ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 12 (8)
Volume: 12  Issue: 8 - December 2012
EDITORIAL
1.Content and news for the Anatolian Journal of Cardiology
Bilgin Timuralp
PMID: 23211742  doi: 10.5152/akd.2012.251  Page 620
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
2.Bosentan ameliorates the expression of fibrotic related growth factors and collagen-1 in diabetic mice
Bo Yang, Min Li, Zhen-Guo Shi, Quan-Zhou Feng
PMID: 22968296  doi: 10.5152/akd.2012.213  Pages 621 - 627
Objective: To investigate the potential beneficial effect of bosentan in ameliorating fibrotic agents in diabetic mice. Methods: Male 6-week old C57BL/6 mice were divided into 3 groups (N=20): Control group, diabetes mellitus (DM) group and DM-B group (diabetes with bosentan group). Streptozotocin (STZ) was injected as 200 mg/Kg for single dose, i.p. (intraperitoneal injection). Fasting blood glucose (FBG) was measured at 0-, 1-, 2-week after STZ injection to confirm that diabetes was induced in the mice. Bosentan (100mg/Kg) and placebo was given i.g. (intragastric administration) once a day immediately after STZ injection for 18 weeks. The mRNA expression of tissue growth factor beta (TGF-b), connective tissue growth factor (CTGF), vascular endothelial growth factor (VEGF) and collagen-1 were evaluated by RT-PCR and real-time PCR. Differences in the data between the groups were compared by Student t-test for independent samples. Results: After 18 weeks of diabetic situation, FBG of DM-B mice was significantly higher than that of control mice and was similar with that of DM mice (DM mice vs. control mice, p<0.001; DM-B vs. control mice, p<0.001; DM mice vs. DM-B mice, p>0.05). The cardiac VEGF mRNA (a potent angiogenic factor) level in DM-B mice was significantly higher than DM mice (p<0.01). The heart of DM-B mice also showed lower expression of fibrotic genes (TGF-b, CTGF and collagen-1) than DM mice (p<0.01). Conclusion: These findings indicate the potential usefulness of an ET receptor antagonist bosentan in the amelioration of fibrotic agents, which may promote tissue fibrosis. This may provide a promising therapeutical strategy for diabetic cardiac fibrosis.

3.Clinical biomarkers of high-density lipoprotein dysfunction among middle-aged Turks
Altan Onat, Günay Can, Sani Murat, Gökhan Çiçek, Ender Örnek, Hüsniye Yüksel
PMID: 22968297  doi: 10.5152/akd.2012.214  Pages 628 - 636
Objective: Impaired function of high-density lipoprotein (HDL) particles generates cardiometabolic disorders in people prone to impaired glucose tolerance for which clinical biomarkers need delineation. Study design: Prospective population-based study. Methods: Totally, data of 2725 adults followed-up over 7.3±3.0 years were analyzed by Cox regression analysis. C-reactive protein (CRP), complement C3 (C3), triglycerides (Trg) and HDL-cholesterol were tested to predict risk for incident diabetes or coronary heart disease (CHD). Results: Beyond atherogenic dyslipidemia, high-Trg/normal HDL-cholesterol category was associated with elevated CRP and diabetes risk in women. Normotriglyceridemic men with normal HDL-cholesterol showed higher apolipoprotein A-I levels and higher diabetes risk than men having low HDL-cholesterol. Diabetes risk doubled in hypertriglyceridemic women regardless of HDL-cholesterol. Trg/HDL-C>2 in men and Trg>1.7 mmol/L in women were best predictors of diabetes. C3>1.3 g/L served additively in women alone. Regarding CHD risk, not CRP, but C3 contributed independently to Trg/HDL>2 in men [RR 2.46 (95% CI 1.33; 4.53)]; a high ratio was merely additive to elevated CRP in women. Among five cut-off values, predictive values for diabetes were highest for CRP >2.5 mg/L in men, Trg>1.7 mmol/L and C3>1.3 g/dL in women. Conclusion: Trg/HDL-C ratio >2 and/or CRP >2.5 mg/L in men and Trg>1.7 mmol/L+C3>1.3 g/dL in women are most appropriate markers regarding impaired antiinflammatory or atheroprotective HDL function. In normotriglyceridemic men with normal HDL-cholesterol levels, diabetes risk may be elevated due to presumably dysfunctional apolipoprotein A-I.

4.Coronary artery ectasia is associated with atrial electrical and mechanical dysfunction: an observational study
Serkan Öztürk, Mehmet Özyaşar, Selim Suzi Ayhan, Mehmet Fatih Özlü, Alim Erdem, Aytekin Alçelik, Selçuk Öztürk, Kemalettin Erdem, Mehmet Yazıcı
PMID: 22968298  doi: 10.5152/akd.2012.215  Pages 637 - 643
Objective: The aim of our study was to investigate total atrial conduction time and left atrial (LA) mechanical function in patients with isolated coronary artery ectasia (ICAE). Methods: Sixty patients with ICAE without any visible coronary stenosis were enrolled to this cross-sectional observational study. The control group consisted of 40 age- and gender-matched patients. Left atrial mechanical functions were measured by the method of discs in the apical-four chamber echocardiographic view. LA mechanical function parameters were calculated. P wave dispersion was measured on electrocardiography (ECG). The total atrial conduction time (PA-tissue Doppler imaging (TDI) duration) was assessed by measuring the time interval between the beginning of the P wave on the surface ECG and point of the peak A wave on TDI from LA lateral wall just over the mitral annulus. Student t, Mann-Whitney U, Pearson’s, and Spearman’s correlation analysis and multiple regression analysis were used for statistical analysis. Results: The clinical and laboratory characteristics were similar in two groups. Both groups were similar in terms of Vmax and LA total emptying volume (29.0±7.3 vs. 31.9±6.5 mL/m2, p=0.082 and 19.9±5.1 vs. 20.0±5.2 mL/m2, p=0.821). However, LA passive emptying volume and LA passive emptying fraction were significantly decreased with ICAE patients (11.1±3.2 vs. 13.5±3.8 ml/m2, p=0.005 and 35.2±7.2 vs. 47.8±9.4 mL/m2, p<0.001). But LA active emptying volume and LA active emptying fraction were significantly increased in ICAE patients (9.1±2.6 vs. 6.4±3.0 mL/m2, p<0.001 and 45.3±8.1 vs. 40.7±6.7 mL/m2, p=0.002). PA-TDI duration was measured significantly higher in patients with ICAE than control group (131.8±5.7 vs. 114.4±9.1 ms, p<0.001). Multiple linear regression analyses showed that ectatic segment number was an independent factor of PA-TDI duration (β=0.581, 95% CI=4.046-6.295, p<0.001). Conclusion: Our study demonstrated presence of LA electrical and mechanical dysfunction in patients with ICAE. LA dysfunction may be associated with cardiac pathologies as arrhythmias, decrease in cardiac output and congestive failure.

EDITORIAL COMMENT
5.Coronary artery ectasia and atrial electrical and mechanical dysfunction
Usama Boles
PMID: 23018088  doi: 10.5152/akd.2012.243  Pages 644 - 645
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
6.Prevalence and clinical features of atrial fibrillation in diabetic neuropathy: a cross-sectional, observational study
İdil Gökçen Koçağra Yağız, Serdar Bayata, Murat Yeşil, Tülay Kurt İncesu, Erdinç Arıkan, Nursen Postacı
PMID: 22968299  doi: 10.5152/akd.2012.216  Pages 646 - 651
Objective: This cross-sectional, observational study investigated prevalence and clinical features of atrial fibrillation (AF) in diabetic patient groups with or without autonomic neuropathy. Methods: One hundred and fourteen consecutive patients with pharmacologically treated type-II diabetes mellitus were enrolled for this study in our institution between January 2010 and December 2010. All patients underwent 12-lead electrocardiography on the day of enrollment for AF detection. All diabetic patients underwent neurologic examination for the presence of diabetic autonomic neuropathy (DAN). Following clinical evaluation, sympathetic skin responses (SSR) and RR interval variability (RRIV) analysis were used for the detection of autonomic neurologic involvement. Patients were divided into two groups according to presence (Group 1) or absence (Group 2) of DAN. Patient groups with or without DAN were compared for AF occurrence. Continuous and categorical data were compared with independent samples t- test and Chi-square statistical tests respectively. Results: Atrial fibrillation prevalence was 24% (n=29) in study population. Diabetic autonomic neuropathy was diagnosed in 47 (39%) patients. Basal characteristics of patients with or without DAN were comparable except glycosylated hemoglobin A (HbA1c) levels. HbA1c levels were found significantly higher in patients with DAN. Atrial fibrillation was diagnosed in 14 patients in Group 1 and in 15 patients in Group 2. Significantly increased AF prevalence (31.9% vs. 20.8%, p=0.014, in groups with and without DAN respectively) was observed in patient group with diabetic autonomic neuropathy. Conclusion: The results of this study demonstrated an increased prevalence of AF in patients with diabetic autonomic neuropathy compared with non-neuropathic, diabetic patients. Further investigation of this relation with prospective studies is needed to demonstrate a causal relationship between diabetic autonomic neuropathy and AF.

7.Increased gamma-glutamyl transferase level is associated with absence of coronary collateral vessels in patients with acute coronary syndrome: an observational study
Mustafa Duran, Özgür Günebakmaz, Onur Kadir Uysal, Ahmet Çelik, Mikail Yarlioglues, Ekrem Karakaya
PMID: 22968300  doi: 10.5152/akd.2012.217  Pages 652 - 658
Objective: Elevated serum gamma-glutamyl transferase (GGT) level has been proposed as a risk factor for coronary artery disease and is associated with poor clinical outcome in acute coronary syndrome (ACS). We aimed to evaluate the relationship between GGT level and presence of coronary collateral vessels (CCV) patients with ACS. Methods: We evaluated 178 patients with ACS in this cross-sectional-observational study. Traditional laboratory and clinical parameters and serum GGT levels were measured. All patients underwent coronary angiography on the first day after admission and patients who had >80% stenosis of coronary artery were included in the study. The CCVs graded according to the Rentrop scoring system and Rentrop 0, 1, 2 and 3 were determined in respectively 76 (42.7%), 32 (18.0%), 33 (18.5%), and 37 (20.8%) patients. Rentrop grade 0 was accepted as no CCV development (Group 1), Rentrop grades 1-2-3 were accepted as presence of CCV development (Group 2). Statistical analysis was performed using independent-samples t, Mann-Whitney U and Chi-squared tests, logistic regression and receiver operator curve analyses. Results: Mean age was 62±10 years and 134 (75.3%) of patients were male. Group 1 consisted of 76 (42.7%) patients and Group 2 consisted of 102 (57.3%) patients. The median and minimum-maximum values of serum GGT were 33.5 (8-128) U/L for Group 1 and 23 (2-83) U/L for Group 2. Absence of CCV was significantly associated with high levels of GGT (p<0.001), alanine-aminotransferase (p=0.001), glucose (p=0.011) and low levels of total protein (p=0.020). At multivariate analysis, high levels of GGT were independent predictors of absence of CCV (OR=0.953, 95%CI 0.912-0.996, p=0.031). Conclusion: High levels of GGT on admission were associated with absence of CCV in patients with ACS.

8.Relationship between cardiac troponin-T and right ventricular Tei index in patients with hemodynamically stable pulmonary embolism: an observational study
Savaş Özsu, Abdülkadir Kırış, Yılmaz Bülbül, Funda Öztuna, Kayıhan Karaman, Merih Kutlu, Tevfik Özlü
PMID: 22968301  doi: 10.5152/akd.2012.218  Pages 659 - 665
Objective: The role of increased troponin level in risk stratification of acute pulmonary embolism (PE) is well documented. However, relation between right ventricular (RV) myocardial performance (Tei) index and cardiac troponin-T (cTn-T) has not been well investigated. The purpose of this observational prospective study was to assess the relationship between the RV Tei index and cTn-T in patients with acute normotensive PE. Methods: Thirty-eight patients with acute PE diagnosed by computed spiral tomography pulmonary angiography were enrolled to this prospective observational study. All study population underwent a comprehensive echocardiographic study including tissue Doppler imaging within first 12 hours of admission. cTn-T levels were measured on admission. Follow-up echocardiography was performed routinely at the 7th day of hospitalization. Echocardiographic evaluation was repeated at 90 days in patients with insufficient improvement of RV Tei index. The difference between the baseline and follow-up data was analyzed using the paired sample t-test or Wilcoxon test according to normality of distribution. Results: The mean of the RV Tei index was 0.46±0.14 and the mean systolic pulmonary artery pressure (sPAP) was 40±20 mmHg. Increased cTn-T level was detected in 37% of the patients (normal value 0.01< ng/mL). Significant correlations were observed between RV Tei index and sPAP with cTn-T levels (r=0.467 and r=0.468, p<0.001, respectively). In logistic regression analysis, RV Tei index was associated with positive cTn-T values (OR-136, 95% CI: 1.3-14657, p=0.039). After the anticoagulant treatment, RV Tei index and sPAP were significantly improved. Conclusion: RV Tei index is frequently impaired in patients with acute PE and a significant recovery is seen after the treatment. Therefore, RV Tei index may be used both the diagnosis of RV dysfunction and the assessment of treatment effectiveness. RV Tei index is may predict myocardial injury in PE.

EDITORIAL COMMENT
9.Right ventricular functions in pulmonary embolism
Sait Demirkol, Şevket Balta
PMID: 23018089  doi: 10.5152/akd.2012.244  Pages 666 - 667
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
10.Cardiac responses to long duration and high magnitude +Gz exposure in pilots: An observational study
Cengiz Öztürk, M. Savaş İlbasmış, Ahmet Akın
PMID: 22968302  doi: 10.5152/akd.2012.219  Pages 668 - 674
Objective: In military aviation, high performance aircraft pilots are exposed to +Gz acceleration at longer durations and higher magnitude than transport/helicopter pilots. The purpose of this study was to reveal the negative or positive cardiac responses to this occupational high +Gz exposure. Methods: Our study design was cross-sectional and observational. We have evaluated 21 echocardiographic parameters of 63 pilots who applied for aircrew periodic medical examination. Of 63 pilots, 33 were grouped as high performance aircraft pilots group (Group A) and 30 were grouped as control group (Group B) whose aircraft type was transport or helicopter. Means of demographic and echocardiography parameters between two groups were compared statistically with Student's t-test, Mann- Whitney U or Chi-square test as appropriate. Results: Among all echocardiographic parameters, mean TV A (tricuspid valve peak velocity during late diastolic filling) was significantly higher and TV E (peak velocity during early diastolic filling)/ A ratio was significantly lower for Group A pilots (p<0.05). In Group A pilots, mean TV A and TV E/A ratio were (52.12±13.85) and (1.36±0.30) respectively. In Group B pilots, mean TV A and TV E/A ratio were (42.61±6.42) and (1.53±0.20) respectively (p=0.001 for TVA and p=0.005 for TV E/A). Mean pulmonary artery pressure (PAP) of Group A pilots (32.04±9.09) was higher than Group B pilots (28.76±7.9) but it was not statistically significant (p>0.05). Conclusion: We conclude that according to the results of our study, long term +Gz exposure has no effects on cardiac morphologic and systolic functions but has effects on right ventricular diastolic functions. We have considered that these effects may be a result of chronic +Gz adaptation or high PAP levels.

EDITORIAL COMMENT
11.Long-term high +Gz effects on cardiac functions in the pilots
Mehmet Gül, Musa Salmanoğlu
PMID: 23018090  doi: 10.5152/akd.2012.245  Page 675
Abstract |Full Text PDF

REVIEW
12.Drug eluting stents: Current status and new developments
Gökhan Ertaş, Heleen Van Beusekom
PMID: 22989796  doi: 10.5152/akd.2012.220  Pages 676 - 683
Despite the favorable impact of drug eluting stents on stent restenosis, their long-term reliability is considered worrisome by some because of stent thrombosis. Often attributed to adverse reactions to the stent platform, both the drugs and polymer characteristics have been further advanced with current technologies. The present review discussed current drug eluting stents and new developments.

13.Brain derived neurotrophic factor (BDNF) in cardiometabolic physiology and diseases
İlker Taşçı, Hasan Kutsi Kabul, Aydoğan Aydoğdu
PMID: 22989797  doi: 10.5152/akd.2012.221  Pages 684 - 688
Important advances in our understanding of the relationships between adipose tissue derived peptides, namely adipokines, and their effects on cardiovascular functions have been achieved in recent years. Growing knowledge of adipokine biology is revealing the complexity of these proteins. Adipose tissue releases some other proteins called neurotrophins that are mainly active in central and peripheral nervous system. However, secretion and activity of these hormones are not only limited to neuronal cells and tissues, but they also take part in adipose tissue development, energy metabolism, glucose utilization, insulin sensitivity, inflammation, lipoprotein synthesis, and atherosclerosis. In this review, we describe the most recent advances in the functions of brain derived nerve growth factor (BDNF), a major type of neurotrophins, focusing primarily on cardiovascular and metabolic diseases.

CASE REPORT
14.Management of acute ischemic stroke occurred during thrombolytic treatment of a patient with prosthetic mitral valve thrombosis: Continuing thrombolysis on top of thrombolysis
Mehmet Özkan, Ozan M. Gürsoy, Banu Atasoy, Zülal Uslu
PMID: 22989798  doi: 10.5152/akd.2012.222  Pages 689 - 690
Abstract |Full Text PDF

15.Starr-Edwards caged ball valve pursuing to astonish us-38 years in mitral position
Gökhan Gökaslan, Neyyir Tuncay Eren
PMID: 22989799  doi: 10.5152/akd.2012.223  Pages 690 - 691
Abstract |Full Text PDF

16.Treatment of aortic valve stenosis and gastrointestinal bleeding by transcatheter aortic valve implantation in Heyde syndrome
Mehmet Gül, Özgür Sürgit, Ender Özal, Aslı Örmeci, İhsan Bakır
PMID: 22989800  doi: 10.5152/akd.2012.224  Pages 691 - 693
Abstract |Full Text PDF

17.Double covered stent closure of extracardiac Fontan multiple fenestrations
Arda Saygılı, Kürşad Tokel, Özgen Ilgan Koçyiğit, Tayyar Sarıoğlu
PMID: 22989801  doi: 10.5152/akd.2012.225  Pages 693 - 695
Abstract |Full Text PDF

18.Acute aortic dissection in a 10-year-old boy with bicuspid aortic valve
Burak Onan, Alper Güzeltaş, Ender Ödemiş, İhsan Bakır
PMID: 22989802  doi: 10.5152/akd.2012.226  Pages 695 - 696
Abstract |Full Text PDF

DIAGNOSTIC PUZZLE
19.Multiple fatal images in right heart
Müslim Şahin, Elnur Alizade, Cemile Pirmemmedova, Göksel Acar
PMID: 23018092  doi: 10.5152/akd.2012.247  Page 697
Abstract |Full Text PDF

LETTER TO THE EDITOR
20.Unconscious plagiarism and withdrawal of the manuscript under consideration
F. Suna Kıraç
PMID: 22989803  doi: 10.5152/akd.2012.227  Page 698
Abstract |Full Text PDF

21.Giant J-wave (Osborn wave) related to hypothermia and hypokalemia
Murat Yalçın, Zafer Işılak, Ömer Uz, Mehmet Doğan
PMID: 22989805  doi: 10.5152/akd.2012.229  Pages 699 - 700
Abstract |Full Text PDF

22.Increased level of cardiac troponin-I due to rheumatoid factor positivity in a healthy patient with normal coronary arteries
Ahmet Çağrı Aykan, Can Yücel Karabay, Mubariz Rasulzada
PMID: 22989806  doi: 10.5152/akd.2012.230  Pages 700 - 701
Abstract |Full Text PDF

23.Multilateral coronary fistulas terminating in the lung parenchyma
Zeki Doğan, Ahmet Karabulut
PMID: 22989807  doi: 10.5152/akd.2012.231  Pages 701 - 702
Abstract |Full Text PDF

24.Minimally invasive on-pump aortic valve replacement with thoracic epidural anesthesia
Fikret Maltepe, Kıvanç Sadık Metin, Baran Şevket Uğurlu, Öztekin Oto
PMID: 22989808  doi: 10.5152/akd.2012.232  Page 702
Abstract |Full Text PDF

25.Knowledge and adherence to treatment in patients with poor or improved anticoagulation control
Meral Altıok, Funda Kuyurtar, Fatma Babalıklı, Semra Erdoğan
PMID: 22989809  doi: 10.5152/akd.2012.233  Page 703
Abstract |Full Text PDF

DIAGNOSTIC PUZZLE
26.Multiple fatal images in right heart
Müslim Şahin, Elnur Alizade, Cemile Pirmemmedova, Göksel Acar
PMID: 23018092  Page 704
Abstract |Full Text PDF

MISCELLANEOUS
27.Prof. Dr. Naci Bor - a man chasing curiosity
Gülsen Öner
PMID: 23018091  doi: 10.5152/akd.2012.246  Pages 705 - 708
Abstract |Full Text PDF

28.Statement on matching language to the type of evidence used in describing outcomes data

PMID: 23211743  doi: 10.5152/akd.2012.252  Page 709
Abstract |Full Text PDF

AUTHOR INDEX
29.Author Index

Pages 710 - 715
Abstract |Full Text PDF

SUBJECT INDEX
30.Subject Index

Pages 716 - 723
Abstract |Full Text PDF

REFEREE INDEX
31.Referee Index

Pages 724 - 725
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
32.Mitral regurgitation secondary to mitral anterior leaflet rupture after mitral valvuloplasty
Sait Demirkol, Murat Ünlü, Şevket Balta, Atila İyisoy
PMID: 22989810  doi: 10.5152/akd.2012.234  Page E40
Abstract |Full Text PDF

33.Incidental diagnosis of an aneurysm of the mitral valve posterior leaflet
Turgay Işık, Mustafa Kurt, Erkan Ayhan, İbrahim Halil Tanboğa
PMID: 22989811  doi: 10.5152/akd.2012.235  Pages E40 - E41
Abstract |Full Text PDF

34.Incidentally diagnosed pseudoaneurysm of mitral-aortic intervalvular fibrosa
Mehmet Doğan, Mustafa Gökhan Vural, Aysel Türkvatan, Ekrem Yeter
PMID: 22989812  doi: 10.5152/akd.2012.236  Pages E41 - E42
Abstract |Full Text PDF

35.3D echocardiographic evaluation of ruptured pseudoaneurysm of the mitral-aortic intervalvular fibrosa
Barış Güngör, Servet Altay, Şennur Ünal Dayı, Osman Bolca
PMID: 22989813  doi: 10.5152/akd.2012.237  Pages E42 - E43
Abstract |Full Text PDF

36.Cor triatriatum sinister demonstrated by 3D-transesophageal echocardiography
Özcan Başaran, Ahmet Güler, Can Yücel Karabay, Elif Eroğlu
PMID: 22989814  doi: 10.5152/akd.2012.238  Pages E43 - E44
Abstract |Full Text PDF

37.Incidentally diagnosed unusual large epicardial adipose tissue
Ferhat Özyurtlu, Erkan Ayhan, Turgay Işık, Halit Acet
PMID: 22989815  doi: 10.5152/akd.2012.239  Page E44
Abstract |Full Text PDF

38.Very late diagnosed complication of coronary artery bypass surgery: coronary artery to right ventricular fistula
Serkan Duyuler, Pınar Türker Bayır, Burcu Demirkan, Sadık Kadri Açıkgöz
PMID: 22989816  doi: 10.5152/akd.2012.240  Pages E44 - E45
Abstract |Full Text PDF



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