O Índice de Inflamação Imune Sistêmica é um Novo Marcador na Previsão da Presença e Gravidade aa Ectasia Coronariana Isolada / Systemic Immune Inflammation Index is a Novel Marker in Predicting the Presence and Severity of Isolated Coronary Artery Ectasia

Resumo Fundamento A patologia subjacente da ectasia da artéria coronária (EC) isolada não foi totalmente elucidada. Objetivo Nosso objetivo foi examinar a relação entre o índice de inflamação imune sistêmica (Sıı), que corresponde à multiplicação da razão neutrófilos-linfócitos (RNL) e as contagens de plaquetas, e EC isolada. Método A população do estudo retrospectivo incluiu 200 pacientes com EC isolada, 200 consecutivos com doença arterial coronariana obstrutiva e 200 consecutivos com angiografia coronária normal. Um valor de p bicaudal <0,05 foi considerado significativo. Resultados Sıı, RNL, razão plaqueta-linfócito (RPL) e razão monócito-colesterol de lipoproteína de alta densidade (MHR) foram significativamente maiores no grupo EC em comparação com os outros grupos (todos p<0,001). Na análise multivariada, Sıı (p<0,001, OR = 1,005, IC 95% =1,004-1,005) foi considerado um preditor independente de EC isolada. Na análise da curva Receiver Operating Characteristic (ROC), Sıı teve uma área sob a curva maior em comparação com RNL, RPL e MHR. O valor de Sıı >517,35 tem 79% de sensibilidade, 76% de especificidade para a predição do EC [AUC: 0,832, (p<0,001)]. Sıı teve correlação significativa com o número de artérias coronárias ectásicas e classificação de Markis (r: 0,214 p=0,002; r:-0,195, p=0,006, respectivamente). Conclusão Até onde sabemos, este é o primeiro estudo em que Sıı foi significativamente associado à presença isolada de EC e gravidade anatômica.

Abstract Background The underlying pathology of isolated coronary artery ectasia (CE) has not been fully elucidated. Objective We aimed to examine the relationship between the systemic immune inflammation index (Sıı), which corresponds to the multiplying of the neutrophil-to-lymphocyte ratio (NLR) and the platelet counts, and isolated CE. Method The retrospective study population included 200 patients with isolated CE, 200 consecutive with obstructive coronary artery disease, and 200 consecutive with a normal coronary artery angiogram. A 2-sided p-value of <0.05 was considered significant. Results Sıı, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-high density lipoprotein cholesterol ratio (MHR) were significantly higher in the CE group compared with the other groups (all p<0.001). In multivariate analysis, Sıı (p<0.001, OR = 1.005, 95% CI =1.004-1.005) was found to be an independent predictor of isolated CE. In Receiver Operating Characteristic curve analysis, Sıı had a higher Area Under the Curve than NLR, PLR, and MHR. Sıı value of >517.35 has 79% sensitivity, 76% specificity for the prediction of the CE [AUC: 0.832, (p<0.001)]. Sıı had a significant correlation with the number of ectatic coronary arteries and Markis classification (r:0.214 p=0.002; r:-0.195, p=0.006, respectively). Conclusion To the best of our knowledge, this is the first study that Sıı was significantly associated with isolated CE presence and anatomical severity.

Glasgow prognostic score as a marker of mortality after TAVI

Abstract Introduction: The Glasgow prognostic score (GPS) reflects host systemic inflammatory response and has been reported to be significant as a prognostic indicator in cancer-bearing patients. The aim of this study was to evaluate the predictive value of GPS in outcomes of patients with severe aortic stenosis who were treated with transcatheter aortic valve implantation (TAVI). Methods: The study population consisted of 79 patients who underwent TAVI due to severe aortic stenosis between January 2018 and March 2019 in our clinic. Echocardiographic and laboratory data were recorded before the procedure and GPS was scored as 0, 1, or 2, based on serum albumin and C-reactive protein levels. European System for Cardiac Operative Risk Evaluation II scoring system was used for risk stratification. The primary endpoints of the study were postoperative in-hospital mortality, hospitalization due to cardiac causes, or mortality within a year. Results: The 79 patients were classified into two groups according to outcomes. Fifteen patients (19%) reached the primary endpoints at one year of follow-up. Compared to the patients who did not reach the endpoints, these 15 patients were not different in terms of age, preoperative mean gradient, and ejection fraction (P>0.05 for all). GPS was the only laboratory parameter with statistically significant difference between the groups (P=0.008) and multivariate analysis showed that GPS was independent predictor of primary endpoints (P=0.012, odds ratio 4.51, 95% confidence interval 1.39-14.60). Conclusion: GPS is an easy, noninvasive laboratory test which may be used as a predictive biomarker for outcomes in patients undergoing TAVI.

Slow Flow Phenomenon Impairs the Prognosis of Coronary Artery Ectasia as Well as Coronary Atherosclerosis

Abstract Introduction: Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders and its prognosis is still debated. Objective: We aimed to review long-term follow-up data in patients with CAE and to evaluate the prognosis of CAE patients with coronary slow flow phenomenon (CSFP). Methods: This study had a prospective design and 143 patients with CAE were included. The angiographic and demographic characteristics were reviewed in detail. The patients were categorized, based on concomitant coronary artery stenosis detected by angiography, as CCAE group (n=87, ≥30% luminal stenosis) and ICAE group (n=56, <30% luminal stenosis) and also categorized by the coronary flow as CSFP group (n=51) and normal flow coronary ectasia - NCEA group (n=92). All patients were re-evaluated at 6-month intervals. Follow-up data, cardiovascular (CV) mortality, hospitalization and major adverse cardiac events (MACE) were collected. The level of statistical significance was set at 5%. Results: Patients were followed up for an average of 56.9±7.4 months. During the follow-up, statistically significant differences were found in hospitalization, CV mortality and MACE between the CCAE and ICAE groups (P=0.038, P=0.003, P=0.001, respectively). The CSFP and NCEA groups were also compared. There was a statistical difference with respect to hospitalization between the CFSP and NCEA groups (P=0.001), but no difference was observed in terms of MACE and CV mortality (P=0.793 and P=0.279). Conclusion: CSFP accompanying CAE may be a predictor of hospitalization. Significant atherosclerotic plaques coexisting with CAE may be predictive for MACE.

Aumento da Rigidez Arterial Pulmonar e Comprometimento do Acoplamento Ventrículo Direito-Artéria Pulmonar na SOP / Increased Pulmonary Arterial Stiffness and Impaired Right Ventricle-Pulmonary Artery Coupling In PCOS

Resumo Fundamento: A síndrome dos ovários policísticos (SOP) é a doença endócrino-metabólica mais comum em mulheres em idade reprodutiva, e ocorre em uma a cada 10 mulheres. A doença inclui irregularidade menstrual e excesso de hormônios masculinos e é a causa mais comum de infertilidade em mulheres. A dispneia é um sintoma frequente e muitas vezes acredita-se que seja decorrente da obesidade, mas não se sabe se é decorrente de disfunção cardíaca. Objetivo: Avaliar o acoplamento ventrículo-arterial (VDAP) e a rigidez arterial pulmonar em pacientes com SOP. Métodos: Foram incluídos 44 pacientes com SOP e 60 controles; amostras de sangue venoso foram coletadas para exames laboratoriais e ecocardiograma transtorácico 2-D, Modo-M e com Doppler tecidual foram realizados em todos os participantes. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados: Quando comparadas ao grupo controle, as pacientes com SOP apresentaram valores maiores de rigidez da artéria pulmonar (p = 0,001), que se correlacionaram positivamente com o índice HOMA-IR (r = 0,545 e p <0,001). O acoplamento VDAP também estava comprometido em 34% dos pacientes do estudo. Conclusão: A rigidez da artéria pulmonar está aumentada e o acoplamento VDAP está comprometido em pacientes com SOP. (Arq Bras Cardiol. 2021; 116(4):806-811)

Abstract Background: Polycystic ovary syndrome (PCOS) is the most common endocrine-metabolic disease in women in reproductive age, and occurs in one of 10 women. The disease includes menstrual irregularity and excess of male hormones and is the most common cause of female infertility. Dyspnea is a frequent symptom and is often thought to be due to obesity, and whether it is due to cardiac dysfunction is unknown. Objective: To evaluate right ventricle-pulmonary artery (RV-PA) coupling and pulmonary arterial stiffness in patients with PCOS. Methods: 44 PCOS patients and 60 controls were included; venous blood samples were taken for laboratory tests and 2-D, m-mode and tissue doppler transthoracic echocardiography were performed for all the participants. P<0,05 was considered as statistically significant. Results: When compared to the control group, PCOS patients had higher pulmonary artery stiffness values (p=0,001), which were positively correlated with HOMA-IR (r=0,545 and p<0,001). RV-PA coupling was also impaired in 34% of the study patients. Conclusion: Pulmonary artery stiffness is increased and RV-PA coupling is impaired in patients with PCOS. (Arq Bras Cardiol. 2021; 116(4):806-811)