Prognostic value of C-reactive protein to albumin ratio for long-term outcomes of patients with peripheral arterial disease underwent endovascular treatment.

BACKGROUND: Peripheral artery disease (PAD) is part of the systemic atherosclerotic process that is highly associated with cardiovascular diseases. Despite successful endovascular treatment (EVT) strategies, mortality and morbidity rates still remain higher in PAD patients. C-reactive protein (CRP) and albumin are biomarkers of inflammation and malnutrition that play key roles in the progression of peripheral arterial disease. In this study, we aimed to investigate the relationship between CRP-to-albumin ratio (CAR) and mortality and amputation-free survival in patients with PAD after successful EVT. METHOD: Our study enrolled 149 consecutive patients who underwent EVT on atherosclerotic obstruction of iliac, femoral, popliteal and/or below-knee arteries with the clinical features of PAD and/or chronic limb-threatening ischaemia between January 2015 and January 2020. Clinical and prognostic follow-up of patients had been done at the outpatient clinic and were collected from institution's medical records. RESULTS: The mean follow-up period was 22 months (14-40). All-cause mortality and amputation rates of patients in the high CAR group were significantly higher than those in the low CAR group (21.3% vs. 6.8% and 18.7% vs. 5.4%, respectively). Kaplan-Meier survival analysis showed significantly better survival for patients in the low CAR group (log-rank p = 0.0058). In multivariate logistic regression analysis, CAR was found to be an independent predictor of amputation and all-cause mortality even after adjusting for other confounding risk factors. ROC curve analysis revealed the optimal cut-off value of CAR for predicting all-cause mortality and amputation to be >1.476 with a sensitivity of 48.5% and specificity of 94.0%. CONCLUSION: The inflammatory state reflected by CAR levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, CAR was found to be an independent predictor of these clinical outcomes after adjusting for other clinically associated parameters.

SPECT myocardial perfusion imaging identifies myocardial ischemia in patients with a history of COVID-19 without coronary artery disease.

We aimed to examine the effect of a history of COVID-19 on myocardial ischemia in single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in patients who presented with shortness of breath and/or chest pain after recovery. For this single-center retrospective study, patients who presented at cardiology outpatient clinics and had SPECT-MPI were screened. A total of 1888 patients were included in the study, 340 of whom had a history of COVID-19. 64 patients with > 50% stenosis on coronary angiography were excluded from the study. The primary outcome of the study was abnormal MPI. In the study population, the median age was 56 (49-64 IQR) years, and 1127 (65%) of the patients were female. Abnormal MPI was detected in 77 patients (23%) in the COVID-19 group and in 244 patients (16%) in the non-COVID-19 group. After adjustment was performed for clinical predictors using Bayesian logistic regression, an important association was found between the presence of a confirmed prior COVID-19 infection and abnormal MPI (posterior median odds ratio, 1.70 [95% CrI, 1.20-2.40], risk difference, 9.6% [95% CrI, 1.8%, 19.7%]). In SPECT-MPI, ischemia rates were observed to be higher in COVID-19 group and it was found that a confirmed prior COVID-19 might predict of abnormal MPI.

Reply to the letter to the editor: [Letter by Yue J, et al. regarding article 'The relationship between atherogenic index of plasma and noreflow in patients with acute ST segment elevation myocardial infarction who underwent primary percutaneous coronary intervention'].

We have read with a great pleasure the letter of Yue J, et al. to the editor about our recent study which showed an association between atherogenic index of plasma and no-reflow in patients with ST segment elevation myocardial infarction who underwent primary percutaneous coronary intervention. Yue J, et al. raises concerns about the timing of blood collection, whether if it was taken before the emergency intervention or after. In emergency department, while performing intravenous line, the blood samples for blood biochemistry and whole blood count were also taken from the patients. Another concern of the author was the timing of left ventricular ejection fraction measurement (LVEF). LVEF measurements were obtained before the emergency intervention and some were after the intervention, but before the patient discharge. In our study we included the LVEF in our model, because we could not ignore that modeling which was comprehensively used in recent studies on relation of LVEF and no-reflow. We designed this statistical model not only for the no-reflow prediction but also for the explanation of the no-reflow pathophysiology. We thank the authors' letter for pointing out these issues that we hope to have addressed.

Reply to the letter to the editor: [Comment on "The relationship between atherogenic index of plasma and no-reflow in patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention].

We have read with a great pleasure the letter of Dr. Cure et al. to the editor about our recent study which showed an association between atherogenic index of plasma (AIP) and no-reflow in patients with ST segment elevation myocardial infarction who underwent primary percutaneous coronary intervention. Dr Cure raises concerns about the miscalculation of AIP value that suggested choosing 'mmol/l' in equation instead of 'mg/dl'. As the AIP is the logarithmic transformation of triglyceride/high density lipoprotein; 'mmol/l' and an alternatively 'mg/dl' units can be used in the equation to calculate AIP values. Cure et al. also argue that our patients' lipoprotein levels were lower than expected. However, in a population based study and in several studies which were held in Turkey, the mean values of lipoprotein levels in Turkish population were nearly similar with our study population findings. We thank the authors' letter for pointing out these issues which we hope to have addressed.

Myocardial Strain Assessment by 2D Speckle-Tracking Echocardiography in Patients with Congenital Myopathy.

Background: Congenital myopathies (CMs) are a group of rare genetic muscle disorders. Cardiac involvement can be seen in these patients. We aimed to evaluate the myocardial strain parameters by 2D speckle-tracking echocardiography (STE) in patients with CM. Materials and Methods: Twenty-four patients with CM whose diagnosis was confirmed by genetic analysis or muscle biopsy were included in the study, and 48 patients were involved as a control group. Left ventricular ejection fraction (LVEF%) was calculated by biplane Simpson method, and myocardial strain analysis was performed by 2D STE. Results: The median age of the study population was 26 (19-35 interquartile range [IQR]) and 43 (60%) were women. In the analysis performed after the exclusion of two patients with multiminicore disease (MMD) who developed heart failure, although mild, LVEF% (62 [60-65 IQR] vs. 64 [63-66 IQR], P = 0.008) and right ventricular global longitudinal strain (RVGLS) were significantly lower in the CM group (-21.8 [-19.7, -24.9 IQR] vs. -23.9 [-22.4, -25.6 IQR], P = 0.0017). Left ventricular global longitudinal strain (LVGLS) was observed similarly in both groups (-19.9 [-18.7, -20.7 IQR] vs. -20.5 [-19.3, -21.9 IQR], P = 0.069). LVEF% (33 and 46), LVGLS (-7.5 and -10.7), and RVGLS (-14.9 and -16.1) values were low in two siblings with MMD. Conclusion: Although LVEF% and RVGLS were significantly lower in the CM group, LVGLS was similar. The decrease in RVGLS and LVEF% was mild, and heart failure was not observed in any patient except MMD patients who were not included in the analysis.

The effect of favipiravir on QTc interval in patients hospitalized with coronavirus disease 2019.

BACKGROUND: The effect of favipiravir on the QTc interval during the treatment of Coronavirus Disease 2019 (COVID-19) patients is unclear. Thus, the current study objective was to evaluate any change in the QTc interval in patients who were hospitalized due to COVID-19 receiving favipiravir treatment. METHOD: Patients hospitalized with COVID-19 were assessed in this single-center retrospective study. 189 patients, whose diagnosis was confirmed using real-time PCR, were included in the study. The patients were divided into three groups: those using hydroxychloroquine (Group 1, n = 66), hydroxychloroquine plus favipiravir (Group 2, n = 66), and favipiravir only (Group 3, n = 57). The QTc interval was measured before treatment (QTc-B) and 48 h after (i.e., the median) starting treatment (QTc-AT). RESULTS: The median age was 53 (39-66 IQR) and 97 (51%) of patients were female. The median QTc(Bazett)-change was 7 ms (p = 0.028) and 12 ms (p < 0.001) and in Group 1 and 2, respectively. In Group 3, the median QTc(Bazett)-change was observed as -3 ms and was not statistically significant (p = 0.247). In multivariable analysis, while there was a significant relationship between QTc-AT(Bazett) and hydroxychloroquine (ß coefficient = 2687, 95%CI 2599-16,976, p = 0,008), there was no significant relationship with favipiravir (ß coefficient = 0,180, 95% CI -6435-7724, p = 0,858). Similarly, there was a significant relationship between the QTc-AT interval calculated using the Fredericia formula and hydroxychloroquine (ß coefficient = 2120, 95% CI 0,514-14,398, p = 0,035), but not with favipiravir (ß coefficient = 0,111, 95% CI -6450- 7221, p = 0,911). CONCLUSION: In the ECG recordings received in the following days after the treatment was started in COVID-19 patients, there was a significant prolongation in the QTc interval with hydroxychloroquine, but there was no significant change with favipiravir.

The predictive value of RS time for short term mortality in patients with acute pulmonary embolism.

OBJECTIVE: Many studies have examined the capability of electrocardiography (ECG) changes to predict the severity and prognosis of patients with acute pulmonary embolism (APE). RS time in ECG is potentially valuable in evaluating the prognosis of APE. In our study, we aimed to assess the predictive value of RS time, which is a novel electrocardiographic parameter of one-month mortality of APE. METHODS: This retrospective study included 216 patients who were diagnosed with APE by pulmonary computed tomography angiography. RS time was measured from the ECG (inferolateral leads) at the time of hospital admission using a computer program (imagej.nih.gov/ij/). The patients were divided into two groups according to the median values of RS time: the group with RS time ≤ 60 msec (n:108) and the group with RS time > 60 msec (n:108). The groups were compared in terms of mortality. RESULTS: In our study, the one-month mortality was 15.3% (33) in the patients hospitalized with APE. In the multivariate analysis, RS time prolongation (HR: 1.037; 95%CI: 1.005-1.065; p = .02) was independently correlated with mortality. The ROC curve analysis revealed that RS time > 64.8 msec predicted the one-month mortality in APE with a sensitivity of 68.6% and a specificity of 73.9% (AUC: 0.708; 95% CI: 0.643-0.768; p < .001). CONCLUSION: As a novel ECG parameter, RS time could be measured for each patient with APE. Prolongation of RS time could be a useful index for predicting the one-month mortality of patients diagnosed with APE.

Assessment of the relation between C-reactive protein to albumin ratio and the severity and complexity of peripheral arterial disease.

BACKGROUND: Peripheral arterial disease is associated with increased cardiovascular mortality and morbidity. C-reactive protein and albumin are biomarkers of inflammation and malnutrition that play key roles in the pathophysiological pathways involved in the progression of atherosclerosis and peripheral arterial disease. In this study, we aimed to assess the relationship between C-reactive protein to albumin ratio and the suprapopliteal peripheral arterial disease severity and complexity as assessed by TransAtlantic Inter-Society Consensus-II (TASC-II) classification. METHOD: Our study enrolled 224 consecutive patients referred for peripheral angiography with the clinical features of possible peripheral arterial disease at a tertiary care center between January 2016 and September 2019. Level of disease and lesion characteristics were defined with reference to angiographic findings according to the TASC-II classification. RESULTS: C-reactive protein/albumin ratio levels were significantly higher in TASC-II class C and D than in TASC-II class B patients with a median level of 1.8 to 2.1 vs 1.4, respectively (p = 0.018). In multivariate regression analysis, C-reactive protein to albumin ratio remained an independent predictor of severe peripheral arterial disease. The predictive performance of C-reactive protein to albumin ratio, C-reactive protein, and albumin were compared by Receiver Operating Characteristic curve analysis. C-reactive protein to albumin ratio surpassed C-reactive protein and albumin in predicting peripheral arterial disease severity and complexity. A level of C-reactive protein to albumin ratio > 0.14 predicted a higher grade of suprapopliteal TASC-II class with sensitivity and specificity of 68.2% and 56.0%, respectively. CONCLUSION: C-reactive protein to albumin ratio was strongly associated with peripheral arterial disease severity and complexity, as assessed by TASC-II classification. Also, C-reactive protein to albumin ratio was found to be a more accurate marker than C-reactive protein and albumin alone in predicting more severe and complex lesions in patients with peripheral arterial disease.

The Association of Fractional Pulse Pressure with Acute Kidney Injury in Patients Undergoing Coronary Intervention due to ST-Segment Elevated Myocardial Infarction.

OBJECTIVE: Acute kidney injury (AKI), which is prevalent in ST-segment elevated myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. As high pulse pressure (PP) is associated with adverse cardiovascular events, the present study's aim was to evaluate the relationship between fractional PP (PPf) and AKI in patients with STEMI who underwent primary PCI. SUBJECTS AND METHODS: All laboratory findings as well as echocardiographic and angiographic data of 1,170 consecutive STEMI patients were retrospectively screened. PPf was calculated from the pressures invasively measured after sheath insertion and before performing coronary angiography. RESULTS: From 1,170 eligible STEMI patients (mean age 56 years, 18.2% female), AKI developed in 143 (12.2%) patients. The PPf and pulsatility index were significantly higher in patients with AKI than those without (0.53 ± 0.10 vs. 0.61 ± 0.10, p < 0.001, and 0.80 ± 0.03 vs. 0.82 ± 0.03, p < 0.001, respectively). PPf was also found to be associated with AKI in univariable (OR 2.183, 95% CI 1.823-2.614, p< 0.001) and multivariable (OR 1.874, 95% CI 1.513-2.322, p < 0.001) analysis. In-hospital mortality was higher in patients with AKI than those without. CONCLUSION: Invasively measured PPf, which can be easily measured and has no additional cost in STEMI patients undergoing coronary intervention, is an independent predictor of AKI. In addition, PPf is superior to other blood pressure values and derivatives in AKI prediction.

The relationship between atherogenic index of plasma and no-reflow in patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention.

Because the phenomenon of no reflow has a poor prognosis in ST-segment elevation myocardial infarction (STEMI) patients and the atherogenic index of plasma (AIP) has been shown to be a strong predictor of coronary heart disease, we aimed to investigate the relationship between AIP and no-reflow in patients with acute STEMI who underwent primary percutaneous coronary intervention (PCI). A total of 763 consecutive STEMI patients (648 men; mean age 58 ± 12 years) who underwent primary PCI were recruited for this study. The patients were classified into a reflow group (n = 537) and a no-reflow group (n = 226) according to the postprocedural angiographic features of thrombolysis in the myocardial infarction flow of the infarct-related artery. The AIP value was significantly higher in the no-reflow group than in the reflow group [0.50 (0.38-0.65) vs. 0.39 (0.25-0.49) p < .001], and AIP was found to be an independent predictor of no-reflow development. The best cut-off value of AIP for predicting no-reflow was 0.54, with sensitivity of 46.02 and specificity of 84,73. In addition, the predictive power of AIP was greater than that of triglycerides and high-density lipoprotein cholesterol based on a receiver operator curve comparison. The AIP was independently associated with no-reflow in patients with STEMI after primary PCI. This might be a superior indicator compared to traditional lipid profiles.

Association of P wave peak time with left ventricular end-diastolic pressure in patients with hypertension.

Left ventricular diastolic dysfunction (LVDD) is commonly seen in hypertensive patients, and it is associated with increased morbidity and mortality. Hence, the detection of LVDD with a simple, inexpensive, and easy-to-obtain method can contribute to improving patient prognosis. Therefore, we aimed to evaluate whether there was any association between the electrocardiographic P wave peak time (PWPT) and invasively measured left ventricular end-diastolic pressure (LVEDP) in hypertensive patients who had undergone coronary angiography following preliminary diagnosis of coronary artery disease. A total of 78 patients were included in this cross-sectional study. The PWPT was defined as the time from the beginning of the P wave to its peak, and it was calculated from the leads DII and VI . In all patients, LVEDP was measured in steady state. The PWPT in lead DII was significantly longer in patients with high LVEDP; however, there was no significant difference between groups in terms of PWPT in the lead VI . In multivariable analysis, PWPT in lead DII was found to be independent predictor of increased LVEDP (OR: 1.257, 95% CI: 1.094-1.445; P = 0.001). In receiver operating characteristic curve analysis, the optimal cut-off value of PWPT in the lead DII for prediction of elevated LVEDP was 64.8 ms, with a sensitivity of 68.7% and a specificity of 91.3% (area under curve: 0.882, 95% CI: 0.789-0.944, P < 0.001). In conclusion, this study result suggested that prolonged PWPT in the lead DII may be an independent predictor of increased LVEDP among hypertensive patients.

Evaluation of myocardial dispersion of repolarization in patients with heart transplantation

Background/aim: The number of patients with heart transplantation has dramatically increased in the last decade. Considerable studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. We analyzed the dispersion of myocardial repolarization using electrocardiographic Tp-e interval and Tp-e/QTc ratio in patients with heart transplantation. Materials and methods: This observational study included 38 patients (12 female and 26 male) with heart transplantation and 38 well-matched controls. From electrocardiograms, Tp-e interval and Tp-e/QTc ratio were calculated and compared between the 2 groups. Results: Noninvasive arrhythmia indicators including Tp-e interval (84.63 ± 14.17 ms vs 71.82 ± 7.47 ms, P < 0.001), Tp-e/QTc ratio (0.19 ± 0.04 vs 0.16 ± 0.02, P < 0.001) and QTc interval except QT interval were significantly higher in transplanted hearts compared to normal hearts. Conclusion: Patients with heart transplantation have increased myocardial dispersion of repolarization.

Relationship Between Prodromal Angina Pectoris and Neutrophil-to Lymphocyte Ratio in Patients With ST Elevation Myocardial Infarction.

BACKGROUND: The aim of this study was to investigate the relationship between prodromal angina (PA) with neutrophil-to-lymphocyte ratio (NLR) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: The study group included 145 patients with STEMI who underwent emergency coronary angiography (CA) within 24hours of symptom onset. Data were collected regarding whether patients had experienced PA before acute myocardial infarction. Seventy-three (73) patients (50.3%) had prodromal angina. Prodromal angina positive and negative groups were compared for demographic characteristics, complete blood count parameters including NLR, blood biochemistry parameters and left ventricular ejection fraction (LVEF). RESULTS: Neutrophil count, NLR, and troponin I levels were significantly higher in the PA negative group. LVEF after reperfusion and lymphocyte count were lower in the PA negative group. In multivariate regression analysis, NLR (ß=-0.419, p<0.001) and LVEF (ß=0.418, p<0.001) were found to be significantly associated with the presence of PA in STEMI patients. CONCLUSIONS: Absence of PA was significantly and independently associated with increased NLR and impaired LVEF after reperfusion, and increased NLR was found as a significant predictor for both lack of PA and impaired LVEF in STEMI patients.

Relationship Between CHA2DS2-VASc Score and Right Ventricular Dysfunction in Patients With Acute Pulmonary Thromboembolism.

In this study, the association between the right ventricular dysfunction (RVD) and CHA2DS2-VASc (C: congestive heart failure or left ventricular systolic dysfunction, H: hypertension, A: age of ≥ 75 years, D: diabetes mellitus, S: previous stroke, V: vascular disease, A: age between 65 and 74 years, Sc: female gender) scores was investigated in patients with acute pulmonary thromboembolism (PTE). The patients have been assigned to 3 subgroups as massive, submassive, and nonmassive PTE. The CHA2DS2-VASc scores were calculated for all of the patients, and the scores have been classified into 3 groups as the scores between 0 and 1, the scores of 2, and the scores of 3 and over. The independent predictors of the RVD were investigated by the univariate and multivariate regression analyses. The independent predictors of the RVD were determined to be the CHA2DS2-VASc scores (P = .034), the systolic pulmonary artery pressure (P < .001), the presence of acute deep vein thrombosis (P = .007), high simplified Pulmonary Embolism Severity Index (P < .001), D-dimer (P < .006), and the mean platelet volume (P < .001). The CHA2DS2-VASc scores predicted the RVD with 70% sensitivity and 50% specificity as determined by the receiver operating characteristic analysis. The CHA2DS2-VASc score is an independent predictor of the RVD in patients with acute PTE.

Comparison of health-related quality of life among patients using novel oral anticoagulants or warfarin for non-valvular atrial fibrillation.

OBJECTIVE: The aim of this study was to compare health-related quality of life (HRQoL) measures between novel oral anticoagulants (NOACs) and warfarin-treated Turkish patients who had been started on oral anticoagulants (OACs) due to non-valvular atrial fibrillation (AF) and to determine the effects of OACs on patient's emotional status, anxiety and depression. METHODS: A total of 182 patients older than 18 years with non-valvular AF and being treated with OACs for at least 6 months according to current AF guidelines who were admitted to outpatient clinics between July 2014 and January 2015 were included in this cross-sectional study. The exclusion criteria were receiving OACs for conditions other than non-valvular AF and being unable to answer the questionnaire. A questionnaire was administered to all participants to evaluate HRQoL, depression and anxiety. The mean differences between the groups were compared using Student's t-test; the Mann-Whitney U test was applied for comparisons of the medians. RESULTS: The annual number of hospital admissions was significantly higher in the warfarin group (p<0.001), and all HRQoL scores were significantly lower and Hospital Anxiety and Depression Scale (HADS) score was higher in the warfarin group (p<0.001). History of any type of bleeding was significantly higher in the warfarin group (p<0.001). However, none of the patients had major bleeding. Among patients who experienced bleeding, all HRQoL scores were significantly lower and HADS score was significantly higher (p<0.001 and p=0.002, respectively). CONCLUSION: Warfarin-treated patients had higher levels of self-reported symptoms of depression and anxiety and compromised HRQoL when compared with NOAC-treated patients. The results may be explained by higher rates of bleeding episodes and higher number of hospital admissions, which may cause restrictions in life while on warfarin treatment.

[The relationship between mitral annular calcification and red cell distribution width: a cross-sectional study]. / Mitral anülüs kalsifikasyonu ile kirmizi kan hücresi dagilim genisligi iliskisi: Kesitsel bir çalisma.

OBJECTIVE: Mitral annular calcification (MAC) and atherosclerosis are similar in regard to risk factors and pathogenesis. Increased red blood cell distribution width (RDW) has been shown to be associated with atherosclerotic diseases. However, no data evaluating the association of MAC with RDW has been available. The aim of this cross-sectional study was to investigate the relationship between MAC and RDW among patients with various cardiovascular risk factors. METHODS: A total of 623 patients (MAC-positive group: n=413; control group: n=210) admitted to our cardiology outpatient clinics were enrolled between March and November 2014. Demographic, clinical, and laboratory parameters of all participants were recorded. RDW was analyzed from complete blood samples of study participants. RESULTS: Patients in MAC-positive group showed older age and higher rate of hypertension. Mean RDW value was significantly higher in MAC-positive group, compared to control group (15.3±1.4% vs. 13.9±1.4%, p<0.001). In Pearson correlation analysis, statistically significant and positive correlation was determined between neutrophil-lymphocyte ratio and RDW (r=0.284, p<0.001). In multivariate logistic regression analysis, age (OR: 1.041, p<0.001), hypertension (OR: 1.540, p=0.039), and RDW (OR: 5.351, p<0.001) were determined as independent predictors of MAC. CONCLUSION: RDW levels were significantly increased in patients with MAC, and RDW was determined as an independent predictor for presence of MAC. Therefore, increased RDW can be used as a marker of continuing inflammatory process in MAC patients.

The association of the platelet-to-lymphocyte ratio with mitral annular calcification.

OBJECTIVES: Mitral annular calcification (MAC) and atherosclerosis are similar in regard to risk factors and pathogenesis. Increased platelet-to-lymphocyte ratio (PLR) has been shown to be associated with atherosclerotic diseases in previous studies. In this study, we aimed to show the association of PLR levels with the presence of MAC. DESIGN: A total of 1060 patients [n = 704 MAC (+), and n = 356 MAC (-)] who were admitted to our cardiology department were enrolled between January 2014 and December 2014. Demographic, clinical, and laboratory parameters of all participants were recorded. PLR was calculated from the complete blood count. RESULTS: The MAC (+) group comprised of those older in age and having a higher rate of hypertension. The mean PLR value was also significantly higher in the MAC (+) group, as compared to that in the MAC (-) group (129.1 ± 32.2 vs 103.5 ± 23.8, p < 0.001). There was a statistically significant and positive correlation between the neutrophil-to-lymphocyte ratio (NLR) and PLR (r = 0.644, p < 0.001). Age, hypertension, mean platelet volume, NLR, and PLR (OR: 1.109, 95% CI: 1.101-1.123, p < 0.001) were independently associated with the presence of MAC. CONCLUSIONS: Our results demonstrated that the PLR was significantly increased in patients with MAC, and that the PLR was independently associated with the presence of MAC.

Severe Tricuspid Regurgitation Diagnosed 13 Years after a Car Accident: A Case Report.

Blunt chest traumas mostly occur due to car accidents and can cause many cardiac complications such as septal rupture, free-wall rupture, coronary artery dissection or thrombosis, heart failure, arrhythmias, and chordae and papillary muscle rupture. One of the most serious complication is tricuspid regurgitation (TR), which can be simply diagnosed by physical examination and confirmed by echocardiography. We describe a 48-year-old female patient, diagnosed with severe TR 13 years after a blunt chest trauma due to a car accident. TR was diagnosed with transthoracic echocardiography and three dimensional transthoracic echocardiography had defined the exact pathology of the tricuspid valve. The patient underwent successful surgery with bioprosthetic valve implantation and was discharged at 6th postoperative day without any complication. The patient had no problem according to the follow-up one month and six months after operation.