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Volume : 25 Issue : 5 Year : 2021
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The Anatolian Journal of Cardiology - Anatol J Cardiol: 25 (5)
Volume: 25  Issue: 5 - May 2021
EDITORIAL
1.Ramadan, TURKMI, REALITY HF, and so on…
Çetin Erol
doi: 10.5152/AnatolJCardiol.2021.5  Page 283
Abstract | Full Text PDF

CONSENSUS REPORT
2.Recommendations for Ramadan fasting to patients with cardiovascular diseases; Turkish Society of Cardiology consensus report
Ahmet Taha Alper, Mehmet Kadri Akboğa, Kazım Serhan Özcan, İstemihan Tengiz, Uğur Önsel Türk, Mustafa Yıldız, Mehmet Birhan Yılmaz, Meral Kayıkçıoğlu, Emine Gazi, Aylin Yıldırır
doi: 10.5152/AnatolJCardiol.2021.206  Pages 284 - 293
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
3.Time delays in each step from symptom onset to treatment in acute myocardial infarction: Results from a nation-wide TURKMI registry
Mustafa Kemal Erol, Meral Kayıkçıoğlu, Mustafa Kılıçkap, Arda Güler, Önder Öztürk, Burcu Tuncay, Sinan İnci, İsmail Balaban, Fatih Tatar, Ömer Faruk Çırakoğlu, Emine Gazi, Eftal Murat Bakırcı, Çağrı Yayla, Mehmet Ali Astarcıoğlu, Bilge Duran Karaduman, Ekrem Aksu, Yakup Alsancak, Nadir Emlek, Mustafa Kürşat Tigen, Nihan Turhan Cağlar, Ramazan Düz, Mehmet Inanir, Öner Özdoğan, Oğuz Yavuzgil
doi: 10.5152/AnatolJCardiol.2021.39797  Pages 294 - 303
Amaç: TURKMI çalışmasının bu analizinde Türkiye’de akut miyokard infarktüsü (AMİ) nedeniyle hastaneye başvuran hastalarda semptom başlangıcından tedaviye ulaşıncaya kadarki gecikmeler ve bunların sebepleri değerlendirilmiş, böylece AMİ hastalarındaki yaklaşımın iyileştirilmesi amaçlanmıştır.
Yöntem: TURKMI çalışması, 7/24 primer perkütan koroner girişim (PKG) uygulanan 50 merkezin katılımıyla gerçekleştirilmiş ulusal çapta bir çalışmadır. 1-16 Kasım 2018 tarihleri arasındaki 2 haftalık periyotta, semptom başlangıcından itibaren 48 saat içinde hastaneye başvuran 1930 AMİ hastası çalışmaya dahil edilmiştir. Tüm hastalar kapı balon zamanı (KPZ) ve total iskemik süre (TİS) dahil olmak üzere semptom başlangıcından tedavi uygulanıncaya kadar her adımda geçen süre açısından ayrıntılı olarak incelenmiştir.
Bulgular: Hastane içi AMİ hastalarının dışlanmasının ardından toplam 1879 hasta değerlendirilmiştir. Hastaların büyük çoğunluğu (%48.2) hastaneye kendi imkanlarıyla başvurmuştur, yalnızca %11.5’inde ambulans ile başvuru gözlenmiştir. Aynı zamanda hastaların %36.7’si PKG uygulanmayan merkezden sevk edilmiştir. Geri kalan % 2.62 ise hastanede yatarken AMI gelişen hastalardır. Semptom başlangıcından 112 aranıncaya kadar geçen süre ortanca olarak 52.5 dakika (15-180), 112 ambulansın aramadan sonra hastaya ulaşma süresi 15 dk (10-20) olarak saptanmıştır. STEMİ hastalarında ortanca KPZ 36.5 dk (25-63), ortanca TİS 195 dk (115-330) saptanmıştır. PKG uygulanmayan merkezden işlem yapılan merkeze sevk edilen hastalarda ise TİS’in ortanca 151 (90-285) dk’dan ortanca 250 (165-372) dk’ya yükseldiği gözlenmiştir. Hem STEMİ hem de NSTEMİ hastalarında saptanan bu gecikmelerde temel faktörlerin hasta ilişkili faktörler ve hastaneye ulaşım şekli olduğu gözlenmiştir.
Sonuç: TURKMI çalışması sonucunda, semptom başlangıcından 48 saat içinde başvuran AMİ hastalarında PKG uygulanıncaya kadar geçen süre kılavuz önerilerinin çok üzerinde saptanmış ve Türkiye’de acil servise ulaşımda 112 ambulansın çok düşük oranda kullanıldığı ortaya konmuştur. Hasta ilişkili faktörler ve hastaneye başvuru şekli tedavinin uygulanmasındaki gecikmede en önemli faktörler olarak saptanmıştır.
Objective: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey.
Methods: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT).
Results: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15–180) min and from EMS call to EMS arrival 15 (10–20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25–63) min, and median TIT was 195 (115–330) min. TIT was significantly prolonged from 151 (90–285) min to 250 (165–372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI.
Conclusion: The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.

4.Resting heart rate and real-life treatment modalities in outpatients with left ventricular systolic dysfunction study: A multicenter, prospective, observational, and national registry
Yüksel Çavuşoğlu, Ömer Kozan, Ahmet Temizhan, Mehmet Serdar Küçükoğlu
doi: 10.14744/AnatolJCardiol.2020.13247  Pages 304 - 312
Amaç: Kalp yetersizliğinde (KY), kalp hızında KH) sağlanan azalmanın klinik yararlarla ilişkili olduğu randomize klinik çalışmalarda gösterilmiştir. Çok merkezli, prospektif, gözlemsel, ulusal nitelikli bu çalışmada, kronik KY olgularında istirahat KH ile KH ilişkili tedavilerin gerçek yaşamda ki etkilerinin araştırılması amaçlanmıştır.
Metod: REALITY HF çalışmasına, 16 merkezden, EF <%40 olan 1054 kronik KY olgusu dahil edildi. Klinik özellikler, KH ve medikasyonlar kaydedildi (kayıt fazı). Sinüs ritminde ve KH≥70/dk olan 487 olgu 4 aylık takip programına alındı (V0). Bunlarda 1.(V1) ve 4.(V2) ayda KH ile medikal tedavi değişimleri değerlendirildi. 4 aylık takip programına alınan 320 olguda Kansas City Cardiomyopathy Questionnaire (KCCQ) ile yaşam kalitesi (QoL) incelendi.
Bulgular: Olguların 794’ü (%75.3) sinus ritminde olup bunlarda istirahat KH 76.7±14/dk ve %69.1’inde istirahat KH ≥70/dk idi. Bu olguların %79.1’i beta bloker (BB) ve %6.1’i ivabradin kullanmaktaydı. BB alanlarda KH daha düşük olmakla beraber (75.8±13 ve 80.4±16/dk, p=0.001), %65.8’inde KH halen ≥70/dk bulundu. Yüksek KH ile daha kötü NYHA, QoL ve EF arasında anlamlı ilişki saptandı. KH ilişkili ilaç düzenlemesinin klinisyenlere bırakıldığı 4 aylık takip programında KH, V0’da 83.6±12 (80) dk’dan V1’de 78.6±13 (77) dk’ya (p=0.001) ve V2’de 73.0±11 (73) dk’ya (p=0.001) anlamlı azalma gösterdi. KH <70 dk olan olgu oranı V1’de %21.7 (p=0.001) ve V2’de %39.9’a (p=0.001) ulaştı. KCCQ skoru V0’da 59.7±23 (62.7)’dan V2’de 73.1±18 (78.5)’a yükseldi (p=0.001). NYHA-I olgu oranı V0’da %22.2’den, V1’de %29.2 ve V2’de %39.4’e kadar artış gösterdi (p=0.01).
Sonuç: Günlük klinik uygulamada yaygın BB kullanımına rağmen KY olgularının büyük bölümünde KH yüksektir ve kötü klinik tablo ile ilişkilidir. KH’nı düşüren tedavilerle KH’da elde edilen azalma ile klinik sonuçlarda düzelme sağlanabilmektedir.
Objective: Heart rate (HR) reduction is associated with improved outcomes in heart failure (HF). This multicenter, prospective, observational, and national registry aimed to evaluate resting HR and the impacts of HR-related medications in real-life clinical practice in patients with HF.
Methods: The Resting HR and Real-Life Treatment Modalities in Outpatients with Left Ventricular Systolic Dysfunction (REALITY HF) study enrolled 1054 patients with HF and left ventricular ejection fraction (LVEF) of <40% from 16 centers. Clinical characteristics, HR, and medications were noted (enrollment phase). A total of 487 patients with sinus rhythm and HR of ≥70 bpm were included in a further 4-month follow-up (FU) program (V0). Changes in HR and medications were reevaluated at 1-month (V1) and 4-month (V2) FU visits. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess the quality of life (QoL) of 320 patients in a 4-month FU program.
Results: During enrollment, 794 patients (75.3%) were in sinus rhythm, in whom resting HR was 76.7±14 bpm, 69.1% had a resting HR of ≥70 bpm, 79.1% were receiving beta blocker (BB), and 6.1% were receiving ivabradine. Resting HR was lower in patients receiving BB (75.8±13 vs. 80.4±16 bpm; p=0.001); however, 65.8% of those still had a resting HR of ≥70 bpm. A significant association was found between elevated HR and worse New York Heart Association (NYHA) class, worse QoL, or lower LVEF. During the 4-month FU, adjustment of HR-lowering therapy was left to the physician’s discretion. Resting HR significantly reduced from 83.6±12 (80) bpm at V0 to 78.6±13 (77) bpm at V1 (p=0.001) and further decreased to 73.0±11 (73) bpm at V2 (p=0.001). Patients achieving a resting HR of <70 bpm were 21.7% at V1 (p=0.001) and 39.9% at V2 (p=0.001). KCCQ significantly increased from 59.7±23 (62.7) at V0 to 73.1±18 (78.5) at V2 (p=0.001). In addition, patients with NYHA I increased from 22.2% at V0 to 29.2% at V1 and 39.4% at V2 (p=0.01).
Conclusion: In real-life clinical practice, elevated HR is highly prevalent in HF despite widely used BB therapy and is associated with worse clinical picture. Therapeutic interventions targeting HR significantly reduce HR, and HR lowering is associated with improved clinical outcomes.

5.Clinical spectrum and long-term course of sustained ventricular tachycardia in pediatric patients: 10 years of experience
Fatma Sevinç Şengül, Hasan Candaş Kafalı, Alper Güzeltaş, Yakup Ergül
doi: 10.14744/AnatolJCardiol.2020.95759  Pages 313 - 322
Amaç: Pediatrik ventriküler taşikardi (VT) heterojen etiyolojiye ve farklı klinik özelliklere sahiptir. Bu çalışmanın amacı pediyatrik sustained ventriküler taşikardilerin klinik spektrumunu ve uzun dönem sonuçlarını değerlendirmektir.
Yöntemler: 2010-2020 yılları arasında sustained VT tanısı alan hastalar geriye dönük olarak incelendi.
Sonuçlar: Toplam 129 VT hastası değerlendirildi. Yetmiş dört hasta erkekti ve ortanca yaş 12,5 (0.25-18 yaş) idi. Hastalar idiyopatik VT (n=85, %65,9), kardiyomiyopati ile ilişkili VT (n=24, %18,6), katekolaminerjik polimorfik VT (n=17, %13,2) ve miyokardit ile ilişkili VT (n=3, %2,3) olarak gruplandırıldı. En sık görülen semptomlar çarpıntı (n=61) ve senkop (n=24) idi. Ventriküler taşikardi hastaların %53,6'sında sağ ventrikülden kaynaklanmaktaydı. Hastaların yarısına elektrofizyolojik çalışma yapıldı, 64 hastaya radyofrekans ablasyon tedavisi uygulandı ve yirmi dokuz hastaya implante edilebilir kardiyak defibrilatör uygulandı. İzlemde hastaların %70,4'ünde tam rezolusyon, 19 hastada kısmi rezolusyon olduğu ve 23 hastada (%19,5) hastalığın stabil seyrettiği saptandı. Monomorfik VT'ler ve sol dal bloklu VT'ler daha başarılı bir şekilde kontrol altına alındı (p = 0.02 ve p = 0.04). Ventriküler taşikardi grupları arasında uzun dönemli sonuçlar açısından istatistiksel fark saptanmadı (p = 0.39). Ölümler sadece idiopatik VT (n=1) ve kardiyomyopati ilişkili VT (n=8) gruplarında gözlendi (p <0.001) ve bu çalışmada pediatrik sürekli VT'nin toplam mortalite oranı %6,9 idi.
Sonuç: Ani kardiyak arreste neden olabilen ventriküler taşikardiler potansiyel olarak hayatı tehdit eden aritmilerdir. Pediatrik VT’ler özellikleri, klinik spektrumu ve yönetimi açısından yetişkin VT'den farklıdır. Ventriküler taşikardilerin heterojenliğinin ve kendine özgü özelliklerinin tanımlanması, uygun tanı ve tedaviyi kolaylaştıracaktır.
Objective: Pediatric ventricular tachycardias (VTs) have heterogeneous etiology and different clinical features. This study aimed to evaluate the clinical spectrum and long-term course of pediatric sustained VTs.
Methods: Patients diagnosed as having sustained VT between 2010 and 2020 were evaluated retrospectively.
Results: A total of 129 patients with VT were evaluated; 74 patients were male, and the median age was 12.5 years (0.25–18 years). Patients were grouped as having idiopathic VT (IVT) [n=85 (65.9%)], cardiomyopathy-associated VT (CMP-VT) [n=24 (18.6%)], catecholaminergic polymorphic VT [n=17 (13.2%)], and myocarditis-associated VT [n=3, (2.3%)]. Palpitations (n=61) and syncope (n=24) were the most common symptoms. VT originated from the right ventricle in 53.6% of the patients. Half of the patients underwent electrophysiological study, 64 patients received radiofrequency ablation therapy, and 29 patients had implantable cardiac defibrillators. During the follow-up, 70.4% of all patients had complete resolution, whereas 19 patients had a partial resolution and 23 patients (19.5%) had stable disease. Monomorphic VTs and VTs with left bundle bunch block were more thriving controlled (p=0.02 vs. p=0.04). In terms of long-term results, no statistical difference was found among the VT groups (p=0.39). Deaths were observed only in IVT (n=1) and CMP-VT (n=8) groups (p<0.001), and the overall mortality rate of pediatric sustained VT was observed at 6.9% in this study.
Conclusion: VTs, which can cause sudden cardiac arrest, are potentially life-threatening arrhythmias. Identifying the heterogeneity of this VT and its peculiar characteristics would facilitate appropriate diagnosis and therapy.

6.Circulating miR-660-5p is associated with no-reflow phenomenon in patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
Jianwei Zhang, Lingjie He
doi: 10.14744/AnatolJCardiol.2020.29267  Pages 323 - 329
Objective: This study aims to investigate the association of circulating miR-660-5p with no-reflow phenomenon (NRP) in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).
Methods: Consecutive patients diagnosed with anterior STEMI within 12 h of pain onset were included; in these patients, coronary angiography confirmed that the left anterior descending artery was infarcted. Angiographic NRP was defined as a final thrombolysis in myocardial infarction (TIMI) flow 2 or 3 with a myocardial blush grade (MBG) <2. High miR-660-5p was defined as a value in the third tertile. The relationship of circulating miR-660-5p with NRP was assessed using Spearman correlation analysis and multiple logistic regression analysis.
Results: Fifty-two eligible patients were finally included in this study (mean age: 56±12.4 years, >65 years: 53.8%, male: 76.9%, and mean Body Mass Index: 26.3±3.5). The incidence of NRP was 38.5%. Circulating miR-660-5p was significantly related to the mean platelet volume (MPV). The patients were grouped into tertiles by miR-660-5p levels (Q1: <7.18, Q2: 7.18–11.31, Q3: >11.31). Those in the high microRNA-660-5p group had nearly a 6-fold higher risk of NRP than those in the low microRNA-660-5p group [odds ratio (OR) = 5.68, 95% confidence interval (CI) 1.40–23.07, p=0.015]. When analyzed by tertiles, relative odds of NRP were consistently increasing (OR1 for Q2 vs. Q1: 1.25, 95% CI: 0.27–5.73, p=0.770; OR2 for Q3 vs. Q1: 5.96, 95% CI: 1.33–26.66, p=0.02), despite multivariable adjustment. Receiver operating characteristic curve analysis demonstrated that the microRNA-660-5p level of 10.17 was the best cut-off level to predict the incidence of the NRP in patients undergoing PPCI with an area under the ROC curve (AUC) of 0.768 (95% CI: 0.636–0.890).
Conclusion: Circulating miR-660-5p was significantly associated with NRP, and it may be a useful biomarker to predict the incidence of NRP in patients with STEMI undergoing PPCI.

7.Elabela as a novel marker: Well-correlated with WIfI amputation risk score in lower extremity arterial disease patients
Mehmet Kaplan, Fethi Yavuz, Gizem Ilgın Kaplan, Nurbanu Bursa, Ertan Vuruşkan, Murat Sucu
doi: 10.14744/AnatolJCardiol.2020.17329  Pages 330 - 337
Amaç: Dünya çapında 200 milyondan fazla insan alt ekstremite arter hastalığı (LEAD) tanısıyla yaşamaktadır. LEAD alt ekstremitenin ampütasyon riskini ve ölüm oranını önemli ölçüde artırır. İskemik istirahat ağrısı veya yaraları olan LEAD tanılı hastaların ilk değerlendirmesinde yeni bir sınıflandırma sistemi (WIfI) önerilmiştir ve bu skor 1 yıllık ampütasyon riskini öngörmektedir. Elabela molekülü ise biyoaktif bir peptittir ve apelinerjik sistemin bir parçasıdır. Elabela hemostaz ve kardiyovasküler sistem üzerinde faydalı etkilere sahiptir. Bu çalışmada LEAD tanılı hastalarda serum elabela düzeylerini araştırmayı amaçladık.
Yöntemler: Bu kesitsel çalışmaya LEAD grubunda 60, kontrol grubunda 59 birey olmak üzere 119 birey alındı. Tüm bireylere fiziksel muayene yapıldı ve serum elabela seviyeleri dahil olmak üzere rutin biyokimyasal testler yapıldı. Ek olarak LEAD grubu Rutherford sınıflandırmasına, ayak bileği-kol basınç indeksi (ABI) değerlerine ve WIfI risk skorlarına göre alt gruplara ayrıldı.
Bulgular: Serum LDL, elabela ve hs-CRP seviyeleri LEAD grubunda istatistiksel olarak daha yüksekti (sırasıyla p = 0.002, p <0.001 ve p <0.001). Rutherford sınıflamasında evre arttıkça elabela seviyeleri ve Hs-CRP seviyeleri benzer şekilde yüksekti (p <0.001). Elabela düzeylerinin hs-CRP ve WIfI risk skoru ile pozitif, ancak ABI ile negatif korele olduğu istatistiksel olarak izlendi (p <0.001).
Sonuçlar: İnflamatuar süreçlerde arttığı bilinen serum Elabela düzeyi LEAD hastalarında alt ekstremite arteriyel obstrüksiyonu ve WIfI amputasyon riskini öngörebilme potansiyeline sahiptir
Objective: Worldwide, over 200 million people are diagnosed with lower extremity arterial disease (LEAD). LEAD significantly increases the risk of death and amputation of the lower limb. A new classification system (WIfI) has been proposed to initially assess all patients with ischemic rest pain or wounds and also predicts 1-year amputation risk. Elabela is a bioactive peptide and a part of the apelinergic system, which has beneficial effects on body fluid homeostasis and cardiovascular health. We aimed to investigate serum Elabela levels in LEAD.
Methods: A total of 119 subjects were enrolled in this cross-sectional study, 60 of whom were in the LEAD group and 59 in the control group. All participants underwent physical examination and routine biochemical tests, including serum Elabela levels. Additionally, the LEAD group was divided into subgroups according to the Rutherford classification, ankle-brachial index (ABI) values, and WIfI risk scores.
Results: Serum low-density lipoprotein, Elabela, and high-sensitivity C-reactive protein (Hs-CRP) levels were statistically higher in the LEAD group (p=0.002, p<0.001, and p<0.001, respectively). In the Rutherford classification, as the stage increased, Elabela and Hs-CRP levels increased similarly (p<0.001). Elabela levels were statistically found to be positively correlated with Hs-CRP and WIfI amputation score but negatively correlated with ABI (p<0.001).
Conclusion: Serum Elabela level, which is known to be increased in inflammatory processes, has the potential in predicting low extremity arterial obstruction and WIfI amputation risk in LEAD patients.

8.Risk factors for recurrence of atrial fibrillation
Antoniya Kisheva, Yoto Yotov
doi: 10.14744/AnatolJCardiol.2020.80914  Pages 338 - 345
Objective: Atrial fibrillation (AF) is a progressive disease, associated with increased risk of mortality, stroke, heart failure, and worsens quality of life. There is a high incidence of AF recurrence despite the treatment. The aim of the study was to assess the time to recurrence of AF after sinus rhythm restoration with electrical or pharmacological cardioversion and to identify the risk factors.
Methods: This study included 101 patients with AF (56% females) at a mean age of 68.02±7 years, after sinus rhythm restoration in a clinical observation of 1-year placebo-controlled treatment with spironolactone (1: 1). The patients were analyzed on the basis of AF recurrence, hospitalization, demographic parameters, comorbidities, embolic risk, and value of biomarker galectin-3 (Gal-3).
Results: The average number of AF recurrences was1.62 per patient per year. The median time of occurrence of at least one new episode was 48 days, 95% confidence interval (CI) 14.24–81.76. Female patients experienced significantly more recurrences than male—53.3% vs. 28.6% hazard ration (HR) =1.76, 95% CI 1.02–3.03, p=0.036. The recurrences were more common with increased age, although not significantly. Patients with arterial hypertension had a threefold risk of recurrences than those without hypertension (p=0.025), independently of the treatment. CHA2DS2-VASc score was significantly associated with AF recurrent episodes. Patients with gout had a twofold increased risk, without statistical significance (p=0.15). There was no difference in the AF episodes according to treatment with spironolactone. The levels of Gal-3 did not affect the number of AF recurrences (p=0.9).
Conclusion: AF is associated with frequent recurrences after restoration of sinus rhythm in the majority of the patients. Most of them occurred within the first 3 months. Female sex, arterial hypertension, and CHA2DS2-VASc score were significant predictors of AF recurrence. Spironolactone did not reduce AF recurrences.

9.Effect of supraphysiological estrogen levels on arterial stiffness and hemodynamic parameters
Murat Akçay, Ayşe Zehra Özdemir
doi: 10.14744/AnatolJCardiol.2020.38890  Pages 346 - 351
Giriş: Bu çalışmada, kontrollü over hiperstimülasyonu ile in vitro fertilizasyona (IVF) bağlı suprafizyolojik östrojen seviyesine sahip hastalarda arteriyel sertlik ve hemodinamik parametreleri değerlendirmektedir.
Yöntem: 24-45 yaş arası toplam 82 kadın hasta çalışmaya dahil edildi. Hastaların arteriyel sertlik parametreleri, Mobil-O-Graph NG (IEM GmbH, Stolberg, Almanya) ile 24 saatlik ayaktan kan basıncı monitör arteriyografisi ile kontrollü over hiperstimülasyonu protokolünden önce ve sonra analiz edildi.
Bulgular: Sistolik, diyastolik, ortalama, santral sistolik ve diyastolik kan basınçları ile periferik vasküler direnç değerleri, kontrollü over hiperstimülasyonu tedavisinden sonra anlamlı olarak daha düşük saptandı (P = 0.001, 0.002, <0.001, <0.001, 0.040 ve <0.001, sırasıyla). Buna karşılık, kalp atım hızı, nabız basıncı ve kalp debisinde istatistiksel olarak anlamlı bir fark izlenmedi. Nabız dalga hızı ölçümü, başlangıç değerleri (5.3 m/s, (4.5-6.9 m/s) karşılık 5.4 m/s, (4.7-7.3 m/s,); P <0.001) ile karşılaştırıldığında, kontrollü over hiperstimülasyonu sonrası anlamlı olarak daha düşüktü. Güçlendirme indeksi açısından ise, anlamlı bir fark yoktu (% 28, (% 4-41) - % 29, (% 5-43); P = 0.090). Hastalar, tüp bebek tedavisi sonrası gebelik oluşumuna göre 2 gruba ayrıldığında gebelik (+) ve gebelik (-) hastaları arasında tüm parametreler farklı değildi (P> 0.05).
Sonuç: Kontrollü over hiperstimülasyonu uygulanan IVF hastalarında arteriyel sertlik ve hemodinamik parametreler anlamlı derecede azaldı. Bu kısa süreli etkinin uzun dönem klinik IVF tedavisi sonrasında gebelik (+) ve gebelik (-) hastaları karşılaştırıldığında ise, tüm parametrelerde kontrollü over hiperstimülasyonu öncesi ve sonrasında anlamlı bir fark yoktu.önemi, prospektif çalışmalarla araştırılmalıdır.
Objective: The present study evaluates the arterial stiffness and hemodynamic parameters in patients with a supraphysiological estrogen level due to in vitro fertilization (IVF) with controlled ovarian hyperstimulation (COH).
Methods: A total of 82 female patients aged 24–45 years were included. Their arterial stiffness parameters were analyzed before and after the appropriate COH protocol involving arteriography using Mobil-O-Graph NG (IEM GmbH, Stolberg, Germany) 24-hour ambulatory blood pressure monitor.
Results: Systolic, diastolic, mean, central systolic, and diastolic blood pressures, as well as peripheral vascular resistance, were significantly lower after COH therapy (p=0.001, 0.002, <0.001, <0.001, 0.040, and <0.001, respectively). In contrast, there was no statistically significant difference observed in heart rate, pulse pressure, or cardiac output. The pulse wave velocity measurement was significantly lower after COH than the baseline levels [5.3 m/s (4.5–6.9 m/s) versus 5.4 m/s (4.7–7.3 m/s,); p<0.001], but the augmentation index was not significantly different [28% (4%–41%) versus 29% (5%–43%); p=0.090]. When the patients were grouped according to the occurrence of a pregnancy after IVF therapy, all parameters were not different between the pregnancy (+) and pregnancy (-) patients (p>0.05).
Conclusion: Arterial stiffness and hemodynamic parameters significantly decreased in IVF patients who underwent COH therapy. The long-term clinical significance of this short-term effect should be investigated with prospective studies. There was no significant difference in all parameters before and after COH when the pregnancy (+) and pregnancy (-) patients were compared.

CASE REPORT
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11.Multivalve dysfunction and cardiogenic shock linked to scurvy: A case report
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12.Percutaneous Treatment of Right Ventricular Rupture with ADO II device via the Subxiphoid Pericardial Window; After Percutaneous Treatment of Cardiac Tamponade
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13.Tip-to-base LAMPOON to prevent left ventricular outflow tract obstruction in a valve-in-ring transcatheter mitral valve replacement: First LAMPOON procedure in Turkey and first LAMPOON case for transseptal Myval™ implantation
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Abstract | Full Text PDF | Video

LETTER TO THE EDITOR
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doi: 10.5152/AnatolJCardiol.2021.60026  Pages 368 - 369
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16.Medicine in philately: History of medical masks
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E-PAGE ORIGINAL IMAGES
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19.A bicuspid aortic valv sign in ascending aorta: An acute circumferential type 1 aortic dissection with intimo-intimal intussusception
İbrahim Altun, Özcan Başaran, Oğuzhan Çelik, İlknur Altun, Buğra Harmandar
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Abstract | Full Text PDF | Video