RESUMO
BACKGROUND Atrial fibrillation (AF) is one of the most common heart rhythm disorders. Identification and early treatment of AF risk factors can improve mortality and morbidity rates. This study aimed to compare the renal venous stasis index (RVSI) and intra-renal venous flow (IRVF) patterns evaluated by intra-renal Doppler ultrasonography in patients with AF and sinus rhythm (SR). MATERIAL AND METHODS A total of 68 patients, 34 with AF (lasting >12 months AF) and 34 with SR (no previous diagnosis of AF and no AF attack in 24-h Holter monitoring) were included in the study. The RVSI was calculated, and the IRVF patterns were determined using intra-renal Doppler ultrasonography. High RVSI was defined as >0.12 RVSI. In addition, echocardiography and a 6-min walk test were performed. A model including diabetes mellitus, hypertension, creatine, Pro-BNP, left ventricular ejection fraction, presence of AF, and systolic pulmonary artery pressure was created to evaluate the effects of variables on high RVSI. RESULTS The RVSI value was significantly higher in patients with AF than in those with SR (P=0.004). The SR group exhibited a higher prevalence of the continuous flow pattern, which is one of the IRVF patterns (P=0.015). In contrast, the biphasic flow pattern was observed more frequently in patients with AF (P=0.003). The presence of AF was found to predict the high RVSI (P=0.002, OR=14.134, 95% CI 2.083-71.277). CONCLUSIONS The presence of AF may affect the IRVF and cause an increase in RVSI.
Assuntos
Fibrilação Atrial , Nefropatias , Humanos , Fibrilação Atrial/complicações , Veias Renais/diagnóstico por imagem , Volume Sistólico , Função Ventricular EsquerdaRESUMO
Background and Objectives: Smokeless tobacco (ST) use has recently become an alternative to cigarettes, and it has been concluded that ST is at least as harmful as cigarettes. ST use is thought to play a role in the pathogenesis of arrhythmia by affecting ventricular repolarization. In this study, we aimed to examine the relationships of Maras powder (MP), one of the ST varieties, with epicardial fat thickness and new ventricular repolarization parameters, which have not previously been described. Materials and Methods: A total of 289 male individuals were included in this study between April 2022 and December 2022. Three groups, 97 MP users, 97 smokers, and 95 healthy (non-tobacco), were compared according to electrocardiographic and echocardiographic data. Electrocardiograms (ECG) were evaluated with a magnifying glass by two expert cardiologists at a speed of 50 m/s. Epicardial fat thickness (EFT) was measured by echocardiography in the parasternal short- and long-axis images. A model was created with variables that could affect epicardial fat thickness. Results: There were no differences between the groups regarding body mass index (p = 0.672) and age (p = 0.306). The low-density lipoprotein value was higher in the MP user group (p = 0.003). The QT interval was similar between groups. Tp-e (p = 0.022), cTp-e (p = 0.013), Tp-e/QT (p =0.005), and Tp-e/cQT (p = 0.012) were higher in the MP user group. While the Tp-e/QT ratio did not affect EFT, MP predicted the epicardial fat thickness (p < 0.001, B = 0.522, 95%CI 0.272-0.773). Conclusions: Maras powder may play a role in ventricular arrhythmia by affecting EFT and causing an increase in the Tp-e interval.
Assuntos
Tabaco sem Fumaça , Humanos , Masculino , Tabaco sem Fumaça/efeitos adversos , Pós , Ecocardiografia , Eletrocardiografia , Arritmias Cardíacas/etiologiaRESUMO
Environmental, genetic, oxidative and biochemical factors play an important role in the atherosclerotic process. We investigated the association of serum fibroblast growth factor (FGF-23), klotho, fetuin-A, osteoprotegerin (OPG), osteopontin (OPN) and high-sensitive-CRP (Hs-CRP) markers with coronary artery disease and whether one was superior to others or not. A study group of 52 patients with coronary artery disease (CAD) and a control group of 30 patients with angiographically normal epicardial coronary arteries were included in the study. Serum FGF-23, klotho, fetuin-A, OPN, OPG and Hs-CRP marker levels were studied. Patients with CAD were classified in two groups as low (SYNTAX ≤22, n = 29) and moderate-high (SYNTAX ≥ 23, n = 23) according to anatomic SYNTAX score. FGF-23 (p = .033), klotho (p < .001), fetuin-A (p = .005) and OPG (p = .001) serum marker levels were significantly lower in CAD patients than the control group. Serum levels of FGF-23 (p = .012), klotho (p = .001), fetuin-A (p = .015) and OPG (p = 0.002) were significantly different between SYNTAX tertiles and control group. Klotho (p = .025, odd ratio (OR) = 0.542, 95% confidence interval (CI): 0.317-0.926) and HT (p = .004, OR = 34.598, 95%CI:1.054-1135.657) were the independent predictors of CAD presence. Serum klotho levels of 91.48 pmol/L predicts the presence of CAD with 60% sensitivity and 96.55% specificity (p < .001, area under curve = 0.864, 95% CI = 0.768, 0.931). We found that serum klotho level is an independent predictor of presence, extent and severity of CAD.
Assuntos
Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Glucuronidase/sangue , Idoso , Biomarcadores/sangue , Proteína C-Reativa/genética , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Angiografia Coronária , Doença da Artéria Coronariana/genética , Doença da Artéria Coronariana/patologia , Feminino , Fator de Crescimento de Fibroblastos 23 , Fatores de Crescimento de Fibroblastos/sangue , Fatores de Crescimento de Fibroblastos/genética , Expressão Gênica , Glucuronidase/genética , Humanos , Proteínas Klotho , Masculino , Pessoa de Meia-Idade , Osteopontina/sangue , Osteopontina/genética , Osteoprotegerina/sangue , Osteoprotegerina/genética , Estudos Prospectivos , Índice de Gravidade de Doença , alfa-2-Glicoproteína-HS/genética , alfa-2-Glicoproteína-HS/metabolismoRESUMO
OBJECTIVE: The use of cardiac implantable electronic devices has increased in recent years. It has also brought some issues. Among these, the complications of cardiac implantable electronic devices infection and pocket hematoma are difficult to manage. It can be fatal with the contribution of patient-related risk factors. In this study, we aimed to find mortality rates in patients who developed cardiac implantable electronic devices infection and pocket hematoma over 5 years. We also investigated the risk factors affecting mortality in patients with cardiac implantable electronic devices. METHODS: A total of 288 cardiac implantable electronic devices patients were evaluated. Demographic details, history, and clinical data of all patients were recorded. Cardiac implantable electronic devices infection was defined according to the modified Duke criteria. The national registry was used to ascertain the mortality status of the patients. The patients were divided into two groups (exitus and survival groups). In addition, the pocket hematoma was defined as significant bleeding at the pocket site after cardiac implantable electronic devices placement. RESULTS: The cardiac implantable electronic devices infection was similar in both groups (p=0.919), and the pocket hematoma was higher in the exitus group (p=0.019). The exitus group had higher usage of P2Y12 inhibitors (p≤0.001) and novel oral anticoagulants (p=0.031). The Cox regression analysis, including mortality-related factors, revealed that renal failure is the most significant risk factor for mortality. Renal failure was linked to a 2.78-fold higher risk of death. CONCLUSION: No correlation was observed between cardiac implantable electronic devices infection and mortality, whereas pocket hematoma was associated with mortality. Furthermore, renal failure was the cause of the highest mortality rate in patients with cardiac implantable electronic devices.
Assuntos
Desfibriladores Implantáveis , Hematoma , Marca-Passo Artificial , Humanos , Feminino , Masculino , Desfibriladores Implantáveis/efeitos adversos , Fatores de Risco , Idoso , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Hematoma/etiologia , Hematoma/mortalidade , Infecções Relacionadas à Prótese/mortalidade , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Fatores de Tempo , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Coronary microvascular dysfunction (CMD) is a common occurrence in individuals with insulin resistance (IR). Homeostatic model assessment for insulin resistance (HOMA-IR) is a widely used surrogate marker of IR, although recent studies suggest Triglyceride-Glucose (TyG) index is a superior marker of IR that had a better accuracy to predict Type 2 Diabetes or cardiovascular outcomes than HOMA-IR. OBJECTIVES: We aimed to assess the accuracy and usefulness of TyG index and HOMA-IR for predicting CMD as assessed with echocardiographic coronary flow reserve (CFR) measurement. METHODS: All cases included in the institutional CFR registry were retrospectively reviewed, and 656 cases without epicardial coronary artery disease and without major risk factors for atherosclerosis were included. A CFR ≤2.0 was defined as CMD. RESULTS: TyG index was available in all cases, while HOMA-IR was available in 398 cases. Both TyG index and HOMA-IR were associated with CMD on univariate analyses, while after adjustment for potential confounders HOMA-IR (OR:1.38, 95 %CI:1.14-1.67, p = 0.001) but not TyG index(OR:1.48, 95 %CI:0.82-2.67, p = 0.19) was associated with CMD. The predictive accuracy of HOMA-IR (c-statistic:0.63, 95 %CI:0.54-0.72, p = 0.003) was higher than TyG index(c-statistic:0.55, 95 %CI:0.47-0.63, p = 0.13), although the difference was not statistically significant (DeLong p = 0.23). There was strong evidence favoring a true difference between CMD vs. non-CMD groups for HOMA-IR (BF10:3507) but not for TyG index(BF10:0.66). CONCLUSIONS: HOMA-IR, but not TyG index, is closely associated with CMD.
RESUMO
BACKGROUND: Atrial fibrillation (AF) is the most common rhythm disorder in the elderly. The AF can cause life-threatening thromboembolic complications. Therefore, there is a need to determine the risk factors of AF. In this study, we aimed to examine the association of markers of malnutrition with AF in individuals aged 75 years and older and to find the factors that may affect mortality. METHODS: In this prospective study, 358 consecutive individuals aged 75 years and older presenting to the cardiology outpatient clinic were included. All participants were divided into AF and sinus rhythm (SR) groups. In addition, a questionnaire and scoring system were used to assess malnutrition status. Information was obtained from all patients through outpatient clinic visits or telephone interviews for one year. Death from any cause was considered as the endpoint. RESULTS: AF was observed in 71 (19.8%) patients. Death was higher in patients with AF (p < 0.001), high CONUT score (p = 0.018), and GLIM malnutrition (p = 0.018). GLIM malnutrition caused a 2.8-fold increase in the development of AF. CONCLUSIONS: Screening for malnutrition in the elderly is essential. According to GLIM criteria, malnutrition may play a role in the development of AF and increase one-year mortality in the elderly.
Assuntos
Fibrilação Atrial , Desnutrição , Idoso , Humanos , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/diagnóstico , Estudos Prospectivos , Desnutrição/complicações , Desnutrição/epidemiologia , Fatores de RiscoRESUMO
OBJECTIVE: The current study investigated the contribution of the dissertations produced in the ï¬eld of cardiology to the scientiï¬c literature and the factors aï¬ecting the publication process. METHODS: The study included 1049 cardiology dissertations archived in the national thesis center database between January 2010 and December 2017. The titles (English and Turkish), abstracts, and author names of cardiology dissertations were searched in Google Academic, TR Directory, and PubMed Central databases. In addition to their publication rates, the subject of the cardiology dissertations, the type of research, the type of institution, the academic title of the cardiology dissertation advisors, the duration of publication, the index of the published journals, and the quartile ranking of the Science Citation Index and Science Citation Index Expanded journals were examined. RESULTS: Among the reviewed 1049 cardiology dissertations 42.7% (n = 448) were published in a journal. The publication rate of cardiology dissertations among male authors was 43.5% and among female authors 40.1%. The cardiology dissertations were published at the highest rate after the 60th month. Among the published cardiology dissertations, 63.4% (n = 284) appeared in journals indexed by the Science Citation Index and Science Citation Index Expanded. There was no statistically signiï¬cant relationship between the academic titles of cardiology dissertation advisors and the quartile ranking of Science Citation Index and Science Citation Index Expanded journals (P = 0.072). CONCLUSIONS: There were diï¬culties in transforming into a publication of dissertations in the ï¬eld of cardiology to gain an academic identity. Incentives should be created to increase the desire and motivation of the residents.
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Cardiologia , Editoração , Feminino , Masculino , HumanosRESUMO
BACKGROUND: Cardiac autonomic neuropathy is a frequent complication of type 2 diabetes mellitus. Cardiac autonomic neuropathy, in which sympathetic tone predominates over parasympathetic activity, increases both cardiovascular morbidity and mortality and unfortunately has no definitive treatment. Sodium-glucose cotransporter-2 inhibitors have been suggested to reduce sympathetic nervous system activity, based on the results from previous studies. In this study, we aimed to investigate the effect of 24-week treatment with dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, on cardiac autonomic function measures in patients with type 2 diabetes mellitus and cardiac autonomic neuropathy. METHODS: Dapagliflozin 10 mg/day (n=42) or non-sodium-glucose cotransporter-2 inhibitor oral antidiabetic(s) (n=38) was added to the treatment of patients whose glycemic control could not be achieved with existing treatments. The patients with definite or confirmed cardiac autonomic neuropathy diagnosed by cardiovascular autonomic reflex tests underwent 24-hour Holter-electrocardiogram recordings to obtain heart rate variability and heart rate turbulence parameters before starting additional medication and after a 24-week treatment period. RESULTS: In-group analyses showed that dapagliflozin 10 mg/day for 24 weeks improved heart rate variability and heart rate turbulence parameters and decreased the frequency of ventricular premature beats relative to their baseline values. No such findings were observed in the control group despite similar glycemic control. Comparisons between dapagliflozin group and the control group showed that these effects of dapagliflozin were significantly better than non-sodium-glucose cotransporter-2 inhibitor oral antidiabetics. CONCLUSION: Dapagliflozin improves measures of cardiac autonomic function compared to the control group in type 2 diabetic patients with cardiac autonomic neuropathy. This intergroup benefit, demonstrated for the first time, may be promising for the regression of cardiac autonomic neuropathy with sodium-glucose cotransporter-2 inhibitors.
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Diabetes Mellitus Tipo 2 , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/diagnóstico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Glucosídeos/uso terapêutico , Glucosídeos/farmacologia , Hipoglicemiantes/uso terapêutico , Glucose/uso terapêuticoRESUMO
SUMMARY OBJECTIVE: The use of cardiac implantable electronic devices has increased in recent years. It has also brought some issues. Among these, the complications of cardiac implantable electronic devices infection and pocket hematoma are difficult to manage. It can be fatal with the contribution of patient-related risk factors. In this study, we aimed to find mortality rates in patients who developed cardiac implantable electronic devices infection and pocket hematoma over 5 years. We also investigated the risk factors affecting mortality in patients with cardiac implantable electronic devices. METHODS: A total of 288 cardiac implantable electronic devices patients were evaluated. Demographic details, history, and clinical data of all patients were recorded. Cardiac implantable electronic devices infection was defined according to the modified Duke criteria. The national registry was used to ascertain the mortality status of the patients. The patients were divided into two groups (exitus and survival groups). In addition, the pocket hematoma was defined as significant bleeding at the pocket site after cardiac implantable electronic devices placement. RESULTS: The cardiac implantable electronic devices infection was similar in both groups (p=0.919), and the pocket hematoma was higher in the exitus group (p=0.019). The exitus group had higher usage of P2Y12 inhibitors (p≤0.001) and novel oral anticoagulants (p=0.031). The Cox regression analysis, including mortality-related factors, revealed that renal failure is the most significant risk factor for mortality. Renal failure was linked to a 2.78-fold higher risk of death. CONCLUSION: No correlation was observed between cardiac implantable electronic devices infection and mortality, whereas pocket hematoma was associated with mortality. Furthermore, renal failure was the cause of the highest mortality rate in patients with cardiac implantable electronic devices.