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Makale Özeti | Ýngilizce Tam Metin

Amaç: Periferik nöropati, statinlerin önemli bir yan etkisidir. Çalýþmamýzda hiperkolesterolemi nedenli atorvastatin veya rosuvastatin kullanan hastalarda perferik polinöropati insidansýný ve bunun tedavi dozu ve süresi ile iliþkisini araþtýrdýk.
Yöntemler: Statin kullanan 50 hasta ve hiçbir zaman statin kullanmamýþ olan cinsiyet ve yaþ ile eþleþtirilmiþ 50 saðlýklý kontrol grubu alýndý. Polinöropati, nörolojik muayene ve elektronöromiyografi (ENMG) ile deðerlendirildi.
Bulgular: Kontrol grubunda polinöropati saptanmazken, statin grubunda 33 (%66) hastada (p<0.01) polinöropati saptandý. Statin gruplarý arasýnda nörolojik muayene, ENMG bulgularý ve polinöropati insidansý arasýnda anlamlý fark yoktu (sýrasýyla, p=0.288 ve p=0.720). Nörolojik muayenede ilk yýl içinde nöropati gözlendi (rosuvastatin %50, atorvastatin %18). Polinöropatinin þiddeti atorvastatin grubunda tedavi süresi ile arttý (p=0.030).
Sonuç: Çalýþmamýz uzun süreli statin kullanýmý ile periferik nöropati riskinin arttýðýný ortaya koymuþtur (bir yýldan fazla). Kontrol grubundaki bireylere göre uzun süreli statin tedavisi alan hastalarda sinir iletim çalýþmalarýnda motor ve duyusal sinirlerde elektrodiyagnostik deðiþiklikler saptanmýþtýr. Periferik nöropati ile iliþkili olarak yürüme sýrasýnda ellerde ve ayaklarda karýncalanma, uyuþma, aðrý ve titreme gibi nörolojik semptomlarýn deðerlendirilmesi uzun süreli statin tedavisi alan hastalarýn takibinde yararlý olabilir. Periferik nöropatinin erken saptanmasý ile hiperkolesterolemi tedavisi deðiþtirilerek kalýcý sinir hasarý önlenebilir.

Objective: Peripheral neuropathy is an important potential side effect of statin use. This study was an investigation of the incidence of peripheral neuropathy in patients taking atorvastatin or rosuvastatin for hypercholesterolemia and the relationship to the dose and duration of the treatment.
Methods: In all, 50 patients using a statin treatment and 50 healthy controls matched for age and gender who had never taken a statin were included in the study. Polyneuropathy was assessed with a neurological examination and electroneuromyography (ENMG).
Results: While no polyneuropathy was detected in the control group, polyneuropathy was seen in 33 (66%) of the patients in the statin group (p<0.01). There was no significant difference between the 2 statin groups in the results of the neurological examination or the ENMG findings regarding the incidence of polyneuropathy (p=0.288 and p=0.720, respectively). Neuropathy was observed in a neurological examination performed within the first year in 50% of the rosuvastatin users and 18% of those taking atorvastatin. The severity of the polyneuropathy increased with the duration of the treatment in the atorvastatin group (p=0.030).
Conclusion: This study revealed an increased risk of peripheral neuropathy with long-term statin use (>1 year). Electrodiagnostic changes have been detected in motor and sensory nerves in nerve conduction studies of patients on long-term statin treatment. The assessment of neurological symptoms, like tingling, numbness, pain and tremor in the hands and feet, and unsteadiness during walking associated with peripheral neuropathy may be useful in the follow-up of the patients on long-term statin treatment. Early detection of peripheral neuropathy and changing hypercholesterolemia treatment may prevent permanent nerve damage.

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Amaç: Atriyal yeniden þekillenmenin elektriksel kardiyoversiyondan sonra atriyal fibrilasyon (AF) nüksünde katkýsý bulunduðu düþünülmektedir. Daha önceki çalýþmalarda, enflamasyon ve ektraselüler matriks döngüsü ile iliþkili belirteçlerin elektriksel kardiyoversiyon sonrasý AF nüksü ile iliþkisi incelenmiþtir. Buna karþýn, kardiyak fibrozis de dahil çeþitli fibrotik durumlarda rol oynadýðý bilinen galektin-3 ile ilgili yeterli veri yoktur. Bu çalýþmada, serum galektin-3 düzeyinin baþarýlý elektriksel kardiyoversiyon sonrasý AF nüksünü öngörmedeki rolü araþtýrýldý.
Yöntemler: Elektriksel kardiyoversiyon planlanan persistan AF’li 90 hasta çalýþmaya alýndý. Hastalarýn serum örneklerindeki galektin-3 seviyeleri elektriksel kardiyoversiyondan önce ELISA yöntemi ile ölçüldü. Hastalar, elektriksel kardiyoversiondan sonra, AF nüksü açýsýndan üç ay süreyle takip edildi.
Bulgular: Baþarýlý elektriksel kardiyoversiyon uygulanan 90 AF’li hasta (55.33±7.94 yýl; %53.33 erkek) çalýþmaya alýndý. Üç aylýk takip sürecinde 28 (%31.11) hastada erken AF nüksü saptandý. AF nüksü olan hastalarda, daha büyük sol atriyum hacim indeksi (33.35±2.45 ve 29.21±3.08 mL/m2, p<0.001) ve daha yüksek serum galektin-3 düzeyleri (0.88 [0.52–1.32] ve 0.60 [0.38–0.91] ng/mL, p<0.001) saptandý. Çok deðiþkenli analizde elektriksel kardiyoversiyon uygulama sayýsý (HR: 1.879, %95 GA: 1.052–3.355, p=0.033), sol atriyum hacim indeksi (HR: 1.180, %95 GA: 1.028–1.354, p=0.018) ve serum galektin-3 düzeyleri (HR: 11.933, %95 GA: 1.220–116.701, p=0.033) erken AF nüksünün baðýmsýz öngördürücüleri olarak bulundu.
Sonuç: Dolaþýmda bulunan galektin-3 seviyesi, elektriksel kardiyoversiyon uygulanan hastalarda erken AF nüksüyle iliþkili olabilir.

Objective: Atrial structural remodeling has been suggested to contribute to atrial fibrillation (AF) recurrence following direct-current cardioversion (DCCV). The role of several inflammatory and extracellular matrix turnover markers in AF recurrence following DCCV has been investigated. However, data on the impact of galectin-3, which is known to play a role in various fibrotic conditions, including cardiac fibrosis are lacking. The aim of this study was to demonstrate the predictive role of serum galectin-3 levels in AF recurrence following successful DCCV.
Methods: A total of 90 persistent AF patients who were sche-duled for DCCV were prospectively enrolled. Serum samples were assayed to determine pre-DCCV galectin-3 levels using the enzyme-linked immunosorbent assay method. Patients were followed up for 3 months for AF recurrence.
Results: Of 90 persistent AF patients (mean age: 55.33±7.94 years; 53.33% male) who underwent successful DCCV, 28 (31.11%) experienced early AF recurrence within 3 months. Patients with AF recurrence had a greater left atrial volume index (LAVI) (33.35± 2.45 mL/m2 vs. 29.21±3.08 mL/m2; p<0.001) and serum galectin-3 levels were higher (0.88 ng/mL [min-max: 0.52–1.32] vs. 0.60 ng/mL [min-max: 0.38–0.91]; p<0.001). In multivariate analysis, the number of DCCV attempts (hazard ratio [HR]: 1.879, 95% confidence interval [CI]: 1.052–3.355; p=0.033), LAVI (HR: 1.180, 95% CI: 1.028–1.354; p=0.018), and serum galectin-3 level (HR: 11.933, 95% CI: 1.220–116.701; p=0.033) were found to be independently associated with early AF recurrence following successful DCCV.
Conclusion: Circulating levels of galectin-3 may have an association with early AF recurrence following DCCV.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Ventriküler repolarizasyon belirteçleri ventriküler aritmileri ve kardiyak arresti öngörebilir. Bu çalýþma hemodiyaliz hastalarýnda hemodiyaliz seansýnýn ve hemodiyaliz etkinliðinin akut etkilerinin ventiküler repolarizasyon üzerine etkisini araþtýrmayý amaçlamýþtýr.
Yöntemler: Ýki üniversite hastanesinde gerçekleþtirilen çalýþma kesitsel olarak düzenlendi, 83 hemodiyaliz hastasýnda ventriküler repolarizasyon belirteçleri hemodiyaliz seansýnýn öncesinde ve sonrasýnda ölçüldü. Bunlar: QT, QTc, QT minimum, QT maksimum, QT dispersionu (QTd), Tp-e intervali ve Tp-e/QT. Ýkinci jenerasyon Daugirdas formülü ile hesaplanan Kt/V diyaliz etkinliðini yansýtýr. Hastalar Kt/V deðerine göre grup 1 ≤1.6 standart diyaliz dozu olarak ve grup 2 >1.6 yüksek diyaliz doz alarak ikiye ayrýldý.
Bulgular: Otuz altý hasta grup 1’de ve 47 hasta grup 2’deydi. Kadýn hastalar istatistiksel açýdan anlamlý olarak grup 2’de daha fazlaydý (p=0.016). Hemodiyaliz sonrasý kalp hýzý arttý ve kan basýncý azaldý, QT, QTc, QT maksimum, QTd, Tpe intervali ve Tpe/QT ise hemodiyaliz seansý sonrasýnda uzuyordu (p<0.05). Ventriküler repolarizasyon belirteçleri iki grup arasýnda benzer bulundu. Diyabetik hastalarda da ventriküler repolarizasyon belirteçleri Kt/V deðerlerinden etkilenmiyordu.
Sonuç: Hemodiyaliz seansý hemodiyaliz etkinliðinden baðýmsýz olarak ventriküler repolarizasyon parametrelerini uzattýðý için hemodiyaliz hastalarýnda kardiyak arest için bir risk faktörü olabilir. Yüksek hemodiyaliz dozu kalp için her zaman en iyisi olmayabilir.

Objective: Ventricular repolarization (VR) markers may predict ventricular arrhythmias and cardiac arrest. The aim of this study was to investigate the acute effects of a hemodialysis (HD) session and HD adequacy on VR markers in HD patients.
Methods: This cross-sectional study was conducted at 2 university hospitals with 83 patients and VR markers were measured before and after an HD session: QT, QTc, QT minimum, QT maximum, dispersion of QT (QTd), T-peak to T-end (Tp-e) interval, and Tp-e/QT. Kt/V measurements calculated using the second generation Daugirdas formula were used to indicate dialysis adequacy. The patients were divided into 2 groups according to the Kt/V value. Group 1 patients had a Kt/V of ≤1.6 with a standard dialysis dose, and Group 2 comprised those with a measurement of >1.6 with a high dialysis dose.
Results: There were 36 patients in Group 1 and 47 patients in Group 2. There were statistically significantly more female patients in Group 2 (p=0.016). After an HD session, heart rate increased, blood pressure decreased, and the QT, QTc, QT maximum, QTd, Tp-e interval, and Tp-e/QT were prolonged (p<0.05). The VR markers measured were similar in the 2 groups. VR markers were not significantly different in diabetic patients.
Conclusion: HD may be a risk factor for cardiac arrest because of prolonged VR parameters, independent of HD adequacy. A high dialysis dose may not always be best for the heart.

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Amaç: Her ne kadar miyoperikarditin uzun dönem prognozunun iyi oldugu bildirilmiþ olsa da, nüks geliþimi sorun olmaya devam etmektedir. Ayrýca, ampirik olarak kullanýlan anti-enflamatuvar ilaçlarýn güvenilirliði için de bazý endiþeler bulunmaktadýr. Bu nedenle, çalýþmamýzda komplikasyonsuz miyoperkardit geçirmiþ ve çoðunluðu nonsteroid antienflamatuvar ilaç ve kolþisin ile tedavi edilmiþ genç hastalarýn klinik sonuçlarýný araþtýrdýk.
Yöntemler: Mayýs 2015 ile Mayýs 2018 tarihleri arasýnda, miyoperikardit nedeniyle hastaneye yatan, normal sol ventrikül fonksiyonuna sahip, 18–40 yaþ arasý hastalar çalýþmaya dahil edildi. Çalýþmanýn birincil sonlaným noktasý, tüm nedenlere baðlý ölüm, miyoperikardit nüksü, aritmi, kalp yetersizliði ve kardiyak tamponad geliþimini içeren majör kardiyak olaylardý. Çalýþmaya toplam 60 hasta dahil edildi. Ortalama izlem süresi 19 aydý.
Bulgular: Majör kardiyak olaylar hastalarýn %11.7’sinde meydana gelmiþ olup bu oran, esas olarak miyoperikardit nüksüne baðlýydý. Hiçbir hastada kalp yetersizliði, belirgin aritmi, kalp tamponadý ve tüm nedenlere baðlý ölüm izlenmedi. Hastalarýn çoðu nonsteroid antienflamatuvar ilaçlar ve kolþisin ile tedavi edildi (sýrasýyla, %96 ve %95). Tek deðiþkenli Cox regresyon analizinde, sadece hastane içi maksimum C-reaktif protein düzeyleri, nüks geliþimi ile iliþkili bulundu (HR: 1.01 [1.01–1.02, %95 GA], p=0.04).
Sonuç: Miyoperikarditin prognozu orta vadede mortalite açýsýndan çok iyi olmasýna raðmen nüks bir sorun olmaya devam etmektedir. C-reaktif proteinin özellikle nüks üzerindeki rolü daha fazla araþtýrýlmalýdýr.

Objective: Although the long-term prognosis of myopericarditis is good, recurrence continues to be a problem. In addition, there are concerns regarding the safety of the empirical use of anti-inflammatory drugs. This study was an investigation of the clinical outcomes of young patients with uncomplicated myopericarditis, the majority of whom received both nonsteroidal anti-inflammatory drugs and colchicine.
Methods: Patients aged 18 to 40 years who were admitted between May 2015 and May 2018 due to myopericarditis and had normal left ventricular function were included in the study. The primary outcome of the research was analysis of major adverse cardiac events (MACEs): all-cause mortality, myopericarditis recurrence, development of significant arrhythmia, heart failure, and cardiac tamponade. A total of 60 patients were included in the study. The median duration of follow-up was 19 months.
Results: A MACE occurred in 11.7% of the patients. None of the patients experienced heart failure, significant arrhythmia, cardiac tamponade, or all-cause mortality. Recurrence of myopericarditis was the only MACE observed. Most patients were treated with both nonsteroidal anti-inflammatory drugs and colchicine (96% and 95% of the patients, respectively). Univariate cox regression analysis indicated that only the maximum in-hospital C-reactive protein (CRP) level was associated with recurrence (hazard ratio: 1.01, 95% confidence interval: 1.01–1.02; p=0.04).
Conclusion: The intermediate-term prognosis of myopericarditis patients was excellent in terms of mortality. However, recurrence remains a challenge. The role of CRP, particularly in recurrence, should be explored further.

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Amaç: Mukopolisakkaridozlar (MPS) önemli bir lizozomal depo hastalýðý grubu olup, kardiyovasküler sistemde en sýk kalp kapakçýklarý ve koroner arterlerde tutulum ile kendilerini gösterirler. Bu çalýþmada, MPS tip VI tanýsýyla izlenen çocuklarda kardiyak tutulumun deðerlendirilmesi amaçlanmýþtýr.
Yöntemler: Mukopolisakkaridoz tip VI tanýsý ile 2016−2018 yýllarý arasýnda izlenen 13 olgunun fizik muayene, elektrokardiyografi ve standart transtorasik ekokardiyografi bulgularý geriye dönük olarak deðerlendirildi. Hastalarýn (8 erkek, 5 kýz) yaþ aralýðý 2–17 yaþ (medyan 9) idi.
Bulgular: Hastalarýn EKG’lerinde ritim bozukluðu ve iskemi bulgusu saptanmadý. Ekokardiyografide mitral kapakta yetersizliði en sýk görülen bulgu idi. Olgularýn 12’sine (%92.3) aort kapak yetersizliði, dördüne (%30.8) triküspit kapak yetersizliði eþlik ediyordu. Ýzole septal hipertrofi iki olguda mevcut idi. Bir olguda kapak tutulumuna ek sol ventrikül sistolik fonksiyonlarýnda bozulma görüldü.
Sonuç: Mukopolisakkaridozda kardiyak tutulum herhangi bir zamanda ortaya çýkabilir. Mitral kapak deformasyonu en sýk görülen bulgudur. MPS’li olgularda belirgin yakýnma ve fizik muayene bulgusu olmasa dahi, ekokardiyografik incelemede kardiyak tutulum saptanmaktadýr. Bu nedenle olgularýn kardiyovasküler deðerlendirmeleri düzenli olarak yapýlmalýdýr.

Objective: The mucopolysaccharidoses (MPS) are an important group of lysosomal storage diseases. Commonly reported cardiac involvement includes mitral leaflet thickening and accompanying prolapsus, regurgitation, and rarely, stenosis. The aim of this study was to evaluate cardiac involvement in patients with MPS type VI.
Methods: The study included a total of 13 children with MPS type VI who were admitted to a single pediatric department between 2016 and 2018. Cardiac status was evaluated prospectively with clinical findings, electrocardiography, and echocardiography. The age of the patients (8 boys, 5 girls) ranged between 2 and 14 years (median: 9 years).
Results: No arrhythmia was observed in any patient. Thickening of the mitral valve with or without regurgitation and prolapsus was the most common lesion seen. Additional involvement of the aortic valve was detected in 12 (92.3%) patients, and additional involvement of the tricuspid valve in 4 (30.8%). Isolated septal hypertrophy was found in 2 patients, and congestive heart failure in another.
Conclusion: Cardiac involvement is frequent in MPS. Mitral valve deformation is the most frequent finding. An echocardiographic examination should be performed periodically even if the patient has no clinical signs of cardiac disease, and any cardiac involvement should be kept under control with medical treatment.

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Amaç: 1. Dünya Pulmoner Hipertansiyon Kongresi’nde (Genova, 1973) pulmoner hipertansiyon (PH), sað kalp katateri ile istirahatte supin pozisyonunda ölçülen ortalama pulmoner arter basýncýnýn (PAB) ≥25 mm Hg olmasý olarak tanýmlandý. Bu sene düzenlenen 6. Dünya Pulmoner Hipertansiyon Kongresi’nde (Nice, 2018) ise bu tanýmýn, ortalama PAB >20 mm Hg, pulmoner kapiller uç basýncý (PKUB) <15 mm Hg ve pulmoner vasküler direnç (PVR) >3 WU olarak güncellenmesi önerildi. Bu çalýþmada, yeni tanýmlamayla birlikte pre-kapiller PH hasta sayýmýzdaki artýþ miktarýný araþtýrmayý amaçladýk.
Yöntemler: 2017–2018 yýllarý arasýnda, hastanemizde çeþitli endikasyonlarla yapýlan sað kalp kateteri raporlarý tarandý. Hem 2015 Avrupa Kardiyoloji ve Solunum Derneði (ESC/ERS) hem de 6. Dünya Pulmoner Hipertansiyon Kongresi PH taný kriterleri kullanýlarak, PH tanýsý alan hasta sayýsý (%) hesaplandý.
Bulgular: Bir yýllýk periyotta hastanemizde 58 hastaya sað kalp katateri uygulandý. Ýþlemlerin çoðunluðu PH ayýrýcý tanýsý endikasyonuyla (n=52) uygulandý. Diðer endikasyonlar arasýnda kalp kapak hastalýðý ve sol kalp hastalýklarý yer almaktaydý (n=6). Hastalarýn 40’ý kadýn (%69), 18’i erkek (%31) hastalardan oluþmaktaydý. Çalýþma grubunun ortalama yaþý 53.3±16.6 idi. Sað kalp kataterinde ortalama PAB 36.4±16.4 mm Hg, ortalama PKUB: 12.6±3.9 ve ortalama PVR: 4.9±4.4 WU olarak saptandý. 2015 ESC ve ERS PH kýlavuz taný kriterlerine göre PH tanýsý alan hasta sayýsý 43/58 (%74.1) iken, bu oran 6. Dünya Pulmoner Hipertansiyon Kongresi PH taný kriterlerine göre 50/58 (%86.2) olarak saptandý.
Sonuç: 6. Dünya PH Kongresinde yeni hemodinamik pre-kapiller PH tanýmlamasýyla hasta sayýsýndaki artýþýn <%10 olacaðý ön görülürken, bizim çalýþmamýzda bu artýþ daha belirgin (%12.1) olarak saptandý.

Objective: Since the first World Symposium on Pulmonary Hypertension (WSPH; Geneva, 1973), pulmonary hypertension (PH) has been defined as a mean pulmonary artery pressure (mPAP) ≥25 mm Hg measured at right heart catheterization (RHC) while at rest in the supine position. At the 6th WSPH congress (Nice, 2018), a new proposal was presented defining pre-capillary PH as mPAP >20 mm Hg, with pulmonary arterial wedge pressure (PAWP) <15 mm Hg, and pulmonary vascular resistance (PVR) >3 WU. The aim of this study was to investigate the impact of the new definition of PH on the number of pre-capillary PH patients.
Methods: The results of RHC performed with various clinical indications between 2017 and 2018 were analyzed. The 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) and the 6th WSPH congress PH definitions were used to identify PH patients.
Results: Fifty-eight RHC procedures were performed in our hospital in a 1-year period. Most were performed with a suspicion of PH (n=52). The remainder (n=6) were performed with indications of valvular heart disease or left heart disease. There were 40 females (69%) and 18 males (31%). The mean age was 53.3±16.6 years. The RHC results revealed a mean PAP of 36.4±16.4 mm Hg, PAWP of 12.6±3.9 mm Hg, and PVR of 4.9±4.4 WU. Forty-three of 58 patients (74.1%) were classified as pre-capillary PH according to the ESC/ERS PH guideline, whereas 50 of 58 patients (86.2%) had pre-capillary PH according to the new WSPH definition.
Conclusion: The results of this study indicated that the impact of the new definition of PH on the number of pre-capillary PH patients identified was greater than the predicted <10%.

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Amaç: Türkiye’de dislipideminin suboptimal yönetimini az sayýda çalýþma doðrudan deðerlendirmiþtir. Bu çalýþma, hastalarýn yüksek kolesterol algýsýný ve lipit yönetim stratejileri ile ilgili olarak hekimlerin kolesterol hakkýndaki bilgi ve farkýndalýðýný deðerlendirmek amacýyla yapýldý.
Yöntemler: Çalýþma gözlemsel ve çok merkezli bir çalýþmadýr (ClinicalTrials.gov identifier: NCT02608645). En az 18 yaþýnda olan, kardiyoloji kliniklerine baþvuran ikincil korunma (SK) grubunda ve çok yüksek, yüksek riskli birincil korunma (PK) grubundaki ardýþýk hastalar çalýþmaya alýndý. Çalýþma popülasyonu, Türkiye’de 40 bölgeden 1868 hasta içermektedir. SK grubunda hastalarýn üçte ikisine (%67.5) statin verildi, PK hastalarýnýn sadece %30.1’ine statin tedavisi verildi (p<0.001).
Bulgular: Düþük yoðunluklu lipoprotein kolesterol (LDL-C) düzeyi önerilen düzeyde olan hastalarýn oraný PK’da %10.6, SK’da %18 idi (p<0.001). Hastaya özgü anket, PK ve SK gruplarýndaki hastalarýn neredeyse yarýsýnýn kolesterol seviyelerinin yüksek olduðunu bildiðini ortaya koydu. Medya programlarýndaki statin tedavisi ile ilgili olumsuz bilgiler (%9.4) tedavinin kesilmesinin en yaygýn nedeniydi.
Sonuç: Gerçek yaþam pratiðinde birincil ve ikincil korunma ile ilgili algý, bilgi ve uyum artmýþtýr, ancak istenen seviyelerin çok altýndadýr. Hastalar ve hekimler hiperlipideminin tedavisi hakkýnda daha fazla bilgi sahibi olmalýdýr. Ayrýca, medya programlarýný kontrollerinin saðlanmasý, hastalarýn yanlýþ bilgilendirilmesini önleyebilir.

Objective: Few studies have directly assessed suboptimal management of dyslipidemia in Turkey. This study was conducted to assess patients’ understanding and perceptions of high cholesterol as well as physicians’ knowledge and awareness of lipid management strategies.
Methods: This was a multicenter, observational study (ClinicalTrials.gov identifier: NCT02608645). Consecutive patients admitted to the participating cardiology clinics who were at least 18 years of age and who had been classified in a secondary prevention (SP) group or a high-risk primary prevention (PP) group were enrolled. The study population included 1868 patients from 40 sites in Turkey. Two-thirds (67.5%) of the patients in the SP group had been prescribed a statin, whereas only 30.1% of the PP group patients received statin therapy (p<0.001).
Results: It was determined that 18% of the SP patients and 10.6% of the PP patients had a low-density lipoprotein cholesterol level at the recommended level (p<0.001). A patient survey revealed that almost half of the patients in the PP and in the SP groups were aware that their cholesterol levels were high. Negative information about statin treatment disseminated by media programs was the most common reason (9.4%) given for treatment discontinuation.
Conclusion: Perceptions, knowledge and compliance with the guidelines for PP and SP patients in real-life practice have increased, but it remains far below the desired level. Patients and physicians should have more information about the treatment of hyperlipidemia. More accurate media programming could help to prevent the dissemination of misinformation.

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Koroner arter anevrizmasý randomize kontrollü çalýþmalardan elde edilen kanýtlarýn yetersizliðine baðlý olarak zorlayýcý bir klinik durumdur. Olgumuzda, sirkümfleks arter orta segmentteki anevrizmanýn PK Papyrus (Biotronik, AG, Bulach, Switzerland) greft stent ile dýþlanmasýný takdim ettik. Bitiþ görüntüleri uygundu.

A coronary artery aneurysm is a challenging cli-nical situation due to the lack of sufficient evidence from randomized controlled studies and the lack of consensus on a management strategy. The present case is a description of the exclusion of a middle segment aneurysm of the left circumflex coronary artery using a PK Papyrus covered stent (Biotronik, AG, Bulach, Switzerland). The final images were favorable.

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Perkütan iliyak anjiyoplasti sonrasý spinal kord iskemisi (SKÝ) ve parapleji çok nadir bir komplikasyondur. Ýki taraflý iliyak stent sonrasý geliþen SKÝ ve paraplejinin olduðu nadir bir olguyu sunarak, yaygýn aterosklerozu varlýðýnda spinal kan akýmýnýn deðiþimi ile böyle bir komplikasyonun olabileceðinin akýlda olmasý gerektiðini vurgulamak istedik.

Paraplegia after percutaneous iliac angioplasty is very rare, and is typically associated with spinal cord ischemia (SCI). Presently described is a case of SCI and paraplegia developing after bilateral iliac stenting. This complication may be caused by a change in spinal blood flow in patients with diffuse atherosclerosis, and should be kept in mind.

Makale Özeti | Ýngilizce Tam Metin

Ýmplante edilebilir elektronik kardiyak cihazlar (ÝEEKC’ler) güncel uygulamada yaygýn olarak kullanýlmaktadýr. Bu cihazlarýn elektrokardiyografik paternlerini analiz etmek ve artefaktlar hakkýnda bilgi sahibi olmak, uygun CIED yönetimi için kritik önemdedir. Otuz iki yaþýndaki kadýn hasta rutin takip ziyareti için cihaz kliniðine baþvurdu. Sinüs düðümü disfonksiyonu için 12 yýl önce kendisine çift odacýklý bir kalp pili takýlmýþtý. Ýlk çekilen 12 derivasyonlu elektrokardiyogramýnda (EKG), çoklu, hýzlý kalp pili uyarý artefaktlarýnýn döngüsel paterni kaygý nedeni olmuþtu. Cihazýn incelenmesi genelde kalp pili fonksiyonunun normal olduðunu gösterdi. EKG makinesini kalp pili uyarýlarýna kapatma artefaktý ortadan kaldýramadý. Hastanýn týbbi öyküsü incelendiðinde, önceden doðuþtan santral hipoventilasyon sendromu ve pulmoner hipertansiyon tanýsý aldýðý ve bu nedenle diyafragma pili takýldýðý tespit edildi. Diyafragma pilinin incelenmesi programlanan parametrelerin EKG’de belirtilen artefaktýn sýklýðý ile iliþkili olduðunu ortaya koydu. Kalp pili çalýþýrken yeterli eþikte tek bir uyarý artefaktý miyokardý etkileyebilir. Bununla birlikte, diyafram pilinin uyarý hýzýný yakalamak, eþiðin üstünde birden fazla uyarý dizisinin varlýðýný gerektirir. Bu nedenle, ÝEEKC’leri potansiyel olarak engelleyebilecek çeþitli elektrikli cihazlarýn pacing konfigürasyonlarýnýn anlaþýlmasý uygun hasta yönetimi için kritik önem taþýr.

Cardiac implantable electronic devices (CIEDs) are widely used in current practice. Analyzing the electrocardiographic patterns of these devices and having knowledge of artifacts is crucial to appropriate CIED management. A 32-year-old female patient presented at the device clinic for a routine follow-up visit. A dual-chamber pacemaker had been implanted 12 years previously for sinus node dysfunction. An initial 12-lead electrocardiogram (ECG) prompted concern due to a cyclical pattern of multiple, rapid pacing stimulus artifacts. Device interrogation revealed normal overall pacemaker function. Turning the pace gain function of the ECG machine off failed to eliminate the artifact. On review of the past medical history, the patient was found to have a prior diagnosis of congenital central hypoventilation syndrome and pulmonary hypertension, for which she underwent insertion of a diaphragmatic pacemaker. Interrogation of the diaphragmatic pacemaker revealed that the programmed parameters correlated with the frequency of the artifact noted on the ECG. In cardiac pacing, a single stimulus artifact of sufficient threshold can enable myocardial capture. Capturing diaphragmatic pacing, however, requires a train of multiple stimuli above the threshold. Thus, an understanding of the pacing configurations of various electrical devices that can potentially interfere with CIEDs is crucial to appropriate patient management.

Makale Özeti | Ýngilizce Tam Metin

Pulmoner stenoz nadir bir valvüler hastalýk olup tüm doðuþtan kalp hastalýklarýnýn %7–%12’sini oluþturur. Hafif ve orta derecede pulmoner stenoz genellikle semptomsuz olup hastalar sýklýkla baþka nedenle yapýlan ekokardiyografik deðerlendirme sýrasýnda tesadüfen taný alýrlar. Ciddi pulmoner stenoz ise artmýþ sað ventrikül basýncý ve sað ventrikül yetersizliði iliþkili semptomlar ile kendini gösterir. Gebelik sürecinde kardiyovasküler sistemde kalp hýzýnda ve ekstraselüler sývýda artýþ ile birlikte büyüyen uterusun inferiyor vena kavaya basýsý sonucu venöz geri dönüþte azalma gibi fizyolojik deðiþiklikler meydana gelir ve bu nedenle kapak hastalýklarý gebelerde artmýþ kardiyovasküler morbidite ve mortalite ile iliþkilidir. Hafif ve orta derecede pulmoner stenoz gebelikte iyi tolere edilirken ciddi pulmoner stenoz maternal ve fetal perinatal komplikasyonlarda artýþ ile iliþkilidir. Bu yazýda üçüncü trimesterde baþarýlý pulmoner balon valvüloplasti uygulanan ciddi pulmoner stenozlu bir gebe hasta sunduk.

Pulmonary valvular stenosis is a rare valvular disease; it accounts for 7% to 12% of all patients with congenital heart disease. Patients with mild or moderate pulmonary stenosis (PS) are usually asymptomatic and the stenosis is often detected incidentally with echocardiography performed for another reason. Severe PS typically presents with symptoms related to increased right ventricular pressure and right heart failure. Valvular heart diseases are associated with increased morbidity and mortality in pregnancy due to cardiovascular alterations that occur during the gestational period, such as increased extracellular volume, a faster heart rate, and decreased venous return due to compression of the vena cava inferior by the enlarged uterus. While mild or moderate PS can be well tolerated in pregnancy, severe PS can lead to maternal and fetal perinatal complications. Presently described is the case of a pregnant patient with severe PS who successfully underwent balloon valvuloplasty in the third trimester.

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