Aims:Reducing elevated left atrial pressure with an atrial septum shunt device is a possible treatment option in symptomatic heart failure patients. This study aimed to investigate the safety and feasibility of the Atrial Flow Regulator (AFR) in heart failure patients.Methods and results: AFR-PRELIEVE is a prospective, non-randomised, open-label, multicentre study in patients with symptomatic heart failure NYHA Class III or IV and pulmonary capillary wedge presof heart failure (two HFrEF patients, one HFpEF patient). Individual patients from both the HFrEF and HFpEF groups showed improvement in symptoms and surrogate parameters of heart failure (NYHA class, six-minute walking distance, Kansas City Cardiomyopathy Questionnaire, PCWP, NT-proBNP).Conclusions: Implantation of the AFR device in heart failure patients is feasible and safe; shunt patency at three months was confirmed in the study. The atrial shunt improved symptoms and surrogate parameters of heart failure in some but not all patients in both the HFpEF and HFrEF groups.

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Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important factor for ensuring efficacy and safety in nonvalvular atrial fibrillation (NVAF). There are controversial results regarding NOAC adherence in real-world data and there are no data about NOAC adherence in Turkish population. This study investigated the NOAC adherence based on self-report, factors affecting nonadherence, and the relation of the adherence level with efficacy and safety outcomes. This multicenter cross-sectional study included 2738 patients (59% female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more than 3 months with >30 days of supply between September 1, 2015, and February 28, 2016. To measure the adherence level, an 8-item Morisky Medication Adherence Scale was used. The mean age of the patients was 70 + 10 years. Of the 2738 patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A total of 630 (23%) patients had high medication adherence, 712 (26%) moderate adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6% vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%, P ¼ .004) bleeding rates. The adherence to NOAC was found to be quite low in Turkey. Nonadherence is associated with bleeding and thromboembolic cardiovascular events. Age, taking NOAC twice a day, and the additional noncardiac diseases, depression, and dementia were the independent factors affecting poor medication adherence.

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Meta AnalysisA meta-analysis of randomized controlled trials investigating tirofiban combined with conventional drugs by intracoronary administration for no-reflow prevention Qian Zeng et al.; Guangxi-China Original Investigations Sex difference in clinical outcomes of Chinese patients with atrial fibrillation and coronary stenting according to age Jian-Yong Zheng et al.; Beijing-China Chronic thromboembolic pulmonary hypertension in patients with persistent chest symptoms after acute pulmonary embolism Elif Şahutoğlu et al.; İstanbul-Turkey How did the updated hemodynamic definitions affect the frequency of pulmonary hypertension in patients with systemic sclerosis? Alper Sarı et al.; Ankara-Turkey Pulmonary hypertension in patients with sarcoidosis: A single-center experience Deniz Kaptan Özen et al.; Kocaeli-Turkey Evaluation of radial artery endothelial functions in transradial coronary angiography according to different radial access sites Elton Soydan et al.; İzmir-Turkey Case Reports An intriguing case of acute coronary syndrome caused by rotten tuna Chiara Gargiulo et al.; Pavia-Italy Failed transcatheter mitral valve-in-ring implantation followed by transapical valve-in-valve within the ring and ad hoc paravalvular leak closure Beytullah Çakal et al.; İstanbul-Turkey A rare cause of mitral regurgitation after aortic valve replacement: Iatrogenic mitral valve perforation Begüm Uygur; İstanbul-Turkey

Objective: Acute heart failure (AHF) is a life-threatening clinical syndrome characterized by rapid onset of heart failure (HF) symptoms and signs and requires urgent therapy. The aim of the present study was to evaluate the overall clinical characteristics, management, and in-hospital outcomes of hospitalized patients with AHF in a large sample of Turkish population. Methods: The Journey HF-TR study is a cross-sectional, multicenter, non-invasive and observational trial. Patients who were hospitalized with a diagnosis of AHF in the intensive care unit (ICU)/coronary care unit and cardiology wards between September 2015 and September 2016 were included in our study. Results: A total of 1606 (male: 57.2%, mean age: 67.8±13 years) patients who were diagnosed with AHF were enrolled in the study. Seventeen percent of the patients were admitted to the hospital with a diagnosis of new onset AHF. Hypertension (67%) and coronary artery disease (CAD) (59.6%) were the most frequent underlying diseases. Acute coronary syndrome accompanying HF (14.7%), infection (29.3%), arrhythmia (25.1%), renal dysfunction (23%), and non-compliance with medication (23.8%) were the precipitating factors. The median length of stay in the ICU was 3 days (interquartile range, IQR 1–72) and 7 days (IQR 1–72) for in-hospital journey. The guideline recommended medications were less likely used in our patient population (<73%) before admission and were similar to European and US registers at discharge. The in-hospital mortality rate was 7.6%. Hypertension and CAD were the most frequent underlying diseases in our population similar to other European surveys. Although our study population was younger than other registers, in-hospital mortality was high. Conclusion: Analyses of such real-world data will help to prepare a national database and distinctive diagnosis and treatment algorithms and to provide observing compliance with the current European Society of Cardiology guidelines for more effective management of HF.

BackgroundCoronary artery ectasia (CAE) is an angiographic definition of coronary artery pathology in which the diameter of the ectatic segment measures more than 1.5 times the diameter of an adjacent healthy reference segment. No previous study has reported on the use of 3D‐STE for assessing the left ventricular (LV) functions in patients with isolated CAE. As a result of this, we aimed to evaluate the effects of isolated CAE on LV functions using 3D‐STE in the present study.MethodsNinety‐one patients with isolated CAE and 90 controls who proved to have normal coronary angiograms were enrolled to the study. 3D‐STE was performed and GLS, GCS, GAS, and GRS were obtained for every subject after coronary angiography.ResultsThe mean age of the patients was 61.75 ± 10.02 years, and 71.8% were male. GLS, GCS, GAS, and GRS were significantly depressed in the isolated CAE group than in the control group (P < .001; P < .001; P = .001; and P = .001, respectively). ROC analyses were performed to find out the ideal strain cut off values to predict the presence of isolated CAE. A GLS value of >‐16 has 92.1 % sensitivity, 88.5 % specificity; and a GCS value of >‐20 has 86.7 % sensitivity, 89.2 % specificity to detect the presence of isolated CAE.ConclusionIsolated CAE has a considerable negative effect on LV functions as evaluated by 3D‐strain parameters, and 3D‐STE could be an effective method to detect early stage myocardial impairment in patients with isolated CAE.