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Volume : 26 Issue : 1 Year : 2022
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The Anatolian Journal of Cardiology - Anatol J Cardiol: 26 (1)
Volume: 26  Issue: 1 - January 2022
EDITORIAL
1.New year, new cover/design, and new articles

doi: 10.5152/AnatolJCardiol.2022.1  Page 1
Abstract | Full Text PDF

META ANALYSIS
2.Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation
Dibbendhu Khanra, Abdul Hamid, Saurabh Deshpande, Anindya Mukherjee, Sanjiv Petkar, Mohammad Saeed, Indranill Basu-ray
doi: 10.5152/AnatolJCardiol.2021.243  Pages 2 - 14
Objective: High power short duration (HPSD) ablation strategy is proposed to be more effective than low power long duration (LPLD) for radiofrequency ablation of atrial fibrillation. Although small trials abound, data from a large cohort are lacking. This meta-analysis compares all the existing studies comparing these two approaches to evaluate perceived advantages of one over the other.
Methods: A systematic search of PubMed, EMBASE, and Cochrane databases identified studies comparing HPSD to LPLD ablation. All the analyses used the random-effects model.
Results: Ablation settings varied widely across 20 studies comprising 2,136 patients who underwent HPSD and 1,753 patients who underwent LPLD. The pooled incidence of atrial arrhythmia recurrence after HPSD ablation was 20% [95% confidence interval (CI): 0.16 0.25; I2=88%]. Atrial arrhythmia recurrences were significantly less frequent with HPSD ablation (incidence risk ratio=0.66; 95% CI: 0.49–0.88; I2=72%; p=0.004). Procedural, fluoroscopy, and ablation times were significantly shorter with HPSD ablation. First-pass pulmonary vein isolations (PVIs) were significantly more [odds ratio (OR)=2.94; 95% CI: 1.50–5.77; I2=89%; p=0.002), and acute pulmonary vein reconnections (PVRs) were significantly lesser (OR=0.41; 95% CI: 0.28–0.62; I2=62%; p<0.001) in the HPSD group. Although radiofrequency energy was significantly higher, esophageal thermal injuries (ETI) were lower with HPSD ablation. Acute complications, including steam-pops, were rare and statistically similar in both the groups.
Conclusion: HPSD ablation enables faster first-pass PVI with fewer PVRs, similar ETI rates, rare collateral damage, and lower recurrence of atrial arrhythmia in the long term than LPLD. Randomized controlled studies with a larger cohort are indicated both to confirm the benefit of HPSD ablation and standardize the ablation protocol.

REVIEW
3.NLRP3 inflammasome as a novel therapeutic target for heart failure
Shuangcui Wang, Jiaqi Zhang, Yuli Wang, Xijuan Jiang, Maojuan Guo, Zhen Yang
doi: 10.5152/AnatolJCardiol.2021.580  Pages 15 - 22
Heart failure (HF) is a leading cause of mortality worldwide. The pathogenesis of HF is complex and has not yet been fully elucidated, which has slowed drug development and long-term treatments. Inflammasome-mediated responses occur during the progression of HF. It has been reported that energy metabolism and metabolites of intestinal flora are also involved in the process of HF, and they interact with each other to promote the progression of HF. NLR family pyrin domain containing 3 (NLRP3) inflammasome may be a key target in the relationship between inflammation-mediated energy metabolism and metabolites of intestinal flora. Elucidating the relationship among the above three factors may help to identify new molecular targets for the prevention and treatment of HF and ultimately affect the course of HF. In this study, we systematically summarize evidence regarding the relationship among NLRP3 inflammasome, energy metabolism, intestinal microflora metabolites, and inflammation, as well as highlight advantages of NLRP3 inflammasome in treating HF.

ORIGINAL INVESTIGATION
4.Prognostic performance of Controlling Nutritional Status score in patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention
Ahmet Zengin, Mehmet Baran Karataş, Yiğit Çanga, Gündüz Durmuş, Özge Güzelburç, Furkan Durak, Ayşe Emre
doi: 10.5152/AnatolJCardiol.2021.190  Pages 23 - 28
Objective: The effect of malnutrition in patients with ST segment elevation myocardial infarction (STEMI) is not fully understood. In this study, we tried to investigate the prognostic consequence of the Controlling Nutritional Status (CONUT) score in patients with STEMI.
Methods: In this study, we evaluated the CONUT scores of 1,028 patients with STEMI and examined its relationship with major adverse cardiovascular events (MACE) (all-cause mortality, myocardial reinfarction, and vessel revascularization) during a period of 19.9±10.3 months. Patients with CONUT score ≥5 were defined as severely malnourished. Predictors of MACE were assessed by Cox regression analysis, and p<0.05 was considered to indicate statistical significance.
Results: MACE was observed in a total of 147 (14.3%) patients. MACE was more frequent in the group with a higher CONUT score (33.3% vs. 10.9%, p<0.001). CONUT score ≥5 was an independent predictor of MACE in the Cox regression analysis (hazard ratio=2.50, 95% confidence interval: 1.61–3.90, p<0.001). Low ejection fraction, Killip class ≥3 at presentation, thrombolysis in myocardial infarction flow grade <3 after intervention, left main artery involvement, and low hemoglobin levels were other independent predictors of MACE in the long-term follow-up. Kaplan–Meier curves showed decreased MACE free survival rates in the high CONUT score group at a mean 19.9±10.3 months’ follow-up duration (log-rank p<0.01).
Conclusion: Malnutrition was strongly associated with poor outcomes in patients with STEMI treated using primary percutaneous coronary intervention.

5.Effect of Different Alcohol Consumption Levels on the Left Atrial Size: a Cross-sectional Study in Rural China
Linlin Miao, Xiaofan Guo, Guozhe Sun, Yinglong Bai, Yingxian Sun, Zhao Li
doi: 10.5152/AnatolJCardiol.2021.24850  Pages 29 - 36
Objective: Previous studies have investigated the relationships between alcohol and ventricular structure, but few studies have evaluated the relation between alcohol consumption and the atrium size. This study aims to test the association between alcohol consumption and left atrium (LA) size in a general population.
Methods: A population-based sample of 10 211 subjects aged ≥ 35 years and free from hypertension at baseline were followed from January 2012 to August 2013. Left atrial enlargement (LAE) was defined as the ratio of LA diameter to body surface area exceeding 2.4 cm/m2 in both genders. Independent factors for LAE were estimated by multiple logistic regression analyses.
Results:The study included 10 211 participants (4 751 men and 5 460 women). Left atrium diameter / body surface area (LAD/BSA) was higher in the moderate and heavy alcohol consumption groups compared with the non-drinker group (non-drinker, 20.5±0.03 cm/m2; moderate, 20.8±0.09 cm/m2; and heavy, 20.6±0.06 cm/m2; P<0.001). Both groups of moderate and heavy drinker had a higher incidence of LAE than the non-drinker group (6.9% of non-drinkers, 9.9% of moderate drinkers and 8.4% of heavy drinkers, P<0.001).After adjusting for related risk factors, multiple logistic regression analyses showed the moderate drinkers had an approximately 1.4-fold higher risk of LAE(OR: 1.387,95%CI,1.056-1.822, P = 0.019) compared with the non-drinkers, and the heavy drinkers had an approximately 1.2-fold higher risk of LAE(OR: 1.229,95%CI, 1.002-1.508, P = 0.047) compared with the non-drinkers.
Conclusion: Both heavy and moderate drinkers had an increased Odds for LAE compared with participants with no alcohol consumption in the general population.

6.Comparison of pain severity, satisfaction, and complications of proximal and distal forearm anesthesia in patients undergoing trans-palmar coronary angiography
Farshad Roghani- Dehkordi, Fereshteh Farazandeh, Mohammad Kermani- Alghoraishi, Alireza Khosravi
doi: 10.5152/AnatolJCardiol.2021.282  Pages 37 - 42
Objective: Trans-palmar access is a novel, safe, and feasible technique for coronary artery angiography wherein its appropriate anesthetic methods is still concerned. In this study, we aimed to evaluate the pain severity, satisfaction, and possible complications with local ulnar nerve anesthesia through both distal and proximal forearm in patients undergoing trans-palmar coronary angiography.
Methods: This was a randomized clinical trial performed on 60 patients who were candidates for trans-palmar coronary angiography. The patients were randomized into 2 equal groups as proximal and distal approaches (those who received the same dose of subcutaneous lidocaine (2%) in the proximal and distal of forearm, respectively). Pain intensity at different times, duration of anesthesia, patient satisfaction, and occurrence of complications were evaluated.
Results: The mean age of the patients was 59.45±7.09 years, and, of them, 34 (61.8%) were men. Pain severity with the proximal anesthesia approach was significantly higher than that in the distal group at the time of puncture (5.39±0.73 vs. 2.30±0.60, p=0.001). Over time and immediately after the procedure and at discharge, the mean pain severity in the proximal group was significantly less than in the distal group (p<0.050). The proximal group also had a longer duration of anesthesia (67.14±11.58) than the distal group (53.52±8.06) (p=0.001). No differences were observed in terms of patient satisfaction and complications (p>0.050).
Conclusion: Using the proximal ulnar nerve anesthesia approach was associated with a delayed onset and longer anesthesia than the distal method.

7.Change in pulmonary arterial compliance and pulmonary pulsatile stress after balloon pulmonary angioplasty
Dursun Akaslan, Halil Ataş, Emre Aslanger, Batur Gönenç Kanar, Derya Kocakaya, Bedrettin Yıldızeli, Bülent Mutlu
doi: 10.5152/AnatolJCardiol.2021.149  Pages 43 - 48
Objective: Although the underlying pathology of chronic thromboembolic pulmonary hypertension (CTEPH) is mechanical obliteration of the major pulmonary vessels, high pulsatile stress penetrating into the normal distal pulmonary microvasculature resulting from reduced pulmonary arterial compliance (CPA) may cause progressive deterioration in pulmonary hemodynamics. Hypothetically, balloon pulmonary angioplasty (BPA) may be beneficial in reducing CPA and pulsatile stress in patients with CTEPH.
Methods: In total, 26 patients with available pre- and post-BPA right heart catheterization results were included in the study. BPA was performed in a series of staged procedures by 2 experienced interventional cardiologists.
Results: The median CPA showed a 59.2% increase (1.03 to 1.64 mL/mm Hg, p=0.005). The median pre-BPA pulsatile stress product decreased by 20.7% (4,266 to 3,380 mm Hg/min, p=0.003). A linear regression model established that the percent change in CPA after BPA accounted for 21.8% of the explained variability in the change in 6-minute walk test (p=0.009).
Conclusion: Our results indicate that BPA decreases CPA and pulmonary pulsatile stress. These changes may be partly responsible for the improvement in functional capacity after BPA.

8.Vascular complications after transcatheter transfemoral aortic valve implantation: Modified sheath-to-femoral artery ratio as a new predictor
Sinem Çakal, Beytullah Çakal, Oğuz Karaca, Yeliz Güler, Özgür Ulaş Özcan, Hacı Murat Güneş, Filiz Kızılırmak Yılmaz, Arzu Yıldırım, Bilal Boztosun
doi: 10.5152/AnatolJCardiol.2021.147  Pages 49 - 56
Objective: Vascular complications (VCs) contribute to increased morbidity and mortality in patients who have undergone transcatheter aortic valve implantation (TAVI); however, studies on their incidence and predictors show conflicting results. In this study, we sought to assess the incidence, impact, and predictors of VCs in transfemoral (TF) TAVI and also investigated the predictive role of manufacturer’s size charts and a new predictor modified sheath-to-femoral artery ratio.
Methods: A total of 223 patients undergoing TF-TAVI were categorized into 2 groups. The patients were divided as eligible and ineligible according to the manufacturer’s guidelines (MG), and the same patient cohort was dichotomized into eligible and ineligible on the basis of sheath-to-femoral artery ratio (SFAR) value of less than or greater than or equal to modified SFAR (md-SFAR). VCs (defined according to the Valve Academic Research Consortium II criteria) were retrospectively compared.
Results: According to the manufacturer’s size charts, 65 patients were unsuitable; however, 35 patients were ineligible for TF-TAVI per the md-SFAR criteria. Although VCs occurred in 42 (18.8%) patients, 17 (27.7%) of those patients were classified as ineligible according to MG, whereas 14 (41.2%) were classified as ineligible in the md-SFAR group. In a multiple logistic regression analysis that included md-SFAR, MG, SFAR ≥1.05, peripheral artery disease, and minimum iliofemoral artery diameter, only md-SFAR was the independent predictor of VCs (odds ratio=3.71, 95% confidence interval=1.13–12.53, p=0.031).
Conclusion: According to our results, md-SFAR might provide better patient selection to prevent VCs and improve outcomes in TF-TAVI procedures.

9.Evaluation of early-onset cardiotoxic effects of anthracyclines used during the treatment of childhood acute lymphoblastic leukemia by speckle-tracking echocardiography
Özlem Arman Bilir, İbrahim İlker Çetin, Dilek Kaçar, Can Barış Aker, Namık Yaşar Özbek, Neşe Yaralı
doi: 10.5152/AnatolJCardiol.2021.926  Pages 57 - 62
Objective: Anthracyclines are widely used in the treatment of acute lymphoblastic leukemia (ALL). However, cardiotoxicity is the most critical side effect that requires dose limitation. It is thought to occur at first exposure, but the clinical presentation may occur years later. In this study, we aimed to determine the time of initial damage and cardiotoxicity that develops in children with ALL.
Methods: In this prospective study, 13 patients with newly diagnosed intermediate-risk precursor B cell ALL treated with the ALL-IC BFM 2009 protocol were included. Conventional echocardiography, tissue Doppler imaging (TDI), and speckle-tracking echocardiography (STE) were performed in all the patients before chemotherapy, after completing the induction phase, and at the end of the reinduction phase.
Results: The mean age of the patients was 7.8±4.6 (3.1–16.3) years. Myocardial velocity during systole (Sm) determined by TDI at the interventricular septum significantly decreased during the induction phase. Despite a decrease in STE parameters, a statistically significant reduction was determined in the global longitudinal strain rate at both left and right ventricles at the end of the induction. Nevertheless, a statistically significant increase was observed among the conventional echocardiographic findings in the left ventricular end-diastolic diameter at the end of the reinduction.
Conclusion: During the treatment of ALL, subclinical anthracycline-associated cardiotoxicity develops in the early stages of treatment. The findings detected by TDI and STE could be missed by conventional echocardiography. We recommend evaluating patients with these newly developed techniques to detect subclinical cardiotoxicity at an early stage and starting appropriate therapy on time.

CASE REPORT
10.Successful aspiration thrombectomy of large right atrial thrombus attached to atrial septal defect repair patch
Özgür Y. Akbal, Hacer C. Tokgöz, Zübeyde Bayram, Nihal Özdemir, Cihangir Kaymaz
doi: 10.5152/AnatolJCardiol.2021.00557  Pages 63 - 65
Abstract | Full Text PDF | Video

11.Successful management of distal coronary artery perforation with the modified cut balloon technique during percutaneous coronary intervention
Lütfi Öcal, Cemalettin Yılmaz, Samet Uysal, Sinan Cerşit, Regaip Zehir
doi: 10.5152/AnatolJCardiol.2021.202  Pages 66 - 68
Abstract | Full Text PDF | Video

12.Pseudocoarctation of the aorta: A rare congenital aortic disease
Serkan Asil, Muhammet Geneş, Murat Çelik, Uygar Çağdaş Yüksel, Cem Barçın
doi: 10.5152/AnatolJCardiol.2021.934  Pages 69 - 71
Abstract | Full Text PDF | Video

13.Kounis syndrome associated with BNT162b2 mRNA COVID-19 vaccine presenting as ST-elevation acute myocardial infarction
Emre Şancı, Cihan Örçen, Osman Muhsin Çelik, Muhammed Tahsin Özen, Serdar Bozyel
doi: 10.5152/AnatolJCardiol.2021.1212  Pages 72 - 74
Abstract | Full Text PDF

LETTER TO THE EDITOR
14.Predicting long-term mortality after acute pulmonary embolism: One issue, multiple faces
Moraru Aurelian- Corneliu, Floria Mariana, Tanase Daniela Maria, Ouatu Anca, Popescu Dragoş- Marian
doi: 10.5152/AnatolJCardiol.2021.862  Pages 75 - 76
Abstract | Full Text PDF

LETTER TO THE EDITOR REPLY
15.Reply to letter to the editor: ‘’Predicting long-term mortality after acute pulmonary embolism: One issue, multiple faces’’
Abdulsamet Sandal, Elif Tuğçe Korkmaz, Funda Aksu, Deniz Köksal, Ziya Toros Selçuk, Ahmet Uğur Demir, Salih Emri, Lütfi Çöplü
Pages 77 - 78
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
16.Use of the snare technique for crossing a severely calcified bicuspid valve and horizontal aorta
Yusuke Oba, Hiroshi Funayama, Hisaya Kobayashi, Kenji Harada, Kouji Kawahito, Kazuomi Kario
doi: 10.5152/AnatolJCardiol.2021.1042  Pages E1 - E2
Abstract | Full Text PDF | Video