Prognostic value of pulmonary artery diameter/aorta diameter ratio in patients with acute pulmonary embolism.

BACKGROUND: The ratio of pulmonary artery diameter (PAD) to ascending aortic diameter (AoD) has been reported to be a prognostic marker in several lung diseases; however, the usefulness of this tool in patients with acute pulmonary embolism (APE) is unknown. Here, we aimed to determine the long-term prognostic value of the PAD/AoD ratio in patients with APE. METHODS: A total of 275 patients diagnosed with APE at our tertiary care center between November 2016 and February 2022 were included in the study. The patients were divided into two groups according to the presence of long-term mortality and their PAD/AoD ratios were compared. RESULTS: Long-term mortality was observed in 48 patients during the median follow-up of 59 (39-73) months. The patients were divided into two groups for analysis: group 1, consisting of 227 patients without recorded mortality, and group 2, consisting of 48 patients with documented mortality. A multivariate Cox regression model indicated that the PAD/AoD ratio has the potential to predict long-term mortality (HR: 2.9116, 95% CI: 1.1544-7.3436, p = 0.023). Analysis of the receiver operating characteristic curve revealed that there was no discernible difference in discriminative ability between the simplified pulmonary embolism severity index (sPESI) and PAD/AoD ratio (area under the curve [AUC] = 0.679 vs. 0.684, respectively, p = 0.937). The long-term predictive ability of the PAD/AoD ratio was not inferior to the sPESI score. CONCLUSIONS: The PAD/AoD ratio, which can be easily calculated from pulmonary computed tomography, may be a useful parameter for determining the prognosis of APE patients.

The Association between Exercise-Induced Ventricular Premature Contractions and Long-Term Mortality in Patients without Obstructive Coronary Artery Disease.

Background: The treadmill exercise test is widely used to determine cardiovascular risk and mortality. Premature ventricular complexes (PVCs) are frequently observed during exercise stress testing. The literature on the role of PVCs observed during treadmill exercise testing in predicting prognosis is controversial. Hence, we aimed to evaluate the clinical results of PVCs seen during exercise testing in patients without obstructive coronary artery disease confirmed by coronary angiography (CAG). Methods: The study population consisted of 1624 consecutive patients who were considered high risk according to the Duke treadmill risk score and had no significant stenosis on CAG from January 2016 to April 2021. The primary endpoints of the study were long-term all-cause mortality of patients who had PVCs during the exercise test or during the resting phase. Results: Long-term mortality was observed in 53 of the 1624 patients after a mean follow-up of 47 months. PVCs were observed in 293 (18.7%) patients without long-term mortality, and in 24 (45.3%) patients with long-term mortality (p < 0.001). The model adjusted for all covariates showed that the presence of PVCs in the recovery phase [p < 0.007, hazard ratio (HR) (95% confidence interval (CI)) 2.244 (1.244-4.047)] and advanced age [p < 0.001, HR (95% CI) 1.194 (1.143-1.247)] were associated with long-term all-cause mortality. Conclusions: PVCs observed during treadmill exercise testing and the recovery phase were related to long-term mortality in patients without obstructive coronary artery disease.

Evaluation of Naples prognostic score to predict long-term mortality in patients with pulmonary embolism.

Background: The Naples prognostic score (NPS), which reflects the inflammatory and nutritional status of patients, is often used to determine prognosis in cancer patients. The aim of this study was to determine the long-term prognostic value of the NPS in acute pulmonary embolism (APE) patients. Methods: Two hundred thirty-nine patients diagnosed with APE were divided into two groups according to their NPS, and long-term mortality was compared. Results: The long-term mortality was observed in 38 patients out of 293 patients in the mean follow-up of 24 months. Multivariate analysis showed that NPS as a categorical parameter and NPS as a numeric parameter were independent predictors of long-term mortality. Conclusion: This study highlights that NPS may have the potential to predict long-term mortality in APE patients.

[Box: see text].

Endoscopic Thoracic Sympathectomy in the Treatment of Vasospastic Angina Resistant to Medical Therapy.

BACKGROUND: In this study, we aimed to investigate the clinical follow-up results of endoscopic thoracic sympathectomy (ETS) in the treatment of vasospastic angina (VSA) resistant to maximal medical therapy. METHODS: A total of 80 patients with VSA who presented to our hospital between 2010 and 2022 were included in our study. Among them, 6 patients who did not respond to medical therapy underwent ETS. In-hospital and long-term clinical outcomes of patients who underwent ETS were recorded. RESULTS: The median age of the patients with VSA was 57 [48-66] years, and 70% of the group were males. In the ETS group, compared to the non-ETS group, higher numbers of hospital admissions and coronary angiographies were observed before ETS (median 6 [5-6] versus 2 [1-3], P <.001; median 5 [3-6] versus 2 [1-3], P =.004, respectively). Additionally, while 2 patients (33.3%) in the ETS group had implantable cardioverter defib-rillator (ICD), only 2 patients (2.7%) in the non-ETS group had ICD (P =.027). Out of the 6 patients who underwent ETS, 2 were females, with a median age of 56 [45-63] years. Four patients underwent successful bilateral ETS, while 2 patients underwent unilateral ETS. During the follow-up period after ETS, only 3 patients experienced sporadic attacks (once in 28 months, twice in 41 months, and once in 9 years, respectively), while no attacks were observed in 3 patients during their median follow-up of 7 years. CONCLUSION: It appears that ETS is effective in preventing VSA attacks without any major complications.

The prognostic importance of the Naples prognostic score for in-hospital mortality in patients with ST-segment elevation myocardial infarction.

BACKGROUND: The Naples prognostic score (NPS) is an effective inflammatory and nutritional scoring system widely applied as a prognostic factor in various cancers. However, the prognostic significance of NPS is unknown in ST-segment elevation myocardial infarction (STEMI). We aimed to analyze the prognostic value of the NPS in-hospital mortality in patients with STEMI. METHODS: The study consisted of 3828 patients diagnosed with STEMI who underwent primer percutaneous coronary intervention. As the primary outcome, in-hospital mortality was defined as all-cause deaths during hospitalization. The included patients were categorized into three groups based on NPS (group 1:NPS = 0,1,2; group 2:NPS = 3; group 3:NPS = 4). RESULTS: Increased NPS was associated with higher in-hospital mortality rates( P  < 0.001). In the multivariable logistic regression analysis, the relationship between NPS and in-hospital mortality continued after adjustment for age, male sex, diabetes, hypertension, Killip score, SBP, heart rate, left ventricular ejection fraction, myocardial infarction type and postprocedural no-reflow. A strong positive association was found between in-hospital mortality and NPS by multivariable logistic regression analysis [NPS 0-1-2 as a reference, OR = 1.73 (95% CI, 1.04-2.90) for NPS 3, OR = 2.83 (95% CI, 1.76-4.54) for NPS 4]. CONCLUSION: The present study demonstrates that the NPS could independently predict in-hospital mortality in STEMI. Prospective studies will be necessary to confirm the performance, clinical applicability and practicality of the NPS for in-hospital mortality in STEMI.

Effect of ivabradine on ventricular arrhythmias in heart failure patients with reduced ejection fraction.

BACKGROUND/INTRODUCTION: Heart failure patients with reduced ejection fraction are at high risk for ventricular arrhythmias and sudden cardiac death. Ivabradine, a specific inhibitor of the If current in the sinoatrial node, provides heart rate reduction in sinus rhythm and angina control in chronic coronary syndromes. OBJECTIVE: The effect of ivabradine on ventricular arrhythmias in heart failure patients with reduced ejection fraction patients has not been fully elucidated. The aim of this study was to investigate the effect of ivabradine use on life-threatening arrhythmias and long-term mortality in heart failure patients with reduced ejection fraction patients. METHODS: In this retrospective study, 1,639 patients with heart failure patients with reduced ejection fraction were included. Patients were divided into two groups: ivabradine users and nonusers. Patients presenting with ventricular tachycardia, the presence of ventricular extrasystole, and ventricular tachycardia in 24-h rhythm monitoring, appropriate implantable cardioverter-defibrillator shocks, and long-term mortality outcomes were evaluated according to ivabradine use. RESULTS: After adjustment for all possible variables, admission with ventricular tachycardia was three times higher in ivabradine nonusers (95% confidence interval 1.5-10.2). The presence of premature ventricular contractions and ventricular tachycardias in 24-h rhythm Holter monitoring was notably higher in ivabradine nonusers. According to the adjusted model for all variables, 4.1 times more appropriate implantable cardioverter-defibrillator shocks were observed in the ivabradine nonusers than the users (95%CI 1.8-9.6). Long-term mortality did not differ between these groups after adjustment for all covariates. CONCLUSION: The use of ivabradine reduced the appropriate implantable cardioverter-defibrillator discharge in heart failure patients with reduced ejection fraction patients. Ivabradine has potential in the treatment of ventricular arrhythmias in heart failure patients with reduced ejection fraction patients.

Body fat percentage and infarct size in patients with non-ST segment elevation myocardial infarction.

OBJECTIVE: Obesity is a global health problem that increases the risk of coronary artery disease (CAD). However in studies, it has been observed that when the disease develops, obese patients have a more favorable prognosis than leaner patients. This is called the "obesity paradox." This study aims to evaluate the effect of obesity assessed with body fat percentage (BFP) and relative fat mass (RFM) besides body mass index (BMI) on infarct size (IS) estimated from peak creatine kinase-MB (CK-MB) levels in patients with non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: Patients with a diagnosis of NSTEMI who underwent coronary angiography between January 2017 and January 2022 were retrospectively evaluated. Patients without available anthropometric data to calculate BMI, BFP, and RFM and serial CK-MB measurements were excluded from the study. BMI was calculated using weight(kg)/(height[m])2 formula. Patients were dichotomized as obese (BMI≥30 kg/m2) and non-obese (BMI<30 kg/m2) to compare baseline characteristics. BFP and RFM were calculated from anthropometric data. Linear regression analysis was performed to define predictors of IS. RESULTS: Final study population consisted of 748 NSTEMI patients (mean age was 59.3±11.2 years, 76.3% were men, 36.1% of the patients were obese). Obese patients were more likely to be female, hypertensive, and diabetic. Smoking was less frequently observed in obese patients. Peak CK-MB levels were similar among groups. Obese patients had higher in-hospital left ventricular ejection fraction, and less severe CAD was observed in coronary angiographies of these patients. Multivariable regression analysis identified diabetes mellitus, systolic blood pressure, white blood cell count, hemoglobin, and BFP (ß=-4.8, 95% CI=-8.7; -0.3, p=0.03) as independent predictors of IS. CONCLUSION: Higher BFP is associated with smaller IS in NSTEMI patients. These findings support the obesity paradox in this patient group, but further, randomized controlled studies are required.

The Effect of Anesthesia Type Applied in Transcatheter Aortic Valve Implantation.

OBJECTIVE: Different results have been obtained in studies on the effect of anesthesia type applied during transcatheter aortic valve implantation on in-hospital outcomes. In this study, we aimed to investigate the association of the type of anesthesia with the lenght of stay in the intensive care unit and the need for inotropes in patients undergoing transcatheter aortic valve implantation. METHODS: A total of 140 patients who underwent transcatheter aortic valve implantation between January 2016 and January 2022 were retrospectively analyzed. The patients were divided into 2 groups as deep sedation and general anesthesia according to the type of anesthesia. RESULTS: The mean age of all patients was 78.5 ± 8.6 years, and 69 of the patients (49.3%) were female. Length of stay in intensive care unit, midazolam dosage, use of inotropic agents, and procedural hypotension were significantly lower in the deep sedation group than in the general anesthesia group [(1[1-2] vs. 1[1-2.5] days, P = 0.03), (2.1 ± 0.4 mg/kg vs. 2.3 ± 05, P = 0.02), (39 (37.9%) vs. 22 (59.5%), P = 0.02), (41 (39.8%) vs. 25 (67.6%), P = 0.004)]. General anesthesia was associated with increased use of inotropic agents during transcatheter aortic valve implantation compared to deep sedation (odds ratio = 2.93 95% CI = 1.18-7.30, P = 0.02). CONCLUSION: The use of inotropes is less in transcatheter aortic valve implantation procedures performed under deep sedation and length of stay in intensive care unit is shorter.

Efficiency of MVP ECG Risk Score for Prediction of Long-Term Atrial Fibrillation in Patients With ICD for Heart Failure With Reduced Ejection Fraction.

BACKGROUND AND OBJECTIVES: The morphology-voltage-P-wave duration (MVP) electrocardiography (ECG) risk score is a newly defined scoring system that has recently been used for atrial fibrillation (AF) prediction. The aim of this study was to evaluate the ability of the MVP ECG risk score to predict AF in patients with an implantable cardioverter defibrillator (ICD) and heart failure with reduced ejection fraction in long-term follow-up. METHODS: The study used a single-center, and retrospective design. The study included 328 patients who underwent ICD implantation in our hospital between January 2010 and April 2021, diagnosed with heart failure. The patients were divided into low, intermediate and high-risk categories according to the MVP ECG risk scores. The long-term development of atrial fibrillation was compared among these 3 groups. RESULTS: The low-risk group included 191 patients, the intermediate-risk group 114 patients, and the high-risk group 23 patients. The long-term AF development rate was 12.0% in the low-risk group, 21.9% in the intermediate risk group, and 78.3% in the high-risk group. Patients in the high-risk group were found to have 5.2 times higher rates of long-term AF occurrence compared to low-risk group. CONCLUSIONS: The MVP ECG risk score, which is an inexpensive, simple and easily accessible tool, was found to be a significant predictor of the development of AF in the long-term follow-up of patients with an ICD with heart failure with reduced ejection fraction. This risk score may be used to identify patients who require close follow-up for development and management of AF.

Risk of Venous Thromboembolism with Statins: Evidence Gathered via a Network Meta-analysis

Background: Anticoagulants are the mainstay of treatment for venous thromboembolism (VTE). Studies have shown conflicting results regarding statins ability to reduce the incidence of VTE. Aims: To perform a network meta-analysis to determine which lipid-lowering agent was more efficacious in and had more evidence regarding reducing the VTE risk. Study Design: Network meta-analysis of the randomized controlled trials (RCTs). Methods: RCTs that assessed the effectiveness and safety of statins or fibrates and compared them to a placebo or another statin were eligible for the study. The outcomes examined in the study were deep vein thrombosis, pulmonary embolism, and/or VTE. We conducted a comprehensive search of the Medline database from 1966 to February 2017, using specific search terms related to VTE and statins. Additionally, we screened, and cross-checked relevant systematic reviews and meta-analyses. We performed a network meta-analysis to compare the different lipid-lowering agents to each other and the placebo and their effectiveness. Results: Twenty-seven RCTs were included in the network meta-analysis (n = 137,940). Pairwise meta-analysis revealed a statistically significant lower incidence of VTE with statins than with placebos (0.79% vs 0.99%, respectively; risk ratios: 0.87, 0.77-0.98; p = 0.022). Rosuvastatin had the most favorable effect in reducing VTE risk than the other statins, fenofibrate, and placebo. Fenofibrate was ranked the worst drug choice, because it increased risk of VTE when compared with the other statins. Rosuvastatin was the best choice for reducing the VTE risk when compared with the placebo (OR: 0.56, 0.42-0.75), atorvastatin (OR: 0.64, 0.44-0.95), pravastatin (OR: 0.50, 0.34-0.74), simvastatin (OR: 0.60, 0.42-0.86) and fenofibrate (OR: 0.37, 0.25-0.56). Compared with a placebo, rosuvastatin reduced the VTE risk by around 45% and fenofibrate increased the risk by 65%. Conclusion: Rosuvastatin is significantly reduces the risk of VTE when compared with a placebo, other statin subtypes, and fibrate. Furthermore, fenofibrate increased the VTE risk when compared with a placebo and statins.

Arrhythmias Beyond Atrial Fibrillation Detection Using Smartwatches: A Systematic Review.

BACKGROUND: Over the past few years, smartwatches have become increasingly popular in the monitoring of arrhythmias. Although the detection of atrial fibrillation with smartwatches has been the subject of various articles, there is no comprehensive research on the detection of arrhythmias other than atrial fibrillation. In this study, we included individual cases from the literature to identify the characteristics of patients with smartwatch-detected arrhythmias other than atrial fibrillation. METHODS: PubMed, Embase, and SCOPUS were searched for case reports, case series, or cohort studies that reported individual participant-level data, until January 6, 2022. The following search string was used for each databases: ('Smart Watch' OR 'Apple Watch' OR 'Samsung Gear') AND ('Supraventricular Tachycardia' OR 'Cardiac Arrhythmia' OR 'Ventricular Tachycardia' OR 'Atrioventricular Nodal Reentry Tachycardia' OR 'Atrioventricular Reentrant Tachycardia' OR 'Heart Block' OR 'Atrial Flutter' OR 'Ectopic Atrial Tachycardia' OR 'Bradyarrhythmia'). RESULTS: A total of 52 studies from PubMed, 20 studies from Embase, and 200 studies from SCOPUS were identified. After screening, 18 articles were included. A total of 22 patients were obtained from 14 case reports or case series. Four cohort studies evaluating various arrhythmias were included. Arrhythmias, including ventricular tachycardia, atrial fibrillation, atrial flutter, atrioventricular nodal reentry tachycardia, atrioventricular reentrant tachycardia, second- or third-degree atrioventricular block, and sinus bradycardia, were detected with smartwatches. CONCLUSIONS: Cardiac arrhythmias other than atrial fibrillation are also commonly detected with smartwatches. Smartwatches have an important potential besides traditional methods in the detection of arrhythmias and clinical practice.

The Relation of Body Mass Index with In-Hospital Mortality in Patients with ST-Segment Elevation Myocardial Infarction.

Objectives: In this study, we aimed to determine whether body mass index (BMI) is an independent predictor of in-hospital mortality in ST-segment elevation myocardial infarction (STEMI) patients and to assess the relationship between BMI and mortality. Methods: One thousand three hundred fifty-seven patients with STEMI were included to the study. Primary outcome was in-hospital mortality. The multivariable logistic regression was used to assess the relationship between BMI and in-hospital mortality using age, gender, diabetes mellitus, systolic blood pressure, heart rate, smoking status, serum creatinine and hemoglobin, type of STEMI, and Killip class as adjustment variables. Results: The frequency of in-hospital mortality was 14.7%. The mean BMI was found to be 28.2 ± 4.8 kg/m2. Considering the in-hospital mortality frequencies between the groups, mortality was observed in 61.7% of the BMI <20 kg/m2 group, 15.5% of the 20-25 kg/m2 group, 8.5% of the 25-30 kg/m2 group, and 9.5% of the >30 kg/m2 group (chi-square P value <0.001). In the multivariable logistic regression analysis, a change in BMI from 20 to 30 kg/m2 was associated with a reduced risk of in-hospital mortality (odds ratio: 0.39, 95% confidence interval: 0.23-0.67, P < 0.001). Conclusion: Our study results revealed that there was inverse significant association between BMI and in-hospital mortality in STEMI patients.

Machine Learning Approach on High Risk Treadmill Exercise Test to Predict Obstructive Coronary Artery Disease by using P, QRS, and T waves' Features.

Treadmill Exercise Test (TET) results and patients' clinical symptoms influence cardiologists' decision to perform Coronary Angiography (CAG) which is an invasive procedure. Since TET has high false positive rates, it can cause an unnecessary invasive CAG. Our primary objective was to develop a machine learning model capable of optimizing TET performance based on electrocardiography (ECG) waves characteristics and signals. TET reports from 294 patients who underwent CAG following high risk TET were collected and categorized into those with critical CAD and others. The signal was converted to time series format. A dataset containing the P, QRS, and T wave times and amplitudes was created. Using this dataset, 5 machine learning algorithms were trained with 5-fold cross validation. All these models were then compared to the performance of cardiologists on V5 signal. The results from 5 machine learning models were clearly superior to the cardiologists' V5 signal performance (P < 0.0001). In addition, the XGBoost model, with an accuracy of 80.92±6.42% and an area under the curve (AUC) of 0.78±0.06, was the most successful model. Machine learning models can produce high-performance diagnoses using the V5 signal markers only as it does not require any clinical markers obtained from TET reports. This can lead to significant contributions to improving clinical prediction in non-invasive methods.

Effect of ivabradine on ventricular arrhythmias in heart failure patients with reduced ejection fraction

SUMMARY BACKGROUND/INTRODUCTION: Heart failure patients with reduced ejection fraction are at high risk for ventricular arrhythmias and sudden cardiac death. Ivabradine, a specific inhibitor of the If current in the sinoatrial node, provides heart rate reduction in sinus rhythm and angina control in chronic coronary syndromes. OBJECTIVE: The effect of ivabradine on ventricular arrhythmias in heart failure patients with reduced ejection fraction patients has not been fully elucidated. The aim of this study was to investigate the effect of ivabradine use on life-threatening arrhythmias and long-term mortality in heart failure patients with reduced ejection fraction patients. METHODS: In this retrospective study, 1,639 patients with heart failure patients with reduced ejection fraction were included. Patients were divided into two groups: ivabradine users and nonusers. Patients presenting with ventricular tachycardia, the presence of ventricular extrasystole, and ventricular tachycardia in 24-h rhythm monitoring, appropriate implantable cardioverter-defibrillator shocks, and long-term mortality outcomes were evaluated according to ivabradine use. RESULTS: After adjustment for all possible variables, admission with ventricular tachycardia was three times higher in ivabradine nonusers (95% confidence interval 1.5-10.2). The presence of premature ventricular contractions and ventricular tachycardias in 24-h rhythm Holter monitoring was notably higher in ivabradine nonusers. According to the adjusted model for all variables, 4.1 times more appropriate implantable cardioverter-defibrillator shocks were observed in the ivabradine nonusers than the users (95%CI 1.8-9.6). Long-term mortality did not differ between these groups after adjustment for all covariates. CONCLUSION: The use of ivabradine reduced the appropriate implantable cardioverter-defibrillator discharge in heart failure patients with reduced ejection fraction patients. Ivabradine has potential in the treatment of ventricular arrhythmias in heart failure patients with reduced ejection fraction patients.

Predictors for early mortality in patients with implantable cardiac defibrillator for heart failure with reduced ejection fraction.

Implantable cardioverter defibrillators (ICD) are recommended in heart failure with reduced ejection fraction (HFrEF) patients to reduce arrhythmic deaths. This study aimed to identify risk factors associated with mortality within one-year following the ICD. The data from our hospital's electronic database system was extracted for patients who were implanted ICD secondary to HFrEF between 2009 and 2019. Overall, 1107 patients were included in the present analysis. Mortality rate at one-year following the device implantation was 4.7%. In multivariate analysis; age, atrial fibrillation, New York Heart Association classification >2, blood urea nitrogen, pro-brain natriuretic peptide and albumin independently predicted one year mortality.

Evaluating systemic immune-inflammation index in patients with implantable cardioverter defibrillator for heart failure with reduced ejection fraction.

BACKGROUND: Pro-inflammatory pathways play an important role in the follow-ups of patients with intracardiac defibrillators (ICDs) for heart failure (HF) reduced with ejection fraction (HFrEF). A newly defined index - the systemic immune-inflammation index (SII)-has recently been reported to have prognostic value in patients with cardiovascular disease. This study's aim is to evaluate the SII value regarding its association with long-term mortality and appropriate ICD therapy during a 10-year follow-up. METHODS: This retrospective study included 1011 patients with ICD for HFrEF. The SII was calculated as the neutrophil-to-lymphocyte ratio × total platelet count in the peripheral blood. The study population was divided into two groups according to the SII's optimal cut-off value to predict long-term mortality. The long-term prognostic impact of SII on these patients was evaluated regarding mortality and appropriate ICD therapy. RESULTS: The patients with a higher SII (≥1119) had significantly higher long-term mortality and appropriate ICD therapy rates. After adjustment for all confounding factors, the long-term mortality rate was 5.1 for a higher SII. (95% CI: 2.9-8.1). The long-term appropriate ICD therapy rate was 2.0 for a higher SII (95% CI: 1.4-3.0). CONCLUSION: SII may be an independent predictive marker for both long-term mortality and appropriate ICD therapy in patients with HFrEF.

Comparison of mortality prediction scores in elderly patients with ICD for heart failure with reduced ejection fraction.

BACKGROUND: This investigation aimed to examine and compare the predictive value of MADIT-II, FADES, PACE and SHOCKED scores in predicting one-year and long-term all-cause mortality in implantable cardioverter-defibrillator (ICD) implanted patients, 75 years old and older, since there has been an area of uncertainty about the utility and usefulness of these available risk scores in such cases. METHODS: In this observational, retrospective study, 189 ICD implanted geriatric patients were divided into two groups according to the presence of long-term mortality in follow-up. The baseline characteristics and laboratory variables were compared between the groups. MADIT-II, FADES, PACE and SHOCKED scores were calculated at the time of ICD implantation. One-year and long-term predictive values of these scores were compared by a receiver-operating curve (ROC) analysis. RESULTS: A ROC analysis showed that the best cutoff value of the MADIT-II score to predict one-year mortality was ≥ 3 with 87% sensitivity and 74% specificity (AUC 0.83; 95% CI 0.73-0.94; p < 0.001) and that for long-term mortality was ≥ 2 with 83% sensitivity and 43% specificity (AUC 0.68; 95% CI 0.60-0.76; p < 0.001). The predictive value of MADIT-II was superior to FADES, PACE and SHOCKED scores in ICD implanted patients who are 75 years and older. CONCLUSION: MADIT-II score has a significant prognostic value as compared to FADES, PACE and SHOCKED scores for the prediction of one-year and long-term follow-up in geriatric patients with implanted ICDs for heart failure with reduced ejection fraction.

The value of C-reactive protein-to-albumin ratio in predicting long-term mortality among HFrEF patients with implantable cardiac defibrillators.

BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) who received implantable cardiac defibrillator (ICD) still remain at high risk due to pump failure and prevalent comorbid conditions. The primary aim of this research was to evaluate the predictive value of C-reactive protein-to-albumin ratio (CAR) for all-cause mortality among patients with HFrEF despite ICD implantation. MATERIALS AND METHODS: Those who were implanted ICD for HFrEF in our institution between 2009 and 2019 were included. Data were extracted from hospital's database. CAR was calculated as ratio of C-reactive protein (CRP) to serum albumin concentration. Patients were grouped into tertiles in accordance with CAR at the time of the implantation. During follow-up duration of 38 [17-77] months, survival times of tertiles were compared by using Kaplan-Meier survival method. Forward Cox proportional regression model was used for multivariable analysis. RESULTS: Thousand and eleven patients constituted the study population. Ischaemic cardiomyopathy was the primary diagnosis in 92.3%, and ICD was implanted for the primary prevention among 33.9% of patients. Of those, 14.5% died after the discharge. Patients in tertile 3 (T3) had higher risk of mortality (4.2% vs 11.0% vs 28.5%) compared with those in other tertiles. Multivariable analysis revealed that when patients in T1 were considered as the reference, both those in T2 and those in T3 had independently higher risk of all-cause mortality. This finding was consistent in the unadjusted and adjusted multivariable models. CONCLUSION: Among patients with HFrEF and ICD, elevated CAR increased the risk of all-cause mortality at long term.

Prognostic nutritional index as the predictor of long-term mortality among HFrEF patients with ICD.

BACKGROUND: The benefit of implantable cardiac defibrillator (ICD) in patients with heart failure and reduced ejection fraction (HFrEF) could be limited in a particular group of patients. Low prognostic nutritional index (PNI) indicates malnutrition and proinflammatory condition. We sought to investigate the value of PNI in predicting long-term mortality among HFrEF patients with ICD. METHODS: Electronic database was searched for identifying patients with HFrEF who were implanted ICD in our institution between 2009 and 2019. Demographic and clinical characteristics of included patients were recorded. PNI was calculated according to the formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3 ). Patients were divided into the quartiles according to PNI values. Differences between the groups were analyzed by the log-rank test. A forward Cox proportional regression model was used for multivariable analysis. RESULTS: One thousand and hundred patients were included to the study. The underlying heart failure etiology was ischemic and nonischemic in 77.3% and 22.7% of patients, respectively. Mortality rate in Q1 (5.1%) was considered as the reference. In the unadjusted model the mortality rate was 9.5% (hazard ratio [HR] 1.76, 95% confidence interval [95% CI] [0.92-3.38]) in Q2, 10.2% (HR 1.88, 95% CI 0.99-3.58) in Q3, and 39.6% (HR 8.12, 95% CI 4.65-14.17) in Q4. The same trend was consistent in the age- and sex-adjusted, comorbidities-adjusted, and covariates-adjusted models. CONCLUSION: Among patients who were implanted with ICD secondary to HFrEF, lower PNI value predicted all-cause mortality during long-term follow-up. This is the first study demonstrating the value of PNI in this population.

Effect of the COVID-19 pandemic on access to primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic caused by the emergence of severe acute respiratory syndrome coronavirus 2 has resulted in a health crisis and a significant number of deaths worldwide. The full effect on access to medical care and the treatment for patients with chronic diseases and acute conditions is still unknown. This is an investigation of access to primary percutaneous coronary intervention (PPCI) for patients diagnosed with ST-segment myocardial infarction (STEMI) during the pandemic. METHODS: Consecutive patients who were diagnosed with STEMI and underwent PPCI during the ongoing COVID-19 pandemic were included in the study. Clinical and angiographic characteristics of the patients were assessed. A control group of patients diagnosed with STEMI and who underwent PPCI during the same time interval a year prior to the outbreak of the disease was analyzed retrospectively for comparison. RESULTS: There was a significant reduction in the number of STEMI cases during the COVID-19 crisis period. Furthermore, these patients had a prolonged ischemic time; they were more likely to have a longer pain-to-balloon (Odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.1-10.2) and door-to-balloon time (OR: 5.4, 95% CI: 3.1-22.8). CONCLUSION: Patients diagnosed with STEMI during the pandemic experienced a significant delay between the onset of symptoms and PPCI.