Burak Altun

Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction.

Background Platelet-to-lymphocyte ratio (PLR) is a new prognostic marker in coronary artery disease. We aimed to evaluate the relationship between PLR and in-hospital mortality in patients with ST-elevated acute myocardial infarction (AMI). Material/Methods The present study included 636 patients with ST-elevated AMI. The study population was divided into tertiles based on their admission PLR. Patients having values in the third tertile was defined as the high PLR group (n=212) and those having values in the lower 2 tertiles were defined as the low PLR group (n=424). Results Risk factors of coronary artery disease and treatments administered during the in-hospital period were similar between the groups. Male patient ratio was found to be lower in the high PLR group (73% vs. 82.8%, p=0.004). In-hospital mortality was increased in the high PLR group when compared to the low PLR group (12.7% vs. 5.9%, p=0.004). The PLR >144 was found to be an independent predictor of in-hospital cardiovascular mortality (HR: 2.16, 95% CI: 1.16–4.0, p=0.014). Conclusions This study showed that PLR is an independent predictor of cardiovascular mortality in patients with ST-elevated AMI.

Prognostic Value of the Neutrophil-Lymphocyte Ratio in Patients With ST-Elevated Acute Myocardial Infarction.

The predictive value of leukocyte counts has been reported in patients with acute myocardial infarction (AMI). We aimed to evaluate the predictive value of the total leukocyte count and neutrophil–lymphocyte (N/L) ratio for mortality due to AMI. A total of 522 patients with acute ST-elevated MI were included in the study. The study population was divided into tertiles based on admission N/L ratio values. High (n = 174) and low N/L (n = 348) ratio groups were defined as patients having values in the third tertile (>5.77) and lower 2 tertiles (≤5.77), respectively. The high N/L ratio group had a significantly higher incidence of in-hospital cardiovascular mortality (13.8% vs 4.6%, P < .001). An N/L ratio >5.77 was found to be an independent predictor of in-hospital cardiovascular mortality (hazard ratio: 3.78, 95% confidence interval: 1.71-8.30, P = .001). A high N/L ratio is a strong and independent predictor of in-hospital cardiovascular mortality of AMI with ST elevation.

Increased Platelet Distribution Width Is Associated With Severity of Coronary Artery Disease in Patients With Acute Coronary Syndrome

Platelet activation plays a pivotal role in acute coronary syndrome (ACS). We investigated the relationship between platelet distribution width (PDW) and severity of coronary artery disease (CAD) in patients with ACS. A total of 502 patients with ACS were enrolled. High (n = 151) and low PDW (n = 351) groups were defined as patients having values in the third tertile (>17%) and lower 2 tertiles (≤17%). There were significantly higher Gensini score (44 [10-168] vs 36 [2-132], P < .001), and neutrophil–lymphocyte ratio (3.1 [0.8-12.4] vs 2.5 [0.3-13], P = .012) and baseline platelet counts were significantly lower (220 [61-623] vs 233 [79-644] 103/mm3, P = .022) in the high PDW group. The variables PDW >17%, diabetes mellitus, and myocardial infarction were found to be associated with high Gensini score (odds ratio [OR]: 1.91, 95% confidence interval [CI]: 1.27-2.88, P = .002; OR: 2.85, 95%CI: 1.91-4.25, P < .001; OR: 2.67, 95% CI:1.74-4.1, P < .001, respectively). An increased PDW (>17%) is associated with severity of CAD in patients with ACS.

Evaluation of Platelet Distribution Width and Mean Platelet Volume in Patients With Carotid Artery Stenosis

Platelets contribute to the pathogenesis of atherosclerosis. Platelet activation has been linked with increased mean platelet volume (MPV) and platelet distribution width (PDW). We investigated the association between PDW, MPW, and the degree of carotid artery stenosis (CS). Patients (n = 229) were divided into 3 groups according to the North American Symptomatic Carotid Endarterectomy Trial criteria. Demographic and clinical features were collected retrospectively. Correlation analysis showed a positive association between PDW and the degree of CS. However, there was no significant correlation between CS and MPV. Moreover, we observed that PDW and low-density lipoprotein cholesterol were independent predictors of the degree of CS. This study showed that PDW, not MPV, is related to the degree of CS. Platelet distribution width could be a useful biomarker for CS. Whether targeting PDW will be of clinical benefit remains to be established.

The relationship between fragmented QRS complexes and SYNTAX and Gensini scores in patients with acute coronary syndrome

BACKGROUNDnFragmented QRS (fQRS) complexes on 12-lead electrocardiography (ECG) have been reported to be predictors of cardiac events and all-cause mortality in coronary artery disease (CAD).nnnAIMnTo investigate the relationship between fQRS complexes and SYNTAX and Gensini scores in patients with acute coronary syndrome (ACS).nnnMETHODSnA total of 302 patients (223 men and 79 women) with ACS (133 ST elevated myocardial infarction [STEMI], 107 non-STEMI [NSTEMI], and 62 unstable angina pectoris [USAP]) were evaluated retrospectively in this study. An fQRS pattern was found in 70 patients (fQRS group) but was not found in 232 patients (non-fQRS group). SYNTAX score > 22 and Gensini score > 20 were defined as high SYNTAX and Gensini scores. The relationship between the presence of fQRS on 12-lead ECG and SYNTAX and Gensini scores was assessed.nnnRESULTSnSYNTAX score (p < 0.001), Gensini score (p < 0.001), NYHA class (p < 0.001), QRS duration (p < 0.001), number of disease vessels (p = 0.003), and high sensitive troponin T levels (p = 0.026) were significantly higher in the fQRS group. The number of fQRS leads (HR 5.79, 95% CI 2.78-12.06, p < 0.001, HR 3.41, 95% CI 1.32-8.78, p = 0.016, respectively) was found to be an independent predictor of high SYNTAX score and high Gensini score in multivariate analysis.nnnCONCLUSIONSnThe number of fQRS leads on 12-lead ECG on admission is associated with the severity and complexity of CAD in patients with ACS.

Assessment of the relationship between red cell distribution width and fragmented QRS in patients with non-ST elevated acute coronary syndrome

Background Red cell distribution width (RDW) and fragmented QRS (fQRS) complexes have also been reported to be predictors of cardiac events and all-cause mortality in coronary artery disease (CAD). We aimed to investigate the association of serum red cell distribution width (RDW) levels and fQRS in patients with non-ST elevated acute coronary syndrome (NST-ACS). Material/Methods We retrospectively evaluated a total of 251 patients (191 men and 60 women) with NST-ACS. The NST-ACS consisted of unstable angina (UA) and non-ST elevated myocardial infarction (NSTEMI). The fQRS pattern was defined as the presence of an additional R’ or crochetage wave, notching in the nadir of the S wave or fragmentation of the RS or QS complexes in 2 contiguous leads corresponding to a major coronary artery territory. The relationships between the RDW and fQRS were assessed. Results The patients in the fQRS group were older, left ventricular ejection fraction (LVEF) levels were significantly lower, and baseline RDW and troponin levels were significantly higher than in the group without fQRS. There were positive correlations between age, number of coronary arteries narrowed, and RDW, and negative correlations between triglyceride, LVEF, and RDW in study patients. There were positive correlations between number of fQRS leads, age, and RDW, and negative correlations between triglyceride, LVEF, and RDW in NSTEMI patients. Conclusions Our results indicate that an elevated RDW values is associated with fQRS in NST-ACS. Elevated RDW values and fQRS together may be useful for identifying NSTEMI patients in NST-ACS.

Relationship of QT dispersion with sex hormones and insulin in young women with polycystic ovary syndrome: an observational study.

OBJECTIVEnPolycystic ovary syndrome (PCOS) is a common endocrinopathy in reproductive women. Cardiovascular disease risk factors are more frequent in this population. We aimed in this study to investigate presence of QT dispersion and effects of sex hormones and insulin on QT duration in young PCOS patients.nnnMETHODSnThis present study was cross-sectional observational study. A total of 47 women, 25 patients with PCOS and 22 healthy, were included. Serum testosterone, estradiol and insulin levels were studied and electrocardiography was performed at 2nd or 3th days of menstrual cycle. The study population was divided into groups according to serum testosterone and estradiol levels. Sub-groups and pairwise groups were compared by Mann-Whitney U or student t-test. The associations of QTc durations with hormone levels were calculated using Spearman rank correlation analysis. The results were evaluated at the p<0.05 significance level.nnnRESULTSnNo differences found between groups regarding to demographic parameters. Estradiol and testosterone levels were higher in patients with PCOS (41.12 ± 13.59 vs. 35.57 ± 19.29 pg/mL, p=0.09 and 105 ± 58.5 vs. 17.6 ± 10.9 ng/dL, p=0.01, respectively). QT dispersion was significantly longer in PCOS patients (47.1 vs. 32.7 ms, p=0.01). A positive correlation was found between the serum insulin level and QTc min, QTc max, and QTc mean (r=0.402, p=0.011; r=0.341, p=0.033; r=0.337, p=0.036; respectively). QT dispersion with serum testosterone and estradiol levels were positively correlated (r=0.525, p=0.001 and r=0.326, p=0.046; respectively).nnnCONCLUSIONnOur results suggest that QT dispersion is prolonged and testosterone, estradiol and insulin are associated with QT duration in young PCOS patients.

atrial electromechanical coupling intervals in pregnant subjects

Summary Objective The aim of this study was to evaluate atrial conduction abnormalities obtained by tissue Doppler imaging (TDI) and electrocardiogram analysis in pregnant subjects. Methods A total of 30 pregnant subjects (28 ± 4 years) and 30 controls (28 ± 3 years) were included. Systolic and diastolic left ventricular (LV) function was measured using conventional echocardiography and TDI. Inter-atrial, intra-atrial and intra-left atrial electromechanical coupling (PA) intervals were measured with TDI. P-wave dispersion (PD) was calculated from a 12-lead electrocardiogram. Results Atrial electromechanical coupling at the septal and left lateral mitral annulus (PA septal, PA lateral) was significantly prolonged in pregnant subjects (62.1 ± 2.7 vs 55.3 ± 3.2 ms, p < 0.001; 45.7 ± 2.5 vs 43.1 ± 2.7 ms, p < 0.001, respectively). Inter-atrial (PA lateral – PA tricuspid), intra-atrial (PA septum – PA tricuspid) and intra-left atrial (PA lateral – PA septum) electromechanical coupling intervals, maximum P-wave (Pmax) duration and PD were significantly longer in the pregnant subjects (26.4 ± 4.0 vs 20.2 ± 3.6 ms, p < 0.001; 10.0 ± 2.0 vs 8.0 ± 2.6 ms, p = 0.002; 16.4 ± 3.3 vs 12.2 ± 3.0 ms, p < 0.001; 103.1 ± 5.4 vs 96.8 ± 7.4 ms, p < 0.001; 50.7 ± 6.8 vs 41.6 ± 5.5 ms, p < 0.001, respectively). We found a significant positive correlation between inter-atrial and intra-left atrial electromechanical coupling intervals and Pmax (r = 0.282, p = 0.029, r = 0.378, p = 0.003, respectively). Conclusion This study showed that atrial electromechanical coupling intervals and PD, which are predictors of AF, were longer in pregnant subjects and this may cause an increased risk of AF in pregnancy.

Endothelial function and germ-line ACE i/d, eNOS and PAI-1 gene profiles in patients with coronary slow flow in the Canakkale population: multiple thrombophilic gene profiles in coronary slow flow

Summary Background We examined the effects of ACE, PAI-1 and eNOS gene polymorphisms on endothelial function. The genes are related to atherosclerosis and endothelial dysfunction in coronary slow flow (CSF). Methods Thirty-three patients with angiographically proven CSF and 48 subjects with normal coronary flow were enrolled in this study. Coronary flow patterns were determined by the thrombolysis in myocardial infarction (TIMI) frame count method. Endothelial function was assessed in the brachial artery by endothelium-dependent flow-mediated dilatation (FMD). PAI-1 4G/5G, eNOS T-786C and ACE I/D polymorphisms were determined by polymerase chain reaction (PCR) amplification. Results No difference was found between the groups regarding age, heart rate and blood pressure. Males were more prevalent among patients with CSF than control subjects (58.8 vs 29.8%, p = 0.009). Mean TIMI frame counts were significantly higher in CSF patients (24.2 ± 4.0 vs 13.1 ± 2.5 fpm, p = 0.001). FMD was significantly lower in CSF patients than in the controls (4.9 ± 6.6 vs 7.9 ± 5.6%, p = 0.029). TIMI frame count and FMD were found to be negatively correlated in a correlation analysis (r = –0.269, p = 0.015). PAI-1 4G/5G, eNOS T-786C and ACE I/D polymorphisms were similar in the two groups. Conclusions This study showed that endothelial function was impaired in patients with CSF. PAI-1, ACE and eNOS polymorphisms were not related to CSF in our study population.

Evaluation of epicardial fat tissue thickness in patients with hyperthyroidism

SummaryBackgroundThyroid hormones have several effects on the cardiovascular system, and recent studies have found that thyroid disorders affect coronary intima-media thickness (CIMT) in particular. Despite increased CIMT in patients with hyperthyroidism, the extent of the relationship between CIMT and epicardial fat thickness (EFT) in those patients is unknown. Furthermore, there is no report evaluating the relationship between EFT and overt hyperthyroidism (OH) in the literature. In this study, we aim to evaluate the effectiveness of EFT in predicting atherosclerosis as well as CIMT in patients with OH.MethodsA total of 30 newly diagnosed, untreated overt hyperthyroid patients and 44 control subjects were included in the study. EFT was measured using a commercially available echocardiography machine (VIVID 7; General Electric Medical Systems, Norway) with a 2.5-MHz probe. The echo-free space between the visceral and parietal pericardium on the anterior wall of the right ventricle was diagnosed as EFT. A linear-array imaging probe of the same echocardiography probe was used to evaluate the CIMT of the right common carotid artery.ResultsThe hyperthyroid patients had a significantly greater EFT (mean: 4.31xa0±xa01.12xa0mm) than the healthy subjects (mean: 3.11xa0±xa00.84xa0mm; pxa0<xa00.001). CIMT was also significantly greater in the hyperthyroid patients (mean: 0.62xa0±xa00.17xa0mm) than in the healthy subjects (mean: 0.50xa0±xa00.11xa0mm; pxa0<xa00.01).ConclusionIn conclusion, the present study shows that mean EFT and CIMT were significantly higher in OH patients, irrespective of confounding factors such as hypertension.ZusammenfassungHintergrundSchilddrüsenhormone haben verschiedene Wirkungen auf das kardiovaskuläre System. Kürzlich publizierte Studien haben berichtet, dass Schilddrüsenerkrankungen vor allem die Intima-Media-Dicke der Koronarien (CIMT) beeinflussen. Obwohl die CIMT bei Patienten mit Hyperthyreose erhöht ist, ist über das Ausmaß eines Zusammenhangs zwischen CIMT und der Dicke des epikardialen Fetts (EFT) bei diesen Patienten nichts bekannt. Es gibt außerdem in der Literatur keine Berichte über mögliche Zusammenhänge zwischen EFT und manifester Hyperthyreose. In der vorliegenden Studie versuchen wir die Wirksamkeit der EFT bei der Vorhersage einer Atherosklerose sowie der CIMT bei Patienten mit Hyperthyreose zu prüfen.MethodikDreißig neu diagnostizierte, unbehandelte Patienten mit manifester Hyperthyreose und 44 Kontrollpersonen wurden in die Studie aufgenommen. Die EFT wurde mittels eines kommerziell erhältlichen Echokardiographiegeräts (VIVID 7; General Electric Medical Systems, Norwegen) mit einer 2,5xa0MHz Sonde erhoben. Der echofreie Raum zwischen viszeralem und parietalem Epicard der Vorderwand des rechten Ventrikels wurde als EFT definiert. Eine bildgebende Linear Array Sonde des gleichen Echokardiographiegeräts wurde zur Evaluierung der CIMT der rechten Arteria carotis communis verwendet.ErgebnisseDie Patienten mit Hyperthyreose hatten eine signifikant größere EFT (Mittelwert: 4,31xa0±xa01,12xa0mm) als die gesunden Kontrollpersonen (Mittelwert: 3,11xa0±xa00,84xa0mm; pxa0<xa00,001). Auch die CIMT war bei den hyperthyreoten Patienten signifikant dicker (MW.: 0,62xa0±xa00,17xa0mm) als bei der gesunden Kontrolle (MW: 0,50xa0±xa00,11xa0mm; pxa0<xa00,01).SchlussfolgerungDie vorliegende Studie zeigt, dass die mittlere EFT und CIMT bei Patienten mit manifester Hyperthyreose unabhängig von anderen Faktoren wie Hypertonie signifikant höher als bei einer Kontrollpopulation ist.