ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 19 (6)
Volume: 19  Issue: 6 - June 2018
1.An issue that is largely about coronary artery disease
Çetin Erol
PMID: 29848930  doi: 10.14744/AnatolJCardiol.2018.6  Page 359
Abstract |Full Text PDF

2.Study of the association of 17 lipid-related gene polymorphisms with coronary heart disease
Nan Wu, Guili Liu, Yi Huang, Qi Liao, Liyuan Han, Huadan Ye, Shiwei Duan, Xiaomin Chen
PMID: 29848931  doi: 10.14744/AnatolJCardiol.2018.23682  Pages 360 - 367
Objective: Blood lipids are well-known risk factors for coronary heart disease (CHD). The aim of this study was to explore the association between 17 lipid-related gene polymorphisms and CHD.
Methods: The current study examined with 784 CHD cases and 739 non-CHD controls. Genotyping was performed on the MassARRAY iPLEX® assay platform.
Results: Our analyses revealed a significant association of APOE rs7259620 with CHD (genotype: χ2=6.353, df=2, p=0.042; allele: χ2=5.05, df=1, p=0.025; recessive model: χ2=5.57, df=1, p=0.018). A further gender-based subgroup analysis revealed significant associations of APOE rs7259620 and PPAP2B rs72664392 with CHD in males (genotype: χ2=8.379, df=2, p=0.015; allele: χ2=5.190, df=1, p=0.023; recessive model: χ2=19.3, df=1, p<0.0001) and females (genotype: χ2=9.878, df=2, p=0.007), respectively. Subsequent breakdown analysis by age showed that CETP rs4783961, MLXIPL rs35493868, and PON2 rs12704796 were significantly associated with CHD among individuals younger than 55 years of age (CETP rs4783961: χ2=8.966, df=1, p=0.011 by genotype; MLXIPL rs35493868: χ2=4.87, df=1, p=0.027 by allele; χ2=4.88, df=1, p=0.027 by dominant model; PON2 rs12704796: χ2=6.511, df=2, p=0.039 by genotype; χ2=6.210, df=1, p=0.013 by allele; χ2=5.03, df=1, p=0.025 by dominant model). Significant allelic association was observed between LEPR rs656451 and CHD among individuals older than 65 years of age (χ2=4.410, df=1, p=0.036).
Conclusion: Our study revealed significant associations of APOE, PPAP2B, CETP, MLXIPL, PON2, and LEPR gene polymorphisms with CHD among the Han Chinese.

3.Admission glycemic variability correlates with in-hospital outcomes in diabetic patients with non-ST segment elevation acute coronary syndrome undergoing percutaneous coronary intervention
Gong Su, Tao Zhang, Hongxia Yang, Wenlong Dai, Lei Tian, Hong Tao, Tao Wang, Shuhua Mi
PMID: 29848920  doi: 10.14744/AnatolJCardiol.2018.47487  Pages 368 - 373
Objective: The aim of this study is to evaluate the effects of admission glycemic variability (AGV) on in-hospital outcomes in diabetic patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI).
Methods: We studied 759 diabetic patients with NSTE-ACS undergoing PCI. AGV was accessed based on the mean amplitude of glycemic excursions (MAGEs) in the first 24 hours after admission. Primary outcome was a composite of in-hospital events, all-cause mortality, new-onset myocardial infarction, acute heart failure, and stroke. Secondary outcomes were each of these considered separately. Predictive effects of AGV on the in-hospital outcomes in patients were analyzed.
Results: Patients with high MAGE levels had significantly higher incidence of total outcomes (9.9% vs. 4.8%, p=0.009) and all-cause mortality (2.3% vs. 0.4%, p=0.023) than those with low MAGE levels during hospitalization. Multivariable analysis revealed that AGV was significantly associated with incidence of in-hospital outcomes (Odds ratio=2.024, 95% CI 1.105-3.704, p=0.022) but hemoglobin A1c (HbA1c) was not. In the receiver-operating characteristic curve analysis for MAGE and HbA1c in predicting in-hospital outcomes, the area under the curve for MAGE (0.608, p=0.012) was superior to that for HbA1c (0.556, p=0.193).
Conclusion: High AGV levels may be closely correlated with increased in-hospital poor outcomes in diabetic patients with NSTE-ACS following PCI.

4.Association of serum levels of lipoprotein A-I and lipoprotein A-I/A-II with high on-treatment platelet reactivity in patients with ST-segment elevation myocardial infarction
Aleksander Siniarski, Rafal Grzybczak, Pawel Rostoff, Jaroslaw Zalewski, Urszula Czubek, Jadwiga Nessler, Grzegorz Gajos
PMID: 29848921  doi: 10.14744/AnatolJCardiol.2018.63549  Pages 374 - 381
Objective: High-density lipoproteins (HDLs) are a very heterogeneous group of particles. Little is known about the impact of their subfractions including lipoprotein A-I (LpA-I) and lipoprotein A-I/A-II (LpA-I/A-II) on platelet function and high on-treatment platelet reactivity (HPR), particularly in the acute phase of ST-segment elevation myocardial infarction (STEMI). The aim of the study was to evaluate the relationship between serum levels of LpA-I and LpA-I/A-II and HPR in STEMI patients.
Methods: Fifty-two consecutive STEMI patients (26.9% women, mean age 60.6±9.1 years) were enrolled into this study. Clinical and demographic data were collected and HDL subfractions were measured by rocket immunoelectrophoresis. Platelet reactivity was assessed using light transmission aggregometry and quantitative flow cytometry.
Results: We found a positive correlation between platelet aggregation after both ADP-5 and ADP-20 stimulation and serum level of LpA-I. Compared with subjects with satisfactory platelet response to clopidogrel, patients with HPR had 32.44% higher serum level of LpA-I (p=0.021). On the other hand, patients with HPR assessed by ADP-5 stimulation had 22.13% lower serum level of LpA-I/A-II (p=0.040). Regression analysis showed that LpA-I [odds ratio (OR) 1.03; 95% confidence interval (CI) 1-1.07; p=0.049] and current smoking (OR 0.18; 95% CI 0.04-0.81; p=0.025) were independent predictors of HPR. With receiver operating characteristic (ROC) curve analysis, we designated the cut-off point at serum level of 57.52 mg/dL for LpA-I for predicting HPR (AUC=0.71, p=0.010).
Conclusion: This study showed that higher serum level of LpA-I measured in the acute phase of STEMI is an independent risk factor for HPR. Our study is the first to demonstrate an important and distinct activity of LpA-I and LpA-I/A-II that can prove pleiotropic and different functions of HDL subfractions in acute STEMI.

5.Major adverse cardiac events and drug-coated balloon size in coronary interventions
David Naguib, Betül Knoop, Lisa Dannenberg, Eva Liebsch, Martin Pöhl, Carolin Helten, Athena Assadi-schmidt, Malte Kelm, Tobias Zeus, Amin Polzin
PMID: 29848922  doi: 10.14744/AnatolJCardiol.2018.67864  Pages 382 - 387
Objective: In-stent restenosis (ISR) is a feared complication after coronary stent implantation. Drug-coated balloon (DCB) is being promoted as a treatment option for ISR. However, the benefit-risk ratio of DCB length has not been investigated. Longer DCBs release more anti-proliferative drug to the vessel wall; however, they are associated with a higher lesion length and vessel injury. Hypothesis: DCB length is associated with clinical outcome.
Methods: We analyzed 286 consecutive Pantera Lux (Biotronik, active component Paclitaxel) DCB-treated patients between April 2009 and June 2012. Of them, 176 patients were treated using a 15-mm DCB and 109 were treated using a 20-mm DCB. Baseline characteristics and major adverse cardiac events (MACE; death, myocardial infarction, and target lesion revascularization) during initial hospital stay and a 2-year follow-up period were obtained.
Results: Patients characteristics such as cardiovascular risk factors, prior diseases, co-medication, clinical presentation, target vessel, and left ventricular function did not differ between the groups. MACE during hospital course was similar [1.7% vs. 2.8%, relative risk (RR) 1.6, 95% confidence interval (CI) 0.3-7.9, p=0.554]. Likewise, at 2-year follow-up, MACE did not differ between the groups (23.2% vs. 27.5%, RR 1.2, 95% CI 0.6-1.5, p=0.408).
Conclusion: DCB length was not associated with clinical outcome during a 2-year follow-up period.

6.Speckle-tracking strain assessment of left ventricular dysfunction in synthetic cannabinoid and heroin users
Aykut Demirkıran, Neslihan Albayrak, Yakup Albayrak, Cafer Sadık Zorkun
PMID: 29848923  doi: 10.14744/AnatolJCardiol.2018.76429  Pages 388 - 393
Objective: There is growing evidence regarding the numerous adverse effects of synthetic cannabinoids (SCBs) on the cardiovascular system; however, no studies have shown the cardiovascular effects of opioids using strain echocardiography. This study examines the cardiac structure and function using echocardiographic strain imaging in heroin and synthetic cannabinoid users.
Methods: This double-blind study included patients who were admitted or referred to a rehabilitation center for heroin (n=31) and synthetic cannabinoid users (n=30). Heroin users and synthetic cannabinoid users were compared with healthy volunteers (n=32) using two-dimensional (2D) speckle-tracking (ST) echocardiography.
Results: No differences were found in the baseline characteristics and 2D echocardiography values. The mean global longitudinal strain value was −20.5%±2.4% for SCB users, −22.3%±2.4% for opioid users, and −22.5%±2.2% for healthy volunteers (p=0.024). The mean apical 2-chamber (AP2C) L-strain values were −20.1%±3.1%, −22.4%±3.0%, and −22.3%±2.8% for SCB users, opioid users, and healthy volunteers, respectively (p=0.032). The mean apical 4-chamber (AP4C) L-strain values were −20.7%±2.5% for SCB users, −23.2%±3.2% for opioid users, and −23.8%±3.1% for healthy volunteers (p<0.001).
Conclusion: SCBs are potential causes of subclinical left ventricular dysfunction.

7.Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement
Alina Cristina Iliescu, Delia Lidia Salaru, Ionut Achitei, Mihaela Grecu, Mariana Floria, Grigore Tinica
PMID: 29848924  doi: 10.14744/AnatolJCardiol.2018.70745  Pages 394 - 400
Objective: Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, with increased risk of stroke and high mortality. Our aim was to identify patients at risk and to design a model that could predict POAF.
Methods: In this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement between January 2000 and June 2014. The patients were followed during the early postoperative period until discharge.
Results: AF occurred in 342 patients (28.71%). Six variables associated with high arrhythmic risk [advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer intensive care unit stay, and dilated left atrium (LA; volume ≥35 ml/m2)] were selected to create a multivariate prediction model. This model predicted POAF in 64.7% of cases, with a moderate discriminative power (AUC=0.65; p=0.001; 95% CI, 0.571-0.771). We also developed the CHAID (Chi-square automatic interaction detection) model showing multilevel interactions among risk factors for POAF. Age had the greatest discriminative power, with patients aged >68 years at a higher risk for POAF. In low-risk patients, the subgroup with dilated LA (volume ≥40 ml) was more prone to develop POAF. For the intermediate-risk group, history of AF was the next deciding variable, whereas for the high-risk group, it was tricuspid regurgitation (at least moderate).
Conclusion: The multivariate logistic model has an acceptable predictive value. CHAID-derived model is a new tool that could be easily applied to identify patients requiring prophylactic regimens.

8.Current state of risk stratification for sudden cardiac death in adults with congenital heart disease
Jim T. Vehmeijer, Barbara J.M. Mulder, Joris R. de Groot
PMID: 29537971  doi: 10.14744/AnatolJCardiol.2018.81782  Pages 401 - 403
Sudden cardiac death (SCD), mainly caused by ventricular arrhythmias, is one of the leading causes of mortality in adult congenital heart disease (ACHD) patients. An implantable cardioverter defibrillator (ICD) may prevent SCD, but risk stratification remains challenging. In this review, we will address the current guideline recommendations for ICD implantation in ACHD patients, as well as review a recent study in which the discriminative ability for SCD of these guidelines is evaluated. In this study, the guideline recommendations were applied to patients who died of SCD and living controls. Among SCD cases, 35%-41% of patients were recommended ICD, whereas 16%-17% of controls were recommended ICD. The discriminative ability for SCD of the guidelines was poor, with an area under the receiver operating characteristic curve of 0.61-0.63. Risk stratification for SCD in ACHD patients, therefore, remains to be a work-in-progress.

9.Role of cardiac T1 mapping and extracellular volume in the assessment of myocardial infarction
Pankaj Garg, Laura C Saunders, Andrew J Swift, Jim M Wild, Sven Plein
PMID: 29638222  doi: 10.14744/AnatolJCardiol.2018.39586  Pages 404 - 411
Although late gadolinium enhancement on cardiac magnetic resonance imaging remains the reference standard for scar assessment, it does not provide quantitative information about the extent of pathophysiological changes within the scar tissue. T1 mapping and extracellular volume (ECV) mapping are steadily becoming diagnostic and prognostically useful tests for in vivo myocardial histology, influencing clinical decision-making. Quantitative native T1 maps (acquired without a contrast agent) represent the longitudinal relaxation time within the myocardium and changes with myocardial extracellular water (edema, focal, or diffuse fibrosis), fat, iron, and amyloid protein content. Post-contrast ECV maps estimate the size of the extracellular space and have sensitivity in the identification of interstitial disease. Both pre- and post-contrast T1 mapping are emerging as comprehensive tools for the assessment of numerous conditions including ischemic scarring that occurs post myocardial infarction (MI). This review outlines the current evidence and potential future role of T1 mapping in MI. We conclude by highlighting some of the remaining challenges such as quality control, standardization of image acquisition for clinical practice, and automated methods for quantifying infarct size, area at risk, and myocardial salvage post MI.

10.Dobutamine-induced takotsubo cardiomyopathy: A systematic review of the literature and case report
Shokoufeh Hajsadeghi, Mohammad Hossein Rahbar, Aida Iranpour, Ali Salehi, Omolbanin Asadi, Scott R Jafarian
PMID: 29848925  doi: 10.14744/AnatolJCardiol.2018.78642  Pages 412 - 416
Takotsubo cardiomyopathy (TCM) is a rare syndrome that precipitates by any physiologic, pathologic, or pharmacologic increase in catecholamine secretion. Here, we report a case of TCM after dobutamine stress echocardiography along with a systematical review of similar studies. After discussing our case, we searched articles for dobutamine stress echocardiography-induced TCM and have gathered and reported basic and clinical characteristics from each study. We identified 22 patients. The mean age of presentation was 64.86±11.64 years, with strong female predominance (n=19). The most common type of TCM was apical type; however, patients younger than 55 years were more likely to have inverted type (n=2) or midventricular type (n=1) and mostly presented with chest pain (n=13), following by asymptomatic cases (n=6). Of all, 16 patients developed symptoms during the intervention while consuming a dobutamine dose of 30–40 mcg/kg/min and three developed during the recovery period. The mean cardiac troponin I level was 2.68±2.70 ng/dL, and the most common finding on electrocardiogram was ST segment elevation (n=15). A complete resolution of any wall motion abnormality was achieved (n = 20), except for a near complete resolution in one patient and death of one patient. TCM should be considered in patients developing ECG change and apical ballooning after dobutamine stress echocardiography. TCM is similar to the classic type, but it can be present even without any symptoms and can occur even in the recovery phase of the test.

11.A case with a giant interatrial septal lipomatous hypertrophy, and thickened epicardial and visceral fat: Different faces of a common metabolic problem?
Gülsüm Kılıçkap
PMID: 29638225  doi: 10.14744/AnatolJCardiol.2018.04264  Pages 417 - 419
Abstract |Full Text PDF | Video

12.Percutaneous intervention of left main coronary artery chronic total occlusion: A case report
Metin Çoksevim, Murat Akçay, Korhan Soylu, Ömer Göktekin
PMID: 29848926  doi: 10.14744/AnatolJCardiol.2018.92693  Pages 419 - 421
Abstract |Full Text PDF | Video

13.Energy drinks and obesity: Preliminary results from a preclinical study
Anna Vittoria Mattioli, Antonio Manenti, Luca Reggiani Bonetti, Alberto Farinetti
PMID: 29848927  doi: 10.14744/AnatolJCardiol.2018.25826  Page 422
Abstract |Full Text PDF

14.Deployment of a SUPERA stent in a dissected lesion in the axillary artery
Göksel Çinier, Can Yücel Karabay, Barış Güngör, Ömer Kozan
PMID: 29848928  doi: 10.14744/AnatolJCardiol.2018.27475  Page E10
Abstract |Full Text PDF | Video

15.Rupture of an uncommon mediastinal aneurysm resulting in spontaneous hematoma
Chunsheng Feng, Xiaoqian Lu, Dianbo Cao
PMID: 29848929  doi: 10.14744/AnatolJCardiol.2018.56563  Page E11
Abstract |Full Text PDF

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