Ticagrelor Induced Cheyne-Stokes Respiration and Asystolic Ventricular Standstill: A Case Report.

Ticagrelor is a potent, direct-acting, and reversible P2Y12­adenosine diphosphate receptor blocker. It has a rapid onset of action and an intense and consistent platelet reactivity inhibition that has been demonstrated to be superior to clopidogrel in decreasing major adverse events in acute coronary syndrome (ACS). Although ticagrelor is well tolerated in ACS patients, it has side effects, such as dyspnea and bradyarrhythmia, as reported in the Platelet Inhibition and Patient Outcomes (PLATO) study. Furthermore, it was reported that ticagrelor's bradyarrhythmic potential was transient and not clinically significant beyond the acute initiation phase. Nor was there a difference in rates of syncope or need for pacemaker insertion during 30 days of follow-up. Here we report a case of ticagrelor associated with Cheyne-Stokes respiration and asystolic ventricular standstill in a patient with ACS who required resuscitation and insertion of a temporary pacemaker.

Associação do Valor Pan-Imune-Inflamatório com Desfechos de Longo Prazo na Insuficiência Cardíaca Agudamente Descompensada / Association of Pan Immune-Inflammation Value with Long Term Outcomes of Acute Decompensated Heart Failure

Resumo Fundamento Embora tenha havido melhorias significativas no tratamento da insuficiência cardíaca (IC) nas últimas décadas, seu prognóstico permanece desfavorável. Embora existam muitos biomarcadores que podem ajudar a prever o prognóstico de pacientes com IC, há necessidade de biomarcadores mais simples, menos dispendiosos e mais facilmente disponíveis. Objetivo Avaliar o valor preditivo do valor pan-imune-inflamatório (PIV, do inglês pan-immune-inflammation value) em pacientes com IC agudamente descompensada. Métodos Analisamos 409 pacientes com IC com fração de ejeção reduzida internados por IC aguda descompensada. Os pacientes foram divididos em 3 grupos de acordo com os tercis de PIV: tercil 1 (PIV < 357,25), tercil 2 (PIV ≥ 357,25 e < 834,55) e tercil 3 (PIV ≥ 834,55). Foram considerados estatisticamente significativos valores de p < 0,05. Curvas de Kaplan-Meier e modelos de regressão de riscos proporcionais de Cox foram utilizados para avaliar a associação entre PIV e mortalidade por todas as causas. O desfecho primário foi mortalidade por todas as causas em 5 anos, e o desfecho secundário compreendeu a mortalidade por todas as causas intra-hospitalar em 30 dias, em 180 dias e em 1 ano Resultados Mostramos que valores mais elevados de PIV estavam associados a desfechos primários e secundários. A curva de Kaplan-Meier mostrou que pacientes com valores mais elevados de PIV apresentaram risco aumentado de mortalidade por todas as causas em curto e longo prazo (log-rank p < 0,001). Na análise multivariada, o PIV foi identificado como um preditor independente de mortalidade por todas as causas em longo prazo em pacientes com IC aguda descompensada, e observamos um aumento de 1,96 vezes no risco de um evento (razão de chances: 1,96; intervalo de confiança de 95%: 1,330 a 2,908; p = 0,001). Conclusões Nosso estudo mostrou que o novo biomarcador PIV pode ser usado como preditor de prognóstico em pacientes com IC aguda descompensada.

Abstract Background Although there have been significant improvements in the treatment of heart failure (HF) in recent decades, its prognosis remains poor. Although there are many biomarkers that can help predict the prognosis of patients with HF, there is a need for simpler, cheaper, and more easily available biomarkers. Objective To evaluate the predictive value of pan-immune-inflammation value (PIV) in patients with acute decompensated HF. Methods We analyzed 409 patients with HF with reduced ejection fraction who were hospitalized for acute decompensated HF. Patients were divided into 3 groups according to tertiles of PIV: tertile 1 (PIV < 357.25), tertile 2 (PIV ≥ 357.25 and < 834.55), and tertile 3 (PIV ≥ 834.55). P values < 0.05 were considered statistically significant. Kaplan-Meier curves and Cox proportional hazards regression models were used to evaluate the association between PIV and all-cause mortality. The primary outcome was 5-year all-cause mortality, and the secondary outcomes were in-hospital 30 days,, 180-day, and 1-year all-cause mortality. Results We showed that higher PIV value was associated with both primary and secondary outcomes. The Kaplan-Meier curve showed that patients with higher PIV values had an increased risk of short- and long-term all-cause mortality (log-rank p < 0.001). In the multivariate analysis, PIV was identified as an independent predictor of long-term all-cause mortality in patients with acute decompensated HF, and we observed a 1.96-fold increase in the hazard of an event (odds ratio: 1.96, 95% confidence interval: 1.330 to 2.908, p = 0.001). Conclusions Our study showed that the novel biomarker PIV can be used as a predictor of prognosis in patients with acute decompensated HF.

Gender differences in clinical characteristics and in-hospital and one-year outcomes of young patients with ST-segment elevation myocardial infarction under the age of 40.

Introduction: Although the incidence of acute ST-segment elevation myocardial infarction (STEMI) in the elderly population has decreased in recent years, this is not the case for young people. At the same time, no reduction in hospitalization rate after STEMI was shown in young people. Clinical characteristics, risk factors, angiographic findings, in-hospital and one-year outcomes of patients under the age of 40 and their gender differences were investigated. Methods: This study has been performed retrospectively in two centers. Between January 2015 and April 2019, 212 patients aged 18-40 years with STEMI and who underwent reperfusion therapy were included. The gender differences were compared. Results: The median age of (male 176; 83.0% and female 36; 17.0%) patients included in the study was 36 (33-38) for men and 36 (34-38) for women. Chest pain was the most common complaint for both genders (96.0% vs. 94.4%; P = 0.651). While men presented more often with Killip class 1,women presented more often with Killip class 2. The anterior myocardial infarction (MI) was the most common MI type and it was higher in women than in man (P = 0.027). At one year of follow-up, the prevalence of all-cause hospitalization was 24%, MI 3.8%, coronary angiography 15.1%, cardiovascular death 1.4%, and all-cause death 0.47%, there was no gender difference. Conclusion: Anterior MI was the most common type of MI and it was more common in women than in men. Left anterior descending artery was the most common involved coronary artery. The most common risk factor is smoking. In terms of in-hospital outcome, left ventricular ejection fraction was significantly lower in women. There was no significant difference in one-year outcomes between both genders.

The impact of hydroxychloroquine and azithromycin on the corrected qt interval in patients with the novel Coronavirus disease 2019

SUMMARY OBJECTIVE: With the coronavirus disease 2019 (COVID-19) continuing to spread all over the world, although there is no specific treatment until now, hydroxychloroquine and azithromycin have been reported to be effective in recent studies. Although long-term use of hydroxychloroquine and azithromycin has been reported to cause QT prolongation and malign arrhythmia, there is not enough data about the effect of short-term use on arrhythmia. Therefore, this study aims to assess the effect of hydroxychloroquine alone and hydroxychloroquine + azithromycin on corrected QT (QTc). METHODS: A baseline electrocardiogram and on-treatment baseline electrocardiogram were retrospectively collected in COVID-19 patients who received hydroxychloroquine and/or azithromycin. The QTc interval was calculated, and the baseline and peak QTc intervals were compared. In addition, the peak QTc intervals of monotherapy and combination therapy were compared. RESULTS: Of the 155 patients included, 102 (65.8%) patients were using hydroxychloroquine, and 53 (34.2%) patients were using hydroxychloroquine + azithromycin combination. The use of both hydroxychloroquine alone and hydroxychloroquine + azithromycin combined therapy significantly prolonged the QTc, and the QTc interval was significantly longer in patients receiving combination therapy. QTc prolongation caused early termination in both groups, 5 (4.9%) patients in the monotherapy group and 6 (11.3%) patients in the combination therapy group. CONCLUSION: In this study, patients who received hydroxychloroquine for the treatment of COVID-19 were at high risk of QTc prolongation, and concurrent treatment with azithromycin was associated with greater changes in QTc.