Long-term prognosis of patients with heart failure: Follow-up results of journey HF-TR study population

Background: Despite advances in therapeutic management of patients with heart failure, there is still an increasing morbidity and mortality all over the world. In this study, we aimed to present the 3-year follow-up outcomes of patients included in the Journey HF-TR study in 2016 that has evaluated the clinical characteristics and management of patients with acute heart failure admitted to the hospital and present a national registry data. Methods: The study was designed retrospectively between November 2016 and December 2019. Patient data included in the previously published Journey HF-TR study were used. Among 1606 patients, 1484 patients were included due to dropout of 122 patients due to inhospital death and due to exclusion of 173 due to incomplete data. The study included 1311 patients. Age, gender, concomitant chronic conditions, precipitating factors, New York Heart Association, and left ventricular ejection fraction factors were adjusted in the Cox regression analysis. Results: During the 3-year follow-up period, the ratio of hospitalization and mortality was 70.5% and 52.1%, respectively. Common causes of mortality were acute decompensation of heart failure and acute coronary syndrome. Angiotensin receptor blockers, beta-blockers, statin, and sacubitril/valsartan were found to reduce mortality. Hospitalization due to acute decompensated heart failure, acute coronary syndrome, lung diseases, oncological diseases, and cerebrovascular diseases was associated with the increased risk of mortality. Implantation of cardiac devices also reduced the mortality. Conclusions: Despite advances in therapeutic management of patients with heart failure, our study demonstrated that the long-term mortality still is high. Much more efforts are needed to improve the inhospital and long-term survival of patients with chronic heart failure

Relationship between plasma apelin level and coronary collateral circulation

Amaç: Koroner kollateral varlığı ya da yokluğu akut iskemi sırasında hayati önem taşımaktadır. Anjiyogenez koroner kollateral oluşumunda önemli bir rol oynamaktadır. Apelinin potent bir anjiyogenik faktör olduğu çalışmalarda gösterilmiştir. Ancak literatürde koroner kollateral gelişimi ile ilişkisine dair herhangi bir veri bulunmamaktadır. Biz bu çalışmada, koroner arter hastalığı olan hastalarda plazma apelin düzeyi ile koroner kollateral dolaşımı arasındaki ilişkiyi incelemeyi amaçladık. Yöntem: Çalışmamıza koroner anjiyografi yapılıp koroner arterlerin proksimal veya orta segmentinde %90 tıkanıklık saptanan toplam 132 (34 kadın, 98 erkek; ort. yaş: 63.5 ± 10.3 yıl) hasta alındı. Kollateral gelişimi Rentrop-Cohen sınıflamasına göre yapıldı. 2 veya 3. derece kollaterali olanlar iyi kollateral grubunu (64 hasta), 0 veya 1. derece kollaterali olanlar da kötü kollateral grubunu (68 hasta) oluşturdu. Bulgular: İyi kollateral grubunda plazma apelin düzeyi istatistiksel olarak anlamlı dercede yüksekti (0.69±0.2 ng/dl karşı 0.59±0.2 ng/dl, p<0.001). Serum nitrik oksit (NO) düzeyi ise iki grupta benzerdi (10.3±11.0 uM karşı 10.2±9.6 uM, p=0,893). İyi kollateral grubunda iki ay veya daha uzun süreli kararlı angina pektoris öyküsü olanlarda fark istatistiksel olarak anlamlıyken (%79.7 karşı %45.6 p<0.001) sigara için istatistiksel anlamlılığa ulaşmadı (%46.2 ile %29.1 p=0.069). Çok değişkenli lojistik regresyon analizinde kararlı angina pektoris varlığı (OR 4.072; CI %95 1.178-14.070; p=0.026), sigara içme (OR 4.442; CI %95 1.114-17.709; p=0,035) ve yüksek apelin düzeyinin (OR 5.582; CI %95 1.517-20.545; p=0,01) iyi kollateral arter gelişiminin bağımsız öngörücüleri olduğunu saptadık. Sonuç: Çalışmamız bildiğimiz kadarıyla yüksek plazma apelin düzeyinin iyi koroner kollateral gelişimi ile ilişkili olduğunu gösteren ilk çalışmadır. Apelinin kollateral gelişimi üzerindeki olumlu etkisini göstermemiz gelecekte koroner kollateral gelişimini artıran antiiskemik ve prognostik tedavi stratejileri içinde apelinin de yer almasını sağlayabilir.Objective: The presence or absence of coronary collaterals is of vital importance during acute ischemia. Angiogenesis play an important role in coronary collateral vessel formation. In previous studies it is shown that apelin is a potential angiogenetic factor. But in these studies there is no data about apelin and coronary collateral circulation relationship. In our study our aim is to investigate the relationship between plasma apelin level and coronary collateral circulation in patients with coronary artery disease. Methods: One hundred and thirty two patients with stable angina pectoris who were performed coronary angiography and in which more than %90 obstruction detected in the proximal or medial segments of coronary arteries are included to our study (34 females, 98 men; average age: 63,5 ± 10,3 years). Coronary collateral degree was graded according to the Rentrop-Cohen classification. Patients with grade 2 or 3 collateral degree were included in the good collateral group (64 patients) and and the patients with grade 0 or 1 collateral degree were included in the poor collateral group (68 patients). Results: The plasma apelin level was significantly higher in the good collateral group (0.69±0.2 ng/dl vs 0.59±0.2 ng/dl, p<0.001). The serum nitric oxide (NO) level were similar between two groups (10.3±11.0 uM vs 10.2±9.6 uM, p=0,893). Patients who have extended stabile angina pectoris for 2 months or longer and current smoking were higher in the good collateral group. This finding was statistically significant for stabile angina pectoris (%79.7 vs %45.6 p<0.001), but not for current smoking (%46.2 vs %29.1 p=0.069). In multivariate analysis stabile angina pectoris (OR 4.072; CI %95 1.178-14.070; p=0.026), smoking (OR 4.442; CI %95 1.114-17.709; p=0,035) and plasma apelin level (OR 5.582; CI %95 1.517-20.545; p=0,01) were independent predictors of well-developed coronary collaterals. Conclusions: To best of our knowledge our study is the first investigation that shows higher plasma apelin level is related to better coronary collateral development. Demonstration of favorable affects of apelin on good collateral development may lead to include apeline in the antiischemic and prognostic treatment strategies which increases collateral development

Increased serum YKL-40 level is associated with the presence and severity of metabolic syndrome.

Metabolic syndrome (MS) is defined by a cluster of interdependent physiological, biochemical, and clinical risk factors and linked to a state of chronic inflammation. YKL-40 is known as an inflammatory glycoprotein, which is secreted by various cell lines during inflammation. Thus, we aimed to assess the association of serum YKL-40 levels with the presence and severity of MS

[Association of red blood cell distribution width with presence and severity of rheumatic mitral valve stenosis].

As an indicator of variability in circulating erythrocyte size, red cell distribution width (RDW) is linked to chronic inflammation. The association of rheumatic heart valve stenosis and inflammation is also well-known. This study aimed to assess the relationship between RDW and presence and severity of rheumatic mitral valve stenosis (RMVS)