Predictive value of the frontal QRS-T angle for a permanent pacemaker requirement in patients undergoing transcatheter aortic valve implantation.

OBJECTIVE: Despite recent advances, the requirement for permanent pacemaker (PPM) implantation after transcatheter aortic valve implantation (TAVI) remains high. The frontal QRS-T angle (fQRS-Ta) indicates ventricular electrical instability as well as ventricular depolarization and repolarization heterogeneity. The predictive value of fQRS-Ta for the PPM requirement after TAVI is lacking. Therefore, we aimed to investigate the predictive value of baseline fQRS-Ta for the requirement of PPM after TAVI. PATIENTS AND METHODS: This is a retrospective study conducted at a single tertiary care center. The patients were divided into two groups: those who required a pacemaker (PPM group) and those who did not (No-PPM group). The optimal fQRS-Ta cut-off value for predicting a PPM requirement was determined by using receiver operating characteristic (ROC) curve analysis. Univariate and multivariate Cox regression analyses were used to determine the independent predictors of post-TAVI PPM placement. RESULTS: Final study population consisted of 184 patients. The mean age of the patients was 79.41 ± 7.88 years, and 61% (n = 113) were women. Twenty-seven patients who required PPM after TAVI were considered as the 'PPM group'. The baseline frontal QRS and T axes did not differ between the groups, but the fQRS-Ta was significantly higher in the PPM group. ROC analysis performed for the prediction of post-TAVI PPM need, the fQRS-Ta cut-off value was found to be 100.5 with a sensitivity of 74.1% and a specificity of 60.5% [AUC (95% CI): 0.637 (0.520 - 0.755), p: 0.023]. In multivariate analysis, age [HR (95% CI): 1.071 (1.005 - 1.142), p: 0.034] and fQRS-Ta [HR (95% CI): 2.509 (1.084 - 6.399), p: 0.044] were identified as independent risk factors for PPM requirement after TAVI. CONCLUSIONS: This study demonstrated that age and baseline fQRS-Ta were independent predictors of PPM requirements after TAVI in patients with aortic stenosis.

Gender differences in early complications after STEMI and their associations with anxiety and depression.

OBJECTIVE: The female gender is known to be associated with a poor outcome in ST-Elevation Myocardial Infarction (STEMI). Anxiety and depression are more common in women and they may contribute to the increase in early complications after STEMI. We sought to determine the gender differences in early complications after STEMI and their relationship with patients' anxiety and depression. SUBJECTS AND METHODS: This is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) is used to screen depression (HADS-D) and anxiety (HADS-A). RESULTS: A total of 188 patients (age 56.8±10.5, 69.2% male) with STEMI were included in this study. The incidence of early complications was significantly higher in women than in men (50.0% vs. 14.6%, p<0.001). The prevalence of anxiety and depression was significantly higher in women than in men (60.3% vs. 40.0% and 50.0% vs. 14.6%, respectively). In multivariable analyses, left ventricular ejection fraction (LVEF) level (OR: 0.942; 0.891-0.996, p=0.036), HADS-A (OR: 1.593; 1.341-1.891, p<0.001) and HADS-D (OR: 1.254; 1.057-1.488, p=0.01) scores were found to be independent risk factors for early complications after STEMI. CONCLUSIONS: The incidence of early complications and the prevalence of anxiety and depression were significantly higher in women. LVEF level, HADS-A, and HADS-D scores were found to be independent risk factors for early complications.

The relationship between fear of hypoglycemia and health-related quality of life in diabetic patients with heart disease.

OBJECTIVE: Individuals with Diabetes Mellitus (DM) frequently experience hypoglycemia, which has significant implications for the possibility of cardiovascular complications. The relationship between fear of hypoglycemia (FoH) and health-related quality of life (HRQoL) in diabetic heart patients was investigated in this study. SUBJECTS AND METHODS: This was a descriptive study, and 260 diabetic inpatients with heart disease were enrolled. The "Data Gathering Form", the "Hypoglycemia Fear Survey" (HFS), and the "Short-Form Health Survey (SF-36)" were used to collect research data. RESULTS: The mean age of the patients was 63.46±11.73 (min 21-max 90) years, and 76.2% of them had type 2 DM. The mean FoH total score of the patients was 70.87±8.03 (min 45-max 113). The mean FoH behavior sub-dimension score was 35.41±4.07 (min 20-max 57), and the mean worry sub-dimension score was 35.55±5.26 (min 20-max 61). The mean total FoH score was found to be significantly higher in patients of 65 years of age and older, not working, with diabetes duration over 10 years, with HbA1c <7%, and with microvascular complications (p<0.05). Of the sub-dimensions of SF-36, "mental health" had the lowest mean score. There was a significant but very weak negative correlation between the other sub-dimensions of SF-36, "physical functioning", "role physical", "role emotional" and "vitality", with the FoH total score. CONCLUSIONS: FoH and HRQoL in diabetic patients with heart disease were found to be negatively correlated in this study. Prevention of hypoglycemia will improve patients' HRQoL by reducing their anxiety and fears.

High BNP level as risk factor for acute kidney injury and predictor of all-cause mortality in STEMI patients.

OBJECTIVES: The aim of this study was to evaluate the predictive value of brain natriuretic peptide (BNP) in the development of acute kidney injury (AKI) and 6-month all-cause mortality after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in a modest-risk population. BACKGROUND: The prognostic value of BNP has been well documented in patients with acute coronary syndrome. However, its value in development of AKI and 6-month all-cause mortality in patients with STEMI undergoing primary PCI remains unclear. METHODS: We prospectively enrolled 424 consecutive STEMI patients (mean age 53.6 ± 12.1 years) undergoing primary PCI. The population was divided into two groups: a high (n = 110) and a low (n = 314) admission BNP group according to the cut-off value (> 88.7 pg/ml) determined by ROC analysis to have the best predictive accuracy for 6-month all-cause mortality. The clinical characteristics as well as the in-hospital and 6-month outcomes of patients undergoing primary PCI were analyzed. RESULTS: Cox multivariate analysis showed that a high-admission BNP value (> 88.7 pg/ml) was an independent predictor of AKI development (odds ratio, 1.002; 95 % confidence interval, 1.000­1.003; p = 0.02) and 6-month all-cause mortality (odds ratio, 1.003; 95 % confidence interval; 1.001­1.004; p = 0.004). CONCLUSION: These results suggest that a high-admission BNP level is associated with an increased risk of AKI development and 6-month all-cause mortality in patients with STEMI undergoing primary PCI.