The predictive value of the epicardial adipose thickness in the rate of expansion of the aortic root.

BACKGROUND: Epicardial adipose tissue (ECAT) is metabolically active and is involved in the development of atherosclerosis. The thickness of ECAT has been positively correlated with the dimensions of the ascending aorta. We aimed to examine whether ECAT thickness predicted the expansion of the aortic dimensions. METHODS: The imaging results of patients who had undergone transthoracic echocardiographic (TTE) examinations more than twice during the period 2005-2015 were surveyed. We included adult patients who had undergone TTE examinations at least 1 year apart. The ECAT was measured in the parasternal long-axis view from the index TTE study. End-diastolic dimensions in three consecutive beats were averaged for all measurements. The annulus, root, and sinotubular junction (STJ) were also measured. The amount of increase (if any) in aortic dimensions per year was calculated and the correlation of this increase with the initial thickness of the ECAT was analyzed. RESULTS: In total, 429 examinations were performed with 197 patients (17 females), from which 394 examinations were analyzed. The ECAT thickness was 8.6 ± 3.6 mm. In the initial examinations, the annulus, STJ, and root measured 23 ± 4, 28 ± 4, and 34 ± 4 mm, respectively. In univariate analysis, for every 1 mm of ECAT thickness, the STJ expanded 0.056 (95% CI: 0.001-0.112 mm/year; p = 0.030) and the aortic root expanded 0.088 mm/year (p < 0.001). In multivariate analysis, ECAT thickness remained an independent predictor of the aortic root expansion. For every 1­mm increase in ECAT thickness, the aortic root expanded by 0.036 mm (95% CI: 0.010-0.062) per year (p = 0.007). CONCLUSION: The thickness of the ECAT is a predictor of more rapid increases in the dimensions of the aortic root. Further studies of patients with established aortic aneurysm are warranted.

Neutrophil-lymphocyte ratio is a marker of survival and cardiac complications rather than patency following revascularization of lower extremities.

The neutrophil-lymphocyte ratio (NLR), as a marker of inflammation, is associated with the severity of peripheral artery disease (PAD). The role of the NLR on predicting future complications after elective revascularization for patients with PAD remains unknown. We aimed to examine the role of the NLR in the development of major adverse limb events (MALE) and the long-term mortality of these patients. We evaluated 1708 revascularization procedures from May 2001 to December 2015 at the Veterans Affairs Western New York Healthcare System from a prospectively maintained vascular database that included demographics, comorbidities and pre-procedural medications. Peri-procedural laboratory findings including complete blood cell count and metabolic panel were further retrieved from the electronic health record. The NLR was calculated, and the patients were categorized into tertiles according to NLR cut-off points. Multivariate Cox regression analysis was performed to determine MALE and 10-year mortality. The primary endpoint of the study was MALE, and the secondary endpoint included 10-year mortality. A total of 1228 patients were included for final analyses. Patients in the third NLR tertile were more likely to experience MALE during the follow-up period ( p<0.001). In addition, fewer patients in tertile 3 survived over the follow-up period compared to tertiles 1 and 2 ( p<0.0001). Patients in tertile 3 tended to be older with a higher frequency of hypertension, diabetes, chronic kidney disease, coronary artery disease and congestive heart failure. Our multivariate analysis demonstrated that the NLR was independently associated with higher rates of MALE in the affected vessels following revascularization procedures. Similarly, the NLR was revealed to be an independent predictor of higher long-term mortality in these patients.

Prognostic value of positive T wave in lead aVR in patients with non-ST segment myocardial infarction.

BACKGROUND: Lead aVR provides prognostic information in various settings in patients with ischemia. We aim to investigate the role of a positive T wave in lead aVR in non-ST segment myocardial infarction (NSTEMI). METHODS: In a prospective cohort study, we included 400 patients with NSTEMI. Presentation electrocardiogram (ECG) was investigated for presence of a positive T wave as well as ST segment elevation (STE) in aVR and study variables were compared. Predictors of primary outcome defined as hospital major adverse cardiovascular events (MACE) and secondary outcome, defined as three-vessel coronary disease and/or left main coronary artery stenosis (3VD/LMCA) stenosis in angiography, were determined in multivariate logistic regression analysis. RESULTS: Patients with a positive T wave in aVR were significantly older and were more likely to be female. Left ventricular ejection fraction was significantly lower in patients of positive T group. Positive T group was more likely to have 3VD/LMCA stenosis (58.3% vs. 19.8%, p < .001). The prevalence of a positive T wave in aVR was significantly higher in MACE group (54.9 % vs. 24.8%, p < .001). However, in multivariate analysis, it was not an independent predictor of MACE (OR: 1.083 95% CI: [0.496-2.365], p: .841). Though, it was independently associated with presence of 3VD/LMCA stenosis (OR: 3.747 95% CI: [2.058-6.822], p < .001). CONCLUSION: Though positive T wave in lead aVR was more common in patients with MACE; it was not an independent predictor. Additionally, a positive T wave in aVR was an independent predictor of 3VD/LMCA stenosis in NSTEMI.

Fine versus coarse atrial fibrillation in rheumatic mitral stenosis: The impact of aging and the clinical significance.

BACKGROUND: Atrial fibrillation (AF) as the most rhythm disturbance in patients with rheumatic mitral stenosis (MS), is classified in to coarse and fine subtypes according to the height of fibrillatory wave amplitude. The aim of this study is to identify the factors associated with the presence of fine versus coarse morphology in patients with rheumatic MS. METHODS: In this cross-sectional study, patients with confirmed diagnosis of severe rheumatic MS admitted between March 2013 and March 2017 were screened. Patients were categorized to sinus rhythm (SR) and AF rhythm (coarse and fine subtypes) groups according to the admission electrocardiogram. The association between various clinical and echocardiographic factors and the development of fine versus coarse AF were examined. RESULTS: Among 754 patients with the diagnosis of rheumatic MS, 288 (198 female) were found to have AF (38%). Among them 206 (71.5%), and 82 (28.5%) patients had fine and coarse morphology respectively. Patient in these two groups were quite similar in terms of echocardiographic parameters and comorbidities. However, patients with fine morphology AF were significantly older. (p-Value=.007). CONCLUSION: Coarse morphology of AF is common in patients with rheumatic MS. While echocardiographic or most clinical parameters do not seem to associate with the occurrence of coarse or fine morphology, age seems to be the only independent factor correlated with the presence of fine subtype of AF in this population.

Higher Frequency of Nocturnal Blood Pressure Dipping but Not Heart Rate Dipping in Inflammatory Bowel Disease.

BACKGROUND: Masked hypertension (MHTN) and lack of nocturnal dipping in blood pressure (BP) have been linked to the state of inflammation. AIMS: We aimed to assess the frequency of nocturnal patterns of BP and heart rate (HR) in patients with IBD. METHODS: Sixty-three normotensive patients with confirmed IBD during remission and 63 healthy subjects were enrolled in a case-control study. All subjects were monitored for BP and HR over a period of 24 h under ambulatory setting. Means for BP and HR were calculated for nighttime and daytime periods. Daytime BP ≥ 135/85 mmHg, nighttime BP ≥ 120/70 mmHg, and 24-h average BP ≥ 130/80 mmHg were defined as MHTN. The main end points of this study were lack of >10% nocturnal decrease in the systolic BP (NDP-BP) and in HR (NDP-HR). RESULTS: After exclusion of 8 patients with IBD from analysis, 55 patients and 63 control subjects (49% men) with a mean age of 37.5 ± 11.0 years were enrolled. NDP-BP was more common in the IBD group compared to controls (55 vs. 33%; P = 0.026). MHTN was detected in 24% of IBD patients compared to 8% among controls (P = 0.017). Meanwhile, NDP-HR was observed in 22% of the IBD patients and 30% of the control group (P = 0.402). IBD remained a significant predictor of NDP-BP (odds ratio 2.60, 95% confidence interval 1.19-5.51) following an adjustment for age and gender. CONCLUSIONS: IBD is associated with higher frequency of NDP-BP and MHTN; however, nocturnal changes in HR were similar in both groups.

Predictive Value of Exercise Stress Test-Induced ST-Segment Changes in Leads V1 and avR in Determining Angiographic Coronary Involvement.

BACKGROUND: The significance of electrocardiographic changes during exercise tolerance testing for distinguishing occluded artery is not well known. We tried to determine the role of ST elevation in leads aVR and V1 during exercise in detecting stenosis of left main coronary artery and proximal left anterior descending artery. METHODS: ST segment changes during exercise in 230 patients, who underwent diagnostic angiography, were documented. The association of ST elevation in lead aVR, V1 , leads aVR + V1 , and STE in leads aVR + V1 with ST depression in other leads with pattern of coronary stenosis were investigated. RESULTS: Left main and proximal left anterior artery stenosis were more common in patients with ST elevation in lead aVR (P < 0.001 for both). Similar association was found in the presence of ST elevation in lead V1 . The presence of ST elevation ≥1 mm in lead aVR had a sensitivity of 100% and 94.3% for detecting left main and left anterior descending artery stenosis, respectively. The specificity was 33.5% and 26.6%, respectively. ST elevation in leads aVR + V1 had a sensitivity of 74.4% and 65.9% and a specificity of 68.5% and 64.4% for detecting left main and left anterior descending arteries stenosis, respectively. CONCLUSION: ST elevation in lead aVR is highly sensitive for left main and proximal left anterior descending artery lesions. Using ST elevation in lead V1 in addition to lead aVR as a positive finding increases the specificity with a further decrease in sensitivity.

Clinical Significance of ST Elevation in Lead aVR in Acute Pulmonary Embolism.

BACKGROUND: Prognostic stratification of patients with acute pulmonary embolism (PTE) is crucial in identifying patients who would benefit from more aggressive treatment. We aimed to examine the value of ST elevation in lead aVR (STEaVR ) in predicting hospital mortality following PTE. MATERIALS: Two hundred patients with a diagnosis of PTE were allocated into two groups based on the presence or absence of STEaVR . Multivariate logistic regression analysis was used to investigate the role of "STEaVR " in relation to the other risk factors in predicting prognosis of PTE. RESULTS: Out of 200 patients, 24 (12.0%) had STEaVR . Patients with STEaVR were more likely to present with hypotension and tachycardia than those who did not have this electrocardiographic finding. A total of 33.3% of patients with STEaVR and 13.1% of those without STEaVR died during hospitalization. STEaVR had a low sensitivity of 25.8% but a high specificity of 90.5% for predicting hospital mortality. Odds ratio for hospital mortality was 3.32 for STEaVR with 95% confidence interval of 1.28-8.64 (P = 0.017) in univariate analysis. In multivariate analysis shock was the strongest predictor of hospital mortality. CONCLUSION: The presence of STEaVR is indicative of hemodynamic instability, thereby having the ability to predict poor outcome. However, its impact on hospital mortality disappears when the presence of shock on admission is factored in the prediction model.

Clinical and laboratory predictors of coronary slow flow in coronary angiography.

BACKGROUND: The coronary slow-flow phenomenon (CSFP) is a multifactorial angiographic finding with no established pathogenesis. OBJECTIVE: To investigate the role of clinical profile and laboratory findings in patients with CSFP. METHODS: We prospectively recruited 69 patients with angiographically diagnosed CSFP and compared them with 88 patients with normal coronary flow. Demographic information, comorbidities and laboratory analysis, including complete blood count with differential, lipid profile and serum biochemical analysis, were documented and compared in univariate and multivariate analyses. RESULTS: Patients with CSFP were more likely to be male and active smokers. Total cholesterol, triglyceride, hemoglobin and hematocrit, platelet count, mean platelet volume, platelet distribution width and red cell distribution width (RDW) were all higher in patients with CSFP. In multivariate regression analysis, including smoking, total cholesterol, hematocrit, fasting blood glucose and red cell distribution width, except fasting blood glucose, all variables were independently associated with CSFP. Receiver operating characteristic curve analysis revealed a cut-off point of 13.05% for RDW with a sensitivity of 74.6% and a specificity of 77.3% (p<0.001, AUC = 0.802) A cut-off value of 11.35% for PDW had a 89.9% sensitivity and 98.9% specificity for the prediction of CSFP (p<0.001, AUC = 0.970) Conclusion: The changes of circulating blood cell components in patients with CSFP may be indicative of underlying inflammation and endothelial dysfunction that should be investigated in experimental studies.

The Value of Lead aVR ST Segment Changes in Localizing Culprit Lesion in Acute Inferior Myocardial Infarction and Its Prognostic Impact.

BACKGROUND: Identifying infarct-related artery (IRA) in patients with inferior ST elevation myocardial infarction (STEMI) has prognostic and therapeutic benefits. OBJECTIVES: To differentiate IRA and the location of culprit lesion in inferior STEMI, using ST segment changes in lead aVR. METHODS: ST segment changes in lead aVR were recorded in 150 patients, admitted with first inferior STEMI. The association of IRA and the location of culprit lesion with ST segment changes in aVR were investigated. RESULTS: ST elevation ≥ 0.5 mm in lead aVR was present in 17 patients (11.3%), ST depression ≥ 0.5 mm in 74 patients (49.3%) and 59 patients (39.3%) did not have significant ST segment changes. Right coronary artery (RCA) was the IRA in 117 patients (78%) and left circumflex artery (LCX) in 33 patients (22%). Prevalence of RCA involvement as the IRA was different in three study groups (94.1% in ST elevation group, 83.1% in isoelectric group and 70.3% in ST depression group, P = 0.049). Presence of ST elevation had a sensitivity and specificity of 13.68 % and 96.97%, for detecting RCA lesions, respectively. ST depression had 66.67% sensitivity and 55.56% specificity for identifying LCX lesions. Clinical complications were low in our study with no significant difference among patients of three groups. CONCLUSIONS: Presence of ST elevation is highly suggestive of RCA lesions versus LCX lesions, whereas absence of ST elevation cannot rule out RCA lesions. Presence of ST depression has a moderate sensitivity and specificity for LCX lesions.

Electrocardiography changes in acute aortic dissection-association with troponin leak, coronary anatomy, and prognosis.

BACKGROUND: Electrocardiography (ECG) offers some information that may be used to prognosticate acute type A aortic dissection (AAOD) for short- and long-term mortality. METHODS: We retrospectively analyzed the electrocardiograms of patients with AAOD admitted from March 2004 to March 2015. The frequency of ECG findings and their prognostic value on hospital and follow-up mortality were investigated. Findings pertaining to coronary involvement and troponin level were also examined. RESULTS: A total of 120 men and 64 women were admitted. Acute ischemic changes were reported in 38.0%, whereas T inversion was the most common recorded abnormality, which occurred in 38.6%. Acute ST-elevation myocardial infarction was detected in 16.3%. Troponin increased in 36.6%; 21.9% of the patients underwent coronary angiography among which 70% were normal. Coronary involvement or troponin increase was not different in patients with acute ECG changes. During hospitalization, 45.7% of the patients died. In multivariate analyses, ST elevation in lead aVR was associated with higher hospital death (odds ratio, 5.30; 95% confidence interval, 1.09-25.73; P = .038), whereas QRS greater than 120 milliseconds was associated with long-term mortality (hazard ratio, 2.45; 95% confidence interval, 1.25-3.76; P = .006). CONCLUSION: Acute ischemic ECG changes are common in AAOD, and a completely normal ECG is infrequently encountered. Acute ECG changes were not associated with the increased troponin or the presence of coronary lesions in angiography.

The prognostic value of a prominent Q wave in lead (-)aVR in acute anterior wall myocardial infarction.

OBJECTIVE: This study aimed to determine the association of a prominent Q wave in lead (-)aVR with clinical, echocardiographic and angiographic findings in anterior ST elevation myocardial infarction (STEMI) and to evaluate the role of this finding in short-term and long-term outcomes. METHODS: During a one-year period, 150 patients with first time anterior STEMI were screened and 121 patients with no other cardiopulmonary and renal comorbid diagnoses were included in the study. Patients were allocated into two groups based on presence or absence of a prominent Q wave in lead (-)aVR. All clinical, electrocardiographic, echocardiographic and angiographic data were recorded and compared between the groups. In-hospital adverse outcomes and mortality as well as two-year survival were also compared. RESULTS: Among 121 patients (mean age: 62.8±12.5 years) 26.4% had a prominent Q wave in lead (-)aVR. The prevalence of multi-vessel disease was higher in patients with a Q wave (76.9% vs. 52.8%, p=0.03). ST-segment elevation in lead V6 was significantly more common in those with a Q wave (50% vs. 30.3%, p=0.04). Posterobasal region motion abnormality was more common in the Q wave group. (9.4% vs. 1.2% respectively, p=0.04). Overall, mortality was higher in the Q wave group; however, it was not statistically significant (15.4% vs. 9.3%, p=0.39). CONCLUSION: In anterior STEMI, presence of a Q wave in lead (-)aVR is associated with occlusion of multiple arteries. Short- and mid-term mortality are not affected by this ECG finding.

Diagnosis and treatment of cardiovascular manifestations of COVID-19: a narrative review.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was the main pathogen in the COVID-19 pandemic. This viral infection has been associated with several respiratory and non-respiratory complications contributing to a higher mortality rate, especially in patients with underlying heart diseases worldwide. Once considered a respiratory tract disease, it is now well-known that COVID-19 patients may experience a wide range of cardiac manifestations. Because of its remarkable direct and indirect effects on the cardiovascular system, herein, we examined the published literature that studied the hypothetical mechanisms of injury, manifestations, and diagnostic modalities, including changes in molecular biomarkers with a predictive value in the prognostication of the disease, as well as emerging evidence regarding the long-term cardiac complications of the disease.

Association between Neutrophil-to-Lymphocyte Ratio and the Systemic Inflammatory Immunologic Index and the Angiographic SYNTAX Score and the TIMI Flow Grade in Acute STEMI: A Cohort Study.

Background: In patients with ST-segment-elevation myocardial infarction (STEMI), it is essential to determine the complexity of coronary lesions on presentation and predict the risk of no-reflow after primary percutaneous coronary intervention (pPCI). Given that inflammation plays an important role in the pathogenesis of atherosclerosis, using inflammatory indices might be helpful in this setting. Methods: This prospective cohort study recruited 200 consecutive patients with STEMI who underwent pPCI. The presentation neutrophil-to-lymphocyte-ratio (NLR) and the systemic inflammatory immunologic index (SII), calculated using the formula platelets × neutrophils/lymphocytes, were recorded. Study outcomes included the SYNTAX score and the TIMI flow grade before and after pPCI. The associations between the NLR and the SII and the study outcomes were investigated using univariate and multivariate logistic regression analyses. Results: Among 200 patients at a mean age of 59.85±11.23 years, 160 (80.0%) were male and 40 (20.0%) were female. The NLR and SII values were not statistically different between the 3 SYNTAX subgroups. While the mean NLR and SII values were similar between the patients with preprocedural TIMI flow grades 0/1 and 2/3, the mean NLR and SII were significantly lower in the group with a postprocedural TIMI flow grade 3. After adjustments for age and sex, the NLR and the SII were independent predictors of postprocedural no-reflow. Conclusion: In patients with STEMI, the presentation NLR and SII are useful for predicting the risk of no-reflow after pPCI. However, the NLR and the SII are not predictors of the SYNTAX score and the preprocedural TIMI flow grade.

Association of neutrophil to lymphocyte ratio (NLR) with angiographic SYNTAX score in patients with non-ST-Segment elevation acute coronary syndrome (NSTE-ACS).

Introduction: Considering the role of inflammation in pathogenesis of atherosclerosis, we aimed to investigate the association of presentation neutrophil to lymphocyte ratio (NLR) with complexity of coronary artery lesions determined by SYNTAX score in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods: From March 2018 to March 2019, we recruited 202 consecutive patients, who were hospitalized for NSTE-ACS and had undergone percutaneous coronary intervention in our hospital. The association of presentation NLR with SYNTAX score was determined in univariate and multivariate linear regression analysis. Results: Higher NLR was significantly associated with higher SYNTAX score (beta = 0.162, P = 0.021). In addition, older age, having hypertension, higher TIMI score, and lower ejection fraction on echocardiographic examination were significantly associated with higher SYNTAX score. TIMI score had the largest beta coefficient among the studied variables (TIMI score beta = 0.302, P < 0.001). In two separate multivariate linear regression models, we assessed the unique contribution of NLR in predicting SYNTAX score in patients with NSTE-ACS. In the first model, NLR was significantly contributed to predicting SYNTAX score after adjustment for age, sex, and hypertension as covariates available on patient presentation (beta = 0.142, P = 0.040). In the second model, NLR was not an independent predictor of SYNTAX score after adjustment for TIMI score (beta = 0.121, P = 0.076). Conclusion: In NSTE-ACS, presentation NLR is associated with SYNTAX score. However, NLR does not contribute significantly to the prediction of SYNTAX score after adjustment for TIMI score. TIMI risk score might be a better predictor of the SYNTAX score in comparison to NLR.

Predictors of ST Depression Resolution in STEMI Patients Undergoing Primary PCI and Its Clinical Significance.

PURPOSE: ST depression resolution (STD-R) in ECG is a prognostic factor indicative of successful fibrinolysis or angioplasty in the treatment of ST elevation myocardial infarction (STEMI) and subsequent mortality. We conducted this study to determine the clinical significance of STD-R and its predictors in patients with anterior STEMI undergoing primary percutaneous intervention (PPCI). METHODS: Admission documents of all patients with diagnosis of anterior STEMI who were admitted to a specialty heart center and underwent PPCI since July 2018 until July 2019 were examined. The amount of ST elevation and depression in all 12 leads of a standard ECG at admission and 90 minutes after PPCI was measured and resolution was determined. All patients were followed-up for 10.8±4.0 months. RESULTS: A total of 179 patients had ST depression besides elevation in the first ECG. Female gender, diabetes, not smoking, lower hemoglobin, and higher platelet counts were significantly more common in the group with less than 50% resolution of ST depression. STD-R <50% was significantly associated with the incidence of in-hospital acute heart failure and major adverse cardiac events (MACE) (p value: 0.025 and 0.012, respectively) and resolution of ST elevation ≥50% was associated with reduced in-hospital mortality (p value <0.0001). According to Kaplan-Meier curve, survival in the two groups of STE-R ≥50% and STE-R <50% was significantly different (Log rank: 31.18, p value<0.0001). CONCLUSION: STD-R can be considered to have high predictive power, like STE-R for predicting incidence of in-hospital acute heart failure and major adverse cardiac events.

Nicotine and smoking in the COVID-19 era.

Introduction: The knowledge regarding the demographic characteristics of patients with Covid-19 and risk factors distribution is still evolving. Considering the role of cigarette smoking in the pathogenesis of lung diseases and the effect of nicotine on expression of the entry receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is important to determine the implications of smoking in COVID-19. Methods: In this brief report, by using the published articles in the literature, we aimed to compare the reported prevalence of smoking in patients with COVID-19 to the prevalence of smoking in the general population of the corresponding report. Binomial tests were conducted and a P value of less than 0.05 was considered statistically significant. Results: Among the screened papers, we found 12 peer-reviewed articles in which epidemiological characteristics of COVID-19 patients, including smoking status, were stated. Based on the descriptive reports of characteristics of COVID-19 patients, we observed a significantly lower proportion of COVID-19 patients with smoking history compared to what is expected, given the population average for each study's geographic area. Conclusion: This analysis of available data showed a lower prevalence of smoking in COVID-19 patients in comparison to the regional average. Considering the limitations of the study, the results should be interpreted with great caution and be viewed just as a preliminary report to motivate related basic and clinical researches.

Prognostic value of platelet indices in patients with acute pulmonary thromboembolism.

Introduction: Given the role of platelets in thrombus formation, markers of platelet activation may be able to predict outcomes in patients with acute pulmonary thromboembolism (PTE). Methods: In a prospective cohort study, 492 patients with acute PTE were enrolled. Patients were evaluated for platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet-lymphocyte-ratio (PLR), as well as for the simplified Pulmonary Embolism Severity Index (PESI) risk score. The primary endpoint was in-hospital all-cause mortality. Major adverse cardiopulmonary events (MACPE, composite of mortality, thrombolysis, mechanical ventilation and surgical embolectomy during index hospitalization) and all-cause death during follow-up were secondary endpoints. Results: MPV, PDW and PLR were 9.9±1.0 fl, 13.5±6.1%, and 14.7±14.5, respectively, in the total cohort. Whilst MPV was higher in those with adverse events (10.1±1.0 vs 9.9±1.0 fl; P= 0.019), PDW and PLR were not different between two groups. MPV with a cut-off point of 9.85 fl had a sensitivity of 81% and a specificity of 50% in predicting in-hospital mortality, but it had lower performance in predicting MACPE (Area under the curve: AUC 0.58; 95%CI 0.52-0.63) or long-term mortality (AUC 0.54; 95% CI 0.47-0.61). The AUC for all these three markers were lower than the AUC calculated for the simplified PESI score (0.80; 0.71-0.88). Conclusion: Platelet indices had only fair-to-good predictive performance in predicting in-hospital all-cause death. Established PTE risk scoring models such as simplified PESI outperform these indices in predicting adverse outcomes.

Biomarkers in diagnosing and treatment of acute heart failure.

Acute heart failure (AHF) is a complex disorder involving different pathophysiological pathways. In recent years, there is an increased focus on biomarkers that help with diagnosis, risk stratification and disease monitoring of AHF. Finding a reliable set of biomarkers not only improves morbidity and mortality but it can also potentially reveal the new targets of therapy. In this paper, we have reviewed the biomarkers found useful for the diagnosis as well as for risk stratification and prognostication in patients with AHF. We have discussed the established biomarkers for AHF including cardiac troponins and natriuretic peptides and emerging biomarkers including adiponectin, mi-RNA, sST2, Gal-3, MR-proADM, OPG, CT-proAVP and H-FABP for the purposes of making diagnosis, their use as a guide of therapy or for determination of prognosis.

The impact of cigarette smoking on infarct location and in-hospital outcome following acute ST-elevation myocardial infarction.

Introduction: Smoking, which is a major modifiable risk factor for coronary artery diseases, affects cardiovascular system with different mechanisms. We designed this study to investigate the association of smoking with location of ST-segment elevation myocardial infarction (STEMI), and short-term outcomes during hospitalization. Methods: In 1017 consecutive patients with anterior/inferior STEMI, comprehensive demographic, biochemical data, as well as clinical complications and mortality rate, were recorded. Patients were allocated into two groups based on smoking status and compared regarding the location of myocardial infarction, the emergence of clinical complications and in-hospital mortality in univariate and multivariate logistic regression analysis. Results: Among 1017 patients, 300 patients (29.5%) were smoker and 717 patients (70.5 %) were non-smoker. Smokers were significantly younger and had lower prevalence of diabetes, hyperlipidemia and hypertension. Inferior myocardial infarction was considerably more common in smokers than in non-smokers (45.7% vs. 36%, P = 0.001). Heart failure was developed more commonly in non-smokers (33.9% vs. 20%, P = 0.001). In-hospital mortality was significantly lower in smokers (6.7% vs. 17.3%, P = 0.001). After adjustment for confounding variables, smoking was independently associated with inferior myocardial infarction and lower heart failure [odds ratio: 1.44 (1.06-1.96), P = 0.01 and odds ratio: 0.61 (0.40-0.92), P = 0.02, respectively]. However, in-hospital mortality was not associated with smoking after adjustment for other factors [odds ratio: 0.69 (0.36-1.31), P = 0.2]. Conclusion: Smoking is independently associated with inferior myocardial infarction. Although smokers had lower incidence of heart failure, in-hospital mortality was not different after adjustment for other factors.