Assessment of Knowledge, Attitude, and Practice Patterns in Pulmonary Arterial Hypertension among Cardiologists and Pulmonologists: Evidence from Turkey.

Background and Objectives: Pulmonary arterial hypertension (PAH) is a rare chronic disease of the small pulmonary arteries that causes right heart failure and death. Accurate management of PAH is necessary to decrease morbidity and mortality. Understanding current practices and perspectives on PAH is important. For this purpose, we intended to determine physicians' knowledge, attitudes, and practice patterns in adult pulmonary arterial hypertension (PAH) in Turkey. Materials and Methods: Between January and February 2022, an online questionnaire was sent via e-mail to all cardiologists and pulmonologists who were members of the Turkish Society of Cardiology (TSC) and the Turkish Thoracic Society (TTS). Results: A total of 200 physicians (122 pulmonologists and 78 cardiologists) responded to the questionnaire. Cardiologists were more frequently involved in the primary diagnosis and treatment of PAH than pulmonologists (37.2% vs. 23.8%, p = 0.042). More than half of the physicians had access to right heart catheterization. In mild/moderate PAH patients with a negative vasoreactivity test, the monotherapy option was most preferred (82.8%) and endothelin receptor antagonists (ERAs) were the most preferred group in these patients (73%). ERAs plus phosphodiesterase-5 inhibitors (PDE-5 INH) were the most preferred (69%) combination therapy, and prostacyclin analogues plus PDE-5 INH was preferred by only pulmonologists. Conclusions: Overall, clinical management of patients with PAH complied with guideline recommendations. Effective clinical management of PAH in specialized centers that having right heart catheterization achieve better outcomes.

Prognostic Value of Systemic Immune-Inflammation Index for Major Adverse Cardiac Events and Mortality in Severe Aortic Stenosis Patients after TAVI.

Background and objectives: In this study, we aimed to evaluate whether the systemic immune-inflammation index (SII) has a prognostic value for major adverse cardiac events (MACEs), including stroke, re-hospitalization, and short-term all-cause mortality at 6 months, in aortic stenosis (AS) patients who underwent transcatheter aortic valve implantation (TAVI). Materials and Methods: A total of 120 patients who underwent TAVI due to severe AS were retrospectively included in our study. The main outcome of the study was MACEs and short-term all-cause mortality at 6 months. Results: The SII was found to be higher in TAVI patients who developed MACEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the SII (HR: 1.002, 95%CI: 1.001-1.003, p < 0.01) was an independent predictor of MACEs in AS patients after TAVI. The optimal value of the SII for MACEs in AS patients following TAVI was >1.056 with 94% sensitivity and 96% specificity (AUC (the area under the curve): 0.960, p < 0.01). We noted that the AUC value of SII in predicting MACEs was significantly higher than the AUC value of the C-reactive protein (AUC: 0.960 vs. AUC: 0.714, respectively). Conclusions: This is the first study to show that high pre-procedural SII may have a predictive value for MACEs and short-term mortality in AS patients undergoing TAVI.

Evaluation of Daily Blood Pressure Alteration in Subclinical Hypothyroidism.

BACKGROUND: Subclinical hypothyroidism is the most common thyroid dysfunction in the general population. The relationship between overt thyroid dysfunction and hypertension is generally understood. Besides high blood pressure, non-dipper hypertension is known to increase cardiovascular risk. Our aim is to investigate daily blood pressure changes and the frequency of non-dipping patterns in patients with subclinical hypothyroidism. METHODS: Forty-nine patients without hypertension with subclinical hypothyroidism were compared with 50 healthy sex- and age-matched controls using ambulatory blood pressure monitoring. RESULTS: Thyroid-stimulating hormone (TSH) levels were significantly higher in the subclinic hypothyroidism group, and there was no difference between free triiodothyronine (FT3) and free thyroxine (FT4) levels which could be predicted as a result of the study design. Levels of mean diastolic, daytime diastolic, nighttime diastolic and nighttime systolic blood pressure were significantly higher in the subclinic hypothyroidism group (p = 0.001 for mean, daytime and nighttime diastolic and p = 0.01 for nighttime systolic). Diastolic non-dipping occurred more frequently in the subclinic hypothyroidism group [subclinical hypothyroidism group 24 patients (49%), control group 13 patients (26%), p = 0.01]. On multivariate analysis, subclinical hypothyroidism was independently associated with diastolic non-dipping (95% confidence interval 1.162-8.053, odds ratio 1.182, p = 0.024). CONCLUSIONS: Our study found that both the frequency of diastolic non-dipping pattern and diastolic blood pressure increase with subclinical hypothyroidism. Therfore, it would appear that searching for non-dipping pattern can add valuable information for patients with subclinical hypothyroidism.

The Presence of Left Atrial Thrombus is Associated with the Neutrophil-to-Lymphocyte Ratio in Patients with Rheumatic Mitral Valve Stenosis.

BACKGROUND: Rheumatic mitral valve stenosis (RMVS)-induced left atrial thrombus (LAT) and embolic complications may have clinically devastating consequences. Stasis in the left atrium induced by valvular obstruction is a major factor in the development of thrombus. However, the development of thrombus may not be solely associated with stasis, as it is known that the inflammatory process increases the tendency for thrombosis. The study aim was to examine the relationship between the neutrophil-to-lymphocyte ratio (NLR), an indicator of inflammation, and the existence of LAT. METHODS: A total of 313 consecutive patients with RMVS and mitral valve area (MVA) <2 cm2 was included in this cross-sectional study. Patients were allocated to two groups with or without LAT using transthoracic and transesophageal echocardiography. Routine biochemical analyses and electrocardiographic examinations were also carried out. The NLR was calculated utilizing blood count analysis. RESULTS: The presence of LAT was identified in 78 RMVS patients (24.9%). No significant differences in terms of age, gender, body mass index were found between the groups with and without LAT. On echocardiographic examination, a higher mean gradient and left atrial diameter, as well as a smaller MVA, were determined in patients with LAT (p<0.001). In those patients with LAT, higher C-reactive protein levels and higher leukocyte and neutrophil counts (p <0.001) and lower lymphocyte counts were noted (p = 0.001). The NLR was shown to be higher in patients with LAT (p <0.001). Multivariate regression analysis showed that the relationship between LAT and a high NLR continued independently (OR 5.3; 95% CI 2.9-9.4; p <0.001). CONCLUSIONS: The NLR is an easily obtained, low-cost and easily repeated parameter that seems effective for identifying RMVS patients who are at high risk of developing LAT.

Vitamin D levels predict hospitalization and mortality in patients with heart failure.

OBJECTIVES: Low levels of vitamin D are closely associated with cardiovascular diseases. Heart failure (HF) is a major health problem globally, occurring with increasing frequency and characterised by poor prognosis despite therapy. We aimed to investigate the effect of vitamin D levels on hospitalisation and mortality in patients with HF. DESIGN: Patients with ejection fraction <50% (n = 219) were included in this prospective study. Demographic, clinical and laboratory parameters were obtained at presentation. Patients were classified into Group 1 (vitamin D level ≤50 nmol/L) and Group 2 (vitamin D level >50 nmol/L). Median follow-up time was 12 months. Hospitalisation rates and overall survival were compared between groups. Independent predictors of hospitalisation and mortality were defined. RESULTS: With a median follow-up period of 12 months, hospitalisation and overall death occurred more frequently in Group 1 than in Group 2 (23.4% vs 7.3% and 16.1% vs 1.2%, respectively; p < 0.005 for both).Vitamin D was defined as an independent predictor of hospitalisation and mortality.Higher levels were found to be associated with decreased hospitalisation (HR 0.89, 95% CI 0.84-0.95, p < 0.001) and mortality (HR 0.83, 95% CI 0.75-0.92, p < 0.001). CONCLUSIONS: Vitamin D deficiency is highly prevalent in patients with HF, and low vitamin D levels are closely associated with increased hospitalisation and mortality.

Association of the CHA2DS2-VASc score with left atrial spontaneous echo contrast: a cross-sectional study of patients with rheumatic mitral stenosis in sinus rhythm.

Mitral valve stenosis is a common manifestation of chronic rheumatic heart disease. In rheumatic mitral valve stenosis (RMVS) patients, left atrial spontaneous echo contrast (LASEC) is an independent predictor of thromboembolism risk. While the anticoagulant therapy algorithm for atrial fibrillation patients is clear, the clinical tools determining high-risk patients in sinus rhythm are insufficient. Our aim is to examine the relationship between CHA2DS2-VASc score in RMVS patients in sinus rhythm and the presence of LASEC. The patients with RMVS upon presentation to the cardiology polyclinic were included in this cross-sectional study consecutively, and CHA2DS2-VASc scores were calculated. All patients were evaluated with transthoracic and transesophageal echocardiography and were divided into two groups as those with and without LASEC. The total number of patients was 265, with LASEC determined in 97 (36.6 %) and not determined in 168 (63.4 %). No significant differences in terms of age, gender, and body mass index were found between the groups. Patients with LASEC had higher mean CHA2DS2-VASc score than patients without LASEC (2.10 ± 1.21 vs. 1.11 ± 0.7, respectively; p < 0.001). In the multivariate logistic regression analysis, it has been determined that there is an independent association between the existence of LASEC and CHA2DS2-VASc score (OR 3.176, CI 1.937-5.206; p < 0.001). The ROC analysis revealed that CHA2DS2-VASc score 2 or more predicted presence of LASEC with a sensitivity of 71 % and a specificity of 82 % (AUC 0.746, 95 % CI 0.682-0.810). The CHA2DS2-VASc score could be useful marker to detect prothrombotic state in patients with RMVS in sinus rhythm.

Impaired aortic elastic properties in primary osteoarthritis.

Osteoarthritis is one of the most common chronic diseases and associated with increased cardiovascular comorbidity and deaths. Elastic properties of aorta are closely associated with cardiovascular mortality and morbidity. In our study, we aimed to evaluate aortic stiffness in primary osteoarthritis patients. A total of 160 patients including 80 patients with primary knee osteoarthritis and 80 controls without osteoarthritis were included in the study. Additionally, osteoarthritis patients were divided into four subgroups according to the severity of the disease. Aortic parameters were evaluated by using transthoracic echocardiography method. While measurements of aortic stiffness of osteoarthritis group were higher compared to the control group (p < 0.01), aortic strain and aortic distensibility measurements of osteoarthritis group are lower than the control group (p < 0.01). Additionally, it was determined that as the severity of osteoarthritis increased also aortic stiffness increased highly significantly (p = 0.001). Presence and severity of osteoarthritis are closely associated with elastic properties of aorta, which are correlated with cardiovascular mortality and morbidity.

Assessment of 25-Hydroxyvitamin D Levels in Patients with Resistant Hypertension.

OBJECTIVE: To investigate the possible correlation between serum 25-hydroxyvitamin D levels and resistant hypertension (RH). SUBJECTS AND METHODS: Patients who had undergone ambulatory blood pressure measurements (ABPM) during outpatient controls were enrolled. Fifty subjects with RH, 50 with controlled hypertension (CHT) and 50 normotensive subjects (NT) were included in the study. RH was defined as 'suboptimal blood pressure control despite using 3 antihypertensive agents including a diuretic or need for 4 or more drugs to control blood pressure'. The 25-hydroxyvitamin D and parathormone levels were compared between the groups. Pearson's correlation coefficient test was applied to assess the correlation between 25-hydroxyvitamin D levels and office blood pressure (BP) and ABPM. Logistic regression analysis was used to determine the independent correlates of RH. RESULTS: The 25-hydroxyvitamin D level was significantly lower in the RH group (17.02 ± 5.4 ng/ml) compared to the CHT (24.9 ± 4.8 ng/ml) and NT groups (28.0 ± 5.7 ng/ml, p < 0.001). In univariate correlation analysis, 25-hydroxyvitamin D levels had a significant negative correlation with office systolic BP (r = -0.329, p < 0.001), office diastolic BP (r = -0.395, p < 0.001), systolic ambulatory BP (r = -0.844, p = 0.004), and diastolic ambulatory BP (r = -0.567, p = 0.005). ROC analysis revealed that 25-hydroxyvitamin D levels <21.50 ng/ml predicted the presence of RH with a sensitivity of 78% and a specificity of 79% (AUC = 0.89, 95% CI 0.83-0.94). In the multivariate logistic regression analysis, 25-hydroxyvitamin D level was independently correlated with the presence of RH (ß 0.660, 95% CI 0.572-0.760, p < 0.001). CONCLUSION: There was an independent correlation between lower 25-hydroxyvitamin D levels and presence of RH.

[Evaluation of arterial elastic parameters in patients with subclinical hypothyroidism]. / Subklinik hipotiroidili hastalarda arter elastik parametrelerinin degerlendirilmesi.

OBJECTIVE: Hypothyroidism is associated with increased cardiovascular morbidity and mortality. Subclinical hypothyroidism is one of the most common endocrine diseases among the general population. The aim of the present study was to investigate aortic elastic parameters related to increased cardiovascular risk in patients with subclinical hypothyroidism. METHODS: Fifty patients newly diagnosed with subclinical hypothyroidism and 50 healthy, age- and sex-matched euthyroid controls were included. Following physical examination and routine biochemical analysis, systolic and diastolic diameters of the ascending aorta were measured by transthoracic echocardiography, and aortic elasticity parameters were calculated. RESULTS: Age, gender, and body mass index were similar between the groups. Patients had significantly higher C-reactive protein and thyroid-stimulating hormone levels than the control group (p=0.002 and p<0.001, respectively). Aortic stiffness was significantly higher in patients, but aortic strain values were significantly lower (p<0.001). Aortic stiffness, C-reactive protein, aortic strain, and systolic blood pressure were found to be independent predictors of subclinical hypothyroidism in multivariate logistic regression analysis (p<0.05). CONCLUSION: Subclinical hypothyroidism is associated with impairment of aortic elastic parameters, independent of other cardiovascular risk factors.

Acute inferior myocardial infarction after electrical weapon exposure: case report and review of the literature.

The use of conducted electrical weapons (CEWs) by legal security forces and in civil society is rapidly increasing. While they are generally considered safe devices, and fatal complications are rare, it is possible to see a small number of complications. In the present case, we describe the detection of acute inferior myocardial infarction in a patient who experienced chest pain after being exposed to a CEW. In such cases, multiple factors should be considered, and the choice of treatment and follow-up should be decided accordingly.

Clinical staging in chronic heart failure associated with low vitamin D and elevated parathormone levels.

OBJECTIVE: Growing evidence in the literature suggests a relationship between heart failure and vitamin D-parathormone cascade. The aim of the present study was to investigate the association of the clinical stage of the heart failure with vitamin D-parathormone levels. METHODS AND RESULTS: Ninety consecutive patients, who were admitted to our clinic from December 2012 to May 2013, were included in the present study. The patients with heart failure were clinically classified into four stages (stage A through stage D). Vitamin D and parathormone levels were measured and echocardiographic recordings were obtained from each patient. The patients with heart failure had significantly lower vitamin D levels compared to the control group (14.5 ng/ml versus 38 ng/ml, P < 0.001). In the four subgroups of patients with heart failure, vitamin D levels significantly decreased (30 ng/ml, 25 ng/ml, 13.5 ng/ml, and 6 ng/ml in stages A, B, C, and D, respectively), and parathormone levels significantly increased (50 pq/ml, 44 pq/ml, 70 pq/ml, and 98.5 pg/ml, respectively) with progression in the heart failure from stage A to stage D (P < 0.001). The log10 EF (B = -2.39, 95% CI = -3.36-1.42, P < 0.001), log10 BNP (B = 0.405, 95% CI = 0.13-0.69, P = 0.005, log10 vitamin D (B = -0.75, 95% CI = -1.18-0.31, P = 0.001) were the independent predictors of heart failure stage in multivariate regression analysis. CONCLUSIONS: Vitamin D and parathormone levels were closely associated with the stage of heart failure. There was a significant decrease in vitamin D levels and a significant increase in serum parathormone levels with clinical deterioration in heart failure.

Ankle brachial index intensifies the diagnostic accuracy of epicardial fat thickness for the prediction of coronary artery disease complexity.

OBJECTIVES: Epicardial fat thickness (EFT) and Ankle brachial index (ABI) are associated with coronary artery disease (CAD). The SYNTAX score (SS) reflects the complexity of CAD. We aimed to evaluate the relation of EFT and ABI with CAD complexity. METHODS: We enrolled 197 patients undergoing coronary angiography. In all patients, ABI and EFT were determined. SS was calculated. The relationship between EFT, ABI and SS was analysed. RESULTS: ABI and EFT were significantly correlated with SS (r = -0.525, p < 0.001, and r = 0.650, p < 0.001, respectively) and found to be independent predictors of SS. ABI<0.9mm identified patients with SS>22 with a sensitivity of 45.28% and a specificity of %82.64 (AUC = 0.689, %95 CI = 0.619-0.763, p<0.001). The optimal cutoff value for EFT was 5mm, yielding a sensitivity of 81.1% and a specificity of 90.3% (AUC = 0.859, 95% CI 0.802-0.904). In order to identify which parameters were the most accurate, we compared both AUC of ROC curves and there was no difference (p = 0.170). CONCLUSION: EFT and ABI enables the noninvasive prediction of CAD severity in patients with suspected CAD and combining ABI to EFT was additive for the prediction of coronary artery disease complexity.

The impact of using SGLT-2 inhibitor on left ventricular longitudinal strain and NT-proBNP levels during six-month follow-up in diabetic patients with and without coronary artery disease with preserved ejection fraction.

BACKGROUND: Optimal glycemic control is necessary to prevent cardiovascular events in patients with type 2 diabetes. The positive impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on cardiovascular events and mortality in these patients has been demonstrated by previous studies although the mechanism is unclear. AIMS: We aimed to compare the influence of SGLT2i on left ventricular remodeling and strain in diabetic patients with coronary artery disease (CAD) and without CAD during 6-month follow-up. METHODS: Between October 2021 and June 2022, 100 diabetic patients with preserved ejection fraction (HbA1c levels 6.5-10%) were started on SGLT2i (empagliflozin or dapagliflozin) and were prospectively followed up. Conventional and speckle-tracking echocardiography was performed by blinded sonographers, at baseline and then at 1 month and 6 months of treatment. After 6 months, the initial and biochemical blood tests were administered, and N-terminal pro-B-type natriuretic peptide levels of the patients were measured. RESULTS: Patients with CAD were older (P = 0.008), more frequently hypertensive (P = 0.035), and had dyslipidemia (P = 0.021). N-terminal pro-B-type natriuretic peptide levels did not change significantly after treatment in both groups. Left ventricular ejection fraction, global, 2-chamber, and 3-chamber strain values were improved significantly following SGLTi administration for the overall patient cohort, regardless of CAD status (P < 0.05 for all groups). CONCLUSIONS: Treatment with SGLT2i resulted in improvement in left ventricular strain parameters, which indicates that they might have a positive impact on outcomes for diabetic patients with preserved EF.

Predictive value of C-reactive protein/albumin ratio for no-reflow in patients with non-ST-elevation myocardial infarction.

Introduction: The focus of this research was to explore the link between CRP (C-reactive protein) /albumin ratio (CAR), a novel inflammatory response marker, and no-reflow (NR) phenomena in non-ST elevation myocardial infarction (non-STEMI) patients during percutaneous coronary intervention (PCI). Methods: The current study recruited 209 non-STEMI participants who underwent PCI. The patients were divided into two groups based on their post-intervention Thrombolysis in Myocardial Infarction (TIMI) flow grade; those with and without NR. Results: In all, 30 non-STEMI patients (6.9%) had NR after PCI. CAR values were substantially greater in the NR group. The CAR was identified to be a determinant of the NR (OR: 1.250, 95% CI: 1.033-1.513, P=0.02), although CRP and albumin were not independently related with NR in the multivariate analysis. In our investigation, low density lipoprotein-cholesterol levels and high thrombus burden were also predictors of the occurrence of NR. According to receiver operating characteristic curve evaluation, the optimal value of CAR was>1.4 with 60% sensitivity and 47% specificity in detecting NR in non-STEMI patients following PCI. Conclusion: To the best of knowledge, this is the first investigation to demonstrate that the CAR, a new and useful inflammatory marker, can be utilized as a predictor of NR in patients with non-STEMI prior to PCI.

Prognostic value of the TyG index for in-hospital mortality in nondiabetic COVID-19 patients with myocardial injury.

OBJECTIVE: The purpose of this study was to explore the efficacy of the triglyceride glucose (TyG) index on in-hospital mortality in nondiabetic coronavirus disease 2019 (COVID-19) patients with myocardial injury. METHODS: This was a retrospective study, which included 218 nondiabetic COVID-19 patients who had myocardial injury. The TyG index was derived using the following equation: log [serum triglycerides (mg/dL) ×fasting blood glucose (mg/dL)/2]. RESULTS: Overall, 49 (22.4%) patients died during hospitalization. Patients who did not survive had a higher TyG index than survivors. In multivariate Cox regression analysis, it was found that the TyG index was independently associated with in-hospital death. A TyG index cutoff value greater than 4.97 was predicted in-hospital death in nondiabetic COVID-19 patients with myocardial damage, with 82% sensitivity and 66% specificity. A pairwise evaluation of receiver operating characteristic (ROC) curves demonstrated that the TyG index (AUC: 0.786) had higher discriminatory performance than both triglyceride (AUC: 0.738) and fasting blood glucose (AUC: 0.660) in predicting in-hospital mortality among these patients. CONCLUSIONS: The TyG index might be used to identify high-risk nondiabetic COVID-19 patients with myocardial damage.

The effect of recanalization of a chronic total coronary occlusion on P-wave dispersion.

Introduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n=64) and it was unsuccessful in 29% of cases (n=26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were significantly elevated in the unsuccessful CTO PCI group. Pre-PCI ECG parameters showed no significant difference. Irrespective of the target vessel revascularization, we observed that PWD and P-max values were significantly lower in the 12th months follow-up. In all Rentrop classes, PWD values were significantly decreased at 12th months follow-up in comparison to the pre-CTO PCI values. Conclusion: This study has determined that PWD and P-max, which are both risk factors for atrial arrhythmias, are significantly reduced within 12th months after successful CTO PCI regardless of the target vessel.

Switching Ticagrelor to 600 mg or 300 mg Clopidogrel Loading Bridge in Patients with Unstable Angina.

Ticagrelor is believed to be a more potent and faster antiplatelet agent compared with clopidogrel and may result in lower ischemic outcomes in patients with acute coronary syndrome. However, the best strategy of switching from ticagrelor to clopidogrel is unclear. Current guidelines advocate clopidogrel bridging with a 600 mg loading dose (LD). This study aimed to compare the safety and feasibility of switching protocols from ticagrelor to clopidogrel 600 mg or 300 mg LD in patients with unstable angina pectoris (USAP). One hundred and eighty patients with USAP undergoing adhoc percutaneous coronary intervention (PCI) received preprocedural ticagrelor 180 mg/daily. The decision to switch antiplatelet therapy to clopidogrel with either 300 mg LD or 600 mg LD at 12 h was left to the discretion of the treating physician. The primary outcome was a composite of an efficacy endpoint major adverse cardiac and cerebrovascular events (MACCEs) and a safety endpoint Bleeding Academic Research Consortium scale (BARC) (≥1). There were no differences in our composite clinical endpoint of MACCE between the two strategies, with one event occurring in each group. One patient in each group had myocardial infarction due to stent thrombosis, and the patient in the 300 mg switching group died due to stent thrombosis. No difference between the two arms was observed in terms of BARC bleeding criteria. This study showed that among USAP patients undergoing PCI, switching to clopidogrel with 300 mg LD showed no significant difference compared to 600 mg clopidogrel LD. Ticagrelor LD in ad hoc PCI and de-escalation to clopidogrel with 300 mg LD could translate to lower costs for patients with USAP without compromising safety and efficacy.

Predictive accuracy of lymphocyte-to-monocyte ratio and monocyte-to-high-density-lipoprotein-cholesterol ratio in determining the slow flow/no-reflow phenomenon in patients with non-ST-elevated myocardial infarction.

OBJECTIVE: To investigate whether inflammation based scores including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) predict the slow flow (SF)/no-reflow (NR) phenomenon comparatively in patients with non-ST-elevated Myocardial Infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). METHODS: Current study is retrospective designed and includes 426 NSTEMI patients (mean age of 56.8 ± 11.4 years). The patients were grouped into non slow flow/no-reflow and slow flow/no-reflow groups according to postintervention thrombolysis in myocardial infarction flow grade. RESULTS: The slow flow/no-reflow group had significantly higher MHR and lower LMR values than the non slow flow/no-reflow group (P < 0.01 and P < 0.01, respectively). Lower LMR [odds ratio (OR): 0.659, P < 0.01] and higher MHR (OR: 1.174, P = 0.04) were independent predictors of slow flow/no-reflow phenomenon in model 1 and 2 multivariate analyses, respectively. Furthermore, left ventricular ejection fraction (LVEF) (OR: 0.934, P = 0.01; OR: 0.930, P < 0.01), smoking (OR: 2.279, P = 0.03; OR: 2.118, P = 0.04), Syntax score (1.038, P = 0.04; 1.046, P = 0.01) and high thrombus grade (OR: 7.839, P < 0.01; OR: 8.269, P < 0.01), independently predicted the slow flow/no-reflow development in both multivariate analysis models, respectively. The predictive performance of LMR and MHR was not different (P = 0.88), but both predictive powers were superior to NLR (P < 0.01 and P = 0.03, respectively). CONCLUSION: The MHR and LMR may be useful inflammatory biomarkers for identifying high-risk individuals for the development of slow flow/no reflow in NSTEMI patients who underwent PCI.

Increased neutrophil to lymphocyte ratio predicts myocardial injury in patients undergoing non-cardiac surgery.

BACKGROUND: The neutrophil to lymphocyte ratio (NLR), has been proposed as potential indicator of cardiovascular events. Our aim was to determine the relationship between NLR and development of myocardial injury after non-cardiac surgery (MINS). METHODS: This observational cohort study included 255 consecutive noncardiac surgery patients aged ≥45 years. Electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels of the patients were obtained for a period of 3 days postoperatively. RESULTS: MINS was detected in 30 (11.8%) patients using the cut-off level of ≥14 ng/L for hscTnT. In the MINS group NLR (3.79 ± 0.7 vs. 2.69 ± 0.6, p < 0.000) values were higher than non-NLR group. The NLR to be independently associated with the development of MINS (OR: 11.690; CI: 4.619-29.585, p < 0.000). CONCLUSIONS: NLR seems to be a simple, easy and cheap tool to predict the development of MINS in patient undergoing non-cardiac surgery.

Comparison of Complication and Success Rates of ProGlide Closure Device in Patients Undergoing TAVI and Endovascular Aneurysm Repair.

INTRODUCTION: Usage of the Perclose ProGlide® (PP: Abbott Laboratories, Chicago, IL, USA) closure device is becoming increasingly prevalent during percutaneous endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI). The respective conditions treated via these procedures, abdominal aortic aneurysm and aortic valve stenosis, share risk factors but are two different physiopathological problems. AIM: Our aim was to compare the complication and success rates of PP closure device use in patients undergoing EVAR and TAVI. MATERIALS AND METHODS: A total of 74 patients, including 58 undergoing TAVI and 16 undergoing EVAR, were analysed in our study. RESULTS: Of the TAVI patients treated using the PP closure device, two (3.4%) had access to site-related bleeding complications and two (3.4%) experienced device failure. Of the EVAR patients who received the PP closure device, three (18.8%) had bleeding complications and three (18.8%) experienced device failure. CONCLUSION: Due to the underlying diffuse aortic wall pathology, the success rate of PP closure device use was lower and the complication rate of PP closure device was higher in the EVAR group versus the TAVI group.