Effects of SGLT2 inhibitors on right ventricular function in heart failure patients: Updated meta-analysis of the current literature.

BACKGROUND: There is some discrepancy in current studies concerning the effect of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) on right ventricular (RV) functions in heart failure (HF) patients. Hence, this meta-analysis was focused on determining the impact of SGLT2i on RV functions in such individuals. MATERIAL AND METHODS: Two independent investigators searched PubMed, Google Scholar, and the Cochrane Library for articles of interest. To analyze heterogeneity, Higgins' I2 as well as prediction intervals and Egger's test were used to assess heterogeneity. The Newcastle-Ottawa standard ratings approach was used to assess the quality of observational studies. The ROBINS-I risk of bias algorithm was used to assess bias risks of randomized studies. RESULTS: This meta-analysis evaluated 8 studies in total. Over the follow-up time frame, patients who used SGLT2i had substantially lower systolic pulmonary artery pressure and higher tricuspid annular plane systolic excursion values (mean difference [MD] = -5.23 [-7.81; -2.66] and, MD = 1.47 [1.01; 1.93]; P <0.01, respectively). There was no significant difference in RVS' values between follow-up and baseline (MD = 1.54 [-0.19; 3.26]; P = 0.08). However, as compared to the baseline period, fractional area contraction values were substantially larger at the end of the follow-up (MD = 5.52 [4.23; 6.82]; P <0.01). CONCLUSION: To the best of our knowledge, this is the first meta-analysis assessing the impact of SGLT2i on RV function in HF patients. Our findings suggest that SGLT2i may improve RV performance in HF patients.

Evaluation of pan-Immuno-Inflammation value for In-hospital mortality in acute pulmonary embolism patients.

Background: Pan-immuno-inflammation value (PIV) is a new and comprehensive index that reflects both the immune response and systemic inflammation in the body. Objective: The aim of this study was to investigate the prognostic relevance of PIV in predicting in-hospital mortality in acute pulmonary embolism (PE) patients and to compare it with the well-known risk scoring system, PE severity index (PESI), which is commonly used for a short-term mortality prediction in such patients. Methods: In total, 373 acute PE patients diagnosed with contrast-enhanced computed tomography were included in the study. Detailed cardiac evaluation of each patient was performed and PESI and PIV were calculated. Results: In total, 60 patients died during their hospital stay. The multivariable logistic regression analysis revealed that baseline heart rate, N-terminal pro-B-type natriuretic peptide, lactate dehydrogenase, PIV, and PESI were independent risk factors for in-hospital mortality in acute PE patients. When comparing with PESI, PIV was non-inferior in terms of predicting the survival status in patients with acute PE. Conclusion: In our study, we found that the PIV was statistically significant in predicting in-hospital mortality in acute PE patients and was non-inferior to the PESI.

Selecting the best optimizers for deep learning-based medical image segmentation.

Purpose: The goal of this work is to explore the best optimizers for deep learning in the context of medical image segmentation and to provide guidance on how to design segmentation networks with effective optimization strategies. Approach: Most successful deep learning networks are trained using two types of stochastic gradient descent (SGD) algorithms: adaptive learning and accelerated schemes. Adaptive learning helps with fast convergence by starting with a larger learning rate (LR) and gradually decreasing it. Momentum optimizers are particularly effective at quickly optimizing neural networks within the accelerated schemes category. By revealing the potential interplay between these two types of algorithms [LR and momentum optimizers or momentum rate (MR) in short], in this article, we explore the two variants of SGD algorithms in a single setting. We suggest using cyclic learning as the base optimizer and integrating optimal values of learning rate and momentum rate. The new optimization function proposed in this work is based on the Nesterov accelerated gradient optimizer, which is more efficient computationally and has better generalization capabilities compared to other adaptive optimizers. Results: We investigated the relationship of LR and MR under an important problem of medical image segmentation of cardiac structures from MRI and CT scans. We conducted experiments using the cardiac imaging dataset from the ACDC challenge of MICCAI 2017, and four different architectures were shown to be successful for cardiac image segmentation problems. Our comprehensive evaluations demonstrated that the proposed optimizer achieved better results (over a 2% improvement in the dice metric) than other optimizers in the deep learning literature with similar or lower computational cost in both single and multi-object segmentation settings. Conclusions: We hypothesized that the combination of accelerated and adaptive optimization methods can have a drastic effect in medical image segmentation performances. To this end, we proposed a new cyclic optimization method (Cyclic Learning/Momentum Rate) to address the efficiency and accuracy problems in deep learning-based medical image segmentation. The proposed strategy yielded better generalization in comparison to adaptive optimizers.

Left Ventricular Mass Index Predicts Pacemaker-Induced Cardiomyopathy in Patients with Dual Chamber Permanent Pacemakers Implanted Due to Complete Atrioventricular Block.

Background: Pacing-induced cardiomyopathy (PICM) occurs as a result of high-burden right ventricular (RV) pacing, which usually develops in patients with complete atrioventricular (AV) block. There is a paucity of data on the association between PICM and pre-implantation left ventricular mass index (LVMI). Thus, the purpose of this study was to analyze the influence of LVMI on PICM in patients who had dual chamber permanent pacemakers (PPMs) implanted secondary to complete AV block. Methods: Overall, 577 patients with dual chamber permanent pacemakers (PPMs) were classified into three tertiles according to their pre- implantation LVMI. The average follow-up period was 57 ± 38 months. The baseline characteristics, laboratory and echocardiographic variables were compared between the tertiles. PICM was defined as a ≥ 10% drop in left ventricular ejection fraction (LVEF) from pre-implantation with a resultant LVEF < 50%. PICM occurred in 42 (7.2%) patients. The independent predictors of PICM development, as well as the impact of LVMI on PICM, were investigated. Results: After controlling for confounding baseline variables, the tertile with the greatest LVMI had a 1.8 times higher risk for the development of long-term PICM compared with the tertile with the lowest LVMI, which was accepted as the reference group. A receiver operating characteristic curve analysis revealed that the best LVMI cut- off value for predicting long-term PICM was 109.8 g/m2 with 71% sensitivity and 62% specificity (area under curve: 0.68; 95% confidence interval: 0.60-0.76; p < 0.001). Conclusions: This investigation revealed that pre-implantation LVMI had a prognostic role in predicting PICM in patients with an implanted dual chamber PPM due to complete AV block.

Comparison of outcomes between single long stent and overlapping stents: a meta-analysis of the literature.

OBJECTIVES: There is no consensus on whether to treat diffuse coronary artery lesions with a single long stent (SLS) or by overlapping two or more stents (OLS). The goal of this review was to compare the outcomes of these two approaches through a meta-analysis of the literature. METHODS: We searched for relevant studies in MEDLINE, Scopus, EMBASE, Google Scholar, and the Cochrane Library. Our meta-analysis included 12 studies (n = 6414) that reported outcomes during the follow-up period. RESULTS: Individuals who received OLS had a greater risk of cardiac mortality and target lesion revascularization (TLR) than those who received SLS (RR: 1.51, CI: 1.03-2.21, p = 0.03, I2 = 0% and RR: 1.64, CI: 1.02-2.65, p = 0.04, I2 = 38%, respectively). The fluoroscopy period in the OLS group was longer than in the SLS group (SMD: 0.35, CI: 0.25-0.46, p < 0.01, I2 = 0%). more contrast volume was sued for the OLS group; however, there was substantial variability in the pooled analysis (I2 = 95%). In terms of all outcomes, there were no differences between stent generation types. CONCLUSION: In the first meta-analysis of mainly observational data comparing OLS vs. SLS for long coronary lesions, OLS had higher rates of cardiac mortality and TLR as well as longer fluoroscopy times compared to SLS.

Evaluation of Intermountain Risk Score for Short- and Long-Term Mortality in ST Elevation Myocardial Infarction Patients.

The aim of this study was to examine the Intermountain Risk Score (IMRS) for short- and long-term mortality in ST elevation myocardial infarction (STEMI) patients and compare it with the well-known risk scores, such as the Thrombolysis in Myocardial Infarction (TIMI) and the Global Registry of Acute Coronary Events (GRACE). In this retrospective and cross-sectional study, 1057 consecutive patients with STEMI were evaluated. The end-points of the study were short- and long-term mortality. The overall mortality rate was 16% (n = 170 patients). The IMRS was significantly higher in STEMI patients who did not survive compared with those who survived. According to multivariable COX proportional regression analysis, the IMRS was independently related to both short- (HR: 1.482, 95% CI: 1.325-1.675, p < .001) and long-term mortality (HR: 1.915, 95% CI: 1.711-2.180, p < .001). The comparison of receiver operating characteristic curves revealed that the IMRS had non-inferior predictive capability for short- and long-term mortality than the TIMI and GRACE risk scores. To the best of our knowledge, this is the first study to show that the IMRS can predict short- and long-term prognosis of patients with STEMI. Further, the IMRS' predictive value for overall mortality was non-inferior compared with TIMI and GRACE scores.

The Association of Serum Uric Acid/Albumin Ratio with No-Reflow in Patients with ST Elevation Myocardial Infarction.

The goal of this investigation was to explore the relationship between serum uric acid/albumin ratio (UAR) and no-reflow (NR) in ST elevation myocardial infarction (STEMI) patients (n = 838) who underwent primary percutaneous coronary intervention (pPCI). Angiographic NR was defined as thrombolysis in myocardial infarction (TIMI) flows 0, 1, and 2 in the absence of coronary spasm or dissection. NR developed in 91 (10.9%) STEMI patients. Patients with NR had higher UAR and according to multivariable logistic regression models, a high UAR was an independent risk factor for NR. The area under the curve (AUC) value of the UAR was .760 (95%CI: .720-.801) in a receiver-operating characteristics curve (ROC) assessment. Notably, the UAR AUC value was greater than that of its components: albumin (AUC: .642) and serum uric acid (AUC: .637) (P < .05 for both comparisons). The optimum UAR value in detecting NR in STEMI patients was >1.21 with a sensitivity of 82% and a specificity of 67%. This was the first study to report that the UAR was independently associated with NR in STEMI patients who underwent pPCI.

Evaluation of electrocardiographic P wave parameters in predicting long-term atrial fibrillation in patients with acute ischemic stroke.

BACKGROUND: Electrocardiographic parameters, such as P wave peak time (PWPT), P wave duration (PWD), and P wave amplitude in lead DI, have been utilized to assess left atrial anomalies linked to the development of atrial fibrillation (AF) in different cohort settings. OBJECTIVE: To compare electrocardiographic parameters, such as P waves, in predicting long-term AF risk in acute ischemic stroke cases. METHODS: The data of 231 consecutive acute ischemic stroke cases were retrospectively collected. Two independent cardiologists interpreted the electrocardiography recordings for PWPT, PWD, and P wave amplitude in lead DI. The median follow-up study period was 16 (interquartile range [IQR]: 11-24) months. RESULTS: In total, AF was detected in 43 (18.6%) cases. All studied P wave parameters were found to be statistically significant in cases with AF. Based on multivariable logistic regression analysis, dementia, left atrium volume index, PWD (razão de chances [RC]: 1.11; 95% confidence interval [CI]: 1.058-1.184; p = 0.003), PWPT in lead DII (RC: 1.030; 95%CI: 1.010-1.050; p = 0.003), and advanced interatrial block morphology were independent predictors of long-term AF. P wave duration had the highest area under the curve value, sensitivity, and specificity for long-term AF in such cases compared with the other P wave parameters. CONCLUSIONS: Our head-to-head comparison of well-known P wave parameters demonstrated that PWD might be the most useful P wave parameter for long-term AF in acute ischemic stroke cases.

ANTECEDENTES: Parâmetros eletrocardiográficos, como tempo de pico da onda P (PWPT, na sigla em inglês), duração da onda P (PWD, na sigla em inglês) e amplitude da onda P na derivação DI, têm sido utilizados para avaliar anomalias atriais esquerdas ligadas ao desenvolvimento de fibrilação atrial (FA) em diferentes cenários de coortes. OBJETIVO: Comparar os parâmetros eletrocardiográficos destas ondas P na predição do risco de FA de longo prazo em casos de acidente vascular cerebral (AVC) isquêmico agudo. MéTODOS: Os dados de 231 casos consecutivos de AVC isquêmico agudo foram coletados retrospectivamente. Dois cardiologistas independentes interpretaram os registros eletrocardiográficos para PWPT, PWD e amplitude da onda P na derivação DI. O período médio do estudo de acompanhamento foi de 16 (intervalo interquartil [IQR, na sigla em inglês]: 11­24) meses. RESULTADOS: No total, FA foi detectada em 43 (18,6%) casos. Todos os parâmetros da onda P estudados foram considerados estatisticamente significativos nos casos com FA. Com base na análise de regressão logística multivariável, demência, índice de volume do átrio esquerdo, PWD (razão de chances [RC]: 1,112; intervalo de confiança [IC] 95%: 1,058­1,184; p = 0,003), PWPT na derivação DII (RC: 1,030; IC95%: 1,010­1,050; p = 0,003) e avançada morfologia do bloqueio interatrial foram preditores independentes de FA de longo prazo. A PWD teve a maior área sob o valor da curva, sensibilidade e especificidade para FA de longo prazo em tais casos em comparação com os outros parâmetros da onda P. CONCLUSõES: Nossa comparação direta de parâmetros da onda P bem conhecidos demonstrou que a PWD pode ser o parâmetro da onda P mais útil para FA de longa duração em casos de AVC isquêmico agudo.

Evaluation of cardiac-electrophysiological balance according to National Institutes of Health Stroke Scale score at admission and discharge in acute ischemic stroke patients: A pilot study.

OBJECTIVE: The main objectives of this investigation were to determine whether there were any relationships between corrected cardiac-electrophysiological balance value and National Institutes of Health Stroke Scale scores at admission and discharge in patients with acute ischemic stroke and to assess whether cardiac-electrophysiological balance value was an independent predictor of high National Institutes of Health Stroke Scale scores (National Institutes of Health Stroke Scale score ≥5). METHODS: In this retrospective and observational study, 231 consecutive adult patients with acute ischemic stroke were evaluated. The cardiac-electrophysiological balance value was obtained by dividing the corrected QT interval by the QRS duration measured from surface electrocardiography. An experienced neurologist used the National Institutes of Health Stroke Scale score to determine the severity of the stroke at the time of admission and before discharge from the neurology care unit. The participants in the study were categorized into two groups: those with minor acute ischemic stroke (National Institutes of Health Stroke Scale score=1-4) and those with moderate-to-severe acute ischemic stroke (National Institutes of Health Stroke Scale scores ≥5). RESULTS: Acute ischemic stroke patients with National Institutes of Health Stroke Scale score ≥5 had higher heart rate, QT, corrected QT interval, T-peak to T-end corrected QT interval, cardiac-electrophysiological balance, and cardiac-electrophysiological balance values compared with those with an National Institutes of Health Stroke Scale score of 1-4. The cardiac-electrophysiological balance value was shown to be independently related to National Institutes of Health Stroke Scale scores ≥5 (OR 1.102, 95%CI 1.036-1.172, p<0.001). There was a moderate correlation between cardiac-electrophysiological balance and National Institutes of Health Stroke Scale scores at admission (r=0.333, p<0.001) and discharge (r=0.329, p<0.001). CONCLUSIONS: The findings of this study demonstrated that the cardiac-electrophysiological balance value was related to National Institutes of Health Stroke Scale scores at admission and discharge. Furthermore, an elevated cardiac-electrophysiological balance value was found to be an independent predictor of National Institutes of Health Stroke Scale score ≥5.

The Triglyceride-Glucose Index Can Predict Long-Term Major Adverse Cardiovascular Events in Turkish Patients With High Cardiovascular Risk.

Objective: There is an evidence gap regarding the predictive accuracy of the triglyceride-glucose (TyG) index for long-term major adverse cardiovascular events (MACEs) in individuals with high cardiovascular risk. The aim of this investigation was to evaluate the predictive value of the TyG index for long-term MACEs in patients at high cardiovascular risk. Methods: In total, 483 patients with high cardiovascular risk were included in this analysis. The study population was separated into 2 groups depending on the occurrence of long-term MACEs. The independent predictors of long-term MACEs in patients with high cardiovascular risk were investigated. The long-term prognostic value of the TyG index in these patients was evaluated in terms of MACEs. Results: Age, male sex, diabetes mellitus, and the TyG index were demonstrated to be independent predictors of long-term MACE occurrence in patients with high cardiovascular risk. The TyG index was independently related to long-term MACEs in patients with high cardiovascular risk (hazard ratio, 1.003; 95% confidence interval [CI], 1.001-1.006; p=0.011). The receiver operating characteristic curve revealed that the optimum value of the TyG index to predict long-term MACEs in the overall study cohort was >9.68, with 65% sensitivity and 63% specificity (area under the curve, 0.71; 95% CI, 0.65-0.77; p<0.001). Conclusion: The TyG index was demonstrated to be an independent predictor of long-term MACE occurrence in patients with high cardiovascular risk who had not been previously diagnosed with cardiovascular disease.

Evaluation of cardiac-electrophysiological balance according to National Institutes of Health Stroke Scale score at admission and discharge in acute ischemic stroke patients: A pilot study

SUMMARY OBJECTIVE: The main objectives of this investigation were to determine whether there were any relationships between corrected cardiac-electrophysiological balance value and National Institutes of Health Stroke Scale scores at admission and discharge in patients with acute ischemic stroke and to assess whether cardiac-electrophysiological balance value was an independent predictor of high National Institutes of Health Stroke Scale scores (National Institutes of Health Stroke Scale score ≥5). METHODS: In this retrospective and observational study, 231 consecutive adult patients with acute ischemic stroke were evaluated. The cardiac-electrophysiological balance value was obtained by dividing the corrected QT interval by the QRS duration measured from surface electrocardiography. An experienced neurologist used the National Institutes of Health Stroke Scale score to determine the severity of the stroke at the time of admission and before discharge from the neurology care unit. The participants in the study were categorized into two groups: those with minor acute ischemic stroke (National Institutes of Health Stroke Scale score=1-4) and those with moderate-to-severe acute ischemic stroke (National Institutes of Health Stroke Scale scores ≥5). RESULTS: Acute ischemic stroke patients with National Institutes of Health Stroke Scale score ≥5 had higher heart rate, QT, corrected QT interval, T-peak to T-end corrected QT interval, cardiac-electrophysiological balance, and cardiac-electrophysiological balance values compared with those with an National Institutes of Health Stroke Scale score of 1-4. The cardiac-electrophysiological balance value was shown to be independently related to National Institutes of Health Stroke Scale scores ≥5 (OR 1.102, 95%CI 1.036-1.172, p<0.001). There was a moderate correlation between cardiac-electrophysiological balance and National Institutes of Health Stroke Scale scores at admission (r=0.333, p<0.001) and discharge (r=0.329, p<0.001). CONCLUSIONS: The findings of this study demonstrated that the cardiac-electrophysiological balance value was related to National Institutes of Health Stroke Scale scores at admission and discharge. Furthermore, an elevated cardiac-electrophysiological balance value was found to be an independent predictor of National Institutes of Health Stroke Scale score ≥5.

Evaluation of electrocardiographic P wave parameters in predicting long-term atrial fibrillation in patients with acute ischemic stroke / Avaliação dos parâmetros eletrocardiográficos da onda P na predição de fibrilação atrial de longa duração em pacientes com acidente vascular cerebral isquêmico agudo

Abstract Background Electrocardiographic parameters, such as P wave peak time (PWPT), P wave duration (PWD), and P wave amplitude in lead DI, have been utilized to assess left atrial anomalies linked to the development of atrial fibrillation (AF) in different cohort settings. Objective To compare electrocardiographic parameters, such as P waves, in predicting long-term AF risk in acute ischemic stroke cases. Methods The data of 231 consecutive acute ischemic stroke cases were retrospectively collected. Two independent cardiologists interpreted the electrocardiography recordings for PWPT, PWD, and P wave amplitude in lead DI. The median follow-up study period was 16 (interquartile range [IQR]: 11-24) months. Results In total, AF was detected in 43 (18.6%) cases. All studied P wave parameters were found to be statistically significant in cases with AF. Based on multivariable logistic regression analysis, dementia, left atrium volume index, PWD (razão de chances [RC]: 1.11; 95% confidence interval [CI]: 1.058-1.184; p = 0.003), PWPT in lead DII (RC: 1.030; 95%CI: 1.010-1.050; p = 0.003), and advanced interatrial block morphology were independent predictors of long-term AF. P wave duration had the highest area under the curve value, sensitivity, and specificity for long-term AF in such cases compared with the other P wave parameters. Conclusions Our head-to-head comparison of well-known P wave parameters demonstrated that PWD might be the most useful P wave parameter for long-term AF in acute ischemic stroke cases.

Resumo Antecedentes Parâmetros eletrocardiográficos, como tempo de pico da onda P (PWPT, na sigla em inglês), duração da onda P (PWD, na sigla em inglês) e amplitude da onda P na derivação DI, têm sido utilizados para avaliar anomalias atriais esquerdas ligadas ao desenvolvimento de fibrilação atrial (FA) em diferentes cenários de coortes. Objetivo Comparar os parâmetros eletrocardiográficos destas ondas P na predição do risco de FA de longo prazo em casos de acidente vascular cerebral (AVC) isquêmico agudo. Métodos Os dados de 231 casos consecutivos de AVC isquêmico agudo foram coletados retrospectivamente. Dois cardiologistas independentes interpretaram os registros eletrocardiográficos para PWPT, PWD e amplitude da onda P na derivação DI. O período médio do estudo de acompanhamento foi de 16 (intervalo interquartil [IQR, na sigla em inglês]: 11-24) meses. Resultados No total, FA foi detectada em 43 (18,6%) casos. Todos os parâmetros da onda P estudados foram considerados estatisticamente significativos nos casos com FA. Com base na análise de regressão logística multivariável, demência, índice de volume do átrio esquerdo, PWD (razão de chances [RC]: 1,112; intervalo de confiança [IC] 95%: 1,058-1,184; p = 0,003), PWPT na derivação DII (RC: 1,030; IC95%: 1,010-1,050; p = 0,003) e avançada morfologia do bloqueio interatrial foram preditores independentes de FA de longo prazo. A PWD teve a maior área sob o valor da curva, sensibilidade e especificidade para FA de longo prazo em tais casos em comparação com os outros parâmetros da onda P. Conclusões Nossa comparação direta de parâmetros da onda P bem conhecidos demonstrou que a PWD pode ser o parâmetro da onda P mais útil para FA de longa duração em casos de AVC isquêmico agudo.

Predictive value of uric acid/albumin ratio for the prediction of new-onset atrial fibrillation in patients with ST-Elevation myocardial infarction.

Background: There is a lack of studies supporting the association between the uric acid/albumin ratio (UAR) and the development of new-onset atrial fibrillation (NOAF) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). Objective: The objective of the study was to assess the efficacy of the UAR for predicting the occurrence of NOAF in STEMI patients undergoing pPCI. Methods: We recruited 1484 consecutive STEMI patients in this retrospective and cross-sectional investigation. The population sample was classified based on the development of NOAF during hospitalization. NOAF was defined as an atrial fibrillation (AF) observed during hospitalization in patients without a history of AF or atrial flutter. The UAR was computed by dividing the serum uric acid (UA) level by serum albumin level. Results: After pPCI, 119 STEMI patients (8%) were diagnosed with NOAF. NOAF patients had higher serum UAR levels than individuals who did not have NOAF. According to the multivariable logistic regression model, the UAR was an independent predictor for NOAF in STEMI patients (OR: 6.951, 95% CI: 2.978-16.28, p < 0.001). The area under curve (AUC) value of the UAR in a receiver operating characteristics (ROC) evaluation was 0.758, which was greater than those of its components (albumin [AUC: 0.633] and UA [AUC: 0.647]) and C-reactive protein (AUC: 0.714). The optimal UAR value in predicting NOAF in STEMI patients was greater than 1.39, with a sensitivity of 69% and a specificity of 74.5%. Conclusion: To the best of our knowledge, this is the first study indicating that the UAR was an independent predictor of NOAF development in STEMI patients.

Cardiac variables associated with atrial fibrillation occurrence and mortality in octogenarians implanted with dual chamber permanent pacemakers.

BACKGROUND: There is a dearth of data on the predictors of atrial fibrillation (AF) and the association between AF and long-term mortality in octogenarians with dual-chamber permanent pacemakers (PPM). We investigate the occurrence of AF and whether it is associated with overall mortality among octogenarians with dual-chamber PPM implants. METHODS: Three hundred and fifty-four patients with PPM implants were divided into two groups based on their long-term survival status. Baseline characteristics, laboratory variables, and echocardiographic variables were then compared between the groups, and independent predictors of the long-term incidence of AF and mortality were determined. RESULTS: Multivariable Cox regression analysis performed after adjusting for the parameters in univariable analysis revealed that diabetes, urea levels, albumin levels, paced QRS duration, and the frequency of atrial high-rate episodes (AHREs) were independently associated with a long-term risk of AF in octogenarians after having dual chamber PPMs implanted. The left ventricular (LV) ejection fraction, left atrial (LA) anteroposterior diameter, and AHRE + AF (HR 1.498, 95%CI 1.003-2.237, p = 0.048) were independent risk factors for the long-term mortality in octogenarians receiving dual-chamber PPMs implants. CONCLUSION: The occurrence of AF following dual-chamber PPM implantation is a significant prognostic factor in octogenarian patients.

Predictive Value of Uric Acid/Albumin Ratio for the Prediction of New-Onset Atrial Fibrillation in Patients with ST-Elevation Myocardial Infarction

ABSTRACT Background: There is a lack of studies supporting the association between the uric acid/albumin ratio (UAR) and the development of new-onset atrial fibrillation (NOAF) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). Objective: The objective of the study was to assess the efficacy of the UAR for predicting the occurrence of NOAF in STEMI patients undergoing pPCI. Methods: We recruited 1484 consecutive STEMI patients in this retrospective and cross-sectional investigation. The population sample was classified based on the development of NOAF during hospitalization. NOAF was defined as an atrial fibrillation (AF) observed during hospitalization in patients without a history of AF or atrial flutter. The UAR was computed by dividing the serum uric acid (UA) level by serum albumin level. Results: After pPCI, 119 STEMI patients (8%) were diagnosed with NOAF. NOAF patients had higher serum UAR levels than individuals who did not have NOAF. According to the multivariable logistic regression model, the UAR was an independent predictor for NOAF in STEMI patients (OR: 6.951, 95% CI: 2.978-16.28, p < 0.001). The area under curve (AUC) value of the UAR in a receiver operating characteristics (ROC) evaluation was 0.758, which was greater than those of its components (albumin [AUC: 0.633] and UA [AUC: 0.647]) and C-reactive protein (AUC: 0.714). The optimal UAR value in predicting NOAF in STEMI patients was greater than 1.39, with a sensitivity of 69% and a specificity of 74.5%. Conclusion: To the best of our knowledge, this is the first study indicating that the UAR was an independent predictor of NOAF development in STEMI patients.

Evaluating the systemic immune-inflammation index for in-hospital and long-term mortality in elderly non-ST-elevation myocardial infarction patients.

INTRODUCTION: This investigation aimed to evaluate the predictive value of the systemic immune-inflammation index (SII) for in-hospital and long-term mortality in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). METHODS: This retrospective investigation included 314 consecutive elderly NSTEMI patients in a tertiary center. SII is computed as (neutrophils × platelets)/lymphocytes. Based on the increased SII values, we classified the research sample into three tertile groups as T1, T2, and T3. The in-hospital and long-term mortality were defined as the primary outcomes. RESULTS: Patients in the T3 group had lower chances of survival in the in-hospital and long-term periods compared with those in the T2 and T1 groups. According to the multivariable Cox regression models, SII independently related with in-hospital (hazard ratio (HR): 1.001, 95% CI: 1.000-1.1003, p = 0.038) and long-term mortality (HR: 1.004, 95% CI: 1.002-1.006, p < 0.001). To predict long-term mortality, the optimal SII value was > 2174 with 80% sensitivity and 85.4% specificity. SII had a slightly lower but statistically non-inferior discriminative ability for long-term mortality compared with the Charlson comorbidity index (CCI) in the receiver operating characteristic curve comparison (AUC: 86.2 vs. AUC: 890, p > 0.05). Additionally, combining SII with traditional risk factors and the CCI revealed a significant improvement in C-statistics. CONCLUSION: This investigation may be the first to demonstrate that SII is independently linked with in-hospital and long-term mortality in elderly NSTEMI patients.

Prognostic value of serum albumin for long-term mortality in patients with dual-chamber permanent pacemakers.

Background: This investigation aims to examine the prognostic utility of albumin concentrations for long-term all-cause mortality in patients undergoing permanent pacemaker implantation. Methods: A total of 1798 patients who received permanent pacemaker implantation were divided into quartiles according to serum albumin concentrations. The significance of albumin in predicting long-term mortality was compared in these quartiles. Results: There was a higher rate of long-term mortality in the Q4 group compared with the Q1-3 groups (49.9 vs 15.8%). The risk of long-term mortality in the Q4 group was 3.6-times higher compared with the Q1-3 groups after adjustment for confounders. Conclusion: Serum albumin level at the time of device implantation has great value when assessing long-term mortality in patients with permanent pacemakers.