Use of the neutrophil to lymphocyte ratio for prediction of in-stent restenosis in bifurcation lesions.

OBJECTIVE: Percutaneous coronary interventions (PCI) are the preferred treatment for coronary artery disease, even though the development of in-stent restenosis (ISR) continues to be an important complication. Neutrophil to lymphocyte ratio (NLR) is indicative of the inflammatory process and can predict the short- and long-term prognosis of cardiovascular diseases. We investigated the relationship between ISR development and neutrophil-lymphocyte ratio (NLR) in bifurcation lesions in stable coronary artery disease (CAD) patients. PATIENTS AND METHODS: We analyzed the clinical and angiographic data of 181 consecutive stable CAD patients who had undergone successful PCI to the true bifurcation lesion from January 2010-December 2012. Patients were divided into two groups based on the development of ISR (group 1, ISR -; group 2, ISR +). RESULTS: NLR(after) (p < 0.001) and NLRΔ (p < 0.001) were significantly higher in group 2. NLRΔ was found to be significant independent predictor of ISR in the multivariate logistic regression analysis. A NLRΔ level > 0.58 mg/dL had 81.8% sensitivity and 93.5% specificity for the prediction of ISR, as identified by the ROC curve. A NLR(after) level > 3.43 predicted ISR with 45.5% sensitivity and 95.8% specificity. The comparison of ROC curve analysis demonstrated that NLRΔ was the strongest independent predictor of ISR (p = 0.001). CONCLUSIONS: As a result, although drug eluting stent implantation is known to be recommended in the bifurcation lesion PCI in worldwide, we want to emphasize the usage of the NLR values in the prediction of ISR. So, we think that NLRΔ levels may be a useful marker for the prediction of ISR in patients who undergo bifurcation PCI.

Conduction characteristics in atrial fibrillation. Predictive value of tissue Doppler echocardiography.

BACKGROUND: Atrial fibrillation (AF) is one of the most common arrhythmias observed in clinical practice. The frequency of AF is increased in patients with impaired interatrial conduction. We aimed to investigate whether tissue Doppler echocardiography could be used for the evaluation of atrial conduction characteristics instead of an electrophysiological study, and to examine the predictive accuracy of tissue Doppler echocardiography for the inducibility of sustained AF. METHODS: We enrolled 86 consecutive patients who underwent an electrophysiological study. We performed electrocardiographic P wave dispersion, M-mode, two-dimensional, Doppler, and tissue Doppler echocardiography as well as an electrophysiological study (EPS) to evaluate the intra- and interatrial conduction times. We tried to induce AF, and the patients were categorized according to the inducibility of sustained (> 120 s) AF. RESULTS: We found a good correlation between intra-left atrial conduction time detected by tissue Doppler echocardiography (ILCT-echo) and by EPS (ILCT-eps; r = 0.744, p < 0.001), and a weak correlation between interatrial conduction times (IACT-echo and IACT-eps, r = 0.396, p < 0.001). In patients with inducible sustained AF, P wave dispersion (46 ± 19 ms vs. 27 ± 18, p < 0.001), ILCT-echo (29 ± 10 ms vs. 17 ± 7 ms, p < 0.001), and IACT-eps (47 ± 11 ms vs. 36 ± 13 ms, p < 0.001) were found to be higher than those of the noninducible/nonsustained AF group. These three parameters were independent predictors of the inducibility of sustained AF. CONCLUSION: We demonstrated that ILCT-echo could be used instead of ILCT-eps for the evaluation of left atrial conduction characteristics. We also showed that ILCT-eps could be a valuable parameter for predicting the development of long-lasting AF.

Gamma glutamyl transferase activity: relationship with thoracic aortic intima media thickness and inflammation.

OBJECTIVE: Increased serum gamma-glutamyl transferase (GGT) activity is known to be associated with atherosclerotic diseases. Thoracic aortic intima-media thickness (IMT) was reported as a marker of preclinical atherosclerosis. However, there is a lack of research directly examining the relationship between serum GGT activity and thoracic aortic IMT. Therefore, we aimed to investigate the association between serum GGT activity and thoracic aortic IMT. PATIENTS AND METHODS: The study population consisted of 329 patients without coronary artery disease, who underwent transesophageal echocardiography (TEE) examination for various indications from January 2011 to April 2013. GGT, high-sensitivity C-reactive protein (hs-CRP) and other biochemical markers were measured in all patients. The patients were classified into tertiles according to their GGT activities (GGTlow < 19 U/l, GGTmid ≥ 19 U/l < 29 U/l, and GGThigh ≥ 29). RESULTS: The highest aortic IMT values were observed in the GGThigh group compared with the GGTmid and GGTlow groups (p < 0.05, for all). Also, aortic IMT values in the GGTmid group were higher than in the GGTlow group (p < 0.05). Multivariate regression analysis showed that GGT activity was independently associated with aortic IMT (ß = 0.487, p < 0.001) hs-CRP (ß = 0.282, p < 0.001), and triglyceride level (ß = 0.161, p = 0.007). CONCLUSION: The higher serum GGT concentrations within the "normal" range were associated with a greater IMT of the thoracic aorta. GGT activity may be a predictor of the extent of subclinical aortic atherosclerosis assessed with thoracic aortic IMT.

NT-proBNP is associated with SYNTAX score and aortic distensibility in patients with stable CAD.

OBJECTIVE: A high N-terminal pro-brain natriuretic peptide (NT-proBNP) level provides significant prognostic information on patients with coronary artery disease (CAD). It is unclear whether aortic distensibility (AD), which reflects the aortic stiffness, and the extent and complexity of CAD, assessed with the SYNTAX score (SS), affect the secretion of NT-proBNP in stable CAD. We aimed to investigate the relationship between NT-proBNP levels and AD as well as with the extent and complexity of CAD in stable CAD patients. METHODS: The study included 411 patients with stable CAD (mean age = 61.7 ± 9.9 years, male/female = 247/164). The patients were divided into two groups according to the median NT-proBNP value (NT-proBNPlow group < 114 pg/ml and NT-proBNPhigh group ≥ 114 pg/ml). AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements. Coronary angiography was performed and SS was determined in all patients. NT-proBNP and other biochemical markers were measured in all subjects. RESULTS: The AD and ejection fraction values of the NT-proBNPhigh group were lower and their SS levels were higher compared with those from the NT-proBNPlow group (p < 0.05, for all). The NT-proBNP level was independently associated with AD (ß = -0.378, p < 0.001), SS (ß = 0.262, p < 0.001), and ejection fraction (ß = - 0.295, p < 0.001) on multiple linear regression analysis. CONCLUSION: NT-proBNP was independently associated with an impaired elastic property of the aorta and with the extent and complexity of CAD as well as with left ventricular systolic dysfunction.

Serum uric acid and slow coronary flow in cardiac syndrome X.

OBJECTIVE: It has been recently shown that cardiac syndrome X (CSX) patients with slow coronary flow (SCF) have a worse long-term prognosis than those with normal coronary flow. Increased uric acid levels were shown to be associated with atherosclerosis, oxidative stress, and endothelial dysfunction. The purpose of the study was to investigate the relationship between coronary flow assessed with TIMI frame count (TFC) and serum uric acid (SUA) levels in patients with CSX. METHODS: The study population consisted of 113 consecutive patients with typical cardiac CSX and 41 controls without cardiac CSX. Frequencies of risk factors as well as biochemical and hematological data were recorded for all participants. Coronary blood flow was evaluated by TFC. All patients with a TFC greater than two standard deviations from the published normal range for any one of the three vessels were accepted as having slow coronary flow (SCF group), while those whose TFC values fell within the standard deviation of the published normal range for all of the three vessels were considered to have normal coronary flow. RESULTS: Of the 113 CSX patients enrolled, 40 (35.4%) had SCF. The mean TFC value was strongly positively correlated with SUA level, but weakly correlated with male sex, hypertension, diabetes, smoking, serum creatinine level, and hemoglobin. Multivariate regression analysis showed that only the SUA level was independently associated with SCF. The cut-off value for uric acid obtained by the ROC curve analysis was 4.55 mg/dl for the prediction of SCF (sensitivity, 77.5%; specificity, 73.6%). CONCLUSION: The SUA level is independently associated with SCF in patients with CSX.