In this case, we report a successful closure of secundum atrial septal defect in a 32-year-old female patient with an interrupted inferior vena cava (IVC). Interrupted IVC was detected coincidentally during right heart catheterization. The defect was successfully closed through transjugular vein approach as an alternative to surgery.

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Electrocardiographic (ECG) abnormalities are often indicative of acute coronary artery occlusion. Early detection of these abnormalities is important for the identification of patients who may be candidates for emergent percutaneous coronary revascularization (PCR). In most cases, ST-segment elevation is the key factor in selecting patients for PCR. However, some cases with acute coronary artery occlusion do not have ST-segment elevation, resulting in delays in coronary reperfusion treatment. A 37-year-old male presented to the emergency department with typical chest pain. The patient indicated that he was a heavy marijuana user. Even though his admission ECG did not reveal ST-segment elevation, he was hemodynamically stable, and he did not develop life-threatening arrhythmias, he was immediately taken to the catheterization laboratory for urgent angiography with the diagnosis of acute myocardial infarction. The occluded left anterior descending artery seen in angiography was successfully revascularized with percutaneous coronary intervention. Herein, we present a case of a patient who was admitted to the emergency department with chest pain and ECG demonstrating the de Winter pattern. Based on this case, we present a detailed evaluation regarding the de Winter ECG pattern, which is equivalent to ST-segment elevation.

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Background: Heart failure (HF) is an important public health problem. We aimed to investigate the predictors of long-term hospitalization in Turkish HF population. Materials and Methods: Journey-HF-TR study is a multicenter, cross-sectional, noninvasive, and observational study that was conducted in intensive care unit (ICU), coronary care unit (CCU), and cardiology wards in seven geographical regions of Turkey. In this subgroup analysis, patients were classified as two groups according to inhospital stay called the patient with the shorter length of stay (S-LOS) (inhospital stay <5 days; S-LOS) and patients with longer LOS (L-LOS) (inhospital stay ≥5 days; L LOS). Results: The study group was consisted of 1606 patients (57.2% male, mean age: 67. 8 ± 13.0 years old). One thousand and thirty seven patients, whom in-hospital stay duration were recorded in case report form, were included in this analysis. There were 487 patients (32.1%) in S LOS group and 1030 patients (67.9%) in L LOS group. In multivariate analysis, correlation was present for NYHA functional capacity, CKD, ACS related HF, right HF, cardiogenic shock, invasive and noninvasive ventilation, and hemodynamic monetarization. The longer inhospital stay increases the probability of morbidity and mortality. Conclusion: We demonstrated that there was positive correlation between longer hospital stay and HF severity (NYHA III-IV), CKD, cardiogenic shock, right ventricular HF, and HF related to ACS. HFpEF patients have less in-hospital stay than HFrEF and HFmrEF patients.

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Heart rate variability (HRV) is one of the promising emerging noninvasive modalities that are extensively used nowadays in research and risk stratification of several diseases. Reduced HRV has been linked to several cardiovascular risk factors such as hypertension (HTN) and diabetes mellitus (DM) also; it has been linked and used for years now in the risk stratification of congestive heart failure, coronary artery disease (CAD), and acute myocardial infarction (AMI). Controversial data are present about the effect of coronary artery bypass graft (CABG) on HRV and the use of HRV for risk stratification in post-CABG patients while percutaneous coronary intervention was linked to a dramatic improvement in HRV and improved survival of CAD patients. Although experimental data are present correlating reduced HRV with increased risk for cardiovascular morbidity and mortality, extensive research is required for further implementation in daily clinical use. In this review, we will discuss the current cardiovascular clinical implications and highlight the limitations of usage and future perspective of HRV.

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Background: Atherosclerotic cardiovascular disease influences young patients as well as the elderly. A large proportion of patients with coronary artery disease (CAD) have metabolic syndrome (MS), although the frequency and association of its different components are not clear. To the best of our knowledge, there is no any study about the prevalence of MS among young patients with ST-elevation myocardial infarction (STEMI). We sought to determine the prevalence of MS in patients below 46 years of age who presented with STEMI and underwent primary percutaneous coronary intervention. Methods: In the present prospective study, 141 consecutive patients with STEMI <46 years of age admitted to intensive coronary care unit. STEMI was defined according to the ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. All patients were grouped presence of MS. In the second step, the components of MS were analyzed, excluding patients with diabetes mellitus (DM). Results: The total prevalence of MS was 46.8% (n = 66). In MS group, the most frequent component of MS was low high-density lipoprotein (HDL) levels (84.8%), followed by elevated triglycerides (TGs) (78.1%). A total of 121 patients did not have DM and 51 (42.1%) of these patients presented with MS. Conclusions: The prevalence of MS in young patients with STEMI is high. Low HDL cholesterol (HDLc) concentrations and high TG levels are cardiovascular risk factors, regardless of low-density lipoprotein cholesterol levels and they are found too often in our study. These results highlight the need to implement preventative strategies for reducing overall cardiovascular risk in young patients as well as elderly.

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Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease of pulmonary hypertension (PH) as a consequence obstructive of pulmonary arteries with thromboembolism. Augmented pulmonary vascular resistance and pulmonary artery pressure (PAP) can ultimately lead to the right ventricular dysfunction, which leads to adaptive and maladaptive changes. Right ventricle (RV) remodeling can cause clinical deterioration and RV failure. Aims and Objectives: We aimed to evaluate the RV functions with a new diagnostic modality 2-deoxy-2-(18F)-fluoro-D-glucose (FDG)-positron emission tomography (PET) in patients with CTEPH. Materials and Methods: We included 53 patients diagnosed with CTEPH who were planned to have pulmonary thromboendarterectomy (PEA) and did not have any contraindication for cardiac PET/computed tomography (CT). We performed transthoracic echo, cardiac PET/CT, 6-minute walk distance (6-MWT), and right heart catheterization 1 week before PEA surgery. Results: The patients divided into two groups according to RV/left ventricle (LV) FDG-PET uptake ratio, RV/LV ≤1, and RV/LV >1. Six-MWD was significantly higher in the RV/LV ≤1 group (P = 0.005). Pro-BNP was considerably higher in the RV/LV >1 group (P = 0.041). Conclusion: The present study aims to demonstrate the RV/LV FDG-PET uptake ratio could be used in the noninvasive diagnostic method in diagnosing, treatment strategy, and clinical follow-up in patients with CTEPH.

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Purpose: This study aims to evaluate left ventricular (LV) functions using speckle-tracking echocardiography (STE)-based analyses in the early stages of obstructive sleep apnea (OSA). Methods: Twenty-one healthy individuals and 79 OSA patients enrolled in the study. The OSA group was classified according to Apnea-Hypopnea Index (AHI) as mild, moderate, and severe. Two-dimensional tissue Doppler imaging and STE was performed. Results: The control and OSA groups were comparable for sex (P = 0.450) and age (P = 0.560), while diabetes (P < 0.001) and hypertension (P < 0.001) diagnoses and body mass index (P < 0.001) were higher in the OSA patients. In OSA group, global longitudinal strain (GLS) (-13.32±3.19%, P < 0.001), global circumferential strain (GCS) (-18.33±3.40%, P < 0.001) and global radial strain (GRS) (37.91±8.11%, P = 0.005) were reduced. GLS and GCS have a decreasing trend toward severe OSA, while GRS increased in mild and moderate OSA. According to linear regression analysis, GRS (β: −1.47, P = 0.001], GCS (β: −1.34, P = 0.001), GLS (β: −1.54, P < 0.001), systolic pulmonary artery pressure (β: 0.99, P = 0.001), and deceleration time (β: 0.13, P = 0.03) have an independent relationship with AHI. Conclusions: In our study, STE technique can be a practical method for manifesting LV functional impairment at the early stages of OSA.

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Objective: Atrial fibrillation (AF) is the most common arrhythmia that increases risk of stroke by 4–5 fold. AF prevalence is approximately 1%–3% in the general population and increases with age. Until 2010, the standard of care (SoC) for prophylaxis of ischemic stroke was Vitamin K antagonists. Phase III randomized controlled trials (RCTs) of non-Vitamin K oral anticoagulants (NOACs) showed that NOACs have comparable or lower risk of stroke, systemic embolism, major bleeding, and death with warfarin in populations with nonvalvular AF (NVAF). Since then, results of these pivotal RCTs were confirmed by postmarketing studies and real-world data. In the last 8 years, they have been replacing warfarin as the SoC not only for preventing stroke in NVAF patients but also for patients with deep vein thrombosis, pulmonary embolism, and those who undergo hip or knee surgery. In recent years, there are emerging data on new clinical areas such as coronary and peripheral artery disease. In this article, it is attempted to review what has changed in the last 8–10 years in the management and prevention of stroke associated with NVAF and other thromboembolic situations and to foresee whether NOACs will be SoC and stand beyond being SoC in anticoagulation therapy. Methods: IMS data were obtained from IQVIA with a permission letter on request of Dr. Ergene. IQVIA grants permission to use the statements for the specified purpose (NOACs share in the total anticoagulation market and role of NOACs as the SoC in the near future) of peer-review publication by Dr. Ergene. Conclusion: NOACs are breakthrough in stroke prevention, and they will prevail eventually. It will take a few years; anticoagulation market will grow in favor of NOACs, and most probably, NOACs will reach over 50% standard unit market share. It is even more exciting to hear about new therapeutic areas and indications for these agents.

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Obstructive mechanical valve thrombosis is a rare and serious disease. Despite therapeutic progress, mortality remains high, and the choice between surgery and thrombolytic therapy remains controversial. We report the case of a 46-year-old woman admitted to the emergency department for obstructive mitral mechanical valve thrombosis successfully thrombolyzed by the recombinant tissue plasminogen activator. Through this case, we would like to discuss the different therapeutic options, and why fibrinolysis was our choice for this particular patient.

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Introduction: Although coronavirus disease-19 (COVID-19) primarily causes respiratory system infection, it may cause thrombosis in the cardiovascular system. In this regard, we aimed to compare cardiovascular outcomes between COVID-19–positive and –negative patients with ST-segment elevation myocardial infarction (STEMI). Methods: This was a retrospective study that consecutively included 96 COVID − and 36 COVID+ patients with STEMI. Clinical, laboratory, and angiographic characteristics were obtained from hospital records, and these variables were compared between groups. Results: COVID-19 patients with STEMI had higher Killip score (3–4) (78 vs. 30, P < 0.001) and mortality (42% vs. 21%, P = 0.017). Among COVID-19 patients with STEMI, 83% had lung infiltration. According to the angiographic findings, COVID-19 patients had a shorter door to balloon time (35 ± 20 vs. 49 ± 17, P = 0.013), glycoprotein IIb/IIIa antagonist use, and shorter door to balloon time. Conclusion: COVID-19 patients with STEMI had a higher rate of cardiogenic shock and mortality.

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Background and Aim: Lifestyles and behavoiral patterns of patients must be known to improve public health and to prevent cardiovascular diseases (CVD). In this study, we aimed to provide insights into the lifestyles and behavioral patterns of patients applied to outpatient cardiology clinics in Turkey. Materials and Methods: The participants completed a self-administered questionnaire about awareness of cardiovascular (CV) risk factors and individual CV risk levels, lifestyles, and medications. Results: A total of 2793 patients, 52.1% of females with a mean age of 57.0 ± 14.0 years were included. The most common risk factor was hypertension. The most common CVD was coronary artery disease. The calculated CV risk level of 1041 patients (37.3%) was high, while only 20.4% of all participants identified themselves as high risk. Participants were aware that hypertension, smoking, hyperlipidemia, diabetes, sedentary, family history, and aging were risk factors for CVD. About 44% of the patients reported that they used additional salt and the majority reported that they did not consume fast food. The most commonly prescribed CV drug was beta-blockers (44.9%) and 22.4% of patients were taking minimum of 5 drugs daily. Conclusion: The awareness of CV risk factors and risk levels is low in the study population. Guideline recommended medications and lifestyle changes are not sufficiently implemented.

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Introduction: The reciprocal ST-segment depression in the electrocardiography (ECG) leads overlying noninfarcting areas was studied previously in acute myocardial ischemia. Multi-vessel disease (MVD) subset of patients have more vague and confusing presentations on ECG; they usually show less ST-segment elevation and profound and diffuse ST-segment depression compared to ST-segment elevation myocardial infarction (STEMI) patients with single-vessel disease (SVD) involving occlusion of one coronary artery only, namely the infarct-related artery (IRA). Aim of the Work: The aim was to study and compare the pattern of reciprocal ECG changes in STEMI patients presenting with SVD versus MVD. Methods and Results: A total of 125 consecutive patients admitted from April 2014 to August 2015 from the emergency room with the diagnosis of acute STEMI and treated by primary percutaneous coronary intervention (PPCI) at our cath lab at Ainshams University Hospitals (a 24/7 tertiary referral center for PPCI) were included. ST-segment deviations were measured at the J-point. Reciprocal ST-segment changes were identified as per guidelines published by the European Society of Cardiology and the American College of Cardiology, i.e., ST-segment depression ≥0.1 mV in any ECG lead other than aVR, while the cutoff value is different for leads V2 and V3 being only 0.05 mV. Coronary angiographies were evaluated by two independent operators blinded to the clinical and electrocardiographic data. Regarding the left anterior descending (LAD) occlusion, the reciprocal ST-segment depression magnitudes in lead III and in lead arteriovenous fistula (aVF) were significantly less in the MVD group compared to the SVD group, i.e., lead III (−0.08 ± 0.10 mV vs. −0.19 ± 0.15, P = 0.015) and lead aVF (−0.07 ± 0.06 mV vs. −0.15 ± 0.11, P = 0.02); while regarding the left circumflex coronary artery (LCX) occlusion, the reciprocal ST-segment depression extended significantly in V4 chest lead in the MVD group compared to the SVD group (−0.16 ± 0.08 mV vs. −0.1 ± 0.04, P = 0.025); and finally regarding the right coronary artery (RCA) occlusion, the reciprocal ST-segment depression extended significantly in V3 chest lead in the MVD group compared to the SVD group (−0.18 ± 0.07 mV vs. −0.1 ± 0.06, P = 0.02). Conclusion: The pattern of reciprocal ST-segment depression was more profound when the LAD was the culprit artery causing the anterior STEMI compared to the same case if the LAD was a part of MVD; this does not apply to the LCX and RCA when they were the culprit in cases of inferior STEMI where the MVD group showed more reciprocal ST-segment depression.

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Background: The proliferation of heart-unhealthy lifestyles may in part be responsible for the unabated scourge from heart disease. Assessments of knowledge and perception are key factors in curbing lifestyle-related diseases. Aims: The aim of the study is to determine the prevalence of heart-unhealthy lifestyles and its association with knowledge and perception of heart disease among young adults in Delta State, Nigeria. Settings and Design: A cross-sectional observational study conducted in Oghara, Nigeria. Materials and Methods: Three hundred healthy adults aged 18–35 years were recruited using the multistage sampling technique. The study instrument was a modified structured interviewer-administered questionnaire. Ethical approval was obtained before conducting the survey. Statistical Analysis Used: Obtained data were summarized and analyzed using SPSS version 22.0 software. Results: The response rate was 98% (294/300): 103 males and 191 females. The mean and median age of the respondents was 27 years. Majority of the respondents had at least 6 years of formal education. Heart-unhealthy lifestyles were prevalent: lack of exercise (71.4%), inadequate fruit intake (46.9%), alcohol consumption (26.5%), and tobacco smoking (19%). The mean knowledge score for heart disease was 39.49%. Using a score of 50% as the benchmark for good knowledge, 59% of the respondents had poor knowledge. Majority of the respondents did not perceive that they were at risk of heart disease. Conclusion: Heart-unhealthy lifestyles are common among young Nigerian adults. Knowledge of and self-perceived susceptibility to heart disease were poor in this study. There is a need for increased and refocused heart-health education at all ecological levels from early on in life.

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Background: Exercise intolerance has a relation with poor prognosis for patients with heart failure (HF). The high C-reactive protein (CRP) levels have prognostic effects on many cardiovascular diseases such as HF, coronary artery disease, and ischemic stroke. The low serum albumin levels are related with poor prognosis in patients with HF. We aimed to investigate whether the assessment of CRP/albumin ratio would enable clinicians to identify patients with advanced HF. Materials and Methods: This retrospective study included 102 HF patients with reduced ejection fraction (≤40%). The mean age of patients was 44 ± 13 years. Advanced HF (New York Heart Association [NYHA] Functional Class III–IV) was observed in 27 patients (26.5%). Results: CRP/albumin ratio was on average higher in patients with NYHA functional Classes III and IV than in patients with NYHA functional Classes I and II (0.4 [0.02–1.97] vs. 0.12 [0.02–1.63], P < 0.001). In multiple logistic regression model with forward stepwise method, CRP/albumin ratio (odds ratio [OR]: 3.084, P: 0.036, 95.0% confidence interval [CI]: 1.074–3.855) and brain natriuretic peptide >500 pg/ml (OR: 3.526, P: 0.014, 95.0% CI: 1.290–9.637) remained associated with advanced HF. Conclusions: For the first time in the literature, we showed that elevated CRP/albumin ratio was found to be independently associated with advanced HF. We have also shown that high CRP/albumin ratio was associated with poor hemodynamic parameters.

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Objective: Specific biomarkers are essential in the diagnosis of heart failure. Our trial aim is determined that relationship between toll-like receptor-5 (TLR-5) and N-terminal pro-B-type natriuretic peptide (NT-ProBNP) in patients with reduced ejection fraction. Methods: Two groups were formed in our study (normal and patient group). Among the two groups were investigated that relationship between TLR-5 and NT-ProBNP. Results: The plasma levels of both NT-ProBNP and TLR-5 are significantly higher in patients with congestive heart failure than healthy individuals. However, there is no definite correlation between plasma levels of NT-ProBNP and TLR-5 in patients with congestive heart failure. The high-level plasma TLR-5 is of prognostic value independent from the plasma NT-ProBNP levels, in these patients. Conclusion: As a conclusion, according to recent studies, the high plasma levels of NT-ProBNP and TLR-5 are mainly associated with high mortality and longer hospitalization rate in individuals with heart failure. Therefore, the higher is plasma levels of markers such as TLR-5 and NT-ProBNP, the worse is the overall prognosis in these patients. NT- ProBNP and TLR-5 are thought to be the cheapest and the most appropriate marker to be determined.

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Background: The aim of this study was to investigate the relationship between neutrophil to lymphocyte ratio (NLR) platelet to lymphocyte ratio (PLR), mean platelet volume to lymphocyte ratio (MPVLR), MPV to platelet ratio (MPVPR) and the complexity of coronary artery disease (CCAD) in patients with acute coronary syndrome (ACS) using the SYNTAX score (SS) algorithm. Materials and Methods: A total of 599 patients with ACS undergoing coronary arteriography were enrolled and divided into three groups according to their SS: low SS group ≤22 (low-SSG,); intermediate SSG ≥23 and ≤32 (in-SSG,); and high- SSG ≥33 (high-SSG). Routine complete blood count parameters were analyzed at hospital admission. Results: There were significant differences between three groups in terms of PLR and MPVLR values (P = 0.007 and P = 0.029). Correlation analysis showed that PLR and MPVLR were positively correlated with CCAD (r = 0.095, P = 0.018 and r = 0.112, P = 0.005, respectively). In multivariate logistic regression analysis, MPVLR was not an independent predictor of CCAD, whereas PLR was found to be a weak independent predictor of CCAD (odds ratio = 1.003 [1.001–1.006], P = 0.021). Receiver operating characteristics analysis showed that PRL had low sensitivity (56.2%) and specificity (51.6%) for prediction of CCAD. Conclusion: Our study showed that NLR, MPVPR, and MPVLR were not independent predictors of CCAD in patients with ACS. PLR had such a weak relationship with CCAD that it could not be used for prediction of CCAD in these patients.

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Introduction: We compared transcatheter and surgical closure of secundum atrial septal defects (ASDs) in terms of cost in this study. Materials and Methods: Between 2006 and 2015, 291 consecutive patients having secundum ASD, in whom percutaneous or surgical closure was performed, were included in this study. We compared the in-hospital cost of transcatheter versus surgical ASD closure in these patients. Results: We collected totaly 291 patients, 214 transcatheter and 77 surgical closure procedures, retrospectively. Patients with a surgical closure had a longer length of stay (11.8 ± 3.8 days vs. 2.8 ± 1.6 days, P < 0.001). There was no in-hospital mortality in two groups. Costs denominated in Turkish lira (TL) and United States Dollar (USD) of transcatheter closure were higher than that of surgical closure (TL 10955.6 ± 183.4 vs. TL 6016.7 ± 371.9 P < 0.001; USD 6531.2 ± 149.62 vs. USD 3896.2 ± 234.7 P < 0.001). The cost of percutaneous ASD closure increase does not correlate with the dollar rate on the annual basis. This with the supplier firms has excessive profits in the first year of the study. Conclusion: Compared with other countries with regard to cost, transcatheter ASD closure is a more expensive treatment than surgical closure in our country.

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Aim: Red blood cell distribution width (RDW) and epicardial fat tissue (EFT) are considered as a novel risk factor for cardiovascular disease. However, their relationship in patients with type II diabetes mellitus (DM) has never investigated before. Materials and Methods: Our study was a single-center prospective study which included 159 diabetic patients and 153 healthy controls. Two-dimensional and M-mode echocardiographic examination was performed using standard apical, parasternal, and subcostal views in all the study participants. Results: EFT thickness and RDW were found to be significantly higher in diabetic patients compared to controls (4.3 ± 1.1 mm vs. 3.7 ± 1.0 mm P = 0.001 and 13.5 ± 0.7 vs. 13.2 ± 0.9 P = 0.044, respectively). EFT thickness and RDW were positively correlated. RDW value of 13.55 predicted EFT thickness >5 mm with a sensitivity of 61.7% and specificity of 58.8% (area under the curve [AUC]: 0.649 and P = 0.001). HgA1C value of >7 predicted EFT thickness ≥4.15 mm with a sensitivity of 60.7% and specificity of 60.4% (AUC: 0.651 and P < 0.001). No correlation found between RDW and HgA1C (AUC: 0.554 and P: 0.169). Conclusion: EFT thickness increased in diabetic patients, independent of age, gender, waist circumference, body mass index, and it was correlated with RDW and HgA1C.

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Background: T wave inversion in leads with ST-segment elevation after reperfusion therapy is considered a sign of reperfusion. However, the significance of T wave inversion on presentation before the initiation of reperfusion therapy is unclear. Aim of the Work: The current study aimed to assess whether the initial T wave morphology in the electrocardiographic (ECG) at presentation can predict patency of the left anterior descending artery (LAD) in patients with acute anterior ST segment elevation myocardial infarction (STEMI) before undergoing primary percutaneous coronary interventions (PCIs). Methods: This study included ninety patients who presented to the emergency department with acute anterior ST-elevation MI. We excluded patients with bundle branch block, postcoronary artery bypass grafting patients, patients with paced rhythm, and patients who received thrombolytic therapy. The T wave morphology in the 2 leads with maximal ST-segment elevation on the presenting ECG was identified as one of the three morphologies, positive T waves (T+; initial positive deflection ≥0.5 mm above the isoelectric line), biphasic T waves (T+/−; where the T wave initially showed a positive deflection above the ST segment afterward followed by a negative deflection ≥0.5 mm below the isoelectric line), and negative T waves (T−; where the T wave initially showed a negative deflection ≥0.5 mm below the isoelectric line without showing any initial positive deflection). Then, according to the results of the initial angiography, patients were classified into spontaneous reperfusion (SR) (those with thrombolysis in MI [TIMI] II or TIMI III flow in the infarct-related artery [IRA] prior to intervention) or non-SR (those with TIMI 0 or TIMI I flow in the IRA prior to intervention). Results: Ninety consecutive patients (77 males and 13 females) presented by STEMI and treated by primary PCI at cath lab of Ainshams University Hospitals (a 24/7 tertiary referral center for primary PCI) between January 2015 and March 2016 were included in this study, of which 40 patients (44.4%) had positive T waves (T+), 34 patients (37.8%) had negative T waves (T−), and 16 patients (17.8%) had biphasic T waves (T+/−). Initial angiogram showed that 18 patients had SR and 72 patients had no SR. With regard to T wave morphology, negative T waves were significantly present in SR group (66.7% vs. 30.6%, P = 0.004), whereas positive T waves were predominantly present in non-SR (50% vs. 22.2%, P = 0.033). Conclusions: For SR of LAD in anterior STEMI patients, prior to primary PCI, T wave inversion had a good sensitivity of 66.7%, a specificity of 69.4%, and a good negative predictive value of 89.29%.

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Introduction: Percutaneous endovascular methods have emerged to the contemporary revascularization choice in patients with infrapopliteal (IP) arterial disease. However, restenosis remains to be the Achilles' heel of this minimally invasive revascularization techniques. We aimed to analyze the association between preprocedural (neutrophil to lymphocyte ratio) Neutrophil-to-Lymphocyte ratio (NLR) and subsequent patency in a cohort of patients with symptomatic IP disease undergoing balloon angioplasty. Methods: All patients primarily treated with angioplasty of at least one IP artery causing severe symptoms or critical limb ischemia (CLI) (Rutherford category 1–6) between January 2014 and August 2015 were analyzed. The baseline demographic, clinical, and angiographic features admission laboratory test results were obtained from hospital files and computer records. NLR was calculated as the preprocedural ratio of neutrophils to lymphocytes. Results: The study population involved 42 (43.8%) CLI patients and 52 (54.2%) claudicants. The most frequent target vessel was the posterior tibial artery. Primary patency at 1 month was 81.9% and 62.7% at 6 months. NLR (odds ratio: 0.04, P = 0.03) independently predicted patency at 1 month but did not have a role on arterial patency after 1 month. Only smoking (odds ratio: 4.8, P = 0.01) associated with patency at 6 months. Conclusion: Preprocedural NLR was an independent risk factor for IP arterial patency at short-term. It may be used as a risk factor for subsequent amputation or recurrent interventions.

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Brugada syndrome is a congenital channelopathy in cardiac ion transmembrane causing an alteration in the electrical conduction of the heart. ST-elevation, as well as right bundle-branch block in anterior precordial electrocardiography (ECG), is pathognomonic in this syndrome. The patient might be asymptomatic or with a history of syncope and prone to develop ventricular tachyarrhythmia which may spontaneously recover or degenerates to ventricular fibrillation, cardiac arrest and even sudden death. Nevertheless, this can be prevented by implantable cardioverter defibrillator implantation. Therefore, it is of paramount importance that clinical suspicion and identification, interpretation of its characteristic ECG pattern and risk stratification to be properly done to diagnose and to manage Brugada syndrome. The author has also done a systematic review (included in the article) for several noninvasive ECG parameters for risk stratification with promising results. Epicardial ablation is an emerging therapy that may “cure” Brugada syndrome.

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Coronavirus disease-2019 (COVID-19) is a novel disease that has become a global health problem with high mortality rates. Up to now, there is neither specific treatment nor a vaccine for the disease; hence, the primary goal is to keep patients alive. There is growing evidence that more men than women are dying from the COVID-19. Although the outbreak of COVID-19 has led to the legislation of exceptional public health measures in various countries, fatality difference among genders has not been changed in favor of women. It is important to understand the role of sex to figure out who is most vulnerable to COVID-19 and the risk factors of death. While the precise mechanism of globally observed lower female death rates is still unknown, there are many speculations such as the effect of X chromosome, immunologic distinction, lifestyle choices, and employment status. The aim of this review is to highlight the most relevant connections between COVID-19 and low mortality rate in women globally.

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Premature atrial complexes (PACs) have long been considered a benign electrophysiological phenomenon unlikely to result in a severe clinical consequence. However, recent evidence had challenged this notion. Several studies showed that excessive PAC leads to the development of atrial fibrillation and subsequent hospitalization. The PAC is also associated with mortality, cardiovascular hospitalization, permanent pacemaker implantation, and nonlacunar ischemic stroke. The cutoff for excessive PAC differs from one study to another ranging from 76 PACs per 24 h to >32 PACs per hour. Increased adverse cardiovascular events demonstrated by recent studies had challenged the long-held paradigm that PACs are unlikely to result in serious clinical consequences.

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