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.

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.

Monocyte heterogeneity in myocardial infarction with and without ST elevation and its association with angiographic findings.

OBJECTIVES: Monocytes and mature macrophages play significant roles after myocardial infarction. Here, our aim is to investigate the monocyte heterogeneity in acute ST elevation myocardial infarction (STEMI) and non-STEMI separately and determine any possible relationships between monocyte heterogeneity and coronary angiographic characteristics. METHODS: Thirty STEMI, 30 non-STEMI, and 25 stable angina pectoris patients were enrolled. Blood samples were taken immediately at admission, and on days 2, 3, 4, 5, and 7 after STEMI or non-STEMI for cytometric analysis to determine monocyte heterogeneity. Peak creatine kinase (CK) and CK-myocardial band (CK-MB) levels were used to determine the severity of myocardial infarction. Coronary angiographic findings, such as the Gensini score, the presence of acute total occlusion, and development of no reflow after stenting, were noted. RESULTS: The peak levels of CD14++CD16- monocytes were higher and were reached later in the STEMI group (631.6±116.7 vs. 539.6±103.0/mm, P=0.003; day 2.73±0.64 vs. 2.27±0.74, P=0.011). Peak CK and CK-MB levels were correlated positively with CD14++CD16- monocytes in the non-STEMI group. The Gensini score was found to be correlated with the peak CD14+CD16+ monocyte levels in the non-STEMI and stable angina pectoris groups. Patients with total occlusion of the culprit artery had significantly higher levels of CD14++CD16- monocytes (642.3±113.2 vs. 532.5±98.2/mm, P<0.001). The peak levels of CD14++CD16- monocytes were higher in patients with no reflow compared with the patients with thrombolysis in myocardial infarction grade 3 flow after percutaneous coronary intervention of the culprit lesion (688.1±104.6 vs. 565.1±111.0, P=0.002). In patients with no reflow, we also found higher peak CD14+CD16+ monocyte levels (82.3±12.1 vs. 71.2±10.6, P=0.02). CONCLUSION: Monocyte heterogeneity differs in STEMI and non-STEMI. Peak levels of CD14++CD16- monocytes were higher and were reached later in the STEMI group compared with the non-STEMI group. More importantly, worse angiographic characteristics related to prognosis are associated with monocyte heterogeneity in both STEMI and non-STEMI patients.

NKX2.5 mutations and congenital heart disease: is it a marker of cardiac anomalies?

Congenital heart defects (CHD) are the leading cause of morbidity and mortality in infants, the etiology of most CHD remains unknown, with the influence of genetics still topic of debate. Heterozygous mutations in the transcription factor, NKX2.5, were among the first evidence of genetic cause for congenital heart disease. For the prevention of CHD identification of specific genetic causes for congenital cardiac malformations will provide insight into the developmental mechanisms that result in normal and abnormal cardiac development and will allow for improved family counseling.

Quadrichambered ventricles.

Double chambered is a term that has been used to describe the subdivision of a ventricle as a result of anomalous septum or muscle bundle. Subdivision of the left ventricular cavity is a rare cardiac anomaly compared to subdivision of the right ventricle. This case features a double chambered right ventricle and a rare double chambered left ventricle at the same time.

[Percutaneous coronary intervention on a single coronary ostium]. / Przezskórna interwencja wiencowa u chorego ze wspólnym ujsciem tetnic wiencowych.

Anomalous origin of the left main coronary artery from the right sinus Valsalva is extremely rare when not associated with other congenital cardiac anomalies. It is reported to constitute just 0.019% of angiographic series. These patients are usually asymptomatic and prone to atherosclerotic disease, however, they also may have normal coronary arteries. We report here the unusual case of a patient with ST segment elevation myocardial infarction who was managed by percutaneous coronary intervention performed through single coronary ostium.

Patent foramen ovale among patients with mild chronic obstructive pulmonary disease and unexplained hypoxia.

PURPOSE: To evaluate whether patent foramen ovale (PFO) is a contributing factor to hypoxia in patients with chronic obstructive pulmonary disease (COPD). METHODS: Twenty-one patients over 40 years of age with mild COPD (Forced expiratory volume (FEV1)/Forced Vital Capacity (FVC): > 50%) who had hypoxia (PO(2) < 80 mmHg, SaO(2) < 95%) that could not be explained by COPD alone were included in this study. Arterial oxygen pressures (PO(2)) and arterial oxygen saturations (SaO(2)) were recorded from laboratory evaluations of arterial blood gases. Respiratory function tests were performed to analyze the degree of COPD. Standard and contrast echocardiography was used to calculate pulmonary artery pressure (PAP) levels and to determine patients with a PFO. RESULTS: The mean age of the patients was 64 +/- 12 years. Four patients (19%) had a PFO. The mean PO(2), mean SaO(2), and mean PAP levels were 57.4 +/- 6.8 mmHg, 90 +/- 3.2%, and 33.8 +/- 5.4 mmHg, respectively, in patients without PFO. The mean PO(2), mean SaO(2), and mean PAP levels were 46.5 +/- 13.7 mmHg, 79.3 +/- 12.8%, and 42.5 +/- 6.5 mmHg, respectively, in patients with PFO. There were no statistically significant differences noted between the two groups in the PO(2) levels (P = 0.172) and SaO(2) levels (P = 0.065). A comparison of the PAP levels revealed a statistically significant difference between the two groups, with values that were more elevated in the PFO group than in the non-PFO group (P = 0.031). CONCLUSION: This study demonstrated that PFO is not a contributing factor to deep hypoxia in COPD patients with lower PO(2) and SaO(2) levels; however, higher PAP levels were detected in patients with a PFO. Further studies involving a larger number of patients are needed to be conclusive.

Partial anomalous pulmonary venous connection of left pulmonary veins to brachiocephalic vein evaluated by multislice computed tomography.

Partial anomalous pulmonary venous drainage with intact atrial septum is a rare congenital anomaly. We report the case of a 47-year-old woman who recently had dyspnea on exertion and was found to have pulmonary hypertension, right atrial enlargement and right ventricular enlargement by two-dimensional transthoracic echocardiography. Multislice computed tomography demonstrated anomalous venous drainage of the left lung into the brachiocephalic vein with an intact interatrial septum. This case illustrates the importance of multislice computed tomography in determining extracardiac vascular malformations.