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Anatol J Cardiol: 19 (1)
Volume: 19  Issue: 1 - January 2018
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1.A New Year, A New Time
Bilgin Timuralp
doi: 10.14744/AnatolJCardiol.2018.1  Page 1
Abstract | Full Text PDF

2.Neuroprotective effect of selective antegrade cerebral perfusion during prolonged deep hypothermic circulatory arrest: Cerebral metabolism evidence in a pig model
Zhixian Tang, Mengya Liang, Guangxian Chen, Jian Rong, Jianping Yao, Zhen Chen, Xiao Yang, Zhongkai Wu
doi: 10.14744/AnatolJCardiol.2017.7946  Pages 2 - 10
Objective: The aim of this study was to elucidate the mechanism of cerebral injury and to evaluate selective antegrade cerebral perfusion (SACP) as a superior neuroprotective strategy for prolonged deep hypothermic circulatory arrest (DHCA).
Methods: Twelve pigs (6–8-week old) were randomly assigned to DHCA alone (n=6) and DHCA with SACP (n=6) at 18°C for 80 min groups. Serum S100 was determined using an immunoassay analyzer. The concentrations of cerebral dialysate glucose, lactate, pyruvate, glycerol, and glutamate were measured using a microdialysis analyzer.
Results: Compared with a peak at T4 (after 60 min of rewarming) in the DHCA group, the serum S100 in the SACP group was significantly lower throughout the study. The DHCA group was susceptible to significant increases in the levels of lactate, glycerol, and glutamate and the ratio of lactate/pyruvate as well as decreases in the level of glucose. These microdialysis variables showed only minor changes in the SACP group. There was a positive correlation between cerebral lactate and intracranial pressure during reperfusion in the DHCA group. However, the apoptosis index and C-FOS protein levels were lower in the SACP group.
Conclusion: Metabolic dysfunction is involved in the mechanism of cerebral injury. SACP is a superior neuroprotective strategy for both mild and prolonged DHCA.

3.Aortic ⍺-smooth muscle actin expressions in aortic disorders and coronary artery disease: An immunohistochemical study
Shi- Min Yuan, Ning Wu
doi: 10.14744/AnatolJCardiol.2017.7839  Pages 11 - 16
Objective: The is to report immunohistochemical observations of aortic ⍺-smooth muscle actin (SMA) expressions in patients with aortic aneurysm, acute aortic dissection, and coronary artery disease and to discuss phenotypic switching of smooth muscle cells (SMCs) of these lesions.
Methods: Forty-nine consecutive patients scheduled for surgical treatment for acute type A aortic dissection (20 patients), aortic aneurysm (9 patients), and coronary artery disease (20 patients) were included. Surgical specimens of the aorta were obtained and prepared for hematoxylin and eosin and immunohistochemical stainings.
Results: A comparison of aortic structural changes between the three groups showed that patients with coronary artery disease had the least severe aorta degeneration with the most intense ⍺-SMA positivity. Aortic structural impairment was the most severe in patients with aortic dissection, whereas ⍺-SMA positivity was more intense in patients with aortic dissection than in those with aortic aneurysm.
Conclusion: Disparities in ⍺-SMA expressions in the aortic tissues of the three groups represent the extent of SMC degenerations or a phenotypic switching between contractile and synthetic SMCs. The results imply severe SMC degenerations in patients with aortic aneurysm, which may be beneficial because of the production of extracellular matrix necessary for healing of the vascular wall, but severe disruptions in elastic fibers in patients with aortic dissection. Patients with coronary artery disease show slight SMC degeneration and phenotypic switching among the three groups. The possible apoptotic and genetic mechanisms of aortic structural impairments warrant further elaborations.

4.Smooth muscle phenotype in aortic diseases: Are there other histopathological markers besides contractile myofibrils?
Zbynek Tonar
doi: 10.14744/AnatolJCardiol.2017.25927  Pages 17 - 18
Abstract | Full Text PDF

5.Chronic ethanol increases calcium/calmodulin-dependent protein kinaseIIδ gene expression and decreases monoamine oxidase amount in rat heart muscles: Rescue effect of Zingiber officinale (ginger) extract
Elaheh Heshmati, Alireza Shirpoor, Fatemeh Kheradmand, Mohammad Alizadeh, Farzaneh Hosseini Gharalari
doi: 10.14744/AnatolJCardiol.2017.8079  Pages 19 - 26
Objective: Association between chronic alcohol intake and cardiac abnormality is well known; however, the precise underlying molecular mediators involved in ethanol-induced heart abnormalities remain elusive. This study investigated the effect of chronic ethanol exposure on calcium/calmodulin-dependent protein kinase IIδ (CaMKIIδ) gene expression and monoamine oxidase (MAO) levels and histological changes in rat heart. It was also planned to find out whether Zingiber officinale (ginger) extract mitigated the abnormalities induced by ethanol in rat heart.
Methods: Male wistar rats were divided into three groups of eight animals each: control, ethanol, and ginger extract treated-ethanol (GETE) groups.
Results: After 6 weeks of treatment, the results revealed a significant increase in CaMKIIδtotal and isoforms δ2 and δ3 of CaMKIIδ gene expression as well as a significant decrease in the MAO levels in the ethanol group compared to that in the control group. Moreover, compared to the control group, the ethanol group showed histological changes, such as fibrosis, heart muscle cells proliferation, myocyte hypertrophy, vacuolization, and focal lymphocytic infiltration. Consumption of ginger extract along with ethanol ameliorated CaMKIIδtotal. In addition, compared to the ethanol group, isoforms gene expression changed and increased the reduced MAO levels and mitigated heart structural changes.
Conclusion: These findings indicate that ethanol-induced heart abnormalities may, in part, be associated with Ca2+ homeostasis changes mediated by overexpression of CaMKIIδ gene and the decrease of MAO levels and that these effects can be alleviated by using ginger extract as an antioxidant and anti-inflammatory agent.

6.The value of real-time myocardial contrast echocardiography for detecting coronary microcirculation function in coronary artery disease patients
Lulu Sun, Zilong Wang, Tongda Xu, Defeng Pan, Li Liang, Ji Hao, Xiaoping Wang, Dongye Li
doi: 10.14744/AnatolJCardiol.2017.8041  Pages 27 - 33
Objective: The aim of this study was to evaluate the value of real-time myocardial contrast echocardiography (RT-MCE) for detecting coronary microcirculation (CM) function in coronary artery disease (CAD) patients.
Methods: Sixty-five consecutive patients were divided into CAD (n=52) and no-CAD (n=13) groups using coronary angiography (CAG). All patients underwent RT-MCE at rest and CAG within 1 week after RT-MCE. The ventricular segments in CAD patients were divided semi-quantitatively into ischemic and non-ischemic myocardial groups based on RT-MCE images. Myocardial blood volume (A), myocardial blood flow velocity (β), and mean myocardial blood flow (Aβ) were obtained. The Gensini scores were calculated for CAD patients. The receiver operating characteristic (ROC) curve areas of A, β, and Aβ were calculated to assess CM function in CAD patients.
Results: A total of 798 and 204 segments were investigated in the CAD and non-CAD groups, respectively. In CAD patients, 332 ischemic and 466 non-ischemic segments were identified. The values of A, β, and Aβ were significantly different among non-CAD, CAD, ischemic, and non-ischemic groups. ROC curve areas of A, β, and Aβ were 0.85, 0.79, and 0.83, respectively, and significant differences were observed in these values among three Gensini score groups of the CAD patients.
Conclusion: Varying degrees of CM function deterioration was observed in CAD patients both in ischemic and non-ischemic areas, with the deterioration being more sever in the former.

7.Association of Interleukin-1 Gene cluster polymorphisms with coronary slow flow phenomenon
Ferit Onur Mutluer, Dilek Ural, Barış Güngör, Osman Bolca, Tolga Aksu
doi: 10.14744/AnatolJCardiol.2017.8071  Pages 34 - 41
Objective: Coronary slow flow phenomenon (CSFP) is characterized by the decreased rate of contrast progression in epicardial coronary arte-ries in the absence of significant coronary stenosis. Mounting evidence has showed a significant association between inflammation and CSFP severity. This study aimed to evaluate possible associations between interleukin-1 receptor antagonist (IL-1ra) gene variable number tandem repeat (VNTR), IL-1β -511 single nucleotide (SNP), and IL-1β+3954 SNP mutations with CSFP.
Methods: Forty-eight patients with CSFP and 62 controls with angiographically normal coronary arteries were prospectively enrolled in the study. Genotypes were assessed using the polymerase chain reaction (PCR)-based restriction fragment length polymorphism (PCR-RFLP) technique.
Results: Homozygote genotype for allele 2 of+3954 C>T 2/2 genotype was significantly more frequent in patients with CSFP than in the control group, whereas 1/2 genotype was more frequent in the control group (35.4% versus 14.5% for 2/2 genotype and 25% versus 35.5% for 1/2 genotype in CSFP and control groups, respectively, X2=6.6; p=0.04). The allelic frequency of allele 2 of this polymorphism was significantly higher in the CSFP group than in the control group (47.9% versus 28.6% in the control group, X2=5.6; p=0.02). However, there was no significant difference with regard to genotype or allelic frequencies of IL-1ra VNTR or IL-1β -511 SNP polymorphisms between patients with CSFP and controls.
Conclusion: IL-1β+3954 SNP mutations are significantly more common in patients with CSFP. It may suggest that the tendency for inflammation may contribute to the presence of this phenomenon.

8.Impact of gender and age on the association of the BUD13-ZNF259 rs964184 polymorphism with coronary heart disease
Xiaofeng Xu, Yirun Li, Yi Huang, Huadan Ye, Liyuan Han, Huihui Ji, Xiaoyin Chen, Nan Wu, Danjie Jiang, Limin Xu, Dongjun Dai, Shiwei Duan, Xiaomin Chen
doi: 10.14744/AnatolJCardiol.2017.8002  Pages 42 - 49
Objective: Coronary heart disease (CHD) is the most common cause of death worldwide. This study aimed to validate the association of the rs964184 polymorphism with the CHD risk and included 874 CHD patients and 776 controls.
Methods: rs964184 polymorphism genotyping was performed using Tm-shift polymerase chain reaction.
Results: A strong association of the rs964184 polymorphism with CHD was found (genotype: X2=14.365, p=0.001; allele: X2=14.191, p=1.6710–4; power=0.965). Gender analysis revealed a significant association only in males (genotype: X2=12.387, p=0.002; allele: X2=12.404, p=4.3210–4; OR=1.467, 95% CI=1.185–1.817, power=0.945). Age and gender analyses revealed significant associations of the rs964184 polymorphism with CHD in males between the ages of 55 and 65 years (genotype: X2=10.070, p=0.007; allele: X2=10.077, p=0.002; OR=1.706, 95% CI=1.224–2.377, power=0.996) and in females older than 65 years (genotype: X2=9.462, p=0.009; allele: X2=9.560, p=0.002; OR=2.112, 95% CI=1.308–3.412, power=0.994). Further subgroup analysis suggested that rs964184 genotypes were significantly associated with TG levels in the patients (r=0.191, adjusted p=1.05 10–5) and controls (r=0.101, adjusted p=0.026).
Conclusion: Our results indicate that both gender and age have great impacts on the association of the rs964184 polymorphism with CHD among Chinese.

9.Assessment of the relationship between reperfusion success and T-peak to T-end interval in patients with ST elevation myocardial infarction treated with percutaneous coronary intervention
Metin Çağdaş, Süleyman Karakoyun, Ibrahim Rencüzoğulları, Yavuz Karabağ, Mahmut Yesin, Yalçın Velibey, Inanç Artaç, Doğan Iliş, Süleyman Çağan Efe, Onur Taşar, Halil Ibrahim Tanboğa
doi: 10.14744/AnatolJCardiol.2017.7949  Pages 50 - 57
Objective: T-peak–T-end (TPE) interval, which represents the dispersion of repolarization, is defined as the interval between the peak and end of the T-wave, and is associated with increased malignant ventricular arrhythmia and sudden cardiac death (SCD) in patients with ST elevation myocardial infarction (STEMI). Although prolonged TPE interval is associated with poor short- and long-term outcomes, even in patients with STEMI treated with successful primary percutaneous coronary intervention (pPCI), clinical, angiographic, and laboratory parameters that affect TPE remain to be elucidated. The aim of our study was to evaluate the potential relationship between prolonged TPE interval and reperfusion success using ST segment resolution (STR) in patients with STEMI undergoing pPCI.
Methods: In the current study, 218 consecutive patients with STEMI who underwent pPCI were enrolled; after exclusion, 164 patients were included in the study population.
Results: Patients were divided into two groups according to the presence of complete (STR%≥70) or incomplete (STR%<70) STR. Preprocedural corrected TPE (cTPEPRE;116±21 ms vs. 108±21 ms; p=0.027), postprocedural TPE (TPEPOST; 107±16 ms vs. 92±21 ms; p<0.001), and postprocedural cTPE (cTPEPOST; 119±19 ms vs. 102±17 ms; p<0.001) intervals were significantly longer in patients with incomplete STR than in patients with complete STR, whereas there was no statistically significant difference between the two groups in terms of pre- and postprocedural and corrected QT intervals. cTPEPRE and cTPEPOST were found to be independent predictors for incomplete STR.
Conclusion: To our knowledge, this is the first study that evaluated the relationship between TPE interval and no-reflow defined by STR in patients with STEMI who were treated with pPCI.

10.Subclinical reduction in left ventricular function using triplane and 2D speckle tracking echocardiography after anthracycline exposure in children
Erman Çilsal, Ayşe Deniz Oğuz, Fatma Sedef Tunaoğlu, Serdar Kula, Ayhan Pektaş
doi: 10.14744/AnatolJCardiol.2017.7944  Pages 58 - 66
Objective: Speckle tracking echocardiography (STE) enables global and regional evaluation of the left ventricle (LV); therefore, it is the most useful method for detecting subclinical dysfunction in patients exposed to cardiotoxic agents. A novel technique triplane (3P) echocardiography also allows single beat assessment of LV global longitudinal strain values. We firstly aimed to demonstrate both two-dimensional (2D)- and 3P-STE-derived LV global longitudinal strain measurements in children after anthracycline exposure.
Methods: This study included 23 cross-sectionally enrolled asymptomatic pediatric cancer patients who received anthracycline chemotherapy and 17 healthy controls matched by age, gender, and body surface area. All subjects underwent detailed 2D, Doppler, 2D-STE, and 3P-STE for assessment of LV function. The patients had received a median cumulative dose of 150 mg/m2.
Results: 1. From “Pulsed” Doppler-based measurements, only pulmonary vein flow ratio showed a significant difference between the groups. 2. When measurements were taken from the interventricular septum, the patients’ ejection time values decreased significantly and their myocardial performance index values increased significantly; when the measurements were taken from the LV free wall, the peak systolic velocities showed a statistically significant difference. 3. Both 2D- and 3P-STE-derived longitudinal myocardial deformation values of LV were lower in the patient group. 4. 2D-STE-derived LV circumferential strain values were decreased in the patient group, whereas radial strain values were not significantly different compared with matched controls.
Conclusion: Using Doppler and 2D- and 3P-STE methods, this study confirmed the subclinical LV dysfunction in patients after anthracycline exposure.

11.Efficacy and safety of oral anticoagulation in elderly patients with atrial fibrillation
Ilaria Cavallari, Giuseppe Patti
doi: 10.14744/AnatolJCardiol.2017.8256  Pages 67 - 71
Elderly patients with atrial fibrillation are at a higher risk of both ischemic and bleeding events compared with younger patients; therefore, balancing risks and benefits of antithrombotic strategies in this population is crucial. Recent studies have shown that because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of oral anticoagulation is the highest in elderly patients in whom it outweighs the risk of bleeding. Direct oral anticoagulants (DOACs) have been developed as a treatment for the prevention of cardioembolic stroke to overcome some limitations of warfarin, such as the need for frequent monitoring, labile INR values requiring frequent dose adjustment, dietary and drugs interactions, and increased risk of intracranial bleeding. Despite the better safety profiles of DOACs compared with warfarin, elderly patients often remain undertreated because of the fear of bleeding complications. This review summarizes current evidence regarding the risks of thromboembolisms and bleeding in different antithrombotic strategies in elderly patients (aged ≥75 years) with atrial fibrillation, including data from the warfarin-controlled phase 3 DOACs trials.

12.A case of asymptomatic large aortopulmonary window in an adult: Role of cardiac CT, CMRI, and 3D printing technology
Aniketh Vijay Balegadde, Vikrant Vijan, Rajesh Thachathodiyl, Mahesh Kappanayil
doi: 10.14744/AnatolJCardiol.2017.7948  Pages 72 - 74
Abstract | Full Text PDF

13.Valve-sparing aortic root replacement in Loeys-Dietz syndrome and a novel mutation in TGFBR2
Taner Kasar, Alper Gezdirici, Pelin Ayyıldız, Sertaç Haydin, Alper Güzeltaş
doi: 10.14744/AnatolJCardiol.2017.7911  Pages 74 - 77
Abstract | Full Text PDF

14.A sad story of a man with two ventricles
Yavuzer Koza, Uğur Kaya, Hakan Taş, Esma Ateş
doi: 10.14744/AnatolJCardiol.2017.8207  Page 78
Abstract | Full Text PDF

15.Tolvaptan should be used very carefully in very elderly patients
Fatih Kahraman, Ahmet Seyda Yılmaz
doi: 10.14744/AnatolJCardiol.2017.8195  Page 79
Abstract | Full Text PDF

16.Author`s Reply
Hiroki Niikura, Raisuke Iijima
Pages 79 - 80
Abstract | Full Text PDF

17.Simultaneous subacute thrombosis in two new-generation drug-eluting stents in different vessels
Duygu Ersan Demirci, Deniz Demirci, Şakir Arslan
doi: 10.14744/AnatolJCardiol.2017.8092  Pages 80 - 81
Abstract | Full Text PDF

18.Short-term evolution of cardiac structure and function in patients on maintenance hemodialysis for end-stage renal disease: A quasi-experimental, non-randomized, evaluation echocardiography study in Cameroon, sub-Saharan Africa
Ba Hamadou, Ingrid Balemaken, Jérôme Boombhi, Félicité Kamdem, Sylvie Ndongo Amougou, Liliane Kuate Mfeukeu, Chris Nadège Nganou, Alain Menanga, Gloria Ashuntantang
doi: 10.14744/AnatolJCardiol.2017.8168  Pages 81 - 82
Abstract | Full Text PDF

19.A case of acute intrastent thrombosis accompanied by arterial thrombosis in the lower extremities after percutaneous coronary intervention
Mao- Xiao Nie, Quan- Ming Zhao
doi: 10.14744/AnatolJCardiol.2017.8107  Pages 82 - 83
Abstract | Full Text PDF

20.A sad story of a man with two ventricles
Yavuzer Koza, Uğur Kaya, Hakan Taş, Esma Ateş
Page 84
Abstract | Full Text PDF | Video

21.Unusual combination of mitral valve prolapse, bicuspid aortic valve, and ventricular septal defect restricted by the tricuspid septal leaflet
Umut Kocabaş, Esra Kaya, Cahide Soydaş Çınar
doi: 10.14744/AnatolJCardiol.2017.8238  Page E1
Abstract | Full Text PDF

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