ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 13 (2)
Volume: 13  Issue: 2 - March 2013
1.The quiet, but severe winter is likely gone,
Bilgin Timuralp
PMID: 23545200  doi: 10.5152/akd.2013.104  Page 102
Abstract |Full Text PDF

2.Assessment of right ventricular systolic function with dP/dt in healthy subjects: an observational study
Sait Demirkol, Zekeriya Arslan, Oben Baysan, Şevket Balta, İbrahim Halil Kurt, Uğur Küçük, Turgay Çelik
PMID: 23228970  doi: 10.5152/akd.2013.032  Pages 103 - 107


Objective: The objective of our study is to determine the mean values of right ventricular (RV) dP/dt and to compare it with other right ventricular function parameters by echocardiography.

Methods: This observational study consisted of 112 healthy subjects who had trivial tricuspid regurgitation. Full echocardiographic examination was performed. RV systolic function was assessed by using myocardial performance index (RV MPI), tricuspid annular plane systolic excursion (TAPSE), myocardial acceleration during isovolumic contraction (RV IVA), RV fractional area change (RV FAC), tissue Doppler–derived tricuspid lateral annular systolic velocity (Tri S`) and RV dP/dt (dP/dt). Pearson correlation test was used in examining the correlation between parameters. Differences between correlations were compared with Fisher’s z transformation.

Results: The mean of RV dP/dt (0.5-2) was 1016±421 mmHg/s (95% CI=891-1142) and the mean of RV dP/dt (1-2) was 1524±573 mmHg/s (95% CI=1354-1694). RV pulse Doppler MPI and RV tissue Doppler imaging MPI were negatively correlated with RV dP/dt (0.5-2) (r=-0.482 and r=-0.504, p<0.01). Tri S’ was positively correlated with RV dP/dt (0.5-2) (r=0.667, p<0.01) and with the RV dP/dt (1-2) (r=0.312, p<0.05). TAPSE was positively correlated with RV dP/dt (0.5-2) (r=0.585, p<0.01) and with the RV dP/dt (1-2) (r=0.323, p<0.05). RV IVA was positively correlated with RV dP/dt (0.5-2) (r=0.512, p<0.01). FAC (%) was not correlated with both RV dP/dt (0.5-2) and RV dP/dt (1-2).

Conclusion: The results of our study were as follows: 1) we described the mean of RV dP/dt (0.5-2) and RV dP/dt (1-2) in healthy population; 2) the correlation between dP/dt (0.5-2) and RV function parameters was better than between dP/dt (1-2) and RV function parameters.

3.The association of eccentricity indexes with cardiac biomarkers in normotensive acute pulmonary embolism patients: an observational study
Mehmet Ali Çetiner, Muhammet Raşit Sayın, Nesligül Yıldırım, Turgut Karabağ, Mustafa Aydın
PMID: 23228971  doi: 10.5152/akd.2013.033  Pages 108 - 114


Objective: The present study aims at investigating the association of systolic and diastolic eccentricity indexes with cardiac biomarkers in hemodynamically stable patients with acute pulmonary embolism (APE).

Methods: Thirty hemodynamically stable (systolic blood pressure >90 mmHg) patients with APE (17M, mean age 61.67±17.6 years) were included in this cross-sectional observational study. The associations of serum troponin I, D-dimer, brain natriuretic peptide (BNP) and heart type fatty acid binding protein (hFABP) levels with systolic and diastolic eccentricity indices, tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI), systolic pulmonary artery pressure and the index of the inferior vena cava were investigated. The relationships between parameters were evaluated by Pearson and Spearman correlation analysis according to the distribution of data.

Results: Correlation analysis revealed that the most significant relationship between cardiac biomarkers and echocardiographic measurements was in the BNP value. Meanwhile, systolic and diastolic eccentricity indexes were found to have significant correlation with serum troponin I (respectively r=0.470, p=0.009/r=0.310, p=0.095) and BNP (respectively r=0.402, p=0.028/r=0.384, p=0.036) values. On the other hand, elevated D-dimer levels led to statistical significance in none of the echocardiographic parameters.

Conclusion: According to our results, hFABP was rarely positive in normotensive patients with APE. An elevated D-dimer alone was not significant in predicting RVD. Eccentricity indexes revealed significant relationship with BNP and troponin I values. The results obtained indicate that early echocardiographic evaluation is important in patients with abnormal cardiac biomarkers. 

4.Effect of nebivolol on endothelial dysfunction in patients with Behçet’s disease; a prospective single-arm controlled study
Hasan Akkaya, Ömer Şahin, Murat Borlu, Abdurrahman Oğuzhan, Mustafa Serkan Karakaş
PMID: 23228972  doi: 10.5152/akd.2013.034  Pages 115 - 120


Objective: Behçet’s disease (BD) is a systemic vasculitis, capable of involving all types of vessels. Endothelial dysfunction (ED) has been previously documented in BD. Previous studies showed that nebivolol might improve endothelial functions in endothelial dysfunction. The aim of our study is to assess the effects of nebivolol on endothelial dysfunction in patients with Behçet’s disease.

Methods: This study was designed as prospective single-arm controlled study. We prospectively studied 35 Behçet’s patients who were diagnosed according to the International Study Group criteria. Patients received 5 mg nebivolol per day for 3 months. Endothelial dysfunction was evaluated by brachial artery flow-mediated dilatation (FMD) method using high-resolution vascular ultrasound device at baseline and after for 3-month therapy. The paired samples t test, Wilcoxon test, Pearson, Spearman correlation analyses were used for statistical analysis.

Results: A significant improvement was observed in FMD after therapy period (4.23±1.19 vs 7.95±2.21%, p<0.001). The correlation analysis showed a negative correlation between post-treatment high-sensitive C-reactive protein and FMD (r=-0.435, p=0.009). No adverse effects were observed in treatment period.

Conclusion: Nebivolol improved endothelial dysfunction in Behçet’s patients. However, further comprehensive studies are needed to determine the long-term effects of nebivolol.

5.Can nebivolol be helpful in Behçet’s disease?
Antonella Tommasino, Giovan Battista Mauro
PMID: 23228973  doi: 10.5152/akd.2013.035  Pages 121 - 122
Abstract |Full Text PDF

6.Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion?
Alpay Arıbaş, Hakan Akıllı, Enes Elvin Gül, Mehmet Kayrak, Kenan Demir, Çetin Duman, Hajrudin Alibasiç
PMID: 23228974  doi: 10.5152/akd.2013.036  Pages 123 - 130


Objective: High neutrophil/lymphocyte ratio (NLR) has been associated with post-operative AF development in patients who underwent cardiac surgery. In this study, effectiveness of NLR for prediction of recurrence after electrical cardioversion (CV) in non-valvular AF was investigated.

Methods: A total of 149 patients who underwent a successful CV were included in this prospective cohort study. Baseline complete blood cell count, routine biochemical tests, high sensitive C-reactive protein (hs-CRP), and echocardiographic measurements were examined. After CV, patients were monitored over six months for recurrence. Baseline characteristics of recurrence group were compared with sinus rhythm group by using Student`s t -test. Logistic regression analysis was used to determine predictors of recurrence.

Results: Recurrence occurred in a total of 46 patients (30.9%). Median AF duration [16 (IQR: 14.25) vs. 12 (IQR: 11) months, p=0.01], baseline hs-CRP [9.80 (IQR: 8.50) mg/dL vs. 4.28 (IQR: 5.65) mg/dL, p=0.002] and left atrium (LA) diameter (4.5±0.4 cm,  4.3±0.5 cm, p=0.023) were significantly higher in the recurrence group than sinus rhythm group. Median NLR was comparable in recurrence and sinus groups [2.38 (IQR: 2.09) vs. 2.23, (IQR: 1.23) p=0.96, respectively].  There was a weak correlation between NLR and hs-CRP (r=0.22, p=0.05) and age (r=0.24, p=0.02). In multiple logistic regression analysis, hs-CRP [OR: 1.34 (1.09-1.65 95% CI) p=0.006], LA diameter [OR: 11.92 (1.84-77.07 95% CI) p=0.01], spontaneous echo contrast positivity, [OR: 5.40 (1.04-12.02 95% CI) p=0.045] and systolic blood pressure [OR: 1.05 (1.01-1.10 95% CI) p=0.03] were independent predictors of AF recurrence.

Conclusion: NLR failed to predict AF recurrence after a successful electrical CV, but hs-CRP remained an inflammatory marker of AF recurrence

7.The role of oxidative stress and inflammation in the early evaluation of acute non-ST-elevation myocardial infarction: an observational study
Mehmet Tahir Gökdemir, Halil Kaya, Özgür Söğüt, Zekeriya Kaya, Levent Albayrak, Abdullah Taşkın
PMID: 23228975  doi: 10.5152/akd.2013.037  Pages 131 - 136


Objective: We aimed to assess the role of oxidative stress (OS) and inflammation in the early evaluation of initial acute non -ST -elevation myocardial infarction (NSTEMI) compared with unstable angina pectoris (USAP).

Methods: Forty-seven (54%) patients with NSTEMI and 40 (46%) with (USAP) were included in this cross-section observational study. We assessed the oxidative stress and inflammation parameters. Statistical analysis was performed using Fisher’s exact test, Chi-square test, Mann-Whitney U test, Student’s t-test, and Pearson correlation analysis for assess the correlations between variables.

Results: Plasma total oxidative stress (TOS) and OS index levels were significantly higher (p<0.001 for both comparisons), in patients with NSTEMI. In addition, white blood cell count (WBC) and high-sensitive C-reactive protein (hs-CRP) levels were significantly higher in patients with NSTEMI (respectively; p<0.001, p=0.02). Age, WBC and low- density lipoprotein cholesterol showed positive correlations with TOS level (Pearson correlation coefficient: r=0.290, p=0.006; r=0.431, p<0.001; r=0.219, p=0.042 respectively), and also age showed positive correlation with OS index (Pearson correlation coefficient; r=0.246; p=0.021). However, the values of the troponin I and creatine kinase-MB fraction did not differ between the two groups (p>0.05 for all).

Conclusion: TOS, OSI, WBC and CRP levels are significantly higher in NSTEMI subject. These data suggest that inflammatory processes and oxidative stress together play a role in the pathogenesis of acute NSTEMI. 

8.Further evidence to support a role of oxidative stress and inflammation in myocardial infarction
Francesca Marchegiani
PMID: 23228976  doi: 10.5152/akd.2013.038  Pages 137 - 138
Abstract |Full Text PDF

9.Serum uric acid level is an independent risk factor for presence of calcium in coronary arteries: an observational case-controlled study
Aslı İnci Atar, Ömer Çağlar Yılmaz, Kayıhan Akın, Yusuf Selçoki, Okan Er, Beyhan Eryonucu
PMID: 23228977  doi: 10.5152/akd.2013.039  Pages 139 - 145


Objective: A link between uric acid levels and cardiovascular diseases has been previously reported. Coronary artery calcium score (CACS) is a marker of atherosclerotic disease and a predictor of cardiovascular events. We sought to determine if serum uric acid level is an independent risk factor for the presence of calcium in coronary arteries.

Methods: Four hundred and forty-two patients who were evaluated in the cardiology outpatient clinic for suspected coronary heart disease with a low-moderate risk for coronary artery disease were included in this observational case-controlled study. Serum uric acid levels were measured with colorimetric methods. CACS were performed using a 64-slice CT scanner. Patients were divided to 3 groups according to their CACS value (Group 1: CACS=0, Group 2: CACS 1-100, Group 3: CACS>100).

Results: The demographical characteristics and laboratory findings of 3 groups were similar, except age, fasting glucose levels and serum uric acid levels. Serum uric acid levels were found to increase significantly with increasing CACS (p=0.001). Patients were grouped according to presence CAC (CACS=0 and CACS?1) and in the multiple regression analysis, age (OR, 1.11, 95% CI, 1.07-1.16), smoking (OR, 3.83, 95% CI, 2.06-7.09), serum uric acid levels (OR, 1.26, 95% CI, 1.04-1.54) and average 10-year total risk of Framingham risk score (OR, 1.13, 95% CI, 1.04-1.09) appeared as independent factors predictive of presence of CAC (p<0.05).

Conclusion: Serum uric acid level is an independent risk factor for presence of coronary calcium. Moreover, increasing levels of serum uric acid are associated with increasing CACS. 

10.Determinants of coronary collateral circulation in patients with coronary artery disease
Cafer Zorkun, Emre Akkaya, Ali Zorlu, İzzet Tandoğan
PMID: 23128542  doi: 10.5152/akd.2012.250  Pages 146 - 151


Objective: This study aims to identify possible determinants of coronary collaterals in patients with severe coronary artery disease.

Methods: The current study has a retrospective cohort design. Seventy four patients with ?90% stenosis or total occlusion of the left anterior descending artery (LAD) were enrolled; coronary collateral grades, high-sensitive C-reactive protein (hs-CRP), fibrinogen, protein C and S, lipids, uric acid levels and medications applied before coronary angiography were noted and compared. Multiple logistic regression analysis was used for the multivariate analyses of independent variables associated with the development of adequate coronary collateral vessels.

Results: The presence of coronary collaterals was significantly higher in males (p=0.018), with higher hs-CRP (p=0.023), prior statin use (p=0.022), and higher Gensini scores (p<0.001). In multiple logistic regression analysis, hs-CRP levels (OR=0.94, 95.0% CI=0.883-1.000, p=0.048), male gender (OR=4.73, 95.0% CI=1.441-15.539, p=0.010) and prior statin usage (OR=4.70, 95.0% CI=1.264-17.452, p=0.021) were identified as independent predictors of coronary collateral development.

Conclusion: Male gender, prior statin usage, and higher hs-CRP levels are determinants of coronary collaterals in patients with coronary artery disease. 

11.The coronary collateral circulation-clinical predictors
Rahul Bahl, Adam Timmis, Pascal Meier
PMID: 23228978  doi: 10.5152/akd.2013.040  Pages 152 - 153
Abstract |Full Text PDF

12.Evaluation of anatomy, variation and anomaly of the coronary arteries with coronary computed tomography angiography
Cengiz Erol, Mustafa Koplay, Yahya Paksoy
PMID: 18608013  doi: 10.5152/akd.2013.041  Pages 154 - 164

Recent technical advances in computed tomography (CT) have improved image quality, diagnostic performance and accuracy of coronary CT angiography (CCTA). Latest dose-reduction strategies reduce radiation dose to an acceptable level even lower than that from conventional coronary angiography. CCTA is a noninvasive imaging modality which can effectively show complex coronary artery anatomy, variations and congenital anomalies of the coronary arteries. Congenital coronary artery anomalies are rare entities, but sometimes have a potential of producing fatal consequences. CCTA is now the primary imaging modality for the evaluation and diagnosis of coronary artery anomalies. Reporters should, therefore, have knowledge of the normal coronary artery anatomy and variations, and understand the different types of coronary artery anomalies and their respective prognostic implications in order to provide correct diagnosis and to prevent undesirable mistakes during interventional and surgical procedures. 

13.Percutaneous coronary intervention in patients with active bleeding or high bleeding risk
James Nguyen, Thach Nguyen
PMID: 23241334  doi: 10.5152/akd.2013.042  Pages 165 - 170

There is a lack of evidence from randomized clinical trials (RCT) supporting percutaneous coronary intervention (PCI) in patients with high bleeding risk or active bleeding. The management decisions are based on extrapolation of subgroups data in RCTs or experts’ opinions. Bleeding in the peri-PCI period also increases mortality. In general, PCI can be performed if bleeding can be stopped by mechanical means (compressing or ligating the artery) and the patient can tolerate 4 hours of anticoagulant without further bleeding. For patient with acquired or inherited high risk of bleeding, anecdotal reports showed that either unfractionated heparin or bivalirudin would be acceptable for PCI. For patients on chronic oral anticoagulants, PCI could be performed without new antithrombotic therapy if the international ratio (INR) is between 2 and 3. Antiplatelet therapy would be needed if new thrombi are detected at the index artery. Ultimately, the decision to perform PCI or treat the patient conservatively must be managed on a case-by-case basis.   If the benefits outweigh the risk, then the patient can undergo PCI. 

14.Basic principles in liquid electrolyte treatment
Ayşegül Zümrütdal
PMID: 23241335  doi: 10.5152/akd.2013.043  Pages 171 - 177

Under normal physiological conditions, our body fluids and electrolytes are protected in complete balance in a wonderful, flawless design. Even small deviations occurring in this equilibrium may lead to impairments, which can end in death. Especially in fairly common sodium metabolism disorders, it is the responsibility of the clinician to determine, according to the patient’s history and her physical examination of him, whether there is an excess or depletion of volume, and to arrange subsequent treatment. Serum sodium levels of 120, 140, or 150 mEq/L alone should be meaningless to the physician in relation to total body sodium and water content because either hyponatremia or hypernatremia can occur while the patient is hypovolemic, euvolemic, or hypervolemic. For example, administering hypertonic or isotonic saline treatment to a patient with hypervolemic hyponatremia in order to correct the sodium will clinically lead to both an increase in edema and a worsening of the hyponatremia. Treatment of hypo- and hypernatremia must be adjusted separately for each patient based on his age, presence of comorbid conditions, and the speed of development of the severity of clinical signs and symptoms. Adjustments either executed too slowly or too quickly will increase mortality or morbidity. For every patient presenting unexplained symptoms of the muscular, skeletal, or neurological systems, including confusion, making the first priority the conduction of electrolyte analyses and the correctly managed effective treatment of excesses or deficiencies may save lives and will certainly save time and money that would otherwise have been spent unnecessarily

15.Management of myocardial infarction related to in situ thrombosis
Ali Çoner, Aylin Yıldırır, Kaan Okyay, Haldun Müderrisoğlu
PMID: 23241336  doi: 10.5152/akd.2013.044  Pages 178 - 180
Abstract |Full Text PDF

16.Cannabis smoking and sildenafil citrate induced acute coronary syndrome in a patient with myocardial bridge
Kyung Been Lee, Bong Gun Song, Gu Hyun Kang, Yong Hwan Park
PMID: 23241337  doi: 10.5152/akd.2013.045  Pages 180 - 181
Abstract |Full Text PDF

17.A case of radial arteriovenous fistula during coronary angiography
Şevket Görgülü, Tuğrul Norgaz, Yusuf Şahingöz
PMID: 23241338  doi: 10.5152/akd.2013.046  Pages 181 - 182
Abstract |Full Text PDF

18.Radiofrequency catheter ablation of fascicular ventricular tachycardia in an elderly patient with complete atrioventricular block and VDD pacemaker
Fethi Kılıçarslan, Ömer Uz, Erdinç Hatipsoylu
PMID: 23241339  doi: 10.5152/akd.2013.047  Pages 183 - 184
Abstract |Full Text PDF

19.Myocardial 99m-Tc tetrofosmin reverse redistribution as a possible marker of tissue at risk
Anna Salerno, Gabriele Fragasso, Francesco Maranta, Luigi Gianolli, Alberto Margonato
PMID: 23241340  doi: 10.5152/akd.2013.048  Pages 184 - 186
Abstract |Full Text PDF

20.Tumor of the pericardium
Birol Özkan, Elnur Alizade, Göksel Acar, Ahmet Güler
PMID: 23443873  doi: 10.5152/akd.2013.097  Page 187
Abstract |Full Text PDF

21.Racial differences of endothelial function and plasma endothelin-1 level in preclinical Tibetan and Han male population
Bo Yang, Min Li, Bin Chen, Gang Wang, Yun-Dai Chen
PMID: 23274200  doi: 10.5152/akd.2013.051  Pages 188 - 189
Abstract |Full Text PDF

22.Intermittent fasting and laboratory findings in patients with prosthetic valves
Osama Rifaie, Ahmad Sami, Abdel Hadi Hamada, Ahmad Ashraf, Wail Nammas
PMID: 23274201  doi: 10.5152/akd.2013.052  Page 189
Abstract |Full Text PDF

23.New and important guide in acute coronary syndrome: optical coherence tomography
Onur Taşar, Özcan Başaran, Elif Eroğlu, Cevat Kırma
PMID: 23274202  doi: 10.5152/akd.2013.053  Page 190
Abstract |Full Text PDF

24.Partial pericardiotomy technique in beating heart coronary artery bypass surgery
Ömer Faruk Doğan, Cenap Özkara
PMID: 23274204  doi: 10.5152/akd.2013.055  Pages 191 - 192
Abstract |Full Text PDF

25.Almanac 2012: cardiovascular risk scores. The journals present selected research that has driven recent advances in clinical cardiology
Jill P. Pell
PMID: 23376646  doi: 10.5152/akd.2013.063  Pages 195 - 201


Global risk scores use individual level information on non-modifiable risk factors (such as age, sex, ethnicity and family history) and modifiable risk factors (such as smoking status and blood pressure) to predict an individual's absolute risk of an adverse event over a specified period of time in the future. Cardiovascular risk scores have two major uses in practice. First, they can be used to dichotomise people into a group whose baseline risk, and therefore potential absolute benefit, is sufficiently high to justify the costs and risks associated with an intervention (whether treatment or prevention) and a group with a lower absolute risk to whom the intervention is usually denied. Second, they can be used to assess the effectiveness of an intervention (such as smoking cessation or antihypertensive treatment) at reducing an individual's risk of future adverse events. In this context, they can be helpful in informing patients, motivating them to change their lifestyle, and reinforcing the importance of continued compliance.

26.An unusual defect and a rare combination: Gerbode defect and subaortic membrane
İbrahim Akpınar, Turgut Karabağ, Muhammet Raşit Sayın, Mehmet Emin Kalkan
PMID: 23274205  doi: 10.5152/akd.2013.056  Pages E7 - E8
Abstract |Full Text PDF

27.Anomalous origin of the right coronary artery from the left sinus of Valsalva
Zafer Işılak, Murat Uğur, Mehmet İncedayı, Mehmet Uzun
PMID: 23274206  doi: 10.5152/akd.2013.057  Pages E8 - E9
Abstract |Full Text PDF

28.Bifid origin of the right coronary artery, coexisting with an anomalous right bronchial artery originating from the circumflex coronary artery
Fahrettin Öz, Işık Erdoğan, Hüseyin Oflaz, Sebahattin Ateşal
PMID: 23274207  doi: 10.5152/akd.2013.058  Pages E9 - E10
Abstract |Full Text PDF

29.A successful percutaneous treatment of a iatrogenic anastomosis between internal mammary artery and great cardiac vein
Özcan Başaran, Ahmet Güler, Can Yücel Karabay, Cevat Kırma
PMID: 23274208  doi: 10.5152/akd.2013.059  Pages E10 - E11
Abstract |Full Text PDF

30.Multiple septal coronary cameral fistulas may cause myocardial ischemia
Turgay Işık, Mahmut Uluganyan, Mehmet Gül
PMID: 23274209  doi: 10.5152/akd.2013.060  Pages E11 - E12
Abstract |Full Text PDF

31.Three-dimensional echocardiography in the evaluation of cor triatriatum sinistrum in an adult patient with atrial septal defect
Sait Demirkol, Şevket Balta, Murat Ünlü, Mehmet Yokuşoğlu
PMID: 23274210  doi: 10.5152/akd.2013.061  Page E12
Abstract |Full Text PDF

32.Successful treatment of a patient with pulmonary embolism and biatrial thrombus
Hale Ünal Aksu, Mehmet Ertürk, Mehmet Gül, Nevzat Uslu
PMID: 23274211  doi: 10.5152/akd.2013.062  Pages E13 - E14
Abstract |Full Text PDF

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