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The Anatolian Journal of Cardiology - Anatol J Cardiol: 18 (3)
Volume: 18  Issue: 3 - September 2017
1.Editorial, Issue: September 2017
Adnan Abacı
PMID: 28883306  PMCID: PMC5689046  doi: 10.14744/AnatolJCardiol.2017.09  Page 167
Abstract | Full Text PDF

2.Protective effects of IL28RA siRNA on cardiomyocytes in hypoxia/reoxygenation injury
Ge Gong, Yanyan Li, Xinxing Yang, Hongyu Geng, Xinzheng Lu, Liansheng Wang, Zhijian Yang
PMID: 28639948  PMCID: PMC5689047  doi: 10.14744/AnatolJCardiol.2017.7763  Pages 168 - 174
Objective: We demonstrate the protective effects of the siRNA-mediated inhibition of the interleukin-28 receptor alpha (IL28RA) subunit on cardiomyocytes in hypoxia/reoxygenation (H/R) injury and explore the associated mechanism.
Methods: After designing and synthesizing three pairs of siRNA that effectively reduced IL28RA gene expression in vitro (siRNA-6158, siRNA-6160, and siRNA-6162), primary neonatal rat cardiomyocytes were transfected using a liposome transfection method. Six groups were included based on the siRNA that was used and the treatment simulating reperfusion injury: control group, H/R group, H/R+negative control group, H/R+siRNA-6158 group, H/R+siRNA-6160 group, and H/R+siRNA-6162 group. Cell survival and apoptosis rates were measured along with lactate dehydrogenase levels in the cell culture supernatant. Protein levels of IL28RA, phosphatidylinositol 3-kinase, catalytic subunit gamma (PI3KCG), Bcl-2, Bax, and β-actin were also measured.
Results: The H/R+siRNA-6158 and H/R+siRNA-6160 groups had significantly higher survival rates and increased PI3KCG-to-β-actin and Bcl-2-to- Bax ratios than the the H/R and H/R+negative control groups (p<0.05). The H/R+siRNA-6158 and H/R+siRNA-6160 groups also exhibited reduced rates of apoptosis and reduced IL28RA-to-β-actin ratios (p<0.05). No significant difference was observed among the H/R+siRNA-6162, H/R, and H/R+negative control groups.
Conclusion: IL28RA siRNA-6158 and -6160 were able to protect cardiomyocytes from H/R injury by inhibiting apoptosis. This strategy of inhibiting IL28RA gene expression may reduce reperfusion injury in the treatment of patients with acute myocardial infarction.

3.Effects of trimetazidine on mitochondrial respiratory function, biosynthesis, and fission/fusion in rats with acute myocardial ischemia
Wen Shi, Wenfeng Shangguan, Yue Zhang, Can Li, Guangping Li
PMID: 28761019  PMCID: PMC5689048  doi: 10.14744/AnatolJCardiol.2017.7771  Pages 175 - 181
Objective: Myocardial ischemia affects mitochondrial functions, leading to ionic imbalance and susceptibility to ventricular fibrillation. Trimetazidine, a metabolic agent, is clinically used in anti-anginal therapy.
Methods: In this study, the rats were orally treated by gavage with trimetazidine 10 mg/kg/d for 7 days, and the effects of trimetazidine on mitochondrial respiratory function, biosynthesis, and fission/fusion in rats with acute myocardial ischemia were evaluated.
Results: It has been suggested that acute myocardial ischemia leads to a damage to mitochondrial functions. However, compared with ischemia group without trimetazidine administration, a significant reduction in the infarct size was observed in trimetazidine-treated ischemia group (31.24±3.02% vs. 52.87±4.89%). Trimetazidine preserved the mitochondrial structure and improved respiratory control ratio and complex I activity. Furthermore, trimetazidine improved mitochondrial biosynthesis and fission/fusion, as demonstrated by the promotion of peroxisome proliferator-activated receptor gamma (PPARγ) co-activator 1α (PGC-1α), mitofusins 1 (Mfn1), dynamin-related protein 1 (Drp1), and optic atrophy 1 (Opa1) expressions in rats with acute myocardial ischemia.
Conclusion: Taken together, it was suggested that in this rat model of myocardial ischemia, trimetazidine demonstrated cardioprotective effects attributing to the preservation of mitochondrial respiratory function, biosynthesis, and fission/fusion and, thus, could be considered as an agent for cardioprotection.

4.Homocysteine enhances the predictive value of the GRACE risk score in patients with ST-elevation myocardial infarction
Yan Fan, Jianjun Wang, Sumei Zhang, Zhaofei Wan, Dong Zhou, Yanhong Ding, Qinli He, Ping Xie
PMID: 28782750  PMCID: PMC5689049  doi: 10.14744/AnatolJCardiol.2017.7798  Pages 182 - 193
Objective: The present study aims to investigate whether the addition of homocysteine level to the Global Registry of Acute Coronary Events (GRACE) risk score enhances its predictive value for clinical outcomes in ST-elevation myocardial infarction (STEMI).
Methods: A total of 1143 consecutive patients with STEMI were included in this prospective cohort study. Homocysteine was detected, and the GRACE score was calculated. The predictive power of the GRACE score alone or combined with homocysteine was assessed by the receiver operating characteristic (ROC) analysis, methods of net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
Results: During a median follow-up period of 36.7 months, 271 (23.7%) patients reached the clinical endpoints. It showed that the GRACE score and homocysteine could independently predict all-cause death [GRACE: HR=1.031 (1.024–1.039), p<0.001; homocysteine: HR=1.023 (1.018–1.028), p<0.001] and MACE [GRACE: HR=1.008 (1.005–1.011), p<0.001; homocysteine: HR=1.022 (1.018–1.025), p<0.001]. When they were used in combination to assess the clinical outcomes, the area under the ROC curve significantly increased from 0.786 to 0.884 (95% CI=0.067–0.128, Z=6.307, p<0.001) for all-cause death and from 0.678 to 0.759 (95% CI=0.055–0.108, Z=5.943, p<0.001) for MACE. The addition of homocysteine to the GRACE model improved NRI (all-cause death: 0.575, p<0.001; MACE: 0.621, p=0.008) and IDI (all-cause death: 0.083, p<0.001; MACE: 0.130, p=0.016), indicating effective discrimination and reclassification.
Conclusion: Both the GRACE score and homocysteine are significant and independent predictors for clinical outcomes in patients with STEMI. A combination of them can develop a more predominant prediction for clinical outcomes in these patients.

5.Assessment of left ventricular systolic function in patients with iron deficiency anemia by three-dimensional speckle-tracking echocardiography
Qiao Zhou, Jiaqi Shen, Yue Liu, Runlan Luo, Bijun Tan, Guangsen Li
PMID: 28639946  PMCID: PMC5689050  doi: 10.14744/AnatolJCardiol.2017.7694  Pages 194 - 199
Objective: The present study aimed to evaluate left ventricular (LV) systolic function in patients with iron deficiency anemia (IDA) by 3-dimensional speckle-tracking echocardiography (3DSTE).
Methods: Participants were grouped by hemoglobin (Hb) levels in order to study the effect of anemia on cardiac function. Group A included 40 healthy volunteers. Eighty-three patients who were diagnosed with IDA were divided into 2 groups according to the Hb level. Group B (Hb 9 g/dL) included 44 patients, while group C (Hb 6–9 g/dL) included 39 patients. Left ventricular end-diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF) were calculated by real-time 3-dimensional echocardiography (RT3D). Left ventricular global longitudinal strain (GLS), global area strain (GAS), global radial strain (GRS), and global circumferential strain (GCS) were obtained by 3DSTE.
Results: LVMI, LVEDV and LVESV of group C increased and GCS, GRS, GLS, and GAS of group C decreased compared with those of groups A and B (all p<0.05). GAS and GLS decreased significantly compared with other parameters (both p<0.01).
Conclusion: LV remodeling and LV systolic dysfunction occurred in patients when the hemoglobin level was in the range of 6–9 g/dL. 3DSTE can evaluate LV systolic function in patients with IDA, and GAS and GLS are more sensitive than other parameters.

6.Prognostic role of soluble suppression of tumorigenicity-2 on cardiovascular mortality in outpatients with heart failure
İbrahim Gül, Oğuzhan Yücel, Abdullah Zararsız, Özlem Demirpençe, Hasan Yücel, Ali Zorlu, Mehmet Birhan Yılmaz
PMID: 28761021  PMCID: PMC5689051  doi: 10.14744/AnatolJCardiol.2017.7741  Pages 200 - 205
Objective: Soluble suppression of tumorigenicity-2 (sST2), a member of the interleukin 1 receptor family, is increased in mechanical stress conditions and is produced by cardiomyocytes and cardiac fibroblasts. Elevated sST2 level is associated with the prognosis of acute coronary syndrome, pulmonary arterial hypertension, and acute and chronic heart failure (HF). In this study, we aimed to investigate the relationship between sST2 levels and cardiovascular mortality in outpatients with HF.
Methods: This study used a prospective observational cohort design. A total of 130 consecutive outpatients with HF were prospectively evaluated. Clinical characteristics, laboratory results, cardiovascular risk factors, comorbidities, and medication use were recorded. The patients were followed up for a mean period of 12±4 months for the development of cardiovascular death. They were classified into two groups: those who survived and those who died.
Results: Mean age of patients was 67±11 years (69% males). After follow-up, 23 of 130 patients (18%) experienced cardiovascular death. sST2 levels were higher among those who died compared with among those who survived [51 (21–162) vs. 27 (9–198) ng/mL, p<0.001]. Optimal cut-off sST2 level to predict cardiovascular mortality was found to be >30 ng/mL with a sensitivity of 87% and a specificity of 67% (AUC =0.808, 95% CI=0.730 to 0.872). sST2 levels were negatively correlated with left ventricular ejection fraction and triglyceride, total cholesterol, LDL cholesterol, and hemoglobin levels and were positively correlated with left atrium size and the presence of right ventricular dilatation. In multiple Cox regression analysis, sST2 level of >30 ng/mL (HR=6.756, p=0.002, 95% CI=1.983–23.018), hemoglobin level (HR=0.705, p<0.001, 95% CI=0.587–0.847), age (HR=1.050, p=0.013, 95% CI=1.010–1.091), and HDL cholesterol level (HR=0.936, p=0.010, 95% CI=0.889–0.984) remained to be associated with an increased risk of mortality.
Conclusion: sST2 measurement could help risk stratification in outpatients with HF. Moreover, this is the first study describing the impact of sST2 protein in Turkish patients with HF.

7.Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure
Hiroki Niikura, Raisuke Iijima, Hitoshi Anzai, Norihiro Kogame, Ryo Fukui, Hiroki Takenaka, Nobuyuki Kobayashi
PMID: 28777097  PMCID: PMC5689052  doi: 10.14744/AnatolJCardiol.2017.7628  Pages 206 - 212
Objective: The establishment of an optimal strategy for elderly patients with acute decompensated heart failure (ADHF) is currently an important issue. Particularly in very elderly (VE) patients, ADHF is associated with a poor prognosis. We therefore aimed to evaluate the efficacy and safety of the early use of tolvaptan (TLV) in VE patients.
Methods: Of 245 patients with ADHF admitted between March 2013 and July 2014, we prospectively enrolled 111 patients with TLV first administered within 24 h of hospitalization. These were divided into two groups according to the age: VE (≥85 years, n=45) and not very elderly (NVE, <85 years, n=66). The endpoints were the incidence of worsening renal function, death by any cause, or the length of hospital stay.
Results: There were no significant differences between the two groups in the incidence of worsening renal function (26.7% in VE vs. 25.8% in not VE, p=0.92), dose of TLV after hospitalization (7.4±0.7 vs. 7.5±1.3 mg/day, p=0.63), mean duration of the use of TLV (4.3±3.5 vs. 5.4±4.8 days, p=0.17), or mean length of hospital stay (16.5±7.8 vs. 15.7±8.0 days, p=0.64).
Conclusion: TLV shows similar efficacy and safety in both VE and NVE groups. Even for VE patients with ADHF, initiation of TLV with standard diuretic treatment may have the potential not to increase the incidence of worsening renal function.

8.Tolvaptan in the very elderly with acute decompensated heart failure- a therapeutic option worthy of consideration
Gjin Ndrepepa
PMID: 28883307  PMCID: PMC5689053  doi: 10.14744/AnatolJCardiol.2017.8033  Pages 213 - 214
Abstract | Full Text PDF

9.Changes in neutrophil-to-lymphocyte ratios in postcardiac arrest patients treated with targeted temperature management
Kazım Başer, Hatice Duygu Baş, Pavan Attaluri, Terrance Rodrigues, Jacob Nichols, Kenneth Nugent
PMID: 28761020  PMCID: PMC5689054  doi: 10.14744/AnatolJCardiol.2017.7716  Pages 215 - 222
Objective: The prognostic value of changes in neutrophil-to-lymphocyte ratios (NLR) in cardiac arrest survivors receiving targeted temperature management (TTM) is unknown. The current study investigated NLR in postcardiac arrest (PCA) patients undergoing TTM.
Methods: This retrospective single-center study included 95 patients (59 males, age: 55.0±17.0 years) with in-hospital and out-of-hospital cardiac arrests who underwent TTM for PCA syndrome within 6 h of cardiac arrest. Hypothermia was maintained for 24 h at a target temperature of 33°C. NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count.
Results: Of the 95 patients, 59 (62%) died during hospital stay. Fewer vasopressors were used in patients who survived. Out-of-hospital cardiac arrest was more frequent in decedents (p=0.005). Length of stay in the hospital and intensive care unit were significantly longer in patients who survived (p=0.0001 and p=0.001, respectively). NLR on admission and during rewarming did not differ between survivors and decedents. NLR during cooling was significantly higher in decedents (p=0.014). Delta NLR cut-off of 13.5 best separated survivors and decedents (AUC=0.68, 95% CI: 0.57–0.79, p=0.003 with a sensitivity and specificity of 64% and 67%, respectively). In multivariate logistic regression analysis, larger increase in NLR was significantly associated with decreased survival (OR: 0.96, 95% CI: 0.94–0.99, p=0.008).
Conclusion: Changes in NLR are an independent determinant of survival in patients with return of spontaneous circulation PCA treated with TTM. An NLR change can be used to predict survival in these patients.

10.Pulmonary arterial hemodynamic assessment by a novel index in systemic lupus erythematosus patients: pulmonary pulse transit time
Tolga Han Efe, Mehmet Doğan, Cem Özişler, Tolga Çimen, Mehmet Ali Felekoğlu, Ahmet Göktuğ Ertem, Engin Algül, Sadık Açıkel
PMID: 28639945  PMCID: PMC5689055  doi: 10.14744/AnatolJCardiol.2017.7666  Pages 223 - 228
Objective: Systemic lupus erythematosus (SLE) is a chronic, inflammatory, and autoimmune connective tissue disease. One of the leading causes of mortality among SLE patients is pulmonary hypertension. The aim of this study was to evaluate the association between echocardiographic findings, including the pulmonary pulse transit time and pulmonary hypertension parameters, in SLE patients.
Methods: Thirty SLE patients (aged 39.9±11 years, 28 females) as the study group and 34 age- and sex-matched healthy volunteers (aged 37.9±11.5 years, 31 females) as the control group were included in the study. After detailed medical histories were recorded, 12-lead electrocardiography, blood tests, and echocardiography were performed in the groups. In addition to basic echocardiographic measurements, other specialized right ventricular indicators [i.e, Tricuspid Annular Plane Systolic Excursion (TAPSE), estimated pulmonary artery systolic pressure (ePASP), right ventricular dimensions, and myocardial performance index (MPI)] were measured. The pulmonary pulse transit time was defined as the time interval between the R-wave peak in ECG and the corresponding peak late-systolic pulmonary vein flow velocity.
Results: The mean disease duration was 121.1±49.9 months. The mean age at diagnosis was 35.0±15.4 years. The mean RV MPI was higher (p=0.026), mean TAPSE measurements were shorter (p=0.021), and mean ePASP was higher (p=0.036) in the SLE group than in the control group. In addition, pPTT was significantly shorter in the SLE group (p=0.003). pPTT was inversely correlated with disease duration (p<0.001), MPI (p=0.037), and ePASP (p=0.02) and positively correlated with TAPSE (p<0.001).
Conclusion: SLE patients have higher pPTT values than controls. Further, pPTT shows an inverse correlation with disease duration, MPI, and ePASP and a positive correlation with TAPSE.

11.A comparison of the in vivo neoendothelialization and wound healing processes of three atrial septal defect occluders used during childhood in a nonrandomized prospective trial
Derya Aydın Şahin, Osman Başpınar, Ayşe Sülü, Tekin Karslıgil, Seval Kul
PMID: 28761023  PMCID: PMC5689056  doi: 10.14744/AnatolJCardiol.2017.7540  Pages 229 - 234
Objective: We prospectively investigated the neoendothelialization of transcatheter secundum atrial septal defect (ASD) closure in children receiving one of three different occluders.
Methods: Transcatheter ASD closure was performed for 44 children. The patients were divided into three groups: group I: Amplatzer, group II: Lifetech CeraFlex, and group III: Occlutech Figulla Flex II septal occluder. The data were prospectively analyzed. Markers of the three phases of wound healing were studied in all patients before and on the 1st and 10th days and 1st month post intervention.
Results: The mean age of children was 7.08±3.51 years, and the mean weight was 26.07±15.07 kg. The mean ASD diameter was 12.65±3.50 mm. Groups I, II, and III comprised 34.1%, 31.8%, and 34.1% patients, respectively. No significant differences were observed between the groups regarding patient number, age, defect size, device diameter, or total septum/device ratio (p>0.05). Inflammatory and proliferative phase marker levels increased following the procedure (p<0.05). However, scar formation markers did not change after 1 month. No significant differences in neoendothelializaton were observed among the different occluders (p>0.05).
Conclusion: All three devices were composed of nitinol with different surface coating techniques. Although the different manufacturing features were claimed to facilitate of neoendothelialization, no differences were observed among the three devices 1 month following the procedure.

12.Successful management of iatrogenic retrograde dissection into the aortic root
Kadir Uğur Mert, Gurbet Özge Mert, Rafet Dizman
PMID: 28883308  PMCID: PMC5689057  doi: 10.14744/AnatolJCardiol.2017.7803  Pages 235 - 237
Abstract | Full Text PDF | Video

13.Preventing Kounis syndrome by stent implantation: a reciprocal process?
Nicholas G Kounis, Ioanna Koniari, Nicholas Patsouras, George Hahalis
PMID: 28883309  PMCID: PMC5689058  doi: 10.14744/AnatolJCardiol.2017.7963  Page 238
Abstract | Full Text PDF

14.Author`s Reply
Kadriye Terzioğlu
PMID: 28883310  PMCID: PMC5689059  Page 239
Abstract | Full Text PDF

15.Patients’ knowledge and perspectives on vitamin K antagonists for stroke prevention in atrial fibrillation: implications for treatment quality
Marija Polovina, Dijana Djikic, Ana Vlajkovic, Matej Vilotijevic
PMID: 28883311  PMCID: PMC5689060  doi: 10.14744/AnatolJCardiol.2017.7980  Pages 239 - 240
Abstract | Full Text PDF

16.Accentuating systolic aortic regurgitation during premature ventricular systole
Serkan Duyuler, Pınar Türker Duyuler
PMID: 28883303  PMCID: PMC5689061  doi: 10.14744/AnatolJCardiol.2017.7918  Pages E3 - E4
Abstract | Full Text PDF | Video

17.Real-time three-dimensional echocardiography imaging of the main pulmonary artery pseudoaneurysm
Yue Zhong, Wenjuan Bai, Hong Tang, Li Rao
PMID: 28883304  PMCID: PMC5689062  doi: 10.14744/AnatolJCardiol.2017.7978  Page E4
Abstract | Full Text PDF | Video

18.Cor calcium: heart trapped in a pericardial cage
Yalçın Velibey, Sinan Şahin, Tolga Sinan Güvenç, Tolga Onuk
PMID: 28883305  PMCID: PMC5689063  doi: 10.14744/AnatolJCardiol.2017.7979  Pages E5 - E6
Abstract | Full Text PDF | Video