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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 6 | Issue 1
Page Nos. 1-34

Online since Thursday, February 13, 2020

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REVIEW ARTICLE  

Frequent premature atrial complex: A neglected marker of adverse cardiovascular events p. 1
Raymond Pranata
DOI:10.4103/IJCA.IJCA_17_19  
Premature atrial complexes (PACs) have long been considered a benign electrophysiological phenomenon unlikely to result in a severe clinical consequence. However, recent evidence had challenged this notion. Several studies showed that excessive PAC leads to the development of atrial fibrillation and subsequent hospitalization. The PAC is also associated with mortality, cardiovascular hospitalization, permanent pacemaker implantation, and nonlacunar ischemic stroke. The cutoff for excessive PAC differs from one study to another ranging from 76 PACs per 24 h to >32 PACs per hour. Increased adverse cardiovascular events demonstrated by recent studies had challenged the long-held paradigm that PACs are unlikely to result in serious clinical consequences.
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ORIGINAL ARTICLES Top

The clinical characteristics of acute heart failure patients with mid-range ejection fraction in Turkey: A subgroup analysis from journey HF-TR study p. 5
Umit Yasar Sinan, Dogac Caglar Gurbuz, Oguzhan Celik, Huseyin Altug Cakmak, Salih Kilic, Sinan Inci, Gulay Gok, Mehmet Serdar Kucukokglu, Mehdi Zoghi
DOI:10.4103/IJCA.IJCA_43_19  
Background: Heart failure (HF) is a clinical syndrome characterized with a wide spectrum of left ventricular (LV) structural and functional abnormalities. LV ejection fraction (EF) is considered important with respect to classifying HF patients because of differing patient demographics and prognosis; as well as the response to HF therapies. We aimed to investigate the clinical characteristics, demographics, in-hospital management and in-hospital outcome of HF patients with mid-range EF (HFmrEF) in comparison with those with HF patients with reduced EF (HFrEF) or HF patients with preserved EF (HFpEF) in a large acute HF (AHF) cohort. Materials-Methods and Results: The Journey HF-TR study is a multicenter, and observational registry. One thousand six hundred and six patients who were diagnosed with AHF were enrolled in this study. The mean age was 67.8 ± 13.0 years and 57.2% of the study population was male. Patients were classified as HFrEF (n = 1028, 64%), HFmrEF (n = 305, 19%), and HFpEF (n = 273, 17%) according to LVEF. HFmrEF patients were elder than HFrEF patients but younger than HFpEF patients and the female proportion was the highest in HFpEF group followed by HFmrEF and HFrEF groups (P < 0.001 and P = 0.03, respectively). The prevalence of coronary artery disease was 56.7% in HFmrEF patients. It was lower than HFrEF patients (65.2%) and higher than HFpEF patients (41.4%) (P < 0.001). The prescription of evidence-based HF drugs (Renin-Angiotensin-System blocker, beta-blocker, mineralocorticoid receptor antagonist) was similar in HFrEF and HFmrEF patients and higher than HFpEF patients. The in-hospital mortality rate was the lowest in patients with HFmrEF (1.8%, 7.3%, and 7.5%, respectively for HFmrEF, HFrEF, and HFpEF patients) (P < 0.001). Conclusion: Patients with HFmrEF has unique clinical, echocardiographic, hemodynamic, and biomarker features compared with HFrEF and HFpEF. However, patients with HFmrEF seem to be more similar to HFrEF, in terms of etiology and use of guideline recommended medical therapy.
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Assessment of the compatibility of the real-world nonvalvular atrial fibrillation patients in Turkey with the study population of Phase 3 novel oral anticoagulant trials: An auxiliary study of NOAC-TR p. 12
Sadik Volkan Emren, Mehdi Zoghi, Ugur Karagöz, Sinan Inci, Gönül Açiksari, Lütfü Bekar, Zeynep Yapan Emren, Oktay Ergene
DOI:10.4103/IJCA.IJCA_39_19  
Introduction: Although the indication of novel oral anticoagulant (NOAC) treatment in atrial fibrillation (AF) is comparatively similar, Phase 3 NOAC trials have variable inclusion criteria that differentiate each other and also from the real-world population. Aim: We aim to investigate the similarity between real-world nonvalvular AF patients and the population of Phase 3 NOAC trials in terms of eligibility. Methods: A total of 2802 patients using rivaroxaban, dabigatran, and apixaban were retrospectively evaluated. All the patients met the exclusion criteria of NOAC Phase 3 trials. These patient population were compared with the population of Phase 3 rivaroxaban (ROCKET-AF), dabigatran (RELY), apixaban (ARISTOTLE), and edoxaban (ENGAGE) trials in terms of inclusion criteria. Furthermore, the patients were stratified on the basis of CHA2-DS2–VASCc is enaogh score. Results: The proportion of population who met the eligible criteria for ARISTOTLE trial (91%) was different from that of RELY (78%), ROCKET-AF (50%), and ENGAGE (61%) trials (P < 0,001). For the population at intermediate risk (CHA2DS2–VASc score ≥1), the proportion which met the inclusion criteria for RE-LY trial (99%) was different from that of ARISTOTLE (91.2%), ROCKET-AF (50%), and ENGAGE trials (61%) (P < 0.001). For the population at high risk (CHA2DS2–VASc score ≥2), the proportion which met the inclusion criteria was as follows: 94% for ARISTOTLE, 83% for RELY, 65% for ENGAGE, and 53% for ROCKET-AF trials (P < 0.001). In this population, 38% of patients using rivaroxaban, 46% of patients using dabigatran, and 12% patients of using apixaban did not meet the inclusion criteria for the ROCKET-AF, RE-LY, and ARISTOTLE trials, respectively. Conclusion: Eligibility of the real-world population for NOAC trials is variable. A considerable number of real-world patients using NOAC do not meet the inclusion criteria of the corresponding drug.
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The relationship between the prevalence and complexity of coronary artery disease and aortic stiffness in myocardial infarction patients without ST-segment elevation p. 16
Yildirim Arafat, Mehmet Kucukosmanoglu, Gur Mustafa
DOI:10.4103/IJCA.IJCA_46_19  
Background: The relationship between elastic properties of the aorta and presence of coronary artery disease (CAD) has been investigated in previous studies. However, the relationship of aortic stiffness (AS) with extent and complexity of CAD in patients with non-ST-segment elevation myocardial infarction (NSTMI) have not been evaluated in previous studies. Aims and Objectives: The aim of this study is to determine the relationship of AS with extent and complexity of CAD in patients with NSTMI. Materials and Methods: Study population includes 400 patients (265 men, 135 women, mean age 61,8 ± 10.4 years) who had coronary angiography (CAG) in our clinic between February 2013 and October 2013 with the diagnosis of NSTMI. Patients were divided into two groups according to the median SYNTAX score as SYNTAX score < 16,5 SYNTAXlow group; and SYNTAX score ≥ 16,5 SYNTAX high group. AS parameters containing pulse wave velocity (PWV) and augmentation index (AIx) were calculated using applanation tonometry. Results: PWV and AIx parameters were found to be significantly higher (P < 0.001 for each) in SYNTAX high group compared to SYNTAX low group. Also age, the frequency of HT (hypertension), HPL (hyperlipidemia) and DM (diabetes mellitus) were significantly higher (P < 0.05 for all) in SYNTAX high group. HT (β = 0.083, P = 0.048), DM (β = 0.160, P < 0.001), PWV (β = 0.520, P < 0.001), and AIx (β = 0.230, P < 0.001) were found to be independently associated with SYNTAX score in multivariate regression analysis. On the other hand, age (β = 0.255, P < 0.001), HT (β = 0.212, P < 0.001), NT-proBNP (β = 0.086, P = 0.012) and SYNTAX score (β = 0.494, P <0.001) were independently associated with PWV in multivariate regression analysis. Conclusion: SYNTAX score was found to be independently associated with increased AS in NSTMI patients. Increased AS may be thought as a predictor of extent and complexity of CAD.
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A cross-sectional study of risk factors and preventive measures among patients presenting to a cardiac center p. 22
Abdulhalim Jamal Kinsara, Sulafa S Alshammari, Reem K Aloqbi, Israa S Aljohani
DOI:10.4103/IJCA.IJCA_45_19  
Objective: Cardiovascular disease (CVD) is highly prevalent and more so in patients with diabetes mellitus (DM). Although many treatment advances have been made, the patient outcomes do not reflect the progress. With improved knowledge about the prevention of risk factors and the availability of educational material, the expectation was that patients would become more knowledgeable. Materials and Methods: The design was a cross-sectional study with patients presenting at a cardiac center in Jeddah, Saudi Arabia. Results: In total, 350 participants were included, both diabetic and nondiabetic patients. Just more than half of the sample (51%) was male, with a mean age of 49 years. There was a high incidence of metabolic syndrome components: 30% of the sample was hypertensive, 24% aware of being hyperlipidemic, and 40% overweight. From an educational perspective, 45% of the sample received no previous education regarding DM, 34% were unaware of the complications of diabetes, 41% reported that physicians did not provide appropriate education, and half of the sample indicated that the media did not provide appropriate education. This lack of education and patient-related factors resulted in 56% not following a diet, 52% did not control their diabetes to avoid complications, and 47% was not physically active. Conclusion: There is a significant gap in the public knowledge of diabetic risk factors, how to control diabetes and appropriate lifestyle changes. Information received from physicians or the media is below the patients' expectations. A combined strategy to raise awareness and improve knowledge between primary health care and media, starting at school age and continued through all admissions, is mandatory. Governmental support is required in all the different levels of education to decrease the burden due to CVD in Saudi Arabia.
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CASE REPORTS Top

Successful surgical correction of anomalous origin of the left pulmonary artery from the ascending aorta in a 16-year-old boy with Fallot's tetralogy p. 26
Deshbandhu Sharma, Rajnish Pathania, Sudhir Mehta, Rajesh Chopra
DOI:10.4103/IJCA.IJCA_18_19  
Tetralogy of Fallot (TOF) is a frequently encountered congenital heart defect, and the detailed diagnostic criteria are well established. There may be other anomalies associated with TOF, but the anomalous origin of the left pulmonary artery (LPA) from the ascending aorta (AOPA) is a rare one. The diagnosis of this anomaly, which may be mistaken for the absence of the LPA, should be made in early life to avoid unilateral pulmonary hypertension and also for appropriate surgical planning. We are reporting a case of a 16-year-old child, with the diagnosis of TOF associated with anomalous origin of the LPA from the AOPA who underwent a one-stage surgical correction of this anomaly.
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An idiopathic giant right atrium aneurysm in old asymptomatic patient p. 29
Abdallah Almaghraby, Mahmoud Abdelnabi, Yehia Saleh
DOI:10.4103/IJCA.IJCA_24_19  
Giant right atrial aneurysm is an extremely rare cardiac anomaly that can be seen anytime in human life from childhood to elderly. Many cases have no symptoms, others may develop arrhythmias such as atrial fibrillation (AF), and sometimes, thrombi may develop inside the right atrium with risk of pulmonary embolism as well as paradoxical embolism through a patent foramen ovale. This condition can be caused due to cor pulmonale, right ventricular disease, and tricuspid valve diseases, and in extremely rare cases, if all these causes are excluded, it is considered idiopathic. We report a very rare case of an asymptomatic 62-year-old male with a previous history of chronic AF who was incidentally diagnosed with a giant right atrial aneurysm in a preoperative transthoracic echocardiography. He was asymptomatic and he was managed conservatively based on his request.
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Percutaneous coronary angiography and intervention via transpalmar access for the first time in Turkey p. 32
Koray Kalenderoğlu, Onur Taşar, Sedat Kalkan
DOI:10.4103/IJCA.IJCA_41_19  
Unstable angina is common in ischemic heart diseases. Patients with unstable angina undergo coronary angiography to detect lesions that may require treatment. Coronary angiography can be performed through several ways of arterial access. Radial access is the most commonly used method. We report a 71 year old male patient who presented with chest pain due to unstabil angina pectoris. Coronary angiograhy was perfomed by a new technique, transpalmar access through superficial palmar branch of the ulnar artery. The patient was treated successfully with percutaneous coronary intervention of the left anterior descending artery. In our case, transpalmar approach was performed for the first time in Turkey.
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