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ABSTRACT Introduction: The aim of this study was to assess the impact of aortic angulation (AA) on periprocedural and in-hospital complications as well as mortality of patients undergoing Evolut™ R valve implantation. Methods: A retrospective study was conducted on 264 patients who underwent transfemoral-approach transcatheter aortic valve replacement with self-expandable valve at our hospital between August 2015 and August 2022. These patients underwent multislice computer tomography scans to evaluate AA. Transcatheter aortic valve replacement endpoints, device success, and clinical events were assessed according to the definitions provided by the Valve Academic Research Consortium-3. Cumulative events included paravalvular leak, permanent pacemaker implantation, new-onset stroke, and in-hospital mortality. Patients were divided into two groups, AA ≤ 48° and AA > 48°, based on the mean AA measurement (48.3±8.8) on multislice computer tomography. Results: Multivariable logistic regression analysis was performed to identify predictors of cumulative events, utilizing variables with a P-value < 0.2 obtained from univariable logistic regression analysis, including AA, age, hypertension, chronic renal failure, and heart failure. AA (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 0.89-3.38, P=0.104), age (OR: 1.04, 95% CI: 0.99-1.10, P=0.099), hypertension (OR: 1.66, 95% CI: 0.82-3.33, P=0.155), chronic renal failure (OR: 1.82, 95% CI: 0.92-3.61, P=0.084), and heart failure (OR: 0.57, 95% CI: 0.27-1.21, P=0.145) were not found to be significantly associated with cumulative events in the multivariable logistic regression analysis. Conclusion: This study demonstrated that increased AA does not have a significant impact on intraprocedural and periprocedural complications of patients with new generation self-expandable valves implanted.
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Abstract Background: Coronary artery ectasia (CAE) is defined by focal enlargement of the coronary artery exceeding 1.5 times the adjacent normal segment. CAE can often cause arrhythmias, heart failure, sudden death, and myocardial ischemia. Ischemia due to microvascular dysfunction may be responsible for the ventricular heterogeneity in CAE. Objectives: The aim of our study was to evaluate the frontal QRS-T angle in patients with CAE. Methods: Our study included 55 patients with CAE and 50 individuals in the control group. Demographic characteristics and electrocardiographic parameters were compared between the two groups. Categorical variables were compared using the chi-square test. Continuous variables were compared using unpaired Student's t-test. P values < 0.05 were considered statistically significant. The frontal QRS-T angle was calculated from 12-lead electrocardiograms (ECGs) using the automatic report from the electrocardiography machine. Results: The average age of patients with CAE was 63.2 ± 3.4 years, with 18 women among them. The control group had an average age of 61.1 ± 3.2 years, with 28 women included. There was no significant difference in demographic parameters between the two groups. Compared to the control group, patients with CAE had significantly wider frontal QRS-T angle (p < 0.001), as well as longer QTmax duration, p = 0.002; Tp-Te interval, p = 0.02; and QT dispersion (QTd), p = 0.04. Conclusion: The frontal QRS-T angle can be calculated easily and time-efficiently using surface electrocardiography. In this study, we showed for the first time that the frontal QRS-T angle was significantly increased in patients with CAE.
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SUMMARY OBJECTIVE: The aim of our study was to compare the traditional radial artery, distal radial artery, and transfemoral artery, which are vascular access sites for coronary angiography, in terms of pain level using the visual analog scale. METHODS: Between April 2021 and May 2022, consecutive patients from three centers were included in our study. A total of 540 patients, 180 from each of the traditional radial artery, distal radial artery , and transfemoral artery groups, were included. The visual analog scale was applied to the patients as soon as they were taken to bed. RESULTS: When the visual analog scale was compared between the groups, it was found to be significantly different (transfemoral artery: 2.7±1.6, traditional radial artery: 3.9±1.9, and distal radial artery: 4.9±2.1, respectively, p<0.001). When the patients were classified as mild, moderate, and severe based on the visual analog scale score, a significant difference was found between the groups in terms of body mass index, process time, access time, and number of punctures (p<0.001). Based on the receiver operating characteristic analysis, body mass index>29.8 kg/m2 predicted severe pain with 72.5% sensitivity and 73.2% specificity [(area under the curve: 0.770, 95%CI: 0.724-0.815, p<0.0001)]. CONCLUSION: In our study, we found that the femoral approach caused less access site pain and a high body mass index predicts severe pain.
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SUMMARY OBJECTIVE: In this study, we investigated the relationship between age, creatinine, and left ventricular ejection fraction risk score and the severity of coronary lesions detected by applying fractional flow reserve in the patient group presenting with chronic coronary syndrome. Also, we presented long-term follow-up results in patients whose age, creatinine, and left ventricular ejection fraction score was evaluated by the fractional flow reserve procedure. METHODS: This study was planned retrospectively and in two centers. For this purpose, 114 patients who met the study criteria and who underwent elective fractional flow reserve between January 2014 and January 2019 were included in the study. Age, creatinine, and left ventricular ejection fraction was calculated as age/left ventricular ejection fraction +1 (if estimated glomerular filtration rate<30 mL/min). RESULTS: They were divided into two groups according to the cutoff value of the age, creatinine, and left ventricular ejection fraction score. A total of 76 patients had an age, creatinine, and left ventricular ejection fraction score of ≤1.17 (Group I) and 38 patients had an age, creatinine, and left ventricular ejection fraction score of >1.17 (Group II). The number of patients with severe lesions in fractional flow reserve was significantly higher in Group II compared with Group I (60.5 vs. 32.9%, p=0.005). According to the Kaplan-Meier analysis, a significant increase was observed in major adverse cardiac events and mortality during the follow-up period in the group with a high-risk score (Log Rank: 15.01, p<0.001 and Log Rank: 8.51, p=0.004, respectively). CONCLUSION: In light of the data we obtained from our study, we found a correlation between the severity of the lesion detected in fractional flow reserve and the age, creatinine, and left ventricular ejection fraction scores. In addition, we found that patients with high age, creatinine, and left ventricular ejection fraction scores had higher mortality and major adverse cardiac events rates during follow-up.
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SUMMARY OBJECTIVES: While studies on the treatment for the coronavirus disease 2019 (COVID-19) pandemic continue all over the world, factors that increase the risk of severe disease have also been the subject of research. Malnutrition has been considered an independent risk factor. Therefore, we aimed to investigate the clinical effect of dietary habits and evaluate the prognostic value of the Controlling Nutritional Status score in the COVID-19 patients we followed up. METHODS: A total of 2760 patients hospitalized for COVID-19 were examined. Patients were retrospectively screened from three different centers between September 1 and November 30, 2020. A total of 1488 (53.9%) patients who met the criteria were included in the study. Risk classifications were made according to the calculation methods of prognostic nutritional index and Controlling Nutritional Status scores and total scores. The primary outcome of the study was in-hospital mortality. RESULTS: The groups with severe Controlling Nutritional Status and prognostic nutritional index scores had a significantly higher mortality rate than those with mild scores. In the multivariable regression analysis performed to determine in-hospital mortality, the parameters, such as age (OR 1.04; 95%CI 1.02-1.06, p<0.001), admission oxygen saturation value (SaO2) (OR 0.85; 95%CI 0.83-0.87, p<0.001), and Controlling Nutritional Status score (OR 1.34; 95%CI 1.23-1.45, p<0.001), were independent predictors. The patient groups with a low Controlling Nutritional Status score had a higher rate of discharge with recovery (p<0.001). CONCLUSIONS: Higher Controlling Nutritional Status scores may be effective in determining in-hospital mortality in patients with COVID-19. Nutrition scores can be used as a useful and effective parameter to determine prognosis in patients with COVID-19.
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SUMMARY OBJECTIVE: Intervention in chronic total occlusion lesions involves long procedure time, a serious contrast load, and complex procedures. In this study, we aimed to investigate mortality rate of patients who had procedural coronary angiography done for chronic total occlusion lesions in coronary angiography series and who developed contrast-induced nephropathy. METHODS: A total of 218 patients with chronic total occlusion lesion in at least one coronary artery, from three different medical centers, who underwent procedural coronary angiography were recruited for the study. Patient population was divided into two groups: those who developed contrast-induced nephropathy and those who did not. Mortality due to all causes was investigated between both groups throughout a 100-month follow-up. RESULTS: Mean age of patients with incidence of contrast-induced nephropathy was 66.7±11.8, and 23.8% of them were comprised by female. We found a significantly higher mortality in long-term follow-up in the patient group with contrast-induced nephropathy (42.9 vs. 57.1%, p≤0.001). According to Kaplan-Meier analysis performed additionally, survival during follow-up was significantly shorter in this group and, in logistic regression analysis, it was an independent predictor of mortality (OR 3.02; 95%CI 1.41-6.45, p=0.004). CONCLUSION: We identified that the development of contrast-induced nephropathy is associated with long-term mortality. It might be possible to reduce adverse events with prophylactic approaches before the procedure and close follow-up of such patients after the procedure.