Prognostic value of thiol/disulfide homeostasis in symptomatic patients with heart failure.

We aimed to examine the role of thiol/disulphide homeostasis (TDH) in heart failure and its stages and the prognosis of heart failure. A total of 140 subjects were included in the study. Total and native thiol levels were higher in the control group compared to the patient groups (p < .001). While the average disulphide/total thiol ratio was similar in groups 1 and 2, it was found to be significantly lower in the control group compared to other groups and significantly higher in group 3 compared to other groups (p < .05). Mean native thiol and total thiol levels were found lower in patients with mortality compared to surviving patients (p < .001). In ROC curve analysis, it was determined that the total thiol level had 81.8% sensitivity and 83.1% specificity, and native thiol level had 81.8% sensitivity and 84.3% specificity. We found that TDH was impaired in favour of disulphide in cases of heart failure.

Usefulness of Tp-Te interval and Tp-Te/QT ratio in the prediction of ventricular arrhythmias and mortality in acute STEMI patients undergoing fibrinolytic therapy.

BACKGROUND AND AIM: Acute ST-elevation myocardial infarction (STEMI) is associated with fatal and non-fatal ventricular arrhythmic events (VAE). Although primary percutaneous intervention (PCI) is first-line treatment in STEMI, fibrinolytic therapy (FT) is still widely used in many countries. Tp-Te interval; Tp-Te/QT ratio and QT dispersion (QTd) are novel markers of ventricular repolarization (VR) and associate with VAE and mortality. Hereby, we assessed Tp-Te, QTd and Tp-Te/QT in acute STEMI patients undergoing FT and analyzed their relationship with post-FT VAE, and arrhythmic and overall deaths. METHODS: A total of 207 consecutive STEMI patients treated with FT were retrospectively evaluated. Patients were divided in Group 1 (non-VAE group) and Group 2 (VAE group). ECG, clinical and demographic data were noted. Relationship between the pre-FT electrocardiographic parameters of VR and post-FT VAE, arrhythmic and overall death was evaluated. RESULTS: Tp-Te, Tp-Te/QT and QTd were significantly higher in Group 2 compared to Group 1 (p < 0.05). Tp-Te, Tp-Te/QT, QTd, QTc and left ventricular ejection fraction (LVEF) predicted VAE. Tp-Te/QT and LVEF predicted arrhythmic death (1.05; 95% CI 1.01-1.08; p = 0.031 and 0.87; 95% CI 0.72-0.96; p = 0.040; respectively). In ROC analysis, cut-off for Tp-Te/QT to predict VAE was >0.305 with 87.5% sensitivity and 60.1% specificity (AUC: 0.90; 95% CI: 0.85-0.95; p < 0.001), and to predict arrhythmic death was >0.315 with 83.3% sensitivity and 62% specificity (AUC: 0.70; 95% CI: 0.60-0.81; p = 0.018). CONCLUSION: Tp-Te, Tp-Te/QT, QTc, QTd and LVEF are independent predictors of post-FT VAE in acute STEMI. Tp-Te/QT ratio is associated with VA-related deaths.

Usefulness of white blood cell count to mean platelet volume ratio in the prediction of SYNTAX score in patients with non-ST elevation myocardial infarction.

OBJECTIVE: White blood cell (WBC) count to mean platelet volume (MPV) ratio (WMR) is associated with major adverse cardiovascular events in patients with non-ST elevation acute coronary syndrome (NSTEMI). We aimed to compare WMR between NSTEMI patients and matched-controls and to evaluate its predictive value on SYNTAX score. METHODS: Total 175 patients with NSTEMI and 160 age and co-morbidity matched subjects were recruited in our study. WMR was compared between the patient and control groups. The patient group was further subdivided into 3 tertiles according to SYNTAX scores as follows: low SYNTAX score tertile (score ≤22, 141 patients); intermediate SYNTAX score tertile (score between 23 and 32, 20 patients); and, high SYNTAX score tertile (score ≥33, 14 patients). WMR was further assessed among the tertiles. RESULTS: WMR was significantly greater in the patient group compared to the control group (p<0,001). WMR among low, intermediate and high score tertiles were calculated to be 890±26, 1090±042 and 1500±65, respectively (p <0,001). In receiver operating characteristics (ROC) analysis, WMR >960 predicted a SYNTAX score ≥23 with 80.6% sensitivity and 67.6% specificity (AUC: 0.756; 95% CI: 0.685 - 0.818; p <0.0001) and a WMR >1360 predicted a SYNTAX score ≥33 with 71.4% sensitivity and 93% specificity (AUC: 0.840; 95%CI: 0.777 - 0.892; p <0.0001). CONCLUSIONS: WMR value was significantly elevated in NSTEMI patients, compared to controls. Higher WMR was associated with greater SYNTAX score in patients with NSTEMI. WMR may be used to predict severity of the CAD and to implement risk stratification in patients with NSTEMI.

The Effect of Lower and Higher Calorie Meal on the Parameters of Ventricular Repolarization in Healthy Subjects.

BACKGROUND: Cardiovascular modulation following meal consumption has been known. Little and conflicting data is present regarding electrocardiographic QT and QTc intervals after a meal, and status of ventricular repolarization following meal is not known comprehensively. AIM: To inquire the electrocardiographic status of ventricular repolarisation thoroughly after lower and higher calorie meal consumption in a comparative manner. METHODS: A group of 61 healthy individuals were studied before and after lunch. They were divided into two groups according to the calorie consumed (higher calorie and lower calorie; median 1580 and 900 kcals, respectively). Calorie consumed was estimated using dietary guidelines. Data was collected from 12-lead ECG both in a fasted state and 2nd postprandial hour for each participant. Parameters of ventricular repolarization, namely, JTp, Tp-e, QT, QTc intervals and their ratios, as well as RR intervals, were compared between fasted and postprandial states for every participant. RESULTS: Tp-e and QTc intervals, and Tp-e/QTc ratio do not significantly change after both higher- and lower-calorie meals. JTp and QT intervals significantly shorten in both groups, regardless of the calorie consumed. While JTp shows a positive correlation with RR interval both before and after a meal in lower calorie intake group, no correlation was found with RR interval after a meal in higher calorie group. Logistic regression analysis revealed that higher calorie intake during a meal is a predictor for greater shortening in JTp and QT, compared to lower calorie meal. CONCLUSION: Our study may guide future studies on ventricular repolarisation, particularly those conducted on various disease conditions or drug effect of cardiac electrophysiology.

Changes in the parameters of ventricular repolarization during preapnea, apnea, and postapnea periods in patients with obstructive sleep apnea.

BACKGROUND: Ventricular arrhythmias are reported to be more common in patients with obstructive sleep apnea (OSA). Preliminary evidence showed such parameters regarding ventricular repolarization as Tp-e, Tp-e/QT, and Tp-e/QTc may be related with increased cardiac arrhythmias and even sudden cardiac death. The purpose of the present study was to evaluate ventricular repolarization during immediately preapnea period, apnea period, and postapnea hyperventilation period in patients with OSA. METHODS: A total of 59 patients who underwent polysomnography and were diagnosed with OSA between the years 2016-2017 in our hospital were included in our study. Of 59 patients (mean age: 52.51 ± 9.66), 28 were male and 31 were female. In all patients, Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, together with some other parameters, were calculated. Categorical variables were expressed as proportion and continuous variables were expressed as mean ± standard deviation. Electrocardiogram calculations of interest were compared through preapnea, apnea, and postapnea periods using Friedman's test. RESULTS: Tp-e interval (85.6 ms [78.3-95.6], 98 ms [88.5-107.7], 91.2 ms [81-98.8], respectively; P < 0.001), Tp-e/QT ratio (0.219 [0.202-0.237], 0.242 [0.224-0.269], 0.233 [0.212-0.246], respectively; P < 0.001), and Tp-e/QTc ratio (0.210 [0.190-0.222], 0.233 [0.209-0.247], 0.212 [0.193-0.229], respectively; P < 0.001) were significantly increased during apnea period compared to the preapnea period and significantly decreased during postapnea hyperventilation period compared to the apnea period. CONCLUSION: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were shown to be increased during apnea period and decreased during postapnea hyperventilation period. Our findings may help explain cardiac arrhythmias and sudden death in OSA patients.

Red cell distribution width and neutrophil-to-lymphocyte ratio predict left ventricular dysfunction in acute anterior ST-segment elevation myocardial infarction.

OBJECTIVES: Red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) are the two markers used to determine risk of mortality and adverse cardiovascular outcomes in patients with acute myocardial infarction. The relationship between RDW, NLR, and left ventricular (LV) systolic functions has not been reported. In this report, we aimed to investigate the relationship between RDW, NLR, and LV systolic function in anterior ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PCI). METHODS: RDW and NLR were measured on admission in 106 STEMI patients treated with primary PCI. Patients were divided into two groups according to left ventricular ejection fraction (LVEF), as Group I (systolic dysfunction, LVEF <50%) and Group II (preserved global left ventricle systolic function, LVEF ⩾50%). The first group included 47 patients and the second group included 59 patients. RESULTS: Mean RDW and NLR were significantly higher in Group I compared to Group II [13.7 ± 0.9% vs. 13.4 ± 0.7%, p = 0.03 and 5.86 (range, 0.66-40.50) vs. 2.75 (range, 0.51-39.39), p = 0.013, respectively]. CONCLUSION: Increased RDW and NLR on admission, in anterior STEMI patients treated with primary PCI are associated with LV systolic dysfunction.

Percutaneous closure of ruptured sinus of Valsalva aneursym with Amplatzer ductal occluder.

Rupture of a sinus of Valsalva aneurysm (SVA) is clinically characterized by widening of an existing sinus of Valsalva aneurysm in time and its opening to other cardiac cavities, primarily to the right atrium and right ventricle. Increased biventricular filling appearing due to rupture causes symptoms of heart failure. Although classical treatment of ruptured SVA is surgical, various percutaneous closure devices are being used successfully for treatment of lesions in recent years. With this paper, we described a case about rupture of a sinus of Valsalva aneurysm causing a haemodynamically important left-to-right shunt and heart failure due to this, and we explained how we successfully repaired it with an Amplatzer ductal occluder device. Our clinical experience and early term results of similar cases in the literature suggest that percutaneous closure methods can be an alternative to surgical treatment to treat ruptured sinus ofValsalva aneurysms.

Acquired QT interval prolongation and ventricular arythmias associated with brucellosis: A case report and review of literature.

Brucellosis is a zoonosis caused by Brucella species and usually involves the lymphoreticular system. Cardiovascular involvement is rare but fatal. Endocarditis is the most common cardiovascular manifestation of brucellosis. Herein we report a case of brucellosis with a presentation of acquired QT prolongation and ventricular tachycardia without a clear clinical picture of endocarditis and myocarditis.

Aortic valve endocarditis and cerebral mycotic aneurysm due to brucellosis.

Brucellosis is an infectious disease caused by Gram-negative coccobacilli. Direct contact with the infected tissue or blood, consumption of infected dairy products, and inhalation of infectious aeresol particles can transmit the disease. Brucella endocarditis is rare but the most fatal complication of brucellosis. The most commonly involved valve is aortic valve. Mycotic aneurysms result as an involvement of central nervous system and can lead to serious complications. Herein we present a case with mycotic aneurysmal rupture and aortic insufficency and sinus valsalva fistula caused by brucella endocarditis. There were rare cases with brucella endocarditis and mycotic aneursymal rupture secondary to neurobrucellosis in the literature. Relevant complications are treated with aortic valve surgery and peripheral endovascular intervention.