Long-Term Prognostic Value of Mean Platelet Volume in Patients with Hypertension.

BACKGROUND: Although it has been shown that high mean platelet volume (MPV) is associated with target organ damage in hypertensive patients, the relationship between MPV and the development of long-term major adverse cardiovascular events (MACE) has not been thoroughly investigated. In this study, we investigated the relationship between MPV and long-term MACE in hypertensive patients. METHODS: From September 2011 to July 2017, 1507 patients with hypertension were included in this study. Ambulatory blood pressure monitoring was performed in all patients. Patients with chronic renal failure, cardiovascular disease, chronic systemic disease and white coat hypertension were excluded from the study. MACE were defined as myocardial infarction, stroke and cardiovascular mortality. Patients were followed-up until january 2020. RESULTS: The mean follow-up duration was 87 (83.3 ± 24.4) months, and 876 patients completed the study. MACE developed in 79 patients, while 797 patients were event-free. In univariate Cox regression analysis, age, diabetes mellitus (DM), MPV, creatinine, 24-hour systolic blood pressure, and non-dipper hypertension were found to be associated with the development of MACE. In multivariate Cox regression analysis, creatinine and 24-hour systolic blood pressure lost significance, and age, DM, non-dipper hypertension and MPV were found to be independent predictors for MACE development (p < 0.001, p < 0.001, p = 0.044, and p = 0.049, respectively). CONCLUSIONS: MPV, age, DM, and non-dipper hypertension were independent predictors of long-term MACE in hypertensive patients.

The Presence of Left Atrial Thrombus is Associated with the Neutrophil-to-Lymphocyte Ratio in Patients with Rheumatic Mitral Valve Stenosis.

BACKGROUND: Rheumatic mitral valve stenosis (RMVS)-induced left atrial thrombus (LAT) and embolic complications may have clinically devastating consequences. Stasis in the left atrium induced by valvular obstruction is a major factor in the development of thrombus. However, the development of thrombus may not be solely associated with stasis, as it is known that the inflammatory process increases the tendency for thrombosis. The study aim was to examine the relationship between the neutrophil-to-lymphocyte ratio (NLR), an indicator of inflammation, and the existence of LAT. METHODS: A total of 313 consecutive patients with RMVS and mitral valve area (MVA) <2 cm2 was included in this cross-sectional study. Patients were allocated to two groups with or without LAT using transthoracic and transesophageal echocardiography. Routine biochemical analyses and electrocardiographic examinations were also carried out. The NLR was calculated utilizing blood count analysis. RESULTS: The presence of LAT was identified in 78 RMVS patients (24.9%). No significant differences in terms of age, gender, body mass index were found between the groups with and without LAT. On echocardiographic examination, a higher mean gradient and left atrial diameter, as well as a smaller MVA, were determined in patients with LAT (p<0.001). In those patients with LAT, higher C-reactive protein levels and higher leukocyte and neutrophil counts (p <0.001) and lower lymphocyte counts were noted (p = 0.001). The NLR was shown to be higher in patients with LAT (p <0.001). Multivariate regression analysis showed that the relationship between LAT and a high NLR continued independently (OR 5.3; 95% CI 2.9-9.4; p <0.001). CONCLUSIONS: The NLR is an easily obtained, low-cost and easily repeated parameter that seems effective for identifying RMVS patients who are at high risk of developing LAT.

Association of the CHA2DS2-VASc score with left atrial spontaneous echo contrast: a cross-sectional study of patients with rheumatic mitral stenosis in sinus rhythm.

Mitral valve stenosis is a common manifestation of chronic rheumatic heart disease. In rheumatic mitral valve stenosis (RMVS) patients, left atrial spontaneous echo contrast (LASEC) is an independent predictor of thromboembolism risk. While the anticoagulant therapy algorithm for atrial fibrillation patients is clear, the clinical tools determining high-risk patients in sinus rhythm are insufficient. Our aim is to examine the relationship between CHA2DS2-VASc score in RMVS patients in sinus rhythm and the presence of LASEC. The patients with RMVS upon presentation to the cardiology polyclinic were included in this cross-sectional study consecutively, and CHA2DS2-VASc scores were calculated. All patients were evaluated with transthoracic and transesophageal echocardiography and were divided into two groups as those with and without LASEC. The total number of patients was 265, with LASEC determined in 97 (36.6 %) and not determined in 168 (63.4 %). No significant differences in terms of age, gender, and body mass index were found between the groups. Patients with LASEC had higher mean CHA2DS2-VASc score than patients without LASEC (2.10 ± 1.21 vs. 1.11 ± 0.7, respectively; p < 0.001). In the multivariate logistic regression analysis, it has been determined that there is an independent association between the existence of LASEC and CHA2DS2-VASc score (OR 3.176, CI 1.937-5.206; p < 0.001). The ROC analysis revealed that CHA2DS2-VASc score 2 or more predicted presence of LASEC with a sensitivity of 71 % and a specificity of 82 % (AUC 0.746, 95 % CI 0.682-0.810). The CHA2DS2-VASc score could be useful marker to detect prothrombotic state in patients with RMVS in sinus rhythm.

Assessment of mean platelet volume and soluble CD40 ligand levels in patients with non-dipper hypertension, dippers and normotensives.

UNLABELLED: Abstract Objective: Patients with a lack of nocturnal decline in blood pressure (BP) are at an increased risk for cardiovascular events. Mean platelet volume (MPV) and soluble CD40 ligand (sCD40L) are accepted biomarkers of platelet activation and considered as a risk factor for cardiovascular disease. The aim of this study was to determine whether MPV and sCD40L levels are higher in non-dipper hypertensive (NDHT) patients than in dipper hypertensive (DHT) patients and healthy controls. METHODS: 124 consecutive patients were included to this study. Patients were divided into three groups: NDHT patient group [n = 43; mean age 51.8 ± 6.6; 31 males (72.1%)]; DHT patient group [n = 41; mean age 50.2 ± 7.3; 22 males (53.7%)]; and normotensive group [n = 40; mean age 49.9 ± 6.7; 22 males (55%)]. Physical examination, laboratory work-up and 24-h ABPM were performed for all participants. RESULTS: The sCD40L and MPV levels were significantly higher in the NDHT group than in the DHT and normotensive groups (p < 0.05). In correlation analysis, MPV, 24-h systolic blood pressure (SBP), 24-h diastolic blood pressure (DBP), night-time SBP and night-time DBP were positively correlated with sCD40L. CONCLUSION: Our study demonstrated that MPV and sCD40L levels were significantly higher in NDHT patients compared to DHT and normotensive patients. sCD40L levels were positively correlated with MPV, 24-h SBP, 24-h DBP, night-time SBP and night-time DBP.

Antihypertensive Efficacy Of Nebivolol And Low Dose Spironolactone In Patients With Resistant Hypertension.

OBJECTIVE: Resistant hypertension is associated with increased mortality and morbidity. The optimal medical therapy is not fully elucidated in resistant hypertension. There are relatively few studies in the literature on the treatment of resistant hypertension. In this study, we compared the effectiveness of nebivolol 5 mg, a third generation beta-blocker, with spironolactone 25 mg in patients with resistant hypertension. METHODS: A total of 81 patients with resistant hypertension were included in the study. The spironolactone group was composed of 38 patients while the nebivolol group was composed of 43 patients. Resistant hypertension was defined as having office blood pressure ≥ 140/90 mmHg while the patients were under 3 or more antihypertensive agents treatment which included diuretic agents. Office and ambulatory blood pressure at basal and after 8 weeks of treatment were recorded. RESULTS: Office systolic blood pressure and diastolic blood pressure in 24-hour ambulatory blood  pressure monitoring were significantly lower when compared to basal values in both nebivolol and spironolactone groups. The decrease in 24-hour mean systolic and diastolic blood pressure in nebivolol group was 14.9 ± 19.8 mmHg and 9.3 ± 12.7 mmHg compared to 19.5 ± 16.4 mmHg and 13.7 ± 10.8 mmHg in the spironolactone group, respectively. The decrease in 24-hour mean systolic and diastolic blood pressure was not significantly different between the nebivolol and spironolactone groups (P = 0.338 and P = 0.153). CONCLUSION: Nebivolol is an effective treatment option for resistant hypertension and the antihypertensive effect of nebivolol is similar to low-dose spironolactone.

The Relationship Between Epicardial Adipose Tissue Thickness and Presence of Left Atrial Thrombus in Mitral Stenosis Patients.

OBJECTIVE: To examine the relationship between the left atrial (LA) thrombus presence and the epicardial adipose tissue (EAT) thickness. METHODS: Three hundred and twelve consecutive rheumatic mitral valve stenosis (RMVS) patients with mitral valve area (MVA) < 2 cm2 were included in this cross-sectional study. Patients were divided into two groups, those with and those without LA thrombus. Routine biochemical analysis and electrocardiographic examinations were carried out. EAT was measured using transthoracic echocardiography. RESULTS: LA thrombus was determined in 84 (26.9%) RMVS patients. In echocardiographic examinations, higher mean gradient and LA diameter as well as lower MVA were found in the group with LA thrombus (P<0.001). In this group, higher C-reactive protein (CRP) and EAT values were also determined (P<0.001). There was significant correlation between EAT and MVA, CRP, LA appendage peak flow velocity, LA anteroposterior diameter, and mean gradient (P<0.001). Higher EAT values were identified as independently associated with the presence of LA thrombus (odds ratio 59.5; 95% confidence interval 12.1-290.10; P<0.001). CONCLUSION: Transthoracic echocardiography, routinely used in patients with RMVS, can measure EAT to determine patients who are under risk for thrombus.

Assessment of electrocardiographic parameters in adult patients undergoing extracorporeal shockwave lithotripsy.

OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) is a safe and effective treatment for urinary tract calculi. While serious side effects are rare, transient cardiac arrhythmias may occur. New electrocardiographic (ECG) parameters, such as P wave dispersion (PWD), QT dispersion (QTd), T peak to T end (Tp-e) interval, Tp-e interval/QT ratio, and Tp-e interval/corrected QT ratio have been defined to help predict atrial and ventricular arrhythmias. However, effect of ESWL on these ECG parameters has not been previously investigated. The present study was an examination of the effect of ESWL on ECG parameters. METHODS: Total of 40 consecutive patients who underwent ESWL were prospectively enrolled in the study. Pre-procedure ECG parameters were compared with post-procedure ECG parameters. RESULTS: PWD values were significantly longer on post-procedure ECG compared with pre-procedure ECG (p=0.017). Corrected QT duration and QTd were significantly longer on postprocedure ECG compared with pre-procedure ECG (p=0.046 and p=0.008, respectively). In addition, Tp-e interval, Tp-e interval/QT ratio, and Tp-e interval/QTc ratio were significantly longer post procedure (p=0.035, p=0.045, and p=0.022, respectively). In univariate correlation analysis, duration of procedure was significantly correlated with post-procedure PWD, QTc, and QTD values. CONCLUSION: Clinical use of ECG parameters may be helpful in monitoring of patients receiving ungated ESWL in order to detect cardiac dysrhythmia.

Higher copeptin levels are associated with worse outcome in patients with hypertrophic cardiomyopathy.

BACKGROUND: Correlation of increased copeptin levels with various cardiovascular diseases has been described. The clinical use of copeptin levels in patients with hypertrophic cardiomyopathy (HCM) has not been investigated before. HYPOTHESIS: In this study, we aimed to investigate the prognostic value of copeptin levels in patients with hypertrophic cardiomyopathy (HCM). METHODS: HCM was defined as presence of left ventricular wall thickness ≥15 mm in a subject without any concomitant disease that may cause left ventricular hypertrophy. Levels of copeptin and plasma N-terminal probrain natriuretic peptide (NT-proBNP) were evaluated prospectively in 24 obstructive HCM patients, 36 nonobstructive HCM patients, and 36 age- and sex-matched control subjects. Blood samples were collected in the morning between 7 and 9 am after overnight fasting. Patients were followed for 24 months. Hospitalization with diagnosis of heart failure/arrhythmia, implantable cardioverter-defibrillator implantation, and cardiac mortality were accepted as adverse cardiac events. RESULTS: Copeptin and NT-proBNP levels were higher in the HCM group compared with controls (14.1 vs 8.4 pmol/L, P < 0.01; and 383 vs 44 pg/mL, P < 0.01, respectively). Copeptin and NT-proBNP levels were higher in the obstructive HCM subgroup compared with the nonobstructive HCM subgroup (18.3 vs 13.1 pmol/L, P < 0.01; and 717 vs 223 pg/mL, P < 0.01, respectively). In multivariable logistic regression analysis, copeptin and NT-proBNP levels remained as independent predictors of heart failure (P < 0.01 for both) and adverse cardiac events (P < 0.01 for both). CONCLUSIONS: Copeptin and NT-proBNP levels were significantly higher in patients with obstructive HCM, and higher levels were associated with worse outcome.

Visfatin levels are increased in patients with resistant hypertension and are correlated with left ventricular hypertrophy.

OBJECTIVE: The aim of this study was to investigate the possible correlation of serum visfatin levels with resistant hypertension (RHT). PATIENTS AND METHODS: Patients who had undergone ambulatory blood pressure measurements (ABPM) during the outpatient controls were prospectively recruited. Seventy-one patients with RHT and 94 patients with controlled hypertension (CHT) were included in the study. RHT was defined as 'uncontrolled blood pressure (BP) despite using three antihypertensive agents including a diuretic or need of four or more drugs to control BP'. The demographic properties, medications used, and laboratory parameters including visfatin levels were recorded. RESULTS: In the RHT group, left ventricular mass index was significantly higher compared with the CHT group (108.13±26.86 vs. 89.46±24.09 g/m, P<0.01). High-sensitivity C-reactive protein and visfatin levels were significantly higher in the RHT group [4.0 (5.2) vs. 2.3 (3.0) mg/l, P<0.01, and 12.87±4.98 vs. 9.46±4.69 ng/ml, P<0.01, respectively] compared with the CHT group. In the multivariate linear regression model, visfatin level remained as an independent predictor for office systolic BP [B: 2.07, 95% confidence interval (CI): 1.17-2.98, P<0.01]; office diastolic BP (B: 0.71, 95% CI: 0.27-1.16, P<0.01); mean 24-h systolic ABPM (B: 1.46, 95% CI: 0.79-2.13, P<0.01); and mean 24-h diastolic ABPM (B: 0.88, 95% CI: 0.42-1.34, P<0.01) and was also correlated independently with left ventricular mass index (B: 3.13, 95% CI: 2.58-3.99, P<0.01). CONCLUSION: In this cohort of RHT patients diagnosed with ABPM, we have found an independent correlation between higher visfatin levels and the presence of RHT and left ventricular hypertrophy.

Relationship between the presence of left atrial thrombus in patients with mitral stenosis and platelet-to-lymphocyte ratio.

OBJECTIVE: Rheumatic carditis-induced mitral valve disease is associated with a chronic inflammatory process. The close relationship between inflammation and prothrombotic processes is known. Our goal was to examine the relationship between the presence of left atrial (LA) thrombus in patients with rheumatic mitral valve stenosis (RMVS) and platelet-to-lymphocyte ratio (PLR), which is an inflammatory marker. METHODS: This cross-sectional study included 351 consecutive patients diagnosed with RMVS upon presentation to the cardiology polyclinic. All patients were evaluated using transthoracic and transesophageal echocardiography and were divided into 2 groups: those with and without LA thrombus. In addition to echocardiographic and biochemical parameters, PLR was compared between the groups. Student's t-test, Mann-Whitney U test, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. RESULTS: No significant differences in terms of age, gender, body mass index, and comorbidities were found between the groups with and without LA thrombus. In the group with LA thrombus, higher red cell distribution width, mean platelet volume, and platelet count and lower lymphocyte count were detected. In addition, C-reactive protein levels were significantly higher in the LA thrombus group (4.7 vs. 2.7 mg/L, p<0.001). PLR was significantly higher in patients with thrombus than in those without (133±38 vs. 119±31, p=0.001). Higher PLR was identified as independently associated with the presence of LA thrombus (odds ratio: 1.03, 95% confidence interval: 1-1.06, p=0.016). CONCLUSION: Higher PLR was detected in the LA thrombus group of patients with RMVS.

Interarm systolic blood pressure difference is associated with myocardial injury after noncardiac surgery.

BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) is closely related to increased cardiovascular mortality. AIM: To evaluate the relationship between MINS and interarm systolic blood pressure difference (IASBPD), which has previously been shown to correlate with the frequency of cardiovascular events and arterial arteriosclerotic processes. METHODS: This observational, single-centre cohort study included 240 consecutive noncardiac surgery patients aged ≥ 45 years. Simultaneous blood pressure recordings were taken preoperatively and IASBPD was calculated. Patients' electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels were obtained for a period of three days postoperatively. RESULTS: Postoperatively, 27 (11.3%) patients were found to have MINS when hscTnT ≥ 14 ng/L was taken as a cut-off value. IASBPD > 10 mm Hg was found in 44 (18.3%) patients. When IASBPD was accepted to be a continuous variable, there was a higher IASBPD value in the MINS group (9.4 ± 5.0 vs. 4.5 ± 3.8, p < 0.000). When patients were grouped as those having IASBPD > 10 mm Hg and those not, exaggerate IASBPD was found to be more frequent in patients developing MINS (16 [59.3%] vs. 28 [13.1%], respectively, p < 0.000). Multiple logistic regression analysis found IASBPD > 10 mm Hg to be independently associated with the development of MINS (OR: 30.82; CI: 9.14-103.98; p < 0.000). Receiver operating char-acteristic curve analysis showed that the optimal IASBPD cut-off value for predicting MINS was 11.5 mm Hg, with a sensitivity of 61.0% and specificity of 89.1% (AUC = 0.79; 95% CI 0.71-0.87). CONCLUSIONS: Increased IASBPD is closely related to development of MINS. The preoperative measurement of blood pressure from both arms may be an important and easy to use clinical tool in determining cardiovascular risk.

The relationship between epicardial adipose tissue thickness and presence of left atrial thrombus in mitral stenosis patients

Abstract Objective: To examine the relationship between the left atrial (LA) thrombus presence and the epicardial adipose tissue (EAT) thickness. Methods: Three hundred and twelve consecutive rheumatic mitral valve stenosis (RMVS) patients with mitral valve area (MVA) < 2 cm2 were included in this cross-sectional study. Patients were divided into two groups, those with and those without LA thrombus. Routine biochemical analysis and electrocardiographic examinations were carried out. EAT was measured using transthoracic echocardiography. Results: LA thrombus was determined in 84 (26.9%) RMVS patients. In echocardiographic examinations, higher mean gradient and LA diameter as well as lower MVA were found in the group with LA thrombus (P<0.001). In this group, higher C-reactive protein (CRP) and EAT values were also determined (P<0.001). There was significant correlation between EAT and MVA, CRP, LA appendage peak flow velocity, LA anteroposterior diameter, and mean gradient (P<0.001). Higher EAT values were identified as independently associated with the presence of LA thrombus (odds ratio 59.5; 95% confidence interval 12.1-290.10; P<0.001). Conclusion: Transthoracic echocardiography, routinely used in patients with RMVS, can measure EAT to determine patients who are under risk for thrombus.

Assessment of the relationship between nondipping phenomenon and microvolt T-wave alternans.

OBJECTIVE: The aim of this cross-sectional study was to evaluate microvolt T-wave alternans (MTWA) as a marker of myocardial electrical instability in normotensive and hypertensive individuals with either nondipper or dipper-type circadian rhythm of blood pressure. MATERIALS AND METHODS: The study group included a total of 181 patients: 118 hypertensive patients and 63 normotensive healthy volunteers [mean age 46 ± 8; 34 men (54%)]. The patients with hypertension were divided into two groups on the basis of their results of 24-h ambulatory blood pressure monitoring: 61 patients with dipper hypertension [mean age 46 ± 6; 32 men (52.5%)] and 57 patients with nondipper hypertension [mean age 48 ± 10; 36 men (63.2%)]. The MTWAs of all patients were analyzed using the time-domain modified moving average method by means of a treadmill exercise stress test. RESULTS: MTWA positivity was statistically significantly different between all groups. Left ventricular mass index, E/E', interventricular septum, posterior wall, 24-h systolic blood pressure and diastolic blood pressure, and night-time systolic blood pressure and diastolic blood pressure were correlated positively with MTWA. Left ventricular mass index and the presence of nondipper hypertension were determined to be independent predictors of MTWA positivity. CONCLUSION: The blunting of the nocturnal decrease in blood pressure was associated with MTWA positivity in hypertensive patients.

Platelet/lymphocyte ratio was associated with impaired myocardial perfusion and both in-hospital and long-term adverse outcome in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention.

INTRODUCTION: Platelet/lymphocyte ratio (PLR) has been shown to be an inflammatory and thrombotic biomarker for coronary heart disease, but its prognostic value in ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. AIM: To investigate the relationship between PLR and no-reflow, along with the in-hospital and long-term outcomes in patients with STEMI. MATERIAL AND METHODS: In the present study, we included 304 consecutive patients suffering from STEMI who underwent primary percutaneous coronary intervention (p-PCI). Patients were stratified according to PLR tertiles based on the blood samples obtained in the emergency room upon admission. No-reflow after p-PCI was defined as a coronary thrombolysis in myocardial infarction (TIMI) flow grade ≤ 2 after vessel recanalization, or TIMI flow grade 3 together with a final myocardial blush grade (MBG) < 2. RESULTS: The mean follow-up period was 24 months (range: 22-26 months). The number of patients characterized with no-reflow was counted to depict increments throughout successive PLR tertiles (14% vs. 20% vs. 45%, p < 0.001). In-hospital major adverse cardiovascular events and death increased as the PLR increased (p < 0.001, p < 0.001). Long-term MACE and death also increased as the PLR increased (p < 0.001, p < 0.001). Multivariable logistic regression analysis revealed that PLR remained an independent predictor for both in-hospital (OR = 1.01, 95% CI: 1.00-1.01; p = 0.002) and major long-term (OR = 1.01, 95% CI: 1.00-1.01; p < 0.001) adverse cardiac events. CONCLUSIONS: Platelet/lymphocyte ratio on admission is a strong and independent predictor of both the no-reflow phenomenon and long-term prognosis following p-PCI in patients with STEMI.

A comparative analysis of leukocyte and leukocyte subtype counts among isolated systolic hypertensive, systo-diastolic hypertensive, and non-hypertensive patients.

BACKGROUND: Isolated systolic hypertension (ISHT) is a subtype of hypertension (HT) that often exhibits wide pulse pressure, and pulse pressure has a strong predictive value for future adverse cardiovascular events. Previous studies have shown the effects of leukocyte count on the prognosis of ischaemic heart disease and HT. AIM: Thus, in this cross-sectional study, we analysed the relationship between leukocyte counts and subtypes in HT and non-HT groups. METHODS: The study population consisted of 960 consecutive patients who were admitted to the outpatient clinic of our hospital. After ambulatory blood pressure values were assessed, the participants were divided into three groups: ISHT (n = 98), systo-diastolic hypertensives (SDHT, n = 405), and non-hypertensives (non-HT, n = 457). RESULTS: The subjects in the ISHT group were older than those in the SDHT and non-HT groups (64 ± 10, 53 ± 12, and 52 ± 13, respectively; p < 0.001). The leukocyte and neutrophil counts and neutrophil/lymphocyte (NL) ratios were significantly different in all groups. In subgroup analysis, the leukocyte count, neutrophil count, and N/L ratio were higher in the ISHT and SDHT groups than in the non-HT group (p < 0.001 for all). The leukocyte count, neutrophil count, and N/L ratio were significantly higher in the ISHT group than in the SDHT group (p = 0.023, p = 0.007, p = 0.010, respectively). Neutrophil count (p = 0.012; OR = 1.229, 95% CI 1.046-1.444) was an independent risk factor for ISHT in multivariate logistic regression analysis. CONCLUSIONS: The leukocyte and neutrophil counts and N/L ratios were higher in the ISHT group than in the SDHT and non-HT groups. High neutrophil count was an independent predictor of ISHT.

Hematologic and clinical parameters after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis.

BACKGROUND: Previous studies have demonstrated that platelet activation occurs in patients with aortic stenosis (AS). This study sought to evaluate the changes in hematologic and clinical parameters noted with the improvement in AS following transcatheter aortic valve implantation (TAVI) in patients with severe AS at high risk of surgery. PATIENTS AND METHODS: The study included 33 patients who underwent TAVI. In addition to biochemical, clinical, and echocardiographic examinations, hematologic blood parameters were recorded before TAVI, at discharge, and at 1 and 4 months. RESULTS: Mean platelet volume (MPV) showed a progressive decrease after TAVI. On echocardiography at 1 month, aortic valve area significantly increased, with significant decreases in peak and mean gradients. Progressive decreases were also noted in N-terminal proB-type natriuretic peptide levels. CONCLUSION: Our findings show that TAVI improves hemodynamic parameters of the valve with marked clinical and echocardiographic improvement, resulting in decreased platelet activation and MPV in patients with severe AS.

The relationship between γ-glutamyl transferase levels and the clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

OBJECTIVES: Serum γ-glutamyl transferase (GGT) activity has been shown to be related to the development of atherosclerosis and cardiovascular events. The aim of this study was to evaluate the prognostic value of GGT in patients with ST-segment elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (PCI). PATIENTS AND METHODS: A total of 683 consecutive patients with STEMI who underwent primary PCI were evaluated. The study population was divided into tertiles on the basis of admission GGT values. A high GGT (n=221) was defined as a value in the upper third tertile (GGT>37) and a low GGT (n=462) was defined as any value in the lower two tertiles (GGT≤37). The mean follow-up time was 29 months. RESULTS: The in-hospital mortality rate was significantly higher in patients in the high GGT group (7.2 vs. 1.7%, P<0.001), as was the rate of adverse outcomes in patients with high GGT levels. In multivariate analyses, a significant association was found between high GGT levels and adjusted risk of in-hospital cardiovascular mortality (odds ratio=8.6, 95% confidence interval: 2.3-32.4, P=0.001). In a receiver operating characteristic curve analysis, a GGT value greater than 37 was identified as an effective cutoff point in STEMI for in-hospital cardiovascular mortality (area under curve=0.71, 95% confidence interval: 0.59-0.82, P<0.001). There were no differences in the long-term adverse outcome rates between the two groups. CONCLUSION: GGT is a readily available clinical laboratory value associated with in-hospital adverse outcomes in patients with STEMI who undergo primary PCI. However, there was no association with long-term mortality.

Predictive value of elevated cystatin C in patients undergoing primary angioplasty for ST-elevation myocardial infarction.

OBJECTIVES: The prognostic value of cystatin C (CysC) has been documented in patients with acute coronary syndrome without ST-segment elevation. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the prognostic value of CysC in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS: We prospectively enrolled 475 consecutive STEMI patients (mean age 55.6±12.4 years, 380 male, 95 female) undergoing primary PCI. The study population was divided into tertiles based on admission CysC values. The high CysC group (n=159) was defined as a value in the third tertile (>1.12 mg/L), and the low CysC group (n=316) included those patients with a value in the lower two tertiles (≤1.12 mg/L). Clinical characteristics and in-hospital and one-month outcomes of primary PCI were analyzed. RESULTS: The patients of the high CysC group were older (mean age 62.8±13.1 vs. 52.3±10.5, P<.001). Higher in-hospital and 1-month cardiovascular mortality rates were observed in the high CysC group (9.4% vs. 1.6%, P<.001 and 14.5% vs. 2.2%, P<.001, respectively). In Cox multivariate analysis; a high admission CysC value (>1.12 mg/L) was found to be a powerful independent predictor of one-month cardiovascular mortality (odds ratio, 5.3; 95% confidence interval, 1.25-22.38; P=.02). CONCLUSIONS: These results suggest that a high admission CysC level was associated with increased in-hospital and one-month cardiovascular mortality in patients with STEMI undergoing primary PCI.