Epicardial adipose tissue thickness and systemic sclerosis

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Purpose: Microvasculopathy and endothelial damage are prominent features of systemic sclerosis (SSc) and increases risk of cardiovascular disease. Epicardial adipose tissue (EAT) is localized beneath the visceral pericardium and has been shown to be closely related with coronary artery disease (CAD). The goal of this study was to investigate the thickness of EAT in SSc patients who had no previous or current history of cardiac involvement. Methods: Thirty patients with SSc and 30 healthy controls (HC) were included to the study. Measurement of EAT was evaluated using echocardiography and Doppler imaging technique. Results: EAT thickness was significantly higher in SSc group compared to HC (6.2±0.9 mm vs. 5.3±0.6 mm, p=0.01) and it was correlated with disease severity score (r=0.45, p=0.01) in SSc patients.\nConclusion: This is the first study, displaying a significantly higher EAT thickness in patients with SSc. We believe that further studies are needed to clarify the role of adipose tissue in patients with SSc

The effect of RAAS inhibitors on acute hypoxemic respiratory failure and in-hospital mortality in the hypertensive Covid-19 patients

Introduction We have aimed to investigate the relationship between use of angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin-receptor-blocker (ARB) drugs and acute hypoxemic respiratory failure (AHRF) and in-hospital mortality in hypertensive Covid-19 patients. Material and method Consecutive 1345 patients diagnosed with Covid-19 between April and October 2020 who met inclusion criteria were divided into two groups based on presence and absence of AHRF and mortality. The groups were compared regarding epidemiological, clinical, radiological, laboratory findings and treatments methods. The patient groups ACEI, ARB and other antihypertensive drugs (non-ACEI/ARB) were compared regarding same parameters. Results Median age was 68 (60–76) years in the patient group including 805 (59.9.1%) females. Of the patients, 475 (35.3%), 644 (47.9%) and 226 (16.8%) were using ACEIs, ARBs and non-ACEI/ARB, respectively. AHRF and in-hospital mortality developed in 1053 (78.3%) and 290 (21.6%) patients, respectively. Age, gender, coronary artery disease, diabetes mellitus (DM), neutrophil, lymphocyte, creatinine, D-dimer, C-reactive protein (CRP), ACEI, beta blocker and aspartate transaminase (AST) found statistically significant in the univariable logistic regression performed to identify independent predictors of mortality were included multivariable logistic regression model. Age (OR: 1.066, 95%CI: 1.049–1.083; p < .001), DM (OR: 1.682, 95%CI: 1.238–2.286; p = .001), neutrophil (OR: 1.041, 95%CI: 1.007–1.077; p = .019), creatinine (OR: 1.178, 95%CI: 1.048–1.325; p = .006), CRP (OR: 1.008, 95%CI: 1.006–1.010; p < .001), ACEI (OR: 0.718, 95%CI: 0.521–0.988; p = .042), AST (OR: 1.005, 95%CI: 1.001–1.010; p = .010) were found associated with in-hospital mortality. Conclusion In our study, it was not detected clinically significant difference between three groups with regard to their relation with in-hospital mortality

The effect of idiopathic premature ventricular complexes on left ventricular ejection fraction.

Aim: Current literature lacks a definitive threshold of idiopathic premature ventricular complex (PVC) burden for predicting cardiomyopathy (CMP). The main objective of the present study was to evaluate relationship between the PVC burden and left ventricular ejection fraction (LVEF). Method: This multicenter, cross-sectional study included 341 consecutive patients with more than 1,000 idiopathic PVC in 24 hr of Holter monitoring admitted to the cardiology clinics between January 2019 and May 2019 in the nineteen different centers. The primary outcome was the LVEF measured during the echocardiographic examination. Result: Overall, the median age was 50 (38-60) and 139 (49.4%) were female. Percentage of median PVC burden was 9% (IQR: 4%-17.4%). Median LVEF was found 60% (55-65). We used proportional odds logistic regression method to examine the relationship between continuous LVEF and candidate predictors. Increase in PVC burden (%) (regression coefficient (RE) -0.644 and 95% CI -1.063, -0.225, p < .001), PVC QRS duration (RE-0.191 and 95% CI -0.529, 0.148, p = .049), and age (RE-0.249 and 95% CI -0.442, -0.056, p = .018) were associated with decrease in LVEF. This inverse relationship between the PVC burden and LVEF become more prominent when PVC burden was above 5%. A nomogram developed to estimate the individual risk for decrease in LVEF. Conclusion: Our study showed that increase in PVC burden %, age, and PVC QRS duration were independently associated with decrease in LVEF in patients with idiopathic PVC. Also, inverse relationship between PVC burden and LVEF was observed in lower PVC burden than previously known

Suboptimal use of non-vitamin K antagonist oral anticoagulants: Results from the RAMSES study

WOS: 000384041400052PubMed ID: 27583892This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance 50mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of 3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients