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Anatol J Cardiol: 23 (1)
Volume: 23  Issue: 1 - January 2020
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1.TAVR, NOACs, NAFLD, and a Happy New Year
Çetin Erol
PMID: 31911572  doi: 10.14744/AnatolJCardiol.2020.1  Page 1
Abstract | Full Text PDF

2.The implications and requirements of transcatheter aortic valve replacement in low-risk patients
Emin Murat Tuzcu, Ahmad Edris
PMID: 31911564  doi: 10.14744/AnatolJCardiol.2019.39293  Pages 2 - 9
Transcatheter aortic valve replacement (TAVR) is a transformative technology that has changed the management of patients with severe, symptomatic aortic stenosis. The use of TAVR in intermediate- to high-risk patients has been validated in several rigorously performed, randomized clinical trials. Recent studies using newer generation devices have demonstrated the noninferiority of TAVR as compared with surgical aortic valve replacement in low-risk patients, supporting the increased utilization and expansion of TAVR. The use of TAVR in low-risk patients has important implications and requires a multifaceted approach that includes a highly functional multidisciplinary heart team for careful patient selection; a need to understand and help mitigate certain key complications, such as stroke, paravalvular regurgitation, and conduction disturbances; careful data collection for continual outcome assessment and improvement; and the necessary expertize and procedural volume to maintain excellent outcomes and ensure optimal clinical care pathways.

3.Non-vitamin K antagonist oral anticoagulants (NOACs) in cancer patients with atrial fibrillation
Anetta Undas, Leszek Drabik
PMID: 31911561  doi: 10.14744/AnatolJCardiol.2019.30766  Pages 10 - 18
Non-vitamin K antagonist oral anticoagulants (NOACs), or direct oral anticoagulants have not been tested in randomized trials conducted in patients with atrial fibrillation (AF), who had malignant disease. However, their use in cancer patients increases and real-life evidence for their effectiveness and safety in this vulnerable subset of patients is growing. The challenges of the use of NOACs in cancer patients with AF and the current expert opinions on this subject have been summarized in this review article.

4.Ischemic postconditioning reduced myocardial ischemia-reperfusion injury: The roles of melatonin and uncoupling protein 3
Gülnur Aslan, Hüseyin Fatih Gül, Ahmet Tektemur, Engin Sahna
PMID: 31911566  doi: 10.14744/AnatolJCardiol.2019.72609  Pages 19 - 27
Amaç: İskemik ardkoşullanma (PostC)’nın koruyucu etkileri yaş ve kronik kalp hastalıklarıyla ile birlikte azalır/ortadan kalkar. Benzer şekilde, aynı risk gruplarında düşük serum melatonin düzeyleri de bildirilmiştir. Bu çalışmanın amacı, iskemi-reperfüzyon (I/R) hasarında PostC'nin koruyuculuğunda melatoninin etkilerini araştırmaktır.
Metod: Sıçanlar, I/R çalışmalarından 2 ay önce pinealektomize (Px) veya sham (non-Px) ikiye ayrıldı. Sol ana koroner artere 30 dakika iskemi ve 120 dakika reperfüzyon uygulandı. PostC, iskemiden sonra 3 siklus R/I (her biri 10 s) ile indüklendi.
Bulgular: İnfarkt alanı Px sıçanlarda (54,68 ± 1,5%) kontrol grubundan (35,1 ± 2,5%) anlamlı olarak yüksek bulundu. Non-Px sıçanlarda PostC ve melatonin uygulamaları infarkt alanını anlamlı azalttı. Öte yandan, Px sıçanlarda PostC anlamlı bir etki oluşturmazken, melatonin ile birlikte uygulandığında koruma görüldü. UCP3 seviyeleri I/R ve Px ile azaldı, PostC ve melatonin ile arttı.
Sonuç: Melatoninin fizyolojik ve farmakolojik konsantrasyonlarının PostC’nin koruyuculuğunda rolü olabilir. Yaşlanma ve kalp hastalıkları gibi fizyolojik melatoninin azaldığı durumlarda koruyuculuk azalabilir ve melatonin replasmanı bu etkiyi geri getirebilir. PostC ve melatonin; UCP3, irisin ve NFkB seviyelerini etkileyerek enerji metabolizmasını ve enflamatuar mediatörleri düzenleyebilir ve mitokondriyi koruyabilir.
Objective: Protective effects of ischemic postconditioning (PostC) decrease/disappear with age and chronic heart diseases. Similarly, low serum melatonin levels have been reported in the same risk groups. The aims of this study were to investigate the effects of melatonin on the protection of PostC in ischemia–reperfusion (I/R)-induced infarct size and roles of uncoupling protein (UCP) 3, irisin, and nuclear factor kappa B (NFkB) levels.
Methods: Rats were pinealectomized (Px) or sham operated (non-Px) 2 months before the I/R studies. The left main coronary artery was occluded for 30 min followed by 120 min reperfusion. PostC was induced with three cycles of R/I (10 s each) after ischemia.
Results: The infarct size was found to be significantly higher in Px rats (54.68±1.5%) than in the control group (35.1±2.5%). PostC and melatonin administrations to non-Px rats significantly reduced the infarct size. On the other hand, PostC did not create a significant effect in Px rats, but protection was provided when PostC was co-administrated with melatonin. While significant decreases were detected in the UCP3 levels, irisin and NFkB levels increased with I/R and Px. Treatment with PostC and melatonin in non-Px groups and their co-administration in Px groups were found to return all the genes close to normal levels.
Conclusion: The physiological and pharmacological concentrations of melatonin may play a role in the protection of PostC. In cases when physiological melatonin is reduced, such as aging and heart diseases, this protection may decrease, and this effect may be restored by melatonin replacement. PostC and melatonin may regulate energy metabolism and inflammatory mediators and protect mitochondria by affecting the UCP3, irisin, and NFkB levels.

5.In-stent restenosis of drug-eluting stents in patients with diabetes mellitus: Clinical presentation, angiographic features, and outcomes
Ganesh Paramasivam, Tom Devasia, Ashwal Jayaram, Abdul Razak U.K, M. Sudhakar Rao, Rajesh Vijayvergiya, Krishnananda Nayak
PMID: 31911567  doi: 10.14744/AnatolJCardiol.2019.72916  Pages 28 - 34
Objective: Diabetes mellitus (DM) is a risk factor for developing in-stent restenosis (ISR) following percutaneous coronary intervention (PCI). This study aimed to examine the presentation and outcomes of drug-eluting stent (DES) ISR in diabetics.
Methods: This retrospective study included consecutive patients with clinical DES-ISR, who were hospitalized between January 2013 and December 2017 and who were grouped based on the presence or absence of DM. Clinical, angiographic features and 1-year outcomes [composite of death, myocardial infarction (MI), and repeat-target lesion revascularization] were compared.
Results: Baseline characteristics of the DM group (n=109) were comparable to the non-DM group (n=82), except for the higher prevalence of hypertension and dyslipidemia in the former (60.6% vs. 46.3%, p=0.050; 74.4% vs. 57.8%, p=0.034, respectively). Clinical presentation was similar in both groups [acute coronary syndrome (ACS): 62.4% vs. 61%, p=0.843; MI: 34.9% vs. 34.1%, p=0.918). Diabetics had a higher prevalence of stent-edge restenosis (20.3% vs. 9.2%, p=0.019). The treatment strategy was similar in both groups with 52.3% in the DM group and 57.3% in the non-DM group undergoing PCI (p=0.513). One-year outcomes of the DM group were not different from those of the non-DM group (14.7% vs. 17.1%, p=0.683). Age [hazard ratio (HR), 1.05; 95% confidence interval (CI), 1.01–1.10; p=0.017], MI presentation (HR, 2.34; 95% CI, 1.14–4.80; p=0.020), and chronic kidney disease (CKD: HR, 2.82; 95% CI, 1.21–6.58; p=0.016) were predictors of poor outcomes.
Conclusion: Stent-edge restenosis is more common in diabetics. Clinical presentation and 1-year outcomes following DES-ISR are similar in diabetics and non-diabetics. Age, MI presentation, CKD, and not DM were predictors of poor outcomes following DES-ISR.

6.Losartan inhibits hyposmotic-induced increase of IKs current and shortening of action potential duration in guinea pig atrial myocytes
Jie Gao, Yun Tian, Xiaolu Xie, Jin Zhao, Chuan-hao Liu, Ying Sheng, Fang Cao
PMID: 31911569  doi: 10.14744/AnatolJCardiol.2019.75332  Pages 35 - 40
Objective: The present study aims to investigate the effect of losartan, an selective angiotensin II type 1 receptor (AT1R) blocker, on both the increase of IKs current and shortening of action potential duration (APD) induced by stretch of atrial myocytes, and to uncover the mechanism underlying the treatment of fibrillation (AF) by AT1R blockers.
Methods: Hyposmotic solution (Hypo-S) was applied in the guinea pig atrial myocytes to simulate cell stretch, then patch-clamp technique was applied to record the IKs and APD in atrial myocytes.
Results: Hypo-S increased the IKs by 105.6%, while Hypo-S+1-20 μM of losartan only increased the IKs by 70.3-75.5% (p<0.05 vs. Hypo-S). Meanwhile, Hypo-S shortened APD90 by 20.2%, while Hypo-S+1-20 μM of losartan shortened APD90 by 13.03-14.56% (p<0.05 vs. Hypo-S).
Conclusion: The above data indicate that the effect of losartan on the electrophysiological changes induced by stretch of atrial myocytes is associated with blocking of AT1 receptor, and is beneficial for the treatment of AF that is often accompanied by the expansion of atrial myocytes and the increase of effective refractory period.

7.Assessment of left ventricular function in type 2 diabetes mellitus patients with non-alcoholic fatty liver disease using three-dimensional speckle-tracking echocardiography
Yu Dong, Hongyan Cui, Lihua Sun, Ying Wang, Ying Li, Wenxing Chang, Guangsen Li, Dongmei Huang
PMID: 31911565  doi: 10.14744/AnatolJCardiol.2019.66805  Pages 41 - 48
Objective: Using three-dimensional speckle-tracking echocardiography (3D-STE), we aimed to evaluate left ventricular (LV) function in type 2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD).
Methods: In total, 97 T2DM patients were categorized into three groups based on hepatic ultrasonography: group A (those without NAFLD, n=30), group B (those with mild NAFLD, n=32), and group C (those with moderate-to-severe NAFLD, n=35). Our conventional echocardiographic parameters included transmitral peak early and late diastolic velocity (E and A), septal and lateral early (e’) mitral annular diastolic tissue velocities, and left atrial maximum volume index (LAVImax). LV end-diastolic and -systolic volume, LV mass index (LVMI), and LV ejection fraction were measured using real-time three-dimensional echocardiography. The 3D-STE parameters included LV global radial strain (GRS), global longitudinal strain (GLS), global area strain (GAS), and global circumferential strain (GCS).
Results: Our results showed that in group C, GCS, GRS, GLS, GAS, and septal and lateral e’ velocity decreased, whereas average E/e’ and LAVImax increased compared to groups B and A (p<0.05). Multiple linear regression analysis showed that NAFLD is independently associated with 3D-STE parameters, and glycosylated hemoglobin also has negative impacts on all LV 3D strains.
Conclusion: When combined with conventional echocardiography, 3D-STE can assess LV function effectively in T2DM patients with NAFLD. Additionally, the severity of LV dysfunction in the moderate-to-severe NAFLD group (group C) was worse than the mild and absent NAFLD groups (groups A and B).

8.How to safely occlude left atrial appendage with a thrombus inside?
Şükrü Akyüz, Ilhan Ilker Avcı, Can Yücel Karabay, Duygu Genç, Ali Palice
PMID: 31911559  doi: 10.14744/AnatolJCardiol.2019.02222  Pages 49 - 52
Abstract | Full Text PDF | Video

9.Young woman with cardiac arrest due to spontaneous coronary artery dissection
Murat Çimci, Tornike Sologashvili, Nurcan Yilmaz, Caroline Frangos, Marco Roffi
PMID: 31911568  doi: 10.14744/AnatolJCardiol.2019.73627  Pages 53 - 55
Abstract | Full Text PDF | Video

10.Left main coronary artery occlusion by external compression with a large pulmonary artery in Eisenmenger syndrome
Ibrahim Başarıcı
PMID: 31911563  doi: 10.14744/AnatolJCardiol.2019.38845  Pages 55 - 56
Abstract | Full Text PDF | Video

11.Measurement of salusin-ß without the addition of NP-40 or Tween-20 in coronary slow-flow phenomenon
Suna Aydin, Meltem Yardim, Ramazan Fazil Akkoc
PMID: 31911570  doi: 10.14744/AnatolJCardiol.2019.88107  Page 57
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12.Author`s Reply
Aydın Akyüz, Fatma Aydın, Seref Alpsoy, Demet Ozkaramanli Gur, Savas Guzel
PMID: 31911573  Pages 57 - 58
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13.Perivascular adipose tissue in cardiovascular diseases
Niki Katsiki, Dimitri Mikhailidis
PMID: 31911562  doi: 10.14744/AnatolJCardiol.2019.32480  Page 58
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14.Visualization of exceptional crosssectional en-face views of pulmonary and tricuspid valves using 2D transthoracic echocardiography in patients with pulmonary hypertension
Ibrahim Başarıcı
PMID: 31911571  doi: 10.14744/AnatolJCardiol.2019.96165  Pages E1 - E2
Abstract | Full Text PDF | Video

15.Biventricular outflow obstruction in a patient with a large sinus of the Valsalva aneurysm
Zahra Khajali, Melody Farrashi, Alireza Alizadeh Ghavidel, Mozhgan Parsaee
PMID: 31911560  doi: 10.14744/AnatolJCardiol.2019.13788  Pages E2 - E3
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