ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 49 (5)
Volume: 49  Issue: 5 - July 2021
EXPERT OPINION
1. New Oral AntiCoagulants Use in REnal Disease and AF (NOACURE-AF) Where do we stand?: An expert consensus view using the Delphi method
Mustafa Arıcı, Tevfik Ecder, İzzet Erdinler, Ercan Ok, Özlem Arıcan Özlük, Uğur Önsel Türk, Emin Alioğlu
doi: 10.5543/tkda.2021.40652  Pages 345 - 352

EDITORIAL COMMENT
2. Sacubitril/valsartan in real-life clinical practice
Yüksel Çavuşoğlu
doi: 10.5543/tkda.2021.21145  Pages 353 - 356
Abstract |Full Text PDF

ORIGINAL ARTICLE
3. Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR)
Berkay Ekici, Mehmet Yaman, Murathan Küçük, Seçkin Dereli, Mustafa Yenerçağ, Zerrin Yiğit, Mehmet Memduh Baş, Yusuf Karavelioğlu, Hüseyin Altuğ Çakmak, Tarık Kıvrak, Hakan Özkan, Cihan Altın, Cengiz Şabanoğlu, Burcu Demirkan, Ali Ekber Ataş, Fethi Kılıçaslan, Hakan Altay, İstemihan Tengiz, Aycan Fahri Erkan, Barış Kılıçaslan, Fatih Erkam Olgun, Murtaza Emre Durakoğlugil, Aslıhan Alhan, Mehdi Zoghi
doi: 10.5543/tkda.2021.63099  Pages 357 - 367
Objective: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey.
Methods: The ARNi-TR is a multicenter, noninterventional, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control.
Results: N‐terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARN.
Conclusion: The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.

4. Prevalence of Jervell-Lange Nielsen syndrome in children with congenital bilateral sensorineural hearing loss
Yakup Ergül, Hasan Candaş Kafalı, Erman Cilsal, Bekir Yükçü, İbrahim Yaman, Filiz Çetinkaya Işık, Alper Güzeltaş, Mehmet Ertürk
doi: 10.5543/tkda.2021.44890  Pages 368 - 376
Objective: Long QT syndrome (LQTS) is an inherited cardiac ion channel disorder (channelopathy) that is characterized by prolonged QT intervals on the electrocardiography (ECG) and possess the risk of sudden cardiac death (SCD). Jervell-Lange Nielsen syndrome (JLNS) is a specific subtype of LQTS that is accompanied by congenital sensorineural hearing loss, inherited autosomal recessively, and higher risk of SCD. In this study, we aimed to investigate JLNS prevalence in deaf children attending special schools for hearing loss, located in our province.
Methods: An ECG screening program was conducted in 6 special schools for children with hearing loss in İstanbul and a total of 440 students between 6 and 18 years old were included. Corrected QT interval (QTc) was calculated using the Bazett formula. Notably, 51 students, detected with any abnormal finding on ECG, were invited to our center for a comprehensive examination.
Results: A total of 8 patients were found with a prolonged QT interval. JLNS was diagnosed in 4 (0.9%) patients. In addition, 2 students had already been diagnosed with JLNS at another center earlier. The other 2 students, being siblings, were newly diagnosed with JLNS; and appropriate treatment was initiated. Genetic testing revealed a pathological homozygous mutation in KCNQ1 gene. The younger sibling (Case 1), who possessed a QTc of greater than 500 ms and a history of syncope, which was very suspicious for SCD, was implanted an implantable cardioverter-defibrillator. Propranolol treatment was initiated for both siblings.
Conclusion: JLNS should be carefully considered and screened, especially in patients with a history of congenital deafness.

5. Comparison of epicardial fat thickness between metabolically healthy and unhealthy obese women
Duygu Ersan Demirci, Deniz Demirci
doi: 10.5543/tkda.2021.75807  Pages 377 - 386
Objective: Epicardial adipose tissue is suggested to play an important role in the progression of metabolic syndrome (MetS). There is not enough evidence regarding the relationship between echocardiographically measured epicardial fat thickness (EFT) and metabolic health status in women with equal obesity. In this study, we aimed to compare the echocardiographically measured EFT between metabolically healthy and unhealthy obese women with similar body mass index (BMI) and waist circumference (WC) values.
Methods: A total of 90 women (mean age 51.7±8.6 years) with BMI ≥30 kg/m² were enrolled in the study. EFT was measured with transthoracic echocardiography in all participants. The patients were then classified into two groups; metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). EFT and clinical and biochemical parameters were compared between the two groups.
Results: Among the study participants, 46 (51.1%) patients were included in the MHO group. The groups were not different with respect to age, WC, waist to hip ratio, and BMI. The mean value of EFT was 5.53±1.42 mm in patients with MUO and 4.80±1.54 mm in patients with MHO with a statistically significant difference (p=0.022). EFT, fasting insulin, and vitamin D were found as independent variables associated with MUO in obese women.
Conclusion: This study demonstrates that EFT is increased in women with MUO, regardless of BMI and waist circumference, than in women with MHO.

6. Predictors for the prolonged R wave peak time among patients with arterial hypertension
Göksel Çinier, Ahmet Seyda Yılmaz, Ahmet İlker Tekkesin, Mustafa Çetin
PMID: 34308872  doi: 10.5543/tkda.2021.80540  Pages 387 - 394
Objective: Hypertension (HT) is prevalent in the general population and is associated with significant cardiovascular adverse events. Major structural and electrical remodeling occurs in the ventricular myocardium in response to the pressure overload. Increased left ventricular mass (LVM) and myocardial fibrosis contribute to the prolongation of the R wave peak time (RWPT), which may indicate electrical remodeling in patients with HT. We evaluated predictors for prolonged RWPT among patients with a previous diagnosis of HT.
Methods: Consecutive patients who had a previous diagnosis of arterial HT and presented to the cardiology clinic for routine visit were included in the study. The standard 12-lead surface electrocardiography (ECG) and transthoracic echocardiography (TTE) was performed on all the patients included in the study for evaluating RWPT and the epicardial fat tissue (EFT). The upper limit for the RWPT was accepted as 40 milliseconds (ms).
Results: Between February 2019 and February 2020, 453 patients were screened; and of these, 237 were included in the study. The mean age was 62.1±11.2 years, and 41.8% of the included patients were men. The mean RWPT of the study population was 41.9±10.8. The RWPT was prolonged in 55 patients, and the remaining 172 patients had normal RWPT. In the univariate analysis, EFT (Odds ratio [OR] 1.222; 95% confidence interval [CI] 1.077-1386; p=0.002), the left ventricular mass index (LVMI) (OR 1.011; 95% CI 1.001-1.021; p=0.026), and fragmented QRS (fQRS) (OR 2.679; 95% CI 1.433-5.004; p=0.002) were associated with a prolonged RWPT. Multivariate analysis revealed that only EFT (OR 1.211; 95% CI 1.061-1.383; p=0.005) and fQRS (OR 2.796; 95% CI 1.459-5.359; p=0.002) predicted prolonged RWPT.
Conclusion: Among the patients with HT, EFT and fQRS predicted prolonged RWPT. These findings may suggest that compared with increased LVM, myocardial fibrosis had a more significant impact on ventricular activation time.

7. Atrial Fibrillation Impact Questionnaire (AFImpact): Validity and reliability of the Turkish version
Melih Zeren, Rengin Demir, Makbule Karcı, Zerrin Yiğit, Işıl Uzunhasan, Hülya Nilgün Gürses
doi: 10.5543/tkda.2021.89242  Pages 395 - 403
Objective: Guidelines recommend measuring and addressing health-related quality of life in the management of atrial fibrillation (AF); however, a disease-specific questionnaire is lacking for the Turkish language. Our aim was to translate and adapt the Atrial Fibrillation Impact Questionnaire (AFImpact) into Turkish and to explore its psychometric properties.
Methods: This cross-sectional study was conducted in two phases, including the translation and cultural adaptation of AFImpact into Turkish language and the analysis of psychometric properties of the translated questionnaire. 98 patients diagnosed with AF were evaluated using the Turkish version of AFImpact, Short Form-36 (SF-36) and Pittsburg Sleep Quality Index (PSQI). Reliability, validity, and factor structure of the Turkish version of AFImpact was explored.
Results: Cronbach’s alpha coefficients for vitality, emotional distress, and sleep domains of AFImpact was 0.956, 0.955, and 0.819, respectively, indicating good-to-excellent internal consistency. No significant difference was detected between the initial and retest scores, and intraclass correlation coefficients of each domain varied between 0.991 and 0.996, indicating excellent test-retest reliability. Each domain of AFImpact highly correlated with similar domains of SF-36 and PSQI, having correlation coefficients between -0.484 and -0.699. AFImpact was able to discriminate between the patients in different functional classes, confirming know-groups validity. Factor analysis revealed AFImpact had the same factorial structure as the original questionnaire.
Conclusion: The Turkish version of AFImpact is a valid and reliable questionnaire for evaluating health-related quality of life in patients with AF.

8. Interrelation between the rs2200733 polymorphism of the ATFB5 gene and atrial fibrillation in Uzbek patients
Guzal Abdullaeva, Alisher Abdullaev, Amayak Kevorkov, Guzal Abduvaliyeva, Nodir Zakirov, Ravshanbek Kurbanov
doi: 10.5543/tkda.2021.08434  Pages 404 - 409
Objective: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and a major predictor of morbidity and mortality. AF is a polygenic and polyetiological disease. In various ethnic groups, the strongest and most independent relationship with the development of AF was found with the 4q25 locus, where the ATFB5 gene is located. An analysis of the literature data showed that the carriage of the TT genotype of the rs2200733 ATFB5 gene polymorphism is the most unfavorable genotype for the development of AF. The purpose of the study was to identify the prevalence of genotypes and alleles of the rs2200733 polymorphism of the ATFB5 gene in Uzbek patients with AF.
Methods: The study included 69 Uzbek patients with paroxysmal (n=20) and persistent AF (n=49). The control group (n=30) was composed of Uzbek patients without AF. Genotyping for the carriage of allelic variants of the rs2200733 polymorphism of the ATFB5 gene was performed using the Polymerase Chain Reaction-Restriction Length Polymorphism (PCR-RFLP) method. The distribution of the C and T alleles and the CC, CT, and TT genotypes of the rs2200733 polymorphism of the ATFB5 gene in patients with AF and controls were compared.
Results: After genotyping 69 patients with AF, the following distribution of the ATFB5 gene polymorphism rs2200733 was revealed: the CC genotype was detected in 35 (50.72%) patients, the CT genotype in 25 (36.23%) patients, and the TT genotype in 9 (13.05%) patients (p<0.001, χ²=22.435). Moreover, the C allele was detected in 95 (68.8%) patients, and the T allele was detected in 43 (31.2%) patients (p<0.001, χ²=37.696). The distribution of genotypes in the control group was as follows: the CC genotype was detected in 17 individuals (56.7%), the CT genotype was detected in 12 individuals (40%), and the TT genotype was detected in 1 individual (3.3%) (p<0.001, χ²=20.100). Moreover, the C allele was detected in 46 (76.7%) patients, and the T allele was detected in 14 (23.3%) patients (p<0.001, χ²=32.033). The TT genotype of the ATFB5 gene was found to be significantly more prevalent in patients with AF than in controls (13.1% vs 3.3%, p=0.0001).
Conclusion: The TT genotype of the rs2200733 polymorphism of the ATFB5 gene was found to be significantly more prevalent in Uzbek patients with AF than in controls.

CASE REPORT
9. Atrial fibrillation-related acute myocardial infarction and acute mesenteric ischemia
Levent Pay, Zeynep Kolak, Bilal Çakır, Tugay Kamber, Selçuk Yazıcı
doi: 10.5543/tkda.2021.96533  Pages 410 - 413
Atrial fibrillation-related synchronous thromboembolism of the mesenteric and coronary arteries is a rare event. This case report is about an 82-year-old male patient who presented to the emergency department with epigastric pain and who was diagnosed with ST-elevated myocardial infarction accompanied with acute mesenteric ischemia. To our knowledge, this is the first report of angiographic evidence of synchronous thrombus in both the arteries.

10. Very delayed sinus arrest during complete remission of diffuse large B-cell lymphoma invading right atrium
Toshimitsu Tsugu, Yuji Nagatomo, Emiko Matsuyama, Patrizio Lancellotti, Hideo Mitamura
doi: 10.5543/tkda.2021.57474  Pages 414 - 418
Diffuse large B-cell lymphoma (DLBCL)-associated arrhythmias may be due to cardiac involvement or may be chemotherapy-induced. There have been no reports of significant arrhythmias with normal cardiac function occurring during the complete remission of DLBCL. A 57-year-old female, who had had no history of abnormal electrocardiograms (ECGs) in annual medical checkups, was admitted to our hospital because of low-grade fever, night sweats, and weight loss. On admission, ECG revealed a variable rhythm consisting of sinus beats and occasional escape beats. Computed tomography and 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) revealed two masses in the right atrium (RA) and the uterus. Total hysterectomy was performed, and pathological findings were consistent with diffuse large B-cell lymphoma (DLBCL). Chemotherapy (R-CHOP) was initiated. After two chemotherapy cycles, RA tumors disappeared, and bradyarrhythmia simultaneously converted to sinus rhythm without antiarrhythmic drug therapy. Six months after completion of chemotherapy, FDG-PET/CT revealed negative uptake in the RA and the uterus. The patient attained complete remission of DLBCL, but ECG showed bradycardia because of sinus arrest. Our case suggests that DLBCL-induced arrhythmia can occur even after its remission and should be monitored.

11. The disappearance of nonsustained ventricular tachycardia after surgical repair in a patient with mitral annular disjunction and mitral valve prolapse
Hasan Ali Barman, Ahmet Yıldız, Mustafa Güden, Emir Özgür Barış Ökçün
doi: 10.5543/tkda.2021.04501  Pages 419 - 423
Mitral annular disjunction (MAD) is a structural abnormality defined as the separation of the ventricular myocardium between the mitral valve annulus and the left atrial wall. It is present in some patients with mitral valve prolapse (MVP) and is associated with papillary muscle fibrosis and ventricular arrhythmia. Although it is easy to diagnose, it can be overlooked in daily practice. This study presents the case of a 42-year-old patient who was admitted to the cardiology clinic with complaints of palpitation and syncope. The patient was diagnosed with bileaflet MVP, MAD, and severe mitral regurgitation using transthoracic echocardiography and cardiac magnetic resonance imaging, in which ventricular tachycardia disappeared following subsequent surgical repair.

CASE IMAGE
12. Bioprosthetic mitral and aortic valve endocarditis associated with Candida Albicans
María Elena Arnaiz-Garcia, Ana-Maria Arnaiz-Garcia, Alberto Iscar- Galán, Javier Arnaiz, José María González- Santos
doi: 10.5543/tkda.2021.78176  Page 424
Abstract |Full Text PDF | Video

13. A case of mitral regurgitation causing patent foramen ovale behaving like an atrial septal defect: A rare finding in an adult patient
Tufan Çınar, Vedat Çiçek, Mert Hayıroğlu, Nurgül Keser, Mehmet Uzun
doi: 10.5543/tkda.2021.28178  Page 425
Abstract |Full Text PDF | Video

OTHER ARTICLES
14. Kardiyoloji yayınlarında gündem ve yorumlar
Ertan Ural
Page 426
Abstract |Full Text PDF



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