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Anatol J Cardiol: 24 (2)
Volume: 24  Issue: 2 - August 2020
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1.European Heart Journal, Thomas F. Lüscher, and new manuscripts
Çetin Erol
PMID: 32749256  doi: 10.14744/AnatolJCardiol.2020.8  Page 67
Abstract | Full Text PDF

2.Myocarditis associated with immune checkpoint inhibitors: Practical considerations in diagnosis and management
Muhammet Gürdoğan, Kenan Yalta
PMID: 32749254  doi: 10.14744/AnatolJCardiol.2020.79584  Pages 68 - 75
Immune checkpoint inhibitors (ICI) have caused radical changes in the treatment scheme of many types of cancer in the past 10 years. ICIs are
specific monoclonal antibodies that increase T-cell mediated immune response against cancer cells. Despite important advances in cancer
treatment, uncontrolled activation of cytotoxic T cells has brought along many autoimmune clinical side effects, especially acute myocarditis.
Although the incidence of ICI-related myocarditis is about 1%, it is remarkable in terms of mortality rate reaching 46% and demonstrating the
necessity of rapid diagnosis and multidisciplinary approach. The present review aimed to summarize the heterogeneous symptomatology of
ICI-associated myocarditis, clinical presentation ranging from elevated asymptomatic cardiac enzyme levels to cardiogenic shock, prominent
diagnostic value of cardiac magnetic resonance imaging, and current information on the effectiveness of immunosuppressants in therapy.

3.Pathophysiological background and clinical practice of lung ultrasound in COVID-19 patients: A short review
Szabo Istvan-Adorjan, Gergely Ágoston, Albert Varga, Ovidiu Simion Cotoi, Attila Frigy
PMID: 32749247  doi: 10.14744/AnatolJCardiol.2020.33645  Pages 76 - 80
The pathological consequences of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) are multiple, with interstitial pneumonia and consecutive respiratory failure being the most dangerous clinical manifestations. Timely diagnosis and follow-up of pulmonary involvement need a comprehensive imaging strategy, which includes standard chest X-ray, chest computed tomography and lung ultrasound (LUS). In the last 10 years, LUS has become a useful, bedside and easily reproducible tool for lung
examination. In the first part of this review, we present the pathophysiological background, technical principles and practical aspects of LUS in
patients with SARS-CoV-2 infection. In the second part, the main echographic findings, their interpretation, and the clinical applications of LUS
are overviewed. The review ends with the presentation of our work methodology, illustrated with images recorded from COVID-19 patients in our department.

4.Trends in acute myocardial infarction admissions during the COVID-19 pandemic in Ankara, Turkey
Harun Kundi, Mustafa Mücahit Balcı, Bülent Güngörer, Metin Yeşiltepe, Nazım Coşkun, Aziz Ahmet Sürel
PMID: 32749251  doi: 10.14744/AnatolJCardiol.2020.70206  Pages 81 - 82
Abstract | Full Text PDF

5.Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?
Padma Subramanyam, Shanmuga Sundaram Palaniswamy
PMID: 32749255  doi: 10.14744/AnatolJCardiol.2020.99148  Pages 83 - 91
Objective: Early identification of viable myocardium in ischemic cardiomyopathy (ICM) patients is essential for early intervention and better
clinical outcome. 99mTechnetium (99mTc) sestamibi gated myocardial perfusion imaging (gMPI) is a well-established technique for myocardial viability evaluation. Detection of potentially viable segments is a predictor of hibernating myocardium. ICM patients with hibernation have a better prognosis after revascularization. We used a novel infusion technique to determine better viability detection preoperatively in challenging situations. Like thallium, does prolonged availability of sestamibi in circulation with additional low dose dobutamine steady infusion (DS Inf) facilitate improved myocardial viability?
Methods: A total of 58 ICM patients with infarct and left ventricular ejection fraction (LVEF) <45% underwent 99mTc sestamibi bolus injection followed by slow intravenous infusion single-photon emission computed tomography (SPECT) using a 2 day protocol. After acquiring the second set of 99mTc sestamibi infusion images, a third SPECT gMPI was performed during DS Inf.
Results: A 17-segment myocardial model was used; 52 of 58 patients (548/986 segments) demonstrated perfusion defects (nonviable myocardium) on bolus study. Only 24 patients demonstrated viable segments by standard bolus imaging protocol. The slow MIBI infusion study demonstrated 158 viable segments (12 ICM patients), while combined infusion (99mTc sestamibi+DS Inf) exhibited an additional 6 patients with improved myocardial viability. Thus, 18 high risk patients benefited by this novel infusion technique to demonstrate viable myocardium on SPECT. There was a significantly higher sensitivity (p=0.05) and positive predictive value (p=0.01) in viability identification with the combined DS Inf technique. In dysfunctional segments, the rate of concordance for detecting viability between infusion and bolus techniques was 65%. Paired t test showed statistically significant improvement in viability detection with combined infusion compared to the bolus study (p=0.001).
Conclusion: This novel infusion technique was shown to be feasible and incremental in viability detection in ICM patients with severe left
ventricular dysfunction. It is a robust tool to guide revascularization, in high risk ICM patients. This study also showed that patients with large
transmural MI demonstrated no significant improvement in myocardial perfusion status using either protocol.

6.Systemic right ventricle in elderly patients with congenitally corrected transposition of the great arteries: Clinical profile, cardiac biomarkers, and echocardiographic parameters
Ewa Kowalik, Anna Kwiatek-Wrzosek, Anna Klisiewicz, Anna Lutynska, Elzbieta Katarzyna Biernacka, Miroslaw Kowalski, Piotr Hoffman
PMID: 32749250  doi: 10.14744/AnatolJCardiol.2020.59689  Pages 92 - 96
Objective: The number of patients with congenitally corrected transposition of the great arteries (ccTGA) surviving to old age is increasing. This
study therefore sought to characterize “geriatric” systemic right ventricle (sRV) in terms of clinical profile, cardiac biomarkers, and echocardiography-derived function when compared with findings in younger patients.
Methods: A single-center cross-sectional study of adults with ccTGA was performed. Patients underwent clinical assessment; transthoracic
echocardiography; and venous blood sampling including N-terminal pro–B-type natriuretic peptide (NTproBNP), galectin-3, and soluble suppression of tumorgenicity 2 (sST2) measurements. In the echocardiographic study, the sRV function was assessed using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), systolic pulsed-wave Doppler velocity (s′), and longitudinal strain (LS).
Results: Ten patients with ccTGA aged 60 years or older and 53 patients younger than 60 years of age were included. There were significantly more individuals with hypertension (40% vs. 5.7%), dyslipidaemia (50% vs. 5.7%), and atrial fibrillation (70% vs. 20.7%) in the older group; similarly, we found higher NTproBNP (2706 pg/mL vs. 784.7 pg/mL; p<0.001), and galectin-3 (10.15 ng/mL vs. 7.24 ng/mL; p=0.007) concentrations in elderly ccTGA individuals, while sST2 content did not vary significantly according to age. Upon echocardiographic assessment, lower sRV FAC (28.6% vs. 36.1%; p=0.028) and LS (−12% vs. −15.5%; p=0.017) values were observed in patients aged 60 years or older. TAPSE and s’ did not differ between the age groups.
Conclusion: Careful screening for acquired comorbidities, particularly atrial fibrillation, in elderly ccTGA patients is warranted. Examining selected cardiac biomarkers and echocardiography-derived parameters are useful in the assessment of the aging sRV.

7.Usefulness of Kawasaki disease risk scoring systems to the Turkish population
Kazım Öztarhan, Yusuf Ziya Varlı, Nuray Aktay Ayaz
PMID: 32749248  doi: 10.14744/AnatolJCardiol.2020.37560  Pages 97 - 106
Objective: Kawasaki disease (KD) is the most common cause of coronary artery aneurysm (CAA) in children. The available risk scores to predict intravenous immunoglobulin (IVIG) resistance and CAA were developed in Asian populations in whom their effectiveness has been proven, but data on non-Asian children are limited. This study aimed to evaluate the ability of 5 risk scoring systems to predict IVIG resistance and CAA in Turkey patients with KD.
Methods: Patients with KD were retrospectively evaluated with clinical, laboratory, and echocardiographic findings. Data analyses were performed in 5 scoring systems (Harada, Kobayashi, Egami, Formosa, and Sano).
Results: A total of 259 patients (Male: Female, 1.7) were treated for KD in our hospital. The mean age of diagnosis in patients with KD, CAA, and IVIG resistance were 3.31, 2.19, and 2.06, respectively. CAA development and IVIG resistance were seen in 11.6% and 12.3% of cases, respectively. IVIG resistance was detected in 35.6% of patients with CAA. In our study, 5 risk scoring systems were applied to our patients. ROC analysis results were found highest in Kobayashi scoring system for IVIG resistance (AUC, 0.864) and in Harada scoring system for CAA development (AUC, 0.727).
Conclusion: Harada score was significant in predicting CAA risk, and Kobayashi score was significant in predicting the risk of developing IVIG
resistance. It is necessary to determine more specific and sensitive risk scores that increase the risk of IVIG resistance and the development of
CAA in Turkey.

8.Does the level of myocardial injury differ in primary angioplasty patients loaded first with clopidogrel and the ones with ticagrelor?
Nil Ozyuncu, Hüseyin Göksülük, Turkan Seda Tan, Kerim Esenboga, Yusuf Atmaca, Çetin Erol
PMID: 32749245  doi: 10.14744/AnatolJCardiol.2020.22903  Pages 107 - 112
Objective: In daily clinical practice, we encounter ST segment elevation myocardial infarction (STEMI) patients loaded with clopidogrel upon
admission to primary angioplasty. These patients are loaded with ticagrelor, if there is no contraindication. This study aimed to compare the
level of injury between STEMI patients who were first loaded with clopidogrel and the ones first loaded with ticagrelor. Although patients were
switched from clopidogrel to ticagrelor at the first hour of angioplasty, antiplatelet action may still be lower than the others.
Methods: This study included STEMI patients with angina onset of ≤3 h and who had primary angioplasty to proximal segment of one coronary
artery. All patients had total thrombotic occlusion at the proximal segment. Δtroponin level (6th-hour troponin–admission troponin) was calculated to compare the level of myocardial injury.
Results: A total of 105 patients were included; 52 were loaded with ticagrelor and 53 with clopidogrel first and switched to ticagrelor. Baseline
characteristics were similar in the two groups, except from type B2 lesions being more common in the ticagrelor-loaded group. Δtroponin levels
were significantly higher in the clopidogrel-loaded group compared with the ticagrelor-loaded group (p=0.013). Major bleeding and in-hospital
MACE rates were similar in both groups.
Conclusion: In STEMI patients, the degree of troponin rise was more prominent in clopidogrel-loaded patients, despite the switch to ticagrelor in
the first hour of intervention. Clopidogrel is slow and modest, and variable platelet inhibition may continue to be a negative factor for protection
from myocardial injury, even after switching to ticagrelor.

9.Late embolization of an atrial septal defect closure device into the main pulmonary artery
Berat Engin, Çağla Canbay, Kemal Nişli, Ahmet Kaya Bilge, Berrin Umman
PMID: 32749253  doi: 10.14744/AnatolJCardiol.2020.78070  Pages 113 - 115
Abstract | Full Text PDF

10.Fatal anaphylactic reaction due to ferric carboxymaltose: A case report
Aylin Mualla Arici, Zeynep Kumral, Ayşe Gelal, Bahri Akdeniz
PMID: 32749249  doi: 10.14744/AnatolJCardiol.2020.38996  Pages 115 - 117
Abstract | Full Text PDF

11.Misinterpretation of dual atrioventricular nodal non-reentrant tachycardia as ventricular tachycardia and implantation of implantable cardioverter-defibrillator followed by inappropriate shocks
Yusuf Türkmen
PMID: 32749252  doi: 10.14744/AnatolJCardiol.2020.73709  Pages 117 - 120
Abstract | Full Text PDF

12.Effects of SARS-CoV-2 on the cardiovascular system: More issues to be addressed
Yang Liu
PMID: 32749243  doi: 10.14744/AnatolJCardiol.2020.11813  Pages 121 - 123
Abstract | Full Text PDF

13.The association of hypertension with obstructive sleep apnea and polysomnographic features
Aydın Akyüz
PMID: 32749242  doi: 10.14744/AnatolJCardiol.2020.04288  Pages 123 - 124
Abstract | Full Text PDF

14.Author`s Reply
Aslıhan Gürün Kaya, Banu Gulbay, Turan Acıcan
PMID: 32749257  Page 124
Abstract | Full Text PDF

15.Giant thrombus occupying the right cardiac chambers in a cancer patient: An unusual and incidental discovery
Radu Stefan Miftode, Ovidiu Mitu, Raluca Elena Arhirii, Irina-Iuliana Costache, Antoniu Petris
PMID: 32749244  doi: 10.14744/AnatolJCardiol.2020.14894  Page E5
Abstract | Full Text PDF | Video

16.Near complete resolution of nonbacterial thrombotic endocarditis in a patient with antiphospholipid antibody syndrome
Justin Shipman, Pradyumna Agasthi, David Majdalany, Farouk Mookadam, Reza Arsanjani
PMID: 32749246  doi: 10.14744/AnatolJCardiol.2020.33027  Pages E5 - E7
Abstract | Full Text PDF | Video

17.The Anatolian Journal of Cardiology Editorial Board

Page E8
Abstract | Full Text PDF

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