A new and easy parameter to predict the requirement for permanent pacemaker implantation after transaortic valve implantation: aortic knob calcification.

Introduction: One of the predictable and preventable complications that may occur after transaortic valve implantation (TAVI) is the requirement for permanent pacemaker (PPM) implantation. Aim: To evaluate the relationship between aortic knob calcification (AKC) assessed by preoperative chest X-ray and the requirement for post-procedure PPM implantation for patients who underwent TAVI. Material and methods: This study was conducted with 110 patients who underwent TAVI with a Myval transcatheter heart valve in our center between June 2020 and December 2022. The patients' electrocardiograms were monitored after the procedure. The patients were evaluated in two groups according to whether they required PPM. The AKC grading was performed by examining the routine posterior-anterior chest radiographs of all patients participating in the study. Results: A PPM was placed in 17 (15.4%) patients after TAVI. The remaining 93 patients formed the control group. AKC (p = 0.002) and membranous septum (p = 0.013) statistically significantly differed between the PPM and control groups; however, no significant difference was detected in relation to the other parameters. In the univariable (p = 0.004) and multivariable (p = 0.024) regression analyses performed to identify predictors of PPM requirement after TAVI, AKC was found to be both a dependent and independent predictor. Conclusions: AKC can be used as a cost-effective and easily accessible parameter for predicting the post-procedure PPM requirement in patients who have undergone TAVI.

The relationship between QRS-T angle and left ventricular global longitudinal strain in prehypertensive patients.

BACKGROUND AND AIM: This study aims to examine the relationship between the QRS-T angle (QRS-Ta) detected on electrocardiography and left ventricular global longitudinal strain (LV-GLS) calculated on echocardiography in prehypertensive patients. MATERIALS AND METHODS: A total of 300 patients were included in our study, and the median value of QRS-Ta of the entire population was 27.The patients were divided into two groups (supramedian 148 patients, inframedian 152 patients) according to the median value. Statistical analysis was performed between the two groups. RESULTS: LV-GLS was lower in the supramedian QRS-Ta group [20 (16-26) vs. 21 (16-27); p < 0.001]. A statistical difference was found between the two groups in age (p < 0.001), BMI (p < 0.001), Hs-troponin I (p < 0.001), aortic velocity (p = 0.023) and TAPSE (p = 0.005) parameters except for LV-GLS.The correlation between QRS-Ta and LV-GLS was determined by Spearman's correlation test (p < 0.001).In the multivariable logistic regression analysis model, LV-GLS (OR: 0.365, 95%CI 0.171-0.780, p = 0.009) was one of the independent predictors for increased QRS-Ta. Others were determined as age (p < 0.001) and TAPSE (p = 0.015). CONCLUSIONS: In this study, a strong relationship was found between QRS-Ta, which is easily calculated by ECG, and LV-GLS, which is an advanced echocardiographic examination, in prehypertensive patients.

Can HALP score predict post-contrast acute kidney injury and 6-year mortality in patients undergoing endovascular abdominal aneurysm repair?

BACKGROUND: The aim of this study is to investigate the relationship between HALP score and post-contrast acute kidney injury (PC-AKI) and average 6-year mortality in patients undergoing endovascular abdominal aortic aneurysm repair (EVAR). METHODS: 125 patients who underwent EVAR between January 2015 and December 2020 were included in our study. HALP score was calculated with the formula "hemoglobin × albumin × lymphocyte count/platelet count." In the first phase of the study, two groups were developed: those who developed PC-AKI and those who did not. In the second stage, statistical analysis was performed by creating two groups: average 6-year mortality and survivors group. RESULTS: HALP score was found to be lower in the PC-AKI group [26.12 (14-61.54) versus 40.53 (7.22-103.61); p < .001]. Low HALP score was found to be both a dependent and independent predictor of the development of PC-AKI (p = .019). HALP score was also found to be lower in the mortality group compared to the survivors [28.97 (12.6-103.61) versus 40.81 (7.22-99) p = .004]. Low HALP score was found to be only a dependent predictor of mortality. The development of PC-AKI was found to be an independent predictor of mortality (p = .042). CONCLUSIONS: The HALP score, which can be calculated with a simple formula, can be used to predict PC-AKI and medium-long-term mortality in EVAR patients.

Delayed Aortic Dissection after Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) offers functional improvement for high-risk patients with aortic stenosis. Vascular complications after TAVI are known to occur frequently. Among them, aortic dissection is a rare but life-threatening vascular complication. We present a case of delayed aortic dissection following a successful TAVI.

Non-Alcoholic Fatty Pancreas Disease is Associated with SYNTAX Score in Acute Coronary Syndrome.

Background: Evidence that individuals with excess fat in the pancreas have an increased risk of cardiovascular disease has been growing recently. Risk evaluation in acute coronary syndrome (ACS) patients plays a crucial role for both prognosis prediction and decision-making. Aim: The main aim of this study was to investigate the relationship between non-alcoholic fatty pancreas disease (NAFPD) and the complexity and severity of coronary artery disease as assessed using the SYNTAX score (SXscore) in ACS patients. Methods: A total of 99 consecutive patients with a first-time diagnosis of ACS were recruited. NAFPD was evaluated using transabdominal ultrasonography (TUS). SXscore was calculated using the SXscore algorithm. Results: The patients with NAFPD had a significantly higher SXscore than those without NAFPD (12.3 ± 6.4 and 8.2 ± 4.3, p < 0.001). Univariable analysis showed that hypertension (p = 0.033) and presence of NAFPD (p = 0.001) were associated with increased SXscore. Moreover, multivariable analysis showed that the presence of NAFPD (p = 0.002) was associated with increased SXscore. Conclusions: NAFPD is easily detected by TUS. The presence of NAFPD in ACS patients may be a warning signal of complexity and severity of coronary artery disease.

Abnormal Circadian Blood Pressure Variation is Associated with SYNTAX Scores in Hospitalized Patients with Acute Coronary Syndrome. / A Variação Anormal da Pressão Arterial Circadiana está Associada aos Escores SYNTAX em Pacientes Hospitalizados com Síndrome Coronariana Aguda.

BACKGROUND: Blunted nocturnal blood pressure (BP) reduction, referred to as non-dipper hypertension, is a strong predictor of cardiovascular morbidity and mortality. OBJECTIVES: This study aimed to investigate the relationship between non-dipper hypertension and the severity and complexity of coronary artery disease using SYNTAX score in hospitalized patients with acute coronary syndrome. METHODS: A total of 306 consecutive patients with acute coronary syndrome were screened. Patients who were clinically stable and admitted to the intermediate intensive care unit at least 24 hours after angiography and/or successful revascularization. After the exclusion criteria, 141 patients (34 female and 107 male; mean age 61 ± 11 years) were included. Non-dipper hypertension has been defined as a 0% to 10% decrease in average systolic BP at nighttime compared to daytime, measured at hourly intervals using the same automatic BP measuring device on bedside monitors (Vismo PVM-2701; Nihon Kohden Corp., Tokyo, Japan). SYNTAX score was calculated with an online calculator. The independent predictors of SYNTAX score were assessed using multivariable logistic regression analysis. P < 0.05 was considered statistically significant. RESULTS: The patients with non-dipper hypertension had higher SYNTAX score than the patients with dipper hypertension (11.12 ± 6.41 versus 6.74 ± 6.45, p < 0.0001). In a multivariable logistic regression model, non-dipper hypertension status (odds ratio: 5.159; 95% confidence interval: 2.246 to 11.852, p < 0.001), sex (p = 0.012) and low-density lipoprotein cholesterol (p = 0.008) emerged as independent predictors of high SYNTAX score. CONCLUSIONS: The results of our study provide a possible additional mechanism linking abnormal circadian BP profile with coronary artery disease severity and complexity in patients with acute coronary syndrome.

FUNDAMENTO: Menor redução da pressão arterial (PA) noturna, conhecida como hipertensão não-dipper, é um forte preditor de morbimortalidade cardiovascular. OBJETIVOS: Este estudo visou investigar a relação entre a hipertensão não-dipper e a gravidade e complexidade da doença arterial coronariana usando o escore SYNTAX em pacientes hospitalizados com síndrome coronariana aguda. MÉTODOS: Foram selecionados 306 pacientes consecutivos com síndrome coronariana aguda. Pacientes clinicamente estáveis internados na unidade de terapia intensiva intermediária pelo menos 24 horas após a angiografia e/ou revascularização bem sucedida. Após os critérios de exclusão, foram incluídos 141 pacientes (34 mulheres e 107 homens; idade média 61 ± 11 anos). A hipertensão não-dipper foi definida como uma queda de 0% a 10% na PA sistólica média durante a noite em comparação com o dia, medida em intervalos de 1 hora, usando o mesmo dispositivo automático de medição de PA em monitores de beira de leito (Vismo PVM-2701; Nihon Kohden Corp., Tóquio, Japão). O escore SYNTAX foi calculado com uma calculadora online. Os preditores independentes do escore SYNTAX foram avaliados por meio de análise de regressão logística multivariada. P < 0,05 foi considerado estatisticamente significativo. RESULTADOS: Os pacientes com hipertensão não-dipper apresentaram escore SYNTAX maior do que os pacientes com hipertensão dipper (11,12 ± 6,41 versus 6,74 ± 6,45, p < 0,0001). Em um modelo de regressão logística multivariável, o status de hipertensão não dipper (odds ratio: 5,159; intervalo de confiança de 95%: 2,246 a 11,852, p < 0,001), sexo (p = 0,012) e colesterol de lipoproteína de baixa densidade (p = 0,008) emergiram como preditores independentes de alto escore SYNTAX. CONCLUSÕES: Os resultados do nosso estudo fornecem um possível mecanismo adicional ligando o perfil anormal da PA circadiana à gravidade e à complexidade da doença arterial coronariana em pacientes com síndrome coronariana aguda.

A Variação Anormal da Pressão Arterial Circadiana está Associada aos Escores SYNTAX em Pacientes Hospitalizados com Síndrome Coronariana Aguda / Abnormal Circadian Blood Pressure Variation is Associated with SYNTAX Scores in Hospitalized Patients with Acute Coronary Syndrome

Resumo Fundamento Menor redução da pressão arterial (PA) noturna, conhecida como hipertensão não-dipper, é um forte preditor de morbimortalidade cardiovascular. Objetivos Este estudo visou investigar a relação entre a hipertensão não-dipper e a gravidade e complexidade da doença arterial coronariana usando o escore SYNTAX em pacientes hospitalizados com síndrome coronariana aguda. Métodos Foram selecionados 306 pacientes consecutivos com síndrome coronariana aguda. Pacientes clinicamente estáveis internados na unidade de terapia intensiva intermediária pelo menos 24 horas após a angiografia e/ou revascularização bem sucedida. Após os critérios de exclusão, foram incluídos 141 pacientes (34 mulheres e 107 homens; idade média 61 ± 11 anos). A hipertensão não-dipper foi definida como uma queda de 0% a 10% na PA sistólica média durante a noite em comparação com o dia, medida em intervalos de 1 hora, usando o mesmo dispositivo automático de medição de PA em monitores de beira de leito (Vismo PVM-2701; Nihon Kohden Corp., Tóquio, Japão). O escore SYNTAX foi calculado com uma calculadora online. Os preditores independentes do escore SYNTAX foram avaliados por meio de análise de regressão logística multivariada. P < 0,05 foi considerado estatisticamente significativo. Resultados Os pacientes com hipertensão não-dipper apresentaram escore SYNTAX maior do que os pacientes com hipertensão dipper (11,12 ± 6,41 versus 6,74 ± 6,45, p < 0,0001). Em um modelo de regressão logística multivariável, o status de hipertensão não dipper (odds ratio: 5,159; intervalo de confiança de 95%: 2,246 a 11,852, p < 0,001), sexo (p = 0,012) e colesterol de lipoproteína de baixa densidade (p = 0,008) emergiram como preditores independentes de alto escore SYNTAX. Conclusões Os resultados do nosso estudo fornecem um possível mecanismo adicional ligando o perfil anormal da PA circadiana à gravidade e à complexidade da doença arterial coronariana em pacientes com síndrome coronariana aguda.

Abstract Background Blunted nocturnal blood pressure (BP) reduction, referred to as non-dipper hypertension, is a strong predictor of cardiovascular morbidity and mortality. Objectives This study aimed to investigate the relationship between non-dipper hypertension and the severity and complexity of coronary artery disease using SYNTAX score in hospitalized patients with acute coronary syndrome. Methods A total of 306 consecutive patients with acute coronary syndrome were screened. Patients who were clinically stable and admitted to the intermediate intensive care unit at least 24 hours after angiography and/or successful revascularization. After the exclusion criteria, 141 patients (34 female and 107 male; mean age 61 ± 11 years) were included. Non-dipper hypertension has been defined as a 0% to 10% decrease in average systolic BP at nighttime compared to daytime, measured at hourly intervals using the same automatic BP measuring device on bedside monitors (Vismo PVM-2701; Nihon Kohden Corp., Tokyo, Japan). SYNTAX score was calculated with an online calculator. The independent predictors of SYNTAX score were assessed using multivariable logistic regression analysis. P < 0.05 was considered statistically significant. Results The patients with non-dipper hypertension had higher SYNTAX score than the patients with dipper hypertension (11.12 ± 6.41 versus 6.74 ± 6.45, p < 0.0001). In a multivariable logistic regression model, non-dipper hypertension status (odds ratio: 5.159; 95% confidence interval: 2.246 to 11.852, p < 0.001), sex (p = 0.012) and low-density lipoprotein cholesterol (p = 0.008) emerged as independent predictors of high SYNTAX score. Conclusions The results of our study provide a possible additional mechanism linking abnormal circadian BP profile with coronary artery disease severity and complexity in patients with acute coronary syndrome.

Evaluation of normal-appearing white matter with perfusion and diffusion MRI in patients with treated glioblastoma.

OBJECTIVE: We tried to reveal how the normal appearing white matter (NAWM) was affected in patients with glioblastoma treated with chemo-radiotherapy (CRT) in the period following the treatment, by multiparametric MRI. MATERIALS AND METHODS: 43 multiparametric MRI examinations of 17 patients with glioblastoma treated with CRT were examined. A total of six different series or maps were analyzed in the examinations: Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) maps, Gradient Echo (GRE) sequence, Dynamic susceptibility contrast (DSC) and Arterial spin labeling (ASL) perfusion sequences. Each sequence in each examination was examined in detail with 14 Region of Interest (ROI) measurements. The obtained values were proportioned to the contralateral NAWM values and the results were recorded as normalized values. Time dependent changes of normalized values were statistically analyzed. RESULTS: The most prominent changes in follow-up imaging occurred in the perilesional region. In perilesional NAWM, we found a decrease in normalized FA (nFA), rCBV (nrCBV), rCBF (nrCBF), ASL (nASL)values (p < 0.005) in the first 3 months after treatment, followed by a plateau and an increase approaching pretreatment values, although it did not reach. Similar but milder findings were present in other NAWM areas. In perilesional NAWM, nrCBV values were found to be positively high correlated with nrCBF and nASL, and negatively high correlated with nADC values (r: 0.963, 0.736, - 0.973, respectively). We also found high correlations between the mean values of nrCBV, nrCBF, nASL in other NAWM areas (r: 0.891, 0.864, respectively). DISCUSSION: We showed that both DSC and ASL perfusion values decreased correlatively in the first 3 months and showed a plateau after 1 year in patients with glioblastoma treated with CRT, unlike the literature. Although it was not as evident as perfusion MRI, it was observed that the ADC values also showed a plateau pattern following the increase in the first 3 months. Further studies are needed to explain late pathophysiological changes. Because of the high correlation, our results support ASL perfusion instead of contrast enhanced perfusion methods.

The Association Between Cardio-Ankle Vascular Index and Primary Idiopathic Complete Atrioventricular Block in an Elderly Population.

The most common cause of complete atrioventricular block (CAVB) is age-related fibrotic degeneration and is referred to as primary idiopathic complete atrioventricular block (iCAVB). This study aims to investigate the relationship between iCAVB and arterial stiffness using the cardio-ankle vascular index (CAVI).In this study, of 205 CAVB patients, 41 patients with iCAVB implanted with a dual-chamber permanent pacemaker and 40 age- and gender-matched controls were studied. Arterial stiffness was assessed by a VaSera VS-1000 CAVI instrument. The CAVI values of patients with iCAVB were significantly higher compared with the controls (9.63 ± 1.42 vs 8.57 ± 1.12, P < .001). Idiopathic complete atrioventricular block frequency was higher among patients with abnormal CAVI values than those with borderline and normal CAVI (P = .04). In multivariate analysis, only CAVI was an independent predictor of iCAVB after adjusting for other relevant factors (odds ratio, 2.575; 95% CI [1.390-4.770]; P = .003). The present study demonstrated that CAVI, as a marker of arterial stiffness, was increased among elderly patients with iCAVB. Thus, we provide a possible additional mechanism linking easily measured CAVI with iCAVB.

Pancretic Fat Accummulation is Associated with Subclinical Atherosclerosis.

We investigated the relationship between pancreatic fat accumulation and markers of atherosclerosis among patients with nonalcoholic fatty liver disease (NAFLD). Patients with NAFLD have been reported to be at an increased risk of vascular events. We grouped 183 patients in whom we detected and graded hepatosteatosis (HS) on transabdominal ultrasonography into 2 groups based on the presence/absence of pancreatic fat. There were 85 participants (50 female; mean age: 53.6 ± 9.7 years) who were nonalcoholic fatty pancreas disease (NAFPD) positive and 98 participants (56 female; mean age: 51.4 ± 9.3 years) who were NAFPD negative. Carotid intima media thickness (cIMT) was significantly greater in the group where HS was accompanied by NAFPD (0.51 [0.40-0.62] vs 0.45 [0.35-0.55] mm; P < .001). Multivariable analyses showed that the independent predictors of increased cIMT were age (odds ratio [OR]: 1.108; 95% CI: 1.059-1.158, P = .001), hypertension (OR: 2.244; 95% CI: 1.099-4.579, P = .026), and the presence of NAFPD (OR: 3.078; CI 95% CI: 1.531-6.190, P = .0002). In the present study we demonstrated that, in patients with NAFLD, pancreatic fat accumulation was significantly associated with cIMT, a marker of early atherosclerosis. NAFPD may increase the risk of vascular events associated with NAFLD.

First experiences with a new balloon-expandable Myval transcatheter aortic valve: a preliminary study.

BACKGROUND: In the present article, we present our first experiences with a new type of balloon-expandable Myval valve (Meril Life Sciences, Gujarat, India). MATERIALS AND METHODS: A total of 25 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) from June 2020 to November 2020 were included in the study. RESULTS: The mean age of the study population was 83 (75-87) years; 17 (68%) were female, and 20 (80%) had hypertension. The Society of Thoracic Surgeons (STS) score of the group was 5.4% ± 3.5%. TAVI was performed via the transfemoral route on all patients. In 19 (76%) cases, we started the procedure without predilation. In two (10.5%) cases performed without predilation, the prosthesis did not pass the native valve. We had to implant the valve from the descending aorta in one (4%) patient. We used Prostar XL (Abbott Vascular, Santa Clara, CA, USA) for six (24%) patients and ProGlide (Abbott Vascular) for 19 (76%) patients for vascular closure. Two (8%) in-hospital deaths occurred in our study but there were no deaths in the 30-day and 90-day follow-up. Vascular complications were observed in one (4%) patient. None of the patients in our study had severe paravalvular leak (PVL), while two (8%) patients had moderate PVL. A permanent pacemaker (PPM) was required in two (8%) patients for the indication of complete atrioventricular block. The mean hospital stay for the whole group was 4 (3-7) days. CONCLUSION: Based on our experiences, the new balloon-expandable valve Myval is easy to use, efficient, and has only a few negligible drawbacks such as the need for predilation of the sheath. While shaft flexibility may have advantages in some situations including in very tortuous arteries, it may cause some difficulties in alignment of the valves.

Epicardial fat thickness assessment by multi-slice computed tomography for predicting cardiac outcomes in patients undergoing transcatheter aortic valve implantation.

INTRODUCTION: Chronic inflammation promotes aortic valve calcification. It is known that epicardial fat is a source of inflammation. The aim of this study was to investigate the relationship between epicardial fat thickness, cardiac conduction disorders and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). METHODS: During a three-year period, 45 patients with severe aortic stenosis who underwent TAVI were recruited to the study. Data were collected retrospectively. Epicardial fat was defined as the adipose tissue between the epicardium and the visceral pericardium. Mean epicardial fat thickness was determined by multi-slice computed tomography, which was performed before the procedure. RESULTS: The average thickness of epicardial fat was 13.06 ± 3.29 mm. This study failed to reveal a significant correlation between epicardial fat thickness and post-procedural left bundle branch block, right bundle branch block, paravalvular aortic regurgitation and pacemaker implantation rates (p > 0.05). CONCLUSIONS: The results of this study failed to show a significant relationship between epicardial fat thickness, cardiac conduction disorders and outcomes, however further studies with larger sample numbers are required to explore the relationship.

Left ventricular global longitudinal strain in low cardiac risk outpatients who recently recovered from coronavirus disease 2019.

The cardiac sequelae of coronavirus disease 2019 (COVID-19), a worldwide global pandemic, are still uncertain, particularly in the asymptomatic, low cardiac risk outpatient population. This study aims to evaluate the asymptomatic, low cardiac risk out-patient population who recently recovered from COVID-19, using 2-D left ventricular-global longitudinal strain (LV-GLS) proven to be capable of detecting subclinical myocardial injury. Out of 305 COVID-19 positive patients, 70 asymptomatic out-patients were determined as the study group and 70 age and sex-matched healthy adults as the control group. The echocardiographic examination was performed with the Philips IE33 system, and LV-GLS was measured using commercially available software QLAB 9 (cardiac motion quantification; Philips Medical Systems). The absolute value of LV-GLS ≤ 18 did deem to be impaired LV-GLS. The absolute value of LV-GLS was statistically significantly lower in the COVID-19 group than in healthy controls (19.17 ± 2.65 vs. 20.07 ± 2.19, p = 0.03). The correlation between having recovered from COVID-19 and impaired LV-GLS (≤18) did detect with the Pearson correlation test (p = 0.02). Having recovered from COVID-19 was found as a predictor for detecting impaired LV-GLS (≤18) in the multivariable logistic regression analysis (odds ratio, 0.133 (0.038-0.461); 95% CI, p = 0.001). This study suggests that COVID-19 may cause subclinical LV dysfunction detected by LV-GLS during early recovery even in a population of patients at low cardiac risk, asymptomatic, and recovered with home quarantine. The study findings indicate that the long-term cardiovascular follow-up of these patients may be more important than thought.

The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting.

BACKGROUND: In this study, we aimed to investigate the possible relationship between aortic calcification as detected by preoperative chest radiography and postoperative neurocognitive impairment in patients undergoing coronary artery bypass grafting. METHODS: A total of 124 patients (101 males, 23 females; mean age: 59.9±8.8 years; range, 34 to 84 years) who underwent coronary artery bypass grafting in our clinic between January 2019 and July 2019 were included. Of these patients, 35 whose preoperative chest radiography revealed aortic calcification in the aortic knuckle were included as the patient group. The control group consisted of 89 patients without aortic calcification. The patients with aortic calcification underwent additional imaging with thoracic computed tomography angiography and ascending aorta and aortic arch calcium scores were calculated. Neurocognitive dysfunction was assessed using the Standardized Mini-Mental State Examination. Postoperative delirium was evaluated by confusion assessment method in the intensive care unit. Both groups were compared for demographic, operative and postoperative data. RESULTS: Of all patients included in the study, the overall cerebrovascular event incidence was 3.2%. Although not statistically significant, the number of patients with neurocognitive decline was higher in the patient group than the control group (48.6% vs. 34.8%, respectively; p=0.157). Both Standardized Mini-Mental State Examination score decline and percentage decline were significantly higher in the patients with high aortic arch calcium scores (>2,250 AU). Carotid artery stenosis was 3.2 times higher in the patient group. In the patients with carotid artery stenosis, the aortic arch calcium scores were also higher (p=0.042). CONCLUSION: Aortic calcification detectable on chest radiography with high calcium scores may be associated with neurocognitive impairment and carotid artery stenosis in patients undergoing coronary artery bypass grafting.

Estimated Glomerular Filtration Rate as a Predictor of Restenosis After Carotid Stenting Using First-Generation Stents.

This study evaluated the impact of the baseline estimated glomerular filtration rate (eGFR) on clinical and angiographic outcomes and long-term in-stent restenosis (ISR) rates in patients undergoing elective carotid artery stenting (CAS) procedures. Consecutive patients who underwent CAS were retrospectively enrolled (n = 456). At the end of 3 years of follow-up, patients who had died or were lost follow-up were excluded from the study and a final analysis was performed using data from the remaining 405 patients. The study population (n = 405) was divided into 3 tertiles based on the tertile values of the eGFR level (T1, T2, and T3); then, clinical and procedural characteristics and 3-year ISR rates were compared between the groups. An ISR of 50% was detected in 49 (12%) surviving patients. The 3-year ISR was higher among patients with the lowest eGFR values (T1) by 3.7 times (95% CI: 2.01-11.38) than that among patients with the highest eGFR values (T3). These significant relationships persisted following adjustment for confounders. A lower baseline eGFR level was significantly associated with an increased ISR rate. Decreased renal function may be a predictor of ISR after CAS using first-generation stents.

The association between neutrophil-to-lymphocyte ratio and contrast-induced acute kidney injury in patients with carotid artery stenting.

OBJECTIVES: Contrast-induced acute kidney injury (CI-AKI) is a life-threatening complication that leads to comorbidities and prolonged hospital stay lengths in the setting of peripheral interventions. The presence of some CI-AKI risk factors has already been investigated. In this study, we evaluated the predictors of CI-AKI after carotid artery stenting. METHODS: A total of 389 patients with 50% to 99% carotid artery stenosis who underwent carotid artery stenting were included in this study. Patients were grouped according to CI-AKI status. RESULTS: CI-AKI developed in 26 (6.6%) patients. Age, baseline creatinine level, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were higher and estimated glomerular filtration rate, haemoglobin and lymphocyte count were lower in CI-AKI patients. In the multivariate regression analysis, the neutrophil-to-lymphocyte ratio triggered a 1.39- to 2.63-fold increase in the risk of CI-AKI onset (p < 0.001). CONCLUSIONS: The neutrophil-to-lymphocyte ratio may be a significant predictor of CI-AKI in patients with carotid artery stenting and higher neutrophil-to-lymphocyte ratio values may be independently associated with CI-AKI.

Abdominal Aortic Intima-Media Thickness Predicts Coronary Artery Disease Severity in Patients With Stable Angina Pectoris: A Prospective Study.

Accurately identifying coronary artery disease (CAD) is the key element in guiding the work-up of patients with suspected angina. Thickening of the arterial wall is a hallmark of atherosclerosis. Therefore, the main purpose of this study was to determine whether abdominal aortic intima-media thickness (AAIMT), which is the earliest zone of atherosclerotic manifestations, has a predictive value in CAD severity. A total of 255 consecutive patients who were referred for invasive coronary angiography due to suspected stable angina pectoris were prospectively included in the study. B-mode ultrasonography was used to determine AAIMT before coronary angiography. Coronary artery disease severity was assessed with the SYNTAX score (SS). A history of hypertension, age, dyslipidemia, and higher AAIMT (odds ratio: 2.570; 95%CI 1.831-3.608; P < .001) were independent predictors of intermediate or high SS. An AAIMT <1.3 mm had a negative predictive value of 98% for the presence of intermediate or high SS and 83% for obstructive CAD. In conclusion, AAIMT showed a significant and independent predictive value for intermediate or high SS. Therefore, AAIMT may be a noninvasive and useful tool for decision-making by cardiologists (eg, to use a more invasive approach).

Relation between fragmented QRS complex and cardio-ankle vascular index in asymptomatic subjects.

OBJECTIVES: Stiffness of large arteries has been related to cardiovascular mortality. Cardio-ankle vascular index (CAVI) is a novel marker of arterial stiffness. Herein, we aimed to study the relationship between fragmented QRS (fQRS) in electrocardiogram and CAVI. METHODS: Asymptomatic patients with fQRS and without fQRS were enrolled in the study consecutively. The fQRS complexes were analyzed in the 12-lead electrocardiogram. Arterial stiffness was assessed by using cardio ankle vascular index (CAVI). It was measured by a VaSera VS-1000 CAVI instrument. RESULTS: CAVI values of the patients with fQRS was significantly higher compared to those without fQRS (8.625 (7.9-9.2) versus 6.65 (6.7-8.4) p < .001). In a univariate analysis, it was revealed that there was a significant correlation between increased CAVI and fQRS, age, and epicardial fat thickness. Multiple binary logistic regression analysis revealed that age [95% confidence interval (CI): 1,068-1.214, p < .001] and fQRS [95% (CI): 1.766-23.117, p: 0.005] were the independent determinants of increased CAVI values. CONCLUSIONS: ECG is a widely and readily available, inexpensive, reproducible technique that can be examined by almost every physician. fQRS values in electrocardiogram may provide a significant predictive value for arterial stiffness in asymptomatic subjects.

Relation of p - wave dispersion with presystolic a - wave and aortic valve sclerosis in asymptomatic subjects.

BACKGROUND: P-wave duration and P-wave dispersion (PWD) are thought to be the surrogate marker of devoloping atrial fibrillation (AF). The main purpose of present study was to investigate the association between presystolic wave (PSW), aortic valve sclerosis, and PWD. PATIENTS AND METHODS: Patients with sinus rhythm admitted to the cardiology outpatient clinic were consecutively enrolled. Maximum (Pmax) and minimum (Pmin) P-wave duration and PWD were measured. Echocardiography was used to assess the aortic valve morphology and presence of PSW. The patients were divided into two groups according to presence or absence of AVSc and PSW. RESULTS: A total of 100 patients were enrolled consecutively. Patients with both PSW and AVSc had higher PWD values compared with those without PSW (42 ± 15 vs 65 ± 20) and AVSc (52 ± 21 vs 69 ± 19). The patients were categorized on the basis of median PWD values. According to univariate analysis, there was significant association between PWD and presence of PSW (P: .004), presence of AVS (P: .011), hypertension (P: .01) interventricular septal thickness (IVST) (P: .026), and posterior wall thickness (PWT) (P: .022). Multivariate logistic regression analyses demonstrated presence of PSW (95% confidence interval (1.058-6.505, P: .037) as an independent determinant of PWD. CONCLUSION: Assessment of presystolic A-wave on echocardiography examination may provide important information regarding the atrial conduction velocities that is a electrophysiological cause of AF. While there was a significant association between AVSc and PWD in univariate analysis, this significance disappeared in multivariate analysis.

Predictors of time to conversion of new-onset atrial fibrillation to sinus rhythm with amiodarone therapy.

BACKGROUND: New-onset atrial fibrillation (AF) is a frequent cause of presentation to the emergency department (ED). Epicardial fat thickness (EFT) is associated with the presence and recurrence of AF. However, no study has investigated the predictors of the time to conversion of AF to sinus rhythm with amiodarone therapy. The aim of this study was to investigate predictors of time to conversion of AF to sinus rhythm in patients with new-onset AF. METHODS: A total of 122 patients admitted to the ED with symptoms of hemodynamically stable new-onset AF (lasting <48 hours) were registered consecutively. These patients received intravenous amiodarone. EFT was measured using 2D echocardiography in parasternal long-axis views. RESULTS: A significant positive correlation was determined between EFT and conversion time (rho = 0.267, P = .017) in all patients. The median time for conversion from the start of amiodarone infusion was 410 min (150-830 minutes). Based on the median conversion time, patients were classified as early conversion (time < 410 minutes; n = 41) and late conversion (time > 410 minutes; n = 40). Multivariate logistic regression analysis demonstrated that EFT (P = .033, odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.6-2.7), higher troponin I level > 0.04 (P = .034, OR: 5.3, 95% CI: 1.1-24.8), and lower age (P = .003, OR: 0.8, 95% CI: 0.8-0.9) were significantly associated with longer conversion time. CONCLUSIONS: We determined that EFT and high troponin level affected the time to conversion to sinus rhythm in patients with new-onset AF.