Baseline Characteristics of a Patient Cohort and Predictors of In-hospital MORtality in CORonary Care Units (MORCOR-TURK) Trial in Türkiye.

OBJECTIVE: The MORtality in CORonary Care Units in Türkiye (MORCOR-TURK) trial is a national registry evaluating predictors and rates of in-hospital mortality in coronary care unit (CCU) patients in Türkiye. This report describes the baseline demographic characteristics of patients recruited for the MORCOR-TURK trial. METHODS: The study is a multicenter, cross-sectional, prospective national registry that included 50 centers capable of 24-hour CCU service, selected from all seven geographic regions of Türkiye. All consecutive patients admitted to CCUs with cardiovascular emergencies between September 1-30, 2022, were prospectively enrolled. Baseline demographic characteristics, admission diagnoses, laboratory data, and cardiovascular risk factors were recorded. RESULTS: A total of 3,157 patients with a mean age of 65 years (range: 56-73) and 2,087 (66.1%) males were included in the analysis. Patients with arterial hypertension [1,864 patients (59%)], diabetes mellitus (DM) [1,184 (37.5%)], hyperlipidemia [1,120 (35.5%)], and smoking [1,093 (34.6%)] were noted. Non-ST elevation myocardial infarction (NSTEMI) was the leading cause of admission [1,187 patients (37.6%)], followed by ST elevation myocardial infarction (STEMI) in 742 patients (23.5%). Other frequent diagnoses included decompensated heart failure (HF) [339 patients (10.7%)] and arrhythmia [272 patients (8.6%)], respectively. Atrial fibrillation (AF) was the most common pathological rhythm [442 patients (14%)], and chest pain was the most common primary complaint [2,173 patients (68.8%)]. CONCLUSION: The most common admission diagnosis was acute coronary syndrome (ACS), particularly NSTEMI. Hypertension and DM were found to be the two leading risk factors, and AF was the most commonly seen pathological rhythm in all hospitalized patients. These findings may be useful in understanding the characteristics of patients admitted to CCUs and thus in taking precautions to decrease CCU admissions.

Long-term results of migraine surgery and the relationship between anatomical variations and pain.

BACKGROUND: Migraine headache surgery has been recently reported and supported by studies as management to provide long-term relief in migraine sufferers. This study aimed to monitor the long-term results of patients who underwent migraine surgery in our clinic and determine the relationship between pain and anatomical anomalies. METHODS: A prospective review was conducted of 93 patients who underwent surgery for migraine headaches performed between 2017 and 2021 by the senior author (M.U.) and had at least 12 months of follow-up. Anatomical data were obtained by recording the findings during surgery. Migraine surgery was performed bilaterally in all patients. Anatomical symmetry differences between the right and left sides were recorded. RESULTS: A total of 79 (84.9%) patients experienced at least 50% reduction in migraine headache. Furthermore, 13 (14%) patients reported complete elimination of migraine headache. A significant difference was found before and after surgery in Migraine Disability Assessment score, migraine headache index, frequency, duration, and pain (p < 0.001). Also, 30 (32.3%) of the patients had bilateral headaches and 63 (67.7%) had primarily unilateral headaches. Then, 51 (81%) patients with mostly unilateral headache were anatomically asymmetrical and 12 (12%) were anatomically symmetrical. Patients with mostly unilateral headache were found to be anatomically highly asymmetrical (p < 0.005). CONCLUSIONS: This study shows that surgical treatment is effective and long-term protection and has mild complications that are easily tolerated by the patient. The fact that headache side and anatomical asymmetry were significant in this study supports the peripheral mechanism.

Use of TIMI Risk Index as a Simple and Valuable Prognostic Tool in Patients with ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention.

OBJECTIVE: Thrombolysis in Myocardial Infarction Risk Index is a risk stratification model developed to determine the prognosis in ST-segment elevation myocardial infarction patients who underwent fibrinolytic therapy. The information on the effectiveness of Thrombolysis in Myocardial Infarction Risk Index in patients who underwent primary percutaneous coronary intervention is limited. This study aimed to demonstrate the predictive value of Thrombolysis in Myocardial Infarction Risk Index on clinical outcomes in patients presenting with ST-segment elevation myocardial infarction and subsequently undergoing primary percutaneous coronary intervention. METHODS: A total of 963 patients who presented with ST-segment elevation myocardial infarction and subsequently underwent primary percutaneous coronary intervention were reviewed retrospectively. The discriminative power of Thrombolysis in Myocardial Infarction Risk Index for each outcome of congestive heart failure, death, stroke, and myocardial infarction within 1 month and 1 year after admission was assessed. RESULTS: Congestive heart failure, death, stroke, and myocardial infarction, and the major adverse cardiac events, which is the composite outcome thereof, were higher in the patient groups with high Thrombolysis in Myocardial Infarction Risk Index values (P < .05). Thrombolysis in Myocardial Infarction Risk Index was an independent predictor of the following outcomes: 1-month survival rate [odds ratio:1.054 (1.036-1.073)], 1-year survival rate [odds ratio:1.048 (1.031-1.065)], hospitalization rate due to congestive heart failure within 1 month [odds ratio:1.041(1.026-1.057)], and within 1 year [odds ratio:1.040 (1.024-1.055)]. The Thrombolysis in Myocardial Infarction Risk Index level was found to have good discriminative power for 1-month mortality and 1-year mortality rates (Thrombolysis in Myocardial Infarction Risk Index: 22.76, C-statistic: 0.71-0.68, respectively). CONCLUSION: The results of this study indicated that Thrombolysis in Myocardial Infarction Risk Index value is an independent predictor of clinical outcomes such as death and heart failure but not subsequent myocardial infarction in ST-segment elevation myocardial infarction patients. The use of Thrombolysis in Myocardial Infarction Risk Index can be considered in ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention as it is an easily applicable and important indicator of prognosis.

Long term effects of mild severity COVID­19 on right ventricular functions.

Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease that has spread rapidly. COVID-19 has been associated with a number of cardiovascular involvements, including ventricular functions. The aim of our study was to evaluate the right ventricular functions of mild severity COVID-19 patients 3 months after, and compare them to the right ventricular functions of healthy volunteers. For this single-center study, data from 105 patients who were treated for mild severity COVID-19 between September 15, 2020 and December 31, 2020 were collected. 105 age and sex matched healthy subjects were included in the study. Right ventricular (RV) functions were evaluated using conventional two-dimensional (2D) echocardiography and 2D speckle-tracking echocardiography (STE) for all patients. 2D-E parameters indicating RV functions were compared between the two groups. RV diamaters, systolic pulmonary artery pressure (sPAP) and RV myocardial performance index (RV MPI) were significantly higher in the COVID-19 patients compared to control group (p < 0.05). Tricuspid annular plane systolic motion (TAPSE), right ventricular fractional area change (RVFAC) and RV S' were significantly lower in the COVID-19 group compared to control group (p < 0.05). RV global longitudinal strain (RV-GLS) (- 19.6 ± 5.2 vs. - 15.1 ± 3.4, p < 0.001) and RV free wall longitudinal strain RV-FWLS (- 19.6 ± 5.2 vs. - 17.2 ± 4.4, p < 0.001) values were significantly lower in the COVID-19 group than the control group. There was a significant negative correlation between RV-FWLS, RV-GLS and C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), d-dimer, ferritin, platelet to lymphocyte ratio (PLR) in patients with mild severity COVID-19. This results suggested that RV-GLS and RV-FWLS decreased in the long term (third month) follow-up of patients treated for mild severity COVID-19 disease. Subclinical RV dysfunction may be observed in patients after mild severity COVID-19.

Relationship between morning blood pressure surge and the frontal plane QRS-T angle in newly diagnosed hypertensive patients.

BACKGROUND: Morning blood pressure surge (MBPS) plays an important role in target organ damage and major adverse cardiac events. The frontal QRS-T [f(QRS-T)] angle is the electrocardiographic marker and index of ventricular arrhythmogenic events. We aimed to investigate the relationship between MBPS and the f(QRS-T) angle, which is an indicator of ventricular repolarization disorder, in patients with newly diagnosed HT. METHODS: Between June 2020 and March 2021, 263 patients with newly diagnosed HT who were admitted to our outpatient clinic were prospectively included in the study. According to ambulatory blood pressure monitoring (ABPM), the patients were categorized into two groups: Group-I: low-value MBPS (<37 mm Hg), and group-II: high-value MBPS (≥37 mm Hg). The f(QRS-T) angle calculated from the 12-lead electrocardiogram and all other data were compared between the groups. RESULTS: A total of 186 newly diagnosed HT patients who met the inclusion criteria were included in the study. The average f(QRS-T) angle in Groups I and 2 was 21° ± 16° and 51° ± 30°, respectively (P < .001). According to multivariate regression analysis, T peak-end and MBPS were found to be independent predictors of the f(QRS-T) angle. CONCLUSIONS: As a result of our study, we found that the f(QRS-T) angle was widened in patients with exaggerated MBPS. The cause of increased cardiovascular outcomes in patients with exaggerated MBPS may be explained by widened in the f(QRS-T) angle that is a ventricular repolarization parameter.

Immediate and long-term outcomes of cryoballoon catheter ablation in patients with atrial fibrillation and left common pulmonary vein anatomy.

PURPOSE: The efficacy of cryoballoon (CB) for atrial fibrillation (AF) ablation is still debatable in case of anatomical variations like left common pulmonary vein (LCPV). We aimed to assess the impact of LCPV trunk on the acute and long-term clinical outcomes in patients with CB based AF ablation. METHODS: We compared a total of 82 AF patients (62.5% paroxysmal and 37.5% persistent) who underwent pulmonary vein isolation using CB (LCPV+ group) with a propensity score-matched cohort of 76 AF patients (LCPV- group) (61.8% paroxysmal and 38.2% persistent). Preprocedural computed tomography was performed in all patients and ostial dimensions and trunk distance were measured. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥ 30 s) after a 3-month blanking period. RESULTS: Acute procedural success was similar between the groups (100% and 98.7% for LCPV- and LCPV+, respectively, P = 0.991). Overall, 22/76 (28.9%) patients in LCPV- and 21/82 (25.6%) patients in LCPV+ had ATa recurrence at a mean follow-up of 31 ± 15 months (P = 0.770). A multivariate analysis identified only the left atrial (LA) diameter as a predictor of recurrent ATs (HR, 3.28; 95% CI, 1.67-6.41; P = 0.001). In the LCPV+ group, patients with single application had higher ATa recurrence (8/18 patients) compared with sequential freeze group (13/64 patients) (P = 0.042). CONCLUSIONS: Our findings indicated that CB was an effective tool in patients with LCPV and freedom from ATa was similar between LCPV- and LCPV+ groups. Only LA diameter predicted the ATa recurrence during long-term follow-up.

Acute and long-term outcomes of left-sided atrioventricular node ablation in patients with atrial fibrillation.

PURPOSE: To present our experience regarding acute and long-term outcomes of left-sided atrioventricular node (AVN) ablation in patients with atrial fibrillation (AF). METHODS: A total of 47 patients with AF in whom left-sided AVN ablation via retroaortic approach as a first-line approach were enrolled in this retrospective study. Indications for AVN ablation were high ventricular rate refractory to medical therapy, inappropriate implantable cardioverter defibrillator (ICD) shocks, or loss of cardiac resynchronization therapy (CRT) pacing. Both acute and long-term outcomes were assessed for all participants. RESULTS: Left-sided AVN ablation was successfully performed in 46/47 (98%) patients without any procedural complication. In the remaining 1 patient (2%), right-sided AVN ablation was performed. No mortality was observed within 30 days of the procedure. Upgrade to CRT was performed in 9 (19%) of the patients. During the median 22.5 months of follow-up, all-cause mortality was 25%. Device interrogations on the last clinical visit revealed complete AV block and intrinsic ventricular rate of < 40 bpm in all patients. CONCLUSION: Left-sided AVN ablation is a safe and effective procedure without recurrence during long-term follow-up.

Comparison of standard vs modified "figure-of-eight" suture to achieve femoral venous hemostasis after cryoballoon based atrial fibrillation ablation.

BACKGROUND: Immediate hemostasis following removal of sheaths is essential to prevent access site complications after atrial fibrillation (AF) ablation. Despite various precautions to achieve complete hemostasis in a safe and effective manner, no standard approach is present yet. OBJECTIVE: We aimed to compare the efficacy and safety of standard vs modified figure-of-eight (sFoE vs mFoE) suture for immediate venous hemostasis after cryoballoon (CB) AF ablation. METHODS: A total of 150 patients who underwent CB catheter ablation were sequentially allocated to either sFoE (n = 75) or mFoE (n = 75) suture to achieve immediate venous hemostasis at right femoral access site after 15 Fr sheath removal. A "three-way stopcock" was used in the mFoE group rather than tying the knot as in a sFoE group. Demographics, clinical and procedural data, and access site complications were recorded. RESULTS: Immediate haemostasis was achieved in all patients (n = 75) with mFoE suture as compared to 90.7% (n = 68) of sFoE suture group (P < .001). Light manual pressure of ≤1 min was required in five patients (6.7%) due to looseness and conventional manual compression because of the snapped silk suture during knotting was required in two patients (2.6%) in the sFoE group. Time to hemostasis was shorter in the mFoE group (P < .001), but time to ambulation and time to discharge were similar in both groups (P > .05). Although no minor or major access site complication has occurred in the mFoE group, in-hospital rebleeding (n = 2, 2.7%) and early local access site infection (n = 2, 2.7%) were observed in the sFoE group. CONCLUSION: The mFoE suture using three-way stopcock is an available, effective, maybe safe, and time- and cost-saving alternative technique to achieve immediate hemostasis after removal of 15 Fr right femoral venous sheath in patients undergoing cryoablation.

Successful resuscitation of prolonged cardiac arrest occurring in association with 'skunk' and toluene toxicity.

We report a case of prolonged and successful resuscitation following cardiotoxicity-related arrest occurring after inhaling toluene and Skunk, which is an increasingly popular synthetic cannabinoid (SC). Following presentation to the emergency department because of lethargy, nausea and chest pain, a 28-year-old male user of Skunk and toluene suffered from cardiac arrest due to ventricular fibrillation (VF). Cardiogenic shock, severe metabolic acidosis and regular wide QRS tachycardia were observed in the patient, and he developed VF every 5-10 minutes over the course of 10 hours. The patient responded to prolonged resuscitation and was discharged on 8th day of his admission in a healthy condition. This case report is the first report that cardiac arrest occurring as a result of Skunk and toluene inhalation, which was resolved without sequelae after prolonged resuscitation.