Predictive Value of the Naples Prognostic Score on Long-Term Outcomes in Patients with Peripheral Artery Disease Revascularized via Percutaneous Intervention.

BACKGROUND: Lower extremity peripheral artery disease (PAD) is the third most common clinical manifestation of atherosclerosis after coronary artery disease and stroke. Despite successful endovascular treatment (EVT), mortality and morbidity rates still remain higher in patients with PAD. Naples prognostic score (NPS) is a novel scoring system, reflects the patient's nutritional and immunological statuses as well as systemic inflammatory responses. In this study, we aimed to investigate the relationship between NPS and long-term outcomes in patients with PAD. METHODS: The population of this retrospective study consisted of 629 PAD patients who underwent EVT at Kafkas University Hospital between 2020 and 2023. For each patient, the NPS was calculated and then patients were divided into 3 groups based on their NPS. The primary end point of the study was the rate of major adverse cardiovascular (MACEs) and limb events (MALEs), that is, all-cause death or development of critical limb ischemia with consequent amputation. RESULTS: Of a total of 629 patients, 62 were classified into group 0 (NPS 0), 315 into group 1 (NPS 1 or 2), and 252 into group 2 (NPS 3 or 4). The distribution of patients' baseline characteristics, angiographic features and MACEs and MALEs according to the NPS groups was analyzed. Significant adverse outcomes differences were observed among the 3 groups (P < 0.001). Multivariate logistic regression analysis revealed that age, diabetes mellitus, chronic kidney disease, lowest preprocedure ankle-brachial index, left ventricular ejection fraction and NPS (hazard ratio 1.916, 95% confidence interval [CI] 1.530-2.398, P < 0.001) were independent predictors of MACE whereas diabetes mellitus, presence of previous PAD, hemoglobin level, in-hospital acute thrombotic occlusion and NPS (odds ratio 1.963, 95% CI 1.489-2.588, P < 0.001) were independent predictors of MALE. CONCLUSIONS: The inflammatory and nutritional state reflected by NPS levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, NPS was found to be an independent predictor of these clinical outcomes.

Value of ATRIA stroke risk score in predicting atrial high-rate episodes: A comparison of six different risk scores.

OBJECTIVES: Atrial high-rate episodes (AHRE) are asymptomatic atrial tachy-arrhythmias detected through continuous monitoring with a cardiac implantable electronic device (CIED). AHRE's have been associated with increased risks of developing clinically manifested atrial fibrillation (AF), thromboembolism, cardiovascular events, and mortality. Several variables has been researched and identified to predict AHRE development. The aim of this study, which compared the six frequently-used scoring systems for thromboembolic risk in AF (CHA2 DS2 -VASc, mC2 HEST, HAT2 CH2 , R2 -CHADS2 , R2 -CHA2 DS2 -VASc, and ATRIA) in terms of their prognostic power in predicting AHRE. MATERIALS AND METHODS: This retrospective study included 174 patients with CIED's. The study population was divided into two groups according to presence of AHRE: patients with AHRE (+) and patients without AHRE (-). Thereafter, patients baseline characteristics and scoring systems were analyzed for prediction of AHRE. RESULTS: The distribution of patients' baseline characteristics and scoring systems according to presence of AHRE was evaluated. Furthermore, ROC curve analyses of the stroke risk scoring systems have been investigated in terms of predicting the development of AHREs. ATRIA, which predicted AHRE with a specificity of 92% and sensitivity of 37.5% for ATRIA values of >6, performed better than other scoring systems in predicting AHRE (AUC: 0.700, 0.626-0.767 95% confidence interval (CI), p = .004) CONCLUSION: AHRE is common in patients with a CIED. In this context, several risk scoring systems have been used to predict the development of AHRE in patients with a CIED. This study's findings revealed that The ATRIA stroke risk scoring system performed better than other commonly used risk scoring systems in predicting AHRE.

Assessment of the efficacy of the electrocardiographic P-wave peak time in predicting atrial high rate episode in patients with cardiac implantable electronic devices.

INTRODUCTION & OBJECTIVE: The incidence of atrial high-rate episode (AHRE) is high among patients with cardiac implantable electronic devices (CIEDs). In this context, the objective of this study is to evaluate the efficacies of P-wave indices (PWIs) obtained from the surface electrocardiography (ECG) in predicting future AHRE development. MATERIAL & METHOD: The study sample consisted of 158 patients with CIEDs. The study group was divided into two subgroups according to the presence of AHRE during device interrogation. PWIs were calculated using the surface ECG. RESULTS: There was no significant difference between the groups in the P-wave indices (PWIs), i.e., minimum P-wave duration (PWDmin), maximum P-wave duration (PWDmax) and P-wave dispersion (PWDIS). On the other hand, P-wave peak time in V1 lead (PWTV1) and P-wave peak time in D2 lead (PWPTD2) were significantly higher in the AHRE group than in the non-AHRE group. CONCLUSION: The study findings revealed that novel ECG parameters PWPTV1 and PWPTD2 had high prognostic value in predicting patients likely to develop AHRE.

Association between international index of erectile function-5 scores and circadian patterns of newly diagnosed hypertension in erectile dysfunction patients.

By the beginning of this study in 2019, it was known that hypertension is a risk factor for erectile dysfunction, and also, there are circadian changes that occur in blood pressure. Further, non-dipping hypertension is known to be linked to poor cardiac outcomes and erectile functions, so the research described in this article was initiated with an aim to explore the potential relationship between erectile dysfunction and circadian patterns of newly diagnosed hypertension. Between April 2019 and May 2022, 583 patients aged 30-70 years were diagnosed with erectile dysfunction (ED) in our outpatient clinic. Applying our exclusion criteria to 583 patients, a group of 371 patients left with us; these patients were referred to the cardiology clinic for hypertension evaluation with consecutive ambulatory blood pressure monitoring (ABPM). Data were collected for the study prospectively. Of the 371 patients evaluated with ABPM, 125 had newly diagnosed hypertension (mean BP ≥135/85 mmHg in ABPM). These patients were divided into two groups according to the pattern of hypertension identified in ABPM: dippers (Group D) and non-dippers (Group ND). They were then compared using clinical and laboratory findings, including erectile function scores. While the number of patients in the ND group was 83, the number in the D group was 42. In the ND group, the mean age was higher (59 ± 10 vs. 54 ± 12, p = 0.0024). IIEF-5 (international index of erectile function) scores were determined to be significantly lower in the ND group (14.4 ± 4.9 vs. 11.5 ± 4.6, p = 0.001). Also, serum creatinine levels were higher in Group ND than in D (0.96 ± 0.12 vs. 1 ± 0.15, p = 0.001). In our multivariate analysis, IIEF-5 scores (OR: 0.880, 95% CI: 0.811-0.955; p = 0.002) and serum creatinine levels (OR: 1027, 95% CI: 1003-1052; p = 0.025) were found to be independent risk factors of non-dipper HT. The cut-off value of the IIEF-5 score for non-dipper HT in a ROC curve analysis was 13.5 with 64.3% sensitivity and 66.1% specificity (area under curve value: 0.673 [95% CI: 0.573-0.772, p < 0.001]). This study showed that, in patients with ED, the non-dipper pattern was associated with poorer erectile function when HT was newly diagnosed. We also found that the severity of erectile dysfunction is an independent marker for non-dipper HT.

The C-Reactive Protein to Albumin Ratio Predicts Acute Kidney Injury in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

BACKGROUND: The relationship between acute kidney injury (AKI) and C-reactive protein (CRP) and albumin has been previously demonstrated in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). However, to our knowledge, CRP to albumin ratio (CAR), a newly introduced inflammation-based risk score, has not yet been studied. In this study, we aimed to investigate the possible relationship between the CAR and AKI. METHOD: A total of 815 consecutive STEMI patients treated with pPCI were reviewed. RESULTS: One hundred ten 110 (13.5%) patients developed AKI in the study population. The subjects were divided into two groups according to AKI development. The in-hospital mortality rate was higher in patients with AKI than those without AKI (15.5% vs. 1.3%; p<0.001). The patients with AKI had significantly higher mean value of CRP and CAR (0.29 [0.16-0.50] vs. 0.55 [0.37-1.05]; p<0.001) and lower mean levels of albumin than those without AKI. Age, diabetes mellitus, haematocrit, left ventricular ejection fraction, hypotension, and CAR (Odds ratio [OR]2.307, 95% confidence interval [CI] 1.397-3.809, p=0.001) were independent predictors of AKI. CONCLUSION: The CAR may be a useful inflammation-based risk score to predict AKI development in STEMI patients treated with pPCI.

Usefulness of The C-Reactive Protein/Albumin Ratio for Predicting No-Reflow in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: The ratio of serum C-reactive protein (CRP) to albumin has been proven to be a more accurate indicator than albumin and CRP levels alone in determining the prognosis of patients with cancer and critical illness. The aim of this study was to determine whether the CRP/albumin ratio (CAR) can be linked to imperfect reperfusion that can worsen the prognosis of ST-elevation myocardial infarction (STEMI) in patients treated with primary percutaneous coronary intervention (pPCI). MATERIALS AND METHODS: A total of 1217 consecutive STEMI patients who achieved epicardial vessel patency with pPCI were recruited to this study. RESULTS: The study population was divided into 2 groups: reflow (n = 874) and no-reflow (NR) (n = 343) groups. The white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR) and CAR (0.03 [0.01-0.04] vs 0.06 [0.03-0.12] (P < .001) were significantly higher in the NR group than in the reflow group, and these factors were found to be independent predictors of NR development. The best cut-off value of CAR predicting NR was 0.59 with a sensitivity of 54.7% and specificity of 86.7. The predictive power of CAR surpassed that of CRP, albumin, WBC count and NLR in the receiver operator curve (ROC) curve comparison. CONCLUSION: No-reflow can be predicted by systemic inflammation markers including WBC count, NLR and CAR measured from the blood sample obtained on admission. CAR has a higher clinical value than CRP, albumin level, WBC count and NLR in NR prediction.

Propensity score matching analysis of the impact of Syntax score and Syntax score II on new onset atrial fibrillation development in patients with ST segment elevation myocardial infarction.

BACKGROUND: New-onset atrial fibrillation (NOAF) is a common complication in the setting of ST segment elevation myocardial infarction (STEMI), and worsened short/long-term prognosis. Several clinical parameters have already been associated with NOAF development. However, relationship between NOAF and coronary artery disease (CAD) severity in STEMI patients is unclear. This study evaluates the relationship between NOAF and CAD severity using Syntax score (SS) and Syntax score II (SSII) in STEMI patients who were treated with primary percutaneous coronary intervention (pPCI). METHOD: We enrolled 1,565 consecutive STEMI patients who were treated with pPCI. Patients with NOAF were compared to patients without NOAF in the entire study population and in a matched population defined by propensity score matching. RESULTS: Patients with NOAF had significantly higher SS and SSII than those without, both in the matched population (18.6 ± 4 vs 16.75 ± 3.6; p < .001 and 42 ± 13.4 vs 35.1 ± 13.1; p < .001, respectively), and in all study population (18.6 ± 4 vs 16.5 ± 4.6; p < .001 and 42 ± 13.3 vs 31.5 ± 11.9; p < .001 respectively). SSII, compared to its components, was the only independent predictor of NOAF (OR: 1,041 95% CI: 1.015-1.068; p = .002). In the long-term follow-up, all-cause long-term mortality was significantly higher in patients with NOAF than those without NOAF (23.3% vs. 11%; p = .032). CONCLUSION: This is the first study to comprehensively examine the relationship between NOAF development and CAD severity using SS and SSII. We demonstrated that, in STEMI patients, high SSII was significantly related to NOAF and was an independent predictor of NOAF. Furthermore, patients with NOAF were associated with poor prognosis.

Diagnostic value of QRS and S wave variation in patients with suspicion of acute pulmonary embolism.

BACKGROUND: This study aimed to investigate the diagnostic value of QRS and S wave variation in patients admitted to the emergency department with suspicion of acute pulmonary embolism (APE). METHOD: Computerized tomographic pulmonary angiography (CTPA) was performed in 118 consecutive patients to evaluate patients with suspected APE, and 106 subjects with appropriate electrocardiogram and CT images constituted the study population. RESULTS: Using CTPA, APE was diagnosed in 48.1% (n:51) of the study population. The comparison of patients with APE and those without APE revealed that increased heart rate, right axis deviation of QRS axis, complete or incomplete right bundle branch block, prominent S wave in lead D1, increased QRS duration, percentage of QRS (9,8[4,8-19,0] vs 3,8[2,7-71]; p<0,001), S wave variation (22,3[9,6-31,9] vs 4,8 [2-8]; p<0,001) and ΔS wave amplitude (1.1[0.5-1.5] vs 0.2[0.1-0.5]; p<0.001) were significantly associated with APE, but no relationship was detected with respect to the presence of atrial arrhythmias, clockwise rotation of the horizontal axis, fragmentation, ST segment deviation, T wave inversion, and S1Q3T3 and S1S2S3 patterns. The percentage of S wave variation (OR: 1072 per 1% increase, 95% CI:1011-1137) was found to be an independent predictor of APE. ΔS wave amplitude>0.5mm predicted APE with a sensitivity of 72.6% and a specificity of 74.6% (AUC:0.805, 95% CI: 0.717-0.876; p<0.001). CONCLUSION: The present study demonstrated that QRS and S wave variation could be useful electrocardiographic signs for the diagnosis of APE.

Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris.

BACKGROUND: Syntax score (SS), which is an angiographic tool used in grading the complexity of coronary artery disease (CAD), has prognostic importance in coronary artery disease (CAD) and provides important information regarding selection of revascularization strategy. C-reactive protein (CRP) and albumin are indicators of inflammation, and high levels of them are associated with high SS. We aimed to investigate whether baseline CRP to albumin ratio C-Reactive Protein/Albumin Ratio (CAR), an easily available and novel inflammatory marker, is associated with SS. METHOD: A total 403 consecutive patients with stabile angina pectoris, who underwent coronary angiography for suspected CAD from January 2015 to June 2016, were classified into two groups, low SS (≤22) and intermediate-high SS (>22). RESULTS: C-Reactive Protein/Albumin Ratio was significantly higher in patients with intermediate-high SS group (P < .001). In multivariate regression analysis, CAR remained an independent predictor of intermediate-high SS group together with hypertension and LDL. The predictive performance of CAR, CRP, and albumin was compared by ROC curve analysis. CAR surpassed CRP and albumin in predicting intermediate-high SS group. CAR >6.3 predicted an intermediate-high SS with sensitivity and specificity of 86.8% and 43.4%, respectively. CONCLUSION: C-Reactive Protein/Albumin Ratio was more tightly associated with the complexity and severity of CAD than CRP and albumin alone and was found to be an independent predictor for intermediate-high SS group.

Association between BNP levels and new-onset atrial fibrillation : A propensity score approach.

BACKGROUND: New-onset atrial fibrillation (NOAF), a common complication of acute ST-segment elevation myocardial infarction (STEMI), is associated with a poor prognosis. Several clinical and laboratory parameters are reported to be associated with NOAF in patients with STEMI. The aim of the present study was to evaluate the predictive value of plasma B­type natriuretic peptide (BNP) levels for NOAF development and long-term prognosis in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). PATIENTS AND METHODS: We retrospectively enrolled 1,928 patients with STEMI who underwent pPCI. After applying exclusion criteria, 1,057 patients were retained in the final study population. Patients with NOAF were compared with patients without NOAF in the entire study population and in a matched group. RESULTS: Patients with NOAF had a significantly higher average plasma BNP level (161 pg/ml, range: 72.3-432) than patients without NOAF in the study population (70.7 pg/ml, range: 70-129; p < 0.001) and in the matched group (104.6 pg/ml, range: 47.2-234.5; p = 0.014). Furthermore, the plasma BNP level was found to be an independent predictor of NOAF development (odds ratio [OR]: 1.003; 95% confidence interval [CI]: 1.000-1.005; p = 0.034) and mortality in the long-term follow-up (OR: 1.004; 95% CI: 1.002-1.006; p < 0.001). CONCLUSION: The present study found that a high plasma BNP level was significantly associated with NOAF development in STEMI patients, and was an independent predictor of NOAF development and all-cause mortality during long-term follow-up, regardless of other NOAF risk factors.

The association between electrocardiographic R wave peak time and coronary artery disease severity in patients with non-ST segment elevation myocardial infarction and unstable angina pectoris.

BACKGROUND: We aimed to evaluate possible association between QRS duration (QRSD), R wave peak time (RWPT), and coronary artery disease severity identified using the SYNTAX score (SS) in patients with unstable angina pectoris (USAP) or non-ST segment elevation myocardial infarction (NSTEMI). METHOD: A total of 176 USAP/NSTEMI patients were enrolled in the study. RESULTS: The high SS group (>22, n:45) patients had a higher prevalence of diabetes mellitus (DM); presence of ST segment depression ≥0.5 mm and 1 mm; ST segment elevation in the AVR lead (AVRSTE); longer QRSD and RWPT; and lower left ventricular ejection fraction (LVEF) than the low SS group (≤22, n: 131). The LVEF, AVRSTE, and RWPT (OR: 1.035, 95% CI: 1.003-1.067; p = 0.030) were independent predictors of high SS. CONCLUSION: The present study demonstrated that RWPT and AVRSTE could be used as predictors of high SS.

The Association between Monocyte HDL-C Ratio and SYNTAX Score and SYNTAX Score II in STEMI Patients Treated with Primary PCI.

BACKGROUND: Monocyte to high-density-lipoprotein cholesterol ratio (MHR) simply reflects proatherogenic and antiatherogenic balance and high level of this ratio is associated with severity of coronary atherosclerosis and cardiac events. We investigated the association between MHR and coronary artery disease severity using SYNTAX score and SYNTAX score II (SSII) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). METHODS: A total of 315 consecutive patients with STEMI who underwent pPCI from January 2014 to January 2016 were enrolled. After exclusion 264 patients remained in the study population. Patients were divided into 2 groups according to median SSII [SSII ≤ 34.2 as low group (n = 132) and > 34.2 as high group (n = 132)]. RESULTS: Median value of MHR was 10.5 in SSII low group and 16.1 in SSII high group (p < 0.001). There was a strong correlation between MHR and SSII (r = 0.580, p < 0.001). Diabetes mellitus [odds ratio (OR): 8.604; 95% confidence interval (CI): 2.469-29.978], glomerular filtration rate (OR: 0.961; 95% CI: 0.939-0.983), infarct related artery of left anterior descending (LAD) (OR: 7.325; 95% CI: 2.262-23.723), SYNTAX score (OR: 1.422; 95% CI: 1.275-1.585), neutrophil to lymphocyte ratio (NLR) (OR: 1.156; 95% CI: 1.058-1.264) and MHR (OR: 1.027; 95% CI: 1.013-1.041) were independent predictors of SSII > 34.2 in multivariate analysis. CONCLUSIONS: MHR could be a better parameter than NLR and C-reactive protein at predicting severity of coronary artery disease in STEMI patients treated with pPCI.

P wave peak time; a novel electrocardiographic parameter in the assessment of coronary no-reflow.

OBJECTIVES: Coronary no-reflow (NR) following primary percutaneous coronary intervention (pPCI) is associated with worsened prognosis in patients with ST segment elevation myocardial infarction (STEMI). Despite rapid developments in cardiovascular area; there are limited data regarding prediction of NR before pPCI. P wave duration and dispersion (PWD, PWDIS, respectively) have been studied in STEMI patients and found to be associated with reperfusion success; however none of them has been found to predict NR before PCI. In our study we aimed to evaluate whether PWD, PWDIS and a novel parameter P wave peak time (PWPT) could predict NR development in STEMI patients. METHOD: Fifty six patients who were admitted with anterior STEMI constituted study populations. The diagnosis and treatment of STEMI was made on the basis of current guidelines. P wave parameters including PWD, PWDIS and PWPT were calculated from electrocardiograms that were obtained on admission and 60 min after pPCI. RESULTS: Patients were divided into two groups according to the development of NR. We observed that PWPT that were obtained from D2 (PWPTD2) and V1 (PWPTV1) leads were longer in NR group than reflow group. There were significant correlations between PWPT and reperfusion parameters regarding percent of ST segment resolution, peak CKMB level and TIMI frame count of infarct related artery. Preprocedural PWPTD2 was found to be an independent predictor of NR development. CONCLUSION: In our study we observed that PWPT could be a useful parameter in the assessment of reperfusion success and prediction of NR development.

The impact of the right heart cavities echocardiographic features on atrial-high rate episodes.

Atrial high-rate episodes (AHRE) defined as atrial tachy-arrhythmias, detected through continuous monitoring with a cardiac implantable electronic device (CIED). AHRE's have been associated with increased risks of developing clinically manifested atrial fibrillation, thromboembolism, cardiovascular events, and mortality. Several variables have been researched and identified to predict AHRE existence. The present study evaluated the association between right-heart structural and functional echocardiographic parameters and AHRE in patients with CIEDs and impaired LVEF. This prospective design study included 194 patients with CIED's. The study population was divided into two groups according to presence of AHRE and analyzed the echocardiographic variables which may able to be a predictor of AHRE. Patients was divided into two groups: patients with AHRE (+) and without AHRE (-). The distribution of patients' characteristics according to presence of AHRE was analyzed. The multivariate analysis revealed Age, LAVI, E/Em tricuspid (HR: 1.106, 1.015-1.205% 95 CI; p = 0.022) and RAVI (HR: 1.035, 1.003-1.069 95% CI; p = 0.033) as independent predictors of AHREs. ROC curve analysis indicated that an E/Em tricuspid (AUC: 0.611, 95% CI 0.538-0.680 p: 0.009) and RAVI (AUC = AUC: 0.707, 95% CI 0.637-0.770 p < 0.001) predicted AHREs with a cut-off value of 6.28 and a sensitivity of 53.2% and specificity of 66.7% and a cut-off value of 29.5 mL/m2 with a sensitivity of 72.7% and a specificity of 65.9%, respectively. The main finding of this study was "RAVI" and "E/Emtricuspid ratio" is associated with AHRE. Additionally, "RAVI" and "E/Emtricuspid ratio" is an independent predictor of AHRE existence.

The Importance of Nitric Oxide and Oxidative Stress in Atrial High-Rate Episodes in Patients with Cardiac Devices.

OBJECTIVE: Atrial High Rate Episodes (AHRE) are subclinical atrial tachyarrhythmias detectable by cardiac implantable electronic devices (CIEDs). AHREs have been associated with an increased risk of developing atrial fibrillation (AF), thromboembolism, cardiovascular and cerebrovascular events, and mortality. Although recent studies have assessed the value of oxidative stress markers in patients with AF, the relationships between AHRE and oxidative stress markers, including nitric oxide, has not yet been elucidated. This study aims to investigate the relationship between these markers and AHRE. METHOD: This prospective, cross-sectional study comprised 180 patients with CIEDs. The study population was divided into two groups based on the presence (n = 78) and absense (n = 102) of AHRE to analyze its association with biomarkers. RESULTS: The AHRE (+) group was significantly older, had a higher prevalence of hypertension, higher NT-proBNP (508.8 ± 249 pg/mL vs. 415.3 ± 292.1; P = 0.037), MDA levels (20.9 ± 4.1 µmol/L vs. 19.1 ± 3.1 µmol/L; P = 0.006), and iNOS activity (1,935.9 ± 326.1 pg/mL vs. 1,677.4 ± 363.2 pg/mL; P < 0.001). Logistic regression analysis identified age, hypertension, MDA (odds ratio [OR]: 1.131, 95%CI: 1.009 - 1.268, P = 0.035), inducible nitric oxide synthase (iNOS) activity (OR = 1.002, 95% CI = 1.001 - 1.003, P < 0.001), and endothelial nitric oxide synthase (eNOS) activity (OR = 0.990, 95% CI = 0.986 - 0.984, P < 0.001) as independent predictors of AHRE. CONCLUSION: The study findings indicated that plasma levels of NT-proBNP, MDA, nitric oxide, and the expression of iNOS and eNOS were significantly associated with AHRE. Moreover, elevated plasma MDA concentrations, increased iNOS activity, and decreased eNOS activity were identified as independent predictors of AHRE.

The prognostic value of the MAGGIC risk score in patients with acute pulmonary embolism.

OBJECTIVES: Acute pulmonary embolism (PE) is a potentially life-threatening condition characterized by the sudden blockage of the pulmonary arteries. Although the MAGGIC risk score has emerged as a valuable tool in predicting outcomes in patients with chronic heart failure, it has also been demonstrated and identified as a prognostic model in various cardiac diseases other than heart failure. In this study, we aimed to investigate the relationship between MAGGIC score and adverse outcomes in patients with PE. MATERIALS AND METHODS: A total of 302 consecutive patients diagnosed with acute PE were retrospectively included in the present study. For each patient, the MAGGIC score was calculated. The study population was divided into two groups according to the median value of MAGGIC score. RESULTS: Patients with high MAGGIC score had a significantly higher proportion of elderly and female individuals, lower BMI, higher presence of CAD, DM, AFib, HF, HT, CKD, COPD, and ACEI/ARB and NOAC usage. Logistic regression analyses was carried out using univariate and multivariate analysis to predict the in-hospital and 30-day mortality predictors in the included PE patients. For in-hospital mortality, diastolic blood pressure, heart rate, RV dilatation, and the MAGGIC score (HR: 1.166, 95 % CI 1.077-1.263, p < 0.001) and for short-term mortality, sPESI and the MAGGIC score (HR: 1.925, 95 % CI 1.243-2.983, p:0.003) were found to be independent predictors for adverse outcomes in patients with acute PE. CONCLUSION: Our study demonstrates that the MAGGIC score can be applied as a valuable prognostic tool for acute pulmonary embolism.

The Relationship between the Systemic Immune-Inflammation Index and Ischemia with Non-Obstructive Coronary Arteries in Patients Undergoing Coronary Angiography. / A Relação entre o Índice de Imuno-Inflamação Sistêmica e Isquemia com Artérias Coronárias Não Obstrutivas em Pacientes Submetidos à Angiografia Coronária.

BACKGROUND: Ischemia with the non-obstructive coronary artery (INOCA) is an ischemic heart disease that mostly includes coronary microvascular dysfunction and/or epicardial coronary vasospasm due to underlying coronary vascular dysfunction and can be seen more commonly in female patients. The systemic immune-inflammation index (SII, platelet × neutrophil/lymphocyte ratio) is a new marker that predicts adverse clinical outcomes in coronary artery disease (CAD). OBJECTIVE: This study aims to investigate the relationship between INOCA and SII, a new marker associated with inflammation. METHODS: A total of 424 patients (212 patients with INOCA and 212 normal controls) were included in the study. Peripheral venous blood samples were received from the entire study population prior to coronary angiography to measure SII and other hematological parameters. In our study, the value of p<0.05' was considered statistically significant. RESULTS: The optimal cut-off value of SII for predicting INOCA was 153.8 with a sensitivity of 44.8% and a specificity of 78.77% (Area under the curve [AUC]: 0.651 [95% CI: 0.603-0.696, p=0.0265]). Their ROC curves were compared to assess whether SII had an additional predictive value over components. The AUC value of SII was found to be significantly higher than that of lymphocyte (AUC: 0.607 [95% CI: 0.559-0.654, p = 0.0273]), neutrophil (AUC: 0.559 [95%CI: 0.511-0.607, p=0.028]) and platelet (AUC: 0.590 [95% CI: 0.541-0.637, p = 0.0276]) in INOCA patients. CONCLUSIONS: A high SII level was found to be independently associated with the existence of INOCA. The SII value can be used as an indicator to add to the traditional expensive methods commonly used in INOCA prediction.

FUNDAMENTO: A isquemia com artéria coronária não obstrutiva (INOCA) é uma doença cardíaca isquêmica que inclui principalmente disfunção microvascular coronariana e/ou vasoespasmo coronariano epicárdico devido à disfunção vascular coronariana subjacente e pode ser observada mais comumente em pacientes do sexo feminino. O índice de inflamação imunológica sistêmica (SII, relação plaquetas × neutrófilos/linfócitos) é um novo marcador que prediz resultados clínicos adversos na doença arterial coronariana (DAC). OBJETIVO: Este estudo tem como objetivo investigar a relação entre INOCA e SII, um novo marcador associado à inflamação. MÉTODOS: Um total de 424 pacientes (212 pacientes com INOCA e 212 controles normais) foram incluídos no estudo. Amostras de sangue venoso periférico foram recebidas de toda a população do estudo antes da angiografia coronária para medir o SII e outros parâmetros hematológicos. Em nosso estudo o valor de p<0,05' foi considerado estatisticamente significativo. RESULTADOS: O valor de corte ideal do SII para prever o INOCA foi 153,8, com sensibilidade de 44,8% e especificidade de 78,77% (Área sob a curva [AUC]: 0,651 [IC 95%: 0,603­0,696, p=0,0265]). Suas curvas ROC foram comparadas para avaliar se o SII tinha um efeito preditivo adicional valor sobre os componentes. O valor da AUC do SII foi significativamente maior do que o do linfócito (AUC: 0,607 [IC 95%: 0,559­0,654, p = 0,0273]), neutrófilos (AUC: 0,559 [IC 95%: 0,511­0,607, p = 0,028]) e plaquetas (AUC: 0,590 [IC 95%: 0,541­0,637, p = 0,0276]) em pacientes INOCA. CONCLUSÕES: Verificou-se que um nível elevado de SII estava independentemente associado à existência de INOCA. O valor do SII pode ser usado como um indicador para adicionar aos métodos tradicionais e caros comumente usados na previsão do INOCA.

The relationship between the systemic immune-inflammation index and reverse-dipper circadian pattern in newly diagnosed hypertensive patients.

Although hypertension is considered high intravascular pressure, impairing circadian blood pressure (BP) has been shown to potentially contribute to poor clinical outcomes. Systemic immune-inflammation index (SII), based on platelet, neutrophil, and lymphocyte counts, has been established as a strong prognostic marker in cardiovascular disease. The role of inflammation in the pathogenesis of hypertension is a well-known issue and inflammatory markers are associated with BP variability. We aimed to investigate whether there is a relationship between circadian BP changes and SII in newly diagnosed hypertensive patients. The study population consisted of 196 newly diagnosed hypertensive patients without LVH. In total, 76 (38%) patients had a dipper BP pattern, 60 (31%) patients had a non-dipper BP pattern, and 60 (31%) patients had a reverse-dipper BP pattern. SII was calculated according to Multivariate logistic regression analysis revealed SII and HDL-C as an independent predictors of reverse-dipper circadian pattern in newly diagnosed hypertensive patients. The cut-off value of the SII for reverse-dipper hypertension in a ROC curve analysis was >639.73 with 63.3% sensitivity and 84.2% specificity. Our study showed that the SII level was higher in the reverse-dipper hypertension patient group than in the dipper and non-dipper hypertension groups. Furthermore, SII was an independent predictor of newly diagnosed reverse-dipper hypertensive patients. The high SII value in newly diagnosed hypertensive patients can be used as an early warning parameter to identify reverse-dipper hypertension patients.

Assessment of the relationship between C-reactive protein to albumin ratio and late-term mortality in patients with acute pulmonary embolism.

OBJECTIVE: In recent years, an increasing number of evidences suggests that inflammation plays a significant role in the pathophysiology of pulmonary embolism. Although the association between inflammatory markers and pulmonary embolism prognosis has been previously reported, no studies have investigated the ability of the C-reactive protein/albumin ratio, defined as an inflammation-based prognostic score, to predict death in patients experiencing a pulmonary embolism. MATERIALS AND METHODS: This retrospective study included 223 patients experiencing a pulmonary embolism. The study population was divided into two groups according to their C-reactive protein/albumin ratio values and analyzed whether the C-reactive protein/albumin ratio was an independent predictor of late-term mortality. Then, the performance of the C-reactive protein/albumin ratio in predicting patients' outcomes was further compared with its components. RESULTS: Out of 223 patients, death was observed in 57 patients (25.60%) during an average follow-up of 18 months (range: 8-26). The average C-reactive protein/albumin ratio was 0.12 (0.06-0.44). The group with a higher C-reactive protein/albumin ratio was older and had a higher troponin level and simplified Pulmonary Embolism Severity Index score. Independent predictors of late-term mortality were found to be C-reactive protein/albumin ratio (hazard ratio: 1.594, 95% CI: 1.003-2.009; p < 0.001), cardiopulmonary disease, simplified Pulmonary Embolism Severity Index score and fibrinolytic therapy. Receiver operating characteristic curve comparisons for both 30-day and late-term mortality demonstrated that the C-reactive protein/albumin ratio was a better predictor than both albumin and C-reactive protein, separately. CONCLUSION: The present study revealed that the C-reactive protein/albumin ratio is an independent predictor of both 30-day and late-term mortality in patients experiencing a pulmonary embolism. As a marker that can be easily obtained, and calculated, and does not require additional costs C-reactive protein/albumin ratio can be an effective parameter used for prognosis estimation of pulmonary embolism.

Evaluation of cardiac electromechanics in patients with newly diagnosed hypertension.

OBJECTIVES: This study aimed to investigate the relationship between subclinical left ventricular (LV) systolic dysfunction and ECG parameters in newly diagnosed hypertension patients. METHODS: In this cross-sectional study, adults diagnosed with hypertension based on 24-h ambulatory blood pressure monitor recordings were included. The patients were classified into two groups based on the presence of subclinical LV systolic dysfunction according to LV global longitudinal strain (LVGLS). Findings were compared between the two groups. RESULTS: A total of 244 patients (female, 55.7%) were included. Based on LVGLS, 82 (33.6%) patients had subclinical LV systolic dysfunction. The proportion of early repolarization pattern (ERP) on ECG was significantly higher in patients with subclinical LV systolic dysfunction than in patients with normal LV systolic function [24 (28.6%) vs. 8 (5%), P < 0.001]. PR and corrected QT intervals were also significantly longer in patients with subclinical LV systolic dysfunction than in patients with normal LV systolic function [median (interquartile range), 148 (132-158) vs. 141 (127-152), P = 0.036 and 443 (427-459) vs. 431 (411-455), P = 0.007, respectively]. According to multivariate regression analysis ERP, early (E) wave velocity/late (A) wave velocity (E/A), and LV mass index were independently associated with subclinical LV systolic dysfunction. CONCLUSION: In newly diagnosed hypertension patients, the ERP on admission ECG could be a sign of subclinical systolic dysfunction.