Relationship between vitamin D deficiency and thrombus load in patients with ST-elevation myocardial infarction

OBJECTIVE

Clinical studies detecting the increase in thrombotic events with vitamin D deficiency note the relationship between vitamin D and thrombosis. This study aims at evaluating the relationship between serum vitamin D levels and coronary thrombus burden.

PATIENTS AND METHODS

We retrospectively evaluated 77 patients with ST-elevated myocardial infarction (STEMI). Serum vitamin D levels, degree of coronary thrombus, Thrombolysis in Myocardial Infarction (TIMI) frame count and the extent and severity of atherosclerosis in coronary arteries were also measured in all cases. Patients were divided into 2 groups, according to thrombus load.

RESULTS

The rate of vitamin D deficiency in the study population was 79.22% (< 20 ng/mL). Vitamin D levels were significantly higher in patients with a mild thrombus load than in patients with a severe thrombus load (16 vs. 13.95 p = 0.018). Gensini scores were significantly higher in patients with a severe thrombus burden than in patients with a mild thrombus burden (42 vs. 54.5 p = 0.014). There was a low negative correlation between vitamin D levels and thrombus burden classification grades (r = -0.304, p = 0.007), Cx TIMI frame counts (r = -0.402, p < 0.001), and RCA TIMI frame counts (r = -0.479, p < 0.001). There was a moderate negative correlation between serum vitamin D levels and LAD TIMI frame count (r = -0.507, p < 0.001).

CONCLUSIONS

The results of our study showed that low 25(OH)D3 levels are an independent predictor of high coronary artery thrombus load and post-procedural TIMI frame count increase in patients with STEMI undergoing primary percutaneous coronary intervention.

ICD detected patient activity is associated with arrhythmic events in heart failure patients

Background

Although implantable cardioverter-defibrillator (ICD) reduces mortality in heart failure patients with reduced left ventricle function, arrhythmic episodes are related with increased mortality. Aim: The aim of this study was to investigate whether low patient activity predicts arrhythmic events in the heart failure patients with primary prevention ICD.

Methods

We examined 206 heart Failure (HF) patients (mean age: 61.3 ± 10.9 years, 77.7% male) with primary prevention implanted ICD who referred to our outpatient clinic for pacemaker control. After pacemaker (PM) controls, the overall study group was categorized into three distinct subgroups: Activity less than 2 h, activity 2-4 h, and activity 4-8 h in a day.

Results

Activity less than 2 h had a substantially higher level of arrhythmic episodes in comparison to other groups (P < 0.05). In addition, appropriate shock or ATP (antitachycardia pacing) was detected higher in patients whose activity was less than 2 h in a day than other groups (P < 0.001).

Conclusions

Detected low patient activity in ICD control may be a predictor of arrhythmic episodes and appropriate therapies. Increasing physical activity may potentially protect these patients from unwanted events.

Non-Sustained Ventricular Tachycardia Episodes Predict Future Hospitalization in ICD Recipients with Heart Failure

Background

Implantable cardioverter-defibrillator (ICD) therapy is well known to reduce mortality in selected patients with heart failure (HF).

Objective

To investigate whether monitored episodes of non-sustained ventricular tachycardia (NSVT) might predict future HF hospitalizations in ICD recipients with HF.

Methods

We examined 104 ICD recipients (mean age: 60 ± 10.1 years, 80.8 % male) with HF who were referred to our outpatient clinic for device follow-up. After device interrogation, patients were divided into NSVT positive and negative groups. The primary endpoint was the rate of hospitalization within the next 6 months after initial ICD evaluation.

Results

Device evaluation demonstrated at least one episode of monitored NSVT in 50 out of 104 patients. As expected, no device therapy (shock or anti-tachycardia) was needed for such episodes. At 6 months, 24 patients were hospitalized due to acute decompensated HF. Hospitalization rate was significantly lower in the NSVT negative as compared with positive groups (38% versus 62%; adjusted hazard ratio [HR] 0.166 ; 95% CI 0.056 to 0.492; p = 0.01).

Conclusions

Monitored NSVT bouts in ICD recordings may serve as a predictor of future HF hospitalizations in ICD recipients with HF suggesting optimization of therapeutic modalities in these patients along with a close supervision in the clinical setting.