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

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

Neutrophil Gelatinase-Associated Lipocalin Level Can Predict Early Organ Damage in Primary Hypertensive Patients: A Pilot Study.

BACKGROUND: Early detection and treatment of complicated arterial hypertension will prevent its effect on the target organs. In line with this purpose, we aimed to reveal the prediction capability of neutrophil gelatinase-associated lipocalin to complicated hypertension. METHODS: In total, 46 patients with hypertension and 21 healthy volunteers were included in the study. Left ventricle morphology and geometry, as systolic and diastolic functions, were analyzed. Global longitudinal strain was measured from recorded apical 3-chamber views. An ophthalmic examination was performed to investigate the presence of retinopathy in individuals with hypertension. In addition, plasma neutrophil gelatinase-associated lipocalin values were evaluated via the method of the enzyme-linked immunosorbent assay. RESULTS: Both neutrophil gelatinase-associated lipocalin levels and global longitudinal strain percentages were statistically significant between the groups with diastolic dysfunction and the groups without diastolic dysfunction. Complicated hypertension was detected in 42 patients. Here, it was found that the neutrophil gelatinase-associated lipocalin level of 144.3 ng/mL predicted complicated hypertension with 0.872 sensitivity and 0.65 specificity values. CONCLUSION: Analyzing neutrophil gelatinase-associated lipocalin levels in patients with hypertension in routine practice can easily and practically detect complicated hypertension patients earlier.

Systemic Immune-Inflammation Index and C-Reactive Protein/Albumin Ratio Could Predict Acute Stent Thrombosis and High SYNTAX Score in Acute Coronary Syndrome.

Acute stent thrombosis (AST) is associated with increased morbidity and mortality. The main aim of this study was to evaluate the prognostic value of the systemic immune-inflammation index (SII) and C-reactive protein (CRP) to albumin ratio (CAR) in predicting AST and high SYNTAX score in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). The criteria of the Academic Research Consortium were used to determine definite stent thrombosis. A total of 2077 consecutive patients with ACS undergoing PCI were retrospectively enrolled. Platelet, white blood cell and neutrophil counts, as well as SII, CRP, CAR, and peak cardiac troponin I (cTnI) values were significantly higher, whereas the lymphocyte count and albumin values were significantly lower in the AST (+) group compared with the AST (-) group (P < .05). SYNTAX score showed significant positive correlations with SII (r = .429, P < .001) and CRP (r = .402, P < .001). Multivariate logistic regression analysis showed that SII and CAR, as well as age, diabetes mellitus, stent length, and peak cTnI are independent predictors of AST and high SYNTAX score. In conclusion, the SII and CAR are simple, relatively cheap, and reliable inflammatory biomarkers that can predict AST and high SYNTAX scores in ACS.

Systemic immune-inflammation index (SII) may be an effective indicator in predicting the left ventricular hypertrophy for patients diagnosed with hypertension.

The development of left ventricular hypertrophy (LVH) induced by hypertension is considered a poor prognosis for patients. Similarly, high values of the systemic immune-inflammation index (SII) are correlated with high mortality and morbidity in cardiovascular events. Within this context, our study aimed to detect the association of SII with LVH caused by hypertension. The study included 150 patients diagnosed with hypertension in total and evaluated them as two separate groups with regard to left ventricular mass index (LVMI), including 56 patients (37.3%) with LVH and 94 patients (62.6%) with non-LVH. SII was calculated as platelet × neutrophil/lymphocyte counts. The SII values regarding the group with LVH were detected remarkably higher than those of the non-LVH group (p < 0.001). Additionally, the SII levels of patients with eccentric and concentric hypertrophy were detected higher than those of the normal ventricular geometry and concentric remodeling groups. About curve analysis of the receiver-operating characteristic (ROC), SII values above 869.5 predicted LVH with a sensitivity of 82.1% and specificity of 86.2% (AUC: 0.861; 95% CI: 0.792-0.930; p < 0.001). LVH can be predicted independently through the use of SII in patients diagnosed with hypertension, which may be a simple and easily calculable marker for judging LVH. Moreover, SII can serve as an accurate determinant for the prediction of LVH, in comparison to NLR and PLR.

The Role of Serum Resolvin D1 Levels in Determining the Presence and Prognosis of ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Resolvin D1 (RvD1) can play a determining role in inflammatory cell migration and reduce the expression of inflammatory cytokines to enhance cardioprotection. The aim of this study was to compare serum RvD1 levels in patients with ST-segment elevation myocardial infarction (STEMI) and individuals with normal coronary arteries (NCAs) and to evaluate the association between serum RvD1 levels and prognostic markers of STEMI. METHODS: 140 subjects (88 patients diagnosed with the indication of STEMI and 52 healthy individuals with NCA) were studied. RESULTS: Regression analysis revealed that RvD1 levels were independently associated with STEMI. While RvD1 levels were negatively correlated with high-sensitivity C-reactive protein, pro-brain natriuretic peptide, peak troponin, and Thrombolysis in Myocardial Infarction thrombus grade, they were positively correlated with left ventricular ejection fraction. An RvD1 cut-off value of 5.07 (ng/mL) was effective in predicting STEMI with a sensitivity of 79.5% and specificity of 96.2%. CONCLUSION: Serum RvD1 levels were found to be lower in the group with STEMI compared to the control group. Levels of RvD1 at admission were associated with poor prognostic markers of STEMI.

Visceral Adiposity Index Is Associated with the Increased Syntax Score in Patients with Type 2 Diabetes Mellitus.

Background: The visceral adipose tissue excess in patients with diabetes mellitus (DM) is one of the mechanisms that plays role in the development of coronary atherosclerosis. Our study aimed to investigate the relationship between visceral adiposity index (VAI), an indicator of visceral adiposity, and Syntax score (SxS), a predictor of the severity of coronary artery disease (CAD), in patients with stable angina pectoris (SAP) and type 2 DM. Methods: A total of 253 patients with SAP and type 2 DM were included in this cross-sectional study. The patients were divided into three risk groups (low risk <22, 32 ≥ intermediate risk ≥22, high risk ≥33) according to the SxS based on invasive coronary angiography. Several adiposity indexes such as body mass index, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI), and lipid accumulation product index (LAPI) were calculated using relevant formulas. In addition, VAI scores for each patient were calculated. Results: There were no statistically significant differences between the low-, intermediate-, and high-risk groups for WHtR, BAI, and LAPI. WHR was found significantly lower in the low SxS group (P = 0.0038), and VAI was found significantly higher (P = 0.021) in the high SxS group. Besides, in multivariate logistic regression analysis, the VAI (odds ratio: 2.455; 95% confidence interval: 1.244-4.845; P = 0.010) was an independent predictor of high SxS. In the receiver operating characteristic curve analysis, VAI with an optimal cutoff value of 2.048 predicted the severe coronary lesion with a sensitivity of 60.8% and a specificity of 61.5%. Conclusion: This study showed that VAI was an independent predictor in estimating CAD severity in patients with SAP and type 2 DM.

Analysis of ambulatory blood pressure monitoring data in patients with ankylosing spondylitis without clinically evident cardiovascular disease.

Ankylosing spondylitis (AS) is associated with an increased risk of cardiovascular morbidity and mortality. Parameters, such as non-dipper, average real variability (ARV), pulse pressure index (PPI), and ambulatory arterial stiffness index (AASI) obtained from ambulatory blood pressure monitoring (ABPM), provide information about adverse cardiovascular outcomes. In this study, these indexes were evaluated in patients with AS. Sixty-five patients with AS and 65 control subjects were included in this study. Non-dipper pattern, ARV, PPI, and AASI parameters were assessed using 24-h ABPM recordings. Twenty-four-hour systolic, diastolic, mean standard deviation, PPI, ARV, and AASI were higher in patients with AS (p < 0.05 all parameters). Non-dipper (43.1% vs. 21.5%, p = 0.007) and reverse dipper (10.8% vs. 0%, p = 0.013) patterns were more common in patients with AS. In addition, disease duration was moderately correlated with AASI and ARV (r = 0.36, p = 0.003; r = 0.31, p = 0.012, respectively). This study showed that PPI, AASI, ARV, and dipper pattern were impaired in patients with AS evaluated with ABPM.

Relationship Between Systemic Immune-Inflammation Index (SII) and the Severity of Stable Coronary Artery Disease.

Systemic immune-inflammation index (SII; platelet count × neutrophil-to-lymphocyte ratio), a novel marker, predicts adverse clinical outcomes in coronary artery diseases (CAD). We hypothesized that SII could provide more valuable information in assessing the severity of CAD than ratios obtained from other white blood cell subtypes. Patients (n = 669) who underwent coronary angiography were analyzed in this retrospective study. We analyzed the relation between the SII and the angiographic severity of CAD. The severity of coronary atherosclerosis was determined by the SYNTAX score (SxS). Patients with CAD were divided into 3 groups according to the SxS. Multivariate logistic analysis was used to assess risk factors of CAD. In multivariate logistic regression analysis, the SII (odds ratio: 1.004; 95% CI: 1.001-1.007; P = .015) was an independent predictor of high SxS. Additionally, there was a positive correlation between SII and SxS (Rho: 0.630, P ≤ .001). In the receiver-operating characteristic curve analysis, SII with an optimal cutoff value of 750 × 103 predicted the severe coronary lesion with a sensitivity of 86.2% and specificity of 87.3%. The SII, an inexpensive and easily measurable laboratory variable, was significantly associated with the severity of CAD and high SxS in patients with stable angina pectoris.

Impact of statin use on high sensitive troponin T levels with moderate exercise.

Background: High-sensitive cardiac troponin (hsTn) levels can be elevated due to non-pathological events such as strenuous exercise. However, the effect of statins on circulating hsTnT levels with moderate exercise is uncertain. Therefore, we evaluated the impact of statins on hsTnT level with moderate exercise. Methods: We enrolled a total of 56 patients: 26 statin users and 30 non-users. All patients were shown to have no coronary artery disease before participating in the study. Participants performed a fixed-protocol moderate level exercise. HsTnT levels were measured before and 4 h after the exercise. Participants were also grouped based on their hsTnT levels, as proposed in the recent European Society of Cardiology guideline (0-1 hour algorithm) for acute coronary syndromes without persistent ST-segment elevation. Results: Statin users showed a significant increase in serum hsTnT levels with moderate exercise (p = .004), whereas the control group showed a modest increase without statistical significance (p = .664). The percentage of patients whose hsTnT levels exceeded the rule-out limits for non-ST-segment myocardial infarction diagnosis (according to the 0-1 algorithm) after moderate exercise varied significantly between groups (p = .024). Conclusions: Statin therapy can cause a significant increase in hsTnT levels after moderate exercise. This increase can jeopardise the accuracy of clinical diagnoses based on the newly implemented algorithms. The awareness of these adverse effects of statins, mainly used by patients with high risk of coronary events, can prevent misdiagnosis or unnecessary hospitalisations.

Association of serum total bilirubin level with severity of coronary atherosclerosis is linked to systemic inflammation.

OBJECTIVE: Although cardiovascular protective action of bilirubin has been attributed to its antioxidant effect, there was scarce data regarding the anti-inflammatory properties. Herein, we aimed to assess the relationship between serum total bilirubin level and severity of coronary artery disease (CAD) in association with the direct inflammatory marker such as C-reactive protein (CRP), the other indirect markers included in inflammation process such as neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) in patients with stable CAD. METHODS: Angiographic data of 1501 patients were analyzed in this retrospective cross-sectional study. Patients were categorized according to Gensini scores as control, mild CAD and severe CAD groups. The association of clinical and laboratory parameters with the severity of CAD were determined by multivariable linear regression analysis. RESULTS: Total bilirubin level in the control group was significantly higher than those of the other groups. After multivariable linear regression analysis total bilirubin [ß=-3.131 (-4.481, -1.782), p<0.001] was significantly associated with the severity of CAD. Futhermore, there was a moderate and significant inverse correlation between serum total bilirubin level and the severity of CAD (r=-0.173, p<0.001), CRP (r=-0.112, p<0.001), NLR (r=-0.070, p=0.026) and RDW (r=-0.074, p=0.027). CONCLUSION: Serum total bilirubin level was independently and inversely associated with the severity of coronary atherosclerosis in patients with stable CAD. In addition, total bilirubin level was inversely correlated with CRP, NLR and RDW. These results suggest that besides its already known effect on the oxidative stress, higher serum total bilirubin level may exhibit an anti-inflammatory effect in the coronary atherosclerotic process.

Neutrophil-to-lymphocyte ratio is increased in patients with rheumatic mitral valve stenosis?

OBJECTIVE: The role of systemic and chronic inflammatory processes in the pathophysiology of rheumatic heart valve disease is well known. The neutrophil-to-lymphocyte ratio (NLR) was shown to be an indicator of systemic inflammation. In this study, we aimed to investigate relationship between NLR as a marker of systemic inflammation and rheumatic mitral valve stenosis (RMVS). METHODS: This is a retrospective study. Among patients who underwent transthoracic echocardiography between January 2008-March 2013, 314 patients with RMVS were included retrospectively in the study. The control group included 57 healthy persons who underwent transthoracic echocardiography during the study period. Basal characteristics and NLR were compared between the two groups. Independent predictors of RMVS were determined by logistic regression analysis. RESULTS: Basal characteristics were similar among the groups (age, 50.2 ± 14.2 vs. 49.2 ± 13.0, p=0.60). The NLR was significantly higher in patients with RMVS [2.9 (0.6-13.0) vs. 2.1 (0.7-5.8), p<0.001]. Besides, C-reactive protein (CRP) was also higher in the RMVS group [5.99 (0.3-23.7) vs. 2.98 (0.6-6.3), p=0.001]. In the regression analysis, NLR (OR: 2.24, p=0.04), CRP (OR: 1.34, p=0.03), and left atrial diameter (OR: 1.21, p=0.001) were independent predictors of RMVS. In the correlation analysis, there was a significant positive correlation between NLR and CRP (r=0.43, p<0.001). CONCLUSION: We found that NLR was significantly increased in RMVS. Furthermore, NLR was an independent predictor of the presence of RMVS in our study population. According to these findings, NLR can be used as a predictor of RMVS. Since it is an easily available and cheap method, it can easily be used in daily clinical practice. Increased NLR can also be a sign of ongoing chronic inflammation in patients with RMVS.