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CASE REPORTS
Transjugular closure of secundum atrial septal defect in a patient with interrupted inferior vena cava
Emre Ozdemir, Sadik Volkan Emren, Nihan Kahya Eren, Cem Nazli, Mehmet Tokac
January-March 2018, 4(1):15-18
DOI:10.4103/IJCA.IJCA_6_18  
In this case, we report a successful closure of secundum atrial septal defect in a 32-year-old female patient with an interrupted inferior vena cava (IVC). Interrupted IVC was detected coincidentally during right heart catheterization. The defect was successfully closed through transjugular vein approach as an alternative to surgery.
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ORIGINAL ARTICLES
Prevalence of metabolic syndrome in young patients with ST-elevation myocardial infarction
Tugba Kemaloglu Oz, Nazmiye Özbilgin, Aylin Sungur, Elif Gülsah Bas, Ahmet Zengin, Tayfun Gürol, Özer Soylu, Bahadir Dagdeviren
July-September 2018, 4(3):53-58
DOI:10.4103/IJCA.IJCA_10_18  
Background: Atherosclerotic cardiovascular disease influences young patients as well as the elderly. A large proportion of patients with coronary artery disease (CAD) have metabolic syndrome (MS), although the frequency and association of its different components are not clear. To the best of our knowledge, there is no any study about the prevalence of MS among young patients with ST-elevation myocardial infarction (STEMI). We sought to determine the prevalence of MS in patients below 46 years of age who presented with STEMI and underwent primary percutaneous coronary intervention. Methods: In the present prospective study, 141 consecutive patients with STEMI <46 years of age admitted to intensive coronary care unit. STEMI was defined according to the ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. All patients were grouped presence of MS. In the second step, the components of MS were analyzed, excluding patients with diabetes mellitus (DM). Results: The total prevalence of MS was 46.8% (n = 66). In MS group, the most frequent component of MS was low high-density lipoprotein (HDL) levels (84.8%), followed by elevated triglycerides (TGs) (78.1%). A total of 121 patients did not have DM and 51 (42.1%) of these patients presented with MS. Conclusions: The prevalence of MS in young patients with STEMI is high. Low HDL cholesterol (HDLc) concentrations and high TG levels are cardiovascular risk factors, regardless of low-density lipoprotein cholesterol levels and they are found too often in our study. These results highlight the need to implement preventative strategies for reducing overall cardiovascular risk in young patients as well as elderly.
  1 2,585 335
The predictors of long-term hospitalization in Turkish heart failure population: A subgroup analysis of journey heart failure-TR study: On behalf of journey heart failure-TR investigators
Umit Yasar Sinan, Mehmet Erturk, Erkan Yıldırım, Duygu Koçyiğit, Ilgın Karaca, Faruk Ertas, Ahmet Celik, Fatih Aksoy, Hasan Ali Gumrukcuoglu, Umit Yuksek, Mahir Cengiz, Mehdi Zoghi
October-December 2018, 4(4):82-85
DOI:10.4103/IJCA.IJCA_40_18  
Background: Heart failure (HF) is an important public health problem. We aimed to investigate the predictors of long-term hospitalization in Turkish HF population. Materials and Methods: Journey-HF-TR study is a multicenter, cross-sectional, noninvasive, and observational study that was conducted in intensive care unit (ICU), coronary care unit (CCU), and cardiology wards in seven geographical regions of Turkey. In this subgroup analysis, patients were classified as two groups according to inhospital stay called the patient with the shorter length of stay (S-LOS) (inhospital stay <5 days; S-LOS) and patients with longer LOS (L-LOS) (inhospital stay ≥5 days; L LOS). Results: The study group was consisted of 1606 patients (57.2% male, mean age: 67. 8 ± 13.0 years old). One thousand and thirty seven patients, whom in-hospital stay duration were recorded in case report form, were included in this analysis. There were 487 patients (32.1%) in S LOS group and 1030 patients (67.9%) in L LOS group. In multivariate analysis, correlation was present for NYHA functional capacity, CKD, ACS related HF, right HF, cardiogenic shock, invasive and noninvasive ventilation, and hemodynamic monetarization. The longer inhospital stay increases the probability of morbidity and mortality. Conclusion: We demonstrated that there was positive correlation between longer hospital stay and HF severity (NYHA III-IV), CKD, cardiogenic shock, right ventricular HF, and HF related to ACS. HFpEF patients have less in-hospital stay than HFrEF and HFmrEF patients.
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The Pattern of reciprocal electrocardiography changes in St-segment elevation myocardial infarction patients presenting with single-vessel disease versus multi-vessel disease
Mohamed Elsayed Zahran
July-September 2019, 5(3):80-85
DOI:10.4103/IJCA.IJCA_2_19  
Introduction: The reciprocal ST-segment depression in the electrocardiography (ECG) leads overlying noninfarcting areas was studied previously in acute myocardial ischemia. Multi-vessel disease (MVD) subset of patients have more vague and confusing presentations on ECG; they usually show less ST-segment elevation and profound and diffuse ST-segment depression compared to ST-segment elevation myocardial infarction (STEMI) patients with single-vessel disease (SVD) involving occlusion of one coronary artery only, namely the infarct-related artery (IRA). Aim of the Work: The aim was to study and compare the pattern of reciprocal ECG changes in STEMI patients presenting with SVD versus MVD. Methods and Results: A total of 125 consecutive patients admitted from April 2014 to August 2015 from the emergency room with the diagnosis of acute STEMI and treated by primary percutaneous coronary intervention (PPCI) at our cath lab at Ainshams University Hospitals (a 24/7 tertiary referral center for PPCI) were included. ST-segment deviations were measured at the J-point. Reciprocal ST-segment changes were identified as per guidelines published by the European Society of Cardiology and the American College of Cardiology, i.e., ST-segment depression ≥0.1 mV in any ECG lead other than aVR, while the cutoff value is different for leads V2 and V3 being only 0.05 mV. Coronary angiographies were evaluated by two independent operators blinded to the clinical and electrocardiographic data. Regarding the left anterior descending (LAD) occlusion, the reciprocal ST-segment depression magnitudes in lead III and in lead arteriovenous fistula (aVF) were significantly less in the MVD group compared to the SVD group, i.e., lead III (−0.08 ± 0.10 mV vs. −0.19 ± 0.15, P = 0.015) and lead aVF (−0.07 ± 0.06 mV vs. −0.15 ± 0.11, P = 0.02); while regarding the left circumflex coronary artery (LCX) occlusion, the reciprocal ST-segment depression extended significantly in V4 chest lead in the MVD group compared to the SVD group (−0.16 ± 0.08 mV vs. −0.1 ± 0.04, P = 0.025); and finally regarding the right coronary artery (RCA) occlusion, the reciprocal ST-segment depression extended significantly in V3 chest lead in the MVD group compared to the SVD group (−0.18 ± 0.07 mV vs. −0.1 ± 0.06, P = 0.02). Conclusion: The pattern of reciprocal ST-segment depression was more profound when the LAD was the culprit artery causing the anterior STEMI compared to the same case if the LAD was a part of MVD; this does not apply to the LCX and RCA when they were the culprit in cases of inferior STEMI where the MVD group showed more reciprocal ST-segment depression.
  1 1,327 193
REVIEW ARTICLE
Brugada syndrome: A brief review on diagnostic approach, risk stratification, and management
Raymond Pranata
January-March 2019, 5(1):1-7
DOI:10.4103/IJCA.IJCA_31_18  
Brugada syndrome is a congenital channelopathy in cardiac ion transmembrane causing an alteration in the electrical conduction of the heart. ST-elevation, as well as right bundle-branch block in anterior precordial electrocardiography (ECG), is pathognomonic in this syndrome. The patient might be asymptomatic or with a history of syncope and prone to develop ventricular tachyarrhythmia which may spontaneously recover or degenerates to ventricular fibrillation, cardiac arrest and even sudden death. Nevertheless, this can be prevented by implantable cardioverter defibrillator implantation. Therefore, it is of paramount importance that clinical suspicion and identification, interpretation of its characteristic ECG pattern and risk stratification to be properly done to diagnose and to manage Brugada syndrome. The author has also done a systematic review (included in the article) for several noninvasive ECG parameters for risk stratification with promising results. Epicardial ablation is an emerging therapy that may “cure” Brugada syndrome.
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Where will non-Vitamin K oral anticoagulants stand beyond being standard of care in anticoagulation therapy?
Oktay Ergene
July-September 2019, 5(3):75-79
DOI:10.4103/IJCA.IJCA_14_19  
Objective: Atrial fibrillation (AF) is the most common arrhythmia that increases risk of stroke by 4–5 fold. AF prevalence is approximately 1%–3% in the general population and increases with age. Until 2010, the standard of care (SoC) for prophylaxis of ischemic stroke was Vitamin K antagonists. Phase III randomized controlled trials (RCTs) of non-Vitamin K oral anticoagulants (NOACs) showed that NOACs have comparable or lower risk of stroke, systemic embolism, major bleeding, and death with warfarin in populations with nonvalvular AF (NVAF). Since then, results of these pivotal RCTs were confirmed by postmarketing studies and real-world data. In the last 8 years, they have been replacing warfarin as the SoC not only for preventing stroke in NVAF patients but also for patients with deep vein thrombosis, pulmonary embolism, and those who undergo hip or knee surgery. In recent years, there are emerging data on new clinical areas such as coronary and peripheral artery disease. In this article, it is attempted to review what has changed in the last 8–10 years in the management and prevention of stroke associated with NVAF and other thromboembolic situations and to foresee whether NOACs will be SoC and stand beyond being SoC in anticoagulation therapy. Methods: IMS data were obtained from IQVIA with a permission letter on request of Dr. Ergene. IQVIA grants permission to use the statements for the specified purpose (NOACs share in the total anticoagulation market and role of NOACs as the SoC in the near future) of peer-review publication by Dr. Ergene. Conclusion: NOACs are breakthrough in stroke prevention, and they will prevail eventually. It will take a few years; anticoagulation market will grow in favor of NOACs, and most probably, NOACs will reach over 50% standard unit market share. It is even more exciting to hear about new therapeutic areas and indications for these agents.
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