Baseline Characteristics of a Patient Cohort and Predictors of In-hospital MORtality in CORonary Care Units (MORCOR-TURK) Trial in Türkiye.

OBJECTIVE: The MORtality in CORonary Care Units in Türkiye (MORCOR-TURK) trial is a national registry evaluating predictors and rates of in-hospital mortality in coronary care unit (CCU) patients in Türkiye. This report describes the baseline demographic characteristics of patients recruited for the MORCOR-TURK trial. METHODS: The study is a multicenter, cross-sectional, prospective national registry that included 50 centers capable of 24-hour CCU service, selected from all seven geographic regions of Türkiye. All consecutive patients admitted to CCUs with cardiovascular emergencies between September 1-30, 2022, were prospectively enrolled. Baseline demographic characteristics, admission diagnoses, laboratory data, and cardiovascular risk factors were recorded. RESULTS: A total of 3,157 patients with a mean age of 65 years (range: 56-73) and 2,087 (66.1%) males were included in the analysis. Patients with arterial hypertension [1,864 patients (59%)], diabetes mellitus (DM) [1,184 (37.5%)], hyperlipidemia [1,120 (35.5%)], and smoking [1,093 (34.6%)] were noted. Non-ST elevation myocardial infarction (NSTEMI) was the leading cause of admission [1,187 patients (37.6%)], followed by ST elevation myocardial infarction (STEMI) in 742 patients (23.5%). Other frequent diagnoses included decompensated heart failure (HF) [339 patients (10.7%)] and arrhythmia [272 patients (8.6%)], respectively. Atrial fibrillation (AF) was the most common pathological rhythm [442 patients (14%)], and chest pain was the most common primary complaint [2,173 patients (68.8%)]. CONCLUSION: The most common admission diagnosis was acute coronary syndrome (ACS), particularly NSTEMI. Hypertension and DM were found to be the two leading risk factors, and AF was the most commonly seen pathological rhythm in all hospitalized patients. These findings may be useful in understanding the characteristics of patients admitted to CCUs and thus in taking precautions to decrease CCU admissions.

Modified Glasgow Prognostic Score May Be Useful to Predict Major Adverse Cardiac Events in Heart Failure Patients Undergone Cardiac Resynchronization Treatment.

OBJECTIVE: Whether modified Glasgow prognostic score predicts prognosis in patients with cardiac resynchronization therapy with defibrillation is unknown. Our aim was to investigate the association of modified Glasgow prognostic score with death and hospitalization in cardiac resynchronization therapy with defibrillation patients. METHODS: A total of 306 heart failure with reduced ejection fraction patients who underwent cardiac resynchronization therapy with defibrillation implantation were categorized into 3 groups based on their modified Glasgow prognostic score categorical levels. C-reactive protein >10 mg/L or albumin <35 g/L was assigned 1 point each and the patients were classified into 0, 1, and 2 points, respectively. Remodeling was determined according to the clinical event and myocardial remodeling criteria. Major adverse cardiac events were defined as mortality and/or hospitalization for heart failure. RESULTS: Age, New York Heart Association functional class, modified Glasgow prognostic score prior to cardiac resynchronization therapy with defibrillation, sodium levels, and left atrial diameter were higher in the major adverse cardiac events(+) group. Age, left atrial diameter, and higher modified Glasgow prognostic score were found to be predictors of heart failure hospitalization/death in multivariable penalized Cox regression analysis. Besides, patients with lower modified Glasgow prognostic score showed better reverse left ventricular remodeling demonstrated by increase in left ventricle ejection fraction and decline in left ventricle end systolic volume. CONCLUSION: Modified Glasgow prognostic score prior to cardiac resynchronization therapy with defibrillation can be used as a predictor of long-term heart failure hospitalization and death in addition to age and left atrial diameter. These results can guide the patient selection for cardiac resynchronization therapy with defibrillation therapy and highlight the importance of nutritional status.

Direct transcatheter aortic valve implantation (TAVI) decreases silent cerebral infarction when compared to routine balloon valvuloplasty.

PURPOSE: Silent cerebral infarctions (SCI), as determined by neuron-specific enolase (NSE) elevations, may develop after the transcatheter aortic valve implantation (TAVI) procedure. Our aim in this study was to compare the SCI rates between patients who underwent routine pre-dilatation balloon aortic valvuloplasty (pre-BAV) and patients who underwent direct TAVI without pre-BAV. METHODS: A total of 139 consecutive patients who underwent TAVI in a single center using the self-expandable Evolut-R valve (Medtronic, Minneapolis, Minnesota, USA) were included in the study. The first 70 patients were included in the pre-BAV group, and the last 69 patients were included in the direct TAVI group. SCI was detected by serum NSE measurements performed at baseline and 12 h after the TAVI. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. In addition, SCI was scanned by MRI (magnetic resonance imaging) in eligible patients. RESULTS: TAVI procedure was successful in all of the study population. Post-dilatation rates were higher in the direct TAVI group. Post-TAVI NSE positivity (SCI) was higher in the routine pre-BAV group (55(78.6%) vs. 43(62.3%) patients, p = 0.036) and NSE levels were also higher in this group (26.8 ± 15.0 vs. 20.5 ± 14.8 ng/ml, p = 0.015). SCI with MRI was found to be significantly higher in the pre-BAV group than direct TAVI group (39(55.1%) vs. 31(44.9%) patients). The presence of atrial fibrillation and diabetes mellitus (DM), total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly higher in SCI (+) group. In the multivariate analysis, presence of DM, total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly associated with new SCI development. CONCLUSIONS: Direct TAVI procedure without pre-dilation seems to be an effective method and avoidance of pre-dilation decreases the risk of SCI development in patients undergoing TAVI with a self-expandable valve.

The predictive value of galectin-3 levels on left atrial low voltage areas assessed by high-density mapping in patients with paroxysmal atrial fibrillation.

Aims: Galectin-3 is an inflammation biomarker that is associated with atrial fibrosis and plays a role in the development of atrial fibrillation (AF). Low voltage areas (LVAs) identified using an electroanatomical mapping system represent the presence of fibrotic tissue. The present study aimed to determine the relationship between coronary sinus (CS) serum sampling of galectin-3 levels and the presence and extent of LVA in patients with paroxysmal AF. Methods: A total of 115 consecutive paroxysmal AF patients underwent pulmonary vein isolation (PVI) included prospectively in the study. Voltage mapping was performed before PVI during sinus rhythm guided by multipolar high-density mapping catheter and LVAs were defined as regions where bipolar peak to peak voltage was <0.5 mV. Galectin-3 levels were measured via enzyme-linked immunosorbent assay. Results: CS serum sampling of galectin-3 levels was significantly higher in paroxysmal AF patients with LVA than those without LVA (16.5 ± 3.7 ng/ml vs. 10.2 ±2.7 ng/ml, respectively, p < .001). CS serum sampling of galectin-3 levels was significantly higher in paroxysmal AF patients with moderate and severe LVA than in paroxysmal AF patients with mild LVA (17 ± 3.5 ng/ml and 20.1 ± 1.3 ng/ml vs. 13.3 ± 2.3 ng/ml, respectively, p = .002). In the multivariate analysis female gender (odds ratio [OR] = 7.537, 95% confidence interval [CI]: 1.011-56.195; p = .049), left atrium volume (OR = 1.326, 95% CI: 1.052-1.67; p = .017), and CS serum sampling of galectin-3 levels (OR = 1.704, 95% CI: 1.169-2.483; p = .006) were significant and independent predictors for LVAs. Conclusion: In this study, we found that the CS serum sampling of galectin-3 levels increased with the extent of LVA and was an independent predictor for the presence of LVA.