AimThis study investigated coronary slow flow (CSF) prevalence in post-COVID-19 patients presenting with unstable angina (UA) and angiographically normal coronary arteries.Materials and methodsThe study included 190 patients presenting with unstable angina (UA) and confirmed normal coronary arteries via invasive angiography. Participants were divided into two age- and sex-matched groups: 95 patients with a history of COVID-19 [COVID (+) UA-NCA] and 95 patients without a prior history of the infection [COVID (–) UA-NCA]. In the study group, COVID-19 was confirmed via RT-PCR and computed tomography. All participants underwent coronary angiography to perform Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) measurements. CSF was diagnosed in patients with a corrected TFC (CTFC) ≥ 27.ResultsCSF prevalence was significantly higher in the COVID (+) UA-NCA group than in the COVID (–) UA-NCA group (18.9% vs. 5.3%, p = 0.003). Individual CTFC values for the LAD, LCX, and RCA were also significantly higher in the COVID (+) UA-NCA group compared to the COVID (–) UA-NCA group (26.1 ± 4.3 vs. 22.4 ± 2.6 [p = 0.01], 24.3 ± 4.5 vs. 21.7 ± 2.4 [p < 0.001], and 24.3 ± 4.5 vs. 21.4 ± 2.5 [p < 0.001], respectively).ConclusionsCSF prevalence is significantly higher in patients with a history of COVID-19, suggesting persistent microvascular impairment.

Background: One of the greatest challenges in the diagnosis of acute mesenteric ischemia (AMI) is the lack of specific laboratory tests that support multidetector computed tomography (CT). Our aim is to investigate the diagnostic value of electrocardiographic QT parameters in AMI and their relationship with CT findings. Materials and Methods: Patients who were admitted to the emergency department with abdominal pain were recruited retrospectively from the hospital information system. Grouping was carried out on the basis of AMI (n=78) and non-AMI (n=78). In both groups, the corrected QT (QTc) and QT dispersion (QTD) were measured on electrocardiographs, and the qualitative and quantitative CT findings were evaluated on CT examinations. Results: The QTc and QTD values were higher in the AMI group. The median QTc values were 456.16 (IQR: 422.88-483.16) for the AMI group and 388.83 (IQR: 359.74-415.83) for the control group (p<0.001), and the median QTD values were 58 (IQR: 50.3-68.25) for the AMI group and 46 (IQR: 42-50) for the control group (p<0.001). In the CT analysis, the QTc values were significantly higher among AMI patients, with images of paper-thin bowel walls and the absence of bowel wall enhancement (p=0.042 and p=0.042, respectively). Meanwhile, the QTD values were significantly higher among patients with venous pneumatosis findings on CT (p=0.005). In the regression analysis, a significant relationship was found between the QT parameters and AMI (p<0.001). For QTc, an AUC of 0.903 (95% CI: 0.857-0.950, p<0.001), a sensitivity of 80.8%, and a specificity of 82.3% were found. For QTD, an AUC of 0.821 (95% CI: 0.753-0.889, p<0.001), a sensitivity of 73.1%, and a specificity of 82.3% were found. Conclusion: We found the QTc and QTD values to be significantly higher among AMI patients. Furthermore, we found a significant relationship between the CT findings and QTc and QTD and a significant relationship between survival and QTc in the AMI group.

Objectives We evaluated carotid artery stiffness in patients with coronary artery disease (CAD) using acoustic radiation force impulse (ARFI) elastography and investigated the relationship between stiffness and CAD. Methods This study examined 76 CAD patients (aged 60.7 ± 11) and 70 healthy individuals (aged 59.6 ± 9). The left common carotid artery mean shear wave velocity (LCmeanSWV) and the right common carotid artery mean shear wave velocity (RCmeanSWV) of the anterior walls were measured using ARFI elastography, and the results of the patient group and the healthy group were compared. The common carotid intima-media thickness (CIMT) was measured in both groups and compared with mean SWV. Results The RCmeanSWVs in the patient and healthy groups were 3.47 ± 1 m/s and 2.69 ± 0.90 m/s, respectively ( p < 0.001). The LCmeanSWVs in the patient and healthy groups were 3.60 ± 0.9 m/s and 2.90 ± 0.80 m/s, respectively ( p < 0.001). A significant correlation was found between the RCmeanSWV and the right CIMT values and between the LCmeanSWV and the left CIMT values (r = 0.231, p = 0.03 and r = 0.331, p = 0.002, respectively). Conclusions The mean SWV values of carotid arteries of CAD patients measured with ARFI elastography were significantly higher than the mean SWV values of the carotid arteries of healthy individuals. Thus, measurement of the carotid artery SWV could be a potential tool in the risk evaluation of cardiovascular disease. Nonetheless, new studies are required to determine whether this method serves as a useful additional tool.

Objective: The right ventricle myocardial infarction (RVMI) is one of the leading reasons for right ventricle(RV) dysfunction. RVMI occurs in 20-50% of inferior infarctions. Echocardiography was applied to study RV involvement and proximal right coronary artery (RCA) occlusion in individuals with acute inferior MI. The objective of this study was to investigate if pulmonary annulus motion velocity (PAMVUT) levels in individuals with acute inferior myocardial infarction were linked to proximal RCA lesions. Method: The study comprised 50 people who had been diagnosed with acute inferior myocardial infarction and had culprit lesions in the right coronary artery. The RCA occlusion in Group A was proximal to the right ventricular branch, while the RCA occlusion in Group B was distant to the RV branch. The PAMVUT was tested, as well as other echocardiographic parameters. Results: In terms of metrics indicating right ventricular function, there were substantial disparities between the groups. A favorable association was established in the univariate correlation analysis between PAMVUT and RV TAPSE, with FAC, and with St.PAMVUT was identified as an independent predictor of proximal RCA occlusion in a multivariate logistic regression test. In the ROC analysis, PAMVUT<8,5 cm/s indicated proximal RCA occlusion with 85 percent sensitivity and 69 percent specificity (AUC=0.80, p<0.001). Conclusion: PAMVUT measurements were revealed to be an important predictor of proximal RCA occlusions in this investigation.

Introduction: Coronary artery ectasia (CAE) is associated with increased morbidity and mortality, and is known to also be associated with atherosclerosis. CAE is considered a variant of coronary artery disease, and is more common in patients with hypertension. We aimed to evaluate the neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) in hypertensive patients with CAE. Patients and Methods: The study was designed retrospectively in the cardiology unit of Bolu Abant Izzet Baysal University Medical Faculty Hospital between January 2017 and October 2019. A total of 7287 coronary angiographies were retrospectively analyzed to detect the incidence of ischemic heart disease. Diagnosis of CAE was made visually by two cardiologists who were blinded to the study aims. All included patients had a diagnosis of hypertension. After appropriate exclusions, hypertensive patients were divided into CAE and normal coronary artery groups, and the laboratory parameters of the two groups were compared. Results: The neutrophil counts [4.2 (2.4-8.6) vs. 4.2 (2.0-6.7) u/mm3 , p= 0.015], red cell distribution width [15.7 (12.8-21.6) vs. 15.3 (13.2-18.6) %, p= 0.002], platelet distribution width [17.9 (15.5-23.0) vs. 17.5 (15.9-20.8) %, p= 0.001], NLR [2.1 (0.7-12.8) vs. 1.9 (0.8-4.5), p< 0.001], platelet-lymphocyte ratio [109.8 (63.0-321.8) vs. 100.9 (34.7-223.6), p= 0.001], MPV (8.4 ± 1.4 vs. 7.9 ± 1.0 fL, p< 0.001), and plateletcrit (0.19 ± 0.05 vs. 0.18 ± 0.4 %, p= 0.007) were significantly higher, and the lymphocytes counts [2.1 (0.5-4.2) vs. 2.2 (1.1-6.7) u/mm3 , p= 0.013] were significantly lower in hypertensive patients with CAE than in those without. Conclusion: Hemogram parameters could be useful biomarkers for determining a thrombotic state and inflammatory response in hypertensive patients with CAE.

ABSTRACT Echocardiographic abnormalities are frequently seen in patients starting dialysis therapy and are also associated with the development of cardiac failure and mortality. In the present study, it was aimed to evaluate the left ventricular hypertrophy (LVH) detected by echocardiography and other echocardiographic factors and cardiovascular mortality in hemodialysis patients (HD). In this descriptive and cross-sectional study, 32 HD patients who died between December 1998 and November 2000were evaluated. Baseline echocardiograms were carried out in all HD patients. Echocardiographic parameters, blood pressure, anemia, levels of albumin and parathormone, age and gender were determined. They were M/F: 20/12, with systolic blood pressure (SBP): 146+41 mmHg and diastolic blood pressure (DBP): 82±19 mmHg. Mean age of cases was a 54±17 yr and mean hematocrit level was 21+3% at the beginning of the chronic HD program. In the present study, we determined that cardiovascular mortality (53.1%) is the leading cause of death in HD patients. We found that cases had generally moderate left ventricular hypertrophy (LV wall thickness (LVPWDd): 1.36+0.23 cm), however, diabetic patients had more severe hypertrophy (1.54+0.27 cm, p<0.05) and larger LV end-diastolic diameter (LVDd: 5.41+1.05 cm). We also found highly positive correlations between DBP and LVPWDd, SBP and LVPWDd (r=0.62, p<0.05 and r=0.85, p=0.007, respectively). As a conclusion, cardiovascular mortality still is the most common cause of death in HD patients. Echocardiographic parameters have been excessively deteriorated in HD patients at the beginning of HD program, and this is rather related hypertension, anemia.

Background Renal insufficiency may occur in patients with coronary artery disease (CAD). Acoustic radiation force impulse (ARFI) is a method for quantifying tissue elasticity, which could be used as an additional diagnostic test for renal insufficiency and provide an additional contribution to the determination of CAD. Purpose To evaluate ARFI elastography with shear wave velocity (SWV) measurements in the diagnosis of mild-to-moderate chronic kidney disease (CKD) in CAD patients, and to analyze the relationship between the severity of CAD assessed by the Gensini scoring system and kidney stiffness. Material and Methods The study included 76 CAD patients and 79 healthy volunteers. SWV was measured for each kidney in the both groups. The CAD group was divided into two subgroups based on Gensini score: mild CAD and severe CAD. SWV values of the CAD patients were compared to those of the healthy volunteers; values of subgroups were also compared with each other. Results The patient group had significantly lower renal mean SWV values than those of the healthy group (1.87 ± 0.58 vs. 2.34 ± 0.38, P < 0.01). The SWV value decreased as the eGFR level decreased. Mean SWV values for kidneys of the patients with severe CAD were lower than those of the mild CAD patients (1.64 ± 0.39 vs. 2.42 ± 0.60, P < 0.01). Conclusion renal mean SWV values of CAD patients decreased in proportion to the reduction in eGFR, and the SWV values decreased as the severity of CAD increased. ARFI elastography is a novel technique for diagnosing CKD and defining illness severity in CAD patients.

Background: Many studies have shown that evidence supporting the relationship between low bone mineral density (BMD) and coronary artery disease (CAD) has been increasing. There is a significant increase of myocardial infarction in men with low BMD.Purpose: We aimed to detect the relationship between BMD and CAD in patients whose CAD was detected with coronary angiography, and its severity and prevalence was detected with Gensini score.Methods: A total of 55 patients were selected who were found to have single or multiple infarctions through using coronary angiography in the cardiology clinic. The CAD severity was evaluated by calculating the Gensini score. These patients were divided into two groups: mild CAD and severe CAD groups. Femur bone mineral density (FBMD) was measured with dual energy X-ray absorptiometry. T score values were determined to be normal if the values were >-1.0 (n=22, 40%), and osteopenia-osteoporosis (osteopenic syndrome) if the T score values were <=-1 (n=33, 60%).Results: The FBMD of severe CAD according to the Gensini risk score was found to be significantly lower. FBMD values in patients decreased as their Gensini scores increased.Conclusion: There was a significant relationship between CAD and osteopenic syndrome. FBMD level in men with severe CAD is significantly low when compared with patients who have mild CAD.

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.

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.

Objectives: Coronary artery calcification (CAC) is associated with coronary atherosclerosis. There is a significant relation between coronary artery wall calcification and coronary artery disease (CAD). The measure of coronary artery calcification is an indicator of subclinical atherosclerosis. In some studies, it has been shown that coronary artery calcification is independent from conventional cardiovascular risks, which suggests data about prognosis. Matrix Gla protein (MGP) is an important protective modulator against calcification since it is an inhibitor of tissue calcification. In this respect, we aimed to establish the relationship between the distributions of nucleotide alterations found in promoter and coding regions of the MGP gene in patients with CAD and patients with normal coronary. Methods: DNA samples (n=115) were obtained from 58 patients with CAD and 57 healthy controls. The DNA samples obtained were analyzed by a Polymerase Chain Reaction (PCR) method using three sets of primer pairs, which cover the coding (Thr83Ala in exon 4) and promoter regions (T-138C and G-7A) of the MGP gene. Amplified regions were analyzed by a Restriction Fragment Length Polymorphism (RFLP) method for possible polymorphisms. Results: The chi-square analysis of the results revealed that there is no relationship between the observed polymorphisms and CAD. Conclusions: In this study, we investigated the relationship between MGP gene polymorphism and CAD. However, according to our findings, there was no statistically significant difference between the CAD and the control group.

The etiology of Behçet’s disease (BD) has not been fully elucidated. However, immunological and environmental factors, endothelial dysfunction (ED), and genetic susceptibility have been proposed to play a role. In this study, we aimed to evaluate epicardial fat thickness (EFT) together with serum asymmetric dimethylarginine (ADMA), carotid intima media thickness (CIMT), and neutrophil-to-lymphocyte ratio (NLR) in BD patients with ocular involvement. Thirty-six ocular BD patients (17 active and 19 inactive ocular involvement), and 35 age and sex-matched healthy controls were enrolled to this cross-sectional study. All patients underwent examinations with transthoracic echocardiography and carotid Doppler ultrasound. Serum ADMA levels, CIMT, EFT, and NLR were compared between groups, and their association with disease activity was evaluated. Behçet’s disease patients had higher WBC counts, neutrophil counts, NLR, CIMT, EFT values, and serum ADMA levels than do healthy controls. The other biochemical, hematological, and echocardiographic parameters were comparable between the two groups. Behçet’s disease duration was positively correlated with EFT and CIMT. Multivariate logistic regression analysis revealed that increased serum ADMA concentration and CIMT are independently associated with BD. Neutrophil counts, NLR, and serum ADMA level were higher, and lymphocyte count was lower in patients with active ocular BD compared to those of inactive ocular BD group. Carotid intima media thickness, serum ADMA level, EFT, and NLR were increased in ocular BD patients compared to healthy subjects. In addition, both serum ADMA level and NLR were associated with disease activity of ocular involvement. Increase in disease duration was associated with increase in CIMT and EFT which suggests that anatomical changes occur in time during the disease course. Increased CIMT, serum ADMA level, EFT, and NLR may provide new clues about the role of ED and inflammation in the etiopathogenesis of BD.

Amac: Stent ici restenoz (SR), perkutan koroner girisimin (PKG) onemli komplikasyonlarindan biridir. Eozinofil ile SR arasindaki iliskiyi ortaya cikaran cok sayida calisma olmasina ragmen, literaturde eozinofil-lenfosit orani (ELO)’nin SR gelisimi ile iliskisi hakkinda veri bulunmamaktadir. Bu calismada, hastalarin basvuru ELO degerlerinin SR ile iliskisini arastirmayi amacladik. Yontemler: Calismaya, daha once koroner stent takilmis olup hastanemize stabil angina nedeniyle basvuran ve tekrar koroner anjiyografisi yapilan 314 hasta dahil edildi. Hastalarin verileri retrospektif olarak incelendi. Anjiyografik olarak SR tespit edilen 197 kisi hasta grubuna alindi, stentleri acik olan 117 hasta ise kontrol grubuna dahil edildi. Bulgular: Yas, cinsiyet, hipertansiyon, diabetes mellitus, LDL-kolesterol, HDL-kolesterol, platelet sayisi, platelet-lenfosit orani (PLO), hemoglobin duzeyleri ve sol ventrikul ejeksiyon fraksiyonu (LVEF) olcumleri bakimindan gruplar arasinda anlamli bir fark yoktu. Basvuruda bakilmis olan kan beyaz kure sayisi (WBC), notrofil, eozinofil, C-reaktif protein (CRP), ELO ve notrofil-lenfosit orani (NLO) degerleri SR grubunda kontrol grubuna gore istatistiksel olarak anlamli sekilde daha yuksek lenfosit degerleri daha dusuktu. Tum hastalar ELO duzeylerine gore iki gruba ayrildiginda, yuksek-ELO grubunda dusuk-ELO grubuna kiyasla daha sik SR goruldu. Basvuru ELO degerinin ≥0,745 olmasi durumunda, SR’u %64 sensitivite ve %61 spesifite ile ongordurebildigi saptandi. Sonuc: Bu calismada ELO degerleri kontrol grubuna kiyasla SR grubunda anlamli olarak daha yuksek bulundu. Calismadan elde ettigimiz bulgular isiginda kolay ve ucuz bir yontem olan ELO, SR acisindan yuksek riskli hastalarin belirlenmesine yardimci olabilir ve yuksek ELO, SR icin bir ongordurucu olarak kullanilabilir.

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.

Objective: Stent thrombosis(ST) is a fatal complication of percutaneous coronary intervention(PCI), the risk of which increases in patients with certain clinical and anjiographic situations. There are a number of studies concerning the relation of RDW with various cardiovascular diseases; however, there is no data about relationship between RDW and ST. In this study, we explored the association between ST and RDW value on admission in patients with ST-elevation myocardial infarction(STEMI) who underwent primary PCI. Methods: The data from 251 patients who admitted with STEMI to our heart center and treated with primary PCI and underwent repeat coronary angiography were analyzed retrospectively. The control group was consisted of 190 patients whose stent was found patent on repeated coronary angiogram, and 61 patients diagnosed as ST formed the study group. Results: The groups were similar in terms of age, gender, stent type, stent diameter and length, frequency of pre- and/or post-dilatation. Red cell distribution width, serum levels of uric acid (UA), CRP, and total bilirubin, platelet count on admission were higher and irregular usage of antiaggregant drugs was more frequent in the ST group compared to the controls. When the participants were categorized into two according to RDW value; ST was more frequent in the high-RDW group compared to low-RDW group. In the multivariate logistic regression analysis, irregular usage of antiaggregant drugs, increased RDW, high serum UA level, and increased platelet count were found as the independent predictors of ST. A RDW value of ≥15.85 predicted ST with 62%sensitivity and 62%specificity. Conclusion: Increased RDW, high serum UA level,increased platelet count and irregular usage of antiaggregant drugs were found as the independent predictors of ST in patients underwent primary PCI due to STEMI. Addition of these laboratory measurements to established clinical and angiographical risk factors may contribute to determination of high-risk patients for ST after primary PCI.

Transvenous right ventricular pacing usually shows a left bundle branch block (LBBB) pattern. When right bundle branch block (RBBB) pattern appears after the insertion of an electrode, perforation or malposition of the pacing lead usually occurs. However, when the pacing lead that is inserted into the coronary sinus or right ventricle extends to right ventricle septum, RBBB pattern may appear. Echocardiography, due to inadequate echo images or reflections, may result in early clinical misdiagnosis since it cannot be evaluated well. Another reason for the errors in diagnosis is that cardiologists generally relegate telegraphy evaluations to a second plan. Here, we present a case of pacemaker malposition, which was diagnosed using X-ray radiography after multiple failed evaluations with echocardiography.