Evaluation of left ventricular myocardial deformation parameters in individuals with electrocardiographic early repolarization pattern.

OBJECTIVE: Although an early repolarization (ER) pattern was considered to be a benign electrocardiographic variant, several studies have shown that it is associated with an increased risk of idiopathic ventricular fibrillation and death. The aim of the present study was to determine whether there is any abnormality in myocardial deformation parameters (strain, strain rate, rotation, and twist) of the left ventricle obtained by speckletracking echocardiography (STE) in subjects with ER pattern. METHODS: There were two groups in this prospective case-control study. The first group consisted of subjects with ER pattern (n=35). The other group was control without ER pattern (n=25). Subjects with poor echocardiographic image quality and history of cardiovascular, pulmonary, systemic, or metabolic disease were excluded from the study. For STE of the left ventricle, two-dimensional images from apical long-axis, twochamber, and four-chamber views and from parasternal short-axis views were obtained. RESULTS: We did not observe significant differences between the groups for left ventricular (LV) longitudinal deformation parameters, rotation, and twist. When LV circumferential deformation parameters were analyzed, early diastolic strain rate value at the level of apex was higher in subjects with ER pattern (2.3±0.7 s-1 vs. 1.9±0.4 s-1, p=0.01). Among LV radial deformation parameters, only peak strain (42.5±16.1% in the ER group vs. 56.9±21.1% in controls, p=0.004) and early diastolic strain rate (-2.0±0.7 s-1 in the ER group vs. -2.3±0.7 s-1 in controls, p=0.03) values at the level of papillary muscle were different. CONCLUSION: In subjects with ER pattern, LV myocardial deformation evaluated by STE is normal with a few regional exceptions. STE does not provide much information about risk stratification of these subjects.

Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome.

OBJECTIVE: Inflammatory mechanisms are known to play an important role in coronary artery disease. The present study aimed to investigate the importance of the neutrophil-to-lymphocyte ratio (NLR) in terms of in-hospital mortality and its association with currently used risk scores in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS: Three hundred and seventeen patients with NSTE-ACS were included. The patients were divided into tertiles according to their NLR values (NLR <2.6, NLR=2.6-4.5, and NLR >4.5). Clinical and angiographic risk was evaluated by the SYNTAX and GRACE risk scores. RESULTS: The GRACE risk score was significantly higher in the group with high NLR values compared to those with moderate or low NLR (161.5±40.3, 130.5±32.3, and 123.9±34.3, respectively, p<0.001). Similarly, the SYNTAX score was significantly higher in the group with high NLR values (20.4±10.1, 15.5±10.5, and 13.4±7.8, respectively, p=0.003). Moreover, both GRACE (r=0.457, p<0.001) and SYNTAX scores (r=0.253, p=0.001) showed a significant positive correlation with NLR. CONCLUSION: NLR has been found to be correlated with clinical and angiographic risk scores. Low NLR might be a good predictor for low in-hospital mortality and simple coronary anatomy in NSTE-ACS patients.