O Índice Nutricional Prognóstico está Associado ao Grau de Circulação Colateral Coronariana em Pacientes com Angina Estável e Oclusão Total Crônica / Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion

Resumo Fundamento: A circulação colateral coronária (CCC) pode efetivamente melhorar o suprimento sanguíneo miocárdico para a área de OCT (oclusão coronariana total crônica) e pode, assim, melhorar o prognóstico de pacientes com síndrome coronariana estável (SCE). O grau de inflamação e alguns marcadores de inflamação foram associados ao desenvolvimento de colaterais. Objetivo: Investigar se o índice nutricional prognóstico (INP) tem associação com o desenvolvimento de CCC em pacientes com SCE. Métodos: Um total de 400 pacientes com SCE com presença de OTC em pelo menos uma importante artéria coronária epicárdica foi incluído neste estudo. Os pacientes foram divididos em dois grupos de acordo com o escore Rentrop. Escores de 0 a 1 foram considerados CCC pouco desenvolvidas e escores de 2 a 3 foram aceitos como CCC bem desenvolvidas. A significância estatística foi definida como um valor p < 0,05 para todas as análises. Resultados: A média de idade da coorte do estudo foi de 63±10 anos; 273 (68,3%) eram do sexo masculino. O grupo CCC pouco desenvolvido apresentou um nível de INP significativamente mais baixo em comparação com o grupo CCC bem desenvolvido (38,29±5,58 vs 41,23±3,85, p<0,001). Na análise multivariada, o INP (odds ratio 0,870; intervalo de confiança de 95% 0,822-0,922; p<0,001) foi um preditor independente de CCC pouco desenvolvida. Conclusão: O INP pode ser utilizado como um dos preditores independentes da formação do CCC. Foi positivamente associado ao desenvolvimento de colaterais coronárias em pacientes com SCE com OTC.

Abstract Background: Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. Objective: To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. Methods: A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. Results: The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. Conclusion: The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.

Impact of catheter ablation procedure on optical coherence tomography angiography findings in patients with ventricular arrhythmia

SUMMARY OBJECTIVE: Catheter ablation procedure may cause retinal complications associated with the risk of thromboembolism. We aimed to evaluate retina and optic disc microvascularity with optical coherence tomography angiography before and after the catheter ablation process in patients with ventricular arrhythmia. METHODS: A total of 40 eyes of 21 ventricular arrhythmia patients were included in this cross-sectional study. Demographic characteristics and ophthalmic examination findings of patients were recorded. optical coherence tomography angiography measurements were evaluated before (group 1) and after (group 2) catheter ablation. Optical coherence tomography angiography was applied to all eyes with 6×6 mm sections for the macula and 4.5×4.5 mm sections for the optic nerve head. Foveal retinal thickness, peripapillary retinal nerve fiber layer thickness, vessel density in different parts of the retina, and optic disc were analyzed. RESULTS: The mean age of ventricular arrhythmia patients was 53.48±13.02 years. In all, 13 (61.9%) of the patients were males and 8 (38.1%) were females. There was no significant difference between the groups in terms of average, inferior, superior, and temporal retinal nerve fiber layer thicknesses, foveal avascular area, flow areas, superficial and deep vessel densities, and optic disc capillary densities of the optic disc. However, when compared with group 1, significantly lower values in foveal retinal thickness and higher values in nasal retinal nerve fiber layer thickness were observed in group 2 (248.42±20.50 vs. 247.20±20.44, p<0.001 and 94.22±18.43 vs. 96.12±20.18, p=0.044, respectively). CONCLUSION: Although foveal retinal thickness and nasal retinal nerve fiber layer thickness are affected in patients undergoing catheter ablation for ventricular arrhythmia, the stable retinal and optic disc vessel densities can be explained by the administration of effective anticoagulants during the procedure.

Serum Prealbumin: a potential predictor of Right Ventricular Dysfunction in patients receiving programmed hemodialysis

SUMMARY OBJECTIVE: Prealbumin has been a reliable marker to predict protein energy malnutrition and hypercatabolic state. In this analysis, we particularly aimed to investigate the potential association between serum prealbumin levels and right ventricular dysfunction in patients receiving programmed hemodialysis. METHODS: A total of 57 subjects were included in the analysis. The subjects were then categorized into two groups: right ventricular dysfunction (n=18) and non-right ventricular dysfunction (n=39) groups. In all patients, detailed transthoracic echocardiography (following hemodialysis) were performed along with the evaluation of complete blood count, routine biochemistry parameters, and, in particular, serum prealbumin levels. RESULTS: Mortality rate at 3 years was found to be significantly higher in the right ventricular dysfunction group (p=0.042). Serum prealbumin levels were also significantly lower in the right ventricular dysfunction group compared with the non-right ventricular dysfunction group (23.83±8.50 mg/dL versus 31.38±6.81 mg/dL, p=0.001). In the receiver operating characteristics curve analysis, a prealbumin cutoff value of <28.5 mg/dL was found to predict right ventricular dysfunction, with a sensitivity of 67% and a specificity of 62% (area under the curve: 0.744). In the correlation analysis, a moderate yet significant positive correlation was demonstrated between serum prealbumin and tricuspid annular plane systolic excursion (r=0.365, p=0.005). CONCLUSION: This study suggests that low serum prealbumin might serve as a potential predictor of right ventricular dysfunction (and its clinical consequences) in patients receiving programmed hemodialysis.

Lower LDL-cholesterol levels associated with increased inflammatory burden in patients with acute ST-segment elevation myocardial infarction

SUMMARY OBJECTIVE: Association of low-density lipoprotein cholesterol and highly sensitive C-reactive protein in ST-elevation myocardial infarction patients was assessed in this study. METHODS: 591 consecutive patients who were hospitalized with a diagnosis of ST-elevation myocardial infarction were enrolled and assigned into tertiles according to their serum low-density lipoprotein cholesterol levels. Differences in highly sensitive C-reactive protein among low-density lipoprotein cholesterol tertiles and correlations between highly sensitive C-reactive protein and low-density lipoprotein cholesterol were assessed. RESULTS: Highly sensitive C-reactive protein levels differed significantly among the groups (p<0.001) and found to be highest in the low-density lipoprotein cholesterol tertile 1 and lowest in the low-density lipoprotein cholesterol tertile 3 (post-hoc p-values: tertile 1 vs. 2 <0.001; tertile 1 vs. 3 <0.001; tertile 2 vs. 3=0.019). There was a negative correlation between hs-CRP and both low-density lipoprotein cholesterol (r=-0.332, p<0.001) and total cholesterol (r=-0.326, p<0.001). There was also a negative correlation between highly sensitive C-reactive protein and high-density lipoprotein cholesterol, though the strength of this relationship was weak (r=-0.103, p=0.014). CONCLUSION: Lower low-density lipoprotein cholesterol levels are associated with higher inflammatory burden in patients with acute STEMI. Further studies are required to elucidate the significance of low-density lipoprotein cholesterol levels in ST-elevation myocardial infarction settings.

Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVES: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention. METHODS: A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. RESULTS: The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio. CONCLUSIONS: An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST-segment ...