Ahmet Zengin

Can the T-peak to T-end interval be a predictor of mortality in patients with ST-elevation myocardial infarction?

BackgroundThe interval between the peak and the end of the T wave (Tp–e interval) on 12-lead ECG is a measure of transmural dispersion of repolarization and may be related to malignant ventricular arrhythmias. The objective of this study was to investigate whether the Tp–e interval predicts in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (pPCI). MethodsThis study included 488 consecutive patients with STEMI treated with pPCI. Electrocardiograms were obtained after pPCI and the Tp–e interval was measured in leads without ST-segment elevation. ResultsThere were 46 (9.4%) deaths in the population, with a mean follow-up time of 21.1±10.2 months. The Tp–e interval was associated with not only in-hospital ventricular tachycardia/fibrillation, target vessel revascularization, and death but also long-term target vessel revascularization and death. Furthermore, the Tp–e interval measured using the tail method was found to be a significant predictor of long-term mortality in multivariable Cox analyses [odds ratio 1.018, 95% confidence interval (1.004–1.033)]. Findings were similar in the Tp–e interval and the heart rate-corrected Tp–e interval (cTp–e). ConclusionTp–e and cTp–e measured using the tail method were found to be predictors of both in-hospital and long-term mortality.

Presence of early repolarization on admission electrocardiography is associated with long-term mortality and MACE in patients with STEMI undergoing primary percutaneous intervention

BACKGROUNDnEarly repolarization (ER) is associated with increased risk of sudden cardiac death and ventricular fibrillation (VF) in patients with/without structural heart disease. In this trial we examined the short- and long-term prognostic value of ER on admission electrocardiogram (ECG) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).nnnMETHODnConsecutive 521 patients with acute STEMI who underwent primary PCI were enrolled prospectively. Twelve-lead ECGs obtained during the initial diagnosis were scanned and stored digitally. The leads showing the typical ST segment elevation due to the acute infarction were excluded and the remaining ECG leads were included in the analysis for the presence of ER.nnnRESULTSnThe study group included 61 STEMI patients (55 male; mean age 57.6±12.6 years) with ER and 460 STEMI patients (378 male; mean age 57.1±12.5) without ER on ECG. In the ER group, 14 patients (22.9%) had notching, 10 patients (16.4%) had slurring, and 37 patients (60.7%) had only J-point elevation. When analyzing regional leads, ER was observed mostly in inferior leads (n=40, 65.6%). During the hospitalization period, ventricular tachycardia or VF occurred more frequently in the ER group (19.6% vs. 10.9%; p=0.04) and 6 patients (6.9%) from the ER group and 14 patients (3%) from the control group died (p=0.01). During a follow-up period of 21.1±10.2 months, mortality was significantly higher in the ER group (12.7% vs. 4.2%; p=0.01). When total mortality rates were considered, highest mortality was observed in patients with notching pattern (5/14 subjects; 35.7%) when compared to patients with slurring (3/10 subjects; 30%), patients with only J-point elevation patterns (5/37subjects; 13.5%) and the control group (33/460 subjects; 7.1%). Presence of notching and slurring pattern on admission ECG was found as independent predictors of long-term mortality; whereas presence of only J-point elevation was not.nnnCONCLUSIONnPresence of ER pattern in admission ECG in patients with STEMI is associated with both in-hospital and long-term mortality.

Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion

BackgroundThe purpose of the present study is to evaluate current echocardiographically (echo)-guided pericardiocentesis practice with regard to procedural success, complication rate, etiological causes, and outcomes of patients with clinically significant pericardial effusion.Patients and methodsPatients who underwent echo-guided pericardiocentesis between January 2004 and February 2014 were identified using an institutional code for the procedure. Other complementary data were obtained by interviewing patients or their relatives (directly or by telephone) and by searching the social security death index.ResultsA total of 301 patients were identified. The pericardium was approached via the subcostal (85u2009%) or apical (15u2009%) route under echo guidance in all procedures. The success rate was 97u2009%, with an intervention-requiring complication rate of 1.3u2009%. No patient died from complications. The most common etiology was malignancy (nu2009=u200984, 28u2009%). Patients were followed-up for a median of 35xa0months. Median survival for patients with malignant effusion was 5.9xa0months compared with 54xa0months for those with nonmalignant effusion.ConclusionsEcho-guided pericardiocentesis has a high success and low complication rate in current practice. Among etiologies, malignancy remains the most common cause of clinically significant pericardial effusion and is associated with a poor prognosis.ZusammenfassungHintergrundZiel der vorliegenden Studie war die Beurteilung des derzeitigen Untersuchungsablaufs bei echokardiographisch kontrollierter Perikardiozentese im Hinblick auf den Erfolg des Verfahrens, die Komplikationsrate, ätiologische Aspekte und Ergebnisse bei Patienten mit klinisch signifikantem Perikarderguss.Patienten und MethodenDie Patienten, bei denen zwischen Januar 2004 und Februar 2014 eine echokardiographisch kontrollierte Perikardiozentese durchgeführt worden war, wurden anhand eines einrichtungsbezogenen Codes für dieses Verfahren ermittelt. Weitere ergänzende Daten wurden durch Befragung der Patienten oder ihrer Angehörigen (direkt oder telefonisch) und mithilfe des Sozialversicherungssterbeindex gewonnen.ErgebnisseInsgesamt wurden 301 Patienten ermittelt. Der Zugang zum Perikard erfolgte subkostal (85u2009%) oder apikal (15u2009%) unter echokardiographischer Kontrolle aller Untersuchungen. Die Erfolgsrate betrug 97u2009%, dabei lag die eine Intervention erfordernde Komplikationsrate bei 1,3u2009%. Es starb kein Patient an Komplikationen. Die häufigste Ätiologie war ein Malignom (nu2009=u200984; 28u2009%). Im Mittel wurden die Patienten 35 Monate lang nachbeobachtet. Das durchschnittliche Überleben lag für Patienten mit einem malignen Perikarderguss bei 5,9 Monaten im Gegensatz zu 54 Monaten für Personen mit nichtmalignem Erguss.SchlussfolgerungDie echokardiographisch kontrollierte Perikardiozentese weist eine hohe Erfolgs- und niedrige Komplikationsrate bei dem derzeitigen Untersuchungsablauf auf. Ätiologisch liegt einem klinisch signifikanten Perikarderguss zumeist ein Malignom zugrunde, das mit einer schlechten Prognose einhergeht.

Inappropriate use of digoxin in patients presenting with digoxin toxicity.

Background Digoxin remains widely used today despite its narrow therapeutic index and toxicity. The objective of this study was to investigate the percentage of inappropriate use of digoxin and long-term outcomes of elderly patients hospitalized for digoxin toxicity. Methods The study included 99 consecutive patients hospitalized for digoxin toxicity. The other study criteria for the inappropriate use of digoxin was regarded if participants having depressed left ventricular systolic function (ejection fraction < 45%) who were not on optimal medical therapy including beta-blocker and angiotensin-converting-enzyme inhibitor therapy or if participants having permanent AF who were not on optimal beta-blocker therapy. Results Appropriate digoxin usage was confirmed in 33 of patients in spite of its narrow therapeutic index. A total of 16 of 99 patients died, with a mean follow-up time of 22.1 ± 10.3 months. Conclusions Contrary to popular belief, the rate of inappropriate digoxin usage remains high. On account of its narrow therapeutic index and toxicity, digoxin should be used more carefully according to the current evidence and guidelines.

Anaphylactic shock associated with intravenous amiodarone

A 64-year-old woman was admitted to our emergency department with shortness of breath and palpitation which started 2xa0h before her admission. She had a history of rheumatic mitral valve disease and was on drug treatment with warfarin and metoprolol. The patient was orthopneic, blood pressure was 108/68xa0mmHg with an irregular pulse with a heart rate of 158 beats per minute, and respiratory rate was 23 times per minute. Her electrocardiogram was consistent with atrial fibrillation with rapid ventricular response. For pharmacological cardioversion the patient was given amiodarone intravenous loading dose of 300xa0mg in 30xa0min. After 10xa0min of infusion the patient complained of pruritus and skin rash consistent with urticaria. At the same time the patient had dyspnea and bronchoconstriction was noted on both lung fields. The blood pressure was measured as 64/40xa0mmHg. The patient was taken to intensive care unit and supportive treatment for anaphylactic shock was given. Amiodarone is a class III antiarrhythmic agent frequently used in the management of atrial fibrillation. This potentially fatal complication of amiodarone should be kept in mind by clinicians and before administration patients should be questioned about previous allergic reactions including previous iodine or iodinated contrast media. Alternative agents should be considered in these conditions. <Learning objective: Anaphylactic shock is a rare complication of amiodarone and it is a commonly used drug. This potentially fatal complication of amiodarone should be kept in mind by clinicians.>.

Neurologic outcome in patients with cardiac arrest complicating ST elevation myocardial infarction treated by mild therapeutic hypothermia: The experience of a tertiary institution

OBJECTIVEnTherapeutic hypothermia improves neurologic prognosis after cardiac arrest. The aim of this study was to report clinical experience with intravascular method of cooling in patients with cardiac arrest resulting from ST-segment elevation myocardial infarction (STEMI).nnnMETHODSnThirteen patients (11 male, 2 famele; mean age was 39.6±9.4 years) who had undergone mild therapeutic hypothermia (MTH) by intravascular cooling after cardiac arrest due to STEMI were included. Clinical, demographic, and procedural data were analyzed. Neurologic outcome was assessed by Cerebral Performance Category (CPC) score.nnnRESULTSnAnterior STEMI was observed in 9 patients. One patient died of cardiogenic shock complicating STEMI. Mean cardiopulmonary resuscitation (CPR) duration and door-to-invasive cooling were 32.9±20.1 and 286.1±182.3 minutes, respectively. Precooling Glasgow Coma Scale score was 3 in 9 subjects. Twelve patients were discharged, 11 with CPC scores of 1 at 1-year follow-up. No major complication related to procedure was observed.nnnCONCLUSIONnIn comatose survivors of STEMI, therapeutic hypothermia by intravascular method is a feasible and safe treatment modality.

Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion@@@Echokardiographisch kontrollierte Perikardiozentese bei Patienten mit klinisch signifikantem Perikarderguss: Outcomes over a 10-year period@@@Ergebnisse im Zeitraum von 10 Jahre

BackgroundThe purpose of the present study is to evaluate current echocardiographically (echo)-guided pericardiocentesis practice with regard to procedural success, complication rate, etiological causes, and outcomes of patients with clinically significant pericardial effusion.Patients and methodsPatients who underwent echo-guided pericardiocentesis between January 2004 and February 2014 were identified using an institutional code for the procedure. Other complementary data were obtained by interviewing patients or their relatives (directly or by telephone) and by searching the social security death index.ResultsA total of 301 patients were identified. The pericardium was approached via the subcostal (85u2009%) or apical (15u2009%) route under echo guidance in all procedures. The success rate was 97u2009%, with an intervention-requiring complication rate of 1.3u2009%. No patient died from complications. The most common etiology was malignancy (nu2009=u200984, 28u2009%). Patients were followed-up for a median of 35xa0months. Median survival for patients with malignant effusion was 5.9xa0months compared with 54xa0months for those with nonmalignant effusion.ConclusionsEcho-guided pericardiocentesis has a high success and low complication rate in current practice. Among etiologies, malignancy remains the most common cause of clinically significant pericardial effusion and is associated with a poor prognosis.ZusammenfassungHintergrundZiel der vorliegenden Studie war die Beurteilung des derzeitigen Untersuchungsablaufs bei echokardiographisch kontrollierter Perikardiozentese im Hinblick auf den Erfolg des Verfahrens, die Komplikationsrate, ätiologische Aspekte und Ergebnisse bei Patienten mit klinisch signifikantem Perikarderguss.Patienten und MethodenDie Patienten, bei denen zwischen Januar 2004 und Februar 2014 eine echokardiographisch kontrollierte Perikardiozentese durchgeführt worden war, wurden anhand eines einrichtungsbezogenen Codes für dieses Verfahren ermittelt. Weitere ergänzende Daten wurden durch Befragung der Patienten oder ihrer Angehörigen (direkt oder telefonisch) und mithilfe des Sozialversicherungssterbeindex gewonnen.ErgebnisseInsgesamt wurden 301 Patienten ermittelt. Der Zugang zum Perikard erfolgte subkostal (85u2009%) oder apikal (15u2009%) unter echokardiographischer Kontrolle aller Untersuchungen. Die Erfolgsrate betrug 97u2009%, dabei lag die eine Intervention erfordernde Komplikationsrate bei 1,3u2009%. Es starb kein Patient an Komplikationen. Die häufigste Ätiologie war ein Malignom (nu2009=u200984; 28u2009%). Im Mittel wurden die Patienten 35 Monate lang nachbeobachtet. Das durchschnittliche Überleben lag für Patienten mit einem malignen Perikarderguss bei 5,9 Monaten im Gegensatz zu 54 Monaten für Personen mit nichtmalignem Erguss.SchlussfolgerungDie echokardiographisch kontrollierte Perikardiozentese weist eine hohe Erfolgs- und niedrige Komplikationsrate bei dem derzeitigen Untersuchungsablauf auf. Ätiologisch liegt einem klinisch signifikanten Perikarderguss zumeist ein Malignom zugrunde, das mit einer schlechten Prognose einhergeht.