A lot of data about coronavirus disease 2019 (COVID-19) have been already published; however, these still form only a part of the pandemic puzzle. Once we have all the pieces of the puzzle, we will be able to successfully treat this disease with its multiple challenges. COVID-19 has a high thrombogenic potential. In this study, we aimed to review published data about COVID-19 associated thrombosis from pathophysiology to treatment and the role in patient evolution. We searched for articles and studies published online through MEDLINE/PubMed database, Google Scholar, ScienceDirect, Wiley Online Library, and Nature Public Health Emergency Collection. We found numerous articles regarding COVID-19 infection but selected only those focused on thrombosis. D-dimers have a predictive value in identifying thrombosis and a high level correlates with the severity of the infection and death. Most patients who were on chronic anticoagulant therapy before contracting the virus had a better prognosis. Heparin has other favorable effects such as a direct antiviral and anti-inflammatory effect in addition to its anticoagulant effect. COVID-19 infections are frequently complicated by thrombotic pathology. High plasma level of D-dimers is a predictive factor for severe prognosis, and the recommended anticoagulant, associated with low mortality, is heparin followed by a direct oral anticoagulant. Randomized studies in large groups of patients and therapeutic guidelines are still needed on this subject.

Amaç: ST segment yükselmeli miyokard infarktüsü (STEMI) olan hastalarda atriyal fibrilasyon (AF) insidansı % 7-21 arasında değişmekte olup bu çalışmaların çoğu trombolitik çağa aittir. Ancak, primer perkütan koroner girişim (PKG) döneminde yeni başlayan AF'nin sıklığı hala belirsizdir. Biz, primer PKG uygulanan hastalarda yeni başlayan AF'nin sıklığını ve uzun dönem klinik olaylar üzerindeki etkilerini araştırmayı amaçladık.
Metod: STEMI tanısı alan ve primer PKG uygulanan toplam 1603 hasta çalışmaya dahil edildi. İşlemden sonra tüm hastalar en az 48 saat monitörize edildi. Çalışmanın birincil sonlanım noktası, hastanede kalış sırasında yeni başlayan AF olarak tanımlandı.
Sonuçlar: Çalışmamızın medyan takip süresi 44 aydı. 85 (% 6.1) hastada yeni başlayan AF gelişti. CHADsVASc >2, Killip >2 ve sol atriyal çapı yeni başlangıçlı AF gelişiminin bağımsız prediktörleri olarak bulundu. AF (+) grubunda, tüm nedenlere bağlı ve hastane içi ölüm oranları anlamlı olarak daha yüksek bulundu. STEMI hastalarında yeni başlayan AF gelişimi, hastane içi mortalitenin bağımsız bir prediktörü olarak tespit edildi.
Varılan Kanı: Primer PTCA çağında, yeni başlayan AF oranlarının literatür verilerinden daha düşük olduğu tespit edildi. Ek olarak, yeni başlayan AF'nin hastane içi mortalitenin bir prediktörü olduğu ve ölümlerin çoğunlukla erken dönemde meydana geldiği saptandı. Bu nedenle bu hastaların erken dönemde yakın takip edilmesi ve hasta stabil hale geldiğinde AF yükü açısından yeniden değerlendirilmesi önem taşımaktadır.

Objective: The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocardial infarction (STEMI) varies between 7% and 21%, and most of these studies were in the thrombolytic era. However, the frequency of new-onset AF during the primary percutaneous coronary intervention (PCI) period is still unclear. We aimed to investigate the frequency of new-onset AF and its effects on long-term clinical events in patients undergoing primary PCI.
Methods: A total of 1,603 patients who were diagnosed with STEMI and underwent primary PCI were included in the study. All the patients were monitored for at least 48 hours after the procedure. The primary endpoint of the study was defined as new-onset AF during hospitalization.
Results: The median follow-up period of our study was 44 months. New-onset AF developed in 85 (6.1%) patients. CHADs-VASc > 2, KILLIP > 2, and left atrial diameter were found to be independent predictors for the development of new-onset AF. In the AF (+) group, the all-cause and in-hospital mortality rates were found to be significantly higher. New-onset AF development in patients with STEMI was detected as an independent predictor of in-hospital mortality.
Conclusion: In the era of primary percutaneous transluminal coronary angioplasty, new-onset AF rates were found to be lower than the literature data. In addition, new-onset AF was found to be a predictor of in-hospital mortality, and deaths occurred mostly in the early period. Therefore, close follow-up of these patients in the early period and re-evaluation in terms of AF burden when the patient becomes stable are important.

Amaçlar: Yürüme hızının prognostik önemi düşünüldüğünde, düşük ejeksiyon fraksiyonlu kalp yetersizliği hastalarında yürüme hızının olası fonksiyonel belirleyicileri hakkında yeterli kanıt yoktur. Bu nedenle, bu çalışmanın amacı düşük ejeksiyon fraksiyonlu kalp yetersizliği hastalarında yürüme hızının fonksiyonel belirleyicilerini araştırmaktı.
Yöntemler: Bu kesitsel çalışmaya düşük ejeksiyon fraksiyonlu elli dokuz kalp yetersizliği hastası dahil edildi. Demografik ve klinik özellikler kaydedildi. Yürüme hızı 4m yürüme testi ile belirlendi. Dispne algılaması, modifiye Tıbbi Araştırma Konseyi skalası ile değerlendirildi. Fonksiyonel kapasite, 6 dakika yürüme testi (6DYT) ile değerlendirildi. Fonksiyonel mobilite ve dengeyi ölçmek için beş tekrarlı otur-kalk (5-TOK) testi ve Berg Denge Ölçeği (BDÖ) kullanıldı. Fiziksel aktivite, Uluslararası Fiziksel Aktivite Anketi (IPAQ) Kısa Form ile değerlendirildi.
Bulgular: Yürüme hızı ile yaş (r = -0,368, p = 0,004), NYHA fonksiyonel sınıfı (r = -0,438, p = 0,001), mMRC skoru (r = -0,422, p = 0,001), 6DYT (r = 0,650, p < 0,001), 5TOK (r = -0,506, p = 0,001), BDÖ (r = 0,586, p < 0,001), IPAQ (r = 0,305, p = 0,019) ve IPAQ-oturma süresi (r = -0,327, p = 0,011) korele idi. Çoklu doğrusal regresyon analizinde, normal yürüme hızının bağımsız belirleyicileri 6DYT mesafesi ve BDÖ idi ve varyansın % 44,4'ünü oluşturuyordu.
Sonuç: Bu çalışma, düşük ejeksiyon fraksiyonlu kalp yetersizliği hastalarında fonksiyonel kapasite ve dengenin yürüme hızının bağımsız fonksiyonel belirleyicileri olduğunu göstermektedir.

Objective: Given the prognostic significance of gait speed, there is insufficient evidence about possible functional determinants of gait speed in patients with heart failure with reduced ejection fraction (HFrEF). Therefore, the objective of this study was to investigate the functional determinants of gait speed in patients with HFrEF.
Methods: Fifty-nine patients with HFrEF participated in this cross-sectional study. Demographic and clinical characteristics were recorded. The gait speed was determined with a 4-meter walking test. Dyspnea perception was assessed with the modified medical research council (mMRC) scale. Functional capacity was evaluated with a 6-minute walk test (6MWT). The five times sit-to-stand (5-STS) test and the Berg Balance Scale (BBS) were used to measure functional mobility and balance. Physical activity was evaluated with the International Physical Activity Questionnaire (IPAQ) Short-Form.
Results: Gait speed was correlated with age (r=−0.368, p=0.004), NYHA functional class (r=−0.438, p=0.001), mMRC score (r=−0.422, p=0.001), 6MWT (r=0.650, p<0.001), 5STS (r=−0.506, p<0.001), BBS (r=0.586, p<0.001), IPAQ (r=0.305, p=0.019) and IPAQ-Sitting time (r=−0.327, p=0.011). On multiple linear regression analysis, the 6MWT distance and BBS were independent determinants of the usual gait speed in patients with HFrEF, accounting for 44.4% of the variance.
Conclusion: This study indicates that functional capacity and balance are independent functional determinants of gait speed in patients with HFrEF.

Objective: In this study, we aimed to determine whether admission hemoglobin versus post-percutaneous coronary intervention (PCI) hemoglobin level at 24 hours is a predictor of in-hospital mortality for patients with ST elevation myocardial infarction (STEMI) without evidence of clinical hemorrhage who underwent primary PCI.
Methods: In this study, we included 1,444 consecutive patients with STEMI who underwent primary PCI at a tertiary heart hospital. The primary outcome of the study was the in-hospital all-cause mortality. We used the penalized maximum likelihood estimation (PMLE) logistic regression method to examine the relationship between primary outcome and candidate predictors.
Results: In total, 172 (11.9%) patients died during the in-hospital course. According to a PMLE logistic regression analysis, age, KILLIP class ≥2, pre-PCI thrombolysis in myocardial infarction (TIMI) flow <3, systolic blood pressure, creatinine, glycoprotein IIb/IIIa inhibitor use, and post-PCI hemoglobin levels at 24 hours were predictors of in-hospital mortality. The relative importance of post-PCI hemoglobin at 24 hours (contributing 6% of the explainable outcome in the model) was significantly higher than admission hemoglobin (contributing only 0.1% of the explainable outcome in the model).
Conclusion: This study demonstrated that post-PCI hemoglobin levels were independently associated with in-hospital survival in patients with STEMI without evidence of bleeding following primary PCI. In addition, post-PCI hemoglobin was a better predictor of in-hospital mortality than admission hemoglobin for patients with STEMI who underwent primary PCI.

Objective: In this study, we aimed to evaluate the possible function of miR-130a in atherosclerosis (AS), protection against AS, and its molecular biological mechanism.
Methods: Apoe-/- mice were fed a high-fat diet as the AS mice model. Human umbilical vein endothelial cells (HUVECs) were used as in vitro model. Serum samples or cells were used to measure the expression of inflammation. Serum samples or cells were used to determine MiRNA expression profiles using the edgeR tool from Bioconductor. Western Blot analysis was used to assess protein expressions of proliferator-activated receptor γ (PPARγ) and nuclear factor (NF)-κB.
Results: MiRNA-130a expression was up-regulated in atherosclerotic mice. In addition, over-expression of miRNA-130a promoted inflammation factors [tumor necrosis factor (TNF)-α and interleukin (IL)-1β, IL-6, and IL-8] in the in vitro model of AS. However, down-regulation of miRNA-130a reduced inflammation (suppressed TNF-α, IL-1β, IL-6 and IL-8) in the in vitro model. Furthermore, over-expression of miRNA-130a could also suppress the protein expression of PPARγ and induce NF-κB protein expression in the in vitro model. However, suppression of miRNA-130a induced the protein expression of PPARγ and suppressed NF-κB protein expression in the in vitro model of AS. Activation of PPARγ reduced the pro-inflammatory effects of miRNA-130a on the AS-induced in vitro model.
Conclusion: These results strongly support that miRNA-130a suppression can protect against atherosclerosis through inhibiting inflammation by regulating the PPARγ/ NF-κB expression.

Objective: In this study, we aimed to examine the prognostic impact of decreased kidney function at admission on the occurrence of new-onset atrial fibrillation (AF) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI).
Methods: The study enrolled 3,115 consecutive patients with STEMI. Kidney function was assessed by estimation of the glomerular filtration rate (eGFR) at admission. Patients with cardiogenic shock at admission, patients on hemodialysis, and patients with a medical history of previous AF (paroxysmal, persistent, or permanent) were excluded. The follow-up period was six years.
Results: New-onset AF occurred in 215 (6.9%) patients, 75 (34.9%) patients presented with AF, and 140 (65.1%) patients developed AF after pPCI. The median time of AF occurrence in patients who did not present with AF was 4.5 (interquartile range 1–25) hours after pPCI. New-onset AF was associated with a higher short- and long-term mortality. In the multiple logistic regression analysis, all stages of reduced kidney function were independent predictors for the occurrence of new-onset AF, and negative prognostic impact increased with the deterioration of kidney function: eGFR <90 mL/min/m2, hazard ratio (HR) 1.96, 95% confidence interval (CI) 1.42-2.89, p=0.011; eGFR 60-89 mL/min/m2, HR 1.54, 95% CI 1.13-2.57, p=0.045; eGFR 45-59 mL/min/m2-, HR 2.09, 95% CI 1.24-2.85, p=0.023; eGFR 30-44 mL/min/m2-, HR 2.93, 95% CI 1.64-5.29, p<0.001; eGFR 15-29 mL/min/m2-, HR 5.51, 95% CI 2.67-11.39, p<0.001.
Conclusion: Decreased kidney function was significantly associated with the occurrence of new-onset AF, and its impact increased with the deterioration in kidney function, starting with an eGFR value of 90 mL/min/m2. New-onset AF was an independent predictor of long-term all-cause mortality in the analyzed patients.

Amaç: Elektrofizyolojik çalışma (EPS), çarpıntının kardiyak kökenini saptamak adına en yararlı tanısal yaklaşımlardan biri olmasına rağmen, belgelenmiş supraventriküler taşikardisi (SVT) olmayan (SVT) çarpıntılı hastalarda EPS gerekliliğini gösteren net bir kriter yoktur. Bu çalışmamızda, belgelenmiş taşikardisi olmayan çarpıntılı hastalarda EPS gerekliliğini saptamak için yeni bir SVT skor modeli oluşturmayı amaçladık.
Metot: Çalışmaya çarpıntı yakınması ile başvuran toplam 154 hasta dahil edildi. SVT skorunu oluşturma adına alt kategorileri de olmak üzere dört ana kriter belirlendi. Onlar semptomların 1- Ciddiyeti, 2- Sıklığı, 3- Süresi ve 4- Sonlanım biçimleri idi. Puanlama değerlendirmelerinden sonra tüm hastalara EPS uygulandı.
Sonuçlar: Taşikardi uyarılan ve uyarılamayan hastaların ortanca skorları sırası ile 10 ve 6 olarak tespit edildi ki bu durum istatistiksel olarak anlamlı bulundu; p<0.001. ROC analizi ile indüklene bilirlik için eşik değer 7,5 puan (%94,9 duyarlılık, %92,1 özgüllük) ve eğri altındaki alan 97,2 (94,8-99,5, p <0,001) olarak belirlendi.
Sonuç: Yeni SVT skor modelimize göre, 8 ve üzeri puanlar, EPS sırasında SVT indüklene bilirliği ile güçlü bir şekilde ilişkilidir.

Objective: Although electrophysiological study (EPS) is one of the most useful diagnostic approaches to detect the cardiac origin of palpitations, there is no clear indication for EPS in patients with palpitation in the absence of documented supraventricular tachycardia (SVT). In this study, we aimed to create a new SVT score model to detect the requirement of EPS in patients with palpitation without documented tachycardia.
Methods: A total of 154 patients with palpitation were included in this study. To create the SVT score, we considered four main criteria with their subunits. They were severity, frequency, duration, and termination of the symptoms. EPS was performed on all the patients after their scoring assessment.
Results: Median SVT score of induced tachycardia and non-induced patients was determined as 10 and 6 points, respectively; and it was found to be statistically significant; p<0.001. The cut-off value for inducibility was found to be 7.5 points through receiver operating characteristic curve analysis, (94.9% sensitivity, 92.1% specificity), and the area under the curve was determined to be 97.2 (94.8–99.5, p<0.001).
Conclusion: According to our new SVT score model, ≥8 points strongly correlates with the inducibility of SVT during EPS.

Amaç: Gama-glutamil transferaz (GGT)/albümin oranının (GAO) koroner arter hastalığının (KAH) teşhisine ve ciddiyetine karar vermede yardımcı olduğu gösterilmiştir. Koroner bilgisayarlı tomografi anjiyografi (KBTA), koroner plakların varlığı, ciddiyeti ve morfolojisi hakkında bilgi veren kılavuzlar tarafından önerilen non-invaziv bir testtir. Bu çalışmanın amacı, daha önce KAH tanısı konulmamış, düşük ve orta riskli olan bireylerde, GAO ile KBTA'da saptanan koroner plakların varlığı, morfolojisi ve ciddiyeti arasındaki ilişkiyi araştırmaktır.
Yöntemler: KBTA yapılan toplam 966 hasta çalışmaya dahil edildi. Hastalarda KAH derecesi ve plak morfolojisi kaydedildi. KAH'ın yaygınlığını belirlemek için KBTA'dan elde edilen Leaman skoru (BT-LeSc) hesaplandı. Çalışma popülasyonu ayrıca GAO tertillerine göre 3 grupta değerlendirildi.
Bulgular: Aterosklerotik plakların, erkek cinsiyette ve geleneksel kardiyovasküler risk faktörleri olan yaşlı hastalarda daha sık olduğu izlendi. GAO, normal KBTA'ya sahip hastalarda, tıkayıcı veya tıkayıcı olmayan darlığı olan hastalara kıyasla önemli ölçüde daha düşüktü. Yüksek GAO tertillerindeki hastalar, daha yüksek koroner arter kalsiyum skoruna (KAKS) ve BT-LeSc'ye sahipti. GAO, ciddi stenotik plağı ve yüksek KAKS’ı öngören bağımsız öngörücülerden biriydi.
Sonuç: GAO, BT-LeSc ile belirlenen KAH'ın varlığını, yaygınlığını ve ciddiyetini bağımsız olarak tahmin edebilir. Ucuz, güvenli ve yaygın olarak ulaşılabilen bir parametre olan GAO, KAH teşhisinde kullanışlı olabilir.

Objective: Gamma-glutamyl transferase (GGT) to albumin ratio (GAR) has been shown to be helpful to diagnose and determine the severity of coronary artery disease (CAD). Coronary computed tomography angiography (CCTA) is a guide recommended non-invasive test that provides information about the presence, severity, and morphology of coronary plaques. In this study, our main aim was to investigate the relationship between the presence, morphology, and severity of coronary plaques detected via CCTA and GAR in patients with low to moderate risk for undiagnosed CAD.
Methods: Nine hundred and sixty six patients were included who underwent CCTA. The severity of CAD and plaque morphology were investigated. CT-adapted Leaman score (CT-LeSc) was calculated to determine the extent of the CAD. The study population was further evaluated in three groups according to tertiles of GAR.
Results: Atherosclerotic plaques were more common in the male gender and older patients with conventional cardiovascular risk factors. GAR was significantly lower in patients with normal CCTA than in patients with a non-obstructive plaque or obstructive plaque on CCTA. Patients in upper GAR tertiles had a higher coronary calcium score (CACS) and CT-LeSc. GAR was one of the independent predictors to predict severe stenotic plaque and high CACS.
Conclusion: GAR can independently predict the presence, extent, and severity of CAD determined by CT-LeSc. We believe as a cheap, safe, and widely available tool, GAR would be useful in the diagnosis of CAD.