Neutrophile/Lymphocyte Ratio is Associated with More Extensive and Severe Coronary Artery Disease and Impaired Myocardial Perfusion

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEY[No Abstarct Available]Turkish Soc Cardio

Neutrophile/Lymphocyte Ratio is Associated with More Extensive and Severe Coronary Artery Disease and Impaired Myocardial Perfusion

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEY[No Abstarct Available]Turkish Soc Cardio

Epicardial Adipose Tissue Thickness Is an Independent Predictor of Critical and Complex Coronary Artery Disease by Gensini and SYNTAX Scores

Epicardial adipose tissue thickness is associated with the severity and extent of atherosclerotic coronary artery disease. We prospectively investigated whether epicardial adipose tissue thickness is related to coronary artery disease extent and complexity as denoted by Gensini and Syntax scores, and whether the thickness predicts critical disease. After performing coronary angiography in 183 patients who had angina or acute myocardial infarction, we divided them into 3 groups: normal coronary arteries, noncritical disease (>= 1 coronary lesion with = 1 coronary lesion with >= 70% stenosis). We used transthoracic echocardiography to measure epicardial adipose tissue thickness, then calculated Gensini and Syntax scores by reviewing the angiograms. Mean thicknesses were 4.3 +/- 0.9, 5.2 +/- 1.5, and 7.5 +/- 1.9 mm in patients with normal coronary arteries, noncritical disease, and critical disease, respectively (P 7 mm), mean Gensini scores were 4.1 +/- 5.5, 19.8 +/- 15.6, and 64.9 +/- 32.4, and mean Syntax scores were 4.7 +/- 5.9, 16.6 +/- 8.5, and 31.7 +/- 8.7, respectively (both P < 0.001). Thickness had strong and positive correlations with both scores (Gensini, r = 0.82, P < 0.001; and Syntax, r = 0.825, P < 0.001). The cutoff thickness value to predict critical disease was 5.75 mm (area under the curve, 0.875; 95% confidence interval, 0.825-0.926; P < 0.001). Epicardial adipose tissue thickness is independently related to coronary artery disease extent and complexity as denoted by Gensini and Syntax scores, and it predicts critical coronary artery disease

Wpływ suplementacji hormonów tarczycy na ograniczenie przyrostu nasierdziowej tkanki tłuszczowej u chorych z subkliniczną niedoczynnością tarczycy

Background: Subclinical hypothyroidism (SCH) is a common disorder which has adverse cardiovascular effects. Epicardial adipose tissue (EAT), a novel marker of cardiovascular risk, is increased in SCH. Aim: We aimed to investigate whether L-thyroxine treatment can reverse the thickening of EAT in SCH. Methods: Forty-four patients with SCH and 42 euthyroid control subjects were included. EAT thickness was measured using transthoracic echocardiography at baseline and after restoration of the euthyroid status with 3 months of L-thyroxine treatment. Results: At baseline, mean EAT thickness was significantly greater in the SCH group when compared to the control group (6.3 ± 1.7 mm vs. 4.1 ± 0.9 mm, respectively, p &lt; 0.001). There was a significant positive correlation between baseline serum thyroid stimulating hormone (TSH) level and EAT thickness in the SCH group. There was a significant reduction in mean EAT thickness in response to L-thyroxine treatment (6.3 ± 1.7 mm vs. 5.1 ± 1.4 mm, p &lt; 0.001). The decrease in EAT thickness after L-thyroxine treatment when compared to baseline (DEAT) significantly correlated to the difference in TSH levels before and after treatment (DTSH; r = 0.323; p = 0.032). Conclusions: Epicardial adipose tissue thickness is increased in patients with SCH. This thickening was alleviated with restoration of the euthyroid status with L-thyroxine treatment in our study population of predominantly male, relatively old subjects with greater baseline EAT thickness.  Wstęp: Subkliniczna niedoczynność tarczycy (SCH) jest częstym zaburzeniem niekorzystnie wpływającym na układ sercowo-naczyniowy. U chorych z SCH stwierdza się zwiększenie grubości nasierdziowej tkanki tłuszczowej (EAT) — nowego wskaźnika ryzyka sercowo-naczyniowego. Cel: Badanie przeprowadzono w celu ustalenia, czy leczenie L-tyroksyną może zmniejszyć grubość EAT u tych chorych. Metody: Do badania włączono 44 chorych z SCH i 42 osoby z eutyreozą, które stanowiły grupę kontrolną. Na początku badania i po przywróceniu eutyreozy w wyniku 3-miesięcznego leczenia L-tyroksyną zmierzono grubość EAT metodą echokardiografii przezprzełykowej. Wyniki: Na początku badania średnia grubość EAT była istotnie większa w grupie SCH niż w grupie kontrolnej (odpowiednio 6,3 ± 1,7 mm vs. 4,1 ± 0,9 mm; p &lt; 0,001). W grupie SCH stwierdzono istotną dodatnią korelację między początkowym stężeniem TSH w surowicy a grubością EAT. Po leczeniu L-tyroksyną nastąpiła istotna redukcja średniej grubości EAT (6,3 ± 1,7 mm vs. 5,1 ± 1,4 mm; p &lt; 0,001). Zmniejszenie grubości EAT po leczeniu L-tyroksyną w stosunku do wartości początkowych (DEAT) korelowało istotnie z różnicą stężeń TSH przed terapią i po jej zakończeniu (DTSH; r = 0,323; p = 0,032). Wnioski: U chorych z SCH grubość EAT jest zwiększona. W populacji niniejszego badania, złożonej głównie z mężczyzn w starszym wieku z większą początkową grubością EAT, zmniejszono ilość nasierdziowej tkanki tłuszczowej dzięki przywróceniu eutyreozy poprzez leczenie L-tyroksyną.

Is High Modified Mallampati Score A Risk Factor for Arterial Hypertension?

Aim: Various studies have shown that one of these predisposing risk factors, namely the anatomical narrowness of the upper airway, is linked to insulin resistance, atherosclerosis, obesity, and HT related diseases. This study investigates the possible relation between HT and the Modified Mallampati Score (MMS) which is linked to the anatomical narrowness of the upper airway at the oropharynx level. Material and Method: The study covers a total of 138 adults of which 57 are women (41.3%) and 81 are men (58.7%). The patients were selected among those adults who had presented to the cardiology clinic with a known history of hypertension, without any systemic diseases, not on medication for any reason, and without any anatomical problems that could give way to airway obstruction through a detailed ENT examination. Results: According to MMS the mean figures of systolic and diastolic blood there was a statistically significant relation between HT and MMS (p < 0.05). There was also a statistically significant difference between the systolic and diastolic blood pressures of patients with MMS1-MMS2, MMS1-MMS3. The same relation was found between MMS2-MMS3 only regarding the diastolic pressures (p < 0.017). Discussion: It is shown that high MMS is related to HT. We think that it would be best for high MMS patients be evaluated concerning HT during the initial examination of the patient by the clinician

Electrocardiographic P-Wave Duration, QT Interval, T Peak to End Interval and Tp-e/QT Ratio in Pregnancy with Respect to Trimesters

Background: P-wave duration helps to determine the risk of atrial arrhythmia, especially atrial fibrillation. QT interval, T peak to end interval (Tp-e), and Tp-e/QT ratio are electrocardiographic indices related to ventricular repolarization which are used to determine the risk of ventricular arrhythmias. We search for any alterations in electrocardiographic indices of arrhythmia in the pregnancy period with respect to trimesters. Methods: We enrolled 154 pregnant and 62 nonpregnant, healthy women into this cross-sectional study. Maximum and minimum P-wave durations (Pmax, Pmin), and QT intervals (QTmax, QTmin) were measured from 12 leads. QT measurements were corrected using Fridericia (QTc-Fr) and Bazett's (QTc-Bz) correction. Tp-e interval was obtained from the difference between QT interval, and QT peak interval (QTp) measured from the beginning of the QRS until the peak of the T wave. Tp-e/QT ratio was calculated using these measurements. Results: Pmax were 93.0 +/- 9.1, 93.9 +/- 8.9, 97.9 +/- 5.6, 99.0 +/- 6.1 in nonpregnant women, first, second, third trimesters of pregnancy, respectively (P = 0.001); whereas Pmin values were not significantly different. QTc-Fr max were 407.4 +/- 14.2, 408.5 +/- 16.1, 410.1 +/- 13.1, 415.1 +/- 10.1 (P = 0.007); Tp-e were 72.7 +/- 6.2, 73.2 +/- 6.5, 77.2 +/- 8.9, 87.2 +/- 9.6 (P < 0.001); and Tp-e/QT were 0.17 (0.14-0.20), 0.17 (0.14-0.20), 0.18 (0.15-0.23), 0.20 (0.16-0.25) in nonpregnant women, first, second, and third trimesters of pregnancy respectively (P < 0.001). None of the participants experienced any arrhythmic event. Conclusions: P-wave duration is prolonged in the second trimester, and resumes a plateau thereafter. Maximum QTc interval, Tp-e interval and Tp-e/QT ratio are increased in the late pregnancy. Although these indices are altered during the course of pregnancy, they all remain in the normal ranges

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)