Platelet-to-lymphocyte ratio but not neutrophil-to-lymphocyte ratio predicts high on-treatment platelet reactivity in clopidogrel-treated patients with acute coronary syndrome.

OBJECTIVES: Dual antiplatelet therapy (DAPT), consisting of clopidogrel and aspirin, is the main-stay treatment of acute coronary syndromes (ACS). However, major adverse cardiovascular events may occur even in patients undergoing DAPT, and this has been related to the variable pharmacodynamic efficacy of these drugs, especially clopidogrel. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are novel inflammatory markers for cardiovascular risk stratification, which may reflect an inflammatory state and thus high on-treatment platelet reactivity (HPR). METHODS: We investigated the usefulness of PLR and NLR in predicting HPR in clopidogrel-treated patients with ACS. A total of 244 patients were enrolled in this study, and 43 of them were nonresponsive to clopidogrel. RESULTS: Logistic regression analysis indicated that PLR was significantly associated with HPR (P < 0.001). Using a cutoff level of 331, PLR predicted HPR with a sensitivity of 73% and a specificity of 69% (odds ratio: 376.15, 95% confidence interval = 37.813-3741.728 P < 0.001, receiver operating characteristic curve: 0.885). CONCLUSIONS: We suggest that more attention should be paid to the PLR values of these patients on admission to identify individuals who may not benefit from clopidogrel during the course of ACS.

Loeffler endocarditis: silent right ventricular myocardium!

We present the case of a 54-year-old male patient with Loeffler endocarditis. It is a rare disorder characterized by fibrous thickening of the endocardium leading to apical obliteration and restrictive cardiomyopathy resulting in heart failure, thromboembolic events or atrial fibrillation. To the best of our knowledge, this is the first case reporting the electrical silence of the right ventricular (RV) apex caused by fibrothrombotic thickening of this area. Under these circumstances RV apical implantation of an implantable cardioverter defibrillator (ICD) or pacemaker electrode may lead to unsuccessful stimulation of these devices.

Volume depletion provided by blood donation alters twist mechanics of the heart: Preload dependency of left ventricular torsion.

OBJECTIVES: The crucial role of twisting motion on both left ventricular (LV) contraction and relaxation has been clearly identified. However, the reports studying the association between LV torsion and loading conditions have revealed conflicting outcomes. Previously normal saline infusion was shown to increase LV rotation. Our aim was to test this phenomenon after volume depletion in healthy volunteer blood donors. DESIGN: A total of 26 healthy male volunteers were included in the study. LV end-diastolic and end-systolic diameter, LV ejection fraction, LV diastolic parameters, LV apical and basal rotation and peak systolic LV torsion were measured by speckle-tracking echocardiography before and after 450 mL blood donation. RESULTS: Blood donation led to a significant decrease in end-diastolic LV internal diameter (48.7 ± 0.4 versus 46.4 ± 0.4 mm; p < 0.001) and cardiac output (6.2 ± 1.0 versus 5.1 ± 0.7 L/min; p < 0.001). There was a significant decrease in the magnitude of peak systolic apical rotation (4.4 ± 1.9° versus 2.9 ± 1.5°; p < 0.001) but no change in basal rotation (2.6 ± 1.4° versus 2.7 ± 1.6°; p = 0.81). Peak systolic LV Torsion decreased after blood donation (6.9 ± 1.9° versus 5.7 ± 2.1°; p = 0.028). CONCLUSIONS: LV apical rotation and peak systolic LV torsion seem to be preload dependent. Preload reduction provided by 450-mL blood donation decreased LV torsion in healthy male volunteers. Volume dynamics should be taken into account in the evaluation of LV torsion.

Infliximab, an anti-TNF-alpha agent, improves left atrial abnormalities in patients with rheumatoid arthritis: preliminary results.

BACKGROUND: Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality. In the current prospective study, we addressed the impact of RA on left atrial (LA) function and electrical remodelling. Further, we tried to demonstrate the effects of infliximab, an anti-TNF-alpha agent, on echocardiographical LA abnormality in RA patients with preserved left ventricular (LV) ejection fraction. METHODS: We compared 38 female RA patients without clinical evidence of heart disease and 30 female controls without RA and clinical evidence of heart disease. Further, we compared RA patients receiving infliximab and increasing doses of prednisolone over a three-month period. At baseline and post treatment, this study assessed (1) LA and LV parameters using conventional and speckle tracking echocardiography (STE), and (2) electrocardiographic P-wave changes. RESULTS: The values of C-reactive protein (CRP), isovolumic relaxation time (IVRT), A wave, and deceleration time (DT) were significantly higher in RA patients compared to the control group (p < 0.05), whereas E/E' and E/A values were found to be lower (p < 0.05) in RA patients. E/E' values were lower in prednisolone- compared to infliximab-treated patients (p < 0.05). After three months of infliximab and prednisolone treatment, CRP and disease activity score (DAS 28) values decreased in both groups (p < 0.05), and Duke activity status index (DASI) increased (p < 0.05). Maximal left atrial volume index (LAVImax), pre-contraction left atrial volume index (LAVIpreA) and maximum P wave (Pmax) of the RA patients were higher compared to the control group (p < 0.05), whereas LA global strain was found to be lower (p < 0.05). There was no difference in Pmax values between groups before and after the treatment period. E/E', LAVImax and LAVIpreA values of infliximab-treated patients decreased and LA global strain increased after three months of therapy compared to baseline (p < 0.05). At baseline in both treatment groups, E/E' and LA global late diastolic strain rate were lower in prednisolone-compared to infliximab-treated patients (p < 0.05). CONCLUSION: There was echocardiographic LA abnormality in these RA patients. In this patient group there was also a meaningful increase in maximum P wave assessed by electrocardiography. Infliximab therapy for a period of three months improved LA abnormality.

Infliximab; an Anti-TNF-Alpha Agent; Improves Left Atrial Abnormalities in Patients with Rheumatoid Arthritis: Preliminary Results : Cardiovascular Topic

Background : Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality. In the current prospective study; we addressed the impact of RA on left atrial (LA) function and electrical remodelling. Further; we tried to demonstrate the effects of infliximab; an anti-TNF-alpha agent; on echocardiographical LA abnormality in RA patients with preserved left ventricular (LV) ejection fraction. Methods: We compared 38 female RA patients without clinical evidence of heart disease and 30 female controls without RA and clinical evidence of heart disease. Further; we compared RA patients receiving infliximab and increasing doses of prednisolone over a three-month period. At baseline and post treatment; this study assessed (1) LA and LV parameters using conventional and speckle tracking echocardiography (STE); and (2) electrocardiographic P-wave changes. Results: The values of C-reactive protein (CRP); isovolumic relaxation time (IVRT); A wave; and deceleration time (DT) were significantly higher in RA patients compared to the control group (p 0.05); whereas E/E' and E/A values were found to be lower (p 0.05) in RA patients. E/E' values were lower in prednisolone- compared to infliximab-treated patients (p 0.05). After three months of infliximab and prednisolone treatment; CRP and disease activity score (DAS 28) values decreased in both groups (p 0.05); and Duke activity status index (DASI) increased (p 0.05). Maximal left atrial volume index (LAVImax); pre-contraction left atrial volume index (LAVIpreA) and maximum P wave (Pmax) of the RA patients were higher compared to the control group (p 0.05); whereas LA global strain was found to be lower (p 0.05). There was no difference in Pmax values between groups before and after the treatment period. E/E'; LAVImax and LAVIpreA values of infliximab-treated patients decreased and LA global strain increased after three months of therapy compared to baseline (p 0.05). At baseline in both treatment groups; E/E' and LA global late diastolic strain rate were lower in prednisolone- compared to infliximab-treated patients (p 0.05). Conclusion: There was echocardiographic LA abnormality in these RA patients. In this patient group there was also a meaningful increase in maximum P wave assessed by