ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 50 (3)
Volume: 50  Issue: 3 - April 2022
FRONTMATTER
1. Front Matter

Pages I - II

EDITORIAL COMMENT
2. Prevention Is Better Than Cure
Necla Özer
doi: 10.5543/tkda.2022.22393  Pages 165 - 167
Abstract | English Full Text

ORIGINAL ARTICLE
3. Surrogates of the Left Ventricular Thrombus Resolution: A Retrospective Data Review
Hosameldin Salah Shabib Ahmed, Hüseyin Ede, Ahmed Sobhy Hassan Ghonim Mahfouz, Alaa Abdullah Ali Rahhal, Muhammad Abdulhakim Ali, Ammar Fares Alhaj Issa, Abdul Baki Jasem Senjar, Sumaya Mehdar Al Saadi Al Yafei, Abdul Rahman Mohammad Said Arabi, Awad Razaq Al-Qahtani
doi: 10.5543/tkda.2022.21068  Pages 168 - 174
Objective: The left ventricular thrombus is one of the serious complications of ischemic cardio- myopathy. In this study, we aimed to search for the independent factors to predict the resolu- tion of left ventricular thrombus.
Methods: This retrospective study included all patients with coronary artery disease, aged above 18 years old, and with the thrombus at the apical location of the left ventricle. Demographic, clinical, and echocardiographic characteristics of the patients were recorded. Major adverse cardiovascular events developed within the follow-up period were recorded. The time in the therapeutic range of each patient was calculated. The presence of left ventricular thrombus beyond 180 days despite warfarin usage was classified as persistent left ventricular thrombus.
Results: The study included 174 subjects (169 males and 5 females). The mean age of the study population was 54.5 ± 11.0 years. The number of patients in whom the left ven- tricular thrombus resolved with treatment in less than 180 days was 56 (32.2%). Median anticoagulation time in the study population was 252 [150-480] days and the meantime in the therapeutic range of the patients was 54 ± 19%. The time in therapeutic range value of the groups was similar (P =.593). It was found that concomitant clopidogrel use (P =.003) and left ventricular thrombus area (P <.001) were the independent predictors of left ventricular thrombus resolution within less than 180 days in the logistic regression analysis.
Conclusion: Concomitant use of clopidogrel was found to be associated with left ventricular thrombus resolution but left ventricular thrombus size was related to left ventricular thrombus persistency. Although standard 3-6 months of anticoagulation is advised for left ventricular thrombus, considering the presence of these predictors in such patients may guide the physi- cians to individualize the treatment.

4. Changing of Left Atrial Function Index in Symptomatic Patients with Patent Foramen Ovale After Device Closure
Gianluca Rigatelli, Marco Zuin, Gabriele Braggion, Daniela Lanza, Silvio Aggio, Alessandro Adami, Loris Roncon
doi: 10.5543/tkda.2022.21027  Pages 175 - 181
Background: Left atrial function is impaired in patients with patent foramen ovale. This study aimed to evaluate the role of left atrial function index in monitoring the course of left atrial function in a patient with patent foramen ovale before and after percutaneous closure.
Methods: We retrospectively reviewed the findings of consecutive patients evaluated in our tertiary center for patent foramen ovale closure to identify those subjects with acute ischemic stroke, transient ischemic attack, or radiological evidence of cerebral ischemic events (index event) who performed a complete echocardiography evaluation reporting evidence of patent foramen ovale between September 2004 and September 2018. The left atrial function was evaluated at baseline and then yearly using the left atrial function index.
Results: The cohort of 448 consecutive patients (mean age 43.4 ± 10.4 years, 257 males) was divided into 2 groups according to the temporal window between the index event and patent foramen ovale closure, defined as <1-year (216 patients) and ≥1-year (232 patients). Patients treated within 1 year from the index event maintained similar parameters of left atrial function and left atrial function index over the time, also after the interventional procedure. Conversely, patients treated after 1 year demonstrated a significant reduction of left atrial emptying func- tion and maximal left atrial volume (P <.001 for all) compared to the basal values. The same parameters slightly increased after the percutaneous closure during the second year without reaching the basal values.
Conclusions: Left atrial function index can be used as a non-invasive marker of atrial dys- function severity in patients with patent foramen ovale before and after the interventional procedure.

5. Upgrades from Previous Cardiac Implantable Electronic Devices Compared to De Novo Cardiac Resynchronization Therapy Implantations: Results from CRT Survey-II in the Turkish Population
Duygu Koçyiğit, Nedim Umutay Sarıgül, Timuçin Altin, Serkan Çay, Camilla Normand, Cecilia Linde, Kenneth Dickstein, Crt Survey-ıı Investigators
doi: 10.5543/tkda.2022.21107  Pages 182 - 191
Objective: Cardiac resynchronization therapy is the guideline-directed treatment option in selected heart failure with reduced left ventricular ejection fraction patients. Data regarding the contemporary clinical practice of cardiac resynchronization therapy in Turkey have been published recently. This sub-study aims to compare clinical and periprocedural characteristics between cardiac resynchronization therapy upgrade and de novo implantations.
Methods: Turkish arm of the Cardiac Resynchronization Therapy Survey-II was conducted between October 1, 2015, and December 31, 2016, at 16 centers. All consecutive patients who underwent an upgrade to cardiac resynchronization therapy system (n=60) or de novo cardiac resynchronization therapy implantation (n=335) were eligible.
Results: Distribution of age, gender, and heart failure etiology were similar in the 2 groups. Atrial fibrillation, valvular heart disease, and chronic kidney disease were more common in car- diac resynchronization therapy upgrade patients. Narrow intrinsic QRS duration and left ven- tricular ejection fraction being <25% were more common in cardiac resynchronization therapy upgrade patients. Successful first attempt rates were 100% and 98.8% in upgrade and de novo implantation groups. Rates of periprocedural complications were similar between the 2 groups (8.3% vs. 5.9%), but postprocedural adverse events during hospitalization were more common in cardiac resynchronization therapy upgrade patients (18.3% vs. 9.0%), with worsening heart failure being the most common reason. Prescription rates of angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers, mineralocorticoid receptor antagonists, and beta- blockers were >75% in both groups, and only beta-blockers were prescribed at rates of >90% in both groups.
Conclusion: Cardiac resynchronization therapy upgrades are performed with high procedural success rates and without excess periprocedural complication risk. Feared complications of cardiac resynchronization therapy upgrades due to the pre-existing device should not delay the procedure if indicated.

6. Use of TIMI Risk Index as a Simple and Valuable Prognostic Tool in Patients with ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention
İdris Buğra Çerik, Ahmet Kaya, Seçkin Dereli, Fatih Akkaya, Mustafa Yenerçağ, Osman Bektaş
doi: 10.5543/tkda.2022.21143  Pages 192 - 201
Objective: Thrombolysis in Myocardial Infarction Risk Index is a risk stratification model developed to determine the prognosis in ST-segment elevation myocardial infarction patients who underwent fibrinolytic therapy. The information on the effectiveness of Thrombolysis in Myocardial Infarction Risk Index in patients who underwent primary percutaneous coronary intervention is limited. This study aimed to demonstrate the predictive value of Thrombolysis in Myocardial Infarction Risk Index on clinical outcomes in patients presenting with ST-segment elevation myocardial infarction and subsequently undergoing primary percutaneous coronary intervention.
Methods: A total of 963 patients who presented with ST-segment elevation myocardial infarction and subsequently underwent primary percutaneous coronary intervention were reviewed retrospectively. The discriminative power of Thrombolysis in Myocardial Infarction Risk Index for each outcome of congestive heart failure, death, stroke, and myocardial infarction within 1 month and 1 year after admission was assessed.
Results: Congestive heart failure, death, stroke, and myocardial infarction, and the major adverse cardiac events, which is the composite outcome thereof, were higher in the patient groups with high Thrombolysis in Myocardial Infarction Risk Index values (P <.05). Thrombolysis in Myocardial Infarction Risk Index was an independent predictor of the following outcomes: 1-month survival rate [odds ratio: 1.054 (1.036-1.073)], 1-year survival rate [odds ratio: 1.048 (1.031-1.065)], hospitalization rate due to congestive heart failure within 1 month [odds ratio: 1.041(1.026-1.057)], and within 1 year [odds ratio: 1.040 (1.024-1.055)]. The Thrombolysis in Myocardial Infarction Risk Index level was found to have good discriminative power for 1-month mortality and 1-year mortality rates (Thrombolysis in Myocardial Infarction Risk Index: 22.76, C-statistic: 0.71-0.68, respectively).
Conclusion: The results of this study indicated that Thrombolysis in Myocardial Infarction Risk Index value is an independent predictor of clinical outcomes such as death and heart failure but not subsequent myocardial infarction in ST-segment elevation myocardial infarction patients. The use of Thrombolysis in Myocardial Infarction Risk Index can be considered in ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention as it is an easily applicable and important indicator of prognosis.

7. Vitamin D Deficiency and Relation to the New York Heart Association Functional Class in Chronic Heart Failure
Gülsüm Meral Yılmaz Öztekin, Ahmet Genç, Şakir Arslan
doi: 10.5543/tkda.2022.21024  Pages 202 - 208
Objective: Heart failure is an important mortality and morbidity. In this study, we aimed to investigate the frequency of vitamin D deficiency in chronic heart failure patients who live in a sunny region and to evaluate its relationship with the New York Heart Association (NYHA) functional classes.
Methods: The study included 657 patients. Demographic clinical, and laboratory parameters were evaluated according to the NYHA classes. Ordinal regression analysis was used to determine the parameters defining the NYHA class.
Results: The median serum 25-hydroxy-vitamin D [25(OH)D] level of study population was 16.88 ng/mL. It was <20 ng/mL in 63.8% and 20-29 ng/mL in 32.9% of the patients. A 25(OH) D <20 ng/mL was significantly more common in women compared to men (74.1% vs. 60%, P <.001). Moreover, 109 patients (16.6%) had severe vitamin D deficiency [25(OH)D <10 ng/mL]. Only 22 (3.3%) patients had a 25(OH)D level >30 ng/mL. 25(OH)D level was positively correlated with eGFR, calcium, albumin, hemoglobin, transferrin saturation, serum iron, while a negative correlation was found with heart rate, parathormon, NT-proBNP, and CRP. Together with dereased ß blocker use, increase in N-terminal pro-brain natriuretic peptide levels and left atrial diameter, a decrease in vitamin D level (OR: 0.970, 95% CI: 0.945-0996, P =.024) was independently associated with an increase in the New York Heart Association class.
Conclusion: Vitamin D deficiency and insufficiency are common in patients with chronic heart failure, and vitamin D level is an important determinant of the NYHA functional class in patients with heart failure.

8. Evaluation of the Perception of Illness and Quality of Life in Patients with Acute Myocardial Infarction
Özkan Sir, Aylin Özakgül
doi: 10.5543/tkda.2022.21048  Pages 209 - 216
Objective: This study aimed to evaluate the illness perception and quality of life of patients who had an acute myocardial infarction.
Methods: This descriptive and correlational study included 301 patients diagnosed with acute myocardial infarction at the cardiology outpatient clinic of a hospital. The data were collected using Illness Perception Questionnaire-Revised and Myocardial Infarction Dimensional Assessment Scale.
Results: The mean age of the patients was 59.04 ± 5.56 years and 51% were female. The evaluation of subdimension mean scores according to the scores of the patients from the Illness Perception Questionnaire-Revised showed that the highest mean score was obtained from the consequences subscale under the Illness Representation dimension whereas the lowest mean score was from the illness coherence subscale. The overall Myocardial Infarction Dimensional Assessment Scale score (49.43 ± 11.40) of the patients was observed to be moderate. The Illness Perception Questionnaire-Revised subdimensions were observed to have a positive and significant correlation with Myocardial Infarction Dimensional Assessment Scale total score and subscales mean scores. According to the regression analysis results, treatment control, illness coherence, and emotional representations subscales under the Illness Representation dimension and immunity subscale under the Causal Representation dimension were observed to predict the quality of life, and patients obtaining higher scores from these dimensions had higher quality of life. On the other hand, the consequences subscale under Illness Representation dimension and psychological attributions under Causal Representation dimension were found to be factors decreasing the quality of life.
Conclusion: This study showed that patients thought some of the symptoms were related to their illness, the level of comprehension of the disease is low, and their quality of life was moderate. Patients should have a positive illness perception to have a higher quality of life.

REVIEW
9. Peritoneal Dialysis in Advanced Heart Failure Patients with Chronic Severe Congestion Resistant to Optimal Pharmacological Treatment
Selda Murat, Sultan Özkurt, Yüksel Çavuşoğlu
doi: 10.5543/tkda.2022.21157  Pages 217 - 224
Resistant congestion is a difficult clinical picture in advanced heart failure with poor quality of life, worse functional capacity, and frequent hospitalizations. Optimal medical treatment is the first-line therapy. However, diuretic resistance, comorbid conditions such as chronic kidney disease, and obstacles in drug up-titration make it difficult to control congestion. In some of these cases, hemodialysis or peritoneal dialysis is required for short or long-term ultrafiltration therapy. Peritoneal dialysis is a more comfortable treatment option for this group of patients because of the slower and longer duration of ultrafiltration, better preservation of residual renal function, ability to be performed at home, and mobility of the patient during the procedure. In this review, home peritoneal dialysis/ultrafiltration methods have been addressed as an alternative treatment option in advanced heart failure patients with chronic severe congestion resistant to optimal pharmacological treatment.

CASE REPORT
10. Too Late Allergic Reaction in a Patient with Permanent Pacemaker
Ferudun Akkuş, Gökay Taylan
doi: 10.5543/tkda.2022.21147  Pages 225 - 227
Contact allergy to cardiac implantable electronic devices is a rare problem in patients. Clinical evaluation and patch tests have an important place in its diagnosis. Also in this case, the diagnosis is supported by ultrasonography. It has been reported in the literature that allergic dermatitis developed after permanent pacemaker implantation in the first few days until the current year. In our case report, we showed that the allergic reaction in the patient was too late. In this article, we present a 94-year-old male patient with a permanent pacemaker who came to us with the complaint of redness and itching in the left chest area and was diagnosed with contact allergy.

11. Thrombotic Complication of COVID-19: A Case Report of Acute Saphenous Vein Graft Thrombosis in a Newly Diagnosed Patient
Kerim Esenboğa, Emir Baskovski, Bilge Nazar Ateş, Nil Özyüncü, Sibel Turhan, Eralp Tutar
doi: 10.5543/tkda.2022.21187  Pages 228 - 230
A 63-year-old man with active COVID-19 infection and a history of coronary artery bypass grafting presented with acute thrombotic occlusion of saphenous venous graft which was anastomosed to the left anterior descending artery. Initial antegrade approach, complicated by a small leakage in the distal left anterior descending artery, was later converted to a retro-grade approach via occluded saphenous vein graft. After successful stenting, TIMI 3 flow was achieved.

CASE IMAGE
12. A Tetralogy of Fallot Patient Survived Only with a Classical Blalock-Taussig Shunt for more Than 50 Years
Mahmoud Abdelnabi, Hoda Shehata, Fatma Elkafrawy, Abdallah Almaghraby, Yehia Saleh, Ahmed Elmogy, Mohamed Elzoghby, Soha Romeih
doi: 10.5543/tkda.2022.88235  Pages 231 - 232
Abstract | English Full Text

13. Subacute Myocardial Infarction Complication: Partial Myocardial Rupture
Gökhun Akkan, Emre Özdemir
doi: 10.5543/tkda.2022.21258  Pages 233 - 234
Abstract | English Full Text

OTHER ARTICLES
14. Comments on Cardiology
Ertan Ural
Pages 235 - 236
Abstract | English Full Text



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