Hamza Duygu

Is SYNTAX Score Predictive of Atrial Fibrillation After On-Pump Coronary Artery Bypass Graft Surgery?

Background and Objectives The relationship of synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score and development of atrial fibrillation (AF) after coronary artery bypass surgery (CABG) has not been studied. Therefore, we assessed the relationship between the SYNTAX score and development of AF after CABG (POAF). Subjects and Methods The medical records of consecutive patients, who underwent CABG surgery from January 2013 to September 2015, were retrospectively reviewed for the development of AF in the postoperative period. SYNTAX score, clinical and echocardiographic parameters were evaluated. The independent variables for the development of POAF were defined and their predictive values were measured. Results The study group consisted of 106 patients, of which 36 (34%) developed POAF. Age, hypertension, stroke, chronic obstructive pulmonary disease (COPD), heart failure (HF), diabetes mellitus (DM), left atrial diameter, neutrophil/lymphocyte ratio, platelet large cell ratio, creatinine, blood urea nitrogen and SYNTAX score were identified as important variables for the development of POAF. However, in logistic regression analysis COPD (OR=19.313, 95% CI=2.416-154.407, p=0.005), HF (OR=28.362, 95% CI=2.034-395.515, p=0.013), SYNTAX score (OR=0.863, 95% CI=0.757-0.983, p=0.026), and DM (OR=20.770, 95% CI=3.791-113.799, p<0.001) appeared as independent variables predicting the development of POAF. In receiver operation characteristic analysis, SYNTAX score (≥22.25) (AUC=0.777, 95% CI=0.676-0.877, p<0.001) was one of the strongest predictors for the development of POAF. Conclusion The SYNTAX score level was independently associated with the development of AF after CABG.

Usefulness of HATCH score as a predictor of atrial fibrillation after coronary artery bypass graft

BACKGROUND Atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery is associated with increased morbidity and mortality. The HATCH score was originally devised to predict the progression of paroxysmal AF to persistent AF. AIM To determine whether the HATCH score predicts the development of AF after CABG surgery. METHODS The medical records of 284 consecutive patients, who underwent CABG surgery between January 2013 and December 2014, were retrospectively reviewed for the development of AF in the postoperative (POAF) period. The HATCH score, and clinical and echocardiographic parameters were evaluated for all patients. RESULTS Seventy (25%) patients developed POAF. The HATCH scores were higher in the POAF group (2.8 ± 1.8 vs. 1.1 ± 1.2, p < 0.001). The area of the HATCH score under the curve in the receiver operating characteristics analysis was 773 (95% CI 706-841, p < 0.001). When the HATCH score was 2 or more as a threshold, there was for POAF 72% sensitivity and 75% specificity. CONCLUSIONS The results of the present study suggest that the HATCH score can be used to predict the development of POAF.

The role of HATCH score in predicting the success rate of sinus rhythm following electrical cardioversion of atrial fibrillation.

BACKGROUND The HATCH score predicts the development of persistent and permanent atrial fibrillation (AF) one year after spontaneous or pharmacological conversion to sinus rhythm in patients with AF. However, it remains unknown whether HATCH score predicts short-term success of the procedure at early stages for patients who have undergone electrical cardioversion (EC) for AF. AIM The present study evaluated whether HATCH score predicts short-term success of EC in patients with AF. METHODS The study included patients aged 18 years and over, who had undergone EC due to AF lasting less than 12 months, between December 2011 and October 2013. HATCH score was calculated for all patients. The acronym HATCH stands for Hypertension, Age (above 75 years), Transient ischaemic attack or stroke, Chronic obstructive pulmonary disease, and Heart failure. This scoring system awards two points for heart failure and transient ischaemic attack or stroke and one point for the remaining items. RESULTS The study included 227 patients and short-term EC was successful in 163 of the cases. The mean HATCH scores of the patients who had undergone successful or unsuccessful EC were 1.3 ± 1.4 and 2.9 ± 1.4, respectively (p < 0.001). The area of the HATCH score under the curve in receiver operating characteristics analysis was (AUC) 0.792 (95% CI 0.727-0.857, p < 0.001). A HATCH score of two and above yielded 77% sensitivity, 62% specificity, 56% positive predictive value, and 87% negative predictive value in predicting unsuccessful cardioversion. CONCLUSIONS HATCH score is useful in predicting short-term success of EC at early stages for patients with AF, for whom the use of a rhythm-control strategy is planned.

A bridge to coronary spasm: Myocardial bridging.

Article history: Received 28 February 2016 Accepted 19 March 2016 Available online 24 March 2016 making further differential diagnosis between type I and type II Kounis syndrome. In place of exercise testing, fractional flow reserve may provide more accurate information about the hemodynamic importance of a bridging segment [7]. In case of occult non-obstructive coronary atherosclerosis, coronary

Age of Statin Therapy; Statin Therapy With Aging

To The Editor: I have read the article entitled “Effect of statin therapy on mortality in older adults hospitalized with coronary artery disease: a propensity-adjusted analysis” by Rothschild et al. with great interest, recently published in the Journal of the American Geriatrics Society. The investigators reported that analysis failed to show a survival benefit of statins in individuals aged 80 years and older hospitalized with acute or chronic coronary artery disease (CAD). Statin therapy is most commonly used for cholesterol lowering. Statin therapy lowers cholesterol, but also has pleiotropic effect, reduces inflammation, improves endothelial function, has anti-oxidant and anti-inflammatory effects. Previous studies, including Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) and the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) suggested that statins might be beneficial in selected high-risk older adults, but the mean age of PROSPER participants was 75.3 years and in the JUPITER subgroup analysis participants were aged 70 years and older and the mean age was 74. In PROSPECT study, which used virtual-histology IVUS for identification of a necrotic core, increased thick cap fibro-atheroma was shown in patients above 65 years, whereas thin cap fibro-atheroma (TCFA) was more frequent in patients below 65 years. Roth et al have reported significant lipid plaques mainly in younger (<58 years) and mid-aged patients (58–65 years). Elderly patients predominantly had smaller lipid plaques, not fulfilling the criteria for TCFA, embedded in large mixed plaques with fibrosis and frequent calcific components. Changes in atherosclerotic plaques with aging may cause the results in the group over 85 years. In this context, IVUS might be a useful diagnostic tool to determine the group of statins that could be effective in elderly patients.

The relation between vitamin B12 and SYNTAX score

BACKGROUND Vitamin B12 is required in the metabolism of homocysteine. Vitamin B12 deficiency has been implicated in endothelial dysfunction and cardiovascular disease via hyperhomocysteinaemia. However, the association of vitamin B12 and the severity of coronary artery disease has not been studied to date. AIM This study was conducted with the aim of evaluating the relationship between vitamin B12 and SYNTAX score. METHODS Medical records of consecutive patients who underwent coronary artery bypass grafting surgery were retrospectively reviewed. The study group consisted of 127 patients. Vitamin B12, other biochemical parameters, clinical and echocardiographic parameters, and SYNTAX score were evaluated for all patients. RESULTS Patients with vitamin B12 deficiency had a higher prevalence of cardiovascular risk factors such as diabetes mellitus, and history of transient ischaemic attack/stroke and heart failure. The SYNTAX score was significantly higher in patients with vitamin B12 deficiency (29.2 ± 4.9 vs. 22.5 ± 4.5, p < 0.05). CONCLUSIONS In our study, we found a significant relationship between vitamin B12 deficiency and SYNTAX score, demon-strating the severity and complexity of coronary artery disease.

Endothelial overactivity maybe a contributing factor in athletes with vasovagal syncope

Article history: Received 5 November 2016 Accepted 14 November 2016 Available online xxxx FMD [4]. Santini et al. [4] showed that vascular hyperreactivity in response to nitrate administration is particularly overt in vasodepressive syncope. In light of these studies, endothelial overactivity leading to paradoxical vasodilation of peripheral arteries maybe underlying mechanism of syncope in athletes. Thus investigating the endothelial function in athletes with VVS would be useful.

Galectin-3 and atrial fibrillation

Article history: Received 15 November 2016 Accepted 2 December 2016 Available online xxxx ed with bodymass index (BMI). Kornej et al. [5] demonstrated a significant association between higher BMI and baseline galectin-3 levels in both the entire and the AF cohort. Therefore, reporting BMI values would be useful. Lastly, type (permanent, persistent) and duration of AFmay have an impact on galectin-3 levels. Thus, it has been proved that patients with

Association of pre-ablation level of vitamin D with atrial fibrillation recurrence after catheter ablation

I have read the article entitled ‘Association of pre-ablation level of potential blood markers with atrial fibrillation recurrence after catheter ablation: a meta-analysis’ by Jiang et al. 1 with great interest, recently published in Europace . The investigators reported that pre-ablation blood markers may be related with post-ablation atrial fibrillation (AF) recurrence and demonstrated that increase …

Letter by Cerit et al Regarding Article, “Thyroid Function and Sudden Cardiac Death: A Prospective Population-Based Cohort Study”

We have read the article by Chaker et al1 with great interest. The investigators reported that although participants with subclinical or overt hypo- or hyperthyroidism did not have a higher risk of sudden cardiac death (SCD) than euthyroid participants, higher free thyroxine (FT4) levels were associated with an increased risk of SCD, even in euthyroid participants.1 Thyroid hormone has a stimulatory effect on β-adrenergic signaling, leading to positive chronotropic, dromotropic, …