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Background: Double-kissing (DK) crush and DK culotte are the recommended 2-stent strategies in true coronary bifurcation lesions. However, it is a matter of curiosity about which of the DK crush and DK culotte stenting techniques will have superior results. We aimed to compare the clinical outcomes of DK crush and DK culotte stenting in nonleft main coronary artery bifurcation., Methods: Consecutive patients who received DK crush or DK culotte technique for de novo true nonleft main coronary artery bifurcation lesion were categorized according to which treatment they received. The primary end point of the study was target lesion failure as a composite end point of target lesion revascularization, target vessel myocardial infarction, and cardiac death. Secondary end points were all-cause death and definite stent thrombosis., Results: A total of 202 patients were categorized as DK crush (101 patients) or DK culotte (101 patients) techniques. The target lesion failure had occurred frequently in the DK crush (10.9%) compared with the DK culotte (3.0%; P =0.028) that was mainly driven by increased target lesion revascularization (9.9% in the DK crush versus 3.0% in the DK culotte; P =0.045). The number of patients with target vessel myocardial infarction (3.0% in the DK crush versus 2.0% in the DK culotte; P =0.651) and cardiac death (1.0% in the DK crush versus 0.0% in the DK culotte; P =0.315) was higher in the DK crush. There were no differences in terms of definite stent thrombosis and all-cause death between groups., Conclusions: In the present analysis, DK culotte was associated with lower 1-year target lesion failure rates compared with DK crush in true nonleft main coronary artery bifurcations., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04789161., Competing Interests: None.

Objectives: Chronic Limb-Threatening Ischemia (CLTI) represents a complex manifestation of peripheral artery disease distinguished by symptoms such as ischemic rest pain, non-healing ulcers on the lower limb or foot, and the development of gangrene. CLTI is associated with a high risk of limb amputation, decreased quality of life, and substantial morbidity and mortality. The Prognostic Nutritional Index (PNI), which is calculated using albumin and lymphocyte levels, reflects the immunological and nutritional status. The objective of this study was to investigate the correlation between PNI levels and mortality among patients diagnosed with CLTI who underwent endovascular therapy., Methods: Individuals diagnosed with CLTI who received endovascular therapy below the knee in our tertiary care center were enrolled in this retrospective study. The patients were divided into two groups: survivors and non-survivors. Logistic regression analyses were performed to detect independent predictors of mortality and using Cox regression model, we assessed the relationship between PNI and mortality. Survival curves were estimated using the Kaplan-Meier method., Results: The study comprised 113 patients diagnosed with PAD who underwent EVT. The non-survivor group (42 patients) was older (62.9±10.9 vs. 67.7±9.9, p=0.045) and had a higher prevalence of chronic renal failure (22.5% vs. 42.9%, p=0.023) and congestive heart failure (8.5% vs. 21.4%, p:0.049) than the survivor group (71 patients). The median PNI value was lower in the non-survivor group than in the survivor group (35.9±5 vs 38.2±4.4, p=0.012). Cox regression analyses showed that Low PNI was associated with increased mortality (HR=0.931, CI=0.872-0.995, p=0.035). PNI cut-off of 37.009 showed 64.3% sensitivity, 64.8% specificity, and AUC of 0.642 for predicting all-cause mortality. Kaplan-Meier analysis supported higher PNI correlating with better survival., Conclusion: The Prognostic Nutritional Index was independently associated with mortality among individuals diagnosed with Chronic Limb-Threatening Ischemia., Competing Interests: No potential conflict of interest was reported by the authors., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: Critical limb ischemia (CLI) patients take too many medications because they are elderly and frail patients with multiple comorbidities. Polypharmacy is associated with frailty, although its prognostic significance in CLI patients is unknown. In this study, we aimed to determine the prevalence of hyperpolypharmacy among adults with CLI and its effect on 1-year amputation and mortality., Methods: A total of 200 patients with CLI who underwent endovascular therapy (EVT) for below-knee (CTC) lesions were included in this study. Hyperpolypharmacy was defined as using ≥10 drugs. Patients were divided into two groups according to the presence of hyperpolypharmacy., Results: We detected hyperpolypharmacy in 66 patients. The incidence of 1-year amputation [24 (36.4) versus 12 (9), p <.001] and mortality [28 (42.4) versus 12 (9), p <.001] were higher in patients with hyperpolypharmacy. Univariate and multivariate cox regression analyses were used to determine the independent predictors of amputation and mortality. In the receiver operating characteristic curve analysis, the cut-off value was defined as 10 or more drug use was able to detect the presence of 1-year mortality with 67.5% sensitivity and 79.4% specificity. The Kaplan-Meier method showed a significant difference (rank p <.001 between log groups), and hyperpolypharmacy was associated with 1-year amputation and mortality., Conclusion: Hyperpolypharmacy was significantly associated with 1-year mortality and major amputation in CLI patients. Hyperpolypharmacy can be a valuable aid in patient risk assessment in the CLI., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Peripheral arterial disease is a common disease all over the world. Medical treatment, percutaneous invasive treatment, and operation are the considerable options. Percutaneous treatment is a valid option with a higher patency rate. Systemic immune-inflammatory index (SII) is a formula which is calculated as neutrophil count to platelet count divided into lymphocyte count. This formula demonstrates the active inflammatory state. In our study, we aimed to demonstrate the relationship with SII and the mortality, major cardiovascular events, and success rates of percutaneous treatment of iliac artery disease., Methods: A total of 600 patients underwent percutaneous intervention due to iliac artery disease were enrolled. The primary end point was mortality and the secondary end points were in-hospital thrombosis, restenosis, residual stenosis, and postintervention complications. The best cut-off value of SII to predict mortality was determined and the patients were divided into 2 groups, as those with higher SII values (1,073.782 <) and as those with lower SII values (1,073.782 >). Each group was evaluated in terms of clinical, laboratory, and technical aspects., Results: After exclusion criteria were applied, 417 patients were enrolled into the study. Patients with high SII values had higher rates of in-hospital thrombosis [0 (0%); 3 (2.2%), P = 0.037] and mortality [38 (13.7%); 46 (33.1%), P < 0.001]. In multivariate logistic regression analysis, chronic kidney disease [odds ratio: 4.104, 95 0.5 confidence interval: 2.250-7.487, P < 0.001] and SII [odds ratio: 3.346, 95 0.5 confidence interval: 1.982-5.649, P < 0.001] were found to be independent risk factors for mortality., Conclusions: SII is a relatively new, simple, and effective mortality risk predictor in patients with iliac artery disease who underwent percutaneous intervention. To the best of our knowledge, our study is the first study which uses SII to predict mortality in such patient group., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). Patients with CLI have poor long-term prognosis. The aim of this study was to investigate the value of sarcopenia in terms of 1-year mortality in patients with below-the-knee lesions who underwent endovascular treatment for CLI., Methods: A total of 190 patients with critical limb ischemia who underwent endovascular treatment (EVT) for below-the-knee (BTK) lesions were enrolled in this study. Sarcopenia was defined using the psoas muscle index (PMI). PMI was obtained by calculating the average psoas muscle area (APMA) of the left and right psoas muscles at the third lumbar vertebra level and dividing by the square of the height (cm 2 /m 2 ). The primary endpoint of the study was 1-year mortality and the secondary endpoint was 1-year amputation. Patients were divided into 2 groups according to presence of sarcopenia., Results: We detected sarcopenia in 64 patients. The mean age, height, and EF were higher in sarcopenia group. The psoas muscle area, weight, psoas muscle index, body-mass index, albumin level, and GFR were lower in sarcopenia group. The incidence of amputation (11.9% vs 29.7%, p = 0.003) and mortality (15.1% vs 35.9%, p = 0.001) were higher in patients with sarcopenia. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of amputation and mortality. The survival curve for 1-year using the sarcopenia was analyzed using the Kaplan-Meier method, and statistical analysis was performed with the log-rank test. The presence of sarcopenia, glomerular filtration rate level, and low ejection fraction were found to be independent predictors of mortality., Conclusions: Sarcopenia was associated with 1-year mortality in patients with CLI undergoing EVT for BTK lesions. Also, patients with sacropenia had higher 1-year amputation rates. Sarcopenia may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.

Background: Transcatheter aortic valve implantation (TAVI) is a less invasive and safe therapeutic alternative in patients who are at very high surgical risk or in whom there are contraindications to open surgery. On the other hand, allocating transcatheter therapy to the adequate candidates and identifying a reliable and validated risk stratification tool for mortality prediction is still lacking. The C-reactive (CRP) to albumin ratio (CAR) is a novel inflammation-based prognostic tool and it is strongly associated with inflammation severity and mortality. In this study, we aimed to elucidate the predictive significance of CAR for mortality in patients who underwent TAVI., Methods: The records of 321 consecutive patients who underwent TAVI due to symptomatic aortic stenosis between 1 January 2015 and 31 December 2020 were analysed. Patients were divided into two groups based on the CAR values. For each group, all-cause, cardiovascular, and non-cardiovascular mortality occurring >72 h after the index procedure and at maximum follow-up was documented., Results: The mean follow-up time was 40 (22-63) months. A total of 180 (56.1%) patients died during long-term follow-up. According to our study, median CAR values were significantly higher among patients who died during follow-ups compared to survivors [1.13 (0.69-2.21) vs 3.56 (1.53-10.00), p  < 0.001]., Conclusion: Our data showed that CAR is an independent predictor of long-term mortality in patients undergoing TAVI due to symptomatic aortic stenosis.

Aim: This work was designed to explore the role of the triglyceride-glucose (TyG) index in the prediction of long-term mortality in patients with lower extremity artery disease (LEAD) undergoing endovascular revascularization. Methods: The records of 723 patients with symptomatic LEAD undergoing endovascular revascularization between January 2016 and December 2021, with long-term follow-up until December 2021, were analyzed. Results: The rate of long-term mortality was significantly higher among patients with high TyG index than patients with low TyG index. Conclusion: The TyG index is an independent predictor of long-term mortality in patients with LEAD undergoing endovascular revascularization.

Background: In this study, we aimed to investigate the prognostic value of C-reactive protein (CRP) to albumin ratio (CAR) for predicting restenosis in superficial femoral artery (SFA) lesions and its association with subsequent clinical outcomes in patients undergoing endovascular intervention., Methods: The records of 685 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into 2 groups, based on the CAR values. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed., Results: According to our study, patients with high CAR values had higher rates of restenosis (30.2% vs. 10.3%, P < 0.05) and mortality (31.3% vs. 12.9%, P < 0.05). The rate of lower extremity amputations was also significantly higher in patients with high CAR values compared to those with low CAR values (9.1% vs. 3%, P < 0.05). With respect to Receiver operating characteristic ROC curves of inflammatory markers, the area under the curve (AUC) value of CAR was statistically significant (AUC: 0.659; 95% confidence interval CI: 0.611-0.706; P < 0.01)., Conclusions: Our data showed that CAR is an independent predictor of restenosis and poor clinical outcomes in patients undergoing endovascular intervention., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: Vascular calcification is a well-known phenomenon and affects coronary and carotid arteries as well as other arterial beds. Presence of arterial calcification is associated with major adverse events in patients undergoing percutaneous coronary artery or carotid artery intervention. Even though there is a clear association between worse outcome and coronary-carotid calcification, there is no research that interrogated the relationship between iliac arterial calcification and clinical outcomes because of lack of data. Therefore, in this study, we aimed to investigate the impact of iliac arterial calcification on procedure success rates and long-term outcomes among patients undergoing endovascular intervention., Methods: The records of 453 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into two groups based on the presence or absence of heavy calcification of iliac arteries. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed., Results: According to our study, the rate of restenosis following endovascular intervention at 6 and 12 months were similar between two groups. On the other hand, long-term restenosis was significantly higher in patients with heavy calcification of iliac arteries as compared to patients with low calcification on iliac arteries (32.2% vs. 12.8%, p  <   0.05)., Conclusions: Our data showed that there was a strong association between heavy calcification of iliac arteries and long-term restenosis in patients undergoing endovascular intervention.

Background and objective Graft patency is one of the major concerns after coronary artery bypass graft (CABG) surgery. The CHA 2 DS 2 -VASc [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus (DM), stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category] score is a tool that was developed to predict the risk of thrombotic events in patients with atrial fibrillation (AF). In this study, we evaluated the use of the CHA 2 DS 2 -VASc score as a simple tool for predicting graft failure (GF) among patients who underwent CABG surgery. Methods In this retrospective case-control study, a total of 280 patients were enrolled after applying the exclusion criteria. Angiograms were analyzed by using the QCA software system (Pie Medical Imaging, Maastricht, The Netherlands) for each patient. A graft was described as failed if it had 70% or more stenosis or was completely occluded. Patients were classified into two groups: group one included patients without GF (GF-N) and group two included patients with GF (GF-Y). Thereafter, the CHA 2 DS 2 -VASc risk score was calculated for each patient. Results In our cohort, 136 patients had GF (GF-Y group) and 144 patients did not have GF (GF-N group). GF-N and GF-Y patients had their angiography performed 100.31 ± 8.04 and 103.49 ± 8.41 months after CABG, respectively. GF-Y group had a significantly higher rate of DM, hypertension, and heart failure with reduced ejection fraction (HFrEF). GF-Y group had higher CHA 2 DS 2  (GF-N group: 1.47 ± 0.91 vs. GF-Y group: 2.57 ± 1.17, p=0.0001) and CHA 2 DS 2 -VASc score (GF-N group: 2.80 ± 1.11 vs. GF-Y group: 4.15 ± 1.25, p=0.0001). Analyses showed that only CHA 2 DS 2 -VASc was an independent predictor of GF while other parameters including DM, hypertension, HFrEF, creatinine, and CHADS 2 were not found to be independent predictors of GF. A CHA 2 DS 2 -VASc score of >3 predicted GF with a sensitivity of 65.44% and a specificity of 74.31%. Conclusions The CHA 2 DS 2 -VASc score might be used as a feasible and simple method to predict the risk of GF after CABG surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Tasbulak et al.)

Mitral valve commissure evaluation is known to be important in the success of percutaneous balloon mitral valvuloplasty (PBMV) and Wilkins score (WS) is used in clinical practice. In our study, we aimed to determine whether WS in redo PBMV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure. Fifty patients who underwent redo PBMV were included in the study. The patients were divided into two groups according to the success of the Redo PBMV procedure which was defined as post-procedural MVA ≥ 1.5 cm 2 and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation after PBMV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PBMV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated. In the study group, 36 patients (72%) had successful redo PBMV procedure. WS was 8 (IQR 7-9) and novel 3D TEE score was found 4 (IQR 3-4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). Specifically, the procedural successes rate was > 90% when novel 3D TEE score was < 4. The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PBMV, especially in patients who are considered for surgery due to the high WS., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: Coronary artery bypass graft (CABG) surgery is a well-established treatment modality for patients with multivessel coronary artery disease (CAD). Syntax II Score has been established as novel scoring system with better prediction of postprocedural outcomes. This study aimed to investigate the prognostic value of SYNTAX II Score for predicting late saphenous vein graft (SVG) failure in patients undergoing isolated CABG., Methods: The records of 1,875 consecutive patients who underwent isolated CABG with at least one SVG were investigated. Those who underwent coronary angiography and SVGs angiography at least 1 year after the CABG were included. Patients were divided into two groups based on the presence or absence of SVG failure. For each group, predictors of late SVG failure and subsequent clinical outcomes were analyzed., Results: According to this study, the presence of hypertension, higher rates of repeat revascularization, and higher SYNTAX II Scores were found to be independent predictors of late SVG failure. In addition, the prognostic value of SYNTAX II Score was found to be significantly higher than anatomical SYNTAX Score in terms of predicting late SVG failure and major adverse cardiovascular and cerebrovascular event., Conclusions: There was a strong association between SYNTAX II Score and late SVG failure in patients undergoing isolated CABG.

Background It is well known that approximately 20% of patients who undergo cardiac surgery experience weight loss in postoperative period. However, there is a lack of data on postoperative consequences of malnutrition. This study aimed to investigate the relationship between nutritional status and long-term outcomes in patients undergoing isolated coronary artery bypass grafting (CABG). Material and methods A total of 586 patients who underwent isolated CABG in our center between January 2015 and March 2016 were included in this study. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of all-cause death, non-fatal myocardial infarction (MI), and stroke. Patients were divided into two groups based on their MACCE outcomes. Prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and controlling nutritional status (CONUT) scores were used to show the nutritional status. Results The mean follow-up time of the whole study group was 38.08 ± 13.4 months. The follow-up time was 39 ± 13 months in patients with mortality, while it was 20 ± 15 months in those without mortality. The PNI and GNRI values were lower in patients with major adverse cardiac and cerebrovascular events (MACCE) compared to patients without MACCE. The median CONUT score was higher in patients with MACCE. Conclusion Our study showed that nutritional indices including PNI, CONUT, and GNRI were associated with long-term MACCE and mortality in patients who underwent isolated CABG. The use of these scores in order to predict prognosis in patients treated with CABG seems to be an applicable method in clinical practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Tasbulak et al.)

Objectives: Malnutrition has been shown to be associated with survival in a variety of diseases. Our aim is to evaluate the prognostic value of objective nutritional indexes indicating malnutrition, in patients underwent endovascular aortic replacement., Methods: We retrospectively evaluated 149 consecutive patients who underwent technically successful endovascular aortic replacement operation between October 2010 and August 2019. Objective nutritional indexes, prognostic nutritional index, geriatric nutritional risk index and controlling nutritional status, scores were calculated using the preoperative data. Optimal cut-off values were obtained by receiver operating characteristic analysis. According to the cut-off values, we investigated the relationship between indexes and the long-term all-cause mortality., Results: During mean 48.0 ± 30.3 months follow-up duration, in 47 of patients (31.5%), all-cause mortality were documented. In mortality group, prognostic nutritional index (42.8 ± 7.1 vs 51.3 ± 5.2, p  < 0.001) and geriatric nutritional risk index (100.7 ± 10.1 vs 107.6 ± 9.2, p  < 0.001) were significantly lower, controlling nutritional status score (2.0 (1.0-4.0) vs 1.0 (0.0-2.0), p  < 0.001) was higher when compared to survivor group. Kaplan-Meier curves presented higher mortality incidence in malnutrition patients evaluated with objective nutritional indexes (Log-rang test, for all three indexes p  < 0.001). Besides Cox-proportional hazard analysis showed all three nutritional indexes may be a predictive marker for all-cause mortality, prognostic nutritional index introduced more valuable data than other two indexes., Conclusions: Malnutrition is associated with significant increase in postoperative long-term mortality in endovascular aortic replacement patients. Preoperatively calculated objective nutritional indexes especially prognostic nutritional index can be used as an important prognostic tool.

Background: Transcatheter aortic valve implantation (TAVI) is an effective, less invasive treatment alternative for symptomatic severe aortic stenosis (AS). Acute kidney injury (AKI) following TAVI is a common complication and is associated with worse outcomes. The age, creatinine, ejection fraction (ACEF) score is a simple scoring method, including only three parameters: age, creatinine, and ejection fraction (EF). The score was well established in predicting AKI after coronary interventions., Aims: We aimed to evaluate whether this simple scoring method, ACEF, may predict a development of AKI in patients who underwent TAVI., Methods: A total of 173 consecutive patients with symptomatic severe AS who underwent TAVI were included retrospectively. The primary endpoint of the study was the development of AKI. Study population was divided into two groups according to the presence of AKI. The ACEF score was calculated with the formula: age/EF + 1 (if baseline creatinine >2 mg/dl)., Results: Twenty-nine patients developed AKI. The median (interquartile range) ACEF score was 1.36 (1.20-1.58). The ACEF score was found to be an independent predictor of AKI (P <0.001). The ACEF score ≥1.36 predicted AKI development with a sensitivity of 96.6% and specificity of 58.8%. Moreover, hypertension, hemoglobin levels, contrast volume, and aortic valve area (AVA) were found to be independent predictors of AKI., Conclusions: Our study revealed that the ACEF score was an independent predictor of AKI. A simple and objective score might be very useful in predicting AKI development in patients undergoing TAVI.

Background: Surgical aortic valve replacement (sAVR) is the ultimate therapy for severe aortic stenosis (AS) in suitable patients. Prognostic factors of sAVR are great interest in recent studies. Frontal QRS-T angle (fQRSTa) is a novel marker of ventricular repolarization abnormalities. In this study, we aimed to investigate the prognostic value of fQRSTa in patients with severe symptomatic AS undergoing sAVR., Methods: A total of 372 patients with severe degenerative AS who underwent successful sAVR were included in this retrospective study. Then, patients were divided into two groups: patients with narrow fQRSTa (≤90°) as group 1 and wide fQRSTa (>90°) as group 2. Perioperative and postoperative clinical evaluation and time of death were recorded from all subjects., Results: The incidence of total mortality was higher in patients with wider fQRSTa (13.8% [15]; 4.9% [9], P = .013) compared to patients with narrow fQRSTa. In multivariate logistic regression analysis, advanced age (odds ratio [OR] = 1.054; 95% confidence interval [CI] = 1.004-1.106; P = .034), dyspnea (OR = 7.687; 95% CI = 2.296-25.729; P = .001), lower efection fraction (OR = 0.924; 95% CI = 0.884-0.966; P = .001), in-hospital duration (OR = 1.051; 95% CI = 1.016-1.088; P = .004) and wider fQRSTa (OR = 4.029; 95% CI = 1.383-11.740; P = .011) were found to be independent predictors of mortality. Additionally, a Kaplan-Meier survival analysis also revealed that long-term survival was found to be significantly decreased in patients with wider fQRSTa (log-rank P = .014)., Conclusion: fQRSTa was related with poor prognosis in patients with AS undergoing sAVR. fQRSTa was also an independent predictor of mortality in this population., (© 2020 Wiley Periodicals LLC.)

Background: Cardiac cachexia is an important predictive factor of the reduction in survival of patients with heart failure with reduced ejection fraction., Objectives: The aims of the present study were to evaluate adropin and irisin levels in cachectic and non-cachectic subjects and the relationships between the levels of these proteins and clinical and laboratory parameters in patients with HFrEF., Methods: The clinical records of patients who were admitted to the cardiology outpatient clinic for heart failure with reduced ejection fraction were screened. Cachectic patients were identified and assigned to the study group (n = 44, mean age, 65.4 ± 11.2 y; 61.4% men). Heart failure with reduced ejection fraction patients without weight loss were enrolled as the control group (n = 42, mean age, 61.0 ± 16.5 y; 64.3% men). The serum adropin and irisin levels of all patients were measured. A p-value < 0.05 was considered significant., Results: Serum adropin and irisin levels were significantly higher in the cachexia group than in the controls (Adropin (ng/L); 286.1 (231.3-404.0) vs 213.7 (203.1-251.3); p < 0.001, Irisin (µg/mL); 2.6 (2.2-4.4) vs 2.1 (1.8-2.4); p = 0.001). Serum adropin and irisin levels were positively correlated with brain natriuretic peptide (BNP) levels and New York Heart Association (NYHA) class and negatively correlated with body mass index (BMI) and serum albumin levels (all p values: < 0.001). In a multivariate analysis, adropin was the only independent predictor of cachexia in the heart failure with reduced ejection fraction patients (OR: 1.021; 95% CI: 1.004-1.038; p = 0.017)., Conclusions: The results suggest that adropin and irisin may be novel markers of cardiac cachexia in heart failure with reduced ejection fraction patients. Adropin and irisin are related with the severity of heart failure.

Introduction: Primary percutaneous coronary intervention (PPCI) is the preferred treatment of ST segment elevation myocardial infarction (STEMI). Manual thrombectomy catheters developed to prevent distant embolization are theoretically attractive; however, their clinical efficacy remains controversial. The effects of manual thrombectomy catheters on angiographically visible distal embolisation (AVDE) have not been studied so far. The aim of this study was to evaluate the effects of manual thrombectomy during PPCI on AVDE and to investigate whether there are differences in the incidence of AVDE according to the catheters used., Material and Methods: Six hundred thirty-six consecutive patients undergoing primary PCI were included in the study between January 2010 and December 2012. Patients were divided into two groups: the PCI only group (465 patients) and the PCI plus manual thrombectomy group (171 patients)., Results: Thrombus aspiration was associated with higher AVDE (13.55% vs. 26.9%, p = 0.0001), lower thrombolysis in myocardial infarction frame rate (2.49 ±0.86 vs. 2.79 ±0.57, p = 0.0001), lower myocardial blush grade (2.31 ±0.87 vs. 2.47 ±0.7, p = 0.016), lower ejection fraction (EF) (49.9 ±8.5 vs. 46.1 ±9.6, p = 0.0001) and higher maximal troponin release (15.7 ±16 vs. 9.4 ±11, p = 0.0001). No difference was observed in terms of mortality between the groups in follow-up (5.2% vs. 9.03%, p = 0.12). Angiographically visible distal embolisation was observed more frequently with Invatec catheters ( p = 0.0001)., Conclusions: Angiographically visible distal embolisation during primary PCI occurs in a significant number of patients treated with manual thrombectomy. The results indicated that the incidence of AVDE may be different depending on the thrombectomy catheters used., Competing Interests: The authors declare no conflict of interest.

Objectives: Galectin-3 is a marker associated with myocardial fibrosis and left ventricular myocardial index (LVMI). Myocardial fibrosis and LVMI have been reported in many studies to be associated with microvolt T-wave alternans (MTWA) positivity. In this study, galectin-3 levels of normotensive individuals and sustained systolic-diastolic hypertensive patients were compared and the association between galectin-3 levels and ambulatory ECG-based MTWA was investigated., Methods: A total of 184 individuals were included in the study, among whom, 43 were normotensive and 141 had sustained systolic-diastolic hypertension without cardiovascular or chronic renal failure. Galectin-3, MTWA, and LVMI were evaluated in all participants. Galectin-3 levels of hypertensive and normotensive participants were compared. The association between galectin-3, MTWA, LVMI, and estimated glomerular filtration rate (eGFR) was investigated in hypertensive patients., Results: LVMI and galectin-3 levels were higher among hypertensive patients compared with normotensives (94.9±26.8 vs. 76.4±22.9 g/m, 7.325±2.123 vs. 5.233±1.506 ng/ml; P<0.001, P<0.001). Correlation analysis carried out among the hypertensive patients showed that the galectin-3 level was correlated positively to LVMI, age, and MTWA positivity (r=0.396, P<0.001; r=0.358, P<0.001; r=0.361, P<0.001, respectively), whereas it was correlated negatively to eGFR and male sex (r=-0.364, P<0.001; r=-0.280, P=0.001, respectively). Multiple logistic regression analysis indicated that LVMI and galectin-3 showed an independent association with MTWA positivity in hypertensive patients (P=0.003 and 0.005, respectively)., Conclusion: Increased galectin-3 levels are associated with ambulatory ECG-based MTWA positivity, decreased eGFR, and increased LVMI in hypertensive patients. This association may be used for risk classification in this patient group.

In contrast to ST-elevation myocardial infarction treatment, there is no clear definition for when and which patient to discharge. Our study's main goal was to test the hypothesis that an early discharge strategy (within 48 to 56 hours) in patients with successful primary percutaneous coronary intervention (PPCI) is as safe as in patients who stay longer. The Early Discharge after Primary Percutaneous Coronary Intervention trial was designed in a prospective, randomized, multicenter fashion and registered with http://clinicaltrials.gov (NCT01860079). Of 900 patients with ST-elevation myocardial infarction, the study randomized 769 eligible patients to the early or the standard discharge group. The study's primary outcomes were all-cause mortality and readmission at 30 days. We considered assessment of functional status and health-related quality of life to be secondary outcomes. The early discharge group had significantly shorter length of hospital stay compared with the standard discharge group (45.99 ± 9.12 vs 114.87 ± 63.53 hours; p <0.0001). Neither all-cause mortality nor readmissions were different between the 2 study groups (p = 0.684 and p = 0.061, respectively). Quality-of-life measures were not statistically different between the 2 study groups. Our study reveals that discharge within 48 to 56 hours after successful PPCI is feasible, safe, and does not increase the 30-day readmission rate. Moreover, the patients perceived health status at 30 days did not differ with early discharge., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Both end-organ damage and high red cell distribution width (RDW) values are associated with adverse cardiovascular events, inflammatory status, and neurohumoral activation in hypertensive disease and in the general population. In this study, we investigated the relationship between RDW and end-organ damage in hypertensive patients., Material and Methods: The 446 systo-diastolic hypertensive patients included in the study received 24-hour ambulatory blood pressure monitoring. Left ventricular mass index, glomerular filtration rate, and microalbuminuria were measured to identify end-organ damage. High-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels of all patients were also examined., Results: The mean age of the participants was 49.96 ±11.04 years. The mean RDW was 13.06 ±1.05%. Red cell distribution width was positively correlated with left ventricular myocardial index (LVMI), urinary albumin, hs-CRP, and NT-proBNP (r = 0.298, p < 0.001; r = 0.228, p < 0.001; r = 0.337, p < 0.001; r = 0.277, p < 0.001, respectively), while RDW was negatively correlated with eGFR (r = -0.153, p < 0.001). Additionally, while there was a positive correlation between RDW and 24-h systolic blood pressure, no correlation was found between RDW and 24-h diastolic blood pressure (r = 0.132, p = 0.006 and r = 0.017, p = 0.725, respectively). Multiple linear regression analysis revealed that RDW levels were independently associated with eGFR, LVMI, and severity of albuminuria (β = 0.126, p = 0.010; β = -0.149, p = 0.002; β = 0.114, p = 0.035)., Conclusions: High RDW levels in systo-diastolic hypertensive patients were found to be an independent predictor of end-organ damage.

Background: Acute pulmonary embolism (APE) is a common disease which is associated with high mortality and morbidity. Circulating level of copeptin, which was demonstrated to be elevated in heart failure, acute myocardial infarction and pulmonary arterial hypertension, were reported to be independent predictors of poor outcome in recent studies. The aim of the present study was to investigate the clinical utility of copeptin in the diagnosis of APE., Methods: A total of 90 consecutive patients, admitted to emergency service due to acute chest pain and/or dyspnea and who underwent pulmonary computerized tomography angiography (CTA) due to suspicion of APE, were included in this prospective study. The patients diagnosed with APE were defined as APE (+) group and the remaining individuals with normal pulmonary CTA result were defined as APE (-) group., Results: Copeptin levels (7.76 ± 4.4 vs. 3.81 ± 1.34 ng/dL; p < 0.001) were higher in the APE (+) group as compared to the APE (-) group. Copeptin was significantly positively correlated with B-type natriuretic peptide (r = 0.434, p < 0.001), D-dimer (r = 0.315, p = 0.003) and troponin I (r = 0.300, p = 0.004) and inversely correlated with arterial oxygen saturations (r = -0.533, p < 0001). When the correlation of copeptin with right ventricular dysfunction parameters was investigated, it was significantly inversely correlated with the tricuspid annular plane systolic excursion (r = -0.521, p < 0.001) and positively correlated with right to left ventricle ratio (r = 0.329, p = 0.024). Copeptin (OR 1.836, 95% CI 1.171-2.878, p = 0.008) was found as a significant independent predictor of APE in a multivariate analysis, after adjusting for other risk parameters., Conclusions: Copeptin is a promising new biomarker, which may be used to support the need for further investigations and to improve the diagnosis of patients with APE.

Background: Vascular adhesion protein-1 (VAP-1), a dual-function glycoprotein, is secreted by endothelial cells, adipocytes, and kidney and vascular smooth muscle cells. It has been reported to participate in the development of atherosclerosis as an adhesion molecule and a pro-inflammatory enzyme. Increased VAP-1 levels are related to type 2 diabetes mellitus, atherosclerosis, stroke and chronic renal failure. The study aim was to investigate serum VAP-1 levels in patients with calcific aortic stenosis (AS) and the possible relationship between VAP-1 and severity of calcific AS., Methods: A total of 168 patients was categorized as having mild (n = 54), moderate (n = 58), or severe (n = 56) AS. Serum VAP-1 levels were measured using an enzyme-linked immunosorbent assay., Results: The mean serum VAP-1 level was significantly higher in patients with AS compared to healthy controls (244.3 ± 50.1 ng/ml versus 149.8 ± 27.5 ng/ml, p <0.001), and in the severe AS group compared to the moderate and mild AS groups (288.3 ± 30.1 ng/ml, 243.1 ± 31.8 ng/ml, and 200.8 ± 43.2 ng/ml, respectively, p <0.001). The VAP-1 level was positively related to the maximum aortic gradient, mean aortic gradient, and maximum aortic jet velocity (r = 0.649, p <0.001; r = 0.660, p <0.001; r = 0.655, p <0.001, respectively) and negatively related to the aortic valve area (r = -0.683, p <0.001)., Conclusions: The present study was the first to demonstrate a significant relationship between increased serum VAP-1 levels and the severity of calcific AS. VAP-1 might be a useful biomarker for the evaluation of AS and the follow up of its severity.

We investigated the association between the preoperative logistic clinical syntax score (log CSS), saphenous vein graft (SVG) patency, and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass surgery (CABG). Of 1875 patients undergoing isolated CABG between 2009 and 2011, 267 patients, who later underwent coronary angiography, were included in the study. The primary end point was at least 1 graft occlusion on the follow-up coronary angiogram. The secondary end point was a composite of MACCE. In multivariate analysis, log CSS was found as a strong predictor of SVG failure (odds ratio [OR] 0.66, 95% confidence interval [CI]: 0.46-0.94, P = .02; and OR: 2.21, 95% CI: 1.02-4.75, P = .04, respectively): log CSS was also associated with MACCE (P = .001 and P < .001, respectively). The addition of clinical parameters to the anatomical SYNTAX score, termed as "log CSS", augmented the accuracy and reliability of the prediction of SVG failure and MACCE in patients undergoing CABG., (© The Author(s) 2014.)

Background and Aim: We investigated the utility of the preprocedural red cell distribution width (RDW) for predicting contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment-elevation myocardial infarction (STEMI) who underwent a primary percutaneous coronary intervention., Materials and Methods: A total of 630 consecutive patients who were routinely referred to coronary angiography for STEMI were included in the present study., Results: CI-AKI was observed in 79 patients (12.5%). The RDW, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the mean platelet volume were significantly higher in the CI-AKI group than in the non-CI-AKI group (P<0.001, P=032, P=0.025, and P=0.039, respectively). Serum total bilirubin and direct bilirubin levels were not different among the study groups. Using multivariate logistic regression analysis, we found that left ventricular ejection fraction [odds ratio (OR)=0.972, 95% confidence interval (CI) 0.945-0.998, P=0.033], estimated glomerular filtration rate (OR=0.970, 95% CI 0.959-0.981, P<0.001), contrast volume (OR=1.007, 95% CI 1.002-1.012, P=0.009), and RDW (OR=1.406, 95% CI 1.120-1.792, P=0.005) were independent predictors of CI-AKI., Conclusion: Red blood cell distribution width, an inexpensive and easily measurable laboratory variable, is associated independently with the development of CI-AKI. Our data suggest that RDW may be a useful marker in CI-AKI risk stratification.

Background: The beneficial effects of the transcatheter aortic valve implantation (TAVI) on echocardiographic parameters including left atrial (LA) and left ventricular (LV) functions were described by previous studies. The aim of this study was to analyze the effects of TAVI on left atrial appendage (LAA) function assessed by transthoracic and transesophageal echocar-diography., Methods: Fifty-five patients with severe symptomatic aortic stenosis were included in this prospective study. LAA early and late emptying velocities, LAA filling velocity, peak early diastolic (EM), late diastolic (AM), and systolic (SM) velocities were measured with pulsed wave Doppler and tissue Doppler imaging, and E/Em ratio was calculated before and 7.1 ± 2.8 days after TAVI. A subgroup analysis was performed in accordance with the left ventricular ejection fraction (LVEF) of the patients and the severity of their LV diastolic dysfunction., Results: Although the post-procedure peaks and mean gradients of the patients decreased sig-nificantly, the LVEF increased significantly in those who had low LVEF before the procedure. The post-procedure E/Em ratio decreased significantly (p < 0.001). The post-procedural LAA mean filling velocity and EM velocity were significantly higher than the pre-procedural filling velocity (p < 0.001, p = 0.002, respectively). In the subgroup analysis, the post-procedural LAA filling velocity, early and late LAA emptying velocities, in addition to the mean velocity of the EM, AM, and SM were significantly higher than before the procedure in patients with LVEF of < 50% and E/Em ratios of > 15., Conclusions: LAA function improved soon after the TAVI procedure, especially in patients with low LVEF and marked LV diastolic dysfunction.

Background: The coronary slow flow (CSF) phenomenon is a delayed antegrade progression of contrast agent to the distal branch of a coronary artery in the absence of obstructive coronary artery disease (CAD). A narrow fragmented QRS (fQRS) has been reported as a significant predictor of sudden cardiac death in patients with idiopathic dilated cardiomyopathy. The present study aimed to investigate the relationship between a narrow fQRS on the admission electrocardiogram (ECG) and CSF on coronary angiography., Methods: This study included 165 consecutive patients (112 CSF, 53 controls) who underwent first-time diagnostic conventional coronary angiography for suspected CAD. Coronary flow was quantified by thrombolysis in myocardial infarction (TIMI) frame count (TFC). The patients were divided into two groups according to the presence or absence of a narrow fQRS complex on the admission ECG., Results: Forty four patients were in the fQRS group (mean age, 52.97 ± 3.13 years). There was no difference between the two groups with respect to age, gender, body mass index, family history, hyperlipidemia, hypertension, or diabetes mellitus. The extent of CSF was significantly greater in the fQRS group compared to the non-fragmented group (p < 0.001). A significant correlation was also found between mean TFC values and fQRS (p < 0.001). On multivariate analysis, only CSF (p = 0.03) was a significant independent predictor for narrow fQRS, after adjustment for other parameters., Conclusions: The narrow fQRS is a simple, inexpensive, and readily available noninvasive ECG parameter that may be a new potential indicator of myocardial damage in patients with CSF.