Air transport of patients with critical cardiac conditions requiring intensive care.

It is extremely important that patients with severe heart disease who need an intensive care unit can be quickly transferred to advanced centers. Air transport is the fastest and safest way for doing this in these patients, and its importance has been recognized in recent years. In this review, we examined the details of air transport of patients with critical cardiac conditions.

Relation between lymphocyte to monocyte ratio and short-term mortality in patients with acute pulmonary embolism.

INTRODUCTION: The relationship between inflammation and mortality after acute pulmonary embolism (APE) has previously been investigated with different variables (platelet/lymphocyte ratio, etc). OBJECTIVES: We investigated the predictive value of lymphocyte to monocyte ratio (LMR) for mortality in first 30 days after APE. METHODS: The study population included 264 APE patients of which 230 patients were survivors, 34 patients were non-survivors. RESULTS: LMR was significantly lower in non-survivors after APE (P < .001). Neutrophil-to-lymphocyte ratio (NLR) was higher in non-survivors after APE (P < .001). Platelet-to-lymphocyte (PLR) had no significance between both groups (P: .241). Simplified pulmonary embolism severity index and LMR were independent predictors of mortality in patients with APE (P: .008 and P: .001, respectively). CONCLUSION: LMR as a novel marker of inflammation seemed to be an independent predictor of short-term mortality in patients with APE.

Parameters of ventricular repolarization in patients with autoimmune hepatitis.

OBJECTIVE: Autoimmune hepatitis (AIH) is a liver disorder that affects both children and adults. It is characterized by inflammatory liver histology, elevated transaminase level, circulating nonorgan-specific autoantibodies, and increased level of immunoglobulin G in the absence of known etiology. Ventricular repolarization has been evaluated using T wave and QT interval measurements in patients with hepatic cirrhosis. Ventricular repolarization may be defined using QT interval, QT dispersion, and T wave measurements. Recently, it has been demonstrated that peak and end of the T wave (Tp-e) interval, Tp-e/QT, and Tp-e/corrected QT interval (QTc) ratios can be novel indicators for prediction of ventricular arrhythmias and mortality. In this study, an investigation of ventricular repolarization using Tp-e interval and Tp-e/QT ratio in patients with AIH was performed. METHODS: Total of 31 patients with AIH and 31 controls were enrolled in the present study. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured on 12-lead electrocardiogram. RESULTS: QT interval (378.9±41.4 vs. 350.0±22.7; p=0.001), QTc interval (396.8±46.7 vs. 367.3±34.9; p=0.039), Tp-e interval (68.2±12.3 vs. 42.5±6.8; p<0.001), Tp-e/QT ratio (0.18±0.02 vs. 0.12±0.01; p<0.001) and Tp-e/QTc ratio (0.17±0.02 vs. 0.11±0.01; p<0.001) were significantly higher in patients with AIH than control patients. CONCLUSION: The results of the present study indicated that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were greater in patients with AIH.

Serum Irisin Level Can Predict the Severity of Coronary Artery Disease in Patients with Stable Angina.

BACKGROUND AND OBJECTIVES: The recently discovered myokine irisin has a proposed role in adipose tissue metabolism. The aim of this study was to evaluate the relationship between serum irisin level and the coronary artery severity in patients with stable coronary artery disease (CAD). SUBJECTS AND METHODS: Sixty-three patients who underwent coronary angiography (CA) diagnosed with stable CAD and twenty-six patients with normal coronary artery (NCA) were enrolled in the study. Stable CAD patients were divided into two groups as high synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score (≥23) and lower SYNTAX score (<23). Serum irisin level measurement was carried out using human irisin colorimetric enzyme-linked immunosorbent assay (ELISA) commercial kit (AG-45A-0046EK-KI01, Adipogen, San Diego, CA, USA) as recommended by the manufacturer's protocol. RESULTS: The patients with stable CAD with a higher SYNTAX score (score ≥23) had significantly lower serum irisin levels (127.91±55.38 ng/mL), as compared the patients with a low SYNTAX score (score <23) (224.69±92.99 ng/mL) and control group (299.54±123.20 ng/mL). Irisin levels showed significant differences between all groups (p<0.001). CONCLUSION: Serum irisin level is an independent predictor of coronary artery severity in patients with stable CAD.

The Association Between Serum Procalcitonin Levels and Severity of Coronary Artery Disease Assessed by SYNTAX Score in Patients With Acute Coronary Syndrome.

The SYNTAX score (SX score) is a useful score for assessing the severity of coronary artery disease (CAD). Previous studies have demonstrated a close relationship between SX score and inflammation. Procalcitonin (PCT) is an early inflammatory marker, especially during sepsis. Thus, in this study, we aimed to investigate the relationship between SX score and serum PCT levels. A total of 545 patients were enrolled in this prospective cross-sectional study and were divided into 2 subgroups, according to their SX score. Serum PCT and high-sensitivity C-reactive protein levels were measured. Serum PCT levels were higher in the high SX score group compared to the low-intermediate SX score group (P < .001). Serum PCT levels were an independent predictor of a high SX score in patients with acute coronary syndrome (P = .001). As patients with a higher SX score had increased serum PCT levels on admission, serum PCT may be useful for identifying patients with severe CAD.

Association between serum adropin level and burden of coronary artery disease in patients with non-ST elevation myocardial infarction.

OBJECTIVE: Previous studies revealed the relationship between stable coronary artery disease (CAD) and serum adropin level, but this relationship has not been investigated in patients with non-ST segment elevation myocardial infarction (NSTEMI). The present study is an analysis of the relationship between adropin and severity of CAD assessed based on SYNTAX score in patients with NSTEMI. METHODS: A total of 109 participants, 80 patients with NSTEMI and 29 healthy individuals, were prospectively enrolled in the study. Patients with NSTEMI were divided to 2 groups: high SYNTAX score (≥32) (35 patients) and low SYNTAX score (<32) (45 patients). Adropin level was measured from blood serum samples using enzyme-linked immunosorbent assay test. RESULTS: Patients with NSTEMI and high SYNTAX score had significantly lower serum adropin level (2357.30 pg/mL±821.58) compared to NSTEMI patients with low SYNTAX score (3077.00 pg/mL±912.86) and control group (3688.00±956.65). Adropin cut-off value for predicting high SYNTAX score on receiver-operating characteristic curve analysis was determined to be 2759 pg/mL, with a sensitivity of 63% and a specificity of 57%. Adropin was an independent predictor for high SYNTAX score (odds ratio=0.999; 95% confidence interval: 0.998-1.000; p=0.007). CONCLUSION: Adropin could be an alternative blood sample value for predicting severity of CAD.

Predictors of in-hospital mortality in octogenarian patients who underwent primary percutaneous coronary intervention after ST segment elevated myocardial infarction.

AIM: Octogenarian patients have higher mortality and morbidity rates after acute coronary syndromes. Risk factors for in-hospital mortality in the primary percutaneous coronary intervention (PCI) era were underrepresented in previous studies. In the present study, we aimed to assess the risk factors of in-hospital mortality after primary PCI in this population. METHODS: We analyzed 2353 patients who underwent primary PCI after ST segment elevated myocardial infarction (STEMI). Patients were divided into two groups according to aged: ≥80 years (octogenarian) and <80 years (control). Risk factors for in-hospital mortality were analyzed in the whole group and octogenarian patients. RESULTS: We found that octogenarians have 10.6-fold higher mortality risk after STEMI. After a univariate and multivariate analysis, acute stent thrombosis was the most explicit risk factor for in-hospital mortality in the octogenarian group (OR 21.13, 95% CI 2.11-102.76, P < 0.001). Additionally, anterior myocardial infarction (OR 4.90, 95% CI 1.90-22.10, P = 0.04), ventricular arrhythmias (OR 15.64, 95% CI 2.81-87.12, P = 0.002), multivessel disease (OR 6.5, 95% CI 1.11-38.85, P = 0.04), ejection fraction <30% (OR 1.24, 95% CI 0.26-6.00, P = 0.04) and KILLIP score ≥2 (OR 1.20, 95% CI 0.20- 7.41, P = 0.01) were also significantly associated with mortality. CONCLUSIONS: Acute stent thrombosis, anterior MI, heart failure, low ejection fraction, ventricular arrhythmias and multivessel disease are the independent risk factors for in-hospital mortality among octogenarian patients after primary PCI. Geriatr Gerontol Int 2017; 17: 584-590.

Change in left ventricular systolic function in patients with ST elevation myocardial infarction: Evidence for smoker's paradox or pseudo-paradox?

BACKGROUND: The 'smoker's paradox' refers to the observation of favorable prognosis in current smokers following an acute ST elevation myocardial infarction (STEMI) in the era of fibrinolysis, however, several STEMI studies have demonstrated conflicting results in patients undergoing primary percutaneous coronary intervention (p-PCI). OBJECTIVE: Aim of the current study was to evaluate the impact of cigarette smoking on left ventricular function in STEMI patients undergoing p-PCI. METHODS: Our population is represented by 74 first-time anterior STEMI patients undergoing p-PCI, 37 of whom were smokers. We assessed left ventricular function by left ventricular ejection fraction (LVEF) on the second day after admission and at 3-month follow-up. Early predictors of adverse left ventricular remodelling after STEMI treated by p-PCI were examined. RESULTS: Basal demographics and comorbidities were similar between groups. Although the LVEF during the early phase was higher in smokers compared to non-smokers (44.95±7.93% vs. 40.32±7.28%; p=0.011); it worsened in smokers at follow-up (mean decrease in LVEF: -2.70±5.95%), whereas it improved in non-smokers (mean recovery of LVEF: +2.97±8.45%). In univariate analysis, diabetes mellitus, peak troponin I, current smoking, and lower TIMI flow grade after p-PCI, pain-to-door time and door-to-balloon times were predictors of adverse left ventricular remodelling. After multivariate logistic regression analysis, smoking at admission, lower TIMI flow grade after p-PCI, the pain-to-door time and door-to-balloon times remained independent predictors of deterioration in LVEF. CONCLUSION: True or persistent 'smoker's paradox' does not appear to be relevant among STEMI patients undergoing p-PCI. The 'smoker's paradox' is in fact a pseudo-paradox. Further studies with larger numbers may be warranted.

Classical electrocardiographic clues for left main coronary artery disease.

Prediction of left main coronary artery (LMCA) or equivalent disease is important with regard to selecting the appropriate treatment strategy. The classical electrocardiographic pattern of LMCA disease includes ST elevation (STE) in lead aVR in the presence of extensive ST depression (most prominent in leads I, II, and V4-6) with the STE in aVR≥V1. Patients with these findings may potentially require early coronary angiography and coronary bypass surgery; therefore selected patients with these findings on exercise testing might benefit from more urgent or expedited angiography.

Reverse Takotsubo cardiomyopathy following intra-abdominal surgery.

Reverse Takotsubo cardiomyopathy (RTC) is a rare condition characterized by systolic dysfunction of the basal segments of the left ventricle in the absence of obstructive coronary artery disease. The case of a 50-year-old woman with RTC following intra-abdominal surgery is described in the present report.

The association between platelet-to-lymphocyte ratio and inflammatory markers with the severity of aortic stenosis.

AIM: Platelet-to-lymphocyte ratio (PLR) was proposed as a novel indirect marker of inflammation. We aimed to evaluate the relationship between PLR and aortic stenosis (AS). PATIENTS & METHODS: The study population included 453 patients of which 98 patients with severe AS, 206 patients with mild-to-moderate AS and 149 patients as control. RESULTS: PLR was significantly increased in parallel to the severity of AS (p < 0.001). There was significant positive correlation between PLR and maximum, and mean systolic transaortic gradient (all p < 0.001). Also, PLR was correlated with C-reactive protein and neutrophil-to-lymphocyte ratio (all p < 0.001) and PLR was independently associated with the presence of AS (p < 0.001). CONCLUSION: We found a significant relationship between PLR and AS.

Usefulness of monocyte to HDL-cholesterol ratio to predict high SYNTAX score in patients with stable coronary artery disease.

AIM: We aimed to investigate whether baseline monocyte to high-density lipoprotein cholesterol ratio (MHR), an easily available inflammatory and oxidative stress marker, is associated with SYNTAX score. PATIENTS & METHODS: In this cross-sectional study, n = 1229 consecutive patients with coronary artery disease were classified into two groups, low SYNTAX score (≤22) and high SYNTAX score (≥23). RESULTS: MHRs were significantly higher in patients with high SYNTAX score (p < 0.05). In multivariate regression analysis, MHR remained as independent predictor of high SYNTAX score together with C-reactive protein (CRP), hypertension and diabetes mellitus. In correlation analysis, MHR showed significant positive correlations with SYNTAX score (r = 0.371, p < 0.001) and CRP level (r = 0.336, p < 0.001). CONCLUSION: This study suggests MHR is independently associated with burden of coronary atherosclerosis.

Novel indexes of arrhythmogenesis in preeclampsia: QT dispersion, Tp-e interval, and Tp-e/QT ratio.

OBJECTIVE: There is increasing evidence that preeclampsia (PE) may also be a risk factor for future cardiovascular diseases (CVDs), including arrhythmia. In this study we aimed to evaluate the association between PE and ventricular repolarization using novel electrocardiogram markers: QT interval duration, Tp-e interval, and Tp-e/QT ratio. MATERIALS AND METHODS: In this controlled cross-sectional study sixty-four pregnant women with PE (31 with mild and 33 with severe disease) and 32 healthy women with uncomplicated pregnancies in the third trimester were compared by measuring QT parameters, Tp-e interval, and Tp-e/QT ratio. RESULTS: Tp-e interval and Tp-e/QT ratio values were significantly higher in both the mild and severe PE groups compared to the healthy pregnant group. CONCLUSION: Prevention of CVD requires that patients be aware of their risk factors, be educated about their risk, and perhaps most importantly perceive them to be at risk. In this study, we documented that PE has a significant effect on ventricular repolarization. This alteration could, in part, explain the increased cardiovascular risk in women with a history of PE. This important association can be used to screen women for increased risk in order to better target counseling regarding lifestyle modifications and to follow up and manage women with a history of hypertensive disease of pregnancy more closely.

Forced expiratory volume in one second can predict SYNTAX score in patients with chronic obstructive pulmonary disease.

BACKGROUND: The SYNTAX score is an angiographic score that predicts coronary artery disease (CAD) complexity. It has been shown to be useful for decision making about percutaneous coronary intervention or coronary artery bypass grafting among patients with CAD. Higher SYNTAX scores are indicative of more complex disease. Chronic obstructive pulmonary disease (COPD) is characterised by limitation of airflow. Measurement of forced expiratory volume in one second (FEV1) in spirometry is used for diagnosis and to determine the severity of the disease. AIM: To evaluate the relationship between FEV1 and SYNTAX score in patients with COPD. METHODS: Seventy-eight patients with a previous diagnosis of COPD and 48 patients without COPD were enrolled. Spirometry and coronary angiography were performed in all patients. SYNTAX score was calculated and compared between the two groups. The correlation between FEV1 and SYNTAX score was analysed. RESULTS: SYNTAX score was higher in patients with COPD than in patients without COPD (23.22 ± 12.10 vs. 17.92 ± 11.21, respectively; p = 0.013). Multivariate analysis demonstrated that COPD was independently predictive for intermediate and high SYNTAX score (odds ratio 4.833; 95% confidence interval 2.228-10.485; p < 0.001). Mean FEV1 (% predicted) was 64.7 ± 11.4 and negatively correlated with SYNTAX score in COPD group (r = -0.266 and p = 0.018). The receiver operating characteristic analysis yielded a cutoff value of 65.5 for the FEV1 to predict SYNTAX score ≥ 23, with sensitivity and specificity being 78.6% and 70%, respectively. CONCLUSIONS: COPD is a predictor of higher SYNTAX scores. FEV1 is associated with more severe and complex CAD.