Electrocardiographic Findings in Children Treated with Leuprolide Acetate for Precocious Puberty: Does it Cause Prolonged QT?

Introduction: Central precocious puberty is treated with long-acting GnRH analogues. Some adult patients undergoing GnRHa treatment experienced prolonged QT syndrome, which is associated with an increased risk of serious cardiac events such as myocardial infarction, stroke, arrhythmias, and sudden cardiac death. Method: Seventy-four patients, aged between 5 and 11 years and diagnosed with central precocious puberty but with no other concomitant disease or medication use, underwent electrocardiogram assessment. They had been receiving 3.75 mg leuprolide acetate (Lucrin® Depot) injections every 28 days for at least three months. Results: The electrocardiograms of all patients showed a QTc interval within normal limits, consistent with the data of healthy Turkish children of the same age and gender. No other pathological physical examination or ECG findings were observed. Furthermore, there was no significant difference in QTc interval in relation to age, anthropometric data, or the duration or cumulative dose of the treatment. Conclusion: The study found no correlation between QTc interval values and age, treatment duration, total cumulative dose, and anthropometric data. The findings suggest that cardiovascular adverse events associated with GnRHa may be related to age and other underlying physiopathological conditions rather than the drug.

Endovascular Repair of Ruptured Aortic Aneurysm: A Single-Center Experience.

OBJECTIVE: Aortic rupture is a rare and catastrophic emergency. Prompt diagnosis and treatment are the primary determinants of mortality. During follow-up, the majority of patients who have been effectively treated die from hypovolemic shock and multiorgan failure. This article describes the clinical and procedural details of sixteen patients with ruptured aortic aneurysms treated endovascularly. In addition, it discusses the main factors contributing to the mortality of these patients. METHOD: Patients who underwent endovascular treatment for acute aortic rupture at our center from October 2016 to March 2023 were included in this retrospective study. RESULTS: A total of 16 patients underwent endovascular aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) for acute aortic rupture. The patients' mean age was 73.06 years (range: 52-92), and 15 of them were male. The ruptures occurred in the abdominal aortic aneurysm in ten patients, in thoracic aortic aneurysm in three patients, in the isolated iliac artery aneurysm in two patients, and there was one case of non-aneurysmal aortic rupture. In our series, patients who presented with an impending, self-limited rupture and stable hemodynamic status had good prognostic outcomes. However, eight patients died due to multiorgan failure, hemorrhagic shock, disseminated intravascular coagulopathy, renal failure, or abdominal compartment syndrome. These patients generally had poor admission vital signs and low hemoglobin values. The most critical determinants for the success of the procedure are promptly stopping the bleeding, avoiding general anesthesia, and opting for blood product replacement instead of fluid replacement. CONCLUSION: Each patient with ruptured aortic aneurysm should be managed according to the patient's hemodynamics at presentation, the size of the aneurysm, the suitability for percutaneous procedure, logistical factors, and the operator-center's experience.

Make your choice: Angiography or periodical health examination?

Periodical health examination is one of the important factors influencing a healthy lifestyle. Patients undergoing routine physical examination in primary care are included in the scope of preventive medical services, which is the most basic principle of primary care. Identifying the risk factors enables individuals to adopt healthier lifestyle practices. In our study, we examined the correlation between patients undergoing coronary angiography for suspected coronary stenosis and the extent of primary care services they had received in their medical history, along with the severity of stenosis observed during the angiography. Patients were interviewed using a pre-structured questionnaire to gather information about their past utilization of primary healthcare services related to coronary matters and their cardiovascular (CV) risk profile as documented in their medical history. The necessary standard tests for angiography procedures were retrieved from patient records. The SYNTAX score, a tool that aids in the objective assessment of the severity of coronary artery disease (CAD), was computed and documented. This score was then compared with the history of primary care utilization. The patients' utilization of services from the Primary Healthcare Center (PHC) was evaluated using a scoring system, with an average score of 29.27 ±â€…11.27 out of 100 points (minimum: 20; maximum: 60). The average SCORE Türkiye indicating the 10-year risk of CV events for all patients was calculated as 14.31% ±â€…8.65% (high-very high risk), while the average SYNTAX score was 15.20 ±â€…9.97. There was a positive and significant correlation found between fasting blood glucose and creatinine values with both SYNTAX score and SCORE Türkiye (respectively; R = 0.238, P = .013; R = 0.289, P = .002). Factors such as smoking and metabolic syndrome were associated with CAD severity. It important to highlight that individual recommended for angiography had a notably lower utilization of healthcare services from the PHC based on their medical histories. This circumstance has resulted in individuals who do not undergo CV event screenings at PHCs having higher SYNTAX scores, indicating more severe CAD that necessitates angiography. Conducting regular periodical health examinations at PHCs can help mitigate these statistics.

Analysis of the cardiovascular effects of hyperbaric oxygen therapy in diabetic patients.

During hyperbaric oxygen (HBO2) therapy in humans, there are changes in cardiovascular physiology due to high pressure and hyperoxygenation. Peripheral vasoconstriction, bradycardia, and a decrease in cardiac output are observed during HBO2 therapy. These physiological effects of HBO2 therapy on the cardiovascular system are tolerated in healthy people. However, patients with underlying cardiac disease may experience severe problems during HBO2 therapy, such as pulmonary edema and death. In addition, cardiac complications may occur in patients with diabetes mellitus (DM). Therefore, HBO2 therapy may negatively affect cardiovascular physiology in patients with DM. The present study aimed to examine the cardiovascular effects of HBO2 therapy in diabetic patients. The findings of NT-ProBNP, troponin I, and electrocardiography (ECG) of diabetic patients who applied to the Ministry of Health University Gülhane Training Research Underwater and Hyperbaric Medicine Clinic were compared before and after the first HBO2 therapy session. When ECG findings were analyzed at the end of a session of HBO2 exposure, a statistically significant increase was observed in the QTc and QTc dispersion measurements (p≺0.001 and p = 0.02, respectively). In cardiac enzymes, there was a statistically significant increase in troponin I values after an HBO2 therapy session, but no statistically significant change was observed in Pro-BNP (p = 0.009, p = 0.3, respectively). Short-term exposure to HBO2 therapy had statistically significant changes in troponin I, QT, and QTc in patients with DM, which did not reach clinical significance. Despite very little evidence of cardiac dysfunction, we recommend caution in using HBO2 therapy in patients with DM and emphasize the need for further investigation of these measurements.

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.

Unrecognized indication for aortic valve neocuspidization: Patient with warfarin-induced Stevens-Johnson syndrome and toxic epidermal necrolysis.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe disorders, characterized by necrosis and epidermal detachment. Most important known acquired etiological factor is medications. Warfarin is one of the most common medications of cardiac valve surgery, which may rarely cause SJS or TEN. From this perspective, Aortic Valve Neocuspidization (AVNeo) procedure may be a good treatment option for such kind of patients, with a unique advantage of anticoagulation free postoperative course. In this report we aimed to share a patient with warfarin-induced STS/TEN, who was successfully treated with AVNeo procedure and mitral valve replacement.

Evaluation of percutaneous annuloplasty for treatment of functional mitral regurgitation: A retrospective study.

OBJECTIVE: The management of severe functional mitral regurgitation (FMR) in patients with heart failure (HF) and low ejection fraction is controversial, but percutaneous transcatheter procedures are promising. In this retrospective analysis, we aimed to assess the efficacy of the Carillon Mitral Contour System in patients with "inoperable" severe FMR. METHODS: Seventy three patients (mean age 66.89, range 31-90 years) with congestive heart failure (CHF), severe FMR, and reduced ejection fraction (<35%) who underwent Carillon device implantation were examined. The study group consisted of patients with successfully implanted devices whereas the control group comprised patients in whom the device could not be deployed. The primary endpoint was combined all-cause mortality and first hospitalization for HF (whichever came first). RESULTS: The median (Q1, Q3) follow-up was 31 (11-49) months. The device was deployed successfully in 50 patients (implant group) and not in 23 patients (non-implant group). Both the primary endpoint and all-cause mortality were lower in the "implant" group, but the differences were not significant. The median to primary endpoint was 21 [95% confidence interval (CI) 8.8-33.2] and six (95% CI 0.1-11.9) months for the implant group and the non-implant group, respectively (p=0.078). CONCLUSION: Carillon Mitral Contour System implantation is a safe procedure and results in the reduction of all-cause mortality and combined endpoint of mortality and hospitalizations for HF in inoperable patients with severe FMR and low ejection fraction, although the difference did not meet the significance level.

Concurrent Transcatheter Aortic Valve Implantation and Percutaneous Transvenous Mitral Commissurotomy for Totally Percutaneous Treatment of Combined Severe Rheumatic Aortic and Mitral Stenosis.

Transcatheter aortic valve implantation (TAVI) is a new promising therapeutic option for patients with symptomatic severe calcific aortic valve stenosis (AS) who are inoperable or at high risk for conventional cardiac surgery. Percutaneous transvenous mitral commissurotomy (PTMC) is performed routinely in patients with severe mitral stenosis (MS) having a favorable anatomy. Although concurrent TAVI and PTMC is a theoretically possible approach in the treatment of patients with severe AS and MS who are unsuitable for conventional surgery, no cases have yet been reported in which this combined technique is used. For patients with severe AS and MS, the standard therapy is replacement of both the mitral and aortic valves. Herein are presented the details of a 52-year-old woman with urethral carcinoma, in whom simultaneous TAVI and PTMC was the chosen technique to treat combined severe rheumatic AS and MS in a single procedure.

Percutaneous Mitral Valve Repair with the MitraClip System in Mitral Regurgitation Due to Mitral Annular Calcification.

Percutaneous valve repair with the MitraClip represents a new and promising therapeutic option for patients with severe mitral regurgitation (MR). Mitral valve prolapse and flail leaflet are two major causes of degenerative MR in patients who underwent the MitraClip procedure. Mitral annular calcification (MAC) is also a less-frequent cause of degenerative MR. Among patients with MAC, open surgical treatment or valvular replacement is the treatment of choice for severe MR. Herein we present a case with severe MR secondary to MAC in whom successful percutaneous valve repair was accomplished with the MitraClip system due to the high risk of open-heart surgery.

An Extreme Case of CoreValve Bioprosthesis Embolization into the Abdominal Aorta and of the Delivery Catheter Cone into the Right Internal Iliac Artery.

Transcatheter aortic valve implantation (TAVI) is a new and hopefully therapeutic option in patients with symptomatic severe calcific aortic valve stenosis and multiple comorbidities who are not eligible for open-heart surgery due to unacceptable conventional surgical risks. Herein is reported the case of a patient who underwent TAVI in whom an unusual CoreValve bioprosthesis embolization occurred into the abdominal aorta. While attempting to retrieve the whole system, the conical tip of the catheter delivery system also became embolized into the right iliac artery. Importantly, this case demonstrated a rare complication of CoreValve bioprosthesis embolization which was managed without surgical intervention. Video 1: Peripheral angiography demonstrating the embolized CoreValve bioprosthesis. Video 2: Fluoroscopy demonstrating completely opened CoreValve bioprosthesis at a level above the iliac artery bifurcation and the mobile conical tip in the valve system. Video 3: Peripheral angiography demonstrating prosthetic valve without any flow limitation and embolized conical tip into the right internal iliac artery. Video 4: Peripheral angiography demonstrating prosthetic valve without any flow limitation and embolized conical tip into the right internal iliac artery. Video 5: Aortography demonstrating the successfully implanted second CoreValve bioprosthesis in an optimal aortic position, with no paravalvular leak. Video 6: Peripheral angiography demonstrating the embolized conical tip into the right iliac artery with a normal external iliac artery flow. Video 7: Peripheral angiography demonstrating the embolized conical tip into the right iliac artery with a normal external iliac artery flow.

First experience with the jailed pressure wire technique in the provisional side branch stenting of coronary bifurcation lesions.

AIMS: The provisional strategy (PS) is an accepted modality of treatment in coronary bifurcation interventions, though, after main vessel (MV) stenting, the assessment of the side branch (SB) becomes more difficult. In bifurcation interventions, the major advantage of fractional flow reserve (FFR) is the avoidance of the need for SB intervention. However, SB access with a pressure wire after MV stenting may be difficult, sometimes impossible. The objective of this paper was to evaluate the feasibility and safety of physiologic assessment of SB lesions using FFR with the jailed pressure wire (JPW) in patients undergoing the PS. Although the JPW technique is theoretically possible in the PS, there is no information available on the use of this technique. METHODS AND RESULTS: We retrospectively evaluated 11 patients who were treated with the JPW technique at a single centre. Procedures were successfully accomplished in all cases without complications, such as damage of the pressure sensor, failure to measure FFR value, removing the polymer coating, and entrapment or fracture of the JPW. CONCLUSIONS: In conclusion, our limited experience suggests that the JPW technique in the PS may be a safe and technically feasible approach. This technical report details the JPW technique in patients undergoing the PS.

Association between admission mean platelet volume and ST segment resolution after thrombolytic therapy for acute myocardial infarction.

OBJECTIVE: Mean platelet volume (MPV), one of the indices of platelet reactivity has been shown to be related to impaired angiographic reperfusion in ST-segment elevation myocardial infarction (STEMI) patients treated with primary angioplasty or thrombolytics. However data regarding MPV and its association with ST-segment resolution; an indicator of epicardial and tissue level reperfusion in the setting of STEMI are limited. In this study, we aimed to investigate whether MPV on admission is associated with ST-segment resolution in STEMI patients treated with thrombolytics. METHODS: We retrospectively evaluated 232 consecutive patients with a diagnosis of first STEMI who were administered thrombolytic therapy within 12 hours of onset of chest pain. ST segment resolution based on baseline and 90 minute electrocardiographies were measured. Patients were grouped into two as with <50% and ≥50% ST-segment resolution. Admission MPV was measured and compared between two groups. RESULTS: Admission MPV was higher in patients with <50% ST-segment resolution than patients with ≥50% ST-segment resolution (9.9±1.3 fL vs. 8.5±1.1 fL respectively, p<0.001). The receiver operating characteristic analysis yielded a cut-off value of 9.3 fL to predict ST-segment resolution, with sensivity and specifity being 66.7% and 77.9%, respectively. In-hospital mortality rate was high in patients with <50% ST -segment resolution (p=0.002). CONCLUSION: High MPV on admission in STEMI patients treated with thrombolytics is associated with impaired ST segment resolution.