Baseline Anemia Is an Independent Predictor of Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation.

This study aimed to investigate the relationship between baseline anemia and long-term mortality in a single-center retrospective study involving patients undergoing transcatheter aortic valve implantation (TAVI). The study population included 412 consecutive patients undergoing TAVI at a center for severe aortic valve stenosis between August 2011 and November 2018. The primary end point of the study was all-cause mortality. Baseline anemia was present in 50% of our study cohort. During the median follow-up of 29 months, all-cause mortality was observed in 40.3% of the whole study population and was more frequently observed in the anemic group compared with the nonanemic group (53.5% vs 27.1%, P < .001, respectively). Cox-regression analysis revealed that Society of Thoracic Surgeons Predicted Risk of Mortality score, previous stroke, pericardial tamponade, and neutrophil-lymphocyte ratio count are independent predictors of long-term mortality after TAVI. Additionally, the presence of anemia at baseline was an independent predictor of long-term mortality with a 2.3-fold difference in the anemic group compared with the nonanemic group (hazard ratio: 2.31, 95% CI: 1.59-3.37, P < .001). Baseline anemia was observed in half of our patient population undergoing TAVI, and baseline anemia was found to be an independent predictor of long-term mortality after TAVI.

Prognostic utility of pulmonary artery and ascending aorta diameters derived from computed tomography in COVID-19 patients.

AIM: Chest computed tomography (CT) imaging plays a diagnostic and prognostic role in Coronavirus disease 2019 (COVID-19) patients. This study aimed to investigate and compare predictive capacity of main pulmonary artery diameter (MPA), ascending aorta diameter (AAo), and MPA-to-AAo ratio to determine in-hospital mortality in COVID-19 patients. MATERIALS AND METHODS: This retrospective study included 255 hospitalized severe or critical COVID-19 patients. MPA was measured at the level of pulmonary artery bifurcation perpendicular to the direction of the vessel through transverse axial images and AAo was measured by using the same CT slice at its maximal diameter. MPA-to-AAo ratio was calculated by division of MPA to AAo. RESULTS: Multivariate logistic regression model yielded MPA ≥29.15 mm (OR: 4.95, 95% CI: 2.01-12.2, p = 0.001), MPA (OR: 1.28, 95% CI: 1.13-1.46, p < 0.001), AAo (OR: .90, 95% CI: .81-.99, p = 0.040), and MPA-to-AAo ratio ≥.82 (OR: 4.67, 95% CI: 1.86-11.7, p = 0.001) as independent predictors of in-hospital mortality. Time-dependent multivariate Cox-proportion regression model demonstrated MPA ≥29.15 mm (HR: 1.96, 95% CI: 1.03-3.90, p = 0.047) and MPA (HR: 1.08, 95% CI: 1.01-1.17, p = 0.048) as independent predictors of in-hospital mortality, whereas AAo and MPA-to-AAo ratio did not reach statistical significance. CONCLUSION: Pulmonary artery enlargement strongly predicts in-hospital mortality in hospitalized COVID-19 patients. MPA, which can be calculated easily from chest CT imaging, can be beneficial in the prognostication of these patients.

Plasma thiol and disulphide levels and their relationship with left ventricular systolic functions: A propensity score matching analysis.

OBJECTIVE: Left ventricular (LV) systolic function measured through LV ejection fraction (LVEF) has prognostic implications in patients with cardiac and non-cardiac conditions. The balance of thiol and disulphide levels reflects oxidative status in the body. In this study, we aimed to investigate the relationship between plasma thiol and disulphide levels, and LVEF calculated by transthoracic echocardiography (TTE). METHODS: This retrospective study included 1,048 patients referred for TTE examination and biochemical analyses, including plasma thiol and disulphide levels. After the application of exclusion criteria, the remaining 611 patients were included in the statistical analysis. Patients were classified into two groups, namely normal LVEF (n-LVEF) (n=446) and low LVEF (l-LVEF) (n=165) according to a cut-off level of LVEF 50%. To reduce sample selection bias and adjust for the influence of differences in patient characteristics on LVEF and oxidative status, 1: 1 propensity score matching analysis was applied. RESULTS: Propensity score matching analysis yielded 125 patients in both groups with comparable demographics, medications, and blood parameters. Native thiol and total thiol levels were lower in l-LVEF patients than in n-LVEF patients (p<0.001 for both), whereas disulphide levels were higher in l-LVEF group (p=0.008). Native thiol (r=0.384, p<0.001), total thiol (r=0.35, p<0.001), and disulphide levels (r=-0.129, p=0.004) significantly correlated with LVEF. CONCLUSION: Plasma thiol levels decrease and disulphide levels increase suggesting the presence of oxidative stress in patients with l-LVEF. Significant correlation between oxidative stress and LVEF sheds light about the possible pathogenetic role of thiol and disulphide in heart failure.

The relationship between calcific severe aortic stenosis and systemic immune-inflammation index.

AIM: Calcific aortic stenosis (AS) is a common valvular disease especially in elderly population. Inflammation plays significant role in the pathophysiological mechanism. Systemic immune-inflammation index (SII) is a novel marker of immune system and inflammation that includes neutrophil, lymphocyte, and platelet cell counts. The aim of this study was to investigate the predictive value of SII in calcific severe AS. MATERIALS AND METHODS: Severe calcific AS patients were categorized into two groups: High flow-high gradient (HFHG) AS (n = 289) and low flow-low gradient AS (n = 79). Control group included 273 patients with similar clinical and demographic characteristics but without AS. SII was calculated as absolute platelet count × absolute neutrophil count/absolute lymphocyte count. RESULTS: SII levels were 525 ± 188, 835 ± 402, and 784 ± 348 in control, HFHG AS, and LFLG AS groups, respectively (P < .001). Correlation analyses revealed significant and positive correlation between SII and mean aortic transvalvular pressure gradient (r = .342, P < .001), and negative and significant correlation between SII and AVA (r = -.461, P < .001). Multivariate analysis performed in separate models demonstrated sex, CAD, LDL, and SII levels (Odds ratio [OR]: 1.004, 95 CI%:1.003-1.004) as independent predictors of severe AS in Model 1. According to Model 2, sex, CAD, LDL, and high SII (>661) (OR:5.78, 95 CI%:3.93-4.89) remained as independent predictors of severe AS. CONCLUSION: SII levels can be useful to predict severe calcific AS patients and significantly correlate with AVA and mean aortic transvalvular pressure gradient.

Systemic immune-inflammation index is a novel marker to predict functionally significant coronary artery stenosis.

Aim: The study aimed to investigate and compare the predictive capacity of a systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) to determine a hemodynamically significant coronary artery stenosis assessed by fractional flow reserve (FFR). Patients & methods: A total of 207 chronic coronary syndrome patients with FFR measurement were enrolled in the study. NLR, PLR and SII levels were calculated. Results: The cut-off value of the SII (620) was associated with 78.4% sensitivity and 64.0% specificity to predict a hemodynamically significant stenosis. SII level independently predicted FFR ≤0.80. Conclusion: SII is an independent predictor of functionally significant coronary stenosis detected by FFR in chronic coronary syndrome patients. SII levels can predict hemodynamically severe obstruction better than NLR and PLR.

Dynamic thiol/disulphide homeostasis and its prognostic value in patients with non-ST elevation-acute coronary syndromes.

BACKGROUND: Cardiovascular diseases are still one of the leading causes of death in industrialised countries, and oxidative stress plays an important role in the pathogenesis of acute coronary syndromes (ACS). The dynamic thiol/disulphide homeostasis plays an important role in maintaining the oxidant-antioxidant balance. AIM: We aimed to demonstrate the relationship between dynamic thiol/disulphide homeostasis parameters and non-ST elevation ACS (NSTE-ACS). METHODS: Patients with NSTE-ACS (n = 210) and a control group (n = 185) were included in the study. The GRACE risk score and the development of major adverse cardiovascular event (MACE) were used to evaluate the prognosis. RESULTS: Native thiol, total thiol, disulphide/native thiol, disulphide/total thiol, and native thiol/total thiol levels were found to be lower in the NSTE-ACS group (p < 0.001). There was a statistically significant difference between native and total thiol levels in the GRACE risk score subgroups (p < 0.001). There was a correlation between MACE and native thiol levels (p = 0.04). CONCLUSIONS: Consequently, the dynamic thiol/disulphide homeostasis parameters were significantly different in the NSTE-ACS group and may be used to predict prognosis in this patient group.

Evaluation of QT dispersion and T-peak to T-end interval in patients with early-stage sarcoidosis.

INTRODUCTION AND AIM: Sarcoidosis increases inhomogeneity in ventricular repolarization due to the presence of sarcoid granuloma, which significantly correlates with ventricular fibrillation. Various studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (T-peak to T-end [Tpe] interval) may correspond to the transmural dispersion of repolarization and that increased Tpe interval and Tpe/QT ratio are associated with malignant ventricular arrhythmias. The present study hypothesized that QT and Tpe intervals are significantly prolonged in sarcoidosis patients without apparent cardiac involvement. METHODS: The study population consisted of 54 patients (37 female; mean age 43.4±10.6 years) under follow-up for sarcoidosis and 56 healthy subjects (37 female; mean age 42.4±8.6 years). RESULTS: There was no statistically significant difference between the groups in maximum QT interval, QT dispersion or corrected QT (QTc) interval, but QTc dispersion and Tpe interval were significantly prolonged in the sarcoidosis group compared to the control group (QTc dispersion 59.9±22.5 and 44.4±23.8, respectively, p=0.001; Tpe interval 79.4±9.3 and 70.7±7.03, respectively, p<0.001). We also found that the Tpe/QT ratio was significantly higher in sarcoidosis patients compared to the control group (0.21±0.02 and 0.18±0.23, respectively, p<0.001). CONCLUSION: Our study revealed that QTc dispersion, Tpe and Tpe/QT ratio were greater in sarcoidosis patients compared to the control group. To our knowledge, the present study is the first to use Tpe interval analysis in patients without cardiac involvement in sarcoidosis. Tpe interval and Tpe/QT ratio may be promising markers for cardiovascular morbidity and mortality due to ventricular arrhythmias in patients with and without cardiac involvement in sarcoidosis.

Evaluation of local carotid stiffness and inflammatory biomarkers in stable angina pectoris.

INTRODUCTION: Arterial stiffness (AS) is a well-accepted and reliable predictor of atherosclerotic diseases. Inflammation plays an important role in the development of AS. AIM: To evaluate local carotid stiffness (CS) together with fibrinogen and high-sensitivity C-reactive protein (hsCRP) levels in stable angina pectoris (SAP) patients. MATERIAL AND METHODS: The study consisted of 353 consecutive patients with SAP. All underwent coronary angiography (CAG) after the evaluation of local CS parameters and carotid intima-media thickness (IMT) from both common carotid arteries by a real-time echo-tracking system. Baseline inflammatory biomarkers, serum hsCRP and fibrinogen levels were measured. Based on CAG findings, the patients were classified into 4 groups: control subjects with normal coronary arteries (group 1, n = 86), single-vessel disease (group 2, n = 104), double-vessel disease (group 3, n = 95) and triple-vessel disease (group 4, n = 68). RESULTS: The mean carotid pulse wave velocity (PWV) in patients with angiographically confirmed coronary artery disease (CAD) was significantly higher than that in patients with normal coronary arteries (7.82 ±1.76 vs. 6.51 ±0.85 cm/s, p = 0.001). The mean carotid IMT was detected to be significantly higher in group 4 patients compared to those in group 1 (p < 0.001) and group 2 (p = 0.001). Significant correlations were observed between both inflammatory biomarkers and the number of diseased vessels and carotid PWV. Using multi-variate analysis, carotid stiffness, carotid IMT, hsCRP and fibrinogen were independently associated with the presence and extent of CAD. CONCLUSIONS: Local CS, carotid IMT, hsCRP and fibrinogen levels are significant predictors of atherosclerotic burden and they may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CAD.

Assessment of local carotid stiffness in seronegative and seropositive rheumatoid arthritis.

OBJECTIVES: Rheumatoid arthritis (RA) is a chronic, inflammatory disease associated with increased risk of cardiovascular (CV) disease. Arterial stiffness (AS) is an independent predictor of CV events. This study aimed to analyse local carotid AS parameters in seronegative and seropositive RA patients. DESIGN: Of 347 consecutive RA patients, we selected specifically those who were free of established CV diseases and risk factors. As a result, 140 patients (126 women, 52.2 ± 10 years) and 140 healthy controls (122 women, 52.7 ± 8.0 years) were enrolled into this study. The common carotid AS was evaluated using radio frequency echo-tracking system to determine the local carotid pulse wave velocity (cPWV) and carotid intima-media thickness (cIMT). Based on rheumatoid factor (RF) and/or anti-citrullinated protein antibody (ACPA) positivity, RA patients were categorized into seronegative and seropositive subgroups. RESULTS: Carotid PWV was determined to be significantly higher in all patients and subgroups than controls (p < .001 for all). Although cIMT was similar between the patients, controls and seropositive subgroup, seronegative patients had significantly higher cIMT compared to controls (p = .035) and seropositive group (p = .010). Moreover, a significant positive correlation was found between cPWV and age (r: 0.603, p < .001), ESR (r: 0.297, p = .004), ACPA (r: 0.346, p = .001) and cIMT (r: 0.290, p = .005) in seropositive patients. CONCLUSIONS: RA per se is sufficient to cause arteriosclerosis in the absence of classical CV risk factors. However, arterial hypertrophy is only increased in seronegative patients but not in seropositive group.

The effect of transcatheter aortic valve implantation on mean platelet volume.

BACKGROUND/AIM: Transcatheter aortic valve implantation (TAVI) is an innovative approach to the treatment of aortic stenosis (AS) as an alternative to surgery in high-risk patients. Mean platelet volume (MPV) is considered an indicator of endothelial dysfunction, platelet function, and activation. In this study, we aimed to investigate MPV changes in patients undergoing TAVI. MATERIALS AND METHODS: This study included 100 patients diagnosed with symptomatic severe AS and treated with TAVI between July 2011 and August 2013. Hematological parameters of the patients were examined prior to the procedure and 24 h, 1 month, and 6 months after TAVI. RESULTS: A statistically significant change in patients' MPV was detected after TAVI compared to the baseline situation (P: 0.001). While no statistically significant change was observed on the first day after TAVI, at discharge, compared to the baseline situation, a statistically significant decrease was seen 1 month and 6 months after discharge. CONCLUSION: We have demonstrated a decrease in MPV after surgery compared to the value before surgery. We have sought to propound the change in MPV as an indication of endothelial function after TAVI.

Comparison between fractional flow reserve and visual assessment for moderate coronary artery stenosis.

BACKGROUND: Fractional flow reserve (FFR) is an interventional diagnostic method, based on intracoronary pressure measurement, used for the assessment of the severity of coronary artery stenoses. AIM: Our study aimed to compare visual measurements made by multiple observers with FFR measurement in the assessment of angiographically moderate coronary artery stenosis. METHODS: The angiographic images of moderate coronary artery lesions of 359 patients enrolled in the study were interpreted independently by three interventional cardiologists assigned as observers (O1, O2, O3). RESULTS: In FFR, 37.9% were haemodynamically significant, while 62.1% were insignificant. 40.3% of the lesions were considered severe by O1, 39.9% by O2, and 44.4% by O3. When we compare the FFR results to the observers' decisions about lesion severity, the serious lesion percentages of all three observers were different both from each other and from the FFR result, at a statistically significant level (respectively, p < 0.001, p < 0.001). The kappa analysis performed to check the agreement between the observers' decisions and FFR revealed significant difference between FFR results and the decisions made by all observers (p < 0.001). The kappa agreement analysis performed by matching observers' decisions in pairs revealed a good agreement between O1 and O2 and a moderate agreement between O2 and O3 as well as O1 and O3, although there was still a significant disagreement between all pairs of observers (p < 0.001). CONCLUSIONS: Visual assessment, even when performed by experienced interventional cardiologists, does not yield similar results with FFR procedure in the process of determination of the functional importance of moderately severe coronary artery stenoses.

An unusual presentation of papillary fibroelastoma originating from right ventricular outflow tract.

Papillary fibroelastomas (PFEs) are primary cardiac tumors with a benign and avascular nature. Majority of the PFEs are originated from the valvular endocardium, while the most common site is aortic valve. In this case, we present a patient with multiple PFEs originating from the right ventricular outflow tract who was admitted to our clinic with exertional dyspnea. As far as we know, this is the first case of this unusual presentation of multiple PFEs and also had a history of breast cancer and permanent pacemaker reported in the literature.

Neutrophil Lymphocyte Ratio as a Predictor of Left Ventricular Apical Thrombus in Patients with Myocardial Infarction.

BACKGROUND AND OBJECTIVES: In this study, we examined the role of inflammatory parameters in an apical mural thrombus with a reduced ejection fraction due to large anterior myocardial infarction (MI). SUBJECTS AND METHODS: A total of 103 patients who had suffered from heart failure, 45 of whom had left ventricular apical thrombus (AT) after a large anterior MI, were enrolled in the study. A detailed clinical history was taken of each participant, biochemical inflammatory markers, which were obtained during admission, were analyzed and an echocardiographical and angiographical evaluation of specific parameters were performed. RESULTS: There were no statistically significant differences in terms of age, gender, and history of hypertension, diabetes mellitus, and atrial fibrillation between both groups (p>0.05). Similarly there were no statistically significant differences in terms of biochemical and echocardiographic parameters (p>0.05). However, there were significant differences in terms of neutrophil lymphocyte ratio (p=0.032). After a multivariate regression analysis, neutrophil lymphocyte ratio (NLR) was an independent predictor of thrombus formation (ß: 0.296, p=0.024). The NLR >2.74 had a 78% sensivity and 61% specifity in predicting thrombus in patients with a low left ventricular ejection fraction. CONCLUSION: In this study, neutrophil lymphocyte ratios were significantly higher in patients with apical thrombus.

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.

Epicardial fat tissue thickness is increased in patients with lichen planus and is linked to inflammation and dyslipidemia.

BACKGROUND AND OBJECTIVES: Lichen planus (LP) is a mucocutaneous inflammatory disease. Inflammation plays a major role in the progression of atherosclerosis. Epicardial fat tissue (EFT) has been shown to produce and secrete various proatherogenic and proinflammatory hormones and cytokines. The aim of this study was to assess EFT in patients with lichen planus. METHODS: Fifty-four patients with LP and 50 controls were enrolled in the study. LP was diagnosed according to the World Health Organization criteria. EFT was measured on the free wall of the right ventricle in parasternal long-axis view, as previously described and validated. RESULTS: There were positive correlations between EFT thickness and platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, duration of LP, and high-sensitivity C-reactive protein (hsCRP) (p<0.001, p<0.001, p=0.002 and p<0.001, respectively). In multivariate analysis, after adjustments for relevant confounders, LDL cholesterol, hsCRP, platelet/lymphocyte ratio and duration of LP were independent predictors of EFT thickness in patients with LP (ß=0.231, p=0.014; ß=0.205, p=0.037; ß=0.361, p=0.001 and ß=0.133, p=0.047, respectively). CONCLUSION: EFT is increased in patients with LP compared to control subjects. Duration of LP is correlated with EFT, and duration of LP is also an independent predictor of increased EFT, which is a predictor of subclinical atherosclerosis.

Higher neutrophil to lymphocyte ratio is related to a lower ejectionfraction in bicuspid aortic valve patients.

BACKGROUND/AIM: Inflammation plays an important role in the pathophysiology of vascular disease. In this study, we aimed to evaluate the associations of neutrophil to lymphocyte ratio (NLR; an indicator of inflammation) with left ventricular ejection fraction and ascending aorta diameter in patients with a bicuspid aortic valve (BAV). MATERIALS AND METHODS: One hundred and thirty-nine consecutive patients with the diagnosis of BAV were enrolled in the study. Complete blood counts were analyzed for neutrophil and lymphocyte levels and NLR. The subjects were separated into two groups based on their ascending aorta diameter. The patients with ascending aorta diameter equal to or above 3.9 cm were included in group 1 whereas those with ascending aorta diameter below 3.9 cm were included in group 2. RESULTS: When the results were compared, it was demonstrated that there was a positive correlation between NLR and ascending aorta diameter (r: 0.485, P = 0.026), whereas there was a negative correlation between NLR and left ventricular end-diastolic diameter (r: 0.475, P = 0.030), left ventricular end-systolic diameter (r: 0.482, P = 0.027), and left ventricular ejection fraction (r: -0.467, P = 0.033) in BAV patients with ascending aorta dilatation (group 1). CONCLUSION: NLR is associated with ascending aorta diameter and left ventricular ejection fraction in BAV patients with ascending aorta dilatation.