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Abstract Background A recently identified viral illness called coronavirus disease 2019 (COVID-19) is spreading quickly. Numerous cardiovascular issues such as arrhythmias and electrocardiogram (ECG) alterations have been linked to COVID-19. Objective In this investigation, we compared ECG indicators of depolarization and repolarization heterogeneity between symptomatic individuals who complained of palpitations and chest discomfort following COVID-19 and those who did not. Methods In this prospective case-control study, 56 post-COVID-19 patients who did not have any symptoms of chest discomfort or palpitations were included in the control group and compared with a study group comprising 73 post-COVID-19 patients who presented at the outpatient clinic with complaints of chest pain and palpitation. Electrocardiographic (ECG) measures were used to assess depolarization and repolarization of the ventricles. These measures included the Tpeak-Tend (Tp-e) interval, QT dispersion (QTd), Tp-e/QT ratio, Tp-e/QTc ratio, frontal QRS-T (fQRS-T) angle, and fragmented QRS (FQRS). Two cardiologists recorded the patients' ECG data. A statistically significant result was defined as a p value less than 0.05. Results The results of multivariate analysis including FQRS, Tp-e interval, Tp-e/QT, and Tp-e/cQT showed that presence of FQRS (OR: 6.707, 95% CI: 1.733-25.952; p = 0.006) was an independent predictor of symptomatic post-COVID -19 patients. Conclusion In our study, FQRS was found to be significantly higher in symptomatic post-COVID-19 patients than in non-symptomatic post-COVID-19 patients, while Tp-e interval was found to be lower.
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Resumo Fundamento: A isquemia com artéria coronária não obstrutiva (INOCA) é uma doença cardíaca isquêmica que inclui principalmente disfunção microvascular coronariana e/ou vasoespasmo coronariano epicárdico devido à disfunção vascular coronariana subjacente e pode ser observada mais comumente em pacientes do sexo feminino. O índice de inflamação imunológica sistêmica (SII, relação plaquetas × neutrófilos/linfócitos) é um novo marcador que prediz resultados clínicos adversos na doença arterial coronariana (DAC). Objetivo: Este estudo tem como objetivo investigar a relação entre INOCA e SII, um novo marcador associado à inflamação. Métodos: Um total de 424 pacientes (212 pacientes com INOCA e 212 controles normais) foram incluídos no estudo. Amostras de sangue venoso periférico foram recebidas de toda a população do estudo antes da angiografia coronária para medir o SII e outros parâmetros hematológicos. Em nosso estudo o valor de p<0,05' foi considerado estatisticamente significativo. Resultados: O valor de corte ideal do SII para prever o INOCA foi 153,8, com sensibilidade de 44,8% e especificidade de 78,77% (Área sob a curva [AUC]: 0,651 [IC 95%: 0,603-0,696, p=0,0265]). Suas curvas ROC foram comparadas para avaliar se o SII tinha um efeito preditivo adicional valor sobre os componentes. O valor da AUC do SII foi significativamente maior do que o do linfócito (AUC: 0,607 [IC 95%: 0,559-0,654, p = 0,0273]), neutrófilos (AUC: 0,559 [IC 95%: 0,511-0,607, p = 0,028]) e plaquetas (AUC: 0,590 [IC 95%: 0,541-0,637, p = 0,0276]) em pacientes INOCA. Conclusões: Verificou-se que um nível elevado de SII estava independentemente associado à existência de INOCA. O valor do SII pode ser usado como um indicador para adicionar aos métodos tradicionais e caros comumente usados na previsão do INOCA.
Abstract Background: Ischemia with the non-obstructive coronary artery (INOCA) is an ischemic heart disease that mostly includes coronary microvascular dysfunction and/or epicardial coronary vasospasm due to underlying coronary vascular dysfunction and can be seen more commonly in female patients. The systemic immune-inflammation index (SII, platelet × neutrophil/lymphocyte ratio) is a new marker that predicts adverse clinical outcomes in coronary artery disease (CAD). Objective: This study aims to investigate the relationship between INOCA and SII, a new marker associated with inflammation. Methods: A total of 424 patients (212 patients with INOCA and 212 normal controls) were included in the study. Peripheral venous blood samples were received from the entire study population prior to coronary angiography to measure SII and other hematological parameters. In our study, the value of p<0.05' was considered statistically significant. Results: The optimal cut-off value of SII for predicting INOCA was 153.8 with a sensitivity of 44.8% and a specificity of 78.77% (Area under the curve [AUC]: 0.651 [95% CI: 0.603-0.696, p=0.0265]). Their ROC curves were compared to assess whether SII had an additional predictive value over components. The AUC value of SII was found to be significantly higher than that of lymphocyte (AUC: 0.607 [95% CI: 0.559-0.654, p = 0.0273]), neutrophil (AUC: 0.559 [95%CI: 0.511-0.607, p=0.028]) and platelet (AUC: 0.590 [95% CI: 0.541-0.637, p = 0.0276]) in INOCA patients. Conclusions: A high SII level was found to be independently associated with the existence of INOCA. The SII value can be used as an indicator to add to the traditional expensive methods commonly used in INOCA prediction.
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BACKGROUND: Critical limb ischemia (CLI) patients take too many medications because they are elderly and frail patients with multiple comorbidities. Polypharmacy is associated with frailty, although its prognostic significance in CLI patients is unknown. In this study, we aimed to determine the prevalence of hyperpolypharmacy among adults with CLI and its effect on 1-year amputation and mortality. METHODS: A total of 200 patients with CLI who underwent endovascular therapy (EVT) for below-knee (CTC) lesions were included in this study. Hyperpolypharmacy was defined as using ≥10 drugs. Patients were divided into two groups according to the presence of hyperpolypharmacy. RESULTS: We detected hyperpolypharmacy in 66 patients. The incidence of 1-year amputation [24 (36.4) versus 12 (9), p<.001] and mortality [28 (42.4) versus 12 (9), p<.001] were higher in patients with hyperpolypharmacy. Univariate and multivariate cox regression analyses were used to determine the independent predictors of amputation and mortality. In the receiver operating characteristic curve analysis, the cut-off value was defined as 10 or more drug use was able to detect the presence of 1-year mortality with 67.5% sensitivity and 79.4% specificity. The Kaplan-Meier method showed a significant difference (rank p <.001 between log groups), and hyperpolypharmacy was associated with 1-year amputation and mortality. CONCLUSION: Hyperpolypharmacy was significantly associated with 1-year mortality and major amputation in CLI patients. Hyperpolypharmacy can be a valuable aid in patient risk assessment in the CLI.
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OBJECTIVE: Atrial ï¬brillation is the most common arrhythmia following coronary artery bypass graft surgery. The relationship between impaired lung function and atrial ï¬brillation has been described previously. We aimed to evaluate the prognostic inï¬uence of small airway function on predicting postoperative atrial ï¬brillation undergoing isolated coronary artery bypass graft surgery (CABG). METHODS: We retrospectively analyzed 283 patients who underwent isolated CABG at our institution between January 2020 and August 2020. The patients were divided into 2 groups according to the development of postoperative atrial ï¬brillation. Demographic characteristics of the patients were recorded; spirometry was performed for each patient before surgery. Small airway function was determined by forced mid-expiratory ï¬ow (forced expiratory ï¬ow 25%-75%) values measured by spirometry. Propensity score matching was applied to ensure a balanced distribution of demographic data between the 2 groups. RESULTS: The frequency of postoperative atrial ï¬brillation was 30.7% in our patient population. After propensity matching, forced expiratory volume in 1 second/forced vital capacity % [80.6 (73.8-87.8) vs. 76.3 (66.7-81.6), P = 0.006] and forced expiratory ï¬ow 25%-75% (87.4 ± 14.2 vs. 75.2 ± 15.8, P = 0.001) were signiï¬cantly lower in postoperative atrial ï¬brillation group. In multivariate analysis, white blood cell count, left ventricular ejection fraction, cross-clamp time, and forced expiratory ï¬ow 25%-75% were found to be independent predictors of postoperative atrial ï¬brillation development after isolated CABG. In the receiver operating characteristic curve analysis, forced expiratory ï¬ow 25%-75% with an optimal threshold value of 81% could detect the presence of postoperative atrial ï¬brillation with 63.8% sensitivity and 70.1% speciï¬city. CONCLUSION: Our study demonstrated that small airway obstruction, as indicated by forced expiratory ï¬ow 25%-75% in spirometry, can be a simple predictive tool for the development of postoperative atrial ï¬brillation in patients undergoing isolated CABG.