ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 28 (2)
Volume: 28  Issue: 2 - February 2024
EDITORIAL
1.Artifical Intelligence and more…
Çetin Erol
PMID: 38295232  PMCID: PMC10837680  doi: 10.14744/AnatolJCardiol.2024.2  Page 73
Abstract |Full Text PDF

REVIEW
2.Artificial Intelligence-Based Clinical Decision Support Systems in Cardiovascular Diseases
Serdar Bozyel, Evrim Şimşek, Duygu Koçyiğit Burunkaya, Arda Güler, Yetkin Korkmaz, Mehmet Şeker, Mehmet Ertürk, Nurgül Keser
PMID: 38168009  PMCID: PMC10837676  doi: 10.14744/AnatolJCardiol.2023.3685  Pages 74 - 86
Despite all the advancements in science, medical knowledge, healthcare, and the healthcare industry, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. The main reasons are the inadequacy of preventive health services and delays in diagnosis due to the increasing population, the failure of physicians to apply guide-based treatments, the lack of continuous patient follow-up, and the low compliance of patients with doctors’ recommendations. Artificial intelligence (AI)-based clinical decision support systems (CDSSs) are systems that support complex decision-making processes by using AI techniques such as data analysis, foresight, and optimization. Artificial intelligence-based CDSSs play an important role in patient care by providing more accurate and personalized information to healthcare professionals in risk assessment, diagnosis, treatment optimization, and monitoring and early warning of CVD. These are just some examples, and the use of AI for CVD decision support systems is rapidly evolving. However, for these systems to be fully reliable and effective, they need to be trained with accurate data and carefully evaluated by medical professionals.

ORIGINAL ARTICLE
3.Turkish Real Life Atrial Fibrillation in Clinical Practice: TRAFFIC Study
Can Yücel Karabay, Hakan Taşolar, Ayşegül Ülgen Kunak, Murat Çap, Mehmet Ali  Astarcıoğlu, Taner Şen, Mehmet Kaplan, Muharrem Said Coşgun, Fahriye Vatansever Ağca, Uğur Arslan, Gönül Açıksarı, Fahri Er, Kadir Uğur  Mert, Öner Özdoğan, Serhat Çalışkan, Ercan Akşit, Ahmet Seyda  Yılmaz, Emrah Aksakal, Zeki Şimşek, Süleyman Çağan  Efe, Gülşah Aktüre, Ferit Böyük, Özcan Başaran, Mehmet Ballı, Ahmet Oğuz  Aslan, Gamze Babur Güler, Ulaankhuu Batgerel, Flora Özkalaycı, Bedri Caner  Kaya, Batur Gönenç  Kanar, Muammer Karakayalı, Emrah Erdoğan, Gürkan İş, Sedat Kalkan, Sinan Demirel, Uğur Aksu, Ümit Güray, Hasan Aydın  Baş, Murat Gök, Mehmet Fatih  Yılmaz, Barış Şimşek, Zeynep Kolak, Melih Öz, Utku Uluköksal, Hüseyin Emre  Kuloğlu, Gizem Çabuk, Fatma Köksal, Ahmet Cem Nizam, Rabia Çoldur, Faysal Şaylık, İbrahim Halil Tanboğa
PMID: 38168008  PMCID: PMC10837672  doi: 10.14744/AnatolJCardiol.2023.3616  Pages 87 - 93
Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and is associated with an increased risk of thromboembolism, ischemic stroke, impaired quality of life, and mortality. The latest research that shows the prevalence and incidence of AF patients in Türkiye was the Turkish Adults’ Heart Disease and Risk Factors study, which included 3,450 patients and collected data until 2006/07.The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study is planned to present current prevalence data, reveal the reflection of new treatment and risk approaches in our country, and develop new prediction models in terms of outcomes.

Methods: The TRAFFIC study is a national, prospective, multicenter, observational registry. The study aims to collect data from at least 1900 patients diagnosed with atrial fibrillation, with the participation of 40 centers from Türkiye. The following data will be collected from patients: baseline demographic characteristics, medical history, vital signs, symptoms of AF, ECG and echocardiographic findings, CHADS2-VASC2 and HAS-BLED (1-year risk of major bleeding) risk scores, interventional treatments, antithrombotic and antiarrhythmic medications, or other medications used by the patients. For patients who use warfarin, international normalized ratio levels will be monitored. Follow-up data will be collected at 6, 12, 18, and 24 months. Primary endpoints are defined as systemic embolism or major safety endpoints (major bleeding, clinically relevant nonmajor bleeding, and minor bleeding as defined by the International Society on Thrombosis and Hemostasis). The main secondary endpoints include major adverse cardiovascular events (systemic embolism, myocardial infarction, and cardiovascular death), all-cause mortality, and hospitalizations due to all causes or specific reasons.

Results: The results of the 12-month follow-up of the study are planned to be shared by the end of 2023.

Conclusion: The TRAFFIC study will reveal the prevalence and incidence, demographic characteristics, and risk profiles of AF patients in Türkiye. Additionally, it will provide insights into how current treatments are reflected in this population. Furthermore, risk prediction modeling and risk scoring can be conducted for patients with AF.

4.Early Systolic Lengthening Is Associated with SYNTAX Score in Patients with Non-ST-Elevation Acute Coronary Syndrome
Tuba Unkun, Çetin Geçmen, Murat Çap, Servet İzci, Emrah Erdoğan, Çağatay Önal, Rezzan Deniz Acar, Ruken Bengi Bakal, Cihangir Kaymaz, Nihal Özdemir
PMID: 37961897  PMCID: PMC10837675  doi: 10.14744/AnatolJCardiol.2023.3064  Pages 94 - 101
Background: Early systolic lengthening is a echocardiographic strain parameter previously used to determine the lesion severity in patients with stable coronary artery disease. In the present study, we aimed to evaluate the relationship between early systolic lengthening and anatomic SYNTAX score in troponin (−) and (+) groups among patients with non-ST-elevation acute coronary syndrome (ACS).

Methods: A total of 95 patients diagnosed with non-ST-elevation ACS were included in the prospective, non-randomized, single-center study. The patients were categorized into 2 groups as troponin (+) and troponin (−). The patients were evaluated in terms of echocardiographic, clinical, and angiographic parameters.

Results: The baseline characteristics, including age (58 ± 13 vs. 60 ± 10 respectively, P =.340), a history of hypertension (67.1% vs. 64%, respectively, P =.479), diabetes (28.6% vs. 32%, respectively, P =.467), global longitudinal strain (−14.37 ± 5.11 vs. −16.42 ± 3.93, respectively, P =.095), left ventricular ejection fraction (58.71 ± 8.73 vs. 57.20 ± 8.70, respectively, P =.263), and E/e’ (8.44 ± 2.13 vs. 8.33 ± 1.99, respectively, P =.785), were similar between troponin (+) and troponin (−) groups. Left ventricle end-systolic diameter (3.2 ± 0.78; 3.50 ± 0.74 vs. 3.2 ± 0.78, respectively, P =.031), left ventricle end-systolic volume (55.57 ± 32.17 vs. 38.28 ± 13.63, respectively, P =.013), left ventricle end-diastolic volume (115.31 ± 49.54 vs. 91.23 ± 20.57, respectively, P =.042), the rate of early systolic lengthening (65.7% vs. 28%, respectively, P =.001), the duration of early systolic lengthening (24.02 ± 31 ms vs. 15.56 ± 30.19 ms, respectively, P =.009), and the SYNTAX score (16 ± 11 vs. 10 ± 10, respectively, P =.023) were higher in the troponin (+) group. Furthermore, a significant correlation was found between early systolic lengthening and SYNTAX score (r = 0.43, P <.001).

Conclusion: The rate and duration of early systolic lengthening were higher in patients in the troponin (+) group. Early systolic lengthening is related to SYNTAX score in patients with non-ST-elevation ACS.

5.The Relationship Between Endocan and Serum Inflammatory Markers in Patients with Senile Calcific Aortic Stenosis
Didar Elif Akgün, Eyüp Avcı, Ali Yaman, Özgen Şafak, Halil Lütfi Kısacık, Onur Argan, Seda Elçim Yıldırım, Tarık Yıldırım, Abdulrahman Naser, Murat Gençbay, Tuncay Kırış
PMID: 38168010  PMCID: PMC10837674  doi: 10.14744/AnatolJCardiol.2023.3695  Pages 102 - 108
Background: Endocan is an indicator of many pathologies accompanied by inflammation, endothelial cell activation, and dysfunction. In this study, we examined the relationship between degenerative aortic sclerosis, which progresses in a similar pathophysiologic mechanism as atherosclerosis, and serum inflammatory markers and endocan levels.

Methods: A total of 155 patients without known coronary artery disease, aged between 65 and 80 years, were consecutively included in the prospective cross-sectional study. The study population was analyzed in 4 different groups. The control group consisted of patients with normal aortic valve structure, while patients with aortic stenosis were classified as mild aortic stenosis (2-2.9 m/s), moderate aortic stenosis (3-3.9 m/s), and severe aortic stenosis (≥ 4 m/s) according to their aortic velocity. While there were 39 patients in the control group, there were 58, 24, and 34 patients in the mild, moderate, and severe aortic stenosis groups, respectively.

Results: There was no statistically significant difference between the groups in terms of patient distribution and characteristics. History of dyspnea and angina was correlated with the severity of aortic stenosis (P <.001). In this study, no statistically significant correlation was found between serum endocan levels and the severity of aortic stenosis (control group: 17.3 ± 6.3 ng/mL, mild aortic stenosis: 17.6 ± 8.7 ng/mL, moderate aortic stenosis: 16.3 ± 3.8 ng/mL, severe aortic stenosis: 15.2 ± 5.9 ng/mL, P =.396). However, it was figured out that there was a positive correlation between endocan levels and hemoglobin (Hg) (r = 0.308, P =.001), platelet (PLT) (r = 0.320, P <.001), and albumin (Alb) (r = 0.206, P =.026).

Conclusion: In this study, no significant correlation was found between serum endocan levels and the severity of aortic stenosis. On the other hand, there was a positive correlation between endocan levels and Hg, PLT, and Alb.

6.Comparison of Evolut-R 34 mm Valve and Smaller Evolut-R Valves in Patients Undergoing Transcatheter Aortic Valve Implantation and Determination of Mild Paravalvular Leak Predictors
Raif Kılıç, Tuncay Güzel, Adem Aktan, Muhammed Demir, Serhat Günlü, Bayram Arslan, Faruk Ertaş
PMID: 38221789  PMCID: PMC10837679  doi: 10.14744/AnatolJCardiol.2023.3563  Pages 109 - 117
Objective: The main purpose of this study was to evaluate and compare the in-hospital, 1-month and 1-year post-procedure outcomes of patients treated with Evolut-R 34 mm and Evolut-R 23/26/29 mm devices. Additionally, the study aimed to identify factors that could predict the occurrence of ≥ mild paravalvular leaks (PVL).

Methods: Between April 2015 and May 2022, 269 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) with Evolut-R 34 mm (n = 66, 24.5%) and Evolut-R 23/26/29 mm (n = 203, 75.5%) devices in a single center were retrospectively analyzed.

Results: Patients in the Evolut-R 34 mm group had a lower female sex ratio (16.7% vs. 66.5%, P <.001, respectively), ejection fraction (50.7 ± 10.1% vs. 54.5 ± 9.3%, P =.016, respectively), and mean aortic gradient (7.4 ± 3.3 vs. 9.2 ± 5.0, P =.026, respectively) compared to the Evolut-R 23/26/29 mm group. The groups did not exhibit any statistically significant distinctions with regard to technical success, the need for a permanent pacemaker, occurrences of stroke, major vascular complications, PVL, major adverse cardiovascular and cerebrovascular events, or mortality. Peak velocity was confirmed as a significant predictor of ≥mild PVL in both patient groups in the receiver operating characteristic curve analysis. In logistic regression analysis; In patients with Evolut-R 34 mm valve, pre-TAVI aortic valve peak velocity (odds ratio (OR) = 23.202; P =.019) and calcium volume 800 Hounsfield Units (mm3) (OR = 1.017; P <.001) were independent predictors of ≥mild PVL.

Conclusion: The Evolut-R 34 mm valve has shown comparable in-hospital results with smaller valve sizes. Pre-TAVI aortic valve peak velocity and calcium volume predicted ≥ mild PVL in Evolut-R 34 mm patients.

7.Cartoid Near Occlusion: Time to Re-think Endarectomy?
Hasan İner, Orhan Gökalp, İsmail Yürekli, Börtecin Eygi, Çağrı Kandemir, Tahsin Murat Tellioğlu, Levent Yılık, Ali Gürbüz
PMID: 38221790  PMCID: PMC10837671  doi: 10.14744/AnatolJCardiol.2023.3779  Pages 118 - 123
Objectives: Carotid near occlusion (CNO) treatment is still controversial. In the discussion of surgical revascularization of these patients, periprocedural complications and technical failure should be considered in addition to the long-term results. We examined the efficacy and safety of surgical treatment in CNO and non-CNO patients undergoing carotid endarterectomy (CEA).

Methods: Data from 152 patients (118 male and 34 female) who underwent isolated CEA between January 2018 and June 2020 without critical contralateral lesions were retrospectively analyzed. Patients were divided into 2 groups: CNO (n = 52) and non-CNO (n = 100). The groups were compared regarding postoperative transient ischemic attack (TIA), ipsilateral ischemic stroke, and mortality.

Results: The success rate of the procedure was 100% in the CNO group and 99% in the Non-CNO group. In the Non-CNO group, 1 patient had ipsilateral ischemic stroke on postoperative day 0, and this patient was treated with carotid artery stenting. While the number of patients who died in the non-CNO group was 3 (3%) overall, the exitus rate was 1 (1.9%) in the CNO group (P >.05). In the CNO group, retinal TIA was observed in 1 patient (1.9%), ischemic stroke in 2 patients (3.8%), and TIA in 1 patient (1.9%). In the non-CNO group; Retinal TIA was observed in 1 patient (1.0%), ischemic stroke in 2 patients (2.0%), and TIA in 2 patients (2.0%). There was no statistically significant difference between the groups in terms of postoperative neurologic complications and primary endpoints at 12-month follow-up (P >.05).

Conclusions: Carotid endarterectomy is a safe, feasible, and advantageous procedure in selected CNO patients, as in non-CNO carotid artery patients. Therefore, we recommend a surgical approach to prevent neurological events in CNO patients.

CASE REPORT
8.Simultaneous Bentall Procedure and Partial Atrioventricular Septal Defect Repair in a 64-Year-Old Patient with Idiopathic Thrombocytopenic Purpura: A Case Report and Literature Review
Melike Demir, Ergida Albrahimi, Erkin Yılmaz, İlknur Şahin, Nevzat Cem Sayılgan, Eser Durmaz, Suat Nail Ömeroğlu, Oktay Korun
PMID: 38234167  PMCID: PMC10837677  doi: 10.14744/AnatolJCardiol.2023.3752  Pages 124 - 127
Abstract |Full Text PDF

LETTER TO THE EDITOR
9.Cardiotoxicity Associated with Antihuman Epidermal Growth Factor Receptor-2 Therapy: Particular Aspects of a Specific Phenomenon
Kenan Yalta
PMID: 38295233  PMCID: PMC10837673  doi: 10.14744/AnatolJCardiol.2023.4093  Pages 128 - 129
Abstract |Full Text PDF

LETTER TO THE EDITOR REPLY
10.Reply to Letter to the Editor: “Cardiotoxicity Associated with Antihuman Epidermal Growth Factor Receptor-2 Therapy: Particular Aspects of a Specific Phenomenon”
Yusuf Ziya Şener, Selin Ardalı Düzgün, Tuncay Hazırolan, Lale Tokgözoğlu
PMID: 38295234  PMCID: PMC10837670  doi: 10.14744/AnatolJCardiol.2023.4095  Pages 130 - 131
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
11.Circumaortic Left Brachiocephalic Vein with Coarctation of Aorta
Pavithra Subramanian, Arun Sharma, Manphool Singhal
PMID: 37961900  PMCID: PMC10837678  doi: 10.14744/AnatolJCardiol.2023.3874  Page E6
Abstract |Full Text PDF

12.Complete Atrioventricular Block Due to Atrioventricular Node Invasion in a Malignant Melanoma Patient
Akın Torun, Yusuf Turan Gül, Samet Yavuz, Yiğithan Okar, Mehmet Uzun
PMID: 37882350  PMCID: PMC10837669  doi: 10.14744/AnatolJCardiol.2023.3896  Pages E7 - E8
Abstract |Full Text PDF



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