Amaç: Başta gençler olmak üzere toplum genelinde enerji içeceği kullanımı hızlı bir şekilde artmaktadır. Ancak enerji içeceklerinin sağlık üzerine etkileri tam olarak bilinmemektedir. Çalışmamızı düşük kafein içerikli enerji içeceklerinin akım aracılı vazodilatasyon (AAV) yanıtı ile endotel disfonksiyonuna akut etkilerinin araştırılması amacıyla tasarladık.
Yöntem: Araştırmamıza bilinen hastalığı olmayan 19 ile 46 yaş arasında sağlıklı 15 erkek ve 15 kadın gönüllü alındı. Gönüllülerin uygun hazırlığını takiben enerji içeceği öncesi kan basıncı, kalp hızları,ve %AAV yanıtları değerlendirildi. İçecek bitiminden 60 dakika sonrasında tekrar kan basıncı, kalp hızları, ve %AAV yanıtları değerlendirilerek karşılaştırmak için kaydedildi.
Bulgular: Enerji içecekleri öncesi ve sonrası sistolik kan basınçları(P=0,59),diastolik kan basınçları(p=0,71),kalp hızları (p=0,056), ve oklüzyon öncesi arter çapları(p=0,24) arasında istatiksel olarak anlamlı fark saptanmadı. Enerji içecekleri öncesi ve sonrası bazal kan akım hızları arasındakı karşılaştırmada da anlamlı farklılık izlenmedi (p=0,49). Enerji içeceği öncesi ve sonrası %AAV değerleri % 9,2±4,6 ve % 8,1±4,7 olarak izlendi (p=0,176). Erkeklerle karşılaştırıldığında kadınlarda enerji içeceği sonrası arter çaplarında anlamlı bir artış izlendi (kadınlarda %3 artış, erkeklerde %2.6 azalma, p=0.026)
Sonuç: 355ml’lik 53,25mg kafein içeren bir kutu enerji içeceği sağlıklı gönüllerde endotel fonksiyonunu, kan basıncı ve kalp hızı değerlerini etkilememektedir.

Objective: Energy drink consumption is increasing among the population, especially adolescents and young adults. The health effects of energy drinks are unknown. In this study, we investigate the effects of low caffeine energy drinks on endothelial functions assessed by flow-mediated dilation (FMD) of the brachial artery.
Methods: Thirty healthy volunteers (15 men, 15 women) aged 19 to 46 years participated in the study. Flow-mediated dilation measurements of the brachial artery were performed and recorded per protocol. The volunteers were asked to drink 355 mL of energy drink containing 53.25 mg of caffeine after baseline measurements, and all measurements were repeated 60 minutes later. Baseline and post-energy drink values were compared.
Results: Systolic blood pressure (p=0.592), diastolic blood pressure (p=0.714), and heart rate values (p=0.056) were similar before and after the consumption of energy drinks. Preocclusion arterial diameters (p=0.236) and blood velocities (p=0.447) did not change after energy drink consumption. FMD levels were 9.2%±4.6% and 8.1%±4.7%, respectively, before and after energy drink consumption (p=0.176). Women had a 3% increase in preocclusion arterial diameters after energy drink consumption, whereas men had a 2.6% decrease (p=0.026)
Conclusion: Low caffeine energy drinks containing 53.25 mg of caffeine/355 mL can did not have any influence on blood pressure, heart rate, or endothelial functions in healthy volunteers.

Objective: The concept of managing patients on the basis of culprit lesion characteristics is emerging. Atherosclerotic plaques are reported to be rare in young patients presenting with acute coronary syndrome (ACS). We aimed to assess culprit lesion characteristics in very young patients presenting with ACS by optical coherence tomography (OCT).
Methods: This was a prospective, single-center, open-label, observational study. Patients aged 35 years or less with ACS who underwent invasive coronary angiography and OCT were studied.
Results: Of the 43 patients, 22 (51.2%) had plaque rupture, 16 (37.2%) had plaque erosion, and five (11.6%) had no specific lesion character. Plaque was fibroatheromatous in 34 (79.1%) patients and fibrous in seven (16.3%). Plaque was not found in two (4.7%) patients; of these, one (2.3%) had left anterior descending coronary artery bridging, and one (2.3%) had intimal dissection without any plaque. Plaque rupture was more commonly associated with fibroatheromatous plaques, whereas plaque erosion was more commonly associated with fibrous plaque (p=0.010).
Conclusion: Although plaque rupture and plaque erosion occurred at the same rate as seen in patients of all ages, calcified nodule as a culprit lesion was not found in young patients. Majority of the patients had plaque rupture and plaque erosion with fibroatheromatous plaque, signifying the occurrence of established coronary artery disease in very young patients of Southeast Asia.

Objective: Presently, an effective model to predict long-term cardiac mortality in patients with hypertrophic obstructive cardiomyopathy (HOCM) is lacking. Therefore, the objective of this study was to evaluate the predictive value of the modified Age, Creatinine clearance, and Ejection Fraction (mACEF) score for long-term cardiac mortality in patients with HOCM.
Methods: Two hundred and ninety two patients with HOCM treated non-invasively were enrolled in this study, all of whom had intact medical information.
Results: Over a median follow-up period of 41.9 months, 28 cardiac deaths occurred. In univariate Cox regression analysis, the mACEF score was associated with long-term cardiac death [hazard ratio (HR)=1.795, 95% confidence interval (CI) 1.518–2.124, p<0.001]. Multiple Cox regression analysis identified the mACEF score as an independent risk factor for long-term cardiac death (adjusted HR=1.372, 95% CI 1.076-1.749, p=0.011). Analysis of the receiver operating characteristic (ROC) for long-term cardiac death showed that the mACEF score had a considerable predictive value (area under ROC 0.844, sensitivity 89.29%, specificity 75.00%) with an optimum cut-off value of 0.96. The study population was divided into high-risk (mACEF score ≥0.96, n=91) and low-risk (mACEF score <0.96, n=201) groups according to the optimum cut-off value. Kaplan-Meier survival analysis was performed and showed a dramatic higher rate of long-term cardiac mortality in the high-risk group than in the low-risk group (27.4% vs. 1.7%, p<0.001 by log-rank test).
Conclusion: The mACEF score has a considerable predictive value for long-term cardiac mortality in patients with HOCM treated non-invasively. A mACEF score ≥0.96 could be considered as a sign of poor prognosis in patients with HOCM.

Amaç: İkili antiplatelet tedavi (DAPT) ile glikoprotein (GP) IIb/IIIa inhibitörlerinin kombinasyonu kanama riskini arttırabilir. Çalışmamızın amacı, akut koroner sendrom (AKS) hastalarında farklı DAPT'lerin tirofiban ile birlikte kullanıldığındaki kanama komplikasyonlarını araştırmaktır.
Yöntemler: Çalışmaya, DAPT'ye ek olarak geleneksel dozda tirofiban (3 dakikada 25 µg/kg, ardından 24 saat süreyle 0,15 µg/kg/dak infüzyon) verilen 224 AKS hastası (ortalama yaş: 56,6 ± 11,1 yıl, 193 erkek) ardışık olarak dahil edildi. DAPT olarak aspirine (300mg yükleme sonrası 100mg/gün) ilave olarak klopidogrel (600mg yükleme sonrası 75mg/gün), ticagrelor (180mg yükleme sonrası günde iki kez 90mg) veya prasugrel (60mg yükleme sonrası 10mg/gün). Hastane içi kanama komplikasyonları kaydedildi.
Bulgular: Çalışmaya dahil edilmiş 224 hastadan 115 hastaya ticagrelor, 32 hastaya prasugrel verildi. Ortalama hemoglobin düşüşü, tikagrelor/prasugrel alan hastalar ile klopidogrel alan hastalar arasında benzerdi. Tikagrelor alan on hastada ve prasugrel alan bir hastada ≥3g/ dL hemoglobin düşüşü gelişmişken klopidogrel grubunda iki hastada gözlendi (P=0,228). Tikagrelor/prasugrel ile klopidogrel alan hastalar arasında gastrointestinal kanama (ticagrelor kullanan 2 hastada), giriş yerinde hematom (ticagrelor kullanan 3 hasta) ve kardiyak tamponad (2 hasta tikagrelor) oranları da benzerdi. Kreatinin düzeyleri hemoglobin düzeyinde ≥3g/dL düşüş ile ilişkili bulunmuş olup (p=0,032, OR: 2,189, %95GA: 1,070–4,479) hemoglobin seviyesinde ≥3g/dL düşüş ile kullanılan antiplatelet ajan, yaş, cinsiyet, hipertansiyon veya diyabet arasında ilişki bulunmadı.
Sonuç: Tirofiban, tikagrelor veya prasugrel verilen hastalarda klopidogrel verilen hastalardakine benzer kanama komplikasyon oranları ile kullanılabilir. Ancak, hastaların özellikle de yüksek kreatinin düzeyleri olanların, kanama riski açısından yakından izlenmesi önerilir.

Objective: Combination of dual antiplatelet therapy (DAPT) with glycoprotein (GP) IIb/IIIa inhibitors can increase bleeding risk. In this study, we aimed to investigate bleeding complications of different DAPTs with concomitant tirofiban use in patients with acute coronary syndrome (ACS).
Methods: This retrospective study included 224 consecutive ACS patients (mean age 56.6±11.1 years, 193 men) who were given conventional dose of tirofiban (25 µg/kg per 3 minutes followed by an infusion of 0.15 µg/kg/min for 24 hours) in addition to DAPT (300 mg aspirin followed by 100 mg/day + 600 mg clopidogrel followed by 75 mg/day or 180 mg ticagrelor followed by 90 mg twice daily or 60 mg prasugrel followed by 10 mg/day). Any intra-hospital bleeding complications were noted.
Results: Of the 224 patients, 115 were given ticagrelor and 32 were given prasugrel. Mean hemoglobin fall was similar between the patients taking ticagrelor/prasugrel and those taking clopidogrel. Ten patients taking ticagrelor and one patient taking prasugrel had hemoglobin fall ≥3 g/dL versus two patients in clopidogrel group (p=0.228). Gastrointestinal bleeding (two patients taking ticagrelor), hematoma at access site (three patients taking ticagrelor), and cardiac tamponade (two patients taking ticagrelor) rates were also similar. Creatinine levels were associated with hemoglobin fall ≥3 g/dL (p=0.032, Odds ratio 2.189, 95% confidence interval 1.070–4.479). There was no relation between hemoglobin fall ≥3 g/dL and antiplatelet agent, age, sex, hypertension, or diabetes.
Conclusion: Tirofiban may be given to patients receiving ticagrelor or prasugrel with a bleeding rate similar to clopidogrel. Close monitoring for bleeding risk is recommended, especially in patients with higher creatinine levels.

Objective: T-Flex registry was designed to investigate the safety and clinical performance of the ultrathin (60 µm) strut biodegradable polymer-coated sirolimus-eluting stent (SES) with a unique long dual Z (LDZ) link design on a cobalt-chromium stent platform (Sahajanand Medical Technologies Pvt. Ltd., Surat, India) in a real-world all-comer population including high-risk subgroups.
Methods: This was an observational, multicenter, single-arm, and investigator-initiated retrospective registry. A total of 1,203 patients treated with an ultrathin biodegradable polymer-coated SES, irrespective of lesion complexity, comorbidities, and acute presentation were analyzed from May 2016 to January 2017. The primary endpoint was the one-year incidence of target lesion failure (TLF), a composite of cardiac death, target-vessel myocardial infarction (TV-MI), and clinically-indicated target lesion revascularization (CI-TLR). Stent thrombosis was assessed as an additional safety endpoint.
Results: At the one-year follow-up, TLF was observed in 3.8% [95% confidence interval (CI) 2.9–5.1] patients, composed of 0.6% (95% CI: 0.3–1.3) cardiac death, 1.3% (95% CI: 0.8–2.2) TV-MI, and 1.9% (95% CI: 1.3–2.9) CI-TLR. In the high-risk subgroups, TLF at one-year was 6.8% (95% CI: 4.6–9.8) in patients with diabetes, 5.2% (95% CI: 3.4–8) in patients with small-vessel disease, 6.1% (95% CI: 3.9-9.6) in patients with ST-elevation myocardial infarction, and 4.5% (95% CI: 2.4-8.3) in patients with total occlusion. During follow-up, stent thrombosis was reported in 0.8% (95% CI: 0.4–1.5) patients in the overall population.
Conclusion: Low event rates of TLF and stent thrombosis at one-year follow-up indicate that this ultrathin biodegradable polymer-coated SES has encouraging safety and clinical performance in real-world all-comer populations as well as in high-risk subgroups.

Objective: With the increase in cardiovascular implantable-electronic devices (CIEDs), complications from insertion and healing are also increasing. Therefore, the objective of this study was to compare the intracutaneous stapling method to the absorbable suture technique in terms of complications, procedure time, and pocket closure time.
Methods: An observational study was conducted over the course of three months on patients with CIED implantation. The patients were divided in two groups according to pocket closure technique. Group 1 included patients with pocket closure using intracutaneous sutures; whereas in Group 2, the pocket was closed by intracutaneous staples. Data were collected regarding patient characteristics and wound problems. The endpoints were wound problems, including early and late wound problems (primary), total procedure time, and the time taken for pocket closure (secondary).
Results: One hundred and nineteen patients and 107 patients were allocated to Group 1 and Group 2, respectively. During the three-month observation period, 27 (22.6%) patients in Group 1 and 13 (12.1%) patients in Group 2 suffered from early wound problems, and the combined primary endpoint reached was statistically significant (p=0.021). Minor and major bleeding events were more common in Group 1 [Odds ratio (OR): 4.49, p=0.024; OR: 0.96, p=0.052]. The time to close the pocket was markedly reduced in Group 2 (7.29±1.42 vs. 3.98±1.19, p<0.001).
Conclusion: The rate of early wound problems is higher using intracutaneous sutures; and therefore, intracutaneous staples should be preferred to prevent these problems.

Amaç: Bu çalışma, uzun-süreli inhale iloprost tedavisinin rutin günlük pratikte pulmoner arteriyel hipertansiyonun (PAH) yönetiminde klinik etkililik, güvenlik ve tolerabilite açısından değerlendirilmesi amacıyla tasarlandı.
Yöntem: Bu gözlemsel çalışmaya inhale iloprost tedavisi altındaki toplam 115 PAH hastası dahil edildi. NYHA fonksiyon sınıflaması, iloprost tedavisi, beyin natriüretik peptid (BNP) ve N-terminal Pro BNP düzeyleri, 6-dakika yürüme mesafesi (6DYM) başlangıç vizitinde ve 3-24. aylar arasındaki takip vizitlerinde kaydedildi. İloprost tedavisinin güvenlik ve tolerabilite verilerinin yanı sıra, sağkalım klinik kötüleşme ve ilişkili risk faktörleri takip sırasında değerlendirildi.
Bulgular: Takip sırasında, fonksiyonel kapasitesi NHYA sınıf II olan hastaların yüzdesinde artış (başlangıçta %0 iken, 24. ay vizitinde %36,2) olduğu tespit edildi. Takip vizitlerinde 6DYM değerlerinde vizitler-arası veya başlangıca göre anlamlı bir değişim gözlenmedi. Klinik kötüleşme hastaların %63,5’ inde gözlenirken, sağ-kalım süresi 43 ay ve sağ-kalım oranı %69,6 olarak gerçekleşti. NT-proBNP düzeylerinin ölen hastalarda sağ-kalan hastalara göre medyan (min-mak) 1291(24-10848) ve 622 (14-5778), p=0.042) anlamlı şekilde daha yüksek olduğu saptandı. Cox regresyon analizine göre, kadın cinsiyet (OR=0.318; %95 GA: 0.128-0.792; p=0.014) ve skleroderma-ilişkili PAH (OR=0.347; %95 GA: 0.140-0.860; p=0.022) anlamlı şekilde daha düşük (sırasıyla 3.14 ve 2.88 kat) mortalite riski ile ilişkili bulundu.
Sonuç: Sonuç olarak, bulgularımız uzun-süreli iloprost tedavisinin tekli veya kombinasyon tedavisi olarak PAH hastalarında iyi düzeyde etkililik, güvenlik ve tolerabiliteye sahip olduğunu, ancak fonksiyonel kapasite NHYA sınıfında gözlenen gelişmeye 6DYM verilerinde önemli bir değişimin eşlik etmediğini göstermiştir. Bulgularımız PAH hastalarında hasta yaşının klinik kötüleşme için bir risk faktörü olduğuna, kadın cinsiyeti, skleoderma alt tipi ve düşük NT-proBNP düzeylerinin ise anlamlı şekilde daha düşük mortalite riski ile ilişkili olduğuna işaret etmektedir.

Objective: To evaluate clinical efficacy, safety and tolerability of long-term inhaled iloprost treatment in the daily practice for the management of pulmonary arterial hypertension (PAH).
Methods: A total of 115 patients with PAH on inhaled iloprost treatment were included. New York Heart Association (NYHA) functional class, brain natriuretic peptide (BNP) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels, and 6-minute walk distance (6MWD) were recorded at baseline and at 3rd to 24th month visits. Safety and tolerability of iloprost treatment were also evaluated during follow-up, as were the survival, clinical worsening, and the related risk factors.
Results: The treatment was associated with an increase in the percentage NYHA functional class II (from 0.0% at enrolment to 36.2% at 24th month visit) patients but no significant difference was noted in 6MWD values. Clinical worsening was observed in 63.5% patients, while survival rate was 69.6%. NT-proBNP levels were significantly higher in non-survivors than in survivors (p=0.042). Cox regression analysis revealed the association of female sex [odds ratio (OR)=0.318; 95% confidence interval (CI), 0.128-0.792; p=0.014] and scleroderma-related PAH (OR=0.347; 95% CI, 0.140-0.860; p=0.022) with significantly lower risk (3.14 fold and 2.88 fold, respectively) of mortality.
Conclusion: Our findings indicate favorable efficacy, safety, and tolerability of long-term iloprost treatment in the management of PAH, whereas improved NYHA functional class was not accompanied with a significant change in 6MWD values. Patient age was a risk factor for clinical worsening, while female sex, scleroderma subtype, and lower NT-proBNP levels were associated with significantly lower mortality risk.

Objective: Endothelium-dependent (ED) and endothelium-independent (EI) flow-mediated vasodilatation (FMD) have been used as measures of systemic arterial vasodilatory reserve. In this study, we aimed to assess both ED-FMD and EI-FMD in different groups with pulmonary hypertension (PH), and to investigate the relationship of these measures with clinical, echocardiographic, and invasive parameters of diseases severity and targeted treatment status.
Methods: Our study population comprised 41 patients with PH [28 (68.2%) women, age 46.3±19.6 years] including idiopathic pulmonary arterial hypertension, Eisenmenger syndrome, and chronic thromboembolic PH in whom diagnosis were confirmed in accordance with current guidelines and 17 age and sex-matched healthy controls. The brachial artery (BA) was used for assessment of FMD with Duplex ultrasound, and serial changes in diameter were recorded at baseline, 1, and 3 minutes after termination of 2-minute external occlusive compression for ED-FMD, and after sublingual intake of glycerol trinitrate for EI-FMD, respectively.
Results: Compared with controls, overall the PH group showed significantly lower ED-FMD (0.65±0.21 vs. 0.30±0.23 and 0.65±0.18 vs. 0.24±0.21) and EI-FMD (0.67±0.15 vs. 0.37±0.25 and 0.75±0.20 vs. 0.32±0.24) responses at 1st and 3rd min (p<0.001 for all). All these changes in the values of ED-FMD and EI-FMD were comparable among the PH subgroups. Neither ED-FMD nor EI-FMD were correlated with measures of PH severity and targeted therapy (TT) status (p>0.05).
Conclusion: Our results suggest an impaired BA vasodilatory reserve in patients with PH regardless of the clinical subgroup. Although these findings seem to be consistent with systemic dysfunction, acute FMD may not reflect the severity of PH and cannot be used as a potential surrogate for outcome in this setting.