ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 20 (3)
Volume: 20  Issue: 3 - September 2018
1.Featured articles in this issue
Mustafa Kılıçkap
PMID: 30152806  doi: 10.14744/AnatolJCardiol.2018.9  Page 135
Abstract |Full Text PDF

2.The effect of rutin on cisplatin-induced oxidative cardiac damage in rats
Ismail Topal, Aslı Özbek Bilgin, Ferda Keskin Çimen, Nezahat Kurt, Zeynep Süleyman, Yasin Bilgin, Adalet Özçiçek, Durdu Altuner
PMID: 30152807  doi: 10.14744/AnatolJCardiol.2018.32708  Pages 136 - 142
Objective: Cisplatin is an anticancer drug used for treating childhood solid tumors. Symptoms related to cisplatin-induced cardiovascular adverse effects may be mild or severe. Rutin (vitamin P1) has many properties, including as antioxidant, anticancer, antidiabetic, antimicrobial, antiulcer, and tissue renewal properties. Therefore, we aimed to biochemically, histopathologically, and immunohistochemically demonstrate the effect of rutin on cisplatin-induced cardiotoxicity in rats.
Methods: The rats included in our study were divided into four groups: Healthy group (HE), 5-mg/kg cisplatin group (CP), 50 mg/kg rutin+5-mg/kg cisplatin (CR-50), 100-mg/kg rutin+5-mg/kg cisplatin (CR-100) group.
Results: CP group administered cisplatin had significantly increased blood, serum, and cardiac tissue malondialdehyde (MDA), interleukin 1 beta (IL-1β), tumor necrosis factor alpha (TNF-α), troponin I, creatine kinase (CK), and CK-MB levels compared to the HE group, whereas there was a significant decrease in the total glutathione (tGSH) levels. Rutin was observed to prevent the increase in MDA, IL-1β, TNF-α, troponin I, CK, and CK-MB levels as well as prevent the decrease in tGSH levels more significantly when administered at a 100-mg/kg dose than at a 50-mg/kg dose. Histopathologically, cardiac necrosis, dilated/congested blood vessels, hemorrhage, polymorphonuclear leukocyte, edema, and cells with pyknotic nuclei were observed in the CP group. Rutin was shown to prevent cisplatin-induced cardiac damage more effectively when used at a100-mg/kg dose than at a 50-mg/kg dose.
Conclusion: These results suggest that rutin is useful for preventing cisplatin-related cardiovascular damage.

3.The utility of high-sensitivity C-reactive protein levels in patients with moderate coronary lesions and gray-zone fractional flow reserve
Lin Li, Qi-wei Liu, Zhe Li, Li Wang, Jian-hong Wang, Lei Song, Bin Li
PMID: 30109863  doi: 10.14744/AnatolJCardiol.2018.80148  Pages 143 - 151
Objective: It remains controversial whether patients with fractional flow reserve (FFR) values of 0.75–0.80 (gray-zone) should be treated with percutaneous coronary intervention (PCI). This study aimed to evaluate the prediction of high-sensitivity C-reactive protein (hs-CRP) levels to guide treatment selection in gray-zone patients.
Methods: This prospective interventional trial was conducted between January 2015 and March 2016. A total of 785 patients with stable angina and single-vessel stenosis with moderate coronary lesions were admitted to hospital in this period. After measurement of hs-CRP levels, coronary angiography, and FFR, gray-zone patients (n=308) were included in the study and were divided into four groups on the basis of a cutoff hs-CRP level of 3 mg/L and then on the basis of whether they underwent PCI or not. Patients in groups I (≥3 mg/L, n=70) and III (<3 mg/L, n=84) underwent PCI, whereas those in groups II (≥3 mg/L, n=70) and IV (<3 mg/L, n=84) were administered only drugs. Major adverse clinical events (MACEs) included cardiac death, nonfatal myocardial infarction (MI), target vessel revascularization (TVR), and PCI or coronary artery bypass grafting (CABG). These parameters were also evaluated during follow-up.
Results: The total Kaplan-Meier curves showed macrodistribution differences among the four groups (p<0.05). There was a significantly increased MACE incidence in group II compared with group I or IV (p=0.039 or 0.006, respectively), and an increased incidence in group I compared with group III (p=0.028). However, there were no differences in MACE incidence between groups III and IV (p=0.095) despite the fact that these patients received different treatments.
Conclusion: Among FFR gray-zone patients, hs-CRP level was a predictor of MACE and risk stratification could guide treatment selection. Increased hs-CRP levels (≥3 mg/L) are an indication for urgent PCI whereas normal levels (<3 mg/L) are an indication for delayed PCI treatment. Patients with identical FFR values could require different treatment.

4.Increased glycoprotein acetylation is associated with high cardiac event rates: Analysis using coronary computed tomography angiography
Lihua An, Qingxu Liu, Haixia Feng, Xueqin Bai, Yan Dang, Chao Li, Zili Yang, Jing Li
PMID: 30152796  doi: 10.14744/AnatolJCardiol.2018.01058  Pages 152 - 158
Objective: Glycoprotein acetylation (GlycA), an emerging inflammatory biomarker, has been used as an indicator of cardiovascular disease. Our research aimed to evaluate the correlation between GlycA and coronary artery disease (CAD) using coronary computed tomography angiography (CCTA).
Methods: In the present study, a total of 342 patients were enrolled, and each of them underwent CCTA. The correlation between GlycA and major adverse cardiac events (MACE) was detected via Cox’s proportional hazards models. Based on differences in the GlycA level, patients were categorized into three groups (T1, T2, and T3).
Results: Compared with the group with the lowest GlycA level (T1), the group with the highest GlycA level (T3) exhibited stronger atherosclerotic pressure involving the extent of atherosclerotic plaque and risk of obstructive CAD. In addition, the patients in the T3 group had a greater chance of experiencing MACE and higher all-cause mortality than those in the T1 group. Among patients without CAD who underwent CCTA, those with high GlycA levels experienced elevated atherosclerotic stress and heightened risk of MACE compared with those with low GlycA levels.
Conclusion: These results suggest that serum GlycA is significantly associated with the long-term clinical results of patients with no known CAD undergoing CCTA. The risks of death and experiencing MACE increase among patients with high GlycA levels.

5.Electroanatomic mapping-guided pediatric catheter ablation with limited/zero fluoroscopy
Serhat Koca, Feyza Ayşenur Paç, Deniz Eriş, Merve Maze Zabun, Özcan Özeke, Fırat Özcan
PMID: 30152797  doi: 10.14744/AnatolJCardiol.2018.72687  Pages 159 - 164
Objective: The use of fluoroscopy in pediatric catheter ablation has decreased because of mapping systems. In this study, we present the efficiency and reliability of the electroanatomic mapping system in nonfluoroscopic pediatric catheter ablation.
Methods: The medical records of patients aged <18 years who underwent ablation between November 2016 and April 2018 were evaluated. Fluoroscopy was not used in cases involving ablation of right sided-arrhythmia foci. Fluoroscopy was used only for trans-septal puncture or retroaortic approach/coronary angiography.
Results: A total of 76 patients underwent catheter ablation for 78 supraventricular and ventricular tachyarrhythmia substrates under the guidance of EnSite Velocity system. Fluoroscopy was used in only 14 (18.4%) of these substrates. The mean fluoroscopy duration in these 14 procedures was 5.4±3.15 min. No complications were noted, except a temporary right bundle branch block in one patient and pericardial effusion in another following cryoablation. The acute success rate in achieving complete elimination of arrhythmia substrates was 97.4% (76/78). The recurrence rate was 5.1% (4/78) at follow-up.
Conclusion: Fluoroscopy can be completely eliminated in most pediatric catheter ablation procedures with the use of mapping systems by achieving high acute success rates and acceptable low complication rates.

6.Assessment of the relationship between the ambulatory electrocardiography-based micro T-wave alternans and the predicted risk score of sudden cardiac death at 5 years in patients with hypertrophic cardiomyopathy
Sinem Özyılmaz, Hamdi Püşüroğlu
PMID: 30152798  doi: 10.14744/AnatolJCardiol.2018.15945  Pages 165 - 173
Objective: Micro T-wave alternans (MTWA) has been associated with poor arrhythmic prognosis in various cardiac disorders. The aim of this study was to assess the relationship between the presence of MTWA and the predicted 5-year risk of sudden cardiac death (HCM Risk-SCD) among patients with hypertrophic cardiomyopathy (HCM).
Methods: A total of 117 consecutive HCM patients were included in this prospective observational study. Patients were divided into two groups, according to the presence [MTWA (+) group (n=44)] or absence [MTWA (−) group (n=73)] of MTWA on ambulatory (Holter) electrocardiography.
Results: The risk of HCM Risk-SCD (%), the rate of high-risk patients (HCM Risk-ECG >6%), the requirement for cardiopulmonary resuscitation, and implanted cardioverter defibrillator therapy, the percentage of some clinical, echocardiographic, and Holter findings were all statistically higher in the MTWA (+) group than in the MTWA (−) group (all p<0.05). Both in the univariate and multivariate analyses, T-wave alternans (+) and the New York Heart Association’s functional classification assigned that the HCM Risk-SCD is an independent predictor of high risk. In the receiver operating characteristic curve analysis, the HCM Risk-SCD >4.9% was identified as an effective cutoff point in the MTWA (+) for HCM. The HCM Risk-SCD value of more than 4.9 yielded a sensitivity of 93.2% and a specificity of 84.5%.
Conclusion: The presence of the MTWA on ambulatory electrocardiogram seems to be significantly associated with increasing percentages of the predicted HCM Risk-SCD score in patients with HCM. The MTWA was determined as an independent high-risk indicator for HCM Risk-SCD.

7.Echocardiographic evolution of pulmonary hypertension in female patients with hyperthyroidism
Cristina Tudoran, Mariana Tudoran, Mihaela Vlad, Melania Balas, Gheorghe Nicusor Pop, Florina Parv
PMID: 30152799  doi: 10.14744/AnatolJCardiol.2018.37096  Pages 174 - 181
Objective: The objective of this study was to highlight the impact of increased cardiac output (CO) and/or pulmonary vascular resistance (PVR) on the occurrence and evolution of pulmonary hypertension (PH) in hyperthyroidism and to follow their evolution in patients under therapy.
Methods: Our study group consisted of 142 women with hyperthyroidism of different severities and etiologies. We divided our patients into three groups: groups A (overt hyperthyroidism), B (recurrent disease), and C (subclinical forms). We performed echocardiography to determine echocardiographically estimated systolic pulmonary arterial pressure (eePAP), CO, and PVR before and at 3, 6, and 12 months after treatment with thyroid suppression therapy and beta-blockers.
Results: In our study group we documented PH of various severities in 73 patients (51.4%). Increased CO, induced mostly by hyperthyroidism-specific tachycardia, was frequently detected in overt hyperthyroidism and also augmented PVR, as documented in 43.66% of patients with severe and recurrent forms. For all patients with PH, we emphasized a strong correlation between eePAP and PVR level (r=0.854, p<0.0001) and a moderate one with CO (r=0.437, p<0.0001) and with hyperthyroidism duration (r=0.545, p<0.0001). Under therapy, CO rapidly normalized and PVR significantly decreased in groups A and C. In group B, the reduction was modest and statistically significant.
Conclusion: The pathophysiological mechanisms responsible for the occurrence of PH are elevated CO and PVR. While increased CO is rapidly alleviated under therapy, elevated eePAP and PVR persist in recurrent cases and are responsible for the perpetuation of PH.

8.Comparison of coronary angiography and intracoronary imaging with fractional flow reserve for coronary artery disease evaluation: An anatomical–functional mismatch
Julien Adjedj, Nikolay Stoyanov, Olivier Muller
PMID: 30152800  doi: 10.14744/AnatolJCardiol.2018.42949  Pages 182 - 189
Myocardial ischemia is a leading cause of death worldwide, and it corresponds to the imbalance between blood supply and myocardial demand. Epicardial coronary artery disease (CAD) is detected on the basis of coronary angiogram, whereas invasive detection of myocardial ischemia induced by coronary stenosis is commonly based on fractional flow reserve (FFR). The use of FFR for revascularization decision-making demonstrated clinical benefit and cost-effectiveness compared with that of angiographic indices. Discrepancies between anatomical metrics and physiological assessment of CAD are frequent, which lead to change in revascularization decision from angiography compared to functional evaluation of CAD. Despite several clinical studies and guidelines recommending with high level of evidence demonstrating that FFR should be adopted in stable CAD, revascularization decision-making is still based on coronary angiogram in current practice. Because of the unique coronary anatomy, coronary stenosis characteristics, risk factors profile, and microcirculation quality, the unique evaluation based on epicardial coronary stenosis threshold failed to be a landmark of ischemia compared with FFR. Furthermore, coronary angiogram can detect only epicardial vessels, which represent only 10% of the entire coronary vasculature; therefore, microcirculation is not seen and is poorly assessed in clinical practice. Thus, the role of microcirculation is of importance in myocardial ischemia and might impact these discrepancies between angiography and FFR evaluation of CAD. In this review, we aimed to describe the poor correlation between anatomical evaluation compared with physiological evaluation to detect myocardial ischemia induced by coronary stenosis as well as the clinical implications of this visual–functional mismatch.

9.Hybrid transcatheter pulmonary valve implantation: The first case series from Turkey
Alper Güzeltaş, İbrahim Cansaran Tanıdır, Selman Gökalp, Sertaç Haydin
PMID: 30152801  doi: 10.14744/AnatolJCardiol.2018.06981  Pages 190 - 191
Abstract |Full Text PDF | Video

10.Transvenous coaxial coil occlusion of the levoatriocardinal vein
Meng- Luen Lee, Ing- Sh Chiu, Chiung- Ying Liao
PMID: 30152802  doi: 10.14744/AnatolJCardiol.2018.50951  Pages 192 - 193
Abstract |Full Text PDF

11.Perioperative predictors of atrial fibrillation
Şahin Iscan, Börteçin Eygi, Yüksel Beşir, Orhan Gökalp
PMID: 30152803  doi: 10.14744/AnatolJCardiol.2018.34946  Page 194
Abstract |Full Text PDF

12.Author`s Reply
Alina Cristina Iliescu, Delia Lidia Salaru, Ionut Achitei, Mihaela Grecu, Mariana Floria, Grigore Tinica
PMID: 30152804  Pages 194 - 196
Abstract |Full Text PDF

13.Diffuse xanthomas with premature atherosclerosis: A case report
Suxuan Liu, Feng Chen, Yongwen Qin, Xianxian Zhao
PMID: 30152805  doi: 10.14744/AnatolJCardiol.2018.46504  Page E4
Abstract |Full Text PDF

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