A 45-year-old man was admitted to our department, with the symptoms of gastric outlet obstruction. A gastric adenocancer metastatic to the liver had been diagnosed at an another institute 10 days previously. Endoscopy revealed pyloric obstruction due to advanced carcinoma of the gastric antrum. Abdominal computed tomography showed the gastric malignancy and liver metastases, and no lesions of the small or large bowel. An uncovered, 20 mm × 12 cm, self-expandable metallic stent (Ultraflex; Boston Scientific, Ireland) was deployed without any complication ([Fig. 1] a). The patient began to feed orally the next day, and we referred him to the medical oncology department for evaluation for chemotherapy.
Objective: Oral anticoagulant therapy is the cornerstone of atrial fibrillation management to prevent stroke and systemic embolism.However, there is limited real-world information regarding stroke and systemic embolism prevention strategies in patients with atrial fibrillation.The aim of the ROTA study is to obtain the real-world data of anticoagulant treatment patterns in patients with atrial fibrillation. Materials and Methods:The ROTA study is a prospective, multicenter, and observational study that included 2597 patients with atrial fibrillation.The study population was recruited from 41 cardiology outpatient clinics between January 2021 and May 2021. Results:The median age of the study population was 72 years (range: 22-98 years) and 57.4% were female.The median CHA 2 DS 2 -VASc and HAS-BLED scores were 4 (range: 0-9) and 1 (range: 0-6), respectively.Vitamin K antagonists and direct oral anticoagulants were used in 15.9% and 79.4% of patients, respectively.The mean time in therapeutic range was 52.9% for patients receiving vitamin K antagonists, and 76% of those patients had an inadequate time in therapeutic range with <70%.The most common prescribed direct oral anticoagulants were rivaroxaban (38.1%), apixaban (25.5%), and edoxaban (11.2%).The rate of overuse of vitamin K antagonists and direct oral anticoagulants was high (76.1%) in patients with low stroke risk, and more than one-fourth of patients on direct oral anticoagulant therapy were receiving a reduced dose of direct oral anticoagulants.Among patients who were on direct oral anticoagulant treatment, patients with apixaban treatment were older, had higher CHA 2 DS 2 -VASc and HAS-BLED scores, and had lower creatinine clearance than the patients receiving other direct oral anticoagulants. Conclusions:The ROTA study provides important real-world information about anticoagulant treatment patterns in patients with atrial fibrillation.
Background Coronary artery disease (CAD) causes electrical heterogeneity on ventricular myocardium and ventricular arrhythmia due to myocardial ischemia linked to ventricular repolarization abnormalities. Objective Our aim is to investigate the impact of increased level of CAD spectrum and severity on ventricular repolarization via Tp-e interval, Tp-e/QT and Tp-e/QTc ratios. Methods 127 patients with normal coronary artery (group 1), 129 patients with stable CAD (group 2) and 121 patients with acute coronary syndrome (group 3) were enrolled. Tp-e interval, Tp-e/QT [...]
A 70-year-old male was admitted to the hospital with shortness of breath.Computed tomography (CT) scans revealed a lesion in the left atrial appendage (LAA) that could not be clearly identified as either a thrombus or a solid mass (Figure 1).Consequently, the patient was referred to our clinic for a cardiac echocardiographic examination.
Abstract Background Digital health technologies (DHTs) have the potential of facilitating both physicians' and patients' lives with regards to the diagnosis, treatment and follow-up of cardiovascular disease. A huge acceleration in relevant research has been noted particularly after the COVID-19 pandemic. Purpose The goal of this study was to determine the reasons for using DHTs in cardiology, as well as the perceived barriers to its use. Methods An electronic survey with 43 question multiple-choice questionnaire was conducted between January 10-March 3, 2022. National cardiac society member cardiology fellows in training and specialists were contacted via e-mail (n=2789). Results 308/2789 (11.04%) subjects responded to the survey (72.40% males, 62.01% aged 30–44 years). 42.53% and 44.81% were affiliated with university hospitals and state hospitals, respectively. 88/297 (29.63%) stated having at least good understanding of DHTs in cardiology. 44.16% utilized smart devices to track their own health status. 117/290 (40.34%) and 193/299 (64.55%) used social media platforms to share medical information with their patients and other physicians, respectively. WhatsApp and Instagram were the most popular platforms for sharing with patients (92/117, 78.63% and 48/117, 41.03%), while WhatsApp and Twitter were the most popular platforms for sharing with other physicians (151/193, 78.24% and 91/193, 47.15%). Considerations and recommendation/utilization patterns of DHTs by physicians are summarized in Table 1. Perceived barriers to the use of DHTs in cardiology is shown on Figure 1 (A: physician-related, B: patient-related, C: technical). Conclusion Findings suggest that nearly half of the physicians use DHTs to collect their own health data and use social media to disseminate health information. The majority of physicians believe that DHT is beneficial to both themselves and their patients, and that DHT use in cardiology has increased as a result of the COVID-19 pandemic. To overcome the challenges to the use of DHTs in cardiology, a multilayered collaborative effort involving patient and professional organizations, as well as technical stakeholders and lawmakers, is required. Funding Acknowledgement Type of funding sources: None.
Purpose: Arterial stiffness has been shown as an independent predictor of cardiovascular and all-cause mortality in hypertensive patients. commonly seen in pulse wave Doppler echocardiographic examination of the left ventricle outflow tract, is related to diastolic dysfunction and arterial stiffness parameters. Our study aims to investigate the relation between aortic distensibility (AD) and presystolic A wave (PSW),.
Materials and Methods: Hypertensive patients were included in the study. Aortic stiffness was calculated by measuring aortic diameters with m-mode in echocardiography, and the presence of PSW was noted from the left ventricle outflow tract just proximal to the aortic valve in apical five-chamber view.
Results: A total of 149 hypertensive patients were included. Diastolic blood pressure, septum diameter, posterior wall diameter, aortic diastolic, and systolic diameter were significantly higher in the presence of PSW. Aortic distensibility (AD) was higher in patients with PSW. Multivariable logistic regression analysis showed that AD (OR: 0.812, 95% CI: 0.712 – 0.927, p = 0.002) was an independent predictor of PSW presence.
Conclusion: PSW presence is associated with aortic stiffness evaluated by decreased aortic distensibility and highlights that PSW presence could be an independent predictor of aortic stiffness in patients with HT.
The aim of this study was to evaluate the diagnostic accuracy of the Lake Louise consensus criteria using cardiac magnetic resonance (CMR) imaging assessment of edema, hyperemia, and late gadolinium enhancement (LGE) in the diagnostic determination of acute myocarditis.A total of 44 patients with acute myocarditis and 24 healthy controls were included in this retrospective study. The presence of edema was defined as a myocardial mean signal intensity >1.9 times that of the skeletal muscle in the same slice on T2-weighted short tau inversion-recovery sequences. Hyperemia was defined as an early gadolinium enhancement ratio (EGEr) ≥4 calculated using the contrast-enhancement of the myocardium and skeletal muscle on TSE T1-weighted sequences, and LGE was assessed by visual examination. The reference methods used to determine the presence of myocarditis were based on the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases guidelines for clinical and biochemical findings.The diagnostic accuracy of edema, hyperemia, LGE, and the Lake Louise criteria (at least 2 of 3 components) was 75.7%, 64.2%, 88.5%, and 84.2%, respectively. Among the 3 components of the Lake Louise criteria, edema had the highest specificity (100%), and LGE had the highest sensitivity (86%). The use of LGE and/or edema as a criterion for acute myocarditis revealed the highest diagnostic accuracy (92.8%) among the CMR sequences and combinations of components examined.LGE and/or edema as a sole criterion for the diagnosis of acute myocarditis demonstrated better diagnostic accuracy than the Lake Louise criteria. The use of EGEr did not improve the performance of CMR-based diagnosis. Alternatives to the use of EGEr are recommended for the diagnosis of acute myocarditis.