Usability of myocardial work parameters in demonstrating myocardial involvement in INOCA patients.

BACKGROUND: Myocardial work (MW) is a novel echocardiographic modality, which has been shown to have diagnostic and prognostic values in patients with cardiovascular diseases, patients with obstructive coronary artery disease, in particular. However, only a handful of studies have examined the MW analysis in ischemia with nonobstructive coronary artery (INOCA) disease. This study, therefore, aimed to detect the early left ventricular involvement in INOCA patients diagnosed by an invasive coronary angiography performing the MW analysis. METHODS: This study included a total of 119 patients with nonobstructive coronary artery disease diagnosed by invasive coronary angiography, who were checked for prior ischemia tests performing myocardial perfusion scintigraphy. Out of these 119 patients, 49 patients developed ischemia (i.e., ischemic group) diagnosed using cardiac single-photon emission computed tomography, whereas 70 patients did not (i.e., nonischemic group). The subjects were divided into three groups based on the global MW tertiles. The groups were compared in terms of the conventional, longitudinal strain, and MW findings by conducting echocardiographic examinations. RESULTS: The study subjects were divided into three groups based on the global constrictive work (GCW) value. The three groups were not statistically different in terms of the mean age of the patients (53.0 ± 12 vs. 52.4 ± 13.3 vs. 52.1 ± 12.3; p = 0.96). Furthermore, the three groups were not statistically different regarding the gender, height, weight, and laboratory parameters of the patients except albumin. There was no statistically difference among the tertiles of GCW groups in the measurements of cardiac chambers, LA diameter, interventricular septum, E wave, and A wave. Also, there was no statistical difference in tissue Doppler recordings. The parameters associated with MW were examined, three groups were not statistically different in terms of the global waste work (GWW) (116 ± 92, 122 ± 73, 135 ± 62, p = 0.52, respectively). In contrast, the three groups were different regarding the Global work index (GWI) (1716 ± 300, 1999 ± 130, 2253 ± 195, p < 0.001, respectively), GCW (1888 ± 206, 2298 ± 75, 2614 ± 155, p < 0.001, respectively), and Global work efficiency parameters (92.8 ± 3.6, 94.4 ± 3.2, 95.1 ± 1.8 p = 0.004, respectively). CONCLUSION: It was concluded that the MW parameters GCW and GWI may have been used for predicting INOCA in patients.

The Impact of Lesion Complexity and the CHA2DS2-VASc Score on Spontaneous Reperfusion in Patients with ST-Segment Elevation Myocardial Infarction.

Background: In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography is defined as spontaneous reperfusion (SR). Objective: The present study aimed to determine the impact of lesion complexity and the CHA2DS2-VASc score on SR in patients with STEMI. Methods: A total number of 1,641 consecutive patients with STEMI undergoing primary PCI were assessed for this study. Patients were divided into 2 groups, those with SR, SR(+) (n = 239), and those without SR, SR(-) (n = 1402), according to their initial angiography and SR status. CHA2DS2-VASc scores were calculated for all patients. The lesion complexity of coronary artery disease was assessed with the SYNTAX score. Results: The CHA2DS2-VASc and SYNTAX scores were significantly lower in the SR(+) group compared to the SR(-) (mean CHA2DS2-VASc, 1.36 ± 0.64 vs. 2.01 ± 0.80, p < 0.001; mean SYNTAX score, 15.51 ± 5.94 vs. 17.08 ± 8.29, p < 0.001). After the multivariate regression analysis, a lower CHA2DS2-VASc (OR = 0.288, p < 0.001), SYNTAX score (OR = 0.920, p=0.007), uric acid (OR = 0.868, p=0.005), CRP (OR = 0.939, p=0.001), BNP (OR = 0.998, p=0.004), and troponin (OR = 0.991, p=0.001) were independent predictors of SR. In-hospital mortality rates were significantly lower in the SR(+) group compared to the SR(-) (0% vs. 6.7%, p < 0.001). Conclusion: Our study demonstrated that lesion complexity and the CHA2DS2-VASc score are independently associated with spontaneous reperfusion.

Spectrum of cardiovascular diseases at a referral tertiary care hospital in Somalia, Mogadishu: an echocardiographic study.

BACKGROUND: To investigate the frequencies and patterns of cardiovascular diseases (CVDs), including rheumatic and congenital heart diseases, among patients with abnormal hearts assessed by echocardiographic examination. METHODS: This retrospective, descriptive registry reviewed abnormal echocardiographic findings of 1140 patients aged 0-100 years who were admitted to the cardiology outpatient clinic at a tertiary training institution in Mogadishu. RESULTS: Hypertensive heart disease (HHD) (n:454, 39.8%), valvular heart disease (VHD) (n:395, 34.6%), and heart failure with reduced ejection fraction (HFrEF) (n:351, 30.8%) were the most frequent comorbidities. Congenital heart diseases (CHDs) were detected in 151 (13.2%) of the patients, with the most common ones including atrial septal defect (ASD) (n:37, 3.2%) and ventricular septal defect (VSD) (n:26, 2.3%). Rheumatic heart disease (RHD) was observed in 84 (7.4%) patients, among whom the most common age range was 16-30 years (40.5%), followed by 31-45 years (31%) and 0-15 years (15.5%). Mitral insufficiency (n:541, 47.5%) was detected as the most frequent VHD, followed by aortic insufficiency (n:437, 38.3%), and tricuspid insufficiency (n:264, 23.2%) and mitral valve stenosis (n:39, 3.4%) was the least common VHD. CONCLUSION: In the present study, we found that HHD was the most common comorbidity, followed by VHD, and HFrEF. Moreover, the most common VHD was mitral insufficiency and the most common CHD was ASD.

The effect of the severity COVID-19 infection on electrocardiography.

OBJECTIVE: Acute myocardial damage is detected in a significant portion of patients with coronavirus 2019 disease (COVID-19) infection, with a reported prevalence of 7-28%. The aim of this study was to investigate the relationship between electrocardiographic findings and the indicators of the severity of COVID-19 detected on electrocardiography (ECG). METHODS: A total of 219 patients that were hospitalized due to COVID-19 between April 15 and May 5, 2020 were enrolled in this study. Patients were divided into two groups according to the severity of COVID-19 infection: severe (n = 95) and non-severe (n = 124). ECG findings at the time of admission were recorded for each patient. Clinical characteristics and laboratory findings were retrieved from electronic medical records. RESULTS: Mean age was 65.2 ± 13.8 years in the severe group and was 57.9 ± 16.0 years in the non-severe group. ST depression (28% vs. 14%), T-wave inversion (29% vs. 16%), ST-T changes (36% vs. 21%), and the presence of fragmented QRS (fQRS) (17% vs. 7%) were more frequent in the severe group compared to the non-severe group. Multivariate analysis revealed that hypertension (odds ratio [OR]: 2.42, 95% confidence interval [CI]:1.03-5.67; p = 0.041), the severity of COVID-19 infection (OR: 1.87, 95% CI: 1.09-2.65; p = 0.026), presence of cardiac injury (OR: 3.32, 95% CI: 1.45-7.60; p = 0.004), and d-dimer (OR: 3.60, 95% CI: 1.29-10.06; p = 0.014) were independent predictors of ST-T changes on ECG. CONCLUSION: ST depression, T-wave inversion, ST-T changes, and the presence of fQRS on admission ECG are closely associated with the severity of COVID-19 infection.

Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: A systematic review and meta-analysis.

BACKGROUND: In this systematic review and meta-analysis, we aimed to investigate the correlation of D-dimer levels measured on admission with disease severity and the risk of death in patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS: We performed a comprehensive literature search from several databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in abstracting data and assessing validity. Quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS). D-dimer levels were pooled and compared between severe/non-severe and surviving/non-surviving patient groups. Weighted mean difference (WMD), risk ratios (RRs) and 95% confidence intervals (CIs) were analyzed. RESULTS: Thirty-nine studies reported on D-dimer levels in 5750 non-severe and 2063 severe patients and 16 studies reported on D-dimer levels in 2783 surviving and 697 non-surviving cases. D-dimer levels were significantly higher in patients with severe clinical status (WMD: 0.45 mg/L, 95% CI: 0.34-0.56; p < 0.0001). Non-surviving patients had significantly higher D-dimer levels compared to surviving patients (WMD: 5.32 mg/L, 95% CI: 3.90-6.73; p < 0.0001). D-dimer levels above the upper limit of normal (ULN) was associated with higher risk of severity (RR: 1.58, 95% CI: 1.25-2.00; p < 0.0001) and mortality (RR: 1.82, 95% CI: 1.40-2.37; p < 0.0001). CONCLUSION: Increased levels of D-dimer levels measured on admission are significantly correlated with the severity of COVID-19 pneumonia and may predict mortality in hospitalized patients.

The association between the renal resistive index and the myocardial performance index in the general population.

OBJECTIVE: The renal resistive index (RRI) is the most described measure of renal hemodynamics. The myocardial performance index (MPI) is widely used to assess overall myocardial performance. In this study, we aimed to investigate the relationship between renal hemodynamics, assessed by the RRI, and cardiac functions, assessed by the MPI in the general population. METHODS: This single-center, cross-sectional study included a total of 302 consecutive patients who presented to our outpatient cardiology clinic between October 2019 and February 2020. All patients underwent transthoracic echocardiography and renal Doppler ultrasonography. The study population was divided into two groups: low RRI group (RRI ≤ 0.7, n = 236) and high RRI group (RRI > 0.7, n = 66). RESULTS: E/A ratio, left ventricular ejection fraction (LVEF), and the MPI were significantly higher in the high RRI group than in the low RRI group (61.3 ± 15.4 vs 55.3 ± 16.4, P = .010 for E velocity; 0.9 ± 0.3 vs 0.7 ± 0.2, P = .008 for E/A ratio; 57.7 ± 4.7 vs 53.2 ± 10.1, P = .029 for LVEF; 0.52 ± 0.1 vs 0.43 ± 0.1, P < .001 for the MPI). A stepwise linear regression analysis demonstrated that LVEF (ß = .123, P = .026), E velocity (ß = .221, P < .001), and the MPI (ß = .392, P < .001) were independently associated with the RRI. CONCLUSION: Left ventricular ejection fraction and intra-cardiac Doppler blood flow indices, including E velocity and the MPI, were significantly and independently associated with the RRI in the general population.

The Relationship Between Contrast Associated Nephropathy and Coronary Collateral Circulation in very Old Patients.

Background: The aim of this study was to investigate whether there is a relationship between coronary collateral circulation (CCC) and contrast associated nephropathy (CAN) in very elderly patients. Methods: Patients aged 90 years or older with at least one major occlusion of the coronary artery proximal or mid-section were included in the study. CCC was graded according to the Rentrop classification. CAN was defined as an increase in blood creatinine value of 25% or more on the second day after coronary angiography. Results: Thirty-six patients who met the study criteria were included in the study. In the study group, CAN developed in 12 patients (CAN (+) group), 24 patients did not develop CAN (CAN (-) group). The creatinine levels before coronary angiography were 1.05 ± 0.12 in the CAN (-) group and 1.22 ± 0.14 in the CAN (+) group. Baseline creatinine values were significantly higher in the CAN (+) group (p = 0.001). The contrast agent used in the CAN (+) group was significantly higher (p = 0.001). In the CAN (+) group, nine patients (43%) had poor collateral circulation, whereas only three patients (20%) had well-developed collateral circulation. In a logistic regression analysis, the collateral class was not a risk factor for CAN, whereas contrast agent volume and basal creatinine were independent predictors of CAN. Conclusion: We found that CCC grade was not associated with the development of CAN in very old patients, but the amount of contrast agent and pre-procedure creatinine values were independent variables in the development of CAN.

The relationship between serum rheumatoid factor level and no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

OBJECTIVE: This study aimed to evaluate the relationship between serum rheumatoid factor (RF) levels and no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: This single-center, cross-sectional study included a total of 318 consecutive patients who were diagnosed with STEMI and underwent primary PCI within 12 hours of the onset of symptoms. Baseline serum RF levels of all patients were measured. The diagnosis of no-reflow phenomenon was defined as a flow of TIMI II or less without the presence of dissection, mechanical obstruction, significant residual stenosis, or other plausible causes. The patients were divided into reflow group (n = 283) and no-reflow group (n = 46) regarding the angiographic features of thrombolysis in myocardial infarction (TIMI) flow of the infarct-related artery. RESULTS: No-reflow phenomenon was observed in 13.8% of the patients. Median RF level was significantly higher in no-reflow group than in reflow group (18.5 (7.0-27.6) vs 8.0 (4.6-50.8), P < .001). Forward conditional logistic regression analysis demonstrated that body mass index (OR = 0.845, 95% CI: 0.765 to 0.933, P = .001), diabetes mellitus (OR = 5.257, 95% CI: 1.124 to 24.587, P = .035), baseline RF level (OR = 1.198, 95% CI: 1.108 to 1.295, P < .001), and SYNTAX score I (OR = 1.065, 95% CI: 1.025 to 1.107, P = .001) were the independent predictors of no-reflow phenomenon. CONCLUSION: Baseline serum RF concentrations are independently associated with the no-reflow phenomenon in patients undergoing primary PCI for acute STEMI.

Decreased plasma adiponectin is associated with impaired left ventricular longitudinal systolic function in hypertensive patients: a two-dimensional speckle tracking study.

The influence of plasma adiponectin levels on myocardial contractile function has not been fully examined. We aimed to investigate the relationship between three-directional systolic function and plasma adiponectin levels in asymptomatic hypertensive patients using two- dimensional speckle-tracking echocardiography. The study population consisted of 78 patients with hypertension and 40 healthy controls. Longitudinal strain was significantly reduced in all patients, including those without LV hypertrophy (p=0.009). In multiple-regression analysis, plasma adiponectin levels (ß=-0.273, p=0.008) and LV mass index (ß=0.458, p<0.001) independently correlated with LV longitudinal strain. Decreased plasma adiponectin concentrations were associated with the progression of LV hypertrophy with impaired LV longitudinal systolic function.

Transcatheter Closure or Surgery for Symptomatic Paravalvular Leaks: The Multicenter KISS Registry.

BACKGROUND: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs. METHODS AND RESULTS: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P=0.549) and procedural success (73.7 versus 65.2%; P=0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75-5.88]; P=0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27-10.0]; P<0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59-1.25]; P=0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67-1.81]; P=0.679). CONCLUSIONS: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.

P-wave dispersion by 12-lead electrocardiography in carotid artery stenting.

OBJECTIVE: Although carotid artery stenting (CAS) is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. And, autonomic functions influence P-wave durations. In this study, our aim was to investigate P-wave durations on 12-lead surface electrocardiography after CAS. METHODS: Patients (19 male, 8 female) who are suitable for CAS, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled in our study. 12-lead surface electrocardiography recordings were obtained at the beginning, immediately after and at the 24 h of the procedure. P-wave maximum, minimum and dispersion durations were analyzed by double-blinded observers. Results were statistically analysed using Friedman and Wilcoxon tests. RESULTS: The P maximum and P dispersion values were significantly increased immediately after the procedure and continued with high levels at 24-h recordings, respectively (128 ± 10/19 ± 7, 143 ± 14/37 ± 11, and 137 ± 11/30 ± 7 ms, p value <0.05). The P minimum value was significantly decreased immediately after the procedure (109 ± 11/105 ± 10 ms, p value <0.05). At 24-h recordings, a nonsignificant increase occured in P minimum values (106 ± 8 ms). CONCLUSIONS: P maximum and dispersion durations were significantly increased after the CAS and continued with high levels at 24-h recordings, which may be associated with the alterations in autonomic functions via augmented parasympathetic activity by vagally mediated stimulus. Overall, these findings suggest that decline in cardiovascular activity is prolonged at least 24 h after CAS.

Evaluation of autonomic functions by heart rate variability after stenting in patients with carotid artery stenosis.

OBJECTIVE: Although carotid stenting is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. Heart rate variability (HRV) is an established tool for the asessment of autonumic functions. In this study, our aim was to investigate the relation between the alterations in autonomic functions and HRV by Holter monitoring parameters. METHODS: Patients (19 male, 8 female) that are suitable for carotid artery stenting, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled to our study. Short-term HRV analysis recordings were obtained at the beginning, and after the procedure. The square root of the mean squared differences of successive NN intervals (RMSSD), total frequency, low frequency (LF), high frequency (HF), normalized units LF (LFnu), normalized units HF (HFnu), LF/HF ratios were analyzed. Results were statistically analysed by using Wilcoxon test. RESULTS: Total frequency did not show any significant changes after the procedure (1101 ± 829, 981 ± 855). While RMSSD and HFnu values significantly increased respectively (23 ± 12/33 ± 22, and 22 ± 10/35 ± 10, p < 0.05) after the procedure, HF values increased nonsignificantly after the procedure (82 ± 92/92 ± 108). LF, LFnu, and LF/HF values were significantly decreased after the procedure. (228 ± 166/112 ± 100, 70 ± 15/55 ± 18, 4 ± 2.5/2.1 ± 2, respectively, p < 0.05) CONCLUSIONS: While RMSSD and HF are used as markers of vagal activity, LF is a marker of sympathetic modulation and LF/HF ratio shows sympathovagal balance. In our study, we showed that carotid artery stenting is associated with increase in parasympathetic activation, and this finding is demonstrated by HRV parameters.

Acute sleep deprivation in healthy adults is associated with a reduction in left atrial early diastolic strain rate.

BACKGROUND: Sleep deprivation (SD) is known to be associated with adverse cardiovascular events. Strain and strain rate measure the local deformation of the myocardium and have been used to evaluate atrial phasic function in various disease states. The aim of the study was to investigate whether strain rate imaging enables the identification of left atrial dysfunction in otherwise healthy young adults with acute SD which has not been studied previously. METHODS: Adequate echocardiographic images of 27 healthy volunteers were obtained both after a night with regular sleep and after a night with SD. Tissue Doppler-derived strain and strain rate were measured from the apical four- and two-chamber views of the left atrium, and global values were calculated as the mean of all segments. Measurements included peak systolic strain, systolic strain rate (S-Sr), early diastolic (E-Sr) and late diastolic (A-Sr) strain rate. Phasic left atrial (LA) volumes and fractions were also calculated. RESULTS: There was no significant difference in the traditional parameters of atrial function and LA volumes. Subjects had similar S-Sr, A-Sr and global atrial strain values after the night of sleep debt when compared after regular sleep, whereas they had significantly reduced E-Sr values (mean (SD) 3.2 (0.7) s(-1) vs 3.7 (0.6) s(-1), p < 0.001). Moreover, global E-Sr showed a significant correlation with sleep time (r = 0.554, p < 0.001). CONCLUSION: Acute SD in healthy adults is associated with a reduction in LA early diastolic strain rate in the absence of geometric alterations or functional impairment of the left atrium, raising the possibility that chronic SD may more profoundly affect LA function and thereby promote the occurrence of atrial fibrillation.

Comparison of left atrial mechanical function in nondipper versus dipper hypertensive patients: a speckle tracking study.

AIM: Nondippers are known to carry a high risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the effects of dipper and nondipper status of hypertension on longitudinal systolic and diastolic functions of left atrial (LA) myocardial tissue by means of two-dimensional speckle-tracking echocardiography in treated hypertensive patients. METHODS: A total of 78 outpatients treated with antihypertensive drugs for at least 1 year were included in the study. The patients were classified as nondippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Global longitudinal LA strain/strain rate data were obtained by two-dimensional speckle imaging with automated software and compared between the groups. RESULTS: LA volume index, left ventricular (LV) wall thickness and mass index as well as filling pressure (E/E') were significantly higher in nondippers (all P < 0.001), whereas systolic tissue velocity (S') was significantly lower in nondippers. They also had decreased values of mean peak LA strain (dippers = 27.6 ± 5.5% vs. nondippers = 21.5 ± 4.5%, P < 0.001), strain rate during reservoir (dippers = 1.27 ± 0.4/sec vs. nondippers = 0.98 ± 0.3/sec, P = 0.001), and conduit period (dippers = 1.41 ± 0.4/sec vs. nondippers = 1.06 ± 0.3/sec, P < 0.001). Moreover, we found that LA mechanical dysfunction was closely associated with LV mass, filling pressure, and regional LV contractility. CONCLUSION: Nondipping in treated hypertensive patients was associated with an adverse cardiac remodeling and impaired LA mechanical function. Further studies are warranted to demonstrate the long-term prognostic significance of these findings.

Time course of right ventricular remodeling after percutaneous atrial septal defect closure: assessment of regional deformation properties with two-dimensional strain and strain rate imaging.

BACKGROUND: Quantitative assessment of the right ventricular (RV) function in atrial septal defect (ASD) patients before and after closure remains difficult. The aim of this study was to assess the regional RV function in ASD patients, to evaluate the extent and time course of RV remodeling following ASD closure, and to investigate whether any regional difference exists in RV remodeling. METHODS: Twenty patients with ASD and 20 age-matched controls were included. All underwent standard echocardiography and two-dimensional strain (S) and strain rate (SR) imaging by speckle tracking before, and 24 hours and 1 month after the defect closure. RESULTS: Right ventricular S was higher in ASD patients except apical lateral segment S, which was lower when compared with controls. There was no difference in RV SR between ASD patients and controls. RV septal S and SR, and lateral SR decreased in 24 hours after the procedure and remained the same at 1 month. RV lateral basal and mid S decreased and apical S increased in 24 hours after the closure. All 3 segments showed some more increase at 1 month. RV apical S showed strong correlations with systolic pulmonary artery pressure and global RV systolic function indices. CONCLUSIONS: Chronic volume overload in ASD patients causes alterations in RV deformation. Percutaneous closure results in rapid remodeling and normalization of RV deformation. The major geometrical and deformational changes are completed in 24 hours. Lateral wall S seems to reflect the RV deformational changes due to volume loading and unloading better than SR in ASD patients.

A case of double coronary perforations and tamponade during left main percutaneous coronary intervention and treatment with stenting and autotransfusion.

Coronary perforation is a rare complication of percutaneous coronary intervention. A 60-year-old male patient with a diagnosis of hepatocellular carcinoma was admitted to our hospital with crescendo anginal attacks. Coronary angiogram revealed significant stenosis in distal left main coronary artery (LMCA). After implanting a 4.0×18 mm coronary stent from LMCA to left anterior descending artery (LAD), coronary angiography showed a perforation in the proximal part of the LAD and a plaque shift to the osteum of circumflex artery (Cx), causing 60% stenosis. Rupture was sealed by implantation of a polytetrafluoroethylene (PTFE) coated stent in proximal LAD. Due to ongoing chest pain and electrocardiographic ischemic changes, a 3.5×18 mm coronary stent was implanted in Cx. Unfortunately, another perforation occurred in Cx. The PTFE coated stent was not flexible enough to advance from the former LMCA to LAD stent to the Cx artery, and another 3.5×18 mm coronary stent was deployed in Cx artery successfully. Although control angiography showed complete sealing of the rupture, echocardiography showed a large pericardial effusion compressing the right side of the heart. Autotransfusion was done to stabilize the hemodynamic status. One-week later, coronary angiography did not show any contrast agent extravasation. In this case, we present double coronary perforations of the LAD and Cx arteries, and successful treatment with both covered and conventional stents and autotransfusion.

The value of PRECISE-DAPT score and lesion complexity for predicting all-cause mortality in patients with NSTEMI.

BACKGROUND: We aimed to evaluate the prognostic effects of stroke risk scores (SRS), SYNTAX score (SX score), and PRECISE-DAPT score on mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Three hundred forty-three patients hospitalized with a diagnosis of NSTEMI and underwent coronary angiography (CAG) between January 1, 2022, and June 1, 2022, were included retrospectively in this single-center study. Patients' demographic, clinical and routine biochemical parameters were recorded. The scores (CHADS2, CHA2DS2-VASc, R2CHA2DS2-VASc, ATRIA, SX score, PRECISE-DAPT) of each patient were calculated. Participants were then divided into two groups by in-hospital status; all-cause mortality (+) and all-cause mortality (-). RESULTS: Overall, the mean age was 63.5 ± 11.8 years, of whom 63.3% (n = 217) were male. In-hospital mortality occurred in 31 (9.3%) patients. In the study population, those who died had significantly higher SX (p < 0.001), PRECISE-DAPT (p < 0.001), and ATRIA (p = 0.002) scores than those who survived. In logistic regression analysis, PRECISE-DAPT score [Odds ratio (OR) = 1.063, 95% CI 1.014-1.115; p = 0.012] and SX score [OR: 1.061, 95% CI 1.015-1.109, p = 0.009] were found to be independent predictors of in-hospital all-cause mortality among NSTEMI patients. In ROC analysis, the PRECISE-DAPT score performed better discriminative ability than the SX score in determining in-hospital mortality [Area under the curve = 0.706, 95% CI 0.597-0.814; p < 0.001]. CONCLUSIONS: During the hospital stay, both PRECISE-DAPT and SX scores showed better performance than SRS in predicting all-cause mortality among NSTEMI patients undergoing CAG. Aside from their primary purpose, both scores might be useful in determining risk stratification for such patient populations.

Comparison of thromboembolic risk scores for evaluating in-hospital events of COVID-19 patients.

Aim: To compare the effectiveness of thromboembolic risk scores in determining in-hospital events of COVID-19 patients. Methods: This retrospective study included a total of 410 consecutive COVID-19 patients. Scores including CHA2DS2-VASc-HS (congestive heart failure, hypertension, age, diabetes mellitus, stroke/transient ischemic attack, vascular disease, sex, hyperlipidemia, smoking); modified R2CHA2DS2-VASc (CHA2DS2-VASc plus renal function), m-ATRIA (modified Anticoagulation and Risk Factors in Atrial Fibrillation score), ATRIA-HSV (ATRIA plus hyperlipidemia, smoking and vascular disease) and modified ATRIA-HSV were calculated. Participants were divided by in-hospital mortality status into two groups: alive and deceased. Results: Ninety-two (22.4%) patients died. Patients in the deceased group were older, predominantly male and had comorbid conditions. CHA2DS2-VASc-HS (adjusted odds ratio [aOR]: 1.31; p = 0.011), m-R2CHA2DS2-VASc (aOR: 1.33; p = 0.007), m-ATRIA (aOR: 1.18; p = 0.026), ATRIA-HSV (aOR: 1.18; p = 0.013) and m-ATRIA-HSV (aOR: 1.24; p = 0.001) scores were all associated with in-hospital mortality. m-R2CHA2DS2-VASc and modified ATRIA-HSV had the best discriminatory performance. Conclusion: We showed that m-R2CHA2DS2-VASc and m-ATRIA-HSV scores were better than the rest in predicting mortality among COVID-19 patients.

COVID-19 continues to be a pandemic that threatens human health all over the world. The main aim of our study was to examine the relationship between risk scores routinely used to determine the probability of clot formation in various cardiovascular diseases and in-hospital deaths of COVID-19 patients. The study comprised 410 adult patients hospitalized with a confirmed diagnosis of COVID-19. The clinical and laboratory data were obtained from the hospital registry system. All risk scores in the study were significantly greater in people who died from COVID-19 than in those who survived. Moreover, scoring systems that include kidney function outperformed the rest in determining in-hospital death. As a result, we discovered that specific risk scores used to indicate a person's likelihood of developing clot formation at a routine cardiology clinic are connected to in-hospital deaths among hospitalized COVID-19 patients.

Thromboembolic risk scores in patients with non-obstructive coronary architecture with and without coronary slow flow: A case-control study.

AIM: Coronary slow flow phenomenon (CSFP) detected on coronary angiography (CA) has been related to poor prognosis. We sought to examine the relationship between thromboembolic risk scores, routinely used in cardiology practice, and CSFP. METHODS: This single-center, retrospective, case-control study comprised 505 individuals suffering from angina and had verified ischemia between January 2021 and January 2022. Demographic and laboratory parameters were obtained from the hospital database. The following risk scores were calculated; CHA2DS2-VASc, M-CHA2DS2-VASc, CHA2DS2-VASc-HS, R2-CHA2DS2-VASc, M-R2-CHA2DS2-VASc, ATRIA, M-ATRIA, M-ATRIA-HSV. The overall population was divided into two groups; coronary slow flow and coronary normal flow. Multivariable logistic regression was performed to compare risk scores between patients with and without CSFP. Pairwise comparisons were then undertaken to test performance in determining CSFP. RESULTS: The mean age was 51.7 ± 10.7 years, of whom 63.2% were male. CSFP was detected in 222 patients. Those with CSFP had higher rates of male gender, diabetes, smoking, hyperlipidemia, and vascular disease. All scores were higher in CSFP patients. Multivariable logistic regression analysis found that CHA2DS2-VASc-HS score was the most powerful determinant of CSFP among all risk schemes (for each one-point increase in score OR = 1.90, p < 0.001; for score of 2-3 OR = 5.20, p < 0.001; for score of >4 OR = 13.89, p < 0.001). Also, the CHA2DS2-VASc-HS score provided the best discriminative performance, with a cut-off value of ≥2 in identifying CSFP (AUC = 0.759, p < 0.001). CONCLUSION: We showed that thromboembolic risk scores may be associated with CSFP in patients with non-obstructive coronary architecture who underwent CA. The CHA2DS2-VASc-HS score had the best discriminative ability.

Early effect of left coronary system revascularization on right ventricular mechanics in patients with right coronary artery chronic total occlusion.

OBJECTIVE: No data exist on the functional relevance of collateral vessels in patients undergoing percutaneous coronary intervention (PCI). Also, the subtle effects of improved collateral flow on right ventricular (RV) function are difficult to assess. However, novel echocardiographic approaches like tissue-Doppler imaging (TDI) and two-dimensional speckle-tracking echocardiography (2DSTE) can quantify RV regional myocardial function. We hypothesized that these techniques may help delineate revascularization therapy-induced changes in regional RV contractility that escape clinical routine studies. METHODS: This study was a prospective registry of consecutive patients undergoing PCI for a collateral supplying artery. All included patients underwent standard echocardiography with TDI and 2DSTE to assess RV function before successful PCI and it was repeated after 24 hours and 1 month. RESULTS: There were no significant changes in either the RV systolic myocardial velocities, or the tricuspid annular plane systolic excursion values. However, RV free wall longitudinal strain/systolic strain rate values showed a significant increase 24 hours after PCI when compared to baseline (-25.9 +/- 6.8% vs. -21.5 +/- 6.6%, P < 0.001 and -2.18 +/- 0.40/s vs. -1.64 +/- 0.41/s, P < 0.001, respectively). Also, the improvement of RV function was further suggested by the tendency of RV isovolumic acceleration to be higher when compared with baseline at 1 month of follow-up (2.49 +/- 0.7 m/s2 vs. 2.1 5 +/- 0.6 m/s2, P = 0.056). CONCLUSION: Both TDI-derived isovolumic acceleration and 2DSTE-derived strain/strain rate produced a similar picture with respect to the change in RV contractile function. However, 2DSTE indicated a much more pronounced and earlier improvement of systolic function; therefore, 2DSTE could be included in future studies that involve functional relevance of collateral vessels.