The utility of inferior vena cava diameter and the degree of inspiratory collapse in patients with systolic heart failure

Introduction: Both inferior vena cava (IVC) diameter and the degree of inspiratory collapse are used in the estimation of right atrial pressure. Aim: The purpose of this study is to evaluate the utility of IVC diameter, using echocardiography as a marker of volume overload and the relationship between these parameters and N-terminal pro-B natriuretic peptide (NT-proBNP) in patients with systolic heart failure (HF). Methods: We included 136 consecutive patients with systolic HF (left ventricular ejection fraction, = 50%, <50%, and no change [absence] groups); NT-proBNP levels were measured, and these data were compared between the 2 groups. Results: Inferior vena cava diameter and NT-proBNP were significantly higher among the patients with HF than among the control subjects (21.7 +/- 2.6 vs 14.5 +/- 1.6 mm, P < .001 and 4789 [330-35000] vs 171 [21-476], P < .001). The mean IVC diameter was higher among the patients with decompensated HF than among the patients with compensated HF (23.2 +/- 2.1 vs 19.7 +/- 1.9 mm, P < .001). The values of NT-proBNP were associated with different collapsibility of IVC subgroups among HF patients. The NT-proBNP levels were 2760 (330-27336), 5400 (665-27210), and 16806 (1786-35000), regarding the collapsibility of the IVC subgroups: greater than or equal to 50%, less than 50%, and absence groups, P < .001, respectively, among HF patients. There was a significant positive correlation between IVC diameter and NT-proBNP (r = 0.884, P < .001). A cut off value of an IVC diameter greater than or equal to 20.5 mm predicted a diagnosis of compensated HF with a sensitivity of 90% and a specificity of 73%. Conclusions: Inferior vena cava diameter correlated significantly with NT-proBNP in patients with HF. Inferior vena cava diameter may be a useful variable in determining a patient's volume status in the setting of HF and may also enable clinicians to distinguish patients with decompensated HF from those with compensated HF

The relationship among neutrophil to lymphocyte ratio, stroke territory, and 3-month mortality in patients with acute ischemic stroke

BackgroundStroke therapy options have focused on limiting the infarct volume. Neutrophil to lymphocyte ratio (NLR) can be valuable to detect the patients that required intensive treatment at early stage by predicting infarct volume. The aim of this study is to evaluate the relationship between NLR and infarct volume according to the stroke territory, and to determine the prognostic value of NLR for predicting 3-month mortality in acute ischemic stroke (AIS) patients.MethodsA total of 107 patients with AIS were enrolled and followed up 3months in terms of mortality. Study population was divided into two groups according to the stroke territory: anterior circulating stroke (ACS) and posterior circulating stroke (PCS). All patients underwent magnetic resonance imaging. The complete blood count and venous blood samples were obtained from the patients on admission to the emergency department.ResultsThere were no difference between ACS and PCS groups regarding baseline characteristics and co-morbid diseases. Also, C-reactive protein and NLR were similar between two groups. In correlation analyses, infarct volume was significantly correlated with CRP and NLR in ACS (r=0.350, p=0.001 and r=0.482, p0.001, respectively), but not correlated with infarct volume in PCS. Also, NLR was correlated with NIHHS in only ACS group (r=0.326, p=0.002). Multivariate analysis showed that NLR was the only independent predictor of 3-month mortality (OR 1.186, 95% CI 1.032-1.363, p=0.016).ConclusionNLR is significantly correlated with ACS infarct volume, but not with PCS infarct volume in AIS. Also, NLR was an independent predictor of 3-month mortality in AIS patient

Ocena wskaźnika wydolności mięśnia sercowego u chorych na nadciśnienie tętnicze z hiperurykemią i prawidłowym stężeniem kwasu moczowego

Background: Myocardial performance index (MPI) is impaired in patients with hypertension. Uric acid is biologically active and can stimulate oxidative stress, endothelial dysfunction, inflammation, and vasoconstriction. Hyperuricaemia may provide a negative contribution to impaired MPI in hypertension. Aim: The study was designed to assess the MPI in hypertensive patients with or without hyperuricaemia. Methods: A total of 96 consecutive hypertensive patients were divided into two groups according to levels of serum uric acid (SUA); 49 normouricaemic patients (defined as SUA &lt; 7.0 mg/dL in men and &lt; 6.0 mg/dL in women) and 47 hyperuricaemic patients. SUA levels and other biochemistry parameters were determined by a standard analytical technique. All patients were evaluated by two-dimensional and Doppler echocardiography. Results: The two groups were similar according to age, body mass index, and smoking status. Mean MPI value (0.498 ± 0.06 vs. 0.410 ± 0.05, p &lt; 0.001) was significantly higher in the hyperuricaemic group than the normouricaemic individuals and positively correlated with the mean value of SUA levels (r = 0.51, p &lt; 0.001). Conclusions: Our study demonstrated that high SUA levels were significantly associated with impaired MPI in hypertensive patients. SUA may suggest a valuable laboratory finding in assessing the risk of developing subclinical impaired left ventricular global function.  Wstęp: U chorych na nadciśnienie tętnicze wartości wskaźnika wydolności mięśnia sercowego (MPI) są nieprawidłowe. Kwas moczowy jest biologicznie czynną substancją, która może powodować rozwój stresu oksydacyjnego, dysfunkcji śródbłonka, zapalenia i skurczu naczyń. Hiperurykemia może wywierać szkodliwy wpływ, przyczyniając się do pogorszenia MPI u chorych na nadciśnienie tętnicze. Cel: Badanie zaprojektowano w celu oceny MPI u chorych na nadciśnienie tętnicze z hiperurykemią i prawidłowym stężeniem kwasu moczowego. Metody: Kolejnych 96 chorych na nadciśnienie podzielono na dwie grupy w zależności od stężenia kwasu moczowego w surowicy (SUA): 49 osób z normourykemią (definiowaną jako SUA &lt; 7,0 mg/dl u mężczyzn i SUA &lt; 6,0 mg/dl u kobiet) oraz 47 pacjentów z hiperurykemią. Wartości SUA i inne parametry biochemiczne określono za pomocą standardowych metod analitycznych. U wszystkich chorych wykonano echokardiografię dwuwymiarową i doplerowską.  Wyniki: Grupy nie różniły się pod względem wieku chorych, wskaźnika masy ciała i palenia tytoniu. Średnie wartości MPI (0,498 ± 0,06 vs. 0,410 ± 0,05; p &lt; 0,001) były istotnie wyższe w grupie pacjentów z hiperurykemią niż u osób z prawidłowym stężeniem kwasu moczowego i korelowały dodatnio ze średnimi wartościami SUA (r = 0,51; p &lt; 0,001). Wnioski: W badaniu wykazano, że wysokie wartości SUA były istotnie związane z gorszym MPI u chorych na nadciśnienie. SUA może być cennym parametrem laboratoryjnym w ocenie ryzyka rozwoju subklinicznych zaburzeń globalnej wydolności lewej komory.

Association between the No-Reflow Phenomenon and Soluble CD40 Ligand Level in Patients with Acute ST-Segment Elevation Myocardial Infarction

Background and objectives: No-reflow (NR) phenomenon is defined as insufficient myocardial perfusion in coronary circulation in the absence of angiographic evidence of mechanical obstruction. The primary mechanisms of the NR occurrence are thought to be high platelet activity and thrombus burden. Soluble CD40 ligand (sCD40L), which is released into the plasma following platelet activation, accelerates the inflammatory process and causes further platelet activation. The aim of our study is to investigate the relationship between the NR phenomenon and sCD40L level in patients with ST-elevation myocardial infarction (STEMI). Methods: A total of 81 acute STEMI patients undergoing primary percutaneous coronary intervention and 40 healthy participants were included in this study. Acute STEMI patients were classified into two groups: 41 patients with the NR phenomenon (NR group) and 40 patients without the NR phenomenon (non-NR group). The serum sCD40L level was measured for all groups. Results: The serum sCD40L level was significantly higher in the NR group than in non-NR and control groups (379 &plusmn; 20 pg/mL, 200 &plusmn; 15 pg/mL and 108 &plusmn; 6.53 pg/mL, respectively; p &lt; 0.001). Univariate regression analysis demonstrated that male sex, age, Gensini score and sCD40L level were the possible factors affecting the occurrence of the NR phenomenon. In multivariate regression analysis, age (odds ratio [OR], 1.091; 95% confidence interval [CI], 1.023&ndash;1.163; p &lt; 0.008) and serum sCD40L (OR, 1.016; 95% CI, 1.008&ndash;1.024; p &lt; 0.001) remained the independent predictor of the presence of NR. Conclusions: Our study showed that serum sCD40L level was an independent predictor of the NR phenomenon occurrence

Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study

© 2020 by Turkish Society of Cardiology.Objective: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recent pre-pandemic registry (TURKMI-1). Methods: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. Results: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. Conclusion: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic