Objective: The aim of this study was to investigate the protective effects of aspirin (AS) and vitamin C (VC) against cardiac damage induced by chronic corn syrup (CS) consumption via a mechanism involving sirtuin-1 (ST-1), hypoxia-inducible factor-1α (HIF-1α), and the caspase-3 pathway in rats.
Methods: Forty male Sprague–Dawley rats (14–16 weeks) that weighed 250–300 g were randomly distributed into 5 groups, each containing 8 rats: control group, CS+AS group, CS+VC group, CS+AS+VC group, and CS group. AS (10 mg/kg/day) and VC (200 mg/kg/day) were orally given to the rats. F30 (30% fructose syrup solution) was given to the rats in drinking water for 6 weeks. The rats were sacrificed by exsanguination 24 h after the last administration. Blood samples and tissue were collected for biochemical, histopathological, and immunohistochemical examinations. Non-parametric Kruskal–Wallis test and Mann–Whitney U test used for the parameters without normal distribution and ANOVA and post-hoc LSD tests were used for parameters with a normal distribution to compare groups.
Results: Uric acid, creatine kinase (CKMB), and lactate dehydrogenase (LDH) levels were increased in the CS group compared with the control group (1.45±0.39 and p=0.011; 3225.64±598.25 and p=0.004; 3906.83±1064.22 and p=0.002, respectively) and decreased in all the treatment groups. In addition, increased levels of MDA and decreased activity of CAT in the CS group (0.172±0.03 and p=0.000; 0.070±0.005 and p=0.007, respectively) were reversed with AS and VC therapy. A decrease in ST-1 activity and increases in caspase-3 and HIF-1 activities corrected by VC and AS therapy were observed.
Conclusion: AS and VC, which display antioxidant and antiapoptotic activities, ameliorated cardiac damage induced by chronic fructose consumption by increasing the levels of ST-1 and decreasing the levels of HIF-1α and caspase-3. (Anatol J Cardiol 2016; 16: 648-54)

Objective: Atrial fibrillation (AF) is the most common arrhythmia following coronary artery by-pass graft surgery (CABG). The value of SYNTAX score to predict postoperative atrial fibrillation (PoAF) has not been clearly addressed. We aimed to evaluate this relationship in patients undergoing isolated CABG.
Methods: This study was designed as a single-center, non-randomized, observational, prospective study. Ninety-four patients undergoing isolated on-pump CABG, who had sinus rhythm and were older than 18 years, were enrolled. Demographic characteristics of the patients were recorded; SYNTAX score was calculated preoperatively for each patient. The univariate and multivariate logistic regression analysis were used to determine for predictors of PoAF.
Results: The median SYNTAX score of the enrolled patients was 21, (56–5). PoAF was observed in 31 (33.3%) patients. Univariate logistic regression showed that age, chronic obstructive pulmonary disease (COPD), red blood cell distribution width (RDW), urea, initial troponin I, peak postoperative troponin I, interventricular septum, left atrial diameter, and SYNTAX score were significantly associated with the frequency of PoAF following CABG. An independent association was identified with age [β: 0.088, p: 0.023, OR: 1.092, 95% CI (1.012–1.179)], COPD [(β: 2.222, p: 0.003, OR: 9.228, 95% CI (2.150–39.602)], and SYNTAX score [(β: 0.130, p: 0.002, OR: 1.139, 95% CI (1.050–1.235)].
Conclusion: This study showed that a higher SYNTAX score was related to more frequent PoAF in patients undergoing isolated on-pump CABG. (Anatol J Cardiol 2016; 16: 655-61)

Objective: Previous genome-wide association studies (GWASs) have identified rs6817105—a single nucleotide polymorphism (SNP) on chromosome 4q25—to be associated with the risk of atrial fibrillation (AF) in a European-descent population. We recently demonstrated this association in a large cohort of Japanese ancestry. Our present study was designed to determine this association in the Chinese Han population.
Methods: This case–control study included 597 AF cases and 996 AF-free controls, and rs6817105 SNPs were genotyped using the TaqMan allelic discrimination assay. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated in logistic regression models.
Results: The genotype distribution of rs6817105-CC was significantly more frequent in the AF patients than in the controls (p=3.24×10−32). In our study, logistic regression analysis showed a strong association between rs6817105 and the risk of AF (additive model: OR=2.22, 95%CI=1.89–2.61, p=2.33×10−22; dominant model: OR=2.96, 95%CI: 2.16–4.07, p=2.03×10−11; recessive model: OR=2.83, 95%CI=2.27–3.54, p=4.00×10−20). Stratification analyses showed a borderline statistical difference between subgroups of age for the association of rs6817105 with AF risk (p=0.049). However, further interactive analysis indicated no significant interaction between genotype of rs6817105 and age (p=0.178).
Conclusion: Our finding suggested that SNP rs6817105 may be associated with a high significant risk of AF in the Chinese Han population, although more replicative studies of larger sample size are needed to confirm this finding. (Anatol J Cardiol 2016; 16: 662-6)

Objective: Cigarette smoking increases the risk of cardiovascular events. The heart rate recovery index (HRRI) is an indicator of autonomous nervous system function and is an independent prognostic risk factor for cardiovascular diseases. In this study, we aimed to evaluate HRRI in heavy smokers.
Methods: A total of 179 apparently healthy subjects (67 non-smokers as the control group and 112 heavy smokers) were enrolled into this prospective cross-sectional study. The presence of hypertension, diabetes mellitus, and known cardiac or non-cardiac diseases was specified as the exclusion criteria. Heavy cigarette smoking was defined as the consumption of more than one packet of cigarette per day. All subjects underwent the maximal Bruce treadmill test. HRRIs of the heavy cigarette smoker group at 1, 2, 3, and 5 min after maximal exercise were calculated and compared to those of the control group. Student t-test, chi-square test, and analysis of covariance were used for statistical analysis.
Results: The baseline characteristics of the two groups were similar, except for body mass index and high-density lipoprotein level. HRRIs at 1, 2, 3, and 5 min after maximal exercise were found to be significantly lower in the heavy smoker group (HRRI1: 26.78±8.81 vs. 32.82±10.34, p<0.001; HRRI2: 44.37±12.11 vs. 51.72±12.87, p<0.001; HRRI3: 52.73±11.54 vs. 57.22±13.51, p=0.018; and HRRI5: 58.31±10.90 vs. 62.33±13.02, p=0.029).
Conclusions: In the present study, we found that HRRI was impaired in heavy smokers. Our results suggest that beside previously known untoward effects on vascular biology, heavy smoking also has deleterious effects on the neuro–cardiovascular system. (Anatol J Cardiol 2016; 16: 667-72)

Objective: Rheumatic carditis-induced mitral valve disease is associated with a chronic inflammatory process. The close relationship between inflammation and prothrombotic processes is known. Our goal was to examine the relationship between the presence of left atrial (LA) thrombus in patients with rheumatic mitral valve stenosis (RMVS) and platelet-to-lymphocyte ratio (PLR), which is an inflammatory marker.
Methods: This cross-sectional study included 351 consecutive patients diagnosed with RMVS upon presentation to the cardiology polyclinic. All patients were evaluated using transthoracic and transesophageal echocardiography and were divided into 2 groups: those with and without LA thrombus. In addition to echocardiographic and biochemical parameters, PLR was compared between the groups. Student’s t-test, Mann–Whitney U test, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were used for statistical analysis.
Results: No significant differences in terms of age, gender, body mass index, and comorbidities were found between the groups with and without LA thrombus. In the group with LA thrombus, higher red cell distribution width, mean platelet volume, and platelet count and lower lymphocyte count were detected. In addition, C-reactive protein levels were significantly higher in the LA thrombus group (4.7 vs. 2.7 mg/L, p<0.001). PLR was significantly higher in patients with thrombus than in those without (133±38 vs. 119±31, p=0.001). Higher PLR was identified as independently associated with the presence of LA thrombus (odds ratio: 1.03, 95% confidence interval: 1–1.06, p=0.016).
Conclusion: Higher PLR was detected in the LA thrombus group of patients with RMVS. (Anatol J Cardiol 2016; 16: 673-7)

Objectives: Right ventricular (RV) pacing induces a left bundle branch block pattern on ECG and may promote heart failure. Patients with dual chamber pacemakers (DCPs) who present with progressive reduction in left ventricular ejection fraction (LVEF) secondary to RV pacing are candidates for cardiac resynchronization therapy (CRT). This study analyzes whether upgrading DCP to CRT with the additional implantation of a left ventricular (LV) lead improves LV function in patients with reduced LVEF following DCP implantation.
Methods: Twenty-two patients (13 males) implanted with DCPs and a high RV pacing percentage (>90%) were evaluated in term of new-onset heart failure symptoms. The patients were enrolled in this retrospective single-center study after obvious causes for a reduced LVEF were excluded with echocardiography and coronary angiography. In all patients, DCPs were then upgraded to biventricular devices. LVEF was analyzed with a two-sided t-test. QRS duration and brain natriuretic peptide (BNP) levels were analyzed with the unpaired t-test.
Results: LVEF declined after DCP implantation from 54±10% to 31±7%, and the mean QRS duration was 161±20 ms during RV pacing. NT-pro BNP levels were elevated (3365±11436 pmol/L). After upgrading to a biventricular device, a biventricular pacing percentage of 98.1±2% was achieved. QRS duration decreased to 108±16 ms and 106±20 ms after 1 and 6 months, respectively. There was a significant increase in LVEF to 38±8% and 41±11% and a decrease in NT-pro BNP levels to 3088±2326 pmol/L and 1860±1838 pmol/L at 1 and 6 months, respectively.
Conclusion: Upgrading to CRT may be beneficial in patients with DCPs and heart failure induced by a high RV pacing percentage. (Anatol J Cardiol 2016; 16: 678-83)

Objective: Despite premedication, anxiety in patients undergoing transesophageal echocardiography (TEE) is prevalent, often causing adverse physiological and psychological effects and contributing to decreased patient compliance. We aimed to evaluate the feasibility of cognitive–behavioral intervention (CBI) in patients undergoing TEE and to assess its impact on the severity of anxiety, patient’s and physician’s comfort, and administered dose of sedatives.
Methods: Our study was designed as a prospective, single-center, single-blinded, case-controlled pilot study. The study group comprised 49 patients (26 men, 66±8 years old) referred for TEE. Before the examination, 26 randomly selected patients underwent CBI. Sedatives were administered, if necessary. After the examination, patient anxiety and patient’s and physician’s comfort were evaluated using dedicated questionnaires and scores. Intergroup comparison was performed using Student’s t-test for independent variables and Mann–Whitney U test and Pearson’s chi-square test or Fisher’s exact test for categorical variables.
Results: The mean level of pre-TEE distress and anxiety were significantly lower in patients receiving CBI than in those without intervention (p=0.022). Furthermore, the application of CBI significantly reduced patient’s discomfort (p<0.001) and resulted in increased comfort of physician (p<0.001) during TEE. The need of sedative administration (31% vs. 91%, p<0.001) and its mean dose was significantly lower in patients receiving CBI (1.6±0.5 mg vs. 2.7±1.6 mg midazolam, p=0.009).
Conclusions: CBI is feasible in patients undergoing TEE. It decreases patient’s anxiety and discomfort and increases physician’s comfort. It also results in reduced use of sedatives during the examination. (Anatol J Cardiol 2016; 16 684-8)

Objective: Antioxidants play a major role in the cellular protection cascade against oxidative damage. Oxidative stress has been linked to the pathogenesis of coronary atherosclerosis. Our aim was to evaluate the association between calculated serum total antioxidant status (cTAS) and the presence and severity of coronary artery disease (CAD).
Methods: One hundred and seventy-four patients with angiographically documented significant (≥50%) luminal stenosis (n=123) or with minimal (<50%) luminal stenosis (n=51) in at least one coronary artery or major branch segment in the epicardial coronary tree were categorized as CAD+ group; 88 patients with no luminal stenosis were considered as the control group. The level of cTAS (mmol/L) was evaluated using the following equation: (0.63×albumin concentration)+(1.02×uric acid concentration)+(1.53×bilirubin concentration).
Results: In univariate analyses, mean levels of cTAS, uric acid, and creatinine were significantly higher in CAD+ group than in controls. However, adjusted cTAS level was not found to be a CAD predictor in the total population [odds ratio (OR)=1.20; 95% confidence interval (CI): 0.81–1.76;p=0.364] or in men (OR=1.25; 95% CI: 0.73–2.12; p=0.420) and women (OR=1.20; 95% CI: 0.66–2.19; p=0.553). A weak but statistically significant correlation was found between cTAS and Gensini score (Spearman’s ρ=0.16, p=0.015).
Conclusion: In patients with suspicious CAD, the level of cTAS was not found to be an independent predictor for the presence of CAD. Further studies with larger sample size are required to confirm the results. (Anatol J Cardiol 2016; 16: 689-95)

Objective: Percutaneous coronary intervention (PCI) for the heavily calcified coronary lesions remains a challenge, and the periprocedural complication rates of the transfemoral approach are high. This study was conducted to investigate the feasibility and long-term results of the transradial approach for rotational atherectomy (RA) prior to stent implantation via the transradial approach in patients with heavily calcified coronary artery lesions.
Methods: RA followed by stent implantation via the transradial approach was performed in 47 patients with severely calcified coronary artery lesions in this retrospectively case-control study. The success rate of the procedure and the 3-year follow-up (36±7.5 months) results were analyzed.
Results: RA with subsequent stent implantation or balloon angioplasty procedures were successfully performed in all cases. 6F guiding catheters were used in 45 cases, and 7F catheters were used in 2 patients. Rotablation was performed with a 1.25-mm burr in 29 cases, a 1.25-mm burr followed by a 1.5-mm burr in 17 patients, and a 1.75-mm burr in 1 patient. Percutaneous transluminal coronary angioplasty after RA was performed, followed by stent implantation in all 47 patients. Restenosis was found in 7 cases (7/38) at 13 months (13±3.6) and in 13 cases (13/28) at 36 months (36±7.5) after the procedure; 3 patients died during the 3-year follow-up. The post-procedure cumulative 3-year event-free survival rate was 78%.
Conclusion: RA prior to stent implantation via the transradial approach is feasible and safe, the success rate is high, and long-term outcome is satisfactory in patients with heavily calcified lesions of the coronary artery. (Anatol J Cardiol 2016; 16: 696-700)

Objective: Syncope is a common problem in children and adolescents. Neurally mediated syncope is the most frequent form of this disorder. Although several studies have evaluated the pathophysiology of neurally mediated syncope, it is still not completely understood.
Methods: We performed a cross-sectional study that included 27 patients aged 5–20 years with unexplained syncope and 30 healthy subjects as a control group. All subjects in both groups were assessed for endothelial function by investigating the following physical and chemical factors: flowmediated dilation (FMD), intima-media thickness (IMT), circulating vascular cell adhesion molecule (VCAM), intercellular adhesion molecule (ICAM)], and endothelial leucocyte adhesion molecule (E-selectin), as well as epinephrine and norepinephrine. The data were statistically analyzed utilizing the SPSS 20.Significant differences between the groups in terms of mean scores were assessed using an independent sample t-test.
Results: Mean FMD was significantly higher in the syncope case group than in the control group (p=0.028). There was no significant difference in IMT between the two groups; however, mean levels of ICAM (p=0.02) and VCAM (p=0.008) were significantly higher in the case group than in the control group. The levels of E-selectin also increased in the case group, but not to a statistically significant extent. The mean levels of epinephrine (p=0.01) were significantly lower in the case group than in the control group, and the level of norepinephrine serum decreased slightly, but not significantly, in the syncope patients.
Conclusion: Our results showed that an endothelial dysfunction or augmented endothelial function might exist in patients with neurally mediated syncope. (Anatol J Cardiol 2016; 16: 701-6)

Septal reduction therapy is accepted as a first therapeutic option for symptomatic drug-resistant hypertrophic obstructive cardiomyopathy (HOCM). Although, surgical septal myectomy is the gold standard method, alcohol septal ablation is a well-studied alternative approach in the patients with suitable anatomy. Endocardial septal ablation (ESA) therapy was relatively new defined modality and outcomes of the procedure were not clearly elucidated yet. We aimed to review the clinical aspects of ESA procedure and provide some historical background. (Anatol J Cardiol 2016; 16: 707-12)

High blood pressure (BP) has been identified as a major risk factor for cardiovascular complications. Although two-way association between BP and hypertensive complications makes hypertension a near-ideal biomarker, BP as “the cause” for the complications of HT per se still needs more evidence. Another entirely possible hemodynamic candidate for causing hypertensive cardiovascular adverse events can be flow or its iterations, which might have escaped the attention because of its perfect correlation with pressure and harder technical measurement. In this article, we analyze the evidence in hand to compare flow- and pressure-related phenomena to delineate which of the two is the dominant mediator of complications related to hypertension and should be the target for therapy. A “flow-” rather than a “pressure-” based factor, as the causative or major driving mediator of common hypertensive complications, may change our understanding of hypertension pathophysiology. (Anatol J Cardiol 2016; 16: 713-9)

Cardiac computed tomography (CT) is most commonly performed for the evaluation of the coronary arteries; however, non-coronary cardiac pathologies are frequently detected on these scans. In cases where magnetic resonance imaging cannot be used, cardiac CT can serve as the first-line imaging modality to evaluate many non-coronary cardiac pathologies. In this article, we discuss congenital non-coronary abnormalities of the left heart and their cardiac CT imaging features. (Anatol J Cardiol 2016; 16: 720-7)

Acute aortic syndromes (AAS) are life-threatening conditions, and despite advances in imaging techniques, their diagnosis and treatment remain challenging. While intramural hematoma is much less common than acute aortic dissection (AD), which is the most common form of AAS, they have similar mortality rates (1). On the other hand, aortitis may mimic intramural hematoma (IMH) due to radiologic similarity and, thus, may lead to misdiagnosis and treatment.
Here, we describe an IgG4-related aortitis case mimicking intramural hematoma (IMH) due to radiologic image and presenting with chest pain and severe aortic regurgitation.