The relationship between echocardiographic parameters and albumin bilirubin (ALBI) score in patients with isolated secundum type atrial septal defect.

BACKGROUND: It has been shown that the increase in volume and pressure in the right heart chambers increases liver stiffness. The Albumin-Bilirubin (ALBI) score is a useful and easy-to-use score for objectively assessing liver function. There is no information in the literature about changes in ALBI score in patients with atrial septal defect (ASD). The aim of our study is to investigate the changes in ALBI score and its clinical impact in patients with ASD. METHODS: Of the 206 analyzed patients, 77 were excluded. The remaining 129 patients with secundum type ASD with left to right shunt were divided into three groups; Group I (16 patients with Qp/Qs < 1.5 and defect diameter < 10 mm), Group II (52 patients with Qp/Qs > 1.5 and defect diameter 10-20 mm) and Group III (61 patients with Qp/Qs > 1.5 and defect diameter > 20 mm). The ALBI score was calculated based on serum albumin and total bilirubin levels using the following formula: ALBI = (log10 bilirubin [umol/L] * .66) + (albumin [g/L] * -.085). RESULTS: ALBI scores as well as total bilirubin levels, transaminases, and functional-structural heart abnormalities (increase in RA and RV dimensions, sPAP, ASD size and decrease in LVEF and TAPSE) showed a significant increasing trend from Group I to Group III (p < .001 for all comparisons). The mean ALBI scores for Group I, Group II, and Group III were -3.71 ± .37, -3.51 ± .25, and -3.27 ± .34, respectively. In multivariate linear regression analysis, ASD size, sPAP, RV-RA diameter were found to be significantly associated with increased ALBI score. CONCLUSION: The ALBI score offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in patients with ASD. ASD size, sPAP, RV and RA diameters were significantly associated with ALBI score.

Effect of the number of parity on right heart chamber quantification.

INTRODUCTION: Pregnancy is a process that can cause several physiologic changes to the cardiovascular system such as ventricular hypertrophy and dilation of cardiac chambers. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number. METHODS: This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200 women who had a parity number of more than 4). Right chambers' measurements were compared between the groups. RESULTS: In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. By multivariate hierarchical logistic regression analysis, the four independent factors that increased the risk of RV dilation were age (OR: 1.16 CI: 1.10-1.20), body mass index (OR: 1.05, CI: 1.02-1.08), smoking (OR: 1.87, CI: 1.28-4.02), and giving a birth (OR: 3.94 CI: 1.82-8.81). There was also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders. CONCLUSION: Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes.

Speckle-tracking echocardiography can predict atrial fibrillation in patients with supraventricular tachycardia.

PURPOSE: Atrioventricular nodal reentry tachycardia (AVNRT) is the most common supraventriculer arrhythmia in daily clinical practice. Comorbidity of AVNRT and atrial fibrillation (AF) has been well documented in some patients and AF development has been observed more frequently in AVNRT patients during their long-term follow-up. This study was conducted in order to investigate the left atrial two-dimensional-speckle-tracking echocardiographic (STE) parametres as the predictors of the occurence of AF in long-term follow-up in patients with spontaneously developed AF during AVNRT ablation. METHODS: Two hundred and thirty two consecutive AVNRT patients who developed spontaneous AF during ablation procedure were included in the study. The patients were followed up for a mean follow-up period of 6.2 ± 2.1 years. All patients were evaluated using the 2D-STE method. AF was developed in 34 patients during the follow-up period. Cox regression analysis was performed in order to identify the independent predictors of AF occurence. RESULTS: Left atrial LA-res, LA-pump, LA-SRs, LA-SRe, and LA-SRa values were found to be significantly decreased in the group of patients that developed AF during the follow-up period (p < .001 for all aforementioned values). Multivariate cox regression analysis revealed that LA-res (hazard ratio [HR], 0.367; 95% confidence interval [CI], 0.161-0.0.683, p < .001) and SRe (HR, 0.472; 95% CI, 0.346-0.825, p = .006) were independent risk factors associated with the occurrence of AF. CONCLUSION: In conclusion, it was demonstrated for the first time with this study that 2D-STE can effectively predict the development of AF in long-term follow-up in patients with spontaneously developed AF during AVNRT ablation.

The Predictive Role of a Novel Risk Index in Patients Undergoing Carotid Artery Stenting: Systemic Immune-Inflammation Index.

BACKGROUND: Inflammatory mechanisms play an important role in both atherosclerosis and stroke. There are several inflammatory peripheral blood count markers associated with carotid artery stenosis degree, symptomatic carotid artery lesions and carotid artery stent restenosis that reported in previous studies. However, the prognostic role of the blood cell counts and their ratios in predicting in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS) has not been comprehensively investigated. Systemic immune-inflammation index (SII) proved its' efficiency in patients with solid tumors and its' role was rarely examined in cardiovascular disorders and stroke. The current study evaluated the effect of this novel risk index on in-hospital and long-term outcomes in a large patient population who underwent CAS. METHOD: A total of 732 patients with carotid artery stenosis who underwent CAS were enrolled to the study. SII was calculated using the following formula: neutrophil-to-lymphocyte ratio × total platelet count in the peripheral blood (per mm3) and the patients were stratified accordingly: T1, T2 and T3. In-hospital and 5-year outcomes were compared between the tertiles of SII. RESULTS: During the hospitalization, major stroke, ipsilateral stoke, myocardial infarction, death and major adverse cardiovascular events (MACE) rates were significantly higher in high SII level (T3) compared to SII levels (T1 and 2). In long-term outcomes, ipsilateral stroke, major stroke, transient ischemic attack, death, and MACE were significantly higher in the patients with higher SII level (T3). The 5-year Kaplan-Meier overall survival for T1, T2, and T3 were 97.5%, 96.7% and 86.0% respectively. In-hospital and 5-year regression analyses demonstrated that high SII was independently associated with MACE and mortality. CONCLUSION: SII was independently associated with in-hospital and long-term clinical outcomes in patients undergoing CAS. Immune and inflammation status, as assessed easily and quickly using SII, has a good discriminative value in these patients.

Prognostic significance of pre-procedural prognostic nutritional index in patients with carotid artery stenting.

BACKGROUND: Inflammation and malnutrition play a critical role in the outcomes of patients undergoing carotid artery stenting (CAS). Prognostic nutritional index (PNI) is commonly utilized to evaluate the peri-operative immune-nutritional status of patients undergoing colorectal cancer surgery and is independently associated with survival. We assessed the association between immune-nutritional status, indexed by PNI, and outcomes in CAS patients. METHODS: A total of 615 patients hospitalized for CAS in a tertiary heart center were enrolled in the study. PNI was calculated using the following formula: 10× serum albumin value (g/dL) + 0.005 × total lymphocyte count in the peripheral blood (per mm3). In-hospital and 5-year outcomes (ipsilateral stroke, major stroke, transient ischemic attack, myocardial infarction, and mortality) were compared between the tertiles of PNI. RESULTS: In-hospital outcomes were similar between the groups except the increased mortality in decreasing tertiles of PNI. During a mean follow-up duration of 51.1 months, the lower PNI tertile was related to unfavorable outcomes. After adjusting for multi-model Cox regression analysis, PNI persisted as an independent prognostic factor for mortality and major stroke. CONCLUSION: PNI was independently associated with long-term mortality and major stroke in CAS patients. Malnutrition and inflammation, which can be assessed easily and quickly using PNI, have an important prognostic value in the patients undergoing CAS.

What should be the Optimal Carotid Stent Opening Rate Without Post-Dilation?

BACKGROUND: There is not a widely accepted optimal rate of stent opening in patients underwent carotid artery stenting. In this study we evaluated the effect of carotid stent opening rate (CSOR) without performing post-dilation on in-hospital and long-term outcomes. METHODS: A total of 825 patient patients underwent carotid artery stenting without post-dilation enrolled to the study. The patients divided into two groups according to their final CSOR (50% ≤ Post-stent deployment (SD) <80% and 80% ≤ Post-SD ≤ 100%). In-hospital and 3-year outcomes were compared between the groups. RESULTS: During hospitalization, the rate of ipsilateral stroke, major stroke and transient ischemic attacks were similar between the groups (respectively; 6.2% vs. 4.1, P = 0.190; 1.5% vs. 1.8, P = 0.811; 1.5% vs. 1.9%, P = 0.683). The 3-year Kaplan-Meier overall survival rates for the first and second groups were 87.6% and 84.4%, respectively (log rank test P = 0.426). The 3-year Kaplan-Meier overall cumulative ipsilateral stroke rates for the first and second groups were 88.0% and 88.6%, respectively (log rank test P = 0.409) CONCLUSION: Our study demonstrated that a CSOR higher than 50% without performing a post-dilation might be an effective therapeutic approach since there was not a significant difference regarding outcomes between the patients with a 50% ≤ Post-SD <80% and 80% ≤ Post-SD ≤ 100%. The need for post-stent balloon dilation might have been eliminated due to subsequent stent self-expansion.

Serum Endocan Levels Predict Drug-Eluting Stent Restenosis in Patients with Stable Angina Pectoris.

BACKGROUND: Endothelial cell-specific molecule 1 (ESM-1 or endocan) is an immunoinflammatory marker strongly associated with inflammation, vascular endothelial dysfunction and atherosclerosis. We explored the relationship between serum endocan concentrations and coronary in-stent restenosis (ISR). METHODS: Fifty consecutive patients with ISR and 50 control subjects were included in this study. Clinical data and angiographic characteristics were collected. Serum endocan concentrations were measured using an enzyme-linked immunosorbent assay. RESULTS: All included patients were divided into four quartiles based on their concentrations of endocan: quartile 1 (0.62-1.31 ng/mL), quartile 2 (1.33-1.74 ng/mL), quartile 3 (1.75-2.77 ng/mL) and quartile 4 (2.78-4.24 ng/mL). The rates of ISR were 16%, 24%, 68%, and 92%, respectively. The patients in quartile 4 had significantly higher rates of ISR than the other groups (p < 0.001). Logistic regression analysis indicated that endocan concentration [odds ratio = 8.65, 95% confidence interval 3.56-20.94; p < 0.001] was an independent predictor of ISR. Receiver operating characteristic curve analysis was used to explore the relationship between endocan and ISR. Using a cutoff value of 1.625 ng/mL, endocan predicted ISR with a sensitivity of 86% and a specificity of 78%. CONCLUSIONS: Our findings suggest that plasma endocan levels may be a novel biomarker of endothelial dysfunction in patients with ISR.

Relationship Between Pulmonary Venous Flow and Prosthetic Mitral Valve Thrombosis.

BACKGROUND: Prosthetic valve thrombosis (PVT) may impair pulmonary venous flow (PVF) and left atrial appendage (LAA) functions. An investigation was conducted to determine the association between left superior PVF and LAA functions and mitral PVT. METHODS: This observational case-control study included 100 consecutive patients (87 females, 13 males; mean age 59 years; range 35-71 years) with mechanical mitral PVT, and 50 age- and gender-matched otherwise healthy controls with normally functioning mitral prostheses. All patients were included after comprehensive transesophageal echocardiography (TEE) examinations for the presence and quantification of PVT, the left atrial diameter, and LAA length. Peak systolic velocity (PSV), velocity-time integral of systolic flow (VTI-s), peak diastolic velocity (PDV), velocity-time integral of diastolic flow (VTI-d), systolic fraction (SFr) of the left upper PVF and the flow of the LAA orifice were each recorded using color-guided pulsed-wave Doppler imaging during TEE. RESULTS: The PSV [30 cm/s (range: 13-77 cm/s) versus 44 cm/s (range: 16-71 cm/s)], respectively (p = 0.002), VTI-s [(2.85 cm (range: 0.5-10.7 cm) versus 5 cm (range: 1.3-12.7 cm)], respectively (p <0.001), VTI-d [(3 cm (range: 0.6-9.7 cm) versus 4.2 cm (range: 1.5-8.3 cm)], respectively (p <0.001), SFr (45.5% (range: 15.66-67.44%) versus 50 % (range: 21.11-82.61%)], respectively (p = 0.008), and LAA orifice velocity [(23 cm/s (range: 11-75 cm/s) versus 34 cm/s (range: 10-112 cm/s)], respectively (p = 0.011) were each significantly lower in patients with PVT compared to controls. The PDV was similar between groups. Patients with obstructive PVT (n = 21) had a lower PDV and a higher VTI-d compared to those with non-obstructive PVT. CONCLUSIONS: Mitral mechanical PVT is associated with decreased systolic PVF and LAA function. The presence of obstructive PVT is associated with further limitations of diastolic flow velocity, and a compensatory prolongation of diastolic flow of the left upper pulmonary vein.

Epicardial fat thickness: A new predictor of successful electrical cardioversion and atrial fibrillation recurrence.

OBJECTIVE: In recent years, epicardial fat tissue (EFT) has been found to be strongly associated with the development of atrial fibrillation (AF) and post-ablation long-term recurrence. The current study investigated the procedural success rate of electrical cardioversion (ECV) and potential predictors of treatment failure in patients with nonvalvular persistent AF. METHODS: A total of 262 nonvalvular persistent AF patients who were scheduled for elective ECV were included in this prospective study. Routine transthoracic echocardiography was performed before the procedure and EFT thickness was measured. The presence of left atrial appendage thrombus was evaluated by transesophageal echocardiography. The patients were followed up for 6 months to examine any recurrence after ECV. RESULTS: The success rate of ECV was 85% and the recurrence rate was 35% during the 6-month follow-up period. The mean EFT thickness was 8.67 ± 1.2 mm in the persistent AF group with unsuccessful ECV and 6.81 ± 0.8 in the patients in whom sinus rhythm (SR) was maintained, the EFT was significantly thicker in the AF group (P = 0.001). EFT (P = 0.001) and left ventricular end-diastolic diameters (LVEDD) (P = 0.001) were significantly different between those who had maintained SR and those with recurrent AF during the 6-month follow-up period after ECV. In the multiple logistic regression analysis, LVEDD (odds ratio [OR]: 1.320 (1.023-1.703 95% confidence interval [CI]), P = 0.032)] and EFT [OR: 3.029 (1.013-9.055 95% CI), P = 0.047)] were identified as independent predictors of successful ECV. CONCLUSION: Epicardial fat tissue thickness can be effectively used for the prediction of successful ECV and AF recurrence during follow-up in AF patients.

Impact of cardiac rehabilitation on ventricular repolarization indexes in patients with rheumatid arthritis.

OBJECTIVE: Abnormalities in ventricular repolarization (VR) parameters have been associated with sudden cardiac death (SCD) in patients with rheumatoid arthritis (RA). The benefits of cardiac rehabilitation (CR) in patients with RA are well recognized. We aimed to assess its impact on VR indexes in patients with RA. METHODS: This study included 45 patients with RA (36 female, age 58 ±â€¯5.5 years) and 50 age- and sex-matched otherwise healthy controls. Baseline electrocardiogram (ECG) recordings were used to compare VR parameters such as maximum and minimum QT intervals, and corrected, and dispersion (QTmax, QTmin, cQTmax, cQTmin, QTd, cQTd, respectively), JT and cJT intervals, Tp-e and cTp-e intervals, and Tp-e/QT and Tp-e/cQT ratios in patients with RA and healthy individuals. The effects of 6-week CR in patients with RA were also evaluated by comparing pre- and post-CR ECGs, exercise tolerance test (MET and VO2max) and RA characteristics (C-reactive protein (CRP), Disease Activity Score 28 (DAS28) and Health Assessment Questionnaire(HAQ)). RESULTS: In comparison with the healthy individuals, the patients with RA had significantly higher cQTmax and QTmin intervals, QTd, cQTd, Tp-e and cTp-e intervals, and Tp-e/QT and Tp-e/cQT ratios. At the end of CR, all VR indexes (p < 005), except QTd, were significantly decreased as did the results for CRP, DAS28, and HAQ (all p < 0.05), and MET and VO2max (p < 0.05 for both) were significantly increased in patients with RA. CONCLUSIONS: CR may provide an improvement in the majority of VR indexes which are related with ventricular arrhythmia and SCD in patients with RA. Changes in ETT parameters and RA characteristics may contribute to improvement of several VR indexes such as cQTd, cJT and Tp-e intervals at the end of CR.

Early Thrombosis of a Mitral Annuloplasty Ring in a Patient with MTHFR and Factor V Leiden Mutations.

Mitral annuloplasty ring thrombosis is an extremely infrequent pathology, for which no evidence-based antithrombotic management has yet been described. Herein is presented a case of heterozygous Factor V Leiden (FVL) and hyperhomocysteinemia with homozygous methylenetetrahydrofolate reductase (MTHFR) mutations that caused early thrombosis of the mitral annuloplasty ring. The clinical management and antithrombotic treatment of the patient, and the implications of hyperhomocysteinemia, are discussed. Video 1: Mobile 9-mm thrombus of mitral annuloplasty ring on two-dimensional (2D) transesophageal echocardiography. Video 2: Mitral annuloplasty ring thrombus on real time three-dimensional (RT-3D) transesophageal echocardiography. Video 3: 2D video showing the morphologic change of mitral annuloplasty ring thrombus after prolonged UFH infusion.

An unusual mass of tricuspid valve in an adult patient: blood-filled cyst.

Blood-filled cysts (BFC) within the heart are common findings at postmortem examinations of fetuses and infants. However, such cysts are very rare entities in adolescents and adults. We report here an adult case of BFC attached to the posterior leaflet of the tricuspid valve, demonstrating the importance of multimodal diagnostic imaging combining both echocardiography and magnetic resonance imaging.

Relation of epicardial fat thickness to the severity of heart failure in patients with nonischemic dilated cardiomyopathy.

BACKGROUND: The aim of this study was to assess whether epicardial fat thickness (EFT) is associated with the severity of heart failure in patients with nonischemic dilated cardiomyopathy (NICMP). METHODS: The study group was composed of 93 patients with NICMP and38 age- and sex-matched healty individuals as the control group. The EFT was identified during end-systole at the point on the free wall of the right ventricle. RESULTS: Patients with NICMP had significantly lower mean EFT than those in the control group (4.1 ± 0.8 vs. 6.1 ± 1.8 mm, P < 0.001). EFT was thinnest in patients with New York Heart Association (NYHA) functional class III or IV (3.5 ± 0.5, P < 0.001). There was a significant correlation between EFT, left ventricle EF (r = 0.540 P < 0.001), and B-type natriuretic peptide (BNP) (r = -0.695, P < 0.001) values in patients with NICMP. In addition, when EFT was corrected for BMI, EFT/BMI was lower in patients with NYHA functional class III-IV than patients with NYHA class I-II and control group (0.13 ± 0.01, 0.16 ± 0.02, 0.23 ± 0.04, respectively; P < 0.001). There was a significant correlation between EFT/BMI, left ventricle EF (r = 0.489, P < 0.001), and BNP (r = -0.549, P < 0.001) in patients with NICMP. In multivariate regression analysis, EFT (P = 0.009), BNP (P = 0.039), and left atrium volume index (P = 0.039) were independently associated with impaired functional status. CONCLUSION: Echocardiographic EFT is an inexpensive, simple, and readily available marker that may be used to asses the severity of chronic heart failure in patients with NICMP.

Association between Plasma Fibrinogen Level and Saphenous Vein Graft Patency.

BACKGROUND: Fibrinogen is related to the pathogenesis of atherosclerosis. The inflammatory process in atherosclerosis may cause an increase in plasma fibrinogen level. Therefore, in this study we proposed to investigate whether plasma fibrinogen is associated with the patency of saphenous vein graft in patients at least 1 year after coronary artery bypass graft (CABG) surgery. METHODS: Patients who had undergone CABG surgery at least 1 year previously with at least one saphenous vein graft were included in the study. Patients were directed to cardiac catheterization for stable anginal symptoms or positive stress test results. Before coronary angiography, all patients underwent routine blood tests including assessment of plasma fibrinogen levels. RESULTS: Saphenous vein grafts were found to be patent in 199 patients and occluded in 132 patients. Plasma fibrinogen levels were significantly different between the two groups (2.85 ± 0.49 g/L vs. 3.62 ± 0.82 g/L, p < 0.001, respectively). Although the time duration after CABG operation differs significantly between the two groups (p = 0.004), multiple logistic regression analysis showed that plasma fibrinogen levels were found to be significantly associated with the patency of vein graft (odds ratio = 0.27, 95% confidence internal: 0.16-0.48, p < 0.001). CONCLUSIONS: Our results demonstrated that plasma fibrinogen levels were higher in patients with an occluded saphenous vein graft. To conclusively prove the relationship between plasma fibrinogen values and saphenous vein graft patency, additional investigation would be necessary. KEY WORDS: Atherosclerosis; Coronary artery bypass graft; Fibrinogen; Saphenous vein.

The Impact of Transcatheter or Surgical Defect Closure on Self-Reported Sleep Quality in Adults with Atrial Septal Defect.

OBJECTIVE: Sleep quality in those with cardiovascular disease is significantly lower than in the general population. This study aimed to explore the effect of transcatheter or surgical closure of atrial septal defect (ASD) on sleep quality. METHODS: One hundred nineteen adult patients with ASD who underwent transcatheter or surgical closure were included in the study. Sleep quality was investigated prospectively just before defect closure and six months after defect closure. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality of these patients. RESULTS: PSQI scores were similar in both groups before the procedure in patients who underwent both transcatheter and surgical closure. The PSQI scores six months after transcatheter closure was significantly improved compared to the PSQI score before transcatheter ASD closure (3.5 ± 2.0 vs. 6.9 ± 3.4, respectively; P<0.001). The PSQI scores six months after surgical ASD closure was significantly improved compared to the PSQI score before surgical closure (4.8 ± 2.1 vs. 7.1 ± 2.0, respectively; P<0.001). Total PSQI scores were also statistically different at six months after transcatheter and surgical closure (3.5 ± 2.0 vs. 4.8 ± 2.1, P=0.014). However, six months after both transcatheter and surgical closure, PSQI scores were significantly decreased in both groups which was more pronounced in patients who underwent transcatheter closure. CONCLUSION: Transcatheter or surgical closure of the defect may be beneficial in improving the sleep quality of adult patients with ASD. Delayed improvement of sleep quality after surgical closure may be an important advantage for transcatheter closure.

Impact of metabolic syndrome on fractional flow reserve.

OBJECTIVE: Fractional flow reserve (FFR) assessment is widely used to determine significance of intermediate coronary lesions. Previously, components of the metabolic syndrome (MS) which may affect FFR validity were not tested cumulatively. In this study, we investigate the possible effect of MS on FFR assessment. METHODS AND RESULTS: We retrospectively evaluated 178 consecutive patients who had undergone FFR assessment. Thirty-two patients were excluded. All of the coronary lesions were in the left anterior descending artery. They were evaluated with quantitative coronary angiography (QCA). In 105 patients the MS was present and 41 patients were without the MS. According to the severity of the coronary lesions in QCA, patients were divided into three groups: 40-50%, 51-60% and 61-70% lesions. FFR measurements were compared in each group with respect to MS presence. Coronary artery lesions were accepted as haemodynamically significant if FFR < or = 0.80. Age of the population, lesion length, lesion diameter and adenosine dosage performed during FFR assessment were not different between patients with MS or without MS. When the lesions were divided into three categories according to the severity of the luminal narrowing expressed in stenosis percentages as 40-50, 51-60, and more than 61%, the observed FFR values decreased with advancing lesion category (P = 0.04). However, observed FFR values did not differ between the patients with MS and without MS in each category (P = 0.88). After exclusion of the diabetic patients, FFR values still did not differ between the patients with MS and without MS in each category (P = 0.78). CONCLUSIONS: Presence of the metabolic syndrome has no significant effect on FFR assessment. This study provides additional data for the reliability of FFR in patients with MS.

The prognostic value of time from symptom onset to thrombolysis in patients with pulmonary embolism.

BACKGROUND: According to clinical practice guidelines, thrombolysis can be administered during the 14 days after the beginning of symptoms in PE. However, the role of the early thrombolysis in PE has not been comprehensively investigated. In this study we evaluated the effect of short symptom-to-thrombolysis time (STT) in these patients who received the thrombolytic therapy within the 48-h. METHOD: A total of 456 patients with pulmonary embolism who underwent thrombolytic therapy in a tertiary center were included in the current study. The patients were stratified into three groups according to STT as: <12 h (Group 1), 12 to 24 h (Group 2) and > 24 to 48 h (Group 3). In-hospital events and long-term mortality were compared between the groups. RESULTS: Group 3 had higher in-hospital mortality, acute kidney injury, cardiogenic shock, asystole, and the use mechanical ventilation and 3-year mortality compared to the other two groups. The 3-year overall survival for Group 1, 2 and 3 were 82.1%, 77.7% and 25.9% respectively. According to regression analysis, a STT > 24 h was independently associated with in-hospital and long-term mortality. Group 1 and 2 had similar in-hospital outcomes and long-term mortality. CONCLUSION: A short STT has a great importance in patients with PE who treated with thrombolytic therapy. The efficacy of systemic thrombolysis significantly drops after 24 h. Because of this situation, the period between the symptom onset and thrombolytic therapy should be kept short as much as possible.

Systemic immune-inflammation index predicts in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction.

OBJECTIVE: This study examines the predictive value of the novel systemic immune-inflammation index (SII) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 1660 patients with STEMI who underwent primary percutaneous coronary intervention (pPCI) were enrolled in the study. In-hospital and 3-year outcomes were compared between the four groups (Q1-4). The SII was calculated using the following formula: neutrophil*platelet/lymphocyte. RESULTS: The frequency of in-hospital cardiogenic shock, acute respiratory failure, acute kidney injury, ventricular arrhythmia, stent thrombosis, recurrent myocardial infarction, major adverse cardiac events and mortality were significantly higher in the high SII groups (Q3 and Q4). Logistic regression models demonstrated that Q3 and Q4 had an independent risk of mortality and Q4 had an independent risk of cardiogenic shock compared to Q1. Receiver operating characteristic analysis showed that the best cutoff value of SII to predict the in-hospital mortality was 1781 with 66% sensitivity and 74% specificity. Kaplan-Meier overall survivals for Q1, Q2, Q3 and Q4 were 97.6, 96.9, 91.6 and 81.0%, respectively. Cox proportional analysis for 3-year mortality demonstrated that Q3 and Q4 had an independent risk for mortality compared to Q1. CONCLUSION: SII, a novel inflammatory index, was found to be a better predictor for in-hospital and long-term outcomes than traditional risk factors in patients with STEMI undergoing pPCI.

Prognostic Value of 3 Nutritional Screening Tools to Predict 30-Day Outcome in Patients Undergoing Carotid Artery Stenting.

The effect of malnutrition on outcomes after carotid artery stenting (CAS) is not well known. This study reports the relationship between malnutrition and post-procedure 30-day major adverse events (MAEs). A total of 978 patients hospitalized for CAS were enrolled in the study. Controlling nutritional status (CONUT) score, the nutritional risk index (NRI), and the prognostic nutritional index (PNI) were calculated. MAEs (myocardial infarction, stroke/transient ischemic attack and mortality) were compared. According to the CONUT score, NRI, and PNI, 9.4%, 41%, and 11.4% patients were moderately or severely malnourished, respectively; 74.8% were at least mildly malnourished by at least 1 score. Forty-seven patients (4.8%) had a post-procedure 30-day MAE. Continuous classifications of the indexes were independently associated with higher MAE. CONUT showed the highest predictive ability, whereas NRI had the lowest (C-index: CONUT, 0.701; NRI, 0.681; PNI, 0.688). According to categorical classification of indexes, only CONUT and PNI showed predictive ability for MAE. Malnutrition assessment could identify patients with CAS at elevated risk for MAE. CONUT, NRI, and PNI continuous scores were independent prognostic factors for the post-procedure 30-day MAE. According to our study, CONUT showed the highest predictive ability.

The Safety and Tolerability of Nebivolol in Hypertensive Patients with Coronary Artery Disease and Left Ventricular Ejection Fraction ≥ 40%: A Population-Based Cohort Study (Nebivolol-TR Study).

BACKGROUND: This study aimed to assess the safety and tolerability of nebivolol in hypertensive patients with coronary artery disease and left ventricular ejection fraction ≥ 40% in a Turkish cohort. METHODS: A total of 1015 hypertensive patients and coronary artery disease with left ventricular ejection fraction ≥ 40% were analyzed from 29 different centers in Turkey. Primary outcomes were the mean change in blood pressure and heart rate. Secondary outcomes were to assess the rate of reaching targeted blood pressure (<130/80 mmHg) and heart rate (<60 bpm) and the changes in the clinical symptoms (angina and dyspnea). Adverse clinical events and clinical outcomes including cardiovascular mortality, cardiovascular hospital admissions, or acute cardiac event were recorded. RESULTS: The mean age of the study population was 60.3 ± 11.5 years (male: 54.2%). During a mean follow-up of 6 months, the mean change in blood pressure was -11.2 ± 23.5/-5.1 ± 13.5 mmHg, and the resting heart rate was -12.1 ± 3.5 bpm. Target blood pressure and heart rate were achieved in 76.5% and 37.7% of patients. Angina and functional classifications were improved by at least 1 or more categories in 31% and 23.2% of patients. No serious adverse events related to nebivolol were reported. The most common cardiovascular side effect was symptomatic hypotension (4.2%). The discontinuation rate was 1.7%. Cardiovascular hospital admission rate was 5% and hospitalization due to heart failure was 1.9% during 6 months' follow-up. Cardiovascular mortality rate was 0.1%. CONCLUSION: Nebivolol was well tolerated and safe for achieving blood pressure and heart rate control in hypertensive patients with coronary artery disease and heart failure with preserved or mildly reduced ejection fraction.