Bendopnea Predicts High SYNTAX Score in Patients With Coronary Artery Disease: A Bayesian Approach.

Coronary artery disease (CAD) is one of the major health problems worldwide. CAD severity, as calculated by SYNTAX score (SS), is associated with higher morbidity and mortality. A new symptom of shortness of breath within 30 s while bending forward is described as bendopnea and is related to elevated cardiac filling pressure. It is also known that a high SS is associated with left ventricular (LV) dysfunction which leads to higher LV filling pressure. We aimed to investigate whether there was an association between bendopnea and high SS in CAD patients. A high SS was defined ≥22. Of 374 stable angina pectoris patients, 238 (64%) patients had bendopnea and 136 (36%) patients had no bendopnea in this study. The bendopnea (+) group had higher SS and Gensini scores than the bendopnea (-) group (posterior probabilities >0.999 and 0.995, respectively). The presence of bendopnea was independently associated with a higher SS (odds ratio [OR] = 3.82, 95% credible intervals [CrI] = 1.93-8.17). When different priors were used in the context of meta-analysis, there was only 18% heterogeneity among the results, indicating that the results of our study were robust. This is the first study to report that bendopnea was independently associated with CAD severity.

Predictive Ability of Inflammatory Markers on In-Hospital Outcomes in Patients Admitted to Coronary Care Unit (MORCOR-TURK INFLAME).

We investigated the prognostic implications of the systemic immune-inflammatory index (SII), atherogenic index of plasma (AIP), C-reactive protein/albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and triglyceride/glucose index (TGI) in the MORtality predictors in the CORonary Care Units in TURKey (MORCOR-TURK) population. This is the largest registry of coronary care unit (CCU) patients in Turkey (3157 patients admitted to CCU in 50 different centers). The study population was divided into two according to in-hospital survival status; 137 patients (4.3%) died in-hospital follow-up. A significant correlation was found between death and SII, CAR, NLR, and PNI but not for AIP and TGI in logistic regression. In Model 1 (combining parameters proven to be risk predictors), the -2 log-likelihood ratio was 888.439, Nagelkerke R2 was 0.235, and AUC (area under curve) was 0.814 (95% CI: 0.771-0.858). All other models were constructed by adding each inflammatory marker separately to Model 1. Only Model 3 (CAR + Model 1) had a significantly greater AUC than Model 1 (DeLong P = .01). Our study showed that CAR, but not other inflammatory index, is a significant predictor of in-hospital mortality in CCU patients when added to proven risk predictors.

Baseline Characteristics of a Patient Cohort and Predictors of In-hospital MORtality in CORonary Care Units (MORCOR-TURK) Trial in Türkiye.

OBJECTIVE: The MORtality in CORonary Care Units in Türkiye (MORCOR-TURK) trial is a national registry evaluating predictors and rates of in-hospital mortality in coronary care unit (CCU) patients in Türkiye. This report describes the baseline demographic characteristics of patients recruited for the MORCOR-TURK trial. METHODS: The study is a multicenter, cross-sectional, prospective national registry that included 50 centers capable of 24-hour CCU service, selected from all seven geographic regions of Türkiye. All consecutive patients admitted to CCUs with cardiovascular emergencies between September 1-30, 2022, were prospectively enrolled. Baseline demographic characteristics, admission diagnoses, laboratory data, and cardiovascular risk factors were recorded. RESULTS: A total of 3,157 patients with a mean age of 65 years (range: 56-73) and 2,087 (66.1%) males were included in the analysis. Patients with arterial hypertension [1,864 patients (59%)], diabetes mellitus (DM) [1,184 (37.5%)], hyperlipidemia [1,120 (35.5%)], and smoking [1,093 (34.6%)] were noted. Non-ST elevation myocardial infarction (NSTEMI) was the leading cause of admission [1,187 patients (37.6%)], followed by ST elevation myocardial infarction (STEMI) in 742 patients (23.5%). Other frequent diagnoses included decompensated heart failure (HF) [339 patients (10.7%)] and arrhythmia [272 patients (8.6%)], respectively. Atrial fibrillation (AF) was the most common pathological rhythm [442 patients (14%)], and chest pain was the most common primary complaint [2,173 patients (68.8%)]. CONCLUSION: The most common admission diagnosis was acute coronary syndrome (ACS), particularly NSTEMI. Hypertension and DM were found to be the two leading risk factors, and AF was the most commonly seen pathological rhythm in all hospitalized patients. These findings may be useful in understanding the characteristics of patients admitted to CCUs and thus in taking precautions to decrease CCU admissions.

A novel method that can be used in both the diagnosis and treatment of peripheral arterial disease in diabetics: vibration-mediated dilation.

OBJECTIVE: The growing incidence of diabetes and the increasing life expectancy of the diabetic population worldwide has increased the number of diabetic vascular complications occurring in cardiology practice. As current treatment and prevention methods are less effective in this patient group, there is a need for new treatment methods in this area. Exercise, which reduces metabolic and vascular problems associated with diabetes, often becomes impossible, especially in advanced-stage patients who need exercise the most. Since exercise and flow-mediated dilation (FMD) are effective by stimulating mechanotransduction mechanisms on the endothelium, it can be expected that the same mechanisms could also be stimulated by direct vibration. METHODS: In order to test this hypothesis, in this study, a group of 20 type 2 diabetes patients (11 males, age 56.80 ± 11.05 years and diagnosed for 15.35 ± 8.61 years) were examined via the application of FMD and vibration-mediated dilation (VMD). We performed vibration for five minutes with 20-Hz frequency and 3-mm vertical amplitude, to the same side forearm, with a 30-minute interval. Using a 10-MHz linear echo probe, brachial artery diameter and flow velocities were recorded for 10 minutes before and at two-minute intervals after the FMD and VMD applications. Then brachial artery flow and resistance were calculated at each stage. RESULTS: In the first minute after FMD and VMD applications, brachial artery diameter and flow velocities increased significantly, and vascular resistance decreased significantly. None of the corresponding FMD or VMD parameters in the first minute was different. The artery diameters in the first minute after FMD and VMD were increased by 6.04 ± 5.29 and 5.49 ± 5.21%, respectively. At the tenth minute, these values decreased to 1.73 ± 3.21 and 2.05 ± 3.31%. In the FMD series, all parameters except brachial artery diameter returned to their baseline values after the fourth minute. After VMD, all parameters also decreased after the first minute, but the recovery was much slower. At each stage after the first minute, the VMD averages were higher than the baseline value and their corresponding FMD values. CONCLUSION: The results of this study indicated that vibration may be a powerful, long-lasting and feasible treatment option in patients with peripheral perfusion failure, developed due to diabetic macro- and microvascular complications.

Fragmented QRS in inferior leads is associated with non-alcholic fatty liver disease, body-mass index, and interventricular septum thickness in young men.

OBJECTIVE: Fragmented QRS (fQRS) has been shown to be related to coronary heart disease, heart failure, hypertension, cardiac arrhythmia, and metabolic syndrome. Although fQRS in lateral leads is shown to be associated with a poor outcome in patients with a known cardiac disease, the knowledge about the significance and prevalence of fQRS in inferior leads is scarce. This study aimed to investigate the prevalence and predictors of fQRS in inferior leads in healthy young men. METHODS: A total of 1,155 men underwent electrocardiography (ECG), hepatic ultrasonography, and routine biochemical tests. A total of 210 eligible men with fQRS in inferior leads (group 1) and 770 eligible men without fQRS in inferior leads (group 2) were compared with each other in terms of clinical, demographic, and laboratory parameters. RESULTS: The prevalence of fQRS in inferior leads was found to 21.4%. Body mass index (BMI), systolic blood pressure (BP), creatinine, and alanine aminotransferase levels; non-alcoholic fatty liver disease (NAFLD) percentage; and interventricular septum thickness (IVST) were significantly greater in group 1 than those in group 2. BMI, IVST, NAFLD, creatinine, ALT, and systolic BP were entered in a model of multiple regression analyses to predict fQRS, a dependent variable. NAFLD was the best independent predictor of fQRS (ß=6.115, p=0.001). BMI (ß=1.448, p=0.014) and IVST (ß=1.058, p=0.029) were the other independent predictors of fQRS in inferior leads. CONCLUSION: This study demonstrated the association of fQRS in inferior leads with NAFLD, BMI, and IVST in young men.