Prognostic value of R wave peak time in COVID-19 pneumonia.

BACKGROUND: R wave peak time (RWPT) is also known as intrinsicoid deflection time or ventricular activation time. It shows the conduction time from the endocardium in the ventricle to the epicardium. It provides diagnostic and prognostic information for many cardiovascular diseases, such as RWPT prolongation, left ventricular hypertrophy, volume overload, conduction system abnormalities, and myocardial ischemia. Objectives The aim of this study is to investigate the relationship between COVID-19 mortality and RWPT in superficial ECG. METHODS: This study retrospectively examined 640 patients diagnosed with COVID-19 and treated in an intensive care unit at a single center between January 2021 and June 2022. All patients included in the study had clinical and radiological characteristics and signs of COVID-19 pneumonia. RESULTS: 640 patients included in the study were divided into 2 groups: surviving and deceased. There were 510 patients in the surviving group and 130 patients in the deceased group. The deceased group was found to be significantly older. The number of patients with COPD was higher in the deceased group. Troponin, lactate dehydrogenase (LDH), C-reactive protein (CRP), D-dimer and T-peak to T-end interval(Tpe) and RWPT were found to be significantly increased in the deceased group. In binary logistic regression analysis; age, COPD, LDH, CRP, troponin, D-dimer, Tpe interval, RWPT were determined as independent risk factors for mortality. CONCLUSIONS: Prolonged RWPT is useful in risk stratification for COVID-19 pneumonia mortality.

The Prognostic Value of Vertebral Bone Density on Chest CT in Hospitalized COVID-19 Patients.

The aim of this study is to evaluate the prognostic value of the vertebral bone mineral density (BMD) on chest computed tomography (CT) in COVID-19 patients. The chest CT of hospitalized patients with COVID-19 pneumonia were evaluated for Pneumonia Severity Score (PSS) as the ratio of the volume of involved lung parenchyma to the total lung volume. In addition, BMD was manually measured from the vertebral corpus using axial CT images. The relationships of clinical variables, PSS and vertebral BMD with patient outcomes, namely mortality, intensive care unit (ICU) admission and mechanical ventilation were investigated. Lower BMD was defined as ≤100 HU. The study included 209 patients (118 males, 56.4%). As a result of the univariate analysis, the rates of mortality, ICU admission and mechanical ventilation were 17.2% (n = 36), 24.8% (n = 52), and 20.6% (n = 43), respectively, and they were significantly higher among the patients with lower BMD (38.1 vs 13.0%, p < 0.001; 33.4 vs 21.2%, p = 0.002; and 38.1 vs 8.2%, p < 0.001, respectively). In the mortality group, PSS was significantly higher (median, 9 vs 5; p < 0.001) and vertebral BMD was significantly lower (median, 83 vs 139; p < 0.001). Severe clinical incidence was significantly higher in patients with lower BMD compared to those with higher BMD (39.7 vs 24.7% and p = 0.028). There was a significant correlation between clinical classification and lower BMD (r = 0.152 and p = 0.028). The multivariate analysis revealed vertebral BMD [odds ratio (OR), 1.028; 95% CI, 1.011-1.045, p = 0.001) and lower BMD (OR, 4.682; 95% CI, 1.784-12.287, p = 0.002) as significant independent predictors of mortality. Vertebral BMD is a strong independent predictor of mortality that is reproducible and can be easily evaluated on the chest CT images of COVID-19 patients.

Impaired left ventricular global longitudinal strain improves with radiofrequency catheter ablation in patients with PVC-induced cardiomyopathy.

BACKGROUND: In our study, we aimed to evaluate left ventricular global longitudinal strain (LV-GLS) value in patients with premature ventricular contractions (PVCs) and reduced LV ejection fraction (LVEF) and to determine the effect of radiofrequency catheter ablation (RFA) procedure on LV-GLS. METHODS: In this cross-sectional study, 150 patients who underwent three-dimensional RFA with the diagnosis of PVCs were included. LV-GLS was measured with strain echocardiography in all patients before RFA and in the sixth-month control. Patients included in the study were grouped as LVEF <50% (Group I) and LVEF ≥50% (Group II) according to baseline LVEF, and patients within Group I were grouped as LVEF <50% (Group A) and LVEF ≥50% (Group B) according to the sixth-month LVEF. RESULTS: There were 39 patients (26%) with baseline LVEF <50%. In 14 (36%) of these patients, LVEF <50% was observed to continue during the sixth-month controls. Both the baseline and sixth-month LV-GLS values were significantly lower in Group I patients (<0.01). RFA treatment significantly increased both LVEF and LV-GLS (<0.01). It was found that age, N-terminal pro-brain natriuretic peptide, LV diameters, and baseline LVEF were higher, and baseline LV-GLS level was lower in Group A patients (P < .01). Baseline LVEF and LV-GLS values were found to independently determine the patients in Group A (P < .01). In receiver operator characteristic analysis, when the limit value is accepted as 40% for baseline LVEF and 18% for baseline LV-GLS, it can determine Group A with acceptable sensitivity and specificity. CONCLUSIONS: LV-GLS decreases significantly in patients with reduced LVEF and PVCs. In these patients, RFA treatment significantly increases both LVEF and LV-GLS.

Morning blood pressure surge increases in patients with hypertensive primary hyperparathyroidism and is independently associated with serum calcium level.

Introduction: There is not enough data on the effects of primary hyperparathyroidism (pHPT) on morning blood pressure surge (MBPS) in the literature. We aimed to determine whether there was any change in MBPS value in patients with hypertensive pHPT and to determine the parameters related to MBPS.Method: 80 patients with newly diagnosed pHPT with hypertension (HT) and 80 controls with newly diagnosed hypertension were included. Routine laboratory examinations and ambulatory blood pressure monitoring (ABPM) were performed in all patients.Results: In patients with pHPT, blood urea nitrogen (BUN), triglyceride, hs-CRP, uric acid, serum calcium (Ca), parathormone (PTH), daytime SBP and MBPS levels are higher than others (p < 0.05). Body mass index (BMI) and Ca level were independently associated with MBPS. In patients with MBPS ≥ 25 mmHg, BMI, BUN, creatinine, uric acid, Ca and PTH levels were found to be higher than others. BMI values and Ca levels determine the patients with MBPS ≥ 25 mmHg (p < 0.05) independently. According to this analysis, increase in BMI (for each 1 unit) and Ca level (for each 0.1 mg/dL) was found to increase the probability of MBPS ≥ 25 mmHg by 17.8% and 7.7%, respectively. When the cut-off value for Ca was taken as 10 mg/dL, the patients with MBPS ≥ 25 mmHg were determined with 73.5% sensitivity and 73.1% specificity.Conclusion: MBPS significantly increases in patients with newly diagnosed hypertensive pHPT. This increase in MBPS is closely associated with increased Ca levels. In patients with pHPT, lowering the Ca level below 10 mg/dL may have clinical implications.

Tp-e interval, Tp-e/QT and Tp-e/QTc ratio in hypertensive patients with primary aldosteronism.

Introduction: There is no study evaluating the Tp-e/QT and Tp-e/QTc ratios with T wave peak to end interval (Tp-e interval) used for evaluation of cardiac arrhythmia risk and ventricular repolarization changes in patients with primary aldosteronism (PA). We aimed to investigate whether there was a change in Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in patients with PA.Method: Thirty patients with newly diagnosed hypertension (HT) and PA and 30 patients with primary HT were included. Twelve-lead electrocardiography (ECG) was performed in all patients. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were measured in addition to routine measurements in ECG.Results: Sodium, potassium, and plasma renin activity (PRA) were significantly lower in patients with PA; systolic and diastolic blood pressure, plasma aldosterone, plasma aldosterone/PRA were significantly higher in patients with PA (p < .05 for each one). When ventricular repolarization parameters were examined; while QT and QTc interval were similar between two groups, Tp-e interval, Tp-e/QT and Tp-e/QTc ratio values were significantly higher in patients with PA (p < .05 for each one). Tp-e interval, Tp-e/QT and Tp-e/QTc ratio values were positively correlated with the serum calcium, aldosterone, and aldosterone/PRA levels and negatively correlated with serum sodium, potassium, renin levels (p < .05 for each one). In linear regression analyses, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were independently associated with the aldosterone/PRA ratio.Conclusion: Tp-e interval, Tp-e/QT and Tp-e/QTc were increased in hypertensive patients with PA and were independently associated with aldosterone/PRA levels. This may be related to the changing neuroendocrine state in patients with PA.

Serum Elabela Levels Are Elevated in Patients with Hyperthyroidism.

The apelinergic system plays an important role in the modulation of the cardiovascular system via the apelin peptide and the apelin receptor (APJ receptor). Apelin and elabela, also known toddler, are peptide ligands for the apelin receptor. These two peptides show similar biological actions, such as vasodilatation, increased myocardial contractility, angiogenesis, and energy metabolism. However, the serum levels of elabela in patients with hyperthyroidism are not well known. The aim of this study was to investigate the changes in serum elabela levels in patients with hyperthyroidism and its association with hypertension. This cross-sectional study included 74 patients with newly diagnosed hyperthyroidism due to Graves' disease and 20 healthy individuals. Serum elabela levels were measured by enzyme-linked immunosorbent assay. The patients were divided into two groups: hyperthyroid patients without hypertension (n = 51) and those with hypertension (n = 23). Basal heart rate, serum glucose and high-sensitive C reactive protein were significantly higher in hyperthyroid patients with and those without hypertension than in healthy controls (p < 0.05 for each). Serum elabela levels were significantly elevated in hyperthyroid patients compared with healthy controls, with higher serum elabela levels found in hyperthyroid patients with hypertension than those without hypertension. Linear regression analysis showed that serum elabela levels were correlated with systolic blood pressure (p < 0.001). In conclusion, serum elabela levels were significantly increased in patients with hyperthyroidism, especially in hyperthyroid patients with hypertension. Elevation in serum elabela levels may contribute to alleviation of cardiovascular complications of hyperthyroidism and hypertension.

A new approach to radiofrequency catheter ablation of premature ventricular contractions: The diurnal variation index.

BACKGROUND: Radiofrequency catheter ablation (RFA) is a frequently used method in the treatment of premature ventricular contractions (PVCs) resistant to drug therapy. RFA is recommended for patients with PVCs burden >10%. This study was aimed to investigate the presence of other parameters to enhance the indication of ablation in 24-hour rhythm Holter recordings. METHODS: 202 patients with >10% PVCs in 24-hour rhythm Holter recordings were included in the study between January 2015 and August 2019. Patients were divided into two groups. Radiofrequency ablation was performed in 163 patients but not in 39 patients. RESULTS: Laboratory findings were compared between two groups. Total cholesterol (p = 0.018), LDL cholesterol (p = 0.013) and triglyceride (p < 0.001) values were significantly higher in the RFA group, When the 24-hour rhythm Holter findings were compared, the diurnal variation index was significantly higher in the RFA group (p < 0.001). Triglyceride (OR: 1.013, 95% CI: 1.001-1.025, p = 0.032) and diurnal variation index (OR: 3.643, 95% CI: 1.440-9.216, p = 0.006) were determined as independent predictors in binominal logistic regression analysis. In the ROC analysis, when the cut-off value of the diurnal variation index was taken as 1.5, it was found that it could predict patients who undergo effective RFA with 76.7% sensitivity and 60% specificity. CONCLUSION: Diurnal variation index may be a useful parameter for RFA indication with PVC burden in 24-hour rhythm Holter recordings.

A new criterion to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia: Combined AVR criterion.

AIM: A combined aVR criterion is described as the presence of a pseudo r' wave in aVR during tachycardia in patients without r' wave in aVR in sinus rhythm and/or a ≥50% increase in r' wave amplitude compared to sinus rhythm in patients with r' wave in the basal aVR lead. We aimed to investigate the use of combined aVR criterion in differential diagnosis of atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). METHODS: In this prospective study, 480 patients with inducible narrow QRS supraventricular tachycardia (SVT) were included. Twelve-lead electrocardiogram (ECG) was conducted during tachycardia and sinus rhythm. The patients were divided into two groups according to the arrhythmia mechanism that determined via EPS, AVNRT, and AVRT. Criteria of narrow QRS complex tachycardia were compared between the two groups. RESULTS: AVNRT was present in 370 (77%) patients and AVRT in 110 (23%) patients. Combined aVR criterion was found to be more frequent in patients with AVNRT (84.1% and 9.1%, p < 0.001). In logistic regression analysis, combined aVR criterion and classical ECG criterion were found to be the most important predictors of AVNRT (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of the combined aVR criterion for AVNRT were 84.1%, 90.9%, 96.9%, and 62.9%, respectively. CONCLUSION: In the differential diagnosis of patients with SVT, the combined aVR criterion identifies the presence of AVNRT with an independent and acceptable diagnostic value. In addition to classical ECG criteria for AVNRT, it is necessary to evaluate the combined aVR criterion in daily practice.

Secret signal delayed mapping in patients with premature ventricular contractions.

Introduction: Mapping and radiofrequency ablation (RFA) of premature ventricular contractions (PVC) that show diurnal changes during the day, and which are rare during 3-D mapping has become very difficult. The most delayed signal mapping in the right ventricular outflow tract (RVOT) with RV apical pacing might be useful in these situations and we called this method Secret Signal Delayed Mapping (SSDM). Aim: To compare the classical RFA and SSDM in patients with PVC. Material and methods: A total of 60 patients with > 10% PVCs detected in 24-hour rhythm Holter recordings and admitted to the laboratory for RFA, 30 of whom underwent classical ablation according to the local activation time (LAT) and 30 of whom were included in the SSDM group, were included in our study. In patients who did not have enough PVCs during 3-D mapping, a catheter was placed in the right ventricle, and delayed signals after the ventricular electrogram (EGM) were collected by fixed pacing and such patients were included in the SSDM group. Results: In all patients, PVC originated from the RVOT. The mean follow-up time of the patients was 10.2 ±1.6 months. Recurrence was detected in 11 (36.6%) patients in the LAT group and 4 (13.3%) patients in the SSDM group. Signal earlyness in LAT mapping was significantly higher in the LAT group (p < 0.001). In the SSDM group, an average of 128 ±24 delayed signals were collected, the mean delayed signal time was 77.6 ±17.7 ms. In the SSDM group, the average distance between the earliest signal on the LAT and the most delayed signal on the SSDM was 4.8 ±1.2 mm. Conclusions: In the treatment of PVCs with RFA, the SSDM method can be used in addition to classical ablation.

Predictors of preinterventional patency of infarct-related artery in patients with ST-segment elevation myocardial infarction: Importance of neutrophil to lymphocyte ratio and uric acid level.

BACKGROUND: Patients with ST-segment elevation myocardial infarction (STEMI) and a patent infarct-related artery (IRA) experience lower mortality and better clinical outcome, but little is known about the predictors of IRA patency before primary percutaneous coronary intervention (PCI) in the setting of STEMI. OBJECTIVE: To assess possible predictors of patency of IRA before primary PCI in patients with STEMI. METHODS: A total of 880 patients with STEMI undergoing primary PCI were prospectively included (646 male, 234 female; mean [± SD] age 58.5±12.4 years). Blood samples were obtained on admission to investigate biochemical markers. Preinterventional thrombolysis in myocardial infarction (TIMI) flow was assessed in all patients. The patients were divided into two groups according to the pre-PCI TIMI flow as impaired flow group (TIMI flow 0, 1 and 2) and normal flow group (TIMI flow 3). Transthoracic echocardiography was performed in all patients. RESULTS: Eighty-three (9.43%) patients had pre-PCI TIMI 3 flow in IRA. Uric acid levels and neutrophil to lymphocyte (N to L) ratio in the normal flow group were lower than in the impaired flow group (P<0.001 for both). However, ejection fraction (EF) was higher in the normal flow group than in the impaired flow group. Multivariate logistic regression analysis showed that IRA patency was independently associated with serum uric acid level (ß 0.673 [95% CI 0.548 to 0.826]; P<0.001), N to L ratio (ß 0.783 [95% CI 0.683 to 0.897]; P<0.001) and EF (ß 1.033 [95% CI 1.006 to 1.061]; P=0.016). CONCLUSION: Serum uric acid level, N to L ratio and EF are independent predictors of the pre-PCI patency of IRA in patients with STEMI undergoing primary PCI.

Does COVID-19 Cause Non-Dipper Hypertension?

Coronavirus disease 2019 (COVID-19) remains a health problem worldwide. The present study aimed to investigate the effect of blood pressure (BP) on the circadian pattern and prevalence of new-onset non-dipper hypertension in the post-COVID period in patients with known hypertension. This prospective single-center study included 722 patients hospitalized for COVID-19 infection. Ambulatory BP (ABP) data were collected during their initial hospitalization. The ABP data were reassessed 1 month after the patients were discharged. The results were compared with a healthy control group with known hypertension but without COVID-19 infection. After exclusion criteria were applied, the study included 187 patients with COVID-19 and 136 healthy hypertensive controls. Post-COVID ABP showed that patients with COVID-19 had significantly higher mean 24-h systolic and diastolic BP, mean nighttime systolic and diastolic BP, and mean daytime diastolic BP than the control group. In addition, new-onset non-dipper hypertension was significantly higher in patients with COVID-19. This study demonstrated for the first time that the circadian pattern is disturbed and a non-dipper pattern develops in individuals with known hypertension during the post-COVID period.

Prognostic Value of Non-HDL Cholesterol in COVID-19 Pneumonia. / Valor Prognóstico do Colesterol não HDL na Pneumonia por COVID-19.

BACKGROUND: In addition to coronary artery disease, non-high-density lipoprotein(non-HDL-C) provides short and long-term predictive information for many chronic inflammatory diseases such as stroke, hemodialysis, post-renal transplant, non-alcoholic hepatosteatosis, and human immunodeficiency virus. OBJECTIVES: This study examined the predictive value of non-HDL-C measured before SARS-CoV-2 for mortality in COVID-19 infection. METHODS: This study retrospectively included 1435 patients diagnosed with COVID-19 and treated in the thoracic diseases ward in a single center between January 2020 and June 2022. All patients included in the study had clinical and radiological features and signs of COVID-19 pneumonia. The COVID-19 diagnosis of all patients was confirmed by a polymerase chain reaction studied from an oropharyngeal swab. Statistical significance was set at p < 0.05. RESULTS: The study patients, including 1435 subjects, were divided into 712 patients in the non-surviving group and 723 in the surviving group. While there was no difference between the groups regarding gender, there was a statistically significant age difference. The non-surviving group was older. Age, lactate dehydrogenase(LDH), C reactive protein(CRP), triglycerides, D-dimer, and non-HDL-C were independent risk factors for mortality in regression analyses. In correlation analysis, age, CRP, and LDH were positively correlated with non-HDL-C. In the ROC analysis, sensitivity for non-HDL-C was 61.6%, and specificity was 89.2%. CONCLUSION: We believe that the non-HDL-C level studied before COVID-19 infection can be used as a prognostic biomarker for the disease.

FUNDAMENTO: Além da doença arterial coronariana, a lipoproteína de não alta densidade (não-HDL-C) fornece informações preditivas de curto e longo prazo para muitas doenças inflamatórias crônicas, como acidente vascular cerebral, hemodiálise, pós-transplante renal, hepatoesteatose não alcoólica e vírus da imunodeficiência humana. OBJETIVOS: Este estudo examinou o valor preditivo do não-HDL-C medido antes do SARS-CoV-2 para mortalidade na infecção por COVID-19. MÉTODOS: Este estudo incluiu retrospectivamente 1.435 pacientes diagnosticados com COVID-19 e tratados na enfermaria de doenças torácicas em um único centro entre janeiro de 2020 e junho de 2022. Todos os pacientes incluídos no estudo apresentavam características clínicas e radiológicas e sinais de pneumonia por COVID-19. O diagnóstico de COVID-19 de todos os pacientes foi confirmado por uma reação em cadeia da polimerase estudada a partir de um swab orofaríngeo. A significância estatística foi estabelecida em p < 0,05. RESULTADOS: Os pacientes do estudo, incluindo 1.435 indivíduos, foram divididos em 712 pacientes no grupo de não sobreviventes e 723 no grupo de sobreviventes. Embora não tenha havido diferença entre os grupos em relação ao sexo, houve uma diferença de idade estatisticamente significativa. O grupo que não sobreviveu era mais velho. Idade, lactato desidrogenase (LDH), proteína C reativa (PCR), triglicerídeos, D-dímero e não-HDL-C foram fatores de risco independentes para mortalidade em análises de regressão. Na análise de correlação, idade, PCR e LDH foram positivamente correlacionados com não-HDL-C. Na análise ROC, a sensibilidade para não-HDL-C foi de 61,6% e a especificidade foi de 89,2%. CONCLUSÃO: Acreditamos que o nível de não HDL-C estudado antes da infecção por COVID-19 pode ser usado como um biomarcador prognóstico para a doença.

Selvester QRS Score is a Predictor of Mortality in Heart Failure with Preserved Ejection Fraction. / O Escore de Selvester QRS é um Preditor de Mortalidade na Insuficiência Cardíaca com Fração de Ejeção Preservada.

BACKGROUND: The Selvester QRS (S-QRS) score on a 12-lead electrocardiogram (ECG) is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its prognostic value in heart failure (HF) with preserved ejection fraction (HFpEF) is unknown. OBJECTIVE: This study aims to investigate the predictive value of the S-QRS score for mortality in HFpEF. METHODS: 359 patients were retrospectively enrolled in this study. Electrocardiographic, echocardiographic, and laboratory features of the patients were recorded. The simplified S-QRS score was measured and recorded. The mean follow-up time of the patients was 38.1±9.5 months. Statistical significance was set at p < 0.05. RESULTS: Of 359 patients, 270 were in the survivor group, and 89 were in the deceased group. Age, Hs-CRP, troponin, pro-BNP, left atrial (LA) diameter, LA volume index, QRS duration, Tpe, and S-QRS score were statistically high in the deceased group. In multivariate logistic regression analysis, age, Hs-CRP, NT-proBNP, LA diameter, LA volume index, Tpe, and S-QRS score were shown to be independent risk factors for mortality. In the receiver-operating characteristic (ROC) analysis, the cut-off value of the S-QRS score was 5.5, the sensitivity was 80.8%, and the specificity was 77.2% (AUC:0.880, p:0.00). In Kaplan-Meier analysis, it was found that mortality was higher in the group with S-QRS score ≥ 5.5 than in the group with S-QRS score < 5.5. (Long-rank, p:0.00). CONCLUSIONS: We think that the S-QRS score can be used as a prognostic indicator of long-term mortality in patients with HFpEF.

FUNDAMENTO: O escore Selvester QRS (S-QRS) em um eletrocardiograma (ECG) de 12 derivações está associado tanto à quantidade de cicatriz miocárdica quanto ao mau prognóstico em pacientes com infarto do miocárdio. Entretanto, seu valor prognóstico na insuficiência cardíaca (IC) com fração de ejeção preservada (ICFEp) é desconhecido. OBJETIVO: Este estudo tem como objetivo investigar o valor preditivo do escore S-QRS para mortalidade na ICFEp. MÉTODOS: 359 pacientes foram incluídos retrospectivamente neste estudo. As características eletrocardiográficas, ecocardiográficas e laboratoriais dos pacientes foram registradas. O escore S-QRS simplificado foi medido e registrado. O tempo médio de seguimento dos pacientes foi de 38,1±9,5 meses. A significância estatística foi estabelecida em p < 0,05. RESULTADOS: Dos 359 pacientes, 270 estavam no grupo sobrevivente e 89 no grupo falecido. Idade, PCR-us, troponina, pro-BNP, diâmetro do átrio esquerdo (AE), índice de volume do AE, duração do QRS, Tpe e escore do S-QRS foram estatisticamente altos no grupo falecido. Na análise de regressão logística multivariada, idade, PCR-us, NT-proBNP, diâmetro do AE, índice de volume do AE, Tpe e escore S-QRS mostraram-se fatores de risco independentes para mortalidade. Na análise da característica operacional do receptor (ROC), o valor de corte do escore S-QRS foi de 5,5, a sensibilidade foi de 80,8% e a especificidade foi de 77,2% (AUC: 0,880, p:0,00). Na análise de Kaplan-Meier, verificou-se que a mortalidade foi maior no grupo com escore S-QRS ≥ 5,5 do que no grupo com escore S-QRS < 5,5. (Long-rank, p:0,00). CONCLUSÃO: Acreditamos que o escore S-QRS pode ser usado como um indicador prognóstico de mortalidade a longo prazo em pacientes com ICFEp.

Subclinical Left Atrial and Ventricular Dysfunction in Acromegaly Patients: A Speckle Tracking Echocardiography Study. / Disfunção Ventricular e do Átrio Esquerdo Subclínica em Pacientes com Acromegalia: Um Estudo de Ecocardiograma de Rastreamento de Manchas.

BACKGROUND: Although it is known that the left ventricular (LV) ejection fraction (EF) measured by echocardiography is preserved in patients with acromegaly, there is not enough information about the LV and left atrial strain (LV-GLS and LAS). OBJECTIVE: This study aimed to evaluate the left ventricular (LV) and left atrial (LA) functions with strain echocardiography (SE) in patients with acromegaly. METHODS: This study included 50 acromegaly patients with active disease and 50 healthy controls with similar age, gender, and body surface area. In addition to routine echocardiography examinations, LV-GLS and LAS measurements were performed with SE. RESULTS: LAS and LV-GLS values were significantly lower in patients with acromegaly (p<0.05 for all). In bivariate analysis, systolic blood pressure, N-terminal prohormone of brain natriuretic peptide, Insulin-like growth factor-1, LA diastolic diameter, and LVMI levels were found to be positively correlated with both LAS and LV-GLS (p <0.05). IGF-1 level was strongly correlated with LAS and LV-GLS (p<0.001 and ß=0.5 vs. p<0.001 and ß=0.626, respectively); 48% of patients with acromegaly have reduced LV-GLS (<20%). Left ventricular mass-index (LVMI) independently determines the presence of reduced LV-GLS and each 1g/m2increase in LVMI level increases the likelihood of reduced LV-GLS by 6%. CONCLUSION: Although LV ejection fraction is normal in patients with acromegaly, LAS and LV-GLS values were significantly reduced. Apart from LVMI increase, another finding of cardiac involvement may be LAS and LV-GLS decrease. Therefore, in addition to routine echocardiography, LAS and LV-GLS may be useful to evaluate early signs of cardiac involvement before the occurrence of irreversible cardiac changes.

FUNDAMENTO: Embora se saiba que a fração de ejeção (FE) do ventrículo esquerdo (VE) medida por eletrocardiograma seja preservada em pacientes com acromegalia, não há informação suficiente sobre deformação longitudinal global e deformação do átrio esquerdo (SLG-VE e SAE). OBJETIVO: O objetivo deste estudo foi avaliar as funções do ventrículo esquerdo (VE) e do átrio esquerdo (AE) por ecocardiograma strain (ES) em pacientes com acromegalia. MÉTODOS: Este estudo incluiu 50 pacientes com acromegalia na forma ativa da doença e 50 controles saudáveis com idade, sexo e área de superfície corporal similares. Além dos ecocardiogramas de rotina, medições de SLG-VE e SAE foram realizadas com o ES. RESULTADOS: Os valores dos SAE e SLG-VE foram significativamente mais baixos em pacientes com acromegalia (p<0,05 para todos). Na análise bivariada, a pressão arterial sistólica, o pró-hormônio N-terminal do peptídeo natriurético cerebral, o fator de crescimento semelhante à insulina tipo 1, e detectou-se que os níveis de IMVE tinham correlação positiva com SAE e SLG-VE (p<0,05). O nível de IGF-1 tinha forte correlação com SAE e SLG-VE (p<0,001 e ß=0,5 vs. p<0,001 e ß=0,626, respectivamente); 48% dos pacientes com acromegalia têm SLG-VE reduzido (<20%). O índice de massa do ventrículo esquerdo (IMVE) determina independentemente a presença de SLG-VE reduzido, e cada 1g/m2 de aumento no nível de IMVE aumenta a probabilidade de redução de SLG-VE em 6%. CONCLUSÃO: Embora a fração de ejeção de VE seja normal em pacientes com acromegalia, os valores de SAE e SLG-VE são significativamente mais baixos. Além do aumento em IMVE, outro achado do envolvimento cardíaco pode ser a redução de SAE e SLG-VE. Portanto, além do ecocardiograma de rotina, SAE e SLG-VE podem ser úteis para avaliar os sinais iniciais de envolvimento cardíaco antes da ocorrência de alterações cardíacas irreversíveis.

Carotid-femoral pulse wave velocity is significantly increased in newly diagnosed hypertensive patients with primary hyperparathyroidism and significantly related with serum calcium level.

BACKGROUND: Primary hyperparathyroidism (PHP) is a rare cause of secondary hypertension (HT), but in patients with PHP, HT is very common and 20-80% of patients have HT. The aim of this study was to evaluate the change in carotid-femoral pulse wave velocity (CF-PWV) in hypertensive patients with PHP, and was to determine the clinical, laboratory, and echocardiographic parameters associated with CF-PWV. METHODS: The study included 83 newly diagnosed hypertensive patients with PHP and 83 patients with newly diagnosed essential HT without PHP. All patients underwent echocardiography and CF-PWV measurements. RESULTS: In patients with PHP, blood urea nitrogen, hs-CRP, uric acid, serum and urine calcium, parathyroid hormone level, CF-PWV value, LV wall thickness, LVMI, aortic and left atrium (LA) diameter, and presence of LVH and CF-PWV > 10 m/s were higher, and serum phosphorus levels were lower. Serum calcium, LA diameter, and LVMI values were closely correlated with CF-PWV. In the ROC analysis, the AUROC was calculated as 0.825 for calcium level to determine the patients with increased CF-PWV. When the serum calcium value was taken as 10 mg/dL, it was determined with CF-PWV > 10 m/s were 79.5% sensitivity and 78.2% specificity. CONCLUSION: CF-PWV significantly increases in newly diagnosed hypertensive patients with PHP and significantly related to serum calcium level. To protect against target organ damage, high serum calcium levels should be monitored as well as blood pressure in hypertensive patients with PHP.

Modified Lung Ultrasound Score in Evaluating the Severity of Covid-19 Pneumonia.

Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (Covid-19), which has been declared as a pandemic by the World Health Organization. The aim of the study described here was to determine the severity of pneumonia and the clinical parameters related to a modified lung ultrasound score (mLUS) in patients with COVID-19 pneumonia. The study included 44 patients with proven COVID-19 pneumonia. Patients were divided into three groups on the basis of pneumonia severity: mild/moderate pneumonia (group I), severe pneumonia (group II) and critically ill patients (group III). It was determined that mLUS values in groups I-III were 6.51 ± 4.12, 23.5 ± 5.9 and 24.7 ± 3.9, respectively. mLUS values were significantly higher in group II and III patients than in group I patients. There was a positive relationship between mLUS and age and N-terminal pro-brain natriuretic peptide level and a negative relationship with PaO2/FiO2 (p = 0.032, ß = 0.275 vs. p = 0.012, ß = 0.315 vs. p = 0.001, ß = -0.520, respectively). In patients with COVID-19 pneumonia, mLUS increases significantly with the severity of the disease.

Residual SYNTAX Score Is Associated With Contrast-Induced Nephropathy in Patients With Non-ST Segment Elevation Myocardial Infarction With Preserved LVEF.

The purpose of this study is to investigate the relation between residual SYNTAX score (rSS) and contrast-induced nephropathy (CIN) development in patients with non-ST segment elevation myocardial infarction (NSTEMI) with normal or near-to-normal left ventricular ejection fraction (LVEF) who underwent percutaneous coronary intervention (PCI). A total of 306 patients who underwent PCI with NSTEMI were included in our study. SYNTAX scores were calculated for the periods before and after PCI. Patients were divided into 2 groups as developed CIN following PCI (CIN +) and patients did not (CIN -). Fifty-four (17.6%) of patients who were included in the study developed CIN. Age (P = .001) and rSS (P = .002) were significantly higher and LVEF was lower (P = .034) in the CIN (+) group. Age (P = .031, odds ratio [OR]: 1.031, 95% CI, 1.003-1.059) and rSS (P = .04, OR: 1.036, 95% CI, 1.002-1.071) were independent predictors for CIN. In receiver operating characteristic analyses, when the cutoff value of rSS was taken as 3.5, it determined CIN with 79% sensitivity and 65% specificity. Contrast-induced nephropathy may develop more frequently in patients with increased rSS value. The rSS may be useful to follow-up these patients for CIN development.

Impaired self-reported sleep quality improves with radiofrequency catheter ablation in patients with premature ventricular complexes.

BACKGROUND: The frequency of premature ventricular contractions (PVCs) increases in patients with poor sleep quality (PSQ). AIMS: The aim of this study was to evaluate PSQ in patients referred for radiofrequency catheter ablation (RFA) due to PVCs and to determine the effect of RFA on PSQ. METHODS: A total of 207 patients who were diagnosed with the PVC burden greater than 10% and underwent 3-dimensional RFA in our center were included in this cross -sectional study. Self -reported sleep quality was assessed in all patients in addition to a 24-hour Holter electrocardiogram before ablation and at 3-month follow -up. The effect of RFA on self -reported sleep quality in patients with PVCs was evaluated. RESULTS: Before RFA, 87% of the study patients had PSQ. In those with PVCs, subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, daytime dysfunction, and the global Pittsburgh Sleep Quality Index (PSQI) improved after RFA (P <0.001). Positive correlations were found between the PSQI and the total number of PVCs, PVC burden, PVC burden in the morning, PVC burden at midday, PVC burden in the evening, and PVC burden at nighttime (P <0.01). In linear regression analysis, only the nighttime PVC burden was found to be related to the PSQI (P = 0.002, ß = 0.397). CONCLUSION: Poor sleep quality is common in patients with PVCs and it improves significantly after the RFA procedure. Poor sleep quality in patients with PVCs is closely related to the PVC burden at nighttime. Our study showed that, while evaluating PVCs, we also should suspect PSQ, especially due to PVCs.

Decreased left atrial global longitudinal strain predicts the risk of atrial fibrillation recurrence after cryoablation in paroxysmal atrial fibrillation.

PURPOSE: We aimed to investigate the association of atrial fibrillation (AF) recurrence with left atrial (LA) strain in nonvalvular paroxysmal AF patients after cryoablation. METHODS: We included 190 patients who underwent successful cryoablation due to paroxysmal AF. In addition to classical echocardiographic data, LA apical 2-chamber (A2C) strain, LA apical 4-chamber (A4C) strain, and LA global longitudinal strain (LA-GLS) values were calculated by speckle tracking echocardiography. Forty-eight-hour Holter monitoring was performed to all patients no later than 6 months after ablation. RESULTS: AF recurrence was detected in 42 patients (22.1%). End-systolic diameter, LA end-systolic diameter, LA-volume, LA-volume index, interatrial septum thickness, coronary sinus diameter, epicardial fat thickness (EFT), and septal E/E` ratio were significantly higher, LV-EF, IVRT, septal S and A` wave, lateral S wave, LA-A2C strain, LA-A4C strain, and LA-GLS were significantly lower in patients with AF recurrence. LA-GLS, LA-volume index, and EFT were found to be independent parameters for predicting AF recurrence. CONCLUSIONS: LA-GLS and LAVI should be included in routine evaluations to determine long-term AF recurrence preoperatively.

Disease Severity Affects Ventricular Repolarization Parameters in Patients With COVID-19. / A Gravidade da Doença Afeta os Parâmetros de Repolarização Ventricular em Pacientes com COVID-19.

BACKGROUND: There is no study evaluating the Tpeak-Tend (Tpe) interval, Tpe/QT ratio, and Tpe/QTc ratio to assess cardiac arrhythmias in patients with COVID-19. OBJECTIVE: We aimed to examine whether there is a change in QT, QTc, Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio in patients with COVID-19. METHODS: The study included 90 patients with COVID-19 infection and 30 age-and-sex-matched healthy controls. QT, QTc, Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio were measured. The participants included in the study were divided into the following 4 groups: healthy controls (group I), patients with COVID-19 without pneumonia (group II), patients with COVID-19 and mild pneumonia (group III), and patients with COVID-19 and severe pneumonia (group IV). Statistical significance was set at p < 0.05. RESULTS: It was found that baseline heart rate, presence of hypertension and diabetes, white blood cell count, blood urea nitrogen, creatinine, potassium, aspartate aminotransferase, alanine aminotransferase, NT-proBNP, high sensitive C reactive protein, D-dimer, hs-cTnI, Tpe, Tpe/QT, and Tpe/QTc increased from group I to group IV, and they were significantly higher in all patients in group IV (p < 0.05). Systolic-diastolic blood pressure, hemoglobin, and calcium levels were found to be lowest in group IV and significantly lower than in other groups (< 0.05). QT and QTc intervals were similar between groups. It was determined that increased heart rate, calcium, D-dimer, NT-proBNP and hs-CRP levels were significantly related to Tpe, Tpe/QT, and Tpe/QTc. CONCLUSIONS: In patients with COVID-19 and severe pneumonia, Tpe, Tpe/QT ratio, and Tpe/QTc ratio, which are among ventricular repolarization parameters, were found to be increased, without prolonged QT and QTc intervals. In this study, we cannot definitively conclude that the ECG changes observed are directly related to COVID-19 infection or inflammation, but rather associated with severe COVID-19 scenarios, which might involve other causes of inflammation and comorbidities. (Arq Bras Cardiol. 2020; 115(5):907-913).

FUNDAMENTO: Não há estudos avaliando o intervalo Tpico-Tfim (Tpe), a relação Tpe/QT e a relação Tpe/QTc para avaliar arritmias cardíacas em pacientes com COVID-19. OBJETIVO: Visamos investigar se há alterações nos intervalos QT, QTc e Tpe e nas relações Tpe/QT e Tpe/QTc em pacientes com COVID-19. MÉTODOS: O estudo incluiu 90 pacientes com infecção por COVID-19 e 30 controles saudáveis pareados por sexo e idade. Foram aferidos os intervalos QT, QTc e Tpe e as relações Tpe/QT e Tpe/QTc. Os participantes incluídos no estudo foram divididos nos seguintes 4 grupos: controles saudáveis (grupo I), pacientes com COVID-19 sem pneumonia (grupo II), pacientes com COVID-19 e pneumonia leve (grupo III) e pacientes com COVID-19 e pneumonia grave (grupo IV). Significância estatística foi definida por valor p < 0,05. RESULTADOS: Verificou-se que a frequência cardíaca basal, a presença de hipertensão e diabetes, a contagem de leucócitos, o nitrogênio ureico no sangue, a creatinina, o potássio, o aspartato aminotransferase, a alanina aminotransferase, o NT-proBNP, a proteína C reativa de alta sensibilidade, o dímero-D, a TncI-as, o intervalo Tpe, a relação Tpe/QT e a relação Tpe/QTc aumentaram do grupo I para o grupo IV e foram significativamente mais altos em todos os pacientes do grupo IV (p < 0,05). A pressão arterial sistólica, a hemoglobina e os níveis de cálcio eram menores no grupo IV e significativamente menores em comparação com os demais grupos (< 0,05). Os intervalos QT e QTc eram semelhantes entre grupos. Determinou-se que os níveis elevados de frequência cardíaca, cálcio, dímero-D, NT-proBNP e PCR-as eram significativamente relacionados a Tpe, Tpe/QT e Tpe/QTc. CONCLUSÕES: Em pacientes com COVID-19 e pneumonia grave, o intervalo Tpe, a relação Tpe/QT e a relação Tpe/QTc, que estão entre os parâmetros de repolarização ventricular, foram aumentados, sem prolongação dos intervalos QT e QTc. A partir deste estudo, não podemos definitivamente concluir que as alterações eletrocardiográficas observadas estão diretamente relacionadas à infecção por COVID-19 ou à inflamação, mas sim associadas a cenários graves de COVID-19, que podem envolver outras causas de inflamação e comorbidades.