Arrhythmogenic right ventricular dysplasia with apical thrombus atypical presentation of cardiomyopaties

Aritmojenik sağ ventrikül displazisi (ARVD) na-dir görülen bir kardiyomiyopatidir. ARVD ço-ğunlukla genç yaşlarda tanı alır ve kendisini ventriküler aritmiler, çarpıntı, baş dönmesi, kalp yetmezliği ve hatta ani kardiyak ölüm ile gösterebilir. Görüntüleme yöntemleri ile sağ ventrikül (SV) dilatasyonu ve apikal anevrizma tipik bulgusudur. Fakat ARVD olgularında int-raventriküler trombüs çok nadir görülmektedir. 19 yaşında erkek hasta, hastanemize çarpıntı ve bayılma şikâyetleri ile başvurdu. Elektrokar-diyografisinde ön yüz derivasyonlarda T nega-tifliği bulunmakta idi. Ekokardiyografide sağ ventrikül dilate ve SV apeksinde anevrizmatik oluşum içinde trombüs görüldü (Fig-1). Kardi-yak manyetik rezonans incelemede sağ vent-rikül genişlemesini, yağ infiltrasyonunu, fibro-tik dokuları, SV duvar hareket bozukluğunu ve trombüslü apikal anevrizma doğrulandı. Anti-koagulan tedaviyle üç ay sonra trombüsün rezole olduğu gözlendi ve ICD implante edildi. ARVD tanısında elektrokardiyografik, aritmik, histolojik ve ailesel özelliklerin yanında görün-tüleme yöntemleri de büyük önem taşımak-tadır. Sağ ventrikül dilatasyonu ve apikal anev-rizması tanı sürecinde önemli kriterler olmakla birlikte bu gibi bulgular saptandığında trom-büs varlığı da dikkatlice değerlendirilmelidArrhythmogenic right ventricular dysplasia (ARVD) is a rare form of cardiomyopathy. It commonly presents in young adults with ventricular tachycardia or sudden death. Right ventricular (RV) dilatation and apical aneurysm are the typical findings in imaging methods. However intraventricular thrombus is rarely seen in ARVD cases. A 19 year old male was admitted to hospital with palpitation and syncope. T wave inversion was detected on anterior surface electrocardiogram. Transthoracic echocardiography revealed dilated RV and apical aneurysm in which thrombus located (Fig-1). Cardiac magnetic rezonans imaging comfirmed RV enlargement, fatty infiltration, fibrosis, wall motion abnormalities and apical aneursym with thrombus. Anticoagulation theraphy commenced to the patient. After three months later trombus resoluted and ICD was implanted. Imaging methods have a great importance in the diagnosis of ARVD besides electrocardiographic, arrhythmic, histological and familial characteristics. While right ventricular dilatation and apical aneurysm are important criteria for the diagnosis process, the presence of thrombus should be evaluated carefully

Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population: ECHO‐DOP‐TR Trial

Aim Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. Methods Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. Results A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity andE/Aratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular laterale ', septale ', and septals ' were higher in younger subjects and in females.E/e ' ratio was increased progressively with advancing decades. Right ventriculare ' ands ' were decreased buta ' was increased with increasing age. Septale ' lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. TheE/e ' ratio greater than 15 (and also 13) was not found. Conclusion This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials

EPIC (yaşlı, ayaktan kardiyak hastalarda polifarmasi ve potansiyel ilaç-ilaç etkileşimlerinin epidemiyolojisi) çalışmasının temel, tasarım ve metodolojisi

Objective: The aim of this study is to assess the prevalence of polypharmacy, inappropriate drug use, and drug-drug interactions (DDIs) in elderly patients presenting at outpatient cardiology clinics in Turkey. Methods: The EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study will be an observational, real-world, multicenter study conducted to evaluate DDIs and polypharmacy in elderly cardiac outpatients. All consecutive patients (aged >= 65 years) admitted to outpatient cardiology clinics between July 30, 2018 and July 30, 2019 who provide written, informed consent will be enrolled. A total of approximately 5000 patients are to be enrolled in this non-interventional study. All of the data will be collected at one point in time and current clinical practice will be evaluated (ClinicalTrials.gov NCT03370523). Result: Patient demographics, comorbid disease characteristics, laboratory test results, and details of medication use will be collected using self-reports and medical records. The severity of comorbid disease will be recorded and scored according to Charlson Comorbidity Index (CCI) and patients will be divided into 3 groups: mild, those with a CCI score of 1-2; moderate, those with a CCI score of 3-4; and severe, those with a CCI score of >= 5. Polypharmacy will be defined as the use of 5 or more medications at one time. DDIs will be determined using the Lexicomp Online drug interaction screening tool and potentially inappropriate medications will be defined based on the 2015 update of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Severe drug interactions will be defined as those in category D or X. Conclusion: EPIC will be the first large-scale study in Turkey to evaluate polypharmacy, potentially inappropriate medications, and DDIs in elderly cardiac outpatients in a real-world clinical setting.Amaç: Türkiye’deki kardiyoloji polikliniklerine başvuran yaşlı hastalarda polifarmasi prevalansını, uygunsuz ilaç kullanımını ve ilaç-ilaç etkileşimlerini (İİE) değerlendirmek. Yöntemler: EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) çalışması kardiyoloji polikliniklerine başvuran yaşlı hastalarda polifarmasi ve İİE’nin değerlendirileceği, gerçek yaşam verilerini aktaran, çok merkezli ve gözlemsel bir çalışma olarak tasarlandı. Çalışmaya; 30 Temmuz 2018 ve 30 Temmuz 2019 tarihleri arasında farklı kardiyoloji polikliniklerine başvuran, aydınlatılmış onam formunu imzalayan, 65 yaş ve üzeri, kadın ve erkek, ardışık 5000 hastanın dahil edilmesi planlandı. Hastalarla ilgili tüm verilerin tek bir ziyarette alınması ve verilerin değerlendirilmesi planlandı (ClinicalTrials.gov numarası NCT03370523). Bulgular: Hastalara ait demografik veriler, komorbid hastalık durumları, laboratuvar test sonuçları ve ilaç bilgileri hasta beyanları ve medikal kayıtlar yoluyla toplanacaktır. Komorbid hastalıklar kaydedilecek ve komorbid hastalıkların ciddiyeti Charlson komorbidite indeksi’ne (CKİ) göre hastalar 3 gruba ayrılacaktır: CKİ skoru 1–2 olanlar hafif, CKİ skoru 3–4 olanlar orta, CKİ skoru ≥5 olanlar ciddi. Polifarmasi aynı hastanın bir kerede 5 ve üzeri ilaç kullanması olarak tanımlanacaktır. İİE Lexicomp® çevrimiçi ilaç etkileşimi tarama aracı ile kontrol edilecek, potansiyel uygunsuz ilaç kullanımı 2015 Beers kriterlerine göre tanımlanacaktır. D ve X kategorisindeki etkileşimler ciddi ilaç etkileşimi olarak sınıflandırılacaktır. Sonuç: EPIC çalışması kardiyoloji polikliniklerine başvuran yaşlı hastalarda polifarmasi, İİE ve potansiyel uygunsuz ilaç kullanımı konularında gerçek yaşam verilerini ayrıntılı olarak aktaran ilk büyük çaplı çalışma olacaktır

Suboptimal use of non-vitamin K antagonist oral anticoagulants: Results from the RAMSES study

WOS: 000384041400052PubMed ID: 27583892This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance 50mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of 3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients