Purpose: Arterial stiffness has been shown as an independent predictor of cardiovascular and all-cause mortality in hypertensive patients. commonly seen in pulse wave Doppler echocardiographic ...examination of the left ventricle outflow tract, is related to diastolic dysfunction and arterial stiffness parameters. Our study aims to investigate the relation between aortic distensibility (AD) and presystolic A wave (PSW),.
Materials and Methods: Hypertensive patients were included in the study. Aortic stiffness was calculated by measuring aortic diameters with m-mode in echocardiography, and the presence of PSW was noted from the left ventricle outflow tract just proximal to the aortic valve in apical five-chamber view.
Results: A total of 149 hypertensive patients were included. Diastolic blood pressure, septum diameter, posterior wall diameter, aortic diastolic, and systolic diameter were significantly higher in the presence of PSW. Aortic distensibility (AD) was higher in patients with PSW. Multivariable logistic regression analysis showed that AD (OR: 0.812, 95% CI: 0.712 – 0.927, p = 0.002) was an independent predictor of PSW presence.
Conclusion: PSW presence is associated with aortic stiffness evaluated by decreased aortic distensibility and highlights that PSW presence could be an independent predictor of aortic stiffness in patients with HT.
Amaç: Arteriyel sertlik, hipertansif hastalarda kardiyovasküler ve tüm nedenlere bağlı mortalitenin bağımsız bir öngörücüsü olarak gösterilmiştir. Sol ventrikül çıkış yolunun nabız Doppler ekokardiyografik incelemesinde sıklıkla görülen presistolik A dalgası (PSW), diyastolik disfonksiyon ve arteriyel sertlik parametreleri ile ilişkilidir. Çalışmamız aort distensibilitesi (AD) ile PSW arasındaki ilişkiyi incelemeyi amaçlamaktadır.
Gereç ve Yöntem: Polikliniğimize ayaktan başvuran hipertansif hastalar çalışmaya dahil edildi. Aort sertliği, ekokardiyografide aort çapları m-modu ile ölçülerek hesaplandı ve apikal beş boşluk görünümde sol ventrikül çıkış yolunda, aort kapağının hemen proksimalinden PSW olup olmadığı kaydedildi.
Bulgular: Toplam 149 hipertansif hasta çalışmaya dahil edildi. PSW varlığında diyastolik kan basıncı, septum çapı, arka duvar çapı, aortik diyastolik ve sistolik çap anlamlı olarak yüksekti. Aort distensibilitesi (AD) PSW'li hastalarda daha. Çok değişkenli lojistik regresyon analizi, AD'nin (OR: 0,812, %95 GA: 0,712 – 0,927, p = 0,002) PSW varlığının bağımsız bir prediktörü olduğunu gösterdi.
Sonuç: PSW varlığı, azalmış aort distensibilitesi ile değerlendirilen aort sertliği ile ilişkilidir ve hipertansiyon hastalarında aort sertliğinin bağımsız bir prediktörü olarak kullanılabilir.
Thrombotic process is triggered in the course of Coronavirus disease-2019 (COVID-19), which is a global pandemic, and both arterial and venous systems are affected. ST-elevation myocardial infarction ...(STEMI) that may develop in these patients may cause more complicated results with the effect of thrombosis burden. Our aim in this study is to determine the frequency of no-reflow phenomenon in COVID-19 patients with STEMI and to determine the factors that predict this complication.
In this study, which is a single-centre, retrospective and observational, a total of 126 patients who underwent primary percutaneous coronary intervention (pPCI) in our centre due to STEMI between 11 March 2020 and 10 January 2021 were evaluated. Patients were divided into two groups according to the presence of COVID-19 infection.
While 62 patients were in the COVID-19 (+) group, 64 patients were evaluated in the COVID-19 (-) group. When the two groups are compared, C-reactive protein, D-dimer, ferritin and neutrophil-lymphocyte ratio (NLR) were significantly higher, and the lymphocyte count was significantly lower in the COVID-19 (+) group. No-reflow was numerically higher in patients with COVID-19. In multivariable analysis, D-dimer and NLR were found to be independent predictors of no-reflow phenomenon in COVID-19 patients.
Although the no-reflow phenomenon was numerically higher in COVID-19 patients who underwent pPCI due to STEMI compared to the non-COVID group, no statistical difference was found in our study. However, NLR and D-dimer have been identified as independent predictors of no-reflow development risk in COVID-19 patients.
The severe acute respiratory syndrome coronavirus 2 is the source of the global pandemic known as coronavirus disease 2019, and the disease prognosis is also linked to the prevalence of cardiac ...problems. In our study, we aimed to contribute to the early diagnosis and treatment of cardiac complications by evaluating ischemic modified albumin levels in adults with coronavirus disease 2019 disease.
Our study was conducted with a total of 176 cases: group 1 (n = 70) with cardiac injury and coronavirus disease 2019 (+), group 2 (n = 57) with cardiac injury and coronavirus disease (-), and group 3 (n = 49) with healthy volunteers. The Mann-Whitney U test, the average, SD, minimum and maximum values, intergroup comparison of the results, and statistical significance were evaluated with the Pearson correlation coefficient.
As a result of the bilateral comparisons, ischemic modified albumin measurements of the coronavirus disease 2019 (+) and coronavirus disease 2019 (-) groups were higher than the control group (P =.006 and P =.006, respectively). There was no statistically significant difference between ischemic modified albumin measurements of coronavirus disease 2019 (+) and coronavirus disease 2019 (-) groups.
Ischemic modified albumin measurement accelerates the diagnosis and treatment process in the evaluation of cardiac injuries in coronavirus disease 2019 patients.
Purpose: The present study sought to investigate the association between Cardiac magnetic resonance (CMR) imaging parameters including late gadolinium enhancement (LGE), total left ventricular mass ...(TLVM), mitral regurgitation, and left atrial (LA) volume, with atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM). patients.
Materials and Methods: Consecutive 122 patients with the diagnosis of HCM and together with having 48-hour Holter monitoring were included in the present work. Two experienced observers evaluated all CMR images. The correlation between AF and CMR parameters including TLVM, LA volume, the presence and extent of LGE, mitral regurgitation, and the maximum left ventricular thickness were evaluated.
Results: Between the LA volume and AF, a significant correlation was observed. Additionally, TLVM was also associated with AF. The logistic multivariate analysis assessing TLVM, LA volume, and the extent of LGE revealed that only the left atrial volume was the independent predictor. Significant correlations were observed between the existence and extent of LGE, TLVM, mitral regurgitation and LA volume.
Conclusion: The presence of LGE was positively correlated with LA volume. LA volume appears to be the most important independent predictor of AF in HCM patients.
Amaç:, Bu çalışmada Hipertrofik kardiyomiyopati (HKMP) hastalarında geç kontrast tututulmu (GKT), toplam sol ventrikül kütlesi (TSVK), mitral yetersizlik ve sol atriyum (SA) hacmi dahil olmak üzere Kardiyak manyetik rezonans (KMR) görüntüleme parametreleri ile atriyal fibrilasyon (AF) arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: Bu çalışmaya HKMP tanısı alan, KMR çekimi yapılmış ve 48 saatlik Holter monitorizasyonu olan ardışık 122 hasta dahil edilmiştir. KMR tecrübesine sahip Radyoloji ve Kardiyoloji uzman hekimleri tarafından KMR görüntüleri değerlendirilmiştir. TSVK, SA hacmi, GKT varlığı ve yaygınlığı, mitral yetersizliği ve maksimum sol ventrikül kalınlığını içeren KMR parametreleri ile AF arasındaki korelasyon değerlendirilmiştir.
Bulgular: SA hacmi ve AF arasında anlamlı bir korelasyon gözlendi. Ek olarak TSVK, AF ile ilişkili bulundu. TSVK, SA hacmi ve GKT'nin kapsamını değerlendiren lojistik çok değişkenli analiz, yalnızca sol atriyal hacmin bağımsız öngörücü olduğunu ortaya koydu. GKT, TSVK, mitral yetersizlik ve SA hacminin varlığı ve yaygınlığı arasında anlamlı korelasyonlar gözlendi.
Sonuç: GKT'nin varlığı, SA hacmi ile pozitif korelasyon gösterdi. SA hacmi, HKMP hastalarında AF'nin en önemli bağımsız belirleyicisi gibi görünmektedir.
Background
Myocardial bridging (MB) and hypertrophic cardiomyopathy (HCM) are associated with the risk of fatal ventricular arrhythmias (VAs). The goal of the study was to determine the relationship ...between MB and fatal VAs in HCM patients with implantable cardiac defibrillators (ICD).
Methods
A total of 108 HCM patients (mean age: 46.6 ± 13.6 years; male: 73) were enrolled in this retrospective study. All patients underwent transthoracic echocardiography and coronary computed tomography angiography. Fatal VAs including sustained ventricular tachycardia and ventricular fibrillation were documented in ICD records.
Results
There were documented fatal VAs in 29 (26.8%) patients during a mean follow-up time of 71.3 ± 30.9 months. Compared with the other groups, the fatal VA group had a higher incidence of the following: presence of MB (82.8 vs. 38%,
p
< 0.001), deep MB (62.1 vs. 6.3%,
p
< 0.001), very deep MB (24.1 vs. 0%,
p
< 0.001), long MB (65.5 vs. 11.4%,
p
< 0.001), presence of > 1 MB (17.2 vs. 0%,
p
= 0.001), and MB of the left anterior descending artery (79.3 vs. 17.7%,
p
< 0.001) . Sudden cardiac death (SCD) risk score (hazard ratio: 1.194; 95% CI: 1.071–1.330;
p
= 0.001) and presence of MB (hazard ratio: 3.815; 95% CI: 1.41–10.284;
p
= 0.008) were found to be independent predictors of fatal VAs in HCM patients.
Conclusions
The current data suggest that the SCD risk score and presence of MB were independent risk factors for fatal VAs in patients with HCM. In addition to conventional risk factors, the coronary anatomical course can provide clinicians with valuable information when assessing the risk of fatal VAs in HCM patients.
Abstract
OBJECTIVES
Fragmented QRS (fQRS), related to myocardial fibrosis, is an important prognostic marker of cardiovascular events and mortality. Aortic stenosis (AS), the most frequent valvular ...heart disease in developed countries, causes myocardial fibrosis due to ventricular pressure overload. The current study aimed to investigate whether fQRS is associated with long-term mortality after isolated surgical aortic valve replacement (SAVR) in patients with severe AS.
METHODS
A total of 289 patients who underwent SAVR for severe AS between May 2009 and January 2020 with interpretable electrocardiogram were included. Patients were divided into 2 groups according to the presence of fQRS. Kaplan–Meier survival analyses were used to detect cumulative survival rates. Univariable and multivariable Cox proportional hazards models were used to determine the predictors of all-cause mortality.
RESULTS
fQRS occurred in 126 (43.5%) patients. A total of 59 (20.4%) patients died over a follow-up period of 54 ± 32 months. All-cause mortality was higher in the fQRS group (23 14.1% vs 36 28.6, log-rank test P = 0.002) in the long term. The presence of fQRS hazard ratio (HR): 1.802, confidence interval (CI): 1.035–3.135, P = 0.037, electrocardiographic left ventricular strain (HR: 1.836, CI: 1.036–3.254, P = 0.038) and history of stroke or transient ischaemic attack (HR: 3.130, CI: 1.528–6.412, P = 0.002) were independent predictors of all-cause mortality in the multivariable Cox regression model.
CONCLUSIONS
fQRS is associated with a 1.8-fold increase in long-term mortality in patients undergoing isolated SAVR for severe AS. Detecting fQRS in electrocardiograms may provide prognostic information about the long-term outcomes.
Aortic stenosis (AS) is the most frequent valvular heart disease in developed countries, especially among the older population 1.
Abstarct
Background
Carotid artery stenting (CAS) is being increasingly used as an alternative revascularization procedure to carotid endarterectomy; however, subclinical ischemic cerebral lesions ...after CAS remain as a matter of concern. Hence, we aimed to assess the clinical utility of the CHADS2 score in predicting subclinical ischemic events after CAS.
Methods
We prospectively evaluated 107 patients (mean age: 70.4 ± 6.6 years, male:77) who underwent CAS for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after CAS were excluded. The presence of new hyperintense lesion on diffusion‐weighted imaging (DWI) without any neurological findings was considered as silent ischemia. Patients were classified into two groups as DWI‐positive and DWI‐negative patients.
Results
Among study population, 28 patients (26.2%) had subclinical embolism. The DWI‐positive group had a significantly higher CHADS2 scores, older age, more frequent history of stroke, higher proportion of type III aortic arch, and longer fluoroscopy time than the DWI‐negative group. Increased CHADS2 score was identified as one of the independent predictors of silent embolism (OR = 5.584; 95%CI: 1.516–20.566; p = .010), and CHADS2 score higher than 2.5 predicted subclinical cerebral ischemia with a sensitivity of 72% and a specificity of 71% (AUC: 0.793; 95% CI: 0.696 – 0.890; p < .001).
Conclusions
CHADS2 score was able to predict the risk of periprocedural subclinical ischemic events in CAS and might be of clinical value in the management of patients with carotid artery stenosis.
•Survival predictors for TAVI are of great interest.•Ventricular repolarization abnormality plays an important role on cardiac outcomes.•Abnormal fQRSTa is related with ventricular repolarization ...heterogeneity.•Wide fQRSTa predicts mortality in patients after TAVI.
Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients ...with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1).
The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period.
A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period 4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001.
The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42).
Chronic limb-threatening ischemia (CLTI), which presents with ischemic rest pain, ulceration, or gangrene, is a complex form of peripheral artery disease that can cause mortality and amputation. ...C-reactive protein (CRP), an inflammatory marker, indicates vascular inflammation resulting from the cytokine-dependent inflammatory process in the arterial wall, and arterial atherosclerosis resulting from the inflammation. Lower albumin levels are also associated with peripheral artery disease. We investigated the association between CRP/Albumin ratio (CAR) and long-term mortality in patients with CLTI.
A total of 172 patients who underwent endovascular treatment (EVT) for below the knee (BTK) lesions were enrolled in this study. Patients with acute infection requiring antibiotic therapy, chronic inflammatory disease, end-stage liver disease, malignancy were excluded from the study. Besides, patients with pre-follow-up intervention to the same vascular bed were also excluded from the study. The primary endpoint of the study was all-cause mortality. Patients were divided into 2 groups according to mortality.
A total of 70 patients (40.6%) died during 32 ± 21 months of follow-up in the present study. The major amputation rate was 21.5%. The mortality (+) group was older and had higher rates of congestive heart failure, chronic kidney disease, history of stroke, and CRP levels. Moreover, statin and ACE inhibitor/angiotensin receptor blocker (ACE/ARB) use, GFR, and albumin levels were lower in the mortality (+) group. CAR was significantly higher in the mortality (+) group when comparing both groups (3.25 1.46 - 7.86 vs. 9.75 4.5 - 17.71, P < 0.001). CAR, congestive heart failure, chronic kidney disease, history of stroke, ACE/ARB, or statin use were independent predictors of all-cause mortality in multivariable Cox regression analysis.
CAR was associated with mortality in CLTI patients undergoing EVT for BTK lesions. CAR may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.
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