Anatol J Cardiol 2016; 16: 364-8 Letters to the Editor 367

Objective: Carotid artery stenting (CAS) is being applied more frequently as an alternative mode of treatment to carotid endarterectomy. We aimed to present the short-term clinical outcomes of the patients admitted to our clinic with a diagnosis of carotid artery disease and revas­cularized by CAS. Methods: The study was retrospective and a single-centered study. Between June 2013-January 2016 the patients with an indication for carotid artery intervention and accepted CAS procedure were included in the study. Clinical characteristics and procedural data of the patients were obtained by scanning patient files. After discharge, hospital records were scanned and patients were called to learn whether or not patients were alive and that they have suffered a recent stroke. Results: We included 82 patients that meet the inclusion criteria in the study. 59% of patients were male with a mean age of 68±9 years. 56% of patients were symp­tomatic. In all patients, stents were used. 85% of patients distal embolic protection devices and 15% MOMA were used. 64 right, 18 left, and two bilateral carotid arteries were stented with a total of 82 patient of 84 successful CAS. Due to residual stenosis a second stent was im­planted only in one patient. One patient experienced a partial muscle weakening in upper extremity due to an air embolism and 2 patients received opac material which recovered spontaneously in 24 hours. Conclusion: CAS is being successfully applied with a very low risk of complications in experienced centers. Short-term clinical results of CAS are quite satisfactory.

BACKGROUND/AIM The thrombolysis in myocardial infarction (TIMI) risk score (TRS), and the TIMI risk index (TRI) have been reported in coronary artery disease patients. We investigated whether admission TRI is associated with no-reflow (NRF) in patients undergoing primary percutaneous coronary intervention (p-PCI). MATERIALS AND METHODS ST-segment elevation myocardial infarction (STEMI) patients treated with p-PCI were included in the study. TRI was calculated on admission using specified variables. We defined the angiographic NRF phenomenon as a coronary TIMI flow grade of ≤2 after the vessel was recanalized or a TIMI flow grade of 3 together with a final myocardial blush grade (MBG) of <2 in a manner as described in previous studies. RESULTS A total of 371 patients (aged 62 ± 14 years; 73/27 men to women ratio) who underwent p-PCI were enrolled in the study. In terms of age, NRF patients were older than reflow patients (P < 0.017 for MBG). Killip class III-IV designations were more common in NRF patients (P = 0.029 for MBG). TRI (P = 0.014 for MBG) values were significantly greater in the NRF group. TRI was an independent predictor of NRF according to MBG flow (P = 0.003, B = -0.035, Exp B = 0966, 95% CI, 0.944-0.988). CONCLUSION Admission TRI may predict the development of NRF phenomenon after p-PCI in patients with acute STEMI.

Mini‐Abstract Aneurysm of the sinus of Valsalva (ASV) is an uncommon condition which may be congential or acquired. Here, we describe a case of ASV thrombosis presented with both acute myocardial infarction and acute stroke.

Background and Objectives The etiopathogenesis of coronary artery ectasia (CAE) is not known completely. In most of the cases, CAE is associated with atherosclerosis; however, isolated CAE has a nonatherosclerotic mechanism. The association between atherosclerotic coronary artery disease and apelin has been examined in previous studies. However, the role of plasma apelin in isolated coronary artery ectasia has not been studied. In this study, we investigated the relationship between plasma apelin levels and isolated coronary artery ectasia. Subjects and Methods The study population included a total of 54 patients. Twenty-six patients had isolated CAE (53.6±8.1 years); 28 patients with normal coronary arteries (51.6±8.8 years) and with similar risk factors and demographic characteristics served as the control group. Apelin levels were measured using an enzyme-linked immunoassay kit. Results Apelin level in the CAE group was significantly lower (apelin=0.181±0.159 ng/mL) than that in the control group (apelin=0.646±0.578 ng/mL) (p=0.033). Glucose, creatinine, total cholesterol, triglyceride, low density lipoprotein cholesterol, and high density lipoprotein cholesterol levels were not significantly different between the two groups. Conclusion In this study, we showed that patients with isolated CAE have decreased plasma apelin levels compared with the control group. Based on the data, a relationship between plasma apelin and isolated CAE was determined.