The Relationship between Coronary Artery Calcium Score and Monocyte to High-Density Lipoprotein Cholesterol Ratio in Patients with Stable Angina Pectoris.

OBJECTIVE: Coronary artery calcification is a cornerstone marker for coronary atherosclerosis. Therefore, the calculation of the coronary artery calcium score has become a routine method in diagnosing coronary artery disease in recent years. Monocyte to high-density lipoprotein cholesterol ratio reflects proatherogenic and antiatherogenic balance, and this ratio is associated with coronary atherosclerosis and cardiovascular events. This study aimed to investigate the value of monocyte to high-densitylipoprotein cholesterol ratio in predicting coronary atherosclerosis, which coronary artery calcium score determines. METHODS: A total of 276 patients with chest pain who underwent coronary computed tomography angiography were enrolled in the study. The patients were divided into 3 groups according to coronary artery calcium score [coronary artery calcium score=0 for very low risk (n=121), coronary artery calcium score=1-99 for low risk (n=100), coronary artery calcium score ≥ 100 for moderate-high risk (n=55)]. The monocyte to high-density lipoprotein cholesterol ratio, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and plateletto-lymphocyte ratio were calculated from venous blood samples. RESULTS: Monocyte to high-density lipoprotein cholesterol ratio values were significantly higher in patients with moderate-high coronary artery calcium score (1.29 ± 0.59 vs 1.41 ± 0.56 vs 1.56 ± 0.58, P =.009). However, there were no differences between the groups in terms of other inflammatory markers (neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and platelet-to-lymphocyte ratio). Age (odds ratio: 1.178; 95% CI: 1.107-1.253; P < .001), dyslipidemia (odds ratio: 14.252; 95% CI: 5.459-37.211; P <.001), smoking (odds ratio: 2.893; 95% CI: 1.317-6.358; P=.008), and monocyte to high-density lipoprotein cholesterol ratio (odds ratio: 2.082 per 1-point increase; 95% CI: 1.016-4.268; P=.045) were independent predictors of coronary artery calcium score in multivariate analysis. CONCLUSION: Our data showed that high monocyte to high-density lipoprotein cholesterol ratio is significantly associated with increased coronary artery calcium score. Monocyte to highdensity lipoprotein cholesterol ratio indicates that it can be applied easily and swiftly in clinics to help predicting the coronary artery disease.

Role of the coronary and non-coronary cardiovascular findings on non-cardiac gated thoracic CT in predicting mortality in SARS-CoV-2 infection.

BACKGROUND: The potential effects of cardiovascular comorbidities on the clinical outcomes in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection remain unclear. Identification of the coronary and non-coronary cardiovascular findings may help to stratify the patients' prognosis. Therefore, we aimed to evaluate the prognostic impact of the coronary and the non-coronary cardiovascular findings in SARS-CoV-2 patients. METHODS: We studied a total of 594 SARS-CoV-2 patients who were hospitalized and performed a non-cardiac gated thoracic computed tomography. Two blinded radiologists assessed the coronary artery calcification segment involvement score (CACSIS) and non-coronary atherosclerosis cardiovascular findings (NCACVF). The baseline characteristics of the patients and CT findings were evaluated according to survival status. Logistic regression analyses were performed to identify the independent predictors of mortality. RESULTS: At a mean follow-up of 8 (4-12.5) days, 44 deaths occurred (7.4%). Compared to survivors, non-survivors had increased CACSIS [27.3% (CACSIS = 0) vs 25% (CACSIS 1-5) vs 47.7% (CACSIS >5), p < 0.001]. Similarly, on NCACVF, non-survivors had much more major findings compared to survivors (29.5% vs. 2.7%, respectively, p < 0.001). At multivariable analysis, age (p = 0.009), creatinine (p < 0.001), hs-cTnI (p = 0.004) and NCACVF (HR 1.789; 95% CI 1.053-3.037; p = 0.031) maintained a significant independent association with in-hospital mortality. CONCLUSION: Our study shows that coronary and non-coronary cardiovascular findings on non-cardiac gated thoracic CT may help to predict mortality in patients with SARS-CoV-2 infection.

Increased Circulating Copeptin Levels Are Associated with Vaso-Occlusive Crisis and Right Ventricular Dysfunction in Sickle Cell Anemia.

OBJECTIVE: Vaso-occlusive crisis (VOC) is a common clinical manifestation of sickle cell anemia (SCA) and is associated with increased proinflammatory mediators. Copeptin is the C-terminal part of the prohormone for provasopressin and seems clinically relevant in various clinical conditions. Right ventricular (RV) dysfunction significantly appears in SCA patients due to pulmonary hypertension. This study aimed to investigate the association of copeptin levels in VOC patients and evaluate RV dysfunction. MATERIALS AND METHODS: A total of 108 patients were enrolled in the study. Twenty-eight SCA patients in steady state (30.2 ± 0.9 years), 25 SCA patients in VOC (36.8 ± 11.8 years), and 55 healthy individuals (31.9 ± 9.4 years) with HbAA genotype were included. Clinical, echocardiographic, and laboratory data were recorded. ELISA was used for the determination of serum levels of copeptin. RESULTS: VOC patients had significantly higher copeptin level compared both with controls and SCA subjects in steady state (22.6 ± 13.0 vs. 11.3 ± 5.7 pmol/L, 22.6 ± 13.0 vs. 12.4 ± 5.8 pmol/L, p = 0.009 for both). Additionally, the copeptin level was significantly higher in SCA patients with RV dysfunction than those without RV dysfunction (23.2 ± 12.2 vs. 15.3 ± 9.5 pmol/L, p = 0.024). Multiple logistic regression analysis revealed that high-sensitivity C-reactive protein and copeptin levels were found to be associated with VOC. CONCLUSION: This study showed that copeptin and hs-CRP levels were increased in patients with VOC, and it was found that RV dysfunction was more common in SCA patients with VOC than in the control group. Copeptin can be considered for use as a potential biomarker in predicting VOC crisis in SCA patients and in the early detection of patients with SCA who have the potential to develop RV dysfunction.

Role of monocyte to high-density lipoprotein cholesterol ratio in predicting left atrial enlargement in hypertensive patients.

OBJECTIVE: Left atrium enlargement is common in hypertension due to left atrium inflammation. Monocyte to high-density lipoprotein cholesterol ratio, an inflammation marker that has become very popular in recent years, is associated with many cardiovascular diseases. The aim of this study is to investigate the monocyte to high-density lipoprotein cholesterol ratio level to predict the Left atrium enlargement in hypertensive patients. METHODS: A total of 216 participants (i.e., 115 hypertensive and 101 control group) were enrolled. Left atrial volumes and left atrial volume indexes were calculated using transthoracic echocardiography. The monocyte to high-density lipoprotein cholesterol ratio was calculated as the ratio of monocyte to high-density lipoprotein cholesterol levels. RESULTS: The left atrial volumes, left atrial volume indexes, and monocyte to high-density lipoprotein cholesterol levels were significantly higher in the hypertensive group than in the control group (43.3±12.4 versus 31.4±7.9, p<0.001; 22.9±5.8 versus 17.1±3.7, p<0.001; 11.4 [4.2-25.0] versus 8.4 [3.5-18.0], p<0.001, respectively). On the multivariate logistic regression analysis, monocyte to high-density lipoprotein cholesterol ratio (OR 1.38; 95%CI 1.20-1.57; p<0.001), (OR 1.28; 95%CI 1.16-1.42; p<0.001), age, and sex (female) were the independent predictors for hypertension. CONCLUSIONS: The increased monocyte to high-density lipoprotein cholesterol ratio level was associated with hypertension and increased left atrial volume indexes. The results of this study supported the presence of inflammation, measured with a readily available and inexpensive marker, in hypertensive patients and revealed the association with left atrial enlargement.

The importance of heart rate variability in predicting cardiac autonomic dysfunction in patients with amyotrophic lateral sclerosis.

AIM: Amyotrophic lateral sclerosis (ALS) is a progressive disease characterized by degeneration in the upper and lower motor neurons of the corticospinal tract, brain stem, and spinal cord. Recent studies have revealed that the disease does not present solely with motor neuron involvement. Accordingly, the aim of this study is to investigate the presence of cardiac autonomic impairment in patients diagnosed with ALS. MATERIAL AND METHOD: A total of 61 patients, who were diagnosed with ALS according to the Revised El Escorial Criteria (R-EEC), were included in this prospective study, in addition to the 29 healthy individuals, who were included in the study as controls. In order to assess the cardiac autonomic involvement, the presence of orthostatic hypotension was investigated, and transthoracic echocardiography and 24-hour electrocardiogram (ECG) using a Holter monitor were performed. RESULTS: Orthostatic hypotension was detected in 14 (22.2%) patients. Holter electrocardiogram results of the patient group revealed statistically significantly lower heart rate variability (HRV) indicators in the time domain (SDNN, SDANN, SDNN index, rMSSD, and pNN50) and in the frequency domain (high frequency [HF], low frequency [LF], and very low frequency [VLF]) than those of the control group (P < .05). CONCLUSION: Contrary to the popular opinion, cardiac autonomic dysfunction in patients with ALS can occur at any stage of the disease. Therefore, it is recommended that the patients are evaluated via periodic examinations during the follow-up period for cardiac autonomic involvement.

Could Serum Copeptin Level Be an Indicator of Coronary Artery Disease Severity in Patients with Unstable Angina?

This study aimed to identify the serum copeptin levels in patients diagnosed with unstable angina (UA) and evaluate the relationship between the patients' copeptin levels and angiographic severity.A total of 200 patients who were diagnosed with UA and underwent coronary angiography were included in the study. Clinical, electrocardiographic, echocardiographic, and laboratory data (high-sensitivity cardiac troponin T and copeptin levels) as well as The Global Registry of Acute Coronary Events (GRACE) 1.0 risk score were recorded upon admission. Moreover, the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was calculated following coronary angiography.We isolated and defined two subgroups within our study population: group 1 included patients with non-significant coronary artery disease (CAD) (< 50% diameter stenosis, n = 105); group 2 included patients with significant CAD (≥ 50% diameter stenosis, n = 95). The number of cases with a GRACE score higher than 140 was significantly higher in group 2 than in group 1 (P < 0.001). The SYNTAX scores and copeptin levels were significantly higher in group 2 than in group 1 (P < 0.001 for both). A positive correlation was observed between the copeptin levels and SYNTAX scores (r = 0.683; P < 0.001), and the cut-off level of copeptin was 18.3 pmol/L (sensitivity of 74.7%, specificity of 83.8%, and area under the curve of 0.795).This study suggests that it may be beneficial to use conventional scoring systems and serum copeptin levels when identifying high-risk UA patients.

Predictive value of plasma copeptin level for diagnosis and mortality of pulmonary embolism.

OBJECTIVE: Early diagnosis and risk stratification may provide a better prognosis in pulmonary embolism (PE). Copeptin has emerged as a valuable predictive biomarker in various cardiovascular diseases. The aim of this study was to determine the levels of copeptin in patients with acute PE and to evaluate its relationship with disease severity and PE-related death. METHODS: Fifty-four patients and 60 healthy individuals were included in this study. Copeptin concentrations and right ventricular dysfunction were analyzed. The correlation between copeptin levels and hemodynamic and echocardiographic parameters was examined. After these first measurements, patients were evaluated with PE-related mortality at the one-year follow-up. RESULTS: The copeptin levels were higher in PE patients than in the control group (8.3 ng/mL vs 3.8 ng/mL, p<0.001). Copeptin levels were found to be significantly higher in patients with PE-related death and right ventricular dysfunction (10.2 vs 7.5 ng/ml, p=0.001; 10.5 vs 7.5 ng/ml, p=0.002, respectively). When the cut-off value of copeptin was ≥5.85, its sensitivity and specificity for predicting PE were 71.9% and 85.0%, respectively (AUC=0.762, 95% CI=0.635-0.889, p<0.001). CONCLUSIONS: The copeptin measurement had moderate sensitivity and specificity in predicting the diagnosis of PE, and the copeptin level was significantly higher in patients with PE-related death at the one-year follow-up. Copeptin may be a useful new biomarker in predicting diagnosis, risk stratification, and prognosis of PE.

Predictive value of plasma copeptin level for diagnosis and mortality of pulmonary embolism

SUMMARY OBJECTIVE: Early diagnosis and risk stratification may provide a better prognosis in pulmonary embolism (PE). Copeptin has emerged as a valuable predictive biomarker in various cardiovascular diseases. The aim of this study was to determine the levels of copeptin in patients with acute PE and to evaluate its relationship with disease severity and PE-related death. METHODS: Fifty-four patients and 60 healthy individuals were included in this study. Copeptin concentrations and right ventricular dysfunction were analyzed. The correlation between copeptin levels and hemodynamic and echocardiographic parameters was examined. After these first measurements, patients were evaluated with PE-related mortality at the one-year follow-up. RESULTS: The copeptin levels were higher in PE patients than in the control group (8.3 ng/mL vs 3.8 ng/mL, p<0.001). Copeptin levels were found to be significantly higher in patients with PE-related death and right ventricular dysfunction (10.2 vs 7.5 ng/ml, p=0.001; 10.5 vs 7.5 ng/ml, p=0.002, respectively). When the cut-off value of copeptin was ≥5.85, its sensitivity and specificity for predicting PE were 71.9% and 85.0%, respectively (AUC=0.762, 95% CI=0.635-0.889, p<0.001). CONCLUSIONS: The copeptin measurement had moderate sensitivity and specificity in predicting the diagnosis of PE, and the copeptin level was significantly higher in patients with PE-related death at the one-year follow-up. Copeptin may be a useful new biomarker in predicting diagnosis, risk stratification, and prognosis of PE.

RESUMO OBJETIVO: O diagnóstico precoce e a estratificação de risco podem proporcionar um melhor prognóstico em casos de embolia pulmonar (EP). A copeptina surgiu como um valioso biomarcador preditivo de várias doenças cardiovasculares. O objetivo deste estudo é determinar os níveis de copeptina em pacientes com EP aguda e avaliar a sua relação com a severidade da doença e mortes relacionadas à EP. MÉTODOS: Um total de 54 pacientes e 60 indivíduos saudáveis foram incluídos neste estudo. As concentrações de copeptina e disfunções ventriculares direitas foram analisadas. A correlação entre os níveis de copeptina e parâmetros ecocardiográficos e hemodinâmicos foi examinada. Após essas primeiras medições, os pacientes foram avaliados em relação à mortalidade relacionada à EP após um ano. RESULTADOS: Os níveis de copeptina foram maiores em pacientes com EP do que no grupo de controle (8,3 ng/mL vs 3,8 ng/mL, p<0,001). Os níveis de copeptina eram significativamente maiores em pacientes com mortes relacionadas à EP e disfunção ventricular direita (10,2 vs 7,5 ng/ml, p=0,001; 10,5 vs 7,5 ng/ml, p=0,002, respectivamente). Com um valor de corte ≥5,85 para a copeptina, sua sensibilidade e especificidade preditivas para EP foram 71,9% e 85,0%, respectivamente (AUC=0,762, 95% IC=0,635 - 0,889, p<0,001). CONCLUSÃO: A medição da copeptina teve sensibilidade e especificidade preditivas moderadas para o diagnóstico de EP, e o nível de copeptina foi significativamente maior em pacientes com mortes relacionadas à EP após um ano. A copeptina pode ser um novo biomarcador preditivo útil para o diagnóstico, a estratificação de risco e o prognóstico de PE.

Determination of the effects of cryoablation for atrial fibrillation on esophageal functions.

OBJECTIVE: Periesophageal vagal plexus injury is a complication of cryoablation for atrial fibrillation (AF). The aim of this study is to investigate the effect of cryoablation on esophageal functions and to determine the relationship between esophageal temperature and esophageal motility. METHODS: Twenty patients with symptomatic paroxysmal AF who underwent cryoablation were included in this study. The lowest cryoballoon temperature for each pulmonary vein (PV) was recorded. Esophageal temperature was measured using an esophageal probe during each cryoapplication. Esophageal manometry was performed before the procedure and one day after the procedure for each patient in order to assess the esophageal functions. RESULTS: During the procedure, the highest esophageal temperature change was found in the left-side PVs in 13 patients (65%) and in the right-side PVs in seven patients (35%). No correlation was found between the lowest cryoballoon temperature and esophageal temperature change (r=0.22, p=0.05). It was detected that the lower esophageal sphincter pressure and esophageal contraction amplitude pressure decreased after the procedure (before: 19.7±9.3 mm Hg, after: 14.3±4.9 mm Hg, p=0.001; before: 84.5±28.3 mm Hg, after: 72.7±34.3 mm Hg, p=0.005, respectively). Five patients (25%) developed gastrointestinal symptoms after the procedure. CONCLUSION: During cryoablation, esophageal temperature measurement can be performed to reduce the probability of esophageal injury. Cryoablation affects esophageal motility, and esophageal manometry can be performed to detect esophageal motility impairments in patients with gastrointestinal symptoms.

Acute Anterior Myocardial Infarction in a Patient With Dextrocardia and Situs Inversus: An Unusual Coexistence.

Situs inversus totalis is a rare disorder. In addition, acute coronary syndromes, especially ST-segment elevation myocardial infarctions, are rarely detected in this group. We demonstrate the electrocardiographic features and discuss the interventional challenges of acute anterior myocardial infarction in a patient with dextrocardia. (Level of Difficulty: Beginner.).

Predictors of the paroxysmal atrial fibrillation recurrence following cryoballoon-based pulmonary vein isolation: Assessment of left atrial volume, left atrial volume index, galectin-3 level and neutrophil-to-lymphocyte ratio.

BACKGROUND: Cryoballoon-based pulmonary vein isolation (PVI) is a treatment option for atrial fibrillation (AF). Left atrial volume (LAV) and left atrial volume index (LAVi) are important parameters for long term success of PVI. Galectin-3 (Gal-3) and neutrophil to lymphocyte ratio (N/L ratio) are biomarkers to demonstrate the cardiac fibrosis and remodelling. METHODS: 50 patients with symptomatic PAF despite ≥1 antiarrhythmic drug(s), who underwent PVI were enrolled. LAV, LAVi, Gal-3 and N/L ratio were calculated before ablation and after ablation at 6 and 12 months. According to AF recurrence patients were divided into two groups, recurrent AF (n = 14) and non-recurrent AF (n = 36). RESULTS: In both groups (recurrent and non-recurrent), initial and 12 months follow-up LAV values were 41.39 ±â€¯18.13 ml and 53.24 ±â€¯22.11 ml vs 48.85 ±â€¯12.89 ml and 42.08 ±â€¯13.85 (p = 0.037). LAVi were 20.9 ±â€¯8.91 ml/m2 and 26.85 ±â€¯11.28 ml/m2 vs 25.36 ±â€¯6.21 and 21.87 ±â€¯6.66 (p = 0.05) for recurrent and non-recurrent AF groups, respectively. In both groups PVI had no significant effect on serum Gal-3 levels and N/L ratio during 12 months follow-up. The comparison between two groups at the end of 12th month showed Gal-3 values of 6.66 ±â€¯4.09 ng/ml and 6.02 ±â€¯2.95 ng/ml (p = 0.516), N/L ratio values of 2.28 ±â€¯1.07 103/µl and 1.98 ±â€¯0.66 103/µl (p = 0.674). CONCLUSION: LAV and LAVi are useful to predict the remodelling of the left atrium and AF recurrence after cryoballoon-based PVI. However, biomarkers such as Gal-3 and N/L ratio are not associated with AF recurrence.

[Important cardiovascular studies and results in the elderly]. / Yasli kardiyovasküler hastalarla ilgili önemli çalismalar ve sonuçlari.

Along with the medical technology that has developed in recent years, the elderly population has started to increase all over the world due to the extension of human life. Chronic diseases have been commonly diagnosed with the increasing population of elderly people. Cardiovascular diseases are the most common cause of death in men and women over 65 years of age. High morbidity and mortality due to cardiovascular disease in elderly patients requires effective prevention and treatment in patients. The incidence of cardiovascular diseases is in direct proportion to age; therefore, hypertension, coronary artery disease, carotid artery disease, stroke, heart failure, arrhythmia and valvular diseases can be identified as common cardiovascular diseases in the elderly population.

Eosinophilic myocarditis associated with eosinophilic pneumonia and eosinophilia following antibiotic and narcotic analgesic treatment.

Eosinophilic myocarditis (EM) is a rare form of myocarditis that usually presents with heart failure due to eosinophilic infiltration. EM is often a component of hypereosinophilic syndrome (HES). HES is a rare disorder characterized by persistent, marked eosinophilia combined with organ system dysfunction. A 38-year-old man was admitted to emergency services with left inguinal pain and fever, and was hospitalized with diagnosis of nephrolithiasis and urinary tract infection. Intravenous antibiotic therapy of 3 grams meropenem per day and analgesic of 50 mg pethidine per day were administered. Typical angina pectoris and dyspnea developed approximately 24 hours after treatment. Rash on the chest, and diminished bilateral lung sounds and rales were observed. Nonspecific changes were present on electrocardiogram. Laboratory analysis showed progressively increasing levels of cardiac biomarkers and eosinophilia. Peripheral blood smear, bone marrow aspiration, and biopsy demonstrated eosinophilia. Chest x-ray revealed diffuse, bilateral interstitial and reticulonodular infiltrates. Transthoracic echocardiography showed thickened left ventricle. Coronary angiography revealed normal coronary arteries. EM was suspected, endomyocardial biopsy was performed, and pathologic specimen confirmed the diagnosis. Corticosteroid treatment was initiated, and within 1 day, angina pectoris and dyspnea had dramatically reduced, and cardiac biomarkers and eosinophil count had decreased. Normal chest x-ray was observed after 72 hours. The patient was discharged with steroid treatment.