The heterogeneity in myocardial repolarization increases the risk of ventricular arrhythmias and sudden death in patients with diabetes mellitus (DM). The Tp-e interval and Tp-e/QTc ratio are found ...to be useful in the prediction of ventricular arrhythmias. In this study, we aimed to investigate the Tp-e interval and Tp-e/QTc ratio in diabetic patients with and without microvascular complications.
This cross-sectional observational study included patients with type 2 DM who presented to the endocrinology outpatient clinic. Diabetic microvascular complications were evaluated. The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were also calculated.
A total of 240 patients with type 2 DM (148 patients had microvascular complications) were included in the study. Diabetic neuropathy rate was 30.4%, diabetic nephropathy rate was 38.4%, and diabetic retinopathy rate was 21.7%. Upon comparing patients according to Tp-e/QTc ratio, the median Tp-e/QTc interval of the group of patients with complications was 0.21 (0.19–0.23) and the median Tp-e/QTc ratio of the group of patients without complications was 0.19 (0.18–0.20) (p < 0.001). When patients were grouped according to the presence and severity of retinopathy, the Tp-e/QTc ratio was more prolonged in the proliferative retinopathy group 0.27 (0.23–0.30) than the non-proliferative retinopathy group 0.20 (0.19–0.22), p < 0.001. When patients were grouped according to the presence and severity of nephropathy, the Tp-e/QTc ratio was more prolonged in the macroalbuminuria and microalbuminuria group than the normoalbuminuric group 0.25 (0.21–0.30), 0.23 (0.19–0.24), and 0.19 (0.20–0.22), respectively, p = 0.002.
Our study is the first to demonstrate the association of the Tp-e interval and Tp-e/QTc ratio with the presence and severity of microvascular complications in patients with type 2 DM.
•DM is associated with the increase risk of sudden cardiac death•Tp-e interval and Tp-e/QTc ratio predicts the risk of arrhythmias•Tp-e interval and Tp-e/QTc ratio is in association with the presence and severity of microvascular complications in DM
Cardiocutaneous syndrome (CCS) is often caused by genetic variants in desmoplakin (
) in the presence of thick calluses on the hands and soles of the feet (palmoplantar keratoderma) in combination ...with arrhythmogenic cardiomyopathy. In this case report, we describe a 58-year-old man presenting with a history of cardiomyopathy with recurrent sustained ventricular tachycardia and palmoplantar keratosis. The cardiological evaluation showed biventricular cardiomyopathy, and repeated genetic testing identified a novel
variant. Repeated genetic testingis clinically meaningful in patients with a high probability of a specific inherited cardiac disease, such as CCS, particularly if molecular screening has been performed in the pre-NGS era with an incomplete NGS panel or outdated technology as presented in this case report.
Objectives:
In this study, we aimed to investigate the relationship between neutrophil to lymphocyte ratio (NLR) and infarct-related artery (IRA) patency in patients with ST-segment elevation ...myocardial infarction (STEMI).
Methods:
A total of 349 patients with STEMI were recruited to this retrospective study. Baseline characteristics were reviewed. Patency of IRA was evaluated by thrombolysis in myocardial infarction flow grade.
Results:
Of all patients, 293 patients formed the occluded IRA group and 56 patients formed the patent IRA group. The NLR was significantly higher in occluded IRA group (4.4 ± 4.1 vs 1.9 ± 1.1, P < .001). Glucose levels were also higher in occluded IRA group (171.3 ± 78.0 vs 144.7 ± 49.7, P = .022). Regression analysis demonstrated admission NLR and plasma glucose levels as independent predictors of IRA patency.
Conclusion:
In this study, we found that admission NLR and glucose levels were higher in patients with occluded IRA than in patients with STEMI. We also found that NLR and glucose levels were independent predictors of IRA patency. Because hemogram is a cheap, fast, and widely available test, it can be used in daily practice as a predictor of IRA patency.
Endothelial cell-specific molecule-1 (endocan) is an immunoinflammatory marker linked to endothelial activation and dysfunction. We investigated the relationship between obstructive coronary artery ...disease (CAD), microvascular angina (MVA), and plasma levels of endocan. We included 53 healthy individuals as controls, 40 MVA patients, and 120 patients with obstructive CAD. The severity of CAD was assessed by the Gensini and SYNergy between percutaneous coronary intervention with TAXUS and Cardiac Surgery (SYNTAX) scores. Endocan levels were 382.7 (313.8-470.2) pg/mL in patients with obstructive CAD; 324.3 (277.1-460.7) pg/mL in MVA group, and 268.0 (226.4-336.5) pg/mL (P < .001) in controls. Endocan levels in obstructive CAD and MVA groups were similar but both were significantly higher than for the control group (P < .001 and P = .002, respectively). In subgroup analysis, similar to the hypertensive subgroup results, endocan was still an independent predictor of presence of obstructive CAD in normotensives (odds ratio = 1.005, 95% confidence interval = 1.001-1.010, P = .024). There was also an independent positive correlation between endocan levels and SYNTAX score both in the hypertensives (β = 0.414, t = 3.21, P = .002) and in the normotensives (β = .301, t = 2.23, P = .031). In conclusion, endocan could be a common predictor of the endothelium-dependent inflammatory processes, rather than related with specific risk factors.
Objectives:
We evaluated the relationship between neutrophil to lymphocyte ratio (NLR) and slow coronary flow (SCF).
Methods:
A total of 180 participants were recruited to the present study. Of all ...the participants, 82 patients were with SCF and 98 participants were with normal coronary arteries. Basal characteristics were recorded. Coronary flow was quantified by thrombolysis in myocardial infarction frame count.
Results:
Basal characteristics were similar between the 2 groups. The NLR was significantly higher in the SCF group when compared to the control group (2.3 ± 0.8 and 1.5 ± 0.4 respectively, P < .001). In multiple logistic regression analysis, NLR remained as the independent predictor of SCF (P < 0.001).
Conclusions:
Our findings showed that NLR was significantly higher in the SCF group when compared to the control group with normal coronary arteries. We also showed that NLR was related to the presence of SCF rather than the extent of SCF. Besides these findings, we also showed the NLR as an independent predictor of SCF.
Elevated red blood cell distribution width (RDW) is an independent prognostic factor for cardiovascular events that are major causes of mortality in patients with carbon monoxide (CO) poisoning. Due ...to the limited number of studies, we aimed to investigate the relationship between RDW levels and long-term mortality for these patients.
This retrospective study included patients with CO poisoning, who presented to the emergency department. Baseline characteristics, laboratory results and survival status were retrieved from patients' hospital records. The severity of poisoning was determined according to COHb level and/or clinical signs and symptoms.
The study included 571 patients (median age was 37.0 years) and less than half of these patients were male (n = 206, 36.1%). There were mild-moderate CO poisoning in 389 (68.1%) patients and severe poisoning in 182 (31.9%). At a median follow-up of 6.2 years, there were 33 deaths (5.8%). Univariate cox-regression analysis demonstrated that age, gender, presence of hypertension or diabetes mellitus, levels of hemoglobin, RDW, creatinine and alanine-aminotransferase, and white-blood-cell count were potential covariates of long-term all-cause mortality. In the multivariate analysis, the median age and RDW level remained independent predictors of mortality (age, Odds ratio OR: 1.070 95% confidence interval CI: 1.030–1.110, p = 0.001; RDW, OR: 1.221 95% CI: 1.042–1.431, p = 0.013). Patients with higher RDW levels had a significantly worse prognosis in terms of mortality than with lower RDW levels (log-rank test, p = 0.003).
This study demonstrated that RDW level is an independent predictor of long-term mortality in patients with CO poisoning.
Purpose:
In this study, we aimed to investigate the relationship between saphenous vein graft disease (SVGD) and neutrophil-to-lympocyte ratio (NLR) with other possible confounding factors.
Methods:
...A total of 120 patients were enrolled into the present study. Of all participants, 40 patients were with SVGD and 80 of them were with patent SVG.
Results:
The NLR, white blood cell (WBC) count, age of SVG, red cell distribution width (RDW), and mean platelet volume were significantly higher in the SVGD group. In regression analysis, NLR, WBC, RDW, and age of SVG remained as independent predictors of SVGD.
Conclusion:
To our knowledge, we showed for the first time that NLR is independently associated with SVGD. It can be easily used in this era, because it is easily available, widely used, and relatively cheap. Besides NLR, WBC count, SVG age, and RDW can also be used to predict SVGD.
To assess the relationship between serum bilirubin levels and fragmented QRS (fQRS), and their association with adverse events in patients with acute coronary syndrome.
This study included a total of ...736 patients. Laboratory results such as bilirubin levels, renal and liver function tests were obtained from the first available blood sample.
Left ventricular ejection fraction, end-diastolic diameter and total bilirubin level were significantly lower in fQRS (+) group than in the control group (45.0 40.0–55.0 vs 50.0 45.0–60.0%; p < 0.001; 4.7 4.6–5.1 vs 4.7 4.5–4.9 cm; p < 0.001; 0.66 0.49–5.1 vs 0.72 0.53–0.97 md/dl; p = 0.017); respectively. Occurrence of adverse events was significantly higher in fQRS (+) group (32.5 vs 20.5 %; p = 0.013) during mean 1-year follow-up period.
Total bilirubin level is an independent predictor of fQRS formation, which is associated with the presence of adverse events in patients with acute coronary syndrome.
This paper recommends a new kind of assembly line rebalancing and worker assignment problem, taking ergonomic risks into account. Assembly line rebalancing problem (ALRBP) occurs when a current line ...must be rebalanced due to conditions such as changes in demand, production processes, product design, or quality issues. Although there are several research attempts on ALRBP in the relevant literature, only a few studies consider workers as unique individuals. This paper aims to solve the double reassignment problem: tasks to workers and workers to stations, considering ergonomic risk factors. This paper is the first study that comprises worker assignment and ergonomic constraints in ALRBP literature to the best of our knowledge. Objectives of our novel problem are to minimize rebalancing cost, which includes transportation of tasks and workers and minimize stations' ergonomic risk factors. A randomized constructive rule-based heuristic approach is developed to cope with the problem. The proposed solution approach is applied to benchmark data, and obtained results are promising. Moreover, the proposed solution approach is implemented in an automotive parts manufacturing plant.
Abstract Study objective Controlled hypotension is a preferred method in various surgical operations, but limited data are available for the effects of drug combinations that are used to ensure the ...desired level of hypotension on cardiac repolarization. Design Randomized, prospective, double-blinded study. Patients The study comprised 65 patients undergoing septorhinoplasty surgery under general anesthesia. Interventions Group S received sevoflurane inhalation alone, group R received sevoflurane and remifentanil, and group N received sevoflurane and nitroglycerine in a way that a mean arterial pressure of 60 ± 5 mm Hg was achieved. Measurements Electrocardiogram was performed before induction (T1), 30 minutes after induction (T2), and 5 minutes after extubation (T3). Corrected QT (QTc), QT dispersion (QTd), and corrected Tp-e (Tp-ec) intervals and Tp-e/corrected QT (Tp-e/QTc) ratio were calculated. Main results QTc prolongation was observed at T2 and T3 in all groups, but only QTc prolongation at T2 was statistically significant in group S ( P > .05). Significant prolongation of QTd interval at T2 and T3 was observed in group S ( P < .05). In all groups, Tp-ec decreased at T2. However Tp-ec decrease was not statistically significant in group S ( P = .103) and group R ( P = .058). Tp-e/QTc was significantly decreased on T2 in all 3 groups, and it was returned to baseline at T3 ( P < .05). Conclusion The present study demonstrated that none of the 3 hypotensive anesthesia methods has an overall negative effect on Tp-e and Tp-e/QTc. Therefore, we conclude that all 3 methods can be used safely in terms of proarrhythmic risk, but increased sevoflurane consumption may require more attention due to significant prolongation of QTc and QTd.
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