Prevalence and clinical profile of patients with myocardial infarction with non-obstructive coronary arteries in Turkey (MINOCA-TR): A national multi-center, observational study.

OBJECTIVE: Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a relatively new term that is characterized by clinical evidence of MI with normal or near-normal coronary arteries on coronary angiography (QCA). To date, there have been no population-based studies on the prevalence of MINOCA in Turkey. The aim of this nationwide study was to document the prevalence and demographics of MINOCA in a Turkish population. METHODS: MINOCA-TR is national, multi-center, prospective, all-comer study that was conducted in 32 hospitals. All consecutive patients who were ≥18 years old, diagnosed with MI according to the Third Universal Definition of Myocardial Infarction, and had undergone QCA were included in the study. Patients with stable coronary artery disease, unstable angina pectoris, a history of revascularization, and type 4/5 MI were excluded. RESULTS: A total of 1793 patients who were diagnosed with MI and had undergone QCA were screened between March 2018 and October 2018, of whom 1626 (mean age: 61.5±12.5 years, 70.7% male) were enrolled from 32 centers. The prevalence of MINOCA was 6.7% (n=109) in the overall study population. Compared with non-MINOCA patients, those with MINOCA were younger, had a higher prevalence of the female gender, and had a history of flu. The percentages of current smokers, ST-segment elevated myocardial infarction patients, and those with a history of hypertension, diabetes mellitus, and hyperlipidemia were significantly lower in MINOCA patients (p<0.05, for all). Also, the median left ventricular ejection fraction as seen on echocardiography and the ratio of Killip Class I status at presentation was significantly higher in MINOCA patients than in non-MINOCA patients (p<0.001). Patients with MINOCA received a preload dose of P2Y12 antagonist before QCA less often than non-MINOCA patients (p<0.001). CONCLUSION: The prevalence of MINOCA in Turkey is 6.7% in patients who were admitted with MI. Also, as compared to non-MINOCA patients, the MINOCA patients were exposed to fewer traditional risk factors of coronary artery disease.

Evaluation of ventricular repolarization features with Tp-e, Tp-e/QTc, JTc and JTd during electroconvulsive therapy.

OBJECTIVE: The purpose of this study was to investigate the influence of electrical stimulation transmitted through the body during electroconvulsive therapy on traditional and relatively new ventricular repolarization parameters (Rate corrected QT interval (QTc), QT dispersion (QTd), rate corrected JT interval (JTc), JT dispersion (JTd), T-peak to T-end interval (Tp-e) and Tp-e/QTc ratio) under propofol anaesthesia. METHODS: Twenty-two patients (aged 18-50 years) who were each scheduled for ECT for major depression, bipolar disorder or schizophrenia enrolled to the study. Electrocardiography (ECG) recordings were obtained before anaesthesia and within 3-5 min after electrical stimulus of ECT for measurements. QTc, QTd, JTc, JTd, Tp-e and Tp-e/QTc were measured as repolarization indices. RESULTS: The study included twenty-two patients, 9(40.9%) females and 13(59.1%) males, and the mean age accounted for 33.57 ±â€¯9.95 years. The comparison of the measured parameters before and after ECT, which were not statistically different, were as follows: QTc (416.52 ±â€¯46.64 vs 430.00 ±â€¯34.00msn; p = 0.18), JTc (308.09 ± 25.09 vs 315.47 ±â€¯26.89msn; p = 0.30), QTd (22.27 ±â€¯11.51 vs 20.45 ±â€¯9.9msn; p = 0.52) and JTd (22.72 ±â€¯11.2 vs 17.72 ±â€¯10.20msn; p = 0.06). Also, no significant difference was detected at the following parameters Tp-e (80.0 ±â€¯13.45 vs 78.63 ±â€¯15.21msn; p = 0.65) and Tp-e/QTc ratio (0.19 ±â€¯0.03 vs 0.18 ±â€¯0.07; p = 0.08). On the other hand, HR showed a significant increase after ECT at 88.13 ±â€¯13.74 vs 93.0 ±â€¯15.2 bpm; p = 0.03. CONCLUSION: QTc, QTd, JTc, JTd, Tp-e interval and Tp-e/QTc ratio, which are thought to be potential repolarisation markers for ventricular arrhythmias, did not demonstrate significant change within 3-5 min of electrical stimulation during ECT.

Plasma microRNA profiling of children with idiopathic dilated cardiomyopathy.

CONTEXT: Dilated cardiomyopathy (DCM) is the most common cardiomyopathy in children. MicroRNAs (miRNA) are small RNAs which have regulatory functions in many biological processes. OBJECTIVE: We aimed to determine miRNA expression levels in plasma of children with DCM. MATERIALS AND METHODS: Plasma expression levels of 379 miRNAs were compared between 23 DCM and 26 healthy children. RESULTS: The expression levels of miR-618, miR-875-3p, miR-205, miR-194, miR-302a, miR-147, and miR-544 were found decreased. The expression levels of miR-518f and miR-454 were found increased in DCM patients. DISCUSSION: miRNA level differences may provide the chance of using these miRNAs as new biomarkers.

Association between serum total antioxidant status and flow-mediated dilation in patients with systemic lupus erythematosus: an observational study.

OBJECTIVE: Endothelial dysfunction (ED) is a condition that involves increased oxidative stress and decreased total antioxidant status (TAS) levels. Systemic lupus erythematosus (SLE) is also associated with ED. We aimed to determine the association between serum TAS and ED as assessed by flow-mediated dilation (FMD) in patients with SLE. METHODS: Thirty-four patients with stable SLE who were not undergoing any treatment and 39 healthy volunteers without any overt cardiovascular disease were included in this cross-sectional study. Doppler ultrasound was used to measure FMD to assess ED in the study groups. Serum TAS levels were measured using a TAS kit. High-sensitivity C-reactive protein (hs-CRP) and anticardiolipin antibody (aCLA) levels were also measured to assess the inflammatory state. The SLE group further was divided into 2 groups according to presence or absence of aCLA. SLE disease activity was assessed using the SLE disease activity index (SLEDAI). Regression analysis was used to define independent predictors. RESULTS: The mean TAS levels were significantly lower in patients with SLE than in controls (1.60±0.11 versus 1.73±0.15 mmol/L, p<0.001). hs-CRP levels were significantly higher in patients with SLE than in controls (8.2±6.0 vs. 2.9±4.0 mg/L; p<0.001), particularly in SLE patients with positive aCLA when compared with SLE patients with negative aCLA (13.8±4.3 vs. 5.6±4.8 mg/L, p<0.001). The FMD percent was significantly lower in patients with SLE than in controls (8.1±4.9 vs. 10.6±4.7, p=0.04). There was a significant positive correlation between FMD and TAS in the SLE group (r=0.448, p=0.008) and the control group (r=0.367, p=0.03) and a significant negative correlation between FMD and serum hs-CRP (r=-0.368, p=0.04) in only the SLE group. In multiple linear regression analysis, TAS, hs-CRP, and SLEDAI were independently correlated with FMD (ß=0.50, p=0.003; ß=-0.33, p=0.03; and ß=-0.36, p=0.03; respectively). CONCLUSION: Patients with SLE who have no overt cardiovascular disease are at increased risk for ED and this may be associated with underlying inflammation and impairment of TAS.

Myocardial Performance Index in Neurocardiogenic Syncope Patients.

BACKGROUND: Many syncopes resulting from neural reflexes in various conditions are called neurocardiogenic syncope (NCS). We aimed to investigate the presence of left ventricular (LV) myocardial performance index (MPI) in patients with NCS, which was diagnosed with head-up tilt table test (HUTT), and the accurateness of the test in order to use it as a method in patients with NCS. Assuming the MPI as a potential cause of syncope, we assessed the Tei index with non-invasive tissue Doppler echocardiography method. METHODS: Consecutive outpatients with a history of recurrent unexplained syncope underwent HUTT. Twenty-nine HUTT (+) patients (24 female and five male, mean age: 30 ± 15 years) as the study group and HUTT (-) 23 healthy patients (six female and 17 male, mean age: 34 ± 16 years) as the control group were included into the study. Conventional and tissue Doppler echocardiography was performed to both groups. The MPI was determined by using PW Doppler. Measurements of Doppler time intervals, according to Tei index ((isovolumic contraction time + isovolumic relaxation time)/ejection time) is calculated as (a - b/b), where "a" is the interval between cessation and onset of the mitral inflow, and "b" is the ejection time (ET) at the LV outflow. RESULTS: When comparing the groups in terms of MPI and ET, there was significant difference between groups. Patients with NCS had significantly longer ET and lower MPI value than control group (284 ± 24 ms vs. 260 ± 24 ms, P < 0.001, respectively and 0.44 ± 0.7 vs. 0.52 ± 0.8, P < 0.001, respectively). There was no significant difference in ejection fraction between groups. CONCLUSION: In the present study, LV MPI value decreases in patients with NCS.