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Anatol J Cardiol: 18 (2)
Volume: 18  Issue: 2 - August 2017
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1.The difficulties of being a physician
Bilgin Timuralp
PMID: 28766517  doi: 10.14744/AnatolJCardiol.2017.08  Page 83
Abstract | Full Text PDF

2.“Desert” gene (Chr9p21) variants as novel markers for coronary artery disease
Heba A. Shendy, Sally I. Hassanein, Mohamed Z. Gad
PMID: 28559532  doi: 10.14744/AnatolJCardiol.2017.7730  Pages 84 - 89
Objective: Previous reports have denoted to the possible link of Chr9p21 locus to the incidence of coronary artery disease (CAD). The entire core of chr9p21 is covered by “ANRIL” (Antisense noncoding RNA in INK4 Locus) and lies in a region that is free from any coding proteins; therefore, it is called the desert gene. The major objectives of this study were to examine the association of rs10757278 and rs2383206 SNPs on Chr9p21 with the incidence of CAD in the presence and absence of type 2 diabetes (T2D) in Egyptians and to correlate these genetic variants with several disease biomarkers (TC, CRP, and HbA1c).
Methods: The study subjects consisted of 150 subjects; 50 healthy controls and 100 patients that were divided into two groups; CAD patients and CAD T2D patients. The genotyping of SNPs was performed using qPCR.
Results: Genotype distribution for both SNPs were found to be significantly different (p=0.0009 for rs10757278 and p=0.001 for rs2383206) between patients and controls. The allele frequency was also different for rs10757278.
Conclusion: The current study showed that rs10757278/rs2383206-G allele increases the risk for CAD in Egyptians. Moreover, AA variant appeared as a protective genotype. However, SNPs did not noticeably contribute in the elevation of TC, hs-CRP, and HbA1c in non-diabetic and diabetic CAD patients.

3.The impact of cardiac rhythm on the mitral valve area and gradient in patients with mitral stenosis
Hasan Arı, Selma Arı, Alper Karakuş, Sencer Camcı, Kübra Doğanay, Ahmet Tütüncü, Mehmet Melek, Tahsin Bozat
PMID: 28554987  doi: 10.14744/AnatolJCardiol.2017.7614  Pages 90 - 98
Objective: The aim of this study was to evaluate the effect of cardiac rhythm on the echocardiographic mitral valve area (MVA) and transmitral gradient calculation in relation to net atrioventricular compliance (Cn).
Methods: Patients (n=22) with mild or moderate pure rheumatic mitral stenosis (MS) (MVA <2 cm2 and MVA >1 cm2) and atrial fibrillation (AF) were evaluated. All patients underwent transthoracic electrical DC cardioversion under amiodarone treatment. Nineteen of the 22 patients were successfully converted to sinus rhythm (SR). The patients were evaluated with transthoracic echocardiography before and two to three days after DC cardioversion. In order to deal with variable R-R intervals, the measurements were averaged on five to eight consecutive beats in AF. Cn was calculated with a previously validated equation [Cn (mL/mm Hg)=1.270 x MVA/E-wave downslope]. The Cn difference between AF and SR was calculated as follows: [(AF Cn−SR Cn)/AF Cn] x 100. The percentage gradient (mean or maximal) difference between AF and SR was calculated as follows: [AF gradient (mean or maximal) – SR gradient (mean or maximal)]/[AF gradient (mean or maximal)] x 100.
Results: The MVA was lower (MVA planimetric; 1.62±0.29 vs. 1.54±0.27; p=.003, MVA PHT; 1.66±0.30 vs. 1.59±0.26; p=0.01) but transmitral gradient (mean gradient; 6.49±2.51 vs. 8.89±3.52; p=0.001, maximal gradient: 16.94±5.11 vs. 18.57±4.54; p=0.01) and Cn values (5.37±0.77 vs. 6.26±0.64; p<0.001) were higher in the AF than SR. There was a significant correlation between Cn difference and transmitral gradient difference (mean and maximal) (Cn difference–mean gradient difference; r=0.46; p=0.05; Cn difference–maximal gradient difference; r=0.72; p=0.001).
Conclusion: Cardiac rhythm has a significant impact on echocardiographic evaluation of MVA, transmitral gradient, and Cn in patients with MS.

4.Ghrelin expression and significance in 92 patients with atrial fibrillation
Tianyi Ma, Yujiang Su, Shijuan Lu, Moshui Chen, Jianghua Zhong, Zhihong Zhou, Dingjun Sun, Hui Yang, Xue Ao
PMID: 28430116  doi: 10.14744/AnatolJCardiol.2017.7621  Pages 99 - 102
Objective: Ghrelin is a polypeptide that is closely associated with many cardiovascular diseases, such as hypertension, atherosclerosis, and heart failure. This article aims to understand the expression of ghrelin in patients with atrial fibrillation (AF).
Methods: A total of 182 patients with non-valvular heart diseases were recruited, among whom 92 had AF and 90 had sinus arrhythmia (SA). The serum ghrelin amount was tested by the ELASA method. Moreover, blood sugar, lipids, liver function, and renal function were tested. All recruited patients underwent echocardiographic examination following admission. Three cardiac cycles were observed under continuous exhalation. The left atrial diameter (LAD) and the left ventricular ejection fraction (LVEF) were measured and averaged. Patients with AF received conventional treatment, and the aforementioned parameters were re-measured after 8 weeks. The results were statistically analyzed.
Results: The serum ghrelin level in the patients in the AF group (199.55±79.59 pg/mL) was lower than that in the patients in the SA group (313.89±71.13 pg/mL, p<0.01), whereas the serum ghrelin level in those in the paroxysmal AF group (224.44±72.33 pg/mL) was higher than that in those in the persistent AF group (176.00±79.88 pg/mL, p<0.01). There was a positive correlation between the serum ghrelin level and LVEF in the patients in the AF group (r=0.704, p=0.046). After treatment, the serum ghrelin level and LVEF in the patients in the AF group significantly increased, whereas LAD decreased.
Conclusion: The serum ghrelin level in patients with AF was reduced, and after treatment, it significantly increased. There was a positive correlation between the serum ghrelin level and LVEF in the patients in the AF group.

5.Fluvastatin therapy could not decrease progression of paroxysmal atrial fibrillation in non-valvular disease patients
Qiang Tan, Shuangyue Zhang, Xiaoyi Zou, Jun Zhao, Jia Hao, Qian Sun
PMID: 28430117  doi: 10.14744/AnatolJCardiol.2017.7664  Pages 103 - 107
Objective: This study aimed to evaluate whether fluvastatin therapy could decrease the probability of atrial fibrillation (AF) progression from paroxysmal AF to permanent AF and decrease the recurrence frequency of AF.
Methods: Analyses were performed using two-tailed Student’s t test or Mann-Whitney U tests. Categorical variables were compared with the χ2 statistics or Fisher’s exact test. Patients with paroxysmal AF were randomized case-control, prospective into either the fluvastatin group (n=61) or control group (n=57). Patients were followed up for 24 months. The primary endpoint event was paroxysmal AF that progressed to permanent AF. Secondary endpoints were AF recurrence, cardiac dysfunction, stroke, or death.
Results: There were no differences in AF progression (fluvastatin group, 8.19% vs. control group, 12.51%; p>0.05) and stroke (fluvastatin group. 6.55% vs. control group. 8.77%; p>0.05). Patients in the fluvastatin group had a lower rate of AF recurrence (fluvastatin group, 24.59% vs. control group, 49.12%; p<0.05) and a lower rate of cardiac dysfunction (fluvastatin group, 6.55% vs. control group, 19.29%; p<0.05). Death did not occur in both the groups. After 1 week of fluvastatin therapy, C-reactive protein (CRP) and homocysteine (HCY) levels were lower in the fluvastatin group than in the control group. At 24 months of follow-up, CRP and HCY levels remained lower in the fluvastatin group than in the control group. The number of endothelial progenitor cells (EPCs) increased in the fluvastatin group compared with that in the control group (fluvastatin group, 72.27±12.49 counts/105 vs. control group, 57.45±8.24 counts/105, p=0.001).
Conclusion: Fluvastatin therapy could not decrease AF progression. However, it could decrease the recurrence frequency of paroxysmal AF and cardiac dysfunction. This may occur because of depressing inflammation and improving circulating EPCs.

6.Statins in paroxysmal atrial fibrillation: Beneficial to prevent recurrence but insufficient to stop progression
Marija M. Polovina
PMID: 28529297  doi: 10.14744/AnatolJCardiol.2017.25184  Pages 108 - 109
Abstract | Full Text PDF

7.Surface electrocardiogram: Could atrioventricular nodal and His bundle potentials be recorded beat by beat on “Saah electrocardiogram”?
Qinghua Chang, Renguang Liu, Juan Chen
PMID: 28639947  doi: 10.14744/AnatolJCardiol.2017.7749  Pages 110 - 114
Objective: The P-QRS-T wave on surface electrocardiogram (ECG) reflects the changes in atrial and ventricular electrical properties. However, the atrioventricular conduction system potentials cannot be recorded to date. This study aimed to explore the possibility of micropotential of the atrioventricular conduction system recorded by surface “SAN-Atrial-AVN-His (Saah) ECG.”
Methods: We randomized 100 healthy volunteers (50 females and 50 males; mean age 25.12±1.62 years) to receive “conventional 12-lead ECG” and “Saah ECG,” which were recorded by the “Saah ECG” machine. We recorded and further analyzed “conventional 12-lead ECG” and “Saah ECG.” According to the microwavelets before the QRS complex, the PR interval was the sum of three intervals: PAs interval (PA interval recorded on surface ECG), AHs interval (AH interval recorded on surface ECG), and HVs interval (HV interval recorded on surface ECG). The PR interval, PAs interval, AHs interval, and HVs interval were measured.
Results: Not only the P-QRS-T waves but also the microwavelets before the P wave, before the QRS complex, and after the QRS complex were recorded in 100 healthy volunteers. The PAs interval, AHs interval, and HVs interval were 22–37 (31.23±2.93) ms, 60–103 (76.07±13.43) ms, and 39–55 (49.29±4.44) ms, respectively. The PAs interval, AHs interval, and HVs interval were consistent with the intracardiac measurements (PA, AH, and HV intervals) obtained in previous studies. Compared with female volunteers, male volunteers had a longer AHs interval (p<0.05).
Conclusion: Not only the P-QRS-T waves but also the microwavelets before the P wave, before the QRS complex, and after the QRS complex were recorded on surface ECG. The wavelets before the QRS complex may be related to atrioventricular nodal, His bundle (bundle branch) potentials.

8.Saah electrocardiography: An insight toward microwaveform of atrioventricular node and His bundle potentials
Sivaraman Jayaraman
PMID: 28766518  doi: 10.14744/AnatolJCardiol.2017.25567  Page 115
Abstract | Full Text PDF

9.Effects of garlic on brachial endothelial function and capacity of plasma to mediate cholesterol efflux in patients with coronary artery disease
Marjan Mahdavi- Roshan, Parvin Mirmiran, Mohammad Arjmand, Javad Nasrollahzadeh, Marjan Rismanchi
PMID: 28554988  doi: 10.14744/AnatolJCardiol.2017.7669  Pages 116 - 121
Objective: This study investigated the effects of garlic on brachial endothelial function and THP-1 macrophage cholesterol efflux (CE) and examined whether garlic modulates ATP-binding cassette (ABC) A1 and ABCG1 mRNA expressions in peripheral blood mononuclear cells (PBMCs) isolated from patients with coronary artery disease (CAD).
Methods: In this randomized, placebo-controlled trial, patients with CAD were randomly divided into two groups: those receiving garlic powder or placebo tablets twice daily for 3 months. Brachial flow-mediated dilation (FMD) was assessed using ultrasound. Fasting blood samples were collected before and after period and PBMC and plasma were isolated. Human THP-1 monocytes were differentiated into macrophages, labeled with 3H-cholesterol, and incubated with plasma samples, and CE was assessed. ABCA1 and ABCG1 mRNA expressions were determined in PBMCs.
Results: After 3 months, brachial FMD values significantly improved (50.7%) in the garlic group compared with those in the placebo group (p=0.016). High-sensitive C-reactive protein (hs-CRP) levels significantly decreased in the garlic group, but the difference between the two groups was not statistically significant. No significant difference was observed with regard to CE and ABCA1 and ABCG1 mRNA expressions in PBMCs. CE was negatively correlated with hs-CRP levels.
Conclusion: Short-term treatment with garlic may improve the endothelial function and may affect hs-CRP levels; however, it could neither significantly improve THP-1 macrophage CE nor affect ABCA1 or ABCG1 expressions in PBMCs.

10.The role of SCUBE1 in the pathogenesis of no-reflow phenomenon presenting with ST segment elevation myocardial infarction
Hasan Ata Bolayır, Hakan Güneş, Tarık Kıvrak, Ömer Şahin, Dursun Akaslan, Recep Kurt, Aslı Bolayır, Oya İmadoğlu
PMID: 28554990  doi: 10.14744/AnatolJCardiol.2017.7705  Pages 122 - 127
Objective: SCUBE1 [signal peptide-CUB (complement C1r/C1 s)-EGF (epidermal growth factor)-like domain-containing protein 1] might function as a novel platelet-endothelial adhesion molecule and play pathological roles in cardiovascular biology. Acute myocardial infarction is one of the most common causes of death in modern society. The concept of “no reflow” (NR) refers to a state of myocardial tissue hypoperfusion in the presence of a patent epicardial coronary artery. The main mechanisms of this phenomenon are thought to be high platelet activity and much thrombus burden. So, we researched the role of SCUBE1 in the pathogenesis of NR.
Methods: A total of 142 patients with ST elevation myocardial infarction (STEMI) (n=42 with NR and n=100 without NR) and 50 healthy individuals were prospectively case-control recruited between March 2015 and October 2016 from our outpatient clinics of cardiology department. Patients with STEMI were diagnosed according to American Heart Association (AHA) guideline for the management of STEMI.
Results: The mean SCUBE1 levels of the control subjects were 34±8.4 ng/mL, the mean SCUBE1 levels of patients with STEMI who were treated successfully with primary percutaneous coronary intervention (PCI) were 51±6.2, and the mean SCUBE1 levels of patients with STEMI who had NR phenomenon after primary PCI procedure were 97.2±8.9 ng/mL.
Conclusion: In our opinion, SCUBE1 might contribute to NR phenomenon via thrombus activation and aggregation. The pathophysiology of NR phenomenon is unclear. The present study is the first clinical study that demonstrated that serum SCUBE1 level was significantly higher in patients with NR and that serum SCUBE1 was an independent predictor for the presence of NR in our study population.

11.Previous cerebrovascular disease is an important predictor of clinical outcomes in elderly patients with percutaneous coronary interventions: The Nobori-Biolimus eluting stent prospective multicenter 1-year observational registry in South Korea
Yong Hoon Kim, Ae- Young Her, Byeong- Keuk Kim, Dong- Ho Shin, Jung- Sun Kim, Young- Guk Ko, Donghoon Choi, Myeong- Ki Hong, Yangsoo Jang
PMID: 28554989  doi: 10.14744/AnatolJCardiol.2017.7670  Pages 128 - 135
Objective: The appropriate selection of elderly patients for revascularization has become increasingly important because these subsets of patients are more likely to experience a major cardiac or cerebrovascular event—percutaneous coronary intervention (PCI). The objective of this study was to determine important independent risk factor for predicting clinical outcomes in the elderly patients after successful PCI, particularly in a series of South Korean population.
Methods: This study is prospective, multicenter, observational cross-sectional study. A total of 1,884 consecutive patients who underwent successful PCI with Nobori® Biolimus A9-eluting stents were enrolled between April 2010 and December 2012. They were divided into two groups according to the age: patients <75 years old (younger patient group) and ≥75 years old (elderly patient group). The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE) at 1-year after index PCI.
Results: The 1-year cumulative incidence of MACCE (12.9% vs. 4.3%, p<0.001) and total death (7.1% vs. 1.5%, p<0.001) was significantly higher in the elderly group than in younger group. Previous cerebrovascular disease was significantly correlated with MACCE in elderly patients 1-year after PCI (hazard ratio, 2.804; 95% confidence interval, 1.290–6.093 p=0.009).
Conclusion: Previous cerebrovascular disease is important independent predictor of the MACCE in elderly patients at 1-year after PCI with Nobori® Biolimus A9-eluting stents especially in a series of South Korean population. Therefore, careful PCI with intensive monitoring and management can improve major clinical outcomes after successful PCI in elderly patients with previous cerebrovascular disease compared with younger patients.

12.Clinical impact and efficacy of bedside echocardiography on patient management in pediatric intensive care units (PICUs): A prospective study
Sanliay Şahin, Mutlu Uysal Yazıcı, Ganime Ayar, Tülin Köksal, İbrahim İlker Çetin, Filiz Ekici, Abdullah Kocabaş
PMID: 28639944  doi: 10.14744/AnatolJCardiol.2017.7659  Pages 136 - 141
Objective: To determine the indication and necessity of echocardiographic assessment and therapeutic interventions in critically ill children.
Methods: A total of 140 children, including 75 mechanically ventilated (MV) and 65 spontaneously breathing (SB) children, who were admitted consecutively from March to August 2013 were evaluated prospectively. Data regarding the indication for echocardiography and therapeutic approaches used were documented. For evaluating disease severity, the Pediatric Risk of Mortality Score III (PRISM) was ascertained. The correlation between PRISM score and the requirement of echocardiographic evaluations were analyzed.
Results: Patients ages were between 45 days to 18 years. The male-to-female ratio was 1.33. In 35.4% patients who underwent echocardiographic evaluation, no definitive alteration occurred in treatment approach, whereas in the remaining 64.6% patients, decisive or supplemental information was gathered. Echocardiography was indicated in 88% MV children and 46.2% SB children. Echocardiographic evaluation was necessary in MV children and there was a positive correlation between the PRISM score and the requirement of echocardiographic assessment (p<0.001).
Conclusion: Echocardiographic evaluation is an invaluable tool especially in MV children and the requirement of echocardiographic assessment increases according to clinical severity. Basic training for intensivists in this procedure is crucial and needs to be improved and supported in critically ill.

13.Vagal denervation in atrial fibrillation ablation: A comprehensive review
Tolga Aksu, Tümer Erdem Güler, Ferit Onur Mutluer, Mehmet Ali Oto
PMID: 28761022  doi: 10.14744/AnatolJCardiol.2017.7788  Pages 142 - 148
Although pulmonary vein isolation is accepted as an established interventional treatment in paroxysmal atrial fibrillation (AF), alternative modalities are being investigated because of the high recurrence rates of nonparoxysmal forms. One of the alternative ablation approaches is ablation or modification of vagal ganglionated plexi (VGP). The technique has not only been used in vagally mediated AF but also investigated in paroxysmal and nonparoxysmal AF. Clinical studies demonstrate significant discrepancy related with detection of VGP sites or ablation targets and definition of procedurel end-points, so far. In this review, we aimed to discuss the current data on the role of VGP in the pathogenesis of AF and potential therapeutic implications of ablation of these ganglia.

14.High-density lipoprotein metabolism and reverse cholesterol transport: strategies for raising HDL cholesterol
Katerina Tosheska Trajkovska, Sonja Topuzovska
PMID: 28766509  doi: 10.14744/AnatolJCardiol.2017.7608  Pages 149 - 154
A key to effective treatment of cardiovascular disease is to understand the body’s complex lipoprotein transport system. Reverse cholesterol transport (RCT) is the process of cholesterol movement from the extrahepatic tissues back to the liver. Lipoproteins containing apoA-I [highdensity lipoprotein (HDL)] are key mediators in RCT, whereas non-high-density lipoproteins (non-HDL, lipoproteins containing apoB) are involved in the lipid delivery pathway. HDL particles are heterogeneous; they differ in proportion of proteins and lipids, size, shape, and charge. HDL heterogeneity is the result of the activity of several factors that assemble and remodel HDL particles in plasma: ATP-binding cassette transporter A1 (ABCA1), lecithin cholesterol acyltransferase (LCAT), cholesteryl ester transfer protein (CETP), hepatic lipase (HL), phospholipid transfer protein (PLTP), endothelial lipase (EL), and scavenger receptor class B type I (SR-BI). The RCT pathway consists of the following steps: 1. Cholesterol efflux from peripheral tissues to plasma, 2. LCAT-mediated esterification of cholesterol and remodeling of HDL particles, 3. direct pathway of HDL cholesterol delivery to the liver, and 4. indirect pathway of HDL cholesterol delivery to the liver via CETP-mediated transfer There are several established strategies for raising HDL cholesterol in humans, such as lifestyle changes; use of drugs including fibrates, statins, and niacin; and new therapeutic approaches. The therapeutic approaches include CETP inhibition, peroxisome proliferator-activated receptor (PPAR) agonists, synthetic farnesoid X receptor agonists, and gene therapy. Results of clinical trials should be awaited before further clinical management of atherosclerotic cardiovascular disease.

15.A fractal physics explanation for acute thrombotic occlusion in an apparently healthy coronary artery
Nicolae Dan Tesloianu, Igor Nedelciuc, Vlad Ghizdovat, Maricel Agop, Corina Lupascu- Ursulescu
PMID: 28766510  doi: 10.14744/AnatolJCardiol.2017.7825  Pages 155 - 157
Abstract | Full Text PDF

16.Unusual cardiac involvement in granulomatosis with polyangiitis manifesting as acute congestive heart failure
Htoo Kyaw, Deepika Misra, Malary M. Mani, Won J. Park, Meir Shinnar
PMID: 28766511  doi: 10.14744/AnatolJCardiol.2017.7732  Pages 158 - 160
Abstract | Full Text PDF

17.Radiofrequency ablation of accessory pathways in a toddler with Ebstein’s anomaly and functional single ventricle physiology
Hasan Candaş Kafalı, İsa Özyılmaz, Serkan Ünal, Alper Güzeltaş, Yakup Ergül
PMID: 28766512  doi: 10.14744/AnatolJCardiol.2017.7597  Pages 160 - 162
Abstract | Full Text PDF

18.Is electrocardiography alone enough to evaluate the right ventricular involvement to predict short-term outcome?
Bernas Altıntaş, Barış Yaylak, Erkan Baysal, Hüseyin Ede
PMID: 28766513  doi: 10.14744/AnatolJCardiol.2017.7894  Page 163
Abstract | Full Text PDF

19.Platelet reactivity unit (PRU) in patients undergoing elective PCI: Rethinking the optimal cut point
Hassan Sharifi, Valiollah Habibi, Amir Emami Zeydi
PMID: 28766514  doi: 10.14744/AnatolJCardiol.2017.7939  Page 164
Abstract | Full Text PDF

20.Impressions from EuroPCR Course 2017
Şevket Görgülü
PMID: 28766515  doi: 10.14744/AnatolJCardiol.2017.7983  Pages 165 - 166
Abstract | Full Text PDF

21.Complete heart block presenting with de Musset’s sign
Semi Öztürk, Gündüz Durmuş, Muhsin Kalyoncuoğlu, Mustafa Sarı, Mehmet Can
PMID: 28766516  doi: 10.14744/AnatolJCardiol.2017.7964  Page E2
Abstract | Full Text PDF | Video

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