Baseline coronary artery stenosis severity is an independent predictor of subsequent poor sleep quality in patients with acute coronary syndrome.

AIM: To investigate the relationship between coronary artery lesion severity determined using the baseline SYNTAX score and sleep problems that might occur after discharge determined using the Pittsburgh Sleep Quality Index (PSQI). METHODS: This prospective study included patients with first acute coronary syndrome (ACS) who underwent percutaneous coronary angiography between February 2019 and August 2019. The severity of coronary artery stenosis was classified according to coronary angiography and SYNTAX scores. Patients were grouped as those with a SYNTAX score of ≤22 and >22. Sleep quality after discharge was classified according to the PSQI. PSQI ≤5 represented good sleep quality, and PSQI >5 represented poor sleep quality. Univariate and multivariate logistic regression was used to investigate the relationship between sleep quality and coronary artery stenosis severity. RESULTS: A total of 424 patients were included in the study. Of these, 294 (69.34%) had a SYNTAX score of ≤22 and 130 (30.66%) had a SYNTAX score of >22. The mean age of all patients was 60.37 ±â€…12.23 years, 59.69 ±â€…11.85 years in the SYNTAX ≤22 groups and 61.90 ±â€…12.98 years in the SYNTAX >22 group (P = 0.086). The majority (78.54%) of the patients were male and there was no significant difference between the SYNTAX ≤22 group and the SYNTAX >22 group in terms of sex distribution (P = 0.383). According to the univariate logistic regression analysis, age (P = 0.014), diabetes (P = 0.027), left ventricular ejection fraction (P = 0.001), estimated glomerular filtration rate (P = 0.039), creatine kinase MB (P = 0.040) and SYNTAX scores (P < 0.001) were significantly associated with high PSQI global scores (>5). However, according to the multivariate logistic regression analysis results, high (>22) SYNTAX scores were the only factor independently associated with the high (>5) PSQI global scores [odds ratio, 3.477; 95% confidence interval (CI), (2.190-5.522); P < 0.001]. Complete revascularization group had significantly higher sleep latency and sleep duration time, sleep efficiency and the percentage of patients with PSQI global score of ≤5 than the incomplete revascularization group (P < 0.001 for all). CONCLUSION: Among patients with ACS, those with high SYNTAX scores should be monitored more carefully for sleep disorders that may occur later.

The association between CHA2DS2-VASc score and aortic valve sclerosis.

BACKGROUND: Antithrombotic therapy in atrial fibrillation is generally managed with the CHA2DS2-VASc score. Aortic valve sclerosis (AVS) is a focal thickening of the aortic valve without a restriction of motion. AVS is related to several cardiovascular risk factors. Our study was performed to evaluate whether the presence of AVS was associated with the CHA2DS2-VASc score. METHODS: This cross-sectional, observational study comprised 411 patients with AVS grades 1-3 [AVS (+)] and 102 patients with AVS grade 0 [AVS (-)]. We compared CHA2DS2-VASc scores between the AVS (+) and AVS (-) groups. RESULTS: We determined that the AVS (+) group had a higher CHA2DS2-VASc score than the AVS (-) group [3 (0-8) vs 1 (0-4), p < 0.001) ]. CONCLUSIONS: In our study, the CHA2DS2-VASc score was found to be higher in patients with AVS than in those without AVS. AVS may predict cardiovascular risk in the general population.

Association between the visceral adiposity index and the coronary artery calcification score and atherosclerotic plaque morphology.

BACKGROUND: The relationship between the visceral adipose index (VAI), a surrogate marker of visceral adipose tissue dysfunction, and coronary atherosclerotic plaque (CAP) morphology remains unclear. AIMS: This study aimed to investigate the relationships between the VAI and the coronary artery calcification (CAC) score and CAP morphology in asymptomatic patients. METHODS: We retrospectively assessed 782 patients between January 2012 and January 2020. CAC scores were determined at the threshold of 130 Hounsfield units according to the Agatston technique using 64-slice computed tomography. Patients were assigned to groups with no plaque (NP), fatty plaque (FP), calcified plaque (CP), and mixed plaque (MP). RESULTS: The median VAI levels were significantly different in each group (NP: 1.2 vs. FP: 1.7 vs. CP: 2.3 vs. MP: 2.8; P <0.001). An increased VAI level was an independent predictor of the CAC score. The threshold value of the VAI exhibited a gradual increase in predicting CAP morphology. VAI threshold values were >1.6 for the FP group (vs. the NP group), >2.1 for the CP group (vs. the FP group), and >2.6 for the MP group (vs. the CP group). CONCLUSION: High VAI levels independently predict an increased CAC score and CAP morphology. The VAI exhibits superior diagnostic performance in distinguishing the presence and morphology of CAP in asymptomatic patients and offers gradual cut-off values. Therefore, the VAI may be a potential screening tool for risk stratification and diagnosing CAP morphology in patients with suspected coronary artery disease.

Prognostic role of the left ventricular global function index in predicting major adverse cardiovascular events in acute coronary syndrome patients.

Aim: This study aimed to evaluate the prognostic role of the left ventricular (LV) global function index (LVGFI) in predicting major adverse cardiovascular events in patients with acute coronary syndrome after long-term follow-up. Methods: This retrospective study included 718 patients with ST-elevated myocardial infarction (STEMI) and 781 patients with non-ST-elevated myocardial infarction (NSTEMI). The LVGFI was calculated on echocardiography with the following formula: (LV stroke volume/[LV cavity volume + LV myocardial volume]) × 100. Results: Mean LVGFI was higher in the NSTEMI group than in the STEMI group. Decreased LVGFI levels were independent predictors of major adverse cardiovascular events in both the STEMI and the NSTEMI group. Conclusion: Echocardiographic LVGFI may be a useful prognostic screening tool for acute coronary syndrome cohorts.

After a heart attack, poor heart performance is an important cause of major adverse cardiovascular events (MACEs). The left ventricular global function index (LVGFI) is a new index that evaluates cardiac performance. Early identification of patients with poor heart performance following a heart attack could prevent the occurrence of major adverse cardiovascular events and improve survival. This study aimed to explore whether the LVGFI is associated with the risk of MACEs in heart attack patients. We found that a decrease in LVGFI levels was independently associated with MACEs at 3-year follow-up in patients after a heart attack. Accordingly, we showed that an assessment of LVGFI using echocardiography offers a good distinction in identifying patients at risk for MACE after a heart attack. These findings indicate that the LVGFI may be helpful in identifying high-risk patients and optimizing treatment strategies in clinical practice.

Appraisal of transthoracic echocardiography for opportunistic screening of abdominal aortic aneurysm.

ABSTRACT: Abdominal aortic aneurysm is a life threatening disease. Most of the patients diagnosed incidentally because of the asymptomatic nature of this disease. This study aimed to determine the frequency of abdominal aortic aneurysm and evaluate the value of opportunistic screening during transthoracic echocardiography.A total of 5138 patients referred for echocardiographic evaluation for any reason were screened for abdominal aortic aneurysm between November 2014 to July 2019. The aneurysm was defined as an abdominal aorta with a diameter greater than 30 mm, or segmental dilatation of more than 50% of its size in non-dilated parts.The overall frequency of abdominal aortic aneurysm was 2.2% (n = 109) in the study population. Male sex (P < .001), older age (P < .001), presence of diastolic dysfunction (P = .036), hypertension (P < .001), coronary artery disease (P < .001), and hyperlipidemia (P < .001) were associated with abdominal aortic aneurysm. Patients with aneurysm had significantly increased diameters of the aortic trunk (P < .001) and ascending aorta (P < .001), significantly thicker interventricular septum (P < .001) and posterior wall (P < .001), significantly increased end-diastolic diameter (P < .001) and enlarged left atrium (P < .001), and significantly decreased ejection fraction (P < .001). The mostly met criteria for screening abdominal aortic aneurysm in international guidelines was the age of the patients.Based on the results of this study, screening patients over 60 years of age who undergo a transthoracic echocardiography for any reason would be beneficial to detect an asymptomatic abdominal aortic aneurysm in Turkish population.

Blood Group Types O and Non-O Are Associated With Coronary Collateral Circulation Development.

Blood group types are associated with coronary artery disease. However, data are scarce about the impact of blood group types on coronary collateral circulation. In this study, we aimed to investigate the relationship between the blood group types and coronary collateral circulation. Two hundred and twelve patients who underwent coronary angiography in our department and had a stenosis of ≥ 90% in at least one major epicardial vessel were included in our study. Collateral degree was graded according to Rentrop-Cohen classification. After grading, patients were divided into poor coronary collateral circulation (Rentrop grade 0 and 1) and good coronary collateral circulation (Rentrop 2 and 3) groups. The ABO blood type of all participants was determined. The incidence rates of O blood group type were significantly higher in the good coronary collateral group compared to the poor collateral group (37.9% vs 17.1%, P < .001). The O type blood group was an independent predictor of good coronary collateral circulation (odds ratio = 1.83, 95% confidence interval = 1.56-6.18, P = .015). Coronary collateral circulation is associated with blood group types. The O blood group predicts good coronary collateral development among patients with coronary artery disease.

The Usefulness of Admission Plasma NT-pro BNP Level to Predict Left Ventricular Aneurysm Formation after Acute ST-Segment Elevation Myocardial Infarction / Utilidade do Nível de NT-Pro-BNP no Plasma à Internação em Predizer a Formação de Aneurisma do Ventrículo Esquerdo após Infarto Agudo do Miocárdio com Elevação do Segmento ST

Abstract Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. Results: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. Conclusions: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.

Resumo Fundamento: O aneurisma do ventrículo esquerdo (AVE) é uma importante complicação do infarto agudo do miocárdio (IAM). Objetivo: Investigar o papel da porção N-terminal do pró-hormônio do peptídeo natriurético do tipo B (NT-proBNP) para predizer o desenvolvimento de AVE após infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST). Métodos: Incluímos prospectivamente 1519 pacientes consecutivos com IAMCST. Os pacientes foram divididos em dois grupos de acordo com o desenvolvimento de AVE nos seis meses após o infarto do miocárdio. Os pacientes com ou sem AVE foram examinados para determinar se existia uma relação significativa entre os valores basais do NT-proBNP e as características clínicas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: O AVE foi detectado em 157 pacientes (10,3%). O nível basal do NT-proBNP foi significativamente maior em pacientes que desenvolveram AVE após IAM (523,5 ± 231,1 pg/mL vs. 192,3 ± 176,6 pg/mL, respectivamente, p < 0,001). Os preditores independentes da formação de AVE após IAM foram idade > 65 anos, tabagismo, classe Killip > 2, cirurgia de revascularização miocárdica anterior, insuficiência cardíaca pós-infarto do miocárdio, fração de ejeção do ventrículo esquerdo < 50%, falha de reperfusão, fenômeno de no-reflow, pico de troponina I e CK-MB e NT-proBNP > 400 pg/mL na internação. Conclusões: Nossos achados indicam que o nível plasmático do fragmento N-terminal do peptídeo natriurético tipo B na admissão, entre outras variáveis, fornece informações preditivas valiosas sobre o desenvolvimento de AVE após o IAMCST agudo.

The Usefulness of Admission Plasma NT-pro BNP Level to Predict Left Ventricular Aneurysm Formation after Acute ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). METHODS: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. RESULTS: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. CONCLUSIONS: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.

An unusual cause of angina pectoris due to dynamic coronary artery compression and successful treatment with cardiac surgical reconstruction.

Extrinsic compression of coronary arteries causing angina pectoris is very unusual. No data regarding the optimal treatment for coronary artery compression due to dilated cardiac chambers have been reported. In this case report, we describe a man with severe mitral valve stenosis and the dilated left atrium, which resulted in coronary artery compression, and the successful management of his condition by surgical reconstruction.

Successful Percutaneous Coronary Intervention for Chronic Total Occlusion of Left Anterior Descending Coronary Artery in a Patient with Dextrocardia.

Dextrocardia is a rare cardiac anomaly in which the heart is located in the right chest along with the cardiac long axis directing to the right and inferiorly. Although, it is a rare clinical phenomenon, coronary artery disease with dextrocardia is presumed to be of similar frequency as in the general population. Percutaneous coronary intervention has some technical difficulties in these patients. We hereby report a male patient with dextrocardia who was previously treated with coronary artery bypass graft surgery.

Percutaneous closure of coronary artery fistula: long-term follow-up results.

INTRODUCTION: Coronary artery fistula consists of abnormal congenital connections between a coronary artery and cardiac chambers, a coronary vessel or an intrathoracic vessel that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, or coronary aneurysms. Recent reports have emphasized the efficacy of percutaneous transcatheter techniques as an alternative to surgical closure, but the reported experience is relatively limited. AIM: To assess angiographic outcomes in a series of 20 patients who underwent transcatheter closure of coronary artery fistula. MATERIAL AND METHODS: We evaluated all patients presenting with significant coronary artery fistula and undergoing transcatheter closure with coils and a vascular plug between March 2008 and June 2012. RESULTS: There were 20 patients (14 men; mean age: 53 ±8 years) with coronary artery fistula. Fistula diameter ranged from 4 to 12 mm; an average of three coils were used in the percutaneous procedure. Post-deployment angiograms demonstrated complete occlusion in all patients. The patients were followed up for 4 ±1.6 years. The control coronary computed tomographic angiography was performed in the sixth month and no patients had recanalization of the embolized vessel. CONCLUSIONS: Percutaneous closure of coronary artery fistula is a safe and effective treatment modality.

Procalcitonin: a marker of heart failure.

OBJECTIVE: Serum procalcitonin levels are associated with congestive heart failure, but are not established biomarkers of the disease. We evaluated the predictive value of serum procalcitonin levels for diagnosing heart failure and assessing its severity. METHODS AND RESULTS: This retrospective, case-control study involved 59 subjects (mean age 59.7-10.1 years; 38 males), including 21 outpa- tients and 19 inpatients with heart failure and left ventricular ejection fractions <45%, and 19 healthy controls. Serum procalcitonin levels were measured and compared among the 3 groups. Procalcitonin levels were significantly higher among inpatients (median [interquartile range], 1.45 [0.25-5.801 ng/mL) than among the outpatients (0.35 [0.001.-1.70] ng/mL; P< 0.001) or controls (0.05 [0.02-0.08] ng/mL; P< 0.0011. Using a procalcitonin cut-off level of 0.09 ng/mL, 35 (87.5%) of the 40 inpatients and outpatients were procalcitonin-positive; all control individuals were procalcitonin-negative. Serum procalcitonin levels differentiated between heart failure patients and healthy controls (sensitivity, 88.9% [95% confidence interval, 75.9-96.2%]; specificity, 100% [82.2-100.0%]; positive predictive value, 100% [91.1-100.0%]; negative predictive value, 79.2% [57.8-92.8%]). Pro calcitonin levels were >0.53 ng/mL in 4/21 (19%) outpatients and in 16/19 (84.2%) inpatients. The sensitivity and specificity of serum procalcitonin levels for differentiating between inpatients and outpatients were 84.2% and 81.0%, respectively (positive predictive value 80% [95% confidence interval, 67.6-92.4%] and 85.0% [73.9-96.1%], respectively). CONCLUSION: Serum procalcitonin levels, showing high sensitivity and specificity for diagnosing and assessing the severity of heart failure in this small study, might be considered ootential heart failure biomarkers.

Transcatheter coil embolization of a coronary artery-left ventricular fistula associated with single coronary artery anomaly.

Single coronary artery anomaly associated with coronary fistula is a rare entity. Transcatheter coil embolization is the treatment of choice for coronary artery fistulas. In this case report, we describe a patient with both single coronary artery anomaly and coronary fistula who was successfully treated with coil embolization.

Retrograde approach for percutaneous closure in a patient with ruptured sinus of Valsalva.

In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treated by percutaneous closure of the rupture using the retrograde approach. The procedure was performed successfully within 26 minutes. We think this approach may be used in future instead of the antegrade approach.