Systolic aortic root motion predicts response to cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is recommended for patients with advanced chronic heart failure. Systolic aortic root motion (SARM) has been investigated in dilated cardiomyopathy patients and found that heart failure patients had reduced SARM. We aimed to investigate the relationship between SARM and response to CRT. METHODS: Fifty-six patients with advanced heart failure, wide QRS complex, and LVEF ≤35% were included. Transthoracic echocardiography was performed before, and repeated at 6 months in follow-up. Systolic aortic root motion was measured in each patient before the device implantation. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months follow-up. RESULTS: Forty patients (71%) had CRT response after 6 months of follow-up. In multivariate analysis, significant associates of response to CRT was evaluated adjusting for functional capacity, etiology of cardiomyopathy, QRS duration, baseline left ventricular dimensions/volumes and SARM. SARM was the only predictor of response to CRT (OR 1.818, 95% CI, 1.101-3.003, P = .019). CONCLUSIONS: SARM predicts non-response to CRT and may help in the selection of CRT candidates.

A simple discharge risk model for predicting 1-year mortality in hospitalised acute decompansated heart failure patients with reduced ejection fraction.

OBJECTIVE: The risk stratification for prognosis in heart failure is very important for optimal disease management and decision making. The aim of this study was to establish a simple discharge 1-year mortality prediction model by integrating data obtained from demographic characteristics, clinical evaluation, laboratory biomarkers and echocardiographic evaluation of hospitalised heart failure with reduced ejection fraction (HFrEF) patients with acute decompensation. METHODS AND RESULTS: A risk score model was developed based on ß-coefficient number of variables in a multivariable logistic regression model which was created with the use of data on clinical, laboratory, imaging and therapeutic findings of 670 patients (65.4% males, 65 ± 11 years) who was hospitalised with acute decompensated HFrEF. The mean left ventricular ejection fraction (LVEF) was 26 ± 9%. Independent predictors of mortality were: age ≥75 years, sodium <130 mEq/L, hepatomegaly at admission, unable to use beta-blocker at discharge and LVEF ≤20%. The 1-year mortality rate was 7.8% in the study population. The existence of each predictor was scored as 1 point and the discharge risk score identified patients into low (0-1 points), intermediate (2-3 points) and high (4-5 points) risk individuals with 3, 15.6 and 44.4% 1-year mortality rates, respectively. The model performance evaluated by concordance index was 0.74. CONCLUSIONS: This simple discharge risk score model for hospitalised acute decompensated HFrEF patients using easily determined demographic characteristics, clinical signs, echocardiographic and laboratory data is a valuable and an easy risk assessment tool to use at point-of-care.

Bendopnea and Its Clinical Importance in Outpatient Patients with Pulmonary Arterial Hypertension.

PURPOSE: Bendopnea is a recently reported novel symptom in patients with heart failure (HF) defined as shortness of breath when bending forward. It has been demonstrated that bendopnea is associated with advanced symptoms and worse outcomes. The aim of this study was to assess the presence of bendopnea and its clinical importance with regards to functional status, hemodynamic and echocardiographic characteristics in outpatient pulmonary arterial hypertension (PAH) patients. METHODS: We conducted this prospective observational study of 53 patients who were admitted to our PAH clinic for routine control visits. We determined the presence of bendopnea and analyzed hemodynamic parameters, World Heart Organization (WHO) functional class, transcutaneous oxygen saturation, 6-minute walking distance (6-MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP) and right ventricular (RV) function indicators in patients with and without bendopnea. RESULTS: Bendopnea was present 33.9% of the PAH patients. The mean age was higher in the patients with bendopnea than in those without bendopnea, but the difference was not significant (p = 0.201). The patients with bendopnea had a lower 6-MWD and higher NT-proBNP level (p < 0.001), and worse WHO functional class symptoms (p = 0.010). Mean right atrial pressure, pulmonary artery pressure, and pulmonary vascular resistance were higher in the patients with bendopnea. The patients with bendopnea had a more dilated RV end-diastolic diameter and lower tricuspid annular plane systolic excursion value (p < 0.001 and p = 0.001, respectively). CONCLUSIONS: Bendopnea was associated with worse functional capacity status, hemodynamic characteristics and RV function in our outpatient PAH patients.

Effect of Oral Nitrates on All-Cause Mortality and Hospitalization in Heart Failure Patients with Reduced Ejection Fraction: A Propensity-Matched Analysis.

BACKGROUND: Hydralazine-nitrate combination is recommended for patients with heart failure with reduced ejection fraction (HFrEF)/systolic heart failure who are symptomatic despite guideline-directed medical therapy (GDMT). Use of nitrates alone for this indication is not well-established. This study aims to evaluate the effect of oral nitrates on all-cause mortality and hospitalization in HFrEF patients using GDMT. METHODS AND RESULTS: Nitrate prescription at discharge and its association with all-cause mortality and heart failure hospitalization were examined in a propensity-matched analysis of 648 HFrEF patients followed for a median of 56 months. A total of 269 (42%) patients died during that period. In Cox regression analysis, nitrate usage was associated with a slightly increased mortality risk compared with not using nitrates (hazard ratio 1.29; 95% confidence interval 1.01-1.65; P = .040), which continued modestly after the propensity-matched analysis (hazard ratio 1.26; 95% confidence interval 0.95-1.68; P = .102). In both prematch and propensity-matched analyses, nitrate use was not associated with risk of rehospitalization. No significant effect was detected on subgroups stratified by coronary artery disease, age, gender, and background medical therapy. CONCLUSIONS: In this study, oral nitrate use alone in addition to GDMT did not affect all-cause mortality and hospitalization risk in HFrEF patients during a long-term follow-up. There was even a modest tendency for increased risk of mortality.

Percutaneous Antegrade Trans-Septal Closure of Mitral Paravalvular Leak without Creation of an Arteriovenous Wire Loop in Patients with Coexistent Mechanical Aortic Valve.

BACKGROUND: Various approaches such as antegrade trans-septal, retrograde transfemoral and transapical techniques have been used to close mitral paravalvular leak (PVL) in patients with an aortic prosthesis. During the implementation of these techniques, an arteriovenous guidewire loop is often created for device delivery. However, passing through a mechanical aortic valve may cause hemodynamic compromise and prolong the procedure. To date, no studies have evaluated antegrade mitral PVL closure without the use of an arteriovenous wire loop in patients with a mechanical aortic prosthesis. Herein is described a different mitral PVL closure technique by means of a trans-septal approach without construction of an arteriovenous guidewire loop in this type of patient. METHODS: Four patients (two males, two females; mean age 57 ± 10 years; range: 46-67 years) with severe mitral PVL and a mechanical aortic prosthesis were referred for percutaneous closure of a mitral PVL. All patients underwent antegrade trans-septal mitral PVL closure without the creation of an arteriovenous wire loop. Data prospectively collected included assessments from preoperative and postoperative two- and three-dimensional transesophageal echocardiography (TEE). RESULTS: Preoperative TEE demonstrated severe mitral PVL in all four patients. All patients experienced a substantial reduction in symptoms associated with the marked reduction in PVL following repair. There were no procedural complications. The median procedural time was 113 min (range: 50-145 min) and median fluoroscopy time was 23 min (range: 17-25 min). CONCLUSIONS: An alternative, safe, effective and efficient mitral PVL closure approach in patients with a mechanical aortic prosthesis has been devised. This technique can prevent aortic valve dysfunction, reduce costs, and also decrease complication rates.

Predictors of Long-Term Mortality and Frequent Re-Hospitalization in Patients with Acute Decompensated Heart Failure and Kidney Dysfunction Treated with Renin-Angiotensin System Blockers.

BACKGROUND Assessment of risk for all-cause mortality and re-hospitalization is an important task during discharge of acute heart failure (AHF) patients, as they warrant different management strategies. Treatment with optimal medical therapy may change predictors for these 2 end-points in AHF patients with renal dysfunction. The aim of this study was to evaluate the predictors for long-term outcome in AHF patients with kidney dysfunction who were discharged on optimal medical therapy. MATERIAL AND METHODS The study was conducted retrospectively. The study group consisted of 225 AHF patients with moderate-to-severe kidney dysfunction, who were hospitalized at Kocaeli University Hospital Cardiology Clinic and who were prescribed beta-blockers and ACE-inhibitors or angiotensin II receptor blockers at discharge. Clinical, echocardiographic, and biochemical predictors of the composite of total mortality and frequent re-hospitalization (≥3 hospitalizations during the follow-up) were assessed using Cox regression and the predictors for each end-point were assessed by competing risk regression analysis. RESULTS Incidence of all-cause mortality was 45.3% and frequent readmissions were 49.8% in a median follow-up of 54 months. The associates of the composite end-point were age, NYHA class, respiration rate on admission, eGFR, hypoalbuminemia, mitral valve E/E' ratio, and ejection fraction. In competing risk regression analysis, right-sided HF, hypoalbuminemia, age, and uric acid appeared as independent associates of all-cause mortality, whereas NYHA class, NT-proBNP, mitral valve E/E' ratio, and uric acid were predictors for re-hospitalization. CONCLUSIONS Predictors for all-cause mortality in AHF with kidney dysfunction treated with optimal therapy are mainly related to advanced HF with right-sided dysfunction, whereas frequent re-hospitalization is associated with volume overload manifested by increased mitral E/E' ratio and NT-proBNP levels.

Associations Between Neutrophil Gelatinase Associated Lipocalin, Neutrophil-to-Lymphocyte Ratio, Atrial Fibrillation and Renal Dysfunction in Chronic Heart Failure.

BACKGROUND Atrial fibrillation (AF) and renal dysfunction are two common comorbidities in patients with chronic heart failure with reduced ejection fraction (HFrEF). This study evaluated the effect of permanent AF on renal function in HFrEF and investigated the associations of atrial fibrillation, neutrophil gelatinase-associated lipocalin (NGAL), and neutrophil-to-lymphocyte ratio (NLR) with adverse clinical outcome. MATERIAL AND METHODS Serum NGAL levels measured by ELISA and NLR were compared between patients with sinus rhythm (HFrEF-SR, n=68), with permanent AF (HFrEF-AF, n=62), and a healthy control group (n=50). RESULTS Mean eGFR levels were significantly lower, and NLR and NGAL levels were significantly higher in the HFrEF patients than in the control patients but the difference between HFrEF-SR and HFrEF-AF was not statistically significant (NGAL: 95 ng/mL in HFrEF-SR, 113 ng/mL in HFrEF-AF and 84 ng/mL in the control group; p<0.001). Independent associates of baseline eGFR were age, hemoglobin, NLR, triiodothyronine, and pulmonary artery systolic pressure. In a mean 16 months follow-up, adverse clinical outcome defined as progression of kidney dysfunction and composite of all-cause mortality and re-hospitalization were not different between HFrEF-SR and HFrEF-AF patients. Although NGAL was associated with clinical endpoints in the univariate analysis, Cox regression analysis showed that independent predictors of increased events were the presence of signs right heart failure, C-reactive protein, NLR, triiodothyronine, and hemoglobin. In ROC analysis, a NLR >3 had a 68% sensitivity and 75% specificity to predict progression of kidney disease (AUC=0.72, 95% CI 0.58-0.85, p=0.001). CONCLUSIONS Presence of AF in patients with HFrEF was not an independent contributor of adverse clinical outcome (i.e., all-cause death, re-hospitalization) or progression of renal dysfunction. Renal dysfunction in HFrEF was associated with both NLR and NGAL levels, but systemic inflammation reflected by NLR seemed to be a more important determinant of progression of kidney dysfunction.

Association between resolution of fragmented QRS and response to cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) has been recommended for patients with symptomatic heart failure and a wide QRS. Fragmented QRS (fQRS) on a 12-lead electrocardiography (ECG) has been shown to predict cardiac events. We aimed to investigate the relationship between resolution of fQRS and response to CRT. METHODS: Sixty-seven consecutive patients (38 men, mean age 65 ± 11) with left bundle branch block and fQRS on ECG undergoing CRT were studied. The presence of fQRS was assessed using standardized criteria. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume (LVESV) and resolution of fQRS was defined as decrease in number of leads with fQRS on ECG at 6 months follow-up. RESULTS: Thirty-nine patients (58%) had response to CRT. LVESV significantly decreased from 150 ± 64 to 100 ± 48 in responders (P = 0.001). There was not any significant decrease in nonresponders (LVESV; from 157 ± 70 to 153 ± 66, P = 0.45). The number of leads with fQRS was decreased from 4.4 ± 1.8 to 1.7 ± 1.6 in responder patients (P < 0.001). The number of leads with fQRS was not significantly changed in nonresponders. (4.2 ± 2.2 vs. 5.1 ± 2.4, P = 0.06). In multivariate analysis, significant associates of response to CRT was evaluated adjusting for etiology of cardiomyopathy, baseline QRS width, left ventricular ejection fraction, number of leads with fQRS and resolution of fQRS. Resolution of fQRS was the only predictor of response to CRT (OR 0.018, 95% CI, 0.004-0.083, P < 0.001). CONCLUSIONS: After adjusting for potential confounders, resolution of fQRS, is associated with response to CRT.

Discharge risk scoring method for predicting mortality in hospitalized chronic heart failure patients with severe systolic dysfunction.

OBJECTIVE: Prognostic risk stratification in heart failure is crucial to guide clinical decision-making.The aim of our study was to develop a prognostic discharge risk score model to predict all-cause mortality for chronic heart failure patients with multiple co-morbidities and severe systolic dysfunction. METHODS AND RESULTS: A multivariable logistic regression model was developed with the use of data on clinical, laboratory, imaging and therapeutic findings of 630 patients with advanced systolic heart failure. A risk score model was developed based on multiplying the beta-coefficient number of each variable in the multivariable model. The model performance was evaluated by concordance index and internally validated by the bootstrapping method. 313 patients (49.7%) of the cohort died during a median follow-up duration of 54 months. Median age was 66 years, 37% were female, 26% had atrial fibrillation and 40% had diabetes mellitus. The mean left ventricular ejection fraction (EF) was 25 +/- 10% and 264 patients (42%) had left ventricular EF < or = 20%. Independent predictors of mortality were older than 70 years, orthopnoea, previous hospitalisations, lack of renin-angiotensin system inhibitor therapy at discharge, hyperuricaemia (>7 mg/dl) and haemoglobin level (<10 g/dL). Discharge risk score identified low-, intermediate- and high-risk individuals with 18%, 40% and 52% mortality rates, respectively. The risk score had a discrimination ability with a concordance index of 0.70. CONCLUSIONS: In a large heart failure cohort, including patients with severe systolic dysfunction and having multiple comorbidities, a simple discharge risk score with non-invasive and easy-to-obtain variables during hospital admission represents a valuable tool for risk assessment.

What is the lowest value of left ventricular baseline ejection fraction that predicts response to cardiac resynchronization therapy?

BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with refractory heart failure. However, many patients do not respond to therapy. Although it has been thought that there was no relation between response to CRT and baseline ejection fraction (EF), the response rate of patients with different baseline LVEF to CRT has not been evaluated in severe left ventricular systolic dysfunction. We aimed to investigate any difference in response to CRT between the severe heart failure patients with different baseline LVEF. MATERIAL AND METHODS: In this study, 141 consecutive patients (mean age 59±13 years; 89 men) with severe heart failure and complete LBBB were included. Patients were divided into 3 groups according to their baseline LVEF: 5-15%, Group 1; 15-25%, Group 2, and 25-35%, Group 3. NYHA functional class, LVEF, LV volumes, and diameters were assessed at baseline and after 6 months of CRT. A response to CRT was defined as a decrease in LVSVi (left ventricular end-systolic volume index) ≥10% on echocardiography at 6 months. RESULTS: After 6 months, a significant increase of EF and a significant decrease of LVESVi and LVEDVi after 6 months of CRT were observed in all groups. Although the magnitude of improvement in EF was biggest in the first group, the percentage of decrease in LVESVi and LVEDVi was similar between the groups. The improvement in NYHA functional class was similar in all EF subgroups. At 6-month follow-up, 100 (71%) patients showed a reduction of >10% in LVESVi (mean reduction: -15.5±26.1 ml/m^2) and were therefore classified as responders to CRT. Response rate to CRT was similar in all groups. It was 67%, 75%, and 70% in Group 1, 2, and 3, respectively, at 6-month follow-up (p>0.05). There was no statistically significant relation between the response rate to CRT and baseline LVEF, showing that the CRT has beneficial effects even in patients with very low LVEF. CONCLUSIONS: It seems there is no lower limit for baseline LVEF to predict non-response to CRT in eligible patients according to current guidelines.

Arrhythmogenic right ventricular cardiomyopathy in pregnancy.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is predominantly a genetically determined heart muscle disorder that is characterized by fibro-fatty replacement of the right ventricular (RV) myocardium.(1)) The clinical spectrum of ARVC may represent from asymptomatic premature ventricular complexes to ventricular tachycardia (VT) and sudden cardiac death (SCD). It is a well-known leading cause of SCD in young adults.(2,3))There is no general consensus on the management of ARVC in pregnancy, and the preferred mode of delivery is uncertain. Herein, we report a case of ARVC diagnosed at 20 weeks of gestation following a sustained VT and treated with an implantable cardiac defibrillator (ICD). We also reviewed the current knowledge and approach to ARVC in pregnancy since the literature on this condition is based on case reports.

The Use of Cangrelor as Bridge Antiplatelet Therapy in a Patient with Recent Percutaneous Coronary Intervention for Acute Coronary Syndrome, Who Developed Esophageal Perforation After Transesophageal Echocardiography.

Dual antiplatelet therapy (DAPT) is a vital part of the pharmacological management in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). While early discontinuation of DAPT increases ischemic risk, some patients on DAPT may require urgent surgery, necessitating its interruption. Cangrelor, an intravenous P2Y12 antagonist, provides strong platelet inhibition within minutes and platelet activity normalizes within one hour after the cessation of the drug. Bridging antiplatelet therapy with cangrelor has been increasingly studied as an alternative option to ensure the continuation of platelet inhibition in CAD patients who require discontinuation of DAPT. The present patient, with a recent history of PCI for acute coronary syndrome, experienced a significant esophageal perforation following transesophageal echocardiography (TEE). This severe complication was effectively managed endoscopically, and as part of the recent PCI treatment, prolonged cangrelor infusion was successfully utilized with no thrombotic or bleeding events throughout the management of the complication.

Neutrophil-to-lymphocyte ratio predicts response to cardiac resynchronization therapy.

BACKGROUND: Neutrophil-to-lymphocyte (N/L) ratio has been associated with adverse outcomes in patients with acute coronary syndromes and increased risk for long-term mortality in patients with acute decompensated heart failure. We aimed to investigate the prognostic value of neutrophil-to-lymphocyte ratio on response to cardiac resynchronization therapy (CRT). MATERIAL AND METHODS: Seventy consecutive patients (mean age 58 ± 13 years; 40 men) undergoing CRT were included in the study. Hematological and echocardiographic parameters were measured before and 6 months after CRT. Echocardiographic response to CRT was defined as a ≥ 15% reduction in left ventricular end-systolic volume at 6-month follow-up. RESULTS: After 6 months of CRT, 49 (70%) patients were responders. After 6 months, left ventricular ejection fraction (LVEF) had significantly increased, from 21 ± 7% to 34 ± 11% in responder patients (p = 0.001). N/L ratio decreased significantly, from 2.4 ± 1 to 2.1 ± 0.7 in responders (p = 0.04). In multivariate analysis, significant associates of echocardiographic response to CRT was evaluated adjusting for age, etiology of cardiomyopathy, baseline LVEF, New York Heart Association functional class, C-reactive protein, and baseline N/L ratio. Baseline N/L ratio was the only predictor of response to CRT (OR 1.506, 95% CI, 1.011-2.243, p = 0.035). CONCLUSIONS: N/L ratio at baseline could help to identify patients with response to CRT.

A Transient Inferolateral ST-Segment Elevation on the Electrocardiogram Due to an Iatrogenic Left-Sided Pneumothorax After an Urgent Tracheostomy in a Patient with Metastatic Hypopharynx Cancer.

The presence of ST-segment elevation on the electrocardiogram alerts physicians in patients with chest pain. Emergency coronary angiography is usually performed in these patients. However, there are many conditions that cause ST-segment elevation on the electrocardiogram, such as pericarditis, hyperkalemia, Brugada syndrome, hypothermia, and early repolarization. Pneumothorax is a rare complication of tracheostomy and its symptoms are sudden chest pain and dyspnea. Also, it has been known that pneumothorax may cause ST-segment changes on the electrocardiogram. We presented a transient inferolateral ST-segment elevation on the electrocardiogram due to an iatrogenic left-sided pneumothorax after an urgent tracheostomy in a patient with metastatic hypopharynx cancer and normal coronary angiogram.

A successful endovascular treatment of a patient with extended-spectrum beta-lactamase positive Escherichia coli related emphysematous distal abdominal aortitis rapidly progressing to a saccular aneursym.

Infectious aortitis is a rare disease and associated with adverse clinical outcomes. A 66-year-old man was admitted to the emergency department with abdominal and lower back pain, fever, chills, and anorexia continuing for a week. A contrast-enhanced computed tomography (CT) scan of the abdomen showed multiple periaortic enlarged lymphatic nodes, mural wall thickening, and gas collections in the infrarenal aorta and proximal segment of right common iliac artery. The patient was hospitalized with the diagnosis of acute emphysematous aortitis. During hospitalization, extended-spectrum beta-lactamase-positive Escherichia coli was grown in all blood and urine cultures. Despite sensitive antibiotherapy, abdominal and back pain, inflammation biomarkers, and fever of the patient were not improved. Control CT demonstrated a newly developed mycotic aneurysm, increased intramural gas collection, and periaortic soft-tissue thickening. Urgent vascular surgery was recommended to the patient by the heart team, but the patient rejected surgery due to the high perioperative risk. Alternatively, an endovascular rifampin-impregnated stent-graft was successfully implanted and antibiotics were completed at 8 weeks. After procedure, inflammatory indicators were normalized and clinical symptoms of the patient were resolved. No microorganism grew on control blood and urine cultures. The patient was discharged with a good health. Learning objective: Aortitis should be suspected in patients who present with fever, abdominal and back pain, especially in the presence of predisposing risk factors. Infectious aortitis (IA) accounts for a small part of all aortitis cases and the most common causative microorganism is Salmonella. The mainstay treatment of IA is sensitive antibiotherapy. Surgery may be required in patients who are unresponsive to antibiotics or develop aneurysm. Alternatively, endovascular treatment can be performed in selected cases.

Thyroid Functions Are Associated with All-Cause Long-Term Mortality in Elderly Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

OBJECTIVE: Our aim in this study was to show the relationship between long-term all-cause mortality and thyroid functions in the elderly patient group that underwent primary percuta-neous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction. METHODS: Two-hundred seventy patients over 65 years of age who underwent primary percutaneous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction were analyzed retrospectively. After applying the exclusion criteria, 198 patients were included in the study. The patients were divided into 2 groups according to their out-of-hospital mortality status. Angiographic, laboratory, echocardiographic, and electrocardiographic data were analyzed. RESULTS: The mean age of 198 patients in the study was 72.5 ± 6.6 years, and the median follow-up time was 101.7 months. Age was higher in the deceased group (70.4 ± 5.4 vs. 74.5 ± 6.9, P < 0.001). In multivariate analysis, age (odds ratio: 1.59, P = 0.003), insulin (odds ratio: 2.561, P = 0.016), angina balloon time (odds ratio: 1.134, P = 0.002), number of serious stenoses (odds ratio: 1.702, P = 0.003), creatinine (odds ratio: 3.043, P < 0.001), and fT4 (odds ratio: 2.026, P = 0.026) were determined as independent predictors of mortality. The fT4 level was correlated with the uric acid level (R: 0.182, P = 0.02) and the fT3 level was correlated with albumin (R: -0.253, P = 0.001) and creatinine (R: -0.224, P = 0.003) levels. A fT4 level cutoff value of 0.99 ng/mL had a sensitivity of 76%, a specificity of 54%, and an area under the curve of 0.675 in predicting mortality. In Kaplan-Meier analysis, fT4 elevation was strongly associated with mortality (P = 0.01). CONCLUSION: In our study, subclinical values in thyroid functions were found to be associated with increased mortality, apart from known factors in elderly patients who underwent primary PTCA with the diagnosis of ST-segment elevation myocardial infarction.

The Relationship Between Coronary Anatomy and Angina Pectoris During Stent Balloon Dilatation in Patients Undergoing Percutaneous Coronary Intervention.

OBJECTIVE: Angina pectoris (AP) is defined as a clinical symptom characterized by sensations such as pressure-heaviness, burning, squeezing, or discomfort in different parts of the body, including the retrosternum, chest, jaw, neck, shoulders, and back. Limited publications exist on the impact of coronary artery disease localization on the placement, character, and severity of AP. This study aimed to investigate the relationship between the frequency of AP development due to myocardial ischemia during percutaneous coronary intervention (PCI), its character, severity, localization, and coronary anatomy. METHODS: A total of 128 patients were included in the study, with 146 lesions treated among them. RESULTS: Among patients who underwent PCI of the right coronary artery (RCA), 31.1% reported no complaints. Similar rates were observed in patients undergoing PCI of the left anterior descending (LAD) and circumflex (Cx) arteries, at 23.7% and 19.1%, respectively. Pressure-heaviness was frequently observed in PCI of the LAD and Cx arteries, while burning was the dominant symptom description in PCI of the RCA. The isolated retrosternal and left thoracic regions were the most common localizations in all main coronary arteries. Epigastric localization occurred most frequently in PCI of the RCA. In terms of the severity of angina, no significant difference was observed between the three coronary arteries. CONCLUSION: Pressure-heaviness angina was commonly observed during PCI of the LAD and Cx, while burning angina was frequent during PCI of the RCA. The severity of AP was similar across the three main coronary arteries.

The Utility of Systemic Immune-Inflammation Index for Predicting Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

OBJECTIVE: The systemic immune-inflammation index (SII), derived from counts of neutrophils, platelets, and lymphocytes, has been developed to predict clinical outcomes in several cancers and cardiovascular diseases. The aim of this study was to evaluate the utility of SII to predict contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS: A total of 632 patients with STEMI who underwent primary PCI were retrospectively included. The patients were divided into two groups based on the presence or absence of CIN. Baseline demographic, laboratory, and clinic characteristics were evaluated between the two groups. Logistic regression analysis was used to identify independent predictors of CIN. RESULTS: The receiver operating characteristic curve analysis demonstrated that the optimal cutoff value of SII for predicting CIN was 1,282 with a sensitivity of 76.1% and specificity of 86.7% (AUC: 0.834; 95% CI: 0.803-0.863; p < 0.001). Multivariate analysis performed in two models (SII; as separate continuous and categorical variables) showed age, estimated glomerular filtration rate (eGFR), diabetes, left ventricular ejection fraction (LVEF), Killip class ≥2, use of an intravenous diuretic, troponin I, and SII as independent predictors of CIN in model 1. In model 2, age, eGFR, diabetes, LVEF, Killip class ≥2, use of an intravenous diuretic, troponin I, and a value of SII >1,282 (p < 0.001, OR 6.205, 95% CI: 2.301-12.552) remained as independent predictors of CIN. CONCLUSION: SII may be a useful and reliable indicator to predict the development of CIN in patients with STEMI undergoing primary PCI than NLR and PLR.

The Systemic Immune-Inflammation Index May Predict the Coronary Slow Flow Better Than High-Sensitivity C-Reactive Protein in Patients Undergoing Elective Coronary Angiography.

Methods: A total of 197 patients (102 patients with CSF; 95 patients with normal coronary flow) were included in this retrospective study. Clinical and angiographic characteristics of patients were obtained from hospital records. Results: Patients with CSF had higher SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and high-sensitivity C-reactive protein (hsCRP) levels compared with the control group. Body mass index (p=0.022, OR 1.151, 95% CI 1.121-1.299), low-density lipoprotein (p=0.018, OR 1.028, 95% CI 1.005-1.052), hsCRP (p=0.044, OR 1.161, 95% CI 1.004-1.343), and SII (p < 0.001, OR 1.015, 95% CI 1.003-1.026) were independent predictors of CSF in the multivariable analysis. The optimal cutoff value of SII in predicting CSF was >877 in ROC curve analysis (p < 0.001, AUC = 0.892, 95% CI 0.848-0.936). This cutoff value of SII predicted the CSF with a sensitivity of 71.5% and specificity of 92.4%. Spearman correlation analysis showed a positive correlation between the mean TFC value and PLR, NLR, hsCRP, and SII. Conclusions: SII may be used as a better indicator for the prediction of CSF than hsCRP.