Objective: The application of 3-D printing has been increasingly used in medicine, with research showing many applications in cardiovascular disease. This systematic review analyzes those studies published about the applications of 3-D printed, patient-specific models in cardiovascular and cerebrovascular diseases.
Methods: A search of PubMed/Medline and Scopus databases was performed to identify studies investigating the 3-D printing in cardiovascular and cerebrovascular diseases. Only studies based on patient’s medical images were eligible for review, while reports on in vitro phantom or review articles were excluded.
Results: A total of 48 studies met selection criteria for inclusion in the review. A range of patient-specific 3-D printed models of different cardiovascular and cerebrovascular diseases were generated in these studies with most of them being developed using cardiac CT and MRI data, less commonly with 3-D invasive angiographic or echocardiographic images. The review of these studies showed high accuracy of 3-D printed, patient-specific models to represent complex anatomy of the cardiovascular and cerebrovascular system and depict various abnormalities, especially congenital heart diseases and valvular pathologies. Further, 3-D printing can serve as a useful education tool for both parents and clinicians, and a valuable tool for pre-surgical planning and simulation.
Conclusion: This systematic review shows that 3-D printed models based on medical imaging modalities can accurately replicate complex anatomical structures and pathologies of the cardiovascular and cerebrovascular system. 3-D printing is a useful tool for both education and surgical planning in these diseases.

Objective: To assist the management strategy of individuals, we determined an algorithm for predicting the risk of coronary heart disease (CHD) death in Turkish adults with a high prevalence of metabolic syndrome (MetS).
Methods: The risk of CHD death was estimated in 3054 middle-aged adults, followed over 9.08±4.2 years. Cox proportional hazard regression was used to predict risk. Discrimination was assessed using C-statistics.
Results: CHD death was identified in 233 subjects. In multivariable analysis, the serum high-density lipoprotein-cholesterol (HDL-C) level was not predictive in men and the non-HDL-C level was not predictive in women. Age, presence of diabetes, systolic blood pressure ≥160 mm Hg, smoking habit, and low physical activity were predictors in both sexes. The exclusion of coronary disease at baseline did not change the risk estimates materially. Using an algorithm of the 7 stated variables, individuals in the highest category of risk score showed a 19- to 50-fold higher spread in the absolute risk of death from CHD than those in the second lowest category. C-index of the model using age alone was as high as 0.774 in men and 0.836 in women (p<0.001 each), while the incorporation of 6 conventional risk factors contributed to a C-index of 0.058 in males and 0.042 in females.
Conclusion: In a middle-aged population with prevalent MetS, men disclosed anticipated risk parameters (except for high HDL-C levels) as determinants of the risk of CHD death. On the other hand, serum non-HDL-C levels and moderate systolic hypertension were not relevant in women. The moderate contribution of conventional risk factors (beyond age) to the estimation of the risk of CHD death in women is consistent with the operation of autoimmune activation. (Anatol J Cardiol 2017; 17: 000-00)

Objective: Determine the incidence of major bleeding events, their risk factors, and their impact on prognosis in Jordanian patients undergoing percutaneous coronary intervention (PCI). Evaluate the ability of the CRUSADE bleeding risk score (BRS) to predict major bleeding. Methods: Major bleeding events were defined according to the CRUSADE classification and their incidence was evaluated from hospital admission to one year of follow up. The CRUSADE bleeding risk score was calculated for each patient during the index admission. Incidence of major bleeding events was evaluated in each of the bleeding score quintiles. JoPCR1 is a prospective, observational, multicenter registry of consecutive patients who underwent PCI at 12 tertiary care centers in Jordan. A case report form was used to record data prospectively at hospital admission, at discharge, and at 1 and 12 months of follow-up. Results: The study included 2426 consecutive patients who underwent PCI. During the index hospitalization, major and minor bleeding events occurred in 0.95% and 2.6% of patients, respectively. Multivariate analysis showed that only two variables were significantly associated with major bleeding: female gender (OR=3.7; 95% CI 1.6, 8.5; p=0.002) and past history of cardiovascular disease (OR=2.6; 95% CI 1.1, 5.9; p=0.026). Patients who had in-hospital major bleeding events had higher cardiac mortality during index hospitalization (13.0% vs. 0.7%, p<0.005) and at one year of follow up (13.0% vs. 1.8%, p<0.005) compared to those who had no such events. Receiver operating characteristic curve analysis showed that the CRUSADE BRS has a high ability to predict major bleeding. Conclusion: Major bleeding events were uncommon in this ME registry of a contemporary cohort of patients undergoing PCI but were associated with a higher mortality rate compared with those who did not have major bleeding events. CRUSADE BRS was highly predictive of the incidence of major bleeding events.

Objective: Allium hirtifolium (Persian shallot) has a hypoglycemic effect on diabetic animals. The aim of this study was to assess the effect of the ethyl acetate fraction of Allium hirtifolium on the function of isolated hearts of diabetic rats. Methods: The control and diabetic animals were randomly divided into four groups: saline- or extract-treated controls (n=10 and n=6, respectively) and saline- or extract-treated diabetic rats (n=8 and n=9, respectively), which received normal saline or extract for four weeks by daily gavage. The hearts were perfused according to the Langendorff method. Cardiac function parameters, including left ventricular developed pressure (LVDP), heart rate (HR), rate pressure product (RPP; LVDP×HR), and dp/dt were measured. Results: The findings of this study showed that in the extract-treated diabetic rats, LVDP (94.5±9.1 mm Hg, mean±SEM), HR (249±15 beats/min), RPP (22732±1246) and +dp/dt (2598±230) at the baseline were significantly higher than those in the saline-treated diabetic animals, (71.5±4.0), (189±6), (13923±984), and (1701±124), respectively. Furthermore, RPP and HR were also significantly higher than the corresponding values obtained in the saline-treated diabetic rats after ischemia. Conclusion: Besides blood glucose lowering action, oral administration of the ethyl acetate fraction of Allium hirtifolium significantly improved the baseline and post-ischemic cardiac function parameters in streptozotocin-induced diabetic rats.

Objective: The standard transcatheter ventricular septal defects (VSD) closure procedure is established with arteriovenous (AV) loop and is called as antegrade approach. The directly retrograde transarterial VSD closure without using AV loop might be better option as shortens the procedure time and decreases radiation exposure.
Methods: Our series consist of twelve sequential adult cases with congenital VSDs (seven with perimembranous, four with muscular, one with postoperative residuel VSD). The mean age was 26.9 (Range 18–58), the mean height was 168.75 cm (Range 155–185cm), and the mean body mass index was 23.4 (Range 17.3–28.4). Maximum and minimum defect sizes were 10 and 5 mm and the mean defect size was 6.24 mm. The procedure was performed with left heart catheterization and advancing the delivery sheath over the stiff exchange wire then VSD occlusion from left side.
Results: The defects were successfully closed with this technique in eleven patients. In sixth patient, the defect could not be cannulated by the delivery sheath, as the tip of the sheath did not reach the defect and VSD was closed with same sheath by standard transvenous approach u- sing AV loop. We didn’t encounter any complication releated to semilunar or atrioventricular valves. Atrioventricular conduction system was not affected by the procedure in any patients. The median procedure and fluoroscopy times were 66 and 16.5 minutes respectively.
Conclusion: Transarterial retrograde VSD closure without using AV loop simplifies the procedure, decreases the radiation exposure, and short- ens the procedure time. The only limitation in adult patients is delivery sheath length.

Objective: To investigate whether switching the ablation catheter between the right and left atria through transseptal puncture site can be accurately performed without fluoroscopy.
Methods: Forty patients with persistent atrial fibrillation (mean age, 60.2±7.4 years; 65% males) got “2C3L” approach were randomized in a 1: 1 ratio to undergo either crossing interatrial septum guided by fluoroscopy (trackless group) or crossing septum guided by track image that was mapped by Carto3 system (track group).
Results: The three-dimensional image of the track could be mapped smoothly and shown clearly. No significant differences were found in the success rates between the two groups (100% vs. 100%, p>0.05). However, the procedure of crossing septum was completed without any fluoroscopy use in track group, which showed a shorter procedure time than trackless group (4±3 s vs. 20±10 s, p<0.01).
Conclusion: Visualizing the track passing through the puncture site using Carto3 system can guide the ablation catheter in safely crossing the intra-atrial septum quickly with zero fluoroscopy.

Objective: Left ventricular (LV) rotation and twist play an important role in LV contraction and relaxation. Left bundle branch block (LBBB) deteriorates both diastolic and systolic functions. We evaluated the LV twist in patients with LBBB and preserved ejection fraction (EF) (>50%) to determine twist as a potential marker for subtle myocardial dysfunction. Methods: This observational cross-sectional study included 34 LBBB patients with preserved EF who were free from ischemic and valvular disease (Group 1) and 36 healthy controls (Group 2). All patients underwent 2-D Doppler and 2-D speckle tracking echocardiography. LV apical, basal rotation, and twist were evaluated in both groups and compared accordingly. In addition, subjects were dichotomized considering the median twist value of the study population. Binary logistic regression analysis was performed to determine the independent variables associated with inframedian twist. Results: Baseline clinical characteristics were similar in LBBB patients and controls. Mean apical rotation (2.5°±1.9° vs. 4.4°±2.9°; p=0.002), basal rotation (−2.9°±2.3° vs. −4.1°±2.7°; p=0.05), and twist (5.4°±3° vs. 8.6°±3.3°; p<0.001) were decreased in group 1. Parameters related to intra- and interventricular mechanical dyssynchrony, such as longitudinal left ventricular dyssynchrony index (LVdys) and preejection interval of LV, interventricular mechanical delay (IVMD), and left posterior wall contractions (SPMWD) were significantly higher in the LBBB group. The median twist value of the studied population was 6.65°. Binary logistic regression analysis showed that only presence of LBBB was independently associated with inframedian twist (OR=6.250; 95% CI: 2.215–17.632; p<0.001). Conclusion: The LBBB might have induced the reduction of LV twist by diminishing the LV rotation before inducing a prominent effect on the left ventricular ejection fraction (LVEF). Therefore, twist may be considered as a marker for subtle LV dysfunction in LBBB with substantially normal EF.

Objective: We aimed to evaluate the relationship of micronucleus (MN) frequency and nuclear division index (NDI) with SYNTAX and Gensini scores and thrombolysis in myocardial infarction (TIMI) frame counts of coronary arteries in patients undergoing coronary angiography.
Methods: In a single-center prospective observational study, a total of 63 individuals, 48 consecutive patients with coronary artery disease (CAD) and 15 healthy people were included. Before coronary angiography (exposure to X-ray), blood samples were collected for lymphocyte cultures, MN and NDI measurements. According to the SYNTAX and Gensini scores, patients were allocated into two groups. Group 1 and 2 included the patients with SYNTAX scores <22 and ≥22 points, respectively. Similarly, groups according to Gensini scores included the ones <23 and ≥23 points. MN test was used for in vitro studies in human peripheral lymphocytes. Binucleated lymphocytes were calculated for each patient.
Results: MN frequency was significantly higher in group 2 than group 1 and in group 1 than control group (p<0.001). NDI was significantly higher in control group than group 1 and in group 1 than group 2 (p=0.003). MN frequency had positive but moderate correlation with SYNTAX and Gensini scores and TFCs of left anterior descending (LAD), circumflex and right coronary arteries (r=0.394, p=0.003; r=0.458, p<0.001; r=0.425, p<0.001; r=0.469, p<0.001; and r=0.475, p<0.001, respectively).
Conclusion: We can conclude that as the degree of atherosclerosis increases and coronary flow worsens, MN frequency increases and NDI decreases. Our results may help to elucidate the relationship of DNA damage in pathophysiology of atherosclerosis and endothelial dysfunction in patients with stable CAD.