Galectin-3: A biochemical marker to detect paroxysmal atrial fibrillation?

PURPOSE: Atrial fibrillation (AF) is the most common form of arrhythmia. AF leads to electrical remodelling and fibrosis of the atria; however, the mechanism(s) remain poorly understood. Galectin-3 is a potential mediator of cardiac fibrosis. The present study aimed to examine the relationship between serum galectin-3 levels and paroxysmal AF. METHODS: Forty-six patients with paroxysmal AF and preserved left ventricular systolic function, and 38 age- and gender-matched control subjects, were involved in the study. Serum galectin-3 levels were analyzed with an enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum galectin-3 levels (median 1.38 ng/mL; 1.21 ng/mL-1.87 ng/mL; p< 0.001) were significantly elevated in patients with paroxysmal AF compared with the control. Left atrial diameter was significantly higher in patients with paroxysmal AF (41.2±3.0 mm vs. 39.6±3.3 mm). Left atrial diameter was found to be significantly correlated with serum galectin-3 levels in patients with paroxysmal AF (r= 0.378, p= 0.001). CONCLUSION: Serum galectin-3 levels are significantly elevated and significantly correlated with left atrial diameter in patients with paroxysmal AF.

Association of mean platelet volume level with in-hospital major adverse events in infective endocarditis.

We hypothesised that increased on-admission and follow-up mean platelet volume (MPV) levels would correlate with adverse outcomes in patients with infective endocarditis (IE). A total of 108 consecutive patients were grouped into two according to median MPV level (≤ 8.6 and > 8.6 fL). Patients with MPV level of > 8.6 fL had a significantly higher rate of end-stage renal disease, Staphylococcus aureus infection, higher CRP levels, embolic events and in-hospital mortality compared to patients with MPV levels ≤ 8.6 fL. In multivariable Cox regression analysis, previous history of IE, S. aureus infection, end-stage renal disease, depressed LVEF, early surgical intervention, vegetation size ≥ 10 mm, presence of perivalvular abscess, higher on-admission platelet count, CRP and MPV levels emerged as independent predictors of in-hospital unfavourable outcomes. Patients with embolic events and in-hospital mortality revealed an incremental trend for MPV levels compared to patients without any adverse events. Our study results suggest that both on-admission and follow-up MPV levels may be a simple and available biomarker for risk stratification of IE patients.

Fragmented QRS predicts the arrhythmic events in patients with heart failure undergoing ICD implantation for primary prophylaxis: more fragments more appropriate ICD shocks.

BACKGROUND: Fragmented QRS complex (fQRS) is associated with cardiovascular outcomes in various patient populations. Although there were clinical studies investigating the association of fQRS with arrhythmic events in patients with systolic heart failure, the results were conflicting regarding the association of implantable cardioverter defibrillator (ICD) shocks and fQRS. In this study, we aimed to evaluate the association between the presence and extent of fQRS with appropriate ICD shocks and/or all-cause mortality. METHODS: A total of 215 patients (age: 58.2 ± 11.6 years, 72.5 % male) with the diagnosis of left ventricular systolic heart failure in whom ICD had been implanted for primary prophylaxis were enrolled. Standard ECG evaluation revealed fQRS complex in 123 patients (57.2 %). The phenomenon of fQRS was defined as deflections at the beginning of the QRS complex, on top of the R wave, or in the nadir of the S wave similar to the definition in CAD. RESULTS: At mean 23.5 ± 12.1 months follow-up, all-cause mortality was observed in 45 (20.9 %) patients and 111 (51.6 %) patients experienced appropriate ICD shocks. Median number of ECG leads with fQRS were higher in patients with appropriate ICD shocks (3 [2-6] vs 1 [0-2], P < 0.001, respectively). The presence of fQRS (HR: 6.64, 95 % CI: 3.54-12.4, P < 0.001) and the number of leads with fQRS (HR: 1.35, 95% CI: 1.22-1.67) were found as independent predictors of appropriate ICD shocks. Additionally, there was a negative correlation between left ventricular ejection fraction and the number of leads with fQRS (r = -0.434, P < 0.001). Rates of all-cause mortality did not differ between the fQRS(+) (29 [24 % ]) and fQRS(-) (16 [17 % ]) groups (P = 0.27). CONCLUSION: Our findings suggest that the presence and extent of fQRS complex on standard 12-lead ECG predicts appropriate ICD shocks in patients with left ventricular systolic heart failure who underwent ICD implantation for primary prophylaxis.

Myocardial tissue perfusion predicts the evolution of fragmented QRS in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

BACKGROUND: Fragmented QRS complex (fQRS) is associated with worse outcomes in several cardiovascular conditions. However, alterations in fQRS in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and association of fQRS with myocardial blush grade (MBG) has not been investigated until now. In this study, we aimed to investigate the association of MBG after primary PCI with evolution of fQRS. METHODS: Our study consisted of 401 consecutive patients with STEMI who underwent primary PCI. Patients were categorized into two subgroups according to persistence or new-onset of fQRS (Group 1) and absence or resolution of fQRS (Group 2) at 48 hours after primary PCI. The evolution of fQRS on pre- and post-PCI ECG and their relation with myocardial reperfusion parameters were investigated. RESULTS: Patients in group 1 showed older age, higher rate of smoking, lower HDL-cholesterol, lower LVEF, higher angina-to-door time, higher TIMI frame count, and high rate of patients with MBG <3 compared to patients with group 2 (P < 0.05). In correlation analysis, LVEF showed positive correlation with MBG (r = 0.448, P < 0.001) and negative correlation with the number of leads with fQRS (r = -0.335, P < 0.001). In multivariate regression analysis, new-onset or persistance of fQRS after primary PCI is significantly associated with MBG <3, peak CK-MB level, pre-PCI fQRS at anterior localization and smoking. CONCLUSION: Our findings showed that despite complete ST-segment resolution in all patients, fQRS is independently associated with impaired microvascular myocardial perfusion. So, fQRS, as a simple and easily available noninvasive marker, may be useful in stratification of high-risk patients with increased extent of infarcted myocardium who underwent primary PCI.

Relation between QRS duration and atrial synchronicity in patients with systolic heart failure.

OBJECTIVES: The association of QRS duration (QRSd) with ventricular dyssynchrony is well-known in systolic heart failure (HF). However, there are no data regarding the relationship between QRSd and atrial dyssynchrony in patients with HF. We aimed to investigate the association of QRSd with intra-atrial and inter-atrial dyssynchrony in patients with systolic HF by using color tissue Doppler imaging (TDI). METHODS: The study consisted of 70 systolic HF patients and 35 healthy controls. According to QRSd, HF patients were categorized into 2 subgroups as narrow QRS (n = 35) and wide QRS (n = 35) groups. Time intervals between the onset of P-wave and the onset of A-wave on color TDI from the right atrium (P-RA), inter-atrial septum (P-IAS) and left atrium (P-LA) were measured. Atrial dyssynchrony was defined as differences between P-RA and P-IAS (RA dyssynchrony), between P-LA and P-IAS (LA dyssynchrony) and between P-RA and P-LA (inter-atrial dyssynchrony). RESULTS: In patients with either HF groups, we observed significant impairment in intra-atrial and inter-atrial synchronicity compared with the controls (P < 0.001). Moreover, LA, RA and inter-atrial synchrony were found to be significantly impaired in the wide QRS group compared to narrow QRS group. There was also a positive and strong correlation between atrial and ventricular dyssynchrony parameters. In stepwise multivariate analysis, QRSd was found to be the independent predictor of intra-atrial and inter-atrial dyssynchrony in systolic HF. CONCLUSION: Among patients with systolic HF, prolonged QRSd is associated with impaired intra-atrial and inter-atrial synchrony. Atrial and ventricular dyssynchrony parameters were well-correlated with each other.

The effect of different circadian blood pressure rhythms on left ventricular systolic dyssynchrony in patients with newly diagnosed essential hypertension.

OBJECTIVES: Left ventricular (LV) synchronous contraction is impaired in patients with hypertension (HT). The deleterious effects of HT on cardiovascular system are more evident in patients with nondipper HT than dippers. In this study, we aimed to investigate the effect of nondipping HT on LV systolic synchronicity compared with dippers and controls. METHODS: One hundred patients with newly diagnosed essential HT and 50 normotensive subjects were enrolled in this study. The hypertensive patients were assigned 2 groups comprising 55 dippers and 45 nondippers. Each subject underwent a comprehensive transthoracic echocardiographic examination. The evaluation of systolic dyssynchrony was performed by tissue synchronization imaging, and the time to regional peak systolic tissue velocity (Ts) in LV was measured on the basis of 12 segmental models. The standard deviation (SD) of the 12 LV segments (Ts-SD-12) and maximal difference in Ts between any two of the 12 LV segments (Ts-12) were calculated. RESULTS: Compared with the control group, the synchronicity indexes were significantly prolonged in the hypertensive patients. Furthermore, Ts-SD-12 and Ts-12 values were found to be significantly impaired in patients with nondipper HT, compared with dippers: Ts-SD-12 (38.1 ± 18.7 vs. 31.8 ± 15.4, P ≤ 0.001); Ts-12 (123.0 ± 50.6 vs. 98.4 ± 42.3, P ≤ 0.001). Stepwise multivariate logistic regression analysis revealed a significant negative association between LV dyssynchrony indices and percentage decline in BP level from day to night. CONCLUSION: Synchronous systolic contraction of LV is found to be significantly impaired in patients with nondipping circadian pattern of HT compared with dippers and the controls.

Usefulness of preprocedural serum uric acid level to predict restenosis of bare metal stents.

Serum uric acid (SUA) level is known as a significant predictor for cardiovascular diseases, partly through increased inflammatory response and smooth muscle cell proliferation. Inflammation and smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relation between SUA and ISR has not been studied. The aim of the present study was to investigate the predictive value of preprocedural SUA on the development of ISR in patients who undergo coronary bare-metal stent implantation. Clinical, biochemical, and angiographic data from 708 consecutive patients (mean age 60.3 ± 9.3 years, 71% men) who had undergone bare-metal stent implantation and additional control coronary angiography for stable or unstable angina pectoris were analyzed. Patients were divided into tertiles on the basis of preprocedural SUA levels. Stent restenosis was observed in 54 patients (23%) in the lowest tertile, in 79 (34%) in the middle tertile, and in 109 (46%) in the highest tertile (p <0.001). Using multiple logistic regression analysis, diabetes mellitus, smoking, high-density lipoprotein cholesterol, stent length, C-reactive protein level, and preprocedural SUA level emerged as independent predictors of ISR. On receiver-operating characteristics curve analysis, SUA level >5.5 mg/dl had 75% sensitivity and 71% specificity (area under the curve 0.784, p <0.001) in predicting ISR. In conclusion, higher preprocedural SUA is a powerful and independent predictor of bare-metal stent restenosis in patients with stable and unstable angina pectoris.

The relationship between functional capacity and ultrasonic tissue characterization in patients with idiopathic dilated cardiomyopathy.

BACKGROUND: Ultrasonic tissue characterization (UTC) has been widely used to investigate left ventricular (LV) dysfunction in various cardiac disorders. The aim of this study was to investigate the correlation between functional capacity and UTC in patients with idiopathic dilated cardiomyopathy (IDCM). METHODS AND RESULTS: Treadmill test according to modified-Bruce protocol was performed in 48 patients with IDCM to assess their functional capacity. Baseline clinical and echocardiographic variables were obtained and UTC was performed on images obtained from septum and posterior wall (PW). Cyclic variation (CV) index of mean gray level (MGL) was calculated according to the formula: [(MGLdiastole - MGLsystole) ÷ MGLdiastole] × 100.PW and septum CV indices were correlated with exercise duration (r = 0.63, p = 0.001 and r = 0.67, p = 0.0001, respectively) and "MET" level (r = 0.80, p = 0.0001 and r = 0.83,p = 0.0001, respectively). The ROC curve analysis revealed that the PW CV index was a strong indicator of good exercise capacity (> 8 METs) with an AUC of 0.97 (95% CI0.90-1.0), as the interventricular septum (IVS) CV index (AUC = 0.97, 95% CI 0.89-1.0). Sensitivity, specificity, positive predictive value, and negative predictive value to identify good exercise capacity for IVS CV index were 90%, 88%, 82%, and 94%, respectively and for the PW CV index, 90%, 88%, 82%, and 94%, respectively. CONCLUSIONS: In this particular study, we found out that in patients with severe LV dysfunction good exercise capacity was related to septum and PW CV indices measured by UTC, and these indices may be used as an indirect prognostic marker in heart failure.

Increased echocardiographic epicardial fat thickness and high-sensitivity CRP level indicate diastolic dysfunction in patients with newly diagnosed essential hypertension.

BACKGROUND: Hypertension (HT) is one of the main conditions associated with left ventricular (LV) diastolic dysfunction. Epicardial fat tissue (EFT) serves as a source of a plenty of proinflammatory cytokines and is associated with increased cardiovascular events. The aim of the current study was to evaluate the relation among echocardiographically measured EFT thickness, systemic inflammation, and LV diastolic dysfunction in patients with essential HT. PATIENTS AND METHODS: The study included 135 newly diagnosed and untreated hypertensive outpatients. On the basis of conventional Doppler and tissue Doppler imaging-derived parameters, patients were divided into two groups: 60 patients with normal diastolic function and 75 patients with LV diastolic dysfunction. EFT thickness was measured from the parasternal long-axis view at end-systole and high-sensitivity C-reactive protein (hs-CRP) was assessed using the latex-enhanced immunoturbidimetric method. RESULTS: In patients with LV diastolic dysfunction, EFT thickness was significantly increased compared with the normal diastolic function group (7.9 ± 1.7 vs. 6.3 ± 1.5 mm; P < 0.001, respectively). Serum hs-CRP level was also significantly higher in the LV diastolic dysfunction group (P < 0.001) and was correlated with EFT thickness (r = 0.442, P < 0.001). In stepwise multivariate logistic regression analysis, EFT thickness (odds ratio 1.27, 95% confidence interval 1.12-1.43; P = 0.006) and hs-CRP level (odds ratio 1.42, 95% confidence interval 1.18-1.72; P = 0.003) emerged as independent positive predictors of LV diastolic dysfunction. CONCLUSION: In patients with newly diagnosed and untreated essential HT, increased EFT thickness and hs-CRP level are significantly related to impaired LV diastolic function independent from other factors, including age, waist circumference, and 24-h systolic blood pressure.

Usefulness of neutrophil-to-lymphocyte ratio to predict in-hospital outcomes in infective endocarditis.

BACKGROUND: The neutrophil-to-lymphocyte ratio is an independent predictor of worse prognosis in both infectious and cardiovascular disease. We hypothesized that an increased neutrophil-to-lymphocyte ratio at admission would predict in-hospital unfavourable outcomes in patients with infective endocarditis (IE). METHODS: We retrospectively analyzed clinical, laboratory, and echocardiographic data in a total of 121 consecutive adult patients (64 men; mean age, 54.7 ± 14.2 years) with definite IE. RESULTS: Among all patients, the prespecified clinical outcomes were experienced in 46 patients (38%). In-hospital mortality and central nervous system (CNS) events occurred in 29 (24%) and 21 patients (17%), respectively. The neutrophil-to-lymphocyte ratio at admission was found to be significantly higher for either composite end point. On using multiple Cox regression analysis, vegetation size ≥ 10 mm, end-stage renal disease, Staphylococcus aureus infection, low hemoglobin level, increased C-reactive protein (CRP) level, and high neutrophil-to-lymphocyte ratio at admission emerged as independent predictors of in-hospital unfavourable outcomes. In the receiver operating characteristics (ROC) curve analysis, a neutrophil-to-lymphocyte ratio > 7.1 had 80% sensitivity and 83% specificity in predicting adverse outcomes. CONCLUSION: High neutrophil-to-lymphocyte ratio at admission is an independent predictor of in-hospital mortality and CNS events in patients with IE. However, prospective validation of these findings is required.

[Mean platelet volume and the extent of coronary atherosclerosis in patients with stable coronary artery disease]. / Kararli anjinasi olan koroner arter hastalarinda ortalama trombosit hacmi ve koroner aterosklerozun yayginligi

OBJECTIVES: The aim of this study was to assess the relationship between mean platelet volume (MPV) and the presence and extent of coronary artery disease (CAD) in patients who underwent coronary angiography for stable chest pain. STUDY DESIGN: A total of 540 patients (350 male, 190 female; mean age: 59.6±11.4 years) were consecutively included in the study. The patients were divided into four groups according to the presence and extent of their CAD as follows: Group 1 - patients with no significant CAD, group 2 - one vessel disease, group 3 - two vessel diseases, and group 4 - three vessel disease. Also, the Gensini score of each coronary angiogram was calculated. RESULTS: There were 159 patients in group 1, 169 in group 2, 110 in group 3, and 102 in group 4. As expected, we found significant differences among the groups regarding mean age and other coronary risk factors including gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. However, there were no significant differences among the groups regarding platelet counts and MPV values (8.5±0.1 fl, 8.5±1.2 fl, 8.6±0.9 fl and 8.6±0.9 fl, MPV values of groups 1-4, respectively). Although the Gensini score was found to be significantly correlated with age, plasma uric acid level, white blood cell count, hemoglobin level, fasting blood glucose, and high density lipoprotein level, no significant association was detected between MPV and Gensini score values. CONCLUSION: This study is one of the largest studies assessing the relationship between MPV and the extent of coronary atherosclerosis in patients with stable CAD to date. However, we found no association between MPV and the presence and extent of coronary atherosclerosis.

The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention.

OBJECTIVES: In the present study we aimed to reveal any probable correlation between neutrophil-to-lymphocyte ratio (N/L ratio) and the occurrence of no-reflow, along with assessment of the prognostic value of N/L ratio in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: The N/L ratio stands practically for the balance between neutrophil and lymphocyte counts in the body, which can also be utilized as an index for systemic inflammatory status. METHODS: In our study, we included 204 consecutive patients suffering from STEMI who underwent primary percutaneous coronary intervention (PCI). Patients with STEMI were assigned into distinct tertiles based on their N/L ratios on admission. No-reflow encountered following PCI was evaluated through both angiography [Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade (MBG)] and electrocardiography (as ST-segment resolution). RESULTS: Patients featured with no ST-resolution were documented to have displayed significantly higher N/L ratio on admission compared to those with intermediate or complete ST-segment resolution. The number of the patients characterized with no-reflow, evident both angiographically (TIMI flow ≤ 2 or TIMI flow 3 with final myocardial bush grade ≤ 2 after PCI) and electrocardiographically (ST-resolution <30%), was encountered to depict increments throughout successive N/L ratio tertiles. Moreover, the same also held true for three-year mortality rates across the tertile groups (9% vs. 15% vs. 35%, p < 0.01). Multivariable logistic regression analysis disclosed that N/L ratio on admission stood for a significant indicator for long-term mortality in patients with no-reflow phenomenon detected with MBG. Elevated N/L ratio on admission was also found to be a significant indicator for three-year mortality and major adverse cardiac events. CONCLUSIONS: In patients with STEMI who underwent primary PCI, elevated N/L ratios on admission were revealed to be correlated with both no-reflow phenomenon and long-term prognosis.

Serum uric acid, inflammation, and nondipping circadian pattern in essential hypertension.

Uric acid (UA) is independently associated with the emergence of hypertension. Nocturnal nondipping pattern of hypertension is associated with a greater risk of cardiovascular, renal, and cerebrovascular complications than dippers. The aim of the present study was to evaluate the relationship between the circadian blood pressure rhythm and UA level in patients with newly diagnosed essential hypertension. The study included 112 essential hypertensive patients and 50 healthy controls. The hypertensive patients were divided into two groups according to the results of 24-hour ambulatory blood pressure monitoring, including 60 dippers (35 men, 25 women; mean age, 52.6±15.8 years) and 52 nondippers (29 men, 23 women; mean age, 55.9±13.2 years). Nondippers had significantly higher serum UA levels than the dippers and controls (5.8±0.8, 5.1±0.9 and 4.2±0.9 mg/dL, respectively; P<.001). Serum high-sensitivity C-reactive protein levels were also significantly higher in the nondipper group than the other groups (P<.001) and significantly correlated with serum UA (r=0.358, P<.001). Multivariate logistic regression analysis revealed an independent positive association between serum UA levels and nondipper pattern (odds ratio, 2.28; 95% confidence interval, 1.33-3.94; P=.003). Serum UA is strongly and independently associated with the nondipper circadian pattern in essential hypertension.

Red cell distribution width and inflammation in patients with non-dipper hypertension.

Red cell distribution width (RDW) is independently associated with morbidity and mortality in cardiovascular diseases. RDW is elevated in hypertensive patients compared with normotensives. Based on the nocturnal course, hypertension classified as dipper and non-dipper. Non-dipper hypertension is associated with higher inflammation and worse prognosis. We aimed to investigate whether RDW and high-sensitive C-reactive protein (hsCRP) are elevated in non-dipper hypertensive patients compared with dippers. The study included total 247 essential hypertensive patients. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed for each patient. Thereafter patients were divided into the two groups on the basis of the results of 24-h ABPM: 127 dipper hypertensives and 120 non-dipper hypertensives. Complete blood count and biochemistry were measured by standard methods and hsCRP was assessed by using BN2 model nephelometer. Non-dippers had significantly higher RDW levels than dippers [14.6 (13.8-17.0) vs 13.0 (12.5-13.4), p < 0.001, respectively]. After adjustment for hemoglobin, low-density lipoprotein-cholesterol, sex, age and hs-CRP, mean RDW values were for dipper and non-dippers 13.4 (12.4-13.2) and 14.5 (13.7-16.8), respectively (p < 0.001). RDW was negatively correlated with the percentage decline of systolic and diastolic BP from day to night (r = - 0.392, p < 0.001 and r = - 0.294, p < 0.001, respectively). Serum hsCRP levels were also significantly higher in the non-dippers (p < 0.001) and it was significantly positively correlated with RDW (r = 0.403, p < 0.001). In receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict non-dipping pattern was > 13.8%, with 80% sensitivity and 75% specificity. RDW is significantly increased in patients with non-dipper hypertension compared with the dipper hypertension. Inflammatory activity was closely related to RDW in non-dipper hypertensives. RDW, as easy and quick measurable tool, can predict non-dipping pattern in essential hypertension.

Heart rate variability and red cell distribution width in patients with systolic left heart failure.

OBJECTIVE: Red cell distribution width (RDW) is a strong prognostic marker for systolic left heart failure regardless of the anemia status, and heart rate variability (HRV) is negatively associated with mortality and sudden cardiac death in patients with systolic left heart failure. Their relationship has not been investigated in the previous literature. DESIGN: One hundred eighty four patients who had been previously diagnosed with systolic left heart failure (with ischemic or non-ischemic etiology) were retrospectively enrolled in our study. Patients underwent 24-h electrocardiographic monitoring, and blood samples for RDW and other variables were analyzed. Study population was grouped into tertiles of RDW (Tertile 1: 13.4 ± 1.4%, Tertile 2: 14.6 ± 1.4%, and Tertile 3: 17.1 ± 1.2%). RESULTS: Most of the characteristics of patients were similar among RDW tertiles. Standard deviation of all normal RR intervals (SDNN), standard deviation of the averages of RR intervals in all 5-min segments (SDANN) and root-mean square of difference of successive RR intervals (RMSSD) values significantly differed among groups (p < 0.001). The highest RDW tertile had the lowest HRV values, and Pearson correlation analysis yielded a negative correlation between HRV parameters and RDW (for SDNN, SDANN, RMSSD; r = 0.373, 0.340, 0.362, respectively, p < 0.001 for all). In stepwise multivariate analysis HRV was independently associated with RDW. CONCLUSIONS: The HRV parameters were independently associated with RDW in patients with systolic left heart failure.

Usefulness of the neutrophil-to-lymphocyte ratio to predict bare-metal stent restenosis.

Inflammation plays a crucial role in the pathogenesis of in-stent restenosis (ISR). Neutrophil-to-lymphocyte ratio (NLR) provides a simple method for assessment of inflammatory status and prognosis in patients with coronary artery disease. The aim of the present study was to investigate the predictive value of preprocedural NLR on development of ISR in patients undergoing coronary stent implantation. We retrospectively analyzed clinical, hematologic, and angiographic data of 624 patients (mean age 60.5 ± 10.2 years, 71.8% men) who had undergone coronary stent implantation and a further control coronary angiography owing to stable or unstable angina pectoris. Patients were divided into 3 tertiles based on preprocedural NLR. Restenosis occurred in 21 patients (10.1%) in the lowest tertile, in 62 (29.8%) in the middle tertile, and in 107 (51.4%) in the highest NLR tertile (p <0.001). Serum C-reactive protein levels were also significantly higher in patients in tertile 3 than in those in tertiles 1 and 2 (p <0.001). Using multiple logistic regression analysis, smoking, diabetes mellitus, stent length, preprocedural NLR, and C-reactive protein levels emerged as independent predictors of ISR. In receiver operating characteristics curve analysis, NLR >2.73 had 80% sensitivity and 75% specificity in predicting ISR. In conclusion, high preprocedural NLR is a powerful and independent predictor of bare-metal stent restenosis in patients with stable and unstable angina pectoris.

Prognostic significance of neutrophil gelatinase-associated lipocalin in ST-segment elevation myocardial infarction.

OBJECTIVES: This study investigated the prognostic value of neutrophil gelatinase-associated lipocalin (NGAL) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Neutrophil gelatinase-associated lipocalin is a promising biomarker for acute kidney injury. Recently, it was concluded that NGAL may be used beyond the boundaries of renal physiopathology. It was found to be an important factor indirectly contributing to the inflammatory processes. Little is known regarding its predictive role in STEMI. METHODS: One hundred six consecutive patients who underwent percutaneous coronary intervention (PCI) for STEMI and control group consisted of age- and sex-matched 60 consecutive patients with chest pain admitted to the hospital for elective PCI. According to median NGAL level, patients were classified into high- and low-NGAL groups. RESULTS: Neutrophil gelatinase-associated lipocalin levels were higher in patients with STEMI compared to the elective PCI group subjects. Inhospital and 1-year mortality rates were found to be significantly greater in patients with high NGAL. In addition, inhospital and 1-year major adverse cardiovascular event rates were significantly greater in the high-NGAL group, compared to the low NGAL group. High NGAL level on admission was a significant predictor for long-term mortality and major adverse cardiovascular events. The receiver operating characteristics curve analysis further illustrated that NGAL level on admission is a strong indicator of mortality, with an area under the curve of 0.76 (95% confidence interval, 0.62-0.89). CONCLUSIONS: High NGAL levels may be associated with poor prognosis after PCI in patients with STEMI. However, further studies with larger numbers of patients and longer follow-up are required to evaluate the usefulness of plasma NGAL level for predicting prognosis of STEMI.