Durmuş Yıldıray Şahin

Mean platelet volume and extent and complexity of coronary artery disease in diabetic and nondiabetic patients with ST elevation myocardial infarction.

We investigated whether the mean platelet volume (MPV) is associated with the extent and complexity of coronary artery disease in patients with ST elevation myocardial infarction (STEMI). We prospectively included 912 STEMI patients (663 male and 249 female; mean age 58.7 ± 12.4 years) who underwent primary percutaneous coronary intervention. The patients were divided into 3 groups according to MPV tertiles. Highest SYNTAX score (SS) was observed in MPVhigh group compared with MPVmid and MPVlow groups (P < .001 for all). The SS of MPVmid group was higher than MPVlow group (P = .036). The MPV in diabetic STEMI patients was higher than in nondiabetic STEMI patients (P < .001). Multivariate linear regression analysis showed that the MPV was associated with diabetes (β = .115, P = .001), troponin level (β = .131, P = .001), platelet count (β = −.241, P < .001), and SS (β = .216, P < .001). The relation between MPV and SS in diabetic STEMI patients was stronger than for nondiabetic STEMI patients (r = .473, P < .001 vs r = .129, P = .001).

Relationship between platelet indices and international normalized ratio in patients with non-valvular atrial fibrillation

Abstract Atrial fibrillation (AF) is the most common sustained arrhythmia and associated with adverse outcomes and increased risk for thromboembolic events. Warfarin is still the most extensively prescribed oral anticoagulant in AF to prevent ischemic complications. We aimed to determine the differences at platelet indices with warfarin usage layered by International Normalized Ratio (INR). A total of 250 patients with permanent non-valvular AF (mean age 70.2u2009±u20099.1; 153 female) were divided into two groups. Group 1 included 125 patients whose INR is between 2.0 and 3.0 (called as “effective”) and Group 2 included 125 patients whose INR is <2.0 (called as “ineffective”). Also 123 age- and sex-matched individuals in sinus rhythm enrolled as control group (Group 3). After physical and echocardiographic examination, complete blood counts and INR were studied. There was no statistically significant difference in age, sex, co-morbidities and medications, also hemoglobin, white blood cell and platelet counts among the groups. The CHA2DS2-VASc scores were similar between Groups 1 and 2. The mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) were significantly higher in Group 2 than Groups 1 and 3 and similar between Groups 1 and 3. MPV was positively correlated with PDW and PCT and also inversely correlated with INR value and platelet count. On multivariate logistic regression analysis, MPV, PDW and PCT were independent predictors of ineffectiveness of INR. The results of this study showed that MPV, PDW and PCT are increased in patients with non-valvular AF without effective warfarin treatment. Warfarin usage adjusted by INR is associated with lower values of these platelet indices, even lower as the values of subjects in sinus rhythm. MPV, PDW and PCT are independent predictors of INR ineffectiveness and seem to be useful parameters for monitoring the effectiveness of warfarin treatment.

Association of mean platelet volume and pre- and postinterventional flow with infarct-related artery in ST-segment elevation myocardial infarction.

Platelets play a role in the pathogenesis of ST-segment elevation myocardial infarction (STEMI). We assessed the relationship between mean platelet volume (MPV) on admission and pre- and postinterventional flow with the infarct-related artery (IRA) in patients with STEMI. We prospectively included 840 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). The patients were divided into 3 groups according to MPV tertiles. Pre- and post-PCI Thrombolysis In Myocardial Infarction (TIMI) flow grade was determined. Initial TIMI flow grade 3 was accepted as patent IRA. After the primary PCI, normal flow was defined as post-PCI TIMI flow 3. When the MPV was increased, the incidence of pre-PCI patent IRA (P = .004) and post-PCI normal TIMI flow (P < .001) was significantly decreased. Multivariate analysis showed that MPV was independently associated with post-PCI TIMI flow grade.

Mean platelet volume is related with ischemic stroke in patients with sinus rhythm.

Stroke is the leading cause of disability worldwide. It is known that atrial fibrillation and left atrial enlargement contribute ischemic stroke, and mean platelet volume (MPV) increases in patients with ischemic stroke and atrial fibrillation. We aimed to determine whether higher MPV is associated with ischemic stroke in patients with sinus rhythm. We evaluated 74 patients in sinus rhythm and with ischemic stroke (Group 1) and 90 age-matched and sex-matched healthy individuals as control group (Group 2). After physical and echocardiographic examination, 24–48u200ah Holter monitoring and complete blood counts were studied. There were no statistically significant differences in age, sex rates, and comorbidities between groups. Left atrial diameter was higher in Group 1 than Group 2 (Pu200a=u200a0.001), but both were in normal range. MPV was significantly higher in Group 1 (Pu200a<u200a0.001) and was an independent determinant [odds ratio (OR): 1.840; Pu200a<u200a0.001; 95% confidence interval (CI) 1.330–2.545] of ischemic stroke with left atrial (OR: 1.138; Pu200a=u200a0.006; 95% CI 1.037–1.248). In conclusion, higher MPV is associated with acute ischemic stroke in patients with sinus rhythm and without heart failure or left atrial enlargement. MPV and left atrial diameter are independent predictors of ischemic stroke in this patient population.

Fibrosis Marker Soluble ST2 Predicts Atrial Fibrillation Recurrence after Cryoballoon Catheter Ablation of Nonvalvular Paroxysmal Atrial Fibrillation

Background and Objectives We aimed to investigate the relationship between the recurrence of atrial fibrillation (AF) and fibrosis marker soluble ST2 (sST2) in patients with nonvalvular paroxysmal AF (PAF). Methods We prospectively included 100 consecutive patients with PAF diagnosis and scheduled for cryoballoon catheter ablation for AF (47 males, 53 females; mean age 55.1±10.8 years). sST2 plasma levels were determined using the ASPECT-PLUS assay on ASPECT Reader device (Critical Diagnostics). The measurement range of these measurements was 12.5–250 ng/mL. Patients had regular follow-up visits with 12-lead electrocardiogram (ECG), medical history, and clinical evaluation. Twenty-four hours Holter ECG monitoring had been recorded 12 months after ablation. Results AF recurrence was detected in 22 patients after 1 year. Age, smoking history, diabetes mellitus,hypertension frequency, angiotensin converting enzyme inhibitor-angiotensin receptor blocker use, CHA2DS2VASc and HAS-BLED scores, serum sST2 level, left atrium (LA) end-diastolic diameter, LA volume and LA volume index were related to AF recurrence. In multivariable logistic regression analysis, sST2 was found to be only independent parameter for predicting AF recurrence (odds ratio, 1.085; p=0.001). Every 10-unit increase in sST2 was found to be associated with 2.103-fold increase in the risk of AF recurrence. The cut-off value of sST2 obtained by receiver operating characteristic curve analysis was 30.6 ng/mL for prediction of AF recurrence (sensitivity: 77.3%, specificity: 79.5%). The area under the curve was 0.831 (p<0.001). Conclusions sST2, which is associated with atrial fibrosis, can be thought to be a useful marker for detection of patients with high-grade fibrosis who will get less benefit from cryoablation.

Subclinical atrial fibrillation frequency and associated parameters in patients with cardiac resynchronization therapy

AimThe presence of subclinical atrial fibrillation (SCAF) is relevant to issues such as the risk of stroke and the necessity of anticoagulant use in patients with cardiac resynchronization therapy (CRT). Our study aimed to investigate SCAF frequency and associated parameters in patients with CRT.MethodsOne hundred ninety-one patients with CRT (77 females, 114 males, mean age 65.9u2009±u20099.8) were included in the study. Atrial high-rate episodes detected by the device, atrial electrode impedance, P-wave sense amplitude, and atrial lead threshold values were measured during pacemaker controls. SCAF was defined as asymptomatic atrial high-rate episodes (AHRE) longer than 6xa0min and shorter than 24xa0h. Patients were divided into two groups as with and without SCAF.ResultsSCAF was detected in 44 (23.2%) of 191 patients with CRT. Age, sex, weight, aortic end-systolic diameter, left atrium (LA) diameter, left bundle branch block morphology, CHA2DS2-VASc score, and right atrium thresholds were associated with SCAF. In multivariate regression analysis, CHA2DS2-VASc score, LA diameter, and atrial threshold values were found to be independent predictors of SCAF occurrence. According to this analysis, every 1 point increase in CHA2DS2-VASc score, every 1xa0mm increase in LA diameter, and every 0.1xa0V increase in atrial threshold increased the risk of SCAF by 32.5, 59.6, and 14.6%, respectively. In the ROC analysis, the area under the curve (AUC) was 0.870, 0.638, and 0,652 for LA diameter, CHA2DS2-VASc score, and atrial lead threshold, respectively (pu2009<u20090.05, for all). The cut-off values were 34xa0mm, 3, and 0.6xa0V for LA diameter, CHA2DS2-VASc score, and atrial lead threshold, respectively.ConclusionPatients with CRT have significantly higher frequency of SCAF than the normal population. CHA2DS2-VASc score, LA diameter, and atrial threshold values were considered to be useful and easily applicable parameters in identifying the patients to develop SCAF.

Association of P wave duration index with atrial fibrillation recurrence after cryoballoon catheter ablation

AIMnWe aimed to investigate the relationship between the recurrence of AF and P wave duration index (PWDI) in patients with nonvalvular PAF.nnnMETHODSnWe included 114 patients who underwent cryoballoon catheter ablation with the diagnosis of paroxysmal atrial fibrillation (PAF) (55 male, 59 female; mean age 55.5±10,9years). PWDI was calculated by dividing the Pwd by the PR interval in DII lead of 12‑lead ECG. Patients had regular follow-up visits with 12-lead ECG, medical history and clinical evaluation. 24h Holter ECG monitoring had been recorded at least 12months after ablation.nnnRESULTSnAF recurrence was detected in 24 patients after 1year. Patients were divided into two groups according to the AF recurrence. All parameters were compared between the two groups. Age, DM, HT frequency, ACEI-ARB use, CHA2DS2VASc and HAS-BLED score, HsCRP, LA diameter, LA volume, LA volume index, Pwd and PWDI were related to AF recurrence. In binary logistic regression analysis, PWDI (OR=1.143, p=0.001) and HT (OR=0.194, p=0.020) were found to be independent parameters for predicting AF recurrence. Every 0,01 unit increase in PWDI was found to be associated with 14.3% increase in the risk of AF recurrence. The cut-off value of PWDI obtained by ROC curve analysis was 59,9 for prediction of AF recurrence (sensitivity: 75.0%, specificity: 69.0%). The area under the curve (AUC) was 0.760 (p<0.001).nnnCONCLUSIONnIncreased PWDI may help to identify those patients in whom electrical remodeling has already occurred and who will get less benefit from cryoablation.

A new use for maximum deflection index: Detection of intraventricular dyssynchrony

AIMnCRT has been shown to be very beneficial for patients with reduced LVEF, symptomatic HF and increased QRS width. But many patients do not benefit from CRT. Maximum deflection index (MDI) is a quantitive measure of the rapidity of depolarization of the myocardium. In previous studies, high MDI was found to indicate epicardial origin of ventricular tachycardia. We aimed to detect the relationship between echocardiographic intraventricular dyssynchrony and MDI.nnnMETHODSnWe included 144 patients with HF, QRS≥120ms, LBBB, NYHA II-IV, LVEF<35% and scheduled for CRT (90 male, 54 female; mean age 65.3±9.9years). Septal-lateral >60ms delay for the beginning of systolic velocity in TDI and septum-posterior >130ms delay in M-mode were accepted as intraventricular dyssynchrony. The MDI was calculated by dividing the time from onset of the QRS complex to the earliest point of maximum deflection in V5-V6 by the QRS duration.nnnRESULTSnSeptal-lateral delay was associated with MDI and QRS width in bivariate analysis. In logistic regression analysis, MDI (beta=0,264, p=0.001) and QRS width (beta=0,177, p=0.028) were found to be independent parameters for predicting significant septal-lateral delay. MDI was also associated with significant septum-posterior delay in bivariate correlations and ROC curve (p<0.05 for all). In bivariate analysis MDI was associated with intraventricular dyssynchrony in both non-strict LBBB (r=0.261, p=0.010) and strict LBBB (r=0.305, p=0.035) groups.nnnCONCLUSIONnMDI is closely associated with all echocardiographic intraventricular dyssynchrony parameters. We suggest that MDI may be used as a marker to detect patients with increased intraventricular dyssynchrony. It may be useful to integrate MDI to CRT patient selection procedure in order to minimize nonresponders.

Increased hs-CRP and decreased 1,25-dihydroxyvitamin D are associated with increased left ventricle lead threshold.

PurposeThere are not enough data about threshold changes in patients with CRT. In this study, we aimed to investigate frequency of significant threshold increase of left ventricle lead and to determine clinical, demographic, medical and laboratory parameters that associated with threshold increase in CRT implanted patients.MethodsWe included CRT implanted 200 patients (124 males, 76 females; mean age 65.8u2009±u200910.3xa0years) to this study. Basal and third month LV R wave amplitude, electrode impedance, and threshold values were recorded. Threshold increase was accepted as ≥0.1xa0V and significant increase as >1xa0V. Patients were divided into two groups: increased threshold and non-increased threshold for LV lead.ResultsNumber of patients with increased LV threshold was 68 (37.6xa0%). Furthermore, 8xa0% of patients had severe increase (≥1xa0V) in LV threshold. We observed that serum levels of hs-CRP and 1,25 (OH)2 vitamin D were independently associated with increased LV threshold. We showed that 1xa0mg/dl increase in hs-CRP and the 1xa0mg/dl decrease in vitamin D are associated with 25.3 and 4.5xa0% increase in the odds of increased LV threshold, respectively.ConclusionsIncreased hs-CRP and decreased 1,25 (OH)2 vitamin D are the strongest predictors of increased LV lead thresholds. We suggest that hs-CRP and 1,25 (OH)2 vitamin D may be used as markers to predict and follow the patients with increased thresholds. It may be useful to finalize CRT procedure with more appropriate basal threshold in patients with high serum hs-CRP and low 1,25 (OH)2 vitamin D levels.