Comparison of long-term outcomes of double kissing crush versus T and minimal protrusion techniques in complex bifurcation lesions: The EVOLUTE-CRUSH II registry.

BACKGROUND: Double kissing (DK)-crush and T-stenting and small protrusion (TAP) techniques are gaining popularity, but the comparison for both techniques is still lacking. This study sought to retrospectively evaluate the long-term outcomes of DK-crush and TAP techniques in patients with complex bifurcation lesions. METHODS: A total of 255 (male: 205 [80.3%], mean age: 59.56 ± 10.13 years) patients who underwent coronary bifurcation intervention at a single-center between January 2014 and May 2021 were included. Angiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven-target lesion revascularization (TLR). The regression models were adjusted applying by the inverse probability weighted (IPW) approach to reduce treatment selection bias. RESULTS: The initial management strategy was DK-crush in 152 (59.6%) patients and TAP in 103 (40.4%) cases. The SYNTAX scores (24.58 ± 7.4 vs. 24.26 ± 6.39, p = 0.846) were similar in both groups. The number of balloon (6.32 ± 1.82 vs. 3.92 ± 1.19, p < 0.001) usage was significantly higher in the DK-crush group than in the TAP group. The rates of TLF (11.8 vs. 22.3%, p = 0.025) and clinically driven TLR (6.6 vs. 15.5%, p = 0.020) were significantly lower in the DK-crush group compared to the TAP group. The long-term TLF was significantly higher in the TAP group compared to the DK-crush group (unadjusted HR: 1.974, [95% CI: 1.044-3.732], p = 0.035 and adjusted HR [IPW]: 2.498 [95% CI: 1.232-5.061], p = 0.011). CONCLUSION: The present study showed that the DK-crush technique of bifurcation treatment was associated with lower long-term TLF and TLR rates compared to the TAP technique.

Transcatheter Closure or Surgery for Symptomatic Paravalvular Leaks: The Multicenter KISS Registry.

BACKGROUND: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs. METHODS AND RESULTS: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P=0.549) and procedural success (73.7 versus 65.2%; P=0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75-5.88]; P=0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27-10.0]; P<0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59-1.25]; P=0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67-1.81]; P=0.679). CONCLUSIONS: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.

In-hospital outcomes of patients undergoing emergent surgical treatment in patients with infective endocarditis.

BACKGROUND: Infective endocarditis is a serious heart disease that may cause several different clinical conditions and can need urgent surgical therapy. In our study, we aimed to evaluate the patients with infective endocarditis undergoing acute surgical treatment results in-hospital mortality. METHODS: A total of 107 consecutive patients with infective endocarditis undergoing acute surgical therapy were included in our retrospective study. The patients were divided into two groups according to the presence of in-hospital mortality as Group 1 without in-hospital mortality (n=89) and Group 2 with in-hospital mortality (n=18). The demographic, laboratory, and clinical parameters were evaluated in both groups. RESULTS: The mean age (50±14; 64±14, P<0.001) and the incidence of chronic renal failure (9 [10.1%]; 8 [44.4%], P=0.001) were higher in Group 2 while the ejection fraction was lower in Group 2 (50.0±9.3; 44.6±12.9, P=0.039). The incidence of positive blood culture was also higher in Group 2 (41 [46.1]; 14 [77.8], P=0.014). Aortic bioprosthesis operation (2 [2.2]; 6 [33.3], P<0.001) and mitral bioprosthesis operation (4 [4.5]; 5 [27.8], P=0.008) were higher in Group 2 as well as the incidence of septic shock was also higher in Group 2 (1 [1.1]; 3 [16.7], P=0.015). In addition, in multivariate logistic regression analyses, advanced age (odds ratio [OR]: 1.068, 95% confidence interval [CI]: 1.009-1.130, P: 0.024) and positive blood culture (OR: 4.436, 95% CI: 1.044-18.848, P: 0.044) were found to be independent predictors of in-hospital mortality. CONCLUSION: Advanced age, lower ejection fraction, high creatinine, positive blood culture, high systolic pulmonary artery pressure, and septic shock predicted in-hospital death in patients who have undergone emergent or urgent surgery due to infective endocarditis.

The Predictive Role of Small Airway Dysfunction in Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Surgery.

OBJECTIVE: Atrial fibrillation is the most common arrhythmia following coronary artery bypass graft surgery. The relationship between impaired lung function and atrial fibrillation has been described previously. We aimed to evaluate the prognostic influence of small airway function on predicting postoperative atrial fibrillation undergoing isolated coronary artery bypass graft surgery (CABG). METHODS: We retrospectively analyzed 283 patients who underwent isolated CABG at our institution between January 2020 and August 2020. The patients were divided into 2 groups according to the development of postoperative atrial fibrillation. Demographic characteristics of the patients were recorded; spirometry was performed for each patient before surgery. Small airway function was determined by forced mid-expiratory flow (forced expiratory flow 25%-75%) values measured by spirometry. Propensity score matching was applied to ensure a balanced distribution of demographic data between the 2 groups. RESULTS: The frequency of postoperative atrial fibrillation was 30.7% in our patient population. After propensity matching, forced expiratory volume in 1 second/forced vital capacity % [80.6 (73.8-87.8) vs. 76.3 (66.7-81.6), P = 0.006] and forced expiratory flow 25%-75% (87.4 ± 14.2 vs. 75.2 ± 15.8, P = 0.001) were significantly lower in postoperative atrial fibrillation group. In multivariate analysis, white blood cell count, left ventricular ejection fraction, cross-clamp time, and forced expiratory flow 25%-75% were found to be independent predictors of postoperative atrial fibrillation development after isolated CABG. In the receiver operating characteristic curve analysis, forced expiratory flow 25%-75% with an optimal threshold value of 81% could detect the presence of postoperative atrial fibrillation with 63.8% sensitivity and 70.1% specificity. CONCLUSION: Our study demonstrated that small airway obstruction, as indicated by forced expiratory flow 25%-75% in spirometry, can be a simple predictive tool for the development of postoperative atrial fibrillation in patients undergoing isolated CABG.

The relation of right ventricular outflow tract measurements with in-hospital clinical outcomes after tricuspid valve surgery.

Right ventricular (RV) function is a determining factor for clinical outcomes in patients undergoing tricuspid valve surgery (TVS). Our aim was to investigate the importance of the function of the right ventricular outflow tract (RVOT), which is an important anatomical region of the RV, in patients underwent TVS. 104 patients who underwent TVS were analyzed retrospectively. Patients with previous cardiac surgery, congenital heart disease, or heart failure were excluded. The parasternal short-axis view at the level of the aortic root was used to measure RVOT dimensions and RVOT fractional shortening (RVOT-FS). The effect of RVOT diameter and function on major adverse cardiac events (MACE) after TVS was investigated. In our study, MACE, consisting of pacemaker implantation, acute kidney injury, postoperative atrial fibrillation and mortality, was developed at 44 (42.3%) patients.We compared the predictive performances of RVOT end-systolic (RVOTs) diameter, RVOT end-diastolic (RVOTd) diameter, RVOT-FS and RV diameters in prediction of MACE. The model including the RVOTs had higher AUC, R2 and likelihood ratio X2 values (0.775, 0.287 and 25.0, respectively) than RVOTd (0.770, 0.279 and 24.2, respectively) and RVOT-FS (0.750, 0.215 and 18.1, respectively). RVOT diameters showed better performance in predicting MACE than RV diameters. Moreover, there was statistically significant association between RVOTs, RVOTd and MACE (p value were 0.014 and 0.027, respectively), while no association between RVOT-FS and MACE (p value was 0.177). In summary, we determined that the RVOT diameters are important predictors for the in-hospital clinical outcomes of patients who underwent TVS.

O Valor Preditivo do Escore CHA2DS2-VASc no Escore Syntax Residual em Pacientes com Infarto do Miocárdio com Supradesnivelamento do Segmento ST / The Predictive Value of CHA2DS2-VASc Score on Residual Syntax Score in Patients With ST Segment Elevation Myocardial Infarction

Resumo Fundamento O escore CHA2DS2-VASc está associado a desfechos clínicos adversos em pacientes com doença cardiovascular. O escore Syntax residual (residual Syntax score — rSS) é uma ferramenta de pontuação que tem valor prognóstico em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Objetivos Este estudo objetivou investigar o valor preditivo do escore CHA2DS2-VASc para o rSS em pacientes com IAMCSST. Métodos Foram avaliados 688 pacientes consecutivos com IAMCSST submetidos à intervenção coronária percutânea. Além do escore CHA2DS2-VASc, variáveis demográficas e clínicas de referência foram analisadas. Os pacientes foram divididos em dois grupos: grupo 1 - indivíduos com rSS até 8 (509 pacientes); grupo 2 - aqueles com rSS acima de 8 (179 pacientes). Valores p<0,05 foram considerados estatisticamente significativos. Resultados O escore CHA2DS2-VASc foi maior no grupo 2 [1 (0-2); 1 (1-3), p<0,001] comparado ao grupo 1. A incidência de hipertensão [151 (29,7%); 73 (40,8%), p=0,006], idade ≥75 anos [18 (3,5%); 21 (11,7%), p<0,001], diabetes mellitus [85 (16,7%); 50 (27,9%), p=0,001] e doença vascular [12 (2,4%); 11 (6,1%), p=0,029] foi maior no grupo 2. Na análise de regressão logística multivariada, o escore CHA2DS2-VASc (odds ratio — OR=1,355; intervalo de confiança de 95% — IC95%=1,171-1,568; p<0,001), idade ≥75 anos [OR=3,218; IC95%=1,645-6,295; p=0,001] e diabetes mellitus [OR=1,670; IC95%=1,091-2,557; p=0,018] foram preditores independentes de rSS elevado. A análise da curva receiver-operating characteristic demonstrou o bom valor preditivo do escore CHA2DS2-VASc para rSS elevado com valor de corte de 1,5 (área sob a curva/area under the curve — AUC= 0,611, IC95%=0,562-0,659, p<0,001). Conclusões O escore CHA2DS2-VASc tem valor preditivo para rSS em pacientes com IAMCSST. Além disso, o escore CHA2DS2-VASc foi um preditor independente de rSS mais alto.

Abstract Background The CHA2DS2-VASc score is associated with adverse clinical outcomes in patients with cardiovascular disease. The residual Syntax score (rSS) is a scoring tool which has prognostic value in patients with ST segment elevation myocardial infarction (STEMI). Objectives Our aim in this study is to investigate the predictive value of the CHA2DS2-VASc score on rSS in STEMI patients. Methods A total of 688 consecutive patients with STEMI undergoing percutaneous coronary intervention were evaluated. Baseline demographic and clinical variables besides the CHA2DS2-VASc score were assessed. The patients were divided into two groups; patients with rSS of 8 or below as group 1 (509 patients) and more than 8 as group 2 (179 patients). A p-value < 0.05 was considered statistically significant. Results The CHA2DS2-VASc score was higher in group 2 [1 (0-2); 1 (1-3), p<0.001] compared to group 1. The incidence of hypertension [151 (29.7%); 73 (40.8%), p=0.006], patients ≥75 years [18 (3.5%); 21 (11.7%), p<0.001], diabetes mellitus [85 (16.7%); 50 (27.9%), p=0.001] and vascular disease [12 (2.4%); 11 (6.1%), p=0.029] were higher in group 2. In multivariate logistic regression analysis, the CHA2DS2-VASc score (OR=1.355; 95%CI=1.171-1.568; p<0.001), age ≥75 years [OR=3.218; 95%CI=1.645-6.295; p=0.001] and diabetes mellitus [OR=1.670; 95%CI=1.091-2.557; p=0.018] were independent predictors of high rSS. The receiver-operating characteristic curve analysis demonstrated that the CHA2DS2-VASc score had good predictive value for high rSS with a cut-off value of 1.5 (area under curve (AUC): 0.611, 95% confidence interval (CI):0.562-0.659, p<0.001). Conclusions The CHA2DS2-VASc score has a predictive value on rSS in patients with STEMI. The CHA2DS2-VASc score was also an independent predictor of higher rSS.

The Predictive Value of CHA2DS2-VASc Score on Residual Syntax Score in Patients With ST Segment Elevation Myocardial Infarction. / O Valor Preditivo do Escore CHA2DS2-VASc no Escore Syntax Residual em Pacientes com Infarto do Miocárdio com Supradesnivelamento do Segmento ST.

BACKGROUND: The CHA2DS2-VASc score is associated with adverse clinical outcomes in patients with cardiovascular disease. The residual Syntax score (rSS) is a scoring tool which has prognostic value in patients with ST segment elevation myocardial infarction (STEMI). OBJECTIVES: Our aim in this study is to investigate the predictive value of the CHA2DS2-VASc score on rSS in STEMI patients. METHODS: A total of 688 consecutive patients with STEMI undergoing percutaneous coronary intervention were evaluated. Baseline demographic and clinical variables besides the CHA2DS2-VASc score were assessed. The patients were divided into two groups; patients with rSS of 8 or below as group 1 (509 patients) and more than 8 as group 2 (179 patients). A p-value < 0.05 was considered statistically significant. RESULTS: The CHA2DS2-VASc score was higher in group 2 [1 (0-2); 1 (1-3), p<0.001] compared to group 1. The incidence of hypertension [151 (29.7%); 73 (40.8%), p=0.006], patients ≥75 years [18 (3.5%); 21 (11.7%), p<0.001], diabetes mellitus [85 (16.7%); 50 (27.9%), p=0.001] and vascular disease [12 (2.4%); 11 (6.1%), p=0.029] were higher in group 2. In multivariate logistic regression analysis, the CHA2DS2-VASc score (OR=1.355; 95%CI=1.171-1.568; p<0.001), age ≥75 years [OR=3.218; 95%CI=1.645-6.295; p=0.001] and diabetes mellitus [OR=1.670; 95%CI=1.091-2.557; p=0.018] were independent predictors of high rSS. The receiver-operating characteristic curve analysis demonstrated that the CHA2DS2-VASc score had good predictive value for high rSS with a cut-off value of 1.5 (area under curve (AUC): 0.611, 95% confidence interval (CI):0.562-0.659, p<0.001). CONCLUSIONS: The CHA2DS2-VASc score has a predictive value on rSS in patients with STEMI. The CHA2DS2-VASc score was also an independent predictor of higher rSS.

FUNDAMENTO: O escore CHA2DS2-VASc está associado a desfechos clínicos adversos em pacientes com doença cardiovascular. O escore Syntax residual (residual Syntax score ­ rSS) é uma ferramenta de pontuação que tem valor prognóstico em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). OBJETIVOS: Este estudo objetivou investigar o valor preditivo do escore CHA2DS2-VASc para o rSS em pacientes com IAMCSST. MÉTODOS: Foram avaliados 688 pacientes consecutivos com IAMCSST submetidos à intervenção coronária percutânea. Além do escore CHA2DS2-VASc, variáveis demográficas e clínicas de referência foram analisadas. Os pacientes foram divididos em dois grupos: grupo 1 ­ indivíduos com rSS até 8 (509 pacientes); grupo 2 ­ aqueles com rSS acima de 8 (179 pacientes). Valores p<0,05 foram considerados estatisticamente significativos. RESULTADOS: O escore CHA2DS2-VASc foi maior no grupo 2 [1 (0­2); 1 (1­3), p<0,001] comparado ao grupo 1. A incidência de hipertensão [151 (29,7%); 73 (40,8%), p=0,006], idade ≥75 anos [18 (3,5%); 21 (11,7%), p<0,001], diabetes mellitus [85 (16,7%); 50 (27,9%), p=0,001] e doença vascular [12 (2,4%); 11 (6,1%), p=0,029] foi maior no grupo 2. Na análise de regressão logística multivariada, o escore CHA2DS2-VASc (odds ratio ­ OR=1,355; intervalo de confiança de 95% ­ IC95%=1,171­1,568; p<0,001), idade ≥75 anos [OR=3,218; IC95%=1,645­6,295; p=0,001] e diabetes mellitus [OR=1,670; IC95%=1,091­2,557; p=0,018] foram preditores independentes de rSS elevado. A análise da curva receiver-operating characteristic demonstrou o bom valor preditivo do escore CHA2DS2-VASc para rSS elevado com valor de corte de 1,5 (área sob a curva/area under the curve ­ AUC= 0,611, IC95%=0,562­0,659, p<0,001). CONCLUSÕES: O escore CHA2DS2-VASc tem valor preditivo para rSS em pacientes com IAMCSST. Além disso, o escore CHA2DS2-VASc foi um preditor independente de rSS mais alto.

A Novel Marker Indicating Restenosis in Superficial Femoral Artery: C Reactive Protein to Albumin Ratio.

BACKGROUND: In this study, we aimed to investigate the prognostic value of C-reactive protein (CRP) to albumin ratio (CAR) for predicting restenosis in superficial femoral artery (SFA) lesions and its association with subsequent clinical outcomes in patients undergoing endovascular intervention. METHODS: The records of 685 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into 2 groups, based on the CAR values. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed. RESULTS: According to our study, patients with high CAR values had higher rates of restenosis (30.2% vs. 10.3%, P < 0.05) and mortality (31.3% vs. 12.9%, P < 0.05). The rate of lower extremity amputations was also significantly higher in patients with high CAR values compared to those with low CAR values (9.1% vs. 3%, P < 0.05). With respect to Receiver operating characteristic ROC curves of inflammatory markers, the area under the curve (AUC) value of CAR was statistically significant (AUC: 0.659; 95% confidence interval CI: 0.611-0.706; P < 0.01). CONCLUSIONS: Our data showed that CAR is an independent predictor of restenosis and poor clinical outcomes in patients undergoing endovascular intervention.

The role of three dimensional transesophageal echocardiography novel-score in the success of redo percutaneous balloon mitral valvuloplasty.

Mitral valve commissure evaluation is known to be important in the success of percutaneous balloon mitral valvuloplasty (PBMV) and Wilkins score (WS) is used in clinical practice. In our study, we aimed to determine whether WS in redo PBMV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure. Fifty patients who underwent redo PBMV were included in the study. The patients were divided into two groups according to the success of the Redo PBMV procedure which was defined as post-procedural MVA ≥ 1.5 cm2 and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation after PBMV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PBMV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated. In the study group, 36 patients (72%) had successful redo PBMV procedure. WS was 8 (IQR 7-9) and novel 3D TEE score was found 4 (IQR 3-4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). Specifically, the procedural successes rate was > 90% when novel 3D TEE score was < 4. The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PBMV, especially in patients who are considered for surgery due to the high WS.

Assessment of proarrhythmic ventricular electrophysiological remodeling in patients with rheumatoid arthritis.

INTRODUCTION: Rheumatoid arthritis (RA) is related to cardiovascular disease and results in increased mortality rates. Ischemia, autonomic nervous system dysfunction, impaired cardiac ionic currents, and genetic predisposition may be the underlying mechanisms. Proarrhythmic ventricular electrophysiological remodeling detected on the basis of Tp­e interval, Tp-e/QT, and Tp-e/QTc ratios plays a key role in the prognosis. Our aim was to assess proarrhythmic ventricular electrophysiological remodeling in patients with RA, a well-known chronic inflammatory disorder. MATERIALS AND METHODS: A total of 163 patients with RA and 47 patients as a control group were included in this retrospective study. Proarrhythmic ventricular electrophysiological remodeling markers were evaluated in both groups along with baseline demographic and clinical variables. Patients using medication or with chronic disorders that can affect ventricular repolarization markers were excluded. RESULTS: The patients with RA had prolonged Tp­e interval (66 ms [44-80]; 80 ms [78-96], p < 0.001) and increased Tp-e/QT ratio (0.18 [0.12-0.22]; 0.22 [0.20-0.24], p < 0.001) and Tp-e/QTc ratio (0.16 [0.11-0.19]; 0.20 [0.17-0.22], p < 0.001) compared to the control group. CONCLUSION: The Tp­e interval and Tp-e/QT ratio, which may help to clarify the pathophysiological mechanisms of ventricular arrhythmias, were increased in patients with RA.

Association Between CRP/Albumin Ratio and Long-Term Mortality in Patients With cHronIc Limb-Threatening Ischemia Undergoing EndovaScular Therapy Below The Knee: The ACHILES-BTK Registry.

BACKGROUND: Chronic limb-threatening ischemia (CLTI), which presents with ischemic rest pain, ulceration, or gangrene, is a complex form of peripheral artery disease that can cause mortality and amputation. C-reactive protein (CRP), an inflammatory marker, indicates vascular inflammation resulting from the cytokine-dependent inflammatory process in the arterial wall, and arterial atherosclerosis resulting from the inflammation. Lower albumin levels are also associated with peripheral artery disease. We investigated the association between CRP/Albumin ratio (CAR) and long-term mortality in patients with CLTI. METHODS: A total of 172 patients who underwent endovascular treatment (EVT) for below the knee (BTK) lesions were enrolled in this study. Patients with acute infection requiring antibiotic therapy, chronic inflammatory disease, end-stage liver disease, malignancy were excluded from the study. Besides, patients with pre-follow-up intervention to the same vascular bed were also excluded from the study. The primary endpoint of the study was all-cause mortality. Patients were divided into 2 groups according to mortality. RESULTS: A total of 70 patients (40.6%) died during 32 ± 21 months of follow-up in the present study. The major amputation rate was 21.5%. The mortality (+) group was older and had higher rates of congestive heart failure, chronic kidney disease, history of stroke, and CRP levels. Moreover, statin and ACE inhibitor/angiotensin receptor blocker (ACE/ARB) use, GFR, and albumin levels were lower in the mortality (+) group. CAR was significantly higher in the mortality (+) group when comparing both groups (3.25 [1.46 - 7.86] vs. 9.75 [4.5 - 17.71], P < 0.001). CAR, congestive heart failure, chronic kidney disease, history of stroke, ACE/ARB, or statin use were independent predictors of all-cause mortality in multivariable Cox regression analysis. CONCLUSIONS: CAR was associated with mortality in CLTI patients undergoing EVT for BTK lesions. CAR may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.

Revascularization strategies in patients with infective endocarditis-related ST-elevation myocardial infarction: The STEMI-ENDO Registry.

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.

The relationship between plasma proadrenomedullin level and severity of the disease in patients with isolated rheumatic mitral stenosis.

OBJECTIVE: In this study, we aimed to determine the plasma proadrenomedullin (ProADM) levels in patients with rheumatic mitral stenosis (MS), to evaluate the relationship between ProADM levels and the echocardiographic parameters that represent the severity of stenosis and symptoms, and to compare the ProADM and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, which is a well-known marker for rheumatic MS. METHODS: Our study included 53 consecutive patients with isolated rheumatic MS and 45 volunteers with similar age and gender features. Patients with MS were divided into two groups based on the presence of an indication for intervention. Detailed echocardiographic examinations were performed on all participants, and blood samples were collected to detect the NT-proBNP and ProADM levels. RESULTS: NT-proBNP and ProADM levels were significantly higher in the rheumatic MS group compared with the control group. In rheumatic MS groups, patients with an indication for intervention had higher levels of NT-proBNP and ProADM compared with patients without an indication for intervention. Moreover, NT-proBNP and ProADM levels were found to be significantly correlated with echocardiographic parameters, which revealed the severity of stenosis in various degrees. Both parameters increased as the New York Heart Association (NYHA) class increased, and this increase had a statistical significance. Additionally, the cut-off values of both parameters (NT-proBNP: 119.9 pg/mL, ProADM: 6.15 nmol/L) could detect patients with an indication for intervention with high sensitivity and specificity rates. NT-proBNP was found to be slightly more effective in this regard. CONCLUSION: The increased NT-proBNP and ProADM levels in patients with isolated rheumatic MS can help clinicians in distinguishing patients with an indication for intervention by providing additional information to echocardiography.

Does patent foramen ovale presence procure favourable outcomes in patients with severe rheumatic mitral stenosis?

Mitral stenosis (MS) is tolerated for an extended period in patients with atrial septal defect (ASD) known as Lutembacher syndrome due to depressurizing effect. In a similar way, patients with patent foramen ovale (PFO) may have clinical benefits in severe MS. We aim to evaluate the clinical effects of PFO in rheumatic MS. Transthoracic and transesophageal echocardiography records of the patients with symptomatic severe MS were screened for the period between 2008 and 2019 in a single center. 320 symptomatic patients with severe MS were included and presence of PFO recorded. Left atrial appendix (LAA) thrombotic status was defined as clear, spontaneous echo contrast, and thrombus. Two different statistical models were used to determine the predictors of either smallest (mitral valve area) MVA at symptomatic presentation or more thrombogenic LAA. 34 patients had PFO. Multivariable ordinary least square model demonstrated that increase in systolic pulmonary arterial pressure, ejection fraction and presence of PFO were associated with smaller MVA on presentation. Multivariable proportional odds logistic regression model demonstrated that advanced age, increased left atrial diameter, absence of PFO were associated with more thrombotic status whereas larger MVA was associated with decreased thrombotic status in LAA. Presence of PFO in severe MS results in two clinical benefits as (i) being asymptomatic with smaller MVA and (ii) having less LAA thrombosis probably caused by depressurizing effect on the left atrial pressure. Our study could serve as an example for patient groups with expected symptomatic benefits from left atrium pressure offloading interventions.

A simplified acute kidney injury predictor following transcatheter aortic valve implantation: ACEF score.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an effective, less invasive treatment alternative for symptomatic severe aortic stenosis (AS). Acute kidney injury (AKI) following TAVI is a common complication and is associated with worse outcomes. The age, creatinine, ejection fraction (ACEF) score is a simple scoring method, including only three parameters: age, creatinine, and ejection fraction (EF). The score was well established in predicting AKI after coronary interventions. AIMS: We aimed to evaluate whether this simple scoring method, ACEF, may predict a development of AKI in patients who underwent TAVI. METHODS: A total of 173 consecutive patients with symptomatic severe AS who underwent TAVI were included retrospectively. The primary endpoint of the study was the development of AKI. Study population was divided into two groups according to the presence of AKI. The ACEF score was calculated with the formula: age/EF + 1 (if baseline creatinine >2 mg/dl). RESULTS: Twenty-nine patients developed AKI. The median (interquartile range) ACEF score was 1.36 (1.20-1.58). The ACEF score was found to be an independent predictor of AKI (P <0.001). The ACEF score ≥1.36 predicted AKI development with a sensitivity of 96.6% and specificity of 58.8%. Moreover, hypertension, hemoglobin levels, contrast volume, and aortic valve area (AVA) were found to be independent predictors of AKI. CONCLUSIONS: Our study revealed that the ACEF score was an independent predictor of AKI. A simple and objective score might be very useful in predicting AKI development in patients undergoing TAVI.

Impact of different degrees of computed tomography-based oversizing on clinical outcomes after transcatheter aortic valve implantation using the Portico system.

OBJECTIVE: The study aimed to evaluate the influence of different degrees of multidetector computed tomography (MDCT)-based perimeter oversizing on incidence and severity of paravalvular aortic regurgitation (PAR) and conduction disturbances (CD) for the Portico device. METHODS: We retrospectively analyzed 63 patients who underwent transcatheter aortic implantation (TAVI) in our center from March 2017 to June 2019. Patients were divided into two groups (group I, below %13.9; group II, above 13.9%) based on the degree of oversizing. Oversizing was calculated as (Device nominal perimeter / MDCT-derived annular perimeter - 1) * 100. Procedural and clinical data were evaluated by VARC-2 definitions. RESULTS: Mild or greater PAR was present in 76.4% of patients in group I and 34.4% of patients in group II (P = 0.009). The rate of CD tended to be lower in the patient's group I (P = 0.034). A cutoff value of 13.9% was identified as having the best predictive value for mild or greater PAR. On multivariate analysis, a lower percentage of oversizing (odds ratio 6.38; %95 confidence interval 2.00 - 20.33; P = 0.002) emerged as the most powerful independent predictor of PAR, whereas the implantation depth and severe oversizing were independent predictors of CD (P = 0.003 and P = 0.029, respectively). We demonstrated that the optimal acceptable perimeter-based oversizing range appears to be between 10 - 15%. CONCLUSION: Perimeter-based oversizing by MDCT inversely correlated with PAR after TAVI for Portico device, and its preoperative evaluation could help in predicting PAR and CD.

The Association between Tp-e interval, Tp-e/QT, and Tp-e/QTc Ratios and Coronary Artery Disease Spectrum and Syntax Score

Abstract Background Coronary artery disease (CAD) causes electrical heterogeneity on ventricular myocardium and ventricular arrhythmia due to myocardial ischemia linked to ventricular repolarization abnormalities. Objective Our aim is to investigate the impact of increased level of CAD spectrum and severity on ventricular repolarization via Tp-e interval, Tp-e/QT and Tp-e/QTc ratios. Methods 127 patients with normal coronary artery (group 1), 129 patients with stable CAD (group 2) and 121 patients with acute coronary syndrome (group 3) were enrolled. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were evaluated as well as baseline demographic and clinical parameters. Kruskal-Wallis one-way ANOVA test was used for comparing quantitative variables with abnormal distribution while One-Way ANOVA test was used for comparing the means between groups with normal distribution. Tukey HSD and Welch tests were used for subgroups analyses with normal distribution. Spearman analysis was used to evaluate the correlation between clinical variables and repolarization markers. A p-value < 0.05 was considered statistically significant. Results Tp-e interval [66(50-83), 71(59-82) and 76(64-86); group 1,2 and 3 respectively, p<0.001], Tp-e/QT (0.170.02, 0.180.01 and 0,190.01; group 1,2 and 3 respectively, p<0.001) and Tp-e/QTc (0.150.02, 0.160.02 and 0.170.02; group 1,2 and 3 respectively, p<0.001) ratios were found to be associated with increased level of CAD spectrum. Syntax score was positively correlated with Tp-e interval (r=0.514, p<0.001), Tp-e/QT (r=0.407, p<0.001), and Tp-e/QTc ratios (r=0.240, p<0.001). Conclusion Prolonged Tp-e interval and increased Tp-e/QT and Tp-e/QTc ratios were detected in the presence of CAD and especially in patients with acute ischemic syndromes. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

The impact of coronary artery disease severity on long-term outcomes in unprotected left main coronary artery revascularization.

OBJECTIVE: The optimal treatment modality for left main coronary artery (LMCA) disease is still controversial. The aim of this study was to investigate long-term prognostic determinants of percutaneous coronary intervention (PCI) for LMCA disease and the role of coronary artery disease (CAD) severity in this population. METHODS: A total of 60 consecutive patients who underwent LMCA PCI were enrolled in this study. Baseline demographic and clinical variables were recorded, as well as the SYNTAX score (SS), SS II, and residual SS (rSS). The primary endpoints of the study were all-cause death, non procedural myocardial infarction (MI), and stroke. The patients were then divided into 2 groups: patients without a composite endpoint (Group 1) and those with a composite endpoint (Group 2). RESULTS: Of the 60 patients, 15 (25%) were female and the mean age was 59.8±14.7 years. The median follow-up time was 25 months (range: 12-33 months). A primary composite endpoint was observed in 16 patients (26.7%): mortality occurred in 10 patients (16.7%), 4 (6.6%) experienced MI, and stroke was seen in 2 patients (3.3%). Target vessel revascularization was performed in 3 patients (5%). The mean SYNTAX score (Group 1: 19.9±9.8; Group 2: 26.8±12.2; p=0.029), SS II PCI (Group 1: 27.7 [range: 17.7-36.8]; Group 2: 34.2 [range: 27.9-55.2]; p=0.030) and rSS (Group 1: 0 [range: 0-5]; Group 2: 12.5 [range: 3.5-22.5]; p=0.001) were higher in patients with a composite endpoint. Additionally, creatinine (odds ratio [OR]: 13.098; 95% confidence interval [CI]: 1.471-116.620; p=0.021), non-postdilatation (OR: 8.340; 95% CI: 1.230-56.570; p=0.030), and rSS (OR: 1.157; 95% CI: 1.024-1.307; p=0.019) were independent predictors of a primary composite endpoint. CONCLUSION: CAD severity has prognostic value for mortality, MI, and stroke in patients who undergo unprotected LMCA PCI. An increased initial SS and post-procedural rSS were related to adverse cardiovascular outcomes. The rSS was also an independent predictor of major adverse cardiac and cerebrovascular events and mortality.

A case of progressive dyspnea: Atrial septal device-related functional mitral regurgitation after myocardial infarction.

Transcatheter device closure is a common treatment option of atrial septal defect. Mitral regurgitation has been reported with comorbid mitral valve prolapse and atrial septal defect. However there is no consensus regarding the pathogenesis of mitral regurgitation after closure. We are reporting a patient with functional mitral regurgitation associated with both an oversize closure device and wall motion abnormality after inferior myocardial infarction.