Serkan Topaloglu

Association of Platelet to Lymphocyte Ratio With Inflammation and Severity of Coronary Atherosclerosis in Patients With Stable Coronary Artery Disease

The platelet to lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker. Hence, we assessed the relationship between PLR and the extent/severity of coronary artery disease (CAD) using the Gensini score in association with the inflammatory marker C-reactive protein (CRP) in patients with stable CAD. Angiographic data of 1646 patients were analyzed in this cross-sectional study. Patients were categorized according to Gensini scores as no CAD (control), mild, and severe CAD groups. The PLR in the control group was significantly lower than those of mild and severe CAD groups. In multivariate logistic regression analysis, PLR was found to be an independent predictor of the presence of severe CAD (odds ratio: 1.043 [1.036-1.049], P < .001). Furthermore, there was a significant correlation between PLR and the severity of CAD (r = .370, P < .001) and CRP levels (r = .312, P < .001). In conclusion, PLR was independently and positively associated with the severity of coronary atherosclerosis. These results suggest that PLR is an easily available and cheap inflammatory indicator that can be used in predicting the severity of CAD.

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.

Usefulness of Neutrophil-to-Lymphocyte Ratio to Predict In-hospital Outcomes in Infective Endocarditis

BACKGROUND The neutrophil-to-lymphocyte ratio is an independent predictor of worse prognosis in both infectious and cardiovascular disease. We hypothesized that an increased neutrophil-to-lymphocyte ratio at admission would predict in-hospital unfavourable outcomes in patients with infective endocarditis (IE). METHODS We retrospectively analyzed clinical, laboratory, and echocardiographic data in a total of 121 consecutive adult patients (64 men; mean age, 54.7 ± 14.2 years) with definite IE. RESULTS Among all patients, the prespecified clinical outcomes were experienced in 46 patients (38%). In-hospital mortality and central nervous system (CNS) events occurred in 29 (24%) and 21 patients (17%), respectively. The neutrophil-to-lymphocyte ratio at admission was found to be significantly higher for either composite end point. On using multiple Cox regression analysis, vegetation size ≥ 10 mm, end-stage renal disease, Staphylococcus aureus infection, low hemoglobin level, increased C-reactive protein (CRP) level, and high neutrophil-to-lymphocyte ratio at admission emerged as independent predictors of in-hospital unfavourable outcomes. In the receiver operating characteristics (ROC) curve analysis, a neutrophil-to-lymphocyte ratio > 7.1 had 80% sensitivity and 83% specificity in predicting adverse outcomes. CONCLUSION High neutrophil-to-lymphocyte ratio at admission is an independent predictor of in-hospital mortality and CNS events in patients with IE. However, prospective validation of these findings is required.

Outcome of Significant Functional Tricuspid Regurgitation Late After Mitral Valve Replacement for Predominant Rheumatic Mitral Stenosis

Significant tricuspid regurgitation (TR) can contribute to increased morbidity and mortality in patients undergoing mitral valve surgery for mitral stenosis. The aim of this study was to evaluate the association between the severity of preoperative functional TR and late adverse outcomes in patients undergoing mitral valve replacement (MVR). The study group comprised 68 patients (54 women, 14 men; mean age 45 ±10 years) with rheumatic mitral stenosis (MS) who had undergone MVR without tricuspid valve surgery between 4 and 13 years (mean 8.1 ±2.6 years) before their last clinical examination. All patients underwent a complete preoperative and late postoperative color-Doppler echocardiographic examination. The severity of TR was assessed echocardiographically by using color-Doppler flow images and flow direction in the inferior vena cava or hepatic veins. Patients were classified into 2 groups; 42 with mild (62%) and 26 with significant (38%) TR. Patients with significant TR showed longer preoperative symptomatic period and more atrial fibrillation than those with mild TR. All patients had medical treatment. Functional capacity and NYHA class of the patients in both groups improved significantly after MVR. Freedom from symptomatic heart failure (functional class III or IV) was higher (86% vs 54%) and the need for hospitalization was significantly lower for the mild TR group. Significant preoperative functional TR diagnosed by echocardiography was associated with an adverse outcome. Therefore, further studies are needed to evaluate the effect of concomitant tricuspid valve repair on the late outcome of patients undergoing mitral valve surgery in order to prevent significant late morbidity.

Porcelain heart: a case of massive myocardial calcification

Reports of massive myocardial calcification are limited mainly to case reports and this type intracardiac calcifications have been usually identified postmortem. We present a very interesting case of massive calcification of the left ventricular myocardium, interventricular and interatrial septae causing restrictive physiology and coronary artery obstruction in a 46-year-old Turkish woman. The diagnosis of myocardial calcification was suspected from chest X-ray and confirmed with computerized tomography and cardiac catheterization. The findings of the chest computed tomography were very similar to those previously reported cases of endomyocardial fibrosis (EMF) with massive calcification of the left ventricle.

Increased dispersion of refractoriness in patients with atrial fibrillation in the early postoperative period after coronary artery bypass grafting.

Preoperative EP Characteristics of Post‐CABG AF. Introduction: Increased atrial effective refractory period (AERP) dispersion is well correlated with vulnerability to atrial fibrillation (AF). However, the preoperative electrophysiologic characteristics of atrial abnormalities that may play an important role in the development of AF postoperatively in patients with coronary artery bypass grafting (CABG) have not been investigated in detail.

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.

Increased epicardial fat thickness is associated with low grade systemic inflammation in metabolic syndrome

OBJECTIVES Epicardial fat tissue is a type of visceral adipose tissue that functions as a metabolically active endocrine organ. Most components of metabolic syndrome (MetS), especially visceral obesity, are associated with a low-grade systemic inflammatory state. In this study, we aimed to assess the relationship between echocardiographic epicardial fat thickness (EFT), MetS, the components of MetS, and high sensitivity C-reactive protein (hs-CRP) levels in patients with MetS. STUDY DESIGN Forty-six patients (25 males, mean age 47.3±6.5 years) with the diagnosis of MetS (according to the Adult Treatment Panel III update criteria) but without clinical coronary artery disease, and 44 age and gender matched healthy volunteers (18 males, mean age 46.0±6.1 years) were included in the study. EFT, which was measured by transthoracic echocardiography, as well as clinical and biochemical parameters were compared between the two groups. RESULTS Waist circumference, total and LDL-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressure levels, hs-CRP, and uric acid levels were significantly higher in patients with MetS. EFT was also significantly increased in patients with MetS (8.7±0.2 mm vs. 4.8±0.1 mm, p<0.001). Multiple regression analysis determined that MetS itself (ß=0.929, p<0.001) and hs-CRP (r=-0.181, p=0.007) are independent predictors of increased EFT. CONCLUSION This study demonstrates that EFT is higher in patients with MetS, and that MetS and hsCRP are independent predictors of this increased EFT. Increased EFT, which is associated with low-grade systemic inflammation, may play a role in the pathogenesis of atherosclerosis in MetS patients.

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.

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.