Selvester Score May Be a Predictor of ICD Therapies in Patients with Non-Ischemic Dilated Cardiomyopathy

ABSTRACT Introduction: The benefit of implantable cardioverter-defibrillator (ICD) in patients with non-ischemic dilated cardiomyopathy (DCM) is still an issue under discussion. Studies examining the relationship between ventricular scar tissue and ICD shock with cardiac magnetic resonance (CMR) are promising. CMR studies have shown that ventricular scar tissue size and Selvester score show a correlation. In the light of this information, this study aimed to investigate the potential relationship between Selvester score and ICD therapies. Methods: The study included 48 patients who had undergone ICD implantation with a diagnosis of DCM and who had undergone routine 6-month ICD control in outpatient clinic controls between December 2018 and October 2019. Selvester score and other data were compared between patients who received ICD therapy (n=10) and those who did not (n=38). Results: Selvester score (P<0.001) was higher in ICD therapy group. Positive correlation was found between ICD shock therapy and Selvester score (P=0.002, r=0.843). Selvester score was detected as an independent predictor for ICD therapy after multiple linear regression analysis (P=0.004). Receiver operating characteristic curve analysis showed that Selvester score (P<0.001) was a significant predictor of ICD therapy. Selvester score cutoff points of 5 for were calculated to estimate ICD therapy, with a sensitivity of 100% and specifity of 81%. Conclusion: In our study, it was found that a high Selvester score may be a predictor for ICD therapies in patients with DCM. As an inexpensive and non-invasive method, Selvester score can help in the decision-making in these patients.

Alteration in serum oxidative stress balance in patients with different circulating high-density lipoprotein cholesterol levels.

INTRODUCTION AND OBJECTIVES: High-density lipoprotein cholesterol (HDL-C) is known to be a key player in reverse cholesterol transport and this function is associated with its atheroprotective role. Low HDL-C is a strong independent risk factor for cardiovascular disease, premature atherosclerosis and increased oxidative stress. However, the clinical benefit of high HDL-C through diet or drug therapy is still controversial. METHODS: This study included 50 patients with isolated low HDL-C (≤35 mg/dl), 52 patients with isolated high HDL-C (≥70 mg/dl), and 33 age- and gender-matched controls with normal HDL-C. 'Isolated' was defined as excluding all clinical conditions associated with increased oxidative stress and inflammation, which may affect the structural state of HDL-C. In addition to arylesterase (ARES) activity and plasma thiol levels, laboratory parameters associated with oxidative stress were also assessed. RESULTS: Levels of ARES (758 [169-1150] vs. 945 [480-1215] and 821 U/l [266-1220]; p<0.01) and total thiols (233±41 vs. 259±46 µmol/l; p=0.02) were markedly higher in patients with high HDL-C. More importantly, total antioxidant capacity, oxidative stress index, creatine and serum ARES levels were associated with changes in serum HDL-C levels. CONCLUSION: In patients with isolated high HDL-C, we determined that while serum ARES activity and plasma thiol concentrations were significantly higher, the other markers associated with oxidative stress decreased markedly. Additionally, the present study demonstrated that serum oxidative stress status is very important to maintain the positive effects of HDL-C.

Selvester Score May Be a Predictor of ICD Therapies in Patients with Non-Ischemic Dilated Cardiomyopathy.

INTRODUCTION: The benefit of implantable cardioverter-defibrillator (ICD) in patients with non-ischemic dilated cardiomyopathy (DCM) is still an issue under discussion. Studies examining the relationship between ventricular scar tissue and ICD shock with cardiac magnetic resonance (CMR) are promising. CMR studies have shown that ventricular scar tissue size and Selvester score show a correlation. In the light of this information, this study aimed to investigate the potential relationship between Selvester score and ICD therapies. METHODS: The study included 48 patients who had undergone ICD implantation with a diagnosis of DCM and who had undergone routine 6-month ICD control in outpatient clinic controls between December 2018 and October 2019. Selvester score and other data were compared between patients who received ICD therapy (n=10) and those who did not (n=38). RESULTS: Selvester score (P<0.001) was higher in ICD therapy group. Positive correlation was found between ICD shock therapy and Selvester score (P=0.002, r=0.843). Selvester score was detected as an independent predictor for ICD therapy after multiple linear regression analysis (P=0.004). Receiver operating characteristic curve analysis showed that Selvester score (P<0.001) was a significant predictor of ICD therapy. Selvester score cutoff points of 5 for were calculated to estimate ICD therapy, with a sensitivity of 100% and specifity of 81%. CONCLUSION: In our study, it was found that a high Selvester score may be a predictor for ICD therapies in patients with DCM. As an inexpensive and non-invasive method, Selvester score can help in the decision-making in these patients.

Serum irisin and adropin levels may be predictors for coronary artery ectasia.

BACKGROUND: There is strong evidence that oxidative stress and inflammation may contribute to the coronary artery ectasia (CAE) pathophysiology. Recent studies have shown that serum irisin and adropin levels are associated with oxidative stress and inflammation. In the light of this information, we aimed to investigate the possible relationship between serum irisin, adropin levels and CAE. PATIENTS & METHODS: A total of 50 consecutive patients with CAE and 50 consecutive patients with normal coronary anatomy (NCA) were enrolled into the study. Serum irisin, adropin and other clinical parameters were compared between groups. RESULTS: Adropin (p < .001) and irisin (p < .001) levels were lower in the CAE group. Low adropin (p = .014) and irisin (p < .001) levels were detected as an independent risk factor for CAE in multiple regression analysis. Receiver operating characteristic curve analysis showed that serum adropin (p < .001) and irisin (p < .001) leves was significant predictor of CAE. CONCLUSIONS: The results of this study showed that serum irisin and adropin level was lower in the CAE group than in the NCA group. Irisin and adropin could play a role in the pathogenesis of CAE.

Nebivolol versus Carvedilol or Metoprolol in Patients Presenting with Acute Myocardial Infarction Complicated by Left Ventricular Dysfunction.

OBJECTIVE: The aim of this study was to evaluate the efficacy of nebivolol, carvedilol or metoprolol succinate on the outcome of patients presenting with acute myocardial infarction (AMI) complicated by left ventricular dysfunction. SUBJECTS AND METHODS: Patients (n = 172, aged 28-87 years) with AMI and left ventricular ejection fraction ≤0.45 were randomized to the nebivolol (n = 55), carvedilol (n = 60) and metoprolol succinate (n = 57) groups. Baseline demographic and clinical characteristics and composite event rates of nonfatal MI, cardiovascular mortality, hospitalization due to unstable angina pectoris or heart failure, stroke or revascularization during the 12-month follow-up were compared among the groups using the x03C7;2 test, t test or log-rank test as appropriate. RESULTS: Baseline demographic and clinical characteristics were similar in the three groups. The composite end point during follow-up was lower in the patients treated with nebivolol than those treated with metoprolol (14.5 vs. 31.5%; p = 0.03). However, event rates were similar between the patients treated with carvedilol and those treated with the metoprolol (20.3 vs. 31.5%, p > 0.05) and between the patients treated with nebivolol and carvedilol (14.5 vs. 20.3%, p > 0.05). CONCLUSION: The patients treated with nebivolol experienced 12-month cardiovascular events at a lower rate than those treated with metoprolol succinate. However, event rates were similar between the carvedilol and the metoprolol succinate groups and between the nebivolol and the carvedilol groups.

Relationship Between Mean Platelet Volume and Pulmonary Embolism in Patients With Deep Vein Thrombosis.

BACKGROUND: Mean platelet volume (MPV) has been demonstrated to be associated with deep vein thrombosis (DVT). However, its role in the prediction of pulmonary embolism (PE), which is a major complication of DVT, is still unclear. Therefore, we investigated the association of MPV values with acute PE in patients with DVT. METHOD: The study included three groups: patients with DVT and PE (n=98); patients with DVT without PE (n=97); and control group (No DVT, No PE, n=98). We also evaluated DVT patients according to the MPV values on admission and categorised them into two groups: MPV≤9.15 fL (n=82) and MPV>9.15 fL (n=113). RESULTS: MPV was significantly higher in all DVT patients than controls (9.3±0.9 fL vs 7.9±0.7 fL, p<0.001) and in DVT patients with PE than DVT patients without PE (9.9±0.6 fL vs 8.7±0.7 fL, p<0.001). The rate of PE was higher in patients with DVT with MPV>9.15 fL than those with MVP≤9.15 fL (75.2% vs 15.9%, p<0.001). The presence of PE in patients with DVT was independently associated with MPV (OR: 22.19, 95%CI: 9.39-53.19, P<0.001). CONCLUSION: Although our findings should be considered within the limitations of the study, they suggest that MPV measures may be elevated in DVT patients and a higher MPV may be associated with PE in patients with DVT.

Strict heart rate control attenuates prothrombotic state and platelet activity in patients with non-valvular permanent atrial fibrillation.

BACKGROUND: The underlying mechanisms of increased risk of thrombo-embolism in atrial fibrillation (AF) are not completely understood; however, substantial evidence supports that AF is associated with a prothrombotic state. Accordingly, we hypothesized that strict rate control could attenuate platelet activity and thrombotic state in patients with non-valvular AF. METHODS: Seventy-five patients with non-valvular AF were divided into 2 groups based on heart rate: (1) normal ventricular rate (n = 34, 18 female) and (2) high ventricular rate (n = 39). Thirty-three sex- and age-matched subjects in sinus rhythm were included as control. Thirty patients with high ventricular rate (16 female) were successfully followed. Markers of platelet function were measured at baseline and repeated 1-month after adequate rate control in high ventricular rate group. RESULTS: Serum fibrinogen levels were significantly higher in AF patients with high ventricular rate than that in controls. Mean platelet volume, soluble CD40L and ß-Thromboglobulin were significantly higher in AF patients with high ventricular rate than those in both AF patients with normal ventricular rate and controls. Soluble CD40L and ß-Thromboglobulin were significantly higher in AF patients with normal ventricular rate than those in controls. One-month after adequate rate control, serum fibrinogen, soluble CD40L and ß-Thromboglobulin levels significantly decreased (from 2.26 ± 1.02, 85.01 ± 37.05, 3.10 ± 0.90 to 1.55 ± 1.08, 66.34 ± 33.72, 2.71 ± 0.53; p < 0.001, p = 0.002, p = 0.03, respectively) in high ventricular rate group. CONCLUSIONS: AF patients with high ventricular rate had increased indices of platelet activity and thrombotic state. Furthermore, strict rate control significantly decreased indices of thrombotic state and platelet activity in those patients.

Effects of prediabetes and diabetes on left ventricular and coronary microvascular functions.

BACKGROUND: Coronary flow reserve (CFR) provides independent prognostic information in diabetic patients with known or suspected coronary artery disease. However, there have been no substantial data to evaluate CFR in prediabetics. Accordingly, we aimed to evaluate CFR in subjects with prediabetes using second harmonic transthoracic Doppler echocardiography. METHODS AND RESULTS: We measured CFR of 65 subjects with prediabetes, 45 patients with overt type 2 diabetes, and 43 sex and age matched normoglycemic healthy subjects with normal glucose tolerance. Ages, gender, existence of hypertension or hypercholesterolemia, smoking status were similar among the groups. CFR was significantly lower in diabetics (2.15 ± 0.39) than in prediabetics (2.39 ± 0.45) and controls (2.75 ± 0.35); in addition, it was significantly lower in prediabetics than controls. Only 2 (5%) of control subjects had abnormal CFR (<2) but 11 (17%) prediabetic subjects and 19 (42%) diabetic patients had abnormal CFR. We found that only age (ß=-0.31, P<0.01) and presence of the diabetes (ß=-0.57, P<0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r=-0.15, P=0.04), fasting glucose level (r=-0.27, P=0.001), postprandial glucose level (r=0.43, P<0.001), hemoglobin A1C level (r=-0.34, P<0.001), LDL cholesterol level (r=0.22, P=0.009), mitral A velocity (r=-0.27, P=0.001) and Tei index (r=-0.19, P=0.02), whereas mitral E/A ratio, mitral Em (r=0.18, P=0.02), mitral Em/Am ratio (r=0.23, P=0.004) were significantly and positively correlated with CFR. CONCLUSION: CFR is impaired in subjects with prediabetics, but this impairment is not as severe as that in diabetics.

Effects of allopurinol on coronary microvascular and left ventricular function in patients with idiopathic dilated cardiomyopathy.

BACKGROUND: Uric acid (UA) is an independent marker of mortality and associated with increased oxidative stress in patients with congestive heart failure (CHF). The present study aimed to investigate the effect of allopurinol on left ventricular (LV) function and coronary microvascular integrity in patients with idiopathic dilated cardiomyopathy (IDC). METHODS: Thirty-nine consecutive IDC patients were divided into 2 groups: elevated (> 7 mg/dL for men and >6.5 mg/dL for women; n = 24) and normal (n = 15) UA. Allopurinol 300 mg per day was given to the elevated UA group. Patients with elevated UA were assessed after a 3-month treatment period. Echocardiography assessing coronary flow reserve (CFR) and systolic and diastolic LV functions were studied. RESULTS: LV ejection fraction was significantly lower in elevated UA group: mean (interquartile range), 32.3% (26.0-36.5%) vs 37.3% (35.5-39.1%) (P < 0.01). Also, CFR and LV diastolic and combined function parameters were more prominently impaired in the elevated UA group. After allopurinol treatment, UA was significantly decreased (7.2 mg/dL [6.8-7.8] to 4.4 mg/dL [3.9-5.8]; P < 0.001) and CFR was markedly improved (1.87 [1.63-2.00] to 2.20 [1.87-2.49]; P < 0.001). The therapeutic effect of allopurinol on the reduction of UA from baseline was directly related to the improvement of CFR (r = 0.49; P = 0.01). Mitral A and E/E' were reduced, while S', E', E/A, and E'/A' were increased significantly. CONCLUSIONS: The present study showed that 3-month treatment with allopurinol was significantly associated with reduced UA levels, and improvement of CFR and LV functions in patients with IDC and hyperuricemia.

Mean platelet volume is associated with culprit lesion severity and cardiac events in acute coronary syndromes without ST elevation.

We investigated the association of mean platelet volume (MPV) with culprit lesion severity and major cardiac outcomes (MCOs) in patients with acute coronary syndrome (ACS) with non-ST elevation (NSTE). This study included 344 patients with NSTE-ACS who had significant coronary stenosis at least 50%. They were divided into high MPV group (n = 109, upper tertile >9.9 fl) and low MPV group (n = 235, lower and mid tertile ≤ 9.9 fl) according to MPV values on admission. They were followed up for MCOs during 12 months. MCO consisted of the composite end-point of cardiac death, myocardial infarction (MI), recurrent angina or hospitalization. High MPV was independently associated with NSTE-MI [odds ratio (OR) 4.24, 95% confidence interval (CI) 2.52-7.15, P = 0.001] and severe culprit stenosis (≥ 80%) (OR 4.05, 95% CI 2.39-6.83, P = 0.001). MPV of 9.9 fl was predictive of severe culprit stenosis with a sensitivity of 73% and specificity of 77% (P < 0.001). At 12 months, MCO rate was higher in high MPV group than low MPV group (39 vs. 26%; P = 0.016). This difference resulted from death (6.4 vs. 2.1; P = 0.06) and recurrent angina (16.5 vs. 8.9%; P = 0.045). The MCO-free survival was worse in patients with high MPV than those with low MPV (61 vs. 74%; P = 0.01). In Cox regression analysis, high MPV remained an independent predictor of MCO (hazard ratio 1.52, 95% CI 1.01-2.29, P = 0.04) after adjusting for baseline characteristics. Elevated MPV was independently associated with NSTE-MI presentation and severity of culprit stenosis in NSTE-ACS patients. Moreover, MPV greater than 9.9 fl was predictive of a 12-month MCO.

Elevated mean platelet volume is associated with impaired coronary microvascular function in patients with idiopathic dilated cardiomyopathy.

Attenuated coronary flow reserve (CFR) has been reported in patients with idiopathic dilated cardiomyopathy (IDC). On the other hand increased platelet activity has been demonstrated in patients with congestive heart failure and left ventricular dysfunction. Accordingly, we aimed to investigate whether mean platelet volume (MPV) is increased in patients with IDC and increased MPV correlates with the degree of coronary microvascular dysfunction. MPV was measured in 37 patients with IDC. Each patient with IDC also underwent echocardiographic examination including CFR measurement. Patients with IDC were divided into two groups based on median CFR value (lower CFR group and normal CFR group). MPV was significantly higher in the lower CFR group than in the normal CFR group (9.00 ± 0.56 vs. 8.25 ± 0.76 fl; respectively, p = 0.001). CFR correlated significantly and inversely to MPV (r = -0.475, p = 0.003). Logistic regression analysis revealed that MPV level was the independent predictor of lower CFR (ß = -0.750, p = 0.002). Furthermore, MPV was an accurate predictor of low CFR (p = 0.001); Area under the curve was 82% (95% CI 0.67-0.96). The best cut-off value of MPV to predict low CFR was 8.3 fl with 95% sensitivity and 69% specificity. In conclusion, the present study showed a negative correlation between MPV and CFR in patients with IDC.

Mean platelet volume has a prognostic value in patients with coronary artery ectasia.

The aim of this study was to investigate the prognostic role of mean platelet volume (MPV) in patients with coronary artery ectasia (CAE). The baseline MPV values of 258 patients with CAE were screened. The mean time of follow-up was 49 ± 21 months for major adverse cardiac events (MACEs) defined as the combination of cardiac death, nonfatal myocardial infarction (MI), rehospitalization due to cardiac disorders, and readmission due to chest pain. During follow-up period, 63 (24%) MACEs developed. There were 4 (2%) cardiovascular deaths, 0 nonfatal MI, 14 (5%) rehospitalization, and 45 (17%) readmission. Mean platelet volume values were significantly higher in patients with CAE with MACEs than in patients with CAE without MACEs (9.5 ± 1.2 fL vs 8.9 ± 1.1 fL, respectively, P = .002). The rate of MACE was higher in CAE patients with MPV of >9 fL than those with MVP of ≤9 fL (33% vs. 15%, P = .001). Mean platelet volume has a prognostic value for MACEs in patients with CAE.

N-3 polyunsaturated fatty acids administration does not reduce the recurrence rates of atrial fibrillation and inflammation after electrical cardioversion: a prospective randomized study.

OBJECTIVE: The purpose of the present prospective randomized study was to evaluate the effects of n-3 polyunsaturated fatty acids on recurrence rates of atrial fibrillation (AF) and inflammation after electrical cardioversion. METHODS: Calculation of the number of patients needed was based on the assumption of 20% and 65% chance of maintaining sinus rhythm with amiodarone and with polyunsaturated fatty acids, respectively. To observe a significant difference with an alpha level of 0.05 and a power of 0.80 it was necessary to include 22 patients in each group. A total of 47 patients were randomized to amiodarone (n=24) and amiodarone plus n-3 polyunsaturated fatty acids (n=23) groups before scheduled electrical cardioversion. The end-point was the recurrence of AF during 12-month follow-up. Effect of n-3 polyunsaturated fatty acids on inflammation was evaluated with high sensitivity C-reactive protein level measurements. Statistical analysis was performed using unpaired Student' t, Mann Whitney U and Chi-square tests. We analyzed the recurrence of AF using the Cox proportional hazards regression model to control for potentially confounding factors. RESULTS: Nine patients in the amiodarone group (37.5%), and 9 patients in the amiodarone plus n-3 polyunsaturated fatty acids group (39.1%) had recurrence of AF during follow-up (p=1). With the Cox proportional model, risk factors for the recurrence of AF were previous electrical cardioversion (HR 10.33, 95% CI 1.74 to 61.10, p=0.01) and high sensitivity C-reactive protein levels (HR 1.07, 95% CI 1.02 to 1.38, p=0.007). High sensitivity C-reactive protein levels at baseline, at day 15 and during AF recurrence were similar between two groups (p > 0.05 for all). CONCLUSION: N-3 polyunsaturated fatty acids administration does not reduce the recurrence rates of atrial fibrillation and inflammation.

Platelet indices in patients with pulmonary arterial hypertension.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a chronic progressive disease characterized by persistent elevation of pulmonary artery pressure. Vasoconstriction, remodeling, and thrombosis cause increased pulmonary vascular resistance and pressure. Previous studies have demonstrated that platelet activation occurs in patients with PAH. Our aim was to assess the mean platelet volume (MPV), an indicator of platelet activation in patients with PAH. PATIENTS AND METHOD: The study group consisted of 22 patients with PAH. An age-, gender-, and body mass index-matched control group was composed of 25 healthy volunteers. All patients underwent physical examination, echocardiography, and diagnostic cardiac catheterization. We measured serum MPV values and platelet counts in patients with PAH and control participant. RESULTS: MPV was significantly higher among the patients with PAH when compared with control group (8.68 ± 0.87 vs 8.02 ± 0.68 fl, respectively; P = .006). CONCLUSION: We have shown that MPV was elevated in patients with PAH.

Can comprehensive echocardiographic evaluation provide an advantage to predict anthracycline-induced cardiomyopathy?

OBJECTIVES: No definite markers have been established to identify patients in whom anthracycline-containing chemotherapy may represent a high risk for the development of cardiotoxicity. We aimed to evaluate the predictive value of comprehensive echocardiography in anthracycline-induced cardiomyopathy. STUDY DESIGN: In a prospective design, the study included 39 patients (9 males, 30 females; mean age 53.7±11.5 years) who received antineoplastic therapy including anthracycline. Comprehensive echocardiographic examination including tissue Doppler imaging and coronary flow reserve was performed before treatment with anthracycline and at the end of a six-month follow-up. RESULTS: Eight patients (20.5%) developed cardiomyopathy during the follow-up period. Compared to patients with unaffected left ventricular ejection fraction at 6 months, patients with cardiomyopathy exhibited significant differences in baseline left ventricular systolic diameter, mitral E/A, E-wave deceleration time, Sm, Em, Em/Am ratio, Sm-Em duration, and the Tei index. In univariate logistic regression analysis, only Sm (OR 0.40, p=0.002) and the Tei index (OR 3.24, p=0.02) were significant variables for the development of cardiotoxicity. These two were also the only independent predictors of anthracycline cardiotoxicity in multivariate linear regression analysis. Receiver operating characteristic curve analysis yielded a cut-off value of 8 cm/sec for Sm and 0.38 for the Tei index to predict cardiomyopathy. CONCLUSION: Our findings suggest that Sm and myocardial performance index (the Tei index) are significant independent markers to identify patients at high risk for the development of anthracycline-induced cardiomyopathy.