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The Anatolian Journal of Cardiology

Anatol J Cardiol: 16 (10)
Cilt: 16  Sayı: 10 - Ekim 2016
Özetleri Gizle | << Geri
EDITORIAL
1.
Rome and ESC 2016
Zeki Öngen
PMID: 27723674  PMCID: PMC5324931  doi: 10.14744/AnatolJCardiol.2016.10  Sayfa 733
Makale Özeti | Tam Metin PDF

HOT TOPIC
2.
ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in non-valvular atrial fibrillation (RAMSES study)
Özcan Başaran, Osman Beton, Volkan Doğan, Mehmet Tekinalp, Ahmet Çağrı Aykan, Ezgi Kalaycıoğlu, İsmail Bolat, Onur Taşar, Özgen Şafak, Macit Kalçık, Mehmet Yaman, İbrahim Altun, Mustafa Özcan Soylu, Cevat Kırma, Murat Biteker
PMID: 27723665  PMCID: PMC5324932  doi: 10.14744/AnatolJCardiol.2016.6752  Sayfalar 734 - 741
Objective: Data regarding stroke prevention strategies in non-valvular atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs). This study aimed to evaluate real-life stroke prevention strategies for NVAF patients in the era of non-VKA oral anticoagulants (NOACs).
Methods: We established a cross-sectional, multicenter, nationwide registry of NVAF patients. All consecutive atrial fibrillation (AF) patients and without mechanical heart valves or rheumatic mitral stenosis (but including those with any degree of mitral regurgitation) were enrolled in the ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study; ClinicalTrials.gov identifier NCT02344901) in Turkey. Baseline demographic data, medical history, and medications prescribed for NVAF treatment were collected. Univariate analyses were performed for continuous variables, and the chi-square test was used for categorical variables.
Results: In total, 6273 patients from 29 provinces of Turkey were enrolled in the study between February and May 2015, with the contribution of 83 investigators. The mean age was 69.6±10.7 years; 56% of the patients were females, and one-fifth of the patients had at least one comorbid disease, the most common being hypertension (69%). The mean CHA2DS2–VASc and HAS-BLED scores were 3.3±1.6 and 1.6±1.1, respectively. The rate of oral anticoagulant (OAC) therapy use was 72% (37% NOAC and 35% VKA).
Conclusion: The RAMSES study showed a higher prevalence of OAC use among NVAF patients than that reported in previous studies. Although NOACs were preferred over VKAs in daily cardiology practice, there is a need for improved OAC therapies for NVAF patients. (Anatol J Cardiol 2016; 16: 734-41)

ORIGINAL INVESTIGATION
3.
CHA2DS2-VASc-HS score in non-ST elevation acute coronary syndrome patients: assessment of coronary artery disease severity and complexity and comparison to other scoring systems in the prediction of in-hospital major adverse cardiovascular events
Hakan Taşolar, Mustafa Çetin, Mehmet Ballı, Adil Bayramoğlu, Yılmaz Ömür Otlu, Serdar Türkmen, Erdal Aktürk
PMID: 27025198  PMCID: PMC5324933  doi: 10.14744/AnatolJCardiol.2015.6593  Sayfalar 742 - 748
Objective: We recently described the CHA2DS2-VASc-HS score as a novel predictor of coronary artery disease (CAD) severity in stable CAD patients. We aimed to assess the accuracy of the CHA2DS2-VASc-HS score in the determination of CAD severity and complexity and its availability in the risk stratification of in-hospital major adverse cardiovascular events (MACE) in non-ST elevation acute coronary syndrome (NSTE-ACS) patients.
Methods: We prospectively analyzed the clinical and angiographic data of consecutive NSTE-ACS patients in our clinic. Patients were classified into three tertiles according to their SYNTAX score (SS): tertile 1 had an SS of 0–22; tertile 2 had an SS of 23–32; and tertile 3 had an SS of >32. There were no specific exclusion criteria except for previous coronary artery bypass grafting (CABG) because SS was validated for only native coronary arteries for this study. We used the following analyses: χ2 or Fisher’s exact tests, one-way analysis of variance or Kruskal–Wallis tests, Pearson’s or Spearman’s tests, the receiver operating characteristics (ROC) curve analysis, the area under the curve (AUC) or C-statistic, and pairwise comparisons of the ROC curves.
Results: A total of 252 patients were enrolled. There were 131 patients in tertile 1, 79 in tertile 2, and 42 in tertile 3. The number of diseased vessels was correlated with the Global Registry for Acute Coronary Events (GRACE) (p<0.001), Thrombolysis in Myocardial Infarction (TIMI) (p<0.001), and CHA2DS2-VASc-HS (p<0.001) scores. In the ROC curve analyses, the cut-off value of the CHA2DS2-VASc-HS score in the prediction of in-hospital MACE was >5 with a sensitivity of 69.6% and specificity of 90.3% (AUC: 0.804, 95%: CI 0.750–0.851, p<0.001). We also compared the diagnostic accuracy of the CHA2DS2-VASc-HS score with the TIMI and GRACE risk scores in the determination of the in-hospital MACE and found no differences.
Conclusion: The CHA2DS2-VASc-HS score was positively correlated with the severity and complexity of CAD. We also found that CHA2DS2-VASc-HS was comparable with other risk scores for the risk stratification of the in-hospital MACE of NSTE-ACS patients. Therefore, it may play an important role as a predictive model of NSTE-ACS patients in clinical practice. (Anatol J Cardiol 2016; 16: 742-8)

4.
Chemerin is not associated with subclinical atherosclerosis markers in prediabetes and diabetes
Kadriye Aydın, Uğur Canpolat, Şafak Akın, Muhammet Dural, Jale Karakaya, Kudret Aytemir, Necla Özer, Alper Gürlek
PMID: 27271473  PMCID: PMC5324934  doi: 10.5152/AnatolJCardiol.2015.6629  Sayfalar 749 - 755
Objective: Chemerin is a novel adipokine that is correlated with adipocyte differentiation, glucose metabolism, and inflammation. We aimed to investigate the relation between serum chemerin level and subclinical atherosclerosis markers as exemplified by brachial artery pulse wave velocity (baPWV), carotid intima–media thickness (CIMT), epicardial fat thickness (EFT), and carotid plaque presence in diabetes and prediabetes.
Methods: Age-, body mass index (BMI)-, and gender-matched patients with type 2 DM (n=30), prediabetes (n=25), and normal glucose tolerance (n=25) were included in this cross-sectional study. Serum chemerin level, lipid parameters, glucose metabolism marker, baPWV, CIMT, EFT, and anthropometric were recorded. The independent risk factors for atherosclerosis markers were determined by linear and/or multiple logistic regression analysis.
Results: baPWV and carotid plaque presence were higher in the diabetes group than in prediabetes and control groups (p=0.039 and p=0.035 respectively), whereas serum chemerin levels were similar among groups (p=0.338). Chemerin levels were not correlated with PWV, CIMT, and epicardial fat thickness overall or in the subgroups. Overall and in the diabetes group, chemerin levels were positively correlated with the key components of metabolic syndrome as BMI, total body fat percentage, waist circumference, triglyceride, and systolic and diastolic blood pressure (BP). After adjusting for age, gender, and BMI, only the association between chemerin and systolic BP remained significant. Chemerin was not found as an independent risk factor for predicting atherosclerosis in diabetes and prediabetes.
Conclusion: Chemerin is not a predictive marker for atherosclerosis in diabetes and prediabetes, but correlates well with key aspects of the metabolic syndrome particularly in diabetes. (Anatol J Cardiol 2016; 16: 749-55)

5.
Serum cystatin C and neutrophil gelatinase-associated lipocalin in predicting the severity of coronary artery disease in diabetic patients
Kaan Okyay, Aylin Yıldırır, Mutlu Çiçek, Alp Aydınalp, Haldun Müderrisoğlu
PMID: 27182610  PMCID: PMC5324935  doi: 10.5152/AnatolJCardiol.2015.6645  Sayfalar 756 - 761
Objective: Cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) are biomarkers of renal functions. We evaluated their roles in predicting the severity of coronary artery disease (CAD).
Methods: Fifty-two consecutive type 2 diabetic patients (32 males, 65.7±8.6 years) who underwent coronary angiography (CAG) for stable CAD were included in this single-center, prospective, cross-sectional study. Patients with an estimated glomerular filtration rate <60 mL/min/1.73 m2 and with a history of by-pass surgery and/or coronary stent implantation were excluded. The vessel score and Gensini score were calculated to assess the presence and severity of CAD. Mann–Whitney U test, Spearman test, and multiple linear regression analysis were used for the main statistical analyses.
Results: Serum cystatin C levels were higher in patients with multivessel disease than in those with single vessel disease [1260 ng/mL (953–1640) vs. 977 ng/mL (599–1114), p=0.017]. According to the median Gensini score, the higher score group also had higher cystatin C levels than the lower score group [1114 ng/mL (948–1567) vs. 929 ng/mL (569–1156), p=0.009]. However, serum NGAL levels were similar between these subgroups. There was a positive correlation between cystatin C and Gensini score (r=0.334, p=0.016). Multiple linear regression analysis revealed serum cystatin C as an independent predictor of the Gensini score (β=0.360, t=2.311, p=0.026). These results may aid in defining cystatin C as a surrogate marker of the extent of CAD in further clinical trials.
Conclusion: Serum Cystatin C, but not NGAL levels, could predict the severity of CAD in diabetic patients. (Anatol J Cardiol 2016; 16: 756-61)

6.
Cardiac autonomic nervous dysfunction detected by both heart rate variability and heart rate turbulence in prediabetic patients with isolated impaired fasting glucose
Akif Serhat Balcıoğlu, Sinan Akıncı, Davran Çiçek, Ali Çoner, Uğur Abbas Bal, İbrahim Haldun Müderrisoğlu
PMID: 27025199  PMCID: PMC5324936  doi: 10.14744/AnatolJCardiol.2015.6654  Sayfalar 762 - 769
Objective: Cardiac autonomic nervous dysfunction (CAND), a severe complication of diabetes, has also been shown to affect prediabetic patients. The role of isolated impaired fasting plasma glucose (IFG), a subtype of prediabetes, is not clear in the pathogenesis of CAND. The aim of this study was to examine the relationship between isolated IFG and cardiac autonomic function using heart rate variability (HRV) and heart rate turbulence (HRT) indices derived from 24-h Holter–electrocardiogram recordings.
Methods: This observational, prospective, cross-sectional study examined 400 consecutive subjects divided into three groups according to oral glucose tolerance test results: the control group [Group I, fasting plasma glucose (FPG) <100 mg/dL and normal glucose tolerance, n=193], the isolated IFG group (Group II, FPG ≥100 and <126 mg/dL, n=134), and the isolated impaired glucose tolerance (IGT), both IFG and IGT, or newly diagnosed diabetes’ group (Group III, n=73). Patients with non-sinus rhythm, known diabetes mellitus, coronary artery disease, heart failure, severe valvular disease, or receiving medical therapy that may affect HRV and HRT indices were excluded. Time domain HRV parameters, turbulence onset (TO), turbulence slope (TS), and HRT category were examined. Chi-square, one-way analysis of variance, Kruskal–Wallis H, and Mann–Whitney U tests were used to compare variables where appropriate. The correlation between Holter data and FPG levels was analyzed using the Spearman’s test. Multiple linear regression analysis was performed to identify independent predictors of the HRV and HRT parameters.
Results: Median (interquartile range 25–75) FPG levels in Groups I, II, and III were 89 (83/93) mg/dL, 109 (104/116) mg/dL, and 174 (150.5/197) mg/dL, respectively. There were significant differences in HRV and HRT parameters between and among all groups. While HRV parameters and TS decreased from Group I to Group III, TO and HRT category gradually increased. Additionally, FPG level was significantly correlated with SDNN, r=–0.220; SDNN index, r=–0.192; SDANN, r=–0.207; RMSSD, r=–0.228; pNN50, r=–0.226; TO, r=0.354; and TS, r=–0.331 (all p<0.001).
Conclusion: CAND, as detected by both HRV and HRT, appear to be present in the isolated IFG subtype of prediabetes. (Anatol J Cardiol 2016; 16: 762-9)

EDITORIAL COMMENT
7.
Novel results and future perspectives of study of cardiovascular autonomic control in prediabetic patients
Anton R. Kiselev, Vladimir A. Shvartz, Olga L. Bockeria
PMID: 27723666  PMCID: PMC5324937  doi: 10.14744/AnatolJCardiol.2016.19958  Sayfalar 770 - 771
Makale Özeti | Tam Metin PDF

ORIGINAL INVESTIGATION
8.
Use of strain and strain rate echocardiographic imaging to predict the progression of mitral stenosis: a 5-year follow-up study
Demet Menekşe Gerede, Aydan Ongun, Cansın Tulunay Kaya, Aynur Acıbuca, Nil Özyüncü, Çetin Erol
PMID: 27182618  PMCID: PMC5324938  doi: 10.14744/AnatolJCardiol.2015.6590  Sayfalar 772 - 777
Objective: Little information is available about echocardiographic progression of mitral stenosis (MS). The aim of this study was to investigate whether the left ventricular (LV) strain is a favorable method predicting the progression of MS.
Methods: Forty-eight patients with isolated mild-to-moderate MS were enrolled in this prospective cohort study. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured by two-dimensional echocardiography (2-DE) at the baseline. Mitral valve area (MVA) was evaluated during the 5-year follow-up. The change in MVA from the beginning to the end of the surveillance period was determined as an indicator of progression. Pearson’s correlation test was used, and significant differences between the groups were analyzed using the Student’s t-test or the Mann–Whitney U test. At the end of follow-up, we evaluated the correlation between the change in MVA and both GLS-GLSR. GLS and GLSR are predictive factors for MS progression, whether or not it has been tested according to the receiver operating characteristics curve analysis.
Results: A meaningful correlation was detected between the change in MVA with both GLS and GLSR (r=0.924 and r=0.980, respectively, p<0.001). The cut-off value for GLS was identified as –16.98 (sensitivity 81%, specificity 96%, p<0.001) and for GLSR as –1.45 (sensitivity 95%, specificity 100%, p<0.001). Patients with MS having a value under (mathematically above) these cut-off values showed more rapid progression.
Conclusion: The progression of MS can be predicted by GLS and GLSR measurements, which are evaluated via strain echocardiography. (Anatol J Cardiol 2016; 16: 772-7)

EDITORIAL COMMENT
9.
Speckle-tracking imaging for the progression of mitral stenosis
Marina Leitman, Zvi Vered
PMID: 27723667  PMCID: PMC5324939  doi: 10.14744/AnatolJCardiol.2016.20172  Sayfa 778
Makale Özeti | Tam Metin PDF

ORIGINAL INVESTIGATION
10.
Echocardiographic assessment of right ventricular functions in healthy subjects who migrated from the sea level to a moderate altitude
Arif Arısoy, Selim Topçu, Selami Demirelli, Fatih Altunkaş, Metin Karayakalı, Ataç Çelik, İbrahim Halil Tanboğa, Enbiya Aksakal, Serdar Sevimli, Hanefi Yekta Gürlertop
PMID: 27271474  PMCID: PMC5324940  doi: 10.5152/AnatolJCardiol.2015.6622  Sayfalar 779 - 783
Objective: The aim of this study was to evaluate right ventricle (RV) functions using echocardiography in healthy subjects who migrated from the sea level to moderate altitude (1890 m).
Methods: The prospective observational in this study population consisted of 33 healthy subjects (23 men; mean age 20.4±3.2 years) who migrated from the sea level to a moderate altitude (Erzurum city centre, 1890 m above sea level) for long-term stay. Subjects underwent echocardiographic evaluation within the first 48 h of exposure to the moderate altitude and at the sixth month of arrival. Conventional echocardiographic parameters such as RV sizes and areas, systolic, and diastolic functional indices [fractional area change (FAC), tricuspid flow velocities, myocardial performance index (MPI), and tricuspid annular plane systolic excursion (TAPSE)] were obtained. Systolic (S) and diastolic (E’, A’) velocities were acquired from the apical four-chamber view using tissue Doppler imaging. Kolmogorov–Smirnov test, student’s t-test, Wilcoxon test, and chi-square test were used in this study.
Results: There were no significant changes in RV size, FAC, MPI, TAPSE, inferior inspiratory vena cava collapse, tricuspid E velocity, and tricuspid annulus E’ velocity. Compared with the baseline, there was a significant increase in mean pulmonary artery pressure (p=0.001); RV end systolic area (p=0.014); right atrial end diastolic area (p=0.021); tricuspid A velocity (p=0.013); tricuspid annulus S and A’ velocity (p=0.031 and p=0.006, respectively); and RV free wall S, E’, and A’ velocity (p=0.007, p<0.001, and p=0.007 respectively) at the sixth month. Also, there was a significant decrease in tricuspid E/A ratio (1.61±0.3 vs. 1.45±0.2, p=0.038) and tricuspid annulus E’/A’ ratio (1.52±0.5 vs. 1.23±0.4, p=0.002) at the sixth month.
Conclusion: Our study revealed that right ventricular diastolic function was altered while the systolic function was preserved in healthy subjects who migrated from the sea level to a moderate altitude. (Anatol J Cardiol 2016; 16: 779-83)

11.
Association between central aortic pulsatility and glomerular filtration rate in patients with coronary artery disease
Serkan Duyuler, Pınar Türker Bayır, Ümit Güray, Abdülkadir Yıldız, Ahmet Korkmaz, Kadir Gökhan Atılgan
PMID: 27182611  PMCID: PMC5324941  doi: 10.5152/AnatolJCardiol.2015.6647  Sayfalar 784 - 790
Objective: Aortic stiffness and chronic kidney disease share common risk factors. Increased aortic stiffness is a predictor of lower estimated glomerular filtration rate (eGFR) at lower levels of renal functions. We aimed to investigate the association between invasively measured central aortic pulsatility (AP) as an indicator of aortic stiffness and eGFR in a population with coronary artery disease and without overt renal disease.
Methods: This study had a cross-sectional design. Data were retrospectively collected. We evaluated 72 patients (44 males and 28 females; mean age 59.0±10.3 years) with coronary artery disease. eGFR was calculated with dividing the Cockcroft–Gault formula by body surface area. Direct measurements of aortic blood pressures were utilized to calculate pulse pressure and AP. Multiple linear regression analysis was performed to test the relationship between eGFR and AP, independent from potential confounders.
Results: eGFR was significantly correlated with age (r=0.489, p<0.001), body surface area (r=0.324, p=0.006), weight (r=0.323, p=0.006), aortic pulse pressure (r=−0.371, p=0.001), and AP (r=−0.469, p<0.001). In multiple linear regression analysis, AP was independently associated with eGFR (p=0.035), beside the age and body surface area. An AP cut-off level of >0.71 had 84% sensitivity and 72% specificity in predicting eGFR of <90 mL/min per 1.72 m2 (receiver–operating characteristic area under curve: 0.851, 95% CI: 0.760–0.942, p<0.001).
Conclusion: We found an independent relationship between invasively measured AP and eGFR in patients with coronary artery disease. Moreover, a higher AP may predict lower eGFR. These results may be utilized to predict eGFR from AP during invasive procedures. (Anatol J Cardiol 2016; 16: 784-90)

12.
The effect of CYP2C9 and VKORC1 genetic polymorphisms on warfarin dose requirements in a pediatric population
Birce Dilge Taşkın, Serdar Kula, Mehmet Ali Ergün, Demet Altun, Rana Olguntürk, Fatma Sedef Tunaoğlu, Ayşe Deniz Oğuz, Türkiz Gürsel
PMID: 27182616  PMCID: PMC5324942  doi: 10.14744/AnatolJCardiol.2015.6150  Sayfalar 791 - 796
Objective: The aim was to investigate the frequency of genetic polymorphisms of cytochrome P4502C9 (CYP2C9) and vitamin K epoxide reductase complex subunit1 (VKORC1) and determine the effect of these polymorphisms on warfarin dose requirements in pediatric patients.
Methods: Fifty-eight pediatric patients with cardiac disease, thrombophilia, or other conditions, taking a stable warfarin dose, aged 0.2–18 years, and with international normalized ratio (INR) between 2 and 3 and 149 healthy children as a control group were included in this prospective, observational study. Patients receiving drugs that interact with warfarin, having chronic liver or renal disease, obesity, or thyroid dysfunctions were excluded. Polymerase chain reaction (real time and restriction fragment length polymorphism) was used to analyze the CYP2C9*2, CYP2C9*3, and VKORC1 polymorphisms. The ideal warfarin dose was calculated according to the patient’s age, height, and the presence of CYP2C9*2, CYP2C9*3, and VKORC1 genetic polymorphisms. The mean daily administered doses and ideal doses were compared. Analysis of variance, Student's t-test, logistic regression analysis, and Pearson's correlation analysis were used for statistical analyses.
Results: The frequency of the CYP2C9 and VKORC1 genetic polymorphisms was determined as CYP2C9*1/*1 (54.6%), *1/*2 (16.4%), *1/*3 (24.2%), *2/*3 (2.9%), *3/*3 (1.9%), wild-type VKORC1 (26.6%), heterozygote alleles (52.7%), and mutant alleles (20.8%). Patients with allelic variants were found to require lower warfarin doses, and a 64.5% correlation was found between the calculated ideal doses and the administered warfarin doses.
Conclusion: Considering CYP2C9 and VKORC1 genetic polymorphisms prior to commencing warfarin treatment will make it easier to reach target INRs and reduce the rate of complications. (Anatol J Cardiol 2016; 16: 791-6)

13.
Early and long-term outcomes and quality of life after concomitant mitral valve surgery, left atrial size reduction, and radiofrequency surgical ablation of atrial fibrillation
Seitkhan Joshibayev, Berik Bolatbekov
PMID: 27025202  PMCID: PMC5324943  doi: 10.14744/AnatolJCardiol.2015.6960  Sayfalar 797 - 803
Objective: Atrial fibrillation (AF) is the most formidable supraventricular tachyarrhythmia, which worsens the natural course of mitral valve disease. In this study, we evaluated early and long-term results and quality of life (QOL) after simultaneous surgical radiofrequency ablation (RFA) of AF, left atrial reduction and mitral valve repair or replacement.
Methods: Overall, 147 patients with mitral valve diseases who underwent mitral valve surgery were included in this prospective cohort study. Patients were divided into two groups according to the type of operation: the study group—patients after mitral valve surgery with concomitant radiofrequency surgical ablation and left atrial reduction procedure (54 patients), and the control group—patients undergoing only mitral valve surgery (93 cases). We assessed AF recurrence and sinus rhythm restoration rates and mortality rates, QOL measures, postoperative complications rates, and left atrial size during follow-up.
Results: In the study group, sinus rhythm restoration rate in the early postoperative period was 63%, but at the time of discharge it reduced to 29%; after 6 months, it significantly increased to 72% and after 3 years, to 81% (p=0.02). In the control group, the sinus rhythm restored only in 14% after 1 year, and at 3 years, it was 22%, although in the early postoperative period it, was 43%. Analysis of left atrial size before and after surgery showed that dimension significantly reduced in both groups (study group, p=0.013; control group, p=0.024). In addition, in patients undergoing surgical RFA procedure, there was a significant association between shorter heart disease history (p=0.02) and shorter AF history (p=0.074) with maintenance of sinus rhythm. The mortality rate in the study group was 4% (two patients) and in the control group 5% (five patients). Comparison of QOL measures between study and control groups after 1 year showed that patients undergoing concomitant atrial reduction surgery and RFA had significant improvement of QOL physical (p=0.03) and role (p=0.03) functioning, heartbeat (p=0.01), general (p=0.03) and mental health (p=0.01), vitality (p=0.007), and social role (p=0.02) functioning measures as compared to preoperative state, being higher than in patients who underwent only mitral valve surgery.
Conclusion: Application of surgical RFA using irrigated cooling electrode and atrial reduction during mitral valve surgery is associated with higher restoration and maintenance of SR as compared to patients undergoing only mitral valve surgery. We did not observe complications related to AF surgery that required permanent pacemaker implantation. Performing concomitant surgery as surgical RFA, atrial reduction along with mitral valve surgery, improves QOL in the short- and long-term and reduces the feeling of heartbeat and discomfort. (Anatol J Cardiol 2016; 16: 797-803)

REVIEW
14.
Vagus nerve stimulation: An evolving adjunctive treatment for cardiac disease
Barış Akdemir, David G. Benditt
PMID: 27723668  PMCID: PMC5324944  doi: 10.14744/AnatolJCardiol.2016.7129  Sayfalar 804 - 810
The vagus nerve is a major component of the autonomic nervous system and plays a critical role in many body functions including for example, speech, swallowing, heart rate and respiratory control, gastric secretion, and intestinal motility. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, with electrical stimulation being the most important. Implantable devices for VNS are approved therapy for refractory epilepsy and for treatment-resistant depression. In the case of heart disease applications, implantable VNS has been shown to be beneficial for treating heart failure in both preclinical and clinical studies. Adverse effects of implantable VNS therapy systems are generally associated with the implantation procedure or continuous on-off stimulation. The most serious implantation-associated adverse effect is infection. The effectiveness of non-invasive transcutaneous VNS for epilepsy, depression, primary headaches, heart failure, and other conditions remains under investigation. VNS merits further study for its potentially favorable effects on cardiovascular disease, especially heart failure. (Anatol J Cardiol 2016; 16: 804-10)

EDITORIAL COMMENT
15.
Vagus nerve stimulation: Invasive or noninvasive?
Yana Anfinogenova
PMID: 27723669  PMCID: PMC5324945  doi: 10.14744/AnatolJCardiol.2016.23113  Sayfalar 811 - 812
Makale Özeti | Tam Metin PDF

CASE REPORT
16.
Transcatheter aortic valve implantation through extra-anatomic iliac graft in a patient with unsuitable iliofemoral and subclavian anatomy
Ali Doğan, Emrah Özdemir, Denyan Mansuroğlu, Kenan Sever, Yelda Saltan, Behzat Özdemir, Ulviye Yılmaz, Nuri Kurtoğlu
PMID: 27723670  PMCID: PMC5324946  doi: 10.14744/AnatolJCardiol.2016.7097  Sayfalar 813 - 814
Makale Özeti | Tam Metin PDF

17.
The first case of chronic Q fever endocarditis and aortitis from Turkey: A 5-year infection before diagnosis with drain in sternum
Serap Şimşek Yavuz, Ezgi Özbek, Seniha Başaran, Bekir Çelebi, Ebru Yılmaz, Murat Başaran, Berrin Umman, Haluk Eraksoy
PMID: 27723671  PMCID: PMC5324947  doi: 10.14744/AnatolJCardiol.2016.7329  Sayfalar 814 - 816
Makale Özeti | Tam Metin PDF

LETTER TO THE EDITOR
18.
Effects of administration of omega-3 fatty acids with or without vitamin E supplementation on adiponectin gene expression in PBMCs and serum adiponectin and adipocyte fatty acidbinding protein levels in male patients with CAD
Magdalena Mostowik, Grzegorz Gajos
PMID: 27723672  PMCID: PMC5324948  doi: 10.14744/AnatolJCardiol.2016.7243  Sayfa 817
Makale Özeti | Tam Metin PDF

19.
Preparedness for sudden cardiac arrest at sports arenas: A survey in Turkey
Şule Özbilgin, Bahar Kuvaki, Volkan Hancı, Gamze Ungur, Onur Tütüncü, Merve Koca, Şule Akın, Agah Certuğ
PMID: 27723673  PMCID: PMC5324949  doi: 10.14744/AnatolJCardiol.2016.7321  Sayfa 818
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E-PAGE ORIGINAL IMAGES
20.
Unusual coexistence of atrial myxoma and mitral stenosis
Servet İzci, Muhittin Demirel, Emrah Acar, Cüneyt Toprak, Gonca Geçmen
PMID: 27723663  PMCID: PMC5324950  doi: 10.14744/AnatolJCardiol.2016.7326  Sayfalar E16 - E17
Makale Özeti | Tam Metin PDF | Video

21.
A giant left ventricular pseudoaneurysm presenting with transient ischemic attack 7 years after acute myocardial infarction: A deep investigation via multiple imaging modalities
Muhammed Keskin, Taha Keskin, Muhsin Nuh Aybay
PMID: 27723664  PMCID: PMC5324951  doi: 10.14744/AnatolJCardiol.2016.7373  Sayfalar E17 - E19
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