The effect of L-thyroxine treatment on ventricular dysfunction and pulmonary arterial stiffness in patients with subclinical hypothyroidism.

OBJECTIVE: In our study, we aimed at evaluating the change in biventricular functions and pulmonary arterial stiffness (PAS) in patients with subclinical hypothyroidism (SH) in whom euthyroidism was achieved with L-thyroxine therapy. PATIENTS AND METHODS: 70 SH patients and 75 healthy volunteers were included in our study consecutively. Baseline demographic and echocardiographic data of the participants were recorded. The data obtained in the control evaluation 6 months after the euthyroidism were achieved in the SH group patients started on L-thyroxine treatment and then compared with the baseline measurements. RESULTS: The mean age of patients in the SH group was 44.1 ± 9.4 years and 47.1% were women. Euthyroidism in SH patients was achieved with a mean daily L-thyroxine treatment of 59 µg/day for a mean of 16.1 ± 4.5 weeks. Positive changes in metabolic and hormonal profiles were achieved after L-thyroxine treatment in SH patients. It was determined that left ventricular and right ventricular isovolumetric relaxation and myocardial performance index were higher in SH patients compared to the control group, and these measurements were observed to decrease significantly with L-thyroxine treatment (p < 0.05 for each). While PAS was 16.9 ± 3.1 kHz/ms in the control group, it was 25.2 ± 5.3 kHz/ms in the SH group (p < 0.05). After L-thyroxine treatment, PAS measurements decreased to 17.2 ± 3.2 kHz/ms (p < 0.05) in the SH group and showed a positive change. Thyroid-stimulating hormone (TSH) change (Δ TSH) with Δ E/A ratio (r: -0.407, p < 0.001), right ventricular myocardial performance index (Δ RV MPI) change (r: 0.404, p < 0.001) and PAS change (Δ PAS) (r: 0.458, p < 0.001) found to be correlated. CONCLUSIONS: SH is associated with dysfunction in the biventricular and pulmonary vascular bed. Biventricular functions and PAS change positively in SH patients with L-thyroxine treatment.

The predictive value of residual SYNTAX score and SYNTAX revascularization index for contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction.

OBJECTIVE: We aimed to evaluate the association of incomplete revascularization score and the treated coronary artery disease burden with the development of contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention. Incomplete revascularization score was expressed by the residual SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) (rSS) and the treated coronary artery disease burden was expressed by the SYNTAX revascularization index (SRI). PATIENTS AND METHODS: In our study, 604 sequential patients who underwent percutaneous coronary intervention diagnosed with STEMI between January 2018 and December 2021 were included. Patients were categorized into two groups; 'CIN (+)' who developed CIN and 'CIN (-)' who did not develop CIN. Baseline demographic, laboratory, echocardiographic, and angiographic data of the groups were compared. SYNTAX score I and II, rSS, and SRI were calculated. The diagnostic power of these angiographic parameters in the prediction of CIN was evaluated. Predictors for the development of CIN in STEMI patients were investigated. RESULTS: The mean age of the patients included in our study was 58.7 ± 12.4 years, and 79.9% of them were men. CIN was observed in 17.8% of study patients. The SYNTAX score [17.8 (11.4-24.2) vs. 15.1 (10.1-21.2); p = 0.008] and rSS [8.14 (3.9-116) vs. 4.2 (2.6-8.2); p < 0.001] were higher and SRI [56.2 ± 10.2 vs. 71.1 ± 13.6; p < 0.001] was lower in the CIN (+) group compared to the CIN (-) group. In predicting CIN, rSS was found to have significant diagnostic power at a cut-off value of 5.2, sensitivity of 81% and specificity of 69% [AUC (95% CI) = 0.752 (0.602-0.814); p < 0.001]. In logistic regression analysis, rSS [OR (95% CI) = 1.492 (1.124-1.884); p < 0.001] and SRI [OR (95% CI) = 1.055 (1.027-1.092); p < 0.001] were defined as independent predictors for the development of CIN. CONCLUSIONS: rSS and SRI are associated with CIN in STEMI patients. Although rSS is superior in predicting CIN, both angiographic scorings have significant diagnostic power. rSS and SRI are independent predictors for the development of CIN.

Frequency of fragmented QRS on ECG and relationship with left ventricular dysfunction in patients with subclinical hypothyroidism.

OBJECTIVE: Subclinical hypothyroidism (SH) is a biochemical definition that has been proven to be associated with cardiovascular diseases. Fragmented QRS (fQRS) is defined as an electrocardiographic (ECG) reflection of cardiac fibrosis. It is associated with increased cardiovascular mortality and morbidity. In this study, we aim to evaluate the presence and frequency of fQRS in SH patients and determine the relationship between fQRS presence and left ventricular dysfunction by using the myocardial performance index (MPI). PATIENTS AND METHODS: Our study included 50 newly diagnosed SH and 50 healthy participants with similar demographic characteristics. We compared demographic characteristics, laboratory findings, electrocardiographic and echocardiographic measurements of the study population. SH patients were evaluated as two groups in the subgroup analysis: [fQRS(+) SH] with fQRS and [fQRS(-) SH] without fQRS. We analyzed the correlation of thyroidstimulating hormone (TSH) levels with demographic characteristics, electrocardiographic and echocardiographic data. Independent predictors of fQRS presence were evaluated by logistic regression analysis. RESULTS: The mean age of SH patients was 44 ± 8 years, and 46% (n = 23) of the patients were women. In the control group, the mean age was 45 ± 11 years, and 52% (n = 26) of the participants were women. MPI was found to be significantly higher in the SH group compared to the control group (0.53 ± 0.07 vs. 0.41 ± 0.08, p< 0.001). fQRS was found to be significantly higher in the SH group compared to the control group (p= 0.004). In echocardiographic measurements, isovolumic relaxation time (IVRT) was found to be significantly longer in the fQRS(+) SH group (105.6 ± 21.8 ms vs. 91.1 ± 24.4 ms, p < 0.001), while isovolumic contraction time (IVCT) was not significantly different between the groups. Ejection time (ET) was significantly longer in the fQRS (-) SH group (286.9 ± 32.1 ms vs. 274.2 ± 30.6 ms; p = 0.011). MPI was 0.57 ± 0.12 in the fQRS (+) SH group and 0.48 ± 0.06 in the fQRS (-) SH group, which was significantly higher (p = 0.001). TSH was found to be 8.82 ± 4.58 in fQRS (+) SH group and 5.73 ± 3.10 in fQRS (-) SH group (p = 0.003). It was found that MPI (r = 0.302, p < 0.001) and fQRS (r = 0.321, p < 0.001) were significantly positively correlated with TSH. TSH levels [OR = 1,645, 95% CI = 1,322 to 2,067 (p = 0.001)], IVRT [OR = 1,502, 95% CI = 1,119 to 95% (p = 0.003)], and MPI [OR = 1,408, 95% CI = 0.989 - 1.806 (p = 0.001)] were found to be independent predictors of the presence of fQRS. CONCLUSIONS: The frequency of fQRS in SH patients was found to be higher than in the healthy population. MPI values were higher in fQRS (+) SH patients compared to fQRS (-) SH patients, resulting indirectly having a higher risk of tendency to left ventricular systolic/diastolic dysfunction. MPI and fQRS had a significant positive correlation with TSH. TSH, IVRT, and MPI were found to be independent predictors of the presence of fQRS in SH patients.

A novel intermediate coronary artery stenosis severity method: Fluoroscopy-Assisted Measurement of Coronary Volume Ratio (The FLAME FFR Trial).

OBJECTIVE: The fluoroscopy-assisted coronary volume measurement (FLASH) algorithm, based on contrast passage time and vessel size, is a simple and non-invasive method of assessing coronary blood volume. The present study evaluated the diagnostic performance of FLASH flow ratio-derived fractional flow reserve (FFRFLAME) compared to wire-based FFR (FFRWB). PATIENTS AND METHODS: FFRFLAME was defined as the ratio of FLASH at baseline to maximal hyperemia. Forty-eight patients with one intermediate coronary lesion (30-70% by angiographic visual estimation) were enrolled in this cross-sectional study. FFRFLAME and FFRWB measurements were collected in each patient. Intravenous administration of adenosine was used to achieve maximal hyperemia. The Pearson correlation coefficient and receiver operating characteristic analysis were performed to determine the predictive accuracy of FFRFLAME. RESULTS: The average age of the patients was 58 years, and 43% (21 of 48) were female. The predominant vessel assessed was the left anterior descending artery system (87.5%). The mean FFRWB was 0.91 ± 0.05 at baseline and 0.83 ± 0.07 at the hyperaemic level, with 27% (13 of 48) of patients having an FFRWB of ≤0.80. For each patient, the mean FFRFLAME was 0.668 ± 0.17. The mean FFRFLAME was 0.85 ± 0.16 for patients having an FFRWB of ≤0.80. A strong relationship existed between FFRFLAME and FFRWB (Pearson's r = - 0.765 p<0.001). The optimal cutoff value of the functional significance of coronary artery stenosis for FFRFLAME was determined to be > 0.84 (AUC: 0.899, 84% sensitivity and 97% specificity) when the FFRWB cutoff value for significant lesions was ≤ 0.80. CONCLUSIONS: FFRFLAME, applied to coronary angiography without the need for an invasive pressure wire, can be a beneficial index for appropriate lesion selection in coronary artery diseases.