Relationship of the modified Glasgow Prognostic Score with peripheral artery disease severity and procedure success in patients who had undergone endovascular treatment.

OBJECTIVES: The modified Glasgow Prognostic Score (mGPS) is one type of inflammation-based index; it includes data on elevated C-reactive protein and reduced albumin content. The predictive value of mGPS for outcomes is investigated in various diseases such as cancer, heart failure, myocardial infarction, acute pulmonary embolism, and inflammatory bowel diseases. This study aimed to evaluate the link between mGPS and the severity and complexity of peripheral arterial disease (PAD) as determined by the Transatlantic Intercommunal Consensus Document (TASC-II) classification and the prediction value of mGPS for procedural success in patients undergoing endovascular treatment (EVT). METHODS: Our study included 203 consecutive patients receiving EVT for atherosclerotic obstruction of aortoiliac, femoro-popliteal, and below-knee arteries between January 2019 and February 2020. The lesion characteristics were determined according to categories in the TASC-II. Operational failure is the inability to position the guidewire through the occluded lesion following percutaneous intervention or achieve distal perfusion following EVT. RESULTS: In our study, we observed 136 patients (%6) with TASC A-B lesions and 67 patients (%33) with TASC C-D lesions. EVT was performed on the femoro-popliteal artery in 59.4% of the patients, on the aortoiliac artery in 30.7%, and on the below-the-knee artery in 9.9%. mGPS was an independent predictor of severe PAD (OR: 17.943, 95% CI: 5.120-62.882; p < .001) and procedural success (odds ratio: 0.004; 95% CI: 0.001-0.099; p < .001). Additionally, we identified age and the presence of a TASC D lesion as independent predictors of interventional success (OR: 0.938, 95% CI: 0.819-0.979; p: .034; OR: 0.104, 95% CI: 0.107-0.643; p: .015, respectively). CONCLUSION: We determined that mGPS independently predicts PAD complexity and severity based on TASC-II classification; the EVT success rate is lower in patients with high mGPS.

Evaluation of subvalvular pannus formation in mechanical aortic valve by transesophageal echocardiography.

Subvalvular pannus formation is a rare but clinically important complication with prosthetic valves. Transthoracic echocardiography still plays a role in the initial assessment of mechanical aortic valve dysfunction. But evaluation with transesophageal echocardiography is more useful. Subvalvular area may be a blind spot of echocardiography due to acoustic shadowing. The case presented herein underlines the significant role of transgastric plane and three-dimensional TEE in the assessment of subvalvular pannus formation in mechanical aortic valves.

The Relationship Between the Modified Glasgow Prognostic and SYNTAX Scores in Patients with Non-ST Elevation Myocardial Infarction.

Objective: This study investigated the modified Glasgow prognostic score (mGPS) to determine its predictive value and how it could be compared with various inflammatory markers, including C-reactive protein (CRP) to albumin ratio and neutrophil-to-lymphocyte ratio, for determining the extent and severity of coronary artery disease (CAD) in patients with non-ST-elevated myocardial infarction (NSTEMI). Methods: This study analyzed the cases of 295 patients with NSTEMI who had undergone coronary angiography. In an effort to determine the seriousness and scope of CAD in each patient, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was calculated and then assessed. The study sample was divided into two separate groups based on the SYNTAX score: moderate to high SYNTAX (>22) and low SYNTAX (≤22). Results: There were 295 patients (23.1% female, 76.9% male) included in the research, with an average age being 61.2±10.9 years, and the mean SYNTAX score being 7.3±10.4 (range: 0-40). Those with a SYNTAX score >22 were observed to possess significantly higher levels of CRP, CRP/albumin ratio, and mean mGPS 1-2 ratios compared with those with a SYNTAX score ≤22 (all p<0.001). Smoking [odds ratio (OR): 3.341, 95% confidence interval (CI): 1.531-7.294; p=0.002], CRP/albumin ratio (OR: 4.958, 95% CI: 1.335-18.418; p=0.017), and mGPS score of 1-2 (OR: 3.121, 95% CI: 1.430-6.814; p=0.004) were independent factors used to help predict a high SYNTAX score. Conclusions: It seems possible to make use of the mGPS when estimating the degree and intricacies of CAD in patients with NSTEMI, as there appears to be a connection with higher SYNTAX scores.

Prognostic value of nutrition for contrast-induced nephropathy in patients undergoing peripheral vascular intervention.

Background: The objective was to examine the predictive value of malnutrition, assessed via the Controlling Nutritional status (CONUT) and Prognostic Nutrition Index (PNI) scores, in the development of contrast-associated acute kidney injury (CA-AKI) following peripheral vascular intervention (PVI).Methods: This retrospective cross-sectional observational study included the enrollment of 243 consecutive patients who underwent PVI. Patients were categorized into two groups based on the occurrence of CA-AKI.Results: Patients with CA-AKI had lower PNI scores and the PNI score was an independent predictor of CA-AKI development (Odds Ratio: 0.518, 95% CI: 2.295-0.908, p = 0.021). Nomogram had higher discriminative ability than both PNI and CONUT scores and discriminative abilities were similar for PNI and CONUT scores.Conclusion: Malnutrition, as identified by the CONUT and PNI, was found to be associated with a high risk of CA-AKI development following PVI.

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Clinical implication of totally occluded infarct-related coronary artery in non-ST-segment elevation myocardial infarction: the TOTAL-NSTEMI study.

BACKGROUND: A subset ofpatients found to have total occlusion of the culprit artery (TOCA), present with non-ST-segment elevation myocardial infarction (NSTEMI) and elevated biomarkers. The aim of this study is to assess the effect of the TOCA in patients presenting with NSTEMI. METHODS: This multicenter observational study was retrospectively conducted between 2015 and 2019. Thrombolysis in myocardial infarction (TIMI) flow grades 0-1 was defined as the TOCA. The primary end point included a combination of all-cause death, myocardial infarction, target vessel revascularization, stent thrombosis, and stroke. RESULTS: Of 3272 patients, TIMI 0-1 flow in the culprit artery was present in 488 (14.9%) patients. TOCA was more likely to be of thrombotic origin (54.1% vs. 10.3%; P < 0.001) and visible collaterals (22.5% vs. 4.4%; P < 0.001). The rates of 30-day (14.3% vs. 7.2%; P < 0.001) and 2-year (25% vs. 19.1%; P = 0.003) primary end points were significantly higher in TOCA patients. Fatal arrhythmias were remarkably higher at 30-day (8.6% vs. 4%; P < 0.001) and 2-year (9% vs. 5.2%; P = 0.001) follow-ups. Mechanical complications were also higher in patients with TOCA at 30 days (0.8% vs. 0.2%; P = 0.013). Moreover, TOCA (OR, 1.379; P = 0.001) was one of the independent predictors of MACCE in NSTEMI patients. CONCLUSION: The current data suggest that patients with TOCA in the context of NSTEMI are at higher risk of MACCE, fatal arrhythmias, and mechanical complications.

Lessons Learned From Intermittent Dysfunction of Mechanical Heart Valve.

BACKGROUND: Intermittent malfunction is a rare but potentially serious complication of prosthetic heart valve replacement. This study aimed to describe the clinical features and etiologic causes of patients with intermittent mechanical prosthetic heart valve dysfunction. METHODS: Between 2010 and 2021, 16 patients who were evaluated in the echocardiography laboratory of Kosuyolu Training and Research Hospital with the diagnosis of intermittent malfunction of prosthetic valves were included in the study. RESULTS: The evaluated patients consisted of 12 bi-leaflet mitral valve replacements and 2 mono-leaflet mitral valve replacements. The underlying causes of intermittent malfunction were classified as follows: residual chord (n=4), obstructive thrombus (n=2), non-obstructive thrombus (n=2), vegetation (n=2), pannus and obstructive thrombus coexistence (n=1), and solely pannus (n=1). One of the patients with mono-leaflet mitral valve replacements had pannus and obstructive thrombus. In the other patient with mono-leaflet mitral valve replacement, a stuck valve was observed in 1 of 12 beats secondary to arrhythmia. There were also 2 patients with aortic valve replacements. One patient had moderate aortic regurgitation due to prominent calcification and the other had moderate obstruction due to pannus. In the patient with pannus, a stuck leaflet was observed in 1 of 6 beats and moderate aortic regurgitation arose in 1 of 2 beats in the patient with calcification. CONCLUSIONS: The intermittent stuck valve may have catastrophic outcomes. When making a treatment decision in these patients, assessing the degree of regurgitation or stenosis is essential. In particular, the frequency of entrapment should be taken into consideration when deciding the optimal therapy for intermittent prosthetic heart valve dysfunction.