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The Anatolian Journal of Cardiology - Anatol J Cardiol: 16 (3)
Volume: 16  Issue: 3 - March 2016
EDITORIAL
1.Fifteenth anniversary: Author-reviewer-editor in scientific research
Bilgin Timuralp
PMID: 27067555  PMCID: PMC5336798  doi: 10.14744/AnatolJCardiol.2016.03  Pages 151 - 153
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
2.Regular blood donation improves endothelial function in adult males
Hasan Yücel, Ali Zorlu, Hakkı Kaya, Mehmet Birhan Yılmaz
PMID: 26467374  PMCID: PMC5336799  doi: 10.5152/akd.2015.6093  Pages 154 - 158
Objective: Endothelial dysfunction, secondary to systemic inflammation and oxidative stress, is known to play a major role in the development and progression of atherosclerosis. It is hypothesized that the lower incidence of coronary artery disease in the premenopausal period in females when compared with males is associated with regular menstrual blood loss. We investigated whether regular blood donation (BD) is associated with improved endothelial function in healthy adult males.
Methods: Fifty young healthy male volunteers volunteers with a mean age of 30±6 years without overt cardiovascular disease were enrolled to participate in serial consecutive BDs. Serum iron levels as oxidative stress parameters, flow-mediated dilatation (FMD) for endothelial function, 24-h mean diastolic blood pressure for peripheral vascular resistance identification, and high-sensitivity C-reactive protein (hs-CRP) levels as systemic inflammatory markers were evaluated before and after BD. This study used a prospective observational cohort design. Patients with cardiovascular and inflammatory diseases were excluded.
Results: BD was found to improve FMD steadily and significantly when compared with the baseline (mean±SD: 9.9%±3.8%, 10.44%±3.9%, 10.65%±3.9%, and 10.75±3.9%, respectively, p=0.15, p=0.02, p=0.006 as compared with the baseline). A steady decrease was identified in hs-CRP levels after serial BDs, although this decrease was not statistically significant in the all phases (2.96±3.3 mg/L, 2.26±1.5 mg/L, and 2.12±1.5 mg/L, respectively, p=0.829, p=0.558). The 24-h mean diastolic blood pressures were significantly lower in the chronic phase (77±9 mm Hg, 75±7 mm Hg, and 72±8 mm Hg, respectively, p=0.50, p=0.003), whereas there was no significant change in iron levels in the acute and chronic phases (66±32 mg/dL, 72±43 mg/dL, and 68±33 mg/dL, respectively, p=1.000, p=1.000).
Conclusion: The results of the study indicate that regular BD improves endothelial function. (Anatol J Cardiol 2016; 16: 154-8)

3.Catheter ablation of drug refractory electrical storm in patients with ischemic cardiomyopathy: A single center experience
Fırat Özcan, Serkan Topaloğlu, Serkan Çay, Uğur Canpolat, Özcan Özeke, Osman Turak, Hande Çetin, Dursun Aras
PMID: 26467375  PMCID: PMC5336800  doi: 10.5152/akd.2015.6095  Pages 159 - 164
Objective: Electrical storm (ES) is a life-threatening pathology that requires immediate and effective treatment due to increased morbidity and mortality. Catheter ablation (CA) is an effective therapeutic option, particularly in patients with drug resistant ventricular arrhythmia episodes. These procedures should only be performed in highly specialized and experienced centers. Here we aimed to assess safety and efficacy of CA in a relatively large cohort with ES in our tertiary center hospital.
Methods: A total of 44 patients (90.9% male; mean age: 59.7±10.3 years) with ischemic cardiomyopathy undergoing CA for drug-refractory ES were prospectively evaluated. Procedures were performed using non-contact and electro-anatomic mapping systems. Long-term follow-up analysis addressed the predictors of ES recurrence and cardiac mortality.
Results: Acute success rates for clinical and non-clinical VTs were 90.8% and 55.5%, respectively. A mean follow-up at 28±11 months revealed cardiac mortality in 8 (18%) patients, 39 (88.6%) patients were free from the ES, and 24 (55%) patients remained free from both ES and paroxysmal VT episodes. In multivariate regression analysis, recurrence of ES (OR=3.11, 95% CI: 1.65-4.62, p=0.001), LVEF, and serum creatinine were found as independent predictors of cardiac mortality. In addition, substrate based ablation, implantation of ICD for secondary prophylaxis, LVEF, and serum creatinine were good predictors of ES recurrence.
Conclusion: Catheter ablation for ventricular arrhythmias in the course of ES in patients with ischemic cardiomyopathy is safe with an acceptable success rate. (Anatol J Cardiol 2016; 16: 159-64)

4.Association of rs17042171 with chromosome 4q25 with atrial fibrillation in Chinese Han populations
Liyan Zhao, Xin-guang Chen, Yaowu Liu, Zhen Fang, Fengxiang Zhang
PMID: 26467376  PMCID: PMC5336801  doi: 10.5152/akd.2015.5999  Pages 165 - 169
Objective: A recent genome-wide association study (GWAS) identified a susceptibility single nucleotide polymorphism (SNP), rs17042171 on 4q25 for atrial fibrillation (AF). The aim of the present study was to investigate whether this association between rs17042171 and AF also exists in Chinese Han populations.
Methods: It was a case-control study. We enrolled a total of 1,593 Chinese Han origin individuals in the study, including 597 AF patients and 996 AF-free controls. Genotyping was performed using the TaqMan allelic discrimination Assay. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in logistic regression models.
Results: There was strongly significant difference between AF patients and control subjects regarding rs17042171 assumption of additive model (OR=2.20, 95% CI: 1.88-2.57, p=2.00 × 10-22), dominant model (OR=2.99; 95% CI: 2.19-4.09; p=6.47 × 10-12) and a recessive (OR=2.75; 95% CI: 2.21-3.43; p=1.30 × 10-19). In the stratification analysis based on age, gender, hypertension, diabetes and coronary artery disease, there was no significant difference of the associations for rs17042171 among the subgroups.
Conclusion: Our results indicated that rs17042171 confers an increased risk of AF in Chinese Han Populations and expanded the association to non-European ancestry populations for the first time. (Anatol J Cardiol 2016; 16: 165-9)

5.Genetic analysis of cardiac SCN5A Gene in Iranian patients with hereditary cardiac arrhythmias
Marzi Asadi, Roger Foo, Zahurul Alam Bhuiyan, Mohammad Reza Samienasab, Ahmad Reza Salehi, Shahab Shahrzad, Rasoul Salehi
PMID: 26467377  PMCID: PMC5336802  doi: 10.5152/akd.2015.6060  Pages 170 - 174
Objective: SCN5A encodes alpha subunit of the major sodium channel (Nav1.5) in human cardiac tissue. Malfunction of this cardiac sodium channel is associated with a variety of cardiac arrhythmias and myocardial inherited diseases.
Methods: Fifty-three members from three families each diagnosed with long-QT syndrome type 3 (LQTS3), Brugada syndrome (BrS), or sick sinus syndrome (SSS) were included in this observational, cross-sectional study. In this study, we analyzed the sequences of coding region of the SCN5A gene.
Results: Eleven members of the LQTS family (39%) showed p.Gln1507-Lys1508-Pro1509del mutation, 8 of BrS family (50%) showed p.Arg222Ter nonsense mutation, and 5 of 9 SSS family members (55%) showed a novel p.Met1498Arg mutation in the SCN5A gene.
Conclusion: p.Gln1507-Lys1508-Pro1509del mutation, p.Arg222Ter nonsense mutation, and p.Met1498Arg in LQTS, BrS, and SSS, respectively, are reported for the first time in the Iranian population. Information regarding underlying genetic defects would be necessary for verifying certain clinically diagnosed arrhythmia types, carrier screening in affected families, and more precise therapy of the patients are required. (Anatol J Cardiol 2016; 16: 170-4)

6.The association of paraoxonase 1 gene L55M polymorphism with the extent and severity of coronary artery disease in the Turkish population and its dependence on gender
Derya Beyza Sayın Kocakap, Mehmet Tolga Doğru, Vedat Şimşek, Feryal Çabuk, Nesligül Yıldırım, Yunus Çelik, Sibel Alyılmaz Bekmez, Solmaz Erdem
PMID: 26467378  PMCID: PMC5336803  doi: 10.5152/akd.2015.6010  Pages 175 - 182
Objective: Coronary artery disease (CAD) is a common, complex, and progressive disorder characterized by the accumulation of lipids and fibrous elements in the arteries. It is one of the leading causes of death in industrialized nations. Oxidative modification of low-density lipoprotein (LDL) in the arterial wall plays an important role in the initiation and progression of atherosclerosis. Paraoxonase1 (PON1) is involved in lipid metabolism and is believed to protect LDL oxidation. In our study, we aimed to clarify the relationship between PON1 gene L55M polymorphism and the extent and severity of CAD.
Methods: In total, 114 patients (54 males, mean age: 56.7±12.0 years; 60 females, mean age: 55.7±13.2 years) with stable angina or angina equivalent symptoms were enrolled in this prospective study. Cardiological evaluation was performed with electrocardiogram and transthoracic echocardiogram. The presence of hypertension, dyslipidemia, diabetes, and smoking status were ascertained. The patients were grouped according to their Gensini scores and gender. Genetic analysis of the PON1 gene L55M polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism.
Results: We determined that the LL genotype was more prevalent in patients with Gensini score higher than or equal to 20 (p=0.026) and that this correlated with severe atherosclerotic coronary artery lesions in both gender groups, reaching a statistical significance in the female subjects (p=0.038).
Conclusion: It was thought that the PON1 gene L55M polymorphism plays a significant role in CAD progression, especially in females. (Anatol J Cardiol 2016; 16: 175-82)

7.Measurement of pulmonary arterial elastance in patients with systolic heart failure using Doppler echocardiography
Sepideh Taghavi, Maryam Esmaeilzadeh, Ahmad Amin, Nasim Naderi, Hooman Bakhshandeh Abkenar, Majid Maleki, Mitra Chitsazan
PMID: 26467379  PMCID: PMC5336804  doi: 10.5152/akd.2015.5980  Pages 183 - 188
Objective: A reliable and easy-to-perform method for measuring right ventricular (RV) afterload is desirable when scheduling patients with systolic heart failure to undergo heart transplantation. The present study aimed to investigate the accuracy of echocardiographically-derived pulmonary arterial elastance as a measurement of pulmonary vascular resistance by comparing it with invasive measures.
Methods: Thirty-one patients with moderate to severe systolic heart failure, including 22 (71%) male patients, with a mean age of 41.16±15.9 years were enrolled in the study. Right heart catheterization and comprehensive echocardiography during the first hour after completion of cardiac catheterization were performed in all the patients. The pulmonary artery elastance was estimated using the ratio of end-systolic pressure (Pes) over the stroke volume (SV) by both cardiac catheterization [Ea (PV)-C] and echocardiography [Ea (PV)-E].
Results: The mean Ea (PV)-C and Ea (PV)-E were estimated to be 0.73±0.49 mm Hg/mL and 0.67±0.44 mm Hg/mL, respectively. There was a significant relation between Ea (PV)-E and Ea (PV)-C (r=0.897, p<0.001). Agreement between echocardiography and catheterization methods for estimating Ea (PV), investigated by the Bland-Altman method, showed a mean bias of -0.06, with 95% limits of agreement from -0.36 mm Hg/mL to 0.48 mm Hg/mL.
Conclusion: Doppler echocardiography is an easy, non-invasive, and inexpensive method for measuring pulmonary arterial elastance, which provides accurate and reliable estimation of RV afterload in patients with systolic heart failure. (Anatol J Cardiol 2016; 16: 183-8)

8.Inappropriate combination of warfarin and aspirin
Burak Turan, Hakan Demir, Ayhan Mutlu, Tolga Daşlı, Ayhan Erkol, İsmail Erden
PMID: 26467380  PMCID: PMC5336805  doi: 10.5152/akd.2015.6050  Pages 189 - 196
Objective: A combination of warfarin and aspirin is associated with increased bleeding compared with warfarin monotherapy. The aim of the study was to investigate the incidence and appropriateness of the combination of warfarin and aspirin in patients with atrial fibrillation (AF) or mechanical heart valve (MHV).
Methods: This cross-sectional study included consecutive patients with AF or MHV on chronic warfarin therapy (>3 months) without acute coronary syndrome or have not undergone a revascularization procedure in the preceding year. Medical history, concomitant diseases, and treatment data were acquired through patient interviews and from hospital records.
Results: Three hundred and sixty patients (213 with AF, 147 with MHV) were included. In those with AF, a significantly higher warfarin-aspirin combination was observed with concomitant vascular disease (38.8% vs. 14.6%), diabetes (36.6% vs. 16.3%), statin therapy (40% vs. 16.9%), left ventricular systolic dysfunction (33.3% vs. 17.5%) (p<0.05 for all). The use of combination therapy was similar between different CHADS-VASc scores. In patients with MHV, higher combination therapy was observed in males (41% vs. 26.7% in females; p=0.070), concomitant vascular disease (47.8% vs. 29.8%; p=0.091), and AF (56.3% vs. 29.8%; p=0.033). Independent predictors of warfarin-aspirin combination were concomitant vascular disease, diabetes, and (younger) age in patients with AF and were concomitant AF and male sex in patients with MHV. Interestingly, the incidence of combination therapy was found to increase with a higher HAS-BLED score in both patients with AF and MHV (p<0.001).
Conclusion: The combination of warfarin and aspirin was found to be prescribed to patients with AF mainly for the prevention of cardiovascular events, for which warfarin monotherapy usually suffices. On the other hand, co-treatment with aspirin appeared to be underused in patients with MHV. (Anatol J Cardiol 2016; 16: 189-96)

9.Renal artery stenosis and mean platelet volume
Muhammet Raşit Sayın, Nesimi Yavuz, Turgut Karabağ, Mehmet Ali Çetiner, İbrahim İlker Öz, Orhan Alper Güngördük, Mustafa Aydın
PMID: 26467381  PMCID: PMC5336806  doi: 10.5152/AnatolJCardiol.2015.6102  Pages 197 - 201
Objective: Increased mean platelet volume (MPV) has been reported in various atherosclerotic diseases. The aim of our study was to investigate the relationship between the atherosclerotic renal artery stenosis (ARAS) and various hematological parameters including MPV.
Methods: This study was performed with a retrospective review of the angiographic images of patients who underwent renal angiography at Bülent Ecevit University catheter laboratory between January 2004 and December 2009. The patients were trichotomized into three groups based on the presence and severity of renal artery stenosis (RAS). Group 1 included patients with a critical RAS (33 patients; 18 female (F), 15 male (M); mean age 61.6±11.5 years), group 2 consisted of patients with non-critical RAS (26 patients; 15 F, 11 M; mean age 58.1±11.3 years), and group 3 was composed of patients without RAS (69 patients; 38 F, 31 M; mean age 53.5±11.9 years). Demographic data, complete blood count, and biochemical parameters were compared between the groups.
Results: Comparison of the hematological parameters revealed that MPV and platelet distribution width were significantly higher in group 1 than in group 2 and 3 (8.96±0.99 fL versus 8.35±0.76 fL, 8.31±0.79 fL, respectively; p=0.001; 16.53±0.58% versus 16.19±0.56%, 16.29±0.53%, respectively; p=0.04).
Conclusion: MPV levels are higher in patients with ARAS. Considering both the effect of platelets on atherosclerosis and their close association with other risk factors, MPV level may be an important factor in pathogenesis of ARAS. (Anatol J Cardiol 2016; 16: 197-201)

10.Femoral neck and spine bone mineral density-Surrogate marker of aortic calcification in postmenopausal women
Petar Avramovski, Maja Avramovska, Miroslav Lazarevski, Aleksandar Sikole
PMID: 26467382  PMCID: PMC5336807  doi: 10.5152/akd.2015.6016  Pages 202 - 209
Objective: Osteoporosis and abdominal aortic calcification (AAC) are associated with increased morbidity and mortality in postmenopausal women. The aim of this study was to determine the accuracy of anterior-posterior (AP) dual-energy X-ray absorptiometry (DXA) compared with that of X-ray lateral lumbar radiography (LLR) in detecting and scoring AAC.
Methods: In this cross-sectional study conducted in 56 postmenopausal asymptomatic females aged 59.0±9.3 years and who never used medications to treat osteoporosis before, we determined femoral neck and lumbar spine bone mineral density (BMD) by AP DXA and AAC by X-ray LLR. We hypothesized that the subtracted femoral neck BMD (BMDFN) from lumbar spine BMD (BMDLS) presented as ΔBMD=BMDLSBMDFN would have a diagnostic value in detecting abdominal vascular calcification.
Results: The mean BMDFN was 0.744±0.184 g/cm2, and the mean BMDLS was 0.833±0.157 g/cm2 (p<0.0001); the mean ΔBMD was 0.089±0.077 g/ cm2, and the mean AAC score was 2.182±1.982. Bivariate Pearson’s correlation analysis revealed a significant positive correlation between AAC and ΔBMD (r=0.449, p=0.0006); by linear regression analysis, R2=0.2019, and by multiple regression analysis, βst=13.5244 (p<0.0001). We found a sensitivity of 64.3% and specificity of 82.9% by receiver operating characteristic [ROC; area under the ROC curve (AUC=0.759)] in the prediction of AAC by ΔBMD.
Conclusion: This AP subtracting BMD DXA method provides a useful tool for detecting and scoring subclinical and extensive AAC in postmenopausal women using a simple, semiquantitative, and accurate scoring system with minimal radiation exposure and low cost. (Anatol J Cardiol 2016; 16: 202-9)

SCIENTIFIC LETTER
11.Two methods for increasing sensitivity of dobutamine stress echocardiography: strain imaging and heart-type fatty acid-binding protein levels
Bekir Çalapkorur, İbrahim Özdoğru, Oğuzhan Baran, Şaban Keleşoğlu, Abdurrahman Oğuzhan, Mehmet Güngör Kaya
PMID: 27067556  PMCID: PMC5336808  doi: 10.14744/AnatolJCardiol.2016.6704  Pages 210 - 211
Abstract | Full Text PDF

CASE REPORT
12.Inappropriate sinus tachycardia-induced cardiomyopathy during pregnancy and successful treatment with ivabradine
Saim Sağ, Hakan Çoşkun, İbrahim Baran, Sümeyye Güllülü, Ali Aydınlar
PMID: 27067557  PMCID: PMC5336809  doi: 10.14744/AnatolJCardiol.2016.6813  Pages 212 - 213
Abstract | Full Text PDF

13.A rare side effect seen due to the use of apixaban: Palmoplantar psoriasiform drug eruption
Vusal Veliyev, İbrahim Özmen, Salim Yaşar, Erol Gürsoy, Mustafa Köklü, Murat Çelik
PMID: 27067558  PMCID: PMC5336810  doi: 10.14744/AnatolJCardiol.2016.6774  Pages 213 - 215
Abstract | Full Text PDF

DIAGNOSTIC PUZZLE
14.Which treatment option should be used?
Ahmet Güler
PMID: 27067559  PMCID: PMC5336811  doi: 10.14744/AnatolJCardiol.2016.6983  Page 216
Abstract | Full Text PDF

LETTER TO THE EDITOR
15.Notes on patient compensation system suggestion
Afşin Emre Kayıpmaz, Orçun Çiftçi, Cemil Kavalcı, Serdar Yılmaz, Haldun Müderrisoğlu
PMID: 27067560  PMCID: PMC5336812  doi: 10.14744/AnatolJCardiol.2016.6913  Pages 217 - 218
Abstract | Full Text PDF

16.Author`s Reply
Ayhan Olcay, Gamze Babür Güler, Ekrem Güler, Kıvanç Yalın
PMID: 27067561  PMCID: PMC5336813  Page 218
Abstract | Full Text PDF

17.Electrical storm might be the initial presentation of arrhythmogenic right ventricular cardiomyopathy
Mustafa Gülgün, Muzaffer Kürşat Fidancı, Alparslan Fatih Genç
PMID: 27067562  PMCID: PMC5336814  doi: 10.14744/AnatolJCardiol.2016.6848  Pages 218 - 219
Abstract | Full Text PDF

18.Author`s Reply
Fırat Özcan, Serkan Topaloğlu, Serkan Çay, Uğur Canpolat, Özcan Özeke, Osman Turak, Hande Çetin, Dursun Aras
PMID: 27067563  PMCID: PMC5336815  Page 219
Abstract | Full Text PDF

19.Practical considerations on non-vitamin K oral anticoagulants in patients with high body weight
Anetta Undas
PMID: 27067564  PMCID: PMC5336816  doi: 10.14744/AnatolJCardiol.2016.6970  Page 220
Abstract | Full Text PDF

20.Author`s Reply
Ekrem Güler, Gamze Babur Güler, Gültekin Günhan Demir, Suzan Hatipoğlu
PMID: 27067565  PMCID: PMC5336817  Pages 220 - 221
Abstract | Full Text PDF

21.The atrial conduction time in patients with normal atrial size
Burcu Demirkan, Yeşim Güray, Esra Gücük İpek
PMID: 27067566  PMCID: PMC5336818  doi: 10.14744/AnatolJCardiol.2016.6972  Pages 221 - 222
Abstract | Full Text PDF

22.Author`s Reply
Ali Hosseinsabet
PMID: 27067567  PMCID: PMC5336819  Pages 222 - 223
Abstract | Full Text PDF

23.Obstructive sleep apnea and cardiovascular disease: Is mean platelet volume one of the links?
Nikolaos Papanas, Dimitri P. Mikhailidis, Paschalis Steiropoulos
PMID: 27067568  PMCID: PMC5336820  doi: 10.14744/AnatolJCardiol.2016.6902  Page 223
Abstract | Full Text PDF

24.Author`s Reply
Marcella Rivas, Atul Ratra, Kenneth Nugent
PMID: 27067569  PMCID: PMC5336821  Pages 223 - 224
Abstract | Full Text PDF

25.The role of platelet-lymphocyte ratio in the severity of coronary artery disease assessed by the angiographic Gensini score
Harun Kundi
PMID: 27067570  PMCID: PMC5336822  doi: 10.14744/AnatolJCardiol.2016.6996  Page 224
Abstract | Full Text PDF

26.The role of platelet-to-lymphocyte ratio in saphenous vein graft disease
Can Ramazan Öncel
PMID: 27067572  PMCID: PMC5336824  doi: 10.14744/AnatolJCardiol.2016.6928  Page 225
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27.Author`s Reply
Murat Yüksel, Abdülkadir Yıldız
PMID: 27067571  PMCID: PMC5336823  Page 225
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28.Effects of pentoxifylline on blood transfusion
Orhan Gökalp, Nihan Karakaş Yeşilkaya, Yüksel Beşir, Ali Gürbüz
PMID: 27067574  PMCID: PMC5336826  doi: 10.14744/AnatolJCardiol.2016.6838  Page 226
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29.Author`s Reply
Harun Kundi
PMID: 27067573  PMCID: PMC5336825  Page 226
Abstract | Full Text PDF

30.Bonsai-induced coronary artery spasm
Can Ramazan Öncel
PMID: 27067575  PMCID: PMC5336827  doi: 10.14744/AnatolJCardiol.2016.6918  Pages 226 - 227
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31.Author`s Reply
Sinan İnci, Gökhan Aksan, Ali Doğan
PMID: 27067576  PMCID: PMC5336828  Pages 227 - 228
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32.Is Turkey a prothrombin gene mutation region similar to the Mediterranean countries?
Barış Buğan, Erkan Yıldırım, Deniz Torun, Salih Kozan, Murat Çelik, Turgay Çelik
PMID: 27067577  PMCID: PMC5336829  doi: 10.14744/AnatolJCardiol.2016.6565  Page 228
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DIAGNOSTIC PUZZLE
33.Puzzle - Answer
Ahmet Güler, Yeliz Güler, Müslüm Şahin
PMID: 27067578  PMCID: PMC5336830  Page 229
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MISCELLANEOUS
34.An autograph letter of Dr. Rene Laennec
J. S Logan
PMCID: PMC5336831  Pages 230 - 232
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
35.Acute anterior myocardial infarction accompanying metastatic intracavitary colorectal carcinoma causing right ventricular outflow obstruction: a rare mixture
Mert İlker Hayıroğlu, Muhammed Keskin, Osman Uzman, Muhammed Burak Günay, Medine Özgür, Ahmet Okan Uzun, Mehmet Eren
PMID: 27111065  PMCID: PMC5336832  doi: 10.14744/AnatolJCardiol.2016.6944  Pages E4 - E6
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