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The Anatolian Journal of Cardiology - Anatol J Cardiol: 12 (7)
Volume: 12  Issue: 7 - November 2012
EDITORIAL
1.Globalization of Health Policies; JCR SCI-E 2011 report is a source of happiness
Bilgin Timuralp
PMID: 23096242  doi: 10.5152/akd.2012.249  Page 542
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
2.Hyperglycemia aggravates atrial interstitial fibrosis, ionic remodeling and vulnerability to atrial fibrillation in diabetic rabbits
Changle Liu, Huaying Fu, Jian Li, Wansong Yang, Lijun Cheng, Tong Liu, Guangping Li
PMID: 22877897  doi: 10.5152/akd.2012.188  Pages 543 - 550
Objective: The purpose of this study was to investigate the effects of hyperglycemia on atrial interstitial fibrosis, ionic remodeling and vulnerability to atrial fibrillation (AF) in alloxan-induced diabetic rabbits. Methods: Sixty Japanese rabbits were randomly assigned to alloxan-induced diabetic group (n=30) and control group (n=30). Ten rabbits in each group were respectively used to electrophysiological and histological study, patch-clamp study and Western blotting analysis. Langendorff perfusion was used to record inter-atrial conduction time (IACT), atrial effective refractory period (AERP) and dispersion (AERPD) and vulnerability to AF. Histological study was measured by Sirius-red stain. Patch-clamp technique was used to measure action potential duration (APD) and atrial ionic currents (INa and ICaL). Western blotting was applied to assess atrial protein expression of transforming growth factor beta 1 (TGFβ1). Results: Compared with control group, electrophysiological studies showed IACT was prolonged (37.91±6.81 vs. 27.43±1.63ms, p<0.01), AERPD was increased (30.37±8.33 vs. 14.70±5.16ms, p<0.01) in diabetic group. Inducibility of AF in diabetic group was significantly higher than in controls (8/10 vs. 1/10 of animals, p<0.01). Collagen volume fraction was increased (6.20±0.64% vs. 2.15±0.21%, p<0.01) in diabetic group. Patch-clamp studies demonstrated APD90 and APD50 were prolonged in diabetic rabbits (p<0.05 vs. control). The densities of INa were reduced and the densities of ICaL were increased (p<0.01 vs. control). Protein expression of TGFβ1 was increased in diabetic group (p<0.001 vs. control). Conclusion: Our study suggests that hyperglycemia contributes to atrial interstitial fibrosis, ionic remodeling and vulnerability to AF in diabetic rabbits, resulting in atrial structural remodeling and electrical remodeling for the development and perpetuation of AF.

EDITORIAL COMMENT
3.Hyperglycemia and atrial fibrillation: new clinical information on electrophysiological changes
Hasan Güngör, Fatih Çam, Ufuk Eryılmaz
PMID: 22877898  doi: 10.5152/akd.2012.189  Pages 551 - 552
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
4.New fully automated software for assessment of brachial artery flow- mediated dilation with advantages of continuous measurement
Ertuğrul Ercan, Bahadır Kırılmaz, İsmail Kahraman, Vildan Bayram, Hüseyin Doğan
PMID: 22877899  doi: 10.5152/akd.2012.190  Pages 553 - 559
Objective: Flow-mediated dilation (FMD) is used to evaluate endothelial functions. Computer-assisted analysis utilizing edge detection permits continuous measurements along the vessel wall. We have developed a new fully automated software program to allow accurate and reproducible measurement. Methods: FMD has been measured and analyzed in 18 coronary artery disease (CAD) patients and 17 controls both by manually and by the software developed (computer supported) methods. The agreement between methods was assessed by Bland-Altman analysis. Results: The mean age, body mass index and cardiovascular risk factors were higher in CAD group. Automated FMD% measurement for the control subjects was 18.3±8.5 and 6.8±6.5 for the CAD group (p=0.0001). The intraobserver and interobserver correlation for automated measurement was high (r=0.974, r=0.981, r=0.937, r=0.918, respectively). Manual FMD% at 60th second was correlated with automated FMD % (r=0.471, p=0.004). Conclusions: The new fully automated software© can be used to precise measurement of FMD with low intra- and interobserver variability than manual assessment.

5.Effect of overnight nasal continuous positive airway pressure treatment on the endothelial function in patients with obstructive sleep apnea
Murat Tulmaç, Emine Tireli, Haksun Ebinç, Vedat Şimşek, Mehmet Tolga Doğru, Nesligül Yıldırım, Üçler Kısa, Mehmet Savaş Ekici
PMID: 22804976  doi: 10.5152/akd.2012.181  Pages 560 - 565
Objective: In this prospective study, we aimed to investigate acute effect of nasal continuous positive airway pressure (CPAP) therapy on the endothelial function of patients with obstructive sleep apnea syndrome (OSA) by using brachial artery flow mediated dilatation (FMD) method. Methods: Newly diagnosed thirty OSA patients with ages between 29 and 72 years were included in this study. FMD and high sensitivity C-reactive protein (hsCRP) values of patients obtained before and after CPAP dose titration test were compared with paired samples t test or Wilcoxon signed ranks test. Results: With CPAP therapy apnea hypopnea indices were reduced (60.6±24.9/h vs. 9.6±7.9/h; p<0.001) and oxygen desaturation indices recovered (50±27/h vs. 6±7/h; p<0.001). Heart rates of patients decreased after CPAP therapy (80±10/min vs. 73±8/min; p=0.003). FMD values significantly increased after CPAP (8.55±5.82 percent vs. 12.08±7.17 percent; p=0.003). HsCRP values after CPAP were not different from baseline values Conclusion: Acute improvement of the endothelial function with one night CPAP therapy suggests endothelial dysfunction in OSA patients to be result of acute pathophysiologic factors. In intermediate and severe OSA patients, CPAP therapy may be considered in acute treatment of diseases associated with endothelial dysfunction.

EDITORIAL COMMENT
6.Effect of one night nasal continuous positive airway pressure treatment on the endothelial function in patients with obstructive sleep apnea
Ralph J. Panos
PMID: 22804977  doi: 10.5152/akd.2012.182  Pages 566 - 567
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
7.Association of aortic flow propagation velocity with ankle-brachial blood pressure index in patients with hypertension: an observational study
Ahmet Güneş, Ünal Güntekin, Sema Yıldız, Bedri Caner Kaya, Ethem Deveci, Zekeriya Kaya, Yusuf Sezen
PMID: 22877895  doi: 10.5152/akd.2012.186  Pages 568 - 573
Objective: Endothelial dysfunction is considered the first stage in the development of atherosclerosis and assessed by flow-mediated dilatation (FMD) and aortic flow velocity propagation (AVP). Ankle-brachial index (ABI) is used to assess peripheral arterial disease and is associated with FMD but the relationship between ABI and AVP is unknown. In this study, we aimed to search the association between AVP, and ABI in patients with newly diagnosed hypertension. Methods: Sixty-eight patients with newly diagnosed hypertension and 34 healthy subjects were enrolled in the cross-sectional observational study. The maximum ankle arterial pres-sures were divided by the maximum of the brachial arterial pressures to calculate the ABI. AVP was calculated from dividing the distance between points corresponding to the begin-ning and end of the propagation slope, to the duration between corresponding time points proximally descending aorta. Statistical analysis was performed using Student t-test, Chi-square test, Pearson correlation and linear regression analyses. Results: Age and gender of both groups were similar. Compared to control group E decelera-tion time of early diastolic flow velocity (184.0±32.2 vs. 217.1±38.6, p<0.001), isovolumic relaxation time (95.5±19.4 vs. 105.7±18.1, p<0.001) and body mass index (25.6±5.1 vs. 27.5±3.8, p=0.044) values were significantly higher, while ABI (1.08±0.07 vs. 1.14±0.07, p=0.001) and AVP (54.97±9.3 vs. 69.17±10.8 cm/sec, p=0.001) values were significantly lower in hypertensive patients. There was a significant correlation between AVP and ABI (r=0.279, p=0.005). Both ABI and AVP were independent predictors of hypertension (OR - 0.353, 95%CI 0.151-0.826, p=0.02 and OR - 0.133, 95%CI 0.0502-0.35, p=0.001, respectively). Conclusion: Our data indicate that in patients with isolated hypertension AVP and ABI decrease. We also conclude that AVP is directly associated with ABI.

EDITORIAL COMMENT
8.Aortic flow propagation velocity in the assessment of arterial stiffness
Ángel García- García
PMID: 22804978  doi: 10.5152/akd.2012.183  Pages 574 - 575
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
9.Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery
Mustafa Çetin, Sinan Altan Kocaman, Turan Erdoğan, Murtaza Emre Durakoğlugil, Yüksel Çiçek, Şahin Bozok, Aytun Çanga, Ahmet Temiz, Sıtkı Doğan, Ömer Şatıroğlu
PMID: 22804979  doi: 10.5152/akd.2012.184  Pages 576 - 583
Objective: Fragmented QRS complexes (fQRS) are defined as various RSR′ patterns in 2 contiguous leads corresponding to a major coronary artery territory. Although the reason of association between fQRS and cardiac events was documented as cardiac fibrosis, the predictive role of fQRS was not studied for postoperative atrial fibrillation (POAF) which is a frequent and serious complication in patients undergoing isolated coronary artery bypass graft (CABG) surgery. Therefore, this issue was investigated in the present study. Methods: The current study has a prospective observational design. Two hundred and seventy two eligible patients who underwent isolated CABG surgery were enrolled consecutively. The patients were divided in two groups with post-op atrial fibrillation (AF) and non-AF. The occurrence of new-onset AF following CABG and the relationship with fQRS were searched. The logistic regression analysis was used to determine independent predictors for POAF. The sensitivity and specificity of study variables in predicting POAF were calculated using a receiver-operating characteristic curve (ROC). Results: POAF occurred in 62 of 272 patients (22.8%). Patients with POAF were generally older (p<0.001) and female (p=0.006), with preexisting hypertension (p=0.008), lower hemoglobin levels (p=0.011), chronic obstructive lung disease (p=0.003), prolonged QRS time (p=0.004), and higher EUROSCORE (p<0.001) compared to non-AF patients. Patients with POAF had lower left ventricular ejection fraction (p<0.001) and high fQRS rate (p<0.001), but similar left atrial size (LA, p=NS). Interestingly, LA size was significantly enlarged in patients with fQRS (3.8±0.6 vs. 4.1±0.5 cm, p=0.002). In addition, the patients with POAF had prolonged stay in the cardiac surgery intensive-care unit (p<0.001) and extended in-hospital care (p=0.001). New-onset POAF was significantly related to the presence and number of fQRS. In the logistic regression analysis, only age (OR: 1.044, 95% CI: 1.008-1.082, p=0.016), female gender (OR: 2.347, 95% CI: 1.079-5.106, p=0.031), the presence and number of fQRS (OR: 6.020, 95% CI: 3.152-11.5 and OR: 1.522, 95% CI: 1.282-1.807, both of, p<0.001) were independent predictors of POAF. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of presence of fQRS on pre-op electrocardiogram to predict POAF were 66%, 76%, 45%, 88% and 74%, respectively. The area under ROC was found as 0.733 (p<0.001, 95% CI: 0.657-0.810). Conclusion: In our study, we found that new-onset POAF was independently related to the presence and number of fQRS in patients undergoing CABG surgery. In addition, fQRS on pre-op surface ECG had high predictive values for new-onset POAF.

10.Diagnostic value of heart-type fatty acid binding protein determined by the rapid qualitative chromatographic immunoassay method for the detection of minor myocardial damage in patients presenting with non-ST elevation acute coronary syndrome
Yüksel Çavuşoğlu, Bülent Gök, Canan Demirüstü, Alparslan Birdane, Bülent Görenek, Necmi Ata
PMID: 22804980  doi: 10.5152/akd.2012.185  Pages 584 - 590
Objective: The aim of this prospective study was to evaluate the diagnostic value of heart-type fatty acid binding protein (H-FABP) determined by qualitative immunoassay method for the detection of minor myocardial damage (MMD) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). Methods: The study consisted of 62 patients with NSTE-ACS. Cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) values were measured at arrival. Myoglobin and H-FABP were obtained if cTnI level was found to be elevated. A control group included 20 subjects with normal cTnI and CK-MB values. H-FABP was determined by a rapid qualitative immunochromatographic test. Patients were classified as MMD-ACS group if they had abnormal cTnI and normal CK-MB (n=24) and as NSTEMI-ACS group if they had elevated both cTnI and CK-MB (n=38). The diagnostic accuracy of H-FABP for minor myocardial damage was determined using ROC analysis. Results: The sensitivity of the H-FABP was significantly higher for NSTEMI-ACS than for MMD-ACS (44.7% vs 0%, p<0.001) and its specificity was 95% for both groups. The diagnostic efficacy rates for myoglobin and H-FABP were 75% and 43% for MMD-ACS, 74% and 62% for NSTEMI-ACS. Positive predictive value for H-FABP and myoglobin were found to be 0% and 80.8% in MMD-ACS, 94% and 87% in NSTEMI-ACS and negative predictive value was 44% and 69.5% in MMD-ACS, 47.5% and 59% in NSTEMI-ACS, respectively. AUC for myoglobin was significantly greater than that for H-FABP in MMD-ACS group (0.754 vs 0.525, p=0.027). The sensitivity of the H-FABP was significantly higher in patients with >3-fold increase in cTnI than those with <3-fold increase in cTnI (46.8% vs. 6.7%, p< 0.001). A positive correlation was found between the magnitude of cTnI rise and H-FABP results (r=0.45, p<0.001). Conclusions: H-FABP determined by the rapid qualitative immunochromatographic test has almost similar diagnostic value to that of myoglobin for identifying NSTEMI-ACS, however, does not seem to represent diagnostic potential for the detection of MMD.

11.Low serum free triiodothyronine levels are associated with the presence and severity of coronary artery disease in the euthyroid patients: an observational study
Faruk Ertaş, Hasan Kaya, Mehmet Serdar Soydinç
PMID: 22877896  doi: 10.5152/akd.2012.187  Pages 591 - 596
Objective: The aim of this study is to investigate the relationship between serum thyroid hormone levels that are within the normal range and the presence and severity of coronary artery disease (CAD) in patients referred for coronary angiography. Methods: In this observational study, we enrolled 119 consecutive patients (77 men, mean age 60.7±13.8 years) who underwent coronary angiography. Blood samples were tested for thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) concentrations. Additionally, risk factors, clinical characteristics and angiographic results were obtained. The patients were separated into two groups according to the Gensini score as those with mild or severe atherosclerosis. Statistical analysis was performed using the Chi-square, Mann-Whitney U, correlation and logistic regression tests, and ROC analysis. Results: FT3 levels were significantly lower in subjects with CAD (4.0±0.7 vs. 4.6±0.6 pmol/L; p<0.001). Moreover, lower FT3 levels were found in patients with severe atherosclerosis (3.9±0.7 vs. 4.5±0.6 pmol/L; p<0.001). Logistic regression analysis demonstrated that the lower FT3 levels were associated with the presence (OR =0.266, 95% CI: 0.097-0.731, p=0.01) and severity (OR=0.238, 95% CI: 0.083-0.685, p=0.008) of CAD. In the ROC analysis, a level of FT3 ≤4.2 pmol/L was found to predict the presence of CAD with 69% sensitivity and 71% specificity (AUC: 0.744, 95% CI: 0.653-0.834, p<0.001); and the severity of CAD with 75% sensitivity and 67% specificity (AUC: 0.733, 95% CI: 0.642-0.824, p<0.001). Conclusions: FT3 levels within the normal range were inversely correlated with the presence and severity of CAD. Moreover, lower FT3 concentrations were correlated with the Gensini score and independently predicted the presence and severity of CAD. Thus, the FT3 levels may be used as the indicator of increased risk for CAD.

MISCELLANEOUS
12.Simultaneous submission: a scientific misconduct case which is detected incidentally and may be ended in the different ways
F. Suna Kıraç
PMID: 23018086  doi: 10.5152/akd.2012.242  Pages 597 - 598
Abstract | Full Text PDF

CASE REPORT
13.A case of Kounis syndrome presented with sudden cardiac death
Ahmet Çağrı Aykan, Regayip Zehir, Can Yücel Karabay, Mehmet Özkan
PMID: 22877900  doi: 10.5152/akd.2012.191  Pages 599 - 600
Abstract | Full Text PDF

14.Refractory hemolytic anemia due to severe swirling flow pattern in chronic mitral regurgitation after myxoma surgery
İbrahim Halil Kurt, Oben Baysan, Levent Korkmaz, Onur Kadir Uysal
PMID: 22877901  doi: 10.5152/akd.2012.192  Pages 600 - 601
Abstract | Full Text PDF

15.Implantation of cardioverter-defibrillator and cardiac resynchronization device in a patient with preserved right ventricular lead after tricuspid valve surgery
Demet Erciyes, Ertan Sağbaş, Murat Gülbaran, Nuran Yazıcıoğlu
PMID: 22877902  doi: 10.5152/akd.2012.193  Pages 601 - 603
Abstract | Full Text PDF

16.Unilateral pulmonary artery agenesis: clinical and laboratory findings of four cases and diagnostic clues for pediatricians
Zehra Karataş, Hayrullah Alp, Hakan Altın, Tamer Baysal
PMID: 22877903  doi: 10.5152/akd.2012.194  Pages 603 - 605
Abstract | Full Text PDF

17.Traumatic pulmonary valve hematoma; an unusual complication of pulmonary balloon valvuloplasty
Murat Özeren, Barlas N. Aytaçoğlu, Kerem Karaca, Nehir Sucu
PMID: 22877904  doi: 10.5152/akd.2012.195  Pages 605 - 606
Abstract | Full Text PDF

DIAGNOSTIC PUZZLE
18.Right paracardiac mass
Mehmet İncedayı, Mehmet Özkan
PMID: 22892103  doi: 10.5152/akd.2012.210  Pages 607 - 608
Abstract | Full Text PDF

LETTER TO THE EDITOR
19.Complete heart block and permanent pacemaker implantation in a patient with systemic sclerosis
Uğur Canpolat, Asena Gökçay Canpolat, Giray Kabakçı
PMID: 22877905  doi: 10.5152/akd.2012.196  Pages 609 - 610
Abstract | Full Text PDF

20.Sturge-Weber syndrome and dilated cardiomyopathy: coincidence or associated disease?
Halil İbrahim Erdoğan, Enes Elvin Gül, Oğuzhan Yıldırım, Mehmet Akif Düzenli
PMID: 22877906  doi: 10.5152/akd.2012.197  Pages 610 - 611
Abstract | Full Text PDF

21.Does intermediate high-altitude level affect major cardiovascular outcomes of patients acute myocardial infarction treated by primary coronary angioplasty? Preliminary results of observational study
Turgay Işık, Erkan Ayhan, İbrahim Halil Tanboğa
PMID: 22877907  doi: 10.5152/akd.2012.198  Page 611
Abstract | Full Text PDF

22.Delirium due to contrast toxicity after coronary angioplasty
Kerem Özbek, Ekrem Hasbek, Fatih Koç
PMID: 22877908  doi: 10.5152/akd.2012.199  Page 612
Abstract | Full Text PDF

23.Clinical analysis of neonates with congenital heart disease in the neonatal intensive care unit: a 5-year experience
Sami Hatipoğlu, Özgül Salihoğlu, Emrah Can, Mehmet Bedir Akyol
PMID: 22877909  doi: 10.5152/akd.2012.200  Pages 612 - 613
Abstract | Full Text PDF

24.Intracoronary shunt use in an adult patient with Bland-White-Garland syndrome
Berk Özkaynak, Özgür Yıldırım, Adil Orman, Ahmet Özdemir
PMID: 22877910  doi: 10.5152/akd.2012.201  Pages 614 - 615
Abstract | Full Text PDF

25.Successful management of an unwanted complication; VAC therapy
Cenk Eray Yıldız, Sadettin Çöhçen, Murat Mert, Gürkan Çetin
PMID: 22877911  doi: 10.5152/akd.2012.202  Pages 615 - 616
Abstract | Full Text PDF

DIAGNOSTIC PUZZLE
26.Right paracardiac mass
Mehmet İncedayı
PMID: 22892103  Page 617
Abstract

MISCELLANEOUS
27.RESCAP-MED project - in framework of EU7 grant (2012-2015)
Belgin Ünal
doi: 10.5152/akd.2012.241  Page 618
Abstract | Full Text PDF

ERRATUM
28.Erratum
Sebahat Gözüm
Page 619
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
29.Unexpected complication- fracture of the IVUS catheter and percutaneous retrieval of a broken IVUS catheter tip from the right coronary artery
Fahrettin Öz, Ahmet Yaşar, Ozan Çakır, Hüseyin Oflaz
PMID: 22877912  doi: 10.5152/akd.2012.203  Pages E33 - E34
Abstract | Full Text PDF

30.Acute myocardial infarction secondary to blunt chest trauma treated with thrombus aspiration
Pınar Türker Bayır, Serkan Duyuler, Serkan Topaloğlu, Belma Uygur
PMID: 22877913  doi: 10.5152/akd.2012.204  Pages E34 - E35
Abstract | Full Text PDF

31.A closer sight to the transapical cardiac resynchronization therapy
Paolo Giuseppe Pino, Giordano Zampi, Amedeo Pergolini, Giovanni Minardi
PMID: 22877914  doi: 10.5152/akd.2012.205  Pages E35 - E36
Abstract | Full Text PDF

32.Melting heart: dilated phase of hypertrophic cardiomyopathy
Uğur Canpolat, Levent Şahiner, Ergün Barış Kaya, Kudret Aytemir
PMID: 22877915  doi: 10.5152/akd.2012.206  Pages E36 - E37
Abstract | Full Text PDF

33.Huge aortic vegetation embolizing to right iliac artery
Taner Şen, Belma Uygur, Omaç Tüfekçioğlu, Zehra Gölbaşı
PMID: 22877916  doi: 10.5152/akd.2012.207  Pages E37 - E38
Abstract | Full Text PDF

34.A rare interventricular mass like view-fibrosis
Ahmet Göktuğ Ertem, Tolga Han Efe, Harun Kılıç, Ekrem Yeter
PMID: 22877917  doi: 10.5152/akd.2012.208  Pages E38 - E39
Abstract | Full Text PDF

35.Persistent left superior vena cava associated with giant coronary sinus
Murat Yalçın, Mehmet İncedayı, Serkan Çay
PMID: 22877918  doi: 10.5152/akd.2012.209  Page E39
Abstract | Full Text PDF