ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 27 (6)
Volume: 27  Issue: 6 - June 2023
EDITORIAL
1.Natriuretic Peptides, Cardio-Oncology
Çetin Erol
PMID: 37257014  PMCID: PMC10250767  doi: 10.14744/AnatolJCardiol.2023.6  Page 298
Abstract |Full Text PDF

REVIEW
2.Cancer Therapy-Related Pulmonary Hypertension: A Review of Mechanisms and Implications for Clinical Practice
Muhammet Gürdoğan, Melik Demir, Kenan Yalta, Yekta Gülertop
PMID: 37257013  PMCID: PMC10250770  doi: 10.14744/AnatolJCardiol.2023.3013  Pages 299 - 307
Cancer therapy-related pulmonary hypertension is a rare yet potentially fatal cardiotoxicity. However, it is a reversible cause of pulmonary hypertension if detected in its early stages. Cancer therapy-related pulmonary hypertension has been encountered in patients using tyrosine kinase inhibitors, particularly dasatinib. However, it is also well known that many agents used in cancer treatment such as alkylating agents, proteasome inhibitors, thoracic radiation exposure, and immune checkpoint inhibitors are particularly associated with pulmonary hypertension evolution. In case that history, symptoms, and clinical findings suggest a potential cancer therapy-related pulmonary hypertension, echocardiography is considered as the initial tool to detect pulmonary hypertension. If the possibility of pulmonary hypertension is high based on echocardiographic data, cancer treatment, as the initial step, should be discontinued due to its potential risks and other causes for pulmonary hypertension should be investigated thoroughly. Right heart catheterization should be the next step to establish the final diagnosis, and medical management, where appropriate, should be started without delay in these patients according to their pulmonary hypertension subgroup. There exists limited information regarding the diagnostic and management strategies of cancer therapy-related pulmonary hypertension in the current guidelines. In this review article, we aim to present current literature data on the mechanisms and management of cancer therapy-related pulmonary hypertension along with its follow-up algorithm in the setting of cardio-oncology practice.

CONSENSUS REPORT
3.How to Use Natriuretic Peptides in Patients with Heart Failure with Non-Reduced Ejection Fraction?
Ahmet Çelik, Barış Kılıçaslan, Ahmet Temizhan, Tolga Sinan Güvenç, Hakan Altay, Yüksel Çavuşoğlu, Mehmet Birhan Yılmaz, Özlem Yıldırımtürk, Sanem Nalbantgil, Dilek Ural
PMID: 37257015  PMCID: PMC10250766  doi: 10.14744/AnatolJCardiol.2023.3297  Pages 308 - 318
Abstract |Full Text PDF

ORIGINAL ARTICLE
4.The Impact of Cystic Fibrosis- and Noncystic Fibrosis-Bronchiectasis on Pulmonary Artery Wall Thickness and Right Heart Functions Assessed by Speckle-Tracking Echocardiography
Emre Gürel, Duygu Vezir, Tuba Güçtekin, Zekeriya Doğan, Derya Kocakaya, Sehnaz Olgun, Murat Sünbül, Altuğ Çinçin, Beste Özben, Nurten Sayar, Mustafa Kürşat Tigen, Berrin Ceyhan
PMID: 37257004  PMCID: PMC10250771  doi: 10.14744/AnatolJCardiol.2023.2864  Pages 319 - 327
Background: Right heart functions are affected in patients with bronchiectasis as a result of pulmonary hypertension induced by chronic hypoxemia. Pulmonary artery wall thickness has recently been introduced as a sign of intensive and prolonged inflammation. The aim of this study was to analyze right ventricular and right atrial functions and to mea-sure pulmonary artery wall thickness in patients with cystic fibrosis-bronch iecta sis in comparison to those with noncystic fibrosis-bronchiectasis and healthy individuals.

Methods: We studied 36 patients with cystic fibrosis-bronchiectasis, 34 patients with noncystic fibrosis-bronchiectasis, and 32 age- and sex-matched control subjects. Lung function tests were performed. All subjects underwent comprehensive echocardiographic evaluation including conventional, tissue Doppler, speckle-tracking, and pulmonary artery wall thickness measurements.

Results: Right ventricular global longitudinal strain and global longitudinal right atrial strain during ventricular systole decreased in cystic fibrosis-bronchiectasis group compared with noncystic fibrosis-bronchiectasis and control groups (P <.001, both). Conversely, pulmonary artery wall thickness was increased in cystic fibrosis-bronchiectasis group in comparison to other groups (P <.001). Moreover, right ventricular global longitudinal strain was lower and pulmonary artery wall thickness was higher in patients with airflow obstruction (P <.001 and P =.025, respectively) than in those without. Only right ventricular global longitudinal strain was significantly correlated with pulmonary function test parameters. The negative effect of cystic fibrosis on right ventricular and right atrial functions was independent of age, gender, and disease duration.

Conclusion: Our study showed that right ventricular and right atrial functions were deteriorated and pulmonary artery wall was thickened in cystic fibrosis-bronchiectasis patients more than noncystic fibrosis-bronchiectasis patients. Right ventricular global longitudinal strain detected subclinical right ventricular dysfunction and was associated with the severity of pulmonary disease.

5.Evaluation of the Potentially Inappropriate Cardiovascular Medication Prescription in Elderly: A Nationwide Study in Turkey
Mehmet Tevfik Kitapçı, Osman Karakuş, Fatma İşli, Mesil Aksoy, Muhammed Cihan Güvel, Canan Uluoğlu
PMID: 37257006  PMCID: PMC10250774  doi: 10.14744/AnatolJCardiol.2023.2618  Pages 328 - 338
Background: Elderly comprises a specific group due to possible alterations in the effects of drugs and comorbidities. We aimed to identify for the first time the characteristics and rates regarding the inappropriate prescriptions of cardiovascular system medications in the geriatric age group in Turkey.

Methods: Cardiovascular system medications prescribed electronically by family physicians to patients aged 65 and over, in the years 2015 and 2016, were obtained through Prescription Information System administered by the Ministry of Health. Evaluation of potentially inappropriate prescriptions was done according to the “Beers Criteria 2015 update.” Prescription rates for each group were evaluated under sub-breakdowns for the specialty of family physicians, gender, age groups, and “Nomenclature of Territorial Units for Statistics” regions.

Results: Approximately 65 million prescriptions were evaluated. The rate of potentially inappropriate cardiovascular medication prescribing was 0.33%. This raised to 11.56% when “drugs to be used with caution” were included. It was observed that potentially inappropriate drugs have been prescribed more by specialist family physicians. The most frequently prescribed potentially inappropriate drugs were doxazosin in the diagnosis of hypertension and methyldopa regardless of indication. Diclofenac-warfarin was the most commonly prescribed concomitant drug use in the potentially clinically important drug–drug interactions group. The rate of potentially inappropriate drug prescribing was higher in males and in aged 80 years and older.

Conclusions: This pharmacoepidemiological study draws attention to potentially inappropriate cardiovascular system drugs prescribed in primary care settings to the elderly. The rate of potentially inappropriate cardiovascular system drug prescribed was found to be very low in Turkey.

6.Dapagliflozin May Protect Against Doxorubicin-Induced Cardiotoxicity
Sebahat Ulusan, Kanat Gülle, Ahmet Peynirci, Murat Sevimli, Adnan Karaibrahimoglu, Mevlüt Serdar Kuyumcu
PMID: 37257007  PMCID: PMC10250773  doi: 10.14744/AnatolJCardiol.2023.2825  Pages 339 - 347
Background: Doxorubicin is a widely used agent in the treatment of cancer, but the cardiotoxicity associated with this drug limits its potential for use. The cardioprotective effects of dapagliflozin, an antidiabetic drug, have the potential to counteract the cardiotoxic effect of doxorubicin therapy. In our study, we aimed to investigate the protective effect of dapagliflozin from possible doxorubicin-induced cardiotoxicity.

Methods: A total of 40 male Wistar albino rats were divided into 4 groups consisting of 10 each (control = 10, dapagliflozin = 10, doxorubicin = 10, doxorubicin + dapagliflozin = 10). Meanwhile, doxorubicin and doxorubicin + dapagliflozin groups received a total dose of 15  mg/kg doxorubicin intraperitoneally, dapagliflozin and doxorubicin + dapagliflozin groups were gavaged daily with 10 mg/kg dapagliflozin. At the sixth week of the study, rats were examined by echocardiography and electrocardiogram. Furthermore, histopathological method was used to evaluate the level of cardiotoxicity.

Results: Ejection fraction decreased by 15% in the doxorubicin group, and this reduction in ejection fraction was alleviated in the doxorubicin + dapagliflozin group. In addition, a 65% increase in QRS duration was observed in the group given doxorubicin, while an increase of 7% was observed in doxorubicin + dapagliflozin group. Corrected QT duration increased by 12% in the doxorubicin group, compared to 2% in doxorubicin + dapagliflozin group. Meanwhile, sarco-myolysis, inflammatory cell infiltration, and necrotic changes were examined heavily in doxorubicin group, they were minimal in doxorubicin  + dapagliflozin group.

Conclusion: Our study showed that dapagliflozin has the potential to reduce the effects of doxorubicin-induced cardiotoxicity.

7.Reappraisal of the Transthoracic Echocardiographic Algorithm in Predicting Pulmonary Hypertension Redefined by Updated Pulmonary Artery Mean Pressure Threshold
Seda Tanyeri, Hacer Ceren Tokgöz, Ali Karagöz, Özgür Yasar Akbal, Berhan Keskin, Barkın Kültürsay, Aykun Hakgör, Şeyhmus Külahçıoglu, Doğancan Çeneli, Ayhan Tosun, Süleyman Efe, Zübeyde Bayram, Ibrahim Halil Tanboga, Nihal Özdemir, Cihangir Kaymaz
PMID: 37257005  PMCID: PMC10250768  doi: 10.14744/AnatolJCardiol.2023.2435  Pages 348 - 359
Background: Although an adopted echocardiography algorithm based on tricuspid regurgitation jet peak velocity and suggestive findings for pulmonary hypertension has been utilized in the non-invasive prediction of pulmonary hypertension probability, the reliability of this approach for the updated hemodynamic definition of pulmonary hypertension remains to be determined. In this study, for the first time, we aimed to evaluate the tricuspid regurgitation jet peak velocity and suggestive findings in predicting the probability of pulmonary hypertension as defined by mean pulmonary arterial pressure > 20 mm Hg and > 25 mm Hg, respectively.

Methods: Our study group was comprised of the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. All echocardiographic and right heart catheterization assessments were performed in accordance with the European Society of Cardiology/European Respiratory Society 2015 Pulmonary Hypertension Guidelines.

Results: Although tricuspid regurgitation jet peak velocity showed a significant relation with mean pulmonary arterial pressure in both definitions, suggestive findings offered a significant contribution only in predicting mean pulmonary arterial pressure ≥ 25 mm Hg but not for mean pulmonary arterial pressure > 20 mm Hg. In predicting the mean pulmonary arterial pressure > 20 mm Hg, tricuspid regurgitation jet peak velocity and suggestive findings showed an odds ratio of 2.57 (1.59-4.14, P <.001) and 1.25 (0.86-1.82, P =.16), respectively. In predicting the mean pulmonary arterial pressure ≥ 25 mm Hg, tricuspid regurgitation jet peak velocity, and suggestive findings showed an odds ratio of 2.33 (1.80-3.04, P <.001) and 1.54 (1.15-2.08, P <.001), respectively. The tricuspid regurgitation jet peak velocity > 2.8 m/s and tricuspid regurgitation jet peak velocity > 3.4 m/s were associated with 70% and 84% probability of mean pulmonary arterial pressure > 20 mm Hg and 60% and 76% probability of mean pulmonary arterial pressure ≥ 25 mm Hg, respectively.

Conclusions: In contrast to those in predicting the mean pulmonary arterial pressure ≥ 25 mm Hg, suggestive findings did not provide a significant contribution to the probability of mean pulmonary arterial pressure > 20 mm Hg predicted by tricuspid regurgitation jet peak velocity solely. The impact of the novel mean pulmonary arterial pressure threshold on the echocardiographic prediction of pulmonary hypertension remains to be clarified by future studies.

8.High-density Mapping Catheter (Advisor™ HD Grid) Usage for Intra-atrial Reentrant Tachycardia Ablation in Children and Young Adult Patients with Congenital Heart Disease
Yakup Ergül, Hasan Candaş Kafalı, Erkut Özturk, Selman Gökalp, Fatma Sevinç Şengül, Özgur Sürgit, Alper Guzeltaş
PMID: 37257008  PMCID: PMC10250763  doi: 10.14744/AnatolJCardiol.2023.2968  Pages 360 - 368
Background: We aimed to share our experience of intra-atrial reentrant tachycardia mapping and ablation with a new grid-style multielectrode high-density mapping catheter (Advisor™ HD Grid) in pediatric and young adult patients with operated congenital heart disease.

Methods: All patients with operated congenital heart disease and intra-atrial reentrant tachycardia mapping with the new grid-style catheter between October 2019 and December 2022 were included (group 1), and the results were compared to those patients who operated with conventional catheter methods before this period (group 2). All procedures were performed using the EnSite Precision 3D mapping system (Abbott Laboratories, Abbott Park, Ill, USA) with a limited fluoroscopy approach. Data were evaluated retrospectively.

Results: In group 1 (n = 16; 9 male), the median age was 21 years (10-36), compared to 19 years (9-27) in group 2 (n = 10; 5 male). While irrigated radiofrequency ablation was pre-ferred in all patients, the median number of 15 lesions (8-38) in group 1 was significantly less than the median of 30 lesions (8-71) in group 2 (P =.027). The median procedure duration of 159 minutes (110-233) in group 1 was significantly shorter compared to 280 minutes (180-370) in group 2 (P <.05). Acute procedural success was achieved in all patients (16/16; 100%) in group 1 compared to 8/10 patients (80%) in group 2. During the median follow-up of 27 months (11-36), there was only 1 intra-atrial reentrant tachycardia recurrence in group 1 (1/16; 6.2%) and 2 recurrences (2/8; 25%) in group 2 during the median follow-up of 110 months (56-151). No complications related to the mapping catheter itself occurred.

Conclusion: In the intra-atrial reentrant tachycardia ablation of children with congenital heart disease to increase procedural success and shorten the mapping duration, the utility of Advisor™ HD Grid mapping catheter seems to be a feasible alternative.

LETTER TO THE EDITOR
9.Diabetes Mellitus as a Protective Factor in Takotsubo Cardiomyopathy
Lovely Chhabra
PMID: 37257011  PMCID: PMC10250765  doi: 10.14744/AnatolJCardiol.2023.3134  Pages 369 - 370
Abstract |Full Text PDF

LETTER TO THE EDITOR REPLY
10.Reply to Letter to the Editor: “Diabetes mellitus as a protective factor in Takotsubo Cardiomyopathy”
Sittinun Thangjui, Harshith Thyagaturu, Angkawipa Trongtorsak, Ratdanai Yodsuwan, Muhammad Fayaz, Jakrin Kewcharoen, Leenhapong Navaravong
PMID: 37257012  PMCID: PMC10250769  doi: 10.14744/AnatolJCardiol.2023.3101  Page 371
Abstract |Full Text PDF

LETTER TO THE EDITOR
11.Paradoxical Role of Interleukin-1R2 in Cardiovascular Disorders
Zohreh Jadali
PMID: 37260113  PMCID: PMC10250762  doi: 10.14744/AnatolJCardiol.2023.2996  Pages 372 - 373
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
12.A Rare Case: Coexistence of Double Aortic Arch and Tetralogy of Fallot in a 1-Year-Old Child
Doğan Çağrı Tanrıverdi, Murat Şahin, İsmihan Selen Onan
PMID: 37257010  PMCID: PMC10250772  doi: 10.14744/AnatolJCardiol.2023.3206  Pages E17 - E18
Abstract |Full Text PDF

13.Circumaortic Duplicated Left Brachiocephalic Vein in a Patient with Tetralogy of Fallot
Niraj Nirmal Pandey, Vidiyala Pujitha, Sanjeev Kumar, Sivasubramanian Ramakrishnan
PMID: 37257009  PMCID: PMC10250764  doi: 10.14744/AnatolJCardiol.2023.3221  Pages E19 - E20
Abstract |Full Text PDF



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