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Volume : 25 Issue : 12 Year : 2021
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The Anatolian Journal of Cardiology - Anatol J Cardiol: 25 (12)
Volume: 25  Issue: 12 - December 2021
EDITORIAL
1.Focus issue on arrhythmias, echo and interventional cardiology
Çetin Erol
doi: 10.5152/AnatolJCardiol.2021.12  Page 844
Abstract | Full Text PDF

META ANALYSIS
2.Evaluation of electrocardiogram and echocardiographic characteristics of pre-and post-operation of His bundle pacing: A comprehensive review and meta-analysis
Mingzhu Li, Fei Ren, Jing Tian, Kai Yang, Jie Zhang, Hejian Song, Delu Yin, Steven Cui
doi: 10.5152/AnatolJCardiol.2021.88661  Pages 845 - 857
Abstract | Full Text PDF

REVIEW
3.Stereotactic ablative body radiotherapy for ventricular tachycardia: An alternative therapy for refractory patients
Carolina De La Pinta, Raquel Besse
doi: 10.5152/AnatolJCardiol.2021.187  Pages 858 - 862
Stereotactic ablative body radiotherapy (SABR) allows the administration of ablative doses of radiation in a focused form with a low probability of side effects and is widely used for cancer treatment. However, in the recent years its usefulness in benign cardiac pathology is being studied. In this study, we aimed to guide the cardiologist in SABR and its applications in treatment of refractory ventricular tachycardia. In this review, we analyzed published literature on PubMed and MEDLINE with papers published in the past 5 years. We included papers in the English language with information about indications, radiotherapy plan, doses and fractionations, and outcomes. All citations were evaluated for relevant content and validation.

ORIGINAL INVESTIGATION
4.Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality
Pelin Karaca Özer, Elif Ayduk Gövdeli, Berat Engin, Adem Atıcı, Derya Baykız, Hüseyin Orta, Zeynep Gizem Demirtakan, Samim Emet, Ali Elitok, Yelda Tayyareci, Berrin Umman, Ahmet Kaya Bilge, Zehra Buğra
doi: 10.5152/AnatolJCardiol.2021.21940  Pages 863 - 871
Objective: In this study, we aimed to compare the functional adaptations of the left ventricle in variant forms of left ventricular hypertrophy (LVH) and to evaluate the use of two-dimensional speckle tracking echocardiography (2D-STE) in differential diagnosis and prognosis.
Methods: This was a prospective cohort study of 68 patients with LVH, including 20 patients with non-obstructive hypertrophic cardiomyopathy (HCM), 23 competitive top-level athletes free of cardiovascular disease, and 25 patients with hypertensive heart disease (HHD). All the subjects underwent 2D transthoracic echocardiography (TTE) and 2D-STE. The primary endpoint was all-cause mortality. Global longitudinal strain (GLS) below −12.5% was defined as severely reduced strain, −12.5% to −17.9% as mildly reduced strain, and above −18% as normal strain.
Results: The mean LV-GLS value was higher in athletes than in patients with HCM and HHD with the lowest value being in the HCM group (HCM: −11.4±2.2%; HHD: −13.6±2.6%; and athletes: −15.5±2.1%; p<0.001 among groups). LV-GLS below −12.5% distinguished HCM from others with 65% sensitivity and 77% specificity [area under curve (AUC)=0.808, 95% confidence interval (CI): 0.699–0.917, p<0.001]. The median follow-up duration was 6.4±1.1 years. Overall, 11 patients (16%) died. Seven of these were in the HHD group, and four were in the HCM group. The mean GLS value in patients who died was −11.8±1.5%. LV-GLS was significantly associated with mortality after adjusting age and sex via multiple analysis (RR=0.723, 95% CI: 0.537–0.974, p=0.033). Patients with GLS below −12.5% had a higher risk of all-cause mortality compared with that of patients with GLS above −12.5% according to Kaplan-Meier survival analysis for 7 years (29% vs. 9%; p=0.032). The LV-GLS value predicts mortality with 64% sensitivity and 70% specificity with a cut-off value of −12.5 (AUC=0.740, 95% CI: 0.617-0.863, p=0.012).
Conclusion: The 2D-STE provides important information about the longitudinal systolic function of the myocardium. It may enable differentiation variable forms of LVH and predict prognosis.

5.Prognostic value of interleukin-6 in atrial fibrillation: A cohort study and meta-analysis
Xiaoyue Jia, Xi Cheng, Na Wu, Ying Xiang, Long Wu, Bin Xu, Chengying Li, Zhihui Zhang, Shifei Tong, Li Zhong, Yafei Li
doi: 10.5152/AnatolJCardiol.2021.69299  Pages 872 - 879
Objective: The prognostic value of interleukin-6 (IL-6) in patients with atrial fibrillation (AF) has not been fully elucidated. Therefore, we conducted a cohort study and a meta-analysis to assess the predictive value of IL-6 for stroke and mortality in patients with AF.
Methods: A cohort study was performed in newly diagnosed non-valvular patients with AF. A total of 217 patients with AF were followed up for a mean of 27 months. A multivariate Cox regression analysis was used to evaluate the association between IL-6 and stroke/all-cause mortality. The incremental value was also assessed by adding IL-6 to the CHA2DS2-VASc score. Besides, a meta-analysis of all reported cohort studies and our cohort study was conducted to validate the association of circulating IL-6 and stroke/mortality in patients with AF.
Results: Our cohort study showed that elevated plasma level of IL-6 was an independent risk factor for predicting stroke [hazard ratio (HR)=3.81; 95% confidence interval (CI), 1.11–13.05; p=0.033] and all-cause mortality (HR=3.11; 95% CI, 1.25–7.72; p=0.015) in patients with AF. Adding IL-6 levels to CHA2DS2-VASc score showed limited improvement of the predictive power for stroke [area under curve (AUC) from 0.81 to 0.88, p=0.006]. Meta-analysis confirmed that increased circulating level of IL-6 was significantly associated with increased risk of stroke (pooled HR=1.97; 95% CI, 1.22–3.17; p=0.006) and all-cause mortality (pooled HR=2.73; 95% CI, 2.29–3.25; p<0.001).
Conclusion: Increased circulating level of IL-6 was significantly associated with greater risk of stroke and all-cause mortality in patients with AF. Adding IL-6 biomarker to the CHA2DS2-VASc score may help to determine the management of AF treatment.

6.Two-dimensional speckle tracking echocardiography derived post systolic shortening in patients with unstable angina and normal left ventricular systolic function
Srinivasan Giridharan, Selvaraj Karthikeyan, Arumugam Aashish, Balasubramaniyan Amirtha Ganesh, Palamalai Arun Prasath, Pandiyan Usha
doi: 10.5152/AnatolJCardiol.2021.40931  Pages 880 - 886
OBJECTIVES: Post systolic shortening (PSS) had been shown to be sensitive in detecting ischemia on stress echocardiography. This work aims to study the diagnostic potential of resting PSS and post systolic index (PSI) in patients with suspected unstable angina (UA).
METHODS: Total of 159 participants with suspected UA without any wall motion abnormalities were recruited. They all underwent speckle tracking echocardiography (STE) and coronary angiogram (CAG). Global longitudinal strain (GLS), presence or absence of pathological PSS, PSI17 and PSI12, PSI in left anterior descending, left circumflex and right coronary artery territories were assessed. Based on CAG those who had more than 70% stenosis were labelled to have obstructive CAD.
RESULTS: Obstructive disease was noted in 54.7% patients. The prevalence of PSS (62.1% Vs 13.9%), mean PSI17 (5.4 Vs 3.3) and PSI12 (6.2 Vs 3.7) were significantly higher in those with CAD compared to patients without obstructive disease. Both PSS (Odds ratio-10.145; 95% CI, 4.577-22.489; p=0.001) and PSI17 (odds ratio-1.217;95 CI, 1.064-1.393; p=0.004) were predictors of CAD by multivariate regression analysis. PSS had a sensitivity of 62.1% and specificity of 86.1% with a positive predictive value of 84.4%. PSI17 (area under curve- 0.637; p=0.003) and PSI12 (AUC- 0.661; p=0.001) have moderate accuracy in identifying obstructive CAD.
CONCLUSION: In patients presenting with suspected UA, STE derived PSS has reasonable sensitivity and good specificity in diagnosis of obstructive CAD. Patients identified to have PSS can be subjected to CAG without further stress testing because of its high positive predictive value.

7.Tp-e/QTc ratio, SYNTAX, and GRACE score in patients who underwent coronary angiography owing to acute coronary syndrome
Kadriye Gayretli Yayla, Çağrı Yayla, Mehmet Akif Erdöl, Mustafa Karanfil, Hamza Sunman, Faruk Aydın Yılmaz, Nail Burak Özbeyaz, Ayşe Nur Özkaya İbiş, Murat Tulmaç
doi: 10.5152/AnatolJCardiol.2021.31  Pages 887 - 895
Objective: Ventricular arrhythmias following acute coronary syndrome (ACS) range from benign to life-threatening fatal arrhythmias. Tpeak-end (Tp-e) interval has been shown to be an important parameter in the assessment of repolarization dispersion. We aimed to evaluate the relationship between SYNTAX and Global Registry of Acute Coronary Events (GRACE) risk score calculated on admission and Tp-e interval and Tp-e/QTc ratio.
Methods: A total of 421 patients were included in the study. The patients were divided into 2 groups as low SYNTAX score (≤22) and moderate and high risk SYNTAX score (>22). According to the GRACE risk score, the patients were divided into 2 groups; high-risk patients ≥140 and <140 low-risk patients.
Results: In the group with SYNTAX score >22, the Tp-e interval (p<0.001) and Tp-e/QTc ratio (p<0.001) was found to be significantly higher than in the group with a SYNTAX score ≤22. Tp-e interval (p<0.001) and Tp-e/QTc ratio (p=0.002) was higher in patients with GRACE risk score ≥140 compared with patients with a GRACE risk score <140. The correlation between Tp-e interval and Tp-e/QTc ratio and SYNTAX score (r=0.489; p<0.001) and GRACE risk score (r=0.274; p<0.001) were found to be significant. A significant and independent correlation was found between the SYNTAX score and Tp-e/QTc ratio (β=0.385; p<0.001).
Conclusion: Tp-e interval and Tp-e/QT ratio increased in patients with severe coronary artery disease assessed with SYNTAX score. Tp-e interval and Tp-e/QT ratio increased in patients with a high GRACE risk score.

8.One-year outcomes of novel BioMime Morph tapered stent in long and multiple coronary artery lesions
Yash Paul Sharma, Lipi Uppal, Prashant Panda, Soumitra Mohanty, Ganesh Kasinadhuni, Darshan Krishnappa, Saurabh Mehrotra, Ankur Gupta, Krishna Prasad, Krishna Santosh, Dinakar Bootla, Soumitra Ghosh
doi: 10.5152/AnatolJCardiol.2021.05763  Pages 896 - 901
Objective: Even with the immense progress achieved in the field of percutaneous coronary interventions (PCIs), treatment of diffuse long atherosclerotic coronary artery disease continues to remain a challenge for durable outcomes. The downstream reduction in diameter along the lesion length of a coronary artery may compel the cardiologist to use either 2 overlapping stents of different diameters or a single long stent leading to stent-vessel mismatch at the edges. Recently, Meril Life Sciences Pvt. Ltd., India, has introduced a long-tapered sirolimus-eluting stent (SES) system, BioMime Morph, which conforms to the normal tapered geometry of coronary arteries along with adequate lesion coverage. In this study, we aimed to provide real world experience regarding the safety and efficacy of the BioMime Morph SES over a follow-up of one year.
Methods: This was a single center, retrospective study involving 172 participants who underwent PCI with the BioMime Morph SES. Mean length of the target lesion was 34.4±10.4 mm, and mean stent length was 53.2±8.7 mm. The most frequent revascularized vessel was the left anterior descending artery (LAD) in 97 lesions (54.4%).
Results: Major adverse cardiac events (MACE) (defined as a composite of target vessel myocardial infarction, target lesion revascularization, and death due to a cardiac cause) at 1, 6, and 12 months were seen in 4 (2.3%), 7 (4.0%), and 8 (4.7%) patients, respectively. Overall, 5 cardiac deaths and 2 definite stent thrombosis were observed in the study.
Conclusion: The study suggests that the novel BioMime Morph SES is an effective and a safe option for PCI in the treatment of long diffuse atherosclerotic lesions.

9.A seven-year single-center experience on AngioJet rheolytic thrombectomy in patients with pulmonary embolism at high risk and intermediate-high risk
Özgur Yaşar Akbal, Berhan Keskin, Hacer Ceren Tokgöz, Aykun Hakgör, Ali Karagöz, Seda Tanyeri, Barkın Kültürsay, Şeyhmus Külahçıoğlu, Zübeyde Bayram, Süleyman Efe, Atakan Erkılınç, İbrahim Halil Tanboğa, Cem Doğan, Mehmet Akbulut, Nihal Özdemir, Cihangir Kaymaz
doi: 10.5152/AnatolJCardiol.2021.28303  Pages 902 - 911
Giriş ve Amaç: Angiojet Reolitik trombektomi (ART), akut pulmoner embolide (PE) kateter bazlı bir tedavi olarak kullanılmaktadır. PE'li hastalarda ART ile ilgili yedi yıllık deneyimimize dayanan bu çalışmada, ART’nin etkililiğini ve güvenlilik sonuçlarını değerlendirdik.
Yöntemler: Çalışmamız, ART uygulanan yaş (62 yıl; çeyrekler arası aralık (IQR): 50-73), yüksek ve orta yüksek riskli PE'li 56 hastanın retrospektif değerlendirmesine dayanmaktadır.
Bulgular: Yüksek ve orta yüksek risk sırasıyla hastaların % 21.4 ve % 78.6'sında görüldü. ART süresi 304 (IQR: 246-468) saniyeydi. Trombotik ölçümler, sağ-sol ventrikül çapı oranı (RV / LV oranı), sağ-sol atriyal çap oranı ve pulmoner arter basınçları düzeldi (tümü için p <0.001). Hastanede kalış süresince akut böbrek yetmezliği, majör ve minör kanama ve ölüm oranları sırasıyla %37.5, %7.1, %12.5 ve %8.9 idi. İşlem sonrası nefropatiyi öngörmede, ileri yaş anlamlı olarak bulundu, ayrıca yüksek risk durumu hastane içi (p = 0.006) ve uzun vadeli mortalite ile ilişkiliydi.
Sonuçlar: ART, yüksek ve orta-yüksek riskli PE'li hastalarda hemodinamik ve klinik olarak, pulmoner arteriyel trombotik yük ve RV gerilimini iyileştirmede faydalı bulundu. İleri yaş işlem sonrası nefropati riskini artırırken, başlangıçtaki yüksek risk durumu hastane içi ve uzun dönem mortaliteyi öngörmektedir.
Background and Aim: Angiojet Rheolytic thrombectomy (ART) has been utilized as a catheter-based treatment in acute pulmonary embolism (PE). In this study based on our seven-year experience on ART in patients with PE, we evaluated efficacy and safety outcomes of ART.
Methods: Our study is based on retrospective evaluation of 56 patients with high- and intermediate-high-risk PE, age (62 years; interquartile-range (IQR): 50-73) who underwent ART.
Results: High- and intermediate-high-risk were noted in 21.4 % and in 78.6 % of patients, respectively. ART duration was 304(IQR: 246-468) seconds. Measures of obstruction, right to left ventricle diameter ratio (RV/LV ratio), right to left atrial diameter ratio and pulmonary arterial pressures were improved (p<0.001 for all). During hospital stay, acute renal failure, major and minor bleeding, and mortality rates were 37.5%, 7.1%, 12.5%, and 8.9%, respectively. Aging related to post-procedural nephropathy while high-risk status was associated with in-hospital mortality (p=0.006) and long-term mortality.
Conclusions: The ART resulted in significant and clinically relevant improvements in the pulmonary arterial thrombotic burden, RV strain and hemodynamics in patients with PE at high- and intermediate-high-risk. Aging increased the risk of post-procedural nephropathy whereas baseline high-risk status predicted in-hospital and long-term mortality.

10.Long-term results of long segment coronary artery lesions overlapped with novolimus-eluting DESolve scaffold: Disappointment or futuristic?
Ersin İbişoğlu, Sinem Çakal, Beytullah Çakal, H. Murat Güneş, Bedrettin Boyraz, Bilal Boztosun
doi: 10.5152/AnatolJCardiol.2021.25  Pages 912 - 919
Objective: The data on using novolimus-eluting DESolve bioresorbable scaffolds (BVS) for long-segment coronary artery lesions remains insufficient. In this study, our main objective was to assess the long-term effects of the overlapping applications of both DESolve-DESolve and the drug-eluting stent (DES)-DESolve.
Methods: A single-centered study of 103 patients scheduled for DESolve placement for long-segment lesions (>28 mm) was conducted (October 2013 to November 2016). A DESolve-DESolve overlap was used on 43 patients and a DES-DESolve overlap on 60 patients. Acute procedural success and major adverse cardiac events (MACE) (stent thrombosis, targeted vessel revascularization, targeted lesion revascularization, and cardiac death) were evaluated. The patients were followed up for 48 months.
Results: Revascularization was performed on 4 (6.7%) patients in the DES-DESolve group and 5 (11.6%) patients in the DESolve–DESolve group for target lesion revascularization. Among the study population, 10 (9.7%) patients had MACE, including 5 (8.3%) patients in the DES–DESolve group and 5 (11.6%) patients in the DESolve–DESolve group.
Conclusion: The positive results of our study concerning the use of DESolve for the treatment of long coronary lesions demonstrate that BVS will emerge with new platforms and become non-inferior to the DES.

CASE REPORT
11.Postpartum infective endocarditis with Enterococcus faecalis after vaginal delivery
İbrahim Etem Dural, Serkan Gökaslan, Zafer Yalım, Uğur Aksu, Ömer Faruk Yılmaz, İbrahim Ersoy, Fehim Can Sevil
doi: 10.5152/AnatolJCardiol.2021.29797  Pages 920 - 921
Abstract | Full Text PDF | Video

12.Thromboembolic ST elevation myocardial infarction due to a large coronary aneurysm: Role of apixaban
Stefania Cherubini, Alessandro Sciahbasi, Maria Cera, Silvio Fedele, Giuseppe Ferraiuolo, Andrea Ciolli
doi: 10.5152/AnatolJCardiol.2021.128  Pages 922 - 923
Abstract | Full Text PDF

13.Alternative methods to overcome the challenging anatomy of the coronary sinus during percutaneous mitral annuloplasty procedure
Suat Görmel, Salim Yaşar, Ender Murat, Ozan Köksal, Uygar Çağdaş Yüksel, Cem Barçın, Murat Çelik
doi: 10.5152/AnatolJCardiol.2021.136  Pages 924 - 925
Abstract | Full Text PDF | Video

LETTER TO THE EDITOR
14.When is old age for cardiologists? An evidence-based historical approach
Steven H. Yale, Halil Tekiner, Eileen S. Yale
doi: 10.5152/AnatolJCardiol.2021.520  Pages 926 - 927
Abstract | Full Text PDF

15.Cardiac myxomas in an unusual location: A glimpse into their potential characteristics
Kenan Yalta, Uğur Özkan, Tülin Yalta, Ertan Yetkin
doi: 10.5152/AnatolJCardiol.2021.797  Pages 928 - 930
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
16.The giant venous wave: Lancisi’s sign
Yalçın Velibey, Gökçem Ayan, Mesut Karataş, Erkan Kahraman, Emre Can Parsova, Özge Güzelburç
doi: 10.5152/AnatolJCardiol.2021.526  Page E45
Abstract | Full Text PDF | Video

17.First diagonal artery arising from the left main coronary artery: A rare anomaly
Nitin Kumar Parashar, Mumun Sinha, Sunil Kumar Verma
doi: 10.5152/AnatolJCardiol.2021.539  Page E46
Abstract | Full Text PDF