Objectives: Left atrial spontaneous echo contrast (LA-SEC) detected by transesophageal echocardiography (TEE) is a strong predictor for thromboembolic events. Few studies investigated the related conditions that lead to appearance of LA- SEC in dilated cardiomyopathy (DCMP) patients. The aim of the study was to investigate the prevalence of LA-SEC in patients with DCMP and to determine its related parameters. Methods: Consecutive patients (29 female, 65 male, mean age 60±11 years) with the diagnosis of ischemic (n=56) and non-ischemic (n=38) DCMP underwent laboratory, transthoracic and TEE examination. Results: LA-SEC was established in 48 patients (51%) of study group. LA-SEC was detected in 33 (59%) of ischemic DCMP and 15 (39%) of non- ischemic patients. In ischemic DCMP, restrictive diastolic filling (RDF) was observed 36% of the patients with LA- SEC vs. 22% in the patients without LA-SEC (p=0.05). Atrial fibrillation (AF) was present in 42% vs. 17% (p=0.05), hypertension was present 67% vs 39% of the patients respectively. In patients with ischemic DCMP, another significant correlate of LA-SEC was high fibrinogen level (471±78 mg/dl vs. 392±83 mg/dl, p=0.003). In non-ischemic DCMP group, AF was observed in 53% of the patients with LA-SEC vs. in 13% of the patients without LA-SEC (p=0.01). In patients with non- ischemic DCMP other significant determinants for LA-SEC were increased age (65±6 years vs. 53±12 years, p< 0.001), decreased cardiac index (2.1±0.6 L/min/m2 vs. 2.7±0.6 L/min/m2, p= 0.009) and reduced left atrial appendage velocities (p<0.001). Conclusions: In patients with DCMP, LA-SEC is frequently detected in patients with AF. In ischemic DCMP frequency of RDF and hypertension, and high fibrinogen level, in non-ischemic DCMP increased age and low cardiac index appeared as other correlates of LA-SEC.

Our case is 54 years old man, who was totally asymptomatic other than high blood pressure. He came to our clinic due to new onset of atrial fibrillation and he was diagnosed as having coarctation of aorta and interesting collateralization between coronary artery and descending aorta. He suddenly died 11 days after successful surgical correction.

Spontaneous pneumothorax may rarely cause midsystolic click. We reported a young patient presenting with dyspnea and chest pain who had spontaneous pneumothorax as a cause of midsystolic click on his examination.

The progress of the output of publications in cardiovascular medicine originating from Turkey's institutions was evaluated by identifying them in the Web of Science. Articles in full-text contained in source publications of Science Citation Index CD Edition alone were taken into consideration, excluding meeting abstracts and letters to the editor. A weighted credit system was utilized for items published jointly with a foreign or a noncardiological Turkish institution. In sum, 106 articles and reviews were identified which represented a drop by 12% over the previous year. Turkey's share of world output in cardiovascular publications also declined from 7.8 to 6.8 per mille. While cardiovascular surgery registered a peak with 35 articles, it was adult (68 articles) and pediatric (3 articles) cardiology that exhibited declines. The median impact factor of source publications used by Turkish cardiologists remained at 1.22 as in the preceding year. Turkey's Advanced Specialty Hospital, S. Ersek Surgical Center and medical faculties in Anatolia performed well this year; by contrast, the decrease in publications may be ascribed to certain centers in Ankara and Izmir. The regulation for academic promotion, in effect for the past 3 years, was also responsible by leading to a preference of submission to journals having a low impact factor; such articles were excluded from this analysis.