ORIGINAL ARTICLE | |
1. | Long-term follow-up in patients with homozygous familial hypercholesterolemia; 13-year experience of a university hospital lipid clinic Meral Kayıkçıoğlu, Erkan Kısmalı, Levent Can, Serdar Payzin PMID: 25490294 doi: 10.5543/tkda.2014.09633 Pages 599 - 611 Objectives: Familial hypercholesterolemia (FH) is a genetic disease characterized by extremely high levels of cholesterol leading to premature atherosclerosis. In homozygous individuals (HoFH) cardiovascular events could develop in child-hood. In this article, long-term clinical experience with adult HoFH patients who were followed in the Department of Cardiology, Ege University Faculty of Medicine was presented. Study design: Seventeen HoFH patients (11 females, 6 males) who were being followed between the years 2000-2013 were included in the study. All data including clinical characteristics, family history, lipid levels, treatment, lipid-apheresis, cardiovascular events, and complications were obtained retrospectively from patient chart records. Results: Mean age on admission was 31±10 years, age at first diagnosis was 25±14.years. Mean cholesterol level at diagnosis was 625±136 mg/dl. Admission complaints were dermatologic (41%) and ischemic symptoms (41%), whereas 3 patients (18%) were diagnosed during family screening. Sixty-five percent of the cases were children of consanguineous marriage. Xanthomas were present in 59%, aortic valve pathology in 59%, and carotid ar-tery plaques in 47% of the patients. Coronary artery disease was documented in 59% of the cases. Though all patients had indications for apheresis, it could be performed only in 10 patients due to high refusal rate of the patients. Mean age at the first session of apheresis was 27±12 years (minimum 10-maximum 42) and adherence to apheresis was 60%. After 2 years of regular apheresis skin depositions were vanished, however carotid atherosclerosis and aortic pathology progressed. During a mean follow-up of 43±42 months, 4 patients died (mean age: 25±5 years). Conclusion: Patients with HoFH are subject to late diagnosis. Due to the delayed initiation of the treatment with lipid apheresis, atherosclerosis and aortic stenosis progress in these patients. The awareness of the physicians and knowledge of the public concerning this disease is warranted. |
2. | Neutrophil to lymphocyte ratio predicts poor functional capacity in patients with heart failure Musa Çakıcı, Mustafa Çetin, Adnan Dogan, Muhammed Oylumlu, Erdal Aktürk, Mustafa Polat, Arif Suner, Sabri Abuş PMID: 25490295 doi: 10.5543/tkda.2014.16363 Pages 612 - 620 Objectives: We aimed to assess the relationship between neutrophil to lymphocyte ratio (N/L ratio) and functional capacity (FC) of patients with compensated heart failure (CHF). Study design: A total of 94 consecutive CHF patients and age-gender matched 70 subjects with normal echocardiographic examination were enrolled. Peripheral venous blood samples were drawn before echocardiography examination and treadmill test in all study population. The treadmill test based on modified Bruce protocol was used to determine the functional status of CHF patients. Poor FC was defined as <5 metabolic equivalant (MET) in the exercise test. Afterwards, patients with CHF were divided into two groups with respect to the top and bottom 3 of the N/L ratio. Results: FC (3.2±2.05 MET vs. 6.1±2.04 MET, p<0.001), ejection fraction (%31.5±7.64 vs. %34.8±6.82, p=0.028) were found to be lower and N-terminal pro-brain natriuretic peptide (NT-proBNP) level (3360±2742 pg/dl vs. 1613±1334 pg/dl, p<0.001) pulmonary artery pressure (46.3±11.50 mmHg vs. 41.5±9.45 mmHg, p=0.049), left atrial diameters (4.6±0.52 cm vs. 4.3±0.43 cm, p=0.005), E/Ea ratio (12.2±4.37 vs. 9.2±3.20, p<0.001) were found to be higher in CHF patients with an N/L ratio >3 than with an N/L ratio <3. The N/L ratio, and log- NT-proBNP level were determined to be a predictive factor of poor FC (odds ratio [OR]=3.085, 95% confidence interval [CI] = 1.520-6.260, p=0.002 and OR=1.585, 95% CI=1.201-2.091, p=0.001, respectively). A cut-off point of 2.74 for the N/L ratio had 79.4% sensitivity and 80% specificity in predicting poor FC. Conclusion: N/L ratio can be used to predict poor FC in patients with CHF. |
3. | Impaired kidney function is associated with SYNTAX score in patients with stable coronary artery disease Hakan Uçar, Mustafa Gür, Taner Şeker, Durmuş Yıldıray Şahin, Gülhan Yüksel Kalkan, Caner Türkoğlu, Arafat Yıldırım, Onur Kaypaklı, Zafer Elbasan, Murat Çaylı PMID: 25490296 doi: 10.5543/tkda.2014.67790 Pages 621 - 628 Objectives: The strong relationship between severe renal dysfunction and coronary artery disease (CAD) is well-known. However, the association between kidney function with SYNTAX Score (SS) has not been investigated in patients with stable CAD with normal to mildly impaired renal function. We aimed to investigate the association between kidney function with SS. Study design: In this study, 411 stable CAD patients in whom coronary angiography (CAG) was performed were prospectively included (247 male, 164 female; mean age 58.6±12.4 years). Glomerular filtration rate was estimated (eGFR) by a modification of diet in renal disease (MDRD) formula. Two different groups were determined according to median eGFR values (GFRlow group <90, and GRFhigh group ≥90). CAG was performed based on clinical indications. SS was determined in all patients. Results: Patients in GFRlow group were older, and have a history of hypertension (HT) and diabetes mellitus and high body mass index. SS values of GFRlow group were higher than GFRhigh group (p<0.001 for all). Multivariate regression analysis showed that eGFR was independently associated with diabetes (β, −0.206, p<0.001), HT (β, −0.093, p=0.026) and SS (β, −0.445, p<0.001). Conclusion: eGFR is independently associated with extent and complexity of CAD as well as diabetes and HT. Importantly, these results may explain, in part, the increase in cardiovascular risk in with slightly impaired renal function. |
4. | Infective endocarditis and complications; a single center experience Olcay Ozveren, Mehmet Akif Ozturk, Cihan Sengul, Ruken Bengi Bakal, Taylan Akgün, Cemil Izgi, Zekeriya Kucukdurmaz, Atiye Elif Eroglu Buyukoner, Muzaffer Degertekin PMID: 25490297 doi: 10.5543/tkda.2014.80708 Pages 629 - 634 Objectives: The aim was to investigate the microbiological characteristics and complications of infective endocarditis (IE) in 119 patients treated in our center for IE, diagnosed by modified Duke criteria. Study design: The archive records of 119 patients (82 [69%] males; 37 [31%] females; mean age 39±16 years) with a definite diagnosis of IE between January 1997 and November 2004 were systematically reviewed for clinical and microbiological properties and complications. Results: The most common complaint of the patients was fever and malaise (102 patients, 85.7%, each). Culture was negative in 68 patients (57.1%), while Staphylococcus aureus was the most common etiological agent in culture positive cases. The aortic valve was the most common region of vegetation (43 patients, 36.1%). The frequency of surgical operation for valvular insufficiency due to IE was 75.6%, and the frequency of congestive heart failure was 53.8% (64 patients). Conclusion: IE is still an important disease considering its high morbidity and mortality rates, increased life expectancy of the patients, and increased number of valve replacement procedures. |
5. | Evaluation of aortic elastic properties in patients with systemic sclerosis Özgül Uçar Elalmış, Hülya Çiçekçioğlu, Ahmet Karagöz, Zeynep Özbalkan Aşlar, Yaşar Karaaslan PMID: 25490298 doi: 10.5543/tkda.2014.03162 Pages 635 - 642 Objectives: The aim of this study was to investigate the elastic properties of the aorta, which are known to be predictors of cardiovascular morbidity and mortality in patients with systemic sclerosis (SSc). Study design: Forty patients (2 males, 38 females) with SSc who had been referred to echocardiography without any exclusion criteria were enrolled in the study. The control group consisted of 38 subjects (4 males, 34 females) who were examined in the cardiology out-patient clinic and referred to echocardiography for any indication in the same period. Parameters related to diastolic functions of the left ventricle were obtained by echocardiography and the following parameters of aortic elasticity were calculated according to these formulas: aortic strain = ([AOS - AOD]/AOD), aortic stiffness index (β) = ln (systolic blood pressure/diastolic blood pressure)/aortic strain and aortic distensibility = 2 × aortic strain/pulse pressure. Results: Aortic strain and distensibility were significantly lower, and aortic stiffness index β was significantly higher in the SSc group compared to the control group. While the systolic diameter of the aorta did not differ between study and control groups, the diastolic diameter of the aorta was significantly higher in SSc patients. On the other hand, left ventricular diastolic functions were compromised in the SSc group. Mitral A velocity, E-wave deceleration time and E/Em ratio were increased and mitral E/A ratio, lateral and medial annular Em velocity were significantly decreased in SSc patients. Conclusion: Our study demonstrated that aortic stiffness is increased and left ventricular diastolic functions are compromised in patients with SSc. |
6. | Transcatheter patent ductus arteriosus closure with echocardiographic guidance: can radiation exposure be reduced? İbrahim Cansaran Tanıdır, Alper Guzeltas, Yakup Ergul, Erkut Ozturk, Isa Ozyilmaz, Ender Odemis PMID: 25490299 doi: 10.5543/tkda.2014.71609 Pages 643 - 650 Objectives: The radiation dose from interventional cardiac catheterization is particularly relevant when treating children because of their greater radiosensitivity compared to adults. The transcatheter closure of patent ductus arteriosus (PDA), as well as other more complex pediatric interventions, have raised concerns regarding radiation exposure, particularly relevant when treating children. The purpose of this study is to show how to perform the transcatheter closure of PDA in children while giving less ionized radiation and to prove that the amount of radiation and contrast material can be reduced. Study design: Following appropriate device selection based on PDA morphology and diameter, transthorasic echocardiography images and control aortography findings were analyzed. The following devices were used during the procedure: Gianturco coils (10/63), an Amplatzer Duct Occluder (ADO, 31/63), Flipper coils (19/63), and an Amplatzer vascular plug (3/63). Results: The scopy time, radiation dose, and contrast were 12±6.4 mins, 28.1±14.7 cmGy/cm2/kg, and 4.2 ± 2.3 cc/ kg, respectively. In the control aortography shortly after the procedure, residual shunt was detected at various levels in 39.7% of patients, and 9.5% demonstrated residual shunt in real-time echocardiography. In the control aortography, the exposure to radiation was 13.3% of the total, and the amount of infused contrast was 27.2% of the total. Conclusion: Patients may be exposed to less radiation and contrast material if an echocardiographic evaluation, instead of a final control aortography injection, is performed after the transcatheter closure of PDA. |
CASE REPORT | |
7. | A case report of coronary artery aneurysm in a patient with Behçet’s disease Ufuk Gürkan, Adnan Kaya, Mustafa Adem Tatlısu, Şahin Avşar PMID: 25490300 doi: 10.5543/tkda.2014.44202 Pages 651 - 654 Behçet’s disease (BD) is a multisystem vasculitis that may involve vessels of all sizes. Acute coronary syndrome (ACS) due to secondary involvement of BD is rare and its management less clear. In this case, a 29-year-old man admitted to the emergency room with ongoing chest pain was interned to the coronary care unit with a diagnosis of ACS. The patient had been diagnosed 1 year before with BD and had been without regular follow-up, despite the suggested use of cholchium. An immediate coronary angiography revealed a fresh thrombus image in the proximal segment of the right coronary artery (RCA), an aneurysm of the left anterior descending artery (LAD) at proximal segment, and a hemodynamically significant lesion following the aneurysm. Intervention was ended because of normal flow (TIMI III) of distal RCA. An intravenous infusion of glycoprotein IIb/ IIIa receptor inhibitor (tirofiban) was administered, and a control angiography showed dissolution of a thrombus in RCA, but enlarged aneurysm of LAD and a new aneurysm in RCA. |
8. | Epileptic seizures secondary to high degree atrioventricular block without escape rhythm İrfan Şahin, Ahmet Karabulut, Fatih Kızkapan, Ertugrul Okuyan PMID: 25490301 doi: 10.5543/tkda.2014.20050 Pages 655 - 657 Differentiation between cardiac and neurological origin of syncope may be challenging. Prolonged cerebral hypoxia secondary to cardiac arrhythmias may lead to epileptic seizures. Moreover, partial epileptic seizures by themselves can trigger cardiac arrhythmias. Herein, we present a case of partial epileptic seizure occurring just after complete atrioventricular block has occurred. The diagnosis was established with simultaneous electroencephalographic and electrocardiographic recordings. |
9. | Esophageal rupture complicated by acute pericarditis Hakan Duman, Eftal Murat Bakırcı, Zakir Karadağ, Yavuz Uğurlu PMID: 25490302 doi: 10.5543/tkda.2014.26350 Pages 658 - 661 Esophageal perforation is a serious condition with a high mortality rate. Delayed detection of esophageal perforation may result in devastating complications such as mediastinitis and pericarditis. Esophageal perforation is rarely due to aspiration of foreign bodies. Here we report the case of a 59-year-old male patient with complicated esophageal perforation due to ingestion of a chicken bone, whose first signs are considered to be acute non-specific pericarditis. |
10. | Can atorvastatin calcium cause asymptomatic hypercalcemia? Suleyman Hilmi Ipekci, Suleyman Baldane, Mehmet Sozen, Levent Kebapcilar PMID: 25490303 doi: 10.5543/tkda.2014.05995 Pages 662 - 666 The use of statins may have unnatural effects. A 54-year-old woman was admitted to the hospital with an incidental finding of hypercalcemia (10.8 mg/dL). There was no disease other than hyperlipidemia, and the patient had been on a course of atorvastatin calcium 10 mg for 1.5 years. A workup investigation to diagnose the cause of hypercalcemia was completed. The investigation did not reveal any pathological diseases that may have caused the hypercalcemia. The hypercalcemia resolved after atorvastatin- calcium was stopped, and the patient developed hypercalcemia shortly after the initiation of the atorvastatin calcium. Here, we report a clinical case of recurrent hypercalcemia possibly induced by atorvastatin calcium administration. |
11. | Resolution of complete heart block after revascularization of acute marginal branch of the right coronary artery Oluwaseyi Bolorunduro, Rami N Khouzam, Dwight Dishmon PMID: 25490304 doi: 10.5543/tkda.2014.91074 Pages 667 - 670 A patient presented with typical angina and a non-ST elevation myocardial infarction. Electrocardiogram showed complete heart block, and she was found to have a 90% acute marginal artery stenosis. The block resolved after balloon angioplasty of this artery that does not supply the atrioventricular node. We propose that increased vagal tone due to inferior wall ischemia from acute marginal artery stenosis has elicited the Bezold-Jarisch reflex. This is a likely mechanism for this uncommon etiology of complete heart block. |
12. | Occlusion of a left superior vena cava-coronary sinus connection in a child with Glenn dysfunction by the transcatheter approach Murat Saygi, Hasan Tahsin Tola, Alper Guzeltas, Ender Odemis PMID: 25490305 doi: 10.5543/tkda.2014.32137 Pages 671 - 674 A 14-year-old male patient presented with cyanosis and tiredness. The patient had undergone a Glenn procedure at age 12 following the echocardiographic determination of a double inlet left ventricle, ventriculoarterial discordance, moderate valvular–subvalvular pulmonary artery stenosis, non-restrictive inlet ventricular septal defect and right ventricle hypoplasia; his oxygen saturation was 70%. Echocardiography evaluation showed retrograde flow from the vena cava superior to the innominate vein and an left superior vena cava opening into the coronary sinus. Here, we report the case of a patient evaluated for Glenn dysfunction in whom an increase in oxygen saturation was observed following transcatheter occlusion of the left superior vena cava–coronary sinus connection using an Amplatzer® septal occluder. |
REVIEW | |
13. | Management of multivalvular heart disease Saim Sağ, Sümeyye Güllülü PMID: 25490306 doi: 10.5543/tkda.2014.67179 Pages 675 - 684 Multivalvular heart valve disease is not an uncommon situation. Although many studies include only patients with regurgitation or stenosis involving only one heart valve, several scenarios in which patients present with regurgitation and/or stenosis involving two or more valves exist. Data on multivalve disease are scarce because of a large number of possible combinations and also owing to difficulties of exact quantification and an overlap in surgical indications. Therefore, many fields related to multiple valve disease are not encountered in the current valvular heart disease guidelines. This article aims to explain multi valvular heart disease from etiology and background definition to surgical outcome, with special emphasis on echocardiographic assessment. |
CASE IMAGE | |
14. | Successful catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with congenital absence of inferior vena cava Oğuz Karaca, Onur Omaygenç, Günhan Demir, Ayhan Olcay, Fethi Kılıçaslan PMID: 25490307 doi: 10.5543/tkda.2014.82593 Page 685 |
15. | An unusual cause of heart failure: Cardiac textiloma Veysel Özgür Barış, Özgür Ulaş Özcan, İrem Müge Akbulut, Yusuf Atmaca PMID: 25490308 doi: 10.5543/tkda.2014.29165 Page 686 |
16. | A rare manifestation of a known disease: Severe non-obstructive hypertrophic cardiomyopathy Yalçın Velibey, Ahmet Ekmekçi, Eyüp Tusun, Mehmet Eren PMID: 25490309 doi: 10.5543/tkda.2014.15359 Page 687 |
17. | Cardiac invasion of the intrabronchial malignant mesenchimal tumor from left pulmonary vein Samim Emet, Mehmet Kocaağa, Zehra Buğra, Berrin Umman PMID: 25490310 doi: 10.5543/tkda.2014.96641 Page 688 |
18. | A large thrombus on false tendon in a cardiomyopathic patient Ali Hosseinsabet PMID: 25490311 doi: 10.5543/tkda.2014.85616 Page 689 |
19. | Answers of specialist İlknur Can, Vedat Aytekin Pages 690 - 691 Abstract | |
20. | Comment on cardiology publications Ertan Ural Page 692 Abstract | |
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