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The Anatolian Journal of Cardiology - Anatol J Cardiol: 14 (5)
Volume: 14  Issue: 5 - August 2014
EDITORIAL
1.Summary of the content of the Anatolian Journal of Cardiology
Bilgin Timuralp
PMID: 25237704  doi: 10.5152/akd.2014.487956  Pages 411 - 412
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
2.The effects of Ramadan fasting on heart rate variability in healthy individuals: a prospective study
Mehmet Cansel, Hakan Taşolar, Jülide Yağmur, Necip Ermiş, Nusret Açıkgöz, Ferhat Eyüpkoca, Hasan Pekdemir, Ramazan Özdemir
PMID: 24901017  doi: 10.5152/akd.2014.5108  Pages 413 - 416
Objective: Ramadan fasting is one of the five fundamental rituals of Islam. Heart rate variability (HRV) is an independent predictor of increased mortality of patients with myocardial infarction and congestive heart failure. Although many patients in this region fast once a year, the effects of fasting on the HRV, which has a prognostic significance for patients with myocardial infarction and congestive heart failure, are not known. Therefore, the study on the effects of one month fast of HRV in healthy volunteers seems to be reasonable to address. Methods: Our study is a prospective cohort study that includes a total of 40 healthy volunteers with sinus rhythm between 19 and 40 years of age (16 female and 24 male). HRV was determined twice by ambulatory 24-hour Holter recordings at fasting in the middle of Ramadan and first week after Ramadan month. Mean values of continuous variables were compared by using the Student t-test or Mann-Whitney U test. Paired t-test or Wilcoxon test were used for comparison of variables between groups. Results: When two groups compared, statistically significant differences were found in terms of RR (p=0.049), SDNNI (p=0.010), rMSSD (p=0.009), pNN50 (p=0.015), T power (p=0.009), LF (p=0.008), Lfnu (p=0.002), HF (p=0,022) and Hfnu (p=0.013) values. Conclusion: In our study, HRV parameters were found to be increased in Ramadan month, so we think that Ramadan fasting enhances the activity of the parasympathetic system.

3.Assessment of right ventricular function by isovolumic contraction acceleration before and after percutaneous closure of atrial septal defects: A preliminary study
Ali Rıza Akyüz, Levent Korkmaz, Turhan Turan, Abdulkadir Kırış, Hakan Erkan, Mustafa Tarık Ağaç, Muslihittin Emre Erkuş, Şükrü Çelik, Ramazan Akdemir
PMID: 24901018  doi: 10.5152/akd.2014.4828  Pages 417 - 421
Objective: The main purpose of present study was to investigate the impact of percutaneous closure of atrial septal defect (ASD) on right ventricular (RV) systolic function assessed by tricuspid annular isovolumic myocardial acceleration (IVA) that is independent of preload and afterload changes. Methods: A prospective cohort study was designed involving twenty five patients with secundum type ASD whom were successfully closed percutaneously between 2009 and 2011. Standard transthoracic echocardiography and tissue Doppler imaging were performed in all patients 12 to 24 hours before and one month after closure. Paired t test was performed to determine the statistical significance of variables before and after closure. Results: Significant decreases were observed in RV end-diastolic diameter, RV/left ventricular (LV) end-diastolic diameter ratio, right ventricular systolic myocardial velocity (Sm), right ventricular early myocardial velocity (Em) and right ventricular late myocardial velocity (Am) in the control echocardiography in the first month when compared with pre-procedure values. While significant increase was observed after procedure in right ventricular IVA (3.4±1.3 m/sec2 vs. 4.2±1.8 m/sec2, p=0.001), no significant change was observed in right ventricular global performance index, in right ventricular Em/Am ratio and left ventricular ejection fraction. Conclusion: Percutaneous closure of ASD resulted in recovery of right ventricular function as early as 1 month after closure.

4.Evaluation of left ventricular functions in patients with pseudoexfoliation syndrome using tissue Doppler echocardiography and its association with plasma BNP levels
Dilek Çiçek Yılmaz, Ayça Yılmaz, İdil Göksel, Abdullah Cirit, Fikret Şen, Lülüfer Tamer
PMID: 24901019  doi: 10.5152/akd.2014.4878  Pages 422 - 426
Objective: Pseudoexfoliation syndrome (PES) is a systemic disorder that involves various visceral organs. In this observational cross-sectional study we aimed to investigate the left ventricular functions in patients with PES by using tissue Doppler imaging and correlations between B-type natriuretic peptide levels and cardiac functions. Methods: The study enrolled 22 patients with PES (9 male, 41%), aged 57.0±8.8 years, and 23 control subjects (9 male, 39%), aged 52.8±4.9 years. Patients with any cardiovascular disease were excluded. Fasting blood samples were taken and tissue Doppler imaging was performed at the mitral annulus with echocardiographic examination. The independent t and Mann-Whitney U tests were used. Results: The Em velocities at the basal septum and lateral annulus were significantly lower in patients with PES showing decreased diastolic functions (7.6±2.0 versus 9.1±1.6 cm/s, p=0.01 and 9.3±3.5 versus 11.5±3.1 cm/s, p=0.04 respectively). While global left ventricular systolic function assessed by ejection fraction was not significantly different between patients with PES and controls, the septum S-wave velocities of PES patients were lower (7.6±1.3 versus 8.5±1.2 cm/s, p=0.03). Total plasma B-type natriuretic peptide (BNP) levels were significantly higher in PES patients (129.04±99.38 pg/mL versus 59.64±53.69 pg/mL; p=0.005) and there was a negative correlation between plasma BNP concentration and mitral annulus average Em velocities (r=-0.554, p=0.009). E/Em ratio was also significantly higher in PES patients (7.85±2.01 versus 6.64±1.48, p=0.03). Conclusion: In this study we showed decreased left ventricular diastolic functions correlated with plasma BNP levels in PES patients. Although further studies needed, evaluation and follow-up of PES patients in terms of left ventricular functions will be useful.

5.Assessment of the severity of aortic regurgitation with pulsed wave Doppler velocity profile in the descending aorta
Belma Kalaycı, Süleyman Kalaycı, Pınar Türker Bayır, Serkan Duyuler, Saadet Güven, Taner Şen, Omaç Tüfekçioglu
PMID: 24901020  doi: 10.5152/akd.2014.4879  Pages 427 - 433
Objective: The quantitative parameters which are used to assess the severity of aortic regurgitation (AR) provide the most accurate information whereas these parameters are difficult and time-consuming. The aim of this study was to get a practical parameter to use in daily practice for assessing the severity of aortic regurgitation. Methods: The study was an observational cohort study on diagnostic accuracy of severity of aortic regurgitation. Thirty-seven patients with aortic regurgitation determined by quantitative parameters (18 patients with severe aortic regurgitation and 19 patients with moderate aortic regurgitation) were included in this study. Each patient’s diastolic flow pattern in the descending aorta was examined by pulsed wave Doppler. Systolic and diastolic flow time-velocity integral (TVI), TVI time, systolic and diastolic TVI ratio in the descending aorta were evaluated. In addition to these parameters, dP/dt, peak acceleration time and end-diastolic flow velocity in the diastolic flow were determined. We investigated whether there a significant difference between two groups or not. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off values of echocardiographic parameters which were used to identify the severity of aortic regurgitation. Results: The study population was composed of 16 female and 21 male patients. Their mean age was 46.5 years. The mean diastolic flow TVI of patients who had moderate and severe aortic regurgitation was found 10.1 cm and 18.6 cm, respectively (p<0.001). In the ROC curve analysis, the values of diastolic flow TVI above 13.5 cm was found to have 83% sensitivity and 90% specifity to predict the severity of aortic regurgitation (AUC: 0.91, 95% CI 0.80-1.0, p<0.001). Also we investigated the other parameters like systolic flow TVI, the ratio of systolic and diastolic flow TVI, mean diastolic flow time, mean systolic flow time, the ratio of systolic and diastolic flow time, end-diastolic velocity, peak acceleration time, dP/dt values in evaluation of diastolic flow in the descending aorta. These parameters were found statistically significant in assessing the severity of aortic regurgitation but their statistical power was weak. Conclusion: TVI of diastolic flow which is measured with pulsed wave Doppler in descending aorta could be a practical parameter in assessing the severity of aortic regurgitation.

6.Could decreased vitamin D levels be related with impaired cardiac autonomic functions in patients with chronic heart failure: an observational study
Metin Çetin, Güliz Kozdağ, Dilek Ural, Göksel Kahraman, İrem Yılmaz, Yaşar Akay, Raşit Onuk, Nigar Dursun
PMID: 24901021  doi: 10.5152/akd.2014.4869  Pages 434 - 441
Objective: Vitamin D status has been implicated in the pathophysiology of heart failure (HF). The aim of this study was to investigate the association between vitamin D levels with heart rate variability and heart rate turbulence in patients with heart failure whom had ischemic and non-ischemic dilated cardiomyopathy. Methods: Study designed as an observational cross-sectional study. Seventy-one patients [36 non-ischemic dilated cardiomyopathy (NIDCM), 35 ischemic dilated cardiomyopathy (IDCM)] with chronic heart failure and 25 control subject were included It was evaluated the association between 25 hydroxyvitamin D [25(OH)D] and calcitriol levels with heart rate variability time domain (SDNN, SDANN, RMSSD) and heart rate turbulence [turbulence onset (TO), turbulence slope (TS)] parameters. Statistical analysis was performed using Kruskal-Wallis test and ANOVA. Results: Calcitriol levels in NIDCM patients with abnormal TO and TS were significantly lower than NIDCM patients with normal TO (17.1±11.3 vs 27.6±15.5 pg/mL, p=0.05) and TS (16.6±9.1 vs 29.4±16.9 pg/mL, p=.018). There was a positive correlation between 25 (OH) D with heart rate variability parameters SDNN (r=0.368, p=0.027) and SDANN (r=0.360, p=0.031). It was not found any association between vitamin D and parameters of heart rate variability and heart rate turbulence in IDCM patients. Conclusion: Insufficiency of vitamin D may have deleterious effects on cardiac autonomic functions which were showed with heart rate turbulence and heart rate variability in patients with NIDCM. Vitamin D levels might be a predictor to determine the sudden cardiac death in patients with non-ischemic etiology.

7.No association between scar size and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia
Kıvanç Yalın, Ebru Gölcük, Erhan Teker, Ravza Yılmaz, Memduh Dursun, Ahmet Kaya Bilge, Kamil Adalet
PMID: 24901022  doi: 10.5152/akd.2014.4918  Pages 442 - 447
Objective: Microvolt T-wave Alternans (TWA) is associated with abnormal repolarization and predicts arrhythmic mortality in patients with previous myocardial infarction (MI). Infarct tissue size and heterogeneity characterized by cardiac magnetic resonance (CMR) has been shown to be associated with arrhythmogenic substrates and sudden cardiac death. Although both delayed enhancement-CMR (de-CMR) and TWA are useful in risk stratification of post-MI patients with preserved left ventricular function, the relationship between scar size and TWA has not studied yet. In this study, we aimed to study the relation between TWA and scar size and characteristics assessed with CMR in post-MI patients (pts) with relatively preserved systolic function presented with nonsustained VT. Methods: This observational cross-sectional study was enrolled 36 post-MI patients with mild-systolic dysfunction and non-sustained ventricular tachycardia. Eight pts were excluded. Both TWA and contrast enhanced CMR were performed. Left ventricular ejection fraction (LVEF), dense scar, peri-infarct zone and total scar masses were assessed and these values to left ventricular (LV) mass ratios were calculated. Infarct ratios and characteristics were determined and compared among patients with negative TWA and those with positive TWA. Results: For the positive (n=12) versus negative (n=16) TWA patients there were no significant difference between LVEF (44.9±5.4% vs. 44.0±3.2%, p=NS) and LV masses (121.89±26.56 g vs. 106.14±21.16 g, p=NS). The ratio of scar core to LV mass (3.37±0.68% vs. 3.31±1.01%, p=NS), peri-infarct zone to LV mass (23.61±7.93% vs. 21.64±9.08%, p=NS), total scar to LV mass (26.98±7.86% vs. 24.96±9.62%, p=NS) were all similar. Conclusion: There were no association between scar size and infarct heterogeneity and prevelance of TWA in post-MI patients with relatively preserved LVEF with non-sustained VT. Our data suggest that these two modalities may reflect different arrhythmogenic mechanisms in this cohort.

EDITORIAL COMMENT
8.No association between scar and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with non-sustained ventricular tachycardia
Ludmila Danilowicz-Szymanowicz
PMID: 24968973  doi: 10.5152/akd.2014.1310325  Pages 448 - 449
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
9.Presence of fragmented QRS and its correlation with myocardial performance index in patients with nephrotic syndrome
Gülsüm Özkan, Adem Adar, Şükrü Ulusoy, Hüseyin Bektaş, Abdulkadir Kırış, Mehmet Fidan, Şükrü Çelik
PMID: 24901023  doi: 10.5152/akd.2014.4886  Pages 450 - 455
Objective: More cardiovascular events are seen in nephrotic syndrome (NS) patients than in the normal population. Fragmented QRS (fQRS) includes various RSR' patterns with different morphologies of the QRS complexes with or without the Q wave on a resting 12-lead ECG. A relationship between the presence of fQRS and myocardial function impairment has been shown in several studies. The purpose of this study was to evaluate the presence of fQRS in this patient group and the relationship with myocardial functions. Methods: Thirty-four NS patients were included in the cross-sectional study. Demographic data were recorded, and electrocardiograms (ECGs) were analyzed for the presence of fQRS following investigation of biochemical parameters and 24-h protein excretion. In addition to classic echocardiographic parameters, the myocardial performance (Tei index) was calculated as an indicator of cardiac function. For comparison of group's data Student’s t-test and Mann-Whitney U test were used. Multiple linear regression analysis was performed for parameters affecting presence of fQRS. Results: We identified fQRS in half of our patients group. Patients with fQRS had significantly greater proteinuria level and Tei index than those without (p<0.05 and p<0.001, respectively). Tei index was also affected presence of fQRS (p<0.05, β=0.45, R2=0.32) and positively correlated with proteinuria levels (p<0.05 r=0.366). Conclusion: We demonstrated, for the first time in the literature, that the determination of fQRS in patients with NS in surface ECG, an easily accessible technique, can be used as a parameter in the prediction of myocardial functions.

10.Mean platelet volume and arterial stiffness in patients with acromegaly
Mustafa Ünübol, Engin Güney, Mevlüt Türe, Ufuk Eryılmaz
PMID: 24901024  doi: 10.5152/akd.2014.4898  Pages 456 - 463
Objective: There are still contradictory data in the literature whether patients with acromegaly are under risk interms of atherosclerotic heart disease. Increased arterial stiffness dev elops before atherosclerosis and is ev aluated to be a risk factor for atherosclerosis. Mean platelet v olume (MPV) is currently gaining interest as a new independent cardiov ascular risk factor. There are contrasting v iews about arterial stiffness in patients with acromegaly. There is no report in literature study ing MPV in acromegaly patients. The aim of this study was to ev aluate MPV and arterial stiffness in patients with acromegaly. Methods: This study was designed as an observ ational cross-sectional, casecontrolled study. Twenty -eight patients with acromegaly and 22 healthy v olunteers were recruited for the study. The arteriography dev ice Mobil-O-Graph® (IEM GmbH. Stolberg, Germany ) which can perform oscillometric measurements was used to measure arterial stiffness. The Mann-Whitney U test, Student's t-test, Spearman's nonparametric correlation analy sis and the chi-square test were used to statistical analy ze. Results: Aortic pulse wav e v elocity (PWV) v alue was found to be 6.41 ±2.1 2 m/s in the patient group with activ e acromegaly and 5.24±1.04 m/s in the healthy control group. The difference was statistically significant (p=0.03). The mean MPV v alue was found to be 9.68±1.1 1 in the patient group with activ e acromegaly and 8.53±1.1 8 in the healthy control group. There was a statistically significant difference between the two groups (p=0.004). In patients with acromegaly, a positiv e correlation was found between MPV and insulin-like growth hormone-I (IGF-1 ) lev el (p=0.021, r=0.434). Conclusion: We determined an increase in aortic PWV and MPV in patients with acromegaly. In conclusion, ev aluation of MPV and arterial stiffness in future studies could be beneficial in determining the risks for cardiov ascular disease in patients with acromegaly.

11.Carotid artery intima-media thickness in pediatric type 1 diabetic patients
Özlem Bayır, Hüseyin Anıl Korkmaz, Ceyhun Dizdarer, Timur Meşe, Vedide Tavlı
PMID: 24901025  doi: 10.5152/akd.2013.4788  Pages 464 - 470
Objective: To compare the carotid artery intima-media thickness in pediatric type 1 diabetic patients with that in healthy control subjects matched for age, sex, height, weight, body mass index (BMI) and waist circumference. Methods: Fifty diabetic patients and forty-five control subjects were enrolled into this observational, cross-sectional, controlled study. Carotid artery intima-media thickness (cIMT), flow-mediated dilation (FMD) and carotid stiffness index were measured by using a carotid Doppler and real-time ultrasound. Student's t, chi-square and Kolmogorov-Smirnov tests and Pearson’s correlation coefficient were used for the statistical analysis. Results: There were no significant differences in the groups for age, sex, height, weight, BMI and waist circumference (mean age 12.10±2.02 vs. 11.49±1.90 years, weight 41.14±11.28 vs. 40.88±11.68 kg, height 149.78 ±20.3 vs. 145.62±20.14 cm, BMI 18.49±2.64 vs. 18.26±2.59 kg/m2, waist circumference 69.72±8.6 vs. 66.05±7.47 cm, respectively). A significantly higher cIMT was found in the patients with type 1 diabetes (0.49±0.05 vs. 0.44±0.03 mm; p<0.001). A higher carotid stiffness index was found in the diabetic group when compared with control group (3.11±0.46 vs. 2.6±0.29 mm; p<0.001). Carotid IMT was not affected by mean HbA1c level and median HbA1c level (r=0.112, p=0.437 and r=0.249, p=0.082). Conclusion: Type 1 diabetes is associated with higher cIMT and carotid stiffness index in a pediatric population.

EDUCATION
12.From wide QRS tachycardia to a diagnostic surprise
Şükrü Akyüz, Selçuk Yazıcı, Sait Terzi, Ufuk Sadık Ceylan, Emel Çeliker
PMID: 24968974  doi: 10.5152/akd.2014.5529  Pages 471 - 474
A 29-year old male patient presented with a hemodynamically significant ventricular tachycardia. Despite a comprehensive examination, the correct diagnosis was unfortunately established after two years. We discuss why the correct diagnosis was initially overlooked in physical examination, electrocardiogram, echocardiography and cardiac magnetic resonance imaging, and which findings led the cardiologists to misdiagnose the patient. We have organized this report in a format that the information is presented to a consultant physician by a resident physician to simulate the way such information emerges in the real life as we have encountered. The consultant physician responds as new information is presented, expressing his reasoning with the reader.

CASE REPORT
13.Percutaneous mitral valve repair with the MitraClip system in a patient with subacute severe mitral regurgitation caused by papillary muscle rupture
Mehmet Bilge, Recai Alemdar, Sina Ali, Ayşe Saatcı Yaşar
PMID: 24968975  doi: 10.5152/akd.2014.5352  Pages 475 - 476
Abstract | Full Text PDF

14.Multiple-site bleeding with prominent rise in coagulation tests in an elderly woman using dabigatran etexilate
Cem Barçın, Hasan Kutsi Kabul, Emre Yalçınkaya, Mustafa Demir
PMID: 24968976  doi: 10.5152/akd.2014.5274  Page 477
Abstract | Full Text PDF

15.Incremental utility of Live/Real time three-dimensional transesophageal echocardiography in a case with ventricular septal aneurysm and hypertrophic obstructive cardiomyopathy: A case report
Mehmet Baran Karataş, Barış Güngör, Ferit Onur Mutluer, Gündüz Durmuş, Yiğit Çanga, Osman Bolca
PMID: 24968977  doi: 10.5152/akd.2014.5282  Pages 478 - 480
Abstract | Full Text PDF

16.A rare cause of recurrent modified Blalock-Taussig shunt thrombosis: Antiphospholipid antibodies
Neslihan Kıplapınar, Ersin Erek, Ender Ödemiş, Erkut Öztürk
PMID: 24968978  doi: 10.5152/akd.2014.5279  Pages 480 - 481
Abstract | Full Text PDF

17.A very rarely seen cardiac mass (Rosai-Dorfman disease)
Ersan Özbudak, Ali Ahmet Arıkan, Şadan Yavuz, Ümit Halıcı, Turan Berki
PMID: 24968979  doi: 10.5152/akd.2014.5297  Pages 481 - 483
Abstract | Full Text PDF

DIAGNOSTIC PUZZLE
18.Newly developed lesions in right coronary artery during PCI
Ahmet Güler
PMID: 24968984  doi: 10.5152/akd.2014.5455  Page 484
Abstract | Full Text PDF

LETTER TO THE EDITOR
19.Diastolic dysfunction and left atrial appendages: Time to phenotype the process of fibrosis
Michele M. Ciulla
PMID: 24968980  doi: 10.5152/akd.2014.5595  Pages 485 - 486
Abstract | Full Text PDF

20.Initial results of code blue emergency call system: First experience in Turkey
Umut Gülaçtı, Mahir Çelik, Salaheddin Akçay, Mehmet Özgür Erdoğan, Cemal Üstün
PMID: 24968981  doi: 10.5152/akd.2014.5266  Pages 486 - 487
Abstract | Full Text PDF

DIAGNOSTIC PUZZLE
21.Newly developed lesions in right coronary artery during PCI
Ahmet Güler, Yeliz Güler, Cevat Kırma
PMID: 24968984  doi: 10.5152/akd.2014.5455  Page 488
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
22.Successful transcatheter closure of large coronary artery fistula
Uğur Arslantaş, Elnur Alizade, Mustafa Tabakçı, Selçuk Pala
PMID: 24968982  doi: 10.5152/akd.2014.5641  Pages E11 - E12
Abstract | Full Text PDF

23.Giant right coronary artery aneurysm with atherosclerotic disease
Arif Süner, Sedat Köroğlu, Hakan Kaya, Murat Ercişli, Ercan Başçeşme, Bülent Petik
PMID: 25091973  doi: 10.5152/akd.2014.5367  Pages E12 - E13
Abstract | Full Text PDF

24.Double aortic arch associated with tracheal and esophageal compression in an adult
Mutlu Çağan Sümerkan, Füsun Helvacı, Muzaffer Başak
PMID: 24968983  doi: 10.5152/akd.2014.5487  Pages E14 - E15
Abstract | Full Text PDF