Neutrophil to lymphocyte ratio predicts SYNTAX score in patients with non-ST segment elevation myocardial infarction.

In this study we aimed to investigate whether there is an association between the neutrophil to lymphocyte ratio (NLR) and severity of coronary artery disease (CAD) in patients with non-ST segment elevation myocardial infarction (NSTEMI) using the SYNTAX score (SXscore). A total of 414 patients with NSTEMI who underwent coronary angiography were enrolled in the study. NLR was measured for all patients at presentation. The study population was then divided into 3 tertiles based on the SYNTAX trial results.(1)) The low syntax group (n = 329) was defined as those with an SXscore ≤ 22, the intermediate syntax group (n = 58) was defined as an SXscore ≥ 23 and < 33, and the high syntax group (n = 27) as those with an SXscore ≥ 33. NLR was significantly lower in patients with a low SXscore compared to patients with an intermediate SXscore or high SXscore (3.7 ± 4 to 4.6 ± 2 and 7.9 ± 4, P < 0.001). Linear regression analysis revealed that NLR (coefficientß = 0.380, 95%CI: 1.165-1.917, P < 0.001) was significantly associated with the SXscore in patients with NSTEMI. Our results indicate that NLR is independently associated with the severity of CAD in patients with NSTEMI.

Association of Left Atrial Spontaneous Echo Contrast to Uric Acid in Patients with Mitral Stenosis.

OBJECTIVES: Spontaneous echo contrast (SEC) is the presence of smoke-like echoes with a characteristic swirling motion of the blood in echocardiography. Previous clinical studies have shown that SEC is a risk factor for left atrial thrombus formation and a predictor of potential systemic embolism originating from the heart. There is an association between uric acid and prothrombotic state. Therefore, we aimed to investigate the role of uric acid in SEC in patients with mitral stenosis (MS). METHODS: A total of 85 consecutive patients with MS were enrolled in the study. Patients were divided into two groups according to whether SEC was present in the left atrium. RESULTS: There were 41 patients (mean age 46.4 ± 11.4 and 68% female) in the SEC(-) group and 44 patients (mean age 45.7 ± 7.2 and 64% female) in the SEC(+) group. High sensitive C-reactive protein (hs-CRP) levels were significantly higher in the SEC(+) group than in the SEC(-) group (9.5 ± 4.2 vs. 4.7 ± 2.2 mg/L, P < 0.001). Uric acid was also significantly higher in the SEC (+) group (6.3 ± 1.4 vs. 4.5 ± 1.3 mg/dL, P < 0.001). In receiver operating characteristics curve analysis, uric acid >5.2 mg/dL had a 73% sensitivity and 76% specificity in predicting SEC in patients with MS. At multivariate analysis, uric acid (OR 3.919, 95% CI 1.911-8.035; P < 0.002) was an independent risk factor for SEC in patients with MS. CONCLUSION: Uric acid is independently associated with SEC in patients with MS. Our findings suggest that this inexpensive, universally available marker may be a useful biomarker for the stratification of risk in patients with MS.

Acute Effects of Intracoronary Tirofiban on No-Reflow Phenomena in Patients With ST-Segment Elevated Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

We evaluated the acute effect of intracoronary administration of tirofiban on no-reflow phenomenon in patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention. Consecutive patients (n = 162) were randomized into 2 groups based on whether intracoronary tirofiban was administered. After the administration of intracoronary tirofiban, thrombolysis in myocardial infarction (TIMI) flow grade significantly increased (P < .001) and successful reperfusion was achieved in 26 (32%) patients. In the placebo group, however, after the administration of intracoronary placebo the TIMI flow grade did not change (P = .070), and successful reperfusion was achieved only in 8 (10%) patients. In-hospital major adverse cardiac events (MACE) were significantly lower in the tirofiban group (36% vs 19%, P = .013). Intracoronary administration of tirofiban significantly improves TIMI flow grade and is associated with a lower in-hospital rate of MACE.

Epicardial Fat Tissue Predicts Increased Long-Term Major Adverse Cardiac Event in Patients With Moderate Cardiovascular Risk.

We investigated the relationship between epicardial fat volume (EFV) measured by multislice computed tomography (MDCT) and long-term major adverse cardiac events (MACEs). Consecutive patients (n = 564) were enrolled in this retrospective study. Patients were divided into tertiles according to EFV. Patients were followed up for an average of 18 months. Patients in each tertile were similar in terms of gender and risk factors. Patients with greater EFV in the third group were more likely to be overweight (P = .001) and older (P = .001). High-density lipoprotein cholesterol levels were relatively lower in the third tertile (45 ± 9, 45 ± 11, and 43 ± 9 mg/dL, respectively; P = .018). The third group had a significantly higher rate of myocardial infarction (0.6%, 1.1%, and 3.7%, respectively; P = .043). The incidence of MACEs during the follow-up period was highest in the third group 15.9% (4.1%, 7.7%, and 15.9%, respectively; P = .001). Epicardial fat volume measured by MDCT was associated with increased long-term cardiovascular risk.

Predictive value of admission platelet volume indices for in-hospital major adverse cardiovascular events in acute ST-segment elevation myocardial infarction.

Although mean platelet volume (MPV) is an independent correlate of impaired angiographic reperfusion and 6-month mortality in ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), there is less data regarding the association between platelet distribution width (PDW) and in-hospital major adverse cardiovascular events (MACEs). A total of 306 patients with STEMI pPCI were evaluated. No reflow was defined as a post-PCI thrombolysis in myocardial infarction (TIMI) flow grade of 0, 1, or 2 (group 1). Angiographic success was defined as TIMI flow grade 3 (group 2). The values of MPV and PDW were higher among patients with no reflow. In-stent thrombosis, nonfatal myocardial infarction, in-hospital mortality, and MACEs were significantly more frequent among patients with no reflow. In multivariate analysis, PDW, MPV, high-sensitivity C-reactive protein, and glucose on admission were independent correlates of in-hospital MACEs. Admission PDW and MPV are independent correlates of no reflow and in-hospital MACEs among patients with STEMI undergoing pPCI.

The protective effect of topical rifamycin treatment against sternal wound infection in diabetic patients undergoing on-pump coronary artery bypass graft surgery.

OBJECTIVES: The aim of this study was to investigate the protective effect of topical rifamycin SV treatment against sternal wound infection (SWI) in diabetic patients undergoing on-pump coronary artery bypass graft (CABG) surgery. METHODS: One hundred and fifty-nine diabetic patients who were scheduled to undergo isolated on-pump CABG surgery were included. Eight were excluded for various reasons. Of the 151 patients, 51 were on insulin therapy and 100 were on oral anti-diabetics. The risk of mediastinitis was assessed using the American College of Cardiology/American Heart Association 2004 guideline update for CABG surgery. According to the risk scores, patients were divided into two comparable groups: the rifamycin group (n = 78) received topical rifamycin treatment after on-pump CABG surgery, and the control group (n = 73) received no topical treatment. RESULTS: Deep sternal wound infection (mediastinitis) was not observed in either group (0/78 vs 0/73, p = 1.0). No superficial sternal wound infection was observed in the rifamycin group, however, it did occur in one patient in the control group (0/78 vs 1/73, p = 0.303). Wound culture was performed and coagulase-negative staphylococci were observed. The infection regressed on initiation of antibiotic therapy against isolated bacteria and the patient was discharged after a full recovery. CONCLUSIONS: Although the difference in rate of superficial sternal wound infection (SSWI) in the rifamycin and control groups was not statistically significant, locally applied rifamycin SV during closure of the sternum in the CABG operation may have had a protective affect against SWI.

Does Serum Bilirubin level on admission predict TIMI flow grade and in-hospital MACE in patients with STEMI undergoing primary PCI.

We evaluated the association of total bilirubin with post-percutaneous coronary intervention (PCI) coronary blood flow and in-hospital major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. A total of 536 consecutive patients with STEMI (male 79%, mean age = 59.9 ± 12.6 years) admitted within 6 hours from symptom onset were enrolled. Patients were divided into 2 groups based on the thrombolysis in myocardial infarction (MI) flow grade. In-stent thrombosis, nonfatal MI, and in-hospital mortality were significantly higher in no-reflow group (P = .007, P = .002, and P < .001, respectively). On multivariate regression, the total bilirubin levels remained independent predictors of no-reflow (odds ratio [OR] 1.586, 95% confidence interval [CI] 1.02-2.47; P = .042) and in-hospital MACE (OR 1.399, 95% CI 1.053-1.857; P = .020). Serum bilirubin levels were independently associated with no-reflow and in-hospital MACE in patients with STEMI undergoing primary PCI.

Neutrophil-to-lymphocyte ratio is associated with severity of coronary artery ectasia.

We investigated the association between coronary artery ectasia (CAE) and Neutrophil-to-lymphocyte ratio (NLR), an indicator of the inflammatory state. The study population included 434 patients (247 males, mean age 62 ± 10 years) including 230 patients with isolated CAE and 104 patients with coronary artery disease and 100 patientss with normal coronary arteries. The NLR was measured at admission and 30 days after coronary angiography in all the patients. The NLR was significantly higher in patients with CAE than those with normal coronary arteries (2.2 ± 0.6-1.3 ± 0.6, P < .001). Linear regression analyses revealed that NLR (coefficient ß = -.61, P < .001) was significantly associated with severity of CAE. The NLR is significantly higher in patients with CAE compared to controls with normal coronary arteries, and NLR is associated with severity of CAE.

Serum omentin 1 level is associated with coronary artery disease and its severity in postmenopausal women.

We evaluated whether serum omentin levels are associated with coronary artery disease (CAD) and its severity among postmenopausal women. We enrolled 193 consecutive postmenopausal women who had undergone coronary angiography for suspected stable CAD. The study population was divided into 2 groups based on the results of coronary angiography (CAD group, n=110 and control group, n=83). Omentin 1 levels were measured and disease severity was assessed using the SYNTAX score (SS) in the CAD group. Those patients with angiographic CAD had significantly decreased omentin 1 levels, compared to those without CAD (247.5+127.4 vs 506+246 ng/mL, P<.001). After adjusting for cardiovascular risk factors, a decreased omentin 1 level was found to be an independent predictor of both angiographic CAD and a high SS. Our data indicate that a decreased omentin 1 level is associated with CAD and its severity among postmenopausal women.

Evaluation of atrial electromechanical coupling times in hemodialysis patients.

BACKGROUND: There are no definite data about the atrial electromechanical coupling times (AEMCT) in patients with end stage renal failure (ESRF). The aim of this study was to investigate the AEMCT in ESRF patients without hypertension (HT) and diabetes mellitus. METHODS: The study population consisted of 47 normotensive, nondiabetic ESRF patients and 41 healthy age/gender-matched control subjects. The time intervals from the onset of P-wave on the surface electrocardiogram to the beginning of late diastolic A-wave (PA) were obtained from the lateral mitral annulus (PA-lateral, maximum AEMCT), septal annulus (PA-septal), and tricuspid lateral annulus (PA-tricuspid). Time intervals were corrected according to the heart rate. The difference between PA-septal and PA-tricuspid (right AEMCT), PA-lateral and PA-septal (left AEMCT), and PA-lateral and PA-tricuspid (inter AEMCT) were calculated. Corrected time intervals were used for calculations. RESULTS: Groups were similar for age (52 ± 12.3 vs. 49.9 ± 6 years, P > 0.05) and gender. Maximum (61 ± 20 vs. 47 ± 13 ms; P < 0.001) AEMCT was significantly higher in the patients compared with the control group, but septal and tricuspid EMCT were not different (P > 0.05). Both inter-atrial (37 ± 21 vs. 24 ± 16 ms, P = 0.002) and left atrial (25 ± 18 vs. 12 ± 9 ms; P < 0.001) EMCT were significantly higher in patients when compared with the controls but intra-right atrial EMCT was not different. CONCLUSIONS: Atrial conduction parameters such as maximal EMCT, left atrial, and inter-atrial EMCTs were prolonged in ESRF patients. This prolongation is seen in ESRF patients even in the absence of factors that affect atrial coupling, such as HT.

The Protective Effect of Topical Rifamycin Treatment against Sternal Wound Infection in Diabetic Patients Undergoing on-Pump Coronary Artery Bypass Graft Surgery : Cardiovascular Topic

Objectives: The aim of this study was to investigate the protective effect of topical rifamycin SV treatment against sternal wound infection (SWI) in diabetic patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods: One hundred and fifty-nine diabetic patients who were scheduled to undergo isolated on-pump CABG surgery were included. Eight were excluded for various reasons. Of the 151 patients; 51 were on insulin therapy and 100 were on oral anti-diabetics. The risk of mediastinitis was assessed using the American College of Cardiology/American Heart Association 2004 guideline update for CABG surgery. According to the risk scores; patients were divided into two comparable groups: the rifamycin group (n = 78) received topical rifamycin treatment after on-pump CABG surgery; and the control group (n = 73) received no topical treatment. Results: Deep sternal wound infection (mediastinitis) was not observed in either group (0/78 vs 0/73; p = 1.0). No superficial sternal wound infection was observed in the rifamycin group; however; it did occur in one patient in the control group (0/78 vs 1/73; p = 0.303). Wound culture was performed and coagulase-negative staphylococci were observed. The infection regressed on initiation of antibiotic therapy against isolated bacteria and the patient was discharged after a full recovery. Conclusion: Although the difference in rate of superficial sternal wound infection (SSWI) in the rifamycin and control groups was not statistically significant; locally applied rifamycin SV during closure of the sternum in the CABG operation may have had a protective affect against SWI

Abnormal heart rate recovery on exercise in ankylosing spondylitis.

OBJECTIVES: This study evaluated the heart rate recovery response in ankylosing spondylitis (AS) patients and control subjects. BACKGROUND: Delayed heart rate recovery after exercise reflects AD and independently predicts adverse cardiac outcome. METHODS: Fifty-one patients with AS and 50 age- and matched controls received electrocardiography, echocardiography, and treadmill exercise testing. The heart rate recovery (HRR) index was calculated as the reduction in heart rate from the rate at peak exercise to the rate at the 1st (HRR1), 2nd (HRR2), 3rd (HRR3) and 5th (HRR5) minute after the cessation of exercise stress testing. RESULTS: There were significant differences in HRR1 and HRR2 indices between patients and controls (24.8 ± 12.1 vs 34.9 ± 11.0; p<0.001 and 41.2 ± 14.2 vs 54.3 ± 11.8; p<0.001, beats/min, respectively). Similarly, HRR3 and HRR5 indices were lower in patients than controls (51.3 ± 15.1 vs 65.2 ± 14.0; p<0.001 and 61.0 ± 14.2 vs 76.1 ± 14.8; p<0.001). In addition, exercise capacity was markedly lower (8.1 ± 2.0 vs 10.5 ± 2.5 METs; p<0.001) in AS than controls. CONCLUSION: The HRR index is impaired in AS patients, implying the occurrence of autonomic dysfunction even without active joint disease or frank cardiac involvement.

Evaluation of left ventricular diastolic function in nonhypertensive nondiabetic hemodialysis patients.

AIM: Diastolic dysfunction (DD) is common in hemodialysis (HD) patients. Because diabetes mellitus (DM) and hypertension (HT) are also common in this patient group, the exact reason for DD in HD patients is not clear. The present study evaluated left ventricular (LV) diastolic function in HD patients without DM and HT. METHODS: Fifty patients on HD and 34 age-matched and sex-matched healthy control individuals were enrolled. Echocardiography was performed in all participants. LV systolic and diastolic functions were evaluated by B-mode echocardiography, pulsed wave, and tissue Doppler imaging. The HD patients were divided into two groups according to the presence or absence of left ventricular hypertrophy (LVH) in echocardiography. RESULTS: LV dimensions and systolic function were within normal limits and similar between groups. However, the HD patients had significantly worse diastolic function (E/A: 0.78 ± 0.26 vs. 1.19 ± 0.28, P < 0.001, e'/a' septal: 0.77 ± 0.36 vs. 1.04 ± 0.21, P < 0.001) and increased filling pressure (E/e': 8.55 ± 3.2 vs. 5.79 ± 1.93, P < 0.001). Thirty-one (62%) patients had LVH, whereas 19 (38%) patients did not have LVH. LV systolic and diastolic functions were similar in HD patients with and without LVH. Seventeen (55%) hypertrophies were concentric and 14 (45%) were eccentric. Diastolic functions were similar in patients with either concentric or eccentric hypertrophy. CONCLUSION: Diastolic function is impaired in HD patients even in the absence of diseases that can cause DD such as HT and DM.

Heart rate recovery is impaired in patients with psoriasis.

OBJECTIVE: The aim of this study was to investigate the relationship between psoriasis and heart rate recovery (HRR) index. PATIENTS AND METHODS: A total of 50 patients with a diagnosis of psoriasis and 32 healthy volunteers were included in the study. In all patients, a stress test was performed to calculate the HRR index in a manner which aimed to reach the age-specific maximum heart rate. HRR indices were calculated in all patients and controls. RESULTS: HRR (beats/minute) indices after the 1st (HRR1, 26 ± 10 vs. 33 ± 8, p = 0.002), 2nd (44 ± 11 vs. 50 ± 6, p = 0.002), 3rd (51 ± 7 vs. 63 ± 8, p < 0.001), 4th (54 ± 7 vs. 65 ± 8, p < 0.001) and 5th (57 ± 8 vs. 70 ± 10, p < 0.001) minutes of the recovery period were significantly lower in the psoriasis group compared to healthy controls. In addition, HRR1 was significantly correlated with duration of psoriasis (r = 0.541, p < 0.001) and psoriasis area and severity index score (r = 0.511, p < 0.001). CONCLUSION: HRR was lower in patients with psoriasis. Given the prognostic value of this test, patients with psoriasis might be at risk for future cardiovascular events and cardiovascular mortality.

A multicenter study on experience of 13 tertiary hospitals in Turkey in patients with infective endocarditis.

OBJECTIVE: The aim of this retrospective multicenter study was to investigate the clinical manifestations, microbiological profile, echocardiographic findings and management strategies of infective endocarditis (IE) in Turkey. METHODS: The study population consisted of 248 Turkish patients with IE treated at 13 major hospitals in Turkey from 2005 to 2012 retrospectively. All hospitals are tertiary referral centers, which receive patients from surrounding hospitals. Data were collected from the medical files of all patients hospitalized with IE diagnosed according to modified Duke Criteria. RESULTS: One hundred thirty seven of the patients were males. Native valves were involved in 158 patients while in 75 participants there was prosthetic valve endocarditis. Vegetations were detected in 223 patients (89%) and 52 patients had multiple vegetations. Mitral valve was the most common site of vegetation (43%). The most common valvular pathology was mitral regurgitation. The most common predisposing factor was rheumatic valvular disease (28%). Positive culture rate was 65%. Staphylococci were the most frequent causative microorganisms isolated (29%) followed by enterococci (11%). In-hospital mortality rate was 33%. CONCLUSIONS: Compared to IE in developed countries younger age, higher prevalence of rheumatic heart disease, more frequent enterococci infection and higher rates of culture negativity were other important aspects of IE epidemiology in Turkey.

Preclinical evaluation of a new left atrial appendage occluder (Lifetech LAmbre™ device) in a canine model.

OBJECTIVES: The study evaluated the feasibility and safety of a novel left atrial appendage (LAA) occluder (LAmbre™, Lifetech Scientific Corp., China) in canines. BACKGROUND: Transcatheter LAA occlusion is comparable to warfarin in preventing atrial fibrillation-related strokes. METHODS: Twenty-two healthy dogs (28 ± 3 kg) received LAmbre implants. The device is delivered by an 8-10 French sheath and has full recapture and repositioning capabilities. All dogs received 1-week antibiotics and 4-week aspirin (80 mg daily) after implants and they were sacrificed in groups at Days 1-3 (n = 5), 1- (n = 7), 3- (n = 4) and 6-months (n = 6) for pathological examinations. Transthoracic echocardiography (TTE) was performed immediately after implant, at Day 3 and before sacrifice. RESULTS: The LAmbre was successfully implanted, retrieved, repositioned and re-implanted in all dogs. The mean implant size was 24 ± 3 mm and the device chosen was 36 ± 7% larger than the measured landing zone diameter. Improper device selection (only 21% oversizing) resulted in dislodgement and death of 1 dog on Day 3. Post-implant angiography and TTE showed well-positioned device without pericardial effusion or impingement on surrounding structures. Late complications included device-related thrombus at 1 month (n = 1) and clinically insignificant pericardial effusion at Day 3 (n = 1). Complete healing on the atrial facing surface with optimal LAA obliteration was confirmed by gross and microscopic examinations in dogs that have been followed up ≥3 months (n = 10). No infarct was detected in major organs. CONCLUSIONS: Our preliminary data suggested the LAmbre™ device is feasible with high success rate in canines. Further studies are needed to evaluate its safety and efficacy.

Effects of ivabradine on 6-minute walk test and quality of life in patients with previously implanted CRT-D.

BACKGROUND: We aimed to evaluate clinical effects of additional heart rate control by ivabradine on life quality score and 6-minute walking test in patients with previously implanted biventricular cardiac resynchronization therapy defibrillator (CRT-D) with ischemic heart failure under regular treatment. METHODS: Fifteen men and 14 women with a median age of 63 years (range, 48-79 years) were studied. Twenty-one patients were in New York Heart Association class II (8 patients were in class III), CRT-D implanted previously, and with resting heart rates greater than 70 beats per minute with sinus rhythm despite conventional medication. Patients were given 2.5- to 7.5-mg ivabradine orally twice a day, and drug dosage was titrated to decrease the patients' average heart rate to 70 beats per minute. Before and 3 months after ivabradine treatment, all patients underwent extensive clinical, echocardiographic, and laboratory evaluation. RESULTS: Ivabradine treatment produced dose-dependent reductions in heart rate at rest and at peak exercise (91.9 ± 6.3 to 71.7 ± 4.8 and 114.4 ± 7.6 to 96.8 ± 4.8; P = 0.001 and P = 0.001, respectively). There were also significant improvements in life quality score (52.4 ± 9.5 to 37.9±7.8; P = 0.001) and 6-minute walking distance (278.7 ± 85.8 to 373.3 ± 94.0; P = 0.001) of patients. All patients with New York Heart Association class III became class II after 3 months of ivabradine treatment. CONCLUSION: Heart rate reduction in a short-term period by ivabradine produced significant improvements in exercise capacity and life quality in patients with CRT-D and conventional therapy.

Usefulness of monocyte chemoattractant protein-1 to predict no-reflow and three-year mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Although monocyte chemoattractant protein-1 (MCP-1) levels are increased in patients with ST-segment elevation myocardial infarction, the prognostic value of MCP-1 in primary percutaneous coronary intervention (pPCI) is not clear. The goal of the present study was to investigate the association of MCP-1 levels with myocardial perfusion and prognosis in patients with ST-segment elevation myocardial infarction undergoing pPCI. Consecutive pPCI patients (n = 192) were assigned to tertiles according to their admission serum MCP-1 levels. Angiographic no-reflow, Thrombolysis In Myocardial Infarction flow grade, myocardial blush grade, and ST-segment resolution were assessed. Mortality and major adverse cardiac events were evaluated during hospitalization and at the 3-year clinical follow-up visit. Failure of ST resolution was associated with greater admission MCP-1 levels. The risk of no-reflow (Thrombolysis In Myocardial Infarction flow ≤2 or Thrombolysis In Myocardial Infarction flow 3 with final myocardial blush grade ≤2 after pPCI and ST resolution <30%) increased as the admission MCP-1 increased. The 3-year mortality increased as the MCP-1 level increased (8% vs 22% vs 28% for the 3 tertiles, p <0.01). Multivariate logistic regression analysis demonstrated that MCP-1 levels at admission are a significant independent correlate of 3-year mortality in patients with no-reflow as detected by myocardial blush grade. A receiver operating characteristics analysis identified an optimum cut point of ≥254 pg/ml, which was associated with a negative predictive value of 95% in association with 1-year mortality. In conclusion, the plasma MCP-1 levels at admission are independently associated with the development of no-reflow and 3-year mortality in patients with ST-segment elevation myocardial infarction undergoing pPCI.