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Volume : 18 Issue : 4 Year : 2021
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The Anatolian Journal of Cardiology - Anatol J Cardiol: 18 (4)
Volume: 18  Issue: 4 - October 2017
1.Noteworthy items in this issue
Bilgin Timuralp
PMID: 29076823  PMCID: PMC5731518  doi: 10.14744/AnatolJCardiol.2017.10  Page 241
Abstract | Full Text PDF

2.Preliminary results from a nationwide adult cardiology perspective for pulmonary hypertension: RegiStry on clInical outcoMe and sUrvival in pulmonaRy hypertension Groups (SIMURG)
Cihangir Kaymaz, Bülent Mutlu, M. Serdar Küçükoğlu, Barış Kaya, Bahri Akdeniz, Burçak Kılıçkıran Avcı, Enbiya Aksakal, Mehmet Akbulut, Zehra Atılgan Arıtürk, Sümeyye Güllülü, Gülten Aydoğdu Taçoy, Meral Kayıkçıoğlu, Sanem Nalbantgil, Cihan Örem, Hatice Betül Erer, Murat Yüce, Necip Ermiş, Omaç Tüfekçioğlu, Mesut Demir, Mehmet Birhan Yılmaz, Mehmet Güngör Kaya, Hakan Kültürsay, Zeki Öngen, Lale Tokgözoğlu
PMID: 29076824  PMCID: PMC5731519  doi: 10.14744/AnatolJCardiol.2017.7549  Pages 242 - 250
Objective: The present study was designed to evaluate the characteristics of pulmonary hypertension (PH) and adult cardiology practice patterns for PH in our country.
Methods: We evaluated preliminary survey data of 1501 patients with PH (females, 69%; age, 44.8±5.45) from 20 adult cardiology centers (AdCCs).
Results: The average experience of AdCCs in diagnosing and treating patients with PH was 8.5±3.7 years. Pulmonary arterial hypertension (PAH) was the most frequent group (69%) followed by group 4 PH (19%), group 3 PH (8%), and combined pre- and post-capillary PH (4%). PAH associated with congenital heart disease (APAH-CHD) was the most frequent subgroup (47%) of PAH. Most of the patients’ functional class (FC) at the time of diagnosis was III. The right heart catheterization (RHC) rate was 11.9±11.6 per month. Most frequently used vasoreactivity agent was intravenous adenosine (60%). All patients under targeted treatments were periodically for FC, six-minute walking test, and echo measures at 3-month intervals. AdCCs repeated RHC in case of clinical worsening (CW). The annual rate of hospitalization was 14.9±19.5. In-hospital use of intravenous iloprost reported from 16 AdCCs in CWs. Bosentan and ambrisentan, as monotreatment or combination treatment (CT), were noted in 845 and 28 patients, respectively, and inhaled iloprost, subcutaneous treprostinil, and intravenous epoprostenol were noted in 283, 30, and four patients, respectively. Bosentan was the first agent used for CT in all AdCCs and iloprost was the second. Routine use of antiaggregant, anticoagulant, and pneumococcal and influenza prophylaxis were restricted in only two AdCCs.
Conclusion: Our nationwide data illustrate the current status of PH regarding clinical characteristics and practice patterns.

3.Optimal duration of dual antiplatelet therapy after drug eluting stent implantation: a network meta-analysis
Rama Dilip Gajulapalli, Sofia Dias, Deepak J. Pattanshetty, Ganesh Athappan
PMID: 29076813  PMCID: PMC5731520  doi: 10.14744/AnatolJCardiol.2017.7672  Pages 251 - 260
Objective: There has been much debate regarding the optimal duration of dual antiplatelet therapy (DAPT) cover after drug eluting stent (DES) implantation. We aimed to assess the relative benefits of shorter and longer durations of DAPT coverage.
Methods: We performed a network meta-analysis (NMA) of all the randomized clinical trials (RCT) comparing different time durations of DAPT cover.
Results: We included 11 unique trials with a total of 33,458 patients; the longest duration of follow-up was 48 months and the shortest was 3 months. NMA results demonstrated that compared with 12 months, longer DAPT of 30 months reduced the hazard ratio (HR) of stent thrombosis (HR, 0.29; 95% CrI, 0.17–0.49). There was no difference in mortality between shorter and longer durations of DAPT except for 30 vs. 48 months (HR, 0.48; 95% CrI, 0.23–0.98). Compared with 12 months, longer DAPT of 30 months reduced the risk of myocardial infarction (HR, 0.47; 95% CrI, 0.37–0.61). Results also demonstrated that compared with 12 months, a shorter-term DAPT reduced the risk of major bleeding (6 months: HR, 0.53; 95% CrI, 0.29–0.98), whereas longer-term DAPT increased the risk of major bleeding (30 months: HR, 1.61; 95% CrI, 1.21–2.15).
Conclusion: As expected, bleeding was less in the shorter duration regimens, whereas the ischemic outcomes were better in the longer duration ones.

4.Effects of rivaroxaban on intimal hyperplasia and smooth muscle cell proliferation at the carotid artery anastomosis site in rabbits
Gökmen Akkaya, Çağatay Bilen, Tuğra Gençpınar, Pınar Akokay, Baran Uğurlu
PMID: 29076814  PMCID: PMC5731521  doi: 10.14744/AnatolJCardiol.2017.7898  Pages 261 - 265
Objective: This study aimed to assess the effect of new generation oral, direct factor Xa inhibitor rivaroxaban on intimal hyperplasia and smooth muscle cell proliferation at the carotid artery anastomosis site of rabbits.
Methods: In total, 14 New Zealand male rabbits weighing 3–3.5 kg were randomized into two groups. Group A (7 rabbits) served as the control group and received no medication. Rivaroxaban was perorally administered to group B (7 rabbits) mg/kg/day for 28 days. Following anesthesia induction, carotid arteries were dissected through a right neck incision. following heparinization at 100 IU/kg, vertical full thickness arteriotomy was performed, then was repaired continuously with 8-0 polypropylene. At day 28, all rabbits were sacrificed and the anastomosed carotid artery segments were analyzed using light microcopy. Hematoxylin–eosin and Masson’s trichrome stained images were analyzed using a digital image analysis program, and lumen diameter, lumen area, intimal and medial thickness, and media areas were measured and results were compared.
Results: In the serial sections, the average lumen diameter of group B was higher than that of group A (p=0.001). The lumen areas of group B were also higher than those of group A (p=0.004). The intimal thickness of group B was lower than that of group A (p=0.001). When the section series were evaluated for media thickness, the thickness of group B was lesser than that of group A; the difference was statistically significant (p=0.002).
Conclusion: This study may imply a potential midterm benefit of rivaroxaban following arterial anastomosis by reducing intimal proliferation and restenosis.

5.PCSK 9 gain-of-function mutations (R496W and D374Y) and clinical cardiovascular characteristics in a cohort of Turkish patients with familial hypercholesterolemia
Esra Kaya, Meral Kayıkçıoğlu, Aslı Tetik Vardarlı, Zuhal Eroğlu, Serdar Payzın, Levent Can
PMID: 28777095  PMCID: PMC5731522  doi: 10.14744/AnatolJCardiol.2017.7654  Pages 266 - 272
Objective: The molecular basis of the mutations in the PCSK9 gene that produces familial hypercholesterolemia (FH) in the Turkish population is unknown. This study was conducted to determine the presence of four different PCSK9 gain-of-function (GOF) mutations (F216L, R496W, S127R, and D374Y) in a group of patients with FH.
Methods: A total of 80 consecutive patients with FH (mean age: 56±11 years; mean maximum LDL cholesterol: 251±76 mg/dL) were included in the study. Patients with FH were diagnosed according to the Dutch Lipid Clinic Network criteria based on serum cholesterol levels, personal and family histories of cardiovascular disease, tendon xanthomas, and genetic analysis. To identify F216L, R496W, S127R, and D374Y mutations of the PCSK9 gene, high-resolution melting analysis was performed on isolated DNAs.
Results: : Of the 80 patients, there were 11 patients (13.8%) with PCSK9 GOF mutations. Detected mutations were D374Y mutation in four (5.0%) patients and R496W in seven patients (8.7%). Only one patient was homozygous for R496W mutation. The other two GOF mutations (S127R and F216 variants) were not detected. There was no significant difference with regard to demographic characteristics and CV disease risk factors and clinical course of the disease between the PCSK9 mutation-positive and PCSK9 mutation-negative groups.
Conclusion: This is the first study from a Turkish FH cohort, revealing a higher frequency (approximately 14%) of two PCSK9 GOF mutations (D374Y and R496W) and a different disease course compared to the world literature.

6.Analysis of geographical variations in the epidemiology and management of non-valvular atrial fibrillation: results from the RAMSES registry
Volkan Doğan, Özcan Başaran, Murat Biteker, Fatma Özpamuk Karadeniz, Ahmet İlker Tekkesin, Yasin Çakıllı, Ceyhan Türkkan, Mehmet Hamidi, Vahit Demir, Mustafa Ozan Gürsoy, Müjgan Tek Öztürk, Gökhan Aksan, Sabri Seyis, Mehmet Ballı, Mehmet Hayri Alıcı, Serdar Bozyel, Cevat Kırma, And Collaborators
PMID: 28811393  PMCID: PMC5731523  doi: 10.14744/AnatolJCardiol.2017.7709  Pages 273 - 280
Objective: This study aimed to determine the differences in terms of demographic characteristics and preferred stroke prevention strategies for patients with non-valvular atrial fibrillation living in seven geographical regions of Turkey.
Methods: In total, 6273 patients were enrolled to this prospective, observational RAMSES study. The patients were divided into seven groups based on the geographical region of residence.
Results: In terms of the geographical distribution of the overall Turkish population, the highest number of patients were enrolled from Marmara (1677, 26.7%). All demographic characteristics were significantly different among regions. Preferred oral anticoagulants (OACs) also differed between geographical regions; non-vitamin K OACs were preceded by warfarin in East Anatolia, Aegean, Southeast Anatolia, and Black Sea. Nearly one-third of the patients (28%) did not receive any OAC therapy. However, the number of patients not receiving any OAC therapy was higher in Southeast Anatolia (51.1%) and East Anatolia (46.8%) compared with other geographical regions of Turkey. Inappropriate use of OACs was also more common in East and Southeast Anatolia.
Conclusion: This study was the first to show that the demographic differences among the geographical regions may result in different preferences of stroke prevention strategies in Turkey. OACs are still under- or inappropriately utilized, particularly in the eastern provinces of Turkey.

7.Role of sympathetic cotransmitter galanin on autonomic balance in heart failure: an active player or a bystander?
Demet Özkaramanlı Gür, Miray Sağbaş, Aydın Akyüz, Savaş Güzel, Şeref Alpsoy, Niyazi Güler
PMID: 28811392  PMCID: PMC5731524  doi: 10.14744/AnatolJCardiol.2017.7831  Pages 281 - 288
Objective: Galanin, a cotransmitter similar to neuropeptide Y (NPY), aggravates autonomic imbalance in systolic heart failure (HF) by attenuating vagal tonus after burst sympathetic activity. In animal HF models, galanin antagonists have improved cardiac function. To determine whether galanin is a promising therapeutic target in HF, we studied its concentrations in HF patients and evaluated its correlation with NPY, markers of humoral activity such as pro-BNP and copeptin, and echocardiographic parameters of HF severity.
Methods: After recording demographic and echocardiographic characteristics of 87 individuals (57 HF patients and 30 control subjects), fasting serum concentrations of galanin, NPY, copeptin, and pro-BNP were determined.
Results: Unlike pro-BNP, copeptin, and NPY, which were significantly elevated in HF patients (p<0.001, p<0.001, and p=0.001, respectively), galanin was similar in HF patients and control subjects (p=0.9). NPY correlated with the echocardiographic parameters of HF severity (r=–0.22, p=0.03 for EF; r=0.3, p=0.005 for Tei index of RV; r=–0.23, p=0.03 for TAPSE; and r=0.24, p=0.024 for E/e′) and pro-BNP (r=0.22, p=0.046). NPY levels were also associated with beta blocker (BB) use, wherein BB significantly decreased NPY in both HF patients and control subjects. Galanin correlated with humoral biomarkers, pro-BNP and copeptin (r=0.39, p<0.001 and r=0.41, p<0.001, respectively). Although current smoking, BB therapy, pro-BNP, copeptin, and body mass index were associated with galanin in univariate analyses, the multiple linear regression model revealed that pro-BNP was the only significant determinant of galanin levels in HF patients.
Conclusion: Our findings confirmed the role of NPY in autonomic balance and suggest that galanin is associated with the proadrenergic state, but its role in HF in humans remains unclear.

8.Cardiac implantable electronic device lead extraction using the lead-locking device system: keeping it simple, safe, and inexpensive with mechanical tools and local anesthesia
Antonis S. Manolis, Georgios Georgiopoulos, Sofia Metaxa, Spyridon Koulouris, Dimitris Tsiachris
PMID: 28811391  PMCID: PMC5731525  doi: 10.14744/AnatolJCardiol.2017.7821  Pages 289 - 295
Objective: We have previously reported our successful approach for percutaneous cardiac implantable electronic device (CIED) lead extraction using inexpensive tools, which we have continued over the years. Herein we report the results of the systematic use of a unique stylet, the lead-locking device (LLD), which securely locks the entire lead lumen, aided with non-powered telescoping sheaths in 54 patients to extract 98 CIED leads.
Methods: This prospective observational clinical study included 38 men and 16 women aged 68.9±13.1 years undergoing lead extraction for device infection (n=46), lead malfunction (n=5), or prior to defibrillator implant (n=3). Leads were in place for 6.7±4.3 years. Infections were more commonly due to Staphylococcus species (n=40). There were 78 pacing (31 ventricular, 37 atrial, 4 VDD, and 6 coronary sinus leads) and 20 defibrillating leads.
Results: Using simple traction (6 leads) and the LLD stylets (92 leads) aided with telescoping sheaths (15 patients), 96 (98%) leads in 52 (96.3%) patients were successfully removed, with all but one leads removed using a subclavian approach; in 1 patient, the right femoral approach was also required. In 2 patients, distal fragments from one ventricular pacing and one defibrillating lead could not be removed. Finally, lead removal was completely (52/54) (96.3%) or partially (2/54) (3.7%) successful in 54 patients for 96 of 98 leads (98%) without major complications.
Conclusion: Percutaneous lead extraction can be successful with mechanical tools using the LLD locking stylet aided with non-powered telescoping sheaths through a simplified, safe, and inexpensive procedure using local anesthesia alone.

9.Transvenous lead extraction: Can it be simple yet safe?
Antonios P. Antoniadis, Vassilios P. Vassilikos
PMID: 29076815  PMCID: PMC5731526  doi: 10.14744/AnatolJCardiol.2017.25858  Pages 296 - 297
Abstract | Full Text PDF

10.Beam projections and radiation exposure in transradial and transfemoral approaches during coronary angiography
Ali Tarighatnia, Amirhossien Mohammadalian, Morteza Ghojazade, Leili Pourafkari, Alireza Farajollahi
PMID: 28777096  PMCID: PMC5731527  doi: 10.14744/AnatolJCardiol.2017.7724  Pages 298 - 303
Objective: We aimed to compare the operator and patient radiation exposure in standard projections during elective diagnostic coronary angiography procedures via transradial (TRA) versus transfemoral (TFA) approaches.
Methods: In this analytical cross-sectional study, a total of 202 consecutive patients who were candidates for diagnostic coronary angiography were randomized to undergo the procedure via TFA or TRA approaches (101 in each group). Patients with abnormal Allen test and history of coronary artery bypass surgery, valvular heart disease, and unsuccessful coronary angiography were excluded from the study. A single operator performed all of the procedures using a single angiography system. Patient and operator radiation exposure were measured using diamentor and an electronic personal dosimeter, respectively. Each procedure comprised a standardized sequence of projections including four standard views for the left coronary system and two standard views for the right coronary system.
Results: Left anterior oblique (LAO) caudal (50°/30°) and right anterior oblique RAO (30°) projections were associated with the highest and lowest patient radiation exposure, respectively. The operator received a significantly higher radiation exposure in the TRA approach for LAO cranial (for both left and right coronary systems) and LAO caudal (for left coronary system) projections during coronary angiography compared with the TFA approach.
Conclusion: Though a similar amount of patient radiation exposure in each projection was observed among TFA and TRA groups; LAO cranial and LAO caudal projections were associated with a significantly higher operator radiation exposure in the TRA group. These findings need to be considered when choosing the optimal arterial approach for patients scheduled for coronary angiography.

11.How to image individual pulmonary veins with transthoracic echocardiography
Zehra Gölbaşı, Kumral Çağlı, Özcan Özeke, Dursun Aras
PMID: 29076816  PMCID: PMC5731528  doi: 10.14744/AnatolJCardiol.2017.7872  Pages 304 - 308
Although Doppler analysis of pulmonary veins (PVs) is crucial in the assessment of cardiac hemodynamics, there is controversy regarding individual anatomical PV imaging with transthoracic echocardiography (TTE). This report is a discussion of how to image PVs accurately using TTE. To resolve any contradiction, multiple TTE images were obtained during the selective catheterization of the PV in patients undergoing atrial fibrillation ablation procedure. Fluoroscopic images were used as a reference for the identification of each PV and simultaneous echocardiographic imaging of the catheter positioned in the distal PV was used for accurate anatomical localization of the ostium and distal part of the PV.

12.The effects of steroids on endothelial function
Orhan Gökalp, Şahin İşcan, Hasan İner, Ali Gürbüz
PMID: 29076817  PMCID: PMC5731529  doi: 10.14744/AnatolJCardiol.2017.8003  Page 309
Abstract | Full Text PDF

13.Author`s Reply
Mehmet Vedat Çaldır, Güner Koyuncu Çelik, Özgür Çiftçi, İbrahim Haldun Müderrisoğlu
PMID: 29076818  PMCID: PMC5731530  Pages 309 - 310
Abstract | Full Text PDF

14.An unusual side effect of weight loss pills in a young man; acute myocardial infarction due to cayenne pepper pills
Murat Akçay, Ömer Gedikli, Serkan Yüksel
PMID: 29076819  PMCID: PMC731531  doi: 10.14744/AnatolJCardiol.2017.8031  Pages 310 - 311
Abstract | Full Text PDF

15.A non-conventional approach to 10-year-delayed extraction of pacemaker leads associated with recurrent infective complications
Nicolae- Dan Tesloianu, Andreea- Mihaela Ignat, Dana Corduneanu, Antoniu- Octavian Petris, Ionut Tudorancea
PMID: 29076820  PMCID: PMC5731532  doi: 10.14744/AnatolJCardiol.2017.8042  Pages 311 - 312
Abstract | Full Text PDF

16.Massive, ring-shaped pericardial calcification of atrioventricular groove
Bernas Altıntaş, Derya Deniz, Rojhat Altındağ, Barış Yaylak, Erkan Baysal, Önder Bilge
PMID: 29076821  PMCID: PMC5731533  doi: 10.14744/AnatolJCardiol.2017.7986  Page E7
Abstract | Full Text PDF

17.Successful management of complications after inappropriate positioning of a hemodialysis catheter
Murat Akçay, Serkan Burç Deşer, Ömer Gedikli, Serkan Yüksel, Okan Gülel
PMID: 29076822  PMCID: PMC5731534  doi: 10.14744/AnatolJCardiol.2017.8001  Pages E7 - E8
Abstract | Full Text PDF | Video