ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 23 (6)
Volume: 23  Issue: 6 - June 2020
1.Atrial fibrillation, exercise ECHO, OSA, and HOCM
Çetin Erol
PMID: 32478696  doi: 10.14744/AnatolJCardiol.2020.6  Page 307
Abstract |Full Text PDF

2.Perspectives by a position statement on atrial fibrillation in acute heart failure a: Mechanisms and therapeutic approaches
Sercan Okutucu, Bülent Görenek
PMID: 32478687  doi: 10.14744/AnatolJCardiol.2020.17064  Pages 308 - 311
The co-existence of atrial fibrillation (AF) and acute heart failure (AHF) is frequently reported and can exacerbate either or both of them. Their combination leads to increased morbidity and mortality. Although there has been a lack of studies on the prevalence and significance, as well as the treatment, of AF in patients with AHF, a position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association has recently reviewed the latest evidence on AF in the setting of AHF. The purpose of this paper is to briefly overview the crucial aspects of this consensus document.

3.Exercise echocardiography in aortic stenosis with preserved ejection fraction
Adriana Postolache, Mai-linh Nguyen, Tridetti Julien, Simona Sperlongano, Alexandra Maria Chitroceanu, Raluca Dulgheru, Patrizio Lancellotti
PMID: 32478694  doi: 10.14744/AnatolJCardiol.2020.76500  Pages 312 - 317
The appropriate timing of intervention and follow-up in asymptomatic patients with aortic stenosis remains controversial. Risk stratification is a key, especially with the use of a multimodality imaging approach, including exercise stress echocardiography. This review focuses on the use of exercise echocardiography in asymptomatic patients with moderate and severe aortic stenosis with preserved left ventricular ejection fraction. It describes the exercise echocardiography protocol, parameters to be evaluated, and its role in guiding the timing of intervention and follow-up in these patients.

4.Does electrocardiogram help in identifying the culprit artery when angiogram shows both right and circumflex artery disease in inferior myocardial infarction?
Özlem Yıldırımtürk, Emre Aslanger, Emrah Bozbeyoğlu, Barış Şimşek, Mustafa Aytek Şimşek, Yusuf Sinan Aydın, Can Yücel Karabay, Muzaffer Murat Değertekin
PMID: 32478688  doi: 10.14744/AnatolJCardiol.2020.24583  Pages 318 - 323
Objective: In a subgroup of patients with inferior myocardial infarction (MI), both the right coronary artery (RCA) and circumflex coronary artery (Cx) show potentially culprit lesions, and angiography may be insufficient to determine which artery is responsible for the clinical presentation. Although many electrocardiographic (ECG) algorithms have been proposed for identifying the infarct-related artery in patients with inferior MI, it is unclear whether the current algorithms have the discriminative power to identify the real culprit artery in these patients.
Methods: The patients with the diagnosis of acute inferior MI and underwent coronary angiography were enrolled in the study. The prediction of the infarct-related artery was attempted from the admission ECG using published algorithms and criteria. For the angiographic definition of the infarct-related artery, multiple criteria were used.
Results: Total 417 inferior MI cases were enrolled during the study period; the final patient population comprised of 318 patients. Forty-five patients (14.2%) had both RCA and Cx lesions on coronary angiography. Although several criteria and algorithms are able to identify the infarct-related artery in the general inferior MI population, they lose their strength in patients with both RCA and Cx lesions. Only the Aslanger-Bozbeyoğlu criterion emerges as a more powerful diagnostic test with a sensitivity, specificity, and c-statistic of 80%, 48%, and 0.650, respectively for the whole population (p<0.001) and 81%, 58%, and 0.709, respectively, for patients with both RCA and Cx lesions (p=0.019).
Conclusion: The Aslanger-Bozbeyoğlu criterion is not only helpful in differentiating the infarct territory in combined inferior and anterior ST-segment elevation as previously shown, but also valuable in identifying the infarct-related artery in patients with inferior STEMI with critical lesions in both the RCA and the Cx. (Anatol J Cardiol 2020; 23: 318-23)

5.Possible key microRNAs and corresponding molecular mechanisms for atrial fibrillation
Huili Zhang, Guangming Yang, Ning Zhong, Jun Shan, Xiaona Li, Yanhai Wu, Yazhou Xu, Ye Yuan
PMID: 32478689  doi: 10.14744/AnatolJCardiol.2020.39483  Pages 324 - 333
Objective: We aimed to find crucial microRNAs (miRNAs) associated with the development of atrial fibrillation (AF), and then try to elucidate the possible molecular mechanisms of miRNAs in AF.
Methods: The miRNA microarray, GSE68475, which included 10 right atrial appendage samples from patients with persistent AF and 11 samples from patients with normal sinus rhythm, was used for the analysis. After data preprocessing, differentially expressed miRNAs were screened using limma. Target genes of miRNAs were predicted using miRWalk2.0. We then conducted functional enrichment analyses for miRNA and target genes. Protein-protein interaction (PPI) network and module analyses for target genes were performed. Finally, transcription factors (TFs)-target genes regulatory network was predicted and constructed.
Results: Seven genes, including CAMK2D, IGF2R, PPP2R2A, PAX6, POU3F2, YWHAE, and AP2A2, were targeted by TFs. Among these seven genes, CAMK2D (targeted by miR-31-5p), IGF2R (targeted by miR-204-5p), PAX6 (targeted by miR-223-3p), POU3F2 (targeted by miR-204-5p), YWHAE (targeted by miR-31-5p), and AP2A2 (targeted by miR-204-5p) belonged to the top 10 degree genes in the PPI network. Notably, MiR-204-5p, miR-31-5p, and miR-223-3p had more target genes. Besides, CAMK2D was enriched in some pathways, such as adrenergic signaling in cardiomyocytes pathway and cAMP signaling pathway. YWHAE was enriched in the Hippo signaling pathway.
Conclusion: miR-31-5p played a crucial role in cardiomyocytes by targeting CAMK2D and YWHAE via cAMP and Hippo signaling pathways. miR-204 was involved in the progression of AF by regulating its target genes IGF2R, POU3F2, and AP2A2. On the other hand, miR-223-3p functioned in AF by targeting PAX6, which was associated with the regulation of apoptosis in AF. This study would provide a theoretical basis and potential therapeutic targets for the treatment of AF. (Anatol J Cardiol 2020; 23: 324-33)

6.Clinical and polysomnographic features of hypertension in obstructive sleep apnea: A single-center cross-sectional study
Aslıhan Gürün Kaya, Banu Gülbay, Turan Acıcan
PMID: 32478693  doi: 10.14744/AnatolJCardiol.2020.71429  Pages 334 - 341
Amaç: Obstrüktif uyku apnesi (OSA) olan hastalarda başta hipertansiyon olmak üzere, kardiyovasküler hastalıkların gelişme riski artmaktadır. Bu çalışmada, hipertansiyonu olan obstrüktif uyku apnesi tanısı alan hastaların klinik ve polisomnografik özelliklerinin belirlenmesi amaçlanmıştır.
Yöntem: Prospektif olarak dizayn edilmiş çalışmaya......................... Üniversitesi Tıp Fakültesi'nde Ocak 2015-Haziran 2016 tarihleri ​​arasında OSA tanısı alan hastalar dahil edildi. Hastalar normotansif (n = 125) ve hipertansif (n = 141) olarak iki gruba ayrıldı. Hastaların kan basıncı ölçümleri polisomnografi öncesinde akşam ve polisomnografi sonrasında sabah kaydedildi. Hipertansiyonu olan ve olmayan hastaların klinik ve polisomnografik bulguları karşılaştırıldı ve hipertansiyon ile ilişkili risk faktörleri analiz edildi.
Bulgular: Hipertansiyonu olan hastalarda yaş, Epworth Uykululuk Skoru (ESS), apne-hipopne indeksi, ortalama apne süresi, arousal indeksi ve oksijen desatürasyon indeksi (ODI) hipertansiyonu olmayan hastalara göre daha yüksek saptandı. Ayrıca hipertansiyonu olan grupta, hipertansiyonu olmayan gruba göre noktürnal oksijen desatürasyonu daha sıktı ve desatüre geçirilen sürenin tüm uyku saatine oranı daha uzundu. Çok değişkenli analizlerde, yaş (OR: 1,095,% 95 CI 1,053-1,139, p <0,001), ESS (OR: 1,186,% 95 CI 1,071-1,313, p = 0,001), ortalama apne süresi (OR: 1,072, 95% CI 1,032-1,113, p= 0,002), ODI (OR: 1,062,% 95 CI 1,025-1,101, p = 0,001) ve gece oksijen desatürasyonunun varlığı (OR: 2,439,% 95 CI 1,170-5,086, p = 0,017) OSA tanılı hastalarda hipertansiyon için bağımsız risk faktörleri olarak saptandı.
Sonuç: Bu çalışma, OSA tanısı olan hastalarda yaş, ESS, oksijen desatürasyonu ve uzamış apne süresinin hipertansiyon ile ilişkili olduğunu göstermektedir. Bu bulguların saptandığı OSA tanısı olan hastalar hipertansiyon açısından değerlendirilmelidir.
Objective: Obstructive sleep apnea (OSA) is associated with elevated blood pressure (BP) and increases the risk of developing cardiovascular diseases. This study aimed to determine the clinical and polysomnographic features of OSA that are significantly associated with hypertension (HT).
Methods: This is a prospective study that enrolled patients diagnosed with OSA in Ankara University Faculty of Medicine from January 2015 to June 2016. The patients were categorized into normotensives (n=125) and hypertensives (n=141). BP was taken at the evening before and the morning after polysomnography (PSG). The polysomnographic findings of normotensive and hypertensive patients were compared, and independent risk factors that are associated with HT were analyzed.
Results: Hypertensive patients exhibited older age and higher Epworth sleepiness scale (ESS), apnea–hypopnea index (AHI), mean apnea duration, arousal index, and oxygen desaturation index (ODI) than normotensive patients. Nocturnal oxygen desaturation (NOD) was more frequent and the percentage of the duration of NOD to total sleep time (TST) was higher in hypertensive than normotensive patients. Multivariate analyses revealed that age (OR: 1.095, 95% CI 1.053 to 1.139, p<0.001), ESS (OR: 1.186, 95% CI 1.071 to 1.313, p=0.001), mean apnea duration (OR: 1.072, 95% CI 1.032 to 1.113, p=0.002), ODI (OR: 1.062, 95% CI 1.025 to 1.101, p=0.001), and NOD (OR: 2.439, 95% CI 1.170 to 5.086, p=0.017) were independent risk factors for HT in OSA.
Conclusion: This study suggests that age, ESS, parameters of oxygenation, and apnea duration were associated with HT in patients with OSA. Hence, patients with OSA with these findings should be evaluated for HT. (Anatol J Cardiol 2020; 23: 334-41)

7.Effects of surgical septal myectomy on survival in patients with hypertrophic obstructive cardiomyopathy
Xiangbin Meng, Mingyu Liang, Yongen Shi, Weijie Zhang, Sijie Zhou, Chuanyu Gao
PMID: 32478684  doi: 10.14744/AnatolJCardiol.2020.05043  Pages 342 - 348
Objective: The purpose of this study was to determine the effects of surgical resection of muscle layer on the long-term survival of patients with hypertrophic obstructive cardiomyopathy (HOCM).
Methods: The original study cohort consisted of 552 patients with hypertrophic cardiomyopathy (HCM), including 380 patients with HOCM and 172 patients with nonobstructive HCM. All these patients had a definite diagnosis in our center from October 1, 2009, to December 31, 2012. They were divided into three groups, viz., HOCM with myectomy group (n=194), nonoperated HOCM group (n=186), and nonobstructive HCM group (n=172). Median follow-up duration was 57.57±13.71 months, and the primary end point was a combination of mortality from all causes.
Results: In this survival study, we compared the prognoses of patients with HOCM after myectomy, patients with nonoperated HOCM, and patients with nonobstructive HCM. Among the three groups, the myectomy group showed a lower rate of reaching the all-cause mortality with statistically indistinguishable overall survival compared with patients with nonobstructive HCM (p=0.514). Among patients with left ventricular outflow tract (LVOT) obstruction, the overall survival in the myectomy group was noticeably better than that in the nonoperated HOCM group (log-rank p<0.001). Parameters that showed a significant univariate correlation with survival included age, previous atrial fibrillation (AF), NT-proBNP, Cr, myectomy, and LV ejection fraction. When these variables were entered in the multivariate model, the only independent predictors of survival were myotomy [hazard ratio (HR): 0.109; 95% CI: 0.013–0.877, p<0.037], age (HR: 1.047; 95% CI: 1.007–1.088, p=0.021), and previous AF (HR: 2.659; 95% CI: 1.022–6.919, p=0.021).
Conclusion: Patients with HOCM undergoing myectomy appeared to suffer from a lower risk of reaching the all-cause mortality and demonstrated statistically indistinguishable overall survival compared with patients with nonobstructive HCM. Multivariate analysis clearly demonstrated myectomy as a powerful, independent factor of survival, confirming that the differences in long-term survival recorded in this study may be due to surgical improvement in the LVOT gradient.

8.Takotsubo syndrome without major stress mimicking myocarditis
Sepideh Taghavi, Maryam Chenaghlou, Marzieh Mirtajaddini, Nasim Naderi, Ahmad Amin
PMID: 32478690  doi: 10.14744/AnatolJCardiol.2020.45773  Pages 349 - 350
Abstract |Full Text PDF | Video

9.Giant right sinus of Valsalva aneurysm led to proximal right coronary artery occlusion
Ke Wei, Hongwei Guo, Fang Fang, Xiang-yang Qian
PMID: 32478685  doi: 10.14744/AnatolJCardiol.2020.10305  Pages 350 - 353
Abstract |Full Text PDF

10.Acute anterior myocardial infarction during myopericarditis treatment in a very young adult
Alparslan Kurtul, Fatih Şen, Özkan Bekler
PMID: 32478692  doi: 10.14744/AnatolJCardiol.2020.68822  Pages 353 - 356
Abstract |Full Text PDF

11.Transcatheter intervention for doublesteal syndrome from isolation of the subclavian artery associated with patent ductus arteriosus
Bekir Yukcu, Fatma Sevinc Sengul, Alper Guzeltas
PMID: 32478691  doi: 10.14744/AnatolJCardiol.2020.51481  Page E15
Abstract |Full Text PDF | Video

12.Intra-atrial path of the right coronary artery: An infrequent and still unknown anomaly
Alejandro Junco-Vicente, Maria Martin-Fernandez, Ana Fidalgo- Argüelles, Helena Cigarran- Sexto
PMID: 32478695  doi: 10.14744/AnatolJCardiol.2020.98444  Pages E15 - E16
Abstract |Full Text PDF

13.Left ventricular outflow tract obstruction due to residual native valve following mitral valve replacement
Justin Shipman, Pradyumna Agasthi, Patrick DeValeria, Farouk Mookadam, Reza Arsanjani
PMID: 32478686  doi: 10.14744/AnatolJCardiol.2020.10744  Pages E16 - E17
Abstract |Full Text PDF | Video

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