The role of serum asprosin levels in predicting the severity of coronary artery disease in patients with diabetes mellitus.

BACKGROUND: Asprosin is an emerging biomarker that plays a role in metabolic diseases. This study investigates asprosin as a predictive marker for coronary artery disease (CAD) severity in diabetic patients. METHODS: Diabetic patients (n = 181) and healthy controls (n = 60) were analyzed. CAD severity was assessed using SYNTAX score. Diabetic patients were divided into 3 groups. Group 1 = patients without CAD, group 2 = patients with low SYNTAX score, and group 3 = patients with moderate-high SYNTAX score. Asprosin levels were measured for all participants using an enzyme-linked immunosorbent assay (ELISA). RESULTS: Asprosin levels were significantly higher in patient group compared to control group (p < 0.001). Asprosin levels were significantly higher in group 3 compared to group 1 and group 2 (p = 0.002). In logistic regression analysis, asprosin levels independently predicted patients with moderate-high SYNTAX scores. According to this analysis, 1 ng/mL increase in asprosin level was found to increase the risk of having moderate-high SYNTAX score by 14.1%. When the threshold value of asprosin level was set as 22.17 ng/mL, it predicted patients with moderate-high SYNTAX score with 63.6% sensitivity and 62.6% specificity. In multivariate regression analysis, SYNTAX score independently correlated with asprosin level. CONCLUSION: This is the first study in the literature to demonstrate a positive correlation between asprosin levels and SYNTAX scores in diabetic patients with CAD. More comprehensive studies with larger groups are needed.

V1r + DIIq is a novel and accurate criterion to predict right vs. left paraseptal accessory pathways.

PURPOSE: The correct estimation of accessory pathway (AP) localization from surface ECG is critical before the procedure. Our study aimed to detect the predictive value of the V1r + DIIq criterion for differentiating right- from left-sided paraseptal APs. METHODS: We retrospectively included 58 patients with (Wolff-Parkinson-White) WPW syndrome and paraseptal APs who underwent successful catheter ablation (37 male, 21 female; mean age 34.4 ± 13.6 years). The V1r + DIIq criterion was calculated using the following formula: V1r + DIIq (mV) = initial r wave amplitude in V1 + q wave amplitude in DII. The combined criterion included V1r + DIIq <2.05 mV and/or no initial r wave in V1. RESULTS: Right-sided paraseptal APs were detected in 36 patients (62.1%), left-sided paraseptal APs were detected in 21 patients (36.2%), and AP from CS was detected in 1 patient (1.7%). The initial r wave amplitude in V1 (mV), q wave amplitude in DII (mV) and V1r + DIIq criterion (mV) were lower in patients with right-sided paraseptal APs (p < 0.001). The percentage of patients with no initial r wave in V1 (36.1% vs. 0%) and those meeting the combined criterion (91.7% vs. 4.5%) were increased in patients with right-sided paraseptal APs. The cutoff value of the V1r + DIIq criterion obtained by ROC curve analysis was 2.05 mV for predicting right-sided paraseptal APs (sensitivity: 86.1%, specificity: 95.5%). The area under the curve (AUC) was 0.943 (95% CI = 0.881-1.000) (p < 0.001). The sensitivity and specificity values were 36.1% and 100%, respectively, for the no initial r wave criterion and 91.7% and 95.5%, respectively, for the combined criterion. CONCLUSION: The V1r + DIIq criterion and the combined criterion represent novel and simple electrocardiographic criteria for accurately differentiating right- from left-sided paraseptal APs. This simple ECG measurement can improve the accuracy of detection of paraseptal AP localization and could be beneficial for decreasing ablation duration and radiation exposure.

Relationship between coarse F waves and thromboembolic events in patients with permanent atrial fibrillation.

BACKGROUND: The coarse F waves on the 12-lead surface electrocardiogram (ECG) in patients with atrial fibrillation (AF) are known as atrial viability and contractility indicator. Our aim in this study was to investigate the effect of coarse F wave on thromboembolism in patients with permanent AF. METHODS: In our study, 328 patients with permanent AF were included. Routine laboratory, echocardiographic and electrocardiographic parameters were examined. Cerebrovascular event (CVE) or acute artery occlusion was considered a thromboembolic event. RESULTS: In our study, 46 (14.0%) of the patients were found to have thromboembolic events and 282 (86%) of them were found without thromboembolic events. In the group with thromboembolic event, the number of patients with hypertension (HT) (P < .001) and history of coronary artery disease (P = .003) and elderly patients (P < .001) was significantly higher and warfarin use was significantly lower (P = .025). In the group of patients without thromboembolic events, the number of patients with a coarse F wave in surface ECG was significantly lower (P = .001). Age (OR: 1.105, 95% CI: 1.066-1.145, P < .001), HT (OR: 2.831, 95% CI: 1.266-6.331, P = .011), and coarse F wave (OR: 0.290, 95% CI: 0.126- 0.670, P = .004) were determined as independent variables for thromboembolic events. CONCLUSION: Coarse F wave in 12-lead surface ECG in patients with permanent AF may be associated with good prognosis.

A new approach to radiofrequency catheter ablation of premature ventricular contractions: The diurnal variation index.

BACKGROUND: Radiofrequency catheter ablation (RFA) is a frequently used method in the treatment of premature ventricular contractions (PVCs) resistant to drug therapy. RFA is recommended for patients with PVCs burden >10%. This study was aimed to investigate the presence of other parameters to enhance the indication of ablation in 24-hour rhythm Holter recordings. METHODS: 202 patients with >10% PVCs in 24-hour rhythm Holter recordings were included in the study between January 2015 and August 2019. Patients were divided into two groups. Radiofrequency ablation was performed in 163 patients but not in 39 patients. RESULTS: Laboratory findings were compared between two groups. Total cholesterol (p = 0.018), LDL cholesterol (p = 0.013) and triglyceride (p < 0.001) values were significantly higher in the RFA group, When the 24-hour rhythm Holter findings were compared, the diurnal variation index was significantly higher in the RFA group (p < 0.001). Triglyceride (OR: 1.013, 95% CI: 1.001-1.025, p = 0.032) and diurnal variation index (OR: 3.643, 95% CI: 1.440-9.216, p = 0.006) were determined as independent predictors in binominal logistic regression analysis. In the ROC analysis, when the cut-off value of the diurnal variation index was taken as 1.5, it was found that it could predict patients who undergo effective RFA with 76.7% sensitivity and 60% specificity. CONCLUSION: Diurnal variation index may be a useful parameter for RFA indication with PVC burden in 24-hour rhythm Holter recordings.

Ischemic changes in lead aVR is associated with left ventricular thrombus or high-grade spontaneous echocontrast in patients with acute anterior myocardial infarction.

OBJECTIVE: The aim of this study was to investigate the relationship between ischemic changes in the lead aVR and left ventricular thrombus (LVT) or high-grade spontaneous echo contrast (SEC) in patients with acute anterior myocardial infarction (MI). METHODS: Quantitative T wave polarity in lead aVR (TPaVR) and ST segment deviation in the lead aVR (STaVR) measured from a surface electrocardiogram (ECG), as well as the absolute numerical values, were recorded. The ST/TPaVR ratio was obtained by dividing the larger absolute value by the smaller. The presence of LVT or high-grade SEC was recorded using echocardiograpy. The SYNTAX score (SS), clinical SS (cSS), and residual SS (rSS) were calculated from angiography results. RESULTS: A total of 34 patients with LVT or high-grade SEC were included in Group 1. Group 2 comprised 170 patients who did not have any LVT or high-grade SEC. The P wave duration, V2 ST-segment elevation, TPaVR, cSS, and ST/TPaVR ratio were significantly higher in Group 1. The ejection fraction (EF) and STaVR were significantly higher in Group 2. The EF (Odds ratio [OR]: 0.9, 95% confidence interval [CI]: 0.833-0.973; p=0.008), TPaVR (OR: 1.454, 95% CI: 1.074-1.967; p=0.015), and ST/TPaVR ratio (OR: 1.6, 95% CI: 1.307-1.959; p<0.001) were determined to be independent predictors for Group 1. CONCLUSION: Ischemic changes in the lead aVR are closely associated with LVT or high-grade SEC in anterior MI patients.