The impact of invasive treatment of superficial venous insufficiency of the lower extremities on cardiac functions.

OBJECTIVE: The aim of the study was to investigate the effect of invasive treatment for chronic venous insufficiency (CVI) on cardiac hemodynamics. METHODS: Fifty three patients diagnosed with saphenofemoral junction or great saphenous vein insufficiency in a level above C3 according to Clinical-Etiology-Anatomy-Pathophysiology classification were included in the study. All the patients underwent 2D echocardiography before and 3 months after the invasive treatment. RESULTS: In postinvasive treatment echocardiographic assessment, significant decreases in right ventricular end-diastolic diameter (p = 0.006), TAPSE (p = 0.006), tricuspid E wave velocity (p = 0.004), tricuspid E/A ratio (p < 0.001), sPAB (p = 0.017), tricuspid lateral s' wave velocity (p = 0.004), and right ventricular free wall longitudinal strain rate (p = 0.011) were observed. CONCLUSIONS: The invasive treatment of superficial venous insufficiency of the lower extremities may lead to reduction in the increased venous return in the supine position subclinically.

The predictive value of the systemic immune-inflammatory index for left atrial appendage thrombus in non-valvular atrial fibrillation.

OBJECTIVE: The systemic immune inflammatory index (SII) has prognostic value in cardiovascular diseases. The aim of current study was to investigate whether or not left atrial appendage (LAA) thrombus could be predicted by SII in patients with non-valvular atrial fibrillation. METHOD: The study included 525 patients newly diagnosed with non-valvular atrial fibrillation, who had not previously had anticoagulant treatment (50.7% male, mean age 62.94±10.79 years). All patients underwent transoesophageal echocardiography. RESULTS: LAA thrombus was observed in 86 patients (16.4%). In the ROC curve SII had a good diagnostic power in predicting LAA thrombus (AUC: 0.760, 95% CI: 0.703-0.818, P<0.001). In the multivariate regression analysis, diabetes (Hazard ratio: 2.264, 95% CI: 1.169-4.389, P=0.015), LAA emptying rate of <20 cm/s (Hazard ratio: 59.347, 95% CI: 25.397-138.680, P<0.001), and SII value of >750 (Hazard ratio: 4.291, 95% CI: 2.144-8.586 P<0.001) were determined as independent predictors for LAA thrombus. A poor correlation was found between SII and the CHADS2 VASc score (r=0.239, P<0.001) Conclusion. The SII, a practical and easily obtained test, can be used as a predictor of LAA thrombus in patients with non-valvular atrial fibrillation, and to decide on the anticoagulant treatment.

Predictive Value of C2HEST Score for Atrial Fibrillation Recurrence Following Successful Cryoballoon Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation.

The C2HEST score ((coronary artery disease (CAD) or chronic obstructive pulmonary disease (COPD) [C2, 1 point each]; hypertension [H, 1 point]; elderly [E, age ≥75 years, 2 points]; systolic heart failure [S, 2 points]; thyroid disease [T, hyperthyroidism, 1 point]) has been validated for predicting incidental atrial fibrillation (AF) in both the general population and patients with ischemic stroke. The present study evaluated the performance of this score in predicting AF recurrence in 252 patients following cryoballoon ablation (CRYO) for paroxysmal AF. The AF recurrence rate in 3-12 months following CRYO was 20,2%. The predictive value of the C2HEST score was significantly better than that of the CHA2DS2-VASc score ((congestive heart failure, hypertension, age (>65 = 1 point, >75 = 2 points), diabetes, previous stroke/transient ischemic attack (2 points), vascular disease, age 65-74 years, and sex category)) (area under curve [AUC]: .881 vs .741; P = .0017). C2HEST score of ≥2, increased atrial diameter, and E/e' ratio as well as, the presence of COPD and systolic heart failure (SHF) were independent predictors for AF recurrence (P < .05). In patients undergoing CRYO for paroxysmal AF, the C2HEST, a simple clinical score, could be useful to assess the risk of AF recurrence.

Impact of residual coronary artery disease on left ventricular function after percutaneous coronary intervention: a two-dimensional strain echocardiography study.

BACKGROUND: The aim of this study was to investigate the relationship between the residual SYNTAX score (rSS) and recovery of left ventricular function after percutaneous coronary intervention (PCI) in stable symptomatic patients. METHOD: Overall, 81 patients (mean age: 62.3 ± 9.1 years, 72.8% male) were included in the study. Echocardiographic parameters were measured before PCI (baseline) and 3 months after PCI (follow-up). The patients were divided into two groups based on rSS: complete revascularized group (CR) with rSS = 0 (n =32; 39.5%) and incomplete revascularized group (iCR) with rSS > 0 (n = 49; 60.5%). RESULTS: The median (25th-75th percentile) SYNTAX score (SS) and rSS values were 8 (5-11) and 2 (0-3), respectively. The difference between basal and follow-up global longitudinal strain (GLS) values (∆ GLS) was significantly higher in the CR group (1.25% ± 1.52 vs. 0.11% ± 1.66% p = 0.003). At the follow-up, there was a significant increase in left ventricular ejection fraction (58.41 ± 6.91% vs. 61.74 ± 5.76%, p < 0.001), a significant decrease in Tei index (0.46 ± 0.18 vs. 0.35 ± 0.16%, p < 0.001), and a significant increase in GLS (14.92 ± 2.76% vs. -15.49 ± 2.66%, p = 0.004). In the linear regression analysis, the only variable related to ∆ GLS was rSS (ß = -0.113, 95% CI: -0.217--0.010; p = 0.033). CONCLUSION: Increased residual coronary artery disease burden has a negative impact on recovery of left ventricular function after PCI.

Does MicroRNA Profile Differ in Early Onset Coronary Artery Disease?

OBJECTIVE: MicroRNAs have been explored as potential biomarkers for many pathological processes including coronary artery disease. In this study, we aimed to compare the circulating levels of selected atherosclerosis-associated miRNAs in patients with a history of early-onset coronary artery disease with that of age- and sex-matched healthy controls and older patients with late-onset coronary artery disease. METHODS: Study population consisted of 30 patients with early onset coronary artery disease, 31 age- and sex-matched healthy controls, and 30 patients with late-onset coronary artery disease. Plasma levels of 13 microRNAs (endothelial cell-related miR-126, -92a/b; vascular smooth muscle cell-related miR-145; inflammation-related miR-16, -21, -125b, -146a/b, -147b, -150, -155; lipometabolism-related miR-27b, -122, -370) were evaluated by using real-time polymerase chain reaction. RESULTS: In patients with early onset coronary artery disease, plasma expressions of the lipometabolism-related miR-27b, miR-122; inflammation-related miR-125b, miR-146a/b, miR-147b, miR-150, miR-155; and VSMC-related miR-145 were significantly downregulated and endothelial cell-related miR-126 was significantly upregulated compared to age- and sexmatched healthy controls. Circulating microRNA profile of patients with early onset coronary artery disease was also different from that of older patients with late-onset coronary artery disease. Plasma levels of miR-21, miR-27b, miR-122, miR-125b, miR-146b, miR-147b, and miR-155 were lower and plasma levels of miR-16 and miR-92a were higher in patients with early onset coronary artery disease compared to older patients with late-onset coronary artery disease. CONCLUSION: MicroRNAs are promising biomarkers for early onset coronary artery disease.

Is coronary artery tortuosity a predisposing factor for drug-eluting stent restenosis?

BACKGROUND: Coronary artery tortuosity (CAT) is a relatively common finding on coronary angiography and may be associated with impaired left ventricular relaxation and coronary ischemia However, the significance of CAT remains unknown. This study aimed to investigate whether the severity of tortuosity in the targeted coronary segment is a predictor of stent restenosis. METHODS: The study included a total of 637 patients undergoing drug-eluting stent implantation due to stable or unstable angina and who had no native coronary artery stenosis on their last coronary angiogram. The patients were separated into two groups: 312 patients with in-stent restenosis and 325 patients without in-stent restenosis. All patients underwent computed tomography (CT) coronary angiography after invasive angiography and CAT was calculated using the computer software. RESULTS: Patients with in-stent restenosis had higher CAT than those without restenosis (1.25 ± 0.11 vs. 1.11 + 0.07, p < 0.001). Multivariate Cox regression analysis showed that the tortuosity index (hazard ratio [HR]: 1.246 95% confidence interval [CI]: 1.127-1.376 p < 0.001) and the circumflex lesion (HR: 1.437 95% CI: 1.062-1.942 p = 0.019) were independently associated with in-stent restenosis. With the threshold value of severe tortuosity set at 1.15, the prediction of could be made with 81% sensitivity and 80% specificity. CONCLUSION: The severity of tortuosity is proportional to coronary in-stent stenosis in patients with stable and unstable angina pectoris undergoing drug-eluting stent implantation for a severe single coronary artery.

Decreased heart rate recovery may predict a high SYNTAX score in patients with stable coronary artery disease.

An impaired heart rate recovery (HRR) has been associated with increased risk of cardiovascular events, cardiovascular, and all-cause mortality. However, the diagnostic ability of HRR for the presence and severity of coronary artery disease (CAD) has not been clearly elucidated. Our aim was to investigate the relationship between HRR and the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score in patients with stable CAD (SCAD). A total of 406 patients with an abnormal treadmill exercise test and ≥50% coronary stenosis on coronary angiography were included. The HRR was calculated by subtracting the HR in the first minute of the recovery period from the maximum HR during exercise. The SYNTAX score ≥23 was accepted as high. Correlation of HRR with SYNTAX score and independent predictors of high SYNTAX score were determined. A high SYNTAX score was present in 172 (42%) patients. Mean HRR was lower in patients with a high SYNTAX score (9.8 ± 4.5 vs. 21.3 ± 9, p < 0.001). The SYNTAX score was negatively correlated with HRR (r: -0.580, p < 0.001). In multivariate logistic regression analysis, peripheral arterial disease (OR: 13.3; 95% CI: 3.120-34.520; p < 0.001), decreased HRR (OR: 0.780; 95% CI: 0.674-0.902; p = 0.001), peak systolic blood pressure (OR: 1.054; 95% CI: 1.023-1.087; p = 0.001), and peak HR (OR: 0.950; 95% CI: 0.923-0.977; p < 0.001) were found to be independent predictors of a high SYNTAX score. Our results showed that HRR is significantly correlated with the SYNTAX score, and a decreased HRR is an independent predictor of a high SYNTAX score in patients with SCAD.

Safety of once- or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: A NOAC-TR study.

Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once- or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1:1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 ± 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.

The role of HATCH score in predicting the success rate of sinus rhythm following electrical cardioversion of atrial fibrillation.

BACKGROUND: The HATCH score predicts the development of persistent and permanent atrial fibrillation (AF) one year after spontaneous or pharmacological conversion to sinus rhythm in patients with AF. However, it remains unknown whether HATCH score predicts short-term success of the procedure at early stages for patients who have undergone electrical cardioversion (EC) for AF. AIM: The present study evaluated whether HATCH score predicts short-term success of EC in patients with AF. METHODS: The study included patients aged 18 years and over, who had undergone EC due to AF lasting less than 12 months, between December 2011 and October 2013. HATCH score was calculated for all patients. The acronym HATCH stands for Hypertension, Age (above 75 years), Transient ischaemic attack or stroke, Chronic obstructive pulmonary disease, and Heart failure. This scoring system awards two points for heart failure and transient ischaemic attack or stroke and one point for the remaining items. RESULTS: The study included 227 patients and short-term EC was successful in 163 of the cases. The mean HATCH scores of the patients who had undergone successful or unsuccessful EC were 1.3 ± 1.4 and 2.9 ± 1.4, respectively (p < 0.001). The area of the HATCH score under the curve in receiver operating characteristics analysis was (AUC) 0.792 (95% CI 0.727-0.857, p < 0.001). A HATCH score of two and above yielded 77% sensitivity, 62% specificity, 56% positive predictive value, and 87% negative predictive value in predicting unsuccessful cardioversion. CONCLUSIONS: HATCH score is useful in predicting short-term success of EC at early stages for patients with AF, for whom the use of a rhythm-control strategy is planned.

Evaluation of Trastuzumab-induced early cardiac dysfunction using two-dimensional Strain Echocardiography.

AIM: Trastuzumab, a chemotherapeutic agent used in the treatment of breast cancer. has been shown to induce subclinical left ventricular (LV) dysfunction during a three to six month period as evidenced by strain echocardiographic examination without any change occurring in the ejection fraction of LV. The present study evaluated the presence of subclinical LV dysfunction using strain echocardiography 1 day and 7 days after the initiation of trastuzumab therapy. MATERIAL AND METHODS: The patients with breast cancer receiving adjuvant trastuzumab therapy underwent 2-dimensional, tissue Doppler, and strain echocardiographic examination at baseline and 1 day and 7 days after therapy. LV global longitudinal strain (GLS), global circumferential strain (GCS) values, and other echocardiographic parameters were calculated. RESULTS: A total of 40 females, mean age 50+/-10 years, were evaluated. Of these patients, 97% received anthracycline and 73% received radiotherapy before the initiation of trastuzumab therapy. No change was observed in any of the echocardiographic parameters 1 day after the initiation of trastuzumab therapy (p>0.05). The LV ejection fraction, tissue Doppler parameters, and GCS values did not show any changes 7 days after the initiation of therapy, whereas significant decreases were observed in GLS value (19.2+/-4.0% vs. 17.2+/-3.4, p=0.001) and systolic annular velocity of the lateral LV wall (S' velocity) (10.5+/-3.2 vs. 8.6+/-2.2, p=0.002). CONCLUSION: Trastuzumab therapy is associated with subclinical LV dysfunction as early as 7 days after initiation of the therapy as evidenced by the decreases in GLS value of LV and systolic annular velocity of the lateral LV wall.

Acute cardiotoxic effects of adjuvant trastuzumab treatment and its relation to oxidative stress.

Our aim was to evaluate the acute cardiac toxicity of adjuvant trastuzumab treatment and its possible relation to changes in oxidative stress. Electrocardiographic and echocardiographic tissue Doppler imaging (TDI) parameters, activity of antioxidant enzymes (superoxide dismutase; SOD), and products of oxidative stress (malondialdehyde; MDA) were analyzed in 30 patients with early-stage breast cancer who had adjuvant trastuzumab treatment. There was a significant prolongation of QT interval after trastuzumab treatment. There was also a significant decrease in left ventricular ejection fraction (LVEF), TDI-derived S' parameters, and SOD enzyme activity and increase in MDA levels after trastuzumab infusion. There was a positive correlation between changes in SOD activity and LVEF and a negative correlation between changes in MDA levels and LVEF. This study demonstrated a correlation between decreases in LVEF and increases in products of the oxidative stress in patients who had adjuvant trastuzumab treatment.

Rate of blood pressure control and antihypertensive treatment approaches in diabetic patients with hypertension.

OBJECTIVES: Hypertension is a common co-morbidity in patients with type 2 diabetes. Management of hypertension is of paramount importance in reducing macro- and microvascular complications of diabetes. The aim of this study is to determine the rate of blood pressure control (<140/85 mmHg) in diabetic patients with hypertension, and to evaluate the prescribing pattern of antihypertensive medications. STUDY DESIGN: This was a prospective, cross-sectional, observational study conducted in a tertiary centre in Turkey. Of 707 patients with diabetes, 500 hypertensive patients were evaluated to determine control of hypertension and treatment attitudes. Logistic regression analysis was used to evaluate the likelihood of prescription of each class of antihypertensive medications for the presence of macro- and microvascular complications. RESULTS: Most of the patients (95%) were on antihypertensive therapy. Only 41% achieved target blood pressure values (<140/85 mmHg). Renin angiotensin system (RAS) blockers were the most frequently (82.4%) prescribed antihypertensive agents, and a combination of RAS blockers and diuretics were the most commonly preferred combination therapy. Most of the patients were on 1 antihypertensive drug or a combination of 2 drugs (39.5% and 44.7%, respectively). Patients with coronary artery disease were more likely to receive beta blockers (Odds ratio=3.6, 95% confidence interval=2.3-5.6; p<0.001). CONCLUSION: Although most of the diabetic hypertensive patients were on hypertensive therapy, more than half had uncontrolled blood pressure.