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Background and Objectives Lymphocyte-to-monocyte ratio (LMR) has emerged as a new indirect marker of inflammation, which is associated with adverse outcomes in cardiovascular diseases. The aim of this study was to evaluate whether admission LMR is associated with contrast-induced nephropathy (CIN) in patients who underwent percutaneous coronary intervention for acute coronary syndrome (ACS). Methods A total of 873 patients were assessed. LMR was calculated via dividing lymphocyte count by monocyte count. Results LMR was significantly lower in the with-CIN group. ROC analysis showed that the LMR ratios Conclusion LMR is an easily accessible marker and could be used as a predictor of CIN in patients with ACS undergoing percutaneous coronary intervention.

Introduction:Cardiac involvement is rare in hydatid cyst disease, which accounted for 0.5%-2% of all hydatidosis cases. Cardiac cysts usually occur as part of a wider infestation with extracardiac involvement. This study aimed to describe the general characteristics, imaging findings, and range of organ involvement in cases of cardiac hydatid disease.Methods:Retrospective assessment of cardiac hydatid disease records, between 2007 and 2019, was undertaken to identify patients with cardiac hydatidosis. Hydatid cysts were assessed by transthoracic echocardiography, magnetic resonance imaging, and computed tomography. Clinical symptoms, treatment modalities, and follow-up were also evaluated.Results:Over the study period, 22 (13 males: 59.1%; mean age: 43.1 years; range: 12-63 years) patients with 24 cardiac hydatid cysts were identified. The most common symptom was chest pain, which occurred in 13 (59.1%) patients. Cardiac cysts were located in the left ventricle (n=10, 41.7%), right ventricle (n=5, 20.8%), interventricular septum (n=5, 20.8%), and pericardium (n=4, 16.7%). Extracardiac involvement was present in 14 (63.6%) patients, most commonly affecting the liver (n=10, 45.4%), but in 8 (36.3%) patients, there was no extracardiac organ involvement. Cardiac hydatid cysts were surgically removed in 20 (90.9%) patients.Conclusion:Cardiac hydatid disease is very uncommon, with the left ventricle as the most commonly affected structure in this series. Chest pain was the most common presenting symptom. Extracardiac involvement is common, so patients with cardiac hydatid cysts should be investigated for involvement of other organs.

Amac: Calisma vaka-kontrol seklinde dizayn edildi. Akut koroner sendrom (AKS), uzun sureli iskemi sonrasi miyokard nekrozu ile sonuclanabilen iskemik bir kalp hastaligidir. Omentin (intelectin-1), yag dokusundan salinan yeni bir biyobelirtectir. Omentin koroner arter hastaligi (CAD) ile iliskilidir ve akut iskemik hasari azaltici etkiye sahiptir. Bu calisma, kararsiz anjina pektoris (USAP), ST elevasyonsuz miyokard enfarktusu (NSTEMI) ve ST elevasyonlu miyokard enfarktusu (STEMI) olan hastalarda omentin duzeylerini degerlendirmeyi amaclamistir. Yontemler: Bu calismaya prospektif olarak 59 AKS hastasi ve 22 saglikli birey dahil edildi. Semptomlarin baslamasindan sonraki alti saat icinde her hastadan alinan venoz kandan kreatin kinaz MB formu (CKMB), troponin, miyoglobin ve omentin duzeyleri olculdu. Plazma omentin seviyeleri, bir omentin enzimine bagli immunosorban test kiti ile belirlenmistir. Bulgular: Hasta grubu kontrol grubundan daha yasliydi (P 0,05). Hasta grubunda sigara icme orani daha fazlaydi ve hasta grubu kontrol grubuna gore daha agirdi (P>0,05). AKS hastalarinda ve kontrol grubunda omentin duzeyleri benzerdi (6,0 (1,7) ve 6,3 (1,3); P=0,40). CKMB, troponin, miyoglobin ve omentin duzeyleri arasinda anlamli bir iliski yoktu. CKMB, troponin, miyoglobin ve omentin duzeyleri arasinda anlamli bir korelasyon yoktu, ayrica AKS alt gruplarinda omentin duzeyleri benzerdi (P=0,58). Vucut kitle indeksi ile omentin duzeyleri arasinda anlamli bir iliski yoktu (r = -0,186, P=0,09). Sonuc: Bu calisma AKS hastalarinda omentin ve miyoglobin duzeyleri arasinda anlamli bir iliski olmadigini ortaya koymustur. Omentin duzeylerinin kan konsantrasyonlarinin AKS ile iliskisinin anlasilmasindaki potansiyel faydasi daha fazla calismaya ihtiyac duyar.

Aim: The systemic immune-inflammation index (SII), a novel inflammation-based biomarker combining platelet, neutrophil and lymphocyte counts, has been shown to be associated with worse clinical outcomes in several malignancies. However, the relationship between SII and response to cardiac resynchronization theraphy (CRT) has not been evaluated yet. The aim of this study was to investigate the association between SII and response to CRT in patients with heart failure (HF). Material and Methods: A total of 88 patients (54.5% male; mean age 58.9±12.9 years) who underwent CRT device implantation were included in the study. Baseline clinical, demographic, laboratory and echocardiographic data of patients’ were recorded. An echocardiographic CRT response was defined as a decrease in left ventricular end‐systolic volume of ≥15% and/or absolute increase of 5% in left ventricular ejection fraction (LVEF) at 6‐month follow-up after CRT implantation.Results: Among included patients, a total of 51 (57.9%) patients were defined as ‘’responders’’ after 6 months of CRT implantation. Lymphocyte count, LVEF and QRS width were significantly higher in responders compared to those responders. In addition, baseline creatinine and SII levels were significantly lower in responders than nonresponders. Multivariate logistic regression analysis showed that a SII of ≤973.3, LVEF and QRS width were independent predictors for response to CRT in the study population.Conclusion: SII may be used as a novel, simple and reliable inflammatory biomarker in the prediction of response to CRT in patients with HF.

Objective: The systemic immune-inflammation index (SII), derived from counts of neutrophils, platelets, and lymphocytes, has been developed to predict clinical outcomes in several cancers and cardiovascular diseases. The aim of this study was to evaluate the utility of SII to predict contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods: A total of 632 patients with STEMI who underwent primary PCI were retrospectively included. The patients were divided into two groups based on the presence or absence of CIN. Baseline demographic, laboratory, and clinic characteristics were evaluated between the two groups. Logistic regression analysis was used to identify independent predictors of CIN. Results: The receiver operating characteristic curve analysis demonstrated that the optimal cutoff value of SII for predicting CIN was 1,282 with a sensitivity of 76.1% and specificity of 86.7% (AUC: 0.834; 95% CI: 0.803–0.863; p < 0.001). Multivariate analysis performed in two models (SII; as separate continuous and categorical variables) showed age, estimated glomerular filtration rate (eGFR), diabetes, left ventricular ejection fraction (LVEF), Killip class ≥2, use of an intravenous diuretic, troponin I, and SII as independent predictors of CIN in model 1. In model 2, age, eGFR, diabetes, LVEF, Killip class ≥2, use of an intravenous diuretic, troponin I, and a value of SII >1,282 (p < 0.001, OR 6.205, 95% CI: 2.301–12.552) remained as independent predictors of CIN. Conclusion: SII may be a useful and reliable indicator to predict the development of CIN in patients with STEMI undergoing primary PCI than NLR and PLR.

Aim: This study aimed to explore the role of peritoneal ultrafiltration (UF) in cardiorenal syndrome (CRS) patients for fluid and metabolic control. Background: Peritoneal UF is safely and efficiently used for the management of CRS. It has been shown to provide efficient UF in hypervolemic patients. Methods: Thirty (20 males and 10 females) CRS patients were treated by peritoneal dialysis (PD) and UF. The baseline data of the patients (demographics, causes of heart failure, the presence of pacemaker or implantable cardioverter-defibrillator, the need for extracorporeal UF or paracentesis or thoracentesis, comorbidity, drugs, left ventricular ejection fraction [LVEF] and pulmonary artery systolic pressure [PAPs], pericardial effusion, physical examination, body weight, NYHA class, dialysis regime, urine output, N-terminal pro-B-type natriuretic peptide [NT-proBNP] level, hemoglobin, estimated glomerular filtration rate [eGFR], and other routine biochemical determinations) were recorded at the onset, every 6 months, and then annually. Echocardiograms were performed at baseline and after 6 and 12 months. The time points of complications associated with PD, the need for hemodialysis, the day of death, and causes of death were documented. Results: Mean age was 69 ± 8 years (range 49–84 years). The average PD duration was 18.25 ± 14.87 months. According to the CKD-EPI, initial mean GFR was 34.34 ± 11.9 mL/min/1.73 m2 (range 16.57–59.0), and this increased to 45.48 ± 26.04, 45.10 ± 28.58, and 41.10 ± 25.68 mL/min/1.73 m2 in the third, sixth, and twelfth months, respectively. There was a significant increase in the first 3 months and a significant decrease between the third and twelfth months (respectively, p = 0.018 and p = 0.043). There was no difference in eGFR levels between baseline and the end of the first year (p = 0.217). In the first 3 months, there was a significant decline in urea levels to 79.38 ± 36.65 from 109.92 ± 42.44 mg/dL and this was maintained until the end of the first year of PD therapy (after 3 months, p = 0.002; after 1 year, p = 0.024). However, there was no significant change in creatinine levels within the first year (p = 0.312). There was a significant increase in hemoglobin level up to the end of the first year of PD (after 3 months, p = 0.000; after 12 months, p = 0.013). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). Functional capacity (according to NYHA classification) improved in all patients by the third month of PD treatment (p < 0.001). This early improvement was maintained in many patients during the following 12 months (p < 0.001). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). At the end of the first year, there was an approximate 15% reduction in NT-proBNP levels (p = 0.647). Hospitalizations decreased to 6 ± 15 days/patient-year (range 18–122 days) from 62 ± 24 days/patient-year (p = 0.000). Conclusion: Peritoneal UF is a treatment method that maintains renal function and electrolyte balance, improves cardiac function, and reduces hospitalizations in CRS patients. We observed that this treatment significantly increased functional capacity and quality of life and significantly reduced hospital admissions.

Resumen Objetivo La terapia de resincronizacion cardiaca (TRC) es una opcion eficaz en el tratamiento de los pacientes con insuficiencia cardiaca y QRS ancho. Se ha demostrado que la presencia de un QRS fragmentado (QRS-f) en el electrocardiograma (ECG) de 12 derivaciones se asocia con una no respuesta a la TRC. El objetivo de este estudio es valorar si la aparicion de la fragmentacion (intervalo Q-f) es importante en la respuesta a la TRC. Metodos Analisis retrospectivo de centro unico de datos recogidos de manera prospectiva procedentes de 38 pacientes con miocardiopatia isquemica dilatada (18 hombres, media de edad de 63 ± 12 anos) sometidos a TRC con un QRS-f en ECG de 12 derivaciones. Se midieron la duracion de la fragmentacion, la relacion duracion del QRS-f/duracion total del QRS (QRS-f/QRS-t) y el intervalo de tiempo transcurrido desde la aparicion de la onda Q hasta el inicio de la fragmentacion del QRS. Resultados No se observaron diferencias estadisticamente significativas entre los pacientes respondedores (24 pacientes, 63%) y los no respondedores en cuanto a las caracteristicas clinicas iniciales y los hallazgos electrocardiograficos. No obstante, en pacientes no respondedores a la TRC, se observo una mayor duracion del QRS-f, una proporcion QRS-f/QRS-t aumentada y un intervalo Q-f mas breve. En el analisis multivariante, se establecio el intervalo Q-f como un predictor independiente de respuesta a la TRC (OR 1,240; IC 95%: 1,049-1,467; p = 0,012). En el analisis de curva ROC, el valor de corte para el intervalo Q-f por lo que se refiere a la prediccion de respondedores fue 32,5 ms, con una sensibilidad y especificidad del 83,3 y 85,7%, respectivamente (AUC 0,899, IC 95%: 0,797-1,000; p = 0,001). Conclusiones Un intervalo de tiempo breve entre el inicio de QRS y el inicio de la fragmentacion es un marcador ECG sencillo para la prediccion de pacientes no respondedores a la TRC.

In-stent restenosis and occlusion are common, well-known complications of superficial femoral artery (SFA) interventions. The treatment options in such cases are re-intervention or surgery. A percutaneous antegrade approach is an effective and safe method to perform SFA stent restenosis or occlusion treatment. If an antegrade intervention fails, a retrograde transpopliteal approach may be an alternative. However, in some patients who are admitted with acute leg ischemia there is no distal vessel flow. This condition can result in the need for extremity amputation. Presently described is a case in which a direct stent puncture technique was applied to recanalize the SFA in-stent occlusion after an initially unsuccessful antegrade intervention.

We aimed to investigate the predictive value of coupling interval variability (ΔCI) in determining the origin of idiopathic outflow tract ventricular tachycardia (OTVT) with V3 transition. We reviewed data from 126 patients who underwent catheter ablation of OTVT between 2015 and 2018 at our institution. We identified 32 patients of successful OTVT ablation with a precordial transition at V3 derivation. The ΔCI (maximum − minimum CI) was measured. CI variability was significantly smaller for right ventricular (RV) OT than left ventricular (LV) OT premature ventricular contractions (PVCs) (p = 0.004). In multivariate analysis, including QRS duration, R-wave duration in lead V1, R-wave amplitude in V1, PVC burden, and ΔCI, ΔCI was the only independent predictor of PVC origin (OR 0.963, 95% CI, 0.939–0.988, p

Background Hydralazine-nitrate combination is recommended for patients with heart failure with reduced ejection fraction (HFrEF)/systolic heart failure who are symptomatic despite guideline-directed medical therapy (GDMT). Use of nitrates alone for this indication is not well-established. This study aims to evaluate the effect of oral nitrates on all-cause mortality and hospitalization in HFrEF patients using GDMT. Methods and Results Nitrate prescription at discharge and its association with all-cause mortality and heart failure hospitalization were examined in a propensity-matched analysis of 648 HFrEF patients followed for a median of 56 months. A total of 269 (42%) patients died during that period. In Cox regression analysis, nitrate usage was associated with a slightly increased mortality risk compared with not using nitrates (hazard ratio 1.29; 95% confidence interval 1.01–1.65; P = .040), which continued modestly after the propensity-matched analysis (hazard ratio 1.26; 95% confidence interval 0.95–1.68; P = .102). In both prematch and propensity-matched analyses, nitrate use was not associated with risk of rehospitalization. No significant effect was detected on subgroups stratified by coronary artery disease, age, gender, and background medical therapy. Conclusions In this study, oral nitrate use alone in addition to GDMT did not affect all-cause mortality and hospitalization risk in HFrEF patients during a long-term follow-up. There was even a modest tendency for increased risk of mortality.

Background Cardiac resynchronization therapy (CRT) is recommended for patients with advanced chronic heart failure. Systolic aortic root motion (SARM) has been investigated in dilated cardiomyopathy patients and found that heart failure patients had reduced SARM. We aimed to investigate the relationship between SARM and response to CRT. Methods Fifty-six patients with advanced heart failure, wide QRS complex, and LVEF ≤35% were included. Transthoracic echocardiography was performed before, and repeated at 6 months in follow-up. Systolic aortic root motion was measured in each patient before the device implantation. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months follow-up. Results Forty patients (71%) had CRT response after 6 months of follow-up. In multivariate analysis, significant associates of response to CRT was evaluated adjusting for functional capacity, etiology of cardiomyopathy, QRS duration, baseline left ventricular dimensions/volumes and SARM. SARM was the only predictor of response to CRT (OR 1.818, 95% CI, 1.101-3.003, P = .019). Conclusions SARM predicts non-response to CRT and may help in the selection of CRT candidates.

Objective Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Presence of fragmented QRS (f-QRS) on 12-lead electrocardiogram (ECG) has been shown to be associated with non-response to CRT. The aim of this study was to evaluate whether onset of fragmentation (Q-f interval) is important for CRT response. Methods This is a single-center retrospective analysis of prospectively collected data of 38 non-ischemic dilated cardiomyopathy patients (18 men, mean age 63 ± 12 years) with f-QRS on 12-lead ECG who underwent CRT. Duration of fragmentation, ratio of f-QRS duration to the total QRS duration (f-QRS/t-QRS ratio) and time interval from Q wave to the onset of QRS fragmentation (Q-f interval) were measured. Results The baseline clinical, echocardiographic findings of patients with responders (24 patients, 63%) and non-responders showed no statistically significant difference, except for longer f-QRS duration, increased ratio of f-QRS duration to the total QRS duration (f-QRS/t-QRS ratio) and shorter time interval from Q wave to the onset of QRS fragmentation (Q-f interval) in patients not responding to CRT. In multivariate analysis, Q-f interval was determined as an independent predictor of response to CRT (OR 1.240, 95% CI: 1.049–1.467, p = .012). In ROC curve analysis, the best cut-off value for Q-f interval to predict responders was 32.5 ms with a sensitivity and specificity of 83.3% and 85.7%, respectively (AUC 0.899, 95% CI: 0.797–1.000, p = .001). Conclusions Shorter time from onset of QRS to beginning of fragmentation is a simple ECG marker to predict non-responsive patients to CRT.

WOS: 000434357200002, PubMed: 29922067, Background: Elevated vitamin B12 is a sign for liver damage, but its significance in chronic stable heart failure (HF) is less known. The present study investigated the clinical correlates and prognostic significance of vitamin B12 levels in stable systolic HF. Methods: A total of 129 consecutive patients with HF and 50 control subjects were enrolled. Data regarding demographics, clinical signs, therapeutic and conventional echocardiographic measurements were recorded for all patients. Right-sided HF was defined as the presence of at least one of the typical symptoms (ankle swelling) or specific signs (jugular venous distention or abdominojugular reflux) of right HF. Cox proportional hazards regression analyses were performed to determine the independent prognostic determinants of mortality. Results: Baseline B12 levels in HF patients (n=129) with and without right sided HF were significantly higher compared to healthy controls (n=50): Median 311 pg/mL and 235 pg/mL vs 198 pg/mL, respectively (P=0.005). Folic acid levels were similar between the study groups. Age, ejection fraction, left atrial size, estimated glomerular filtration rate, and direct and indirect bilirubin levels were significantly correlated to serum B12 level in univariate analysis. In multivariate analysis, independent correlates of B12 were direct bilirubin (R=0.51, P= 270 pg/mL had 80% sensitivity and 58% specificity for predicting all-cause mortality (area under the curve=0.672, 95% CI=0.562-0.781; P=0.003). However, in Cox regression analysis, only left atrial diameter, level of direct bilirubin, and the presence of abdominojugular reflux were independent predictors of death. Conclusion: Increased B12 in stable HF patients is associated with increased direct bilirubin due to right HF, indicating a cardiohepatic syndrome, but neither B12 nor folic acid are independently associated with mortality.

Background. The mean platelet volume (MPV), the most commonly used measure of the platelet size, is a cheap and easy-to-use marker of the platelet activation. We aimed to evaluate the relationship between preprocedural MPV and other hematologic blood count parameters and in-stent restenosis in patients with superficial femoral artery (SFA) stenting.Methods and Results. The consecutive 118 patients who successfully underwent endovascular stenting of the SFA were enrolled retrospectively in the study. The mean follow-up was 23 ± 12 months. The in-stent restenosis was observed in 42 patients (35.6%). There were no statistically significant differences between the restenosis group and no-restenosis group in terms of age, gender, and smoking (p=0.116,p=0.924, andp=0.428, resp.). In the restenosis group, the MPV level was markedly higher than that in the no-restenosis group, and it was statistically significant (p<0.001). According to the ROC curve analysis, the optimal cutoff value of the MPV to determine the restenosis was >8.7 fL, and the level of the MPV >8.7 fL was a strong predictor of the restenosis (p<0.001) in logistic regression analysis.Conclusions. The measurement of the preprocedural MPV levels may help to identify high-risk patients for development of the in-stent restenosis. These patients may benefit from an aggresive antiplatelet therapy and close follow-up.

WOS: 000431104400008, PubMed: 28786775, Objective: The risk stratification for prognosis in heart failure is very important for optimal disease management and decision making. The aim of this study was to establish a simple discharge 1-year mortality prediction model by integrating data obtained from demographic characteristics, clinical evaluation, laboratory biomarkers and echocardiographic evaluation of hospitalised heart failure with reduced ejection fraction (HFrEF) patients with acute decompensation. Methods and results: A risk score model was developed based on beta-coefficient number of variables in a multivariable logistic regression model which was created with the use of data on clinical, laboratory, imaging and therapeutic findings of 670 patients (65.4% males, 65 +/- 11 years) who was hospitalised with acute decompensated HFrEF. The mean left ventricular ejection fraction (LVEF) was 26 +/- 9%. Independent predictors of mortality were: age >= 75 years, sodium

Myocardial non-compaction (NC) is a rare genetic cardiomyopathy commonly believed to develop an intrauterine arrest of endomyocardial morphogenesis. NC is characterized by markedly hypertrabeculations in left ventricle or both ventricles with deep intertrabecular recesses. NC is usually seen isolated, but sometimes other congenital heart abnormalities may accompany to the myocardial NC. In this article we have presented an adult patient with biventricular myocardial NC cardiomyopathy accompanied by severe valvular pulmonary stenosis and patent foramen ovale.