Fragmented QRS predicted major adverse cardiovascular events in patients with coronary artery disease and percutaneous coronary intervention, 10-years of follow-up

Aim Identifying high-risk groups in patient with coronary artery disease (CAD) is critical for predicting future adverse events. fQRS has been shown to be related to major cardiovascular adverse events (MACE) in patients with CAD. However, predictive value of fQRS for more than 5 yrs has not been evaluated. This study examined the predictive value of fQRS in patients with CAD and percutaneous coronary intervention during a 10-yrs period. Material and methods Patients with CAD and percutaneous coronary intervention between March 2007 and May 2009 were included the study. An electrocardiogram was recorded following percutaneous coronary intervention and analyzed for the presence of fQRS. The fQRS pattern was defined as an additional spike inside the QRS complexes of at least two consecutive leads. Patients were followed for 10 yrs. A MACE was all-cause mortality or new-onset decompensated heart failure. Patients were divided into two groups according to presence or absence of MACE, and their clinical variables were compared. Results Of 1261 patients included in the study, MACE developed in 374 (29.6%). MACE (+) patients were older (p<0.001), more likely to have diabetes mellitus (p=0.003), fQRS (p<0.001), and ST-elevated myocardial infarction (STEMI) (p<0.001). Multivariable Cox regression analysis revealed that age (p<0.001), STEMI (p=0.001), fQRS (p=0.017), and elevated serum creatinine (p=0.001) were independent predictors of MACE. Conclusion The presence of fQRS predicted MACE during 10 yrs of follow-up of patients with CAD and percutaneous coronary intervention

Sol anterior fasiküler bloğun stabil anginalı hastalarda sol ana ve/veya proksimal sol ön inen koroner arter hastalığının belirlenmesinde öngördürücü değerinin araştırılması: bir eğilim skoru eşleştirme analizi

Introduction: Successful revascularization of lesions located in the left main and/or proximal left anterior descending (LM and/or pLAD) coronary artery improves survival than medical therapy only. Therefore, accurate identification of high-risk patients with suspected stable angina pectoris is critical for outpatient clinics. Since the septal perforators of the left anterior descending coronary artery are the main source of blood supply of the left anterior fascicle, we hypothesized that the presence of left anterior fascicular block (LAFB) can predict obstructive stenoses of LM and/or pLAD coronary arteries in patients with suspected stable angina pectoris. Methods: We consecutively enrolled 790 patients referred for invasive coronary angiography due to suspected stable angina pectoris. Results: The number of patients with LAFB5 was 68 (8.6%). Furthermore, 218 patients (27.6%) had obstructive coronary artery disease (CAD). The prevalence of obstructive CAD, revascularization with coronary artery bypass graft surgery, and obstructive LM and/or pLAD coronary artery lesions was higher in patients with LAFB. From univariate analysis, the presence of LAFB was significantly associated with predicting obstructive LM and/or pLAD lesions (odds ratio: 3,587; 95% confidence interval: 1,465-5,785; p=0.005). However, this association disappeared after adjustment for other cardiovascular risk factors. Conclusion: In patients with suspected stable angina pectoris, LAFB is not frequently a 'normal variant" and is associated with known cardiovascular risk factors. It acts as a marker rather than a determinant of obstructive LM and/or pLAD coronary artery lesions

Lipid profile, atherogenic indices, and their relationship with SYNTAX score in patients with Non-ST-segment elevation Myocardial infarction

Amaç: Birçok çalışmada lipoproteinle ilişkili indeksler ile aterojenik süreç arasındaki ilişki gösterilmiştir. Ancak lipoprotein indekslerinin SYNTAX skoru ile ifade edilen koroner arter hastalığı yaygınlığı ve ciddiyeti ile ilişkisi ST segment yükselmesiz miyokard enfarktüsü has‐ talarında henüz ortaya konmamıştır. Bu çalışmada ST segment yükselmesiz miyokard enfarktüsü hastalarında aterojenik indeksler ile SYNTAX skoru arasındaki ilişkiyi araştırmayı ve sonuçları geleneksel lipit parametreleriyle karşılaştırmayı amaçladık. Gereç ve Yöntem: Toplam 451 ardışık ST segment yükselmesiz miyokard enfarktüsü hastası (64±11 yıl; %72,9 erkek, n=329) analiz edil‐ di. Sosyodemografik veriler ve geleneksel lipit parametreleri kaydedildi. Hastalar düşük SYNTAX skoru ( ≤22, n=370) ve orta veya yüksek SYNTAX skoru (>22, n=81) olmak üzere iki gruba ayrıldı. Bulgular: İstatiksel anlamlı ve bağımsız prediktörleri saptamak için lojistik regresyon analizleri kullanıldı. Tek değişkenli lojistik regres‐ yonda yaş, diabetes mellitus, hipertansiyon, azalmış sol ventrikül ejeksiyon fraksiyonu, C‐reaktif protein, yüksek yoğunluklu lipoprotein kolesterol, trigliserit, non‐yüksek yoğunluklu lipoprotein kolesterol/yüksek yoğunluklu lipoprotein kolesterol oranı, düşük yoğunluklu li‐ poprotein kolesterol/yüksek yoğunluklu lipoprotein kolesterol oranı, total kolesterol/yüksek yoğunluklu lipoprotein kolesterol oranı ve plazmanın aterojenik indeksi (log[trigliserit/HDL‐K]) parametrelerinin istatiksel anlamlı prediktörler olduğu görüldü. Tek yönlü analizde anlamlı bulunan tüm aterojenik indeksler arasında sadece plazmanın aterojenik indeksi bağımsız olarak orta veya yüksek SYNTAX sko‐ ru ile ilişkili idi (olasılık oranı= 1.471, %95 güven aralığı=1.167‐1.854, p=0.001). Orta veya yüksek SYNTAX skorunu tahmin etmek için op‐ timal plazmanın aterojenik indeksinin kesme değeri %81,5 duyarlılık ve %40,7 özgüllük ile 0,44 idi. Sonuç: Bu çalışmamızda lipoprotein oranlarının koroner arter kompleksitesini geleneksel lipit parametrelerinden daha iyi öngördüğünü saptadık. Bağımsız bir prediktör olarak plazmanın aterojenik indeks değeri, NSTEMI hastalarında orta ve yüksek SYNTAX skorunu tah‐ min etmek için kullanılabilecek basit bir belirteçtir.Objective: Many previous studies have demonstrated the relationship between lipoprotein‐related indices and the atherogenic process. However, their association with the coronary artery disease complexity expressed by the SYNTAX score has not been demonstrated in non‐ST segment elevation myocardial infarction patients. In this study, we aimed to investigate the relationship between atherogenic indices and SYNTAX score in patients with non‐ST segment elevation myocardial infarction and to compare the results with conventional lipid parameters. Material and Method: A total of 451 consecutive non‐ST segment elevation myocardial infarction patients (64±11 years; 72.9% male, n=329) analyzed for the study. Sociodemographic data and the traditional lipid parameters were recorded. Patients were divided into two groups; low SYNTAX score (≤22, n=370) and intermediate or high SYNTAX score (>22, n=81). Results: Logistic regression analyses were used to detect significant and independent predictors. Univariable logistic regression demon‐ strated significant predictors including age, diabetes mellitus, hypertension, left ventricular ejection fraction, C‐reactive protein, high density lipoprotein‐cholesterol, triglyceride, non‐high density lipoprotein‐cholesterol/high density lipoprotein‐cholesterol ratio, low den‐ sity lipoprotein‐cholesterol/high density lipoprotein‐cholesterol ratio, total cholesterol/high density lipoprotein‐cholesterol ratio and atherogenic index of plasma (log[triglyceride/high density lipoprotein‐cholesterol]). After adjustment with significant covariates, only AIP remained independently associated with intermediate or high SYNTAX scoreamong all atherogenic indices (odds ratio=1.471; 95% confidence interval=1.167‐1.854; p=0.001). The best cut‐off value of atherogenic index of plasma for predicting intermediate or high SYNTAX score was 0.44 with a sensitivity of 81.5% and specificity of 40.7%. Conclusion: The results of our article suggest that lipoprotein ratios predict coronary artery complexity better than conventional lipid parameters. As an independent predictor, the AIP value could be a useful parameter to predict severe coronary artery disease in pa‐ tients with on‐ST segment elevation myocardial infarction

Left atrial dimension to left ventricle ejection fraction ratio can predict longterm major adverse events ın patients with acute coronary syndrome

Background: It is critical to specify the high-risk group in acute coronary syndrome following percutaneous coronary intervention. Left atrial diameter and Left ventricle ejection fraction are functional echocardiographic parameters for risk classification thanks to easy obtainable, cheap, and non-invasive nature. However, major adverse cardiovascular events may be predicted less than actual where ejection fraction or left atrial diameter are in the normal range. We aimed to assess the left atrial diameter to ejection fraction ratio for major adverse cardiovascular events prediction in acute coronary syndrome. Materials and Methods: Individuals with acute coronary syndrome were included in the study. Atrial diameter and ejection fraction parameters were obtained at admission. The left atrial diameter to left ventricular ejection fraction ratio was calculated through atrial diameter dividing by ejection fraction, and the relationship between new-onset heart failure and all-cause mortality with this ratio was investigated for two years period. Results: The mean age of total 262 patients were 62.1±11.5 years. Thirty-nine (18.9 %) of patients were female and major adverse cardiovascular events occurred in 73 (28%) of the patients. In the backward multivariable Cox regression analysis, age [Hazard ratio (HR)=1.039, 95%CI:1.017-1.060, p<0.001], Killip class [HR=2.099, 95%CI:1.011-4.365, p=0.045], serum creatinine level [HR=2.202, 95%CI:1.247-3.811, p=0.003], and left atrial diameter to left ventricular ejection fraction ratio [HR=1.029, 95%CI:1.019-1.038, p<0.001] were revealed to be independent predictors of major adverse events. Conclusion: Left atrial diameter to left ventricular ejection fraction ratio were predictors of two years new-onset heart failure and mortality in acute coronary syndrome. This novel practical index may provide better prediction for adverse events in all patient groups.Amaç: Akut koroner sendromlu hastalarda perkütan koroner girişim sonrası yüksek riskli grupların belirlenmesi oldukça önemlidir. Sol ventrikül ejeksiyon fraksiyonu ve sol atrium çapı, kolay elde edilebilebilir, ucuz ve invaziv olmaması nedeniyle risk sınıflandırması için fonksiyonel ekokardiyografik parametrelerdir. Bununla birlikte, majör istenmeyen kardiyovasküler olaylar, ejeksiyon fraksiyonu veya atrium çapının normal aralıkta olduğu durumlarda gerçek olandan daha az tahmin edilebilir. Bu nedenle akut koroner sendrom hastalarında majör istenmeyen olay öngörüsü için sol atrium çapının sol ventrikül ejeksiyon fraksiyonuna oranının değerlendirilmesini amaçladık. Materyal ve Metod: Çalışmaya akut koroner sendrom tanısı almış hastalar dahil edildi. Tüm hastalardan sol ventrikül ejeksiyon fraksiyonu ve sol atrium çapları parametreleri başvuru sırasında elde edildi. Sol atrial çapın sol ventrikül ejeksiyon fraksiyonuna oranı, sol atriyal çapın ejeksiyon fraksiyonuna bölünmesi ile hesaplandı ve 2 yıllık takiplerde tüm nedenlere bağlı ölüm ve yeni başlayan kalp yetmezliği ile olan ilişkisi incelendi. Bulgular: Toplam 262 hastanın ortalama yaşı 62.1±11.5 yıldı. Hastaların 39'u (%18.9) kadındı ve major istenmeyen kardiyovasküler olay 73 (%28) hastada meydana geldi. Geriye dönük çok değişkenli Cox regresyon analizinde, yaş [Hazard ratio (HR)=1.039, 95%CI:1.017-1.060, p<0.001], Killip sınıfı [HR=2.099, 95%CI:1.011-4.365, p=0.045], serum kreatinin düzeyi [HR=2.202, 95%CI:1.247-3.811, p=0.003], ve sol atrial çapın sol ventrikül ejeksiyon fraksiyonuna oranı [HR=1.029, 95%CI:1.019-1.038, p<0.001] major istenmeyen olayların bağımsız prediktörleri olarak bulundu. Sonuç: Sol atrial çapın sol ventrikül ejeksiyon fraksiyonuna oranı, akut koroner sendrom hastalarında 2 yıllık yeni tanı kalp yetmezliği ve ölümün bağımsız prediktörleriydi. Bu yeni pratik index istenmeyen olayların öngörülmesi için tüm hasta gruplarında daha fazla öngörü sağlayabili

Total serum protein predicted mortality in patients with st-elevation myocardial ınfarction who underwent primary percutaneous coronary ıntervention: Results of 8-year follow-up

Objectives: ST-elevation myocardial infarction (STEMI) is globally one of the leading causes of mortality. Determining modifiable mortality predictors to improve outcomes is critical. Total serum protein (TSP) is a composite indicator of immunity, nutrition, and inflammation and it plays a vital role in biological pathways contributing to cardiovascular diseases. TSP level has not been evaluated in patients with STEMI in the prediction of mortality previously. Materials and Methods: The patients diagnosed with STEMI between March 2007 and May 2009 were included in the study. TSP was obtained at admission to the hospital. Follow-up period of the study was 8 years and primary endpoint was all-cause mortality. Participants were separated according to the presence of mortality and clinical parameters compared between these two groups. Results: The mean age of the total 99 patients was 61±12.4 years and 82 (82.8%) of them were male. While left ventricular ejection fraction (LVEF) (p=0.001), serum albumin (p=0.014), and TSP (p<0.001) were lower, serum creatinine was higher (p=0.003) in the mortality group. Diabetes mellitus (p=0.007), increased age (p=0.027), LVEF (p=0.006), serum creatinine level (p=0.023), and TSP (hazard ratio: 0.159, 95% confidence interval: 0.062-0.408, p<0.001) predicted mortality independently. Conclusion: TSP level predicted all-cause mortality independently in STEMI patients who underwent primary percutaneous coronary intervention during 8-year follow-u

Relation of apolipoprotein E gene polymorphism with the severity of coronary artery disease in patients with stable ischemic heart diseas

Aim: Atherosclerosis begins from an early age and manifests in later years as Coronary artery disease (CAD). This inflammatory process is aggravated by age, smoking, hypercholesterolemia, hypertension, diabetes mellitus, and genetic factors. We aimed to investigate which isoform of APOE is related to extensive coronary lesions in patients with stable coronary heart disease. Materials and Methods: This study was carried on single center. One hundred and ten patients diagnosed with stable coronary artery disease by coronary angiogram were enrolled consecutively. Syntax score was calculated by a tool of website calculator (www. syntax.com). According to the Syntax score, patients were split into three groups. APOE genotyping was performed through blood samples. Patients split into three groups according to the APOE genotypes: E4 (3/4 and 4/4 genotypes), E3(3/3 genotype), E2 (2/2 and 2/3 genotypes). APOE groups were compared according to baseline characteristics and syntax scores. (%82.6) değil (82.6%) olacak. Lütfen İngilizce kurala göre düzeltiniz. Tüm sayısal değerlerde virgülleri de nokta yapmayı unutmayınız. Results: Coronary angiography and APOE genotypes of 98 patients were analyzed. 81 of patients (%82.6) had E3E3 allele; 6 of patients (%6.1) had E2E3 allele; 10 patients (%10.2) had E3E4 allele and 1 patient (%1) had E2E4 allele. Due to the contrast effect of E2 and E4 on CAD, we excluded patients with E2E4 allele from the study. Firstly, we assessed distribution of APOE genotype E2 (E2E3), E3 (E3E3 and E3E4), E4 (E3E4) within 3 groups of syntax scores. Total of 6 patients of E2 allele was at low syntax score group. 83 patients of E3 allele were at the low-risk group of syntax score. 10 patients of E3 allele were at the mid group and 4 patients were at the high-risk group of syntax score. 7 patients of E4 allele subjects were at the low-risk and 1 patient was at the high-risk group of syntax score. Compared to syntax score groups and APOE genotypes, E2 alleles were in lower syntax score group versus E3 (P=0.046) and E4 (P=0.003) alleles. However E4 alleles were in higher syntax score group versus E3 alleles (P= 0.034). The Syntax score was seemed to be lower in the E2 allele group versus E4 and E2 groups (P=0.013). Conclusion: we reported the first study that E2 allele was related with less and E4 allele was more extensity and severity of CAD in patients with stable ischemic coronary diseas

Late onset, hospital acquired infective endocarditis after COVID-19

Scientists worked on the diagnosis and treatment of coronavirus disease-2019 (COVID-19) in the beginning of the pandemic, which started in December 2019. However, as time goes by, we began to face the long-term complications of COVID-19. Arrhythmias, myocarditis, myocardial infarction, thromboembolic events are cardiovascular complications that we frequently encounter. Severe acute respiratory syndrome-coronavirus-2; attaches to the angiotensin-converting enzyme 2 receptor to enter the cell, which is overexpressed in pericytes. This binding causes endothelial activation and inflammation. Inflamed endothelium becomes susceptible to attachment of microorganisms, particularly staphylococci, and may lead infection of endocardium and so infective endocarditis. There are cases of infective endocarditis described in the literature, that occur early or late after suffering from COVID-19. In this study, we mentioned about a case diagnosed as healthcare-associated infective endocarditis. The patient had a history of COVID-19 and hospitalization due to late complications and developed infective endocarditis after 10 days of discharge

Serum fibrinopeptide A is increased in patients with acute coronary syndrome

OBJECTIVE: Acute coronary syndrome (ACS) is one of the leading causes of mortality, globally. Atherosclerosis is an under-lying factor in ACS process and coagulative cascade is activated secondary to atherosclerotic plaque rupture. Fibrinopeptide A (FPA) takes an active role in thrombus formation and is an indicator of coagulative process. We aimed to evaluate serum FPA level in patients with ACS.METHODS: Patients diagnosed with ACS and chronic coronary syndrome (CCS), with non-obstructive coronary artery dis-ease as a control group, were included in the study. Blood samples and demographic data of all patients were obtained at admission. Obtained data were compared between ACS and control groups.RESULTS: The study consisted of 107 patients with ACS and 69 patients with CCS. ACS group was older (p3.38 ng/mL predicted ACS with 89.7% sensitivity and 78% specificity (AUC: 0.825, 95% CI 0.745-0.905; p<0.001).CONCLUSION: Serum FPA may be used for the differential diagnosis of ACS. In addition, patients with increased FPA may be considered to be given more aggressive antithrombotic medication

Is PRECISE-DAPT score an independent predictor of long-term cardiovascular Mortality in patients with acute coronary syndrome?

Amaç: Stent yerleştirilmesi ve ardından ikili antitrombosit tedavi uygulanan hastalarda kanama komplikasyonlarının önceden belirlen mesi (PRECISE DAPT) skorunun kanama riskini tahmin etmesinin ötesinde diğer klinik alanlarda da faydası gösterilmiştir. Akut ko roner sendrom hastalarında çeşitli kısa ve uzun dönem prognostik faktörler bildirilmiştir. Bu çalışmada hastaneden taburcu olan akut koroner sendromlu hastalarda PRECİSE DAPT skorunun uzun dönem kardiyovasküler mortalite üzerindeki etkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: Ocak 2017 ve Ocak 2022 arasında kardiyoloji kliniğine başvuran akut koroner sendrom tanısı ile hastaneye yatırılıp, taburcu edilen 278 ardışık hasta çalışmaya dahil edildi. PRECISE DAPT skoru her hasta için hesaplandı. Bulgular: Çalışmaya 228 (%83,2) erkek, 50 (%18,2) kadın hasta dahil edildi. Hastalar kardiyovasküler mortalite gelişen (n=44, %15,8) ve gelişmeyen (n=234, %84.1) olarak iki gruba ayrıldı. PRECISE DAPT skoru>11,5 olan grupta daha ilk aylardan itibaren (Long Rank, Ki Kare= 20,1, p<0,001) kardiyovasküler mortalitenin artış gösterdiği belirlendi. Sonuç: PRECISE DAPT skoru hastaneden taburcu olan akut koroner sendromlu hastalarda uzun dönem kardiyovasküler mortalitenin ba ğımsız öngördürücüsüdür

Serum uric acid level independently predicted metabolic syndrome in non-diabetic hypertensive patients

Background: Arterial hypertension may accompany metabolic syndrome (MetS) which is strongly associated with cardiovascular diseases. Determining high-risk groups concerning MetS development is crucial to prevent this undesirable clinic. Serum uric acid level was demonstrated to be associated with development of hypertension and MetS in normal population. It was aimed to investigate the role of serum uric acid for the prediction of MetS in non-diabetic hypertensive individuals. Material and methods: Patients who were diagnosed with arterial hypertension between January 2021 and June 2021 were included in the study. Diabetes mellitus was determined as an exclusion criteria. Metabolic syndrome was considered as the clustering of high blood pressure, elevated glucose level, abnormal cholesterol levels, and abdominal obesity conditions according to the National Cholesterol Education Program (NCEP) definition. Patients were divided into two groups by the presence of MetS. Results: The mean age of 107 non-diabetic hypertensive patients was 48.5 ± 8.6 years and 50 (46.7%) of them were female. A total of 56 patients (52%) had MetS. Waist circumference (101.2 ± 11.3 vs. 106.7 ± 10.1 cm, p = 0.020), body mass index (30.6 ± 4.9 vs. 32.8 ± 4.1, p = 0.016), E/e’ ratio [9.2 (7.3–11.1) vs. 10.6 (9.1–13.4), p = 0.003], EAT [5.9 (4.8–8) vs. 7.9 (6–9.6), p = 0.006], and serum uric acid level (4.75 ± 1.10 vs. 5.82 ± 1.21 mg/dL, p &lt; 0.001) were higher in MetS (+) group. Multivariable regression demonstrated that serum uric acid [(odds ratio) OR = 2.217, 95% confidence interval (CI): 1.300–3.783, p = 0.003] and body mass index (OR = 1.214, 95% CI: 1.032–1.428, p = 0.019) were independent predictors of MetS presence. Conclusion: Serum uric acid level predicted MetS presence in non-diabetic hypertensive individuals independently. This practical blood parameter can be used to evaluate those who are at risk of MetS development.