Post-discharge heart failure monitoring program in Turkey: Hit-PoinT

Objective: The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. Methods: The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Results: Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001). Conclusion: These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patients.Türk Kardiyoloji Derneği Kalp Yetmezliği Çalışma Grub

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

Impact of metabolic syndrome on future cardiovascular events in patients with first acute myocardial infarction

The prevalence of metabolic syndrome (MetS) is increasing worldwide and patients with MetS have increased risk of cardiovascular events. Recent studies in different populations showed higher prevalences of MetS in patients with acute myocardial infarction (MI) and identified MetS as an independent predictor of future cardiac events. This study sought to determine the prevalence of MetS in patients with acute MI and investigate the impact of MetS on adverse cardiovascular events after acute MI. One hundred and eighty-eight patients (155 men, 33 women) admitted with first acute MI were enrolled into the study. Of the total patients, 80 (42.6%) patients were diagnosed with MetS according to the National Cholesterol Education Program Adult Treatment Panel III criteria with modifications for high blood pressure and high fasting plasma glucose. Kaplan-Meier curves showed that the cumulative event-free survival rates did not differ between the patients with and without MetS during a median follow-up period of 27.7 (min:14, max:42) months (P>0.05). On multivariate Cox regression analysis controlling for hypertension, diabetes mellitus, glucose, MetS, and waist-to-hip ratio, there was no association between the major adverse coronary events and the presence of MetS (P>0.05), whereas Killip class (relative risk: 2.853, 95% confidence interval: 1.606-5.070; P<0.001) was identified as the only independent predictor of long-term cardiovascular outcomes. This study shows that MetS has no effect on long-term prognosis after MI. However, Killip class was identified as an independent predictor of major cardiac events. Coron Artery Dis 20:370-375 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

The association between statin dosage and malignant ventricular arrhythmias in patients with primary prevention implantable cardioverter-defibrillators for ischemic cardiomyopathy

Background: Malignant ventricular arrhythmias are a common cause of death in ischemic heart diseases. Implantable cardioverter-defibrillators (ICDs) demonstrate significant efficacy in reducing mortality linked to ventricular arrhythmias. Statins exhibit the potential to stabilize the atherosclerotic and ischemic burden, thereby potentially manifesting indirect anti-arrhythmic effects. This study evaluated the relationship between statin levels and arrhythmic events in patients with primary prevention ICDs for ischemic cardiomyopathy. Methods: This study was conducted as a retrospective observational study at a single center, involving consecutive patients who were admitted to the cardiology outpatient clinic and underwent primary prevention ICD. The study population was stratified into two groups based on statin usage. Results: This study included a cohort of 80 patients diagnosed with ischemic cardiomyopathy who underwent primary prevention implantation of ICDs. Group 1 consisted of 24 patients who were prescribed low-dose statins, whereas Group 2 consisted of 56 patients who were prescribed high-dose statins. Univariate and multivariate analyses showed that left ventricular ejection fraction and use of low-dose statins were independent predictors of arrhythmic events. Conclusion: The study cohort exhibited comparable clinical and laboratory characteristics, suggesting that statin dosage is associated with malignant arrhythmic events in a homogeneous patient population

Relapse of Multiple Myeloma Presenting as Extramedullary Plasmacytomas in Multiple Organs

Multiple myeloma is a neoplastic plasma cell disorder. It is characterized by collections of abnormal plasma cells accumulating in the bone marrow, where they interfere with the production of normal blood cells. It usually presents as a multisystemic involvement, whose symptoms and signs vary greatly. Some patients have slowly progressive disease while others have aggressive clinical behavior by extramedullary involvement. In addition to renal failure, anemia, hypercalcemia, lytic bone lesions, and immunodeficiency, it also affects multiple organ system, such as pancreas, adrenal glands, kidney, skin, lung, liver, spleen, lymph nodes, and bone. To raise awareness of the variable presentations of this disease, we report a 53-year-old male patient, with multiple myeloma in his first remission who relapsed with extramedullary plasmacytomas (EMPs) involving multiple organs, such as pancreas, adrenal glands, kidney, skin, lung, liver, spleen, and lymph nodes

Frequency of Nerve Root Sleeve Cysts in Autosomal Dominant Polycystic Kidney Disease

Background: There is sporadic data about the occurrence of spinal meningeal cysts in patients with autosomal dominant polycystic kidney disease (ADPKD). We suggest that there is a relationship with the frequency and size of spinal meningeal cysts and headache, intracranial aneurysms, and cerebrospinal fluid leakage in patients with ADPKD. Aim: To investigate the relationship with spinal meningeal cyst, cerebrospinal fluid leakage, and headache in patients with ADPKD. Study Design: Cross-sectional study. Methods: We enrolled 50 patients with ADPKD and 37 healthy volunteers. This cross-sectional study included patients with ADPKD and matched healthy volunteers. Magnetic resonance imaging myelography was performed using the 3D-T2 HASTE technique in an MRI scanner. We questioned our subjects regarding presence of headache and evaluated headache severity using a visual analog scale. The relationship between the number and size of spinal meningeal cysts with headache, intracranial aneurysms, and liver cysts was also investigated. Results: Spinal meningeal cysts were more numerous and larger in patients than in controls (14.8±11.6 vs. 6.4±4.6 cysts respectively, p<0.001, 68.3±49.3 vs. 25.4±20.1 mm, p<0.001, respectively). Spinal cyst number and size were similar in APDKD patients with or without intracranial aneurysms. Headache score was correlated with the size and number of spinal meningeal cysts. This was valid only in patients with ADPKD. Conclusion: Abnormality involving the vessel wall in ADPKD may explain the increased number of spinal meningeal cysts in ADPKD. Moreover, leakage of cerebrospinal fluid secondary to spinal meningeal cyst may be responsible for recurrent severe headache by causing spontaneous intracranial hypotension in these patients