Microvascular Dysfunction in COVID-19 Patients with Acute Coronary Syndrome.

Objective: Coronavirus disease 2019 (COVID-19) is considered to deteriorate endothelial function through hyperinflammation. We aimed to investigate microvascular dysfunction using the angiographic parameters thrombolysis in myocardial infarction frame count (TFC) and myocardial blush grade (MBG), in COVID-19 patients with acute coronary syndrome (ACS). Methods: One hundred and sixty-five patients presented with ACS (62.4% ST elevated myocardial infarction) and underwent percutaneous coronary intervention between March 1 and June 30, 2020, were enrolled in the study. The polymerase chain reaction test was performed in case of suggestive symptoms or typical computerized tomography findings. Results: Twenty-six patients (15.7%) were tested positive for COVID-19. Significantly higher values were observed in TFC in patients with COVID-19 (p<0.001), whereas COVID-19 patients had significantly lower MBGs (Grade 0 and 1) (p<0.001). Peak troponin-I value was also higher in the COVID-19 group (27335 vs. 15959 ng/dL, p=0.006). Mortality risk was higher in COVID-19 patients (38.4% vs. 7.2%, p<0.001). TFC and ejection fraction may predict in-hospital mortality among COVID-19 patients with ACS according to logistic regression results. In correlation analysis, TFC correlated positively with C-reactive protein (r=0.340, p<0.001) and peak troponin-I value (r=0.369, p<0.001). Conclusion: COVID-19 is associated with slow coronary flow and microvascular impairment in ACS.

Assessment of a new electrocardiographic criterion for the diagnosis of left ventricle hypertrophy: A prospective validation study.

OBJECTIVE: Many criteria have been developed to predict left ventricular hypertrophy using an electrocardiogram (ECG). However, one major common limitation of all has been their low sensitivity. Based on that, recently, a novel criterion has been proposed, which is believed to have higher sensitivity without a compromise in specificity. Therefore, in our study, we aimed to test this novel ECG criterion prospectively in large, unselected cardiac patients. METHODS: Patients who were referred to our echocardiography laboratory due to various etiologies were prospectively enrolled. The novel Peguero-Lo Presti criterion was assessed along with other established ECG criteria. The left ventricular mass index was calculated using echocardiography. The performance of each index was evaluated. RESULTS: Overall, 767 patients were enrolled in this study. The sensitivity and specificity of the Peguero-Lo Presti criterion were 17.5% and 94.5%, respectively. Although the highest sensitivity belonged to the Peguero-Lo Presti criterion, in ROC analysis, it showed modest predictive capability, which was similar to the established Cornell voltage criterion (AUC=0.64 [0.56-0.68 95% CI], p<0.01). CONCLUSION: Although this novel criterion had higher sensitivity, the overall performance was similar to the current indices. Further adjustments, particularly based on age and body mass index, may yield better results.

Clinical characteristics and intermediate-term outcomes of young patients with uncomplicated myopericarditis.

OBJECTIVE: Although the long-term prognosis of myopericarditis is good, recurrence continues to be a problem. In addition, there are concerns regarding the safety of the empirical use of anti-inflammatory drugs. This study was an investigation of the clinical outcomes of young patients with uncomplicated myopericarditis, the majority of whom received both nonsteroidal anti-inflammatory drugs and colchicine. METHODS: Patients aged 18 to 40 years who were admitted between May 2015 and May 2018 due to myopericarditis and had normal left ventricular function were included in the study. The primary outcome of the research was analysis of major adverse cardiac events (MACEs): all-cause mortality, myopericarditis recurrence, development of significant arrhythmia, heart failure, and cardiac tamponade. A total of 60 patients were included in the study. The median duration of follow-up was 19 months. RESULTS: A MACE occurred in 11.7% of the patients. None of the patients experienced heart failure, significant arrhythmia, cardiac tamponade, or all-cause mortality. Recurrence of myopericarditis was the only MACE observed. Most patients were treated with both nonsteroidal anti-inflammatory drugs and colchicine (96% and 95% of the patients, respectively). Univariate cox regression analysis indicated that only the maximum in-hospital C-reactive protein (CRP) level was associated with recurrence (hazard ratio: 1.01, 95% confidence interval: 1.01-1.02; p=0.04). CONCLUSION: The intermediate-term prognosis of myopericarditis patients was excellent in terms of mortality. However, recurrence remains a challenge. The role of CRP, particularly in recurrence, should be explored further.

In-hospital Outcomes of Patients with ST-segment Elevation Myocardial Infarction who were Intubated before Primary Percutaneous Intervention: Experience of a tertiary center.

OBJECTIVES: ST-segment elevation myocardial infarction (STEMI) complicated by respiratory failure is associated with a greater number of in-hospital and out-of-hospital adverse cardiovascular events (CVEs). The aim of this study was to analyze in-hospital outcomes and the factors affecting the outcomes of intubated patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (pPCI) at a single tertiary care center. METHODS: The data of 592 patients diagnosed with acute STEMI who were admitted to the emergency department between May 2017 and January 2019 and subsequently underwent pPCI were retrospectively reviewed. Cardiovascular risk factors as well as biochemical and angiographic characteristics of patients who were intubated in the emergency room or ambulance due to cardiac arrest and those who were not intubated were compared. Adverse CVEs were defined as in-hospital death, cerebrovascular stroke, and acute stent thrombosis. RESULTS: A total of 60 patients (70% male; mean age: 63.6±14.0 years) who were intubated and 532 non-intubated patients (81% male; mean age: 60.2±12.1 years) were included in the study. The angiographic features of the 2 groups were similar. An adverse CVE was experienced by 43.3% of the intubated patients and 3.6% of the non-intubated patients. Multivariate analysis indicated that age (odds ratio [OR]: 1.065; p<0.001), serum lactate level (OR: 1.308; p<0.001), and left ventricle ejection fraction (OR: 0.946; p<0.001) were independent predictors of in-hospital adverse CVE in the intubated patient group. CONCLUSION: The results of this single-center study showed that 1 in 10 patients hospitalized with STEMI were intubated, and approximately 4 in 10 intubated STEMI patients had an in-hospital CVE.