Pulmonary embolism (PE) is a potentially life-threatening condition and the fact that 90% of PE originate from lower limb veins highlights the significance of early detection and treatment of deep vein thrombosis. Massive/high risk PE involving circulatory collapse or systemic arterial hypotension is associated with an early mortality rate of approximately 50%, in part from right ventricular (RV) failure. Intermediate risk/submassive PE, on the other hand, is defined as PE-related RV dysfunction, troponin and/or B-type natriuretic peptide elevation despite normal arterial pressure. Without prompt treatment, patients with intermediate risk PE may progress to the massive category with a potentially fatal outcome. In patients with PE and right ventricular dysfunction (RVD), in hospital mortality ranges from 5% to 17%, significantly higher than in patients without RVD.

SUMMARY OBJECTIVE: Early diagnosis and risk stratification may provide a better prognosis in pulmonary embolism (PE). Copeptin has emerged as a valuable predictive biomarker in various cardiovascular diseases. The aim of this study was to determine the levels of copeptin in patients with acute PE and to evaluate its relationship with disease severity and PE-related death. METHODS: Fifty-four patients and 60 healthy individuals were included in this study. Copeptin concentrations and right ventricular dysfunction were analyzed. The correlation between copeptin levels and hemodynamic and echocardiographic parameters was examined. After these first measurements, patients were evaluated with PE-related mortality at the one-year follow-up. RESULTS: The copeptin levels were higher in PE patients than in the control group (8.3 ng/mL vs 3.8 ng/mL, p<0.001). Copeptin levels were found to be significantly higher in patients with PE-related death and right ventricular dysfunction (10.2 vs 7.5 ng/ml, p=0.001; 10.5 vs 7.5 ng/ml, p=0.002, respectively). When the cut-off value of copeptin was ≥5.85, its sensitivity and specificity for predicting PE were 71.9% and 85.0%, respectively (AUC=0.762, 95% CI=0.635-0.889, p<0.001). CONCLUSIONS: The copeptin measurement had moderate sensitivity and specificity in predicting the diagnosis of PE, and the copeptin level was significantly higher in patients with PE-related death at the one-year follow-up. Copeptin may be a useful new biomarker in predicting diagnosis, risk stratification, and prognosis of PE.

Background: The prevalence of coronary artery anomalies (CAA) are reportedbetween 0.6–1.3% in the literature. CAA are usually asymptomatic incidental findings, but they may deteriorate coronary circulation, cause symptoms andlead to sudden cardiac death; especially in young athletes. Since interventionalprocedures are increasing rapidly for treatment of coronary artery disease (CAD) inthe modern era, comprehensive understanding of CAA is becoming progressively critical element in dealing with CAD. Materials and methods: We reviewed the database of the Cardiac Catheterisation Laboratory of Sani Konukoglu University Hospital in Gaziantep, Turkey. All patientswho were subjected to coronary angiography from 1998 to 2006 were included. Results: Among 53,655 coronary angiographies performed, CAA were foundin 653 patients (incidence of 1.21%); 590 (90.3%) patients had anomalies oforigin and distribution and 63 (11.7%) had coronary fistulae. Separate origins ofleft anterior descending (LAD) and left circumflex (LCX) coronary artery from theleft sinus of Valsalva was the most common anomaly (64.1%). Coronary arteriesbranching from anomalous aortic origin was the second most common anomaly(16.5%). Right coronary artery (RCA) originating from left sinus of Valsalva or leftmain coronary artery (LMCA) was observed in 55 (8.4%) patients, LCX arising fromRCA or right sinus of Valsalva (RSV) was seen in 52 (7.9%) patients and LMCA orLAD originating from RSV was seen in 14 (0.2%) patients. There were 16 (2.45%) patients with single coronary artery and 1 (0.15%) patient with LMCA originating from pulmonary artery.Conclusions: The incidence and the pattern of CAA in our patient population were similar with previous studies. Angiographic recognition of these vessels is importantbecause of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery. Background: The prevalence of coronary artery anomalies (CAA) are reportedbetween 0.6–1.3% in the literature. CAA are usually asymptomatic incidental findings, but they may deteriorate coronary circulation, cause symptoms andlead to sudden cardiac death; especially in young athletes. Since interventionalprocedures are increasing rapidly for treatment of coronary artery disease (CAD) inthe modern era, comprehensive understanding of CAA is becoming progressively critical element in dealing with CAD. Materials and methods: We reviewed the database of the Cardiac Catheterisation Laboratory of Sani Konukoglu University Hospital in Gaziantep, Turkey. All patientswho were subjected to coronary angiography from 1998 to 2006 were included. Results: Among 53,655 coronary angiographies performed, CAA were foundin 653 patients (incidence of 1.21%); 590 (90.3%) patients had anomalies oforigin and distribution and 63 (11.7%) had coronary fistulae. Separate origins ofleft anterior descending (LAD) and left circumflex (LCX) coronary artery from theleft sinus of Valsalva was the most common anomaly (64.1%). Coronary arteriesbranching from anomalous aortic origin was the second most common anomaly(16.5%). Right coronary artery (RCA) originating from left sinus of Valsalva or leftmain coronary artery (LMCA) was observed in 55 (8.4%) patients, LCX arising fromRCA or right sinus of Valsalva (RSV) was seen in 52 (7.9%) patients and LMCA orLAD originating from RSV was seen in 14 (0.2%) patients. There were 16 (2.45%) patients with single coronary artery and 1 (0.15%) patient with LMCA originating from pulmonary artery.Conclusions: The incidence and the pattern of CAA in our patient population were similar with previous studies. Angiographic recognition of these vessels is importantbecause of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery.

Cryoballoon-based pulmonary vein isolation (PVI) is a treatment option for atrial fibrillation (AF). Left atrial volume (LAV) and left atrial volume index (LAVi) are important parameters for long term success of PVI. Galectin-3 (Gal-3) and neutrophil to lymphocyte ratio (N/L ratio) are biomarkers to demonstrate the cardiac fibrosis and remodelling. 50 patients with symptomatic PAF despite ≥1 antiarrhythmic drug(s), who underwent PVI were enrolled. LAV, LAVi, Gal-3 and N/L ratio were calculated before ablation and after ablation at 6 and 12 months. According to AF recurrence patients were divided into two groups, recurrent AF (n = 14) and non-recurrent AF (n = 36). In both groups (recurrent and non-recurrent), initial and 12 months follow-up LAV values were 41.39 ± 18.13 ml and 53.24 ± 22.11 ml vs 48.85 ± 12.89 ml and 42.08 ± 13.85 (p = 0.037). LAVi were 20.9 ± 8.91 ml/m2 and 26.85 ± 11.28 ml/m2 vs 25.36 ± 6.21 and 21.87 ± 6.66 (p = 0.05) for recurrent and non-recurrent AF groups, respectively. In both groups PVI had no significant effect on serum Gal-3 levels and N/L ratio during 12 months follow-up. The comparison between two groups at the end of 12th month showed Gal-3 values of 6.66 ± 4.09 ng/ml and 6.02 ± 2.95 ng/ml (p = 0.516), N/L ratio values of 2.28 ± 1.07 103/μl and 1.98 ± 0.66 103/μl (p = 0.674). LAV and LAVi are useful to predict the remodelling of the left atrium and AF recurrence after cryoballoon-based PVI. However, biomarkers such as Gal-3 and N/L ratio are not associated with AF recurrence.