EDITORIAL COMMENT | |
1. | Influences of cardiac resynchronization therapy on cardiac biomarkers in patients with chronic heart failure Yüksel Çavuşoğlu PMID: 29512623 doi: 10.5543/tkda.2018.48280 Pages 81 - 83 Abstract | |
ORIGINAL ARTICLE | |
2. | Association between reverse electrical remodeling and cardiac fibrosis markers in patients with cardiac resynchronization therapy Hamza Sunman, Uğur Canpolat, Hikmet Yorgun, Adem Özkan, Muhammet Ulvi Yalçın, Tülin Bayrak, Levent Şahiner, Ergün Barış Kaya, Asuman Özkara, Kudret Aytemir, Ali Oto PMID: 29512624 doi: 10.5543/tkda.2017.80236 Pages 84 - 91 Objective: Cardiac resynchronization therapy (CRT) induces structural and electrical reverse remodeling of the failing heart. However, the association between native QRS narrowing and cardiac fibrosis markers has not been investigated in patients with an implanted CRT device. Methods: A total of 41 symptomatic patients diagnosed with systolic heart failure who underwent CRT implantation were included in this study. Electrocardiogram findings and cardiac fibrosis marker levels [galectin-3, growth-differentiation factor-15 (GDF-15) and procollagen III N-terminal propeptide (P3TD)] were collected before and 12 months after initiation of biventricular pacing. Reverse electrical remodeling was defined as a decrease in 12-month intrinsic QRS (iQRS) duration by ≥20 milliseconds after CRT implantation. Results: The median QRS duration decreased from 155 milliseconds (interquartile range [IQR]: 142–178 milliseconds) before CRT to 142 milliseconds (IQR: 130–161 milliseconds) (p=0.001) after 12 months of CRT. According to the predefined criteria, electrical remodeling was detected in 16 (39.0%) patients. The median galectin-3, GDF-15, and P3TD levels were significantly decreased after CRT implantation in patients with electrical remodeling [27.65 ng/mL (IQR: 24.4–35.2 ng/mL) vs 23.00 ng/mL (IQR: 16.0-36.7 ng/mL), p=0.017; 3104 pg/mL (IQR: 2923–4825 pg/mL) vs 2276 pg/mL (IQR: 1294–3209 pg/mL), p=0.002; 0.43 ng/mL (IQR: 0.23–0.64) vs 0.15 ng/mL (IQR: 0.04–0.29 ng/mL), p=0.034, respectively]. The galectin-3, GDF-15, and P3TD levels were not significantly changed in patients without electrical remodeling [26.80 ng/mL (IQR: 23.9–31.5 ng/mL) vs 28.80 ng/mL (IQR: 23.0–34.8 ng/mL), p=0.211; 4221 pg/mL (IQR: 2709–4995 pg/mL) vs 3035 pg/mL (IQR: 2038–4872 pg/mL), p=0.143; and 0.34 ng/mL (IQR: 0.11–0.68 ng/mL) vs 0.21 ng/mL (IQR: 0.09–0.37 ng/mL), p=0.112, respectively]. Conclusion: The results from the small sample used in this study indicated that electrical reverse remodeling after CRT was associated with a decrease in cardiac fibrosis. |
3. | Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey Bülent Özin, Kudret Aytemir, Özgür Aslan, Türkay Özcan, Mehmet Kanadaşı, Mesut Demir, Mustafa Gökçe, Mehmet Murat Sucu, Murat Özdemir, Zerrin Yiğit, Mustafa Ferzeyn Yavuzkır, Ali Oto PMID: 29512625 doi: 10.5543/tkda.2017.79367 Pages 92 - 102 Objective: The goal of this study was to define clinical practice patterns for assessing stroke and bleeding risks and thromboprophylaxis in nonvalvular atrial fibrillation (NVAF) and to evaluate treatment outcomes and patient quality of life. Methods: A clinical surveillance study was conducted in 10 tertiary healthcare centers across Turkey. Therapeutic approaches and persistence with initial treatment were recorded at baseline, the 6th month, and the 12th month in NVAF patients. Results: Of 210 patients (57.1% male; mean age: 64.86±12.87 years), follow-up data were collected for 146 patients through phone interviews at the 6th month and 140 patients at the 12th month. At baseline, most patients had high CHADS2 score (≥2: 48.3%) and CHA2DS2-VASc (≥2: 78.7%) risk scores but a low HAS-BLED (0–2: 83.1%) score. Approximately two-thirds of the patients surveyed were using oral anticoagulants as an antithrombotic and one-third were using antiplatelet agents. The rate of persistence with initial treatment was approximately 86%. Bleeding was reported by 22.6% and 25.0% of patients at the 6th and 12th month, respectively. The proportion of patients with an INR of 2.0–3.0 was 41.8% at baseline, 65.7% at the 6th month, and 65.9% at the 12th month. The time in therapeutic range was 61.0% during 1 year of follow-up. The median EuroQol 5-dimensional health questionnaire (EQ-5D) score of the patients at baseline and the 12th month was 0.827 and 0.778, respectively (p<0.001). The results indicated that patient quality of life declined over time. Conclusion: In atrial fibrillation, despite a high rate of persistence with initial treatment, the outcomes of stroke prevention and patient quality of life are not at the desired level. National health policies should be developed and implemented to better integrate international guidelines for the management of NVAF into clinical practice. |
4. | Iron deficiency and hematinic deficiencies in atrial fibrillation: A new insight into comorbidities Muhammed Keskin, Dilek Ural, Servet Altay, Onur Argan, Edibe Betül Börklü, Ömer Kozan PMID: 29512626 doi: 10.5543/tkda.2018.51001 Pages 103 - 110 Objective: Iron deficiency (ID) is the most common nutritional deficiency, and iron metabolism becomes further deteriorated in the presence of certain conditions, such as heart failure (HF). Atrial fibrillation (AF) has many similarities to HF, including a chronic inflammatory pathophysiology; however, the prevalence of ID and other hematinic deficiencies in AF patients have not been determined. Methods: In this study, the prevalence of iron (serum ferritin <100 µg/L or ferritin 100–299 µg/L with transferrin saturation <20%), vitamin B12 (<200 pg/mL), and folate deficiency (<4.0 ng/mL) was evaluated in 101 patients with non-valvular AF with preserved left ventricular ejection fraction and no signs of HF, and the results were compared with 35 age- and gender-matched controls. Results: Anemia was detected in 26% of the patients. A total of 48 (47.6%) patients had ID, 10 (9.9%) had a vitamin B12 deficiency, and 13 (12.9%) had a folate deficiency. The prevalence of ID was similar in the controls and the paroxysmal AF patients, but increased gradually in persistent and permanent AF. Univariate logistic regression analysis demonstrated that permanent vs. paroxysmal AF [Odds ratio (OR): 2.17; 95% confidence interval (CI): 0.82–5.69; p=0.011], high sensitive C-reactive protein (OR: 1.47; 95% CI: 0.93–2.36; p=0.019), N-terminal pro b-type natriuretic peptide (OR: 1.24; 95% CI: 0.96–1.71; p=0.034), and white blood cell count (OR: 1.21; 95% CI: 0.95–1.58; p=0.041) were associated with ID. In multivariable analysis, permanent AF remained as an independent clinical associate of ID (OR: 4.30; 95% CI: 0.83–12.07; p=0.039). Conclusion: ID is common in permanent AF, as in HF. Inflammation and neurohormonal activation seem to contribute to its development. |
5. | Evaluation of the association between serum uric acid level and the predicted risk score of sudden cardiac death in five years in patients with hypertrophic cardiomyopathy Sinem Özyılmaz, Muhammet Hulusi Satılmışoğlu, Mehmet Gül, Huseyin Uyarel, Osman Akin Serdar PMID: 29512627 doi: 10.5543/tkda.2017.60094 Pages 111 - 120 Objective: The aim of this study was to determine the relationship between serum uric acid (UA) level and the predicted risk score for sudden cardiac death in 5 years (the HCM Risk-SCD), galectin-3 level, and positive fragmented QRS (fQRS) on electrocardiography (ECG) in patients with hypertrophic cardiomyopathy (HCM). Methods: This was a prospective, observational study. In all, 115 consecutive patients (age >17 years) with HCM and 80 healthy participants were included in the study. The HCM Risk-SCD score (%), galectin-3 level, and fQRS on ECG were evaluated in all patients. Results: The serum UA, galectin-3 level, UA/Creatinine ratio, incidence of ventricular tachycardia (VT) and syncope, and some echocardiographic parameters were significantly higher in the patient group than in the control group (all p<0.05). The UA value was significantly higher in patients with a high score on the HCM Risk-SCD, a positive fQRS, a high galectin-3 level, VT incidence, and need for implantable cardioverter defibrillator (ICD) implantation or cardiopulmonary resuscitation (CPR) than in those without (HCM Risk-SCD >6%. Namely, HCM Risk-SCD >6%, UA: 6.71±1.29 mg/dL, HCM Risk-SCD ≤5.9%, UA: 5.84±1.39 mg/dL, p=0.001; fQRS(+), UA: 6.56±1.20 mg/dL, fQRS(-), UA: 5.63±1.49 mg/dL, p<0.001; galectin-3 >6.320 pg/mL, UA: 6.56±1.27 mg/dL, galectin-3 ≤6.310 pg/mL, p=0.016; left atrium anterior-posterior dimension (LAAPD) >36 mm, UA: 6.31±1.33 mg/dL, LAAPD <36 mm, UA: 5.20±1.60 mg/dL, p=0.005; VT(+), UA: 6.83±1.19 mg/dL, VT(-), UA: 5.97±1.42 mg/dL, p=0.008; ICD(+), UA: 7.08±0.88 mg/dL, ICD(-), UA: 6.06±1.42 mg/dL, p=0.022; CPR(+), UA: 7.03±0.96 mg/dL, CPR(-), UA: 6.04±1.42 mg/dL, p=0.018. A statistically significant correlation was observed between UA and HCM Risk-SCD, galectin-3 level, LAAPD, and left ventricular (LV) mass (LVM) (r and p values, respectively: 0.355, <0.001; 0.297, 0.002; 0.309, 0.001; 0.276, 0.003. Conclusion: The serum UA level was significantly higher in patients with HCM compared with the control group. A high UA level was associated with a higher HCM Risk-SCD score, positive fQRS, higher galectin-3 level, greater LAAPD, VT incidence, and the need for ICD implantation and CPR in patients with HCM. |
6. | The association between serum hepcidin-25 level and subclinical atherosclerosis in peritoneal dialysis patients Bülent Erdoğan, Barış Eser, Özlem Yayar, Mehmet Deniz Aylı PMID: 29512612 doi: 10.5543/tkda.2017.17666 Pages 121 - 128 Objective: Recently, the role of hepcidin as a cardiovascular marker in the chronic kidney disease (CKD) population has gained interest. The aim of this study was to investigate the relationship between serum hepcidin-25, inflammation, iron parameters, and carotid intima-media thickness (CIMT) in peritoneal dialysis (PD) patients. Methods: A total of 58 patients (30 male, 51.3%; mean age: 46.8±13.6 years; mean dialysis duration: 69.2±39.1 months) were included in this cross-sectional study. Clinical and routine laboratory data were recorded and the CIMT and hepcidin values were determined. The study population was divided into 2 groups according to the median hepcidin value of 60 ng/mL. Correlation analysis and logistic regression analysis were performed to determine the relationship between the hepcidin level and other parameters. Results: Age (p=0.003), systolic blood pressure (p=0.039), body mass index (p=0.031), glucose (p=0.028) level, C-reactive protein (CRP) level (p<0.001), and CIMT (p=0.011) were found to be statistically significantly higher in the high hepcidin group. In correlation analysis, hepcidin was positively correlated with age (p<0.001), dialysis duration (p=0.041), glucose (p=0.015), ferritin (p=0.005), CRP (p<0.001), and CIMT (p=0.035). In multivariate linear regression analysis, age (p<0.001) and CRP (p=0.005) were found to be related to CIMT. Conclusion: Hepcidin-25 was strongly associated with both age and CRP in patients undergoing PD treatment. The results suggest that hepcidin may be involved in the pathophysiology of atherosclerosis. Prospective studies should be carried out in this patient population to determine whether hepcidin has an effect on atherosclerosis. |
7. | Neutrophil-to-lymphocyte ratio predicts functionally significant coronary artery stenosis in patients with stable coronary artery disease Samet Yılmaz, Uğur Canpolat, Kazim Başer, Sefa Ünal, Mevlüt Serdar Kuyumcu, Sinan Aydoğdu PMID: 29512613 doi: 10.5543/tkda.2017.16709 Pages 129 - 135 Objective: The aim of this study was to determine the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the functional severity of coronary stenosis assessed according to the fractional flow reserve (FFR) in stable coronary artery disease (CAD). Methods: The clinical and laboratory data of 420 patients who underwent index coronary angiography for stable angina pectoris were analyzed retrospectively. The functional severity of an intermediate lesion was determined by FFR. An FFR value of >0.80 was considered non-significant (Group 1), whereas ≤0.80 was accepted as significant stenosis (Group 2). Results: A total of 137 (32.6%) patients had functionally significant coronary artery stenosis. The median NLR value was significantly greater in Group 2 compared with Group 1 [3.13 (0.93–9.75) vs 2.22 (0.75–6.02); p<0.001]. In multivariable logistic regression analysis, the Gensini score [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.02–1.06; p<0.001], diabetes mellitus (OR: 2.56; 95% CI: 1.38–4.75; p=0.003), smoking (OR: 2.09; 95% CI: 1.12–3.94; p=0.021), and NLR (OR: 1.62; 95% CI: 1.26–2.09; p<0.001) were found to be independent predictors of the presence of functionally significant coronary stenosis using an FFR value of ≤0.80. The optimal cut-off value of NLR for predicting functionally significant coronary stenosis was 2.3. An NLR value greater than 2.3 had a sensitivity of 72% and a specificity of 61% to predict stenosis with an FFR value of ≤0.80. Conclusion: The pre-angiographic NLR is a simple, noninvasive, and inexpensive biomarker that was significantly higher in patients with functionally significant coronary stenosis; it can be used to predict the hemodynamic severity of intermediate coronary stenosis in patients with stable CAD. |
CASE REPORT | |
8. | Heparin-induced thrombocytopenia after MitraClip: A case report Özge Çetinarslan, Ümit Yaşar Sinan, Emir Barış Ökçün, Cengiz Çeliker, Nuh Nazmi Gültekin PMID: 29512614 doi: 10.5543/tkda.2017.76666 Pages 136 - 139 Heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia and thrombosis are potentially fatal adverse reactions to heparin therapy caused by the formation of polyclonal antibodies against the platelet factor 4-heparin complex. Fatal limb and organ damage or death may occur as a result of this immunological drug reaction. Described in this case report is the management of a patient who developed HIT after undergoing a MitraClip transcatheter mitral valve repair. The aim was to encourage clinicians to pay special attention to a frail patient who receives heparin therapy and to advise clinicians that clinical scores and laboratory tests should be used as a complement for certain diagnosis. The decision about continuation or cessation of heparin therapy is an important cornerstone for hospitalized patients with HIT. |
9. | Contrast-induced encephalopathy after percutaneous peripheral intervention Muzaffer Kahyaoğlu, Mustafa Ağca, Ender Özgün Çakmak, Çetin Geçmen, İbrahim Akın İzgi PMID: 29512615 doi: 10.5543/tkda.2017.16517 Pages 140 - 142 Contrast-induced encephalopathy (CIE) is a rare complication of angiography. Presently reported is the case of a patient diagnosed with CIE following peripheral angioplasty with the non-ionic contrast agent, iohexol. A 66-year-old male patient described intermittent claudication and peripheral arterial disease was suspected. Lower extremity angiography was performed, and following dilation of a 7.0x150-mm balloon, a 9.0x57-mm stent was placed in the lesioned vessel. The patient subsequently developed confusion and cortical blindness, and a seizure occurred 1 hour after the procedure. An emergency cerebral computed tomography scan did not reveal any signs of intracerebral hemorrhage. The neurological symptoms disappeared within 24 hours after hydration and sedative medication. CIE was diagnosed based on the patient`s clinical course findings and cerebral imaging. |
10. | Successful treatment of massive pulmonary embolism with reteplase Ali Çoner, Davran Çiçek, Serhat Balcıoğlu, Sinan Akıncı, Haldun Müderrisoğlu PMID: 29512616 doi: 10.5543/tkda.2017.33568 Pages 143 - 146 Unexpected and unexplained out-of-hospital cardiac arrests have a poor prognosis. Difficulties encountered during the differential diagnosis phase may delay the administration of specific treatment for treatable and reversible causes of cardiac arrest. Massive pulmonary embolism is a reversible cause of cardiac arrest, but without proper management it has a high mortality rate. Presently described is the case of a 53-year-old female patient with a massive pulmonary embolism. |
11. | Infective endocarditis of a bicuspid aortic valve complicated by septal aneurysm and mitral-aortic intervalvular fibrosa pseudoaneurysm Hicaz Zencirkıran Ağuş, Oya Atamaner, Begüm Uygur, Ali Kemal Kalkan, Mehmet Ertürk PMID: 29512617 doi: 10.5543/tkda.2017.50245 Pages 147 - 150 Aortic valve endocarditis can lead to the destruction or perforation of the leaflets, ring abscess, fistula, or perivalvular regurgitation; less commonly, the regurgitation itself may result in secondary damage to subaortic structures. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare complication of native aortic valve endocarditis. This region is a relatively avascular area and is prone to endocarditis infection and subsequent aneurysm formation. Herein, the case of a 33-year-old man who was diagnosed with bicuspid aortic valve endocarditis complicated by a pseudoaneurysm, an aneurysm, and aortic valve rupture is described. |
12. | The hemostatic power of fat: An effective, inexpensive, and biocompatible method to achieve hemostasis in cardiac surgery María Elena Arnáiz García, Jose María González- Santos, Javier López- Rodríguez, Ana María Arnáiz- García, Javier Arnáiz PMID: 29512618 doi: 10.5543/tkda.2017.89803 Pages 151 - 154 Postoperative bleeding with its important socioeconomic cost is associated with an increased morbidity and mortality. It causes hemodynamic instability, increases blood loss, and multiplies the number of transfusions required. Especially in vascular or aortic surgery, postoperative bleeding can become a life-threatening complication due to anticoagulant or antiaggregation preoperative status or postoperative coagulation dysfunction after a high level of heparinization. Presently described is the case of a patient who underwent an aortic valve and ascending aorta replacement. A simple but effective method to achieve hemostasis, designed particularly for aortic surgery and the use of Dacron grafts, is presented. No residual adherence or contraindications exist, and it can potentially be applied to any kind of surgical process. This method offers a cheap, biocompatible, and highly effective means to achieve complete hemostasis without the use of extra sutures, or expensive synthetic or allogeneic hemostatic agents or sealants. |
INVITED REVIEW | |
13. | A practical and case-based approach to thrombocytopenia in cardiology practice Erman Öztürk, Ferit Onur Mutluer PMID: 29512619 doi: 10.5543/tkda.2018.76968 Pages 155 - 162 In cardiology practice, anticoagulation and antiplatelet therapies are essential for most patients. As of yet, there is no high quality evidence regarding these treatments in thrombocytopenic patients, which continues to be an issue. Thrombocytopenia is defined as a platelet count of <150x109/L and is classified as severe when the platelet count is <50x109/L. Pseudothrombocytopenia, drug-induced thrombocytopenia, immune thrombocytopenia, heparin-induced thrombocytopenia, and thrombotic thrombocytopenic purpura are some of the main causes of thrombocytopenia. The current treatment suggestions are conservative, as a result of the lack of evidence, built on defensive treatment strategies and the fear of bleeding complications. Many patients with acute myocardial infarction with thrombocytopenia have undergone percutaneous coronary intervention successfully with adjunctive antiplatelet and anticoagulant use, as has been described in case reports. A risk-benefit ratio should be evaluated for antiplatelet therapy. In the relevant guidelines, while full dose low-molecular-weight heparin (LMWH) is recommended for patients with a thrombocyte count of >50x109/L, a half-dose of LMWH is recommended in patients with thrombocytopenia between 25 and 50x109/L. According to the current guidelines, avoiding antiplatelet and anticoagulant treatment should be restricted to patients with very severe thrombocytopenia (i.e., a platelet count <25x109/L), but new data and recommendations are needed. |
CASE IMAGE | |
14. | Hybrid aortic repair for a massive aneurysm Ahmet Güner, Mehmet Altuğ Tuncer, Sabahattin Gündüz, Nuri Havan, Mehmet Özkan PMID: 29512620 doi: 10.5543/tkda.2017.40032 Page 163 Abstract | |
15. | Left ventricular pseudoaneurysm as a silent complication of non-ST segment elevation myocardial infarction İbrahim Yıldız, Pınar Özmen Yıldız, İsmail Gürbak, Bülent Kaya PMID: 29512621 doi: 10.5543/tkda.2017.22934 Page 164 |
16. | Bovine-type aortic arch and compression of the kissing carotid arteries by a retrosternal goiter: An uncommon cause of carotid bruit Ahmet Çağrı Aykan, Ayşegül Karadeniz, Ismail Gökhan Çavuşoğlu PMID: 29512622 doi: 10.5543/tkda.2017.23483 Page 165 Abstract | |
17. | A rare coincidence of hypoplasia of the posterior mitral leaflet and the bicuspid aortic valve Muhittin Demirel, Emrah Acar, Serkan Sivri, Erdoğan Sökmen, Sinan Cemgil Özbek PMID: 29521308 doi: 10.5543/tkda.2017.12387 Page 166 |
OTHER ARTICLES | |
18. | Kardiyoloji yayınlarında gündem ve yorumlar Ertan Ural Page 167 Abstract | |
Copyright © 2025 Archives of the Turkish Society of Cardiology