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A case difficult to diagnose in adults: High sinus venous atrial septal defect
Ozge Cetinarslan, Umit Yasar Sinan, Mehmet Serdar Kucukoglu
January-March 2018, 4(1):12-14
Sinus venous atrial septal defect (SVD) is highly difficult to diagnose because of its location. Below, we report a case of SVD which is misdiagnosed as pulmonary hypertension and anomalous pulmonary venous return. A 57-year-old female patient was referred to congenital disease outpatient clinic of a tertiary center. She was admitted to the hospital with complaints of fatigue and exercise dyspnea which had started a year ago. She had transthoracic echocardiography (TTE) examination done in another hospital which showed dilated right heart chambers and pulmonary hypertension. She underwent transesophageal echocardiography (TEE) examination with the suspicion of atrial septal defect (ASD), but no defect was seen. As her symptoms persisted, we repeated the TTE and TEE examination in our center. TEE revealed 0.6 cm ASD on the upper side of the interatrial septum. All four pulmonary veins were draining into the left atrium. Right heart catheterization (RHC) confirmed the diagnosis. A left-to-right shunt was detected and localized by a significant step-up in blood oxygen saturation found between mid and upper segments of the right atrium. According to our TEE and RHC results, we planned the surgical closure of the defect. Sinus venous ASD is deficiency of the superior portion of atrial septum adjacent to superior vena cava. Diagnosis of SVD is often more difficult than other forms of ASD and may require special imaging such as TEE, magnetic resonance imaging, or computed tomographic scanning. In conclusion, cardiologists must be aware about the possibility of SVD patients who have unexplained exertional dyspnea and fatigue, dilated right atrium and ventricle, pulmonary hypertension, paradoxical embolism, or atrial arrhythmias in their respective populations.
  1,499 153 -
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
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.
  1,441 188 -
Exercise training in heart failure: High-intensity interval training versus moderate-intensity continuous training
Raymond Pranata, Emir Yonas, Bambang Budi Siswanto, Budhi Setianto Purwowiyoto
July-September 2018, 4(3):41-45
Prevalence of heart failure (HF) increases over time and is associated with high mortality. Shortness of breath, exercise intolerance, and low quality of life related to health are the common problems in HF patients despite optimum pharmacological therapy. Exercise training counteracts the progression of devastating compensatory mechanisms of HF, leading to improvement in functional capacity and quality of life. Resistance training improves peak oxygen uptake, quality of life, and walking performance in HF patients. Adherence is central to training for the best result. Any exercise training program whether continuous or interval training is sufficient to improve the prognosis, quality of life, and anatomic function.
  1,386 236 -
In-Hospital cost comparison of transcatheter closure versus surgical closure of secundum atrial septal defect
Emre Ozdemir, Eser Variş, Tuncay Kiriş, Sadik Volkan Emren, Cem Nazli, Mehmet Tokaç
April-June 2018, 4(2):28-31
Introduction: We compared transcatheter and surgical closure of secundum atrial septal defects (ASDs) in terms of cost in this study. Materials and Methods: Between 2006 and 2015, 291 consecutive patients having secundum ASD, in whom percutaneous or surgical closure was performed, were included in this study. We compared the in-hospital cost of transcatheter versus surgical ASD closure in these patients. Results: We collected totaly 291 patients, 214 transcatheter and 77 surgical closure procedures, retrospectively. Patients with a surgical closure had a longer length of stay (11.8 ± 3.8 days vs. 2.8 ± 1.6 days, P < 0.001). There was no in-hospital mortality in two groups. Costs denominated in Turkish lira (TL) and United States Dollar (USD) of transcatheter closure were higher than that of surgical closure (TL 10955.6 ± 183.4 vs. TL 6016.7 ± 371.9 P < 0.001; USD 6531.2 ± 149.62 vs. USD 3896.2 ± 234.7 P < 0.001). The cost of percutaneous ASD closure increase does not correlate with the dollar rate on the annual basis. This with the supplier firms has excessive profits in the first year of the study. Conclusion: Compared with other countries with regard to cost, transcatheter ASD closure is a more expensive treatment than surgical closure in our country.
  1,464 116 -
Percutaneous intervention in acute pulmonary embolism
Berkay Ekici, Murat Eren
January-March 2018, 4(1):6-9
Pulmonary thromboembolism (PTE) is usually caused by deep vein thrombosis (DVT) in the lower extremities; which can be as varied clinical spectrum as asymptomatic embolism detected incidentally to serious disease with massive embolism causing death. A 44 year-old female patient was admitted to emergency department with complaints of general condition impairment, hypotension and marked dyspnea. She had a fracture on the right femur proximal region after falling a month ago. Lower extremity Doppler ultrasonography revealed findings consistent with acute deep vein thrombosis in the right lower extremity. Emergency pulmonary CT angiography revealed bilateral massive pulmonary thromboembolism extending especially from the main pulmonary artery to the right pulmonary artery. IV thrombolytic was contraindicated as a result of head trauma and subdural hematoma history a month ago. The patient was taken to the catheter laboratory and we performed a selective thrombus aspiration and fragmentation. The vital signs and hemodynamics of the patient improved rapidly after the procedure. This case report is important for demonstrating rapid percutaneous management of a young female patient with a life-threatening condition and favourable outcome of percutaneous intervention despite many comorbid conditions.
  1,158 165 -
Predictors of premature clopidogrel discontinuation within 30 days of successful coronary artery stenting
Çayan Cakir, Haci Ates, Baris Kiliçaslan, Cem Nazli, Oktay Ergene
January-March 2018, 4(1):1-5
Objective: We aimed to determine the prevalence, predictors, and mortality rate of premature clopidogrel discontinuation within 30 days of successful coronary stenting. Methods: All consecutive patients who underwent successful coronary stent implantation at our hospital between December 2006 and December 2007 were prospectively included in this study. Patients were interviewed by telephone 30 days after stent implantation. Premature clopidogrel discontinuation was defined as follows: patients who did not continue clopidogrel after discharge were defined as “never used” and patients who received clopidogrel for <20 days or interrupted therapy for at least 5 successive days within the first 30 days were defined as “partially used.” Results: Follow-up data were available for 381 patients and 58 (15.2%) patients reported premature clopidogrel discontinuation. No mortality and only 1 (0.3%) stent thrombosis occurred in adherent patients, whereas there were 2 (3.4%) mortalities and 6 (10.3%) stent thrombosis in the patients who prematurely discontinued clopidogrel. Those who discontinued clopidogrel therapy were older (P = 0.02), more likely to be female (P = 0.02), single (P = 0.03), of lower economic (P < 0.05) and educational status (P < 0.01), more likely to have chronic disease (P = 0.04), less likely to have undergone previous stenting (P = 0.01), and were more likely to be receiving a larger number of drugs (P < 0.05). In multivariate analysis, low- or intermediate-economic status, no history of previous stent implantation, and total number of prescribed drugs using were factors independently associated with premature clopidogrel discontinuation. Conclusion: This study demonstrates several predictors of premature clopidogrel discontinuation. This data may help clinicians pay particular attention to these patients in an attempt to improve the outcomes of coronary stenting.
  1,074 150 -
Complete aortic prosthetic valve dehiscence after modified Bentall-De Bono procedure
Onur Tasar, Arzu Kalayci, Can Yucel Karabay, Cevat Kirma
January-March 2018, 4(1):10-11
A 56-year-old male patient was admitted to our clinic due to persistent fever despite the use of antibiotics for 2 weeks, chest pain, and presyncope. His medical history revealed that the patient underwent modified Bentall-De Bono procedure 2 months ago due to ascending aortic aneurysm and severe aortic insufficiency. Transthoracic apical 5 chamber view showed that mobile vegetation prolapsed into the left ventricular outflow tract during ventricular diastole and that mechanical prosthetic valve was superior to the aortic annulus. Transesophageal echocardiography revealed normal aortic mechanical prosthetic valve function; however, the valve was positioned more superior to the annular plane and a dense vegetation was observed. Moreover, a complete dehiscence of the prosthetic valve was attached to aortic annulus with a single stitch in an area between noncoronary sinus and left coronary sinus. Dense thrombus formation was observed in the perivalvular region. Many cases with prosthetic valve endocarditis and partial dehiscence as its complication have been reported in the literature. However, to the best of our knowledge, there is no reported case of complete dehiscence secondary to infective endocarditis following complete ascending aortic graft and prosthetic aortic valve replacement (modified Bentall-De Bono procedure).
  1,017 128 -
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
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.
  993 122 -
Congenital and acquired Lutembacher's syndrome presenting in two adults
Umut Kocabas, Ugur Onsel Turk
July-September 2018, 4(3):59-61
The coexistence of atrial septal defect (ASD) and mitral stenosis (MS) is defined as Lutembacher's syndrome (LS). LS was originally defined as the development of MS in a patient having a congenital ASD diagnosis. However, as the percutaneous interventions for MS have become widespread, the persistence of associated iatrogenic ASDs caused has given rise to a different form of the disease. LS may occur as spontaneous or iatrogenic ASD concomitant with acquired MS; this form is known as “acquired LS.” This report presents two cases illustrating congenital LS and “acquired LS.”
  957 129 -
Double orifice mitral valve: An incidental finding
Bhavin Brahmbhatt, Nikunj Vaidhya, Vaibhav Jain, Mrinal Patel, Amit Mishra
July-September 2018, 4(3):62-63
A double orifice mitral valve (DOMV) represents a rare congenital malformation characterized by two valve orifices with two separate subvalvular apparatus. We present an interesting case of an asymptomatic 1 year and 8 months old male child with DOMV who successfully underwent surgery.
  876 130 -
Does pulmonary endarterectomy have arrhythmia prevention effect?
Tarik Kivrak, Bedrettin Yıldızeli, Bülent Mutlu
April-June 2018, 4(2):23-27
Background: The aim of the present study was therefore to evaluate the evolution of electrocardiography (ECG) markers indicator of morbidity and mortality after pulmonary endarterectomy (PEA). It may be a good predictor of mortality and morbidity in chronic thromboembolic pulmonary hypertension (CTEPH) with patients who underwent PEA. PEA may be reduced risk of arrhythmia in patients with CTEPH. However, this claim must to be supported with long-term results. Materials and Methods: We collected demographic, ECG, and echocardiographic parameters data (baseline and after the operation) in patients undergoing PEA for CTEPH at our institution from 2009 to 2013.We assessed 62 CTEPH patients who underwent PEA. Results: P wave amplitude in DII, PR interval, P and QT dispersion changed significantly at 3 months after surgery. The P dispersion (17.66 ± 6.2, P < 0.04) and QT dispersion (23.75 ± 11.37, P < 0.015) were longer in before operation than in after operation. Conclusions: In our study, we found in ECG analyses of CTEPH with patients who are undergoing PEA that P dispersion, QT dispersion were changed when compared with before operation. For this reason, we think that PEA reduces the risk of atrial fibrillation and malignant arrhythmia.
  865 111 -
The association of uncarboxylated matrix gla protein with mitral annular calcification in patients without significant coronary artery disease
Zeki Simsek, Elnur Alizade, Firdovsi Ibrahimov, Ali Metin Esen
April-June 2018, 4(2):19-22
Objective: Mitral annular calcification (MAC) is associated with systemic calcification and cardiovascular disease (CVD) events. Matrix Gla protein (MGP) is a strong inhibitor of vascular and soft-tissue calcification and reduced levels of its circulating precursor, uncarboxylated MGP (ucMGP), was found associated with vascular calcification in pilot studies. Methods and Results: In this study, which includes 86 outpatients with no significant coronary artery and chronic kidney diseases, we measured serum ucMGP levels and evaluated MAC using echocardiography. In participants with MAC (n = 44), serum ucMGP levels were lower than the control group (n = 42) (216.1 ± 154.1 vs. 390.2 ± 256.3, P = 0.001, respectively). The patients with MAC were divided into two groups: mild MAC group and moderate MAC group. Serum ucMGP levels were significantly lower in the moderate MAC group than the mild MAC group (139.0 ± 121.8 vs. 248.4 ± 156.3, P = 0.03, respectively). Conclusions: In patients with MAC, serum ucMGP level was significantly low, and this association has been detected for the first time in patients with no significant coronary artery disease (CAD).
  839 106 -
Is it a new late complication of transcatheter aortic valve implantation?
Özgen Safak, Ilgın Karaca, Murat Özgüler
April-June 2018, 4(2):32-34
Transcatheter aortic valve implantation (TAVI) is a novel method for patients with severe aortic stenosis at high surgical risk. Although short- and medium-term outcomes after TAVI are encouraging, long-term data on valve function and clinical outcomes are limited. Hence, our case can make a contribution to literature. An 80-year-old patient with severe aortic stenosis underwent TAVI in our clinic in October 2015. After 5 months, she admitted to our emergency department with severe dyspnea. Her symptoms were started within 2 days and getting worse day by day. Echocardiography revealed us a severe aortic regurgitation due to dislocation of the valve to the left ventricular outflow tract side. After diagnosis, aortic regurgitation was treated by valve-in-valve technique. TAVI may provide an alternative therapeutic approach to ineligible or poor surgical candidates of degenerative aortic stenosis. However, this technique also has some complications such as mortality, atrioventricular (AV) block, stroke, and coronary obstruction. Valve embolization is an another rare complication of this procedure and usually can be prevented by careful preprocedure annulus measurements, stable lead positioning for rapid pacing, optimal valve positioning, full balloon inflation at the time of valve deployment, and complete balloon deflation before stopping rapid pacing. At this point, our case became important for the complication literature with its time, about 5 months. Because it is the more recently used technique, we need much more time to detect the usefulness and complications of TAVI and learn how to avoid these complications.
  784 102 -
Thrombus in transit causing acute massive pulmonary emboli treated successfully with reteplase administration
Muhammet Bugra Karaaslan, Aziz Inan Celik, Caglar Emre Cagliyan, Mesut Demir
April-June 2018, 4(2):35-36
Acute pulmonary thromboembolism (PTE) is a leading cause of mortality and morbidity. Observation of the right atrial thrombi is a rare condition, which usually accompanies to massive PTE. Urgent treatment strategies for rapid thrombus removal are mandatory in patients presenting with acute massive PTE. In this paper, we present a patient admitting with acute massive PTE to our emergency department, in whom concomitant right atrial thrombus was successfully treated with reteplase.
  760 112 -
Glomerular filtration rate calculated by modification of diet in renal disease formula can be an indicator of impaired glucose tolerance and diabetes in coronary artery disease
Sinan Varol, Okay Abaci, Muhsin Kalyoncuoglu, Vedat Sansoy
July-September 2018, 4(3):46-52
Background: There is an increased risk for coronary artery disease (CAD) at modestly elevated levels of blood glucose which is still below the present threshold for type 2 diabetes mellitus (T2DM). In the present study, we aimed to define impaired glucose tolerance (IGT) and T2DM in patients with stable CAD and observe the relationship between clinical and laboratory findings. Materials and Methods: A total of 132 patients who had stable CAD and who had not been diagnosed as glucose intolerance or diabetes were enrolled. In one of the groups, there were patients with IGT or T2DM results and the other one consisted of patients with normal oral glucose tolerance test (OGTT) results. The Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was investigated in patients with fasting plasma glucose (FPG) <100 mg/dl. Results: The prevalance of IGT and T2DM was 30.3%. In IGT + T2DM group, waist/hip ratio and creatinin level were significantly higher and estimated glomerular filtration rate (eGFR) was low. Only eGFR calculated by Modification of Diet in Renal Disease (MDRD) formula was a reliable parameter. MDRD eGFR ≤70 ml/dk/m2 independently predicted IGT + T2DM diagnosis with 50% sensitivity but with 82% specificity. Although it is insufficient to use it as an optimal screening test because of lower sensitivity, it can be a reliable indicator of IGT + DM in patients who had eGFR ≤70. Insulin resistance was diagnosed in 29% of patients whose pretest values were FPG <100 mg/dl. Conclusion: MDRD eGFR can be an indicator for IGT + T2DM. OGTT irrespective of FPG level should be used to determine the presence of IGT + T2DM in stable CAD.
  733 133 -
Comparison of anthropometric indices in predicting the risk of hypertension, Iran - 2014
Hossein Lashkardoost, Fateme Hoseyni, Elham Rabbani, Farzane Qorbani Moqadam, Leila Hosseini, Salimeh Azizi, Andishe Hamedi
October-December 2018, 4(4):77-81
Purpose: The best anthropometric index has not been established to investigate the relationship between hypertension and obesity. Since a similar study was not conducted in Bojnurd, we began to investigate the comparison of anthropometric indices (body mass index, waist circumference, and waist-to-hip and waist-to-height ratios) in predicting the risk of hypertension. Materials and Methods: The present cross-sectional study was conducted on women referring to Bojnurd health centers. For analyzing the data, we used t-test, Chi-square, logistic regression, and the receiver operating characteristic curve in SPSS 19 software. Results: The prevalence of blood pressure was 53.4% (confidence interval = 46.8–60). All four anthropometric indicators were used as a screening tool for hypertension diagnosis; however, body mass index (BMI) had a higher sub-curved surface than other anthropometric indices (area under curve = 0.717). The cutoff point of BMI for predicting the risk of hypertension was 25.6. Conclusions: This study suggested that BMI as an anthropometric indicator to evaluate the risk of hypertension. Since a significant percentage of people are unaware of the existence of hypertension, continuing education is needed to encourage people to pay more attention to this problem.
  661 115 -
Predictive values of inflammatory cell ratios for complexity of coronary artery disease in patients with acute coronary syndrome
Ahmet Karakurt, Cennet Yildiz
October-December 2018, 4(4):70-76
Background: The aim of this study was to investigate the relationship between neutrophil to lymphocyte ratio (NLR) platelet to lymphocyte ratio (PLR), mean platelet volume to lymphocyte ratio (MPVLR), MPV to platelet ratio (MPVPR) and the complexity of coronary artery disease (CCAD) in patients with acute coronary syndrome (ACS) using the SYNTAX score (SS) algorithm. Materials and Methods: A total of 599 patients with ACS undergoing coronary arteriography were enrolled and divided into three groups according to their SS: low SS group ≤22 (low-SSG,); intermediate SSG ≥23 and ≤32 (in-SSG,); and high- SSG ≥33 (high-SSG). Routine complete blood count parameters were analyzed at hospital admission. Results: There were significant differences between three groups in terms of PLR and MPVLR values (P = 0.007 and P = 0.029). Correlation analysis showed that PLR and MPVLR were positively correlated with CCAD (r = 0.095, P = 0.018 and r = 0.112, P = 0.005, respectively). In multivariate logistic regression analysis, MPVLR was not an independent predictor of CCAD, whereas PLR was found to be a weak independent predictor of CCAD (odds ratio = 1.003 [1.001–1.006], P = 0.021). Receiver operating characteristics analysis showed that PRL had low sensitivity (56.2%) and specificity (51.6%) for prediction of CCAD. Conclusion: Our study showed that NLR, MPVPR, and MPVLR were not independent predictors of CCAD in patients with ACS. PLR had such a weak relationship with CCAD that it could not be used for prediction of CCAD in these patients.
  653 116 -
Is there a correlation between systolic heart failure and levels of toll-like receptor-5 and N-terminal pro-B-type natriuretic peptide?
Cetin Mirzaoglu, Tarik Kivrak, Mehmet Balin, Mehmet Ali Kobat, Orhan Dogdu, Ilgin Karaca
October-December 2018, 4(4):65-69
Objective: Specific biomarkers are essential in the diagnosis of heart failure. Our trial aim is determined that relationship between toll-like receptor-5 (TLR-5) and N-terminal pro-B-type natriuretic peptide (NT-ProBNP) in patients with reduced ejection fraction. Methods: Two groups were formed in our study (normal and patient group). Among the two groups were investigated that relationship between TLR-5 and NT-ProBNP. Results: The plasma levels of both NT-ProBNP and TLR-5 are significantly higher in patients with congestive heart failure than healthy individuals. However, there is no definite correlation between plasma levels of NT-ProBNP and TLR-5 in patients with congestive heart failure. The high-level plasma TLR-5 is of prognostic value independent from the plasma NT-ProBNP levels, in these patients. Conclusion: As a conclusion, according to recent studies, the high plasma levels of NT-ProBNP and TLR-5 are mainly associated with high mortality and longer hospitalization rate in individuals with heart failure. Therefore, the higher is plasma levels of markers such as TLR-5 and NT-ProBNP, the worse is the overall prognosis in these patients. NT- ProBNP and TLR-5 are thought to be the cheapest and the most appropriate marker to be determined.
  620 127 -
A snare retrieval experience of coil migration in a large coronary artery fistula
Mithat Selvi, Hasan Gungor, Sevil Gulasti
April-June 2018, 4(2):37-39
A 45-year-old female patient was referred due to the abnormal myocardial perfusion scintigraphy showing ischemia in the inferior and lateral wall. Coronary arteries were normal, and a large fistula was detected from the proximal portion of the circumflex coronary artery (Cx) draining into the pulmonary artery. Percutaneous closure of the coronary artery fistula (CAF) was considered, and a 3 mm × 50 mm-Balt coil was planned to place the proximal portion of the fistulized artery. Unfortunately, during placement of the coil, it was opened early and migrated to the proximal segment of the Cx, the left anterior descending artery, and the distal part of the left main coronary artery. A snare was moved into the extra backup guiding catheter immediately. The migrated coil was retrieved with the snare successfully. Subsequently, 4 mm × 12 mm and 2 mm × 25 mm-Balt coils were placed in the mid portion of the fistulized artery until total occlusion was obtained. A CAF is described as a direct connection between one or more of the coronary arteries and a cardiac chamber or great vessel. The fistula may cause serious hemodynamic disturbances such as myocardial ischemia, high-flow heart failure, right ventricle volume overload, endocarditis, rupture, thrombosis, embolism, and arrhythmias. Percutaneous closure is the prior technique, in the absence of complex conditions such as multiple fistulas and large fistula branches and in cases where the fistula can be simply reached. There have been very rare data which contain complications about the percutaneous closure of CAFs.
  612 71 -
Potential factors affecting the anticoagulation control in patients treated with warfarin: Results WARFARIN-TR study
Salih Kilic, Ahmet Çelik, Ali Sabri Seyis, Ozge Kurmus, Kamil Tülüce, Zeynep Yapan Emren, Ali Kemal Kalkan, Mehdi Zoghi
October-December 2018, 4(4):86-89
Background: In the present study, we aimed to evaluate the factors that might be caused by adequate anticoagulation control in patients treated with warfarin for any reason. Methods: The WARFARIN-TR (The Awareness, Efficacy, Safety, and Time in Therapeutic Range of Warfarin in Turkish Population) study included 4987 patients using warfarin between January 1, 2014 and December 31, 2014. Time in therapeutic range (TTR) was calculated according to F. R. Roosendaal's algorithm with linear interpolation. The study population divided into two groups; adequate international normalized ratio (INR) control when TTR ≥70% (Group 1, n = 1068, 21.4%) and inadequate INR control when TTR <70% (Group 2, n = 3919, 78.6%). All demographic and clinic characteristics of the patients were compared to determine possible factors that might be cause adequate warfarin use. Results: The mean age of the study population was 60.7 ± 13.5 years, and there was no significant difference between groups. The mean TTR value of Group 1 was significantly higher than Group 2 (80 ± 8.5 vs. 40.9 ± 17.2; P < 0.001). The traditional cardiovascular risk factors were similar between groups except hypertension (Group 1 51.4% and Group 2 56.4%; P = 0.004) and chronic kidney disease (Group 1 8.3% and Group 2 5.5%; P = 0.001). There were no significant differences between groups regarding bleeding. The awareness of warfarin use was significantly higher in Group 1 patients than Group 2 patients. Multivariate logistic regression analysis revealed that age (odds ratio [OR], 1.007; P = 0.014), hypertension (OR, 0.821; P = 0.01), atrial fibrillation (OR, 1.180; P = 0.033), chronic kidney disease (OR, 1.697; P < 0.001), to know warfarin use reason (OR, 1.699; P < 0.001), and know to food-drug interaction with warfarin (OR, 1.583; P < 0.001) were independent predictors of adequate coagulation. Conclusion: Our study demonstrated that a low proportion of patients taking warfarin achieve an adequate TTR in daily practice. Furthermore, the patients with adequate TTR are more aware of warfarin use.
  587 91 -
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
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.
  548 84 -
Brugada syndrome: A brief review on diagnostic approach, risk stratification, and management
Raymond Pranata
January-March 2019, 5(1):1-7
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.
  457 96 1
Association of neutrophil to lymphocyte ratio with lower patency rates among patients with infrapopliteal arterial disease undergoing balloon angioplasty
Abdulkadir Uslu, Regayip Zehır, Elnur Alızade, Ayhan Küp, Zubeyde Bayram, Ahmet Guner, Süleyman Barutcu
October-December 2018, 4(4):90-95
Introduction: Percutaneous endovascular methods have emerged to the contemporary revascularization choice in patients with infrapopliteal (IP) arterial disease. However, restenosis remains to be the Achilles' heel of this minimally invasive revascularization techniques. We aimed to analyze the association between preprocedural (neutrophil to lymphocyte ratio) Neutrophil-to-Lymphocyte ratio (NLR) and subsequent patency in a cohort of patients with symptomatic IP disease undergoing balloon angioplasty. Methods: All patients primarily treated with angioplasty of at least one IP artery causing severe symptoms or critical limb ischemia (CLI) (Rutherford category 1–6) between January 2014 and August 2015 were analyzed. The baseline demographic, clinical, and angiographic features admission laboratory test results were obtained from hospital files and computer records. NLR was calculated as the preprocedural ratio of neutrophils to lymphocytes. Results: The study population involved 42 (43.8%) CLI patients and 52 (54.2%) claudicants. The most frequent target vessel was the posterior tibial artery. Primary patency at 1 month was 81.9% and 62.7% at 6 months. NLR (odds ratio: 0.04, P = 0.03) independently predicted patency at 1 month but did not have a role on arterial patency after 1 month. Only smoking (odds ratio: 4.8, P = 0.01) associated with patency at 6 months. Conclusion: Preprocedural NLR was an independent risk factor for IP arterial patency at short-term. It may be used as a risk factor for subsequent amputation or recurrent interventions.
  429 54 -
Nebivolol prevents the increase of asymmetric dimethylarginine and oxidants in hyperhomocysteinemic rats
Mustafa Ahmet Huyut
January-March 2019, 5(1):8-14
Objective: The objective of this study was to determine nebivolol's inhibitory effect on endothelial dysfunction in hyperhomocysteinemic rats, based on heart pathology and biochemical analysis of serum samples. Methods: Male Wistar albino rats weighing between 200 g and 450 g were randomly divided into four groups of equal number (n = 7) as follows: control group, nebivolol group, methionine group, and methionine + nebivolol group. After 28 days, homocysteinemia (Hcy), asymmetric dimethylarginine (ADMA), malondialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR), superoxide dismutase (SOD), and catalase (CAT) levels were measured in blood samples and compared between groups. Each rat's hearts were dissected to observe cardiomyocyte degeneration; findings were compared between groups. Results: Moderate hyperHcy (hHcy) (Hcy 35.62 ± 7.60 μmol/L) was noted in methionine group (P < 0.001). The levels of the antioxidant molecules CAT, GSH, GPx, GR, and SOD were lower, and the levels of the oxidant molecules ADMA, Hcy, and MDA were higher in methionine group (P < 0.001). A decrease in antioxidants and also increase in oxidants did not occur in the methionine + nebivolol group (P < 0.001). Cardiomyocyte degeneration was more severe in methionine group (P = 0.01). Conclusion: Endothelial dysfunction induced through short-term hHcy can be prevented through the administration of nebivolol. Nebivolol can prevent elevation of the Hcy levels, and hHcy might cause cardiomyocyte degeneration.
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Cardioembolic ischemic stroke as the initial presenting complaint of a patient with acute infective endocarditis and acquired immunodeficiency syndrome
Raymond Pranata, Veresa Chintya, Emir Yonas, Vito Damay
January-March 2019, 5(1):18-21
Human immunodeficiency virus (HIV) infection is an independent predictor of ischemic stroke, especially in the younger age group. Approximately 1%–5% of HIV/acquired immunodeficiency syndrome patients develop stroke. A 16-year-old male presented with a decreased level of consciousness and a history of right-sided hemiparesis, fever, cough, and dyspnea. The patient was an intravenous drug user (IVDU). Examination revealed the following: blood pressure: 130/70 mmHg, heart rate: 124×/min, temperature 38.5°C, and respiratory rate: 26×/min. Electrocardiographic findings revealed the following: sinus tachycardia: 124×/min, right-axis deviation, incomplete right bundle branch block, and right ventricular hypertrophy. Laboratory findings were as follows: microcytic hypochromic anemia (7.33 g/dL), leukocytosis (32.2 × 10^3/μL) with shift to the left, hyponatremia (122 mmol/L), HIV was positive, and chest X-ray showed pneumonia. Echocardiography showed vegetation in the posterior mitral leaflet, mitral regurgitation, and tricuspid regurgitation with an intact interatrial septum. Computed tomography scan revealed ischemic stroke of the left parieto-occipital lobe. HIV-infected individuals are at 1.5 times increased risk of stroke compared to those without. This case involves an IVDU and a HIV-positive young male presenting with large ischemic stroke in large-vessel territory, suggestive of embolic origin. A part of vegetation on the left side of the heart of this patient dislodged and caused a cerebrovascular accident. There was also unconfirmed suspicion of pulmonary embolism from the right side of the heart. Empiric antibiotics should be started before tailoring to the result of blood culture. Endocarditis conveys a significant risk of cerebral embolism resulting in ischemic stroke and a potentially dismal prognosis.
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