Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion?

OBJECTIVE: High neutrophil/lymphocyte ratio (NLR) has been associated with post-operative AF development in patients who underwent cardiac surgery. In this study, effectiveness of NLR for prediction of recurrence after electrical cardioversion (CV) in non-valvular AF was investigated. METHODS: A total of 149 patients who underwent a successful CV were included in this prospective cohort study. Baseline complete blood cell count, routine biochemical tests, high sensitive C-reactive protein (hs-CRP), and echocardiographic measurements were examined. After CV, patients were monitored over six months for recurrence. Baseline characteristics of recurrence group were compared with sinus rhythm group by using Student`s t -test. Logistic regression analysis was used to determine predictors of recurrence. RESULTS: Recurrence occurred in a total of 46 patients (30.9%). Median AF duration [16 (IQR:14.25) vs. 12 (IQR:11) months, p=0.01], baseline hs-CRP [9.80 (IQR: 8.50) mg/dL vs. 4.28 (IQR: 5.65) mg/dL, p=0.002] and left atrium (LA) diameter (4.5±0.4 cm, 4.3±0.5 cm, p=0.023) were significantly higher in the recurrence group than sinus rhythm group. Median NLR was comparable in recurrence and sinus groups [2.38 (IQR: 2.09) vs. 2.23, (IQR: 1.23) p=0.96, respectively]. There was a weak correlation between NLR and hs-CRP (r=0.22, p=0.05) and age (r=0.24, p=0.02). In multiple logistic regression analysis, hs-CRP [OR: 1.34 (1.09-1.65 95% CI) p=0.006], LA diameter [OR: 11.92 (1.84-77.07 95% CI) p=0.01], spontaneous echo contrast positivity, [OR: 5.40 (1.04-12.02 95% CI) p=0.045] and systolic blood pressure [OR: 1.05 (1.01-1.10 95% CI) p=0.03] were independent predictors of AF recurrence. CONCLUSION: NLR failed to predict AF recurrence after a successful electrical CV, but hs-CRP remained an inflammatory marker of AF recurrence.

The evaluation of doxorubicin-induced cardiotoxicity: comparison of Doppler and tissue Doppler-derived myocardial performance index.

BACKGROUND: Doxorubicin is a chemotherapeutic agent used in a wide spectrum of cancers. However, cardiotoxic effects have limited its clinical use. The early detection of doxorubicin-induced cardiotoxicity is crucial. The purpose of our study was to assess values of Doppler and tissue Doppler imaging (TDI)-derived myocardial performance index (MPI) in adult cancer patients receiving doxorubicin treatment. METHODS: A total of 45 patients underwent echocardiographic examinations before any doxorubicin had been administered and then after doxorubicin. Doppler and TDI-derived MPI of left ventricular (LV) were determined in the evaluation of cardiotoxicity. Additionally, TDI-derived MPI of right ventricular (RV) was determined. RESULTS: All patients underwent control echocardiographic examination after mean 5 ± 1.7 months. The LV MPI obtained by both Doppler and TDI were increased after doxorubicin treatment (0.56 ± 0.11, 0.61 ± 0.10, p = 0,005 vs 0.51 ± 0.09, 0.59 ± 0.09, p = 0.001, respectively). There was no correlation between Doppler-derived MPI and cumulative doxorubicin dose (coefficient of correlation 0.11, p = 0.6). TDI-derived MPI was correlated with cumulative doxorubicin dose (coefficient of correlation 0.35, p = 0.015), but this correlation is weak (r = 0.38). The study population was divided into two groups according to doxorubicin dose (below and above 300 mg level). There was a moderate correlation between TDI-derived MPI and less than 300 mg of doxorubicin dose (coefficient of correlation 0.51, p = 0.028). However, Doppler-derived MPI was not correlated with less than 300 mg of doxorubicin dose (coefficient of correlation 0.38, p = 0.123). Also, there was no significant change in the TDI-derived RV-MPI (0.49 ± 0.14, 0.50 ± 0.12, p = 0.56). CONCLUSIONS: TDI-derived MPI is a useful parameter and an early indicator compared with Doppler-derived MPI in the detection of cardiotoxicity during the early stages. Also, doxorubicin administration does not affect RV function.

Soluble CD40 ligand levels in acute pulmonary embolism: a prospective, randomized, controlled study.

CD40 ligand is a thromboinflammatory molecule that predicts cardiovascular events. Platelets constitute the major source of soluble CD40 ligands (sCD40L), which has been shown to influence platelet activation. The main aim of this study was to evaluate sCD40L levels in patients with acute pulmonary embolism (PE). Sixty-five PE patients (32 males, mean age 58 ± 12 years) and 29 healthy controls (15 males, mean age 56 ± 14 years) were enrolled in the study. sCD40L levels were evaluated at the enrollment by ELISA method. Multislice detected pulmonary computed tomography was performed on all patients with a suspected diagnosis of PE. In addition, echocardiography was performed to evaluate right ventricular (RV) dysfunction. There was no statistically significant difference between the two groups regarding demographic features. sCD40L levels were significantly higher in acute PE group compared to healthy controls (5.3 ng/ml and 1.4 ng/ml, respectively; p < 0.001). sCD40L levels of patients with and without RV dysfunction were similar. Correlation analysis between echocardiographic findings and sCD40L levels did not show significant difference. The present study demonstrated a role of sCD40L in pathogenesis of PE for the first time. Further studies are needed to clarify a predictive and prognostic value of sCD40L levels in acute PE patients.

Lithium intoxication causing ST segment elevation and wandering atrial rhythms in an elderly patient.

Lithium overdoses causing cardiotoxicity are uncommon and electrocardiographic changes suggesting myocardial ischemia are rare. However, some authors have specifically reported the occurrence of ischemic electrocardiography changes due to a lithium overdose. This paper describes a case where electrocardiography changes mimic inferior myocardial infarction during the course of chronic lithium treatment in an elderly patient. The patient's electrocardiography changes were partially resolved after hemodialysis.

A bizarre electrocardiographic pattern due to chronic lithium therapy.

Cardiotoxicity that results from lithium overdose is uncommon and electrocardiographic (ECG) changes are rarely reported. However, some authors have specifically reported the occurrence of ischemic ECG changes due to a lithium overdose. This article describes a case that is demonstrating ECG changes that mimic inferior myocardial infarction during the course of chronic lithium treatment and showing QTc prolongation in this patient. The patients' ECG changes were partially recovered after hemodialysis.

Type II bidirectional ventricular tachycardia in a patient with myocardial infarction.

A 84-year-old man presented to the emergency department complaining of chest pain and palpitations. He had no history of coronary artery disease. The 12-lead electrocardiography showed bidirectional ventricular tachycardia (BVT). Coronary angiography revealed severe mid left anterior descending and mid left circumflex lesions. The BVT, in this case, was most likely due to myocardial ischema. The ethiology of published BVT cases are most commonly digitalis toxicity and rarely herbal aconitine poisoning, hypokalemic periodic paralysis, cathecolaminergic VT, myocarditis, and Anderson-Tawil syndrome. The patient had neither of these underlying conditions. To the best of our knowledge and research in the literature, there was no report of bidirectional VT in the patients with myocardial infarction.