Search

Ramadan interferes with circadian rhythms mainly by disturbing the routine patterns of feeding and smoking. The objective of this study was to investigate the circadian pattern of ST elevation acute myocardial infarction (STEMI) during the month of Ramadan. We studied consecutive STEMI patients 1 month before and after Ramadan (non-Ramadan group-NRG) and during Ramadan (Ramadan group-RG). The RG group was also divided into two groups, based on whether they chose to fast: fasting (FG) and non-fasting group (NFG). The time of STEMI onset was compared. A total of 742 consecutive STEMI patients were classified into 4 groups by 6 h intervals according to time-of-day at symptom onset. No consistent circadian variation in the onset of STEMI was observed both between the RG ( P = .938) and NRG ( P = .766) or between the FG ( P = .232) and NFG ( P = .523). When analyzed for subgroups of the study sample, neither smoking nor diabetes showed circadian rhythm. There was a trend towards a delay from symptom onset to hospital presentation, particularly at evening hours in the RG compared with the control group. In conclusion, there was no significant difference in STEMI onset time, but the time from symptom onset to hospital admission was significantly delayed during Ramadan.

Introduction: This study was designed to evaluate the relationship between left atrial volume index, which is an important indicator of left ventricular diastolic dysfunction, and electrocardiographic parameters such as P wave duration, P wave dispersion (PWDISP), P wave terminal force (PWTF), and P wave peak time (PWPT) in hypertensive patients. Patients and Methods: A total of 58 patients with a diagnosis of hypertension between June 2017 and April 2018 were included in this retrospective study. Age-sex matched 58 healthy subjects constituted the control group. The patients without diastolic dysfunction and stage I diastolic dysfunction were included in the normal left atrial pressure (NLAP) group, while stage II and stage III diastolic dysfunction patients constituted the high left atrial pressure (HLAP) group. Results: The PWDmax, PWDISP, and PWPT which are calculated from the lead DII (PWPTDII) were found to be longer in the group of hypertensive patients (p< 0.05, for all). Electrocardiographic parameters of PWDmax, PWDISP, PWTF, PWPTDII, and PWPTVI were found to be longer in patients with HLAP. Both PWPTVI (p= 0.008 r= 0.395) and PWPTDII (p< 0.001 r= 0.456) were significantly correlated with left atrial volume index. Conclusion: In this study, the relationship between PWPT and diastolic dysfunction was revealed for the first time in the literature. In addition, the PWPT was found to be increased in patients with increased left atrial pressure (LAP). Our findings deserve attention because electrocardiography is an inexpensive and easily accessible diagnostic method that can be used to detect diastolic dysfunction in hypertensive patients.

SUMMARY OBJECTIVE: A decrease in the left ventricular ejection fraction (≤40%) in the setting of ST-segment elevation myocardial infarction is a significant predictor of mortality in the young ST-segment elevation myocardial infarction population. In this study, we aimed to investigate the predictors of left ventricular ejection fraction reduction and evaluate the long-term mortality rates in young ST-segment elevation myocardial infarction patients with or without decreased left ventricular ejection fraction. METHODS: We enrolled retrospectively 411 consecutive ST-segment elevation myocardial infarction patients aged 45 years or below who underwent primary percutaneous coronary intervention. Young ST-segment elevation myocardial infarction patients were divided into two groups according to their left ventricular ejection fraction (≤40%, n=72 and >40%, n=339), which were compared with each other. RESULTS: Statin use, white blood cell count, C-reactive protein, peak creatine kinase-MB, prolonged ischemia time, left anterior descending artery-related infarction, proximally/ostial located lesion, and no-reflow were independently associated with low left ventricular ejection fraction. Additionally, long-term mortality was considerably higher in the left ventricular ejection fraction ≤40% group than those in the left ventricular ejection fraction>40% group (18.1% versus 2.4%; p

Background Peripheral artery disease (PAD) is part of the systemic atherosclerotic process that is highly associated with cardiovascular diseases. Despite successful endovascular treatment (EVT) strategies, mortality and morbidity rates still remain higher in PAD patients. C-reactive protein (CRP) and albumin are biomarkers of inflammation and malnutrition that play key roles in the progression of peripheral arterial disease. In this study, we aimed to investigate the relationship between CRP-to-albumin ratio (CAR) and mortality and amputation-free survival in patients with PAD after successful EVT. Method Our study enrolled 149 consecutive patients who underwent EVT on atherosclerotic obstruction of iliac, femoral, popliteal and/or below-knee arteries with the clinical features of PAD and/or chronic limb-threatening ischaemia between January 2015 and January 2020. Clinical and prognostic follow-up of patients had been done at the outpatient clinic and were collected from institution’s medical records. Results The mean follow-up period was 22 months (14–40). All-cause mortality and amputation rates of patients in the high CAR group were significantly higher than those in the low CAR group (21.3% vs. 6.8% and 18.7% vs. 5.4%, respectively). Kaplan–Meier survival analysis showed significantly better survival for patients in the low CAR group (log-rank p = 0.0058). In multivariate logistic regression analysis, CAR was found to be an independent predictor of amputation and all-cause mortality even after adjusting for other confounding risk factors. ROC curve analysis revealed the optimal cut-off value of CAR for predicting all-cause mortality and amputation to be >1.476 with a sensitivity of 48.5% and specificity of 94.0%. Conclusion The inflammatory state reflected by CAR levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, CAR was found to be an independent predictor of these clinical outcomes after adjusting for other clinically associated parameters.

Coronary artery fistulas (CAFs) are described as abnormal communications between a coronary artery and cardiac chambers, or other vascular structures. The two types of CAFs are defined as type I (singular fistula) and type II (microfistulas). Even though various electrocardiographic changes have been previously described in CAF patients, coronary-artery microfistulas causing ST-segment elevation in diverse locations have not been reported. We describe a case report of an adult patient who presented with acute inferior myocardial infarction due to coronary-artery microfistulas. During the hospital stay, the patient re-experienced chest pain, and control electrocardiography revealed ST-segment elevation in the I and AVL leads along with reciprocal ST-segment depression in the inferior precordial leads. Although CAFs are clinically rare, they can have important clinical consequences. Microfistulas should be kept in mind as a cause of ST elevation myocardial infarction in some patients.

A 32-year-old woman underwent radiofrequency catheter ablation of narrow QRS tachycardia that was terminated with intravenous adenosine.

Because the phenomenon of no reflow has a poor prognosis in ST-segment elevation myocardial infarction (STEMI) patients and the atherogenic index of plasma (AIP) has been shown to be a strong predictor of coronary heart disease, we aimed to investigate the relationship between AIP and no-reflow in patients with acute STEMI who underwent primary percutaneous coronary intervention (PCI). A total of 763 consecutive STEMI patients (648 men; mean age 58 ± 12 years) who underwent primary PCI were recruited for this study. The patients were classified into a reflow group (n = 537) and a no-reflow group (n = 226) according to the postprocedural angiographic features of thrombolysis in the myocardial infarction flow of the infarct-related artery. The AIP value was significantly higher in the no-reflow group than in the reflow group [0.50 (0.38–0.65) vs. 0.39 (0.25–0.49) p

Objective: Acute kidney injury (AKI), which is prevalent in ST-segment elevated myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. As high pulse pressure (PP) is associated with adverse cardiovascular events, the present study’s aim was to evaluate the relationship between fractional PP (PPf) and AKI in patients with STEMI who underwent primary PCI. Subjects and Methods: All laboratory findings as well as echocardiographic and angiographic data of 1,170 consecutive STEMI patients were retrospectively screened. PPf was calculated from the pressures invasively measured after sheath insertion and before performing coronary angiography. Results: From 1,170 eligible STEMI patients (mean age 56 years, 18.2% female), AKI developed in 143 (12.2%) patients. The PPf and pulsatility index were significantly higher in patients with AKI than those without (0.53 ± 0.10 vs. 0.61 ± 0.10, p < 0.001, and 0.80 ± 0.03 vs. 0.82 ± 0.03, p < 0.001, respectively). PPf was also found to be associated with AKI in univariable (OR 2.183, 95% CI 1.823–2.614, p< 0.001) and multivariable (OR 1.874, 95% CI 1.513–2.322, p < 0.001) analysis. In-hospital mortality was higher in patients with AKI than those without. Conclusion: Invasively measured PPf, which can be easily measured and has no additional cost in STEMI patients undergoing coronary intervention, is an independent predictor of AKI. In addition, PPf is superior to other blood pressure values and derivatives in AKI prediction.

The relationship between acute kidney injury (AKI) and C-reactive protein (CRP) and albumin has been previously demonstrated in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). However, to our knowledge, CRP to albumin ratio (CAR), a newly introduced inflammation-based risk score, has not yet been studied. In this study, we aimed to investigate the possible relationship between the CAR and AKI.A total of 815 consecutive STEMI patients treated with pPCI were reviewed.One hundred ten 110 (13.5%) patients developed AKI in the study population. The subjects were divided into two groups according to AKI development. The in-hospital mortality rate was higher in patients with AKI than those without AKI (15.5% vs. 1.3%; p0.001). The patients with AKI had significantly higher mean value of CRP and CAR (0.29 [0.16-0.50] vs. 0.55 [0.37-1.05]; p0.001) and lower mean levels of albumin than those without AKI. Age, diabetes mellitus, haematocrit, left ventricular ejection fraction, hypotension, and CAR (Odds ratio [OR]2.307, 95% confidence interval [CI] 1.397-3.809, p=0.001) were independent predictors of AKI.The CAR may be a useful inflammation-based risk score to predict AKI development in STEMI patients treated with pPCI.

Objective: An increased left atrial volume index (LAVI) is related to increased mortality in hemodialysis patients. In the present study, we evaluated the association between the LAVI and the P wave peak time (PWPT), a newly introduced electrocardiographic parameter, in hemodialysis patients. Methods: The study population was made up of 79 hemodialysis patients with a mean age of 53 ± 18 years (55.7% were males). These patients were divided into a normal LAVI (≤28 mL/m2) group (n = 45) and an increased LAVI (>28 mL/m2) group (n = 34). The demographic, clinical, laboratory, echocardiographic, and electrocardiographic variables of the groups were compared. Results: The P wave terminal force from lead V1, P wave dispersion and PWPTs obtained from leads V1 and D2 (PWPTD2) were significantly higher in the patients with increased LAVIs. In multivariable analysis, only the PWPTD2was an independent predictor of an increased LAVI (odds ratio = 1.117, 95% CI = 1.052–1.185, p < 0.001). The receiver-operating characteristic curve analysis showed that the best PWPTD2 cutoff value for predicting an increased LAVI was 60 ms, with a sensitivity of 76.5% and a specificity of 66.7% (area under the curve = 0.736, 95% CI = 0.625–0.829, p < 0.001). Conclusion: This study showed that a prolonged PWPTD2 was independently associated with an increased LAVI in hemodialysis patients. Therefore, measuring the PWPTD2 duration on an electrocardiogram may help define high-risk hemodialysis patients with increased LAVIs.

Background Multi-vessel coronary artery disease (CAD) is associated with worse outcome in non-ST segment elevation myocardial infarction (NSTEMI) patients. Depending on the severity of CAD, there may be prolongation of atrial depolarization time as a result of left ventricular dysfunction and atrial ischemia. Therefore, we aimed to study whether the severity of CAD can be predicted with the P wave peak time (PWPT) in the electrocardiography (ECG) obtained during the diagnosis in NSTEMI patients. Method A total of 162 patients were included. The coronary angiography records of all patients were analyzed and SYNTAX scores were calculated. Patients were divided into two groups, according to CAD severity. In addition to well-known P wave parameters, PWPT, defined as the time from the beginning of the P wave to its peak, was measured in the leads DII and V1. Results The PWPTs in the leads DII and V1 were significantly longer in the group with severe CAD (71 ± 13 vs. 61 ± 12, p Conclusion Our findings show that prolonged PWPT, which is a parameter easily obtainable from the ECG, is associated with severe CAD. Recognition of NSTEMI patients with severe CAD at the time of diagnosis before performing coronary angiography may be important for the planning of treatment.

Objectives Pulmonary embolism (PE) is one of the leading causes of cardiovascular mortality worldwide. Electrocardiography (ECG) may provide useful information for patients with acute PE. In this study, we aimed to investigate the diagnostic value of the QRS duration and RS time in inferolateral leads in patients admitted to the emergency department, and pre-diagnosed with acute PE. Methods We retrospectively enrolled 136 consecutive patients, admitted to the emergency department, pre-diagnosed with the clinical suspicion of acute PE, and underwent computerized tomographic pulmonary angiography (CTPA) to confirm the PE diagnosis. The study subjects were divided into two groups according to the presence or absence of PE, and the independent predictors of PE were investigated. Results Sixty-eight patients (50%) had PE. Patients with PE had a longer RS time. Among the ECG parameters, only RS time was an independent predictor of PE (OR: 1.397, 95% CI: 1.171–1.667; p Conclusion As a novel ECG parameter, RS time could be measured for each patient. A longer RS time can be a very useful index for diagnosing acute PE as well as for estimating the RV end-diastolic diameter and SPAP.

Objective There are lack of studies considering the suboptimal management of dyslipidemia especially in cardiology outpatient clinics. This study was conducted to assess the patient adherence to cholesterol treatment recommendations and attainment of low-density-lipoprotein cholesterol (LDL-C) goals. Methods EPHESUS (NCT02608645) is a national, observational and multicenter registry which has been designed as a cross-sectional study to allow inclusion of all consecutive patients with hypercholesterolemia in cardiology outpatient clinics. The present subgroup analyses of the EPHESUS trial included patients with known peripheral artery disease or atherosclerotic cerebrovascular disease, and coronary heart disease namely secondary prevention. Results The present analysis of the EPHESUS study included 1482 patients (62.79 +/- 10.4 years, 38.2% female) with secondary prevention from 40 sites in Turkey. Regarding recommended lipid targets for LDL-C, only 267 patients (18%) were below the target of 70 mg/dL. Females were significantly more off-target when compared with male patients (396, 85.5% vs 67, 14.5%; P = 0.017). Moreover, the achievement of LDL-C goal was significantly decreased with illiteracy (233, 19.2% vs 35, 13.1%; P = 0.02). Patients who think that the cholesterol treatment should be terminated when the cholesterol level of a patient has normalised were higher in the off-target group (34.0% vs 24.7%, P < 0.001). Besides, physician perceptions about LDL-C goal for secondary prevention were significantly related with LDL-C target attainment. Conclusions EPHESUS is an important study with large population in terms of representing real-life practice of the adherence to dyslipidemia guidelines in secondary prevention patients in Turkey. Perceptions, knowledge, and compliance with the guidelines for secondary prevention have increased, but it is far below from the desired levels even in cardiology outpatient clinics. There is a need for patients' and physicians' education regarding the treatment of hyperlipidemia. WOS:000483810100004 2-s2.0-85066839340 PubMed: 31038781

Introduction: Stent restenosis remains a clinical challenge for patients with ischemic heart disease, since it is associated with repeated coronary interventions as well as higher hospitalization rates and medical costs. Inflammation plays a significant role. Although an association between stent restenosis, increased C-reactive protein (CRP) and decreased albumin levels has been previously reported, no studies have investigated the ability of the CRP/albumin ratio to predict stent restenosis. Methods: This retrospective study included 448 patients who had previously undergone primary percutaneous coronary intervention and who were referred for subsequent reintervention due to recurrence of anginal symptoms. The study population was divided into two groups based on whether the patient had developed stent restenosis. They were then stratified into three groups according to their CRP/albumin ratio. Results: Out of 448 patients, stent restenosis was observed in 24.5% (n=110), as determined by coronary angiography. Patients with stent restenosis had a higher CRP/albumin ratio, greater platelet distribution width (PDW), higher CRP levels, and lower levels of both high-density lipoprotein (HDL) cholesterol and serum albumin. The CRP/albumin ratio (OR: 2.289, 95% CI: 1.056-4.959; p=0.036), stent diameter, PDW and HDL cholesterol levels were found to be independent predictors of stent restenosis. A ROC curve comparison demonstrated that the CRP/albumin ratio was a better predictor of restenosis than either albumin and CRP individually, but it was not better than PDW and HDL cholesterol. Conclusion: As a novel inflammation-based risk score, the CRP/albumin ratio may be an easily accessible marker for assessment of stent restenosis risk. Resumo: Objetivo: A reestenose de stent permanece como um desafio clínico em doentes com cardiopatia isquémica. A reestenose de stent está associada a intervenções coronárias recorrentes bem como a aumento de internamentos e de custos médicos. A inflamação tem um papel significativo. Embora a associação entre reestenose de stent e o aumento dos níveis de proteína C-reativa (PCR) e a diminuição dos níveis de albumina tenham sido previamente registados, nenhum estudo pesquisou a possibilidade da PCR/albumina prever um diagnóstico de reestenose de stent. Métodos: Este estudo retrospetivo incluiu 448 doentes que tinham sido previamente submetidos a intervenção coronária percutânea primária e que foram referidos para reintervenção posterior devido a ressurgimento dos sintomas de angina. A população do estudo foi dividida em dois grupos com base no facto do doente ter desenvolvido reestenose de stent. Posteriormente, foram estratificados em três grupos de acordo com as relações PCR/albumina. Resultados: De um grupo de 448 doentes, a reestenose de stent foi observada em 24,5% (n = 110), conforme determinado por avaliação através de angiografia coronária. Os doentes com reestenose de stent apresentaram uma relação PCR/albumina mais elevada, variação maior do diâmetro das plaquetas (DP), níveis mais elevados de PCR e níveis mais baixos de colesterol de lipoproteínas de alta densidade (HDL) e de albumina sérica. Os níveis da relação PCR/albumina (OR: 2,289, IC 95%:1,056 – 4,959; p = 0,036), o diâmetro do stent, a variação maior do DP e o colesterol HDL foram considerados fatores preditores independentes da restenose de stent. A comparação das curvas ROC demonstrou que a relação PCR/albumina constituiu um fator preditor melhor do que a albumina e a PCR, isoladamente, não sendo, no entanto, melhor do que o DP e o colesterol HDL. Conclusão: Como novo score de risco baseado em inflamação, a relação PCR/albumina pode ser um marcador facilmente acessível para a avaliação do risco de reestenose de stent. Keywords: Stent restenosis, C-reactive protein/albumin ratio, ST-segment elevation myocardial infarction, Inflammation, Palavras chave: Reestenose de stent, Proteína C reativa/albumina, Enfarte do miocárdio com elevação do segmento ST, Inflamação

Although the prognostic efficacy of C-reactive protein (mg/L) and albumin levels (g/L) has been previously associated with poor prognosis in ST elevation myocardial infarction (STEMI), to the best of our knowledge, the prognostic efficacy of C-reactive protein/Albumin ratio (CAR) (mg/g) has not been investigated yet. Thus, this study aimed to investigate the potential efficacy of the CAR in predicting prognosis in STEMI patients.We conducted a detailed investigation of 2437 patients with first STEMI treated with a primary percutaneous coronary intervention. After evaluation regarding to exclusion criteria, 2243 patients were found to be eligible for analysis. The mean follow-up of the study was 34 ± 15 months.The median CAR value of the study population was 2.70 (range: 1.44-4.76), and the patients were divided into three tertiles according to their CAR values. Kaplan-Meier survival analysis showed significantly lower in-hospital and long-term survival rates for the patients in a high CAR tertile. In addition, the CAR was found to be an independent predictor of all-cause mortality (Hazards ratio: 1.033, 95% Confidence Interval: 1.007-1.061, p = .033), and the prognostic performance of the CAR was superior to that of C-reactive protein, albumin, and neutrophil to lymphocyte ratio in the receiver operating characteristic curve comparison.The CAR, a newly introduced inflammation-based risk index, was found to be a potentially useful prognostic tool for predicting a poor prognosis in STEMI patients. However, this finding needs to be validated in the future prospective studies.

Objectives: To investigate the effects of low-flow anesthesia on hemodynamic parameters and recovery from anesthesia in obese individuals undergoing laparoscopic surgery. Methods: This randomized-controlled and prospective study included 44 obese patients who underwent laparoscopic sleeve gastrectomy operation. The patients were randomly allocated into 2 groups as low-flow and high-flow anesthesia. Further, the groups compared in terms of hemodynamic parameters, anesthesia recovery times, operation times, and arterial blood gas parameters. Results: The groups were similar with respect to demographic data. Heart rate, peripheral oxygen saturation, arterial blood pressure measurements, end-tidal, and CO2, lactate levels measurements were similar in both groups during the entire procedure. There was also no statistically significant difference in terms of arterial blood gas parameters or anesthesia recovery periods. Conclusion: Low-flow anesthesia in laparoscopic obesity surgery seems to be safer compared to high-flow anesthesia in terms of the adequacy of tissue perfusion, depth of anesthesia, and postoperative recovery. األهداف: تزايد استخدام التدفق املنخفض في التخدير العام في السنوات األخيرة بسبب التطورات التكنولوجية ومزاياها العديدة.ومع ذلك ، ال تزال الدراسات حول التخدير منخفض التدفق لدى األفراد الذين يعانون من السمنة غير متوفرة. في هذه الدراسة ، هدفنا إلى التحقيق في آثار التخدير منخفض التدفق على معايير الدورة الدموية والتعافي من التخدير لدى األفراد الذين يعانون من السمنة املفرطة والذين يخضعون لعملية جراحية باملنظار املنهجية: شملت هذه الدراسة العشوائية املرتقبة 44 ً مريضا يعانون من السمنة املفرطة خضعوا لعملية جراحية مناسبة. مت تقسيم املرضى بشكل عشوائي إلى ً مجموعتني: التخدير منخفض التدفق وعالي التدفق. متت مقارنة املجموعات أيضا من حيث املعلمات الديناميكية الدموية ، وأوقات التعافي من التخدير ، وأوقات العمليات ، ومعلمات غاز الدم الشرياني. النتائج: كانت املجموعات متشابهة فيما يتعلق بالبيانات الدميوغرافية: معدل ضربات القلب ، تشبع األكسجني احمليطي ،قياسات ضغط الدم الشرياني )الضغط االنقباضي ، االنبساطي ، الضغط الشرياني املتوسط( ، قياسات نهاية املد و ثاني أكسيد الكربون كانت متشابهة في كال املجموعتني خالل اإلجراء بأكمله.عندما مت فحص معلمات غاز الدم الشرياني وفترات استعادة التخدير ، لم يتم العثور على فرق معتد به إحصائيا. اخلالصة: يبدو أن التخدير منخفض التدفق في جراحة السمنة باملنظار آمن من حيث كفاية نضح األنسجة وعمق التخدير والتعافي بعد اجلراحة ، مقارنة بالتخدير عالي التدفق

Background and aims Effective treatment of high low-density lipoprotein cholesterol (LDL-C) levels has been shown to improve cardiovascular outcomes of patients with diabetes mellitus (DM). Herein, we aimed to provide insight to the real-life management of patients with DM in terms of LDL-C goal attainment and adherence to lipid management recommendations. Our objective was also to reveal the reasons of poor LDL-C goal attainment by assessing the perceptions of both physicians and patients. Methods We compared the diabetic and non-diabetic patients from the database of a nationwide registry conducted in cardiology outpatient clinics with regard to the demographic characteristics, educational status, comorbidities, medications, laboratory parameters and LDL-C goal attainment. Also, both the patients and attending physicians were surveyed to analyse perceptions and awareness of hypercholesterolemia. Results Of the 1868 consecutively enrolled patients, 873 (47%) had DM. Proportion of patients on statins was significantly lower in patients with DM (67.8% vs 55.3%; P < .001). The proportion of patients who attained LDL-C targets were lower among the diabetic patients (17.8% vs 15%; P = .06). The most common causes of the discontinuation of statin therapy were negative media coverage about statins (32.1%), and recommendations of physicians to stop the lipid lowering therapy (29.6%). Analysis of the physician survey revealed that the physicians could determine the off-target patients accurately (negative predictive value 98.4%) while the positive predictive value (48.8%) was low. The reasons for not attaining the LDL-C goals in diabetic patients were not prescription of statins (38%) and inadequate (eg low-dose, non-adherent) statin (28.3%) dosages. Conclusions In real-life clinical cardiology practice, diabetic patients are far below the recommended LDL-C treatment goals. High-intensity statin treatment in diabetic population is still avoided because of the concerns about polypharmacy and drug interactions. Also, the inertia of physicians and even cardiologists is probably a major cause of refraining of prescription of optimal statin dosages. WOS:000627464100001 2-s2.0-85102297383 PubMed: 33630348

Contrast-induced nephropathy (CIN) is a prevalent and serious complication after primary percutaneous coronary intervention (pPCI). Although the association between serum osmolarity and chronic kidney disease is well established, its relation to CIN in patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI needs to be elucidated. We evaluated the predictive value of serum osmolarity for CIN development in patients with STEMI (n = 768) undergoing pPCI. Serum osmolarity on admission was calculated. The study population was divided into 2 groups according to CIN development, and both groups were compared according to clinical, laboratory, and demographic features, including the serum osmolarity. Serum osmolarity was significantly higher in patients with CIN than in those without CIN (278 [8] vs 284 [9]; P = .024). Serum osmolarity (odds ratio: 1.052; 95% confidence interval: 1.018-1.086; P = .002), hemoglobin, contrast media volume, creatinine on admission, basal SYNergy between PCI with TAXus and cardiac surgery II score, and left ventricular ejection fraction were found to be independent predictors of CIN. Serum osmolarity (given the simple calculation of this parameter on admission) can be useful to define patients with STEMI undergoing pPCI who are more likely to develop CIN.

Background Peripheral arterial disease is associated with increased cardiovascular mortality and morbidity. C-reactive protein and albumin are biomarkers of inflammation and malnutrition that play key roles in the pathophysiological pathways involved in the progression of atherosclerosis and peripheral arterial disease. In this study, we aimed to assess the relationship between C-reactive protein to albumin ratio and the suprapopliteal peripheral arterial disease severity and complexity as assessed by TransAtlantic Inter-Society Consensus-II (TASC-II) classification. Method Our study enrolled 224 consecutive patients referred for peripheral angiography with the clinical features of possible peripheral arterial disease at a tertiary care center between January 2016 and September 2019. Level of disease and lesion characteristics were defined with reference to angiographic findings according to the TASC-II classification. Results C-reactive protein/albumin ratio levels were significantly higher in TASC-II class C and D than in TASC-II class B patients with a median level of 1.8 to 2.1 vs 1.4, respectively ( p = 0.018). In multivariate regression analysis, C-reactive protein to albumin ratio remained an independent predictor of severe peripheral arterial disease. The predictive performance of C-reactive protein to albumin ratio, C-reactive protein, and albumin were compared by Receiver Operating Characteristic curve analysis. C-reactive protein to albumin ratio surpassed C-reactive protein and albumin in predicting peripheral arterial disease severity and complexity. A level of C-reactive protein to albumin ratio > 0.14 predicted a higher grade of suprapopliteal TASC-II class with sensitivity and specificity of 68.2% and 56.0%, respectively. Conclusion C-reactive protein to albumin ratio was strongly associated with peripheral arterial disease severity and complexity, as assessed by TASC-II classification. Also, C-reactive protein to albumin ratio was found to be a more accurate marker than C-reactive protein and albumin alone in predicting more severe and complex lesions in patients with peripheral arterial disease.

Objective: Contrast-induced acute kidney injury (CI-AKI) is a well-known and life-threating complication in patients with ST-elevation myocardial infraction (STEMI) after primary percutaneo...

Objective Many studies have examined the capability of electrocardiography (ECG) changes to predict the severity and prognosis of patients with acute pulmonary embolism (APE). RS time in ECG is potentially valuable in evaluating the prognosis of APE. In our study, we aimed to assess the predictive value of RS time, which is a novel electrocardiographic parameter of one-month mortality of APE. Methods This retrospective study included 216 patients who were diagnosed with APE by pulmonary computed tomography angiography. RS time was measured from the ECG (inferolateral leads) at the time of hospital admission using a computer program ( imagej.nih.gov/ij /). The patients were divided into two groups according to the median values of RS time: the group with RS time ≤ 60 msec (n:108) and the group with RS time > 60 msec (n:108). The groups were compared in terms of mortality. Results In our study, the one-month mortality was 15.3% (33) in the patients hospitalized with APE. In the multivariate analysis, RS time prolongation (HR: 1.037; 95%CI: 1.005–1.065; p = .02) was independently correlated with mortality. The ROC curve analysis revealed that RS time > 64.8 msec predicted the one-month mortality in APE with a sensitivity of 68.6% and a specificity of 73.9% (AUC: 0.708; 95% CI: 0.643–0.768; p Conclusion As a novel ECG parameter, RS time could be measured for each patient with APE. Prolongation of RS time could be a useful index for predicting the one-month mortality of patients diagnosed with APE.

Objective: The aim of this study was to assess the clinical characteristics of patients with heart failure and preserved ejection fraction (HFpEF) and atrial fibrillation (AF) and compare them with those of HFpEF patients without AF. Methods: This study was a sub-group analysis of a multicenter, observational, and cross-sectional registry conducted in Turkey (ClinicalTrials.gov identifier: NCT03026114). Patients with HFpEF were divided into 2 groups: HFpEF with AF and HFpEF with sinus rhythm (SR), and the clinical characteristics of the groups were compared. Results: In a total of 819 HFpEF patients (median age: 67 years; 58% women), 313 (38.2%) had AF. Compared to the patients with SR, those with AF were older (70 years vs 66 years; p

Introduction: Multiple studies have shown the relationship between heart failure (HF) and development ofdepression. Several studies have demonstrated worse perception of quality of life among patients with type 2diabetes mellitus (T2DM). We aimed to assess the association between glycated hemoglobin (HbA1c) levelsand depression severity in patients with diabetic HF.Patients and Methods: Between July 2015 and June 2016, 179 patients with HF (left ventricular ejectionfraction < 35%) and T2DM were included in the study. Blood samples for HbA1c were obtained from patientswith T2DM. The severity of depression was assessed using the Beck Depression Inventory (BDI). Patientswith depression were classified as follows: minimal with score 0-13 (group I), mild with score 14-19 (groupII), moderate with score 20-28 (group III), and severe with score 29-63 (group IV).Results: The median age of the study population was 64 (57-75) years (98 females and 81 males). There wasno significant difference between the groups regarding the frequency of hypertension and gender. There wasa significant positive correlation between BDI and HbA1c levels in patients with HF (r= 0.488, p< 0.001).According to the analysis performed between the groups, HbA1c values were found to be significantly higher ingroup IV than in groups I, II, and III (6.0 ± 1.47, 6.4 ± 0.6, 7.03 ± 0.7, and 7.6 ± 1.23, respectively; p< 0.001),which indicate the association between severity of depression and HbA1c level.Conclusion: We detected a significant association between BDI and HbA1c level in patients with chronic HFwith T2DM. Therefore, more strict control of blood glucose level may improve quality of life and decreasedepressive symptoms in patients with diabetic HF., Giriş: Birçok çalışma kalp yetmezliği ile depresyon gelişimi arasındaki ilişkiyi göstermiştir. Bazı çalışmalartip 2 diabetes mellitus (DM) olanlarda yaşam kalitesinin bozulduğunu göstermiştir. Diyabetik kalp yetmezliklihastalarda HbA1c düzeyleri ile depresyon arasındaki ilişkiyi değerlendirmeyi amaçladık.Hastalar ve Yöntem: Temmuz 2015 ve Haziran 2016 tarihleri arasında, 179 Tip 2 DM’li kalp yetmezliğiolan (LV-EF < %35) hastalar çalışmaya dahil edildi. Tip 2 DM’li hastalardan HbA1c için kan örneklerialındı. Depresyonun şiddeti Beck Depresyon Envanteri (BDE) kullanılarak değerlendirildi. Depresyonuolan hastalar aşağıdaki gibi sınıflandırıldı: minimal skor 0-13 (grup I), hafif skor 14-19 (grup II), orta skor20-28 (grup III) ve şiddetli skor 29-63 (grup IV).Bulgular: Çalışma popülasyonunun medyan yaşı 64 (57-75) idi (kadın: 98, erkek: 81). Hipertansiyon ve cinsiyetsıklığı açısından gruplar arasında anlamlı fark yoktu. BDE skorlama sistemine göre sınıflandırılan hastalarınsayısı, I ila IV. gruplarda sırasıyla 42, 45, 46 ve 46 idi. Kalp yetmezliği olan hastalarda BDE ve HbA1c düzeyleriarasında anlamlı pozitif korelasyon vardı (r= 0.488, p< 0.001). Gruplar arasında yapılan analizlere göre HbA1cdeğerleri grup 4 te grup I, II ve III’e göre anlamlı olarak yüksek bulundu (6.0 ± 1.47, 6.4 ± 0.6, 7.03 ± 0.7, 7.6 ±1.23, sırasıyla, p< 0.001).Sonuç: Tip 2 DM’li kronik kalp yetmezlikli hastalarda BDE ve HbA1c düzeyleri arasında anlamlı ilişki saptadık. Bu nedenle, kan glukoz seviyesinindaha sıkı kontrolü, diyabetik kalp yetmezlikli hastalarda yaşam kalitesini artırabilir ve depresif belirtileri azaltabilir.

This study aimed to investigate the diagnostic value of QRS and S wave variation in patients admitted to the emergency department with suspicion of acute pulmonary embolism (APE).Computerized tomographic pulmonary angiography (CTPA) was performed in 118 consecutive patients to evaluate patients with suspected APE, and 106 subjects with appropriate electrocardiogram and CT images constituted the study population.Using CTPA, APE was diagnosed in 48.1% (n:51) of the study population. The comparison of patients with APE and those without APE revealed that increased heart rate, right axis deviation of QRS axis, complete or incomplete right bundle branch block, prominent S wave in lead D1, increased QRS duration, percentage of QRS (9,8[4,8-19,0] vs 3,8[2,7-71]; p0,001), S wave variation (22,3[9,6-31,9] vs 4,8 [2-8]; p0,001) and ΔS wave amplitude (1.1[0.5-1.5] vs 0.2[0.1-0.5]; p0.001) were significantly associated with APE, but no relationship was detected with respect to the presence of atrial arrhythmias, clockwise rotation of the horizontal axis, fragmentation, ST segment deviation, T wave inversion, and S1Q3T3 and S1S2S3 patterns. The percentage of S wave variation (OR: 1072 per 1% increase, 95% CI:1011-1137) was found to be an independent predictor of APE. ΔS wave amplitude0.5mm predicted APE with a sensitivity of 72.6% and a specificity of 74.6% (AUC:0.805, 95% CI: 0.717-0.876; p0.001).The present study demonstrated that QRS and S wave variation could be useful electrocardiographic signs for the diagnosis of APE.

Given that parameters used in the calculation of the PRECISE-DAPT risk score are important contributors to contrast-induced nephropathy (CIN) development, we hypothesized that the PRECISE-DAPT risk score would show good accuracy for predicting CIN in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Therefore, in this study, we aimed to determine the predictive value of the admission PRECISE-DAPT score for the occurrence of CIN in patients with STEMI treated with primary PCI. After evaluation regarding with exclusion criteria, 1280 patients were, respectively, enrolled in the study. The primary end-point was the incidence of CIN. The PRECISE-DAPT score of CIN group was higher than the non-CIN group [31 (24–41) vs. 14 (9–23), p

Background: Even though the relationship between syntax score (SS) and fragmented QRS (fQRS) has been studied, the relation between syntax score II (SS II) and fQRS in patients with ST elevation myocardial infarction (STEMI) is undefined. We aimed to define the relationship between fQRS and SS II for the evaluation of extension and complexity of coronary artery disease. Material and methods: This study enrolled 167 patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI. The standard 12-lead electrocardiograms (ECGs) were obtained from all patients before and after PCI. SS and SS II were calculated in all patients. Transthoracic echocardiography was performed to all patients. Results: Thirty-nine patients (23.4%) had fQRS on their ECGs. The median SS II was 27 (22.9–33.9). SS II values in the fQRS(+) group were statistically significantly higher than that of the fQRS(?) group (35.2 (26.4–47.2) vs. 25.7 (22.1–30.7), p < 0.001). Also, in patients with higher SS II, there was significantly higher number of ECG derivations with fQRS. Conclusions: The presence of fQRS and high number of derivations with fQRS on ECG may be associated with high SS II in patients undergoing pPCI for STEMI. © 2018 Elsevier Inc.

Serum uric acid (SUA) level was shown in various studies to be related to the presence of coronary artery disease and subsequent cardiovascular events. The aim of the present study was to evaluate the association of SUA with SYNTAX score II (SSII) and the long-term prognosis of patients with stable angina pectoris who underwent percutaneous revascularization due to multivessel disease (MVD) and/or unprotected left main disease (UPLMD). Two-hundred and ninety patients with MVD and/or UPLMD who were treated consecutively with percutaneous coronary intervention (PCI) were included in the present study. The study population was divided into high SSII (n: 145; SSII > 32.9) and low SSII (n: 145; SSII ≤ 32.9) according to the median SSII value. The SUA value was significantly higher in the high SSII group than in the low SSII group (5.53 ± 1.95 vs. 6.07 ± 1.88; p = 0.001) and was found to be an independent predictor of high SSII (OR 1.306; 95% CI 1.119–1.525; p = 0,001). Twenty-eight patients (9.7%) died during the long-term follow-up, and SUA and SSII were additionally found to be independent predictors of long-term mortality (HR 1.245, 95% CI 1.046–1.482, p = 0.014; HR 1.042, 95% CI 1.007–1.079, p = 0.018, respectively). In the present study, SUA level was demonstrated to be associated with high SSII and long-term mortality in patients with MVD and/or UPLMD who were treated with PCI.

To evaluate left atrial (LA) deformation parameters strain (S)/strain rate (SR) and time to peak S/SR obtained by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension for three LA mechanical phases and to compare them with the same indices in the control subjects.Fifty-five patients with hypertension (HT) and 29 healthy controls were included in the study. All patients had normal LA poster-anterior diameter, LA and left ventricular ejection fractions (LVEF50%) in two-dimensional echocardiography (2-DE). The peak S/SR values (PS/PSR), the time to peak S/SR (TPS/TPSR) were measured using the 12-segment model for the left atrium during contractile (CP) reservoir (RP) and conduit period (COP) of the LA cycle.For two periods (RP and COP), all of the PS and PSR values were significantly lower in hypertensive patients with preserved LAEF and LVEF compared to those in the controls, except for the CP. Similarly, hypertensive patients had significantly higher TPS and TPSR than those in the controls for the RP and COP in the LA wall, except for the CP.LA mechanical function was impaired in hypertensive patients with preserved LA and LV ejection fraction compared to the controls. Although the PS and PSR were decreased for the RP and COP of LA mechanical phases, the TPS/TPSR were prolonged in the HT patients compared to the controls. This might be additional diagnosis criteria to detect the LA myocardial dysfunction and might be a predisposing factor for atrial arrhythmia formation in the hypertensive patients.

Amac: Kalp yetmezligi (KY), fonksiyonel kapasite ve hayat kalitesinin azalmasi, morbidite ve mortalitenin artisi ile karakterize progresif, kronik bir sendromdur. Korunmus ejeksiyon fraksiyonlu (EF) kalp yetmezligi, KY olgularinin yaklasik yarisini temsil eder. Diyabetes mellitus (DM), KY ile yakindan iliskilidir ve DM hastalarinda KY, iki-sekiz kat daha siktir. Prediyabet, diyabetten onceki asama olup, bozulmus glukoz toleransi (BGT), bozulmus aclik glukozu (BAG) veya her ikisinin varligi olarak tanimlanmistir. DM’nin, korunmus EF’li kalp yetmezligi ve diyastolik disfonksiyonla iliskisi ortaya konmussa da, prediyabetik evrenin diyastolik disfonksiyonla iliskisi net degildir. Bu calisma prediyabet ile diyastolik disfonksiyon arasindaki iliskiyi ortaya koymayi amaclamaktadir. Materyal ve Metot: Bu calisma tek merkezli, prospektif, kesitsel bir calismadir. Calismaya, basvuru sirasinda 75 gr glukoz ile yapilan oral glukoz tolerans testi (OGTT) ile normal, yeni diyabet veya prediyabet tanisi konulan 110 hasta alindi. Hastalarin sistolik, diyastolik ve diger kardiyak parametleri konvansiyonel ekokardiyografi ve doku Doppler ekokardiyografi ile degerlendirildi. Kontrol, prediyabet ve diyabet gruplari, mitral kapak akim hizlari ve doku Doppler bulgulari ile diyastolik fonksiyonlar acisindan karsilastirildi. Bulgular: Prediyabetiklerde, Mitral E/A orani (kontrol: 1,10±0,26; prediyabet: 0,90±0,16; diyabet: 0,93±0,24; p=0,001), ortalama doku Doppler Em/Am orani (kontrol: 1,13±0,33; prediyabet: 0,94±0,33; diyabet: 0,92±0,26; p=0,001), diyabetiklerde oldugu gibi azalmis olarak izlendi. Ayri-ca deselerasyon zamani, izovolumik relaksasyon zamani, ve miyokardiyal performans indeksi prediyabetiklerde de diyabetiklerde oldugu gibi yuksek izlendi. Ayrica bu calismada aclik kan sekeri ve OGTT ikinci saat kan sekeri ile mitral akim E/A orani ve Doppler global Em/Am orani arasinda korelasyon saptandi. Sonuc: Diyastolik disfonksiyon indekslerini ve MPI’yi diyabetik hastalarla ve kontrol grubu ile karsilasti-ran bu calismada, prediyabetik hastalarda, diyastolik disfonksiyon oldugu tespit edildi. Bu calis-ma, diyabet komplikasyonlarinin bu glukoz seviyelerinde dahi basladigini ve diyastolik disfonksi-yonun kan seker seviyeleri korele oldugunu ortaya koymustur.

Background. We aimed to investigate the effects of continuous positive airway pressure (CPAP) treatment on electrocardiography (ECG), premature ventricular contraction load on 24-hour Holter recordings, and implantable cardioverter defibrillator (ICD) shocks in patients with obstructive sleep apnea syndrome (OSAS) and heart failure. Methods. Patients with heart failure and ICD and patients with newly diagnosed OSAS were divided into two groups according to CPAP treatment. To compare the impact of CPAP on ECG parameters, both baseline and 6-month ECG, 24-hour Holter ECG, ambulatory blood pressure monitoring, echocardiography, polysomnography, and laboratory parameters were collected. Results. CPAP treatment significantly reduced the frequency of premature ventricular contractions, T-peak to T-end, corrected QT, corrected QT dispersion, and T-peak to T-end/corrected QT ratio in the study group (p .001 for all). Although the baseline NT-pro-BNP levels were similar between study and control groups, after six months, the NT-pro-BNP levels of the study group were significantly lower than that of the control group (39.18 ± 7.57 versus 46.11 ± 7.65; p Conclusions. CPAP treatment in patients with heart failure and ICD and in patients with newly diagnosed OSAS may have beneficial effects on premature ventricular contractions and electrocardiographic arrhythmia indices and NT-pro-BNP levels. However, these results are needed to be clarified with further studies.

The association of coronary artery disease (CAD) severity with increased C-reactive protein (CRP) and decreased albumin levels has been reported. However, to our knowledge, no study has investigated the usefulness of the CRP to albumin ratio (CAR) in predicting intermediate–high SYNergy between Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score (SS) and high SS II. Consecutive patients (n = 344) treated with percutaneous coronary intervention comprised the study population. The study population was divided into 2 groups according to SS >22 and mean SS II values, respectively. Patients with intermediate–high SS and high SS II had higher CAR than patients with low SS and SS II. History of diabetes mellitus, decreased albumin, lower left ventricular ejection fraction, and elevated CAR (odds ratio [OR]: 1.020; 95% confidence interval [CI], 1.009-1.031; P < .001) were independent predictors of high SS. The presence of hypertension, decreased hemoglobin and albumin levels, and increased CAR (OR: 1.014; 95% CI, 1.004-1.023; P < .001) were independent predictors of SS II. In receiver operating characteristic curve comparison, CAR was superior to CRP and albumin in prediction of intermediate–high SS, but only CRP in prediction of high SS II. The CAR calculated from the admission blood samples could be a useful parameter for predicting CAD severity using SS and SS II.

PubMed: 28623012 Objectives Coronary no-reflow (NR) following primary percutaneous coronary intervention (pPCI) is associated with worsened prognosis in patients with ST segment elevation myocardial infarction (STEMI). Despite rapid developments in cardiovascular area; there are limited data regarding prediction of NR before pPCI. P wave duration and dispersion (PWD, PWDIS respectively) have been studied in STEMI patients and found to be associated with reperfusion success; however none of them has been found to predict NR before PCI. In our study we aimed to evaluate whether PWD, PWDIS and a novel parameter P wave peak time (PWPT) could predict NR development in STEMI patients. Method Fifty six patients who were admitted with anterior STEMI constituted study populations. The diagnosis and treatment of STEMI was made on the basis of current guidelines. P wave parameters including PWD, PWDIS and PWPT were calculated from electrocardiograms that were obtained on admission and 60 min after pPCI. Results Patients were divided into two groups according to the development of NR. We observed that PWPT that were obtained from D2 (PWPTD2) and V1 (PWPTV1) leads were longer in NR group than reflow group. There were significant correlations between PWPT and reperfusion parameters regarding percent of ST segment resolution, peak CKMB level and TIMI frame count of infarct related artery. Preprocedural PWPTD2 was found to be an independent predictor of NR development. Conclusion In our study we observed that PWPT could be a useful parameter in the assessment of reperfusion success and prediction of NR development. © 2017 Elsevier Inc.

We have read with a great pleasure the letter of Yue J, et al. to the editor about our recent study which showed an association between atherogenic index of plasma and no-reflow in patients with ST segment elevation myocardial infarction who underwent primary percutaneous coronary intervention. Yue J, et al. raises concerns about the timing of blood collection, whether if it was taken before the emergency intervention or after. In emergency department, while performing intravenous line, the blood samples for blood biochemistry and whole blood count were also taken from the patients. Another concern of the author was the timing of left ventricular ejection fraction measurement (LVEF). LVEF measurements were obtained before the emergency intervention and some were after the intervention, but before the patient discharge. In our study we included the LVEF in our model, because we could not ignore that modeling which was comprehensively used in recent studies on relation of LVEF and no-reflow. We designed this statistical model not only for the no-reflow prediction but also for the explanation of the no-reflow pathophysiology. We thank the authors' letter for pointing out these issues that we hope to have addressed.

We have read with a great pleasure the letter of Dr. Cure et al. to the editor about our recent study which showed an association between atherogenic index of plasma (AIP) and no-reflow in patients with ST segment elevation myocardial infarction who underwent primary percutaneous coronary intervention. Dr Cure raises concerns about the miscalculation of AIP value that suggested choosing 'mmol/l' in equation instead of 'mg/dl'. As the AIP is the logarithmic transformation of triglyceride/high density lipoprotein; 'mmol/l' and an alternatively 'mg/dl' units can be used in the equation to calculate AIP values. Cure et al. also argue that our patients' lipoprotein levels were lower than expected. However, in a population based study and in several studies which were held in Turkey, the mean values of lipoprotein levels in Turkish population were nearly similar with our study population findings. We thank the authors' letter for pointing out these issues which we hope to have addressed.

Arteriosclerosis obliterans (ASO), which mainly affects medium- and large-sized arteries of the lower extremities, is characterized by thickening and calcification of arterial walls due to atherosc...

INTRODUCTION AND OBJECTIVES The aim of this study was to investigate the association of serum albumin (SA) level with long-term prognosis in patients with acute pulmonary embolism (PE). MATERIALS AND METHODS We retrospectively enrolled 269 patients with acute PE. The SA level was obtained within 12-24 hours following admission. The primary endpoints were the incidence of short- and long-term mortality in acute PE patients. The mean duration of the study follow-up was 21 ± 19 months. RESULTS During the follow-up period, short- and long-term mortality rates were higher in patients who had low SA level compared to those who did not have. In multivariate Cox regression analysis, the SA level was found to be independently associated with long-term mortality (HR: 0.47, 95%CI: 0.28-0.78, P = 0.004). In receiver operating characteristics analysis, the SA level of ≤3.17 predicted long-term mortality with a sensitivity of 77.5% and a specificity of 79.5% (area under the curve 0.82, 95%CI: 0.76-0.87, P