Inadvertent misplacement of pacemaker lead presented with acute ischemic stroke.

If a permanent pacemaker lead is misplaced in the left ventricle (LV), the lead may interfere with normal functioning of the heart leading various complications, including heart rhythm problems and blood clots. In our case, the LV lead that passed through the patent foramen ovale and was misplaced into the LV was detected in a 78-year-old patient who presented with embolic stroke. Thrombus regression was achieved with anticoagulation, and then the lead extraction was planned. The lead extraction is a priority in acute cases; but it is not the primary approach in long-term leads that were misplaced into the LV. A patient-based individual approach should be preferred in such cases.

Prognostic value of pulmonary artery diameter/aorta diameter ratio in patients with acute pulmonary embolism.

BACKGROUND: The ratio of pulmonary artery diameter (PAD) to ascending aortic diameter (AoD) has been reported to be a prognostic marker in several lung diseases; however, the usefulness of this tool in patients with acute pulmonary embolism (APE) is unknown. Here, we aimed to determine the long-term prognostic value of the PAD/AoD ratio in patients with APE. METHODS: A total of 275 patients diagnosed with APE at our tertiary care center between November 2016 and February 2022 were included in the study. The patients were divided into two groups according to the presence of long-term mortality and their PAD/AoD ratios were compared. RESULTS: Long-term mortality was observed in 48 patients during the median follow-up of 59 (39-73) months. The patients were divided into two groups for analysis: group 1, consisting of 227 patients without recorded mortality, and group 2, consisting of 48 patients with documented mortality. A multivariate Cox regression model indicated that the PAD/AoD ratio has the potential to predict long-term mortality (HR: 2.9116, 95% CI: 1.1544-7.3436, p = 0.023). Analysis of the receiver operating characteristic curve revealed that there was no discernible difference in discriminative ability between the simplified pulmonary embolism severity index (sPESI) and PAD/AoD ratio (area under the curve [AUC] = 0.679 vs. 0.684, respectively, p = 0.937). The long-term predictive ability of the PAD/AoD ratio was not inferior to the sPESI score. CONCLUSIONS: The PAD/AoD ratio, which can be easily calculated from pulmonary computed tomography, may be a useful parameter for determining the prognosis of APE patients.

Evaluation of pan-Immuno-Inflammation value for In-hospital mortality in acute pulmonary embolism patients.

Background: Pan-immuno-inflammation value (PIV) is a new and comprehensive index that reflects both the immune response and systemic inflammation in the body. Objective: The aim of this study was to investigate the prognostic relevance of PIV in predicting in-hospital mortality in acute pulmonary embolism (PE) patients and to compare it with the well-known risk scoring system, PE severity index (PESI), which is commonly used for a short-term mortality prediction in such patients. Methods: In total, 373 acute PE patients diagnosed with contrast-enhanced computed tomography were included in the study. Detailed cardiac evaluation of each patient was performed and PESI and PIV were calculated. Results: In total, 60 patients died during their hospital stay. The multivariable logistic regression analysis revealed that baseline heart rate, N-terminal pro-B-type natriuretic peptide, lactate dehydrogenase, PIV, and PESI were independent risk factors for in-hospital mortality in acute PE patients. When comparing with PESI, PIV was non-inferior in terms of predicting the survival status in patients with acute PE. Conclusion: In our study, we found that the PIV was statistically significant in predicting in-hospital mortality in acute PE patients and was non-inferior to the PESI.

Higher C-Reactive Protein to Albumin Ratio Portends Long-Term Mortality in Patients with Chronic Heart Failure and Reduced Ejection Fraction.

Background and Objectives: In this study, we aimed to investigate the prognostic value of the C-reactive protein to albumin ratio (CAR) for all-cause mortality in patients with chronic heart failure with reduced ejection fraction (HFrEF). Materials and Methods: In total, 404 chronic HFrEF patients were included in this observational and retrospective study. The CAR value of each patient included in this analysis was calculated. We stratified the study population into tertiles (T1, T2, and T3) according to CAR values. The primary outcome of the analysis was to determine all-cause mortality. Results: The median follow-up period in our study was 30 months. In the follow-up, 162 (40%) patients died. The median value of CAR was higher in patients who did not survive during the follow-up [6.7 (IQR = 1.6-20.4) vs. 0.6 (IQR = 0.1-2.6), p < 0.001]. In addition, patients in the T3 tertile (patients with the highest CAR) had a higher rate of all-cause mortality [n = 90 cases (66.2%), p < 0.001]. Multivariate Cox regression analysis revealed that CAR was an independent predictor of mortality in patients with HFrEF (hazard ratio: 1.852, 95% confidence interval: 1.124-2.581, p = 0.005). In a receiver operating characteristic curve analysis, the optimal cut-off value of CAR was >2.78, with a sensitivity of 66.7% and specificity of 76%. Furthermore, older age, elevated N-terminal pro-brain natriuretic peptide levels, and absence of a cardiac device were also independently associated with all-cause death in HFrEF patients after 2.5 years of follow-up. Conclusions: The present study revealed that CAR independently predicts long-term mortality in chronic HFrEF patients. CAR may be used to predict mortality among these patients as a simple and easily obtainable inflammatory marker.

The Association between Exercise-Induced Ventricular Premature Contractions and Long-Term Mortality in Patients without Obstructive Coronary Artery Disease.

Background: The treadmill exercise test is widely used to determine cardiovascular risk and mortality. Premature ventricular complexes (PVCs) are frequently observed during exercise stress testing. The literature on the role of PVCs observed during treadmill exercise testing in predicting prognosis is controversial. Hence, we aimed to evaluate the clinical results of PVCs seen during exercise testing in patients without obstructive coronary artery disease confirmed by coronary angiography (CAG). Methods: The study population consisted of 1624 consecutive patients who were considered high risk according to the Duke treadmill risk score and had no significant stenosis on CAG from January 2016 to April 2021. The primary endpoints of the study were long-term all-cause mortality of patients who had PVCs during the exercise test or during the resting phase. Results: Long-term mortality was observed in 53 of the 1624 patients after a mean follow-up of 47 months. PVCs were observed in 293 (18.7%) patients without long-term mortality, and in 24 (45.3%) patients with long-term mortality (p < 0.001). The model adjusted for all covariates showed that the presence of PVCs in the recovery phase [p < 0.007, hazard ratio (HR) (95% confidence interval (CI)) 2.244 (1.244-4.047)] and advanced age [p < 0.001, HR (95% CI) 1.194 (1.143-1.247)] were associated with long-term all-cause mortality. Conclusions: PVCs observed during treadmill exercise testing and the recovery phase were related to long-term mortality in patients without obstructive coronary artery disease.

Validation of the HCM Risk-SCD model in patients with hypertrophic cardiomyopathy and future perspectives.

BACKGROUND: The hypertrophic cardiomyopathy (HCM) risk- sudden cardiac death (SCD) model provides a convenient tool for determining the risk of SCD in patients with HCM even though some patients with low-risk scores still remain at risk of SCD. Hence, the aim of our study was to assess the performance of HCM Risk-SCD in a large series of consecutive patients with HCM who had been followed up in a tertiary center. METHODS: The study population consisted of 389 consecutive HCM patients who had been followed up between 2004 and 2021. Demographic and clinical characteristics, estimated 5-year risk using the HCM Risk-SCD model, were compiled, and survival data were collected during follow-up. Patients were divided into 2 groups according to their long-term survival, and HCM risk-SCD scores of these two groups were compared. RESULTS: The long-term mortality was observed in 47 patients out of 389 patients in the during a mean follow-up of 55.5 ± 12.7 months. The mean HCM Risk-SCD score of surviving patients was significantly lower than that of non-survivors (1.8% vs. 3.0%, p < .001). The HCM Risk-SCD score was above 6% in nine (2.6%) survivors and nine (19.1%) non-survivors (p < .001). The ROC curve based on the HCM Risk-SCD score had 61% sensitivity and 61% specificity for risk threshold of for 2.0%, 38% sensitivity and 99% specificity a threshold of ≥4%, 17% sensitivity, and 99% specificity for a threshold of ≥6%. CONCLUSION: A new risk algorithm with higher sensitivity is needed, although the HCM risk-SCD model is still quite useful in identifying patients at a high risk for SCD.

Comparison of outcomes between single long stent and overlapping stents: a meta-analysis of the literature.

OBJECTIVES: There is no consensus on whether to treat diffuse coronary artery lesions with a single long stent (SLS) or by overlapping two or more stents (OLS). The goal of this review was to compare the outcomes of these two approaches through a meta-analysis of the literature. METHODS: We searched for relevant studies in MEDLINE, Scopus, EMBASE, Google Scholar, and the Cochrane Library. Our meta-analysis included 12 studies (n = 6414) that reported outcomes during the follow-up period. RESULTS: Individuals who received OLS had a greater risk of cardiac mortality and target lesion revascularization (TLR) than those who received SLS (RR: 1.51, CI: 1.03-2.21, p = 0.03, I2 = 0% and RR: 1.64, CI: 1.02-2.65, p = 0.04, I2 = 38%, respectively). The fluoroscopy period in the OLS group was longer than in the SLS group (SMD: 0.35, CI: 0.25-0.46, p < 0.01, I2 = 0%). more contrast volume was sued for the OLS group; however, there was substantial variability in the pooled analysis (I2 = 95%). In terms of all outcomes, there were no differences between stent generation types. CONCLUSION: In the first meta-analysis of mainly observational data comparing OLS vs. SLS for long coronary lesions, OLS had higher rates of cardiac mortality and TLR as well as longer fluoroscopy times compared to SLS.

Meta-analysis of the Current Research on the Relationship Between Blood Lipid Levels and the Occurrence of Atrial Fibrillation.

BACKGROUND: There is still debate in the literature about the relationship between lipid profile and the occurrence of atrial fibrillation (AF). In order to assess the association between blood lipid profiles and incidence of AF, this review was conducted to perform a meta-analysis of all available studies. METHODS: This review analysed all studies up to 28 February 2023 in PubMed, Google Scholar, and the Cochrane Library that included data regarding blood lipid levels and incidence of AF. For the purpose of calculating pooled estimates, the hazard ratios were extracted from all studies. RESULTS: Fourteen studies including 19 cohorts with 3,990,484 patients were included in this meta-analysis. An elevation of one standard deviation in total cholesterol (TC) level was associated with an 8% reduction (HR=0.92, 0.88-0.96; p<0.01) in the risk of developing AF. Although increased low-density lipoprotein cholesterol levels were associated with a 7% reduction in the development of AF (HR=0.93, 0.87-1.00; p=0.04), there was high heterogeneity in the random effects model (I2=92%). Changes in high-density lipoprotein cholesterol and triglyceride levels were not found to be associated with AF risk in the pooled analysis. Dose-response meta-analysis showed that TC was inversely linearly associated with the risk of AF (p<0.001). CONCLUSIONS: Higher TC levels were shown to be independently attributed to an increased risk of AF in individuals without cardiovascular disease. There was no association between the incidence of AF and triglyceride, high-density lipoprotein cholesterol, or low-density lipoprotein cholesterol blood levels.

Left Ventricular Mass Index Predicts Pacemaker-Induced Cardiomyopathy in Patients with Dual Chamber Permanent Pacemakers Implanted Due to Complete Atrioventricular Block.

Background: Pacing-induced cardiomyopathy (PICM) occurs as a result of high-burden right ventricular (RV) pacing, which usually develops in patients with complete atrioventricular (AV) block. There is a paucity of data on the association between PICM and pre-implantation left ventricular mass index (LVMI). Thus, the purpose of this study was to analyze the influence of LVMI on PICM in patients who had dual chamber permanent pacemakers (PPMs) implanted secondary to complete AV block. Methods: Overall, 577 patients with dual chamber permanent pacemakers (PPMs) were classified into three tertiles according to their pre- implantation LVMI. The average follow-up period was 57 ± 38 months. The baseline characteristics, laboratory and echocardiographic variables were compared between the tertiles. PICM was defined as a ≥ 10% drop in left ventricular ejection fraction (LVEF) from pre-implantation with a resultant LVEF < 50%. PICM occurred in 42 (7.2%) patients. The independent predictors of PICM development, as well as the impact of LVMI on PICM, were investigated. Results: After controlling for confounding baseline variables, the tertile with the greatest LVMI had a 1.8 times higher risk for the development of long-term PICM compared with the tertile with the lowest LVMI, which was accepted as the reference group. A receiver operating characteristic curve analysis revealed that the best LVMI cut- off value for predicting long-term PICM was 109.8 g/m2 with 71% sensitivity and 62% specificity (area under curve: 0.68; 95% confidence interval: 0.60-0.76; p < 0.001). Conclusions: This investigation revealed that pre-implantation LVMI had a prognostic role in predicting PICM in patients with an implanted dual chamber PPM due to complete AV block.

Evaluating systemic immune-inflammation index in patients with implantable cardioverter defibrillator for heart failure with reduced ejection fraction.

BACKGROUND: Pro-inflammatory pathways play an important role in the follow-ups of patients with intracardiac defibrillators (ICDs) for heart failure (HF) reduced with ejection fraction (HFrEF). A newly defined index - the systemic immune-inflammation index (SII)-has recently been reported to have prognostic value in patients with cardiovascular disease. This study's aim is to evaluate the SII value regarding its association with long-term mortality and appropriate ICD therapy during a 10-year follow-up. METHODS: This retrospective study included 1011 patients with ICD for HFrEF. The SII was calculated as the neutrophil-to-lymphocyte ratio × total platelet count in the peripheral blood. The study population was divided into two groups according to the SII's optimal cut-off value to predict long-term mortality. The long-term prognostic impact of SII on these patients was evaluated regarding mortality and appropriate ICD therapy. RESULTS: The patients with a higher SII (≥1119) had significantly higher long-term mortality and appropriate ICD therapy rates. After adjustment for all confounding factors, the long-term mortality rate was 5.1 for a higher SII. (95% CI: 2.9-8.1). The long-term appropriate ICD therapy rate was 2.0 for a higher SII (95% CI: 1.4-3.0). CONCLUSION: SII may be an independent predictive marker for both long-term mortality and appropriate ICD therapy in patients with HFrEF.

Association of Tp-e/QT ratio with SYNTAX score II in patients with coronary artery disease.

Background. The SYNTAX score II (SS) is an angiographic tool, which grades the complexity of coronary artery lesions and predicts short- and long-term events. Tp-e/QT ratio is a novel electrocardiographic marker for the risk of ventricular arrhythmias. We aimed to investigate whether there was a correlation between SS and Tp-e/QT ratio.Methods. A total of 227 consecutive patients who underwent elective coronary angiography were enrolled in this study. Patients who had a lumen diameter >1.5 mm and at least % 50 diameter stenosis on coronary angiogram were determined as coronary artery disease (CAD) group, and others were identified as a control group. The SS was calculated for the CAD group, and SS ≥23 was defined as a high SS group, and SS < 23 was identified as a low SS group. Electrocardiographic indices, such as Tp-e and Tp-e/QT, were measured for all patients. A multivariable logistic regression analysis was performed with variables age, interventricular septum thickness (IVS), hypertension, and Tp-e/QT. Results. Tp-e interval and Tp-e/QT ratio were higher in the CAD group compared with the control group. Tp-e, corrected Tp-e (cTP-e) and Tp-e/QT were higher in the high SS group than in the low SS group. The cTp-e and Tp-e/QT were correlated with SS score. Age, IVS and Tp-e/QT ratio were independent predictors of high SS in the logistic regression analysis. Conclusions. Tp-e/QT ratio was an independent predictor of high SS and might be used for risk stratification in CAD patients.

Evaluating the systemic immune-inflammation index for in-hospital and long-term mortality in elderly non-ST-elevation myocardial infarction patients.

INTRODUCTION: This investigation aimed to evaluate the predictive value of the systemic immune-inflammation index (SII) for in-hospital and long-term mortality in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). METHODS: This retrospective investigation included 314 consecutive elderly NSTEMI patients in a tertiary center. SII is computed as (neutrophils × platelets)/lymphocytes. Based on the increased SII values, we classified the research sample into three tertile groups as T1, T2, and T3. The in-hospital and long-term mortality were defined as the primary outcomes. RESULTS: Patients in the T3 group had lower chances of survival in the in-hospital and long-term periods compared with those in the T2 and T1 groups. According to the multivariable Cox regression models, SII independently related with in-hospital (hazard ratio (HR): 1.001, 95% CI: 1.000-1.1003, p = 0.038) and long-term mortality (HR: 1.004, 95% CI: 1.002-1.006, p < 0.001). To predict long-term mortality, the optimal SII value was > 2174 with 80% sensitivity and 85.4% specificity. SII had a slightly lower but statistically non-inferior discriminative ability for long-term mortality compared with the Charlson comorbidity index (CCI) in the receiver operating characteristic curve comparison (AUC: 86.2 vs. AUC: 890, p > 0.05). Additionally, combining SII with traditional risk factors and the CCI revealed a significant improvement in C-statistics. CONCLUSION: This investigation may be the first to demonstrate that SII is independently linked with in-hospital and long-term mortality in elderly NSTEMI patients.

The predictive value of the MELD-XI score for short- and long-term mortality in elderly patients with non-ST elevation myocardial infarction.

BACKGROUND: In this study, we investigated the utility of the Model for End-stage Liver Disease excluding INR (MELD-XI) score in predicting short- and long-term mortality in elderly patients with non-ST elevation myocardial infarction (NSTEMI) who underwent coronary angiography (CAG). METHODS: In total, we analyzed 228 elderly NSTEMI patients above the age of 75. We used the modified 5-item frailty index and the Charlson Comorbidity Index (CCI) to assess the comorbidities. The MELD-XI score was calculated using the logarithmic relationship between the serum creatinine and total bilirubin. RESULTS: The median long-term follow-up was 530 [interquartile range (IQR) = 303-817] days and the short- and long-term mortality rates were 11.8% (n = 27) and 16.4% (n = 33), respectively. Patients who did not survive had a substantially higher MELD-XI score than those who did [10.1 (IQR = 7.8-15.1) vs. 4.5 (IQR = 1.9-6.9), p < 0.001, respectively]. Multivariable Cox regression analyses indicated that the MELD-XI score predicted both short- and long-term mortality independently. When the MELD-XI score, serum creatinine, and total bilirubin area under the curve (AUC) values were compared to predict long-term mortality, the MELD-XI score had the highest value (AUC: 0.833), followed by the serum creatinine (AUC: 0.741), and the total bilirubin (AUC: 0.723). The accuracy of the MELD-XI score was further tested with the GRACE risk score, which demonstrated noninferiority. CONCLUSION: This was the first investigation which indicated that elderly NSTEMI patients with a high MELD-XI score had poor prognosis in the short- and long-term period.

Cardiac variables associated with atrial fibrillation occurrence and mortality in octogenarians implanted with dual chamber permanent pacemakers.

BACKGROUND: There is a dearth of data on the predictors of atrial fibrillation (AF) and the association between AF and long-term mortality in octogenarians with dual-chamber permanent pacemakers (PPM). We investigate the occurrence of AF and whether it is associated with overall mortality among octogenarians with dual-chamber PPM implants. METHODS: Three hundred and fifty-four patients with PPM implants were divided into two groups based on their long-term survival status. Baseline characteristics, laboratory variables, and echocardiographic variables were then compared between the groups, and independent predictors of the long-term incidence of AF and mortality were determined. RESULTS: Multivariable Cox regression analysis performed after adjusting for the parameters in univariable analysis revealed that diabetes, urea levels, albumin levels, paced QRS duration, and the frequency of atrial high-rate episodes (AHREs) were independently associated with a long-term risk of AF in octogenarians after having dual chamber PPMs implanted. The left ventricular (LV) ejection fraction, left atrial (LA) anteroposterior diameter, and AHRE + AF (HR 1.498, 95%CI 1.003-2.237, p = 0.048) were independent risk factors for the long-term mortality in octogenarians receiving dual-chamber PPMs implants. CONCLUSION: The occurrence of AF following dual-chamber PPM implantation is a significant prognostic factor in octogenarian patients.

Comparison of mortality prediction scores in elderly patients with ICD for heart failure with reduced ejection fraction.

BACKGROUND: This investigation aimed to examine and compare the predictive value of MADIT-II, FADES, PACE and SHOCKED scores in predicting one-year and long-term all-cause mortality in implantable cardioverter-defibrillator (ICD) implanted patients, 75 years old and older, since there has been an area of uncertainty about the utility and usefulness of these available risk scores in such cases. METHODS: In this observational, retrospective study, 189 ICD implanted geriatric patients were divided into two groups according to the presence of long-term mortality in follow-up. The baseline characteristics and laboratory variables were compared between the groups. MADIT-II, FADES, PACE and SHOCKED scores were calculated at the time of ICD implantation. One-year and long-term predictive values of these scores were compared by a receiver-operating curve (ROC) analysis. RESULTS: A ROC analysis showed that the best cutoff value of the MADIT-II score to predict one-year mortality was ≥ 3 with 87% sensitivity and 74% specificity (AUC 0.83; 95% CI 0.73-0.94; p < 0.001) and that for long-term mortality was ≥ 2 with 83% sensitivity and 43% specificity (AUC 0.68; 95% CI 0.60-0.76; p < 0.001). The predictive value of MADIT-II was superior to FADES, PACE and SHOCKED scores in ICD implanted patients who are 75 years and older. CONCLUSION: MADIT-II score has a significant prognostic value as compared to FADES, PACE and SHOCKED scores for the prediction of one-year and long-term follow-up in geriatric patients with implanted ICDs for heart failure with reduced ejection fraction.

Predictive value of uric acid/albumin ratio for the prediction of new-onset atrial fibrillation in patients with ST-Elevation myocardial infarction.

Background: There is a lack of studies supporting the association between the uric acid/albumin ratio (UAR) and the development of new-onset atrial fibrillation (NOAF) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). Objective: The objective of the study was to assess the efficacy of the UAR for predicting the occurrence of NOAF in STEMI patients undergoing pPCI. Methods: We recruited 1484 consecutive STEMI patients in this retrospective and cross-sectional investigation. The population sample was classified based on the development of NOAF during hospitalization. NOAF was defined as an atrial fibrillation (AF) observed during hospitalization in patients without a history of AF or atrial flutter. The UAR was computed by dividing the serum uric acid (UA) level by serum albumin level. Results: After pPCI, 119 STEMI patients (8%) were diagnosed with NOAF. NOAF patients had higher serum UAR levels than individuals who did not have NOAF. According to the multivariable logistic regression model, the UAR was an independent predictor for NOAF in STEMI patients (OR: 6.951, 95% CI: 2.978-16.28, p < 0.001). The area under curve (AUC) value of the UAR in a receiver operating characteristics (ROC) evaluation was 0.758, which was greater than those of its components (albumin [AUC: 0.633] and UA [AUC: 0.647]) and C-reactive protein (AUC: 0.714). The optimal UAR value in predicting NOAF in STEMI patients was greater than 1.39, with a sensitivity of 69% and a specificity of 74.5%. Conclusion: To the best of our knowledge, this is the first study indicating that the UAR was an independent predictor of NOAF development in STEMI patients.

Association of Uric Acid Albumin Ratio with Recurrence of Atrial Fibrillation after Cryoballoon Catheter Ablation.

Objective: Despite improvements in the technology of catheter ablation of atrial fibrillation (AF), recurrences are still a major problem, even after a successful procedure. The uric acid/albumin ratio (UAR), which is an inexpensive and simple laboratory parameter, has recently been introduced in the literature as a predictor of adverse cardiovascular events. Hence, we aimed to investigate the relationship between the UAR and AF recurrence after catheter ablation. Methods: A total of 170 patients who underwent successful catheter ablation for AF were included. The primary outcome was the late recurrence after treatment. The recurrence (+) and recurrence (−) groups were compared for clinical, laboratory and procedural characteristics as well as the predictors of recurrence assessed by regression analysis. Results: In our study population, 53 (26%) patients developed AF recurrence after catheter ablation. Mean UAR was higher in the recurrence (+) group compared to recurrence (−) group (2.4 ± 0.9 vs. 1.8 ± 0.7, p < 0.01). In multivariable regression analysis, left atrial diameter (HR: 1.08, 95% CI: 1.01−1.16, p = 0.01) and UAR (HR:1.36, 95% CI: 1.06−1.75, p = 0.01) were found to be independent predictors of recurrence. In ROC analysis, the UAR > 1.67 predicted recurrence with a sensitivity of 77% and a specificity of 57% (AUC 0.68, p < 0.01). Conclusion: For the first time in the literature, the UAR were found to be correlated independently with AF recurrence after catheter ablation.

A Novel Electrocardiographic Score Predicts the Severity of Coronary Artery Disease and Clinical Outcomes in Patients with Non-ST Segment Elevation Myocardial Infarction.

Background: There are many electrocardiographic (ECG) changes in non-ST segment elevation myocardial infarction (NSTEMI). However, the diagnostic power is limited in determining the severity of coronary artery disease (CAD) and clinical outcomes. Objective: This study investigated the role of a risk-based ECG score in predicting the severity of CAD and clinical outcomes in NSTEMI patients. Methods: One hundred and fifty-two patients were enrolled in the study. Severe CAD was defined as; intermediate (> 22) or high SYNTAX score (> 32), three-vessel disease, and left main coronary artery lesions. A risk-based ECG score was calculated, and the patients were categorized. All patients were followed up, and mortality and repeat revascularizations were evaluated. Results: The severe CAD group had a significantly higher risk-based ECG score than the non-severe CAD group (p = 0.013). The patients with a high risk-based ECG score had more severe CAD (p = 0.013), higher SYNTAX score (p < 0.001), more three-vessel disease (p = 0.003), coronary artery calcification (p = 0.02), and one-year mortality (p = 0.006) than those with medium or low ECG scores. Multivariate logistic regression analysis showed that a 1-point increase in the risk-based ECG score was associated with a 1.573-fold [95% confidence interval (CI): 1.111-2.227, p = 0.011] increase probability of severe CAD. Kaplan-Meier analysis demonstrated that the high-risk group had a significantly higher one-year mortality rate than the low-risk and moderate-risk groups (hazard ratio: 2.383, 95% CI: 1.395-4.072, p = 0.001). Conclusions: This study demonstrated that higher ECG scores were associated with a higher risk of severe CAD and worse clinical outcomes in NSTEMI patients.

Assessment of pulmonary arterial stiffness in patients with cirrhosis: A prospective cohort study.

INTRODUCTION: In the current literature, several studies show that PAS (pulmonary artery stiffness) is associated with RV (right ventricular) dysfunction, PAH (pulmonary arterial hypertension), and disease severity in subjects with structural cardiac disease, HIV (human immunodeficiency virus), and chronic lung disease. Hence, our main aim was to use PAS to show the early changes in the pulmonary vascular region in subjects with cirrhosis. MATERIAL AND METHODS: In this prospective cross-sectional study, 39 subjects who were being followed up with cirrhosis and 41 age- and sex-matched healthy subjects were included in this study. For each case, the PAS value was obtained by dividing mean peak velocity of the pulmonary flow by the PfAT (pulmonary flow acceleration time). RESULTS: The measured PAS was 23.62 ± 5.87 (Hz/msn) in cirrhotic participants and 19.09 ± 4.16 (Hz/msn) in healthy cases (P < .001). We found a positive statistical significance between PAS and RVSP (right ventricle systolic pressure)/sPAP (systolic pulmonary arterial pressure) (r = .395; P = .013). PAS was an independent predictor that was associated with cirrhosis disease according to multivariate LR (logistic regression) analysis (OR: 1.209; 95% CI: 1.059-1.381; P = .005). CONCLUSION: Based on the study results, we consider that PAS may help in the early detection of findings in the pulmonary vascular area, even if the RV function findings or sPAP is within the normal range.

A simple formula to predict echocardiographic diastolic dysfunction-electrocardiographic diastolic index.

BACKGROUND: Diastolic dysfunction (DD) in transthoracic echocardiography (TTE), which is a poorly understood entity due to its limited treatment, is frequently encountered in daily clinical practice of cardiology. An electrocardiographic (ECG) index to predict echocardiographic DD has not been elucidated yet. We aim to exhibit an electrocardiographic diastolic index (EDI) to predict TTE DD with high sensitivity and specificity. MATERIALS AND METHODS: In this retrospective investigation, we tested the DD predictive value of EDI [aVL R amplitudeâ€¯× (V1S amplitude + V5R amplitude)/D1 P amplitude] on 204 consecutive adult patients without known coronary artery disease. Patients were divided into tertiles according to their EDI starting from the lowest one. The power of the EDI was also compared with the subunits of its formula by a receiver operating curve (ROC) analysis. RESULTS: After adjustment for confounding baseline variables, EDI in tertile 3 was associated with 24.2-fold hazard ratio of DD (odds ratio 25.2, 95% confidence interval [CI] 11.2-51.1, p < 0.001). The Spearman correlation analysis revealed moderate correlation between E/e' and EDI. A ROC analysis showed that the optimal cut-off value of the EDI to predict DD was 8.53 mV with 70% sensitivity and 70% specificity (area under the curve 0.78; 95% CI 0.71-0.84; p < 0.001). CONCLUSION: The electrocardiographic diastolic index (EDI), which is an inexpensive, feasible, and easy to use formula, appears to have a considerable role to predict diastolic dysfunction (DD) in adult patients.