Background. The white blood cell count to mean platelet volume ratio (WMR) is an indicator of inflammation in patients with atherosclerotic disease. Residual SYNTAX Score (RSS) is an objective ...measure of degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). We investigated the relationship between WMR and clinical prognosis and RSS in patients undergoing primary percutaneous coronary intervention (P-PCI). Method. Between June 2015 and December 2018, 537 patients who underwent primary PCI were evaluated for in-hospital events, and 477 patients were evaluated for clinical events during follow-up after discharge. The endpoint of our study is major adverse cardiac events (MACEs) seen in the in-hospital and follow-up periods. Results. In our study, 537 patients were stratified into two groups according to admission median WMR. There were 268 patients in the low WMR group (WMR<1286) and 269 patients in the high WMR group (WMR≥1286). RSS (p=0.01) value of the high WMR group was higher than that of the low WMR group. The rates of in-hospital MACE (p=0.001), cardiac death (p<0.001), decompansated heart failure (0.007), and ventricular tachycardia/fibrillation (p=0.003) were higher in the high WMR group than in the low WMR group. The follow-up MACEs (p=0.043), cardiac death (p=0.026), and reinfarction (p=0.031) ratio were higher in the high WMR group. In ROC analysis, cut-off values of in-hospital and follow-up MACEs were >1064 (sensitivity: 83.12%, and specificity: 36.29%) and >1130 (sensitivity: 69.15%, and specificity: 44.91%), respectively. The Kaplan-Meier analysis showed that the high WMR group had the significantly lowest MACE-free survival rate (log-rank test, p=0.006). A moderate correlation was observed between WMR and RSS (r: 456, p=0.002). Conclusion. A higher WMR value on admission was associated with worse outcomes in patients with P-PCI and independently predicted for follow-up MACEs. The WMR provides both a rapid and an easily obtainable parameter to identify reliably high-risk patients who underwent primary percutaneous coronary intervention due to STEMI.
Aims. We investigated the prognostic significance of residual SYNTAX score (RSS) in patients undergoing PCI due to STEMI and relationship between RSS and in-hospital and long-term ischemic cardiac ...events. Methods. Between June 2015 and December 2018, 538 patients who underwent primary PCI were evaluated for in-hospital events and 478 patients were evaluated for clinical events during follow-up. Primary and secondary endpoints for both in-hospital and follow-up periods were cardiac death and major adverse cardiac events (MACE). Results. 538 patients were included the study. RSS values of 131 patients were 0, and RSS values of 407 patients were >0. The median value of the RSS > 0 group was 7. According to this value, the RSS > 0 group was divided into 2 groups as R-ICR (RSS < 7, N = 188) and ICR (RSS ≥ 7, n = 219). In the RSS ≥ 7 group, during in-hospital and follow-up period, both mortality and MACE rates were higher than the other two groups. Area under the curve (AUC) for RSS for in-hospital death was found to be higher than SS (p=0.035) but similar to Grace Score (GS) (p=0.651). For MACE, RSS was higher than SS (p=0.025) and higher than the GS (p=0.041). For follow-up cardiac mortality, the AUC of the RSS was found to be higher than SS (0.870/0.763, p=0.02) and GS (0.870/0.733, p=0.001). For MACE, the AUC of RSS was higher than SS (p=0.03) and GS (p=0.004). Conclusions. High RSS values in STEMI patients are associated with increased risk of ischemic cardiac events. RSS may help determine revascularization and level of additional PCI to improve prognosis by reducing the risk of ischemic cardiac events after P-PCI.
Objective
Nondippers are known to carry a high risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the effects of dipper and nondipper status of hypertension on ...left atrial (LA) systolic and diastolic functions using two‐dimensional speckle tracking echocardiography (2D‐STE), P‐wave dispersion (PWD), and P terminal force (PTF) in hypertensive patients.
Methods
A total of 72 patients and 39 healthy individuals were included in the study. The patients were classified as nondippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Atrial electromechanical delay times, LA strain values were obtained by 2D‐STE with automated software and compared between the groups. PWD and PTF data were calculated on the electrocardiography.
Results
Inter‐atrial (dippers: 25.5 ± 3.9, nondippers: 32.2 ± 7.4, P < .001), left‐atrial (dippers: 14.9 ± 3.7, nondippers: 18.2 ± 6.0, P = .016), and right atrial (dippers: 10.5 ± 2.1, nondippers: 14.2 ± 5.2, P < .001) electromechanical delay times were significantly longer in nondippers. LA strain S (dippers: 34.2 29.7–38.7, nondippers: 27.7 22.7–32.2, P < .001), LA strain E (dippers: 18.2 16.6–20.1, nondippers: 14.4 11.6–16.8, P < .001), and LA strain A (dippers: 15.8 13.5–17.9, nondippers: 12.7 9.9–14.5, P < .001) were significantly lower in nondippers. Nondippers also had an increased values of maximum P‐wave duration (dippers: 0.117 0.10–0.12, nondippers: 0.126 0.12–0.14, P < .001), PWD (dippers: 0.062 0.06–0.07, nondippers: 0.069 0.06–0.08, P = .004), and PTF (dippers: 0.055 ± 0.02, nondippers: 0.066 ± 0.02, P = .02).
Conclusion
Nondipping pattern in hypertensive patients had a worse cardiac remodeling, and impaired mechanical LA function compared with dipping pattern. The PWD and PTF findings support these changes.
This study was conducted to evaluate arterial structure and function with assessment of pulse wave velocity (PWV) and carotid intima-media thickness (CIMT) in patients with Behçet's disease (BD).
...Thirty patients (13 female, 17 male) with BD and 30 age, sex-matched healthy controls (12 female, 18 male) with no known cardiovascular disease were enrolled in this study. Carotid-femoral PWV and CIMT were measured.
PWV was higher in BD patients compared with control group (6.35±1.05 vs. 5.75±0.83, respectively; p=0.017). There was no significant difference in maximum CIMT (0.751±0.077 mm vs. 0.735±0.079 mm, respectively; p=0.435), or mean CIMT (0.643±0.070 mm vs. 0.629±0.069, respectively; p=0.452). Maximum CIMT, mean CIMT, and PWV were positively correlated with duration of disease (r=0.410, p=0.025; r=0.404, p=0.027; and r=0.362, p=0.049, respectively).
Findings suggest that endothelial function is impaired in cases of BD before visible structural changes to arterial wall. PWV is more useful measurement than CIMT in determination of vascular damage in BD, especially in early stage of disease duration.
Endovascular aneurysm repair (EVAR) of abdominal aorta is a valuable treatment option in selected patients with abdominal aortic aneurysm. Renal artery occlusion is a serious complication after EVAR ...and may progress to permanent renal injury requiring hemodialysis. In this report, case of unexpected renal artery occlusion after EVAR treated with renal artery stenting in the late postoperative period is described.
We aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction with the automated function imaging method (AFI) based on speckle tracking echocardiography (STE) in obstructive sleep ...apnea patients (OSA) with normal left ventricular ejection fraction (LVEF) and without any confounding disease that can cause myocardial dysfunction.
Twenty-one healthy individuals and 58 OSA patients were included in this observational cross-sectional study. According to the severity of disease, OSA patients were examined in three groups; mild, moderate and severe OSA. Apical 2-, 3- and 4- chamber images were obtained for AFI evaluation. The global systolic longitudinal strain (GLS) values were determined for each view, and averages of these were used in comparison of the patient groups. One-way ANOVA, Kruskal-Wallis, Pearson correlation tests and linear regression analysis were used for statistical analysis.
The GLS values of the OSA patients were lower than of the healthy individuals and these values were decreased along with the OSA severity (Healthy:-25.58±-2.16%, Mild:-23.93±-3.96%, Moderate:-21.27±-2.60%, Severe:-16.94±-2.66%, respectively). The difference was significant between moderate OSA patients and healthy individuals, and significant between severe OSA patients and all other groups (p<0.03). The apnea-hypopnea index was found to be correlated with the GLS (β=-0.659, 95% CI: 0.09-0.17, p<0.001).
Longitudinal LV mechanics in OSA patients with normal LVEF are deteriorated in the subclinical stage being associated with the severity of disease. AFI can be used as an effective and safe method in the determination of subclinical myocardial dysfunction in OSA patients, because it is semi-automated and easy to use with a short analysis time.
Obstructive sleep apnea syndrome (OSAS) is associated with increased cardiovascular morbidity and mortality. Platelet activation and aggregation are central processes in the pathophysiology of ...atherothrombosis. Mean platelet volume (MPV), a determinant of platelet activation, is a newly-emerging risk factor for atherothrombosis. Therefore, we have investigated the possible association between OSAS and MPV.
We selected 30 mild, 32 moderate, and 31 severe OSAS patients and 31 healthy control subjects matched for age, sex, and body mass index. MPV was measured using an automated blood cell counter.
The MPV levels were significantly higher in the severe OSA group than in the control group (8.6±1.1 vs. 7.8±0.7 fl, p=0.03). There were no significant differences in respect to MPV between controls and patients with mild and moderate OSA (7.8±0.7 vs. 8.3±1.2 fl, p=0.2; 7.8±0.7 vs. 8.4±1.3 fl, p=0.08) and between patients with mild, moderate, and severe OSA (8.3±1.2 vs. 8.4±1.3 vs. 8.6±1.1 fl, p=0.9). Significant correlations were seen between MPV and apnea-hypopnea index (r=0.347, p?0.001), minimal oxygen saturation (r=-0.224, p=0.03), and the percentage of recording time spent at a oxygen saturation less than 90% (r=0.240, p=0.02).
Our results suggest that OSAS patients tend to have relatively increased platelet activation andatherothrombotic risk.
An aneurysm of the sinus of Valsalva (SVA) may rupture into the cardiac cavities and cause abnormal connections between these cavities and the aorta. The right atrium and/or right ventricle are the ...cavities into which the SVA is most commonly observed to rupture. A 30-year-old patient presented to our cardiology clinic with the complaint of dyspnea. His physical examination revealed a thrill localized in the 5th intercostal space on the right edge of the sternum and systolic-diastolic murmur beginning from the aortic focus and spreading to the neck and back along the right edge of the sternum. The echocardiographic and invasive examinations revealed two defects leading to a passage from the right sinus Valsalva to the right ventricle. While the left-to-right shunt ratio was calculated as 3.8, the anatomic locations and dimensions of the defects were found to be eligible for percutaneous closure. Using the Amplatzer Duct Occluder I device, the defects were closed in two sessions. Although the classical treatment method of ruptured SVA is surgical repair, percutaneous closure devices may be used as a reliable alternative method in suitable patients.
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