Burak Sezenöz

Short and long term complications of device closure of atrial septal defect and patent foramen ovale: Meta-analysis of 28,142 patients from 203 studies

Device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) are both associated with short‐ and long‐term complications. Our knowledge of the complication rates of ASD and PFO closure is limited. Our objective was to review the peri‐procedural and long‐term complications of ASD and PFO closure.

Relationship between serum vitamin D levels and angiographic severity and extent of coronary artery disease

Vitamin D is known for its effect in calcium and bone homeostasis. There is an increasing evidence for health benefits accomplished by activated vitamin D that go beyond these classical functions. Previous studies have suggested that lower vitamin D levels are associated with increased cardiovascular disease risk. Therefore, we aimed to evaluate relationship between vitamin D levels and extent and severity of coronary artery disease.

Association of rs10757274 and rs2383206 Polymorphisms on 9p21 locus with Coronary Artery Disease in Turkish Population

Background and Objectives Genetic predisposition is an important risk factor for coronary artery disease (CAD). In this study, we aimed to evaluate the impact of rs10757274 and rs2383206 polymorphisms in chromosome 9p21 on presence and severity of CAD in a Turkish population. Subjects and Methods A total of 646 patients who underwent coronary angiography were included in this study. Coronary vessel score and Gensini score were calculated to assess the angiographic severity of CAD. Alleles of AA, AG, and GG were determined for rs10757274 (polymorphism-1) and rs2383206 (polymorphism-2) polymorphisms located in chromosome 9p21 from the blood samples. Results There was a significant difference between the alleles in polymorphism-1 in the presence of coronary artery disease (38.9% in AA, 48.0% in GG and 56.4% in AG, p=0.017). However, there was no difference between the alleles in polymorphism-2. According to vessel scores, there was a significant difference between the alleles in polymorphism-1 (AA 0.71±1.04, GG 0.88±1.07, AG 1.06±1.12, p=0.018). In polymorphism-2, vessel scores did not show a difference between the alleles. In polymorphism-1, there was a significant difference in Gensini score (p=0.041). Gensini scores did not differ between the alleles in polymorphism-2 (p>0.05 for all). In multivariate analyses, none of the alleles was an independent factor for presence of CAD. Conclusion The presence of rs10757274 polymorphism including AG allele in chromosome 9p21 was related to CAD. However, this relationship was not independent of other cardiovascular risk factors.

Woven Coronary Artery Disease Successfully Managed with Percutaneous Coronary Intervention: A New Case Report

Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.

Impact of statin use on high sensitive troponin T levels with moderate exercise

Abstract Background: High-sensitive cardiac troponin (hsTn) levels can be elevated due to non-pathological events such as strenuous exercise. However, the effect of statins on circulating hsTnT levels with moderate exercise is uncertain. Therefore, we evaluated the impact of statins on hsTnT level with moderate exercise. Methods: We enrolled a total of 56 patients: 26 statin users and 30 non-users. All patients were shown to have no coronary artery disease before participating in the study. Participants performed a fixed-protocol moderate level exercise. HsTnT levels were measured before and 4 h after the exercise. Participants were also grouped based on their hsTnT levels, as proposed in the recent European Society of Cardiology guideline (0-1 hour algorithm) for acute coronary syndromes without persistent ST-segment elevation. Results: Statin users showed a significant increase in serum hsTnT levels with moderate exercise (p = .004), whereas the control group showed a modest increase without statistical significance (p = .664). The percentage of patients whose hsTnT levels exceeded the rule-out limits for non-ST-segment myocardial infarction diagnosis (according to the 0-1 algorithm) after moderate exercise varied significantly between groups (p = .024). Conclusions: Statin therapy can cause a significant increase in hsTnT levels after moderate exercise. This increase can jeopardise the accuracy of clinical diagnoses based on the newly implemented algorithms. The awareness of these adverse effects of statins, mainly used by patients with high risk of coronary events, can prevent misdiagnosis or unnecessary hospitalisations.

Heart rate variability in Eisenmenger syndrome and its correlation with echocardiographic parameters and plasma BNP, high sensitivity troponin-I level

Eisenmenger syndrome (ES) is the latest stage of congenital heart disease associated pulmonary arterial hypertension (PAH) and is more common in our daily practice lately. Despite all improvements, there are several limitations to determining prognosis of these patients (1). Therefore, different parameters with high prognostic values are needed. Heart rate variability (HRV) and autonomic dysfunction can be early prognostic markers in patients with ES. Twenty patients with ES (12 female, 8 male) and 20 healthy matched volunteers were enrolled in the study. Plasma brain natriuretic peptide (BNP) and troponin-I levels were measured. HRV parameters were calculated from 24-hour Holter electrocardiogram recordings. HRV parameters were compared with those of 20 healthy subjects. Bivariate analysis was performed to evaluate correlation between echocardiographic parameters and plasma BNP, high sensitivity (hs)-troponin-I levels. Mean age was 29.25±12.53 years and patients were clinically stable. All patients were receiving specific pulmonary hypertension treatment. Eight patients (40%) were receiving combination therapy, while 12 patients (60%) were receiving single agent. There were significantly lower time-domain HRV parameters [SD of all RR intervals (SDNN): 125.8±36.96 vs. 173.30±34.47 (p<0.0001); mean of SD of all RR intervals for all 5-minute segments over the entire recording (SDNNi): 48.30±14.65 vs. 71.65±19.74 (p<0.0001); SD of averaged normal RR intervals calculated for all 5-minute periods (SDANN): 116.15±37.22 vs. 157.00±31.18 (p<0.0001); 32.25±14.32 vs. 39.05±14.98 (p=0.151); triangular index (TI): 40.31±20.05 vs. 48.45±14.16 (p=0.150)] in ES patients compared to healthy controls. Root-mean-square of successive normal sinus RR interval difference (RMSSD) and TI were lower in ES patients, but without statistical significance (p=0.151). Anatol J Cardiol 2017; 17: 75-80 Letters to the Editor 78

Association between parathyroid hormone levels and the extensiveness of coronary artery disease

Objective: Previous studies have suggested that there is a relationship between coronary artery disease (CAD) and parathyroid hormone (PTH) levels. Here, we aimed to evaluate the association between PTH levels and severity of CAD. Methods: Patients were divided into two groups based on their serum PTH values. Patients with PTH levels ≤72 pg/mL were accepted as Group 1 (n=568) and >72 pg/mL as Group 2 (n=87). Gensini score system and >50% stenosis in any coronary artery with conventional coronary angiography were used to determine the extensiveness of CAD. This study was designed as a prospective and cross-sectional study. Results: Baseline characteristics except for age, gender, and blood pressure were similar between groups. Mean serum PTH levels of the entire cohort was 43.4±29.5 pg/mL. Median Gensini score was 19.5 in Group 1 and 14.5 in Group 2 (p=0.75). On the other hand, PTH levels were weakly correlated with Gensini score (Spearman’s Rho=0.11, p=0.003). Additionally, we did not observe a statistically significant difference between PTH levels and the number of stenotic vessels (p=0.14). This study was designed as a prospective and cross-sectional study. Conclusion: There is no association between serum PTH levels and extensiveness of CAD.

Acute Anterior Myocardial Infarction Accompanied by Acute Inferior Myocardial Infarction: A Very Rare Coronary Artery Anomaly

Coronary artery anomalies are rare and mostly silent in clinical practice. First manifestation of this congenital abnormality can be devastating as syncope, acute coronary syndrome, and sudden cardiac death. Herein we report a case with coronary artery anomaly complicated with ST segment myocardial infarction in both inferior and anterior walls simultaneously diagnosed during primary percutaneous coronary intervention.

Cardiac computed tomography and radiation

Son yıllardaki teknik gelişmeler nedeniyle kardiyovasküler hastalıkların tanısında bilgisayarlı tomografinin yeri gün geçtikçe artmaktadır. Ancak bu işlem sırasında kullanılan radyasyon dozu, buna bağlı oluşabilecek potansiyel sonuçlar konusunda tartışma yaratmaktadır. Elimizde henüz bilgisayarlı tomografide kullanılan radyasyon dozunun yol açabileceği istenmeyen etkiler konusunda net veriler bulunmamaktadır. Bu derlemede bilgisayarlı tomografi ve radyasyon riski ile ilgili literatürdeki veriler gözden geçirilmiştir. Bilgisayarlı tomografide kullanılan radyasyon dozunu azaltmak için alınabilecek önlemlerin başında testin doğru endikasyonla, uygun hastada yapılması gelmektedir. Bunun yanında son yıllarda geliştirilen radyasyon azaltıcı teknolojiler ve kişiye özgü çekim teknikleri sayesinde kullanılan radyasyon dozu belirgin ölçüde azaltılabilmektedir. Klinisyenlerin radyasyon riskinin azaltılması açısından kullanılması gereken teknikler konusunda bilgi sahibi olmaları ve çalıştıkları merkezdeki teknik olanakların farkında olmaları önem taşımaktadır.

High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate

BACKGROUND Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stage renal disease. METHODS Patients included were between 18 and 85 years of age and were receiving hemodialysis for at least 6 months. High sensitive cardiac troponin T (hs-cTnT) levels were studied in blood samples taken at the beginning and end of HD. Two-dimensional speckle tracking strain imaging was used to evaluate myocardial contractility. RESULTS Seventy patients (50.7 ± 16.9 years of age, 27 women) were included in study. The mean volume of ultrafiltration was 3260 ± 990 mL. A significant increase in circulating hs-cTnT levels was observed, as well as a prominent decrease in left ventricular global longitudinal strain (GLS) after HD (52.4 ± 40.2 ng/L vs. 66.8 ± 48.5 ng/L, p < 0.001 and 20.1 ± 3.6% vs. 16.8 ± 3.8% p < 0.001, respectively). Moreover, ultrafiltration rate and GLS were found as the strongest independent variables in relation to the relative increase in hs-cTnT. CONCLUSIONS Hemodialysis can cause a significant increase in hsTnT. This can jeopardize the accuracy of clinical diagnoses based on hs-TnT measurements. GLS may be used as a determinant of this hs-TnT increase. The influence of HD on the cardiovascular system should be kept in mind to prevent unnecessary interventions.