Incomplete right bundle branch block (IRBBB), an entity undefined by a general consensus, can express a large pallet of both benign and pathological patterns. IRBBB is a common electrocardiogram (ECG) finding at all ages, more frequent in men and athletes. Usually, IRBBB does not need further evaluation; however, if abnormalities are found on the clinical exam, heart disease should be excluded. The RSR’ pattern and a QRS width below 100 ms define the crista supraventricularis (CSV) pattern. CSV is a right ventricular crest, one of the last structures to be depolarized by the Purkinje network. CSV pattern might result from posterior apex deviation, subpulmonic area delay, or late CSV activation. IRBBB can appear because of higher placement of electrodes V1 and V2 and pectus excavatum, in which P wave is negative, or in athletes, considered a benign pattern unless family history, symptoms, or left ventricular hypertrophy. It is necessary to differentiate IRBBB from pathological patterns such as type-2 Brugada ECG pattern, right ventricular enlargement, arrhythmogenic right ventricular cardiomyopathy, ventricular preexcitation—Wolf-Parkinson-White syndrome, and hyperkalemia. Examiners should be particularly alert to the splitting of the second heart sound because RBBB is a common finding in ostium secundum atrial septal defect. Therefore, clinicians need to be familiar with this ECG finding, which is not always a benign condition.

Amaç: Bu çalışmadaki amacımız gerçek yaşam verilerini taşıyan hasta grubumuzda multidisipliner olarak değerlendirilmiş ve yapılmış olan KAS işleminin ilk 30 günlük klinik, periprosedürel asemptomatik kranial emboli ve uzun dönem restenoz sonuçlarını değerlendirmektir.
Yöntemler: Merkezimizde Aralık 2010 ile Şubat 2019 tarihleri arasında ardışık olarak KAS işlemi yapılmış olan 610 hasta ortalama 6 yıl boyunca klinik ve radyolojik olarak takip edildi. Hastalarımızın 274 (%45) tanesi karotis arter darlığı açısından semptomatik, 336 (%55) tanesi ise asemptomatik idi. Emboli koruma yöntemi olarak; hastaların %52’sinde distal koruma, %43’ünde proksimal koruma, %0.3 ‘ünde double (distal + proksimal) koruma kullanıldı.
Bulgular: KAS İşlem başarısı % 96 idi. Başarılı şekilse KAS işlemi uyguladığımız hastalardan 4 (%0.6) tanesinde işlemle ilişkilendirilen exitus izlendi. Toplam 4 (%0.6) hastada akut karotis arter stent trombozu görüldü. 2 (%0.3) hastada hiperperfüzyon sendromu yaşandı.2 (%0.3) hastada periprosedürel majör stroke, 12 (1.9) hastada periprosedürel minör stroke izlendi. Periprosedürel ilk 30 günlük toplam klinik komplikasyon oranları asemptomatik ve semptomatik gruplarda sırasıyla 10 (1.6%), 19 (3.1%) olarak izlendi. 61 (%11.6) hastada kranial magnetik rezonans (KMR)’ da asemptomatik ipsilateral kranial mikroemboli, 20 (%3.8) hastada asemptomatik kontrlateral kranial mikroemboli, 23 (%4.4) hastada bilateral asemptomatik kranial mikroemboli saptandı. Toplam 24 hastada (%3,9) asemptomatik restenoz izlendi.
Sonuç: KAS işlemi, multidisipliner değerlendirmeyle karar verilip uygulandığında, riskli hasta gruplarında da olmak üzere, semptomatik ve asemptomatik karotis arter darlıklarının tedavisinde klavuzların kabul ettiği komplikasyon ve başarı oranlarıyla uygulanabilir, güvenilir bir tedavi seçeneğidir.

Objective: This study aimed to evaluate the first 30-day results of clinical, periprocedural asymptomatic cranial embolism, and long-term restenosis of the multidisciplinary conducted and evaluated carotid artery stenting (CAS) procedure in our patient group with real-life data.
Methods: A total of 610 patients who were subjected to consecutive CAS procedures in our center between December 2010 and February 2019 were clinically and radiologically followed up for a mean duration of 6 years. Of the 610 patients, 274 (45%) were symptomatic for carotid artery stenosis, whereas 336 (55%) were identified as asymptomatic. As embolism protection methods, distal protection, proximal protection, and double (distal + proximal) protection was used in 52%, 43%, and 0.3% of patients, respectively.
Results: The success rate of the CAS procedure was 96%. Procedure-related death was reported in 4 (0.6%) patients who successfully underwent the CAS procedure. Moreover, acute carotid artery stent thrombosis, hyperperfusion syndrome, periprocedural major stroke, and periprocedural minor stroke was observed in 4 (0.6%), 2 (0.3%), 2 (0.3%), and 12 (1.9%) patients, respectively. The total clinical complication rates during the first 30 periprocedural days were 1.6% (10 patients) and 3.1% (19 patients) in the asymptomatic and symptomatic groups, respectively. On cranial magnetic resonance imaging performed, asymptomatic ipsilateral cranial microembolism, asymptomatic contralateral cranial microembolism, and bilateral asymptomatic cranial microembolism was detected in 61 (11.6%), 20 (3.8%), 23 (4.4%) patients, respectively. Asymptomatic restenosis was observed in 24 (3.9%) patients.
Conclusion: The CAS procedure is a reliable treatment option applicable with acceptable complication and success rates as outlined in the guidelines, when performed following a multidisciplinary evaluation, in the treatment of symptomatic and asymptomatic carotid artery stenosis, including high-risk patient groups.

Objective: This study evaluates the safety and efficacy of percutaneous coronary intervention in moderately and severely calcified coronary lesions, which are either not crossed or dilated using a Scoreflex balloon at nominal pressure, using single-burr rotational atherectomy (burr–artery ratio, ≤0.6) followed by scoring balloon dilatation (balloon–artery ratio, 0.9).
Methods: We retrospectively identified 144 patients with severely and moderately calcified native coronary lesions, which were either not crossed or fully opened using an appropriately sized Scoreflex balloon at nominal pressure, from a tertiary care center in India. All patients underwent rotational atherectomy. The primary endpoint was angiographic and procedural success and in-hospital clinical outcomes. The secondary endpoint was the incidence of major adverse cardiac events (MACE) at one-year clinical follow-up.
Results: The mean age of the patients was 68.75±8.37 years, and 83.33% of them were over 60 years old. Moderate calcification was present in 21.53%, and the remaining 78.47% had severe calcification. Procedural success was achieved in 139 (96.52%) patients. In-hospital death was reported in four (2.77%) patients. Multiple regression analysis revealed that in severely calcified coronary lesions, burr rotation speed and heparin dose were significantly associated with in-hospital MACE occurrence (p=0.0337).
Conclusion: A modified small-burr rotational atherectomy technique with scoring balloon angioplasty pre-dilatation is a safe and effective surgical procedure with favorable clinical outcomes for moderately and severely calcified coronary lesions.

Objective: Novel hemostasis strategies, including PreludeSYNC DISTAL, Merit Medical Systems, Inc. South Jordan, UT, USA (PSD) radial compression device for distal radial artery (DRA) access, have been described for radial access protocols. This study aimed to compare the safety profile of PSD and Terumo radial (TR) Band®.
Methods: This prospective interventional study was conducted on patients who underwent coronary interventions via either the DRA or forearm radial artery (FRA). Patients with an arterial diameter of <2 mm, requiring dialysis, with unstable acute coronary syndrome, failed radial cannulation, and sheath insertion were excluded. PSD and TR Band® were used for hemostasis after DRA and FRA access, respectively. The time to hemostasis and complications, including minor/major hematoma, radial artery occlusion (RAO), and neurological symptoms (after 20 days) were recorded. The mean and standard deviation were calculated for age and hemostasis duration. Frequency and percentages were calculated for categorical variables. Independent t-test and Chi-squared test were performed to determine the significance of the differences between the two groups. A p-value of <0.05 was significant.
Results: Of 139 participants, TR Band® and PSD were used in 76 and 63 patients, respectively. The mean age of the participants was 58.70±10.00 years, and the majority of the patients were men (67.60%). The hemostasis time of both devices was similar (p>0.490). Compared with PSD, TR Band® had more complications (52.63% vs. 23.81%; p=0.020), particularly RAO [odds ratio (OR), 3.17; p=0.018] and neurological problems (OR, 5.33; p=0.005).
Conclusions: Although, PSD seems safer in patients with coronary interventions, the device should further be explored in crossover trials for the two access types to determine the overall safety profile.

Amaç: Son dönem toplum-tabanlı çalışmalarda uyku yoksunluğunun yüksek kan basıncı için önemli, modifiye edilebilir bir risk faktörü olduğu tanınlanmıştır. Ancak, uykusuzluk ve hipertansiyon ilişkisinde altta yatan mekanizmalar açık değildir. Bu çalışmada uyku yoksunluğunda kardiyak otonom stres testlere kan basıncı yanıtını araştırmayı amaçladık. Ayrıca, uyku kaybını kan basıncı artışına bağlayabilecek olası mekanizma olarak vasküler inflamatuvar biyobelirteçleri inceledik.
Yöntemler: On sağlıklı erkek gönüllü (ortalama yaş = 21,6 ± 1,2 yıl) ardışık üç gün boyunca (başlangıç, uyku yoksunluğu, ve telafi günleri) tekrarlanan otonom stres testlere alındılar. Otonom stres testler Valsalva manevrası, mental aritmetik, izometrik el sıkma ve soğuk pressör testlerini içerdi. Deney günlerinde dinlenim kan basıncı ve kalp tepe atımı ölçümleri yapıldı ve serum ICAM-1, VCAM-1 ve E-selektin ölçümü için venöz kan örnekleri toplandı. Stres testler sabah saat 09.00-11.00 arasında tamamlandı. Ambulatuvar kan basıncı kayıtları tüm uyku yoksunluğu süresince (24 saat) yapıldı.
Bulgular: Bir gece uyku yoksunluğu Valsalva, izometrik el sıkma, ve soğuk pressör testlerine kan basıncı reaktivitesini ortadan kaldırdı ve bu etki telafi uykusu sonrası düzeldi. Ambulatuvar kan basıncı takibi uyku yoksunluğu süresince ortalama sistolik ve diyastolik kan basınçlarının saat 07.00-23.00 arasında 121.1 ± 8.5 ve 72.8 ± 6.3 mm Hg iken saat 23.00-07.00 arasında 120.3 ± 9.6 ve 74.1 ± 6.1 mm Hg olduğunu gösterdi (her ikisi için p>0.05). Vasküler inflamatuvar belirteçler ile kan basıncı değişiklikleri arasında ilişki saptanmadı.
Sonuç: Sağlıklı erkeklerde akut uyku yoksunluğu dinlenim kan basıncı düzeylerini etkilemeden kardiyak otonom stres testlere kan basıncı yanıtlarını değiştirdi. Ambulatuvar kan basıncı kayıtları uyku yoksunluğunun bir çeşit “non-dipping” paterne yol açtığını düşündürdü. Bu bulgular kan basıncı düzenlenmesinde uykunun önemini vurgulamaktadır.

Objective: Recent community-based studies have identified sleep deprivation (SD) as an important modifiable risk factor for hypertension However, the underlying mechanisms linking SD to hypertension remain elusive. Thus, this study investigates blood pressure (BP) responses to cardiac autonomic stress tests in the presence of SD. Furthermore, we analyzed vascular inflammatory biomarkers as a possible underlying factor linking SD to increased BP.
Methods: Ten healthy male volunteers (age, 21.6±1.2 years) underwent repeated autonomic stress tests for three consecutive days (baseline, SD, and recovery). The autonomic stress tests included the Valsalva maneuver, mental arithmetic, isometric handgrip, and cold pressor tests. Each day, resting BPs were measured, venous blood samples were collected for intercellular adhesion molecule 1, vascular cell adhesion molecule 1, and E-selectin measurements, and stress tests were performed between 0900 and 1100. Ambulatory BP was recorded during the entire SD period (24 h).
Results: One-night SD abolished BP reactivity to the Valsalva maneuver, isometric hand grip, and cold pressor tests, which returned after recovery sleep. Ambulatory BP monitoring showed that the mean systolic and diastolic BPs were 121.1±8.5 mm Hg and 72.8±6.3 mm Hg, respectively, between 0700 and 2300 and 120.3±9.6 mm Hg and 74.1±6.1 mm Hg, respectively, between 2300 and 0700 during the SD day (p>0.05 for both). Vascular inflammatory markers seemed unrelated to BP changes.
Conclusion: Acute SD altered BP responses to cardiac autonomic stress tests in healthy men without affecting resting BP levels. SD led to a non-dipping pattern in BP oscillation. Collectively, these findings highlight the importance of sleep in regulating BP.

Objective: This study aimed to investigate the functions of mRNA, long non-coding RNA (lncRNA), and circular RNA (circRNA) in paroxysmal and persistent atrial fibrillation (AF) patients.
Methods: A total of 9 left atrial appendage (LAA) tissues were collected from patients with AF (ParoAF patients = 3 and PersAF patients = 3) and donors (n=3). Genes and circRNAs were identified by per kilobase per million reads (RPKM) and number of circular reads/number of mapped reads/read length (SRPBM), respectively. Differentially expressed mRNAs (DE mRNAs), lncRNAs (DE lncRNAs), and circRNAs (DE circRNAs) were identified by | log2 (Fold Change) | ≥ 2 and p-value < 0.05. Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed. Protein-protein, mRNA-lncRNA, and circRNA-miRNA interaction networks were constructed. In addition, logistic analysis was conducted among AF and circRNAs.
Results: A total of 285 (116 up-regulated and 169 down-regulated) and 275 (110 up-regulated and 165 down-regulated) DE mRNAs, 575 (276 up-regulated and 299 down-regulated) and 583 (330 up-regulated and 253 down-regulated) DE lncRNAs, and 83 (48 up-regulated and 35 down-regulated) and 99 (58 up-regulated and 41 down-regulated) circRNAs were detected in ParoAF and PersAF, respectively, as compared with control. MAPK signal pathway as well as voltage-dependent, L type, and alpha 1C subunit calcium channel (CACNA1C) might participate in AF occurrence by preventing atrial parasympathetic remodeling. Collagen type I alpha 1 (COL1A1) and COL1A2 mostly participated in the enriched GO and KEGG terms and connected with most of the DE mRNAs. The expression of chr10: 69902697|69948883 was a protective factor against PersAF after adjusting for age (p=0.022, 95% CI: 0.003–0.634).
Conclusion: We found that some mRNAs, lncRNAs, circRNAs, and pathways play essential roles in AF pathogenesis and development. Moreover, one protective factor against PersAF was detected.

Objective: This study investigated the potential microRNAs (miRNAs) having a diagnostic value in atrial fibrillation (AF).
Methods: The miRNA and mRNA expression profiles of atrial tissue from healthy individuals and patients with AF were downloaded from the Gene Expression Omnibus database. Differentially expressed miRNAs/mRNAs (DEMis/DEMs) were identified in patients with AF. Furthermore, an interaction network between DEMis and DMEs was constructed. The biological processes, molecular functions, and signaling pathways of DEMs were enriched. Then, the diagnostic values of candidate DECs among healthy individuals and patients with AF were preliminarily evaluated in the GSE101586, GSEE101684, and GSE112214 datasets.
Results: Twenty DEMis were identified in patients with AF, including seven upregulated and 13 downregulated DEMis. Furthermore, 2,307 DEMs were identified in patients with AF. In the DEMi–DEM interaction network, downregulated miR-193b and upregulated miR-16 interacted with the most targeted DEMs, which interacted with 72 and 65 targeted DEMs, respectively. The targeted DEMs were significantly enriched in biological functions including apoptosis and the PI3K–Akt, mTOR, Hippo, HIF-1, and ErbB signaling pathways. Four of the 20 DEMis (i.e., miR-490-3p, miR-630, miR-146b-5p, and miR-367) had a potential value to distinguish patients with AF from healthy individuals in the GSE68475, GSE70887, and GSE28954 datasets. The area under the curve values for those four DEMis were 0.751, 0.719, 0.709, and 0.7, respectively.
Conclusion: DEMis might play key roles in AF progression through the mTOR and Hippo signaling pathways. miR-409-3p, miR-630, miR-146b-5p, and miR-367 had a potential diagnostic value to discriminate patients with AF from healthy controls in this study.

Giriş: Kalp nakli adaylarında, artmış pulmoner arter basıncı (PAB) ve pulmoner vasküler resistans (PVR) önemli bir prognostik faktördür. İleri mitral yetersizliğinin, (PAB)’ı arttırdığı iyi bilinmektedir. Ancak, Avrupa Kardiyoloji Derneği ileri fonksiyonel mitral yetersizliği (FMY) tanımını ve 6. Dünya Pulmoner Hipertansiyon Sempozyumu da pulmoner hipertansiyon (PH) tanımını güncelledi. Bu iki yeni tanım baz alınarak, kalp nakli adaylarında, ileri FMY’nin PAB ve PVR üzerindeki etkisini araştırmayı amaçladık. Yöntem: Toplam 212 tane kalp nakli adayı ileri FMY’si olanlar (n=70) ve olmayanlar (n=142) olmak üzere iki gruba ayrıldı. İleri FMY, mitral kapak morfolojisi normal iken, efektif regurgitan orifis alanının ≥20 mm2 ve regurgitan hacminin de ≥30 ml olması ve PH ise ortalama PAB’nın > 20 mmHg olması olarak tanımlandı. Sol ventrikül ejeksiyon fraksiyonu ≤ %25 olanlar çalışmaya dahil edildi. Bulgular: Sistolik PAB, ortalama PAB ve PVR ileri FMY’si olanlarda olmayanlara kıyasla daha yüksekti [58.5 (48.0-70.2) & 45.0 (36.0-64.0), p<0.001; 38.0 (30.2-46.6) & 31.0 (23.0-39.5), p=0.004; 4.0 (2.3-6.8) & 2.6 (1.2-4.3), p=0.001, sırasıyla]. Tek değişkenli regresyon analizinde, ileri FMY, PVR ≥3 ve 5 WU olması açısından bir risk faktörü olarak tespit edildi (OR: 2.0, % 95 CI: 1.1-3.6, p=0.009; ve OR: 3.2, % 95 CI: 1.5-6.7, p=0.002).Çok değişkenli regresyon analizi sonuçları, şiddetli FMR varlığının PVR’nin ≥3WU olması ve kombine pre-post kapiller PH için bağımsız bir risk faktörü olduğunu ortaya koymuştur (OR: 2.23, % 95 CI: 1.30-3.82, p=0.003 ve OR: 2.30, % 95 CI: 1.25-4.26, p=0.008). Sonuç: Daha düşük bir eşikle güncellenmiş biçiminde bile, şiddetli FMR, daha yüksek PVR, sistolik ve ortalama PAB ile ilişkilidir ve kalp nakli adaylarında pulmoner hemodinamikler üzerinde olumsuz bir etkiye sahip gibi görünmektedir

Objective: Increased pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) are important prognostic factors in patients with heart transplantation (HT). It is well known that severe mitral regurgitation increases pulmonary pressures. However, the European Society of Cardiology and the 6th World Symposium of pulmonary hypertension (PH) task force redefined severe functional mitral regurgitation (FMR) and PH, respectively. We aimed to investigate the effect of severe FMR on PAP and PVR based on these major redefinitions in patients with HT.
Methods: A total of 212 patients with HT were divided into 2 groups: those with severe FMR (n=70) and without severe FMR (n=142). Severe FMR was defined as effective orifice regurgitation area ≥20 mm2 and regurgitation volume ≥30 mL where the mitral valve was morphologically normal. A mean PAP of >20 mm Hg was accepted as PH. Patients with left ventricular ejection fraction ≤25% were included in the study.
Results: The systolic PAP, mean PAP, and PVR were higher in patients with severe FMR than in those without severe FMR [58.5 (48.0–70.2) versus 45.0 (36.0–64.0), p<0.001; 38.0 (30.2–46.6) versus 31.0 (23.0–39.5), p=0.004; 4.0 (2.3–6.8) versus 2.6 (1.2–4.3), p=0.001, respectively]. Univariate analysis revealed that the severe FMR is a risk factor for PVR ≥3 and 5 WU [odds ratio (OR): 2.0, 95% confidence interval (CI): 1.1–3.6, p=0.009; and OR: 3.2, 95% CI: 1.5–6.7, p=0.002]. The multivariate regression analysis results revealed that presence of severe FMR is an independent risk factor for PVR ≥3 WU and presence of combined pre-post-capillary PH (OR: 2.23, 95% CI: 1.30–3.82, p=0.003 and OR: 2.30, 95% CI: 1.25–4.26, p=0.008).
Conclusion: Even in the updated definition of FMR with a lower threshold, severe FMR is associated with higher PVR, systolic PAP, and mean PAP and appears to have an unfavorable effect on pulmonary hemodynamics in patients with HT.