Predicting long-term cardiovascular outcomes of patients with acute myocardial infarction using soluble ST2.

Background The increase in soluble suppression of tumorigenicity 2 (sST2) both in the diagnosis and prognosis of heart failure is well established; however, existing data regarding sST2 values as the prognostic marker after myocardial infarction (MI) are limited and have been conflicting. This study aimed to assess the clinical significance of sST2 in predicting 1-year adverse cardiovascular (CV) events in MI patients. Materials and methods In this prospective study, 380 MI patients were included. Participants were grouped into low sST2 (n = 264, mean age: 60.0 ± 12.1 years) and high sST2 groups (n = 116, mean age: 60.5 ± 11.6 years), and all study populations were followed up for major adverse cardiovascular events (MACE) which are composed of CV mortality, target vessel revascularization (TVR), non-fatal reinfarction, stroke and heart failure. Results During a 12-month follow-up, 68 (17.8%) patients had MACE. CV mortality and heart failure were significantly higher in the high sST2 group compared to the low sST2 group (15.5% vs. 4.9%, p = 0.001 and 8.6% vs. 3.4% p = 0.032, respectively). Multivariate Cox regression analysis concluded that high serum sST2 independently predicted 1-year CV mortality [hazard ratio (HR) 2.263, 95% confidence interval (CI) 1.124-4.557, p = 0.022)]. Besides, older age, Killip class >1, left anterior descending (LAD) as the culprit artery and lower systolic blood pressure were the other independent risk factors for 1-year CV mortality. Conclusions High sST2 levels are an important predictor of MACE, including CV mortality and heart failure in a 1-year follow-up period in MI patients.

The relationship between a combination of vitamin D deficiency and hyperuricemia and the severity of coronary artery disease in myocardial infarction patients.

OBJECTIVE: Vitamin D deficiency has been shown to be associated with coronary artery disease (CAD). In addition, there are studies suggesting that hyperuricemia is an independent risk factor for atherosclerosis, whereas the relationship between the combination of these 2 parameters and severity of CAD remains unclear. The aim of this study was to investigate the association between the combination of vitamin D deficiency and hyperuricemia and the extent of CAD. METHODS: A total of 502 patients who had experienced myocardial infarction (MI) were included in this cross-sectional study. The 25-hydroxyvitamin D (25OHD) and serum uric acid (SUA) levels were measured in blood samples taken at the time of admission. A 2x2 factorial design was used to create groups according to the presence of hyperuricemia (>7 mg/dL) and vitamin D deficiency (<20 ng/mL). All of the patients underwent coronary angiography and the severity of CAD was determined using the Gensini score, SYNTAX score, and the number of diseased vessels. RESULTS: Both vitamin D deficiency and hyperuricemia were present in 83 patients (16.5%). Patients with hyperuricemia/vitamin D deficiency had more multivessel disease (24.1% vs 8.5%), and a higher SYNTAX score and Gensini score compared with the control group (13.9±8.0 vs. 9.5±6.3, 54.8±24.0 vs. 40.5±19.9, respectively). Age, male sex, presence of diabetes mellitus, family history of CAD, and levels of SUA and 25OHD were independent predictors of the severity of CAD. Moreover, the hyperuricemia/vitamin D deficiency group had 4 times greater odds of severe CAD than the control group. CONCLUSION: The combination of hyperuricemia and vitamin D deficiency appears to be an independent predictor of severe CAD in MI patients.

The Elevated Soluble ST2 Predicts No-Reflow Phenomenon in ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

AIM: The primary percutaneous procedure resulted in a significant improvement in the prognosis of myocardial infarction. However, no-reflow phenomenon restrains this benefit of the process. There are studies suggesting that soluble suppression of tumorigenicity (sST2) can be valuable in the diagnosis and progression of heart failure and myocardial infarction. In this study, we aimed to investigate the effect of sST2 on no-reflow phenomenon in ST-elevated myocardial infarction (STEMI). METHOD: This study included 379 patients (258 men; mean age, 60±11 years) who underwent primary percutaneous treatment for STEMI. sST2 levels were measured from blood samples taken at admission. Patients were divided into two groups according to Thrombolysis in Myocardial Infarction(TIMI) flow grade: group 1 consists of TIMI 0,1,2, accepted as no-reflow, and group 2 consists of TIMI 3, accepted as reflow. RESULTS: No-reflow phenomenon occurred in 60 patients (15.8%). The sST2 level was higher in the no-reflow group (14.2±4.6 vs. 11.3±5.0, p=0.003). Moreover, regression analysis indicated that diabetes mellitus, lower systolic blood pressure, multivessel vascular disease, high plaque burden, and grade 0 initial TIMI flow rate were other independent predictors of the no-reflow phenomenon in our study. Besides, when the patients were divided into high and low sST2 groups according to the cut-off value from the Receiver operating characteristics analysis, being in the high sST2 group was associated with 2.7 times increased odds for no-reflow than being in the low sST2 group. CONCLUSION: sST2 is one of the independent predictors of the no-reflow phenomenon in STEMI patients undergoing primary percutaneous coronary intervention.

The relationship of age-adjusted Charlson comorbidity index and diurnal variation of blood pressure.

BACKGROUNDS: Charlson Comorbidity index (CCI) is a scoring system to predict prognosis and mortality. It exhibits better utility when combined with age, age-adjusted Charlson Comorbidity Index (ACCI). The aim of this study was to evaluate the relationship between ACCI and diurnal variation of blood pressure parameters in hypertensive patients and normotensive patients. METHODS: We enrolled 236 patients. All patients underwent a 24-h ambulatory blood pressure monitoring (ABPM) for evaluation of dipper or non-dipper pattern. We searched the correlation between ACCI and dipper or non-dipper pattern and other ABPM parameters. To further investigate the role of these parameters in predicting survival, a multivariate analysis using the Cox proportional hazard model was performed. RESULTS: 167 patients were in the hypertensive group (87 patients in non-dipper status) and 69 patients were in the normotensive group (41 patients in non-dipper status) of all study patients. We found a significant difference and negative correlation between AACI and 24-h diastolic blood pressure (DBP), awake DBP, awake mean blood pressure (MBP) and 24-h MBP and awake systolic blood pressure(SBP). Night decrease ratio of blood pressure had also a negative correlation with ACCI (p = 0.003, r = -0.233). However, we found a relationship with non-dipper pattern and ACCI in the hypertensive patients (p = 0.050). In multivariate Cox analysis sleep MBP was found related to mortality like ACCI (p = 0.023, HR = 1.086, %95 CI 1.012-1.165) Conclusion: ACCI was statistically significantly higher in non-dipper hypertensive patients than dipper hypertensive patients while ACCI had a negative correlation with blood pressure. Sleep MBP may predict mortality.

Pacemaker lead endocarditis with hiccups (Kalayci).

BACKGROUND: Lead-related infections that might develop after pacemaker implantation associated with high mortality and morbidity rates are challenging to manage and pose high-cost. Patients with lead-related infections usually present with fever, chills and fatigue and the treatment can be challenging unless the implant system is extracted. CASE PRESENTATION: A 66-year old male patient who underwent dual chamber pacemaker and implantable cardioverter defibrillator was admitted to the emergency service with a six-week history of complaints of hiccups and fever. After a detailed investigation, lead-related infective endocarditis was the diagnosis. The patient was initiated on antibiotic therapy and lead extraction was performed. CONCLUSIONS: Patients with signs of infection who underwent pacemaker implantation may present with atypical symptoms such as hiccup. In these cases, imaging, particularly echocardiography, should be performed as soon as possible and the localization of the pacemaker leads and signs of infective endocarditis should be investigated.