Global longitudinal strain score predicts all cause death in patients with chronic total occlusion with preserved ejection fraction.

OBJECTIVE: Change in LVEF is one of the most important indicators of prognosis in CTO cases. Studies in patients with CTO have shown improvement in LVEF approximately at 3 and 6 months after successful PCI. It has been shown that LV global longitudinal strain (GLS) starts to improve even 1 day after CTO-PCI. We aimed at investigating the effect of subclinical echocardiographic involvement on all-cause mortality in the group with CTO and preserved ejection fraction by evaluating the LV GLS score. PATIENTS AND METHODS: Patients with LVEF ≥ 50% were considered to have preserved ejection fraction and were included in the study. The endpoint of the study was all-cause death. For this retrospective study, 1,171 patients with coronary angiography who had had CTO in any of their vessels were screened. RESULTS: A total of 86 consecutive patients were reviewed in the study. The optimum GLS score cut-off value (≥ 14.18) for predicting mortality was determined using receiver operating characteristic (ROC) curve analysis (AUC: 0.897, sensitivity 87.5%, specificity 81.5% p<0.001). At a mean follow-up of 49 months, a significant difference was found between the two groups in all-cause mortality determined by the GLS score [2 (3.4%) vs. 14 (51.9%), p<0.001]. A significant difference in mortality was observed between the group with a low GLS score and the group with a high GLS score, according to Kaplan-Meier analysis. The effect of GLS score in predicting all-cause mortality was demonstrated in multivariate cox regression analysis (Low GLS score; OR: 6.36 95%CI (1.039-39.013), p=0.045). Cox regression multivariate analysis and the effect of GLS score in predicting mortality were observed [Low GLS score; OR: 6.368 95%CI (1.039-39.013), p=0.045]. CONCLUSIONS: As a predictor, GLS may be a valuable marker of cardiac subclinical dysfunction for all caused mortality in CTO patients.

Predictive value of lymphocyte to monocyte ratio for cardiac syndrome X.

OBJECTIVE: Cardiac syndrome X (CSX) is typically described with ischemia in stress tests in addition to angina-like chest pain and without stenosis in coronary angiography. We aimed at determining the relationship between LMR and CSX. PATIENTS AND METHODS: We retrospectively collected patients with CSX between January 2016 and December 2019. Patients with typical angina-like chest pain, normal 12-lead electrocardiography at rest, a positive response to the exercise test (> 0.1 mV ST-segment depression at 80 ms after the J point in two or more contiguous leads) or ischemia on myocardial perfusion scintigraphy and normal coronary angiography were included in the study as CSX patients. RESULTS: This study consisted of 116 patients with CSX and 153 control groups. The mean age of the patients with CSX was 52.7±9.7 years, and the mean age of the control group was 53.7±10.6 years (p= 0.416). The patients with CSX were more likely to have higher monocyte counts and LMR. According to the Pearson correlation test, the CRP value negatively correlated with the LMR. In multivariate logistic regression analysis, LMR remained a significant predictor of CSX. In ROC analysis, LMR < 4.1 had 64% sensitivity and 50% specificity (ROC area under curve: 0.587, 95% CI: 0.519-0.655, p=0.015) in accurately predicting a CSX diagnosis. CONCLUSIONS: We showed that lower LMR levels were associated with the presence of CSX.

Association between the neutrophil to lymphocyte ratio and prehypertension.

OBJECTIVES: To explore the neutrophil-lymphocyte ratio (NLR) in patients with prehypertension (PHT). BACKGROUND: Inflammation plays an important role in the development of cardiovascular diseases. A pathophysiological link also exists between inflammation and PHT. NLR is a simple marker for the assessment of inflammatory status. There is a lack of data regarding the association between NLR and pre-hypertensive state. METHODS: The present cross-sectional study included 33 newly diagnosed PHT patients and 35 normotensive control subjects. Prehypertension was defined as a systolic blood pressure (BP) of 120-139 mm Hg and/or a diastolic BP of 80-89 mm Hg. RESULTS: Patients were divided into tertiles based on NLR values: 1.17 (0.9-1.42) in tertile 1; 1.57 (1.43-1.78) in tertile 2; and 2.40 (1.82-4.5) in tertile 3. The frequency of PHT was significantly higher for patients in the upper NLR tertile compared to the middle and lower NLR tertiles (21 (91.3%), 7 (30.4%), and 5 (22.7%), respectively; p<0.001). Systolic BP and diastolic BP were significantly higher among patients in the upper NLR tertile than among those in the other NLR tertiles. CONCLUSION: An association exists between PHT and NLR. NLR measurement, as well as monocyte count, may be used to indicate increased risk of prehypertension (Tab. 2, Ref. 48).

Assessment of atrial electromechanical delay and P-wave dispersion in patients with psoriasis.

BACKGROUND: In this study, we sought to evaluate atrial electromechanical properties and conduction homogeneity by tissue Doppler imaging and electrocardiography in patients with psoriasis. METHODS: Thirty-four patients with psoriasis and 30 age- and gender-matched healthy controls were included in the study. Atrial electromechanical coupling intervals were assessed by means of tissue Doppler echocardiography and P-wave dispersion (Pd) was calculated from electrocardiogram. RESULTS: A total of 64 subjects (33 male) with a mean age of 36.8 ± 11.9 years were included in the study. Basal characteristics were similar between 2 groups. Intra-atrial (15 ± 7 ms vs. 12 ± 5 ms, P = 0.009) and inter-atrial (28 ± 7 ms vs. 23 ± 7 ms, P = 0.002) electromechanical delays were significantly higher in patients with psoriasis compared with control groups. P-maximum (112 ± 16 ms vs. 103 ± 8 ms, P = 0.006) and Pd (35 ± 9 ms vs. 20 ± 6 ms, P < 0.001) were also prolonged in patients with psoriasis. CONCLUSION: This study demonstrated that atrial electromechanical coupling intervals and P-wave dispersion were prolonged in patients with psoriasis, which may cause an increased risk of atrial fibrillation in this patient group.

Non-valvular atrial fibrillation in the elderly; preliminary results from the National AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) Study.

OBJECTIVE: This study aimed at the assessment of the clinical approach to atrial fibrillation (AF) in the older population and the consistency with the guidelines based on the records of the multicenter, prospective AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) study. PATIENTS AND METHODS: 2242 consecutive patients admitted to the Cardiology Outpatient Clinics of 17 different tertiary Health Care Centers with at least one AF attack determined on electrocardiographic examination, were included in the study. Among the patients included in the study, 631 individuals aged 75 years and older were analyzed. RESULTS: The mean age of the patients was determined as 80.3±4.2 years. The most frequent type of AF in geriatric population was the persistent-permanent type with a percentage of 88%. 60% of the patients with AF were female. Hypertension was the most common co-morbidity in patients with AF (76%). While in 16% of patients a history of stroke, transient ischemic attack or systemic thromboembolism was present, a history of bleeding was present in 14% of the patients. 37% of the patients were on warfarin treatment and 60% of the patients were on aspirin treatment. In 38% of the patients who were on oral anticoagulant treatment, INR level was in the effective range. CONCLUSIONS: The rate of anticoagulant use in the elderly with AF was 37% and considering the reason of this situation was the medication not being prescribed by the physician, one should pay more attention particularly in the field of treatment.

Explicit memory, repetition priming and cognitive skill learning in schizophrenia.

Explicit memory and two forms of implicit memory, repetition priming and cognitive skill learning, were examined in twenty-four schizophrenic patients and twenty-four normal control subjects previously matched for sex, age, and educational level. Two explicit tasks, free recall and frequency monitoring, and two implicit tasks, word completion and the Tower of Toronto puzzle, a variant of the Tower of Hanoi puzzle, were selected. The performance of schizophrenic patients was impaired in both explicit tasks, whereas repetition priming was intact; in the Tower of Toronto puzzle, a deficit was observed in problem solving, but not in skill learning. This dissociation between explicit and implicit memory is not entirely consistent with the hypothesis of a deficiency in effort-demanding information processing. It could be better accommodated by a model of a disturbance in the internal representation of context.

Effects of chlorpromazine and lorazepam on explicit memory, repetition priming and cognitive skill learning in healthy volunteers.

To assess the influence of neuroleptics on explicit memory and two forms of implicit memory, repetition priming and cognitive skill learning, the effects of two low doses of chlorpromazine (12.5 and 25 mg orally) were contrasted to those of lorazepam (2.5 mg orally) and of a placebo using a free-recall task, a word-completion task and repeated testing on the Tower of Toronto puzzle, a version of the Tower of Hanoi puzzle. Seventy-two healthy volunteers took part in this double-blind study. Chlorpromazine spared free-recall and word-completion performance, but impaired the acquisition of a cognitive routine in the subjects who completed the first trials of the Tower of Toronto puzzle efficiently. Lorazepam induced an opposite pattern of memory disruption. These preliminary results suggest that chlorpromazine and lorazepam induced a double dissociation between priming and the acquisition of a cognitive routine. They provide evidence that the two forms of implicit memory rely upon distinct neurochemical systems, the latter, but not the former, being dependent upon dopaminergic systems.