Higher C-Reactive Protein to Albumin Ratio Portends Long-Term Mortality in Patients with Chronic Heart Failure and Reduced Ejection Fraction.

Background and Objectives: In this study, we aimed to investigate the prognostic value of the C-reactive protein to albumin ratio (CAR) for all-cause mortality in patients with chronic heart failure with reduced ejection fraction (HFrEF). Materials and Methods: In total, 404 chronic HFrEF patients were included in this observational and retrospective study. The CAR value of each patient included in this analysis was calculated. We stratified the study population into tertiles (T1, T2, and T3) according to CAR values. The primary outcome of the analysis was to determine all-cause mortality. Results: The median follow-up period in our study was 30 months. In the follow-up, 162 (40%) patients died. The median value of CAR was higher in patients who did not survive during the follow-up [6.7 (IQR = 1.6-20.4) vs. 0.6 (IQR = 0.1-2.6), p < 0.001]. In addition, patients in the T3 tertile (patients with the highest CAR) had a higher rate of all-cause mortality [n = 90 cases (66.2%), p < 0.001]. Multivariate Cox regression analysis revealed that CAR was an independent predictor of mortality in patients with HFrEF (hazard ratio: 1.852, 95% confidence interval: 1.124-2.581, p = 0.005). In a receiver operating characteristic curve analysis, the optimal cut-off value of CAR was >2.78, with a sensitivity of 66.7% and specificity of 76%. Furthermore, older age, elevated N-terminal pro-brain natriuretic peptide levels, and absence of a cardiac device were also independently associated with all-cause death in HFrEF patients after 2.5 years of follow-up. Conclusions: The present study revealed that CAR independently predicts long-term mortality in chronic HFrEF patients. CAR may be used to predict mortality among these patients as a simple and easily obtainable inflammatory marker.

Turkish Real Life Atrial Fibrillation in Clinical Practice: TRAFFIC Study.

BACKGROUND: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and is associated with an increased risk of thromboembolism, ischemic stroke, impaired quality of life, and mortality. The latest research that shows the prevalence and incidence of AF patients in Türkiye was the Turkish Adults' Heart Disease and Risk Factors study, which included 3,450 patients and collected data until 2006/07.The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study is planned to present current prevalence data, reveal the reflection of new treatment and risk approaches in our country, and develop new prediction models in terms of outcomes. METHODS: The TRAFFIC study is a national, prospective, multicenter, observational registry. The study aims to collect data from at least 1900 patients diagnosed with atrial fibrillation, with the participation of 40 centers from Türkiye. The following data will be collected from patients: baseline demographic characteristics, medical history, vital signs, symptoms of AF, ECG and echocardiographic findings, CHADS2-VASC2 and HAS-BLED (1-year risk of major bleeding) risk scores, interventional treatments, antithrombotic and antiarrhythmic medications, or other medications used by the patients. For patients who use warfarin, international normalized ratio levels will be monitored. Follow-up data will be collected at 6, 12, 18, and 24 months. Primary endpoints are defined as systemic embolism or major safety endpoints (major bleeding, clinically relevant nonmajor bleeding, and minor bleeding as defined by the International Society on Thrombosis and Hemostasis). The main secondary endpoints include major adverse cardiovascular events (systemic embolism, myocardial infarction, and cardiovascular death), all-cause mortality, and hospitalizations due to all causes or specific reasons. RESULTS: The results of the 12-month follow-up of the study are planned to be shared by the end of 2023. CONCLUSION: The TRAFFIC study will reveal the prevalence and incidence, demographic characteristics, and risk profiles of AF patients in Türkiye. Additionally, it will provide insights into how current treatments are reflected in this population. Furthermore, risk prediction modeling and risk scoring can be conducted for patients with AF.

Endoscopic Thoracic Sympathectomy in the Treatment of Vasospastic Angina Resistant to Medical Therapy.

BACKGROUND: In this study, we aimed to investigate the clinical follow-up results of endoscopic thoracic sympathectomy (ETS) in the treatment of vasospastic angina (VSA) resistant to maximal medical therapy. METHODS: A total of 80 patients with VSA who presented to our hospital between 2010 and 2022 were included in our study. Among them, 6 patients who did not respond to medical therapy underwent ETS. In-hospital and long-term clinical outcomes of patients who underwent ETS were recorded. RESULTS: The median age of the patients with VSA was 57 [48-66] years, and 70% of the group were males. In the ETS group, compared to the non-ETS group, higher numbers of hospital admissions and coronary angiographies were observed before ETS (median 6 [5-6] versus 2 [1-3], P <.001; median 5 [3-6] versus 2 [1-3], P =.004, respectively). Additionally, while 2 patients (33.3%) in the ETS group had implantable cardioverter defib-rillator (ICD), only 2 patients (2.7%) in the non-ETS group had ICD (P =.027). Out of the 6 patients who underwent ETS, 2 were females, with a median age of 56 [45-63] years. Four patients underwent successful bilateral ETS, while 2 patients underwent unilateral ETS. During the follow-up period after ETS, only 3 patients experienced sporadic attacks (once in 28 months, twice in 41 months, and once in 9 years, respectively), while no attacks were observed in 3 patients during their median follow-up of 7 years. CONCLUSION: It appears that ETS is effective in preventing VSA attacks without any major complications.

Transcatheter Closure or Surgery for Symptomatic Paravalvular Leaks: The Multicenter KISS Registry.

BACKGROUND: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs. METHODS AND RESULTS: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P=0.549) and procedural success (73.7 versus 65.2%; P=0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75-5.88]; P=0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27-10.0]; P<0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59-1.25]; P=0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67-1.81]; P=0.679). CONCLUSIONS: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.

The prognostic importance of the Naples prognostic score for in-hospital mortality in patients with ST-segment elevation myocardial infarction.

BACKGROUND: The Naples prognostic score (NPS) is an effective inflammatory and nutritional scoring system widely applied as a prognostic factor in various cancers. However, the prognostic significance of NPS is unknown in ST-segment elevation myocardial infarction (STEMI). We aimed to analyze the prognostic value of the NPS in-hospital mortality in patients with STEMI. METHODS: The study consisted of 3828 patients diagnosed with STEMI who underwent primer percutaneous coronary intervention. As the primary outcome, in-hospital mortality was defined as all-cause deaths during hospitalization. The included patients were categorized into three groups based on NPS (group 1:NPS = 0,1,2; group 2:NPS = 3; group 3:NPS = 4). RESULTS: Increased NPS was associated with higher in-hospital mortality rates( P  < 0.001). In the multivariable logistic regression analysis, the relationship between NPS and in-hospital mortality continued after adjustment for age, male sex, diabetes, hypertension, Killip score, SBP, heart rate, left ventricular ejection fraction, myocardial infarction type and postprocedural no-reflow. A strong positive association was found between in-hospital mortality and NPS by multivariable logistic regression analysis [NPS 0-1-2 as a reference, OR = 1.73 (95% CI, 1.04-2.90) for NPS 3, OR = 2.83 (95% CI, 1.76-4.54) for NPS 4]. CONCLUSION: The present study demonstrates that the NPS could independently predict in-hospital mortality in STEMI. Prospective studies will be necessary to confirm the performance, clinical applicability and practicality of the NPS for in-hospital mortality in STEMI.

Body fat percentage and infarct size in patients with non-ST segment elevation myocardial infarction.

OBJECTIVE: Obesity is a global health problem that increases the risk of coronary artery disease (CAD). However in studies, it has been observed that when the disease develops, obese patients have a more favorable prognosis than leaner patients. This is called the "obesity paradox." This study aims to evaluate the effect of obesity assessed with body fat percentage (BFP) and relative fat mass (RFM) besides body mass index (BMI) on infarct size (IS) estimated from peak creatine kinase-MB (CK-MB) levels in patients with non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: Patients with a diagnosis of NSTEMI who underwent coronary angiography between January 2017 and January 2022 were retrospectively evaluated. Patients without available anthropometric data to calculate BMI, BFP, and RFM and serial CK-MB measurements were excluded from the study. BMI was calculated using weight(kg)/(height[m])2 formula. Patients were dichotomized as obese (BMI≥30 kg/m2) and non-obese (BMI<30 kg/m2) to compare baseline characteristics. BFP and RFM were calculated from anthropometric data. Linear regression analysis was performed to define predictors of IS. RESULTS: Final study population consisted of 748 NSTEMI patients (mean age was 59.3±11.2 years, 76.3% were men, 36.1% of the patients were obese). Obese patients were more likely to be female, hypertensive, and diabetic. Smoking was less frequently observed in obese patients. Peak CK-MB levels were similar among groups. Obese patients had higher in-hospital left ventricular ejection fraction, and less severe CAD was observed in coronary angiographies of these patients. Multivariable regression analysis identified diabetes mellitus, systolic blood pressure, white blood cell count, hemoglobin, and BFP (ß=-4.8, 95% CI=-8.7; -0.3, p=0.03) as independent predictors of IS. CONCLUSION: Higher BFP is associated with smaller IS in NSTEMI patients. These findings support the obesity paradox in this patient group, but further, randomized controlled studies are required.

The Effect of Anesthesia Type Applied in Transcatheter Aortic Valve Implantation.

OBJECTIVE: Different results have been obtained in studies on the effect of anesthesia type applied during transcatheter aortic valve implantation on in-hospital outcomes. In this study, we aimed to investigate the association of the type of anesthesia with the lenght of stay in the intensive care unit and the need for inotropes in patients undergoing transcatheter aortic valve implantation. METHODS: A total of 140 patients who underwent transcatheter aortic valve implantation between January 2016 and January 2022 were retrospectively analyzed. The patients were divided into 2 groups as deep sedation and general anesthesia according to the type of anesthesia. RESULTS: The mean age of all patients was 78.5 ± 8.6 years, and 69 of the patients (49.3%) were female. Length of stay in intensive care unit, midazolam dosage, use of inotropic agents, and procedural hypotension were significantly lower in the deep sedation group than in the general anesthesia group [(1[1-2] vs. 1[1-2.5] days, P = 0.03), (2.1 ± 0.4 mg/kg vs. 2.3 ± 05, P = 0.02), (39 (37.9%) vs. 22 (59.5%), P = 0.02), (41 (39.8%) vs. 25 (67.6%), P = 0.004)]. General anesthesia was associated with increased use of inotropic agents during transcatheter aortic valve implantation compared to deep sedation (odds ratio = 2.93 95% CI = 1.18-7.30, P = 0.02). CONCLUSION: The use of inotropes is less in transcatheter aortic valve implantation procedures performed under deep sedation and length of stay in intensive care unit is shorter.

Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study.

OBJECTIVE: Severe pulmonary embolism (PE) has a high mortality rate, which can be lowered by thrombolytic therapy (TT). However, full-dose TT is associated with major complications, including life-threatening bleeding. The aim of this study was to explore the efficacy and safety of extended, low-dose administration of tissue plasminogen activator (tPA) on in-hospital mortality and outcomes in massive PE. METHODS: This was a single-center, prospective cohort trial at a tertiary university hospital. A total of 37 consecutive patients with massive PE were included. A peripheral intravenous infusion was used to administer 25 mg of tPA over 6 hours. The primary endpoints were in-hospital mortality, major complications, pulmonary hypertension, and right ventricular dysfunction. The secondary endpoints were 6-month mortality and pulmonary hypertension and right ventricular dysfunction 6 months after the PE. RESULTS: The mean age of the patients was 68.76±14.54 years. The mean pulmonary artery systolic pressure (PASP; 56.51±7.34 mmHg vs. 34.16±2.81 mmHg, P<0.001) and right/left ventricle diameter (1.37±0.12 vs. 0.99±0.12, P<0.001) decreased significantly after TT. Tricuspid annular plane systolic excursion (1.43±0.33 cm vs. 2.07±0.27 cm, P<0.001), myocardial performance index (0.47±0.08 vs. 0.55±0.07, P<0.001), and systolic wave prime (9.6±2.8 vs. 15.3±2.6) increased significantly after TT. No major bleeding or stroke was observed. There was one in-hospital death and two additional deaths within 6 months. No cases of pulmonary hypertension were identified during follow-up. CONCLUSION: The results of this pilot study suggest that an extended infusion of low-dose tPA is a safe and effective therapy in patients with massive PE. This protocol was also effective in decreasing PASP and restoring right ventricular function.

Double trouble during the left atrial appendage occlusion procedure.

Percutaneous structural interventions are being performed at increased numbers and rare findings or complications occur more frequently. Lipomatous hypertrophy of the interatrial septum (LHIS) is a relatively uncommon finding on transthoracic echocardiogram (TTE). The major challenge is the difficulty in performing transseptal puncture. We aimed to report the difficulties that were experienced during the left atrial appendage (LAA) closure in a case with an extreme form of LHIS.

The Relation of Body Mass Index with In-Hospital Mortality in Patients with ST-Segment Elevation Myocardial Infarction.

Objectives: In this study, we aimed to determine whether body mass index (BMI) is an independent predictor of in-hospital mortality in ST-segment elevation myocardial infarction (STEMI) patients and to assess the relationship between BMI and mortality. Methods: One thousand three hundred fifty-seven patients with STEMI were included to the study. Primary outcome was in-hospital mortality. The multivariable logistic regression was used to assess the relationship between BMI and in-hospital mortality using age, gender, diabetes mellitus, systolic blood pressure, heart rate, smoking status, serum creatinine and hemoglobin, type of STEMI, and Killip class as adjustment variables. Results: The frequency of in-hospital mortality was 14.7%. The mean BMI was found to be 28.2 ± 4.8 kg/m2. Considering the in-hospital mortality frequencies between the groups, mortality was observed in 61.7% of the BMI <20 kg/m2 group, 15.5% of the 20-25 kg/m2 group, 8.5% of the 25-30 kg/m2 group, and 9.5% of the >30 kg/m2 group (chi-square P value <0.001). In the multivariable logistic regression analysis, a change in BMI from 20 to 30 kg/m2 was associated with a reduced risk of in-hospital mortality (odds ratio: 0.39, 95% confidence interval: 0.23-0.67, P < 0.001). Conclusion: Our study results revealed that there was inverse significant association between BMI and in-hospital mortality in STEMI patients.

Metformin and CI-AKI Risk in STEMI: Evaluation Using Propensity Score Weighting Method.

OBJECTIVE: Discontinuation of metformin treatment is a frequently used approach in clinical practice in diabetic ST-segment elevation myocardial infarction patients using metformin in order to reduce the risk of contrast-induced acute kidney injury. There is insufficient evidence in the literature to support this approach. The aim of this study is to determine whether the risk of contrast-induced acute kidney injury is different in diabetic ST-segment elevation myocardial infarction patients using metformin compared to those not taking metformin. METHODS: The population of the study consisted of patients who applied to our centers that are covered by this study with the diagnosis of ST-segment elevation myocardial infarction and underwent primary percutaneous intervention between 2014 and 2019. Three forty-three diabetic patients that met the study inclusion criteria were divided into 2 groups as who have been receiving metformin and who have not. Patients' creatinine values at admission and peak creatinine values were compared in order to determine whether they have developed contrastinduced acute kidney injury. The 2 groups were compared using conditional logistic regression analysis conducted with the inverse probability weighting method. RESULTS: Non-weighted classic multivariable logistic regression analysis revealed that metformin use was not associated with acute kidney injury. Weighted conditional multivariable logistic regression revealed that the increase in the risk of acute kidney injury was associated with baseline creatinine levels [odds ratio: 1.49 (1.06-2.10; 95% CI) P=.02] and that the increase in the risk of contrast-induced acute kidney injury was not associated with metformin usage [odds ratio: 0.92 (0.57-1.50, 95% CI) P=.74]. CONCLUSION: No statistically significant difference was found between the metformin and nonmetformin users among the diabetic ST-segment elevation myocardial infarction patients who underwent primary percutaneous intervention in the risk of contrast-induced acute kidney injury.

The Role of Prophylactic Ipsilateral Distal Femoral Artery Cannulation in Preventing Periprocedural Peripheral Complications During Transcatheter Aortic Valve Implantation.

OBJECTIVE: Access site-related vascular complications are common complications of trans- catheter aortic valve replacement. In this study, we aimed to investigate the efficacy and safety of prophylactic cannulation of the ipsilateral distal femoral artery in the management of access site-related vascular complications. METHODS: One hundred sixty-four patients, who were evaluated by the Heart Team of our institution and found eligible for transcatheter aortic valve replacement procedure between January 2016 and August 2019, were included in this retrospective study. Patients were divided into two groups according to the management of peripheral complications. The antegrade crossover was used as bailout treatment in the first 70 patients. Prophylactic cannulation of the ipsilateral distal femoral artery was performed in the last 94 patients. These 2 groups were compared. RESULTS: Peripheral complications developed in 15 of the first 70 patients included in the study. The percutaneous intervention was unsuccessful in 4 of the patients who underwent bailout antegrade crossover. Peripheral complications developed in 14 of the last 94 patients in whom prophylactic cannulation of the ipsilateral distal femoral artery was performed, and all these patients were managed successfully with percutaneous intervention. CONCLUSION: Prophylactic cannulation of the ipsilateral distal femoral artery is a simple, effec- tive, and safe method in the management of access site-related vascular complications.

Effects of RAAS blocker use on AKI in elderly hypertensive STEMI patients with propensity score weighed method.

Studies reported conflicting results on the effect of renin-angiotensin-aldosterone system (RAAS) blocker use on acute kidney injury (AKI) in patients undergoing elective coronary angiography but association in elderly patients with ST-elevation myocardial infarction (STEMI) is not known. Also, there are limited data on the effect of inflammatory markers on AKI. We aimed to investigate the effects of RAAS blocker pretreatment and inflammatory markers on AKI in this population. A total of 471 patients were compared according to presence of RAAS blocker pretreatment at admission. Conventional and inverse probability weighed conditional logistic regression were used to determine independent predictors of AKI. Mean age of the study group was 75.4 ± 7.1 years and 29.1% of the patients were female. AKI was observed in 17.2% of the study population. Weighted conditional multivariable logistic regression analysis revealed that AKI was associated with baseline creatinine levels and C-reactive protein/albumin ratio (CAR) (OR 2.08, 95% CI = 1.13-3.82, p = .02 and OR 1.19, 95% CI = 1.01-1.41, p = .04, respectively). No significant association was found between RAAS blocker pretreatment and AKI. CAR and elevated baseline creatinine levels were independent predictors of AKI in this patient group.

Successful Usage of FlexCath Steerable Catheter in Case of Atrial Septal Closure Device Comes Perpendicular to Interatrial Septum.

OBJECTIVE: Percutaneous closure of atrial septal defects is challenging in cases where the device is perpendicular to the septum during the procedure. Hence, different techniques, maneuvers, and auxiliary equipment may be required. We aimed to demonstrate the effectiveness of the FlexCath steerable catheter application in percutaneous closure of atrial septal defect cases in which the device was perpendicular to the septum. METHODS: Patients with atrial septal defect who presented to our clinic between January 2017 and December 2020 and were deemed eligible for percutaneous closure were included in the study. RESULTS: Atrial septal defects of 101 patients out of 110 patients were successfully closed using standard methods. Nine patients in whom it was seen if the device was perpendicular to the interatrial septum were successfully closed with FlexCath steerable catheter support. There was no statistically significant difference between patients in terms of age, gender, floopy rim, and multiple defects. In the group that was treated with FlexCath steerable catheter support, the aortic rim was smaller, and the defect diameter and the size of the atrial septal defects device were larger. The success of the procedure was 100% while using the flexcath steerable catheter in patients with the device perpendicular to the interatrial septum. There were no complica tions during the procedure. CONCLUSION: Percutaneous closure with FlexCath steerable catheter support in difficult cases with atrial septal defects was effective in those with the atrial septal closure device being per pendicular to the interatrial septum and was performed easily without any safety issues.

A New Predictor of Mortality in ST-Elevation Myocardial Infarction: The Uric Acid Albumin Ratio.

Several studies have shown that high uric acid (UA) and low serum albumin (SA) values increase the risk of cardiovascular disease and mortality in ST-elevation myocardial infarction (STEMI). We determined whether the uric acid/albumin ratio (UAR) is a predictor of mortality in STEMI patients. All patients who presented at our center with a diagnosis of STEMI and underwent percutaneous intervention from 2015 to 2020 were screened consecutively; 4599 patients were included. A Cox proportional hazards model was used to evaluate UAR, and adjusted predictors obtained from laboratory findings and clinical characteristics contributed to mortality. Also, a regression model was presented with a directed acyclic graph (DAG). The median age of the patients was 58 years (IQR [interquartile range]: 50-67); 3581 patients (77.9%) were male. The incidence of mortality in the entire patient group was 11.9%. Median follow-up duration of all groups was 42 months. Multivariate Cox proportional regression (model-1) analysis showed age (increase 50 to 67 years; HR [hazard ratio]: 1.34, 95% CI 1.18-1.52) and UAR (increase 1.15-1.73; HR: 1.33, 95% CI 1.16-1.52) were associated with mortality. UAR may be a prognostic factor for mortality in STEMI patients and an easily accessible parameter to identify high-risk patients.

A Clinical Score to Predict "Corrected Thrombolysis in Myocardial Infarction Frame Count" in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Corrected thrombolysis in myocardial infarction frame count (cTFC) is an objective, simple, and reproducible method to assess coronary blood flow which is a surrogate for cardiovascular outcomes. It is important to learn which factors are associated with cTFC. The goal of this study was to determine predictive models for epicardial blood flow assessed by cTFC and develop a diagnostic predictive model that indicates the individualized assessment of epicardial blood flow prior to primary percutaneous coronary intervention. This is a retrospective study including 3205 patients with ST-segment elevation myocardial infarction who underwent pPCI. The primary outcome was cTFC. Multivariable linear regression analysis was performed. Subsequently, a nomogram was developed to predict cTFC according to the candidate predictors. Median age was 58; the number of male patients was 2381 (74.3%). Median value of cTFC was 22 and interquartile range (IQR): 16.5-28.0). Age, diabetes mellitus (DM), total ischemic time, systolic blood pressure (SBP), heart rate (HR), and history of statin use remained in both full and reduced models. Our model may potentially allow clinicians to identify patients at high risk for impaired epicardial perfusion.

Serum heparanase levels and left atrial/left atrial appendage thrombus in patients with nonvalvular atrial fibrillation.

INTRODUCTION: Data regarding the possible role of heparanase (HPA) in the occurrence of left atrial/left atrial appendage (LA/LAA) thrombus in patients with atrial fibrillation (AF) is lacking. The goal of the present study was to assess the association between plasma levels of HPA and LA/LAA thrombus in AF. METHODS: A total of 687 patients with nonvalvular AF (NVAF) without anticoagulation therapy were included from January 2016 to June 2019. Serum HPA analysis was performed with a commercially available human ELISA kit. Logistic regression models were used to test for association. RESULTS: Serum HPA levels were significantly higher in patients with LA/LAA thrombus than in those without LA/LAA thrombus (270.8 [193.4 ± 353.2] pg/mL vs 150.3 [125.2 ± 208.4] pg/mL; P < 0.001). In multivariate analysis, serum HPA remained a significantly independent predictor of LA/LAA thrombus (odds ratio 1.674, 95% confidence interval [CI] 1.339-2.289, P < 0.001). In the receiver operating characteristic (ROC) curve analysis, HPA showed a predictive value with an area under the curve (AUC) of 0.757 (95% CI 0.652-0.810, P < 0.001). The optimal cutoff level for HPA predicting LA/LAA thrombus was 210.7 pg/mL, with a sensitivity of 74.3% and a specificity of 64.8%. CONCLUSION: An elevated HPA level was associated with the presence of LA/LAA thrombus in patients with AF. HPA might portend the risk for the prothrombotic state in AF patients.

C-Reactive Protein/Albumin Ratio Predicts Acute Kidney Injury in Patients With Moderate to Severe Chronic Kidney Disease and Non-ST-Segment Elevation Myocardial Infarction.

In this study, we aimed to evaluate the predictive value of admission C-reactive protein/albumin ratio (CAR) for acute kidney injury (AKI) in cases with moderate to severe chronic kidney disease (CKD) not on dialysis who presented with non-ST-segment elevation myocardial infarction (NSTEMI) and underwent coronary angiography (CAG). This cross-sectional and observational study included 420 NSTEMI patients. The study population was categorized based on the CAR tertiles as groups T1, T2, and T3. The primary outcome of the study was AKI development; 92 (21.9%) cases developed AKI. The frequency of AKI was significantly higher in the T3 group compared with the T2 and T1 groups (34% vs 17% vs 14%, P < .001). Age, estimated glomerular filtration rate, contrast media volume, and CAR (odds ratio: 1.36; 95% CI: 1.17-1.57; P < .01) were significant predictors of AKI. In a receiver operating characteristic curve analysis, CAR levels >0.20 predicted AKI development with a sensitivity of 74% and a specificity of 45%. We observed that the CAR may be a promising inflammatory parameter for AKI in NSTEMI patients with moderate to severe CKD after CAG.