Evaluation of cardiac electromechanics in patients with newly diagnosed hypertension.

OBJECTIVES: This study aimed to investigate the relationship between subclinical left ventricular (LV) systolic dysfunction and ECG parameters in newly diagnosed hypertension patients. METHODS: In this cross-sectional study, adults diagnosed with hypertension based on 24-h ambulatory blood pressure monitor recordings were included. The patients were classified into two groups based on the presence of subclinical LV systolic dysfunction according to LV global longitudinal strain (LVGLS). Findings were compared between the two groups. RESULTS: A total of 244 patients (female, 55.7%) were included. Based on LVGLS, 82 (33.6%) patients had subclinical LV systolic dysfunction. The proportion of early repolarization pattern (ERP) on ECG was significantly higher in patients with subclinical LV systolic dysfunction than in patients with normal LV systolic function [24 (28.6%) vs. 8 (5%), P < 0.001]. PR and corrected QT intervals were also significantly longer in patients with subclinical LV systolic dysfunction than in patients with normal LV systolic function [median (interquartile range), 148 (132-158) vs. 141 (127-152), P = 0.036 and 443 (427-459) vs. 431 (411-455), P = 0.007, respectively]. According to multivariate regression analysis ERP, early (E) wave velocity/late (A) wave velocity (E/A), and LV mass index were independently associated with subclinical LV systolic dysfunction. CONCLUSION: In newly diagnosed hypertension patients, the ERP on admission ECG could be a sign of subclinical systolic dysfunction.

Value of ATRIA stroke risk score in predicting atrial high-rate episodes: A comparison of six different risk scores.

OBJECTIVES: Atrial high-rate episodes (AHRE) are asymptomatic atrial tachy-arrhythmias detected through continuous monitoring with a cardiac implantable electronic device (CIED). AHRE's have been associated with increased risks of developing clinically manifested atrial fibrillation (AF), thromboembolism, cardiovascular events, and mortality. Several variables has been researched and identified to predict AHRE development. The aim of this study, which compared the six frequently-used scoring systems for thromboembolic risk in AF (CHA2 DS2 -VASc, mC2 HEST, HAT2 CH2 , R2 -CHADS2 , R2 -CHA2 DS2 -VASc, and ATRIA) in terms of their prognostic power in predicting AHRE. MATERIALS AND METHODS: This retrospective study included 174 patients with CIED's. The study population was divided into two groups according to presence of AHRE: patients with AHRE (+) and patients without AHRE (-). Thereafter, patients baseline characteristics and scoring systems were analyzed for prediction of AHRE. RESULTS: The distribution of patients' baseline characteristics and scoring systems according to presence of AHRE was evaluated. Furthermore, ROC curve analyses of the stroke risk scoring systems have been investigated in terms of predicting the development of AHREs. ATRIA, which predicted AHRE with a specificity of 92% and sensitivity of 37.5% for ATRIA values of >6, performed better than other scoring systems in predicting AHRE (AUC: 0.700, 0.626-0.767 95% confidence interval (CI), p = .004) CONCLUSION: AHRE is common in patients with a CIED. In this context, several risk scoring systems have been used to predict the development of AHRE in patients with a CIED. This study's findings revealed that The ATRIA stroke risk scoring system performed better than other commonly used risk scoring systems in predicting AHRE.

Assessment of the efficacy of the electrocardiographic P-wave peak time in predicting atrial high rate episode in patients with cardiac implantable electronic devices.

INTRODUCTION & OBJECTIVE: The incidence of atrial high-rate episode (AHRE) is high among patients with cardiac implantable electronic devices (CIEDs). In this context, the objective of this study is to evaluate the efficacies of P-wave indices (PWIs) obtained from the surface electrocardiography (ECG) in predicting future AHRE development. MATERIAL & METHOD: The study sample consisted of 158 patients with CIEDs. The study group was divided into two subgroups according to the presence of AHRE during device interrogation. PWIs were calculated using the surface ECG. RESULTS: There was no significant difference between the groups in the P-wave indices (PWIs), i.e., minimum P-wave duration (PWDmin), maximum P-wave duration (PWDmax) and P-wave dispersion (PWDIS). On the other hand, P-wave peak time in V1 lead (PWTV1) and P-wave peak time in D2 lead (PWPTD2) were significantly higher in the AHRE group than in the non-AHRE group. CONCLUSION: The study findings revealed that novel ECG parameters PWPTV1 and PWPTD2 had high prognostic value in predicting patients likely to develop AHRE.

The association between frontal QRS-T angle and reverse dipper status in newly diagnosed hypertensive patients.

The frontal QRS-T angle (fQRS-T angle) in ECG is a new measure of myocardial repolarization, in which a higher fQRS-T angle is linked with worse cardiac outcomes. Reverse dipper hypertension is also linked to poor cardiac outcomes. The purpose of this study was to investigate the association between the fQRS-T angle and reverse dipper status in individuals newly diagnosed with hypertension who did not have left ventricular hypertrophy (LVH). The investigation recruited 171 hypertensive individuals without LVH who underwent 24-h ambulatory blood pressure monitoring (ABPM). On the basis of the findings of 24-h ABPM, the study population was categorized into the following three groups: patients with dipper hypertension, non-dipper hypertension, and reverse dipper hypertension. LVH was defined by echocardiography. The fQRS-T angle was measured using the 12-lead ECG. The fQRS-T angle in individuals with reverse dipper hypertension was substantially greater than in patients with and without dipper hypertension (51° ± 28° vs. 28° ± 22° vs. 39° ± 25°, respectively, P < 0.001). The fQRS-T angle (odds ratio: 1.040, 95% confidence interval: 1.016-1.066; P = 0.001) was independently associated with reverse dipper hypertension according to multivariate analysis. In receiver operating characteristic curve analysis, the fQRS-T angle to predict reverse dipper hypertension was 33.5° with 76% sensitivity and 71% specificity. This study showed that an increased fQRS-T angle was associated with reverse dipper hypertension in newly diagnosed hypertensive patients without LVH.

A Rare Case of Multiple Thrombosis Associated with COVID-19 Pneumonia.

Coronavirus disease 2019 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 virus. Hypoxic respiratory failure, multiorgan dysfunction, septic shock, thrombosis, and thromboembolic complications have been associated with the severe acute respiratory syndrome coronavirus 2 infection. We report the presentation of the severe acute respiratory syndrome coronavirus 2 infection with acute upper extremity ischemia and mesenteric ischemia clinic. We also report that this patient had an aortic arch mural thrombus as a possible source of thromboembolism, and we emphasize that the aorta should also be carefully evaluated in thromboembolic patients with coronavirus disease 2019.

Prognostic value of C-reactive protein to albumin ratio for long-term outcomes of patients with peripheral arterial disease underwent endovascular treatment.

BACKGROUND: Peripheral artery disease (PAD) is part of the systemic atherosclerotic process that is highly associated with cardiovascular diseases. Despite successful endovascular treatment (EVT) strategies, mortality and morbidity rates still remain higher in PAD patients. C-reactive protein (CRP) and albumin are biomarkers of inflammation and malnutrition that play key roles in the progression of peripheral arterial disease. In this study, we aimed to investigate the relationship between CRP-to-albumin ratio (CAR) and mortality and amputation-free survival in patients with PAD after successful EVT. METHOD: Our study enrolled 149 consecutive patients who underwent EVT on atherosclerotic obstruction of iliac, femoral, popliteal and/or below-knee arteries with the clinical features of PAD and/or chronic limb-threatening ischaemia between January 2015 and January 2020. Clinical and prognostic follow-up of patients had been done at the outpatient clinic and were collected from institution's medical records. RESULTS: The mean follow-up period was 22 months (14-40). All-cause mortality and amputation rates of patients in the high CAR group were significantly higher than those in the low CAR group (21.3% vs. 6.8% and 18.7% vs. 5.4%, respectively). Kaplan-Meier survival analysis showed significantly better survival for patients in the low CAR group (log-rank p = 0.0058). In multivariate logistic regression analysis, CAR was found to be an independent predictor of amputation and all-cause mortality even after adjusting for other confounding risk factors. ROC curve analysis revealed the optimal cut-off value of CAR for predicting all-cause mortality and amputation to be >1.476 with a sensitivity of 48.5% and specificity of 94.0%. CONCLUSION: The inflammatory state reflected by CAR levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, CAR was found to be an independent predictor of these clinical outcomes after adjusting for other clinically associated parameters.

The Association of Fractional Pulse Pressure with Acute Kidney Injury in Patients Undergoing Coronary Intervention due to ST-Segment Elevated Myocardial Infarction.

OBJECTIVE: Acute kidney injury (AKI), which is prevalent in ST-segment elevated myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. As high pulse pressure (PP) is associated with adverse cardiovascular events, the present study's aim was to evaluate the relationship between fractional PP (PPf) and AKI in patients with STEMI who underwent primary PCI. SUBJECTS AND METHODS: All laboratory findings as well as echocardiographic and angiographic data of 1,170 consecutive STEMI patients were retrospectively screened. PPf was calculated from the pressures invasively measured after sheath insertion and before performing coronary angiography. RESULTS: From 1,170 eligible STEMI patients (mean age 56 years, 18.2% female), AKI developed in 143 (12.2%) patients. The PPf and pulsatility index were significantly higher in patients with AKI than those without (0.53 ± 0.10 vs. 0.61 ± 0.10, p < 0.001, and 0.80 ± 0.03 vs. 0.82 ± 0.03, p < 0.001, respectively). PPf was also found to be associated with AKI in univariable (OR 2.183, 95% CI 1.823-2.614, p< 0.001) and multivariable (OR 1.874, 95% CI 1.513-2.322, p < 0.001) analysis. In-hospital mortality was higher in patients with AKI than those without. CONCLUSION: Invasively measured PPf, which can be easily measured and has no additional cost in STEMI patients undergoing coronary intervention, is an independent predictor of AKI. In addition, PPf is superior to other blood pressure values and derivatives in AKI prediction.

Prolonged P wave peak time is associated with the severity of coronary artery disease in patients with non-ST segment elevation myocardial infarction.

BACKGROUND: Multi-vessel coronary artery disease (CAD) is associated with worse outcome in non-ST segment elevation myocardial infarction (NSTEMI) patients. Depending on the severity of CAD, there may be prolongation of atrial depolarization time as a result of left ventricular dysfunction and atrial ischemia. Therefore, we aimed to study whether the severity of CAD can be predicted with the P wave peak time (PWPT) in the electrocardiography (ECG) obtained during the diagnosis in NSTEMI patients. METHOD: A total of 162 patients were included. The coronary angiography records of all patients were analyzed and SYNTAX scores were calculated. Patients were divided into two groups, according to CAD severity. In addition to well-known P wave parameters, PWPT, defined as the time from the beginning of the P wave to its peak, was measured in the leads DII and V1. RESULTS: The PWPTs in the leads DII and V1 were significantly longer in the group with severe CAD (71 ±â€¯13 vs. 61 ±â€¯12, p < 0.001, 63 ±â€¯24 vs. 53 ±â€¯18, p = 0.024, respectively). PWPT was found to be an independent predictor of severe CAD and the best cut-off value of PWPT in the lead DII was 69.6 ms with sensitivity of 58.3% and specificity of 78.9%. CONCLUSION: Our findings show that prolonged PWPT, which is a parameter easily obtainable from the ECG, is associated with severe CAD. Recognition of NSTEMI patients with severe CAD at the time of diagnosis before performing coronary angiography may be important for the planning of treatment.

A novel ECG parameter for diagnosis of acute pulmonary embolism: RS time: RS time in acute pulmonary embolism.

OBJECTIVES: Pulmonary embolism (PE) is one of the leading causes of cardiovascular mortality worldwide. Electrocardiography (ECG) may provide useful information for patients with acute PE. In this study, we aimed to investigate the diagnostic value of the QRS duration and RS time in inferolateral leads in patients admitted to the emergency department, and pre-diagnosed with acute PE. METHODS: We retrospectively enrolled 136 consecutive patients, admitted to the emergency department, pre-diagnosed with the clinical suspicion of acute PE, and underwent computerized tomographic pulmonary angiography (CTPA) to confirm the PE diagnosis. The study subjects were divided into two groups according to the presence or absence of PE, and the independent predictors of PE were investigated. RESULTS: Sixty-eight patients (50%) had PE. Patients with PE had a longer RS time. Among the ECG parameters, only RS time was an independent predictor of PE (OR: 1.397, 95% CI: 1.171-1.667; p < 0.001). The ROC curve analyses revealed that the cut-off value of RS time for predicting acute PE was 64.20 ms with a sensitivity of 85.3% and a specificity of 79.4% (AUC: 0.846, 95%CI: 0.749-0.944; p < 0.001). In the correlation analyses; the RS time was correlated with RV end-diastolic diameter (r = 0.422; p < 0.001), RV/left ventricle (LV) ratio (r = 0.622; p < 0.001), and systolic pulmonary artery pressure (SPAP) (r = 0.508; p < 0.001). CONCLUSION: As a novel ECG parameter, RS time could be measured for each patient. A longer RS time can be a very useful index for diagnosing acute PE as well as for estimating the RV end-diastolic diameter and SPAP.

Diagnostic value of QRS and S wave variation in patients with suspicion of acute pulmonary embolism.

BACKGROUND: This study aimed to investigate the diagnostic value of QRS and S wave variation in patients admitted to the emergency department with suspicion of acute pulmonary embolism (APE). METHOD: Computerized tomographic pulmonary angiography (CTPA) was performed in 118 consecutive patients to evaluate patients with suspected APE, and 106 subjects with appropriate electrocardiogram and CT images constituted the study population. RESULTS: Using CTPA, APE was diagnosed in 48.1% (n:51) of the study population. The comparison of patients with APE and those without APE revealed that increased heart rate, right axis deviation of QRS axis, complete or incomplete right bundle branch block, prominent S wave in lead D1, increased QRS duration, percentage of QRS (9,8[4,8-19,0] vs 3,8[2,7-71]; p<0,001), S wave variation (22,3[9,6-31,9] vs 4,8 [2-8]; p<0,001) and ΔS wave amplitude (1.1[0.5-1.5] vs 0.2[0.1-0.5]; p<0.001) were significantly associated with APE, but no relationship was detected with respect to the presence of atrial arrhythmias, clockwise rotation of the horizontal axis, fragmentation, ST segment deviation, T wave inversion, and S1Q3T3 and S1S2S3 patterns. The percentage of S wave variation (OR: 1072 per 1% increase, 95% CI:1011-1137) was found to be an independent predictor of APE. ΔS wave amplitude>0.5mm predicted APE with a sensitivity of 72.6% and a specificity of 74.6% (AUC:0.805, 95% CI: 0.717-0.876; p<0.001). CONCLUSION: The present study demonstrated that QRS and S wave variation could be useful electrocardiographic signs for the diagnosis of APE.