The Role of Pan-Immune-Inflammation Value in Determining the Severity of Coronary Artery Disease in NSTEMI Patients.

BACKGROUND: Even though medication and interventional therapy have improved the death rate for non-ST elevation myocardial infarction (NSTEMI) patients, these patients still have a substantial residual risk of cardiovascular events. Early identification of high-risk individuals is critical for improving prognosis, especially in this patient group. The focus of recent research has switched to finding new related indicators that can help distinguish high-risk patients. For this purpose, we examined the relationship between the pan-immune-inflammation value (PIV) and the severity of coronary artery disease (CAD) defined by the SYNTAX score (SxS) in NSTEMI patients. METHODS: Based on the SxS, CAD patients were split into three groups. To evaluate the risk variables of CAD, multivariate logistic analysis was employed. RESULTS: The PIV (odds ratio: 1.003; 95% CI: 1.001-1.005; p = 0.005) was found to be an independent predictor of a high SxS in the multivariate logistic regression analysis. Additionally, there was a positive association between the PIV and SxS (r: 0.68; p < 0.001). The PIV predicted the severe coronary lesion in the receiver-operating characteristic curve analysis with a sensitivity of 91% and specificity of 81.1%, using an appropriate cutoff value of 568.2. CONCLUSIONS: In patients with non-STEMI, the PIV, a cheap and easily measured laboratory variable, was substantially correlated with a high SxS and the severity of CAD.

Cut-off value for interleukin-34 as an additional potential inflammatory biomarker for estimation of slow coronary flow risk.

BACKGROUND: Inflammatory markers may provide insights into the underlying mechanisms of slow coronary flow (SCF), including subclinical atherosclerosis and endothelial dysfunction. Interleukin-34 (IL-34), known for its role in immuno-inflammatory diseases, might hold significance in SCF. We aimed to explore the potential association between IL-34 and SCF in patients undergoing diagnostic elective coronary angiography. METHODS: This observational, cross-sectional study enrolled 256 participants: 124 with SCF and 132 with normal coronary flow (NCF). All participants had undergone outpatient coronary angiography for suspected coronary artery disease. SCF assessment employed the TIMI frame count (TFC) for quantifying coronary flow rate. RESULTS: SCF patients exhibited significantly elevated TFC in all three major coronary arteries compared to controls (p < 0.05). IL-34 displayed a noteworthy positive correlation with average TFC [for all participants: r = 0.514, p < 0.001; for SCF patients: r = 0.526, p < 0.001; for normal controls: r = -0.288, p > 0.05]. Similarly, high-sensitivity C-reactive protein (hsCRP) showed a significant and positive relationship with average TFC [for all participants: r = 0.504, p < 0.001; for SCF patients: r = 0.558, p < 0.001; for normal controls: r = -0.148, p > 0.05]. SCF patients presented coronary arteries of larger size compared to controls. CONCLUSION: Mean coronary diameter and IL-34 emerged as independent predictors of SCF. Additionally, hsCRP, mean coronary diameter, and IL-34 exhibited a positive correlation with mean TFC values. IL-34 appears to be a more effective indicator than hsCRP in SCF patients.

Unveiling cardiac insights: Exploring early left ventricular dysfunction in polycythemia vera through 4D-STE and fragmented QRS analysis.

BACKGROUND: Polycythemia vera (PV), characterized by elevated red blood cell counts, poses challenges to cardiovascular health with potential impacts on cardiac function. Myocardial infarction (MI) and heart failure are major causes of mortality in PV patients. Early detection of left ventricular systolic dysfunction is crucial for optimizing outcomes. METHODS: Fifty-two PV patients and 45 healthy controls were recruited. Four-dimensional speckle tracking echocardiography (4D-STE) and fragmented QRS complexes (fQRS) on electrocardiograms were utilized to assess cardiac mechanics. Hematological and echocardiographic parameters were measured, and statistical analyses were performed. RESULTS: PV patients exhibited significantly higher hematocrit and red cell distribution width compared to controls. Global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were lower in PV patients. fQRS complexes were associated with longer disease duration and reduced GCS and GAS values. Hematocrit correlated positively with LV-GCS and LV-GAS. Multiple linear regression revealed that disease duration and fQRS presence independently predicted LV-GAS. CONCLUSION: This study underscores the intricate link between elevated red blood cell counts, disease duration, and cardiac function in PV patients. Combining 4D-STE and fQRS complexes enhances the identification of early left ventricular systolic dysfunction. These findings offer potential improvements in recognizing and managing cardiovascular complications in PV patients, with implications for future research and clinical practice. Further investigations are needed to elucidate underlying mechanisms and validate these markers in larger cohorts.

Effect of diabetes mellitus on association between galectin-3 and H2FPEF score in patients with unexplained dyspnea and a preserved left ventricular ejection fraction.

OBJECTIVES: The aim of this study was to investigate the effect of diabetes mellitus (DM) on the association between Galectin-3 (Gal-3) and the H2FPEF score in patients with unexplained dyspnea and a preserved left ventricular ejection fraction (LVEF). METHODS: A cross-sectional observational study was conducted on patients with unexplained dyspnea and a preserved LVEF in the Cardiology Department of Elazig Medical Park Hospital, Turkey. The patients were evaluated based on the presence of DM and the H2FPEF score. Gal-3 levels were compared between groups, and the effect of DM on Gal-3 was assessed. The level of statistical significance in all tests was set at p < .05. RESULTS: Gal-3 and H2FPEF scores were higher in patients with DM (p < .001 and p = .027, respectively). Gal-3 and HbA1C values were elevated in patients with moderate to high H2FPEF scores (p < .01 and p = .036, respectively). DM and Hypertension were more prevalent in patients with moderate to high H2FPEF scores (p = 0.024, p < 0.001, respectively). A strong correlation was observed between Gal-3 and the H2FPEF score (r = 0.375, p < .001). Gal-3 could predict patients with a moderate to high H2FPEF score using a cut-off value of 14.7, with a sensitivity of 69% and specificity of 67% (AUC: 0.702). CONCLUSIONS: Gal-3 serves as an independent predictor of the H2FPEF score in the presence of DM, and the diagnostic capability of Gal-3 for Heart Failure with preserved LVEF remains unaffected by DM.

Four-dimensional speckle tracking echocardiography and fragmented QRS in detection of early left ventricular systolic dysfunction in patients with subclinical hyperthyroidism.

BACKGROUND: Thyroid disorders are associated with many cardiovascular risk factors. The importance of thyroid hormones in the pathophysiology of heart failure is underlined by the European guidelines of the European Society of Cardiology. However, the role of subclinical hyperthyroidism (SCH) in subclinical left ventricular (LV) systolic dysfunction is not entirely clear. METHODS: This cross-sectional study included 56 SCH patients and 40 healthy volunteers. The 56 SCH group was divided into two subgroups depending on the presence of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with four-dimensional (4D) echocardiography. RESULTS: GAS, GRS, GLS, and GCS values were significantly different in SCH patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-17.06 ± 1.00 vs. -19.08 ± 1.71, p < .001, and -26.61 ± 2.38 vs. -30.61 ± 2.57, p < .001, respectively). ProBNP was positively correlated with LV-GLS (r = 0.278, p = .006) and LV-GAS (r = 0.357, p < .001). Multiple linear regression analysis showed that fQRS was an independent predictor of LV-GAS. CONCLUSIONS: 4D strain echocardiography may be helpful for the prediction of early cardiac dysfunction in patients with SCH. The presence of fQRS may be an indicator of subclinical LV dysfunction in SCH.

Effect of altitude on ticagrelor-induced dyspnea in patients with acute coronary syndrome.

OBJECTIVE: This study aimed to define the association between altitude and ticagrelor-associated dyspnea in patients with acute coronary syndrome (ACS). METHODS: We studied consecutive patients with de novo ACS who were admitted to two centers at a low altitude (18 and 25 m, n = 65) and two centers at a high altitude (1313 and 1041 m, n = 136). We managed them with ticagrelor between May 2017 and September 2017. Patients with ACS underwent an interventional procedure within <90 minutes in those with ST elevation and within <3 hours in those without ST elevation. We recorded the incidence of dyspnea in patients with ACS receiving ticagrelor therapy. RESULTS: The mean age was 59.5 ± 10 years, and the mean ejection fraction was 43% ± 18%. A total of 110 (56.7%) patients had ST elevation and 84 (43.3%) did not. There were no significant differences in cardiac risk factors, concurrent medications, or procedural variables between the two groups. Dyspnea developed during hospitalization in 53 (38%) patients from high-altitude centers and in 13 (20%) patients from low-altitude centers (66 patients represented 32% of the total ACS cohort). CONCLUSIONS: Dyspnea is a common multifactorial symptom in patients following development of ACS. Ticagrelor-induced dyspnea appears to be associated with altitude.

Predictive value of the systemic immune inflammatory index in cardiac syndrome x.

INTRODUCTION: Patients with normal coronary arteries in whom increased vasospasm cannot be detected with the stress test should be evaluated in terms of cardiac syndrome x (CSX). Inflammatory systems are effective in endothelial activation and dysfunction in CSX. The systemic immune inflammation index (SII) is thought to be an important factor in determining the course of diseases, especially in infectious diseases or other diseases, as an indicator of the inflammation process. The aim of this study is to determine the role of SII levels in the diagnosis of CSX disease. METHODS: The study group included 80 patients who applied to the cardiology department of Firat University with typical anginal complaints between October 2021 and April 2022, and were diagnosed with ischemia after the myocardial perfusion scan, and then coronary angiography was performed and normal coronary arteries were observed. RESULTS: When the study and control groups were examined according to age, gender and body mass index, hypertension, smoking, diabetes mellitus, dyslipidemia and family history, no statistical significant difference was observed between the groups. It was observed that there was a significant difference between the high sensitive C- reactive protin levels of the individuals in the study and control groups (p = 0.028). SII levels measured in samples taken from patients were significantly higher than control subjects (p = 0.003). SII cutoff at admission was 582 with 82% sensitivity and 84% specificity (area under the curve 0.972; 95% CI:0.95-0.98;p < 0.001). CONCLUSION: It has been demonstrated that systemic SII parameters, which can be simply calculated with the data obtained from the complete blood count and do not require additional costs, can contribute to the prediction of CSX disease.

Evaluation of the Effects of Dual Antiplatelet Therapy on Guided Bone Regeneration in Peri-Implant Bone Defect.

In this study, the authors aim to investigate the effect of dual antiplatelet agents on peri-implant-guided bone regeneraation by studying a sample of rats with titanium implants in their tibias. The rats were randomly divided into 5 groups: acetylsalicylic acid (ASA) (n=10), treated with 20 mg/kg of ASA; ASA+CLPD (Clopidogrel): (n=10), treated with 20 mg/kg of ASA and 30 mg/kg of clopidogrel; ASA+PRSG (Prasugrel): (n=10), treated with 20 mg/kg of ASA and 15 mg/kg of prasugrel; ASA+TCGR (Ticagrelor): (n=10), treated with 20 mg/kg of ASA and 300 mg/kg of ticagrelor; and a control group (n=10) received no further treatment after implant surgery. Bone defects created half of the implant length circumferencial after implant insertion and defects filled with bone grafts. After 8 weeks experimental period, the rats sacrified and implants with surrounding bone tissues were collected to histologic analysis; bone filling ratios of defects (%) and blood samples collected to biochemical analysis (urea, creatinine, aspartate aminotransferase, alanine aminotransferase, phosphorus, magnesium, alkaline phosphatase, calcium, and parathormone). A statistically significant difference was not detected between the groups for all parameters ( P >0.05). When the percentage of new bone formation was examined, it was found that there was no statistically significant difference between the groups ( P >0.05). Antiplatelet therapy may not adversely affect guided bone regeneration in peri-implant bone defects.

The relationship between defence mechanisms and clinical variables in myocardial infarction patients.

Introduction: Although patients with myocardial infarction (MI) history exhibit individual differences, several psychological problems can be observed in these patients. The present study aimed to investigate the correlation between defence mechanisms and other clinical and sociodemographic data in the early period in patients with MI history. Material and methods: Sixty patients diagnosed with MI and hospitalized in the cardiology department were included in the study. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Defence Styles Questionnaire (DSQ) were applied. Results: It was determined that the mean BDI score of the participants was 15.9 ±11.2, and the mean BAI score was 15.98 ±10.9. There was a positive correlation between the depression and immature defence mechanism scores of the patients, and there was a negative correlation between the depression and mature defence mechanism scores of the patients (p = 0.001, r = 0.412; p = 0.005, r = -0.359). A negative correlation was determined between anxiety scores and mature defence mechanism scores (p = 0.002, r = -0. 397). Conclusions: The findings demonstrated that depressive complaints of the post-MI patients increased as the immature defence mechanism score increased, and depressive complaints decreased as the maturity defence mechanism score increased. The correlation between the defence mechanisms adopted by MI patients and depression and anxiety symptoms should not be neglected.

An accurate valvular heart disorders detection model based on a new dual symmetric tree pattern using stethoscope sounds.

BACKGROUND AND PURPOSE: Valvular heart disease (VHD) is an important cause of morbidity and mortality. Echocardiography is the reference standard for VHD diagnosis but is not universally accessible. Manual cardiac auscultation is inadequate for screening VHD. Many machine learning models using heart sounds acquired with an electronic stethoscope may improve the accuracy of VHD diagnosis. We aimed to develop an accurate sound classification model for VHD diagnosis. MATERIALS AND METHODS: A new large stethoscope sound dataset containing 10,366 heart sounds divided into ten categories (nine VHD and one healthy) were prospectively collected. We developed a handcrafted learning model that comprised multilevel feature extraction based on a dual symmetric tree pattern (DSTP) and multilevel discrete wavelet transform (DWT), feature selection, and classification. The multilevel DWT was used to create subbands to extract features at both high and low levels. Then, iterative neighborhood component analysis was used to select the most discriminative 512 features from among the extracted features in the generated feature vector. In the classification phase, a support vector machine (SVM) was used with 10-fold cross-validation (CV) and leave-one-subject-out (LOSO) CV. RESULTS: Our proposed DSTP-based model attained 99.58% and 99.84% classification accuracies using SVM classifier with 10-fold CV and LOSO CV, respectively. CONCLUSIONS: The presented DSTP-based classification model attained excellent multiclass classification performance on a large prospective heart sound dataset at a low computational cost.