Kamil Gülşen

Neutrophil to Lymphocyte Ratio is Related to Stent Thrombosis and High Mortality in Patients With Acute Myocardial Infarction

We investigated whether the neutrophil to lymphocyte ratio (NLR) can predict stent thrombosis (STh) and high mortality rate in patients with ST-segment elevation myocardial infarction (STEMI). We analyzed data of 102 patients with STh and 450 patients with STEMI admitted to 2 high volume hospitals. Preprocedural NLR was significantly higher in patients with STh (P < .001). There was a significantly higher mortality rate in patients with high NLR during hospitalization (P < .001). Also, in the STh group there was a significantly higher mortality rate in patients with high NLR (P < .001). In receiver–operating characteristic analysis, NLR >4.8 had 56% sensitivity and 68% specificity for predicting STh. The NLR >4.9 had 70% sensitivity and 65% specificity for predicting in-hospital mortality. On multivariate regression analysis, NLR was found to be significantly related to STh. In patients with STEMI, preprocedural high NLR is associated with both STh and higher mortality rates.

Relationship between Vitamin D and the development of atrial fibrillation after on-pump coronary artery bypass graft surgery.

Summary Background: Vitamin D deficiency is associated with many diverse cardiovascular disorders, such as hypertension, heart failure, stroke, coronary artery disease and atrial fibrillation. The relationship between Vitamin D and the development of atrial fibrillation after coronary artery bypass surgery (CABG) has not been studied. Therefore, we assessed the relationship between Vitamin D and the development of postoperative atrial fibrillation (POAF) after CABG. Methods: Medical records of consecutive patients who underwent CABG surgery were retrospectively reviewed for the development of atrial fibrillation in the postoperative period. Vitamin D, other biochemical parameters, and clinical and echocardiographic parameters were evaluated in all patients. The independent variables for the development of postoperative atrial fibrillation were defined and their predictive values were measured. Results: The study group consisted of 128 patients, of whom 41 (32%) developed POAF. Age, diabetes mellitus, chronic obstructive pulmonary disease, history of transient ischaemic attack/stroke, heart failure, left atrial diameter, platelet:largecell ratio, and creatinine, urea, uric acid, calcium and potassium levels were identified as important variables for the development of POAF. However, with logistic regression analysis, chronic obstructive pulmonary disease (OR: 28.737, 95% CI: 0.836–16.118, p < 0.001), heart failure (OR: 15.430, 95% CI: 0.989–7.649, p = 0.006), diabetes mellitus (OR: 11.486, 95% CI: 0.734–11.060, p = 0.001) and left atrial diameter (OR: 1.245, 95% CI: 0.086–6.431, p = 0.011) appeared as independent variables predicting the development of POAF. Conclusion: In our study, although there was a significant negative correlation between Vitamin D and left atrial diameter, Vitamin D level was not an independent predictor for POAF.

Does SYNTAX score predict in-hospital outcomes in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention?

BACKGROUND SYNTAX score (SxS) has been demonstrated to predict long-term outcomes in stable patients with coronary artery disease. But its prognostic value for patients with acute coronary syndrome remains unknown. AIM To evaluate whether SxS could predict in-hospital outcomes for patients admitted with ST elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (pPCI). METHODS The study included 538 patients with STEMI who underwent pPCI between January 2010 and December 2012. The patients were divided into two groups: low SxS (< 22) and high SxS (> 22). The SxS of all patients was calculated from aninitial angiogram and TIMI flow grade of infarct related artery was calculated after pPCI. Left ventricular systolic functions of the patients were evaluated with an echocardiogram in the following week. The rates of reinfarction and mortality during hospitalisation were obtained from the medical records of our hospital. RESULTS The high SxS group had more no-reflow (41% and 25.1%, p < 0.001, respectively), lower ejection fraction (38.2 ± 7.5% and 44.6 ± 8.8%, p < 0.001, respectively), and greater rates of re-infarction (9.5% and 7.3%, p = 0.037, respectively) and mortality (0.9% and 0.2%, p = 0.021, respectively) during hospitalisation compared to the low SxS group. On multivariate logistic regression analysis including clinical variables, SxS was an independent predictor of no-reflow (OR 1.081, 95% CI 1.032-1.133, p = 0.001). CONCLUSIONS SxS is a useful tool that can predict in-hospital outcomes of patients with STEMI undergoing pPCI.

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.

Predictors of poor coronary collateral development in patients with stable coronary artery disease: Neutrophil-to-lymphocyte ratio and platelets.

We read with great interest the paper titled “Predictors of poor coronary collateral development in patients with stable coronary artery disease: Neutrophil-to-lymphocyte ratio and platelets” by Akın et al. (1) that was published in the April issue of the Anatol J Cardiol 2015; 15: 218-23. In this original article, the authors revealed that the neutrophil/ lymphocyte (N/L) ratio is independently associated with the presence of coronary collateral circulation (CCS) in patients with stable angina pectoris. Also, they found that an N/L ratio higher than 2.55 could predict a good collateral circulation with 76% sensitivity and 63% specificity using ROC analysis. Data in current scientific literature reveal that CCS is associated with metabolic syndrome and serum cholesterol levels (HDL and especially triglyceride) (2, 3). There are similar findings in the present study (1). In particular, the study found that a lower triglyceride level is significantly related with good CCS and is an independent predictor in multivariate regression analysis. Exercise has a positive effect on the lipid profile, and it does improve metabolic syndrome parameters. Furthermore, Wang et al. (4) showed in their study that diet and exercise improve the N/L ratio. The study also demonstrated that a decrease in the N/L ratio is positively correlated with interleukin-6 levels. As a result, they concluded that diet and exercise have a positive impact on proinflammatory mediators. The positive impact of exercise on CCS development has been well known for some time (5). As the positive effect of exercise on lipid parameters and the N/L ratio is already known, the questions that come to our mind are whether patients who have good CCS exercise more, and could a lower triglyceride level and a lower N/L ratio be related to exercise? However, for us to answer these questions, more information about the functional status and exercise capacity of the study patients is required, and this was not mentioned in the article. Furthermore, body mass index data for these patients are unavailable. In our opinion, the findings from this study could be related to the amount of exercise, and further studies in this area could answer this question.

Coronary vasospasm-induced periodic ventricular fibrillation and successful ablation through coronary stenting

Coronary vasospasm-induced ventricular fibrillation (VF) is a well-documented clinical condition, and there are existing reports in medical publications on this subject [1]. Treatment approaches for these patients can be challenging. In most cases, vasodilator therapy relieves anginal and VF episodes, but sometimes, in the case of recurrence, intracardiac defibrillator (ICD) implantation is performed with concomitant medical therapy [2]. When a patient receives multiple ICD shocks for recurrent VF episodes after vasospastic attacks in spite of the use of vasodilator therapy, it is an undesirable situation for both the patient and the doctor. In this paper, we present a case of a patient suffering from this clinical condition that was successfully treated through coronary stent placement.

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.

Spider-Like Coronary Anatomy; the True Spider!

A 55 year-old man was admitted to the hospital with typical chest pain; the ECG and cardiac biomarkers were normal. He had a history of hypertension and coronary angiography (CAG) a year ago due to unstable angina pectoris and a drugeluting stent was implanted at the left anterior descending (LAD) coronary artery. CAG was performed at admission due to persistent chest pain and a single right coronary ostium was seen at the right coronary sinus, where LAD artery, left circumflex coronary (LCx) artery and right coronary artery (RCA) arose altogether. Non-significant plaques were seen at LAD and LCx, whereas RCA was obstructed from the middle segment and retrograde perfusion was observed (Figure 1A and 1B). The patient was treated conservatively and reported no chest pain 12 months later. The single coronary ostium is classified into 20 categories based on the ostiums location and our patient had characteristics of type IID3 (Figure 1C). Although type IID coronary anomaly has been described before, it has been reported only once and this is the second case of literature showing a single coronary ostium originating from the right coronary ostium.

A huge echolucent structure resembling cyst adjacent to left atrium: Revealing persistent left superior vena cava with 4D echocardiography.

Fig. 1 – Persistent left superior vena cava mimicking defect, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, and cor triatriatum. A 81-year-old male was admitted to syncope and palpitation. He had history of hypertension and paroxysmal atrial fibrillation. Physical examination was normal. Cranial MRI was normal. 2D and 4D transthoracic echocardiography revealed normal findings except moderate mitral regurgitation and a hugely dilated coronary sinus suggestive of a PLSVC in apical 4-chamber view (Fig. 1). Agitated saline contrast study from the left antecubital vein demonstrated prior contrast enhancement of this giant coronary sinus before the right atrium on 2D and 4D transthoracic echocardiography (Fig. 2). We thought his syncope attack due to orthostatic hypotension. The patient was discharged with warfarin, angiotensin-converting enzyme inhibitor, and beta-blocker.

A case of coronary microfistula: A newborn microfistula

Coronary artery fistula is an abnormal connection between a coronary artery and a cardiac chamber, a great artery or the vena cava. Although coronary artery fistulas are known to be congenital malformations they might occur due to infection, trauma or may be iatrogenic. We present a case with acquired coronary microfistula, without any history of interventional procedure.