Fibrinogen-to-albumin ratio predicts mortality in COVID-19 patients admitted to the intensive care unit

Introduction: Coronavirus disease 2019 (COVID-19) is an inflammatory disease, and serum albumin and fibrinogen are two important factors in systemic inflammation. We aimed to investigate the relationship between the fibrinogen-to-albumin ratio (FAR) and in-hospital mortality in COVID-19 patients admitted to the intensive care unit (ICU).Material and methods: Patients diagnosed with COVID-19 admitted to the Adiyaman Training and Research Hospital from August to November 2020 were enrolled in this retrospective cohort study. They were divided into 2 groups based on in-hospital mortality: a survivor group (n = 188) and a non-survivor group (n = 198). FAR was calculated by dividing the fibrinogen value by the albumin value. Mortality outcomes were followed up until December 15, 2020.Results: The average age of the patients was 71.2 ± 12.9 years, and 54% were male. On multivariate logistic analysis, diabetes mellitus (OR: 1.806; 95% CI: 1.142–2.856; p = 0.011), troponin I levels (OR: 1.776; 95% CI: 1.031–3.061; p = 0.038), and FAR (OR: 1.004; 95% CI: 1.004–1.007; p = 0.010) at ICU admission were independent predictors of in-hospital mortality in patients with COVID-19.Conclusions: The FAR at admission was associated with mortality in patients infected with SARS-CoV-2 in the ICU

The predi?cti?ve value of plasma TGF-b levels i?n i?n-stent restenosi?s

YÖK Tez No: 435495Giriş: Koroner arter hastalığı (KAH) gelişmiş ülkelerde olduğu gibi Türkiye'de de mortalite ve morbidite nedeni olarak birinci sırada yer almaktadır. Perkütan koroner girişim (PKG), KAH tedavisinde en yaygın kullanılan revaskülarizasyon yöntemidir. Başlangıçta yalnız balon anjiyoplasti(PTCA) yapılırken, günümüzde olguların %80'inden fazlasına stent uygulanmaktadır. Başarılı PTCA takiben yaklaşık 6 ay sonra olguların %32-57'sinde restenoz ortaya çıkmaktadır (6). Her ne kadar, peruktan koroner stentlemenin (PCI) yaygınlaşmasıyla restenoz oranları PTCA'ya kıyasla anlamlı olarak azalsa da stent-içi restenoz (SİR) hala vakaların %10-40'ında görülmektedir (8,9). SiR, koroner arter hastalarında stent implantasyonu sonrası erken ve geç dönem morbiditenin en önemli nedenlerinden birisidir. Restenoz ön görülebilir ise maliyet etkinliği ve mortalite ve morbiditeyi azaltması açısından ve hatta tedavi stratejisini belirlemede çok önemli bir potansiyele sahip olabilir. Amaç: Biz bu çalışmada serum transforming growth faktör- ? (TGF- ?) düzeyleri ile restenoz arasında bir korelasyon olup olmadığını ve TGF- ? düzeyin gelişebilecek SİR'i ön gördürüp gördürmeyeceğini araştırmayı planladık. Materyal-metod: Düzce Üniversitesi Tıp Fakültesi Hastanesi Kardiyoloji Bölümünde daha önce PCI uygulanmış ve herhangi bir endikasyonla koroner anjiografi (KAG) planlanmış toplam 82 hasta çalışmaya dahil edildi. Restenoz, stent içinde >%50 daralma olması şeklinde tanımlandı. 34 hastada restenoz saptanırken 48 hastada anjiografik olarak kritik lezyon saptanmadı. Tüm hastalarda plazma TGF- ? düzeyi ölçüldü. Bulgular: SİR ile TGF- ? düzeyi arasında istatistiksel olarak anlamlı bir ilişki saptanamamıştır(p=0,754). Yapılan alt grup çok değişkenli regresyon analizinde hedef damar çapı ile SİR arasında negatif, RCA lezyonları ile SİR arasında pozitif korelasyon saptanmıştır. Sonuç: TGF- ? ile SİR arasındaki ilişkiyi irdeleyen başka çalışma yoktur. Bu çalışma her hangi bir zamanda bakılan TGF- ?'nin SİR ön gördürücü bir özelliği olmadığını ortaya koymuştur. Bu çalışmanın daha geniş hasta sayılarıyla ve mümkünse prospektif olarak planlanarak tekrarlanması ve başka moleküllerin de beraberinde çalışılması gerekliliği açıktır.Introduction: Coronary artery disease (CAD) is the leading cause of mortality and morbidity in Turkey as well as the other developed countries. Percutaneous coronary intervention(PCI) is the most common revascularization strategy in management of CAD. Earlier, PTCA is the only revascularization strategy; however, today over %80 of the patients has undergone PCI. Restenosis rate six month after succesfull PTCA is reported as %32-57 (6). Although restenosis rates compared to PTCA has been significantly decreased after PCI has become prevalent, in-stent restenosis(ISR) has been encountered about %10-40 of the cases (8,9). ISR is one of the most important cause of both early and late morbidity in CAD. If predicted, ISR could have very important potential to decrease the mortality and morbidity rates and provide cost-effectivity and even in picking up the treatment strategy. Objectives: We planned to investigate if there is a corelation between plasma TGF- ? levels and ISR and whether or not this molecule could predict future ISR. Method: 82 patients who has prior PCI history in Düzce University Medicine Faculty Hospital and is scheduled for coronary angiography for any reason is included the study. ISR is defined as >%50 narroing inside the stent. Plasma TGF- ? levels are studied in all patients. Findings: We found no significant corelation between ISR and TGF- ? levels (p=0,754). In multivariate regression analysis there is negative corelation between ISR and target vessel diameter, and positive corelation between ISR and RCA lesions. Conclusion: As far as we know there is no study investigating the corelation between ISR and TGF- ? levels. This study has shown that there is no quality of TGF- ? in predicting ISR. It is clear that this study should be redisigned with larger cohort and conducted as a prospective study with other molecules assumed to have predictive values of ISR as well as TGF- ? if possible

Congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery: An interesting case report

PubMed ID: 24411822Intercoronary communication is a very rare coronary artery anomaly. It is defined as an open-ended circulation with bidirectional blood flow between two coronary arteries. Coronary artery fistulas are abnormal communications between a coronary artery and a cardiac chamber or major vessel. A 62-year-old man was admitted to our hospital with sudden development of general weakness, dizziness and a sensation of compression in his chest. At presentation his blood pressure was 80/40 mmHg and heart rate was 65 beats/min. The ECG revealed sinus rhythm and 1-2 mm ST elevation in the anterior leads. The patient was taken to the catheterization laboratory for percutaneous coronary intervention. The left main and left circumflex coronary arteries were normal. Coronary angiography showed a communication between the left main and the diagonal branch of the left anterior descending and a fistula between the intercoronary connection and the left atrium. The other coronary arteries were normal. Laboratory test results, including cardiac troponin I and creatine kinase-MB levels, were normal. The angina symptoms disappeared and the ST elevation resolved within four hours. We report an interesting case of congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery presenting as an acute coronary syndrome. To the best of our knowledge, this is the first case in the literature involving a coronary artery fistula in an intercoronary communication. © 2013 Sociedade Portuguesa de Cardiologia Published by Elsevier España, S.L. All rights reserved

The relationship between acute coronary syndrome and sildenafil

Turker, Yasin/0000-0002-5157-4624WOS: 000324332900046PubMed: 23791459Sildenafil is a drug used for male erectile dysfunction. Sildenafil's fatal cardiac effects except due to hypotension with simultaneous nitrate use have not been reported. We reported in this case a 70-year-old man admitted to the emergency service with chest pain, which occurs in an hour after sildenafil use. Electrocardiogram showed inferoposterior ST-segment elevation. In angiography, total circumflex artery occlusion has been seen

Acute coronary syndrome and sildenafil - coincidence or coexistence: Author reply

WOS: 000330583800015PubMed: 24332251

Prerequisite Revascularization of Unprotected Left Main Coronary Artery Before Culprit Lesion Stenting

Güncel kılavuzlar ana koroner arter hastalığı olan asemptomatik iskemi, stabil anjina yada unstabil anjina / non-STEMI olan hastalarda CABG önerir. Ancak eşlik eden ciddi ana koroner arter hastalığı olan STEMI ile başvuran hastalarda hiç bir öneri yoktur. Bizim vakamızda suçlu lezyonu revaskülarizasyon amacıyla önce ciddi ana koroner arter lezyonu ile uğraşmak zorunda kaldık.Current guidelines recommend CABG as the treatment of choice for patients with asymptomatic ischemia, stable angina, or unstable angina/non-ST elevation myocardial infarction who have left main coronary artery disease. However there is no suggestion for patients presenting with ST elevation MI who have concomitant severe LMCA disease. In our case we had to deal with the stable but severe LMCA lesion first, in order to revascularize the culprit lesion

Associations between Vaspin Levels and Coronary Artery Disease

The relationship between serum vaspin levels and metabolic or coronary artery disease is currently of interest for researchers. Although adipokine concentrations have been shown to be increased significantly in atherosclerotic lesions, the role adipokines in the atherosclerotic process remains to be elucidated. Vaspin is a new biological marker associated with obesity and impaired insulin sensitivity. Plasma vaspin concentration has been shown to correlate with the severity of coronary artery disease. Vascular inflammation triggered by vaspin inhibits atherogenesis by suppressing macrophage foam cell formation and vascular smooth muscle cell migration and proliferation. Vaspin also contributes to plaque stabilization by increasing collagen content and reducing the intraplaque macrophage to vascular smooth muscle cell ratio. The therapeutic goal concerning vaspin is to fight atherosclerosis and related diseases, as well as to maintain vascular health

Predictors of Major Adverse Cardiovascular Events by Combining Clinical Data with Non-Invasive Screening Methods

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEYWOS: 000329858400261…Turkish Soc Cardio

Major adverse events rate and characteristics in düzce the results of Melen study with 36 months prospective follow-up

Amaç: MELEN çalışması kapsamında takibe alınan Türk erişkinlerinin 36 ay takip sonrasında meydana gelen majör istenmeyen olay sıklığının ve karakteristiğinin saptanması, saptanan olayların hasta risk profilleri ile ilişkilendirilmesi, predispozan faktörlerin ortaya koyulması amaçlanmıştır. Gereç ve Yöntem: 2010 yılında taranan 2.298 kişi telefonla arandı. 1.495 kişiye (570 erkek, 925 kadın) ulaşıldı ve çalışmaya dahil edildi. Ulaşılan bireylerde; ölüm, iskemik veya hemorajik serebrovasküler olay (svo), dekompanse kalp yetersizliği, akut koroner sendrom, hipertansif kriz, periferik arter hastalığı, angina atağı ve non-kardiyak nedenlerle hastaneye yatış sebepleri primer son nokta olarak sorgulandı. Bulgular: Takip boyunca 16 kişide ölüm, 14 kişide serebrovasküler olay, 13 kişide dekompanse kalp yetmezliği, 12 kişide akut koroner sendrom, 31 kişide hipertansif kriz, 11 kişide aritmi ve 23 kişide non-kardiyak nedenlerle hastaneye yatış saptandı. 1.495 kişiden toplamda 137 kişi olay yaşadı. Olaysız yaşam oranı %90,8 ölçüldü. Majör sonlanım noktası olarak ölüm, serebrovasküler olay ve miyokard enfarktüsü alındığında 42 kişinin bu olayları yaşadığı görüldü. Olay hızı artışında en dikkat çekici risk faktörü hipertansiyon olarak belirlendi. Non-kardiyak nedenli hastane yatışlarında en sık neden kas-iskelet sistemi olup, toplamda bu nedenle 6 kişi hastaneye yatmıştır. Toplam 4 kişide kanser ortaya çıkmıştır. Sonuç: Majör istenmeyen olay ile en çok ilişkili risk faktörü hipertansiyondu. Bu sonuç hipertansiyonun ülkemizde hala çok önemli bir mortalite ve morbidite nedeni olduğunu desteklemektedir.Aim: The MELEN study was designed to determine major adverse events rates and characteristics after thirty-six moths follow up of Turkish adults. Also we aimed to evaluate the risk associates of adverse events and predisposing factors. Material and Method: 2.298 participants, who joined the study in 2010, were followed. A total of 1.495 people (570 male, 925 female) were reached via telephone call and included in the study. The individuals were questioned for primary end points of death, ischemic or hemorrhagic cerebrovascular events, decompensated heart failure, acute coronary syndrome, hypertensive crisis, peripheral vascular disease, angina attack and hospitalization for non-cardiac reasons. Results: During thirty-six months follow up, sixteen participants died, fourteen participants had cerebrovascular events, thirteen were hospitalized with heart failure, twelve had acute coronary syndrome, thirty-one had hypertensive crisis, eleven had arrhythmia. A number of 23 participants hospitalized for non-cardiac reasons. The most common cause of non-cardiac hospitalization was musculoskeletal diseases. Six patients admitted for this reason. A total of four patients developed cancer. Conclusion: Hypertension was the most common risk factor associated with major adverse events. The results are concordant with the general concept that hypertension is one of the biggest mortality and morbidity causes in Turkey

Predictors of major adverse cardiovascular events; results of population based MELEN study with prospective follow-up

WOS: 000354535200018PubMed: 25967720OBJECTIVE: In healthy persons, cardiovascular risk is the result of multiple interacting risk associates including demographic, clinical, genetic and environmental factors. Several non-invasive tools such as echocardiography, ultrasonography and electrocardiography as well as new biochemical markers were shown to be applicable to predict cardiovascular events. However, implementation of all of these tools has not been tested before. The aim of the study was to evaluate the independent predictors of major adverse cardiovascular events in a prospective population based study, with the use of bioempedance analysis, echocardiography, ultrasonography and ECG. PATIENTS AND METHODS: The baseline measurements were conducted on 2230 participants (1427 women, 803 men with a mean age of 49 +/- 15). The follow-up was done 36 months after the baseline admission via telephone call. Major adverse event was defined as mortality or myocardial infarction or stroke. RESULTS: Follow-up data was possible in 1495 participants (65%). During the follow-up of 36 months (4485 patient years), 42 major adverse events occurred (0.03%). Among them, 16 were death (1 stroke, 2 cancer, 13 cardiac related), 12 were stroke and 14 were myocardial infarction. Age, body mass index and atrial fibrillation were independent predictors of major adverse events; AF being the most powerful (Odds ratio 10.46; 95% confidence interval [1.73-63.14]; p = 0.010). CONCLUSIONS: Age, lower body mass index and atrial fibrillation were independent predictors of major cardiovascular events in our cohort.Duzce University Bureau of Scientific InvestigationsDuzce University [2009.04.03.034]This study was funded in full by Duzce University Bureau of Scientific Investigations, grant number 2009.04.03.034