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Volume : 15 Issue : 12 Year : 2021
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The Anatolian Journal of Cardiology - Anatol J Cardiol: 15 (12)
Volume: 15  Issue: 12 - December 2015
EDITORIAL
1.What Should be Expected from Medical Congresses?
Zeki Öngen
PMID: 26663223  PMCID: PMC5368466  doi: 10.5152/AnatolJCardiol.2015.17112015  Page 962
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
2.Cilostazol ameliorates atrial ionic remodeling in long-term rapid atrial pacing dogs
Zhiqiang Zhao, Weimin Li, Xinghua Wang, Yan Chen, Jian Li, Wansong Yang, Lijun Cheng, Enzhao Liu, Tong Liu, Guangping Li
PMID: 25880049  PMCID: PMC5368467  doi: 10.5152/akd.2014.5962  Pages 963 - 969
Objective: Ionic remodeling has a close correlation with the occurrence of atrial fibrillation (AF). Atrial tachypacing remodeling is associated with characteristic ionic remodeling. The purpose of this study was to assess the efficacy of cilostazol, an oral phosphodiesterase 3 inhibitor, for preventing atrial ionic remodeling in long-term rapid atrial pacing (RAP) dogs. Methods: We use the methods of patch-clamp and molecular biology to investigate the effect of cilostazol on ion channel and channel gene expression in long-term RAP dogs. Twenty-one dogs were randomly assigned to sham, control paced, and paced+cilostazol (5 mg/kg/d, cilo) groups, with 7 dogs in each group. The sham group was instrumented with a pacemaker but without pacing. RAP at 500 beats/min was maintained for 2 weeks in the paced and cilo groups. During the pacing, cilostazol was given orally in the cilo group. Whole-cell patch-clamp technique was used to record atrial L-type Ca2+ (ICaL) and fast sodium channel (INa) ionic currents. Western blot and RT-PCR were applied to estimate the gene expression of the ICaLα) 1C (Cav1.2) and INav1.5α) Nav1.5α) subunits. Statistical analysis was performed using SPSS 13.0. Results: The density of ICaL and INa currents (pA/pF) was significantly reduced in the paced group (ICaL: -6.55±1.42 vs. -4.46±0.59 pA/pF; INa: -48.24±10.54 vs. -30.48±5.20 pA/pF, p<0.01). The paced+cilo group could not increase the density of ICaL currents (ICaL: -4.37±1.25 pA/pF, p>0.05), while the INa currents were recovered (-44.54±12.65 pA/pF, p<0.01) compared with the paced group. The mRNA and protein expression levels of Cav1.2 and Nav1.5α were apparently down-regulated in the paced group (p<0.01), but after cilostazol treatment, both of these subunits were up-regulated significantly (p<0.01). Conclusion: Cilostazol may have protective effects on RAP-induced atrial ionic remodeling.

3.Protective effects of Hawthorn (Crataegus oxyacantha) extract against digoxin-induced arrhythmias in rats
Hayrullah Alp, Burak Cem Soner, Tamer Baysal, Ayşe Saide Şahin
PMID: 25880053  PMCID: PMC5368468  doi: 10.5152/akd.2014.5869  Pages 970 - 975
Objective: Digitalis preparations are commonly used by children and adults with heart diseases worldwide, although excessive doses may cause cardiac effects. The aim of the study is to evaluate the antiarrhythmic effect of Crataegus oxyacantha extract on digoxin-induced arrhythmias in anesthetized Wistar rats. Methods: Control and experimental groups were evaluated for arrhythmias induced by digoxin. Fifteen rats (7 as controls and 8 as the experimental group) were included in the study. The dry fruits of 100 mg Crataegus oxyacantha were extracted by percolation method. Digoxin, at a dose of 40 µg/kg/min, was infused to form the arrhythmias in all rats. Simultaneously, the extract was infused into the experimental group, while 0.9% NaCl was infused into control group. Electrocardiographic QRS prolongation and arterial blood pressure changes were analyzed. Results: The experimental group lived longer (62.13±2.20 min) than the controls (p=0.002). On the other hand, the time to beginning of QRS prolongation did not differ between the two groups (p=0.812). Bradycardia was significant in the control group (288.01±10.54 beat/min and p=0.01). The maximum QRS duration was observed in the control group during the digoxin and 0.9% NaCl infusion period (53.29±3.99 ms and p=0.001). Also, the durations of atrial and ventricular arrhythmias were shorter in the experimental group. However, arterial blood pressure dipping was significant in the experimental group (23.67±10.89 mm Hg and p<0.001). Conclusion: Crataegus oxyacantha alcoholic extract produced an antiarrhythmic effect that was induced by digoxin in Wistar rats. However, in the clinical use of this extract, the hypotensive effect should be considered. Also, the alcoholic extract of Crataegus oxyacantha may be an alternative treatment medication for arrhythmias induced by digoxin toxicity in humans.

4.Effects of amplitudes of whole-body vibration training on left ventricular stroke volume and ejection fraction in healthy young men
Farshad Ghazalian, Laleh Hakemi, Lotfali Pourkazemi, Mohammadreza Akhoond
PMID: 25880050  PMCID: PMC5368469  doi: 10.5152/akd.2014.5863  Pages 976 - 980
Objective: The aim of this study was to evaluate the effects of different whole-body vibration (WBV) training amplitudes on left ventricular stroke volume and ejection fraction in healthy young men. Methods: A total of 24 healthy men (age 21.71±1.49 year, height 176.17±6.61 cm, weight 70.73±10.08 kg, BMI 22.36±3.57 kg/m2, and body surface area 1.87±0.13 m2) were divided into two groups: high and low amplitude vibration (n=12). The vibration training consisted of 8 weeks of WBV 3 times a week with amplitudes of 2 or 4 mm and progressive frequencies from 20 Hz with increments of 5 Hz weekly. As outcome measures, left ventricular stroke volume and ejection fraction at baseline and after 8 weeks were evaluated. Mann-Whitney U test was used for the comparison between groups; Wilcoxon signed-ranks tests were used to compare pretest and post-test results in each group. A p value less than 0.05 was considered significant. Results: Whole-body vibration training with low amplitude (2 mm) caused an numerically increase in stroke volume (pre-test: 72.42±14.34; post-test: 78.42± 23.19 cm3; p=0.06) and ejection fraction (pre-test: 65.22±3.41; post-test: 67.00±4.18%; p=0.52). So; the increase was not significant. In the high-amplitude (4 mm) group, post-test results were nearly unchanged compared to the pre-test results. No significant difference was evident between groups. Conclusion: The intensity and volume of whole-body vibration training were not enough to affect systolic function.

5.Effects of administration of omega-3 fatty acids with or without vitamin E supplementation on adiponectin gene expression in PBMCs and serum adiponectin and adipocyte fatty acid-binding protein levels in male patients with CAD
Atena Ramezani, Fariba Koohdani, Abolghasem Djazayeri, Ebrahim Nematipour, Seyed Ali Keshavarz, Ali-Akbar Saboor-Yaraghi, Mohammad-Reza Eshraghian, Abbas Yousefinejad, Hassan Javanbakht, Mahnaz Zarei, Sanaz Gholamhosseini, Mahmoud Djalali
PMID: 25880054  PMCID: PMC5368470  doi: 10.5152/akd.2015.5849  Pages 981 - 989
Objective: Adiponectin is a unique anti-atherogenic adipocytokine. Regulation of adiponectin secretion is dysfunctional in cardiovascular diseases. The current trial study assessed the effects of omega-3 fatty acids with or without vitamin E on adiponectin gene expression in peripheral blood mononuclear cells and serum adiponectin and adipocyte fatty acid-binding protein (A-FABP; also called ap2 and FABP4) levels in patients with coronary artery disease (CAD). Methods: This randomized, double-blind, placebo-controlled trial included 67 male patients with CAD. First of the four group of participants received 4 g/day omega-3 fatty acids plus 400 IU/day vitamin E (OE), second group 4 g/day omega-3 fatty acids plus vitamin E placebo (OP), or both omega-3 fatty acid and vitamin E placebos (PP) for 8 weeks. Adiponectin gene expression and serum adiponectin and FABP4 levels were evaluated. Results: The combination of omega-3 fatty acids and vitamin E in patients with CAD affected their serum adiponectin and FABP4 levels and the adiponectin/FABP4 ratio significantly. In the OP group, serum adiponectin levels did not change significantly. Consumption of omega-3 fatty acids with and without vitamin E had no significant effect on adiponectin gene expression. Conclusion: Omega-3 fatty acids with or without vitamin E improve adiponectin levels in patients, without any significant changes in adiponectin gene expression. This nutritional intervention may prevent complications in patients with CAD because of increased adiponectin levels.

6.Relationship between epicardial fat tissue and left ventricular synchronicity: An observational study
Abdulkadir Kırış, Gülhanım Kırış, Oğuzhan Ekrem Turan, Mustafa Öztürk, Mürsel Şahin, Abdulselam İlter, Osman Bektaş, Merih Kutlu, Şahin Kaplan, Ömer Gedikli
PMID: 25880051  PMCID: PMC5368471  doi: 10.5152/akd.2014.5877  Pages 990 - 994
Objective: Left ventricular (LV) systolic synchrony is defined as simultaneous activation of corresponding cardiac segments. Impaired synchrony has some adverse cardiovascular effects, such as LV dysfunction and impaired prognosis. Epicardial fat tissue (EFT) is visceral fat around the heart. Increased EFT thickness is associated with some disorders, such as LV dysfunction and hypertrophy, which play a role in the impairment of LV synchrony. However, the relationship between EFT and LV systolic synchrony has never been assessed. Thus, we aimed to evaluate the possible relationship between EFT and LV synchrony in this study. Methods: The study population consisted of 55 consecutive patients (mean age 46.4±13.4 years, 32 female) without bundle branch block (BBB). EFT and LV systolic synchrony were evaluated by transthoracic echocardiography using 2D and tissue Doppler imaging. Maximal difference (Ts-6) and standard deviation (Ts-SD-6) of time to peak systolic (Ts) myocardial tissue velocity obtained from 6 LV basal segments were used to assess LV synchrony. Multiple regression analysis was used to detect the independently related factors to LV synchrony. Results: The mean values of EFT thickness, Ts-6, and Ts-SD-6 were found to be 2.7±1.6 mm (ranging from 1-7 mm), 20.1±14.2 msec, and 7.7±5.6, respectively. EFT thickness also was independently associated with Ts-6 (β=0.332, p=0.01) and Ts-SD-6 (β=0.286, p=0.04). Conclusion: EFT thickness is associated with LV systolic synchrony in patients without BBB.

7.A combination of the neutrophil-to-lymphocyte ratio and the GRACE risk score better predicts PCI outcomes in Chinese Han patients with acute coronary syndrome
Dong Zhou, Zhaofei Wan, Yan Fan, Juan Zhou, Zuyi Yuan
PMID: 26663224  PMCID: PMC5368472  doi: 10.5152/AnatolJCardiol.2015.6174  Pages 995 - 1001
Objective: The aims of this study are to evaluate the relationship between the Global Registry of Acute Coronary Events (GRACE) risk score and neutrophil to lymphocyte ratio (NLR) and to determine whether a combination of these factors improves the predictive value for long-term cardiovascular events in Chinese Han patients with acute coronary syndrome (ACS). Methods: In this prospective, observational, and single-center study, NLRs (neutrophil count/lymphocyte count) were calculated from the complete blood count of 1050 patients with ACS, whereas GRACE risk scores were calculated from patients’ clinical parameters obtained on arrival at our hospital. Cox proportional hazards models were used to determine independent factors associated with cardiovascular events. Results: NLR was positively correlated with the GRACE risk score (r=0.66, p<0.001), and both the GRACE risk score (HR: 1.01; 95% CI: 1.01–1.02; p<0.001) and NLR (HR: 1.09; 95% CI: 1.06–1.14; p<0.001) independently predicted cardiovascular events. The area under the receiver operating characteristic (ROC) curve was 0.69 (95% CI: 0.64–0.72; p<0.001) when the GRACE score was calculated alone; however, it significantly increased (p<0.001) to 0.77 (95% CI: 0.74–0.80; p<0.001) when the GRACE score was combined with NLR. Conclusion: This study shows for the first time that NLR is positively associated with the GRACE risk score and demonstrates that a combination of these two factors may improve the predictive value for cardiovascular events in Chinese Han patients with ACS.

8.Neutrophil-to-lymphocyte ratio predicts hemodynamic significance of coronary artery stenosis
Ahmet Akyel, Çağrı Yayla, Mehmet Erat, Tolga Çimen, Mehmet Doğan, Sadık Açıkel, Sinan Aydoğdu, Ekrem Yeter
PMID: 25880055  PMCID: PMC5368453  doi: 10.5152/akd.2015.5909  Pages 1002 - 1007
Objective: Coronary artery disease is closely linked with inflammation, and the neutrophil-to-lymphocyte ratio (NLR) has emerged as a new inflammatory marker. Fractional flow reserve (FFR) is a well-established method for determining hemodynamic significance of coronary artery stenosis. In this study, we aimed to investigate the relationship between NLR and hemodynamic significance of coronary artery lesion as assessed by FFR. Methods: A total of 134 patients with FFR measurement between January 2012 and December 2013 were enrolled in this retrospective study. Patients with single intermediate-grade coronary artery stenosis were enrolled, and those with second intermediate or severe coronary artery stenosis were excluded from study. Patients’ NLR were calculated. An FFR value of ≤0.80 was accepted for hemodynamic significance. Statistical analysis was performed by the chi-square test, Student’s t-test, Mann–Whitney U test, logistic regression analysis, and ROC curve analysis. Results: Patients with hemodynamically significant lesions had higher NLR values (3.3±1.2 vs. 2.0±0.9, p<0.001). White blood cell count, male gender, high-density lipoprotein levels, platelet-to-lymphocyte ratio, and NLR were found to be possible confounding factors predicting hemodynamically significant coronary artery stenosis. In multiple logistic regression analysis, NLR remained as the only independent predictor for hemodynamically significant coronary artery stenosis. An NLR value of 2.4 had 87.5% sensitivity and 78.4% specificity for prediction of hemodynamically significant coronary artery stenosis. Conclusion: In present study, we showed that NLR was significantly higher in patients with hemodynamically significant coronary artery stenosis. We also found NLR to be an independent predictor of hemodynamically significant coronary artery stenosis as measured by FFR. Further studies are needed to find a causal relationship.

9.Homocysteine levels in normotensive children of hypertensive parents
Ali Yıldırım, Fatma Keleş, Gökmen Özdemir, Pelin Koşger, Birsen Uçar, Özkan Alataş, Zübeyir Kılıç
PMID: 25880056  PMCID: PMC5368454  doi: 10.5152/akd.2015.5862  Pages 1008 - 1013
Objective: There are several studies showing an association between an increase in the plasma levels of homocysteine and the pathogenesis of hypertension. In this study, we assessed normotensive children of hypertensive adult parents to determine whether there is any change in homocysteine levels prior to the onset of hypertension. Methods: A total of 79 normotensive children of essential hypertensive parents who were followed-up at the cardiology department and 72 healthy children of normotensive parents who presented to the department of pediatrics at our clinic with complaints such as nonspecific chest pain and innocent murmur were included in the study. The participants’ complete blood count and low-density lipoprotein, high-density lipoprotein, triglyceride, total cholesterol, folic acid, vitamin B12, and homocysteine levels were noted. Results: No statistically significant differences were noted between the two groups in terms of age, gender, height, weight, body mass index, or levels of fasting lipids, folic acid, and vitamin B12 (p>0.05). Although the mean systolic and diastolic blood pressures were within the normal limits in both groups, they were significantly higher in children with a family history of hypertension than in controls (p<0.05). Similarly, homocysteine levels of children with a family history of hypertension were significantly higher than those of controls (p<0.01). Conclusion: Homocysteine levels of normotensive children of hypertensive parents are elevated before they develop hypertension. Homocysteine levels may be predictive of the subsequent development of hypertension in normotensive children of hypertensive parents.

10.Preoperative oral pentoxifylline in case of coronary artery bypass grafting with left ventricular dysfunction (ejection fraction equal to/less than 30%)
Soheil Mansourian, Payvand Bina, Arezoo Fehri, Abbas Ali Karimi, Mohammad Ali Boroumand, Kyomars Abbasi
PMID: 25880052  PMCID: PMC5368455  doi: 10.5152/akd.2014.5883  Pages 1014 - 1019
Objective: Most coronary artery bypass grafts are done by applying cardiopulmonary bypass, which usually induces unwanted inflammatory reactions and impairs the outcomes. In order to minimize the perilous response of cardiopulmonary bypass, pentoxifylline was getting used orally. Methods: In a prospective, placebo-controlled, randomized clinical trial, 178 coronary artery bypass graft candidates with ejection fraction lower/equal to 30%, divided into two equal groups (pentoxifylline and control), participated in the study. Pentoxifylline patients received 400 mg pentoxifylline 3 times a day for 3 days before operation. The outcomes were compared between groups using student’s t-test, Mann-Whitney U-test, Pearson chi-square, or Fisher’s exact test. Results: Pentoxifylline administration did not significantly affect troponin-T (p=0.68), but it reduced tumor necrosis factor-α (p=0.01) and interleukin-6 (p=0.01). It improved left ventricular ejection fraction significantly (p=0.01). White blood cell and platelet counts, hemoglobin, and hematocrit were not influenced by pentoxifylline. The drug did not affect blood urea nitrogen and creatinine, occurrence of renal failure, cerebrovascular accidents, and in-hospital mortality rate. The need for an intra-aortic balloon pump, cardiopulmonary bypass, and aortic cross-clamp times were not affected, either. Pentoxifylline decreased the intensive care unit stay (p<0.001), ventilation time, 10.4 hours in the pentoxifylline group against 14.7 hours in the control group (p=0.01), and the requirement of inotropic agents (p=0.02) and blood transfusion (p=0.01). Conclusion: Pentoxifylline has more beneficial potencies in reducing adverse events after coronary artery bypass graft using cardiopulmonary bypass, than what are known.

EDUCATION
11.A review of the fixed dose use of new oral anticoagulants in obese patients: Is it really enough?
Ekrem Güler, Gamze Babur Güler, Gültekin Günhan Demir, Suzan Hatipoğlu
PMID: 26663225  PMCID: PMC5368456  doi: 10.5152/AnatolJCardiol.2015.6532  Pages 1020 - 1029

Obesity is a significant cause of morbidity and mortality, and it is becoming increasingly prevalent worldwide. Altered pharmacodynamics and pharmacokinetics of drugs in obese patients require dose adjustment according to body weight. New oral anticoagulants (NOACs), which are more frequently used for anticoagulation, are recommended to be used at a fixed dose based on data derived from phase 2 and 3 studies. However, the representation of obese patients [>100 kg or a body mass index (BMI) of >30 kg/m2] in subgroups with a small sample size and reports of various emboli cases under drug treatment have raised suspicions about the adequacy of fixed dose use. To address this issue, we analyzed several patients with a body weight of >100 kg or BMI of >30 kg/m2 participating in NOAC studies and evaluated whether these numbers were sufficient to enable an accurate recommendation of fixed dose use in obese patients. 


CASE REPORT
12.Mitral-aortic intervalvular fibrosa pseudoaneurysm with rupture into the left atrium: a three-dimensional trans-esophageal echocardiographic approach
Tolga Çimen, Mehmet Doğan, Uğursay Kızıltepe, Ahmet Akyel, Hamza Sunman, Ekrem Yeter
PMID: 26663226  PMCID: PMC5368457  doi: 10.5152/AnatolJCardiol.2015.6663  Pages 1030 - 1031
Abstract | Full Text PDF

13.Thrombosis of the left internal mammary artery graft causing acute coronary syndrome after 4 years of coronary bypass surgery
Süleyman Sezai Yıldız, Gökhan Aksan, Serhat Sığırcı, Kudret Keskin, Kadriye Kılıçkesmez
PMID: 26663227  PMCID: PMC5368458  doi: 10.5152/AnatolJCardiol.2015.6614  Pages 1031 - 1032
Abstract | Full Text PDF

DIAGNOSTIC PUZZLE - ANSWER
14.Hyponatremia and heart failure: the overlooked piece of the puzzle
Yavuzer Koza, Muhammed Hakan Taş, Ziya Şimşek, Fuat Gündoğdu
PMID: 26663228  PMCID: PMC5368459  doi: 10.5152/AnatolJCardiol.2015.6743  Page 1033
Abstract | Full Text PDF

LETTER TO THE EDITOR
15.Balloon test occlusion, device selection, and extracorporeal membrane oxygenation in the transcatheter closure of coronary artery fistula
Mustafa Gülgün, Muzaffer Kürşat Fidancı, Alparslan Fatih Genç
PMID: 26663229  PMCID: PMC5368460  doi: 10.5152/AnatolJCardiol.2015.6735  Pages 1034 - 1035
Abstract | Full Text PDF

16.Duration after coronary artery bypass graft surgery and saphenous vein graft disease
Mehmet Eyüboğlu, İlhan Koyuncu
PMID: 26663230  PMCID: PMC5368462  doi: 10.5152/AnatolJCardiol.2015.6754  Page 1035
Abstract | Full Text PDF

17.The first succesful extracorporeal membranous oxygenation treatment in a child with refractory fulminant myocarditis in Turkey
Ayşe Berna Anıl, Fulya Kamit Can, Soysal Turhan, Neslihan Zengin, Murat Anıl, Ali Rahmi Bakiler, Buket Doğrusöz
PMID: 26663231  PMCID: PMC5368464  doi: 10.5152/AnatolJCardiol.2015.6681  Pages 1036 - 1037
Abstract | Full Text PDF

DIAGNOSTIC PUZZLE
18.Hyponatremia and heart failure: the overlooked piece of the puzzle
Yavuzer Koza, Muhammed Hakan Taş, Ziya Şimşek, Fuat Gündoğdu
PMID: 26663228  PMCID: PMC5368465  doi: 10.5152/AnatolJCardiol.2015.6743  Page 1038
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
19.The X-mark signature of pulmonary veins in an infant’s heart
Pelin Ayyıldız, İbrahim Cansaran Tanıdır, Erkut Öztürk, Alper Güzeltaş
PMID: 26663232  PMCID: PMC5368473  doi: 10.5152/AnatolJCardiol.2015.6707  Page E30
Abstract | Full Text PDF

20.A man with a pellet gunshot wound
Mengsi Li, Dongxu Li, Qi An
PMID: 26663233  PMCID: PMC5368474  doi: 10.5152/AnatolJCardiol.2015.6783  Pages E30 - E31
Abstract | Full Text PDF