Evaluation of Inflammation-Based Prognostic Risk Scores in Predicting in-Hospital Mortality Risk in COVID-19 Patients: A Cross-Sectional Retrospective Study.

Objective: Systemic inflammatory parameters are predictors of poor prognosis in COVID-19 patients. This study evaluated whether the prognostic nutritional index, which was also related to nutrition risk and other inflammation-based prognostic scores, was predictive of in-hospital mortality in COVID-19 patients. Materials and Methods: This was a retrospective cross-sectional single-center study. Based on the exclusion criteria, 151 patients over 18 years old diagnosed with COVID-19 and hospitalized in the intensive care unit between March 2020 and December 2020 were eligible for this study. Multivariable logistic regression analysis was performed to evaluate the predictive value of the Glasgow Prognostic Score (GPS), Prognostic Index (PI), Prognostic Nutritional Index (PNI), and Systemic Inflammatory Index (SII). Results: In the univariate analyses, age, diabetes mellitus (DM), chronic kidney disease, acute kidney injury, hypothyroidism, hospitalization stay, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), D-dimer, ferritin, C-reactive protein (CRP), albumin, hemoglobin level, platelet count, urea, creatinine level, PNI, GPS were significantly associated with mortality. However, in the multivariable logistic regression analysis of the inflammation-based prognostic scores, only PNI was statistically significant in predicting in-hospital mortality (OR=0.83; [95% CI=0.71-0.97]; p =0.019). Conclusion: PNI is a more useful and powerful tool among these inflammation-based prognostic risk scores in predicting in-hospital mortality in COVID-19 patients.

Association between fragmented QRS and left ventricular dysfunction in acromegaly patients.

Background: In acromegaly patients; it has been observed that heart failure may develop even in the absence of predisposing factors such as hypertension, diabetes mellitus, so a specific acromegalic cardiomyopathy has been suggested. We aimed to evaluate the fQRS frequency in acromegaly patients and the left ventricular (LV) functions of acromegaly patients with fQRS.Methods: Our study included 60 acromegalic patients. Each patient underwent conventional echocardiography and tissue Doppler imaging. The patients included were separated into two groups: those with (n:23) and without (n:37) fQRS.Results: Significant differences were identified between fQRS(+) and fQRS (-) groups with respect to disease duration (p < .001), Left ventricular end diastolic volume (EDV) (p < .001), E velocity (p < .001), E\A ratio (p < .001), E' velocity (p < .001), E/E' ratio (p < .001), isovolumic relaxation time (IVRT) (p < .001), MPI (p < .001). Disease duration (odds ratio [OR]: 2.120 (1.023-1.703 95% confidence interval [CI]), p = .002), E' (OR:3.029 (1.013-1.703 95% CI) p = .004) and fQRS (OR:4.59 (1.94-10.87 95% CI), p = .001) were identified as the independent predictors of myocardial performance index (MPI). However, disease duration (OR:1.078 (1.030-1.128 95% CI), p = .001), E/E' (OR: 1.43 (1.22-1.97 95% CI), p = .001), IVRT (OR:1.65 (1.32-2.06 95% CI), p = .001) and MPI (OR:1.014 (1.004-1.024 95% CI), p = .002) were the independent predictors of fQRS.Conclusions: fQRS was frequent and an independent predictor of MPI that was independelty associated with LV dysfunction in patients with acromegaly. In light of these findings the presence of fQRS is thought to be an indicator of acromegalic CMP development.

Evaluation of left atrial volume and function by real time three-dimensional echocardiography in anemic patients without overt heart disease before and after anemia correction.

There are few data on the effects of low hemoglobine levels on the left atrium (LA) in anemic patients. Our aim was to evaluate left atrial (LA) volume and functions in anemic patients using real time three-dimensional echocardiography (RT3DE) and also to investigate changes in variables of LA after the correction of anemia. In total, 55 iron-deficiency anemia patients without traditional cardiovascular (CV) risk factors and 30 age- and gender-matched controls were studied. Assessments included history, physical examination and echocardiography. Of the 55 patients with anemia enrolled, 50 (39 females and 11 males 40.3 years) were followed and underwent echocardiography after correction of the anemia. LA maximum volume (LAVmax), LA minimal volume (LAVmin), LAVmax index (LAVI), before atrial contraction volume (LAVpreA), LA total emptying fraction, LA active emptying volume were higher in anemic patients. LA passive emptying fraction was significantly lower in anemic patients. Following correction of anemia, LA volume and function parameters were observed to be significantly reduced. Moreover, significant increase was noted in LA passive emptying fraction. Correlation analysis was performed and a significant negative correlation was noted between the percentage change in hemoglobin level and percentage change in LAVI (r = - 0.382, p = 0.003). It was shown that volume and functions of LA are impaired in anemic patients. However impaired parameters were improved after correction of anemia. It may be thought that RT3DE LA parameters can be used as an important preclinical marker of disease pathogenesis before developing heart failure or atrial arrhythmia.

Evaluation of left atrial volume and functions by real time three-dimensional echocardiography in patients with subclinical hypothyroidism before and after levothyroxine therapy.

BACKGROUND/AIMS: The cardiovascular system is one of the major targets of thyroid hormones. Subclinical hypothyroidism (SCH) is a common disease that can represent "early" thyroid failure. Our aim was to evaluate left atrial (LA) volume and functions in patients with SCH using real time three-dimensional echocardiography (RT3DE) and also to investigate changes in LA parameters after the levothyroxine treatment. METHODS: In total, 44 patients with SCH and 40 age- and gender-matched controls were studied. Assessments included history, physical examination and echocardiography. All patients with SCH were followed up with replacement therapy until the euthyroid status was achieved. RESULTS: In patients with SCH, LA total emptying volume, passive emptying volume, and passive ejection fraction were significantly reduced while LA minimal volume, active emptying volume, and active emptying fraction were significantly increased than in control group. Following the levothyroxine treatment, LA volume and function parameters were observed to be significantly improved. A negative correlation between the change of thyroid stimulating hormone (TSH) and change of LA active emptying volume and a positive correlation between the change of TSH level and change of LA passive emptying volume were found. CONCLUSION: It was shown that volume and functions of LA were impaired in patients with SCH. However, impaired parameters were improved after the levothyroxine treatment. These findings may be indicative of subclinical heart involvement that could lead to functional and structural changes in patients with SCH.

Effects of coronary angiography and femoral arterial access on endothelial functions.

BACKGROUND: Impairment of endothelial function is an independent predictor of coronary events. The aim of this study was to clarify the influence of arterial access and coronary angiography on endothelial function. METHODS: Eighteen patients with stable angina pectoris who underwent coronary angiography were included in this study. Brachial artery flow-mediated dilatation of patients was measured before angiography, after femoral arterial sheath insertion, and after coronary angiography. RESULTS: Of 18 patients, 11 had angiographically apparent atherosclerosis. Flow-mediated dilatation after femoral arterial sheath insertion (mean ± SD, 6.62% ± 3.87%) was found to be significantly lower than either before (10.62% ± 5.18%) or after coronary angiography (11.66% ± 5.30%; P = 0.007 and P = 0.001, respectively). Basal and postangiographic flow-mediated dilatation values were similar. Flow-mediated dilatation significantly decreased after sheath insertion in the group with angiographically normal coronary arteries (14.47% ± 4.34% vs 5.98 ± 4.00%, respectively; P = 0.006), whereas the difference was not significant in patients with CAD (8.17% ± 4.16% vs 7.03% ± 3.92%, respectively). CONCLUSIONS: Coronary angiography did not result in endothelial vasomotor dysfunction. Femoral arterial sheath insertion during coronary angiography was associated with a short-lived endothelial dysfunction. Larger studies are needed to interpret the effect of coronary atherosclerosis on attenuation of endothelial response against arterial wall injury.

Differences in autonomic activity in individuals with optimal, normal, and high-normal blood pressure levels.

OBJECTIVES: We investigated differences in autonomic activity in normotensive individuals having optimal, normal and high-normal blood pressure (BP) levels according to the guidelines of the European Society of Hypertension and European Society of Cardiology (ESH/ESC). STUDY DESIGN: The study included 294 normotensive subjects (135 males, 159 females; age range 16 to 75 years) with similar clinical, morphometric, biochemical, electrocardiographic, and echocardiographic features. The subjects were classified into the following BP groups: group 1 (n=113) with optimal BP (<120/80 mmHg); group 2 (n=104) with normal BP (120-129/80-84 mmHg), and group 3 (n=77) with high-normal BP (130-139/85-89 mmHg). All the subjects underwent 24-hour Holter monitoring to obtain heart rate variability (HRV) parameters of 24-hour, daytime, and nighttime periods. Normalized low (LFn) and high (HFn) frequency powers, and logarithmic (Log) values of HRV parameters were also calculated. RESULTS: On 24-hour Holter monitoring, heart rates were similar in three groups. Compared to group 1 and 2, group 3 exhibited significantly higher LF/HF (p<0.001) and LFn (p=0.001) values, and significantly lower HFn (p=0.001), pNN50 (p=0.001), and rMSSD (p=0.005) values. There were no significant differences between the groups with respect to daytime HRV parameters; however, nighttime LF/HF, LFn, and HFn values were significantly different between the groups. Log LF/HF values obtained during the 24-hour and nighttime periods showed significant differences between group 1 and group 3 (for 24 hours, p<0.001; for night, p=0.001) and between group 2 and group 3 (for 24 hours, p<0.001; for night, p=0.009), but group 1 and group 2 did not differ significantly in this respect (p>0.05). CONCLUSION: These findings suggest that subjects with high-normal BP have increased sympathetic activity and decreased parasympathetic activity, possibly making them more liable to hypertension.