The impact of daily troponin I and D-dimer serum levels on mortality in COVID-19 pneumonia patients.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an infection resulting in very high morbidity and mortality rates globally. Limited data are available on the cardiovascular manifestations in these patients. The aim of this study was to analyse the daily troponin I and D-dimer levels and their impact on the need for intensive care and on mortality rates of COVID-19-infected patients. METHODS: Two-hundred and five patients who were hospitalised between 20 March and 5 May 2020, with a diagnosis of moderate-to-severe COVID-19 pneumonia, were analysed retrospectively. Serum troponin I and D-dimer levels were recorded for at least 10 days after admission. RESULTS: The average age was higher in the group of patients who died compared to the group who were discharged (67.79 ± 14.9 vs 56.87 ± 18.15 years, respectively, p < 0.001). The presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease statistically significantly affected mortality rates (p = 0.003, 0.004, 0.045, 0.02, 0.003, 0.007, respectively). The first 10 days of measurements of troponin I and D-dimer were associated with intensive care requirements and mortality (p < 0.001). Both troponin I and D-dimer were higher in the group who died compared to the patients requiring intensive care. Troponin I values of ≥ 16.05 pg/ml on the seventh day were related to the need for intensive care [area under the curve (AUC) 0.896, sensitivity 78.6%, specificity 78.3%, p < 0.001). Troponin I values ≥ 30.25 pg/ml on the ninth day were related to mortality (AUC 0.920, sensitivity 89.5%, specificity 89.3%, p < 0.001). D-dimer values ≥ 878 hg/ml on the second day were associated with intensive care need (AUC 0.896, sensitivity 78.6%, specificity 78.3%, p < 0.001). D-dimer values ≥ 1 106 hg/ml on the 10th day were associated with mortality (AUC 0.817, sensitivity 68.4%, specificity 65.2%, p < 0.001). It was observed that hospitalisation periods ≥ 9.5 days were associated with mortality (AUC 0.738, sensitivity 68.4%, specificity 65.9%, p < 0.001). CONCLUSIONS: We showed that hospitalisations ≥ 9.5 days in duration were related to increased mortality rates. Troponin I and D-dimer follow-up values in the serum were more effective than other inflammatory markers in predicting mortality and the need for intensive care. A high troponin I value should alert the clinician in terms of clinical deterioration.

De-novo development of fragmented QRS during a six-month follow-up period in patients with COVID-19 disease and its cardiac effects.

OBJECTIVE: The aim of this study is to examine the probability of de-novo fQRS in patients with mild COVID-19 disease, as an indicator of cardiac injury. METHODS: Data of 256 patients with normal admission electrocardiography and no comorbidities between 1.12.2020-31.12.2021, were examined retrospectively 6-month after mild COVID-19 disease. Patients were divided into two groups: fQRS+ group (n = 102) and non-fQRS group (n = 154). Relation between fQRS and other electrocardiography, echocardiographic and laboratory findings were investigated. RESULTS: No significant difference was found between the groups among age and gender. Troponin-I and creatine kinase myocardial band values (retrospectively 9.10 ± 1.76 vs 0.74 ± 1.43, 34.05 ± 82.20 vs. 14.68 ± 4.42), COVID-19 IgG levels (45.78 ± 14.82 vs. 36.49 ± 17.68), diastolic dysfunction (39.21% vs. 15.07%), EF value (58.02 ± 1.95 vs. 64.27 ± 3.07), dyspnea (41.17% vs. 6.84%), post-COVID-19 tachycardia syndrome (19.6% vs. 2.74) were more frequent in fQRS+ group compared to non-fQRS group. The EF value was lower in the presence of fQRS in the high lateral leads (57.12 ± 1.99, 58.47 ± 1.79, p:0.018). There was a positive correlation between IgG value and endsystolic diameter, septum thickness and left atrium diameter. In multivariate analysis de-novo fQRS, dyspnea, high troponin and IgG values, diastolic dysfunction, low EF value and left atrial diameter were determined as independent risk factors for post-COVID-19 tachycardia syndrome in follow-up. CONCLUSION: In COVID-19 disease de-novo fQRS, dyspnea, high IgG and troponin value, left atrial diameter, lower EF value, diastolic dysfunction were associated with post-COVID-19 tachycardia syndrome. The de-novo fQRS in SARS-COV-2 may be a predictor of future more important adverse cardiovascular outcomes and this should alert clinicians.

The Association Between SYNTAX Score II and Carotid Artery Disease Severity in Patients Who Underwent Coronary Artery Bypass Grafting.

The SYNTAX score (SS) and SS II, which include additional clinical parameters, are widely used today for deciding revascularization following coronary angiography. We investigated the association between the presence and severity of carotid artery disease (CrAD) using the SS and SS II in 287 patients who underwent coronary artery bypass grafting. We based this investigation on the known association between coronary artery disease and CrAD. A significant association was observed between the groups with and without CrAD in terms of SS II values (28.4 ± 9.6 vs 21.4 ± 7.7, respectively; P < .001). A significant difference was also observed when stenosis was classified according to severity as <50%, 50% to 70%, and >70% (P < .001). The results indicated a positive correlation between the presence and severity of CrAD as SS II increased (r = 0.187, P = .005). According to the results of multivariate logistic regression analysis, the SS II was an independent predictor of CrAD.

Ischemia-Modified Albumin is not Elevated in Deep Venous Thrombosis.

BACKGROUND: In this article, we aimed to determine the diagnostic role of ischemia-modified albumin (IMA) in the evaluation of patients with deep venous thrombosis (DVT). METHODS: Fifty-five patients with a diagnosis of DVT and 47 healthy subjects as the control group were included in the study. Blood samples of the patients were obtained within the first 24 hours after DVT diagnosis for IMA analysis. Patient and control groups were compared with respect to IMA levels. RESULTS: We found that HDL and albumin levels were significantly higher in the control group. However, we could not determine a significant increase in IMA levels in patients with DVT when compared to the control group. CONCLUSIONS: Our study revealed that IMA is not a useful marker in the diagnosis of DVT.

Rare etiological causes of iliofemoral deep venous thrombosis: Reports of 2 cases.

Deep venous thrombosis is frequently seen in lower extremities. However, when seen in the iliac level, mass effect of an underlying pathology must be considered. In this report, we present two cases with upper region deep venous thrombosis, which had underlying pathologies of appendicitis and non-Hodgkin lymphoma.

Saphenous vein wrapping for the treatment of a perigraft seroma: report of a case.

A 61-year-old man who had undergone an iliofemoral bypass with an expanded polytetrafluoroethylene (PTFE) graft was readmitted to our hospital for the investigation and treatment of a possible complication of the surgery. A tender, pulsatile, bulging mass, about the size of an adult fist, was palpated around the left lower abdominal region. Diagnostic procedures showed a large low-density area around the PTFE graft and angiography revealed a patent graft with no anastomotic leakage. An operative inspection revealed the mass to be a large perigraft seroma. The PTFE graft was covered with a saphenous vein strip, a treatment that has not previously been mentioned in the literature. The success of this strategy was confirmed by clinical observations and diagnostic procedures including ultrasonography and computed tomography, with no sign of recurrence for 5 months.

Inferior vena cava aneurysm with hemothorax: rare presentation.

We presented a case of hemothorax secondary to inferior vena cava (IVC) aneurysm. A 47-year-old woman was presented to our hospital with nausea, vomiting, and right superior abdominal pain. There was pleural effusion on the right side of the posteroanterior chest x-ray for which a thoracentesis was performed and serohemorrhagic fluid was determined. Biochemical tests showed a mixed transudate and hemorrhage (hemothorax). Cytology was negative for malignancy. Computed tomography revealed a right-sided pleural effusion and a suprahepatic mass that was neighboring IVC and right atrium. Suprahepatic IVC aneurysm without venous obstruction was shown by magnetic resonance imaging and angiography. Mass was explored with right thoracotomy through sixth intercostal space, and the aneurysmal mass was seen and dissected from neighboring tissues. The mass was discrete and directly related to IVC just above the right hepatic vein entrance. After the excision of the aneurysm, the IVC wall was repaired. Histopathologic examination confirmed our diagnosis as venous aneurysm. The patient was discharged without any complication on the sixth postoperative day.

Preoperative beta-blocker use reduces atrial fibrillation in off-pump coronary bypass surgery.

BACKGROUND: Atrial fibrillation (AF) after coronary artery bypass graft surgery constitutes the most common sustained arrhythmia and results in many complications. The purpose of this study was to assess the effects of prophylactic use of beta-blockers against atrial fibrillation in off-pump surgery patients in the early postoperative period. METHODS: From 2002 to 2005, 78 patients were enrolled and 41 patients received 50 mg metoprolol succinate daily, which was initiated minimum four days before surgery. Preoperative beta-blocking therapy was continued until the morning of surgery. Thirty-seven patients were free of beta-blocker therapy. Esmolol was used within same range of doses in both groups during operations. Both groups received metoprolol succinate following operations. The frequency of AF occurrence was analysed from the operation time to the sixth postoperative day. RESULTS: Sixteen patients developed AF with an overall incidence of 22.5%. Four patients from the study group and three patients from the control group were excluded from the study because of transfer to on-pump surgery. There was no difference with regard to the number of grafts carried out, duration of operations and ventilation, intensive care unit stay and inotropic need among groups. Length of hospital stay did not differ among groups either. There was a higher incidence of postoperative AF in patients without beta-blocker prophylaxis (11.7-32.4% P=0.049). CONCLUSION: Low-dose postoperative beta-adrenergic blockade is valuable for patients who receive these medications before off-pump coronary artery bypass grafting procedures and may be beneficial against AF in all patients.

The management of complicated sternal dehiscence following open heart surgery.

BACKGROUND: Wound infection after median sternotomy for cardiac or thoracic surgery is a serious complication, and there is a lack of agreement regarding the best treatment method. We present our results in patients with mediastinitis treated with longitudinally affixed titanium plates on sternal halves. METHODS: The technique was composite closure using titanium fixation plates to buttress the sternum in combination with circumferential stainless steel wires. The series included 21 patients who developed sternal non-union resulting from mediastinitis. Mobilization of muscular flaps was performed in 8 cases. This technique also consists of sternal and soft tissue debridement and wound closure over mediastinal tubes with continuous irrigation and drainage. Antibiotherapy based on culture and sensitivity data continued for 4 to 7 weeks. RESULTS: Twenty patients achieved complete wound healing without further operative intervention or major complication. Nineteen patients treated with this technique survived. One patient died from sepsis after developing residual focus of chondritis and undergoing wide resection of cartilage, and 1 patient died from complications of severe stroke. CONCLUSION: We had good success using aggressive early debridement, closure of the sternal halves with titanium plates, mobilization of muscular flaps, high-volume mediastinal irrigation, and intravenous antibiotics. This approach was a successful salvage technique for revision cases in achieving sternal stability and union when standard methods of closure failed or were unlikely to succeed.

Free intra-abdominal hemorrhage after open-heart surgery: an unusual gastrointestinal complication.

Gastrointestinal complications after open-heart surgery are rare. Many preoperative, intraoperative, and postoperative factors may predispose patients to these complications or cause them. Our patient was a 64-year-old woman who underwent aortic valve replacement due to aortic stenosis. Free intra-abdominal hemorrhage occurred on the 2nd postoperative day. During exploratory laparotomy, it was determined that the hemorrhage was from a vein near the falciform ligament of the liver and from a bleeding laceration of the splenic capsule. The complication was repaired surgically. To our knowledge, intra-abdominal hemorrhage of both liver and spleen after open-heart surgery has never been reported before, even in large patient series. We report the case and present our ideas regarding the cause of the bleeding.