C-reactive protein to albumin ratio provides important long-term prognostic information in patients undergoing endovascular abdominal aortic repair

BACKGROUND

The prognostic value of C-reactive protein/albumin ratio (CAR) is of import in cardiovascular diseases. Our aim was to evaluate the impact of the CAR in patients with asymptomatic abdominal aortic aneurysm (AAA) undergoing endovascular aneurysm repair (EVAR).

MATERIAL AND METHOD

We retrospectively evaluated 127 consecutive patients who underwent technically successful elective EVAR procedure between December 2014 and September 2020. The optimal CAR cut-off value was determined by using receiver operating characteristic (ROC) curve analysis. Based on the cut-off value, we investigated the association of CAR with long-term all-cause mortality.

RESULTS

32 (25.1%) of the patients experienced all-cause mortality during a mean 32.7 ± 21.7 months' follow-up. In the group with mortality, CAR was significantly higher than in the survivor group (4.63 (2.60-11.88) versus 1.63 (0.72-3.24), p < 0.001). Kaplan-Meier curves showed a higher incidence of all-cause mortality in patients with high CAR compared to patients with low CAR (log-rank test, p < 0.001). Multivariable Cox regression analysis revealed that glucose ≥ 110 mg/dL (HR: 2.740; 95% CI: 1.354-5.542; p = 0.005), creatinine ≥ 0.99 mg/dL (HR: 2.957, 95% CI: 1.282-6.819, p = 0.011) and CAR > 2.05 (HR: 8.190, 95% CI: 1.899-35.320, p = 0.005) were the independent predictors of mortality.

CONCLUSION

CAR was associated with a significant increase in postoperative long-term mortality in patients who underwent EVAR. Preoperatively calculated CAR can be used as an important prognostic factor.

The diagnostic role of "acceleration time" measurement in patients with classical low flow low gradient aortic stenosis with reduced left ventricular ejection fraction

PURPOSE

In our study, we aimed to assess the role of acceleration time (AT), ejection time (ET), and AT/ET ratio to distinguish between true and pseudo severe AS in patients with classical low flow-low gradient (LF-LG) aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF).

METHODS

Sixty-seven classical LF-LG AS with reduced LVEF patients who underwent dobutamine stress echocardiography (DSE) were included in the study. According to DSE results, all patients were divided into two groups; true AS and pseudo severe AS. Aortic valve calcium score was measured in patients with inconclusive DSE results. AT and other ejection dynamics (ET and AT/ET) were calculated by taking baseline echocardiographic records into account for all patients. The predictive power of AT and other ejection dynamics were evaluated to estimate true and pseudo severe AS.

RESULTS

According to DSE results, out of 67 patients, 44 (65.7%) was diagnosed as true severe AS. There was a statistically significant relation between baseline AT and true AS [adjusted OR 4.47 (95% CI 1.93-10.4), p = 0.001]. The best cutoff value of AT was measured as 100 msec according to the Youden index. This value had a sensitivity value of 77%, specificity value of 87%, positive predictive value of 92%, and a negative predictive value of 67%.

CONCLUSION

The measurement of AT can predict the DSE outcome and can be used for diagnostic purposes to distinguish between true and pseudo severe AS in classical LF-LG AS patients with reduced LVEF.

A simplified acute kidney injury predictor following endovascular aortic repair: ACEF score

OBJECTIVES

Treatment of abdominal aortic aneurysms (AAA) with endovascular aortic repair (EVAR) has become quite common in recent years. This method, which has many advantages compared to the open surgical procedure, also has some complications. One of these complications is acute kidney injury (AKI). ACEF (age, creatinine, and ejection fraction) score, which is gaining popularity, can be an easy-to-use and cost-effective method in detecting this condition that causes increased morbidity and mortality. We aimed to evaluate whether this ACEF score may predict a development of AKI in patients who underwent EVAR.

METHODS

A total of 133 consecutive patients with AAA who underwent EVAR were analyzed. The primary endpoint of the study was the development of AKI. The best cut-off value for the ACEF score to predict the development of AKI was calculated and according to this value, the patients were divided into two groups as those with high ACEF scores and those with low ACEF scores. ACEF score was calculated by the formula of age/EF + 1 (if baseline creatinine > 2 mg/dL).

RESULTS

After the exclusion criteria, a total of 118 patients were included in the study, and 20 (16.9%) of them developed AKI after EVAR. In the ROC curve analysis, a cut-off value of 1.34 was found for the ACEF score, and scores above this value were found to be independent predictors of AKI development after EVAR. In addition to the ACEF score, the contrast media volume was also found to be an independent predictor of the development of AKI.

CONCLUSION

In conclusion, ACEF is a simple and effective scoring system in patients undergoing EVAR. To the best our knowledge, our study is the first study which applies ACEF score to predict AKI in EVAR patients.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

The prognostic value of C-reactive protein to albumin ratio in patients undergoing transcatheter aortic valve implantation

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is a less invasive and safe therapeutic alternative in patients who are at very high surgical risk or in whom there are contraindications to open surgery. On the other hand, allocating transcatheter therapy to the adequate candidates and identifying a reliable and validated risk stratification tool for mortality prediction is still lacking. The C-reactive (CRP) to albumin ratio (CAR) is a novel inflammation-based prognostic tool and it is strongly associated with inflammation severity and mortality. In this study, we aimed to elucidate the predictive significance of CAR for mortality in patients who underwent TAVI.

METHODS

The records of 321 consecutive patients who underwent TAVI due to symptomatic aortic stenosis between 1 January 2015 and 31 December 2020 were analysed. Patients were divided into two groups based on the CAR values. For each group, all-cause, cardiovascular, and non-cardiovascular mortality occurring >72 h after the index procedure and at maximum follow-up was documented.

RESULTS

The mean follow-up time was 40 (22-63) months. A total of 180 (56.1%) patients died during long-term follow-up. According to our study, median CAR values were significantly higher among patients who died during follow-ups compared to survivors [1.13 (0.69-2.21) vs 3.56 (1.53-10.00), p < 0.001].

CONCLUSION

Our data showed that CAR is an independent predictor of long-term mortality in patients undergoing TAVI due to symptomatic aortic stenosis.

New perspective on fatigue in hemodialysis patients with preserved ejection fraction: diastolic dysfunction : Fatigue and diastolic dysfunction

The relationship between diastolic dysfunction and fatigue in hemodialysis patients with preserved ejection fraction is unknown. In this context, the objective of this study is to assess fatigue using the relevant scales and to demonstrate its relationship with diastolic dysfunction. The patients who underwent hemodialysis were evaluated prospectively. Patients' fatigue was assessed using the Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F). The echocardiographic works were performed as recommended in the American Society of Echocardiography guidelines. A total of 94 patients [mean age 64.7 ± 13.5 years, 54 males (57.4%)] were included in the study. The median VAS-F score of these patients was 68.5 (33.25-91.25), and they were divided into two groups according to this value. Peak myocardial velocities during early diastole (e') and tricuspid annular plane systolic excursion (TAPSE) values were found to be significantly lower in the group with high VAS-F scores, whereas the early diastolic flow velocities (E)/e' ratio and pulmonary artery peak systolic pressures (PAP) were found to be significantly higher (p < 0.05, for all). E/e' ratio (r 0.311, p 0.002) and PAP (r 0.281, p 0.006) values were found to be positively correlated with the VAS-F score, as opposed to the TAPSE (r - 0.257, p 0.012) and e' (r - 0.303, p 0.003) values, which were found to be negatively correlated with the VAS-F score. High fatigue scores in hemodialysis patients may be associated with diastolic dysfunction. In addition, in our study, we determined the correlation of VAS-F score with E/e' ratio, PAP and TAPSE.

Association of dipping pattern of blood pressure and atherosclerotic burden of coronary arteries in hypertensive patients

Aim    The aim of this study was to determine the association between the dipping pattern of BP and coronary artery disease in hypertensive patients.Material and methods    A total of 356 hypertensive patients were included in the study. The results of ambulatory BP monitoring, echocardiography, and coronary computerised tomographic angiography were evaluated retrospectively. The patients were divided into two groups on the basis of their ambulatory BP monitoring: 1) patients with the dipping pattern of BP; 2) patients with the non-dipping pattern (NDP).Results    Among the 356 patients, 145 were male (40.7 %). The smoking status was higher in patients with NDP (p=0.023). The statin usage in patients with the dipping pattern was higher in patients with NDP (p=0.027). There were no significant differences in the echocardiographic findings. 58.6 % of the patients without plaque formation had the dipping pattern of BP (p&lt;0.05), however 84.4 % of patients with &gt;50 % plaque formation had the NDP of BP (p&lt;0.001).Conclusion    The NDP of BP might be related to the increased atherosclerotic process in coronary arteries, and pa-tients with NDP might have an increased atherosclerotic burden for coronary arteries when compared with patients with a dipping pattern.

The role of coronary sinus in the risk stratification and the prognostic evaluation of idiopathic pulmonary arterial hypertension

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary sinus (CS) is a venous structure draining into the right atrium, therefore it can reflect the pressure and the volume load of the right heart chambers. Idiopathic pulmonary arterial hypertension (IPAH) is a progressive, life-threatening disease in which the risk assessment plays a critical role.

Purpose

We aimed to evaluate the correlation of CS diameter with the well-known risk assessment parameters in IPAH patients and to search the utility of CS diameter in the prediction of mortality and hospitalization.

Methods

A total of 25 IPAH patients were enrolled in our retrospective study.  All patients underwent detailed echocardiographic examination, laboratory examination, 6 minutes walking test and cardiopulmonary exercise test at the same day. The patients were followed-up for a mean 16.8 ± 10.1 months. Primary endpoint was mortality or hospitalization. The relationship between CS diameter and well-known risk parameters and the prognosis were analyzed.

Results

Mean CS diameter was 9.9 ± 3.7 mm. CS diameter had moderate positive correlation with age (r:0.560, p:0.004), NT-proBNP (r:0.625, p:0.001) and weak positive correlation with functional class (r:0.483, p:0.017) and moderate negative correlation with 6 minutes walking distance (r:-0.553, p:0.005) and peak oxygen uptake (r:-0.506 p:0.038). Six (24%) patients were hospitalized, and three patients (12%) died during mean 16.8 ± 10.1 months follow-up. The CS diameter &gt; 9 mm predicted mortality and hospitalization with a sensitivity of 77.8%, specificity of 75.0% (Area under curve (AUC): 0.788; 95% CI: 0.580-0.996; P = 0.019).

Conclusion

CS which is a noninvasive, cheap and readily available echocardiographic parameter, might be used in the risk assessment and the evaluation of prognosis in IPAH patients. Abstract Figure. Coronary sinus measurement  Abstract Figure. Basal features

The role of three dimensional transesophageal echocardiography novel score in the success of redo percutaneous mitral balloon valvuloplasty

Funding Acknowledgements

Type of funding sources: None.

Background

Mitral valve morphology is traditionally evaluated according to the images of two-dimensional transthoracic echocardiography and Wilkins score (WS) criteria in the selection of suitable patients for Percutaneous balloon mitral valvuloplasty (PBMV).  However, WS does not include mitral commissural morphology, it is known that not only WS but mitral valve commissure morphology is also important in the success of PBMV. It is known that mitral stenosis might develop secondary to the progression of the disease in the follow-up of the patients after first PBMV, and there are a limited knowledge about outcome and success in terms of redo PBMV.

Purpose

We aimed to determine whether WS in redo PMBV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure.

Methods

Our study designed as a retrospective, single center study. Fifty patients who underwent redo PMBV were included in the study. The patients were divided into two groups according to the success of the Redo PMBV procedure which was defined as post-procedural Mitral valve area (MVA) ≥ 1.5 cm2 and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation immediately after Redo PMBV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PMBV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated.

Results

In the study group, 36 patients (72%) had successful redo PMBV procedure. WS was 8 (IQR 7 - 9) and novel 3D TEE score was found 4 (IQR 3 - 4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). According to these findings; when both models were compared, the predictive accuracy and performance of the model developed with novel 3D TEE score to predict procedural success was found to be more favorable than the model developed with WS. When the probability of procedural success was calculated according to novel 3D TEE score using univariable logistic regression analysis, the probability of procedural successes was calculated &gt; 90%, especially when novel 3D TEE score was &lt;4. 

Conclusion

The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PMBV, especially in patients who are considered for surgery due to the high WS. Abstract Figure. Definition of novel 3D TEE scoring  Abstract Figure. Information about novel 3D TEE scoring

Role of N-terminal pro-B-type natriuretic peptide and troponin T in predicting right ventricular recovery in myocardial infarction

OBJECTIVES

The determinants of right ventricular (RV) recovery after successful revascularization in ST-elevation myocardial infarction (STEMI) patients are not clear. Besides, the relationship between Troponin T (TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and improvement in RV function is also unknown. This study hypothesizes that a lower TnT and NT-proBNP level would be associated with RV recovery.

METHODS

One hundred forty-eight STEMI patients were included in our study. Echocardiography were performed before and 12-18 weeks after discharge. Patients were divided into three groups according to the changes in tricuspid annular plane systolic excursion (TAPSE) as 53 patients with ≥10% change, 41 patients with 1-9% change, and 54 patients ≤0% change. RV recovery was accepted as ≥10% TAPSE improvement and the predictors of RV recovery were investigated.

RESULTS

RV recovery was detected in 35.8% of the patients. Low baseline left ventricular ejection fraction (OR: 0.91 [0.84-0.98], p=0.023), NT-proBNP (OR: 0.93 [0.89-0.98], p=0.014), TnT (OR: 0.84 [0.68-0.93], p=0.038), inferior myocardial infarction (OR: 2.66 [1.10-6.40], p=0.028), wall motion score index ratio (OR: 0.93 [0.88-0.97], p=0.002) and post-percutaneous coronary intervention TIMI flow 3 (OR: 5.84 [1.41-24.22], p=0.015) were determined as independent predictors of RV recovery. Being in the high TnT group 4.2 times, and being in the high NT-proBNP group 5.3 times could predict the failure to achieve RV recovery. Furthermore, when high TnT level was combined with high NT-proBNP level, the odds ratio of failure to achieve RV recovery was the highest (OR: 8.03 [2.59-24.89], p<0.001).

CONCLUSIONS

Lower TnT and lower NT-proBNP level was associated with better improvement in RV function in STEMI patients.

The role of three dimensional transesophageal echocardiography novel-score in the success of redo percutaneous balloon mitral valvuloplasty

Mitral valve commissure evaluation is known to be important in the success of percutaneous balloon mitral valvuloplasty (PBMV) and Wilkins score (WS) is used in clinical practice. In our study, we aimed to determine whether WS in redo PBMV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure. Fifty patients who underwent redo PBMV were included in the study. The patients were divided into two groups according to the success of the Redo PBMV procedure which was defined as post-procedural MVA ≥ 1.5 cm² and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation after PBMV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PBMV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated. In the study group, 36 patients (72%) had successful redo PBMV procedure. WS was 8 (IQR 7-9) and novel 3D TEE score was found 4 (IQR 3-4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). Specifically, the procedural successes rate was > 90% when novel 3D TEE score was < 4. The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PBMV, especially in patients who are considered for surgery due to the high WS.

Relationship between Late Gadolinium Enhancement and Ventricular Repolarization Parameters in Heart Failure Patients with Reduced Ejection Fraction

BACKGROUND

Heart failure with reduced ejection fraction (HFrEF) is a highly prevalent disease that requires repeating hospitalizations, causes significant morbidity and mortality. Therefore, early recognition of poor outcome predictors is essential for patient management.

OBJECTIVE

The aim of the present study is to investigate the relationship between late gadolinium enhancement (LGE) detected by cardiac magnetic resonance (CMR) and repolarization parameters such as corrected QT (QTc) interval, Tp-e interval, frontal QRS-T angle detected by 12 lead electrocardiograph (ECG) in HFrEF.

METHOD

In this single-center, retrospective observational study included 97 consecutive HFrEF patients who had CMR scan. Study population was divided into two groups according to the presence of LGE. Echocardiographic and CMR measurements and demographic features were recorded. QTc intervals, Tp-e intervals, frontal QRS-T angles were calculated from the ECG. A p-value less than 0.05 was considered statistically significant.

RESULTS

LGE was detected in 52 (53.6%) out of 97 HFrEF patients. QTc intervals (p=0.001), Tp-e intervals (p<0.001), frontal QRS-T angles (p<0.001) were found to be significantly higher in LGE group when compared to non-LGE group. In univariate regression analysis which was performed to investigate the predictors of LGE in HFrEF, all three repolarization parameters were reached significant values but in multivariate analysis the only repolarization parameter remained significant was Tp-e interval (OR=1.085 95% CI 1.032-1.140, p=0.001).

CONCLUSION

With the prolongation of the Tp-e interval, the presence of myocardial fibrosis which is an arrhythmogenic substrate, can be predicted in patients with HFrEF.

Growth Differentiation Factor 15 is Related with Left Ventricular Recovery in Patients with ST-Elevation Myocardial Infarction after Successful Reperfusion by Primary Percutaneous Intervention

Background

The determinants of left ventricular (LV) recovery after successful revascularization in ST-elevation myocardial infarction (STEMI) patients are not clear. In addition, the relationship between growth differentiation factor15 (GDF-15) and left ventricular ejection fraction (LVEF) improvement is also unknown. This study hypothesizes that a low GDF-15 level would be associated with LVEF recovery.

Methods

One hundred and sixty-one STEMI patients were included in this study. Echocardiographic examinations were performed before and 12-18 weeks after discharge. The patients were divided into three groups according to the changes in LVEF as 62 patients with ≥ 10% change, 47 patients with 1-9% change, and 52 patients ≤ 0% change. LV recovery was defined as ≥ 10% LVEF improvement and the predictors of LV recovery were investigated. Moreover, two groups were created according to GDF-15 values, and the follow-up/baseline echocardiographic parameters were compared between these groups.

Results

LV recovery was detected in 38.5% of the patients. Low baseline LVEF [odds ratio (OR): 0.85, 95% confidence interval (CI) 0.82-0.94, p = 0.001], low GDF-15 (OR: 0.79, 95% CI 0.68-0.93, p = 0.004), previous angina (OR: 2.34, 95% CI 1.10-4.96, p = 0.027), and symptom-to-balloon time (OR: 0.97, 95% CI 0.95-1.00, p = 0.043) were independent predictors of LV recovery. The ratios of follow-up/baseline LV end-diastolic volume index, LV end-systolic volume index and wall motion score index were lower in the low GDF-15 group (0.96 vs. 1.04, p < 0.001; 0.96 vs. 1.10, p < 0.001; 0.89 vs. 0.96, p < 0.001). Moreover, being in the low GDF-15 group was associated with LV recovery (OR: 2.93, 95% CI 1.43-6.02, p = 0.001).

Conclusions

Lower GDF-15 level was associated with better LV improvement and less adverse remodeling in STEMI patients.

Pentraxin-3 is Associated with Adverse Diastolic Remodeling in Patients with ST-Elevation Myocardial Infarction after Successful Reperfusion by Primary Percutaneous Intervention

Background:

Determinants of adverse diastolic remodeling in ST-elevated myocardial infarction (STEMI) after successful revascularization are not well established. Besides, the relationship between Pentraxin-3 (PTX-3) and diastolic function deterioration is unknown. This study hypothesizes that PTX-3 level would be associated with diastolic remodeling.

Materials and Methods:

Ninety-eight STEMI patients were included in our study. Echocardiography was performed before and 12–18 weeks after discharge. Two groups were generated according to the PTX-3 value, and the follow-up/baseline echocardiographic parameters were compared. Diastolic adverse remodeling was accepted as a persistent restrictive filling pattern or an increase in at least one grade of diastolic dysfunction. The independent predictors of diastolic adverse remodeling were investigated.

Results:

Adverse diastolic remodeling was detected in 19.3% of patients. High left ventricular mass index (odds ratio [OR]: 1.096, confidence interval [CI] 95%: 1.023–1.174, P = 0.009), high PTX-3 (OR: 1.005, CI 95%: 1.001–1.009, P = 0.024), and failing to achieve thrombolysis in myocardial infarction flow 3 after percutaneous coronary intervention (OR: 6.196, CI 95%: 1.370–28.023, P = 0.005) were determined as independent predictors of adverse diastolic remodeling. The ratio of follow-up/baseline left atrial volume index was higher in the high PTX-3 group (1.15 vs. 1.05, P = 0.029). Moreover, being in the high PTX-3 group predicted adverse diastolic remodeling at 7.4 times.

Conclusion:

Higher PTX-3 level is associated with adverse diastolic remodeling in STEMI patients.

Detection of a rare cause of pulmonary hypertension by multimodality imaging: Left ventricular endomyocardial fibrosis

Endomyocardial fibrosis (EMF), a restrictive cardiomyopathy characterized by subendocardial fibrosis, is commonly seen in tropical and subtropical regions. EMF involving the left ventricle presents with severe pulmonary hypertension (PH) and is a rare cause of PH in non-tropical areas. Multimodality imaging is important for accurate diagnosis, especially cardiac magnetic resonance imaging which is the cornerstone. Herein, we report the case of a patient who presented with heart failure symptoms and severe PH, and in whom EMF was diagnosed by multimodality imaging.

A simplified acute kidney injury predictor following transcatheter aortic valve implantation: ACEF score

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is an effective, less invasive treatment alternative for symptomatic severe aortic stenosis (AS). Acute kidney injury (AKI) following TAVI is a common complication and is associated with worse outcomes. The age, creatinine, ejection fraction (ACEF) score is a simple scoring method, including only three parameters: age, creatinine, and ejection fraction (EF). The score was well established in predicting AKI after coronary interventions.

AIMS

We aimed to evaluate whether this simple scoring method, ACEF, may predict a development of AKI in patients who underwent TAVI.

METHODS

A total of 173 consecutive patients with symptomatic severe AS who underwent TAVI were included retrospectively. The primary endpoint of the study was the development of AKI. Study population was divided into two groups according to the presence of AKI. The ACEF score was calculated with the formula: age/EF + 1 (if baseline creatinine >2 mg/dl).

RESULTS

Twenty-nine patients developed AKI. The median (interquartile range) ACEF score was 1.36 (1.20-1.58). The ACEF score was found to be an independent predictor of AKI (P <0.001). The ACEF score ≥1.36 predicted AKI development with a sensitivity of 96.6% and specificity of 58.8%. Moreover, hypertension, hemoglobin levels, contrast volume, and aortic valve area (AVA) were found to be independent predictors of AKI.

CONCLUSIONS

Our study revealed that the ACEF score was an independent predictor of AKI. A simple and objective score might be very useful in predicting AKI development in patients undergoing TAVI.

Malnutrition provides important long-term prognostic information in patients undergoing endovascular abdominal aortic aneurysm repair

OBJECTIVES

Malnutrition has been shown to be associated with survival in a variety of diseases. Our aim is to evaluate the prognostic value of objective nutritional indexes indicating malnutrition, in patients underwent endovascular aortic replacement.

METHODS

We retrospectively evaluated 149 consecutive patients who underwent technically successful endovascular aortic replacement operation between October 2010 and August 2019. Objective nutritional indexes, prognostic nutritional index, geriatric nutritional risk index and controlling nutritional status, scores were calculated using the preoperative data. Optimal cut-off values were obtained by receiver operating characteristic analysis. According to the cut-off values, we investigated the relationship between indexes and the long-term all-cause mortality.

RESULTS

During mean 48.0 ± 30.3 months follow-up duration, in 47 of patients (31.5%), all-cause mortality were documented. In mortality group, prognostic nutritional index (42.8 ± 7.1 vs 51.3 ± 5.2, p < 0.001) and geriatric nutritional risk index (100.7 ± 10.1 vs 107.6 ± 9.2, p < 0.001) were significantly lower, controlling nutritional status score (2.0 (1.0-4.0) vs 1.0 (0.0-2.0), p < 0.001) was higher when compared to survivor group. Kaplan-Meier curves presented higher mortality incidence in malnutrition patients evaluated with objective nutritional indexes (Log-rang test, for all three indexes p < 0.001). Besides Cox-proportional hazard analysis showed all three nutritional indexes may be a predictive marker for all-cause mortality, prognostic nutritional index introduced more valuable data than other two indexes.

CONCLUSIONS

Malnutrition is associated with significant increase in postoperative long-term mortality in endovascular aortic replacement patients. Preoperatively calculated objective nutritional indexes especially prognostic nutritional index can be used as an important prognostic tool.

The prognostic value of elevated matrix metalloproteinase-9 in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: A two-year prospective study

INTRODUCTION

Increased matrix metalloproteinase-9 (MMP-9) levels in ST-elevation myocardial infarction (STEMI) are well established; however, existing data on MMP-9 values as a prognostic marker after STEMI are limited and have been conflicting.

OBJECTIVE

This study aimed to assess the clinical significance of MMP-9 in predicting two-year adverse cardiovascular events in patients who underwent primary percutaneous coronary intervention (PCI) after STEMI.

METHODS

In this prospective study, 204 patients with STEMI undergoing PCI were included. Participants were classified as high MMP-9 (n=102) or low MMP-9 (n=102) based on a cutoff of 12.92 ng/ml. Both groups were assessed at one and two years after STEMI.

RESULTS

Higher cardiovascular mortality at one year was observed in the high MMP-9 group (13.7% vs. 4.9% in the low MMP-9 group, p=0.03). When the follow-up period was extended to two years, the difference in cardiovascular mortality between the groups was more significant (17.6% vs. 4.9%, p=0.004). There was no significant difference at one-year follow-up in rates of advanced heart failure, however at the end of the second year, advanced heart failure was more prevalent in the high MMP-9 group (16.7% vs. 5.9%, p=0.015). After adjustment for potential confounders, a high MMP-9 value had 3.5-fold higher odds for cardiovascular mortality at two-year follow-up than low MMP-9.

CONCLUSION

These results suggest that high MMP-9 levels are a strong predictor of cardiovascular mortality and advanced heart failure at two-year follow-up in STEMI patients.

The Prognostic Value of C-reactive Protein to Albumin Ratio in Patients with Isolated Degenerative Aortic Valve Stenosis Undergoing Surgical Aortic Valve Replacement

Objective

To evaluate the prognostic value of C-reactive protein to albumin ratio (CAR) in patients with severe aortic valve stenosis undergoing surgical aortic valve replacement (AVR).

Methods

Four hundred seventy-six patients with severe degenerative aortic stenosis who underwent successful isolated surgical AVR were enrolled. Hospitalization due to heart failure, surgical aortic reoperation, paravalvular leakage rates, and long-term mortality were evaluated in the whole study group. The participants were divided into two groups, as 443 patients without mortality (group 1) and 33 patients with mortality (group 2) during the follow-up time.

Results

CAR was lower in patients without mortality than in those with mortality during the follow-up time (0.84 [0.03-23.43] vs. 2.50 [0.22-26.55], respectively, P<0.001). Age (odds ratio [OR]: 1.062, confidence interval [CI]: 1.012-1.114, P=0.014), CAR (OR: 1.221, CI: 1.125-1.325, P<0.001), ejection fraction (OR: 0.956, CI: 0.916-0.998, P=0.042), and valve type (OR: 2.634, CI: 1.045-6.638, P=0.040) were also found to be independent predictors of long-term mortality. Additionally, rehospitalization (0.86 [0.03-26.55] vs. 1.6 [0.17-24.05], P=0.006), aortic reoperation (0.87 [0.03-26.55] vs. 1.6 [0.20-23.43], P=0.016), and moderate to severe aortic paravalvular leakage (0.86 [0.03-26.55] vs. 1.86 [0.21-19.50], P=0.023) ratios were associated with higher CAR.

Conclusion

It was firstly described that CAR was strongly related with increased mortality rates in patients with isolated severe aortic stenosis after surgical AVR. Additionally, rehospitalization, risk of paravalvular leakage, and aortic reoperation rates were higher in patients with increased CAR than in those without it.

Predicting long-term cardiovascular outcomes of patients with acute myocardial infarction using soluble ST2

Background The increase in soluble suppression of tumorigenicity 2 (sST2) both in the diagnosis and prognosis of heart failure is well established; however, existing data regarding sST2 values as the prognostic marker after myocardial infarction (MI) are limited and have been conflicting. This study aimed to assess the clinical significance of sST2 in predicting 1-year adverse cardiovascular (CV) events in MI patients. Materials and methods In this prospective study, 380 MI patients were included. Participants were grouped into low sST2 (n = 264, mean age: 60.0 ± 12.1 years) and high sST2 groups (n = 116, mean age: 60.5 ± 11.6 years), and all study populations were followed up for major adverse cardiovascular events (MACE) which are composed of CV mortality, target vessel revascularization (TVR), non-fatal reinfarction, stroke and heart failure. Results During a 12-month follow-up, 68 (17.8%) patients had MACE. CV mortality and heart failure were significantly higher in the high sST2 group compared to the low sST2 group (15.5% vs. 4.9%, p = 0.001 and 8.6% vs. 3.4% p = 0.032, respectively). Multivariate Cox regression analysis concluded that high serum sST2 independently predicted 1-year CV mortality [hazard ratio (HR) 2.263, 95% confidence interval (CI) 1.124-4.557, p = 0.022)]. Besides, older age, Killip class >1, left anterior descending (LAD) as the culprit artery and lower systolic blood pressure were the other independent risk factors for 1-year CV mortality. Conclusions High sST2 levels are an important predictor of MACE, including CV mortality and heart failure in a 1-year follow-up period in MI patients.

The relationship between myocardial fibrosis detected by cardiac magnetic resonance and Tp-e interval, 5-year sudden cardiac death risk score in hypertrophic cardiomyopathy patients

BACKGROUND

The aim of this study was to investigate the relationship between QT (QTc) interval, Tp-e interval, Tp-e/QTc ratio, 5-year sudden cardiac death (SCD) risk score, and late gadolinium enhancement (LGE) detected by CMR in hypertrophic cardiomyopathy (HCM) patients.

METHOD

A total of 74 consecutive patients who underwent CMR with HCM diagnosis were included in the study. These patients were divided into two groups according to the presence of LGE on CMR. All patients underwent detailed echocardiography and QTc interval, Tp-e interval, and Tp-e/QTc ratios and 5-year SCD risk scores were calculated. These parameters were compared for two groups.

RESULTS

CMR revealed LGE in 32 (43.2%) of 74 HCM patients. In the group with LGE, significantly higher QTc interval (p = 0.002), Tp-e interval (p < 0.001), Tp-e/QTc ratio (p = 0.004), and 5-year SCD risk score were detected. In addition, QTc interval, Tp-e interval, Tp-e/QTc ratio, maximum wall thickness, left ventricular mass index, 5-year SCD risk score, and cardiac fibrosis index were found to be correlated with various degrees in correlation analysis. Also, Tp-e interval is found to be an independent predictor of LGE detected by CMR in HCM patients (p = 0.017, OR [%95 CI] = 1.017 [1.001-1.034]). In addition, the Tp-e interval can detect the LGE with a sensitivity of 64.3% and a specificity of 84.2% at 99.4 ms. (p < 0.001, AUC [95% CI] = 0.790 [0.676-0.905]).

CONCLUSION

The Tp-e interval can be used to optimize SCD risk stratification in HCM patients and determine which patients will benefit from implantable cardioverter-defibrillator (ICD) treatment.

The Elevated Soluble ST2 Predicts No-Reflow Phenomenon in ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Aim: The primary percutaneous procedure resulted in a significant improvement in the prognosis of myocardial infarction. However, no-reflow phenomenon restrains this benefit of the process. There are studies suggesting that soluble suppression of tumorigenicity (sST2) can be valuable in the diagnosis and progression of heart failure and myocardial infarction. In this study, we aimed to investigate the effect of sST2 on no-reflow phenomenon in ST-elevated myocardial infarction (STEMI).

Method: This study included 379 patients (258 men; mean age, 60 ± 11 years) who underwent primary percutaneous treatment for STEMI. sST2 levels were measured from blood samples taken at admission. Patients were divided into two groups according to Thrombolysis in Myocardial Infarction(TIMI) flow grade: group 1 consists of TIMI 0,1,2, accepted as no-reflow, and group 2 consists of TIMI 3, accepted as reflow.

Results: No-reflow phenomenon occurred in 60 patients (15.8%). The sST2 level was higher in the no-reflow group (14.2 ± 4.6 vs. 11.3 ± 5.0, p = 0.003). Moreover, regression analysis indicated that diabetes mellitus, lower systolic blood pressure, multivessel vascular disease, high plaque burden, and grade 0 initial TIMI flow rate were other independent predictors of the no-reflow phenomenon in our study. Besides, when the patients were divided into high and low sST2 groups according to the cut-off value from the Receiver operating characteristics analysis, being in the high sST2 group was associated with 2.7 times increased odds for no-reflow than being in the low sST2 group.

Conclusion: sST2 is one of the independent predictors of the no-reflow phenomenon in STEMI patients undergoing primary percutaneous coronary intervention.

Long Term Cardiovascular Outcome Based on Aspirin and Clopidogrel Responsiveness Status in Young ST-Elevated Myocardial Infarction Patients

Background

A subset of patients who take antiplatelet therapy continues to have recurrent cardiovascular events which may be due to antiplatelet resistance. The effect of low response to aspirin or clopidogrel on prognosis was examined in different patient populations.

Objective

We aimed to investigate the prevalence of poor response to dual antiplatelet therapy and its relationship with major adverse cardiovascular events (MACE) in young patients with ST-elevation myocardial infarction (STEMI).

Methods

In our study, we included 123 patients under the age of 45 with STEMI who underwent primary percutaneous intervention. A screening procedure to determine both aspirin and clopidogrel responsiveness was performed on the fifth day of admission. We followed a 2x2 factorial design and patients were allocated to one of four groups, according to the presence of aspirin and/or clopidogrel resistance. Patients were followed for a three-year period. A p-value less than 0.05 was considered statistically significant.

Results

We identified 48% of resistance against one or more antiplatelet in young patients with STEMI. More MACE was observed in patients with poor response to dual platelet therapy or to clopidogrel compared those with adequate response to the dual therapy (OR: 1.875, 1.144-3.073, p < 0.001; OR: 1.198, 0.957-1.499, p = 0.036, respectively). After adjustment for potential confounders, we found that poor responders to dual therapy had 3.3 times increased odds for three-year MACE than those with adequate response to the dual therapy.

Conclusion

Attention should be paid to dual antiplatelet therapy in terms of increased risk for cardiovascular adverse events especially in young patients with STEMI.

MicroRNA 199a Is Downregulated in Patients After Coronary Artery Bypass Graft Surgery and Is Associated with Increased Levels of Sirtuin 1 (SIRT 1) Protein and Major Adverse Cardiovascular Events at 3-Year Follow-Up

Background

The cardioprotective protein SIRT1 is elevated in patients with coronary artery disease (CAD) to compensate for the disease-related adverse effects, but less is known about the prognostic role of SIRT 1 regulating microRNAs in patients after coronary artery bypass graft (CABG) surgery.

Material/Methods

The expression of the SIRT 1-specific microRNAs miR-199a and miR-195 was analyzed using real-time PCR in 68 patients referred for CABG surgery and 34 control patients undergoing heart valve surgery. In CABG patients, major adverse cardiac and cerebrovascular events (MACCEs), including all-cause death, myocardial infarction (MI), re-vascularization, heart failure symptoms ≥NYHA II, re-hospitalization for any cardiovascular reason, and stroke, were analyzed at a median follow-up (FU) of 3.2 years (range: 3.0–3.6).

Results

The level of miR-199a in patients with CAD was significantly reduced compared to the control group (relative expression: 0.89±0.49 vs. 1.90±0.90, p=0.001), while SIRT 1 protein was markedly enhanced (p<0.001). In patients undergoing CABG who had MACCEs, miR-199a was significantly lower compared to patients with an uneventful FU (0.71±0.25 vs. 0.98±0.53, p=0.007). Heart failure status, death, and total MACCEs rate were inversely correlated with the amount of miR-199a (p=0.039) at 3-year FU.

Conclusions

Altered expression of miR-199a in myocardial tissue was found to be associated with SIRT 1 upregulation in patients with CAD undergoing CABG and was associated with an increased MACCEs rate at mid-term follow-up.

The Relationship Between Aspirin Resistance and Carotid Imaging in Young Patients With ST-Segment Elevated Myocardial Infarction: A Cross-Sectional Study

The presence of carotid atherosclerosis accompanied by coronary artery disease is associated with poor prognosis. A subset of patients who take aspirin continue to have recurrent cardiovascular events, which may be due to aspirin resistance (AR). Also, carotid plaques may cause turbulent flow which in turn may lead to platelet activation and poor antiplatelet response. In our study, we aimed to show the prevalence of AR and its relationship between high-risk carotid images in young patients with ST-segment elevated myocardial infarction (STEMI). In our study, we included 112 patients younger than 45 years with STEMI. Aspirin response test was evaluated 1 hour after aspirin intake using multiplate platelet function analyzer, and carotid ultrasonography has been performed to determine carotid intima–media thickness (CIMT) and the presence of carotid plaque. We identified 30.3% AR in young patients with STEMI. Carotid intima–media thickness (P = .002), carotid plaque (P = .012), and high-risk carotid image (P = .015) values are significantly high in patients who have AR. Independent of other risk factors, the presence of carotid plaque and being in the high-risk carotid group were associated with 3.7 times and 3.2 times increased odds for AR, respectively. In young patients with STEMI, physicians should be careful about AR, especially in patients who have carotid plaque and thicker CIMT.

Predictive value of a fragmented QRS complex in patients undergoing primary angioplasty for ST elevation myocardial infarction

OBJECTIVES

The aim of this study was to evaluate the prognostic value of fragmented QRS (fQRS) on electrocardiography (ECG) patients with acute ST-segment elevation in myocardial infarction (STEMI), who are undergoing primary percutaneous coronary intervention (PCI).

METHODS

We prospectively enrolled 414 consecutive STEMI patients (mean age of 55.2 ± 12.2 years old, range of 26-91-years old) undergoing primary PCI. The study patients were divided into two groups according to the presence or absence of fQRS as shown by ECG in the first 48 hours. The presence of fQRS group was defined as fQRS(+) (n = 91), and the absence of fQRS group was defined as the fQRS(-) (n = 323) group. Clinical characteristics and the one-year outcome of the primary PCI were analyzed.

RESULTS

The patients in the fQRS(+) group were older (mean age 60.7 ± 12.5 vs. 53.6 ± 11.6 years old, P < 0.001). Higher one-year all-cause mortality rates were observed in the fQRS group upon ECG (23.1% vs. 2.5%, P < 0.001, respectively). When using the Cox multivariate analysis, the presence of fQRS on the ECG was found to be a powerful independent predictor of one-year all-cause mortality (hazard ratio: 5.24, 95% confidence interval: 1.43-19.2, P = 0.01).

CONCLUSIONS

These results suggest that the presence of fQRS on ECG was associated with an increased in-hospital cardiovascular mortality, and one-year all-cause mortality in patients with STEMI who are under primary PCI.