Baseline coronary artery stenosis severity is an independent predictor of subsequent poor sleep quality in patients with acute coronary syndrome

AIM

To investigate the relationship between coronary artery lesion severity determined using the baseline SYNTAX score and sleep problems that might occur after discharge determined using the Pittsburgh Sleep Quality Index (PSQI).

METHODS

This prospective study included patients with first acute coronary syndrome (ACS) who underwent percutaneous coronary angiography between February 2019 and August 2019. The severity of coronary artery stenosis was classified according to coronary angiography and SYNTAX scores. Patients were grouped as those with a SYNTAX score of ≤22 and >22. Sleep quality after discharge was classified according to the PSQI. PSQI ≤5 represented good sleep quality, and PSQI >5 represented poor sleep quality. Univariate and multivariate logistic regression was used to investigate the relationship between sleep quality and coronary artery stenosis severity.

RESULTS

A total of 424 patients were included in the study. Of these, 294 (69.34%) had a SYNTAX score of ≤22 and 130 (30.66%) had a SYNTAX score of >22. The mean age of all patients was 60.37 ± 12.23 years, 59.69 ± 11.85 years in the SYNTAX ≤22 groups and 61.90 ± 12.98 years in the SYNTAX >22 group (P = 0.086). The majority (78.54%) of the patients were male and there was no significant difference between the SYNTAX ≤22 group and the SYNTAX >22 group in terms of sex distribution (P = 0.383). According to the univariate logistic regression analysis, age (P = 0.014), diabetes (P = 0.027), left ventricular ejection fraction (P = 0.001), estimated glomerular filtration rate (P = 0.039), creatine kinase MB (P = 0.040) and SYNTAX scores (P < 0.001) were significantly associated with high PSQI global scores (>5). However, according to the multivariate logistic regression analysis results, high (>22) SYNTAX scores were the only factor independently associated with the high (>5) PSQI global scores [odds ratio, 3.477; 95% confidence interval (CI), (2.190-5.522); P < 0.001]. Complete revascularization group had significantly higher sleep latency and sleep duration time, sleep efficiency and the percentage of patients with PSQI global score of ≤5 than the incomplete revascularization group (P < 0.001 for all).

CONCLUSION

Among patients with ACS, those with high SYNTAX scores should be monitored more carefully for sleep disorders that may occur later.

COVID-19 survivors may exhibit deterioration in frontal plane QRS-T angle and other electrocardiogram parameters

OBJECTIVE

COVID-19 infection is known to injure myocardial tissue and increase arrhythmic events. However, data on the subject is limited in the literature. In our study, our aim was to investigate possible arrhythmic damages in COVID-19 survivors using the frontal plane QRS-T [f(QRS)-T] angle and a few other ECG parameters.

PATIENTS AND METHODS

269 patients who recovered from COVID-19 between April 2020 and January 2021 were included into the study. Pre-admission electrocardiograms and first-month outpatient clinic control ECGs of the patients were compared.

RESULTS

After COVID-19, left bundle branch block (p<0.001), right bundle branch block (p<0.001), right bundle branch block (p<0.001), and atrial fibrillation (p<0.001) rates had increased. Prolongation was detected in QRS duration (p<0.001), QT interval (p=0.014), adjusted QT interval (p=0.007) and Tpe interval (p=0.012). F(QRS)-T angle (p<0.001) and fragmented QRS rate (p<0.001) were increased.

CONCLUSIONS

It was observed in our study that even if patients survived COVID-19, permanent deterioration in ECG parameters may occur.

Clozapine-Induced Myocarditis in a Young Man with Refractory Schizophrenia: Case Report of a Rare Adverse Event and Review of the Literature

Patient: Male, 29-year-old

Final Diagnosis: Clozapine-induced myocarditis

Symptoms: Fever

Medication: —

Clinical Procedure: —

Specialty: Cardiology • Pharmacology and Pharmacy • Psychiatry

Cardiac involvement in MRI in young population after COVID-19: A single tertiary center experience

Background

Coronavirus 2019 (COVID‐19) causes morbidity and mortality in an increasing number of people worldwide. Although it mainly affects the respiratory system, it influences all organs, including the heart. It is associated with a broad spectrum of widespread cardiovascular problems ranging from mild myocardial injury to fulminant myocarditis. We aimed to evaluate the presence and prevalence of cardiac involvement in asymptomatic or symptomatic patients after they recovered from COVID 19 infection.

Methods

A total of 100 consecutive patients with COVID‐19 proven by reverse transcription polymerase chain reaction (RT‐PCR), under 40 years of age and without any known additional chronic diseases were analyzed retrospectively for cardiac magnetic resonance (CMR) results and symptoms.

Results

Cardiac involvement was detected in 49 out of 100 patients on CMR imaging. In the cardiac involvement group, the number of patients with chest pain and/or dyspnea was 41 (84%), which was statistically significant (p = 0.001). Twenty‐four patients (47%) in the without cardiac involvement group were asymptomatic and this was also statistically significant (p = 0.001). LV ejection fraction was statistically significantly lower in the group with cardiac involvement (61% vs 66%, p = 0.001). LV stroke volume and tricuspid annular plane systolic excursion (TAPSE) were statistically significantly lower in patients with cardiac involvement (p = 0.028 and p = 0.019, respectively).

Conclusion

Based on single center experience, myocardial involvement is common in symptomatic patients after COVID‐19. More studies are needed for long‐term side effects and clinical results in these patients.

Monocyte-to-HDL-cholesterol ratio is associated with Ascending Aorta Dilatation in Patients with Bicuspid Aortic Valve

BACKGROUND

The importance of monocyte count-to-HDL-cholesterol ratio (MHR) in cardio- vascular diseases has been shown in various studies. Ascending aortic dilatation (AAD) is a common complication in the patients with bicuspid aortic valve. In this study, we aimed to investigate the relationship between MHR and the presence of aortic dilatation in the patients with bicuspid aortic valve.

METHODS

The study population included totally 347 patients with bicuspid aortic valve.169 patients with aortic dilatation (ascending aorta diameter ≥ 4.0 cm) and 178 patients with no aortic dilatation. Echocardiographic and laboratory measurement was done and compared between groups.

RESULTS

The mean age of the participants was 44.7 ± 15.4 years and average ascending aorta diameter was 3.2 ± 0.3 cm in dilatation negative group and 4.4 ± 0.4 cm in positive group. MHR was significantly increased in in patients with aortic dilatation. MHR and uric acid level was independently associated with the presence of aortic dilatation in the patients with bicuspid aortic valve.

CONCLUSION

We found a significant relationship between MHR and aortic dilatation in the patients with bicuspid aortic valve.

A new risk model for the evaluation of the thromboembolic milieu in patients with atrial fibrillation: the PALSE score

BACKGROUND

The evaluation of thromboembolic risk is the cornerstone of atrial fibrillation (AF) management. Thromboembolic risk is associated with the presence of left atrial (LA) thrombus and spontaneous echo contrast (SEC), namely the thromboembolic milieu.

AIMS

We aimed to assess the predictors of the thromboembolic milieu in terms of LA thrombus and/ or SEC in patients with paroxysmal AF undergoing electrical cardioversion or catheter ablation, and to develop an effective risk model for detecting the thromboembolic milieu.

METHODS

We included a total of 434 patients with nonvalvular paroxysmal AF who underwent transesophageal echocardiography prior to cardioversion or catheter ablation.

RESULTS

In patients with the thromboembolic milieu, total protein and C‑reactive protein levels, LA diameter, and systolic pulmonary artery pressure (SPAP) were higher, while left ventricular ejection fraction (LVEF) was lower than in patients without the thromboembolic milieu. In a multivariate logistic regression analysis, age, total protein levels, LVEF, LA diameter, and SPAP were independent predictors of LA thrombus and/or SEC. In a receiver operating characteristic curve analysis, the optimal cutoff values for the discrimination of patients with the thromboembolic milieu were as follows: 60 years for age; 7.3 mg/dl for total protein; 40% for LVEF; 40 mm for LA diameter; and 35 mm Hg for SPAP. Based on these cutoff values, we developed a novel risk model, namely, the PALSE score. The area under the curve for the PALSE score was 0.833. Patients with a PALSE score lower than 1 did not show thrombus or spontaneous echo contrast.

CONCLUSIONS

The PALSE score, which includes total protein levels, age, LA diameter, SPAP, and LVEF, seemed to accurately predict the presence of the thromboembolic milieu in patients with paroxysmal AF.

Nesfatin-1: A novel regulatory peptide associated with acute myocardial infarction and Mediterranean diet

We evaluated the relationship between nesfatin-1 and acute myocardial infarction (AMI) and Mediterranean diet scores. 67 patients with AMI and 33 patients with normal coronary arteries (control group) were included in the study. The patients with AMI were divided into 2 groups based on low (<32) (n = 33) and high values of the synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) scores (≥34) (n = 35). Mediterranean diet score, serum nesfatin-1 concentrations and all other data were compared between the groups. Serum nesfatin-1 concentrations were significantly lower in 67 AMI patients (both the high and low SYNTAX groups) than in the control group (p < 0.001). Moreover, serum nesfatin-1 concentrations were lower in the high SYNTAX group than those in the low SYNTAX group (p < 0.001). There were positive correlations between the serum nesfatin-1 concentrations and Mediterranean diet scores in both the AMI patients and the control subjects, and there was a negative correlation between the serum nesfatin-1 concentrations and SYNTAX scores in the AMI patients. This study has shown that serum nesfatin-1 concentrations are closely related to the severity of AMI and Mediterranean diet scores.