The Anatolian Journal of Cardiology

Anatol J Cardiol: 16 (1)
Cilt: 16  Sayı: 1 - Ocak 2016
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Zeki Öngen
PMID: 26854671  PMCID: PMC5336697  doi: 10.14744/AnatolJCardiol.2015.01  Sayfa 1
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Protective effects of methotrexate against ischemic cardiovascular disorders in patients treated for rheumatoid arthritis or psoriasis: novel therapeutic insights coming from a meta-analysis of the literature data
Renato De Vecchis, Cesare Baldi, Leonardo Palmisani
PMID: 26467356  PMCID: PMC5336700  doi: 10.5152/akd.2015.6136  Sayfalar 2 - 9
Objective: The association between chronic use of methotrexate and decreased risk of ischemic cardiovascular events (CVE) among patients with psoriatic or rheumatoid arthritis (RA) was investigated using a systematic review and meta-analysis.
Methods: The studies should have recruited adults receiving methotrexate, followed up for at least one year. Moreover, studies should have reported "hard" cardiovascular endpoints, by evaluating the cardiovascular outcomes of the habitual users of the drug or of new users compared with patients with the same disease who had never used methotrexate. The outcome of interest was the overall pooled odds ratio (OR) of major adverse cardiovascular events, i.e., a composite of new- onset angina, acute coronary syndrome, need for percutaneous or surgical coronary revascularization, stroke, and cardiovascular death. The study was performed according to the PRISMA statement.
Results: Seven observational studies, mostly engaging patients with RA, were included in the meta-analysis. The pooled odds ratio (OR) was 0.73 (95% CI=0.70- 0.77 p<0.001). When stratified meta-analysis models were assessed, the pooled OR was 0.80 (95% CI=0.66-0.97; p=0.022) for studies adjusting for clinical severity of RA. Furthermore, the OR was even more significant after adjustment for concomitant use of other drugs specific for RA (OR=0.71, 95% CI=0.67-0.75, p<0.001).
Conclusion: Methotrexate at low doses, such those used for maintenance therapy of RA, predicted a decreased risk of CVE. Since methotrexate doesn’t interfere with blood lipids, platelet aggregation or insulin resistance, the protective association may originate from mechanisms other than those exerted by antiplatelet drugs or statins.

Admission serum potassium level is associated with in-hospital and long-term mortality in ST-elevation myocardial infarction
Mahmut Uluganyan, Ahmet Ekmekçi, Ahmet Murat, Şahin Avşar, Türker Kemal Ulutaş, Hüseyin Uyarel, Mehmet Bozbay, Gökhan Çiçek, Gürkan Karaca, Mehmet Eren
PMID: 26467357  PMCID: PMC5336698  doi: 10.5152/akd.2015.5706  Sayfalar 10 - 15
Objective: Current guidelines recommend a serum potassium (sK) level of 4.0-5.0 mmol/L in acute myocardial infarction patients. Recent trials have demonstrated an increased mortality rate with an sK level of >4.5 mmol/L. The aim of this study was to figure out the relation between admission sK level and in-hospital and long-term mortality and ventricular arrhythmias.
Methods: Retrospectively, 611 patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention were recruited. Admission sK levels were categorized accordingly: <3.5, 3.5-<4, 4-<4.5, 4.5-<5, and ≥5 mmol/L.
Results: The lowest in-hospital and long-term mortality occurred in patients with sK levels of 3.5 to <4 mmol/L. The long-term mortality risk increased for admission sK levels of >4.5 mmol/L [odds ratio (OR), 1.58; 95% confidence interval (CI) 0.42–5.9 and OR, 2.27; 95% CI 0.44-11.5 for sK levels of 4.5-<5 mmol/L and ≥5 mmol/L, respectively]. At sK levels <3 mmol/L and ≥5 mmol/L, the incidence of ventricular arrhythmias was higher (p=0.019).
Conclusion: Admission sK level of >4.5 mmol/L was associated with increased long-term mortality in STEMI. A significant relation was found between sK level of <3 mmol/L and ≥5 mmol/L and ventricular arrhythmias.

Comparison of the effects of metoprolol or carvedilol on serum gamma-glutamyltransferase and uric acid levels among patients with acute coronary syndrome without ST segment elevation
Lütfü Aşkın, Şule Karakelleoğlu, Hüsnü Değirmenci, Selami Demirelli, Ziya Şimşek, Muhammed Hakan Taş, Selim Topçu, Zakir Lazoğlu
PMID: 26467358  PMCID: PMC5336699  doi: 10.5152/akd.2015.5708  Sayfalar 16 - 22
Objective: Serum gamma-glutamyltransferase (GGT) and uric acid levels measured in patients with acute coronary syndrome without ST segment elevation (NSTEMI) are important in diagnosis and in predicting the prognosis of the disease. There is a limited number of clinical studies investigating the effects of beta-blockers on GGT and uric acid levels in these patients. In our study, we aimed to investigate the effects of beta-blocker therapy on GGT and uric acid levels.
Methods: We conducted a randomized, prospective clinical study. Hundred patients with NSTEMI were included in this study, and they were divided into two groups. Fifty patients were administered metoprolol succinate treatment (1 x 50 mg), whereas the remaining 50 patients were administered carvedilol treatment (2 x 12.5 mg). Thereafter, all of the patients underwent coronary angiography. Blood samples were taken at the time of admission, at the 1st month, and 3rd month to detect GGT and uric acid levels.
Results: There was no statistically significant difference among the metoprolol or carvedilol groups in terms of the GGT levels measured at the baseline, 1st month, and 3rd month (p=0.904 and p=0.573, respectively). In addition, there was no statistically significant difference among the metoprolol or carvedilol groups in terms of uric acid levels measured at the baseline, 1st month, and 3rd month (p=0.601 and p=0.601, respectively).
Conclusion: We found that GGT and uric acid levels did not show any change compared to the baseline values, with metoprolol and carvedilol treatment initiated in the early period in patients with NSTEMI.

Neutrophil serine proteases and their endogenous inhibitors in coronary artery ectasia patients
Ruifeng Liu, Lianfeng Chen, Wei Wu, Houzao Chen, Shuyang Zhang
PMID: 26467359  PMCID: PMC5336701  doi: 10.5152/akd.2015.6072  Sayfalar 23 - 28
Objective: Proteolytic enzymes possibly contribute to coronary artery ectasia (CAE). This study aimed to determine whether neutrophils, neutrophil serine proteases (NSPs), and their endogenous inhibitors participated in the pathological process of CAE.
Methods: The study consisted of 30 patients with CAE, 30 patients with coronary artery disease (CAD), and 29 subjects with normal coronary arteries (Control). The following circulating items were measured: the main NSPs, including human neutrophil elastase (HNE), cathepsin G (CG), and proteinase 3 (PR3); soluble elastin (sElastin), which was a degradation product of elastin fibres; NSP inhibitors such as α1-protease inhibitor (α1-PI), α2-macroglobulin (α2-MG), secretory leucoprotease inhibitor (SLPI), and elafin; as well as two neutrophil activation markers (myeloperoxidase and lactoferrin) and three classic neutrophil activators [tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), and bacterial endotoxin].
Results: The levels of HNE, CG, and sElastin were elevated in the CAE group. The levels of α1-PI and α2-MG were also significantly increased in the CAE group. The levels of myeloperoxidase and lactoferrin were higher in the CAE group. The levels of TNF-α, IL-8, and endotoxin were unchanged in the CAE group compared with those in the CAD group.
Conclusion: Neutrophils may participate in the process of vessel extracellular matrix destruction and coronary ectasia by releasing NSPs in a non-classical manner.

Assessment of the neutrophil/lymphocyte ratio in patients with supraventricular tachycardia
Mesut Aydın, Abdülkadir Yıldız, Murat Yüksel, Nihat Polat, Adem Aktan, Yahya İslamoğlu
PMID: 26467360  PMCID: PMC5336702  doi: 10.5152/akd.2015.5927  Sayfalar 29 - 33
Objective: The neutrophil/lymphocyte ratio (NLR) has been evaluated as a new predictor of cardiovascular risk. Inflammation has been shown to be associated with various arrhythmias including supraventricular tachycardias (SVTs). In this study, we aimed to investigate the relation between NLR and SVT in patients with a documented atrial tachyarrhythmia.
Methods: The study used a retrospective cross-sectional design. Patients who had SVT but were otherwise healthy were included. The exclusion criteria included drug use (except antiarrhythmic agents), morbid obesity, acute or chronic infection, inflammatory diseases, systemic diseases, and cancer. Total and differential leukocyte counts and routine biochemical tests were performed before the ablation procedure.
Results: The study included 150 patients with SVT and 98 healthy controls. The biochemical and hematological parameters were comparable between the groups, except neutrophil and lymphocyte counts. The neutrophil count was significantly higher (4.7±1.5x103/μL versus 4.1±1.0x103/μL; p<0.001) and lymphocyte count was significantly lower (2.2±0.6x103/μL versus 2.5±0.6x103/μL; p=0.001) in the SVT group than in the control group. As a result, the SVT group had significantly higher NLR values than the control group (2.2±0.9 versus 1.7±0.5; p<0.001). In addition, NLR values were higher in patients in whom tachycardia was induced during an electrophysiological study (EPS) (2.3±0.9 versus 2.0±0.8; p=0.02). The association between NLR and SVT remained significant after multivariate analysis (odds ratio: 1.5, 95% confidence interval: 1.001-2.263, p=0.049).
Conclusion: Our study indicated that NLR values were significantly higher in patients with documented SVT than in control subjects. Inducibility of SVT during EPS was associated with higher NLR values.

Assessment of left atrial appendage function during sinus rhythm in patients with obstructive sleep apnea
Mustafa Gökhan Vural, Süha Çetin, Hüseyin Gündüz, Özge Özcan Abacıoğlu, Ramazan Akdemir, Hikmet Fırat, Ekrem Yeter
PMID: 26467361  PMCID: PMC5336703  doi: 10.5152/akd.2015.5751  Sayfalar 34 - 41
Objective: Obstructive sleep apnea (OSA) is associated with thromboembolic events. Compromised left atrial appendage (LAA) function due to left ventricular (LV) performance abnormality, often present in patients with OSA, may play an important role. The purpose of this study is to evaluate LV and LAA mechanical functions during sinus rhythm (SR) in patients with OSA.
Methods: LV and LAA functions were assessed in 43 OSA patients and compared with that of 20 control patients in SR. Tissue Doppler velocities of the LAA apex and emptying velocities (EV) of LAA were obtained on parasternal short-axis view.
Results: The baseline clinical characteristics were similar except for AHI (apnea-hypopnea index), minimal SaO2, mean SaO2, hypertension, and body-surface area. Most of the LV echocardiographic parameters significantly deteriorated in OSA patients in comparison with those in the control group. LAA EV, LAA systolic relaxation velocity (SM), LAA early-diastolic velocity (EM), LAA contraction velocity (AM), left atrial (LA) minimum volume index, LA ejection fraction, LA conduit volume index, and LA reservoir volume index were lower in OSA patients compared with those in the control group (p<0.05). LAA AM was negatively correlated with AHI and the ratio of peak early diastolic flow velocity (E) to early-diastolic (E′) and positively correlated with LA conduit volume (p<0.05). Multiple predictors for LAA AM were AHI, presence of diastolic dysfunction, and E/E′ values (p<0.05).
Conclusion: LAA mechanical function is significantly depressed in patients with OSA and SR. LAA dysfunction may predispose these patients to thromboembolic events. The evaluation of LAA mechanical function by tissue Doppler study using transthoracic echocardiography (TTE) may become an alternative for routine work-up in OSA patients.

Assessment of left atrial volume and mechanical functions using realtime three-dimensional echocardiography in patients with mitral annular calcification
Adil Bayramoğlu, Hakan Taşolar, Yılmaz Ömür Otlu, Şıho Hidayet, Fuat Kurt, Adil Doğan, Hasan Pekdemir
PMID: 26467362  PMCID: PMC5336704  doi: 10.5152/akd.2015.5897  Sayfalar 42 - 47
Objective: Mitral annular calcification (MAC) is degeneration of the fibrous annular ring of the mitral valve. Left atrial (LA) function and volume have been evaluated by many methods; however, none have used real-time three-dimensional echocardiography (RT3DE) in patients with MAC. Our study is the first to evaluate LA volume and mechanical function using RT3DE in patients with MAC.
Methods: Our study was a prospective cross-sectional study. In total, 32 patients with echocardiographic evidence of MAC and 30 volunteers without MAC were enrolled in the study. Kolmogorov–Smirnov test, Student’s t-test, Mann-Whitney U test, chi-square test, Pearson’s correlation test, and multiple linear regression analyses were used in this study.
Results: LA diameter was significantly higher in patients with MAC (38.5±3.8 vs. 31.1±2.9, p<0.001). Maximum LA volume (49.6±11.2 vs. 35.6±2.5, p<0.001), minimum LA volume (23.8±7.9 vs. 12.6±2.3, p<0.001), and LA volume index (LAVI) (26.9±6.1 vs. 20.5±2.4, p<0.001) were also higher in the MAC group. LAVI was correlated with age (p<0.001), blood urea nitrogen levels (p=0.089), total cholesterol levels (p=0.055), left ventricular systolic myocardial velocity (p=0.048), E/A ratio (p<0.001), and MAC (p<0.001). Multiple linear regression analyses revealed that age (β=0.390, p<0.001) and MAC (β=0.527, p<0.001) were independent predictors of LAVI.
Conclusion: We found that LA mechanical function was impaired in patients with MAC. Furthermore, age and MAC were independent predictors of increased LAVI according to our RT3DE examination.

Assessment of the effects of frequent ventricular extrasystoles on the left ventricle using speckle tracking echocardiography in apparently normal hearts
Ahmet Barutçu, Adem Bekler, Ahmet Temiz, Bahadır Kırılmaz, Emine Gazi, Burak Altun, Semra Özdemir, Feyza Ulusoy Aksu
PMID: 26467363  PMCID: PMC5336705  doi: 10.5152/akd.2015.6166  Sayfalar 48 - 54
Objective: Impairment in left ventricular (LV) function due to excessive ventricular extrasystoles (VESs) occurs during long-time follow-up. Speckle tracking echocardiography (STE) has been shown to be superior to conventional methods for evaluating cardiac functions. We aimed to use STE for early detection of LV dysfunction in patients with apparently normal hearts who have frequent VESs.
Methods: Fifty-five patients with frequent VESs were identified according to the Lown classification (Grade 2; unifocal more than 30 times in 1 h). Subjects aged 22-60 years with frequent VESs that had been detected for at least 1 year were included in the study according to the inclusion criteria. Forty-five subjects with similar demographic characteristics, but without VESs, were included as the control group. All participants were evaluated by STE.
Results: Fifty-five patients with frequent VESs (mean age 47 years, range 22-60 years; 42.2% male) and 45 control subjects (mean age 46 years, range 22–60 years; 37.8% male) were enrolled in the study. Global LV longitudinal strain (GLS) was decreased in patients with frequent VESs (-18.41±3.37 and -21.82±2.43; p<0.001). In addition, global LV circumferential strain was decreased in patients with frequent VESs (-16.83±6.06, -20.51±6.02; p<0.001). The frequency and exposure time of VESs were negatively correlated with GLS (r=-0.398, p<0.001; r=-0.191, p=0.001, respectively).
Conclusion: STE revealed that LV functions were decreased in patients with VESs. This deterioration increased with the frequency and exposure time of VESs. Impairment of LV function due to excessive VESs occurs during long-time follow-up. STE may be used for early detection of LV dysfunction.

Evaluation of myocardial function in pediatric patients with transposition of great arteries after arterial switch operation
Taliha Öner, Rahmi Özdemir, Barış Güven, Murat Muhtar Yılmazer, Önder Doksöz, Timur Meşe, Vedide Tavlı
PMID: 26467364  PMCID: PMC5336706  doi: 10.5152/akd.2015.5692  Sayfalar 55 - 61
Objective: An arterial switch operation converts the left ventricle (LV) into the systemic ventricle, replacing the right ventricle (RV), which is the systemic ventricle during the prenatal period. The procedure is performed in patients with arterial transposition and those in whom a coronary reimplantation procedure is performed. Therefore, the adaptation of LV and RV to the arterial switch operations is an interesting issue. This study aimed to evaluate systolic and diastolic functions in the LV and RV myocardium using echocardiography in pediatric patients with transposed great arteries after an arterial switch operation.
Methods: This observational case control study included 28 patients and 20 gender-and age-matched healthy controls. A group study was performed using patients who were followed for at least 6 months after the operation and who visited the pediatric cardiology outpatient between October 2009 and May 2011. Systolic and diastolic parameters, LV and RV myocardial performance index (MPI) values, and left atrium (LA) volume index were assessed in both groups.
Results: The LV MPI and tricuspid valve (TV) E/Ea ratio measured using pulsed-wave Doppler were higher in the patient group than in the control group. The TV E/A ratio and late velocity of lateral mitral annulus (Aa) and systolic velocity (Sa)-early diastolic velocity (Ea)-late velocity (Aa) of the septal mitral annulus and systolic velocity (Sa)-early diastolic velocity (Ea)-late velocity (Aa) of the lateral tricuspid annulus were lower in the patient group than in the control group.
Conclusion: Considering the present study’s findings obtained during short-to mid-term follow-up, the RV tissue Doppler flows and the LV MPI were found impaired.

Evaluation of myocardial function in pediatric patients with the transposition of great arteries after arterial switch operation
Efstathios D. Pagourelias, Christodoulos E. Papadopoulos
PMID: 26645267  PMCID: PMC5336707  doi: 10.5152/akd.2015.16406  Sayfa 62
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Huge thrombus formation 1 year after percutaneous closure of an atrial septal defect with an Amplatzer septal occluder
Fahrettin Uysal, Özlem Mehtap Bostan, Işık Şenkaya Sığnak, Mustafa Güneş, Ergün Çil
PMID: 26854672  PMCID: PMC5336708  doi: 10.14744/AnatolJCardiol.2015.6538  Sayfalar 63 - 64
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Treatment of pulmonary hypertension in three patients with β-thalassemia intermedia using pulmonary arterial hypertension-specific medications
Demet Menekşe Gerede, Aynur Acıbuca, Tamer Sayın, Çetin Erol
PMID: 26854673  PMCID: PMC5336709  doi: 10.14744/AnatolJCardiol.2015.6624  Sayfalar 64 - 66
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Spontaneous pneumopericardium in a pregnant woman
Adil Bayramoğlu, Zeki Yüksel Günaydın, Osman Bektaş, Ahmet Karagöz, Yılmaz Ömürotlu
PMID: 26854674  PMCID: PMC5336710  doi: 10.14744/AnatolJCardiol.2015.6722  Sayfalar 66 - 67
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Mercury overexposure and atrial fibrillation
Gianpaolo Guzzi, Anna Ronchi, Paolo D. Pigatto
PMID: 26854675  PMCID: PMC5336711  doi: 10.14744/AnatolJCardiol.2015.6766  Sayfa 68
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Nonthyroidal illness syndrome in offpump coronary artery bypass surgery
Barçın Özcem
PMID: 26854677  PMCID: PMC5336713  doi: 10.14744/AnatolJCardiol.2015.6787  Sayfa 69
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Author`s Reply
Selma Caluk, Jasmin Caluk
PMID: 26854678  PMCID: PMC5336714  Sayfalar 69 - 70
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Renal dysfunction as a marker of increased mortality in patients with pulmonary thromboembolism
Dan Octavian Nistor, Voichita Sîrbu, Galafteon Oltean, Mihaela Opriş
PMID: 26854679  PMCID: PMC5336715  doi: 10.14744/AnatolJCardiol.2015.6828  Sayfa 70
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Author`s Reply
Anca Ouatu, Mariana Floria, Catalina Arsenescu Georgescu
PMID: 26854680  PMCID: PMC5336716  Sayfa 71
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Coronary slow flow: Benign or ominous?
Mohammed Omer Anwar, Yasser Al Omran
PMID: 26854681  PMCID: PMC5336717  doi: 10.14744/AnatolJCardiol.2015.6777  Sayfalar 71 - 72
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Author`s Reply
Tahereh Saedi, Mohammad Ali Sadrameli, Sedigheh Saedi
PMID: 26854682  PMCID: PMC5336718  Sayfalar 72 - 73
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In stent restenosis after percutaneous coronary intervention
Mehmet Eyüboğlu
PMID: 26854683  PMCID: PMC5336719  doi: 10.14744/AnatolJCardiol.2015.6775  Sayfa 73
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Author`s Reply
Wenwei Liu
PMID: 26854684  PMCID: PMC5336720  Sayfalar 73 - 74
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Frequency of emergencies in adults due to unrecognized coarctation of the aorta
Radka Hazuková, Eva Cermáková, Miloslav Pleskot
PMID: 26854685  PMCID: PMC5336721  doi: 10.14744/AnatolJCardiol.2015.6817  Sayfa 74
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