A guidewire-free approach for percutaneous closure of left ventricular pseudoaneurysm.

A 78-year-old male patient with a history of coronary artery disease (he had undergone coronary artery bypass surgery 4 years ago), heart failure with mildly reduced ejection fraction, diabetes mellitus, and transient ischemic attack presented to the emergency department with complaints of dyspnea (New York Heart Association Class 4) despite the optimal medical therapy.

A novel technique to reach the contralateral iliac artery in Leriche syndrome.

BACKGROUND/OBJECTIVE: The endovascular approach is the first choice of treatment in high-risk patients suffering from Leriche syndrome. Although many techniques and devices have been developed, there are still difficulties in accessing the true lumen. Herein, we reported a novel technique to increase the support and ease of crossing the lesion. METHOD: We presented a case report of a 45-year-old male patient with Leriche syndrome. The patient refused surgery; therefore, he was scheduled for endovascular treatment. RESULTS: We attempted to cross the right and left common iliac occlusions by intraluminal crossing. The left common iliac artery couldn't be cannulated despite the stiff wires and percutaneous intentional extraluminal revascularization (PIER). Afterward, a cross-over approach was performed from the right side to reach the ostium of the left common iliac artery. To increase the support, a non-absorbable suture was stitched up to the tip of the guiding catheter and kept slightly taut like a lasso. Finally, successful penetration was achieved with the novel assistive technique. CONCLUSION: Endovascular treatment for Leriche syndrome is a precious alternative to open surgery. Intraluminal crossing, PIER, and re-entry devices are the most preferred techniques. Increasing the technical success of intraluminal crossing and PIER leads to an apparent reduction in cost.

Cardioneuroablation for treatment of carotid sinus syndrome secondary to oropharyngeal squamous cell cancer.

Head and neck tumors can rarely cause carotid sinus syndrome and this often resolves by surgical intervention or palliative chemoradiotherapy. If these modalities are not an option or are ineffective, the most preferred treatment is permanent pacemaker therapy. Here, we present the first case of cardioneuroablation treatment performed in patient with oropharyngeal squamous cell cancer who developed recurrent asystole and syncope attacks due to compression of the carotid sinus on neck movement.

The Relationship between Coronary Artery Calcium Score and Monocyte to High-Density Lipoprotein Cholesterol Ratio in Patients with Stable Angina Pectoris.

OBJECTIVE: Coronary artery calcification is a cornerstone marker for coronary atherosclerosis. Therefore, the calculation of the coronary artery calcium score has become a routine method in diagnosing coronary artery disease in recent years. Monocyte to high-density lipoprotein cholesterol ratio reflects proatherogenic and antiatherogenic balance, and this ratio is associated with coronary atherosclerosis and cardiovascular events. This study aimed to investigate the value of monocyte to high-densitylipoprotein cholesterol ratio in predicting coronary atherosclerosis, which coronary artery calcium score determines. METHODS: A total of 276 patients with chest pain who underwent coronary computed tomography angiography were enrolled in the study. The patients were divided into 3 groups according to coronary artery calcium score [coronary artery calcium score=0 for very low risk (n=121), coronary artery calcium score=1-99 for low risk (n=100), coronary artery calcium score ≥ 100 for moderate-high risk (n=55)]. The monocyte to high-density lipoprotein cholesterol ratio, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and plateletto-lymphocyte ratio were calculated from venous blood samples. RESULTS: Monocyte to high-density lipoprotein cholesterol ratio values were significantly higher in patients with moderate-high coronary artery calcium score (1.29 ± 0.59 vs 1.41 ± 0.56 vs 1.56 ± 0.58, P =.009). However, there were no differences between the groups in terms of other inflammatory markers (neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and platelet-to-lymphocyte ratio). Age (odds ratio: 1.178; 95% CI: 1.107-1.253; P < .001), dyslipidemia (odds ratio: 14.252; 95% CI: 5.459-37.211; P <.001), smoking (odds ratio: 2.893; 95% CI: 1.317-6.358; P=.008), and monocyte to high-density lipoprotein cholesterol ratio (odds ratio: 2.082 per 1-point increase; 95% CI: 1.016-4.268; P=.045) were independent predictors of coronary artery calcium score in multivariate analysis. CONCLUSION: Our data showed that high monocyte to high-density lipoprotein cholesterol ratio is significantly associated with increased coronary artery calcium score. Monocyte to highdensity lipoprotein cholesterol ratio indicates that it can be applied easily and swiftly in clinics to help predicting the coronary artery disease.

Role of the coronary and non-coronary cardiovascular findings on non-cardiac gated thoracic CT in predicting mortality in SARS-CoV-2 infection.

BACKGROUND: The potential effects of cardiovascular comorbidities on the clinical outcomes in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection remain unclear. Identification of the coronary and non-coronary cardiovascular findings may help to stratify the patients' prognosis. Therefore, we aimed to evaluate the prognostic impact of the coronary and the non-coronary cardiovascular findings in SARS-CoV-2 patients. METHODS: We studied a total of 594 SARS-CoV-2 patients who were hospitalized and performed a non-cardiac gated thoracic computed tomography. Two blinded radiologists assessed the coronary artery calcification segment involvement score (CACSIS) and non-coronary atherosclerosis cardiovascular findings (NCACVF). The baseline characteristics of the patients and CT findings were evaluated according to survival status. Logistic regression analyses were performed to identify the independent predictors of mortality. RESULTS: At a mean follow-up of 8 (4-12.5) days, 44 deaths occurred (7.4%). Compared to survivors, non-survivors had increased CACSIS [27.3% (CACSIS = 0) vs 25% (CACSIS 1-5) vs 47.7% (CACSIS >5), p < 0.001]. Similarly, on NCACVF, non-survivors had much more major findings compared to survivors (29.5% vs. 2.7%, respectively, p < 0.001). At multivariable analysis, age (p = 0.009), creatinine (p < 0.001), hs-cTnI (p = 0.004) and NCACVF (HR 1.789; 95% CI 1.053-3.037; p = 0.031) maintained a significant independent association with in-hospital mortality. CONCLUSION: Our study shows that coronary and non-coronary cardiovascular findings on non-cardiac gated thoracic CT may help to predict mortality in patients with SARS-CoV-2 infection.

Association of Serum Osmolarity With Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction.

Contrast-induced nephropathy (CIN) is a prevalent and serious complication after primary percutaneous coronary intervention (pPCI). Although the association between serum osmolarity and chronic kidney disease is well established, its relation to CIN in patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI needs to be elucidated. We evaluated the predictive value of serum osmolarity for CIN development in patients with STEMI (n = 768) undergoing pPCI. Serum osmolarity on admission was calculated. The study population was divided into 2 groups according to CIN development, and both groups were compared according to clinical, laboratory, and demographic features, including the serum osmolarity. Serum osmolarity was significantly higher in patients with CIN than in those without CIN (278 [8] vs 284 [9]; P = .024). Serum osmolarity (odds ratio: 1.052; 95% confidence interval: 1.018-1.086; P = .002), hemoglobin, contrast media volume, creatinine on admission, basal SYNergy between PCI with TAXus and cardiac surgery II score, and left ventricular ejection fraction were found to be independent predictors of CIN. Serum osmolarity (given the simple calculation of this parameter on admission) can be useful to define patients with STEMI undergoing pPCI who are more likely to develop CIN.

Assessment of Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Artery Disease Severity in Patients With Acute Coronary Syndrome.

The association of coronary artery disease (CAD) severity with increased C-reactive protein (CRP) and decreased albumin levels has been reported. However, to our knowledge, no study has investigated the usefulness of the CRP to albumin ratio (CAR) in predicting intermediate-high SYNergy between Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score (SS) and high SS II. Consecutive patients (n = 344) treated with percutaneous coronary intervention comprised the study population. The study population was divided into 2 groups according to SS >22 and mean SS II values, respectively. Patients with intermediate-high SS and high SS II had higher CAR than patients with low SS and SS II. History of diabetes mellitus, decreased albumin, lower left ventricular ejection fraction, and elevated CAR (odds ratio [OR]: 1.020; 95% confidence interval [CI], 1.009-1.031; P < .001) were independent predictors of high SS. The presence of hypertension, decreased hemoglobin and albumin levels, and increased CAR (OR: 1.014; 95% CI, 1.004-1.023; P < .001) were independent predictors of SS II. In receiver operating characteristic curve comparison, CAR was superior to CRP and albumin in prediction of intermediate-high SS, but only CRP in prediction of high SS II. The CAR calculated from the admission blood samples could be a useful parameter for predicting CAD severity using SS and SS II.

The association of PRECISE-DAPT score with development of contrast-induced nephropathy in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Given that parameters used in the calculation of the PRECISE-DAPT risk score are important contributors to contrast-induced nephropathy (CIN) development, we hypothesized that the PRECISE-DAPT risk score would show good accuracy for predicting CIN in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Therefore, in this study, we aimed to determine the predictive value of the admission PRECISE-DAPT score for the occurrence of CIN in patients with STEMI treated with primary PCI. After evaluation regarding with exclusion criteria, 1280 patients were, respectively, enrolled in the study. The primary end-point was the incidence of CIN. The PRECISE-DAPT score of CIN group was higher than the non-CIN group [31 (24-41) vs. 14 (9-23), p < 0.001, respectively]. In multivariate logistic regression analysis, PRECISE-DAPT score was independently associated with the development of CIN [odds ratio (OR) 1.090, 95% confidence interval (CI) 1.066-1.114, p < 0.001]. A receiver-operating characteristic (ROC) analysis was drawn to show the best cut-off value of the PRECISE-DAPT score to predict CIN was ≥ 21 with 81.3% sensitivity and 72.7% specificity [area under curve (AUC): 0.834; 95% CI 0.812-0.854; p = 0.017]. The PRECISE-DAPT score may be a significant independent predictor of CIN in patients with STEMI treated with primary PCI. Therefore, follow-up of patients with higher PRECISE-DAPT score should be performed more cautiously, and it should be noted that the development of CIN risk of these patients group is high.

Successful treatment of massive thrombosis in different locations with prolonged thrombolytic therapy: A life-saving intervention.

Venous thrombosis is recognized as one of the most important complications of nephrotic syndrome (NS). In patients with NS, venous thrombosis may develop in the renal veins, the deep veins of the lower limb, and the inferior vena cava. Here, we describe a case report of an NS patient with multiple venous thrombosis in the right renal vein, the left iliac vein, the vena cava inferior, the right atrium, and the pulmonary arteries. Moreover, we describe the successful treatment of multiple venous thrombosis with prolonged thrombolytic treatment in spite of an increased risk of bleeding due to renal biopsy.

Usefulness of The C-Reactive Protein/Albumin Ratio for Predicting No-Reflow in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: The ratio of serum C-reactive protein (CRP) to albumin has been proven to be a more accurate indicator than albumin and CRP levels alone in determining the prognosis of patients with cancer and critical illness. The aim of this study was to determine whether the CRP/albumin ratio (CAR) can be linked to imperfect reperfusion that can worsen the prognosis of ST-elevation myocardial infarction (STEMI) in patients treated with primary percutaneous coronary intervention (pPCI). MATERIALS AND METHODS: A total of 1217 consecutive STEMI patients who achieved epicardial vessel patency with pPCI were recruited to this study. RESULTS: The study population was divided into 2 groups: reflow (n = 874) and no-reflow (NR) (n = 343) groups. The white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR) and CAR (0.03 [0.01-0.04] vs 0.06 [0.03-0.12] (P < .001) were significantly higher in the NR group than in the reflow group, and these factors were found to be independent predictors of NR development. The best cut-off value of CAR predicting NR was 0.59 with a sensitivity of 54.7% and specificity of 86.7. The predictive power of CAR surpassed that of CRP, albumin, WBC count and NLR in the receiver operator curve (ROC) curve comparison. CONCLUSION: No-reflow can be predicted by systemic inflammation markers including WBC count, NLR and CAR measured from the blood sample obtained on admission. CAR has a higher clinical value than CRP, albumin level, WBC count and NLR in NR prediction.

Assessment of the relationship between reperfusion success and T-peak to T-end interval in patients with ST elevation myocardial infarction treated with percutaneous coronary intervention.

OBJECTIVE: T-peak-T-end (TPE) interval, which represents the dispersion of repolarization, is defined as the interval between the peak and end of the T-wave, and is associated with increased malignant ventricular arrhythmia and sudden cardiac death (SCD) in patients with ST elevation myocardial infarction (STEMI). Although prolonged TPE interval is associated with poor short- and long-term outcomes, even in patients with STEMI treated with successful primary percutaneous coronary intervention (pPCI), clinical, angiographic, and laboratory parameters that affect TPE remain to be elucidated. The aim of our study was to evaluate the potential relationship between prolonged TPE interval and reperfusion success using ST segment resolution (STR) in patients with STEMI undergoing pPCI. METHODS: In the current study, 218 consecutive patients with STEMI who underwent pPCI were enrolled; after exclusion, 164 patients were included in the study population. RESULTS: Patients were divided into two groups according to the presence of complete (STR%≥70) or incomplete (STR%<70) STR. Preprocedural corrected TPE (cTPEPRE;116±21 ms vs. 108±21 ms; p=0.027), postprocedural TPE (TPEPOST; 107±16 ms vs. 92±21 ms; p<0.001), and postprocedural cTPE (cTPEPOST; 119±19 ms vs. 102±17 ms; p<0.001) intervals were significantly longer in patients with incomplete STR than in patients with complete STR, whereas there was no statistically significant difference between the two groups in terms of pre- and postprocedural and corrected QT intervals. cTPEPRE and cTPEPOST were found to be independent predictors for incomplete STR. CONCLUSION: To our knowledge, this is the first study that evaluated the relationship between TPE interval and no-reflow defined by STR in patients with STEMI who were treated with pPCI.

Association of Syntax Score II with Contrast-induced Nephropathy and Hemodialysis Requirement in Patients with ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (pPCI) and is associated with high mortality and morbidity and long hospital stay in patients with ST elevation myocardial infarction (STEMI). The Syntax Score (SS) has previously been studied in STEMI patients, and it was associated with increased CIN development and long-term mortality. This study investigates a possible relationship between CIN development and Syntax Score II (SSII) and compares SS and SSII by assessing CIN risk in STEMI patients treated with pPCI. METHODS: A total of 1,234 patients who underwent pPCI were divided into 2 groups according to CIN development. Patients with CIN were further divided into 2 groups according to whether or not they required hemodialysis. Reclassification tables, net reclassification improvement, and integrated discriminative improvement methods were used to assess the additive predictive value of SSII for predicting CIN. RESULTS: In the present study, 166 patients (13.5%) had CIN. Although both SS and SSII were significantly higher in CIN patients, only SSII was an independent predictor of CIN (odds ratio [OR], 1.031; 95% confidence interval [CI], 1.012-1.051; p<0.001) and hemodialysis requirement (OR, 1.078; 95% CI, 1.046-1.078; p<0.001). When comparing SSII and SS in their ability to determine CIN risk, we found SSII to have a reclassification improvement of 27.59% (p<0.001) and an integrated discrimination improvement of 9.1% (p<0.001). CONCLUSIONS: The combination of clinical and anatomic variables can more accurately identify patients who are at high risk for CIN after pPCI. While SSII is harder to calculate than SS, it provides better prediction for CIN and hemodialysis requirement than SS.

Association of the SYNTAX Score II with cardiac rupture in patients with ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention.

BACKGROUND: Despite advances in reperfusion strategies, medical therapy, and emergent surgery, cardiac rupture (CR) is still a major lethal complication. Numerous parameters have been found to be associated with CR development after a primary percutaneous coronary intervention (pPCI). SYNTAX Score (SS) and SYNTAX Score II (SSII) have been studied in ST-segment elevation myocardial infarction (STEMI) patients, and higher scores have been associated with higher mortality. However, the relationship between CR and SSII is unclear. This study investigates the possible relationship between CR and SS, SSII in STEMI patients treated with pPCI. PATIENTS AND METHODS: We enrolled 1663 consecutive STEMI patients treated with pPCI, who were divided into two groups according to CR development and compared with each other. Patients were further stratified into the three groups according to their SSII values. RESULTS: In this study, 33 (1.98%) patients developed CR. Both SS and SSII of those with CR were significantly higher than those without (19.27±4.0 vs. 16.40±4.55; P<0.001 and 49.40±16.54 vs. 30.92±11.80; P<0.001, respectively). It was also observed that CR increased gradually according to increasing SSII tertiles. SSII was found to be an independent predictor for CR (odds ratio=1.043, 95% confidence interval: 1.012-1.074; P=0.006). In the long-term follow-up, all-cause mortality was significantly higher in patients with CR than those without (60.6 vs. 8.8%; P<0.001). CONCLUSION: This study shows that SSII is an independent predictor for CR. Furthermore, patients with CR were associated with a poor prognosis. Closer follow-up of patients with high SSII may be useful in the early detection and treatment of this fatal complication.

Predictive value of red cell distribution width in intrahospital mortality and postintervention thrombolysis in myocardial infarction flow in patients with acute anterior myocardial infarction.

OBJECTIVES: Recent studies have reported a strong independent association between increased red cell distribution width (RDW) and the risk of adverse outcomes in patients with heart failure, stable coronary disease, and acute coronary syndromes. However, in this study we aimed to determine the impact of an elevated RDW level on the postinterventional thrombolysis in myocardial infarction (TIMI) flow and intrahospital mortality in patients with acute anterior myocardial infarction (AMI). METHODS: A total of 763 patients with acute AMI undergoing a primary percutaneous coronary intervention were evaluated retrospectively. Upon admission, the RDW level was measured by an automated complete blood count. Postinterventional TIMI flow and intrahospital mortality was documented for all patients from hospital registries. The patients were classified according to the RDW level. RDW more than 14.8% was defined as elevated RDW. All groups were compared statistically according to the preinterventional characteristics. RESULTS: Elevated RDW was found to be an independent predictor of increased intrahospital mortality in multivariate regression analysis (hazard ratio: 3.677, 95% confidence interval: 1.228-11.008, P=0.02). Other independent predictors for intrahospital mortality were diabetes mellitus (hazard ratio: 6.743, 95% confidence interval: 1.941-23.420, P=0.003), smoking (hazard ratio: 6.779, 95% confidence interval: 1.505-30.534, P=0.013), and creatinine more than 0.8 mg/dl (hazard ratio: 7.982, 95% confidence interval: 1.759-36.211, P=0.007). However, there were no independent predictors for TIMI including elevated RDW. CONCLUSION: A high admission RDW level in patients with acute AMI undergoing a primary percutaneous coronary intervention was associated with an increased risk for intrahospital cardiovascular mortality, but was not associated with worse postinterventional TIMI flow.

Initial dose effect of 5-fluorouracil: rapidly improving severe, acute toxic myopericarditis.

5-Fluorouracil (5-FU) has a significant antineoplastic activity and has been used for the management of various malignant neoplasms. Cardiotoxicity of 5-FU is rare but may be life-threatening. A 55-year-old female patient was admitted to our hospital with atypical chest pain. Her electrocardiogram revealed widespread ST-segment elevations, and she had an elevated troponin level. Transthoracic echocardiography revealed global myocardial hypokinesia with impaired left ventricular systolic function (ejection fraction, 20%). Coronary angiography revealed normal coronary arteries with no vasospasm, and therefore, she was hospitalized with the diagnosis of acute toxic myopericarditis and was treated medically. In literature, this case is the first case of acute toxic myocarditis occurring because of the first dose of 5-FU.

An unusual microorganism, Aerococcus viridans, causing endocarditis and aortic valvular obstruction due to a huge vegetation.

Aerococcus viridans is not a common pathogen, and endocarditis due to A. viridans is very rare. A 44-year-old woman with persistent atrial fibrillation and rheumatic valvular heart disease was admitted with fever, sweating, weakness, and progressive shortness of breath. Transthoracic echocardiography (TTE) demonstrated a 8x9-mm vegetation attached to the right coronary cusp of the aortic valve, causing aortic obstruction. Blood cultures yielded A. viridans susceptible to penicillin. Despite optimal antibiotherapy, subsequent TTE controls revealed enlargement of the vegetation, reaching a size of 21x10 mm, and an increasing gradient across the aortic valve. The patient underwent successful aortic and mitral valve replacement and was stable in the postoperative period without any problem. This represents the first reported case of A. viridans endocarditis in which the size and location of vegetation caused obstruction to blood flow, indicating surgery.