Impact of Preloading Strategy With Ticagrelor on Periprocedural Myocardial Injury in Patients With Non-ST Elevation Myocardial Infarction Undergoing Early Invasive Strategy.

ABSTRACT: Pretreatment with an oral P2Y12 receptor blocker (before coronary angiography) versus treatment in the catheterization laboratory has been a matter of debate in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI). The primary aim of this study was to assess the impact of an immediate preloading strategy with ticagrelor on periprocedural myocardial injury in patients with NSTEMI treated with an early invasive strategy. NSTEMI patients who underwent coronary angiography and subsequent percutaneous coronary intervention (PCI) within 24 hours after hospital admission were divided into 2 groups: the first group (pretreatment group) included patients who received ticagrelor pretreatment as soon as possible after admission and the second group (no pretreatment group) included patients who received a loading dose of ticagrelor after coronary angiography. The pretreatment group included 232 patients, and the no pretreatment group included 87 patients. Male patients represented the majority of the patients. The 2 groups were similar in baseline characteristics, except for a greater incidence of hypertension ( P = 0.014) and higher hemoglobin levels ( P = 0.01) in the pretreatment group in comparison with the no pretreatment group. Patients in the ticagrelor pretreatment group had less myocardial injury until coronary angiography based on troponin measurements collected at 12 hours after admission ( P = 0.025). Patients in the ticagrelor pretreatment group also had fewer periprocedural myocardial injuries based on troponin measurements taken between 12 and 24 hours after the PCI ( P = 0.026 and P = 0.022, respectively). Our findings suggested that ticagrelor pretreatment reduces periprocedural myocardial injury in NSTEMI patients who underwent PCI within 24 hours after admission.

Diagnostic accuracy of Apple Watch Series 6 recorded single-lead ECGs for identifying supraventricular tachyarrhythmias: a comparative analysis with invasive electrophysiological study.

BACKGROUND: The advancements in wearable technology have made the detection of arrhythmias more accessible. While smartwatches are commonly used to detect patients with atrial fibrillation, their effectiveness in the differential diagnosis of supraventricular tachycardias (SVT) lacks consensus. METHODS: A study was conducted on 47 patients with documented SVTs on a 12-lead ECG. All patients in the cohort underwent electrophysiology study with induction of SVT. A 6th generation Apple Watch was used to record ECG tracings during baseline sinus rhythm and during induced SVT. Cardiology residents and attending cardiologists evaluated these recordings to diagnose the differential diagnosis of SVT. RESULTS: The evaluation revealed 27 cases of typical atrioventricular nodal reentrant tachycardia (AVNRT), 11 cases of atrioventricular reentrant tachycardia (AVRT), and 9 cases of atrial tachycardia/atrial flutter (AT/AFL) among the induced tachycardias. Attending physicians achieved an accuracy of 66.0 to 76.6%, and residents demonstrated accuracy rates between 68.1 and 74.5%. Interrater reliability was assessed using Fleiss's Kappa method, resulting in a moderate level of agreement between residents (Kappa = 0.465, p < 0.001, 95% CI 0.30-0.63) and attendings (Kappa = 0.519, p < 0.001, 95% CI 0.35-0.68). The overall Kappa value was 0.417 (p < 0.001, 95% CI 0.34-0.49). CONCLUSIONS: Smartwatch recordings demonstrate moderate feasibility in diagnosing SVT when following a pre-specified algorithm. However, this diagnostic performance was lower than the accuracy obtained from 12-lead ECG tracings when blinded to procedure outcomes.

The validation of left atrial strain imaging for the assessment of diastolic functions in patients with ST-segment elevation myocardial infarction.

Assessment of left ventricular filling pressure (LVFP) is crucial in patients with ST-segment elevation myocardial infarction (STEMI). Since current guideline recommended echocardiographic parameters have limited value, more comprehensive assessment methods are required in this patient subset.In this study, we aimed to investigate the clinical utility of left atrial reservoir strain (LARS) imaging in patients treated with primary percutaneous coronary intervention (pPCI). Patients who underwent successful pPCI were included. Left ventricular end-diastolic pressure (LVEDP) was measured invasively following pPCI. Left atrial strain imaging was performed following pPCI within 24 h of pPCI. Normal LARS value was accepted as above 23%. We prospectively enrolled 69 patients; there were 18 patients with LARS below 23% who were included into group 1 and rest of the study population included into group 2. There was no significant difference between groups in terms of comorbidities.Troponin and pro-BNP levels were significantly higher in group 1 (p: 0.036 and 0.047 respectively). Left atrial volume and tricuspid regurgitation velocity were similar between groups (p: 0.416 and p: 0.351 respectively). Septal tissue velocity was higher (p: 0.001) and Septal E/e' ratio was lower (p: 0.004) in group 2. Left ventricular (LV) global longitudinal strain value was higher in group 1 which is consistent with observed lower ejection (LVEF) fraction in group 1 (p: 0.001 for LV strain and p: 0.001 for LVEF). Estimated mean LVFP was also higher in group 1 (p: 0.003).Correlation analyses revealed moderate correlation between LARS and LVEDP (r: - 0.300). Our results indicate that left atrial strain imaging is a promising tool for the assessment of left atrial pressure in patients with STEMI.

Echocardiographic assessment of left ventricular filling pressure in patients with acute ST elevation myocardial infarction: an invasive validation study.

Backgrounds Assessment of left ventricular filling pressure (LVFP) is of clinical importance in patients with ST elevation myocardial infarction (STEMI). Although several echocardiographic parameters are recommended for the assessment of LVFP, validation of these parameters in patients with STEMI is missing. We aimed to investigate the clinical utility of these parameters in acute settings. Methods: We prospectively included consecutive patients with STEMI. LV end-diastolic pressure (LVEDP) was measured following primary PCI and echocardiographic examination was performed within 24 hours. Mean left atrial pressure (mLAP) was calculated both invasively using Yamamoto's formula and non-invasively using Naugeh's formula. Mean LAP was considered increased when exceeded 18 mmHg. Results: Patients were grouped according to LVEDP, group 1(41 patients) and group 2(114 patients).There was no significant difference between groups in terms of comorbidities. NT pro-BNP levels (p < 0.001) and peak level of Hs-TnT (p-value: 0.002) were significantly higher in group 2. Average E/e' ratio was significantly higher in group 2 (10.19 ± 3.15 vs. 12.04 ± 4.83, p: 0.046). Isovolumetric relaxation time was longer in group 2 (p < 0.001) and left atrial volume index (LAVI) was also significantly higher in group 2 (p < 0.001). Regression analyses revealed that septal, lateral and average E/e' ratio, tricuspid regurgitation velocity, LAVI and left ventricular volume are correlated with mLAP. Among group 2 patients only 14 Patients fulfilled the increased LVFP criteria suggested by current guidelines. Conclusions Echocardiographic parameters indicating increased LVFP require validation and may need to be modified in patients with STEMI. Moreover, current algorithms underestimate the actual number of patients with increased LVFP.

Obstructive sleep apnea syndrome and autonomic dysfunction in Duchenne muscular dystrophy.

PURPOSE: Cardiac and respiratory involvement constitutes serious complications of Duchenne muscular dystrophy (DMD). We hypothesized that obstructive sleep apnea syndrome (OSAS) may play a role in cardiac autonomic dysfunction in DMD. We sought to assess the presence of cardiac autonomic function in patients with DMD by analyzing heart rate variability (HRV) during polysomnography (PSG). METHODS: In a prospective study, all participants had whole-night PSG recorded and scored according to American Academy of Sleep Medicine guidelines. HRV analysis was performed on electrocardiography recordings from PSG recordings. RESULTS: Twelve consecutive males with DMD (mean age 9.0 ± 3.1 years, mean BMI 20.6 ± 4.8 kg/m2) and eight age-matched healthy males were enrolled. On clinical evaluation, 58% of patients with DMD had at least one symptom related to OSAS, such as snoring, witnessed apnea, or restless sleep. None of the controls had OSAS-related complaints. By PSG none of the controls had OSAS, while 42% of patients with DMD had OSAS (p = 0.004). Average R-R duration and mean percentage of successive R-R intervals > 50 ms values were significantly lower in patients with DMD than those in controls (p < 0.006). In patients with DMD and OSAS, LF/HF (low/high-frequency) ratio was significantly increased in NREM sleep compared with those in controls (p = 0.005). Higher apnea-hypopnea index and lower oxygen saturation showed significant correlations with higher LF power and LF/HF ratio (p < 0.001). CONCLUSION: Cardiac autonomic dysfunction is present in DMD, being more pronounced in the presence of OSAS.

The impact of lesion complexity on no-reflow phenomenon and predictors of reversibility in patients treated with primary percutaneous intervention.

OBJECTIVES: Complex coronary lesions are more prone to complications; however, the relationship between complex coronary lesions and no-reflow phenomenon in patients undergoing primary percutaneous intervention (pPCI) is still not clarified. Previous studies reported the association of total coronary artery complexity with no-reflow; however, impact of culprit lesion complexity on no-reflow is not known. In this study, we aimed to investigate the impact of culprit lesion complexity on no-reflow phenomenon. Furthermore, we aimed to investigate the factors that are related to reversibility of no-reflow. METHODS: We prospectively included 424 patients treated with pPCI. Patients' baseline characteristics and clinical variables were recorded. Reversibility of no-reflow was decided according to final angiography or ST resolution during the first hour following pPCI. There were 90 patients with a diagnosis of no-reflow constituted group 1 and patients without no-reflow constituted group 2. Complexity of coronary artery disease was assessed with SYNTAX score and culprit lesion complexity was assessed with both American College of Cardiology/Society of Cardiovascular Angiography and Interventions lesion classification and SYNTAX score. RESULTS: Complexity of culprit lesion was significantly higher in group 1 patients (type C lesion 76.6 vs. 27.8%; P < 0.001 and SYNTAX score 8.7 ± 3.0 vs. 6.2 ± 2.6; P < 0.001, respectively, group 1 vs. 2). Multivariate analyses revealed that lesion complexity is independently associated with no-reflow. Among 90 patients of group 1, 43 patients were classified as reversible no-reflow. Logistic regression analysis revealed that only ischaemia duration is independently associated with reversibility of no-reflow. CONCLUSION: Our study demonstrated that culprit lesion complexity is independently associated with no-reflow phenomenon and short ischaemic duration is significantly associated with reversibility of no-reflow.