Mithat Selvi

Association between hematologic parameters and in-hospital mortality in patients with infective endocarditis

Early and accurate risk prediction is an important clinical demand in patients with infective endocarditis (IE). The platelet‐to‐lymphocyte ratio (PLR) is an independent predictor of worse prognosis in various cardiovascular diseases. The aim of this study was to determine the value of PLR in the prediction of in‐hospital mortality among IE patients. We retrospectively analyzed the clinical, laboratory, and echocardiographic data of 59 adult patients with definite IE and in 40 adult controls. In‐hospital mortality occurred in 16 (27%) patients. Vegetation size, levels of high‐sensitive C‐reactive protein and procalcitonin, neutrophil‐to‐lymphocyte ratio, and PLR were significantly higher in the in‐hospital‐mortality‐positive group than in the in‐hospital‐mortality‐negative group (p = 0.004, p = 0.009, p = 0.030, p = 0.001, and p = 0.008, respectively). Lymphocyte count was, however, significantly lower in the in‐hospital‐mortality‐positive group (p = 0.004). In the receiver‐operating characteristic analysis, PLRs over 191.01 predicted in‐hospital mortality with 56.3% sensitivity and 81.4% specificity [area under the curve 0.725, 95% confidence interval (CI) 0.594–0.833; p = 0.0027]. In the multivariate analysis, PLR was found to be an independent predictor of in‐hospital mortality in patients with IE (odds ratio 1.022, 95% CI 1.003–1.042; p = 0.021). In conclusion, higher PLR may predict in‐hospital mortality in patients with IE.

Association of Preoperative Platelet-to-Lymphocyte Ratio with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery.

Objective: The aim of this study was to investigate the association between platelet-to-lymphocyte ratio (PLR) and atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery. Subjects and Methods: A total of 125 patients were retrospectively analyzed. AF was diagnosed using standard clinical criteria, and PLR was calculated as the ratio of the platelets to lymphocytes, obtained from the blood samples that were taken in the fasting state before CABG surgery. The association of different variables with postoperative AF and PLR was calculated using univariate and multivariate analysis. The receiver operating characteristics curve was used to determine the sensitivity and specificity of PLR and the optimal cutoff value for predicting post-CABG AF. Results: Of the 125 patients, 50 with AF (mean age: 67.0 ± 9.5 years, 38 males and 12 females) and 75 patients without AF (mean age: 61.1 ± 9.1 years, 58 males and 17 females) were identified, and the difference in the mean age was statistically significant (p = 0.01). PLR was also significantly higher in those with AF (152.8 ± 82.2) than those without AF (118.2 ± 32.9) (p = 0.012). Univariate analysis showed that age and PLR were associated with AF after CABG surgery (p < 0.001 and p = 0.005, respectively). Using a multivariate logistic regression model with the backward elimination method, age and PLR remained as independent predictors of AF after CABG surgery (p < 0.001 and p = 0.005, respectively). PLR levels >119.3 predicted postoperative AF with 64% sensitivity and 56% specificity (AUC: 0.634, p = 0.012). Conclusion: In this study, age and PLR level were independent predictors of AF after CABG surgery. Patients with an elevated preoperative PLR were at higher risk of AF after CABG surgery.

Preoperative poor coronary collateral circulation can predict the development of atrial fibrillation after coronary artery bypass graft surgery.

AimCoronary collateral circulation (CCC) helps to protect and preserve myocardium from episodes of ischemia, and reduce angina symptoms, arrhythmia, and cardiovascular events. Atrial fibrillation (AF) is the most frequent form of arrhythmia after coronary artery bypass graft (CABG) surgery. The aim of this study was to investigate the association between CCC and the development of AF in patients undergoing CABG surgery. MethodsA total of 165 patients (mean age 63±10 years, 74% men, 26% women) who were undergoing CABG surgery at our department were enrolled into this study. Patients were categorized into two groups according to preoperative CCC using the Rentrop method. ResultsOf the patients, 79 had poor CCC and 89 had good CCC. The AF incidence rate in the poor collateral group was significantly higher than that in the good collateral group [37 (49%) vs. 12 (14%), P<0.001]. In univariate analysis, age, left atrium size, and poor CCC grade were associated with AF after CABG surgery. Multivariate analysis showed that only poor CCC grade (odds ratio: 11.500; 95% confidence interval 3.977–33.253, P<0.001) was an independent predictor of the development of AF after adjustment of other potential confounders in patients undergoing CABG surgery. ConclusionThe present study showed that preoperative poor CCC is a powerful predictor of the development of AF after CABG surgery.

Circumflex-to-bronchial artery fistula with saccular aneurysm

We report a case of fistulous communication with two saccular aneurysms (9 mm and 7 mm) between the sinoatrial branch of the circumflex artery and the bronchial arteries.

Huge saphenous vein graft aneurysm presenting as non-ST elevation myocardial infarction and compressing the heart.

Coronary artery bypass grafting (CABG) surgery maintains an important role in the treatment of coronary artery disease. The huge saphenous vein graft aneurysm (HSVGA) is rare and occurs as a late complication after CABG. Here, we reported a case of HSVGA presenting as non-ST elevation myocardial infarction.

A new predictor of atrial fibrillation after coronary artery bypass graft surgery: HATCH score

The aim of this study was to investigate the association between HATCH score and atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery. 369 patients (103 patients with AF and 266 patients without AF) undergoing isolated CABG surgery were analyzed. Complete medical records were retrospectively collected to investigate HATCH score. The median age of patients with AF was significantly higher than the median age of non-AF group (60.8±10.0 years vs 67.8±9.5 years, P<0.001). HATCH score was significantly higher in patients who developed AF after CABG surgery than the non-AF group (P=0.017). Multivariate logistic regression analysis showed that HATCH score (OR 1.334; 95% CI 1.022 to 1.741, P=0.034) was an independent predictor of AF after CABG surgery. Receiver operating characteristic curve analysis showed that the cut-off point of HATCH score related to predict AF was >1 (two or more), with a sensitivity of 42% and specificity of 70%. Patients with elevated preoperative HATCH score may have higher risk for AF after CABG surgery.

Removal of the broken part of implantable cardioverter-defibrillator's electrode causing pulmonary embolism via femoral vein

A 66-year-old patient with idiopathic dilated cardiomyopathy underwent transvenous extraction of an implantable cardioverter-defibrillator. The distal part of the electrode was broken during manual traction through the left subclavian vein. In the present case, we showed a rare complication of transvenous lead extraction and its management.