ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 27 (5)
Volume: 27  Issue: 5 - May 2023
1.COVID-19 Revisited, Biomarkers in Myocardial Infarction
Çetin Erol
PMID: 37119196  PMCID: PMC10160835  doi: 10.14744/AnatolJCardiol.2023.5  Page 231
Abstract |Full Text PDF

2.A Literature Review of Pathophysiology, Clinical Manifestations, Medications and Optimal Dosage, Outpatient, and Post-hospitalization Use of Anticoagulation in COVID-19 Patients
Dimitrios Velissaris, Christos Michailides, Iosif Karalis, Themistoklis Paraskevas, Ioanna Koniari, Charalampos Pierrakos, Vasileios Karamouzos
PMID: 37119193  PMCID: PMC10160838  doi: 10.14744/AnatolJCardiol.2023.3023  Pages 232 - 239
Since severe acute respiratory syndrome coronavirus 2 led to a world pandemic, extensive research has been conducted to identify its characteristics and form an appropriate management plan. One recognized complication of COVID-19 is coagulation defects that can lead to thromboembolic events.

We have reviewed the literature to summarize and present the latest research about the pathophysiology, clinical manifestations, anticoagulation use and appropriate dose in COVID-19 patients, as well as the effect of anticoagulation in outpatient and post-hospital settings. The pathophysiology of coagulation abnormalities in COVID-19 is not fully understood yet, but multiple mechanisms appear to be involved, such as a direct viral attack, hyperinflammation, increased immune response, blood stasis, and endothelial injury. Clinical manifestations are mainly venous thromboembolism (deep vein thrombosis and pulmonary embolism), arterial thromboembolism, ischemic stroke, central venous sinus thrombosis, and central retinal vein occlusion. Anticoagulation is widely used in hospitalized patients with COVID-19, unless it is contraindicated. Heparinoid is the main anticoagulant used. However, the appropriate dosage is still debated as research is trying to find a balance between benefits and risks. In outpatients, it appears that anticoagulation has no benefit in contrast to post-hospitalization use, where benefit could be observed in severely affected patients.

We concluded that thromboprophylaxis should be used in treating hospitalized COVID-19 patients, but the dosage is still a matter of debate. More research needs to be done on outpatient and post-hospitalized patients to derive accurate conclusions.

3.Malnutrition Predicts Adverse Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
Mingqi Dong, Jifang Cheng, Li Gong, Yajing Xiao, Shengwen Shao, Jianping Song
PMID: 37119184  PMCID: PMC10160837  doi: 10.14744/AnatolJCardiol.2023.2710  Pages 240 - 248
Background: Several studies have shown that malnutrition helps to predict the occurrence of adverse outcomes after transcatheter aortic valve replacement. However, there is still controversy and uncertainty regarding the prevalence and consequences of malnutrition. We performed a systematic review and meta-analysis to assess the relationship between malnutrition and poor postoperative outcomes in transcatheter aortic valve replacement.

Methods: Observational studies were searched in PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE regarding the relationship between malnutrition and adverse outcomes after transcatheter aortic valve replacement, with the primary end-point being all-cause mortality and secondary outcomes such as cardiovascular complications and readmission rates. This meta-analysis was registered in PROSPERO (number CRD42022310139).

Results: A total of 10 studies involving 5936 subjects were included in the systematic review and meta-analysis. The results showed that malnourished patients had an increased risk of all-cause mortality after transcatheter aortic valve replacement compared with non-malnourished patients (hazard ratios [HR] = 1.32, 95% CI [1.13, 1.53], P <.01). Subgroup analysis showed that in Asia, postoperative all-cause mortality was significantly higher in malnourished transcatheter aortic valve replacement patients than in non-malnourished transcatheter aortic valve replacement patients (P <.01), and in addition, sample size and follow-up time may have contributed to the large heterogeneity.

Conclusion: Malnutrition increases the risk of all-cause mortality in such patients and may predict the occurrence of adverse postoperative outcomes.

4.Impact of Bivalirudin on Patients with Acute Coronary Syndrome Undergoing Rotational Atherectomy in Real-Life Setting: A Retrospective Cohort Study
Longwei Li, Hao Hu, Hongwu Chen, Buchun Zhang, Jianyuan Pan, Junling Zhou, Xiangyong Kong, Jinsheng Hua, Dongbiao Yu, Jiawei Wu, Dan Li, Likun Ma
PMID: 37119190  PMCID: PMC10160839  doi: 10.14744/AnatolJCardiol.2022.2308  Pages 249 - 257
Background: No evidence exists on the impact of bivalirudin in patients with the acute coronary syndrome undergoing rotational atherectomy. This study aimed to evaluate the impact of bivalirudin on patients with acute coronary syndrome undergoing rotational atherectomy.

Methods: This was a retrospective cohort study conducted in our hospital between January 2017 and December 2019. The study included patients with acute coronary syndrome undergoing rotational atherectomy. Furthermore, 2 cohorts were included in this study (bivalirudin cohort and control cohort unfractionated heparin). The primary end-point was in-hospital net adverse clinical events. The secondary endpoint was all-cause mortality at 23 months.

Results: The study included 157 patients with 33 (21.0%) in the bivalirudin cohort and 124 (79.0%) in the control cohort. Net adverse clinical events during hospitalization in the bivalirudin cohort were higher than that in the control cohort [9 (27.3%) vs. 14 (11.3%), P = .021]. However, there was no significant difference in all-cause mortality at 23 months between the 2 cohorts [25 (20.2%) vs. 10 (30.3%), P =.214]. After adjusting for potential confounders, the usage of bivalirudin was not associated with net adverse clinical event (odds ratio = 0.90; 95% CI: 0.18-4.45; P =.890), and the hazard ratio for all-cause mortality at 23 months was 1.01 (95% CI: 0.33-3.15; P =.983).

Conclusion: Bivalirudin appears to exhibit a similar impact as unfractionated heparin on patients with acute coronary syndrome undergoing rotational atherectomy in real-life setting.

5.Rationale, Design, and Methodology of the MORCOR-TURK Trial: Predictors of In-hospital MORtality in CORonary Care Patients in Turkey
Fatih Kahraman, İbrahim Ersoy, Ahmet Seyda Yılmaz, Adem Atıcı, Alpin Mert Tekin, Burak Açar, Çağlar Kaya, Faruk Kara, Feyza Kurt, Fulya Avcı Demir, İdris Buğra Çerik, İshak Yılmaz, Mehmet Koray Adalı, Mehtap Yeni, Mustafa Beğenç Taşcanov, Mustafa Yenerçağ, Mürsel Şahin, Ramazan Düz, Sevil Gülaştı, Sefa Erdi Ömür, Şahin Topuz, Şıho Hidayet, Yücel Kaçmaz, Nazif Aygül
PMID: 37119186  PMCID: PMC10160834  doi: 10.14744/AnatolJCardiol.2022.2824  Pages 258 - 265
Background: Coronary care units are sophisticated clinics established to reduce deaths due to acute cardiovascular events. Current data on coronary care unit mortality rates and predictors of mortality in Turkey are very limited. The MORtality predictors in CORonary care units in TURKey (MORCOR-TURK) trial was designed to provide information on the mortality rates and predictors in patients followed in coronary care units in Turkey.

Methods: The MORCOR-TURK trial will be a national, observational, multicenter, and noninterventional study conducted in Turkey. The study population will include coronary care unit patients from 50 centers selected from all regions in Turkey. All consecutive patients admitted to coronary care units with cardiovascular diagnoses between 1 and 30 September 2022 will be prospectively enrolled. All data will be collected at one point in time, and the current clinical practice will be evaluated ( number NCT05296694).

In the first step of the study, admission diagnoses, demographic characteristics, basic clinical and laboratory data, and in-hospital management will be assessed. At the end of the first step, the predictors and rates of in-hospital mortality will be documented. The second step will be in cohort design, and discharged patients will be followed up till 1 year. Predictors of short- and long-term mortality will be assessed. Moreover, a new coronary care unit mortality score will be generated with data acquired from this cohort.

Results: The short-term outcomes of the study are planned to be shared by early 2023.

Conclusion: The MORCOR-TURK trial will be the largest and most comprehensive study in Turkey evaluating the rates and predictors of in-hospital mortality of patients admitted to coronary care units.

6.The Acute Effects of 2 Different Intensities of Resistance Exercise on Autonomic Function in Heart Failure Patients: A Randomized Controlled Trial
Marzieh Saeidi, Roya Ravanbod, Mohammad Hossein Pourgharib Shahi, Hosein Navid, Babak Goosheh, Abdolvahab Baradaran, Giti Torkaman
PMID: 37119185  PMCID: PMC10160845  doi: 10.14744/AnatolJCardiol.2022.2282  Pages 266 - 273
Background: Although a wide spectrum of resistance exercise intensities was recommended in the guidelines, none of them investigated the acute effects of different intensities of the resistance exercise on cardiac autonomic function in patients with chronic heart failure. This study aimed to investigate the acute effects of the low and high intensities of the resistance exercise on heart rate variability in chronic heart failure.

Methods: This randomized controlled trial was performed between October 2019 and December 2020. Fifty-seven patients with chronic heart failure (New York Heart Association class II and class III) underwent hemodynamic, functional capacity, and heart rate variability (time and frequency domains) assessments. They were randomly divided into R1, R2, and control groups. The intervention consisted of performing a short aerobic exercise including 15 minutes of walking at an intensity of 50% reserved heart rate for all 3 groups and additional resistance exercise with the intensity of 50% 1-repetition maximum and 75% 1-repetition maximum for R1 and R2 groups, respectively.

Results: The standard deviation of normal to normal intervals and standard deviation of average NN intervals became significantly lower in R2 (P =.031), and both high-frequency power and low-frequency power were significantly higher in R1 (P =.039 and P =.004, respectively) after the intervention. No significant changes were observed in the control group. Between-group changes were not significant for hemodynamics and functional capacity after treatment. The between-group comparison demonstrated a significant increase in root mean square of successive differences of the NN intervals in R1 in comparison to the control (P =.035).

Conclusions: These findings indicate that resistance exercise in 50% 1-repetition maximum in comparison to 75% 1-repetition maximum had more favorable effects on the heart rate variability in chronic heart failure.

7.Screening of Biomarkers Related to Myocardial Infarction Based on the Construction of a ceRNA Regulation Network
Pingwei Ma, Jianfeng Li, Ming Cheng
PMID: 37119187  PMCID: PMC10160844  doi: 10.14744/AnatolJCardiol.2023.2388  Pages 274 - 281
Background: This study aimed to identify the biomarkers related to myocardial infarction based on building lncRNA–miRNA–mRNA ceRNA regulation network.

Methods: The expression profile data were obtained from the Gene Expression Omnibus database. The differentially expressed RNAs (DElncRNAs, DEmiRNAs, and DEmRNAs) were analyzed using the limma package of R. In addition, the differential myocardial infarction-related genes were obtained and the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway on the differential myocardial infarction-related genes were analyzed. The co-expression network of lncRNA–mRNA was constructed, and the Kyoto Encyclopedia of Genes and Genomes pathway of such a co-expression network was analyzed. Moreover, the lncRNA–miRNA–mRNA ceRNA network associated with myocardial infarction was built, and the key biomarkers of the ceRNA network were verified using the GSE141512 and GSE66752 datasets.

Results: In total, we acquired 51 DElncRNAs, 276 DEmiRNAs, and 1200 DEmRNAs as well as 291 differential myocardial infarction-related genes. Moreover, the co-expression network of lncRNA–mRNA was built, and mRNAs were found to be associated with 109 Kyoto Encyclopedia of Genes and Genomes pathways (the target gene of RP3-394A18.1 was significantly related to lipid and atherosclerosis). In addition, the ceRNA network related to myocardial infarction was constructed, and the dataset analyses of the RNAs were validated between the myocardial infarction and normal groups. It was also found that the expression levels of hsa-miR-1291 and Retinoid acid receptor-related orphan
receptor α (RORA) in the myocardial infarction group were noticeably lower than those in the normal group, whereas the expression levels of ENTPD1, QSOX1, and TIMP2 in the myocardial infarction group were noticeably higher than those in the normal group.

Conclusion: In this study, we built a ceRNA regulation network of myocardial infarction. This study could help identify the biomarkers related to myocardial infarction.

8.A New Index for the Prediction of In-Hospital Mortality in Patients with Acute Pulmonary Embolism: The Modified Shock Index
Sevim Türkday Derebey, Hacer Ceren Tokgöz, Berhan Keskin, Ayhan Tosun, Aykun Hakgör, Ali Karagöz, Özgür Yaşar Akbal, Zübeyde Bayram, Süleyman Efe, Cem Doğan, İbrahim Halil Tanboğa, Nihal Özdemir, Cihangir Kaymaz
PMID: 37119189  PMCID: PMC10160840  doi: 10.14744/AnatolJCardiol.2023.2530  Pages 282 - 289
Background: Pulmonary embolism severity index, its simplified version, and shock index have been used for risk stratification in acute pulmonary embolism. In this study, we proposed a modification in severity index and evaluated the correlates and prognostic value of modification in severity index in this setting.

Methods: The study group comprised retrospectively evaluated 181 patients with acute pulmonary embolism. Systematic workup including pulmonary embolism severity index, its simplified version, shock index, biomarkers, and echocardiographic and multidetector computed tomography assessments was performed in all patients. Moreover, we calculated modification in severity index by multiplying original shock index (heart rate/systolic blood pressure ratio) and a third component, 1/pulse oxymetric saturation (pSat O2%) ratio. The primary endpoint was defined as all-cause mortality and hemodynamic collapse during the hospital stay.

Results: On the basis of initial risk stratification, ultrasound-assisted thrombolysis, systemic tissue-type plasminogen activator, and unfractionated heparin therapies were utilized in 83 (45.9%), 37 (20.4%), and 61 (33.7%) patients, respectively. The primary end-point occurred in 13 (7.2%) patients. Receiver-operating curve analysis revealed that modification in severity index had the highest area under the curve of 0.739 (0.588-0.890, P =.002) compared with shock index, pulmonary embolism severity index, or its simplified version. The modification in severity index > 0.989 predicted primary endpoint with 73% sensitivity and 54% specificity.

Conclusions: The modification in severity index seems to be a simple, quick, and compre-hensive risk assessment tool for bedside evaluation at initial stratification, in monitoring the clinical benefit from therapies, and decision-making for escalation to other reperfusion strategies in patients with acute pulmonary embolism. However, the prognostic value of modification in severity index needs to be validated with further studies.

9.Nano-Culotte Stenting for Coronary Bifurcation Lesions: Pros and Cons of a Novel Strategy
Kenan Yalta
PMID: 37119191  PMCID: PMC10160836  doi: 10.14744/AnatolJCardiol.2023.3149  Pages 290 - 291
Abstract |Full Text PDF

10.Reply to Letter to the Editor: Provisional (Reverse) Double-Kissing Nano-Culotte Stenting
Serkan Kahraman, Ahmet Güner, Ahmet Yaşar Çizgici, Mehmet Ertürk
PMID: 37119194  PMCID: PMC10160833  doi: 10.14744/AnatolJCardiol.2023.3150  Pages 292 - 294
Abstract |Full Text PDF | Video

11.The Movahed Coronary Bifurcation Lesion Classification Introduces Limitless Optional Suffixes That Can Easily be Used for Clinical Use or Coding Purposes
Mohammad Reza Movahed
PMID: 37119195  PMCID: PMC10160842  doi: 10.14744/AnatolJCardiol.2023.3182  Pages 295 - 296
Abstract |Full Text PDF

12.Reply to Letter to the Editor: “The Movahed Coronary Bifurcation Lesion Classification Introduces Limitless Optional Suffixes That Can Easily be Used for Clinical Use or Coding Purposes”
Mustafa Tarık Ağaç, Mehmet Bülent Vatan, Mehmet Akif Çakar, Ersan Tatlı
PMID: 37119192  PMCID: PMC10160843  doi: 10.14744/AnatolJCardiol.2023.3184  Page 297
Abstract |Full Text PDF

13.Fourth Recurrence of Cardiac Myxoma in a Patient with Carney Complex
Damla Yalçınkaya, Uğur Nadir Karakulak
PMID: 37119188  PMCID: PMC10160841  doi: 10.14744/AnatolJCardiol.2022.2849  Pages E13 - E14
Abstract |Full Text PDF | Video

14.Giant Coronary Artery Aneurysm with a Thrombus
Mehmet Ali Ali Astarcıoğlu, Taner Şen, Furkan Ertürk Urfalı, Mevlüt Demir
PMID: 37119197  PMCID: PMC10160832  doi: 10.14744/AnatolJCardiol.2023.3186  Pages E15 - E16
Abstract |Full Text PDF | Video

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