Níveis mais Baixos de Fetuína-A Sérica estão Associados a um Maior Risco de Mortalidade em Dez Anos em Pacientes com Infarto do Miocárdio por Supradesnivelamento do Segmento ST / Lower Serum Fetuin-A Levels are Associated with a Higher Ten-Year Mortality Risk in Patients with ST-Elevation Myocardial Infarction

Resumo Fundamento A fetuína-A é um fator anti-inflamatório e anticalcificação envolvido no curso da doença arterial coronariana (DAC). Em alinhamento com essas funções, investigou-se a fetuína-A como marcador de risco cardiovascular em vários estudos. Porém, a associação entre a fetuína-A e o prognóstico dos pacientes com DAC ainda é controversa. Objetivos O presente estudo foi conduzido para identificar a associação entre o nível de fetuína-A sérica e doença cardiovascular (DCV) de longo prazo e a mortalidade global por infarto do agudo do miocárdio por supradesnivelamento do segmento ST (STEMI). Métodos Foram cadastrados no estudo cento e oitenta pacientes consecutivos com STEMI. A população do estudo foi dividida em subgrupos (mais baixo, ≤288 µg/ml; e mais alto, >288 µg/ml) de acordo com a mediana do nível de fetuína-A. Dados de acompanhamento clínico foram obtidos por contato telefônico anual com pacientes ou familiares. As causas das mortes também foram confirmadas pelo banco de dados de saúde nacional. P-valores bilaterais <0,05 foram considerados estatisticamente significativos. Resultados Durante um acompanhamento médio de 10 anos, foram registradas 71 mortes, das quais 62 foram devidas a DCV. Identificou-se um índice de mortalidade global e por DCV significativamente mais alto no grupo com nível de fetuína-A mais baixo que no grupo com nível de fetuína-A mais alto (44% versus 24%, p= 0,005; 48% versus 31%, p= 0,022, respectivamente). Nas análises de risco proporcionais por regressão de Cox, detectou-se que a fetuína-A era um preditor independente de mortalidade global e por DCV. Conclusões A baixa concentração de fetuína-A está associada ao prognóstico de longo prazo ruim pós-STEMI, independentemente de fatores de risco cardiovascular tradicionais. Nossos achados fortaleceram estudos prévios demonstrando consistentemente o papel determinante dos mediadores anti-inflamatórios em síndromes coronárias agudas.

Abstract Background Fetuin-A is an anti-inflammatory and anti-calcification factor involved in the course of coronary artery disease (CAD). In line with these functions, fetuin-A has been investigated as a cardiovascular risk marker in many studies. However, the association between fetuin-A and the prognosis of CAD patients is still controversial. Objectives The present study was conducted to identify the association between serum fetuin-A level and long-term cardiovascular disease (CVD) and all-cause mortality of ST-elevation acute myocardial infarction (STEMI). Methods One hundred eigthy consecutive patients with STEMI were enrolled in the study. The study population was divided into subgroups (lower, ≤288 µg/ml; and higher, >288 µg/ml) according to the median fetuin-A level. Clinical follow-up data was obtained by annual contact with the patients or family members by telephone. The causes of death were also confirmed by the national health database. Two-sided p-values<0.05 were considered statistically significant. Results During a median follow-up of 10 years, 71 deaths were recorded , 62 of whom died from CVD. Both CVD and all-cause mortality were found to be significantly higher in the lower fetuin-A group than the higher fetuin-A group (44% vs 24%, p= 0.005; 48% vs 31%, p= 0.022, respectively). In Cox regression proportional hazard analyses, fetuin-A was found to be an independent predictor of CVD and all-cause mortality. Conclusions Low fetuin-A concentration is associated with a poor long-term prognosis after STEMI, regardless of the traditional cardiovascular risk factors. Our findings have strengthened previous studies that consistently demonstrate the determining role of anti-inflammatory mediators in acute coronary syndromes.

Assessment of the relationship between semaphorin4D level and recurrence after catheter ablation in paroxysmal atrial fibrillation.

OBJECTIVE: Semaphorin4D (Sema4D), a novel integral membrane glycoprotein, plays a role in atherosclerosis, angiogenesis and chronic inflammation. Elevated levels of sema4D were presented in myocardial infarction, heart failure and atrial fibrillation. Aim of the study was to investigate the relation between sema4D and recurrence after catheter ablation (CA) in paroxysmal AF. METHODS: The present study included 161 paroxysmal AF patients (PAF) (101 patients undergone CA) and 60 healthy subjects. Serum levels of sema4D were measured and study participants were followed-up for 3 months and 1 year since CA in terms of recurrence respectively. RESULTS: Sema4D levels were significantly elevated in the recurrent group compared to the non-recurrent PAF patients (p < 0.001). Sema4D was importantly positively correlated with both left atrial volume index (r = 0.51, p < 0.013) and high sensitive C-reactive protein (r = 0.38), p < 0.011). In multivariate analysis, sema4D [odds ratio (OR) = 1.23, 95% CI 1.11-1.42; p < 0.001] and left atrial diameter (OR = 1.13, 95% CI 1.02-1.23; p = 0.012) were found to be significant independent risk parameters for recurrence. CONCLUSIONS: Sema4D is a novel biomarker that may help to identify individuals with recurrence after CA procedure in long term period in PAF.

Relationship between epicardial adipose tissue thickness and coronary thrombus burden in patients with ST-elevation myocardial infarction.

BACKGROUND: Epicardial fat reflects abdominal visceral adiposity and visceral fat plays an important role in the development of an unfavorable metabolic and atherosclerosis risk profile. Intracoronary thrombus burden is an important factor affecting the success of the procedure particularly in patients undergoing percutaneous coronary intervention (PCI). Therefore, determining the factors predicting thrombus burden has great importance in predicting adverse cardiovascular events as well as determining the most appropriate treatment strategy to prevent failure in PCI. AIM: The aim of the current study was to evaluate the relationship between Epicardial adipose thickness (EAT) and thrombus burden in the patients with ST-elevation myocardial infarction (STEMI) who undergo primary PCI (pPCI). METHODS: The study was prospective and included patients (n=156) who were referred to Kosuyolu Research and Education hospital with STEMI between 2016 and 2017. Thrombus burden was scored as follows: 0 (no thrombus), 1 (possible thrombus), 2 (definite thrombus <0.5xreference vessel diameter), 3 (definite thrombus 0.5-2xreference vessel diameter), 4 (definite thrombus >2xreference vessel diameter), and 5 (complete vessel occlusion). According to thrombus grade the patients were grouped as low thrombus burden (grades 0-3) and high thrombus burden (grades 4 and 5). EAT, identified as an echo-free space between the myocardium and visceral pericardium, was measured perpendicularly, on the free wall of the right ventricle at both parasternal long- and short-axis views at end-diastole in three cardiac cycles. RESULTS: Fifty-one subjects were in the low thrombus burden group and 105 in the high thrombus burden group. There were no differences in the two groups for LVEF, smoking status, family history of coronary artery disease (CAD), diabetes mellitus (DM), hypertension (HT), and hypercholesterolemia and for total cholesterol, triglyceride, GFR, LDL-C and HDL-C. In multivariate logistic regression analysis the EAT (odds ratio: 2.53, 95% CI: 1.76-3.67; p < .001) was found as an independent predictor of high thrombus burden. CONCLUSIONS: The present study showed that EAT was an independent predictor of coronary thrombus burden in STEMI.

Successful cryoablation of atrial fibrillation from jugular approach in patient with interrupted inferior vena cava and azygos continuation.

We herein report successful cryoablation of paroxysmal atrial fibrillation via right jugular vein in a patient with interrupted inferior vena cava. We preferred cryoablation instead of radiofrequency ablation in the treatment of our patient. For stronger support in aiming the Brockenbrough needle toward the septum, we manuallly curved the needle with a 120° angle about 6 cm proximal to the tip. After successful transseptal puncture, we performed balloon dilatation in the septal puncture zone to facilitate passage. Cryoablation has theoretical advantage, particularly in challenging anatomies, in which it eliminates the need for point-by-point ablation around the pulmonary vein.

Assessment of atrial electromechanical interval and P wave dispersion in patients with polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk, including ischemic stroke. Prolonged atrial electromechanical interval (EMI) is related to increased atrial fibrillation (AF) risk. The aim of the study is to evaluate atrial EMI and electrocardiographic P-wave indices related to increased AF risk in patients with PCOS. METHODS: Forty PCOS patients diagnosed on the basis of the Rotterdam criteria and 20 age-matched controls were prospectively included. patients with atrioventricular or intraventricular conduction abnormalities, dysrhythmia or taking antiarrhythmic drugs, atherosclerotic heart disease, cardiomyopathies, valvular lesions, pericardial disease, a history of pulmonary emboli or pulmonary hypertension, and abnormal thyroid function were excluded. Intra and interatrial EMI were measured by tissue Doppler imaging and P-wave dispersion (Pd) was calculated on 12-lead electrocardiography (ECG). The Isovolumetric relaxation time was the interval between the aortic valve closure artifact at the end of the LV outflow envelope and the mitral valve opening artifact at the beginning of the mitral E wave. RESULTS: Patients with PCOS had significantly higher interatrial [38 (24-65) ms vs. 16 (9-19) ms p<0.001], left-sided intra-atrial (14.8±6.1 vs. 7±1.7 ms, p<0.001), and right-sided intra-atrial (22.3±8.1 vs. 8.6±3.6 ms, p<0.001) EMI compared with the control group. Pd was significantly greater in the PCOS group compared with control group [45 (27-60) ms vs. 30 (26-38) ms, p<0.001]. Echocardiographic parameters of atrial EMI were significantly correlated with body mass index, Pd, and isovolumetric relaxation time in patients with PCOS. CONCLUSION: PCOS is associated with prolonged inter- and intra-atrial conduction times, which are related to increased AF risk.

[Mean platelet volume and the extent of coronary atherosclerosis in patients with stable coronary artery disease]. / Kararli anjinasi olan koroner arter hastalarinda ortalama trombosit hacmi ve koroner aterosklerozun yayginligi

OBJECTIVES: The aim of this study was to assess the relationship between mean platelet volume (MPV) and the presence and extent of coronary artery disease (CAD) in patients who underwent coronary angiography for stable chest pain. STUDY DESIGN: A total of 540 patients (350 male, 190 female; mean age: 59.6±11.4 years) were consecutively included in the study. The patients were divided into four groups according to the presence and extent of their CAD as follows: Group 1 - patients with no significant CAD, group 2 - one vessel disease, group 3 - two vessel diseases, and group 4 - three vessel disease. Also, the Gensini score of each coronary angiogram was calculated. RESULTS: There were 159 patients in group 1, 169 in group 2, 110 in group 3, and 102 in group 4. As expected, we found significant differences among the groups regarding mean age and other coronary risk factors including gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. However, there were no significant differences among the groups regarding platelet counts and MPV values (8.5±0.1 fl, 8.5±1.2 fl, 8.6±0.9 fl and 8.6±0.9 fl, MPV values of groups 1-4, respectively). Although the Gensini score was found to be significantly correlated with age, plasma uric acid level, white blood cell count, hemoglobin level, fasting blood glucose, and high density lipoprotein level, no significant association was detected between MPV and Gensini score values. CONCLUSION: This study is one of the largest studies assessing the relationship between MPV and the extent of coronary atherosclerosis in patients with stable CAD to date. However, we found no association between MPV and the presence and extent of coronary atherosclerosis.

Prognostic significance of neutrophil gelatinase-associated lipocalin in ST-segment elevation myocardial infarction.

OBJECTIVES: This study investigated the prognostic value of neutrophil gelatinase-associated lipocalin (NGAL) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Neutrophil gelatinase-associated lipocalin is a promising biomarker for acute kidney injury. Recently, it was concluded that NGAL may be used beyond the boundaries of renal physiopathology. It was found to be an important factor indirectly contributing to the inflammatory processes. Little is known regarding its predictive role in STEMI. METHODS: One hundred six consecutive patients who underwent percutaneous coronary intervention (PCI) for STEMI and control group consisted of age- and sex-matched 60 consecutive patients with chest pain admitted to the hospital for elective PCI. According to median NGAL level, patients were classified into high- and low-NGAL groups. RESULTS: Neutrophil gelatinase-associated lipocalin levels were higher in patients with STEMI compared to the elective PCI group subjects. Inhospital and 1-year mortality rates were found to be significantly greater in patients with high NGAL. In addition, inhospital and 1-year major adverse cardiovascular event rates were significantly greater in the high-NGAL group, compared to the low NGAL group. High NGAL level on admission was a significant predictor for long-term mortality and major adverse cardiovascular events. The receiver operating characteristics curve analysis further illustrated that NGAL level on admission is a strong indicator of mortality, with an area under the curve of 0.76 (95% confidence interval, 0.62-0.89). CONCLUSIONS: High NGAL levels may be associated with poor prognosis after PCI in patients with STEMI. However, further studies with larger numbers of patients and longer follow-up are required to evaluate the usefulness of plasma NGAL level for predicting prognosis of STEMI.