Muzaffer Kahyaoglu

Intramyocardial dissecting hematoma (IDH) is a rare mechanical complication following acute myocardial infarction, characterized by blood accumulation within myocardial layers without complete rupture. Clinical outcomes are highly variable, ranging from spontaneous resolution to death. The optimal management strategy remains unclear, particularly regarding the role of conservative versus surgical approaches in hemodynamically stable patients. A 79‐year‐old male presented 1 month after anterior myocardial infarction treated with percutaneous coronary intervention. Echocardiography revealed a large (70 × 80 mm) heterogeneous mass with scattered echolucent spaces occupying more than half of the left ventricular cavity, originating from the akinetic apex and extending along the interventricular septum. Unlike typical thrombus, no communication with ventricular cavities or color Doppler flow was detected. Cardiac computed tomography revealed a hypodense, non‐enhancing lesion (91 × 70 mm), raising the possibility of an intramyocardial hematoma. Despite the massive intracardiac mass, the patient remained hemodynamically stable. Serial echocardiographic monitoring over 2 weeks documented progressive hematoma reduction without additional medical intervention, anticoagulation, or surgical management. Complete resolution of the hematoma occurred without progression to ventricular septal rupture or free wall rupture. Spontaneous resolution of post‐myocardial infarction IDH can occur in hemodynamically stable patients without surgical intervention. Serial echocardiographic monitoring is essential for detecting spontaneous regression and guiding management decisions. This case highlights the potential role of conservative management with close imaging surveillance and suggests that conservative management may represent an alternative to surgery in selected patients, particularly those who are hemodynamically stable.

Objectives: The deposition of calcium in the vascular bed can reflect the presence of atherosclerotic lesions, and aortic knob calcification (AKC) has been shown to correlate with a heightened risk of cardiovascular disease (CVD) events. This retrospective research was undertaken with the aim of evaluating the relationship between AKC and the coronary artery calcium score (CACS) by chest X-ray and investigating the possibility of using AKC to predict the risk of CVD. We hypothesized that AKC would be detected more frequently on chest X-rays among patients with severe CACS values. Methods: The study included 282 consecutive patients diagnosed with stable angina pectoris (SAP) who had presented to our cardiology outpatient clinic between 2018 and 2020 and underwent cardiac computed tomography and chest X-ray. Those whose chest X-rays revealed small spots or singular areas of fine calcification were considered to have AKC. CACS values were classified according to the Agatston score and CACS severity was defined as none-mild (100). Results: The mean age of the 282 enrolled patients was 47.5±11.3 years and 169 (59.9%) of the patients were male. CACS values of >100 signifying moderate-severe risk were observed more commonly among patients with diabetes mellitus, hypertension (HT), older age, and smoking habits (pConclusion: It is important to establish the risk of CVD in patients with SAP using simple and non-invasive methods. Our study showed that the presence of AKC on chest X-ray is associated with higher CACS values in patients presenting with SAP. Therefore, AKC may be used more frequently for the evaluation of the risk of CVD.

Objectives: The modified Glasgow Prognostic Score (mGPS) is one type of inflammation-based index; it includes data on elevated C-reactive protein and reduced albumin content. The predictive value of mGPS for outcomes is investigated in various diseases such as cancer, heart failure, myocardial infarction, acute pulmonary embolism, and inflammatory bowel diseases. This study aimed to evaluate the link between mGPS and the severity and complexity of peripheral arterial disease (PAD) as determined by the Transatlantic Intercommunal Consensus Document (TASC-II) classification and the prediction value of mGPS for procedural success in patients undergoing endovascular treatment (EVT). Methods: Our study included 203 consecutive patients receiving EVT for atherosclerotic obstruction of aortoiliac, femoro-popliteal, and below-knee arteries between January 2019 and February 2020. The lesion characteristics were determined according to categories in the TASC-II. Operational failure is the inability to position the guidewire through the occluded lesion following percutaneous intervention or achieve distal perfusion following EVT. Results: In our study, we observed 136 patients (%6) with TASC A–B lesions and 67 patients (%33) with TASC C–D lesions. EVT was performed on the femoro-popliteal artery in 59.4% of the patients, on the aortoiliac artery in 30.7%, and on the below-the-knee artery in 9.9%. mGPS was an independent predictor of severe PAD (OR: 17.943, 95% CI: 5.120–62.882; p < .001) and procedural success (odds ratio: 0.004; 95% CI: 0.001–0.099; p < .001). Additionally, we identified age and the presence of a TASC D lesion as independent predictors of interventional success (OR: 0.938, 95% CI: 0.819–0.979; p : .034; OR: 0.104, 95% CI: 0.107–0.643; p : .015, respectively). Conclusion: We determined that mGPS independently predicts PAD complexity and severity based on TASC-II classification; the EVT success rate is lower in patients with high mGPS.

Hypertrophic cardiomyopathy,speckle tracking echocardiography,ventricu- lar arrhythmia

Aim: This study aims to evaluate the association between prognostic nutritional index (PNI) and contrast-induced nephropathy (CIN). Material and methods: A total of 251 patients who were at high risk for contrast nephropathy were included in the study. The patients were grouped according to their PNI score (PNI score <45 or PNI score ≥45). CIN was defined as a 25% relative increase, or 0.5 mg/dL absolute increase in serum creatinine level above baseline within 72 hours of contrast exposure, in the absence of an alternative explanation. Results: Two groups were assigned according to the PNI score. The first group consists of 111 patients (PNI<45) and the second group has 140 patients (PNI≥45). CIN developed in 162 (%64.8) patients. C-reactive protein was higher in the low-PNI group. Also, the patients with the low-PNI group had lower ejection fraction, lower serum albumin levels, and lower hemoglobin levels. CIN, postprocedure renal replacement therapy requirement and in-hospital mortality were higher in the low PNI group. Multivariable logistic regression analysis revealed that advanced age (p=0.012, [OR] = 1.044 [1.009-1.079]), low baseline GFR (p=0.033, [OR]= 1.022 [1.002-1.043]), high amount of contrast media (p=0.022, [OR]= 1.017 [1.002-1.031]), and low PNI score (p=0.033 , [OR]= 2.069 [1.060-4.039]) were independent predictors of CIN. Conclusion: Our study demonstrated that the PNI score was an independent risk factor for the development of CIN.

Congenital absence of the pericardium (CAP) is a rare cardiac malformation and can be defined as the partial or total absence of the fibroelastic sac that surrounds the heart and great vessels. As the patients are often asymptomatic or have nonspecific symptoms, the diagnosis of this rare congenital anomaly is difficult. Therefore, it is usually diagnosed incidentally during imaging, intraoperatively, or during postmortem examinations. In this regard, it is important to keep specific images in mind during the examination and to suspect CAP to make an accurate diagnosis. In this report, we present a case of a 42-year-old male who presented with a complaint of atypical chest pain and was diagnosed with CAP using multimodality imaging.

In this study, we investigated whether early systolic lengthening (ESL) which reflects subclinical ischemia and other echocardiographic and clinic parameters predict primary outcome [appropriate ICD shock, cardiovascular mortality and ventricular tachycardia (VT) or fibrillation] in patients with hypertrophic cardiomyopathy (HCM). 202 Patients with HCM (68% male, mean age 48 ± 13.9 years) were included in the study. Patients’ clinical, electrocardiographic, 2D classic and speckle tracking echocardiography (STE) data were collected. ESL was defined as time from onset of the Q wave on ECG (onset of the R wave if the Q wave was absent) to maximum myocardial systolic lengthening. Patients were divided into two groups as occurrence or absence of primary outcome during 5 years follow up. During the follow-up period of 5 years (mean follow-up duration, 45.9 ± 10.8 months), 31 patients (15%) developed primary outcome [appropriate ICD shock 22 (11%), cardiovascular death 6 (3%), VT/VF 3(1.5%)]. Higher HCM Risk SCD score, longer ESL, and decreased global longitudinal peak strain (GLPS) were observed in patients with primary outcome. A Cox regression analysis, ESL, GLPS and HCM Risk SCD score were found to be independent predictors of occurrence of primary outcome. In ROC curve analysis, ESL > 53.5 msn could discriminate between groups with and without a primary outcome (AUC 0.768, 80% sensitivity and 60% specificity, CI 95% 0.666–0.871). ESL were found to be predictive for primary outcome in patients with HCM. Readily measurable ESL could be helpful to distinguish patients at high risk who could optimally benefit from ICD therapy.

Left ventricular apical thrombus (LVAT) formation is a well-known complication of acute anterior myocardial infarction (AMI). The CHA2DS2VASc is a scoring system that has been used to estimate the risk of thromboembolism in patients with nonvalvular atrial fibrillation. This score has also been used for other clinical conditions. The aim of this study was to investigate the relationship between CHA2DS2VASc score and development of LVAT in patients with AMI. The study population included 378 patients (mean age: 56.5 ± 12.3 years, male: 318) presenting with AMI between January 2016 and January 2020. Primary percutaneous coronary intervention procedure was performed in all patients. Initial echocardiogram was performed within 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and 12th months. Patients were divided into two groups according to the presence of LVAT on echocardiography. The incidence of the LVAT was 8.5% (n = 32) during a mean follow-up time of 233.1 ± 66.7 days. The mean CHA2DS2VASc score was notably higher in patients with LVAT compared to patients in the control group (3.1 ± 1.9 vs. 1.9 ± 1.2, p < 0.001). In Cox regression analysis, high CHA2DS2VASc score, low left ventricular ejection fraction (LVEF) and the presence of LV apical akinesis/aneurysm were the independent predictors for LVAT formation. All of these parameters were associated with higher cumulative incidence of LVAT formation in Kaplan-Meier analyses (p < 0.001 for all). High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneurysm may be used for LVAT risk prediction among patients presenting with AMI.

Background: Echocardiography is generally used in our daily practice to detect cardiovascular complications in COVID‐19 patients and for etiological research in the case of worsened clinical status. Many echocardiographic parameters have been the subject of investigation in previous studies on COVID‐19. Recently, the right ventricle early inflow‐outflow (RVEIO) index has been identified as a possible and indirect marker of the severity of tricuspid regurgitation and right ventricular dysfunction in pulmonary embolism. In this study, we aimed to investigate the relationship between the severity of pneumonia in COVID‐19 patients and the RVEIO index.Methods: A total of 54 patients diagnosed with COVID‐19 pneumonia were enrolled in this study. Our study population was separated into two groups as severe pneumonia and nonsevere pneumonia based on computed tomography imaging.Results: Saturation O₂, C‐reactive protein, D‐dimer, deceleration time, tricuspid annular plane systolic excursion, tricuspid lateral annular systolic velocity, and RVEIO index values were found to be significantly different between severe and nonsevere pneumonia groups. The result of the multivariate logistic regression test revealed that saturation O2, D‐dimer, Sm, and RVEIO index were the independent predictive parameters for severe pneumonia. Receiver operating characteristic curve analysis demonstrated that RVEIO index >4.2 predicted severe pneumonia with 77% sensitivity and 79% specificity.Conclusion: The RVEIO index can be used as a bedside, noninvasive, easily accessible, and useful marker to identify the COVID‐19 patient group with widespread pneumonia and, therefore high risk of complications, morbidity, and mortality.