The impact of using SGLT-2 inhibitor on left ventricular longitudinal strain and NT-proBNP levels during six-month follow-up in diabetic patients with and without coronary artery disease with preserved ejection fraction.

BACKGROUND: Optimal glycemic control is necessary to prevent cardiovascular events in patients with type 2 diabetes. The positive impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on cardiovascular events and mortality in these patients has been demonstrated by previous studies although the mechanism is unclear. AIMS: We aimed to compare the influence of SGLT2i on left ventricular remodeling and strain in diabetic patients with coronary artery disease (CAD) and without CAD during 6-month follow-up. METHODS: Between October 2021 and June 2022, 100 diabetic patients with preserved ejection fraction (HbA1c levels 6.5-10%) were started on SGLT2i (empagliflozin or dapagliflozin) and were prospectively followed up. Conventional and speckle-tracking echocardiography was performed by blinded sonographers, at baseline and then at 1 month and 6 months of treatment. After 6 months, the initial and biochemical blood tests were administered, and N-terminal pro-B-type natriuretic peptide levels of the patients were measured. RESULTS: Patients with CAD were older (P = 0.008), more frequently hypertensive (P = 0.035), and had dyslipidemia (P = 0.021). N-terminal pro-B-type natriuretic peptide levels did not change significantly after treatment in both groups. Left ventricular ejection fraction, global, 2-chamber, and 3-chamber strain values were improved significantly following SGLTi administration for the overall patient cohort, regardless of CAD status (P < 0.05 for all groups). CONCLUSIONS: Treatment with SGLT2i resulted in improvement in left ventricular strain parameters, which indicates that they might have a positive impact on outcomes for diabetic patients with preserved EF.

Could We Predict POAF With a Simple Ambulatory Oscillometry Evaluating Aortic Stiffness?

OBJECTIVE: To investigate the relationship between aortic stiffness and postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). METHODS: This study included 110 patients undergoing elective isolated CABG. Aortic stiffness was measured using a noninvasive oscillometric sphygmomanometer before surgery. Characteristics of patients with and without POAF were compared. RESULTS: POAF developed in 32 (29.1%) patients. Patients with POAF were older (63.7±8.6 vs. 58.3±8.4; P=0.014). Chronic obstructive pulmonary disease (COPD) was more common in patients with POAF (11.5% vs. 37.5%; P=0.024), whereas the frequency of hypertension, diabetes mellitus, smoking, and previous coronary artery disease did not differ. C-reactive protein and cholesterol levels were similar between patients with and without POAF. Left atrial diameter was greater in patients with POAF (35.9±1.6 vs. 36.7±1.7; P<0.039). Peripheral (p) and central (c) systolic and diastolic blood pressures were also similar between the groups, whereas both p and c pulse pressures (PP) were greater in patients with POAF (pPP: 44.3±11.9 vs. 50.3±11.6; P=0.018, cPP: 31.4±8.1 vs. 36.2±8.9; P=0.008). Pulse wave velocity (PWV) was significantly higher in POAF (8.6+1.3 vs. 9.4+1.3; P=0.006). PWV, pPR and COPD were independent predictors of POAF in multivariate regression analysis. In receiver operating characteristic analysis, PWV and pPP have similar accuracy for predicting POAF (PWV, area under the curve [AUC]: 0.661, 95% confidence interval [CI] [0.547-0.775], P=0.009) (pPP, AUC: 0.656, 95% CI [0.542-0.769], P=0.012). CONCLUSION: COPD, PWV, and PP are predictors of POAF. PP and PWV, easily measured in office conditions, might be useful for detecting patients with a higher risk of POAF.

The Prognostic Significance of Uric Acid/Albumin Ratio in Patients with Aortic Stenosis Following Transcatheter Aortic Valve Implantation for Major Adverse Cardiac and Cerebral Events.

Background: The goal of this study was to examine if the uric acid/albumin ratio (UAR) could predict major adverse cardiac and cerebral events (MACCEs) such as stroke, readmission, and short-term all-cause death in aortic stenosis (AS) patients, after transcatheter aortic valve implantation (TAVI). Material and Methods: A total of 150 patients who had TAVI for AS between 2013 and 2022 were included in our study, retrospectively. Before the TAVI, each patient's baseline uric acid/albumin was determined. The study's major endpoint was MACCEs, which included stroke, re-hospitalization, and 12-month all-cause death. Results: The UAR was found to be higher in TAVI patients who developed MACCEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the UAR (HR: 95% CI; 2.478 (1.779-3.453) p < 0.01), was an independent predictor of MACCEs in AS patients after TAVI. The optimal value of the UAR for MACCEs in AS patients following TAVI was >1.68 with 88% sensitivity and 66% specificity (AUC (the area under the curve): 0.899, p < 0.01). We noted that the AUC of UAR in predicting MACCEs was significantly higher than the AUC of albumin (AUC: 0.823) and uric acid (AUC: 0.805, respectively). Conclusion: MACCEs in AS patients who received TAVI may be predicted by high pre-procedural uric acid/albumin levels. The uric acid/albumin ratio (UAR) can be used to determine MACCEs in such patients following TAVI because it is inexpensive and straightforward to calculate inflammatory parameters.

Could We Predict POAF With a Simple Ambulatory Oscillometry Evaluating Aortic Stiffness?

ABSTRACT Objective: To investigate the relationship between aortic stiffness and postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). Methods: This study included 110 patients undergoing elective isolated CABG. Aortic stiffness was measured using a noninvasive oscillometric sphygmomanometer before surgery. Characteristics of patients with and without POAF were compared. Results: POAF developed in 32 (29.1%) patients. Patients with POAF were older (63.7±8.6 vs. 58.3±8.4; P=0.014). Chronic obstructive pulmonary disease (COPD) was more common in patients with POAF (11.5% vs. 37.5%; P=0.024), whereas the frequency of hypertension, diabetes mellitus, smoking, and previous coronary artery disease did not differ. C-reactive protein and cholesterol levels were similar between patients with and without POAF. Left atrial diameter was greater in patients with POAF (35.9±1.6 vs. 36.7±1.7; P<0.039). Peripheral (p) and central (c) systolic and diastolic blood pressures were also similar between the groups, whereas both p and c pulse pressures (PP) were greater in patients with POAF (pPP: 44.3±11.9 vs. 50.3±11.6; P=0.018, cPP: 31.4±8.1 vs. 36.2±8.9; P=0.008). Pulse wave velocity (PWV) was significantly higher in POAF (8.6+1.3 vs. 9.4+1.3; P=0.006). PWV, pPR and COPD were independent predictors of POAF in multivariate regression analysis. In receiver operating characteristic analysis, PWV and pPP have similar accuracy for predicting POAF (PWV, area under the curve [AUC]: 0.661, 95% confidence interval [CI] [0.547-0.775], P=0.009) (pPP, AUC: 0.656, 95% CI [0.542-0.769], P=0.012). Conclusion: COPD, PWV, and PP are predictors of POAF. PP and PWV, easily measured in office conditions, might be useful for detecting patients with a higher risk of POAF.

The Relationship between Extracellular Volume Compartments and Matrix Metalloproteinases-2 in Left Ventricular Remodeling after Myocardial Infarction. / A Relação entre Compartimentos de Volume Extracelular e Matriz Metaloproteinase 2 na Remodelação do Ventrículo Esquerdo após o Infarto do Miocárdio.

BACKGROUND: Matrix metalloproteinases (MMPs) can affect myocardial extracellular volume (ECV) and its compartments, and this can provide more detailed information about the mechanism of adverse left ventricular (LV) remodeling (AR) after acute myocardial infarction (MI). OBJECTIVES: To investigate the role of changes (Δ) in ECV compartments (matrix volume (MVi) and cell volume (CVi)) in the development of AR after MI, and their relationship with MMP-2 expressions. METHODS: Ninety-two first MI patients who underwent 3 Tesla cardiovascular magnetic resonance imaging performed 2 weeks (baseline) and 6 months post-MI. We measured T1 mapping with MOLLI sequences. ECV was performed post-gadolinium enhancement. ECV and LV mass were used to calculate MVi and CVi. AR was defined as an increase of ≥ 12% in LV end-diastolic volume in 6 months. MMPs were measured using a bead-based multiplex immunoassay system at first day (baseline) and 2 weeks post-MI. P <0.05 was accepted as statistically significant. RESULTS: Mean ECV and mean MVi baseline levels were higher in AR group compared to without AR group (42.9±6.4 vs 39.3±8.2%, p= 0.037; 65.2±13.7 vs 56.7±14.7 mL/m2, p=0.010; respectively). CVi levels was similar between groups. A positive correlation was found between baseline levels of MMP-2 and baseline levels of ECV (r=0.535, p<0.001) and MVi (r=0.549, p<0.001). Increased ΔMVi levels was independently predictor of AR (OR=1.03, p=0.010). ΔMVi had superior diagnostic performance compared to ΔECV in predicting AR (ΔAUC: 0.215±0.07, p<0.001). CONCLUSION: High MVi levels are associated with AR, and ΔMVi was independently predictor of AR. This may be associated with MMP-2 release due to increased inflammatory response.

FUNDAMENTO: As matrizes metaloproteinases (MMPs) podem afetar o volume extracelular (VEC) e seus compartimentos, e isso pode oferecer informações mais detalhadas sobre o mecanismo de remodelação adversa (RA) do ventrículo esquerdo (VE) após o infarto agudo do miocárdio (IM). OBJETIVOS: Investigar o papel que as alterações (Δ) nos compartimentos de VEC (volume matriz (MVi) e volume celular (CVi)) desempenham no desenvolvimento de RA após o IM, e sua relação com as expressões de MMP-2. MÉTODOS: Um total de noventa e dois pacientes com primeiro IM passaram por exames de imagens por ressonância magnética cardiovascular 3 Tesla realizados 2 semanas (linha de base) e 6 meses após o IM. Medimos o mapeamento T1 com sequências MOLLI. O VEC foi obtido após o realce pelo gadolínio. O VEC e a massa do VE foram usados para calcular o MVi e o CVi. A RA foi definida como um aumento de ≥ 12% no volume diastólico final do VE em 6 meses. As MMPs foram medidas usando-se um sistema de imunoensaio multiplex em grânulos no primeiro dia (linha de base) e 2 semanas após o IM. Um P valor <0,05 foi aceito como estatisticamente significativo. RESULTADOS: Os níveis de linha de base de MVi média e VEC médio foram mais altos no grupo com RA em comparação com o grupo sem RA (42,9±6,4 vs. 39,3±8,2 %, p= 0,037; 65,2±13,7 vs. 56,7±14,7 mL/m2, p=0,010; respectivamente). Os níveis de CVi eram semelhantes entre os grupos. Foi encontrada uma correlação positiva entre os níveis de linha de base de MMP-2 e os níveis de linha de base de VEC (r=0,535, p<0,001) e MVi (r=0,549, p<0,001). O aumento dos níveis de ΔMVi foi um preditor independente da RA (RC=1,03, p=0,010). O ΔMVi teve um desempenho diagnóstico superior quando comparado ao ΔVEC na previsão do (ΔAUC: 0,215±0,07, p<0,001). CONCLUSÃO: Níveis altos de MVi estão associados à RA, e o ΔMVi foi um preditor independente de RA. Isso pode estar associado à liberação de MMP-2 devido ao aumento da resposta inflamatória.

A Relação entre Compartimentos de Volume Extracelular e Matriz Metaloproteinase 2 na Remodelação do Ventrículo Esquerdo após o Infarto do Miocárdio / The Relationship between Extracellular Volume Compartments and Matrix Metalloproteinases-2 in Left Ventricular Remodeling after Myocardial Infarction

Resumo Fundamento: As matrizes metaloproteinases (MMPs) podem afetar o volume extracelular (VEC) e seus compartimentos, e isso pode oferecer informações mais detalhadas sobre o mecanismo de remodelação adversa (RA) do ventrículo esquerdo (VE) após o infarto agudo do miocárdio (IM). Objetivos: Investigar o papel que as alterações (Δ) nos compartimentos de VEC (volume matriz (MVi) e volume celular (CVi)) desempenham no desenvolvimento de RA após o IM, e sua relação com as expressões de MMP-2. Métodos: Um total de noventa e dois pacientes com primeiro IM passaram por exames de imagens por ressonância magnética cardiovascular 3 Tesla realizados 2 semanas (linha de base) e 6 meses após o IM. Medimos o mapeamento T1 com sequências MOLLI. O VEC foi obtido após o realce pelo gadolínio. O VEC e a massa do VE foram usados para calcular o MVi e o CVi. A RA foi definida como um aumento de ≥ 12% no volume diastólico final do VE em 6 meses. As MMPs foram medidas usando-se um sistema de imunoensaio multiplex em grânulos no primeiro dia (linha de base) e 2 semanas após o IM. Um P valor <0,05 foi aceito como estatisticamente significativo. Resultados: Os níveis de linha de base de MVi média e VEC médio foram mais altos no grupo com RA em comparação com o grupo sem RA (42,9±6,4 vs. 39,3±8,2 %, p= 0,037; 65,2±13,7 vs. 56,7±14,7 mL/m2, p=0,010; respectivamente). Os níveis de CVi eram semelhantes entre os grupos. Foi encontrada uma correlação positiva entre os níveis de linha de base de MMP-2 e os níveis de linha de base de VEC (r=0,535, p<0,001) e MVi (r=0,549, p<0,001). O aumento dos níveis de ΔMVi foi um preditor independente da RA (RC=1,03, p=0,010). O ΔMVi teve um desempenho diagnóstico superior quando comparado ao ΔVEC na previsão do (ΔAUC: 0,215±0,07, p<0,001). Conclusão: Níveis altos de MVi estão associados à RA, e o ΔMVi foi um preditor independente de RA. Isso pode estar associado à liberação de MMP-2 devido ao aumento da resposta inflamatória.

Abstract Background: Matrix metalloproteinases (MMPs) can affect myocardial extracellular volume (ECV) and its compartments, and this can provide more detailed information about the mechanism of adverse left ventricular (LV) remodeling (AR) after acute myocardial infarction (MI). Objectives: To investigate the role of changes (Δ) in ECV compartments (matrix volume (MVi) and cell volume (CVi)) in the development of AR after MI, and their relationship with MMP-2 expressions. Methods: Ninety-two first MI patients who underwent 3 Tesla cardiovascular magnetic resonance imaging performed 2 weeks (baseline) and 6 months post-MI. We measured T1 mapping with MOLLI sequences. ECV was performed post-gadolinium enhancement. ECV and LV mass were used to calculate MVi and CVi. AR was defined as an increase of ≥ 12% in LV end-diastolic volume in 6 months. MMPs were measured using a bead-based multiplex immunoassay system at first day (baseline) and 2 weeks post-MI. P <0.05 was accepted as statistically significant. Results: Mean ECV and mean MVi baseline levels were higher in AR group compared to without AR group (42.9±6.4 vs 39.3±8.2%, p= 0.037; 65.2±13.7 vs 56.7±14.7 mL/m2, p=0.010; respectively). CVi levels was similar between groups. A positive correlation was found between baseline levels of MMP-2 and baseline levels of ECV (r=0.535, p<0.001) and MVi (r=0.549, p<0.001). Increased ΔMVi levels was independently predictor of AR (OR=1.03, p=0.010). ΔMVi had superior diagnostic performance compared to ΔECV in predicting AR (ΔAUC: 0.215±0.07, p<0.001). Conclusion: High MVi levels are associated with AR, and ΔMVi was independently predictor of AR. This may be associated with MMP-2 release due to increased inflammatory response.

Prognostic value of the TyG index for in-hospital mortality in nondiabetic COVID-19 patients with myocardial injury.

OBJECTIVE: The purpose of this study was to explore the efficacy of the triglyceride glucose (TyG) index on in-hospital mortality in nondiabetic coronavirus disease 2019 (COVID-19) patients with myocardial injury. METHODS: This was a retrospective study, which included 218 nondiabetic COVID-19 patients who had myocardial injury. The TyG index was derived using the following equation: log [serum triglycerides (mg/dL) ×fasting blood glucose (mg/dL)/2]. RESULTS: Overall, 49 (22.4%) patients died during hospitalization. Patients who did not survive had a higher TyG index than survivors. In multivariate Cox regression analysis, it was found that the TyG index was independently associated with in-hospital death. A TyG index cutoff value greater than 4.97 was predicted in-hospital death in nondiabetic COVID-19 patients with myocardial damage, with 82% sensitivity and 66% specificity. A pairwise evaluation of receiver operating characteristic (ROC) curves demonstrated that the TyG index (AUC: 0.786) had higher discriminatory performance than both triglyceride (AUC: 0.738) and fasting blood glucose (AUC: 0.660) in predicting in-hospital mortality among these patients. CONCLUSIONS: The TyG index might be used to identify high-risk nondiabetic COVID-19 patients with myocardial damage.

Association of eosinophil-to-lymphocyte ratio with coronary slow-flow phenomenon in patients undergoing coronary angiography.

Introduction: The current investigation intended to evaluate the correlation between eosinophil-to-lymphocyte ratio (ELR) and the coronary slow-flow phenomenon (CSFP) in patients undergoing elective coronary angiography. Material and methods: A case-control investigation was conducted on 200 individual CSFP patients and another 200 individuals with normal coronary arteries and who were matched for age, gender, and body mass index. ELR was computed by dividing the number of eosinophils by the number of lymphocytes. Thrombolysis in myocardial infarction frame count was used to determine the CSFP. Results: The ELR in the CSFP group was substantially greater than in the control group [0.38 (0.28-0.50)] and [0.22 (0.17-0.35)], p < 0.001, respectively). With the help of multivariable logistic regression analysis, ELR independently predicted the CSFP presence (odds ratio = 1.040, 95% CI: 1.026-1.053), p < 0.001). The effective cutoff point of ELR in predicting CSFP presence was > 0.29 with sensitivity of 77% and specificity of 70%. ELR had better diagnostic accuracy to predict CSFP than either lymphocyte or eosinophil count alone [AUC = 0.746 vs. AUC = 0.687 vs. AUC = 0.687, respectively]. Conclusions: To our knowledge, this was the first investigation to determine the connection between ELR and CSFP. We discovered that individuals with CSFP had higher ELR than those with normal coronary arteries in the control group.

Predictive value of C-reactive protein/albumin ratio for no-reflow in patients with non-ST-elevation myocardial infarction.

Introduction: The focus of this research was to explore the link between CRP (C-reactive protein) /albumin ratio (CAR), a novel inflammatory response marker, and no-reflow (NR) phenomena in non-ST elevation myocardial infarction (non-STEMI) patients during percutaneous coronary intervention (PCI). Methods: The current study recruited 209 non-STEMI participants who underwent PCI. The patients were divided into two groups based on their post-intervention Thrombolysis in Myocardial Infarction (TIMI) flow grade; those with and without NR. Results: In all, 30 non-STEMI patients (6.9%) had NR after PCI. CAR values were substantially greater in the NR group. The CAR was identified to be a determinant of the NR (OR: 1.250, 95% CI: 1.033-1.513, P=0.02), although CRP and albumin were not independently related with NR in the multivariate analysis. In our investigation, low density lipoprotein-cholesterol levels and high thrombus burden were also predictors of the occurrence of NR. According to receiver operating characteristic curve evaluation, the optimal value of CAR was>1.4 with 60% sensitivity and 47% specificity in detecting NR in non-STEMI patients following PCI. Conclusion: To the best of knowledge, this is the first investigation to demonstrate that the CAR, a new and useful inflammatory marker, can be utilized as a predictor of NR in patients with non-STEMI prior to PCI.

The effect of recanalization of a chronic total coronary occlusion on P-wave dispersion.

Introduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n=64) and it was unsuccessful in 29% of cases (n=26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were significantly elevated in the unsuccessful CTO PCI group. Pre-PCI ECG parameters showed no significant difference. Irrespective of the target vessel revascularization, we observed that PWD and P-max values were significantly lower in the 12th months follow-up. In all Rentrop classes, PWD values were significantly decreased at 12th months follow-up in comparison to the pre-CTO PCI values. Conclusion: This study has determined that PWD and P-max, which are both risk factors for atrial arrhythmias, are significantly reduced within 12th months after successful CTO PCI regardless of the target vessel.

Association of systemic immune-inflammation index (SII) with presence of isolated coronary artery ectasia.

INTRODUCTION: The systemic immune-inflammation index (SII) has been developed based on the calculation of N×P/L (N, P and L represent neutrophil count, platelet count and lymphocyte count, respectively), and it is widely used as a marker of inflammation and an indicator of cardiovascular outcomes in patients with coronary artery disease. We examined a possible association between SII and the presence of isolated coronary artery ectasia (CAE). MATERIAL AND METHODS: In this retrospective case-control study, a total of 4400 patients who underwent elective coronary angiography between June 2015 and July 2020 were retrospectively screened. Following the application of exclusion criteria, our study population consisted of 139 CAE patients and 141 age- and gender-matched subjects who proved to have normal coronary angiograms. RESULTS: The median value of SII was found to be statistically significantly higher in patients with CAE (p < 0.01). SII level ≥ 809 measured on admission had 48% sensitivity and 82% specificity in predicting isolated CAE in ROC curve analysis. In this ROC analysis, the predictive powers of neutrophil-to-lymphocyte ratio (NLR) and SII in determining the presence of ectasia were compared, and the predictive power of SII was significantly stronger than N/L ratio (p = 0.003). In the multivariate analysis, hyperlipidaemia (OR = 1.978, 95% CI: 1.168-3.349, p = 0.01), smoking (OR = 1.86, 95% CI: 1.090-3.127, p = 0.023) N/L ratio (OR = 1.192, 95% CI: (1.114-1.997, p = 0.07) and SII (OR = 1.002, 95% CI: 1.001-1.003, p < 0.01) were independent predictors of the presence of isolated CAE. CONCLUSIONS: SII is a readily available clinical laboratory value that is associated with the presence of isolated CAE. Our findings may indicate a common pathophysiological mechanism between CAE and coronary artery disease.

Switching Ticagrelor to 600 mg or 300 mg Clopidogrel Loading Bridge in Patients with Unstable Angina.

Ticagrelor is believed to be a more potent and faster antiplatelet agent compared with clopidogrel and may result in lower ischemic outcomes in patients with acute coronary syndrome. However, the best strategy of switching from ticagrelor to clopidogrel is unclear. Current guidelines advocate clopidogrel bridging with a 600 mg loading dose (LD). This study aimed to compare the safety and feasibility of switching protocols from ticagrelor to clopidogrel 600 mg or 300 mg LD in patients with unstable angina pectoris (USAP). One hundred and eighty patients with USAP undergoing adhoc percutaneous coronary intervention (PCI) received preprocedural ticagrelor 180 mg/daily. The decision to switch antiplatelet therapy to clopidogrel with either 300 mg LD or 600 mg LD at 12 h was left to the discretion of the treating physician. The primary outcome was a composite of an efficacy endpoint major adverse cardiac and cerebrovascular events (MACCEs) and a safety endpoint Bleeding Academic Research Consortium scale (BARC) (≥1). There were no differences in our composite clinical endpoint of MACCE between the two strategies, with one event occurring in each group. One patient in each group had myocardial infarction due to stent thrombosis, and the patient in the 300 mg switching group died due to stent thrombosis. No difference between the two arms was observed in terms of BARC bleeding criteria. This study showed that among USAP patients undergoing PCI, switching to clopidogrel with 300 mg LD showed no significant difference compared to 600 mg clopidogrel LD. Ticagrelor LD in ad hoc PCI and de-escalation to clopidogrel with 300 mg LD could translate to lower costs for patients with USAP without compromising safety and efficacy.

Prognostic Value of Systemic Immune-Inflammation Index for Major Adverse Cardiac Events and Mortality in Severe Aortic Stenosis Patients after TAVI.

Background and objectives: In this study, we aimed to evaluate whether the systemic immune-inflammation index (SII) has a prognostic value for major adverse cardiac events (MACEs), including stroke, re-hospitalization, and short-term all-cause mortality at 6 months, in aortic stenosis (AS) patients who underwent transcatheter aortic valve implantation (TAVI). Materials and Methods: A total of 120 patients who underwent TAVI due to severe AS were retrospectively included in our study. The main outcome of the study was MACEs and short-term all-cause mortality at 6 months. Results: The SII was found to be higher in TAVI patients who developed MACEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the SII (HR: 1.002, 95%CI: 1.001-1.003, p < 0.01) was an independent predictor of MACEs in AS patients after TAVI. The optimal value of the SII for MACEs in AS patients following TAVI was >1.056 with 94% sensitivity and 96% specificity (AUC (the area under the curve): 0.960, p < 0.01). We noted that the AUC value of SII in predicting MACEs was significantly higher than the AUC value of the C-reactive protein (AUC: 0.960 vs. AUC: 0.714, respectively). Conclusions: This is the first study to show that high pre-procedural SII may have a predictive value for MACEs and short-term mortality in AS patients undergoing TAVI.

Predicting One-Year Deaths and Major Adverse Vascular Events with the Controlling Nutritional Status Score in Elderly Patients with Non-ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

The prognostic value of malnutrition in elderly patients with non-ST-elevated myocardial infarction (NSTEMI) is not fully understood. Nutritional characteristics were evaluated by novel Controlling Nutritional status (CONUT), the prognostic nutritional index (PNI) and the geriatric nutritional risk index (GNRI) scores. The impact of these scores on major outcomes in 253 NSTEMI patients over 60 years and older were assessed. Compared to those with good nutritional status; malnourished patients had more major adverse cardiac and cerebrovascular events (MACCEs) at 1-year follow up. Multivariable cox regression analysis revealed that CONUT (hazard ratio = 1.372; p < 0.01) was independent predictor of MACCEs, whereas PNI (p = 0.44) and GNRI (p = 0.52) were not. The discriminating power of the CONUT (AUC: 0.79) was adequate and significantly superior to both the PNI (AUC: 0.68) and the GNRI (AUC: 0.60), with a p-value for both < 0.01. Patients with elevated CONUT exhibited the highest event rate for all-cause mortality and MACCEs in survival analysis (p < 0.01). We conclude that malnutrition is strongly associated with adverse outcomes in older patients with NSTEMI. In fact, the CONUT score adequately predicts one-year MACCEs among elderly NSTEMI patients who achieve complete revascularization after coronary intervention.

Predictive accuracy of lymphocyte-to-monocyte ratio and monocyte-to-high-density-lipoprotein-cholesterol ratio in determining the slow flow/no-reflow phenomenon in patients with non-ST-elevated myocardial infarction.

OBJECTIVE: To investigate whether inflammation based scores including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) predict the slow flow (SF)/no-reflow (NR) phenomenon comparatively in patients with non-ST-elevated Myocardial Infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). METHODS: Current study is retrospective designed and includes 426 NSTEMI patients (mean age of 56.8 ± 11.4 years). The patients were grouped into non slow flow/no-reflow and slow flow/no-reflow groups according to postintervention thrombolysis in myocardial infarction flow grade. RESULTS: The slow flow/no-reflow group had significantly higher MHR and lower LMR values than the non slow flow/no-reflow group (P < 0.01 and P < 0.01, respectively). Lower LMR [odds ratio (OR): 0.659, P < 0.01] and higher MHR (OR: 1.174, P = 0.04) were independent predictors of slow flow/no-reflow phenomenon in model 1 and 2 multivariate analyses, respectively. Furthermore, left ventricular ejection fraction (LVEF) (OR: 0.934, P = 0.01; OR: 0.930, P < 0.01), smoking (OR: 2.279, P = 0.03; OR: 2.118, P = 0.04), Syntax score (1.038, P = 0.04; 1.046, P = 0.01) and high thrombus grade (OR: 7.839, P < 0.01; OR: 8.269, P < 0.01), independently predicted the slow flow/no-reflow development in both multivariate analysis models, respectively. The predictive performance of LMR and MHR was not different (P = 0.88), but both predictive powers were superior to NLR (P < 0.01 and P = 0.03, respectively). CONCLUSION: The MHR and LMR may be useful inflammatory biomarkers for identifying high-risk individuals for the development of slow flow/no reflow in NSTEMI patients who underwent PCI.

Lower vitamin D level is associated with poor coronary collateral circulation.

OBJECTIVES: Vitamin D regulates calcium and bone homeostasis, and parathyroid hormone (PTH) secretion. Cross-sectional associations between lower vitamin D levels and cardiovascular diseases have been reported, but the relationship between vitamin D levels and collateral arteries in stable coronary artery disease (CAD) has not been reported before. DESIGN: Two hundred and fourteen patients with above 95% stenosis in at least one epicardial coronary artery were consecutively recruited after coronary angiography (CAG) during the winter season. The coronary collateral circulation (CCC) was graded using Rentrop classification. Poor CCC group included patients with Rentrop Grade 0-1 CCC and control group included patients with Rentrop Grade 2-3 CCC. Vitamin D and PTH levels were measured on the day of CAG. RESULTS: In the poor CCC group, vitamin D levels were lower (34 ± 25 pmol/L vs. 49 ± 33 pmol/L; p = 0.01) and the prevalence of vitamin D deficiency (< 37 pmol/L) was higher (67% vs. 43%; p = 0.01) compared to the controls. PTH levels, calcium, and phosphate levels were not significantly different between the groups. Female gender, lower HDL cholesterol, and lower vitamin D levels were independently correlated with poor CCC in the study population. CONCLUSION: Lower vitamin D levels may be associated with poor collateral development in patients with stable CAD.

Prevalence of Subclinical Hypothyroidism among Patients with Acute Myocardial Infarction.

Introduction. Subclinical hypothyroidism (SCH) is defined as a serum thyroid-stimulating hormone (TSH) level above the upper limit of normal despite normal levels of serum free thyroxine. There is growing evidence that SCH is associated with increased cardiovascular risk. We tried to investigate prevalence of SCH in acute myocardial infarction patients. Methods and Results. We evaluate free T3, free T4, and TSH levels of 604 patients (age 58.4) retrospectively, who have been admitted to the coronary intensive care unit between years 2004-2009 with the diagnosis of ST elevation (STEMI) or non-ST elevation acute myocardial infarction (NSTEMI). Mild subclinical hypothyroidism (TSH 4.5 to 9.9 mU/l) was present in 54 (8.94%) participants and severe subclinical hypothyroidism (TSH 10.0 to 19.9 mU/l) in 11 (1.82%). So 65 patients (10.76%) had TSH levels between 4.5 and 20. Conclusions. In conclusion, 65 patients (10.76%) had TSH levels between 4.5 and 20 in our study, and it is a considerable amount. Large-scale studies are needed to clarify the effects of SCH on myocardial infarction both on etiologic and prognostic grounds.

Homocysteine levels in patients with heart failure with preserved ejection fraction.

OBJECTIVES: Increased homocysteine (HCY) levels are associated with an increased risk of cardiovascular disease. Plasma HCY is increased in chronic heart failure (CHF) patients, and previous studies suggest that hyperhomocysteinemia causes adverse cardiac remodeling and affects pump function. We aimed to evaluate the HCY levels in patients with diastolic heart failure with preserved left ventricular ejection fraction (LVEF). METHODS: We prospectively studied 68 patients (39 females and 29 males) who were hospitalized for symptomatic heart failure, as well as 40 age- and sex-matched healthy subjects who comprised the control group. CHF was diagnosed in all cases based on Framingham diagnostic criteria. CHF with preserved LVEF was defined as cases with CHF with an LVEF of 50% or more. Patients with regional left ventricular wall motion abnormalities, atrial fibrillation, and renal failure were excluded. RESULTS: The mean age was 65.5 ± 9.6 years in the heart failure group and 65.2 ± 9.7 years in the control group. The mean LVEF was 59.8 ± 5.3 in the heart failure group and 61.4 ± 5.2 in the control group. The mean total fasting HCY concentrations were significantly higher in patients with heart failure (16.9 ± 5.27 µmol/l vs. 10.15 ± 3.49 µmol/l, respectively; p < 0.001). Multiple regression analysis indicated that NT-proBNP, hs-CRP, E/A ratio, and HbA1C were independently associated with hyperhomocysteinemia. CONCLUSIONS: Our results suggest that hyperhomocysteinemia is prevalent in heart failure with preserved ejection fraction. Larger scale studies are needed to clarify its pathogenic mechanisms and effects on the natural history of heart failure.