Relationship between impaired repolarization parameters and poor cardiovascular clinical outcomes in patients with potentially serious coronary artery anomalies.

BACKGROUND: Congenital coronary artery anomalies (CCAAs) have the potential for life-threatening complications, including malignant ventricular arrhythmias and sudden cardiac death (SCD). In this study, we aimed to evaluate the relationship between impaired repolarization parameters and poor cardiovascular clinical outcomes in patients with potentially serious CCAAs. METHODS: This retrospective study included 85 potentially serious CCAA patients (mean age: 54.7 ± 13.6 years; male:44) who were diagnosed with conventional and coronary computed tomography angiography (CCTA). All patients underwent transthoracic echocardiography and 12-lead surface electrocardiography. Cardiac events were defined as sustained ventricular tachycardia or fibrillation, syncope, cardiac arrest and SCD. RESULTS: The presence of interarterial course (IAC) was confirmed by CCTA in 37 (43.5%) patients. During a median follow-up time of 24 (18-50) months, a total of 11 (12.9%) patients experienced cardiac events. The presence of IAC was significantly more frequent and Tp-e interval, Tp-e/QTc ratio and frontal QRS/T angle (fQRSTa) were significantly greater in patients with poor clinical outcomes. Moreover, the presence of IAC, high Tp-e/QTc ratio and high fQRSTa were found to be independent predictors of poor clinical outcomes and decreased long-term cardiac event-free survival in these patients. A net reclassification index was +1.0 for the Tp-e/QTc ratio and +1.3 for fQRSTa which were confirmable for additional predictability of these repolarization abnormalities. CONCLUSION: Impaired repolarization parameters, including wider fQRSTa, prolonged Tp-e interval, and increased Tp-e/QTc ratio, and IAC may be associated with poor cardiovascular clinical outcomes in potentially serious CCAA patients.

Acute effects of inhaled iloprost on intracardiac conduction in patients with pulmonary arterial hypertension.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a severe, life-threatening disorder despite the availability of specific drug therapy. A lack of endogenous prostacyclin secondary to downregulation of prostacyclin synthase in PAH may contribute to vascular pathologies. Therefore, prostacyclin and its analogs including inhaled iloprost may decrease pulmonary arterial pressure and ventricular pressure. METHODS: Here, we studied that acute effects of iloprost used in pulmonary vasoreactivity testing on the intracardiac conduction system in patients with PAH. A total of 35 (15 idiopathic PAH, 20 congenital heart disease) patients with PAH were included in this prospective study. Patients were divided into two groups: 22 patients with negative pulmonary vasoreactivity in group 1 and 13 with positive pulmonary vasoreactivity in group 2. Electrophysiological parameters including basic cycle length, atrium-His (AH) interval, His-ventricle (HV) interval, PR interval, QT interval, QRS duration, Wenckebach period, and sinus node recovery time (SNRT) were evaluated before and after pulmonary vasoreactivity testing in both groups. RESULTS: The AH interval (81 [74-93]; 80 [65.5-88], p = 0.019) and SNRT (907.7 ± 263.4; 854.0 ± 288.04, p = 0.027) was significantly decreased after pulmonary vasoreactivity testing. Mean right atrium pressure was found to be correlated with baseline AH (r = 0.371, p = 0.031) and SNRT (r = 0.353, p = 0.037). CONCLUSION: Inhaled iloprost can improve cardiovascular performance in the presence of PAH, primarily through a reduction in right ventricular afterload and interventricular pressure. Decreased pressure on the interventricular septum and ventricles leads to conduction system normalization including of the AH interval and SNRT due to resolution of inflammation and edema.

Speckle-tracking echocardiography can predict atrial fibrillation in patients with supraventricular tachycardia.

PURPOSE: Atrioventricular nodal reentry tachycardia (AVNRT) is the most common supraventriculer arrhythmia in daily clinical practice. Comorbidity of AVNRT and atrial fibrillation (AF) has been well documented in some patients and AF development has been observed more frequently in AVNRT patients during their long-term follow-up. This study was conducted in order to investigate the left atrial two-dimensional-speckle-tracking echocardiographic (STE) parametres as the predictors of the occurence of AF in long-term follow-up in patients with spontaneously developed AF during AVNRT ablation. METHODS: Two hundred and thirty two consecutive AVNRT patients who developed spontaneous AF during ablation procedure were included in the study. The patients were followed up for a mean follow-up period of 6.2 ± 2.1 years. All patients were evaluated using the 2D-STE method. AF was developed in 34 patients during the follow-up period. Cox regression analysis was performed in order to identify the independent predictors of AF occurence. RESULTS: Left atrial LA-res, LA-pump, LA-SRs, LA-SRe, and LA-SRa values were found to be significantly decreased in the group of patients that developed AF during the follow-up period (p < .001 for all aforementioned values). Multivariate cox regression analysis revealed that LA-res (hazard ratio [HR], 0.367; 95% confidence interval [CI], 0.161-0.0.683, p < .001) and SRe (HR, 0.472; 95% CI, 0.346-0.825, p = .006) were independent risk factors associated with the occurrence of AF. CONCLUSION: In conclusion, it was demonstrated for the first time with this study that 2D-STE can effectively predict the development of AF in long-term follow-up in patients with spontaneously developed AF during AVNRT ablation.

The Association between Tp-e interval, Tp-e/QT, and Tp-e/QTc Ratios and Coronary Artery Disease Spectrum and Syntax Score

Abstract Background Coronary artery disease (CAD) causes electrical heterogeneity on ventricular myocardium and ventricular arrhythmia due to myocardial ischemia linked to ventricular repolarization abnormalities. Objective Our aim is to investigate the impact of increased level of CAD spectrum and severity on ventricular repolarization via Tp-e interval, Tp-e/QT and Tp-e/QTc ratios. Methods 127 patients with normal coronary artery (group 1), 129 patients with stable CAD (group 2) and 121 patients with acute coronary syndrome (group 3) were enrolled. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were evaluated as well as baseline demographic and clinical parameters. Kruskal-Wallis one-way ANOVA test was used for comparing quantitative variables with abnormal distribution while One-Way ANOVA test was used for comparing the means between groups with normal distribution. Tukey HSD and Welch tests were used for subgroups analyses with normal distribution. Spearman analysis was used to evaluate the correlation between clinical variables and repolarization markers. A p-value < 0.05 was considered statistically significant. Results Tp-e interval [66(50-83), 71(59-82) and 76(64-86); group 1,2 and 3 respectively, p<0.001], Tp-e/QT (0.170.02, 0.180.01 and 0,190.01; group 1,2 and 3 respectively, p<0.001) and Tp-e/QTc (0.150.02, 0.160.02 and 0.170.02; group 1,2 and 3 respectively, p<0.001) ratios were found to be associated with increased level of CAD spectrum. Syntax score was positively correlated with Tp-e interval (r=0.514, p<0.001), Tp-e/QT (r=0.407, p<0.001), and Tp-e/QTc ratios (r=0.240, p<0.001). Conclusion Prolonged Tp-e interval and increased Tp-e/QT and Tp-e/QTc ratios were detected in the presence of CAD and especially in patients with acute ischemic syndromes. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

The relationship between incomplete surgical obliteration of the left atrial appendage and thromboembolic events after mitral valve surgery (from the ISOLATE Registry).

Left atrial appendage (LAA) is a common site of thrombus formation especially in patients with atrial fibrillation (AF). Complete surgical LAA closure (cSLC) is the surgical aim, however incomplete surgical LAA closure (iSLC) is not rare. In this study, we aimed to evaluate the risk of thromboembolic complications (TEC) in AF patients with iSLC after mitral valve surgery. A total of 101 AF patients (mean age: 61.8 ± 11.8 years; male:32), who underwent surgical suture ligation during mitral valve surgery were enrolled in this retrospective study. All patients underwent transthoracic and transesophageal echocardiography (TEE) at least 3 months after surgery. The primary outcome was the occurrence of TEC including any ischemic stroke, transient ischemic attack, coronary or peripheral embolism. TEE examination revealed cSLC in 66 (65.3%) and iSLC in 35 patients (34.6%). A total of 12 TECs (11.9%) occurred during a mean follow-up time of 41.1 ± 15.6 months. TECs were found to be significantly higher in the iSLC group (25.7% vs 4.5%, p = 0.002). The prevalence of iSLC was significantly higher in patients with TEC (75 vs. 29.2%, p = 0.002). High CHA2DS2-VASc Score and iSLC were found to be independent predictors of TEC. Long term TEC free survival was found to be significantly decreased in patients with iSLC. The presence of iSLC was associated with a significantly increased risk of TEC in AF patients after mitral valve surgery. Routine intraoperative and postoperative screening for iSLC by TEE and long-term strict anticoagulation therapy are recommended in these patients.

Safety of low-dose prolonged infusion of tissue plasminogen activator therapy in patients with thromboembolic events in the intensive care unit.

Objective Thromboembolic events such as acute coronary syndrome related prosthetic heart valve thrombosis, pulmonary artery embolism and renal artery embolism are a rare condition but a major cause of morbidity and mortality. In this study we discussed low-dose thrombolytic therapy, in patients with thromboembolic events in the intensive care unit.Methods The study was performed on 12 consecutive patients [8 female; 50.3±16.0 (35-95) years] with acute thromboembolism including acute coronary syndrome related prosthetic heart valve thrombosis, acute pulmonary embolism and acute renal embolism who were treated with low-dose (25 mg) and slow infusion (6 hours) of t-PA. We evaluated mainly in-hospital safety and also effectiveness.Total treatment episodes was 1.66±0.88 (1-4) times.Results All thromboembolic events have been successfully treated with low-dose (25 mg) and slow infusion (6 hours) of t-PA. The success criteria were clinically improvement and radiologically lysis. None of the patients had ischemic stroke, intracranial hemorrhage, embolism (peripheral and recurrence of coronary artery embolism), bleeding requiring transfusion. The most frequent in-hospital complication was a gum bleeding without need for transfusion (two patients).Conclusions In our case series low-dose (25 mg) and slow infusion (6 hours) of t-PA have been performed successfully for thromboembolic events including acute coronary syndrome related prosthetic heart valve thrombosis, pulmonary embolism and renal embolism in patients with in the intensive care unit. Safety is promising and if efficacy will be proved; this method may be a valuable alternative to standard fibrinolytic regimen.

Impaired repolarization parameters may predict fatal ventricular arrhythmias in patients with hypertrophic cardiomyopathy (from the CILICIA Registry).

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is significantly associated with high risk of fatal ventricular arrhythmias (VAs). Increased frontal QRST angle (fQRSTa), Tpe interval, and Tp-e/QTc ratio are described as ventricular repolarization parameters which are related to arrhythmias. In this study, we aimed to investigate the predictive value of these repolarization parameters for fatal VAs in patients with HCM. METHODS: A total of 127 HCM patients (mean age: 47.9 ±â€¯12.6 years; male:79) were enrolled in this retrospective study. All patients underwent transthoracic echocardiography. Moreover, the last electrocardiograms within 3 months prior to the fatal VA documentation were assessed. The primary outcome was the occurrence of fatal VAs including sustained ventricular tachycardia and ventricular fibrillation which were documented from implantable cardioverter defibrillator records. RESULTS: There were documented fatal VAs in 37 (29.1%) patients during a mean follow-up time of 70.1 ±â€¯22.6 months. The prevalence of fatal VAs was significantly higher in patients with fQRSTa ≥140 degrees (67.4 vs. 7.4%; p < 0.001) and in patients with Tp-e/QTc ratio ≥ 0.19 (61.5 vs. 6.7%; p < 0.001) as compared to others. High Tp-e/QTc ratio (hazard ratio: 1.564; 95% confidence interval: 1.086-4.796; p = 0.032) and high fQRSTa (hazard ratio: 1.864; 95% confidence interval: 1.106-8.745; p = 0.002) were found to be independent predictors of fatal VAs in HCM patients. CONCLUSIONS: Wider fQRSTa, prolonged Tp-e interval, and increased Tp-e/QTc ratio may be associated with fatal VAs in HCM patients. In addition to traditional risk factors, these simple ECG parameters may provide valuable information during evaluation of sudden cardiac death risk in HCM patients.

Prognostic nutritional index predicts mortality in infective endocarditis.

OBJECTIVE: The prognostic nutritional index (PNI), based on serum albumin and lymphocyte concentration, is an inflammation-based nutritional score that has been shown to be a prognostic determinant in several populations. The aim of this study was to investigate the impact of PNI on mortality in patients with infective endocarditis (IE). METHODS: A total of 131 patients with IE were enrolled in this retrospective study. The patients were divided into 2 groups based on in-hospital mortality. The PNI value of the patients was evaluated, as well as baseline clinical and demographical variables. RESULTS: Among the study group, 29 patients died in-hospital during the median follow-up of 37 days. The PNI was found to be lower in cases of mortality (35.90±6.96; 31.09±5.88; p=0.001). ROC curve analysis also demonstrated that the PNI had a good predictive value for in-hospital mortality with a cut-off value of 35.6 (Area under the curve: 0.691; 95% confidence interval [CI]: 0.589-0.794; p=0.002). In multivariate logistic regression analysis, advanced age (Odds ratio [OR]: 1.078; 95% CI: 1.017-1.143; p=0.012), PNI (OR: 0.911; 95% CI: 0.835-0.993; p=0.034), and leaflet perforation (OR: 5.557; 95% CI: 1.357-22.765; p=0.017) were found to be independent predictors of mortality. Kaplan-Meier survival analysis revealed that long-term survival was found to be significantly decreased in patients with a lower PNI (Log rank: p=0.008). CONCLUSION: The PNI result was associated with an increased in-hospital mortality rate in patients with IE. The PNI value, advanced age, and cardiac valve perforation as a complication of IE were found to be independent predictors of mortality.

Post-traumatic pneumolabyrinth: a rare cause of hearing loss.

Pneumolabyrinth (PL) is the presence of air within the vestibule, semicircular canals, or cochlea. It represents an abnormal connection between the inner ear and middle ear spaces. PL most commonly occurs after blunt head trauma, followed by penetrating injuries. Temporal fractures may or may not accompany. Prognosis of hearing loss is poor, while prognosis of vestibular symptoms is good. Herein we present a 45-year-old female with unilateral pneumolabyrinth, who presented with significant dizziness and unilateral total hearing loss after a car accident.

Effects of atrial electromechanical delay and ventriculoatrial conduction over the atrial functions in patients with frequent extrasystole and preserved ejection fraction.

BACKGROUND: The deterioration of left atrial and ventricular functions was demonstrated in patients with frequent ventricular extrasystole (fVES). The exact pathophysiology of left atrial dysfunction in patients with fVES is unclear. Retrograde ventriculoatrial conduction (VAC) often accompanies fVES, which may contribute to atrial dysfunction. We investigated whether atrial electromechanical delay and VAC are related to these atrial functions in patients with frequent right ventricular outflow tract (RVOT) VES and preserved ejection fraction (pEF). METHODS: This study included 21 patients with pEF (eight males, 48 ± 11 years), who had experienced more than 10 000 RVOT-VES during 24-h Holter monitoring and had undergone electrophysiological study/ablation. The study also included 20 healthy age- and sex-matched control subjects. Transthoracic echocardiography was performed on all of the subjects. Atrial conduction time was obtained by using tissue Doppler imaging. Strain analysis was performed with two-dimensional speckle tracking echocardiography. RESULTS: The peak atrial longitudinal strain was significantly impaired in patients with fVES (P = 0.01). In addition, although the interatrial and left atrial conduction delay times were significantly different between each group (P < 0.001, P < 0.001), the right atrial conduction delay times were similar. When patients with fVES were divided into groups depending on the existence of retrograde VAC, atrial deformation parameters and conduction delay time did not significantly differ between either group. CONCLUSION: Frequent RVOT-VES causes left atrial dysfunction. This information is obtained through strain analyses and recordings of left atrial conduction times in patients with pEF. Regardless, retrograde VAC is not related to atrial dysfunction.

Does blindness affect ocular vestibular evoked myogenic potentials?

OBJECTIVE: The aim of the present study was to investigate the influence of blindness on ocular vestibular evoked myogenic potentials (oVEMP) responses. METHODS: Thirty-one subjects with unilateral blindness (UB group) and 25 age and sex-matched healthy subjects (control group) were recruited for the present study. The oVEMP responses including latency, amplitude and amplitude asymmetry ratio (AR) were measured and compared between the blind side, the contralateral eye of the UB group and the control subjects. RESULTS: Ocular VEMP recordings were obtained from 29 of 31 patients (93.5%) for the blind side of the UB group. There was no significant difference in terms of latency, amplitude and AR value between the blind side and the contralateral eye of the UB group and the control subjects. CONCLUSION: Clear oVEMP recordings can be elicited as long as the eyeball and extraocular muscles are preserved in a blind eye.

Assessment of vestibular-evoked myogenic potentials and video head impulse test in type 2 diabetes mellitus patients with or without polyneuropathy.

This study aimed to compare cervical vestibular-evoked myogenic potentials (cVEMP), ocular vestibular-evoked myogenic potentials (oVEMP) and video head impulse test (vHIT) results between patients with type 2 diabetes mellitus (DM) or diabetic polyneuropathy (DPN) and healthy controls to determine vestibular end-organ pathologies. The participants in the present study consisted of three groups: the type 2 DM group (n = 33 patients), the DPN group (n = 33 patients), and the age- and sex-matched control group (n = 35). Cervical VEMP, oVEMP and vHIT were performed for each participant in the study and test results were compared between the groups. Peak-to-peak amplitudes of cVEMP (p13-n21) and oVEMP (n10-p15) were significantly lower in the DM and DPN groups than the control group. The values of vHIT were not statistically different between the groups. To our knowledge, the present study is the first report investigating oVEMP and cVEMP responses combined with vHIT findings in patients with DM and DPN. Vestibular end-organ pathologies can be determined via clinical vestibular diagnostic tools in spite of prominent vestibular symptoms in patients with type 2 DM as well as patients with DPN.

In-Hospital and long term results of primary angioplasty and medical therapy in nonagenarian patients with acute myocardial infarction.

Introduction: Although percutaneous coronary intervention is an accepted "first-line" therapy in acute ST elevation myocardial infarction (STEMI) in general population, few data are available on the short- and long-term outcomes of very old patients (age >90 years). Our aim is to evaluate and compare the short and long-term outcomes after primary percutaneous coronary intervention (PPCI) or medical therapy in nonagenarian patients with STEMI. Methods: We retrospectively identified patients older than 90 years old in our clinic, with acute STEMI who presented within 12 hours after symptoms onset, either underwent PPCI or medically treated. In hospital events and long-term results analyzed subsequently. Results: From January 2005 to December 2014, 73 patients with STEMI either underwent PPCI (PPCI group n = 42) or had only medical treatment (Non-PPCI group n = 31). Mean age was 92.4 ± 3.1 (90-106). Patients were followed 26.5 ± 20.1 months. Recurrent myocardial infarction during hospitalization was not observed in both groups. In-hospital mortality, cerebrovascular events and acute renal failure rate were similar between two groups (respectively P = 0.797 and P = 1.000, P = 0.288), whereas arrhythmia was significantly higher in the PPCI group ( 0; 21.4%, P = 0.009). Results show re-infarction was similar in both groups (respectively 3.2%; 11.9%, P = 0.382) but mortality in long-term was significantly lower in the PPCI group (respectively 40.9%; 12.9%, P = 0.02). Conclusion: In nonagenarian patients, with STEMI mortality is very high. Although; in-hospital events were similar, the long-term mortality rate was significantly lower in patients treated with PPCI.

An Unusual Bullet Trajectory: Entered Through the Face and Ended Up in the Neck.

The authors describe a case of gunshot injury in a 26-year-old male patient with an unusual bullet trajectory. The bullet had an entry hole just near the right lateral alar cartilage of the nose, and the trajectory descended through the left side of the neck by route of the hard palate, soft palate, and posterior pharyngeal wall, respectively. Surgical removal of the bullet was achieved with neck exploration. Gunshot injuries of the head and neck necessitate a thorough clinical and radiological evaluation due to the possibility of an unusual bullet trajectory.

Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection.

INTRODUCTION: The inflammatory process has been reported to be associated with aortic dissection (AD) from the development to the prognosis. The aim of the study was to investigate a relationship between the neutrophil to lymphocyte ratio (NLR) and in-hospital outcomes in patients with acute aortic dissection (AAD) who underwent surgical repair. METHODS: One hundred and eighty-four patients who were admitted with the diagnosis of type A AAD who underwent surgical repair at two large tertiary hospitals. According to their NLR, 91 patients had high NLR (>6.0) and 93 patients had low NLR (⩽6.0). RESULTS: The frequency of major bleeding, hospital-related infection, multi-organ dysfunction and mortality in hospital were higher in the high NLR group compared to the low NLR group. NLR, WBC count and operation duration were found to be independent predictors for in-hospital mortality. CONCLUSIONS: The novel inflammatory marker NLR may be used to predict worse outcomes and hospital mortality in patients with AAD treated by surgical repair.

The level of knowledge and awareness about prostate cancer in the Turkish male and the relevant effective factors.

OBJECTIVE: Our aim was to determine the general knowledge and awareness levels, information sources, and the state of medical check-up for prostate cancer (PCa) and relevant effective factors. MATERIAL AND METHODS: The participants were asked to answer to 14 questions of a questionnaire about age, education, economic and social condition, knowledge about PCa, state of being examined and their related factors. According to demographic characteristics of the participants, levels of awareness about PCa, sources of information, affecting factors and their interrelationships were examined. Two groups were formed according to age (<60 years, >60 years) and variations according to ages were investigated. RESULTS: Two hundred and ninety-three men with an average age of 57 years (range 40-85) were included in the study. Our findings showed that 68.3% of the participants were thinking that PCa is a frequently seen disease, 88.4% were thinking that it can be treated and 62.8% of men specified that their information sources are doctors. We also found that 60.8% of the participants had not undergone prostate examination and prostate specific antigen (PSA) control. The most reason for not having annual examinations was (44.4%) "negligence". Significantly greater number of men with higher education (high school/university) were highly informed about PCa (p=0.037). Check-up rates were statistically significantly higher among men with intermediate income (p=0.041). Curability of PCa diagnosed at an early stage was acknowledged by statistically higher number of individuals under the age 60 (p<0.05). Health control, prostate examination and/or PSA control rates were higher in men with a family history of PCa and in the group of >60 years. CONCLUSION: Although PCa has a high prevalence and mortality rates, personal and social information and sensitivity levels must be increased as it can be treated if diagnosed at an early stage. We think that social and medical impact of the disease can be decreased with the planning of effective methods based on sociocultural and economic factors.

Paratesticular Fibrous Pseudotumors.

Paratesticular fibrous pseudotumors (PFPs) are rare pathologies with quite wide and variable topographic-morphological features. It is difficult to distinguish PFPs from malignant masses. Treatment can be done by resection of the mass. We reported a young patient's findings about this rare pathology.

The diagnostic value of serum copeptin levels in an acute pulmonary embolism.

BACKGROUND: Acute pulmonary embolism (APE) is a common disease which is associated with high mortality and morbidity. Circulating level of copeptin, which was demonstrated to be elevated in heart failure, acute myocardial infarction and pulmonary arterial hypertension, were reported to be independent predictors of poor outcome in recent studies. The aim of the present study was to investigate the clinical utility of copeptin in the diagnosis of APE. METHODS: A total of 90 consecutive patients, admitted to emergency service due to acute chest pain and/or dyspnea and who underwent pulmonary computerized tomography angiography (CTA) due to suspicion of APE, were included in this prospective study. The patients diagnosed with APE were defined as APE (+) group and the remaining individuals with normal pulmonary CTA result were defined as APE (-) group. RESULTS: Copeptin levels (7.76 ± 4.4 vs. 3.81 ± 1.34 ng/dL; p < 0.001) were higher in the APE (+) group as compared to the APE (-) group. Copeptin was significantly positively correlated with B-type natriuretic peptide (r = 0.434, p < 0.001), D-dimer (r = 0.315, p = 0.003) and troponin I (r = 0.300, p = 0.004) and inversely correlated with arterial oxygen saturations (r = -0.533, p < 0001). When the correlation of copeptin with right ventricular dysfunction parameters was investigated, it was significantly inversely correlated with the tricuspid annular plane systolic excursion (r = -0.521, p < 0.001) and positively correlated with right to left ventricle ratio (r = 0.329, p = 0.024). Copeptin (OR 1.836, 95% CI 1.171-2.878, p = 0.008) was found as a significant independent predictor of APE in a multivariate analysis, after adjusting for other risk parameters. CONCLUSIONS: Copeptin is a promising new biomarker, which may be used to support the need for further investigations and to improve the diagnosis of patients with APE.