ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 26 (9)
Volume: 26  Issue: 9 - September 2022
EDITORIAL
1.Atrial Fibrillation

doi: 10.5152/AnatolJCardiol.2022.9  Page 672
Abstract |Full Text PDF

REVIEW
2.Understanding the Burden of Atrial Fibrillation and Importance of Screening: A Global Perspective and Recommendations for Turkey
Dursun Aras, Erdem Birgül, Bülent Görenek, Erdem Gürkaş, Atilla Özcan Özdemir, Mehmet Akif Topçuoğlu, Erdinç Yavuz, Mehdi Zoghi
doi: 10.5152/AnatolJCardiol.2022.1689  Pages 673 - 684
Considering the aging population, the increase in predisposing factors, and the improvement in healthcare with increased survival rates, atrial fibrillation has been the most common cardiac arrhythmia in adults with a rise in the estimated lifetime risk over recent years. While aging is a powerful risk factor for atrial fibrillation, the leading prevalent comorbidities are hypertension, heart failure, obesity, obstructive sleep apnea, diabetes mellitus, and chronic kidney disease. Atrial fibrillation is associated with substantial morbidity, impaired quality of life, and increased mortality and healthcare costs. As a significant proportion of the total atrial fibrillation population is asymptomatic or mildly symptomatic, early identification and initiation of appropriate treatment for atrial fibrillation may prevent potentially detrimental outcomes such as stroke and heart failure and decrease all-cause mortality. Although screening via evolving health technologies has recently been emerging, verification of the electrocardiogram track recording over at least 30 seconds by a physician with expertise is still required for a definite diagnosis. Based on the global and national data and the current healthcare environment in Turkey, this targeted review with cardiology, neurology, and family physicians’ perspectives highlights the importance of early detection by implementing the advancing screening modalities as well as the need for raised awareness of both patients and healthcare professionals and establishment of a multidisciplinary clinical approach for a better outcome in atrial fibrillation management.

META ANALYSIS
3.Catheter Ablation Versus Medical Therapy for Atrial Fibrillation in Patients with Heart failure: A Meta-Analysis of Randomized Controlled Trials
Zhangjie Yu, Yangbo Xing, Jiahao Peng, Buyun Xu, Ying Qi, Zhaohai Zheng, Yinyin Qiu, Feiyan Qiu, Fang Peng
doi: 10.5152/AnatolJCardiol.2022.1826  Pages 685 - 695
Background: The optimal treatments for atrial fibrillation in heart failure patients are controversial. The present study compared the efficacy of catheter ablation and medical therapy in patients with atrial fibrillation and heart failure.

Methods: Pubmed, Embase, Cochrane Library, and Web of Science were searched until January 15, 2022. Randomized controlled trials comparing catheter ablation for atrial fibrillation with medical therapy in patients with atrial fibrillation and heart failure were enrolled. Primary outcome was all-cause mortality. Secondary outcomes included the heart failure hospitalization and the change in left ventricular ejection fraction, 6-minute walk test distance, peak oxygen consumption, and Minnesota Living with Heart Failure questionnaire score.

Results: Totally 8 randomized controlled trials involving 1693 patients were included. Compared with medical therapy, catheter ablation significantly reduced all-cause mortality (risk ratios = 0.60, 95% Cl: 0.45 to 0.80, P <.001) and hospitalization due to heart failure (risk ratios = 0.58, 95% Cl: 0.46 to 0.73, P <.001), improved left ventricular ejection fraction (mean difference = 5.25%, 95% CI: 2.78% to 7.71%, P <.001), improved the performance of 6-minute walk test (mean difference = 28.83 m, 95% CI: 8.61 to 49.05 m, P =.005), increased peak oxygen consumption (mean difference = 3.11 mL/kg/min, 95% CI: 1.04 to 5.18 mL/kg/min, P =.003), and reduced Minnesota Living with Heart Failure score (mean difference = −8.45, 95% CI: −16.28 to −0.62, P =.03).

Conclusion: In heart failure patients with atrial fibrillation, catheter ablation provides more benefits over medical therapy in the important clinical outcomes, exercise capacity, and quality of life.

4.Catheter Ablation Versus Medical Therapy for Atrial Fibrillation in Patients with Heart failure: A Meta-Analysis of Randomized Controlled Trials
Zhangjie Yu, Yangbo Xing, Jiahao Peng, Buyun Xu, Ying Qi, Zhaohai Zheng, Yinyin Qiu, Feiyan Qiu, Fang Peng
doi: 10.5152/AnatolJCardiol.2022.1826  Pages 685 - 695
Background: The optimal treatments for atrial fibrillation in heart failure patients are controversial. The present study compared the efficacy of catheter ablation and medical therapy in patients with atrial fibrillation and heart failure.

Methods: Pubmed, Embase, Cochrane Library, and Web of Science were searched until January 15, 2022. Randomized controlled trials comparing catheter ablation for atrial fibrillation with medical therapy in patients with atrial fibrillation and heart failure were enrolled. Primary outcome was all-cause mortality. Secondary outcomes included the heart failure hospitalization and the change in left ventricular ejection fraction, 6-minute walk test distance, peak oxygen consumption, and Minnesota Living with Heart Failure questionnaire score.

Results: Totally 8 randomized controlled trials involving 1693 patients were included. Compared with medical therapy, catheter ablation significantly reduced all-cause mortality (risk ratios = 0.60, 95% Cl: 0.45 to 0.80, P <.001) and hospitalization due to heart failure (risk ratios = 0.58, 95% Cl: 0.46 to 0.73, P <.001), improved left ventricular ejection fraction (mean difference = 5.25%, 95% CI: 2.78% to 7.71%, P <.001), improved the performance of 6-minute walk test (mean difference = 28.83 m, 95% CI: 8.61 to 49.05 m, P =.005), increased peak oxygen consumption (mean difference = 3.11 mL/kg/min, 95% CI: 1.04 to 5.18 mL/kg/min, P =.003), and reduced Minnesota Living with Heart Failure score (mean difference = −8.45, 95% CI: −16.28 to −0.62, P =.03).

Conclusion: In heart failure patients with atrial fibrillation, catheter ablation provides more benefits over medical therapy in the important clinical outcomes, exercise capacity, and quality of life.

ORIGINAL INVESTIGATION
5.Pleuropericardial Window Prevents Pericardial Effusion Following Surgical Atrial Septal Defect Closure
Murat Özkan, Deniz Sarp Beyazpınar, Mehmet Çelik, Çağrı Günaydın
doi: 10.5152/AnatolJCardiol.2022.1686  Pages 696 - 701
Background: Pericardial effusion occurs frequently after surgical atrial septal defect closure. This complication carries the risk of development of cardiac tamponade and death. It is also the responsibility of the hospital for readmissions. Any measure in preventing the development of pericardial effusion is of paramount importance. In this report, our objective was to demonstrate the protective effect of creating a pleuropericardial window against the development of postsurgical pericardial effusion.

Methods: Hospital records of all patients who underwent surgical atrial septal defect closure between January 2015 and December 2020 were reviewed. Patients were divided into 2 groups according to the creation of right/left pleuropericardial window during surgical ASD closure. There were 45 patients in group I in which a right pleuropericardial window was done, and 85 patients constituted group II in which pericardium was left intact.

Results: None of the 45 patients in group I developed pericardial effusion, while 15 of 85 patients in group II developed pericardial effusion (P =.001). Ten patients developed more than mild pericardial effusion which required medical treatment, while 5 patients had to be re-hospitalized because of massive pericardial effusion and effusions were managed by percutaneous drainage.

Conclusions: The creation of a right pleuropericardial window resulted in a safe postoperative recovery after surgical atrial septal defect closure in all patients with the development of no pericardial effusion. No adverse effect of the creation of a pleural communication was noted.

6.Prenatal Diagnosis, Associations and Outcome for Fetuses with Congenital Absence of the Pulmonary Valve Syndrome
Kadir Babaoğlu, Yasemin Doğan, Sevcan Erdem, Nazan Özbarlas, Eviç Başar, Orhan Uzun
doi: 10.5152/AnatolJCardiol.2022.1461  Pages 702 - 709
Background: The aim of this study is to review the spectrum of the prenatally detected absent pulmonary valve syndrome and its outcome after diagnosis.

Methods: Clinical data and echocardiographic findings of 37 cases with a fetal diagnosis of absent pulmonary valve syndrome between 2008 and 2020 were analyzed in this retrospective multicenter study.

Results: Median gestational age at diagnosis was 25 weeks. Three subtypes of absent pulmonary valve syndrome were observed: (1) with tetralogy of Fallot (n = 30; 81.0%); (2) absent pulmonary valve syndrome with intact ventricular septum (n = 5; 13.5%); (3) with complete atrioventricular septal defect (n = 2; 5.4%). In contrast to 7/25 fetuses (28%) with tetralogy of Fallot-absent pulmonary valve syndrome who had a patent ductus arteriosus, all 5 fetuses with absent pulmonary valve syndrome-intact ventricular septum had a patent ductus arteriosus (P <.001). No significant difference was found between the z-scores of pulmonary artery branches in fetuses with or without patent ductus arteriosus (P >.05). The analysis did not reveal any correlation between gestational week and z-scores of pulmonary artery, pulmonary artery branches (right pulmonary artery, left pulmonary artery), and ratio of aorta/pulmonary artery ratio. The echocardiographic measurements of survivors did not differ significantly from non-survivors (P >.05). Extracardiac anomalies were observed in 8/37 fetuses (21.6%). The incidence of extracardiac anomaly was significantly higher in cases of tetralogy of Fallot-absent pulmonary valve syndrome (P <.05). Overall, 9 fetuses (24%) had genetic anomalies. All 6 fetuses (20%) with 22q11.2 microdeletion were within the tetralogy of Fallot-absent pulmonary valve syndrome group. Overall survival after initial diagnosis in the total cases was 36.6% (11/30), with 9 of 30 (30%) tetralogy of Fallot-absent pulmonary valve syndrome cases and 2 of 5 (40%) absent pulmonary valve syndrome-intact ventricular septum cases.

Conclusions: In this largest series of absent pulmonary valve syndrome, extracardiac,and chromosomal anomalies were found to be a common occurrence. The risk of 22q11.2 microdeletion was higher in tetralogy of Fallot cases at 40%. The sizes of the pulmonary artery and its branches and the aorta had no correlation of high mortality antenatally or after birth, which were 63.4% and 47.7%, respectively.

7.Over-expression of IL1R2 in PBMCs of Patients with Coronary Artery Disease and Its Clinical Significance
Qiang Chen, Zhenlong Li, Manman Wang, Guangping Li
doi: 10.5152/AnatolJCardiol.2022.1241  Pages 710 - 716
Background: IL-1 has been widely explored and played a role in regulating inflammatory and immune responses to various disorders. Nevertheless, the role of interleukin-1 receptor type II, a protein-coding gene of interleukin-1 in coronary artery disease patients with peripheral blood mononuclear cells, persists to be undetermined.

Methods: Our study discovered the IL-1 receptor type II expression through gene expression omnibus (GEO) public repository based on bioinformatics tools and further validation was carried out between coronary artery disease patients and healthy participants using peripheral blood mononuclear cells samples in Second Hospital of Tianjin Medical University. A total of 180 participants, comprising 90 cases of coronary artery disease and 90 samples of healthy control were retrospectively evaluated and the correlation of IL-1 receptor type II was observed between serum levels of oxidized low-density lipoprotein and SYNTAX score. Furthermore, the clinical significance of IL-1 receptor type II was evaluated in peripheral blood mononuclear cells of coronary artery disease patients by the receiver operating curve using the area under the curve.

Results: IL-1 receptor type II was markedly overexpressed in peripheral blood mononuclear cells and severe patients with coronary artery disease compared to the healthy control participants. Meanwhile, a positive correlation of IL-1 receptor type II expression was significantly observed between SYNTAX score and oxidized low-density lipoprotein of coronary artery disease patients. Further, the receiver operating curve achieved a significantly higher area under the curve of 0.813 in coronary artery disease patients with peripheral blood mononuclear cells. Thus, IL-1 receptor type II expressions were not only directly correlated with peripheral blood mononuclear cells but also showed potential significance in coronary artery disease patients.

Conclusion: IL-1 receptor type II might be involved in the immune/inflammatory responses of coronary artery disease accompanied by other cytokine receptor genes.

8.Eosinophil-to-Monocyte Ratio as a Candidate for a Novel Prognostic Marker in Acute Pulmonary Embolism: Is it a Consumptive Mechanism?
Şeyhmus Külahçıoğlu, Hacer Ceren Tokgöz, Özgür Yaşar Akbal, Berhan Keskin, Barkın Kültürsay, Seda Tanyeri, Doğancan Çeneli, Kadir Bıyıklı, Ali Karagöz, Süleyman Çağan Efe, İbrahim Halil Tanboğa, Nihal Özdemir, Cihangir Kaymaz
doi: 10.5152/AnatolJCardiol.2022.1780  Pages 717 - 724
Background: The role of eosinophils in thrombotic processes is well known, and the prognostic value of eosinophil to monocyte ratio had been determined in patients with ST elevated myocardial infarction and acute ischemic stroke in recent studies. We aimed to evaluate the impact of the eosinophil-to-monocyte ratio on short- and long-term allcause mortality in patients with pulmonary embolism, which is another clinical condition closely related to the thrombotic pathway.

Methods: In this study, a total of 212 retrospectively evaluated patients with intermediate-high risk and high-risk pulmonary embolism who underwent catheter-directed therapies with ultrasound-assisted thrombolysis or rheolytic thrombectomy (Angiojet©) and intravenous thrombolytic treatment were included.

Results: The median Pulmonary Embolism Severity Index score was 105 (86-128; interquartile range: 25-75, min-max: 35-250). The intermediate-high status and high-risk status were noted in 83.5% and 16.5% of the patients, respectively. All of the reperfusion strategies resulted in significant improvements in the measures of pulmonary arterial pressure and right ventricular strain. Death was recorded in 42 (18.6%) patients during the follow-up period (median 1029 days, interquartile range: 651-1358). Multiple Cox regression analysis revealed that a higher pulmonary embolism severity index score (from 85 to 128; hazard ratio=3.00; 95% CI: 2.11-4.29; P <.001) and a lower eosinophil-to-monocyte ratio (from 0.02 to 0.24; hazard ratio=0.56; 95% CI: 0.34-0.98; P =.032) were 2 independent predictors for long-term all cause mortality. The eosinophil-to-monocyte ratio at the admission of less than 0.03 was documented to be associated with higher mortality (P <.001).

Conclusion: Our results revealed that a lower eosinophil-to-monocyte ratio and a higher pulmonary embolism severity index score independently predict the long-term mortality in patients with intermediate-high- and high-risk pulmonary embolism.

9.Lessons Learned From Intermittent Dysfunction of Mechanical Heart Valve
Semih Kalkan, Ahmet Güner, Macit Kalçık, Mustafa Ozan Gürsoy, Sabahattin Gündüz, Emrah Bayam, Mahmut Yesin, Süleyman Karakoyun, Mustafa Ferhat Keten, Mehmet Özkan
doi: 10.5152/AnatolJCardiol.2022.1677  Pages 725 - 732
Background: Intermittent malfunction is a rare but potentially serious complication of prosthetic heart valve replacement. This study aimed to describe the clinical features and etiologic causes of patients with intermittent mechanical prosthetic heart valve dysfunction.

Methods: Between 2010 and 2021, 16 patients who were evaluated in the echocardiography laboratory of Koşuyolu Training and Research Hospital with the diagnosis of intermittent malfunction of prosthetic valves were included in the study.

Results: The evaluated patients consisted of 12 bi-leaflet mitral valve replacements and 2 mono-leaflet mitral valve replacements. The underlying causes of intermittent malfunction were classified as follows: residual chord (n = 4), obstructive thrombus (n = 2), non-obstructive thrombus (n = 2), vegetation (n = 2), pannus and obstructive thrombus coexistence (n = 1), and solely pannus (n = 1). One of the patients with mono-leaflet mitral valve replacements had pannus and obstructive thrombus. In the other patient with mono-leaflet mitral valve replacement, a stuck valve was observed in 1 of 12 beats secondary to arrhythmia. There were also 2 patients with aortic valve replacements. One patient had moderate aortic regurgitation due to prominent calcification and the other had moderate obstruction due to pannus. In the patient with pannus, a stuck leaflet was observed in 1 of 6 beats and moderate aortic regurgitation arose in 1 of 2 beats in the patient with calcification.

Conclusions: The intermittent stuck valve may have catastrophic outcomes. When making a treatment decision in these patients, assessing the degree of regurgitation or stenosis is essential. In particular, the frequency of entrapment should be taken into consideration when deciding the optimal therapy for intermittent prosthetic heart valve dysfunction.

CASE REPORT
10.Endovascular Management of Giant Isolated Iliac Artery Aneurysms: A Case Series
Gönül Zeren, Fatma Can, İlhan İlker Avcı, Mustafa Azmi Sungur, Mehmet Fatih Yılmaz, Can Yücel Karabay
doi: 10.5152/AnatolJCardiol.2022.1885  Pages 733 - 736
Abstract |Full Text PDF

11.Improvising Wet-Cupping Therapy for the Management of Severe Forearm Hematoma Following Transradial Percutaneous Coronary Intervention in a Geriatric Patient
Serhan Özyıldırım
doi: 10.5152/AnatolJCardiol.2022.1892  Pages 737 - 739
Access site complications, such as hematoma, are less frequent with transradial cardiac catheterization when compared to transfemoral procedures. 1 Significant forearm hematoma is seen in approximately 0.3%-0.7% of cases.1,2 Evacuation of a severe hematoma is usually performed via surgical exploration since it is resistant to aspiration due to clot formation. 3 However, this procedure might have devastating consequences for an elderly patient suffering from acute myocardial infarction. We adapted the wet-cupping suction technique to evacuate severe hematoma safely.

LETTER TO THE EDITOR
12.Circulating MicroRNA-423-5p in Hypertensive Patients with Heart Failure: Correspondence
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
Page 740
Abstract |Full Text PDF

LETTER TO THE EDITOR REPLY
13.Reply to Letter to the Editor: “Circulating MicroRNA-423-5p in Hypertensive Patients with Heart Failure: Correspondence”
Ying Huang, Yun Zhang, Wenzheng Nong, Biyang Lan, Dingmin Zhang
doi: 10.5152/AnatolJCardiol.2022.2060  Page 741
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
14.A Rare 5-chambered Heart: Giant Left Atrial Appendage Aneurysm
Leizhi Ku, Yafeng He, Xiaojing Ma
doi: 10.5152/AnatolJCardiol.2022.2128  Pages E14 - E15
Abstract |Full Text PDF



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