Publications by authors named "Dursun Aras"

293 Publications

Telltale termination of an A-on-V tachycardia with two blocked atrial activations: What is the mechanism?

Pacing Clin Electrophysiol 2021 Aug 18. Epub 2021 Aug 18.

Ankara City Hospital, Department of Cardiology, University of Health Sciences, Ankara, Turkey.

The termination of tachycardia may provide important clues toward the mechanism of the tachycardia and that close vigilance may clinch the diagnosis before proceeding to other pacing maneuvers.
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http://dx.doi.org/10.1111/pace.14343DOI Listing
August 2021

Effect of conscious sedation and deep sedation on the vagal response characteristics during ganglionated plexus ablation.

J Cardiovasc Electrophysiol 2021 Aug 7;32(8):2333-2336. Epub 2021 Jul 7.

Department of Cardiology, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Missouri, USA.

Introduction: We aimed to determine the effects of conscious and deep sedation on vagal response (VR) characteristics during ganglionated plexus (GP) ablation.

Methods: Forty consecutive patients undergoing GP ablation for vasovagal syncope were divided to receive conscious sedation with midazolam (Group 1, n = 29) or deep sedation with the midazolam-propofol combination (Group 2, n = 11). VR was defined on three levels. R-R interval increase of >50% (Level 1); R-R interval increase of 20%-50% (Level 2); and R-R interval increase of <20% (Level 3).

Results: The ratio of Level 1 VR during ablation on left superior and inferior GPs was significantly lower in Group 2 (p < .0001 and p = .034, respectively). Once the cut-off for VR was decreased to Level 2, the ratio of (+) VR was similar between groups during ablation of left-sided GPs. Positive VR in any level was lower than 20% during ablation of right-sided GPs.

Conclusions: The autonomic tone might be affected in different ways by the level or type of intravenous sedation. Awareness of anesthesia-related differences may be important if GP ablation will be performed by using VR characteristics during ablation.
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http://dx.doi.org/10.1111/jce.15133DOI Listing
August 2021

The transition of the tachycardia from narrow to wide by a spontaneous atrial premature beat: What is the mechanism?

J Arrhythm 2021 Apr 29;37(2):462-463. Epub 2021 Jan 29.

Department of Cardiology University of Health Sciences Ankara City Hospital Ankara Turkey.

The transition of the tachycardia from narrow to wide by a spontaneous atrial premature contraction causing a long-short sequence and right branch block.
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http://dx.doi.org/10.1002/joa3.12499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021983PMC
April 2021

A dual nodal response to the parahisian pacing and induction of the retrograde right bundle branch block maneuvers.

J Arrhythm 2021 Feb 7;37(1):266-268. Epub 2020 Dec 7.

Department of Cardiology Ankara City Hospital University of Health Sciences Ankara Turkey.

We presented intracardiac electrograms during the parahisian pacing, which represent three types of retrograde conduction and focus on the mechanism of types of retrograde conduction on wide QRS complexes and conclude that the two types of QRS of the retrograde conduction resulted from the presence or absence of retrograde block at the right bundle branch.
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http://dx.doi.org/10.1002/joa3.12474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896456PMC
February 2021

When You Hear Hoofbeats, Look for Horses, Not Zebras.

Circulation 2021 Feb 22;143(8):862-864. Epub 2021 Feb 22.

University of Health Sciences, Ankara City Hospital, Department of Cardiology, Turkey.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.052468DOI Listing
February 2021

Lower levels of triiodothyronine are associated with poor hemodynamic profile and all-cause mortality in heart failure.

Biomark Med 2021 Mar 10;15(4):273-283. Epub 2021 Feb 10.

Department of Cardiology, Ankara City Hospital, Ankara, Turkey.

We aimed to assess the association of triiodothyronine (T3) hormone with invasive hemodynamic parameters and all-cause mortality in heart failure with reduced ejection fraction (HFrEF).  About 483 HFrEF patients were enrolled. Patients with the lowest T3 tertile had advanced New York Heart Association (NYHA) classes, had higher uric acid, brain natriuretic peptide. T3 level had a positive correlation with cardiac index (CI) and a negative correlation with pulmonary vascular resistance and pulmonary capillary wedge pressure. Adjusted with NYHA III-IV classes, uric acid, aspartate aminotransferase and CI, T3 level was found to be an independent predictor of all-cause mortality. In Kaplan-Meier analysis, the lowest T3 tertile had the lowest survival function. Free T3 is positively correlated with CI and negatively correlated with pulmonary vascular resistance and pulmonary capillary wedge pressure in patients with HFrEF. Lower levels of T3 seems to be a poor prognostic factor in this particular patient population.
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http://dx.doi.org/10.2217/bmm-2020-0425DOI Listing
March 2021

Termination, Advancement, and Delaying Responses to His Synchronous Premature Ventricular Contractions During Narrow QRS Tachycardia: What Are the Possible Mechanisms?

J Innov Card Rhythm Manag 2021 Jan 15;12(1):4376-4380. Epub 2021 Jan 15.

Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

The differential diagnosis of a regular, narrow QRS, long-R-P tachycardia includes atypical atrioventricular nodal reentry tachycardia, atrial tachycardia, and atrioventricular reentry tachycardia via a slowly conducting accessory pathway with decremental conduction properties. Almost all described diagnostic maneuvers in the electrophysiology laboratory have exceptions to their primary interpretation. The usual proviso is that the observation must be reproducible.
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http://dx.doi.org/10.19102/icrm.2021.120108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834043PMC
January 2021

Whole blood viscosity in the evaluation of thrombogenic milieu in mitral stenosis.

Biomark Med 2021 02 20;15(3):181-190. Epub 2021 Jan 20.

Ankara City Hospital, Cardiology Department, Ankara, Turkey.

We aimed to assess the association of whole blood with thromboembolic milieu in significant mitral stenosis patients. We included 122 patients and classified patients into two groups as having thrombogenic milieu, thrombogenic milieu (+), otherwise patients without thrombogenic milieu, thrombogenic milieu (-). Whole blood viscosity (WBV) in both shear rates were higher in thrombogenic milieu (+) group comparing with thrombogenic milieu (-). WBV at high shear rate and WBV at low shear rate parameters were moderately correlated with grade of spontaneous echo contrast. Adjusted with other parameters, WBV parameters at both shear rates were associated with presence of thrombogenic milieu. We found that extrapolated WBV at both shear rates was significantly associated with the thrombogenic milieu in mitral stenosis. This easily available parameter may provide additional perspective about thrombogenic diathesis.
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http://dx.doi.org/10.2217/bmm-2020-0329DOI Listing
February 2021

Left atrial or left atrial appendage thrombus as a cardiac source of embolus: that is the question or Faustian bargain for left atrial appendage closure?

Europace 2021 02;23(2):324

Department of Cardiology, University of Health Sciences, Ankara City Hospital, Kardiyoloji Klinigi, Bilkent, 06800 Ankara, Turkey.

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http://dx.doi.org/10.1093/europace/euaa337DOI Listing
February 2021

Change in the atrial activation timing and sequence during narrow QRS tachycardia: What is the mechanism?

J Cardiovasc Electrophysiol 2021 01 23;32(1):148-150. Epub 2020 Nov 23.

Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14813DOI Listing
January 2021

The other side of the medallion in heart failure: Reverse metabolic syndrome.

Nutr Metab Cardiovasc Dis 2020 10 2;30(11):2041-2050. Epub 2020 Jul 2.

Ankara City Hospital, Cardiology Department, Ankara, Turkey.

Background And Aims: Lower levels of cardiovascular risk factors are associated with an increase in mortality in H.F. To explain this paradox, the term reverse metabolic syndrome (RMetS) has recently been proposed. We suggest defining these patients with lower levels of three risk factors can be combined under the heading "RMetS." We aimed to investigate the effect of MetS and RMetS on hemodynamic parameters and prognosis in patients with H.F. and reduced ejection fraction (HFrEF).

Methods And Results: We included 304 patients who were performed right heart catheterization and followed up for a median of 16 (0-48) months. We first grouped patients according to the presence of MetS or not, then we added the RMetS category and stratified patients into three groups as MetS, RMetS, and metabolic healthy. Compared with not MetS group, Pulmonary arterial pressures and VO were higher in MetS group. In the second step, LVEF, CI, VOI, O delivery, and LVSWI were lowest in RMetS, pulmonary artery pressures were higher in MetS group. In multivariate Cox regression analysis, being in RMetS group was associated with 2.4 times and 1.8 times increased risk for composite end point (CEP) and all-cause mortality, respectively. In Kaplan Meier analysis, RMetS had the highest all-cause mortality and CEP.

Conclusions: We determined that RMetS patients had the worst prognosis with unfavorable hemodynamic profile. Hence, a better understanding of the pathophysiology of RMetS may help refine the treatment targets of CV risk factors, may yield new interventions targeting catabolic syndrome.
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http://dx.doi.org/10.1016/j.numecd.2020.06.027DOI Listing
October 2020

Coronary Sinus Diameter to Inferior Vena Cava Diameter Ratio in the Diagnosis of Cardiac Tamponade: A Novel Approach.

J Comput Assist Tomogr 2020 Jul/Aug;44(4):599-604

From the Cardiology Department, Ankara City Hospital.

Background: In cardiac tamponade, coronary sinus (CS) as an intrapericardial structure can be easily compressed, whereas inferior vena cava (IVC) dilates. This inverse relationship may augment their roles in the evaluation of tamponade imaging.

Aim: We assessed the usefulness of computerized tomographic measures of CS diameter and also CS/IVC ratio to predict tamponade in clinically stable patients with large pericardial effusion.

Methods: Sixty-six clinically stable patients who had large pericardial effusions were included. Coronary sinus diameter was measured from the point at 1 cm proximal to the CS ostium. Inferior vena cava diameter was measured from the segment between its right atrial orifice and hepatic vein.

Results: Patients with tamponade had smaller CS diameter and CS/IVC ratio. After adjusting with other parameters, only either CS diameter or CS/IVC ratio predicted tamponade, respectively. (Nagelkerke r value for CS was 53.7% and 72.1% for CS/IVC ratio). In Receiver Operating Characteristic Curve analysis, a cutoff value of 6.85 mm for CS diameter had 82.6% sensitivity and 83.7% specificity and a cutoff value of 27% for CS/IVC ratio had 87.0% sensitivity and 86.0% specificity for predicting cardiac tamponade.

Conclusions: The tomographic measures of both the CS diameter and the CS/IVC ratio predicted tamponade in clinically stable patients with large pericardial effusion. Compared with CS diameter, CS/IVC ratio seemed to be a more powerful predictor of tamponade.
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http://dx.doi.org/10.1097/RCT.0000000000001064DOI Listing
July 2020

EP lessons by legendary quartet of "Jackman-Klein-Prystowsky-Stevenson": "A priceless opportunity" during the COVID-19 era.

J Cardiovasc Electrophysiol 2020 12 22;31(12):3104-3105. Epub 2020 Jun 22.

Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14615DOI Listing
December 2020

His bundle pacing using a simple stylet and a standard active fixation electrode.

J Electrocardiol 2020 Jul - Aug;61:37-40. Epub 2020 Apr 29.

Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.

Conventionally, His bundle pacing (HBP) is achieved using specially designed pacing leads and delivery sheaths. This paper describes the feasibility of permanent HBP with a pre-shaped simple stylet and a standard active-fixation electrode, through axillary vein access, without using dedicated delivery tools. This method may be a feasible and safe alternative to the only commercially available system.
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http://dx.doi.org/10.1016/j.jelectrocard.2020.04.020DOI Listing
June 2021

Simple approaches to reduce radiation in the electrophysiology laboratory.

J Cardiovasc Electrophysiol 2020 09 2;31(9):2544-2545. Epub 2020 Jun 2.

Department of Cardiology, Division of Arrhythmia and Electrophysiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14587DOI Listing
September 2020

A new risk model for the evaluation of the thromboembolic milieu in patients with atrial fibrillation: the PALSE score.

Kardiol Pol 2020 08 1;78(7-8):732-740. Epub 2020 Jun 1.

Cardiology Department, Ankara City Hospital, Ankara, Turkey

Background: The evaluation of thromboembolic risk is the cornerstone of atrial fibrillation (AF) management. Thromboembolic risk is associated with the presence of left atrial (LA) thrombus and spontaneous echo contrast (SEC), namely the thromboembolic milieu.

Aims: We aimed to assess the predictors of the thromboembolic milieu in terms of LA thrombus and/ or SEC in patients with paroxysmal AF undergoing electrical cardioversion or catheter ablation, and to develop an effective risk model for detecting the thromboembolic milieu.

Methods: We included a total of 434 patients with nonvalvular paroxysmal AF who underwent transesophageal echocardiography prior to cardioversion or catheter ablation.

Results: In patients with the thromboembolic milieu, total protein and C‑reactive protein levels, LA diameter, and systolic pulmonary artery pressure (SPAP) were higher, while left ventricular ejection fraction (LVEF) was lower than in patients without the thromboembolic milieu. In a multivariate logistic regression analysis, age, total protein levels, LVEF, LA diameter, and SPAP were independent predictors of LA thrombus and/or SEC. In a receiver operating characteristic curve analysis, the optimal cutoff values for the discrimination of patients with the thromboembolic milieu were as follows: 60 years for age; 7.3 mg/dl for total protein; 40% for LVEF; 40 mm for LA diameter; and 35 mm Hg for SPAP. Based on these cutoff values, we developed a novel risk model, namely, the PALSE score. The area under the curve for the PALSE score was 0.833. Patients with a PALSE score lower than 1 did not show thrombus or spontaneous echo contrast.

Conclusions: The PALSE score, which includes total protein levels, age, LA diameter, SPAP, and LVEF, seemed to accurately predict the presence of the thromboembolic milieu in patients with paroxysmal AF.
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http://dx.doi.org/10.33963/KP.15402DOI Listing
August 2020

Percutaneous Interventricular Septal Access Guided by Subcostal Echocardiography and Fluoroscopy for Ventricular Tachycardia Ablation in a Patient with Aortic and Mitral Mechanical Valves.

J Innov Card Rhythm Manag 2019 Jul 15;10(7):3719-3721. Epub 2019 Jul 15.

Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey.

Mechanical prosthetic aortic and mitral valves preclude either a retrograde aortic or transseptal approach to the left ventricular (LV) endocardium. Several operators have reported on the application of nonconventional techniques for ventricular tachycardia (VT) ablation including transventricular septal puncture, epicardial approach, transmechanical valve approach, transcoronary venous approach, and transapical approach. Incorporating transventricular access to the LV under intracardiac echocardiography (ICE) guidance has been previously attempted in VT ablation procedures in patients with both aortic and mitral mechanical valves. However, while ICE is readily used in the United States, its use is less common in Europe, since the health insurance agencies largely do not cover the costs of ICE catheters. We therefore herein present a case of VT ablation in the LV using a transventricular approach in a patient who underwent mechanical double valve replacement performed under subcostal echocardiographic and fluoroscopic guidance.
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http://dx.doi.org/10.19102/icrm.2019.100702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252692PMC
July 2019

The other side of the circulation: The arterial system.

J Cardiovasc Electrophysiol 2020 08 29;31(8):2267. Epub 2020 May 29.

Division of Arrhythmia and Electrophysiology, Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14574DOI Listing
August 2020

Overcoming difficulties related with persistent left superior vena cava.

J Cardiovasc Electrophysiol 2020 08 25;31(8):2264-2265. Epub 2020 May 25.

Division of Arrhythmia and Electrophysiology, Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14578DOI Listing
August 2020

An alternative way to reach the ventricular surface of the sinuses of valsalva: Antegrade transseptal approach.

J Cardiovasc Electrophysiol 2020 08 16;31(8):2257-2259. Epub 2020 May 16.

Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14536DOI Listing
August 2020

Bear track hypothesis in outcomes of ventricular tachycardia ablation: Risk factor or risk marker or both for heart failure?

Pacing Clin Electrophysiol 2020 06 30;43(6):621-622. Epub 2020 May 30.

Department of Cardiology, Ankara City Hospital, Yuksek Iktisas Kalp Damar Hastanesi, Health Sciences University, Ankara, Turkey.

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http://dx.doi.org/10.1111/pace.13942DOI Listing
June 2020

The boundaries between primary and secondary prevention with defibrillators after acute myocardial infarction: Gray areas of the terminology and definition.

J Cardiovasc Electrophysiol 2020 07 11;31(7):1888-1889. Epub 2020 May 11.

Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14528DOI Listing
July 2020

Wettability and roughness: Important determinants of bacterial adhesion and biofilm formation.

J Cardiovasc Electrophysiol 2020 07 30;31(7):1885. Epub 2020 Apr 30.

Division of Arrhythmia and Electrophysiology, Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14515DOI Listing
July 2020

Multimodality imaging to characterize a mass on a lead.

J Cardiovasc Electrophysiol 2020 07 24;31(7):1884. Epub 2020 Apr 24.

Department of Cardiology, Division of Arrhythmia and Electrophysiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14504DOI Listing
July 2020

Usefulness of positive T wave in lead aVR in predicting arrhythmic events and mortality in patients with hypertrophic cardiomyopathy.

Heart Rhythm 2020 08 14;17(8):1312-1319. Epub 2020 Apr 14.

Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.

Background: Positive T wave in lead aVR (TaVR) has been associated with increased risk of adverse events in patients with various cardiovascular diseases.

Objective: The purpose of this study was to investigate the prevalence and prognostic significance of positive TaVR in patients with hypertrophic cardiomyopathy (HCM).

Methods: This study investigated 421 consecutive patients with HCM (177 women; age 51.1 ± 14.9 years). Admission electrocardiogram was examined for the presence of a positive TaVR. The primary endpoint was defined as a composite of major arrhythmic events (MAEs), which included sudden cardiac death, sustained ventricular tachycardia or fibrillation, or appropriate implantable cardioverter-defibrillator therapy. Cardiovascular mortality and all-cause death were evaluated as secondary endpoints.

Results: During median follow-up period of 6.0 years (interquartile range 4.0-11.6 years), 53 patients (12.6%) experienced the primary endpoint. On multivariable competing analysis, after adjusting for other confounding factors, the presence of positive TaVR was found to be an independent and strong predictor of the primary composite endpoint. Time-dependent receiver operating characteristic analysis, net reclassification index, and integrated discrimination improvement showed that the addition of positive TaVR to conventional HCM risk factors improved prediction of arrhythmic events. However, in subgroup analysis, a positive TaVR lost statistical significance in patients with apical HCM but remained significant in patients with all other hypertrophy patterns.

Conclusion: Positive TaVR is associated with MAE in HCM patients, independent of and incremental to traditional risk factors.
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http://dx.doi.org/10.1016/j.hrthm.2020.03.030DOI Listing
August 2020

Time perception: What's "early"? What's "delayed"?

J Cardiovasc Electrophysiol 2020 07 16;31(7):1880. Epub 2020 Apr 16.

Department of Cardiology Division of Arrhythmia and Electrophysiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14492DOI Listing
July 2020

Impaired myocardial blood flow in atrial fibrillation.

J Cardiovasc Electrophysiol 2020 07 15;31(7):1882. Epub 2020 Apr 15.

Department of Cardiology, Division of Arrhythmia and Electrophysiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14494DOI Listing
July 2020

Manifest 1:2 tachycardia or atrioventricular nodal reentrant tachycardia with complete ventriculoatrial dissociation.

J Cardiovasc Electrophysiol 2020 06 7;31(6):1563-1564. Epub 2020 Apr 7.

Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey.

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http://dx.doi.org/10.1111/jce.14465DOI Listing
June 2020

Unusual response to His-refractory atrial premature complex: What is the mechanism?

J Cardiovasc Electrophysiol 2020 05 6;31(5):1232-1234. Epub 2020 Apr 6.

Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey.

A 32-year-old woman underwent radiofrequency catheter ablation of narrow QRS tachycardia that was terminated with intravenous adenosine.
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http://dx.doi.org/10.1111/jce.14458DOI Listing
May 2020

Prognostic nutritional index as a novel marker for prediction of prognosis in patients with peripartum cardiomyopathy.

Medicine (Baltimore) 2020 Mar;99(11):e19524

Department of Cardiology, University of Health Sciences, Ankara City Hospital.

The clinical significance of poor nutritional status in patients with peripartum cardiomyopathy (PPCM) is not clearly understood. Prognostic nutritional index (PNI) is a simple nutritional assessment tool, which was first demonstrated to be valuable in patients with colorectal surgeries. We aimed to investigate the predictive value of PNI in patients with PPCM.A total of 92 patients diagnosed with PPCM were enrolled in this study. PNI was calculated using the following formula: 10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count. The primary endpoint was defined as composite adverse cardiac events that included cardiac death or hospitalization due to worsening heart failure (HF). Cardiac death, hospitalization due to worsening HF, and persistent left ventricular (LV) systolic dysfunction were evaluated, respectively, as secondary endpoints.Primary composite endpoint was higher in the lower PNI group. After adjusting for other risk factors, PNI was found to be as an independent predictor of primary composite endpoint (odds ratio 0.805; 95% confidence interval 0.729-0.888; P < .001). In addition, PNI was significantly associated with secondary endpoints; persistent LV systolic dysfunction as well as cardiac death.This study identified nutritional status assessed by the PNI seems to be a novel predictor of adverse cardiovascular outcomes in patients with PPCM.
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http://dx.doi.org/10.1097/MD.0000000000019524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440167PMC
March 2020
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