ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 42 (1)
Volume: 42  Issue: 1 - January 2014
EDITORIAL
1. xxx x
Cem Barçın
Pages 1 - 6
xx
x

2. What has changed with the new European Society of Cardiology/European Society of Hypertension guideline?
Cem Barçın
PMID: 24481087  doi: 10.5543/tkda.2014.46095  Pages 1 - 6
INTRODUCTION: Avrupa Kardiyoloji ve Hipertansiyon Derneklerinin (ESC/ESH) 2013 yılında Arteriyal Hipertansiyonun Yönetimi konusunda yayımladığı son kılavuz, derneğin bir önceki 2007 yılı kılavuzuna göre bazı önemli farklılıklar içermektedir.[1,2] Amerikan Kardiyoloji Koleji (ACC) ve Amerikan Kalp Cemiyetinin (AHA) en son kılavuzu olan Birleşik Ulusal Komite (JNC) 7’nin yayınlanmasından sonra yaklaşık 10 yıl geçtiği düşünülürse, uluslararası nitelikteki ESC/AHA kılavuzu tüm ülkelerde çok dikkatle incelenmiştir.

ACC/AHA’nın uzun süredir beklenen JNC 8 raporu 2013 yılının son ayı içerisinde çok özet bir şekilde bilimsel literatüre girmiştir.[3] Ancak beklenmeyen bir şekilde, yine 2013 yılı Aralık ayında Amerikan Hipertansiyon ve Uluslararası Hipertansiyon Dernekleri (ASH/ISH) ortaklaşa ve JNC8’den ayrı bir başka hipertansiyon kılavuzu yayımlamıştır.[3,4] Bu durum aslında JNC 8’i birlikte çıkarmaları beklenen bu gruplar arasında her konuda fikir birliği olmadığını düşündürmektedir.

Bu yazıda temel olarak ESC/ESH 2013 kılavuzu ve bunun eski kılavuzlara göre neleri değiştirdiği veya vurguladığı kısaca ele alınacaktır
METHODS:
RESULTS:
DISCUSSION AND CONCLUSION:

3. Stable coronary artery disease management: What has changed in the 2013 European Society of Cardiology guideline?
M. Emre Özpelit, Nihat Pekel, İstemihan Tengiz
PMID: 24481088  doi: 10.5543/tkda.2014.26628  Pages 7 - 10
Abstract |Full Text PDF

ORIGINAL ARTICLE
4. The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation
Mehmet Akkaya, Nassir Marrouche, Koji Higuchi, Matthias Koopmann, Kavitha Damal, Eugene Kholmovski, Chris Mcgann
PMID: 24481089  doi: 10.5543/tkda.2014.20726  Pages 11 - 19
The extent of left atrial (LA) wall structural remodeling (fibrosis) detected by late gadolinium enhancementmagnetic resonance imaging (LGE-MRI) is correlated with advanced atrial fibrillation (AF). The concomitant occurrence of AF and left ventricular (LV) dysfunction is not uncommon. We studied the effect of LA fibrosis, a confounder of both AF and LV dysfunction, on LV ejection fraction (EF).
For the analysis, we identified and included 384 patients from our retrospective AF database who underwent LGE-MRI and transthoracic echocardiography prior to AF ablation. Based on the degree of LA fibrosis, patients were categorized into four stages as: Utah 1 (<5% LA fibrosis), Utah 2 (5–20% fibrosis), Utah 3 (20–35% fibrosis), and Utah 4 (>35% fibrosis).
The average pre-ablation LVEF was 60.5%±8.5% (n=24) in Utah stage 1 patients, 55.7%±10.3% (n=240) in Utah stage 2 patients, 51.7±11.5% (n=90) in Utah stage 3 patients, and 48.9%±11.6% (n=30) in Utah stage 4 patients (p<0.001, one-way ANOVA). The percentage of LA fibrosis was significantly negatively correlated to LVEF pre-ablation in a univariate analysis (p<0.001). In a multivariate model accounting for age, gender, AF type, and comorbidities such as diabetes and hypertension, Utah stage remained a significant predictor of pre-ablation EF (p<0.001).
Patients with extensive LA fibrosis appear to have depressed LV function pre-ablation, suggesting that structural remodeling in the LA may also be triggering and promoting remodeling within the ventricular myocardium.

5. Editorial: Left atrial fibrosis affects left ventricular systolic function in patients with atrial fibrillation
Elif Eroğlu
PMID: 24481090  doi: 10.5543/tkda.2014.62661  Pages 20 - 21
Abstract |Full Text PDF

6. Relation between mean platelet volume and subclinical atherosclerosis in patients with metabolic syndrome
Ali Rıza Gülcan, Mustafa Serkan Karakaş, Barış Akdemir, Mustafa Uçar, Refik Emre Altekin, Hüseyin Yılmaz
PMID: 24481091  doi: 10.5543/tkda.2014/50708  Pages 22 - 28
Objectives: Metabolic syndrome (MetS) is associated with increased cardiovascular morbidity and mortality. There is evidence of platelet activation in MetS. Mean platelet volume (MPV), a determinant of platelet activation, is a newly emerging risk factor for atherothrombosis. Therefore, we investigated the possible association between subclinical atherosclerosis, as evaluated by carotid intima-media thickness (CIMT) measurement and MPV, in MetS patients.
Study design: Seventy-four patients with MetS were enrolled in the study. Patients were divided into two groups according to CIMT measurement: 35 patients with CIMT ≥1.0 mm were in Group 1 and 39 patients with CIMT <1.0 mm were in Group 2. MPV was measured using an automated blood cell counter.
Results: The MPV level was significantly higher in patients with CIMT ≥1.0 mm than in patients with CIMT <1.0 mm (8.2±0.7 vs. 7.8±0.6 fl; p=0.01). In our study, we observed that platelet count was lower in KIMK ≥1.0 mm group and this finding was also found to be statistically significant.
Conclusion: The risk of atherosclerosis could be shown by following the MPV values in MetS patients. Therefore, our results suggest that MPV is an important marker for early detection of atherosclerotic risk in patients with MetS.

7. Evaluation of Tp-e interval and Tp-e/QT ratio in patients with rheumatoid arthritis
Gurkan Acar, Murat Akkoyun, Alper Buğra Nacar, İmran Dirnak, Gözde Yıldırım Çetin, Makbule Nur Yıldırım, Cemil Zencir, Kayıhan Karaman, Mustafa Çetin, Mehmet Sayarlıoğlu
PMID: 24481092  doi: 10.5543/tkda.2014/52959  Pages 29 - 34
Objective: Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that inreased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate ventricular repolarization by using Tp-e interval and Tp-e/QT ratio in patients with rheumatoid arthritis (RA), and to assess the relation with inflammation.
Study design: Ninety-six patients with RA and and 50 controls were included. From the 12-lead electrocardiogram Tp-e interval and Tp-e/QT ratio were measured. Blood samples were taken for erythrocyte sedimentation rate (ESR) and plasma levels of C-reactive protein (CRP). These parameters were compared between groups. The relationship between ventricular repolarization and inflammation was assessed by Pearson correlation coefficients.
Results: Tp-e interval and Tp-e/QT ratio were increased in RA patients compared to the controls (72.6±8.2 vs 66.4±8.5 milliseconds, 0.20 ± 0.02 vs 0.18 ± 0.02; P<0.001 and P<0.001, respectively). Tp-e interval was significantly correlated with CRP, ESR, and disease acticity score (DAS-28) (r=0.56, P<0.001, r=0.57, P<0.001, and r=0.29, P=0.02, respectively). Tp-e/QT ratio was also correlated with CRP, ESR, and DAS-28 score (r=0.43, P<0.001, r=0.53, P<0.001, and r=0.25, P=0.03, respectively).
Conclusions: Increased frequency of ventricular arrhythmias may explain by increased indexes of ventricular repolarization and their relationship with inflammation in RA patients.

8. Evaluation of the long-term effect of percutaneous balloon valvuloplasty on right ventricular function using tissue Doppler imaging in patients with mitral stenosis
Zekeriya Kaya, Hekim Karapınar, Hasan Kaya, Özlem Batukan Esen, Mustafa Akçakoyun, Göksel Acar, Ali Metin Esen, Cevat Kırma
PMID: 24481093  doi: 10.5543/tkda.2014.52711  Pages 35 - 43
Objectives: We investigated the effects of percutaneous mitral balloon valvuloplasty (PMBV) on right ventricular function in the long term using tissue Doppler imaging.
Study design: Twenty-seven patients who underwent successful PMBV were enrolled in the study. Echocardiographic examination, including color tissue Doppler imaging, was done from the lateral tricuspid annulus 24 hours before the intervention, and the examination was repeated 24 hours and 6 months after the intervention.
Results: At 24 hours after the intervention, S wave velocity and A’ wave velocity were seen to have increased significantly (9.52±1.85 cm/s vs. 10.92±1.20 cm/s, p=0.012; -10.44±2.64 cm/s vs. -11.73±2.05 cm/s, p=0.029, respectively). E’ wave velocity and E’/A’ ratio did not change significantly (p>0.05 for both). In the late period, S wave velocity was similar to the value in the early period and significantly higher than the basal level (9.52±1.85 cm/s vs. 10.69±1.72 cm/s, p=0.023). However, A’ wave velocity in the late period was decreased compared to the early period and was not different from the basal level (-10.44±2.64 cm/s vs. -10.74±2.63 cm/s, p>0.05). The increase in E’ wave velocity in the late period when compared to the basal level was found to be statistically significant (-7.85±1.54 cm/s vs. -9.21±1.81 cm/s, p=0.046).
Conclusion: Right ventricular systolic function improved in the early period, and this improvement was seen to continue in the late period of PMBV. Diastolic function did not improve in the early period, but did improve in the late period. Right atrium systolic function improved in the early period; however, in the late period, levels were similar to the basal levels.

9. Editorial: Injured accomplice in mitral stenosis: the right ventricle
Leyla Elif Sade
PMID: 24481094  doi: 10.5543/tkda.2014.14704  Pages 44 - 46
Abstract |Full Text PDF

10. Epicardial fat thickness in patients with psoriasis vulgaris
Ahmet Bacaksız, Abdurrahman Tasal, Emrah Sevgili, Ercan Erdoğan, Nahide Onsun, Osman Sönmez, Buğçe Topukcu, Emin Asoğlu, Ömer Göktekin
PMID: 24481095  doi: 10.5543/tkda.2014.78949  Pages 47 - 54
Objectives: Psoriasis vulgaris is one of the most common skin disorders. Patients with psoriasis carry an excessive risk of coronary artery disease. Visceral adipose tissue around the heart affects the heart and coronaries by secreting proatherogenic mediators. It can be evaluated easily by measurement of epicardial fat thickness (EFT). The aim of this study was to investigate EFT in patients with psoriasis vulgaris.
Study design: One hundred and fifteen adult patients (62 male; mean age 33.6±6.0 years) with psoriasis vulgaris (Group 1) and 60 age- and sex-matched healthy individuals (28 male; mean age, 32.5±8.3 years) (Group 2) were included in this study. EFT was obtained by transthoracic echocardiography. Disease-specific characteristics of the patients were recorded. Serum glucose, lipid profile and high-sensitive C-reactive protein (hs-CRP) levels were measured.
Results: EFT and hs-CRP were significantly higher in Group 1 than in Group 2 (5.7±1.2 vs. 4.1±1.0 mm, p<0.001 and 0.52±0.45 mg/dl vs. 0.19±0.17 mg/dl, p<0.001, respectively). The psoriasis disease activity score and hs-CRP were found to be independent predictors of EFT in patients with psoriasis vulgaris (β=0.21, t=2.67, p=0.01 and β=0.62, t=7.72, p=0.001, respectively).
Conclusion: Our findings indicate that EFT was significantly higher in patients with psoriasis vulgaris compared with the controls. It was more prominent in patients with severe disease.

11. Association between endothelial nitric oxide synthase intron 4a/b polymorphism and aortic dissection
Ahmet Ekmekçi, Mahmut Uluganyan, Barış Güngör, Neslihan Abacı, Kazım Serhan Özcan, Gokhan Ertaş, Aycan Zencirci, Ahmet Yavuz Balcı, Sema Sırma Ekmekçi, Nurten Sayar, Duran Ustek, Mehmet Eren
PMID: 24481096  doi: 10.5543/tkda.2014.88269  Pages 55 - 60
Objectives: The genetic risk factors that contribute to the risk of developing aortic dissection (AD) have been studied. We assessed the association of endothelial nitric oxide synthase (eNOS) gene polymorphism with AD.
Study design: Patients who underwent surgery with the diagnosis of AD and survived after the operation in our center between May 2007 and June 2011 were recruited retrospectively. The eNOS intron 4a/b polymorphism was determined by polymerase chain reaction (PCR) using oligonucleotide primers (sense: 5’-AGGCCCTATGGTAGTGCCTTT-3’; antisense: 5’-TCTCTTAGTGCTGTGGTCAC-3’) that flank the region of the 27 bp VNTR in intron 4.
Results: Thirty-nine patients (88%) had type A AD, while the remainder (12%) had type B AD. The distribution of eNOS4 a/b gene polymorphism differed significantly from the control group, with higher frequencies of eNOS 4a/a and 4a/b genotypes in the AD group (χ2=7.16, p=0.03).
Conclusion: In this study, the distribution of eNOS genotypes differed between the AD and control groups; however, this polymorphism was not found to be an independent factor for the development of AD.

CASE REPORT
12. Thrombus attached to suture materials successfully thrombolysed with low-dose tissue plasminogen activator
Macit Kalçık, Ozan Mustafa Gürsoy, Süleyman Karakoyun, Mehmet Özkan
PMID: 24481097  doi: 10.5543/tkda.2014.28227  Pages 61 - 63
Mechanical prosthetic heart valve thrombosis is one of the most common complications of valve surgery. We herein describe an unusual clinical vignette. A 60-yearold man who underwent prosthetic mitral valve reoperation suffered from nonobstructive thrombus attached to the elongated suture materials in the postoperative sixth month. The thrombus was precisely depicted by two- and three-dimensional transesophageal echocardiography and was successfully lysed with low-dose slow infusion of tissue plasminogen activator after failed heparin treatment.

13. Alternative causes of bioreaction to prosthetic heart valves: three cases with pannus formation
Süleyman Karakoyun, Ozan Mustafa Gürsoy, Macit Kalçık, Şermin Çoban Kökten, Mehmet Özkan
PMID: 24481098  doi: 10.5543/tkda.2014.22737  Pages 64 - 67
Pannus formation is an infrequent but serious complication of prosthetic heart valve surgery. The cause of pannus is recognized as a bioreaction to the prostheses; histological investigations have shown that pannus comprises collagen and elastic tissues containing endothelial cells, chronic inflammatory cells, and myofibroblasts. However, the detailed mechanism of its formation has not been fully demonstrated. We aimed to evaluate the potential role of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-2 (MMP-2) in the pathogenesis of pannus formation in three patients with mechanical prosthetic heart valves. Pannus specimens removed from the prostheses were fixed in 10% neutral-buffered formalin for 24 hours after surgical removal and paraffin-embedded using standard procedures. Serial sections were cut at 4 μm for immunohistochemistry analysis. Hematoxylin and eosin (HE) was used in the histological analysis. VEGF and MMP- 2 were studied in the immunohistochemistry analysis. Three patients with mechanical prosthetic obstruction due to pannus overgrowth underwent redo valve surgery. In the first and second patients, the mitral prosthesis was explanted along with the pannus overgrowth. The third patient had both aortic and mitral prostheses; the aortic prosthesis was explanted with obstructive pannus formation, whereas the mitral valve was spared with excision of the nonobstructive pannus. The immunohistochemical study demonstrated the expressions of MMP-2 and VEGF in all of the pannus specimens acquired from these cases. VEGF and MMP-2 may play a role in the mechanism of pannus formation as the elements of the chronic active inflammatory process.

14. A diagnostic dilemma: early repolarization syndrome associated with ventricular fibrillation
Yavuzer Koza, Zakir Lazoğlu, Kamuran Kalkan, Serdar Sevimli
PMID: 24481099  doi: 10.5543/tkda.2014.07404  Pages 68 - 70
An early repolarization (ER) pattern, characterized by J-point elevation, slurring of the terminal part of the QRS and ST-segment elevation, is a common finding on the 12-lead electrocardiogram. It has been suggested that J-point elevation, which was considered benign for many years, may play a critical role in the pathogenesis of idiopathic ventricular fibrillation (VF). Recent studies have shown that an ER pattern in inferior leads or inferolateral leads is associated with increased risk for life-threatening arrhythmias. We report the case of a 52-year-old man with no structural heart disease whose electrocardiogram showed type 2 ER pattern (with evidence of J-point and ST-segment elevation in electrocardiogram leads II, III, and aVF). The patient presented with VF.

15. Long QT-induced ventricular tachycardia associated with Takotsubo cardiomyopathy
Musa Çakıcı, Mustafa Çetin, Mustafa Polat, Arif Süner
PMID: 24481100  doi: 10.5543/tkda.2014.42272  Pages 71 - 75
Takotsubo cardiomyopathy (TC) is a syndrome characterized by transient left ventricular apical ballooning associated with electrocardiogram changes and mimicking acute myocardial infarction in patients without significant coronary disease at angiography. We report an unusual case of a patient who presented with TC associated with long-QT syndrome induced ventricular tachycardia. QT interval prolongation was normalized and ventricular tachycardias were stopped within same day after metoprolol treatment.

16. Percutaneous treatment of superior vena cava syndrome caused by chronic thrombosis
Müslüm Şahin, Süleyman Aktürk, Mustafa Bulut, Cevat Kırma
PMID: 24481101  doi: 10.5543/tkda.2014.49207  Pages 76 - 79
Chronic upper extremity deep vein thrombosis (UEDVT) and superior vena cava syndrome (SVCS) are becoming increasingly common due to the use of indwelling catheters and implantable central venous access devices. Hypercoagulable syndromes, malignancy, extrinsic compression, tumor invasion are other reasons. Endovascular management of chronic UEDVT and SVCS is accepted as an important first- line treatment given its high overall success rate and low morbidity as compared
with medical and surgical treatments. In this case, we present successful managed by stenting of superior vena cava obstruction syndrome as a result of chronic thrombosis.

17. Mitral valve with a single leaflet
Tahir Bezgin, Ali Elveran, Ali Karagöz, Yiğit Canga, Fatih Yılmaz
PMID: 24481102  doi: 10.5543/tkda.2014.44380  Pages 80 - 82
Congenital anomalies of the mitral valve apparatus are rare. Of such cases, congenital mitral stenosis, atresia, accessory valvular tissue, and cleft mitral valve are more common. Descriptions of unileaflet mitral valves (either partial or complete leaflet agenesis/hypoplasia) are extremely rare and largely limited to a few case reports. We report herein a 45-year-old nulliparous woman presenting to our outpatient clinic with chest discomfort and dyspnea on minimal exertion. Mitral valve with a single leaflet leading to a significant obstruction in left ventricular outflow was seen on transthoracic echocardiography and confirmed with transesophageal two- (2D) and three-dimensional (3D) echocardiography. Metoprolol was prescribed to relieve obstruction and symptoms.

REVIEW
18. Paravalvular Aortic Regurgitation After Transcatheter Aortic Valve Replacement
Barış Buğan, Emin Murat Tuzcu
PMID: 24481103  doi: 10.5543/tkda.2014.93636  Pages 83 - 93
Transcatheter aortic valve replacement (TAVR) is a rapidly evolving technology that has been accepted as a treatment option in patients with severe aortic stenosis who are not suitable for or are at high risk for conventional surgery. Randomized trials have shown that TAVR decreases mortality and improves quality of life in patients who are not suitable for conventional surgery and that TAVR is not inferior to standard surgery in operable but high- risk patients. However, TAVR has several important limitations, the most prominent of which is residual paravalvular aortic regurgitation (PAR). The purpose of this review is to present the mechanism, incidence, assessment, and treatment of PAR after TAVR.

19. Almanac 2013: heart failure
Andrew L Clark Clark
PMID: 24481104  Pages 94 - 101
Abstract |Full Text PDF

20. Almanac 2013: stable coronary artery disease
Islam Shahed, Timmis Adam
PMID: 24481105  Pages 102 - 111
Abstract |Full Text PDF

CASE IMAGE
21. A giant calcified left ventricular aneurysm
Serhat Karadavut, Shkelqim Hoxha, Mehmet Güngör Kaya, Mahmut Akpek
PMID: 24481106  doi: 10.5543/tkda.2014.26243  Page 112
Abstract |Full Text PDF

22. Giant right atrial myxoma mimicking a thrombus
María Elena Arnáiz García, Jose María González Santos, Javier López Rodríguez, María José Dalmau Sorlí
PMID: 24481107  doi: 10.5543/tkda.2014.62819  Page 113
Abstract |Full Text PDF

23. A rare case of aortic dissection; prolapse of flap into the ventricle
Kadriye Gayretli Yayla, Sadık Açıkel, Çağrı Yayla, Ekrem Yeter
PMID: 24481108  doi: 10.5543/tkda.2014.12571  Page 114
Abstract |Full Text PDF | Video

24. A rare disease causing mitral regurgitation: posterior mitral leaflet aneurysm
Uğur Aksu, Kamuran Kalkan, Pınar Demir, İbrahim Halil Tanboğa
PMID: 24481109  doi: 10.5543/tkda.2014.80464  Page 115
Abstract |Full Text PDF | Video

25. Asymptomatic giant internal carotid artery aneurysm
Ruken Bengi Bakal, Süleyman Karakoyun, Yeliz Güler, Nihal Özdemir
PMID: 24481110  doi: 10.5543/tkda.2014.88389  Page 116
Abstract |Full Text PDF | Video

LETTER TO EDITOR
26. Increased serum asymmetric dimethylarginine level is an independent predictor of contrast-induced nephropathy
Belma Kalaycı, Süleyman Kalaycı, Ayşe Çolak
PMID: 25826828  Page 117
To the editor,

We read the article entitled “ Increased serum asymmetric dimethylarginine level is an independent predictor of contrast-induced nephropathy” by Günebakmaz et al in October 2013.[1] We congratulate the authors for this original study. They investigated asymmetric dimethylarginine (ADMA) levels and contrast-induced nephropathy(CIN) in patients with stable coronary disease. Günebakmaz and his colleagues found a possitive correlation between baseline serum creatinine and ADMA levels.

LETTER TO THE EDITOR REPLY
27. Authors' Reply
Özgür Günebakmaz, Mustafa Duran, Ekrem Karakaya, Esen Tanrıkulu, Mahmut Akpek, Ali Ergin, Mehmet Güngör Kaya
Page 118
Abstract |Full Text PDF

LETTER TO EDITOR
28. The main argument about the etiology of coronary artery ectasia: is it inflammation or not?
Şevket Balta, Cengiz Ozturk
PMID: 25826830  Pages 119 - 120
We read with interest the article ‘Association of neutrophil to lymphocyte(N/L) ratio with presence of isolated coronary artery ectasia(CAE)’ by Isık et al. They a possible association between N/L ratio and the presence of isolated CAE. They concluded that N/L ratio is a readily available clinical laboratory value that is associated with the presence of isolated CAE.

29. Coronary slow flow: Phenomenon? Syndrome?
Yavuzer Koza
Page 121
I read the paper entitled '' Evaluation of left ventricular systolic and diastolic functions in patients with coronary slow phenomenon '' by Dr. Zencir et al. with interest. I have some comments about this paper.

INVITED REVIEW
30. ICD cihazı taşıyan hastaların hangi meslek gruplarında görev yapması uygun değildir?
Erdem Diker
Page 122
Abstract |Full Text PDF

LETTER TO EDITOR
31. 
Ertan Ural
Page 123
Abstract |Full Text PDF



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