Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology最新文献

Infection of cardiac implantable electronic devices is one of the most dangerous complications, and the main treatment approach is the removal of cardiac implantable electronic device from the body. We present a case of successful lead removal of implantable cardioverter-defibrillator infection at which right ventricular lead had giant vegetation material. We performed percutaneous debulking of giant right ventricular lead vegetation by percutaneous approach under the realtime intracardiac echocardiography visualization because of the high risk of pulmonary artery embolization of giant infectious material and poor lung and general condition of the patient.

Objective: Our aim in this study was to show the relationship between long-term all-cause mortality and thyroid functions in the elderly patient group that underwent primary percuta-neous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction.

Methods: Two-hundred seventy patients over 65 years of age who underwent primary percutaneous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction were analyzed retrospectively. After applying the exclusion criteria, 198 patients were included in the study. The patients were divided into 2 groups according to their out-of-hospital mortality status. Angiographic, laboratory, echocardiographic, and electrocardiographic data were analyzed.

Results: The mean age of 198 patients in the study was 72.5 ± 6.6 years, and the median follow-up time was 101.7 months. Age was higher in the deceased group (70.4 ± 5.4 vs. 74.5 ± 6.9, P < 0.001). In multivariate analysis, age (odds ratio: 1.59, P = 0.003), insulin (odds ratio: 2.561, P = 0.016), angina balloon time (odds ratio: 1.134, P = 0.002), number of serious stenoses (odds ratio: 1.702, P = 0.003), creatinine (odds ratio: 3.043, P < 0.001), and fT4 (odds ratio: 2.026, P = 0.026) were determined as independent predictors of mortality. The fT4 level was correlated with the uric acid level (R: 0.182, P = 0.02) and the fT3 level was correlated with albumin (R: -0.253, P = 0.001) and creatinine (R: -0.224, P = 0.003) levels. A fT4 level cutoff value of 0.99 ng/mL had a sensitivity of 76%, a specificity of 54%, and an area under the curve of 0.675 in predicting mortality. In Kaplan-Meier analysis, fT4 elevation was strongly associated with mortality (P = 0.01).

Conclusion: In our study, subclinical values in thyroid functions were found to be associated with increased mortality, apart from known factors in elderly patients who underwent primary PTCA with the diagnosis of ST-segment elevation myocardial infarction.

Objective: Atrial fibrillation is the most common arrhythmia following coronary artery bypass graft surgery. The relationship between impaired lung function and atrial fibrillation has been described previously. We aimed to evaluate the prognostic influence of small airway function on predicting postoperative atrial fibrillation undergoing isolated coronary artery bypass graft surgery (CABG).

Methods: We retrospectively analyzed 283 patients who underwent isolated CABG at our institution between January 2020 and August 2020. The patients were divided into 2 groups according to the development of postoperative atrial fibrillation. Demographic characteristics of the patients were recorded; spirometry was performed for each patient before surgery. Small airway function was determined by forced mid-expiratory flow (forced expiratory flow 25%-75%) values measured by spirometry. Propensity score matching was applied to ensure a balanced distribution of demographic data between the 2 groups.

Results: The frequency of postoperative atrial fibrillation was 30.7% in our patient population. After propensity matching, forced expiratory volume in 1 second/forced vital capacity % [80.6 (73.8-87.8) vs. 76.3 (66.7-81.6), P = 0.006] and forced expiratory flow 25%-75% (87.4 ± 14.2 vs. 75.2 ± 15.8, P = 0.001) were significantly lower in postoperative atrial fibrillation group. In multivariate analysis, white blood cell count, left ventricular ejection fraction, cross-clamp time, and forced expiratory flow 25%-75% were found to be independent predictors of postoperative atrial fibrillation development after isolated CABG. In the receiver operating characteristic curve analysis, forced expiratory flow 25%-75% with an optimal threshold value of 81% could detect the presence of postoperative atrial fibrillation with 63.8% sensitivity and 70.1% specificity.

Conclusion: Our study demonstrated that small airway obstruction, as indicated by forced expiratory flow 25%-75% in spirometry, can be a simple predictive tool for the development of postoperative atrial fibrillation in patients undergoing isolated CABG.

Secondary infection of the aorta is a sporadic and life-threatening disease. It is usually caused by infection and abscess in an adjacent structure. The most common mechanism for secondary aortic infection is a psoas abscess eroding the aortic wall, which rarely results in non-aneurysmal aortic rupture. Primary treatment is surgical aortic reconstruction, but the risk of emergency surgical treatment is high. Endovascular aortic stent-graft implantation can be lifesaving in this setting by stopping the bleeding. However, the crucial question of durability and late infections remains unanswered and warrants long-term antibiotic treatment and follow-up. In this report, we present a case of primary psoas abscess, which resulted in non-aneurysmal aortic rupture and its endovascular treatment.

Objective: Carcinoembryonic antigen is a serological marker used in the diagnosis of malignancies and is also associated with inflammatory events. It has also been reported that carcinoembryonic antigen is associated with cardiovascular diseases. However, not much is known about the relationship between arterial stiffness and carcinoembryonic antigen. In this study, we investigated the relationship between serum carcinoembryonic antigen levels and arterial stiffness.

Methods: The data of 371 (female = 192, male = 179) individuals who applied for cardiac check-up without obvious cardiovascular diseases were analyzed cross-sectionally. Echocardiography was used to assess the participants' aortic stiffness index.

Results: In our sample, aortic stiffness index and carcinoembryonic antigen were determined as median = 8.98, interquartile range 7.60 and median = 1.58 ng/mL, interquartile range 1.52, respectively. Aortic stiffness index and carcinoembryonic antigen levels were significantly higher in males than females. A significant correlation was observed between carcinoembryonic antigen and aortic stiffness index in the whole sample (r = 0.550, P < 0.001) and separately in females (r = 0.480, P < 0.001) and males (r = 0.602, P < 0.001). In multivariate stepwise regression analysis, female gender (r = -0.081, P < 0.001), age (r = 0.006, P < 0.001), BMI (r = 0.007, P = 0.002), and carcinoembryonic antigen (r = 0.375, P < 0.001) were determined as the strongest independent variables associated with aortic stiffness. When the model was adapted separately for females and males, age and carcinoembryonic antigen were determined as independent variables for aortic stiffness in both genders.

Conclusion: Carcinoembryonic antigen level is associated with aortic stiffness in healthy individuals. However, the clinical significance of this relationship is unknown.

Objective: The current study investigated the contribution of the dissertations produced in the field of cardiology to the scientific literature and the factors affecting the publication process.

Methods: The study included 1049 cardiology dissertations archived in the national thesis center database between January 2010 and December 2017. The titles (English and Turkish), abstracts, and author names of cardiology dissertations were searched in Google Academic, TR Directory, and PubMed Central databases. In addition to their publication rates, the subject of the cardiology dissertations, the type of research, the type of institution, the academic title of the cardiology dissertation advisors, the duration of publication, the index of the published journals, and the quartile ranking of the Science Citation Index and Science Citation Index Expanded journals were examined.

Results: Among the reviewed 1049 cardiology dissertations 42.7% (n = 448) were published in a journal. The publication rate of cardiology dissertations among male authors was 43.5% and among female authors 40.1%. The cardiology dissertations were published at the highest rate after the 60th month. Among the published cardiology dissertations, 63.4% (n = 284) appeared in journals indexed by the Science Citation Index and Science Citation Index Expanded. There was no statistically significant relationship between the academic titles of cardiology dissertation advisors and the quartile ranking of Science Citation Index and Science Citation Index Expanded journals (P = 0.072).

Conclusions: There were difficulties in transforming into a publication of dissertations in the field of cardiology to gain an academic identity. Incentives should be created to increase the desire and motivation of the residents.

Background: Liver is one of the target organs in patients with symptomatic severe aortic stenosis and reduced ejection fraction. We aimed to evaluate the prognostic impact of liver function reserve as assessed by albumin-bilirubin score on 30-day and 1-year mortality and rehospitalization at 1 year in patients with severe symptomatic aortic stenosis and reduced ejection fraction undergoing transcatheter aortic valve implantation.

Methods: The patients with severe symptomatic aortic stenosis and reduced ejection fraction who were hospitalized between 2013 and 2021 were included in this single-center retrospective study. Preoperative bilirubin and albumin levels were used for albumin-bilirubin score calculation as in the original report. The total primary outcomes were defined as 30-day and 1-year all-cause mortality and hospitalization for decompensated heart failure within 1 year. Two groups were generated based on albumin-bilirubin score scores: high (>-2.25) and low (≤-2.25) albumin-bilirubin score groups.

Results: A total of 77 patients (49 male) were included in the study. and 29 (37.7%) patients died within 1 year of follow-up with 17 corresponding to 30-day mortality. There was no difference between high and low albumin-bilirubin score groups in terms of length of hospital stay, postprocedural complications, and re-hospitalization within 1 year, while 30-day mortality (50.0% vs. 4.3%, P < 0.0001) and 1-year mortality (80.0% vs. 10.6%, P < 0.0001) were significantly higher in the high albumin-bilirubin score group. Hence, total primary outcomes (86.7% vs. 44.7%, P < 0.0001) were significantly higher in the high albumin-bilirubin score group.

Conclusion: High albumin-bilirubin score (> -2.25) was found as an independent risk factor associated with 30-day and 1-year mortality and total primary outcomes. The results of this study suggest that preprocedural assessment of the albumin-bilirubin score gives additional information to stratify of patients with severe symptomatic aortic stenosis with reduced ejection fraction.

Wolff-Parkinson-White syndrome is rarely associated with a right atrial aneurysm. However, when such a condition occurs, it will be hard to manage since pre-excitation will be induced as long as the aneurysm persists. A 14-year-old female patient received emergency treatment for irregular wide QRS complex tachycardia in our center, and a pre-excitation pattern was then observed on the surface electrocardiogram. An initial electrophysiological study revealed a high-risk right posterior accessory pathway that was resistant to both radiofrequency and irrigated radiofrequency ablations. Subsequently, fluoroscopy showed that this was due to a right atrial aneurysm. Although successful ablation with irrigated radiofrequency was performed in the second procedure, the procedure was considered suboptimal due to the association of aneurysm. Accordingly, we initiated anti-thrombotic and anti-arrhythmic drug therapy. We decided to omit surgery and followed the case under medical treatment for 2 years without complications. Here, we report this rare coexistence and our treatment approach in detail.