ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 49 (8)
Volume: 49  Issue: 8 - December 2021
EDITORIAL COMMENT
1. Left ventricular function after transcatheter aortic valve replacement: When reversibility matters
Juan Pablo De Brahi, Juan Maria Farina, Adrian Baranchuk
doi: 10.5543/tkda.2021.21256  Pages 603 - 605
Abstract |Full Text PDF

ORIGINAL ARTICLE
2. Impact of the recovery of left ventricular ejection fraction after TAVI on mortality in patients with aortic stenosis
Barış Kılıçaslan, Barış Ünal, Bayram Arslan, Tuba Ekin, Erdem Özel, Faruk Ertaş, Hüseyin Dursun, Öner Özdoğan
doi: 10.5543/tkda.2021.66495  Pages 606 - 614
Objective: To assess the effects of transvalvular aortic valve implantation (TAVI) on the outcomes of the patients with symptomatic severe aortic stenosis (AS), and predict the effect of left ventricular ejection fraction (LVEF) and cardiac structural recovery on mortality after the TAVI in patients with different stage of LV function.

Methods: Out of 191 patients, 151 consecutive patients in 3 centers were evaluated for outcome analysis. Patients were classified into 3 subgroups as AS with reduced ejection fraction (ASrEF) (LVEF <40%), AS with mildly reduced EF (ASmrEF) (LVEF 40-49%) and AS with preserved EF (ASpEF) (LVEF ≥50%).

Results: The mean follow-up period was 19.4±12.4 (up to 54) months. All-cause mortality was not different among all 3 groups. (p=0.901). In multivariate analysis, stroke volume index (SVI) (Exp(B): 0.039, 95% confidence interval [CI]: 0.011-0.013, p<0.001), baseline blood urea nitrogen (Exp(B): 1.022, 95% CI: 1.006-1.038, p=0.006), and percent LVEF change after TAVI (d-LVEF) (Exp(B): 0.046, 95% CI: 0.004-0.610, p=0.046) were the independent predictors for mortality after TAVI. The receiver operating characteristic curve analysis showed that the cutoff value of “≤10%” for d-LVEF had sensitivity of 50%, specificity of 75%, and an area under the curve of 0.72 in predicting mortality in patients with SVI <35 mL/m2.

Conclusion: Improvement of LVEF after TAVI, which reflected the marked LV reverse remodeling, has an impact on the prediction of the survival in patients with AS, and this is more prominent in patients with low SVI.

EDITORIAL COMMENT
3. Is it time to abandon Friedewald formula? New equations for LDL-C calculation
Özcan Başaran
doi: 10.5543/tkda.2021.21265  Pages 615 - 618
Abstract |Full Text PDF

ORIGINAL ARTICLE
4. Comparison of Martin and Friedewald equation for estimated LDL-C in adults
Medine Alpdemir, Mehmet Fatih Alpdemir
doi: 10.5543/tkda.2021.90446  Pages 619 - 626
Objective: In this study, we aimed to compare the directly measured low-density lipoprotein cholesterol (LDL-C), Friedewald, and a new Martin LDL-C formula in the Turkish adult population.
Methods: A total of 1,558 patients between the ages of 18 and 65 years with a triglyceride level of <400 mg/dL were included in this study. Serum lipid profiles of all the patients were measured with Cobas 6000 c501 (Roche Diagnostic), and LDL-C concentrations were measured by a homogeneous direct method using reagents. [TC- (HDL-C+(TG/5)] and Martin [TC- (HDL-C+TG / new adjustable factor)] formulas were used to estimate LDL-C.
Results: The average age of the patients was 52.7±12.3 years. Of the 1,558 patients, 56% were women and 44% were men. The d-LDL-C, F-LDL-C, and M-LDL-C concentrations in all the patients were 148.6±39.8 mg/dL, 123.9±38.7 mg/dL, and 133.4±35.9 mg/dL, respectively. The mean difference between F-LDL-C and M-LDL-C concentrations according to d-LDL-C was 24.6±10.7 and 15.10±10.3, respectively. For comparing the scatter blot plot [estimated LDL-C(x) and d-LDL-C(y)] were calculated by the equations y=1.1665x+0 for Friedewald and y=1.1667x+0 for Martin. When compared to the d-LDL-C concentration, both the Friedewald and Martin formulas showed a strong correlation (r=0.963, r=0.968, respectively). The new adjustable factor mean of the Martin formula was 6.1±0.9.
Conclusion: In our study, the Martin formula showed a relatively better separation. Although there was a strong correlation between the formulas and d-LDL-C, there was a negative bias for the two formulas. These formulas show a lower risk in the determination of the risk of coronary heart disease and in the planning of treatment strategies.

EDITORIAL COMMENT
5. Generalizability and transportability of research findings: Randomized trials vs observational studies
Oğuzhan Birdal, İbrahim Halil Tanboğa
doi: 10.5543/tkda.2021.21283  Pages 627 - 629
Abstract |Full Text PDF

ORIGINAL ARTICLE
6. Dabigatran for stroke prevention in real life in a sample of population from Turkey: D-SPIRIT registry
Cihan Altın, Caner Topaloğlu, Nurullah Çetin, Onur Dalgıç, Veysel Yavuz, Emin Alioğlu, Nazile Bilgin, Cenk Ekmekçi, Nihat Pekel, Mehmet Emre Özpelit, Eşref Tunçer, Ebru İpek Türkoğlu, Kamil Tülüce, Umut Kocabaş, Kıvanç Yüksel, Uğur Önsel Türk
doi: 10.5543/tkda.2021.07734  Pages 630 - 640
Objective: The D-SPIRIT registry is designed to investigate the safety and effectiveness of dabigatran etexilate in patients with atrial fibrillation in routine clinical practice.

Methods: D-SPIRIT is the first national, multicenter, prospective, observational, postmarketing registry that investigates the usage of dabigatran in real life. A total of 326 noveloral anticoagulant–eligible patients with atrial fibrillation who have been taking dabigatran etexilate therapy for stroke prevention at least 6 months from 9 different centers were enrolled into the registry. Patients were followed up for 2 years to evaluate the effectiveness and safety of the treatment. All adverse clinical events including bleeding, thromboembolic events, stroke, systemic embolism, transient ischemic attack, myocardial infarction, and all-cause death were recorded.

Results: The mean age was 71.1±9.6 years, and 57.4% of the study participants were female. The mean CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack [TIA], vascular disease, age 65-74 years, sex category) score was 3.4±1.6. The cumulative adverse clinical events rate was 6.30% per year. The rate for embolic events including TIA, ischemic stroke, and peripheral embolism was 1.26% per year. The rate for major bleeding was 2.20% per year, and the mortality rate was 0.94% per year.

Conclusion: This registry obtained an important overview of the current safety and effectiveness of the dabigatran etexilate in Turkey. Our results indicate similar rates of thromboembolic and bleeding events with pivotal phase 3 trial and other real-life registries. However, rate of undertreatment usage of dabigatran etexilate in real life was found to be considerable.

7. Investigation of Scavenger Receptor Class B Type I gene variants in patients with coronary heart disease with a history of early myocardial infarction
Burcu Çaykara, Bengü Tokat, Ender Coşkunpınar, Özlem Küçükhüseyin, Deniz Kanca Demirci, Zehra Buğra, Gülçin Özkara, Oğuz Öztürk, Sadrettin Pençe, Hülya Yılmaz Aydoğan
doi: 10.5543/tkda.2021.08691  Pages 641 - 653
Objective: The scavenger receptor class B type 1 (SR-BI, SCARB1), which is a high-density lipoprotein (HDL) receptor that mediates selective cholesteryl ester uptake, plays an important role in reverse cholesterol transport. This study investigated the distribution of polymorphic variants of the SR-BI gene in patients with coronary heart disease (CHD) with a history of early myocardial infarction (MI) at an early age and their effects on their serum lipid levels.
Methods: SR-BI rs5888(T>C), rs4238001(C>T), and rs10846744(G>C) were analyzed in 100 male patients with CHD with a history of MI (MI+) who were younger than 50 years and 89 male control subjects without MI history (MI−) using real-time polymerase chain reaction (PCR) and mutant-allele–specific PCR techniques.
Results: SR-BI rs4238001 common-CC genotype was found to be more frequent in patients with MI+ than in control subjects (MI−; odds ratio 4.046, p<0.001). The rs10846744 rare-C allele showed a significant association with increased total cholesterol (p=0.014) and triglyceride (p=0.009) levels in the MI+ CHD group. Logistic regression analysis confirmed that there may be an association between the rs4238001-CC genotype (p=0.002), smoking (p=0.026), and MI+ CHD in the presence of other risk factors associated with CHD, whereas haplotype analysis confirmed that patients with MI+ CHD (rs5888-C, rs10846744-G, and rs4238001-C alleles) and CCC (rs5888-C, rs10846744-C, and rs4238001-C alleles) haplotypes were highly frequent (p<0.01 and p=0.027, respectively).
Conclusion: These results indicated that SR-BI gene variants show different distribution in patients with MI+ CHD compared with that in MI– control subjects, and these variants may have effects in favor of dyslipidemia.

8. Revascularization strategies in patients with infective endocarditis-related ST-elevation myocardial infarction: The STEMI-ENDO Registry
Ahmet Güner, Yeşim Uygun Kızmaz, Sabahattin Gündüz, Çağdaş Arslan, Serpil Özkan Öztürk, Elnur Alizade, Macit Kalçık, Serkan Kahraman, Cemalettin Akman, Ali Kemal Kalkan, Mehmet Özkan
doi: 10.5543/tkda.2021.21173  Pages 654 - 665
Objective: Infective endocarditis (IE)-related ST elevation myocardial infarction (STEMI) is extremely rare. A clear clinical consensus is lacking regarding the management of this emergency. In this study, we aimed to describe the clinical outcomes of treatment strategies in this patient population.
Methods: The study population comprised 19 retrospectively evaluated patients (nine women; mean age 52±11.8 years) with a diagnosis of IE-related STEMI. Transesophageal echocardiography detected vegetation in all the patients. The study population was divided into two groups on the basis of in-hospital mortality.
Results: Major clinical manifestations included dyspnea (89.5%), fever (78.9%), and chest pain (63.2%). Catheter-based coronary angiography was performed in all the patients. The causative agent was isolated in all the cases, and Staphylococcus aureus was identified in seven (36.8%). The most common infarction was in the left anterior descending artery (n=12 [63.2%]). The treatment strategy consisted of mechanical thrombectomy (n=1), valve replacement following stent implantation (n=5), direct balloon angioplasty (n=4), valve replacement along with coronary artery bypass grafting (CABG; n=6), and medical follow-up (n=3). Moreover, thrombolysis in myocardial infarction III flow was significantly higher in the survival group (100% vs. 0%, p<0.001). All these patients preferred CABG or stent implantation for revascularization.
Conclusion: The current data suggest that a revascularization strategy with stent implantation or revascularization with CABG has a lower mortality rate in patients with IE-related STEMI.

9. The relationship between serum rheumatoid factor level and SYNTAX score I in patients with acute myocardial infarction
Alaa Quisi, Huda Almadhoun, Gökhan Alıcı, Ömer Genç, Taner Şeker, İbrahim Halil Kurt
doi: 10.5543/tkda.2021.22457  Pages 666 - 674
Objective: Rheumatoid factor (RF) has been associated with an increased likelihood of developing coronary artery disease and cardiovascular mortality. This study aimed to evaluate the relationship between serum RF levels and SYNTAX score I (SSI) in patients with acute myocardial infarction.
Methods: This study included 418 consecutive patients who were diagnosed with acute myocardial infarction and underwent coronary angiography. The baseline serum RF levels of all patients were measured. The study population was divided into 2 groups, namely, ST-segment elevation myocardial infarction (STEMI) group (218 patients) and non-ST-segment elevation myocardial infarction (NSTEMI) group (200 patients). Each group was further divided into 2 subgroups, namely, SSI ≤22 group and SSI >22 group.
Results: In the STEMI group, RF levels were significantly higher in the SSI >22 group than that in the SSI ≤22 group (13.0 IU/mL [7.0-51.0 IU/mL] versus 11.0 IU/mL [4.0-37.0 IU/mL], respectively, p=0.002). In the NSTEMI group, RF levels were significantly higher in the SSI >22 group than that in the SSI ≤22 group (15.5 IU/mL [8.0-69.5 IU/mL] versus 13.0 IU/mL [4.0-36.0 IU/mL, respectively], p<0.001). Forward conditional logistic regression analysis demonstrated that neutrophil-to-lymphocyte ratio, total cholesterol level, positive RF, and left ventricular ejection fraction were independently associated with intermediate and high SSI in patients with STEMI. Furthermore, cardiac troponin T levels and positive RF were independently associated with intermediate and high SSI in patients with NSTEMI.
Conclusion: Serum RF concentrations are independently associated with SSI in patients with acute myocardial infarction.

REVIEW
10. Evaluation of coronary flow with computed tomography derived FFR: Advantages and pitfalls
İbrahim Altun, İlknur Altun
doi: 10.5543/tkda.2021.21012  Pages 675 - 681
Coronary computed tomographic angiography (CCTA) is an excellent noninvasive, anatomic imaging modality for direct visualization of coronary arteries and for the assessment of coronary artery disease (CAD). CCTA has high sensitivity and high negative-predictive value for the identification of obstructive CAD; however, its specificity and positive-predictive value are low. After more than a decade of using CCTA to assess the anatomic severity of CAD, novel modalities of obtaining functional information from CCTA have been developed to increase its specificity and accuracy. These modalities use computational fluid dynamics to calculate fractional flow reserve (FFR) from CCTA datasets. Computed tomography-derived FFR (FFRCT) predicts virtual hyperemia for computation. Therefore, no additional image acquisition, medication, radiation exposure, or pharmacologic stress agent during CCTA examination are necessary for the calculation of FFRCT. Multiple, prospective single or multicenter studies have shown that FFRCT is poised to become a gate-keeper for catheterization laboratory. In this article, we aim to review the principles, diagnostic accuracy, advantages, limitations, and pitfalls of FFRCT.

CASE REPORT
11. Percutaneous closure of a complex fistula that originates from all coronary arteries and drains to the pulmonary artery
Ali Nazmi Çalık, Mustafa Azmi Sungur, Şükrü Akyüz
doi: 10.5543/tkda.2021.21059  Pages 682 - 684
A coronary-to-pulmonary-artery fistula (CPAF) is defined as a connection between the coronary arteries and the pulmonary arteries (PAs). Invasive treatment options for CPAFs include surgical ligation and transcatheter coil or plug embolization. A 60-year-old female patient was referred to our hospital with symptoms of exercise-induced angina (Canadian Cardiovascular Society Class III [CCS-3]). Her relevant history included elective stenting of the left anterior descending (LAD) artery in 2013 and surgery for an LAD to PA fistula in 2015. Upon recurrence of the same fistula in 2017, she underwent a failed antegrade (from LAD to PA) attempt for percutaneous closure of the fistula. A retrograde approach was decided because of the extensive tortuosity of the fistula’s proximal part that led to the previous failed attempt and the likelihood of ceasing whole blood flow at the fistula’s distal neck. Through right femoral venous access, we advanced a 5 Fr. 45 cm TorqVue low-profile delivery system (St. Jude Medical, Little Canada, MN, USA) over a J-tip 0.035-inch guidewire to the PA. The antegrade imaging guidance enabled us to advance the guidewire to the distal neck of the fistula retrogradely. As the distal part of the fistula was similar to a tunnel-shaped patent ductus arteriosus (PDA) and was measured 4 mm at the narrowest diameter, we opted for an Amplatzer duct occluder II 6 × 6 (Abbott Vascular, Chicago, IL, USA) to close it.

12. A case of congenital partial absence of the left pericardium presenting with atypical chest pain
Muzaffer Kahyaoğlu, Çetin Geçmen
doi: 10.5543/tkda.2021.21054  Pages 685 - 687
Congenital absence of the pericardium (CAP) is a rare cardiac malformation and can be defined as the partial or total absence of the fibroelastic sac that surrounds the heart and great vessels. As the patients are often asymptomatic or have nonspecific symptoms, the diagnosis of this rare congenital anomaly is difficult. Therefore, it is usually diagnosed incidentally during imaging, intraoperatively, or during postmortem examinations. In this regard, it is important to keep specific images in mind during the examination and to suspect CAP to make an accurate diagnosis. In this report, we present a case of a 42-year-old male who presented with a complaint of atypical chest pain and was diagnosed with CAP using multimodality imaging.

13. Giant ventricular pseudoaneurysm and associated eccentric severe mitral regurgitation: Surgery or follow-up?
Serkan Asil, Veysel Özgür Barış, Suat Görmel, Murat Çelik, Uygar Çağdaş Yüksel
doi: 10.5543/tkda.2021.21148  Pages 688 - 692
A ventricular pseudoaneurysm develops mainly after myocardial infarction complicated by a ventricular free wall rupture contained by localized pericardial adhesions. The risk of rupture in untreated pseudoaneurysms is approximately 30%-45%, and the mortality rate is 50%. Although there is no clear evidence of treatment in the literature, the main suggestion is to perform surgical treatment without delay. However, the age of the patients, additional comorbidities, and the accompanying severe mitral regurgitation and left ventricular systolic dysfunction considerably increase the mortality rate of the surgical procedure. The treatment of left ventricular pseudoaneurysm accompanied by severe mitral regurgitation has not been clarified in the literature, and patient-based individual approaches vary. In this case report, the clinical course of the three patients was explained with different treatment approaches, and we tried to create a resource for treatment approaches in light of the literature.

CASE IMAGE
14. How to deal with a pitfall for left atrial appendix thrombus on CT?
Çağdaş Topel, Sinem Aydın, Gamze Babur Güler
doi: 10.5543/tkda.2021.99079  Page 693
Abstract |Full Text PDF | Video

15. Impact of collateral circulation with fractional flow reserve derived from coronary computed tomography angiography
Toshimitsu Tsugu, Kaoru Tanaka, Dries Belsack, Argacha Jean-François, Johan de Mey
doi: 10.5543/tkda.2021.04567  Pages 694 - 695
Abstract |Full Text PDF | Video

16. Congenital absence of the pericardium
Eyüp Aslan, İbrahim Cemal Maslak, Nevzat Karabulut
doi: 10.5543/tkda.2021.21132  Pages 696 - 697
Abstract |Full Text PDF | Video

LETTER TO EDITOR
17. Plasma proadrenomedullin level and severity of the disease in patients with isolated rheumatic mitral stenosis
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
doi: 10.5543/tkda.2021.21268  Page 698
Abstract |Full Text PDF

OTHER ARTICLES
18. Kardiyoloji yayınlarında gündem ve yorumlar
Ertan Ural
Page 699
Abstract |Full Text PDF

WITHDRAWAL NOTICE
19. WITHDRAWN: Effects of new drug interaction index on drug adherence in older patients with hypertension
Archives Of The Turkish Society Of Cardiology Editorial Office
doi: 10.5543/tkda.2021.W1  Page 700
Abstract |Full Text PDF



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