Leadless pacemaker implantation following tricuspid interventions: multicenter collaboration of feasibility and safety.

BACKGROUND: Permanent pacing is often required following valve intervention (either surgical or percutaneous); however, tricuspid interventions pose specific challenges to conventional pacing. Therefore, leadless pacemaker (LP) implantation may be the preferred strategy when permanent pacing is required after tricuspid valve intervention. PURPOSE: To report periprocedural outcomes and follow-up of patients undergoing implantation of a LP system following tricuspid valve interventions. METHODS: Patients with previous tricuspid valve intervention at the time of attempted implantation of a LP (MicraTM, Medtronic, Minneapolis, MN, USA) were included. RESULTS: Between 2019 and 2022, 40 patients underwent LP implantations following tricuspid interventions in 5 large tertiary centers. The mean age was 68.9 ± 13.7 years, and 48% patients were male. The indication for pacing was as following: AVB in 27 (68%) patients, AF with slow ventricular response in 10 (25%) patients, and refractory rapid atrial fibrillation (AF) referred to AV junction ablation in 3 (7%) patients. Most of the patients received Micra VR (78%). The procedure was successful in all patients. The mean procedural time is 58 ± 32 min, and the median fluoroscopy time is 7.5 min. Electrical parameters were within normal range (threshold: 1.35 ± 1.2 V@0.24 ms, impedance: 772 ± 245 Ohm, R-wave: 6.9 ± 5.4 mV). No acute complications were observed. During a mean follow-up of 10 months, electrical parameters remained stable, and 4 deaths were occurred (not related to the procedure). CONCLUSION: A LP is a safe and efficient option following tricuspid valve interventions.

Assessment of subtle cardiac dysfunction induced by premature ventricular contraction using two-dimensional strain echocardiography and the effects of successful ablation.

INTRODUCTION AND OBJECTIVES: We aimed to assess the effects of successful ablation on impaired left ventricular global longitudinal strain (LV-GLS) in patients with frequent premature ventricular contractions (PVCs). We also evaluated the potential risk factors of impaired LV-GLS. METHODS: Thirty-six consecutive patients without any structural heart disease, who were treated with radiofrequency (RF) ablation due to frequent PVCs, were included in the study. All patients were evaluated with standard transthoracic and two-dimensional speckle tracking echocardiography. RESULTS: Mean LV-GLS before ablation was 17.3±3.7 and 20.5±2.6 after ablation; the difference was statistically significant (p<0.01). Patients were categorized into two groups: those with LV-GLS value >-16% and those ≤16%. Low PVC E flow/post-PVC E flow and PVC SV/post-PVC SV ratios were associated with impaired LV-GLS. CONCLUSION: In symptomatic patients with frequent PVCs and normal left ventricular ejection fraction, we observed significant improvement in LV-GLS value following successful RF ablation. Patients with impaired LV-GLS more often display non-ejecting PVCs and post-extrasystolic potentiation (PEP) compared to patients with normal LV-GLS.

Prenatal Sonographic Three-dimensional Virtual Organ Computer-assisted Analysis Thymic Volume Calculation May Predict Intrauterine Growth Restriction.

Background: Intrauterine growth restriction (IUGR) refers to fetuses that are small for their gestational age. There is no effective test to predict this disease. The aim of our study is whether fetal three-dimensional (3D) ultrasonography (USG)-assisted thymus volume (TV) measurement predicts IUGR cases. Methods: Fetal 3D USG thymus measurement between 15 and 24 weeks of gestation was performed in a total of 100 women of reproductive age. Fetal TV was measured using the virtual organ computer-assisted analysis system program. All cases were followed up in terms of pregnancy complications until delivery. Results: IUGR was developed in six cases in total. In cases with IUGR, mean fetal TV was found to be statistically significantly lower than in healthy cases without it. When the fetal TV was taken as 0.1645, the sensitivity was calculated as 89.5% and the specificity as 50% for predicting IUGR. The use of low fetal volume parameters is a significant and good indicator for predicting IUGR according to the binary logistic regression analysis result. Conclusion: According to the results of this study, 3D fetal TV measurement may be used in routine second-trimester sonographic anomaly screening to predict the development of fetal IUGR. In this way, fetal mortality and morbidity caused by IUGR may be reduced.

Brugada phenocopy associated with multiple psychotic drugs.

Brugada phenocopy (BrP) is a clinical condition characterized by transient ECG changes of Brugada syndrome (BrS), which can be due to various clinical conditions. We describe a case report of BrP due to psychotic drugs.

Impact of Promising Biomarkers on Severity and Outcome of Acute Pulmonary Embolism.

Background: Acute pulmonary embolism (APE) is a common clinical condition. Its severity ranges from asymptomatic radiological findings to fatal obstructive shock. The potential circulating biomarkers have been studied to predict APE outcomes. This study aimed to explore their predictive power on prognosis in APE. Material and Method: It was a prospective observational study between March 2008 and April 2010. All consecutive patients diagnosed with APE were categorized as massive/high-risk, submassive/moderate-risk, and non-massive/low-risk. Cardiac troponin T (cTnT), myoglobin, N-terminal pro-brain natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein (H-FABP), growth differentiation factor-15 (GDF-15), and D-dimer levels were measured. Results: Of these patients, 14 (29.8%), 16 (34.0%), and 17 (36.2%) patients were categorized as low-risk, moderate-risk, and high risk-patients, respectively. There was no significant difference between the patient groups categorized based on the risk stratification in terms of demographic and clinical characteristics. The cTnT, myoglobin, HFABP, and D-dimer levels have also not differed significantly between the groups. There was a significant difference between the groups in respect of NT-proBNP and GDF-15 levels (p=0.009 and p=0.037, respectively). Nine (19.1%) patients had died by the 3rd-month follow-up. Adverse events were seen in 26 (55.3%) patients. GDF-15 had the highest area under the curve (AUC) value for predicting any adverse event (cut-off value=9.3 ng/mL, AUC=0.796, CI (confidence interval) 95%: 0.653-0.899). NT-ProBNP was determined as the best predictor for mortality (cut-off value=229.2 pg/mL, AUC=0.889, CI 95%: 0.756-0.964). Conclusion: Higher levels of NT-proBNP and GDF-15 were found to be associated with more severe APE, worse outcomes, and mortality.

Evaluation of the relationship between monocyte to high-density lipoprotein cholesterol ratio and thrombus burden in patients with deep vein thrombosis.

OBJECTIVE: The purpose of this study was to evaluate monocyte count and high-density lipoprotein cholesterol levels and their ratio (monocyte/high-density lipoprotein ratio) in patients with deep venous thrombosis as well as to determine whether this ratio at the time of diagnosis can be an indicator of thrombus burden in terms of thrombus location in deep venous thrombosis. METHODS: We retrospectively analyzed the patient's diagnosis of deep venous thrombosis confirmed with venous Doppler ultrasound, using a database query for outpatients between 2018 and 2022. Of 378 patients included, blood count results at the time of diagnosis were available for 356. We recruited 300 age- and sex-matched patients with appropriate blood counts, without a diagnosis of deep venous thrombosis, as the control group, by querying the outpatient clinic database. The monocyte/high-density lipoprotein ratio was computed from the ratio of monocyte count to high-density lipoprotein-C. Patients were categorized based on the level of thrombus and the number of vein segments involved as evidenced by Doppler ultrasound findings. RESULTS: The serum level of monocyte/high-density lipoprotein ratio was significantly higher in the patient group compared to the control group (p<0.01). Patients with proximal deep venous thrombosis had a higher mean monocyte/high-density lipoprotein ratio (19.6±5.1 vs. 17.1±5.5; p<0.01) than patients with distal deep venous thrombosis. Monocyte/high-density lipoprotein ratio increased with the number of vein segments involved (p<0.01). CONCLUSION: Monocyte/high-density lipoprotein ratio is significantly elevated in patients with deep venous thrombosis when compared to the control group. Monocyte/high-density lipoprotein ratio levels were correlated with disease burden reflected by thrombus location and the number of vein segments involved in deep venous thrombosis patients.

Association Between History of Polymerase Chain Reaction-verified COVID-19 Infection and Outcomes of Subsequent ST-Elevation Myocardial Infarction.

While the acute phase of coronavirus disease 2019 (COVID-19) is associated with worsening cardiac outcomes, it is unclear whether it affects the outcome of patients with ST-segment elevation myocardial infarction (STEMI) after the acute phase. In addition, while many studies compared the course of STEMI during the COVID-19 pandemic with the years before the outbreak, we evaluated the course of STEMI during the pandemic according to whether or not patients had history of COVID-19. Patients diagnosed with STEMI during the ongoing COVID-19 pandemic were included in the study. The Ministry of Health database was analyzed retrospectively, and patients with (n = 191) and without (n = 127) a history of polymerase chain reaction (PCR) confirmed COVID-19 infection were divided into groups. Clinical and angiographic characteristics were assessed. The rates of in-hospital major adverse cardiac events (MACE) were higher in those who had a history of PCR-verified COVID-19 infection. Angiographic and procedural findings indicating successful reperfusion were better in patients without a history of COVID-19. A history of COVID-19 infection (odds ratio 1.40, 95% confidence interval 1.25-1.60, P < .01) independently predicted MACE. A history of COVID-19 infection is a predictor of worse outcomes following coronary intervention and in-hospital MACE among patients with STEMI.

Cardiovascular drugs and analysis of potential risk factors associated with mortality in severe coronavirus disease 2019 patients.

OBJECTIVES: Cardiovascular diseases are also considered to increase the risk of death in COVID-19 patients. However, real-world data concerning the risk factors for death in patients with severe COVID-19 still remain vague. This study aimed to identify the potential risk factors associated with mortality in severe COVID-19 patients. METHODS: All consecutive patients admitted to the intensive care unit (ICU) of our institute for COVID-19 for severe COVID-19 pneumonia from April 1, 2020 to July 20, 2020 were included in the analysis. Patient characteristics, including complete medical history and comorbid diseases, blood test results during admission and on day 7, and clinical characteristics were compared between survivors and nonsurvivors. RESULTS: There was no significant difference between survivors and nonsurvivors regarding age, gender, and preexisting cardiovascular diseases. Moreover, the rate of the medications including angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blockers did not differ between survivors and nonsurvivors. The peak C-reactive protein (CRP), procalcitonin, fibrinogen, and d-dimer levels and the rate for chronic renal failure were significantly higher in nonsurvivors compared with survivors. Intubated patients had a higher risk of death than the others had. CONCLUSIONS: This study failed to demonstrate a significant difference in preexisting cardiovascular diseases and cardiovascular medications between survivors and nonsurvivors who were admitted to ICU for severe COVID-19. Our findings indicate that the presence of chronic renal failure, a high peak ferritin concentration, and the need for invasive mechanical ventilation appear predictive for mortality. We propose that these risk factors should be taken into account in defining the risk status of severe COVID-19 patients admitted to the ICU.

Prasugrel-related hepatotoxicity.

Prasugrel is usually preferred over Clopidogrel to reduce the risk of recurrent coronary thrombosis in patients who undergo percutaneous coronary interventions during an acute coronary syndrome owing to its more potent and more rapid antithrombotic activation. Little is known about Prasugrel-induced hepatotoxicity, although mild-to-moderate alanine transaminase (ALT) and gamma glutamyl transpeptidase (GGT) elevations have been noticed in post-marketing surveillance. Herein, we report the case of a patient with Prasugrel-related hepatotoxicity that was reverted after switching from Prasugrel to Ticagrelor.

Evaluation of the aortic velocity propagation, epicardial fat thickness, and carotid intima-media thickness in patients with subclinical hypothyroidism.

Subclinical hypothyroidism (SH) is associated with hemodynamic and metabolic abnormalities that cause endothelial dysfunction and atherosclerotic cardiovascular diseases. Aortic velocity propagation (AVP), epicardial fat thickness (EFT), and carotid intima-media thickness (CIMT) may provide additional information in SH patients. This study aimed to evaluate thyroid stimulating hormone (TSH), AVP, EFT, and CIMT in SH patients, and determine the associations among these parameters. Eighty patients with SH and 43 euthyroid (EU) individuals were enrolled. Blood samples were collected to measure laboratory parameters. Patients were divided into two groups based on their TSH values (TSH ≥10 or TSH <10 mIU/L). AVP, EFT, and CIMT were measured and compared between the study groups. A multivariate linear regression model was used for analysis of the independent predictors of AVP (beta = -0.298; 95% confidence interval = -0.946 to -0.287; p < 0.001). AVP was significantly lower in SH patients than the control group (43.7 ± 12.5 and 62.6 ± 13.8, respectively; p < 0.001). EFT values were similar between the SH and control groups (0.7 ± 0.3 and 0.6 ± 0.2, respectively; p = 0.10). SH patients had higher CIMT values than the control group (0.8 ± 0.3 and 0.5 ± 0.2, respectively; p < 0.001). In the multivariate linear analysis, TSH was an independent predictor of AVP. AVP was lower and CIMT was higher in SH patients compared to EU individuals. The increased CIMT and decreased AVP levels were significantly associated with TSH levels in SH patients.

The Association of Glomerular Filtration Rate With Echocardiographic Parameters in Chronic Kidney Disease.

BACKGROUND: Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in chronic kidney disease (CKD) patients. Aortic propagation velocity (APV), epicardial fat thickness (EFT) and carotid intima-media thickness (CIMT) measurements could provide additional information on assessing renal decline in CKD patients. The study aimed to evaluate EFT, AVP and CIMT in CKD patients and then investigate the association among those parameters. METHODS: A total of 170 CKD consecutive subjects were enrolled in the study. Patients were divided into five groups according to their estimated glomerular filtration rate (eGFR) values. Each patient underwent complete transthoracic echocardiography examination. APV, EFT and CIMT were measured for analyses. A multivariate linear regression model was used for analysis to determine the independent predictors of eGFR. RESULTS: The lowest APV was observed in stage IV-V, and the highest APV was observed in stage I-II (P < 0.001). Stage IV-V patients had the highest EFT and stage I-II patients had the lowest EFT (P < 0.001). Moreover, the lowest CIMT was observed in stage III, and the highest CIMT was observed in stage V (P < 0.001). eGFR was significantly and positively correlated with APV and negatively correlated with EFT and CIMT. In multivariate analyses, APV (odds ratio (OR): 0.289, P < 0.001), EFT (OR: -0.135, P < 0.001) and CIMT (OR: -0.388, P < 0.001) were independent predictors of eGFR. CONCLUSION: We found that APV decreased, and EFT and CIMT increased as CKD progress. The present study suggests that APV, EFT and CIMT might be incorporated with the examination of CKD patients in daily practice.

Lymphocyte to monocyte ratio may predict increased carotid intima-media thickness in patients with subclinical hypothyroidism.

BACKGROUND: Inflammation has an important role in the pathogenesis of atherosclerosis. Lymphocyte-to-monocyte ratio (LMR) is accepted as an indicator of inflammation. OBJECTIVE: Our aim was to scrutinize the relationship between LMR and subclinical atherosclerosis (SubAth) measured by carotid intima-media thickness (CIMT) in subclinical hypothyroidism (SubHT). METHODS: Newly identified 190 SubHT patients were prospectively included into the study. Blood samples were taken for measuring laboratory parameters. Then, CIMT was computed. Patients were seperated into 2 groups by their CIMT value (Group-1: ≤0.9 and Group-2: >0.9 mm), and then stratified into tertiles pursuant to LMR and thyroid-stimulating hormone (TSH) levels, respectively. RESULTS: 59 patients had an increased CIMT value (Group-2), and 131 patients had a normal CIMT value (Group-1). Group-2 had a lower LMR and a greater high-sensitivity C-reactive protein (hsCRP), CIMT and TSH than Group-1 (for all, p < 0.05). Patients in the lowest tertile of LMR had a higher hsCRP, TSH and CIMT than those in the highest tertile (for all, p < 0.05). LMR was negatively associated with hsCRP, CIMT and TSH (for all, p < 0.05). LMR and TSH were independent predictors of increased CIMT. CONCLUSIONS: Pre-ultrasonographic LMR, which is a simple and inexpensive inflammatory marker, may give additional predictive information to determine SubAth in SubHT.

Non-ST Elevation Myocardial Infarction Triggered by Subclavian Steal Syndrome.

Coronary-subclavian artery (SCA) steal syndrome is an uncommon phenomenon in which coronary flow is diverted into the SCA through the patent left internal mammary artery (LIMA) conduit due to critical subclavian stenosis. The prevalence of significant left SCA (LSCA) stenosis in patients, referred for coronary bypass surgery, has been reported to be 0.2 to 6.8%. Most patients usually present with angina pectoris, and secondary myocardial infarction is rarely reported. Herein, we present a case of coronary bypass graft in which a left anterior descending artery-LIMA graft was applied to supply the left arm due to complete LSCA occlusion. The patient was hospitalized with a diagnosis of non-ST elevation myocardial infarction.

Percutaneous intervention of sequential coronary venous graft.

We present a case with coronary bypass grafts in which venous graft was anastomosed to obtuse marginal (OM) 1 and OM2 branches sequentially. We performed percutaneous intervention to the proximal circumflex (CX), OM1, and bridging segment of the venous graft. Finally, bridging segment of the venous graft began to function as a CX body extending between the OM1 and OM2.

Impact of serum alkaline phosphatase level on coronary collateral circulation.

BACKGROUND: Serum alkaline phosphatase (ALP) level has been shown to be a prognostic factor for myocardial infarction and stroke via its promotion of vascular calcification. AIM: To investigate for the first time the correlation between serum ALP level and coronary collateral circulation (CCC) development. METHODS: A total of 356 patients with stable angina pectoris were evaluated retrospectively. Patients were classified according to ALP level and CCC grade. Rentrop 0-1 flow was defined as impaired CCC. Serum ALP > 129 mg/dL in men and > 104 mg/dL in women was defined as elevated ALP. All groups were compared statistically according to clinical, laboratory and demographic features. RESULTS: Impaired CCC was observed in 53.7% of the patients. The mean ALP level was 102.8 ± 57.9 mg/dL, and elevated ALP levels were obtained in 19.4% of cases. There was a significant correlation between ALP and CCC grade, and impaired CCC was associated with relatively higher ALP values (65.2% vs. 50.9%, p = 0.03). Multivariate regression analysis also showed a significant correlation between elevated ALP level and impaired CCC (OR 1.85, with a 95% CI 1.056-3.264; p = 0.03). CONCLUSIONS: Serum ALP is a widely avaliable unfavourable prognostic parameter in coronary heart disease. Elevated ALP levels were associated with inadequate CCC, which supports the previously reported literature concerning the negative prognostic value of ALP levels in cardiovascular settings.

Impact of serum alkaline phosphatase level on the pathophysiologic mechanism of contrast-induced nephropathy.

BACKGROUND: Contrast-induced nephropathy (CIN) accounts for 10% of all causes of hospital-acquired renal failure. It leadsto a prolonged in-hospital stay, and represents a powerful predictor of poor early and late outcomes. More than half of casesare observed after cardiovascular procedures. AIM: To determine the predictive value of the serum alkaline phosphatase (ALP) level in the development of CIN, something which has not been assessed before. METHODS: We prospectively evaluated a total of 430 patients with acute coronary syndrome. Patients were classified according to the development of CIN and both groups were compared statistically according to clinical, laboratory and demographic features, including the serum ALP level. RESULTS: CIN was observed in 20.5% of patients. Advanced age, male gender, elevated creatinine, uric acid and phosphate levels, and low glomerular filtration rate were correlated with the development of CIN. Correlation analysis also showed a significant association between the ALP level and the development of CIN (126.1 ± 144.9 vs. 97.2 ± 46.9, p = 0.004). Univariate regression analysis also showed the impact of ALP on the development of CIN (OR 1.004, 95% CI 1.001­1.007, p = 0.02). Conclusions: Our outcomes indicate a possible active role of ALP in the mechanism of CIN. An elevated ALP level may predict the development of CIN.

A case with a huge left ventricular thrombus growing over the posterior papillary muscle and chordae tendinae.

We present a case with a giant left ventricular thrombus grown over papillary muscle and chordae tendinae. The patient had declined both surgical and fibrinolytic therapy. After long-term anticoagulation therapy, regression was observed without embolic complication. Anticoagulation with warfarin may be preferred in such cases presenting with huge left ventricular thrombus encircling papillary muscle and chordae tendinae. .

Coronary-carotid artery collateral formation in Takayasu's arteritis: First reported case in the literature.

We present the first case report of coronary-carotid artery collateral formation in Takayasu's arteritis. There was a vasculitic involvement of both subclavian and carotid arteries with critical stenosis; cerebral perfusion was supported with collaterals arising from the mesenteric arteries and coronary artery. .