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Background: End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke. Methods: Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition–Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million person-years of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25 917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank. Results: There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eGFR values 105 mL·min –1 ·1.73 m –2 , compared with those with eGFR between 60 and 105 mL·min –1 ·1.73 m –2 . Mendelian randomization analyses for CHD showed an association among participants with eGFR –1 ·1.73 m –2 , with a 14% (95% CI, 3%–27%) higher CHD risk per 5 mL·min –1 ·1.73 m –2 lower genetically predicted eGFR, but not for those with eGFR >105 mL·min –1 ·1.73 m –2 . Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin A1c, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD. Conclusions: In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches that preserve and modulate kidney function.

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes.This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as65 years old, 65-75 yo, 75-84 yo and85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups.A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p0.05).Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.A delírium gyakran jelentkezik intenzív osztályon ápolt betegek körében, és rossz prognózissal társul. A de­lírium intenzív osztályos ellátása leginkább általános és palliatív intenzív osztályos adatokon alapul. Ebben a vizsgálatban azt a célt tûztük ki, hogy megállapítsuk a delí­rium incidenciáját és sajátosságait coronaria intenzív osztályon (CICU), továbbá megállapítsuk prognózisát, életkori eloszlását és a betegkimenetre gyakorolt hatását.A vizsgálatba egy tercier egyetemi kórház CICU-ján 2017. augusztus 1. és 2018. augusztus 1. között ápolt betegeit vontuk be. Részletesen tanulmányoztuk a betegdokumentációkat, rögzítettük a demográfiai, klinikai és laboratóriumi paramétereket. A delírium diagnózisát pszichiáter konzulens erôsítette meg. A betegeket két csoportra osztottuk (delírium vs. delíriummentesség), megállapítottuk a két csoportba kerülô betegek sajátosságait a vizsgálat kezdetén, és prognózisukat a kórházi ápolás és az utánkövetés során. Életkori sajátosságok alapján négy csoportba osztottuk a pácienseket:65 éves, 65–75 éves, 75–84 éves és85 éves, és a különbözô életkori csoportok között összehasonlítottuk a delí­rium incidenciáját, sajátosságait és prognózisát.1108, különbözô indikációk miatt intenzív osztályon ápolt beteget vontunk be a vizsgálatba (átlagos életkor: 64,4 ± 13,9 év; 66% férfi). Az összes beteg 11,1%-a esetében alakult ki delírium a CICU-n. A delí­riumban szenvedô betegek idôsebbek voltak, több kísérô betegségben szenvedtek, magasabb volt a szervezetük gyulladásos szintje, és magasabb volt a mortalitásuk is a kórházi ápolás során, mint azok esetében, akiknél nem alakult ki delírium (p0,05). A delirálók csoportjában az átlagosan 9 hónapos utánkövetés során szignifikánsan magasabb volt a kórházi újrafelvétel, az ismételt infarktus, a kognitív diszfunkció, a pszichiátriai kezelés szükségessége és a mortalitás is (p0,05). Az életkori alcsoportok szerinti felosztásban a delirálók csoportjában az életkor elôrehaladtával szignifikánsan nôtt a delírium és a mortalitás incidenciája egyaránt (p0,05).Amennyiben a coronaria intenzív osztályon ápolt betegnél delírium alakul ki, megnô a morbiditás és mortalitás incidenciája a kórházi ápolás alatt és az utánkövetés során is. A delírium gyakrabban fordul elô geriátriai betegek és társbetegségekkel küzdôk körében, és rosszabb prognózissal társul. A delírium mielôbbi felismerése érdekében a nagy kockázatú betegeket szorosan után kell követni.

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

OBJECTIVE: This study aimed to evaluate the safety of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) during daily clinical practice. METHODS: This was a prospective study conducted between January 01, 2016, and April 01, 2017, in patients aged ≥18 years with a diagnosis of NVAF. We performed the study in 9 clinical centers from different regions of Turkey, and the mean follow-up period was 12+2 months. We investigated major and minor bleeding events of DOAC. RESULTS: A total of 1807 patients with NVAF were enrolled. The mean age of the patients was 73.6±10.2 years, CHA2DS2-VASc score was 3.6±1.4, and HAS-BLED score was 2±1.2. The most frequently prescribed DOAC was dabigatran 110 mg bid in 409 (22.6%) patients. The patients on apixaban 2.5 mg bid were older (p

Background and objectives: Mortality may increase in hypouricemia as well as inhyperuricemia. We assessed the predictive value of low serum uric acid (SUA) levels on the risk of overall mortality or a composite endpoint of death and nonfatal events. Materials and Methods: In 1013 community-based middle-aged adults, free of uncontrolled diabetes and coronary heart disease at baseline, the association of sex-specific SUA tertiles with defined outcomes was evaluated prospectively by logistic regression, stratified to gender and presence of type-2 diabetes, using recent criteria. Results: Totally, 43 deaths and additional incident nonfatal events in 157 cases were recorded at a median 3.4 years’ follow-up. Multivariable linear regression disclosed SUA to be significantly associated among non-diabetic individuals positively with creatinine, triglycerides, and body mass index in women further with fasted glucose. In multivariable-adjusted logistic regression analysis, sex-specifically dichotomized baseline uric acid (&lt, 5.1 and &lt, 4.1 mg/dL vs. higher values) significantly predicted the non-fatal events in the whole sample (relative risk (RR) 1.51 [95% confidence interval (CI) 1.02, 2.26]), as well as in men, while composite endpoint in the whole sample tended to rise (RR 1.38). Compared with the intermediate one, the top and bottom SUA tertiles combined tended to confer mortality risk (RR 2.40 [95% CI 0.89, 6.51]). Adverse outcomes in diabetic women were predicted by tertiles 2 and 3. Conclusions: Inverse association of SUA with adverse outcomes, especially in men, is consistent with the involvement of uric acid mass in autoimmune activation. The positive association of uric acid with adverse outcomes in diabetic women is likely mediated by concomitant high-density lipoprotein dysfunction.

Objectives The prognostic effects of poor nutritional status and cardiac cachexia on coronary artery disease (CAD) are not clearly understood. A well-accepted nutritional status parameter, the prognostic nutritional index (PNI), which was first demonstrated to be valuable in patients with cancer and those undergoing gastrointestinal surgery, was introduced to patients requiring coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the prognostic value of PNI in patients with CAD undergoing CABG. Methods We evaluated the in-hospital and long-term (3-y) prognostic effect of PNI on 644 patients with CAD undergoing CABG. Baseline characteristics and outcomes were compared among the patients by PNI and categorized accordingly: Q1, Q2, Q3, and Q4. Results Patients with lower PNI had significantly higher in-hospital and long-term mortality. Patients with lower PNI levels (Q1) had higher in-hospital mortality and had 12 times higher mortality rates than those with higher PNI levels (Q4). The higher PNI group had the lower rates and was used as the reference. Long-term mortality was higher in patients with lower PNI (Q1)—4.9 times higher than in the higher PNI group (Q4). In-hospital and long-term mortality rates were similar in the non-lower PNI groups (Q2–4). Conclusion The present study demonstrated that PNI, calculated based on serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients undergoing CABG.

Keskin, Muhammed/0000-0002-4938-0097; Cinier, Goksel/0000-0001-5064-1816; Guvenc, Tolga Sinan/0000-0002-6738-266X WOS: 000430070500012 PubMed: 28401800 The prognostic impact of nutritional status in patients with pulmonary embolism (PE) is poorly understood. A well-accepted nutritional status parameter, prognostic nutritional index (PNI), which was first demonstrated to be valuable in patients with cancer and gastrointestinal surgery, was introduced to patients with PE. Our aim was to evaluate the predictive value of PNI in outcomes of patients with PE. We evaluated the in-hospital and long-term (53.8 +/- 5.4 months) prognostic impact of PNI on 251 patients with PE. During a median follow-up of 53.8 +/- 5.4 months, 27 (11.6%) patients died in hospital course and 31 (13.4%) died in out-of-hospital course. The patients with lower PNI had significantly higher in-hospital and long-term mortality. The Cox proportional hazard analyses showed that PNI was associated with an increased risk of all-cause death for both unadjusted model and adjusted for all covariates. Our study demonstrated that PNI, calculated based on serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients with PE.

Background: The Glasgow prognostic score (GPS), which is obtained from a combination of C-reactive protein (CRP) and serum albumin level, predicts poor prognoses in many cancer types. Systemic inflammation also plays an important role in pathogenesis of cardiovascular diseases. In this study, we aimed to investigate the effect of inflammation-based GPS on in-hospital and long-term outcomes in patients hospitalized in intensive cardiovascular care unit (ICCU). Methods: A total of 1004 consecutive patients admitted to ICCU were included in the study, and patients were divided into three groups based on albumin and CRP values as GPS 0, 1, and 2. Patients’ demographic, clinic, and laboratory findings were recorded. In-hospital and one-year mortality rates were compared between groups. Results: Mortality occurred in 109 (10.8%) patients in in-hospital period, 82 (8.1%) patients during follow-up period, and thus, cumulative mortality occurred in 191 (19.0%) patients. Patients with a high GPS score had a higher rate of comorbidities and represented increased inflammatory evidence. In the multivariate regression model there was independent association with in-hospital mortality in GPS 1 patients compared to GPS 0 patients (Odds ratio, (OR), 5.52, 95% CI: 1.2–16.91, p = 0.025) and in GPS 2 patients compared to GPS 0 patients (OR, 7.01, 95% CI: 1.39–35.15, p = 0.018). A higher GPS score was also associated with a prolonged ICCU and hospital stay, and increased re-hospitalization in the follow-up period. Conclusion: Inflammation based GPS is a practical tool in the prediction of worse prognosis both in in-hospital and one-year follow-up periods in ICCU patients.

Background and objectives: Despite being within the normal reference range, changes in thyroid stimulating hormone (TSH) levels have negative effects on the cardiovascular system. The majority of patients admitted to hospital with acute coronary syndrome (ACS) are euthyroid. The aim of this study was to investigate the effect of TSH level on the prognosis of in-hospital and follow-up periods of euthyroid ACS patients. Materials and Methods: A total of 629 patients with acute coronary syndrome without thyroid dysfunction were included in the study. TSH levels of patients were 0.3–5.33 uIU/mL. Patients were divided into three TSH tertiles: TSH level between (1) 0.3 uIU/mL and &lt, 0.90 uIU/mL (n = 209), (2) 0.90 uIU/mL and &lt, 1.60 uIU/mL (n = 210), and (3) 1.60 uIU/mL and 5.33 uIU/mL (n = 210). Demographic, clinical laboratory, and angiographic characteristics were compared between groups in terms of in-hospital and follow-up prognosis. Results: Mean age was 63.42 ± 12.5, and 73.9% were male. There was significant difference between tertiles in terms of TSH level at admission (p &lt, 0.001), the severity of coronary artery disease (p = 0.024), in-hospital mortality (p &lt, 0.001), in-hospital major hemorrhage (p = 0.005), total adverse clinical event (p = 0.03), follow-up mortality (p = 0.022), and total mortality (p &lt, 0.001). In multivariate logistic regression analysis, the high–normal TSH tertile was found to be cumulative mortality increasing factor (OR = 6.307, 95%, CI: 1.769–22.480, p = 0.005) during the 6-month follow-up period after hospitalization and discharge. Conclusions: High–normal TSH tertile during hospital admission in euthyroid ACS patients is an independent predictor of total mortality during the 6-month follow-up period after hospitalization and discharge.

Background and objectives: Cranial magnetic resonance imaging findings of patients considered to be cryptogenic stroke may be useful in determining the clinical and prognostic significance of arrhythmias, such as atrial premature beats and atrial run attacks, that are frequently encountered in rhythm Holter analysis. This study was conducted to investigate the relationship between short atrial runs and frequent premature atrial contractions detected in Holter monitors and infarct distributions in cranial magnetic resonance imaging of patients diagnosed with cryptogenic stroke. Materials and Methods: We enrolled the patients with acute ischemic stroke whose etiology were undetermined. We divided the patients in two groups according to diffusion-weighted magnetic resonance imaging as single or multiple vascular territory acute infarcts. The demographic, clinical, laboratory, echocardiographic, and rhythm Holter analyses were compared. Results: The study investigated 106 patients diagnosed with cryptogenic stroke. Acute cerebral infarctions were detected in 31% of the investigated patients in multiple territories and in 69% in a single territory. In multivariate logistic regression analysis, the total premature atrial contraction count (OR = 1.002, 95% CI: 1.001&ndash, 1.004, p = 0.001) and short atrial run count (OR = 1.086, 95% CI: 1.021&ndash, 1.155, p = 0.008) were found as independent variables that could distinguish between infarctions in a single or in multiple vascular territories. Conclusions: Rhythm Holter monitoring of patients with infarcts detected in multiple vascular territories showed significantly higher premature atrial contractions and short atrial run attacks. More effort should be devoted to the identification of cardioembolic etiology in cryptogenic stroke patients with concurrent acute infarcts in the multiple vascular territories of the brain.

Aim The aim of the study was to evaluate the predictive value of HbA1c for risk of overall mortality or a composite endpoint of death and nonfatal events. Methods Logistic regression retrospectively assessed the longitudinal association of measured HbA1c with outcome in 746 middle-aged adults, recruited from a tertiary health center and stratified to absence or presence of type 2 diabetes, using the recent American Diabetes Association criteria. Results A total of 70 deaths and additional incident nonfatal events in 82 cases were recorded at a median of 3.1-year follow-up. Multivariable linear regression revealed among nondiabetic individuals HbA1c to be significantly associated—independent of fasted glucose—inversely with triglycerides and high-density lipoprotein cholesterol, distinct from the diabetic sample. Sex and diabetes status differed in baseline HbA1c values with respect to the development of outcome. Nondiabetic men who subsequently died exhibited significantly lower HbA1c, as did men and women with incident coronary heart disease. Similar difference was observed for incident hypothyroidism and nondiabetic subjects developing malignancy. In logistic regression analysis, adjusted for sex, age, and fasting glucose, each 0.7% (SD, 1) decrement of baseline HbA1c predicted the composite endpoint in the nondiabetic sample (risk estimates, 1.49%; 95% confidence interval, 1.07–2.04), but not in the diabetic sample, whereas overall mortality in the whole sample was increased (risk estimates, 1.51%; 95% confidence interval, 1.05–2.17). Conclusions Inverse association of HbA1c with adverse outcomes in men and nondiabetic people indicates the involvement of HbA1c levels in autoimmune activation. The weaker inverse association with prevalent diabetes and in women is consistent with the operation of more pronounced confounding autoimmune processes.

Keskin, Muhammed/0000-0002-4938-0097; Altay, Servet/0000-0001-7112-3970; Guvenc, Tolga Sinan/0000-0002-6738-266X WOS: 000418481400018 PubMed: 29226903 …

WOS: 000398125400006, PubMed ID: 28424435, Objective: Data from EUROASPIRE-IV Turkey report investigating risk factors and adherence to guidelines in patients hospitalized for coronary artery disease are presented and results are compared with those of EUROASPIRE-III Turkey and EUROASPIRE-IV Europe. Methods: Study was performed in 24 European countries, including Turkey (17 centers). Patients (18-80 years old) hospitalized for coronary (index) event during preceding 3 years were identified from hospital records and interviewed >= 6 months later. Patient information regarding index event was acquired from hospital records. Anamnesis was obtained during the interview, and physical examination and laboratory analyses were performed. Results: Median age at the index coronary event was 58.8 years, and it was significantly decreased compared with last EUROASPIRE-III study (60.5 years), which was conducted at the same centers 6 years earlier (p=0.017). Of all patients, 19.3% were under 50 years of age and mean age was lower than that of EUROASPIRE-IV Europe (62.5 years). Comparing EUROASPIREIV Turkey with EUROASPIRE-III Turkey, rate of smokers increased to 25.5% from 23.1% (p=0.499), obesity increased to 40.7% from 35.5% (p=0.211), total cholesterol level increased to 49.6% from 48.3% (p=0.767), and diabetes rate increased to 39.7% from 33.6% (p=0.139), however none of the differences reached a level of statistical significance. Only 11.7% of the smokers quit after coronary event. Rates for these factors were lower in EUROASPIRE-IV Europe (16% for smoking, 37.6% for obesity, and 26.8% for diabetes). Conclusion: EUROASPIRE-IV Turkey data revealed that secondary prevention was unsatisfactory and had progressed unfavorably compared with last EUROASPIRE study, some risk factors were more uncontrolled than overall European average, and coronary artery events at young age remain an important problem.

BackgroundPeriprocedural management of antiplatelet or anticoagulant therapy at the time of device implantation remains controversial.MethodsWe reviewed all cases for whom a pacemaker was implanted in our institution between January 2008 and June 2009. In addition, beginning in June 2009, we prospectively collected data from all patients admitted to our institution, for whom a pacemaker was placed. Clinical characteristics and anticoagulant/antiplatelet drug use were evaluated.ResultsA total of 574 patients underwent a permanent pacemaker implantation. Of these, 20 patients (3.6%, 9 women) experienced a hematoma on pacemaker pocket site. Patients were aged between 35 and 79 years (mean 60.6±12 years). The frequency of hematoma formation was significantly higher (p0.05). Eleven pocket revisions for hematoma evacuation were needed in 9 patients (1.6%), six of whom were on warfarin therapy (p>0.05). Co-morbidities were similar in patients with and without hematoma (p>0.05).ConclusionThe frequency of hematoma is within acceptable ranges after pacemaker placement. The use of warfarin seriously increases the risk of hematoma. Bridging to LMWH safely prevents thromboembolism.

Background Cardiac device-related endocarditis (CDE) is a major complication of the implantation of a pacemaker and defibrillator. The experience in a single high-volume tertiary center is reported. Methods Thirty one years (1980–2011) of cases of CDE were analyzed retrospectively and compared to overall insertion data; the clinical course and management strategies of these patients have been reviewed. Results A total of 23 cases (16 male, median age 72 years) were identified, 20 of these cases were determined at our institution where 5287 procedures were performed (endocarditis rate 0.38%). Thirteen patients were determined to have a cardiac device pocket infection. Infection in 7 cases (30%) was caused by lead(s). However, in 16 cases (70%) both leads and the pocket of devices were the reason of infection. Median time was 13.5 months for presentation. Patients who had undergone the last procedure within 6 months were admitted earlier than those with longer post procedure time (p

Objectives Recent studies have reported a strong independent association between increased red cell distribution width (RDW) and the risk of adverse outcomes in patients with heart failure, stable coronary disease, and acute coronary syndromes. However, in this study we aimed to determine the impact of an elevated RDW level on the postinterventional thrombolysis in myocardial infarction (TIMI) flow and intrahospital mortality in patients with acute anterior myocardial infarction (AMI). Methods A total of 763 patients with acute AMI undergoing a primary percutaneous coronary intervention were evaluated retrospectively. Upon admission, the RDW level was measured by an automated complete blood count. Postinterventional TIMI flow and intrahospital mortality was documented for all patients from hospital registries. The patients were classified according to the RDW level. RDW more than 14.8% was defined as elevated RDW. All groups were compared statistically according to the preinterventional characteristics. Results Elevated RDW was found to be an independent predictor of increased intrahospital mortality in multivariate regression analysis (hazard ratio: 3.677, 95% confidence interval: 1.228-11.008, P=0.02). Other independent predictors for intrahospital mortality were diabetes mellitus (hazard ratio: 6.743, 95% confidence interval: 1.941-23.420, P=0.003), smoking (hazard ratio: 6.779, 95% confidence interval: 1.505-30.534, P=0.013), and creatinine more than 0.8 mg/dl (hazard ratio: 7.982, 95% confidence interval: 1.759-36.211, P=0.007). However, there were no independent predictors for TIMI including elevated RDW. Conclusion A high admission RDW level in patients with acute AMI undergoing a primary percutaneous coronary intervention was associated with an increased risk for intrahospital cardiovascular mortality, but was not associated with worse postinterventional TIMI flow.

Altay, Servet/0000-0001-7112-3970; Guvenc, Tolga Sinan/0000-0002-6738-266X; Keskin, Muhammed/0000-0002-4938-0097 WOS: 000403554000009 PubMed: 28392077 Background and aim: The prognostic impact of poor nutritional status and cardiac cachexia in myocardial infarction is not clearly understood. Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in colorectal surgeries and postoperative septic complications. The present study aimed to evaluate the prognostic value of PNI in ST-segment elevation myocardial infarction (STEMI) patients. Methods and results: We evaluated the in-hospital and long-term (3 years) prognostic impact of PNI on 1823 patients with STEMI undergoing primary percutaneous coronary intervention. Patients with lower PNI had significantly higher in-hospital and long-term mortality and major adverse cardiac events. After adjustment for all confounders, the in-hospital mortality rates were 7.9 times higher at the lower PNI level (95% CI: 5.0-15.8) than those at the higher PNI level. The long-term mortality rates were also 6.4 times higher at the lower PNI level (95% CI: 4.4-12.4) than those at the higher PNI level. Conclusion: The present study demonstrated that the PNI, calculated based on the serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients with STEMI. (C) 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Objective: A predictive role of serum Pentraxin 3 (PTX3) for short-term adverse cardiovascular events including mortality in acute myocardial infarction (AMI) was reported in recent studies. The aim of the study was to investigate long-term prognostic significance of serum PTX3 in an AMI with 5-year follow-up period in this study. Methods: In this prospective study, 140 patients, who were admitted to the emergency department between January 2011 and December 2011 with acute chest pain and/or dyspnea and diagnosed with AMI and 60 healthy controls were included. PTX3 levels were measured at admission by using an ELISA method. The study group was divided into tertiles on the basis of admission PTX3 values: the high-PTX3 group (≥4.27 ng/mL), the middle-PTX3 groups (4.27–1.63 ng/mL), and the low-PTX3 group (≤1.63 ng/mL). Results: PTX3 level was significantly more greatly increased in the AMI group than in the controls (2.27±0.81 vs. 0.86±0.50 ng/mL, p

Objective: We investigated the possible association of serum acylation stimulating protein (ASP) with cardiometabolic disorders and the evidence of autoimmune activation. Methods: Population-based randomly selected 1024 participants were cross-sectionally and prospectively analyzed. ASP concentrations were measured with a validated ELISA kit. Correlations were sought separately in subjects with no cardiometabolic disorders (n=427) designated as “healthy.” Results: ASP was positively correlated with total testosterone and inversely correlated with platelet activating factor (PAF), PAF-acetylhydrolase (AH), in each gender, and positively correlated in “healthy” men with lipoprotein [Lp](a) and apolipoprotein B. Correlations of ASP with PAF values ≥22 nmol/L were abolished, contrasted to a strongly inverse one in subjects with PAF

Background: A tombstoning pattern (T-pattern) is associated with in-hospital poor outcomes patients with ST-segment elevation myocardial infarction (STEMI), but no data are available for midterm follow-up. We sought to determine the prognostic value of a T-pattern on admission electrocardiography (ECG) for in-hospital and midterm mortality in patients with anterior wall STEMI treated with primary percutaneous coronary intervention (PCI). Methods: After exclusion, 169 consecutive patients with anterior wall STEMI (mean age: 55 ± 12.9 years; 145 men) undergoing primary PCI were prospectively enrolled in this study. Patients were classified as a T-pattern (n = 32) or non–T-pattern (n = 137) based upon the admission ECG. Follow-up to 6 months was performed. Results: In-hospital mortality tended to be higher in the T-pattern group compared with non–T-pattern group (9.3% vs 2.1% respectively, P = 0.05). All-cause mortality was higher in the T-pattern group than non–T-pattern group for 6 month (P = 0.004). After adjusting the baseline characteristics, the T-pattern remained an independent predictor of 6-month all-cause mortality (odds ratio: 5.18; 95% confidence interval: 1.25–21.47, P = 0.02). Conclusion: A T-pattern is a strong independent predictor of 6-month all-cause mortality in anterior STEMI treated with primary PCI. Therefore, it may be an indicator of high risk among patients with anterior wall STEMI.

Herein we describe 6 cases of patients with Alzheimer’s disease presented with syncope, dizziness, and dyspnea soon after the initiation of cholinesterase inhibitor therapy. All patients had bradyarrhythmia on electrocardiogram (ECG). Two patients had complete atrioventricular block, 2 pateints had 2/1 type atrioventricular block, 1 patient had sinus bradycardia and hypersensitive carotid sinus syndrome, and 1 had sick sinus syndrome. All these patients were treated with pacemaker implantation and the cholinesterase inhibitor therapy continued. At 13-month follow-up, no syncope, dizziness, or dyspnea was reported.

Objectives We aimed to observe the relationship of the metabolic syndrome and proarrythmogenic ECG parameters and to evaluate a possible correlation of these parameters to the metabolic syndrome score in patients without overt diabetes mellitus. Methods The study population consisted of 142 patients with the metabolic syndrome and 170 age- and gender-matched control subjects. In the ECG recordings, resting heart rate, QRS duration, corrected QT duration and corrected QT dispersion were measured. Patients were classifi ed into three groups based on number of fulfi lled metabolic syndrome criteria: group 1 (three metabolic syndrome criteria), group 2 (four metabolic syndrome criteria) and group 3 (fi ve metabolic syndrome criteria). Results Patients with the metabolic syndrome had a higher increased resting heart rate, QTcd, prolonged QRS and QTc duration. Resting heart rate increases signifi cantly parallel to the increase in the metabolic syndrome score across the groups, whilst QRS duration remained unchanged. QTc duration and QTc dispersion were signifi cantly higher in groups 2 and 3 when compared to group 1. However, no signifi cant diff erences were observed between groups 2 and 3. Conclusion We demonstrated that the metabolic syndrome and its score related with increased resting heart rate and prolonged repolarization durations in patiens without overt diabetes mellitus. These pro arrhythmogenic parameters could be used in the development of risk stratifi cation schemes for sudden cardiac death in patients with the metabolic syndrome.

OBJECTIVES We analyzed all-cause and coronary mortality data of the Turkish Adult Risk Factor Study cohort in Marmara and Central Anatolia regions, surveyed in 2011, and overall performance of long-term (21 years) follow-up of participants. STUDY DESIGN A total of 1,588 participants with an age range of 45 to 74 years were surveyed. Information on the mode of death was obtained from first-degree relatives and/or personnel of local health offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiograms. Loss to follow-up was defined as the lack of physical examination for at least eight years. RESULTS Of the surveyed participants, 854 were examined, information on health status was obtained in 606 subjects, 46 individuals (28 men, 18 women) were ascertained to have died, and 82 subjects were lost to follow-up. A total of 2,800 person-years were added to follow-up. Nineteen deaths were attributed to coronary heart disease (CHD) and five deaths to cerebrovascular events. Overall mortality was estimated as 10.9 per 1000 person-years. In the age bracket of 45-74 years, overall annual all-cause mortality and CHD mortality were 12.8 and 5.5 per mille, respectively. Based on the total loss to follow-up (31.2%) during the past two decades, an annual loss to follow-up may be derived as 19.3 for every 1000 participants. This loss was nearly twice as high in participants living in big cities compared to those in smaller towns and rural areas. CONCLUSION A trend to slight reduction in coronary mortality, though not in overall mortality, before the age 75 years is noted in Turks. Annual loss to follow-up amounts to 2% of the participants.

Congenital absence of the pericardium is a rare cardiac defect with variable clinical presentations and is usually discovered incidentally. The pathology may lead to serious complications such as incarceration of cardiac tissue, myocardial ischemia, aortic dissection or valvular insufficiency. Diagnosis is not difficult so long as some tips are remembered. We present the cases of two patients with congenital absence of left pericardium.

Isolated left ventricular noncompaction (LVNC) is a rare hereditary cardiomyopathy characterized by prominent intraventricular trabeculations separated by deep intertrabecular recessus. While cardiac ischemia due to microvascular dysfunction is common in these patients, ST-segment elevation myocardial infarction (STEMI) is rare and usually seen as a consequence of coincidental coronary artery disease. We report the case of a 20 year-old male patient admitted to our emergency department with a complaint of squeezing chest pain who was subsequently diagnosed with STEMI according to electrocardiographic findings, although an emergent coronary angiogram demonstrated normal coronary arteries. Echocardiography revealed isolated LVNC, and the diagnosis was confirmed via magnetic resonance imaging. Repeat coronary catheterization with acetylcholine infusion and coronary flow reserve measurement failed to demonstrate vasospasm or microvascular dysfunction. As no apparent cause was found, this case was designated ‘idiopathic’ myocardial infarction. Coronary thromboembolism due to stagnation of blood in the left ventricular cavity remained as the most probable mechanism underlying myocardial infarction.

Cigarette smoking increases the oxidative stress mediated vascular dysfunction in young adults. We aimed to investigate the relation between the oxidative stress indices and coronary artery disease (CAD) severity in young patients presenting with acute myocardial infarction (AMI).Young patients (aged 〈 35 years) who were admitted consecutively to our hospital with a diagnosis of AMI were included in the study. Age matched healthy subjects were selected as controls. Oxidative stress indices including lipid hydroperoxide (LOOH), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase (PON) and arylesterase (ARE) activities were measured in serum. CAD severity was assessed by calculating the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Study) score. We analyzed the association between the oxidative indices and CAD severity.Forty two young patients were admitted to the hospital with AMI (age 32.4 ± 2.6 years; 39 males, 3 females). Current and heavy smoking was commonly observed among the patients (79%). All patients underwent emergency coronary angiography. Twenty-eight healthy subjects were selected as controls. Patients had significantly higher OSI and TOS levels (median, interquartile range) [0.44 (0.26-1.75) vs 0.25 (0.22-0.30), p0.001 and 6.0 (4.4-20.8) vs 4.1 (3.7-4.6), p0.001], respectively, and lower TAS and LOOH levels [1.6 ± 0.1 vs 1.7 ± 0.1, p = 0.02 and 3.0 ± 0.8 vs 3.6 ± 0.4, p = 0.001], respectively, compared to the control group. CAD severity correlated positively with OSI (r = 0.508, p = 0.001) and TOS levels (r = 0.471, p = 0.002). Subjects with an intermediate to high SYNTAX score (≥ 22) demonstrated significantly higher OSI (median, interquartile range) [0.40 (0.34-1.75) vs 0.34 (0.26-0.68), p = 0.01] and TOS [6.9 (4.4-20.8) vs 5.8 (4.5-11.4), p = 0.01] levels compared to subjects with low SYNTAX score.Oxidative stress is an important contributor to CAD severity among young smokers. Elevated OSI and TOS levels reflect disease severity and vascular damage related to heavy smoking in early onset CAD.

Summary Background Topical beta-blockers have a well-established role in the treatment of glaucoma. We aimed to investigate the outcome of patients who developed symptomatic atrioventricular (AV) block induced by topical beta-blockers. Methods All patients admitted or discharged from our institution, the Siyami Ersek Training and Research Hospital, between January 2009 and January 2013 with a diagnosis of AV block were included in the study. Subjects using ophthalmic beta-blockers were recruited and followed for permanent pacemaker requirement during hospitalisation and for three months after discontinuation of the drug. A permanent pacemaker was implanted in patients in whom AV block persisted beyond 72 hours or recurred during the follow-up period. Results A total of 1 122 patients were hospitalised with a diagnosis of AV block and a permanent pacemaker was implanted in 946 cases (84.3%) during the study period. Thirteen patients using ophthalmic beta-blockers for the treatment of glaucoma and no other rate-limiting drugs were included in the study. On electrocardiography, eight patients had complete AV block and five had high-degree AV block. The ophthalmic beta-blockers used were timolol in seven patients (55%), betaxolol in four (30%), and cartelol in two cases (15%). The mean duration of ophthalmic beta-blocker treatment was 30.1 ± 15.9 months. After drug discontinuation, in 10 patients the block persisted and a permanent pacemaker was implanted. During follow up, one more patient required pacemaker implantation. Therefore in total, pacemakers were implanted in 11 out of 13 patients (84.6%). The pacemaker implantation rate did not differ according to the type of topical beta-blocker used (p = 0.37). The presence of infra-nodal block on electrocardiography was associated with higher rates of pacemaker implantation. Conclusion Our results indicate that topical beta-blockers for the treatment of glaucoma may cause severe conduction abnormalities and when AV block occurs, pacemaker implantation is required in a high percentage of the patients.

Objective: The objective of this study was to retrospectively analyze the clinical course and postoperative long-term survival of patients diagnosed with isolated left main coronary artery (LMCA) stenosis after surgical revascularization. Methods: A total of 38 patients (27 males, 11 females) who were diagnosed with isolated LMCA stenosis and underwent surgical revascularization were enrolled in the study. Isolated LMCA stenosis was classified into 2 groups: ostial stenosis and nonostial stenosis. Coronary events were defined as death of cardiac origin, the need for a new myocardial revascularization procedure, or the occurrence of myocardial infarction in the course of follow-up. The postoperative assessment period included short- and long-term follow-up. The study endpoint was defined as all-cause mortality. Results: Among the 38 patients who participated in the study, 25 suffered from ostial LMCA stenosis. The early postoperative mortality rate before hospital discharge was 2.6%. Median duration of postoperative long-term follow-up was 73.43 months (range: 0.17–187.23). Median duration of long-term follow-up free from coronary events or percutaneous coronary interventions was 73.43 months. Postoperative 2-year survival rate was 97.4%, and 5-year survival rate was 92.1%. The postoperative survival period and period free of coronary events of patients with isolated ostial LMCA stenosis did not differ significantly from those of patients with nonostial stenosis (p=0.801, p=0.970, respectively). Conclusion: Postoperative short- and long-term prognosis of isolated LMCA stenosis appears good in terms of mortality and coronary event symptoms.

Altay, Servet/0000-0001-7112-3970; Ademoglu, Evin/0000-0003-2933-3119; WOS: 000362968700001 PubMed: 25592098 Objective: The potential association of rheumatoid factor (RF) and lipoprotein (Lp)(a) levels, as well as with the likelihood of type 2 diabetes and hypertension, needs exploring. Methods: Cross-sectional associations were sought in this unselected and population-based 1539-adult cohort (age 58.8 +/- 10.6 years). RF was assayed nephelometrically. Multiple logistic regression analyses were used for covariates of RF positivity and for the latter's association with diabetes and hypertension. Results: RF-positive individuals were older, fewer current smokers, had significantly lower fasting triglycerides (by 13%), higher fibrinogen, and tended to higher sex hormone-binding globulin (SHBG) levels. Whereas, women had a similar risk profile irrespective of RF status, RF-positive men had significantly higher Lp(a). In contrast to Lp(a) being positively correlated with SHBG in RF-negative subjects (r = 0.08; p = 0.007), an inverse correlation existed in seropositive individuals (r = -0.32, p = 0.011), suggesting the interplay of an immune complex. In regression analyses, RF positivity was associated with Lp(a) in men but not in women, [OR 1.53 (1.19; 1.96)], independent of age, SHBG, and C-reactive protein (CRP). RF positivity was further associated with diabetes [OR 1.98 (95% CI 1.11; 3.52)] in the whole sample, additively to waist circumference and CRP, major determinants of diabetes. RF-positive subjects were not significantly associated independently with hypertension. Conclusion: Autoimmune activation linked to Lp(a) is mediated by the autoantibody RF in contributing to the development of type 2 diabetes.

Background The definition of glomerular hyperfiltration has not been agreed upon and the pathophysiological mechanisms have not been well explored. Low serum creatinine concentrations may be associated with increased risk of coronary heart disease (CHD) or cardiopulmonary events the impact of which needs further study. Methods Consecutive applicants to a cardiovascular hospital free of moderate/severe chronic kidney disease (age 55.6 ± 8.2 years) were grouped into those without (“healthy”, n = 469) and with CHD (320 stable and acute coronary syndrome cases) at baseline and into sex-specific quartiles of CKD-EPI equation-estimated glomerular filtration rate (eGFR). New or recurrent cardiovascular (myocardial infarction, stroke, heart failure [HF]) events, obstructive pulmonary disease (COPD) and death were determined during 3-years’ follow-up. Results Among 25 deaths and 75 cardiopulmonary events, HF was the leading nonfatal event. Age, serum uric acid and left ventricular ejection fraction proved the best independent inverse covariates of eGFR in the “healthy” sample. The highest eGFR quartile (“hyperfiltrators”), exhibiting significantly lower serum LDL-cholesterol levels, significantly predicted the combined outcome (at a RR of 6) in “healthy” subjects, after adjustment for sex, age, body mass index, smoking status and presence of hypertension. This finding was paralleled by the highest eGFR quartile calculated also by the MDRD equation, replicating this also in the CHD group. Conclusion Renal “hyperfiltrators” represent individuals with autoimmune activation (involving serum creatinine, partly escaping assay), are misclassified into optimal renal function and actually are at significantly higher risk of death, HF or cardiopulmonary events. Low serum creatinine levels may represent a clue to the existence of autoimmune activation.

The incidence of contrast-induced acute kidney injury (CI-AKI) is rising due to increased use of coronary angiography and percutaneous coronary intervention. Many agents, including statins, have been evaluated in several studies for the prevention of CI-AKI. To date, there have been 14 prospective randomized studies regarding the efficacy of statins on the patient. Most of these studies and 3 recent meta-analyses have concluded that statins should be used for this purpose, even in patients with reduced low-density lipoprotein cholesterol levels. However, there are also conflicting results, most likely due to marked heterogeneity of patient characteristics, dosage and administration patterns of statins, definition of CI-AKI, and different statistical analyses. In conclusion, it is uncertain whether statins should be prescribed to prevent CI-AKI in the absence of other indications.

Purpose Ventricular noncompaction/hypertrabeculation (NC/HT) is a rare form of congenital cardiomyopathy. We aimed to investigate the presence of serum tenascin-C (TN-C) in adult patients with NC/HT and evaluate its value. Methods and Results Serum TN-C levels were measured by ELISA in 50 NC/HT patients both with/without systolic dysfunction and in 23 normal controls. Systolic dysfunction was defined as ejection fraction (EF) ≤ 40. Mann–Whitney U-test and ROC curve analysis were done. Of 49 NC/HT patients, 24 (49%) patients had systolic dysfunction (mean age 36 ± 15) and 25 patients (51%) had normal systolic function (mean age 36 ± 17). The ages between groups were not different. The mean levels of serum TN-C in patients with or without systolic dysfunction were 26 ± 10 ng/mL and 26 ± 8 ng/mL respectively, compared to normal controls, 7 ± 2 ng/mL (P

Background: Efficacy of intravenous (IV) volume expansion in preventing contrast-induced acute kidney injury (CI-AKI) is well known. However, the role of oral hydration has not been well established. The aim of this work was to evaluate the efficacy of oral hydration in preventing CI-AKI. Methods: We prospectively randomized 225 patients undergoing coronary angiography and/or percutaneous coronary intervention in either oral hydration or IV hydration groups. Patients who have at least one of the high-risk factors for developing CI-AKI (advanced age, type 2 diabetes mellitus, anemia, hyperuricemia, a history of cardiac failure or systolic dysfunction) were included in the study. All patients had normal renal function or stage 1-2 chronic kidney disease. Patients in the oral hydration group were encouraged to drink unrestricted amounts of fluids freely whereas isotonic saline infusion was performed by the standard protocol in the IV hydration group. Results: CI-AKI occurred in 8/116 patients (6.9%) in the oral hydration group and 8/109 patients (7.3%) in the IV hydration group (p = 0.89). There was also no statistically significant difference between the two groups when different CI-AKI definitions were taken into account. Conclusion: Oral hydration is as effective as IV hydration in preventing CI-AKI in patients with normal kidney function or stage 1-2 chronic kidney disease, and who also have at least one of the other high-risk factors for developing CI-AKI.

Ergelen, Mehmet (Balikesir Author), Objectives: The neutrophil to lymphocyte ratio (NLR) has been investigated as a new predictor for cardiovascular risk. Admission NLR would be predictive of adverse outcomes after primary angioplasty for ST-segment elevation myocardial infarction (STEMI). Methods: A total of 2410 patients with STEMI undergoing primary angioplasty were retrospectively enrolled. The study population was divided into tertiles based on the NLR values. A high NLR (n = 803) was defined as a value in the third tertile (> 6.97), and a low NLR (n = 1607) was defined as a value in the lower 2 tertiles ( 6.97) was found as an independent predictor of inhospital cardiovascular mortality (odds ratio: 2.8, 95% confidence interval: 1.37-5.74, P = .005). Conclusions: High NLR level is associated with increased inhospital and long-term cardiovascular mortality in patients with STEMI undergoing primary angioplasty.

In view of recent evidence that serum creatinine and dysfunctional apolipoprotein (apo)A-I may serve as inflammation mediators in people with enhanced inflammation, we studied whether or not these molecules were interrelated and associated with coronary heart disease (CHD) likelihood even in subjects without metabolic syndrome (MetS) or type-2 diabetes.Among unselected middle-aged Turkish adults with available serum apo A-I, lipoprotein(a) and creatinine measurements, 697 participants (designated as 'healthy') were enrolled, after exclusion of the stated metabolic disorders. CHD was identified in 87 subjects, roughly half during 3.1 years' follow-up.'Healthy' individuals were overweight and had partly impaired fasting glucose but otherwise normal serum creatinine and other biochemical measurements. Being consistent with lacking anti-inflammatory activity, apoA-I was linearly and positively associated with apoB, in women further with creatinine. Logistic regression analyses showed that, beyond age, not non-HDL-cholesterol, systolic blood pressure and smoking status, but serum creatinine in each sex (OR in men 1.63 [95% CI 1.14; 2.31]) and CRP in women were significantly associated with CHD likelihood. The combined highest and lowest creatinine quartiles in women displayed an OR 2.14 (1.02; 4.51) compared with the intermediate quartiles, after similar adjustments.Elevated creatinine levels within normal range, linked to apoA-I dysfunctionality, are independently associated with CHD likelihood even in non-diabetic subjects without MetS. In such women the lowest creatinine quartile is also linked to CHD risk.

Kazim Serhan Özcan, Damirbek Osmonov, Servet Altay, Cevdet Dönmez, Ersin Yildirim, Ceyhan Türkkan, Baris Güngör, Ahmet Ekmekçi, Ahmet Taha Alper, Kadir Gürkan, Ä°zzet ErdinlerDepartment of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, TurkeyAims: To evaluate the complication rate differences between elderly and younger patients who receive a permanent pacemaker implantation.Methods: We reviewed all cases admitted to our institution between January 2008 and June 2009 with symptomatic bradyarrhythmia for whom a permanent pacemaker was implanted. Beginning in June 2009, we prospectively collected data from all patients with the same diagnosis and procedure. The frequency of complications due to the pacemaker implantation procedure was evaluated and compared between young (

Noncompaction of the ventricular myocardium is a congenital cardiomyopathy characterized by prominent ventricular trabeculations and deep intertrabecular recesses. In most cases, noncompaction is an isolated disease confined to the left ventricular myocardium. Fertile eunuch syndrome is a hypogonadotropic hormonal disorder in which the levels of testosterone and follicle-stimulating hormone are low. We report a case of biventricular noncompaction in association with bicuspid aortic valve and severe aortic stenosis in a 42-year-old man who was diagnosed with talipes equinovarus and fertile eunuch syndrome during childhood.

We explored the association of serum uric acid (UA) concentrations with pro-inflammatory state and high-density lipoprotein (HDL) dysfunction. UA tertiles in tracked 1,508 nondiabetic participants were analyzed cross-sectionally for associations with inflammation biomarkers and protective proteins over a mean follow-up of 4.9 years for incident coronary heart disease (CHD) using Cox proportional hazards regression. In the absence of metabolic syndrome (MetS), UA tertiles significantly distinguished, in each sex, increasing categories of three MetS components (inflammation/oxidation markers, apolipoprotein (apo)B) and (inversely) current smoking (but not protective proteins such as HDL, apoA-I, and adiponectin). Distinctions attenuated in the presence of MetS. Linear regression model revealed fasting triglycerides (1.86 mg/dl variance), male sex, and gamma-glutamyl transferase and age as covariates of UA levels in women. In Cox analysis, incident CHD (n = 137) was predicted by mid and upper UA tertile in men alone at significant hazard ratios of 2.7, additively to conventional risk factors. Elevated serum UA levels, linked to triglycerides, mark in nondiabetic people pro-inflammatory state, and, notably, HDL dysfunction. CHD risk is independently predicted by elevated UA levels in nondiabetic men and is modulated by MetS and gender.

Ventricular hypertrabeculation/noncompaction is a morphologic and functional anomaly of myocardium characterized by prominent trabeculae accompanied by deep recessus. Dilated cardiomyopathy with left ventricular failure is observed in these patients, while the cause or pathophysiologic nature of this complication is not known. Anti-troponin antibodies are formed against circulating cardiac troponins after an acute coronary event or conditions associated with chronic myocyte necrosis, such as dilated cardiomyopathy. In present study, we aimed to investigate cardiac troponins and anti troponin autoantibodies in ventricular noncompaction/hypertrabeculation patients with/without reduced ejection fraction. A total of 50 patients with ventricular noncompaction and 23 healthy volunteers were included in this study. Noncompaction/hypertrabeculation was diagnosed with two-dimensional echocardiography using appropriate criteria. Depending on ejection fraction, patients were grouped into noncompaction with preserved EF (LVEF >50%, n = 24) and noncompaction with reduced EF (LVEF

Background: Resistin is a novel adipokine that is suggested to be involved in inflammatory conditions and atherosclerosis. Aim: To investigate the prognostic importance of resistin in acute myocardial infarction (AMI) patients. Methods: Resistin levels were measured in a population of 132 patients with AMI, of whom 72 (54%) had a diagnosis of ST elevation myocardial infarction (STEMI), and 60 (46%) had non-ST elevation myocardial infarction (NSTEMI). Thirty-three consecutive subjects who were referred to elective coronary angiography due to chest pain evaluation with normal coronary angiograms served as controls. All patients were followed-up for the occurrence of major adverse cardiac events (MACE). Results: There was a significant increase in serum resistin levels in patients with AMI compared to controls (3.71 ± 4.20 vs. 2.00 ± 1.05, p = 0.001, respectively). However, serum resistin levels were similar in patients with STEMI and NSTEMI. (4.26 ± 5.11 vs. 3.06 ± 2.64, p = 0.49, respectively). The patients with MACE had significantly higher levels of serum resistin levels compared to either the AMI or the control group (6.35 ± 5.47, p = 0.005, respectively). Logistic regression analysis revealed that resistin, left ventricular ejection fraction, and coronary artery bypass graft were independent predictors of MACE in AMI patients (OR = 1.11, 95% CI 1.01–1.22, p = 0.03 and OR = 3.84, 95% CI 1.26–11.71, p = 0.018, respectively). Conclusions: Serum resistin level was increased in patients with AMI and constituted a risk factor for MACE in this group.

OBJECTIVES We aimed to examine in-hospital and long-term outcomes of red blood cell (RBC) transfusions in patients undergoing a primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). METHODS Overall, 2537 consecutive STEMI patients (mean age 56.2 ± 11.7 years, 2111 men, 426 women) undergoing primary angioplasty were enrolled retrospectively into the present study. Patients were categorized according to whether they received RBC transfusions during hospitalization. Clinical characteristics, and in-hospital and long-term outcomes of the primary PCI were analyzed. RESULTS Of the consecutive 2537 patients, 88 (3.4%) received RBC transfusions during the index hospitalization. The transfused patients were older than nontransfused patients (mean age 63.6 ± 12.1 vs. 56.2 ± 11.8, P