ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 16 (2)
Volume: 16  Issue: 2 - February 2016
1.What do biomarkers mark?
Zeki Öngen
PMID: 26898250  PMCID: PMC5336739  doi: 10.14744/AnatolJCardiol.2016.02  Page 75
Abstract |Full Text PDF

2.Effect of intermittent hypoxia on the cardiac HIF-1/VEGF pathway in experimental type 1 diabetes mellitus
Derya Güzel, Ali Doğan Dursun, Hakan Fıçıcılar, Demet Tekin, Ayhan Tanyeli, Fırat Akat, Ferda Topal Çelikkan, Bizden Sabuncuoğlu, Metin Baştuğ
PMID: 26467365  PMCID: PMC5336740  doi: 10.5152/akd.2015.5925  Pages 76 - 83
Objective: High altitude and hypoxic preconditioning have cardioprotective effects by increasing coronary vascularity, reducing post-ischemic injury, and improving cardiac function. Our purpose was to examine if intermittent hypoxia treatment has any restoring effects related to the possible role of the HIF-1/VEGF pathway on diabetic cardiomyopathy.
Methods: Wistar Albino male rats (n=34) were divided into four groups: control (C), intermittent hypoxia (IH), diabetes mellitus (DM), and diabetes mellitus plus intermittent hypoxia (DM+IH). Following a streptozotocin (STZ) injection (50 mg/kg, i.p.), blood glucose levels of 250 mg/dL and above were considered as DM. IH and DM+IH groups were exposed to hypoxia 6 h/day for 42 days at a pressure corresponding to 3000 m altitude. Twenty-four hours after the IH protocol, hearts were excised. Hematoxylin and eosin-stained apical parts of the left ventricles were evaluated. Hypoxia inducible factor-1 (HIF-1), vascular endothelial growth factor 164 (VEGF164), and VEGF188 polymerase chain reaction products were run in agarose gel electrophoresis. Band density analysis of UV camera images was performed using Image J. The data were compared by one-way ANOVA, repeated measures two-way ANOVA, and the Kruskal-Wallis test.
Results: The percent weight change was lower in the DM group than in the controls (p=0.004). The tissue injury was the highest in the DM group and the least in the IH group. Diabetes decreased, whereas the IH treatment increased the vascularity. A decrease was observed in the VEGF188 mRNA levels in the DM+IH group compared with the C group, but there were no difference in HIF-1α and VEGF164 mRNA levels between the groups.
Conclusion: The IH treatment restored the diabetic effects on the heart by reducing tissue injury and increasing the capillarity without transcriptional changes in HIF-1/VEGF correspondingly.

3.Using a standardized follow-up program to improve coronary heart disease secondary prevention
Yanjun Gong, Fan Yang, Tao Hong, Yong Huo
PMID: 26467366  PMCID: PMC5336741  doi: 10.5152/akd.2015.5571  Pages 84 - 91
Objective: To reveal the current status and effectiveness of a standardized follow-up of the secondary prevention of coronary heart disease (CHD) at Peking University First Hospital.
Methods: The study group comprised 496 patients diagnosed with CHD between January 1, 2007 and December 31, 2009 after a standardized follow-up program began. A group of 300 patients with CHD diagnosed between January 1, 2004 and December 31, 2004 was evaluated as the control group. The study group participants were followed-up every 3 months for 1 year in the outpatient department and were interviewed by telephone between November 2012 and January 2013. Data on the control of risk-factors, medical therapy, and clinical events were collected.
Results: At discharge, 75.4% of the study group patients were non-smokers, 51.4% exercised regularly, 42.4% were overweight, 56.7% had blood pressure <140/90 mm Hg (<130/80 in those with diabetes mellitus), 51% had serum low-density-lipoprotein cholesterol <2.60 mmol/L, and 64.2% had fasting plasma glucose <6.11 mmol/L. Antiplatelet medication was used by 99.4% of the study group patients, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers by 64.5%, beta-blockers by 79.1%, and statins by 94.3%. Major adverse cardiac events, the primary clinical outcome, occurred in 22.7% of the study group patients. The proportions of non-smokers (82.2% vs. 73.7%, p=0.014), control of serum lipids (84.4% vs. 45.6%, p<0.001), and use of statins (92.5% vs. 54.3%, p<0.001) at the end of follow-up were significantly greater in the study group than those in the control group.
Conclusion: Although some patients with CHD were still not achieving the goals of lifestyle change, control of risk factors, and medication therapy, standardized follow-up helped improve and standardize CHD secondary prevention.

4.Effectiveness of a standard secondary coronary prevention program: not obligate
Altan Onat
PMID: 26898251  PMCID: PMC5336742  doi: 10.14744/AnatolJCardiol.2015.15958  Pages 92 - 93
Abstract |Full Text PDF

5.Effects of energy drinks on blood pressure, heart rate, and electrocardiographic parameters: An experimental study on healthy young adults
Shokoufeh Hajsadeghi, Fatemeh Mohammadpour, Mohammad Javad Manteghi, Kiarash Kordshakeri, Masoud Tokazebani, Elham Rahmani, Morteza Hassanzadeh
PMID: 26467367  PMCID: PMC5336743  doi: 10.5152/akd.2015.5930  Pages 94 - 99
Objective: To evaluate the effects of the consumption of energy drinks on cardiovascular parameters in a group of healthy young individuals.
Methods: In a quasi-experimental study, 44 healthy adult participants aged between 15 and 30 years were evaluated. The blood pressure (BP) as well as electrocardiographic indices, including heart rate (HR), PR interval, QRS duration, corrected QT (QTc) interval, and ST-T changes were recorded before consumption of a caffeine-containing energy drink and at the specific time points over a 4-h test duration.
Results: We found statistically significant HR decline (p=0.004) and more frequent ST-T changes (p=0.004) after the participants consumed the energy drink. However, readings for systolic BP (p=0.44), diastolic BP (p=0.26), PR interval (p=0.449), QRS duration (p=0.235), and QTc interval (p=0.953) showed no significant change post-consumption.
Conclusion: In conclusion, we demonstrated that the consumption of energy drinks could contribute to HR decline and ST-T change in healthy young adults.

6.Assessment of atrial electromechanical interval and P wave dispersion in patients with polycystic ovary syndrome
Pınar Türker Bayır, Ümit Güray, Serkan Duyuler, Burcu Demirkan, Oya Kayaalp, Selçuk Kanat, Yeşim Güray
PMID: 26467368  PMCID: PMC5336722  doi: 10.5152/AnatolJCardiol.2015.6388  Pages 100 - 105
Objective: Polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk, including ischemic stroke. Prolonged atrial electromechanical interval (EMI) is related to increased atrial fibrillation (AF) risk. The aim of the study is to evaluate atrial EMI and electrocardiographic P-wave indices related to increased AF risk in patients with PCOS.
Methods: Forty PCOS patients diagnosed on the basis of the Rotterdam criteria and 20 age-matched controls were prospectively included. patients with atrioventricular or intraventricular conduction abnormalities, dysrhythmia or taking antiarrhythmic drugs, atherosclerotic heart disease, cardiomyopathies, valvular lesions, pericardial disease, a history of pulmonary emboli or pulmonary hypertension, and abnormal thyroid function were excluded. Intra and interatrial EMI were measured by tissue Doppler imaging and P-wave dispersion (Pd) was calculated on 12-lead electrocardiography (ECG). The Isovolumetric relaxation time was the interval between the aortic valve closure artifact at the end of the LV outflow envelope and the mitral valve opening artifact at the beginning of the mitral E wave.
Results: Patients with PCOS had significantly higher interatrial [38 (24-65) ms vs. 16 (9-19) ms p<0.001], left-sided intra-atrial (14.8±6.1 vs. 7±1.7 ms, p<0.001), and right-sided intra-atrial (22.3±8.1 vs. 8.6±3.6 ms, p<0.001) EMI compared with the control group. Pd was significantly greater in the PCOS group compared with control group [45 (27-60) ms vs. 30 (26–38) ms, p<0.001]. Echocardiographic parameters of atrial EMI were significantly correlated with body mass index, Pd, and isovolumetric relaxation time in patients with PCOS.
Conclusion: PCOS is associated with prolonged inter- and intra-atrial conduction times, which are related to increased AF risk.

7.Significance of a fragmented QRS complex in patients with chronic total occlusion of coronary artery without prior myocardial infarction
Hamidreza Bonakdar, Hassan Moladoust, Jalal Kheirkhah, Esmat Abbaspour, Mohammad Assadian Rad, Arsalan Salari, Anoosh Barzigar, Bijan Shad
PMID: 26467369  PMCID: PMC5336723  doi: 10.5152/akd.2015.5887  Pages 106 - 112
Objective: Fragmented QRS (fQRS) complexes that have numerous RSR´ patterns represent alteration of ventricular depolarization. We evaluated the relationship between fQRS and poor coronary collateral circulation and the diagnostic ability of fQRS for myocardial scar detection in patients with chronic total occlusion (CTO) without a history of myocardial infarction.
Methods: The study population consisted of patients undergoing coronary angiography with a suspicion of CAD. Seventy-nine patients with one totally occluded major coronary artery were enrolled. Exclusion criteria were history of MI; recent acute coronary syndrome; pathologic Q wave on 12-lead ECG; cardiomyopathy or severe valvular disease; coronary artery bypass surgery or percutaneous coronary angioplasty. Collateral circulation was scored on the basis of Rentrop’s classification. All patients were assessed by myocardial perfusion SPECT. Fragmented QRS was characterized as existence of an R´ or R wave or S wave notch in two adjacent leads related to the location of a major coronary artery region. Single and multiple logistic regression analyses were completed in the forward method.
Results: Forty-nine patients had poor and 30 had well-developed collateral circulation. Fragmented QRS complexes were significantly higher in the poor collateral group (81% vs. 20%, p<0.001). Sensitivity, specificity, and the positive and negative predictive values of fQRS for myocardial scar identification were 89.4%, 87.5%, and 91.3% and 84.8%, respectively. The summed stress score and the summed rest score on SPECT were significantly higher in the poor collateral group than in the well-developed group (p<0.001) as well as in the fQRS group than the non-fQRS group (p<0.001). Logistic regression analysis revealed that the presence of fQRS was significantly and independently associated with poor collateral circulation and myocardial scar in patients with CTO.
Conclusion: Fragmented QRS is independently related to poor coronary collateral circulation in patients with CTO without prior myocardial infarction. Notably, it can be a good predictor of myocardial scar rather than merely ischemia, with high diagnostic accuracy.

8.Diagnostic performance of late gadolinium enhancement in the assessment of acute cellular rejection after heart transplantation
Evrim Şimşek, Sanem Nalbantgil, Naim Ceylan, Mehdi Zoghi, Hatice Soner Kemal, Çağatay Engin, Tahir Yağdı, Mustafa Özbaran
PMID: 26467370  PMCID: PMC5336724  doi: 10.5152/AnatolJCardiol.2015.5961  Pages 113 - 118
Objective: Allograft rejection is still an important cause of morbidity and mortality after heart transplantation (HTx). Many techniques in cardiac magnetic resonance imaging (CMR) were investigated to diagnose acute cellular rejection (ACR). However, there is not enough information about late gadolinium enhancement (LGE) in the myocardium and ACR.
Methods: We prospectively analyzed our consecutive 41 heart transplant recipients who were admitted for routine endomyocardial biopsies. CMR was performed maximum 6 h before the scheduled endomyocardial biopsy. Correlation between LGE in the myocardium and ACR was investigated.
Results: Twenty-seven patients showed no rejection, and nine of them had LGE in the myocardium. Fourteen patients had LGE in the left ventricle (LV), and two patients had LGE also in the right ventricle (RV). There was no correlation between LGE and ACR (p=0.879). There was no difference in the left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), and cardiac ischemic time between the groups (p=0.825, p=0.370, and p=0.419, respectively). LGE in the myocardium could be due to previous rejection episodes; therefore, all patients were retrospectively searched for previous rejection grades and number of episodes. Thirty-eight of the 41 patients had a history of one ACR episode, but none of them had a statistically significant correlation with LGE (for grade 1R, p=0.964 and grade 3R, p=1) There was also no correlation between number of rejection episodes history and LGE.
Conclusion: LGE is not suitable to detect ACR in heart transplant patients. LGE and the history of ACR have no correlation.

9.Effect of iterative reconstruction on image quality in evaluating patients with coronary calcifications or stents during coronary computed tomography angiography: a pilot study
Ezgi Güler, Volkan Vural, Emre Ünal, Ilgaz Çağatay Köse, Deniz Akata, Muşturay Karcaaltıncaba, Tuncay Hazırolan
PMID: 26467371  PMCID: PMC5336725  doi: 10.5152/akd.2015.5920  Pages 119 - 124
Objective: To determine the effect of “Iterative Reconstruction in Image Space” (IRIS) on image quality by comparing reconstructions of both medium and sharp kernels when evaluating coronary calcifications or stents during coronary computed tomography (CT) angiography.
Methods: Thirty one consecutive patients were scanned with an electrocardiogram-gated helical technique on a dual-source CT system. Image reconstruction was performed using standard filtered back projection (FBP) and IRIS algorithm on both medium and sharp kernels (B26f, I26f, B46f, I46f). Each reconstruction was derived from the same raw data. Two blinded readers graded image quality using a five-point scale. Noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) were obtained. Noise was derived from the ascending aorta and left ventricle. SNR was obtained from sinus Valsalva, interventricular septum, and coronary vessels. CNR was obtained from septum, coronary vessels, and left ventricle. Comparisons of paired results between FBP and IRIS images were analyzed using the repeated measures analysis of variance method. Interreader correlation was assessed using weighted Kappa statistic.
Results: Noise values of the ascending aorta and left ventricle were significantly lower in the images reconstructed with IRIS than those reconstructed with FBP for the evaluation of the same filters. SNR and CNR values were higher in the IRIS images (p<0.05). Interreader agreement for four reconstructions was interpreted as moderate (κ=0.40–0.59).
Conclusion: IRIS significantly reduced image noise and improved imaging of coronary calcifications or stents. When combined with a sharp kernel, IRIS can improve image quality by reducing the negative effects of decreased signal that may result from using a sharp kernel.

10.The effect of iterative reconstruction on image quality in evaluating patients with coronary calcifications or stents at coronary computed tomography angiography
Sherif Moustafa, Karuna M. Das, Khalid Al-dossari
PMID: 26645268  PMCID: PMC5336726  doi: 10.5152/akd.2015.17395  Page 125
Abstract |Full Text PDF

11.Is transesophageal electrophysiologic study valuable in children with successful radiofrequency ablation of supraventricular tachycardia on follow-up for recurrence?
Mustafa Gülgün, Sema Özer, Tevfik Karagöz, Alper Akın, Hayrettin Hakan Aykan, Süheyla Özkutlu, Dursun Alehan, Alpay Çeliker
PMID: 26467372  PMCID: PMC5336727  doi: 10.5152/akd.2015.5895  Pages 126 - 130
Objective: The aim of this study was to evaluate the efficacy of transesophageal electrophysiologic study (TEEPS) for the determination of supraventricular tachycardia (SVT) recurrences in symptomatic and asymptomatic children after successful radiofrequency ablation (RFA) for SVT.
Methods: A total of 66 patients who underwent TEEPS after successful RFA were included. The demographic features, symptoms of the patients, and the characteristics of the recurrences induced by TEEPS were evaluated. The arrhythmia types induced during RFA were compared with those induced by TEEPS in terms of the compatibility of the diagnosis.
Results: Forty-two (63.6%) girls and 24 (36.4%) boys with a mean age of 11.8±3.4 years were followed-up for 44.1±15.7 months. The average time between RFA and TEEPS was 5.2±5.9 months. The diagnoses during RFA were atrioventricular nodal reentrant tachycardia (AVNRT) in 47 of 66 patients, atrioventricular reentrant tachycardia (AVRT) in 18 of 66 patients, and ectopic atrial tachycardia in 1 of 66 patients. SVT was induced by TEEPS in 2 of 25 symptomatic and 5 of 41 asymptomatic patients. The SVT inducibility rate was 5.5% (1/18) and 12.7% (6/47) in patients with AVRT and AVNRT, respectively. In addition, 85.7% (6/7) of all recurrences occurred within 3.5 months. The recurrences as AVNRT in 2 of 25 symptomatic patients occurred in the first month after RFA. AVNRT in 4 of 41 and AVRT in 1 of 41 asymptomatic patients were induced within 3.5 months and 15 months, respectively.
Conclusion: TEEPS seems to be a valuable screening and diagnostic method for the determination of recurrence in symptomatic and asymptomatic children who underwent successful RFA.

12.Nebivolol compared with metoprolol for erectile function in males undergoing coronary artery bypass graft
Mustafa Aldemir, İbrahim Keleş, Mustafa Karalar, Evren Tecer, Fahri Adalı, Mehmet Bilgehan Pektaş, Ali İhsan Parlar, Osman Tansel Darçın
PMID: 26467373  PMCID: PMC5336728  doi: 10.5152/akd.2015.5936  Pages 131 - 136
Objective: The aim of this study was to evaluate erectile function in males undergoing coronary artery bypass graft (CABG) while on two different adrenoceptor beta-blocker regimens, namely nebivolol and metoprolol. We hypothesize that the negative effects of cardiopulmonary bypass on erectile function may be possibly attenuated by preferring a vasodilating selective β1-blocker, nebivolol, to metoprolol as an antiischemic and antiarrhythmic agent in males undergoing CABG.
Methods: This randomized, double-blind, prospective clinical study was conducted in patients scheduled for CABG surgery between February 2012 and June 2014. A total of 60 consecutive patients who met inclusion criteria were randomized and divided into the following two groups: N group, which received 5 mg of nebivolol orally for 2 weeks before surgery plus 12 weeks after surgery or M group, which received 50 mg of metoprolol orally for the same period. All patients were evaluated by the erectile function domain of the International Index of Erectile Function-5 (IIEF-5) at the time of admission (before starting the beta-blocker) and 3 months after surgery.
Results: In the metoprolol group, the mean IIEF-5 score decreased significantly from a baseline of 15.2±5.8 to 12.9±5.8 (p<0.001), but in the nebivolol group, this difference was not significant (from a baseline 12.9±5.5 to 12.4±5.5, p=0.053). In all patients, the mean IIEF-5 score decreased significantly from a baseline of 14.0±5.7 to 12.6±5.6 (p<0.001).
Conclusion: Although erectile function in males undergoing CABG surgery decreases when metoprolol is used, nebivolol exerts protective effects on erectile function against the disruptive effects of cardiopulmonary bypass in patients undergoing CABG.

13.Recurrent spontaneous dissection affecting different coronary arteries of a young female
Necip Ermiş, Erdoğan Yaşar, Mehmet Cansel
PMID: 26898252  PMCID: PMC5336729  doi: 10.14744/AnatolJCardiol.2015.6648  Pages 137 - 138
Abstract |Full Text PDF

14.Combined implantation of dualchamber ICD and optimizer through a persistent left superior vena cava
Fabian Fastenrath, Susanne Röger, İbrahim Akın, Martin Borggrefe, Jürgen Kuschyk
PMID: 26898253  PMCID: PMC5336730  doi: 10.14744/AnatolJCardiol.2015.6730  Pages 138 - 140
Abstract |Full Text PDF

15.What is your diagnosis?
Kadir Uğur Mert
PMID: 26898254  PMCID: PMC5336731  doi: 10.14744/AnatolJCardiol.2015.6702  Page 141
Abstract |Full Text PDF | Video

16.Left ventricular hypertrophy, inflammation, and insulin resistance
Can Ramazan Öncel
PMID: 26898255  PMCID: PMC5336732  doi: 10.14744/AnatolJCardiol.2015.6857  Page 142
Abstract |Full Text PDF

17.Author`s Reply
Hakan Uçar, Mustafa Gür, Murat Çaylı
PMID: 26898256  PMCID: PMC5336733  Pages 142 - 143
Abstract |Full Text PDF

18.Non-thyroidal illness syndrome and erectile function in males undergoing coronary artery bypass graft
Can Ramazan Öncel
PMID: 26898257  PMCID: PMC5336734  doi: 10.14744/AnatolJCardiol.2015.6884  Page 143
Abstract |Full Text PDF

19.Author`s Reply
Mustafa Aldemir
PMID: 26898258  PMCID: PMC5336735  Page 144
Abstract |Full Text PDF

20.Scientific Puzzle - Answer
Kadir Uğur Mert, Gurbet Özge Mert, Can Yücel Karabay, Arzu Kalaycı
PMCID: PMC5336736  Page 145
Abstract |Full Text PDF | Video

21.Medicine in philately: Rene T. H. Laënnec, the father of stethoscope
E. Elif Vatanoğlu-lutz, Ahmet Doğan Ataman
PMID: 26898259  PMCID: PMC5336737  doi: 10.14744/AnatolJCardiol.2015.6866  Pages 146 - 147
Abstract |Full Text PDF

22.Impressions from the PCR İstanbul Peripheral
İsmail Doğu Kılıç, Ömer Göktekin
PMID: 26898260  PMCID: PMC5336738  doi: 10.14744/AnatolJCardiol.2015.6993  Pages 148 - 150
Abstract |Full Text PDF

23.A hypothermic case with giant Osborn waves and atrial fibrillation after using synthetic cannabinoid
Serkan Doğan, Canan Akman, Alp Yılmaz, Utku Murat Kalafat, Tarık Ocak
PMID: 26898262  PMCID: PMC5336744  doi: 10.14744/AnatolJCardiol.2015.6856  Page E1
Abstract |Full Text PDF

24.Compression of left ventricle by a rare giant unruptured sinus of Valsalva aneurysm
Hong Qian, Qin Ouyang, Yajiao Li, Wei Meng
PMID: 26898261  PMCID: PMC5336745  doi: 10.14744/AnatolJCardiol.2015.6904  Pages E1 - E2
Abstract |Full Text PDF | Video

25.Aortic valve aneurysm involved in interventricular septum
Hong Qian, Yong Liu, Yajiao Li, Eryong Zhang
PMID: 26898263  PMCID: PMC5336746  doi: 10.14744/AnatolJCardiol.2015.6905  Pages E2 - E3
Abstract |Full Text PDF | Video

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