ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 45 (4)
Volume: 45  Issue: 4 - June 2017
EDITORIAL COMMENT
1. Daptomycin for the treatment of infective endocarditis: When do we use it?
Serap Şimşek Yavuz
PMID: 28595198  doi: 10.5543/tkda.2017.79168  Pages 303 - 307

2. Coronary collateral circulation and ghrelin peptide
Alp Burak Çatakoğlu
PMID: 28595199  doi: 10.5543/tkda.2017.01138  Pages 308 - 309
Abstract |Full Text PDF

ORIGINAL ARTICLE
3. Daptomycin in left-sided endocarditis: A single center experience
Burak Açar, Yasemin Tezer Tekçe, Çağrı Yayla, Sefa Ünal, Ahmet Göktuğ Ertem, Bihter Şentürk, Sinan Aydoğdu
PMID: 28595200  doi: 10.5543/tkda.2017.60784  Pages 310 - 315
Objective: Infective endocarditis (IE) carries a high risk of cardiac morbidity and mortality, despite advances in the contemporary armamentarium. Along with the development of antibiotic resistant strains, research focusing on the efficacy of novel agents other than standard antibiotic regimens continues. Daptomycin, one of these antibiotics, is approved for the treatment of Staphylococcus bacteremia and right-sided endocarditis. This retrospective study was an investigation of the effectiveness of daptomycin in patients with left-sided IE.
Methods: Fourteen patients (mean age 50.9±16.5; range 24 to 70 years) with the diagnosis of left-sided IE based on modified Duke criteria received daptomycin as monotherapy. Outcome was evaluated according to clinical improvement, microbiological eradication, and in-hospital mortality.
Results: Blood culture was positive in 13 patients (92.8%) and staphylococci were isolated in all but 1 patient (92.3%). Daptomycin was administered as monotherapy at a dose of 6 or 8 mg/kg/day for mean of 40.6±4.4 days. Clinical recovery rate was 71.4% and microbiological eradication rate was 85.7%. Mean duration of clinical recovery was 8.7±3.2 days and duration of microbiological eradication was 11.1±3.6 days. Side effects developed in 6 patients, but drug discontinuation was not required in any patient. Ten patients improved without complications. Two patients were lost due to heart failure and multiple-organ failure while treatment was continuing, and 2 patients died in early cardiac postoperative period.
Conclusion: Daptomycin is an effective and safe alternative to standard antibiotic therapy for the treatment of left-sided IE.

4. As cardioprotective and angiogenic biomarker, can ghrelin predict coronary collateral development and severity of coronary atherosclerosis?
Mehmet Kadri Akboğa, Gülten Taçoy, Canan Yılmaz Demirtaş, Sedat Türkoğlu, Bülent Boyacı, Atiye Çengel
PMID: 28595201  doi: 10.5543/tkda.2017.96169  Pages 316 - 323
Objective: Ghrelin exerts protective effects on cardiovascular system by inhibiting progression of atherosclerosis, supression of vascular inflammation, and stimulating angiogenesis. Thus, the aim of this study was to investigate the effect of serum ghrelin on coronary collateral development and SYNTAX score in patients with severe coronary artery disease.
Methods: Total of 91 patients who had ≥90% stenosis in at least one major coronary artery were prospectively included in this cross-sectional, observational study. Collateral degree was graded according to Rentrop-Cohen classification. Patients with grade 2 or 3 collateral degree were allocated to Good Collateral Group and patients with grade 0 or 1 collateral degree were included in Poor Collateral Group. Ghrelin and vascular endothelial growth factor A (VEGF-A) levels were measured using radioimmunoassay and ELISA kits.
Results: Serum ghrelin and VEGF-A levels were significantly higher in Good Collateral Group. Furthermore, ghrelin level showed significant inverse correlation with SYNTAX score (r=-0.348; p=0.001). In multivariable regression analysis, ghrelin (Odds ratio, 1.013; 95% confidence interval, 1.011–1.017; p=0.013), VEGF-A, fasting plasma glucose and presence of chronic total occlusion were independent predictors of good collateral development. In receiver operating characteristic curve analysis, ghrelin value cut-off point of ≥781 pg/mL predicted good collateral development with sensitivity of 73.1% and specificity of 67.7%.
Conclusion: Findings suggested that ghrelin has antioxidant and antiinflammatory properties that protect endothelial functions and also stimulate angiogenesis, which results in development of good coronary collateral and inhibition of progression of coronary atherosclerosis.

5. Vitamin D is a predictor of ST segment resolution and infarct size following thrombolysis in patients with acute ST elevation myocardial infarction
Ahmad Separham, Bahram Sohrabi, Leili Pourafkari, Nazli Sepasi, Samad Ghaffari, Naser Aslanabadi, Nader D Nader
PMID: 28595202  doi: 10.5543/tkda.2017.17737  Pages 324 - 332
Objective: Vitamin D (VitD) insufficiency is linked to various chronic conditions, including cardiovascular disease. Aim of the present study was to examine role of serum VitD in resolution of ST segment elevation (STR) in response to thrombolytic therapy following acute ST elevation myocardial infarction (STEMI).
Methods: VitD was measured prospectively in all consecutive patients who were admitted with STEMI and received thrombolysis during the calendar year of 2014. STR was defined as ≥50% decrease in initial magnitude of STR 90 minutes after treatment. Multivariate binary logistic regression analysis was performed to identify effect of confounding variables on STR.
Results: Average age was 58±14 years in 227 patients (41 female and 186 male). Total of 24.7% of patients had sufficient VitD (>30 ng/mL), whereas 46.2% had VitD insufficiency (10–30 ng/mL), and remaining 29.1% had VitD deficiency (<10 ng/mL). Significant STR occurred in 57.3% of the patients. In a nonlinear pattern, serum VitD concentration directly correlated with likelihood of STR (p=0.012). VitD deficient patients had larger enzymatic infarct size compared with those with sufficient VitD (p=0.026). In multivariate logistic regression analysis, while diabetes doubled (p=0.033) and involvement of anterior wall created 2.7-fold increase in probability of non-resolution (p=0.001), for every unit increase in serum VitD, likelihood of STR increased by 2.1% (p=0.023).
Conclusion: VitD deficiency in patients with STEMI was associated with lower occurrence of STR and larger enzymatic infarct size in response to thrombolytic therapy.

6. Parameters of ventricular repolarization in patients with autoimmune hepatitis
Burak Açar, Mahmut Yüksel, Çağrı Yayla, Özgür Kırbaş, Sefa Ünal, Ahmet Göktuğ Ertem, Koray Demirtaş, Mustafa Kaplan, Meral Akdoğan, Sabite Kaçar, Ertuğrul Kayaçetin, Sinan Aydoğdu
PMID: 28595203  doi: 10.5543/tkda.2017.57870  Pages 333 - 338
Objective: Autoimmune hepatitis (AIH) is a liver disorder that affects both children and adults. It is characterized by inflammatory liver histology, elevated transaminase level, circulating nonorgan-specific autoantibodies, and increased level of immunoglobulin G in the absence of known etiology. Ventricular repolarization has been evaluated using T wave and QT interval measurements in patients with hepatic cirrhosis. Ventricular repolarization may be defined using QT interval, QT dispersion, and T wave measurements. Recently, it has been demonstrated that peak and end of the T wave (Tp-e) interval, Tp-e/QT, and Tp-e/corrected QT interval (QTc) ratios can be novel indicators for prediction of ventricular arrhythmias and mortality. In this study, an investigation of ventricular repolarization using Tp-e interval and Tp-e/QT ratio in patients with AIH was performed.
Methods: Total of 31 patients with AIH and 31 controls were enrolled in the present study. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured on 12-lead electrocardiogram.
Results: QT interval (378.9±41.4 vs. 350.0±22.7; p=0.001), QTc interval (396.8±46.7 vs. 367.3±34.9; p=0.039), Tp-e interval (68.2±12.3 vs. 42.5±6.8; p<0.001), Tp-e/QT ratio (0.18±0.02 vs. 0.12±0.01; p<0.001) and Tp-e/QTc ratio (0.17±0.02 vs. 0.11±0.01; p<0.001) were significantly higher in patients with AIH than control patients.
Conclusion: The results of the present study indicated that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were greater in patients with AIH.

7. Association of neutrophil/lymphocyte ratio and CHA2DS2-VASc score with left atrial thrombus in patients who are candidates for percutaneous mitral balloon valvuloplasty
Orhan Maden, Kevser G Balci, Mustafa M Balci, Serdar Kuyumcu, Hatice Selçuk, Mehmet T Selçuk
PMID: 28595204  doi: 10.5543/tkda.2017.50475  Pages 339 - 347
Objective: Association between inflammation and pro-thrombotic state has been described previously. Aim of the present study was to investigate if presence of left atrial (LA) thrombus or spontaneous echocardiographic contrast (SEC) in rheumatic mitral stenosis (MS) was related to neutrophil/lymphocyte ratio (NLR), and to determine predictive utility of the CHA2DS2-VASc risk stratification score in patients with mitral stenosis complicated by LA thrombus.
Methods: NLR and CHA2DS2-VASc score of 188 patients with MS and 35 healthy controls were evaluated. All analyses were also conducted according to rhythm status, excluding control group.
Results: Among patients with MS, there were 31 patients in thrombus-positive group, 142 patients in SEC-positive group, and 15 patients in thrombus/SEC-negative group. Among patients with MS and sinus rhythm (SR) (n=105; 55.8%); 9.5% of them had LA thrombus, and 78% of them had SEC. In the SR group, median NLR was significantly higher in thrombus-positive group compared with thrombus/SEC-negative and control groups (p<0.001). Among patients with MS and atrial fibrillation (AF); there was no significant difference regarding NLR according to thrombus and SEC presence (p=0.214). In both SR and AF groups, there was no significant difference according to SEC/thrombus presence regarding median CHA2DS2-VASc score (p>0.05).
Conclusion: Elevated NLR is related to presence of LA thrombus in patients with MS and SR. The utility of CHA2DS2-VASc score in patients with MS and SR complicated by LA thrombus is debatable, according to our results.

8. The relationship between serum lipid parameters and renal frame count in hypertensive patients with normal renal functions
Emrah Ipek, Mustafa Yolcu, Erkan Yıldırım
PMID: 28595205  doi: 10.5543/tkda.2017.05248  Pages 348 - 354
Objective: Atherosclerosis can contribute to renovascular disease, and high cholesterol level is an independent risk factor for disease progression. Renal frame count (RFC) is an objective angiographic method of measuring macrovascular blood flow in the main renal artery and its segmental branches. The aim of the present study was to demonstrate relationship between serum lipid parameters and RFC.
Methods: In this cross-sectional study, 116 hypertensive patients were allocated into 2 groups according to serum low-density lipoprotein (LDL) levels. Group 1 comprised 60 patients with LDL <130 mg/dL and Group 2 consisted of 56 individuals with LDL ≥130 mg/dL. The patients were also divided into 2 groups according to total cholesterol (TC) levels (52 patients in group with TC <200 mg/dL and 64 patients in group with TC ≥200 mg/dL).
Results: Group 2 had higher mean RFC than Group 1 (p<0.001). RFC of both kidneys in Group 2 was significantly higher than results in Group 1 (p<0.001 and p=0.023, respectively). We found similar significant results in comparison of TC-based patient groups. RFC had positive correlation with smoking, TC, and LDL (r=0.326, p=0.035; r=0.393, p=0.010; and r=0.386, p=0.012, respectively). In multivariate linear regression analysis, LDL, TC, smoking, and creatinine clearance were independent predictors of RFC.
Conclusion: In conclusion, in hypertensive patients with normal renal function, LDL, TC, and smoking may be predictors of RFC and aggressive risk factor modification may help to reduce the risk of renal failure.

CASE REPORT
9. Transcatheter closure of atrial septal defect with atrial septal occluder in a patient with nickel allergy
Hasan Arı, Selma Arı, Ahmet Tütüncü, Alper Karakuş, Mehmet Melek
PMID: 28595206  doi: 10.5543/tkda.2016.23552  Pages 355 - 357
Presently described is transcatheter closure of atrial septal defect with atrial septal occluder (ASO) device in a patient with nickel allergy. Patients with metal allergy who will undergo nitinol device implantation should be tested for possible nickel hypersensitivity. ASO device and treatment strategy (percutaneous or surgical) should be selected according to allergy test result.

10. Eosinophilic myocarditis presenting as acute coronary syndrome
Evrim Şimşek, Filiz Özerkan Çakan, Mustafa Akın
PMID: 28595207  doi: 10.5543/tkda.2016.49392  Pages 358 - 361
Eosinophilic myocarditis (EM) is a rare condition that may result from several heterogeneous eosinophilic diseases, including parasite infection, hypersensitivity reaction, vasculitis, and hypereosinophilic syndrome. Regardless of etiology, the disease may present with various cardiac conditions, such as acute coronary syndrome, heart failure, or arrhythmia. Irreversible endomyocardial fibrosis, which causes restrictive cardiomyopathy, occurs in the late phase of the disease. Early diagnosis and treatment is crucial to prevent disease progression. Presently described is a case of EM presenting as acute coronary syndrome that was treated with steroids.

11. Atrial fibrillation following synthetic cannabinoid abuse
Tolga Han Efe, Mehmet Ali Felekoglu, Tolga Çimen, Mehmet Doğan
PMID: 28595208  doi: 10.5543/tkda.2016.70367  Pages 362 - 364
Marijuana and its synthetic forms, called synthetic cannabinoids (SCs), are used as recreational drugs. Bonzai is a kind of SC. Adverse cardiovascular events have been reported with abuse of marijuana and SCs, including arrhythmia, myocardial infarction, and sudden cardiac death. Presently described is a case of a 23-year-old, previously healthy man, who was admitted to the emergency department with atrial fibrillation after Bonzai abuse. Sinus rhythm was restored during observation.

12. Longest surviving case of unoperated Stanford type A aortic dissection
Mert İlker Hayıroğlu, Muhammed Keskin, Taha Keskin, Muhsin Nuh Aybay, Göksel Çinier
PMID: 28595209  doi: 10.5543/tkda.2016.45642  Pages 365 - 368
Stanford type A aortic dissection requires urgent intervention and immediate surgical approach in the emergency department. Survival rate is low, even in patients who undergo immediate surgery. Presently described is a case of unoperated Stanford type A aortic dissection that has been in follow-up under beta-blocker treatment for 7 years. To the best of our knowledge, our case is the longest surviving patient with unoperated type A aortic dissection reported in the literature.

13. Perioperative management of combined coronary bypass surgery and thyroidectomy
Monish S Raut, Arun Maheshwari, Ganesh Shivnani
PMID: 28595210  doi: 10.5543/tkda.2016.33726  Pages 369 - 372
Significant swelling of the thyroid compromising the airway can be a challenging situation when combined thyroidectomy and cardiac surgery is planned. Induction, intubation, intraoperative management, and extubation require special attention in such cases.

14. Closure of wide patent ductus arteriosus using a fenestrated muscular VSD occluder device in a pediatric patient with Down syndrome and pulmonary hypertension
Osman Güvenç, Murat Saygı, İbrahim Halil Demir, Ender Ödemiş
PMID: 28595211  doi: 10.5543/tkda.2016.38283  Pages 373 - 376
Patients with wide patent ductus arteriosus and significant pulmonary hypertension not treated in time constitute a significant problem for cardiologists. For these patients, tests that could aid in decision-making for further planning include reversibility and balloon occlusion tests performed in the catheterization laboratory. Devices developed for the closure of ductus as well as different devices with off-label use may be employed in patients scheduled for transcatheter occlusion. When result of reversibility test is borderline positive, the use of fenestrated device may be applicable for selected patients. Presently described is case of a 10-year-old patient with Down syndrome who had a wide ductus and systemic pulmonary hypertension. Transcatheter closure procedure was performed with off-label use of a fenestrated muscular ventricular septal defect occluder device.

REVIEW
15. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors´ Network
Fernando Alfonso, Karlen Adamyan, Jean- Yves Artigou, Michael Aschermann, Michael Boehm, Alfonso Buendia
PMID: 28595212  doi: 10.5543/tkda.2017.92725  Pages 377 - 384
The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiology.

CASE IMAGE
16. Long and single-piece thrombus aspirated from right coronary artery in inferior ST-elevation myocardial infarction
Mustafa Topuz, Abdurrahman Yücel Çölkesen, Örsan Deniz Urgun
PMID: 28595213  doi: 10.5543/tkda.2016.58980  Page 385
Abstract |Full Text PDF

17. Extreme left diaphragm displacement in the context of tension pneumothorax after cardiac surgery
María Elena Arnáiz García, Ana María Arnáiz García, Jose María González-santos, Javier López-rodríguez, Javier Arnáiz
PMID: 28595214  doi: 10.5543/tkda.2016.99328  Page 386
Abstract |Full Text PDF

18. The moment of return from the edge of death: Holter ECG recording in a patient with syncope
Yalçın Velibey, Ahmet İlker Tekkeşin, Göksel Çinier, Özge Güzelburç, Ahmet Taha Alper
PMID: 28595215  doi: 10.5543/tkda.2016.90672  Page 387
Abstract |Full Text PDF

19. Unusual protruding intracardiac mass: Lipoma of left ventricular apex
Semi Öztürk, Muhsin Kalyoncuoğlu, Mazlum Şahin, Gündüz Durmuş, Mehmet Can
PMID: 28595216  doi: 10.5543/tkda.2016.99566  Page 388
Abstract |Full Text PDF | Video

OTHER ARTICLES
20. Kardiyoloji yayınlarında gündem ve yorumlar
Ertan Ural
Page 389
Abstract |Full Text PDF



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