Association of ABO blood types with ST resolution following thrombolysis in acute ST elevation myocardial infarction.

Introduction: There is paucity of data about the possible role of ABO antigen in response to pharmacologic reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) and its relationship with ST segment recovery; thus, we aimed to evaluate the association of ABO antigen with ST-segment resolution in STEMI patients treated with thrombolysis. Methods: This prospective and observational study was conducted between March 2016 and September 2017 on patients with first acute STEMI within the first 12 hours after onset of symptoms treated with thrombolysis. Myocardial reperfusion success was determined by single-lead ST-segment recovery in 12-lead ECG. Patients were considered as responders if ST-segment resolved ≥50% or were assigned as non-responders if ST-segment resolution was <50%. Univariable and multivariable analyses were performed to examine the contribution of "A" and "B" blood group antigens to ST-segment resolution and the occurrence of major adverse cardiovascular or cerebrovascular event (MACCE). Odds ratio (OR) with 95% confidence interval (CI) were reported for each variable. Results: In this study 303 patients (187 males and 116 females) with a mean age of 56.6 ± 16.8 (ranging from 39 to 87 years) were enrolled. 184 patients (60.7%) were responders and 119 patients (39.2%) were non-responders. The presence of either A (4.5 folds increase) or B (5.4 folds increase) antigen was associated with a higher likelihood of a response to thrombolytic therapy, while had not effect on the occurrence of MACCE. Conclusion: We conclude that the presence of A or B blood group antigens is associated with a better response to thrombolytic therapy in patients with acute STEMI. This finding may imply a higher likelihood for thrombotic occlusion of coronary arteries in patients who have either A or B antigen in their blood.

Absent left atrial appendage: case report and review of the literature.

Congenital absence of left atrial appendage (LAA) is an extremely rare condition and is usually diagnosed incidentally in imaging intended for other purposes. Herein, we report a rare case of absent left atrial appendage in an 80-year-old gentleman who was candidate for radiofrequency catheter ablation procedure for atrial flutter rhythm in whom we observed the absence of left atrial appendage in echocardiographic examination. Computed tomography angiographic examination performed in the evaluation course of the patient was also confirmative of this finding. As there is no data on anticoagulating of patients with absent left atrial appendage, after successful radiofrequency catheter ablation procedure, we continued rivaroxaban per guidelines. The results of a second imaging modality and a thorough medical history are critical for diagnosis of absent left atrial appendage. These steps are required to rule out imitating conditions such as prior surgical/percutaneous exclusion, unusual anatomical features or flush thrombotic exclusion of left atrial appendage. In this case report, we also provide a brief review of the characteristics of 17 cases that have been reported in the literature so far.

Prediction Model for Significant Bleeding in Patients with Supratherapeutic International Normalized Ratio After Oral Administration of Warfarin.

BACKGROUND AND OBJECTIVE: The use and range of indications for anticoagulation therapy are steadily growing. The objective of this study was to develop a scoring model to predict the occurrence of significant bleeding in patients taking warfarin with a supra-therapeutic international normalized ratio. METHODS: Data were collected from the medical records of patients taking warfarin with an international normalized ratio > 3.5. The characteristics of bleeding episodes and the need for transfusion of blood products were recorded. Regression models were constructed to predict the occurrence of significant bleeding (requiring a transfusion of more than 2 units of packed red blood cells, intrapericardial or intracranial hemorrhage). The predictive values of previously published scores (ATRIA: anemia, hypertension, severe renal disease, age ≥ 75 years, or prior bleeding history; and ORBIT: old, reduced hemoglobin, bleeding history, kidney insufficiency or antiplatelet treatment) were compared with our New Bleeding Score (NBLDSCOR); the areas under the curve for the receiver-operating characteristic plots were compared using a non-parametric DeLong test. RESULTS: Significant bleeding was reported in 87 out of 389 admitted patients. With an area under the curve of 0.736 ± 0.032, NBLDSCOR was the best predictor of significant bleeding in this population. Neither ATRIA nor ORBIT was a good predictor of significant bleeding, where the area under the curve for the receiver-operating characteristic plot for ATRIA was 0.654 ± 0.034 and for ORBIT was 0.604 ± 0.033. The predictive power of NBLDSCOR was superior to ATRIA and ORBIT (p < 0.001), while there was no meaningful difference in the predictive powers of ATRIA and ORBIT. CONCLUSION: The NBLDSCOR including age, negative Rhesus factor, low hemoglobin, renal impairment, and concomitant peptic ulcer and disseminated cancer is a good predictor of significant bleeding in this patient population.

The association between severe mitral stenosis and the size of the aortic root and the ascending thoracic aorta.

OBJECTIVE: The aim of this study was to examine the role of isolated rheumatic mitral stenosis (MS) in remodeling of the aorta at various locations. METHODS: In this prospective study, patients who were to undergo transesophageal echocardiography for various indications were screened. The study participants were classified into 2 groups according to the presence of MS with a valve area ≤1.5 cm2. Factors associated with the index dimensions of the aorta at the levels of the annulus, root, sinotubular junction (STJ), and the proximal ascending portion (5 cm from the annulus) were evaluated. Multivariate linear models were constructed including factors that affect the size of the aorta at any of the aforementioned levels. Pearson's correlation coefficient was used to investigate the association between mitral valve area, mitral valve gradient, and dimensions of the aorta. RESULTS: A total of 179 men and 354 women were enrolled. Eighty-four patients had MS (15.8%). The patients with MS were younger and less likely to have hypertension. In univariate analysis, patients with MS had a smaller annulus and STJ (p=0.003 and p=0.043, respectively). Multivariate analysis indicated that MS was correlated with a smaller indexed size of the aortic annulus, yielding a regression coefficient value of 0.541 (p=0.005). CONCLUSION: The presence of significant stenosis at the level of the mitral valve is associated with a smaller diameter in the aortic annulus. It is yet to be clarified whether this phenomenon occurs due to chronic, long-standing, low stroke volume or involvement of the aortic annulus in the fibrotic process of mitral disease.

Fine versus coarse atrial fibrillation in rheumatic mitral stenosis: The impact of aging and the clinical significance.

BACKGROUND: Atrial fibrillation (AF) as the most rhythm disturbance in patients with rheumatic mitral stenosis (MS), is classified in to coarse and fine subtypes according to the height of fibrillatory wave amplitude. The aim of this study is to identify the factors associated with the presence of fine versus coarse morphology in patients with rheumatic MS. METHODS: In this cross-sectional study, patients with confirmed diagnosis of severe rheumatic MS admitted between March 2013 and March 2017 were screened. Patients were categorized to sinus rhythm (SR) and AF rhythm (coarse and fine subtypes) groups according to the admission electrocardiogram. The association between various clinical and echocardiographic factors and the development of fine versus coarse AF were examined. RESULTS: Among 754 patients with the diagnosis of rheumatic MS, 288 (198 female) were found to have AF (38%). Among them 206 (71.5%), and 82 (28.5%) patients had fine and coarse morphology respectively. Patient in these two groups were quite similar in terms of echocardiographic parameters and comorbidities. However, patients with fine morphology AF were significantly older. (p-Value=.007). CONCLUSION: Coarse morphology of AF is common in patients with rheumatic MS. While echocardiographic or most clinical parameters do not seem to associate with the occurrence of coarse or fine morphology, age seems to be the only independent factor correlated with the presence of fine subtype of AF in this population.

Factors Influencing Various Aspects of Patients' Knowledge of Oral Anticoagulation.

OBJECTIVES: To identify and examine individual characteristics and socioeconomic factors that contribute to the knowledge of patients who receive warfarin anticoagulation. METHODS: All patients treated using warfarin for anticoagulation were enrolled during a 6-month period at a university-affiliated cardiac clinic. All relevant demographic and clinical information were collected and the Anticoagulation Knowledge Assessment (AKA) questionnaire consisting of 29 questions was administered. After completion, the questionnaires were scored and the percent correct answers were analyzed for overall scores, as well as the following categories: drug/food interactions, pharmacological knowledge, recognition of complications, and patient compliance. Multiple linear regression analysis was used to identify the contributing factors to the knowledge level of the patients in each category. RESULTS: One hundred fifty patients (79 men and 71 women) with a median age of 61.5 years completed the AKA questionnaire. The average overall score was 29.3%. Living alone (P = 0.008), higher levels of education (P = 0.001), and durations of ≥3 years of warfarin therapy (P = 0.018) positively impacted overall AKA scores. CONCLUSIONS: Socioeconomic factors and level of general education remain the most important elements determining the patient awareness of therapeutic goals, possible drug/food interaction, recognition of adverse effects, and compliance of warfarin treatment.