ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 16 (4)
Volume: 16  Issue: 4 - April 2016
EDITORIAL
1.The waiting period
Zeki Öngen
PMID: 27111197  PMCID: PMC5368430  doi: 10.14744/AnatolJCardiol.2016.04  Page 233
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
2.Cardioprotective effect of metformin against doxorubicin cardiotoxicity in rats
Mustafa Argun, Kazım Üzüm, Mehmet Fatih Sönmez, Abdullah Özyurt, Derya Karabulut, Zeynep Soyersarıca, Kübra Tuğçe Çilenk, Sunay Unalmış, Özge Pamukcu, Ali Baykan, Figen Narin, Ferhan Elmalı, Nazmi Narin
PMID: 26642465  PMCID: PMC5368431  doi: 10.5152/akd.2015.6185  Pages 234 - 241
Objective: The clinical use of doxorubicin, which is a strong antineoplastic agent, is limited due to its cardiotoxic side effects. Metformin is a drug with antihyperglycemic effects, and it has been shown to have a cardioprotective effect on left ventricular function in experimental animal models of myocardial ischemia. The present study investigated the cardioprotective effect of metformin in rats with doxorubicin cardiotoxicity.
Methods: Wistar albino rats were used in the study. Forty male, 10-week-old Wistar albino rats were randomly divided four groups. The control group rats were intraperitoneally administered saline solution twice a week, four doses in total. The doxorubicin group rats received doxorubicin (4 mg/kg, twice a week, cumulative dose: 16 mg/kg) intraperitoneally. The metformin group rats received metformin (250 mg/kg/day, every day for 14 days) via gavage. The doxorubicin + metformin group rats received doxorubicin and metformin at the same dose. Left ventricular functions were evaluated by using M-mode echocardiography one day after the last dose of doxorubicin. Heart tissue samples were histopathologically examined. Cardiomyocyte apoptosis was detected using in situ terminal deoxynucleotide transferase assay (TUNEL). Serum brain natriuretic peptide and C-type natriuretic peptide levels were measured. Catalase, superoxide dismutase, glutathione peroxidase, and tumor necrosis factor alpha levels were analyzed in the heart tissue. The assumptions of equality of variances and normal distribution were checked for all variables (Shapiro-Wilk test and Q-Q graphics).To identify intergroup differences, one-way variant analysis or the Kruskal-Wallis test was used. A p<0.05 value was accepted as statistically significant.
Results: Our results showed that doxorubicin treatment caused significant deterioration in left ventricular functions by echocardiography, histological heart tissue damage, and increase in cardiomyocyte apoptosis. Doxorubicin + metformin group showed protection in left ventricular function, elimination of histopathologic change, and reduced of cardiomyocyte apoptosis.
Conclusion: The present study provided evidence that metformin has cardioprotective effects against doxorubicin cardiotoxicity. (Anatol J Cardiol 2016; 16: 234-41)

EDITORIAL COMMENT
3.Cardioprotective effect of metformin against doxorubicin cardiotoxicity in rats
Yi- Tang Tseng
PMID: 27111198  PMCID: PMC5368432  doi: 10.14744/AnatolJCardiol.2016.18505  Pages 242 - 243
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
4.What is better for predilatation in bioresorbable vascular scaffold implantation: a non-compliant or a compliant balloon?
Erdem Özel, Ahmet Taştan, Ali Öztürk, Emin Evren Özcan, Samet Uyar, Ömer Şenarslan
PMID: 26642470  PMCID: PMC5368433  doi: 10.5152/AnatolJCardiol.2015.6184  Pages 244 - 249
Objective: The bioresorbable vascular scaffold system (BVS) is a fully absorbable vascular treatment system. In this study, we aimed to compare the periprocedural effectiveness and long term results of non-compliant balloon (NCB) and compliant balloon (CB) systems, which are used for predilatation before BVS implantation.
Methods: One hundred forty-six BVS-treated lesions from 119 patients were retrospectively analyzed in the study. Patients with acute coronary syndrome, stable angina and silent ischemia were included in the study. Lesions and patients were categorized into the NCB and CB groups according to the type of balloon used for predilatation. NCB was implemented on 72 lesions (59 patients) and CB was implemented on 74 lesions (60 patients). The two groups were compared on terms of procedural features and both in-hospital and 1-year clinical follow-up results. Chisquare and independent sample t test were performed for statistical analysis.
Results: There was no significant difference between the two groups in terms of patient characteristics and lesion properties. The number of postdilated lesions was significantly higher in the CB group. Procedure time, fluoroscopy time, and contrast volume were significantly lower in the NCB group. At follow-up, one patient had myocardial infarction in the CB group because of scaffold thrombosis and no mortality was observed.
Conclusion: Predilatation with NCB before BVS implantation reduces the need for postdilatation. In addition, use of NCB reduces the procedure time, fluoroscopy time, and contrast volume but had no effect on 1 year clinical follow-up results compared with CB. (Anatol J Cardiol 2016; 16: 244-9)

5.Impaired quality of life in patients with intermittent atrial fibrillation
Cem Nazlı, Nihan Kahya Eren, Selcen Yakar Tülüce, İdil Gökçen Koçağra Yağız, Barış Kılıçaslan, Uğur Kocabaş
PMID: 26168457  PMCID: PMC5368434  doi: 10.5152/AnatolJCardiol.2015.6144  Pages 250 - 255
Objective: The quality of life (QoL) is impaired in patients with atrial fibrillation (AF). However, the data on the perceived QoL of patients with different types of AF is limited. In this study, we investigated the QoL of patients with intermittent and chronic AF.
Methods: The study was designed as an observational cross-sectional study, and 135 consecutive patients with documented AF admitted to the cardiology outpatient clinic in a tertiary hospital were recruited. The pattern of AF was classified as intermittent or chronic AF. The European Heart Rhythm Association (EHRA) classification and symptom severity score were used to quantify the symptoms related to AF. The QoL was assessed by the Short Form-36 and the Canadian Cardiovascular Society Severity in Atrial Fibrillation (SAF) scale.
Results: Thirty-nine percent of the patients (n=52) had intermittent AF and 61% (n=83) had chronic AF. In the overall patient population, 92% reported having at least one of the symptoms that can be attributable to AF. Although the prevalence of symptoms were similar in patients with intermittent or chronic AF, the patients with intermittent AF perceived more severe palpitations (symptom severity score 2.4±1.7 vs. 1.5±1.5, p=0.003). Patients with intermittent AF had higher EHRA and SAF scores than the patients with chronic AF (2.6±0.9 vs. 1.9±0.8, p<0.001; 2.5±1.3 vs. 1.7±1.2, p<0.001, respectively).
Conclusion: Outpatients with AF have a high prevalence of symptoms and impaired QoL. The impairment of subjective health-related QoL is worse in patients with intermittent AF. (Anatol J Cardiol 2016; 16: 250-5)

6.Heart rate recovery, cardiac rehabilitation and erectile dysfunction in males with ischaemic heart disease
Dariusz Kalka, Zygmunt Domagala, Leslaw Rusiecki, Lukasz Karpinski, Jana Gebala, Piotr Koleda, Malgorzata Rusiecka, Bohdan Gworys, Witold Pilecki
PMID: 26642468  PMCID: PMC5368435  doi: 10.5152/AnatolJCardiol.2015.6122  Pages 256 - 263
Objective: Heart rate recovery (HRR) is a recognised marker used in clinical practice for assessing the risk of sudden cardiac death. Physical exercise leads to an improvement in HRR and has a proven beneficial effect on erection quality (EQ) related to the activity of the autonomic nervous system in men with ischaemic heart disease (IHD). This paper evaluates the relationship between HRR and EQ in patients with IHD and erectile dysfunction (ED) who underwent cardiac rehabilitation.
Methods: The main analysis was based on the Mann–Whitney U test, Wilcoxon signed-rank test, Spearman correlation coefficient, Pearson's chi-square test, chi-square test, with the Yates correction and (if possible) parametric tests were used. This prospective, non-randomised intervention study included 124 men with IHD and ED [International Index of Erectile Function (IIEF-5) scores of ≤21]. Of these, 89 patients underwent a 6-month cardiac rehabilitation phase III programme, whereas 35 did not. The results of the participants’ total IIEF-5 scores and their HRR, demographic and clinical data were analysed.
Results: The results of the 89 rehabilitated patients (mean age: 60.44±9.29 years) and 35 controls (mean age: 61.43±8.81 years) were analysed. In the rehabilitated patients, the mean baseline IIEF-5 score was 13.15±5.76 (95% CI: 11.93–14.36) and HRR was 16.49±7.68/min (95% CI: 14.88– 18.11). After cardiac rehabilitation, the parameters of ED and HRR improved significantly and were significantly higher than those of the controls; the mean IIEF-5 score of the rehabilitated group increased to 15.36±6.51 (95% CI: 13.99–16.73), while HRR increased to 21.40±7.25/min (95% CI: 19.88–22.93). A significant correlation was found between ΔHRR and ΔEQ (r=0.409791) as a result of the 6-month cardiac training programme
Conclusion: Cardiac rehabilitation assessed by HRR has a sizable effect on autonomic balance in patients with IHD and ED, which plays a significant role in the mechanism of erection improvement. (Anatol J Cardiol 2016; 16: 256-63)

7.Deterioration of heart rate recovery index in patients with erectile dysfunction
Şeref Ulucan, Zeynettin Kaya, Ahmet Keser, Hüseyin Katlandur, Mustafa Karanfil, İsmail Ateş
PMID: 26642469  PMCID: PMC5368436  doi: 10.5152/AnatolJCardiol.2015.6132  Pages 264 - 269
Objective: Heart rate recovery (HHR) after exercise is a function of vagal reactivation. This study aimed to evaluate HHR index in patients with erectile dysfunction.
Methods: Men over the age of 18 years who were diagnosed with erectile dysfunction were included in the study. Ninety patients with erectile dysfunction (mean age=56.1±8.3 years) and 50 healthy subjects as controls (mean age=53.1±10.4 years) were compared. The erectile status of patients was evaluated using the sexual health inventory for men questionnaire. Basal electrocardiography, echocardiography, and treadmill exercise testing were performed in all patients and controls. The HHR index was defined as the reduction in heart rate from the rate at peak exercise to the rate at the first minute (HRR1), second minute (HRR2), third minute (HRR3), and fifth minute (HRR5) after terminating exercise stress testing. An independent sample t-test, Pearson correlation coefficient test, linear multivariate regression analysis, and receiver operating characteristic curve analysis were used for statistical assessment.
Results: All HHR indices were found to be significantly decreased in patients with erectile dysfunction (p<0.001). Effort capacity was markedly lower (9.1±2.3 vs. 10.4±2.3 METs, p=0.002) among patients with erectile dysfunction. HRR1 and HRR3 were found to be an independent risk factor for erectile dysfunction (Beta=0.462, p<0.001; Beta=0.403, p<0.001; respectively) in linear regression analysis.
Conclusion: Decreased HHR index may be considered as one of the independent predictors of impaired autonomic function in patients with erectile dysfunction. (Anatol J Cardiol 2016; 16: 264-9)

8.Computed tomography pulmonary embolism residua index (CTPER-index): a simple tool for pulmonary embolism residua description
Zdenek Vavera, Pavel Elias, Pavel Ryska, Jan Vojacek
PMID: 26642467  PMCID: PMC5368437  doi: 10.5152/akd.2015.6178  Pages 270 - 275
Objective: Chronic thromboembolic pulmonary hypertension (CTEPH) is a relatively common long-term complication of acute pulmonary embolism (PE) with severely negative impact on the patient's quality of life and prognosis. The aim of our study was to assess morphological changes, with respect to CTEPH development, in the pulmonary artery vascular bed 6 months after diagnosis of acute PE as the first thromboembolic event in the patient`s history.
Methods: Our prospective study included a population of 87 consecutive patients with proven PE. Multidetector computer tomography pulmonary arteriography (CTA) was performed 6 months after acute PE to assess residua of thrombi and abnormalities supporting the presence of pulmonary hypertension. To quantify the individual totality of morphological abnormalities, a computer tomography pulmonary embolism residua index (CTPER-index) was constructed and groups of patients with and without CTEPH were compared. The study follow-up was 24 months, with echocardiography performed 6, 12, and 24 months after PE.
Results: Morphological abnormalities corresponding to thrombi residua or pulmonary hypertension on CTA were found in 68% of patients. The CTPER-index reached significantly higher values in patients with CTEPH during a 2-year follow-up. A CTPER-index value ≥4 equates to a 12-fold higher risk of CTEPH development (p=0.013) with sensitivity 0.80 (95% CI 0.31; 0.989) and specificity 0.79 (95% CI 0.754; 0.799).
Conclusion: Our CTPER-index may provide useful information for a clinician performing CTA for differential diagnosis of dyspnea in a patient with a history of PE. (Anatol J Cardiol 2016; 16: 270-5)

9.Evaluation of cardiac biomarkers and right ventricular dysfunction in patients with acute pulmonary embolism
Neşe Dursunoğlu, Dursun Dursunoğlu, Ali İhsan Yıldız, Simin Rota
PMID: 26645262  PMCID: PMC5368438  doi: 10.5152/akd.2014.5828  Pages 276 - 282
Objective: Right ventricular dysfunction (RVD) with myocardial damage may lead to fatal complications in patients with acute pulmonary embolism (PE). Cytoplasmic heart-type fatty acid-binding protein (HFABP) and the N-terminal fragment of its prohormone (NT-proBNP) are sensitive and specific biomarkers of myocardial damage. We evaluated RVD and cardiac biomarkers for myocardial damage and short-term mortality in patients with acute PE.
Methods: We analyzed 41 patients (24 females, 17 males) with confirmed acute PE prospective. Three groups (massive, submassive, and nonmassive) of patients were defined, based on systemic systolic blood pressure measured on admission and RVD by transthoracic echocardiography (TTE). Also, systolic (s) and mean (m) pulmonary artery pressures (PAPs) were recorded by TTE, and plasma concentrations of cardiac troponin T (cTn-T), NT-proBNP, and HFABP were evaluated 6 month follow-up.
Results: Seventeen (41.5%) patients experienced a complicated clinical course in the 6-month follow-up for the combined end-point, including at least one of the following: death (n=12, 29.3%; 3 PE-related), chronic PE (n=4, 9.8%), pulmonary hypertension (n=2, 4.9%), and recurrent PE (n=1, 2.4%). Multivariate hazard ratio analysis revealed HFABP, NT-proBNP, and PAPs as the 6-month mortality predictors (HR 1.02, 95% CI 1.01- 1.05; HR 1.01, 95% CI 1.01-1.04; and HR 1.02, 95% CI 1.02-1.05, respectively).
Conclusion: HFABP, NT-proBNP, and PAPs measured on admission may be useful for short-term risk stratification and in the prediction of 6-month PE-related mortality in patients with acute PE. (Anatol J Cardiol 2016; 16: 276-82)

10.The value of coronary artery calcium score in the early diagnosis of coronary artery disease in patients with stable chronic obstructive pulmonary disease
Sinem Özyılmaz, Mehmet Fethi Alışır, Osman Akın Serdar, Esra Uzaslan
PMID: 26642466  PMCID: PMC5368439  doi: 10.5152/AnatolJCardiol.2015.6020  Pages 283 - 289
Objective: Our aim was to assess the value of coronary artery calcium score (CACS) in the early diagnosis of coronary artery disease in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II chronic obstructive pulmonary disease (COPD) patients and to identify high-risk patients.
Methods: Forty-two patients with GOLD stage II COPD and 31 healthy control subjects were enrolled in the study. This study was designed as a prospective observational cross-sectional study. Pearson’s correlation coefficient was used for comparisons between groups. Criteria for stage II COPD diagnosis were forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of <70% and 50%≤FEV1<80%. Excluded from the study were individuals who had a previous diagnosis of coronary artery disease, GOLD stage I-III-IV COPD, or left ventricular systolic dysfunction.
Results: As compared with the control group, CACS values were significantly higher in the patient group (p=0.030 and 0.001, respectively). CACS was significantly higher in male patients with a positive family history, physical inactivity, long duration of disease, and low FEV1 (0.027, 0.008; 0.001 and 0.001; 0.001, respectively). Logistical regression analysis of sex, age, diabetes mellitus, hypertension, cigarette smoking, family history, physical inactivity, and FEV1 values showed that physical inactivity was independently correlated with high CACS [odds ratio (OR): 7; confidence interval (CI): 3–20; p=0.001].
Conclusion: The value of CACS is high in stage II COPD patients. Male stage II COPD patients with a disease duration of 10 years, physical inactivity, and/or a positive family history should be monitored for early stage coronary artery disease and coronary events, regardless of risk factors such as diabetes, hypertension, and hyperlipidemia. (Anatol J Cardiol 2016; 16: 283-9)

11.Heart rate variability improvement in children using transcatheter atrial septal defect closure
İsa Özyılmaz, Yakup Ergül, Hasan Tahsin Tola, Murat Saygı, Erkut Öztürk, İbrahim Cansaran Tanıdır, Öyku Tosun, Sinem Özyılmaz, Mehmet Gül, Alper Güzeltaş, Ender Ödemiş, İhsan Bakır
PMID: 26642471  PMCID: PMC5368440  doi: 10.5152/akd.2015.5922  Pages 290 - 295
Objective: We evaluated autonomic behavior by examining heart rate variability (HRV) in the time domain and frequency domain in pediatric patients who underwent transcatheter closure of atrial septal defect (ASD).
Methods: A prospective study design was used. Holter ECG was performed in a control group of 30 healthy subjects and a group of 47 patients who underwent transcatheter ASD closure. ECG was taken one day before, one day after, and six months after the procedure to evaluate changes in the time domain [SDNN, rMSSD, NN, pNN50(%), and SDANN] and frequency domain (VLF, LF, HF, VHF, and LF/HF) in the patient group. Student’s t-test was used to evaluate changes prior to and after the procedure.
Results: There were 28 females (60%) in the patient group and 21 females (70%) in the control group. The mean age and weight of the participants in the patient group were 9.61±4.72 years and 32.40±19.60 kg, respectively; the mean age and weight of the control subjects were 10.43±5.31 years and 32.83±13.00 kg, respectively. In both the time domain and frequency domain analyses, the patient group values were found to be lower than those in the control group prior to the procedure; the values in the patient group were found to approach the values in the control group following the procedure. By the sixth month, the values in the patient group reached the control levels with no statistically significant difference (SDNN: 145±0.84, 137.50±42.50; rMSSD: 72.18±48.22, 58.14±28.49; SDANN: 125.13±13.50, 122.40±41.06; VLF: 112.85±29.07, 114.41±98.39; LF: 50.40±24.09, 45.69±15.13; HF: 39.28±19.86, 44.29±13.14; VHF: 10.29±4.24, 9.99±6.47; LF/HF: 1.90±1.44, 1.24±0.81; p>0.05).
Conclusion: The transcatheter closure of secundum ASDs was found to have a positive effect on HRV. Consequently, it may contribute to reduced mortality and morbidity. We can conclude that in children, HRV recovers approximately six months after transcatheter ASD closure. (Anatol J Cardiol 2016; 16: 290-5)

CASE REPORT
12.Successful treatment of total occluded innominate artery in a patient with subclavian steal syndrome
Taner Şeker, Hazar Harbalıoğlu, Mustafa Gür, Murat Çaylı
PMID: 27111199  PMCID: PMC5368441  doi: 10.14744/AnatolJCardiol.2016.7008  Pages 296 - 297
Abstract |Full Text PDF | Video

LETTER TO THE EDITOR
13.The role of left atrial deformation parameters in the prediction of atrial fibrillation recurrence after cryoballoon ablation therapy
Can Ramazan Öncel
PMID: 27111201  PMCID: PMC5368442  doi: 10.14744/AnatolJCardiol.2016.6984  Page 298
Abstract |Full Text PDF

14.Natriuretic peptide and cardiac troponin levels in doxorubicin-induced cardiotoxicity
Mustafa Gülgün, Kürşat Fidancı, Fatih Alparslan Genç, Vural Kesik
PMID: 27111202  PMCID: PMC5368444  doi: 10.14744/AnatolJCardiol.2016.7001  Page 299
Abstract |Full Text PDF

15.Author`s Reply
Demet Menekşe Gerede
PMID: 27111200  PMCID: PMC5368443  Page 299
Abstract |Full Text PDF

16.Author`s Reply
Mustafa Argun, Kazım Üzüm, Ali Baykan, Nazmi Narin
PMID: 27111203  PMCID: PMC5368445  Pages 299 - 300
Abstract |Full Text PDF

17.Late huge thrombus formation after percutaneous closure of an atrial septal defect with an Amplatzer septal occluder: Implications of Kounis syndrome
Nicholas G. Kounis, Dimitrios Lianas, George N. Kounis, George D. Soufras
PMID: 27111204  PMCID: PMC5368446  doi: 10.14744/AnatolJCardiol.2016.7046  Pages 300 - 301
Abstract |Full Text PDF

18.Author`s Reply
Fahrettin Uysal
PMID: 27111205  PMCID: PMC5368447  Pages 301 - 302
Abstract |Full Text PDF

19.Admission serum potassium level is associated with in-hospital and long-term mortality in ST-elevation myocardial infarction
Levent Cerit
PMID: 27111206  PMCID: PMC5368448  doi: 10.14744/AnatolJCardiol.2016.7066  Page 302
Abstract |Full Text PDF

20.Author`s Reply
Mahmut Uluganyan
PMID: 27111207  PMCID: PMC5368449  Pages 302 - 303
Abstract |Full Text PDF

21.ATP-binding cassette, sub-family B (MDR/TAP), member 1 (ABCB1) polymorphism and clopidogrel concentration in acute coronary syndrome: molecular change can explain the observed therapeutic concentration
Beuy Joob, Viroj Wiwanitkit
PMID: 27111208  PMCID: PMC5368450  doi: 10.14744/AnatolJCardiol.2016.7027  Pages 303 - 304
Abstract |Full Text PDF

22.Emergency endovascular treatment of peripheral arterial injuries occurring during the Syrian civil war: Gaziantep Dr. Ersin Arslan Education and Research Hospital Experience
Ertan Vuruşkan, Erhan Saraçoğlu, Mehmet Küçükosmanoğlu, Fethi Yavuz, Zülfiye Kuzu, İsa Sincer
PMID: 27111209  PMCID: PMC5368451  doi: 10.14744/AnatolJCardiol.2016.6964  Page 304
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
23.A case of constrictive pericarditis due to angiosarcoma mimicking acute ST elevation myocardial infarction
Veysel Özgür Barış, Hüseyin Göksülük, Başar Candemir, Aylin Okçu Heper
PMID: 27111210  PMCID: PMC5368452  doi: 10.14744/AnatolJCardiol.2016.6869  Pages E7 - E8
Abstract |Full Text PDF | Video



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