Systemic immune inflammation index: a novel predictor for coronary collateral circulation.

AIM: Recently, a new inflammatory and prognostic marker has emerged called as Systemic Immune Inflammation Index (SII). In the current study, we searched the relation between SII and Coronary Collateral Circulation (CCC) formation in stable Coronary Artery Disease (CAD). MATERIALS & METHODS: 449 patients with stable CAD who underwent coronary angiography and documented coronary stenosis of 95% or more in at least one major coronary vessel were included in the study. The study patients were divided into two groups according to the Rentrop score as well CCC (Rentrop 2-3) and bad CCC (Rentrop 0-1). Blood samples for SII and other laboratory parameters were gathered from all the patients on admission. The SII score was formulized as platelet × neutrophil/lymphocyte counts. RESULTS: Patients, who had developed bad CCC had a higher C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelets/lymphocyte ratio (PLR) and SII levels compared to those who had developed well CCC (p < 0.001, for all). Multivariate logistic regression analysis showed that high levels of SII was an independent predictor of bad CCC (OR: 1.005, 95% confidence interval (CI): 1.003-1.006, p < 0.001) together with dyslipidemia, high levels of CRP and NLR. In Receiver Operator Characteristic curve (ROC) analysis, the optimal cutoff value of SII to predict poor CCC was found to be 729.8, with 78.4% sensitivity and 74.6% specificity (area under ROC curve = 0.833 (95% CI: 0.777-0.889, p < 0.001). CONCLUSION: We have demonstrated that SII, a novel cardiovascular risk marker, might be used as one of the independent predictors of CCC development.

Effects of irradiation, restoration and crown fracture type on the maximum load to fracture traumatized incisors: An ex vivo study.

BACKGROUND/AIMS: Radiotherapy makes teeth prone to tooth fractures. However, the relationship between radiotherapy and maximum load to fracture teeth that suffered a crown fracture is not fully understood. The aim of this study was to evaluate the influence of fracture type, radiation dose, fracture time, and their interactions on maximum load to fracture irradiated teeth. MATERIAL AND METHODS: A total of 140 permanent incisors were divided into two fracture type groups (uncomplicated and complicated) each of which included seven radiation dose subgroups (0, 10, 20, 30, 40, 50, and 60). The test groups were exposed to high-energy X-ray at 2 Gy/day, 5 days/week for a total dose of 10-60 Gy. Control groups were not irradiated. The load where the specimen started to break was obtained two different times. The 1st fracture was performed after radiation therapy, and the 2nd fracture was performed after the restoration of these samples. RESULTS: Fracture type had no effect on the maximum load to fracture. In contrast, the maximum load to fracture teeth decreased with increasing radiation doses. Maximum load to fracture the restored teeth was lower than the 1st fracture results. The general linear model procedure revealed a significant interaction between radiation dose and fracture time. Similarly, there was a significant interaction between the fracture type, radiotherapy dose, and fracture time. Maximum load values of teeth with complicated crown fractures restored with fiber posts and composite were not affected by radiation. CONCLUSION: Teeth that have been subjected to radiotherapy have an increased risk of fracture during dental trauma. However, restoration of the irradiated teeth with fiber posts and composite resin did not affect the maximum load required to fracture them.

Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios in patients with primary hyperparathyroidism and their relationship with cardiac arrhythmic events.

BACKGROUND: Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by hypercalcemia caused by excessive parathyroid hormone (PTH) secretion from the parathyroid gland. PHPT was previously shown to increase cardiac arrhythmias. Besides, new indices, such as the Tpeak-Tend (Tp-e) interval, Tp-e interval/QT interval (Tp-e/QT) ratio, and Tp-e interval/corrected QT interval (Tp-e/QTc) ratio may be associated with ventricular arrhythmias and sudden cardiac death. Therefore, we aimed to investigate the relationship between PHPT and the changes to Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. METHODS: We carried out the study with 41 patients with PHPT and 40 control subjects. We calculated the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio of the participants from the V5 derivations on their ECG papers. While we defined Tp-e interval as the distance between the peak and the end of the T wave, Tp-e/QT and Tp-e/QTc ratios were calculated by dividing Tp-e by QT and Tp-e by QTc, respectively. RESULTS: Total calcium, albumin-corrected calcium, phosphorus, and PTH levels were significantly higher in patients with PHPT. We also found positive correlations between albumin-corrected calcium and PTH levels and Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio (p < 0.001). DISCUSSION: : Our results suggest that Tp-e may enhance the current knowledge on arrhythmic risk in PHPT patients better than basal ECG. In addition, both high PTH and high calcium levels appear to have the potential to cause arrhythmogenic effects.

Relationship between thiol, disulphide volume and contrast-induced nephropathy in acute coronary syndrome patients treated with percutaneous coronary intervention.

BACKGROUND: This study aimed to evaluate thiol disulphide volume for the risk of contrast-induced nephropathy (CIN) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS: A total of 638 patients with ACS were enrolled in the study. CIN was defined as an increase in serum creatinine level of ≥0.5 mg/dL or ≥25% above baseline within 72 h after the procedure. Patients were divided into two groups: patients with and without CIN. Demographics, clinical risk factors, angiographic and laboratory parameters, CIN incidence, thiol, disulphide, and CHA2DS2-VASc score were compared between the two groups. RESULTS: Native thiol, total thiol, and disulphide at baseline were significantly lower in patients who developed CIN compared to those who did not. Also, the CHA2DS2-VASc score was found to be higher in patients with CIN than those without CIN. In receiver operating characteristic analysis showed that at a cutoff of <342.1, the value of native thiol exhibited 82% sensitivity and 80% specificity for detecting CIN. Total thiol< 383.1 calculated on admission had an 80% sensitivity and 80% specificity in predicting CIN. CONCLUSION: Our study suggested that the thiol disulphide volume on admission was independently associated with the development of CIN after PCI in patients with ACS.

New onset atrial fibrilation and risk faktors in COVID-19.

BACKGROUND: There is limited data concerning the prevalence of arrhythmias, particularly atrial fibrillation (AF), which may develop as a consequence of direct myocardial injury and the inflammatory state existing in COVID-19. METHODS: This single-center study included data concerning 658 COVID-19 patients, who were hospitalized in our institute, between April 20th, 2020 and July 30th, 2020. Demographic data, findings of the imaging studies, and laboratory test results were retrieved from the institutional digital database. RESULTS: New onset AF (NOAF) was identified in 33 patients (5%). Patients who developed AF were older (72.42 ± 6.10 vs 53.78 ± 13.80, p < 0.001) and had higher frequencies of hypertension and heart failure compared to patients without NOAF (p < 0.001, for both). The CHA2DS2-VASc score was higher in patients, who developed NOAF, compared to those who did not during hospitalization for COVID-19 (p < 0.001). Subjects, who developed NOAF during hospitalization, had a higher leukocyte count, neutrophil / lymphocyte ratio (NLR), C-reactive protein, erythrocyte sedimentation rate, and procalcitonin levels compared to those without NOAF (p < 0.001 for all comparisons). Diffuse lung infiltration was also more frequent in COVID-19 patients, who developed NOAF, during hospitalization (p = 0.015). Multivariate logistic regression analysis demonstrated that age, CHA2DS2-VASc score, CRP, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT were predictive for NOAF. CONCLUSION: The prevalence of NOAF in hospitalized COVID-19 patients is higher than the general population. Age, CHA2DS2-VASc score, C-reactive protein, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT may be used to identify patients at high risk for development of NOAF. Especially among these parameters, the presence of diffuse lung infiltration on thorax CT it was the most powerful independent predictor of NOAF development.

Microtensile Bond Strength of Polyacid-modified Composite Resin to Irradiated Primary Molars.

AIM: This study evaluated the influence of various doses of radiotherapy on the microtensile bond strength (pTBS) of compomer resin to dentin and enamel in primary molars. MATERIALS AND METHODS: Thirty-five intact primary molars were collected and divided into seven groups. Teeth were irradiated with doses from 10 to 60 Gy, except for the control group. Compomer restorations were performed, and enamel-compomer resin beams and dentin-compomer resin beams were tested at a crosshead speed of 1 mm/min. RESULTS: No statistically significant difference was found between the irradiated tooth enamel and the control group (F = 1.1468; p = 0.194). However, statistically significant differences were evident among the dentin groups (F = 11.050; p < 0.001). CONCLUSION: Radiation may not cause a significant difference in the pTBS of compomer resin to primary tooth enamel, but appears to dose dependently decrease its bond strength to primary tooth dentin. CLINICAL SIGNIFICANCE: Radiotherapy may affect the success rate of compomer fillings in primary teeth, especially in deeper cavities with exposed dentin.

Assessment of oral hygiene and periodontal health around posterior primary molars after their restoration with various crown types.

OBJECTIVE: To compare the time-dependent changes in oral hygiene and periodontal health after restoring primary posterior molars with a traditional stainless steel crown (SSC) or an aesthetic crown using various measures of periodontal health and oral hygiene. DESIGN: This investigation was a randomized, non-blinded prospective controlled clinical trial in which 264 crowns of different types were fitted onto the first and/or second primary molars of 76 children. The oral hygiene and the gingival health of the restored teeth and the antagonistic teeth were evaluated clinically and radiographically at 3- and 6-month intervals for 18 months after fitting the crowns. RESULTS: The periodontal health of the control teeth was better than that of the remaining 215 restored teeth. The oral hygiene, as measured by the simplified oral hygiene index, and gingival health, as measured by the gingival index and the volume of gingival crevicular fluid, of the restored teeth, irrespective of crown type, progressively increased during the 18-month study period. CONCLUSIONS: Oral hygiene and gingival health around a restored primary tooth deteriorate with time. Our results suggest that SSC, an open-faced SSC, or a NuSmile(®) pediatric crown should be the preferred crown type for restoring posterior primary teeth.

The Importance of Pan-Immune Inflammation Value (PIV) in Predicting Coronary Collateral Circulation in Stable Coronary Artery Patients.

In this study, the correlation between pan-immune-inflammation value (PIV) and coronary collateral circulation (CCC) in patients with chronic coronary syndrome (CCS) was analyzed. The study included 663 patients with CCS who underwent coronary angiography and had coronary stenosis of ≥95% in at least one major coronary vessel. The participants were divided into two groups: good CCC (Rentrop score 2-3) and poor CCC (Rentrop score 0-1). PIV score was calculated as monocyte x platelet x neutrophil/lymphocyte count. When the patient groups who developed good and poor CCC were compared, neutrophil/lymphocyte ratio (NLR) (P < .001), C-reactive protein (CRP) levels, CRP/albumin ratio (CAR) (P < .001), systemic immune-inflammation index (SII) (P < .001), and PIV (P < .001) were higher in patients with poor CCC. In multivariate logistic regression analysis, age, SII, NLR, CRP, CAR, and PIV were found to be independent predictors of poor CCC (P < .001, for all). Receiver operating characteristic (ROC) analysis demonstrated that a cut-off value of 442.2 for PIV predicted poor CCC slightly better compared to other markers, with 76.8% sensitivity and 70.1% specificity (area under ROC curve = 0.808 (95% CI: 0.764-0.851), P < .001). These findings suggest that PIV can be used as an independent predictor of CCC development.

Is There a Relationship Between Metabolic Equivalence and the SYNTAX Score as Strong Prognostic Markers?

OBJECTIVE: The metabolic equivalent (MET) and Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score are two parameters with known cardiovascular prognostic significance. In this study, we aimed to investigate the direct relationship between MET and SYNTAX score in patients with chronic coronary syndrome (CCS). METHOD: This retrospective study included 200 patients over 18 years of age who underwent coronary angiography and had a positive exercise electrocardiography test result. Patients were divided into two groups: Group 1 with a low SYNTAX score and Group 2 with a medium-high SYNTAX score. MET values were then compared between these groups. RESULTS: Baseline demographic characteristics and laboratory values were similar between the groups. The mean MET values in the low and medium-high SYNTAX score groups were 9.36 ± 2.38 and 8.78 ± 2.43, respectively. No statistical difference was observed (P = 0.086). Additionally, there was no statistical difference between the two groups in terms of MET values being 10 ≤ or 10 > (P = 0.172). CONCLUSION: The main conclusion of our study is that there is no correlation between the SYNTAX score and functional MET value in CCS.

The Role of Pan-Immune-Inflammation Value in Determining the Severity of Coronary Artery Disease in NSTEMI Patients.

BACKGROUND: Even though medication and interventional therapy have improved the death rate for non-ST elevation myocardial infarction (NSTEMI) patients, these patients still have a substantial residual risk of cardiovascular events. Early identification of high-risk individuals is critical for improving prognosis, especially in this patient group. The focus of recent research has switched to finding new related indicators that can help distinguish high-risk patients. For this purpose, we examined the relationship between the pan-immune-inflammation value (PIV) and the severity of coronary artery disease (CAD) defined by the SYNTAX score (SxS) in NSTEMI patients. METHODS: Based on the SxS, CAD patients were split into three groups. To evaluate the risk variables of CAD, multivariate logistic analysis was employed. RESULTS: The PIV (odds ratio: 1.003; 95% CI: 1.001-1.005; p = 0.005) was found to be an independent predictor of a high SxS in the multivariate logistic regression analysis. Additionally, there was a positive association between the PIV and SxS (r: 0.68; p < 0.001). The PIV predicted the severe coronary lesion in the receiver-operating characteristic curve analysis with a sensitivity of 91% and specificity of 81.1%, using an appropriate cutoff value of 568.2. CONCLUSIONS: In patients with non-STEMI, the PIV, a cheap and easily measured laboratory variable, was substantially correlated with a high SxS and the severity of CAD.

Comprehensive dental evaluation of children with congenital or acquired heart disease.

OBJECTIVE: The aims of this case­control study were to (a) compare the caries experience and oral hygiene, and (b) quantify the persistence of a delay in the dental age in children with cardiac disease and a group of healthy children. METHODS AND MATERIALS: The study population comprised a group of 268 3- to 16-year-old children and adolescents with a cardiac disease and a group of 268 age- and sex-matched healthy children and adolescents. Specifically, the decayed, missed, and filled teeth indices, simplified oral hygiene index, and the dental ages of the two groups of children were calculated and then compared. RESULTS: Although the oral health of the children with either a congenital or an acquired heart disease was the same as that of the healthy children, there were significant differences in the decayed, missed, and filled teeth indices. Dental ages of the children with a congenital heart disease were significantly lower than those of healthy children. The findings showed that complex univentricular heart diseases had the highest negative impact on dental development (21.1), followed by complex biventricular (20.9), simple surgical (20.5), and mild (20.4) heart disease patients. CONCLUSION: Once thorough knowledge of the child's cardiac status is gained, a definitive dental treatment plan for the child with a cardiac disease can be established.

Serum gamma-glutamyltransferase and the burden of atherosclerosis in patients with acute coronary syndrome.

OBJECTIVES: We evaluated the relationship between serum gamma-glutamyltransferase (GGT) levels and the burden of atherosclerosis in patients with acute coronary syndrome (ACS). STUDY DESIGN: This study involved 180 patients (139 male, 41 female; mean age 63±11 years) with the diagnosis of ACS (non-ST elevation myocardial infarction and unstable angina) who underwent coronary angiography on the first day after hospital admission. The burden of atherosclerosis was assessed by the number of involved vessels, and the Gensini and Syntax scores. Serum GGT levels were measured by enzymatic caloric test. RESULTS: Patients with high Syntax scores (>=33) were more frequently diabetic, hypertensive, and had higher GGT and creatinine levels compared to the patients with low Syntax scores (<=23). Similarly, patients with >=3 diseased vessels were more frequently diabetic, hypertensive, and smokers. In addition, these patients were older and had higher serum glucose, urea and GGT levels. Correlation analysis revealed that the level of GGT was significantly associated with Gensini and Syntax scores, number of diseased vessels, and the number of critical lesions (r=0.378 p<0.001, r=0.301 p<0.001, r=0.159 p=0.036, r=0.355 p<0.001, respectively). Multivariate linear regression analysis demonstrated that increased GGT level was an independent risk factor for high Gensini and Syntax scores (p=0.029 and p=0.035, respectively), together with age (p=0.001 and p=0.002, respectively) and serum glucose levels (p=0.017 and p=0.012, respectively). CONCLUSION: Serum GGT levels on admission are associated with increased burden of atherosclerosis in patients with ACS. This may account for the cardiovascular outcomes associated with increased GGT levels.

Increased red cell distribution width level is associated with absence of coronary collateral vessels in patients with acute coronary syndromes.

OBJECTIVES: Several studies have evaluated a relationship between increased red cell distribution width (RDW) and morbidity and mortality of acute coronary syndrome (ACS). In this study, we aimed to investigate the association of serum RDW levels and development of coronary collateral vessel (CCV) in patients with ACS. STUDY DESIGN: We evaluated 226 patients with ACS in this prospective and cross-sectional study. Traditional laboratory and clinical parameters and serum RDW levels were measured on admission. All patients underwent coronary angiography on the first day after admission and patients with >80% stenosis were included in the study. The CCV was graded according to the Rentrop scoring system, and a Rentrop grade 0 was accepted as no CCV development (Group 1), while Rentrop grades 1-2-3 were accepted as presence of CCV development (Group 2). RESULTS: Only levels of RDW were significantly higher in Group 1 than in Group 2 (Group 1 RDW 14.6±1.9, Group 2 RDW 14.1±1.4, p=0.02). The predictive value of serum RDW level for absence of collaterals (sensitivity of 58% and specificity of 54%, area under the receiver operating characteristic (ROC) curve = 0.573) was 13.90. CONCLUSION: We found that high levels of RDW were associated with absence of CCV in patients with ACS.

Predictive Values of Systemic Immune-Inflammation Index in New-Onset Atrial Fibrillation Following Coronary Artery Bypass Grafting.

INTRODUCTION: We investigated the relationship between the newly-defined systemic immune-inflammation index and the new-onset atrial fibrillation in patients undergoing coronary artery bypass grafting. METHOD: This study included 392 patients who underwent coronary artery bypass grafting. We divided the participants into two groups as those with and without new-onset atrial fibrillation. Prior to coronary artery bypass grafting, we evaluated blood samples, including systemic immune-inflammation index, and other laboratory parameters of the patients. We formulized the systemic immune-inflammation index score as platelet × neutrophil/lymphocyte counts. RESULTS: The findings revealed that new-onset atrial fibrillation occurred in 80 (20.4%) of 392 patients during follow-ups. Such patients had higher systemic immune-inflammation index, neutrophil/lymphocyte ratio, and C-reactive protein levels than those who did not develop new-onset atrial fibrillation (P<0.001, P<0.001, P=0.010, respectively). In receiver operating characteristic curve analysis, systemic immune-inflammation index levels > 712.8 predicted new-onset atrial fibrillation with a sensitivity of 85% and a specificity of 61.2% (area under the curve: 0.781, 95% confidence interval: 0.727-0.835; P<0.001). CONCLUSION: Overall, systemic immune-inflammation index, a novel inflammatory marker, may be used as a decisive marker to predict the development of atrial fibrillation following coronary artery bypass grafting.

Are Thiols Useful Biomarkers for Coronary Collateral Circulation in Patients with Stable Coronary Artery Disease?

Our aim was to investigate the relationship between thiol, which is the main component of the antioxidant system, and coronary collateral circulation (CCC). Our patients consisted of people with stable coronary artery disease (sCAD) and total occlusion in at least one vessel (n = 249). We divided the patients into two groups, good and poor, according to their CCC degree. We determined that DM, total thiol, and disulfide are independent predictors of poor CCC in multivariate logistic regression analysis (OR: 1.012, 95% CI: 1.008-1.017, p < 0.001; OR: 1.022, 95% CI: 1.000-1.044, p = 0.044; OR: 2.671, 95% CI: 1.238-5.761, p = 0.012, respectively). The ROC analysis showed a cut-off value of 328.7 for native thiol regarding the prediction of poor CCC, with 67.4% specificity and 78% sensitivity. For disulfide, it revealed a cut-off value of 15.1 regarding the prediction of poor CCC, with 57.9% specificity and 69.5% sensitivity. In this study, we detected that the patients with sCAD who developed poor CCC had lower levels of native thiol, total thiol, and disulfide compared to those with good CCC. The most interesting finding of our study is that CCC formation is an effective predictor of the antioxidant cascade rather than the inflammation cascade in sCAD patients.

Increased Serum Systemic Immune-Inflammation Index is Independently Associated With Severity of Carotid Artery Stenosis.

Stroke is a significant contributor to morbidity and mortality. The present study investigated how the systemic immune inflammation index (SII) could be used to predict the likelihood of developing carotid artery stenosis (CAS), which can be seen using carotid artery angiography (CAAG). This study comprised 418 individuals who underwent CAAG for CAS. SII was calculated by multiplying the platelet count by the neutrophil/lymphocyte ratio (NLR). The patients were divided into two groups: non-critical and critical CAS (stenosis below %70 and above ≥70%, respectively). Compared with the non-critical CAS, the critical CAS group had greater high sensitivity C-reactive protein levels (4.5 [3.1-5.7] vs 3.9 [2-5] [mg/L], P < .001), NLR (4.1 [2.9-7.5] vs 2.9 [1.8-3.7], P < .001), platelet/lymphocyte ratio (233 [110-297] vs 119 [96-197], P < .001), and SII (860 [608-2455] vs 604 [458-740], P < .001). Receiver Operating Characteristic Curve analysis demonstrated the best cutoff value of 672.3 for SII to predict the critical CAS with 71.2% sensitivity and 60.1% specificity. According to our study, an increase in SII is an independent predictor of the severity of CAS in patients undergoing CAAG.

Papillon-Lefèvre syndrome: report of three cases in the same family.

Papillon-Lefèvre syndrome is a rare autosomal recessive disorder caused by cathepsin C gene mutation leading to the deficiency of cathepsin C enzymatic activity. The disease is characterized by palmoplantar hyperkeratosis, periodontopathy and precocious loss of dentition, and increased susceptibility to infections. Pyogenic liver abscess is an increasingly recognized complication. Three cases of Papillon-Lefevre syndrome in the same family are presented here. Two of the three siblings presented with characteristic manifestations of the syndrome. The third case had died previously due to liver abscess prior to a diagnosis of Papillon-Lefèvre syndrome.

A Novel Predictor of Contrast-Induced Nephropathy in Patients With Carotid Artery Disease; the Systemic Immune Inflammation Index.

Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity. The present study investigated the role of systemic immune inflammation index (SII) in predicting the risk of developing CIN after carotid artery angiography (CAAG). This study included 262 patients who underwent CAAG for symptomatic carotid artery stenosis (CAS). Simultaneous carotid stenting was applied to 232 of these patients. CIN was defined as an increase in serum creatinine level ≥.5 mg/dL or ≥25% above baseline within 72 hours after the procedure. The SII score was calculated as platelet × neutrophil/lymphocyte counts. Patients who developed CIN, had higher glucose (P = .009), total cholesterol (P < .001), low density lipoprotein cholesterol (<.001), and high sensitivity C-reactive protein (P = .001) levels, as well as greater neutrophil counts (P < .001), platelet counts (P < .001), neutrophil-lymphocyte ratio (P < .001), and SII score (P < .001) than those who did not develop CIN. The Receiver Operating Characteristic analysis showed that at a cutoff of 519.9, the SII exhibited 80% sensitivity and 64% specificity for detecting CIN. SII levels on admission were independently associated with CIN development after CAAG in patients with CAS.

Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease.

We investigated the relationship between the C-reactive protein (CRP) to albumin ratio (CAR) and coronary collateral circulation (CCC) in stable coronary artery disease (CAD). Patients with stable CAD (n = 354) who underwent coronary angiography for suspected CAD and had a total occlusion ≥1 major coronary artery were included in the study. The participants were divided into 2 groups according to the Rentrop score as satisfactory CCC (Rentrop 2-3) and poor CCC (Rentrop 0-1). Patients who had poor CCC had a higher CRP, neutrophil/lymphocyte ratio (NLR), and CAR levels compared with those who had satisfactory CCC (P < .001, P = .046, P < .001, respectively). The CAR (odds ratio: 3.522, 95% CI: 2.515-4.932, P < .001), CRP, NLR, and diabetes mellitus were independent predictors of poor CCC. In receiver operator characteristic curve (ROC) analysis, the optimal cutoff value of CAR to predict poor CCC was 1.27 (area under ROC curve = 0.735 [95% CI: 0.667-0.803], P < .001). A raised CAR may be an independent predictor of poor CCC.

Atrial electromechanical delay is impaired in patients with primary hyperparathyroidism.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is an endocrine disease that poses a risk for cardiac arrhythmias. Atrial electromechanical delay (EMD) has been known as an early marker of atrial fibrillation (AF). This study aimed to evaluate the atrial EMD in PHPT. MATERIAL AND METHODS: Fifty PHPT patients (45 females, 5 males) aged 30-75 years and 38 controls (35 females, 3 males) aged 31-73 years were included in the study. Atrial EMD parameters were measured by using tissue Doppler imaging (TDI). Inter-atrial EMD was calculated as the difference between PA lateral and PA tricuspid; intra-atrial EMD was calculated as the difference between PA septum and PA tricuspid, and left-atrial EMD was calculated as the difference between PA lateral and PA septum. RESULTS: Atrial EMD parameters (PA lateral, PA septum, PA tricuspid) significantly increased in the PHPT group compared to the control group (p < 0.001, for all). Also, inter-atrial and intra-atrial EMD were higher in the PHPT group than in the control group (p < 0.001, for all). In correlation analysis, calcium was closely associated with PA lateral (r = 0.749, p < 0.001), PA septum (r = 0.735, p < 0.001), inter-atrial EMD (r = 0.807, p < 0.001), and intra-atrial EMD (r = 0.838, p < 0.001). The same correlation relationship was seen between PTH levels with PA lateral (r = 671, p < 0.001), PA septum (r = 0.660, p < 0,001), inter-atrial EMD (r = 0.674, p < 0.001), and intra-atrial EMD (r = 0.732, p < 0.001). CONCLUSIONS: Atrial EMD parameters were prolonged in PHPT. The measurement of atrial EMD parameters might be used in determining the risk of AF development in PHPT.