EuroSCORE which had been published in 1999, was revised as a Logistic EuroSCORE in 2003. Further it was reconsidered and published as EuroSCORE II in 2011. In this study we compared Standard, Logistic EuroSCORE and EuroSCORE II in prediction of early mortality following coronary artery bypass grafting. Methods: We retrospectively analyzed 406 patients who underwent coronary artery bypass grafting operation between 2011-1012. Standard, Logistic and new version were compared with ROC analysis. Results: In general population, mean standard EuroSCORE was 3.25±1.05, mean logistic EuroSCORE was found 2.48±0.58, mean EuroSCORE II was found 1.30 ± 0.09 and overall mortality was 10 (10/406 2.46%). Area under curve (AUC) was found 0.992 95% CI: 0.978-0.998 for standard EuroSCORE, 0.992 95% CI: 0.977-0.998 for logistic EuroSCORE and 0.990 95% CI: 0.975-0.997 for EuroSCORE II. In high risk patients (patients with standard EuroSCORE ≥ 6) AUC was found 0.870 95% CI 0.707-0.961 for standard EuroSCORE, 0.857 95% CI 0.691-0.954 for logistic EuroSCORE, and 0.961 95% CI: 0.829-0.998 for EuroSCORE II. Conclusion: Standard, Logistic EuroSCORE and EuroSCORE II are similarly successful in mortality prediction. EuroSCORE II may be better in high-risk patients which needs confirmation in large prospective studies.

Objective: Exercise training has been known to cause structural and functional alterations in the heart called athletes heart. We aimed to investigate the effects of incremental endurance exercise training (IEET) on the left ventricular (LV) mechanics in healthy subjects. Methods: This prospective observational study included 34 healthy young men who participated in competitive sports. The participants were subjected to a six-month IEET program. The LV mechanics measured using two-dimensional speckle tracking echocardiography was recorded while the participants were in an inactive state before and at the end of the six months. To compare continuous variables before and after IEET, Wilcoxon or paired-t test were used. Results: Baseline and post training echocardiographic measurements showed that there was no significant change in LV ejection fraction (%) (p=0.64) and there were an increase in end-systolic and end-diastolic diameters, posterior and septal wall thickness, relative wall thickness and LV mass index (p<0.05, for all). LV mechanical parameters such as global strain (S) (19.8±1.33% vs. 20.4±1.26%, p=0.001), apical four -chamber S (19.4±1.96% vs. 20.1±1.86%, p=0.01), apical two- chamber S (19.9±1.75% vs. 20.7±1.75%, p=0.003), apical (23.0±3.1% vs. 23.6±3.2%, p=0.03), and basal circumferential S (21.1±2.2 % vs. 21.6±2.5%, p=0.03), and apical rotation (degree) (7.9±0.95 vs. 8.4±0.74, p=0.001) values were significantly increased by IEET. Conclusion: We demonstrated that IEET has led to exercise related cardiac structural and functional changes such as LV dilatation and LV hypertrophy, accompanied by a significant increase in LV systolic S and LV twist measurements.

Objective: Cardiac resynchronization therapy (CRT) improves heart rate variability (HRV) and heart rate turbulence (HRT) parameters. Herein, our aim was to compare these parameters with intracardiac- cardioverter defibrillator (ICD) patients with similar functional status to detect possible additional benefits of CRT on autonomic functions. Methods: Patients who had systolic HF (NYHA class II and III) with an ejection fraction <35% were enrolled in this observational, cross-sectional study. These patients were implanted either an ICD or a CRT device. A 24-hour Holter recording was obtained to assess HRV and HRT parameters in 2 groups. Unpaired t-test and Chi-square test were used for comparisons between 2 groups. Logistic regression analysis was performed to determine the variables affecting functional status. Results: Of 105 patients included in the study; 55 had CRT and 50 had ICD device. The baseline characteristics of the patients were similar in both groups. SDNN, SDANN, SDNN index, and LFnu were similar in both groups; however, RMSSD, pNN50, HFnu, LF/HF ratio, turbulence slope and albeit to a non-significant value turbulence onset were better in CRT group. When the HRV and HRT parameters were compared according to functional status, patients in functional class II had significantly better HRV and HRT parameters when compared to the ones in class III (p<0.05 for all). Regression analysis showed that only SDNN was associated with functional class [OR: 0.89 (95% CI: 0.80-0.98), p=0.03]. After the covariance analysis to eliminate the effects of functional status on HRV and HRT parameters; the parameters mostly related with the parasympathetic system activity, namely RMSSD, pNN50, HFnu, LF/HF ratio, turbulence onset and turbulence slope were still better in CRT group. Conclusion: The most striking finding in our study is that HRV and HRT values related with parasympathetic activation are better in CRT patients when compared to ICD patients with similar functional status. Therefore, upgrading to CRT may have additional benefits on autonomic functions, which needs further investigation.

Objective: Prehypertension is one of the primary causes of major cardiovascular events independent from other cardiovascular risk factors. The aim of the study was to evaluate the effect of therapeutic lifestyle modifications (LSMs) on cardiac diastolic function and aortic stiffness in prehypertensive subjects. Methods: This study designed as a prospective cohort study. Sixty-one prehypertensive adults were included in this study. The goals of LMS were weight loss of at least 5 kg in subjects with a BMI ≥25 kg/m2 and moderate-intensity physical activity at least 180 minutes per week. We evaluated left ventricular (LV) diastolic function and aortic stiffness parameters at baseline and after 6 months by conventional and tissue Doppler imaging (TDI) echocardiography. Statistical analyses were performed using Wilcoxon-signed rank test and the paired sample t test. Results: Transmitral early velocity (E), the ratio of E to transmitral late velocity (E/A), TDI diastolic early septal velocity (septal E), TDI systolic septal velocity (septal S), TDI early lateral velocity (lateral E), the ratio of septal E to TDI late septal (septal A) velocity (septal E/A) and the ratio of lateral E to late lateral (lateral A) velocity (lateral E/A) were found to be significantly increased after the LSMs (p<0.05 for all). The beta stiffness index was decreased (12.07 vs. 6.33; p < 0.001) and the aortic compliance (0.02 cm/mmHg vs. 0.05 cm/mmHg; p<0.001) and the aortic strain (3.28% vs. 7.02%; p<0.001) were increased significantly after the LSMs. Conclusion: LSMs improve conventional and TDI echocardiographic parameters and aortic stiffness measurements in subjects with prehypertension.

Objective: Although aortic valve sclerosis (AVS) and atherosclerosis may share same atherosclerotic process, there is still a controversy whether AVS may be related to atherosclerotic and nonatherosclerotic processes. The purpose of present study was to investigate this relation. Methods: In this cross-sectional and observational study, we enrolled 60 patients diagnosed with AVS and risk factor matched 76 subjects without AVS. Applanation tonometry was applied to assess the augmentation index and aortic pulse-wave velocity (PWV). Control and AVS group were examined by B-mode ultrasound to measure the intima-media thickness (IMT). Continuous variables were compared using unpaired t-test and Mann-Whitney U test. Logistic regression analysis was performed in order to find independent predictors of AVS. Results: PWV and augmentation index did not differ between control and AVS groups (11.2±3.6 vs 12±3.2, p=0.18 and 26±7.6 vs 27±9.8, p=0.2 respectively). But IMT was significantly higher in AVS group than in control one (0.76 mm±0.17 vs 0.6 mm±0.16; p<0.001). There was a significant positive bivariate correlation between the presence of AVS, IMT (r=0.43, p<0.001), male gender(r=0.31, p<0.001), augmentation index (r=0.17, p: 0,04), and age (r=0.36, p<0.001). Logistic regression analysis demonstrated that only IMT (OR: 1.46, 95% CI: 1.1-1.9, p=0.009) and age (OR: 1.1, 95% CI: 1.01-1.16, p=0.013) were independent predictors of AVS. Conclusion: Increased IMT but not PWV in subjects with AVS compared to control group may suggest that, AVS is probably a multifactorial disease, related to the both atherosclerotic and nonatherosclerotic processes.

Objective: Renal dysfunction commonly accompanies the course of cardiac disorders and strongly associates with increased morbidity and mortality. Elevated central venous pressure is related to worsening renal function in patients with heart failure. However, predictors of worsening renal function in mitral stenosis-whose pathophysiologic process is similar to heart failure with regard to right heart dysfunction-are unknown. This study aimed to evaluate whether clinical and echocardiographic parameters might predict worsening renal function in patients with mild-to-moderate mitral stenosis. Methods: The current study has a prospective cohort design. Sixty consecutive patients (9 male, 51 female, mean age 50±13 years) with mild-to-moderate mitral stenosis were followed up for 34±13 months (range 1-60) and their renal functions were monitored. Worsening renal function was defined as a decline in glomerular filtration rate of ≥ 20% on follow-up. In order to presence or absence of worsening renal functions, study patients divided into two groups. Statistical analysis was performed using the Chi-square, Independent samples t / Mann-Whitney U tests, univariate and multivariate Cox proportional hazards analyses, receiver operating characteristic (ROC) and Kaplan-Meier curve analyses. Results: Worsening renal function was observed in 14 patients (23%). In univariate analysis, male gender, mean pulmonary artery pressure (mPAP), peak tricuspid regurgitation velocity, systolic pulmonary artery pressure, digitalis and antiplatelet usage, right atrial size, and TEI index were determined to be predictors of worsening renal function. In a multivariate Cox proportional hazards model, mPAP (HR=1.136, 95% CI: 1.058-1.220, p<0.001) and male gender (HR=4.110, 95% CI: 1.812-9.322, p=0.001) were associated with increased risk of worsening renal function during the follow-up period. In ROC curve analysis, the optimal cut-off value of mPAP to predict worsening renal function was measured as more than 21 mmHg, with 78.6% sensitivity and 58.7% specificity (AUC 0.725, 95% CI 0.595-0.838). According to the Kaplan-Meier curve, a significant difference was found between those who had mPAP of >21 mmHg, and those who did not have, in terms of worsening renal function (p=0.006), and the difference between the groups increased after 30 months of follow-up. Conclusion: Elevated mean pulmonary artery pressure at the time of initial evaluation, in patients with mild-to-moderate mitral stenosis, might help to predict worsening renal function.

Objective: YKL-40, a new biomarker of localized inflammation, is secreted by macrophages within the atherosclerotic plaques. Coronary artery ectasia (CAE) is a clinical entity with unclear etiopathogenesis. Some studies have revealed that CAE may be a form of atherosclerosis that has more localized and intense inflammatory properties than atherosclerosis. The goal of this study was to investigate YKL-40 and C-reactive protein (CRP) levels in patients with isolated CAE compared to patients with normal coronary arteries (NCA) and coronary artery disease (CAD). Methods: Our study has an observational and cross-sectional design. Forty-nine patients with isolated CAE (mean age: 60±10 years), 30 age-and gender-matched control participants with NCA (30 patients, mean age: 58±12 years) and 30 patients with CAD (mean age: 61±10 years), were included in the study. The relationship between YKL-40, CRP levels and the presence of CAE was investigated. Univariate and multiple logistic regression analysis were used for analysis of independent variables to predict CAE. Results: Serum YKL-40 levels were significantly different among study groups (NCA: 110±53 μg/L, CAE: 144±68 and CAD: 180±117, p=0.005). CAD group and CAE group had significantly higher YKL-40 levels than NCA group (p=0.004 and p=0.015, respectively). CRP was not significantly different between three groups. In addition, there were no any statistically significant differences, with respect to age, gender, the presence of hypertension or diabetes mellitus, and the smoking status (p>0.05). Logistic regression analysis revealed only YKL-40 level as the determinant of CAE (OR: 1.010, 95% CI: 1.001-1.019, p=0.027). Conclusion: YKL-40 levels in patients with isolated CAE compared to patients with NCA were found significantly high and only YKL-40 level was established as the determinant of CAE. We believe that further studies are needed to clarify the possible causative roles of YKL-40 in patients with isolated CAE.

Objective: This study was aimed to evaluate whether there is any potential role of the measurement of the carotid intima-media thickness (cIMT) in patients with suspected coronary artery disease (CAD) during the echocardiography session on decision-making to refer patients for further diagnostic evaluation such as gated myocardial perfusion imaging (gMPI). Methods: cIMT of 199 consecutive patients was measured during the echocardiography session and all patients underwent gMPI. According to gMPI results, patients were divided into two groups as CAD and normal groups and according to cIMT measurements patients were divided into four subgroups. Results: Although, there was a good correlation between the age and cIMT values of the patients (r=0.546, p<0.001), the correlation between the summed stress scores and the age of the patients was very weak (r=0.142, p=0.045) and the correlation between the summed stress scores and the cIMT values was very weak (r=0.107, p=0.131). The cIMT measurements of the CAD group (0.74±0.17 mm) were significantly higher than those of the normal group (0.67±0.16 mm) (p=0.012), but after the age correction, the significance between the cIMT measurements of the CAD and the normal groups was not found (p=0.131). Besides, the relationship between the categorical cIMT values of both the CAD and the normal groups was insignificant (p=0.059) and the correlation between the increasing cIMT values and the presence of detectable CAD was also very weak (r=0.187, p=0.08). Conclusion: cIMT can predict occurrence of cardiovascular events in subjects, but single cIMT measurement during echocardiographic examination does not seem to have potential role on decision making for further investigation in patients with suspected CAD.

Objective: The purpose of the study is to compare the effects of lidocaine alone, epinephrine-combined lidocaine and prilocaine with octapressin on the cardiovascular system during minor oral surgery of sedated cardiac dental patients under local anesthesia. Methods: Connected to a Holter electrocardiogram (ECG) monitor for a total of 5 hours starting 1 hour before the procedure, twenty patients with high risk of coronary artery disease were included in the prospective cohort study. All the patients had three operations at 3 different appointments with at least one-week intervals and each operation was performed under local anesthesia achieved by 3.6 mL of 3% prilocaine with octapressin, 3.6 mL of 2% lidocaine with 1: 80.000 epinephrine and 3.6 mL of 2% lidocaine without a vasoconstrictor. Data of the Holter ECG device assessed at the end of every hour and evaluated statistically. Repeated measures ANOVA, Friedman test, and Wilcoxon signed ranks test were used to perform statistical analysis. Results: Heart-rate showed significant differences between lidocaine with epinephrine and pure lidocaine in an hour following the injection (p<0.05 for all). Cardiac rhythm showed significant differences between prilocaine with octapressin and pure lidocaine at the second hour after its administration (p<0.05 for all). There were no significant differences between 3 local anesthetics in terms of ST segment deviation. Conclusion: In minor oral operation on the sedated patients with cardiac disease, the use of 3.6 mL or a less amount of local anesthetic injection containing epinephrine appears to be a predictable and safe method.

Studies indicate that 5-7% patients undergoing percutaneous coronary intervention (PCI) have an indication for anticoagulation therapy. Most commonly atrial fibrillation (AF) is the indication. These subjects require triple therapy with aspirin, clopidogrel, and an oral anticoagulant (OAC). Several questions, concerns and challenges exist regarding the duration, benefit, risks and alternatives related to triple therapy. These questions constitute a moving target with recently approved antiplatelet and anticoagulant agents. This brief review will summarize the current literature regarding triple therapy, potential solutions that can mitigate the formidable risk of bleeding. Arising from that discussion, a logical consensus can be developed that should be applicable to studies with novel agents that interfere with homeostasis. The ultimate goal is to enhance cardiovascular outcome and decrease thrombotic and bleeding complications.