Value of systemic inflammation-response index in predicting contrast-induced nephropathy in patients with ST-elevation myocardial infarction.

BACKGROUND: Contrast induced nephropathy (CIN) is one of the feared complications of contrast medium-using procedures. Present study was conducted in order to evaluate the value of systemic inflammatory-response index (SIRI) for development of CIN among patients who underwent primary percutaneous intervention. METHODS: Six hundred seventy-six patients with the diagnosis of ST elevation myocardial infarction were included. The patients were divided into two groups according to the presence of CIN. Patients without (n = 530) and with (n = 146) CIN constituted group 0 and group 1, respectively. Clinical and biochemical features of the patients were recorded. Calculation of SIRI was made for each patient. RESULT: CIN patients were older, had higher prevalence of hyperlipidaemia, higher values of pre- and post-procedural creatinine levels, neutrophil and monocyte counts, neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) and SIRI. They had lower values of left ventricular ejection fraction (LVEF), haemoglobin and high-density lipoprotein-cholesterol levels. SIRI had the highest area under the curve (AUC) for prediction of CIN. Pairwise analyses of the AUC's demonstrated that SIRI had statistically significantly higher AUC compared to NLR and MLR. Multivariate logistic regression analysis showed that besides from LVEF and pre-procedural creatinine, NLR and SIRI were the independent predictors of CIN. SIRI had a higher odds ratio compared to NLR. CONCLUSION: SIRI had greater diagnostic power than NLR and MLR and it can easily be used by physicians for the identification of high-risk patients for the occurrence of CIN.

Evaluation of pericardiocentesis videos on YouTube as a reliable source for on-line education in the COVID-19 period.

INTRODUCTION: Pericardiocentesis is an invasive procedure performed to drain fluid from the pericardial cavity. AIM: We investigated the quality of videos about pericardiocentesis on YouTube and analysed their reliability and teaching properties, in the covid 19 period when online education has come to the fore. MATERIAL AND METHODS: We searched YouTube using the terms "pericardiocentesis, cardiac tamponade, pericardial effusion, pericardial effusion drainage, pericardial tamponade" for uploaded videos. We scored every video according to the questions we prepared using the guidelines about pericardiocentesis. We used the HONcode score, GQS score, and RELIABILITY score to assess the quality of videos. Two physicians independently and blindly classified videos as useful or misleading and rated them. RESULTS: A total of 168 videos were examined. After the application of exclusion criteria, 38 videos were evaluated. The pericardiocentesis checklist average score was 10.45 ±2.56. According to sources of videos, the average score for university or research hospital videos was 13.1 ±1.5, and videos whose source could not be identified had an average score of 7.5 ±2.0. According to the level of HONcode, 17 (44.7%) videos were low quality; according to GQS score, 8 (21.1%) videos were poor quality. The quality of university hospital uploads (ß-coefficient 3.960, p-value 0.004) were higher and statistically significant than other upload centres. CONCLUSIONS: The educational value of pericardiocentesis videos on YouTube are low. It is recommended that doctors and patients be aware of and adopt the developing technology, and they should prefer videos uploaded from university hospitals and educational hospitals.

Temporal association of contamination obsession on the prehospital delay of STEMI during COVID-19 pandemic.

BACKGROUND: One of the modifiable risk factors for ST elevation myocardial infarction is prehospital delay. The purpose of our study was to look at the effect of contamination contamination obsession on prehospital delay compared with other measurements during the Covid-19 pandemic. METHOD: A total of 139 patients with acute STEMI admitted to our heart center from 20 March 2020 to 20 June 2020 were included in this study. If the time interval between the estimated onset of symptoms and admission to the emergency room was >120 min, it was considered as a prehospital delay. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and Padua Inventory-Washington State University Revision (PI-WSUR) test were used to assess Contamination-Obbsessive compulsive disorder (C-OCD). RESULT: The same period STEMI count compared to the previous year decreased 25%. The duration of symptoms onset to hospital admission was longer in the first month compared to second and third months (180 (120-360), 120 (60-180), and 105 (60-180), respectively; P = 0.012). Multivariable logistic regression (model-2) was used to examine the association between 7 candidate predictors (age, gender, diabetes mellitus (DM), hypertension, smoking, pain-onset time, and coronary artery disease (CAD) history), PI-WSUR C-OCD, and admission month with prehospital delay. Among variables, PI-WSUR C-OCD and admission month were independently associated with prehospital delay (OR 5.36 (2.11-13.61) (P = 0.01); 0.26 (0.09-0.87) p < 0.001] respectively]. CONCLUSION: Our study confirmed that contamination obsession was associated with prehospital delay of STEMI patients, however anxiety and depression level was not associated during the pandemic.

Relative Fat Mass Index can be solution for obesity paradox in coronary artery disease severity prediction calculated by SYNTAX Score.

BACKGROUND: The relation between body mass index (BMI) and coronary artery disease (CAD) extension remains controversial. A new score was developed to estimate body fat percentage (BFP) known as Relative Fat Mass (RFM) Index. This study aimed to evaluate the value of RFM Index in predicting the severity of the CAD, compared with other anthropometric measurements. METHODS: A total of 325 patients with chronic CAD were investigated. RFM, BFP, BMI and other anthropometric characteristics of patients were measured before angiography. CAD severity was determined by SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery trial (SYNTAX) Score. The association between SYNTAX Score and variables was evaluated using linear regression models. In order to compare the model performance, R-squared (R2), Akaike's information criterion, Bayesian information criterion and root mean square error were used. RESULTS: Univariate linear regression outcome variable, SYNTAX was used to determine whether there was any relationship between variables. Independent variables were included in the multivariable linear logistic regression models. The analysis showed that in model 1, RFM (ß coefficient: 2.31 (0.90 to 3.71), p=0.001)), diabetes mellitus (ß coefficient: 3.72 (1.67 to 3.76), p=0.004)), haemoglobin (ß coefficient: -2.12 (-3.70 to -0.53), p=0.03) and age (ß coefficient: 1.83 (0.29 to 3.37), p=0.02)) were statistically significant. The adjusted R2 values in model 1 were higher than model 2 (BFP) and model 3 (BMI) (0.155, 0.137 and 0.130, respectively), and χ2 values of RFM were higher than BFP and BMI (10.5, 3.4 and 1.0, respectively). CONCLUSION: RFM Index is a more reliable and compatible marker of obesity in showing the severity of CAD compared to BMI.

Heparanase is a predictive marker for high thrombus burden in patients with ST-segment elevation myocardial infarction.

Objective: Heparanase (HPA) is an endo-ß-D-glucuronidase capable of degrading heparin sulphate (HS) and heparin side chains. HPA plays a role in tumour growth, angiogenesis, cell invasion and in activation of the coagulation system. We aimed to investigate the relationship between HPA and thrombus burden (TB) in patients with ST-Segment Elevation Myocardial Infarction (STEMI). Methods: This prospective study enrolled 187 patients with STEMI who were treated with primary percutaneous coronary intervention (pPCI). Blood samples were taken to determine serum HPA levels prior to coronary angiography and heparin administration. Serum HPA analysis was performed with a commercially available Human Elisa kit. Results: Patients were divided into two groups: high TB (n:58) and low TB (n:129) group. Serum HPA levels were significantly higher in patients with high TB than low TB [250.1 (188.5-338.1) vs. 173.6 (134.3-219.8) pg/mL] (p < 0.001). Serum HPA levels were higher in patients with no-reflow phenomenon compared with others [(409.3 (375.6-512.5) pg/mL vs. 186.2 (144.2-247.4) pg/mL, p < 0.001]. In multiple logistic regression analysis HPA was a predictor of high TB. Conclusion: Elevated HPA level in patients with STEMI is related to high TB. Furthermore, increased HPA level may be associated with thrombotic complications such as no-reflow phenomenon in patients with STEMI.

Design and rationale for the ASSOS study: Appropriateness of aspirin use in medical outpatients a multicenter and observational study.

OBJECTIVE: The aim of this study was to describe the current status of aspirin use and the demographic characteristics of patients on aspirin for primary and secondary prevention of cardiovascular diseases. METHODS: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) trial was a multicenter, cross-sectional, and observational study conducted in Turkey. The study was planned to include 5000 patients from 14 cities in Turkey. The data were collected at one visit, and the current clinical practice regarding aspirin use was evaluated (ClinicalTrials.gov number NCT03387384). RESULTS: The study enrolled all consecutive patients who were admitted to the outpatient cardiology clinics from March 2018 until June 2018. Patients should be at least 18 years old, have signed written informed consent, and on aspirin (80-325 mg) therapy within the last 30 days. Cardiologists from the hospital participates in the study. Patients were divided into 2 categories according to presence or absence of atherosclerotic cardiovascular disease, namely secondary prevention group and primary prevention group, respectively. The appropriate use of aspirin in the primary and secondary prevention groups was assessed according to the European Society of Cardiology guidelines and US Preventive Services Task Force. The patients' gastrointestinal bleeding risk factors and colorectal cancer risk were evaluated. CONCLUSION: The ASSOS registry will be the most comprehensive and largest study in Turkey evaluating the appropriateness of aspirin use. The results of this study help understand the potential misuse of aspirin in a real-world setting.

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.

Papillary Muscle Free Strain in Patients with Severe Degenerative and Functional Mitral Regurgitation / Free Strains de Músculos Papilares em Pacientes com Insuficiência Mitral Funcional e Degenerativa Grave

Abstract Fundamento: The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy. Objectives: To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method. Methods: 64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging. Results: Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation. Conclusions: Measuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR.

Resumo Fundamento: O papel da função do músculo papilar na regurgitação mitral grave com fração de ejeção do ventrículo esquerdo preservada e reduzida e o método de escolha para avaliar PM ainda são objetos de controvérsia. Objetivos: Avaliar e comparar a função dos músculos papilares entre pacientes com insuficiência mitral funcional e degenerativa pelo método free strain. Métodos: 64 pacientes com insuficiência mitral grave - 39 pacientes com insuficiência mitral degenerativa grave (grupo IMD) e 25 com insuficiência mitral funcional grave (grupo IMF) - e 30 indivíduos controle (grupo controle) foram incluídos no estudo. A função dos músculos papilares foi avaliada pelo método free strain a partir de imagens apicais quatro-câmaras do músculo papilar anterolateral (MPA) e imagens apicais três-câmaras do músculo papilar posteromedial (MPP). Strains circunferenciais e longitudinais globais do ventrículo esquerdo foram avaliados por meio de imagens bidimensionais a partir do rastreamento de conjunto de pontos de cinza (speckle tracking). Resultados: O strain longitudinal global do ventrículo esquerdo (grupo IMD, -17 [-14,2/-20]; grupo IMF, -9 [-7/-10,7]; grupo controle, -20 [-18/-21] p < 0,001); strain circunferencial global do ventrículo esquerdo (grupo IMD, -20 [-14,5/-22,7]; grupo IMF, -10 [-7/-12]; grupo controle, -23 [-21/-27,5] p < 0,001) e strains de músculos papilares (MPP; grupo IMD, -30,5 [-24/-46,7]; grupo IMF, -18 [-12/-30]; grupo controle; -43 [-34,5/-39,5] p < 0,001; MPA; grupo IMD, (-35 [-23,5/-43]; grupo IMF, -20 [-13,5/-26]; grupo controle, -40 [-32,5/-48] p < 0,001) mostraram-se significativamente diferentes nos grupos. MPA e MPP mostraram-se altamente correlacionados com a FEVE (p < 0,001, p < 0,00; respectivamente), SLG (p < 0,001, p < 0,001; respectivamente) e SCG (p < 0,001, p < 0,001; respectivamente) do VE entre todos os grupos. Não foi encontrada correlação entre os strains de músculos papilares e área eficaz do orifício (AEO) nos grupos de insuficiência mitral grave. Conclusões: A medição do strain longitudinal de músculos papilares pelo método free strain é prática e aplicável. A disfunção dos músculos papilares tem um papel pequeno em IM grave devido a causas degenerativas e funcionais, e a função dos músculos papilares, em general, parece seguir a função ventricular esquerda. O MPP é o MP mais afetado na insuficiência mitral em ambos os grupos, IMD e IMF.

Peripheral self-expandable stent catheter fracture: Retrieval of two different components with two different modalities.

A 58-year-old man whose right superficial femoral artery had been stented 2 weeks previously presented at the emergency service complaining of right leg pain of 2 days' duration. Angiography revealed a radiopaque foreign body distal to the stent. It was removed with a snare. Due to sudden disappearance of the popliteal artery pulse seventy-two hours after the procedure, an urgent control angiogram was performed, which showed a large thrombus occluding the superficial femoral artery. Surgery revealed a second larger radiolucent foreign body causing the thrombus. This was recognized as the distal tip and shaft of the peripheral self-expandable stent catheter used in the initial procedure. This report discusses preventive measures to be taken against this complication.

Thrombus Formation on the Tricuspid Valve After De Vega's Annuloplasty and Repair of Endocardial Cushion Defect.

Endocardial cushion defect (ECD) can be partial (with two distinct valves) or complete (only one atrioventricular valve), and surgical therapy is usually required. The optimal surgical technique is controversial but De Vega's annuloplasty is widely performed. Tricuspid valve thrombosis are rarely seen after surgery. We present a 39-year-old male patient with tricuspid valve thrombosis after De Vega's annuloplasty without the use of a ring.