Association between Systolic Pulmonary Artery Pressure and Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction

Introduction

The objective of this study was to examine whether there is an elevated risk of developing contrast induced nephropathy (CIN) in patients with high systolic pulmonary artery pressure (SPAP) in ST-segment elevation myocardial infarction (STEMI).

Methods

A total of 213 patients diagnosed with STEMI and who underwent primary percutaneous coronary intervention were enrolled in the study. The patients were stratified into two groups based on the presence of CIN. Comparisons between these groups included an assessment of demographic characteristics, laboratory findings, and risk factors. SPAP was calculated for each patient upon admission through echocardiography, and subsequent comparisons were performed between the groups.

Results

The distribution of the study population was as follows: 33 (15.5%) were CIN(+) and 180 (84.5%) were CIN(-). SPAP [odds ratio (OR) = 1.295, 95% confidence interval (CI): 1.157-1.451, p < 0.001], and diabetes (OR = 1.241, 95% CI: 1.194-1.287, p = 0.013) were identified as independent factors associated with CIN development. In receiver operating characteristic curve analysis, SPAP above a cut-off level of 31.5 mmHg could determine the presence of CIN with a sensitivity of 91.0% and specificity of 90.0% (p < 0.001).

Conclusions

SPAP on echocardiography is an independent predictor of the development of CIN in patients with STEMI. Its ease of calculation renders it a valuable tool for predicting CIN among STEMI patients.

The triglyceride-glucose index as a predictive marker for coronary slow flow phenomenon

OBJECTIVE

The triglyceride-glucose index (TyG) has been proposed as a marker of insulin resistance (IR) and has shown associations with cardiovascular diseases. This study aimed to investigate the relationship between the TyG and the coronary slow flow phenomenon (CSFP) and explore the index's potential as a predictor of this condition.

PATIENTS AND METHODS

A total of 187 patients who underwent coronary angiography were included; of these, 91 patients were diagnosed with CSFP, and 96 patients with normal coronary flow served as a control group. The TyG was calculated using fasting triglyceride and glucose levels.

RESULTS

The results showed that the TyG was significantly higher in the CSFP group compared with the control group (p < 0.001). Additionally, the TyG exhibited a moderate positive correlation with the thrombolysis-in-myocardial-infarction frame count in coronary arteries (p < 0.001). A multivariate logistic regression analysis revealed that the TyG, along with gender, ejection fraction, and uric acid, remained significant predictors of CSFP (p < 0.05).

CONCLUSIONS

This study's findings suggest that the TyG may serve as a useful marker for identifying individuals at risk of CSFP and provide insights into the potential role of IR in its pathophysiology.

Thromboembolic risk scores in patients with non-obstructive coronary architecture with and without coronary slow flow: A case-control study

AIM

Coronary slow flow phenomenon (CSFP) detected on coronary angiography (CA) has been related to poor prognosis. We sought to examine the relationship between thromboembolic risk scores, routinely used in cardiology practice, and CSFP.

METHODS

This single-center, retrospective, case-control study comprised 505 individuals suffering from angina and had verified ischemia between January 2021 and January 2022. Demographic and laboratory parameters were obtained from the hospital database. The following risk scores were calculated; CHA₂DS₂-VASc, M-CHA₂DS₂-VASc, CHA₂DS₂-VASc-HS, R₂-CHA₂DS₂-VASc, M-R₂-CHA₂DS₂-VASc, ATRIA, M-ATRIA, M-ATRIA-HSV. The overall population was divided into two groups; coronary slow flow and coronary normal flow. Multivariable logistic regression was performed to compare risk scores between patients with and without CSFP. Pairwise comparisons were then undertaken to test performance in determining CSFP.

RESULTS

The mean age was 51.7 ± 10.7 years, of whom 63.2% were male. CSFP was detected in 222 patients. Those with CSFP had higher rates of male gender, diabetes, smoking, hyperlipidemia, and vascular disease. All scores were higher in CSFP patients. Multivariable logistic regression analysis found that CHA₂DS₂-VASc-HS score was the most powerful determinant of CSFP among all risk schemes (for each one-point increase in score OR = 1.90, p < 0.001; for score of 2-3 OR = 5.20, p < 0.001; for score of >4 OR = 13.89, p < 0.001). Also, the CHA₂DS₂-VASc-HS score provided the best discriminative performance, with a cut-off value of ≥2 in identifying CSFP (AUC = 0.759, p < 0.001).

CONCLUSION

We showed that thromboembolic risk scores may be associated with CSFP in patients with non-obstructive coronary architecture who underwent CA. The CHA₂DS₂-VASc-HS score had the best discriminative ability.

A new inflammatory marker: elevated eosinophil-tolymphocyte ratio associated with presence and severity of isolated coronary artery ectasia

OBJECTIVES

The pathophysiology of isolated coronary artery ectasia (CAE) involves atherosclerosis and inflammation. Eosinophils and lymphocytes have been found to play a significant role in inflammation, atherosclerosis and endothelial dysfunction. Many studies have explored the relationship between isolated CAE and systemic inflammation. However, there are no data regarding the relationship between eosinophil-to-lymphocyte ratio (ELR) and isolated CAE. Therefore, this study analysed the relationship between ELR and isolated CAE.

METHODS

All patients who underwent coronary angiography between January 2009 and June 2018 were investigated retrospectively. Of 16 240 patients, 232 patients with isolated CAE (141 males) and 247 age- and gender-matched control subjects (130 males) with normal coronary angiography (NCA) were enrolled in this study. Baseline demographic and laboratory data were obtained from the hospital database. The severity of isolated CAE was determined according to the Markis classification, vessel count and diffuseness of ectasia.

RESULTS

Patients with angiographic isolated CAE had significantly elevated white blood cell (WBC) and eosinophil counts and ELR values compared to patients with NCA [8.11 ± 1.75 vs 7.49 ± 1.80 × 10⁹ cells/l, p < 0.0001; 0.22 (0.13-0.32) vs 0.19 (0.12-0.28) × 10⁹ cells/l, p = 0.02; 0.11 (0.06-0.17) vs 0.08 (0.05-0.12), p < 0.0001. The ELR value for Markis I was significantly higher than for Markis IV (p = 0.04), and three-vessel isolated CAE was significantly higher than onevessel isolated CAE (p = 0.04). Additionally, the ELR value for diffuse ectasia (Markis class I, II and III) was significantly higher compared to focal (Markis class IV) ectasia (p = 0.02). In receiver operating characteristics (ROC) analyses, it was determined that an ELR value > 0.099, measured in isolated CAE patients at application, had a predictive specificity of 60.3% and a sensitivity of 56.5% (area under the curve: 0.604, 95% confidence interval: 0.553-0.655, p < 0.0001).

CONCLUSIONS

Patients with isolated CAE had higher blood eosinophil counts and ELR. Furthermore, the ELR was significantly correlated with severity of isolated CAE. These findings demonstrate that ELR may have a significant role in the aetiopathogenesis of isolated CAE.

Spotlights on some electrocardiographic paradigms: How should we evaluate normal reference values of Tp-Te interval, Tp-Te dispersion and Tp-Te/QT ratio?

BACKGROUND

Experimental and clinical studies evaluating the Tp-Te interval and Tp-Te/QT ratio have reported conflicting data. The overlap between normal Tp-Te/QT ratios (0.17 ±0.02-0.27 ±0.06 ms) and pathological values (0.20 ±0.03-0.30 ±0.06 ms) measured in earlier studies has raised questions about this ECG measurement technique.

OBJECTIVES

To analyze normal values of the Tp-Te interval, Tp-Te dispersion Tp-Te(d) and the Tp-Te/QT ratio based on electrocardiographic (ECG) assessment across sex and age groups in a healthy Turkish population.

MATERIAL AND METHODS

A total of 1,485 healthy participants (723 men) were enrolled into the study. The age of the participants ranged 17-75 years and they did not have either any cardiovascular/systemic disorders or risk factors for atherosclerosis which were detected with physical examination and laboratory tests. The Tp-Te interval, Tp-Te(d) and Tp-Te/QT ratio were determined from V1-V6 derivations.

RESULTS

For the entire study, the median Tp-Te interval was 66.0 (64.0-70.0) ms, the Tp-Te(d) was 15.0 (10.0-20.0) ms, and the Tp-Te/QT ratio was 0.18 (0.17-0.19). The Pearson's correlation test demonstrated that the Tp-Te/QT ratio significantly correlated with older age (r = 0.297; p < 0.0001), left ventricular (LV) end-diastolic diameter (LVEDD; r = 0.481; p < 0.0001), body mass index (BMI; r = 0.421; p < 0.0001), body surface area (BSA; r = 0.191; p < 0.0001), LV end-diastolic volume (LVEDV; r = 0.484; p < 0.0001), LVEDV index (r = 0.450; p < 0.0001), LV mass (r = 0.548; p < 0.0001), and LV mass index (r = 0.539; p < 0.0001).

CONCLUSIONS

The reference values for Tp-Te interval, Tp-Te(d) and Tp-Te/QT ratio are associated with age, BMI, BSA, LVEDV, LVEDV index, LV mass, and LV mass index. These structural elements should be considered when using these ECG parameters for assessing repolarization inhomogeneity. These findings may guide further studies assessing healthy and diseased populations.

Performance of HAS-BLED and CRUSADE risk scores for the prediction of haemorrhagic events in patients with stable coronary artery disease

We aimed to compare the power of the HAS-BLED and CRUSADE risk scores in predicting in-hospital bleeding events in patients with stable coronary artery disease undergoing elective coronary angiography. A total of 405 consecutive patients were included in the study. The mean HAS-BLED score was significantly higher (p < 0.001) in the in-hospital bleeding group. In patients with a HAS-BLED score ≥ 3, the in-hospital bleeding rate was significantly higher than in those with a HAS-BLED score < 3 (p < 0.001). Receiver operating characteristic curve analysis revealed that the HAS-BLED score was superior in predicting in-hospital bleeding events compared to the CRUSADE score [area under the curve (AUC) = 0.684 vs 0.569, respectively, p = 0.002]. Also in the percutaneous coronary intervention subgroup, the HAS-BLED score was superior to the CRUSADE score (AUC = 0.722 vs 0.520, respectively, p = 0.002). We showed that the HAS-BLED and CRUDASE scores are helpful in stable patients undergoing elective coronary angiography. Our results suggest that as a practical, easy-to-implement and more predictive scoring system, the HAS-BLED score was more useful for predicting in-hospital bleeding in patients who did not present with acute coronary syndrome.

Focusing on a complete blood cell parameter: mean platelet volume levels may be a predictor of coronary slow flow

Background

The relationship between increased mean platelet volume (MPV) and atherosclerosis is well known. In the present study, MPV in patients with coronary slow flow (CSF) and in cases with normal coronary anatomy (NCA) was investigated and compared with the aim of identifying the relationship between CSF and MPV.

Patients and methods

We studied 40 patients previously determined via coronary angiography as having NCA and 40 patients with CSF in the coronary blood stream, as identified by thrombolysis in myocardial infarction square. Thus, a total of 80 patients from the Elaziğ Education and Research Hospital (Elaziğ, Turkey) were included in the present study retrospectively and laboratory and anamnesis information was scanned into their files. The relationship between MPV and CSF was studied.

Results

MPV levels were observed to be significantly higher in the CSF group compared to the NCA group (10.05±1.3 and 8.6±0.6, p<0.001). In receiver operating characteristics analyses, it was determined that an MPV >9.05 measured in CSF patients at application had a predictive specificity of 77.5% and sensitivity of 77.5% for CSF (area under the curve: 0.825, 95% confidence interval [CI]: 0.726–0.924, p<0.0001). It was found that MPV level was an independent predictor of CSF (β=−600, p<0.001, 95% CI: −0.383 to −0.176).

Conclusion

MPV is increased in patients with CSF when compared to patients with NCA. This finding supports the fact that MPV could be a predictor of CSF.

Is Fasting for Ramadan Safe in Patients with Mechanical Cardiac Valves?

BACKGROUND AND AIM OF THE STUDY

The study aim was to investigate the safety and effects of fasting during Ramadan on the International Normalized Ratio (INR) in patients with mechanical cardiac valves.

METHODS

A total of 105 patients admitted to the authors' hospital between June and October 2015, who had history of prosthetic valve replacement, was investigated. The patients were allocated to two groups: those fasting during Ramadan (n = 42) and those not fasting (n = 63). All patients were examined by a cardiologist, and the clinical findings and complaints for the past three months were evaluated. The INR, complete blood count (CBC) and a basic biochemical panel were monitored for all patients.

RESULTS

The mean corpuscular volume (MCV) of the fasting group was significantly higher than that of the non- fasting group (87.59 ± 6.39 (μm3) versus 84.28 ± 6.387 (μm3); p = 0.011). Other CBC parameters and basic biochemical values did not differ significantly different between groups. Neither were significant differences noted in INR values during Ramadan (fasting group 2.87 ± 0.97; non-fasting group 2.73 ± 0.78; p = 0.50) and at routine control one month later (fasting group 3.07 ± 1.55; non-fasting group 2.94 ± 1.03; p = 0.601). No significant differences related to increased rates of hospitalization, valvular dysfunction on echocardiography, thrombus, embolism, bleeding and clinical complaints were identified between the groups.

CONCLUSIONS

Fasting during Ramadan had no adverse effects on the INR of patients, and appears to be safe for patients with mechanical prosthetic cardiac valves.

Could neutrophil/lymphocyte ratio be an indicator of coronary artery disease, coronary artery ectasia and coronary slow flow?

Objective

To determine whether neutrophil/lymphocyte ratio (NLR) differed between patients with isolated coronary artery disease (CAD), isolated coronary artery ectasia (CAE), coronary slow flow and normal coronary anatomy.

Methods

Patients who underwent coronary angiography were consecutively enrolled into one of four groups: CAD, coronary slow flow, CAE and normal coronary anatomy.

Results

The CAD (n = 40), coronary slow flow (n = 40), and CAE (n = 40) groups had similar NLRs (2.51 ± 0.7, 2.40 ± 0.8, 2.6 ± 0.6, respectively) that were significantly higher than patients with normal coronary anatomy (n = 40; NLR, 1.73 ± 0.7). Receiver operating characteristics demonstrated that with NLR > 2.12, specificity in predicting isolated CAD was 85% and sensitivity was 75%, with NLR > 2.22 specificity in predicting isolated CAE was 86% and sensitivity was 75%. With NLR > 1.92, specificity in predicting coronary slow flow was 89% and sensitivity was 75%. Multivariate logistic regression analyses identified NLR as an independent predictor of isolated CAE (β = −0.499, 95% CI −0.502, −0.178; P <  0.001), CAD (β = −0.426, 95% CI −1.321, −0.408; P <  0.001), and coronary slow flow (β = −0.430, 95% CI −0.811, −0.240; P = 0.001 Table 2).

Conclusions

NLR was higher in patients with CAD, coronary slow flow and CAE versus normal coronary anatomy. NLR may be an indicator of CAD, CAE and coronary slow flow.

The effect of the duration of clopidogrel use on hsCRP levels after stenting the target vessel in patients with acute coronary syndrome

PURPOSE

The aim of this study is to investigate the relationship between the duration of clopidogrel use and the inflammation process after acute coronary syndrome in patients who received bare metal stent (BMS) or drug eluting stent (DES).

METHOD

Sixty patients with acute coronary syndrome who received a stent were divided into three groups: 20 patients with BMS receiving clopidogrel for one month (BMS1 group), 20 patients with BMS receiving clopidogrel for 6 months (BMS6 group), and 20 patients with DES receiving clopidogrel for 6 months (DES group). High sensitive C-reactive protein (hsCRP, mg/dL) was measured at baseline, and then at first, third and sixth post-operative month.

RESULTS

The inital hsCRP levels were similar and decreased significantly in all groups by one month of clopidogrel treatment (from 7.1±1.9 to 3.8±2.3 in BMS1 group, p=0,002, from 6.5±2.8 to 4.3±2.5 in BMS6 group, p= 0,01 and from 7.7±2 to 3.6±2.4 in DES group, p < 0.001). In the BMS1 group, after termination of the clopidogrel therapy after the first month, hsCRP levels increased again at the third and sixth months. In the BMS6 and DES groups, hsCRP levels continued to show a decrease at the third month and sixth months.

CONCLUSIONS

Clopidogrel decreases hsCRP levels in patients with acute coronary syndrome. It might be desirable to lengthen the duration of the clopidogrel therapy to maintain its anti-inflammatory effects.