The relationship between the serum uric acid/creatinine ratio and prognosis in patients with transcatheter aortic valve implantation.

OBJECTIVE: Aortic valve stenosis is a common valve disease in developed countries where the elderly population is high. Aortic valve stenosis is not a simple calcification; it is a dynamic process in which uric acid plays a serious role. We investigated the role of the serum uric acid/creatinine (SUA/Cr) ratio, which is an indicator of uric acid level independent of renal function, in determining the prognosis in patients who had undergone transcatheter aortic valve implantation (TAVI). PATIENTS AND METHODS: In this retrospective cohort study, 357 patients who underwent TAVI for symptomatic severe aortic stenosis between March 2019 and March 2022 were retrospectively analyzed. After applying exclusion criteria, the remaining 269 patients were included in the study. According to the Valve Academic Research Consortium criteria, major adverse cardiac and cerebrovascular events (MACCE) defined the endpoint of the study. Therefore, patients were divided into two groups: the MACCE group and the no MACCE group. RESULTS: Serum uric acid level was significantly higher in the MACCE group (7.0 ± 2.6) than in the no MACCE group (6.0 ± 1.7) (p = 0.008). SUA/Cr ratio was significantly higher in the MACCE group (6.7 ± 2.3) than in the no MACCE group (5.9 ± 1.1) (p = 0.007). CONCLUSIONS: The serum UA/creatinine ratio is important in determining the prognosis of patients undergoing TAVI.

Effect of frailty on major bleeding in octogenarian patients undergoing percutaneous coronary intervention.

OBJECTIVE: There has been an increase in the number of percutaneous coronary intervention (PCI) procedures performed in octogenarian patients due to increased life expectancy and developments in modern medicine. Frailty is associated with the aging process, gradual loss of multiple body functions, and poor health outcomes. We examined the association between frailty and major bleeding in octogenarian patients undergoing PCI. PATIENTS AND METHODS: We retrospectively analyzed the records of two local research hospitals in Turkey. In total, 244 patients were enrolled in this study. Patients were divided into two groups based on their Clinical Frailty Scale (CFS) score. The non-frail group included patients with CFS scores of 1 (very fit) to 4 (living with very mild frailty), while the frail group included those with CFS scores of 5 (living with mild frailty) to 9 (terminally ill). RESULTS: Of the 244 patients, 131 were classified into the non-frail group and 113 into the frail group. Ticagrelor use was significantly more common in the non-frail group (31.3% vs. 20.4%, p=0.036). Major bleeding was more common in the frail than non-frail group (20.4% vs. 6.1%, p<0.001). The rates of stroke and all-cause death were higher in the frail than in non-frail group (stroke 15.9% vs. 3.8%, p<0.001, as well as all-cause mortality rate (27.4% vs. 2.3%, p<0.001). CONCLUSIONS: Frailty is an independent predictor of major bleeding in patients undergoing PCI for acute coronary syndrome. Use of the P2Y12 inhibitor ticagrelor increases the risk of major bleeding in frail patients.

Relationship between red cell distribution width levels and severity of coronary artery ectasia.

OBJECTIVE: Coronary artery ectasia (CAE) is defined as abnormal dilatation of coronary arteries. Inflammation is thought to be important in the pathogenesis of CAE. Red blood cell distribution width (RDW) is also an inflammatory marker. In this study, we examined the association between RDW levels and CAE severity. PATIENTS AND METHODS: A total of 6737 patients who were admitted to the Cardiology Clinic of our hospital between January 2010 and December 2015 and diagnosed with coronary artery disease (CAD) were evaluated for inclusion. Of them, 126 patients who had CAE as a result of retrospective scanning, 104 randomly selected patients with CAD, and 76 patients who had normal coronary arteries were included in the study (n = 306). RESULTS: The severity and prevalence of CAE were evaluated according to the Markis ectasia classification, and the RDW value for type 1 CAE was significantly higher than that of other types of CAE. The RDW values for types 1-4 were 19.48 ± 11.81, 15.26 ± 9.17, 15.51 ± 8.07, and 15.33 ± 7.26, respectively (p= 0.098; r = 0.114). CONCLUSIONS: High RDW values are associated with CAE and CAD, and correlate with the severity of CAE. These findings indicate that RDW values can be used to estimate the severity of CAE disease.

Screening of coronary artery anomalies in 11,707 patients reveals that the radial approach is safe for cannulating coronary anomalies.

OBJECTIVE: This study evaluated the transradial approach for its ability to diagnose coronary artery anomalies, its requirement for catheter usage, the number of images obtained and fluoroscopy time required. PATIENTS AND METHODS: A total of 11,707 patients' coronary angiograph reports from January 2009 to January 2016 were evaluated with 179 patients identified as having coronary artery anomalies. Subsequent analyses compared patients' access sites with multiple angiographic parameters, including the number of images obtained, catheters used, and the fluoroscopy time required. RESULTSesults: The frequency of coronary artery anomalies identified by angiographies was 0.015%. Coronary anomalies were detected by transradial access (TRA) in 133 patients and by transfemoral access (TFA) in 46 patients. The most common anomaly was in the right coronary artery originating from the left sinus Valsalva (71 patients; 39.2%). The fluoroscopy times required and the number of catheters used was similar between the TRA and TFA groups (p = 0.887 and 0.302, respectively) while the number of images obtained during coronary angiographies was higher in the TFA group (p = 0.021). CONCLUSIONS: TRA is safe and effective for cannulation and the diagnosis of congenital coronary artery anomalies.

Total pulmonary vein diameter is a strong predictor of atrial fibrillation after coronary artery bypass graft surgery.

OBJECTIVE: Recent studies have shown that the pulmonary veins are important in atrial fibrillation (AF). This study evaluated the relationship between total pulmonary vein diameter and postoperative AF in on-pump coronary artery bypass graft (CABG) patients. PATIENTS AND METHODS: Our study enrolled 149 patients undergoing on-pump CABG. The primary endpoint was defined as postoperative new-onset in-hospital AF. All patients underwent preoperative non-contrast tomography to measure pulmonary vein diameter. RESULTS: The patients who developed AF had significantly greater total pulmonary vein diameters than those who remained in sinus rhythm. Logistic multivariate regression analysis revealed that only total pulmonary vein diameter was an independent predictor of the development of new-onset AF. CONCLUSIONS: To our knowledge, this is the first report of an association between total pulmonary vein diameter and the development postoperative AF. The identification of high-risk patients using pulmonary vein diameters should facilitate preventive measures.

Two families of GTPases dominate the complex cellular response to IFN-gamma.

IFN-gamma induces a number of cellular programs functional in innate and adaptive resistance to infectious pathogens. It has recently become clear that the complete cellular response to IFN-gamma is extraordinarily complex, with >500 genes (i.e., approximately 0.5% of the genome) activated. We made suppression-subtractive hybridization differential libraries from IFN-gamma-stimulated primary mouse embryonic fibroblasts and from a mouse macrophage cell line, ANA-1, in each case with reference to unstimulated cells. Of approximately 250 clones sequenced at random from the two libraries, >35% were representatives of one or the other of two small unrelated families of GTPases, the 65-kDa and 47-kDa families. These families dominate the IFN-gamma-induced response in both cell types. We report here the full-length sequences of one new 65-kDa and two new 47-kDa family members. The 65-kDa family members are under transcriptional control of IRF-1, whereas the 47-kDa family members are inducible in embryonic fibroblasts from IRF-1(-/-) mice. Members of both GTPase families are strongly up-regulated in livers of wild-type mice infected with the pathogenic bacterium, Listeria monocytogenes, but not in IFN-gammaR(0/0) mice. These GTPases appear to be dedicated to the IFN-gamma response, since resting levels are negligible and since neither family shows any significant relationship to any other described family of GTPases. Understanding the role of these GTPases in IFN-gamma-mediated resistance against pathogens is the task for the future.