The Importance of Inflammatory Markers in Predicting Chronic Venous Insufficiency

Objective: Chronic venous insufficiency can be missed unless it comes to mind. We need a simplified diagnosis of chronic venous insufficiency. This study is aimed to analyze the potential role of inflammatory markers like monocyte count/high-density lipoprotein cholesterol on the diagnosis of chronic venous insufficiency. Methods: This is a retrospective study. A total of 419 patients admitted to our clinics between September 1, 2019, and January 20, 2021, were included. Blood tests and venous Duplex ultrasound examinations applied to lower limb veins on the same day were studied. Monocyte count/high-density lipoprotein cholesterol was measured. A reflux time longer than 1 second in Duplex ultrasonography was considered venous insufficiency. The patients were divided into 2 groups according to the presence or absence of venous insufficiency. The relation between these results and the presence of venous insufficiency was examined. Results: When compared with the patients without venous insufficiency, monocyte count was higher (0.61 ± 0.18 vs. 0.55 ± 0.15 109 /L; P = .00) and high-density lipoprotein cholesterol was found to be lower (49 ± 9.1 vs. 53.4 ± 13.6 mg/dL; P = .02) in the patients with chronic venous insufficiency. The monocyte count to high-density lipoprotein cholesterol ratio was higher in the patients with chronic venous insufficiency (12.5 ± 5 vs. 10.9 ± 4; P = .005). According to multivariate regression analysis, monocyte count (95% CI: 1.003-1.035; P = .020) and monocyte count to high-density lipoprotein cholesterol ratio (95% CI: 1.017-1.154; P = .013) were independent risk factors for the occurrence of venous insufficiency. Conclusions: If the monocyte count to high-density lipoprotein cholesterol ratio is high, it may be predicted that this patient may have chronic venous insufficiency. This prediction may focus us on the lower extremity examination in clinical routine practice

The Relationship Between the Frontal QRS-T Angle and High Blood Pressure Response to Exercise

Introduction:In this study, we compared frontal QRS-T angles between normotensive subjects with high blood pressure (BP) respons to exercise test and the control group.Methods:Patients who were scheduled for an exercise test between January 2017 and January 2022 were included in the study. The patient group consisted of people who responded to the exercise test with elevated BP, and the control group included people who responded to the exercise test with normal BP. The data in the electrocardiography device’s report section was used to calculate the QRS and T-axis. The frontal QRS-T angle was identified as the absolute difference between these two axes.Results:Frontal QRS-T angles were found to be significantly higher in the patient group compared with the control group (36.09±14.51 and 20.46±8.12; p<0.001). In multivariate analysis, frontal QRS-T angles were found to be an independent predictor of higher BP response to exercise test [odds ratio: 1,189, 95% confidence interval (CI); 1,083-1,305; p<0.001]. Receiver operating characteristic curve analysis showed that the frontal QRS-T angle value predicting an excessive BP response to exercise test was 27.5º with a sensitivity of 71% and a specificity of 75% (area under the curve: 0.832; 95% CI: 0.75-0.91; p<0.001).Conclusion:The frontal QRS-T angles were found to be significantly higher in the group that gave higher BP response to the exercise test compared to the control group. Patients with a high BP response to exercise test can be detected using the frontal QRS-T angle before the test

Risk Factors for Atrial Fibrillation Recurrence in Patients Undergoing Ablation

Aim:The current study aimed to investigate the predictors of recurrence in patients with paroxysmal atrial fibrillation (AF) undergoing cryoballoon ablation.Materials and Methods:This study was conducted with the participation of the patients who underwent cryoballoon ablation between October 2013 and March 2016. Patients’ medical records were retrospectively evaluated. Patients were divided into two groups as those with AF recurrence and those without AF recurrence.Results:A total of 68 patients undergoing cryoballoon ablation were included in the study. The mean age of the patients was 57.3±12 years, and 32% were male. Concomitant conditions included coronary artery disease in 25 patients (36.8%), diabetes mellitus in 9 (13.2%), hypertension in 46 (67.6%), and history of cerebrovascular event in 3 (4.4%). During the early period involving the initial three months, AF recurrence was found in 16 patients (23.5%), while 52 (76.5%) remained in the sinus rhythm during the follow-up. There were significant differences between two groups in left atrium size (38±5.3 and 44±6.6, p=0.003), left atrial appendage (LAA) flow rate [38 (24-62) cm/sec and 28 (22-55) cm/sec, p=0.001], presence of pulmonary venous anomaly [5 (9.6%) and 6 (37.5%), p=0.016], the number of antiarrhythmic drugs before the ablation (1.78±0.7 and 2.43±0.5, p=0.002), interventricular septal thickness (11±1.7 mm and 12±1.47 mm, p=0.008), left ventricular posterior wall thickness (11±0.9 mm and 12±1.3 mm, p=0.007), and left ventricular mass (195±51 g and 181±37.9 g, p=0.028).Conclusion:According to the results, AF recurrence after ablation was found to be associated with the use of multiple antiarrhythmic drugs before the ablation, increased left atrial diameter, the reduced flow rate in the LAA, presence of a pulmonary venous anomaly, increased interventricular septal thickness, left ventricular posterior wall thickness, and left ventricular mass

Association of epicardial adipose tissue thickness by echocardiography and blunted heart rate recovery in metabolic syndrome patients

Metabolik sendrom diabetes mellitus, obezite, hipertansiyon ve koroner arter hastalığı gibi gibi ölümcül birçok sistemik bozukluğun birbirine eklendiği bir modern yaşam hastalığıdır. Çağımızın önemli bir halk sağlığı problemi haline gelen metabolik sendrom dünyada olduğu gibi ülkemizde de önemli bir sorun haline gelmiştir. Metabolik sendromun kardiyovaküler hastalıklar ile ilişkisi birçok çalışmanın konusu olmuştur. Çalışmamızda metabolik sendromun komplikasyonları oluşmadan tanı ve tedavide yol gösterici olabilecek ve kardiyovasküler olayların prediktörü olarak öne sürülen epikardiyal yağ dokusu miktarının efor stres testinde azalmış kalp hızı değişkenliği ile ilişkisi incelendi. Çalışmaya poliklinik kontrollerinde ilk kez metabolik sendrom tanısı konan 48 olgu ile 30 kontrol grubu olmak üzere toplam 78 olgu alındı. Çalışmaya alınan hasta ve kontrol grubuna transtorasik ekokardiyografi ve efor stres testi yapıldı. Ekokardiyografik olarak ölçülen epikardiyal yağ dokusunun koroner arter hastalığının bilinen risk faktörleri ve efor stres testinde recovery fazda azalmış kalp hızı toparlanma indeksi arasındaki ilişki incelendi. Çalışmada epikardiyal yağ doku miktarı beden-kitle indeksi (BKİ), diabetes mellitus (DM), yüksek trigliserid ve düşük HDL ile korele bulundu. Çalışmaya alınan metabolik sendrom grubunda epikardiyal yağ dokusu miktarı anlamlı olarak daha yüksek bulundu (p <0.001). metabolik sendrom ve kontrol grubunun kalp hızı toparlanma indeksi ROC-CURVE eğrisi kullanılarak kıyaslandı. Metabolik sendrom ve kontrol grubunun efor stres testi recovery fazda kalp hızı toparlanma indeksi incelendiğinde; metabolik sendrom grubunda kalp hızı toparlanması azalmış bulundu. Çalışmamızda metabolik sendrom grubunun kalp hızı toparlanması Lipid Research Prevalans çalışmasına benzer olarak <43 bulundu. Epikardiyal yağ dokusu diğer faktörlerden bağımsız olarak kalp hızı toparlanmasına etkili en önemli faktör olarak saptandı. Sonuç olarak çalışmamızda, epikardiyal yağ dokusu metabolik sendromlu hastalarda anlamlı olarak daha kalın bulundu. Koroner kalp hastalığının ve ani ölümün iyi bir öngörüsü olan azalmış kalp hızı toparlanma indeksinin epikardiyal yağ dokusu ile korele saptanması epikardiyal yağ dokusunun, metabolik sendromlu hastalarda tanı ve takipte iyi bir belirteç olabileceğini göstermiştir.Metabolic syndrome is a disease related to the modern way of life in which many systemic defects with adverse effects affect each other.It starts with insulin resistance and/or diabetes mellitus, obesity, hypertension and coronary artery disease.Obesity and metabolic syndrome which are amongst the most important public health problems in our century are progressively gaining significance because of their increasing prevalence in our country and worldwide and their related risks. The aim of this study is to compare, find the correlation between the epicardial adipose tissue and reduced changes in heart rate postexercise in those with metabolic syndrome and the importance of risk factors like age, sex, diabetes mellitus (DM), hypertension and hyperlipidemia. This is a prospective study carried out on a group of 78 patients. 48 people consisting of 21 men and 27 women applying for the first time to Uludag University faculty of medicine Hospital, Cardiology outpatient service and with metabolic syndrome diagnosis. The control group was up 30 patients between 30-50 years old from the same outpatient service with normal echocardiographic and exercise stres tests. The information making the basics for the study like history, blood biochemistry, exercise stres test and echocardiography have been adequately collected from all the 78 patients. In our study we have investigated epicardial adipose tissue and its effect on heart rate recovery (HRR) index. The group with metabolic syndrome included in our study had been to have a significantly higher epicardial adipose tissue. (P<0.001). In our study, the cases with low HDL, high BMI and high triglyseride values had been found to have a significantly higher epicardial adipose tissue (P<0.05). Epicardial adipose tissue may be used as a predictive risk factor for coronary artery diseases since it shows a correlation with the coronary artery disease risk factors. On analysing the HRR index in the second minute after exercise for the group with metabolic syndrome and the control group in our study, it was found that the group with metabolic syndrome had a significantly lower HRR index (P<0.05). A cutt-off value of 43 for HRR index was obtained using the ROC CURVE (AUC; 0,82, p;0,001). The group with metabolic syndrome in our study had a second minute recovery heart rate of <43 similar to that by Lipids Research Prevalence study. In our study it was observed that the effect of the epicardial adipose tissue thickness on HRR index was independent of LDL, HDL, triglyseride and the BMI. Finally, our study has found that epicardial adipose tissue might be a predictor for coronary artery diseases and sudden death in individuals with metabolic syndrome and, thus, might be useful in the diagnosis and follow up of metabolic syndrome

Association of epicardial adipose tissue thickness by echocardiography and heart rate recovery in metabolic syndrome

Bu çalışma, 26-29, Ekim 2013 tarihlerinde Antalya[Türkiye]’de düzenlenen 29. Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation Kongresi‘nde bildiri olarak sunulmuştur.Turkish Soc Cardio

Awareness and knowledge of pneumococcal vaccination in cardiology outpatient clinics and impact of physicians' recommendation on vaccination rates

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Although there is not enough data on pneumococcal vaccination status in patients with cardiovascular disease and or risk factors in our country, it is known that vaccination rates are quite low in the current data. PURPOSE: We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physician’s recommendation (with educational brochures) on vaccination rate. METHODS: Awareness of vaccination, before COVID-19 pandemic, was measured in patients admitting to cardiology outpatient clinics from 40 center of our country by a questionnaire contained 19 questions. The demographics (including gender, age, educational level, awareness vaccination level) and comorbidities were obtained. The vaccination rates were calculated within 3-months follow-up from the admitting of patient to cardiology clinics. RESULTS: The 403 (18.2%) of patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n=1808) was 61.9±12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The 98.5% were referred to family medicine (n=1412, 78.1%) or vaccination outpatient clinics (n=370, 20.5%) and the vaccination rate was 62.1% during the follow-up period. The differences between vaccinated and not-vaccinated patients are presented in Table 1. The physician’s recommendation was positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant between vaccination and female sex [OR=1.55 (95% CI=1.25–1.92), p<0.001], higher education level [OR=1.49 (95% CI=1.15-1.92), p=0.002] patients’ knowledge [OR=1.93 (95% CI=1.56-2.40), p<0.001], and their physician’s recommendation [OR=5.12 (95% CI=1.92-13.68), p=0.001]. CONCLUSION: To our knowledge this is the first report about the awareness pneumococcal vaccination rates and impact of physician’s recommendation in patients with cardiovascular disease by high study population. These findings suggest providing information on the benefits of vaccination by physician’s and educational advice was significantly associated with an increase vaccination rate and have a key role

Heart Failure Awareness Survey in a Turkish Population: HFAS-TR.

Objective: Heart failure is a leading cause of death and the most common diagnosis leading to hospitalization. Its awareness is lower than that of other cardiovascular diseases, both in the general population and among patients with heart failure (HF). This study aimed to establish the current level of knowledge about HF in patients with HF with reduced ejection fraction (HFrEF) and mildly reduced ejection fraction (HFmrEF) in Türkiye. Methods: This questionnaire-based survey study is multicenter, conducted across 34 centers from December 2021 to July 2022. We performed a survey consisting of two sets of questions focusing on individual characteristics of the patients and HF-related knowledge. Results: The study included a total of 2,307 outpatient HF patients, comprising 70.5% males and 29.5% females with a mean age of 64.58 ± 13 (56-74) years and a mean body mass index value of 32.5 ± 10 kg/m2. HFrEF and HFmrEF were determined in 74.7% and 25.3% of patients, respectively. Thirty percent of the patients were unaware that they had HF. While 28.7% of the patients thought that they had sufficient information about HF, 71.3% believed they lacked adequate knowledge. In the study, 25.2% of the participants identified dyspnea, 22% identified tiredness, and 25.4% identified leg edema as the most common symptoms of HF. Only 27.4% of patients recognized all three typical symptoms of HF. Conclusion: We found that the study population’s knowledge about HF symptoms and the nature of the disease was poor. Educational and awareness activities are necessary to optimize outcomes and benefits

Turkish Real Life Atrial Fibrillation in Clinical Practice: TRAFFIC Study

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and is associated with an increased risk of thromboembolism, ischemic stroke, impaired quality of life, and mortality. The latest research that shows the prevalence and incidence of AF patients in Türkiye was the Turkish Adults’ Heart Disease and Risk Factors study, which included 3,450 patients and collected data until 2006/07.The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study is planned to present current prevalence data, reveal the reflection of new treatment and risk approaches in our country, and develop new prediction models in terms of outcomes. Methods: The TRAFFIC study is a national, prospective, multicenter, observational registry. The study aims to collect data from at least 1900 patients diagnosed with atrial fibrillation, with the participation of 40 centers from Türkiye. The following data will be collected from patients: baseline demographic characteristics, medical history, vital signs, symptoms of AF, ECG and echocardiographic findings, CHADS2-VASC2 and HAS-BLED (1-year risk of major bleeding) risk scores, interventional treatments, antithrombotic and antiarrhythmic medications, or other medications used by the patients. For patients who use warfarin, international normalized ratio levels will be monitored. Follow-up data will be collected at 6, 12, 18, and 24 months. Primary endpoints are defined as systemic embolism or major safety endpoints (major bleeding, clinically relevant nonmajor bleeding, and minor bleeding as defined by the International Society on Thrombosis and Hemostasis). The main secondary endpoints include major adverse cardiovascular events (systemic embolism, myocardial infarction, and cardiovascular death), all-cause mortality, and hospitalizations due to all causes or specific reasons. Results: The results of the 12-month follow-up of the study are planned to be shared by the end of 2023. Conclusion: The TRAFFIC study will reveal the prevalence and incidence, demographic characteristics, and risk profiles of AF patients in Türkiye. Additionally, it will provide insights into how current treatments are reflected in this population. Furthermore, risk prediction modeling and risk scoring can be conducted for patients with AF