Effect of Ticagrelor on Left Ventricular Function in Patients with Mildly Reduced Ejection Fraction after Acute Myocardial Infarction

Abstract Background There are limited data about the effect of new P2Y12 inhibitors on left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). Objectives We aimed to investigate the effect of ticagrelor on left ventricular function, compared to clopidogrel in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after AMI. Methods In this cross-sectional, single-center study, we included 251 patients with LVEF between 40% and 50% after AMI before discharge. The patients were divided into 2 groups according to the use of ticagrelor (166 patients) and clopidogrel (85 patients). At the end of the 12-month period, LVEF changes were assessed by echocardiography. P < 0.05 was considered statistically significant. Results The mean LVEF before discharge was 46.5% ± 3.6%, and no difference was observed between the ticagrelor and clopidogrel groups (p = 0.20). At the end of the first year, the mean LVEF of the patients increased to 49.8% ± 7.6% in both groups. The use of ticagrelor (β ± SE = 2.05 ± 0.93; p = 0.029), low creatinine level (β ± SE = −10.44 ± 2.35; p < 0.001), low troponin level (β ± SE = −0.38 ± 0.14; p = 0.006), and low heart rate (β ± SE = −0.98 ± 0.33; p = 0.003) were found to be independent predictors of the increase in LVEF (β ± SE 2.05 ± 0.93; 95% confidence interval: 0.21 to 3.90; p = 0.029). Conclusion In our study, ticagrelor improved left ventricular function in 12 months follow-up compared to clopidogrel in patients with HFmrEF after AMI.

Effect of Atherogenic Index of Plasma on Pre-Percutaneous Coronary Intervention Thrombolysis in Myocardial Infarction Flow in Patients With ST Elevation Myocardial Infarction.

Dyslipidemia is an important risk factor for cardiovascular morbidity and mortality. Although low-density lipoprotein (LDL) is primarily responsible, the importance of triglyceride (TG) and high-density lipoprotein (HDL) has also been recognized. The present study investigated the effect of the atherogenic index of plasma (AIP), in which atherogenic and protective lipoproteins were evaluated together, on the initial flow in patients with ST elevation myocardial infarction. AIP was calculated as log(TG/HDL-cholesterol). Patients included in the study (n = 1535) were divided into Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 and >0. AIP was found to be significantly different between 2 groups (.55 ± .23 vs .67 ± .21; P < .001). AIP was an independent predictor for pre-intervention TIMI flow (Odds Ratio: 2.778). A moderate correlation was found between TIMI frame count measurements, calculated in patients with TIMI 2-3, and AIP (Pearson correlation coefficient: .63, P < .001). In the receiver operating characteristic analysis, AIP showed the highest area under curve (AUC) compared with other lipid parameters for predicting vascular patency. The AUC of AIP was .634, the cut-off value was .59, and the sensitivity and specificity were 67.6% and 68.4%, respectively (P < .001). In conclusion, AIP was found to be an important marker affecting pre-percutaneous coronary intervention TIMI flow.

Predicting hospitalization by TAPSE/SPAP and the role of spironolactone in asymptomatic heart failure patients.

Aim: To appraise the prediction of tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (SPAP) with regard to hospitalization and the effect of spironolactone use. Materials & methods: A total of 245 patients were evaluated for the study. Patients were followed for 1 year and cardiovascular outcomes were determined. Results: It was determined that TAPSE/SPAP was an independent predictor of hospitalization. A 0.1-mmHg decrease in TAPSE/SPAP was associated with a 9% increase in relative risk. No event was observed above the 0.47 level. Negative correlation with TAPSE (uncoupling) began in the spironolactone group when SPAP was ≥43 and in nonusers when SPAP was 38 (Pearson's correlation coefficient: -,731 vs -,383; p < 0.001 vs p = 0.037). Conclusion: TAPSE/SPAP measurement may be useful in predicting 1-year hospitalization in asymptomatic heart failure patients. This ratio was also found to be higher in patients who used spironolactone.

Could Systemic Inflammation in Healthy Individuals With Obesity Indicate Subclinical Atherosclerosis?

Obesity is one of today's pandemics. The link between obesity and inflammation is well established and contributes to atherogenesis. We aimed to determine the relationship between carotid intima-media thickness (cIMT) and inflammation in healthy obese patients (n = 289). The patients were referred to the outpatient clinic due to obesity but had no chronic diseases. Subclinical atherosclerosis was defined as present in participants with cIMT values greater than those expected according to their age group. In patients with subclinical atherosclerosis, the neutrophil-lymphocyte ratio (1.86 ± .65 vs 1.57 ± .45, P < .01), platelet-lymphocyte ratio (120.0 ± 41.2 vs 106.8 ± 30.5, P ≤ .01), and systemic immune-inflammatory index (SII) (550.0 ± 232.8 vs 430.4 ± 135.0, P ≤ .01) were found to be higher. SII was the only independent risk factor for developing subclinical atherosclerosis (odds ratio (OR): 1.995, odds ratio (95% confidence interval): 1.692-4.099), P = .004). The area under the curve (AUC) was .664 (95% CI: .605-.729, P ≤ .001), and the optimal cut-off value was 436.7 (69.3% sensitivity and 61.6% specificity). In conclusion, SII may indicate subclinical atherosclerosis in healthy obese patients, thus leading to early initiation of treatment to reduce cardiovascular morbidity and mortality.

H2FPEF Score and Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Contrast-induced nephropathy (CIN) is one of the most common complications associated with coronary angiography and percutaneous coronary intervention (PCI). This study evaluated the relationship between the H2FPEF (obesity (H), hypertension(H), atrial fibrillation (F), pulmonary hypertension (P), an age >60 years (E), and E/e' > 9 (F)) score which is used to diagnose heart failure with preserved ejection fraction and CIN. Patients (n = 1346) who underwent PCI for acute coronary syndrome (ACS) between December 2018 and January 2021 were retrospectively included. Contrast-induced nephropathy patients had significantly higher H2FPEF scores (4.10 ± 1.92 vs 2.28 ± 1.56, P < .001). In addition, the H2FPEF score was found to be an independent risk factor for the development of CIN (Odd Ratio 1.633 95% CI (1.473-1.811), P < .001) together with age, diabetes mellitus, systolic pulmonary arterial pressure, and left anterior descending as an infarct-related artery. According to point biserial correlation analysis, CIN and H2FPEF score have a strong correlation (rpb = .376, P < .001). The receiver operating characteristic curve showed the optimal cutoff value of the H2FPEF score to predict the development of CIN was 2.5, with 79.8% sensitivity and 64.1% specificity. In conclusion, the H2FPEF score may predict the development of CIN in patients presenting with ACS and undergoing PCI.

The relationship between pesi score and pulmonary venous flow parameters in patients with acute pulmonary embolism.

BACKGROUND: Acute pulmonary embolism (APE) is an important cause of cardiovascular morbidity and mortality. PESI scoring is used in risk classification. This study was designed to determine the relationship between echocardiographic pulmonary vein measurements and PESI score, which is an important tool in diagnosis and treatment. METHODS: A total of 210 patients were evaluated. Pulmonary vein measurements and PESI scores of the patients at the time of diagnosis were calculated. Correlation analysis was performed to determine the relationship between the two parameters. RESULTS: Total PESI scores were 112.9 ± 33.9. The pulmonary vein S wave .39 ± .14, the D wave .48 ± .18, and the S/D ratio was found to be .86 ± .35. It was determined that there was a significant correlation between pulmonary S/D ratio and PESI score. (Pearson correlation coefficient = -.693, R2 Linear:.484; p < .001) The AUC of S/D for mortality prediction was .729 (95% CI = .653-.804; p < .001), the cutoff value was .63, the sensitivity and specificity were 55.6% and 55.7%, respectively. CONCLUSION: Pulmonary vein measurements were found to be correlated with the PESI score and were found to be a parameter that could predict mortality.

Platelet-hemoglobin ratio predicts amputation in patients with below-knee peripheral arterial disease.

BACKGROUND: Peripheral arterial disease (PAD) causes significant morbidity today. Atherosclerosis is evident in the pathophysiological process in most patients, so PAD has similar risk factors as coronary artery disease. Platelet-Hemoglobin ratio (PHR) has been proven to predict mortality in atherosclerotic heart disease. We aimed to determine the relationship between PHR and below-knee amputation. METHODS: The study is a single-center retrospective study. Platelet count/hemoglobin amount formula was used for PHR. Only PAD patients with below-knee critical extremity ischemia and unsuitable for revascularization were included in the study. RESULTS: 235 patients were included in the study retrospectively. The mean age was 65.7 ± 9.9 years and 175(74.5%) of them were male. In the amputated group, white blood cell, neutrophil, platelet, creatinine, glucose, and PHR were higher (p = .031, p = .045, p = .011, p = .048 p = .018, p = .004, respectively). Only hemoglobin values were lower (p = .003). Multivariable regression analysis showed; age, albumin and PHR were determined as independent risk factors for amputation (Age; OR (95%CI): (1.094(1.040-1.152), p = .001) (Albumin; OR (95% CI): 1.950(1.623-1.799), p = .001) (PHR; OR (95% CI): 1.872(1.246-2.812), p = .003). Receiver operating characteristics analysis performed to determine the optimal cut-off value of PHR for amputation, the optimal value was found 2.08 (65.8% sensitivity, 67.5% specificity, p < .001). CONCLUSIONS: PHR was a good predictor for BKA. Using the PHR, it may be possible to identify high-risk patients for amputation.

Novel marker for predicting the severity and prognosis of acute pulmonary embolism: platelet-to-hemoglobin ratio.

Background: We investigated the ability of the platelet-to-hemoglobin ratio (PHR) to predict mortality and disease severity in patients with acute pulmonary embolism (APE). Materials & methods: The severity of APE was classified as massive (high risk), submassive (intermediate risk) or nonmassive (low risk). PHR is defined as platelet count/hemoglobin count. Results: PHR was significantly higher in patients with massive APE, and this elevation showed a gradual increase from the nonmassive group to the massive group (p < 0.001). In-hospital and 1-month mortality were higher in patients with high PHR values. PHR was an independent risk factor for the development of massive APE (odds ratio: 1.014; 95% CI: 1.011-1.017; p = 0.009). Conclusion: PHR values predicted massive APE and were an independent predictor of mortality in APE.

Acute pulmonary embolism is an important cause of death and disability. It is essential to diagnose this disease early, determine its severity and give appropriate treatments. Our study was carried out to investigate whether it is possible to determine the severity of this disease and reveal how it might progress by using the platelet-to-hemoglobin ratio, which is a simple blood measurement and can be found in any health institution.

Copeptin levels predict left ventricular systolic function in STEMI patients: A 2D speckle tracking echocardiography-based prospective observational study.

In the present study, we aimed to investigate whether copeptin values on admission are related to left ventricle (LV) systolic function and its improvement at 6 months in ST-segment elevation myocardial infarction (STEMI) patients.In this single-center, prospective observational study, we included 122 STEMI patients from January 2016 to November 2016. LV systolic functions in the form of global longitudinal strain (GLS) in addition to conventional echocardiography parameters were evaluated on admission and at 6-month. Serum copeptin levels were determined using an ultrasensitive immunofluorescence assay.The study population was divided into 2 groups according to median values of copeptin. GLS was significantly lower in patients with high copeptin levels compared to those with low copeptin levels at early stage and 6-month (-16% (16-16.5) vs -15% (15-15.5), P < .001 and -18% (18-19) vs -16% (16-16.25), P < .001, respectively). Copeptin values were negatively correlated with an early and 6-month GLS (r = -0.459 at early stage and r = -0.662 at 6-month). In addition, we observed that copeptin values were negatively correlated with the improvement of GLS at 6-month follow-up (r = -0.458, P < .001 and r = -0.357, P = .005, respectively).Serum copeptin levels in STEMI patients at the time of admission may predict early and 6-month LV systolic function assessed by two-dimensional GLS. To the best of our knowledge, this study is the first to specifically address the relationship between copeptin values and GLS in STEMI patients.

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Background/aim: Ticagrelor is a drug widely used in patients with acute coronary syndromes (ACS) that specifically increases the plasma level of adenosine, which is likely to cause atrial fibrillation (AF). Therefore, in this study we aimed to investigate the electrocardiographic and echocardiographic predictors of AF development after P2Y12 receptor antagonists in ACS patients. Materials and methods: This cross-sectional study included 831 patients with ACS (486 [58.5%] with ST elevated myocardial infarction [STEMI] and 345 [41.5%] with non-ST elevated myocardial infarction [NSTEMI]). Patients were divided into ticagrelor (n = 410) and clopidogrel (n = 421) groups. P wave properties including P wave dispersion and atrial electromechanical conduction properties were measured as AF predictors with surface ECG and tissue Doppler imaging. Results: Baseline characteristics such as age, sex, heart rate, blood pressure, and laboratory parameters were almost the same in the ticagrelor and clopidogrel groups. The statistical analysis showed no significant difference in P wave dispersion (PWD) between ticagrelor and clopidogrel groups (40.98 ± 12 ms versus 40.06 ± 12 ms, P = 0.304). Subgroups analysis according to ACS types also showed no significant difference in PWD (NSTEMI: 41.16 ± 13.8 ms versus 40.76 ± 13.55 ms, P = 0.799; STEMI: 40.9 ± 12.62 ms versus 39.19 ± 11.18 ms, P = 0.132). In addition, we did not find significant difference in atrial electromechanical delay (EMD) with tissue Doppler imaging (interatrial EMD 24.11 ± 3.06 ms versus 24.46 ± 3.23 ms, P = 0.279). Conclusion: In conclusion, we did not find any difference in detailed electrocardiographic and echocardiographic parameters as AF predictors between ticagrelor and clopidogrel groups in patients with ACS

The effects of supraphysiological oestrogen levels on ventricular repolarisation parameters.

BACKGROUND: The frequency of arrhythmic death developing without a structural cardiac disease is higher in women. Also, female sex is an independent risk factor regarding development of torsades de pointes. Several studies have been conducted on the physiological and therapeutic effects of sex hormones on the cardiac conduction system. AIM: In this study we aim to examine the effect of hormonal changes, especially supraphysiological E2 level changes occurring during in vitro fertilisation treatment, on ventricular repolarisation parameters. METHODS: The study included female patients aged between 23 and 39 years, who were administered controlled ovarian hyperstimulation treatment. Patients' electrocardiograms and blood samples were obtained and analysed before and after the ovarian hyperstimulation treatment. RESULTS: Mean QTc intervals before ovarian hyperstimulation were 411.9 ± 23.7 ms. Measurements during oestradiol peak were calculated as 420.7 ± 23.3 ms, and the QTc interval increase was significant (p = 0.007). Corrected QT dispersion averages were not significant before or after hyperstimulation (53 ± 17 ms vs. 54.5 ± 18.2 ms, respectively, p > 0.05). Tp-e, J-T peak, and PR dispersion changes were not significant after the ovarian hyperstimulation therapy. CONCLUSIONS: Supraphysiological oestradiol levels that occur during controlled ovarian hyperstimulation cause prolongation of QTc intervals, but not to a pathological level. Although this prolongation is not significant in healthy individuals, it might increase ventricular arrhythmia risk in patients with congenital long QT syndrome and in patients taking medication that prolongs QT.

The relationship between 24-hour ambulatory blood pressure load and neutrophil-to-lymphocyte ratio.

INTRODUCTION AND OBJECTIVE: The neutrophil-to-lymphocyte ratio (NLR) is established as a reliable marker of systemic inflammation. Low-grade inflammation has a key role in the pathogenesis and progression of hypertension (HTN). Blood pressure (BP) load, defined as the percentage of abnormally elevated BP readings, is a good marker of HTN severity. We aimed to evaluate the relationship between HTN severity and NLR using averaged ambulatory BP readings and BP load. METHODS: A total of 300 patients with untreated essential HTN were included in this cross-sectional study. Patients were divided into quartiles according to NLR values (first: <1.55; second: 1.55-1.92; third: 1.92-2.48; and fourth: >2.48). Averaged ambulatory BP values and BP load were assessed for each quartile. RESULTS: In the interquartile evaluation there were no differences between quartiles in terms of baseline demographic, clinical and echocardiographic characteristics (p>0.05). Daytime systolic BP (SBP), 24-hour diastolic BP (DBP), daytime DBP, daytime SBP load, 24-hour DBP load and daytime DBP load were found to be significantly higher in the upper two quartiles (p<0.05 for all). In correlation analysis, log NLR values were found to be positively correlated with 24-hour SBP, DBP, SBP load and DBP load (Pearson coefficients of 0.194, 0.197, 0.157 and 0.181, respectively; p<0.01 for all). In multivariate analysis, log NLR had an independent association with 24-hour SBP and DBP and 24-hour SBP and DBP load. CONCLUSION: This study showed for the first time that increased NLR is independently associated with HTN severity in untreated essential HTN patients.