Objective: Autonomic imbalance in patients with chronic heart failure (CHF) and cardiovascular diseases (CVD) is characterized by reduced parasympathetic and enhanced sympathetic activity. Aerobic exercise improves autonomic function in patients with CHF and CVD. However, little is known about the effects of resistance training (RT) on cardiac autonomic function. Therefore, we aimed to investigate the effects of RT added on aerobic training on autonomic function in patients with CHF and CVD. Data sources: The relevant clinical trials were searched in PubMed, Physiotherapy evidence Database (PEDro, Science Direct and Google Scholar databases using the following keywords, “resistance or strength training”, “chronic heart failure”, “coronary artery disease”, “myocardial infarction”, “hypertension”, “cardiovascular disease”, “heart rate variability (HRV)”, “heart rate recovery (HRR)”, “muscle sympathetic nerve activity (MSNA)”, and “autonomic function”.
Data synthesis: Twelve articles with 323 subjects were eligible to be evaluated. The outcome measures included HRV, HRR, and MSNA. There were seven studies on CHF, two on CAD, and three studies on hypertension. Meta-analysis of all the studies showed that combined RT and aerobic training decreased MSNA significantly in patients with CHF and CAD (mean difference: -3.796; CI: -6.779 to 0.813; p=0.013; I2 =93.5%). No study evaluated the effects of RT or combined training on HRR.
Conclusion: We could not find sufficient data about the effects of RT alone on HRV and HRR, but the results showed that combined RT and aerobic training improved MSNA in patients with CHF and CAD, significantly. Further studies with similar methodological principles on the same patient population are needed.

Infective endocarditis (IE) has been recognized as a biofilm-related disease caused by pathogenic microorganisms, such as bacteria and fungi that invade and damage the heart valves and endocardium. There are many difficulties and challenges in the antimicrobial treatment of IE, including multi-drug resistant pathogens, large dose of drug administration with following side effects, and poor prognosis. For the past few years, the development of nanotechnology has promoted the use of nanoparticles as antimicrobial nano-pharmaceuticals or novel drug delivery systems (NDDS) in antimicrobial therapy for chronic infections and biofilm-related infectious disease as these molecules exhibit several advantages. Therefore, nanoparticles have a potential role to play in solving problems in the treatment of IE, including improving antimicrobial activity, increasing drug bioavailability, minimizing frequency of drug administration, and preventing side effects. In this article, we review the latest advances in nanoparticles against drug-resistant bacteria in biofilm and recommends nanoparticles as an alternative strategy to the antibiotic treatment of IE.

Objective: Fragmented QRS (fQRS) has been shown to be related to coronary heart disease, heart failure, hypertension, cardiac arrhythmia, and metabolic syndrome. Although fQRS in lateral leads is shown to be associated with a poor outcome in patients with a
known cardiac disease, the knowledge about the significance and prevalence of fQRS in inferior leads is scarce. This study aimed to investigate the prevalence and predictors of fQRS in inferior leads in healthy young men.
Methods: A total of 1,155 men underwent electrocardiography (ECG), hepatic ultrasonography, and routine biochemical tests. A total of 210 eligible men with fQRS in inferior leads (group 1) and 770 eligible men without fQRS in inferior leads (group 2) were compared with each other in terms of clinical, demographic, and laboratory parameters.
Results: The prevalence of fQRS in inferior leads was found to 21.4%. Body mass index (BMI), systolic blood pressure (BP), creatinine, and alanine aminotransferase levels; non-alcoholic fatty liver disease (NAFLD) percentage; and interventricular septum thickness (IVST) were significantly greater in group 1 than those in group 2. BMI, IVST, NAFLD, creatinine, ALT, and systolic BP were entered in a model of multiple regression analyses to predict fQRS, a dependent variable. NAFLD was the best independent predictor of fQRS (β=6.115, p=0.001). BMI (β=1.448, p=0.014) and IVST (β=1.058, p=0.029) were the other independent predictors of fQRS in inferior leads.
Conclusion: This study demonstrated the association of fQRS in inferior leads with NAFLD, BMI, and IVST in young men.

Objective: Radial artery occlusion (RAO) is a common complication during transradial coronary intervention. Its incidence is variably reported in literature and its predictors are not completely understood. In this study, we aimed to define the incidence and factors influencing RAO in patients undergoing transradial coronary intervention.
Methods: This was a single-center prospective study (October 2018 to September 2019) that enrolled 1,754 patients who were evaluated for RAO 24 hours after transradial coronary intervention. Univariate as well as multivariate analyses were done to identify patient and procedure related factors predicting the occurrence of RAO.
Results: A total of 1,374 patients (78.3%) underwent angioplasty, whereas 380 (21.7%) underwent angiography alone. RAO was diagnosed in 11.97% patients. Lower glomerular filtration rate, multiple puncture attempts for radial artery access, larger sheath size, complex nature of interventional procedure, longer homeostasis time, and forearm hematoma formation were independent predictors for RAO.
Conclusion: RAO was not an uncommon complication in transradial coronary interventions, especially in the Indian population; and the knowledge of predictors may be helpful in its
prevention.

Amaç: Stent trombozu (ST), perkütan koroner girişim (PKG) yapılan hastalarda nadir fakat ciddi bir komplikasyondur. Bu çalışmanın amacı, aterosklerozu ve şiddetini belirleyebildiği bilinen bir biyobelirteç olan plazma aterojenite indeksinin (PAİ) stent trombozu üzerindeki etkisini araştırmaktır.
Yöntemler: Ocak 2018-Aralık 2020 tarihleri ​​arasında koroner anjiyografi yapılan 10258 hastadan stent trombozuna bağlı akut koroner sendrom (AKS) tanısı ile PKG uygulanan 239 hasta çalışma grubu (ST grubu) olarak, 459 hasta kontrol grubu alındı. ST sınıflandırması ARC tanımına göre yapıldı.Hastalardan yoğun bakıma alındıklarında alınan kan örneklerindeki HDL ve trigliserit değerleri kullanılarak, log (TG / HDL-C) formülüne göre PAİ hesaplandı.
Bulgular: Hastaların ortalama yaşı 63.3 ± 10.6 yıl (483 erkek,% 69.2) idi. Gruplar karakteristik özellikleri, komorbiditeleri ve kullandıkları ilaçlar açısından benzerdi (tümü için p> 0.05). Hastaların % 86,5'inde ilaç salınımlı stent kullanıldı. ST grubunda stent implantasyonundan tromboza kadar geçen medyan süre 285 gündü Çok geç ST hastaların % 41'inde ve geç ST % 40'ında meydana geldi. Medyan PAİ ST grubunda kontrollere göre istatistiksel olarak anlamlı derecede yüksekti (p <0.001) ve stent implantasyonundan tromboza kadar geçen süre ile PAİ arasında pozitif korelasyon gözlendi (rS: 0.229, p = 0.010). Çok değişkenli lojistik regresyon analizi, stent uzunluğu ve PAİ'nin ST'nin bağımsız prediktörleri olduğunu ortaya koydu.
Sonuç: PAİ, özellikle geç ve çok geç tipleri olmak üzere ST'yi tahmin etmek için bir biyolojik belirteç olarak kullanılabilir.

Objective: Stent thrombosis (ST) is an uncommon but serious complication in patients undergoing percutaneous coronary intervention (PCI). This study aimed to investigate the effect of atherogenic index of plasma (AIP) on ST.
Methods: Among the 10,258 patients who underwent coronary angiography between January 2018 and December 2020, 239 patients who underwent PCI with the diagnosis of acute coronary syndrome (ACS) due to ST were included as the study group (ST group) and 459 patients who underwent percutaneous intervention for ACS and did not have any in-stent lesion as the control group (non-ST group). ST classification was done according to the Academic Research Consortium definition.
Results: The mean age of the patients was 63.3±10.6 years (483 male, 69.2%). The groups were similar in terms of characteristic properties, comorbidities, and the drugs being used (p>0.05 for all). Drug eluting stents were used in 86.5% of the patients. In the ST group, the median time from stent implantation to thrombosis was 285 days. Mean AIP and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) were statistically significantly higher in the ST group than in the controls (p<0.001 and p=0.018, respectively), and a positive correlation was observed between time from stent implantation to thrombosis and AIP and TG/HDL-C (rS=0.229, p=0.010 and rS=0.222, p=0.010, respectively). Multivariate logistic regression analysis revealed that stent length, prior ST elevation myocardial infarction, TG/HDL-C, and AIP were independent predictors of ST.
Conclusion: AIP is an easy calculable biomarker, and the performance of AIP to predict ST is better than TG/HDL-C.

Objective: Global studies report a significant decline in ST-elevation myocardial infarction (STEMI) related hospitalization rates during the coronavirus disease 2019 (COVID-19) pandemic outbreak. However, there have been several divergent reports on hospital outcomes. In this study, we aim to investigate the impact of the COVID 19 outbreak on hospitalizations because of STEMI and in-hospital outcomes in Albania.
Methods: This was a retrograde study, collecting data for hospitalizations because of STEMI from March 9, (first COVID 19 case in our country) to April 30, 2020, (period of total lockdown) compared with the same period in 2019 at our center. The incidence rate ratio (IRR) was used to compare admissions because of STEMI and procedures and the risk ratio (RR) to compare mortality and other complication rates.
Results: Admissions for STEMI declined during the COVID-19 period from a total of 217 in 2019 to 156 in 2020 (−28.1%) representing IRR 0.719 (p=0.033). PCIs also reduced from 168 procedures in 2019 to 113 in 2020 (−33%), representing an IRR of 0.67, p=0.021. The time
from symptom onset to arrival at our intensive care unit was significantly higher in 2020 compared to 2019 (925.6±1097 vs. 438.7±385 minutes, p<0.001). The STEMI death rate during the pandemic compared to the control period was significantly increased to 14.1%
vs. 7.8% (RR=1.91 p=0.037, but with no significant increase in primary PCI-STEMI death rate (8.9% vs. 4.8% RR=1.85 p=0.217). Cardiogenic shock also increased during the pandemic to 21.2% from 12.4% in 2019 (RR=1.70 p=0.025).
Conclusion: Hospitalizations and revascularization procedures for STEMI significantly reduced during the COVID-19 pandemic. We identified a substantial increase in the STEMI mortality rate and cardiogenic shock during the pandemic outbreak. Delayed timely
reperfusion intervention might be responsible for the increased risk for complications.

Amaç: Sol ventrikül ejeksiyon fraksiyonunun (SVEF) ekokardiyografide görsel olarak değerlendirilmesi halen rutin klinik uygulamada kullanılmaktadır. Bununla birlikte, görsel olarak tahmin edilen SVEF (gt-SVEF) ile kantitatif olarak ölçülen SVEF (kö-SVEF) arasındaki uyumu değerlendiren çalışmaların çoğunda ne uygun istatistiksel yöntemler ne de karşılaştırma için altın standart görüntüleme modalitesi kullanılılmıştır. Biz de bu çalışmada güncel istatistiksel yöntemler ve Kardiyak Manyetik Rezonans görüntüleme (KMRG) kullanarak gt-SVEF ve kö-SVEF arasındaki uyumu değerlendirmeyi amaçladık.
Yöntemler: 1.5-T KMRG uygulanan 54 hastanın aynı gün KMRG işleminden sonra ekokardiyografik görüntüleri kaydedildi. SVEF değerleri rastgele ve kör bir şekilde ekokardiyografik kayıtlar üzerinden 2 bağımsız gözlemci tarafından tahmin edildi. SVEF’nin kantitatif değerlendirilmesi KMRG ile yapıldı. Görsel ve kantitatif SVEF değerleri arasındaki uyum ile SVEF'nin gözlemciler arası/ gözlemci içi tahminleri arasındaki uyum, sınıf içi korelasyon katsayısı, Bland-Altman analizi ve kappa istatistikleri kullanılarak değerlendirildi.
Bulgular: SVEF'nin görsel olarak değerlendirilmesiyle, kantitatif yöntem olarak KMRG ile değerlendirilmesi arasında yüksek düzeyde uyum tespit edildi. (Sınıf içi korelasyon katsayısı: 0,93; [%95 güven aralığı 0,88-0,96]). Bland-Altman analizleri de iki yöntem arasında iyi bir uyumun olduğunu göstermektedir. Grafiklerde görsel SVEF’nin KMRG’ye kıyasla ortalama %0,6 daha düşük ölçüldüğü, bu değerin %95 dağılım aralığının +%9,3 ile -%10,5 arasında değiştiği görüldü. Kappa istatistiğine göre SVEF değerleri ≤%35, %36-54 ve ≥ %55 olarak üçlü gruba kategorize edildiğinde her iki yöntem arasındaki uyumun iyi düzeyde olduğu belirlendi ( kappa 0,71, doğrusal olarak ağırlıklandırılmış kappa 0,76). SVEF değerleri <%55 ve ≥ %55 olarak ikili gruba kategorize edildiğinde de her iki yöntem arasındaki uyumun iyi düzeyde olduğu belirlendi ( kappa 0,80). SVEF'nin görsel değerlendirilmesinde gözlemci içi ve gözlemciler arası uyumun iyi olduğu görüldü (Sınıf içi korelasyon katsayısı değeri sırasıyla 0,96 ve 0,91).
Sonuç: SVEF'nin görsel olarak değerlendirilmesi, klinik pratikte özellikle görüntü kalitesi iyi olan hastalarda sol ventrikül sistolik fonksiyonlarını hızlı bir şekilde değerlendirmek amaçlı kullanılabilir.

Objective: Visual estimation of left ventricular ejection fraction (LVEF) is still used in routine clinical practice. However, most of the studies evaluating the agreement between the visually estimated LVEF (ve-LVEF) and quantitatively measured LVEF (qm-LVEF) either have not used appropriate statistical methods or gold standard imaging modality. We aimed to assess the agreement between the ve-LVEF and qm-LVEF using contemporary statistical methods and Cardiac Magnetic Resonance imaging (CMRI).
Methods: In 54 subjects who underwent 1.5-T CMRI, echocardiographic images were recorded after the CMRI procedure on the same day. ve-LVEFs were estimated by 2 independent observers on echocardiographic records in a random and blinded fashion. qm-LVEF was obtained by CMRI. Agreement between the ve-LVEF and qm-LVEF values, and intra/interobserver ve-LVEF estimations were assessed using intraclass correlation coefficient (ICC), Bland-Altman analysis, and kappa statistics.
Results: There was a high agreement between the ve-LVEF and qm-LVEF (ICC 0.93, [95% CI 0.88-0.96]). Bland-Altman analysis also demonstrated a good agreement between the ve-LVEF and qm-LVEF; visually estimated LVEF was, on average, 0.6% lower than that obtained by CMRI (mean -0.6, limits of agreement -10.5 and +9.3). A good agreement was also observed for LVEF categories of ≤35%, 36-54%, and ≥55% (unweighted kappa 0.71, linearly weighted kappa 0.76); and LVEF of <55% and ≥55% (Kappa 0.80). Intra/interobserver agreement was good for ve-LVEFs (ICC value: 0.96 and 0.91, respectively).
Conclusion: Visual approach for LVEF assessment may be used for rapid assessment of left ventricular systolic function in clinical practice, particularly in patients with good image quality.

Objective: The impact of the coronavirus disease 2019 (COVID-19) pandemic has been unceasingly ongoing worldwide. Recent bioinformatics analysis and epidemiologic studies have highlighted that the functional polymorphisms on the angiotensin converting enzyme
(ACE) gene may have an impact on the clinical progress of COVID-19. In this study, we aimed to determine the impact of the ACE1 gene I/D polymorphism and ACE2 peptidase-2 domain variants on disease severity.
Methods: Hundred patients with confirmed COVID-19 related pneumonia [50 patients with severe disease in intensive care unit (ICU) and 50 patients not in ICU] were compared on the basis of genetic and clinical characteristics. Genomic DNA was purified from peripheral blood lymphocytes with an automated QIA symphony DSP DNA Mini-Kit. The Sanger sequencing analysis was performed. The frequencies of ACE1 gene polymorphism and ACE2 PD variants were compared in patients hospitalized in ICU and those not in ICU. The Statistical Package for Social Sciences version 22.0 was used for statistical analysis.
Results: The sequencing analysis of the ACE2 gene exon 1 and 2 revealed none of the polymorphisms investigated or any other variants in the present cohort. The frequencies of the ACE1 ID, DD, and II genotypes were 51%, 31%, and 18%, respectively. The frequency of the D
allele was similar between the ICU and non-ICU groups (50.4% versus 49.6%). Older age and the presence of advanced stage radiologic abnormalities on admission were detected as independent predictors of ICU requirement.
Conclusion: No effect of any ACE1 gene polymorphism on predicting ICU requirement was detected. To the best of our knowledge, this is the first study investigating the impact of ACE gene polymorphisms on clinical severity of COVID-19 in a Turkish cohort.