Comparison of Glidesheath Slender and Subcutaneous Nitrate Administration in Terms of Radial Artery Complications: A Retrospective Single-Center Experience.

Objectives: The transradial route is used in most coronary procedures today. Although this method seems to be advantageous in terms of bleeding complications and patient comfort, the small radial artery diameter brings with it complications such as radial artery spasm and occlusion. It has been demonstrated in previous studies that subcutaneous nitrate administration dilates the radial artery. The Glidesheath Slender, which has a thinner outer wall than conventional sheaths, is another method that has been shown to reduce complications by reducing friction on the radial artery wall. Our aim was to compare these two methods in terms of complications. Methods: We retrospectively reviewed patients with complete clinical and radial Doppler ultrasound records who had undergone transradial interventions. We compared procedures using subcutaneous nitrate application plus conventional sheaths with procedures using the Glidesheath Slender sheath in terms of procedural and post-procedural complications. Results: Eighty-seven patients in the subcutaneous nitrate group and 35 patients in the Glidesheath Slender group were included in the study. There were no significant differences between the two groups in terms of procedural and postprocedural complications (p = 0.511 and p = 0.333, respectively). Conclusions: In cases where a thin-walled sheath such as a Glidesheath Slender is not available, subcutaneous nitrate administration seems to be similar, especially in terms of preventing radial artery spasm.

Poor Nutritional Status Is Associated with Arrhythmic Events on 24-Hour Holter Recording.

BACKGROUND: Malnutrition is associated with cardiovascular disease morbidity and mortality. Arrhythmias may be the cardiac consequences of malnutrition. OBJECTIVES: The objective of the study was to evaluate the association between prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and arrhythmic events on 24-h electrocardiography (ECG) Holter recording in patients without manifested arrhythmia. METHODS: In this retrospective analysis of 477 patients who underwent 24-h ECG Holter monitoring, PNI and CONUT score were calculated and patients were divided into tertiles according to PNI and into three groups according to CONUT score; 0: normal, 1-2: mild risk of malnutrition, ≥3: moderate-severe risk of malnutrition. Arrhythmic events were compared between PNI tertiles and CONUT score groups. RESULTS: Total number of premature atrial contractions, premature ventricular contractions (PVCs), PVC burden, and incidence of paroxysmal atrial fibrillation (PAF) were significantly higher in patients within the lowest PNI tertile. Total number of PVCs, PVC burden, and incidence of PAF were significantly higher in patients with CONUT score ≥3. The cut-off value for PNI to predict the presence of PVC was defined as 39.41 using ROC curve analysis. The area under the curve was 0.650 (p < 0.001). Multivariate analysis showed that PNI was independent predictor of the presence of PVC and PAF. Also, CONUT score was independent predictor of the presence of PVC and PAF. Incidence of nonsustained ventricular tachycardia did not differ between PNI tertiles or CONUT score groups. CONCLUSION: Poor nutritional status, assessed by PNI and CONUT score, is associated with arrhythmic events on 24-h ECG Holter recording in patients without manifested arrhythmia.

Prognostic Nutritional Index as a New Prediction Tool for Coronary Collateral Development.

BACKGROUND: Nutritional status is a predictor of the prognosis of cardiovascular diseases. The association between the Prognostic Nutritional Index (PNI), which is an immunonutritional parameter, and cardiovascular diseases has been extensively studied in the literature. OBJECTIVES: The aim of this study was to investigate whether PNI is associated with coronary collateral development. METHODS: This retrospective study included 172 patients with chronic total occlusion. The patients were diagnosed with stable coronary artery disease, and all patients underwent coronary angiography. PNI was calculated using serum albumin level and lymphocyte count. Collateral circulation was classified according to Rentrop grade. RESULTS: There was a positive correlation between PNI and Rentrop grade (r = 0.168, p = 0.026) and a negative correlation between C-reactive protein and PNI (r = -0.353, p < 0.001). Multivariate logistic regression analysis showed that uric acid and PNI were independent predictors of Rentrop grade (p = 0.008 and p = 0.037, respectively). CONCLUSIONS: This study showed that PNI, which can easily be calculated using serum albumin level and lymphocyte count, was a predictor of coronary collateral development in terms of Rentrop grade.

Serum and saliva levels of ischemia-modified albumin in patients with acute myocardial infarction.

OBJECTIVE: Ischemia-modified albumin (IMA) is a novel marker for diagnosis of myocardial ischemia and it is considered as a serum marker. The aim of the study was to evaluate salivary IMA levels in patients with acute myocardial infarction (AMI) and to determine the relation between serum and salivary IMA levels. METHODS: A total of 60 patients with AMI and 40 control subjects who are age and sex matched with AMI group were included in our study. The diagnosis of AMI was based on the WHO classification criteria. All patients underwent the clinical assessment, consisting of electrocardiography, and serum cardiac markers. Serum and salivary IMA levels were measured at the first and second days of AMI by using a colorimetric method. RESULTS: Serum IMA levels were significantly higher in the first and second day of AMI patients, however, salivary IMA levels were significantly higher in the first day of AMI patients compared to the control (P < 0.05). There was a positive correlation between salivary IMA levels and serum IMA levels both in the first and second day of AMI patients (r = 0.298, P < 0.05; r = 0.319, P < 0.05, respectively). CONCLUSION: We concluded that salivary IMA levels at the first day of AMI could be used as an alternative marker to serum IMA levels for diagnosis of AMI.

Same family, same mutation, different ECG.

BACKGROUND: Different types of long QT syndromes (LQTS) have distinct ECG manifestations according to the type and magnitude of ion channel dysfunction. While LQT1 carriers usually have broad-based T waves and LQT3 carriers have extended ST segments with relatively narrow peaked T waves; LQT2 carriers have low-amplitude T waves with high incidences of notches. METHODS: We describe three members of a family with the same LQTS2 pathogenic variant, but different surface ECG findings. CONCLUSION: This case shows ECG differences may also occur between family members who have pathogenic variants associated with long QT syndrome.

Relationship between C-reactive protein/albumin ratio and dipper/nondipper pattern in normotensive individuals.

OBJECTIVE: Nondipper blood pressure pattern plays an important role in cardiovascular events even in normotensive individuals. The relationship between CRP (C-reactive protein)/albumin ratio (CAR), a valuable marker of inflammation and cardiovascular diseases, has been studied for a long time. We aimed to investigate the relationship between CAR and dipper/nondipper pattern in normotensive subjects. METHODS: A total of 78 dipper and 78 nondipper participants, based on ambulatory blood pressure monitoring (ABPM), were retrospectively included in our study. CAR and other parameters of all participants were collected from blood samples taken at the time of monitoring. RESULTS: CAR was significantly higher in the nondipper group than dipper group ( P = 0.001). CAR was negatively and significantly correlated with nocturnal SBP fall ratio and nocturnal DBP fall ratio ( P < 0.001). CRP/albumin ratio was found significantly and independently associated with the nondipper pattern ( P = 0.002). CONCLUSION: We found that normotensive individuals with nondipping pattern tend to have increased CAR. Increased inflammatory response could contribute to increase in the atherosclerotic risk in nondippers compared with dippers even in a normotensive profile.

Evaluation of the relationship between aspartate aminotransferase/alanine aminotransferase ratio and coronary slow-flow phenomenon.

Aim: To assess the correlation between the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and slow coronary flow (SCF). Methods: A total of 119 patients with SCF and 121 age- and sex-matched patients with normal coronary flow were included in this retrospective cross-sectional study. Thrombolysis in myocardial infarction frame count of angiography images was marked by two interventionalists. In addition to AST and ALT levels, complete blood count; kidney, liver and thyroid function tests; age; sex; medication and medical history were recorded. Results: Significant spikes in AST/ALT ratio were discovered in the SCF group compared with the normal coronary flow group (p < 0.001). Thrombolysis in myocardial infarction frame count values were significantly higher in all coronaries for the SCF group compared with the normal coronary flow group (p < 0.001). Thrombolysis in myocardial infarction frame count values of the left anterior descending artery (r = 0.258; p < 0.001), left circumflex artery (r = 0.297; p < 0.001) and right coronary artery (r = 0.195; p = 0.002) were positively correlated with AST/ALT ratio. Conclusion: AST/ALT ratio is significantly correlated with SCF; therefore, this ratio may have predictive value.

Effect of chelation therapy on arrhythmogenic and basal ECG parameters of lead exposed workers.

Lead exposure has etiological role on cardiovascular system diseases as hypertension, atherosclerosis, stroke, and arrhythmic events. In this study, we aimed to compare the basal and arrhythmogenic ECG parameters of lead exposed workers before and after chelation therapy and to evaluate the effect of acute change of blood lead levels on ECG. Fourty consecutive occupationally lead exposed workers were enrolled, demographic, blood, echocardiographic, and electrocardiographic data's were analyzed before and after chelation therapy. Pmax, P min, P Wave Dispersion, and QT Dispersion values which are arrhythmia predictors were significantly lower after chelation therapy compared to values before chelation therapy. Lead exposed workers are under the risk of ventricular and atrial arrythmias and chelation treatment has a positive effect on these parameters.

Nutritional status and severity of coronary artery disease.

OBJECTIVE: The aim of this study is to evaluate the association between Nutritional Risk Index (NRI), a simple tool to assess nutritional status, and coronary artery disease severity and complexity in patients undergoing coronary angiography. METHODS: This study is a retrospective analysis of 822 patients undergoing coronary angiography. Patients with previous revascularization were excluded. Gensini and SYNTAX scores were calculated according to the angiographic images to determine atherosclerosis severity. NRI was calculated as follows: NRI = [15.19 × serum albumin (g/dl)] + [41.7 × (body weight/ideal body weight)]. In patients ≥65 years of age, Geriatric NRI (GNRI) was used instead of NRI. GNRI was calculated as follows: GNRI = [14.89 × serum albumin (g/dl)] + [41.7 × (body weight/ideal body weight)]. Patients were then divided into three groups as previously reported: NRI < 92, NRI 92-98 and NRI > 98. Gensini and SYNTAX scores were compared between three groups. RESULTS: The mean age of study population was 61.9 ± 11.1 years. NRI < 92, 92-98, and >98 was measured in 212, 321 and 289 patients, respectively. There was no difference regarding to sex, BMI, smoking, hypertension and diabetes mellitus between three groups. Patients with NRI < 92 had the highest mean Gensini score than the patients with NRI 92-98 and NRI > 98 (38.0 ± 40.6 vs. 31.17 ± 42.4 vs. 25.8 ± 38.4, P = 0.005). Also patients with NRI < 92 had the highest mean SYNTAX score than the patients with NRI 92-98 and NRI > 98 (11.8 ± 12.9 vs. 9.3 ± 12.4 vs. 7.7 ± 11.8, P = 0.001). Also, Gensini score of ≥20 and high SYNTAX score of ≥33 were associated with lower NRI (P < 0.001 and P < 0.001, respectively). CONCLUSION: In our study, nutritional status evaluated by the NRI was associated with more extensive and complex coronary atherosclerosis in patients undergoing coronary angiography.

Relationship between Discordance of Low-Density Lipoprotein and Non-High-Density Lipoprotein Cholesterol and Risk Stratification in Acute Myocardial Infarction

Abstract Background: Sizeable proportion of patients have discordant low-density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (NHDL-C). It has been shown that discordance of LDL-C and NHDL-C either underestimates or overestimates coronary risk. Objectıve: We assessed whether this discordance has an impact on GRACE and TIMI risk scores in patients with acute myocardial infarction (AMI). Methods: We retrospectively evaluated the data of 198 consecutive patients with AMI. Fasting serum lipid profiles were recorded, GRACE and TIMI scores were calculated. Patients were divided into 3 groups according to LDL-C and NHDL-C percentiles: Discordant group: LDL-C<NHDL-C (n=38), concordant group: LDL-C=NHDL-C (n=112) and discordant group LDL-C>NHDL-C (n=48). GRACE and TIMI scores, mortality and cardiovascular events (heart failure, non-fatal myocardial infarction and angina) at sixth month were compared between these three groups. Differences between these groups were analyzed with One-way ANOVA or Kruskal-Wallis rank test, and with chi-square for percentages. Also, post hoc LSD or Conover-Iman's non-parametric multiple comparison test were used. A p value <0.05 was accepted as statistically significant. Results: TIMI risk score didn't differ between discordant or concordant groups. Mean GRACE (death) and GRACE (death and MI) scores were higher in group with LDL-C<NHDL-C than with LDL-C=NHDL-C and LDL-C>NHDL-C (p=0.029 and 0.008, respectively). Cardiovascular events and mortality at sixth month were not different among groups (p=0.473 and p=0.176, respectively). Conclusion: GRACE score was higher in discordant group with LDL-C<NHDL-C, but there is no difference regarding TIMI scores between discordant and concordant groups in AMI patients.

Is it a typical crosstalk: Need for re-implantation?

With constantly evolving technology and an ever-increasing number of patients with pacemakers, clinicians will encounter various pacemaker malfunctions in their practice. While some of these issues can be solved even by using only the pacemaker׳s mode settings, others require re-intervention; neglecting a pacemaker׳s malfunction without full investigation threatens the patient׳s life. In this report, we describe a patient with a dual-chamber pacemaker with neglected or unresolved dyssynchronization that occurred 2 years after implantation.