Myocardial injury in COVID-19 patients is associated with the thickness of epicardial adipose tissue

Aim High sensitive troponin (hs-TnI) levels may increase secondary to Coronavirus disease-2019 (COVID-19), and this increase is associated with cardiovascular mortality in COVID-19 patients. Epicardial adipose tissue (EAT) is associated with myocardial injury directly as a reservoir tissue for coronavirus, and indirectly through mediators it secretes as an apocrine gland. We aimed to evaluate the relationship between myocardial injury secondary to COVID-19 infection and EAT thickness. Material and methods Thoracic computed tomography (CT) was performed in 73 consecutive patients diagnosed with COVID-19. EAT thickness and volume were calculated by two radiologists blind to the study data. We formed two groups according to hs-TnI concentrations, patients with myocardial damage (hs-TnI >= 11.6 ng/l) and without myocardial damage (hs-TnI<11.6 ng/dl). Results A total of 46 patients were women (63.0%). The mean age was 66.4 +/- 12.3 yrs in the myocardial injury group and 55.9 +/- 9.7 yrs in the group without myocardial injury (p<0.001). There were 20 hypertensive patients (68.9%) in the injury group, while there were 12 hypertensive patients (27.3%) in the group without injury (p=0.001). Glucose, C-reactive protein, D-dimer, white blood cell count, neutrophil, and neutrophil/lymphocyte ratio were higher in the injury group (p<0.05, for all variables). The mean EAT thickness was 5.6 +/- 1.6 mm in the injury group, whereas it was 4.8 +/- 1.8 mm in the group without injury (p=0.031). EAT thickness of 4.85 mm and above was associated with the myocardial injury with 65% sensitivity and 39% specificity (AUC=0.65, 95% CI: 0.52-078, p=0.031). Conclusion In patients with COVID-19 infection, higher rates of myocardial injury were observed as the EAT thickness increased. Epicardial adipose tissue, contributes to cytokine-mediated myocardial injury either directly or indirectly by acting as a reservoir for coronavirus. Increased EAT thickness is associated with myocardial injury in COVID-19 patients

COVID-19 hastalarında mitral anüler kalsifikasyonun mortalite ve miyokard hasarı ile ilişkisi

Coronavirus disease-2019 (COVID-19) can particularly affect the respiratory and cardiovascular systems and cause serious mortality. Mitral annular calcification (MAC) is a mitral valve pathology associated with cardiac mortality. We aimed to evaluate the effect of MAC on myocardial injury (MI) and mortality, which can develop secondary to COVID-19 infection. Materials and Methods After applying the exclusion criteria, thorax computed tomography (CT) images of the remaining 1151 consecutive COVID-19 patients were evaluated. Calculation of MAC scores was done by two expert radiologists blinded to the study data. MI was defined as those with hs-TnI level (≥34 ng/dl). Patients included in the study were classified as having mortality and not occurring. Results Male gender, advanced age (>65), hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease (CKD), coronary artery disease, heart failure and atrial fibrillation rates were statistically higher in the mortality group (p<0.05). The presence of MAC was 34.1% in the mortality group, while it was 16% in the survival group (p<0.001). MI was observed 49.3% in the mortality group, while it was 16.2% in the survival group (p<0.001). Presence of MAC was associated with MI (14.8% vs 38.7%, p<0.001). Age (OR=1.976, 95% CI 1.166-3.346, p=0.011), male gender (OR=1.784, 95% CI 1.101-2.892, p=0.019), CKD (OR=2.293, 95% CI 1.085-4.485, p=0.030), MI (OR=2.893, 95% CI 1.735-4.823, p<0.001) and advanced lung involvement on CT (OR=2.231, 95% CI 1.084-4.594, p=0.029) were the independent predictors of mortality Conclusion In terms of MI and mortality risk in COVID-19 patients, it may be recommended to evaluate MAC from the CT images.Koronavirüs hastalığı-2019 (COVID-19) özellikle solunum ve kardiyovasküler sistemleri etkileyerek mortaliteye ve ciddi morbiditelere neden olabilir. Mitral halka şeklindeki kalsifikasyon (MAC), kardiyak mortalite ile ilişkili bir mitral kapak patolojisidir. Bu çalışmada, MAC’ın COVID-19 enfeksiyonuna sekonder gelişebilen miyokard hasarı (MI) ve mortalite üzerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemle Dışlama kriterleri uygulandıktan sonra geriye kalan 1151 ardışık COVID-19 hastasının toraks bilgisayarlı tomografi (BT) görüntüleri değerlendirildi. MAC puanlarının hesaplanması, çalışma verilerine kör olan iki uzman radyolog tarafından yapıldı. MI, hs-TnI düzeyi (≥34 ng/dl) olanlar olarak tanımlandı. Çalışmaya dahil edilen hastalar mortalitesi olan ve olmayan olarak sınıflandırıldı. Bulgular Mortalite grubunda erkek cinsiyet, ileri yaş (>65), hipertansiyon, diabetes mellitus, kronik obstrüktif akciğer hastalığı, kronik böbrek hastalığı (KKD), koroner arter hastalığı, kalp yetmezliği ve atriyal fibrilasyon oranları istatistiksel olarak daha yüksekti (p<0.05). Mortalite grubunda MAC varlığı %34.1, sağkalım grubunda ise %16 idi (p<0.001). Miyokardiyal hasar mortalite grubunda %49.3, sağkalım grubunda ise %16.2 olarak saptandı (p<0.001). MAC varlığı MI ile ilişkiliydi (%14.8’e karşılık %38.7, p<0.001).Yaş (OR=1.976, 95% CI 1.166-3.346, p=0.011), erkek cinsiyet (OR=1.784, 95% CI 1.101-2.892, p=0.019), kronik böbrek yetersizliği (OR=2.293, 95% CI 1.085-4.485, p=0.030), MI (OR=2.893, 95% CI 1.735-4.823, p<0.001) ve küçük hücreli akciğer tutulumu (OR=2.231, 95% CI 1.084-4.594, p=0.029) mortalitenin bağımsız belirleyicileri idi. Sonuç COVID-19 hastalarında MI ve mortalite riski açısından BT görüntülerinden MAC değerlendirilmesi önerilebilir

Epicardial fat thickness is associated with retinopathy in patients with newly diagnosed hypertension

OBJECTIVE: Hypertensive retinopathy develops based on endothelial dysfunction, inflammation, and atherosclerosis. Epicardial fat secretes various cytokines associated with endothelial dysfunction, oxidative stress, inflammation, and atherosclerosis. We aimed to evaluate whether epicardial adipose tissue (EAT) thickness is a marker for retinopathy in newly diagnosed hypertensive patients. METHODS: A total of 73 newly diagnosed hypertension (HT) patients were included in the study. Transthoracic echocardiography (TTE) was used to measure EAT thickness. To evaluate the presence of retinopathy in HT patients, hypertensive retinopathy staging was performed by ophthalmologists, according to Scheie classification. RESULTS: Retinopathy was detected in 27 (37.0%) of 73 patients. EAT thickness in HT patients with retinopathy was higher than the group without retinopathy (5.07 +/- 1.45 mm vs. 4.19 +/- 1.20 mm, p=0.007). Low-density lipoprotein cholesterol (LDL-C) levels in HT patients with retinopathy were higher than the group without retinopathy (162.4 +/- 41.2 mg/dl vs. 138.1 +/- 35.6 mg/dl, p=0.010). As a result of the regression analysis, LDL-C (OR=1.016, 95% CI 1.001-1.031, p=0.043) and EAT thickness (OR=1.674, 95% CI 1.069-2.626, p=0.043) were the independent predictors of retinopathy. CONCLUSION: Increased EAT thickness is associated with the presence of retinopathy in hypertensive patients

Effects of Inappropriate Acetylsalicylic Acid Use on Non-fatal Bleedings

Aim: This study aims to assess of using asetylsalicyclic acid (ASA) on non-fatal major and minor bleeding events in patients with inappropriate, primary and secondary prevention groups

The Effect of Anthracycline Chemotherapy on Arterial Stiffness

Objective Anthracycline-derived chemotherapy for cancer treatment may cause dose-dependent irreversible heart failure. Arterial stifness is a predictor of cardiovascular events. Weaimed to investigate the relationship between chemotherapy and arterial stiffness.Materialsand MethodsPatients diagnosed non-Hodgkin's lymphoma, agreed to recieve anthracycline chemotherapy, were included in the study. Arterial stiffness was evaluated with applanationtonometer before, first and sixth cycles of chemotherapy.Results There was a tendency to increase first and sixth cycles pulse wave velocity values before anthracycline chemotherapy [9.08 (8.12-9.76), 10.31 (8.22-12.62), 9.64 (8.22-12.62)m/s, p = 0.053] but those changes were not reach statistically significance. Augmentation index change did not significantly change between anthracycline chemotherapycycles (p = 0.810). There was also a tendency to decrease first and sixth cycle subendocardial viabilty ratio values before151.60 (122.20-188.70) and after 124.30 (94.50-154.10), p = 0.058 chemotherapy.Conclusion Anthracycline chemotherapy tends to impaire arterial stiffness parameters

Ciddi Koroner Arter Hastalığı Olmayan Akut Koroner Sendrom Hastalarında Mortalite Değerlendirmesi

Amaç: Bu çalışmada, akut koroner sendromla başvuran fakat ciddi koroner arter hastalığı olmayan hastalarda bir yıllık sağkalım ve iliş‐ kili faktörlerin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Akut koroner sendrom tanısıyla koroner anjiyografi yapılan 150 hasta retrospektif olarak değerlendirildi. Hastane ve‐ ri tabanından demografik veriler, kardiyak risk faktörleri ve anjiyografik veriler kaydedildi. Bir yıllık sağkalım ve bununla ilişkili faktörler incelendi. Bulgular: Hastaların ortalama yaşı 62±13 yıldı ve %57'si (n=86) erkekti. Hastaların çoğu kararsız angına (%62) tanısı ile başvurmuştu. Sadece 11 hasta (%7,3) ST‐segment yükselmeli miyokard enfarktüsü tanısıyla hastaneye yatırıldı. Bir yıllık takip süresi boyunca tüm ça‐ lışma grubununda %5,3 (n=8) hastada ölüm meydana geldi. Mortalite, koroner ektazi grubunda ve troponin seviyesi yüksek olan has‐ talarda diğer gruplara göre istatistiksel olarak anlamlıydı (p=0,035). Sonuç: Akut koroner sendromla başvuran fakat ciddi koroner arter hastalığı olmayan hastalarda bir yıllık sağkalım yüksek troponin se‐ viyeleri ve ektazi‐yavaş akım varlığı ile ilişkili bulundu. Bu hastaların risk faktörleri kontrol altında tutulmalı ve hastalar daha yakın ta‐ kip edilmelidir.Objjective: This study aims to evaluate one year survey and related factors of patients with acute coronary syndrome but without sig‐ nificant coronary artery disease. Material and Method: One hundred and fifty patients who had coronary angiography with the diagnosis of acute coronary syndrome were evaluated retrospectively. Demographic data, cardiac risk factors, and angiographic data were recorded from the hospital database. The one year survey and associated factors were examined. Results: The mean age of the patients was 62 ± 13 years and 57% (n=86) were male. Most of the patients were diagnosed with unsta‐ ble angına (62%). Only 11 patients (7.3%) hospitalized with the diagnosis of ST‐segment elevation myocardial infarction. The death oc‐ curred in 5.3% of the whole study group during one year follow‐up period (n=8). Mortality was statistically significant in the coronary ectasia group and patients with high troponin levels when compared to other groups (p=0.035). Conclusion: One‐year survival in patients presenting with acute coronary syndrome but without severe coronary artery disease was found to be associated with high Troponin levels and the presence of ectasia‐slow flow. The risk factors of these patients should be kept under control and patients should be followed up more close