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The Anatolian Journal of Cardiology - Anatol J Cardiol: 13 (1)
Volume: 13  Issue: 1 - February 2013
1.Increased manuscript number and letters from the readers (``Sister Guzin``!!!)
Bilgin Timuralp
PMID: 23565529  doi: 10.5152/akd.2013.077  Pages 1 - 2
Abstract | Full Text PDF

2.Acute cardiotoxic effects of high dose toluene: an experimental study
Ufuk Taş, Fatih Ekici, Fatih Koç, Erkan Söğüt, Murat Ayan, Tuncay Kuloğlu, Akgül Arıcı, Birsen Özyurt
PMID: 23070630  doi: 10.5152/akd.2013.001  Pages 3 - 8


Objective: This study aimed to investigate the acute cardiotoxic effects of high dose toluene and its damage mechanisms on heart tissue in the acute period.

Methods: Twenty adult male Wistar Albino rats (200-220 g) were used in this controlled experimental animal study. Animals were divided into two equal groups: a control group (Group 1) and a high dose (6 mL/kg/gavage) toluene-administered group (Group 2). Arterial blood pressure (BP) and heart rate (HR) values were measured at 30th, 60th and 90th minutes after toluene was administered. At the end of the experimental period, blood samples and heart tissues were taken from the rats. Serum troponin T levels were assayed. Heart tissue sections were stained using routine histological methods and examined under a light microscope. In addition, the sections were immunohistochemically stained using the avidin-biotin-peroxidase method to determine caspase-3 immunoreactivity and TUNEL to detect apoptosis. To compare the apoptotic index, the Mann-Whitney U test was used. For comparisons between the two groups, the independent t- test was used. In addition, time-based changes of intra-group parameters were evaluated using paired t tests.

Results: BP and HR values were low in toluene-treated rats compared to the control group. Troponin T levels were increased in toluene-administered animals as compared with controls [Toluene group: 0.140 (0.010-2.000) ng/mL vs control group: 0.010 (0.010-0.010) ng/mL, p=0.01]. Histopathologic examination of heart tissue sections showed congestion and edema in toluene administrated rats. Higher TUNEL positivity and (+++) immunoreactivity for caspase-3 protein were observed in the toluene group compared to the control group.

Conclusion: The present study demonstrated that high doses of toluene cause apoptosis and may lead to impairment of cardiac function in the acute period. 

3.High prevalence of cardiovascular risk factors in a Western urban Turkish population: a community-based study
Belgin Ünal, Kaan Sözmen, Reyhan Uçku, Gül Ergör, Ahmet Soysal, Hakan Baydur, Reci Meseri, Hatice Şimşek
PMID: 23070631  doi: 10.5152/akd.2013.002  Pages 9 - 17


Objective: Cardiovascular diseases (CVD) are the largest cause of morbidity and mortality in Turkey and in the World. Heart of Balçova Project is a community- based health promotion project that aims to reduce CVD incidence and prevalence through risk factor modification in the individual and population level. This paper presents results of the baseline survey that aimed to define CVD risk factors and risk of developing coronary heart disease (CHD) in the Balçova population.

Methods: The study population included 36,187 people over 30 years of age residing in Balçova in 2007. Individuals were interviewed at their homes. Anthropometrics and blood pressure were measured and in total 12914 fasting blood samples were collected for lipid and glucose analyses. CHD risk was estimated using Framingham risk equation. Student’s t test, Chi-square for trend test and ANOVA were used to compare mean levels and percentages of risk factors between age groups and gender.

Results: In total 5552 men and 10528 women participated in the study. Smoking prevalence was 38.6% in men and 26.8% in women. The prevalence of obesity was 29.4% among men and 44.2% among women and obesity prevalence increased until the age group 75 years old. While 14.6% of men and 12.6% of women had diabetes, 39.8% of men and 41.8% of women had hypertension. The prevalence of high total cholesterol was 56.0% in men and 50.6% in women. Men had a higher risk of developing CHD compared to women in the following 10 years (13.4% vs 2.5%).

Conclusion: The prevalence of preventable risk factors for CHD is very high in Balçova population. Community-based interventions should be planned and implemented targeting both the high-risk individuals and whole population. 

4.The significance of the left atrial volume index in cardioversion success and its relationship with recurrence in patients with non-valvular atrial fibrillation subjected to electrical cardioversion: a study on diagnostic accuracy
Barış Akdemir, Refik Emre Altekin, Murathan Küçük, Atakan Yanıkoğlu, Mustafa Serkan Karakaş, Anıl Aktaş
PMID: 23070632  doi: 10.5152/akd.2013.003  Pages 18 - 25


Objective: The aim of this study was to assess the predictive value of the left atrial volume index (LAVI) in electrical cardioversion (ECV) and observe the recurrence rate of atrial fibrillation (AF) after a successful ECV in patients with non-valvular atrial fibrillation.

Method: This study was designed as a diagnostic accuracy and prospective cohort study. Eighty patients (mean age 62±12 years; 52.5% female) were enrolled in study. LAVI was measured using the area-length method and the indexed body surface area. Patients in whom the sinus rhythm (SR) was established following the ECV were assessed according to the clinical and electrocardiography (ECG) findings at the first month and grouped as those with continued SR or recurrent AF. The Student’s t, Mann-Whitney U, Fisher’s exact, Chi-square tests, ROC and logistic regression analyses were used for statistical analysis.

Results: Subsequent to the ECV, SR was achieved in 62.5% (n=50) of the patients. In those where SR was established, the AP-Lad (4.32±0.62 vs. 4.77±0.4 cm/p=0.002) and LAVI (35.3±11.5 vs. 53.1±10.1 mL/m2/p<0.001) values were observed to be lower. ECV success was found to be associated only with the LAVI (OR: 1.122, 95%CI: 1.058-1.191, p<0.001). The AUC was found as 0.892±0.041 for the LAVI (95% CI: 0.075-0.285, p<0.001). During the controls at the end of the 1st month, SR was maintained in 72% (n=36) of the successful ECV group. Among the patients with maintained SR, the antero-posterior left atrial dimension (4.17±0.62 vs. 4.72±0.5 cm/p=0.004) and LAVI (30.8±6.2 vs. 46.8±13.9 mL/m2/p<0.001) values were also observed to be lower. Only the LAVI was found to be associated with the recurrence of the AF (OR: 1.355, 95% CI: 1.154-1.591, p<0.001). The AUC was found as 0.950±0.029 for the LAVI (95% CI: 0.063-0.313, p=0.003)

Conclusion: Lower LAVI values before the ECV are strong and independent predictors of the success of the ECV and the maintenance of SR after a successful ECV. 

5.Expert panel on cost analysis of atrial fibrillation
Ali Serdar Fak, M. Serdar Küçükoğlu, Nazire Afşar Fak, Mesut Demir, Mustafa Demirtaş, Sedat Köse, Murat Özdemir
PMID: 23070633  doi: 10.5152/akd.2013.004  Pages 26 - 38


Objective: To estimate total cost of atrial fibrillation (AF) management concerning acute coronary syndrome, heart failure, stroke and drug related adverse events with respect to clinical practice and available guidelines.

Methods: This cost analysis study was based on identification of total costs related to management of acute coronary syndrome, heart failure, stroke and the drug related adverse events in patients with AF based on standardized questionnaire forms filled by experts according to their daily clinical practice and also to ACCF/AHA/ESC guidelines. Total cost included cost items related to treatment, healthcare resources utilization, and diagnostic test and consultations.

Results: The yearly cost of acute coronary syndrome per patient was 5.478.43 TL according to expert’s view reflecting real clinical practice whereas it was 11.319.44 TL when calculation was based on recommendations in the guidelines. The average total cost of heart failure was 4.523.74 TL according to expert’s view whereas it was 2.925.86 TL based on guidelines. The average total cost of stroke was 5.719.25 TL according to expert’s view but 7.931.18 TL based on guidelines. Among drug related adverse events, only those related to cardiac adverse events were estimated to be higher according to expert view as compared to guideline recommendations (288.65 vs. 150.99 TL).

Conclusions: Reflecting the treatment algorithms in the management of AF and related adverse events, our findings seem to emphasize the extra burden on health economics posed by patients suffering from the uncontrolled disease. 

6.Increased circulating soluble CD40 levels in patients with slow coronary flow phenomenon: an observational study
Murtaza Emre Durakoğlugil, Sinan Altan Kocaman, Mustafa Çetin, Aynur Kırbaş, Aytun Çanga, Turan Erdoğan, Yüksel Çiçek
PMID: 23070634  doi: 10.5152/akd.2013.005  Pages 39 - 44


Objective: Slow coronary flow (SCF) is an angiographic finding characterized with delayed opacification of epicardial coronary arteries without obstructive coronary disease. CD40/CD40 ligand (CD40L) signaling seems closely related to atherosclerosis due to increased inflammation and prothrombotic state. We investigated whether soluble CD40 (sCD40), an indirect marker of CD40/CD40L dyad, is related to SCF.

Methods: The present study was cross-sectional and observational, consisting of seventy individuals who underwent coronary angiography with suspicion of CAD and had angiographically normal coronary arteries of varying coronary flow rates. The relationship between sCD40, C-reactive protein (CRP) and SCF phenomenon was investigated. Fifty patients with isolated SCF (mean age: 56±10 years) and 20 age- and gender-matched control participants with normal coronary flow (NCF) and normal coronary arteries (NCA), (mean age: 55±10 years) were included in the study. We used logistic regression analysis to determine the predictors of SCF.

Results: The clinical characteristics were not statistically significant different between SCF and NCA group. Serum CRP levels were also similar between two groups. Serum sCD40 level was significantly higher in the SCF group compared to control group (74±31 vs. 59±16 pg/mL, p=0.014). In multiple regression analyses, mean coronary diameter strongly (OR: 7.358, 95% CI: 1.990-27.20, p=0.003) and sCD40 (OR: 1.044, 95% CI: 1.006-1.084, p=0.023) weakly predicted SCF.

Conclusion: This study revealed, significantly increased serum sCD40 levels in patients with SCF. Although we cannot conclude the underlying pathological process of SCF, we believe that these findings may be pivotal for further studies searching the specific roles of CD40/CD40L signaling on SCF phenomenon in coronary vasculature.

7.The light of inflammation in the darkness of the coronary slow flow phenomenon
Gabriele Fragasso
PMID: 23154121  doi: 10.5152/akd.2013.030  Pages 45 - 47
Abstract | Full Text PDF

8.Effect of family history of type-2 diabetes on coronary flow reserve and it’s relationship with insulin resistance: an observational study
Mustafa Çalışkan, Barış Önder Pamuk, Hakan Güllü, Özgür Çiftçi, Zuhal Çalışkan, Doğan Erdoğan, Aytekin Güven, Ezgi Polat, Haldun Müderrisoğlu
PMID: 23086803  doi: 10.5152/akd.2013.006  Pages 48 - 56


Objective: Coronary microvascular function among offspring of patients with diabetes mellitus might be compromised when compared to persons with no first-degree relative with diabetes mellitus. The aim of the study was to evaluate effect of family history of type-2 diabetes on coronary flow reserve. 

Methods: In this observational study, we evaluated coronary flow reserve (CFR) via echocardiography of 95 subjects having a biological parent with type-2 diabetes and 34 healthy volunteers without any biological parent with type-2 diabetes. We have analyzed possible association with CFR and homeostasis model assessment - insulin resistance (HOMA-IR). Comparison analyses were made using independent samples t test, Chi-square test and one-way ANOVA. Association of independent variables with CFR was obtained by correlation analysis and stepwise linear regression model including potential confounders.

Results: CFR was significantly lower in the positive family history group than in the controls. Moreover, when compared with controls, the subgroup of insulin-sensitive subjects in the positive family history group also had significantly reduced CFR (2.67±0.28 vs. 2.83±0.19; p=0.01).  Correlation analysis revealed that CFR was inversely correlated with HOMA-IR, (r=-0.433), fasting glucose (r=-0.331), fasting insulin  (r=-0.396), and hemoglobin (Hb)A1c (r=-0.405). When the positive family history group was divided into tertiles of insulin resistance (HOMA-IR <1.3, 1.3-2.6, and >2.6; Groups 1-2, and 3), there was a significant difference in CFR between Groups 1 and 2 and between Groups 1 and 3 (p

Conclusion: Nondiabetic first-degree relatives of patients with type-2 diabetes are at increased risk of developing coronary microvascular dysfunction. 

9.Predictive value of mean platelet volume in young patients with non-ST-segment elevation acute coronary syndromes: a retrospective observational study
Mehmet Fatih Özlü, Serkan Öztürk, Suzi Selim Ayhan, Mehmet Tosun, Aytekin Alçelik, Alim Erdem, Mehmet Yazıcı
PMID: 23086804  doi: 10.5152/akd.2013.007  Pages 57 - 61


Objective: Platelets play an important role in both initiation and propagation of acute coronary syndromes. We sought to evaluate the predictive value of mean platelet volume (MPV) in young patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS).

Methods: This is a retrospective observational study; evaluating the MPV values of 79 NSTE-ACS patients aged under 45 years and 45 control subjects having normal coronary anatomy. NSTE-ACS group was composed of 41 non-ST elevation myocardial infarction (NSTEMI) and 38 unstable angina pectoris (USAP) patients. MPV was measured using an automated hematologic analyzer called Coulter counter. The predictive value of MPV was evaluated using logistic regression analysis and comparison of MPV between NSTE-ACS and control groups was performed by Mann-Whitney U test.

Results: The MPV was found to be significantly higher in the NSTE-ACS compared with control group (8.49±1.22 versus 7.78±0.65 fL, p=0.001). In logistic regression analysis, MPV was found to be an independent predictor of NSTE-ACS (OR=3.1, 95% CI 1.2-8.2, p=0.022). The MPV values of NSTEMI group were not significantly different from USAP group (8.78±1.38 versus 8.17±0.95 fL, p=0.66). Similarly, the MPV values of the 3 groups (Control, USAP and NSTEMI) were found to be significantly different (7.78±0.65, 8.18±0.95, 8.78±1.38 fL respectively, p=0.001).

Conclusion: In conclusion, MPV was found to be elevated in NSTE-ACS patients compared with control subjects in young population. In addition, increased MPV was established to be an independent predictor of NSTE-ACS.  

10.Heart disease in patients with thyroid dysfunction: hyperthyroidism, hypothyroidism and beyond
Michele Coceani
PMID: 23086805  doi: 10.5152/akd.2013.008  Pages 62 - 66


The thyroid and the cardiovascular system are closely related, both in physiological and pathological conditions. The adverse consequences on the heart of overt thyroid disease are well-known and even subclinical forms of both hyperthyroidism and hypothyroidism are associated with increased cardiovascular mortality. In recent years, attention has shifted towards milder forms of thyroid disease, such as the so-called “low T3 syndrome”, which is characterized by an isolated reduction in circulating levels of the biologically active form of thyroid hormone, triiodothyronine (T3). Furthermore, variations of T3 within the physiological range have been linked to coronary artery disease, one of the leading causes of morbidity and mortality worldwide. The present manuscript provides an overview of thyroid physiology and pathophysiology, with a particular focus on cardiovascular disease in patients with milder forms of thyroid dysfunction. 

11.Diurnal variation in acute thrombotic cardiovascular events
Turgay Işık, Erkan Ayhan, Hüseyin Uyarel
PMID: 23086806  doi: 10.5152/akd.2013.009  Pages 67 - 71


Circadian clocks affect cardiovascular system and thought to be responsible for the increased vascular events during certain periods. Determination of the diurnal variation of acute vascular thrombotic events might help us for protection of patients during vulnerable periods. In this review, we investigate diurnal variation in acute thrombotic vascular events in the light of recent information. 

12.Reel syndrome: dislodgement of an active fixation lead
Serkan Saygı, Bahadır Kırılmaz, Hicran Yıldız, Ertuğrul Ercan
PMID: 23128543  doi: 10.5152/akd.2013.010  Pages 72 - 73
Abstract | Full Text PDF

13.Successful percutaneous balloon mitral valvuloplasty in patients with left atrial appendage thrombus
Hakan Akıllı, Alpay Arıbaş, Gökhan Altunbaş, Kurtuluş Özdemir
PMID: 23128544  doi: 10.5152/akd.2013.011  Pages 73 - 74
Abstract | Full Text PDF

14.The role of two-dimensional speckle -tracking echocardiography in a patient with Behçet's disease
Regayip Zehir, Can Yücel Karabay, Ahmet Çağrı Aykan, Mehmet Özkan
PMID: 23128545  doi: 10.5152/akd.2013.012  Pages 74 - 76
Abstract | Full Text PDF

15.Aneurysm of ascending and descending aorta in a 10-year-old-boy with Wiskott-Aldrich syndrome
Kadir Babaoğlu, Zeynep Seda Uyan, Köksal Binnetoğlu, Cenk Eray Yıldız, Nazan Sarper
PMID: 23128546  doi: 10.5152/akd.2013.013  Pages 76 - 77
Abstract | Full Text PDF

16.Vacuum-assisted closure for skin infection in a patient with Berlin Heart Excor biventricular assist device
Öztekin Oto, Sadık Kıvanç Metin, Melih Bal, Gökçen Özserim, Baran Şevket Uğurlu
PMID: 23128547  doi: 10.5152/akd.2013.014  Pages 77 - 78
Abstract | Full Text PDF

17.Electrocardiography in a patient with orthotopic cardiac transplantation
Sinan Cerşit, Gizem Çabuk, Ümit Güray, Omaç Tüfekçioğlu
PMID: 23154120  doi: 10.5152/akd.2013.029  Page 79
Abstract | Full Text PDF

18.Prevalence of metabolic syndrome, its relationship with mental health (anger) and sociodemographic characteristics in women residing in central district of Malatya: a cross-sectional observational study
Yalçın Önem
PMID: 23154113  doi: 10.5152/akd.2013.022  Page 80
Abstract | Full Text PDF

19.World Hypertension Congress 2013
İstemihan Tengiz
PMID: 23425589  doi: 10.5152/akd.2013.077  Page 81
Abstract | Full Text PDF

20.The difficulties during transcatheter aortic valve implantation and appropriate precautions
Mehmet Gül, Mehmet Ertürk, Aydın Yıldırım, İhsan Bakır
PMID: 23154114  doi: 10.5152/akd.2013.023  Pages 81 - 82
Abstract | Full Text PDF

21.A challenging case of transcatheter aortic valve implantation under left main coronary artery protection
Ahmet Çağrı Aykan, Tayyar Gökdeniz, Mustafa Tarık Ağaç, Şükrü Çelik
PMID: 23154115  doi: 10.5152/akd.2013.024  Pages 82 - 83
Abstract | Full Text PDF

22.Left atrial appendix thrombus presenting with acute coronary syndrome in a patient with rheumatic mitral stenosis
Arzu Kalaycı, Suzan Akpınar, Ahmet Güler, Can Yücel Karabay
PMID: 23154116  doi: 10.5152/akd.2013.025  Pages 83 - 84
Abstract | Full Text PDF

23.Psychological problems in patients awaiting coronary angiography: a preliminary study
Nahid Jamshidi, Abbas zadeh, Majid Najafi Kalyani
PMID: 23154117  doi: 10.5152/akd.2013.026  Pages 84 - 85
Abstract | Full Text PDF

24.Double outlet right ventricle: Fallot type or non-Fallot type
Ayhan Çevik
PMID: 23154118  doi: 10.5152/akd.2013.027  Pages 85 - 86
Abstract | Full Text PDF

25.Video of minimally invasive totally endoscopic surgical treatment of a myxoma on the mitral valve
Pınar Köksal Coşkun, Gül Baytan Sezer, Alper Tosya, Tayfun Aybek
PMID: 23154119  doi: 10.5152/akd.2013.028  Page 86
Abstract | Full Text PDF

26.Electrocardiography in a patient with orthotopic cardiac transplantation
Sinan Cerşit, Gizem Çabuk, Ümit Güray, Omaç Tüfekçioğlu
PMID: 23154120  Page 87
Abstract | Full Text PDF

27.An Interview with Prof. Dr. Richard Sutton
Sema Güneri
PMID: 23154122  doi: 10.5152/akd.2013.031  Pages 88 - 90
Abstract | Full Text PDF

28.Almanac 2012: interventional cardiology
Pascal Meier, Adam Timmis
PMID: 23248052  doi: 10.5152/akd.2013.049  Pages 91 - 101

The field of interventional cardiology continues to progress quickly. The efficacy of percutaneous interventions with newer generation drug-eluting stents has advanced a lot over the last decade. This improvement in stent performance has broadened the level of indication towards more complex interventions such as left main and multi- vessel PCI. Major improvements continue in the field of medical co-therapy such as antiplatelet therapies (bivalirudin, prasugrel, ticagrelor) and this will further improve outcomes of PCI. The same is true for intravascular imaging such as ultrasound IVUS and optical coherence tomography OCT. However, interventional cardiology has become a rather broad field, also including alcohol septal ablation for hypertrophic obstructive cardiomyopathy, etc. At the moment, the fastest growing area is the structural interventions, especially for aortic valve stenosis (transcatheter aortic valve implantation TAVI) and for mitral regurgitation (mitral clipping). This review covers recent advances in all these different fields of interventional cardiology

29.Giant left main coronary artery aneurysm complicated with anterior myocardial infarction in Behçet’s syndrome
Ahmet Yaşar Çizgici, Fahrettin Öz, Murat Sezer, Sabahattin Umman
PMID: 23128548  doi: 10.5152/akd.2013.015  Pages E1 - E2
Abstract | Full Text PDF

30.Controlled removal of a dislodged stent causing myocardial ischemia 1 year after stent placement
Ercan Erdoğan, Mehmet Akif Vatankulu, Mehmet Akkaya, Ahmet Bacaksız
PMID: 23128549  doi: 10.5152/akd.2013.016  Page E2
Abstract | Full Text PDF

31.Accordion-like giant interatrial septal aneurysm
Zafer Işılak, Murat Yalçın, Alptuğ Tokatlı, Mehmet İncedayı
PMID: 23128551  doi: 10.5152/akd.2013.018  Pages E3 - E4
Abstract | Full Text PDF

32.Huge caseous calcification of the mitral annulus mimicking cardiac mass presented with atrioventricular block and severe mitral regurgitation
İsa Öner Yüksel, Şakir Arslan, Göksel Çağırcı, Erkan Köklü
PMID: 23128552  doi: 10.5152/akd.2013.019  Pages E4 - E5
Abstract | Full Text PDF

33.Three-dimensional echocardiographic evaluation of an anterior mitral leaflet perforation and aortic vegetation due to infective endocarditis
Sait Demirkol, Murat Ünlü, Şevket Balta, Uygar Çağdaş Yüksel
PMID: 23128553  doi: 10.5152/akd.2013.020  Pages E5 - E6
Abstract | Full Text PDF

34.Prosthetic mitral valve obstruction: diagnosis with real-time three- dimensional transesophageal echocardiography
Saide Aytekin, Selen Yurdakul, Yelda Tayyareci
PMID: 26392458  doi: 10.5152/akd.2013.021  Page E6
Abstract | Full Text PDF