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Background: T-wave peak to T-wave end interval (Tp-e) correlates with dispersion of ventricular repolarization. The purpose of this study was to assess the ability of Tp-e to predict appropriate implantable cardioverter defibrillator (ICD) shocks and all-cause mortality in patients who underwent ICD implantation for primary prophylaxis., Methods: Two hundred twenty-eight patients with left ventricular ejection fraction ≤35% and an ICD implanted were followed-up prospectively. Patients divided into two subgroups according to presence of appropriate ICD shocks (Group 1: 112 patients with ICD shocks, Group 2: 116 patients without shocks). End points were appropriate ICD therapy due to ventricular tachycardia (VT)/ventricular fibrillation (VF), death, and a combined end point of VT/VF or death., Results: During a mean follow-up of 22.3 ± 7.7 months, appropriate ICD shocks were observed in 112 of 228 patients (49.1%). The mean duration of the Tp-e Group 1 was significantly longer than Group 2 (115.3 ± 22.2 vs 104.7 ± 20.2 ms, P < 0.001). Ischemic etiology and Tp-e duration were found to be independent predictors of ICD therapy. When the patients were divided into two groups based on Tp-e interval, there was no significant difference regarding the mortality between groups (21.2% vs 21.8%, P: 0.186). However, appropriate ICD shocks due to VT/VF (37.5% vs 58.8%, P < 0.001) and combined end point (39.4% vs 64.5%, P: 0.002) were significantly higher in patients with longer Tp-e group., Conclusions: Tp-e interval independently predicts appropriate ICD shocks in patients with systolic dysfunction and ICDs implanted for primary prevention., (© 2016 Wiley Periodicals, Inc.)

Acute stent thrombosis (AST) is associated with increased morbidity and mortality. The main aim of this study was to evaluate the prognostic value of the systemic immune-inflammation index (SII) and C-reactive protein (CRP) to albumin ratio (CAR) in predicting AST and high SYNTAX score in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). The criteria of the Academic Research Consortium were used to determine definite stent thrombosis. A total of 2077 consecutive patients with ACS undergoing PCI were retrospectively enrolled. Platelet, white blood cell and neutrophil counts, as well as SII, CRP, CAR, and peak cardiac troponin I (cTnI) values were significantly higher, whereas the lymphocyte count and albumin values were significantly lower in the AST (+) group compared with the AST (-) group (P < .05). SYNTAX score showed significant positive correlations with SII (r = .429, P < .001) and CRP (r = .402, P < .001). Multivariate logistic regression analysis showed that SII and CAR, as well as age, diabetes mellitus, stent length, and peak cTnI are independent predictors of AST and high SYNTAX score. In conclusion, the SII and CAR are simple, relatively cheap, and reliable inflammatory biomarkers that can predict AST and high SYNTAX scores in ACS.

Atrial fibrillation (AF) is one of the most encountered arrhythmias in clinical practice. It is also estimated that the absolute AF burden may increase by greater than 60% by 2050. It is inevitable that AF will become one of the largest epidemics in the world and may pose a major health problem for countries. Although AF rarely causes mortality in the acute period, it causes a significant increase in mortality and morbidity, including a fivefold increase in the risk of stroke, a twofold increase in dementia, and a twofold increase in myocardial infarction in the chronic period. Despite all the advances in the treatment of AF, it is better understood day by day that preventing AF may play a key role in reducing AF and its related complications. Modification of the main modifiable factors such as quitting smoking, abstaining from alcohol, changing eating habits, and exercise seems to be the first step in preventing AF. The strict adherence to the treatment process of secondary causes predisposing to AF such as DM, hypertension, obesity, and sleep apnea is another step in the prevention of AF. Both an individual approach and global public health campaigns can be highly beneficial to reduce the risk of AF. In this review, we aimed to summarize the current evidence on the relationship between modifiable risk factors and AF, and the impact of possible interventions on these factors in preventing or reducing the AF burden in the light of recently published guidelines and studies., Competing Interests: Disclosure: The authors declare no funding and conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: The relationship between inflammation and mortality after acute pulmonary embolism (APE) has previously been investigated with different variables (platelet/lymphocyte ratio, etc)., Objectives: We investigated the predictive value of lymphocyte to monocyte ratio (LMR) for mortality in first 30 days after APE., Methods: The study population included 264 APE patients of which 230 patients were survivors, 34 patients were non-survivors., Results: LMR was significantly lower in non-survivors after APE (P < .001). Neutrophil-to-lymphocyte ratio (NLR) was higher in non-survivors after APE (P < .001). Platelet-to-lymphocyte (PLR) had no significance between both groups (P: .241). Simplified pulmonary embolism severity index and LMR were independent predictors of mortality in patients with APE (P: .008 and P: .001, respectively)., Conclusion: LMR as a novel marker of inflammation seemed to be an independent predictor of short-term mortality in patients with APE., (© 2016 John Wiley & Sons Ltd.)

The CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age 65-74 years, female gender) score is used to estimate thromboembolic risk in atrial fibrillation (AF). Its usefulness in predicting in-stent restenosis (ISR) is unknown. We evaluated the predictive value of the CHA 2 DS 2 -VASc score in AF-free patients who have undergone stent implantation. A total of 1350 patients who underwent coronary angiography and successful bare-metal stent implantation were analyzed. The CHA 2 DS 2 -VASc score was calculated before percutaneous coronary intervention, and the association between the score and ISR was investigated. Patients (n = 700; mean age: 61.4 [8.7] years, 63% men) were divided in 2 subgroups according to the presence of ISR; 265 of 700 patients had ISR. Mean CHA 2 DS 2 -VASc score was significantly higher in the ISR (+) group than the ISR (-) group (3.7 [1.8] vs 2.1 [1.4], P < .001). According to multivariate logistic regression analysis, diabetes, hyperlipidemia, smoking, stent length, and CHA 2 DS 2 -VASc score were independent predictors of ISR. In conclusion, the CHA 2 DS 2 -VASc score may be useful as a new and simple tool to predict ISR.

The relationship between atrial fibrillation and human immunodeficiency virus (HIV) infection was evaluated. Electro-echocardiographic methods can be used to predict the development of atrial fibrillation (AF). In this study, we aimed to investigate the atrial electromechanical delay (AEMD) parameters of HIV (+) patients. Forty-two HIV (+) patients and 40 HIV (-) healthy volunteers were prospectively enrolled in this study. The electromechanical properties of the subjects' atria were evaluated with tissue Doppler imaging. The left-AEMD, right-AEMD and inter-AEMD were increased in the HIV (+) patients relative to the controls (p=0.003, p<0.001, and p<0.001, respectively). The CD4 count was inversely correlated with the inter-AEMD (r=-0.428, p<0.001). The CD4 count was an independent predictor of the inter-AEMD (β=0.523, p=0.007). Our study demonstrated that both the inter- and intra-atrial electromechanical delays were prolonged in the patients with HIV. This non-invasive and simple technique may provide significant contributions to the assessment of the risk of atrial arrhythmia in patients with HIV., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Letter in regards to: Akboga MK, Balci KG, Maden O et al. Usefulness of monocyte to HDL-cholesterol ratio to predict high SYNTAX score in patients with stable coronary artery disease. Biomark. Med. 10(4), 375-383 (2016). In response to: Soylemez S.Oxidative stress and SYNTAX score in patients with stable coronary artery disease. Biomark. Med. 11(8), doi:10.2217/bmm-2016-0326 (2017) (Epub ahead of print).

Aim: We aimed to investigate the relationships between metabolic syndrome (MS) and monocyte to high density lipoprotein cholesterol ratio (MHR) and lymphocyte-to-monocyte ratio (LMR)., Methods: 762 patients (n = 371 MS present and n = 391 MS absent) were enrolled., Results: MHR was significantly higher [13.9 (10.5-18.1) vs 11.1 (8.0-14.8); p < 0.001], whereas LMR was significantly lower [4.5 (3.6-5.7) vs 3.6 (2.9-4.8); p < 0.001] in patients with MS. LMR [OR: 0.796 (95% CI): 0.711-0.892); p < 0.001], MHR [OR: 1.052 (95% CI: 1.018-1.088); p = 0.003] and C-reactive protein [OR: 1.048 (95% CI: 1.032-1.065); p < 0.001] remained as independent variables for the presence of MS., Conclusion: The present study shows that both LMR and MHR may be novel and useful indicators of MS.

Background  Previous studies proposed that inflammation, oxidative stress, and impaired endothelial dysfunction have a crucial role in occurrence of saphenous vein graft (SVG) disease (SVGD). The aim of this study was to assess the relationship between monocyte-to-high-density lipoprotein cholesterol (HDL-C) ratio (MHR) and serum albumin (SA) level as readily available inflammatory and oxidative stress markers with the presence of SVGD in patients with a coronary bypass. Methods  In this retrospective cross-sectional study, a total of 257 patients ( n  = 112 SVGD [+] [mean age was 65.3 ± 8.4 years, 75.0% males] and n  = 145 SVGD [-] [mean age was 66.5 ± 10.1 years, 74.5% males]) were enrolled. At least one SVG with ≥ 50% stenosis was defined as SVGD. Independent predictors of SVGD were determined by logistic regression analysis. Results  White blood cell, neutrophil, monocyte, the age of SVG, and MHR were significantly higher, whereas SA level was significantly lower in patients with SVGD. In regression analysis, neutrophil, age of SVG, SA (odds ratio [OR]: 0.232 [0.156-0.370], p  < 0.001), and MHR (OR: 1.122 [1.072-1.174], p  < 0.001) remained as independent predictors of SVGD. Moreover, age of SVG showed a significant negative correlation with SA ( r  = - 0.343, p  < 0.001) and a positive correlation with MHR ( r  = 0.238, p  < 0.001). In the receiver-operating characteristic curve analysis, the cutoff value of ≤ 3.75 g/dL for SA has a 73.2% sensitivity and 64.8% specificity and the cutoff value of ≥ 12.1 for MHR has a 71.4% sensitivity and 60.0% specificity for prediction of SVGD. Conclusion  Consequently, to the best of our knowledge, this is the first study showing a significant and independent association between SA and MHR with SVGD., Competing Interests: Conflict of Interest: The authors declared no conflict of interest., (Georg Thieme Verlag KG Stuttgart · New York.)

We investigated the relationship between resting heart rate (HR) and The Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score in patients with stable coronary artery disease (SCAD). A total of 420 patients who were admitted to our outpatient clinic for stable angina pectoris with sinus rhythm and had at least 50% narrowing in at least 1 coronary artery after coronary angiography were included in the study. Patients were divided into 3 tertiles based on the resting HR: HR of tertile 1 was ≤65 (n = 138), tertile 2 was between 66 and 76 (n = 139), and tertile 3 was ≥77 beats/min (n = 143). The SYNTAX score (7.6 ± 4.6, 12.4 ± 5.6, 20.3 ± 8.1; P < .001) was significantly higher for those in tertile 3 than for those in tertiles 1 and 2. Leukocyte count (7.8 ± 2.2, 7.9 ± 2.2, 8.4 ± 2.3 × 10 9 /L; P = .035) and C-reactive protein (CRP) levels (2.4 ± 0.5, 3.2 ± 0.7, 4.5 ± 1.2 mg/L, P < .001) were increasing from the lowest to the highest tertile. Using multiple logistic regression analysis, CRP (odds ratio [OR] 1.54 [1.17-2.11], P = .001) and resting HR (OR 1.67 [1.25-2.19], P < .001) emerged as independent predictors of SYNTAX score. Resting HR is related to SYNTAX score in patients with SCAD.

Background: Arrhythmias and electrocardiographic changes are reported in several noncardiac diseases, including liver cirrhosis (LC). We intended to evaluate the interval from the peak to the end of the electrocardiographic T wave (Tp-e), Tp-e/QTc ratio, and fQRS as presumed markers of arrhythmias in LC., Methods: In this cross-sectional study, a total of 88 consecutive patients with LC according to clinical, biological, ultrasonographic, or histological criteria and 73 control subjects were enrolled. The severity of cirrhosis was classified according to Pugh-Child's classification and Model for End-Stage Liver Disease (MELD) score. Tp-e interval, Tp-e/QTc ratio, and fQRS rates were measured from the 12-lead electrocardiogram., Results: Tp-e interval, Tp-e/QTc ratio and fQRS rates were significantly increased in parallel to the severity of LC (P < 0.001, P < 0.001, and P = 0.003, respectively). In correlation analysis, Pugh-Child stage showed a significantly positive correlation with Tp-e interval (r = 0.462, P < 0.001), QTc interval (r = 0.373, P < 0.001), Tp-e/QTc ratio (r = 0.352, P < 0.001), and fQRS (r = 0.407, P < 0.001). Furthermore, Tp-e interval (r = 0.414, P < 0.001) and Tp-e/QTc ratio (r = 0.426, P< 0.001) had significant positive correlation with MELD score., Conclusions: Our study demonstrated that Tp-e interval, Tp-e/QTc ratios, and fQRS rates were significantly increased in parallel to the severity of LC. Thus, these findings may implicate that Tp-e interval, Tp-e/QTc ratio, and fQRS may be novel and useful indicators for prediction of arrhythmias in LC., (© 2016 Wiley Periodicals, Inc.)

Objective: Many studies have revealed a role of YKL-40 as a new inflammatory biomarker in angiogenesis, inflammation, atherosclerosis and cardiovascular events. Thus, the aim of this study was to investigate the association of serum YKL-40 level with coronary collateral development and SYNTAX score in patients with stable coronary artery disease., Methods: A total of 165 patients who had ≥90% stenosis in at least one major coronary artery were prospectively enrolled in the study. Collateral degree was graded according to Rentrop-Cohen classification. Patients with grade 2 or 3 collateral degree were included in good collateral group and patients with grade 0 or 1 collateral degree were included in poor collateral group. The patients were also classified according to SYNTAX criteria, those with low (≤22) and those with high (>22) SYNTAX score., Results: Serum YKL-40 and hs-CRP levels were significantly lower in good collateral group. Furthermore, YKL-40 level showed significant positive correlations with SYNTAX score (r=0.486, p<0.001) and hs-CRP level (r=0.340, p<0.001). In multivariate regression analysis, serum YKL-40 (odds ratio: 0.928; 95% confidence interval: 0.917-0.940; p<0.001), duration of ischemic symptom and total occlusion were independent predictors of good collateral development. In ROC curve analysis, a YKL-40 value cut-off point of ≥168.5 predicted the high SYNTAX score with a sensitivity of 81.0% and specificity of 72.4%., Conclusions: Increased serum YKL-40 level was related with poor collateral development and high SYNTAX score. According to these findings YKL-40 can be used as a predictor of good collateral development and high SYNTAX score., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Endothelial dysfunction plays a major role in erectile dysfunction (ED). Atrial fibrillation (AF), regardless of subtype, is associated with a prothrombotic state, which is related to endothelial dysfunction. In this study, we aimed to determine whether AF is an independent risk factor for ED., Methods: A total of 50 patients diagnosed with paroxysmal lone AF and 80 age-, gender-, and body mass index-matched controls without AF who admitted to outpatient clinics at a tertiary center were enrolled. Diagnosis of ED was performed by using Sexual Health Inventory for Men (SHIM) questionnaire. Patients with a SHIM score ≤21 were defined as having ED., Results: Mean age of patients were 51.8 ± 7.7 and all of the study population were male. Twenty-nine of 50 patients in lone AF group and 25 of 80 patients in control group were diagnosed with ED (58 vs 31.2 %, p = 0.002). Mean SHIM score was significantly lower in lone AF group compared with controls (20.74 ± 2.67 vs 22.39 ± 2.21, p < 0.001). The multivariate stepwise logistic regression analyses showed that lone AF (OR 1.94 (1.44-2.46), p < 0.001), smoking (OR 1.92 (1.35-2.44), p = 0.003), fasting blood glucose (OR 1.51 (1.10-1.85), p = 0.012), and uric acid levels (OR 1.56 (1.13-1.92), p = 0.009) were independent predictors of ED., Conclusions: Beat-to-beat variation may lead to ED in patients with paroxysmal lone AF and questioning erectile function in patients with lone AF may be recommended.

Aim: The aim of the present study was to investigate the predictive value of preprocedural monocyte count-to-high-density lipoprotein cholesterol ratio (MHR) on development of in-stent restenosis in patients undergoing coronary bare-metal stent (BMS) implantation., Patients & Methods: Data from 705 patients who had undergone BMS implantation and additional control coronary angiography were analyzed., Results: Patients were divided into three tertiles based on preprocedural MHR. Restenosis occurred in 59 patients (25%) in the lowest tertile, 84 (35%) in the middle tertile and 117 (50%) in the highest MHR tertile (p < 0.001). Using multiple logistic regression analysis, smoking, diabetes mellitus, stent length, preprocedural MHR and C-reactive protein levels emerged as independent predictors of in-stent restenosis., Conclusion: High preprocedural MHR is related to BMS restenosis.

Background: Previous studies proposed that both inflammation, oxidative stress, and impaired endothelial dysfunction have a significant role in occurrence of slow coronary flow (SCF). monocyte-to-high density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress, which have been studied only in patients with chronic kidney disease., Hypothesis: We aimed to assess the relationship between MHR and SCF., Methods: Patients who had angiographically normal coronary arteries were enrolled in this retrospective study (n = 253 as SCF group and n = 176 as control group). Patients who had corrected thrombolysis in myocardial infarction frame counts (cTFCs) above the normal cutoffs were defined as with SCF., Results: The MHR and high-sensitivity C-reactive protein (hsCRP) were significantly higher in the SCF group. In correlation analysis, MHR has a significantly positive correlation with cTFC and serum hsCRP levels (P < .001). In multivariate logistic regression analysis, MHR was found as independently associated with the presence of SCF (odds ratio: 1.24, P < .001)., Conclusion: Higher MHR which indicates an enhanced inflammation and oxidative stress was significantly and independently associated with the presence of SCF. Besides, MHR was positively correlated with serum hsCRP level as a conventional marker for systemic inflammation., (© The Author(s) 2015.)

We investigated the relationship between epicardial adipose tissue (EAT) and infarct-related artery (IRA) patency before mechanical reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Patients (n = 640) were divided into 2 groups based on the thrombolysis in myocardial infarction (TIMI) flow grade. Impaired flow was defined as TIMI grades 0, 1, and 2, and normal flow was defined as TIMI 3. On the admission angiography, 65 (10.2%) patients had TIMI 3 flow, and the remaining 575 (89.8%) had TIMI 0, 1, or 2 flow. The impaired flow group patients had a higher incidence of diabetes mellitus (53.7% vs 41.5%, P = .035), higher EAT thickness (5.66 ± 1.84 vs 4.87 ± 2.09 mm, P = .001), and lower ejection fraction (43.1% ± 8.9% vs 47.4% ± 9.1%, P = .025). Multivariate stepwise logistic regression analysis showed that IRA patency was independently associated with EAT thickness (odds ratio [OR] 0.785; 95% confidence interval [CI] 0.712-0.858; P = .001) and neutrophil-lymphocyte ratio (OR 0.815; 95% CI 0.732-0.917; P = .025). Thickness of EAT was an independent predictor of lower TIMI flow in IRA in patients with STEMI., (© The Author(s) 2015.)

The platelet to lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker. Hence, we assessed the relationship between PLR and the extent/severity of coronary artery disease (CAD) using the Gensini score in association with the inflammatory marker C-reactive protein (CRP) in patients with stable CAD. Angiographic data of 1646 patients were analyzed in this cross-sectional study. Patients were categorized according to Gensini scores as no CAD (control), mild, and severe CAD groups. The PLR in the control group was significantly lower than those of mild and severe CAD groups. In multivariate logistic regression analysis, PLR was found to be an independent predictor of the presence of severe CAD (odds ratio: 1.043 [1.036-1.049], P < .001). Furthermore, there was a significant correlation between PLR and the severity of CAD (r = .370, P < .001) and CRP levels (r = .312, P < .001). In conclusion, PLR was independently and positively associated with the severity of coronary atherosclerosis. These results suggest that PLR is an easily available and cheap inflammatory indicator that can be used in predicting the severity of CAD., (© The Author(s) 2015.)

Metabolic syndrome (MetS) as a cluster of several cardio-metabolic components is rapidly growing public-health problem worldwide and significantly associated with poor cardiovascular outcomes. Increased visceral adiposity activates the important pathways connecting low-grade chronic inflammation, oxidative stress and blood coagulation. Recently, platelet to lymphocyte ratio (PLR) has been evidenced as a novel indirect inflammatory marker. Therefore, for the first time, we aimed to investigate the association of PLR with both the presence and severity of MetS. In this cross-sectional study, a total of 1146 participants were enrolled (n = 539 with MetS and n = 607 without MetS). MetS was defined according to NCEP-ATP III criteria. MetS (+) group revealed significantly higher PLR and C-reactive protein (CRP) levels as compared to MetS (-) group (p < 0.05). There was a graded relationship between increasing number of MetS components and PLR (p < 0.05). Also, PLR was positively correlated with CRP level (r = 0.163, p < 0.001). In multivariate regression analysis, PLR [1.121 (1.113-1.135), p < 0.001], CRP [1.044 (1.029-1.060), p < 0.001], and age [1.030 (1.017-1.043), p < 0.001] were remained as independent predictors for the presence of MetS. In conclusion, our findings showed that increased PLR was significantly associated with both the presence and severity of MetS which was linked to systemic inflammation based on the correlation between PLR and CRP. As PLR is an easily available, simple and cheap indirect indicator of inflammation, it can be used in clinical practice as a predictor of MetS.

Objective: The aim of this study was to determine whether the Macruz index (P/P-R segment) could predict the severity of valvular involvement and the success of percutaneous mitral balloon valvuloplasty (PMBV) in patients with mitral stenosis (MS)., Subjects and Methods: Sixty-one patients with MS eligible for PMBV and 72 healthy subjects (61 females and 11 males) with sinus rhythm were enrolled into this study. PMBV was performed in all patients using a percutaneous transseptal antegrade approach and a multitrack balloon technique. The P/P-R segment ratio and echocardiographic variables were measured before and 48-72 h after the procedure. The optimal cutoff point for differences in the Macruz index to determine clinical success was evaluated by receiver operating characteristic analysis by calculating the area under the curve as giving the maximum sum of sensitivity and specificity for the significant test., Results: In the patient group (mean age 42.9 ± 11.1 years), the preprocedural Macruz index was significantly higher than in the control group (2.79 ± 1.03 vs. 1.29 ± 0.11; p < 0.001). In the successful-procedure group (n = 53), the mean postindex value was significantly lower (2.12 ± 0.71 vs. 2.81 ± 1.0, p = 0.020), and the decrease in the Macruz index was significantly higher than in the unsuccessful-procedure group (p = 0.007). An index decrease of 0.105 was the best cutoff value to distinguish the successful-PMBV group from the unsuccessful- PMBV group (area under the curve = 0.888, 95% confidence interval 0.788-0.988, p < 0.001)., Conclusion: The Macruz index was significantly higher in patients with MS compared to healthy subjects. A greater decrease in the Macruz index was associated with a successful PMBV., (© 2015 S. Karger AG, Basel.)