The effects of Digoxin use on long-term prognosis in patients with heart failure with reduced ejection fraction.

OBJECTIVE: This study aimed to investigate the effect of digoxin on mortality and rehospitalization in heart failure with reduced ejection fraction (HFrEF) patients. Heart failure is a clinical syndrome that requires frequent rehospitalization and has a high mortality. This study aimed to investigate the effect of digoxin on mortality and rehospitalization in patients with heart failure with reduced ejection fraction. PATIENTS AND METHODS: The study included 326 patients with HFrEF that were hospitalized for decompensation between September 2014 and January 2016. The patients were divided into two groups: digoxin users and a control group. The study's endpoints were cardiovascular death and rehospitalization after 24-month long-term follow-ups. RESULTS: Rehospitalization was lower in patients taking digoxin (25% vs. 47%, p = 0.001). The mean age of patients taking digoxin (n: 78) was 63.7 ± 12.4 years, among which 64% were males. The mean age of the control group was 65.4 ± 11.8 years, among which 74% were males. However, there was no difference in mortality between the two groups (34% vs. 45%, p = 0.10). While Kaplan-Meier curves revealed no significant differences between mortality rates in the groups (log-rank p = 0.508), a statistical difference was found between the groups in rehospitalization rates (log-rank p =  0.013). A multiple linear regression analysis revealed that smoking (HR: 1.97, CI: 1.24-3.11, p = 0.004), systolic blood pressure (HR: 0.983, CI: 0.974-0.992, p < 0.001), atrial fibrillation (HR: 2.09, CI: 1.17-3.72, p = 0.012), C-reactive protein (CRP) (HR: 1.009, CI: 1.003-1.015, p = 0.004), beta-blockers (HR: 0.891, CI: 0.799-0.972, p = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (HR: 0.778, CI: 0.641-0.956, p < 0.001), mineralocorticoid receptor antagonists (HR: 0.41, CI:0.26-0.65, p < 0.001), and digoxin use (HR: 0.59, CI: 0.43-0.80, p = 0.001) are independent predictors of rehospitalization in patients with HFrEF. CONCLUSIONS: Our results show that digoxin use does not affect mortality in HFrEF patients. However, rehospitalization decreased in patients taking digoxin in HFrEF.

The importance of circulating levels of salusin-α, salusin-ß, and heregulin-ß1 in atherosclerotic coronary arterial disease.

OBJECTIVE: The relationship between the severity of atherosclerotic coronary artery disease (CAD) and circulating levels of salusin-α, salusin-ß and heregulin-ß1 has been investigated. In addition, the relationship with these peptides and high sensitive C-reactive protein (hsCRP) has been investigated. METHODS: The study was conducted on 55 volunteers who had normal coronary angiography (CAG) as the control group, 35 volunteers with the degree of coronary artery stenosis below 50% in CA as the non-critical stenosis group, 37 volunteers with narrowing of one coronary artery above 50% as single vessel group and 41 volunteers with narrowing of more than one coronary artery above 50% as multi-vessel group. One hundred and thirteen volunteers have been included to CAD group. RESULTS: There was no statistically significant difference in serum salusin-α levels between groups. Serum salusin-ß ve hsCRP levels were significantly lower in control group compared to other groups and CAD group. There was no statistically significant difference in salusin-ß and salusin-α levels in reciprocal comparison of other groups other than heregulin-ß1 levels. Heregulin-ß1 levels were significantly lower in 'non-critical occlusion' and 'multiple artery occlusion' groups compared to control group. Heregulin-ß1 levels in 'single artery occlusion' group were significantly higher than control, 'non-critical occlusion' and 'multiple artery occlusion' groups. CONCLUSION: Salusin-α levels does not indicate any significant differences between any groups in our study however the relationship of salusin-α with salusin- ß and heregulin-ß1 levels drives to cogitate that these peptides can be used as biomarkers and therapeutic approaches in CAD. We think that these peptides will be used in laboratories routinely in future in addition to hsCRP for CAD.

The relationship between T-wave peak-to end interval and ST segment recovery on intracoronary ECG during primary PCI.

OBJECTIVE: T-wave peak to end interval (TPE) is a measure of repolarization dispersion, which has been reported as a major arrhythmogenic factor post acute myocardial infarction. The aim of our study was to investigate the changes in TPE in this patient population with regard to peri-procedural intracoronary ECG findings. PATIENTS AND METHODS: Forty-four patients (34 male and mean age of 54.9 ± 10.9 years) with acute STEMI were included. Intracoronary ECG was performed during primary PCI. TPE indices were calculated before and after the procedure. Measurement of the intracoronary ST-segment was carried out before and just after coronary blood flow was established in the infarct related artery. Intracoronary ST-segment resolution (IC-STR) was defined as ≥ 1 mm compared to baseline. RESULTS: There was no difference with respect to baseline characteristics when patients with IC-STR were compared with patients without IC-STR. TPE values decreased significantly after primary PCI in patients with IC-STR (80.9 ± 22.8 ms vs. 65.8 ± 14.4 ms; p < 0.001) whereas they did not change significantly after PCI in patients without IC-STR (79.2 ± 20.9 ms vs. 68.5 ± 16.3 ms; p = 0.18). CONCLUSIONS: TPE measured from surface ECG recordings is significantly reduced in STEMI patients with successful reperfusion after primary PCI, as determined by IC-ECG recordings.

Prognostic utility of serum vitronectin levels in acute myocardial infarction.

BACKGROUND: Vitronectin (VN) functions as a regulator of platelet adhesion and aggregation, coagulation, and fibrinolysis. The aim of this study was to assess the prognostic significance of serum VN levels in patients with acute myocardial infarction (MI). METHODS: In this study 62 patients admitted with ST-elevation myocardial infarction (STEMI), or non-ST-elevation myocardial infarction (NSTEMI) were enrolled. Serum VN levels were measured within 6 h after onset of chest pains. RESULTS: The VN serum levels were higher in MI patients with a mean of 2.257 µg/ml (range 1.541-4.493 µg/ml) in the STEMI group, 1.785 µg/ml (range 1.372-4.113 µg/ml) in the NSTEMI group, and 1.222 µg/ml (range 1.033-1.466 µg/ml) in the controls (p = 0.012). Major adverse cardiovascular events could be predicted at 6 months using VN levels independently of other variables [odds ratio (OR) 9.87, 95 % confidence interval (CI) 2.54-47.37, p = 0.001]. There was a significant positive correlation between VN levels and the Gensini score in NSTEMI patients (r = 0.436, p = 0.013). CONCLUSION: The VN level may be relevant as a clinical biomarker for adverse cardiovascular outcomes not only in patients with ischemic heart disease undergoing coronary interventions, as previously reported, but also in coronary artery disease patients presenting with acute MI.