Serkan Cay

The role of preprocedural monocyte-to-high-density lipoprotein ratio in prediction of atrial fibrillation recurrence after cryoballoon-based catheter ablation

AIMS Previous studies evidenced that increased monocyte count or activity and lower high-density lipoprotein (HDL) cholesterol levels were associated with more prevalent atrial fibrillation (AF) which attributed to pro-inflammatory and pro-oxidant effects. Monocyte-to-HDL ratio (M/H ratio) is a recently emerged indicator of inflammation and oxidative stress which have been only studied in patients with chronic kidney disease. We aimed to investigate the prognostic impact of M/H ratio on AF recurrence after cryoballoon-based catheter ablation. METHODS AND RESULTS A total of 402 patients (43.5% female, age 53.5 ± 10.9 years, and 80.8% paroxysmal AF) with symptomatic AF underwent initial cryoablation procedure. Patients were categorized into quartiles on the basis of their pre-procedural M/H ratio. Post-ablation blanking period was observed for 3 months. At a mean follow-up of 20.6 ± 6.0 months, 95 patients (23.6%) had developed AF recurrence. Atrial fibrillation recurrence rates from the lowest to the highest M/H ratio quartiles were 7.4, 7.4, 16.8, and 68.4%, respectively (P < 0.001). On multivariate Cox regression analysis, the preablation M/H ratio (HR: 1.20, 95% CI: 1.15-1.25, P < 0.001), left atrial diameter, duration of AF history, and early AF recurrence were independent predictors of AF recurrence. Using a cut-off level of 11.48, the pre-ablation M/H ratio predicted AF recurrence during follow-up with a sensitivity of 85% and a specificity of 74%. CONCLUSION Elevated pre-ablation M/H ratio was associated with an increased recurrence of AF after cryoballoon-based catheter ablation. Our results support the role of pre-ablation pro-inflammatory and pro-oxidant environment in AF recurrence after ablation therapy but suggest that other factors are also important.

Metabolic syndrome is associated with extension of coronary artery disease in patients with non-ST segment elevation acute coronary syndromes.

BackgroundMetabolic syndrome (MS) comprises a group of factors that are associated with increased risk for cardiovascular events. Acute coronary syndromes account for the most important part of cardiovascular events with considerable morbidity and mortality. We aimed to investigate the association of MS with extension of coronary artery disease in patients presenting with non-ST segment elevation (NSTE) acute coronary syndromes (ACS). MethodsThree hundred and six consecutive patients (220 men, 86 women patients) with the diagnosis of NSTE ACS, who were hospitalized within the first 24 h of their chest pain in the coronary care unit, were prospectively enrolled into our study. Patients with elevation of troponins (T or I) were classified as NSTE myocardial infarction (MI) and otherwise as unstable angina pectoris (USAP). Components of MS were noted as previously identified. Coronary angiograms were evaluated by two authors, who were blinded to the study plan and each other, via Sullivans method. ResultsMS was noted in 49% of all patients, and was significantly more common in women than in men (62.8 versus 43.6%, P=0.003). The mean total stenosis score of patients with MS was significantly higher than for those without MS (16±6 versus 12±5, P<0.001), and the mean extension score of patients with MS was significantly higher than for those without MS (63±29 versus 44±26, P<0.001). The presence of MS together with some clinical factors and poor total cholesterol/high-density lipoprotein cholesterol ratio, hypertension and diabetes mellitus, was found to be independently predictive of extension of coronary artery disease (CAD) in a group of patients presenting with NSTE ACS. ConclusionsMS is independently associated with CAD extension, and hence, might account for poor cardiovascular outcomes through CAD extension in patients with NSTE ACS.

Aortic Pulse Pressure and Aortic Pulsatility in Patients with Coronary Slow Flow

Objective: Coronary slow flow (CSF) is an angiographic phenomenon characterized by delayed opacification of coronary arteries in the absence of obstructive coronary disease. Recently, increased aortic pulse pressure (PP) and aortic pulsatility were both linked to the presence of angiographic coronary artery disease. In this study aortic PP and aortic pulsatility, derived from the invasively measured ascending aortic pressure waveform, were analyzed in patients with CSF and otherwise normal epicardial coronary arteries and compared with those with completely normal coronary arteries. Methods: Fifty consecutive patients with CSF (35 men, mean age: 51.7 ± 10 years) and fifty age and gender-matched controls (34 men, 51.1 ± 9 years) were included in the study. For determination of coronary flow, the thrombosis in myocardial infarction (TIMI) frame count method was used. Blood pressure waveforms of the ascending aorta were measured during cardiac catheterization with a fluid-filled system. Aortic pulsatility was estimated as the ratio of aortic PP to mean pressure. Results: Study groups were well matched with respect to age, gender and atherosclerotic risk factors. Although systolic, diastolic and mean pressures of the ascending aorta were similar, aortic PP (60.5 ± 19 vs. 51.7 ± 14 mm Hg, p = 0.01) and aortic pulsatility (0.63 ± 0.1 vs. 0.54 ± 0.1, p = 0.006) were significantly higher in patients with CSF compared with the controls. Besides, in all subjects, corrected TIMI frame counts of all three coronary arteries correlated with both ascending aorta PP and aortic pulsatility values. No association was found between corrected TIMI frame counts of coronary arteries and aortic mean blood pressure or brachial blood pressure parameters. Conclusion: Our findings suggest that CSF is, as with obstructive coronary artery disease, associated with more diffuse vascular disease rather than being an isolated finding.

P-Wave dispersion increases in prehypertension

Background. Prolongation of P‐wave durations and increased P‐wave dispersion are independent predictors of atrial fibrillation (AF). AF is the most common arrhythmia of the general population. Prehypertension, including those with systolic blood pressure ranging from 120–139 mmHg or diastolic blood pressure ranging from 80–89 mmHg was described by JNC7. Prehypertension is the predictor of development of hypertension in the future. Prehypertension is associated with excess cardiovascular morbidity and mortality. In this study, we evaluated relationship between prehypertension and P‐wave dispersion. Methods. Seventy‐eight prehypertensive patients (group 1: mean age 44.6±11.2 years; 45 male) and 78 normotensive patients (group 2: mean age 43.3±7.0 years; 43 male) were enrolled in this study. Standard 12‐lead ECGs were recorded in all patients using a paper speed of 50 mm/s. In all patients, transthoracic echocardiographic examination was performed. Results. Pmax and P‐wave dispersion were significantly higher in group 1 compared with group 2 (103.59±19.8 ms vs 93.59±13.4 ms, p<0.001; 50.51±18.6 ms vs 39.85±10.6 ms, p<0.001, respectively). Conclusion. Pmax and P‐wave dispersion increase in prehypertensive patients compared with normotensive patients. This data might show increased risk of AF in prehypertension.

Serum albumin levels on admission are associated with angiographic no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.

Low serum albumin (SA) levels are associated with increased cardiovascular mortality. We investigated whether baseline SA levels are associated with no-reflow following primary percutaneous coronary intervention (pPCI). A total of 536 patients (aged 60 ± 13 years; 74% men) who underwent pPCI were enrolled. The patients were divided into 2 groups: no-reflow and normal-reflow. No-reflow was defined as thrombolysis in myocardial infarction ≤2 flow. Admission SA levels were significantly lower in the no-reflow group than in the normal-reflow group (3.55 ± 0.44 vs 4.01 ± 0.32 mg/dL, P < .001). Also, high-sensitivity C-reactive protein (hsCRP), creatinine, creatine kinase myocardial band isoenzyme, and troponin T were significantly higher while hemoglobin and left ventricular ejection fraction (LVEF) were significantly lower in the no-reflow group. In multivariate analysis, SA level remained an independent predictor of angiographic no-reflow (odds ratio 0.114, 95% confidence interval 0.032-0.405, P = .001) together with LVEF, hsCRP, and baseline culprit artery patency. Admission SA level was an independent predictor of no-reflow after pPCI.

Tissue Doppler atrial conduction times and electrocardiogram interlead P-wave durations with varying severity of obstructive sleep apnea

OBJECTIVES Obstructive sleep apnea (OSA) has been reported to be associated with an increased risk of atrial fibrillation. The aim of this study was to investigate atrial electromechanical couplings in patients with OSA and the relationship between these parameters and P-wave dispersion (Pd). METHODS One hundred twenty-six patients were enrolled in this study. All patients underwent polysomnographic examination. The apnea-hypopnea index (AHI) was defined as the number of apneas and hypopneas per hour of sleep. An AHI score of 5 or more was diagnosed as OSA, and an AHI score of less than 5 was diagnosed as OSA (-). Thirty-nine of the patients had an AHI score of less than 5 (group 1), 42 of the patients had AHI score between 5 and 30 (mild and moderate, group 2), 45 of the patients had an AHI score more than 30 (severe, group 3). Atrial electromechanical coupling (PA), intra-atrial, and interatrial electromechanical delay were measured with tissue Doppler imaging. P-wave dispersion was calculated from 12-lead electrocardiogram. RESULTS Maximum P-wave duration was higher in group 3 compared with groups 2 and 1 (126.0 ± 16.7 vs 111.0 ± 12.5 [P < .001] and 126.0 ± 16.7 vs 99.9 ± 10.0 [P < .001], respectively). Maximum P-wave duration was higher in group 2 than in group 1 (111.0 ± 12.5 vs 99.9 ± 10.0, P < .001). P-wave dispersion was higher in group 3 compared with groups 2 and 1 (50.9 ± 11.5 vs 37.0 ± 8.6 [P < .001] and 50.9 ± 11.5 vs 27.9 ± 6.8 [P < .001], respectively). P-wave dispersion was higher in group 2 than in group 1 (37.0 ± 8.6 vs 27.9 ± 6.8, P < .001). Minimum P-wave duration did not differ between the groups. Atrial PA at the left lateral mitral annulus (lateral PA), septal mitral annulus (septal PA), and right ventricular tricuspid annulus (RV PA) were significantly higher in group 3 than in group 2 (P < .001, P = .001, and P = .009, respectively). Lateral PA, septal PA, and RV PA were higher in group 2 compared with group 1 (P < .001, P = .003, and P = .009, respectively). Interatrial electromechanical delay (lateral PA - RV PA) was significantly longer in group 3 compared with groups 2 and 1 (33.6 ± 12.1 vs 22.4 ± 9.4 [P < .001] and 33.6 ± 12.1 vs 14.9 ± 9.2 [P < .001], respectively). Interatrial electromechanical delay was longer in group 2 than in group 1 (22.4 ± 9.4 vs 14.9 ± 9.2, P = .001). There was a positive correlation between AHI and Pd, lateral PA, septal PA, RV PA, interatrial electromechanical delay, and left-sided intra-atrial electromechanical delay. CONCLUSION Prolongation of electromechanical delay and increased Pd are associated with apnea-hypopnea index (AHI) and hence the severity of disease.

Evaluation of left ventricular diastolic functions in patients with frequent premature ventricular contractions from right ventricular outflow tract.

This study was sought to examine the effects of repetitive monomorphic premature ventricular contractions (PVCs) on left ventricular (LV) diastolic function. Thirty-three symptomatic patients (Study group, 10 males, mean age 40 ± 8 years) with normal LV systolic function and repetitive PVCs originating from the right ventricular outflow tract (RVOT-PVCs) on 24-h Holter monitoring, and 30 healthy controls (Control group, 9 males, mean age 37 ± 9 years) were enrolled in the study. None of the patients had structural heart disease. Diastolic function was assessed by echocardiographic mitral inflow pattern and tissue Doppler imaging. The study group displayed a lower E/A ratio, longer isovolumetric relaxation time (IVRT), and longer E-wave deceleration time (EDT). In the study group 13 patients showed impaired relaxation. While mean values of the systolic velocity (Sa), early diastolic velocity (Ea), and early/late diastolic velocity (Ea/Aa) ratio were significantly lower in the study group, the Aa velocity and E/Ea ratio were significantly higher. Ea velocity was <10 cm/s in 7 study patients. Mitral inflow pattern and Ea velocity was normal in all controls. Significant correlations were found between ventricular premature beats percentage and early to late transmitral flow velocity ratio, EDT, IVRT, Ea velocity, the Ea/Aa ratio, and the E/Ea ratio. In multivariate analysis, total PVC count and age were found to be independent predictors of impaired relaxation. These results suggest that repetitive monomorphic RVOT-PVCs lead to abnormalities of LV diastolic function that may contribute to clinical symptoms in patients with structurally normal hearts.

Prognostic Significance of Neutrophil Gelatinase–Associated Lipocalin in ST-Segment Elevation Myocardial Infarction

Objectives This study investigated the prognostic value of neutrophil gelatinase–associated lipocalin (NGAL) in patients with ST-segment elevation myocardial infarction (STEMI). Background Neutrophil gelatinase–associated lipocalin is a promising biomarker for acute kidney injury. Recently, it was concluded that NGAL may be used beyond the boundaries of renal physiopathology. It was found to be an important factor indirectly contributing to the inflammatory processes. Little is known regarding its predictive role in STEMI. Methods One hundred six consecutive patients who underwent percutaneous coronary intervention (PCI) for STEMI and control group consisted of age- and sex-matched 60 consecutive patients with chest pain admitted to the hospital for elective PCI. According to median NGAL level, patients were classified into high- and low-NGAL groups. Results Neutrophil gelatinase–associated lipocalin levels were higher in patients with STEMI compared to the elective PCI group subjects. Inhospital and 1-year mortality rates were found to be significantly greater in patients with high NGAL. In addition, inhospital and 1-year major adverse cardiovascular event rates were significantly greater in the high-NGAL group, compared to the low NGAL group. High NGAL level on admission was a significant predictor for long-term mortality and major adverse cardiovascular events. The receiver operating characteristics curve analysis further illustrated that NGAL level on admission is a strong indicator of mortality, with an area under the curve of 0.76 (95% confidence interval, 0.62–0.89). Conclusions High NGAL levels may be associated with poor prognosis after PCI in patients with STEMI. However, further studies with larger numbers of patients and longer follow-up are required to evaluate the usefulness of plasma NGAL level for predicting prognosis of STEMI.

Is Elevated Neutrophil-to-Lymphocyte Ratio a Predictor of Stroke in Patients with Intermediate Carotid Artery Stenosis?

OBJECTIVE An increased neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical prognosis in patients with cardiovascular disease. In this study, we aimed to investigate if there was a correlation between NLR and the risk of stroke in patients with intermediate carotid artery stenosis. METHODS A total of 254 patients with a 50%-70% stenosis in the carotid artery, 115 of whom were symptomatic and 139 of whom were asymptomatic, were included in the study. Patients with a history of ischemic cerebrovascular event with or without sequelae, transient ischemic attack, and amaurosis fugax in the last 1-6 months were included in the symptomatic group of the study. The symptomatic and asymptomatic groups were compared in terms of total neutrophil count, lymphocyte count, and NLR. RESULTS The total white blood cell count (WBC), neutrophil count, and NLR were found to be higher and the lymphocyte count was found to be lower in the symptomatic patients than those in the asymptomatic patients (symptomatic/asymptomatic, respectively, WBC [10(3)/mm(3)]: 9.0/8.2, neutrophil count [10(3)/mm(3)]: 6.1/5.0, NLR: 3.08/2.2, lymphocyte count [10(3)/mm(3)]: 1.9/2.2) (P < .001). The cutoff value for NLR was found to be 2.6 or higher. In the multivariate regression analysis, an NLR value of 2.6 or higher was shown to be an independent variable for carotid artery stenosis to become symptomatic. CONCLUSIONS NLR is increased in symptomatic intermediate carotid artery stenosis. An increased NLR value is an independent variable for carotid artery plaques to become symptomatic.

Late drug eluting stent thrombosis due to acemetacine: Type III Kounis syndrome: Kounis syndrome due to Acemetacine

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