ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 16 (5)
Volume: 16  Issue: 5 - May 2016
EDITORIAL
1.Chicago Spring and ACC.16
Zeki Öngen
PMID: 27240606  PMCID: PMC5336775  doi: 10.14744/AnatolJCardiol.2016.05  Page 305
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
2.Hypotensive effect of alpha-lipoic acid after a single administration in rats
Magdalena Dudek, Katarzyna Razny, Anna Bilska - Wilkosz, Malgorzata Iciek, Jacek Sapa, Lidia Wlodek, Barbara Filipek
PMID: 26488376  PMCID: PMC5336776  doi: 10.5152/AnatolJCardiol.2015.6217  Pages 306 - 309
Objective: The effect of alpha-lipoic acid on blood pressure was investigated many times in chronic studies, but there are no studies on the effect of this compound after a single administration. Alpha-lipoic acid is a drug used in diabetic neuropathy, often in obese patients, to treat hypertension. Therefore, knowledge of the potential antihypertensive effect of alpha-lipoic acid even after a single dose and possibly too much pressure reduction is interesting and useful.
Methods: The mechanism of the hypotensive effect of alpha-lipoic acid was examined in normotensive rats in vivo after a single intraperitoneal administration, blood pressure in the left carotid artery of the rats was measured prior to the administration of the compounds (alphalipoic acid and/or glibenclamide) and 80 min thereafter.
Results: Alpha-lipoic acid at a dosage of 50 mg/kg b.w. i.p. significantly decreased the blood pressure from the 50th min after drug administration. This cardiovascular effect of this compound was reversed by glibenclamide, a selective KATP blocker. Glibenclamide alone at this dose did not significantly affect the blood pressure. Statistical significance was evaluated using two-way ANOVA.
Conclusion: This suggests that alpha-lipoic acid affects ATP-dependent potassium channels. It is possible that this is an indirect effect of hydrogen sulfide because alpha-lipoic acid can increase its concentration. The results obtained in this study are very important because the patients taking alpha-lipoic acid may be treated for co-existing hypertension. Therefore, the possibility of blood pressure lowering by alphalipoic acid should be taken into account, although it does not lead to excessive orthostatic hypotension. (Anatol J Cardiol 2016; 16: 306-9)

3.Therapeutic effects of pentoxifylline on diabetic heart tissue via NOS
Derya Karabulut, Hasan Basri Ulusoy, Emin Kaymak, Mehmet Fatih Sönmez
PMID: 26488377  PMCID: PMC5336777  doi: 10.5152/akd.2015.6252  Pages 310 - 315
Objective: Diabetes mellitus causes a decrease in cardiac output, arterial blood pressure, and heart rate. In this study, we aimed to investigate, at the molecular level, the effect of nitric oxide synthase (NOS) on heart pathology in type 1 diabetes and look at the therapeutic effect of pentoxifylline on this pathology.
Methods: In this experimental study, 50 Wistar albino male rats were used. The rats were divided into 5 groups: group C, control; group D, only diabetes; group D+PI and D+PII, diabetes + pentoxifylline; group P, only pentoxifylline. Group D+PI rats received 50 mg/kg/day pentoxifylline over two months. However, group D+PII rats received saline in the first month and 50 mg/kg/day of pentoxifylline over the following month. At the end of two months, NOS expressions in heart tissue were assessed through immunohistochemistry analysis. The data were compared by one-way ANOVA.
Results: At the end of the experiments, there was increased cytoplasmic vacuolization, myofibrillar loss, cytoplasmic eosinophilia, and degeneration of cardiomyocytes; nNOS and iNOS expressions in group D decreased compared with that in group C. In group D+PI and group D+PII, nNOS and iNOS expressions improved compared with group D.
Conclusion: As a result, we found that diabetes, a known chronic disease, causes serious damage in heart tissue. NOS plays a role in this damage, and pentoxifylline aided in improving nNOS and iNOS expression in this damage. (Anatol J Cardiol 2016; 16: 310-5)

4.Evaluation of left atrial volume and function in systemic sclerosis patients using speckle tracking and real-time three-dimensional echocardiography
Halil Ataş, Alper Kepez, Kürşat Tigen, Fuad Samadov, Gülsen Özen, Altuğ Cincin, Murat Sünbül, Mehmet Bozbay, Haner Direşkeneli, Yelda Başaran
PMID: 26488378  PMCID: PMC5336778  doi: 10.5152/AnatolJCardiol.2015.6268  Pages 316 - 322
Objective: The aim of the present study was to evaluate left atrial (LA) volume and functions using real-time three-dimensional echocardiography (RT3DE) and speckle tracking in systemic sclerosis (SSc) patients.
Methods: The study was designed as a cross-sectional observational study. We studied 41 consecutive SSc patients (38 females, mean age: 49.5±11.6 years) and 38 healthy controls (35 females, mean age: 48.5±10.8 years). Patients with evidence or history of cardiovascular disease and patients with risk factors as hypertension, diabetes and chronic renal failure were excluded from the study. All study subjects underwent standard echocardiography; LA speckle tracking and RT3DE was performed to assess LA volume and phasic functions. Differences between numeric variables were tested using the independent sample Student's t-test or Mann-Whitney U test, where appropriate.
Results: There were no significant differences between SSC patients and controls regarding left ventricular (LV) systolic functions and twodimensional (2-D) atrial diameters. Presence of LV diastolic dysfunction (LVDD) was evaluated and graded according to recommendations of the American Society of Echocardiography. Accordingly, LVDD was observed to be significantly more frequent in SSc patients; 16 SSc patients (39%) and 5 controls (12.8%) were observed to have LVDD (p=0.007). With regard to results obtained from RT3DE, LA maximum, minimum, and before atrial contraction volumes were significantly higher (40.5±14.6 vs. 32.6±8.9, 15.5±8.4 vs. 9.9±3.5 and 28.7±11.7 vs. 21.4±7.0 mL respectively, p<0.05 for all), whereas LA active emptying fraction, LA total emptying fraction, LA expansion index, and passive emptying fraction values were significantly (47.1±12.0 vs. 52.9±10.1%, 62.8±10.5 vs. 69.5±6.7%, 187.5±76.0 vs. 246.6±96.0, 29.6±9.3 vs. 34.4±11.0% respectively, p<0.05 for all) in SSc patients than in controls. In addition, regarding results obtained from speckle tracking echocardiography, atrial peak-systolic longitudinal strain (ε), early negative strain rate (SR), late negative SR, and peak positive SR values were observed to be significantly lower in SSc patients.
Conclusion: LA volumes were significantly increased, and LA reservoir, conduit, and contractile functions were significantly impaired in SSc patients compared with controls. LA volume and functional analyses with RT3DE and speckle tracking may facilitate the recognition of subtle LA dysfunction in SSc patients. (Anatol J Cardiol 2016; 16: 316-22)

5.Heart rate variability and heart rate turbulence in patients with polycystic ovary syndrome
Gülay Özkeçeci, Bekir Serdar Ünlü, Hüseyin Dursun, Önder Akçi, Gülengül Köken, Ersel Onrat, Alaettin Avşar
PMID: 26488379  PMCID: PMC5336779  doi: 10.5152/AnatolJCardiol.2015.6307  Pages 323 - 327
Objective: Cardiac autonomic dysfunction may develop in patients with polycystic ovary syndrome (PCOS). Heart rate variability (HRV) and heart rate turbulence (HRT) are used in assessing cardiac autonomic functions. The goal of this study was to compare the cardiac autonomic functions in patients with PCOS and healthy controls. To our knowledge, this is the first study evaluating cardiac autonomic functions in patients with PCOS with respect to both HRV and HRT.
Methods: Twenty-three patients with PCOS (mean age 22.8±3.9 years) and 25 healthy female volunteers who were matched for age and body mass index (BMI) (mean age 23.5±6.2 years) were enrolled in this as case-control study. Twenty-four hour ambulatory electrocardiogram recordings of all participants were taken using Pathfinder software. The time domain parameters of HRV and HRT, including turbulence onset (TO) and turbulence slope, were calculated. Diagnosis of PCOS was made with physical and laboratory findings of hirsutism or biochemical hyperandrogenism and chronic anovulation. Diabetes mellitus, other hormon disorders or hormon therapy, pregnancy, atrial fibrilation, obesite, chronic diseases, disorders of the autonomic nervous system, a history of drug use affecting the autonomic nervous system were excluded.
Results: There were no significant differences in HRV and HRT parameters between the two groups. Cardiovascular risk factors, such as BMI, blood pressure, fasting blood glucose, and lipid parameters, were also similar. Triangular index measure of HRV was negatively correlated with high density lipoprotein cholesterol levels (r=-0.47, p<0.05), while age and BMI were significantly correlated with TO (r=0.31 and 0.47, respectively; p<0.05 for all).
Conclusion: Cardiac autonomic functions were not found to be altered in patients with PCOS in comparison with healthy controls. These results may be explained with the absence of concomitant cardiovascular risk factors with the patients being in the early stage of the disease. (Anatol J Cardiol 2016; 16: 323-27)

6.Effects of balanced propofol sedation on QT, corrected QT, and P-wave dispersion on upper endoscopy
Esef Bolat, Mehmet Çelikbilek, Savaş Sarıkaya, Yunus Keser Yılmaz, Serkan Doğan, Ömer Özbakır
PMID: 26488380  PMCID: PMC5336780  doi: 10.5152/AnatolJCardiol.2015.6264  Pages 328 - 332
Objective: Combined sedation with propofol and benzodiazepines, known as balanced propofol sedation (BPS), was developed to increase patient comfort during endoscopy. However, the effects of BPS on P-wave dispersion (Pwd), QT interval, and corrected QT (QTc) interval after endoscopy have not been investigated.
Methods: The study population consisted of 40 patients with BPS and 42 without sedation who were scheduled to undergo upper endoscopy in this cross-sectional prospective study. Patients with hypertension, diabetes mellitus, renal failure, chronic obstructive pulmonary disease, coronary artery disease, or valvular heart disease and those on medications that interfere with cardiac conduction times were excluded. Electrocardiograms (ECGs) was recorded in all patients pre-endoscopy and 10 min post-endoscopy. QT, QT dispersion (QTd), and Pwd were defined from 12-lead ECG. The QTc interval was calculated using Bazett’s formula. All analyses were performed using SPSS 15.0.
Results: Post-endoscopy P max duration and Pwd were prolonged compared with baseline values (86±13 ms vs. 92±10 ms and 29±12 ms vs. 33±12 ms, respectively; p<0.05). Post-endoscopy QTc and QTd were decreased compared with baseline values, but these decreases were not statistically significant (431±25 ms vs. 416±30 ms and 62±28 ms vs. 43±22 ms, respectively; p>0.05).
Conclusion: The present study showed that P-wave duration and Pwd values increased after endoscopy with a combination of midazolam and propofol sedation. Physicians should be made aware of the potential effects of BPS in terms on P-wave duration and Pwd values. (Anatol J Cardiol 2016; 16: 328-32)

7.GuideLiner catheter application in complex coronary lesions: experience of two centers
Hüseyin Dursun, Ahmet Taştan, Zülkif Tanrıverdi, Erdem Özel, Dayimi Kaya
PMID: 26168458  PMCID: PMC5336781  doi: 10.5152/AnatolJCardiol.2015.6214  Pages 333 - 339
Objective: GuideLiner catheter provides adequate back-up support and a coaxial guide engagement for stent delivery in complex coronary anatomies. In this study, we aimed to present one of the largest series of experience with GuideLiner catheter utilized for challenging percutaneous coronary interventions in two centers.
Methods: We retrospectively collected the coronary angiography records of 64 patients between January 1, 2012 and August 1, 2014 in whom conventional techniques failed for stent delivery and 5-in-6 Fr GuideLiner catheter was used for this purpose. The data were assessed in terms of the lesion characteristics, procedural success, and complications. Descriptive statistics and frequencies were used in statistical analyses.
Results: The mean age of the patients was 69.8±10.0 years. Femoral approach was employed in all cases. Lesions were mostly (90.6%) class B2 or C according to the AHA/ACC lesion classification. The GuideLiner catheter was mainly used to increase back-up of the guide catheter (85.9%), and in 95.3% of all cases, the procedure was successful. The mean depth of the GuideLiner catheter intubation was 30.3±21.6 mm. None of the patients had coronary dissection or major complications.
Conclusion: In this study, we presented a large registry of two centers used the GuideLiner catheter. The device effectively allowed stent delivery in challenging lesions, where conventional techniques have failed, without major complications. (Anatol J Cardiol 2016; 16: 333-9)

EDITORIAL COMMENT
8.Citius, Altius, Fortius: The impact of guide catheter extensions in contemporary percutaneous coronary intervention
Georgios E. Christakopoulos, Emmanouil Brilakis
PMID: 27240607  PMCID: PMC5336782  doi: 10.14744/AnatolJCardiol.2015.00013  Pages 340 - 341
Abstract |Full Text PDF

9.Are catheter extension devices one step forward for complex coronary interventions?
Sergio García Blas, Julio Nunez
PMID: 27240608  PMCID: PMC5336783  doi: 10.14744/AnatolJCardiol.2015.00014  Pages 342 - 343
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
10.Galectin-3 levels in patients with hypertrophic cardiomyopathy and its relationship with left ventricular mass index and function
Selcen Yakar Tülüce, Kamil Tülüce, Zafer Çil, Sadık Volkan Emren, Zehra İlke Akyıldız, Oktay Ergene
PMID: 26488381  PMCID: PMC5336784  doi: 10.5152/AnatolJCardiol.2015.6191  Pages 344 - 348
Objective: Cardiac fibrosis is an important contributor to adverse left ventricular (LV) remodeling and arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Galectin-3 (Gal-3) is a novel marker of cardiac fibrosis and inflammation. In this study, we investigated Gal-3 levels in patients with HCM and controls and assessed the relationship between Gal-3 level and echocardiographic indices using strain echocardiography in patients with HCM.
Methods: Forty patients with HCM in sinus rhythm and 35 healthy controls were prospectively enrolled in this case-control study. The HCM diagnosis was based on two-dimensional echocardiographic demonstration of a hypertrophied and non-dilated left ventricle (LV) with a wall thickness ≥15 mm in one or more LV myocardial segments in the absence of any cardiac or systemic disease capable of inducing LV hypertrophy. Patients with one of the followings were excluded: coronary artery disease, atrial fibrillation episodes on 24-h Holter electrocardiogram (ECG) monitoring, history of an invasive intervention to alleviate an LV outflow (LVOT) obstruction, inadequate image quality, renal disease, diabetes mellitus, hyperlipidemia, liver cirrhosis, and pulmonary fibrosis. Global LV longitudinal, circumferential strain and strain rates, peak torsion, and LV mass index (LVMI) of all subjects were assessed by echocardiography. Gal-3 levels were measured in all subjects.
Results: Left ventricular global longitudinal strain (-13.37±4.6% vs. -18.93±2.5%, p<0.001) and strain rate (0.66±0.22 s-1 vs. 1.08±0.14 s-1, respectively; p<0.001) values were lower in patients with HCM than in controls. Gal-3 levels were significantly higher in patients with HCM than in controls (16.9±6.64 ng/mL vs. 13.21±3.42 ng/mL, p=0.005). Gal-3 levels were associated with the thickness of the interventricular septum (r=0.444, p=0.004) and LVMI (r=0.365, p=0.021); however, they were not associated with LV global longitudinal strain (p=0.42) or strain rate (p=0.28).
Conclusion: Gal-3 levels increased and were correlated with the degree of LV hypertrophy in patients with HCM. Gal-3 is not a good marker of decreased myocardial LV diastolic and systolic functions in these patients. (Anatol J Cardiol 2016; 16: 344-8)

11.Association between platelet to lymphocyte ratio and saphenous vein graft disease in patients with stable angina pectoris
Harun Kundi, Ahmet Balun, Hülya Çiçekcioğlu, Mustafa Çetin, Emrullah Kızıltunç, Zehra Güven Çetin, Feridun Vasfi Ulusoy, Ender Örnek
PMID: 26488382  PMCID: PMC5336785  doi: 10.5152/akd.2015.6224  Pages 349 - 353
Objective: In this study, we aimed to investigate the relation of platelet to lymphocyte ratio (PLR) in saphenous vein graft disease (SVGD) in patients with stable angina pectoris after coronary artery bypass graft surgery.
Methods: A total of 455 patients were included in the study. There were 210 patients with SVGD and 245 patients without SVGD. The effects of different variables on SVGD were computed in logistic regression analysis.
Results: The platelet count, lymphocyte count, PLR, high-density lipoprotein (HDL), Na, and ALT were significantly associated with SVGD. In multivariate regression analysis, HDL and PLR were found to be significantly associated with SVGD.
Conclusion: To the best of our knowledge, this is the first study showing the significant association of PLR with SVGD. This study suggests that PLR can be used as a marker of SVGD because it is an easily available and inexpensive test. (Anatol J Cardiol 2016; 16: 349-53)

12.Determination of reference values for tricuspid annular plane systolic excursion in healthy Turkish children
Fahrettin Uysal, Özlem Mehtap Bostan, Ergun Çil
PMID: 26488383  PMCID: PMC5336786  doi: 10.5152/akd.2015.6227  Pages 354 - 359
Objective: Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic measurement used for evaluating right ventricular systolic function. While established reference values of TAPSE exist for the adult population, only a limited number of studies have attempted to evaluate reference values for the pediatric population. The aim of the present study was to determine the reference values for TAPSE in healthy children in Turkey.
Methods: A total of 765 healthy children aged between 0 and 18 years, all of whom were referred to our clinic with cardiac murmurs, were evaluated prospectively. Patients with no cardiac pathologies or other disorders were excluded from the study. The measurement of TAPSE was obtained using a 2D-guided M-mode technique with echocardiography, and the relationship between age and surface area with TAPSE was investigated. The statistical analysis was carried out using the SPSS 20.0 software package (SPSS Inc., Chicago, IL, USA, 2012).
Results: The mean TAPSE value was found to be 19.56±5.54 mm, and no significant difference was identified between male and female children. TAPSE values showed a positive correlation with increasing age and surface area. The mean TAPSE value was 9.09±1.36 mm in newborns and 25.91±3.60 mm in the 13-18 years age group. A negative correlation was seen between TAPSE and heart rate.
Conclusion: In the present study, the reference values for TAPSE in healthy Turkish children were presented in percentile tables and the corresponding z-scores were determined. These reference values may be useful in daily practice for the evaluation of right ventricular systolic function in children. (Anatol J Cardiol 2016; 16: 354-9)

SCIENTIFIC LETTER
13.Wood units · m2 or Wood units/m2: does it matter?
Serdar Kula, Tayfun Göktaş
PMID: 27240609  PMCID: PMC5336787  doi: 10.14744/AnatolJCardiol.2016.6966  Page 360
Abstract |Full Text PDF

14.The role of protein Z and protein Z-dependent protease inhibitor polymorphisms in the development of prosthetic heart valve thrombosis
Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Mahmut Yesin, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Zübeyde Bayram, Mehmet Özkan
PMID: 27240610  PMCID: PMC5336788  doi: 10.14744/AnatolJCardiol.2016.6719  Pages 361 - 363
Abstract |Full Text PDF

LETTER TO THE EDITOR
15.Psychological effects of treatment with novel oral anticoagulants in non-valvular atrial fibrillation patients
Can Ramazan Öncel
PMID: 27240611  PMCID: PMC5336789  doi: 10.14744/AnatolJCardiol.2016.7030  Page 364
Abstract |Full Text PDF

16.Author`s Reply
Kevser Gülcihan Balcı
PMID: 27240612  PMCID: PMC5336790  Pages 364 - 365
Abstract |Full Text PDF

17.Do spontaneous coronary artery dissections always need intervention in patients with no atherosclerosis?
Cengiz Öztürk, Turgay Çelik, Şevket Balta, Atila İyisoy
PMID: 27240613  PMCID: PMC5336791  doi: 10.14744/AnatolJCardiol.2016.7120  Pages 365 - 366
Abstract |Full Text PDF

18.Author`s Reply
Necip Ermiş
PMID: 27240614  PMCID: PMC5336792  Page 366
Abstract |Full Text PDF

19.Effects of cardiopulmonary bypass on new-onset atrial fibrillation
Orhan Gökalp, Börtecin Eygi, Yüksel Beşir, Ali Gürbüz
PMID: 27240615  PMCID: PMC5336793  doi: 10.14744/AnatolJCardiol.2016.6990  Pages 366 - 367
Abstract |Full Text PDF

20.Author`s Reply
Çetin Geçmen
PMID: 27240616  PMCID: PMC5336794  Page 367
Abstract |Full Text PDF

21.Myocardial infarction in an 11-year-old child with systemic lupus erythematosus
Meki Bilici, Fikri Demir, Mehmet Türe, Alper Akın, Habip Çil, Aydın Ece, Nihat Polat
PMID: 27240617  PMCID: PMC5336795  doi: 10.14744/AnatolJCardiol.2016.7021  Pages 367 - 368
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
22.Partial detachment of tricuspid valve annuloplasty ring detected by three-dimensional transesophageal echocardiography
Begüm Uygur, Mehmet Ertürk, Hale Ünal Aksu, Aydın Yıldırım
PMID: 27240619  PMCID: PMC5336796  doi: 10.14744/AnatolJCardiol.2016.7118  Page E9
Abstract |Full Text PDF | Video

23.Transcatheter closure of ruptured sinus of valsalva aneurysm using symmetrical perimembraneous VSD device
Kemal Nişli, Serra Karaca, Ümrah Aydoğan
PMID: 27240618  PMCID: PMC5336797  doi: 10.14744/AnatolJCardiol.2016.7044  Page E10
Abstract |Full Text PDF



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