Lack of right ventricular hypertrophy is associated with right heart failure in patients with left ventricular failure.

Presence of right heart failure (RHF) is associated with a worse prognosis in patients with left ventricular failure (LVF). While the cause of RHF secondary to LVF is multifactorial, an increased right ventricular (RV) afterload is believed as the major cause of RHF. However, data are scarce on the adaptive responses of the RV in patients with LVF. Our aim was to understand the relationship of right ventricular hypertrophy (RVH) with RHF and RV systolic and diastolic properties in patients with LVF. 55 patients with a left ventricular ejection fraction of 40% or less were included in the present study. A comprehensive two-dimensional transthoracic echocardiographic examination was done to all participants. 12 patients (21.8%) had RHF, and patients with RHF had a significantly lower right ventricular free wall thickness (RVFWT) as compared to patients without RHF (5.3 ± 1.7 mm vs. 6.6 ± 0.9 mm, p = 0.02) and the difference remained statistically significant after adjusting for confounders (Δx̅:1.34 mm, p = 0.002). RVFWT had a statistically significant correlation with tricuspid annular plane systolic excursion (r = 0.479, p < 0.001) and tricuspid annular lateral systolic velocity (r = 0.360, p = 0.007), but not with the indices of the RV diastolic function. None of the patients with concentric RVH had RHF, while 22.2% of patients with eccentric RVH and 66.7% of patients without RVH had RHF (p < 0.01 as compared to patients with concentric RVH). In patients with left ventricular systolic dysfunction, absence of RVH was associated with worse RV systolic performance and a significantly higher incidence of RHF.

Decrease in Pulse Wave Velocity is Associated with Clinical Improvement in Patients with Ischemic Stroke.

BACKGROUND: Arterial stiffness is an independent determinant of cardiovascular and cerebrovascular risks. The relationship between the increase in arterial stiffness parameters and the severity of stroke has been shown in previous studies. We aimed to investigate the association between clinical improvement and changes in arterial stiffness parameters in patients presenting acute ischemic stroke. METHODS: A total of 107 patients were enrolled in this study. On the first and seventh day of the hospitalization, 24 h non-invasive blood pressure was monitored and arterial stiffness parameters were measured. The National Institutes of Health Stroke Scale (NIHSS) was used to determine the severity of stroke, and the Modified Rankin Scale was used to determine dependency and to evaluate functional improvements. RESULTS: Arterial stiffness parameters of augmentation index (AIx@75) and pulse wave velocity (PWV) were significantly higher in patients who died during hospitalization than patients who were discharged (respectively p <0.001, p = 0.04). In the group with clinical improvement, PWV values measured on the seventh day were significantly lower than PWV values measured on the first day (p = 0.032). When the changes in PWV value measured on the first and seventh day for both groups were analyzed using mixed ANOVA test, p value were significant (p = 0.033). Multivariate binary logistic regression analyses showed that negatively change in PWV and CDBP independently predicts the clinical improvement. CONCLUSIONS: Increased AIx@75 and PWV appear to be associated with higher in-hospital mortality rates in patients with acute ischemic stroke. Additionally, clinical improvement in patients with ischemic stroke is associated with a decrease in PWV .

Interpretation of the effect of CYP2C9, VKORC1 and CYP4F2 variants on warfarin dosing adjustment in Turkey.

It was aimed to underline the importance and explain the meaning of genetic testing in warfarin dosing and investigate and evaluate the contributions of the CYP2C9, VKORC1, and CYP4F2 variants in a Turkish population. Two hundred patients were genotyped for CYP2C9 (rs1799853, rs1057910 and rs56165452), VKORC1 (rs9934438, rs8050894, rs9923231, rs7294 and rs2359612) and CYP4F2 (rs2108622), yet, only 127 patients were found suitable for further evaluation in terms of their personal response to warfarin due to long term usage and available INR and dose usage information. The DNA sequences were determined by the ABI PRISM 3100 Genetic Analyzer to 3130xl System (Applied Biosystems, Foster City, California). Warfarin dose application suggestions by warfaringdosing.org, FDA and MayoClinic were followed. Dose requirements in the Turkish population were found higher than the suggested doses by warfarindosing.org. The multivariate logistic regression analysis reveals the utilization of VCORC1 genetic evaluation is valuable in warfarin dosing (low and moderate vs. high) in this study (p < 0.001). The present study provides findings for clinicians to adapt the genetic data to the daily practice. We observed that the VKORC1 variant showed a more potent impact in warfarin dosing in this study.

The Effect of Left Ventricular Assist Device Implantation on Serum Albumin, Total Protein and Body Mass: A Short-Term, Longitudinal Follow-Up Study.

BACKGROUND: Cardiac cachexia and low serum albumin levels are poor prognostic signs in advanced heart failure, while overweight patients or patients who gain weight after treatment have more favourable outcomes. Weight gain following LVAD implantation is common, while the dynamic changes in body mass or serum proteins have not been studied adequately. Our aim was to study short-term changes in serum albumin, total protein and body weight following LVAD implantation and to compare these changes with heart failure patients treated medically. MATERIALS AND METHODS: A total of 15 patients scheduled for LVAD implantation and 15 patients receiving medical treatment were prospectively enrolled. Anthropometric and laboratory data for the patients were obtained at baseline and at first and sixth months after LVAD implantation. RESULTS: Anthropometric, demographic and clinical characteristics between two groups were similar at baseline. Both serum albumin (3.59±0.71 vs. 4.17±0.46g/dl, p=0.01) and total protein (6.45±0.80 vs. 7.12±0.35g/dl, p<0.01) levels were significantly lower in LVAD group at baseline. Both total protein and serum albumin levels increased significantly in LVAD group (final total protein 7.60±0.62g/dl and serum albumin 4.20±0.46g/dl; p<0.01 for both), while there was a nonsignificant small decrease in serum albumin in medical group. The change in serum albumin, but not total protein was significantly different between LVAD and medical groups at the sixth month. Body weight initially decreased in LVAD group at first month but was nonsignificantly higher compared to baseline and medical group at the sixth month. There was a moderate correlation between the percentage weight gain and percentage increase in serum albumin in LVAD group at six months (r=0.44). CONCLUSIONS: In suitable patients with advanced heart failure, LVAD treatment can correct hypoalbuminaemia associated with heart failure within six months after implantation.

Rhabdomyolysis Secondary to Therapeutic Hypothermia After Cardiopulmonary Resuscitation: A Rare Complication.

Patient maintenance after successful cardiopulmonary resuscitation starts with decreasing the neurological damage despite serious difficulties such as hypoxic ischemic infarcts and reperfusion infarcts. Therapeutic hypothermia is the most rejoicing method in use to prevent neurological damage. Here, we discuss about a 35-year-old woman resuscitated for 20 minutes in hospital who was followed because of postpartum cardiomyopathy. Sudden onset of ventricular fibrillation subsequent to ventricular tachycardia was the underlying cause of cardiac arrest. To prevent neurological damage, therapeutic hypothermia was used, and she was cooled for 24 hours. After therapeutic hypothermia, her Glasgow coma score was 15, fortunately no sequela appeared. Although we were successful to prevent neurological damage, rhabdomyolysis arose secondary to therapeutic hypothermia. As a result, the intubation process was prolonged, and acute tubular necrosis due to myoglobinuria was occurred. Despite all complications patient faced, she was discharged on her 31th day; without sequela and with no need for hemodialysis; under medical therapy.

Prognostic Value of Neutrophil-to-Lymphocyte Ratio for Patients Undergoing Heart Valve Replacement.

BACKGROUND AND AIM OF THE STUDY: The neutrophil-tolymphocyte ratio (NLR) was found to be a predictor of adverse outcome in patients with coronary artery disease (CAD). The ratio may also be a useful marker to predict mortality following valve replacement surgery. METHODS: A total of 932 patients was enrolled retrospectively. Patients were allocated to three tertiles based on their NLR (group 1, NLR ≤1.90; group 2, 1.90 < NLR ≤2.93; group 3, NLR >2.93). RESULTS: Patients in the highest tertile were older (p = 0.049, 95% CI 0.09-5.98), tended to have chronic renal failure (p = 0.028, OR: 2.6, 95% CI 1.08-6.35), and had more frequent critical CAD on preoperative angiography (p <0.001, OR 2.1, 95% CI 1.38-3.21). Postoperatively, patients in the highest NLR tertile had a higher in-hospital mortality rate than those in the first tertile (p <0.001, OR 4.67, 95% CI 2.37-9.20) and second tertile (p = 0.002, OR 2.26, 95% CI 1.32-3.86). Patients in the third tertile had the highest mortality at day 300 (log-rank p <0.001). The hazard ratio (HR) for the second tertile was 1.8 (p = 0.11, 95% CI 0.88-3.79), and for the third tertile was 2.8 (p = 0.003, 95% CI 1.40-5.59). CONCLUSIONS: The NLR is a useful parameter to assess postoperative in-hospital mortality risk after valvular surgery.

Usefulness of the thrombolysis in myocardial infarction risk index in acute heart failure: a pilot study.

BACKGROUND: Risk stratification in acute heart failure (AHF) is vital for both physicians and paramedical personals. Thrombolysis in myocardial infarction (TIMI) risk index (TRI) and modified TRI (mTRI) are novel and simple predictive risk indices that have been examined in patients with acute coronary syndrome. OBJECTIVE: In the current study, we evaluated the relationship among TRI, mTRI, and mortality in patients with AHF. METHODS: A total of 293 patients with AHF were retrospectively analyzed. The patients were divided into 2 groups: group 1 consisted of patients who survived and group 2 consisted of patients who died during a follow-up period of 120 days. Multivariate hierarchical logistic regression analysis was performed to evaluate the relationship among TRI, mTRI, and mortality. RESULTS: All causes of death occurred in 84 patients (28.6%). Thrombolysis in myocardial infarction risk index was significantly higher in patients who died during follow-up (20.2 ± 12.4 vs 14.8 ± 8.9). The new risk score showed good predictive value for 120-day mortality. Before laboratory analysis, in-multivariate hierarchical logistic regression analysis TRI remained as an independent risk factor for mortality (odds ratio, 2.56; P < .001). After the laboratory analysis, despite the fact that TRI has lost its predictive value, mTRI remained an independent risk factor for mortality (odds ratio, 2.08; P = .01). CONCLUSION: The TRI is a simple and strong predictor of all-cause mortality in patients who were admitted with AHF. The current study reveals for the first time the strong predictive value of TRI in patients with AHF.

Giant calcific pericardial cyst: certainly unexpected during primary percutaneous coronary intervention.

Pericardial cyst is a rare congenital anomaly that is usually diagnosed during evaluation for right-sided heart failure. We report a 50-year-old man with a primary diagnosis of ST-segment elevation myocardial infarction at admission, whose emergent angiography revealed a calcific mass close to right coronary artery. Further analysis of the mass with computed tomography and three-dimensional echocardiography revealed a giant pericardial cyst causing partial obstruction of superior vena cava. Unlike previous cases reported, the patient had no symptoms compatible with right-sided heart failure.

The relationship between epicardial adipose tissue and ST-segment resolution in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

The relationship between epicardial adipose tissue (EAT) and coronary artery disease has been predominantly demonstrated in the last two decades. The aim of this study was to investigate the predictive value of EAT thickness on ST-segment resolution that reflects myocardial reperfusion in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-segment elevation myocardial infarction (STEMI). The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, range 35-83, 15 women) with first acute STEMI who underwent successful pPCI. ST-segment resolution (ΔSTR) <70 % was accepted as ECG sign of no-reflow phenomenon. The EAT thickness was measured by two-dimensional echocardiography. EAT thickness was increased in patients with no-reflow (3.9 ± 1.7 vs. 5.4 ± 2, p = 0.001). EAT thickness was also found to be inversely correlated with ΔSTR (r = -0.414, p = 0.001). Multivariate logistic regression analysis demonstrated that EAT thickness independently predicted no-reflow (OR 1.43, 95 % CI 1.13-1.82, p = 0.003). Receiver operating characteristic curve analysis demonstrated good diagnostic accuracy for EAT thickness in predicting no-reflow [area under curve (AUC) = 0.72, 95 % CI 0.63-0.82, p < 0.001]. In conclusion, increased EAT thickness may play an important role in the prediction of no-reflow in STEMI treated with pPCI.

ST-segment elevation of right precordial lead (V4 R) is associated with multivessel disease and increased in-hospital mortality in acute anterior myocardial infarction patients.

BACKGROUND: ST segment elevation of chest lead V4 R is associated with worse prognosis in acute inferior ST-elevation myocardial infarction (STEMI). This study tried to determine the relationship between ST elevation in the right precordial lead V4 R and acute anterior STEMI. METHODS: Prospective study of 144 consecutive anterior STEMI patients: all had 15-lead ECG recordings (12 conventional leads and V3 R-V5 R) obtained. Patients were classified into two groups on the basis of presence (Group I, 50 patients) or absence (Group II, 94 patients) of ST-segment elevation ≥0.5 mm in lead V4 R. RESULTS: Multivessel involvement was significantly higher in Group I compared with Group II (54% and 23% respectively, P < 0.001). Major adverse cardiac events and in-hospital mortality was also significantly higher for those in Group I (P < 0.02 for both). A significant correlation was found between in-hospital mortality and those in Group I (P = 0.03, OR: 6.27, CI: 1.22-32.3). There was an independent relationship between in-hospital mortality and V4 R-ST elevation (P = 0.03, OR: 11.64, CI: 1.3-27.4). CONCLUSION: ST segment elevation in chest lead V4 R is associated with multivessel disease and increased in-hospital mortality in patients with anterior STEMI that had undergone primary percutaneous coronary intervention to the left anterior descending artery.

Presence of sigma shaped right coronary artery is an indicator of poor prognosis in patients with inferior myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: The effectiveness of primary percutaneous coronary intervention (PCI) in ST segment elevation myocardial infarction (STEMI) is well established. The clinical variables associated with poor prognosis in patients with STEMI have been extensively investigated. Right coronary artery (RCA) has two anatomical variations detected on coronary angiography namely C-shaped and sigma shaped RCA. The clinical importance of the shape of RCA in patients with STEMI has not been investigated before. PURPOSE: To investigate the prognostic value of RCA shape in patients with inferior STEMI treated with primary PCI. METHODS: Angiographic data of patients with inferior STEMI who were treated with primary PCI were retrospectively recruited. The differentiation of sigma and C-shaped RCAs was shown using single-frame angiograms, obtained during end-diastole of cardiac cycle in the left anterior oblique projection at 25° to 35° with no cranio-caudal angulation. Cardiovascular events at 30-days and on follow up were obtained through review of hospital records and telephone contact with the patient or the patient's relatives. Patients with C-shaped RCAs served as the control group. RESULTS: A total number of 824 patients with inferior STEMI who were treated with primary PCI for RCA were included. Sigma shaped RCA was observed in 15.1% of the subjects. In the sigma shaped RCA group, the door-to-balloon times were longer (32.5 ± 5.1 vs. 27.8 ± 4.6 min; P = 0.01) and TIMI 3 flow restoration rates were lower (76.8% vs. 94.1%; p=0.01) compared to the controls. Mean SYNTAX scores were significantly higher in patients with sigma shaped RCA. Four patients (3.2%) in the sigma shaped RCA group and 23 patients (3.3%) in the control group died by day 30. The incidence of stent thrombosis, recurrent MI, and target lesion revascularization, were similar between the groups. During the follow-up (mean 37.6 ± 13.4 months) 15 patients (12.3%) from the sigma shaped RCA group and 28 (4.1%) patients from the control group died (P = 0.01). The incidence of recurrent MI (27.2% vs. 13.7%; P = 0.01) and major adverse cardiovascular events (29.7% vs. 16.3%; P = 0.01) were significantly higher in the sigma shaped RCA group. In multivariate analysis, age, Killip class of >1, the presence of sigma shaped RCA, post PCI TIMI flow <3 and decreased left ventricular ejection fraction were the independent predictors of long term mortality. CONCLUSION: Presence of sigma shaped RCA is associated with more severe form of coronary artery disease and worse clinical outcome in patients with inferior STEMI.

Elevated levels of RDW is associated with non-valvular atrial fibrillation.

Red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) have been found to be associated with cardiovascular diseases. Only a few trials have investigated the correlation of these parameters with postoperative atrial fibrillation (AF). However, the correlation of these parameters in non-valvular AF is still unclear. We retrospectively analyzed consecutive AF patients from medical records and included 117 non-valvular AF patients (103 paroxysmal and 14 chronic AF). All subjects underwent physical examination and echocardiographic imaging. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW, neutrophil and lymphocyte counts as well as mean corpuscular volume. Results of CBC tests within the previous year were also included and the averages were used. The demographic and echocardiographic properties of non-valvular AF group were comparable to the control group except for left atrial volumes which were increased in AF (median 33.1, IQR 26.3-41.1 cm(3) vs. median 26.4, IQR 24.2-28.9 cm(3); p = 0.01). RDW levels were significantly higher in the AF group (median 13.4 %, IQR 12.9-14.1 %) compared to the control (median 12.6 %, IQR 12.0-13.1 %; p = 0.01). NLR was not statistically different in the AF group and the controls (2.04 ± 0.94 vs. 1.93 ± 0.64, respectively; p = 0.32). Hs-CRP levels were higher in the AF group compared to the controls (median 0.84, IQR 0.30-1.43 mg/L vs. median 0.29, IQR 0.18-0.50 mg/L, respectively; p = 0.01). Multivariate logistic regression analysis revealed RDW (OR 4.18, 95 % CI 2.15-8.15; p = 0.01), hs-CRP (OR 3.76, 95 % CI 1.43-9.89; p = 0.01) and left atrial volume (OR 1.31, 95 % CI 1.06-1.21; p = 0.01) as the independent markers of non-valvular AF. Multivariate linear regression analysis revealed that hemoglobin levels (standardized ß coefficient = -0.252; p = 0.01) and the presence of AF (standardized ß coefficient = 0.336; p = 0.01) were the independent correlates of RDW levels. Elevated RDW levels, not NLR, may be an independent risk marker for non-valvular AF.

Arterial stiffness and carotid intima-media thickness in diabetic peripheral neuropathy.

BACKGROUND: We investigated the relationship between peripheral neuropathy and parameters of arterial stiffness and carotid intima media thickness (CIMT) in patients with type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS: The study included 161 patients (80 females and 81 males), 69 of whom had peripheral neuropathy. All patients underwent 24-h blood pressure monitoring, and arterial stiffness parameters were measured. The CIMT was measured using B-mode ultrasonography and patients also underwent transthoracic echocardiographic examination. RESULTS: Patients with peripheral neuropathy, compared with those without it, were older (54.68±8.35 years vs. 51.04±7.89 years; p=0.005) and had T2DM for longer periods (60 vs. 36 months; p=0.004). Glycated hemoglobin (HbA1c) values (8.55±1.85 mg/dL vs. 7.30±1.51 mg/dL; p<0.001), pulse wave velocity (PWV) (7.74±1.14 m/s vs. 7.15±1.10 m/s; p=0.001), CIMT (anterior 0.74±0.15 mm vs. 0.67±0.13 mm; p=0.01), and left ventricular mass (LVM) index (98.68±26.28 g/m2 vs. 89.71±19.70 g/m2; p=0.02) were all significantly increased in the group with peripheral neuropathy compared to the group without peripheral neuropathy. We determined that duration of diabetes, HbA1c, and LVM index were predictors of peripheral neuropathy. CONCLUSIONS: A significant relationship was found between diabetic neuropathy and increased PWV, a parameter of arterial stiffness, as well as CIMT, a marker of systemic atherosclerosis. Diabetic peripheral neuropathy may be a determinant of subclinical atherosclerosis in T2DM.

Combination of hemoglobin and left ventricular ejection fraction as a new predictor of contrast induced nephropathy in patients with non-ST elevation myocardial infarction.

BACKGROUND: Hemoglobin concentration (Hb) and left ventricular ejection fraction (EF) are known predictors of contrast induced nephropathy (CIN). We hypothesized that combination of Hb concentration and left ventricular EF is superior to either variable alone in predicting contrast induced nephropathy in patients with acute coronary syndrome (ACS). MATERIAL AND METHODS: Consecutive patients with ACS were prospectively enrolled. Patients considered for invasive strategy were included. Baseline creatinine levels were detected on admission and 24, 48 and 72 hours after coronary intervention. 25% or 0,5 umol/L increase in creatinine level was considered as CIN. RESULTS: 268 patients with ACS (mean age 58±11 years, 77% male) were enrolled. Contrast induced nephropathy was observed in 26 (9.7%) of patients. Baseline creatinine concentration, left ventricular EF, and Hemoglobin was significantly different between two groups. Contrast volume to estimated glomerular filtration rate ratio (OR: 1.310, 95% CI: 1.077-1.593, p=0.007) and the combination of Hb and left ventricular EF (OR: 0.996, 95% CI: 0.994-0.998, p=0.001) were found to be independent predictors for CIN. Hb × LVEF ≤690 had 85% sensitivity and 57% specificity to predict CIN (area under curve: 0.724, 95% CI: 0.625-0.824, p<0.001). In addition, Hb × LVEF ≤690 had a negative predictive value of 97% in our analysis CONCLUSIONS: The combination of Hb and left ventricular EF is better than either variable alone at predicting CIN in patients with ACS that undergone percutaneous coronary intervention. The prediction was independent of baseline renal function and volume of contrast agent.

Evaluation of human immunodeficiency virus infection-related left ventricular systolic dysfunction by tissue Doppler strain echocardiography.

OBJECTIVE: Cardiovascular involvement causes significant morbidity and mortality among patients with human immunodeficiency virus (HIV) infection. Since the introduction of highly active antiretroviral treatment (HAART), subtle changes in left ventricular (LV) function, which may be clinically silent, have become more pronounced in HIV patients. Echocardiographic strain imaging (SI) may detect subclinical myocardial dysfunction at an earlier stage compared with conventional echocardiography. The aim of this study was to evaluate tissue Doppler-derived LV strain and strain rate (SR) along with conventional measures of LV function in asymptomatic, stable adult HIV patients on HAART. METHODS: Twenty-one patients with HIV infection (mean age: 37.8 ± 11.9 years, 11 males) who had no cardiovascular complaints and 27 healthy volunteers (mean age: 40.9 ± 5.8 years, 14 males) were enrolled. Traditional parameters including LV ejection fraction (EF) were measured along with tissue velocity imaging (TVI) and tissue Doppler SI parameters using transthoracic echocardiography. RESULTS: The mean duration of HIV infection was 30.8 ± 25.1 (3-120) months. The mean LVEF in HIV group was within normal limits but lower than controls (64.5% ± 10.2% vs. 72.2% ± 6.4%, P = 0.003). There were no differences in other major traditional measures, as well as TVI parameters between groups. LV systolic strain and SR parameters were impaired indicating subtle LV systolic dysfunction in HIV group. No difference in diastolic function was observed between groups. CONCLUSION: Left ventricular systolic strain parameters may be utilized to demonstrate subtle LV systolic dysfunction in asymptomatic HIV patients.

Assessment of tenascin-C levels in ventricular noncompaction/hypertrabeculation patients: a cross-sectional study.

PURPOSE: Ventricular noncompaction/hypertrabeculation (NC/HT) is a rare form of congenital cardiomyopathy. We aimed to investigate the presence of serum tenascin-C (TN-C) in adult patients with NC/HT and evaluate its value. METHODS AND RESULTS: Serum TN-C levels were measured by ELISA in 50 NC/HT patients both with/without systolic dysfunction and in 23 normal controls. Systolic dysfunction was defined as ejection fraction (EF) ≤ 40. Mann-Whitney U-test and ROC curve analysis were done. Of 49 NC/HT patients, 24 (49%) patients had systolic dysfunction (mean age 36 ± 15) and 25 patients (51%) had normal systolic function (mean age 36 ± 17). The ages between groups were not different. The mean levels of serum TN-C in patients with or without systolic dysfunction were 26 ± 10 ng/mL and 26 ± 8 ng/mL respectively, compared to normal controls, 7 ± 2 ng/mL (P < 0.001). No significance was observed between 2 groups of NC/HT patients regarding TN-C levels (P = 0.8). The ROC curve analysis revealed that a TN-C value of 11.7 ng/mL identified patients with NC/HT with 100% sensitivity and specifity. CONCLUSION: High serum TN-C levels are present in adult NC/HT cardiomyopathy even when left ventricular systolic function remains normal. Also, serum TN-C levels could be regarded as a candidate biomarker in the diagnosis of NC/HT which needs to be tested in larger prospective studies.

Association between endothelial nitric oxide synthase intron 4a/b polymorphism and aortic dissection.

OBJECTIVES: The genetic risk factors that contribute to the risk of developing aortic dissection (AD) have been studied. We assessed the association of endothelial nitric oxide synthase (eNOS) gene polymorphism with AD. STUDY DESIGN: Patients who underwent surgery with the diagnosis of AD and survived after the operation in our center between May 2007 and June 2011 were recruited retrospectively. The eNOS intron 4a/b polymorphism was determined by polymerase chain reaction (PCR) using oligonucleotide primers (sense: 5'-AGGCCCTATGGTAGTGCCTTT-3'; antisense: 5'-TCTCTTAGTGCTGTGGTCAC-3') that flank the region of the 27 bp VNTR in intron 4. RESULTS: Thirty-nine patients (88%) had type A AD, while the remainder (12%) had type B AD. The distribution of eNOS4 a/b gene polymorphism differed significantly from the control group, with higher frequencies of eNOS 4a/a and 4a/b genotypes in the AD group (x(2)=7.16, p=0.03). CONCLUSION: In this study, the distribution of eNOS genotypes differed between the AD and control groups; however, this polymorphism was not found to be an independent factor for the development of AD.

Red cell distribution width is increased in patients with ascending aortic dilatation.

OBJECTIVES: The prognostic importance of red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) in cardiovascular diseases has been shown. Ascending aortic dilatation (AAD) is a common cardiovascular disease and is associated with aortic wall inflammation and cystic degeneration. In this study, we aimed to investigate the relationship between serum levels of RDW, NLR and the presence of AAD. STUDY DESIGN: Two-hundred consecutive patients with AAD diagnosed by transthoracic echocardiography were prospectively recruited and were compared to 170 age-gender- matched subjects with normal aortic diameters. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW and NLR counts, as well as mean corpuscular volume (MCV). If possible, results of CBC tests within the previous two years were also included and the averages were used. RESULTS: RDW [median 13.9, interquartile range (IQR) 1.40 vs. median 13.3, IQR 1.05%, p=0.01], NLR (median 2.04, IQR 1.09 vs. median 1.78, IQR 0.90, p=0.01) and high-sensitive C-reactive protein (hs-CRP) (median 0.60, IQR 0.80 vs. median 0.44, IQR 0.68 mg/L, p=0.01) levels were significantly higher in the AAD group compared to the control group. In univariate correlation analysis, ascending aortic diameters were correlated with RDW levels (r=0.31, p=0.01), NLR levels (r=0.15, p=0.01) and hs-CRP levels (r=0.12, p=0.03). In multivariate logistic regression analysis, increased levels of RDW and hs-CRP remained as the independent correlates of AAD in the study population. Receiver operating characteristic (ROC) curve analysis revealed that a RDW measurement higher than >13.8% predicted AAD with a sensitivity of 49.5% and a specificity of 82.8% (area under the curve [AUC] 0.681, p=0.01). CONCLUSION: In patients with AAD, RDW and hs-CRP levels are increased, which may indicate the role of inflammation in the pathogenesis of AAD.

The Impact of the Neutrophil-to-Lymphocyte Ratio on In-Hospital Outcomes in Patients With Acute ST-Segment Elevation Myocardial Infarction.

Introduction The neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of cardiovascular diseases, influencing their progression and prognosis. The exact role of the NLR in acute ST-segment elevation myocardial infarction (STEMI) is unclear. We investigated the possible association between peak NLR values within the first three days after STEMI onset and in-hospital outcomes in patients undergoing primary percutaneous coronary intervention (PCI). Methods This retrospective study included 641 patients who were diagnosed with acute STEMI and treated with primary PCI for 18 months at Dr. Siyami Ersek Hospital. The NLR was calculated using the maximum values obtained during the first three days after admission. The patients were divided into quartiles according to their NLR values for further analysis of potential complications during and after hospitalization, up to a follow-up period of three months. Results Significant differences were found in factors such as age, body mass index (BMI), and length of hospital stay among these groups. Specifically, we found that in-hospital mortality rates were significantly higher in the Q4 group, and there were variations in target vessel revascularization (TVR) rates, major adverse cardiac events (MACE) rates, and other clinical outcomes. Some parameters, such as reinfarction rates and certain procedural outcomes, did not show significant differences among the groups. However, despite the differences, most of the patients achieved successful outcomes after PCI, with the best results in the low NLR group and the worst results in the high NLR group. Conclusion Higher NLR values were associated with a higher risk of unfavorable outcomes during hospitalization.

Mean Platelet Volume and Its Association With In-Hospital Outcomes in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Background Mean platelet volume (MPV), reflecting platelet size and activation, has been associated with cardiovascular disease (CVD) risk and mortality. Yet, its prognostic significance in acute coronary syndrome (ACS) patients undergoing primary percutaneous coronary intervention (PCI) remains uncertain. This study investigates whether elevated MPV levels upon admission in ST-segment elevation myocardial infarction (STEMI) patients predict adverse in-hospital outcomes after primary PCI. Objectives The aim of this study was to measure MPV in patients with STEMI who underwent primary PCI and to evaluate its association with in-hospital outcomes such as death, recurrent myocardial infarction, heart failure, and bleeding. Methods We enrolled 400 consecutive patients with STEMI (mean age 56.20 years, 356 males, 44 females) who underwent primary PCI at our center. We obtained MPV values from complete blood count tests performed at admission. We divided the patients into two groups based on the normal MPV range of 7.40 to 12 fL. We compared the baseline characteristics and in-hospital outcomes of the two groups. We used Cox proportional hazards regression analysis to adjust for potential confounders and evaluate the impact of MPV on in-hospital outcomes. Results There was no significant difference in MPV values between the two groups (9.10 ± 1.20 fL vs. 9.00 ± 1.10 fL, p = 0.54). Patients who died exhibited higher age, male predominance, hypertension, diabetes, a lower left ventricular ejection fraction, lower levels of low-density lipoprotein cholesterol, and lower levels of hemoglobin and hematocrit compared to survivors. MPV was not associated with any of the in-hospital outcomes in the unadjusted or adjusted analyses. Conclusion In this cohort of patients with STEMI who underwent primary PCI, admission MPV was not a predictor of in-hospital outcomes. Further studies are needed to clarify the role of MPV in the pathophysiology and prognosis of ACS.