Mehmet Serkan Cetin

Platelet to Lymphocyte Ratio as a Prognostic Marker of In-Hospital and Long-Term Major Adverse Cardiovascular Events in ST-Segment Elevation Myocardial Infarction.

We assessed the prognostic value of the platelet to lymphocyte ratio (PLR) on in-hospital and long-term major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in a large prospective study. Patients (n = 1938) admitted with acute STEMI within 12 hours of symptom onset and who underwent pPCI between January 2010 and January 2015 were followed up for 31.6 ± 16.2 months. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, nonfatal myocardial infarction, and mortality were higher in the third PLR tertile group. A PLR in the third tertile had 2.4-fold increased risk of in-hospital MACE and 2.8-fold risk of long-term MACE. The PLR was significantly and positively correlated with peak creatine kinase MB (CK-MB) levels (r = 0.562, P < .001) and Gensini score (r = 0.408, P < .001). Kaplan-Meier analysis of long-term MACE-free survival revealed a higher occurrence of MACE in the third PLR tertile group compared to the other tertiles. In conclusion, the PLR may be a marker of inflammatory and prothrombotic status and predicted in-hospital and long-term MACE in a population with STEMI.

Monocyte to HDL Cholesterol Ratio Predicts Coronary Artery Disease Severity and Future Major Cardiovascular Adverse Events in Acute Coronary Syndrome

BACKGROUND We aimed to investigate the usefulness of monocyte to HDL cholesterol ratio (MHR) in predicting coronary artery disease severity and future major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS). METHODS 2661 patient with ACS were enrolled and followed up during median 31.6 months. RESULTS MHR were significantly positively correlated with neutrophil to lymphocyte ratio (r=0.438), CRP (r=0.394), Gensini (r=0.407), and SYNTAX score (r=0.333). During in-hospital and long-term follow-up, MACE, stent thrombosis, non-fatal MI, and mortality occurred more frequently in the third tertile group. Kaplan-Meier analysis revealed the higher occurrence of MACE in the third tertile group compared with other tertiles. Adjusting for other factors, a MHR value in the third tertile group was determined as an independent predictor of in-hospital and long-term MACE. CONCLUSIONS MHR as a novel inflammation-based marker seemed to be an independent predictor of severity of coronary artery disease and future cardiovascular events in patients with ACS. MHR may utilise the identification of patients who are at higher risk for MACE and individualisation of targeted therapy.

An overlooked parameter in coronary slow flow phenomenon: whole blood viscosity

AIMS We aimed to assess the relationship between coronary slow flow phenomenon (CSFP) and whole blood viscosity (WBV). MATERIALS & METHODS Two hundred patients with CSFP and 200 subjects with normal coronary arteries as control group were enrolled. WBV was calculated from hematocrit and plasma protein concentration at low shear rate (LSR) (0.5 s(-1)) and high shear rate (HSR) (208 s(-1)) by a validated equation. RESULTS CSFP patients had significantly higher WBV for LSR and HSR. The mean corrected TIMI frame count was highest in the highest tertile group for both shear rates. Corrected TIMI frame count revealed a significant relationship with WBV for LSR (r = 0.562) and HSR (r = 0.611). At multivariate analysis, WBV at LSR and HSR were independent predictors of CSFP. CONCLUSION WBV seemed to have a significant and an independent predictor of CSFP.

The Forgotten Variable of Shear Stress in Mitral Annular Calcification: Whole Blood Viscosity.

Objective: The aim of this research was to assess the relationship between mitral annular calcification (MAC) and whole blood viscosity (WBV). Subjects and Methods: A total of 184 patients with MAC and 133 patients without MAC were enrolled in the study. The WBV was calculated with a confirmed formulation using the hematocrit and total plasma protein at a low shear rate (LSR) and high shear rate (HSR). Early diastolic mitral annular velocity (Ea) and late diastolic mitral annular velocity (Aa) were measured using pulse Doppler tissue echocardiography. Pearsons correlation analysis was performed to assess the relationship between WBV and mitral annular motion velocities. The effects of different variables on the occurrence of MAC were assessed in univariate and multivariate logistic regression analysis. Results: In patients with MAC, WBV values were significantly higher at HSR (18.04 ± 0.84 vs. 17.25 ± 0.96 208 s-1, p < 0.001) and at LSR (78.0 ± 14.2 vs. 61.9 ± 17.1 0.5 s-1, p < 0.001). The WBV at HSR and LSR were significantly correlated with Ea (r = -0.477, p < 0.001; r = -0.385, p < 0.001, respectively) and Aa (r = -0.544, p < 0.001; r = -0.323, p < 0.001, respectively). Multivariate analysis showed that WBV of both shear rates was an independent predictor of MAC. Using the ROC curve, a cut-off value of 70.1 for WBV at LSR had a sensitivity of 83.7% and a specificity of 73.7% (AUC 0.785, p < 0.001) and a WBV cut-off value of 17.5 at HSR had a sensitivity of 79.6% and a specificity of 71.4% (AUC 0.761, p < 0.001) for the prediction of MAC. Conclusion: Patients with MAC had significantly higher WBV, which independently predicted the presence of MAC. WBV had an inverse correlation with mitral annular motion velocities, indicating that a higher WBV may lead to greater limitation in annular motion and, thus, more calcification.

Effectiveness of computed tomography attenuation values in characterization of pericardial effusion

Objective: The aim of this study was to evaluate the effectiveness of computed tomography (CT) attenuation values in the characterization of pericardial effusion. Methods: This study consisted of 96 patients with pericardial effusion who underwent pericardiocentesis. For further diagnostic evaluation of pericardial effusion, all the patients were assessed by thorax CT. CT attenuation values were measured from at least 5 different areas of pericardial fluid by specifying the largest region of interest. The average of these measurements was computed and considered as the CT attenuation value of the patient. The patients were classified into two groups: patients with transudative pericardial effusion and those with exudative pericardial effusion. Results: CT attenuation values were significantly higher in patients with exudative pericardial effusion than in those with transudative pericardial effusion [14.85±10.7 Hounsfield unit (HU) vs. 1.13±4.3 HU, p<0.001]. CT attenuation values had a close correlation with the pericardial fluid albumin (r=0.829), protein (r=0.752), and LDH (r=0.708) levels; WBC count (r=0.564); protein ratio (r=0.739); and LDH ratio (r=0.689) as well as the albumin gradient (r=–0.725). A cut-off value of 4.7 HU had 80% sensitivity and 87.7% specificity for the identification of exudative pericardial effusion. In addition, a cut-off value of 6.5 HU had 71.4% sensitivity and 72.3% specificity for the prediction of cardiac tamponade. Conclusion: In patients with pericardial effusion, CT attenuation values seem to be correlated with the characterization parameters of the fluid and may distinguish exudative pericardial effusion from transudative pericardial effusion. This parameter was also found to be a predictor of cardiac tamponade. CT attenuation values can be a useful tool in the clinical evaluation of patients with pericardial effusion.

Platelet-to-lymphocyte ratio as a novel marker of in-hospital and long-term adverse outcomes among patients with acute pulmonary embolism: A single center large-scale study

BACKGROUND The interaction of platelets with leukocytes is a well-known process both in progression and prognosis of acute pulmonary embolism (PE). Recently, platelet to lymphocyte ratio (PLR) is emerged as an indirect inflammatory indicator which was shown to be associated with adverse cardiovascular events in various clinical conditions, including acute PE. However, the long-term prognostic value of PLR in acute PE has not been investigated thoroughly. Therefore, we aimed to assess the impact of PLR on both in-hospital and long-term adverse outcomes in acute PE. METHODS A total of 459 patients with definite diagnosis of acute PE between January 2009 and January 2016 were enrolled. On admission, blood sampling to calculate PLR and detailed clinical data were obtained. Patients were divided into tertiles according to the admission PLR levels. Simplified PE severity index (sPESI) score and computerized tomography (CT) based pulmonary artery obstruction index were calculated for each patient. RESULTS Mean sPESI score of the study population was 1.6. A total of 34 patients (7.4%) died during index hospitalization. At median 28.8months follow-up, all-cause mortality was observed in 81 patients (1.9%). Patients in the highest tertile of PLR revealed a higher rate of in-hospital adverse events including cardiogenic shock, the necessity for thrombolytic therapy and in-hospital mortality as well as long-term all-cause mortality. In multivariate analysis, the PLR was found to be a significant predictor of both in-hospital adverse events (OR: 1.588, 95% CI:1.116-2.154, p=0.004) and long-term all-cause mortality (OR:1.746, 95% CI:1.211-2.865, p=0.001). CONCLUSIONS The PLR, as a simple, inexpensive and available marker of inflammatory and prothrombotic status, seemed to be a novel predictor of in-hospital and long-term adverse outcomes in patients with acute PE.

Association between RDW and stent thrombosis in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Abstract Stent thrombosis is a rare but potentially fatal complication of percutaneous coronary interventions (PCIs). In recent years, the predictive and prognostic value of the red cell distribution width (RDW) as an indicator of inflammation has been shown in many cardiovascular diseases. Aim of this study was to examine the predictive value of RDW for stent thrombosis in patients who underwent successful stent implantation for ST-elevation myocardial infarction (STEMI). In this retrospective study, 146 patients who underwent successful PCI to native coronary artery due to STEMI previously and presented with acute coronary syndrome with stent thrombosis were included (stent thrombosis group). A total of 175 patients who had similar procedural characteristics (type, diameter, and length of stent) and not had stent thrombosis were consisted control group. Patients were divided into tertiles according to the admission RDW values (12.9 ± 0.4, 14.2 ± 0.4, and 16.3 ± 1.5, respectively). Stent thrombosis developed in 47 (40.9%) patients in the lowest tertile, 39 (37.9%) patients in mid tertile, and 60 (58.3%) patients in the highest tertile (P = 0.006). Female gender ratio was statistically significantly higher in the 3rd tertile (13 [11.3%], 8 [7.8%], 24 [23.3%], P = 0.003, respectively). RDW (OR: 1.397 [95% CI 1.177–1.657], P < 0.001) and platelet count (OR: 1.008 [95% CI 1.004–1.012], P < 0.001) remained independent predictors of stent thrombosis after multivariate logistic regression analysis. ROC curve analysis demonstrated that, admission RDW values higher than 13.9 can predict the development of stent thrombosis with a sensitivity of 57% and a specificity of 52% (The area under the ROC curve: 0.59 [95% CI 0.53–0.65] P = 0.007). High RDW values found to be independently associated with the development of stent thrombosis in patients with STEMI.

Platelet distribution width and plateletcrit: novel biomarkers of ST elevation myocardial infarction in young patients

BACKGROUND Platelets play a central role in myocardial infarction, and platelet activity can be evaluated with platelet indices, including platelet distribution width (PDW) and plateletcrit (PCT). These indices have been demonstrated as markers of prothrombotic state in cardiovascular diseases. AIM Therefore, we aimed to investigate, the usefulness of these biomarkers in ST-elevation myocardial infarction (STEMI) in young patients. METHODS This cross-sectional study consisted of 565 subjects who were classified into three groups: group 1 (168 young patients with STEMI), group 2 (173 non-young patients with STEMI), and group 3 (224 age-matched controls with angiographically normal coronary arteries). Male patients aged under 45 years and female patients aged under 55 years were defined as young STEMI. RESULTS In group 1, PDW and PCT (17.2 ± 0.67, 0.249 ± 0.05, respectively) were significantly higher than the other groups (group 2, 16.4 ± 0.56, 0.231 ± 0.04; group 3, 15.1 ± 0.63, 0.227 ± 0.04). PDW and PCT had moderate negative correlation (r = -0.305, r = -0.330, respectively) with age and moderate positive correlation with peak creatine kinase MB (r = 0.259, r = 0.320, respectively). At multivariate analysis, adjusted for other factors, 1 fL increase in PDW levels was 13.5% more likely to be associated with young STEMI, and similarly, a 1% increase in PCT levels was 18.9% more likely associated with young STEMI. CONCLUSIONS Platelet distribution width and plateletcrit levels seem to be independent markers of STEMI in young patients and may reflect prothrombotic state in this specific population.

Prognostic significance of whole blood viscosity estimated by de Simone’s formula in ST-elevation myocardial infarction

BACKGROUND We assessed the predictive value of estimated whole blood viscosity (WBV) in-hospital and long-term cardiovascular outcomes in patients with ST-elevation myocardial infarction (STEMI). MATERIALS & METHODS One thousand eight hundred and thirty-five STEMI patients were followed up for median 34.6 months. WBV was calculated consistent with the de Simones formula. RESULTS In-hospital and long-term major adverse cardiovascular events (MACE) demonstrated an incremental trend in ascending order of WBV tertiles at low and high shear rate. Kaplan-Meier analysis showed a higher occurrence of long-term MACE in third WBV tertiles compared with other tertiles. CONCLUSION WBV seems to be a feasible prognostic indicator of short- and long-term cardiovascular adverse events in patients with STEMI. As an easily available parameter, WBV may be utilized in identifying high-risk patients for subsequent MACE.

Coronary slow flow phenomenon: Not only low in flow rate but also in myocardial energy expenditure

BACKGROUND AND AIM Coronary slow flow phenomenon (CSFP) is a miscellaneous clinical entity leading to angina-like symptoms, and electrocardiographic and scintigraphic evidence of ischemia. The impact of this syndrome on myocardial performance has not been comprehensively evaluated. In this study, we sought to evaluate the myocardial energy expenditure (MEE) in patients with CSFP and its relationship with exercise capacity. METHODS AND RESULTS A total of 64 patients (64.1% male, mean age 53.2 ± 10.3 years) with CSFP and 64 patients (60.9% male, mean age 52.2 ± 10.9 years) with normal coronary artery as control group were included. MEE was calculated by a validated formula that uses transthoracic echocardiography (TTE) parameters, including left ventricular circumferential end-systolic stress, stroke volume, and ejection time CSFP patients had significantly lower MEE (0.79 cal/systole ± 0.15 vs. 0.91 cal/systole ± 0.09, p < 0.001). In correlation analysis, MEE had a significant negative correlation with mean corrected TIMI frame count (mTFC) (β = -0.523; p < 0.001) and positive correlations with metabolic equivalents (METs) (β = 0.560; p < 0.001), rate pressure product (β = 0.649; p < 0.001), and exercise duration (β = 0.408; p < 0.001). At multivariate analysis, MEE was demonstrated as an independent predictor of CSFP (OR 1.863, CI 95% 1.485-2.338 p < 0.001). CONCLUSION Myocardial energy consumption, as a calculation obtained from TTE parameters, was reduced in patients with CSFP, and it had a significant relationship with exercise capacity. Considering its significant correlation with exercise capacity, myocardial energy consumption seemed to use evaluation of myocardial performance and functional status in another cardiovascular disease.