[Consensus Report from Turkish Society of Cardiology: COVID-19 and Cardiovascular Diseases. What cardiologists should know. (25th March 2020)]. / Türk Kardiyoloji Dernegi Uzlasi Raporu: COVID-19 Pandemisi ve Kardiyovasküler Hastaliklar Konusunda Bilinmesi Gerekenler (25 Mart 2020).

In December 2019, in the city of Wuhan, in the Hubei province of China, treatment-resistant cases of pneumonia emerged and spread rapidly for reasons unknown. A new strain of coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) was identified and caused the first pandemic of the 21st century. The virus was officially detected in our country on March 11, 2020, and the number of cases increased rapidly; the virus was isolated in 670 patients within 10 days. The rapid increase in the number of patients has required our physicians to learn to protect both the public and themselves when treating patients with this highly infectious disease. The group most affected by the outbreak and with the highest mortality rate is elderly patients with known cardiovascular disease. Therefore, it is necessary for cardiology specialists to take an active role in combating the epidemic. The aim of this article is to make a brief assessment of current information regarding the management of cardiovascular patients affected by COVID-19 and to provide practical suggestions to cardiology specialists about problems and questions they have frequently encountered.

Association between fractional flow reserve and Duke treadmill score in patients with single-vessel disease.

BACKGROUND: Duke treadmill score (DTS) is an index that provides prognostic information calculated at exercise stress test. Fractional flow reserve (FFR) is an invasive method used to evaluate intermediate coronary stenosis. The direct relation of DTS and FFR has not been studied to date. AIM: The present study aims to investigate the relationship between the DTS and FFR. METHODS: The study population consisted of a total of 106 patients with single-vessel disease, as confirmed by coronary angiography performed following EST, and whose FFRs were measured. The patients were separated into three groups according to the DTS values: low risk (DTS ≥ +5), intermediate risk (-10 ≤ DTS ≤ +4), and high risk (DTS ≤ -11). According to the FFR values, the patients were separated into two groups: FFR < 0.80 and FFR ≥ 0.80. RESULTS: Angina symptoms and chronic heart failure were more frequent in the group with FFR < 0.80 than the group with FFR ≥ 0.80; respectively, 95% vs. 69.8%, p = 0.020 and 15% vs. 3.5%, p = 0.045. The mean DTS value was lower in the group with FFR < 0.80 than the group with FFR ≥ 0.80 (1.60 vs. 5.07; p = 0.011). However, there were no statistically significant differences in the DTS risk groups among the FFR groups (p = 0.070). A weak positive correlation was found between the numerical DTS and FFR values (r = 0.139; p = 0.156). When the patients with high-risk were excluded, a statistically significant relationship was determined between the FFR and in the groups with low- and intermediate-risk in terms of the DTS values (p = 0.029). CONCLUSION: In conclusion, our study results showed an association with FFR and in the groups with low and intermediate risk in terms of the DTS values. DTS levels can be useful to determine patients who require invasive management.

Rare postsurgical complication of atrial septal defect closure: right inflow obstruction due to inadvertent suturing of eustachian valve to interatrial septum.

We report the case of a 20-year-old woman who received corrective surgery for a secundum atrial septal defect, during which right atrial inflow obstruction developed because of inadvertent suturing of the eustachian valve to the interatrial septum. Although reliable cardiac surgical techniques are available, this rather rare complication may have deleterious results for patients. If a previously absent murmur is detected in the lower left parasternal border after atrial septal defect surgery, right atrial inflow obstruction caused by the eustachian valve should be kept in mind and further careful examination undertaken.

Poor coronary collateral circulation is associated with higher concentrations of soluble adhesion molecules in patients with single-vessel disease.

OBJECTIVE: As the endothelium and inflammatory cells play a crucial role in the development of collaterals after a sudden or slowly progressing stenosis of coronary arteries, the levels of soluble endothelial adhesion molecules (CAMs) including vascular cell adhesion molecule (VCAM-1) intercellular adhesion molecule-1 (ICAM-1) and E-selectin were compared between patients with poor coronary collaterals and patients with well-developed collaterals. METHODS: In the study, 97 non-diabetic subjects with single-vessel disease were included. Collateral supply to the stenotic coronary artery was determined by angiographic grading system of 0-3 (Rentrop et al. J Am Coll Cardiol 1985; 5:587-592). Serum levels of adhesion molecules were measured by enzyme-linked immunosorbent assay. RESULTS: Patients were divided into two groups according to the collateral degree (group A: 50 patients with grade 0 and 1; group B: 47 patients with grade 2 and 3 collaterals). The groups were well matched with respect to baseline clinical and angiographic characteristics. Levels of soluble VCAM-1 (mean+/-SEM; 875+/-26.6 versus 742.7+/-35.1 ng/ml; P=0.004), ICAM-1 (322.4+/-12.4 versus 269.4+/-13.3 ng/ml; P=0.005), and E-selectin (43.6+/-2.6 versus 33+/-2.4 ng/ml; P=0.004) were found to be significantly higher in group A in comparison with group B. In addition, when patients were divided into four groups according to the collateral degree, patients with grade 0 collaterals had the highest values and those with grade 3 collaterals had the lowest values for all these molecules. CONCLUSIONS: We concluded that poor collateral circulation is associated with increased levels of soluble CAMs in patients with obstructive coronary artery disease. However, further studies are needed to elucidate the exact role of these inflammatory markers in the setting of poor collateral circulation.

Levels of soluble adhesion molecules in various clinical presentations of coronary atherosclerosis.

Adhesion molecules play an important role in the development and course of coronary atherosclerosis. In this study, soluble forms of vascular cell adhesion molecule (VCAM-1) intercellular adhesion molecule-1 (ICAM-1), E-selectin and P-selectin were evaluated in patients with various clinical presentations of coronary atherosclerosis and compared them to those with angiographically documented normal coronary arteries. Venous plasma samples were collected from 43 patients with acute myocardial infarction (AMI), 45 with unstable angina pectoris (UAP), 34 with stable angina pectoris (SAP) and 29 subjects with normal coronary arteries (control). The VCAM-1 level was significantly higher in patients with AMI (mean +/- SEM; 799.8 +/- 26.3 ng/ml) than those with UAP (644.2 +/- 26.7 ng/ml) and SAP (526 +/- 32.5 ng/ml) and controls (270 +/- 26.8 ng/ml). In patients with UAP, VCAM-1 was found to be significantly elevated as compared to the SAP group and controls. VCAM-1 level was also higher in SAP group than the controls. Serum levels ICAM-1 were similar among patients with AMI (424.1 +/- 15.2 ng/ml), UAP (403 +/- 12.3 ng/ml) and SAP (381.2 +/- 16.2 ng/ml); however, levels of ICAM-1 was significantly elevated in these groups as compared to the controls (244.3 +/- 11). The mean level of E-selectin was not different in AMI and UAP groups (47.2 +/- 2.2 vs. 42.6 +/- 2.1 ng/ml; respectively). However, it was significantly higher in acute coronary syndrome groups as compared to SAP (33.4 +/- 2.3 ng/ml) and control subjects (30.7 +/- 1.9 ng/ml). Serum levels of E-selectin were similar in SAP group and controls. For P-selectin, no significant difference was observed between AMI and UAP groups (187.5 +/- 7.2 vs. 181.7 +/- 4.7 ng/ml; respectively), however, it was significantly higher in both groups as compared to SAP group (146.1 +/- 7.4 ng/ml) and controls (108 +/- 6.6 ng/ml). Serum level of P-selectin was significantly higher in patients with SAP than the control group. In conclusion, determination of serum VCAM-1, E-selectin and P-selectin levels seems more useful for detecting coronary plaque destabilization.