Amaç: Son çalışmalar, glukagon benzeri peptid-1 (GLP-1) reseptör agonistleri ve sodyum-glukoz ko-transporter-2 (SGLT-2) inhibitörlerinin tip-2 diyabetes mellitusta major kardiyovasküler (KV) olayları azalttığını göstermiştir. Bu derlemede, bu ilaçların KV olay çalışmalarını metodoloji ve sonuçları açısından değerlendirmeyi, ve meta-analitik yaklaşımla her bir KV olay için havuzlanmış (pooled) sonuçları hesaplayıp yorumlamayı planladık.
Yöntem: GLP-1 reseptör agonistleri ve SGLT-2 inhibitörlerinin, ana hedefi üçlü major KV olay (3’lü-MACE: KV ölüm, MI ve inme) olan çalışmaları PubMed’de sistematik olarak tarandı. Sonuçlar, her bir ilaç grubu için ayrı olarak sabit etkili model ile havuzlandı. Ek olarak, SGLT-2 inhibitörleriyle spesifik olarak kalp yetersizliği hastalarında yapılan iki çalışma kısaca yorumlandı.
Bulgular: Amaca uygun 12 çalışma bulundu (7 çalışma GLP-1 reseptör agonistleriyle, n=56,004; ve 5 çalışma SGLT-2 inhibitörleriyle, n=49,969). 3’lü-MACE açısından bu ilaçların tümü plaseboya göre non-inferiror, ve bazıları süperior bulundu. Havuzlanmış analizde GLP-1 reseptör agonistleri (özellikle GLP-1 reseptörü ile yüksek yapısal homoloji gösterenler) ve SGLT-2 inhibitörlerinin 3’lü-MACE (sırasıyla %12 ve %10 oranında), KV mortalite (%12 ve %15), total mortalite (%12 ve %13), ve daha düşük derecede fatal veya non-fatal miyokard infarktüsünde (%8 ve %9 oranında) anlamlı azalmaya neden olduğu görüldü. GLP-1 reseptör agonistleri iskemik inme riskinde %15 oranında azalma oluşturuyorken, SGLT-2 inhibitörleri kalp yetersizliği nedeniyle hastaneye yatışta %32’lik bir azalma oluşturmaktadır.
Sonuç: GLP-1 agonistleri ve SGLT-2 inhibitörleri, başlangıçta KV hastalığı olan veya bu açıdan riskli grupta olan tip 2 diyabetik hastalarda majör KV olayları azaltmaktadır. Ek olarak, SGLT-2 inhibitörleri diyabet olup olmamasından bağımsız olarak kalp yetersizliği nedeniyle hastaneye yatışta anlamlı azalmaya yol açmaktadır.

Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose co-transporter-2 (SGLT-2) inhibitors reduce major cardiovascular (CV) events in patients with type 2 diabetes mellitus. In this review, we assessed the CV outcome trials of GLP-1 receptor agonists and SGLT-2 inhibitors in terms of their methodological properties and results, and also, using a meta-analytic approach, we calculated and interpreted the pooled analyses. A systematic PubMed search was conducted for CV outcome studies of GLP-1 receptor agonists and SGLT-2 inhibitors with the main outcome of three-point major adverse cardiovascular events (MACE), which is the composite of CV death, non-fatal myocardial infarction (MI), and non-fatal stroke. We pooled the results of each outcome for each group of medications using a fixed effect model. Also, the results of two studies of SGLT-2 inhibitors conducted in patients with heart failure were discussed briefly. We found 12 eligible studies, 7 with GLP-1 agonists (n=56,004) and 5 with SGLT-2 inhibitors (n=46,969). All of the drugs analyzed were non-inferior, and some superior, to placebo in terms of three-point MACE. Pooled analyses demonstrated that GLP-1 receptor agonists, especially those having structural homology for human GLP-1 receptor, and SGLT-2 inhibitors reduced the risk of three-point MACE (by 12% and 10%, respectively), CV mortality (12% and 15%), total mortality (12% and 13%), and to a lesser extent, fatal or non-fatal MI (8% and 9%). While GLP-1 receptor agonists reduced the risk of ischemic stroke by 15%, SGLT-2 inhibitors decreased the risk of hospitalization for heart failure by 32%. GLP-1 agonists and SGLT-2 inhibitors reduced the risk of MACE in patients with type 2 diabetes with established CV disease or those with high risk for CV disease. Also, SGLT-2 inhibitors reduced the risk of hospitalization for heart failure independent of the diabetes status.

Amaç: Cerrahi operasyonlar sonrası miyokard hasarı önemli bir morbidite ve mortalite nedenidir. Bu çalışmamızda Framingham skoruna göre orta ve yüksek riskli hastalarımızdaki perioperatif miyokard infarktüsü sıklığını ortaya koymayı amaçladık.

Materyal ve metod: Çalışmaya; hastanemiz Ortopedi ve Üroloji servislerinde yatmakta olan, cerrahi girişim planlanmış, 40 yaş üzeri, Framingham risk skorları %10 ve üzeri olan 101 olgu (62 erkek, 39 kadın, ortalama yaş: 72±11 yıl) alındı. Bu hastaların preoperatif dönemdeki demografik özellikleri, komorbid durumları, kan basınçları ve biyokimyasal verileri kayıt edildi. Olguların preoperatif ve postoperatif ikinci gün troponin değerleri ve elektrokardiyografik bulguları kaydedilerek karşılaştırıldı.

Bulgular: Toplam 44 hastada (%43) troponin değeri postoperatif dönemde preoperatif döneme göre değişiklik gösterdi. Hastaların %25’inin (26 hasta) elektrokardiyografisinde miyokard iskemisi veya hasarı ile ilişkili olabilecek nitelikte değişiklik saptandı. Anlamlı EKG değişikliği ile birlikte troponin değişikliği 6 hastada (%6) saptandı.

Sonuç: Framingham skoruna göre orta ve yüksek riskli gruba dahil olan hastalarımızda postoperatif miyokard hasar riskinin yüksek olduğu görülmüştür. Bu sonuçlar riskli gruptaki tüm hastaların pre ve postoperatif dönemde, EKG ve troponin ile yakından takip edilmesinin önemini ortaya koymaktadır.

Objective: Perioperative myocardial infarction is a major cause of morbidity and mortality in patients undergoing surgical operations. We aimed to determine the incidence of perioperative myocardial infarction in patients with intermediate- or high-risk Framingham scores.

Methods: One hundred and one patients (62 males, 39 females) over 40 years of age (mean age 72±11 years) median 73 (65-81), min- max (46-96), with Framingham risk scores of 10% or higher, and scheduled for surgical interventions in the orthopedics and urology departments of our hospital were included in the study. Patient demographics, comorbidities, blood pressures, and biochemical data were recorded. Troponin values and electrocardiographic findings were obtained during the immediate preoperative period and on postoperative day 2 and then compared. Perioperative myocardial injury and infarction were diagnosed using the third universal definition of myocardial infarction.

Results: In 44 (43%) patients, postoperative troponin values were compared with the preoperative values. In 26 (25%) patients, the changes were consistent with myocardial ischemia or damage. Alterations in troponin values with significant electrocardiogram (ECG) changes were found in 6 patients (6%).

Conclusion: The risk of postoperative myocardial damage was high in our patients with intermediate or high-risk Framingham scores. This im-plies that close follow-up of these patients with abnormal ECG and troponin values during the pre- and postoperative period is required.

Giriş: Sağ ventrikül-pulmoner arter konduitli olgularda Perkütan Pulmoner Kapak Yerleştirilmesi (PPKY) giderek daha fazla uygulanmaktadır, ancak geniş native sağ ventrikül çıkış yolu (SVÇY) olan hastalar için çok az seçenek vardır. Seçeneklerden birisi Edwards SAPIEN® kapakların etiket dışı olarak kullanımıdır. Bu çalışmanın amacı, dilate native SVÇY olan hastalarda pulmoner pozisyonuna yerleştirilmiş olan SAPIEN XT ve SAPIEN 3 (S3) kapakların sonuçlarını değerlendirmektir. Yöntem: Ocak 2015 ile Mart 2020 arasında toplam 129 hasta PPKY öncesi değerlendirildi. Bunların 103’ü (%80) dilate native SVÇY olan hastalardı. Bu 103 hastanın 86'sı stent yerleştirilmesi ve kapak implantasyonu için uygun bulundu. Başarılı bir şekilde SAPIEN XT veya S3 kapak yerleştirilmesi yapılan 84 hastanın verileri retrospektif olarak değerlendirildi. Bulgular: İşlem başarısı 84/86 (% 98) idi. Ortanca yaş 18.7 yıl (8-46) ve ortanca ağırlık 57 kg (22-102 kg) idi. Altta yatan temel tanı Fallot tetralojisi (n = 77/84) idi. Elli hastada (50/84,% 60) stent ve kapak yerleştirilmesi eş zamanlı yapılırken (6 olguda hibrit prosedür uygulandı), 34/84 hastada PPKY’den 3-14 hafta önce ön-stentleme yapıldı. PPKY’den önce, ölçülen stentlerin medyan çapları sağ ön oblik bakıda 26 mm (20-32 mm) ve lateral bakıda 28 mm (21-32 mm) idi. Kullanılan kapak tipleri; XT-26 mm (n=13), XT-29 mm (n=64) ve S3-29 mm (n=7) idi. Elli dokuz hastada, kapak stabilizasyonunun sağlanması için kapakların balonlarına ilave 1-5 ml (medyan 2 ml) sıvı eklendi. Tüm hibrid prosedürlerde stent ve kapak aynı seansta implante edildi. Bir ila 59 aylık (medyan 14 ay) takipte mortalite görülmedi. Üç hastada prosedüre bağlı orta derecede triküspit kapak yetersizliği gelişti. Takiplerde tüm hastalarda kapaklar tam verim ile çalışmaya devam etti. Sonuç: Edwards SAPIEN XT ve S3 kapakları geniş native SVÇY olan hastalarda PPKY için bir alternatif olabilir.

Objective: Percutaneous pulmonary valve implantation (PPVI) into right ventricle–to–pulmonary artery conduits is increasingly being performed, but a few options are available for patients with a dilated native right ventricular outflow tract (RVOT), among which is the off-label use of Ed-wards SAPIEN® valves. This study reviews the results of the SAPIEN XT and SAPIEN 3 (S3) valve implantations in the pulmonary position in patients with a dilated native RVOT.

Methods: Between January 2015 and March 2020, PPVI procedures were performed on 129 patients. Among them, 103 (80%) had dilated native RVOT, 86 of whom were eligible for PPVI prestenting and valve implantation. Retrospective analysis was performed on 84 patients who have undergone successful PPVI implantation using the SAPIEN XT or S3 valves with dilated native RVOT.

Results: The procedural success rate was 84/86 (98%). The median age was 18.7 years (8–46 years), and the median weight was 57 kg (22–102 kg). The primary underlying diagnosis was tetralogy of Fallot (n=77/84). Stenting was performed simultaneously with valve implantation in 50/84 (60%) cases-six of which were hybrid procedures-whereas prestenting was performed 3 to 14 weeks earlier in 34/84 cases. Before valve im-plantation, the median right anterior oblique and lateral diameters of the stents were 26 mm (20–32 mm) and 28 mm (21–32 mm). Valve sizes were 26 mm (n=13) and 29 mm (n=64) for XT and 29 mm (n=7) for S3. In 59 patients, an additional 1–5 ml (median 2 ml) volume was added to the valves’ balloons for stabilization. In all hybrid procedures, the stent and valve were implanted in the same session. During follow-ups of 1 to 59 months (median 14 months), no deaths were reported, 3 patients developed tricuspid regurgitation secondary to the procedure, and valves continued to function in all patients.

Conclusion: The Edwards SAPIEN XT and S3 valves may be an alternative to PPVI in patients with dilated native RVOT.

Objective: Primary cardiac sarcoma, a rare tumor with an aggressive course and imprecise prognosis, constitutes over 95% of all malignant cardiac tumors. Given the sparsely available evidence, there is a paucity of information regarding current knowledge on cardiac sarcoma. This study aimed to determine the incidence and incidence-based rates, patient characteristics, treatment modalities, and survival factors of cardiac sarcoma.

Methods: A retrospective analysis of the incidence, incidence-based mortality rates and characteristics of cardiac sarcoma between 1975 and 2016 was carried out using the Surveillance, Epidemiology, and End Results (SEER) database. The National Cancer Institute’s Joinpoint Regression program was used to calculate the Annual Percentage Changes (APC). Univariate and multivariate regression analysis were used to determine the survival characteristics.

Results: A total 408 patients were identified for the incidence analysis, while 385 eligible patients were identified for the survival analysis. The mean age at diagnosis was 46.3±17.9 years. The incidence rate (per 100.000 per year) of cardiac sarcoma within the indicated years was 0.22, with an increased APC of 1.7 (p=0.013, 95% CI=0.5–2.9). A total of 251 (61.5%) patients underwent surgery, 93 (22.8%) patients received adjuvant radiotherapy, and 197 (50.2%) patients received chemotherapy. Surgical resection, chemotherapy, stage of tumor, and younger age significantly improved the survival outcomes (p<0.001).

Conclusion: Cardiac sarcoma is a rare type of soft tissue sarcomas with poor prognosis. Over the past 30 years, the incidence of cardiac sar-coma has been on the increase. Surgery remains the mainstay of management. Further studies are needed to compare different diagnostic and treatment modalities so as to ascertain the best treatment option that would enhance survival and prognosis of cardiac sarcoma.

Objective: Although thin-strut drug-eluting stents (DES) with a more flexible design are easily obtainable, data regarding using ultralong DES (≥40 mm) for long coronary lesions are limited in the literature. Therefore, the current study assessed the safety and efficacy of an ultralong (≥40 mm) and ultrathin (60 μm) biodegradable polymer-coated sirolimus-eluting stent (SES), Supralimus Grace, with a unique Long Dual Z-link (LDZ-link) design (Sahajanand Medical Technologies Pvt. Ltd., Surat, India) in real-world patients with long coronary lesions.

Methods: The assigned stents were implanted in 684 patients. The primary endpoint was target lesion failure (TLF), which is a composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularization (TLR), whereas periprocedural secondary endpoints included device failure (failure of stent delivery, change of stent, and stent fracture) and patient-oriented composite endpoint (POCE), which is a composite of all deaths, any MI, and any revascularization, and stent thrombosis (ST). These outcomes were analyzed at one-year follow-up and during the procedure.

Results: The patients’ mean age was 52.7±15.9 years; 537 (78.5%) were males. 626 (91.5%) patients suffered from acute coronary syndrome and 58 (8.5%) patients from chronic coronary syndrome (CSS). 989 lesions were removed. The mean numbers of lesions and stents implanted per patient were 1.3±0.2 mm and 1.4±0.3 mm, respectively. TLF occurred in 42 (6.1%) as a result of cardiac death, target vessel MI, and TLR in 9 (1.3%), 20 (2.9%), and 13 (1.9%) patients, respectively. POCE was observed in 131 patients (19.1%) at one-year follow-up, mainly in 63 (9.2%) patients because of any revascularization. Stent failure was seen in 21 patients (3.1%) as a result of delivery failure (2.2%), edge dissection (0.8%), and fracture (0.1%). Definite and probable ST were observed in 8 (1.1%) and 9 (1.3%) patients, respectively.

Conclusion: Ultralong (≥40 mm), ultrathin (60 μm) Supralimus Grace stent can be safely implanted in vessels having long and multiple lesions.

Objective: This study was conducted to assess the prevalence of central and general obesity and compare nine anthropometric indices as predictors of the risk factors for cardiovascular disease (CVD) in Iranian adults.

Methods: A total of 10,520 adults between ages 35 and 70 years old who were referred to the PERSIAN Guilan Cohort Study were included in this study. Anthropometric indices, including body mass index (BMI), waist circumference (WC), waist‑to‑height ratio (WHtR), waist‑to‑hip ratio (WHR), conicity index, hip circumference (HC), waist‑to‑hip‑to‑height ratio (WHHR), body adiposity index, and a body shape index (ABSI), were measured using the standard methods. The risk factors for CVD (diabetes mellitus, hypertension, and out‑of‑range lipid profiles) were defined by laboratory tests and medical history. The odds ratio of the risk factors based on a unit increase in anthropometric indices was examined by an adjusted logistic model.

Results: The mean of all anthropometric indices was higher in women than in men (p<0.01). After adjusting for confounders, the risk of diabetes mellitus, hypertension, and hypertriglyceridemia increased with an increase in all anthropometric indices. The highest risk of diabetes mellitus and hypertriglyceridemia was found in higher WHHR. The highest risk of low high‑density lipoprotein cholesterol (HDL‑C) and high low‑density lipoprotein cholesterol (LDL‑C) was found in an increase in the WHR and ABSI, respectively.

Conclusion: Our findings emphasize higher levels of general and central obesity in adults in the north of Iran. The WHHR and WHtR seem to be more valuable indices than BMI and WC for predicting distinct risk factors for CVD. However, the WHR was the strongest index for the prediction of high LDL‑C/HDL‑C ratio.

Amaç: Genom çapındaki ilişkilendirme çalışmaları farklı toplumlarda tek nükleotid polimorfizmlerinin (TNP) atriyal fibrilasyon (AF) ile ilişkili olduğunu ve kateter ablasyonu sonrası AF rekürensini belirleyebildiğini ortaya koymuştur. Ancak, Türk toplumunda bu konuda herhangi bir veri bulunmamaktadır. Çalışmada PITX2, ZFHX3, EPHX2, CAV1, TBX5, TGF-1 and SCN10A genlerindeki 11 adet TNP’nin Türk hastalarda AF ile ilişkili olup olmadığını ve bu polimorfizmlerin AF için pulmoner ven izolasyonundan (PVİ) sonra uzun dönem atriyal taşiaritmi (ATa) rekürrensini belirleyip belirlemediğini araştırmayı amaçladık.
Metodlar: Toplam 245 valvüler olmayan AF’li hasta (%44.9 erkek, ortalama yaş: 60.2 ± 13.2, %65.3 paroksismal AF) ve 50 yaş ve cinsiyet uyumlu kontrol çalışmaya alındı. Gruplar arasında klinik özellikler ve genetik varyantlar karşılaştırıldı. Bunlardan ikinci nesil kriyobalon ile PVİ yapılan 128 hasta işlem sonrası uzun dönem rekürrens için daha ileri incelendi.
Bulgular: PITX2 genindeki dört TNP AF ile anlamlı ilişki içinde idi (rs10033464_T: OR 3.29, 95%CI: 1.38-7.82, p=0.007; rs6838973_T: OR 3.06, 95% CI 1.36-6.87, p=0.007; rs3853445_C: OR 2.84, 95%CI: 1.27-6.36, p=0.011; rs17570669_T: OR 4.03, 95% CI: 1.71-9.51, p=0.001). Atriyal fibrilasyon için PVİ yapılan hastalarda CAV1 geninde bir yer (rs3807989_G: OR 4.50, 95% CI 1.04-19.31, p=0.043) ve erken rekürrens varlığı (OR: 8.06, 95% CI: 2.12-30.55, p=0.002) kateter ablasyonu sonrası uzun dönem rekürrens için belirleyiciydi.
Sonuç: Türk hastalarda PITX2 genindeki dört TNP (rs10033464, rs6838973, rs3853445 ve rs17570669) ile AF arasında anlamlı ilişkiler mevcuttur. İlaveten, CAV1 genindeki bir genetik varyant (rs3807989) ve erken rekürrens kateter ablasyonu sonrası uzun dönem ATa rekürrensini belirler.

Objective: Genome-wide association studies have revealed that single nucleotide polymorphisms (SNPs) are associated with atrial fibrillation (AF) and can predict AF recurrence after catheter ablation in different populations. However, there exists no such data for the Turkish population. We aimed to investigate whether 11 SNPs in the PITX2, ZFHX3, EPHX2, CAV1, TBX5, TGF-1, and SCN10A were related to AF and whether these SNPs can predict long-term atrial tachyarrhythmia (ATa) recurrence after pulmonary vein isolation (PVI) for AF in Turkish patients.

Methods: A total of 245 consecutive patients with non-valvular AF (44.9% men, mean age: 60.2±13.2 years, 65.3% paroxysmal AF) and 50 age- and sex-matched controls were included in this analysis. The clinical features and genetic variants were compared between the 2 groups. Of the 245 patients, 128 who underwent PVI with second-generation cryoballoon were further examined for long-term recurrence after the procedure.

Results: Four SNPs in PITX2 were significantly associated with AF (rs10033464_T: OR 3.29, 95%CI: 1.38–7.82, p=0.007; rs6838973_T: OR 3.06, 95% CI 1.36–6.87, p=0.007; rs3853445_C: OR 2.84, 95%CI: 1.27–6.36, p=0.011; rs17570669_T: OR 4.03, 95% CI: 1.71–9.51, p=0.001). Among these patients who underwent PVI, one locus in CAV1 (rs3807989_G: OR 4.50, 95% CI 1.04–19.31, p=0.043) and early recurrence (OR: 8.06, 95% CI: 2.12–30.55, p=0.002) predicted long-term AF recurrence after catheter ablation.

Conclusion: Significant associations exists between 4 SNPs in PITX2 and AF (rs10033464, rs6838973, rs3853445, and rs17570669) in Turkish patients. In addition, 1 genetic variant in CAV1 (rs3807989) and early recurrence can predict long-term ATa recurrence after catheter ablation.