ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 27 (11)
Volume: 27  Issue: 11 - November 2023
EDITORIAL
1.Machine Learning, Pulmonary Hypertension…
Çetin Erol
PMID: 37909349  PMCID: PMC10621612  doi: 10.14744/AnatolJCardiol.2023.11  Page 615
Abstract |Full Text PDF

2.Time to Treat the Climate and Nature Crisis as One Indivisible Global Health Emergency
Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski, Gregory Efosa Erhabor
PMID: 37909350  PMCID: PMC10621607  doi: 10.14744/AnatolJCardiol.2023.13  Pages 616 - 618
Abstract |Full Text PDF

REVIEW
3.Outcomes of Ozaki Procedure/Aortic Valve Neocuspidization for Aortic Valve Diseases: A Systematic Review
Samson S. Badalyan, Syune V. Markosyan, Alisher M. Ismailbaev, Andleeb Asghar, Aniq Ur Rehman
PMID: 37909351  PMCID: PMC10621611  doi: 10.14744/AnatolJCardiol.2023.3477  Pages 619 - 627
Background: Perfect heart valve prostheses have optimized hemodynamics, reduced surgical morbidity, long-lasting durability, and extended patient survival with greater quality of life. Mechanical valves are recommended; however, young children may need anticoagulant medication for life. In this study, we looked at the success rate and viability of aortic valve neocuspidization (AVNeo) surgery for a variety of aortic disorders.

Methods: A methodical search strategy was used to fully evaluate the AVNeo results. Boolean operators were used to combine important words like “Ozaki Procedure,” “Aortic Valve Neocuspidization,” “AVNeo,” and associated terms. Reputable databases such as PubMed, MEDLINE, Embase, Web of Science, and Scopus were the focus of our search. Study quality was assessed using a critical evaluation created with the Critical Appraisal Skills Programme tool.

Results: The findings are summarized in the ”Results” section that contains descriptive and critical analysis, ramifications, and explanations. According to research, AVNeo improved valve function and had few side effects. Aortic valve neocuspidization has a lower mean pressure gradient and a larger mean efficient orifice area than Trifecta. Aortic valve neocuspidization surgery reduces aortic valve regurgitation and pressure gradients. Postoperative echocardiograms indicated a decrease in peak and a rise in mean pressure gradient.

Conclusion: The Ozaki method restores a healthy laminar flow pattern while preventing bivalvular disease. Ozaki procedure should be explored for valve repair in infants with truncal valve and congenital aortic disease. Aortic valve tricuspidization with glutaraldehyde-treated autologous pericardium results in considerable effective orifice area, modest pressure gradients, and little regurgitation.

ORIGINAL ARTICLE
4.The Definition of Sarcomeric and Non-Sarcomeric Gene Mutations in Hypertrophic Cardiomyopathy Patients: A Multicenter Diagnostic Study Across Türkiye
Veysel Oktay, Omaç Tüfekçioğlu, Dilek Çicek  Yılmaz, Ersel Onrat, Dilay Karabulut, Murat Çelik, Akif Serhat Balcıoğlu, Mehmet Murat  Sucu, Güllü Özdemir, Hakkı Kaya, Mehmet Kış, Barış Güven, Oktay Bağdatoğlu, Fatma Nihan  Turhan Çağlar, Uygar Çağdaş  Yüksel, İrfan Veysel  Düzen, Ahmet Barutçu, Özgüç Semih  Şimşir, İbrahim Başarıcı, Afşin Parspur, Onur Dalgıç, Fatma Özlem  Arıcan Özlük, Mert Evlice, Saim Sağ, Muhammed Furkan  Deniz, Arslan Öcal, Emine Gazi, Taner Şen, Osman Özdabakoğlu, Nermin Bayar Çakıcı, Eren Ozan  Bakır, Ayşegül Ülgen Kunak, Gizem Çaylı, Aybike Gül Taşdelen, Ercan Akşit, Şefika Uslu Çil, Hüseyin Onay
PMID: 37466024  PMCID: PMC10621609  doi: 10.14744/AnatolJCardiol.2023.2805  Pages 628 - 638
Background: Hypertrophic cardiomyopathy is a common genetic heart disease and up to 40%-60% of patients have mutations in cardiac sarcomere protein genes. This genetic diagnosis study aimed to detect pathogenic or likely pathogenic sarcomeric and non-sarcomeric gene mutations and to confirm a final molecular diagnosis in patients diagnosed with hypertrophic cardiomyopathy.

Methods: A total of 392 patients with hypertrophic cardiomyopathy were included in this nationwide multicenter study conducted at 23 centers across Türkiye. All samples were analyzed with a 17-gene hypertrophic cardiomyopathy panel using next-generation sequencing technology. The gene panel includes ACTC1, DES, FLNC, GLA, LAMP2, MYBPC3, MYH7, MYL2, MYL3, PLN, PRKAG2, PTPN11, TNNC1, TNNI3, TNNT2, TPM1, and TTR genes.

Results: The next-generation sequencing panel identified positive genetic variants (variants of unknown significance, likely pathogenic or pathogenic) in 12 genes for 121 of 392 samples, including sarcomeric gene mutations in 30.4% (119/392) of samples tested, galactosidase alpha variants in 0.5% (2/392) of samples and TTR variant in 0.025% (1/392). The likely pathogenic or pathogenic variants identified in 69 (57.0%) of 121 positive samples yielded a confirmed molecular diagnosis. The diagnostic yield was 17.1% (15.8% for hypertrophic cardiomyopathy variants) for hypertrophic cardiomyopathy and hypertrophic cardiomyopathy phenocopies and 0.5% for Fabry disease.

Conclusions: Our study showed that the distribution of genetic mutations, the prevalence of Fabry disease, and TTR amyloidosis in the Turkish population diagnosed with hypertrophic cardiomyopathy were similar to the other populations, but the percentage of sarcomeric gene mutations was slightly lower.

5.Gender-Related Differences in Patients with Acute Heart Failure: Observation from the Journey Heart Failure—Turkish Population Study
Filiz Akyıldız Akçay, Ümit Yaşar Sinan, Dogaç Çağlar Gürbüz, Özgen Şafak, Hakkı Kaya, Ümit Yüksek, Mehdi Zoghi
PMID: 37466026  PMCID: PMC10621605  doi: 10.14744/AnatolJCardiol.2023.2971  Pages 639 - 649
Background: Gender-related clinical variations in patients with acute heart failure have been described in previous studies. However, there is still a lack of research on gender differences in patients hospitalized for acute heart failure in Türkiye. The aim of this study is to compare the clinical features, in-hospital approaches, and outcomes of male and female patients hospitalized for acute heart failure.

Methods: Differences in clinical characteristics, medication prescription, hospital management, and outcomes between males and females with acute heart failure were investigated from the Journey Heart Failure—Turkish Population study.

Results: Nine hundred eighteen patients (57.2%) were men and 688 (42.8%) were women. Women were older than men (70.48 ± 13.20 years vs. 65.87 ± 12.82 years; P <.001). The frequency of comorbidities such as hypertension (72.7% vs. 62.4%, P <.001), diabetes (46.5% vs. 38.5%, P = .001),  atrial  fibrillation  (46.5%  vs.  33.4%,  P <.001), New York Heart Association class III-IV symptoms (80.6% vs. 71.2%, P =.001), and dyspnea in the rest (73.8% vs. 68.3%, P =.044) were more common in women on admission. Male patients were more frequently hospitalized with reduced left ventricular ejection fraction (51.0% vs. 72.4%, P <.001). In-hospital mortality was higher among female patients (9.3% vs. 6.4%, P =.022). Higher  New  York  Heart  Association  class,  lower  estimated  glomerular  filtration  rate, higher N-terminal pro-B type natriuretic peptide on admission, and mechanical ventilation usage were the independent parameters of in-hospital mortality, whereas the female gender was not.

Conclusion: Our study clearly demonstrated the diversity in presentation, management, and in-hospital outcomes of acute heart failure between male and female patients. Although left ventricular systolic functions were better in female patients, in-hospital mortality was higher. Recognizing these differences in the management of heart failure in different sexes will serve better results in clinical practice.

6.Could Impedance Cardiography be a Non-Invasive Alternative Method of Measuring Cardiac Output in Patients with Pulmonary Hypertension?
Burcu Yağmur, Evrim Şimşek, Meral Kayıkçıoğlu, Elif İlkay Yüce, Yeşim Bayazıt Candemir, Sanem Nalbantgil, Nesrin Moğolkoç, Levent Can, Hakan Kültürsay
PMID: 37466025  PMCID: PMC10621604  doi: 10.14744/AnatolJCardiol.2023.2820  Pages 650 - 656
Background: Pulmonary hypertension guidelines recommend invasive right heart catheterization for diagnosis and clinical follow-up. Our aim was to compare non-invasive impedance cardiography with invasive techniques for cardiac index measurements and mortality prediction in patients with pulmonary hypertension.

Methods: Between 2008 and 2018, 284 right heart catheterizations were performed for the diagnosis of pulmonary hypertension in 215 patients with mean pulmonary artery pressure >25 mm Hg, and at least 2 methods used for cardiac output measurement were included in the study retrospectively. Patients were evaluated with Pearson’s correlation in 3 groups: estimated Fick (eFick) method and thermodilution (group 1), eFick method and impedance cardiography (group 2), and thermodilution and impedance cardiography (group 3). We also compared the predictive power of cardiac index measured by different methods for 1-year overall mortality and hospitalizations.

Results: There were strong and moderate positive correlations in groups 1 and 3, respectively (r = 0.634, P <.001, r = 0.534, P =.001), and the weakest correlation was in group 2 (r = 0.390, P =.001). The mean difference (bias) between eFick method versus impedance cardiography, impedance cardiography vs. thermodilution, and eFick method vs.
thermodilution was 0.6 mL/min, 0.47 mL/min, and −0.2 mL/min respectively, but limits of agreement were wide. In both groups, cardiac index <2.5 L/min/m2 as measured by thermodilution significantly predicted 1-year mortality. Also, impedance cardiography was better than eFick method in predicting mortality (P =.02).

Conclusions: Our single-center real-life data showed that for cardiac output and cardiac index measurements, impedance cardiography provides a moderate correlation with thermodilution and is fair with eFick method methods. Moreover, thermodilution appeared superior to both eFick method and impedance cardiography, while impedance cardiography was even better than eFick method in predicting 1-year adverse events, including total mortality and hospitalization, in patients with pulmonary hypertension.

7.Identifying Cardiovascular Disease Risk Factors in Adults with Explainable Artificial Intelligence
Kevser Kübra Kırboğa, Ecir Uğur Küçüksille
PMID: 37624075  PMCID: PMC10621606  doi: 10.14744/AnatolJCardiol.2023.3214  Pages 657 - 663
Background: The aim of this study was to evaluate the relationship between risk factors causing cardiovascular diseases and their importance with explainable machine learning models.

Methods: In this retrospective study, multiple databases were searched, and data on 11 risk factors of 70 000 patients were obtained. Data included risk factors highly associated with cardiovascular disease and having/not having any cardiovascular disease. The explainable prediction model was constructed using 7 machine learning algorithms: Random Forest Classifier, Extreme Gradient Boost Classifier, Decision Tree Classifier, KNeighbors Classifier, Support Vector Machine Classifier, and GaussianNB. Receiver operating characteristic curve, Brier scores, and mean accuracy were used to assess the model’s performance. The interpretability of the predicted results was examined using Shapley additive description values.

Results: The accuracy, area under the curve values, and Brier scores of the Extreme Gradient Boost model (the best prediction model for cardiovascular disease risk factors) were calculated as 0.739, 0.803, and 0.260, respectively. The most important risk factors in the permutation feature importance method and explainable artificial intelligence–Shapley’s explanations method are systolic blood pressure (ap_hi) [0.1335 ± 0.0045 w (weight)], cholesterol (0.0341 ± 0.0022 w), and age (0.0211 ± 0.0036 w).

Conclusion: The created explainable machine learning model has become a successful clinical model that can predict cardiovascular patients and explain the impact of risk factors. Especially in the clinical setting, this model, which has an accurate, explainable, and transparent algorithm, will help encourage early diagnosis of patients with cardiovascular diseases, risk factors, and possible treatment options.

8.Remembering the Occam’s Razor: Could Simple Electrocardiographic Findings Provide Relevant Predictions for Current Hemodynamic Criteria of Pulmonary Hypertension?
Hacer Ceren Tokgöz, Bahadır Erdem Öcal, Yiğit Cengiz Erkuş, Seda Tanyeri, Barkın Kültürsay, Ayhan Tosun, Berhan Keskin, Aykun Hakgör, Dicle Sırma, Çağdaş Buluş, Ali Karagöz, İbrahim Halil Tanboğa, Şeyhmus Külahçıoğlu, Zübeyde Bayram, Ahmet Sekban, Nihal Özdemir, Cihangir Kaymaz
PMID: 37842758  PMCID: PMC10621608  doi: 10.14744/AnatolJCardiol.2023.3181  Pages 664 - 672
Background: We evaluated the predictive value of electrocardiographic (ECG) findings for pulmonary hemodynamics assessed by right heart catheterization (RHC).

Methods: Our study population comprised 562 retrospectively evaluated patients who underwent RHC between 2006 and 2022. Correlations between ECG measures and pulmonary arterial systolic and mean pressures (PASP and PAMP) and pulmonary vascular resistance (PVR) were investigated. Moreover, receiver operating characteristic (ROC) curve analysis assessed the predictive value of ECG for pulmonary hypertension (PH) and precapillary PH.

Results: The P-wave amplitude (Pwa) and R/S ratio (r) in V1 and V2, Ra in augmented voltage right (aVR), right or indeterminate axis, but not P wave duration (Pwd) or right bundle branch block (RBBB) significantly correlated with PASP, PAMP, and PVR (P <.001 for all). The partial R2 analysis revealed that amplitude of R wave (Ra) in aVR, R/Sr in V1 and V2, QRS axis, and Pwa added to the base model provided significant contributions to variance for PASP, PAMP, and PVR, respectively. The Pwa > 0.16 mV, Ra in aVR > 0.05 mV, QRS axis > 100° and R/Sr in V1 > 0.9 showed the highest area under curve (AUC) values for PAMP > 20 mm Hg. Using the same cutoff value, Ra in aVR, Pwa, QRS axis, and R/Sr in V1 showed highest predictions for PVR > 2 Wood Units (WU).

Conclusion: In this study, Pwa, Ra in aVR, right or indeterminate axis deviations, and R/Sr in V1 and V2 showed statistically significant correlations with pulmonary hemodynamics, and Ra in aVR, R/Sr in V2 and V1, QRS axis, and Pwa contributed to variance for PASP, PAMP, and PVR, respectively. Moreover, Pwa, Ra in aVR, QRS axis, and R/Sr in V1 seem to provide relevant predictions for PH and precapillary PH.

CASE REPORT
9.Does Transcatheter Therapy Replace Surgery? Transcatheter Closure of Sinus Venosus Atrial Septal Defect and Partial Pulmonary Venous Return
Muhammet Hamza Halil Toprak, Erkut Öztürk, Ali Can Hatemi, Alper Güzeltaş, İbrahim Cansaran Tanıdır
PMID: 37731350  PMCID: PMC10621613  doi: 10.14744/AnatolJCardiol.2023.3302  Pages 673 - 674
Abstract |Full Text PDF | Video

ERRATUM
10.Erratum

PMID: 37909348  doi: 10.14744/AnatolJCardiol.2023.3762.ER-1  Page 675
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
11.Using Aortic and Mitral Annuluses S Curves to Transcatheter Aortic Valve Implantation in Patient with Mechanical Mitral Valve
Veysel Özgür Barış, Emin Erdem Kaya, Esra Polat, Elif İlkay Yüce, Sedat Sakallı
PMID: 37487229  PMCID: PMC10621610  doi: 10.14744/AnatolJCardiol.2023.3518  Pages E32 - E33
Abstract |Full Text PDF | Video

12.Early-Period Coronary Aneurysm Formation After Sirolimus-Eluting Stent Implantation
Cihad Kaya, Serkan Asil, Sude Cesaretli, Yakup Yavaş, Barış Buğan, Cem Barçın
PMID: 37791772  PMCID: PMC10621614  doi: 10.14744/AnatolJCardiol.2023.3622  Pages E34 - E35
Abstract |Full Text PDF | Video



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