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 | |
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 | |
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 |
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 |
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 |
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 | |
19. | Authors reply Gökhan Çakırca, Muhammet Murat Çelik PMID: 30516539 doi: 10.5543/tkda.2018.02361 Pages 739 - 740 Abstract | |
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 | |
21. | Authors reply Serkan Cay, Firat Ozcan, Ozcan Ozeke, Dursun Aras, Serkan Topaloglu PMID: 30516540 doi: 10.5543/tkda.2018.95486 Page 741 Abstract | |
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 | |
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 | |
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 | |
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 | |
OTHER ARTICLES | |
26. | Comment on cardiology publications Ertan Ural Page 746 Abstract | |
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