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Anatol J Cardiol: 24 (5)
Volume: 24  Issue: 5 - November 2020
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EDITORIAL
1.COVID-19 and TURKMI, miRNAs in CAD, effects of cannabis and tramadol use, and more
Çetin Erol
PMID: 33122487  doi: 10.14744/AnatolJCardiol.2020.11  Page 289
Abstract | Full Text PDF

META ANALYSIS
2.The diagnostic value of circulating microRNAs as biomarkers for coronary artery disease: A meta‑analysis
Qin Fang, Yuanjiang Liao, Zhonglin Xu, Jinmei Li, Xiaoliang Zhang, Yunhong Wang
PMID: 33122485  doi: 10.14744/AnatolJCardiol.2020.91582  Pages 290 - 299
Objective: In recent years, research on microRNAs (miRNAs) associated with coronary artery disease (CAD) has attracted considerable attention. However, findings of these studies on the validity of circulating miRNAs in CAD diagnosis are controversial. A meta-analysis was therefore conducted to determine the potential value of miRNAs as biomarkers in CAD diagnosis.
Methods: Relevant documents on miRNAs expression levels in the diagnosis of CAD were searched and collected from Pubmed, Embase, and Web of Science. They were collected from the time of inception of the database till January 31, 2020. A meta-analysis was conducted using Stata14.0 software. Forest maps were studied and a comprehensive evaluation of the diagnostic value of the expression levels of mRNAs in CAD was conducted using statistical indicators such as the summary receiver operating characteristic curve.
Results: Overall, 14 studies were included, with 38 data sets, involving 29 miRNAs with 846 cases and 898 controls. The meta-analysis revealed that the average sensitivity and specificity of miRNAs for CAD diagnosis were 0.80 (0.75–0.84) and 0.78 (0.75–0.81), respectively. The positive likelihood, negative likelihood, and diagnostic odds ratios were 3.7 (3.1–4.4), 0.26 (0.21–0.33), and 14 (10–21), respectively, and the area under the curve was 0.85 (0.82–0.88). Subgroup analysis revealed that the accuracy in the Asian population was higher than that in the non-Asian population. Multiple miRNAs may be more diagnostically accurate than single miRNAs. MiRNAs in whole blood were more accurate than those in plasma, serum, and peripheral blood mononuclear cells. The diagnostic performance of the quantitative real-time polymerase chain reaction group was better than that of the qPCR group.
Conclusion: According to our study, miRNAs may be a new, non-invasive diagnostic tool for the diagnosis of CAD. As a screening tool in clinical practice, it has potential diagnostic value and is worthy of clinical promotion. Considering the number and quality of the studies included in this meta-analysis, the above conclusion requires more quality research to verify it.

SCIENTIFIC LETTER
3.Ascending aortic estrogen receptor positivity and aortic valve stenosis
Ari Mennander, Nitta-Nea Valtonen, Eetu Niinimäki, Ivana Kholová, Timo Paavonen
PMID: 33122475  doi: 10.14744/AnatolJCardiol.2020.37665  Pages 300 - 302
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
4.Correlation between serum matrix metalloproteinase and myocardial fibrosis in heart failure patients with reduced ejection fraction: A retrospective analysis
Ömer Çelik, Ahmet Anıl Şahin, Serdar Sarıkaya, Begüm Uygur
PMID: 33122477  doi: 10.14744/AnatolJCardiol.2020.54937  Pages 303 - 308
Objective: A strong correlation exists between myocardial fibrosis and heart failure (HF). Myocardial fibrosis can be detected by cardiac magnetic resonance (CMR), which is a crucial noninvasive imaging method with high specificity and sensitivity. Matrix metalloproteinases (MMPs) are primary proteases responsible for the degradation of extracellular matrix (ECM) components, and they play a vital role in maintaining the balance between anabolism and catabolism of ECM. This study aims to investigate the correlation between cardiac fibrosis detected on CMR and serum MMP-9 levels in patients with HF.
Methods: We enrolled 53 patients (age: ≥18 years) with left ventricular ejection fraction (LVEF) ≤40%, who received CMR because of various indications. All patients were divided into two groups-with cardiac fibrosis (n=32) and without cardiac fibrosis (n=21)-detected by CMR with late-Gadolinium. Both groups were then compared according to MMP-9 levels.
Results: MMP-9 levels were significantly higher in patients with cardiac fibrosis than those without fibrosis (p<0.01). A correlation was determined between the diffusiveness of fibrosis and serum MMP-9 levels. Besides, a statistically significant correlation was determined between MMP-9 measurements and the number of segments with fibrosis (p<0.05). In the group with cardiac fibrosis, LVEF measurements by CMR were significantly lower (p<0.01), with left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) measurements significantly higher (p<0.01), than the other group. Furthermore, we found a statistically significant correlation between MMP-9 levels and LVEDV and LVESV.
Conclusion: MMP-9 levels correlate with cardiac remodeling in patients with HF and could be useful in predicting left ventricular fibrosis. In clinical practice, the use of serum MMP-9 could provide early consideration of therapies for structural and functional pathology of the heart in patients with HF.

5.Cystatin C and uncontrolled hypertension
Mehmet Onur Omaygenç, Özgür Ulaş Özcan, Beytullah Çakal, Oğuz Karaca
PMID: 33122483  doi: 10.14744/AnatolJCardiol.2020.78974  Pages 309 - 315
Objective: Increased serum level of cystatin C, a sensitive biomarker for renal function, seems to predict adverse cardiovascular events. We investigated the predictive value of serum cystatin C for controlling hypertension in an observational study.
Methods: We screened 1037 adults residing in both rural and urban communities. They were grouped based on their diagnosis and control of hypertension.
Results: Serum cystatin C levels in patients with uncontrolled hypertension were higher than those in patients with controlled hypertension (0.98±0.23 mg/L vs. 0.89±0.19 mg/L, p=0.001). However, serum creatinine levels were similar between these groups (0.72±0.20 mg/dL vs. 0.70±0.18 mg/dL, p=0.89). Serum cystatin C levels increased the probability of uncontrolled hypertension independent from confounding factors (odds ratio, 1.48; 95% confidence interval, 1.09–5.64; p=0.03).
Conclusion: Subtle kidney dysfunction may be detected using serum cystatin C concentrations among patients with poor blood pressure control and normal serum creatinine levels.

6.Cannabis and tramadol addiction: Do they imply additive risk for acute myocardial infarction in adults younger than 45 years?
Hazem Mansour, Mona Rayan, Mina Shnoda, Diaa Kamal
PMID: 33122481  doi: 10.14744/AnatolJCardiol.2020.67206  Pages 316 - 325
Objective: Acute myocardial infarction (AMI) is the main cause of cardiovascular events worldwide. AMI commonly occurs in elderly patients because of atherosclerotic process related to common risk factors. Consequently, the rupture of atheromatous plaque with deleterious sequela is the common etiology of the disease. However, there are less studied etiological factors in youth compared with the usual population. Therefore, this study aimed to examine the risk profile of Egyptian youth presenting with AMI.
Methods: A study was conducted in 106 patients aged ≤45 years admitted with AMI in our university hospital to explore their clinical profile risk factors.
Results: In the study, 71 (67%) and 35 (33%) patients presented with ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Anterior wall MI was predominant in 49 patients (46.2%). Moreover, 93 patients (88%) were smokers, 31 (29.2%) used tramadol, 43 (40.6%) smoked cannabis, 50 (47.2%) had poor sleeping habits, 29 (27.4%) had high stress levels, 37 (34.9%) had hypertension, and 22 (20.8%) had diabetes. Twenty (18.9%) patients had a family history of premature coronary artery disease. High and low high-density lipoprotein (HDL) levels were observed in 20 (18.9%) and 47 (44.3%) patients, respectively. The left anterior descending artery (LAD) was involved in 56% of the studied population associated with tramadol use. A significant association was found between both tramadol use and cannabis smoking and presence of heavy thrombus burden on coronary angiography.
Conclusion: AMI in Egyptian youth was predominantly observed in men, with anterior STEMI as the most common presentation. Cannabis and tramadol addiction were high risk factors for AMI in Egyptian youth.

7.Sex-specific associations of TCF7L2 variants with fasting glucose, type 2 diabetes and coronary heart disease among Turkish adults
Ayşe Berna Yüzbaşıoğulları, Evrim Kömürcü-bayrak, Altan Onat, Gunay Can, Nina Mononen, Reijo Laaksonen, Mika Kähönen, Terho Lehtimäki, Nihan Erginel-ünaltuna
PMID: 33122478  doi: 10.14744/AnatolJCardiol.2020.57736  Pages 326 - 333
Objective: TCF7L2 is a repressor and transactivator of genes, and its variants are strongly associated with diabetes. This study aimed to evaluate the sex-specific relationship between the most common TCF7L2 gene variants (-98368G>T, rs12255372 and -47833C>T, rs7903146) with diabetes and coronary heart disease in Turkish Adult Risk Factor (TARF) Study.
Methods: Single nucleotide variants (SNVs) have been genotyped using the TaqMan allelic discrimination assays in 2,024 (51.3% in women, age: 55±11.8) Turkish adults participating in the TARF study. Statistical analyses were used to investigate the association of genotypes with clinical and biochemical measurements.
Results: Among the TARF study participants, 11.7%, 24.3%, 14.1%, and 38.3% had diabetes, hypertension, coronary heart disease (CHD), and obesity, respectively. The frequencies of T allele for -47833C>T and -98368G>T in Turkish adults were determined to be 0.35 and 0.33, respectively. -47833C>T was significantly associated with higher fasting glucose concentrations in all participants, especially in men. Both SNVs were significantly associated with diabetes and CHD in all participants (p<0.05). When study population was stratified according to sex, -98368G>T was associated with diabetes in women (p=0.041) and -47833C>T was associated with diabetes and CHD in men (p=0.018 and p=0.032, respectively). Also, both SNVs and the diplotypes of common haplotype (H1) remained strongly associated with type 2 diabetes after risk factors were adjusted (p<0.05).
Conclusion: T allele homozygosity of two SNVs as well as the diplotype H1-/H1- reflects risk of diabetes primarily in men. Enhanced CHD risk is determined by the presence of diplotype H1-/H1- among nondiabetic participants.

8.Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study
Mustafa Kemal Erol, Meral Kayıkçıoğlu, Mustafa Kılıçkap, Arda Güler, Abdullah Yıldırım, Fatih Kahraman, Veysi Can, Sinan Inci, Sadettin Selçuk Baysal, Okan Er, Utku Zeybey, Çağrı Kafkas, Çağrı Yayla, Can Baba Arin, Ibrahim Aktaş, Ahmet Arif Yalçın, Ömer Genç
PMID: 33122486  doi: 10.14744/AnatolJCardiol.2020.98607  Pages 334 - 342
Objective: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1).

Methods: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The
inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period.

Results: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival
increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20–3.22) for NSTEMI, p=0.007; and 2.08 (1.38–3.13) for STEMI, p<0.001].

Conclusion: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI
during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the
increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare
services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42)

CASE REPORT
9.Pericardial hematoma after cardiac surgery: An unexpected cause of constrictive pericarditis
Nil Özyüncü, Buse Güleç, Kerim Esenboğa, Sibel Turhan
PMID: 33122474  doi: 10.14744/AnatolJCardiol.2020.34732  Pages 343 - 344
Abstract | Full Text PDF | Video

10.Intravascular lithotripsy to treat an ostial left main coronary artery stenosis due to porcelain aorta in a patient with congenital high-density lipoprotein deficiency
Murat Çimci, Juan F. Iglesias, Christoph Huber, Francois Mach, Marco Roffi
PMID: 33122479  doi: 10.14744/AnatolJCardiol.2020.62254  Pages 345 - 346
Abstract | Full Text PDF | Video

11.An impressive image of unilateral pulmonary artery agenesis associated with coronary collateralization in an adult
Yakup Alsancak, Sefa Tatar, Ahmet Seyfeddin Gürbüz, Celalettin Korkmaz, Mehmet Akif Düzenli
PMID: 33122484  doi: 10.14744/AnatolJCardiol.2020.80829  Pages 346 - 348
Abstract | Full Text PDF | Video

E-PAGE ORIGINAL IMAGES
12.Free-floating occluder device in the left atrium during paravalvular leak closure in a child: Nightmare in the cath lab
Ibrahim Cansaran Tanıdır, Bekir Yükcü, Mugisha Kyaruzi, Alper Güzeltaş
PMID: 33122482  doi: 10.14744/AnatolJCardiol.2020.68740  Page E14
Abstract | Full Text PDF | Video

13.Left ventricular outpouching - A challenging diagnosis
Alexandra Maria Chitroceanu, Roxana Cristina Rimbas, Alina Ioana Nicula, Dragos Vinereanu
PMID: 33122480  doi: 10.14744/AnatolJCardiol.2020.66059  Pages E14 - E16
Abstract | Full Text PDF | Video

14.Retained outflow graft following the explantation of left ventricular assist device
Ender Örnek, Yücel Kanal, Cihan Dündar, Harun Kundi, Ümit Kervan
PMID: 33122476  doi: 10.14744/AnatolJCardiol.2020.54142  Pages E16 - E17
Abstract | Full Text PDF | Video



 
 
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