Objective: The non-O alleles of the ABO genotype have been associated with an increased risk of thrombosis. We aimed to assess the associa- tion between blood group status and prosthetic valve thrombosis.
Methods: The association between AB0 blood group status and prosthetic valve thrombosis was assessed in this retrospective study. Trans- esophageal echocardiography was performed in 149 patients with a diagnosis of prosthetic valve thrombosis and in 192 control subjects. Results: Non-0 blood group type (p<0.001), presence of NYHA class III-IV status (p<0.001), and central nervous system (p<0.001) and non-central nervous system (p<0.001) emboli were significantly more prevalent in prosthetic valve thrombosis patients than in the control subjects. The incidence of ineffective anticoagulation was higher in patients with prosthetic valve thrombosis than in controls (p<0.001), as was the presence of moderate to severe left atrial spontaneous echo contrast (p<0.001). The non-0 blood prosthetic valve thrombosis subgroup had a higher inci- dence of obstructive thrombi and central nervous system thrombotic events than having 0 blood prosthetic valve thrombosis subgroup. Non-0 blood group, ineffective anticoagulation, left atrial spontaneous echo contrast, and a poor NYHA functional capacity were identified to be the predictors of prosthetic valve thrombosis.
Conclusion: Our data demonstrate that patients with non-0 compared with 0 blood groups have higher incidence of prosthetic valve thrombosis and central nervous system embolism and similar rates of non-central nervous system embolism at presentation compared with 0 blood group type. Thus, non-O blood group may be a risk factor that may be prone to the development of prosthetic valve thrombosis in patients with pros- thetic heart valves. (Anatol J Cardiol 2016; 16: 820-3)

Objective: Microvolt T-wave alternans (MTWA) is a well-examined parameter for the risk stratification of sudden cardiac death (SCD) in patients with left ventricular dysfunction (LVD). However, the role of MTWA in pulmonary arterial hypertension (PAH) remains obscure. Consequently, the present study aimed to analyze the profile of MTWA among PAH patients in comparison with LVD patients and healthy volunteers.
Methods: The prospectively study included 22 patients with PAH (mean pulmonary artery pressure ≥ 25 mm Hg and pulmonary capillary wedge pressure ≤15 mm Hg during right heart catheterization; mean age, 40±17 years); 24 with LVD [left ventricular ejection fraction (LVEF) ≤35%; mean age, 40±11 years]; and 28 healthy volunteers (mean age, 41±8 years). Patients with persistent atrial arrhythmia were excluded. The MTWA (spectral meth- od) categories were positive, negative, or indeterminate (MTWA_pos, MTWA_neg, or MTWA_ind, respectively). MTWA_pos and MTWA_ind were qualified as abnormal (MTWA_abn). Statistical analyses (Mann–Whitney U, chi-square with Yates’s correction, Fisher’s exact test) were performed. Results: PAH patients had higher LVEF than LVD patients (61±7% vs. 27±7%; p<0.05). MTWA_abn was observed more frequently in the PAH and LVD groups than in the healthy volunteers. Patients with PAH were characterized by a considerable percentage of MTWA_pos and MTWA_abn (59% and 73%, respectively), but this did not differ from LVD patients.
Conclusion: Patients with PAH are characterized by a high rate of MTWA abnormalities similar to LVD patients, despite the relevant differences in LVEF. Further research is required to elucidate the clinical significance and prognostic value of this data, particularly in the context of SCD- underlying mechanisms in PAH patients. (Anatol J Cardiol 2016; 16: 825-30)

Objective: This study aimed to estimate the influence of the duration of mobile phone use on heart rate variability (HRV) in healthy individuals. Methods: One hundred forty-eight individuals without any established systemic disease and who had undergone 24-h ambulatory ECG monitoring were included in the case-control study. All the individuals had been using mobile phones for more than 10 years. Three-channel 24-h Holter monitor- ing was performed to derive the mean heart rate, standard deviation of normal NN intervals (SDNN), standard deviation of 5-min (m) mean NN intervals (SDANN), the proportion of NN50 divided by the total number of NNs (pNN50), the root mean square differences of successive NN intervals (RMSSD), high (HF)-, low (LF)-, very low (VLF)-frequency power, total power components, and the LF/HF ratio. Individuals were divided into four groups according to their duration of mobile phone use [no mobile phone use (Control group), <30 min/day (Group 1), 30–60 min/day (Group 2), and >60 min/day (Group 3)]. Results: All the groups had similar features with regard to demographic and clinical characteristics. No significant arrhythmias were observed in any of the groups. The LF/HF ratio was higher, whereas the SDNN, SDANN, RMSSD, and pNN50 values were lower in the study groups than in the control group (p<0.05). No significant differences were identified among groups with respect to heart rate, VLF, and total power values (p>0.05). Conclusion: In this study, it was shown that the duration of mobile phone use may affect the autonomic balance in healthy subjects. The elec- tromagnetic field created by mobile phone use may induce HRV changes in the long term. (Anatol J Cardiol 2016; 16: 833-8)

Objective: Previous studies have suggested that there is a relationship between coronary artery disease (CAD) and parathyroid hormone (PTH) levels. Here, we aimed to evaluate the association between PTH levels and severity of CAD.
Methods: Patients were divided into two groups based on their serum PTH values. Patients with PTH levels ≤72 pg/mL were accepted as Group 1 (n=568) and >72 pg/mL as Group 2 (n=87). Gensini score system and >50% stenosis in any coronary artery with conventional coronary angiog- raphy were used to determine the extensiveness of CAD. This study was designed as a prospective and cross-sectional study.
Results: Baseline characteristics except for age, gender, and blood pressure were similar between groups. Mean serum PTH levels of the entire cohort was 43.4±29.5 pg/mL. Median Gensini score was 19.5 in Group 1 and 14.5 in Group 2 (p=0.75). On the other hand, PTH levels were weakly correlated with Gensini score (Spearman’s Rho=0.11, p=0.003). Additionally, we did not observe a statistically significant difference between PTH levels and the number of stenotic vessels (p=0.14). This study was designed as a prospective and cross-sectional study.
Conclusion: There is no association between serum PTH levels and extensiveness of CAD. (Anatol J Cardiol 2016; 16: 839-43)

Objective: There are many factors related to high left atrial volume index (LAVI) and global left ventricular longitudinal peak systolic strain (GLS- %) decline in chronic kidney disease. The purpose of our study is to investigate the relation between the β-2 microglobulin (β-2μ) and GLS-% and LAVI in patients with chronic kidney disease not yet on dialysis.
Methods: Our study was a non-randomized, controlled, prospective study. We included 87 consecutive patients with eGFR levels below 60 ml/ min/m2 not on dialysis and 82 normal healthy individuals with complaints of atypical chest pain and negative stress tests as control group in our study. Patients with hospitalization related to dialysis or heart failure attacks within 3 months, active malignancy, malnutrition, pregnancy, and uncontrolled hypertension were excluded. Brachial pulse wave velocity (PWV), augmentation index, augmentation pressure and central hemodynamics, and PWV analysis were performed in order to assess the arterial stiffness and blood pressure. According to the distribution of data, Spearman and Pearson correlations and multiple linear regression were used to determine significant and independent factor associated with high LAVI and low GLS-%.
Results: There were significant correlations between β-2μ with LAVI (r=0.313, p=0.004) and with GLS-% (r=–0.222, p=0.04). In multiple linear re- gression, the relationship between β-2μ with GLS-% [β=–0.037, 95% CI (–0.062, –0.013), p=0.004] and LAVI [β=4.522, 95% CI (2.806, 6.238), p<0.001] was independent of age, PWV, central and peripheral blood pressures, parathormone, CalciumXPhospor, Hgb levels, and eGFR.
Conclusion: Increasing β-2μ levels were found to be associated with increased LAVI and decreased GLS-%. Additional experimental studies are needed to clarify these relationships. (Anatol J Cardiol 2016; 16: 844-9)

Objective: Although an early repolarization (ER) pattern was considered to be a benign electrocardiographic variant, several studies have shown that it is associated with an increased risk of idiopathic ventricular fibrillation and death. The aim of the present study was to determine whether there is any abnormality in myocardial deformation parameters (strain, strain rate, rotation, and twist) of the left ventricle obtained by speckle- tracking echocardiography (STE) in subjects with ER pattern.
Methods: There were two groups in this prospective case-control study. The first group consisted of subjects with ER pattern (n=35). The other group was control without ER pattern (n=25). Subjects with poor echocardiographic image quality and history of cardiovascular, pulmonary, systemic, or metabolic disease were excluded from the study. For STE of the left ventricle, two-dimensional images from apical long-axis, two- chamber, and four-chamber views and from parasternal short-axis views were obtained.
Results: We did not observe significant differences between the groups for left ventricular (LV) longitudinal deformation parameters, rotation, and twist. When LV circumferential deformation parameters were analyzed, early diastolic strain rate value at the level of apex was higher in subjects with ER pattern (2.3±0.7 s–1 vs. 1.9±0.4 s–1, p=0.01). Among LV radial deformation parameters, only peak strain (42.5±16.1% in the ER group vs. 56.9±21.1% in controls, p=0.004) and early diastolic strain rate (–2.0±0.7 s–1 in the ER group vs. –2.3±0.7 s–1 in controls, p=0.03) values at the level of papillary muscle were different.
Conclusion: In subjects with ER pattern, LV myocardial deformation evaluated by STE is normal with a few regional exceptions. STE does not provide much information about risk stratification of these subjects. (Anatol J Cardiol 2016; 16: 850-4)

Objective: The aim of this study was to investigate the relationship between platelet-to-lymphocyte ratio (PLR), an easily available inflammatory marker, and coronary artery ectasia (CAE).
Methods: After applying the exclusion criteria, the retrospective study population consisted of 330 patients, including 110 patients with isolated CAE, 110 with obstructive coronary artery disease (CAD), and 110 with normal coronary artery angiograms (NCA). The severity of isolated CAE was determined according to the Markis classification. SPSS 22.0 statistical package program was used for data analysis.
Results: PLR was significantly higher in patients with isolated CAE than in those with NCA and obstructive CAD [123 (113–156), 100 (86–138), and 110 (102–141), respectively]. Logistic regression analysis showed that PLR and C-reactive protein level were significantly correlated with the severity of isolated CAE.
Conclusion: To the best of our knowledge, this study showed for the first time that PLR was significantly associated with CAE.
(Anatol J Cardiol 2016; 16: 857-62)

Objective: Although the role of platelet activation has been debated in patients with mitral stenosis (MS) and spontaneous echocardiographic contrast (SEC), data on differences in mean platelet volume (MPV) according to the presence of SEC/left atrial thrombus and the rhythm status are lacking. In this study, MPV was analyzed in patients with MS according to the presence of SEC/left atrial thrombus.
Methods: Between January 2005 and March 2014, 188 symptomatic patients having moderate or severe MS (mean age, 45.0±11.7 years; female, 81.4%) with favorable valve morphology for percutaneous mitral balloon valvuloplasty (PMBV) and underwent a transesophageal echocardio- gram to assess the eligibility for PMBV were retrospectively enrolled in the study. The relation between MPV and echocardiographic thrombo- embolic risk factors were evaluated. Independent predictors of SEC/left atrial thrombus presence were determined by multiple logistic regres- sion analyses.
Results: Among all patients, MPV did not differ according to the rhythm status or the presence of SEC/left atrial thrombus (p>0.05). Also, MPV did not vary according to the gender and presence of prior stroke in both atrial fibrillation and sinus rhythm groups (p>0.05). In correlation analysis, MPV did not show any significant correlation with the echocardiographic thrombus predictors (p>0.05).
Conclusion: Using MPV with echocardiographic and clinical thrombus risk determinants for predicting individual thromboembolism risk in MS is debatable according to our results. (Anatol J Cardiol 2016; 16: 863-7)

Objective: Saphenous venous grafts (SVGs) are established choices for coronary artery bypass grafting (CABG); however, their lumen patency is limited. Our goal was to investigate the risk factors of SVG degeneration.
Methods: Seventy-five patients (mean age, 57.5±10.4 years) with 133 SVG conduits who had cardiac catheterization ≥1 year after CABG were selected; follow-up period was 67.6±36.8 months. Patients were divided into 3 groups according to angiographic status at follow up [intact: <20% (n=23); narrowed: 20–99% (n=24); and occluded (n=28)]. Baseline clinical conditions were evaluated in relation to follow-up angiography. As onset date of chronic total occlusions is usually uncertain, they arise typically from thrombotic lesions; thus, their value in evaluation is limited. Results: There were no significant differences between the 3 groups in clinical parameters. Linear correlation analysis found significant (p<0.01) positive connection of SVG disease (luminal diameter reduction 20–99%) with C-reactive protein (CRP) and homocysteine (Hcy), as well as between CRP and Hcy. Multiple regression analysis showed plasma Hcy level to be significantly related to graft diameter reduction normalized to time elapsed until angiography in narrowed grafts: 1 μmol/L increase of Hcy was associated with 0.053%/month decrease in lumen diameter (p<0.01; R2=0.428); extrapolating: +10 μmol/L higher Hcy level during 5 years is associated with 32.1% lumen reduction.
Conclusion: Medium- to long-term SVG degeneration is related to elevated plasma total Hcy in patients with sub-occlusive graft stenosis, while in cases with intact SVGs, the beneficial local flow conditions may protect the grafts from degeneration. (Anatol J Cardiol 2016; 16: 868-73)

Objective: Pulsatile flow, generated by a pump during cardiopulmonary bypass, has been accepted as more physiological in coronary artery bypass grafting surgery (CABG). Therefore, we aimed to investigate the effects of pulsatile and nonpulsatile flow on postoperative cognitive function and to review relationship with the biomarkers S100β and neuron-specific enolase (NSE).
Methods: Patients who underwent isolated CABG were included this prospective, randomized, double-blind study, which was performed be- tween March 2010 and December 2010. Patients were divided into two groups: pulsatile (Group I, n=20) and nonpulsatile (Group II, n=20) flow. Blood samples were collected 1 day before surgery and in the sixth postoperative hour for the analysis of S100β and NSE. In addition, Mini- Mental State Examination (MMSE) was performed during preoperative period and on third postoperative day. Outcomes were determination of effects of pump flow type on cognitive function and relationships with concentrations of S100β and NSE.
Results: Forty patients were included. No differences were observed between the groups with respect to complications, mortality, S100β (Group I: 1.9±0.2 μ/L; Group II: 2.0±0.2 μ/L), NSE (Group I: 12.5±0.8 μ/L; Group II: 12.4±0.7 μ/L), MMSE scores [Group I: 25 (23–27); Group II: 25 (23–27)], and postoperative cognitive dysfunction (POCD) (p>0.05). No correlation was observed between MMSE scores and concentrations of S100β (r=–0.032) and NSE (r=–0.423) (p>0.05).
Conclusion: There was no difference between types of pump flow for POCD and no relationship between cognitive dysfunction and S100β and NSE concentrations. Pump flow type does not affect NSE concentrations. (Anatol J Cardiol 2016; 16: 875-80)

Heart has long been considered a terminally differentiated organ. Recent studies, however, have suggested that there is a modest degree of cardiomyocyte (CM) turnover in adult mammalian heart, albeit not sufficient for replacement of lost CMs following cardiac injuries. Cardiac regeneration studies in various model organisms including zebrafish, newt, and more recently in neonatal mouse, have demonstrated that CM dedifferentiation and concomitant proliferation play important roles in replacement of lost CMs and restoration of cardiac contractility. Further studies with neonatal cardiac regeneration mouse model suggested that major source of new CMs is existing CMs, with the possibility of in- volvement of cardiac stem cells. Numerous studies have now been conducted on induction of cardiac regeneration and have identified various cardiogenic factors, cardiogenic micro ribonucleic acid and cardiogenic small molecules. This report is a review of studies regarding generation of CM and prospects for application. (Anatol J Cardiol 2016; 16: 881-6)

Sudden cardiac death (SCD) constitutes one of the most important unsolved challenges in the practice of forensic medicine. Most SCD are caused by hereditary conditions, of which hereditary cardiovascular diseases are the most frequent. More than 20 different pathological entities have been identified as a cause of SCD. Hypertrophic cardiomyopathy (HCM) is the major contributor to overall mortality resulting from ventricular tachyarrhythmia, followed by dilated cardiomyopathy (DCM) (1). The identification of multiple disease-causing gene variants has already improved patient management and increased our understanding of HCM/DCM associated with SCD risk in young adults; however, additional genetic modifiers exist (2). Herein we report a case of sudden death via DCM/HCM that may be strongly associated with sarcoglycan (SGCD) and titin (TTN) gene variants.