Blood urea nitrogen to left ventricular ejection fraction ratio is associated with long-term mortality in the stable angina pectoris patients.

OBJECTIVE: Left ventricle (LV) dysfunction remains a significant cause of morbidity and mortality in patients with stable angina pectoris (SAP) and has prognostic significance. However, new prognostic indicators may be more useful in clinical practice. There is a growing interest in the role of blood urea nitrogen (BUN) in cardiovascular diseases. Blood urea nitrogen is an indicator of cardiac dysfunction and neurohormonal activation. We aimed to determine the relationship of BUN/LV ejection fraction ratio (BUNLVEFr) with long-term mortality and de novo decompensated heart failure (HF) in SAP patients. PATIENTS AND METHODS: The study comprised 603 consecutive SAP patients who underwent coronary angiography. The median duration of the follow-up period was 112.6±17.8 months. All-cause mortality and de novo decompensated HF were determined as the endpoints. RESULTS: Adverse cardiac events were observed in 141 patients (23.3%), including mortality in 103 (17.1%) and decompensated HF in 38 (6.3%) of them during the follow-up period. Age (p=0.027), BUNLVEFr (p=0.001), glucose (p=0.043), hemoglobin (p=0.035), and Gensini score (p=0.012) were found as independent predictors of mortality and decompensated HF. BUNLVEFr was superior to BUN alone (BUNLVEFr vs. BUN: Z=5.715, p<0.001) and LVEF alone (BUNLVEFr vs. LVEF: Z=4.075, p<0.001) in predicting endpoints. In addition, BUNLVEFr >29 predicted all-cause mortality/decompensated HF with high sensitivity (78%) and low specificity (68%). CONCLUSIONS: BUNLVEFr may provide better prognostic information than either BUN or EF can give alone in determining therapeutic strategies for SAP patients.

Epicardial fat thickness is associated with severity of disease in patients with chronic obstructive pulmonary disease.

OBJECTIVE: Cardiovascular diseases (CVD) are common in patients with chronic obstructive pulmonary disease (COPD) and the BODE index is an important tool for the prognostic assessment of COPD patients. It is well known that epicardial fat thickness (EFT) is related to CVD. However, there are very few data about the relationship between EFT and BODE index. The aim of this study is to investigate the relationship between EFT and BODE index in patients with COPD. PATIENTS AND METHODS: We prospectively included 157 patients with COPD and 45 controls in the present study. All patients underwent pulmonary function tests and six-minute walking test. EFT and other echocardiographic parameters were measured using transthoracic echocardiography on admission. Patients were divided into four quartiles according to the BODE index scores (Quartile-1 (Q1): 0-2 points; Quartile-2 (Q2): 3-4 points; Quartile-3 (Q3): 5-6 points; Quartile-4 (Q4): 7-10 points). High sensitive C-reactive protein (Hs-CRP) and other biochemical parameters were measured in all participants. RESULTS: COPD patients had higher EFT values compared with control group (p<0.05). When COPD patients were classified according to BODE index quartiles, the highest EFT values were observed in Q1 compared with other quartiles (p<0.05, for all). EFT values showed a decreasing trend from Q1 to Q4. Furthermore, EFT was independently associated with BODE index (ß=0.405, p<0.001), Hs-CRP (ß=0.300, p<0.001) and diabetes (ß=0.338, p<0.001) in multivariate linear regression analysis. CONCLUSIONS: Our findings suggested that EFT is independently and negatively associated with the severity of disease as indicated by BODE index in patients with COPD.

Real-life use of digoxin in patients with non-valvular atrial fibrillation: data from the RAMSES study.

WHAT IS KNOWN AND OBJECTIVE: Although inappropriate use of digoxin has been described in various populations, a real-world evaluation of patterns of digoxin prescription has not been well studied in patients with atrial fibrillation (AF). The aim of this study was to identify prevalence, indications and appropriateness of digoxin use in the general population of patients with non-valvular AF (NVAF) in Turkey. METHODS: We included and classified patients from the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke prevention strategies in Turkey) study, a prospective registry including 6273 patients with NVAF, on the basis of digoxin use. After excluding the data of 73 patients whose medical history about digoxin use or left ventricle function was absent, 6200 patients were included for the final analysis. Digoxin use was considered inappropriate if patients did not have left ventricular systolic dysfunction or symptomatic heart failure (HF). RESULTS AND DISCUSSION: Digoxin was used in 1274 (20·5%) patients. Patients treated with digoxin were older (71·4 ± 9·8 years vs. 69·2 ± 10·9 years, P < 0·001), more likely to be female (58·8% vs. 55·9%, P = 0·019) and had more common comorbidities such as HF (40·2% vs. 17·4%), diabetes (26·4% vs. 21·1%), coronary artery disease (35·3 vs. 27·6%) and persistent/permanent AF (93·4% vs. 78·4%; P < 0·001 for each comparison). Of the 1274 patients, the indication of digoxin use was considered inappropriate in 762 (59·8%). WHAT IS NEW AND CONCLUSION: Our findings show that nearly one-fifth of the patients with NVAF were on digoxin therapy and nearly 60% of these patients were receiving digoxin with inappropriate indications in a real-world setting.

Management and outcomes of coronary artery perforations during percutaneous treatment of acute coronary syndromes.

BACKGROUND: Coronary artery perforation (CAP) is an infrequent and life-threatening complication of percutaneous coronary intervention (PCI), requiring prompt intervention. There is insufficient data about the prognosis and management of CAP in patients with acute coronary syndrome (ACS). The aim of this study was to investigate the management of CAP in patients with ACS. METHODS: The results of 25 patients with CAP were retrospectively analyzed. RESULTS: Of the 25 patients, 14 patients (56%) had ACS. According to the Ellis classification, the grade of perforation was type-I in 8 (32%) patients, type-II in 6 (24%) patients and type-III in 11 (44%) patients. Prolonged balloon inflation was performed to 20 (80%) cases of CAP. It successfully sealed the perforation in three cases of type-I, five cases of type-II CAP and in seven cases of type-III CAP. Seven patients underwent covered stent implantation. Emergent CABG was required in two patients with type-III CAP. In-hospital mortality was not observed in the patients. CONCLUSION: The outcomes of CAP in patients with ACS were similar to patients with stable coronary disease. The continuation of anti-platelet agents after the successful management of CAP may be encouraged in these patients.

Assessment of arterial stiffness in chronic obstructive pulmonary disease by a novel method: cardio-ankle vascular index.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular morbidity and mortality. Increased arterial stiffness is associated with the presence and severity of cardiovascular disease. The cardio-ankle vascular index (CAVI) is a new method for assessment of arterial stiffness that is not influenced by blood pressure at the time of measurement and is significantly correlated with the presence and severity of cardiovascular disease. The aim of the present study was to evaluate whether there is an association between the spirometric severity of COPD, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, with arterial stiffness as assessed by CAVI. METHODS: We enrolled 123 patients with COPD (102 men) followed up by the chest medicine outpatient clinics and 35 healthy subjects (26 men). All patients were assessed with spirometry, CAVI, and clinical history. RESULTS: Patients with COPD had significantly increased CAVI values compared with control subjects (10.37 ± 2.26 vs. 6.74 ± 1.42, p < 0.001). CAVI was correlated with FEV1 % predicted, FEV1/FVC, and COPD stage (r: - 0.54, p < 0.001; r: - 0.58, p < 0.001 and r: 0.78, p < 0.001, respectively). Multivariate regression analysis showed that CAVI was independently associated with GOLD stages (p < 0.001). CONCLUSION: In this study, we have shown that increased arterial stiffness assessed by CAVI is associated with the spirometric severity of COPD.

Surgical treatment and complications of thoracic hydatid disease. Report of 61 cases.

Echinococcus cysts in the thoracic cavity were diagnosed and treated in 61 patients. Diagnosis was usually made by clinical and radiological manifestations of hydatid disease. Empyema, broncho-biliary, and biliary-pleural fistulae are complications of thoracic echinococcosis. Portal hypertension, systemic venous obstruction, paraplegia, arterial emboli due to endocardial cysts are complications of echinococcus cysts. In 40 patients with uncomplicated cysts, cystectomy-capitonnage was performed. Lobectomy or segmental resection was undertaken for complicated cysts and destroyed lung parenchyma, in ten patients. Extirpation of the cyst is preferred for extrapulmonary location, and median sternotomy is applied for bilateral multiple pulmonary hydatid cysts. In our series, the incidence of surgical complications was low and there was no surgical mortality. Recurrence or pleural implantation of pulmonary echinococcus cyst have not been found during an average nine-months follow up.