Relationship between neutrophil - to - lymphocyte ratio and major adverse cardiac events in patients with saphenous vein graft disease

Amaç: Safen ven greft hastalığında perkütan koroner girişim ile revaskülarizasyon sağlanan hastalarda işlem öncesi nötrofil lenfosit oranı ile uzun dönem kardiyovasküler sonuçlar arasındaki ilişkiyi değerlendirmeyi araştırdık. Gereç ve Yöntem: Safen ven grefte perkütan girişim yapılan hastalar retrospektif olarak taranarak toplamda 98 hasta; majör olumsuz kardiyak olayların varlığına (42 hasta) veya yokluğuna (56 hasta) göre iki gruba ayrıldı. Grupların işlem öncesi nötrofil lenfosit oranları karşılaştırıldı. Bulgular: Majör olumsuz kardiyak olayların olduğu grupta nötrofil lenfosit oranı, total beyaz kan hücre sayısı ve C-reaktif protein seviyesi majör olumsuz kardiyak olayların olmadığı gruba kıyasla anlamlı olarak yüksek bulunmuştur. Sonuç: Safen ven greft hastalığında perkütan koroner girişim öncesi nötrofil lenfosit oranları gelişebilecek kardiyovasküler olayları tahmin etmede kullanılabilen ucuz ve kolay ulaşılabilir bir belirteçtir.Objectives: In this study, we aimed to investigate relationship between neutrophil/lymphocyte ratio and the long term cardiovascular outcomes in saphenous vein graft disease who were revascularizated with percutaneous coronary intervention. Material and Method: We retrospectively analyzed 98 patients (mean age 64.4±9.3 and 76% men) with significant saphenous vein graft disease whom treated with percutaneous coronary intervention. Of all the participants, 42 patients experienced one or more major adverse cardiac events and 56 of them were free of major adverse cardiac events. Results: The median follow-up period of the study was 47.3 months. Patients with major adverse cardiac events have significantly higher neutrophil to lymphocyte ratio when compared to patients without major adverse cardiac events (3.4±1.4 vs. 2.3±0.8, p <0.001). Higher white blood cell counts, neutrophil counts, CRP levels and lower lymphocyte counts were significantly associated with major adverse cardiac events. Conclusion: Higher neutrophil /lymphocyte ratio values were associated with major adverse cardiac events in patients with saphenous vein graft disease revascularized by percutaneous coronary intervention. It can be used in this era, because it is an inexpensive and readily available marker that provides an additional level of risk scores in predicting in hospital and long-term outcomes in patients with saphenous vein graft disease

The relationship between fragmented QRS and functional significance of coronary lesions

Background: Recently fragmented QRS (fQRS) on electrocardiography (ECG) has been introduced as a predictor of myocardial scarring and myocardial ischemia in coronary artery disease (CAD)

The classical “R-on-T” phenomenon

The polymorphic ventricular tachycardia (PVT) is uncommon arrhythmia with multiple causes and has been classified according to whether they are associated with long QT interval or normal QT. Whereas “Torsade de pointes (TdP)” is an uncommon and distinctive form of PVT occurring in a setting of prolonged QT interval, which may be congenital or acquired (congenital or acquired), “PVT with normal QT” is associated with myocardial ischemia, electrolyte abnormalities (hypokalemia), mutations of the cardiac sodium channel (Brugada syndrome), and the ryanodine receptor (catecholaminergic PVT). This distinction is crucial because of the differing etiologies and management of these arrhythmias. Moreover, the PVT in the setting of acute MI generally occurs during the hyperacute phase, is related to ischemia (“ischemic PVT”) and is not associated with QT prolongation. It is triggered by ventricular extrasystoles with very short coupling interval (the “R-on-T” phenomenon) and is not pause-dependent. However, recently there has been described a new PVT during the “healing phase” of MI in patients with no evidence of ongoing ischemia and following excessive QT prolongation, the electrophysiologic abnormality being a “pause-dependent infarct-related TdP” due to a LQTS in healing MI patients. Therefore, “ischemic PVT” differs from “infarct-related TdP” in terms of pathophysiology and ECG manifestations

The Time in Therapeutic Range and Bleeding Complications of Warfarin in Different Geographic Regions of Turkey: A Subgroup Analysis of WARFARIN-TR Study

WOS: 000423237800009PubMed ID: 28443575Background: The time in therapeutic range values may vary between different geographical regions of Turkey in patients vitamin K antagonist therapy. Aims: To evaluate the time in therapeutic range percentages, efficacy, safety and awareness of warfarin according to the different geographical regions in patients who participated in the WARFARIN-TR study (The Awareness, Efficacy, Safety and Time in Therapeutic Range of Warfarin in the Turkish population) in Turkey. Study Design: Cross-sectional study. Methods: The WARFARIN-TR study includes 4987 patients using warfarin and involved regular international normalized ratio monitoring between January 1, 2014 and December 31, 2014. Patients attended follow-ups for 12 months. The sample size calculations were analysed according to the density of the regional population and according to Turkish Statistical Institute data. The time in therapeutic range was calculated according to F.R. Roosendaal's algorithm. Awareness was evaluated based on the patients' knowledge of the effect of warfarin and fooddrug interactions with simple questions developed based on a literature review. Results: The Turkey-wide time in therapeutic range was reported as 49.5% +/- 22.9 in the WARFARIN-TR study. There were statistically significant differences between regions in terms of time in therapeutic range (p<0.001). The highest rate was reported in the Marmara region (54.99%+/- 20.91) and the lowest was in the South-eastern Anatolia region (41.95 +/- 24.15) (p< 0.001). Bleeding events were most frequently seen in Eastern Anatolia (41.6%), with major bleeding in the Aegean region (5.11%) and South-eastern Anatolia (5.36%). There were statistically significant differences between the regions in terms of awareness (p< 0.001). Conclusion: Statistically significant differences were observed in terms of the efficacy, safety and awareness of warfarin therapy according to different geographical regions in Turkey