Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir最新文献

Cardiac amyloidosis is a rare systemic condition in which amyloid proteins accumulate outside the cells of the heart. These proteins can be deposited in various parts of the heart, including the valves, endocardium, myocardium and pericardium. This abnormal protein deposition can disrupt normal heart function, leading to a range of symptoms and complications, including heart failure, arrhythmias, and even sudden cardiac death. Diagnosis of cardiac amyloidosis is suspected based on characteristic findings, electrocardiogram abnormalities, and echocardiographic features, which prompt further evaluation and confirmation. We present the case of a 57-year-old female who was hospitalized due to significant exertional dyspnea, hypotension, lower extremity edema, and proteinuria. The aim of this case report is to augment clinicians' understanding of this condition and to minimize the interval between symptom onset and diagnosis, thereby potentially improving the prognosis of affected patients.

Cardiac myxomas are the most common primary tumor of the heart, and they cause systemic embolization if they are located in the left atrium. We present a rare case of a left atrial myxoma resulting in total occlusion of the infrarenal abdominal aorta. A 60-year-old man was admitted to the hospital because of back pain with paresthesia in the lower extremities, and subsequent development of paraplegia. Computed tomography (CT) showed evidence of total occlusion of the infrarenal aorta. Emergent surgery was performed. Intraoperative specimen removed from the aorta was histologically found to be a myxomatous-like material. Transthoracic echocardiography (TTE) revealed a mass located in the left atrium. Despite the second surgery for the removal of cardiac mass, embolism attacks caused by myxoma could not be prevented. Prompt diagnosis and therefore prompt treatment can improve clinical outcomes by preventing embolization-related complications.

Objective: No-reflow (NR), a complication of percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. Identifying reliable predictors of NR is crucial for risk stratification and improving clinical outcomes. The CRP-albumin ratio (CAR), a marker of systemic inflammation, has been suggested as a potential predictor of NR. This systematic review and meta-analysis aimed to evaluate the relationship of CAR with the NR after PCI.

Methods: A comprehensive literature search was conducted in Cochrane, Embase and PubMed databases, following PRISMA 2020 guidelines. Studies evaluating the predictive value of CAR for NR were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using Cochrane's Q and I² statistics.

Results: Four studies comprising 2,068 patients were included. The pooled analysis showed a significant association between higher CAR and an increased risk of NR (OR: 2.34; 95% CI: 1.19-4.60; p = 0.01; I² = 96%).

Conclusion: We found that elevated CAR is associated with NR after PCI, suggesting its potential utility as a prognostic biomarker. However, high heterogeneity underscores the need for large-scale studies to validate its clinical applicability.

Objective: Moderate-intensity exercise modulates the immunological response in cardiac tissue. Meteorin-like protein (metrnl) is a myokine secreted by muscle cells during exercise and is involved in immune response regulation. However, the effects of metrnl on mast cells and plasma cells in cardiac tissue are not fully understood. This study was designed to assess the effects of exogenous metrnl infusion on the cardiac mast cells and plasma cells. In addition, serum levels of musclin, an exercise-responsive factor, were evaluated during the effects of moderate-intensity exercise on cardiac immune cells.

Method: Twenty-seven female rats were randomly divided into three groups (n=9 each): control (deionized water), exercise (moderate-intensity swimming exercise) and metrnl (1 µg/day). For histological studies, hematoxylin-eosin, toluidine blue and methyl green-pyronin staining were performed on heart tissues. Musclin levels were measured in serum samples using the ELISA method.

Results: Metrnl infusion increased cardiac mast cell and plasma cell numbers in female rats like moderate-intensity exercise. In addition, the increase in cardiac mast cell count was greater in the exercise group, whereas musclin concentration decreased in female rats subjected to moderate-intensity exercise.

Conclusion: Our data suggests that moderate-intensity exercise's effects on the cardiac immune system may be mediated, by downregulating musclin and metrnl-dependent upregulating cardiac mast cells and plasma cells. Thus, exercise-induced metrnl may affect the cardiac immune response by modulating cardiac immune cells.

Objective: Aorta, particularly in its proximal segments, expands during systole to store blood, which is subsequently released into the peripheral circulation during diastole, morphologically and histologically. This function, referred to as the "Windkessel effect," ensures continuous and regular blood flow in the peripheral circulation. Thoracic Endovascular Aortic Repair (TEVAR) was introduced in the literature as a treatment for Type B aortic dissections (TBAD). In patients who undergo TEVAR, the placement of a stent graft in the proximal segments of the aorta, which are responsible for the highest capacity of blood storage and elasticity, may disrupt this function. Consequently, this alteration may lead to increased afterload and, over the long term, impair left ventricular systolic function. Previous studies have demonstrated that measurements of left ventricular global longitudinal strain (LVGLS) can detect early systolic dysfunction before any significant changes in left ventricular ejection fraction (LVEF) occur. The aim of this study is to compare preoperative and postoperative LVGLS measurements in patients who underwent TEVAR, thereby illustrating changes in LVGLS associated with the procedure.

Methods: Patients who underwent TEVAR for TBAD or Thoracic Aortic Aneurysm (TAA) were included in the study. Patients with malignancy, advanced valvular pathology, end-stage chronic kidney disease, liver failure, or heart failure were excluded. Preoperative data, including comorbidities, medication use, blood parameters, electrocardiography findings, transthoracic echocardiography images, and LVGLS values, were recorded. These parameters were then compared with the values obtained at the postoperative 3-month outpatient follow-up.

Results: After TEVAR procedure, a significant decrease in LVGLS was observed (p<0.001). A strong correlation was found between the change in mean arterial pressure (MAP) and the reduction in LVGLS (ρ=0.555, p=0.017). Postoperatively, significant increases were noted in systolic blood pressure (SBP) and MAP (both p<0.001). No significant differences were observed in other parameters before and after the procedure.

Conclusion: In our study, a significant increase in SBP and MAP, along with a notable decrease in LVGLS values, were observed following TEVAR procedure. A significant and strong correlation was identified between the increase in MAP and the decrease in LVGLS.