Comparison of the Relationship Between Inflammatory Markers and Atrial Fibrillation Burden.

BACKGROUND: Atrial fibrillation is a complex disease with irregular ventricular response and tachycardia as a result of irregular and rapid contraction of the atria, with poor cardiovascular outcomes unless treated. Various mechanisms are involved in its pathohysiology. Inflammation has an important place among these mechanisms. Many cardiovascular events accompany inflammation. Understanding and correct evaluation of inflammation in current situations contribute to the diagnosis and severity of the disease. The aim of our study was to understand the role of inflammatory biomarkers in patients with atrial fibrillation and to evaluate the difference between whether the disease is paroxysmal and persistent (atrial fibrillation burden). METHODS: The study was done retrospectively, and a total of 752 patients who were admitted to the cardiology outpatient clinic were recruited. The normal sinus rhythm group of the study consisted of 140 patients, and the atrial fibrillation group consisted of 351 [permanent atrial fibrillation (n = 206) and paroxysmal atrial fibrillation (n = 145)] patients. Inflammation markers were evaluated by dividing the patients into 3 groups. RESULTS: Higher permanent atrial fibrillation [209.71 (40.73-604.0)], paroxysmal atrial fibrillation [188.51 (53.95-617.46)], normal sinus rhythm [629.47 (104-4695)]; permanent atrial fibrillation [4.53 (0.27-17.94)], paroxysmal atrial fibrillation [3.09 (0.40-11.0)], normal sinus rhythm [2.34 (0.61-13.51)] (P <.05); and permanent atrial fibrillation [1569.54 (139-6069)], paroxysmal atrial fibrillation [1035.09 (133-4013)], normal sinus rhythm [130.40 (26.42-680.39)] (P <.05) were detected in the systemic immune inflammation index, neutrophil-lymphocyte ratio, and platelet/lymphocyte ratio atrial fibrillation groups compared to normal sinus rhythm group. Correlation between C-reactive protein and systemic immune inflammation index (r = 0.679, r = 0.483 P <.05, respectively) was found in the permanent atrial fibrillation and paroxysmal atrial fibrillation groups. CONCLUSION: Systemic immune inflammation index, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio were found to be higher in permanent atrial fibrillation compared to paroxysmal atrial fibrillation and in the whole atrial fibrillation group compared to the normal sinus rhythm group. This indicates that inflammation is associated with AF burden and the SII index is successful in reflecting this.

The effect of dapagliflozin therapy on ventricular repolarization parameters in electrocardiography in patients with diabetic cardiovascular disease.

BACKGROUND: Dapagliflozin is an agent that has both antihyperglycemic effects and is significantly associated with a lower risk of cardiovascular events in patients with diabetes mellitus (DM). However, there is insufficient data and information about the effect of dapagliflozin on electrocardiographic (ECG) parameters. AIM: The effects of dapagliflozin on ventricular repolarization parameters have not been fully elucidated yet. This study aimed to investigate whether dapagliflozin has a positive effect on ventricular repolarization heterogeneity parameters in patients with type 2 DM. METHOD: We retrospectively enrolled 140 patients with a known diagnosis of type 2 DM who were newly prescribed dapagliflozin in addition to standard anti-diabetic therapy. The patients were divided into two groups according to whether they had cardiovascular disease (CVD). The effect of dapagliflozin treatment on ventricular repolarization parameters (frontal plane QRST angle, Tp-e interval, Tp-e/QTc, QTc, and QTc dispersion) was investigated, patient groups were compared before and after treatment. RESULTS: Among 140 patients, 70 (50 %) had CVD and 70 (50 %) did not have CVD. Dapagliflozin treatment resulted in significant reductions in ventricular repolarization parameters over the study period in the CVD group with diabetes. Mean fQRST angle, Tp-e interval, Tp-e/QTc, QTc, and QTc dispersion were significantly lower than baseline values at 6-month follow-up visits in the CVD group (61.61 ± 9.22° vs 52.55 ± 8.31°, 74.45 ± 16.06 msec vs 63.27 ± 13.99 msec, 0.19 ± 0.03 vs 0.16 ± 0.03, 384.12 ± 47.93 msec vs 356.15 ± 43.31 mesc, 55.28 ± 5.50 msec vs 48.08 ± 6.48 msec for all pairwise comparisons p < 0.001). CONCLUSION: Similar antihyperglycemic effects were found with dapagliflozin treatment in patients with and without CVD. However, significant reductions in ventricular repolarization parameters were observed only in patients with CVD.

The relationship between radial artery spasm and adropin levels in patients undergoing transradial coronary angiography.

Introduction: Transradial coronary angiography (TRA) is associated with a lower incidence of bleeding rate and access site complications and is associated with better outcomes compared to transfemoral angiography. However, radial artery spasm (RAS) is an important limitation of TRA procedures. Little is known regarding the relationship of serum vasodilator and inflammatory markers with RAS. Therefore, the present study aimed to investigate the association between serum adropin level and RAS in patients undergoing TRA. Methods: From February 2020 to January 2021, 39 consecutive patients who underwent elective daiagnostic TRA and experienced RAS during the procedure, and 42 age and sex matched controls who did not experience RAS were prospectively included into the study. The groups were compared regarding serum adropin levels and inflammatory markers. Results: Although adropin levels were found to be lower in the RAS group, this difference was not statistically significant between the the patients with RAS and controls (14.9 vs. 16.1, P=0.105). However, inflammatory parameters monocyte count and MHR (monocyte/HDL cholesterol ratio) were found to be statistically significantly higher in the RAS group compared to controls (P=0.001 and P=0.010, respectively). Moreover, a significant positive correlation was found between the monocyte count and RAS (r:0.360, P<0.001), and between MHR and RAS (r:0.288, P=0.009). Furthermore, multivariate analysis demonstrated that monocyte count (OR:1.671, 95%CI:1.312-2.094, P=0.001) and MHR (OR:1.116, 95%CI:1.054-1.448, P=0.022) were found to be independent predictors of RAS. Conclusion: Serum vasodilator and inflammatory markers may be useful in the prediction of RAS in patients undergoing TRA procedures.

Association between coronary dominance pattern and left ventricular mass index: Is there a gender disparity?

BACKGROUND: Increased left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH) are independent predictors of adverse cardiovascular events. However, little is known regarding the association between coronary circulation and LVMI. We aimed to investigate the association between coronary dominance and LVMI, and to demonstrate the impact of coronary dominance pattern on the emergence of LVH. METHODS: In total, 367 consecutive patients without known cardiovascular disease and significant obstructive coronary artery disease who underwent diagnostic coronary angiography were prospectively included in the study. Patients were divided into three groups according to coronary dominance pattern. Patients with right dominance (RD), co-dominance (CD) and left dominance (LD) patterns were compared regarding echocardiographically detected LVMI. Additionally, the association between coronary dominance pattern and LVH was investigated. RESULTS: The frequency of RD, CD and LD patterns was 70.3%, 19.1% and 10.6%, respectively. LVMI was significantly higher in patients with CD pattern compared with those with RD and LD patterns (P < .001, for both comparisons). LVH was present in 71 (19.3%) patients. Importantly, the CD pattern was more frequent in patients with LVH compared with those without LVH (P < .001). No significant difference was found between women and men regarding the type of coronary dominance pattern. However, while the presence of CD pattern was found to be an independent predictor of LVH in women (OR:1.221, 95%CI:1.048-1.872, P < .001), no association was observed between coronary dominance pattern and LVH in men. CONCLUSIONS: Coronary dominance pattern may significantly affect the LVMI, and it may be useful in the further risk stratification of female patients.

Electrocardiographic Evaluation of the Ventricular Arrhythmia Risk in Patients Diagnosed With Schizophrenia.

Objective: The purpose of this study was to examine electrocardiographic ventricular arrhythmia predictors in patients with schizophrenia by comparing with healthy controls. Methods: The study included 100 patients with schizophrenia and 100 healthy controls. Electrocardiography (ECG) was performed on all participants in resting position. T-wave peak to end (Tp-e), QT ranges, P-wave dispersion (Pd), and R-R range were measured. Then, the Schizophrenia Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS) were applied to the schizophrenia group. Results: The PANSS positive symptom subscale was calculated as 10.41 (SD = 2.27), the negative symptom subscale was calculated as 14.44 (SD = 5.42), and the overall functionality level was calculated as 27.04 (SD = 5.43). The mean CDSS score was determined to be 3.74 (SD = 2.15). No differences were detected in the heart rate measurements of the patient and control groups in ECG results (P = .427). The minimum QT interval and minimum Tp-e wave times were found to be low in the patient group (P < .001 for both intervals). Corrected QTc dispersion, Pd, Tp-e dispersion, and QT dispersion were found to be higher in the patient group than in healthy controls (P < .001 for all intervals). Discussion: Based on our results, it is possible to speculate that patients with schizophrenia are at a risk of developing cardiac arrhythmia and cardiac dysfunction if they do not receive treatment. For this reason, clinicians should pay attention to cardiac transmission problems when organizing the treatment of patients. Further studies should be conducted to determine cardiac problems in patients with schizophrenia.

Comparison of RCHA2DS2-VASc score and CHA2DS2-VASc score prediction of no-reflow phenomenon in patients with ST-segment elevation myocardial infarction.

OBJECTIVE: No-reflow is a phenomenon that can arise due to factors such as distal embolization, microvascular occlusion, or prolonged myocardial ischemia and damage. It occurs in about 5% to 10% of patients after primary percutaneous coronary intervention. The CHA2DS2-VASc score can be easily calculated in daily practice and the components of this score are similar to common risk factors for no-reflow. Chronic renal disease generates a hypercoagulable state, which is associated with increased risk of no-reflow in cases of ST-segment elevation myocardial infarction (STEMI). A modified CHA2DS2-VASc score has been developed to include patients with renal dysfunction. The aim of this study was to investigate the prognostic significance of this scoring system, the RCHA2DS2-VASc score, in patients with no-reflow. METHODS: A total of 75 patients with no-reflow and 1138 patients without no-reflow after STEMI were retrospectively enrolled in this study. The CHA2DS2-VASc and RCHA2DS2-VASc scores of the two groups were compared. RESULTS: The median CHA2DS2-VASc score and the median RCHA2DS2-VASc score were significantly higher in the no-reflow group (p<.001, for both). There was a statistically significant difference between the groups in all of the components of the CHA2DS2-VASc score. An RCHA2DS2-VASc score of ≥2 was a predictor of no-reflow with a sensitivity of 83% and specificity of 62%. CONCLUSION: The RCHA2DS2-VASc score is a simple, inexpensive, and easily accessible score to predict no-reflow.

Comparison of the Relationship Between Inflammatory Markers and Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome After Coronary Angiography.

Contrast-induced nephropathy (CIN) is one of the most important complications after invasive cardiovascular procedures. The neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-lymphocyte ratio (MPVLR), and platelet-to-lymphocyte ratio (PLR) may be markers of the risk of CIN. We aimed to investigate the association of these indices with the development of CIN in patients with ST-elevation myocardial infarction and non-ST-elevation-acute coronary syndrome who underwent percutaneous coronary intervention. We retrospectively collected the data of patients with ACS after coronary angiography (CA); 564 patients were included (mean age, 62.3 ± 13.0 years; 41.1% female). We compared 62 (10.9%) patients who developed CIN and 502 patients who did not, after CA in terms of NLR, PLR, and MPVLR. Patients who developed CIN had significantly higher MPVLR, NLR, and PLR; the MPVLR (P ≤ .001) was an independent predictor of CIN. NLR, MPVLR, and PLR are simple, cheap, and easily accessible tests that can predict CIN; the MPVLR was the strongest of these predictors.

Association of the Monocyte to HDL Cholesterol Ratio With Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction.

Intracoronary thrombus burden is associated with some adverse events and poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Identifying predictors of the intracoronary thrombus burden may contribute to the management of STEMI. In this study, we evaluated whether monocyte count to high-density lipoprotein cholesterol ratio (MHR) is a predictor of intracoronary thrombus burden in patients with STEMI. The study population consisted of 414 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). Angiographic thrombus burden was classified based on thrombolysis in myocardial infarction (TIMI) thrombus grades. The patients were grouped into 2 categories of low thrombus burden and high thrombus burden. The MHR was significantly higher in the high thrombus burden group compared with the low thrombus group (16.0 [9.2-22.1] vs 25.4 [13.5-44.6]; P < .001). In multivariate logistic regression analysis, MHR was an independent predictor of high thrombus burden (odds ratio: 1.067, 95% CI: 1.031-1.105; P < .001). The area under the receiver-operating characteristic curve of the MHR was 0.688 (0.641-0.733; P < .001) to predict high thrombus burden. In conclusion, MHR was independent predictor of high thrombus burden in patients with STEMI who underwent primary PCI.

Association of fragmented QRS complexes on ECG with left ventricular diastolic function in hypertensive patients.

OBJECTIVES: Diastolic dysfunction occurs as a result of interstitial fibrosis in hypertensive patients. Fragmented QRS (fQRS) on ECG signifies myocardial fibrosis in various clinical situations. We investigated whether fQRS on ECG is related to diastolic dysfunction in patients with hypertension. STUDY DESIGN: The study population included 72 hypertensive patients with normal coronary angiogram. Fragmented QRS was defined as the presence of an additional R wave (R'), notching of the R or S wave or fragmentation in two contiguous leads corresponding to a major coronary artery. Echocardiography was performed to all patients to detect diastolic dysfunction. Diastolic dysfunction was regarded as non-severe if patients had normal diastolic function or grade 1 diastolic dysfunction or severe if they had grade ≥2 diastolic dysfunction. RESULTS: Thirty-two patients had fQRS on ECGs (fQRS [+] group) and there were 40 patients who did not have fQRS on their ECGs (fQRS [-] group). The two groups were similar in terms of baseline characteristics. In patients with fQRS on the ECG, severe diastolic dysfunction was more prevalent (59.4% vs. 7.5%, p<0.001). The duration of hypertension was longer in patients with fQRS on the ECG (p<0.001). The presence of fQRS on the ECG was an indicator for severe diastolic dysfunction (B=1.954; odds ratio=7; 95% confidence interval=1.4-35.4; p=0.018). CONCLUSION: The presence of fQRS complexes on ECG predicts more severe diastolic dysfunction in patients with hypertension.