ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 44 (6)
Volume: 44  Issue: 6 - September 2016
ORIGINAL ARTICLE
1. Frequency of genetic polymorphism for adrenergic receptor beta and cytochrome p450 2D6 enzyme, and effects on tolerability of beta-blocker therapy in heart failure with reduced ejection fraction patients: The Beta GenTURK study
Mehdi Zoghi, Hakki Kaya, Yuksel Cavusoglu, Enbiya Aksakal, Serafettin Demir, Ceyhun Yucel, Hasim Mutlu, Oktay Ergene, Mehmet Birhan Yilmaz, On Behalf Of The Beta Genturk Study
PMID: 27665326  doi: 10.5543/tkda.2016.10733  Pages 457 - 465
Objective: The present objective was to determine frequency of Arginine389Glycine (Arg389Gly) and Cytochrome p450 2D6*10 (Cyp2D6*10) polymorphism in cases of heart failure-reduced ejection fraction (HFREF), and to evaluate the influence of the polymorphisms in response to beta-blocker (BB) therapy.
Methods: A total of 206 HFREF patients and 90 healthy controls were prospectively enrolled. Genotypes for Arg389Gly and Cyp2D6*10 polymorphisms of the healthy controls and 162 of the 206 heart failure (HF) patients were measured, identified by polymerase-chain-reaction- and restriction-fragment-length-polymorphism analysis. HFREF patients and healthy controls were compared regarding Arg389Gly polymorphism. The HFREF patients were separated into 2 subgroups based on achievement of maximal target dose (MTD) of BB.
Results: When comparing frequency of genotype distribution for Arg389Gly polymorphism in HFREF patients to the healthy controls, a statistically significant association was observed with CC genotype and Glisin-Glisin (GG) genotype (p<0.001, odds ratio [OR]=16, confidence interval [CI]: 3.8–67.9 and p<0.001, OR=0.3, CI: 0.2-0.6). Frequency of genotypes for Arg389Gly and Cyp2D6*10 polymorphism were similar in patients who could or could not achieve BB MTD (p=0.13 and p=0.60, respectively).
Conclusion: The frequency of Arg389Gly polymorphism in patients with HFREF in the present Turkish population differed from that of the healthy controls. However, neither Arg389Gly polymorphism nor Cyp2D6*10 polymorphism was associated with dose tolerability of BB therapy.

2. Right ventricular function in coronary slow flow: A two-dimensional speckle-tracking echocardiographic study
Ali Hosseinsabet, Shima Yarmohamadi, Sima Narimani, Nazanin Amini-farshidmehr
PMID: 27665327  doi: 10.5543/tkda.2016.72699  Pages 466 - 473
Objective: Coronary slow-flow phenomenon (CSFP) is described as protracted passage of angiographic contrast agent to the distal portion of the epicardial coronary arteries in the absence of stenosis. Few studies have addressed the effects of this condition on right ventricular (RV) dysfunction. The present objective was to assess RV function in CSFP via 2-dimensional speckle-tracking echocardiography (2DSTE).
Methods: A total of 29 patients with CSFP and 29 participants with normal coronary flow were compared regarding RV systolic and diastolic functions. Participants were matched for age, sex, hypertension, and diabetes mellitus. RV systolic and diastolic functions were evaluated with pulsed-wave tissue Doppler echocardiography and 2DSTE.
Results: There were no statistically significant differences between the CSFP group and the control group regarding tissue Doppler echocardiographic and 2DSTE-derived indices.
Conclusion: CSFP was not associated with tissue Doppler echocardiographic and 2DSTE-derived indices of RV systolic and diastolic function.

3. Diagonal earlobe crease associated with increased epicardial adipose tissue and carotid intima media thickness in subjects free of clinical cardiovascular disease
Murat Ziyrek, Sinan Sahin, Emrah Ozdemir, Zeydin Acar, Serkan Kahraman
PMID: 27665328  doi: 10.5543/tkda.2016.37806  Pages 474 - 480
Objective: Atherosclerotic coronary artery disease is a leading cause of death, worldwide. Diagonal earlobe crease (DELC) has been suggested as a simple, noninvasive marker of cardiovascular disease. Although epicardial adipose tissue (EAT) thickness and carotid intima media thickness (CIMT) are closely related to atherosclerosis, the relation between EAT, CIMT, and DELC had yet to be studied. The present objective was to analyze this association.
Methods: Subjects were apparently healthy individuals referred to the cardiology outpatient clinic. A total of 65 subjects with DELC and 65 age- and sex-matched controls without DELC were enrolled. EAT thickness and CIMT were measured and analyzed.
Results: Epicardial adipose tissue thickness was significantly higher in the DELC group (0.57±0.12 vs. 0.35±0.05; p<0.0001). CIMT was also significantly higher in DELC group (0.85±0.16 vs. 0.60±0.15; p<0.0001). Correlation analysis showed that CIMT was significantly correlated with EAT thickness (r: 0.594; p<0.0001). Linear regression analysis showed that presence of DELC was independently associated with CIMT and EAT thickness.
Conclusion: A significant and independent association between the presence of DELC and increased CIMT and EAT thickness was presently determined, for the first time, in subjects free of clinical cardiovascular disease.

4. Relationship between functional capacity and socioeconomic status in a cohort of Turkish heart failure patients
Hakkı Kaya, Meltem Refiker Ege, Ali Zorlu, Osman Beton, Hasan Güngör, Ahmet Temizhan, Yeşim Güray, Yüksel Çavuşoğlu, Mehdi Zoghi, Mehmet Birhan Yılmaz, On Behalf Of TREAT-HF Investigators
PMID: 27665329  doi: 10.5543/tkda.2015.85594  Pages 481 - 487
Objective: New York Heart Association (NYHA) classification predicts prognosis for heart failure (HF) patients. Socioeconomic status (SES) has the potential to affect treatment strategy and disease course. The present objective was to investigate whether SES of Turkish HF patients affected NYHA classification.
Methods: Turkish research team-HF (TREAT-HF) is a questionnaire study with 52 questions, the purpose of which is to aid in the assessment of various qualities of HF patients. The 2013 TREAT-HF cohort included 503 patients from 11 centers in Turkey. Patients were divided into 2 groups according to NYHA functional classification: I-II, a better functional classification, or III-IV, a poorer functional classification. In addition, patients were analyzed according to gender.
Results: Evaluated were NYHA functional classifications of 459 (326 males and 133 females) patients with a mean age of 59.7±14.07 years and a mean ejection fraction (EF) of 31.7±9.22%. Total monthly family income level of ≥1000 TL, younger age, higher EF, and male gender were independently associated with better NYHA functional classification. In addition to EF, regular weight control was found to be independently associated with better NYHA classification for females, while younger age and income of ≥1000 TL were independently associated with better NYHA classification for males.
Conclusion: The present results demonstrated that SES was associated with NYHA functional classification in a cohort of Turkish HF patients.

5. Physical inactivity and low quality of life of Turkish women after hospitalization for coronary heart disease: Inferences from EUROASPIRE III
Lale Tokgözoğlu, Sercan Okutucu, Ergun Barış Kaya, Çetin Erol, Oktay Ergene
PMID: 27665330  doi: 10.5543/tkda.2016.30788  Pages 488 - 497
Objective: The present objective was to compare changes in lifestyle between (i) Turkish women and Turkish men, and (ii) Turkish women and European women, after hospitalization for coronary heart disease (CHD). Risk factor management, physical activity, mood, and quality of life (QOL) indices were compared.
Methods: A total of 2268 women (25.3% of 8966 patients, mean age: 65.8±9.0 years) were interviewed using the European Action on Secondary and Primary Prevention by Intervention to Reduce Events III (EUROASPIRE III). In the Turkey cohort, 65 women (mean age: 63.3±9.9 years) and 273 men (mean age: 59.1±9.6 years) were interviewed, and underwent clinical and biochemical tests at a minimum of 6 months after hospital admission. Patients completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ), the International Physical Activity Questionnaire (IPAQ), the Hospital Anxiety and Depression Scale (HADS), and questionnaires assessing QOL.
Results: After hospitalization for CHD, (i) Turkish women have lower participation in cardiac rehabilitation (CR) programs and lower physical activity indices than European women, (ii) Turkish women have lower physical activity indices than Turkish men, (iii) HADS anxiety scores and HADS depression scores were higher for Turkish women than for Turkish men, (iv) HADS anxiety scores and HADS depression scores were higher for Turkish women than for European women, (v) QOL indices were lower for Turkish women than for either European women or Turkish men.
Conclusion: Turkish women engage in less physical activity, have lower QOL, and have higher rates of depression and anxiety after hospitalization for CHD than either of the other groups assessed. Every effort should be made to increase physical activity, and CR program adherence in general, particularly in female patients.

6. Cardiac evaluation in children with hemangiomas
İlkay Erdoğan, Faik Sarıalioğlu
PMID: 27665331  doi: 10.5543/tkda.2016.65171  Pages 498 - 502
Objective: Hemangiomas are tumors most commonly encountered in pediatric patients, and are frequently treated with propranolol. However, there are currently no standard methods for evaluating cardiac function in patients prior to propranolol treatment. The present study was designed to aid in the evaluation of pretreatment cardiac and effects of propranolol on vital signs in pediatric hemangioma patients.
Methods: A pediatric oncology specialist and a pediatric cardiology specialist examined all patients prior to initiation of propranolol treatment. All patients were examined by the same 2 physicians. Cardiac evaluation included complete echocardiogram and electrocardiography. From September 2009 to January 2014, 146 patients aged 4 days to 10 years were screened.
Results: No patient had cardiac contraindication to propranolol. The effect of hemangioma on left ventricle size was examined, but left ventricle dilatation was found in only 3 patients. However, 68 patients had abnormal echocardiogram: 17 had patent foramen ovale, 4 had ventricular septal defect, 9 had atrial septal defect (associated with right heart enlargement), 8 had patent ductus arteriosus, 6 had physiologic pulmonary stenosis, and 1 had an aortic coarctation. No contraindications to propranolol or side effects were observed. However, cardiac anatomic defects were more common in this patient group than in the general population.
Conclusion: Hemangiomas in infants or children, even in small or premature infants, can be treated with propranolol without significant cardiac side effects. In addition, large dermal hemangiomas were not found to affect ventricular size in pediatric patients.

CASE REPORT
7. Hypertrophic cardiomyopathy with Jeune syndrome: The first reported case
Osman Güvenç, Saime Sündüs Uygun, Derya Çimen, Eyüp Aslan, Ali Annagür
PMID: 27665332  doi: 10.5543/tkda.2015.29677  Pages 503 - 506
Summary– Jeune syndrome (Asphyxiating thoracic dysplasia) is a rare dystrophy of the skeleton, inherited as an autosomal recessive condition. Patients develop a narrowed thorax, rhizomelic dwarfism, and hepatic, renal, and pancreatic abnormalities. High rates of pulmonary hypoplasia and pulmonary hypertension have been reported. Some patients die in early stages of life due to respiratory failure. The case of a patient referred with a history of severe asphyxiating birth, who had been diagnosed with Jeune syndrome and later hypertrophic cardiomyopathy (HCM) upon echocardiographic examination is described in the present report. This rare disease is discussed with respect to the current literature, as the present is the first reported case to be accompanied by HCM.

8. First trans-subclavian transcatheter aortic valve replacement using Lotus valve system
Serdal Baştuğ, Abdullah Nabi Aslan, Cenk Sarı, Hakan Süygün, Engin Bozkurt
PMID: 27665333  doi: 10.5543/tkda.2015.81242  Pages 507 - 510
Summary– Transcatheter aortic valve implantation (TAVI), most commonly performed via retrograde femoral artery access, is a promising alternative to surgical aortic valve replacement in elderly, high-risk patients with severe aortic stenosis (AS). Approximately one-third of these patients suffer from severe iliofemoral arteriopathy, ruling out transfemoral approach. The case of a 74-year-old man with severe AS and bilateral iliofemoral arteriopathy treated with left trans-subclavian (TS) TAVI using the Lotus valve system is described in the present report.

9. Eosinophilic myocarditis associa ted with eosinophilic pneumonia and eosinophilia following antibiotic and narcotic analgesic treatment
Aziz İnan Çelik, Ali Deniz, Mustafa Tangalay, Muhammet Buğra Karaaslan, Emine Bağır Kılıç
PMID: 27665334  doi: 10.5543/tkda.2015.09056  Pages 511 - 513
Summary– Eosinophilic myocarditis (EM) is a rare form of myocarditis that usually presents with heart failure due to eosinophilic infiltration. EM is often a component of hypereosinophilic syndrome (HES). HES is a rare disorder characterized by persistent, marked eosinophilia combined with organ system dysfunction. A 38-year-old man was admitted to emergency services with left inguinal pain and fever, and was hospitalized with diagnosis of nephrolithiasis and urinary tract infection. Intravenous antibiotic therapy of 3 grams meropenem per day and analgesic of 50 mg pethidine per day were administered. Typical angina pectoris and dyspnea developed approximately 24 hours after treatment. Rash on the chest, and diminished bilateral lung sounds and rales were observed. Nonspecific changes were present on electrocardiogram. Laboratory analysis showed progressively increasing levels of cardiac biomarkers and eosinophilia. Peripheral blood smear, bone marrow aspiration, and biopsy demonstrated eosinophilia. Chest x-ray revealed diffuse, bilateral interstitial and reticulonodular infiltrates. Transthoracic echocardiography showed thickened left ventricle. Coronary angiography revealed normal coronary arteries. EM was suspected, endomyocardial biopsy was performed, and pathologic specimen confirmed the diagnosis. Corticosteroid treatment was initiated, and within 1 day, angina pectoris and dyspnea had dramatically reduced, and cardiac biomarkers and eosinophil count had decreased. Normal chest x-ray was observed after 72 hours. The patient was discharged with steroid treatment.

10. Reverse Takotsubo cardiomyopathy following intra-abdominal surgery
Burak Açar, Özgür Kırbaş, Sefa Ünal, Zehra Gölbaşı, Sinan Aydoğdu
PMID: 27665335  doi: 10.5543/tkda.2016.33348  Pages 514 - 516
Summary– Reverse Takotsubo cardiomyopathy (RTC) is a rare condition characterized by systolic dysfunction of the basal segments of the left ventricle in the absence of obstructive coronary artery disease. The case of a 50-year-old woman with RTC following intra-abdominal surgery is described in the present report.

11. Congenitally corrected transposition of the great arteries in patient with atrial septal defect and acute inferior segment myocardial infarction
Veysel Tosun, Necmettin Korucuk, Mustafa Serkan Karakaş, Ünal Güntekin
PMID: 27665336  doi: 10.5543/tkda.2015.34624  Pages 517 - 520
Summary– Congenitally corrected transposition of the great arteries is a rare abnormality accounting for approximately 1% of clinically apparent congenital heart disease. Age at time of diagnosis and survival rate vary and depend on associated anomalies, including pulmonary stenosis, ventricular septal defect, atrial septal defect, atrioventricular block, and atrioventricular valve regurgitation. Reported cases of corrected transposition of the great arteries with single coronary ostium anomaly and atrial septal defect are very rare. Described in the present report is the case of a 55-year-old male who presented with acute inferior ST-segment elevation myocardial infarction and coincidental single coronary ostium arising from the right sinus of Valsalva, as observed on coronary angiography. Successful balloon angioplasty and stenting of the circumflex artery were performed. Echocardiography demonstrated the corrected transposition of the great arteries with negative contrast enhancement between the atrial chambers. The patient was discharged with medical therapy on the eighth postoperative day. To our knowledge, the present is the first report to describe corrected transposition of the great arteries, atrial septal defect, single coronary ostium, and acute myocardial infarction as comorbidities.

12. Balloon valvuloplasty for aortic stenosis using umbilical vein access in a newborn: First experience in Turkey
Kemal Nişli, Serra Karaca, Aygün Dindar
PMID: 27665337  doi: 10.5543/tkda.2016.39969  Pages 521 - 523
Summary– Balloon valvuloplasty is an effective therapy for severe congenital aortic valve stenosis, with mild aortic insufficiency and minimal intermediate-term restenosis.
No consensus currently exists regarding optimal vascular approach for balloon dilatation in newborns with critical or severe aortic valve stenosis. Critical aortic valve stenosis in newborns must be treated promptly and effectively. Transcatheter therapy may offer marked advantages, as surgical therapy has been associated with significant rates of morbidity and mortality. Percutaneous balloon dilatation is usually performed as emergent therapy of valve stenosis, with various options for vascular approach. While umbilical artery and vein access is rarely used in the treatment of critical aortic valve stenosis and aortic coarctation, this approach is a safe, simple, and effective choice for balloon dilatation in newborns, even in those weighing under 2.5 kg.

REVIEW
13. Depression following coronary artery bypass grafting surgery revisited
Nosratollah Pourafkari, Leili Pourafkari, Nader D Nader
PMID: 27665338  doi: 10.5543/tkda.2016.49697  Pages 524 - 529
Summary– Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure. Depression is a frequent comorbidity in patients with ischemic heart disease that can affect the course of the disease and the process of recovery after CABG. Depression after CABG is more common in women and is an independent predictor of mortality in long-term. However, fewer than half of cardiologists ask about depression symptoms in their patients, and with screening measures not being routinely utilized, depression remains under-recognized in this patient population. Treatment of depression in patients with ischemic heart disease can be challenging, considering unwanted medication side effects and interactions. The present report is a review of risk factors, prognosis, prevention, and treatment of depression in patients following CABG.

CASE IMAGE
14. Massive liver hematoma secondary to overdose of warfarin treatment
Çetin Geçmen, Muzaffer Kahyaoglu, Ecem Yanık, Mesut Alp Karatas, Ibrahim Akin Izgi
PMID: 27665339  doi: 10.5543/tkda.2016.88472  Page 530
Abstract |Full Text PDF

15. An extremely unusual pacemaker complication
Ricardo C Rodrigues, André Correia, Susana Gomes, Graça Caires, Décio Pereira
PMID: 27665340  doi: 10.5543/tkda.2016.12980  Page 531
Abstract |Full Text PDF

16. Cannon ‘A’ waves during complete atrioventricular block
Luis Álvarez - Acosta, Alejandro Quijada - Fumero, Raquel Pimienta - Gónzalez, Julio S. Hernández - Afonso
PMID: 27665341  doi: 10.5543/tkda.2016.45640  Page 532
Abstract |Full Text PDF | Video

17. Left atrial appendage ostial stenosis in a patient with rheumatic mitral valve disease
Muhittin Demirel, Cüneyt Toprak, Emrah Acar, Servet İzci, Lütfi Öcal
PMID: 27665342  doi: 10.5543/tkda.2016.33490  Page 533
Abstract |Full Text PDF | Video

18. Isolated accessory mitral valve leaflet
Mehrnoush Toufan, Leili Pourafkari, Nader Nader
PMID: 27665343  doi: 10.5543/tkda.2016.89356  Page 534
Abstract |Full Text PDF | Video

LETTER TO EDITOR
19. A patient with ventricular fibrillation and inverted Takotsubo syndrome triggered by sinus surgery: plausible causes, and electrocardiographic features
John Madias
PMID: 27665344  doi: 10.5543/tkda.2016.22924  Page 535
Abstract |Full Text PDF

20. Authors’ reply
Gültekin Günhan Demir, Gamze Babur Güler, Ekrem Güler, Hacı Murat Güneş, Filiz Kızılırmak
PMID: 27665345  Pages 536 - 537
Abstract |Full Text PDF

21. Cholesterol embolization syndrome
Joob Beuy, Viroj Wiwanitkit
PMID: 27665346  doi: 10.5543/tkda.2016.65623  Pages 537 - 538
Abstract |Full Text PDF

22. Authors' reply
Nazlı Dizman, Kübra Aydın Bahat, Şeyma Özkanlı, Abdullah Özkök
PMID: 27665347  Page 538
Abstract |Full Text PDF

23. Ductus arteriosus aneursym causing hoarseness which is the best treatment option; surgery or endovascular?
Namık Ozmen
PMID: 27665348  doi: 10.5543/tkda.2016.89289  Page 539
Abstract |Full Text PDF

24. Authors' reply
Onur Sinan Deveci, Aziz Inan Celik, Caglar Emre Cagliyan, Nazan Ozbarlas, Mustafa Demirtas
PMID: 27665349  doi: 10.5543/tkda.2016.57438  Pages 539 - 540
Abstract |Full Text PDF

OTHER ARTICLES
25. Cardiology agenda
Ertan Ural
Page 541
Abstract |Full Text PDF



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