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Anatol J Cardiol: 21 (3)
Volume: 21  Issue: 3 - March 2019
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1.More novel findings…
Çetin Erol
PMID: 30821725  doi: 10.14744/AnatolJCardiol.2019.3  Page 123
Abstract | Full Text PDF

2.D-Dimer is a strong predictor of in-hospital mortality in patients with infective endocarditis
Veysel Özgür Barış, Mustafa Kılıçkap, Hüseyin Göksülük, Demet Menekşe Gerede Uludağ, Çetin Erol
PMID: 30821726  doi: 10.14744/AnatolJCardiol.2018.56752  Pages 124 - 133
Objective: Infective endocarditis (IE) is a rare disease with a high mortality. Therefore, prognostic markers can play an important role in the follow-up. In this study, we investigated the relationship between the D-dimer (DD) level and in-hospital mortality and complications in patients with IE, because DD indicates both the fibrin turnover in vegetation and the autoimmune inflammatory response in patients with IE.
Methods: Seventy-nine patients with IE were included in the study. In-hospital death for any reason was considered to be the primary endpoint. Secondary endpoints were embolism and in-hospital death or embolism.
Results: In-hospital mortality occurred in 31 (39%) patients. The DD level was significantly higher in the group with in-hospital mortality [median (interquartile range) values 3048.0 (4911.0) vs. 556.0 (1100.2) ng/mL, p<0.001]. When the DD level was 795 ng/mL or higher, the sensitivity was 83.5%, specificity was 66.7%, the positive predictive value was 66.4%, and the negative predictive value was 94.1%, to determine in-hospital mortality. Categorically, the DD level of 795 ng/mL or higher was found to increase the risk of in-hospital mortality by 29 times (odds ratio=29; 95% confidence interval=6.13–137.11; p<0.001). In a multiple logistic regression analysis, the DD level was found to be the best independent predictor of in-hospital mortality (the AUC value only for DD was 0.86, and for the multiple logistic regression model, it was 0.89, p=0.48). A significant correlation was found between the DD level and in-hospital death or embolization [1863.0 (4914, 0) vs. 376 (607, 0) ng/mL, p<0.001]. In the multiple logistic regression analysis, DD was found to be the best independent parameter showing in-hospital mortality or embolization (the AUC value was 0.83 for DD, and 0.84 for the multiple logistic regression analysis, p=0.69).
Conclusion: These findings support that a high DD is a strong parameter predicting in-hospital mortality, and in-hospital mortality or embolic events in patients with IE.

3.Catheter-based renal sympathetic denervation induces acute renal inflammation through activation of caspase-1 and NLRP3 inflammasome
Dong Won Lee, Jeong-Su Kim, Il Young Kim, Hyang Sook Kim, Joo-Young Kim, Harin Rhee, Eun Young Seong, Sang Heon Song, Soo Bong Lee, Charles Louis Edelstein, Ihm Soo Kwak
PMID: 30821713  doi: 10.14744/AnatolJCardiol.2018.62257  Pages 134 - 141
Objective: Catheter-based renal sympathetic denervation (RDN) is implemented as a strategy to treat resistant hypertension. Serum creatinine and estimated glomerular filtration rate have some limitations to predict the early stage of acute kidney injury (AKI). We investigated the changes of early inflammatory biomarkers in AKI following the RDN procedure.
Methods: Twenty-five female swine were divided into three groups: normal control (Normal, n=5), sham-operated (Sham, n=5), and RDN groups (RDN, n=15). The RDN group was further subdivided into three subgroups according to the time of sacrifice: immediately (RDN-0, n=5), 1 week (RDN-1, n=5), and 2 weeks (RDN-2, n=5) after RDN. Renal cortical tissue was harvested, and clinical parameters and inflammatory biomarkers were checked.
Results: There were no significant changes in the clinical parameters between the normal control and sham-operated groups using contrast media. Inflammatory interleukin (IL)-1β, IL-18, IL-6, tumor necrosis factor-α, and anti-inflammatory IL-10 increased immediately and then decreased at week 2 after RDN in the renal cortical tissue. Leaderless protein, IL-1α level, increased at week 1 and then decreased at week 2 after RDN. Caspase-1 increased immediately after RDN until week 2. Apoptosis-associated speck-like protein containing a caspase recruitment domain and NLRP3 expressions increased immediately and then decreased at week 2 after RDN.
Conclusion: The RDN could induce acute renal inflammation through the activation of caspase-1 and NLRP3 inflammasome.

4.A novel score in the prediction of rhythm outcome after ablation of atrial fibrillation: The SUCCESS score
Fabian Nicolas Jud, Slayman Obeid, Firat Duru, Laurent Max Haegeli
PMID: 30821714  doi: 10.14744/AnatolJCardiol.2018.76570  Pages 142 - 149
Objective: The aim of the present study was to assess the predictive value of the CHADS2, CHA2DS2-VASc, R2CHADS2, and APPLE scores for rhythm outcome in patients with atrial fibrillation (AF) after catheter ablation.
Methods: The cohort of the present study consisted of 192 patients with AF who underwent a total of 265 ablations. Rhythm outcome was documented between 3 and 24 month after ablation. The mentioned scores were calculated for every patient.
Results: Of the patients, 139 (72%) were successfully treated having freedom of any atrial tachyarrhythmia, whereas 21 (11%) had partial success, and 32 (17%) had failure. For univariate analysis, the APPLE score was the only significant predictor of outcome after ablation with an odds ratio (OR) of 1.485 [95% confidence interval (CI) 1.075–2.052, p-value 0.017]. A multivariate binary regression corrected for possible confounders showed that the APPLE score (OR 1.527, 95% CI 1.082–2.153, p-value 0.016) along with the number of previous ablations (OR 5.831, 95% CI 1.356–25.066, p-value 0.018) is a significant predictor of outcome. A novel score (SUCCESS) was created by adding one point to the APPLE score for each previously performed ablation. This novel score demonstrated an improvement in receiver operating characteristic curve analysis (area under the curve 0.657 vs. 0.620). However, these findings were not significant in our study (p-value 0.219).
Conclusion: Both the APPLE and the novel SUCCESS scores are superior to the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores in predicting AF recurrence after catheter ablation. The SUCCESS score appears to have a higher predictive value than the APPLE score and might be a valuable tool to estimate the risk of AF recurrence in patients eligible for catheter ablation.

5.Left main bronchus as a guide for individualized transseptal puncture using a conventional fluoroscopic approach in cryoballoon ablation of atrial fibrillation
Yuan Yuan, Minxia Zhang, Wangwei Yang, Ling Tao, Hexiang Cheng
PMID: 30792376  doi: 10.14744/AnatolJCardiol.2018.08566  Pages 150 - 154
Objective: Although imaging modalities, such as transesophageal and intracardiac echocardiography, have helped to improve the safety of atrial transseptal puncture (TSP), fluoroscopy is still traditionally and widely used in TSP. The aim of the present study was to evaluate an individual knack for TSP during cryoballoon ablation of atrial fibrillation (AF) under fluoroscopy.
Methods: Through the prospective study of 72 cases of patients with paroxysmal or persistent AF admitted for cryoablation in our center, 46 cases using a puncture site toward the bifurcation of the left main bronchus (LMB group) and 26 cases using an anterior–inferior puncture site (AI group) were included in the study. The acute pulmonary vein (PV) isolation success rate, single-procedure success rate, and time-to-effect (TTE) between the two groups were analyzed.
Results: All PVs were identified and successfully isolated, and there are no differences in the two groups. However, the mean TTE was shorter in the LMB group than in the AI group. Moreover, a higher single-procedure success rate was observed in the LMB group.
Conclusion: The bifurcation of the LMB can be clearly evaluated in each patient under fluoroscopy and is an anatomical landmark for the location of the left PV. TSP guided by the LMB is a new practical method for choosing individualized transseptal sites for catheter ablation of AF, which can help to shorten TTE and procedure time.

6.Long-term follow-up of patients with Buerger’s disease after autologous stem cell therapy
Çağdaş Baran, Serkan Durdu, Evren Özçınar, Mehmet Çakıcı, Ali Ihsan Hasde, Bahadır Inan, Mustafa Şırlak, Rüçhan Akar
PMID: 30821715  doi: 10.14744/AnatolJCardiol.2018.12354  Pages 155 - 162
Objective: We investigated the long-term results of autologous bone marrow mononuclear cells (ABMMNCs) implantation in patients with Buerger’s disease (BD).
Methods: Twenty-eight patients (25 males and 3 females) who had BD and critical unilateral limb ischemia were investigated between April 2003 and August 2005. The patients were administered multiple injections of CD34+ and CD45+ positive ABMMNCs into the gastrocnemius muscle, the intermetatarsal region, and the dorsum of the foot (n=26) or forearm (n=2) and saline injection into the contralateral limb.
Results: The mean follow-up time was 139.6±10.5 months. No complication related to stem cell therapy was observed during the follow-up. The ankle–brachial pressure index evaluated at 6 months and 120 months was compared to the baseline scores (p<0.001 and p=0.021, respectively). Digital subtraction angiography (DSA) was performed for all patients at baseline, 6 months, and 120 months. The angiographic improvement was 78.5% and 57.1% at 6 and 120 months, respectively. Patients demonstrated a significant improvement in the quality of life parameters at 6 months compared to baseline (p=0.008) and 120 months compared to the baseline (p=0.009). The 10-year amputation-free rate was 96% (95% CI=0.71-1) in ABMMNC-implanted limbs and 93% (95% CI=0.33–0.94) in saline-injected limbs (p=1).
Conclusion: Autologous stem cell therapy could be an alternative therapeutic method for BD at long-term follow-up.

7.Sustained nicorandil administration reduces the infarct size in ST-segment elevation myocardial infarction patients with primary percutaneous coronary intervention
Shanjie Wang, Yu Duan, Xinyu Feng, Liang Liu, Zhaofeng Shi, Bo Wang, Chenhai Xia, Wanrong Man, Haichang Wang, Zhijing Zhao, Dongdong Sun
PMID: 30821716  doi: 10.14744/AnatolJCardiol.2018.57383  Pages 163 - 171
Objective: Currently, there is still no effective strategy to diminish the infarct size (IS) in patients with ST-segment elevation myocardial infarction (STEMI). According to a previous animal study, nicorandil treatment is a promising pharmaceutical treatment to limit the infarct area. In this study, we aim to investigate the effects of continual nicorandil administration on the IS and the clinical outcomes in patients with STEMI who underwent primary percutaneous coronary intervention (pPCI).
Methods: One hundred seventeen patients with STEMI and undergoing pPCI were randomly divided into the sustained nicorandil group (5 mg, three times daily) or the control group (only single nicorandil before PCI). The primary endpoint was the IS, evaluated by single-photon emission computed tomography (SPECT) 3 months after pPCI.
Results: Eighty-five patients completed the IS assessment via SPECT, and 99 participants were available for follow-up after 6 months. Finally, there was a statistical difference in the IS between the nicorandil and control groups {13% [interquartile range (IQR), 8–17] versus 16% [IQR, 12–20.3], p=0.027}. Additionally, we observed that maintained nicorandil administration significantly improved the left ventricular ejection fraction at 3 months and enhanced the activity tolerance (physical limitation and angina stability) at 6 months after PCI.
Conclusion: Sustained nicorandil treatment reduced the IS and improved the clinical outcomes compared to the single nicorandil administration for patients with STEMI undergoing the pPCI procedure. Continuous cardioprotective therapy may be more beneficial for patients with STEMI.

8.Concurrent cor triatriatum sinister and levoatriocardinal vein in an 11-year-old boy presenting with foudroyant pulmonary edema after appendectomy: A living tribute to the mal-incorporation theory
Meng Luen Lee, Chiung-fang Tu
PMID: 30821717  doi: 10.14744/AnatolJCardiol.2018.60980  Pages 172 - 174
Abstract | Full Text PDF

9.Apixaban successfully resolved a warfarin-resistant left atrial appendage thrombus in a patient with end-stage renal disease on hemodialysis
Yae Min Park, Jeonggeun Moon, Wook-Jin Chung, Mi-Seung Shin, In Suck Choi
PMID: 30821718  doi: 10.14744/AnatolJCardiol.2019.66789  Pages 174 - 175
Abstract | Full Text PDF | Video

10.Incremental value of transesophageal echocardiography in the evaluation of patients before percutaneous closure of atrial septal defects
Macit Kalçık, Ahmet Güner, Mehmet Özkan
PMID: 30821719  doi: 10.14744/AnatolJCardiol.2018.80707  Pages 176 - 177
Abstract | Full Text PDF

11.Author`s Reply
Qiang Chen, Hua Cao, Gui-can Zhang, Liang-wan Chen, Heng Lu, Ling-li Yu
PMID: 30821720  Page 177
Abstract | Full Text PDF

12.Echogenicity and echocardiographic guidance
Kevser Gülcihan Balcı, Mustafa Mücahit Balcı
PMID: 30821721  doi: 10.14744/AnatolJCardiol.2018.92596  Pages 177 - 178
Abstract | Full Text PDF

13.Author`s Reply
Qiang Chen, Hua Cao, Gui-can Zhang, Liang-wan Chen, Heng Lu, Ling-li Yu
PMID: 30821722  Page 178
Abstract | Full Text PDF

14.Myocardial ischemia caused by external compression due to shotgun bullets
Bedri Caner Kaya, Veysel Tosun
PMID: 30821723  doi: 10.14744/AnatolJCardiol.2018.66267  Page E6
Abstract | Full Text PDF | Video

15.First septal and diagonal arteries anomalously originating from the left main coronary artery: A very rare coincidence
Erdoğan Sökmen
PMID: 30821724  doi: 10.14744/AnatolJCardiol.2018.58630  Page E7
Abstract | Full Text PDF | Video

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