ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 24 (6)
Volume: 24  Issue: 6 - December 2020
1.New interventional cardiology devices, CRT survey in Turkey, and more
Çetin Erol
PMID: 33253138  doi: 10.14744/AnatolJCardiol.2020.12  Page 349
Abstract |Full Text PDF

2.A comprehensive review of the diagnosis and management of mitral paravalvular leakage
Mustafa Ozan Gürsoy, Ahmet Güner, Macit Kalçık, Emrah Bayam, Mehmet Özkan
PMID: 33253127  doi: 10.14744/AnatolJCardiol.2020.10018  Pages 350 - 360
Mitral paravalvular leaks (PVLs) commonly occur in patients with prosthetic valves. Paravalvular defects may be clinically inconsequential and may aggravate hemolysis or cause heart failure through regurgitation. Accordingly, patients may eventually require intervention such as redo surgery or a transcatheter closure of the defects. The introduction of purpose-specific closure devices and new steerable catheters has opened a new frontier for the transcatheter PVL closure. This mode of treatment is an initial therapy in most centers with experienced structural heart team. However, head-to-head data comparing two treatment modalities (surgery and transcatheter closure) are limited, and the world-wide experience is based on nonrandomized studies. Multimodality imaging, including three-dimensional transesophageal echocardiography, facilitates the delineation of mitral PVLs and provides essential data that aids the communication between the members of the structural heart team. In the near future, the success of interventional therapies will most probably increase in patients with mitral PVLs with the introduction of hybrid imaging modalities (echocardiography, cardiac computed tomography, and fluoroscopy). In conclusion, this paper summarizes the etiopathogenesis, clinical characteristics, diagnosis, and treatment of mitral PVLs.

3.First experiences with the balloon-expandable Myval® transcatheter aortic valve from Turkey
Uğur Arslan, Güney Erdoğan, Melisa Uçar, Mustafa Yenerçağ
PMID: 33253135  doi: 10.14744/AnatolJCardiol.2020.93584  Pages 361 - 363
Abstract |Full Text PDF | Video

4.Twelve-month clinical outcomes of sirolimus-eluting stent in coronary artery disease: An experience in real-world Indian patients
Srikanth Nathani, Asif Raheem, Harish Sanadhya, Prakash Chandra Purohit, Ramesh Patel, Praveen K Alane, Deepeshkumar Agarwal, Ramanand Sinha
PMID: 33253136  doi: 10.14744/AnatolJCardiol.2020.98452  Pages 364 - 369
Objective: Supraflex (Sahajanand Medical Technologies Pvt. Ltd, Surat, India) is the latest generation of biodegradable polymer-coated sirolimus-eluting coronary stent designed on ultra-thin (60 µm) cobalt–chromium platform with flexible “S-link.” The present study was designed to establish the safety and clinical performance of Supraflex in real-world Indian patients with coronary artery disease.
Methods: The study included 839 consecutive patients with coronary artery disease who were implanted with Supraflex from January 2014 to August 2017 at six different tertiary care centers in India. Follow-up was performed at 30 days, 6 months, and 12 months after the index procedure. The primary end-point of the study was the incidence of major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) at the 12-month follow-up. The occurrence of stent thrombosis was analyzed as safety end-point.
Results: A total of 1025 lesions were treated by implantation of 1098 Supraflex stents. At the 12-month follow-up, MACE was 4.92%, including 7 (0.86%) cardiac deaths, 16 (1.97%) MI, and 17 (2.09%) TLR. Only three incidences of stent thrombosis were found at the 12-month follow-up.
Conclusion: The study results showed excellent safety and clinical effectiveness of Supraflex in a high proportion of high-risk real-world Indian patients with coronary artery disease.

5.Electrophysiologic characteristics and catheter ablation results of tachycardia-induced cardiomyopathy in children with structurally normal heart
Hasan Candaş Kafalı, Erkut Öztürk, Senem Özgür, Gülhan Tunca Şahin, Alper Güzeltaş, Yakup Ergül
PMID: 33253137  doi: 10.14744/AnatolJCardiol.2020.99165  Pages 370 - 376
Objective: The aim of this study is to present electrophysiologic characteristics and catheter ablation results of tachycardia-induced cardiomyopathy (TIC) in children with structurally normal heart.
Methods: We performed a single-center retrospective review of all pediatric patients with TIC, who underwent an electrophysiology study and ablation procedure in our clinic between November 2013 and January 2019.
Results: A total of 26 patients, 24 patients with single tachyarrhythmia substrates and two patients each with two tachyarrhythmia substrates, resulting with a total of 28 tachyarrhythmia substrates, underwent ablation for TIC. The median age was 60 months (2–214 months). Final diagnoses were supraventricular tachycardia (SVT) in 24 patients and ventricular tachycardia (VT) in two patients. The most common SVT mechanisms were focal atrial tachycardia (31%), atrioventricular reentrant tachycardia (27%), and permanent junctional reciprocating tachycardia (15%). Radiofrequency ablation (RFA) was performed in 15 tachyarrhythmia substrates, and cryoablation was performed in 13 tachyarrhythmia substrates, as the initial ablation method. Acute success in ablation was achieved in 24 out of 26 patients (92%). Tachycardia recurrence was observed in two patients (8%) on follow-up, who were treated successfully with repeated RFA later on. Overall success rates were 92% (24 out of 26) in patients and 93% (26 out of 28) in substrates. On echocardiography controls, the median left ventricular recovery time was 3 months (1–24 months), and median reversible remodeling time was 6 months (3–36 months).
Conclusion: TIC should be kept in mind during differential diagnosis of dilated cardiomyopathy. Pediatric TIC patients can be treated successfully and safely with RFA or cryoablation. With an early diagnosis of TIC and quick restoration of the normal sinus rythm, left ventricular recovery, and remodeling may be facilitated.

6.Can T1 mapping be an alternative of post-contrast magnetic resonance sequences in patients with surgically corrected tetralogy of Fallot?
Hasan Yiğit, Elif Ergün, Pelin Seher Öztekin, Pınar Nercis Koşar
PMID: 33253132  doi: 10.14744/AnatolJCardiol.2020.73576  Pages 377 - 381
Objective: The objective of this study is to investigate the ability of native T1 mapping in the determination of myocardial fibrosis in patients with surgically corrected tetralogy of Fallot (TOF).
Methods: We included 35 patients with surgically corrected TOF who underwent cardiac magnetic resonance imaging in this study. Additionally, we added pre- and post-contrast T1 mapping sequences at the right ventricular outflow tract (RVOT) and short-axis planes to the routine protocol. We visually evaluated the pre-contrast native T1 mapping images to determine the presence of areas with higher T1 times that indicate focal fibrosis. We compared the findings with the findings of post-contrast images.
Results: In 22 of the 35 cases, RVOT enhancement was observed in the delayed enhancement images; however, none of these cases could be distinguished on the native T1 maps. When compared to post-contrast imaging, 28 of the 30 contrast enhancements at right ventricle insertion points and 14 of the 17 contrast enhancements at the remaining left ventricle walls were visually observed on the color-coded native T1 maps. The sensitivity, specificity, positive and negative predictive values of native T1 mapping for the detection of focal fibrosis at the right ventricle insertion points were found to be 93.3%, 100%, 100%, and 71.4%, respectively, whereas these values were found to be 82.4%, 100%, 100%, and 85.8% in the detection of fibrosis in the remaining left ventricle walls.
Conclusion: Native T1 mapping is valuable in the detection of focal fibrosis at the right ventricle insertion points and the remaining left ventricle walls; however, it was not possible to visually detect RVOT fibrosis by native T1 mapping. Hence, T1 mapping may not replace the contrast-enhanced imaging in patients with surgically corrected TOF.

7.Current clinical practice of cardiac resynchronization therapy in Turkey: Reflections from Cardiac Resynchronization Therapy Survey-II
Duygu Koçyiğit, Nedim Umutay Sarıgül, Ali Timuçin Altın, Serkan Çay, Veli Polat, Serkan Saygı, Hasan Ali Gümrükçüoğlu, Kani Gemici, Barış İkitimur, Ahmet Akyol, Ahmet Kaya Bilge, İbrahim Başarıcı, Emin Evren Özcan, Mesut Demir, Hasan Kutsi Kabul, Ender Ornek, Camilla Normand, Cecilia Linde, Kenneth Dickstein
PMID: 33253125  doi: 10.14744/AnatolJCardiol.2020.02680  Pages 382 - 396
Objective: Cardiac resynchronization therapy (CRT) has been shown to reduce mortality in selected patients with heart failure with reduced ejection fraction (HFrEF). CRT Survey-II was a snapshot survey to assess current clinical practice with regard to CRT. Herein, we aimed to compare Turkish data with other countries of European Society of Cardiology (ESC).
Methods: The survey was conducted between October 2015 and December 2016 in 42 ESC member countries. All consecutive patients who underwent a de novo CRT implantation or a CRT upgrade were eligible.
Results: A total of 288 centers included 11,088 patients. From Turkey, 16 centers recruited 424 patients representing 12.9% of all implantations. Compared to the entire cohort, Turkish patients were younger with a lower proportion of men and a higher proportion with ischemic etiology. Electrocardiography (ECG) showed sinus rhythm in 81.5%, a QRS duration of <130 ms in 10.1%, and ≥150 ms in 63.8% of patients. Left bundle branch block (LBBB) was more common. Median left ventricular ejection fraction (LVEF) was 25%, lower than in the overall ESC cohort, but NYHA class was more often II. Most common indication for CRT implantation was HF with a wide QRS (70.8%). Almost 98.3% of devices implanted were CRT-D, in contrast to the overall cohort. Fluoroscopy time was longer, but duration of overall procedure was shorter. LV lead implantation was unsuccessful in 2.6% patients. Periprocedural complication rate was 6.3%. The most common complication was bleeding. Remote monitoring was less utilized.
Conclusion: These are the first observational data reflecting the current CRT practice in Turkey and comparing it with other countries of Europe. Findings of this study may help detect gaps and provide insights for improvement.

8.Evaluation of serum platelet-derived growth factor receptor-ß and brain-derived neurotrophic factor levels in microvascular angina
Gamze Aslan, Veli Polat, Evin Bozcali, Mustafa Hakan Şahin, Nurcan Çetin, Dilek Ural
PMID: 33253128  doi: 10.14744/AnatolJCardiol.2020.44388  Pages 397 - 404
Objective: Microvascular angina (MVA) is a coronary microcirculation disease. Research on microcirculatory dysfunction has revealed several biomarkers involved in the etiopathogenesis of MVA. Platelet-derived growth factor receptor β (PDGFR-β) and brain-derived neurotrophic factor (BDNF) are 2 biomarkers associated with microcirculation, particularly pericytes function. The aim of this study was to investigate the role of PDGFR-β and BDNF in MVA.
Methods: Ninety-one patients (median age, 56 y; age range, 40–79 y; 36 men) with MVA and 61 control group subjects (median age, 52 y; age range, 38–76 y; 29 men) were included in the study. Serum concentrations of PDGFR-β and BDNF were measured with commercially available enzyme-linked immunosorbent assay kits.
Results: PDGFR-β [2.82 ng/ml; interquartile range (IQR), 0.57–7.79 ng/ml vs. 2.27 ng/ml; IQR, 0.41–7.16 ng/ml; p<0.0005] and BDNF (2.41 ng/ml; IQR, 0.97–7.97 ng/ml vs. 1.92 ng/ml; IQR, 1.07–6.67 ng/ml; p=0.023) concentrations were significantly higher in patients with MVA compared with the controls. PDGFR-β correlated positively with age (r=0.26, p=0.001), low-density lipoprotein (r=0.18; p=0.02), and BDNF (r=0.47; p<0.001), and BDNF showed a significant positive correlation with age (r=0.20; p=0.01). In binary logistic regression analysis, high-sensitivity C-reactive protein, uric acid, and PDGFR-β values were found to be independent predictors of MVA.
Conclusion: MVA is associated with higher PDGFR-β and BDNF levels. This association may indicate an abnormality in microvascular function. Future studies are required to determine the role of these biomarkers in the pathogenesis of MVA.

9.Focal atrial tachycardia-the localization differences between men and women: A study of 487 consecutive patients
Yusuf Turkmen, Per Insulander, Hamid Bastani, Nikola Drca, Ott Saluveer, Jari Tapanainen, Tara Bourke, Göran Kennebäck, Jonas Schwieler, Frieder Braunschweig, Mats Jensen-Urstad
PMID: 33253134  doi: 10.14744/AnatolJCardiol.2020.93024  Pages 405 - 409
Objective: The preferential sites for focal atrial tachycardia (FAT) are mainly in the right atrium in both sexes. However, a limited number of studies have indicated that sex differences in the localization of FAT. This study investigated possible sex differences in the distribution of FAT in a large cohort of patients referred for ablation.
Methods: From 2004 to 2019, 487 patients (298 women) were referred to our institution for ablation of FAT. A standard electrophysiological study was conducted, and isoproterenol or atropine was given when needed. Conventional catheter mapping, electroanatomic contact mapping, and noncontact mapping were used to assess the origin of ectopic atrial tachycardia.
Results: Overall, 451 foci were successfully ablated in 436 patients (90%). Although the foci located along the crista terminalis were more common in women than in men (42% vs. 29%; p=0.023), the opposite were found in the foci located along the tricuspid annulus (5% vs. 11%; p=0.032) and the right atrial appendage (RAA) (1% vs. 3%; p=0.032). Other locations were similarly distributed in men and women. In addition, the presence of persistent FAT was more frequent in men than in women (22% vs. 5%; p<0.001). Finally, the difference in the induction pattern of FAT was also remarkable between sexes.
Conclusion: The distribution of FAT in women and men is different. In addition, persistent FAT seems more often in men than in women. The different distribution, persistency, and induction pattern of FAT should be considered in the successful management of this type of tachycardia.

10.Myocardial infarction caused by compression of the left coronary artery by an aortic pseudoaneurysm
Jan Rocek, Michal Smetana, Hana Linkova, Jakub Sulzenko, Petr Kacer
PMID: 33253124  doi: 10.14744/AnatolJCardiol.2020.01564  Pages 410 - 411
Abstract |Full Text PDF

11.A proximal right coronary artery occlusion presenting with ST-segment depression in leads II, III, and aVF
Göktuğ Savaş, Selçuk Yazıcı, Sait Terzi
PMID: 33253129  doi: 10.14744/AnatolJCardiol.2020.48596  Pages 411 - 414
Abstract |Full Text PDF

12.Atypical localization, atypical clinical course, unexpected age: Myxoma
Hande İştar
PMID: 33253133  doi: 10.14744/AnatolJCardiol.2020.78346  Pages 414 - 416
Abstract |Full Text PDF

13.Composed aortic root replacement and left ventricular outflow tract reconstruction with translocated valve graft in a prosthesis infective endocarditis
Binggang Wu, Hong Qian, Jun Shi, Yingqiang Guo
PMID: 33253126  doi: 10.14744/AnatolJCardiol.2020.03603  Pages E18 - E19
Abstract |Full Text PDF | Video

14.Multimodality imaging of a thymoma within the superior venae cava extending into the right atrium
Mingzhu Qian, Yali Yang, Manwei Liu, Mingxing Xie, Yuman Li
PMID: 33253130  doi: 10.14744/AnatolJCardiol.2020.61680  Pages E19 - E21
Abstract |Full Text PDF | Video

15.Clear demonstration of the different mechanisms of severe mitral regurgitation caused by mitral ring dehiscence during transesophageal echocardiography
Ferhat Mustafa Keten, Berhan Keskin, Ahmet Karaduman, İsmail Balaban, Gökhan Kahveci
PMID: 33253131  doi: 10.14744/AnatolJCardiol.2020.69091  Pages E21 - E22
Abstract |Full Text PDF | Video

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