BackgroundWe wished to compare the San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in Syncope Study (EGSYS) and the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk scores and to assess their efficacy in recognising patients with syncope at high risk for short-term adverse events (death, the need for major therapeutic procedures, and early readmission to the hospital). We also wanted to test those variables to designate a local risk score, the Anatolian Syncope Rule (ASR).MethodsThis prospective, cohort study was conducted at the emergency department of a tertiary care centre. Between December 1 2009 and December 31 2010, we prospectively collected data on patients of ages 18 and over who presented to the emergency department with syncope.ResultsWe enrolled 231 patients to the study. A univariate analysis found 23 variables that predicted syncope with adverse events. Dyspnoea, orthostatic hypotension, precipitating cause of syncope, age over 58 years, congestive heart failure, and electrocardiogram abnormality (termed DO-PACE) were found to predict short-term serious outcomes by logistic regression analysis and these were used to compose the ASR. The sensitivity of ASR, OESIL, EGSYS and SFSR for mortality were 100% (0.66 to 1.00); 90% (0.54 to 0.99), 80% (0.44 to 0.97) and 100% (0.66 to 1.00), respectively. The specificity of ASR, OESIL, EGSYS and SFSR for mortality were 78% (0.72 to 0.83); 76% (0.70 to 0.82); 80% (0.74 to 0.85) and 70% (0.63 to 0.76). The sensitivity of ASR, OESIL, EGSYS and SFSR for any adverse event were 97% (0.85 to 1.00); 70% (0.52 to 0.82); 56% (0.40 to 0.72) and 87% (0.72 to 0.95). The specificity of ASR, OESIL, EGSYS and SFSR for any adverse event were 72% (0.64 to 0.78); 82% (0.76 to 0.87); 84% (0.78 to 0.89); 78% (0.71 to 0.83), respectively.ConclusionThe newly proposed ASR appears to be highly sensitive for identifying patients at risk for short-term serious outcomes, with scores at least as good as those provided by existing diagnostic rules, and it is easier to perform at the bedside within the Turkish population. If prospectively validated, it may offer a tool to aid physicians' decision-making.

Objective We aimed to investigate both the impact of COVID-19 pandemic on ST-segment elevation myocardial infarction (STEMI) admission, and demographic, angiographic, procedural characteristics, and in-hospital clinical outcomes of patients with COVID-19 positive STEMI in Turkey. Methods This was a multi-center and cross-sectional observational study. The study population included 1788 STEMI patients from 15 centers in Turkey. The patients were divided into two groups: COVID-19 era (March 11st–May 15st, 2020; n = 733) or pre- COVID-19 era group (March 11st–May 15st, 2019; n = 1055). Also, the patients in COVID-19 era were grouped as COVID-19 positive (n = 65) or negative (n = 668). Results There was a 30.5% drop in STEMI admission during COVID-19 era in comparison to pre-COVID-19 era. The patients admitted to the medical centers during COVID-19 era had a longer symptom-to-first medical contact time [120 (75–240) vs. 100 (60–180) minutes, p < 0.001]. COVID-19 positive STEMI patients had higher thrombus grade and lower left ventricular ejection fraction compared to COVID-19 negative patients. COVID-19 positive patients had higher mortality (28% vs. 6%, p < 0.001) and cardiogenic shock (20% vs. 7%, p < 0.001) rates compared with those without COVID-19. Matching based on propensity scores showed higher mortality and high thrombus grade in STEMI patients who were infected by SARS-COV-2 (each p < 0.05). Conclusions We detected significantly lower STEMI hospitalization rates and significant delay in duration of symptom onset to first medical contact in the context of Turkey during the COVID-19 outbreak. Moreover, high thrombus grade and mortality were more common in COVID-19 positive STEMI patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11239-021-02487-3.

The interatrial conduction time can be estimated with a relatively noninvasive method using P-LAA measurements. This technique can be applied widely in predicting AF recurrence, and appropriate therapy may be applied.

oronary ectasia (CE) is a clinical situation which is characterized by luminal widening of the coronary arteries and the resultant decrease in the coronary blood flow. Its incidence has been reported to be between 0.3% and 4.9% in the autopsy and cardiac catheterization series. 1 Coronary atherosclerosis (50%), congenital diseases (20%), inflammatory diseases (10-20%), collagenous and connective tissue diseases are presumed to be responsible for its cause. 2 The essential histopathological finding in the diagnosis of CE is the replacement of coronary artery media layer smooth muscle cells with hyalinized collagen, as a consequence of the increased degeneration of the media layer. 3 As a result, the loss of musculo-elastic components is observed in the media. 2 Thus, progressive artery dilatation occurs. Moreover, along with this disease, the presence of extracardiac artery dilatation has been reported in the previous studies. 4,5 Arterial stiffness, which is defined as the arterial rigidity caused by the loss of elastic tissue in the artery wall, decreases the widening capacity of the artery. Many studies searching the effects of the cardiovascular risk factors on the arteries showed that, as a consequence of the structural changes in the arteries caused by these risk factors, arterial rigidity develops and arterial widening capacity is deteriorated. It has been established that as the stiffness of the large arteries such as aorta increases, cardiovascular mortality and morbidity also increase. 6 Consequently, aortic stiffness has recently been regarded as a risk factor that needs to be treated. 7 It has also been established that aortic stiffness is increased in individuals with coronary artery disease (CAD) and in those with atherosclerosis and that it is an independent predictor of CAD. 8 In the present study, we reported that there might possibly be a relationship between the increment in aortic stiffness and left ventricular (LV) diastolic dysfunction. 9 In the current study our objective was to investigate the elastic properties of the aorta in the patients with CE and the relationship between these characteristics and LV diastolic functions. Methods Study PopulationThe cases were selected from the patients who admitted to our cardiology department for coronary angiography between the years 2001 and 2004. The study population was divided into 3 groups according to the results of the coronary angiograms. A total of 105 patients were enrolled in the present study; in the first group there were 35 patients with CE, the second group consisted of 35 patients with CAD (coronary lesion causing ≥50% luminal narrowing in at least 1 coronary artery) and the third group consisted of 35 patients with normal coronary arteries. CE was defined as localized or diffuse non-obstructive lesions of the epicardial Aortic Elastic Properties in Patients WithCoronary Artery Ectasia Nurullah Tuzun, MD; Halil Tanriverdi, MD*; Harun Evrengul, MD*; Deniz Seleci Kuru, MD*; Asim Oktay Ergene, MD** Background The purpose of the present...

Aim Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. Methods Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. Results A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity and E/A ratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular lateral e′, septal e′, and septal s′ were higher in younger subjects and in females. E/e′ ratio was increased progressively with advancing decades. Right ventricular e′ and s′ were decreased but a′ was increased with increasing age. Septal e′ lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. The E/e′ ratio greater than 15 (and also 13) was not found. Conclusion This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials.