RESUMO
BACKGROUND: Coronavirus 2019 (COVID-19) causes morbidity and mortality in an increasing number of people worldwide. Although it mainly affects the respiratory system, it influences all organs, including the heart. It is associated with a broad spectrum of widespread cardiovascular problems ranging from mild myocardial injury to fulminant myocarditis. We aimed to evaluate the presence and prevalence of cardiac involvement in asymptomatic or symptomatic patients after they recovered from COVID 19 infection. METHODS: A total of 100 consecutive patients with COVID-19 proven by reverse transcription polymerase chain reaction (RT-PCR), under 40 years of age and without any known additional chronic diseases were analyzed retrospectively for cardiac magnetic resonance (CMR) results and symptoms. RESULTS: Cardiac involvement was detected in 49 out of 100 patients on CMR imaging. In the cardiac involvement group, the number of patients with chest pain and/or dyspnea was 41 (84%), which was statistically significant (p = 0.001). Twenty-four patients (47%) in the without cardiac involvement group were asymptomatic and this was also statistically significant (p = 0.001). LV ejection fraction was statistically significantly lower in the group with cardiac involvement (61% vs 66%, p = 0.001). LV stroke volume and tricuspid annular plane systolic excursion (TAPSE) were statistically significantly lower in patients with cardiac involvement (p = 0.028 and p = 0.019, respectively). CONCLUSION: Based on single center experience, myocardial involvement is common in symptomatic patients after COVID-19. More studies are needed for long-term side effects and clinical results in these patients.
Assuntos
COVID-19 , Miocardite , Humanos , Imageamento por Ressonância Magnética , Miocardite/diagnóstico por imagem , Estudos Retrospectivos , SARS-CoV-2 , Volume SistólicoRESUMO
Objectives. Frontal plane QRS-T angle is a novel marker of myocardial repolarization, and an increased frontal plane QRS-T angle is associated with adverse cardiac outcomes. Slow coronary flow may cause fatal cardiac arrhythmias by causing electrical abnormalities and altering ventricular repolarization. We aimed to evaluate the frontal plane QRS-T angle in patients with slow coronary flow. Design. A total of 60 consecutive patients with slow coronary flow and 60 consecutive patients with normal coronary flow were enrolled into the study. Laboratory and some electrocardiography parameters including frontal plane QRS-T angle were compared between the two groups. Results. We have found that the angle of frontal QRS-T was higher in the group with slow coronary flow (p < .001). In addition, there was a negative correlation between thrombolysis in myocardial infarction frame count and frontal QRS-T angle (r = -0.496, p < .001). Conclusions. In conclusion, increased frontal plane QRS-T angle might be an important indicator of slow coronary flow.
Assuntos
Potenciais de Ação , Circulação Coronária , Eletrocardiografia , Ventrículos do Coração/fisiopatologia , Fenômeno de não Refluxo/diagnóstico , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenômeno de não Refluxo/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Fatores de TempoRESUMO
AIM: To investigate the relationship between coronary artery lesion severity determined using the baseline SYNTAX score and sleep problems that might occur after discharge determined using the Pittsburgh Sleep Quality Index (PSQI). METHODS: This prospective study included patients with first acute coronary syndrome (ACS) who underwent percutaneous coronary angiography between February 2019 and August 2019. The severity of coronary artery stenosis was classified according to coronary angiography and SYNTAX scores. Patients were grouped as those with a SYNTAX score of ≤22 and >22. Sleep quality after discharge was classified according to the PSQI. PSQI ≤5 represented good sleep quality, and PSQI >5 represented poor sleep quality. Univariate and multivariate logistic regression was used to investigate the relationship between sleep quality and coronary artery stenosis severity. RESULTS: A total of 424 patients were included in the study. Of these, 294 (69.34%) had a SYNTAX score of ≤22 and 130 (30.66%) had a SYNTAX score of >22. The mean age of all patients was 60.37â ±â 12.23 years, 59.69â ±â 11.85 years in the SYNTAX ≤22 groups and 61.90â ±â 12.98 years in the SYNTAX >22 group (Pâ =â 0.086). The majority (78.54%) of the patients were male and there was no significant difference between the SYNTAX ≤22 group and the SYNTAX >22 group in terms of sex distribution (Pâ =â 0.383). According to the univariate logistic regression analysis, age (Pâ =â 0.014), diabetes (Pâ =â 0.027), left ventricular ejection fraction (Pâ =â 0.001), estimated glomerular filtration rate (Pâ =â 0.039), creatine kinase MB (Pâ =â 0.040) and SYNTAX scores (Pâ <â 0.001) were significantly associated with high PSQI global scores (>5). However, according to the multivariate logistic regression analysis results, high (>22) SYNTAX scores were the only factor independently associated with the high (>5) PSQI global scores [odds ratio, 3.477; 95% confidence interval (CI), (2.190-5.522); Pâ <â 0.001]. Complete revascularization group had significantly higher sleep latency and sleep duration time, sleep efficiency and the percentage of patients with PSQI global score of ≤5 than the incomplete revascularization group (Pâ <â 0.001 for all). CONCLUSION: Among patients with ACS, those with high SYNTAX scores should be monitored more carefully for sleep disorders that may occur later.
Assuntos
Síndrome Coronariana Aguda , Angiografia Coronária , Estenose Coronária , Índice de Gravidade de Doença , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/complicações , Estenose Coronária/fisiopatologia , Estenose Coronária/complicações , Angiografia Coronária/métodos , Estudos Prospectivos , Idoso , Qualidade do Sono , Fatores de RiscoRESUMO
Recent randomized clinical trials demonstrated that treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduces the risk of cardiac mortality due to sudden cardiac death and progressive pump failure in patients with heart failure (HF). Mechanisms underlying the potential anti-arrhythmic effects of SGLT2is are not well understood. We aimed to examine the effect of SGLT2i treatment on the frontal-plane QRS-T (f[QRS-T]) angle, a novel marker of myocardial repolarization and an independent predictor of adverse cardiac outcomes. The study included 106 patients with HF with reduced ejection fraction (HFrEF) who received an SGLT2i, empagliflozin, or dapagliflozin. All study participants underwent screening 12-lead electrocardiography (ECG) before and â¼90 days after treatment. We compared ECG repolarization parameters before and after treatment. During study enrollment, there were statistically significant decreases in the Tp-e/QT ratio (P ≤ .0001), Tp-e/corrected QT ratio (P = .0002), Tp-e interval (P < .0001), and f(QRS-T) angle (P = .04) in response to SGLT2i therapy. In addition, study participants experienced an improvement in functional capacity (2.06 ± 0.6 vs. 1.82 ± 0.6, P = .0001) and reduced N-terminal pro-b-type natriuretic peptide values. In this retrospective cohort study, SGLT2i therapy was associated with improved cardiac repolarization parameters in patients with HFrEF. More comprehensive studies are needed to evaluate the impact of SGLT2i on cardiac repolarization and its potential relation to cardiac arrhythmia and sudden cardiac death risk.
RESUMO
Many hypotheses have been proposed to explain no-reflow (NR). Some of these hypotheses, state that NR may be caused by damage to the vascular endothelium and an inflammatory process. In a recent study that did not include patients with coronary artery bypass graft (CABG), the ratio of C-reactive protein (CRP) to albumin (CAR) was found to be associated with NR. Our study aims to evaluate the relationship between CAR and NR in patients who underwent percutaneous coronary intervention (PCI) for saphenous vein graft (SVG). In this retrospective study, among the patients with CABG who underwent primary or elective coronary angiography, 242 patients who underwent PCI to the SVG were selected. The incidence of NR was 19.8% (n = 48). Diabetes mellitus, left ventricular ejection fraction (LVEF), stent length, and CAR were found as independent predictors of NR in multivariate logistic regression analysis (P < .05). Using a cut-off level of .930, the CAR predicted NR with a sensitivity of 75% and a specificity of 73% (AUC: .814, 95% CI: .749-.879, P < .001). The CAR was a better predictor than both stent length and LVEF. CAR was found to be the strongest predictor of NR in our study.
Assuntos
Intervenção Coronária Percutânea , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Proteína C-Reativa , Estudos Retrospectivos , Constrição Patológica , Veia Safena/diagnóstico por imagem , Veia Safena/transplante , Volume Sistólico , Função Ventricular Esquerda , Angiografia Coronária , Resultado do TratamentoRESUMO
BACKGROUND Myocarditis is cardiac muscle inflammation caused by infectious or noninfectious agents. Rarely, clozapine, an atypical antipsychotic drug used to treat resistant schizophrenia, has been reported to cause myocarditis, as we report in this case. CASE REPORT A 29-year-old man, who was known to have schizophrenia and was on olanzapine therapy, presented in our Emergency Department with active psychosis, and was subsequently admitted to the psychiatric ward for refractory schizophrenia. He was started on clozapine, which was cross-titrated with olanzapine. On day 20 of being treated with clozapine, he developed a high-grade fever and chest pain. EKG demonstrated new-onset prolonged QT corrected for heart rate (QTc), premature ventricular contractions, ST-T wave changes with an increased ventricular rate, and ventricular bigeminy with elevated troponin and inflammatory markers. Echocardiography showed a reduced left ventricular ejection fraction. Coronary angiography showed normal coronary arteries, low cardiac output, and cardiac index consistent with cardiogenic shock was also observed. Other pertinent laboratory results included negative respiratory viral panel, including COVID-19 PCR, negative blood cultures, and negative stool screen for ova and parasite. Clozapine was discontinued and the patient received management for heart failure with reduced ejection fraction. He improved clinically with return of EKG to normal sinus rhythm and improved left ventricular ejection fraction on repeat echocardiogram. CONCLUSIONS Acute myocarditis can occur due to a myriad of causes, both infectious and noninfectious; thus, determining the lesser-known causes, such as drug-related etiology, is essential to provide appropriate treatment for patients.
Assuntos
COVID-19 , Clozapina , Miocardite , Esquizofrenia , Adulto , Clozapina/efeitos adversos , Humanos , Masculino , Miocardite/induzido quimicamente , Miocardite/diagnóstico , Olanzapina/efeitos adversos , Esquizofrenia/tratamento farmacológico , Esquizofrenia Resistente ao Tratamento , Volume Sistólico , Função Ventricular EsquerdaRESUMO
Lead exposure has etiological role on cardiovascular system diseases as hypertension, atherosclerosis, stroke, and arrhythmic events. In this study, we aimed to compare the basal and arrhythmogenic ECG parameters of lead exposed workers before and after chelation therapy and to evaluate the effect of acute change of blood lead levels on ECG. Fourty consecutive occupationally lead exposed workers were enrolled, demographic, blood, echocardiographic, and electrocardiographic data's were analyzed before and after chelation therapy. Pmax, P min, P Wave Dispersion, and QT Dispersion values which are arrhythmia predictors were significantly lower after chelation therapy compared to values before chelation therapy. Lead exposed workers are under the risk of ventricular and atrial arrythmias and chelation treatment has a positive effect on these parameters.
Assuntos
Terapia por Quelação , Chumbo , Arritmias Cardíacas/induzido quimicamente , Eletrocardiografia , HumanosRESUMO
BACKGROUND: The importance of monocyte count-to-HDL-cholesterol ratio (MHR) in cardio- vascular diseases has been shown in various studies. Ascending aortic dilatation (AAD) is a common complication in the patients with bicuspid aortic valve. In this study, we aimed to investigate the relationship between MHR and the presence of aortic dilatation in the patients with bicuspid aortic valve. METHODS: The study population included totally 347 patients with bicuspid aortic valve.169 patients with aortic dilatation (ascending aorta diameter ≥ 4.0 cm) and 178 patients with no aortic dilatation. Echocardiographic and laboratory measurement was done and compared between groups. RESULTS: The mean age of the participants was 44.7 ± 15.4 years and average ascending aorta diameter was 3.2 ± 0.3 cm in dilatation negative group and 4.4 ± 0.4 cm in positive group. MHR was significantly increased in in patients with aortic dilatation. MHR and uric acid level was independently associated with the presence of aortic dilatation in the patients with bicuspid aortic valve. CONCLUSION: We found a significant relationship between MHR and aortic dilatation in the patients with bicuspid aortic valve.
Assuntos
Aorta/fisiopatologia , Valva Aórtica/anormalidades , HDL-Colesterol , LDL-Colesterol/sangue , Dilatação Patológica/diagnóstico por imagem , Doenças das Valvas Cardíacas/sangue , Monócitos , Adulto , Idoso , Valva Aórtica/patologia , Doença da Válvula Aórtica Bicúspide , Dilatação Patológica/complicações , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. METHODS: 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. RESULTS: The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. CONCLUSIONS: High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.
Assuntos
Fibrilação Atrial , Fibrilação Atrial/etiologia , Ponte de Artéria Coronária/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico , Função Ventricular EsquerdaRESUMO
BACKGROUND: Sexual activity is an important indicator of quality of life and is significantly impaired in patients with heart failure (HF). Cardiac resynchronization therapy (CRT) has positive effects on cardiac dysfunction and endothelial dysfunction that lead to erectile dysfunction (ED). We aimed to evaluate whether CRT may improve sexual activity in patients with HF. METHODS: In total, 136 patients (mean age 61.8 ± 12.8 years) were evaluated for the study. All patients filled the Sexual Health Inventory for Men (SHIM) questionnaire for evaluation of their erectile functions before CRT device implantation. One hundred eighty days after CRT device implantation, the patients were re-evaluated with SHIM questionnaire. RESULTS: In the whole study population, SHIM test scores were significantly increased after CRT (12.99 ± 3.22 vs. 18.03 ± 5.00; p<0.001). The patients were divided into two groups according to the CRT response. The increase in SHIM test scores was significantly more in the response (+) group than in the response (-) group [response (+) group: 6.94 ± 3.36; p<0.001 vs. response (-) group: 0.81 ± 1.77; p = 0.465]. A positive CRT response was found to be an independent predictor of SHIM score (p<0.001). CONCLUSION: Our study showed that CRT had positive effects on ED of patients with HF.
Assuntos
Terapia de Ressincronização Cardíaca/efeitos adversos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Comportamento Sexual/fisiologia , Idoso , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Estudos Transversais , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/estatística & dados numéricos , Endotélio Vascular/fisiopatologia , Disfunção Erétil/fisiopatologia , Seguimentos , Insuficiência Cardíaca/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Comportamento Sexual/psicologia , Inquéritos e Questionários , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
BACKGROUND: The evaluation of thromboembolic risk is the cornerstone of atrial fibrillation (AF) management. Thromboembolic risk is associated with the presence of left atrial (LA) thrombus and spontaneous echo contrast (SEC), namely the thromboembolic milieu. AIMS: We aimed to assess the predictors of the thromboembolic milieu in terms of LA thrombus and/ or SEC in patients with paroxysmal AF undergoing electrical cardioversion or catheter ablation, and to develop an effective risk model for detecting the thromboembolic milieu. METHODS: We included a total of 434 patients with nonvalvular paroxysmal AF who underwent transesophageal echocardiography prior to cardioversion or catheter ablation. RESULTS: In patients with the thromboembolic milieu, total protein and Creactive protein levels, LA diameter, and systolic pulmonary artery pressure (SPAP) were higher, while left ventricular ejection fraction (LVEF) was lower than in patients without the thromboembolic milieu. In a multivariate logistic regression analysis, age, total protein levels, LVEF, LA diameter, and SPAP were independent predictors of LA thrombus and/or SEC. In a receiver operating characteristic curve analysis, the optimal cutoff values for the discrimination of patients with the thromboembolic milieu were as follows: 60 years for age; 7.3 mg/dl for total protein; 40% for LVEF; 40 mm for LA diameter; and 35 mm Hg for SPAP. Based on these cutoff values, we developed a novel risk model, namely, the PALSE score. The area under the curve for the PALSE score was 0.833. Patients with a PALSE score lower than 1 did not show thrombus or spontaneous echo contrast. CONCLUSIONS: The PALSE score, which includes total protein levels, age, LA diameter, SPAP, and LVEF, seemed to accurately predict the presence of the thromboembolic milieu in patients with paroxysmal AF.
Assuntos
Fibrilação Atrial , Tromboembolia , Fibrilação Atrial/complicações , Criança , Ecocardiografia Transesofagiana , Átrios do Coração , Humanos , Fatores de Risco , Volume Sistólico , Tromboembolia/etiologia , Função Ventricular EsquerdaRESUMO
We evaluated the relationship between nesfatin-1 and acute myocardial infarction (AMI) and Mediterranean diet scores. 67 patients with AMI and 33 patients with normal coronary arteries (control group) were included in the study. The patients with AMI were divided into 2 groups based on low (<32) (n = 33) and high values of the synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) scores (≥34) (n = 35). Mediterranean diet score, serum nesfatin-1 concentrations and all other data were compared between the groups. Serum nesfatin-1 concentrations were significantly lower in 67 AMI patients (both the high and low SYNTAX groups) than in the control group (p < 0.001). Moreover, serum nesfatin-1 concentrations were lower in the high SYNTAX group than those in the low SYNTAX group (p < 0.001). There were positive correlations between the serum nesfatin-1 concentrations and Mediterranean diet scores in both the AMI patients and the control subjects, and there was a negative correlation between the serum nesfatin-1 concentrations and SYNTAX scores in the AMI patients. This study has shown that serum nesfatin-1 concentrations are closely related to the severity of AMI and Mediterranean diet scores.