Myocardial injury in COVID-19 patients is associated with the thickness of epicardial adipose tissue

Aim High sensitive troponin (hs-TnI) levels may increase secondary to Coronavirus disease-2019 (COVID-19), and this increase is associated with cardiovascular mortality in COVID-19 patients. Epicardial adipose tissue (EAT) is associated with myocardial injury directly as a reservoir tissue for coronavirus, and indirectly through mediators it secretes as an apocrine gland. We aimed to evaluate the relationship between myocardial injury secondary to COVID-19 infection and EAT thickness. Material and methods Thoracic computed tomography (CT) was performed in 73 consecutive patients diagnosed with COVID-19. EAT thickness and volume were calculated by two radiologists blind to the study data. We formed two groups according to hs-TnI concentrations, patients with myocardial damage (hs-TnI >= 11.6 ng/l) and without myocardial damage (hs-TnI<11.6 ng/dl). Results A total of 46 patients were women (63.0%). The mean age was 66.4 +/- 12.3 yrs in the myocardial injury group and 55.9 +/- 9.7 yrs in the group without myocardial injury (p<0.001). There were 20 hypertensive patients (68.9%) in the injury group, while there were 12 hypertensive patients (27.3%) in the group without injury (p=0.001). Glucose, C-reactive protein, D-dimer, white blood cell count, neutrophil, and neutrophil/lymphocyte ratio were higher in the injury group (p<0.05, for all variables). The mean EAT thickness was 5.6 +/- 1.6 mm in the injury group, whereas it was 4.8 +/- 1.8 mm in the group without injury (p=0.031). EAT thickness of 4.85 mm and above was associated with the myocardial injury with 65% sensitivity and 39% specificity (AUC=0.65, 95% CI: 0.52-078, p=0.031). Conclusion In patients with COVID-19 infection, higher rates of myocardial injury were observed as the EAT thickness increased. Epicardial adipose tissue, contributes to cytokine-mediated myocardial injury either directly or indirectly by acting as a reservoir for coronavirus. Increased EAT thickness is associated with myocardial injury in COVID-19 patients

The effect of ısolated coronary artery ectasia on mortality in long-term follow-up in patients with stable angina pectoris

Amaç: Koroner arter ektazisi koroner anjiyografi ile tespit edilen bir koroner anomalidir. Koroner arter ektazisinin klinik ve progrostik öne‐ mi hala daha aydınlatılabilmiş değildir. Çalışmamızda izole koroner arter ektazisinin uzun süreli takip sonucunda normal koroner ar ter li hasta grubuna göre ölüm gelişimi ile ilişkili olup olmadığını değerlendirerek bu alandaki çelişkili sonuçlara cevap vermeyi amaç la dık. Gereç ve Yöntem: Çalışmaya göğüs ağrısı ve/veya eşdeğeri semptomlarla hastaneye başvuran, koşu bandı egzersiz testi ile iskemi lehi‐ ne bulgu izlenen, stabil anjina pektoris tanılı hastalar alındı. Koroner anjiyografi işlemi sonucunda koroner darlık oluşturan lezyonu ol‐ mayan, izole koroner arter ektazisi ve normal koroner arterli 262 hasta ile çalışmaya devam edildi ve hastalar ortalama 8.2 yıl boyunca takip edildi. Takip sürecinde ölüm gelişen hastalar belirlenerek analiz edildi. Bulgular: Çalışma takip süresince 35 hastada ölüm gerçekleşti. Takip süresi içerisinde koroner arter ektazili ve normal koroner arterli hasta grupları arasında ölüm oranları açısından istatistiki olarak anlamlı farklılık izlenmedi (p=0,179). İzole koroner arter ektazisinin ile‐ ri yaş (p<0,001), erkek cinsiyet (p<0,001), diabetus mellitus (p=0,011), serum kreatinin düzeyi yüksekliği (p=0,036) ve dislipidemi (p=0,006) ile normal koroner arterli gruba göre daha yakından ilişkili olduğu izlendi. Sonuç: İzole koroner arter ektazisinin, uzun süreli takip sonucunda normal koroner arterlere göre ölüm oranlarında artışa neden olma‐ dığı gösterilmiştirObjective: Coronary artery ectasia is a common coronary anomaly detected by coronary angiography. The clinical and prognostic significance of coronary artery ectasia is still unclear. We compared isolated coronary artery ectasia patients to the patients with normal coronary arteries in terms of mortality during long‐term following. Material and Method: Stable angina pectoris patients who were admitted to the hospital with chest pain or equivalent symptoms and diag‐ nosed as ischemia with treadmill exercise test were included in the study. As a result of coronary angiography, 262 patients with isolated co‐ ronary artery ectasia or normal coronary artery without coronary stenosis were included, and patients were followed for an average of 8.2 years. We identified and analyzed patients in terms of mortality during the follow‐up period. Results: A total of 35 patients died during follow‐up. There was no statistical difference between the normal coronary artery group and the iso‐ lated coronary artery ectasia group in terms of mortality (p=0.179). Age (p<0.001), male gender (p<0.001), serum creatinine level (p=0.036), diabetes mellitus (p=0.011), and dyslipidemia (p=0.006) were more closely related to coronary artery ectasia than normal coronaries. Conclusion: Isolated coronary artery ectasia cause no increase in mortality rates compared to normal coronary arteries after long‐term following

COVID-19 hastalarında mitral anüler kalsifikasyonun mortalite ve miyokard hasarı ile ilişkisi

Coronavirus disease-2019 (COVID-19) can particularly affect the respiratory and cardiovascular systems and cause serious mortality. Mitral annular calcification (MAC) is a mitral valve pathology associated with cardiac mortality. We aimed to evaluate the effect of MAC on myocardial injury (MI) and mortality, which can develop secondary to COVID-19 infection. Materials and Methods After applying the exclusion criteria, thorax computed tomography (CT) images of the remaining 1151 consecutive COVID-19 patients were evaluated. Calculation of MAC scores was done by two expert radiologists blinded to the study data. MI was defined as those with hs-TnI level (≥34 ng/dl). Patients included in the study were classified as having mortality and not occurring. Results Male gender, advanced age (>65), hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease (CKD), coronary artery disease, heart failure and atrial fibrillation rates were statistically higher in the mortality group (p<0.05). The presence of MAC was 34.1% in the mortality group, while it was 16% in the survival group (p<0.001). MI was observed 49.3% in the mortality group, while it was 16.2% in the survival group (p<0.001). Presence of MAC was associated with MI (14.8% vs 38.7%, p<0.001). Age (OR=1.976, 95% CI 1.166-3.346, p=0.011), male gender (OR=1.784, 95% CI 1.101-2.892, p=0.019), CKD (OR=2.293, 95% CI 1.085-4.485, p=0.030), MI (OR=2.893, 95% CI 1.735-4.823, p<0.001) and advanced lung involvement on CT (OR=2.231, 95% CI 1.084-4.594, p=0.029) were the independent predictors of mortality Conclusion In terms of MI and mortality risk in COVID-19 patients, it may be recommended to evaluate MAC from the CT images.Koronavirüs hastalığı-2019 (COVID-19) özellikle solunum ve kardiyovasküler sistemleri etkileyerek mortaliteye ve ciddi morbiditelere neden olabilir. Mitral halka şeklindeki kalsifikasyon (MAC), kardiyak mortalite ile ilişkili bir mitral kapak patolojisidir. Bu çalışmada, MAC’ın COVID-19 enfeksiyonuna sekonder gelişebilen miyokard hasarı (MI) ve mortalite üzerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemle Dışlama kriterleri uygulandıktan sonra geriye kalan 1151 ardışık COVID-19 hastasının toraks bilgisayarlı tomografi (BT) görüntüleri değerlendirildi. MAC puanlarının hesaplanması, çalışma verilerine kör olan iki uzman radyolog tarafından yapıldı. MI, hs-TnI düzeyi (≥34 ng/dl) olanlar olarak tanımlandı. Çalışmaya dahil edilen hastalar mortalitesi olan ve olmayan olarak sınıflandırıldı. Bulgular Mortalite grubunda erkek cinsiyet, ileri yaş (>65), hipertansiyon, diabetes mellitus, kronik obstrüktif akciğer hastalığı, kronik böbrek hastalığı (KKD), koroner arter hastalığı, kalp yetmezliği ve atriyal fibrilasyon oranları istatistiksel olarak daha yüksekti (p<0.05). Mortalite grubunda MAC varlığı %34.1, sağkalım grubunda ise %16 idi (p<0.001). Miyokardiyal hasar mortalite grubunda %49.3, sağkalım grubunda ise %16.2 olarak saptandı (p<0.001). MAC varlığı MI ile ilişkiliydi (%14.8’e karşılık %38.7, p<0.001).Yaş (OR=1.976, 95% CI 1.166-3.346, p=0.011), erkek cinsiyet (OR=1.784, 95% CI 1.101-2.892, p=0.019), kronik böbrek yetersizliği (OR=2.293, 95% CI 1.085-4.485, p=0.030), MI (OR=2.893, 95% CI 1.735-4.823, p<0.001) ve küçük hücreli akciğer tutulumu (OR=2.231, 95% CI 1.084-4.594, p=0.029) mortalitenin bağımsız belirleyicileri idi. Sonuç COVID-19 hastalarında MI ve mortalite riski açısından BT görüntülerinden MAC değerlendirilmesi önerilebilir

Epicardial fat thickness is associated with retinopathy in patients with newly diagnosed hypertension

OBJECTIVE: Hypertensive retinopathy develops based on endothelial dysfunction, inflammation, and atherosclerosis. Epicardial fat secretes various cytokines associated with endothelial dysfunction, oxidative stress, inflammation, and atherosclerosis. We aimed to evaluate whether epicardial adipose tissue (EAT) thickness is a marker for retinopathy in newly diagnosed hypertensive patients. METHODS: A total of 73 newly diagnosed hypertension (HT) patients were included in the study. Transthoracic echocardiography (TTE) was used to measure EAT thickness. To evaluate the presence of retinopathy in HT patients, hypertensive retinopathy staging was performed by ophthalmologists, according to Scheie classification. RESULTS: Retinopathy was detected in 27 (37.0%) of 73 patients. EAT thickness in HT patients with retinopathy was higher than the group without retinopathy (5.07 +/- 1.45 mm vs. 4.19 +/- 1.20 mm, p=0.007). Low-density lipoprotein cholesterol (LDL-C) levels in HT patients with retinopathy were higher than the group without retinopathy (162.4 +/- 41.2 mg/dl vs. 138.1 +/- 35.6 mg/dl, p=0.010). As a result of the regression analysis, LDL-C (OR=1.016, 95% CI 1.001-1.031, p=0.043) and EAT thickness (OR=1.674, 95% CI 1.069-2.626, p=0.043) were the independent predictors of retinopathy. CONCLUSION: Increased EAT thickness is associated with the presence of retinopathy in hypertensive patients

Impact of Postdilation on Intervention Success and Long-Term Major Adverse Cardiovascular Events (MACE) among Patients with Acute Coronary Syndromes

Postdilation is frequently used during coronary interventions to prevent stent malapposition. Currently there are contradictory findings regarding the benefits of postdilation for both intraprocedural and long-term outcomes. We evaluated the impact of postdilation among patients who presented with acute coronary syndromes (ACS) and underwent percutaneous coronary interventions (PCI). A total of 258 consecutive patients who presented with ACS and underwent PCI were included in the study. The patients were followed up for 25±1.7 months for the occurrence of major adverse cardiovascular events (MACE). During follow-up, 65 patients (25.2%) had MACE. Among patients without MACE, intracoronary nitrate infusion was less frequently used (P=0.005), myocardial blush grade was higher (P<0.001), and a drug-eluting stent was more frequently used (P=0.005). No significant differences were noted between groups regarding the predilation, recurrent dilation, postdilation, and other angiographic characteristics. In multivariate analysis, female sex (P=0.047), myocardial blush grade (P=0.038), previous coronary artery disease (P=0.030), and peak troponin level (P=0.002) were found to be predictors of MACE. In patients who were treated with PCI for ACS, performing postdilation did not predict final Thrombolysis in Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count, myocardial blush grade, or MACE

Snapshot evaluation of acute and chronic heart failure in real-life in Turkey: a follow-up data for mortality

Objective: Heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided. Methods: This is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM. Results: There were 1054 patients with a mean age of 63.3±13.3 years and with a median follow-up period of 16 (7–17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p<0.001). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist were present in 70.6%, 88.2%, and 50.7%, respectively. In the whole cohort, survival curves were graded according to guideline-directed medical therapy (GDMT) scores ?1 versus 2 versus 3 as 28% versus 20.2% versus 12.2%, respectively (p<0.001). Multivariate analysis of the whole cohort yielded age (p=0.009) and AHF (p=0.028) as independent predictors of mortality in 1 year. Conclusion: One-year mortality is high in Turkish patients with HF compared with contemporary cohorts with AHF and CHF. Of note, GDMT score is influential on 1-year mortality being the most striking one on chronic HFrEF. On the other hand, in the whole cohort, age and AHF were the only independent predictors of death in 1 yea

A genomic snapshot of demographic and cultural dynamism in Upper Mesopotamia during the Neolithic Transition

Upper Mesopotamia played a key role in the Neolithic Transition in Southwest Asia through marked innovations in symbolism, technology, and foodways. We present thirteen ancient genomes (c.8500-7500 calBCE) from Pre-Pottery Neolithic Çayönü in the Tigris basin together with bioarchaeological and material culture data. Our findings reveal that Çayönü was a genetically diverse population, carrying a mixed ancestry from western and eastern Fertile Crescent, and that the community received immigrants. Our results further suggest that the community was organised along biological family lines. We document bodily interventions such as head-shaping and cauterization among the individuals examined, reflecting Çayönü's cultural ingenuity. Finally, we identify Upper Mesopotamia as the likely source of eastern gene flow into Neolithic Anatolia, in line with material culture evidence. We hypothesise that Upper Mesopotamia's cultural dynamism during the Neolithic Transition was the product not only of its fertile lands but also of its interregional demographic connections

Türk hazır giyim sektöründe hedef maliyet yönetim sisteminin uygulanabilirlik düzeyi ve çeşitli firma özelliklerinin bu düzey üzerindeki etkileri

Bu çalışmanın amacı, Türk hazır giyim sektöründe hedef maliyet yönetim sisteminin uygulanabilirlik düzeyini ve bu düzey üzerinde çeşitli firma özelliklerinin etkilerini araştırmaktır. Araştırmamızın sonuçlarına göre, Türk Hazır Giyim Sektöründe “kesinlikle uygulanamaz”, “uygulanamaz”, “uygulanabilir”, “uygulanır” ve “kesinlikle uygulanır” şeklinde beş seviyede ölçülen uygulanabilirlik düzeyi, “uygulanır” olarak belirlenmiştir. Bulgularımız, uygulanabilirlik düzeyinin; firma büyüklüğü, ihracat miktarı gibi bir dizi firma karakteristiğinden etkilenmekte olduğunu ortaya koymaktadır.The purpose of this study is to investigate the applicability level of target costing management system in Turkish ready to wear industry and to explore the effects of various firm characteristics on this level above mentioned. According to the results of our research, the applicability level of target costing management system which has been measured as “certainly unapplicable”, “unapplicable”, “neither applicable nor unapplicable”, “applicable” and “certainly applicable” in Turkish ready to wear industry is applicable ( 57 .3=X ). This study has also showed that the applicability level of target costing management system has been affected from various firm characteristics such as firm size, export etc