Monocyte to HDL ratio may predict thrombosis in patients with mechanical mitral and aortic valve prosthesis.

Increased inflammatory biomarkers have been reported in prosthetic heart valve thrombosis (PHVT). Monocyte to HDL ratio (MHR) and albumin to CRP levels (CAR) are two biomarkers used widely for systemic inflammation but there is a lack of data on prosthetic heart valves. This study aimed to find out the potential predictive value of MHR and CAR for PHVT. Patients who had the diagnosis of mechanical mitral/aortic PHVT and normally functioning prosthesis were retrospectively analyzed. Laboratory data including complete blood count and biochemistry were recorded. Transesophageal echocardiography was performed to diagnose PHVT. The study included 118 patients with mechanical PHVT and 120 patients with normally functioning prosthesis. White blood count, monocyte levels, C-reactive protein, MHR and CAR were significantly higher whereas the lymphocyte, HDL and INR levels on admission were lower in patients with PHVT. Multivariate analysis showed that as well as inadequate anticoagulation, MHR, but not CAR, was found to be an independent predictor of thrombosis in patients with PHVT. Receiver operating characteristic curve analysis was performed to detect the best cut-off value of MHR in the prediction of thrombosis in patients with prosthetic valves. MHR level of > 12.8 measured on admission, yielded an AUC value of 0.791 [(CI 95% 0.733-0.848 p < 0.001) sensitivity 71%, specificity 70%]. Inadequate anticoagulation is the primary cause that leads to thrombosis in mechanical prosthetic valves. Increased MHR, but not CAR, was also shown to be an independent predictor of thrombosis in patients with mechanical mitral and aortic prosthetic valves.

Is coronary artery tortuosity a predisposing factor for drug-eluting stent restenosis?

BACKGROUND: Coronary artery tortuosity (CAT) is a relatively common finding on coronary angiography and may be associated with impaired left ventricular relaxation and coronary ischemia However, the significance of CAT remains unknown. This study aimed to investigate whether the severity of tortuosity in the targeted coronary segment is a predictor of stent restenosis. METHODS: The study included a total of 637 patients undergoing drug-eluting stent implantation due to stable or unstable angina and who had no native coronary artery stenosis on their last coronary angiogram. The patients were separated into two groups: 312 patients with in-stent restenosis and 325 patients without in-stent restenosis. All patients underwent computed tomography (CT) coronary angiography after invasive angiography and CAT was calculated using the computer software. RESULTS: Patients with in-stent restenosis had higher CAT than those without restenosis (1.25 ± 0.11 vs. 1.11 + 0.07, p < 0.001). Multivariate Cox regression analysis showed that the tortuosity index (hazard ratio [HR]: 1.246 95% confidence interval [CI]: 1.127-1.376 p < 0.001) and the circumflex lesion (HR: 1.437 95% CI: 1.062-1.942 p = 0.019) were independently associated with in-stent restenosis. With the threshold value of severe tortuosity set at 1.15, the prediction of could be made with 81% sensitivity and 80% specificity. CONCLUSION: The severity of tortuosity is proportional to coronary in-stent stenosis in patients with stable and unstable angina pectoris undergoing drug-eluting stent implantation for a severe single coronary artery.

Platelet distribution width in young patients with chronic venous insufficiency.

OBJECTIVE: Platelet distribution width (PDW) has been reported in a wide range of pathological settings. In this study, we aimed to investigate the relationship between PDW and lower extremity chronic venous insufficiency (CVI) by comparing the levels of PDW and other parameters derived from complete blood count (CBC) tests in young individuals with or without lower extremity CVI. METHODS: This prospective clinical study was conducted between January 2020 and December 2020. A total of 108 patients, 72 patients with lower extremity CVI (study group) and 36 healthy volunteers (control group) were enrolled from the Bursa Yuksek Ihtisas Education Research Hospital and the Bolu Abant Izzet Baysal University Training and Research Hospital. The age range of the participants was between 18 and 50 years old. Participants' baseline clinical features and CBC parameters including PDW, white blood cell, hemoglobin, hematocrit, mean corpuscular volume, red cell distribution width, neutrophil, lymphocyte, platelet count, mean platelet volume, plateletcrit, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were compared between the two groups. RESULTS: The groups were statistically similar in terms of baseline clinical features. The median PDW value was significantly higher for the CVI patients relative to the control group (17.6 vs 16.8; p < 0.001). In terms of other CBC parameters, there were no significant differences between the groups. According to ROC analysis, area under the curve of PDW was 0.749 (95% confidence interval: 0.653-0.846 and p < 0.001). If the value of PDW was accepted as 17, it could predict CVI with 76% sensitivity and 59% specificity, whereas a PDW value of 17.5 could predict CVI with 51% sensitivity and 81% specificity. CONCLUSION: Platelet distribution width might be a useful marker to determine an increased inflammatory response and thrombotic status in young patients with CVI.

Platelet-Lymphocyte ratio is a predictor for the development of no-reflow phenomenon in patients with ST-segment elevation myocardial infarction after thrombus aspiration.

BACKROUND: We aimed to evaluate the utility of the preprocedural platelet-lymphocyte ratio (PLR) for predicting the no-reflow phenomenon after thrombus aspiration during percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). METHOD: We retrospectively analyzed postprocedural thrombolysis in myocardial infarction (TIMI) flow grades and myocardial blush grades (MBG) of 247 patients who underwent a PCI procedure with thrombus aspiration.We divided these patients into two groups according to whether they had no-reflow (TIMI < 3, MBG < 2) or not (TIMI 3, MBG ≥ 2). RESULTS: No-reflow developed in 43 (17%) patients.Preprocedural PLR was significantly higher in the no-reflow group (183.76 ± 56.65 vs 118.32 ± 50.42 p < 0.001).Independent predictors of no-reflow were as follows: higher preprocedural platelet-lymphocyte ratio (PLR) (OR = 1.018; 95% CI = 1.004, 1.033; p = 0.013),mean corpuscular volume (MCV) (OR = 1.118; 95% CI = 1.024, 1.220; p = 0.012) and SYNTAX Score-2 (OR = 1.073; 95% CI = 1.005, 1.146; p = 0.036). PLR of 144 had 79% sensitivity and 75% specificity for the prediction of no-reflow. CONCLUSION: PLR is a reliable predictor for no-reflow in STEMI patients undergoing thrombus aspiration.

The effect of successful parathyroid surgery on left ventricle function in patients with primary hyperparathyroidism evaluated with strain echocardiography.

BACKGROUND: Hyperparathyroidism (PHP) is the most common cause of hypercalcemia in outpatients. It is characterized by many cardiac complications including chronic cardiac arrhythmia, hypertrophy, and diastolic insufficiency. However, there are insufficient data about the cardiac systolic function in PHP. Data regarding the positive effects of surgical treatment on cardiac complications are limited and inadequate. The aim of this study was to evaluate the postoperative changes in the left ventricle functions of patients with PHP using strain echocardiography (STE) instead of traditional echocardiographic evaluation. METHODS: This prospective study included 29 patients with PHP. Detailed echocardiographic evaluations were made including conventional and STE' ventricle function preoperatively and at 6 months after surgery. Then, preoperative and postoperative STE changes, global longitudinal (GLS) and circumferential strain (GCS), were compared. Patients with recurrent surgery, poor echogenicity, and comorbid conditions affecting STE were excluded. RESULTS: No significant change was determined in ejection fraction in the period from preoperative to 6 months postoperative (P > .05). The GLS value increased from 18.53 ± 3.06 to 20.25 ± 3.89, to a statistically significant level (P = .004). The other echocardiographic parameters remained unchanged for the same patients. CONCLUSION: Despite normal 2D echocardiography data, it was determined that the GLS values deteriorated preoperatively and improved by the 6th postoperative month. The detection of early disorders in PHP that cannot be detected on 2D echocardiography, even in asymptomatic patients, may suggest a new treatment indication. For asymptomatic PHP patients, strain echocardiography may be more valuable than 2D echocardiographic evaluation to determine myocardial dysfunction. The recent literature is insufficient, and there is a need for further, more extensive studies with longer follow-up periods.

Evaluation of early myocardial dysfunction with strain echocardiography in chronic hepatitis B patients.

INTRODUCTION: It is well known that chronic hepatitis B virus infection (CHBV) can be associated with cirrhosis and hepatocellular carcinoma but it can also be associated with extra-hepatic effects, of which cardiac manifestations are the one of the least known. There is a limited amount of data about myocardial dysfunction in CHBV and insufficient data of strain echocardiography in CHBV. The aim of this study was to detect early myocardial dysfunction in CHBV using strain echocardiography. METHOD: This prospective study included 40 CHBV patients without anti-viral treatment, 40 CHBV patients under anti-viral treatment, and 40 healthy volunteers as control group from 2017 October to 2018 May. The patients in all groups were aged 30-60 years, with no co-morbid diseases. Any patients with pathologies that would cause myocardial dysfunction were excluded from the study. All patients were evaluated with transthoracic two-dimensional (2D), tissue Doppler, and strain echocardiography. RESULTS: The mean age and gender distribution were similar in all groups (P = 0.677). A statistically significant difference was determined between the groups in respect of the global circumferential strain and global longitudinal strain values (P < 0.01). The difference in the mean lateral s' was of statistical significance between the CHBV patients and the control group (P = 0.035). No statistically significant difference was determined in respect of the other echocardiographic parameters. CONCLUSION: As it is a chronic necro-inflammatory period, chronic HBV can affect myocardial functions. Traditional echocardiographic parameters may not be useful in the detection of early myocardial dysfunction. The results of this study showed that strain echocardiography may be more valuable in early myocardial dysfunction rather than routine 2D echocardiography in CHBV patients.

Primary pulmonary arterial hypertension with preserved right ventricular function leads to lower extremity venous insufficiency.

Objectives Pulmonary hypertension with heart failure is related to venous insufficiency. However, there is no clear data whether pulmonary arterial hypertension with preserved right ventricular function cause venous insufficiency. In this study, we aim to investigate the relation between pulmonary arterial pressure with venous insufficiency in pulmonary arterial hypertension patients with preserved right ventricular function. Methods Between January 2012 and October 2014, 38 patients with a diagnosis of pulmonary arterial hypertension and 47 control group patients were included. Venous disability score and venous segmental disease score of both groups were calculated in order to measure venous insufficiency. The relationship between venous disability score and venous segmental disease scores and mean pulmonary arterial pressure and World Heart Organization functional capacity was examined. Results Total venous segmental disease score (5 ± 3.9 vs. 2 ± 1.8 p < 0.001), right venous segmental disease score (2.6 ± 2.2 vs. 1 ± 0.9 p < 0.001), left venous segmental disease score (2.4 ± 2.2 vs. 1 ± 0.9 p < 0.001), and venous disability scores (2.2 ±1 vs. 1.6 ± 0.7 p < 0.001) of patients with pulmonary arterial hypertension were higher than the control group. While the total venous segmental disease score was highly related to mean pulmonary arterial pressure (r = 0.829, p < 0.001), the venous disability score was only weakly related (r = 0.343, p = 0.037). Total venous segmental disease score (r = 0.606, p < 0.001) and venous disability scores (r = 0.601, p < 0.001) were moderately related with World Health Organization functional capacity intensity. Conclusions The degree of venous insufficiency increase in accordance with the mean pulmonary arterial pressure even in patients with preserved right ventricular function.

Does Deficiency of Vitamin D Increase New Onset Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery?

BACKGROUND: Deficiency of vitamin D is known to be effective in the development of hypertension, coronary artery disease, myocardial infarction, and stroke. Deficiency of vitamin D was also shown to be associated with new onset atrial fibrillation (AF) by activating the renin-angiotensin system. This study investigated whether or not levels of vitamin D are effective in the development of AF after coronary artery bypass grafting (CABG) surgery. METHODS: A total of 283 patients undergoing CABG were included in this study. Clinical information, history of medication use, serum 25 hydroxy(OH) vitamin D, and calcium levels of all patients were evaluated preoperatively. RESULTS: AF developed postoperatively in 72 (25%) of patients. Serum 25(OH) vitamin D levels of patients in whom AF developed after CABG were significantly lower than patients in whom AF did not occur (15.6 ± 7.4 versus 19.1 ± 9.1; P = .004). Independent variables which were predictors of AF development in multivariate logistic regression analysis were ejection fraction (odds ratio [OR]: 0.93; 95% confidence interval [CI] 0.89-0.97; P = .003), left atrial dimensions (OR: 1.47; 95% CI 1.26-1.71; P < .001), and serum 25(OH) vitamin D levels (OR: 0.95; 95% CI 0.91-0.99; P = .035). CONCLUSION: This study has shown that deficiency of vitamin D is associated with new onset AF post-CABG surgery.

Isolated Congenital Unilateral Agenesis of the Left Pulmonary Artery with Left Lung Hypoplasia in an Asymptomatic Adult Patient.

UNLABELLED: The congenital unilateral agenesis of pulmonary artery is a congenital cardiovascular anomaly rarely seen in adulthood. A 21-year-old asymptomatic male was admitted to our hospital to obtain a routine health report to accompany a job application. Posteroanterior chest radiograph revealed a mediastinal shift to the left, with increased radiopacity in the left lung and increased radiolucency in the right lung. Thoracoabdominal computed tomography revealed hypoplasia of the left pulmonary artery. Transthoracic echocardiography excluded any accompanying cardiac abnormalities. Pulmonary angiography was undertaken and confirmed diffuse hypoplasia of the left pulmonary artery while right pulmonary artery was significantly enlarged. The patient's pulmonary artery pressure was within the normal limits, after which he decided to be carefully followed-up. KEY WORDS: Cardiovascular anomaly; Hypoplasia; Pulmonary artery.

[Evaluation of quality of life using the Umea 22 questionnaire among patients with atrioventricular nodal tachycardia undergoing successful radiofrequency ablation treatment]. / Basarili radyofrekans ablasyon islemi uygulanan atriyoventriküler nodal reentran tasikardili hastalarda yasam kalitesinin Umea 22 anketi ile degerlendirilmesi.

OBJECTIVE: Atrioventricular nodal reentrant tachycardia (AVNRT) attacks is one of the common arrhythmias adversely affecting quality of life. The Umea 22 (U22) is a questionnaire developed for the assessment of symptoms associated with supraventricular tachycardia (SVT), and it is found to be effective in evaluation of quality of life after radiofrequency ablation. Using this questionnaire, the study aimed to assess quality of life among Turkish patients with ANRT before and after the successful RFA. METHODS: The study was conducted between January 2011 and September 2013, and included 57 patients who had undergone RFA due to AVNRT. The U22 questionnaire was administered pre-procedure and at 6 months post-procedure. The participants were asked to report on their general well-being, arrhythmia effects on their wellbeing, and intensity of discomfort associated with episodes. They were asked to provide a score from 1 to 10 in order to determine to severity of discomfort, and the quantity of symptoms was then assessed according to the visual analogue scale (VAS). RESULTS: Patients' general wellbeing (7.5±2.3 vs. 8.7±1.8, p<0.001), the effects of arrhythmia episodes on general well-being (8.1±1.7 vs. 1.0±2.1, p<0.001), frequency of symptoms (2.8±0.8 vs. 0.4±0.9, p<0.001) and duration of symptoms were reduced significantly after RFA. The rate of drug use among patients also decreased after RFA (70% vs. 23%, p=0.017). CONCLUSION: Treatment success was high in patients undergoing RFA due to AVNRT according to the U22 quality of life questionnaire. General and arrhythmia-associated quality of life had improved significantly by the 6th month post-procedure.

Acute pulmonary embolism mimicking inferior myocardial infarction.

Pulmonary embolism (PE) is a potentially life-threatening emergency that is sometimes difficult to diagnose due to nonspecific symptoms and findings. A 69-year-old male was admitted to our hospital with new-onset chest pain and sweating. The electrocardiogram (ECG) revealed sinus rhythm with ST elevations in the inferior leads. His angiogram showed noncritical coronary artery disease with a few plaques. Right heart catheterization was made, which revealed an elevated pulmonary artery pressure of 45/23 mmHg. A pulmonary angiogram was then performed, at first from the pulmonary trunk and then the right pulmonary artery, which showed occlusion of the pulmonary artery to the right lower lobe. This report emphasizes that acute PE should be suspected in every patient with ST elevation myocardial infarction and normal coronary arteries. ST changes may be in the inferior as well as the anterior leads.

Rate of blood pressure control and antihypertensive treatment approaches in diabetic patients with hypertension.

OBJECTIVES: Hypertension is a common co-morbidity in patients with type 2 diabetes. Management of hypertension is of paramount importance in reducing macro- and microvascular complications of diabetes. The aim of this study is to determine the rate of blood pressure control (<140/85 mmHg) in diabetic patients with hypertension, and to evaluate the prescribing pattern of antihypertensive medications. STUDY DESIGN: This was a prospective, cross-sectional, observational study conducted in a tertiary centre in Turkey. Of 707 patients with diabetes, 500 hypertensive patients were evaluated to determine control of hypertension and treatment attitudes. Logistic regression analysis was used to evaluate the likelihood of prescription of each class of antihypertensive medications for the presence of macro- and microvascular complications. RESULTS: Most of the patients (95%) were on antihypertensive therapy. Only 41% achieved target blood pressure values (<140/85 mmHg). Renin angiotensin system (RAS) blockers were the most frequently (82.4%) prescribed antihypertensive agents, and a combination of RAS blockers and diuretics were the most commonly preferred combination therapy. Most of the patients were on 1 antihypertensive drug or a combination of 2 drugs (39.5% and 44.7%, respectively). Patients with coronary artery disease were more likely to receive beta blockers (Odds ratio=3.6, 95% confidence interval=2.3-5.6; p<0.001). CONCLUSION: Although most of the diabetic hypertensive patients were on hypertensive therapy, more than half had uncontrolled blood pressure.

Predictive Value of the Modified Mehran Score for Contrast-Induced Nephropathy After Transcatheter Aortic Valve Implantation.

Considering the increasing use of the transcatheter aortic valve implantation (TAVI) procedure, the relationship of contrast-induced nephropathy (CIN) with post-TAVI mortality has become important. The Mehran score was developed to detect the risk of CIN development after cardiac intervention. We aimed to compare the role of the modified Mehran score, which can be calculated pre-procedure, in predicting CIN development and compare it with the original Mehran score. We retrospectively collected data from TAVI procedures at our institution between December 2016 and June 2021; of 171 patients, 44 (25.7%) had CIN. We found no association between contrast media volume and CIN (387 ± 120 vs 418 ± 139 mL, P = .303). High and very high modified Mehran score and preoperative C-reactive protein (CRP) level were independent risk factors for CIN development after TAVI procedure. The area under curve (AUC) was .686 with 95% CI: .591-.780 and P < .001, and also, with a cut-off point of >7.5 points, there was 79.5% sensitivity and 63.0% specificity; otherwise, with a cut-off point of >9.5 points, there was 54.5% sensitivity and 71.7% specificity, for the modified Mehran score. The modified Mehran score comes into prominence compared with the original Mehran score since it can be calculated pre-procedure.

Left Ventricular Hypertrophy Findings on Electrocardiogram Predict Impaired Left Atrial Functions.

OBJECTIVE: Electrocardiographic left ventricular hypertrophy (ECG LVH) holds significant clinical importance in cardiovascular disease. Pathological processes that lead to left ventricular hypertrophy (LVH) also induce remodeling and impair left atrial (LA) function. Atrial function can be assessed using speckle-tracking echocardiography. This study investigates the potential impact of ECG LVH on LA strain. METHODS: A total of 62 individuals diagnosed with LVH, based on the echocardiographic left ventricular mass index, were included. ECG LVH was assessed using established protocols: the Sokolow-Lyon voltage criteria (SV1 + RV5/RV6 > 35 mm), Cornell voltage criteria (RaVL + SV3 > 28 mm for men and > 20 mm for women), and the Cornell product criteria [(SV3 + RaVL + (for women 8 mm)] x QRS duration > 2440 mm x ms). Participants were categorized into two groups based on the presence or absence of ECG LVH. The relationship between LA strain measures and ECG characteristics was explored. RESULTS: The study population had a median age of 58.3 ± 10.1 years, with 40.3% being female, 91.9% hypertensive, and 35.5% diabetic. Nineteen patients (30.6%) were identified with ECG LVH based on Sokolow-Lyon voltage, Cornell voltage, or Cornell product criteria. These patients exhibited significantly reduced LA reservoir, conduit, and contraction strains (P < 0.001). Statistically significant correlations were observed between all three phases of LA strain measures and Sokolow-Lyon voltage (reservoir r = -0.389, P < 0.01; conduit r = -0.273, P < 0.05; contraction r = -0.359, P < 0.01), Cornell voltage (reservoir r = -0.49, P < 0.001; conduit r = -0.432, P < 0.001; contraction r = -0.339, P < 0.01), and Cornell product (reservoir r = -0.471, P < 0.001; conduit r = -0.387, P < 0.01; contraction r = -0.362, P < 0.01). CONCLUSION: ECG LVH is associated with impaired LA strain, validating its use as an effective tool for predicting LA dysfunction.

PFAS and their association with the increased risk of cardiovascular disease in postmenopausal women.

Cardiovascular diseases (CVDs) are one of the major causes of death globally. In addition to traditional risk factors such as unhealthy lifestyles (smoking, obesity, sedentary) and genetics, common environmental exposures, including persistent environmental contaminants, may also influence CVD risk. Per- and polyfluoroalkyl substances (PFASs) are a class of highly fluorinated chemicals used in household consumer and industrial products known to persist in our environment for years, causing health concerns that are now linked to endocrine disruptions and related outcomes in women, including interference of the cardiovascular and reproductive systems. In postmenopausal women, higher levels of PFAS are observed than in premenopausal women due to the cessation of menstruation, which is crucial for PFAS excretion. Because of these findings, we explored the association between perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), and perfluorobutanesulfonic acid in postmenopausal women from our previously established CVD study. We used liquid chromatography with tandem mass spectrometry, supported by machine learning approaches, and the detection and quantification of serum metabolites and proteins. Here, we show that PFOS can be a good predictor of coronary artery disease, whereas PFOA can be an intermediate predictor of coronary microvascular disease. We also found that the PFAS levels in our study are significantly associated with inflammation-related proteins. Our findings may provide new insight into the potential mechanisms underlying the PFAS-induced risk of CVDs in this population. This study shows that exposure to PFOA and PFOS is associated with an increased risk of cardiovascular disease in postmenopausal women. PFOS and PFOA levels correlate with amino acids and proteins related to inflammation. These circulating biomarkers contribute to the etiology of CVD and potentially implicate a mechanistic relationship between PFAS exposure and increased risk of cardiovascular events in this population.

[Left ventricular thrombus formation in a patient with normal ejection fraction]. / Normal ejeksiyon fraksiyonlu hastada sol ventrikül içinde trombüs olusumu.

Left ventricular (LV) thrombi usually occur in the presence of impaired LV function, such as in dilated cardiomyopathy, aneurysm or following myocardial infarction. Thrombus formation in a normally functioning LV is extremely rare. We report a patient with LV thrombus formation despite a normal systolic function. The patient, who was admitted to the emergency service with transient loss of consciousness and diagnosed with cerebral embolism, was found to have a pedunculated and hypermobile mass in the LV apex by echocardiography. The LV mass was excised by urgent surgery due to its high embolic risk. The histopathological examination revealed that the LV mass was a thrombus. This case highlights that although very rare, LV thrombus formation may occur in patients with normal ejection fraction.

The Clinical Value of the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy Score in Predicting Long-Term Major Adverse Cardiovascular And Cerebrovascular Events and Major Bleeding in Acute Coronary Syndrome Patients Who Underwent Percutaneous Coronary Intervention.

The PRECISE-DAPT (predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy) score is recommended for predicting out-of-hospital bleeding after percutaneous coronary intervention (PCI). However, its long-term prediction remains unclear. We investigated the performance of this score in predicting long-term outcomes in patients with the acute coronary syndrome (ACS). We divided retrospectively enrolled patients (n = 1071) into two groups according to their PRECISE-DAPT scores: low < 25 and high ≥ 25. Bleeding was assessed using the Bleeding Academic Research Consortium criteria. The ischemic endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). During follow-up (median 7.3 years), MACCE (55 vs 35%, P<.001) and major bleeding (9 vs 4%, P = .002) rates were greater in the high score group. The PRECISE-DAPT score was an independent predictor of MACCE in multivariate analysis (Hazard ratio [HR]: 1.028, 95% confidence interval [CI]: 1.016-1.039, P < .001). Also, the PRECISE-DAPT score predicted all-cause mortality (HR: 2.115, 95% CI: 1.508-2.965, P < .001) at long-term follow-up. The PRECISE-DAPT score may be useful for predicting MACCE at long-term follow-up in addition to the risk of bleeding.

Strain Echocardiographic Evaluation of Myocardial Involvement in Patients with Continuing Chest Pain after COVID-19 Infection. / Avaliação Ecocardiográfica com Strain do Envolvimento Miocárdico em Pacientes com Dor Torácica Contínua após Infecção por COVID-19.

BACKGROUND: A new clinical manifestation called post or long coronavirus disease (p/l COVID) has walked into our lives after the acute COVID-19 phase. P/l COVID may lead to myocardial injury with subsequent cardiac problems. Diagnosing these patients quickly and simply has become more important due to the increasing number of patients with p/l COVID. OBJECTIVES: We compared strain echocardiography (SE) parameters of patients who suffered from atypical chest pain and had sequel myocarditis findings on cardiac magnetic resonance (CMR). We aimed to investigate the value of SE for detection of myocardial involvement in patients with p/l COVID. METHODS: A total of 42 patients were enrolled. Our population was separated into two groups. The CMR(-) group (n = 21) had no myocardial sequelae on CMR, whereas the CMR(+) group had myocardial sequelae on CMR (n = 21). The predictive value of SE for myocarditis was also evaluated by age-adjusted multivariate analysis. P values < 0.05 were considered statistically significant. RESULTS: When compared with left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) had a stronger relationship (LVEF, p = 0.05; GLS, p < 0.001; GCS, p < 0.001) with p/l COVID associated myocardial involvement. GLS < 20.35 had 85.7% sensitivity and 81% specificity; GCS < 21.35 had 81% sensitivity and 81% specificity as diagnostic values for myocardial sequelae detected with CMR. While there was no difference between the groups in terms of inflammatory markers (C-reactive protein, p = 0.31), a difference was observed between biochemical markers, which are indicators of cardiac involvement (brain natriuretic peptide, p < 0.001). CONCLUSION: SE is more useful than traditional echocardiography for making diagnosis quickly and accurately in order not to delay treatment in the presence of myocardial involvement.

FUNDAMENTO: Tem surgido uma nova manifestação clínica chamada pós-COVID ou COVID longa (COVID p/l) após a fase aguda da COVID-19. COVID p/l pode levar à lesão miocárdica com problemas cardíacos subsequentes. Diagnosticar esses pacientes de forma rápida e simples é cada vez mais importante devido ao número crescente de pacientes com COVID p/l. OBJETIVOS: Comparamos os parâmetros de ecocardiografia com strain (ES) de pacientes que apresentaram dor torácica atípica e achados de sequelas de miocardite na ressonância magnética cardíaca (RMC). Nosso objetivo foi investigar o valor da ES para detecção de envolvimento miocárdico em pacientes com COVID p/l. MÉTODOS: Foram incluídos um total de 42 pacientes. Nossa população foi separada em 2 grupos. O grupo RMC(-) (n = 21) não apresentou sequelas miocárdicas na RMC, enquanto o grupo RMC(+) apresentou sequelas miocárdicas na RMC (n = 21). O valor preditivo da ES para miocardite também foi avaliado por análise multivariada ajustada por idade. Valores de p < 0,05 foram considerados estatisticamente significativos. RESULTADOS: Quando comparado com a fração de ejeção do ventrículo esquerdo (FEVE), o strain longitudinal global (SLG) e o strain circunferencial global (SCG) tiveram uma relação mais forte (FEVE, p = 0,05; SLG, p < 0,001; SCG, p < 0,001) com envolvimento miocárdico associado à COVID p/l. SLG < 20,35 apresentou sensibilidade de 85,7% e especificidade de 81%; SCG < 21,35 apresentou sensibilidade de 81% e especificidade de 81% como valores diagnósticos para sequelas miocárdicas detectadas com RMC. Enquanto não houve diferença entre os grupos quanto aos marcadores inflamatórios (proteína C-reativa, p = 0,31), houve diferença entre os marcadores bioquímicos, que são indicadores de envolvimento cardíaco (peptídeo natriurético cerebral, p < 0,001). CONCLUSÃO: A ES é mais útil do que a ecocardiografia tradicional para diagnosticar com rapidez e precisão, a fim de não atrasar o tratamento na presença de envolvimento miocárdico.

Kinesiophobia, physical performance, and health-related quality of life in patients with coronary artery disease.

Introduction: Kinesiophobia is an important risk factor for physical activity and exercise restrictions. It is important to assess kinesiophobia and identify high-risk patients to help prevent sedentary behaviour and increase exercise participation among cardiac patients. Aim: To evaluate kinesiophobia and its association with physical performance, health-related quality of life (HRQOL), patients' limitations and symptoms, and disease history in patients with coronary artery disease (CAD). Material and methods: Fifty-two patients diagnosed with CAD were enrolled in this study. Kinesiophobia was assessed with the Tampa Scale of Kinesiophobia for Heart. The 5× Sit-to-Stand Test (5-STST), the Timed Up and Go Test (TUGT), and the 6-Minute Walk Test (6-MWT) were used to assess physical performance. Patients' limitations and symptoms and HRQOL were evaluated with the Cardiovascular Limitations and Symptoms Profile. CAD duration and history of myocardial infarction (MI) were also recorded. Results: 87.2% of the patients had high level of kinesiophobia, which was higher in patients with previous MI compared to patients without history of MI (p = 0.031). Kinesiophobia was positively correlated with 5-STST duration, TUGT duration, angina, shortness of breath, HRQOL, and CAD duration, and it was negatively correlated with 6-MWT distance (p < 0.05). According to regression analysis, only angina was a significant predictor for kinesiophobia (p = 0.014). Kinesiophobia was found to be a predictor of physical performance and HRQOL (p < 0.05). Conclusions: Levels of kinesiophobia are high in patients with CAD, especially in those with a history of MI. Angina is a predictor of kinesiophobia while kinesiophobia is a predictor of both physical performance and HRQOL in CAD patients.

Determinants of Coronary Angiography in Non-ST-elevation Myocardial Infarction with Low Ejection Fraction.

OBJECTIVE: To investigate the clinical and demographic factors affecting the selection of angiography in patients with severe left ventricular systolic dysfunction (SLVSD, ejection fraction lower than 30%) developing non-ST-segment elevation (NSTEMI). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: This study was conducted at the Department of Cardiology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey, between March 2018 and March 2021. METHODOLOGY: Patients with SLVSD (Ejection fraction <30%) developing Clinical and demographic factors were compared between the patients who were or were not decided for angiography. Associated factors for the decision of angiography were evaluated. RESULTS: Overall, 68 (46%) out of 147 patients underwent coronary angiography. Angiography led to coronary artery bypass grafting (CABG) in 14 (21%), percutaneous coronary intervention (PCI) in 30 (44%), and medical treatment in 24 (35%). Among the patients who decided for CABG, 10 (71%) underwent surgery. In multivariate analysis; Killip score ≥2 [Odds ratio (OR) :33.85, 95% Confidence Interval (CI): 5.03-227.405 p<0.001], lower education level (OR: 17.66, 95% CI: 2.25-138.44, p=0.006), anaemia (OR: 10.60, 95% CI: 2.07-54.28, p=0.005), age ≥65 years (OR: 7.124, 95% CI: 1.33-38.12, p=0.02), and PCI history (OR: 0.132, 95% CI: 0.02-0.84, p=0.032) were associated factors with the decision of only medical treatments instead of angiography. CONCLUSION: Demographic factors such as age and education level and clinical factors such as decompensation, PCI history, and anaemia significantly affect the decision of angiography in the patients with SLVSD and NSTEMI. KEY WORDS: Heart failure, NSTEMI, Revascularisation, Severe left ventricular systolic dysfunction, Ejection fraction.