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Volume : 23 Issue : 5
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Anatol J Cardiol: 23 (5)
Volume: 23  Issue: 5 - May 2020
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1.ECHO, Thrombi histology, TAVI in Turkey, and more
Çetin Erol
PMID: 32352413  doi: 10.14744/AnatolJCardiol.2020.5  Page 243
Abstract | Full Text PDF

2.Application of strain echocardiography in valvular heart diseases
Marta Cvijic, Jens-Uwe Voigt
PMID: 32352410  doi: 10.14744/AnatolJCardiol.2020.09694  Pages 244 - 253
Echocardiographic strain imaging allows new insight into a complex cardiac mechanics and enables more precise evaluation of cardiac function. Hence, it has been shown to have clinical utility in a variety of valvular heart diseases. In particular, global longitudinal strain has been shown to be more sensitive to detect systolic dysfunction than left ventricular ejection fraction. In patients with valvular heart diseases, it provides both diagnostic and prognostic information in addition to standard echocardiographic and clinical parameters. In this review, we summarize current clinical application of strain echocardiography in patients with valvular heart diseases and discuss pathophysiological mechanisms that lead to respective findings in specific diseases.

3.The potential value of histological analysis of thrombi extracted through mechanical thrombectomy during acute ischemic stroke treatment
Luca Mengozzi, Petr Widimsky
PMID: 32352416  doi: 10.14744/AnatolJCardiol.2020.81342  Pages 254 - 259
Studies on thrombus composition in acute stroke or acute myocardial infarction may help elucidate clot etiology and understand reperfusion success or failure. Moreover, such studies may certainly aid in the development of new technologies aimed at retrieving specific subtypes of thrombi; as a matter of fact, thrombus composition is suggested to influence the choice of techniques used during mechanical thrombectomy and plays a role in potential device and thrombus interaction. Over the years, histological analysis on the composition of thrombi causing ischemic stroke has proved to be a powerful tool to set standard prevention and treatment protocols. By isolating clot components, it is possible to provide a more accurate diagnosis and distinguish different stroke subtypes. Studies on histological clot composition support the theory that cryptogenic stroke can have a cardiogenic origin too. Components found in thrombi extracted from stroke patients support the importance of antithrombotic therapy in preventing and treating cerebral ischemia; however, more studies are needed to improve results in all types and subtypes of stroke. Hence, more research is required to further comprehend the role that platelets, fibrin, von Willebrand factor (vWF), and DNA play in relation to mechanical thrombectomy and recombinant tissue plasminogen activator (rtPA) resistance and to overcome certain limitations.

4.Clinical characteristics and in-hospital outcomes of acute decompensated heart failure patients with and without atrial fibrillation
Umut Kocabaş, Ümit Yaşar Sinan, Emre Aruğaslan, Mustafa Kurşun, Ali Çoner, Özlem Özcan Çelebi, Cengiz Öztürk, Onur Dalgıç, Ebru Ipek Türkoğlu, Hatice Soner Kemal, Emine Gazi, Cihan Altın, Mehdi Zoghi
PMID: 32352420  doi: 10.14744/AnatolJCardiol.2020.94884  Pages 260 - 267
Objective: Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases. The impact of AF on in-hospital outcomes in acute decompensated heart failure (ADHF) is controversial. The aim of this study is to determine the prevalence of AF among hospitalized patients with ADHF and describe the clinical characteristics and in-hospital outcomes of these patients with and without AF.
Methods: We examined the multicenter, observational data from the real-life data of hospitalized patients with HF: Journey HF-TR study in Turkey that studied the clinical characteristics and in-hospital outcomes of hospitalized patients with ADHF between September 2015 and September 2016.
Results: Of the 1,606 patients hospitalized with ADHF, 626 (39%) had a history of AF or developed new-onset AF during hospitalization. The patients with AF were older (71±12 vs. 65±13 years; p<0.001) and more likely to have a history of hypertension, valvular heart disease, and stroke. The AF patients were less likely to have coronary artery disease and diabetes. In-hospital adverse event rates and length of in-hospital stay were similar in ADHF patients, both with and without AF. In-hospital all-cause mortality rate was higher in patients with AF than in patients without AF, although the difference was not statistically significant (8.9% vs. 6.8%; p=0.121).
Conclusion: AF has been found in more than one-third of the patients hospitalized with ADHF, and it has varied clinical features and comorbidities. The presence of AF is not associated with increased adverse events or all-cause mortality during the hospitalization time.

5.Comparison of 3-year clinical outcomes between Endeavor Resolute® and Resolute Integrity® zotarolimus-eluting stents in an Asian population
Yong Hoon Kim, Ae-young Her, Seung-woon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Yoonjee Park, Dong Oh Kang, Won Young Jang, Woohyeun Kim, Cheol Ung Choi, Hong Seog Seo
PMID: 32352415  doi: 10.14744/AnatolJCardiol.2020.80845  Pages 268 - 276
Objective: There is a scarcity of comparative studies between Endeavor Resolute®-zotarolimus-eluting stent (R-ZES) and Resolute Integrity®-ZES (I-ZES) during long-term follow-up periods. Although the stent alloy and the polymer of these two ZESs are similar, the platform and the design of these two stents are different. This study was conducted to compare the efficacy and safety of these two different ZESs in the all-comer Korean patients who underwent percutaneous coronary intervention (PCI) during a 3-year follow-up period.
Methods: This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. In this single-center, retrospective, and all-comer patients’ cohort study, a total of 889 patients who underwent PCI with R-ZES (n=394) or I-ZES (n=495) were enrolled. The primary endpoint was the occurrence of major adverse cardiac events (MACEs) defined as all-cause death, nonfatal myocardial infarction (MI), any repeat revascularization including target lesion revascularization (TLR), target vessel revascularization (TVR), and non-TVR, and the secondary endpoint was stent thrombosis (ST) at 3 years.
Results: To adjust for any potential confounders, the propensity score-adjusted multivariable analysis was performed using the logistic regression model (C-statistics=0.689). The cumulative incidence rates of MACEs [adjusted hazard ratio (aHR), 1.341; 95% confidence interval (CI), 0.615–2.922; p=0.461], all-cause death, nonfatal MI, any repeat revascularization, and ST (aHR, 2.090; 95% CI, 0.163–26.77; p=0.571) were similar between the two groups during the 3-year follow-up period.
Conclusion: R-ZES and I-ZES demonstrated comparable efficacy and safety after PCI during a 3-year follow-up period. However, these results can perhaps be more precisely defined by other large and long-term follow-up studies in the future. (Anatol J Cardiol 2020; 23: 268-76)

6.Assessment of right ventricular function in patients with pulmonary arterial hypertension-congenital heart disease and repaired and unrepaired defects: Correlation among speckle tracking, conventional echocardiography, and clinical parameters
Hatice S. Kemal, Meral Kayıkçıoğlu, Sanem Nalbantgil, Levent Hürkan Can, Nesrin Moğulkoç, Hakan Kültürsay
PMID: 32352408  doi: 10.14744/AnatolJCardiol.2020.01379  Pages 277 - 287
Objective: The purpose of this study is to compare the analysis of right ventricular (RV) free wall strain via 2D speckle tracking echocardiography with conventional echocardiography and clinical parameters in patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) receiving specific treatment. This study also aims to describe the differences between patients with repaired and unrepaired defects.
Methods: This prospective study included 44 adult patients with PAH-CHD who were receiving PAH-specific treatment in a single center. This study excluded patients with complex congenital heart disease. The authors studied the conventional echocardiographic parameters, such as RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), right atrial (RA) area, Tricuspid S', and hemodynamic parameters, such as functional class, 6-minute walking distance (6MWD), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.
Results: The mean age of participants was 33.8±11.6 years, and 65.9% of participants were female. The mean RV free wall strain was −14.8±4.7%. Majority of the patients belonged to WHO functional class 2 (61.4%) with a mean NT-proBNP level of 619.2±778.4 and mean 6MWD of 400.2±86.9 meters. During the follow-up of 30.8±9.0 months, 6 patients (13.6%) developed clinical right heart failure, whereas 9 (20.5%) of them died. There was a positive and significant correlation between RV free wall strain and WHO functional class (r=0.320, p=0.03), whereas there was a negative correlation between RV free wall strain and FAC (r=−0.392, p=0.01), TAPSE (r=−0.577, p=0.0001), and Tricuspid S' (r=−0.489, p=0.001). There was no significant correlation of RV free wall strain with either RA area or 6MWD. Patients with repaired congenital heart defects had worse RV functional parameters and RV free wall strain than patients with unrepaired defects.
Conclusion: The assessment of RV free wall strain via 2D speckle tracking echocardiography is a feasible method and correlates well with conventional echocardiography and clinical parameters in patients with PAH-CHD receiving specific treatment. (Anatol J Cardiol 2020; 23: 277-87)

7.Evaluation of procedural and clinical outcomes of transcatheter aortic valve implantation: A single-center experience
Bilge Duran Karaduman, Hüseyin Ayhan, Telat Keleş, Engin Bozkurt
PMID: 32352409  doi: 10.14744/AnatolJCardiol.2020.03942  Pages 288 - 296
Arka plan ve Amaç: Artık transkateter aort kapak implantasyonu (TAVI) cerrahi aort kapak replasmanına net olarak alternatiftir. Çalışmamızda geniş hacimli tek merkezimizde TAVI yapılan tüm hastaların kısa ve uzun dönem takip sonuçlarını değerlendirmeyi amaçladık.
Yöntem: Temmuz 2011 ve Aralık 2019 tarihleri arasında, TAVI uygulanan semptomatik ciddi aort darlıklı 556 ardışık hasta bu retrospektif tek merkezli analize dahil edilmiştir.
Bulgular: Tüm popülasyonun ortalama yaşı 77.6 ± 7.9 yıl idi ve hastaların %54.9'u kadındı. Kohortun ortalama STS skoru %6.0±3.5 idi. Çalışmada balon ile yerleştirilen kapak (Sapien XT, Sapien 3; Edwards Lifesciences, Irvine, California) en sık kullanılan kapak idi (%94.6). Hastaların %96.3’ünde transfemoral yol kullanıldı. Başarılı implantasyon vakaların 96.6’sında gerçekleştirildi. TAVI işlemi sonrası hastaların toplam %7.2’sinde kalıcı kalp pili ihityacı oldu ve %37.5 oran ile en çok kalp pili ihtiyacı Lotus kapak grubunda oldu. Ortalama hastanede kalış süresi 4.5±2.3 gün idi. Taburculuktan önce hastane içi 22 (%3.9) hastada ölüm gözlendi. Tüm hastalar için ortalama 15.1±14.9 ay takip süresince fonksiyonel kapasitede ve tüm ekokardiyografik parametrelerde anlamlı iyileşme gözlendi. Taburculukta hastaların %18.9’unda paravalvular kaçak (PVK) saptanmış olup bunların %17.9’u hafif ve %1’I orta idi. Ek işlem gerektiren ileri PVK olmadı. Çok değişkenli lojistik regresyon analizi cinsiyet, STS skoru, bazal syntaks skoru, biküspit kapak morfolojisi, ana femoral arter çapı ve post-TAVI PVK'nIn toplam mortalitenin bağımsız prediktörleri olduğunu göstermiştir.
Sonuç: Bildiğimiz kadarıyla, TAVI'nin Türkiye'deki en geniş tek merkezli gerçek dünya deneyimi olan bu çalışma ile TAVI uygulanan hastalarda olumlu kısa ve orta vadeli transkateter kapak performansı ile düşük komplikasyon oranları gösterilmiştir.
Objective: Transcatheter aortic valve implantation (TAVI) is an established alternative to surgical aortic valve replacement. Our study aimed to evaluate the implementation of TAVI at our large-volume center, having an all-comer patient population with short and long-term follow-ups.
Methods: This retrospective, single-center analysis included 556 consecutive patients with symptomatic severe aortic stenosis (AS) who underwent TAVI between July 2011 and December 2019.
Results: The mean age of the entire population was 77.6±7.9 years, and 54.9% were women. The Society of Thoracic Surgeons (STS) mean score of the cohort was 6.0%±3.5%. The balloon-expandable valve (Sapien XT, Sapien 3; Edwards Lifesciences, Irvine, California) was the most frequently used valves in this cohort (94.6%). Transfemoral access was used in 96.3% of patients. Implantation success was achieved in 96.6% of cases. During the TAVI procedure, 7.2% of patients required permanent pacemaker implantation, with 37.5% in the Lotus valve group needing the most permanent pacemakers. The mean length of hospital stay for the entire cohort was 4.5±2.3 days. Overall, 22 (3.9%) in-hospital deaths occurred before hospital discharge. The mean follow-up period was 15.1±14.9 months for all patients, and a significant improvement was noted in all echocardiographic parameters and functional capacity. Paravalvular leak (PVL) was documented in 18.9% patients, mild in 17.9%, and moderate in 1% at discharge. No cases with severe PVL, necessitating additional procedures. The multiple logistic regression analysis revealed that sex, STS score, baseline SYNTAX score, bicuspid valve morphology, common femoral artery diameter, and post-TAVI PVL were independent predictors of overall mortality.
Conclusion: To our knowledge, this study, which is the largest single-center real-world experience of TAVI in Turkey, demonstrated low complication rates with favorable short- and mid-term THV performance in patients undergoing TAVI. (Anatol J Cardiol 2020; 23: 288-96)

8.Editorial: We need more national data on transcatheter aortic valve implantation
Cem Barçın
PMID: 32352417  doi: 10.14744/AnatolJCardiol.2020.82289  Pages 297 - 298
Abstract | Full Text PDF

9.Bayés syndrome phenocopy in a patient with 1: 1 atrial flutter and corrected tetralogy of Fallot
Lucian Muresan, Ronan Le Bouar, Yasmine Doghmi, Crina Muresan, Jacques Levy
PMID: 32352411  doi: 10.14744/AnatolJCardiol.2020.16064  Pages 299 - 302
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10.Acute left main coronary artery occlusion following transcatheter aortic valve replacement without obvious risk factors of coronary obstruction
Beytullah Çakal, Sinem Çakal, Oguz Karaca, Bilal Boztosun
PMID: 32352418  doi: 10.14744/AnatolJCardiol.2020.91535  Pages 302 - 304
Abstract | Full Text PDF | Video

11.Successful percutaneous treatment of pulsatile tinnitus, a rare symptom of carotid artery stenosis
Fatih Yilmaz, Ahmet Karaduman, İsmail Balaban, Murat Velioğlu, Nuri Havan
PMID: 32352414  doi: 10.14744/AnatolJCardiol.2020.76366  Pages 304 - 306
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12.Fistulization of the right coronary artery to the superior vena cava
Nesat Cullu, Murat Yunus Özdemir, Eda Özlek, Önder Yeniçeri, Ibrahim Altun
PMID: 32352419  doi: 10.14744/AnatolJCardiol.2020.94727  Page E13
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13.Giant pulmonary aneurysm
Jianglong Hou, Yibing Fang
PMID: 32352412  doi: 10.14744/AnatolJCardiol.2020.57598  Page E14
Abstract | Full Text PDF

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