Hemoglobin/Red Cell Distribution Width Ratio is Associated With Poor Prognosis in Patients With Acute Coronary Syndrome in Long-Term Follow-Up

Abstract Background Acute coronary syndrome (ACS) is the most common subtype of coronary artery disease (CAD). It is one of the main reasons affecting the expected life expectancy and quality of life. Objetives In this study, we aimed to investigate the relationship between major adverse cardiac events (MACE) and Hemoglobin (Hb)/Red cell distribution width (RDW) in long-term follow-up after ACS. Methods A total of 1,146 ACS patients were included in the study, being classified according to the type of myocordial infarction (MI). MACE were recorded in long-term follow-up. The relationship between Hb/RDW and MACE was investigated. The statistical analyses of Mann-Whitney U test for comparison of two independent groups and chi-square test for categorical variables were used. In order to determine the diagnostic feature of the HB/RDW ratio, the diagnostic ratios were calculated by applying Receiver Operating Characteristic Curve (ROC) analysis. A p < 0.05 value was considered statistically significant in all analyses. Results: When the patients were analyzed according to MI types — ST segment elevation myocardial infarction (STEMI)/Non-ST segment elevation myocardial infarction (NSTEMI) —, it was observed that Hb/RDW (p = 0.038) was significantly higher in the STEMI group. The Hb/RDW ratio was statistically significant in predicting mortality. As a result of ROC analysis, Area Under the Curve (AUC) = 0.654 (p < 0.001) was found. The cut-off value for the Hb/RDW ratio was calculated as 0.947. The sensitivity and specificity of 76.9% and 48.4% for the diagnostic rates obtained were moderately acceptable. Conclusion The Hb/RDW-long-term mortality relationship was found to be significant in ROC analysis. It can be used in clinical practice as it is cheap, easy to apply, and reduces possible bias in post-ACS follow-up.

The relationship between epicardial adipose tissue thickness and coronary artery disease progress.

BACKGROUND: The relationship between epicardial adipose tissue and inflammatory events has been shown in many studies. Because it is an inflammatory process in coronary progression, it is aimed to examine the relationship between coronary artery disease progression and epicardial adipose tissue thickness. MATERIALS AND METHODS: Our research was conducted with 50 patients (33 men, 17 women) who underwent planned or emergency coronary angiography, by evaluating the coronary artery disease progression from the coronary angiography images together with the echocardiographic epicardial adipose tissue thickness measurement. Patients were examined in two groups according to their tissue thickness, 17 patients with less than 0.55 cm were defined as group 1 and 33 patients with ≥ 0.55 were determined as group 2. RESULTS: There was no significant difference between the groups in terms of gender, diabetes, age, hypertension. In addition, a significant relationship was found with epicardial adipose tissue thickness (> 0.5 cm), ejection fraction and smoking in the group with coronary progression. Patients without stenotic changes were found to be statistically significantly lower p < 0.005. CONCLUSION: An independent relationship was found between epicardial adipose tissue and coronary artery progression. In the light of these findings, it can be concluded that epicardial adipose tissue residue is effective in the development of coronary artery stenosis and calcific-atherosclerotic changes in the coronary arteries. In the light of the information obtained, a positive correlation was determined between epicardial adipose tissue thickness and coronary artery disease (Tab. 3, Fig. 2, Ref. 15). Text in PDF www.elis.sk Keywords: coronary artery disease, epicardial adipose tissue, progression.

Is the Naples prognostic score useful for predicting heart failure mortality.

Aim    The Naples prognostic score (NPS) simultaneously evaluates inflammation and malnutrition, which are two main factors that play a role in the pathophysiology and prognosis of heart failure (HF). In this study, we aimed to examine the relationship of NPS with in-hospital mortality of hospitalized patients with a diagnosis of HF.Material and Methods    A total of 496 hospitalized HF patients included in this study. The patients were divided into two groups as deceased and living. The clinical and demographic characteristics of each patient were recorded. NPS of each patient was calculated.Results    NPS was significantly higher in the deceased group compared to the living group (3.6±0.61, 3.21±0.97, respectively; p=0.003). According to multivariate regression analysis: NPS (OR: 1.546, 95 % CI: 1.027-2.327; p=0.037), systolic blood pressure (OR: 0.976, 95 % CI: 0.957-0.995; p=0.015), and white blood cell count (OR: 1.072, 95 % CI: 1.007-1142; p=0.03) are independent predictors for in-hospital mortality in HF patients.Conclusion    This study demonstrated a strong correlation between NPS and mortality in HF. This new score can be used to predict the prognosis of HF as it shows both the level of inflammation and nutrition.

Predictors and Prognostic Implications of Myocardial Injury After Transcatheter Aortic Valve Replacement.

Myocardial injury (MI) is not unusual after transcatheter aortic valve replacement (TAVR). To determine precipitating factors and prognostic outcomes of MI after TAVR, we retrospectively investigated relationships between MI after TAVR and aortic root dimensions, baseline patient characteristics, echocardiographic findings, and procedural features. Of 474 patients who underwent transfemoral TAVR for severe aortic stenosis in our tertiary center from June 2011 through June 2018, 188 (mean age, 77.7 ± 7.7 yr; 96 women [51%]) met the study inclusion criteria. Patients were divided into postprocedural MI (PMI) (n=74) and no-PMI (n=114) groups, in accordance with high-sensitivity troponin T levels. We found that MI risk was associated with older age (odds ratio [OR]=1.054; 95% CI, 1.013-1.098; P=0.01), transcatheter heart valve type (OR=10.207; 95% CI, 2.861-36.463; P=0.001), distances from the aortic annulus to the right coronary artery ostium (OR=0.853; 95% CI, 0.731-0.995; P=0.04) and the left main coronary artery ostium (OR=0.747; 95% CI, 0.616-0.906; P=0.003), and baseline glomerular filtration rate (OR=0.985; 95% CI, 0.970-1.000; P=0.04). Moreover, the PMI group had a longer time to hospital discharge (P=0.001) and a higher permanent pacemaker implantation rate (P=0.04) than did the no-PMI group. Our findings may enable better estimation of which patients are at higher risk of MI after TAVR and thus improve the planning and course of clinical care.

Trans-subclavian aortic valve replacement with various bioprosthetic valves: Single-center experience.

OBJECTIVE: Transcatheter aortic valve replacement (TAVR) has been accepted as an alternative to surgery in high risk or inoperable patients with severe aortic stenosis (AS). Although transfemoral approach is the most often preferred means of access, in patients with severe ilio-femoral arteriopathy, other vascular access sites may be required. The aim of the present study was to report our experience with trans-subclavian approach for TAVR using different valve systems. METHODS: Among 273 patients undergoing TAVR between June 2011 and May 2016, 10 patients (mean age: 68.3±7.6 years; 6 males) with high surgical risk were excluded from transfemoral TAVR because of ilio-femoral arteriopathy. Under general anesthesia, 9 of these patients underwent TAVR via left subclavian artery (SCA) and 1 patient via right SCA. Surgical cut-down and closure techniques were utilized in all patients. Eight balloon-expandable Edwards Sapien XT valves (size: one 23 mm, six 26 mm, and one 29 mm) were used, 1 patient received 26 mm balloon-expandable Sapien 3 valve, and 1 patient had 27 mm self-expandable Lotus valve implanted. RESULTS: Procedural success rate was 90%. Mean aortic gradient decreased to 10.6 mmHg from 47.4 mmHg. Emergent surgery was required in 1 patient due to complication of ventricular valve embolization. Thrombus formation at right SCA was detected in 1 patient and resolved with medical therapy. In-hospital mortality was not observed in any patients. CONCLUSION: Trans-subclavian approach for TAVR is safe and feasible. Proper patient and valve selection concurrent with utilization of multimodal imaging techniques are crucial for successful and uncomplicated procedure.

Low-dose oral contraceptive-induced acute myocardial infarction.

OBJECTIVES: Since their introduction, oral contraceptives (OCs) have been associated with risk to both the venous and the arterial systems. Studies have shown that OC use is associated with a risk of venous thromboembolism, ischaemic stroke and acute myocardial infarction (MI). MI is rarely seen in patients using OCs, particularly in the absence of clinical risk factors or smoking. CASE: We report a case of acute inferior MI in a 20-year-old non-smoker who had used a low-dose OC (3 mg drospirenone and 30 µg ethinyl estradiol) for 1 month. As far as we know, this is the youngest case of acute MI associated with a low-dose OC. CONCLUSION: Low-dose OCs may also be responsible for acute MI even in a very young female without any cardiovascular risk factors. Therefore, the clinicians should be aware of this mortal events during follow-up of the patient using OCs.

First trans-subclavian transcatheter aortic valve replacement using Lotus valve system.

Transcatheter aortic valve implantation (TAVI), most commonly performed via retrograde femoral artery access, is a promising alternative to surgical aortic valve replacement in elderly, high-risk patients with severe aortic stenosis (AS). Approximately one-third of these patients suffer from severe iliofemoral arteriopathy, ruling out transfemoral approach. The case of a 74-year-old man with severe AS and bilateral iliofemoral arteriopathy treated with left trans-subclavian (TS) TAVI using the Lotus valve system is described in the present report.

Transcatheter aortic valve implantation with the Edwards Sapien 3 valve: First experiences in Turkey.

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) has shown promising results in patients with severe aortic stenosis (AS) at high risk for open heart surgery. We aimed to evaluate outcomes of patients who underwent TAVI with Edwards SAPIEN 3 Transcatheter Heart Valve (S3), a second-generation TAVI device. METHODS: Between November 2014 and June 2016, 31 high-risk patients received balloon-expandable S3 valve at Atatürk Training and Research Hospital that has the largest case series in Turkey. RESULTS: Mean age of the patients was 76.1±12.6 years. Mean Society of Thoracic Surgeons and logistic European System for Cardiac Operative Risk Evaluation scores were 7.8%±3.1 and 31.4%±17.6, respectively. S3 valve was implanted in 27 patients via transfemoral approach and via trans-subclavian approach in 4 patients under local (n=29) or general (n=2) anesthesia. Procedural success rate was 100% (23 mm, n=7; 26 mm, n=16; 29 mm, n=8). Paravalvular aortic regurgitation (PAR) was absent or trivial in 29 (93.6%) patients and mild in 2 (6.4%) patients. Permanent pacemaker implantation (PPI) was required in 2 (6.4%) patients during the procedure, and in-hospital mortality occurred in 1 (3.2%) of those 2 patients. CONCLUSION: S3 valve is associated with higher rate of device success and lower incidence of PAR, peripheral vascular complications, and need for new PPI.

Impact of transcatheter aortic valve implantation on the left ventricular mass.

BACKGROUND: Aortic stenosis (AS) induces pressure overload of the left ventricle (LV) and results in left ventricular hypertrophy. The remodeling of the LV in patients with AS is a com-plex process including structural and functional disturbances. After aortic valve replacement, reverse remodeling of LV begins. The aim of this study was to evaluate the impact of transcatheter aortic valve implantation (TAVI) on LV mass (LVM) in early and mid-term follow-ups after the procedure. METHODS AND RESULTS: We enrolled consecutive 75 patients who underwent successful TAVI. Transthoracic echocardiography was performed prior to TAVI and at hospital discharge, in the 1st month and 6th month of the follow-ups. The mean LV ejection fraction improved significantly after TAVI (54.2 ± 15.0% to 57.3 ± 11.7%, p < 0.001). There were no significant changes between the baseline and discharge mean LVM and LVM index values (LVMI; p = 0.1). However, LVMI decreased significantly in the 1st month of follow-up compared to baseline (123.3 ± 20.3 to 127.9 ± 21.3 g/m², respectively, p < 0.001). Also, significant regression of LVM was observed at the 1st month of follow-up compared to baseline (228.3 ± 33.5 g vs. 236.5 ± 34.2 g, respectively, p < 0.001). Furthermore, the significant regression in both of LVM and LVMI continued at 1st and 6th months of the follow-ups (p < 0.001). CONCLUSIONS: A significant regression of LVM was observed after TAVI. These changes may have prognostic value in patients with severe AS.

[Bonsai induced acute myocardial infarction]. / Bonzai kullanimi sonrasi ortaya çikan akut miyokart enfarktüsü

Incidences of drug abuse and cannabis have increased in young adults, recently. Cannabis induced myocardial infarction has rarely been reported in these people. There is no any literature about a synthetic cannabinoid, being recently most popular Bonsai, to cause myocardial infarction. In this case report we presented a 33-year-old male patient who developed acute myocardial infarction after taking high doses of Bonsai.