Impact of Preloading Strategy With Ticagrelor on Periprocedural Myocardial Injury in Patients With Non-ST Elevation Myocardial Infarction Undergoing Early Invasive Strategy.

ABSTRACT: Pretreatment with an oral P2Y12 receptor blocker (before coronary angiography) versus treatment in the catheterization laboratory has been a matter of debate in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI). The primary aim of this study was to assess the impact of an immediate preloading strategy with ticagrelor on periprocedural myocardial injury in patients with NSTEMI treated with an early invasive strategy. NSTEMI patients who underwent coronary angiography and subsequent percutaneous coronary intervention (PCI) within 24 hours after hospital admission were divided into 2 groups: the first group (pretreatment group) included patients who received ticagrelor pretreatment as soon as possible after admission and the second group (no pretreatment group) included patients who received a loading dose of ticagrelor after coronary angiography. The pretreatment group included 232 patients, and the no pretreatment group included 87 patients. Male patients represented the majority of the patients. The 2 groups were similar in baseline characteristics, except for a greater incidence of hypertension ( P = 0.014) and higher hemoglobin levels ( P = 0.01) in the pretreatment group in comparison with the no pretreatment group. Patients in the ticagrelor pretreatment group had less myocardial injury until coronary angiography based on troponin measurements collected at 12 hours after admission ( P = 0.025). Patients in the ticagrelor pretreatment group also had fewer periprocedural myocardial injuries based on troponin measurements taken between 12 and 24 hours after the PCI ( P = 0.026 and P = 0.022, respectively). Our findings suggested that ticagrelor pretreatment reduces periprocedural myocardial injury in NSTEMI patients who underwent PCI within 24 hours after admission.

Effects of obesity on arrhythmic events and survival in patients with an implantable cardioverter defibrillator.

Background    Studies have shown that increased body weight and obesity may be associated with an increased risk of arrhythmic events. The aim of this study was to evaluate the effect of obesity on the risk of arrhythmic events, hospitalization, and death in patients who received implantable cardioverter defibrillator (ICD) therapy for primary or secondary prevention.Material and Methods    A single-center, prospective, observational study was conducted. Patients with body mass index (BMI) <30 kg / m2 were classified as non-obese, and patients with BMI ≥30 kg / m2 were classified as obese. The primary endpoints were arrhythmic events and device interventions. The secondary endpoints were all-cause mortality, cardiac mortality, cardiac rehospitalization, and a composite endpoint of mortality and hospitalization.Results    Among a total of 340 patients, 78.2 % were male, and 22.1 % were obese. The mean age was 60.9 yrs. Ventricular tachycardia (VT) was more frequent in non-obese patients (HR 0.57, [CI] 0.38-0.87, p=0.009). All-cause mortality and cardiac mortality in all patients tended to be more frequent in non-obese (HR 2.71, [CI] 0.93-7.93, p= 0.069 for all-cause mortality; HR 3.29, [CI] 0.97-11.17, p=0.056 for cardiac mortality). In the subgroup analysis, VT, all-cause mortality, and cardiac mortality were more common for non-obese patients in primary prevention and ischemic heart failure (HF) groups.Conclusion    While VT was more frequent in non-obese patients, VF, ICD appropriate shock, inappropriate shock, and antitachycardia pacing were similar in obese and non-obese patients. All-cause mortality and cardiac mortality were more frequent in non-obese patients.

Management of periprocedural anticoagulant therapy: a novel individualized approach-a transeusophageal echocardiographic study.

Patients with non-valvular atrial fibrillation who are under chronic oral anticoagulant therapy (OAC) treatment frequently require interruption of OAC treatment. By examining the presence of left atrial/left atrial appendage (LA/LAA) thrombus or dense spontaneous echo contrast (SEC) with transesophageal echocardiography (TEE) we aimed to develop an individualized strategy. To test the validity of CHA2DS2VASc score based recommendations was our secondary purpose. In this prospective study patients with non-valvular atrial fibrillation on OAC therapy were included. Patients' baseline characteristics, CHA2DS2VASc and HASBLED scores, medications, type of invasive procedures and clinical events were recorded. Each patient underwent to TEE examination prior to the invasive procedure. Bridging anticoagulation was recommended only to patients with LA/LAA thrombus. We included 155 patients and mean CHA2DS2VASc score of the study population was 3.4 ± 1.4. Seventy-one of them had LA/LAA thrombi or SEC on TEE examination and bridging anticoagulation was applied. OAC treatment was not bridged in 8 of 11 patients with prior cerebrovascular accident and 17 of 31 patients with CHA2DS2VASc score of > 4. 57 of 124 patients with CHA2DS2VASc score of ≤ 4 required bridging anticoagulation. There were 14 major bleedings decided according to ISTH bleeding classification. Major bleeding was observed only in patients underwent to high-risk bleeding procedure. In conclusion CHA2DS2VASc score by itself is not enough for decision-making regarding ischemic risk. Furthermore, since major bleedings occurred only in patients underwent to high-risk bleeding surgery, TEE-based individualisation may be a feasible approach particularly for those with high thromboembolic risk undergoing high-bleeding risk procedure.

The clinical significance of premature atrial contractions: How frequent should they become predictive of new-onset atrial fibrillation.

BACKGROUND: Although previous studies reported frequent premature atrial contractions(fPACs) increased the risk of adverse cardiovascular outcomes, especially atrial fibrillation(AF), there is a substantial inconsistency between reports concerning the definition of fPAC. In this study, we aimed to investigate the relationship between fPAC and cardiovascular outcomes, especially AF. We further searched for a cutoff value of fPAC for prediction of AF. METHODS: We retrospectively analyzed the ambulatory 24-hr Holter monitoring records and 392 patients included. Frequent PAC was defined as more than 720 PAC/24 hr as used for frequent ventricular premature beats. Patients' baseline characteristics, echocardiographic variables and medical history were recorded. RESULTS: There were 189 patients with fPAC and 203 patients without fPAC. Patients with fPAC had more comorbidities in terms of hypertension, diabetes mellitus, coronary artery disease and congestive heart failure. CHA2DS2-VaSc was higher in patients with fPAC. Mean follow-up duration was 31 months, and the number of patients with new-onset AF during follow-up was significantly higher in fPAC group (22% vs. 5%, p < .001). fPAC was significantly and independently associated with new-onset AF and predicted AF with a cutoff value of 3,459 PAC/24 hr, and the risk of AF was 11-fold higher than those with <3,000 PAC/24 hr. In addition, an increased CHA2DS2-VaSc score was also associated with new-onset atrial fibrillation. CONCLUSION: In our study, we have demonstrated that fPAC is significantly associated with new-onset AF, and this association is the strongest among those patients who have more than 3,000 PAC in 24 hr.

Long-Term Impact of Different Immunosuppressive Drugs on QT and PR Intervals in Renal Transplant Patients.

BACKGROUND: Sudden cardiac deaths due to arrhythmias are thought to be an important cause of mortality in patients with renal transplants. Exposure to immunosuppressive drugs may lead to QT or PR interval abnormalities which may consequently cause arrhythmias. Our study investigated the long term impact of four different immunosuppressive drugs on PR and corrected QT intervals (QTc) in renal transplant patients METHODS: The study population consisted of 98 kidney transplant recipients. Study patients were receiving immunosuppressive management with tacrolimus, cyclosporine A, everolimus or azathioprine according to the local protocols. QTc and PR intervals obtained from the most recent post-transplant electrocardiograms were compared with the pre-transplant intervals dated before the transplantation procedure. RESULTS: Post-transplant QTc intervals had prolonged significantly in comparison to the pre-transplant QTc intervals in all groups. However, there were no significant differences between the immunosuppressive agents with regard to post-transplant QTc interval prolongation (p > 0.05). There were no significant differences between the groups with regard to the pre and post-transplant PR interval changes (p > 0.05). CONCLUSIONS: QT interval prolongation, a marker of risk for arrhythmias and sudden death, is highly prevalent among kidney transplant patients receiving different classes of immunosuppressive drugs.

The relationship between aortic stiffness and serum hyaluronidase levels in patients with diabetes mellitus and hypertension.

The aim of this study was to investigate the association of serum hyaluronidase and nitric oxide (NO) levels with arterial stiffness in patients with hypertension (HT) and diabetes mellitus (DM). A total of 101 patients with diagnosis of DM and HT were enrolled in this study. The patients were divided into three groups as follows: only hypertensive (I), only diabetic (II) and both diabetic and hypertensive (III). Serum hyaluronidase levels were negatively correlated with aortic strain (AS) and aortic distensibility (AOD) in all groups, whereas a significant positive correlation was noted between serum hyaluronidase levels and aortic strain index (ASI) (all p-values < 0.05). There was a significant negative correlation between serum hyaluronidase and NO levels in all patients (p < 0.001). When the correlation between serum hyaluronidase and serum NO levels was investigated in the individual patient groups, a negative correlation was found in groups I, II and III (p = 0.017, p < 0.001 and p < 0.001, respectively). A significant relationship between plasma hyaluronidase level and parameters of aortic stiffness was found in patients with HT and/or DM. We suggest that the pathophysiological mechanisms responsible for the development of arterial stiffness in subjects with impaired endothelial function may involve pathological changes in the HA metabolism.

Unilateral absence of the left pulmonary artery with patent ductus arteriosus and interrupted inferior vena cava.

Unilateral absence of the pulmonary artery and interrupted inferior vena cava are rare congenital disorders. The clinical presentation is variable, and many patients can be asymptomatic for many years and even throughout their lives. We report the case of a 44-year-old female patient with a history of hemoptysis. She was referred to our clinic with a diagnosis of pulmonary artery agenesis. Computed tomography revealed absence of the left main pulmonary artery and long-tract patent ductus arteriosus (PDA). Blood supply to the left lung was provided by major aortopulmonary collateral arteries (MAPCAs). Right heart catheterization through the right femoral vein was problematic, as the catheter could not be negotiated from the inferior vena cava to the right atrium. We revealed the interrupted inferior vena cava, which continued as a dilated azygos vein to the superior vena cava. The magnitude of the shunt flow from the PDA was too small, and the calculated shunt fraction was not significant. Hemoptysis was possibly due to MAPCAs. However, as the patient had no active bleeding when she was referred, the exact source of the hemoptysis could not be identified.

Structural and Functional Impact of Adrenoceptor Beta-1 Gene Polymorphism in Patients with Hypertrophic Cardiomyopathy and Response to Beta-Blocker Therapy.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetically inherited cardiac disorder with diverse clinical presentations. Adrenergic activity, primarily mediated through beta-adrenoceptors, plays a central role in the clinical course of HCM. Adrenergic stimulation increases cardiac contractility and heart rate through beta-1 adrenoceptor activation. Beta-blocker drugs are recommended as the primary treatment for symptomatic HCM patients to mitigate these effects. METHODS: This prospective study aimed to investigate the impact of common ADRB-1 gene polymorphisms, specifically serine-glycine at position 49 and arginine-glycine at position 389, on the clinical and structural aspects of HCM. Additionally, the study explored the association between these genetic variations and the response to beta-blocker therapy in HCM patients. RESULTS: A cohort of 147 HCM patients was enrolled, and comprehensive assessments were performed. The findings revealed that the Ser49Gly polymorphism significantly influenced ventricular ectopic beats, with beta-blocker therapy effectively reducing them in Ser49 homozygous patients. Moreover, natriuretic peptide levels decreased, particularly in Ser49 homozygotes, indicating improved cardiac function. Left ventricular outflow obstruction, a hallmark of HCM, was also reduced following beta-blocker treatment in all patient groups. In contrast, the Arg389Gly polymorphism did not significantly impact baseline parameters or beta-blocker response. CONCLUSION: These results emphasize the role of the Ser49Gly polymorphism in the ADRB-1 gene in shaping the clinical course and response to beta-blocker therapy in HCM patients. This insight may enable a more personalized approach to managing HCM by considering genetic factors in treatment decisions. Further research with larger populations and longer follow-up periods is needed to confirm and expand upon these findings.

Chromosome 9p21 rs10757278 polymorphism is associated with the risk of metabolic syndrome.

Metabolic syndrome (MetS) is a common multifactorial disorder that involves abdominal obesity, dyslipidemia, hypertension, and hyperglycemia. Genome-wide association studies have identified a major risk locus for coronary artery disease and myocardial infarction on chromosome 9p21. Here, we examined the frequency of single nucleotide polymorphisms (SNPs) on chromosome 9p21 in a sample of Turkish patients with MetS and further investigated the correlation between regional SNPs, haplotypes, and MetS. The real-time polymerase chain reaction (RT-PCR) was used to analyze 4 SNPs (rs10757274 A/G, rs2383207 A/G, rs10757278 A/G, rs1333049 C/G) in 291 MetS patients and 247 controls. Analysis of 4 SNPs revealed a significant difference in the genotype distribution for rs2383207, rs10757278, and rs1333049 between MetS patients and controls (p = 0.041, p = 0.005, p = 0.023, respectively) but not for rs10757274 (p = 0.211). MetS and control allelic frequencies for rs2383207, rs10757278, and rs1333049 were statistically different (p < 0.05). The rs2383207 AG variant, was identified as a MetS risk factor (p = 0.012, OR = 33.271; 95 % CI: 2.193-504.805) and the AA haplotype in block 1 and the GC, AG haplotypes in block 2 were associated with MetS (χ(2) = 3.875, p = 0.049; χ(2) = 9.334, p = 0.0022; χ (2) = 9.134, p = 0.0025, respectively). In this study, we found that chromosome 9p21 SNP rs10757278 and related haplotypes correlate with MetS risk. This is the first report showing an association between a 9p21 variant and MetS and suggests that rs10757278 polymorphism may confer increased risk for disease.

The Long-Term Impact of Ionizing Radiation on DNA Damage in Patients Undergoing Multiple Cardiac Catheterizations.

Ionizing radiation (IR) exposures have increased exponentially in recent years due to the rise in diagnostic and therapeutic interventions. A number of small-scale studies investigated the long-term effect of IR on health workers or immediate effects of IR on patients undergoing catheterization procedures; however, the long-term impact of multiple cardiac catheterizations on DNA damage on a patient population is not known. In this study, the effects of IR on DNA damage, based on micronuclei (MN) frequency and 8-hydroxy-2'-deoxyguanosine (8-OHdG) as markers in peripheral lymphocytes, were evaluated in patients who previously underwent multiple cardiac catheterization procedures. Moreover, genetic polymorphisms in genes PARP1 Val762Ala, OGG1 Ser326Cys, and APE1 Asn148Glu as a measure of sensitivity to radiation exposure were also investigated in the same patient population. The patients who underwent ≥ 3 cardiac catheterization procedures revealed higher DNA injury in comparison to the patients who underwent ≤ 2 procedures, documented with the presence of higher level of MN frequency (6.4 ± 4.8 vs. 9.1 ± 4.3, p = 0.002) and elevated serum 8-OHdG levels (33.7 ± 3.8 ng/mL vs. 17.4 ± 1.9 ng/mL, p = 0.001). Besides, OGG1 Ser326Cys and APE1 Asn148Glu heterozygous and homozygous polymorphic types, which are related with DNA repair mechanisms, were significantly associated with MN frequency levels (p = 0.006 for heterozygous and p = 0.001 for homozygous with respect to OGG1 Ser326Cys, p = 0.007 for heterozygous and p = 0.001 for homozygous with respect to APE1 Asn148Glu). There was no significant difference in terms of PARP1 Val762Ala gene polymorphism between two groups.

Instantaneous Wave-Free Ratio: Novel Adenosine-Free Method to Assess Intracoronary Physiology.

Fractional flow reserve assessment was accepted as a crucial strategy in stable patients undergoing coronary angiography without prior noninvasive evaluation in the presence of borderline lesions and in patients with multivessel coronary artery disease. Instantaneous wave-free ratio, measured during a specific diastolic interval, emerged as a nonhyperemic pressure ratio. Due to its advantages such as not requiring a vasodilating agent, rapidity of procedure, pullback phenomena for the assessment of individual stenosis in tandem lesions or diffusely infiltrated vessels, and virtual percutaneous coronary intervention which allows the assessment and justification 'of' optimal coronary revascularization, instantaneous wave-free ratio became a valuable option in the field of coronary physiology. This review aims to address coronary physiological concept with fractional flow reserve and emergence of instantaneous wave-free ratio through cornerstone studies as well as the use of instantaneous wave-free ratio in different clinical scenarios.

Non-dominant right coronary artery (RCA) is associated with suspected inferior ischemia on SPECT in patients without significant coronary artery disease (CAD).

OBJECTIVE: There is a huge uncertainty in the medical community regarding the significance of non-dominant right coronary artery (RCA) in patients with inferior wall ischemia on myocardial perfusion single-photon emission computed tomography (SPECT). The purpose of this study is to determine the effect of non-dominant RCA on myocardial perfusion SPECT (MPS) with respect to the misleading detection of ischemia in the inferior wall of the myocardium. METHODS: This is a retrospective study of 155 patients, who had undergone elective coronary angiography owing to an indication of inferior wall ischemia by MPS between 2012 and 2017. Patients were divided into two groups based on the coronary dominance: group 1 (n = 107), if RCA is the dominant artery, and group 2 (n = 48), if there are dominance of left artery and codominance of both arteries. Obstructive CAD was diagnosed in the case of stenosis that had severity greater than 50%. The positive predictive value (PPV), which was calculated as per the correlation between the inferior wall ischemia in MPS and obstruction level in RCA, was compared in both groups. RESULTS: Majority of patients were male (109, 70%) and the mean age was 59.5 ± 10.2. There were 45 patients with obstructive RCA disease (PPV: 42%) among 107 patients in group 1, whereas there were only 8 patients with obstructive coronary artery disease (CAD) in RCA among 48 patients in group 2, (PPV: 16% and p = 0.004). CONCLUSIONS: The results demonstrated that non-dominant RCA is associated with false-positive detection of inferior wall ischemia via MPS.

[Perioperative management in patients receiving newer oral anticoagulant and antiaggregant agents]. / Yeni oral antikoagülan ve antiagregan ilaçlari kullanan hastalarda perioperatif yaklasim.

It is anticipated that an increasing number of patients undergoing surgical procedures will be taking new anticoagulants and antiaggregants. Currently, only a small amount of data (which were derived from subgroup analyses of undedicated studies) exist regarding the optimal strategy in these patients. Clinical studies are urgently required to establish safe surgical procedures for this high risk patient population. Unlike warfarin, dabigatran and rivaroxaban have predictable and consistent anticoagulant effects with a rapid onset of action, short half-life, and consequently no need for routine laboratory testing. The pharmacologic profiles of these drugs represent an advantage for patients on chronic oral anticoagulant treatment who are undergoing invasive procedures. These drugs may minimize patient time spent without the antithrombotic effects of oral anticoagulants during the perioperative period, potentially eliminating the need for bridging therapy altogether.

Cardiac Hydatid Disease and Peritoneal Tuberculosis Coexistence.

Hydatid cyst is a parasitic infection caused by Echinocococcus granulosus. The coexistence of tuberculosis and cardiac hydatid cyst is extremely rare and generally seen in developing coun- tries. Here, we describe a unique case of a patient presenting with cardiac and gastrointestinal symptoms, who has coexistence of cardiac hydatid cyst and peritoneal tuberculosis.

The validation of left atrial strain imaging for the assessment of diastolic functions in patients with ST-segment elevation myocardial infarction.

Assessment of left ventricular filling pressure (LVFP) is crucial in patients with ST-segment elevation myocardial infarction (STEMI). Since current guideline recommended echocardiographic parameters have limited value, more comprehensive assessment methods are required in this patient subset.In this study, we aimed to investigate the clinical utility of left atrial reservoir strain (LARS) imaging in patients treated with primary percutaneous coronary intervention (pPCI). Patients who underwent successful pPCI were included. Left ventricular end-diastolic pressure (LVEDP) was measured invasively following pPCI. Left atrial strain imaging was performed following pPCI within 24 h of pPCI. Normal LARS value was accepted as above 23%. We prospectively enrolled 69 patients; there were 18 patients with LARS below 23% who were included into group 1 and rest of the study population included into group 2. There was no significant difference between groups in terms of comorbidities.Troponin and pro-BNP levels were significantly higher in group 1 (p: 0.036 and 0.047 respectively). Left atrial volume and tricuspid regurgitation velocity were similar between groups (p: 0.416 and p: 0.351 respectively). Septal tissue velocity was higher (p: 0.001) and Septal E/e' ratio was lower (p: 0.004) in group 2. Left ventricular (LV) global longitudinal strain value was higher in group 1 which is consistent with observed lower ejection (LVEF) fraction in group 1 (p: 0.001 for LV strain and p: 0.001 for LVEF). Estimated mean LVFP was also higher in group 1 (p: 0.003).Correlation analyses revealed moderate correlation between LARS and LVEDP (r: - 0.300). Our results indicate that left atrial strain imaging is a promising tool for the assessment of left atrial pressure in patients with STEMI.

Perforations of right heart chambers associated with electrophysiology catheters and temporary transvenous pacing leads.

OBJECTIVES: Perforation of heart chambers is one of the rare complications observed during electrophysiological studies and placement of pacemaker leads. In this study, we performed a retrospective evaluation of patients with catheter-related right heart perforation, aiming to determine its incidence and clinical course. STUDY DESIGN: We reviewed cases with catheter-related cardiac perforations observed at our institution from June 2002 to November 2007. RESULTS: During the study period, a total of 2,385 procedures were performed (1,287 electrophysiologic studies, 1,098 temporary nonballoon-floating pacing lead placements). Eight cardiac perforations were diagnosed, with the overall procedure-based and catheter-based incidences of 0.34% (8/2,385) and 0.14% (8/5,603), respectively. Three of these perforations were related to diagnostic electrophysiology catheters, and five were related to temporary (1 permanent) transvenous pacemaker leads. Seven perforations involved the right ventricle and one involved the right atrium. Three patients in whom right ventricular perforation was detected at a late stage died suddenly after pacemaker lead implantation. One patient underwent surgical exploration because of right atrial perforation. Two patients underwent coronary bypass operation and, in one of these patients, perforation was detected during surgery. Two patients were managed conservatively. CONCLUSION: Although right ventricular perforations detected early have a relatively benign course, those detected late and right atrial perforations require emergent surgical exploration and may have catastrophic consequences.

Development of chylothorax and chylous ascites in a patient with congestive heart failure.

Chylothorax and chylous ascites are very rare clinical entities generally caused by obstruction and disruption of the thoracic duct. A 60-year-old man presented with exertional dyspnea, fatigue, and chest discomfort of 18-month history. Physical examination revealed S4, bilateral pretibial edema, and moderate amount of ascites. Computed tomography and X-ray of the thorax showed left-sided pleural effusion. Abdominal imaging showed normal liver and spleen structure with intraperitoneal effusion and periportal edema. Thoracentesis and paracentesis yielded a milky, lipemic fluid of exudative nature. Biochemical analysis of the fluids showed a high triglyceride content and elevated lymphocyte count, typical of chylous fluid. All laboratory analyses for possible etiologies including neoplasms, tuberculosis, and cirrhosis were negative. Positron-emission tomography did not show any pathological uptake. Transthoracic echocardiographic examination showed bilateral atrial enlargement, left ventricular hypertrophy, anteroseptal hypokinesia and akinesia, and moderate mitral and tricuspid regurgitation, with an ejection fraction of 25%. Coronary arteries were normal on angiography. The patient was diagnosed with severe congestive heart failure accompanied by chylothorax and chylous ascites. Despite appropriate treatment, there was little change in congestion and no change in symptoms. He died during ultrafiltration therapy due to hemodynamic collapse and asystole.

Echocardiographic assessment of left ventricular filling pressure in patients with acute ST elevation myocardial infarction: an invasive validation study.

Backgrounds Assessment of left ventricular filling pressure (LVFP) is of clinical importance in patients with ST elevation myocardial infarction (STEMI). Although several echocardiographic parameters are recommended for the assessment of LVFP, validation of these parameters in patients with STEMI is missing. We aimed to investigate the clinical utility of these parameters in acute settings. Methods: We prospectively included consecutive patients with STEMI. LV end-diastolic pressure (LVEDP) was measured following primary PCI and echocardiographic examination was performed within 24 hours. Mean left atrial pressure (mLAP) was calculated both invasively using Yamamoto's formula and non-invasively using Naugeh's formula. Mean LAP was considered increased when exceeded 18 mmHg. Results: Patients were grouped according to LVEDP, group 1(41 patients) and group 2(114 patients).There was no significant difference between groups in terms of comorbidities. NT pro-BNP levels (p < 0.001) and peak level of Hs-TnT (p-value: 0.002) were significantly higher in group 2. Average E/e' ratio was significantly higher in group 2 (10.19 ± 3.15 vs. 12.04 ± 4.83, p: 0.046). Isovolumetric relaxation time was longer in group 2 (p < 0.001) and left atrial volume index (LAVI) was also significantly higher in group 2 (p < 0.001). Regression analyses revealed that septal, lateral and average E/e' ratio, tricuspid regurgitation velocity, LAVI and left ventricular volume are correlated with mLAP. Among group 2 patients only 14 Patients fulfilled the increased LVFP criteria suggested by current guidelines. Conclusions Echocardiographic parameters indicating increased LVFP require validation and may need to be modified in patients with STEMI. Moreover, current algorithms underestimate the actual number of patients with increased LVFP.

2021 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region: Special Populations.

Advanced age, diabetes, and chronic kidney disease not only increase the risk for ischaemic events in chronic coronary syndromes (CCS) but also confer a high bleeding risk during antiplatelet therapy. These special populations may warrant modification of therapy, especially among Asians, who have displayed characteristics that are clinically distinct from Western patients. Previous guidance has been provided regarding the classification of high-risk CCS and the use of newer-generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) after acute coronary syndromes (ACS) in Asia. The authors summarise evidence on the use of these P2Y12 inhibitors during the transition from ACS to CCS and among special populations. Specifically, they present recommendations on the roles of standard dual antiplatelet therapy, shortened dual antiplatelet therapy and single antiplatelet therapy among patients with coronary artery disease, who are either transitioning from ACS to CCS; elderly; or with chronic kidney disease, diabetes, multivessel coronary artery disease and bleeding events during therapy.

Assessment of atrial electromechanical delay and P wave dispersion in patients with chronic obstructive pulmonary disease.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is associated with atrial fibrillation (AF) and reduced forced expiratory volume (FEV1) is an independent predictor for new onset AF. The aims of this study were (1) to analyze the atrial electromechanical delay (AEMD) and P wave dispersion which are two predictors of AF development in patients with COPD and without any cardiovascular disease, and (2) to assess the relationship of those with pulmonary functions as quantified by FEV1 measurements. METHODS: The study included 41 patients with COPD (33 male; mean age: 51 years) and 32 healthy controls. P wave dispersion was calculated as the difference between the maximum and minimum P wave duration in a 12-lead surface electrocardiography (ECG) recording. AEMD, defined as the time interval from the P wave onset on the ECG to the initiation of the late diastolic (Am) wave using a tissue Doppler examination, was measured from the lateral mitral annulus (LAEMD), septal annulus (SAEMD), and tricuspid lateral annulus (TAEMD). RESULTS: P wave dispersion was significantly longer in the COPD group than those in the controls (76±19 ms vs. 45±10 ms; p<0.001). All of the AEMD measurements demonstrated significant prolongation in patients with COPD (LAEMD: 74±9 ms vs. 64±11 ms; SAEMD: 66±10 ms vs. 57±12 ms; and TAEMD: 65±9 ms vs. 46±7 ms; p<0.001 for all). The only correlation with FEV1 was observed in the TAEMD values of the COPD group (rs: -401; p<0.009). CONCLUSION: Both P wave dispersion and AEMD parameters were significantly longer in COPD patients without any established structural or functional cardiac abnormalities, indicating an increased tendency for AF development, beginning from the initial stages of the disease.