ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 41 (7)
Volume: 41  Issue: 7 - October 2013
ORIGINAL ARTICLE
1. Increased serum asymmetric dimethylarginine level is an independent predictor of contrast-induced nephropathy
Özgür Günebakmaz, Mustafa Duran, Ekrem Karakaya, Esen Tanrıkulu, Mahmut Akpek, Ali Ergin, Mehmet Güngör Kaya
PMID: 24164987  doi: 10.5543/tkda.2013.88403  Pages 581 - 588
Objectives: The aim of our study was to evaluate whether serum asymmetric dimethylarginine (ADMA) level is an independent predictor of contrast-induced nephropathy (CIN).
Study design: The study involved 90 consecutive patients with stable angina pectoris who underwent coronary angiography and ventriculography. Baseline serum creatinine (SCr) levels ranged between ≥1.2 and <2 mg/dl. All patients were hydrated with intravenous isotonic saline at a rate of 1 ml/kg per hour for 6 hours before and 12 hours after the procedure. The primary end point was the occurrence of CIN. The secondary end point was the change in SCr levels at day 2 after the contrast exposure. Serum ADMA was determined by the ELISA method.
Results: The CIN rate was 11.1%. We detected a statistically significantly higher serum ADMA level in the CIN(+) group compared to that of the CIN(–) group [210.6 ng/ml (115.6-217.2) vs. 91.5 ng/ml (65.2-122.1), p=0.01]. Mehran risk score and diabetes mellitus (DM) ratio were higher in the CIN(+) group compared to those values in the CIN(-) group [8 (5.75-10) vs. 5 (5-7), p=0.01 and 70% vs. 26.3%, p=0.01, respectively]. Serum ADMA level, Mehran risk score and DM were independent predictors of CIN (odds ratio (OR) 1.030, 95% confidence interval (CI) 1.011-1.050, p=0.002; OR 1.565, 95% CI 1.102- 2.223, p=0.012; OR 9.422, 95% CI 1.441-61.598, p=0.019, respectively). A serum ADMA level of >124.7 ng/ml had 80% sensitivity and 76% specificity in predicting the development of CIN. In addition, we found a positive correlation between SCr change and serum ADMA level (p=0.001, r=0.35).
Conclusion: Our study demonstrates that increased serum ADMA level is an independent predictor of CIN.

2. Relationship between D-dimer and systemic embolism in patients with infective endocarditis
Ruken Bengi Bakal, Süleyman Karakoyun, Gökhan Kahveci, Olcay Özveren, Onur Omaygenç, Suzan Hatipoğlu Akpınar, Taylan Akgün, Nihal Özdemir
PMID: 24164988  doi: 10.5543/tkda.2013.02058  Pages 589 - 594
Objectives: The aim of this study was to investigate the value of plasma D-dimer (DD) levels for predicting systemic embolism in patients with infective endocarditis (IE).
Study design: A total of 42 patients (mean age: 46±16 years; 78% males) with IE were included. Clinical, laboratory and echocardiographic findings of the patients were evaluated.
Results: Increased plasma DD levels were determined in 13 patients with systemic embolism (p=0.016). Moreover, when patients were divided in two groups as DD >500 ng/dl and DD <500 ng/dl, systemic embolism was increased in the DD >500 ng/dl group (p=0.036). Receiver operating characteristics (ROC) curve analysis was performed to detect the best cut-off value of DD in the prediction of systemic embolism. DD >425 ng/dl yielded an area under the curve (AUC) value of 0.735 (95% CI 0.560-0.909, p=0.016). DD >425 ng/dl demonstrated a sensitivity of 77% and specificity of 62% for the prediction of clinical embolism. Hematocrit (r=-0.31, p=0.045), platelet count (r=-0.40, p=0.009), albumin (r=-0.37, p=0.026), and globulin (r=0.38, p=0.028) levels were correlated with DD levels.
Conclusion: Plasma DD levels are increased in patients with IE who suffered from clinically significant systemic embolism. Further studies are needed to determine the predictive value of DD levels for clinically silent systemic embolism.

3. Editorial: Using the D-dimer test in infective endocarditis
Recep Demirbağ
PMID: 24164989  doi: 10.5543/tkda.2013.09483  Pages 595 - 597
D-dimer is a global indicator of coagulation activation. Levels of D-dimer are elevated in a wide variety of inflammatory and prothrombotic conditions. Clinicians should be aware of the possibility of systemic embolism in infective endocarditis patients with elevated D-dimer levels. Comprehensive evaluation of the patients, consisting of clinical risk assessment in combination with measurement of D-dimer level besides other suggested risk parameters for embolism in infective endocarditis.

4. No relevant association between coronary artery ectasia and mean platelet volume, gamma-glutamyltransferase and uric acid levels
Bahadır Şarlı, Ahmet Oğuz Baktır, Hayrettin Sağlam, Hüseyin Arınç, Serkan Kurtul, Zakir Karadağ, Hüseyin Katlandur, Mahmut Akpek, Mehmet Güngör Kaya
PMID: 24164990  doi: 10.5543/tkda.2013.03704  Pages 598 - 603
Objectives: In this study, we aimed to investigate whether there is an association between mean platelet volume (MPV), gamma-glutamyltransferase (GGT) and uric acid and coronary artery ectasia (CAE) in a large patient population.
Study design: A total of 406 patients (245 male, 161 female; mean age: 55±9 years) were selected retrospectively as the study population from among 3265 individuals who underwent coronary angiography between August 2011 and December 2012. Information regarding blood tests of the patients obtained during hospitalization was extracted from the institute electronic database.
Results: MPV, GGT and uric acid levels were significantly higher in subjects with stenotic coronary artery disease (CAD) and in subjects with both CAD and CAE compared with subjects with isolated CAE and subjects with normal coronary arteries (NCA). There were no significant differences between the isolated CAE and NCA groups in terms of MPV (8.6±1.2 fL vs. 8.6±1.1, respectively, p=0.993), serum GGT (33±15 U/L vs. 30±15 U/L, respectively, p=0.723) and uric acid levels (5.4±1.6 mg/dl vs. 5.2±1.7 mg/dl, respectively, p=0.845).
Conclusion: Unlike previous studies, our study failed to demonstrate any association between CAE and MPV, uric acid and GGT levels.

5. Association between neutrophil to lymphocyte ratio and pulmonary arterial hypertension
Abdulkadir Yıldız, Hasan Kaya, Faruk Ertas, Mustafa Oylumlu, Mehmet Zihni Bilik, Murat Yüksel, Nihat Polat, Mehmet Ata Akil, Zuhal Atılgan, Mehmet Sıddık Ülgen
PMID: 24164991  doi: 10.5543/tkda.2013.93385  Pages 604 - 609
Objectives: Pulmonary hypertension (PH) is composed of a heterogeneous group of disorders marked by increased pulmonary artery resistance leading to right heart failure, with high mortality. Evidence is increasing to propose that inflammation plays a significant role in the pathophysiological mechanism. Increased prevalence of PH in patients with systemic inflammatory diseases is already known. Herein, we sought to evaluate the association between neutrophil to lymphocyte ratio (N/L ratio) and pulmonary arterial hypertension (PAH).
Study design: Twenty-five patients with PAH and 25 controls were evaluated. Baseline clinical and echocardiographic variables were obtained. Complete blood counts in all patients and controls were reviewed retrospectively.
Results: The N/L ratio was higher in patients with PAH compared to healthy volunteers (p=0.05). A cut-off value of 1.65 for N/L ratio predicted the presence of PAH with 72% sensitivity and 69% specificity. After multivariate analysis, only N/L ratio remained a significant predictor of PAH.
Conclusion: We showed for the first time that N/L ratio was significantly increased in patients with PAH compared to controls.

6. Relation of heart-type fatty acid-binding protein with the degree and extent of atherosclerosis in patients with non-ST elevation acute coronary syndrome
Gönül Zeren, Hatice Betül Erer, Tuncay Kırış, Osman Şahin, Hüseyin Aksu, Diyar Köprülü, Tolga Sinan Güvenç, Güney Erdoğan, Nurten Sayar, Zeki Yüksel Günaydın, Mehmet Eren
PMID: 24164992  doi: 10.5543/tkda.2013.26974  Pages 610 - 616
Objectives: The relationship between markers of myocardial ischemia and severity of coronary artery disease (CAD) has been investigated in several studies. In this study, we examined the relationship between severity of CAD and heart-type fatty acid-binding protein (H-FABP), a new marker of ischemia in patients with non-ST-segment elevation acute coronary syndrome (ACS).
Study design: This prospective study comprised 49 patients who were referred to the emergency room with a diagnosis of non-ST elevation myocardial infarction. Troponins, creatine kinase-MB, lactate dehydrogenase, and aspartate aminotransferase levels were measured quantitatively, while blood H-FABP levels were measured qualitatively in the 4th- 8th hour from the onset of symptoms. All patients underwent coronary angiography within 72 hours after admission. Clinical and coronary angiographic characteristics of patients with positive and negative values of H-FABP were compared. Gensini and SYNTAX scores were used to determine the severity of CAD.
Results: There were no statistically significant differences in mean age, gender distribution, risk factors for CAD, ischemic changes on ECG, or Gensini and SYNTAX scores between the H-FABP-negative and -positive groups (p>0.05). The duration of chest pain in the H-FABP-positive group was significantly longer than in the negative group (p<0.001). Troponin, CK-MB, and AST levels as well as thrombolysis in myocardial infarction (TIMI) risk scores were found to be significantly higher in the H-FABP-positive group (p<0.05).
Conclusion: H-FABP is a useful marker for the diagnosis and risk evaluation of patients with non-ST elevation ACS. However, it is insufficient in evaluating the severity of CAD.

7. Relation of plasma matrix metalloproteinase-8 levels late after myocardial infarction with left ventricular volumes and ejection fractio
Ayhan Erkol, Selçuk Pala, Vecih Oduncu, Alev Kılıcgedik, Filiz Kızılırmak, Can Yücel Karabay, Ahmet Güler, Cevat Kırma
PMID: 24164993  doi: 10.5543/tkda.2013.68625  Pages 617 - 624
Objectives: Enhanced matrix metalloproteinase-8 (MMP-8) activity in the early post-myocardial infarction (MI) period has been related to early remodeling. However, it has been demonstrated that plasma MMP-8 level has a biphasic profile, and the relation between the late plasma levels and remodeling is unclear. We evaluated the plasma MMP-8 levels and its correlates 20±3 months after acute MI.
Study design: 58 post-MI patients and 26 control subjects underwent quantitative single-photon emission computed tomography (SPECT) and echocardiography. The plasma MMP-8 levels were measured and its correlates were investigated.
Results: The MMP-8 levels were significantly higher in post- MI patients [median 3.88 ng/ml, interquartile range (1.88- 6.43) vs. 0.67 ng/ml (0.34-2.47); p<0.001]. Plasma MMP-8 levels were significantly correlated with left ventricular ejection fraction (LVEF) (ρ=0.34, p=0.009), end diastolic volume index (EDVi) (ρ=-0.39, p=0.002) and end systolic volume index (ESVi) (ρ=-0.40, p=0.002).
Conclusion: Plasma MMP-8 levels were found to still be high in post-MI patients 20±3 months after the index event. The levels were significantly correlated with left ventricular volume indices and LVEF. We speculate that, in contrast to the relation between the higher early MMP-8 activity and the extent of cardiac remodeling, higher late levels may be associated with relative preservation of left ventricular systolic function.

CASE REPORT
8. Left ventricular thrombus formation in a patient with normal ejection fraction
Nihan Kahya Eren, Sadık Volkan Emren, Hamza Duygu, Uğur Kocabaş
PMID: 24164994  doi: 10.5543/tkda.2013.71598  Pages 625 - 628
Left ventricular (LV) thrombi usually occur in the presence of impaired LV function, such as in dilated cardiomyopathy, aneurysm or following myocardial infarction. Thrombus formation in a normally functioning LV is extremely rare. We report a patient with LV thrombus formation despite a normal systolic function. The patient, who was admitted to the emergency service with transient loss of consciousness and diagnosed with cerebral embolism, was found to have a pedunculated and hypermobile mass in the LV apex by echocardiography. The LV mass was excised by urgent surgery due to its high embolic risk. The histopathological examination revealed that the LV mass was a thrombus. This case highlights that although very rare, LV thrombus formation may occur in patients with normal ejection fraction.

9. Rapidly improving acute myocarditis after a scorpion sting
Nermin Bayar, Selçuk Küçükseymen, İsa Öner Yüksel, Şakir Arslan
PMID: 24164995  doi: 10.5543/tkda.2013.36459  Pages 629 - 632
Scorpion stings are usually benign, but especially cardiovascular death has been reported due to complications. Local reactions at the site of the sting as well as organ dysfunction may be due to the effects of a systemic toxin. As a result of the toxic effects of the scorpion toxin on the cardiovascular system, hypertension, arrhythmia, myocarditis, acute heart failure, and pulmonary edema may occur. In this report, we present a 49-year-old male patient who was admitted to our hospital with acute pulmonary edema and respiratory distress following scorpion sting at the wrist. In this case, detection of diffuse left ventricular systolic dysfunction on presentation, immediate improvement with medical treatment, and increased troponin levels in the absence of critical stenosis on coronary angiography suggest the diagnosis of acute myocarditis associated with scorpion bite.

10. A new hope in the treatment of coronary vasospasm: bosentan
İlker Gül, Ahmet Çağrı Aykan, Tayyar Gökdeniz, Şükrü Çelik
PMID: 24164996  doi: 10.5543/tkda.2013.37998  Pages 633 - 637
Atherosclerosis is the most important cause of acute coronary syndromes. The mediators that trigger vasospasm, including endothelin and serotonin, are synthesized and secreted into circulation from atherosclerotic plaques and surrounding tissues. A 68-year-old man was hospitalized due to acute coronary syndrome four times in a one-year period. The patient presented to emergency service again with heartburn and a pressure-like pain in his upper abdomen in February 2012. He was admitted to the coronary care unit with the detection of a more than three-fold increase in troponin values and ischemic changes on electrocardiography. By decision of the cardiology council, the endothelin receptor antagonist, bosentan was added to the treatment. There were no contraindications to this medication according to his blood and hepatic indicators. After confirmation of the Social Security Institution, bosentan was started as 62.5 mg twice a day. After the first month, the dose was increased to 125 mg b.i.d. As of completion of the eighth month of treatment with bosentan, the patient had not been hospitalized due to angina attack or acute coronary syndrome.

11. Heart failure after transvenous closure of atrial septal defect associated with atrial standstill and thiamine-responsive megaloblastic anemia
Vehbı Dogan, Filiz Şenocak, Utku Arman Örün, Özben Ceylan
PMID: 24164997  doi: 10.5543/tkda.2013.63295  Pages 638 - 641
Despite advances in device closure for atrial septal defect, post-closure heart failure remains a clinical problem in adult patients but is seen only rarely in children. An eight-year-old boy, who had been followed by a local pediatrician with the diagnosis of diabetes mellitus and congenital heart disease, was consulted to us for cardiac re-evaluation. Electrocardiography demonstrated absent P waves, and echocardiography revealed enlargement of the right ventricle and both atria and secundum atrial septal defect. With the diagnosis of atrial standstill, secundum atrial septal defect and thiamine-responsive megaloblastic anemia, acute heart failure developed after transvenous closure of the atrial septal defect, which improved dramatically with thiamine and supportive treatment.

12. A huge intracardiac thrombus developed in the presence of antithrombin III deficiency in a patient with end-stage renal failure
Fatih Köksal Binnetoğlu, Kadir Babaoğlu, Nazan Sarper, Kenan Bek
PMID: 24164998  doi: 10.5543/tkda.2013.88288  Pages 642 - 645
In this study, we report a 15-year-old female with end-stage renal disease undergoing hemodialysis, who admitted with acute respiratory failure and generalized edema. Abdominal tomography detected thrombi in the right renal vein, in the hepatic segment of the inferior vena cava and in iliac veins. Levels of proteins C and S, antinuclear antigen, anti-dsDNA, C3, and C4 were in normal limits. The thrombi persisted despite treatment with nadroparin, heparin with fresh frozen plasma and warfarin. Due to heparin resistance, antithrombin III levels were measured and were found abnormally low. The first echocardiographic examination was in normal limits but the second echocardiography revealed a huge thrombus occluding the tricuspid valve. Urgent thrombectomy was planned but the patient died in the intensive care unit due to severe pulmonary edema.

13. Chest pain with myocardial ischemia in a child: should we think about coronary slow flow phenomenon?
Abdullah Kocabaş, Fırat Kardelen, Gayaz Akçurin, Halil Ertuğ
PMID: 24164999  doi: 10.5543/tkda.2013.50951  Pages 646 - 650
The coronary slow flow phenomenon (CSFP) is an angiographic finding characterized by delayed opacification of epicardial coronary arteries in the absence of stenotic lesion. Herein, we present a 13-year-old boy with recurrent chest pain who was diagnosed with acute ST-segment elevation myocardial infarction associated with CSFP, which has not been reported previously in the pediatric age group. Coronary angiography revealed only the presence of slow flow in the left anterior descending (LAD) coronary artery. Myocardial perfusion scintigraphy revealed a reversible perfusion defect in the LAD territory, which regressed partially at rest and showed complete improvement after dipyridamole infusion. All the symptoms, electrocardiogram abnormalities and cardiac markers returned to normal after dipyridamole treatment during the follow-up. We conclude that CSFP should be kept in mind in the differential diagnosis of chest pain with myocardial ischemia in the pediatric age group.

HOW TO?
14. Suggestions on how to do? How to Perform Electrical Cardioversion
Dursun Aras, Firdevs Ayşenur Ekizler
PMID: 24165000  Pages 651 - 655
Abstract |Full Text PDF

15. ESC National Societies Cardiovascular Journals Editors´ Network Championing cardiovascular health innovation in Europe
Michel Komajda, Andrew Coats, Martin R. Cowie, Neville Jackson, Anders Svensson, Panagiotis Vardas
PMID: 24165001  Pages 656 - 663
Abstract |Full Text PDF

INVITED REVIEW
16. Editorial - Championing cardiovascular health innovation in Europe
Adnan Abacı
PMID: 24165002  doi: 10.1093/eurheartj/eht211  Pages 664 - 666
Yazının türü gereği özet verilmemiştir.

CASE IMAGE
17. An unusual cause of implantable cardioverter defibrillator malfunction: Twiddler syndrome
Ufuk Eryılmaz, Hasan Güngör, Çağdaş Akgüllü
PMID: 24165003  doi: 10.5543/tkda.2013.18828  Page 667
Abstract |Full Text PDF

18. A rare coronary artery anomaly: posterior descending artery arising from septal perforator artery
Fatih Mehmet Uçar, Murat Gül, Rıza Sarper Ökten, Serkan Topaloğlu, Esra Gücük
PMID: 24165004  doi: 10.5543/tkda.2013.48840  Page 668
Abstract |Full Text PDF | Video

19. Non-obstructive supracardiac total anomalous pulmonary venous return in a 3-year-old patient who was admitted with complaint of mild cyanosis
Yılmaz Yozgat, Onder Doksöz, Rahmi Özdemir, Timur Meşe
PMID: 24165005  doi: 10.5543/tkda.2013.57142  Page 669
Abstract |Full Text PDF | Video

20. Cardiac metastasis of an esophageal cancer: a rare cause of ventricular tachycardia and left ventricle outlet obstruction
Ozcan Basaran, Can Yucel Karabay, Ahmet Guler, Cevat Kırma
PMID: 24165006  doi: 10.5543/tkda.2013.28475  Page 670
Abstract |Full Text PDF

21. Cor triatriatum sinister with non-fenestration in a seven-month-old patient
Yılmaz Yozgat, Önder Doksoz, Cem Karadeniz, Timur Meşe
PMID: 24165007  doi: 10.5543/tkda.2013.79346  Page 671
Abstract |Full Text PDF

22. Answers of specialist
Murat Özdemir
Page 672
Abstract |Full Text PDF

23. Comments on cardiology publications
Ertan Ural
Page 673
Abstract |Full Text PDF



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