Evaluation of the Transcatheter Aortic Valve Replacement Results in Patients with Borderline Aortic Annulus and the Impact of Under- or Oversizing the Valve.

BACKGROUND: Optimal valve sizing provides improved results in transcatheter aortic valve replacement. Operators hesitate about the valve size when the annulus measurements fall into borderline area. Our purpose was to compare the results of borderline versus non-borderline annulus and to understand the impact of valve type and under or oversizing. METHODS: Data from 338 consecutive transcatheter aortic valve replacement procedures were analyzed. The study population was divided into 2 groups as 'borderline annulus' and 'non-borderline annulus.' Balloon expandable valves already have a grey zone definition. Similar to balloon expandable valves, annulus sizes that are within 15% above or below the upper or lower limit of a particular self-expandable valve size are defined as the 'borderline annulus' for self-expandable valves. The borderline annulus group was also divided into 2 subgroups according to the smaller or larger valve selection as 'undersizing' and 'oversizing.' Comparisons were made regarding the paravalvular leakage and residual transvalvular gradient. RESULTS: Of these 338 patients, 102 (30.1%) had a borderline and 226 (69.9%) had a non-borderline annulus. Both the transvalvular gradient (17.81 ± 7.15 vs. 14.44 ± 6.27) and the frequency of paravalvular leakage (for mild, mild to moderate, and moderate, 40.2%, 11.8%, and 2.9% vs., 18.8%, 6.7%, and 0.4%, respectively) were significantly higher in the borderline annulus than the non-borderline annulus group (P <.001). There were no significant differences between the groups balloon expandable versus self-expandable valves and oversizing versus undersizing regarding the transvalvular gradient and paravalvular leakage in patients with borderline annulus (P >.05). CONCLUSION: Regardless of the valve type and oversizing or undersizing, borderline annulus is related to significantly higher transvalvular gradient and paravalvular leakage when compared to the non-borderline annulus in transcatheter aortic valve replacement.

Atrial and ventricular arrhythmia predictors with electrocardiographic parameters in myocardial infarction with non-obstructive coronary artery disease (MINOCA).

BACKGROUND: The clinical importance and recognition of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasing. Nevertheless, no studies are investigating the risk of atrial fibrillation and ventricular arrhythmia in MINOCA patients. This study aimed to determine the risk of arrhythmia with electrocardiographic predictors in MINOCA patients. METHODS: In this study, patients diagnosed with MINOCA and stable out-patients without significant lesions in their coronary arteries were compared. Morphology-voltage-Pwave duration electrocardiography (MPV ECG) score was used to determine atrial arrhythmia risk. QT interval and QT dispersion Tpeak-Tend time and Tpeak-Tend/QT interval were used to determine ventricular arrhythmia risk. RESULTS: A total of 155 patients were included in our study. Seventy-seven of these patients were in the MINOCA group. There was no statistically significant difference between the two groups in MPV ECG score (1.95 ± 1.03 vs 1.68 ± 1.14, p = 0.128). P-wave voltage, P-wave morphology and P-wave duration, which are components of the MPV ECG score, were not statistically significantly different. The QRS complex duration (90.21 ± 14.87 vs 82.99 ± 21.59 ms, p = 0.017), ST interval (271.95 ± 45.91 vs 302.31 ± 38.40 ms, p < 0.001), corrected QT interval (438.17 ± 43.80 vs 421.41 ± 28.39, p = 0.005) and QT dispersion (60.75 ± 22.77 vs 34.19 ± 12.95, p < 0.001) were statistically significantly higher in the MINOCA group. The Tpeak-Tend (89.53 ± 32.16 vs 65.22 ± 18.11, p < 0.001), Tpeak-Tend/QT interval (0.2306 ± 0.0813 vs 0.1676 ± 0.0470, p < 0.001) and Tpeak-Tend/corrected QT interval (0.2043 ± 0.6997 vs 0.1551 ± 0.4310, p < 0.001) ratios were also significantly higher in patients with MINOCA. CONCLUSIONS: In the MINOCA patients, there was no increase in the risk of atrial fibrillation based on ECG predictors. However, it was shown that there could be a significant increase in the risk of ventricular arrhythmia. We believe this study could be helpful for specific recommendations concerning duration of hospitalisation and follow up in MINOCA patients.

The Relationship Between Sexual Activity and Heart Rate Variability in Menopausal Women.

BACKGROUND: Menopause is an important life stage for women, which can bring along sex- ual and cardiac problems. Increased heart rate variability is an indicator of parasympa- thetic activity and is associated with mental and physical health and life expectancy. This study aimed to evaluate the effect of sexual activity (only penile-vaginal intercourse but not masturbation or non-coital sex with a partner) on heart rate variability in healthy menopausal women. METHODS: We evaluated 130 menopausal patients aged 45-60 years, without chronic dis- ease. The average weekly sexual activity numbers remembered in the last 1 year were questioned. The patients were divided into 2 groups according to the presence of sexual activity. The sexually active group was divided into subgroups as 1 per week and 2 or more per week. Menopause Rating Scale was applied for menopausal symptoms. Heart rate variability was analyzed from the 24-hour electrocardiography Holter recording. RESULTS: Heart rate variability parameters were higher in the sexually active group than in the sexually inactive group (mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording: P = .004; root mean square of differences between adjacent normal RR intervals, expressed in ms: P=.001; number of NN intervals exceeding 50 milliseconds: P = .011; percentage of adjacent RR intervals with a difference of duration >50 ms: P = .009; low frequency: P = .011; high fre- quency: P=.008, low frequency/high frequency: P=.018). When assessed by multiple linear regression analysis by adjusting for age, body mass index, and menopause dura- tion, the variables mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording, root mean square of differences between adjacent normal RR intervals, expressed in ms, and low frequency were inde- pendently associated with the number of sexual activities per week (B = 2.89 ± 1.02, 95% CI = 0.866-4.91, P = .005; B = 4.57 ± 1.83, 95% CI = 0.94-8.2, P = .014; and B = 1174.9 ± 592.2, 95% CI = 2.9-2346.9, P = .049, respectively). CONCLUSION: In healthy menopausal women, continued sexual activity with penile-vagi- nal intercourse is associated with better health outcomes on cardiac autonomic function through higher heart rate variability, an index of parasympathetic activity.

Prognostic Value of Nutritional Indexes in Evaluating the 1-Year Results after Implantation of the Carillon Mitral Contour System.

Background: The prognostic importance of nutritional indexes has been shown in some diseases. We aimed to examine the prognostic value of these indexes in patients implanted with the Carillon Mitral Contour System (CMCS). Methods: Fifty-four patients who underwent successful CMCS implantation were evaluated. Prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI) and controlling nutritional status (CONUT) scores were calculated. The relationships between these indexes and 1-year clinical outcomes including all-cause mortality and re-hospitalization due to heart failure were investigated. Results: In Kaplan-Meier analysis, 1-year all-cause mortality rates were significantly higher in the patients with low PNI and GNRI and high CONUT scores (52.0% vs. 0%, p < 0.001; 54.2% vs. 0%, p < 0.001; 52.4%, 6.1%, p < 0.001; respectively). For the composite endpoint, a significant difference was observed between those below and above the cut-off values (70.0% vs. 16.7%, p < 0.001; 75.0% vs. 23.3%, p < 0.001; 66.7% vs. 20.8%, p < 0.001, respectively). In multivariate Cox regression analysis, GNRI was determined to be an independent predictor of 1-year all-cause mortality [hazard ratio: 0.707; 95% confidence interval: 0.510-0.979; p = 0.037]. Conclusions: Nutritional indexes have prognostic value in predicting 1-year all-cause mortality in severe functional mitral regurgitation patients undergoing CMCS implantation. In particular, GNRI can guide the selection of patients who will benefit from CMCS.

Poor Nutritional Status Is Associated with Arrhythmic Events on 24-Hour Holter Recording.

BACKGROUND: Malnutrition is associated with cardiovascular disease morbidity and mortality. Arrhythmias may be the cardiac consequences of malnutrition. OBJECTIVES: The objective of the study was to evaluate the association between prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and arrhythmic events on 24-h electrocardiography (ECG) Holter recording in patients without manifested arrhythmia. METHODS: In this retrospective analysis of 477 patients who underwent 24-h ECG Holter monitoring, PNI and CONUT score were calculated and patients were divided into tertiles according to PNI and into three groups according to CONUT score; 0: normal, 1-2: mild risk of malnutrition, ≥3: moderate-severe risk of malnutrition. Arrhythmic events were compared between PNI tertiles and CONUT score groups. RESULTS: Total number of premature atrial contractions, premature ventricular contractions (PVCs), PVC burden, and incidence of paroxysmal atrial fibrillation (PAF) were significantly higher in patients within the lowest PNI tertile. Total number of PVCs, PVC burden, and incidence of PAF were significantly higher in patients with CONUT score ≥3. The cut-off value for PNI to predict the presence of PVC was defined as 39.41 using ROC curve analysis. The area under the curve was 0.650 (p < 0.001). Multivariate analysis showed that PNI was independent predictor of the presence of PVC and PAF. Also, CONUT score was independent predictor of the presence of PVC and PAF. Incidence of nonsustained ventricular tachycardia did not differ between PNI tertiles or CONUT score groups. CONCLUSION: Poor nutritional status, assessed by PNI and CONUT score, is associated with arrhythmic events on 24-h ECG Holter recording in patients without manifested arrhythmia.

The relationship of systemic inflammatory biomarkers and cardiac parameters with malignancy in patients with soft tissue tumors located in the extremity.

OBJECTIVES: In this study, we aimed to investigate the contribution of systemic inflammatory biomarkers to the diagnosis and to examine the relationship between cardiac parameters and malignancy in patients with extremity soft tissue sarcomas (STSs). PATIENTS AND METHODS: Between January 2011 and December 2020, a total of 256 patients (155 males, 101 females; median age: 50 years; range, 18 to 87 years) who were diagnosed with benign and malignant soft tissue tumors were retrospectively analyzed. The control group consisted of a total of 150 age- and sex-matched healthy individuals (83 males, 67 females; median age: 52 years; range 19 to 76 years) with complete blood count analysis and having no STS. Demographic characteristics, laboratory parameters, and echocardiographic data of the patients were obtained from the hospital database. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. RESULTS: Of a total of 256 patients included, 99 were diagnosed with benign tumors and 157 with malignant tumors. Lipoma was observed with the highest frequency of 40.4% among benign tumors, while malignant mesenchymal tumor (35.0%) was the most common tumor in the malignant group. There was no significant difference between the control and benign groups (p=0.198 and p=0.553, respectively), while the NLR and PLR of the malignant group were higher than both the control and benign groups, indicating a statistical significance (p<0.001). Total cholesterol, albumin, and ejection fraction (EF) levels of patients in the malignant group were significantly lower than the benign group (p=0.01, p<0.001, and p=0.046, respectively). According to the receiver operating characteristic curve, a cut-off value of 2.17 for NLR (sensitivity=64.1%, specificity=72%) and a cut-off value of 138.2 for PLR (sensitivity=60.9%, specificity=60.7%) were determined to distinguish malignant patients from healthy individuals. To distinguish malignant patients from the benign group, the cut-off values of NLR and PLR were 2.24 (sensitivity=62.8%, specificity=67.7%) and 137.9 (sensitivity=61%, specificity= 59.6%), respectively. CONCLUSION: Our study results suggest that NLR and PLR can be used as diagnostic markers in malignant soft tissue tumors located in the extremities. In addition, total cholesterol, albumin, and EF values are lower than normal in malignant soft tissue tumors.

Relationship between Discordance of Low-Density Lipoprotein and Non-High-Density Lipoprotein Cholesterol and Risk Stratification in Acute Myocardial Infarction

Abstract Background: Sizeable proportion of patients have discordant low-density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (NHDL-C). It has been shown that discordance of LDL-C and NHDL-C either underestimates or overestimates coronary risk. Objectıve: We assessed whether this discordance has an impact on GRACE and TIMI risk scores in patients with acute myocardial infarction (AMI). Methods: We retrospectively evaluated the data of 198 consecutive patients with AMI. Fasting serum lipid profiles were recorded, GRACE and TIMI scores were calculated. Patients were divided into 3 groups according to LDL-C and NHDL-C percentiles: Discordant group: LDL-C<NHDL-C (n=38), concordant group: LDL-C=NHDL-C (n=112) and discordant group LDL-C>NHDL-C (n=48). GRACE and TIMI scores, mortality and cardiovascular events (heart failure, non-fatal myocardial infarction and angina) at sixth month were compared between these three groups. Differences between these groups were analyzed with One-way ANOVA or Kruskal-Wallis rank test, and with chi-square for percentages. Also, post hoc LSD or Conover-Iman's non-parametric multiple comparison test were used. A p value <0.05 was accepted as statistically significant. Results: TIMI risk score didn't differ between discordant or concordant groups. Mean GRACE (death) and GRACE (death and MI) scores were higher in group with LDL-C<NHDL-C than with LDL-C=NHDL-C and LDL-C>NHDL-C (p=0.029 and 0.008, respectively). Cardiovascular events and mortality at sixth month were not different among groups (p=0.473 and p=0.176, respectively). Conclusion: GRACE score was higher in discordant group with LDL-C<NHDL-C, but there is no difference regarding TIMI scores between discordant and concordant groups in AMI patients.

Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience.

OBJECTIVE: Catheter ablation following electrophysiologic study (EPS) is the mainstay of diagnosis and treatment for patients with atrioventricular reentrant tachycardia (AVRT), demonstrating excellent long-term outcome and a low rate of complications. In this study, our aim was to assess our experience in patients with accessory pathway (AP) and to compare our data with the literature. METHODS: We included 1,437 patients who were diagnosed and treated for AP in our hospital between 1998 and 2020. The demographic data of all the patients, AP location, and periprocedural results were recorded. RESULTS: Of the 1,437 patients, 1,299 (90.4%) were men; and the mean age of the population was 26.67 years. The location of 1,418 APs were along the left free wall (647 [45.6%] patients), in the posteroseptal region (366 [25.3%] patients), in the anteroseptal region (290 [20.4%] patients), and along the right free wall (115 [8.1%] patients). The ratio of the second AP existence was 3.0% and AVNRT co-existence was 2.0%. A total of 55 (3.8%) patients had recurrent sessions for relapse. Our center's total success rate was 95.5%, and total complication rate was 0.26%. CONCLUSION: According to our retrospective analysis, EPS is a highly functional tool in the diagnosis and management of arrhythmias such as AVRT for high-risk patient groups like military personnel with the aim of risk stratification and medical management.

Antinociceptive effect of ranolazine and trimetazidine.

Background:Ranolazine and trimetazidine are piperazine derivatives used in antianginal therapy. There are data on the use of these drugs in the treatment of neuropathic pain. In this study, it was aimed to evaluate the antinociceptive effects of ranolazine and trimetazidine.Methods: Sixty patients who were started on trimetazidine or ranolazine treatment were included in the study. The patients were evaluated with Seattle Angina Questionnaire (SAQ), Visual Analog Scale (VAS) and State-Trait Anxiety Inventory (STAI) on the first day of treatment and at the first month follow-up.Results: The SAQ scores of the patients given ranolazine were statistically significantly higher than the patients given trimetazidine. The most significant increase was observed in terms of treatment satisfaction (53.03 ± 8.11 vs. 72.88 ± 5.29, p < 0.001) and quality of life (49.79 ± 8.62 vs. 68.01 ± 0.65, p = 0.016). The decrease in VAS (p = 0.001) and the decrease in STAI scores (p = 0.002) after treatment in the ranolazine group were significantly higher than in the trimetazidine group.Conclusions: Ranolazine and trimetazidine are two effective drugs in antianginal treatment. While both drugs are effective on general systemic musculoskeletal pain and anxiety, the efficacy of ranolazine is more pronounced.

Rhythm and orthopedics: The effect of music therapy in cast room procedures, a prospective clinical trial.

INTRODUCTION: Cast room procedures generally cause anxiety in patients. Anxiety complicates the procedure as well as increases the risk of a complication. Listening to music was found to be the safest and most common non-drug treatment method. The aim of this study is to evaluate the effect of listening to music on adult patients in cast room procedures. This study points out the relation between anxiety and anxiety relevant cardiac arrhythmia. MATERIALS AND METHODS: The study was performed on 199 patients with stable general condition, aged above 18. The patients were divided into two groups. Randomization method used in the study was coin flip. The first group (Group 1) listened to music during cast room procedures whereby the second group (Group 2) did not listen to music. Length of the procedure, complication, blood pressure and heart rate evaluations before and after the procedure, Visual Analogue Scale (VAS scores for pain), State-Trait Anxiety Inventory (STAI) anxiety score, patient satisfaction, willingness of the patient to repeat the procedure, P wave dispersion (Pd) and corrected QT interval dispersion (QTcd) as electrocardiographic arrhythmia predictors were evaluated. The Clinical Research Ethics Committee approval was obtained for this study. RESULTS: Significant difference was shown between the two groups for the following criteria: VAS scores (p = 0.005), anxiety scores (p = 0.032), processing time (p = 0.027), and QTcd values (p = 0.031). Patient satisfaction (p < 0.001) and willingness to repeat the procedure (p < 0.001) were higher for the group who listened to music. No significant difference in Pd values, blood pressure and heart rate was reported within the groups. CONCLUSION: Music therapy is a non-invasive, safe, nonpharmacologic, anxiolytic, and analgesic treatment. Music therapy should become standard protocol in cast room procedures. One of the most important achievements of this study was the fact that music decreases anxiety and anxiety-related cardiac arrhythmia. Therefore, conducting further prospective studies including high cardiac risk patients especially with arrhythmia is crucial.

Comparison of coronary risk scoring systems to predict the severity of coronary artery disease using the SYNTAX score.

BACKGROUND: Reliable risk scoring systems that can predict the severity of coronary artery disease (CAD) are necessary to implement effective management strategies in high-risk patients. Atherosclerotic vascular disease and with cardiovascular morbidity and mortality risk are patients who would benefit most from a change in patients at high risk factors. Framingham Risk Score, the Prospective Cardiovascular Münster (PROCAM) score and Systematic Coronary Risk Evaluation (SCORE) risk scores are used for this purpose. The severity of the CAD as detected by coronary angiography can be estimated using the SYNTAX score. In this study, it is aimed to assess the relation between SYNTAX score and the Framingham, PROCAM and SCORE scores in the context of their utility for the determination of the severity of the CAD. METHODS: A total of 205 patients with documented CAD who underwent coronary angiography due to a diagnosis of stable angina pectoris were included in this study. Coronary risk scores were determined for each patient. The relation between the SYNTAX score and the results of coronary risk scoring systems were analyzed. RESULTS: A positive relationship between the SYNTAX score, which reflects the severity of the CAD and coronary risk scores was found. However, Framingham and SCORE were superior, i.e., had more predictive value, regarding their ability to predict the SYNTAX score (p = 0.029, 0.033 and 0.002, respectively). CONCLUSIONS: Examination of the distribution of SYNTAX score across low, intermediate and high-risk groups showed a significantly higher predictive value of SCORE for high-risk patients (p = 0.005).

Transcatheter aortic valve implantation with a CoreValve bioprosthesis in a 57-year-old man.

Transcatheter aortic valve implantation (TAVI) is a promising new technology which is typically used to treat elderly patients with severe aortic stenosis who cannot undergo surgical aortic valve replacement due to high risk factors. This procedure may also be a therapeutic option in particular relatively young cases with severe symptomatic aortic stenosis who are unsuitable candidates for surgery. Clinical experience with TAVI in these patients is very limited due to concerns regarding long-term valve durability. Herein, the case is reported of a 57-year-old man with severe aortic stenosis who presented with decompensated heart failure and successfully underwent transfemoral CoreValve implantation. To the best of the present authors' knowledge, this is the youngest reported patient to have received a CoreValve bioprosthesis to date.

Assessment of coronary veins in patients with isolated coronary artery ectasia by antegrade coronary venous angiography.

BACKGROUND: Coronary artery ectasia (CAE) is characterized by an abnormal dilatation of the coronary arteries. The most common cause of CAE is atherosclerosis but other possible etiologies include congenital abnormalities and inflammatory and connective tissue disease. Earlier studies have documented the association of CAE with the presence of aneurysms in other vascular beds. However, cardiac venous system in patients with isolated CAE has not been studied earlier. In this study, we aimed to assess coronary venous vessels by antegrade coronary venous angiography in patients with isolated CAE. METHODS: Twenty-four patients with isolated CAE without significant stenosis and 21 age-matched and sex-matched controls without CAE were included in this study. The anatomy of the coronary venous system was imaged in a left anterior oblique view at an angle of 45° by antegrade coronary angiography. RESULTS: Patients with isolated CAE had significantly larger coronary veins compared with control individuals with angiographically normal coronary arteries (coronary sinus ostium: 10.1 ± 1.0 vs. 8.5 ± 2.2 mm, respectively, P=0.003; coronary sinus mid level: 7.9 ± 1.4 vs. 6.5 ± 1.6, respectively, P=0.003; great cardiac vein: 5.6 ± 1.0 vs. 4.3 ± 0.8, respectively, P=0.001; middle cardiac vein: 3.9 ± 1.3 vs. 3.7 ± 1.4, respectively, P=0.52; posterior or lateral vein: 3.2 ± 1.1 vs. 2.4 ± 0.7, respectively, P=0.016). CONCLUSION: We have shown for the first time a significant dilatation in the coronary veins in patients with isolated CAE, suggesting the presence of a more extensive vascular destruction in the coronary circulation.