ORIGINAL ARTICLE | |
1. | Tricuspid Valve Transcatheter Edge-to-Edge Repair (TriClip): Initial Outcomes and Experience in Türkiye Fuat Polat, Zeynettin Kaya, Gökhan Kahveci, İsmail Ateş PMID: 39225646 doi: 10.5543/tkda.2024.34954 Pages 375 - 383 Objective: This study aims to assess the efficacy and safety of tricuspid valve (TV) transcatheter edge-to-edge repair (TEER) procedures using the MitraClip or TriClip device in high-risk patients with severe secondary tricuspid regurgitation (TR) and provide Turkish-specific data on procedural outcomes and clinical follow-up. Methods: This study enrolled 42 high-risk patients with severe secondary TR who underwent transcatheter edge-to-edge repair using either the MitraClip or TriClip device. Patient selection criteria included severe TR, high surgical risk (EuroScore ≥ 8 and Tricuspid Regurgitation Impact Severity Score (TRI-SCORE) ≥ 6), symptomatic despite medical therapy, and anatomical suitability for TriClip. Patients underwent rigorous evaluation by a specialized cardiac team before the procedure, including 2D/3D transesophageal echocardiography to assess eligibility. Results: The study achieved a 100% procedural success rate, defined as successful implantation and at least one-degree reduction in TR severity. Post-procedure assessments revealed that 88.1% of patients had mild to moderate TR, indicating significant improvement, while only 11.9% retained severe TR. During the median follow-up of 11.5 months, rehospitalization occurred in 23.8% of patients, and mortality was observed in 7.1% of patients, demonstrating a favorable safety profile. Comparative analysis between TriClip and MitraClip devices showed similar efficacy and safety outcomes, with no significant differences in procedural durations or complication rates. Conclusion: The study demonstrates the effectiveness and safety of TV TEER using TriClip or MitraClip devices in managing severe secondary TR in high-risk patients. Procedure success, improved TR severity, and favorable clinical outcomes were observed, supporting the role of transcatheter techniques in TR management. |
2. | Assessment of Lipoprotein (a) Levels in Patients with Atherosclerotic Cardiovascular Disease: Single Center Experience from Türkiye Barış Güngör, Barış Şimşek, Tufan Çınar, Melih Öz, Gökçem Ayan Bayraktar, Duygu İnan, Recep Hacı, Yusuf Oflu, Müjgan Mihmanli, Can Yücel Karabay PMID: 39225648 doi: 10.5543/tkda.2024.70979 Pages 384 - 389 Objective: This study aims to evaluate the role of elevated lipoprotein (a) [Lp(a)] levels as a potential contributor to residual risk in individuals with atherosclerotic cardiovascular disease (ASCVD). Considering that approximately 90% of Lp(a) levels are genetically determined and can vary regionally, we assessed Lp(a) levels in a cohort of ASCVD patients from the Turkish population, where data is currently limited. Methods: We conducted a retrospective analysis of data and Lp(a) measurements collected from individuals diagnosed with ASCVD at a single center. Results: The analysis included Lp(a) levels of 1193 consecutive individuals. The mean Lp(a) level was 28.2 mg/dL, with a median of 16 mg/dL and an interquartile range (IQR) from the 25th to the 75th percentile, 7 mg/dL to 39 mg/dL. The highest recorded Lp(a) level was 326 mg/dL. Among the cases, 18.7% exhibited Lp(a) levels ≥ 50 mg/dL, 10.8% had levels ≥ 70 mg/dL, and 5.8% had levels ≥ 90 mg/dL. The mean levels of low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were 132 ± 47 mg/dL and 212 ± 54 mg/dL, respectively. Lp(a) levels were significantly higher in females compared to males. Furthermore, the proportion of females with Lp(a) levels ≥ 90 mg/dL was higher than in males (11.4% vs. 1.4%; P < 0.01). Additionally, a modest but significant correlation was observed between Lp(a) levels and TC (r = 0.075, P = 0.01) as well as LDL-C (r = 0.106, P < 0.01). Conclusion: This study revealed that Lp(a) concentrations were higher in women and statin users among ASCVD patients and identified a weak but significant correlation between Lp(a) levels and both TC and LDL-C. |
EDITORIAL COMMENT | |
3. | The Burden of Lipoprotein (a) in Türkiye: What We Know and What We Need to Learn Meral Kayıkçıoğlu, Ece Yurtseven PMID: 39225649 doi: 10.5543/tkda.2024.29267 Pages 390 - 393 Abstract | |
ORIGINAL ARTICLE | |
4. | Effects of Sandbag-Free Follow-up After Manual Compression in Patients Who Underwent Transfemoral Access for Percutaneous Intervention Ahmet Soylu, Ahmet Taha Şahin, Hasan Kan, Hasan Sarı, Sefa Tatar PMID: 39225641 doi: 10.5543/tkda.2024.59987 Pages 394 - 399 Objective: Femoral access site complications (ASC) are frequent yet significant conditions associated with percutaneous intervention procedures that affect patient-physician comfort. In this study, we compared ASC rates between patients who received compression with a sandbag, the standard practice in many clinics, and patients monitored solely with bedrest without sandbag compression. Methods: This study included patients undergoing any transfemoral percutaneous intervention (mostly coronary interventions) between April 2019 and May 2023 at our clinic. Patients were classified into two groups: those monitored without a sandbag (n = 160) and those with a sandbag (n = 158). ASC rates (ecchymosis, pseudoaneurysm, hematoma, bleeding) were compared between the two groups. Results: No differences were observed between the two groups in gender, age, sheath size, and bed rest times. Complications were observed in 16.9% (n = 27) of patients without sandbags and 25.3% (n = 40) of patients with sandbags. The most common complication was ecchymosis, seen in 10.6% (n = 17) of the no-sandbag group and 13.9% (n = 22) of the sandbag group. Conclusion: Following manual compression after femoral sheath removal, patients receiving bedrest without sandbag use are less likely to develop ASC. Additionally, dismissing sandbag use leads to a significant increase in patient comfort. |
5. | Comparison of Serum Spexin Level and its Relationship with Echocardiographic Findings in Prediabetic Patients with and without Hypertension Sedat Taş, Ümmü Taş, Tuncay Küme PMID: 39225645 doi: 10.5543/tkda.2024.03078 Pages 400 - 410 Objective: Prediabetes mellitus, hypertension, and their frequent coexistence are risk factors for macrovascular and cardiovascular complications. In this study we aimed to determine the relationship between spexin levels and echocardiographic findings and hypertension in prediabetic patients. Methods: This study included 118 adult patients diagnosed with prediabetes mellitus who presented to outpatient clinics between April 2021 and January 2022. The patients were grouped into prediabetic patients with hypertension (n = 58) and those without hypertension (n = 60). The hypertension group was further divided into dipper and non-dipper groups according to the 24-hour ambulatory blood pressure monitoring. Blood samples were collected from all patients and echocardiography was performed. Spexin levels were measured by ELISA. Serum spexin levels, echocardiographic and ambulatory blood pressure monitoring findings were compared between the groups. Results: The hypertension and non-dipper groups had significantly lower spexin levels and higher left atrial volume index, E/Em index, and interventricular septum and posterior wall thicknesses. Spexin levels were negatively correlated with body mass index (r = -0.298, P < 0.001), nighttime systolic blood pressure (r = -0.264, P = 0.006), nighttime diastolic blood pressure (r =-.255, P = 0.005), left atrial volume index (r =-.238, P = 0.009), E/Em (r =-.214,P = 0.020), and low-density lipoprotein cholesterol (r = -.243, P = 0.008). Obesity, overweight and spexin <780 pg/mL were independently associated with hypertension. Conclusion: Circulating spexin levels were lower in prediabetic patients with overall hypertension and in non-dipper patients, and were associated with echocardiographic and lipid parameters. The cut-off value of spexin identified in our study may be a useful indicator for hypertension detection and raise clinicians’ awareness about evaluating prediabetic patients for hypertension. |
6. | Short-Term Prognosis of Elderly Patients Admitted to the Coronary Care Unit: A Subgroup Analysis of the MORCOR-TURK (Mortality and Morbidity in Coronary Care Units in Türkiye) Trial Gökay Taylan, Çağlar Kaya, Mehmet Özbek, Feyza Kurt, Yücel Kaçmaz, Fatih Akkaya, Fatih Kahraman, Ahmet Seyda Yılmaz PMID: 39225647 doi: 10.5543/tkda.2024.51282 Pages 411 - 419 Objective: This subgroup analysis of the MORCOR-TURK (Mortality and Morbidity in Coronary Care Units in Türkiye) trial aimed to determine the short-term prognosis, mortality rates, and predictors for elderly patients followed in coronary care units (CCUs) in Türkiye. Methods: The MORCOR-TURK trial is a national, non-interventional, multicenter observational study conducted in Türkiye (ClinicalTrials.gov number NCT05296694). The study population includes CCU patients from 50 centers selected from all regions of Türkiye (between September 1 and 30, 2022 prospectively). In the subgroup analysis, patients were divided into two groups: Group 1 (ages 65 to < 75 years, n = 923 patients) and Group 2 (ages ≥ 75 years, n = 713 patients). At the end of the analysis, short-term prognosis, mortality rates, and predictors were documented. Results: The mean age of Group 1 was 69 (67-72) years, and Group 2 was 80 (77-84) years. Chest pain was the most common reason for admission (968 patients [59.16%]), and acute coronary syndrome was the most common reason for hospitalization in the CCU (1,053 patients [64%]). Atrial fibrillation (AF) was the most common arrhythmia (356 patients [21.76%]). The mortality rate was 6.11% in elderly patients (4.23% in Group 1 and 8.56% in Group 2). The multivariate regression analysis showed that age (P = 0.046, P = 0.003), chronic kidney disease (P = 0.011, P = 0.045), and ventricular tachycardia/ventricular fibrillation (VT/VF) during hospitalization (P < 0.001) were the main factors that increased mortality in both groups. Other independent mortality risk factors were smoking for Group 1 and aortic stenosis for Group 2. Conclusion: This study represents the most comprehensive assessment of the short-term prognosis for elderly patients admitted to CCUs in Türkiye. It showed that coronary artery disease was the most common reason for admission and age over 75 and chronic kidney disease were the main determinants of mortality. |
7. | The Relationship Between Coronary Artery Angiographic Characteristics, Occupational Factors, and Return to Work Fakhri Rezaei, Saber Mohammadi, Abdollah Amirfarhangi, Mahin Hosseininejad PMID: 39225644 doi: 10.5543/tkda.2024.86918 Pages 420 - 428 Objective: Coronary artery disease is one of the most common causes of disability and work loss among working-age individuals. Since the ability to return to work after cardiovascular events depends on several factors, identifying these factors can be helpful in treatment planning and effective rehabilitation. In this study, we aimed to assess the employment status and related factors one year after angiography in patients with stable angina and acute coronary syndrome and to investigate the impact of occupational factors on angiographic characteristics. Methods: This retrospective study included 447 patients with coronary artery disease who underwent angiography between February 2020 and March 2021 at a teaching hospital. Data regarding employment status and other related variables, including the Job Content Questionnaire, were collected through medical record reviews and telephone interviews one year after hospital discharge. The participants’ occupational factors and return-to-work status were then compared. Results: One year after angiography, the rate of returning to work was 70%. Of these, 86.3% had resumed their previous job. Factors associated with a reduced return to work included major coronary artery involvement, a history of hypertension, lower ejection fraction, and increased hospitalization days. Occupational risk factors such as low income, longer working hours, and high job demand also decreased the likelihood of returning to employment. Conclusion: Various clinical and socioeconomic factors can predict the probability of returning to work after angiography in patients with coronary artery disease. Considering these factors could be useful in formulating clinical guidelines to improve employment outcomes for these patients. |
EXPERT OPINION | |
8. | Current Use of Sodium Glucose Co-transporter 2 Inhibitors in Heart Failure Therapy Yüksel Çavuşoğlu, Hakan Altay, Ahmet Çelik, Tolga Sinan Güvenç, Barış Kılıçarslan, Sanem Nalbantgil, Ahmet Temizhan, Özlem Yıldırımtürk, Mehmet Birhan Yılmaz PMID: 39225638 doi: 10.5543/tkda.2024.52707 Pages 429 - 454 Sodium-glucose cotransporter-2 inhibitors (SGLT2i) inhibit urinary glucose and sodium reabsorption in the proximal tubule of the nephron and result in glucosuria, natriuresis and diuresis. In patients with T2DM who have atherosclerotic cardiovascular (CV) disease or CV risk factors, SGLT2is have been shown to reduce major CV events and heart failure (HF) hospitalization. The greatest and most consistent effect of SGLT2is in these trials was found to be reduction in HF hospitalization, which raised the possibility of clinical benefit of SGLT2i in HF patients. In DAPA-HF and EMPEROR-Reduced trials in HFrEF patients with or without T2DM, SGLT2is, dapagliflozin and empagliflozin treatment on top of standard HF therapy has been shown to have clear clinical benefit in reducing primary endpoint of CV mortality or HF hospitalization and improving quality of life. Recently published EMPEROR-Preserved and DELIVER trials showed that SGLT2is were also very effective in the treatment of HFpEF (EF >40%). Furthermore, SGLT2is have also been shown to have potential in improving clinical outcomes in hospitalized acute HF patients in EMPULSE and DICTATE-AHF trials. All of this evidence has changed guidelines recommended therapies, not only for HFrEF but also for HFpEF treatment. The aim of this article is to provide a comprehensive overview focused on the role of SGLT2i in the treatment of HF based on the recent evidence. |
CASE REPORT | |
9. | Takotsubo Cardiomyopathy Mimicking Obstructive Hypertrophic Cardiomyopathy Samuray Zekeriyeyev, Uğur Canpolat PMID: 39225642 doi: 10.5543/tkda.2023.93429 Pages 455 - 459 Takotsubo cardiomyopathy (TCM) is characterized by transient left ventricular dysfunction, diagnosed via echocardiography or left ventriculography. In most cases, TCM involves an emotional, physical, or combined trigger. Acute coronary syndrome is one of the most frequent misdiagnoses in TCM patients due to electrocardiogram (ECG) abnormalities and elevated cardiac biomarkers. Typically, coronary angiography reveals no stenosis or occlusion of the coronary arteries. Hypertrophic cardiomyopathy (HCM) is a distinct pathology characterized by a hypertrophied left ventricle with various phenotypes. However, some reports have described TCM cases mimicking obstructive-type HCM in some patients. We present a case of a female patient diagnosed with TCM based on clinical, laboratory, and imaging tests. Differentiating TCM from HCM was challenging due to ventriculography and echocardiography findings, as hyperdynamic contraction of the basal segments of the left ventricle caused an increased left ventricular outflow tract (LVOT) gradient and severe mitral valve regurgitation. Detailed evaluation and close echocardiographic follow-up are essential in such rare cases. |
10. | Swyer-James-MacLeod Syndrome in a Patient with Eisenmenger Syndrome Dolunay Gürses, Merve Oğuz, Doğangün Yüksel, Furkan Ufuk, Münevver Yılmaz PMID: 39225640 doi: 10.5543/tkda.2023.59829 Pages 460 - 463 Swyer-James-MacLeod syndrome is characterized radiologically by hyperlucency in a single lung lobe, accompanied by reduced vascularity, alveolar hyperdistention, and air trapping, without bronchial airway obstruction. The most common congenital heart defect in childhood, ventricular septal defect, leads to irreversible pulmonary hypertension and Eisenmenger syndrome if not treated promptly. This case report presents a 25-year-old patient with Swyer-James-MacLeod syndrome and Eisenmenger syndrome. It is crucial to include Swyer-James-MacLeod syndrome in the differential diagnosis of patients with atypically distributed pulmonary emphysema and unilateral hyperlucency for early diagnosis and timely intervention. |
11. | Mulibrey Nanism: A Case with Heart Failure Ahmet Yiğit Temizhan, Mehmet Numan Çolakoğlu, Meryem Kara, Etga Köprücü, Ahmet Korkmaz, Serkan Topaloğlu, Feride Pınar Altay, Ekin Yiğit Köroğlu, İnci Elif Erbahçeci Timur, Nagihan Uğurlu, Ahmet Temizhan PMID: 39225643 doi: 10.5543/tkda.2023.95443 Pages 464 - 467 Mulibrey Nanism is a rare genetic disorder characterized by a variety of systemic manifestations, including cardiac involvement. We report the case of a 26-year-old male who underwent partial pericardiectomy for constrictive pericarditis at age 4 and presented to our cardiology clinic with heart failure symptoms. Examination revealed dysmorphic features characteristic of Mulibrey Nanism such as short stature, macrocephaly, and hypertelorism. Genetic testing identified a homozygous likely pathogenic mutation in the TRIM37 gene. The patient’s heart failure was managed through a multidisciplinary approach, involving consultations with various specialties to address and diagnose the syndrome’s complex multisystem pathologies. This case underscores the importance of including Mulibrey Nanism in the differential diagnosis of patients with a history of constrictive pericarditis at an early age and dysmorphic features, as well as the necessity of a multidisciplinary approach to manage the diverse manifestations of this rare genetic disorder. |
CASE IMAGE | |
12. | Sensitivity of Transesophageal Echocardiogram Versus Cardiac Computed Tomography in Severe Acute Aortic Regurgitation Secondary to Aortic Dissection Located in the Sinus of Valsalva Nisha Lal-Trehan Estrada, Leydimar Anmad Shihadeh, Marta Guillén Tena, Ramón De Castro, Alfredo Bardaji Ruíz PMID: 39225639 doi: 10.5543/tkda.2023.59465 Pages 468 - 469 |
13. | Importance of the Careful Inspection of Chest X-Ray Yalçın Velibey, Kemal Emrecan Parsova, Levent Pay, Özge Güzelburç, Tolga Sinan Güvenç PMID: 39225637 doi: 10.5543/tkda.2023.23572 Pages 470 - 471 Abstract | |
EDITORIAL | |
14. | News and Comments from Cardiology Ertan Ural PMID: 39225650 Page 472 Abstract | |
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