Multiple Arterial Thrombosis after COVID-19: A Case Report.

Since the beginning of severe acute respiratory syndrome Coronavirus 2 pandemic, many reports have pointed to states of incrieased hypercoagulability during the acute phase of the disease. We report a 63-year-old female who developed acute mesenteric ischemia due to celiac trunk and superior mesenteric artery thrombi together with acute lower extremity ischemia caused by saddle embolism of the iliac bifurcation and thrombosis of the left external iliac artery. These thrombi developed 20 days after discharge from an intensive care unit due to severe pneumonia and pulmonary embolism associated with COVID-19. The patient had consecutive interventions. Surgical thrombectomy for aortoiliac thrombosis was performed and the mesenteric thrombosis was treated by percutaneous endovascular intervention. We emphasize that the prothrombotic state after COVID-19 infection may persist long after the acute symptomatic phase.

COVID-19-related cardiomyopathy: Can dual-energy computed tomography be a diagnostic tool?

BACKGROUND: No study on dual energy computed tomography (DECT) has been found in the literature to evaluate possibly fatal cardiac/myocardial problems in corona virus disease 2019 (COVID-19) patients. Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion, and these deficits can be shown via DECT with a perfect interrater agreement. AIM: To assess lung perfusion alterations in COVID-19 patients. To our knowledge, no study using DECT has been performed to evaluate possibly fatal cardiac/ myocardial problems in COVID-19 patients. The purpose of this study is to evaluate the role of DECT in the detection of COVID-19-related cardiac diseases. METHODS: Two blinded independent examiners evaluated CT images using the 17-segment model according to the American Heart Association's classification of the segmentation of the left ventricular myocardium. Additionally, intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. Following segment-by-segment analysis, perfusion deficiencies identified on the iodine map pictures on DECT were identified. RESULTS: The study enrolled a total of 87 patients. Forty-two of these individuals were classified as COVID-19 positive, and 45 were classified as controls. Perfusion deficits were identified in 66.6% (n = 30) of the cases. All control patients had a normal iodine distribution map. Perfusion deficits were found on DECT iodine map images with subepicardial (n = 12, 40%), intramyocardial (n = 8, 26.6%), or transmural (n = 10, 33.3%) anatomical locations within the left ventricular wall. There was no subendocardial involvement in any of the patients. CONCLUSION: Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion. These deficits can be shown via DECT with a perfect interrater agreement. Additionally, the presence of perfusion deficit is positively correlated with D-dimer levels.

Association between hyperlipidemia and prostatic enlargement: A case-control study.

OBJECTIVE: A high-fat diet is associated with the development of benign prostatic enlargement (BPE), but whether hyperlipidemia is associated with BPE remains unclear. This study aimed to evaluate whether hyperlipidemia is a risk factor for the development of BPE. MATERIAL AND METHODS: This study included 265 BPE patients with lower urinary tract symptoms (LUTS) and 248 age-matched healthy individuals without LUTS. The patient and control groups included in the study were compared in terms of fasting serum glucose, serum lipid values, prostate specific antigen (PSA), and prostate size measured by abdominal ultrasonography. RESULTS: The prostate sizes of the patient and healthy control group were 59.4 ± 12.6 and 41.8 ± 11.1 ml, respectively (p = 0.007). It was observed that the mean PSA value of the patient group (2.33 ± 1.69) was statistically higher than that of the control group (1.21 ± 1.05) (p = 0.002). Total cholesterol and LDL-cholesterol were significantly higher and HDL-cholesterol was significantly lower among the patients compared to the controls. Prostate size had a negative correlation with HDL-cholesterol and a positive correlation with LDL-cholesterol and total cholesterol. Additionally, LDL-cholesterol and total cholesterol were independent risk factors for prostate enlargement. CONCLUSION: This study indicates that increased levels of LDL-cholesterol and total cholesterol are significantly associated with the enlargement of the prostate. Hyperlipidemia may be one of the risk factors in the processes of prostatic growth and progression.

Aortic propagation velocity in the prediction of coronary artery disease severity.

AIMS: To investigate the association of the aortic propagation velocity (APV) with coronary artery disease (CAD) in patients with stable angina pectoris (SAP) through SYNTAX scores (SS). METHODS: The study population comprised 214 SAP subjects who received a coronary angiography. The APV and carotid intima-media thickness (CIMT) were examined and SS was calculated. Subjects were grouped following specific SS criteria: SS less than 22 (low) and SS greater than or equal to 22 (high). RESULTS: High SS subjects had lower APV compared to low SS [39.0 (32.0-51.7) vs. 55.0 (45.0-62.0) cm/s, respectively; P<0.001] and higher CIMT (0.86 ± 0.24 vs. 0.74 ± 0.21 mm, respectively; P<0.001). APV demonstrated a negative correlation with the CIMT (r=-0.239, P<0.001), age (r=-0.188, P=0.006) , and SS (r=-0.561, P<0.001) and showed a positive association with LV ejection fraction (r=0.163, P=0.017). APV, CIMT, diabetes, low-density lipoprotein cholesterol (LDL-C), and age were determined to be markers independently of a high SS. CONCLUSION: APV, CIMT, diabetes, LDL-C and age are independently linked to the CAD severity of SAP subjects. Decreased APV, an indicator of subclinical atherosclerosis, may independently help determine the severity of atherosclerotic CAD in SAP patients.

Sensitive Marker Affected by All Systemic Abnormalities-troponine.

Whether due to myocardial infarction or not, we find troponin levels to be high when myocardial damage occurs. Elevated troponin may not always be a myocardial infarction caused by plaque rupture on the basis of classically known coronary thrombosis. In this sense, infarction types have been defined. In this review, we aimed to bring together the conditions that may directly or indirectly affect the myocardium, except for acute coronary syndromes.

Relationship between heart rate recovery index and erectile dysfunction.

OBJECTIVE: Heart rate recovery (HRR) is a cardiac parameter that can be used to evaluate autonomic nervous system (ANS) function problems. We examined the possible relationship between erectile dysfunction (ED) and HRR which is a clinical condition associated with ANS dysfunction. METHODS: Seventy-six male patients that were examined with an exercise stress test and completed the International Index of Erectile Function Questionnaire Form (IIEF-5) were included in the study. The patients were divided into two groups as those with a normal HRR index (≥12, n=42) and those with an abnormal HRR index (<12, n=34). Then, statistical analyses were conducted to evaluate the correlations between ED and HRR. RESULTS: There were no differences between the groups in terms of risk factors, such as laboratory findings, age, BMI, hypertension, and smoking. However, in the group with an abnormal HRR index, the IIEF-5 score was significantly lower than the other group (11.2±4.2 vs. 20.3±4.6, p<0.001). A statistically significant positive correlation was observed between the IIEF-5 score and HRR index (r=0.702, p<0.001). In addition, the presence of diabetes mellitus and HRR index was independent risk factors for lowering the IIEF-5 score. CONCLUSION: The HRR index can be considered as an independent predictor of ED since a reduced value, which is associated with cardiovascular mortality and also causes ANS dysfunction.

B-type natriuretic peptide/ferritin ratio as a predictor of the risk of developing acute renal injury in acute decompensated heart failure.

OBJECTIVES: Acute decompensated heart failure (ADHF) is a clinical condition that requires urgent diagnosis and treatment. Patients present with pulmonary capillary wedge pressure, pulmonary arterial pressure, and venous pressure elevation. Along with the progressive deterioration observed in the clinical picture, impairment or deterioration of kidney function may also occur. In this study, we evaluated the B-type natriuretic peptide (BNP)/ferritin ratio as a predictor of the risk of developing acute renal injury (ARI) in ADHF. METHODS: A total of 157 patients with a diagnosis of ischemic dilated cardiomyopathy for more than 6 months that presented to our clinic with ADHF were included in this cohort study. After the treatment protocol was applied, the sample was divided into two groups as patients with and without ARI. The BNP and ferritin levels were examined along with the routine blood parameters (BNP), and the BNP, ferritin, and BNP/ferritin values were compared between the groups. RESULTS: ARI was present in 34.3% (n = 54) of the patients, who were also found to have higher BNP (892.76 vs. 817.54), lower ferritin (86.78 ± 57.2 vs. 105.46 ± 38.3), and higher BNP/ferritin (10.48 ± 2.14 vs. 7.89 ± 1.89). The multivariate logistic regression analysis revealed the BNP/ferritin ratio as an independent risk factor for ARI (odds ratio = 3.19; 95% CI, 1.92-6.54; P = 0.001). Using the receiver operating characteristic curve, a cutoff value of 9.32 for BNP/ferritin ratio had a sensitivity of 81.8% and a specificity of 93.5% (area under the curve 0.842, P < 0.001) for the prediction of ARI. CONCLUSION: The BNP/ferritin ratio is a new parameter that can be used to draw attention to the severity of the treatment and renal function in ADHF cases in emergency situations.

Is heart rate variability a risk factor for premature ejaculation?

OBJECTIVE: The purpose of this study is to assess the parameters of heart rate variability, which is an indicator of the change in autonomic nervous system (ANS) activity, in individuals with premature ejaculation (PE). MATERIAL AND METHODS: This study was performed by comparing 40 patients with PE (mean age, 31.2 ± 4.1 years) and 40 healthy individuals (mean age, 30.4 ± 4.8 years) without PE from May 2018 to December 2019. HRV parameters were compared between men with PE and healthy controls in 24-hour heart rhythm Holter examination. RESULTS: In the time domain analysis, which is a subgroup of HRV, square root of differences between consecutive normal NN intervals (RMSSD), which is an indicator of parasympathetic activity, was lower in patients with PE compared with controls (P = .025). Moreover, within the frequency domain analysis, high frequency (HF), another indicator of parasympathetic activity, was lower in patients compared with controls (P = .032). Finally, the LF/HF ratio, reflecting sympathetic/parasympathetic activity ratio, was significantly higher in patients compared with controls (P = .008). Furthermore, the multivariate logistic regression analysis showed that LF/HF ratio is independently associated with PE (P = .005). The ROC curve analysis showed that the optimal cut-off value of LF/HF above 2.7 predicted PE at a sensitivity of 77.5% and specificity of 82.5% (positive predictive value: 81.5% and negative predictive value: 78.5%). CONCLUSION: Different HRV parameters were exhibited in the comparison of patients with PE and normal controls. It suggests that the change in HRV parameters will be an indicator of imbalance in ANS and this imbalance may cause PE. Therefore, HRV analysis can be a diagnostic tool to assess altered ANS activity in patients with PE and may be considered as a rapid screening tool.

Relationship between Whole Blood Viscosity and Lesion Severity in Coronary Artery Disease.

Objective This article investigates the relationship of fractional flow reserve (FFR) with whole blood viscosity (WBV) in patients who were diagnosed with chronic coronary syndrome and significant stenosis in the major coronary arteries and underwent the measurement of FFR. Material and Method In the FFR measurements performed to evaluate the severity of coronary artery stenosis, 160 patients were included in the study and divided into two groups as follows: 80 with significant stenosis and 80 with nonsignificant stenosis. WBVs at low shear rate (LSR) and high shear rate (HSR) were compared between the patients in the significant and nonsignificant coronary artery stenosis groups. Results In the group with FFR < 0.80 and significant coronary artery stenosis, WBV was significantly higher compared with the group with nonsignificant coronary artery stenosis in terms of both HSR (19.33 ± 0.84) and LSR (81.19 ± 14.20) ( p < 0.001). In the multivariate logistic regression analysis, HSR and LSR were independent predictors of significant coronary artery stenosis (HSR: odds ratio: 1.67, 95% confidence interval: 1.17-2.64; LSR: odds ratio: 2.46, 95% confidence interval: 2.19-2.78). In the receiver operating characteristic (ROC) curve analysis, when the cutoff value of WBV at LSR was taken as 79.23, it had 58.42% sensitivity and 62.13% specificity for the prediction of significant coronary artery stenosis (area under the ROC curve: 0.628, p < 0.001). Conclusion WBV, an inexpensive biomarker that can be easily calculated prior to coronary angiography, was higher in patients with functionally severe coronary artery stenosis, and thus could be a useful marker in predicting the hemodynamic severity of coronary artery stenosis in patients with chronic coronary syndrome.

Relationship between the Severity of Coronary Artery Disease and Overactive Bladder.

BACKGROUND: Overactive bladder is a urological disease that can seriously impair a person's quality of life, however its etiology remains unclear. The aim of this study was to evaluate the relationship between overactive bladder and SYNTAX score, which is based on coronary angiographic imaging to evaluate the severity of coronary artery disease. METHODS: A total of 380 patients diagnosed with coronary artery disease by coronary angiography were included in the study. Each participant completed the Overactive Bladder-Validated 8 questionnaire. The patients were divided into two groups as overactive bladder (n = 177; score ≥ 8), and non-overactive bladder (n = 203; score < 8). SYNTAX scores were calculated for both groups and compared. RESULTS: The SYNTAX score was significantly higher in the patients with overactive bladder (25.4 ± 4.2) than in those without an overactive bladder (18.3 ± 3.4) (p < 0.001). In addition, age, smoking rate, body mass index and diabetes mellitus were significantly higher and heart rate was significantly lower in the overactive bladder group (p < 0.001). In logistic regression analysis, the SYNTAX score was the sole independent predictor of overactive bladder (odds ratio: 1.47, 95% confidence interval: 1.35-9.19, p < 0.001). CONCLUSIONS: Our study suggests that the presence of a high SYNTAX score in patients with coronary artery disease may be associated with overactive bladder.

The relationship of the serum endocan level with the CHA2DS2-VASc score in patients with paroxysmal atrial fibrillation.

BACKGROUND: In this study considering the relationship between serum endocan and CHA2DS2-VASc score, we assumed that endocan level could be a new biomarker for stroke risk in patients with paroxysmal atrial fibrillation (PAF). It was examined that endocan could be an alternative to determine the risk of stroke and anticoagulation strategy in patients with PAF. The CHA2DS2-VASc scores were calculated for 192 patients with PAF, and their serum endocan levels were measured. The patients were divided into two groups as those with low to moderate (0-1) and those with high (≥ 2) CHA2DS2-VASc scores, and the endocan levels were compared between these two groups. RESULTS: The serum endocan level was significantly higher in the high CHA2DS2-VASc score group (p < 0.001). In the multivariate logistic regression analysis, endocan, C-reactive protein, and low-density lipoprotein were found to be independent determinants of the CHA2DS2-VASc score. The predictive value of endocan was analyzed using the ROC curve analysis, which revealed that endocan predicted a high stroke risk (CHA2DS2-VASc ≥ 2) at 82.5% sensitivity and 71.2% specificity at the cutoff value of 1.342. CONCLUSION: This study indicates that endocan is significantly associated with CHA2DS2-VASc score. We demonstrated that endocan could be a new biomarker for the prediction of a high stroke risk among patients diagnosed with PAF.

The Monocyte/High Density Lipoprotein Cholesterol Ratio (MHR) as an Indicator of the Need for Amputation in Patients With Peripheral Artery Disease Developing Critical Limb Ischemia.

The monocyte/high density lipoprotein cholesterol ratio (MHR) reflects the proatherogenic and antiatherogenic balance, and a high ratio is associated with the severity of atherosclerosis. We measured the MHR of patients with critical limb ischemia (CLI) due to peripheral artery disease (PAD) requiring amputation. Patients diagnosed with PAD were divided into 2 groups; those who underwent an amputation due to CLI without any sign of infection and those treated with surgical or percutaneous revascularization or followed up medically. A healthy control group was also included. In patients diagnosed with PAD (n = 563), the MHR value was higher for the control group (n = 200), (12.4 ± 0.42 vs 11.5 ± 0.28, P < .001). In the amputation group, the MHR was significantly higher for the group treated by other methods (15.7 ± 1.52 vs 12.8 ± 1.45, P < .001). Possible confounding factors affecting the MHR value were determined by the univariate regression analysis, and the multiple regression analysis revealed that MHR was an independent predictor of amputation in patients with PAD (P < .001). This study suggests that the MHR may be the predictor of amputation risk in patients with PAD and CLI.

A rare cause of erectile dysfunction: left ventricular diastolic dysfunction.

BACKGROUND: The aim of this study was to investigate the association between left ventricular diastolic dysfunction (LVDD) and erectile dysfunction (ED) without overt cardiovascular disease. METHODS: A total of 80 patients with LVDD and without a history of coronary artery disease were compared with 80 age- and gender-matched healthy controls. The International Index of Erectile Function Questionnaire (IIEF-5) was used to diagnose and grade ED. LVDD and its relation with ED severity were assessed. RESULTS: The mean age, Body Mass Index, total testosterone, low- and high-density lipoprotein cholesterol, and triglyceride levels did not significantly differ between the LVDD and control groups (P>0.05). There was a negative correlation between the stage of LVDD and IIEF-5 score (r=-0.635, P<0.05). Additionally, the left atrial volume index, peak TR velocity and E/e' ratio were independent risk factors for lowering the IIEF-5 score. CONCLUSIONS: This study indicates that LVDD is significantly associated with ED. There were significant associations between the increased severity of ED and the presence of LVDD in middle-aged men.

Evaluation of ventricular repolarization parameters during migraine attacks.

AIMS: Migraine is a chronic neurovascular disorder characterized by intermittent episodes of severe headache. Abnormalities in the autonomic nervous system (sympathetic and parasympathetic nervous systems) have been detected during migraine-free periods in patients with migraine. In these patients, disrupted autonomic innervations of the heart and coronary arteries may lead to electrocardiographic changes during a migraine attack. T-wave peak-to-end interval (Tp-e interval) and Tp-e/QT ratio are relatively new markers of ventricular arrhythmogenesis and repolarization heterogeneity. In the present observational study, we investigated the changes in ventricular repolarization during migraine attacks and attack-free periods by performing 12­lead electrocardiography (ECG). METHODS: This study included 63 patients (54 [86%] women; mean age: 33.3 ±â€¯9.9 years) with migraine. The QT and corrected QT (QTc) intervals, Tp-e interval, and Tp-e/QT ratio of the patients during migraine attacks and attack-free periods were measured by performing 12­lead ECG. RESULTS: The QT and QTc intervals, Tp-e interval, and Tp-e/QT ratio were higher during migraine attacks than during attack-free periods (P < 0.001 for all). CONCLUSION: These results indicate that migraine attacks are associated with an increase in ventricular repolarization parameters compared with attack-free periods possibly because of the dysregulation of the autonomic nervous system.

Serum YKL-40/chitinase 3-like protein 1 level is an independent predictor of atherosclerosis development in patients with obstructive sleep apnea syndrome.

OBJECTIVE: The inflammatory process plays an important role in the development of cardiovascular complications in patients with obstructive sleep apnea syndrome (OSAS). YKL-40/chitinase 3-like protein 1 is a novel biomarker of systemic inflammation. This study aimed to investigate whether carotid intima-media thickness (CIMT), a useful marker for early atherosclerosis, is associated with serum YKL-40/chitinase 3-like protein 1 levels in patients with normotensive and nondiabetic OSAS. METHODS: The study included 40 OSAS patients and 40 age- sex- and body mass index-matched healthy controls. Serum YKL-40 levels were detected by enzyme-linked immunosorbent assay. CIMT was measured by B-mode ultrasound. RESULTS: The patients with OSAS had significantly increased CIMT and higher YKL-40 and high sensitivity C-reactive protein (hsCRP) levels than those of the controls. CIMT was strongly correlated with serum YKL-40 levels (r=0.694, p<0.001), hsCRP (r=0.622, p<0.001), age (r=0.525, p=0.001), and weakly correlated with apnea-hypopnea index (AHI) (r=0.365, p=0.021) and the percentage of recording time spent (PRTS) of oxygen saturation<90% (r=0.488, p=0.001). Moreover, it was detected that serum YKL-40 levels were strongly correlated with AHI (r=0.617, p<0.001), and weakly correlated with SaO2<90% of PRTS (r=0.394, p=0.012) and hsCRP (r=0.486, p=0.001). In multiple regression analyses, age and serum levels of YKL-40 and hsCRP were found to be independent predictors of CIMT. CONCLUSION: In patients with OSAS, CIMT was increased. This increase was associated with serum YKL-40 level. Increased serum level of YKL-40 may be an early predictor of atherosclerosis development in patients with OSAS.

New inflammatory markers for prediction of non-dipper blood pressure pattern in patients with essential hypertension: Serum YKL-40/Chitinase 3-like protein 1 levels and echocardiographic epicardial adipose tissue thickness.

The aim of the present study was to investigate whether YKL-40 levels and epicardial adipose tissue (EAT) thickness were associated with non-dipping pattern in essential hypertension (HT). Age- and sex-matched 40 dipper hypertensive patients and 40 non-dipper hypertensive patients were included in the study. Non-dippers had significantly increased EAT thickness and higher YKL-40 and high-sensitivity C-reactive protein levels than dippers. Multivariate logistic regression analysis showed that the EAT thickness and serum levels of YKL-40 and high-sensitivity C-reactive protein were independent predictors of non-dipping pattern in essential HT. In essential HT, presence of non-dipping pattern is associated with increased inflammatory response.

Relationship of the total atrial conduction time to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus.

OBJECTIVES: The aim of our study was to evaluate the total atrial conduction time and its relationship to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus. METHODS: A total of 132 patients with type 2 diabetes mellitus (mean age 54.5 ± 9.6 years; 57.6% male) and 80 age- and gender-matched controls were evaluated. The total atrial conduction time was measured by tissue-Doppler imaging and the carotid intima-media thickness was measured by B-mode ultrasonography. RESULTS: The total atrial conduction time was significantly longer in the patients with type 2 diabetes mellitus than in the control group (131.7 ± 23.6 vs. 113.1 ± 21.3, p<0.001). The patients with type 2 diabetes mellitus had significantly increased carotid intima-media thicknesses, neutrophil to lymphocyte ratios and high-sensitivity C-reactive protein levels than those of the controls. The total atrial conduction time was positively correlated with the high-sensitivity C-reactive protein level, neutrophil to lymphocyte ratio, carotid intima-media thickness and left atrial volume index and negatively correlated with the early diastolic velocity (Em), Em/late diastolic velocity (Am) ratio and global peak left atrial longitudinal strain. A multiple logistic regression analysis demonstrated that the neutrophil to lymphocyte ratio, carotid intima-media thickness and global peak left atrial longitudinal strain were independent predictors of the total atrial conduction time. CONCLUSIONS: We suggest that subclinical atherosclerosis and inflammation may represent a mechanism related to prolonged total atrial conduction time and that prolonged total atrial conduction time and impaired left atrial myocardial deformation may be represent early subclinical cardiac involvement in patients with type 2 diabetes mellitus.

Relationship of the total atrial conduction time to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus

OBJECTIVES: The aim of our study was to evaluate the total atrial conduction time and its relationship to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus. METHODS: A total of 132 patients with type 2 diabetes mellitus (mean age 54.5±9.6 years; 57.6% male) and 80 age- and gender-matched controls were evaluated. The total atrial conduction time was measured by tissue-Doppler imaging and the carotid intima-media thickness was measured by B-mode ultrasonography. RESULTS: The total atrial conduction time was significantly longer in the patients with type 2 diabetes mellitus than in the control group (131.7±23.6 vs. 113.1±21.3, p<0.001). The patients with type 2 diabetes mellitus had significantly increased carotid intima-media thicknesses, neutrophil to lymphocyte ratios and high-sensitivity C-reactive protein levels than those of the controls. The total atrial conduction time was positively correlated with the high-sensitivity C-reactive protein level, neutrophil to lymphocyte ratio, carotid intima-media thickness and left atrial volume index and negatively correlated with the early diastolic velocity (Em), Em/late diastolic velocity (Am) ratio and global peak left atrial longitudinal strain. A multiple logistic regression analysis demonstrated that the neutrophil to lymphocyte ratio, carotid intima-media thickness and global peak left atrial longitudinal strain were independent predictors of the total atrial conduction time. CONCLUSIONS: We suggest that subclinical atherosclerosis and inflammation may represent a mechanism related to prolonged total atrial conduction time and that prolonged total atrial conduction time and impaired left atrial myocardial deformation may be represent early subclinical cardiac involvement in patients with type 2 diabetes mellitus. .