The MAPH Score Predicts Coronary Slow Flow. A Retrospective Case-Controlled Study.

AIM: The MAPH score is a new score that combines mean platelet volume (MPV), hematocrit, and total protein, which are markers of whole blood viscosity (WBV). We aimed to investigate the relationship between the MAPH score and the coronary slow flow phenomenon (CSF). MATERIAL AND METHODS: A total of 201 patients were included in the study. 105 had CSF and 96 had normal coronary flow (NCF). Coronary flow was measured by the Thrombolysis in Myocardial Infarction frame count (TFC) method. The patients' MPV, age, hematocrit, and total protein were recorded. High (HSR) and low shear rates (LSR) were calculated, based on total protein and hematocrit values. Cut-off values for CSF were determined using the Youden's index, and the score was determined as 0 or 1 according to the cut-off values. The sum of these scores was the MAPH score. RESULTS: The mean age of the patients included in the study was 51.1±7.9 (n=201, 54.2 % male). Hyperlipidemia, DM, and HT rates of both groups were similar, but the mean age of the CSF group was higher (p=0.773; p=0.549; p=0.848; p <0.001, respectively). Total protein, MPV, hematocrit, HSR and LSR were higher in the CSF group (p< 0.001, for all values). Comparative receiver operating characteristic (ROC) curve analysis showed that the performance of the MAPH score in predicting CSF is better than the performance of these parameters separately. CONCLUSION: A new score, the MAPH score, may be used to identify the presence of CSF.

Association between Circulating Omentin-1 Levels and Aortic Valve Sclerosis.

Background: Aortic valve sclerosis (AVS) is characterized by thickening of the valve leaflets accompanied by increased echogenicity and calcification without significant limitations in valve movements. Omentin-1 is a glycoprotein of the adiponectin family released from visceral adipose tissue, and it can be used as a biomarker of atherosclerosis, obesity, and metabolic syndrome. No studies have demonstrated any relationship between AVS and omentin-1 in the literature. We aimed to explore the association of serum omentin-1 levels with AVS. Methods: Eighty-six patients with AVS and 92 age- and sex-matched controls were enrolled into the study. The baseline clinical characteristics of the patients were recorded. Conventional 2-dimensional echocardiography was performed. Omentin-1 levels were measured. Results: The mean omentin-1 level was significantly lower in the AVS (+) group compared to the control group (78.16 ± 44.95 vs. 163.57 ± 59.84 ng/mL, p < 0.001). Omentin-1 [odds ratio (OR) = 3.45, 95% confidence interval (CI) = 1.88-5.39, p < 0.001,] and LDL-C (OR = 1.82, 95% CI = 1.33-2.16, p = 0.015) were found to be independent predictors of AVS in multivariate logistic regression analysis. An omentin-1 level of < 92.45 ng/mL had 90.5% sensitivity and 71.4% specificity for the prediction of AVS (area under curve: 0.697, p < 0.001). Conclusions: Our results indicated that a lower omentin-1 level was associated with an increased risk of AVS. We suggest that omentin-1 could be used as a treatment target as well as to predict AVS.

Predictive role of Frontal QRS-T angle and Selvester QRS Score in determining angiographic slow flow phenomenon following percutaneous coronary intervention in patients with Non-ST elevation myocardial infarction.

AIM: Slow flow (SF) that develops after percutaneous coronary intervention (PCI) is significantly associated with poor prognosis in Non-ST elevation myocardial infarction (Non-STEMI) patients. Increased Selvester QRS score and Frontal QRS-T angle [f(QRS-T)] are related to adverse cardiovascular outcomes. We aimed to investigate the predictive role of the Selvester QRS score and f(QRS-T) for the development of post-PCI SF in patients with Non-STEMI. METHOD AND RESULTS: In a retrospective study, 210 patients with Non-STEMI were divided into two groups as SF (29) and Non-SF (181) according to their TIMI coronary flow grade. For all patients the Selvester QRS score and f(QRS-T) were calculated from automatic electrocardiography (ECG) reports. The mean age of the study population was 63 (55-75) years and 102 (68.6%) of patients were male. The Selvester QRS score and f(QRS-T) were higher in the SF group than in the Non-SF group [(5[3-8], 3[2-5]); (67° [42°-88°], 39° [24°-59°]), respectively, all p <0.01]. In a logistic regression analysis, the Selvester QRS score (OR = 4,862; 95% (CI) = 1,131-20,904, p =0.03) and f(QRS-T) (OR = 5,489; 95% (CI)= 11,433-21,034, p =0.01) were found independent predictors of post-PCI SF in Non-STEMI patients. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic values of the Selvester QRS score [86% sensitivity; 44% specificity; cut off 2; (AUC, 0.693)] and f(QRS-T) [62% sensitivity; 73% specificity; cut off 58°; (AUC, 0.778)]. CONCLUSION: The Selvester QRS score and f(QRS-T), both easy-to-calculate ECG parameters, are predictors of post-PCI SF in Non-STEMI patients.

Relationship between Serum Salusin Beta Levels and Coronary Artery Ectasia.

BACKGROUND: Local or diffuse dilatation of the coronary artery is defined as coronary artery ectasia (CAE). Salusin beta plays a role in the proliferation of cardiomyocytes, inhibition of apoptosis, and proliferation of vascular smooth muscle cells and fibroblasts. In this study, we aimed to investigate the relationship between serum salusin beta and CAE. METHODS: This study was conducted between July 2019 and December 2019 and included 71 patients with CAE (age 59.3 ± 11 years, 67.7% male) and 72 healthy subjects (age 57.1 ± 10.2 years, 69.4% male) with coronary artery angiography (CAG) findings. Venous blood samples of the participants were collected for serum salusin beta level evaluation. CAG examinations and the diagnosis of CAE were performed by two invasive cardiologists blinded to the clinical conditions of the patients. RESULTS: Mean systolic (SBP) and diastolic arterial blood pressures were significantly higher in the CAE group than in the control group, and the mean left ventricular ejection fraction (LVEF) was significantly lower (all p < 0.05). The median serum salusin beta value was statistically significantly higher in the CAE group compared to the control group [415 (interquartile range (IQR): 51.7) pg/mL vs. 365 (IQR: 55.8) pg/mL; p < 0.001]. In receiver operating characteristic curve analysis, a cut-off value of salusin beta ≥ 393 pg/mL had 78.9% sensitivity and 75.0% specificity for predicting CAE (area under the curve: 0.822; p < 0.001). Multivariate analysis demonstrated that serum salusin beta [odds ratio (OR): 1.011; p = 0.002], LVEF (OR: 0.816; p = 0.001) and SBP (OR: 1.041;p = 0.001) were independent predictors of CAE. CONCLUSIONS: This study revealed a significant and independent relationship between serum salusin beta level and the presence of CAE.

Complement C1q/Tumor Necrosis Factor-Related Protein-3 (CTRP3) is Significantly Decreased in Patients with Heart Failure and Closely Related with Ventricular Tachycardia.

BACKGROUND: The relationship between serum complement C1q/tumor necrosis factor (TNF)-related protein-3 (CTRP3) levels and ventricular tachycardia (VT) in heart failure patients with reduced ejection-fraction (HFrEF) is unclear. The aim of this study was to investigate changes in serum CTRP3 level and the relationship with VT in HFrEF. METHODS: The study included 88 patients with HFrEF with and without VT and 30 age- and sex-matched healthy controls. Serum CTRP3 levels were measured in addition to routine anamnesis, physical, laboratory and echocardiography examinations. The patients were divided into groups with and without HFrEF and HFrEF patients with and without VT. RESULTS: Serum CTRP3 levels were significantly lower in the patients with HFrEF than in the control group (206 ± 16 ng/mL and 427 ± 49 ng/mL, p < 0.001). Similarly, CTRP3 levels were lower in the patients with VT (194 ± 10 ng/mL and 216 ± 15 ng/mL, p < 0.001). Left ventricular (LV) volume and tricuspid regurgitation pressure gradient were significantly higher and LV ejection-fraction was significantly lower in the patients with VT (all p < 0.05). Serum CTRP3 and LV end-systolic volume values independently determined the patients with VT (all p < 0.01). Every 10 ng/mL decrease in CTRP3 level increased the odds ratio of VT by 79%. In the receiver operating characteristic curve (ROC) analysis, the area under the ROC curve for CTRP3 was 0.884 (p < 0.001). A CTRP3 cut-off value of 200 ng/mL could predict VT with 88.1% sensitivity and 80.2% specificity. CONCLUSIONS: Serum CTRP3 levels were significantly decreased in the patients with HFrEF, and decreased CTRP3 levels were very closely related to the presence of VT in these patients.

Prediction of subtle left ventricular systolic dysfunction in homozygous and heterozygous familial hypercholesterolemia: Genetic analyses and speckle tracking echocardiography study.

BACKGROUND AND AIMS: Few studies have shown the direct effect of familial hypercholesterolemia (FH) on myocardial systolic function. Studies focused on heterozygote FH patients but not homozygote ones, and they did not perform genetic analyses. We aimed to evaluate all types of patients with FH using the potentially more sensitive speckle tracking echocardiography (STE) technique to identify early left ventricular (LV) dysfunction. METHODS: Genetic analyses of patients with FH were conducted for LDL-receptor, PCSK9, and ApoB100. Nine homozygote, two compound heterozygote, and 82 heterozygote FH patients and 85 healthy subjects were prospectively studied. Longitudinal and circumferential strain measurements and conventional echocardiography findings were obtained. RESULTS: LV ejection fractions were similar for all (homozygote, heterozygote, and control) groups. The LV average longitudinal strain (aLS) and average circumferential strain (aCS) levels were significantly reduced in the homozygote and heterozygote groups when compared with the controls (for aLS, P = .008 (<.001); for aCS, P =< .001). A significant inverse correlation was found between LDL-C levels and LS (P < .001, r = .728) and CS (P < .001, r = .642) for all FH patients. CONCLUSIONS: This study demonstrates the potential of using systolic strain values obtained using 2D STE for determining lipotoxicity in the myocardium owing to hypercholesterolemia. Our study found that cardiac functions of homozygote patients who had the highest cholesterol levels were disrupted at very early ages. Therefore, starting lipid reduction treatment and early reverse LV remodelling therapy at early ages may be beneficial for high-risk patients.

Coronary collateral development and arterial stiffness in patients with chronic coronary total occlusions.

OBJECTIVE: Coronary collateral circulation (CCC) mainly develops through arteriogenesis in response to shear forces. Increased arterial stiffness (AS) causes decreased coronary perfusion, which may reduce shear stress, arteriogenesis, and thus collateral formation. The aim of this study was to assess the relationship between CCC and AS in patients with chronic coronary total occlusion (CTO). DESIGN: We prospectively enrolled 163 patients with CTO. Patients were divided into two groups according to their Rentrop scores: (a) poorly developed (PD) CCC group (Rentrop 0-1) and (b) well-developed (WD) CCC group (Rentrop 2-3). AS measurements were carried out using a Mobil-O-Graph arteriography system. RESULTS: Fasting glucose, creatinine, uric acid, neutrophil count, and neutrophil-to-lymphocyte ratio were found to be higher in patients with PD-CCC. Moreover, patients with PD-CCC had significantly higher augmentation index (AIx) and pulse wave velocity (PWV) compared with WD-CCC group (27.3 ± 8.9 vs. 18.7 ± 7.4, p < 0.001 and 11.7 ± 2.6 vs. 8.5 ± 1.4, p < 0.001, respectively). In multivariate logistic regression analysis, PWV, AIx, and serum uric acid were found to be independently associated with the development of CCC. CONCLUSION: AS parameters, such as AIx and PWV, as well as serum uric acid are independently associated with the development of CCC in stable coronary artery disease with CTO.

The association between aortic distensibility and coronary flow reserve in newly diagnosed diabetic patients.

INTRODUCTION: Aortic distensibility (AD) is an important parameter affecting coronary hemodynamics. Coronary flow velocity reserve (CFVR) is a reliable marker of coronary endothelial function in diabetic patients. The aim of this study was to investigate the association between AD and CFVR in newly diagnosed diabetic patients. METHOD: We studied 77 patients with newly diagnosed diabetes mellitus (DM) and 30 age- and sex-matched healthy control subjects. CFVR was calculated as the hyperemic to resting coronary diastolic velocities ratio by using transthoracic echocardiography. Pulse pressure (PP) and AD were calculated. RESULTS: Fasting blood glucose, HbA1c and PP were significantly higher in patients with diabetes (P < 0.001, P < 0.001 and P = 0.009, respectively). Other clinical and demographical characteristics, laboratory findings and echocardiographic findings were similar in both groups (P > 0.05, for all). The measurement of CFVR and AD in patients with diabetes were significantly lower compared with the controls (P < 0.001 and P = 0.001, respectively). CFVR was significantly negatively correlated with age, body mass index, HbA1c, systolic blood pressure, and PP, while significantly positively correlated with AD (P < 0.05, for all). Multivariate regression analysis showed that only AD (ß = 0.485, P < 0.0001) and HbA1c (ß = -0.362, P < 0.0001) were independently associated with CFVR. The cutoff value of AD obtained by the receiver operator characteristic (ROC) curve analysis was 2.44 for the prediction of impaired CFVR. CONCLUSION: Aortic distensibility and HbA1c were independently associated with CFVR. The decrease in AD may be used as a marker of impaired coronary microcirculation in asymptomatic diabetic patients.

Cardiac diastolic function is impaired at rest and worsens with exercise in otherwise healthy individuals with insulin resistance.

Insulin resistance (IR) is a pathophysiological condition and is associated with cardiovascular risk factors including heart failure. However, studies demonstrating myocardial abnormalities in the early phases of IR are limited. The aim of this study was to investigate myocardial function in otherwise healthy individuals with IR.Individuals with IR who were free of cardiovascular risk factors and healthy controls were included. Stress echocardiography with tissue Doppler imaging (TDI) was performed. Systolic and diastolic TDI waves were compared in both groups.A total of 77 individuals (51 with IR and 26 controls) were included in our study. The tissue early flow (e')/atrial contraction (a') ratio at rest was significantly lower in the IR group (P = 0.003). The annular early flow (E)/e' ratio, a predictor of left ventricular filling pressure, was similar in both groups at rest (P = 0.522). After exercise, e'/a' impairment became more prominent in the IR group (P < 0.001); whereas the E/e' ratio was also significantly lower (7.6 ± 1.8 versus 6.7 ± 0.9; P = 0.007) in the IR group.Myocardial involvement seems to occur in patients with IR, before the appearance of other cardiovascular risk factors. Exercise induced diastolic worsening may be a predictor of reduced compliance and increased ventricular stiffness. More detailed prospective studies are required for more precise results.

Impaired kidney function is associated with SYNTAX score in patients with stable coronary artery disease.

OBJECTIVES: The strong relationship between severe renal dysfunction and coronary artery disease (CAD) is well-known. However, the association between kidney function with SYNTAX Score (SS) has not been investigated in patients with stable CAD with normal to mildly impaired renal function. We aimed to investigate the association between kidney function with SS. STUDY DESIGN: In this study, 411 stable CAD patients in whom coronary angiography (CAG) was performed were prospectively included (247 male, 164 female; mean age 58.6 ± 12.4 years). Glomerular filtration rate was estimated (eGFR) by a modification of diet in renal disease (MDRD) formula. Two different groups were determined according to median eGFR values (GFRlow group <90, and GRFhigh group ≥ 90). CAG was performed based on clinical indications. SS was determined in all patients. RESULTS: Patients in GFRlow group were older, and have a history of hypertension (HT) and diabetes mellitus and high body mass index. SS values of GFRlow group were higher than GFRhigh group (p<0.001 for all). Multivariate regression analysis showed that eGFR was independently associated with diabetes (ß, -0.206, p<0.001), HT (ß, -0.093, p=0.026) and SS (ß, -0.445, p<0.001). CONCLUSION: eGFR is independently associated with extent and complexity of CAD as well as diabetes and HT. Importantly, these results may explain, in part, the increase in cardiovascular risk in with slightly impaired renal function.

Aortic distensibility and extent and complexity of coronary artery disease in patients with stable hypertensive and nonhypertensive coronary artery disease.

OBJECTIVE: To assess the relationship between aortic distensibility (AD) and the extent and complexity of atherosclerotic lesions assessed with SYNTAX score (SS) in patients with stable coronary artery disease. SUBJECTS AND METHODS: Three hundred and seventy-six consecutive patients (230 males and 146 females; mean age: 61.6 ± 9.9 years) with angiographically proven coronary artery disease were included in the study. The SS was calculated using the SS algorithm on the baseline diagnostic angiogram in the 376 patients. AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements in all patients. Frequencies of risk factors, biochemical and hematological data were recorded. The patients were divided into two groups according to the median AD value as AD(low) and AD(high) groups. RESULTS: The SS was higher in the AD(low) group compared with the AD(high) group (18.5 ± 10.2 vs. 8.3 ± 5.9, p < 0.001). The AD was independently related to age (ß = -0.104, p = 0.019), hypertension (ß = -0.202, p < 0.001) and SS (ß = -0.457, p < 0.001) and was more strongly associated with SS in hypertensive patients compared to nonhypertensive patients (r = -0.524 vs. r = -0.414, p < 0.001 for all). CONCLUSION: The findings showed that impaired AD might be an independent predictor for the severity of coronary atherosclerosis, particularly in patients with hypertension.

Relationship between blood viscosity and thrombus burden in ST-segment elevation myocardial infarction.

BACKGROUND: Increased whole blood viscosity (WBV) is associated with increased infarct area, impaired microvascular circulation and mortality in patients with ST-elevation myocardial infarction (STEMI). OBJECTIVES: We aimed to analyze the association between the WBV and thrombus burden (TB) in STEMI patients. METHODS: This cross-sectional study included 167 STEMI patients who received primary percutaneous coronary intervention. WBV values were assessed using hematocrit and total protein values, and low shear rate(LSR) and high shear rate(HSR) were calculated. Angiographic TB was assessed according to the definition of the Thrombolysis in Myocardial Infarction (TIMI) study group. The cases were dichotomized into low TB (grade 1-3) (n = 87) and high TB (grade 4-5) (n = 80) groups. RESULTS: The mean HSR and LSR values of the high TB group were significantly increased compared to the low TB group (p < 0.001, for each). In ROC analysis,for prediction of TB, a cut-off value of 3.83 WBV for HSR had a 71% sensitivity and a 60.7% specificity, and a cut-off value of 21 WBV for LSR had a 70% sensitivity and 59.9% specificity (p < 0.001,for each). Multivariate regression analysis showed that both HSR (OR = 2.408;p=0.020) and LSR (OR = 1.055;p=0.021) were independent predictors for high TB. CONCLUSION: Increased WBV was an independent predictor for the presence of high TB in patients with STEMI.

Systemic Immune Inflammation Index is a Novel Marker in Predicting the Presence and Severity of Isolated Coronary Artery Ectasia. / O Índice de Inflamação Imune Sistêmica é um Novo Marcador na Previsão da Presença e Gravidade aa Ectasia Coronariana Isolada.

BACKGROUND: The underlying pathology of isolated coronary artery ectasia (CE) has not been fully elucidated. OBJECTIVE: We aimed to examine the relationship between the systemic immune inflammation index (Sii), which corresponds to the multiplying of the neutrophil-to-lymphocyte ratio (NLR) and the platelet counts, and isolated CE. METHOD: The retrospective study population included 200 patients with isolated CE, 200 consecutive with obstructive coronary artery disease, and 200 consecutive with a normal coronary artery angiogram. A 2-sided p-value of <0.05 was considered significant. RESULTS: Sii, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-high density lipoprotein cholesterol ratio (MHR) were significantly higher in the CE group compared with the other groups (all p<0.001). In multivariate analysis, Sii (p<0.001, OR = 1.005, 95% CI =1.004-1.005) was found to be an independent predictor of isolated CE. In Receiver Operating Characteristic curve analysis, Sii had a higher Area Under the Curve than NLR, PLR, and MHR. Sii value of >517.35 has 79% sensitivity, 76% specificity for the prediction of the CE [AUC: 0.832, (p<0.001)]. Sii had a significant correlation with the number of ectatic coronary arteries and Markis classification (r:0.214 p=0.002; r:-0.195, p=0.006, respectively). CONCLUSION: To the best of our knowledge, this is the first study that Sii was significantly associated with isolated CE presence and anatomical severity.

FUNDAMENTO: A patologia subjacente da ectasia da artéria coronária (EC) isolada não foi totalmente elucidada. OBJETIVO: Nosso objetivo foi examinar a relação entre o índice de inflamação imune sistêmica (Sii), que corresponde à multiplicação da razão neutrófilos-linfócitos (RNL) e as contagens de plaquetas, e EC isolada. MÉTODO: A população do estudo retrospectivo incluiu 200 pacientes com EC isolada, 200 consecutivos com doença arterial coronariana obstrutiva e 200 consecutivos com angiografia coronária normal. Um valor de p bicaudal <0,05 foi considerado significativo. RESULTADOS: Sii, RNL, razão plaqueta-linfócito (RPL) e razão monócito-colesterol de lipoproteína de alta densidade (MHR) foram significativamente maiores no grupo EC em comparação com os outros grupos (todos p<0,001). Na análise multivariada, Sii (p<0,001, OR = 1,005, IC 95% =1,004-1,005) foi considerado um preditor independente de EC isolada. Na análise da curva Receiver Operating Characteristic (ROC), Sii teve uma área sob a curva maior em comparação com RNL, RPL e MHR. O valor de Sii >517,35 tem 79% de sensibilidade, 76% de especificidade para a predição do EC [AUC: 0,832, (p<0,001)]. Sii teve correlação significativa com o número de artérias coronárias ectásicas e classificação de Markis (r: 0,214 p=0,002; r:-0,195, p=0,006, respectivamente). CONCLUSÃO: Até onde sabemos, este é o primeiro estudo em que Sii foi significativamente associado à presença isolada de EC e gravidade anatômica.

The Role of Systemic Immune Inflammation Index for Predicting Saphenous Vein Graft Disease in Patients with Coronary Artery Bypass Grafting.

As inflammation plays a significant role in the development of coronary artery disease, we hypothesized that there may be a relation between the systemic immune inflammation index (SII) and saphenous vein graft disease (SVGD). The study population consisted of 716 consecutive patients who underwent elective coronary angiography (CAG) >1 year after bypass grafting. The patients were divided into 2 groups depending on the extent of SVG patency. SII value was significantly higher in the SVGD(+) group compared with the SVGD(-) group (P < .001). In multivariate logistic regression analysis, SII (P < .001, odds ratio (OR) = 3.27, 95% CI = 1.94-5.65) and neutrophil-to-lymphocyte ratio (NLR) (P < .001, OR = 2.08, 95% CI = 1.59-3.11) were found to be independent predictors of SVGD. An SII value of >935 (x103/ml) has 89.2% sensitivity and 70.6% specificity for the prediction of the SVGD, and an NLR value of >4.15 has 54.6% sensitivity and 68.5% specificity for the prediction of the SVGD. The AUC of SII was found to be greater than the AUC of NLR (P = .002), platelet-to-lymphocyte ratio (PLR) (P = .009), lymphocyte-to-monocyte ratio (LMR) (P = .013), MPV (P = .011), and C-reactive protein (CRP) (P = .034) in predicting SVGD. In conclusion, we demonstrated that SII, which is among the new inflammation indexes, is a more reliable predictor in determining SVGD than the NLR, PLR, and LMR.

Reduced CTRP3 Levels in Patients with Stable Coronary Artery Disease and Related with the Presence of Paroxysmal Atrial Fibrillation. / Níveis Reduzidos de CTRP3 em Pacientes com Doença Arterial Coronariana Estável Relacionados à Presença de Fibrilação Atrial Paroxística.

BACKGROUND: Serum Complement C1q/tumor necrosis factor-related protein-3 (CTRP3) levels and the relationship with atrial fibrillation (AF) in stable coronary artery disease (CAD) are not clearly known. OBJECTIVE: The aim of this study was to investigate the change in serum CTRP3 levels and its relationship with paroxysmal AF in stable CAD. METHOD: The study included 252 patients with CAD and 50 age-sex matched healthy control subjects. Serum CTRP3 levels were measured in addition to routine anamnesis, physical examination, laboratory and echocardiography examinations. The patients were divided into groups with and without CAD and CAD patients with and without paroxysmal AF. Statistical significance was accepted as p<0.05. RESULTS: Serum CTRP3 levels were found to be significantly lower in patients with CAD than in the control group (p<0.001). AF was detected in 38 patients (15.08%) in the CAD group. The frequency of hypertension and female gender, hs-CRP, blood urea nitrogen, creatinine levels and left atrial end-diastolic (LAd) diameter were higher (p<0.05 for each one), and CTRP3 levels were lower in patients with AF (p <0.001). In the logistic regression analysis, serum CTRP3 levels and LAd diameters were independently determined the patients with AF (p<0.01 for each one). In this analysis, we found that every 1 ng/mL reduction in CTRP3 levels increased the risk of AF by 10.7%. In the ROC analysis of CTRP3 values for detecting patients with AF, the area under the ROC curve for CTRP3 was 0.971 (0.951-991) and was statistically significant (p<0.001). When the CTRP3 cut-off value was taken as 300 ng/mL, it was found to predict the presence of AF with 87.9% sensitivity and 86.8% specificity. CONCLUSION: Serum CTRP3 levels were significantly reduced in patients with stable CAD and decreased CTRP3 levels were closely related to the presence of paroxysmal AF in these patients.

FUNDAMENTO: Os níveis de Proteína 3 relacionada ao fator de necrose tumoral/complemento sérico C1q (CTRP3) e a relação com a fibrilação atrial (FA) na doença arterial coronária estável (DAC) não estão claros atualmente. OBJETIVOS: O objetivo deste estudo foi investigar a mudança nos níveis séricos de CTRP3 e sua relação com a FA paroxística em DAC estável. MÉTODO: O estudo incluiu 252 pacientes com DAC e 50 controles saudáveis com idade/sexo compatíveis. Os níveis séricos de CTRP3 foram medidos, além da anamnese de rotina, exame físico, exames laboratoriais e ecocardiograma. Os pacientes foram divididos em grupos com e sem DAC e indivíduos com DAC com e sem FA paroxística. Os valores eram estatisticamente significativos quando p<0,05. RESULTADOS: Os níveis séricos de CTRP3 foram significativamente menores em pacientes com DAC do que no grupo controle (p<0,001). A FA foi detectada em 28 pacientes (15,08%) no grupo DAC. A frequência de hipertensão e do sexo feminino, a proteína C reativa de alta sensibilidade (PCR-as), o nitrogênio ureico no sangue, os níveis de creatinina e o diâmetro diastólico do átrio esquerdo foram maiores (p<0,05 para cada um), e os níveis de CTRP3 foram mais baixos em pacientes com FA (p<0,001). Na análise de regressão logística, os níveis séricos de CTRP3 e os diâmetros diastólicos do átrio esquerdo foram independentemente determinados pelos pacientes com FA (p<0,01 para cada um). Nesta análise, observamos que cada 1 ng/mL de redução nos níveis de CTRP3 aumentou o risco de FA em 10,7%. Na análise ROC dos valores de CTRP3 para detectar pacientes com FA, a área da curva ROC para CTRP3 foi 0,971 (0,951­991) e considerada estatisticamente significativa (p<0,001). Quando o ponto de corte de CTRP3 foi considerado em 300 ng/mL, demonstrava a presença de FA com 87,9% de sensibilidade e 86,8% de especificidade. CONCLUSÃO: Os níveis séricos de CTRP3 caíram significativamente em pacientes com DAC estável, e níveis reduzidos de CTRP3 estiveram relacionados à presença de FA paroxística nesses pacientes.

The ATRIA and Modified-ATRIA Scores in Evaluating the Risk of No-Reflow in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention.

The no-reflow (NR) phenomenon is frequently encountered in acute coronary syndrome. We evaluated the association between anticoagulation and risk factors in atrial fibrillation (ATRIA) and modified ATRIA risk scores and NR in ST-elevation myocardial infarction (STEMI). Consecutive patients (n = 551) who underwent primary percutaneous coronary intervention between December 2019 and June 2020 due to STEMI were included. The mean age of the patients was 60.5 ± 10.8 years (n = 369, 67% male). The ATRIA and modified anticoagulation and risk factors in atrial fibrillation-hyperlipidemia, smoking, male (m-ATRIA-HS) scores were calculated. The NR group had higher frequency of diabetes mellitus (DM), serum creatine kinase-MB (CK-MB) levels, and corrected thrombolysis in myocardial infarction frame count (cTFC) (P = .002, P = .006, and P < .001, respectively). In regression analysis, ATRIA, m-ATRIA-HS, thrombus grade, and cTFC were independent predictors of NR. Age, higher CK-MB, and neutrophil-to-lymphocyte ratio and DM were the other predictors for NR. Pairwise comparison of receiver operating characteristics curve analysis showed that the m-ATRIA-HS (>2, area under curve [AUC]: 0.715) has better performance than ATRIA score (>1, AUC: 0.656), with a P < .022 and z statistics 2.279. In conclusion, ATRIA, especially the m-ATRIA-HS, can be used to evaluate NR risk in STEMI.

Relationship between atherogenic index of plasma and stent thrombosis in patients with acute coronary syndrome.

OBJECTIVE: Stent thrombosis (ST) is an uncommon but serious complication in patients undergoing percutaneous coronary intervention (PCI). This study aimed to investigate the effect of atherogenic index of plasma (AIP) on ST. METHODS: Among the 10,258 patients who underwent coronary angiography between January 2018 and December 2020, 239 patients who underwent PCI with the diagnosis of acute coronary syndrome (ACS) due to ST were included as the study group (ST group) and 459 patients who underwent percutaneous intervention for ACS and did not have any in-stent lesion as the control group (non-ST group). ST classification was done according to the Academic Research Consortium definition. RESULTS: The mean age of the patients was 63.3±10.6 years (483 male, 69.2%). The groups were similar in terms of characteristic properties, comorbidities, and the drugs being used (p>0.05 for all). Drug eluting stents were used in 86.5% of the patients. In the ST group, the median time from stent implantation to thrombosis was 285 days. Mean AIP and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) were statistically significantly higher in the ST group than in the controls (p<0.001 and p=0.018, respectively), and a positive correlation was observed between time from stent implantation to thrombosis and AIP and TG/HDL-C (rS=0.229, p=0.010 and rS=0.222, p=0.010, respectively). Multivariate logistic regression analysis revealed that stent length, prior ST elevation myocardial infarction, TG/HDL-C, and AIP were independent predictors of ST. CONCLUSION: AIP is an easy calculable biomarker, and the performance of AIP to predict ST is better than TG/HDL-C.

Association of serum elabela levels with carotid artery stenosis in patients with non-cardioembolic ischemic stroke.

Aim: Elabela (ELA) is a peptide of the apelinergic system and is known to play a role in endothelial homeostasis and vascular pathobiology. In this study, the relationship between carotid artery stenosis, which is the main culprit, and ELA level in patients with non-cardioembolic ischemic stroke was investigated. Materials & methods: Cross-sectional observation included two groups of 40 patients with critical carotid artery stenosis and 40 patients with age-sex matched noncritical carotid artery stenosis. Results: ELA levels were significantly higher in the noncritical stenosis group. ELA had a significantly moderate negative correlation with the carotid score (r = -0.334, p = 0.003), maximal carotid plaque length (r = -0.413, p < 0.001) and degree of stenosis (r = -0.397, p < 0.001). Conclusions: There is a significant inverse correlation between critical carotid artery disease and ELA level in patients with non-cardioembolic ischemic stroke.

A New Score for Determining Thrombus Burden in STEMI Patients: The MAPH Score.

AIM: to investigate whether the MAPH score, which is a new score that combines blood viscosity biomarkers such as mean platelet volume (MPV), total protein and hematocrit, can be used to predict thrombus burden in ST-segment elevation myocardial infarction (STEMI) patients. METHODS: A total of 473 consecutive patients with STEMI were included in the study. Intracoronary tirofiban/abciximab infusion was applied to patients with thrombus load ≥3 and these patients (n = 71) were defined as the patient group with high thrombus load. MPV, age, hematocrit and total protein values of the patients were recorded. High shear rate (HSR) and low shear rate (LSR) were calculated from total protein and hematocrit values. Cut-off values were determined for high thrombus load by using Youden index, and score was determined as 0 or 1 according to cut-offs. The sum of the scores was calculated as the MAPH score. RESULTS: The mean age of the patients included in the study was 59.6 ± 12.6 (n = 354 male, 74.8%). There was no difference between the groups in terms of gender, HT and DM (P = .127, P = .402 and P = .576, respectively). In the group with high thrombus load; total protein, MPV and hematocrit values were higher (P < .001, P = .001 and P = .03, respectively). Comparison of receiver operating characteristic (ROC) curve analysis revealed that the MAPH score had better performance in predicting higher thrombus load than both other self-containing parameters and HSR and LSR. CONCLUSION: The MAPH score may be a new score that can be used to determine thrombus burden in STEMI patients.

The ATRIA score is superior to the m-CHA2DS2-Vasc score in predicting in-hospital mortality in COVID-19.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has become a health and social problem all over the world. Most of the deaths occur from embolism and thrombus formation. We aimed to compare the predictive value of the anticoagulation and risk factors in atrial fibrillation (ATRIA) and m-CHA2DS2-Vasc scores in in-hospital mortality in COVID-19. METHODS: Three-hundred and ninety-four patients who were hospitalized due to COVID-19 between 10 June 2020 and 10 September 2020 were included. Three-hundred and sixty patients who survived were defined as the non-mortality group and the remaining 34 whose hospitalizations resulted in death were defined as the mortality group. The anticoagulation and risk factors in atrial fibrillation and m-CHA2DS2-Vasc scores of the patients were calculated. RESULTS: A total of 394 patients, mean age 66.2±9.7 (221 male [56.1%]) were included in this retrospective study. The median values of the anticoagulation and risk factors in atrial fibrillation and m-CHA2DS2-Vasc scores were different between the groups (p<0.000 for both). The multivariate logistic regression analysis showed that both the m-CHA2DS2-Vasc and anticoagulation and risk factors in atrial fibrillation scores were independent predictors of in-hospital mortality (p=0.024, 95%CI 1.039-1.704 for anticoagulation and risk factors in atrial fibrillation and p=0.043, 95%CI 1.012-2.088 for m-CHA2DS2-Vasc). In the receiver operating characteristic curve analysis, the anticoagulation and risk factors in atrial fibrillation score was superior to the m-CHA2DS2-Vasc score with an AUC 0.774 and SE:0.037, and p<0.001. CONCLUSIONS: In our study, we showed that the anticoagulation and risk factors in atrial fibrillation and m-CHA2DS2-Vasc scores can be used as predictors of thrombosis and mortality in COVID-19 patients. In addition, the predictive value of the anticoagulation and risk factors in atrial fibrillation score was higher than that of m-CHA2DS2-Vasc. The use of the anticoagulation and risk factors in atrial fibrillation score to assess high-risk patients in COVID-19 may be recommended.