Clinical implication of the Naples prognostic score on transcatheter aortic valve replacement in patients with severe aortic stenosis.

BACKGROUND: One of the hallmarks of frailty in patients with severe aortic stenosis (AS) is malnutrition, for which one of the most up-to-date scoring systems is the Naples prognostic score (NPS). This study sought to investigate the predictive role of the NPS in determining mortality in patients undergoing transcatheter aortic valve replacement (TAVR) under long-term follow-up. METHODS: A total of 430 consecutive patients with symptomatic severe AS who underwent TAVR were included retrospectively. The primary endpoint of the study was the long-term all-cause mortality. The study population was divided into two groups according to the NPS value, including Group 1 (NPS 0-2) and Group 2 (NPS 3-4). RESULTS: The all-cause mortality occurred in 250 patients (62.5%) patients during a follow-up time of 40.6 (22.0-69.4) months. During the follow-up period, all-cause mortality was higher in Group 2 compared with Group 1 (87.9% vs. 42.9%, p < 0.001). Older age (p < 0.001), chronic obstructive pulmonary disease (p = 0.015), left ventricular ejection fraction (p = 0.021), and being in Group 2 (high NPS) (hazard ratio: 7.058, 95% confidence interval: 5.174-9.629, p < 0.001) were found to be independent predictors of all-cause mortality at long-term follow-up. CONCLUSION: The NPS as a malnutrition and inflammation marker in patients with severe aortic stenosis who underwent TAVR provides valuable information for all-cause mortality under long-term follow-up.

The relationship between sarcopenia and one-year mortality in patients with critical limb ischemia undergoing endovascular therapy below the knee.

OBJECTIVE: Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). Patients with CLI have poor long-term prognosis. The aim of this study was to investigate the value of sarcopenia in terms of 1-year mortality in patients with below-the-knee lesions who underwent endovascular treatment for CLI. METHODS: A total of 190 patients with critical limb ischemia who underwent endovascular treatment (EVT) for below-the-knee (BTK) lesions were enrolled in this study. Sarcopenia was defined using the psoas muscle index (PMI). PMI was obtained by calculating the average psoas muscle area (APMA) of the left and right psoas muscles at the third lumbar vertebra level and dividing by the square of the height (cm2/m2). The primary endpoint of the study was 1-year mortality and the secondary endpoint was 1-year amputation. Patients were divided into 2 groups according to presence of sarcopenia. RESULTS: We detected sarcopenia in 64 patients. The mean age, height, and EF were higher in sarcopenia group. The psoas muscle area, weight, psoas muscle index, body-mass index, albumin level, and GFR were lower in sarcopenia group. The incidence of amputation (11.9% vs 29.7%, p = 0.003) and mortality (15.1% vs 35.9%, p = 0.001) were higher in patients with sarcopenia. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of amputation and mortality. The survival curve for 1-year using the sarcopenia was analyzed using the Kaplan-Meier method, and statistical analysis was performed with the log-rank test. The presence of sarcopenia, glomerular filtration rate level, and low ejection fraction were found to be independent predictors of mortality. CONCLUSIONS: Sarcopenia was associated with 1-year mortality in patients with CLI undergoing EVT for BTK lesions. Also, patients with sacropenia had higher 1-year amputation rates. Sarcopenia may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.

Role of triglyceride glucose index in long-term mortality of patients with lower extremity arterial disease.

Aim: This work was designed to explore the role of the triglyceride-glucose (TyG) index in the prediction of long-term mortality in patients with lower extremity artery disease (LEAD) undergoing endovascular revascularization. Methods: The records of 723 patients with symptomatic LEAD undergoing endovascular revascularization between January 2016 and December 2021, with long-term follow-up until December 2021, were analyzed. Results: The rate of long-term mortality was significantly higher among patients with high TyG index than patients with low TyG index. Conclusion: The TyG index is an independent predictor of long-term mortality in patients with LEAD undergoing endovascular revascularization.

Acute effects of inhaled iloprost on intracardiac conduction in patients with pulmonary arterial hypertension.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a severe, life-threatening disorder despite the availability of specific drug therapy. A lack of endogenous prostacyclin secondary to downregulation of prostacyclin synthase in PAH may contribute to vascular pathologies. Therefore, prostacyclin and its analogs including inhaled iloprost may decrease pulmonary arterial pressure and ventricular pressure. METHODS: Here, we studied that acute effects of iloprost used in pulmonary vasoreactivity testing on the intracardiac conduction system in patients with PAH. A total of 35 (15 idiopathic PAH, 20 congenital heart disease) patients with PAH were included in this prospective study. Patients were divided into two groups: 22 patients with negative pulmonary vasoreactivity in group 1 and 13 with positive pulmonary vasoreactivity in group 2. Electrophysiological parameters including basic cycle length, atrium-His (AH) interval, His-ventricle (HV) interval, PR interval, QT interval, QRS duration, Wenckebach period, and sinus node recovery time (SNRT) were evaluated before and after pulmonary vasoreactivity testing in both groups. RESULTS: The AH interval (81 [74-93]; 80 [65.5-88], p = 0.019) and SNRT (907.7 ± 263.4; 854.0 ± 288.04, p = 0.027) was significantly decreased after pulmonary vasoreactivity testing. Mean right atrium pressure was found to be correlated with baseline AH (r = 0.371, p = 0.031) and SNRT (r = 0.353, p = 0.037). CONCLUSION: Inhaled iloprost can improve cardiovascular performance in the presence of PAH, primarily through a reduction in right ventricular afterload and interventricular pressure. Decreased pressure on the interventricular septum and ventricles leads to conduction system normalization including of the AH interval and SNRT due to resolution of inflammation and edema.

Clinical safety and efficacy of thrombolytic therapy with low-dose prolonged infusion of tissue type plasminogen activator in patients with intermediate-high risk pulmonary embolism.

: The patients with intermediate-high risk pulmonary embolism who have acute right ventricular (RV) dysfunction and myocardial injury without overt hemodynamic compromise may be candidates for thrombolytic therapy. Alternative low-dose thrombolytic therapy strategies with prolonged infusion may further decrease the complication rates as its efficacy and safety have been previously proven in the management of prosthetic valve thrombosis. In this study, we aimed to investigate the clinical outcomes of low-dose prolonged thrombolytic therapy regimen in intermediate-high risk pulmonary embolism patients. This study enrolled 16 retrospectively evaluated patients (female 9, mean age: 70.9 ±â€Š13.5 years) with the diagnosis of acute pulmonary embolism who were treated with low-dose and slow-infusion of tissue-type plasminogen activator (t-PA). All patients underwent transthoracic echocardiography and computed tomography scan for assessment of thrombolytic therapy success. Low-dose prolonged thrombolytic therapy was successful in all patients. The mean t-PA dose used was 48.4 ±â€Š6.3 mg. There was residual segmental thrombus in nine (56.3%) patients after thrombolytic therapy. The arterial oxygen saturation and tricuspid annular plane systolic excursion increased after thrombolytic therapy whereas heart rate, RV to left ventricular (LV) ratio, systolic pulmonary artery pressure, and the frequencies of hypotension and tachypnea significantly decreased. There was no cerebrovascular accident or major bleeding requiring transfusion. There were two minor bleedings (12.5%) including hemoptysis and epistaxis. Thrombolytic therapy in these intermediate-high risk pulmonary embolism patients was associated with excellent clinical outcomes and survival to discharge (100%) without any 60-day mortality. Prolonged thrombolytic therapy regimen with low-dose and slow-infusion of t-PA may be associated with lower complication rates without comprimising effectiveness in patients with acute intermediate-high risk pulmonary embolism.

Left ventricular apical thrombi: Silent but terrifying.

We present a case with a large left ventricular (LV) thrombus that presented to the emergency department with dyspnea. Bedside transthoracic echocardiography demonstrated a huge hypermobile thrombus with a maximum of 8.6 × 2 cm in size extending to the aortic valve originating from the aneurysmatic apical wall of the LV. Treatment of the patient included complete thrombus resection with aneurysmectomy.

Successful treatment of massive pulmonary embolism with low-dose tissue plasminogen activator after meniscus surgery.

: Pulmonary embolism is a life-threatening disease which represents with high mortality and morbidity. Systemic fibrinolysis is the first-line recommended therapy in hemodynamically instable patients with massive pulmonary embolism. Systemic fibrinolytic treatment remains controversial for pulmonary embolism after surgery due to high risk of hemorrhage. Herein, we report a 49-year-old man with massive pulmonary embolism after meniscus surgery, successfully treated with low-dose prolonged infusion of tissue type plasminogen activator.

Assessment of relationship between galectin-3 and ambulatory ECG-based microvolt T-wave alternans in sustained systolic-diastolic hypertension patients.

OBJECTIVES: Galectin-3 is a marker associated with myocardial fibrosis and left ventricular myocardial index (LVMI). Myocardial fibrosis and LVMI have been reported in many studies to be associated with microvolt T-wave alternans (MTWA) positivity. In this study, galectin-3 levels of normotensive individuals and sustained systolic-diastolic hypertensive patients were compared and the association between galectin-3 levels and ambulatory ECG-based MTWA was investigated. METHODS: A total of 184 individuals were included in the study, among whom, 43 were normotensive and 141 had sustained systolic-diastolic hypertension without cardiovascular or chronic renal failure. Galectin-3, MTWA, and LVMI were evaluated in all participants. Galectin-3 levels of hypertensive and normotensive participants were compared. The association between galectin-3, MTWA, LVMI, and estimated glomerular filtration rate (eGFR) was investigated in hypertensive patients. RESULTS: LVMI and galectin-3 levels were higher among hypertensive patients compared with normotensives (94.9±26.8 vs. 76.4±22.9 g/m, 7.325±2.123 vs. 5.233±1.506 ng/ml; P<0.001, P<0.001). Correlation analysis carried out among the hypertensive patients showed that the galectin-3 level was correlated positively to LVMI, age, and MTWA positivity (r=0.396, P<0.001; r=0.358, P<0.001; r=0.361, P<0.001, respectively), whereas it was correlated negatively to eGFR and male sex (r=-0.364, P<0.001; r=-0.280, P=0.001, respectively). Multiple logistic regression analysis indicated that LVMI and galectin-3 showed an independent association with MTWA positivity in hypertensive patients (P=0.003 and 0.005, respectively). CONCLUSION: Increased galectin-3 levels are associated with ambulatory ECG-based MTWA positivity, decreased eGFR, and increased LVMI in hypertensive patients. This association may be used for risk classification in this patient group.

Serum copeptin levels in predicting nondippers in newly diagnosed hypertension.

OBJECTIVES: The nondipper pattern in hypertension is associated with worse cardiovascular outcomes. In this study, we hypothesized that high copeptin levels could predict nondippers among hypertensive patients and investigated the associations between copeptin levels and nondipper pattern in newly diagnosed hypertensive patients. METHODS: Ambulatory blood pressure measurements were obtained and the patients were divided into two groups according to ambulatory blood pressure measurement as nondippers and dippers. Serum copeptin levels were measured in addition to routine laboratory investigations. A total of 76 patients were included in the study. RESULTS: The clinical and laboratory characteristics of the two groups were similar. The mean copeptin values were found to be significantly higher in the nondipper hypertensive group [1.66 (1.19-4.01) and 1.35 (1.12-2.09) IU/ml, respectively, P=0.026]. In the correlation analysis, no correlation was found between copeptin levels and daytime diastolic blood pressure, but there were weak positive correlations with daytime systolic, 24 h systolic, and diastolic blood pressure values (r=0.335, P=0.034, r=0.350, P=0.027, r=0.372, P=0.018, respectively). However, there were significant positive correlations between serum copeptin levels and nocturnal systolic and diastolic blood pressure values (r=0.593, P<0.001, r=0.523, P=0.001, respectively). CONCLUSION: This study showed that high serum copeptin levels could predict the nondipper pattern in newly diagnosed hypertension.