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Anatol J Cardiol: 18 (1)
Volume: 18  Issue: 1 - July 2017
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1.The expectations of SCI-E Journal editors from June
Bilgin Timuralp
PMID: 28680020  doi: 10.14744/AnatolJCardiol.2017.07  Pages 1 - 2
Abstract | Full Text PDF

2.Connexin 43 is involved in the sympathetic atrial fibrillation in canine and canine atrial myocytes
Chenglin Shu, Weiqiang Huang, Zhiyu Zeng, Yan He, Beibei Luo, Hao Liu, Jinyi Li, Jian Xu
PMID: 28554986  doi: 10.14744/AnatolJCardiol.2017.7602  Pages 3 - 9
Objective: Atrial fibrillation (AF) is the most common rapid cardiac arrhythmia associated with high morbidity and mortality. Stimulation of the sympathetic nerve is involved in AF occurrence. The gap junction protein connexin 43 (Cx43) plays a key role in electrical conduction velocity in cardiac tissues, and under expression of Cx43 was linked with AF. The aim of this study was to investigate whether Cx43 was involved in sympathetic AF.
Methods: Fifteen dogs were randomly divided into 3 groups (5 in each group). Sympathetic AF was induced in dogs and isolated canine atrial myocytes by isoproterenol (ISO) perfusion and rapid atrium pacing (RAP). The expression levels of nerve growth factor (NGF) and tyrosine hydroxylase (TH) in the atrial tissues were detected using immunohistochemical staining. The transcription and protein expression of Cx43 in the AF cell model was measured. Subsequently, Cx43 was blocked by short interfering (si) RNA in atrial myocytes and the gap junctional intercellular communication was detected using the scrape-loading and dye transfer assay.
Results: Sympathetic AF was successfully induced by a combination of ISO perfusion and RAP. The expression levels of NGF and TH were increased in the RAP group, and further increased in the RAP + ISO group. Tissue samples from the AF dogs had a lower Cx43 level than those of the control group (p<0.05). The expressions of mRNA and protein of Cx43 in sympathetic AF cell model decreased by 26% and 28%, respectively, when compared with the control group, with p<0.05. Silencing Cx43 in cells by siRNA could also efficiently reduce Cx43 expression. The relative levels of Cx45 mRNA were decreased by 73% compared with unaffected cells. The scrape-loading and dye transfer assay showed that gap junctional intercellular communication was hampered in the sympathetic AF cell model and silencing Cx43 could impede channel conduction.
Conclusion: The results suggested that low expression of Cx43 was involved in sympathetic AF by influencing intercellular channel conduction. Intervention of Cx43 expression might be an appealing therapy to sympathetic AF.

3.Evaluation of the ambulatory arterial stiffness index in lead-exposed workers
Uğur Nadir Karakulak, Ömer Hınç Yılmaz, Engin Tutkun, İhsan Ateş, Ceylan Bal, Meside Gündüzöz
PMID: 28554985  doi: 10.14744/AnatolJCardiol.2017.7170  Pages 10 - 14
Objective: Lead exposure has been associated with various cardiovascular disorders. It may also cause increased inflammation and fibrosis in the arterial system resulting in an increase in arterial stiffness. In this study, the ambulatory arterial stiffness index (AASI), which is a technique that measures arterial stiffness, was evaluated in occupationally lead-exposed workers.
Methods: In this cross-sectional study, 68 lead-exposed workers without known cardiovascular risk factors and 68 healthy subjects were evaluated according to the 24-hour ambulatory blood pressure monitorization (ABPM) profiles and blood and 24-hour urine lead levels. A regression slope of diastolic over systolic blood pressure (BP) was computed in each participant. AASI was defined as 1 minus the regression slope.
Results: There were no significant differences in terms of baseline demographic, clinical, echocardiographic characteristics, and ABPM profiles between the groups. In lead-exposed workers, the mean age was 34.7±8.1 years, and the median blood and urine lead levels were 40.5 μg/dL and 34.9 μg/L, respectively. AASI was 0.42±0.10 in lead-exposed workers and 0.37±0.10 in control subjects (p=0.007). In correlation analysis, AASI was correlated with both blood (r=0.417, p<0.001) and urine lead (r=0.242, p=0.047) levels. In regression analysis, blood lead level was found to be associated with AASI (β=0.086, p<0.001).
Conclusion: AASI, which is an indicator of arterial stiffness, was found to be higher in lead-exposed workers than in healthy individuals. Increased AASI may be considered an early sign of arterial involvement in case of lead exposure.

4.Association between left atrial function assessed by speckle-tracking echocardiography and the presence of left atrial appendage thrombus in patients with atrial fibrillation
Karolina Kupczynska, Blazej W. Michalski, Dawid Miskowiec, Jaroslaw D. Kasprzak, Paulina Wejner- Mik, Katarzyna Wdowiak- Okrojek, Piotr Lipiec
PMID: 28559531  doi: 10.14744/AnatolJCardiol.2017.7613  Pages 15 - 22
Objective: The aim of the study was to investigate whether the deformation of left atrium (LA) measured by speckle-tracking analysis (STE) is associated with the presence of LA appendage thrombus (LAAT) during non-valvular atrial fibrillation (AF).
Methods: Eighty-seven patients (mean age 67 years, 59% men) were included to retrospective cross-sectional study. On top of standard echocardiography we assessed: LA longitudinal systolic strain (LS), systolic (LSSR) and early diastolic strain rate (LESR) in four-chamber and two-chamber apical views. All patients underwent transesophageal echocardiography disclosing LAAT in 36 (41%) patients.
Results: Subgroups with and without thrombi did not differ with regard to clinical characteristics. Univariate factors associated with LAAT were as follows: CH2ADS2-VASc Score, left ventricular ejection fraction (LVEF), LV mass, and STE measurements. In a multivariate model only LVEF (p=0.002), LS (p=0.02), LESR (p=0.008), and LSSR (p=0.045) were independently associated with LAAT presence. Moreover, LVEF and LA STE measurements provided incremental value over the CH2ADS2-VASc Score.
Conclusion: Speckle-tracking TTE may be used to describe LA reservoir and conduit function during AF, allowing the identification of patients with higher risk of LAAT and providing incremental value over the CH2ADS2-VASc Score.

5.Should physicians instead of industry representatives be the main actor of cardiac implantable electronic device follow-up? (Super Follow-up)
Çağın Mustafa Üreyen, Cem Yunus Baş, İsa Öner Yüksel, Görkem Kuş, Göksel Çağırcı, Şakir Arslan
PMID: 28430113  doi: 10.14744/AnatolJCardiol.2017.7374  Pages 23 - 30
Objective: This retrospective study sought to research the adequacy of the follow-up and optimization of cardiac implantable electronic devices (CIEDs) performed by industry representatives.
Methods: A total of 403 consecutive patients (35% females; median age, 67 years; age range 18–97 years) with either pacemakers (n=246), implantable cardioverter-defibrillators (ICDs), (n=117) or cardiac resynchronization therapy with defibrillator (CRT-D) (n=40) applied to our hospital’s outpatient pacemaker clinic for follow-up. These patients had been followed up by industry representatives alone until September 2013 and then by a cardiologist who is dealing with cardiac electrophysiology and has a knowledge of CIED follow-up.
Results: It was ascertained that 117 (47.6%) of 246 patients with pacemakers had a programming error. Forty-three (36.8%) of 117 patients were symptomatic, and after reprogramming, all symptoms diminished partially or completely during the follow-up. Moreover, 30 (25.6%) of 117 patients with ICDs had a programming error. Furthermore, 6 (15%) of 40 patients with CRT-Ds had a programming error. To conclude, when all patients with CIEDs were assessed together, it was ascertained that 153 (38%) of 403 patients had programming errors.
Conclusion: The prevalence of inappropriate programming of CIEDs by industry representatives was quite higher than expected. Therefore, our study strongly demonstrates that CIED follow-up should not be allowed to be performed entirely by manufacturers’ representatives alone.

6.Comet assay in evaluating deoxyribonucleic acid damage after out-of-hospital cardiac arrest
Radka Hazuková, Martina Rezácová, Renata Köhlerová, TomᚠTomek, Eva Cermáková, Jaromír Kocí, Miloslav Pleskot
PMID: 28639949  doi: 10.14744/AnatolJCardiol.2017.7578  Pages 31 - 38
Objective: This study aimed to investigate whether out-of-hospital cardiac arrest (OHCA) may induce severe DNA damage measured using comet assay in successfully resuscitated humans and to evaluate a short-term prognostic role.
Methods: In this prospective, controlled, blinded study (1/2013–1/2014), 41 patients (age, 63±14 years) successfully resuscitated from non-traumatic OHCA and 10 healthy controls (age, 53±17 years) were enrolled. DNA damage [double-strand breaks (DSBs) and single-strand breaks (SSBs)] was measured using comet assay in peripheral lymphocytes sampled at admission. Clinical data were recorded (according to Utstein style). A good short-term prognosis was defined as survival for 30 days.
Results: Among the patients, there were 71% (29/41) short-term survivors. After OHCA, DNA damage (DSBs and SSBs) was higher (11.0±7.6% and 0.79±2.41% in tail) among patients than among controls (1.96±1.63% and 0.02±0.03% in tail), and it was more apparent for DSBs (p<0.001 and p=0.085). There was no difference in the DNA damage between patients with cardiac and non-cardiac etiology, or between survivors and non survivors. Among Utstein style parameters, ventricular fibrillation, asystole, and early electrical defibrillation influenced DSBs; none of the factors influenced SSBs. Factors influencing survival were SSBs, ventricular fibrillation, length of cardiopulmonary resuscitation by professionals ≤15 min, cardiogenic shock, and postanoxic encephalopathy. In contrast to DSBs [area under the curve (AUC)=0.520], SSBs seem to have a potential in prognostication (AUC=0.639).
Conclusion: This study for the first time demonstrates revelation of DNA damage using comet assay in patients successfully resuscitated from OHCA. Whether DNA damage measured using comet assay may be a prognostic marker remains unknown, although our data may encourage some suggestions.

7.Urban and rural differences in hypertension risk factors in Turkey
İlker Daştan, Ayşegül Erem, Volkan Çetinkaya
PMID: 28430114  doi: 10.14744/AnatolJCardiol.2017.7452  Pages 39 - 47
Objective: Existing literature shows considerable regional differences in terms of hypertension (HT) prevalence in Turkey. The purpose of this study was to analyze some of the known HT risk factors contributing to the variations between urban and rural areas of Turkey in HT development.
Methods: We used data from the 2011 Chronic Diseases and Risk Factors Survey that was conducted by the Turkish Ministry of Health on a representative sample of the Turkish adult population aged 20 years or more (n=16.227). HT was defined as having at least one of the following: a mean systolic/diastolic blood pressure of at least 140/90 mm Hg, a previously diagnosed disease, or use of antihypertensive medication. Stepwise multiple logistic regression analysis was used to estimate HT risk factors in urban and rural settings.
Results: Although the HT prevalence was higher in rural areas (28.4%) than in urban areas (23.9%), in this study, urbanization was found to be a contributing factor in multivariate regression analysis. Furthermore, separate regressions for urban and rural settings revealed that age, obesity, diabetes, hyperlipidemia, and smoking were independently and positively associated (p<0.05) with HT in both settings, while marital status, employment type, mental health, and lifestyle patterns; nutritional habits; and amount of physical activity and sedentary time (p<0.05) were risk indicators in urban areas only.
Conclusion: The findings of our study demonstrate that contributory factors show some variations between urban and rural settings, and on gender within each setting. Taking into account the variations between urban and rural areas in HT development may provide greater insight into the design of prevention strategies.

8.Tp-e interval and Tp-e/QTc ratio as novel surrogate markers for prediction of ventricular arrhythmic events in hypertrophic cardiomyopathy
Mehmet Kadri Akboğa, Kevser Gücihan Balcı, Samet Yılmaz, Selahattin Aydın, Çağrı Yayla, Ahmet Göktuğ Ertem, Sefa Ünal, Mustafa Mücahit Balcı, Yücel Balbay, Dursun Aras, Serkan Topaloğlu
PMID: 28315570  doi: 10.14744/AnatolJCardiol.2017.7581  Pages 48 - 53
Objective: Hypertrophic cardiomyopathy (HCM) as a common genetic heart disease characterized by ventricular hypertrophy and myocardial fibrosis is significantly associated with a higher risk of fatal ventricular arrhythmic events (VAEs). We aimed to assess the interval between the peak and the end of the electrocardiographic T wave (Tp–e) and Tp–e/corrected QT (QTc) ratio as candidate markers of ventricular arrhythmias in patients with HCM.
Methods: In this single-center, prospective study, a total of 66 patients with HCM and 88 controls were enrolled. The patients were divided into two groups: those with VAEs (n=26) and those without VAEs (n=40). Tp–e interval and Tp–e/QTc ratio were measured using a 12-lead electrocardiogram.
Results: Tp–e interval was significantly longer and Tp–e/QTc ratio were significantly higher in HCM patients than in the controls. In correlation analysis, maximal left ventricular (LV) thickness also has a significant positive correlation with Tp–e interval (r=0.422, p<0.001) and Tp–e/QTc ratio (r=0.348, p<0.001). Finally, multivariable regression analysis showed that a history of syncope, Tp–e interval [OR (odds ratio): 1.060; 95% confidence interval (CI): 1.005–1.117); p=0.012], Tp–e/QTc ratio (OR: 1.148; 95% CI: 1.086–1.204); p=0.049], and maximal LV thickness were independent predictors of VAEs in patients with HCM.
Conclusion: Our findings suggested that prolonged Tp–e interval and increased Tp–e/QTc ratio may be good surrogate markers for the prediction of VAEs in HCM. (Anatol J Cardiol 2017; 17: 000-00)

9.Assessment of the association between the presence of fragmented QRS and the predicted risk score of sudden cardiac death at 5 years in patients with hypertrophic cardiomyopathy
Sinem Özyılmaz, Özgür Akgül, Hüseyin Uyarel, Hamdi Pusuroğlu, Muammer Karayakalı, Mehmet Gül, Mustafa Çetin, Hulusi Satılmışoğlu, Aydın Yıldırım, İhsan Bakır
PMID: 28559533  doi: 10.14744/AnatolJCardiol.2017.7593  Pages 54 - 61
Objective: It has been shown that the presence of fragmented QRS (fQRS) is associated with poor prognosis in many cardiovascular diseases and in patients with hypertrophic cardiomyopathy (HCM). However, no study has shown an association with the absolute risk score of sudden cardiac death. The aim of this study was to determine the relationship between QRS and the predicted risk score of sudden cardiac death at 5 years (HCM Risk-SCD) in HCM patients.
Methods: In total, 115 consecutive HCM patients were included in this prospective observational study. The patients were divided into two groups according to the presence [fQRS(+) group (n=65)] or absence [fQRS(–) group (n=50)] of fQRS on a 12-lead electrocardiogram (ECG).
Results: The HCM Risk-SCD (%) HCM Risk-SCD (>6%) values and some echocardiographic parameters, including ventricular extrasystole, ventricular tachycardia, cardiopulmonary resuscitation, implantable cardioverter defibrillator implantation, appropriate shock, and heart failure at the time of admission, were significantly higher in the fQRS(+) group than in the fQRS(–) group (all p<0.05). Both univariate and multivariate analyses revealed fQRS and New York Heart Association (NYHA) class as independent predictors of HCM Risk-SCD. In a receiver operating characteristic (ROC) curve analysis, an HCM Risk-SCD value of >4 was identified as an effective cut-off point in fQRS for HCM. An HCM Risk-SCD value of >4 yielded a sensitivity of 77% and a specificity of 76%.
Conclusion: fQRS is determined to be an independent high-risk indicator of HCM Risk-SCD. It seems to be associated with increased ventricular arrhythmias and some echocardiographic parameters.

10.Diurnal blood pressure parameters in normal tension glaucoma, primary open angle glaucoma, and healthy subjects
Tolga Kocatürk, Çağdaş Akgüllü, Gökhan E. Evliçoğlu, İmran K. Ömürlü, Harun Çakmak, Ufuk Eryılmaz, Volkan Dayanır
PMID: 28315568  doi: 10.14744/AnatolJCardiol.2017.7562  Pages 62 - 67
Objective: The pathophysiology of glaucoma is still undisclosed. Cardiovascular hemodynamic changes are hypothesized to contribute to glaucoma. This study aimed to determine the differences in the diurnal blood pressure (BP) of patients with normal tension glaucoma (NTG), primary open angle glaucoma (POAG), and controls without glaucoma.
Methods: A total of 129 patients were included in this study. The day–night average systolic and diastolic BPs, the day–night average pulse pressures (PPs), the day–night average heart rates, and the percentage of BP decline at night were obtained from the Holter devices and compared. Study design: Prospective, randomized, case-control study.
Results: This study included 43 NTG patients (Group 1), 44 POAG patients (Group 2), and 42 healthy subjects without glaucoma (Group 3). The age (p=0.138) and sex (p=0.216) distributions between the groups were similar. The average day–night PP values of Group 1 were 49.17±9.90 and 46.07±10.84 mm Hg, respectively, while their total average PP was 48.48±9.60, their total average systolic BP was 120.02±12.65, and their night average systolic BP was 111.93±15.87 mm Hg. In Group 2, the average day and night PP values were 54.83±10.35 and 51.73±9.10 mm Hg, respectively, their total average PP was 54.00±9.87, their total average systolic BP was 126.75±11.50, and their night average systolic BP was 119.21±12.38 mm Hg. These differences were statistically significant and the corresponding p values were 0.040, 0.040, 0.037, 0.033, and 0.038.
Conclusion: NTG patients have low diurnal BP parameters, which may reduce their optic nerve perfusion and may be responsible for their glaucomatous visual field damage. (Anatol J Cardiol 2017; 17: 000-00)

11.Potential of lipoproteins as biomarkers in acute myocardial infarction
Haseeb Ahmad Khan, Aishah Ekhzaimy, Isra Khan, Meena Kishore Sakharkar
PMID: 28680021  doi: 10.14744/AnatolJCardiol.2017.7403  Pages 68 - 74
Acute myocardial infarction (AMI), commonly known as heart attack, is a medical emergency that is potentially fatal if not promptly and properly managed. The early diagnosis of AMI is critically important for the timely institution of pharmacotherapy to prevent myocardial damage and preserve cardiac function. Ischemic insults during AMI cause myocardial tissue damage, releasing the cardiac muscle protein troponin T into the blood stream. Therefore, serum troponin T levels are used as a sensitive and specific indicator of myocardial injury for diagnosing AMI. However, there remains a requirement for developing technologies for more accurate biomarkers or signatures for AMI diagnosis or prognosis. Previous studies have implicated impaired lipid metabolism as a causative factor in AMI development. Lipoproteins are important constituents of lipid metabolism; their levels in the blood stream are a convenient biomarker tool for monitoring lipid metabolism. This review summarizes recent findings (data of studies from 2001 to 2016) regarding the biomarker potentials of various lipoproteins, including low-density lipoprotein, oxidized low-density lipoprotein, high-density lipoprotein, lipoprotein-a, and remnant lipoprotein, for the risk stratification of AMI.

12.Evaluation of vitamin D levels in patients with acute rheumatic fever
Sertaç Hanedan Onan, Hüseyin Demirbilek, Bedri Aldudak, Meki Bilici, Fikri Demir, Murat Muhtar Yılmazer
PMID: 28680013  doi: 10.14744/AnatolJCardiol.2017.7720  Pages 75 - 76
Abstract | Full Text PDF

13.Can rivaroxaban be a drug of choice for treating heparin-induced thrombocytopenia in a patient with pulmonary thromboembolism?
Marija Vavlukis, Irina Kotlar, Hajber Taravari, Lidija Poposka, Sasko Kedev
PMID: 28680014  doi: 10.14744/AnatolJCardiol.2017.7805  Pages 77 - 79
Abstract | Full Text PDF | Video

14.Fistula between the right coronary artery and coronary sinus: a case report and literature review
Miao Yuan, Wen Juan Bai, Chun Mei Liu, Li Rao
PMID: 28680015  doi: 10.14744/AnatolJCardiol.2017.7868  Pages 79 - 80
Abstract | Full Text PDF | Video

15.Factors affecting the left atrial diameter
Yüksel Beşir, Orhan Gökalp, Hasan İner, Levent Yılık, Ali Gürbüz
PMID: 28680016  doi: 10.14744/AnatolJCardiol.2017.7909  Page 81
Abstract | Full Text PDF

16.Author`s Reply
Shimaa Ahmed Mostafa
PMID: 28680017  Page 81
Abstract | Full Text PDF

17.Professor Doctor Ahmet Birand
İstemi Nalbantgil
PMID: 28680018  doi: 10.14744/AnatolJCardiol.2017.7987  Page 82
Abstract | Full Text PDF

18.Neovascularization of floating myxoma clearly depicted on angiograms
Ali Doğan, Kenan Sever, Emrah Özdemir, Denyan Mansuroğlu, Payam Hacısalihoğlu, Nuri Kurtoğlu
PMID: 28680019  doi: 10.14744/AnatolJCardiol.2017.7895  Page E1
Abstract | Full Text PDF | Video

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