Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia

Abstract Background: Coronary artery ectasia (CAE) is defined by focal enlargement of the coronary artery exceeding 1.5 times the adjacent normal segment. CAE can often cause arrhythmias, heart failure, sudden death, and myocardial ischemia. Ischemia due to microvascular dysfunction may be responsible for the ventricular heterogeneity in CAE. Objectives: The aim of our study was to evaluate the frontal QRS-T angle in patients with CAE. Methods: Our study included 55 patients with CAE and 50 individuals in the control group. Demographic characteristics and electrocardiographic parameters were compared between the two groups. Categorical variables were compared using the chi-square test. Continuous variables were compared using unpaired Student's t-test. P values < 0.05 were considered statistically significant. The frontal QRS-T angle was calculated from 12-lead electrocardiograms (ECGs) using the automatic report from the electrocardiography machine. Results: The average age of patients with CAE was 63.2 ± 3.4 years, with 18 women among them. The control group had an average age of 61.1 ± 3.2 years, with 28 women included. There was no significant difference in demographic parameters between the two groups. Compared to the control group, patients with CAE had significantly wider frontal QRS-T angle (p < 0.001), as well as longer QTmax duration, p = 0.002; Tp-Te interval, p = 0.02; and QT dispersion (QTd), p = 0.04. Conclusion: The frontal QRS-T angle can be calculated easily and time-efficiently using surface electrocardiography. In this study, we showed for the first time that the frontal QRS-T angle was significantly increased in patients with CAE.

The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome.

BACKGROUND: The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited. OBJECTIVE: This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS. METHODS: This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI). RESULTS: The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02-5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45-0.63), p < 0.001], and age > 74 years [OR (95 % CI), 1.03 (1.01-1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61-3.95), p < 0.001] and risk categories [OR (95 % CI), 3.06 (1.69-5.52), p < 0.001]. Comparison of c-indexes for major bleeding events revealed a non-significant difference for the discriminative ability of the two tested scores (p = 0.07) with a continuous NRI of 6.6 % (p = 0.026) and an IDI of 4.2 % (p < 0.001). CONCLUSION: In ACS patients, the ORBIT score independently predicted major bleeding.

Predictors of adequate intraprocedural premature ventricular complex (PVC) frequency during idiopathic PVC ablation.

BACKGROUND: The aim of the present study was to determine the predictors of adequate intraprocedural premature ventricular complex (PVC) frequency for successful mapping and ablation of idiopathic PVCs. METHODS: A total of 101 consecutive patients (45 men; age: 47.9 ± 14.2 years) who had undergone idiopathic PVC ablation between 01 November 2018 and 24 June 2020 constituted our study population. Clinical and demographic data, procedural details and 24 h rhythm recordings that had been recorded before the procedure were retrospectively evaluated. Total PVC burden and diurnal variability assessed by the ratio of night time (22:00-06:00) over day time (06:00-22:00) PVC burden was calculated. The relationship between hourly PVC number and heart rate was also evaluated for each patient. Clinical characteristics and Holter parameters were compared between groups with and without adequate intraprocedural frequency of PVCs that permitted activation mapping. RESULTS: In all, 27 patients (26.7%) had infrequent intraprocedural PVCs which necessitated isoproterenol infusion or cancellation of ablation procedure due to inability of activation mapping. PVC burden was significantly higher in the group with frequent intraprocedural PVCs (26.1 ± 9.4% vs 21.2 ± 10.3%; p: 0.026). There were no significant differences between groups regarding the relationship between hourly PVC number and heart rate or the ratio of night/day PVC burden. Binary logistic regression analysis revealed the 24 h Holter PVC burden as the sole parameter that is significant predictor of frequent intraprocedural PVCs permitting activation mapping. CONCLUSION: The 24 h PVC burden was the only predictor of adequate intraprocedural PVC frequency permitting activation mapping during idiopathic PVC ablation.

Fluoroscopy time and scattered radiation during electrophysiology procedures: analysis of one-year data of a laboratory providing electrophysiology training.

OBJECTIVES: Patients and medical staff expose to significant radiation during electro-physiological (EP) procedures. There are few data regarding the leading factors of longer fluoroscopy time and higher scattered radiation in a laboratory giving EP training during those interventions. MATERIAL AND METHODS: The patients' recordings that underwent EP procedure in a single centre arrhythmia unit from February 2019 to January 2020 were examined. Prospectively collected data regarding procedure duration, fluoroscopy time and total air kerma, demographic characteristics of the patients, type of procedure, success of ablation and the use of electro anatomic mapping were retrospectively evaluated. Predictors of total air kerma were analysed with linear regression analysis. RESULTS: Study population consisted of 437 patients with a median age of 47 (39-56); 184 (42.1%) were male. Median fluoroscopy time was 768 (420-1320) seconds and median cumulative air kerma was 369 (191-750) mGy. Fluoroscopy time and cumulative air kerma were significantly lower in diagnostic EP studies compared to other procedures. There was no difference in terms of total air kerma between the procedures other than the diagnostic EP study. In multivariable linear regression analysis; body surface area, fluoroscopy time, not using the electro-anatomical mapping, unsuccessful ablation and atrial flutter ablation were predictors of total air kerma in EP studies performed by trainees. CONCLUSION: Scattered radiation during EP procedures performed by in-training operators is related with some factors. Awareness about those may help to effort reducing the harmful effect of ionising radiation.

Catheter-induced premature ventricular complexes (PVCs) may aid in the determination of optimal timing for clinical PVC ablation.

BACKGROUND: The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs. METHODS: Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 1 July 2018 and 1 July 2019 constituted our study population. The time interval between the beginning of the EGM and the beginning of the QRS of each catheter-induced PVC (Cath EGM-ECG) and the time interval between the beginning of the EGM of clinical PVCs at the earliest site and the beginning of the QRS of clinical PVCs (PVC earliest EGM-ECG) were noted for each patient. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG. RESULTS: Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG. A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population. CONCLUSION: Cath EGM-ECG seems to serve as a reliable guide for finding the optimal timing of the earliest site for successful PVC ablation.

Serum Levels of IL-17 and IL-23 in Patients With Rheumatic Mitral Stenosis.

Rheumatic mitral valve stenosis (RMS) is a complication of rheumatic heart disease (RHD) and leads to significant morbidity and mortality. RHD is a chronic inflammatory and autoimmune disease that is associated with cytokine activities. The etiology of RMS is not fully understood yet. Interleukin (IL)-17 and IL-23 have a key role in development of the autoimmunity. The expression of these cytokines in RMS remains unclear. In this study, we investigated the serum levels of IL-17 and IL-23 in RMS patients compared to healthy subjects.A total of 35 patients admitted to cardiology outpatient clinic between December 2014 and May 2015 who were diagnosed with RMS formed the study group. Age- and gender-matched 35 healthy subjects were included as the control group. Statistical analyses were performed using SPSS 18.0 and P value <0.05 was considered as statistically significant.The patients with RMS had higher WBC count, hsCRP, systolic pulmonary artery pressure (PAPs), left atrial diameter (LAD), IL-17, and IL-23 levels compared to the control subjects. The levels of IL-17 (P = 0.012) and IL-23 (P = 0.004) were significantly higher in the RMS group. Correlation analysis revealed that IL-17 and IL-23 levels had a significant correlation with each other and with hsCRP and LAD.We demonstrated that serum levels of IL-17 and IL-23 are significantly higher in patients with RMS compared to those of healthy subjects. IL-17 and IL-23 expression may have a possible role in inflammatory processes that result in RMS development.

Peripartum cardiomyopathy in Turkey: Experience of three tertiary centres.

We conducted this study to determine demographic details, and clinical presentations in patients with peripartum cardiomyopathy (PPCMP) of Turkish origin. The study population consisted of 58 patients with PPCMP treated at 3 major hospitals in Turkey, retrospectively. In this study, demographic details and initial echocardiographic data were recorded and long-term clinical status was evaluated. The mean age for the patient cohort was 31.47 ± 6.31 years. Thirty-eight patients (73.1%) were multigravida and seven patients had multifetal pregnancy (13.7%). The mean follow-up left ventricular (LV) ejection fraction increased from 31 ± 7 to 38 ± 19. A minority of patients were defined as improvers according to our pre-specified criteria. The average survival period after diagnosis of PPCMP was 20.66 ± 14.44 months. Initial values for LV end-diastolic diameter and urea were higher in the deceased patients compared with the surviving patients, respectively. Twenty-eight (48%) patients with PPCMP showed improvement in the follow-up period. Of the 58 PPCMP patients, 9 (15%) died during a mean follow-up of 32 ± 22 months.

Clinical Characteristics and Outcome of Cardiovascular Implantable Electronic Device Infections in Turkey.

Infection is one of the most devastating outcomes of cardiovascular implantable electronic device (CIED) implantation and is related to significant morbidity and mortality. In our country, there is no evaluation about CIED infection. Therefore, our aim was to investigate clinical characteristics and outcome of patients who had infection related to CIED implantation or replacement. The study included 144 consecutive patients with CIED infection treated at 11 major hospitals in Turkey from 2005 to 2014 retrospectively. We analyzed the medical files of all patients hospitalized with the diagnosis of CIED infection. Inclusion criteria were definite infection related to CIED implantation, replacement, or revision. Generator pocket infection, with or without bacteremia, was the most common clinical presentation, followed by CIED-related endocarditis. Coagulase-negative staphylococci and Staphylococcus aureus were the leading causative agents of CIED infection. Multivariate analysis showed that infective endocarditis and ejection fraction were the strongest predictors of in-hospital mortality.

Relationship between platelet-to-lymphocyte ratio and coronary slow flow.

OBJECTIVE: The coronary slow flow phenomenon (CSFP), which is characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease, is an angiographic finding. The aim of this study is to investigate the association between platelet-to-lymphocyte ratio (PLR) and coronary blood flow rate. METHODS: This is a retrospective observational study. It was based on two medical centers. A total of 197 patients undergoing coronary angiography were included in the study, 95 of whom were patients with coronary slow flow without stenosis in coronary angiography and 102 of whom had normal coronary arteries and normal flow. RESULTS: The PLR was higher in the coronary slow flow group compared with the control groups (p=0.001). In the correlation analysis, PLR showed a significant correlation with left anterior descending (LAD) artery thrombolysis in myocardial infarction (TIMI) frame count. After multiple logistic regression, high levels of PLR were independently associated with coronary slow flow, together with hemoglobin. CONCLUSION: PLR was higher in patients with CSFP, and we also showed that PLR was significantly and independently associated with CSFP.

[Assessment of right ventricular systolic function in patients with chronic renal failure before and after hemodialysis by means of various echocardiographic modalities]. / Kronik böbrek yetersizligi olan hastalarda hemodiyaliz öncesi ve sonrasi sag ventrikül sistolik fonksiyonlarinin farkli ekokardiyografi yöntemleri ile degerlendirilmesi.

OBJECTIVES: The goal of the study was to determine the effect of decreased preload on right ventricular systolic function, as measured by new and old echocardiographic parameters in chronic renal failure (CRF) patients. STUDY DESIGN: A total of 30 CRF patients (mean age 48±15 years, 11 male and 19 female) undergoing hemodialysis were included in the study. Echocardiography was used to determine left ventricular ejection fraction (LVEF), left atrial volume, right atrial area, right ventricular end-diastolic area, systolic pulmonary artery pressure, right ventricular fractional area change (RV FAC), right ventricular myocardial performance index (Tei index), right ventricular tissue Doppler S' (RV S') velocity, isovolumic myocardial acceleration (IVA), tricuspid annular plane systolic excursion (TAPSE) and right ventricular outflow tract systolic excursion (RVOT SE) before and after hemodialysis. RESULTS: The RV S' velocity and RVOT SE parameters, which are indicators of right ventricular systolic function, did not change significantly after hemodialysis (p=0.919, p=0.186). However, the RV FAC, Tei index, IVA and TAPSE values were significantly increased (p<0.001 for all). TAPSE was found to be the only parameter that had a positive correlation with the amount of fluid removed (p=0.041 and r=0.375). CONCLUSION: Although RV S' velocity and RVOT SE, was found to be independent of preload, RV FAC, Tei index, IVA and TAPSE values were dependent on preload. In addition, TAPSE correlated with the amount of fluid removed.

[Cardiac device related infective endocarditis; analysis of 15 cases]. / Kardiyak cihazlara bagli olarak gelisen enfektif endokardit; 15 olgunun analizi.

OBJECTIVES: We aimed to investigate the demographic and clinical characteristics, echocardiographic and microbiologic features, and outcomes of patients with permanent pacemaker (PM) and implantable cardioverter-defibrillator (ICD) endocarditis in this study. STUDY DESIGN: The study population consisted of 15 patients with permanent PM and ICD endocarditis. Data on demographics, medications, clinical procedures, microbiology, echocardiography, surgery, and outcome were collected. RESULTS: The mean age of the patients was 57 ± 16. Seven patients (47%) were female. Of the 15 permanent PM and ICD endocarditis patients, 5 died during hospital follow-up (33%). Four patients (27%) experienced a pulmonary embolism. Culture-negative endocarditis was seen in 5 cases (33%). Staphylococci were the most common causative organisms (60%). Three patients had undergone surgical treatment (20%). CONCLUSION: Cardiac device-related endocarditis remain a rare but potentially fatal complication of device implantation.