Positive blood pressure response may predict the recovery of renal function after transcatheter aortic valve implantation.

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) may ameliorate renal function and increase blood pressure (BP). We aimed to investigate the association between increased BP and improved renal function (IRF) after TAVI. METHODS: A total of 176 patients who had undergone TAVI were evaluated retrospectively. BP records that were taken 24 h before and 72 h after TAVI were reviewed. Pre-procedural, post-procedural 48 h, and the first month estimated glomerular filtration rate (eGFR) levels were noted. IRF was accepted as a ≥ 10% increase in eGFR. The predictors of acute kidney injury (AKI) development at 48 h and IRF at 1 month were investigated. The association between mortality and BP response was assessed. RESULTS: A total of 157 patients were included in this study after exclusion as defined in the methodology. Mean age was 78.1 ±â€…7,1 and 51.6% were female. AKI occurred in 25.5% of patients and baseline eGFR and male gender were found as independent predictors for AKI development. IRF was observed in 16% at 48 h and 31.8% of patients at 1-month follow-up. Positive BP response was seen in 42% of patients. Pre-procedural chronic kidney disease, positive BP response, and an early increase in eGFR emerged as independent predictors of IRF at the first month. The patients with positive BP response were found to have decreased mortality at 710 days follow-up. CONCLUSION: Positive BP response after TAVI is related to improved survival and renal functions. The beneficial effect of TAVI on renal function may be precisely evaluated at 1st month rather than 48 h.

Can GRACE Risk Score Predict Mortality and the Need for Thrombolytic Treatment in Acute Pulmonary Embolism?

Acute coronary syndrome and pulmonary embolism (PE) are clinical entities sharing similar presentation and risk factors. Risk scores and indexes help to identify disease severity in both diseases. In this study, we aimed to evaluate if the Global Registry of Acute Coronary Events (GRACE) risk score could predict 30-day mortality and the need for thrombolytic treatment in patients with acute PE. Patients hospitalized with a diagnosis of PE in our tertiary center between January 2018 and May 2022 were included in this retrospective study. Pulmonary Embolism Severity Index (PESI) and GRACE risk scores on admission were calculated using clinical, electrocardiographic, and laboratory parameters for each patient. A total of 197 patients were included. The 30-day mortality rate was 28.4% whereas 32.5% of the patients required thrombolytic treatment. GRACE and PESI scores were found independent risk factors associated with 30-day mortality and the need for thrombolytic treatment. A cut-off value of 160.5 for GRACE score was associated with 88.5% sensitivity and 89.4% specificity in prediction of 30-day mortality. In contrast, GRACE score had 61.0% sensitivity and 60.0% specificity in the prediction of the need for thrombolytic treatment when the cut-off value was 147. In conclusion, GRACE risk score has an effective discriminating power in determining the early mortality of patients with acute PE. The incidence of short-term PE-related mortality was significantly increased in patients with high GRACE risk scores. Concomitant use of GRACE and PESI risk scores may aid in defining patients with high-risk PE and help predict poor prognosis with high specificity and probability.

The association between hemogram parameters and the development of contrast-induced nephropathy in patients presenting with non-ST-elevation myocardial infarction.

Objectives: Hemogram parameters such as mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLr), red cell distribution width and platelet distribution width are widely used inflammatory indicators to assess prognosis in various cardiovascular diseases. In this study, we aimed to investigate the role of hemogram parameters to predict the development of contrast-induced nephropathy (CIN) in patients presenting with non-ST segment elevation myocardial infarction (non-STEMI) and treated with percutaneous coronary intervention (PCI). Methods: All pateints who underwent PCI with a diagnosis of non-STEMI between 2017 and 2020 in our center were included retrospectively in this study. Results: A total of 387 patients were included in this retrospective study. Advanced age (p=0.001, ß:0.005, OR [95 % CI]: 0.002-0.007), diabetes mellitus (p=0.013, ß:0.205, OR [95 % CI]: 0.150-0.260), congestive heart failure (p=0.009, ß:0.095, OR [95 % CI]: 0.024-0.166), volume of contrast medium (p=0.008, ß:0.241, OR [95 % CI]: 0.184-0.392), MPV (p=0.02, ß:0.047, OR [95 % CI]: 0.028-0.065) and NLr (p=0.001, ß:0.052, OR [95 % CI]: 0.040-0.063) were found as independent risk factors associated with CIN development according to multivariate logistic regression analysis. A cut off value of 5.5 for NLr was associated with 79.6 % sensitivity and 79.5 % specificity and 9.05 for MPV was associated with 64.1 % sensitivity and 58.7 % specificity in prediction of CIN development. Conclusions: Hematological parameters, assessed by routine blood count analysis may serve as a promising and useful marker for CIN especially when used in combination with traditional risk factors. MPV and NLr were demonstrated as predictors of CIN development in non-STEMI patients who were treated with PCI in our study.

Is dynamic change in mean platelet volume related with composite endpoint development after transcatheter aortic valve replacement?

Aortic valve stenosis (AS) is the most common valvular disease, and surgical or transcatheter aortic valve replacement (TAVR) are the treatment options. Diminish in platelet production or dysfunction may occur due to shear stress, advanced age, and other coexisting diseases in AS patients. Bleeding is one of the complications of TAVR and associated with increased mortality. MPV (mean platelet volume) indicates platelet's thrombogenic activity. Overproduction or consumption of platelets in various cardiac conditions may affect MPV values. We aimed to investigate the pre and postprocedure MPV percentage change (MPV-PC) and its association with post-TAVR short-term complications. A total of 204 patients who underwent TAVR with a diagnosis of severe symptomatic AS were included. The mean age was 78.66 ±â€Š6.45 years, and 49.5% of patients were women. Two groups generated according to composite end point (CEP) development: CEP(+) and CEP(-).110 patients(53.9%) formed CEP(+) group. Although baseline MPV and platelet levels were similar between groups, MPV was increased ( P  < 0.001) and platelet was decreased ( P  < 0.001) significantly following the procedure when compared to baseline. MPV-PC was significantly higher in the VARC type 2-4 bleeding ( P   =  0.036) and major vascular, access-related, or cardiac structural complication groups ( P   =  0.048) when CEP subgroups were analyzed individually. Regression analysis revealed that diabetes mellitus [ P   =  0.044, ß: 1.806 odds ratio (95% confidence interval): 1.016-3.21] and MPV-PC [ P   =  0.007,ß: 1.044 odds ratio (95% confidence interval): 1.012-1.077] as independent predictors of CEP development at 1 month after TAVR. The MPV increase following TAVR may be an indicator of adverse outcomes following TAVR procedure within 1-month.

The Predictive Ability of MAGGIC Score After Coronary Artery Bypass Grafting: A Comparative Study.

INTRODUCTION: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II and the Society of Thoracic Surgeons (STS) are validated scoring systems for short-term risk estimation after coronary artery bypass grafting (CABG). The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score is originally aimed to estimate mortality in heart failure patients; however, it has showed a similar power to predict mortality after heart valve surgery. In this study, we sought to evaluate whether MAGGIC score may predict short and long-term mortality after CABG and to compare its power with EuroSCORE II and STS scoring systems. METHODS: Patients who underwent CABG due to chronic coronary syndrome at our institution were included in this retrospective study. Follow-up data were used to define the predictive ability of MAGGIC and to compare it with STS and EuroSCORE-II for early, one-year, and up to 10-year mortality. RESULTS: MAGGIC, STS, and EuroSCORE-II scores had good prognostic power, moreover MAGGIC was better for predicting 30-day (area under the curve [AUC]: 0.903; 95% confidence interval [CI]: 0.871-0.935), one-year (AUC: 0.931; 95% CI: 0.907-0.955), and 10-year (AUC: 0.923; 95% CI: 0.893-0.954) mortality. MAGGIC was found to be an independent predictor to sustain statistically significant association with mortality in follow-up. CONCLUSION: MAGGIC scoring system had a good predictive accuracy for early and long-term mortality in patients undergoing CABG when compared to EuroSCORE-II and STS scores. It requires limited variables for calculation and still yields better prognostic power in determining 30-day, one-year, and up to 10-year mortality.

What Is the Impact of Liver Function to Predict Mortality in Patients with Severe Aortic Stenosis and Reduced Ejection Fraction?

BACKGROUND: Liver is one of the target organs in patients with symptomatic severe aortic stenosis and reduced ejection fraction. We aimed to evaluate the prognostic impact of liver function reserve as assessed by albumin-bilirubin score on 30-day and 1-year mortality and rehospitalization at 1 year in patients with severe symptomatic aortic stenosis and reduced ejection fraction undergoing transcatheter aortic valve implantation. METHODS: The patients with severe symptomatic aortic stenosis and reduced ejection fraction who were hospitalized between 2013 and 2021 were included in this single-center retrospective study. Preoperative bilirubin and albumin levels were used for albumin-bilirubin score calculation as in the original report. The total primary outcomes were defined as 30-day and 1-year all-cause mortality and hospitalization for decompensated heart failure within 1 year. Two groups were generated based on albumin-bilirubin score scores: high (>-2.25) and low (≤-2.25) albumin-bilirubin score groups. RESULTS: A total of 77 patients (49 male) were included in the study. and 29 (37.7%) patients died within 1 year of follow-up with 17 corresponding to 30-day mortality. There was no difference between high and low albumin-bilirubin score groups in terms of length of hospital stay, postprocedural complications, and re-hospitalization within 1 year, while 30-day mortality (50.0% vs. 4.3%, P < 0.0001) and 1-year mortality (80.0% vs. 10.6%, P < 0.0001) were significantly higher in the high albumin-bilirubin score group. Hence, total primary outcomes (86.7% vs. 44.7%, P < 0.0001) were significantly higher in the high albumin-bilirubin score group. CONCLUSION: High albumin-bilirubin score (> -2.25) was found as an independent risk factor associated with 30-day and 1-year mortality and total primary outcomes. The results of this study suggest that preprocedural assessment of the albumin-bilirubin score gives additional information to stratify of patients with severe symptomatic aortic stenosis with reduced ejection fraction.

Effect of SGLT-2 inhibitors as an add-on therapy to metformin on P wave indices and atrial electromechanics in type 2 diabetes mellitus patients.

INTRODUCTION: Sodium-glucose co-transporter 2 (SGLT-2) inhibitors have been shown to reduce the risk of atrial fibrillation (AF) occurrence in patients with diabetes mellitus (DM). In this prospective study, we aimed to analyze the effect of SGLT-2 inhibitors as an add-on therapy to metformin on P wave indices and atrial electromechanics in patients with type 2 DM. METHODS: A total of 144 patients enrolled. Electrocardiographic indices were recorded on admission and at 3rd and 6th month of the combination therapy. P wave indices and atrial electromechanical coupling intervals were measured and compared. RESULTS: Although decrease in P wave dispersion (62.78 ± 9.59 vs. 53.62 ± 10.65; p = .002) became significant at 6th month of combination therapy, significant decreases in P wave terminal force in V1 (37.79 ± 3.45 vs. 32.01 ± 5.74; p = .035), left atrial volume index (35.87 ± 6.57 vs. 31.33 ± 7.31; p = .042), left sided intra-atrial electromechanical delay (32.09 ± 9.17 vs. 27.61 ± 8.50; p = .016), right sided intra-atrial electromechanical delay (31.82 ± 4.92 vs. 27.65 ± 8.05; p = .042), and interatrial electromechanical delay (29.65 ± 7.52 vs. 25.96 ± 4.30; p = .044) were seen as early as 3rd month of treatment. Besides, there was no statistically significant difference between Empagliflozin and Dapagliflozin subgroups in terms of mentioned parameters. CONCLUSION: SGLT-2 inhibitors as an add-on therapy to metformin were shown to significantly improve P wave indices and atrial electromechanics in type 2 DM patients as early as the 3rd month of treatment. It was thought that this may be one of the underlying mechanisms of the decrease in the frequency of AF with the use of SGLT2 inhibitors.

Predictive Value of CHA2DS2-VASc Score in Patients with Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention for ST-Elevated Myocardial Infarction.

OBJECTIVE: Contrast-induced nephropathy (CIN) is one of the well-known complications of cardiac catheterization and related with in-hospital and long-term morbidity and mortality. We aimed to evaluate if CHA2DS2-VASc score can also be used as a surrogate for CIN development and moreover the relationship between CIN development and in-hospital major adverse cardiac events (MACE) in patients presenting with STEMI and undergoing primary PCI. METHODS: All patients presented with STEMI and underwent primary PCI between 2015-2019 in our center were included retrospectively. RESULTS: A total of 572 patients were included. Age [P = 0.032, ß: 0.153, odds ratio (95% CI): 0.014-0.302], diabetes mellitus [(P = 0.023, ß: 0.134, odds ratio (95% CI): 0.017-0.217], history of stroke [P = 0.034, ß: 0.118, OR (95% CI): 0.017-0.436], volume of contrast medium [P = 0.042, ß: 0.155, OR (95% CI): 0.109-0.462], left ventricular ejection fraction [P = 0.003, ß: 0.376, OR (95% CI): 0.214-0.517], and CHA2DS2-VASc score [P = 0.001, ß: 0.115, OR (95% CI): 0.054-0.177] were detected as independent risk factors associated with contrast-induced nephropathy development. The area under the curve for CHA2DS2-VASc score was 0.809 (95% CI: 0.760-0.857). A cut-off value of 2.5 for CHA2DS2-VASc score was associated with 80.1% sensitivity and 71.4% specificity in the prediction of contrast-induced nephropathy development. CONCLUSION: Our current study showed that the CHA2DS2-VASc risk score has an effective discriminating power in determining the contrast-induced nephropathy development and a score ≥2 defines the group at risk in patients presenting with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention. Moreover, contrast-induced nephropathy development is associated with longer coronary care unit stay and major adverse cardiac events (in-hospital decompensated heart failure, cardiogenic shock, cardiac arrest, and mortality).

A Retrospective Study to Evaluate the Association Between the Glasgow Prognostic Score and Atrial Fibrillation, Stroke, and Mortality at 30 Days and at 1 Year After Coronary Artery Bypass Graft Surgery.

BACKGROUND The Glasgow prognostic score (GPS) consists of a combination of serum C-reactive protein and albumin levels as indicators of systematic inflammatory response and nutritional status, respectively. The present retrospective study aimed to evaluate the association between the GPS and atrial fibrillation, stroke, and mortality at 30 days and 1 year after coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS Patients with chronic coronary syndromes who underwent CABG surgery between 2012 and 2019 in a single center were included. Preoperative GPS was calculated. Then, patients were grouped according to postoperative atrial fibrillation (POAF) development. Further, groups were formed to evaluate the relationship between GPS and 30-day and 1-year cardiovascular mortality as well as stroke development. RESULTS Patients who developed POAF had higher GPS, higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) score, advanced age, lower angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use, lower left ventricular ejection fraction, and were more likely to be female and to have a history of carotid artery disease (P<0.05, for all). Additionally, GPS, EuroSCORE II, advanced age, and lower left ventricular ejection fraction were detected as independent risk factors for POAF development. When adverse outcomes were assessed, cardiovascular mortality at 30 days or 1 year, and stroke development at 1 year, were more frequent in patients with POAF. Moreover, POAF development was found to be an independent risk factor for adverse outcomes. Also, GPS was established as an independent risk factor both for 30-day and 1-year cardiovascular mortality (P<0.0001 and P=0.001, respectively). CONCLUSIONS GPS is an easy-to-calculate score that has reasonable diagnostic accuracy in determining the risk of POAF and stroke as well as 30-day and 1-year cardiovascular mortality.

Role of Cardiac Risk Scores in Clinical Use to Predict Outcomes of Acute Ischemic Stroke.

Introduction: Acute coronary syndromes and ischemic stroke have similar risk factors. Risk scores help to identify disease severity in both diseases. We aimed to evaluate if HEART (History, ECG, Age, Risk factors, and Troponin) score could predict re-hospitalization, recurrent cardiac/cerebrovascular events risk, and mortality within 1-year follow-up in patients presenting with acute ischemic stroke. Methods: Patients hospitalized with a diagnosis of acute ischemic stroke in our tertiary center between 2019 and 2021 were included in this retrospective study. CHA2DS2-VASc and HEART scores on admission were calculated. In-hospital, 1-month, and 1-year mortalities, as well as re-hospitalization due to recurrent ischemic (cardiac/cerebral), were defined as major adverse cardiac and cerebrovascular events (MACCE), and occurrence of MACCE was accepted as the primary endpoint of the study. Comparative statistical and regression analyses were obtained. Results: A total of 297 patients were included. The mortality rate for 30 days was 7.4% and 1 year was 20.5%. HEART and CHA2DS2-VASc scores were found independent risk factors associated with the occurrence of MACCE. Patients who experienced MACCE had higher HEART and CHA2DS2-VASc scores. Meanwhile, HEART score had better prognostic accuracy than CHA2DS2-VASc score when a cutoff value of 3.5 was set, which is associated with 84.7% sensitivity and 75.2% specificity in the prediction of MACCE. Conclusion: HEART score is effective in determining re-hospitalization and recurrent cerebral ischemic event risk as well as mortality within 30 days and 1 year in patients presenting with acute ischemic stroke. Thus, concomitant use of HEART and CHA2DS2-VASc scores may provide better characterization of worse prognosis in ischemic stroke patients with high sensitivity and specificity.

Prognostic significance of serum galectin-3 in hospitalized patients with COVID-19.

BACKGROUND: There are no major tools that could predict disease severity in COVID-19. The aim of this study is to evaluate if serum galectin-3 levels can identify disease progression in COVID-19. METHODS: Patients that were hospitalized due to COVID-19 between March and June 2020 were included in this cross-sectional prospective study. Baseline demographic and clinical data in addition to levels of serum parameters including galectin-3 were measured at the time of hospital admission. Patients with COVID-19 were categorized into two groups (non-severe and severe illness). The need for ICU during hospital stay, duration from hospital admission to the transfer to the ICU, and the total length of hospital stay were recorded. RESULTS: A total of 175 patients were included in the study and among these, 64 patients formed the severe illness group whereas 111 comprised the non-severe illness group. There was statistically significant difference in terms of galectin-3 levels between groups (1.07 ± 0.75 vs 0.484 ± 0.317, p < 0.0001, respectively). Our results showed that galectin-3, IL-6 and CRP levels at admission were independent risk factors associated with transfer to the ICU whereas only galectin-3 was an independent factor for the need for advanced ventilatory support. Also, galectin-3 and IL-6 were independent risk factors related to in-hospital mortality. CONCLUSION: In conclusion, our results indicated that galectin-3 had moderate power in outlining disease severity and the need for ICU transfer throughout the clinical course in COVID-19.

Prognostic value of GRACE risk score in patients hospitalized for coronavirus disease 2019.

OBJECTIVE: COVID-19 pandemic continues to threaten human health as novel mutant variants emerge and disease severity ranges from asymptomatic to fatal. Thus, studies are needed to identify the patients with ICU need as well as those who have subsequent mortality. Global Registry of Acute Coronary Events (GRACE) risk score is a validated score in acute coronary syndrome. We aimed to evaluate if GRACE score can indicate adverse outcomes and major ischemic events in hospitalized COVID-19 patients. METHODS: All hospitalized patients due to COVID-19 at our institution between March 2020 and September 2020 were included in this retrospective study. Patients were grouped according to GRACE risk scores: low risk 0-108 points, intermediate risk 109-140 and high risk ≥141. RESULTS: A total of 787 patients were enrolled; 434 patients formed group 1. One-hundred forty-one patients in group 2 and 212 patients formed group 3. We found that inhospital mortality, length of hospital stay, ICU and advanced ventilatory support need were associated with increasing GRACE risk score. In addition, major ischemic events were more frequently observed in higher risk groups and strong positive correlations between GRACE risk score and pro-BNP, procalcitonin and moderate positive correlation with D-dimer, CRP, NLR was found. Regression analysis showed that only GRACE risk score was an independent risk factor associated with inhospital mortality, major ischemic events, advanced ventilatory support and ICU need. CONCLUSION: The GRACE risk score is easy to apply on hospital admission and useful for classifying those in medium-high-intensity care units and to raise the assignments of sources.

C-Reactive Protein to Albumin Ratio as A Novel Inflammatory-Based Marker for 30-Day Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract Objective: We aimed to investigate whether C-reactive protein to albumin ratio (CAR) predicts the early and late mortality in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: This study was retrospectively designed and includes 170 TAVR patients with a mean age of 78.4±7.1 years. Patients were divided into 2 groups as those who died and those who survived, taking into account the follow-up period. Complete blood count, serum CRP and serum albumin were obtained on admission. The CAR value of all patients was calculated and the relationship of CAR with early (≤30 days) and late mortality (>30 days) was evaluated. Results: The median follow-up period was 19 [7-31] months (maximum 66 months). Early mortality was observed in 20 (11.8%) patients, whereas late mortality was observed in 39 (22.9%) patients, most of them male (61.1%, P=0.04). Non-survivors had greater CAR value, higher baseline serum CRP level and lower baseline albumin level than survivors (P<0.01, for all parameters). According to multivariate analysis models, CAR (HR: 1.020, P<0.01) and TVAR score (HR: 1.294, P<0.01) were found to be independent predictors of early mortality while CRP and albumin were not. The area under the curve (AUC) for CAR was 0.73 with a P <0.01. A CAR >15.6 predicted the early mortality with 80% sensitivity and 57% specificity. Conclusion: The novel inflammatory marker CAR can be used as a reliable marker in predicting 30-day mortality in patients undergoing TAVR.

Long-Term Clinical Consequences of Patients Hospitalized for COVID-19 Infection.

BACKGROUND: Coronavirus disease 2019, putatively caused by infection with severe acute respiratory coronavirus 2, often involves injury to multiple organs and there are limited data regarding the mid- to long-term consequences of coronavirus disease 2019 after discharge from the hospital. The study aimed to describe the mid- to long-term consequences of coronavirus disease 2019 in hospitalized patients after discharge. METHODS: This single-center, prospective study enrolled coronavirus disease 2019 patients who were discharged uneventfully from our center. All participants underwent face-toface interviews by trained physicians and were asked to complete a series of questionnaires on third and sixth months' follow-up visits. RESULTS: A total of 406 consecutive discharged coronavirus disease 2019 patients were enrolled in this study. Patients were divided into 3 groups according to World Health Organization classification as follows: World Health Organization-3 (n=83); World Health Organization-4 (n=291); and World Health Organization-5,6 (n=32). Length of hospital stay was highly, significantly increased in the higher World Health Organization groups (World Health Organization-3 vs. World Health Organization-4, P < .0001; World Health Organization-3 vs. World Health Organization-5,6, P < .0001; World Health Organization-4 vs. World Health Organization-5,6, P < .0001), whereas the length of intensive care unit stay was highly, significantly increased only in World Health Organization-5,6 group compared to other groups (World Health Organization-3 vs. World Health Organization-5,6, P < .0001; World Health Organization-4 vs. World Health Organization-5,6, P < .0001). The most frequent complaints were chest pain (39%), and the frequency of complaints decreased during the 3-6 months follow-up period. Multiple logistic regression analysis indicated that age, coronary artery disease, fibrinogen, C-reactive protein, troponin I, D-dimer, use of steroid and/or low molecular weight heparin, and World Health Organization class were found to be independent predictors of ongoing cardiovascular symptoms. CONCLUSIONS: The current data demonstrated that persistent symptoms were common after coronavirus disease 2019 among hospitalized patients. This should raise awareness among healthcare professionals regarding coronavirus disease 2019 aftercare.

Assessment of treatment patterns and patient awareness in atrial fibrillation patients using non-vitamin K antagonist oral anticoagulants (ASPECT-NOAC).

Background and Aim: Despite the advances in oral anticoagulation with NOACs, careful patient and dose selection is required with NOAC therapy. Our study aimed to assess treatment patterns of NOACs in AF along with patients' continuity to NOAC treatments in first year, and their knowledge level of AF and NOAC treatment. Methods: ASPECT-NOAC was designed as an observational, prospective, and multicenter study. AF patients who were prescribed NOACs within last four months were recruited from 34 outpatient cardiology clinics covering all geographic regions of Turkey. Baseline data were collected initially whereas patient awareness was evaluated at 3 to 4 weeks. Final study visit was performed at 12 months. Results: In total, 991 patients were included to the study. Mean ± standard deviation of age was 69.4 ± 10.2 years and 53.0% of patients were female. Mean duration from AF diagnosis was 24.9 ± 50.9 months. Mean CHA2DS2-VASc and HAS-BLED scores were 3.1 ± 1.5 and 1.6 ± 1.1, respectively. AF disease and NOAC treatment knowledge levels were found to be 48.9 ± 23.1% and 73.0 ± 19.3%, respectively. Among reduced dose users 71.4% of patients were prescribed inappropriate reduced doses. Through the study follow-up, 32 patients (3.2%) deceased and NOAC therapy was discontinued in 74 patients (8.7%). Conclusion: AF patients who recently started NOAC treatment in Turkey were found to have variable knowledge about their disease and anticoagulation treatment. It was observed that most of the patients continued the NOAC treatment throughout the study. Reduced dosing of NOACs was common, which was associated with higher baseline risk for bleeding as well as stroke.

C-Reactive Protein to Albumin Ratio as A Novel Inflammatory-Based Marker for 30-Day Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement.

OBJECTIVE: We aimed to investigate whether C-reactive protein to albumin ratio (CAR) predicts the early and late mortality in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS: This study was retrospectively designed and includes 170 TAVR patients with a mean age of 78.4±7.1 years. Patients were divided into 2 groups as those who died and those who survived, taking into account the follow-up period. Complete blood count, serum CRP and serum albumin were obtained on admission. The CAR value of all patients was calculated and the relationship of CAR with early (≤30 days) and late mortality (>30 days) was evaluated. RESULTS: The median follow-up period was 19 [7-31] months (maximum 66 months). Early mortality was observed in 20 (11.8%) patients, whereas late mortality was observed in 39 (22.9%) patients, most of them male (61.1%, P=0.04). Non-survivors had greater CAR value, higher baseline serum CRP level and lower baseline albumin level than survivors (P<0.01, for all parameters). According to multivariate analysis models, CAR (HR: 1.020, P<0.01) and TVAR score (HR: 1.294, P<0.01) were found to be independent predictors of early mortality while CRP and albumin were not. The area under the curve (AUC) for CAR was 0.73 with a P <0.01. A CAR >15.6 predicted the early mortality with 80% sensitivity and 57% specificity. CONCLUSION: The novel inflammatory marker CAR can be used as a reliable marker in predicting 30-day mortality in patients undergoing TAVR.

The Prognostic Value of C-Reactive Protein/Albumin Ratio in Acute Pulmonary Embolism.

Background: Serum C-reactive protein (CRP) to albumin ratio (CAR) has been defined as an inflammation-based prognostic marker. We evaluated the association and prognostic value of CRP/albumin ratio in patients with pulmonary embolism (PE). Methods: A total of 256 patients with acute PE who were hospitalized between March 2016 and December 2020 were retrospectively reviewed. PE severity index (PESI) was calculated. Serum levels of CRP and albumin that were obtained at the time of admission were used for calculation. CAR was evaluated for correlation with PESI, and thus, foresee the risk of death due to PE. Results: There were 186 patients eligible for inclusion. 54 patients were in intermediate, 34 patients were in high risk and 98 patients were in very high-risk group according to PESI score. In the correlation analysis, we observed moderate positive correlations between CRP/albumin ratio, troponin and PESI score (r = 0.584, p < 0.0001; r = 521, p < 0.0001, respectively). Regression analysis revealed that only CRP/albumin ratio and PESI score were independent risk factors associated with 6-month mortality of acute PE patients. The AUC for CRP/albumin ratio was 0.643, 0.751, and 0.763 for 30-day, 90-day, and 6-month mortality, respectively (95% CI: 0.550-0.737, 0.672-0.830, 0.687-0.838]. A cut-off value of 5.33 for CRP/albumin ratio was associated with 65.3% sensitivity and 65.6% specificity in predicting 6-month mortality. Conclusion: The CRP/albumin ratio, an inexpensive and easily measurable laboratory variable, may be a useful prognostic marker of PE, especially when other causes that alter serum levels are excluded from the study.