Use of TIMI Risk Index as a Simple and Valuable Prognostic Tool in Patients with ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention.

OBJECTIVE: Thrombolysis in Myocardial Infarction Risk Index is a risk stratification model developed to determine the prognosis in ST-segment elevation myocardial infarction patients who underwent fibrinolytic therapy. The information on the effectiveness of Thrombolysis in Myocardial Infarction Risk Index in patients who underwent primary percutaneous coronary intervention is limited. This study aimed to demonstrate the predictive value of Thrombolysis in Myocardial Infarction Risk Index on clinical outcomes in patients presenting with ST-segment elevation myocardial infarction and subsequently undergoing primary percutaneous coronary intervention. METHODS: A total of 963 patients who presented with ST-segment elevation myocardial infarction and subsequently underwent primary percutaneous coronary intervention were reviewed retrospectively. The discriminative power of Thrombolysis in Myocardial Infarction Risk Index for each outcome of congestive heart failure, death, stroke, and myocardial infarction within 1 month and 1 year after admission was assessed. RESULTS: Congestive heart failure, death, stroke, and myocardial infarction, and the major adverse cardiac events, which is the composite outcome thereof, were higher in the patient groups with high Thrombolysis in Myocardial Infarction Risk Index values (P < .05). Thrombolysis in Myocardial Infarction Risk Index was an independent predictor of the following outcomes: 1-month survival rate [odds ratio:1.054 (1.036-1.073)], 1-year survival rate [odds ratio:1.048 (1.031-1.065)], hospitalization rate due to congestive heart failure within 1 month [odds ratio:1.041(1.026-1.057)], and within 1 year [odds ratio:1.040 (1.024-1.055)]. The Thrombolysis in Myocardial Infarction Risk Index level was found to have good discriminative power for 1-month mortality and 1-year mortality rates (Thrombolysis in Myocardial Infarction Risk Index: 22.76, C-statistic: 0.71-0.68, respectively). CONCLUSION: The results of this study indicated that Thrombolysis in Myocardial Infarction Risk Index value is an independent predictor of clinical outcomes such as death and heart failure but not subsequent myocardial infarction in ST-segment elevation myocardial infarction patients. The use of Thrombolysis in Myocardial Infarction Risk Index can be considered in ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention as it is an easily applicable and important indicator of prognosis.

New prognostic markers in pulmonary arterial hypertension: CRP to albumin ratio and uric acid.

INTRODUCTION: Idiopathic pulmonary hypertension(IPAH) is a rare disease that causes severe morbidity and mortality despite advances in treatment management. Evaluating the prognosis of the disease is critical in determining therapeutic approaches. We aimed to evaluate the prognostic significance of C-reactive protein/albumin ratio (CAR) and uric acid, which is an easily applicable and inexpensive parameter in patients with IPAH. METHODS: Seventy-two IPAH patients and 99 consecutive non-IPAH patients as a control group were enrolled in the study retrospectively. Right heart catheterization(RHC), echocardiography, and laboratory parameters of the two groups and those who died and survived among the IPAH patients were compared. RESULTS: IPAH and control group were compared at the first stage and CAR (1.98(0.28-10.74), 0.75(0.22-4.7),respectively;p < 0.01) and uric acid (0.33(0.19-0.87), 0.3(0.11-0.48) mmol/L, respectively; p = 0.03) values were significantly higher in the pulmonary hypertension group compared to the control group. Compared with the surviving IPAH patients, CAR (4.60(1.39-10.74),1.54(0.28-6.74),respectively;p < 0.001) and uric acid levels (0.458(0.26-0.87), 0.315(0.19-0.56) mmol/L, respectively; p < 0.001) were significantly higher in the group of patients who died. In the multivariate Cox regression models uric acid(p < 0.001) and CAR(p < 0.001) were found to be associated with survival time. Receiver operating characteristic curves (ROC) analyses showed that > 1.54 CAR value (AUC = 0.81,Sens:85.7%,Spec:56.9%,p < 0.001) and > 5.85 mg/dL (>0.348 mmol/L) uric acid value (AUC = 0.864, Sens:85.7%, Spec:78.4%, p < 0.001) are strong predictors for mortality. CONCLUSION: In this study, we showed that simple markers such as CAR, which augment the inflammation marker feature of CRP, and uric acid can give prognostic information in PAH patients.

Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR).

OBJECTIVE: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey. METHODS: The ARNi-TR is a multicenter, noninterventional, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control. RESULTS: N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARN. CONCLUSION: The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.

Effect of COVID-19 pandemic on anxiety depression and intention to go to hospital in chronic patients.

OBJECTIVE: The aim of this study was to investigate the effects of the COVID-19 pandemic on anxiety depression and intention to go to the hospital in chronic patients. METHODS: The Bostan Intention to Go to Hospital Scale developed by one researcher (SB) as the data collection tool and the Beck Anxiety-Depression Inventories were used. RESULTS: Of all patients, 56.8% stated that they would go to the hospital in case of emergency and 28.3% expressed that they did not want to go to the hospital even in this case. 50% of the participants said that they did not want to go to the hospital under any circumstances during the pandemic process. As a result of the correlation analysis, there was an inverse correlation between the anxiety-depression levels and encountering COVID-19 patients and having a relative with COVID-19 (P = .001). Inverse correlation was found between intention to go to hospital and encountering COVID-19 patients (P = .001). CONCLUSION: It was revealed that chronic patients did not have any intentions to go to hospital during the COVID-19 pandemic and only half of the people were willing to go to the hospital in case of emergency. Anxiety and depression levels were found to increase when COVID-19 patients were encountered or a relative had COVID-19.

Modified model for end-stage liver disease score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units.

OBJECTIVES: The Model for End-stage Liver Disease excluding the international normalised ratio that is derived from prothrombin time which is calculated as a ratio of the patient's prothrombin time to a control prothrombin time standardized (MELD-XI) and modified MELD, which uses albumin in place of the international normalised ratio (MELD-Albumin) scores reflect liver and renal function and are predictors of mortality. However, their prognostic value in acute pulmonary embolism (APE) has not been studied. DESIGN: We assessed the predictive value of the MELD scores in patients diagnosed with high-risk APE admitted to the intensive care unit. The primary outcome was 30-day mortality. RESULTS: Of the 273 patients included in the study, 231 were survivors and 42 were non-survivors. The mortality rate was 15.3%. The mean MELD-XI and MELD-Albumin scores were significantly higher in the non-survivors than in the survivors (MELD XI, 11.8 ± 1.8 and 10.6 ± 1.43, respectively; p = .002; MELD-Albumin, 10.5 ± 1.6 and 8.7 ± 1.1, respectively; p = .001). The multiple logistic regression analysis identified the MELD-XI (hazard ratio: 3.029, confidence interval: 1.06-1.21, p = .007) and MELD-Albumin (hazard ratio: 1.13, confidence interval: 1.06-1.21, p = .002) scores as independent predictors of mortality. Receiver operating characteristic analysis revealed that the predictive power of the MELD-Albumin score (0.871 ± 0.014; p < .001) was higher than those of the MELD-XI (0.726 ± 0.022, p < .001), APACHE III (0.682 ± 0.024, p < .001), and PESI (0.624 ± 0.023, p < .001) scores. CONCLUSIONS: The MELD-Albumin score is an easily calculable, reliable, and practical risk assessment tool and independent predictor of 30-day mortality in patients with high-risk APE.

Effects of angiotensin receptor neprilysin inhibition on pulmonary arterial stiffness in heart failure with reduced ejection fraction.

The sacubitril/valsartan combination is an important agent used in the treatment of heart failure with reduced ejection fraction (HFrEF). Pulmonary artery stiffness (PAS) is an index developed to evaluate the pulmonary vascular bed. Changes in pulmonary vascular structures in HFrEF patients can affect PAS. In this study, we aimed to investigate the effect of sacubitril/valsartan on PAS in HFrEF patients. One hundred fifty HFrEF patients, who received sacubitril/valsartan therapy and continued for at least 6 months without interruption, were examined retrospectively. N-terminal pro-B-type natriuretic peptide levels (NT-proBNP), NYHA classes, Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores, New York Heart Association (NYHA) functional classes and echocardiograpic parameters such as left ventricular ejection fraction (LVEF), mean pulmonary artery pressure (mPAP), right ventricle myocardial performance index (RV-MPI), Tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RV-FAC) and PAS changes were evaluated before and 6 months after sacubitril/valsartan treatment. PAS was calculated by using the maximal frequency shift and acceleration time of the pulmonary artery flow trace measured in the echocardiogram. PAS values were significantly reduced (23.8 ± 2.8 vs 19.1 ± 3.1 kHz/ms, p < 0.001) after the sacubitril/valsartan treatment. Sacubitril/valsartan treatment was associated with significant improvements in NYHA class and MLWHFQ scores; significant reductions in the NT-proBNP levels, mPAP, and RV-MPI, and significant increases in LVEF, TAPSE, and RV-FAC (p < 0.05). The significant reduction in the PAS value was significantly correlated with the improvements in the MLWFQ scores, NT-proBNP levels, mPAP, RV-MPI, TAPSE and RV-FAC. In HFrEF patients, switching from angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapy to sacubitril/valsartan may result in reduction in PAS.

Association of C-Reactive Protein-to-Albumin Ratio With the Presence and Progression of Abdominal Aortic Aneurysm.

Aortic dilatation due to inflammation may lead to an increase in C-reactive protein (CRP) levels. We investigated the possible relationship between CRP-to-albumin ratio (CAR) and presence and progression of abdominal aortic aneurysms (AAAs). The study included 150 patients previously diagnosed with AAA (diameter 40-54 mm) and 100 normal controls. Clinical and laboratory parameters and maximal cross-sectional AAA diameters (measured by computed tomography angiography) were obtained from all participants at baseline assessment as well as after 1 year for those with an AAA. The patients with AAA had significantly higher serum CAR compared with controls at baseline (P < .001). Increased serum CAR was found to be an independent predictor of the presence of AAA (odds ratio: 3.162, 95% CI: 1.690-5.126, P = .001) after multivariate logistic regression analysis. There was a significant increase in aortic diameter and CAR after 1 year in the patients with AAA (P < .001; P = .003); a significant correlation was found between changes in the diameter of AAAs and CAR (r = 0.414; P = .005). Serum CAR may be useful as an inflammatory biomarker for the presence and progression of AAA.

Usefulness of CHA2DS2-VASc Score to predict clinical outcomes of patients undergoing carotid artery stenting.

The CHA2DS2-VASc score predicts stroke and mortality risk in several cardiovascular diseases regardless of atrial fibrillation. In this study, we aimed to investigate the ability of CHA2DS2-VASc score to predict in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS). The study population included 558 patients undergoing CAS. The patients were stratified into three groups based on their CHA2DS2-VASc scores [low (≤ 2, n = 123), moderate (3-5, n = 355) and high (6-8, n = 80)]. In-hospital and 3-year outcomes were compared between the groups. In-hospital rates of ipsilateral and major strokes and death were significantly different between the groups (1.6% vs. 3.9% vs. 16.2%; 1.6% vs. 4.5% vs. 16.2%; 0.8% vs. 3.1% vs. 13.8%, p < 0.001 for all, respectively). At 3 years of follow-up, rates of ipsilateral and major strokes and death were significantly increased in patients with highscore compared to those with moderate and low scores (1.6% vs. 5.8% vs. 13%, p = 0.005; 0.8% vs. 5.2% vs. 13%, p = 0.001; 1.6% vs. 8.4% vs. 15.9%; p = 0.002, respectively). After adjusting for multi-model Cox regression analysis, CHA2DS2-VASc score persisted as an independent prognostic factor for mortality and major stroke in patients undergoing CAS. Higher CHA2DS2-VASc score predicted increased risk of in-hospital and 3- year stroke and mortality in patients undergoing CAS.

Evaluation of P-wave dispersion in patients with newly diagnosed coronavirus disease 2019.

AIM: The aim of the current study was to evaluate P-wave dispersion (PWD) as a predictor of atrial fibrillation in patients with newly diagnosed COVID-19. In addition, the relationship between the PWD and inflammation parameters was investigated. METHODS: A total of 140 newly diagnosed COVID-19 patients and 140 age- and sex-matched healthy individuals were included in the study. The risk of atrial fibrillation was evaluated by calculating the electrocardiographic PWD. C-reactive protein (CRP), white blood cell, neutrophil and neutrophil-to-lymphocyte ratio (NLR) were measured in patients with newly diagnosed COVID-19. RESULTS: PWD, white blood cell, NLR and CRP levels were significantly higher in the COVID-19 group than the control group. There was a significant positive correlation between PWD and CRP level (rs = 0.510, P < 0.001) and NLR in COVID-19 group (rs = 0.302, P = 0.001). In their follow-up, 13 (9.3%) patients, 11 of whom were in the ICU, developed new atrial fibrillation. CONCLUSION: Our study showed for the first time in literature that the PWD, evaluated electrocardiographically in patients with newly diagnosed COVID-19, was prolonged compared with normal healthy individuals. A positive correlation was found between PWD, CRP level and NLR. We believe that pretreatment evaluation of PWD in patients with newly diagnosed COVID-19 would be beneficial for predicting atrial fibrillation risk.

The relationship between severe acute respiratory syndrome coronavirus 2 (SARS - COV - 2) pandemic and fragmented QRS.

OBJECTIVE: The aim of the study is to determine the frequency of fragmented QRS (FQRS) in patients with SARS - COV - 2. METHODS: A total of 125 consecutive patients over 20 years of age who were hospitalized for SARS - COV - 2 between 20th March 2020 and 18th May 2020 were included in the study. The data of the patients in the inpatient ward and in the intensive care unit were recorded separately. The duration of QRS and presence of FQRS were evaluated by two experienced cardiologists. The patients were divided into two groups as FQRS positive and FQRS negative considering presence of FQRS. Moreover, the frequency of FQRS in the patients in the inpatient ward and in the intensive care unit were compared with each other. RESULTS: FQRS was found in 24% of the patients who had SARS-COV-2. There was no difference between FQRS positive and negative groups in terms of age and gender. Heart rate was higher in FQRS positive group. C-reactive protein (7.25 ±â€¯6.65 mg/dl vs. 4.80 ±â€¯4.48 mg/dl; p = .02) levels were also significantly higher in the FQRS positive group. In patients with SARS-COV-2, intensive care unit requirement increased with increasing levels of troponin (p < .000). A positive correlation was detected between serum CRP levels and FQRS (r = 0.204, p = .024). CONCLUSIONS: The frequency of FQRS is high in patients with SARS - COV - 2. Serum CRP levels increase with increasing frequency of FQRS in patients with SARS - COV - 2 indicating that patients with FQRS are exposed to more inflammation. Presence of FQRS in SARS - COV - 2 patients may be useful in predicting cardiovascular outcomes.

Assessment of the Relationship Between C-Reactive Protein-to-Albumin Ratio and the Presence and Severity of Isolated Coronary Artery Ectasia.

We investigated the relationship between C-reactive protein-to-albumin ratio (CAR) and coronary artery ectasia (CAE). The retrospective study population included 150 patients with isolated CAE, 150 with obstructive coronary artery disease (CAD), and 150 with a normal coronary artery angiogram (NCA). The severity of isolated CAE was determined according to the Markis classification. C-reactive protein-to-albumin ratio was significantly higher in patients with isolated CAE than in those with obstructive CAD and NCA (10.5 [5.9-30.9], 5.7 [1.8-13.2] and 3.0 [0.9-8.9], respectively). Logistic regression analysis showed that CAR (odds ratio [OR]: 3.054, 95% CI: 1.021-9.165, P = .001), platelet-to-lymphocyte ratio (PLR; OR: 1.330, 95% CI: 1.025-1.694, P = .044), and monocyte-to-high density cholesterol ratio (MHR; OR: 1.031, 95% CI: 1.009-1.054, P = .006) were independently associated with the presence of isolated CAE. Receiver operating characteristic curve analysis showed that CAR (area under the curve [AUC] ± standard error [SE] = 0.838 ± 0.016; P < .001) had a stronger diagnostic value for detecting significant CAE than PLR (AUC ± SE = 0.632 ± 0.023) and MHR (AUC ± SE = 0.726 ± 0.022). C-reactive protein-to-albumin ratio had a significantly strong correlation with the severity of isolated CAE (r = 0.536, P < .001). To the best of our knowledge, this study showed for the first time that CAR was significantly associated with CAE presence and severity.

Impact of sacubitril/valsartan treatment on depression and anxiety in heart failure with reduced ejection fraction.

Background: In patients with heart failure (HF), depression and anxiety disorders are common and associated with adverse outcomes. Sacubitril/valsartan, which is an angiotensin receptor neprilysin inhibitor (ARNI), has been shown to reduce mortality and hospitalisation in patients with heart failure with reduced ejection fraction (HFrEF). However, its effects on depression and anxiety levels remain unclear.Methods: Sacubitril/valsartan was initiated in 115 symptomatic patients with HFrEF receiving an optimal medical treatment with angiotensin inhibition. Patients underwent 6-minute walk test (6-MWT), The Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) were administered at the switching to ARNI and at the third-month follow-up of the maximum sacubitril/valsartan dose.Results: A significant improvement was observed in BDI-II and BAI scores when compared before and after the sacubitril/valsartan treatment (13.7 ± 9.7 to 7.6 ± 3.8, p < 0.001 and 13.3 ± 8.9 to 8.1 ± 4.1, p < 0.001, respectively). The 6-MWT distance significantly increased from 213 ± 95 to 327 ± 118 mt (p < 0.001). Overall, the patients exhibited a significant functional improvement following the initiation of sacubitril/valsartan: 27% of the patients improved by two New York Heart Association (NYHA) classes, 52% improved by one NYHA functional class, and 31% remained stable.Conclusion: In patients with HFrEF, the switch from angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapy to sacubitril/valsartan resulted in a significant improvement in both depression, anxiety symptoms and functional statuses.

Association between fragmented QRS and left ventricular dysfunction in acromegaly patients.

Background: In acromegaly patients; it has been observed that heart failure may develop even in the absence of predisposing factors such as hypertension, diabetes mellitus, so a specific acromegalic cardiomyopathy has been suggested. We aimed to evaluate the fQRS frequency in acromegaly patients and the left ventricular (LV) functions of acromegaly patients with fQRS.Methods: Our study included 60 acromegalic patients. Each patient underwent conventional echocardiography and tissue Doppler imaging. The patients included were separated into two groups: those with (n:23) and without (n:37) fQRS.Results: Significant differences were identified between fQRS(+) and fQRS (-) groups with respect to disease duration (p < .001), Left ventricular end diastolic volume (EDV) (p < .001), E velocity (p < .001), E\A ratio (p < .001), E' velocity (p < .001), E/E' ratio (p < .001), isovolumic relaxation time (IVRT) (p < .001), MPI (p < .001). Disease duration (odds ratio [OR]: 2.120 (1.023-1.703 95% confidence interval [CI]), p = .002), E' (OR:3.029 (1.013-1.703 95% CI) p = .004) and fQRS (OR:4.59 (1.94-10.87 95% CI), p = .001) were identified as the independent predictors of myocardial performance index (MPI). However, disease duration (OR:1.078 (1.030-1.128 95% CI), p = .001), E/E' (OR: 1.43 (1.22-1.97 95% CI), p = .001), IVRT (OR:1.65 (1.32-2.06 95% CI), p = .001) and MPI (OR:1.014 (1.004-1.024 95% CI), p = .002) were the independent predictors of fQRS.Conclusions: fQRS was frequent and an independent predictor of MPI that was independelty associated with LV dysfunction in patients with acromegaly. In light of these findings the presence of fQRS is thought to be an indicator of acromegalic CMP development.

Effects of sacubutril/valsartan on nutritional status in heart failure with reduced ejection fraction.

BACKGROUND: Malnutrition commonly occurs in patients with heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan, which is an AT1 neprilysin inhibitor, has been shown to reduce mortality and hospitalization in patients with HFrEF. However, its effects on nutritional status remain unclear. METHODS: Sacubitril/valsartan was initiated in 164 symptomatic patients with HFrEF receiving an optimal medical treatment with angiotensin inhibition (mean age: 63 ±â€Š20 years; 120 males, 60% ischemic cause). The New York Heart Association (NYHA) functional class and nutritional statuses of the patients were evaluated at the switching to AT1 neprilysin inhibitor and at the 6th-month follow-up of the maximum sacubitril/valsartan dose using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and prealbumin. RESULTS: After the sacubutril/valsartan treatment, a significant reduction in the number (%) of malnourished patients was observed according to CONUT (before 47% vs. after 7%, P < 0.001), GNRI (before 39% vs. after 19%, P < 0.001), PNI scores (before 36% vs. after 12%, P = 0.002), and prealbumin (before 41% vs. after 12%, P < 0.001). Also significant changes were observed at the baseline and follow-up in the mean scores of the three different nutritional indexes and prealbumin levels [CONUT: 2.68 ±â€Š2.5, 1.02 ±â€Š1.0 (P < 0.001); GNRI: 97.1 ±â€Š9.7, 101.2 ±â€Š5.9 (P < 0.001); PNI: 38.8 ±â€Š4.8, 41.6 ±â€Š3.7 (P < 0.001); prealbumin: 14.6 ±â€Š6.9 mg/dl, 17.1 ±â€Š5.2 mg/dl (P < 0.001)]. Overall, the patients exhibited a significant functional improvement following the initiation of sacubitril/valsartan: 23% of the patients improved by two NYHA classes, 48% improved by one NYHA class, and 39% remained stable. CONCLUSION: In patients with HFrEF, the switch from angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapy to sacubitril/valsartan resulted in a significant improvement in both nutritional and functional statuses.

Evaluation of left atrial volume and function by real time three-dimensional echocardiography in anemic patients without overt heart disease before and after anemia correction.

There are few data on the effects of low hemoglobine levels on the left atrium (LA) in anemic patients. Our aim was to evaluate left atrial (LA) volume and functions in anemic patients using real time three-dimensional echocardiography (RT3DE) and also to investigate changes in variables of LA after the correction of anemia. In total, 55 iron-deficiency anemia patients without traditional cardiovascular (CV) risk factors and 30 age- and gender-matched controls were studied. Assessments included history, physical examination and echocardiography. Of the 55 patients with anemia enrolled, 50 (39 females and 11 males 40.3 years) were followed and underwent echocardiography after correction of the anemia. LA maximum volume (LAVmax), LA minimal volume (LAVmin), LAVmax index (LAVI), before atrial contraction volume (LAVpreA), LA total emptying fraction, LA active emptying volume were higher in anemic patients. LA passive emptying fraction was significantly lower in anemic patients. Following correction of anemia, LA volume and function parameters were observed to be significantly reduced. Moreover, significant increase was noted in LA passive emptying fraction. Correlation analysis was performed and a significant negative correlation was noted between the percentage change in hemoglobin level and percentage change in LAVI (r = - 0.382, p = 0.003). It was shown that volume and functions of LA are impaired in anemic patients. However impaired parameters were improved after correction of anemia. It may be thought that RT3DE LA parameters can be used as an important preclinical marker of disease pathogenesis before developing heart failure or atrial arrhythmia.

Evaluation of left atrial volume and functions by real time three-dimensional echocardiography in patients with subclinical hypothyroidism before and after levothyroxine therapy.

BACKGROUND/AIMS: The cardiovascular system is one of the major targets of thyroid hormones. Subclinical hypothyroidism (SCH) is a common disease that can represent "early" thyroid failure. Our aim was to evaluate left atrial (LA) volume and functions in patients with SCH using real time three-dimensional echocardiography (RT3DE) and also to investigate changes in LA parameters after the levothyroxine treatment. METHODS: In total, 44 patients with SCH and 40 age- and gender-matched controls were studied. Assessments included history, physical examination and echocardiography. All patients with SCH were followed up with replacement therapy until the euthyroid status was achieved. RESULTS: In patients with SCH, LA total emptying volume, passive emptying volume, and passive ejection fraction were significantly reduced while LA minimal volume, active emptying volume, and active emptying fraction were significantly increased than in control group. Following the levothyroxine treatment, LA volume and function parameters were observed to be significantly improved. A negative correlation between the change of thyroid stimulating hormone (TSH) and change of LA active emptying volume and a positive correlation between the change of TSH level and change of LA passive emptying volume were found. CONCLUSION: It was shown that volume and functions of LA were impaired in patients with SCH. However, impaired parameters were improved after the levothyroxine treatment. These findings may be indicative of subclinical heart involvement that could lead to functional and structural changes in patients with SCH.

Usefulness of platelet to lymphocyte ratio for predicting recurrence of atrial fibrillation after direct current cardioversion.

OBJECTIVE: Atrial fibrillation (AF) is the most common cardiac rhythm disorder with the associated risks of stroke and mortality. The usefulness of platelet to lymphocyte ratio (PLR), a recently described inflammatory marker, in predicting adverse cardiovascular events has been demonstrated in several studies. In the current study, we investigated the role of PLR in predicting recurrence after successful electrical cardioversion (ECV) in patients with non-valvular persistent AF. METHODS: A total of 287 patients with non-valvular persistent AF achieving restoration of the sinus rhythm after successful ECV were included in this study. At study entry, complete blood count, routine biochemistry tests, and transthoracic echocardiography (TTE) were performed routinely in all subjects. Patients were followed up for 6 months following the procedure and comparisons were performed between patients who recurred and who maintained the sinus rhythm (SR). RESULTS: At 6 months of follow-up, AF recurred in 108 patients, corresponding to a recurrence rate of 39%. Mean PLR values in the "AF recurrence group" (mean age 57.4 ± 12.0 years, 47.6% [n = 80] female) and in "SR maintenance" group (mean age 65.0 ± 9.4 years, 55.6% [n = 60] female) were 184.8 ± 44.2 and 103.3 ± 44.2, respectively, with a significant difference between the two groups (p < 0.001). In multiple regression analyses, PLR emerged as a risk factor associated with AF recurrence during the 6-month follow-up period after successful ECV (odds ratio [OR]: 3.029 (1.013-9.055 95% confidence interval [CI]), p = 0.047). When a cutoff value of 147 was used, the sensitivity and specificity of PLR for predicting AF recurrence were 83.3% and 84.5%, respectively. CONCLUSION: Elevated PLR is a marker of increased inflammation and may serve as a practical and inexpensive predictor for recurrence during 6 months of follow-up in patients with non-valvular persistent AF who had restoration of the sinus rhythm after successful ECV.

Epicardial fat thickness: A new predictor of successful electrical cardioversion and atrial fibrillation recurrence.

OBJECTIVE: In recent years, epicardial fat tissue (EFT) has been found to be strongly associated with the development of atrial fibrillation (AF) and post-ablation long-term recurrence. The current study investigated the procedural success rate of electrical cardioversion (ECV) and potential predictors of treatment failure in patients with nonvalvular persistent AF. METHODS: A total of 262 nonvalvular persistent AF patients who were scheduled for elective ECV were included in this prospective study. Routine transthoracic echocardiography was performed before the procedure and EFT thickness was measured. The presence of left atrial appendage thrombus was evaluated by transesophageal echocardiography. The patients were followed up for 6 months to examine any recurrence after ECV. RESULTS: The success rate of ECV was 85% and the recurrence rate was 35% during the 6-month follow-up period. The mean EFT thickness was 8.67 ± 1.2 mm in the persistent AF group with unsuccessful ECV and 6.81 ± 0.8 in the patients in whom sinus rhythm (SR) was maintained, the EFT was significantly thicker in the AF group (P = 0.001). EFT (P = 0.001) and left ventricular end-diastolic diameters (LVEDD) (P = 0.001) were significantly different between those who had maintained SR and those with recurrent AF during the 6-month follow-up period after ECV. In the multiple logistic regression analysis, LVEDD (odds ratio [OR]: 1.320 (1.023-1.703 95% confidence interval [CI]), P = 0.032)] and EFT [OR: 3.029 (1.013-9.055 95% CI), P = 0.047)] were identified as independent predictors of successful ECV. CONCLUSION: Epicardial fat tissue thickness can be effectively used for the prediction of successful ECV and AF recurrence during follow-up in AF patients.

A New and Simple Risk Predictor of Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention: TIMI Risk Index.

BACKGROUND: The thrombolysis in myocardial infarction risk index (TRI) was developed to estimate prognosis at the initial contact of the healthcare provider in coronary artery disease patients without laboratory parameters. In this study, we aimed to investigate the relationship of the baseline TRI and contrast-induced nephropathy (CIN) in patients with ST-elevation myocardial infarction (STEMI). METHODS: A total of 963 consecutive STEMI diagnosed patients who underwent primary percutaneous intervention were included in the study. TRI was calculated using the formula "heart rate × (age/10) 2/SBP" on admission. CIN was defined as an increase in serum creatinine concentration ≥25%, 48 hours later over the baseline. RESULTS: Of the total of 963 patients, CIN was observed in 13% (n=128). TRI was significantly higher in the CIN (+) group compared with the CIN (-) group (32.9 ± 18.8 vs 19.9 ± 9.9, P < 0.001). There was a stronger correlation between CIN and age, diastolic blood pressure, heart rate, Killip class, left ventricular ejection fraction, amount of contrast media, and diabetes mellitus. The amount of contrast media (OR 1.010, 95% CI 1.007-1.012, P < 0.001) and TRI (OR 1.047, 95% CI 1.020-1.075, P=001) were independent predictors of CIN. The best threshold TRI for predicting CIN was ≥25.8, with a 67.1% sensitivity and 80.4% specificity (area under the curve (AUC): 0.740, 95% CI: 0.711-0.768, P < 0.001). CONCLUSION: TRI is an independent predictor of CIN, and it may be used as a simple and reliable risk assessment of CIN in STEMI patients without the need for laboratory parameters.