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Volume : 25 Issue : 11 Year : 2021
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The Anatolian Journal of Cardiology - Anatol J Cardiol: 25 (11)
Volume: 25  Issue: 11 - November 2021
EDITORIAL
1.Colchicine, fragmented QRS, coronavirus disease 2019, and more
Çetin Erol
doi: 10.5152/AnatolJCardiol.2021.11  Page 752
Abstract | Full Text PDF

META ANALYSIS
2.Colchicine for cardiovascular therapy: A drug interaction perspective and a safety meta-analysis
Selçuk Şen, Eda Karahan, Cansu Büyükulaş, Yasin Onur Polat, Ali Yağız Üresin
doi: 10.5152/AnatolJCardiol.2021.707  Pages 753 - 761
Abstract | Full Text PDF

3.Revisiting the clinical evidence of heart rate target in patients with heart failure treated with beta-blockers
Xue Geng, Jidong Zhang, Yanan Zhang, Haijuan Hu, Jing Yang, Wei Cui
doi: 10.5152/AnatolJCardiol.2021.90  Pages 762 - 773
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
4.Echocardiographic findings in patent ductus arteriosus-associated infective endarteritis
Huitzilihuitl Saucedo-Orozco, Jesús Vargas- Barrón, Clara A. Vázquez- Antona, Francisco Castillo- Castellón
doi: 10.5152/AnatolJCardiol.2021.36156  Pages 774 - 780
Background. Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge in patients with a fever of undetermined origin; Two-dimensional transthoracic echocardiography (TTE) performs a fundamental role in diagnosis and follow-up.
Methods. A retrospective analysis was then made of the data of all patients admitted at our center with PDA-IE within 15 years, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed.
Results. A total of 17 patients were identified. The mean age was 17.8 years. The TTE done in all patients confirmed the PDA and PA vegetations diagnosis; in five cases, one vegetation was present; in three cases, two vegetations were found, and in the nine remaining cases, three or more vegetations were observed. In two-thirds of the cases, the vegetations' size was 3 to 28 mm, and the principal morphology was filiform. In all cases, at least one of the vegetations was developed in the DA's lateral wall. Pulmonary valve (PV) was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in 7 cases and pulmonary aneurism in one case.
Conclusions. Decreased incidence of PDA-IE has been currently achieved with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures' involvement.

5.A clinical trial comparing complete revascularization at the time of primary percutaneous coronary intervention versus during the index hospital admission in patients with multi-vessel coronary artery disease and STEMI uncomplicated by cardiogenic shock
Mihnea Traian Nichita Brendea, Mircea I. Popescu, Virgil Popa, Polojintef Corbu Dorina Carmen
doi: 10.5152/AnatolJCardiol.2021.71080  Pages 781 - 788
Objective: In this study, we aimed to compare major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, stroke, myocardial infarction and symptom-induced revascularization, and mortality within one year of randomization between two strategies; complete revascularization including non-culprit lesions percutaneous coronary intervention (PCI) during primary PCI (PPCI) versus complete revascularization during the same hospital admission in patients with multi-vascular coronary artery disease (MVD) presenting with ST-elevation myocardial infarction (STEMI) uncomplicated by cardiogenic shock.
Methods: We randomized in a 1: 1 manner 100 patients with MVD and STEMI uncomplicated by cardiogenic shock who had undergone successful culprit-lesion PCI to either a strategy of complete revascularization with PCI of angiographically significant non-culprit lesions in the index PPCI procedure or to a strategy of complete revascularization during a second procedure that took place during the same hospital admission.
Results: The first primary outcome was death within a timeframe of one year and the second a composite of MACCE within a year following complete revascularization. Of the total number of patients monitored, 4% in each of the two groups was associated with the first primary outcome (p=0.984) and the second primary outcome in 6% (p=0.970). There was no statistical difference between outcomes in the two groups.
Conclusion: Among patients with MVD and STEMI uncomplicated by cardiogenic shock, there was no difference regarding outcomes when using a strategy of complete revascularization of non-culprit lesions during PPCI or the same hospital admission.

6.Prognostic value of CHA2DS2-VASc score in predicting high SYNTAX score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation
Mehmet Kadri Akboğa, Samet Yılmaz, Rıdvan Yalçın
doi: 10.5152/AnatolJCardiol.2021.03982  Pages 789 - 795
Amaç: Atriyal fibrilasyonda (AF) tromboembolik riskleri belirlemek için kullanılan CHA2DS2-VASc skorunun, AF’den bağımsız olarak akut koroner sendromlu hastalarda önemli olumsuz klinik sonuçları öngördürdüğü yakın zamanda bildirilmiştir. Bu çalışmanın temel amacı, ST yükselmesiz miyokard enfarktüsü (NSTEMI) ile başvuran ve AF olmayan hastalarda yüksek SYNTAX skoru ve hastane içi mortaliteyi öngördürmede prosedür öncesi CHA2DS2-VASc skorunun prognostik değerini değerlendirmektir.
Yöntemler: NSTEMI tanısı alan ve koroner anjiyografi yapılan toplam 906 hasta bu çalışma için geriye dönük olarak kaydedildi ve SYNTAX skorlarına (düşük, orta ve yüksek) göre 3 gruba ayrıldı. Her hastanın CHA2DS2-VASc skoru hesaplandı.
Bulgular: Spearman korelasyon analizinde, SYNTAX skoru CHA2DS2-VASc skoru ile anlamlı pozitif korelasyona sahipti (r=0.320, p<0.001). CHA2DS2-VASc skoru (Odds oranı [OR]= 1.445;% 95 güven aralığı [CI]: 1.268-1.648; p<0.001), LVEF, kreatinin, CRP, HDL-kolesterol ve LDL-kolesterol yüksek SYNTAX skorunun bağımsız belirleyicileri oldukları gösterildi. çok değişkenli Cox-regresyon modelinde, CHA2DS2-VASc skoru (Risk oranı [HR]= 1.867; 95% CI: 1.462-2.384; p<0.001), SYNTAX skoru (HR= 1.049, p=0.003) ve yaş (HR= 1.057, p=0.002) bağımsız olarak daha yüksek hastane içi mortalite riski ile ilişkiliydi. Ayrıca, CHA2DS2-VASc skoruna göre tabakalandırılan Kaplan-Meier sağkalım eğrileri (<4'e karşı ≥4) daha yüksek CHA2DS2-VASc skorunun daha yüksek hastane içi mortalite ile ilişkili olduğunu gösterdi.
Sonuç: AF olmayan NSTEMI hastalarında CHA2DS2-VASc ve SYNTAX skorları prognoz değerlendirmesinde faydalıdır ve hastane içi mortalite açısından daha yüksek risk altında olan hastaları belirlemek için kullanılabilir.
Objective: To evaluate the prognostic value of preprocedural CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, previous stroke or transient ischemic attack (TIA) (doubled), vascular disease, age 65-74 years, female gender] score in predicting high SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score and in-hospital mortality for non-atrial fibrillation (AF) patients presenting with non-ST elevation myocardial infarction (NSTEMI). The CHA2DS2-VASc score used to determine thromboembolic risks in AF was recently reported to predict major adverse clinical outcomes in patients with the acute coronary syndrome, irrespective of AF.
Methods: A total of 906 patients with a diagnosis of NSTEMI who underwent coronary angiography were retrospectively enrolled and divided into three groups according to their SYNTAX scores (low, intermediate, and high). The CHA2DS2-VASc score of each patient was calculated.
Results: SYNTAX score had a significant positive correlation with the CHA2DS2-VASc score (r=0.320; p<0.001) in the Spearman correlation analysis. The CHA2DS2-VASc score [Odds ratio, 1.445; 95% confidence interval (CI), 1.268-1.648, p<0.001], left ventricular ejection fraction, creatinine, C-reactive protein, and high-density and low-density lipoprotein cholesterol levels were demonstrated to be independent predictors of high SYNTAX score. The CHA2DS2-VASc score [Hazard ratio (HR), 1.867; 95% CI: 1.462-2.384; p<0.001], the SYNTAX score (HR, 1.049; p=0.003), and age (HR, 1.057; p=0.002) were independently associated with higher risk of in-hospital mortality in a multiple Cox-regression model. Kaplan-Meier survival curves stratified by the CHA2DS2-VASc score (<4 vs. ≥4) also showed that higher CHA2DS2-VASc scores were associated with higher in-hospital mortality.
Conclusions: In non-AF patients with NSTEMI, CHA2DS2-VASc and SYNTAX scores are useful for prognosis assessment and can be used to identify patients at higher risk for in-hospital mortality.

7.Surgical treatment for improved 1-year survival in patients with primary cardiac sarcoma
Xiaowei Jiang, Min Yan
doi: 10.5152/AnatolJCardiol.2021.60378  Pages 796 - 802
Objective: Surgery is considered a relative contraindication in sarcoma tumor. Because of the unique characteristics of heart, whether surgery is optimally chosen in primary cardiac sarcoma (PCS) is unknown. In this study, we aimed to evaluate the 1-year survival after surgery for PCS.
Methods: Patients with PCS from the Surveillance, Epidemiology, and End Results Database (SEER) between 1975 and 2015 were recruited. The endpoints were defined as 1-year all-cause mortality (ACM) and 1-year cancer-specific mortality (CSM).
Results: The study population consisted of 335 patients diagnosed with PCS. The 1-year ACM and CSM were 49.0% and 42.1% respectively. The Kaplan-Meier curves revealed that decreased 1-year ACM&CSM were significantly associated with surgical treatment. Multiple COX regression analysis, surgery, and chemotherapy showed a significantly decreased rate of 1-year ACM and CSM. The adjusted hazard ratio of surgery was significant when the year of diagnosis was ≥2000, patients were aged <50 years, SEER stage was localized, and patients did not undergo chemotherapy (all p<0.05), and was insignificant when the year of diagnosis was <2000, patients were aged ≥50 years, SEER stage was distance, regional, and unstaged/unknown, and the patients underwent chemotherapy (all p>0.05). No interaction effects were detected between the variables and surgery (all p for interaction >0.05).
Conclusion: Surgery should be highly recommended in patients with PCS to improve the 1-year survival rate, especially in younger patients with localized SEER stage and non-chemotherapy management.

8.Does coexistence of fragmented QRS and cardiovascular disease have the ability to predict the mortality in hospitalized, critically ill patients with COVID-19?
Fahrettin Katkat, Muhsin Kalyoncuoğlu, Serkan Karahan, Hanife Abanus, Fatma Nihan Turhan Çağlar, Dilay Karabulut, Sinan Varol, İrfan Şahin, Kerem Erkalp, Ertuğrul Okuyan
doi: 10.5152/AnatolJCardiol.2021.13611  Pages 803 - 810
Amaç: Kardivasküler hastalığı (KVH) olan kritik koronavirus hastalığı 2019 (COVİD-19) tanısı alan hastalarda başvuruda çekilen elektrokardiyogramda (EKG) fragmente QRS (fQRS) varlığının prognostik değerini araştırmayı amaçladık.
Metod: Retrospektif olarak dizayn edilen bu çalışmada çalışma popülasyonu bilinen KVH’ı olan ve kritik COVID-19 tanısı konan 169 hastayı (ortalama yaş 62 ± 15 yıl) içermekteydi. Çalışma kohortu ölenler ve hayatta kalanlar olmak üzere iki gruba ayrıldı.
Bulgular: Ölen hastalar hayatta kalanlara göre daha yaşlı olup, KVH ( p=0.009) hipertansiyon (p=0.046), diyabet (p=0.048), kanser (p=0.023) ve konik böbrek yetersizliği (p=0.001) bu hastalarda daha fazla idi. Bazal EKG'de fQRS varlığı ölen hastalarda daha sık görülmesine rağmen, bu istatistiksel olarak anlamlı değildi. (p=0.059). Bununla beraber KVH ve fQRS birlikteliği ölen hastalarda daha sıkla gözlemlendi. (p=0.029). Model 1 çok değişkenli regresyon analizinde tek başına KVH varlığı mortaliteyi öngörmezken (p=0.078), model 2 çok değişkenli regresyon analizinde KVH ve bazal EKG de fQRS birlikteliği mortalitenin bağımsız öngördürücüsü idi (hazard ratio (HR): 2.243; p =0.003). Ayrıca, model 1 ve 2 analizlerde, ileri yaş (HR: 1.022; p = 0.006 ve HR: 1.023; p =0.005, sırasıyla), kanser (HR: 1.912; p = 0.021 ve HR = 1.858; p = 0.031, sırasıyla), yüksek SOFA skoru (HR: 1.177; p = 0.003 ve HR: 1.215; p < 0.001, sırasıyla), artmış CRP düzeyi (HR: 1.003; p = 0.039, ve HR: 1.003; p = 0.027, sırasıyla) mortalitenin bağımsız öngördürücüleri olarak bulundu.
Sonuç: fQRS, özellikle KVH olanlarda yüksek riskli bireyleri belirleyerek klinik sonuçlar için kullanışlı bir risk sınıflandırması aracı olabilir.
Objective: In this study, we aimed to investigate the prognostic accuracy of the presence of fragmented QRS (fQRS) on baseline electrocardiogram on the adverse outcome in critical patients with coronavirus disease 2019 (COVID-19) with cardiovascular disease (CVD).
Methods: The current study was retrospective designed and included 169 patients who were critically ill with COVID-19 and CVD (mean age of 62±15 years). The patients were grouped into those who died (non-survivor group) and those who survived (survivor group).
Results: The non-survivors were older and more often had CVD (p=0.009), hypertension (p=0.046), diabetes (p=0.048), cancer (p=0.023), and chronic renal failure (p=0.001). Although the presence of fQRS on the basal electrocardiogram was more common in patients who died, this was not statistically significant (p=0.059). Furthermore, non-survivors had more frequent the coexistence of CVD and fQRS (p=0.029). In Model 1 multivariate regression analysis, CVD alone was not a predictor of mortality (p=0.078), whereas coexistence of CVD and fQRS was found to be an independent predictor of mortality in Model 2 analysis [hazard ratio (HR): 2.243; p=0.003]. Furthermore, older age (HR: 1.022; p=0.006 and HR: 1.023; p=0.005), cancer (HR: 1.912; p=0.021 and HR: 1.858; p=0.031), high SOFA score (HR: 1.177; p=0.003 and HR: 1.215; p<0.001), and increased CRP level (HR: 1.003; p=0.039 and HR: 1.003; p=0.027) independently predicted the mortality in both multivariate analysis models, respectively.
Conclusion: fQRS may be a useful and handy risk-stratification tool for clinical outcomes by identifying high-risk individuals, especially among those with CVD.

9.Fragmented QRS is a marker of mortality in patients with severe COVID-19: A retrospective observational study
İbrahim Halil Özdemir, Bülent Özlek, Mehmet Burak Özen, Ramazan Gündüz, Nurullah Çetin, Eda Özlek, Bekir Sedat Yıldız, Hakan Tıkız
doi: 10.5152/AnatolJCardiol.2021.62  Pages 811 - 820
Objective: In this study, we aimed to investigate the association of fragmented QRS (f-QRS) with in-hospital death in patients with severe novel coronavirus disease 2019 (COVID-19).
Methods: This was a retrospective and observational study. A total of 201 consecutive patients with severe COVID-19 were enrolled. Demographic data, laboratory parameters, medications, electrocardiographic (ECG) findings, and clinical outcomes were recorded. Patients with and without f-QRS were compared, and predictors of all-cause in-hospital mortality were analyzed.
Results: A total of 135 patients without f-QRS (mean age of 64 years, 43% women) and 66 patients with f-QRS (mean age of 66 years, 39% women) were included. C-reactive protein (CRP), D-dimer, troponin I, ferritin levels, and CRP to albumin ratio were significantly higher in patients with f-QRS. The need for invasive mechanical ventilation (63.6% vs. 41.5%, p=0.003) and all-cause in-hospital mortality [54.5% vs. 28.9%, log rank p=0.001, relative risk 1.88, 95% confidence interval (CI) 1.16–4.78] were significantly higher in patients with f-QRS. A number value of f-QRS leads ≥2 yields sensitivity and specificity (85.3% and 86.7%, respectively) for predicting in-hospital all-cause mortality. Multivariable analysis showed that f-QRS (odds ratio: 1.041, 95% Cl: 1.021–1.192, p=0.040) were independently associated with in-hospital death.
Conclusion: This study revealed that the presence of f-QRS in ECG is associated with higher in-hospital all-cause mortality in patients with severe COVID-19. f-QRS is an easily applicable simple indicator to predict the risk of death in these patients.

10.Angiotensin receptor-neprilysin inhibition by sacubitril/valsartan attenuates doxorubicin-induced cardiotoxicity in a pretreatment mice model by interfering with oxidative stress, inflammation, and Caspase 3 apoptotic pathway
Ferhat Dindaş, Hüseyin Güngör, Mehmet Ekici, Pınar Akokay, Füsun Erhan, Mustafa Doğduş, Mehmet Birhan Yılmaz
doi: 10.5152/AnatolJCardiol.2021.356  Pages 821 - 828
Objective: Doxorubicin (DOX) is a well-known cardiotoxic agent, whereas sacubitril/valsartan (Sac/Val) is an effective treatment option in heart failure. In this study, we aimed to evaluate the effect of Sac/Val on DOX-induced cardiotoxicity in pretreatment mice model.
Methods: A total of 24 mice were equally classified into 4 groups; control group, DOX (20 mg/kg; fifth day), Sac/Val (80 mg/kg), and Sac/Val+DOX (Sac/Val was given from day one of the study before doxorubicin administration). Electrocardiography parameters, including durations of QRS, ST, QT, PP segment, and QT/PQ index were measured. Total antioxidant status (TAS), total oxidant status (TOS), tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β), IL-6, NT-proBNP concentrations, and Caspase 3 activity were evaluated.
Results: At the end of the 9-day study duration, QRS, ST, QT intervals, QT/PQ index and TAS, TOS, TNF-α, IL-1β, IL-6 levels were significantly higher in the DOX group than in the control group (p<0.001). Moreover, there were significant differences only in the PP interval when comparing the Sac/Val+DOX and control groups (p<0.001). QRS, ST, QT intervals, and QT/PQ index, TAS, TOS, TNF-α, IL-1β, IL-6 levels were significantly lower in the Sac/Val+ DOX group compared with the DOX group (p<0.001). Furthermore, NT-proBNP levels were lower in the Sac/Val+DOX group compared with the DOX group along with less Caspase 3 apoptosis.
Conclusion: Sac/Val seems to be cardioprotective against DOX-induced cardiotoxicity in pretreatment mice model. These findings can be attributed to the antiarrhythmic, anti-inflammatory, antioxidant, and antiapoptotic effects of Sac/Val as shown in this study.

CASE REPORT
11.Percutaneous suture based device closure of an inadvertent right ventricle perforation following pericardiocentesis
Rajesh Vijayvergiya, Yamasandi S. Shrimanth, Ganesh Kasinadhuni, Harkant Singh, Ashish Sharma, Anish Bhargav, Navjyot Kaur
doi: 10.5152/AnatolJCardiol.2021.49  Pages 829 - 831
Abstract | Full Text PDF

12.Unexpected complication of septal ablation 22 years later, septal diverticule with thrombus
İrem Okçular Sezer, Tuğrul Okay
doi: 10.5152/AnatolJCardiol.2021.56  Pages 832 - 833
Abstract | Full Text PDF | Video

13.Improvement in cardiac function after renal transplantation in four patients with severe left ventricular systolic dysfunction
Emre Aslanger, Ayça Türer Cabbar, Burak Hünük, Mustafa Aytek Şimşek, Fırat Demircan, Süheyla Apaydın, Gürkan Tellioğlu, Muzaffer Murat Değertekin
doi: 10.5152/AnatolJCardiol.2021.68295  Pages 834 - 837
Abstract | Full Text PDF | Video

LETTER TO THE EDITOR
14.Management of left ventricular outflow tract obstruction in transcatheter mitral valve replacement
Engin Bozkurt, Hüseyin Ayhan, Bilge Duran Karaduman
doi: 10.5152/AnatolJCardiol.2021.513  Pages 838 - 840
Abstract | Full Text PDF

15.Acute myocarditis after coronavirus disease 2019 vaccination
Beuy Joob, Viroj Wiwanitkit
doi: 10.5152/AnatolJCardiol.2021.689  Pages 841 - 842
Abstract | Full Text PDF

CORRIGENDUM
16.Corrigendum

doi: 10.5152/AnatolJCardiol.2021.C1  Page 843
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
17.Multiple aortic aneurysms because of infective endocarditis after repair of aortic coarctation
Erman Çilsal, Bahar Çaran, Aysel Türkvatan, Hacer Kamalı, Sertaç Haydin, Alper Güzeltaş
doi: 10.5152/AnatolJCardiol.2021.350  Pages E42 - E43
Abstract | Full Text PDF | Video

18.Real stenosis in the vein graft ostium? The aortic wall protrusion may mislead you
Chun-wei Liu, Zhi-gang Guo, Yue-cheng Hu, Hong-liang Cong
doi: 10.5152/AnatolJCardiol.2021.435  Page E44
Abstract | Full Text PDF | Video