Altered cardiac autonomic function after recovery from COVID-19.

BACKGROUND: Autonomic dysfunction may occur during the acute phase of COVID-19. Heart rate variability (HRV) is a useful tool for the assessment of cardiac sympathetic and parasympathetic balance. We aimed to evaluate cardiac autonomic function by using HRV in subjects after recovery from COVID-19 who had previously symptomatic and were followed outpatiently. METHODS: The study group composed of 50 subjects with a confirmed history of COVID-19 and the control group composed of 50 healthy subjects without a history of COVID-19 and vaccination. All the study participants underwent 2-dimensional, pulsed- and tissue-Doppler echocardiographic examinations and 24-hour Holter monitoring for HRV analysis. RESULTS: Time domain parameters of SDNN, SDANN, SDNNi, RMSSD, pNN50, and HRV triangular index were all decreased in the study group when compared with the control group. Frequency domain parameters of TP, VLF, LF, HF, and HFnu were also decreased in the study group in comparison with the control group. LFnu was similar between groups. Nonlinear parameters of HRV including α1 and α2 decreased in the study group. By contrast, Lmax, Lmean, DET, REC, and Shannon entropy increased in the study population. Approximate and sample entropies also enhanced in the study group. CONCLUSIONS: The present study showed that all three domain HRV significantly altered in patients after recovery from COVID-19 indicating some degree of dysfunction in cardiac autonomic nervous system. HRV may be a useful tool for the detection of preclinical autonomic dysfunction in this group of patients.

Association of High-Sensitivity Troponin T With Left Ventricular Dysfunction in Ankylosing Spondylitis.

BACKGROUND: Ankylosing spondylitis (AS) is a systemic inflammatory disease, and cardiac dysfunction has not been clearly described clinically. High-sensitivity cardiac troponin T (hs-cTnT) is a noninvasive marker for subclinical myocardial injury. OBJECTIVE: In this study, we aimed to investigate any relationship between hs-cTnT and left ventricular (LV) function evaluated via tissue Doppler imaging in AS patients with no known cardiac risk factor. METHODS: Our study used a cross-sectional case protocol design and was conducted between January 2016 and June 2016. In total, 40 AS patients (17 females and 23 males) were age and sex matched with healthy volunteers (20 females and 20 males) and enlisted for this study. Detailed transthoracic echocardiography was performed, and tissue Doppler imaging was used to assess systolic and diastolic functions. High-sensitivity cardiac troponin T levels were measured and compared between 2 groups. RESULTS: Compared with control subjects, AS patients had lower early (Em)/late (Am) diastolic myocardial velocities, mitral annular plane systolic excursion, and end-diastolic distance from the mitral annulus to the LV apex. Conversely, they had greater systolic myocardial velocity (Sm), isovolumetric relaxation time, and displacement index (p < 0.001, for all). Higher hs-cTnT levels were measured in AS patients (0.45 ± 0.22 vs. 1.11 ± 0.27, p < 0.001), and multivariate logistic regression analyses revealed that hs-cTnT was an independent predictor of LV diastolic dysfunction in AS patients. CONCLUSIONS: These data show that AS patients had impaired LV functions and increased hs-cTnT levels. Tissue Doppler imaging may be a useful tool for detection of early functional LV abnormalities, and hs-cTnT may be valuable biomarker of diastolic LV dysfunction in AS patients.

Left ventricular myocardial performance index in prediabetic patients without coronary artery disease.

INTRODUCTION: Prediabetes is a high-risk condition for diabetes mellitus type 2, which is an important public health issue. The myocardial performance index (MPI) is a noninvasive Doppler measurement of global ventricular function. We evaluated the MPI and left ventricular (LV) function in prediabetic patients who did not have coronary artery disease. METHODS: In total, 80 prediabetics (34 females and 46 males) and an equal number of sex-matched healthy volunteers (35 females and 45 males) were enrolled prospectively. All subjects underwent laboratory analyses and echocardiographic examinations, including MPI measurements. RESULTS: There was a moderate increase in MPI between healthy controls and prediabetics (P < .001). Prediabetes was strongly associated with MPI (r = .553, P < .001). We found that MPI was associated with prediabetes on multivariate logistic regression analysis (Odds Ratio (OR) = 1.967, 95% confidence interval [CI] = 1.574-2.459, P < .001). CONCLUSIONS: The results of this study show that systolic functions and LV diastolic parameters were adversely affected in prediabetic patients. Prediabetes is closely associated with subclinical LV systolic and diastolic dysfunction as assessed by MPI.

An extensive caseous calcification of the mitral annulus complicated with severe mitral regurgitation.

Caseous calcification of the mitral annulus (CCMA) is considered a rare variant of mitral annular calcification (MAC) due to caseous transformation of the inner material and prevalence of CCMA, about 0.63% of all MAC cases and 0.06%-0.07% of the population. The precise pathophysiology of CCMA is still unknown. It is a chronic degenerative disorder common in the elderly, particularly in women. Caseous calcification of the mitral annulus (CCMA) is a soft peri-annular extensive calcification, resembling cardiac tumors, abscesses, vegetation, or calcified thrombus, which is composed of an admixture of calcium, fatty acids, and cholesterol with a toothpaste-like texture. In the characteristic appearance on echocardiography, the calcification is a round, large, soft mass with a central echo dense area, typically located at the basal area of the posterior mitral valve. It usually carries a benign prognosis but rarely may be complicated with mitral valve dysfunction (valve stenosis/mitral regurgitation) or systemic embolization. The current data suggest conservative medical therapy and clinical follow-up for management of CCMA unless there is a need of cardiac surgery for severe mitral stenosis and/or regurgitation. We present a case, complicated with severe mitral regurgitation, and need surgical resection of the CCMA because of the CCMA-induced symptomatic severe mitral regurgitation despite optimal medical therapy. Macroscopic and microscopic examination of caseous material also demonstrated the characteristic appearance of CCMA.

Comparison of the Predictive Roles of Risk Scores of In-Hospital Major Adverse Cardiovascular Events in Patients with Non-ST Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

OBJECTIVE: We evaluated the relationship between various risk scores (SYNTAX score [SS], SYNTAX score-II [SS-II], thrombolysis in myocardial infarction [TIMI] risk scores, and Global Registry of Acute Coronary Events [GRACE] risk scores) and major adverse cardiovascular events (MACE) in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: The study population were selected from among 589 patients who underwent coronary angiography with a diagnosis of NSTEMI. TIMI and GRACE risk scores were calculated. SS and SS-II were calculated in all patients, and points were added according to the predefined algorithm, taking into account the other 6 clinical variables being monitored (age, sex, left ventricular ejection fraction, creatinine clearance, chronic obstructive pulmonary disease, and peripheral artery disease). Patients were classified into tertile 1 (SS < 22), tertile 2 (SS 23-32), and tertile 3 (SS > 32). RESULTS: The group with high SS-II for PCI values in the risk scores were observed from tertile 1 to tertile 3 (from 25.0 ± 7.7 to 31.6 ± 9.4, p < 0.001, respectively). The SS-II score in patients with PCI was an independent predictor of MACE, in-hospital mortality, nonfatal myocardial infarction, and stent thrombosis (OR 1.082, 95% CI 1.036-1.131, p < 0.001). The overall MACE, in-hospital mortality, and nonfatal myocardial infarction rates were significantly higher in the high SS-II for PCI group (p < 0.001). CONCLUSION: TIMI and GRACE risk scores were able to predict MACE. In addition to these, SS-II was also able to predict in-hospital mortality, nonfatal myocardial infarction, and stent thrombosis.

Negative effects of acute sleep deprivation on left ventricular functions and cardiac repolarization in healthy young adults.

BACKGROUND: Sleep deprivation (SD) is associated with an increased incidence of adverse cardiovascular events, we aimed to determine the impact of acute SD on structural and functional alterations of the left ventricle (LV) and on electrocardiogram (ECG) markers including T wave peak-to-end interval (TpTe), QT interval, and TpTe/QT ratio in healthy subjects after a night of SD. METHODS: The study population consisted of 40 healthy young adults (19 males, 21 females; mean age: 28.2 ± 3.86 years). Echocardiographic images and ECGs were obtained from the participants after a night of regular sleep (RS) and SD. The average sleep time of the subjects was 6.67 ± 1.76 hours during RS and 1.25 ± 0.74 hours during a night of SD. RESULTS: The myocardial performance index, isovolumic relaxation time, and deceleration time values were significantly higher after SD. In addition, the corrected TpTe interval, corrected QT interval (QTc) max, and TpTe/QT ratio were significantly increased after a night of SD when compared with a night of RS (78.5 ± 6.8 ms vs 70.7 ± 7.6 ms, P < 0.001; 407.5 ± 18.6 ms vs 395.07 ± 21.3 ms, P = 0.001; and 0.189 ± 0.014 ms vs 0. 0.179 ± 0.016 ms, P < 0.001, respectively). However, subjects had similar QTp interval values (defined as beginning of the QRS complex to peak of the T wave) after a night of SD as a night of RS (294.6 ± 19.0 vs 291.9 ± 18.5, P = 233). CONCLUSION: Our crossover study revealed the presence of subclinical LV diastolic functional changes and increased QT intervals, TpTe intervals, and TpTe/QT ratios in healthy young adults after one night SD. Therefore, the increased QT interval occurred secondary to the increased TpTe interval in this population.

Neutrophil to lymphocyte ratio predicts poor functional capacity in patients with heart failure.

OBJECTIVES: We aimed to assess the relationship between neutrophil to lymphocyte ratio (N/L ratio) and functional capacity (FC) of patients with compensated heart failure (CHF). STUDY DESIGN: A total of 94 consecutive CHF patients and age-gender matched 70 subjects with normal echocardiographic examination were enrolled. Peripheral venous blood samples were drawn before echocardiography examination and treadmill test in all study population. The treadmill test based on modified Bruce protocol was used to determine the functional status of CHF patients. Poor FC was defined as <5 metabolic equivalant (MET) in the exercise test. Afterwards, patients with CHF were divided into two groups with respect to the top and bottom 3 of the N/L ratio. RESULTS: FC (3.2 ± 2.05 MET vs. 6.1 ± 2.04 MET, p<0.001), ejection fraction (%31.5 ± 7.64 vs. %34.8 ± 6.82, p=0.028) were found to be lower and N-terminal pro-brain natriuretic peptide (NT-proBNP) level (3360 ± 2742 pg/dl vs. 1613 ± 1334 pg/dl, p<0.001) pulmonary artery pressure (46.3 ± 11.50 mmHg vs. 41.5 ± 9.45 mmHg, p=0.049), left atrial diameters (4.6 ± 0.52 cm vs. 4.3 ± 0.43 cm, p=0.005), E/Ea ratio (12.2 ± 4.37 vs. 9.2 ± 3.20, p<0.001) were found to be higher in CHF patients with an N/L ratio >3 than with an N/L ratio <3. The N/L ratio, and log-NT-proBNP level were determined to be a predictive factor of poor FC (odds ratio [OR]=3.085, 95% confidence interval [CI]= 1.520-6.260, p=0.002 and OR=1.585, 95% CI=1.201-2.091, p=0.001, respectively). A cut-off point of 2.74 for the N/L ratio had 79.4% sensitivity and 80% specificity in predicting poor FC. CONCLUSION: N/L ratio can be used to predict poor FC in patients with CHF.

Effect of masked hypertension on aortic elastic properties.

Aortic stiffness is increased in patients with sustained hypertension (SH). The aim of this study was to investigate the relationship between aortic elastic properties and masked hypertension (MH). We evaluated aortic elastic properties in 35 individuals with MH, 35 patients with SH, and 35 normotensive healthy volunteers using transthoracic Doppler echocardiography. All aortic distensibility values were carried out at the same time or immediately after the blood pressure (BP) measurement. Baseline clinical and demographic characteristics of the patients were similar in all three groups. Aortic stiffness index and elastic modulus values were higher in MH group compared to SH group and control group (8.9 ± 6.3 vs. 5.4 ± 2.2 vs. 4.2 ± 2.5, P < .001 and 9.0 ± 6.3 vs. 6.4 ± 2.5 vs. 4.1 ± 2.4, P < .001, respectively). Aortic strain values were lower in MH group compared to SH group and control group (7.4 ± 5.3 vs. 9.5 ± 4.1 vs. 14.6 ± 7.1, P < .001, respectively). Aortic distensibility values were lower in MH and SH groups compared to controls (3.1 ± 1.9 vs. 3.7 ± 1.6 vs. 6.4 ± 3.4, P < .001, respectively). Furthermore, diastolic aortic diameter, left ventricular mass index, interventricular septum, and posterior wall thickness were higher in MH and SH groups when compared to controls. This study shows that masked hypertensive patients are at higher risk of "aortic" stiffness, a risk factor for cardiovascular morbidity and mortality, than normotensive and sustained hypertensive patients.

Elevated red blood cell distribution width in healthy smokers.

OBJECTIVES: Red blood cell distribution width (RDW) has been reported to be a marker of morbidity and mortality for some cardiovascular and pulmonary diseases. We aimed to evaluate RDW values in otherwise healthy smokers. STUDY DESIGN: Two hundred and twenty consecutive subjects with current smoking and 230 age- and gender-matched healthy subjects without smoking history were enrolled. Number of cigarettes smoked per day and duration of smoking, evaluated as pack years, were recorded. Complete blood count, high-sensitivity C-reactive protein (hs-CRP) levels and lipid profile were analyzed in all study participants. RESULTS: The mean RDW values were higher in smokers than in nonsmokers (13.9±1.2 vs. 13.1±0.8, p<0.0001). The mean leukocyte count, mean platelet volume and hs-CRP levels were also significantly greater in smokers when compared to nonsmokers (8440±1.750 vs. 7090±1550, p<0.0001; 8.7±0.8 fL vs. 8.3±0.6 fL, p<0.0001; 2.42±0.53 mg/L vs. 1.46±0.52 mg/L, p<0.0001, respectively). Significant positive correlations between RDW and number of cigarettes smoked per day and between RDW and duration of smoking were identified (r=0.565 and r=0.305, respectively). CONCLUSION: Elevated RDW is associated with cigarette smoking and may be a useful indicator of inflammatory activity in smokers.

Association of mitral annulus calcification with high-sensitivity C-reactive protein, which is a marker of inflammation.

OBJECTIVES: There are limited clinical data revealing the relationship between mitral annular calcification (MAC) and systemic inflammation. The goal of the present study was to compare high-sensitivity C-reactive protein (hs-CRP) levels in patients with and without MAC and investigate the relationship between MAC and hs-CRP. METHODS: One hundred patients with MAC who underwent transthoracic echocardiography (TTE) and 100 age-matched controls without MAC who underwent TTE were included in our study. Hs-CRP levels were compared between groups. RESULTS: Prevalence of female gender, hypertension, and coronary artery disease were significantly higher in the MAC group than in the control group (64% versus 45%, P = 0.007, 42% versus 28%, P = 0.03 and 37% versus 18%, P = 0.003, resp.). On multivariate analysis, age, gender, and coronary artery disease were the only independent predictors of MAC. The levels of hs-CRP were higher in the MAC group than in the control group (2.02 ± 0.35 versus 1.43 ± 0.47 mg/dl, P < 0.001). This increase in hs-CRP levels in the MAC group persisted in patients without hypertension, coronary artery disease, and in male patients when compared to the control group. CONCLUSIONS: Our study demonstrated that hs-CRP, which is a sensitive marker of systemic inflammation, increased in patients with MAC.

Saddle pulmonary embolism visualized by real time three-dimensional echocardiography.

Saddle pulmonary embolism is defined as a visible thromboembolus straddling the bifurcation of the main pulmonary artery. It is very unusual to visualize a pulmonary artery thrombus on transthoracic echocardiography. We describe a case of a saddle embolus of the main pulmonary artery visualized by real time three-dimensional echocardiography and successfully treated with intravenous unfractionated heparin, followed by oral anticoagulation achieving a complete dissolution of the thrombus.

Early left atrial mechanics and volume abnormalities in subjects with prehypertension: a real time three-dimensional echocardiography study.

The aim of this study was to evaluate left atrial (LA) volume and mechanical functions by real time three-dimensional echocardiography (RT3DE) in prehypertensive subjects. The study included 54 (34 male and 20 female) prehypertensive subjects and 36 (14 male and 22 female) healthy control subjects. Transthoracic echocardiography and RT3DE were performed in all patients. Interventricular septum thickness and isovolumetric relaxation time were significantly higher in prehypertensives than in controls (10.7 ± 0.7 vs. 10.1 ± 0.8 P = 0.001 and 89.9 ± 10 vs. 82.4 ± 11 P = 0.002, respectively). LA maximum volume, volume before atrial contraction, total and active stroke volume, total and active emptying fractions, expansion index, and LA max volume index were significantly higher in prehypertensives when compared with controls (P < 0.0001 for all). However, the passive emptying fraction was significantly lower in prehypertensives than controls (45.7 ± 5.6 vs. 48.6 ± 4.1, P = 0.006), and the minimum LA volume between the two groups was similar. The main finding of this study was that although LA volume and LA active systolic functions were significantly increased in prehypertensive people, there was a reduction in passive LA systolic functions. These parameters may be important in showing hemodynamic and structural changes in cardiac tissue caused by prehypertension.

[Assessment of left ventricular volume and functions by real-time three-dimensional echocardiography in patients with compensated and decompensated heart failure]. / Kompanse ve dekompanse kalp yetersizligi olan hastalarin sol ventrikül hacim ve islevlerinin gerçek zamanli üçboyutlu ekokardiyografi ile degerlendirilmesi.

OBJECTIVES: The aim of the study was to evaluate congestive heart failure (HF) patients with real-time three-dimensional echocardiography (3DE) to investigate why some of them present with acute decompensation despite having two-dimensional echocardiographic (2DE) parameters with compensated HF patients. STUDY DESIGN: The study population consisted of 36 patients with decompensated HF (24 males, 12 females; mean age 65.8±10.4 years) and 30 patients with compensated HF (21 males, 9 females; mean age 63.2±11.5 years).The levels of pro-brain natriuretic peptide (pro-BNP), serum electrolytes, renal function tests and complete blood counts were determined. All patients underwent 2DE and 3DE evaluations. RESULTS: Heart rate and blood urea nitrogen levels were higher in patients with decompensated HF than those with compensated HF (95.8±21.4 vs. 81.2±14.9, p=0.002; 28.3±15.7 mg/dl vs. 18±6.8 mg/dl, p=0.001, respectively). Pro-BNP levels and NYHA class were significantly higher in patients with decompensated heart failure [4925 pg/ml (2199-8711) vs. 330 pg/ml (197-756), p<0.0001 and 2.3±0.6 vs. 1.2±0.4, p<0.0001, respectively]. Although 2DE parameters were similar between groups, left ventricular ejection fraction was lower in patients with decompensated HF while end-diastolic and end-systolic volumes by 3DE were significantly higher in the same group (26.3±3.8% vs. 30.3±4.0%; 205.6±55.5 ml vs. 145.0±33.7 ml; 178.4±55.6 ml vs. 115.7±32.5 ml, all p<0.0001, respectively). However, systolic volume was higher in patients with compensated HF (52.0±15.5 ml vs. 62±12 ml, p=0.005). CONCLUSION: We think that 3DE provides more reliable information about left ventricular volume and functions in the evaluation of patients with HF.

Differential Expression of Long Noncoding RNAs in Patients with Coronary Artery Disease.

Long noncoding RNAs (lncRNAs) constitute the largest class of noncoding RNAs and play significant roles in the development of cardiovascular pathologies. In the present study, we aimed to evaluate whether 4 candidate lncRNAs - MIAT, MEG3, MALAT1, and MCM3AP-AS1 - have distinct expression levels in patients with obstructive coronary artery disease (CAD) and reveal the diagnostic and therapeutic potentials of these lncRNAs for CAD. A total of 90 patients who subjected to coronary angiography were enrolled. Relative expression of lncRNAs were assayed using qRT-PCR methodology. As a result, MIAT was downregulated, while MEG3 was upregulated in CAD patients. Receiver operating characteristic curves demonstrated that these lncRNAs have a high potential to provide sensitive and specific diagnosis of CAD. The calculated area under curve levels indicated that MIAT and MEG3 have high diagnostic value for detecting the presence of significant CAD. However, MALAT1 and MCM3AP-AS1 levels were not sufficiently reliable for CAD development in our cases. Here, we demonstrate that MIAT and MEG3 were differentially expressed in our patients and might be promising biomarkers and therapeutic targets for CAD. These results indicate that MIAT and MEG3 could play chief roles in CAD development.

Epicardial adipose tissue thickness as a new risk factor for atherosclerosis in patients with ankylosing spondylitis.

PURPOSE: The aim of this study was to compare epicardial adipose tissue thickness (EATT), which is a novel cardiometabolic risk factor in patients with ankylosing spondylitis (AS), and carotid intima media thickness (CIMT) with healthy controls to assess the relationship between these markers and disease activity. MATERIALS AND METHODS: This study involved 38 patients with AS and 38 controls with no history of cardiovascular disease. CIMT was measured by Doppler ultrasound, and EATT by echocardiography, in all participants. Total cholesterol (TC), low density lipoprotein (LDL) cholesterol, high density lipoprotein cholesterol, triglycerides, thyroid stimulating hormone, erythrocyte sedimentation rate, C-reactive protein, and hemogram measurements were performed in all subjects after 8 hours of fasting. In addition, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) scores of the patients with AS were recorded. RESULTS: EATT was significantly higher in patients with AS (0.45 ± 0.17 mm) compared with healthy (0.37 ± 0.10 mm) controls (p= 0.01). Significant positive correlations were detected between EAT thickness and BASFI, CIMT, and disease duration in patients with AS (p= 0.008, p= 0.024, and p= 0.012, respectively). Significant negative correlations were observed between EATT and TC and LDL cholesterol concentrations (p= 0.016 and p= 0.009, respectively). No significant difference was detected in CIMT between the patients (0.515 ± 0.08 mm) and the controls (0.517 ± 0.094 mm, p= 0.98). No significant correlation was observed between CIMT of the patients with AS and the BASDAI, BASFI, TC, HDL cholesterol, systolic blood pressure, or diastolic blood pressure values. Significant positive correlations were observed between CIMT and waist circumference, weight, body mass index, and LDL cholesterol in patients with AS and the controls. CONCLUSIONS: This study demonstrated increased EATT in patients with AS compared with a healthy population, which was positively correlated with disease duration and BASFI.

Evaluation of contrast nephropathy in percutaneous treatment of chronic total occlusions.

BACKGROUND: Contrast-induced nephropathy (CIN) is a leading cause of morbidity and mortality in patients undergoing percutaneous coronary intervention (PCI). Chronic total occlusions (CTO) are frequently observed among patients undergoing coronary angiography. METHODS: A total of 128 CTO patients were included. Mehran score, lesion characteristics, interventional procedure, serological specimens and devices were recorded. The first group was administered with 1 ml · kg-1 · h-1 saline (0.9% NaCl) infusion that started 12 h before the procedure and continued 12 h post procedure as recommended by the guidelines. The second group was administered with saline infusion of 12 ml · kg-1 · h-1 only during CTO-PCI procedure, which is called as intensive infusion. RESULTS: CIN development was similar in two groups (four patients in standard hydration group and five patients in intensive hydration group). The amount of saline was significantly higher in the standard group (1,767 ± 192.2 vs. 1,043.6 ± 375; p < 0.001). Patients with higher creatinine levels prior to PCI had a higher rate of CIN development after procedure. Interestingly, age, left ventricular ejection fraction, and diabetes mellitus independently predicted CIN. CONCLUSION: Intensive hydration administration appears to be an effective and cost-effective method in CTO-PCI patients, especially in patients without left ventricular function failure.

Copeptin levels in patients with coronary artery ectasia.

BACKGROUND AND AIMS: The etiology and pathophysiology of coronary artery ectasia (CAE) has not been fully elucidated. A rapid rise in plasma copeptin has been observed in cardiovascular diseases, stroke, sepsis, and shock. This increase has diagnostic and prognostic value. The aim of this study was to investigate whether copeptin has a relationship with CAE. METHODS: This observational prospective study was carried out between October 2012 and March 2013 in the cardiology catheter laboratory with the inclusion of 44 subjects with a diagnosis of CAE and 44 age- and gender-matched individuals with normal coronary arteries. Blood samples obtained from the patients were stored at -70 °C until analysis and copeptin levels in sera were measured by ELISA. RESULTS: This study comprised 88 study participants, among whom 44 were patients meeting ectasia criteria [mean age: 58.0 ± 11.5 years; 59% (n = 26) male], and 44 were control subjects with angiographically normal coronary anatomy [mean age: 49.2 ± 10.1 years; 30% (n = 13) male]. Copeptin levels were similar between the groups (p > 0.05). In addition, there was no correlation between copeptin levels and CAE. CONCLUSION: In this study, it is examined that copeptin levels were not elevated in CAE patients.

Association between SYNTAX II score and electrocardiographic evidence of no-reflow in patients with ST-segment elevation myocardial infarction.

OBJECTIVE: This study was performed to examine the association between the SYNTAX II score (SS-II) and no-reflow observed on electrocardiography and examine their use in the evaluation of risk of an in-hospital major adverse cardiovascular event (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 126 consecutive STEMI patients who underwent primary percutaneous coronary intervention (pPCI) were recruited. The SS-II was derived using angiographic and basic patient clinical features. The difference in the sum of Stsegment elevations measured between before the pPCI and the assessment determined approximately 60 minutes after the pPCI was interpreted as the sum of ST-segment resolution (ΣSTR). MACE is a composite endpoint frequently used in cardiovascular research and usually includes endpoints reflecting safety and effectiveness. ΣSTR <50% was defined as incomplete ΣSTR (no-reflow group; n=44), while ΣSTR <50% was defined as complete ΣSTR (normal-flow group, n=82). RESULTS: The SS-II was significantly higher in the no-reflow group (p<0.001). SS-II and no-reflow findings were associated with MACE. Logistic regression analysis demonstrated significant predictive values of SS-II (Odds ratio [OR]: 1.169; 95% confidence interval [CI]: 1.084-1.260; p<0.001) and ΣSTR (OR: 0.764; 95% CI: 0.632-0.924; p=0.006) for in-hospital MACE. CONCLUSION: SS-II was significantly associated with no-reflow as assessed by electrocardiography. In patients with STEMI, SS-II and no-reflow (incomplete ΣSTR) may be important predictive factors for in-hospital MACE.

The relationship between monocyte/high-density lipoprotein ratio and Selvester QRS score in patients with STEMI.

OBJECTIVE: The ratio of monocytes to high-density lipoprotein (MHR) has recently been recommended as a new prognostic factor in cardiovascular disease. Studies have documented the value of the Selvester QRS score for prediction of prognosis of ST-elevation myocardial infarction (STEMI). However, no study has examined the association between the QRS score and MHR in patients with STEMI. The present study analyzed the relationship between MHR and QRS score in patients with STEMI. METHODS: A cohort of 99 consecutive patients who experienced STEMI between June and September 2016 was retrospectively evaluated. Serial electrocardiogram, monocyte count, and lipid panel measurements (day 1, day 2, and after discharge) were performed in all patients, and MHR was calculated. The patients were classified into 2 groups based on the median values according to the estimated infarct size: QRS score <6 and QRS score ≥6. RESULTS: The MHR was higher in the high QRS score group on day 1 in hospital (p=0.001). The MHR value was associated with QRS score in univariate logistic regression analysis and was found to be an independent predictor of the QRS score (Odds ratio: 0.390, 95% Confidence interval: 0.252-0.605; p<0.001). CONCLUSION: A higher MHR serves as an indicator of inflammation and oxidative stress and was reported to be associated with a high QRS score. In addition, it was found to be an independent predictor of such scores during follow-up in patients with STEMI.

Discerning the relationship between left ventricular geometry, high-sensitivity troponin T, and nondipper hypertension.

INTRODUCTION: Hypertension can cause anatomic changes in the left ventricle, generally leading to abnormal geometry. High-sensitivity cardiac troponin T (hs-cTnT) values have been shown to be positively correlated with left ventricular hypertrophy in hypertensive patients. The current study investigated the diagnostic value of hs-cTnT in patient with nondipper hypertension (NDH) as well as determined the correlation between left ventricular geometric patterns and hs-cTnT values in hypertensive patients. PATIENTS AND METHODS: A total of 100 consecutive patients (58 women and 42 men) who were referred to our clinic between 1 October 2015 and 1 March 2016 with elevated blood pressure (BP) were included. Of the patients, 63 had dipper hypertension [nocturnal decline in mean BP (≥10%)], whereas the remaining 37 had NDH [nocturnal decline in mean BP (<10%)]. Of note, hs-cTnT levels were measured only once during admission. Echocardiographic examinations were performed at baseline month and repeated at the sixth month. RESULTS: Hs-cTnT was significantly increased in those with NDH (P<0.001). The NDH group experienced significant decreases in concentric hypertrophy pattern over 6 months (P=0.014). Hs-cTnT was significantly related with nondipping status (r=0.747, P<0.001). Hs-cTnT was also an independent predictor of NDH (odds ratio=1.034, 95% confidence interval: 1.018-1049, P<0.001). Hs-cTnT value of more than 0.95 ng/l predicted NDH with a sensitivity of 75% and specificity of 98% (area under the curve: 0.86; 95% confidence interval: 0.782-0.925; P<0.001). CONCLUSION: Our current results indicate that patients with NDH had higher hs-cTnT levels than the patients with dipper hypertension. Hs-cTnT was an independent predictor of NDH and was significantly related with nondipping status. Hence, hs-cTnT may be used as diagnostic biomarker in NDH.