Ablation of Atrioventricular Nodal Reentrant Tachycardia with Focal Cryoablation, Compared with Radiofrequency Ablation: Single-Center Experience. / Ablação de Taquicardia Reentrante Nodal Atrioventricular com Crioablação Focal, Comparada com Ablação por Radiofrequência: Experiência em Centro Único.

BACKGROUND: The ablation of atrioventricular nodal reentrant tachycardia (AVNRT) with cryoablation is an alternative to radiofrequency (RF) ablation in patients due to the low risk of total atrioventricular block. An increase in early-late recurrences after cryoablation is reported as an important disadvantage. OBJECTIVES: In this study, we aimed to compare the acute procedural success and the long-term recurrence rates of patients, with AVNRT who underwent methods. METHODS: 73 patients with AVNRT were included in the study: 32 with cryoablation and 41 with RF ablation. There was no statistically significant difference between acute procedural success in methods. The ablation procedure was performed by an operator experienced in arrhythmology. The choice of RF or cryoablation was made in the electrophysiology laboratory based on the material already available during the procedure. After the procedure, the patients were evaluated every 3 months for 2 years in polyclinic control. The significance level adopted in the statistical analysis was 5%. RESULTS: The 2 groups of patients were homogeneous. The fluoroscopy time (p<0.001) was shorter, but atrium-his (p=0.004) and his-ventricular (p=0.015) times were longer in the cryoablation group. There was no significant difference, in terms of acute procedural success, post-procedure jump without a single echo, and presence of echo and jump. CONCLUSIONS: Cryoablation requires less fluoroscopy time and is a safe non-inferior alternative to RF ablation in patients with AVNRT. The risk of AV block is a significant problem with the use of RF energy, making it less suitable for use in young and physically active patients.

FUNDAMENTO: A ablação da taquicardia por reentrada nodal atrioventricular (TRNAV) com crioablação é uma alternativa à ablação por radiofrequência (RF) em pacientes devido ao baixo risco de bloqueio atrioventricular total. Um aumento nas recorrências precoces e tardias após a crioablação é relatado como uma desvantagem importante. OBJETIVOS: Neste estudo, objetivamos comparar o sucesso do procedimento agudo e as taxas de recorrência em longo prazo de pacientes com TRNAV submetidos a métodos. MÉTODOS: Foram incluídos no estudo 73 pacientes com TRNAV: 32 com crioablação e 41 com ablação por RF. Não houve diferença estatisticamente significativa entre o sucesso agudo do procedimento nos métodos. O procedimento de ablação foi realizado por operador com experiência em arritmologia. A escolha entre RF ou crioablação foi feita no laboratório de eletrofisiologia com base no material já disponível durante o procedimento. Após o procedimento, os pacientes foram avaliados a cada 3 meses durante 2 anos em controle policlínico. O nível de significância adotado na análise estatística foi de 5%. RESULTADOS: Os dois grupos de pacientes foram homogêneos. O tempo de fluoroscopia (p<0,001) foi menor, mas os tempos his-átrio (p=0,004) e his-ventricular (p=0,015) foram maiores no grupo crioablação. Não houve diferença significativa em termos de sucesso agudo do procedimento, salto pós-procedimento sem eco único e presença de eco e salto. CONCLUSÕES: A crioablação requer menos tempo de fluoroscopia e é uma alternativa segura e não inferior à ablação por RF em pacientes com TRNAV. O risco de bloqueio AV é um problema significativo com o uso de energia de RF, tornando-o menos adequado para uso em pacientes jovens e fisicamente ativos.

Real-world data on Empagliflozin and Dapagliflozin use in patients with HEART failure: The RED-HEART study.

AIMS: We aimed to determine the use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and to identify clinical factors associated with their use in patients with heart failure (HF) in a real-life setting. METHODS: Real-world data on Empagliflozin and Dapagliflozin use in patients with HEART failure: The RED-HEART study is a multicentre, cross-sectional and observational study that included HF patients in the outpatient setting regardless of ejection fraction from 19 cardiology centres between August 2023 and December 2023. RESULTS: The study population consisted of 1923 patients with HF, predominantly men (61.2%), with a median age of 66 (range: 19-101) years. Overall, 925 patients (48.1%) were receiving SGLT2is. Among the study population, 22.1% had HF with preserved ejection fraction, 21.5% had HF with mildly reduced ejection fraction, 56.4% had HF with reduced ejection fraction and the use of SGLT2is was 42.0%, 47.9% and 50.6% in each group, respectively (P = 0.012). The use of SGLT2is was 76.6% in patients with HF and diabetes, 19.8% in patients with HF and chronic kidney disease and 26.8% in patients without diabetes and chronic kidney disease (P < 0.001). Higher education level [odds ratio (OR): 1.80; 95% confidence interval (CI): 1.06-3.05; P = 0.027], higher household income (OR: 3.46; 95% CI: 1.27-9.42; P = 0.015), New York Heart Association functional class IV (OR: 2.72; 95% CI: 1.16-6.35; P = 0.021), diabetes (OR: 9.42; 95% CI: 6.72-13.20; P < 0.001), the use of angiotensin receptor-neprilysin inhibitors (ARNis) (OR: 4.09; 95% CI: 2.39-7.01; P < 0.001), the use of mineralocorticoid receptor antagonists (MRAs) (OR: 2.02; 95% CI: 1.49-2.75; P < 0.001), the use of loop diuretics (OR: 1.62; 95% CI: 1.18-2.22; P = 0.003) and the use of thiazide diuretics (OR: 1.72; 95% CI: 1.30-2.29; P < 0.001) were independently associated with the use of SGLT2is. Conversely, atrial fibrillation (OR: 0.63; 95% CI: 0.45-0.88; P = 0.008), chronic kidney disease (OR: 0.53; 95% CI: 0.37-0.76; P = 0.001), the use of dihydropyridine calcium channel blockers (OR: 0.68; 95% CI: 0.48-0.98; P = 0.042) and the use of statins (OR: 0.67; 95% CI: 0.49-0.91; P = 0.010) were independently associated with the non-use of SGLT2is. CONCLUSIONS: The RED-HEART study provided comprehensive real-world data about implementing SGLT2is in patients with HF. These results suggest that there is a need for organized action and close collaboration between healthcare providers to improve the implementation of SGLT2is, especially in patients with HF with preserved ejection fraction and chronic kidney disease.

Evaluation of Plasma Atherogenic Index, Triglyceride-Glucose Index and Other Lipid Ratios as Predictive Biomarkers of Coronary Artery Disease in Different Age Groups.

(1) Background: Dyslipidaemia and insulin resistance are major risk factors for coronary artery disease (CAD). This study investigated the relationship between plasma atherogenic index (PA-I), triglyceride-glucose index (TGI) and other lipid ratios with the presence and prediction of CAD among different age categories. (2) Methods: The study included 223 participants diagnosed with CAD and those with normal coronary arteries (normal group) by coronary computed tomography angiography (CCTA). Participants were categorised by age and sex: premature CAD (PCAD) for men under 55 and women under 65, and older groups as elderly. (3) Results: PA-I, Lipid Combined Index, Castelli Risk Indices, and TGI were significantly higher in the PCAD group compared to the control group (p < 0.05). ROC analysis showed that a PA-I cut-off of 0.41 had a sensitivity of 62% and a specificity of 58% for predicting PCAD, while a TGI cut-off of 8.74 had a sensitivity of 68% and a specificity of 62%. In the elderly, no significant differences in these indices were found between the CAD and normal groups. (4) Conclusions: Traditional lipid profiles and non-traditional lipid indices such as PA-I and TGI show significant differences in predicting CAD in younger populations but not in older groups. TGI and PA-I may be promising biomarkers for the prediction of PAD, although further validation is needed.

A New Scoring System for the Evaluation of Ibrutinib-Associated Arrhythmias in Chronic Lymphocytic Leukemia: The ACEF Score

Objective: Bruton tyrosine kinase inhibition in cardiac tissue causes inhibition of the PI3K-AKT signaling pathway, which is responsible for protecting cardiac tissue during stress. Therefore, there is an increase in the risk of arrhythmia. This study explores the prediction of that risk with the Age-Creatinine-Ejection Fraction (ACEF) score as a simple scoring system based on the components of age, creatinine, and ejection fraction. Materials and Methods: Patients diagnosed with chronic lymphocytic leukemia (CLL) and receiving ibrutinib treatment for at least 1 year were evaluated with echocardiography and Holter electrocardiography and the results were compared with a control group of CLL patients who had not received treatment. ACEF score was calculated with the formula age/left ventricular ejection fraction+1 (if creatinine >2.0 mg/dL). Results: When the arrhythmia development of the patients was evaluated, no statistically significant difference was found between the control and ibrutinib groups in terms of types of arrhythmias other than paroxysmal atrial fibrillation (PAF). PAF was found to occur at rates of 8% versus 22% (p=0.042) among ibrutinib non-users versus users. For patients using ibrutinib, an ACEF score of >1.21 predicted the development of PAF with 77% sensitivity and 75% specificity (area under the curve: 0.830, 95% confidence interval: 0.698-0.962, p<0.001). Conclusion: The ACEF score can be used as a risk score that predicts the development of PAF in patients diagnosed with CLL who are scheduled to start ibrutinib.

Screening Tests Predicting Cancer Metastasis in the Etiology of Pericardial Effusion: HALP Score and PNI. / Testes de Triagem Prevendo Metástase de Câncer na Etiologia do Derrame Pericárdico: HALP Score e PNI.

BACKGROUND: Cancer screening is absolutely necessary in patients with pericardial effusion, given that cancer is one of the most serious diseases in the etiology of pericardial effusion. In previous studies, it was stated that the systemic immune-inflammation index (SII); the prognostic nutrition index (PNI); and the hemoglobin, albumin, lymphocyte, platelet (HALP) score can produce scores related to cancer. OBJECTIVES: This study began considering that these scoring systems could predict cancer in the etiology of patients with pericardial effusion. METHODS: This study produced a retrospective analysis of patients who underwent pericardiocentesis between 2006 and 2022. Pericardiocentesis was performed in a total of 283 patients with moderate-to-large pericardial effusion or pericardial tamponade within the specified period. HALP, PNI, and SII scores were calculated according to the peripheral venous blood taken before the pericardiocentesis procedure. The statistical significance level was set at p<0.05. RESULTS: The HALP score proved to be 0.173 (0.125-0.175) in cancer patients and 0.32 (0.20-0.49) in non-cancer patients (p<0.001). The PNI score proved to be 33.1±5.6 in cancer patients and 39.8±4.8 in non-cancer patients (p<0.001). CONCLUSION: The HALP score and PNI proved to be easy and fast cancer screening tests that can predict cancer metastasis in the etiology of patients with pericardial effusion.

FUNDAMENTO: A triagem do câncer é absolutamente necessária em pacientes com derrame pericárdico, pois o câncer é uma das doenças mais graves em sua etiologia. Estudos anteriores indicaram que o índice de inflamação imunológica sistêmica (IIS), o índice prognóstico nutricional (PNI) e o escore de hemoglobina, albumina, linfócitos e plaquetas (HALP) podem ser escores relacionados ao câncer. OBJETIVOS: Este estudo foi iniciado considerando que esses sistemas de pontuação poderiam prever o câncer na etiologia de pacientes com derrame pericárdico. MÉTODOS: Os pacientes submetidos à pericardiocentese entre 2006 e 2022 foram analisados retrospectivamente. A pericardiocentese foi realizada em um total de 283 pacientes com derrame pericárdico ou tamponamento cardíaco de moderado a grande no período especificado. Os índices de HALP, PNI e IIS foram calculados do sangue venoso periférico retirado antes do procedimento de pericardiocentese. O nível de significância estatística foi aceito em p<0,05. RESULTADOS: O escore HALP foi de 0,173 (0,125-0,175) em pacientes com câncer. Detectou-se que em pacientes não oncológicos o escore foi de 0,32 (0,20-0,49; p<0,001). O escore de PNI foi de 33,1±5,6 em pacientes com câncer. Detectou-se que em pacientes não oncológicos o escore foi 39,8±4,8 (p<0,001). CONCLUSÃO: Os escores HALP e PNI são testes de triagem de câncer fáceis e rápidos que podem prever metástases de câncer na etiologia de pacientes com derrame pericárdico.

Testes de Triagem Prevendo Metástase de Câncer na Etiologia do Derrame Pericárdico: HALP Score e PNI / Screening Tests Predicting Cancer Metastasis in the Etiology of Pericardial Effusion: HALP Score and PNI

Resumo Fundamento: A triagem do câncer é absolutamente necessária em pacientes com derrame pericárdico, pois o câncer é uma das doenças mais graves em sua etiologia. Estudos anteriores indicaram que o índice de inflamação imunológica sistêmica (IIS), o índice prognóstico nutricional (PNI) e o escore de hemoglobina, albumina, linfócitos e plaquetas (HALP) podem ser escores relacionados ao câncer. Objetivos: Este estudo foi iniciado considerando que esses sistemas de pontuação poderiam prever o câncer na etiologia de pacientes com derrame pericárdico. Métodos: Os pacientes submetidos à pericardiocentese entre 2006 e 2022 foram analisados retrospectivamente. A pericardiocentese foi realizada em um total de 283 pacientes com derrame pericárdico ou tamponamento cardíaco de moderado a grande no período especificado. Os índices de HALP, PNI e IIS foram calculados do sangue venoso periférico retirado antes do procedimento de pericardiocentese. O nível de significância estatística foi aceito em p<0,05. Resultados: O escore HALP foi de 0,173 (0,125-0,175) em pacientes com câncer. Detectou-se que em pacientes não oncológicos o escore foi de 0,32 (0,20-0,49; p<0,001). O escore de PNI foi de 33,1±5,6 em pacientes com câncer. Detectou-se que em pacientes não oncológicos o escore foi 39,8±4,8 (p<0,001). Conclusão: Os escores HALP e PNI são testes de triagem de câncer fáceis e rápidos que podem prever metástases de câncer na etiologia de pacientes com derrame pericárdico.

Abstract Background: Cancer screening is absolutely necessary in patients with pericardial effusion, given that cancer is one of the most serious diseases in the etiology of pericardial effusion. In previous studies, it was stated that the systemic immune-inflammation index (SII); the prognostic nutrition index (PNI); and the hemoglobin, albumin, lymphocyte, platelet (HALP) score can produce scores related to cancer. Objectives: This study began considering that these scoring systems could predict cancer in the etiology of patients with pericardial effusion. Methods: This study produced a retrospective analysis of patients who underwent pericardiocentesis between 2006 and 2022. Pericardiocentesis was performed in a total of 283 patients with moderate-to-large pericardial effusion or pericardial tamponade within the specified period. HALP, PNI, and SII scores were calculated according to the peripheral venous blood taken before the pericardiocentesis procedure. The statistical significance level was set at p<0.05. Results: The HALP score proved to be 0.173 (0.125-0.175) in cancer patients and 0.32 (0.20-0.49) in non-cancer patients (p<0.001). The PNI score proved to be 33.1±5.6 in cancer patients and 39.8±4.8 in non-cancer patients (p<0.001). Conclusion: The HALP score and PNI proved to be easy and fast cancer screening tests that can predict cancer metastasis in the etiology of patients with pericardial effusion.

Ablação de Taquicardia Reentrante Nodal Atrioventricular com Crioablação Focal, Comparada com Ablação por Radiofrequência: Experiência em Centro Único / Ablation of Atrioventricular Nodal Reentrant Tachycardia with Focal Cryoablation, Compared with Radiofrequency Ablation: Single-Center Experience

Resumo Fundamento A ablação da taquicardia por reentrada nodal atrioventricular (TRNAV) com crioablação é uma alternativa à ablação por radiofrequência (RF) em pacientes devido ao baixo risco de bloqueio atrioventricular total. Um aumento nas recorrências precoces e tardias após a crioablação é relatado como uma desvantagem importante. Objetivos Neste estudo, objetivamos comparar o sucesso do procedimento agudo e as taxas de recorrência em longo prazo de pacientes com TRNAV submetidos a métodos. Métodos Foram incluídos no estudo 73 pacientes com TRNAV: 32 com crioablação e 41 com ablação por RF. Não houve diferença estatisticamente significativa entre o sucesso agudo do procedimento nos métodos. O procedimento de ablação foi realizado por operador com experiência em arritmologia. A escolha entre RF ou crioablação foi feita no laboratório de eletrofisiologia com base no material já disponível durante o procedimento. Após o procedimento, os pacientes foram avaliados a cada 3 meses durante 2 anos em controle policlínico. O nível de significância adotado na análise estatística foi de 5%. Resultados Os dois grupos de pacientes foram homogêneos. O tempo de fluoroscopia (p<0,001) foi menor, mas os tempos his-átrio (p=0,004) e his-ventricular (p=0,015) foram maiores no grupo crioablação. Não houve diferença significativa em termos de sucesso agudo do procedimento, salto pós-procedimento sem eco único e presença de eco e salto. Conclusões A crioablação requer menos tempo de fluoroscopia e é uma alternativa segura e não inferior à ablação por RF em pacientes com TRNAV. O risco de bloqueio AV é um problema significativo com o uso de energia de RF, tornando-o menos adequado para uso em pacientes jovens e fisicamente ativos.

Abstract Background The ablation of atrioventricular nodal reentrant tachycardia (AVNRT) with cryoablation is an alternative to radiofrequency (RF) ablation in patients due to the low risk of total atrioventricular block. An increase in early-late recurrences after cryoablation is reported as an important disadvantage. Objectives In this study, we aimed to compare the acute procedural success and the long-term recurrence rates of patients, with AVNRT who underwent methods. Methods 73 patients with AVNRT were included in the study: 32 with cryoablation and 41 with RF ablation. There was no statistically significant difference between acute procedural success in methods. The ablation procedure was performed by an operator experienced in arrhythmology. The choice of RF or cryoablation was made in the electrophysiology laboratory based on the material already available during the procedure. After the procedure, the patients were evaluated every 3 months for 2 years in polyclinic control. The significance level adopted in the statistical analysis was 5%. Results The 2 groups of patients were homogeneous. The fluoroscopy time (p<0.001) was shorter, but atrium-his (p=0.004) and his-ventricular (p=0.015) times were longer in the cryoablation group. There was no significant difference, in terms of acute procedural success, post-procedure jump without a single echo, and presence of echo and jump. Conclusions Cryoablation requires less fluoroscopy time and is a safe non-inferior alternative to RF ablation in patients with AVNRT. The risk of AV block is a significant problem with the use of RF energy, making it less suitable for use in young and physically active patients.

Prognostic significance of medical therapy in patients with heart failure with reduced ejection fraction.

AIMS: The use of guideline-directed medical therapy (GDMT) among patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains suboptimal. The SMYRNA study aims to identify the clinical factors for the non-use of GDMT and to determine the prognostic significance of GDMT in patients with HFrEF in a real-life setting. METHODS AND RESULTS: The SMYRNA study is a prospective, multicentre, and observational study that included outpatients with HFrEF. Patients were divided into three groups according to the status of GDMT at the time of enrolment: (i) patients receiving all classes of HF medications including renin-angiotensin system (RAS) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRAs); (ii) patients receiving any two classes of HF medications (RAS inhibitors and beta-blockers, or RAS inhibitors and MRAs, or beta-blockers and MRAs); and (iii) either patients receiving class of HF medications (only one therapy) or patients not receiving any class of HF medications. The primary outcome was a composite of hospitalization for HF or cardiovascular death. The study population consisted of 1062 patients with HFrEF, predominantly men (69.1%), with a median age of 68 (range: 20-96) years. RAS inhibitors, beta-blockers, and MRAs were prescribed in 76.0%, 89.4%, and 55.1% of the patients, respectively. The proportions of patients receiving target doses of guideline-directed medications were 24.4% for RAS inhibitors, 11.0% for beta-blockers, and 11.1% for MRAs. Overall, 491 patients (46.2%) were treated with triple therapy, 353 patients (33.2%) were treated with any two classes of HF medications, and 218 patients (20.6%) were receiving only one class of HF medication or not receiving any HF medication. Patient-related factors comprising older age, New York Heart Association functional class, rural living, presence of hypertension, and history of myocardial infarction were independently associated with the use or non-use of GDMT. During the median 24-month period, the primary composite endpoint occurred in 362 patients (34.1%), and 177 of 1062 (16.7%) patients died. Patients treated with two or three classes of HF medications had a decreased risk of hospitalization for HF or cardiovascular death compared with those patients receiving ≤1 class of HF medication [hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.49-0.85; P = 0.002, and HR: 0.61; 95% CI: 0.47-0.79; P < 0.001, respectively]. CONCLUSIONS: The real-life SMYRNA study provided comprehensive data about the clinical factors associated with the non-use of GDMT and showed that suboptimal GDMT is associated with an increased risk of hospitalization for HF or cardiovascular death in patients with HFrEF.

Evaluation of left atrial and left ventricular functions with 3D speckle-tracking echocardiography in patients with coronary artery tortuosity.

BACKGROUND: Tortuosity in the coronary arteries is a very common entity encountered during angiography. The effect of coronary artery tortuosity (CAT) on the myocardium has not been completely investigated. The aim of the current study was to assess the effects of CAT on left atrial (LA) and left ventricular (LV) myocardial functions by 3D speckle-tracking echocardiography (3D-STE). METHODS: Seventy-five patients with CAT and 80 age- and gender-matched controls who proved to have normal coronary angiograms (CAG) were enrolled into the study. Following CAG, the 2D images were obtained first, and then 3D images were obtained for strain analysis. RESULTS: The LAS-r, LAS-active, and LV-GLS were significantly depressed in the CAT (+) group (p < .001, p < .001, p = .012, respectively). The multivariate regression models demonstrated that LAS-r (p < .001), LAS-active (p = .009), and LV-GLS (p = .024) were found to be independent factors predicting CAT. CONCLUSION: The current study is the first to focus on the assessing both LA and LV myocardial dynamics in CAT (+) patients by strain echocardiography. The results of our study support the patients with CAT may have subclinical LA and LV myocardial involvements.

Obstructive - Nonobstructive hypertrophic cardiomyopathy: differences and predictors.

INTRODUCTION: Hypertrophic cardiomyopathy(HCM) is a genetic cardiomyopathy with a prevalence of 1/500 and causes adverse outcomes, usually due to left ventricular outflow tract obstruction. AIM: In this study, we aimed to determine the possible differences and predictors of obstructive hypertrophic cardiomyopathy HCM (Obs-HCM) and nonobstructive HCM (Nonobs-HCM) by electrocardiographic (ECG) and echocardiographic (ECHO) evaluations with clinical, demographic, and biochemical characteristics. METHODS: This study is a subgroup analysis of a multicentre, national, and observational 'LVH-TR study' that included 886 left ventricular hypertrophy(LVH) patients in 22 centres between February 2020 and August 2021. After excluding six patients with atrial fibrillation, pace rhythm, bundle branch blocks, and second, and third-degree atrioventricular(AV) block, 60 HCM patients were included, 23 of whom were obstructive, and 37 were nonobstructive. RESULTS: Body surface area(BSA) (2.01 ± 0.17, 1.89 ± 0.19; p = .01), ST-segment depression (%82.6, %54.1; p = .02), QT and QTc durations (436.3 ± 58.3, 398.0 ± 65.5; p = .02/470.6 ± 58.7, 432.8 ± 74.7; p = .04), left ventricular mass index(LVMI) (176.4 ± 47.0, 152.7 ± 10.2; p = .004), and systolic anterior motion(SAM) rates (%82.6, %18.9; p < 0.001) were significantly higher in the obstructive HCM compared to nonobstructive HCM. Furthermore, the significance of ST-segment depression, QT duration, LVMI, and SAM continued in the univariate analyses to assess obstruction prediction (all p values < .05). CONCLUSION: In multivariate and correlation analyses, ST segment depression (rho = 0.29), QT prolongation (rho = 0.34), and SAM (rho = 0.62) are found as predictors for obstruction (all p values < .05). Our study will guide future studies since it has detailed ECG and ECHO comparisons of Obs-HCM and Nonobs-HCM patients over 18 are made.

Demonstration of subclinical left ventricular electrical and mechanical dysfunction in overweight subjects by frontal QRS-T angle and 3D-speckle tracking echocardiography.

BACKGROUND: Overweightness is a considerable step in the process leading to obesity. There are no sufficient studies on the effect of cardiomyopathy defined in obese patients about overweight subjects. We thought that it may be useful to examine the myocardial involvement in overweight individuals electro-mechanically with more sensitive techniques before the development of obesity cardiomyopathy. AIM: The aim of the present study was to demonstrate whether or not there are subclinical left ventricular (LV) electrical and mechanical dysfunctions in overweight patients using frontal QRS-T (fQRS-T) angle (electrically) and 3D-speckle tracking echocardiography (mechanically). METHODS: A total of 80 overweight patients and 80 age- and sex-matched normal weight individuals were enrolled into the study. 3D-STE examinations of the patients were performed. Electrocardiographic recordings were obtained for fQRS-T angle assessment. RESULTS: The LV-GLS and LV-GCS were significantly depressed in the overweight group than in the normal weight group (-14.5 ± 3.4 vs. -21.7 ± 3.6, p < .001; -15.2 ± 4.6 vs. -24.3 ± 4.8, p < .001, respectively). The fQRS-T angle was found to be increased in the overweight group (142.5 ± 39.2 vs. 114.7 ± 43.5, p = < .001). Statistically significant positive linear correlations were observed between BMI with LV-GLS, LV-GCS, and fQRS-T angle. LV-GLS and LV-GCS were found to be disrupted linearly as BMI increased (r = .718 for BMI and LV-GLS, r = .653 for BMI and LV-GCS). As BMI increased, it was found that the fQRS-T angle increased (r = .692 for BMI and fQRS-T angle). CONCLUSION: Our results support that, overweight individuals, despite their being apparently healthy, may have subclinical LV myocardial mechanical and electrical dysfunction.

Real-World Evaluation of Anticoagulant Treatment Patterns in Patients with Atrial Fibrillation: Data from Multicenter ROTA Study.

OBJECTIVE: Oral anticoagulant therapy is the cornerstone of atrial fibrillation management to prevent stroke and systemic embolism. However, there is limited real-world information regarding stroke and systemic embolism prevention strategies in patients with atrial fibrillation. The aim of the ROTA study is to obtain the real-world data of anticoagulant treatment patterns in patients with atrial fibrillation. METHODS: The ROTA study is a prospective, multicenter, and observational study that included 2597 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January 2021 and May 2021. RESULTS: The median age of the study population was 72 years (range: 22-98 years) and 57.4% were female. The median CHA2DS2-VASc and HAS-BLED scores were 4 (range: 0-9) and 1 (range: 0-6), respectively. Vitamin K antagonists and direct oral anticoagulants were used in 15.9% and 79.4% of patients, respectively. The mean time in therapeutic range was 52.9% for patients receiving vitamin K antagonists, and 76% of those patients had an inadequate time in therapeutic range with <70%. The most common prescribed direct oral anticoagulants were rivaroxaban (38.1%), apixaban (25.5%), and edoxaban (11.2%). The rate of overuse of vitamin K antagonists and direct oral anticoagulants was high (76.1%) in patients with low stroke risk, and more than one-fourth of patients on direct oral anticoagulant therapy were receiving a reduced dose of direct oral anticoagulants. Among patients who were on direct oral anticoagulant treatment, patients with apixaban treatment were older, had higher CHA2DS2-VASc and HAS-BLED scores, and had lower creatinine clearance than the patients receiving other direct oral anticoagulants. CONCLUSIONS: The ROTA study provides important real-world information about anticoagulant treatment patterns in patients with atrial fibrillation.time in therapeutic range with <70%.

Systemic Immune Inflammation Index is a Novel Marker in Predicting the Presence and Severity of Isolated Coronary Artery Ectasia. / O Índice de Inflamação Imune Sistêmica é um Novo Marcador na Previsão da Presença e Gravidade aa Ectasia Coronariana Isolada.

BACKGROUND: The underlying pathology of isolated coronary artery ectasia (CE) has not been fully elucidated. OBJECTIVE: We aimed to examine the relationship between the systemic immune inflammation index (Sii), which corresponds to the multiplying of the neutrophil-to-lymphocyte ratio (NLR) and the platelet counts, and isolated CE. METHOD: The retrospective study population included 200 patients with isolated CE, 200 consecutive with obstructive coronary artery disease, and 200 consecutive with a normal coronary artery angiogram. A 2-sided p-value of <0.05 was considered significant. RESULTS: Sii, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-high density lipoprotein cholesterol ratio (MHR) were significantly higher in the CE group compared with the other groups (all p<0.001). In multivariate analysis, Sii (p<0.001, OR = 1.005, 95% CI =1.004-1.005) was found to be an independent predictor of isolated CE. In Receiver Operating Characteristic curve analysis, Sii had a higher Area Under the Curve than NLR, PLR, and MHR. Sii value of >517.35 has 79% sensitivity, 76% specificity for the prediction of the CE [AUC: 0.832, (p<0.001)]. Sii had a significant correlation with the number of ectatic coronary arteries and Markis classification (r:0.214 p=0.002; r:-0.195, p=0.006, respectively). CONCLUSION: To the best of our knowledge, this is the first study that Sii was significantly associated with isolated CE presence and anatomical severity.

FUNDAMENTO: A patologia subjacente da ectasia da artéria coronária (EC) isolada não foi totalmente elucidada. OBJETIVO: Nosso objetivo foi examinar a relação entre o índice de inflamação imune sistêmica (Sii), que corresponde à multiplicação da razão neutrófilos-linfócitos (RNL) e as contagens de plaquetas, e EC isolada. MÉTODO: A população do estudo retrospectivo incluiu 200 pacientes com EC isolada, 200 consecutivos com doença arterial coronariana obstrutiva e 200 consecutivos com angiografia coronária normal. Um valor de p bicaudal <0,05 foi considerado significativo. RESULTADOS: Sii, RNL, razão plaqueta-linfócito (RPL) e razão monócito-colesterol de lipoproteína de alta densidade (MHR) foram significativamente maiores no grupo EC em comparação com os outros grupos (todos p<0,001). Na análise multivariada, Sii (p<0,001, OR = 1,005, IC 95% =1,004-1,005) foi considerado um preditor independente de EC isolada. Na análise da curva Receiver Operating Characteristic (ROC), Sii teve uma área sob a curva maior em comparação com RNL, RPL e MHR. O valor de Sii >517,35 tem 79% de sensibilidade, 76% de especificidade para a predição do EC [AUC: 0,832, (p<0,001)]. Sii teve correlação significativa com o número de artérias coronárias ectásicas e classificação de Markis (r: 0,214 p=0,002; r:-0,195, p=0,006, respectivamente). CONCLUSÃO: Até onde sabemos, este é o primeiro estudo em que Sii foi significativamente associado à presença isolada de EC e gravidade anatômica.

The predictive value of electrocardiographic polarization parameters on appropriate ICD shock in primary prevention heart failure patients.

OBJECT: The effect of frontal QRS-T angle, Tp-e and Tp-e/QT ratio on cardiac events have been shown in many studies. In this study, we aimed to determine the prognostic value of frontal QRS-T angle, TPe and Tp-e/QT ratio on ICD shock in patients who had ICD (Implantable Cardioverter Defibrillator) implanted due to heart failure with reduced ejection fraction (HFrEF). MATERIAL AND METHOD: 158 patients with HFrEF who had previous ICD implantation were retrospectively analyzed. 27 patients were found to have an appropriate shock. Frontal QRS-T angle, Tp-e interval, Tp-e/QT ratio were calculated by evaluating the basal ECG records of the patients. Comparisons of these arrhythmogenic predictors were made in patients with and without ICD shock at follow-up. RESULT: When 158 patients with previous ICD implantation were analyzed in two groups with and without ICD shock, the number of patients with frontal QRS-T angle >120°, Tp-e interval > 105 ms, Tp-e/QT > 0.2 in the shock group (n: 27) was found to be high with a different significance (p:<0.01, p:<0.01, p:<0.01). There was no significant difference between the two groups regarding other ECG parameters such as QRS duration, QT interval, PR interval, fragmented QRS and positive T wave. In addition, more amiodarone use was observed in the shock group, and more hyperlipidemia cases were observed in the non-shocked group (p:0.01; p:<0.01). CONCLUSION: Increased frontal QRS-T angle, Tp-e interval, and Tp-e/QT ratio are arrhythmogenic parameters and predict appropriate ICD shock.

The Role of Systemic Immune Inflammation Index for Predicting Saphenous Vein Graft Disease in Patients with Coronary Artery Bypass Grafting.

As inflammation plays a significant role in the development of coronary artery disease, we hypothesized that there may be a relation between the systemic immune inflammation index (SII) and saphenous vein graft disease (SVGD). The study population consisted of 716 consecutive patients who underwent elective coronary angiography (CAG) >1 year after bypass grafting. The patients were divided into 2 groups depending on the extent of SVG patency. SII value was significantly higher in the SVGD(+) group compared with the SVGD(-) group (P < .001). In multivariate logistic regression analysis, SII (P < .001, odds ratio (OR) = 3.27, 95% CI = 1.94-5.65) and neutrophil-to-lymphocyte ratio (NLR) (P < .001, OR = 2.08, 95% CI = 1.59-3.11) were found to be independent predictors of SVGD. An SII value of >935 (x103/ml) has 89.2% sensitivity and 70.6% specificity for the prediction of the SVGD, and an NLR value of >4.15 has 54.6% sensitivity and 68.5% specificity for the prediction of the SVGD. The AUC of SII was found to be greater than the AUC of NLR (P = .002), platelet-to-lymphocyte ratio (PLR) (P = .009), lymphocyte-to-monocyte ratio (LMR) (P = .013), MPV (P = .011), and C-reactive protein (CRP) (P = .034) in predicting SVGD. In conclusion, we demonstrated that SII, which is among the new inflammation indexes, is a more reliable predictor in determining SVGD than the NLR, PLR, and LMR.

O Índice de Inflamação Imune Sistêmica é um Novo Marcador na Previsão da Presença e Gravidade aa Ectasia Coronariana Isolada / Systemic Immune Inflammation Index is a Novel Marker in Predicting the Presence and Severity of Isolated Coronary Artery Ectasia

Resumo Fundamento A patologia subjacente da ectasia da artéria coronária (EC) isolada não foi totalmente elucidada. Objetivo Nosso objetivo foi examinar a relação entre o índice de inflamação imune sistêmica (Sıı), que corresponde à multiplicação da razão neutrófilos-linfócitos (RNL) e as contagens de plaquetas, e EC isolada. Método A população do estudo retrospectivo incluiu 200 pacientes com EC isolada, 200 consecutivos com doença arterial coronariana obstrutiva e 200 consecutivos com angiografia coronária normal. Um valor de p bicaudal <0,05 foi considerado significativo. Resultados Sıı, RNL, razão plaqueta-linfócito (RPL) e razão monócito-colesterol de lipoproteína de alta densidade (MHR) foram significativamente maiores no grupo EC em comparação com os outros grupos (todos p<0,001). Na análise multivariada, Sıı (p<0,001, OR = 1,005, IC 95% =1,004-1,005) foi considerado um preditor independente de EC isolada. Na análise da curva Receiver Operating Characteristic (ROC), Sıı teve uma área sob a curva maior em comparação com RNL, RPL e MHR. O valor de Sıı >517,35 tem 79% de sensibilidade, 76% de especificidade para a predição do EC [AUC: 0,832, (p<0,001)]. Sıı teve correlação significativa com o número de artérias coronárias ectásicas e classificação de Markis (r: 0,214 p=0,002; r:-0,195, p=0,006, respectivamente). Conclusão Até onde sabemos, este é o primeiro estudo em que Sıı foi significativamente associado à presença isolada de EC e gravidade anatômica.

Abstract Background The underlying pathology of isolated coronary artery ectasia (CE) has not been fully elucidated. Objective We aimed to examine the relationship between the systemic immune inflammation index (Sıı), which corresponds to the multiplying of the neutrophil-to-lymphocyte ratio (NLR) and the platelet counts, and isolated CE. Method The retrospective study population included 200 patients with isolated CE, 200 consecutive with obstructive coronary artery disease, and 200 consecutive with a normal coronary artery angiogram. A 2-sided p-value of <0.05 was considered significant. Results Sıı, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-high density lipoprotein cholesterol ratio (MHR) were significantly higher in the CE group compared with the other groups (all p<0.001). In multivariate analysis, Sıı (p<0.001, OR = 1.005, 95% CI =1.004-1.005) was found to be an independent predictor of isolated CE. In Receiver Operating Characteristic curve analysis, Sıı had a higher Area Under the Curve than NLR, PLR, and MHR. Sıı value of >517.35 has 79% sensitivity, 76% specificity for the prediction of the CE [AUC: 0.832, (p<0.001)]. Sıı had a significant correlation with the number of ectatic coronary arteries and Markis classification (r:0.214 p=0.002; r:-0.195, p=0.006, respectively). Conclusion To the best of our knowledge, this is the first study that Sıı was significantly associated with isolated CE presence and anatomical severity.

PrevAleNce and Associated factors of inappropriaTe dosing of direct Oral anticoaguLants In pAtients with Atrial Fibrillation: the ANATOLIA-AF Study.

PURPOSE: Inappropriate dosing of direct oral anticoagulants is associated with an increased risk of stroke, systemic embolism, major bleeding, cardiovascular hospitalization, and death in patients with atrial fibrillation. The main goal of the study was to determine the prevalence and associated factors of inappropriate dosing of direct oral anticoagulants in real-life settings. METHODS: This study was a multicenter, cross-sectional, observational study that included 2004 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January and May 2021. The main criteria for inappropriate direct oral anticoagulant dosing were defined according to the recommendations of the European Heart Rhythm Association. RESULTS: The median age of the study population was 72 years and 58% were women. Nine-hundred and eighty-seven patients were prescribed rivaroxaban, 658 apixaban, 239 edoxaban, and 120 dabigatran. A total of 498 patients (24.9%) did not receive the appropriate dose of direct oral anticoagulants. In a logistic regression model, advanced age, presence of chronic kidney disease and permanent atrial fibrillation, prescription of reduced doses of direct oral anticoagulants or edoxaban treatment, concomitant use of amiodarone treatment, and non-use of statin treatment were significantly associated with potentially inappropriate dosing of direct oral anticoagulants. CONCLUSION: The study demonstrated that the prevalence of inappropriate direct oral anticoagulant dosing according to the European Heart Rhythm Association recommendations was 24.9% in patients with atrial fibrillation. Several demographic and clinical factors were associated with the inappropriate prescription of direct oral anticoagulants.