Effect of chronic toluene exposure on heart rhythm parameters.

BACKGROUND: Toluene is used extensively in various industrial processes, and an increasing number of workers are getting exposed to its vapor. Cardiac abnormalities that have been reported in association with toluene exposure (in toxic doses) are atrioventricular conduction abnormalities, sinus bradycardia, ventricular tachycardia, recurrent myocardial infarction, dilated cardiomyopathy, and coronary vasospasm. HYPOTHESIS: We aimed to investigate the effects of chronic toluene exposure on cardiac rhythm. METHODS: In this study, 40 workers in the polishing industry with more than 3 months of exposure to a mixture of organic solvents including toluene and 38 control subjects working in other fields who were matched by age, sex, smoking, habits, and living accommodation were investigated. Twelve-lead surface electrocardiogram and 24-hour Holter recordings were performed to determine QRS duration, PR duration (P and R wave interval on electrocardiograms), P wave dispersion, corrected QT dispersion, and heart rate variability parameters. RESULTS: The maximum heart rate was significantly lower in the toluene-exposed group compared to the control group (130.5 ± 15.1 vs 138.6 ± 16.0, P = 0.02). Corrected low frequency (cLF) and cLF/corrected high frequency (cHF) were also significantly lower in toluene-exposed group (43.6 ± 7.2 vs 50.7 ± 10.5, P = 0.01 and 1.4 ± 0.4 vs 2.2 ± 1.0, P < 0.01, respectively). Mean cHF, root-mean-square successive difference, and standard deviation of all five-minute NN interval means values were significantly higher in the toluene-exposed group (32.8 ± 8.1 vs 25.4 ± 8.2, P ≤ 0.01; 74.0 ± 46.1 vs 60.3 ± 59.4, P = 0.02; and 149.5 ± 77.0 vs 108.9 ± 43.2, P = 0.01, respectively). CONCLUSIONS: This study implies that chronic toluene exposure disturbs cardiac autonomy, particularly by suppressing sympathetic activity, and parasympathetic suppression also occurs with increased exposure duration. We also demonstrated that chronic toluene exposure was not associated with major cardiac arrhythmias and rhythm conduction system disorders.

Heart rate turbulence in patients with stable coronary artery disease and its relationship with the severity of the disease.

OBJECTIVE: Heart rate turbulence (HRT) indicates the impairment of cardiac autonomic function. With the literature containing insufficient information on HRT in stable coronary artery disease (CAD), this study aimed to investigate the role of HRT in patients with stable CAD. METHODS: The study included 58 patients (mean age: 58.9 ± 10.0 years; 25 male) with documented CAD and demonstrating ventricular premature complexes on Holter monitoring, and a control group of 52 patients (mean age: 55.9 ± 9.3 years; 36 male) with no history of CAD and demonstrating ventricular premature complexes. HRT parameters such as turbulence onset (TO) and slope (TS) were analyzed. Angiographic Gensini score were used to evaluate CAD severity. RESULTS: There was a significant difference in HRT parameters between the 2 groups. TO: 0.47 ± 1.52% vs. -1.61 ± 2.0% (p=0.001) and TS: 4.7 ± 3.0 vs. 6.4 ± 3.7 ms/RR (p=0.009) in patients with CAD and control group respectively. Given also that TO ≥ 0% and TS ≤ 2.5 ms/ RR values are considered abnormal, there was significant difference between the two groups; TO abnormal: 27 patients (46.6%) vs. 7 patients (13.5%), p=0.001, and TS abnormal: 15 patients (25.9%) vs. 4 patients (7.7%), (p=0.004) in CAD patients and control group respectively. A positive correlation was detected between TO and Gensini score (r=0.282, p=0.001) and a negative correlation detected between TS and Gensini score (r=-0.287, p=0.001). CONCLUSION: The study demonstrated that HRT variables are impaired in patients with stable CAD when compared to those in the control group, and that these variables also correlate with severity of CAD.

Factors predicting long-term mortality in patients with hypertrophic cardiomyopathy.

OBJECTIVES: In this study, we aimed to elucidate the factors affecting long-term all-cause mortality in patients with hypertrophic cardiomyopathy (HCM). METHOD: We retrospectively examined 31 patients (22 males and 9 females) diagnosed with HCM from 1999 to 2013. All subjects had sinus rhythm at the time of evaluation. Four patients had history of paroxysmal atrial fibrillation (PAF). In addition to echocardiographic examination plasma angiotensin-converting enzyme (ACE) activity and gene polymorphism were determined. The variables that were found to be significant in mortality were then included in multivariate analysis. RESULTS: At the final follow-up examination, 12 patients had died, including 2 due to congestive heart failure and 10 due to sudden cardiac death. Patients with PAF had significantly higher mortality (P = 0.008). Moreover, left ventricular (LV) end-diastolic diameter (P = 0.04), LV systolic diameter (P = 0.001), LV mass index (P = 0.01), and left atrium diameter (P = 0.003) were found to be significantly correlated with mortality. However, no significant correlation was noted between mortality and age, type of HCM (familial/nonfamilial and obstructive/nonobstructive), ACE gene polymorphism, and plasma ACE level. In the multivariate analysis, left atrial (LA) diameter was still significantly associated with mortality. The LA diameter with a cutoff value of 4.1 cm predicted 13-year mortality with a sensitivity of 82% and specificity of 78%. CONCLUSION: Instead of the ACE genotype and activity, echocardiographic evaluation findings such as LV systolic and diastolic diameters, LV mass index, and particularly LA dimension may predict long-term mortality in patients with HCM. PAF has also significant importance in the long-term mortality in patients with HCM.

The effect of oxidative stress related with ischemia-reperfusion damage on the pathogenesis of atrial fibrillation developing after coronary artery bypass graft surgery.

OBJECTIVES: We aimed to investigate the role of oxidative stress related with ischemia- reperfusion damage on the pathogenesis of atrial fibrillation (AF) developing after coronary artery bypass graft (CABG) surgery. STUDY DESIGN: In our prospective, single-center study, 118 patients who underwent elective isolated on-pump CABG surgery were included. Patients were divided into two groups according to the development of postoperative atrial fibrillation (POAF) as Group 1: Patients who developed POAF, and Group 2: Patients who remained in sinus rhythm. In addition to preoperative demographic, laboratory, echocardiographic, intraoperative, and postoperative clinical characteristics, levels of plasma total oxidative status (TOS) after placement and removal of aortic cross clamp (ACC) were compared between the two groups. Predictors of POAF were also investigated by multivariate logistic regression analysis. RESULTS: A comparison of preoperative demographic, laboratory, echocardiographic, and postoperative clinical characteristics between the two groups showed that patients in Group 1 were significantly older (65.6±7.20 vs. 59.6±9.07, p<0.001), had a lower hematocrit level (37.5±5.16 vs. 39.7±5.28; p=0.034), and an enlarged left atrium diameter (39±0.45 vs. 3.6±0.48; p=0.006). Changes in plasma TOS levels after placement and removal of ACC were statistically significant in Group 1 [13 (8.6-23), 30 (18.1-47.3); p=0.001 vs. 14 (8.8-22.2), 24 (21.4-42.7); p=0.060]. Length of stay in the intensive care unit [3 (2-14) vs. 2 (1-58); p=0.001] and length of stay in hospital [7 (6-85) vs. 7 (5-58); p=0.001] were prolonged in Group 1. In multivariate logistic regression analysis, aging (odds ratio (OR): 1.088, 95% confidence interval (CI): 1.005-1.177; p=0.036), hematocrit level (OR: 0.718, 95% CI: 0.538-0.958; p=0.025), pump temperature (OR: 1.445, 95% CI: 1.059-1.972; p=0.020), and plasma TOS level (OR: 1.040, 95% CI: 1.020-1.050; p=0.040) were found to be independent predictors of POAF. CONCLUSION: Ischemia-reperfusion damage related with ACC placement may be an important factor on the pathogenesis of POAF. Minimizing the oxidative stress occurring intraoperatively should be targeted for preventing mortality and morbidity due to POAF.

Matrix metalloproteinase-2 and -9 levels in patients with dilated ascending aorta and bicuspid aortic valve.

BACKGROUND: Predictors of aortic dilatation are not well-described in patients with bicuspid aortic valve (BAV). Changes in extracellular matrix composition in the aortic wall may play an important role. Our study aimed to examine the relationship between ascending aortic dilatation and biochemical markers for collagen metabolism, such as matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) levels in patients with BAV. METHODS: All patients underwent cardiac echocardiography using a standard protocol, and aortic measurements were made in end-diastole. One hundred twelve BAV patients with no or mild valvular impairment were recruited and grouped according to the aortic dimensions corrected for body surface area (BSA) and age. There were 54 patients with dilated ascending aorta (Group 1) and 58 patients with nondilated ascending aorta (group 2). The plasma levels of MMP-2 and MMP-9 were determined by ELISA. RESULTS: The mean ascending aorta diameter was 4.49 ± 0.49 mm in group 1 and 3.51 ± 0.46 mm in group 2 (P < 0.001). There were no significant difference in gender, BSA, presence of hypertension, diabetes mellitus, hyperlipidemia, and smoking between the 2 groups. Nevertheless, no significant difference was observed in the levels of MMP-2 and MMP-9 between the 2 groups. The ascending aorta diameter correlated significantly with age (r = 0.438 P < 0.001). No significant correlation was observed between plasma MMP-2 and MMP-9 concentration and ascending aorta diameter, respectively (r = -0.005 P = 0.58, r = -0.106 P = 0.07). Multivariate analysis showed that age was independent predictor of aortic dilatation (P ≤ 0.001). CONCLUSION: Age was an independent predictor of aortic dilatation in patients with BAV, whereas MMP-2 and 9 levels were not relevant by aortic dilatation.

Comparison of rosuvastatin versus atorvastatin for preventing postoperative atrial fibrillation.

BACKGROUND: Postoperative atrial fibrillation (AF) following cardiac surgery is associated with an increased risk of stroke, prolonged hospitalization, and increased costs. Statin therapy is associated with a lower incidence of postoperative AF. We aimed to compare the preventive effects of rosuvastatin and atorvastatin on postoperative AF. METHODS: This study included 168 patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were divided into 2 groups according to treatment of statin. Group 1 (n = 96) was patients receiving atorvastatin, and group 2 (n = 72) was patients receiving rosuvastatin. Postoperative electrocardiographs (ECGs) and telemetry strips were examined for AF within postoperative period during hospitalization. RESULTS: The incidences of postoperative AF were 17.9% (n = 17) in group 1 and 22.2% (n = 16) in group 2 (P = .48). Left ventricular end-diastolic diameter (LVEDD) and ejection fraction (EF) were not different between groups. Incidence of diabetes, hypertension, hyperlipidemia, smoking, myocardial infarction in past medical history, family history of atherosclerosis, male sex, drug use, and perioperative features were similar between groups. CONCLUSIONS: The present study revealed that preoperative rosuvastatin or atorvastatin treatment did not have a different effect in preventing postoperative AF.

Dilatation of the ascending aorta and serum alpha 1-antitrypsin level in patients with bicuspid aortic valve.

Predictors of aortic dilatation are not well described in patients with bicuspid aortic valves (BAV). This study sought to examine the relationship between proximal aortic dilatation and matrix metalloproteinase-9 (MMP-9) and alpha 1-antitrypsin (α1AT) levels in patients with BAV. All patients underwent echocardiography using a standard protocol, and aortic measurements were taken in end-diastole. We studied 82 patients with BAV and categorized them into two groups according to aortic dimensions corrected for body surface area and age. The plasma level of α1AT was routinely determined using a BN ProSpec analyzer (Siemens Healthcare Diagnostics, Marburg, Germany), and that of MMP-9 were determined by ELISA (RayBiotech Inc. Norcross, GA, USA). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS; SPSS Inc., Chicago, IL, USA) software for Windows version 12. This study included patients with BAV with no or mild valvular impairment. There were no significant differences between groups in terms of gender, body surface area, associated hypertension, diabetes mellitus, hyperlipidemia, or smoking. The mean ascending aortic diameter was 4.38 ± 0.5 mm in group 1 and 3.34 ± 0.35 mm in group 2 (p < 0.001). Plasma concentration of α1AT in patients with ascending aortic dilatation was significantly lower than that in the non-dilated group (1.32 ± 0.27 and 1.49 ± 0.25 g/l, respectively; p = 0.005). However, no significant difference was found in the MMP-9 level between the two groups (336.49 ± 233.11 and 336.39 ± 268.072 pg/ml, respectively; p = 0.96). We observed a significantly negative correlation between ascending aortic diameter and α1AT level (r = -0.300, p = 0.006) and a positive correlation between ascending aortic diameter and age (r = 0.413, p < 0.001). No significant correlation was found between plasma MMP-9 concentration and ascending aortic diameter (r = -0.008, p = 0.94). A multiple linear regression analysis was performed, including age, α1AT level, MMP-9 level, and left ventricular diastolic diameter. In this analysis, α1AT level and age were the independent predictors of aortic dilatation (p = 0.03 and p = 0.02, respectively).

Usefulness of the SYNTAX Score II to Predict In-Hospital and Long-Term Mortality in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

Objectives: The prognostic significance of SYNTAX Score II (SS-II) is well-known in patients with chronic coronary syndromes. However, its predictive ability for mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI) remains unclear. Therefore, we aimed to investigate the prognostic accuracy of SS-II in STEMI patients who underwent p-PCI. Methods: A total of 743 STEMI patients treated with p-PCI were retrospectively analyzed. Study population was divided into three groups according to SS-II and defined as SS-IILOW ≤22.5 (n=245), 22.5 31 (n=255). In-hospital and long-term mortality at long-term follow-up were defined as clinical endpoints of the study. Results: The incidence of in-hospital (15% vs. 0.4% vs. 0.8%, p<0.001) and all-cause mortality (32.2% vs. 6.6% vs. 2.9%, p<0.001) were significantly higher in SS-IIHIGH group compared with the other two groups. In addition, Kaplan-Meier analysis showed statistically significantly increased incidence of death in SS-II > 31 group (P [log-rank] <0.001). SS-II >31 was defined as an independent predictor of all-cause mortality (hazard ratio 5.22 95% confidence interval 2.11-12.87 p<0.001). Area under the curve values derived from ROC analysis to evaluate the predictive accuracy of SS-II, anatomical and clinical SS, modified ACEF score, and Global Registry of Acute Coronary Events risk scores for all-cause mortality were 0.82, 0.71, 0.81, 0.82, and 0.82, respectively (p<0.001). Conclusion: SS-II has an increased predictive ability for in-hospital and long-term mortality in STEMI patients undergoing p-PCI.

Long-Term Follow-Up of Patients With Isolated Side Branch Coronary Artery Disease.

The data with respect to stable coronary artery disease (SCAD) are mainly confined to main vessel disease. However, there is a lack of information and long-term outcomes regarding isolated side branch disease. This study aimed to evaluate long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with isolated side branch coronary artery disease (CAD). A total of 437 patients with isolated side branch SCAD were included. After a median follow-up of 38 months, the overall MACCE and all-cause mortality rates were 14.6% and 5.9%, respectively. Among angiographic features, 68.2% of patients had diagonal artery and 82.2% had ostial lesions. In 28.8% of patients, the vessel diameter was ≥2.75 mm. According to the American College of Cardiology lesion classification, 84.2% of patients had either class B or C lesions. Age, ostial lesions, glycated hemoglobin A1c, and neutrophil levels were independent predictors of MACCE. On the other hand, side branch location, vessel diameter, and lesion complexity did not affect outcomes. Clinical risk factors seem to have a greater impact on MACCE rather than lesion morphology. Therefore, the treatment of clinical risk factors is of paramount importance in these patients.

Laboratory signs of aspirin response in haemodialysis patients.

INTRODUCTION: Aspirin is effective in the secondary prevention and high-risk primary prevention of cardiovascular events. However, clinical and laboratory evidence demonstrates diminished or no response to aspirin in some patients. This study was designed to assess aspirin response in haemodialysis patients. METHODS: We prospectively enrolled 78 haemodialysis patients (28 female; 58.4 ± 12.6 years old) and 79 patients (29 female; 58.4 ± 10.6 years old) with normal renal function (glomerular filtration rate (GFR) >60 mL/min/1.73 m(2)). All subjects in both the haemodialysis patient group and the control group were taking aspirin (80-300 mg) for at least 30 days and were not taking other antiplatelet agents. Platelet function was assessed by arachidonic acid-induced aggregometry with a Multiplate analyser (Dynabyte Medical, Munich, Germany). Multiplate electrode aggregometry values below 300 AU were applied as a cut-off for response to aspirin. RESULTS: Aspirin non-response was two-fold more prevalent in haemodialysis patients (42.3%) than in patients with normal renal function (21.5%), and this difference was statistically significant (p = 0.005). The two groups were similar in terms of sex, age, tobacco use, the presence of diabetes mellitus, and platelet count. CONCLUSIONS: The frequency of aspirin non-response as defined in this study was higher in haemodialysis patients than in patients with normal renal function. However, larger subsets of patients are needed to confirm the present study.

Serum N-terminal brain natriuretic peptide indicates exercise induced augmentation of pulmonary artery pressure in patients with mitral stenosis.

INTRODUCTION: To determine whether elevated N-terminal pro-BNP (NT pro-BNP) predicts pulmonary artery systolic pressure increase on exercise stress echocardiography in asymptomatic or mildly symptomatic patients with moderate to severe mitral stenosis. METHODS AND RESULTS: Forty-one asymptomatic or mildly symptomatic patients with moderate to severe mitral stenosis and 21 age- and sex-matched healthy subjects. Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and to measure pulmonary artery pressure before and immediately after treadmill exercise. Blood samples for NT pro-BNP were also collected before and immediately after treadmill exercise at the time of echocardiographic examination. The plasma concentrations of NT pro-BNP levels were significantly higher in patients with mitral stenosis than in control subjects before and after exercise (P < 0.001). Patients with atrial fibrillation had significantly higher NT pro-BNP levels compared to those with sinus rhythm (P < 0.001). Pre- and postexercise NT pro-BNP levels correlated statistically significantly with the left atrial (LA) dimension, right ventricle enddiastolic diameter, exercise duration, heart rate, rest, and exercise pulmonary artery systolic pressure, after exercise mitral valve mean gradient. Area under the receiver-operating characteristic curve for NT pro-BNP as an exercise induced augmentation of pulmonary artery pressure was 0.78. Using an optimized cutoff value of 251 pg/mL for NT pro-BNP, sensitivity was 89.47%. The independent determinants of higher pulmonary artery pressure were LA diameter and pretest NT pro-BNP levels in multivariante analysis. CONCLUSION: NT pro-BNP levels correlate with functional class and echocardiographic findings in patients with mitral stenosis and indicate exercise induced augmentation of peak PAP > 60 mmHg. (Echocardiography 2011;28:8-14).

Incidence of atrial fibrillation and its effects on long-term follow-up outcomes in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.

OBJECTIVE: The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocardial infarction (STEMI) varies between 7% and 21%, and most of these studies were in the thrombolytic era. However, the frequency of new-onset AF during the primary percutaneous coronary intervention (PCI) period is still unclear. We aimed to investigate the frequency of new-onset AF and its effects on long-term clinical events in patients undergoing primary PCI. METHODS: A total of 1,603 patients who were diagnosed with STEMI and underwent primary PCI were included in the study. All the patients were monitored for at least 48 hours after the procedure. The primary endpoint of the study was defined as new-onset AF during hospitalization. RESULTS: The median follow-up period of our study was 44 months. New-onset AF developed in 85 (6.1%) patients. CHADs-VASc > 2, KILLIP > 2, and left atrial diameter were found to be independent predictors for the development of new-onset AF. In the AF (+) group, the all-cause and in-hospital mortality rates were found to be significantly higher. New-onset AF development in patients with STEMI was detected as an independent predictor of in-hospital mortality. CONCLUSION: In the era of primary percutaneous transluminal coronary angioplasty, new-onset AF rates were found to be lower than the literature data. In addition, new-onset AF was found to be a predictor of in-hospital mortality, and deaths occurred mostly in the early period. Therefore, close follow-up of these patients in the early period and re-evaluation in terms of AF burden when the patient becomes stable are important.

Avoiding the emergence of contrast-induced acute kidney injury in acute coronary syndrome: routine hydration treatment.

BACKGROUND: Patients with acute coronary syndrome (ACS) have about a three-fold risk for developing contrast-induced acute kidney injury(CI-AKI). Investigating studies on routine hydration therapy have frequently included patients with stable coronary artery disease and high risk of CI-AKI [estimated glomerular filtration rate (eGFR) < 60 ml/min]. However, data on routine hydration treatment in non-ST segment elevation myocardial infarction (NSTEMI) patients with eGFR ≥60 ml/min are insufficient. We aimed to investigate the association between routine hydration therapy and CI-AKI development in NSTEMI patients at low risk for nephropathy. METHODS AND RESULTS: We randomly assigned a total of 401 NSTEMI patients to two groups: the routine hydration group (198 patients) and the nonhydration group (control group) (203 patients). Intravenous hydration with isotonic saline (1 ml/kg/h, 0.9% sodium chloride) was given for 3-12 h before and 24 h after contrast exposure to the hydration group. CI-AKI was defined as the increase in serum creatinine values 0.5 mg/dl or 25% between 48 and 72 h after the invasive procedures. In our study, the incidence of CI-AKI development in the routine hydration group (7.1%) was significantly lower than in the nonhydration group (14.1%) (P: 0.02). This study revealed that older age, amount of contrast media, and routine hydration were independent risk factors for developing CI-AKI (P < 0.01, P: 0.04, P < 0.01, respectively). CONCLUSION: We found that preprocedural and postprocedural intravenous hydration therapy reduces the development of CI-AKI in patients with NSTEMI at low risk for CI-AKI. We suggest administering routine hydration therapy in all ACS patients regardless of eGFR values.

Effects of ECE-1b rs213045 and rs2038089 polymorphisms on the development of contrast-induced acute kidney injury in patients with acute coronary syndrome.

OBJECTIVE: Endothelin-1 (ET-1) promotes the progression and induction of sclerotic renal changes in end-stage kidney disease. Membrane-bound endothelin-converting enzyme 1 (ECE-1) is involved in the production of ET-1. The aim of this study was to assess the effects of ECE-1b rs213045 and rs2038089 polymorphisms, which have been shown to be involved in the development of atherosclerosis, hypertension, and nephropathy, on the development of contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome. METHODS: Our study included 38 patients with CI-AKI (CI-AKI[+]) and 55 patients without CI-AKI (CI-AKI[-]) who had coronary syndrome. The ECE-1b polymorphisms rs213045 and rs2038089 were assessed using real-time PCR. Serum ET-1 levels were measured by ELISA. RESULTS: The distributions of ECE-1b rs213045 and rs2038089 polymorphisms were similar between the two groups. Additionally, the serum ET-1 level did not different between the groups and was not associated with the ECE-1b polymorphisms. Peri-procedural low systolic blood pressure (SBP) was identified as a risk factor for CI-AKI development. CONCLUSION: Our findings indicate that ECE-1b rs213045 and rs2038089 polymorphisms are not associated with CI-AKI development and that peri-procedural low SBP is a risk factor for CI-AKI. However, variations in ECE-1b rs2038089 may contribute to the development of CI-AKI.

The relationship between protein convertase subtilisin kexin type-9 levels and extent of coronary artery disease in patients with non-ST-elevation myocardial infarction.

BACKGROUND: Cardiovascular disease is one of the leading causes of death worldwide. According to the results of various studies, protein convertase subtilisin kexin type-9 (PCSK9) was determined as a novel risk factor for stable coronary artery disease. Few studies have investigated the relationship between PCSK9 levels and the severity of coronary artery disease in patients with acute coronary syndrome; thus, we herein aimed to investigate this relationship in patients with non-ST-elevation myocardial infarction (NSTEMI) who underwent coronary angiography. PATIENTS AND METHODS: Herein, 168 patients with NSTEMI were prospectively enrolled, and severity of atherosclerotic lesions was determined using SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX), Gensini and Jeopardy scores. Plasma PCSK9 levels, lipid parameters and C-reactive protein levels were measured after a 12-h fasting period. The relationship of PCSK9 levels and clinical and laboratory parameters of patients with their SYNTAX, Gensini and Jeopardy scores was investigated. RESULTS: Pearson correlation analysis showed a strong positive correlation between PCSK9 and the three scores (P < 0.001, r > 0.5 for all). In ROC analysis, a mid-high SYNTAX score of at least 25 was predicted with a sensitivity of 81% and a specificity of 63% when the PCSK9 level was higher than 52.8 ng/ml (area under a curve 0.76, P < 0.001). Multivariate linear regression analysis revealed that PCSK9, low-density lipoprotein cholesterol and creatinine levels were independent predictors of a high SYNTAX score. CONCLUSION: Taken together, high PCSK9 levels may be a risk factor for adverse events in patients with NSTEMI. Aggressive lipid-lowering therapies may benefit this group of patients.

The association of neutrophil to lymphocyte ratio and TIMI frame count in primary percutaneous coronary intervention.

BACKGROUND: This study was sought to evaluate the relationship between admission neutrophil lymphocyte ratio (NLR) and estimated coronary flow by the TIMI frame count (TFC) method in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS: TFC of 262 consecutive STEMI patients were evaluated after PPCI. Admission NLR were calculated and TFC was determined after PPCI. According to admission NLR value, patients were divided in to two groups. NLR levels higher than 3.5 were defined "higher NLR" whereas lower than 3.5 were accepted as "lower NLR". RESULTS: TFC was significantly higher in patients with higher NLR (56.6±41.1 vs. 37.9±36.1, P<0.001). No-reflow phenomenon was more frequent in higher NLR group compared to lower NLR group (10.1% vs. 5.2%, P=0.001). In multivariate linear regression analysis admission NLR was an independent predictor of high TIMI frame count (B=2.24 95 % CI (1.17-3.31), P<0.001). CONCLUSIONS: Our findings suggest that admission NLR predicts coronary blood flow in means of TFC.

Unusual electrocardiographic presentation of pacemaker battery depletion with lead failure: pacing spike, artefact or native QRS? A short communication.

Herein we report an unusual electrocardiographic presentation of a patient with pacemaker battery depletion and lead insulation failure.

Comparative performance of AnTicoagulation and Risk factors In Atrial fibrillation and Global Registry of Acute Coronary Events risk scores in predicting long-term adverse events in patients with acute myocardial infarction.

OBJECTIVE: This study is designed to evaluate the recently developed AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) risk score (RS), which determines the predisposition to thromboembolic and hemorrhagic events in atrial fibrillation, as a predictor of prognosis in patients having acute myocardial infarction (AMI), and to compare the predictive ability of ATRIA RS with GRACE RS. METHODS: We analyzed 1627 patients having AMI who underwent coronary angiography and/or percutaneous coronary intervention (PCI) between January 2011 and February 2015. The primary endpoints included all-cause mortality, non-fatal MI, and cerebrovascular events during follow-up. RESULTS: Multivariate Cox regression analysis showed that the ATRIA RS>3 was an independent predictor of major adverse cardiac events in patients with AMI [hazard ratio, 2.00, 95% confidence interval, 1.54 to 2.60, p<0,001]. The area under the curve (AUC) for ATRIA RS and GRACE RS was 0.66 and 0.67 (p<0.001, and p<0.001), respectively. We performed a pair-wise comparison of receiver operating characteristic curves,and noted the predictive value of ATRIA RS with regard to primary endpoints was similar to that of GRACE RS (By DeLong method, AUCATRIA vs. AUCGRACE z test=0.64, p=0.52). CONCLUSION: ATRIA RS may be useful in predicting prognosis in patients having AMI during long-term follow-up.

Relationship between myocardial performance index and severity of coronary artery disease in patients with non-ST-segment elevation acute coronary syndrome.

OBJECTIVES: We aimed to investigate the relationship between myocardial performance index (MPI) and severity of coronary artery disease, as assessed by the Gensini score (GS), in patients with non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: Ninety patients with an initial diagnosis of NSTEMI were enrolled in our study. They were divided into tertiles according to the GS: low GS < 19; mid GS > 19 and ≤ 96; and high GS > 96. RESULTS: The low-, mid- and high-GS groups included 24, 38 and 28 patients, respectively. Clinical features such as gender distribution; body mass index (BMI); prevalence of diabetes mellitus, hypertension and hyperlipidaemia; and smoking status were similar in the three groups. MPI and isovolumic relaxation time were significantly higher in the high-GS group than in the low- and mid-GS groups (p < 0.001 and p = 0.005, respectively). Furthermore, the high-GS group had a significantly lower ejection fraction and ejection time (p = 0.01 and p < 0.001, respectively). MPI was positively correlated with the GS (r = 0.47, p < 0.001), and multivariate regression analysis showed that MPI was an independent predictor of the GS (ß = 0.358, p < 0.001). CONCLUSIONS: Patients with NSTEMI who fall within the high-risk group may be identified by means of a simple MPI measurement.

Contrast-Induced Acute Kidney Injury Is Associated With Long-Term Adverse Events in Patients With Acute Coronary syndrome.

Contrast-induced acute kidney injury (CI-AKI) is associated with increased mortality, morbidity, and prolonged hospitalization. Patients with acute coronary syndrome (ACS) have a 3-fold higher risk of developing CI-AKI. The aim of our study was to evaluate the predictors of CI-AKI and long-term prognosis in patients with ACS who developed CI-AKI (1083 patients were enrolled). Contrast-induced acute kidney injury was defined as an increase of ≥0.5 mg/dL and/or an increase of ≥25% of pre-percutaneous coronary intervention (PCI) to post-PCI serum creatinine levels within 48 to 72 hours after the procedure. Primary end point was defined as all-cause mortality, myocardial infarction, and cerebrovascular event at long-term follow-up (36 ± 12 months). Contrast-induced acute kidney injury occurred in 178 (16.4%) of the 1083 patients. The primary end points were significantly high in patients with ACS who developed CI-AKI ( P < .001). The occurrence of CI-AKI was identified as an independent predictor of primary end point. Risk of CI-AKI development was more frequently seen in patients with ACS. Also, patients who developed CI-AKI have worse prognosis at long-term follow-up. Additional preventive treatment strategies need to be developed in this group of patients.