Determinants of coronary angiography in Non-ST-elevation myocardial infarction with low ejection fraction

Objective: To investigate the clinical and demographic factors affecting the selection of angiography in patients with severe left ventricular systolic dysfunction (SLVSD, ejection fraction lower than 30%) developing non-ST-segment elevation (NSTEMI). Study Design: Descriptive study. Place and Duration of Study: This study was conducted at the Department of Cardiology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey, between March 2018 and March 2021. Methodology: Patients with SLVSD (Ejection fraction = 2 [Odds ratio (OR) :33.85, 95% Confidence Interval (CI): 5.03-227.405 p= 65 years (OR: 7.124, 95% CI: 1.33-38.12, p=0.02), and PCI history (OR: 0.132, 95% CI: 0.02-0.84, p=0.032) were associated factors with the decision of only medical treatments instead of angiography. Conclusion: Demographic factors such as age and education level and clinical factors such as decompensation, PCI history, and anaemia significantly affect the decision of angiography in the patients with SLVSD and NSTEMI

Clinical features and factors affecting in-hospital mortality of patients who underwent pericardiocentesis due to moderate to severe pericardial effusion

Introduction: The aim of this study was to determine the primary etiology of pericardial effusion in patients undergoing percutaneous pericardiocentesis. Possible in-hospital mortality related predictors were also investigated. Patients and Methods: A retrospective analysis was made of the clinical and laboratory features of 268 patients who underwent pericardiocentesis due to moderate to severe pericardial effusion between January 2009 and March 2020. Results: The patients comprised 57.5% males and 42.5% females with a mean age of 62.3 ± 15.4 years. Cardiac compression was detected in 220 (82.1%) patients, of which 208 (77.6%) were clinically tamponade and 12 (4.5%) were asymptomatic cardiac compression. The most common symptom was dyspnea (58.6%) and 10.8% of patients were asymptomatic. Pericardial fluid was exudate in 235 (87.7%) patients. The most common causes were malignancy (37.3%) followed by idiopathic (22.1%) and iatrogenic (12.7%) causes. The patients with asymptomatic cardiac compression were more likely to have malignant effusion than those with other etiologies (p= 0.001). In-hospital mortality developed in 37 (13.8%) patients. The independent predictors of in-hospital mortality were determined as follows; etiology other than infectious or idiopathic (OR= 3.447; 95% CI= 1.266, 9.386; p= 0.015), and receiving antithrombotic therapy (OR= 2.306; 95% CI= 1.078, 4.932; p= 0.031). Conclusion: Malignancy is the most common cause of moderate to severe pericardial effusions. The detection of cardiac compression in asymptomatic patients may be an important indicator of malignancy. Receiving antithrombotic therapy and having a non-idiopathic and non-infectious etiology may be predictors of in-hospital mortality

ACİL GEÇİCİ KALP PİLİ TAKILAN HASTALARIN KLİNİK ÖZELLİKLERİ VE HASTANE İÇİ MORTALİTE ORANLAR

Giriş: Geçici kalp pili(GKP) uygulaması birçok bradiaritminin acil tedavisinde hayat kurtarıcı role sahiptir.Özellikle ilaçların etkisiz olduğu infra nodal atriyoventriküler blokların (AVB) acil tedavisi için tek seçenektir.Bu çalışmada,kliniğimizde acil GKP uygulanan hastaların klinik özelliklerini ve hastane içi mortalite oranlarını tespit etmeyi amaçladık. Gereç ve Yöntem:Ekim 2016-Haziran 2021 tarihleri arasında kliniğimizde acil GKP tak ılan 229 hasta çalışmaya dahiledildi. Hastaların klinik ve laboratuvar özellikleri hastane kayıtları vasıtasıyla geriye dönük olarak incelendi. Bulgular: Hastaların 225’ine bradiaritmi nedeniyle, 4’üne ise taşiaritmi nedeniyle (over-drive pacing amaçlı) GKP implante edildi.GKP gerektiren bradiaritmi nedenleri s ırasıyla; idiopatik (%33.3), ilaçlar (%30.6), iskemi (%30.6), hiperpotasemi (%4.9) ve konjenital at riyoventriküler bloktu (%0.4). En s ık bradikardi türü 2. ve 3. derece atriyoventriküler bloklardı (%77.3). Bradiaritmi nedeniyle GKP tak ılan hastaların 110 (%48.9)’una kalıcı kalp pili implantasyonu gerekti. Hastaların 35 (%15.3)’inde hastane içi mortalite gelişti. Mortalite oranı, iskemi ve hiperpotasemi gruplarında diğerlerine göre anlamlı olarak daha yüksekti (p<0.001). Sonuç: Acil GKP implantasyonu gerektiren en sık neden idiopatik ardından iskemi ve ilaçlardı. Hiperpotasemi ve iskeminin neden olduğu ciddibradikardilerde hastane içimortalite oranı oldukça yüksekti

Effect of Covid-19 Pandemic and CoronaVac Vaccine on Blood Pressure Regulation in Chronic Hypertensive Patients

Objective: The most common comorbidity in patients with Covid-19 infection is hypertension. Apart from the direct effects of the virus on hypertensive patients, the pandemic period also negatively affected these patients. In addition, the effect of the newly discovered CoronaVac vaccine, which has been widely used in our country in recent months for the prevention of covid-19 infection, on blood pressure regulation is unknown. In this study, we aimed to investigate the effects of the pandemic period and the CoronaVac vaccine in patients receiving treatment for essential hypertension.Method: One hundred ninety-six patients who applied to the cardiology outpatient clinic between 4 June - 9 July 2021, were treated for essential hypertension and had at least 1 dose of CoronaVac vaccine were included in the study. In the pre-pandemic, pre-vaccine and post-vaccine period, mean home and office blood pressures of the patients were examined separately. Results: While the mean home blood pressures of the patients differed significantly between the pre-pandemic and pre-vaccine pandemic period (systolic: 125.1±12.6 vs 129.1±14.1 mmhg, p<0.001, diastolic: 75.3±9.7 vs 77.1±9.8 mmhg, p=0.004), there was no significant difference between the pre- and post-vaccination period (systolic: 129.1±14.1 vs 129.7±13.7 mmhg, p=0.229, diastolic: 77.1±9.8 vs 77.9±9.9 mmhg, p=0.091). Similarly, while office blood pressures differed significantly between the pre-pandemic and pre-vaccine pandemic period (systolic: 133.5±16.5 vs 136.1±16.4 mmhg, p=0.015, diastolic: 79.4±10.9 vs 81.2±12.1 mmhg, p=0.036), there was no significant difference between the pre- and post-vaccination period (systolic: 136.1±16.4 vs 135.6±16.9 mmhg, p=0.651, diastolic: 81.2±12.1 vs 81.1±11.2mmhg, p=0.914). Conclusion: While the Covid-19 pandemic increased the blood pressure of chronic hypertensive patients, the CoronaVac vaccine did not affect the blood pressure regulation of these patients

Evaluation of Bleeding Rate and Time in Therapeutic Range in Patients Using Warfarin Before and During the COVID-19 Pandemic—Warfarin Treatment in COVID-19

The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal’s method. The mean age of the patients was 61 ± 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 ± 21 vs 68 ± 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding

The effect of hemodialysis on left ventricular global longitudinal strain in chronic hemodialysis patients with preserved left ventricular ejection fraction

Objectives: In the present study, we aimed to evaluate the acute effects of hemodialysis (HD) on left ventricular functions with left ventricular (LV) global longitudinal strain (GLS). Patients and methods: This prospective study included a total of 38 patients (24 males, 14 females; mean age: 60.8±13.8 years; range, 31 to 82 years) who were on chronic HD for at least six months and had a LV ejection fraction of ?50% between December 2021 and January 2022. The clinical and echocardiographic features of the patients were recorded before and after HD. The GLS was calculated using two-dimensional speckle-tracking method. Results: The mean dialysis time of the patients was 6.3±3.9 years. The left atrial volume index was significantly lower after HD than before (30.1±10.0 vs. 27.5±8.2 mL/m 2 , p=0.005). Pulsed Doppler echocardiography showed significantly decreased E and A wave peak velocity after HD (99.3±38.2 vs. 80.4±27.8 cm/s, p=0.001 and 99.4±23.2 vs. 90.4±25.5 cm/s, p=0.022), but no significant change in the E/A ratio (1.1±0.5 vs. 1±0.6, p=0.660). There was no significant change on the LV GLS between before and after HD (-17.3±2.6 vs. -16.9±2.6%, p=0.088). Conclusion: Hemodialysis has no significant effect on LV GLS in the acute phase in patients with end-stage chronic renal disease