The Relationship of Plasma Aterogenity Index and Mean Platelet Volume with the Risk of Development of 1-Year Total Major Adverse Cardiac Event in Patients with Non-ST Elevation Myocardial Infarction.

In our study, we aimed to reveal the role of plasma atherogenicity index and mean platelet volume in predicting the risk of developing a 1-year major adverse cardiac event (MACE) in patients with non-ST elevation myocardial infarction (NSTEMI). This study, which was planned from the retrospective cross-sectional study model, was performed with 100 patients diagnosed with NSTEMI and scheduled for coronary angiography. The laboratory values of the patients were evaluated, the atherogenicity index of plasma was calculated, and the 1-year MACE status was evaluated. In total, 79 of the patients were male and 21 were female. The average age is 60.8 years. At the end of the first year, the MACE improvement rate was found to be 29%. The PAI value was below 0.11 in 39% of the patients, between 0.11 and 0.21 in 14%, and above 0.21 in 47%. The 1-year MACE development rate was found to be significantly higher in diabetic patients and patients with hyperlipidemia. Lymphocyte count and triglyceride values of the patients in the high-risk group of atherogenic index of plasma (AIP) were found to be higher than the patients in the low-risk group. The neutrophil/lymphocyte, thrombocyte/lymphocyte ratios and high-density lipoprotein values of the patients in the high-risk group of AIP were found to be lower than those in the low-risk group. The rate of MACE development was found to be significantly higher in patients in the high-risk group of AIP ( p = 0.02). No correlation was found between the mean platelet volume and the MACE development status. While no significant relationship was found between MPV and MACE in NSTEMI patients, AIP, which includes atherogenic parameters, was found to be correlated with MACE.

Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs.

Background: Heart failure (HF) is considered a significant public health issue with a substantial and growing epidemiologic and economic burden in relation to longer life expectancy and aging global population. Aims: To determine cost-of-disease of heart failure (HF) in Turkey from the payer perspective. Study Design: Cross-sectional cost of disease study. Methods: In this cost-of-disease study, annual direct and indirect costs of management of HF were determined based on epidemiological, clinical and lost productivity inputs provided by a Delphi panel consisted of 11 experts in HF with respect to ejection fraction (EF) status (HF patients with reduced EF (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF)) and New York Heart Association (NYHA) classification. Direct medical costs included cost items on outpatient management, inpatient management, medications, and non-pharmaceutical treatments. Indirect cost was calculated based on the lost productivity due to absenteeism and presenteeism. Results: 51.4%, 19.5%, and 29.1% of the patients were estimated to be HFrEF, HFmrEF, and HFpEF patients, respectively. The total annual direct medical cost per patient was $887 and non-pharmaceutical treatments ($373, 42.1%) were the major direct cost driver. Since an estimated nationwide number of HF patients is 1,128,000 in 2021, the total annual national economic burden of HF is estimated to be $1 billion in 2021. The direct medical cost was higher in patients with HFrEF than in those with HFmrEF or HFpEF ($1,147 vs. $555 and $649, respectively). Average indirect cost per patient was calculated to be $3,386 and was similar across HFrEF, HFmrEF and HFpEF groups, but increased with advanced NYHA stage. Conclusion: Our findings confirm the substantial economic burden of HF in terms of both direct and indirect costs and indicate that the non-pharmaceutical cost is the major direct medical cost driver in HF management, regardless of the EF status of HF patients.

Long-term follow-up of antithrombotic management patterns in acute coronary syndrome patients.

OBJECTIVE: The aim of this study was to evaluate the longterm, post-discharge follow-up of antithrombotic management patterns (AMPs), clinical outcomes, and real-life health status of patients hospitalized acute coronary syndrome (ACS). METHODS: A total of 1034 patients hospitalized for ACS within 24 hours of symptom onset who survived to discharge were included. Of those, 514 had ST-segment elevation myocardial infarction (STEMI) and 520 had unstable angina (UA)/non-STEMI (NSTEMI). Data on follow-up AMPs, clinical outcomes, and health status were collected during 24 months of follow-up. RESULTS: The overall all-cause mortality was 6.4% (6.7% in UA/NSTEMI and 6.0% in STEMI patients), cardiovascular (CV) events had occurred in 9.4% (9.8% in UA/NSTEMI and 8.9% in STEMI patients), and bleeding events in 2.0% (2.3% in STEMI and 1.7% in UA/NSTEMI patients) of patients at 2 years after discharge. EuroQol-visual analogue scales scores increased from 78.9 to 81.6 in STEMI patients, and from 76.0 to 76.2 in UA/NSTEMI patients. Discharge and 2-year postdischarge scores for the EuroQol-5D index were 0.7 and 0.9, respectively in STEMI patients, while it was 0.8 for each period in UA/STEMI patients. Overall, 57.5% of the patients on dual antiplatelet (AP) therapy at discharge remained on this treatment at 2 years after discharge. The use of 1AP/0 anticoagulant (AC) and ≥2AP/0AC were associated with a CV event risk of 10.5% and 8.9%, a mortality risk of 10.5% and 5.8%, and a bleeding event risk of 0.9% and. 2.2%, respectively. CONCLUSION: These findings in a real-life population of ACS patients emphasize the importance of longer-term follow-up of ACS patients surviving hospitalization and support the likelihood of more favorable long-term outcomes in ACS management with the current treatment practices.

Pre- and in-hospital antithrombotic management patterns and in-hospital outcomes in patients with acute coronary syndrome: data from the Turkish arm of the EPICOR study.

OBJECTIVE: To evaluate the acute phase (pre- and in-hospital) antithrombotic management patterns (AMPs) and in-hospital outcomes for patients hospitalized with an acute coronary syndrome (ACS). METHODS: In total, 1034 patients [514 patients with ST-segment elevation myocardial infarction (STEMI) and 520 with unstable angina/non-STEMI (UA/NSTEMI)] hospitalized for ACS within 24 h of symptom onset were included in this multicenter prospective registry study conducted at 34 hospitals across Turkey. Patient characteristics, index event description, pre- and in-hospital AMPs, and clinical outcomes were evaluated. RESULTS: Majority (89.1%) of patients did not receive pre-hospital treatment. Overall 87.9% patients with STEMI and 55.6% patients with NSTEMI underwent percutaneous coronary intervention and dual antiplatelet therapy (DAPT) was based mainly on acetylsalicylic acid (ASA) and clopidogrel during hospitalization (99.8% and 98.2%, respectively). DAPT use at discharge was 98.4% and 86.8%, respectively. The percentage of patients with STEMI who received pre-hospital care, in-hospital cardiac catheterization, and pre and/or in-hospital triple antiplatelet therapy was higher than that of patients with UA/NSTEMI. In addition, higher rate of in-hospital hemorrhagic (2.3% vs. 0.8%) and cardiac ischemic (1.2% vs. 0.4% for MI and 1.6% vs. 0.8% for recurrent ischemia) complications and earlier induction of pre and/or in hospital antiplatelet therapy and cardiac catheterization were also noted in patients with STEMI than in those with UA/NSTEMI. CONCLUSION: Our findings revealed in-hospital and at-discharge management to be mainly based on DAPT in patients with ACS. Interventional strategies were used in the majority of patients with STEMI, while the usage and timing of immediate pre-hospital ECG from symptom onset should be improved in these patients.

Effect of hypertension on coronary remodeling patterns in angiographically normal or minimally atherosclerotic coronary arteries: an intravascular ultrasound study.

Whether there is any particular role of hypertension in remodeling process has not been completely understood yet. The aim of this study was to assess the association between hypertension and remodeling patterns in normal or minimally atherosclerotic coronary arteries. Seventy-nine patients who were free of significant coronary atherosclerosis were divided into two groups according to the absence (n = 39) or presence (n = 40) of hypertension; and standard intravascular ultrasound examination was performed in 145 segments. To determine the remodeling pattern in early atherosclerotic process, patients were also analyzed according to the level of plaque burden at the lesion site after the analysis of remodeling patterns. Positive remodeling was more prevalent in the hypertensive group (52.5% vs. 12.8%; P < .001) whereas negative remodeling was more common in diabetic patients (53.6% vs. 27.4%; P = .03). Mean remodeling index was 1.04 for hypertensives and 0.96 for normotensives (P = .03). There were no correlations between remodeling patterns and other risk factors such as age, family history, and hypercholesterolemia. Early atherosclerotic lesions (< 30%) exhibited more negative remodeling characteristics while intermediate pattern was observed more frequently in patients with high plaque burden (P = .006 and .02, respectively). Positive remodeling showed no association in this context (P = .07). This study demonstrated that minimal atherosclerotic lesions in hypertensives had a tendency for compensatory arterial enlargement. Positive remodeling may result from local adaptive processes within vessel wall or hemodynamic effects of blood pressure itself.

Anticalcifying nanoparticle antibody titer is an independent risk factor for coronary artery calcification.

BACKGROUND: Calcium phosphate deposition is present even in the early phases of the atherosclerotic plaque formation. Calcifying nanoparticles (CNPs), previously known as nanobacteria, have emerged as a potential causative agent for pathological calcification in human vasculature. This study investigates the relationship between the anti-CNPs antibody titers and the extent of coronary calcification. METHODS: A total of 197 consecutive patients undergoing multidetector computed tomography were enrolled in this study. The patients with coronary artery calcification (CAC; n=103) were included in the CAC group, and those without calcification (n=94) were determined as controls. The commercially available enzyme-linked immunosorbent assay kits were used to detect IgG antibodies against CNPs in serum samples. RESULTS: Mean titers of anti-CNPs antibodies were higher in individuals with CAC than in the control group (0.4 ± 0.4 vs. 0.19 ± 0.21U; P<0.0001). Multivariate logistic regression analysis revealed that high anti-CNPs antibody levels were an independent correlate of CAC in addition to conventional risk factors such as age, hypertension, diabetes mellitus, and low levels of high-density lipoprotein cholesterol. When the CAC scores were subcategorized: score 0, 1-100, 101-400, and more than 400, they still correlated significantly with the anti-CNPs antibody, especially in the group having CAC scores greater than 400 (P<0.0001). CONCLUSION: Anti-CNPs antibodies are an independent risk factor for CAC and the antibody levels correlate with CAC scores.

Association between antibodies against calcifying nanoparticles and mitral annular calcification.

BACKGROUND AND AIM OF THE STUDY: Mechanisms leading to vascular and tissue calcification are not yet fully understood. Previously, an association has been demonstrated between a controversial calcifying nanoparticle (CNP; also known as 'nanobacteria') and vascular calcification and kidney stone formation. The study aim was to evaluate a possible association between mitral annular calcification (MAC) and CNP infection. METHODS: A total of 93 patients with MAC, detected using echocardiography, and 94 asymptomatic subjects without valvular and coronary artery calcification, were enrolled in the study. The serum levels of anti-CNP-antibodies were monitored in all subjects. RESULTS: Patients with MAC were generally older and had a higher prevalence of systemic hypertension, diabetes mellitus, and dyslipidemia. The anti-CNP-antibody titers, which were significantly associated with MAC (p < 0.0001), were increased with older age and MAC thickness, but decreased in line with serum levels of HDL-cholesterol (p < 0.0001). In order to provide a cut-off point for anti-CNP-antibodies when detecting MAC, a receiver operating characteristic curve was created. Serum CNP-antibody levels above 0.19 units/ml showed a sensitivity of 73%, a specificity of 72%, and positive and negative predictive values of 72% and 73%, respectively. Multivariate logistic regression analysis revealed that increasing age, systemic hypertension, diabetes, HDL-cholesterol levels and high anti-CNP titers were risk factors that were independently associated with calcification in the mitral annuli. CONCLUSION: The study results suggested that CNP might play an important role in the pathogenesis of MAC.

[Statins with a perspective of lifelong therapy]. / Yasam boyu tedavi perspektifinde statinler.

LDL cholesterol is the primary target of treatment for lowering the risk of cardiovascular events in both primary and secondary prevention. The usual drug to achieve this goal is HMG-CoA reductase inhibitors (statins), which constitute the most potent and effective class to reduce LDL cholesterol. Statins have been shown to be associated with good patient compliance, lower adverse events, and few drug interactions. Clinical trials have demonstrated that statin therapy reduces all clinical manifestations of atherosclerotic disease. These trials have also shown that the amount of risk reduction achieved is closely related to the degree of adherence to treatment. Despite evidence for the benefits of LDL-lowering with statins, initiation of treatment, achievement of the goals, and long-term adherence to therapy remain far from optimal. However, in order to achieve maximum benefit from statin therapy as seen in clinical trials, it is important that patients receive optimal-dose therapy for the rest of their lives. This review is concerned with a combination of patient-, physician-, and health delivery system-focused interventions, as outlined by the ATP III guidelines to improve adherence in clinical practice.

Total blush score: a new index for the assessment of microvascular perfusion in idiopathic dilated cardiomyopathy.

BACKGROUND: The aim of this study was to evaluate tissue-level perfusion in patients with idiopathic dilated cardiomyopathy (IDC), using the myocardial blush grade technique. METHOD: The study population consisted of 26 prospectively enrolled IDC patients (15 women and 11 men; mean age, 59+/-8.8 years) and 26 control subjects (11 women and 15 men; mean age, 54.9+/-10.6 years), whose angiographic films were technically adequate for myocardial blush grade analysis. After grading, we measured total blush score (TBS) for both groups. TBS was determined as the sum of the blush grades of each coronary territory. RESULTS: A total of 156 coronary territories in both groups were assessed. Average of TBS was significantly lower in patients with IDC than in control group (7.6+/-1.2 vs. 8.8+/-0.4; P<0.0001). The TBS significantly and inversely correlated with New York Heart Association class, heart rate, left ventricular end-systolic dimension, and left ventricular end-diastolic pressure, and positively correlated with left ventricular ejection fraction (r=-0.76, P<0.001; r=-0.61, P=0.001; r=-0.77, P<0.0001; r=-0.68, P<0.0001; and r=0.67, P<0.0001, respectively). CONCLUSION: In IDC, decreased TBS might be assumed to be a surrogate marker for a diseased microvascular network in the catheterization laboratory. The relationship between reduced TBS and IDC severity suggests that this index might have prognostic significance.

Erectile dysfunction may predict coronary artery disease: relationship between coronary artery calcium scoring and erectile dysfunction severity.

OBJECTIVES: The aim of this prospective study is to evaluate patients with erectile dysfunction (ED) in terms of coronary artery calcium (CAC) levels assessed by multidetector computed tomography (MDCT) and to find out if ED severity may predict coronary heart disease risk. PATIENTS AND METHOD: Sixty men with a mean age of 55.7 (41-77) years with ED and 23 men with a mean age of 53.2 (39-76) years without ED, who admitted to our clinic between January 2005 and December 2005, were included in the study. All patients answered the standard International Index of Erectile Function (IIEF) forms, and were classified into four groups as mild, moderate, severe ED and no ED. CAC levels were assessed by MDCT protocol. CAC levels and IIEF scores were analyzed within each group. RESULTS: Pearson correlation test demonstrated significant negative correlation between IIEF score and CAC score (r= -497; P<0.0001). CAC scores increased significantly with regard to IIEF scores decrease: IIEF 1-10 (n=18), mean CAC: 557.7; IIEF 11-16 (n=13), mean CAC: 541.3; IIEF 17-25 (n=29), mean CAC: 84.6; and IIEF >or= 26 [n=23 (Control group)], mean CAC: 10.1. The difference between the mean CAC scores of these four groups was statistically significant (P<0.0001). When we took the cut-off value for IIEF score 26 we observed significantly higher CAC scores at the group of IIEF <26 (mean 325.5 vs 10.1; P<0.0001). CONCLUSION: We observed positive correlation with ED severity and CAC levels. Therefore, we think that detection and quantification of preclinical coronary artery disease by CAC scoring with a non-invasive method might have a great potential for early cardiac preventive measures.

Relationship between angiotensin-converting enzyme gene polymorphism and severity of aortic valve calcification.

OBJECTIVE: To investigate the role of angiotensin-converting enzyme (ACE) gene polymorphism in patients with degenerative aortic valve calcification (AVC). PATIENTS AND METHODS: Our study consisted of 305 Turkish patients of European descent (139 male, 166 female; mean plus or minus age, 68 plus or minus 9 years) referred to our echocardiography laboratory for aortic valve evaluation between June 2, 2003, and April 29, 2005. The severity of AVC was graded from 1 to 6 by echocardiography. We used polymerase chain reaction to determine ACE gene polymorphism. RESULTS: The ACE insertion/deletion genotype distributions for the study population were in Hardy-Weinberg equilibrium (chi square equals 3.5, P equals .18). The study population was divided into 3 groups based on the severity of AVC: those with grade 1 calcification were in group 1, those with grades 2 to 4 in group 2, and those with grades 5 to 6 in group 3. Group 1 patients were significantly younger, less likely to have hypertension and diabetes, and had higher high-density lipoprotein cholesterol levels. The genotype frequencies were significantly different among groups, with the insertion/insertion genotype being less prevalent in group 3 patients. In multivariate analysis, independent predictors of severe AVC were hypertension (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.8 to 11.0; P less than .001), low high-density lipoprotein cholesterol (OR, 2.7; 95 percent CI, 1.5 to 4.9; P equals .001), and the deletion/deletion and insertion/deletion vs insertion/insertion genotype (OR, 3.2; 95 percent CI, 1.5 to 7.2; P equals .004). CONCLUSION: These results suggest that ACE gene polymorphism may be associated with severe AVC.

Unrecognized side effect of statin treatment: unilateral blepharoptosis.

A 43-year-old man receiving statin monotherapy (10 mg atorvastatin) for hypercholesterolemia had unilateral blepharoptosis as the result of isolated myositis of the levator muscle. Statin-induced myositis in the levator muscle should be considered in the differential diagnosis of acquired unilateral blepharoptosis of unknown cause.

Effect of statin treatment on coronary collateral development in patients with diabetes mellitus.

Coronary collateral development is an important compensatory mechanism in advanced coronary artery disease, and patients with diabetes mellitus have impaired coronary collateral development. This study tested the hypothesis that statin treatment may increase coronary collateral development in patients with diabetes mellitus. The study population consisted of 149 consecutive diabetic patients who underwent clinically indicated coronary angiography and had >95% stenosis of > or =1 major coronary artery. Clinical information, including age, gender, history of hypertension, smoking, myocardial infarction, clinical presentation, and medications, was recorded before coronary angiography. Coronary collaterals were graded according to the Cohen-Rentrop method. Collateral grading was classified as poor when the collateral grade was 0 to 1 and good when it was 2 to 3. Among 149 patients (85 men; mean age 62 +/- 10 years), 74 (56%) were receiving statin treatment. In multivariate analysis, among demographic, clinical, and angiographic parameters, only statin therapy (odds ratio 3, 95% confidence interval 1.5 to 6.03, p = 0.002) and stable angina pectoris (odds ratio 3.24, 95% confidence interval 1.42 to 7.41, p = 0.005) were found to be independent predictors of better collateral formation. In conclusion, stable angina pectoris and statin treatment are associated with better coronary collateral development in patients with diabetes mellitus.

Effect of direct stent implantation on QTc dispersion.

The aim of this study was to evaluate whether direct stenting is superior to conventional stent implantation technique with respect to QTc dispersion in prospectively selected patients with simple lesion morphology and class II stable angina undergoing elective coronary stenting. One hundred thirty-four consecutive patients were divided into 2 groups based on the stenting technique used: the direct stenting without predilation group, group I (n = 64), and the stenting with predilation group, group II (n = 70). All patients had single-vessel disease. The primary end point of the study was the QTc dispersion at the 24th hour and at the first month after the procedure and the secondary end point of the study was the major clinical events (MCEs) rate in the hospital period and up to 1 month. Baseline maximum QTc, minimum QTc, and QTc dispersion were not different between the 2 groups. QTc dispersion decreased from 47+/-8 msec before stent implantation to 41+/-11 msec at 24 hours and 37+/-7 msec 1 month after angioplasty in group I (p < 0.006 and p < 0.01, respectively), whereas QTc dispersion decreased from 49+/-9 msec before stent implantation to 46+/-8 msec at 24 hours and 42+/-10 msec 1 month after angioplasty in group II (p < 0.03 and p < 0.01, respectively). Compared with group II, the decrease in QTc dispersion was significantly greater at the 24th hour and at the first month after the procedure in group I (p < 0.003 and p < 0.001, respectively). There was a decreased trend toward MCE rate in group I in relation to that of group II, but the statistical difference was not significant. Direct stenting is a feasible and safe technique. It is superior to conventional stenting technique in decreasing the QTc dispersion at the 24th hour and at the first month after the procedure, whereas it is equivalent to single-vessel conventional stent implantation technique with respect to MCEs rate in the short-term period.

The prevention of minor myocardial injury with ticlopidine pretreatment in patients undergoing elective coronary stenting.

The aim of the study was to determine whether ticlopidine treatment prior the coronary stenting would be associated with lower rates of procedure-related minor myocardial injury (MMI) in patients undergoing elective coronary stenting. In this retrospective, nonrandomized, uncontrolled study, a total of 153 consecutive patients with a mean age of 63.4+/-8.9 years were divided into two groups based on the duration of ticlopidine treatment: group I (n=81), ticlopidine >/=3 days before the procedure, group II (n=72), on the same day as stent placement. Cardiac troponin T (cTnT) was measured immediately before and 12 h after the procedures. All patients were followed-up during the hospital stay with respect to MMI and major clinical events (MCE). The increase frequency and the amount of cTnT level in group I was found to be significantly lower compared with group II (4 vs. 13; P<0.01, and 0.35+/-0.06 vs. 0.52+/-0.11 ng/ml; P<0.01, respectively). In general, patients with elevated cTnT levels are more likely to have C type lesion and multivessel procedure than those of normal cTnT level (41 vs.10%; P<0.002 and 47 vs. 17%; P<0.009, respectively). Though there was a trend toward increased MCE rates in group II than that of group I, this did not reached statistical significance (3 vs.1; P=NS). The present study shows that an anti-platelet treatment with ticlopidine prior the coronary stenting of adequate duration to allow for the development of maximal inhibition is associated with a markedly decreased incidence of procedure-related MMI. Therefore, ticlopidine pretreatment may be a cost alternative for the prevention of platelet-rich microembolism in patients undergoing elective coronary stenting.

Effect of direct stent implantation on minor myocardial injury.

UNLABELLED: This nonrandomized study evaluated the incidence of minor myocardial injury (MMI) in prospectively selected patients with simple lesion morphology and class II stable angina undergoing stenting with or without predilatation. METHODS: A total of 154 patients were divided into two arms based on the stenting technique used: direct stenting without predilatation (Group I; n = 78) and stenting with predilatation (Group II; n = 76). Cardiac troponin T (cTnT) was measured immediately before, at 12 hours and 24 hours postprocedure. The primary endpoint was the MMI in-hospital. The secondary endpoint of the study was the major clinical event (MCE) rate in-hospital and up to 6 months. RESULTS: The frequency increase in Group I was found to be significantly lower compared with Group II (5.1% vs. 21%, respectively; p < 0.007), as was the amount of cTnT release (0.28 0.04 vs. 0.51 0.12 ngr/ml at 12 hours, p < 0.001; 0.28 0.06 vs. 0.51 0.10 ngr/ml at 24 hours, p < 0.0004). No MCE was seen during the in-hospital period in both groups. Furthermore, no significant differences were found between the 2 groups with respect to MCE (12.8% vs. 18.4%, respectively; p > 0.05) at 6 months. The balloon inflation time (BIT) was significantly longer in patients with abnormal cTnT level than in those with normal cTnT level in Group II (120.3 4.7 seconds vs. 118.2 1.3 seconds; p < 0.002) but there wasn t any statistical difference in Group I (32.4 2.1 seconds vs. 30.6 2.4 seconds; p > 0.05). Furthermore, there was not any statistical difference with respect to the number of balloon inflations in patients with normal and abnormal cTnT levels in either group (1.2 0.2 inflations vs. 1.3 0.4 inflations in Group I, p > 0.05; 3.2 0.9 inflations vs. 3.0 1.4 inflations in Group II, p > 0.05). CONCLUSION: This study showed that MMI probably occurs less frequently after direct stenting.