Does MicroRNA Profile Differ in Early Onset Coronary Artery Disease?

OBJECTIVE: MicroRNAs have been explored as potential biomarkers for many pathological processes including coronary artery disease. In this study, we aimed to compare the circulating levels of selected atherosclerosis-associated miRNAs in patients with a history of early-onset coronary artery disease with that of age- and sex-matched healthy controls and older patients with late-onset coronary artery disease. METHODS: Study population consisted of 30 patients with early onset coronary artery disease, 31 age- and sex-matched healthy controls, and 30 patients with late-onset coronary artery disease. Plasma levels of 13 microRNAs (endothelial cell-related miR-126, -92a/b; vascular smooth muscle cell-related miR-145; inflammation-related miR-16, -21, -125b, -146a/b, -147b, -150, -155; lipometabolism-related miR-27b, -122, -370) were evaluated by using real-time polymerase chain reaction. RESULTS: In patients with early onset coronary artery disease, plasma expressions of the lipometabolism-related miR-27b, miR-122; inflammation-related miR-125b, miR-146a/b, miR-147b, miR-150, miR-155; and VSMC-related miR-145 were significantly downregulated and endothelial cell-related miR-126 was significantly upregulated compared to age- and sexmatched healthy controls. Circulating microRNA profile of patients with early onset coronary artery disease was also different from that of older patients with late-onset coronary artery disease. Plasma levels of miR-21, miR-27b, miR-122, miR-125b, miR-146b, miR-147b, and miR-155 were lower and plasma levels of miR-16 and miR-92a were higher in patients with early onset coronary artery disease compared to older patients with late-onset coronary artery disease. CONCLUSION: MicroRNAs are promising biomarkers for early onset coronary artery disease.

Arcuate artery calcification on transvaginal sonography may predict coronary artery heart disease.

Atherosclerosis is a systematic disease affecting all arteries and is the most common cause of mortality. Our aim was to evaluate the predictive value of the presence of uterine arcuate artery calcification (AAC) for coronary heart disease (CHD) in women. Seventy women presenting with angina pectoris or a finding suggestive of cardiac ischaemia in non-invasive tests, scheduled for angiography between June 2014 and July 2015 were recruited in the study. One day before the coroner artery angiography, all of the patients were examined about the presence of AAC by transvaginal ultrasonography and were classified in the presence of CHD. CHD is classified as obstructive (obstruction >70%) or as non-obstructive (obstruction <70%) according to the severity of stenosis. The association of AAC is evaluated with the presence and severity of CHD that's diagnosed by angiography. CHD was present in 87.2% of women with positive for AAC and in 4.3% of who were negative for AAC (p = .001). AAC positive women were more likely to develop obstructive CHD than non-obstructive CHD (66.6% versus 30.9%, p = .001), respectively. Sensitivity and specificity of AAC for CHD were 97.6% and 78.5%, respectively. AAC detected by transvaginal ultrasound seems to have a strong association with both presences of CHD and the severity of disease. Impact statement What is already known on this subject? Atherosclerosis affecting all arteries is the primary cause of mortality and morbidity of coronary heart disease (CHD) (Lim et al. 2011). Uterine artery calcification and its association with atherosclerosis were first reported by Camiel et al. (1967). Ozdemir et al. (2016) found a correlation between carotid artery intima thickness and the presence of uterine arcuate artery calcification (AAC). What do the results of this study add? Very few studies have been performed in this area investigating the relationship of AAC and non-invasive predictors of atherosclerosis or the relationship between arterial calcifications and cardiovascular or systemic disease. Our study is the first to evaluate the correlation between AAC and CHD confirmed using coronary artery angiography at a high sensitivity rate (97.6%). What are the implications of these findings for clinical practice and/or further research? Our study presents an alternative, easy and non-invasive method for the prediction of subclinical CHD in clinical practice. From the view of a gynaecologist, cardiology consultation of patients with AAC detected by transvaginal ultrasonography during the routine gynaecologic examination may be useful and protective against serious cardiac problems. Thus, this study is of great importance in terms of predicting when the majority of CHD patients are asymptomatic or in the subclinical phase.

Impaired quality of life in patients with intermittent atrial fibrillation.

OBJECTIVE: The quality of life (QoL) is impaired in patients with atrial fibrillation (AF). However, the data on the perceived QoL of patients with different types of AF is limited. In this study, we investigated the QoL of patients with intermittent and chronic AF. METHODS: The study was designed as an observational cross-sectional study, and 135 consecutive patients with documented AF admitted to the cardiology outpatient clinic in a tertiary hospital were recruited. The pattern of AF was classified as intermittent or chronic AF. The European Heart Rhythm Association (EHRA) classification and symptom severity score were used to quantify the symptoms related to AF. The QoL was assessed by the Short Form-36 and the Canadian Cardiovascular Society Severity in Atrial Fibrillation (SAF) scale. RESULTS: Thirty-nine percent of the patients (n=52) had intermittent AF and 61% (n=83) had chronic AF. In the overall patient population, 92% reported having at least one of the symptoms that can be attributable to AF. Although the prevalence of symptoms were similar in patients with intermittent or chronic AF, the patients with intermittent AF perceived more severe palpitations (symptom severity score 2.4±1.7 vs. 1.5±1.5, p=0.003). Patients with intermittent AF had higher EHRA and SAF scores than the patients with chronic AF (2.6±0.9 vs. 1.9±0.8, p<0.001; 2.5±1.3 vs. 1.7±1.2, p<0.001, respectively). CONCLUSION: Outpatients with AF have a high prevalence of symptoms and impaired QoL. The impairment of subjective health-related QoL is worse in patients with intermittent AF.

Predictors of Future Atrial Fibrillation Development in Patients with Hypertrophic Cardiomyopathy: A Prospective Follow-Up Study.

BACKGROUND: We evaluated whether left atrial (LA) phasic functions, P-wave dispersion (PWD), and plasma NT-proBNP levels could predict future development of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). METHODS: Seventy patients with HCM were evaluated. The LA phasic functions including the LA total emptying volume (LATEV), LA total emptying fraction (LATEF), LA active emptying volume (LAAEV), LA active emptying fraction (LAAEF), LA passive emptying volume (LAPEV), and LA passive emptying fraction (LAPEF) were evaluated. P-wave dispersion was calculated. Plasma NT-proBNP levels were measured on the same day with echocardiographic study. RESULTS: Patients were followed up 53.09 ± 1.87 months. Patients who developed AF (n = 18) had significantly higher PWD values, NT-proBNP levels, LAVI, E/E' av, and resting LVOT gradients and significantly lower LATEF and LAAEF. In multivariate analysis, LATEF (P = 0.002), LAAEF (P = 0.007), logNT-proBNP level (P = 0.022), and PWD (P = 0.018) were associated with AF development. The results of receiver operating characteristic analysis revealed that a LATEF cutoff value 49% with 72% sensitivity and 81% specificity, a LAAEF cutoff value of 36% with 72% sensitivity and 71% specificity, and an NT-proBNP cutoff value of 720 pg/mL predicted future AF development with 72% sensitivity and 60% specificity. A PWD cutoff value of 47.5 msecond predicted future AF development with 78% sensitivity and 72% specificity. CONCLUSION: In patients with HCM, LA phasic functions, PWD, and NT-proBNP levels predict future development of AF. Assessment of LA phasic functions during routine echocardiographic evaluation and measuring NT-proBNP levels and PWD values of patients with HCM during daily practice may provide important data in predicting those at high risk of AF occurrence.

Percutaneous closure of perimembranous ventricular septal defects associated with septal aneurysm in adults.

OBJECTIVE: Percutaneous closure of perimembranous ventricular septal defects (pmVSD) has become an accepted alternative to surgical closure in selected cases. However, closure of pmVSDs associated with septal aneurysm is more challenging. We report our experience of device closure of pmVSDs associated with septal aneurysm. METHODS: Between 2008 and 2012, percutaneous closure of pmVSD associated with septal aneurysm was attempted in 11 adult patients in our institution. The patients were followed up at 1, 3, 6, and 12 months after the procedure. RESULTS: Mean age of the patients (64% male, 36% female) was 36.2±1.3 years. Diameter of the left and right ventricular openings of the aneurysm measured by ventriculography was 13.5±5.6 mm and 5.9±2.2 mm, respectively. The defect was occluded with Amplatzer pmVSD Occluder in 4 patients, Amplatzer Muscular Ventricular Septal Defect Occluder in 4 patients, Amplatzer Duct Occluder I in 1 patient, and Amplatzer Duct Occluder II in 2 patients (AGA Medical Corp., Plymouth, MN, USA). The procedure was succesfull in all patients. Mean follow-up time was 22±1.9 months. There was no device- or procedure-related complications at the acute setting or mid-term follow-up. CONCLUSION: Percutaneous closure of pmVSDs associated with aneurysm is more challenging than that of simple defects. The selection of the device type and size should be made according to the configuration and size of the aneurysm and defect.

[Evaluation of quality of life using the Umea 22 questionnaire among patients with atrioventricular nodal tachycardia undergoing successful radiofrequency ablation treatment]. / Basarili radyofrekans ablasyon islemi uygulanan atriyoventriküler nodal reentran tasikardili hastalarda yasam kalitesinin Umea 22 anketi ile degerlendirilmesi.

OBJECTIVE: Atrioventricular nodal reentrant tachycardia (AVNRT) attacks is one of the common arrhythmias adversely affecting quality of life. The Umea 22 (U22) is a questionnaire developed for the assessment of symptoms associated with supraventricular tachycardia (SVT), and it is found to be effective in evaluation of quality of life after radiofrequency ablation. Using this questionnaire, the study aimed to assess quality of life among Turkish patients with ANRT before and after the successful RFA. METHODS: The study was conducted between January 2011 and September 2013, and included 57 patients who had undergone RFA due to AVNRT. The U22 questionnaire was administered pre-procedure and at 6 months post-procedure. The participants were asked to report on their general well-being, arrhythmia effects on their wellbeing, and intensity of discomfort associated with episodes. They were asked to provide a score from 1 to 10 in order to determine to severity of discomfort, and the quantity of symptoms was then assessed according to the visual analogue scale (VAS). RESULTS: Patients' general wellbeing (7.5±2.3 vs. 8.7±1.8, p<0.001), the effects of arrhythmia episodes on general well-being (8.1±1.7 vs. 1.0±2.1, p<0.001), frequency of symptoms (2.8±0.8 vs. 0.4±0.9, p<0.001) and duration of symptoms were reduced significantly after RFA. The rate of drug use among patients also decreased after RFA (70% vs. 23%, p=0.017). CONCLUSION: Treatment success was high in patients undergoing RFA due to AVNRT according to the U22 quality of life questionnaire. General and arrhythmia-associated quality of life had improved significantly by the 6th month post-procedure.

To Be or Not to Be Patent: The Relationship Between Migraine and Patent Foramen Ovale.

OBJECTIVE/BACKGROUND: Migraine is a common neurological disorder with an uncertain pathogenesis. A pathophysiological link has been proposed between the migraine headache and patent foramen ovale (PFO). However, the data about the association of migraine with the presence of PFO are conflicting. The study aims to prospectively investigate the prevalence of PFO in patients with migraine compared with that of control subjects. METHODS: A total of 203 migraineous patients and 212 control subjects with similar demographic characteristics to that of case subjects regarding age and gender were included in the study. Transthoracic echocardiography with agitated saline injection was used to evaluate the presence of PFO. PFO was judged to be present if any microbubble was seen in the left cardiac chambers within the first 5 cardiac cycles from the maximum right atrial opacification at rest or after provocative maneuvers. RESULTS: Mean age of the patients was 37.2 ± 9.8 years and 93% were female. Migraine with aura was present in 32% (n = 65) of the patients. The prevalence of PFO was similar in patients with migraine and the control subjects (42% vs 44%; odds ratio 0.90, 95% confidence interval 0.61-1.33, P = .61). Likewise, the prevalence of PFO was similar in migraineurs patients with or without aura (41% vs 42%; odds ratio 0.95, 95% confidence interval 0.51-1.76, P = .87). CONCLUSION: This study suggest that PFO is not more common in patients with migraine compared with healthy subjects. Therefore, our findings suggest that the relationship between migraine headache and the presence of PFO is questionable.

Echocardiographic signs of right ventricle changes after Trastuzumab treatment in breast cancer patients with erb-2 overexpression.

OBJECTIVE: Left ventricular (LV) dysfunction after trastuzumab treatment in erb-2 breast cancer cases has been fully investigated. However, there is not enough data about the effect of trastuzumab treatment on right ventricular (RV) functions. This study is designed to evaluate the right heart changes by performing echocardiography after trastuzumab treatment in patients with erb-2 breast cancer. METHODS: Forty-two consecutive breast cancer patients with erb-2 overexpression mean age 50.4 ± 11.6 years who were decided to receive trastuzumab treatment were enrolled. Echocardiographic examinations including 2-D, spectral, and tissue Doppler measurements were performed at the baseline (T1) and repeated after 6 months (T2). RESULTS: Tricuspid annular plane systolic excursion (TAPSE) was decreased, RV myocardial performance index (RVMPI) and tricuspid E/e' ratio was increased after trastuzumab treatment (1.84 vs. 2.14; p<0.01) (0.46 vs. 0.56, p<0.01) (4.4 ± 1.07 vs. 5.08 ± 1.46; p=0.04). Median serum NT-ProBNP levels, troponin I, and hs-CRP levels were similar between the groups. LVEF and TAPSE were negatively correlated with dosage of trastuzumab (r=-0.392, p=0.04; r=-0.522, p=0.006). There was a stepwise decrease in LVEF when trastuzumab used with anthracyclines however this not reached statically significant (62.4 ± 2, 60 ± 4.5; p=0.06). CONCLUSION: In our study; we observed a trend of RV deterioration after trastuzumab treatment. These preliminary RV changes were demonstrated by using TAPSE, RV tissue Doppler imaging derived MPI and E/e' ratio parameters by echocardiography and these parameters could also use as markers of trastuzumab toxicity in this population.

Relationships between P wave dispersion, atrial electromechanical delay, left atrial remodeling, and NT-proBNP levels, in patients with hypertrophic cardiomyopathy.

BACKGROUND: We evaluated the associations among the well-known atrial fibrillation (AF) predictors including P-wave dispersion (PWD), intra- and inter-atrial electromechanical dyssynchrony (EMD), left atrial (LA) phasic functions, and plasma N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels, in patients with hypertrophic cardiomyopathy (HCM). METHODS: Seventy patients with HCM and age and sex matched 70 subjects were enrolled. PWD, LA total emptying fraction (LATEFr), active emptying fraction (LAAEFr), passive emptying fraction (LAPEFr), expansion index (LAEI) intra- and inter-atrial EMD were calculated. Levels of NT-proBNP of all subjects were determined. RESULTS: Higher PWD (p = 0.006), significantly decreased LAEI (p < 0.001), LATEFr, and LAPEFr (both p values < 0.001) values and significantly increased inter-atrial (p < 0.001), LA (p = 0.001), and right atrial dyssynchrony (p < 0.001) were observed in the HCM group compared to controls. PWD was negatively correlated with LAEI (r = -0.236, p = 0.005) and LATEFr (r = -0.242, p = 0.04), however not with LAPEFr (p = 0.7), or LAAEFr (p = 0.3). Except for the LA lateral wall PA' (r = 0.283, p = 0.02), PWD was not correlated with any atrial EMD parameter. Inter-atrial dyssynchrony was related to LAEI (r = -0.272, p = 0.001), LATEFr (r = -0.256, p = 0.03), and LAPEFr (r = -0.332, p = 0.006), but not, however, to LAAEFr (p = 0.4). The plasma NT-proBNP levels of patients were not correlated with either PWD (p = 0.927) or inter-atrial dyssynchrony (p = 0.102). CONCLUSIONS: PWD and inter-atrial dysynchrony seem to independently promote AF, although both are associated with LA reservoir function in HCM populations. The NT-proBNP level is not associated with these two AF predictors in patients with HCM. NT-proBNP seems to be a poor marker of atrial electrical remodeling in HCM patients.

Epidemiology, anticoagulant treatment and risk of thromboembolism in patients with valvular atrial fibrillation: Results from Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER).

BACKGROUND: The aim of this study was to perform a multicenter, prospective investigation regarding the epidemiology, the current effectiveness of therapeutic anticoagulation, and the risk of thromboembolism in patients with valvular atrial fibrillation (AF) based on the records of the Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. METHODS: Patients were selected from a total of 2,242 consecutive admissions that presented with AF diagnosed via electrocardiogram. Those diagnosed with non-valvular AF were excluded from the AFTER study population, which left 497 patients with valvular AF for analysis. RESULTS: The etiology of valvular AF in patients was either attributed to rheumatic mitral valve stenosis (n = 217) or possessing a prosthetic heart valve (n = 280). Out of all the patients with valvular AF, 83.1% were taking warfarin for anticoagulation. Only 36.1% demonstrated a therapeutic international normalized ratio (INR), and among those patients it was found that 19.1% exhibited a labile INR. Multivariate analysis revealed that age was the only independent predictor of thromboembolic events in patients with valvular AF. CONCLUSIONS: Many valvular AF patients are not maintained at therapeutic INR levels, which poses a threat to patient health as they age and are at greater risk for thromboembolism.

Rate of blood pressure control and antihypertensive treatment approaches in diabetic patients with hypertension.

OBJECTIVES: Hypertension is a common co-morbidity in patients with type 2 diabetes. Management of hypertension is of paramount importance in reducing macro- and microvascular complications of diabetes. The aim of this study is to determine the rate of blood pressure control (<140/85 mmHg) in diabetic patients with hypertension, and to evaluate the prescribing pattern of antihypertensive medications. STUDY DESIGN: This was a prospective, cross-sectional, observational study conducted in a tertiary centre in Turkey. Of 707 patients with diabetes, 500 hypertensive patients were evaluated to determine control of hypertension and treatment attitudes. Logistic regression analysis was used to evaluate the likelihood of prescription of each class of antihypertensive medications for the presence of macro- and microvascular complications. RESULTS: Most of the patients (95%) were on antihypertensive therapy. Only 41% achieved target blood pressure values (<140/85 mmHg). Renin angiotensin system (RAS) blockers were the most frequently (82.4%) prescribed antihypertensive agents, and a combination of RAS blockers and diuretics were the most commonly preferred combination therapy. Most of the patients were on 1 antihypertensive drug or a combination of 2 drugs (39.5% and 44.7%, respectively). Patients with coronary artery disease were more likely to receive beta blockers (Odds ratio=3.6, 95% confidence interval=2.3-5.6; p<0.001). CONCLUSION: Although most of the diabetic hypertensive patients were on hypertensive therapy, more than half had uncontrolled blood pressure.

The validity and reliability of the Turkish version of the University of Toronto Atrial Fibrillation Severity Scale.

BACKGROUND/AIM: There are various instruments to assess quality of life (QoL) in patients with atrial fibrillation (AF). The aim of this study is to determine the reliability and validity of the Turkish version of the University of Toronto Atrial Fibrillation Severity Scale (AFSS). MATERIALS AND METHODS: The AFSS and Short Form-36 (SF-36) were completed by 130 patients with documented AF. The Canadian Cardiovascular Society Severity in Atrial Fibrillation (SAF) scale and European Heart Rhythm Association (EHRA) scale were also utilized by the attending physicians. To assess test-retest reliability, the AFSS was readministered to 47 clinically stable patients at a 1-month follow-up visit. Internal consistency reliability, test-retest reproducibility, and construct validity were evaluated. RESULTS: The mean age of the patients was 63.1 + 10.9 years and 58.5% of patients were male. The outcome scores of the Turkish version of the AFSS showed good correlations with theoretically related SF-36 domains. Additionally, AFSS outcome scores showed a linear correlation with the SAF and EHRA scores. Cronbach's alpha values for internal consistency were consistent and similar with the English language version of the AFSS. Intraclass correlation coefficients for reproducibility exceeded 0.80 for every item. CONCLUSION: Convergent-divergent and known-groups validity and reliability were established for the Turkish version of the University of Toronto AFSS.

[Left ventricular thrombus formation in a patient with normal ejection fraction]. / Normal ejeksiyon fraksiyonlu hastada sol ventrikül içinde trombüs olusumu.

Left ventricular (LV) thrombi usually occur in the presence of impaired LV function, such as in dilated cardiomyopathy, aneurysm or following myocardial infarction. Thrombus formation in a normally functioning LV is extremely rare. We report a patient with LV thrombus formation despite a normal systolic function. The patient, who was admitted to the emergency service with transient loss of consciousness and diagnosed with cerebral embolism, was found to have a pedunculated and hypermobile mass in the LV apex by echocardiography. The LV mass was excised by urgent surgery due to its high embolic risk. The histopathological examination revealed that the LV mass was a thrombus. This case highlights that although very rare, LV thrombus formation may occur in patients with normal ejection fraction.

Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER study.

OBJECTIVES: Although atrial fibrillation (AF) is one of the most common rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. STUDY DESIGN: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency departments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. RESULTS: The mean age of the patients was determined as 66.8 ± 12.3 years with female patients representing 60% of the study population. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co-morbidity in patients with AF. While a stroke or transient ischemic attack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspirin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. CONCLUSION: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

[Cardiac device related infective endocarditis; analysis of 15 cases]. / Kardiyak cihazlara bagli olarak gelisen enfektif endokardit; 15 olgunun analizi.

OBJECTIVES: We aimed to investigate the demographic and clinical characteristics, echocardiographic and microbiologic features, and outcomes of patients with permanent pacemaker (PM) and implantable cardioverter-defibrillator (ICD) endocarditis in this study. STUDY DESIGN: The study population consisted of 15 patients with permanent PM and ICD endocarditis. Data on demographics, medications, clinical procedures, microbiology, echocardiography, surgery, and outcome were collected. RESULTS: The mean age of the patients was 57 ± 16. Seven patients (47%) were female. Of the 15 permanent PM and ICD endocarditis patients, 5 died during hospital follow-up (33%). Four patients (27%) experienced a pulmonary embolism. Culture-negative endocarditis was seen in 5 cases (33%). Staphylococci were the most common causative organisms (60%). Three patients had undergone surgical treatment (20%). CONCLUSION: Cardiac device-related endocarditis remain a rare but potentially fatal complication of device implantation.

Obstruction of superior vena cava flow during transcatheter atrial septal defect closure with the Atriasept ASD occluder.

In this paper, we describe a patient with a large secundum atrial septal defect ASD (26 mm) with adequate rims that were suitable for percutaneous closure. While closing this ASD, the superior vena cava (SVC) was occluded with the right atrial disc of the Atriasept ASD occluder (Cardia) and thus the device was retrieved before its release. After retrieval of this device, an Amplatzer ASD occluder was successfully implanted without disturbing the caval flow.