COVID-19 disease, which has recently become an important cause of mortality and morbidity all over the world, is remarkably associated with thrombotic complications. Although many factors are ...responsible for these increased thrombotic complications in COVID-19 disease, its relationship with a marker that increases the risk of thrombosis such as Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) has not yet been clarified. This is the first study to examine the potential diagnostic and prognostic value of SCUBE1 levels in patients with COVID-19. In this study, we aimed to clarify the relationship between the increased risk of thrombosis and SCUBE1 in the course of COVID-19 disease.
553 patients with COVID-19 and 553 healthy controls were compared in terms of SCUBE1 levels. Additionally, patients with COVID-19 were divided into two groups according to their SCUBE1 levels and compared in terms of severity of disease, thrombotic complications and ın-hospital mortality.
SCUBE1 levels were significantly higher in patients with COVID-19 compared to the control group (p < 0.001). Plasma SCUBE1 levels were significantly higher in patients with severe disease and thrombotic complications, those with mild to moderate disease, and those without thrombotic complications (p < 0.001, for both). In addition, SCUBE1 was found to be an independent predictor of in-hospital mortality (p < 0.001).
SCUBE1 may be one of the major determinants of thrombotic complications, which is an increased cause of mortality and morbidity in COVID-19 patients so inhibition of this peptide may be among the therapeutic targets in patients with COVID-19.
Currently, the gold standard treatment for ST-elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (pPCI), but even after successful pPCI, a perfusion disorder in the ...epicardial coronary arteries, termed no-reflow phenomenon (NR), can develop, resulting in short- and long-term adverse events. The present study assessed the relationship between NR and HbA1c/C-peptide ratio (HCR) in 1834 consecutive patients who underwent pPCI due to STEMI. Participants were divided into two groups according to NR status and the demographic, clinical and periprocedural characteristics of the groups were compared. NR developed in 352 (19.1%) of the patients in the study. While C-peptide levels were significantly lower in the NR group, HbA1c and HCR were significantly higher ( P < .001, for all). In multivariable analysis, C-peptide, HbA1c, and HCR, were determined as independent predictors for NR ( P < .05, for all). In Receiver Operating Characteristic (ROC) analysis, HCR predicted the NR with 80% specificity and 77% sensitivity. In STEMI patients, combining HbA1c and C-peptide in a single fraction has a predictive value for NR independent of diabetes. This ratio may contribute to risk stratification of STEMI patients.
The relationship between C-reactive protein (CRP) to albumin ratio (CAR) and contrast-induced nephropathy (CIN) in patients with acute coronary syndrome has been reported. However, the relevance of ...CAR in patients with stable angina pectoris (SAP) has not been clarified. We hypothesized that CAR might predict the development of CIN in patients with SAP undergoing coronary angiography (CAG). Patients (n = 554) with SAP who underwent CAG were included in the study. CIN was defined as a ≥25% increase in serum creatinine compared with baseline value within 72 h of CAG. Participants were divided into two groups: CIN (n = 87) and non-CIN (n = 467). Age, CRP, CAR, mean corpuscular volume (MCV), urea, uric acid, contrast medium volume, the percent of percutaneous coronary intervention were significantly greater, whereas albumin and high-density lipoprotein were significantly lower in the CIN group than non-CIN group (p < .05, for all). Multivariate analysis showed that CAR was the only independent predictor for CIN (odds ratio = 7.065, 95% confidence interval (CI); 3.279–15.221, p < .001). Receiver operating characteristic ROC analysis showed that a CAR ≥ 0.1164 could predict CIN (sensitivity of 71% and specificity of 72%; area under curve = 0.736; 95% CI: 0.677–0.795, p < .001). CAR was significantly greater in patients who developed CIN and this independently predicted CIN.
No-reflow (NR) is the inability to achieve adequate myocardial perfusion despite successful restoration of attegrade blood flow in the infarct-related artery after primary percutaneous coronary ...intervention. The non-HDL-C/HDL-C ratio has been shown to be superior to conventional lipid markers in predicting most cardiovascular diseases. In this study, we wanted to reveal the predictive value of the NR by comparing the Non-HDL-C/HDL-C ratio with traditional and non-traditional lipid markers in patients who underwent primary percutaneous coronary intervention (pPCI) due to ST-elevation myocardial infarction (STEMI).
A total of 1284 consecutive patients who underwent pPCI for STEMI were included in this study. Traditional lipid profiles were detected and non-traditional lipid indices were calculated. Patients were classified as groups with and without NR and compared in terms of lipid profiles.
No-reflow was seen in 18.8% of the patients. SYNTAX score, maximal stent length, high thrombus burden, atherogenic index of plasma and non-HDL-C/HDL-C ratio were determined as independent predictors for NR (
< 0.05, for all). The non-HDL-C/HDL-C ratio predicts the development of NR in STEMI patients with 71% sensitivity and 67% specificity at the best cut-off value. In ROC curve analysis, the non-HDL-C/HDL-C ratio was superior to traditional and non-traditional lipid markers in predicting NR (
< 0.05, for all).
The non-HDL-C/HDL-C ratio can be a strong and independent predictor of NR in STEMI patients and and therefore non-HDL-C/HDL-C ratio may be a useful lipid-based biomarker that can be used in clinical practice to improve the accuracy of risk assessment in patients with STEMI.
Contrast-induced nephropathy (CIN) has become one of the most important causes of in-hospital acute renal failure with the increasing use of contrast-mediated imaging tools. This significantly ...increases the morbidity and mortality of the affected subjects and causes a financial burden on the health system. In this context, prediction of CIN is important and some risk scores have been developed to predict CIN. The most frequently used and popular among these is the Mehran Score (MS), which is based on a number of hemodynamic and metabolic parameters. The Intermountain Risk Score (IMRS) is a recently developed risk score that highly predicts short-term mortality based on common laboratory parameters, and many parameters of this risk score have been found to be closely associated with CIN. In this context, we aimed to compare MS and IMRS in terms of CIN and short-term mortality estimation. The study included 931 patients who underwent percutaneous coronary intervention. CIN developed in 21.5% of patients. Both MS and IMRS independently predicted CIN. In receiver operating characteristic analysis, IMRS was found to be non-inferior to MS in predicting CIN and IMRS was superior to MS in predicting short-term mortality. IMRS and MS were independently associated with short-term mortality.
Optimal first-trimester anticoagulation is still challenging in pregnant women with mechanical heart valves (MHVs) requiring high-dose warfarin. This multicenter prospective study aims to determine ...the optimal anticoagulation regimens for pregnant patients with MHVs.
All women were allocated to one of three treatment options during first trimester including lone low-molecular-weight heparin (LMWH), combination of LMWH + 2.5 mg warfarin, and LMWH+4 mg warfarin. Primary maternal outcome included a combination of death, thromboembolism, severe bleeding, and need for treatment of mechanical valve thrombosis (MVT). Any fetal loss was determined as primary fetal outcome.
The study included 78 pregnancies in 65 women with MHVs. Primary maternal outcome rate was 44%, 12.5%, 3.5%, respectively. The rates of primary maternal outcome (44 vs 3.5%, P < .001), obstructive MVT (16 vs 0%, P = .04), MVT requiring treatment (28 vs 0%, P = .003), and cerebral embolism (24 vs 3.4%, P = .041) were found to be significantly higher in lone LMWH group compared to LMWH + 4 mg warfarin group. Moreover, the rates of primary maternal outcome (12.5 vs 44%, P = .015) and treatment for MHV thrombus (4.2 vs 28%, P = .049) were significantly lower in LMWH + 2.5 mg warfarin group compared to lone LMWH group. The incidences of fetal loss were 8 (32%) in the lone LMWH group, 8 (33.3%) in LMWH + 2.5 mg warfarin group, and 11 (37.9%) in LMWH + 4 mg warfarin group (P = .890 for 3-group).Warfarin related-embryopathy was not observed in any case.
The combined anticoagulation strategy of LMWH plus low-dose warfarin during the first trimester of pregnancy may result in less maternal complications with comparable fetal outcomes in patients with MHVs.
Low-molecular-weight heparin (LMWH) is thought to be safer for the fetus, however it is suspected to be less protective for the mother. To solve this dilemma, the authors suggested a novel anticoagulation strategy in pregnant women with prosthetic valves. Seventy-eight pregnancies of 65 women (median age 32 27-35 years) were included in the study. A combination of LMWH and a reduced dose warfarin were associated with low rates of thrombus-related complications in pregnant patients with mechanical heart valves.
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Hepatokines are proteins secreted by hepatocytes and many hepatokines such as fetuin A/B, selenoprotein P have been shown to play a role in the pathogenesis of many metabolic dysfunctions such as ...diabetes, insulin resistance, hypertension, and metabolic syndrome by showing autocrine, paracrine and systemic effects. Ectodysplasin A (EDA) is a recently discovered hepatokine that plays a role in the development of ectodermal structures. In recent studies, it has been revealed that EDA may be associated with the pathogenesis of non-alcoholic liver disease, insulin resistance, Type 2 diabetes mellitus. The close relationship between these metabolic diseases and coronary artery disease (CAD), which may be associated with insulin resistance, has been well documented in previous studies. However, until now, there is no study examining the relationship of EDA with CAD and its effect on long-term outcomes. In this study, we aim to reveal this relationship on patients presenting with ST elevation myocardial infarction (STEMI).
EDA levels of 544 patients who applied to the study with STEMI and 544 people without coronary artery disease were included in the control group, and the patients with STEMI were followed for median of 33.7 ± 6.8 months.
We found that EDA levels were significantly higher in patients with STEMI and that EDA levels were proportional to the severity of CAD (p < 0.001) also EDA levels may be an independent predictor of poor clinical outcome in patients with STEMI.
These results suggest that EDA is closely related to the presence and severity of CAD.
Many inflammation-based markers (IBMs) have been shown to be closely related to coronary slow flow (CSF), but the effect of the uric acid/albumin ratio (UAR) on CSF and its relationship with other ...IBMs are not clearly known. In this study, we aimed to compare the effects of UAR and other IBMs on CSF.
After the exclusion criteria, 126 patients with CSF detected on coronary angiography and 126 subjects with normal coronary flow as the control group were included in the study.
UAR was determined as an independent predictor for CSF. In addition, the UAR was superior to other IBMs in detecting CSF (p < 0.05 for all).
This study is the first to investigate the effect of UAR on CSF in comparison with other IBMs.
Aim
Although Myocardial bridge (MB) is known as a benign condition, it has been demonstrated to be associated with cardiac arrhythmias and poor outcomes. Frontal QRS‐T angle (fQRSTa) is a novel ...indicator of repolarization and depolarization heterogeneity. Last studies indicated that associated with fQRSTa and adverse cardiac events. No study evaluated the relationship between fQRSTa and MB. In the present study, we aimed to investigate the relationship between MB and fQRSTa.
Methods
This study included 91 patients with normal coronary arteries and 89 patients with MB. Coronary angiography was performed in all patients due to ischemia findings on treadmill exercise test or myocardial scintigraphy.2‐lead surface electrocardiograms (ECGs) of all patients were evaluated. QT interval, fQRSTa, QTc interval were measured from surface ECGs.
Results
Baseline clinical, echocardiographic and laboratory parameters were similar between MB and control group. However, when compared to control group, patients with MB had importantly raised fQRSTa 27 (20–41) vs. 23 (12–37) p = 0.007. In correlation analysis, fQRSTa was positively correlated with MB length (r = 0.411, p < 0.001). Linear regression analysis showed that MB length was the just considerable predictor of fQRSTa (β = 0.247, p = 0.041).
Conclusions
The fQRSTa is a novel electrocardiographic marker that can be easily obtained from surface ECG. We have shown for the first time that MB length is a significant predictor of fQRSTa.
Isolated coronary artery ectasia (ICAE) is a rare coronary artery disease (CAD) encountered during coronary angiography. Although many mechanisms have been suggested today that may be associated with ...ICAE, the underlying pathogenesis has not been fully understood. In this study, we aimed to reveal the possible relationship between intestinal permeability and ICAE.
Of the 12 850 patients who underwent coronary angiography, 138 consecutive patients with ICAE and 140 age- and sex-matched subjects with normal coronary arteries as the control group and 140 subjects with stenotic CAD were included in the study.
Serum zonulin and lipopolysaccharide levels were significantly higher in patients with ICAE than in the control group and CAD group. Additionally, zonulin and lipopolysaccharide levels were significantly higher in the CAD group than in the ICAE group. In the correlation analysis, serum zonulin levels were correlated with the mean diameter and length of the ecstatic segment. In multivariate analysis, zonulin and lipopolysaccharide were identified as independent predictors for ICAE.
These results suggest that there may be a pathophysiological relationship between increased intestinal permeability and ICAE.
