Hypertension and Occupational Health: A General Overview and Expert Consensus Suggestions.

Hypertension is a common public health issue, and its incidene increases parallel to age. It is inevitable that certain occupational conditions may pose risks for high blood pressure or cause difficulties in managing blood pressure. Working under specific circumstances may compromise the safety of individuals with hypertension and potentially others. Therefore, it is crucial to implement activities that enhance awareness of hypertension, to ensure regular periodic examinations, and to establish necessary precautions in the workplace for the health of employees and the public. Given the limited resources offering guidance on hypertension in the context of occupational health, the authors of this paper, who hail from different disciplines, have prepared a set of consensus-based suggestions.

A Novel Potential Biomarker for Predicting the Development of Septic Embolism in Patients with Infective Endocarditis: Systemic Coagulation Inflammation Index.

OBJECTIVE: Early diagnosis of septic emboli is crucial to prevent the associated morbidity and mortality. This study aimed to examine the relationship between the systemic coagulation inflammation index (SCII) and septic embolism in patients with infective endocarditis (IE). METHODS: We retrospectively analyzed the data of 167 IE patients treated at our tertiary care hospital between January 2007 and January 2023. We collected information on symptoms, comorbidities, predisposing valve diseases, prosthetic valves, devices, history of injectable drug use, blood culture results, echocardiographic findings, and complications. The SCII index was calculated using the formula: [platelet count (PLT) × fibrinogen level (g/L) / white blood cell count (WBC)]. RESULTS: The mean age of the patients was 61 years, with rheumatic valve disease being the most common predisposing factor. The most common etiologic microorganism was Staphylococcus species. Septic embolism developed in 25.7% of the patients, with the cerebral system being the most commonly affected (46.5%). The SCII was identified as an independent marker for the development of septic embolism. Receiver operating characteristic (ROC) curve analysis confirmed that an optimal SCII value of 59.8 predicted septic emboli with a sensitivity of 65.1% and a specificity of 59.6% (area under the ROC curve: 0.649 [95% confidence interval (CI): 0.556 - 0.743], P = 0.004). CONCLUSION: This study demonstrates that high SCII levels are an independent predictor for the development of septic embolism in patients with IE.

Hyponatremia and takotsubo syndrome: a review of pathogenetic and clinical implications.

Hyponatremia is a common electrolyte abnormality with important prognostic and therapeutic implications. It might exert detrimental effects on various organ systems including the central nervous system (CNS), bone, and heart along with its potential association with poor quality of life. These adverse effects might be largely mediated through a variety of mechanisms including osmotic stress, dysfunctional transmembrane exchangers, and enhanced oxidative stress.Interestingly, hyponatremia might also have an important association with takotsubo syndrome (TTS) that has been universally considered as a reversible form of cardiomyopathy usually emerging in response to various stressors. In this context, severe hyponatremia was previously reported to serve as a direct trigger of TTS evolution largely through its potential impact on CNS and heart. However, pathogenetic and clinical implications of hyponatremia still need to be thoroughly evaluated in patients with TTS. This paper aims to analyze the clinical features of published cases with TTS primarily triggered by hyponatremia and also aims to discuss the association between hyponatremia and TTS from a broader perspective.

Novel Predictor of the AF Development in Patients with OSAS: Importance of Visceral Adipose Index.

Objective: Obstructive sleep apnea syndrome (OSAS) is a sleep disorder whose frequency is increasing daily due to modern lifestyle. Patients with atrial fibrillation (AF), which has the same predisposing factors, frequently visit the outpatient clinic with complaints of palpitation. Existing symptoms are often associated with the course of OSAS, and the development of AF, a disease with high morbidity and mortality, cannot be detected. In our study, we investigated the relationship between the visceral adiposity index (VAI) and AF development in these patients. Methods: We retrospectively analyzed 207 patients with OSAS who visited the cardiology outpatient clinic. The data of 44 patients with AF and 163 patients without AF were compared. Results: Demographic characteristics and clinical risk factors were similar between the groups (p>0.05). VAI, apnea-hypopnea index, and inflammatory markers were higher in the AF group, and these risk factors were significant in the multivariate analysis (p<0.05). Conclusions: Our study is important in terms of showing VAI as one of the most important predictors of AF, which has an impact on mortality and morbidity in patients with OSAS, whose frequency is increasing daily. Further prospective studies are required to confirm our observations and determine their clinical applicability.

Coexistence of Anti-PD1-Induced Immune Myocarditis and Complete Atrioventricular Block: A Case Report.

The present report describes the late recovery of an emerging complete atrioventricular (AV block) in a patient with immune check point inhibitor-related myocarditis following a period of immunosuppresive therapy. Therefore, decision-making for permanent pacemaker implantation should be implemented after a substantial period of time owing to the potential recovery of bradyarrhythmic complications in similar cases.

A Stent Misplaced in the Septal Perforating Artery: Right Ventricular Fistula, Interventricular Septal Hematoma, and Right Ventricular Outflow Tract Obstruction. / Um Stent Mal Colocado na Artéria Septal Perfurante: Fístula Ventricular Direita, Hematoma do Septo Interventricular e Obstrução da Via de Saída do Ventrículo Direito.

Coronary-cameral fistulas, though mostly regarded as congenital entities, have also been encountered as complications of major traumas and percutaneous coronary interventions (PCIs).1 On the other hand, interventricular septal (IVS) hematoma might potentially arise mostly during retrograde chronic total occlusion (CTO) interventions and has a benign course in this context.2 Herein, we describe a challenging PCI complication (and its management strategy) presenting with IVS hematoma, right ventricular fistula, and right ventricular outflow tract (RVOT) obstruction due to a misimplanted coronary stent in the septal perforating artery (SPA).

As fístulas coronário-camerais, embora consideradas em sua maioria como entidades congênitas, também têm sido encontradas como complicações de grandes traumas e intervenções coronárias percutâneas (ICPs).1 Por outro lado, o hematoma do septo interventricular (SIV) pode potencialmente surgir principalmente durante intervenções de oclusão total crônica retrógrada (OTC) e tem um curso benigno nesse contexto.2 Aqui, descrevemos uma complicação desafiadora da ICP (e sua estratégia de manejo) apresentando hematoma do SIV, fístula ventricular direita e obstrução da via de saída do ventrículo direito (VSVD) devido a um stent coronário mal implantado na artéria septal perfurante (ASP).

TyG index as a predictor of spontaneous coronary artery dissection in young women.

OBJECTIVE: Spontaneous coronary artery dissection (SCAD) is a rare but potentially life-threatening pathology and cases are especially seen in women under 50 years of age and with relatively fewer cardiovascular risk factors. Although risk factors facilitating the development of SCAD have been defined in the literature, modifiable risk factors remain unclear. In this study, it was aimed to investigate the relationship between the triglyceride glucose index (TyG) and the development of SCAD in the population of young women. METHODS: The results of 281 patients were analyzed and compared with each other in terms of clinical, demographic, laboratory parameters, and coronary angiography results. RESULTS: The mean age was 45 years and all of them were female. When the groups were compared, the TyG and inflammatory parameters were higher in the SCAD group (p < 0.001). When these two groups with low cardiovascular risk factors were compared in logistic regression analysis, high TyG was found to be an independent predictor of SCAD development in young women (p < 0.001). CONCLUSION: As a result, our study shows that the development of these non-atherosclerotic conditions can be predicted by simple biochemical tests in young women with low atherosclerotic cardiovascular risk factors.

Comparison of Myocardial Perfusion Scintigraphy and Coronary Angiography Results in Breast Cancer Patients Treated with Radiotherapy.

Breast cancer is the most common type of malignancy in women and radiotherapy (RT) is an important part of treatment. Although it reduces cancer recurrence, it has been shown to cause accerelerated athnerosclerosis. This study aimed to compare the results of myocardial perfusion scintigraphy (MPS) for ischemia investigation with coronary angiography (CAG) findings and to investigate the effect of RT on the development of coronary artery disease in breast cancer patients who underwent RT. The results of 660 patients were analyzed and compared with each other in terms of clinical, demographic, laboratory parameters and MPS results. The mean age was 57.5 years and all of them were female. When the groups were compared, the Gensini score and marking of the left anterior descending artery (LAD) area as ischemic area localization were found more, but angiographically, the rate of severe stenosis in the area indicated by MPS was found to be lower in the RT group (p < 0.001). While the sensitivity of MPS in the RT group was 67.5% and non-RT group was 88.5% (p < 0.001), the result of our study shows that the sensitivity of the MPS test is significantly lower in the patient group receiving RT.

Cancer Therapy-Related Pulmonary Hypertension: A Review of Mechanisms and Implications for Clinical Practice.

Cancer therapy-related pulmonary hypertension is a rare yet potentially fatal cardiotoxicity. However, it is a reversible cause of pulmonary hypertension if detected in its early stages. Cancer therapy-related pulmonary hypertension has been encountered in patients using tyrosine kinase inhibitors, particularly dasatinib. However, it is also well known that many agents used in cancer treatment such as alkylating agents, proteasome inhibitors, thoracic radiation exposure, and immune checkpoint inhibitors are particularly associated with pulmonary hypertension evolution. In case that history, symptoms, and clinical findings suggest a potential cancer therapy-related pulmonary hypertension, echocardiography is considered as the initial tool to detect pulmonary hypertension. If the possibility of pulmonary hypertension is high based on echocardiographic data, cancer treatment, as the initial step, should be discontinued due to its potential risks and other causes for pulmonary hypertension should be investigated thoroughly. Right heart catheterization should be the next step to establish the final diagnosis, and medical management, where appropriate, should be started without delay in these patients according to their pulmonary hypertension subgroup. There exists limited information regarding the diagnostic and management strategies of cancer therapy-related pulmonary hypertension in the current guidelines. In this review article, we aim to present current literature data on the mechanisms and management of cancer therapy-related pulmonary hypertension along with its follow-up algorithm in the setting of cardio-oncology practice.

The Effect of SGLT2 Inhibitors on the Development of Contrast-Induced Nephropathy in Diabetic Patients with Non-ST Segment Elevation Myocardial Infarction.

Background and Objectives: Percutaneous procedures using contrast agents are modern diagnosis and treatment methods for cardiovascular diseases. Contrast use may cause nephropathy, especially in diabetic patients. SGLT2 inhibitors have strong cardioprotective and renal protective effects. In our study, we investigated the effectiveness of this drug group in preventing the development of Contrast-Induced Nephropathy (CIN). Materials and Methods: The results of 312 diabetic patients who underwent CAG were analyzed. The study group included 104 DM patients using SGLT2 and the control group did not use SGLT2. These groups were compared with each other in terms of clinical, demographic, and laboratory parameters. Results: The groups were similar characteristics. However, post-CAG creatinine values compared with before the procedure, the development of CIN was observed to be significantly less in the group using SGLT2 inhibitor (p = 0.03). When the results of the multivariate analysis were examined, it was seen that the use of SGLT2 inhibitors significantly reduced the risk of CIN (odds ratio (OR): 0.41, 95% confidence interval (CI): 0,142-0.966, p = 0.004). Conclusions: Our study showed that SGLT2 inhibitors may be protective against the development of CIN, especially in patients with comorbid conditions such as diabetes.

Systemic Immune-Inflammation Index: A Novel Predictor of Coronary Thrombus Burden in Patients with Non-ST Acute Coronary Syndrome.

Background and Objectives: Excessive coronary thrombus burden is known to cause an increase in mortality and major adverse cardiac events (MACEs) in NSTE-ACS (non-ST acute coronary syndrome) patients. We investigated the association between the systemic immune-inflammation index (SII) and coronary thrombus burden in patients with non-ST segment elevation myocardial infarction (NSTEMI) who underwent coronary angiography and percutaneous coronary intervention (PCI). Materials and Methods: A total of 389 patients with the diagnosis of NSTEMI participated in our study. Coronary thrombus burden was classified in the TIMI (thrombolysis in myocardial infarction) thrombus grade scale and patients were divided into two groups: a TIMI thrombus grade 0-1 group (n = 209, 157 males) and a TIMI thrombus grade 2-6 group (n = 180, 118 males). Demographics, angiographic lesion images, coronary thrombus burden, clinical risk factors, laboratory parameters, and SII score were compared between the two groups. Results: The high thrombus burden patient group had a higher neutrophil count, WBC count, platelet count, and systemic immune-inflammation index (SII) (p < 0.001). The receiver operating characteristic (ROC) curve analysis showed that at a cutoff of 1103, the value of SII manifested 74.4% sensitivity and 74.6% specificity for detecting a high coronary thrombus burden. Conclusions: Our study showed that the SII levels at hospital admission were independently associated with high coronary thrombus with NSTEMI.

Myocarditis associated with immune checkpoint inhibitors: Practical considerations in diagnosis and management.

Immune checkpoint inhibitors (ICI) have caused radical changes in the treatment scheme of many types of cancer in the past 10 years. ICIs are specific monoclonal antibodies that increase T-cell mediated immune response against cancer cells. Despite important advances in cancer treatment, uncontrolled activation of cytotoxic T cells has brought along many autoimmune clinical side effects, especially acute myocarditis. Although the incidence of ICI-related myocarditis is about 1%, it is remarkable in terms of mortality rate reaching 46% and demonstrating the necessity of rapid diagnosis and multidisciplinary approach. The present review aimed to summarize the heterogeneous symptomatology of ICI-associated myocarditis, clinical presentation ranging from elevated asymptomatic cardiac enzyme levels to cardiogenic shock, prominent diagnostic value of cardiac magnetic resonance imaging, and current information on the effectiveness of immunosuppressants in therapy.

The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis.

Background and purpose: Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. Methods: This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. Results: A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Conclusion: Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.