Clinical implication of the Naples prognostic score on transcatheter aortic valve replacement in patients with severe aortic stenosis.

BACKGROUND: One of the hallmarks of frailty in patients with severe aortic stenosis (AS) is malnutrition, for which one of the most up-to-date scoring systems is the Naples prognostic score (NPS). This study sought to investigate the predictive role of the NPS in determining mortality in patients undergoing transcatheter aortic valve replacement (TAVR) under long-term follow-up. METHODS: A total of 430 consecutive patients with symptomatic severe AS who underwent TAVR were included retrospectively. The primary endpoint of the study was the long-term all-cause mortality. The study population was divided into two groups according to the NPS value, including Group 1 (NPS 0-2) and Group 2 (NPS 3-4). RESULTS: The all-cause mortality occurred in 250 patients (62.5%) patients during a follow-up time of 40.6 (22.0-69.4) months. During the follow-up period, all-cause mortality was higher in Group 2 compared with Group 1 (87.9% vs. 42.9%, p < 0.001). Older age (p < 0.001), chronic obstructive pulmonary disease (p = 0.015), left ventricular ejection fraction (p = 0.021), and being in Group 2 (high NPS) (hazard ratio: 7.058, 95% confidence interval: 5.174-9.629, p < 0.001) were found to be independent predictors of all-cause mortality at long-term follow-up. CONCLUSION: The NPS as a malnutrition and inflammation marker in patients with severe aortic stenosis who underwent TAVR provides valuable information for all-cause mortality under long-term follow-up.

The relationship between sarcopenia and one-year mortality in patients with critical limb ischemia undergoing endovascular therapy below the knee.

OBJECTIVE: Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). Patients with CLI have poor long-term prognosis. The aim of this study was to investigate the value of sarcopenia in terms of 1-year mortality in patients with below-the-knee lesions who underwent endovascular treatment for CLI. METHODS: A total of 190 patients with critical limb ischemia who underwent endovascular treatment (EVT) for below-the-knee (BTK) lesions were enrolled in this study. Sarcopenia was defined using the psoas muscle index (PMI). PMI was obtained by calculating the average psoas muscle area (APMA) of the left and right psoas muscles at the third lumbar vertebra level and dividing by the square of the height (cm2/m2). The primary endpoint of the study was 1-year mortality and the secondary endpoint was 1-year amputation. Patients were divided into 2 groups according to presence of sarcopenia. RESULTS: We detected sarcopenia in 64 patients. The mean age, height, and EF were higher in sarcopenia group. The psoas muscle area, weight, psoas muscle index, body-mass index, albumin level, and GFR were lower in sarcopenia group. The incidence of amputation (11.9% vs 29.7%, p = 0.003) and mortality (15.1% vs 35.9%, p = 0.001) were higher in patients with sarcopenia. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of amputation and mortality. The survival curve for 1-year using the sarcopenia was analyzed using the Kaplan-Meier method, and statistical analysis was performed with the log-rank test. The presence of sarcopenia, glomerular filtration rate level, and low ejection fraction were found to be independent predictors of mortality. CONCLUSIONS: Sarcopenia was associated with 1-year mortality in patients with CLI undergoing EVT for BTK lesions. Also, patients with sacropenia had higher 1-year amputation rates. Sarcopenia may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.

Role of triglyceride glucose index in long-term mortality of patients with lower extremity arterial disease.

Aim: This work was designed to explore the role of the triglyceride-glucose (TyG) index in the prediction of long-term mortality in patients with lower extremity artery disease (LEAD) undergoing endovascular revascularization. Methods: The records of 723 patients with symptomatic LEAD undergoing endovascular revascularization between January 2016 and December 2021, with long-term follow-up until December 2021, were analyzed. Results: The rate of long-term mortality was significantly higher among patients with high TyG index than patients with low TyG index. Conclusion: The TyG index is an independent predictor of long-term mortality in patients with LEAD undergoing endovascular revascularization.

Serum copeptin levels in predicting nondippers in newly diagnosed hypertension.

OBJECTIVES: The nondipper pattern in hypertension is associated with worse cardiovascular outcomes. In this study, we hypothesized that high copeptin levels could predict nondippers among hypertensive patients and investigated the associations between copeptin levels and nondipper pattern in newly diagnosed hypertensive patients. METHODS: Ambulatory blood pressure measurements were obtained and the patients were divided into two groups according to ambulatory blood pressure measurement as nondippers and dippers. Serum copeptin levels were measured in addition to routine laboratory investigations. A total of 76 patients were included in the study. RESULTS: The clinical and laboratory characteristics of the two groups were similar. The mean copeptin values were found to be significantly higher in the nondipper hypertensive group [1.66 (1.19-4.01) and 1.35 (1.12-2.09) IU/ml, respectively, P=0.026]. In the correlation analysis, no correlation was found between copeptin levels and daytime diastolic blood pressure, but there were weak positive correlations with daytime systolic, 24 h systolic, and diastolic blood pressure values (r=0.335, P=0.034, r=0.350, P=0.027, r=0.372, P=0.018, respectively). However, there were significant positive correlations between serum copeptin levels and nocturnal systolic and diastolic blood pressure values (r=0.593, P<0.001, r=0.523, P=0.001, respectively). CONCLUSION: This study showed that high serum copeptin levels could predict the nondipper pattern in newly diagnosed hypertension.

High levels of serum uric acid impair development of coronary collaterals in patients with acute coronary syndrome.

We evaluated the association of serum uric acid (SUA) level and development of coronary collateral vessels (CCVs) in patients with acute coronary syndrome (ACS). Patients (n = 224) with ACS were included in the study. Coronary collateral vessels were graded according to the Rentrop scoring system. Rentrop grade 0 was accepted as absence of CCV (group 1; n = 117) and Rentrop grade ≥1 was accepted as presence of CCV (group 2; n = 107). Rentrop 0-1 (poor CCV) were determined in 167 patients and Rentrop 2-3 (good CCV) were determined in 57 patients. Both presence of CCV (P < .001) and development of good CCV (P = .003) were significantly associated with low levels of SUA. We suggest that high levels of SUA affect the CCV development negatively in nondiabetic and nonhypertensive patients with ACS.

Elevation of QT dispersion after obesity drug sibutramine.

BACKGROUND: QT dispersion (QTd) is an arrhythmia parameter that can be used to assess homogeneity of cardiac repolarization. An antiobesity drug sibutramine is linked with several cardiovascular adverse events, including arrhythmias. Previous studies showed that sibutramine may prolong the QT interval and may be associated with cardiac arrest. OBJECTIVES: The aim of this study was to evaluate the effect of sibutramine on QTd. METHODS: The study group consisted of 65 consecutive patients with obesity. All patients were to receive 15 mg of sibutramine once a day in addition to standard care for lifestyle change. Twelve-lead ECG was performed before the onset of the medication and after 16 weeks of treatment. QTd was calculated. RESULTS: Three individuals were withdrawn from the study because of the adverse effects of sibutramine. Sixty-two patients with obesity were recruited into the study. All patients were women (62, 100%). Body weight (106.3 ± 15.0 kg vs. 101.6 ± 16.9 kg, P < 0.001) and low-density lipoprotein cholesterol (128.4 ± 29.7 mg/dl vs. 111.6 ± 24.6 mg/dl, P < 0.001) levels were significantly decreased whereas QTd (46.1 ± 22.6 ms vs. 53.7 ± 16.7 ms, P = 0.026) was significantly increased after 16 weeks of sibutramine treatment. The increase in QTd was not correlated with the decrease in body weight. There was no correlation between QTd and any conditions such as diabetes or hypertension. CONCLUSION: This study has shown an elevation in QTd, which may lead to cardiac arrhythmias, after sibutramine treatment. Molecular mechanisms may play role in increasing QTd. Further randomized studies are needed to clarify cardiac adverse events of the sibutramine.

Hashimoto's thyroiditis is a frequent occurrence in patients with rheumatic mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: Rheumatic mitral stenosis (RMS), an autoimmune sequel of streptococcal infection, causes significant morbidity and mortality. As Hashimoto's thyroiditis (HT) is recognized as the major form of chronic autoimmune thyroiditis, it was hypothesized that the coexistence of HT and RMS might have an autoimmune origin. The study aim was to examine this possible relationship. METHODS: A total of 55 consecutive patients with RMS was examined and compared to 54 healthy controls with normal echocardiographic findings. All subjects underwent transthoracic echocardiography and thyroid ultrasonography after a complete medical history and laboratory examination. RESULTS: The demographic data of the RMS group (38 females, 17 males; mean age 39.9 +/- 9.3 years) and control group (39 females, 15 males; mean age 39.6 +/- 10.5 years) were similar. HT was found to occur significantly more frequently in RMS patients (n = 16; 29%) than in controls (n = 6; 11%) (p = 0.019) CONCLUSION: The higher frequency of HT in patients with RMS than controls may have genetic associations. Hence, further genetic-based studies should be conducted to provide a better understanding of this suggested relationship.