Predictive Value of Resting Fractional Flow Reserve and Atherogenic Index of Plasma for Evaluation of Physiologically Significant Coronary Artery Lesions.

This study aimed to assess the relationship between the atherogenic index of plasma (AIP) and resting distal-to-aortic pressure ratio (Pd/Pa) in patients with intermediate coronary artery stenosis. This retrospective study included 802 chronic coronary syndrome patients with intermediate coronary artery stenosis who underwent fractional flow reserve (FFR) measurement. The resting Pd/Pa showed a significant negative correlation with AIP (rho= -.205, p < .001). When final FFR was divided into three tertiles (≤80, 81-89, ≥90), resting Pd/Pa was significantly lower, and AIP was markedly higher in the lower final FFR tertiles (both AIP and resting Pd/Pa differed significantly across the all three tertiles, p < .001). Furthermore, functionally significant stenosis independent predictors in multivariate analyses were AIP and resting Pd/Pa (p = .010 and p < .001, respectively). We observed for the first time an increase in AIP levels in the presence of functionally significant stenoses that may help better planning and identification of those patients with the functionally substantial atherosclerotic burden.

Association of neutrophil/lymphocyte ratio and CHA2DS2-VASc score with left atrial thrombus in patients who are candidates for percutaneous mitral balloon valvuloplasty.

OBJECTIVE: Association between inflammation and pro-thrombotic state has been described previously. Aim of the present study was to investigate if presence of left atrial (LA) thrombus or spontaneous echocardiographic contrast (SEC) in rheumatic mitral stenosis (MS) was related to neutrophil/lymphocyte ratio (NLR), and to determine predictive utility of the CHA2DS2-VASc risk stratification score in patients with mitral stenosis complicated by LA thrombus. METHODS: NLR and CHA2DS2-VASc score of 188 patients with MS and 35 healthy controls were evaluated. All analyses were also conducted according to rhythm status, excluding control group. RESULTS: Among patients with MS, there were 31 patients in thrombus-positive group, 142 patients in SEC-positive group, and 15 patients in thrombus/SEC-negative group. Among patients with MS and sinus rhythm (SR) (n=105; 55.8%); 9.5% of them had LA thrombus, and 78% of them had SEC. In the SR group, median NLR was significantly higher in thrombus-positive group compared with thrombus/SEC-negative and control groups (p<0.001). Among patients with MS and atrial fibrillation (AF); there was no significant difference regarding NLR according to thrombus and SEC presence (p=0.214). In both SR and AF groups, there was no significant difference according to SEC/thrombus presence regarding median CHA2DS2-VASc score (p>0.05). CONCLUSION: Elevated NLR is related to presence of LA thrombus in patients with MS and SR. The utility of CHA2DS2-VASc score in patients with MS and SR complicated by LA thrombus is debatable, according to our results.

Evaluation of endothelial dysfunction with flow-mediated dilatation after transradial coronary angiography.

Objective Transradial coronary angiography (TRCA) may lead to endothelial dysfunction. Therefore, this study investigated the TRCA-related endothelial dysfunction and its relation to operator experience, the number of punctures and procedure duration. Methods and results A total of 57 patients (42 males and 17 females) who underwent TRCA were included in this single-centre study. Nine months after the procedure, all patients underwent radial artery B-mode ultrasound imaging, and flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD) techniques were employed. The non-intervened right radial artery was accepted as control. The percentage change in diameter after FMD was significantly greater in the right radial artery compared to the left radial artery (right 13.6% vs left 10.1%, P = 0.041). The percentage change in diameter after NMD was similar in both right and left radial arteries (right 23.8% vs left 23.4%, P = 0.932). According to the puncture numbers, the percentage change was significantly lower in the intervened artery among patients with more than one puncture (13.3% vs 7.8%, P = 0.005). According to the operator experience, the percentage change in the intervened artery was significantly higher in patients in whom the procedure was performed by experienced operators (13.7% vs 7.6%, P = 0.002). The procedure duration also showed a negative correlation with the percentage change in the intervened artery (r = -0.349, P = 0.008). Conclusions TRCA may lead to endothelial dysfunction represented by FMD. Moreover, higher puncture numbers for sheath insertion, longer procedure durations and less experience in radial interventions may have adverse effects on the endothelial function.

The Relationship Between Resting Heart Rate and SYNTAX Score in Patients With Stable Coronary Artery Disease.

We investigated the relationship between resting heart rate (HR) and The Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score in patients with stable coronary artery disease (SCAD). A total of 420 patients who were admitted to our outpatient clinic for stable angina pectoris with sinus rhythm and had at least 50% narrowing in at least 1 coronary artery after coronary angiography were included in the study. Patients were divided into 3 tertiles based on the resting HR: HR of tertile 1 was ≤65 (n = 138), tertile 2 was between 66 and 76 (n = 139), and tertile 3 was ≥77 beats/min (n = 143). The SYNTAX score (7.6 ± 4.6, 12.4 ± 5.6, 20.3 ± 8.1; P < .001) was significantly higher for those in tertile 3 than for those in tertiles 1 and 2. Leukocyte count (7.8 ± 2.2, 7.9 ± 2.2, 8.4 ± 2.3 × 109/L; P = .035) and C-reactive protein (CRP) levels (2.4 ± 0.5, 3.2 ± 0.7, 4.5 ± 1.2 mg/L, P < .001) were increasing from the lowest to the highest tertile. Using multiple logistic regression analysis, CRP (odds ratio [OR] 1.54 [1.17-2.11], P = .001) and resting HR (OR 1.67 [1.25-2.19], P < .001) emerged as independent predictors of SYNTAX score. Resting HR is related to SYNTAX score in patients with SCAD.

Usefulness of the monocyte-to-high-density lipoprotein cholesterol ratio to predict bare metal stent restenosis.

AIM: The aim of the present study was to investigate the predictive value of preprocedural monocyte count-to-high-density lipoprotein cholesterol ratio (MHR) on development of in-stent restenosis in patients undergoing coronary bare-metal stent (BMS) implantation. PATIENTS & METHODS: Data from 705 patients who had undergone BMS implantation and additional control coronary angiography were analyzed. RESULTS: Patients were divided into three tertiles based on preprocedural MHR. Restenosis occurred in 59 patients (25%) in the lowest tertile, 84 (35%) in the middle tertile and 117 (50%) in the highest MHR tertile (p < 0.001). Using multiple logistic regression analysis, smoking, diabetes mellitus, stent length, preprocedural MHR and C-reactive protein levels emerged as independent predictors of in-stent restenosis. CONCLUSION: High preprocedural MHR is related to BMS restenosis.

T-peak to T-end Interval Predicts Appropriate Shocks in Patients with Heart Failure Undergoing Implantable Cardioverter Defibrillator Implantation for Primary Prophylaxis.

BACKGROUND: T-wave peak to T-wave end interval (Tp-e) correlates with dispersion of ventricular repolarization. The purpose of this study was to assess the ability of Tp-e to predict appropriate implantable cardioverter defibrillator (ICD) shocks and all-cause mortality in patients who underwent ICD implantation for primary prophylaxis. METHODS: Two hundred twenty-eight patients with left ventricular ejection fraction ≤35% and an ICD implanted were followed-up prospectively. Patients divided into two subgroups according to presence of appropriate ICD shocks (Group 1: 112 patients with ICD shocks, Group 2: 116 patients without shocks). End points were appropriate ICD therapy due to ventricular tachycardia (VT)/ventricular fibrillation (VF), death, and a combined end point of VT/VF or death. RESULTS: During a mean follow-up of 22.3 ± 7.7 months, appropriate ICD shocks were observed in 112 of 228 patients (49.1%). The mean duration of the Tp-e Group 1 was significantly longer than Group 2 (115.3 ± 22.2 vs 104.7 ± 20.2 ms, P < 0.001). Ischemic etiology and Tp-e duration were found to be independent predictors of ICD therapy. When the patients were divided into two groups based on Tp-e interval, there was no significant difference regarding the mortality between groups (21.2% vs 21.8%, P: 0.186). However, appropriate ICD shocks due to VT/VF (37.5% vs 58.8%, P < 0.001) and combined end point (39.4% vs 64.5%, P: 0.002) were significantly higher in patients with longer Tp-e group. CONCLUSIONS: Tp-e interval independently predicts appropriate ICD shocks in patients with systolic dysfunction and ICDs implanted for primary prevention.

The role of baseline indirect inflammatory markers in prediction of response to cardiac resynchronisation therapy.

BACKGROUND: In many cardiovascular diseases (CVD), white blood cell counts with differentials are used to predict adverse events. Both platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are studied in various CVDs. AIM: The role of inflammatory condition assessed using routine laboratory tests in cardiac resynchronisation therapy (CRT) response has not been investigated thoroughly. Therefore, we aimed to assess the association of NLR, PLR, and relative lymphocyte count (L%) with response to CRT. METHODS: A total of 157 patients (76.4% male; mean age 58.7 ± 11.8 years) who underwent CRT implantation at our tertiary referral hospital were retrospectively analysed. RESULTS: Among included patients, a total of 50 (31.8%) patients were defined as "non-responders". Median NLR and PLR were significantly higher in the non-responder group (p < 0.001), and median L% was significantly lower in the non-responder group (p < 0.001). Also, median NLR was significantly higher in patients with New York heart Association (NYHA) class II-III when compared to patients with NYHA class I after six months of CRT implantation (p < 0.001, p = 0.004, respectively). Correlation analysis demonstrated a positive correlation between paced QRS duration and NLR (p = 0.031) and a negative correlation between paced QRS duration and L% (p = 0.002). In addition, both NLR and L% showed significant correlations with post-procedural NYHA functional classes (p < 0.001; p = 0.008, respectively). Patients with PLR > 173.09 had a 2.9­fold and NLR > 3.45 had a 12.2-fold increased risk of CRT nonresponse, respectively. CONCLUSIONS: In the current study non-responders to CRT had higher NLR and PLR and lower L%, which may support the deleterious effects of baseline inflammatory condition in advanced heart failure.

The relationship between vitamin D levels and saphenous vein graft patency.

OBJECTIVE: A growing body of evidence supports an association between vitamin D and cardiovascular diseases. Coronary artery bypass grafting surgery is a treatment modality for suitable patients with coronary artery disease; however, patency rates of saphenous vein grafts (SVGs) are low. In this study we aimed to determine the association between vitamin D levels and the SVG disease. METHODS: The study population included 180 patients who had undergone a primary coronary artery bypass grafting surgery with at least one SVG and later had a control angiography because of clinical indications. Patients were divided into two groups: 100 patients with SVG disease and 80 of them with patent SVG. RESULTS: The mean age of 180 patients was 57.4±8.8 years, and 64.4% of the study population were men. The total number of SVGs was 364, and the mean number of SVGs to each patient was 2.02±0.61. Vitamin D levels were higher in the patent SVG group than in the SVG disease group (36.2±10.7 and 21.1±10.4, respectively; P<0.001). C-reactive protein levels were significantly higher in the SVG disease group (8.3 vs. 6.5 mg/dl, P=0.001). In a multivariate regression analysis, current smoking, diabetes mellitus, target artery diameter less than 1.5 mm, bypass time duration, and vitamin D levels remained as independent factors associated with SVG disease. CONCLUSION: Lower vitamin D levels are associated with occlusion of SVGs in patients with coronary artery disease.

Right ventricular functions in patients with slow coronary flow.

OBJECTIVE: The objective of this study was to evaluate right ventricular systolic and diastolic functions with the use of conventional and tissue Doppler echocardiography in patients with slow coronary flow (SCF). METHODS AND RESULTS: Patients who were detected to have SCF but otherwise normal epicardial coronary arteries between October 2010 and July 2011 were included in our study. The control group was selected from the patients with normal coronary arteries but no SCF. All patients underwent echocardiography to evaluate left and right cardiac functions with conventional methods and tissue Doppler imaging. The study consisted of 86 patients [59 (68.6%) males, mean age: 54 +/- 10 years) with SCF. Sixty-six subjects [42 (63.6%) males, mean age: 55 +/- 8 years] with normal coronary arteries without SCF constituted the control group.Tissue Doppler findings of left ventricular systolic and diastolic functions were significantly disturbed in the SCF group (myocardial performance index: 0.37+/- 0.02 vs. 0.28 +/- 0.02, P<0.001; E/A ratio: 0.9 +/-0.1 vs. 1.1 0.1, P < 0.001). However, when the right ventricular functions were considered, no significant difference was observed between the 2 groups (myocardial performance index: 0.25 +/- 0.10 vs. 0.25 +/- 0.10, P = 0.9; E/A ratio: 0.50 +/- 0.06 vs. 0.50 +/- 0.08, P= 0.3; TAPSE: 26.2 +/- 2.2 vs. 25.9 +/- 2.2, P = 0.6). CONCLUSIONS: Preserved right ventricular diastolic and systolic functions in contrast to the impaired left ventricular functions in patients with SCF was the main finding of our study. The exact mechanisms of this new finding should be investigated by further studies.