Karşıyaka Prevalance and Awareness of Hypertension Study (KARHIP)

Background: The study was planned to assess potential differences in hypertension prevalance and hypertension related demographic properties in an urban area with relatively higher income and cultural population compared to the national average. Methods: Fieldwork was done by educated and dedicated personnel at Karsiyaka Municipality Building by one by one interviewing poll, blood pressure measurement, rhythm and body composition analysis in February 2014. Hypertension was defined as an average systolic blood pressure ≥140 mmHg or an average diastolic blood pressure ≥90 mmHg. Results: Out of a total of 1417 (627 males and 790 females) people enrolled, 780 people were hypertensive (prevalence 55%). Hypertension prevalence in the middle age group (age 35-65) was 46% and in the geriatric age group (age>65) it was %79. 216 out of 780 hypertensive (27.7%) people were not aware of their disease. The proportion of people taking antihypertensive treatment was 69.4% and the proportion under control was 34.7%, whereas the control rate was 50.1% in 541 patients who were aware of their diseases. Conclusions: Hypertension prevalances in our study were similar to the PatenT 2 trial prevalances, which were 46 % for the middle age group and 78% for the geriatric age group. Compared to PatenT 2 data, the rate of hypertension awareness (54.7% vs 72.3%) and the rate of being under treatment (47.5% vs 69.4%) were higher. The rate of controlled hypertension was a little bit higher (28.7 % vs 34.7% ) in our group, whereas control rates in aware and treated groups were similar (53.9 % and 50.1 %) in both studies

Hipertrofik kardiyomiyopatili hastaların risk sınıflandırmasında görüntüleme yöntemlerinin yeri

Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disorder. It is the most common reason of sudden cardiac death (SCD) in young athletes. Prevention of these deaths is of high concern among physicians. Patients with high risk of SCD are canditates for implantable cardioverter device therapy. Cardiac imaging modalities provide important data in risk stratification for identifying HCM patients with high risk of SCD and interpreting the data obtained by different imaging modalities is important for prevention of SCD in this population. in this review, we evaluated the role of imaging modalities and their values in risk stratification of patients with HCM.Hipertrofik kardiyomiyopati (HKM) genetik geçişli bir kalp hastalığıdır. Genç sporcularda ani kardiyak ölümün (AKÖ) en sık nedenidir. Bu ölümlerin önlenebilmesi için hekimler büyük özen göstermektedir. Ani kardiyak ölüm açısından yüksek riskli hastalar implante edilebilen kardiyoverter defibrilatör tedavisi için adaydırlar. Ani kardiyak ölüm açısından yüksek riskli bu bireylerin saptanabilmesi için yapılan risk sınıflandırmasında kardiyak görüntüleme yöntemleri önemli bilgiler sağlamaktadır. Görüntüleme yöntemleri ile elde edilen bilgilerin doğru yorumlanması ve önlemlerin alınması bu hastalar için hayat kurtarıcı olması nedeniyle büyük önem taşımaktadır. Teknolojideki gelişmeler yüksek riskli hastaların erken tespitine önemli katkılar sağlamaktadır. Bu derlemede biz HKM’li hastaların risk sınıflandırmasında görüntüleme yöntemlerinin yeri ve önemini değerlendirdik

Current clinician perspective on non-vitamin K antagonist oral anticoagulant use in challenging clinical cases

Objective: The evolution of non-vitamin K antagonist anticoagulants (NOACs) has changed the horizon of stroke prevention in atrial fibrillation (SPAF). All 4 NOACs have been tested against dose-adjusted warfarin in well-designed, pivotal, phase III, randomized, controlled trials (RCTs) and were approved by regulatory authorities for an SPAF indication. However, as traditional RCTs, these trials have important weaknesses, largely related to their complex structure and patient participation, which was limited by strict inclusion and extensive exclusion criteria. In the real world, however, clinicians are often faced with complex, multimorbid patients who are underrepresented in these RCTs. This Article is based on a meeting report authored by 12 scientists studying atrial f ibrillation (AF) in diverse ways who discussed the management of challenging AF cases that are underrepresented in pivotal NOAC trials. Methods: An advisory board panel was convened to confer on management strategies for challenging AF cases. The Article is derived from a summary of case presentations and the collaborative discussions at the meeting. Conclusion: This expert consensus of cardiologists aimed to def ine management strategies for challenging cases with patients who underrepresented in pivotal trials using case examples from their routine practice. Although strong evidence is lacking, exploratory subgroup analysis of phase III pivotal trials partially informs the management of these patients. Clinical trials with higher external validity are needed to clarify areas of uncertainty. The lack of clear evidence about complex AF cases has pushed clinicians to manage patients based on clinical experience, including rare situations of off-label prescriptions

Evaluating functional capacity, and mortality effects in the presence of atrial electromechanical conduction delay in patients with systolic heart failure

Objective: Atrial functions are relatively suppressed in heart failure (HF). We aimed to investigate the associations of intra- and inter-atrial electromechanical conduction delay (EMCD) with functional class and mortality over a 12-month follow-up period.Methods: the prospective study included 65 patients with systolic HF and 65 healthy subjects with normal sinus rhythm. Left ventricular (LV) systolic functions and left atrial (LA) dimensions and volumes were evaluated by transthoracic echocardiography. Tissue Doppler imaging (TDI) signals at the lateral border of the mitral annulus (lateral PA'), septal mitral annulus (septal PA'), and tricuspid annulus (tricuspid PA') were measured. Intra- and inter-atrial EMCD were calculated.Results: Mitral inflow velocities were studied using pulsed-wave Doppler after placing the sample volume at the leaflets' tips. the peak early (E wave) and late (A wave) velocities were measured. the septal annular E/E' ratio was relatively higher and lateral, septal, and right ventricular S, E', and A' waves were significantly lower in the HF group than in the control group (12.49±6.03 - 7.16±1.75, pE/E' <0.0001). Intra-atrial EMCD was detected as 117.5 ms and inter-atrial EMCD as 127.5 ms in patients with prolonged atrial EMCD. A significant increase was found in prolonged intraand inter-atrial EMCD according to functional capacity increase (p=0.012 and p=0.031, respectively). the incidence of mortality was significantly higher in patients with prolonged atrial EMCD (p=0.025), and 5 patients in the HF group died during the study over the 12-month follow-up period.Conclusions: in this study, we found a relationship between prolonged atrial conduction time and increased functional class and mortality in patients with systolic HF

Potential factors affecting the anticoagulation control in patients treated with warfarin: Results WARFARIN-TR study

Background: In the present study, we aimed to evaluate the factors that might be caused by adequate anticoagulation control in patients treated with warfarin for any reason. Methods: The WARFARIN-TR (The Awareness, Efficacy, Safety, and Time in Therapeutic Range of Warfarin in Turkish Population) study included 4987 patients using warfarin between January 1, 2014 and December 31, 2014. Time in therapeutic range (TTR) was calculated according to F. R. Roosendaal's algorithm with linear interpolation. The study population divided into two groups; adequate international normalized ratio (INR) control when TTR ≥70% (Group 1, n = 1068, 21.4%) and inadequate INR control when TTR <70% (Group 2, n = 3919, 78.6%). All demographic and clinic characteristics of the patients were compared to determine possible factors that might be cause adequate warfarin use. Results: The mean age of the study population was 60.7 ± 13.5 years, and there was no significant difference between groups. The mean TTR value of Group 1 was significantly higher than Group 2 (80 ± 8.5 vs. 40.9 ± 17.2; P < 0.001). The traditional cardiovascular risk factors were similar between groups except hypertension (Group 1 51.4% and Group 2 56.4%; P = 0.004) and chronic kidney disease (Group 1 8.3% and Group 2 5.5%; P = 0.001). There were no significant differences between groups regarding bleeding. The awareness of warfarin use was significantly higher in Group 1 patients than Group 2 patients. Multivariate logistic regression analysis revealed that age (odds ratio [OR], 1.007; P = 0.014), hypertension (OR, 0.821; P = 0.01), atrial fibrillation (OR, 1.180; P = 0.033), chronic kidney disease (OR, 1.697; P < 0.001), to know warfarin use reason (OR, 1.699; P < 0.001), and know to food-drug interaction with warfarin (OR, 1.583; P < 0.001) were independent predictors of adequate coagulation. Conclusion: Our study demonstrated that a low proportion of patients taking warfarin achieve an adequate TTR in daily practice. Furthermore, the patients with adequate TTR are more aware of warfarin use