The effect of body mass index on complications in cardiac implantable electronic device surgery.

BACKGROUND: Cardiac implantable electronic device (CIED) procedures are prone to complications. In our study, we investigated the effect of body mass index (BMI) on CIED-related complications. METHODS: 1676 patients who had undergone CIED surgery (de novo implantation, system upgrade, generator change, pocket revision or lead replacement) at two heart centers in Turkey and met the study criteria were included in our study. For analysis of primary and secondary endpoints, patients were classified as non-obese (BMI < 25 kg/m2 ), overweight (25 ≤ BMI < 30 kg/m2 ), and obese (BMI ≥ 30 kg/m2 ). The primary endpoint was accepted as cumulative events, including the composite of clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to the device system. Secondary outcomes included each component of cumulative events. RESULTS: The rate of cumulative events, defined as primary outcome, was higher in the obese patient group, and we found a significant difference between the groups (3.0%, 4.3%, 8.9%, p = .001). CSH and pneumothorax rates were significantly higher in the obese patient group (0.3%, 0.9%, 1.9%, p = .04; 1.0%, 1.4%, 3.3%, p = .04, respectively). According to our multivariate model analysis; gender (OR:1.882, 95%CI:1.156-3.064, p = .01), hypertension (OR:4.768, 95%CI:2.470-9.204, p < .001), BMI (OR:1.069, 95%CI:1.012-1.129, p = .01) were independent predictors of cumulative events rates. CONCLUSIONS: Periprocedural complications associated with CIED (especially hematoma and pneumothorax) are more common in the group with high BMI.

Role of simple inflammatory parameters in predicting the severity of coronary artery disease.

OBJECTIVE: In our study, we aimed to find simple, useful biomarkers in patients with non-ST elevation myocardial infarction to predict coronary artery severity. METHODS: Between May 2022 and December 2022, patients diagnosed with non-ST elevation myocardial infarction according to the European cardiology guidelines were included in our study. The Synergy between PCI with Taxus and Cardiac Surgery score was calculated to determine the severity of coronary artery disease. These patients were classified into two groups according to Synergy between PCI with Taxus and Cardiac Surgery≥23 and Synergy between PCI with Taxus and Cardiac Surgery<23 scores. Biochemical markers such as platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were studied in blood tests taken before coronary angiography in patients diagnosed with non-ST elevation myocardial infarction according to current guidelines. These two groups were compared in terms of the data obtained. RESULTS: There were 281 patients in group 1 and 67 patients in group 2. There was no significant difference between the two groups in terms of demographic data such as age and gender. Platelet-to-lymphocyte ratio [group 1=125 (26-134) and group 2=156 (73-293); p=0.001] and neutrophil-to-lymphocyte ratio [group 1=2.71 (1.3-30.2) and group 2=3.2 (2.1-32.1); p=0.002] were higher in the group of patients with a Synergy between PCI with Taxus and Cardiac Surgery score of <23, while lymphocyte-to-monocyte ratio [group 1=3.6 (0.56-11) and group 2=3.4 (0.64-5.75); p=0.017] was lower in group 2. CONCLUSION: We observed that elevated platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios showed coronary artery severity. Multivessel disease and chronic total occlusion rates were observed to be higher in patients with high platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios.

Role of simple inflammatory parameters in predicting the severity of coronary artery disease

SUMMARY OBJECTIVE: In our study, we aimed to find simple, useful biomarkers in patients with non-ST elevation myocardial infarction to predict coronary artery severity. METHODS: Between May 2022 and December 2022, patients diagnosed with non-ST elevation myocardial infarction according to the European cardiology guidelines were included in our study. The Synergy between PCI with Taxus and Cardiac Surgery score was calculated to determine the severity of coronary artery disease. These patients were classified into two groups according to Synergy between PCI with Taxus and Cardiac Surgery≥23 and Synergy between PCI with Taxus and Cardiac Surgery<23 scores. Biochemical markers such as platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were studied in blood tests taken before coronary angiography in patients diagnosed with non-ST elevation myocardial infarction according to current guidelines. These two groups were compared in terms of the data obtained. RESULTS: There were 281 patients in group 1 and 67 patients in group 2. There was no significant difference between the two groups in terms of demographic data such as age and gender. Platelet-to-lymphocyte ratio [group 1=125 (26-134) and group 2=156 (73-293); p=0.001] and neutrophil-to-lymphocyte ratio [group 1=2.71 (1.3-30.2) and group 2=3.2 (2.1-32.1); p=0.002] were higher in the group of patients with a Synergy between PCI with Taxus and Cardiac Surgery score of <23, while lymphocyte-to-monocyte ratio [group 1=3.6 (0.56-11) and group 2=3.4 (0.64-5.75); p=0.017] was lower in group 2. CONCLUSION: We observed that elevated platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios showed coronary artery severity. Multivessel disease and chronic total occlusion rates were observed to be higher in patients with high platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios.

Prolonged P Wave Peak Time May Be a Sign of LV Diastolic Dysfunction in the Coronary Slow Flow Phenomenon.

Background: The coronary slow flow phenomenon (CSFP) is an atherosclerotic process that causes ischemia at the microvascular level. The CSFP may affect P wave durations, especially P wave peak time (PWPT), by microvascular ischemia, left ventricular diastolic dysfunction, and changes in the left atrial dimension. Therefore, in the present study, we aimed to assess PWPT in the CSFP. Method: One hundred and ninety-five patients were included in this single-center, retrospective study. Ninety patients were enrolled in the CSFP group and 105 patients in the control group. PWPT was defined as the duration between the beginning and peak of the p wave and obtained from the leads Dii and V i. Results: The mean age of the study population was 48.5 ± 9.5, and 108 (55.3%) of the patients were female. We found PWPT was longer in the CSFP group than in the control group. Correlation analysis showed a positive correlation between PWPT in both leads (D II, V i) and left atrial anterior-posterior diameter, mean TIMI frame count (TFC), and E/e. A significant relationship was observed between mean TFC, E/e, EF, heart rate, and PWPT in lead D ii (ß coefficient = 0.33, 95% CI 0.44-1.33, p < 0.001, ß coefficient = 0.23, 95% CI 0.25-1.85, p=0.01, ß coefficient = -0.140, 95% CI -1.04--0.53, p=0.03, and ß coefficient = -0.13, 95% CI -0.29--0.014, p=0.03, respectively) in multivariable linear analysis. Conclusion: In the present study, we found prolonged PWPT in patients with the CSFP and found a relationship between PWPT and mean TFC.

The relationship between serum NT-proBNP levels and severity of coronary artery disease assessed by SYNTAX score in patients with acute myocardial infarction

Background/aim: In the present study, we aimed to investigate the relationship between NT-proBNP and SYNTAX score, which is a measure of the complexity of coronary artery disease. Materials and methods: We enrolled 405 consecutive patients with myocardial infarction who underwent coronary angiographic examination. Patients were divided into 3 groups according to their SYNTAX scores. Those with SYNTAX score ≤22 were included in the low SYNTAX score group (LSTX), those with a score of 23­32 were included in the intermediate SYNTAX score group (ISTX), and those with a score of ≥33 were included in the high SYNTAX score group (HSTX). Results: NT-proBNP levels were found to be significantly higher in the HSTX group compared to the other groups (P < 0.001) and in the ISTX group compared to the LSTX group (P < 0.001). The NT-proBNP levels demonstrated an increase from low SYNTAX score to high SYNTAX score tertiles. Conclusions: NT-ProBNP levels in patients with myocardial infarction on admission were independently associated with extent, severity, and complexity of coronary atherosclerosis as assessed by SYNTAX score.

Anterior myocardial infarction in a patient with isolated left ventricular non-compaction.

We presented a 55-year-old male patient with isolated left ventricular non-compaction who was admitted to our emergency department for chest pain and exertional dyspnoea. He was hospitalised due to anterior myocardial infarction, and during his assessment, isolated left ventricular non-compaction was diagnosed.

Serum pentraxin-3 levels and flow-mediated dilation in dipper and non-dipper hypertension.

BACKGROUND: Endothelial dysfunction is one of the main pathological processes of hypertension. The association of serum pentraxin-3 (PTX3) levels and endothelial dysfunction becomes a more interesting scientific research issue due to high potential of PTX3 as a diagnostic and prognostic biomarker. We aimed to investigate the relationship between serum PTX3 levels and flow-mediated dilation results in patients with dipper and non-dipper hypertension. METHODS: This study included 90 hypertensive patients were divided into two groups based on 24 hours ambulatory blood pressure monitoring (ABPM): 38 patients with a dipper pattern and 52 patients with non-dipper pattern. Noninvasive evaluation of the endothelial functions was performed using flow-mediated dilation (FMD) method. RESULTS: Serum pentraxin-3 levels were higher in patients with non-dipper HT compared to dipper hypertension (P = 0.028). In addition, we found negative correlation between serum PTX3 and FMD basal/FMD hyperemia ratio (r = -0.297, P = 0.05 for FMD basal/FMD hyperemia ratio, respectively). CONCLUSIONS: Serum PTX3 levels are closely related with the measures of indirect noninvasive evaluation methods (FMD) in both DH and NDH patients.

Hyperhomocysteinemia Predicts the Severity of Coronary Artery Disease as Determined by the SYNTAX Score in Patients with Acute Coronary Syndrome.

BACKGROUND: Hyperhomocysteinemia is a known risk factor for acute coronary syndrome (ACS) and is related with the severity of coronary artery disease (CAD). Previous studies have used less quantifiable scoring systems for assessing the severity of CAD. Therefore, we aimed to assess the relationship between homocysteine levels and SYNTAX score (SXscore), which is currently more widely used to grade the severity of CAD. METHODS: A total of 503 patients with adiagnosis of ACS were examined angiographically with SXscore. The patients were divided into three groups according to SXscore; Group 1 a low SXscore (≤ 22), Group 2 a moderate SXscore (23-32), and Group 3 a high SXscore (≥ 33). RESULTS: Plasma homocysteine levels were 16.3 ± 6.2 nmol/mL in Group 1, 18.1 ± 9.6 nmol/mL in Group 2, and 19.9 ± 9.5 nmol/mL in Group 3. Homocysteine levels were significantly higher in Group 2, and Group 3 compared to Group 1 (p = 0.023 and 0.007, respectively). In the correlation analysis, homocysteine levels were correlated with SXscore (r: 0.166, p < 0.01). CONCLUSIONS: Serum homocysteine levels on admission were associated with an increased severity of CAD in the patients with ACS.

Association of total serum antioxidant capacity with the Tei index in echocardiography in patients with microvascular angina.

OBJECTIVES: Cardiac syndrome X (CSX) is a condition characterized by exercise-induced chest pain that occurs considering a normal coronary angiogram. We aimed to investigate the total serum antioxidant capacity (TAC) and biventricular global functions using echocardiography in patients with CSX. PATIENTS AND METHODS: The study population included 55 patients with typical anginal symptoms and a positive exercise stress test, or ischemia in myocardial perfusion scintigraphy and normal coronary arteries detected angiographically, and 49 healthy volunteers with atypical chest pain and a negative stress test. TAC was assessed from blood samples. Transthoracic echocardiography was performed for the entire study population. The Tei index was calculated using the formula IVCT+IVRT/ET. RESULTS: TAC was found to be significantly lower in the CSX group compared with the control group (0.70±0.37 vs. 1.5±0.30, respectively, P<0.001). The Tei index was significantly higher in patients with CSX than the control group (0.60±0.18 vs. 0.42±0.12, respectively, P<0.001).There was a significant and inverse relationship between TAC and the Tei index (r=-0.41, P<0.001). When we divided the study population according to the normal range of TAC into the decreased TAC group (<1.30 mmol/l), the normal TAC group (1.30-1.77 mmol/l), and the increased TAC group (>1.77 mmol/l), it was found that the Tei index was higher in the decreased TAC group compared with the other groups (0.66±0.18 vs. 0.49±0.10 and 0.46±0.13 mmol/l, P<0.001, respectively). CONCLUSION: Our study suggested that TAC was significantly decreased in CSX patients and decreased antioxidant levels were related to impaired Tei index in echocardiography in patients with microvascular angina.

High Sensitive CRP Level Is Associated With Intermediate and High Syntax Score in Patients With Acute Coronary Syndrome.

High sensitive C-reactive protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). We investigated whether baseline hs-CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore).We enrolled 321 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23).Subjects in the intermediate-high SXScore tertile had higher serum hs-CRP levels compare to low SXScore tertile patients (7.7 ± 3.4 mg/L versus 4.9 ± 2.5 mg/L, P < 0.001). The mean age of patients and prevalance of diabetes in the intermediate-high SXScore tertile were significantly higher than in the low SXScore tertile (63 ± 13 versus 58 ± 12 years P = 0.001 for age, P = 0.007 for diabetes). Multivariate logistic regression analysis showed that the strongest predictors of high SXScore were increased serum hs-CRP levels (OR: 1.14) together with multivessel disease (OR: 0.23), left ventricular ejection fraction (LVEF) (OR: 0.90), and troponin levels (OR: 1.12).Serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease, LVEF, and troponin levels. Thus, increased serum levels of hs-CRP were one of the strong predictors of high SXScore in ACS patients.

Is there a correlation between coronary artery ectasia and neutrophil-lymphocyte ratio?

We aimed to investigate the association between the neutrophil-lymphocyte ratio (NLR) and coronary artery ectasia (CAE). The study included 198 patients who had undergone coronary angiography for suspected coronary artery disease (CAD). The patients were divided into the following 4 groups: group 1, 44 patients with normal coronary arteries; group 2, 61 patients with CAD; group 3, 40 patients with isolated CAE; and group 4, 53 patients with CAE coexisting with CAD. Neutrophil-lymphocyte ratio was significantly lower in group 1 than the other groups and significantly higher in group 4. Patients in group 1 had significantly lower neutrophil counts and significantly higher lymphocyte counts than the patients in group 4. The isolated CAE and CAD groups were similar in terms of NLR, neutrophil count, and lymphocyte count. In addition, we found significant positive correlations between presence of ectasia, number of ectatic vessels, and NLR. Our findings provide additional evidence for the role of NLR in CAE.

The association of red cell distribution width with in-stent restenosis in patients with stable coronary artery disease.

Increased red cell distribution width (RDW) is closely related to the poor prognosis and adverse events of cardiovascular diseases. We aimed to investigate the association of serum RDW levels and in-stent restenosis (ISR) after coronary stenting with bare-metal stent in patients with stable coronary artery disease. A total of 251 patients (age 62 ± 11 years, 69% male) with a history of coronary stenting who underwent control coronary angiography (128 with ISR and 123 without ISR) were enrolled into the study. Laboratory parameters were measured before angiography. ISR was defined as luminal stenosis ≥50% within the stent or within 5 mm of its edges by the quantitative coronary analysis. The patients were divided into the two groups: ISR group and no-ISR group. Baseline characteristics of the patients were similar. The ISR group had significantly higher RDW levels compared with patients in no-ISR group (14.47 ± 1.37 vs. 13.59 ± 0.88, p < 0.001). Furthermore, the ISR group had significantly longer stent length and lower stent diameter when compared to no-ISR group (p = 0.001 and p = 0.004, respectively). In a multivariate analysis, RDW levels >13.75%, high-sensitivity C-reactive protein levels, stent diameter and stent length were independently associated with ISR [odds ratio (OR) = 2.12, 95% confidence interval (CI) = 1.71-3.15, OR = 2.80, 95% CI = (1.34-4.61), OR = -2.60, 95% CI = -(1.19-4.51), OR = 2.02, 95% CI = 1.99-3.76, p = 0.001, respectively]. We concluded that increased serum RDW levels were independently associated with bare-metal ISR in patients with stable coronary artery disease.

Atrial electromechanical delay in type 2 diabetes mellitus.

BACKGROUND: Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Increased atrial electromechanical delay (AEMD) is known to be a precursor of AF. In this study, we aimed to investigate AEMD in patients with type 2 DM. METHODS: A total of 110 participants were recruited to the present study. Of them, 70 were diabetic patients, and 40 were healthy control subjects. Basal characteristics were recorded and transthoracic echocardiography was performed for all study participants. RESULTS: Basal characteristics were similar between the two groups. There was significant intra-atrial and interatrial electromechanical delay in the diabetic group compared with the control group. In the correlation analysis, no correlation existed between AEMD and hemoglobin A1C or fasting plasma glucose levels. CONCLUSION: In the present study, we showed that there was significant AEMD in patients with type 2 DM compared with healthy control subjects. Increased AEMD might be an early marker of AF in this patient subset. To clear this hypothesis, further studies are needed.

Glomerular filtration rate is associated with burden of coronary atherosclerosis in patients with acute coronary syndrome.

We aimed to elucidate the relationship between mild to moderate renal impairements and burden of atherosclerosis in patients with acute coronary syndrome (ACS). A total of 380 patients with ACS were included in the study. Gensini and SYNTAX scores were also calculated. Kidney function was classified based on estimated glomerular filtration rate (eGFR) into stage 1: eGFR >90, stage 2: 60 to 89, and stage 3: 30 to 60 mL/min per 1.73 m(2). Gensini and SYNTAX scores were higher in stages 2 and 3 than in stage 1. Also, the number of diseased vessels, number of critical lesions (>50 and 70%), left main disease, and number of total occlusion vessels were higher in stages 2 and 3 than in stage 1. Multivariate linear regression analysis demonstrated that a decreased eGFR was an independent risk factor for SYNTAX and Gensini scores together with age and male gender.

The relationship between neutrophil/lymphocyte ratio and infarct-related artery patency before mechanical reperfusion in patients with ST-elevation myocardial infarction.

OBJECTIVES: Reduced baseline coronary flow in an infarct-related artery (IRA) before a primary percutaneous coronary intervention (PPCI) increases mortality in patients with ST-elevation myocardial infarction (STEMI). Increased neutrophil/lymphocyte (N/L) ratio has been linked to poor clinical outcomes in patients with STEMI. We investigated whether the N/L ratio, as measured at admission, was associated with IRA patency before mechanical reperfusion in patients with STEMI undergoing PPCI. PATIENTS AND METHODS: A total of 404 patients who had undergone PPCI on a single culprit artery were enrolled in this study. According to thrombolysis in myocardial infarction (TIMI) flow grade in the IRA before PPCI, the study population was divided into two groups as TIMI 0 or 1 group (occluded IRA) and TIMI 2 or 3 group (patent IRA). RESULTS: The N/L ratios were found to be significantly higher in the TIMI flow 0/1 group when compared with the TIMI flow 2/3 group (6.08±3.94 vs. 4.01±2.87, P=0.001). The absence of early IRA patency was associated with higher Syntax score, mean platelet volume, creatine kinase-myocardial band, and troponin T levels (P=0.0001, P=0.03, P<0.001, and P=0.004, respectively), and lower left ventricular ejection fraction (P=0.02). Multivariate logistic regression analysis showed that the N/L ratio and Syntax score were independent predictors of IRA patency (odds ratio: 1.89, 95% confidence interval: 1.82-1.98; odds ratio=2.80, 95% confidence interval: 1.75-3.86, respectively; P=0.001). CONCLUSION: The N/L ratio has been found to be associated independently with early IRA patency before PPCI in patients who have undergone PCI for STEMI. This simple and cheap parameter can provide useful information on the related risk evaluation in these patients.

Red blood cell distribution width in saphenous vein graft disease.

BACKGROUND: Red blood cell distribution width (RDW) is related to morbidity and mortality in a wide spectrum of conditions, including atherosclerotic processes. In the present study, we aimed to investigate the significance of RDW in saphenous vein graft disease (SVGD), in which atherosclerosis plays an important pathophysiological role. METHODS: In all, 90 patients were enrolled in the study, 58 with patent SVGs and 32 with SVGD. Stable angina and/or positive stress tests were indications for coronary angiography. RDW and other laboratory parameters were measured before coronary angiography. RESULTS: Baseline characteristics of the patient groups were similar. Although triglyceride levels of the SVGD group were higher than those of the patent SVG group, the difference did not reach statistical significance (188.9 ± 99.8 mg/dL vs 151.0 ± 75.5 mg/dL, respectively; P = 0.068). Mean time interval after bypass surgery was longer in the SVGD group compared with the patent SVG group (7.8 ± 4.5 years vs 5.6 ± 3.1 years, respectively; P = 0.008). The RDW values of patients with SVGD were higher than those of patients in the patent SVG group. In logistic regression analysis, RDW and time since bypass graft were retained as independent predictors for SVGD. CONCLUSION: In the present study, we showed for the first time that RDW, which is a simple and inexpensively measured parameter used routinely in daily clinical practice, can be used as a predictor of SVGD, together with time since bypass surgery.