Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion. / O Índice Nutricional Prognóstico está Associado ao Grau de Circulação Colateral Coronariana em Pacientes com Angina Estável e Oclusão Total Crônica.

BACKGROUND: Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. OBJECTIVE: To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. METHODS: A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. RESULTS: The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. CONCLUSION: The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.

FUNDAMENTO: A circulação colateral coronária (CCC) pode efetivamente melhorar o suprimento sanguíneo miocárdico para a área de OCT (oclusão coronariana total crônica) e pode, assim, melhorar o prognóstico de pacientes com síndrome coronariana estável (SCE). O grau de inflamação e alguns marcadores de inflamação foram associados ao desenvolvimento de colaterais. OBJETIVO: Investigar se o índice nutricional prognóstico (INP) tem associação com o desenvolvimento de CCC em pacientes com SCE. MÉTODOS: Um total de 400 pacientes com SCE com presença de OTC em pelo menos uma importante artéria coronária epicárdica foi incluído neste estudo. Os pacientes foram divididos em dois grupos de acordo com o escore Rentrop. Escores de 0 a 1 foram considerados CCC pouco desenvolvidas e escores de 2 a 3 foram aceitos como CCC bem desenvolvidas. A significância estatística foi definida como um valor p < 0,05 para todas as análises. RESULTADOS: A média de idade da coorte do estudo foi de 63±10 anos; 273 (68,3%) eram do sexo masculino. O grupo CCC pouco desenvolvido apresentou um nível de INP significativamente mais baixo em comparação com o grupo CCC bem desenvolvido (38,29±5,58 vs 41,23±3,85, p<0,001). Na análise multivariada, o INP (odds ratio 0,870; intervalo de confiança de 95% 0,822-0,922; p<0,001) foi um preditor independente de CCC pouco desenvolvida. CONCLUSÃO: O INP pode ser utilizado como um dos preditores independentes da formação do CCC. Foi positivamente associado ao desenvolvimento de colaterais coronárias em pacientes com SCE com OTC.

O Índice Nutricional Prognóstico está Associado ao Grau de Circulação Colateral Coronariana em Pacientes com Angina Estável e Oclusão Total Crônica / Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion

Resumo Fundamento: A circulação colateral coronária (CCC) pode efetivamente melhorar o suprimento sanguíneo miocárdico para a área de OCT (oclusão coronariana total crônica) e pode, assim, melhorar o prognóstico de pacientes com síndrome coronariana estável (SCE). O grau de inflamação e alguns marcadores de inflamação foram associados ao desenvolvimento de colaterais. Objetivo: Investigar se o índice nutricional prognóstico (INP) tem associação com o desenvolvimento de CCC em pacientes com SCE. Métodos: Um total de 400 pacientes com SCE com presença de OTC em pelo menos uma importante artéria coronária epicárdica foi incluído neste estudo. Os pacientes foram divididos em dois grupos de acordo com o escore Rentrop. Escores de 0 a 1 foram considerados CCC pouco desenvolvidas e escores de 2 a 3 foram aceitos como CCC bem desenvolvidas. A significância estatística foi definida como um valor p < 0,05 para todas as análises. Resultados: A média de idade da coorte do estudo foi de 63±10 anos; 273 (68,3%) eram do sexo masculino. O grupo CCC pouco desenvolvido apresentou um nível de INP significativamente mais baixo em comparação com o grupo CCC bem desenvolvido (38,29±5,58 vs 41,23±3,85, p<0,001). Na análise multivariada, o INP (odds ratio 0,870; intervalo de confiança de 95% 0,822-0,922; p<0,001) foi um preditor independente de CCC pouco desenvolvida. Conclusão: O INP pode ser utilizado como um dos preditores independentes da formação do CCC. Foi positivamente associado ao desenvolvimento de colaterais coronárias em pacientes com SCE com OTC.

Abstract Background: Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. Objective: To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. Methods: A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. Results: The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. Conclusion: The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.

Electrophysiological characteristics of epicardial atrial tachycardias and endocardial breakthrough site targeting for ablation: a single center experience.

BACKGROUND: Despite being increasingly observed in daily practice, epicardial atrial tachycardias (Epi AT) have not been extensively characterized. In the present study, we retrospectively characterize electrophysiological properties, electroanatomic ablation targeting, and outcomes of this ablation strategy. METHODS: Patients who underwent scar-based macro-reentrant left atrial tachycardia mapping and ablation patients with at least one Epi AT, which had a complete endocardial map, were selected for the inclusion. Based on current electroanatomical knowledge, Epi ATs were classified based by utilization of following epicardial structures: Bachmann's bundle, septopulmonary bundle, vein of Marshall. Endocardial breakthrough (EB) sites were analyzed as well as entrainment parameters. EB site was targeted for initial ablation. RESULTS: Among seventy-eight patients undergoing scar-based macro-reentrant left atrial tachycardia ablation, fourteen (17.8%) patients met the inclusion criteria for Epi AT and were included in the study. Sixteen Epi ATs were mapped, four utilizing Bachmann's bundle, five utilizing septopulmonary bundle, and seven utilizing vein of Marshall. Fractionated, low amplitude signals were present at EB sites. Rf terminated the tachycardia in ten patients; activation changed in five patients and in one patient atrial fibrillation ensued. During the follow-up, there were three recurrences. CONCLUSIONS: Epicardial left atrial tachycardias are a distinct type of macro-reentrant tachycardias that can be characterized by activation and entrainment mapping, without need for epicardial access. Endocardial breakthrough site ablation reliably terminates these tachycardias with good long-term success.

Stepwise mapping and ablation algorithm in patients undergoing ablation of unstable, unmappable scar-based atrial tachycardias.

BACKGROUND: Scar based atrial tachycardia (AT)'s usually presents with a complex electrophysiological substrate. It is not uncommon that multiple instable ATs are present in a single patient. The aim of this study was to analyze clinical and electrophysiological characteristics of patients who had undergone ablation for instable ATs, and report outcomes of the stepwise substrate ablation procedure during the follow-up. METHODS: Patients scheduled to undergo AT ablation were screened for enrollment to the study. When instable ATs were diagnosed a stepwise mapping and ablation algorithm was applied to all patients. After the procedure, patients were clinically and electrocardiographically followed. RESULTS: Twenty-six patients were enrolled in the study. The mean number of ATs observed during the procedures is 3.1±0.7. At the end of the procedure, 18 (69.2%) patients had isolated posterior wall. Anterior mitral line ablation was successfully performed in 13 (50%), mitral isthmus line in 4 (15.4%), roof line in 4 (15.4%) patients. The mean follow-up was 13.5±5.4 months. During the follow-up period 6(23.1%) patients developed arrhythmia recurrence. CONCLUSIONS: A reasonable mid-term success can be expected in patients with instable ATs undergoing ablation according to the stepwise substrate modification algorithm, however due to extensive ablation it should be reserved for patients where conventional activation mapping cannot be performed.

Comparison of Biochemical Markers and Echocardiographic Parameters in the Diagnosis of Prosthetic Valve and Intracardiac Device Endocarditis.

BACKGROUND: The use of prosthetic valves and intracardiac devices has steadily increased in recent years. In this group of patients with prosthetic valves or intracardiac devices, infective endocarditis could not be easily diagnosed, and in general, infective endocar- ditis can be missed in many patients. The purpose of this study was to evaluate the diag- nostic performance of clinical, laboratory, and imaging parameters in a group of patients with pre-diagnosis of infective endocarditis. METHODS: Ninety-four patients diagnosed with prosthetic valve or intracardiac device endocarditis during 2008-2019 were included in the study. The patients' data were evalu-ated according to modified Duke criteria, and the data of the patients who were diag- nosed with and without a definitive infective endocarditis were compared accordingly. RESULTS: Values of procalcitonin (P < .001), leukocytes (P=.004), C-reactive protein (P < .001), sedimentation (P < .001), and maximal vegetation size (P = .012) were found to be significant in the diagnosis of IE. Criteria to determine definitive IE included a C-reactive protein level of 105 mg/dL or higher, 77% sensitivity, 75% specificity, 60% positive predic- tive value, and 87% negative predictive value. In particular, a C-reactive protein level of ≥105 mg/dL was found to positively indicate the diagnosis of definitive infective endocar- ditis by 10 times (odds ratio = 10; 95% CI: 3.6-27.8, P < .001). In a multiple logistic regression analysis, the C-reactive protein level was found to be the best independent predictor of definitive infective endocarditis in this population. CONCLUSION: In cases of prosthetic valve and intracardiac devices endocarditis where pre- diagnosis is difficult to confirm, measuring C-reactive protein levels is a reliable, strong, and simple parameter for definitive infective endocarditis diagnosis.

Procedural Characteristics, Safety, and Follow-up of Modified Right-Sided Approach for Cardioneuroablation.

BACKGROUND: Cardioneuroablation is one of the emerging therapies in vasovagal syncope. In this study, we present a simple method of cardioneuroablation performed via a rightsided approach, targeting anterior-right and right-inferior ganglionated plexi, along with procedural and follow-up data. METHODS: Patients who had underwent cardioneuroablation between March 2018 and September 2019 with vasovagal syncope in 2 clinics were enrolled in the study. All patients underwent radio-anatomically guided radiofrequency ablation targeting anterior-right ganglionated plexi and right-inferior ganglionated plexi. Syncope and symptom burden, 24-hour ambulatory electrocardiogram data at presentation, and at follow-up were assessed along with procedural data. RESULTS: A total of 23 patients underwent modified right-sided cardioneuroablation. Mean basal cycle length decreased significantly from 862.3 ± 174.5 ms at the beginning of the procedure 695.8 ± 152.1 ms following the final radiofrequency ablation (P < .001). Mean 24-hour ambulatory heart rate increased significantly from 66.4 ± 10.7 bpm at baseline to 80 ± 7.6 bpm at follow-up (P < .001). Only 1 patient had 1 episode of syncope following the procedure at the mean follow-up period of 10 ± 2.9 months. The same patient had recurrent presyncope. CONCLUSION: The right-sided cardioneuroablation approach was found to be an effective treatment for vasovagal syncope and may be regarded as a default initial cardioneuroablation technique.

Long-Term Results of Pulmonary Vein Isolation Plus Modified Posterior Wall Debulking Utilizing High-Power Short-Duration Strategy: An All-Comers Study in Real World.

BACKGROUND: High-power short-duration radiofrequency ablation has improved lesion durability in pulmonary vein isolation. In this study, we investigate long-term clinical out-comes of high-power short-duration pulmonary vein isolation and posterior wall debulk- ing as an initial treatment modality in all corner atrial fibrillation patients. METHODS: This is a single-center, retrospective, observational study including all patients who have undergone high-power short-duration pulmonary vein and posterior wall deb-ulking, regardless of atrial fibrillation type and/or duration. High-power short-duration power delivery protocol was defined as 45 W at all ablation sites. Clinical and electrocar-diographic follow-up were performed in all patients. RESULTS: One hundred forty-two patients were enrolled in this study. Paroxysmal atrial fibrillation was present in 88 (62%) of patients. The mean follow-up of this study was 36.9 months ± 12.2 months. During the follow-up period, 10 patients (11.4%) with a diag- nosis of paroxysmal atrial fibrillation had recurrence, while recurrence in patients with persistent and long-standing persistent atrial fibrillation was slightly higher (15 patients (28.1%) and 5 patients (50%), respectively). No major life-threatening complicationsoccurred. CONCLUSION: This study has demonstrated excellent arrhythmia-free outcomes in unselected, real world atrial fibrillation patients undergoing high-power short-duration pulmonary vein and debulking posterior wall isolations, however larger randomized trials are warranted.

A Difficult Route for Percutaneous Coronary Intervention: Single Coronary Artery Anomaly.

Coronary artery anomalies (CAA) are frequently asymptomatic clinical entities, associated with variable prognosis. Single coronary artery anomaly is a rare type of coronary anatomy anomaly with little data in the literature. Although prognostic data are not clear, it is thought that the course of anomalous artery is the most important determinant. Percutaneous revascularisation of concomitant atherosclerotic disease in anomalous coronary arteries may be technically challenging. In this report, we present a case of a single coronary artery undergoing percutaneous revascularisation with an alternative technique of advancing a guidewire into the anomalous left main coronary artery and then crossing the culprit lesion in the left anterior descending artery. This report highlights the importance of catheter stabilisation during percutaneous revascularisation with a simple yet very practical solution. Key Words: Coronary angiography, Coronary vessel anomalies, Myocardial infarction, Percutaneous coronary intervention.

Thrombotic Complication of COVID-19: A Case Report of Acute Saphenous Vein Graft Thrombosis in a Newly Diagnosed Patient.

A 63-year-old man with active COVID-19 infection and a history of coronary artery bypass grafting presented with acute thrombotic occlusion of saphenous venous graft which was anastomosed to the left anterior descending artery. Initial antegrade approach, complicated by a small leakage in the distal left anterior descending artery, was later converted to a retrograde approach via occluded saphenous vein graft. After successful stenting, TIMI 3 flow was achieved.