Abdurrahman Tasal

Neutrophil/lymphocyte ratio is associated with thromboembolic stroke in patients with non-valvular atrial fibrillation

BACKGROUND Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of NLR in patients with thromboembolic stroke due to atrial fibrillation (AF). We aimed to compare the NLR ratios between non-valvular AF patients with or without thromboembolic stroke. METHODS A total of 126 non-valvular AF patients with or without stroke were included in the study; 126 consecutive patients (52 males and 74 females), mean age, 70 ± 10.2 years old. No patient had a recent history of an acute infection or an inflammatory disease. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. WBC count>12.000 cells per μL or <4.000 cells per μL and high body temperature>38 º are excluded from the study. RESULTS Mean NLR was significantly higher among persons with stroke compared to individuals without a stroke (5.6 ± 3.4 vs. 3.1 ± 2.1, p=0.001). There were no significant differences in RDW levels between the two groups (p>0.05). HAS-BLED and CHADS(2) scores were significantly higher in the stroke group. CONCLUSION Higher NLR, an emerging marker of inflammation, is associated with thromboembolic stroke in non-valvular AF patients.

Relation of neutrophil-to-lymphocyte ratio with the presence and complexity of coronary artery disease: an observational study.

OBJECTIVE The neutrophil -to- lymphocyte ratio (NLR) is a new predictor for cardiovascular risk and mortality. The SYNTAX score is an angiographic tool used in grading the complexity of coronary artery disease (CAD). However, its relation with CAD severity and complexity is not yet known. We hypothesized that NLR would be associated with a greater complexity of CAD as assessed using the SYNTAX score. METHODS This cross-sectional observational study included 106 patients who had undergone coronary angiography for stable angina pectoris and 69 patients who had normal coronary angiogram. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. The patients were classified two groups as CAD (-) (n=69) and CAD (+) (n=106), then patients in CAD (+) group were divided into 3 groups according to SYNTAX scores (SYNTAX score 1-22, 23-32, >32) as pointed in European Society of Cardiology (ESC) revascularization guideline. Statistical analysis was performed using the Mann-Whitney U and Kruskal-Wallis tests, and multiple logistic regression analysis was used to identify the independent predictors of complexity of CAD-SYNTAX score. RESULTS Patients with CAD had a significantly higher value of NLR [1.6 median (1.2-3.3 IQR) vs. 2.3 median (1.8-3.0 IQR) p<0.001]. The group with high SYNTAX scores (>32) more frequently had diabetes mellitus (DM), hypercholesterolemia (HL), were of older age, and also had significantly elevated NLR values [2.4 (1.3-2.6), 2.6 (2.3-3.9), 2.0 (1.5-2.6) p=0.006]. In univariate analysis, age, DM, HL, creatinine, neutrophil count and NLR were predictors of high SYNTAX score. In the multiple logistic regression analysis, only NLR [odds ratio (OR)=2.1, 95% confidence interval (CI) 1.2-3.8, p=0.09], was identified as independent predictor of a high SYNTAX score. CONCLUSION NLR is a strong clinical laboratory value that is associated with presence and complexity of CAD.

Novel fibro-inflammation markers in assessing left atrial remodeling in non-valvular atrial fibrillation

Background Structural remodeling is associated with the fibroinflammatory process in the atrial extracellular matrix. In the present study we aimed to investigate whether serum levels of new circulating remodeling markers differ in patients with atrial fibrillation (AF) compared to patients with sinus rhythm. Material/Methods The study population included 52 patients diagnosed with non-valvular AF and 33 age-matched patients with sinus rhythm. Serum levels of Galectin-3, matrix metalloproteinase-9 (MMP-9), lipocalin-2 (Lcn2/NGAL), N-terminal propeptide of type III procollagen (PIIINP), Hs-Crp, and neutrophil-to-lymphocyte ratio (NLR) were measured. The left atrial volume (LAV) was calculated by echocardiographic method and LAV index was calculated. Results Galectin-3, MMP-9, and PIIINP levels were significantly higher in AF patients except NGAL levels (1166 pg/ml (1126–1204) and 1204 pg/ml (1166–1362) p=0.001, 104 (81–179) pg/ml and 404 (162–564) pg/ml p<0.0001, and 1101 (500–1960) pg/ml and 6710 (2370–9950) pg/ml p<0.0001, respectively). The NLR and Hs-CRP levels were also higher in AF (2.1±1.0 and 2.7±1.1 p=0.02 and 4.2±1.9 mg/L and 6.0±4.7 mg/L p=0.04, respectively). In correlation analyses, NLR showed a strongly significant correlation with LAVi, but Hs-CRP did not (p=0.007 r=0.247, Pearson test and p=0.808 r=0.025, Pearson test, respectively). Moreover, Galectin-3, MMP-9, and PIIINP had a strong positive correlation with LAVi (p=0.021 r=640, Spearman test and p=0.004 r=0.319 Pearson test, and p=0.004 r=0.325 Pearson test, respectively). Conclusions Novel fibrosis and inflammation markers in AF are correlated with atrial remodeling. Several unexplained mechanisms of atrial remodeling remain, but the present study has taken the first step in elucidating the mechanisms involving fibrosis and inflammation markers.

Red cell distribution width predicts new-onset atrial fibrillation after coronary artery bypass grafting

Abstract Introduction. Red cell distribution width (RDW) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of RDW in prediction of new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG). We aimed to investigate the relation between the RDW and postoperative AF in patients undergoing CABG. Methods. A total of 132 patients undergoing nonemergency CABG were included in the study. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. We retrospectively analyzed 132 consecutive patients (mean age, 60.55 ± 9.5 years; 99 male and 33 female). The RDW level was determined preoperatively and on postoperative Day 1. Results. Preoperative RDW levels were significantly higher in patients who developed AF than in those who did not (13.9 ± 1.4 vs. 13.3 ± 1.2, p = 0.03). There was not any correlation between postoperative RDW levels and AF. Using a cutpoint of 13.45, the preoperative level correlated with the incidence of AF with a sensitivity of 61% and specificity of 60%. Conclusion. Preoperative RDW level predicts new-onset AF after CABG in patients without histories of AF.

Transcatheter trans-apical closure of paravalvular mitral and aortic leaks using a new device: First in man experience

This report describes the first use of a new paravalvular leak (PVL) device designed specifically to close paravalvular mitral and paravalvular aortic leaks. The first patient had severe paravalvular mitral leak that was closed using the transapical route with a rectangular designed PVL device that has an oval waist for self‐centering and the second patient had moderate paravalvular aortic leak that was closed with a square designed device that has a round waist for self‐centering. Both patients had complete closure.

A New Parameter Predicting Chronic Total Occlusion of Coronary Arteries Platelet Distribution Width

Platelet distribution width (PDW) measures the variability in platelet size and is a marker of platelet activation. We investigated whether PDW is associated with the extent of coronary artery disease (CAD) and coronary total occlusions (CTOs). We studied 162 patients: 108 had a coronary lesion with a diameter stenosis of ≥50%, the CAD(+) group, and 54 patients had normal coronary anatomy, the CAD(−) group. The CAD(+) group was subdivided into CAD(+) CTO(+) and CAD(+) CTO(−) groups. Among patients with CAD, the CTO(+) group had a significantly greater PDW (%) than the CTO(−) group (16.9 ± 2.8, 15.4 ± 3.0, and 15.4 ± 1.9, respectively; P = .008). In a receiver–operating characteristic analysis, a PDW cut point of 15.7% was identified in patients with CTO(+) (area under curve = 0.64, 95% confidence interval 0.54-0.75). A PDW value of more than 15.7% demonstrated a sensitivity of 64% and a specificity of 66%. The PDW is a simple platelet index that may predict the presence of CTO.

Early experience of percutaneous paravalvular leak closure using a novel Occlutech occluder.

AIMS Paravalvular regurgitation is an important complication of mitral valve replacement. Although surgical repair is mostly recommended, it is associated with significant morbidity. On the other hand, percutaneous closure is a less invasive alternative approach. Percutaneous approaches to treatment of paravalvular prosthetic regurgitation have emerged recently. One of them is the Occlutech Paravalvular Leak Device. The aim of this study was to evaluate early and midterm outcomes of percutaneous paravalvular leak closure utilising a novel occluder. METHODS AND RESULTS Twenty-one consecutive symptomatic patients who had moderate or severe paravalvular prosthetic regurgitation on transoesophageal echocardiography were included in the study. All the patients were clinically evaluated and found inoperable for surgery. They underwent transapical repair with the Occlutech Paravalvular Leak Device. The patients were followed for 17±5 months. Attempts were made to rectify 41 defects in 21 patients with 100% success. Mean procedure time was 76±40 min and fluoro-scopy time was 44±37 min. Early post-procedural outcome was uneventful in all cases, with ≥1 grade reduction in regurgitation in all of the patients. There was no mortality during hospital stay. There was one case of haemothorax in one patient and one case of pneumothorax in another. Post-implantation 90-day follow-up data were obtained for 19 patients, and 12-month data were obtained for 12 patients. No deaths due to any cause, stroke or surgery for prosthetic impingement, worsening or relapse of paravalvular leak during follow-up were recorded. One patient underwent reintervention and was treated successfully with the same occluder 11 months after the index procedure. CONCLUSIONS The novel Occlutech Paravalvular Leak Device, which was designed specifically for mitral and aortic paravalvular regurgitation, is an additional, useful tool in the device armamentarium for the treatment of PVL.

Utility of the neutrophil to lymphocyte ratio for predicting in-hospital mortality after levosimendan infusion in patients with acute decompensated heart failure.

BACKGROUND The aim of this study was to investigate the effect of a levosimendan infusion on hematological variables in patients with acute decompensated heart failure (ADHF). The predictive value of these variables for in-hospital mortality was also evaluated. METHODS A total of 553 patients (368 males; mean age, 63.4 ± 14.9 years) with acute exacerbations of advanced heart failure (ejection fraction ≤ 35%) and treated with either dobutamine or levosimendan were included in this retrospective analysis. The patients that received levosimendan therapy were divided into two groups according to in-hospital mortality: group 1 (21%) included patients who died during hospitalization (n=45), while group 2 (79%) included patients with a favorable outcome (n=174) after levosimendan infusion. Changes in several hematological variables between admission and the third day after levosimendan infusion were evaluated. RESULTS The demographic characteristics and risk factors of the two groups were similar. A comparison of changes in laboratory variables after the infusion of levosimendan revealed significant improvement only in those patients who had not died (group 2) during hospitalization. The neutrophil to lymphocyte (N/L) ratio after levosimendan infusion was an independent predictor of in-hospital mortality (odds ratio: 1.310, 95% CI: 1.158-1.483, p<0.001). In a receiver-operating characteristic curve analysis, a value of 5.542 for the N/L ratio after levosimendan administration was identified as an effective cut-off point for predicting in-hospital mortality (area under the curve=0.737; 95% confidence interval=1100-1301; p<0.001). CONCLUSIONS Levosimendan treatment was associated with significant changes in hematological variables in patients with ADHF. A sustained higher N/L ratio after levosimendan infusion is associated with an increased risk of in-hospital mortality in patients with ADHF.

High SYNTAX score predicts worse in-hospital clinical outcomes in patients undergoing primary angioplasty for acute myocardial infarction.

ObjectiveA high SYNTAX score (SXscore) is a predictor of adverse outcomes for stable and unstable coronary syndromes. We aimed to examine whether a high SXscore will determine in-hospital clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. MethodsA total of 646 (mean age 56.1±12.5; 516 males, 130 females) patients with STEMI undergoing a primary percutaneous coronary intervention were evaluated prospectively. The study population was divided into tertiles based on the SXscore values. A high SXscore (n=196) was defined as a value in the third tertile (>21.75), and a low SXscore (n=450) was defined as a value in the lower two tertiles (⩽21.75). Patients were followed up for in-hospital clinical outcomes. ResultsIn-hospital cardiovascular mortality occurred more in the high SXscore group than in the low SXscore group (10.7 and 2.4%, respectively, P<0.001). In a receiver-operating characteristic curve analysis, an SXscore value of 21.75 was identified as an effective cut point in STEMI for in-hospital cardiovascular mortality (area under curve=0.75, 95% confidence interval: 0.66–0.83, P<0.001). An SXscore value of more than 21.75 yielded a sensitivity of 66% and a specificity of 71.5%. A significant association was noted between a high SXscore level and the adjusted risk of in-hospital cardiovascular mortality (odds ratio: 3.92, 95% confidence interval: 1.1–13.9, P=0.03). ConclusionOur findings showed that patients with a high SXscore undergoing primary angioplasty for STEMI have a poor in-hospital survival, and that a high SXscore represents an independent risk factor for in-hospital cardiovascular mortality.

Endovascular therapy of acute ischaemic stroke by interventional cardiologists: single-centre experience from Turkey.

AIMS We report our single-centre experience with the Solitaire AB self-expanding retrievable stent system in patients with acute ischaemic stroke. METHODS AND RESULTS Demographic, clinical, and angiographic findings of thirty-eight consecutive patients with acute ischaemic stroke who underwent mechanical thrombectomy were evaluated retrospectively. The mean initial National Institutes of Health Stroke Scale (NIHSS) score was 17.8±4.6. Nearly half of the patients had a middle cerebral artery (MCA) occlusion (45%). Both internal carotid artery and MCA occlusions were detected in five patients. Successful revascularisation (Thrombolysis in Cerebral Infarction [TICI] 2b and 3) was achieved in 34 of 38 (89%) patients; a TICI 3 state was observed in 24 (63%) patients. Almost three quarters of the patients (74.3%) improved by >5 points on the NIHSS at discharge, and 57.9% showed a modified Rankin Scale (mRS) score of ≤2 at 90 days. CONCLUSIONS This single-centre experience with mechanical thrombectomy devices demonstrated that the procedure could be performed safely with high success rates by experienced interventional cardiologists in suitably equipped cathlabs.