Increased coronary thrombus burden is known to be a strong predictor of adverse cardiovascular (CV) outcomes. C-reactive protein to albumin ratio (CAR) can be used as a surrogate marker of ...pro-inflammation which is closely related to prothrombotic state. We aimed to evaluate the association between CAR and coronary thrombus burden in patients who presented with acute coronary syndrome (ACS). Patients who presented with ACS and treated with primary percutaneous coronary intervention were included in the study. Patients were divided into 2 groups as high thrombus burden and low thrombus burden. The study population included 347 patients with non-ST-segment elevation myocardial infarction (169 48.7%) and ST-segment elevation myocardial infarction (178 51.3%). The CAR was significantly higher in patients with higher thrombus burden (24.4 1.2-30.2 vs 31.9 2.2-31.3, P < .001). Independent predictors for increased thrombus burden were higher CRP level (odds ratio OR: 0.047; 95% confidence interval CI: 0.004-0.486; P = .010), lower serum albumin level (OR: 0.057; 95% CI: 0.033-0.990; P = .049), higher CAR (OR: 1.13; 95% CI: 1.03-1.23; P = .008), higher neutrophil–lymphocyte ratio (OR: 1.18; 95% CI: 1.05-1.31; P = .004), and baseline troponin I level (OR: 1.06; 95% CI: 1.01-1.13; P = .017). Novel CAR can be used as a reliable marker for increased coronary thrombus burden that is associated with adverse CV outcomes.
Objective: Continuous inflammation at the level of the vascular endothelium plays an important role in the formation of hypertension. Diurnal blood pressure (BP) variation also is a risk factor for ...hypertensive target organ damage. This study planned to evaluate these inflammation processes in normotensive and hypertensive patients.
Methods: This study is observational cross-sectional cohort in-design. 151 patients with a prediagnosis of hypertension included. The patients were divided into three groups (group 1: dipper normotensive, group 2: non-dipper normotensive, group 3: dipper-hypertensive) based on the results of ambulatory blood pressure monitoring. The groups were compared in terms of systemic inflammation index (SII; platelet count×neutrophil count/lymphocyte count), neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and other inflammation processes.
Results: There was a significant difference between the three groups in terms of mean platelet volume (MPV) and red blood cell distribution width (RDW) levels (p=0.001 and p<0.001, respectively). A statistically significant difference was found between the groups in terms of NLR, PLR, systemic inflammation index, lymphocyte-monocyte ratio (LMR). In subgroup analysis, NLR and systemic inflammation index were similar in group 2 and group 3, but higher than in group 1 in both groups. LMR was similar in group 2 and group 3 but lower than in group 1. In subgroup analysis PLR levels were similar in group 2 and group 3 but higher than group 1 in both groups.
Conclusion: This study showed that normotensive non-dipper patients had inflammation as much as dipper hypertensive patients according to measurement of MPV, RDW systemic inflammation index, PLR, NLR levels.
The systemic effects of COVID-19 disease are still largely uncertain and needs to be scrutinized with further trials. Endothelial dysfunction (ED) is responsible for the majority of adverse ...cardiovascular events. Flow-mediated dilation (FMD) is easily obtainable method to assess ED accurately. It is aimed to evaluate ED by measuring FMD following COVID-19 disease. Patients diagnosed with COVID-19 disease were recruited to the hospital two month after the discharge. Sex and age-matched healthy subjects were determined as the control group. Blood samples and FMD measurements were obtained from each participant. All subjects were divided into two groups according to the presence of ED determined by FMD measurements. These two groups were compared in terms of demographic features and the presence of recovered COVID-19 disease. A total of 92 subjects consisting of 59 without ED and 33 with ED were included in the study. ED (+) group was older (p = 0.015) and more likely to have hypertension (p = 0.044) and COVID-19 rate was higher in ED (+) group (p = 0.009). While neutrophil count (p = 0.047) and CRP (p = 0.036) were higher, eGFR (p = 0.044) was lower in ED (+) group. In the backward multivariable regression analysis, COVID-19 disease OR = 3.611, 95% CI 1.069–12.198, p = 0.039 and BMI OR = 1.122, 95% CI 1.023–1.231, p = 0.015 were independent predictors of ED. COVID-19 disease may cause ED which is the major underlying factor of cardiovascular diseases. Furthermore, COVID-19 disease may deteriorate the existing cardiovascular disease course. Detecting ED in the early phase or preventing by new treatment modalities may improve short and long-term outcome.
The identification of interatrial block (IAB) through electrocardiography (ECG) has been correlated with an elevated likelihood of developing atrial fibrillation (AF) and stroke. IAB is diagnosed by ...evaluating P-wave prolongation on a surface ECG. The presystolic wave (PSW) is an echocardiographic marker determined by pulse-wave examination of the aortic root during late diastole. As IAB and PSW share similar pathophysiological mechanisms, we speculated that PSW, as a component of the P wave, might be useful in predicting IAB. In the present study, we aimed to determine the relationship between PSW and IAB. Patients with pre-diagnosis of supraventricular tachycardia (SVT) on electrocardiography or rhythm Holter monitoring between January 2021 and December 2022 were included in the study. Surface 12-lead ECG and transthoracic echocardiography (TTE) were performed for the diagnosis of IAB and PSW. Patients were divided into two groups based on the presence of IAB, and PSW was compared between the groups. In total, 104 patients were enrolled in this study. IAB was diagnosed in 16 patients (15.3%) and PSW was detected in 33 patients (31.7%). The PSW was higher in the IAB ( +) group than in the IAB ( −) group (10 patients (71.4%) vs. 23 patients (32.4%),
p
= 0.008). PSW may be a useful tool for predicting IAB in patients with SVT. Further studies are needed to determine the clinical utility of PSW in the diagnosis and management of IAB.
Background: Arterial hypertension (AH) leads to systolic and/or diastolic dysfunction of the left ventricle (LV) by causing structural changes in the myocardium. Myocardial performance index (MPI) ...provides the evaluation of LV systolic and diastolic functions together. Prognostic nutritional index (PNI) is an indicator of immunonutritional status. PNI was studied in patients with malignancy, malnutrition, and cardiovascular diseases so far. It was aimed to investigate the relationship between PNI and MPI in hypertensive patients.
Methods: A total of 91 consecutive patients with newly diagnosed AH were included in the study. PNI was calculated according to the following formula: ((10 × serum albumin (g/dL))+(0.005 × total lymphocyte count)). MPI was obtained by dividing the sum of isovolumetric relaxation time (IVRT) and isovolumetric contraction time (IVCT) by the ejection time (ET) ((IVRT+IVCT)/ET). Patients were divided into two groups according to MPI is above or below the value of 0.5. The demographic characteristics and PNI values of patients were compared between two groups.
Results: There were 65 patients in the higher and 26 patients were in the normal MPI group. Higher MPI group had male predominance (p = .002). Diastolic blood pressure (p = .021), interventricular septum thickness (p = .005), posterior wall thickness (PWT) (p = .001), serum albumin concentration (p = .045), and PNI (p = .013) were differed between groups. Multivariate logistic regression analysis revealed that PWT OR = 1.835, 95% CI: 1.126-2.992, p = .015 and PNI OR = 1.161, 95% CI: 1.004-1.343, p = .018 predicted higher MPI.
Conclusion: Higher PNI was an independent predictor of LV dysfunction in newly diagnosed hypertensive patients. Immunonutritional status may be used as an indicator of the left ventricular function in patients with AH.
Objectives: In the present study, we investigated the relationship between mentioned markers and chronic total occlusion collateral development. Patients and methods: A total of 243 patients (210 ...males, 33 females; mean age: 63.3±11.5; range, 51 to 76 years) who underwent coronary angiography due to typical chest pain or myocardial ischemia detected in noninvasive stress tests and diagnosed with ≥1 major coronary artery occlusion between January and September 2020 were included in the cross-sectional observational study. The angiographic collateral index was determined according to the Cohen-Rentrop classification. The patients were divided into two groups according to the sufficiency of collateral development: the well-developed collaterals group (n=155) and the poor-developed collaterals group (n=88). Results: Statistically significant parameters in univariate logistic regression analysis were evaluated with multivariate (stepwise) logistic regression analysis; as a result, presence of chronic total occlusion in left anterior descending artery (odds ratio OR=2.447; 95% confidence interval CI, 1.160-5.162; p=0.019), total number of occlusions (OR=3.503; 95% CI, 1.445-8.494; p=0.006), left ventricular ejection fraction (OR=1.056; 95% CI, 1.022-1.091; p=0.001), and the atherogenic index of plasma (OR=0.017; 95% CI, 1.022-1.091; p<0.001) were independently associated with well-developed collaterals. Although the triglyceride-glucose index had statistical significance in the univariate analysis, it was not detected as an independent variable in the multivariate analysis. The monocyte-lymphocyte ratio was not significant in the univariate analysis. Conclusion: Of the new atherosclerosis markers, only the atherogenic index of plasma had an independent association with poor collateral development.
Background: YKL-40 (human cartilage glycoprotein 39, chitinase-3-like protein 1) is an inflammatory marker secreted mainly by macrophages and has distinctive roles on extracellular matrix remodeling, ...macrophage maturation, adhesion, and migration. Despite the presence of robust data suggesting the association of YKL-40 with variety of cardiovascular diseases (CV), there is no study up to date evaluating the role of YKL-40 on the long-term prognosis in patients with hypertension (HT).
Methods: A single center, prospective, observational cohort study that included 327 consecutive hypertensive patients which were presented to a cardiology outpatient clinic. Patients were followed up for 7.89 ± 0.12 years. Primary outcome of the study was the occurrence of major cardiovascular outcomes (MACE) defined as all-cause mortality, new onset heart failure (HF), and coronary artery disease (CAD) requiring revascularization.
Results: A total of 135 patients constituted the final study population mean age: 52.4 ± 10.2, female: 63 (46%). A total of 28 (20.7%) patients had MACE during the follow up. Cox regression analysis revealed that age (HR: 1.046, 1.016-1.093 CI 95%, p = .026), diabetes (HR: 2.278, 1.026-5.057 CI 95%, p = .043), and YKL-40 level (HR: 1.019, 1.013-1.026 CI 95%, p = .005) significantly predicted MACE. We found that sensitivity and specificity of YKL-40 > 93.5 for predicting MACE was 71.4% and 65%, respectively with an area under curve (AUC) 0.723 (0.617-0.828 CI 95%, p < .001)
Conclusion: Elevated serum YKL-40 level predicted MACE in hypertensive patients during a long-term follow up.
In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with ...acute myocardial infarction (AMI) in Turkey.
The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT).
After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI.
The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.
Background High serum uric acid (UA) levels and low high-density lipoprotein cholesterol (HDL-C) levels are accepted as risk factors for cardiovascular mortality. Hyperuricemia and low HDL-C ...levels were associated with an increased risk of cardiovascular mortality and the development of diabetes and hypertension. However, the association of UA with cardiovascular (CV) mortality,collateral index are undetermined in patients with chronic total occlusion (CTO).Material and methods 124 patients who underwent coronary angiography with the diagnosis of stable or unstable angina pectoris and had chronic total occlusion were included in our study. Blood samples were collected from all patients before the angiography procedure. Coronary collateral circulation (CCC) was graded according to the Rentrop grading system of 0-3. Rentrop grades of 0 and 1 indicated low-grade CCC group, whereas grades 2 and 3 indicated high-grade CCC group. We divided our patients into two groups as low-grade CCC and high-grade CCC and examined these two groups in terms of uric acid / HDL ratios. Group 1: Rentrop classification grade 0-1 (mean age, 63,9±9,9), Group 2: Rentrop classification grade 2-3 (mean age, 62,1±9,4).Results The baseline characteristics were similar in both groups. Uric acid / High density lipoprotein-cholesterol ratios and uric acid levels were higher in group 1 with poor collateral circulation group 1; 0,21 (0,07-0,39) vs. group 2; 0,16 (0,08-0,31), group 1; 8,2 (3,4-10,4) vs. group 2; 5,85 (3,5-7,7), p<0,001, p<0,001 respectively.Conclusions We found that high Uric acid / High-density lipoprotein-cholesterol ratios and high uric acid levels are associated with poor collateral circulation.
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