U. Canpolat

Fragmented QRS Complex Predicts the Arrhythmic Events in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Fragmented QRS (frQRS) complex, with various morphology, has been recently described as a diagnostic criterion of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). However, there are little data regarding the prognostic role of frQRS in these patients. Therefore, we aimed to investigate the association of frQRS with arrhythmic events in patients with ARVC/D.

A Prospective DE-MRI Study Evaluating the Role of TGF-β1 in Left Atrial Fibrosis and Implications for Outcomes of Cryoballoon-Based Catheter Ablation: New Insights into Primary Fibrotic Atriocardiomyopathy

Transforming growth factor (TGF)‐β1 mediated atrial fibrosis plays a major role in the development of vulnerable atrial substrate for atrial fibrillation (AF). Although cryoablation effectively eliminates the triggers for AF, the impact of atrial substrate on the success of cryoablation remains unclear.

Effect of Vitamin D Replacement on Atrial Electromechanical Delay in Subjects with Vitamin D Deficiency

Limited data are available regarding cardiac arrhythmias in vitamin D (VitD) deficiency. Therefore, we aimed to assess whether atrial electromechanical delay (AEMD) measured by tissue Doppler imaging (TDI), which is an indicator for atrial fibrillation (AF) development, is prolonged in patients with VitD deficiency as compared to the control group. The effect of vitD replacement on AEMD was also evaluated.

Evaluation of cardiac autonomic functions in patients with systemic lupus erythematosus

Background: Cardiovascular involvement is one of the leading causes of death among patients with systemic lupus erythematosus (SLE). In this study, we aimed to investigate cardiac autonomic functions in SLE patients. Methods: We enrolled 36 patients (25 female; mean age 34.2 ± 10.2 years) with SLE and 32 healthy subjects (23 female; mean age 35.0 ± 10.3 years). All participants underwent 24-h Holter recording. Heart rate recovery (HRR) indices were calculated by subtracting first, second, and third-minute heart rates from maximal heart rate. All patients underwent heart rate variability (HRV), heart rate turbulence (HRT) and QT dispersion analysis. The mean SLE duration was 8.4 ± 4.0 years. Results: According to the baseline demographic characteristics, both groups were similar with regard to age, gender, body mass index and left ventricular ejection fraction. Mean HRR1 (32.6 ± 10.9 vs. 42.5 ± 6.5, p = 0.038), HRR2 (51.0 ± 16.9 vs. 61.0 ± 10.8, p = 0.01) and HRR3 (52.8 ± 17.5 vs. 65.8 ± 9.8, p < 0.001) values were significantly higher in control group. When HRV was considered, SDNN, SDANN, RMSSD, PNN50 and high frequency (HF) component were significantly decreased in patients with SLE compared with healthy controls, but low frequency (LF) component and LF/HF were significantly higher in SLE patients. In addition, HRT onset and HRT slope values were significantly less negative in SLE patients. QT dispersion was significantly greater in SLE patients than healthy subjects (81.3 ± 15.8 vs. 53.2 ± 13.1, p < 0.001). Conclusion: Our study results suggest that cardiac autonomic functions are impaired in SLE patients despite the absence of overt cardiac involvement and symptoms. Further studies are needed to elucidate the prognostic significance and clinical implications of impaired autonomic functions in patients with SLE.

Percutaneous Closure of Coronary Artery Fistulae in Adults with Intermediate Term Follow‐Up Results

OBJECTIVE Percutaneous closure of coronary artery fistulae (CAF) has become an alternative method to surgery. But there are limited data about intermediate and long-term results. In this manuscript, we aimed to review our experience about the closure of CAF with several percutaneous methods in our center. METHODS Seven patients who admitted to our hospital, either symptomatic or having complications attributable to CAF, were analyzed. The immediate closure results and clinical follow-up were reviewed. RESULTS Five patients were male (71%) and mean age was 58.3 ± 13.3 years. Five of the CAF were draining into pulmonary artery and 2 of them were draining into the right atrium. Closure of CAF was performed with coil embolization in 5 patients, detachable balloon in 1 patient, and a combination of coil embolization and glue in the remaining 1 patient. In the early follow-up, 1 patient had atrial fibrillation and 1 patient had chest pain immediately after the closure procedure; other patients discharged from hospital uneventfully. Intermediate term follow-up results (32-83 months; median, 54 months) revealed that the procedure was clinically successful in all of the patients, despite the complaint of chest pain in 3 patients and minimal flow in 1 of these patients. CONCLUSION Percutaneous closure of CAF is feasible and safe in anatomically suitable vessels with good results at intermediate term follow-up.

Myocardial infarction due to coronary thrombosis in a patient with Henoch-Schönlein purpura.

Henoch–Schönlein purpura (HSP) is characterized by vasculitic involvement of small-sized vessels and results in multisystem manifestations. Cardiac involvement is extremely rare and myocardial infarction with coronary thrombus formation in those patients has also rarely been reported. Herein, we report a 33-year-old man with acute myocardial infarction due to coronary thrombus formation and HSP.ZusammenfassungDie Purpura Schönlein-Henoch (PSH) ist gekennzeichnet durch eine Vaskulitis kleinkalibriger Gefäße und manifestiert sich multisystemisch. Eine kardiale Beteiligung ist extrem selten, auch ein Myokardinfarkt mit Thrombusbildung bei PSH wurde nur selten dokumentiert. Wir berichten von einem Patienten mit durch einen Thrombus und PSH bedingten akuten Myokardinfarkt.

Use of Fenofibrate During the First Trimester of Unplanned Pregnancy in a Patient with Hypertriglyceridemia

OBJECTIVE To describe a successful pregnancy in a patient who used fenofibrate during the first trimester. CASE SUMMARY A 30-year-old female with a history of polycystic ovarian syndrome was referred to our department for evaluation of hypertriglyceridemia, and fenofibrate treatment was initiated. After 1 year of therapy, a gynecologic visit for menstrual cycle abnormalities revealed an unplanned pregnancy at 8 weeks of gestation (dating from the first day of the last menstrual period). Fenofibrate was discontinued and the pregnancy was continued despite the potential risks involved with the use of fibrates during early pregnancy. Fetal ultrasound performed routinely during each trimester showed normal fetal growth with no malformation. The patient delivered a healthy male infant at 36 weeks of gestation. No congenital malformation was recorded. The baby was healthy on pediatrician examination at 1 year. DISCUSSION Fibrates have good efficacy in lowering fasting triglyceride (TG) levels as well as postprandial TG and TG-rich lipoprotein remnant particles. Previous reports showed that fibrates have been administered cautiously in pregnant women after embryogenesis if their use is necessary; however, in our case, the embryo had been exposed to fenofibrate from the beginning of fertilization. Nevertheless, fenofibrate did not cause significant damage, such as external, skeletal, and visceral abnormalities, to the developing embryo. CONCLUSIONS In this case, no harmful effects on fetal development were observed after exposure to fenofibrate during organogenesis.

Acute coronary syndrome due to dilated coronaropathy in a young patient with gouty arthritis.

This article was not funded by any institution. Authors do not have any conflict of interest.

Is heart failure a debatable end‐point for biphosphonate treatment in older osteoporotic population?

In the recent issue of the Journal of Internal Medicine, wewere interested to read an intriguing article by Grove et al. [1] on the occurrence of heart failure with bisphosphonate or raloxifene treatment in a nationwide retrospective cohort study. All users of bisphosphonates and raloxifene (n = 102 342; mean age 70.5 11.4 years) were included in the ‘exposed’ group and for each user three ageand gender-matched subjects (n = 307 026; mean age 70.5 11.4 years) from the general population comprised the control group. The authors reported that theabsolute riskof heart failurewas4.4% in the exposed group and 3.7% in the control group (P < 0.01). Although the adjusted hazard ratio (HR) of heart failure was significantly increased in users of bisphophonates (HR 1.41, 95% confidence interval 1.34–1.48), raloxifene was not associated with an increased risk of heart failure. Furthermore, users of alendronate, a nitrogen-containing bisphosphonate, showed a dose-dependent reduction in heart failure risk, in contrast to users of other bisphosphonates.

Effect of age and plaque morphology on diagnostic accuracy of dual source multidetector computed tomography coronary angiography.

Background Multidetector computed tomography (MDCT) coronary angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease. The purpose of this study is to investigate the effect of age and coronary plaque calcification on diagnostic accuracy of MDCT. Methods The patients were examined by using dual-source MDCT and conventional coronary angiography. MDCT results were analyzed with regard to the severity (> 50% stenosis) and morphology (non-calcified, mixed, or calcified) of coronary atherosclerotic plaques evaluated in a 16-segment model. Results In total, 181 patients (94 men and 87 women) with 2,687 coronary artery segments were examined with MDCT. Ninety three patients were older than 65 years of age (group A, 42 men) and 88 were younger (group B, 52 men). Two-hundred nine coronary artery segments (7.2%) were excluded because of small distal coronary vessel segments and/or motion artifacts. The overall number of segments with non-diagnostic image quality was similar in both groups of patients. Of the 2,687 evaluated segments, 157 (5.8%) were significantly diseased, and 144 of them were correctly detected by MDCT. Diagnostic evaluation showed that the sensitivity, positive predictive value, specificity, and negative predictive value were 89.5%, 62.5%, 96.0%, and 99.2%, respectively in group A, and 95.2%, 64.8%, 97.5%, and 99.8% in group B, respectively. In addition, detailed segment-based analyses in coronary segments with non-calcified, mixed and calcified plaques in both groups were similar diagnostic accuracy. Conclusions Very high diagnostic accuracy observed in this study suggests that MDCT coronary angiography could be a suitable diagnostic tool for not only younger patients but also for older patients.