Mitral annular plane systolic excursion (MAPSE) as a predictor of atrial fibrillation development after coronary artery bypass surgery.

OBJECTIVE: To predict the possibility of postoperative atrial fibrillation (AF) with mitral annular plane systolic excursion (MAPSE) measurement, which is a cheap, reproducible echocardiographic method and to monitor these patients more closely and to evaluate them more effectively postoperatively. MATERIAL AND METHODS: 247 patients scheduled for coronary artery bypass surgery were evaluated and 200 patients were included in the study.The enrolled patients were classified into the two groups according to the occurrence of postoperative AF or maintained sinus rhythm after coronary artery bypass surgery (normal sinus rhythm [NSR] group vs. AF group).The clinical and demographic data of all the patients were recorded on admission. Two-dimensional transthoracic echocardiography (TTE) was performed prior to elective surgery. RESULTS: Postoperative new onset AF occurred in 37 (18.5%) patients. In the multivariate logistic regression analysis carried out after the formation of the model based on the parameters related to AF development, the relationships with white blood cell count, LAd and MAPSE were observed to be prevalent.When MAPSE, which is a parameter used to predict the development of postoperative atrial fibrillation, was compared in the ROC analysis, the area under the curve was found to be 0.831, 95% CI lower-95% CI upper (0.761-0.901) (p<0.001).The distinguishing MAPSE value in predicting postoperative atrial fibrillation development was found to be 11.6 (sensitivity: 90%, specificity: 81%). CONCLUSIONS: We showed that MAPSE could play a role in determining postoperative atrial fibrillation development after coronary artery bypass surgery (Tab. 2, Fig. 2, Ref. 28).

Predicting Postoperative Atrial Fibrillation Using HARMS2-AF Score.

BACKGROUND: Postoperative atrial fibrillation (POAF) remains a common complication after cardiac surgery. The ability to accurately identify patients at risk through previous risk scores is limited. This study aimed to evaluate the new HARMS2-AF risk score to predict POAF after coronary artery bypass grafting (CABG) surgery. METHODS: In this retrospective cohort study, we included 265 patients undergoing CABG surgery from 2022-2023. Data were obtained from the medical files of the patients and hospital records. Each patient was assigned a HARMS2-AF risk score. A univariate and multivariate regression analyses were done to analyze independent predictors of POAF. RESULTS: Of 265 patients, 49 had postoperative atrial fibrillation. HARMS2-AF score was significantly higher in patients with POAF. Age, sleep apnea,a left atrial diameter (LAd), and HARMS2-AF score were independently associated with POAF. A HARMS2-AF score ≥ 4.5 predicted POAF with 91% sensitivity and 64% specificity (AUC = 0.787, 95% CI = 0.731-0.842, P < .001). CONCLUSION: The HARMS2-AF score is a strong predictor of atrial fibrillation (AF) development after isolated CABG surgery. It can be used as a novel stratification tool to estimate AF after cardiac surgery.

Evaluation of left ventricular myocardial deformation parameters in individuals with electrocardiographic early repolarization pattern.

OBJECTIVE: Although an early repolarization (ER) pattern was considered to be a benign electrocardiographic variant, several studies have shown that it is associated with an increased risk of idiopathic ventricular fibrillation and death. The aim of the present study was to determine whether there is any abnormality in myocardial deformation parameters (strain, strain rate, rotation, and twist) of the left ventricle obtained by speckletracking echocardiography (STE) in subjects with ER pattern. METHODS: There were two groups in this prospective case-control study. The first group consisted of subjects with ER pattern (n=35). The other group was control without ER pattern (n=25). Subjects with poor echocardiographic image quality and history of cardiovascular, pulmonary, systemic, or metabolic disease were excluded from the study. For STE of the left ventricle, two-dimensional images from apical long-axis, twochamber, and four-chamber views and from parasternal short-axis views were obtained. RESULTS: We did not observe significant differences between the groups for left ventricular (LV) longitudinal deformation parameters, rotation, and twist. When LV circumferential deformation parameters were analyzed, early diastolic strain rate value at the level of apex was higher in subjects with ER pattern (2.3±0.7 s-1 vs. 1.9±0.4 s-1, p=0.01). Among LV radial deformation parameters, only peak strain (42.5±16.1% in the ER group vs. 56.9±21.1% in controls, p=0.004) and early diastolic strain rate (-2.0±0.7 s-1 in the ER group vs. -2.3±0.7 s-1 in controls, p=0.03) values at the level of papillary muscle were different. CONCLUSION: In subjects with ER pattern, LV myocardial deformation evaluated by STE is normal with a few regional exceptions. STE does not provide much information about risk stratification of these subjects.

Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome.

OBJECTIVE: Inflammatory mechanisms are known to play an important role in coronary artery disease. The present study aimed to investigate the importance of the neutrophil-to-lymphocyte ratio (NLR) in terms of in-hospital mortality and its association with currently used risk scores in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS: Three hundred and seventeen patients with NSTE-ACS were included. The patients were divided into tertiles according to their NLR values (NLR <2.6, NLR=2.6-4.5, and NLR >4.5). Clinical and angiographic risk was evaluated by the SYNTAX and GRACE risk scores. RESULTS: The GRACE risk score was significantly higher in the group with high NLR values compared to those with moderate or low NLR (161.5±40.3, 130.5±32.3, and 123.9±34.3, respectively, p<0.001). Similarly, the SYNTAX score was significantly higher in the group with high NLR values (20.4±10.1, 15.5±10.5, and 13.4±7.8, respectively, p=0.003). Moreover, both GRACE (r=0.457, p<0.001) and SYNTAX scores (r=0.253, p=0.001) showed a significant positive correlation with NLR. CONCLUSION: NLR has been found to be correlated with clinical and angiographic risk scores. Low NLR might be a good predictor for low in-hospital mortality and simple coronary anatomy in NSTE-ACS patients.