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Anatol J Cardiol: 23 (3)
Volume: 23  Issue: 3 - March 2020
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1.SELFIE-TR, TURKMI, MINOCA-TR: New data for you
Çetin Erol
PMID: 32120371  doi: 10.14744/AnatolJCardiol.2020.3  Page 119
Abstract | Full Text PDF

2.Molecular diagnosis methods in familial hypercholesterolemia
Valeriu Moldovan, Claudia Banescu, Minodora Dobreanu
PMID: 32120369  doi: 10.14744/AnatolJCardiol.2019.95038  Pages 120 - 127
Familial hypercholesterolemia (FH) is considered the genetic cause of coronary heart disease and ischemic stroke. FH is mainly an autosomal codominant pattern-based disorder and is primarily determined by point mutations within the low-density lipoprotein receptor, apolipoprotein B, and proprotein convertase subtilisin/kexin type 9 genes, causing increased low-density lipoprotein cholesterol levels in the serum of untreated individuals. The accumulation will eventually lead to atherosclerotic cardiovascular disease. Although clinical criteria comprising several prognosis scores, such as the Simon Broome, Dutch Lipid Clinic Network, Make Early Diagnosis to Prevent Early Death, and the recently proposed Montreal-FH-SCORE, are the conventional basis of diagnosing FH, the genetic diagnosis made by single nucleotide polymorphism genotyping, multiplex ligation-dependent probe amplification analysis, and sequencing (both Sanger and Next-Generation sequencing) offers unequivocal diagnosis. Given the heterogeneity of known mutations, the genetic diagnosis of FH is often difficult to establish, despite the growing evidence of the causative mutations, as well as the polygenic aspect of this pathology and the importance of cascade screening of the FH patient’s healthy family members. This review article details different genetic techniques that can be used in FH identification when there is a clinical FH suspicion based on criteria comprised in prognosis scores, knowing that none of these are exhaustive in the diagnosis, yet they efficaciously overlap and complement each other for confirming the disease at the molecular level.

3.New perspectives by imaging modalities for an old illness: Rheumatic mitral stenosis
Tuğba Kemaloğlu Öz, Özge Özden Tok, Leyla Elif Sade
PMID: 32120357  doi: 10.14744/AnatolJCardiol.2020.01575  Pages 128 - 140
Mitral stenosis (MS) is a progressive and devastating disease and most often occurs among young women. Given its considerable prevalence in Mediterranean and Eastern European countries according to the Euro Heart Survey, new imaging modalities are warranted to improve the management of patients with this condition. A wide spectrum of abnormalities occurs involving all parts of this complex structure and causing different grades of MS and/or regurgitation as a consequence of rheumatic affection. Novel imaging modalities significantly improved the assessment of several aspects of this rheumatic destructive process including the morphological alterations of the mitral valve apparatus, left atrial (LA) function, LA appendage, right and left ventricular function, and complications, namely, atrial fibrillation and thromboembolic events. Furthermore, new imaging modalities improved the prediction of outcome of patients who underwent percutaneous balloon mitral comissurotomy and changed the paradigm of patient selection for intervention and risk stratification. The present review aimed to summarize the role of new multimodality, multiparametric imaging approaches to assess the morphological characteristics of the rheumatic MS and its associated complications, and to guide patient management.

4.Advanced glycation end products facilitate the proliferation and reduce early apoptosis of cardiac microvascular endothelial cells via PKCβ signaling pathway: Insight from diabetic cardiomyopathy
Yi Luan, Jiefang Zhang, Min Wang, Guosheng Fu, Wenbin Zhang
PMID: 32120359  doi: 10.14744/AnatolJCardiol.2019.21504  Pages 141 - 150
Objective: To investigate the effects of advanced glycation end products (AGEs) on the proliferation and apoptosis of cardiac microvascular endothelial cells (CMECs) in rats and their underlying signaling pathway.
Methods: CMECs were isolated from Sprague–Dawley rats. We first examined the effects of AGEs on the proliferation and apoptosis of CMECs and then tested whether protein kinase C (PKC) β blockers could counteract the effects of AGEs. The PKC agonists phorbol 12-myristate 13-acetate (PMA) and PKCβ blockers were also used to verify whether PKC could act independently on CMECs. The receptor for AGEs (RAGE)–small interfering RNA (siRNA) transfection was used to verify the effect of AGEs on PKC. Following the above steps, we explained whether AGEs regulated the CMEC proliferation and early apoptosis through the PKCβ signaling pathway. Proliferation of CMECs was detected using the Cell Counting Kit-8 (CCK-8) assay, and early apoptosis was determined using the Annexin V- Fluorescein Isothiocyanate (FITC)/propidium iodide (PI) double staining. Expression of proliferation and apoptosis-related proteins and PKC phosphorylation were determined by western blotting analysis. Cell cycle distributions were assayed using a BD FACSCalibur cell-sorting system.
Results: AGEs facilitated the proliferation of CMECs, upregulated phosphorylated extracellular signal regulated kinase (p-ERK), and accelerated the entry of cells from G1 phase to the S+G2/M phase, which was consistent with the upregulated cyclin D1 by AGEs. AGEs inhibited early apoptosis of CMECs by increasing the expression of survivin and decreasing the expression of cleaved-caspase3. All these effects can be reversed by PKCβ1/2inhibitors. In addition, AGE upregulated the RAGE expression and phosphorylation of PKCβ1/2 in CMECs, while the inhibition of RAGE reversed the phosphorylation, as well as the effects of AGEs on proliferation and apoptosis in CMECs.
Conclusion: The study indicated that AGEs facilitated the proliferation and reduced early apoptosis of CMECs via the PKCβ signaling pathway.

5.The expression of interleukin-25 increases in human coronary artery disease and is associated with the severity of coronary stenosis
Yao Xu, Jing Ye, Menglong Wang, Jianfang Liu, Zhen Wang, Huimin Jiang, Di Ye, Jishou Zhang, Jun Wan
PMID: 32120360  doi: 10.14744/AnatolJCardiol.2019.24265  Pages 151 - 159
Objective: Interleukin (IL) 25, also known as IL-17E, is an inflammatory cytokine and has been demonstrated to be closely related to cardiovascular diseases by regulating immunity and inflammation, including atherosclerosis. This study was aimed to evaluate the expression of IL-25 in patients with coronary artery disease (CAD).
Methods: In this study, the expression of IL-25 in normal (n=6) and atherosclerotic (n=10) human coronary arteries was detected by immunofluorescent staining. In addition, the serum IL-25, IL-6, and tumor necrosis factor (TNF) α concentrations in stable angina pectoris (SAP, n=44), unstable angina pectoris (UAP, n=46), acute myocardial infarction (AMI, n=34), and non-CAD (control, n=36) were measured using enzyme-linked immunosorbent assay (ELISA) kits.
Results: IL-25 was significantly increased in coronary arteries of CAD patients when compared with normal coronary arteries, with macrophages and T lymphocytes being the sources of IL-25, especially macrophages. Moreover, the serum concentrations of IL-25 were markedly elevated in CAD patients and gradually increased in SAP, UAP, and AMI groups. In addition, IL-25 levels were positively correlated with the IL-6 and TNF-α levels, and Gensini score in CAD patients. Logistic regression analysis showed that IL-25 was independently positively correlated with the occurrence of acute coronary syndrome (ACS). A receiver operator characteristic curve suggested that IL-25 presented a significant diagnosis value in ACS.
Conclusion: IL-25 is increased in the coronary arteries and serum of CAD patients and is associated with the severity of coronary stenosis and the occurrence of ACS, suggesting that IL-25 may be one of the biomarkers of ACS.

6.Snapshot evaluation of acute and chronic heart failure in real-life in Turkey: A follow-up data for mortality
Mehmet Birhan Yılmaz, Emrah Aksakal, Uğur Aksu, Hakan Altay, Yıldırım Nesligül, Ahmet Çelik, Mehmet Ata Akil, Lütfü Bekar, Mustafa Gökhan Vural, Rengin Çetin Güvenç, Savaş Özer, Dilek Ural, Yüksel Çavuşoğlu, Lale Tokgözoğlu
PMID: 32120368  doi: 10.14744/AnatolJCardiol.2019.87894  Pages 160 - 168
Objective: Heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided.
Methods: This is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM.
Results: There were 1054 patients with a mean age of 63.3±13.3 years and with a median follow-up period of 16 (7–17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p<0.001). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist were present in 70.6%, 88.2%, and 50.7%, respectively. In the whole cohort, survival curves were graded according to guideline-directed medical therapy (GDMT) scores ≤1 versus 2 versus 3 as 28% versus 20.2% versus 12.2%, respectively (p<0.001). Multivariate analysis of the whole cohort yielded age (p=0.009) and AHF (p=0.028) as independent predictors of mortality in 1 year.
Conclusion: One-year mortality is high in Turkish patients with HF compared with contemporary cohorts with AHF and CHF. Of note, GDMT score is influential on 1-year mortality being the most striking one on chronic HFrEF. On the other hand, in the whole cohort, age and AHF were the only independent predictors of death in 1 year.

7.Rationale and design of the Turkish acute myocardial infarction registry: The TURKMI Study
Mustafa Kemal Erol, Meral Kayıkçıoğlu, Mustafa Kılıçkap
PMID: 32120363  doi: 10.14744/AnatolJCardiol.2019.57522  Pages 169 - 175
Objective: To the best of our knowledge, there is no up-to-date information regarding the presentation, management, and clinical course of patients with acute myocardial infarction (MI) in Turkey. The TURKMI registry is designed to provide an insight into the characteristics, management from the symptoms onset to the hospital discharge, and outcome of patients with acute MI in Turkey.
Methods: The TURKMI study, as a nationwide registry, will be conducted in 50 percutaneous coronary intervention-capable centers, selected from each EuroStat NUTS region in Turkey according to their population sampling weight, prioritizing the hospital volume in each region. All consecutive patients with acute MI admitted to the coronary care units within the 48 hours of the symptoms onset will be prospectively enrolled during a predefined 2-week period.
The first step of the study has a cross-sectional design in which baseline information such as symptoms, risk factors, time periods at each step from the symptoms onset to revascularization, way of arrival to hospital, biochemical analysis, and in-hospital management and outcome will be assessed. The second step has a cohort characteristic in which the enrolled patients will be followed-up up to 2 years. Follow-up visits will be conducted at the 1st, 6th, 12th, and 24th month, and predictors and risk of cardiovascular events and implementation of guidelines will be assessed as secondary outcomes.
Conclusion: The national TURKMI registry is expected to provide important information to improve the national policy regarding diagnosing, management, and outcomes of MI in Turkey.

8.Prevalence and clinical profile of patients with myocardial infarction with non-obstructive coronary arteries in Turkey (MINOCA-TR): A national multi-center, observational study
Salih Kilic, Gökhan Aydın, Ali Çoner, Yasemin Kılavuz Doğan, Özlem Arican Özlük, Yunus Çelik, Ismail Ungan, Mustafa Tascanov, Ramazan Düz, Veli Polat, Hakan Özkan, Mehmet Özyaşar, Kamil Tülüce, Devrim Kurt, Nurullah Çetin, Murat Gül, Sinan Inci, Fatma Yilmaz Coskun, Hasan Ari, Megdi Zoghi, Oktay Ergene, Uğur Önsel Türk
PMID: 32120362  doi: 10.14744/AnatolJCardiol.2019.46805  Pages 176 - 182
Objective: Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a relatively new term that is characterized by clinical evidence of MI with normal or near-normal coronary arteries on coronary angiography (QCA). To date, there have been no population-based studies on the prevalence of MINOCA in Turkey. The aim of this nationwide study was to document the prevalence and demographics of MINOCA in a Turkish population.
Methods: MINOCA-TR is national, multi-center, prospective, all-comer study that was conducted in 32 hospitals. All consecutive patients who were ≥18 years old, diagnosed with MI according to the Third Universal Definition of Myocardial Infarction, and had undergone QCA were included in the study. Patients with stable coronary artery disease, unstable angina pectoris, a history of revascularization, and type 4/5 MI were excluded.
Results: A total of 1793 patients who were diagnosed with MI and had undergone QCA were screened between March 2018 and October 2018, of whom 1626 (mean age: 61.5±12.5 years, 70.7% male) were enrolled from 32 centers. The prevalence of MINOCA was 6.7% (n=109) in the overall study population. Compared with non-MINOCA patients, those with MINOCA were younger, had a higher prevalence of the female gender, and had a history of flu. The percentages of current smokers, ST-segment elevated myocardial infarction patients, and those with a history of hypertension, diabetes mellitus, and hyperlipidemia were significantly lower in MINOCA patients (p<0.05, for all). Also, the median left ventricular ejection fraction as seen on echocardiography and the ratio of Killip Class I status at presentation was significantly higher in MINOCA patients than in non-MINOCA patients (p<0.001). Patients with MINOCA received a preload dose of P2Y12 antagonist before QCA less often than non-MINOCA patients (p<0.001).
Conclusion: The prevalence of MINOCA in Turkey is 6.7% in patients who were admitted with MI. Also, as compared to non-MINOCA patients, the MINOCA patients were exposed to fewer traditional risk factors of coronary artery disease.

9.Closure of residual leakage after the use of hybrid umbrella in umbrella technique: A case report
Mingxian Chen, Jianjun Tang, Zhenfei Fang, Xiangqian Shen, Shenghua Zhou
PMID: 32120365  doi: 10.14744/AnatolJCardiol.2019.77782  Pages 183 - 186
Abstract | Full Text PDF | Video

10.Successful management of a rare and fatal complication of cardiac catheterization: Abdominal compartment syndrome
Ismail Balaban, Berhan Keskin, Ahmet Karaduman, Ali Karagöz, Regayip Zehir
PMID: 32120370  doi: 10.14744/AnatolJCardiol.2019.96049  Pages 187 - 188
Abstract | Full Text PDF | Video

11.Percutaneous closure of a secundum atrial septal defect through femoral approach in an adult patient with interrupted inferior vena cava and azygos continuation
Elnur Alizade, Ahmet Karaduman, Ismail Balaban, Berhan Keskin, Semih Kalkan
PMID: 32120364  doi: 10.14744/AnatolJCardiol.2019.70968  Pages 188 - 191
Abstract | Full Text PDF | Video

12.Brain-derived neurotrophic factor as biomarker
Pathum Sookaromdee, Viroj Wiwanitkit
PMID: 32120366  doi: 10.14744/AnatolJCardiol.2020.84699  Page 192
Abstract | Full Text PDF

13.Author`s Reply
Hasan Ali Barman, Irfan Sahin, Adem Atici, Eser Durmaz, Ece Yurtseven, Baris Ikitimur, Ertugrul Okuyan, Ibrahim Keles
PMID: 32120372  Pages 192 - 193
Abstract | Full Text PDF

14.A new marker for ventricular tachyarrhythmias in patients with postinfarction left ventricular aneurysm: Big endothelin-1
Tufan Çınar, Mert Hayıroğlu, Vedat Çiçek, Ahmet L. Orhan
PMID: 32120361  doi: 10.14744/AnatolJCardiol.2020.46595  Pages 193 - 194
Abstract | Full Text PDF

15.Ruptured abdominal aortic aneurysm presented as Cullen's sign and Grey Turner’s sign
Che-yu Su, Chi-wei Lee, Chun-Yen Huang
PMID: 32120358  doi: 10.14744/AnatolJCardiol.2019.11786  Pages E7 - E8
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16.Percutaneous treatment of the Gerbode defect causing heart failure after mitral valve surgery
Emre Refik Altekin, Hüseyin Yılmaz
PMID: 32120367  doi: 10.14744/AnatolJCardiol.2019.86721  Pages E8 - E9
Abstract | Full Text PDF | Video

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