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Anatol J Cardiol: 19 (5)
Volume: 19  Issue: 5 - May 2018
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1.A new study protocol for heart failure in Turkey (APOLLON) and the others…
Çetin Erol
PMID: 29724982  doi: 10.14744/AnatolJCardiol.2018.93276  Page 295
Abstract | Full Text PDF

2.Catalpol pretreatment attenuates cardiac dysfunction following myocardial infarction in rats
Fangjie Bi, Yujia Xu, Quansan Sun
PMID: 29724983  doi: 10.14744/AnatolJCardiol.2018.33230  Pages 296 - 302
Objective: To investigate the effects and mechanisms of catalpol on cardiac function in rats with isoproterenol (ISO)-induced myocardial infarction (MI).
Methods: Adult male Wistar rats were divided into four groups: control group, ISO group, catalpol (L, low dose) group, and catalpol (H, high dose) group. Isoproterenol (85 mg/kg) was injected subcutaneously for 2 consecutive days to induce experimental MI. At the end of experiment, the effects of catalpol on cardiac function; apelin levels; apoptosis index; apelin, APJ, Bcl-2, and Bax protein expression; and caspase-3/9 activities were investigated.
Results: The rats in the ISO group showed lower left ventricular maximum rate of positive or negative pressure development (±LVdp/dtmax) and left ventricular end-systolic pressure (LVSP) and higher left ventricular end-diastolic pressure (LVEDP) than those in the control group, suggesting severe cardiac dysfunction. Interestingly, catalpol administration significantly ameliorated the ISO-induced cardiac dysfunction. The groups administered low and high dosages catalpol (5 and 10 mg/kg/day, respectively) showed higher ±LVdp/dtmax and LVSP and lower LVEDP than the group administered ISO alone. Catalpol markedly upregulated apelin levels in the plasma and myocardium. Further, catalpol increased the apelin and APJ expression levels in the myocardium of the ISO-treated rats. In addition, catalpol pretreatment inhibited cardiomyocyte apoptosis as indicated by a decrease in the TUNEL-positive cell percentage, alterations in the Bax and Bcl-2 expression levels, and a decline in caspase-3 and caspase-9 activities.
Conclusion: Our results revealed that catalpol can improve cardiac function. Its protective effects may be linked to the enhancement of myocardium contractility, regulation of the apelin/APJ pathway, and inhibition of cardiomyocyte apoptosis.

3.Increased microvolt T-wave alternans in children and adolescents with Eisenmenger syndrome
Derya Karpuz, Olgu Hallıoğlu, Dilek Çiçek Yılmaz
PMID: 29638226  doi: 10.14744/AnatolJCardiol.2018.60487  Pages 303 - 310
Objective: To determine the values of microvolt T-wave alternans (MTWA) in children and adolescents with Eisenmenger syndrome (ES) and controls.
Methods: Thirteen were included in the study. After analyzing the 24-h ECG recordings, MTWA was considered using three leads (V5, V1, and aVF). Right heart catheterization and 6-minute walk test (6-MWD) were applied to the patients and pro-brain natriuretic peptide levels were assessed; echocardiographic parameters were obtained from both the groups and the results were compared.
Results: The MTWA value in lead V5 was 81.08±10.73 μV in the patient group (63.50±18.78 μV in the control group), in lead V1 was 75.00±16.86 μV (73.94±16.77 μV in the control group), and in lead aVF was 73.77±17.81 μV (72.61±16.21 μV in the control group). Comparison of MTWA values between patients and controls revealed that only lead V5 values were statistically different in the ES group. The 6-MWD scores significantly correlated with lead V5. Right atrial volume and right ventricular fractional area change were significantly correlated with lead V1. The Tei index was significantly correlated with lead aVF.
Conclusion: The MTWA lead V5 value was significantly higher in children with ES than in controls and was also correlated with decreased exercise tolerance.

4.Rationale, Design, and Methodology of the APOLLON trial: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejectiON fraction
Bülent Özlek, Eda Özlek, Oğuzhan Çelik, Cem Çil, Volkan Doğan, Mehmet Tekinalp, Hicaz Zencirkıran Ağuş, Serkan Kahraman, Altuğ Ösken, Ibrahim Rencüzoğulları, Veysel Ozan Tanık, Lütfü Bekar, Mustafa Ozan Çakır, Bedri Caner Kaya, Hakan Tibilli, Yunus Çelik, Özcan Başaran, Kadir Uğur Mert, Samet Sevinç, Erkan Demirci, Engin Dondurmacı, Murat Biteker
PMID: 29724973  doi: 10.14744/AnatolJCardiol.2018.95595  Pages 311 - 318
Objective: Although almost half of chronic heart failure (HF) patients have mid-range (HFmrEF) and preserved left-ventricular ejection fraction (HFpEF), no studies have been carried out with these patients in our country. This study aims to determine the demographic characteristics and current status of the clinical background of HFmrEF and HFpEF patients in a multicenter trial.
Methods: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejectiON fraction (APOLLON) trial will be an observational, multicenter, and noninterventional study conducted in Turkey. The study population will include 1065 patients from 12 sites in Turkey. All data will be collected at one point in time and the current clinical practice will be evaluated ( number NCT03026114).
Results: We will enroll all consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had New York Heart Association class II, III, or IV HF, elevated brain natriuretic peptide levels within the last 30 days, and an left ventricular ejection fraction (LVEF) of at least 40%. Patients fulfilling the exclusion criteria will not be included in the study. Patients will be stratified into two categories according to LVEF: mid-range EF (HFmrEF, LVEF 40%-49%) and preserved EF (HFpEF, LVEF ≥50%). Regional quota sampling will be performed to ensure that the sample was representative of the Turkish population. Demographic, lifestyle, medical, and therapeutic data will be collected by this specific survey.
Conclusion: The APOLLON trial will be the largest and most comprehensive study in Turkey evaluating HF patients with a LVEF ≥40% and will also be the first study to specifically analyze the recently designated HFmrEF category.

5.Comparison of the transradial and transfemoral approach in treatment of chronic total occlusions with similar lesion characteristics
Mustafa Ahmet Huyut, Aylin Hatice Yamaç
PMID: 29724974  doi: 10.14744/AnatolJCardiol.2018.02779  Pages 319 - 325
Objective: There is limited data on the efficacy and the safety of the transradial approach (TRA) for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), particularly in comparison with the transfemoral approach (TFA) in lesions with similar complexity.
Methods: We included 358 patients, who underwent elective CTO PCI between January 2012 and August 2017 and compared the radial (179 patients) and femoral (179 patients) approaches. The J-CTO score was similar in both groups (TRA, 2.5±1.3 vs. TFA, 2.8±1.4, n.s.). The endpoints analyzed included (i) the composite of all-cause death and nonfatal myocardial infarction (MI) and (ii) the composite safety endpoint of major adverse cardiovascular and cerebrovascular events (MACCEs), including death, MI, coronary perforation, contrast-induced nephropathy (CIN), bleeding at the vascular access site requiring transfusion, cardiac tamponade requiring pericardiocentesis, and periprocedural stroke.
Results: Patients’ demographics, lesion location, lesion characteristics, and the proportion of antegrade vs. retrograde approach were similar in both groups. The procedural success rate of 96.4% in the radial group and 92.9% in the femoral group was comparable. The total fluoroscopy time (TRA, 42.4±15.7 min vs. TFA, 40.5±15.3 min, n.s.) and contrast medium use (TRA, 532.2±21.7 mL vs. TFA, 528.2±24.6 mL, n.s.) was similar in both groups. There was no in-hospital death or periprocedural MI in both groups. There were three coronary perforations in the TFA group, among them one with tamponade, and one coronary perforation the TRA group. Vascular access site complications (TRA, 0.01% vs. TFA, 0.02%) and CIN (TRA, 0.006% vs. TFA, 0.006%) were rare. One stroke as a result of the procedure was observed in the TFA group. No death was registered.
Conclusion: The radial approach in CTO PCI was as fast and successful as the femoral approach, even in a complex lesion subset.

6.Long-term consumption of energy drinks induces biochemical and ultrastructural alterations in the heart muscle
Camelia Munteanu, Corina Rosioru, Corneliu Tarba, Camelia Lang
PMID: 29724975  doi: 10.14744/AnatolJCardiol.2018.90094  Pages 326 - 333
Objective: Energy drinks (EDs) target young and active individuals and they are being marketed as enhancers of energy, concentration, and physical and cognitive performance. Their long-term consumption raises serious health concerns related to cardiovascular events. Here we investigate the effects of long-term Red Bull® consumption and its combination with alcohol on certain biochemical parameters and the ultrastructure of the myocardium.
Methods: Male Wistar rats were categorized into four groups and given different treatments via oral administration. The Control (C) group received tap water, the Red Bull (RB) group received 1.5 ml/100 g body weight of Red Bull, the ethanol group (E) received 0.486 mg/100 g body weight of ethanol, and the Red Bull and ethanol (RBE) received a combination of the two beverages for 30 days. In the last 6 days of the experiment, the animals were tested for their physical performance by conducting a weight-loaded forced swim test. Immediately after swimming exhaustion, the animals were sacrificed under anesthesia and samples of the heart muscle were harvested for ultrastructural and biochemical analyses.
Results: Our results showed a significant increase in the heart glucose and glycogen concentrations in the RB and RBE groups. Total cholesterol concentration significantly decreased in the RBE and RB groups. Total protein concentration and ALT and AST activities increased in all groups. The biochemical changes were accompanied by ultrastructural alterations.
Conclusion: Based on these results, we recommend that athletes and active persons should avoid the long-term consumption of the Red Bull ED and, particularly, its combination with alcohol.

7.Case-control study on PCSK9 R496W (rs374603772) and D374Y (rs137852912) mutations in Turkish patients with primary dyslipidemia
Zuhal Eroğlu, Aslı Tetik Vardarlı, Zekeriya Düzgün, Cumhur Gündüz, Vildan Bozok Çetintaş, Meral Kayıkçıoğlu
PMID: 29724976  doi: 10.14744/AnatolJCardiol.2018.86648  Pages 334 - 340
Objective: The aim of this study was to investigate the relationships between F216L (rs28942112), R496W (rs374603772), S127R (rs28942111), and D374Y (rs137852912) PCSK9 gain-of-function (GOF) mutations and primary dyslipidemia and serum lipid levels in patients with primary dyslipidemia.
Methods: In this case-control study, DNA was isolated from blood samples collected from patients diagnosed with primary dyslipidemia in cardiology outpatient clinic of Ege University (n=200) and healthy individuals (n=201). F216L, R496W, S127R, and D374Y GOF mutations in the PCSK9 gene were evaluated and genotyped according to the results of melting curve analysis performed in a real-time polymerase chain reaction (PCR) 480 instrument using specific primers for each mutation.
Results: There were statistically significant differences between the patient and individuals in control groups in the R496W and D374Y mutations (χ2=10.742 p=0.005; χ2=6.078 p=0.048, respectively). In addition, triglyceride levels in patients with primary dyslipidemia heterozygous for R496W and D374Y mutations were 12.8-fold (p=0.015) and 3.4-fold (p=0.03) higher than that in mutant and wild-type genotype, respectively. Additionally, in the entire study group (n=401), PCSK9 R496W and D374Y mutation carriers had increased total cholesterol (p=0.021), triglycerides (p=0.0001), HDL cholesterol (p=0.028), and low-density lipoproteins (LDL) cholesterol (p=0.028) levels. However, F216L (rs28942112) and S127R (rs28942111) mutations were not detected in patients with primary dyslipidemia and healthy controls.
Conclusion: We conclude that the PCSK9 R496W (rs374603772) and D374Y (rs137852912) GOF mutations may be significant risk factors in the development of primary dyslipidemia and may have significant impact on lipid parameters in general population.

8.First successful percutaneous treatment of a totally occluded HeartWare outflow graft: Case report and literature review
Cemal Kemaloğlu, Refik Emre Altekin, Ömer Bayezid
PMID: 29724977  doi: 10.14744/AnatolJCardiol.2018.76736  Pages 341 - 345
As the number of implanted left ventricular assist devices (LVADs) used increases, the frequency of chronic complications encountered also increases. The pause of blood flow in the outflow graft is a rare, but fatal, complication. The aim of this article was to present the case of a patient in whom HeartWare outflow graft occlusion was removed by balloon angioplasty and to examine the treatment modalities of HeartWare outflow graft occlusions that have been percutaneously performed to date. The literature was searched for percutaneous interventions on outflow grafts of the left ventricular assist devices. The results of six patients who underwent interventions on outflow grafts were analyzed. Three of six patients with HeartWare outflow graft stenosis were treated with covered stents, while the remaining three were treated with bare metal stents. All procedures were applied successfully. Percutaneous interventions can be performed with appropriate equipment in patients with HeartWare outflow graft stenosis or total occlusion.

9.Role of no reflow and microvascular obstruction in the prognostic stratification of STEMI patients
Alessandro Durante
PMID: 29537970  doi: 10.14744/AnatolJCardiol.2018.62343  Pages 346 - 349
Effective reperfusion of ischemic myocardium is the final aim of both pharmacological and mechanical reperfusive strategies in patients with
ST-segment elevation myocardial infarction. More effective reperfusion is related to better prognosis. In contrast, ineffective reperfusion (no
reflow) has been showed to be related to an increased rate of adverse events in the flow-up. Several techniques can be used to assess the effectiveness of reperfusion, and the evolved over the last decades according to the treatment methods but also to technological advancements. ST-segment resolution represented the only way to assess reperfusion in the era of pharmacological treatment. Later, angiographic assessment became the gold standard to assess reperfusion after primary percutaneous coronary intervention. In the last years, cardiac magnetic resonance showed improved accuracy and prognostic stratification ability compared with angiography. However, in clinical practice, coronary angiographic still remains the more widely used assessment technique for no reflow.

10.Atypical presentation of moyamoya disease with pulmonary hypertension: A case report
Mete Han Kızılkaya, Fahrettin Uysal, Emre Gürbüz, Mevlüt Özgür Taşkapılıoğlu, Özlem Mehtap Bostan
PMID: 29724978  doi: 10.14744/AnatolJCardiol.2018.65642  Pages 350 - 351
Abstract | Full Text PDF

11.Unexpected complication during transcatheter aortic valve replacement: Balloon that cannot inflate!
Nermin Bayar, Isa Öner Yüksel, Selçuk Küçükseymen, Şakir Arslan
PMID: 29537972  doi: 10.14744/AnatolJCardiol.2018.02170  Pages 351 - 353
Abstract | Full Text PDF | Video

12.A different approach to multilayer flow modulator implantation in aortic aneurysm
Cengiz Ovalı, Mustafa Behçet Sevin
PMID: 29638223  doi: 10.14744/AnatolJCardiol.2018.49274  Pages 353 - 356
Abstract | Full Text PDF

13.QRS narrowing and prediction of res-ponse to cardiac resynchronization therapy
Fatih Mehmet Uçar
PMID: 29724979  doi: 10.14744/AnatolJCardiol.2018.50146  Page 357
Abstract | Full Text PDF

14.Author`s Reply
Abdulcebbar Şipal, Serdar Bozyel, Müjdat Aktaş, Emir Derviş, Tayyar Akbulut, Onur Argan, Umut Çelikyurt, Dilek Ural, Tayfun Şahin, Ayşen Ağır, Ahmet Vural
PMID: 29724980  Pages 357 - 358
Abstract | Full Text PDF

15.Milking-like effect in the left anterior descending artery secondary to systolic expansion of a post-infarction left ventricular aneurysm
Veysel Tosun, Necmettin Korucuk, Ünal Güntekin
PMID: 29638224  doi: 10.14744/AnatolJCardiol.2018.98598  Page E8
Abstract | Full Text PDF | Video

16.Uncommon right ventricular mass: Ectopic thyroid
Yutian Sun, Jing Wang, Dianbo Cao
PMID: 29724981  doi: 10.14744/AnatolJCardiol.2018.83792  Pages E8 - E9
Abstract | Full Text PDF

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