Prognostic impact of cardiohepatic syndrome in patients with ST-segment elevation myocardial infarction.

Background: Cardiohepatic syndrome (CHS) indicates a bidirectional interaction between the heart and liver. This study was designed to evaluate the impact of CHS on in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention. Materials & methods: 1541 consecutive STEMI patients were examined. CHS was defined as the elevation of at least two of three cholestatic liver enzymes: total bilirubin, alkaline phosphatase and gamma-glutamyl transferase. Results: CHS was present in 144 (9.34%) patients. Multivariate analyses revealed CHS as an independent predictor of in-hospital (odds ratio: 2.48; 95% CI: 1.42-4.34; p = 0.001) and long-term mortality (hazard ratio: 2.4; 95% CI: 1.79-3.22; p < 0.001). Conclusion: The presence of CHS is a predictor of poor prognosis in patients with STEMI and should be evaluated during the risk stratification of these patients.

Relationship between in-hospital mortality and creatinine/albumin in patients with ST-elevation myocardial infarction without standard modifiable risk factors.

Background: Diabetes, hypertension, hyperlipidemia and smoking are associated with coronary artery disease and ST-elevation myocardial infarction (STEMI). However, patients without any classic risk factors have a higher mortality rate in the post-STEMI period. The aim of this study was to investigate the relationship between in-hospital mortality and creatinine/albumin ratio in patients with STEMI without modifiable risk factors. Materials & methods: All patients included in this study with a diagnosis of STEMI and who underwent primary percutaneous intervention between 2016 and 2020 were retrospectively analyzed. Patients were included in the standard modifiable cardiovascular risk factor (SMuRF) group if at least diabetes, hypertension, smoking or hyperlipidemia was present according to risk factors. Patients without these risk factors were considered the non-SMuRF group. Results: Creatinine/albumin ratio was found to be higher in non-SMuRF patients with mortality (p < 0.001). In multivariate logistic regression analysis, ejection fraction, hemoglobin and SMuRF were found to be inversely associated with in-hospital mortality (odds ratio [OR]: 0.48, 95% CI: 0.35-0.66, p < 0.001; OR: 0.70, 95% CI: 0.56-0.88, p = 0.002; OR: 0.57, 95% CI: 0.34-0.95, p = 0.03, respectively). Conclusion: The creatinine/albumin ratio can be used as a predictor of mortality in these patients; it can help identify high-risk patients beforehand.

Peritoneal dialysis for refractory heart failure: A single-center experience.

INTRODUCTION: Heart failure (HF) is a disease associated with poor quality of life. Peritoneal dialysis (PD) can be an alternative in the treatment of these patients to overcome fluid overload. The objective of this study is to observe the effects of PD in refractory HF patients. METHODS: We conducted an observational study including 10 patients with refractory congestive HF. PD started solely for fluid overload. Patients' baseline parameters were compared with follow-up parameters. RESULTS: Median age was 57.5 (44.8-64.3) years. Median left ventricular ejection fraction was 20% (18.8-31.3), and all patients had right ventricular dysfunction. Median estimated glomerular filtration rate was 51.2 (43.8-101.3) ml/min/1.73 m2 . Two patients (20%) died during the follow-up period. New York Heart Association (NYHA) functional class decreased significantly from a median of 4 to 2,1 and 1 in the 3rd, 6th, and 12th months, respectively (p ≤ 0.01 for all from baseline). Number and length of hospitalization decreased significantly after treatment (number from a median of 3 to 0, p = 0.013; days from 50.5 to 0, p = 0.028). CONCLUSION: PD significantly reduced NYHA functional class, number and days of hospitalization for HF. It could be a reasonable option in chronic treatment of patients with refractory HF.

Low-Level Vitamin D Is Associated with Atrial Fibrillation in Patients with Chronic Heart Failure.

BACKGROUND: Atrial fibrillation (AF) frequently accompanies heart failure (HF), and causes exacerbation of symptoms and treatment failure in such patients. Vitamin D was recently suggested to be an important mediator of cardiovascular disease, including HF. OBJECTIVES: The aim of this study was to evaluate the relationship between vitamin D deficiency and AF in patients with chronic HF. MATERIAL AND METHODS: The study included 180 chronic HF patients that were divided into 2 groups based on having sinus rhythm [AF (-) group] or chronic AF [AF (+) group]. Vitamin D status was assessed via measurement of the serum 25-hydroxyvitamin D (25[OH]D) concentration. RESULTS: Mean age of the patients was 66 ± 8.7 years and 53.9% were male. There weren't any significant differences in age, gender, body mass index, etiology or chronic HF stage between the 2 groups. The vitamin D level in the AF (+) group was significantly lower than in the AF (-) group (11.05 ng/mL vs. 20 ng/mL, p < 0.001) and the parathyroid hormone level was significantly higher in the AF (+) group (76.7 vs. 55 pq mL, p < 0.001). The left atrium to body surface area ratio (LA/BSA) was significantly higher in the AF (+) group (45.03 mm/m2 vs. 42.05 mm/m2, p < 0.01). Independent predictors (based on multiple regression) of AF were vitamin D level (OR = 0.854, 95% CI: 0.805-0.907, p < 0.001) and LA/BSA ratio (OR = 1.077, 95% CI: 1.003-1.156, p < 0.05). The optimal vitamin D cut-off value for the prediction of AF was 16.50 ng/mL, with a sensitivity of 76.0% and specificity of 65.5% (AUC = 0.75, 95% CI: 0.67-0.82). CONCLUSIONS: A low plasma vitamin D concentration was strongly associated with AF in patients with chronic HF.

Assessment of epicardial adipose tissue thickness in patients with resistant hypertension.

OBJECTIVE: Recent studies have shown that epicardial adipose tissue (EAT) thickness is increased in patients with hypertension. In this study, we aimed to investigate the relation of EAT thickness with resistant hypertension (RHT). PARTICIPANTS AND METHODS: Study participants (n=150) were classified into three groups according to their office and ambulatory blood pressure measurements: RHT (n=50), controlled hypertension (CHT, n=50), and normotension (NT, n=50). All patients underwent a transthoracic echocardiographic examination to measure EAT thickness. RESULTS: Clinical and biochemical characteristics of the groups were similar, except the CRP level, which was significantly increased in hypertensive patients compared with patients with NT (P<0.001). EAT thickness differed significantly between groups (P<0.001). The highest values were obtained in the RHT group (4.64±1.24 cm), followed by the CHT (3.3±0.82 cm) and NT (2.6±0.76 cm) groups. Multivariate analysis indicated age, physical activity level, and EAT thickness as independent predictors of RHT. The optimal cut-off value of EAT thickness for detection of RHT was found to be 3.42 cm, with a sensitivity and specificity of 82 and 77%, respectively (AUC=0.87, 95% confidence interval 0.81-0.92, P<0.000). CONCLUSION: EAT can be effective on blood pressure by several mechanisms. In this study, for the first time in the literature, the association of EAT with RHT is reported.