ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 46 (8)
Volume: 46  Issue: 8 - December 2018
EDITORIAL COMMENT
1. What is the association between obesity and diastolic dysfunction: Obesity or obesity phenotype?
Servet Altay
PMID: 30516521  doi: 10.5543/tkda.2018.16626  Pages 649 - 650
Abstract |Full Text PDF

ORIGINAL ARTICLE
2. Predictive power of different obesity measures for the presence of diastolic dysfunction
Yalın Tolga Yaylalı, Güzin Fidan-yaylalı, Beray Can, Hande Şenol, Mehmet Kılınç, Mustafa Yurtdaş
PMID: 30516522  doi: 10.5543/tkda.2018.12844  Pages 651 - 658
Objective: Body mass index (BMI) and waist circumference (WC) as measures of obesity have some limitations. The aim of this study was to evaluate whether one measure could predict the presence of diastolic dysfunction (DD) more accurately than the other measures.
Methods: A total of 91 obese patients without any other risk factors for DD were prospectively enrolled. Echocardiographic examination was performed. DD was defined and categorized according to recent guidelines. The study participants were divided into 2 groups according to the presence of DD. Weight, height, and WC were measured; BMI and waist-to-hip ratio (WHR) were calculated; and a body shape index (ABSI) was calculated as WC/(BMI2/3height1/2). The associations between ABSI, BMI, WHR, and WC and the presence of DD were examined using logistic regression analyses. Analysis of covariance was used to examine the differences.
Results: WC and BMI were significantly greater in subjects with DD (p=0.049 and 0.051, respectively). A greater BMI, WC, and WHR increased the risk of the presence of DD (BMIDD: odds ratio [OR]=1.096, p=0.024; WC-DD: OR=1.059, p=0.007; WHR-DD: OR=2.363, p=0.007). After adjustment for age and sex, only BMI continued to be significantly associated with DD (p=0.031). ABSI was not associated with DD.
Conclusion: After adjustment for age and sex, BMI was the only predictor of DD in obesity. Despite its limitations, BMI may still be a potentially more accurate measure of DD compared with other obesity measures.

3. Mid-term clinical outcomes of new generation drug-eluting stents for treatment of diffuse coronary artery disease
Ali Çoner, Davran Çiçek, Sinan Akıncı, Serhat Balcıoğlu, Cihan Altın, Haldun Müderrisoğlu
PMID: 30516523  doi: 10.5543/tkda.2018.62678  Pages 659 - 666
Objective: Diffuse coronary artery disease (CAD) is a challenging issue in clinical cardiology practice. There are limited data about percutaneous revascularization in these patients.
Methods: This study was an observational clinical evaluation. The records of patients with diffuse CAD revascularized with new-generation drug-eluting stents (DES) were researched retrospectively. Patients treated with multiple, overlapping new-generation DES (at least 60mm in length per vessel) were included. The incidence of major adverse cardiac events (MACE), defined as cardiac death, stent thrombosis, non-fatal myocardial infarction, and target lesion revascularization (TLR), at the end of the first year following the index procedure was recorded.
Results: A total of 71 patients (with 75 coronary vessels) treated with new-generation DES for diffuse CAD were enrolled in the study. Zotarolimus-eluting stents were used in 48 vessels and biolimus A9-eluting stents were used in 27 vessels. The median total stent length per vessel was 75.0 mm (60.0–106.0) and the median number of stents implanted was 3 (2–4) for each vessel. The cumulative incidence of MACE at the end of the first year was 11.2% (8 patients). The presence of diabetes mellitus (DM) and ST-segment elevated myocardial infarction (STEMI) were defined as independent clinical risk factors related to MACE development.
Conclusion: Coronary artery revascularization with new-generation drug-eluting stents can be a good choice in the treatment of selected patients with diffuse CAD. DM and STEMI were found to be related to poorer clinical outcomes with this treatment option in our study.

4. Pulmonary hypertension spectrum: 16 years of experience from a single center
Ramin Hacıyev, Serkan Ünlü, Mehmet Rıdvan Yalçın, Gülten Taçoy, Atiye Çengel
PMID: 30516524  doi: 10.5543/tkda.2018.28909  Pages 667 - 674
Objective: Pulmonary hypertension (PH) is multidisciplinary disorder that should be diagnosed and treated by specialized centers. Progress in the field of PH diagnosis has led to new classifications of the disease. The aim of this study was to determine the etiological properties of PH diagnosed at one center.
Methods: A retrospective search of the database of the right heart catheterization laboratory was conducted. All of the patients who underwent right heart catheterization (RHC) and were diagnosed with PH were included in the study and grouped according to etiology.
Results: A total of 379 patients with PH (23 female; 53.2±14.7 years) were included in the current research. There were 82 patients classified as having pulmonary arterial hypertension (PAH). The leading cause among the PAH subgroups was congenital heart disease, and valve disease were found to be most the common reason for postcapillary PH. There was a statistically significant difference in the mean and systolic
pulmonary artery pressure and left ventricular ejection fraction between the PH groups (p<0.001, p=0.003, p<0.001, respectively).
Conclusion: The results of this study indicated that the leading causes of PAH and postcapillary PH were congenital heart disease and valve disease, respectively. Additional research of the etiological properties of PH should be performed by specialized centers in Turkey.

5. Arrhythmia during diagnostic cardiac catheterization in pediatric patients with congenital heart disease
Taner Kasar, Ibrahim Cansaran Tanıdır, Erkut Öztürk, Selman Gökalp, Gülhan Tunca Şahin, Mehmet Akın Topkarcı, Yakup Ergül, Alper Güzeltaş
PMID: 30516525  doi: 10.5543/tkda.2018.06025  Pages 675 - 682
Objective: Diagnostic and interventional cardiac catheterization procedures for congenital heart diseases (CHD) are becoming increasingly more popular, and arrhythmia is a well-known complication. This study was an evaluation of the incidence and causative agents of arrhythmia and the subsequent treatment strategies applied during cardiac catheterization.
Methods: The catheterization data of all of the patients who underwent diagnostic cardiac catheterization for CHD between January 2012 and 2018 at a single center were examined retrospectively.
Results: A total of 1316 children underwent diagnostic cardiac catheterization due to CHD. The median age and body weight was 18 months (6 days-21 years) and 9.9 kg (2.2–135 kg), respectively. Patients with ventricular septal defect (281 patients) and those with tetralogy of Fallot (257 patients) represented 2 major groups in the study population. In 93 (7%) patients, arrhythmia developed during cardiac catheterization. Among them, there were 58 (62%) cases of bradyarrhythmia and 35 (38%) cases of tachyarrhythmia. Arrhythmia was classified as low, high, or major, according to the adverse event severity score; the rates were 2.7%, 4.3%, and 1.2%, respectively. In 36 (39%) patients, there was no need for therapy, whereas 57 (61%) required treatment to eliminate the arrhythmia. Treatment modalities included catheter manipulation in 15, pharmacological therapy in 24, and cardioversion in 3 patients. Eleven patients required cardiopulmonary resuscitation. Temporary pacemaker implantation was required in 2 patients, while 2 others underwent permanent pacemaker implantation secondary to catheterization-related arrhythmia. There were no cases of mortality secondary to catheterization-related arrhythmia.
Conclusion: Diagnostic cardiac catheterization in CHD may result in various types of cardiac arrhythmias. The proper management of arrhythmias may reduce morbidity and mortality related to cardiac catheterization.

6. Is there a gender gap in secondary prevention of coronary artery disease in Turkey?
Duygu Koçyiğit, Lale Tokgözoğlu, Meral Meral Kayıkçıoğlu, Servet Altay, Sinan Aydoğdu, Cem Barçın, Cem Bostan, Hüseyin Altuğ Çakmak, Alp Burak Çatakoğlu, Samim Emet, Oktay Ergene, Ali Kemal Kalkan, Barış Kaya, Cansın Kaya, Cihangir Kaymaz, Nevrez Koylan, Hakan Kültürsay, Aytekin Oğuz, Ebru Özpelit, Serkan Ünlü
PMID: 30516526  doi: 10.5543/tkda.2018.45392  Pages 683 - 691
Objective: It has been reported that women receive fewer preventive recommendations regarding pharmacological treatment, lifestyle modifications, and cardiac rehabilitation compared with men who have a similar risk profile. This study was an investigation of the impact of gender on cardiovascular risk profile and secondary prevention measures for coronary artery disease (CAD) in the Turkish population.
Methods: Statistical analyses were based on the European Action on Secondary and Primary Prevention through Intervention to Reduce Events (EUROASPIRE)-IV cross-sectional survey data obtained from 17 centers in Turkey. Male and female patients, aged 18 to 80 years, who were hospitalized for a first or recurrent coronary event (coronary artery bypass graft, percutaneous coronary intervention, acute myocardial infarction, or acute myocardial ischemia) were eligible.
Results: A total of 88 (19.7%) females and 358 males (80.3%) were included. At the time of the index event, the females were significantly older (p=0.003) and had received less formal education (p<0.001). Non-smoking status (p<0.001) and higher levels of depression and anxiety (both p<0.001) were more common in the female patients. At the time of the interview, conducted between 6 and 36 months after the index event, central obesity (p<0.001) and obesity (p=0.004) were significantly more common in females. LDL-C, HDL-C or HbA1c levels did not differ significantly between genders. The fasting blood glucose level was significantly higher (p=0.003) and hypertension was more common in females (p=0.001). There was no significant difference in an increase in physical activity or weight loss after the index event between genders, and there was no significant difference between genders regarding continuity of antiplatelet, statin, beta blocker or ACEi/ARB II receptor blocker usage (p>0.05).
Conclusion: Achievement of ideal body weight, fasting blood glucose and blood pressure targets was lower in women despite similar reported medication use. This highlights the importance of the implementation of lifestyle measures and adherence to medications in women.

7. The caregiver burden and the psychosocial adjustment of caregivers of cardiac failure patients
Filiz Dirikkan, Leyla Baysan Arabacı, Ece Mutlu
PMID: 30516527  doi: 10.5543/tkda.2018.69057  Pages 692 - 701
Objective: This cross-sectional, descriptive study evaluated the relationship between the caregiver burden and the psychosocial adjustment of caregivers to cardiac failure patients.
Methods: Between November 18, 2015 and March 1, 2016, a preliminary information form, the Caregiver Burden Scale, and the Psychosocial Adjustment to Illness Scale were used to assess the caregivers of 200 patients being treated in the cardiology service of a university hospital.
Results: Among the caregivers, 75% were primary or secondary school graduates, 36% were housewives, and 43% were the patients’ spouse. Of the group, 71% had been caring for the patients for 5 years or less. The caregivers described cardiac failure as “difficulty with inhalation, fatigue, asthenia, insomnia, and swelling in the hands and feet.” They reported feelings of sorrow, fear, despair, bewilderment, anger, and guilt when they learned about the diagnosis, and they indicated that they generally managed those feelings by themselves. A total of 94% of the caregivers remarked that after the diagnosis they experienced physical, psychological, social, occupational, or economic changes. Of the respondents,74% felt sad and adversely affected, 71.5% faced difficulties with care provision, and 84% felt anxiety about the possibility of losing the patient while under their care, the disease prognosis, surgery (pacemaker implantation), and adjustment to the treatment. The study participants’ caregiver burden and psychosocial adjustment scale scores were below average. There were moderate statistically significant relationships between 3 subdimensions of the caregiver burden and psychosocial adjustment to illness scales (p<0.05).
Conclusion: The participating caregivers of cardiac failure patients described moderate difficulties due to caregiving and adjusting to the illness. It was determined that as the distress felt due to caregiving increased, psychosocial adjustment to illness deteriorated.

CASE REPORT
8. Acute anterior myocardial infarction in the 36th week of pregnancy: A successful stepwise treatment approach
Murat Akçay, Murat Meriç, Ömer Gedikli, Serkan Yüksel, Mahmut Şahin
PMID: 30516528  doi: 10.5543/tkda.2018.79092  Pages 702 - 705
Acute myocardial infarction (AMI) is associated with a high incidence of maternal and fetal complications when it develops during pregnancy or the early postpartum period. The pathophysiology involves various factors, including alterations in the vascular wall and hypercoagulability as a result of the hormonal and hemodynamic effects of pregnancy. It frequently occurs due to the development of a thrombus following a ruptured plaque. In addition, coronary artery dissection constitutes a significant cause of AMI in pregnancy. In the literature, the therapeutic approach covers a wide spectrum, ranging from conservative follow-up to percutaneous coronary intervention, urgent bypass surgery, and occasionally, thrombolytic therapy. The success rate is often low; however, maternal and fetal complications are seen more frequently during invasive interventions and bypass surgeries because of the structural changes in the coronary intima and media wall. Presently described is the case of a woman in the 36th week of pregnancy who presented with AMI. The occlusion could not be detected during the primary percutaneous intervention, and thrombolytic treatment and a stepwise percutaneous intervention were performed with a successful result.

9. Unilateral leg edema: Is it always vascular?
Ferit Onur Mutluer, Cenk İndelen, Neris Dincer, Gamze Aslan, Mehmet Şanser Ateş
PMID: 30516529  doi: 10.5543/tkda.2018.85601  Pages 706 - 709
Unilateral lower extremity edema below the knee commonly results from deep venous thrombosis, venous insufficiency, or lymphedema. The patient history, a physical examination, and lower extremity venous duplex ultrasound often reveal the underlying etiology, which is frequently of vascular origin. Presently described is the case of a 23-year-old patient who underwent a diagnostic work-up for unilateral leg swelling and was found to have a relatively uncommon cause of edema: lipedema. Lipedema is a disease characterized by subcutaneous adipose tissue deposition, and although diagnosed very rarely in general cardiology outpatient clinics, it has been demonstrated to be a cause of lower extremity edema in approximately one-fifth of cases in specialized clinics.

10. Removal of a catheter kinked in the radial artery by anchoring the distal part of the catheter with a needle via transcutaneous approach
Yakup Balaban, Ali Hıdır Kayışoğlu, Altuğ Tokatlı, Aykut Tantan
PMID: 30516530  doi: 10.5543/tkda.2018.TKDA-45095  Pages 710 - 713
Presently described is a case in which a catheter became twisted in the radial artery during coronary angiography and was removed after stretching it with an external needle tip inserted into the brachial artery. A 77-year-old male patient had undergone coronary artery bypass surgery 10 years earlier and implantation of a permanent pacemaker 2 years prior. He had presented with typical angina and a regional wall motion defect had been observed on echocardiography. Coronary angiography was scheduled. A 5-F sheath (Terumo Corp., Tokyo, Japan) was inserted, and angiography via the right radial artery was initiated. Soon after, the 5-F diagnostic catheter became twisted due to subclavian artery tortuosity. The fold in the catheter could not be flattened with 0.038-mm or 0.035-mm guidewires or rotation movements. With scopy assistance, a 21-gauge, 40-mm, green needle was inserted percutaneously into the catheter through the brachial artery. So, the catheter was stretched and the kink could then be corrected and the catheter was removed from the sheath. Subsequent Images revealed no trauma or deformity to the brachial or radial arteries. It was not possible to straighten the fold until the distal portion of the catheter was fixed in place and stretched. A catheter can be transdermally anchored with a needle if it becomes kinked in the upper extremity vessels. This is a simple and reliable method that is a traumatic.

11. Revascularization of superficial femoral artery due to chronic total occlusion: Collateral approach
Özkan Candan, Sabahattin Gündüz, Müslüm Şahin
PMID: 30516531  doi: 10.5543/tkda.2017.96920  Pages 714 - 717
Endovascular interventions are now used more frequently in the treatment of femoropopliteal occlusions, and antegrade passage through the occlusion is preferred as the first option. However, when antegrade passage fails for any of several reasons, retrograde, or less frequently, collateral passage may be used. Although collateral passage may present serious complications, it can be successfully applied in selected cases in experienced centers. In the present case, a superficial femoral artery occlusion was successfully opened with a collateral approach.

12. Can flecainide totally eliminate bidirectional ventricular tachycardia in pediatric patients with Andersen-Tawil syndrome?
Yakup Ergül, Senem Özgür, Sertaç Hanedan Onan, Volkan Tuzcu
PMID: 30516532  doi: 10.5543/tkda.2017.77856  Pages 718 - 722
Andersen-Tawil syndrome (ATS) is a disorder that causes episodes of muscle weakness (periodic paralysis), changes in heart rhythm, and developmental abnormalities. QT prolongation and ventricular arrhythmias, including bidirectional ventricular tachycardia (VT) and polymorphic VT, may occur. About 60% of all cases of the disorder are caused by mutations in the KCNJ2 gene. A 13-year-old female patient was referred for frequent premature ventricular contractions. Suspicion of ATS due to dysmorphic findings, electrocardiogram changes, and periodic muscle weakness was genetically confirmed. Beta-blocker therapy was initiated as a first-line treatment for bidirectional VT and frequent polymorphic premature ventricular contractions. Despite proper treatment, the VT attacks were not brought under control. Flecainide was added to the treatment regime. The number of premature ventricular contractions was dramatically reduced with flecainide and the VT attacks completely disappeared. This patient is a rare example of ATS in our country. This article provides a description of successful management of rhythm disturbance in a patient with ATS

EXPERT OPINION
13. Vaccination of adults with heart failure and chronic heart conditions: Expert opinion
Ahmet Çelik, Hakan Altay, Alpay Azap, Yüksel Çavuşoğlu, Sanem Nalbantgil, Esin Şenol, Ahmet Temizhan, Mehmet Birhan Yılmaz
PMID: 30516533  doi: 10.5543/tkda.2018.37048  Pages 723 - 734

CASE IMAGE
14. Iatrogenic radial artery psedoaneurysm after cardiac catheterization
Leydimar Anmad Shihadeh Musa, Raquel Pimienta- González, Carlos Rubio- Iglesias, Marcos Rodriguez- Esteban, Julio Hernández- Afonso
PMID: 30516534  doi: 10.5543/tkda.2018.04135  Page 735
Abstract |Full Text PDF

15. Endovascular coil treatment of a right coronary artery aneurysm related to atherosclerosis
Ali Rıza Akyüz, Sinan Şahin, Ayşegül Karadeniz
PMID: 30516535  doi: 10.5543/tkda.2018.21533  Page 736
Abstract |Full Text PDF | Video

16. Treatment of a fistula between coronary and pulmonary arteries with simultaneous use of two microcatheters for antegrade coil embolization
Anıl Avcı, Mehmet Aytürk, Ahmet Güner, Mahmut Buğrahan Çiçek, Ramazan Kargın
PMID: 30516536  doi: 10.5543/tkda.2018.43638  Page 737
Abstract |Full Text PDF | Video

17. Disproportionate right heart enlargement in a patient with small atrial septal defect: Hidden abnormal pulmonary venous return
Kumral Çağlı, Mustafa Karakurt, Halil Lütfi Kısacık, Mustafa Özdemir, Zehra Gölbaşı
PMID: 30516537  doi: 10.5543/tkda.2018.84669  Page 738
Abstract |Full Text PDF | Video

LETTER TO EDITOR
18. Lipid disorders in Familial Mediterranean Fever patients: Is inflammation the only cause?
Yusuf Ziya Şener, Metin Okşul, Gül Sinem Kılıç
PMID: 30516538  doi: 10.5543/tkda.2018.44389  Page 739
Abstract |Full Text PDF

19. Authors reply
Gökhan Çakırca, Muhammet Murat Çelik
PMID: 30516539  doi: 10.5543/tkda.2018.02361  Pages 739 - 740
Abstract |Full Text PDF

20. Where is the missing piece of the puzzle? Failed device therapy in patients with left ventricular assist device
Sohaib Haseeb, Enes Elvin Gul
PMID: 30516545  doi: 10.5543/tkda.2018.61365  Pages 740 - 741
Abstract |Full Text PDF

21. Authors reply
Serkan Cay, Firat Ozcan, Ozcan Ozeke, Dursun Aras, Serkan Topaloglu
PMID: 30516540  doi: 10.5543/tkda.2018.95486  Page 741
Abstract |Full Text PDF

22. Implantable cardioverter-defibrillator therapies are associated with increased incidence of depression and mortality
Metin Okşul, Yusuf Ziya Şener, Arzu Yıldırım
PMID: 30516541  doi: 10.5543/tkda.2018.01361  Page 742
Abstract |Full Text PDF

23. Authors reply
Georgiy Pushkarev, Vadim A Kuznetsov, Yakov A Fisher, Anna M Soldatova, Tatiana N Enina
PMID: 30516542  doi: 10.5543/tkda.2018.38834  Pages 742 - 743
Abstract |Full Text PDF

24. Is Cardiac Syndrome X associated with altered myocardial energy expenditure?
Gamze Babur Güler
PMID: 30516543  doi: 10.5543/tkda.2018.41635  Pages 743 - 744
Abstract |Full Text PDF

25. Author's reply
Elif Hande Özcan Çetin, Mehmet Serkan Çetin, Ahmet Temizhan
PMID: 30516544  doi: 10.5543/tkda.2018.23177  Pages 744 - 745
Abstract |Full Text PDF

OTHER ARTICLES
26. Comment on cardiology publications
Ertan Ural
Page 746
Abstract |Full Text PDF



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