A Novel Score to Predict One-Year Mortality after Transcatheter Aortic Valve Replacement, Naples Prognostic Score.

Background and Objectives: Aortic stenosis (AS) is a widespread valvular disease in developed countries, primarily among the elderly. Transcatheter aortic valve replacement (TAVR) has become a viable alternative to aortic valve surgery for patients with severe AS who are deemed a high surgical risk or for whom the AS is found to be inoperable. Predicting outcomes after TAVR is essential. The Naples Prognostic Score (NPS) is a new scoring method that evaluates nutritional status and inflammation. Our study is aims to examine the relationship between the NPS and outcomes for patients receiving TAVR. Material and Methods: We conducted a retrospective study of 370 patients who underwent TAVR across three tertiary medical centres from March 2019 to March 2023. The patients were divided into two groups based on their NPS, namely, low (0, 1, and 2) and high (3 and 4). Our study is primarily aimed to determine the one-year mortality rate. Results: Within one year, the mortality rate for the entire group was 8.6%. Nonetheless, the low-NPS group had a rate of 5.0%, whereas the high-NPS group had a rate of 13%. The difference between the two groups was statistically significant, with a p-value of 0.06. Conclusions: Our results show that NPS is an independent predictor of one-year mortality in patients undergoing TAVR.

Predictive Value of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Patients with Coronary Slow Flow.

BACKGROUND: Increased microvascular resistance due to chronic inflammation is assumed to be one of the mechanisms associated with coronary slow flow (CSF). Previous studies have shown that the platelet-to-lymphocyte ratio (PLR) and the neutrophil-lymphocyte ratio (NLR) are markers of inflammation for various diseases. In this study we aimed to evaluate the relationship between CSF and PLR-NLR. METHODS: Seventy-eight patients with CSF and 50 patients with normal coronary flow were enrolled into this study. The study subjects underwent medical examination and testing, after which their platelet-to-lymphocyte ratios and NLR values were calculated. An independent observer measured the coronary flow rate by Thrombolysis in Myocardial Infarction Frame Count (TFC) method. The platelet-to-lymphocyte ratio and NLR values were compared between the groups and correlation analysis was performed to explore the relationship between mean TFC with PLR and NLR. RESULTS: Platelet-to-lymphocyte ratio and NLR values were significantly higher in patients with CSF (p < 0.001). There was a positive significant correlation between TFC with NLR and PLR (Spearman's Rho: 0.59, p < 0.001 and Spearman's Rho: 0.30, p = 0.001, respectively). Multivariate logistic regression analysis revealed that NLR is the one independent predictor for CSF. CONCLUSIONS: This study demonstrated an association between CSF and PLR-NLR. Although the exact mechanism could not be explained, our findings support the possible role of inflammation in CSF physiopathology.

An Unusual Case of Loffler Endomyocarditis after Takotsubo Cardiomyopathy Induced by Deep Neck Infection.

UNLABELLED: In this case, we herein have described a 72-year-old female patient with deep neck infection induced Takotsubo cardiomyopathy and idiopathic hypereosinophilic syndrome with Loffler endocarditis characterized by right atrial thrombus and right ventricular fibrothrombotic obliteration within two months. KEY WORDS: Cardiac thrombi; Hypereosinophilic syndrome; Takotsubo cardiomyopathy.

Acetylsalicylic Acid resistance in patients with type 2 diabetes mellitus, prediabetes & non-diabetic coronary artery disease.

UNLABELLED: Objective : Several studies have demonstrated the beneficial role of antiplatelet therapy with acetylsalicylic acid (ASA) at atherosclerotic vascular disease. Antiaggregant effect of ASA is not uniform in all patients. Purpose of the present study is to evaluate the prevalence of ASA resistance in patients with type 2 diabetes mellitus (T2DM), pre-diabetes and non-diabetic coronary artery disease (CAD). METHODS: Effect of ASA was assessed using the platelet function analyzer (PFA-100) system. Resistance to ASA was defined as a normal collagen/epinephrine induced closure time after one week of ASA therapy. Patients with non-diabetic CAD, pre-diabetes and T2DM were compared. RESULTS: ASA resistance was found in 26 (37.1%), 6 (17.6%) and 41 (26.5%) patients in the groups, respectively (p=0.154). ASA resistance was found to be significantly higher in men, smokers and insulin users, besides this it was found to be significantly lower in beta blocker (BB) users, angiotensin converting enzyme inhibitor (ACEI) users with univariate analysis. However insulin usage was found to be the single effective parameter on ASA resistance in multivariate analysis. CONCLUSION: There was no difference with regard to ASA resistance between groups. While ASA resistance was higher in men, smokers and insulin users, it was lower in patients using BBs and ACEIs.

Left ventricular noncompaction associated with a sinoatrial node artery originating from the posterolateral branch of the right coronary artery.

Noncompaction of the ventricular myocardium (NVM) is a rare unclassified cardiomyopathy which is characterized by multiple prominent trabeculations and deep intertrabecular recesses. This cardiomyopathy can be isolated or in combination with other congenital cardiac disorders, including coronary artery abnormalities. A 56-year-old female patient presented to the cardiology department with complaints of exertional dyspnoea and chest pain. Transthoracic echocardiography revealed left ventricular dilatation with diffuse hypokinesis. Multiple prominent trabeculations with deep inter-trabecular recesses were observed at the left ventricular apex. Also, coronary angiography demonstrated a sinoatrial node artery originating from the posterolateral branch of the right coronary artery.

[A case of asymptomatic Brugada syndrome with type 1 ECG pattern and cardiac arrest: an evaluation of the prognostic value of electrophysiologic study]. / Asemptomatik, tip 1 EKG bulgulari olan ve ani kalp durmasi gelisen Brugada sendromlu bir olgu: Elektrofizyolojik çalismanin prognoz belirleme üzerine etkisinin irdelenmesi.

Brugada syndrome is characterized by ST-segment elevation in the leads V1-3 of electrocardiography (ECG) in the absence of a structural heart disease. A 26-year old male patient was admitted with sudden cardiac arrest. Cardiopulmonary resuscitation was successful and he was referred to the reanimation unit due to unconsciousness. A year before, he was diagnosed as having Brugada syndrome with type 1 ECG pattern at another center, at which time electrophysiologic study (EPS) was not performed due to lack of symptoms and a family history of sudden cardiac death. In addition, family screening revealed two asymptomatic brothers having Brugada syndrome with type 1 ECG pattern. Medical follow-up was recommended to one of them. The other sibling underwent EPS at a different center where ventricular fibrillation was induced. An implantable cardioverter defibrillator (ICD) was recommended, but the patient refused. A further analysis of the family made at our center showed type 2 ECG changes in the father and in one of the cousins. Due to the development of persistent brain injury and an expected survival of less than a year, an ICD was not considered in the patient. The prognostic value of EPS is still controversial in asymptomatic patients with type 1 Brugada syndrome, without a family history of sudden cardiac death.

Association between platelet to lymphocyte ratio and saphenous vein graft disease in patients with stable angina pectoris.

OBJECTIVE: In this study, we aimed to investigate the relation of platelet to lymphocyte ratio (PLR) in saphenous vein graft disease (SVGD) in patients with stable angina pectoris after coronary artery bypass graft surgery. METHODS: A total of 455 patients were included in the study. There were 210 patients with SVGD and 245 patients without SVGD. The effects of different variables on SVGD were computed in logistic regression analysis. RESULTS: The platelet count, lymphocyte count, PLR, high-density lipoprotein (HDL), Na, and ALT were significantly associated with SVGD. In multivariate regression analysis, HDL and PLR were found to be significantly associated with SVGD. CONCLUSION: To the best of our knowledge, this is the first study showing the significant association of PLR with SVGD. This study suggests that PLR can be used as a marker of SVGD because it is an easily available and inexpensive test.

Relation Between Monocyte to High-Density Lipoprotein Cholesterol Ratio With Presence and Severity of Isolated Coronary Artery Ectasia.

The aim of this study was to investigate an easily available inflammatory and oxidative stress marker and monocyte to high-density lipoprotein cholesterol ratio (MHR) in patients with coronary artery ectasia (CAE). The study population included 405 patients of which 135 patients had isolated CAE, 135 patients had obstructive coronary artery disease (CAD), and 135 patients had normal coronary angiograms (NCAs). The severity of isolated CAE was determined according to the Markis classification. The MHR was significantly greater in patients with isolated CAE than those with obstructive CAD and NCAs: 14.8 (11.6 to 19.8), 11.4 (9.6 to 13.5), 9.8 (7.5 to 11.9), respectively. Linear regression analyses showed that MHR and C-reactive protein were significantly related with the severity of isolated CAE. In conclusion, the MHR is significantly greater in patients with CAE compared to controls with obstructive CAD and NCAs, and MHR is associated with the severity of CAE.

The relation between platelet-to-lymphocyte ratio and Pulmonary Embolism Severity Index in acute pulmonary embolism.

PURPOSE: In this study, we aimed to investigate the value of the platelet-to-lymphocyte ratio (PLR) for predicting disease severity based on simplified Pulmonary Embolism Severity Index (sPESI), as well as in-hospital mortality in patients with acute pulmonary embolism (APE). MATERIALS AND METHODS: Our hospital's electronic patient database was searched for the patients with ICD-9 code I26, and eligible 646 patients were included in the study. RESULTS: Univariate logistic regression analysis showed that PLR, pulmonary artery systolic pressure, right ventricular dysfunction, D-dimer level, and white blood cell, lymphocyte, platelet and neutrophil counts were significantly correlated with a high sPESI score in patients with APE. CONCLUSIONS: To the best of our knowledge, this is the first study in the literature showing that a high PLR is independently associated with a high risk of mortality in patients with APE.

Long-Term Survival Following Cardiac Arrest Without Implantable Defibrillator Protection in a Hypertrophic Cardiomyopathy Patient.

Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death in young people. Implantable cardioverter defibrillator (ICD) is the optimal therapy in patients with HCM, both for primary or secondary prevention of sudden death. Left ventricular systolic function in HCM is usually normal. However, in few patients, HCM has been reported to progress to a state that is characterized by left ventricular dilation and systolic dysfunction, resembling dilated cardiomyopathy (DCM). Although arrhythmias are common in HCM, advanced or complete atrioventricular block (AV) is very rare. This case report describes a HCM patient who progressed to DCM with advanced AV block and survived 31 years following cardiac arrest without ICD protection.

Value of IGF-I levels in the evaluation of response to treatment with levosimendan in patients with severe heart failure.

OBJECTIVE: Levosimendan treatment has inotropic, anti-stunning, and cardioprotective effects in the setting of acute decompensated heart failure (HF). Among studies conducted on the treatment of heart failure, those based on the growth hormone axis are of particular interest. The aim of this study was to determine the value of baseline insulin-like growth factor 1 (IGF-I) measurements in predicting response to levosimendan treatment. METHODS: The study population included patients on standard heart failure treatment who presented with functional capacity NYHA class 3-4 and left ventricular (LV) ejection fraction less than 35% were enrolled in this prospective, cohort study. Pre- and post-treatment symptoms of patients (72 hours after the completion of levosimendan infusion) and echocardiographic parameters were evaluated and blood samples were collected. Mann-Whitney U, Pearson Chi-square and Wilcoxon Sign Rank tests were used for statistical analysis. Correlations were determined using Spearman correlation analysis. RESULTS: Thirty patients were enrolled in this study, 83.3% of whom were male and 16.7% were female, with a mean age of 62.6 ±10.1 years. Mean baseline IGF-I level was 106.9±47.0 µg/L. Statistically significant improvements were observed in NYHA class, mean brain natriuretic peptide (BNP) levels, LV ejection fraction and LV end-systolic volume values following treatment with levosimendan (respective pre-treatment and post-treatment values: 3.5±0.5 vs. 2.5±0.7, p<0.001; 1209.8±398.6 pg/ml vs. 704.1±344.6 pg/ml, p<0.001, and 25.7±6.6% vs. 29.0±6.8%, p=0.021, and 164.1±45.7 ml vs. 152.8±50.6 ml, p=0.012). Fourteen patients (46.7%) had low IGF-I levels, taking into consideration variations due to age and gender. Patients with normal baseline IGF-I values showed more significant decreases in BNP levels in response to treatment compared to those with low baseline IGF-I levels (650.5±367.2 pg/ml vs. 340.1±269.0 pg/ml, p=0.014). CONCLUSION: Baseline IGF-I levels may be used to predict response to levosimendan treatment in patients hospitalized for decompensated HF.

A case of carbon monoxide poisoning presenting with supraventricular tachycardia.

Carbon monoxide intoxication is one of the most common types of poisoning in the world. Cardiac manifestations after exposure to carbon monoxide including myocardial ischemia, heart failure and arrhythmias have been reported. A 17-year-old woman was admitted to the emergency service with the complaints of palpitation, headache and nausea. Electrocardiogram revealed supraventricular tachycardia. The arterial blood gas analysis was normal. Her carboxyhemoglobin level was 19% and oxygen treatment was started promptly. Echocardiographic examination demonstrated normal cardiac function. To the best of our knowledge, this case report is the first carbon monoxide intoxication case in the literature presenting with supraventricular tachycardia attack.