Association between BNP levels and new-onset atrial fibrillation : A propensity score approach.

BACKGROUND: New-onset atrial fibrillation (NOAF), a common complication of acute ST-segment elevation myocardial infarction (STEMI), is associated with a poor prognosis. Several clinical and laboratory parameters are reported to be associated with NOAF in patients with STEMI. The aim of the present study was to evaluate the predictive value of plasma B­type natriuretic peptide (BNP) levels for NOAF development and long-term prognosis in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). PATIENTS AND METHODS: We retrospectively enrolled 1,928 patients with STEMI who underwent pPCI. After applying exclusion criteria, 1,057 patients were retained in the final study population. Patients with NOAF were compared with patients without NOAF in the entire study population and in a matched group. RESULTS: Patients with NOAF had a significantly higher average plasma BNP level (161 pg/ml, range: 72.3-432) than patients without NOAF in the study population (70.7 pg/ml, range: 70-129; p < 0.001) and in the matched group (104.6 pg/ml, range: 47.2-234.5; p = 0.014). Furthermore, the plasma BNP level was found to be an independent predictor of NOAF development (odds ratio [OR]: 1.003; 95% confidence interval [CI]: 1.000-1.005; p = 0.034) and mortality in the long-term follow-up (OR: 1.004; 95% CI: 1.002-1.006; p < 0.001). CONCLUSION: The present study found that a high plasma BNP level was significantly associated with NOAF development in STEMI patients, and was an independent predictor of NOAF development and all-cause mortality during long-term follow-up, regardless of other NOAF risk factors.

Procedural sedation during transradial coronary angiography to prevent spasm.

AIM: Radial artery spasm is common during transradial procedures and is the most common cause of procedural failure. The objectives of this study were to assess whether the routine administration of sedation at the beginning of transradial coronary angiography with the use of hydrophilic-coated and smaller sheaths/catheters would reduce the incidence of radial artery spasm. PATIENTS AND METHODS: Patients undergoing transradial coronary angiography were prospectively randomized to receive midazolam during the procedure or no sedative treatment. The primary endpoint was angiographically confirmed radial artery spasm. Stenosis of the radial artery was measured with a computer-assisted quantification method. RESULTS: In all, 150 patients were randomized into a treatment group and a control group. Spasm occurred in 15 patients of the treatment group (20 %) versus 16 in the control group (21.3 %). There were no differences between the two groups regarding the incidence of spasm and the distribution of spasm severity (p > 0.05). No significant differences were observed between the two groups in terms of 30-day mortality or repeat hospitalization for any cause (p > 0.05). CONCLUSION: Routine use of midazolam could not reduce the occurrence of radial artery spasm during transradial coronary angiography.

Neutrophil-lymphocyte ratio may predict in-hospital mortality in patients with acute type A aortic dissection.

INTRODUCTION: Inflammation has been reported to be associated with aortic dissection (AD), from the development to the prognosis of AD. In this study we aimed to find the role of the neutrophil-lymphocyte ratio (NLR) in the prediction of clinical events in patients with acute AD type A. PATIENTS AND METHODS: The study comprised 37 patients who were hospitalized at our center between 2009 and 2013 with the diagnosis of acute AD type A. RESULTS: The mean NLR was significantly higher in patients with pericardial effusion than those without effusion (15.6 ± 11.4 vs. 7.5 ± 4.8, p = 0.005). An NLR value > 8.51 yielded an area under the curve (AUC) value of 0.829 [95 % confidence interval (CI) 0.674-0.984, p = 0.004], which demonstrated a sensitivity of 77 % and specificity of 74 % for the prediction of mortality. CONCLUSIONS: The novel inflammatory marker NLR could be used to predict pericardial effusion and in-hospital mortality in patients with acute AD type A.

Effect of cardiac rehabilitation on left atrial functions in patients with acute myocardial infarction.

BACKGROUND: The objective of this study was to analyze the effects of cardiac rehabilitation (CR) on the atrial function of patients with acute myocardial infarction (AMI) who had been successfully revascularized through percutaneous coronary intervention (PCI). METHODS: Forty-two AMI patients having undergone CR were enrolled in this observational study. Assessments were performed before and after 6 weeks of CR. Left atrial strain analysis was carried out by two-dimensional speckle tracking echocardiography. Left ventricular ejection fraction (LVEF) was measured by the biplane Simpson's method. Pulsed-wave Doppler at the tip of mitral valve leaflets enabled us to measure early (E) and late (A) diastolic filling velocities, deceleration time (DT) of early filling velocity and isovolumic relaxation time (IVRT). Left ventricle tissue velocity was measured by tissue Doppler imaging of the lateral mitral annulus (e') and E/e' was subsequently calculated. Ratio of E/e' to left atrium (LA) peak strain was used to estimate LA stiffness. RESULTS: Following CR, LVEF (P=0.010), LA strain (P<0.001) and LA stiffness (P=0.013) all showed improvement, while other parameters remained unchanged. CONCLUSION: Post-AMI cardiac rehabilitation and revascularization by PCI might have favourable effects on LA function.