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.

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.

Crucial role of safety guidewire in transcatheter aortic valve implantation: Two cases with vascular complication.

Vascular complications increasing the rates of morbidity and mortality are among the most common complications observed during transcatheter aortic valve implantation (TAVI). Endovascular management is often life-saving. However, due to limitations of time in cases of iliac rupture and dissection, precautions taken prior to the procedure and the placement of safety guidewire in the contralateral femoral artery are crucial. Here, an 85-year-old woman and and 84-year-old man who had severe symptomatic aortic stenosis and underwent TAVI were presented. Although the valves were successfully implanted, the procedures were complicated by rupture and dissection of the right iliofemoral artery. With the use of safety guidewire, 2 self-expandable graft stents were inserted at the site of rupture and in the place of dissection in the iliofemoral artery, and the patients could be managed successfully.