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OBJECTIVE: To investigate the association between serum omentin-1 levels and adverse cardiac events in patients with hypertrophic cardiomyopathy (HCM). SUBJECTS AND METHODS: This prospective, observational study included 87 patients with HCM and 50 age- and sex-matched control subjects. Serum omentin-1 and brain natriuretic peptide (BNP) levels were measured in all subjects, using enzyme-linked immunosorbent assay and electrochemiluminescence, respectively. Patients with HCM were divided into 2 groups according to their omentin levels, i.e., low: ≤291 ng/mL (n = 48) and high: > 291 ng/mL (n = 39). Cardiac mortality, hospitalization due to heart failure, and implantable cardioverter-defibrillator (ICD) implantation were considered adverse cardiac events. Statistical analysis included uni- and multivariant logistic regression, receiver-operating characteristic (ROC) analysis, and the Kaplan-Meier method. RESULTS: Serum omentin-1 levels were significantly lower in the obstructive (253.9 ± 41.3 ng/mL) and nonobstructive (301.9 ± 39.8 ng/mL) HCM groups than in the control group (767.1 ± 56.4 ng/mL), p < 0.001, respectively. The BNP levels were higher in the obstructive and nonobstructive HCM groups than in the control group (269.5 ± 220, 241.0 ± 227, and 24.0 ± 18.9 pg/mL, respectively, p < 0.001). The Kaplan-Meier analysis indicated that patients with low omentin-1 levels showed a significantly higher (48.2%) 2-year cumulative incidence of overall adverse cardiac events than those with high omentin-1 levels (16.2%) (log-rank test, p = 0.001). In the multivariate logistic regression analysis, omentin-1, interventricular septum (IVS) thickness, and male gender were independent predictors of adverse cardiac events in the follow-up. CONCLUSION: Omentin-1 levels were lower in patients with HCM than in the control group, and this was associated with worse cardiac outcomes.
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Biomarcadores/sangre , Cardiomiopatía Hipertrófica/sangre , Cardiomiopatía Hipertrófica/complicaciones , Citocinas/sangre , Lectinas/sangre , Péptido Natriurético Encefálico/sangre , Adulto , Anciano , Cardiomiopatía Hipertrófica/mortalidad , Cardiomiopatía Hipertrófica/fisiopatología , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática , Femenino , Proteínas Ligadas a GPI/sangre , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Distribución por Sexo , Turquía/epidemiologíaRESUMEN
OBJECTIVE: To investigate the possible correlation between serum 25-hydroxyvitamin D levels and resistant hypertension (RH). SUBJECTS AND METHODS: Patients who had undergone ambulatory blood pressure measurements (ABPM) during outpatient controls were enrolled. Fifty subjects with RH, 50 with controlled hypertension (CHT) and 50 normotensive subjects (NT) were included in the study. RH was defined as 'suboptimal blood pressure control despite using 3 antihypertensive agents including a diuretic or need for 4 or more drugs to control blood pressure'. The 25-hydroxyvitamin D and parathormone levels were compared between the groups. Pearson's correlation coefficient test was applied to assess the correlation between 25-hydroxyvitamin D levels and office blood pressure (BP) and ABPM. Logistic regression analysis was used to determine the independent correlates of RH. RESULTS: The 25-hydroxyvitamin D level was significantly lower in the RH group (17.02 ± 5.4 ng/ml) compared to the CHT (24.9 ± 4.8 ng/ml) and NT groups (28.0 ± 5.7 ng/ml, p < 0.001). In univariate correlation analysis, 25-hydroxyvitamin D levels had a significant negative correlation with office systolic BP (r = -0.329, p < 0.001), office diastolic BP (r = -0.395, p < 0.001), systolic ambulatory BP (r = -0.844, p = 0.004), and diastolic ambulatory BP (r = -0.567, p = 0.005). ROC analysis revealed that 25-hydroxyvitamin D levels <21.50 ng/ml predicted the presence of RH with a sensitivity of 78% and a specificity of 79% (AUC = 0.89, 95% CI 0.83-0.94). In the multivariate logistic regression analysis, 25-hydroxyvitamin D level was independently correlated with the presence of RH (ß 0.660, 95% CI 0.572-0.760, p < 0.001). CONCLUSION: There was an independent correlation between lower 25-hydroxyvitamin D levels and presence of RH.
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Hipertensión/tratamiento farmacológico , Vitamina D/análogos & derivados , Antihipertensivos/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial , Estudios Transversales , Resistencia a Medicamentos , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , Vitamina D/sangreRESUMEN
Coronary artery spasm should always be suspected in patients who have myocardial infarction with normal coronary arteries. This case report presents a 33-year-old woman with anterior myocardial infarction, whose coronary angiograph revealed normal left anterior descending artery and new onset complete occlusion of the circumflex artery at the time of the procedure. Nitroglycerin up to 800 mcg was administered without success. In such resistant cases, when all efforts fail, including prompt recognition and application of vasodilator drugs, retracting the catheter and waiting may play a role.
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Vasoespasmo Coronario/diagnóstico , Infarto del Miocardio/etiología , Adulto , Angiografía Coronaria , Vasoespasmo Coronario/complicaciones , Vasoespasmo Coronario/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Infarto del Miocardio/diagnóstico por imagen , Vasodilatadores/administración & dosificaciónRESUMEN
PURPOSE: It is not clear whether cognitive functions are impaired in young patients with acute coronary syndrome (ACS). This study aims to detect whether or not there is cognitive impairment and cerebral changes in young patients with ACS undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS: All 50 patients with ACS who were treated with primary PCI were eligible for this prospective study. All participants had normal cognitive function before ACS. Brain magnetic resonance imaging (MRI) was performed to quantify changes in brain white and gray matter. Cognitive functions (CFs) were evaluated by seven cognitive tests. Patients were categorized by MRI findings and test scores were compared from the first day to after the first month. RESULTS: We determined 25 patients with impaired CFs on the first day. After the first month, we identified 18 patients with transient impaired CFs. No structural difference was observed between impaired CF and normal CF. While 25 patients had a score of 1 according to Fazekas, 10 patients had a score of 1 according to MTLA. While the mean Stroop test completion time and Stroop test error rate scores were significantly higher on the first day than after the first month in the Fazekas+ group (p = 0.003, p < 0.001, respectively), other cognitive test scores-except clock drawing test, digital span forwards, and backwards-were significantly lower on the first day compared to after the first month in the Fazekas+ group (p < 0.05). CONCLUSIONS: Patients with ACS have transient impairment in cognitive functions. Acute coronary syndrome is not associated with structural changes in the brain.
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OBJECTIVE: Acute myocardial infarction constitutes one of the leading reasons for cardiac mortality. Therefore, early identification of high-risk patients provides better prognostic accuracy. This study aimed to investigate the prognostic significance of novel inflammatory biomarkers such as neutr ophil -to-l ympho cyte ratio, systemic immune-inflammation index, and prognostic nutritional index in acute myocardial infarction patients treated with percutaneous coronary intervention and to compare their predictive abilities with each other. METHODS: A total of 828 acute myocardial infarction patients treated with percutaneous coronary intervention were retrospectively analyzed. The inflammatory indices, such as neutr ophil-to-l ympho cyte ratio, systemic immune-inflammation index, and prognostic nutritional index, were calculated by admission blood tests. The study population was divided into 2 groups according to the occurrence of major adverse cardiac events, which were defined as all-cause mortality, non-fatal myocardial infarction, and cerebrovascular events. RESULTS: Multivariate Cox regression analysis determined prognostic nutritional index as an independent predictor of major adverse cardiac event and all-cause mortality (hazard ratio: 1.05, 95% CI: 1.02-1.07, P < .001 for major adverse cardiac event and hazard ratio: 1.05, 95% CI: 1.02-1.09, P = .002 for all-cause mortality). Receiver operating characteristic curves revealed that the predictive value of prognostic nutritional index with both regard to major adverse cardiac event and all-cause mortality was better than the systemic immune-inflammation index and neutr ophil -to-l ympho cyte ratio (by DeLong method, area under curvePNI vs. area under curveSII z test = 2.66, P = .008; area under curvePNI vs. area under curveNLR z test = 2.8, P = .006; area under curvePNI vs. area under curveSII z test = 2.58, P = .009; area under curvePNI vs. area under curveNLR z test = 3.28, P = .001; respectively). CONCLUSIONS: Prognostic nutritional index was demonstrated as an independent predictor of major adverse cardiac events and all-cause mortality and a more powerful prognostic index than other novel inflammatory biomarkers in acute myocardial infarction patients treated with percutaneous coronary intervention.
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Infarto del Miocardio , Intervención Coronaria Percutánea , Biomarcadores , Humanos , Inflamación , Evaluación Nutricional , Intervención Coronaria Percutánea/efectos adversos , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
OBJECTIVES: As the feasibility of obtaining health care has improved in the last decade, there is an increase in the number of performing unnecessary coronary angiogram. Red Cell Distribution Width (RDW), which shows erythrocyte dispersion volume, is associated with coronary artery disease. The present study aims to evaluate the relationship between RDW value and the severity of coronary artery disease in patients who undergo myocardial perfusion scintigraphy (MPS) as an evaluation for coronary ischemia and after which patients had a coronary angiography. METHODS: This retrospective study included 452 patients diagnosed as stabile angina that had MPS to evaluate coronary ischemia and after which coronary angiography was performed. Complete blood count was obtained on the same day. Patients were first divided into two groups: patients with and without ischemia on MPS. Then, the group who had ischemia on the MPS where divided into another two groups: patients who had RDW values ≥13.5 and the others who had RDW value <13.5. Patients who had fixed perfusion defect, chronic kidney disease, thyroid dysfunction, hematological disease, those who use iron supplements, and those who had active infectious disease were excluded from this study. RESULTS: The basic characteristics were the same between study groups. We found that severe coronary vessel disease, single vessel, two vessels and three vessels diseases were higher in patients who had ischemia on the MPS and RDW values ≥13.5 (p-value were 0.032, 0.004, 0.042 respectively). RDW values ≥13.5 was found to be an independent predictor for the presence of severe coronary artery disease (p<0.001 OR: 3.55). CONCLUSION: Patients who have MPS for ischemic evaluation and RDW values of ≥ 13.5 were more severe coronary heart diseases. As a result, the findings suggest that using of RDW value is a cheap and feasible parameter that may prevent performing unnecessary coronary angiography for patients after MPS.
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Although there are reviews and meta-analyses focusing on hematological indices for risk prediction of mortality in patients with ST segment elevation myocardial infarction (STEMI), there are not enough data with respect to direct to head-to-head comparison of their predictive values. We aimed to investigate which hematological indices have the most discriminatory capability for prediction of in-hospital and long-term mortality in a large STEMI cohort. We analyzed the data of 1186 patients with STEMI. In-hospital and long-term all-cause mortality was defined as the primary end point of the study. In-hospital mortality rate was 8.6% and long-term mortality rate 9.0%. Although the neutrophil to lymphocyte ratio (NLR) and age were found to be independent predictors of in-hospital mortality in the multivariate regression analyses; Cox regression analysis revealed that age, ejection fraction, red cell distribution width (RDW), and monocyte to high-density lipoprotein ratio (MHDLr) were independently associated with long-term mortality. Neutrophil to lymphocyte ratio had the highest area under curve value in the receiver operating characteristic curve analyses for prediction of in-hospital mortality. In conclusion, while NLR may be used for prediction of in-hospital mortality, RDW and MHDLr ratio are better hematological indices for long-term mortality prediction after STEMI than other most common indices.
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Pruebas Hematológicas , Mortalidad Hospitalaria , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Índices de Eritrocitos , Femenino , Humanos , Lipoproteínas HDL/sangre , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/sangre , Infarto del Miocardio con Elevación del ST/terapia , Factores de TiempoAsunto(s)
Ventrículos Cardíacos , Trombosis , Obstrucción del Flujo Ventricular Externo , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Humanos , Masculino , Persona de Mediana Edad , Trombosis/diagnóstico , Trombosis/patología , Trombosis/terapia , Ultrasonografía , Obstrucción del Flujo Ventricular Externo/diagnóstico , Obstrucción del Flujo Ventricular Externo/patología , Obstrucción del Flujo Ventricular Externo/terapiaRESUMEN
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity with an inflammatory etiopathogenesis. This study investigated the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients with MINOCA. Coronary angiographies performed between June 2015 and August 2018 were analyzed retrospectively and included 72 patients with MINOCA and 248 controls with normal coronary angiograms. The predictors of mortality were determined by univariate Cox regression analysis. The mean age of the subjects was 46 ± 9 years, and 176 (55%) were female. Median follow-up was 21 (max: 42) months. Neutrophil-to-lymphocyte ratio was significantly higher in the MINOCA group than in the controls (P < .01). During long-term follow-up, the number of deaths was 6 in the MINOCA group and none in the control patients (P < .01). Univariate Cox regression analysis revealed that the NLR (hazard ratio: 1.24, 95% confidence interval: 1.09-1.41, P = .001) was a predictor of mortality in patients with MINOCA. Kaplan-Meier analysis also showed that patients with MINOCA had relatively higher mortality rate (long-rank test; P < .01). In conclusion, the NLR is significantly higher in patients with MINOCA compared with controls, and it is a predictor of long-term mortality.
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Recuento de Linfocitos , Infarto del Miocardio/sangre , Infarto del Miocardio/mortalidad , Neutrófilos , Adulto , Angiografía Coronaria , Vasos Coronarios/patología , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Pronóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Tasa de SupervivenciaRESUMEN
OBJECTIVE: Many criteria have been developed to predict left ventricular hypertrophy using an electrocardiogram (ECG). However, one major common limitation of all has been their low sensitivity. Based on that, recently, a novel criterion has been proposed, which is believed to have higher sensitivity without a compromise in specificity. Therefore, in our study, we aimed to test this novel ECG criterion prospectively in large, unselected cardiac patients. METHODS: Patients who were referred to our echocardiography laboratory due to various etiologies were prospectively enrolled. The novel Peguero-Lo Presti criterion was assessed along with other established ECG criteria. The left ventricular mass index was calculated using echocardiography. The performance of each index was evaluated. RESULTS: Overall, 767 patients were enrolled in this study. The sensitivity and specificity of the Peguero-Lo Presti criterion were 17.5% and 94.5%, respectively. Although the highest sensitivity belonged to the Peguero-Lo Presti criterion, in ROC analysis, it showed modest predictive capability, which was similar to the established Cornell voltage criterion (AUC=0.64 [0.56-0.68 95% CI], p<0.01). CONCLUSION: Although this novel criterion had higher sensitivity, the overall performance was similar to the current indices. Further adjustments, particularly based on age and body mass index, may yield better results.
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OBJECTIVE: Sudden cardiac death (SCD) plays an important part in all-cause mortality in patients infected with human immunodeficiency virus (HIV). The T-peak to T-end (Tp-e) interval, corrected Tp-e (Tp-ec) interval, and Tp-e/QT ratio on the ECG are parameters used to stratify risk for SCD. The objective of this study was to investigate the differences between HIV-infected patients and healthy individuals in terms of Tp-e interval, Tp-ec interval, and Tp-e/QT ratio, as well as other influencing factors. METHODS: Ninety-eight HIV-infected patients and 62 healthy controls were included in this prospective case-control study. Tp-e interval, Tp-ec interval, and Tp-e/QT ratio were measured in all participants. Echocardiographic examination and routine laboratory analysis were performed. In addition, CD4 T-cell count and HIV RNA levels were assessed in HIV-infected patients. RESULTS: All baseline characteristics were comparable in both groups. The median survival of those living with HIV was 20.63 months; 53% of them had controlled viral load, and 74% were receiving antiretroviral therapy. Mean baseline CD4 T-cell count was 409. In HIV-infected patients, the Tp-e interval and Tp-ec interval were prolonged, and the Tp-e/QT ratio was higher (p<0.001, p<0.001 and p=0.021, respectively). In bivariate and partial correlation analyses, there was a negative correlation between CD4 T-cell level and Tp-e interval, Tp-ec interval, and Tp-e/QT ratio. CONCLUSION: Tp-e interval, Tp-ec interval, and Tp-e/QT ratio were greater in HIV-infected patients compared with healthy individuals. HIV-infected patients, particularly those with low baseline CD4 T-cell counts, should be closely monitored due to risk of SCD.
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Muerte Súbita Cardíaca/etiología , Electrocardiografía/estadística & datos numéricos , Infecciones por VIH/complicaciones , Sistema de Conducción Cardíaco/fisiopatología , Adulto , Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Recuento de Linfocito CD4/estadística & datos numéricos , Estudios de Casos y Controles , Ecocardiografía/métodos , Electrocardiografía/métodos , Femenino , VIH/genética , VIH/inmunología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/mortalidad , Infecciones por VIH/virología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Análisis de Supervivencia , Carga Viral/estadística & datos numéricosRESUMEN
OBJECTIVES: The effects of chronic renin-angiotensin-aldosterone system (RAAS) blockers usage on adverse outcomes and disease severity remain uncertain in COVID-19 patients with hypertension. In this study, we aimed to determine the relationship between chronic use of RAAS inhibitors and in-hospital adverse events among hypertensive patients hospitalized with COVID-19. METHODS: In this retrospective single-center study, we enrolled 349 consecutive hypertensive patients diagnosed with COVID-19 infection. All patients were chronically on angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin II receptor blockers (ARB) or other antihypertensive therapies before hospital admission. Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and intubation. RESULTS: Patients were categorized into two groups according to the type of antihypertensive therapy. (ACEI/ARBs users, N=201; ACEI/ARB nonusers, N=148) There was no statistically significant difference between ACEI/ARBs users and ACEI/ARBs nonusers concerning adverse clinical events, such as in-hospital mortality (29 (14.4%) vs. 20 (13.5%), p=0.81), ICU admission (45(22.4%) vs. 27 (18.2%), p=0.34), need for high-flow oxygen (97 (48.3%) vs. 68 (45.9%), p=0.67) and need for intubation (32(15.9%) vs. 23(15.5%), p=0.92), respectively. Also, the severity of infection did not differ among groups. The logistic regression multivariate analysis showed that age, neutrophil-lymphocyte ratio, procalcitonin and ferritin levels were independent predictors of in-hospital mortality. CONCLUSION: Our results suggest that chronic use of ACEI/ARBs did not increase in-hospital adverse outcomes of hypertensive patients hospitalized with COVID-19. Although the recent data are contradictory, chronic ACEI/ARB therapy is not recommended to be discontinued in hypertensive patients during their hospitalization for COVID-19.
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OBJECTIVE: The pathophysiology of the slow coronary flow (SCF) phenomenon is still unclear. The two most frequently cited mechanisms of SCF are endothelial dysfunction and subclinical diffuse atherosclerosis. The aim of this study was to investigate the relation of SCF to serum endocan levels which is associated with endothelial dysfunction and to serum omentin-I levels which is associated with atherosclerosis. METHODS: A total of 42 patients with SCF and 43 controls with normal coronary flow based on a coronary angiogram were enrolled. Serum endocan and omentin-I levels were measured and the presence of SCF was determined according to Thrombolysis in Myocardial Infarction frame count (TFC) calculations. RESULTS: The omentin-I level was significantly lower and the endocan level was significantly higher in patients with SCF than in the controls. Receiver operating characteristic curve analysis revealed that the sensitivity and specificity of endocan for SCF was 66% and 70%, respectively (area under the curve [AUC]: 0.760, 95% confidence interval [CI]: 0.65-0.86; p<0.001), and the comparable values for omentin were 66% and 61% (AUC: 0.630, 95% CI: 0.51-0.75; p=0.049). Multivariate logistic regression analysis revealed that a high endocan level (odds ratio [OR]: 6.8, 95% CI: 1.849-2.439, cutoff: 2.45 ng/mL; p=0.003) and a low omentin-I level (OR: 3.6, 95% CI: 1.057-12.893, cutoff: 4.63 ng/mL; p=0.041) were independently associated with the presence of SCF. In patients with SCF, the endocan level was positively correlated with the mean TFC, while the omentin-I level was negatively correlated (r=0.44; p<0.001 and r=-0.22; p=0.049, respectively). CONCLUSION: These results revealed that endocan and omentin-I might be useful biomarkers for predicting the presence and severity of SCF.
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Aterosclerosis/fisiopatología , Enfermedad de la Arteria Coronaria/fisiopatología , Circulación Coronaria/fisiología , Citocinas/sangre , Lectinas/sangre , Proteínas de Neoplasias/sangre , Proteoglicanos/sangre , Biomarcadores/sangre , Estudios de Casos y Controles , Angiografía Coronaria , Proteínas Ligadas a GPI/sangre , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: An association between ventricular repolarization parameters (VRPs) and ventricular arrhythmias has been demonstrated in previous studies. However, there are limited data related to a relationship between synthetic cannabinoids (SCs) and VRPs. The aim of this study was to analyze the acute effects of SCs on VRPs using electrocardiogram (ECG) measurements of the T-peak to T-end interval (Tp-e), Tp-e/QT ratio, and Tp-e/corrected QT (QTc) ratio. METHODS: The present study included 58 patients who were admitted to the emergency department who used SCs (SC +) between 2014 and 2016, and 50 healthy control subjects (SC -). The QT and QTc intervals, Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured from a 12-lead ECG. These parameters were compared between groups and correlation analysis was performed. RESULTS: The Tp-e and QTc intervals were significantly higher in SC + patients when compared with the SC- group (92.2±177;10.0, 77.4 ±177;9.3, p<0.001; 434.5±177;30.8, 410.9±177;27.3, p<0.001, respectively). Tp-e/QT and Tp-e/QTc ratios were greater in SC + patients in comparison with SC - participants (0.26±177;0.02, 0.22±177;0.02, p<0.001; 0.21±177;0.02, 0.18±177;0.02, p<0.001, respectively). Significant correlations were found between the use of SCs and the Tp-e interval (r=0.610; p<0.001), Tp-e/QT (r=0.655; p<0.001) and Tp-e/ QTc ratios (r=0.437; p<0.001). CONCLUSION: The Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were greater in subjects who used SCs. Therefore, SC users might have an increased risk of ventricular arrhythmia.
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Cannabinoides/efectos adversos , Electrocardiografía/efectos de los fármacos , Ventrículos Cardíacos , Drogas Ilícitas/efectos adversos , Estudios de Casos y Controles , Ventrículos Cardíacos/efectos de los fármacos , Ventrículos Cardíacos/fisiopatología , HumanosRESUMEN
The incidence of contrast-induced nephropathy (CIN) increases in the range from patients with unstable angina to ST-segment elevation myocardial infarction (STEMI). Platelet activation has been associated with pathophysiology of nephropathy and thrombus burden in the infarct-related arteries. We investigated the impact of thrombus burden on CIN in patients with STEMI. We enrolled 883 patients with STEMI who received primary percutaneous coronary intervention. Patients were divided into groups according to thrombus burden and CIN development. Thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades (TGs). Thrombus grade 4 was defined as large thrombus burden (LTB), while thrombus burden Asunto(s)
Lesión Renal Aguda/inducido químicamente
, Angiografía Coronaria/efectos adversos
, Trombosis Coronaria/complicaciones
, Intervención Coronaria Percutánea/efectos adversos
, Infarto del Miocardio con Elevación del ST/cirugía
, Lesión Renal Aguda/diagnóstico
, Adulto
, Anciano
, Trombosis Coronaria/diagnóstico por imagen
, Femenino
, Humanos
, Masculino
, Persona de Mediana Edad
, Valor Predictivo de las Pruebas
, Estudios Retrospectivos
, Medición de Riesgo
, Factores de Riesgo
, Infarto del Miocardio con Elevación del ST/diagnóstico por imagen
, Infarto del Miocardio con Elevación del ST/etiología
, Índice de Severidad de la Enfermedad
, Resultado del Tratamiento
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The pathophysiology of an early and accelerated atherosclerotic process is complex and multifactorial in HIV-infected men compared with HIV-non-infected men. Several biomarkers have been well studied in the detection of the early stage of atherosclerosis, but studies are limited in HIV-infected men. The objective of this study was to investigate the association between serum pregnancy-associated plasma protein-A (PAPP-A) and carotid intima-media wall thickness (CIMT) in asymptomatic HIV-infected men. This a case-control study group comprising 118 HIV-infected men and 60 age-matched and gender-matched HIV-non-infected men. Serum PAPP-A was measured using an ELISA kit and carotid IMT was evaluated by Doppler ultrasonography in all subjects. Statistical analysis included receiver-operating characteristic (ROC) analysis, Pearson correlation and logistic regression analysis. Serum PAPP-A level was significantly higher in HIV +CIMT+ group compared with HIV +CIMT group and HIV-CIMT- group. We found a positive correlation between PAPP-A and increased CIMT (r=0.737, p<0.0001), and a negative correlation between nadir CD4 T cell counts and increased CIMT (r=-0.526, p<0.001). In multivariate logistic regression analyses, PAPP-A, nadir CD4 T cell count and age were significantly associated with subclinical atherosclerosis (p<0.001, p=0.006 and p=0.032, respectively). In ROC analysis, PAPP-A levels of >3.70 µg/mL were associated with subclinical atherosclerosis in HIV+ men with a specificity of 100% and a sensitivity of 71% (area under the curve: 0.949, 95% CI 0.875 to 1.000, p<0.001). Serum PAPP-A level was strongly correlated with increased CIMT in HIV-infected men. PAPP-A might be used as an early biomarker to identify atherosclerosis in asymptomatic HIV-infected men.
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Aterosclerosis/complicaciones , Aterosclerosis/metabolismo , Infecciones por VIH/complicaciones , Infecciones por VIH/metabolismo , Proteína Plasmática A Asociada al Embarazo/metabolismo , Adulto , Aterosclerosis/patología , Grosor Intima-Media Carotídeo , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Curva ROCRESUMEN
OBJECTIVES: ST-segment elevation myocardial infarction (STEMI) complicated by respiratory failure is associated with a greater number of in-hospital and out-of-hospital adverse cardiovascular events (CVEs). The aim of this study was to analyze in-hospital outcomes and the factors affecting the outcomes of intubated patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (pPCI) at a single tertiary care center. METHODS: The data of 592 patients diagnosed with acute STEMI who were admitted to the emergency department between May 2017 and January 2019 and subsequently underwent pPCI were retrospectively reviewed. Cardiovascular risk factors as well as biochemical and angiographic characteristics of patients who were intubated in the emergency room or ambulance due to cardiac arrest and those who were not intubated were compared. Adverse CVEs were defined as in-hospital death, cerebrovascular stroke, and acute stent thrombosis. RESULTS: A total of 60 patients (70% male; mean age: 63.6±14.0 years) who were intubated and 532 non-intubated patients (81% male; mean age: 60.2±12.1 years) were included in the study. The angiographic features of the 2 groups were similar. An adverse CVE was experienced by 43.3% of the intubated patients and 3.6% of the non-intubated patients. Multivariate analysis indicated that age (odds ratio [OR]: 1.065; p<0.001), serum lactate level (OR: 1.308; p<0.001), and left ventricle ejection fraction (OR: 0.946; p<0.001) were independent predictors of in-hospital adverse CVE in the intubated patient group. CONCLUSION: The results of this single-center study showed that 1 in 10 patients hospitalized with STEMI were intubated, and approximately 4 in 10 intubated STEMI patients had an in-hospital CVE.
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OBJECTIVES: Apelin is a recently discovered peptide that is expressed in many tissues particularly in the cardiovascular system and exerts several actions, most of which are vasodilatory and positive inotropic effects. Based on this, an apelin deficiency is believed to play a significant role in the development of hypertension and heart failure. However, the association of apelin with the pathogenesis of atherosclerosis and especially plaque vulnerability remains unestablished. Thus, to contribute to the literature, in this study, we sought to determine the association of apelin concerning plaque vulnerability in the setting of the acute coronary syndrome. METHODS: In this study, we prospectively enrolled a total of 80 patients; 40 with acute coronary syndrome and 40 patients with stable chronic ischemic heart disease. Plasma apelin levels were measured in all patients along with other routine biochemical parameters, and all patients underwent a transthoracic echocardiographic examination. RESULTS: Plasma apelin levels were significantly lower in patients with the acute coronary syndrome (221.2±66.7 vs 254.3±77.9 p=0.04). However, there was no correlation between plasma apelin levels and serum inflammatory markers or coronary artery disease severity. CONCLUSION: Low plasma apelin levels may create a tendency towards vulnerable plaque and acute coronary syndrome.
RESUMEN
OBJECTIVE: Although the long-term prognosis of myopericarditis is good, recurrence continues to be a problem. In addition, there are concerns regarding the safety of the empirical use of anti-inflammatory drugs. This study was an investigation of the clinical outcomes of young patients with uncomplicated myopericarditis, the majority of whom received both nonsteroidal anti-inflammatory drugs and colchicine. METHODS: Patients aged 18 to 40 years who were admitted between May 2015 and May 2018 due to myopericarditis and had normal left ventricular function were included in the study. The primary outcome of the research was analysis of major adverse cardiac events (MACEs): all-cause mortality, myopericarditis recurrence, development of significant arrhythmia, heart failure, and cardiac tamponade. A total of 60 patients were included in the study. The median duration of follow-up was 19 months. RESULTS: A MACE occurred in 11.7% of the patients. None of the patients experienced heart failure, significant arrhythmia, cardiac tamponade, or all-cause mortality. Recurrence of myopericarditis was the only MACE observed. Most patients were treated with both nonsteroidal anti-inflammatory drugs and colchicine (96% and 95% of the patients, respectively). Univariate cox regression analysis indicated that only the maximum in-hospital C-reactive protein (CRP) level was associated with recurrence (hazard ratio: 1.01, 95% confidence interval: 1.01-1.02; p=0.04). CONCLUSION: The intermediate-term prognosis of myopericarditis patients was excellent in terms of mortality. However, recurrence remains a challenge. The role of CRP, particularly in recurrence, should be explored further.
Asunto(s)
Miocarditis/mortalidad , Adolescente , Adulto , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Biomarcadores , Proteína C-Reactiva/metabolismo , Colchicina/administración & dosificación , Colchicina/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Miocarditis/tratamiento farmacológico , Pronóstico , Recurrencia , Análisis de Regresión , Análisis de Supervivencia , Turquía , Adulto JovenRESUMEN
Iatrogenic acute dissection of the ascending aorta is a serious but rare complication of cardiac catheterization and percutaneous coronary intervention (PCI). Although treatment of ascending aortic dissection may require surgical repair, stenting at the origin of the dissection area may be sufficient in aortocoronary dissection (AD) following PCI. Described is the case of a 64-year-old female patient who was treated with PCI for a critical lesion of the right coronary artery (RCA). Immediate stenting at the source of the dissection was sufficient to repair the RCA lesions and successfully seal the site of retrograde propagation of the dissection. The ascending aortic dissection was monitored with computed tomography and the dissection was spontaneously repaired within 72 hours.