Role of Short-Term Percutaneous Mechanical Circulatory Support Devices as Bridge-to-Heart Transplantation

Cardiogenic shock is a life-threatening condition and mortality remains high if there is no response with medical therapy. Recently, short-term percutaneous mechanical circulatory support (pMCS) devices have increased in use for refractory cardiogenic shock. These devices can provide full treatment or bridging to long-term MCS devices if patients need long-term support. There are four types of well-known MCS devices including Impella (Abiomed, Danvers, MA), TandemHeart (CardiacAssist, Pittsburgh, PA), and extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump for short-term and percutaneous application. In this chapter, we aim to discuss the physiologic concept, clinical evidences and applications, indications-contraindications, complications, and comparison of these most commonly used short-term pMCS devices for advanced heart failure

Role of Cholesterol as a Risk Factor in Cardiovascular Diseases

Cardiovascular disease is the most common cause of death in adult population in the world. The disease includes numerous problems, many of which are related to a process called atherosclerosis. Atherosclerosis is a condition that develops when a substance called plaque builds up in the walls of the arteries. This plaque narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can stop the blood flow. This can cause a heart attack or stroke. There are many risk factors associated with cardio vascular disease (CVD). While some risk factors cannot be changed, such as family history, some of them can be modified with treatment such as abnormal blood lipid and sugar levels, obesity, smoking, and high blood pressure. Research makes it clear that abnormal blood lipid (fat) levels have a strong correlation with the risk of coronary artery disease, heart attack and coronary death. Cholesterol plays detrimental roles in the pathogenesis of atherosclerosis and CVD. In this chapter, we aim to summarize the relationship between blood cholesterol levels and CVD

Cannulation of Innominate Artery during Proximal Aortic Aneurysm Repair

Objective: There are many debates for cannulation sites during aortic surgeries. The cannulation technique which is providing antegrade flow is associated with better survival and neurological outcomes than retrograde flow. For this purpose, innominate and axillary artery cannulation have been increasingly used for cardiopulmonary bypass recently. We aimed to present our experience with innominate artery cannulation for cardiopulmonary bypass and antegrade selective cerebral perfusion during proximal aortic aneurysm repair. Methods: A total of eighteen patients with proximal aortic aneurysm underwent surgical repair were included into the study. Pre-operative patient’s charecteristis, surgical details and postoperative outcomes were investigated. Results: The mean age was 58.8±10.2 and majority of the patients were male (72%). Bicuspit leafletes was found in 9 patients (50%). Two patients died in postoperative period. No stroke or new neurological deficit was seen after procedures. Conclusions: This study is emphasize that cannulation of innominate artery can be used in safe and effective during aortic surgery

The predictive value of the prognostic nutritional index for postoperative acute kidney injury in patients undergoing on-pump coronary bypass surgery

Abstract Background We aimed to investigate the predictive value of the prognostic nutritional index (PNI) regarding the development of acute kidney injury (AKI) after elective coronary artery bypass grafting (CABG). Methods A total of 336 consecutive patients with normal serum creatinine levels undergoing CABG were enrolled in this retrospective study. AKI was defined as meeting Acute Kidney Injury Network (AKIN) criteria based on the occurrence of creatinine changes within the first 48 h after CABG surgery. The patients were grouped according to whether they developed AKI or not into an AKI (−) and an AKI (+) group. Results AKI developed in 88 (26.2%) of all patients. The PNI was independently predictive of AKI (OR: 0.829, 95% CI: 0.783–0.877, p <  0.001). Moreover, C-reactive protein (CRP), a history of diabetes mellitus, and positive inotropric usage were independent risk factors for AKI in the multivariate logistic regression analysis. The area under the curve (AUC) of the multivariable model, including positive inotrope support, a history of diabetes mellitus, and CRP, was 0.693 (95% CI: 0.626–0.760, p <  0.001) in predicting AKIN. When the PNI was added to the multivariable model, the AUC was 0.819 (95% CI, 0.762–0.865, z = 3.777, difference p = 0.0002). Also, the addition of the PNI to the multivariable model was associated with a significant net reclassification improvement estimated at 88.2% (p <  0.001) and an integrated discrimination improvement of 0.22 (p <  0.001). Conclusions Our study demonstrated that decreasing the PNI could be associated with the development of AKI after coronary artery bypass surgery

Relationship between high-density lipoprotein cholesterol and the red cell distribution width in patients with coronary artery disease

Abstract Background The red cell distribution width (RDW) is a numerical measurement of variability in the size of red blood cells. Many studies have shown that high-density lipoprotein cholesterol (HDL-C), has an anti-inflammatory effect. The aim of this study was to investigate the relationship between the serum HDL-C level and RDW in patients with coronary artery disease (CAD). Methods Patients who underwent coronary angiography were reviewed. Patients who had moderate or severe heart failure, moderate or severe renal failure, significant systemic disease, anemia, a blood transfusion within the last 3 months, or a hematologic disease, as well as those who were taking lipid-lowering medication, were excluded from the study. The Gensini scoring system was used to determine the severity of CAD. Biochemical and hematological parameters were measured from venous blood samples taken after the patient fasted for at least 8 h. The RDW was routinely obtained from a hemogram. Results In total, 328 patients were included in the study. The patients were categorized according to quartiles. There were 80 patients in Quartile 1 (RDW < 13.2), 84 patients in Quartile 2 (13.2 ≥ RDW < 14.15), 81 patients in Quartile 3 (14.15 ≥ RDW < 16), and 83 patients in Quartile 4 (RDW ≥ 16). There was a significant and inverse relationship between the serum HDL level and RDW. Regression analysis showed that the HDL-C, hemoglobin, and hs-CRP levels and Gensini score were predictors for the RDW. Conclusion We found an inverse and gradual association between the serum HDL-C level and RDW, and the serum HDL-C level was an independent predictor for the RDW

Morning blood pressure surge and its relation to insulin resistance in patients of reproductive age with polycystic ovary syndrome

Abstract Background Our aim in this study was to investigate morning blood pressure surge (MBPS) in patients of reproductive age with polycystic ovary syndrome (PCOS) and its relation to insulin resistance (IR). Methods Fifty-three patients with PCOS without additional illness were included in the study. Forty-two age-matched subjects without PCOS were selected as the control group. All study subjects underwent 24-h blood pressure monitoring. Patients with additional illnesses, drug users, smokers, and alcohol and drug abusers were excluded. Blood insulin, fasting glucose, lipid profile, and hormone profile were measured. Insulin resistance was calculated using the HOMA-IR formula. Results Median age (years) was 27 (20–33) in the PCOS group and 27 (22–33) in the control group. Body mass index was higher in the PCOS group. Office systolic and diastolic blood pressure was higher in the PCOS group. Mean awakening 2-h BPs (mmHg) was 110 ± 7 in the control group and 118 ± 5 in the PCOS group (p < 0.001). Mean MBPS (mmHg) was 21 ± 6 in the control group and 29 ± 8 in the PCOS group. Mean MBPS was higher in the PCOS group (p < 0.001). IR was more frequent in the PCOS group. Based on logistic regression analysis, the presence of PCOS and IR were independent predictors for MBPS. Conclusions The results of our study showed that MBPS increased excessively when compared to non-PCOS controls in young women with PCOS during reproductive age. In addition, PCOS and insulin resistance were independent risk factors for exaggerated MBPS

Using Soluble ST2 to Predict Adverse Postoperative Outcomes in Patients with Impaired Left Ventricular Function Undergoing Coronary Bypass Surgery

Background and Objectives: The aim of this study was to investigate the prognostic value of soluble ST2 (sST2) in predicting postoperative adverse events in patients with impaired left ventricular (LV) function undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: This study included 80 consecutive patients with stable coronary artery disease (CAD) and impaired LV function (ejection fraction &le; 45%) undergoing on-pump coronary artery bypass graft surgery. The patients were divided into the &ldquo;high&rdquo; or &ldquo;low&rdquo; group according to their ST2 levels (&ge;35 or &lt;35 ng/mL). Results: Postoperative adverse events were more common in patients with high sST2 levels than in patients with low sST2 levels (100% vs 26%, p &lt; 0.0001). Multivariate analysis showed that sST2 level was an independent predictor of the presence of postoperative adverse events (OR: 1.117 (95% CI: 1.016&ndash;1.228), p = 0.022). The receiver operating characteristic curve (ROC) analysis of sST2 revealed an area under the curve (AUC) of 0.812 (95% CI: 0.710&ndash;0.913, p &lt; 0.001) in predicting postoperative adverse events. An sST2 level of 26.50 ng/ml was identified as the optimal cut-off value, with a sensitivity and specificity of 74.1% and 75.3%, respectively. Conclusion: Higher sST2 levels were associated with adverse outcomes after CABG in patients with impaired LV and stable CAD

The monocyte counts to HDL cholesterol ratio in obese and lean patients with polycystic ovary syndrome

Abstract Background Women with polycystic ovary syndrome are more likely to suffer from obesity, insulin resistance, and chronic low-grade inflammation. In fact, the excessive activation of monocytes exacerbates oxidative stress and inflammation. However, high-density lipoprotein cholesterol neutralizes the pro-inflammatory and pro-oxidant effects of monocytes. The aim of this study is to investigate whether monocyte counts to high-density lipoprotein cholesterol ratio can predict the inflammatory condition in patients with polycystic ovary syndrome. Methods In this cross-sectional study, a total of 124 women (61 of them with polycystic ovary syndrome and 63 age-matched healthy volunteers) were included in the study population. Obese polycystic ovary syndrome patients (n = 30) with a body mass index of ≥25 kg/m2 and lean polycystic ovary syndrome patients (n = 31) with a body mass index of < 25 kg/m2 were compared to age-and body mass index-matched healthy subjects (30 obese and 33 non-obese). Results The monocyte counts to high density lipoprotein cholesterol values in women with polycystic ovary syndrome were significantly higher than in control subjects (p = 0.0018). Moreover, a regression analysis revealed that body mass index, the homeostasis model assessment of insulin resistance and the high sensitivity C-reactive protein levels were confounding factors that affected the monocyte counts to high density lipoprotein cholesterol values. Additionally, a univariate and multivariate logistic regression analysis demonstrated that the increased monocyte counts to high density lipoprotein cholesterol values were more sensitive than the other known risk factors (such as increased body mass index, homeostasis model assessment of insulin resistance and high sensitive C-reactive protein levels) in the prediction of the inflammation in patients with polycystic ovary syndrome. Conclusion The present study demonstrated that the monocyte count to high density lipoprotein cholesterol may be a novel and useful predictor of the presence of polycystic ovary syndrome