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Objectives: We investigated the relationship between anemia and cardiac functions by conventional and speckle-tracking echocardiography (STE) in patients with end-stage renal disease (ESRD) receiving hemodialysis. Methods: One hundred and six patients with ESRD receiving hemodialysis were included in this cross-sectional study. The conventional echocardiography and STE findings were compared between the patients with and without anemia. In addition, a comparison of the findings between the ESRD patients and healthy controls consisting of 68 participants was conducted. Results: Compared to healthy controls, ESRD patients had lower left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LVGLS), and left atrial reservoir strain (LASr) [53% (48-57) vs. 65% (62-68), -15.2 (-16.9˗ -13.6) vs. -19.7 (-16.9˗ -13.6), and -21.9 (-29.5˗ -15.3) vs. -29.9 (-35.3˗ -22.8), respectively, P-value <0.001 for all]. Of the ESRD patients, 70 (66%) had anemia. ESRD patients with anemia had higher interventricular septum (IVS), posterior wall (PW), and left atrial volume index (LAVi) values than patients without anemia. In addition, ESRD patients with anemia had lower LVEF, LVGLS, and LASr than patients without anemia [median (IQR), 13 (12-15) vs. 12 (11-14), P=0.004, 13 (12-15) vs. 12 (11-13.5), P<0.005, 43 (35-55) vs. 34.7 (28-50), P=0.013, 52 (48-55) vs. 56 (47.5-60), P=0.016, -14.6 (-16.4˗ -13.5) vs. -16 (-18.6˗ -14.7), P=0.003, and -21.6 (-30.5˗ -16.3) vs. -30.5 (-33.6˗ -23.3), P=0.006, respectively]. In multivariable logistic regression analysis, diabetes, PW, LASr, and LVGLS were independently associated with the presence of anemia in ESRD patients. Conclusion: Our study confirmed impaired cardiac mechanics in ESRD hemodialysis patients and showed that anemia was associated with further worsening cardiac mechanics in this population. [ABSTRACT FROM AUTHOR]

Background: The relationship between acute kidney injury (AKI) and C-reactive protein (CRP) and albumin has been previously demonstrated in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). However, to our knowledge, CRP to albumin ratio (CAR), a newly introduced inflammation-based risk score, has not yet been studied. In this study, we aimed to investigate the possible relationship between the CAR and AKI.Method: A total of 815 consecutive STEMI patients treated with pPCI were reviewed.Results: One hundred ten 110 (13.5%) patients developed AKI in the study population. The subjects were divided into two groups according to AKI development. The in-hospital mortality rate was higher in patients with AKI than those without AKI (15.5% vs. 1.3%; p<0.001). The patients with AKI had significantly higher mean value of CRP and CAR (0.29 [0.16-0.50] vs. 0.55 [0.37-1.05]; p<0.001) and lower mean levels of albumin than those without AKI. Age, diabetes mellitus, haematocrit, left ventricular ejection fraction, hypotension, and CAR (Odds ratio [OR]2.307, 95% confidence interval [CI] 1.397-3.809, p=0.001) were independent predictors of AKI.Conclusion: The CAR may be a useful inflammation-based risk score to predict AKI development in STEMI patients treated with pPCI. [ABSTRACT FROM AUTHOR]

• Considering the worse prognosis of elderly STEMI patients, an identifying the most suitable risk scoring system is crucial. • We observed that the Syntax Score (SS) II was an independent predictor of long-term mortality in octogenarians. • A ROC comparison showed that SSII was a better predictor of long-term mortality than SS, PAMI, TIMI, and GRACE risk scores. • The SSII may be a better predictor of mortality than other risk-scoring systems in octogenarians. The aim of this study was to evaluate the usefulness of the Syntax Score II (SSII) in predicting in-hospital and long-term mortality in octogenarians who presented with ST-segment elevation myocardial infarction (STEMI) and were treated with primary percutaneous coronary intervention (pPCI) in addition to compare SS II with other risk-scoring systems. We retrospectively enrolled 312 consecutive STEMI patients in the eighth decade of life or older who underwent pPCI. The octogenarians were divided into two groups according to their median SSII (low SSII ≤ 43.6 and high SSII > 43.6), and these groups were compared in terms of mortality. The performance of the SSII in predicting patients' outcomes was further compared with that of other well-known risk-scoring systems. In the study, the SSII was an independent predictor of long-term mortality (OR: 1.036 95% CI: 1.005–1.068; p = 0.024). Both in-hospital (20.8% vs. 1.2%; p < 0.001) and long-term mortality (45.0% vs. 11%; p < 0.001) were higher among the patients with a high SSII compared to those with a low SSII. An ROC curve comparison showed that SSII was a better predictor (AUC: 0.807; 95% CI: 0.750-0.863) of long-term mortality than SS, PAMI, TIMI, and GRACE risk scores but not CADILLAC. Based on the study findings, octogenarians with a high SSII had worse in-hospital and long-term survival. The SSII, which includes several clinical and anatomical parameters, may be a better predictor of mortality than other risk-scoring systems in octogenarians. [ABSTRACT FROM AUTHOR]

Left ventricular diastolic dysfunction (LVDD) is commonly seen in hypertensive patients, and it is associated with increased morbidity and mortality. Hence, the detection of LVDD with a simple, inexpensive, and easy-to-obtain method can contribute to improving patient prognosis. Therefore, we aimed to evaluate whether there was any association between the electrocardiographic P wave peak time (PWPT) and invasively measured left ventricular end-diastolic pressure (LVEDP) in hypertensive patients who had undergone coronary angiography following preliminary diagnosis of coronary artery disease. A total of 78 patients were included in this cross-sectional study. The PWPT was defined as the time from the beginning of the P wave to its peak, and it was calculated from the leads DII and VI . In all patients, LVEDP was measured in steady state. The PWPT in lead DII was significantly longer in patients with high LVEDP; however, there was no significant difference between groups in terms of PWPT in the lead VI . In multivariable analysis, PWPT in lead DII was found to be independent predictor of increased LVEDP (OR: 1.257, 95% CI: 1.094-1.445; P = 0.001). In receiver operating characteristic curve analysis, the optimal cut-off value of PWPT in the lead DII for prediction of elevated LVEDP was 64.8 ms, with a sensitivity of 68.7% and a specificity of 91.3% (area under curve: 0.882, 95% CI: 0.789-0.944, P < 0.001). In conclusion, this study result suggested that prolonged PWPT in the lead DII may be an independent predictor of increased LVEDP among hypertensive patients. [ABSTRACT FROM AUTHOR]

Objective: Although the prognostic efficacy of C-reactive protein (mg/L) and albumin levels (g/L) has been previously associated with poor prognosis in ST elevation myocardial infarction (STEMI), to the best of our knowledge, the prognostic efficacy of C-reactive protein/Albumin ratio (CAR) (mg/g) has not been investigated yet. Thus, this study aimed to investigate the potential efficacy of the CAR in predicting prognosis in STEMI patients.Method: We conducted a detailed investigation of 2437 patients with first STEMI treated with a primary percutaneous coronary intervention. After evaluation regarding to exclusion criteria, 2243 patients were found to be eligible for analysis. The mean follow-up of the study was 34 ± 15 months.Results: The median CAR value of the study population was 2.70 (range: 1.44-4.76), and the patients were divided into three tertiles according to their CAR values. Kaplan-Meier survival analysis showed significantly lower in-hospital and long-term survival rates for the patients in a high CAR tertile. In addition, the CAR was found to be an independent predictor of all-cause mortality (Hazards ratio: 1.033, 95% Confidence Interval: 1.007-1.061, p = .033), and the prognostic performance of the CAR was superior to that of C-reactive protein, albumin, and neutrophil to lymphocyte ratio in the receiver operating characteristic curve comparison.Conclusion: The CAR, a newly introduced inflammation-based risk index, was found to be a potentially useful prognostic tool for predicting a poor prognosis in STEMI patients. However, this finding needs to be validated in the future prospective studies. [ABSTRACT FROM AUTHOR]

The association of coronary artery disease (CAD) severity with increased C-reactive protein (CRP) and decreased albumin levels has been reported. However, to our knowledge, no study has investigated the usefulness of the CRP to albumin ratio (CAR) in predicting intermediate–high SYNergy between Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score (SS) and high SS II. Consecutive patients (n = 344) treated with percutaneous coronary intervention comprised the study population. The study population was divided into 2 groups according to SS >22 and mean SS II values, respectively. Patients with intermediate–high SS and high SS II had higher CAR than patients with low SS and SS II. History of diabetes mellitus, decreased albumin, lower left ventricular ejection fraction, and elevated CAR (odds ratio [OR]: 1.020; 95% confidence interval [CI], 1.009-1.031; P < .001) were independent predictors of high SS. The presence of hypertension, decreased hemoglobin and albumin levels, and increased CAR (OR: 1.014; 95% CI, 1.004-1.023; P < .001) were independent predictors of SS II. In receiver operating characteristic curve comparison, CAR was superior to CRP and albumin in prediction of intermediate–high SS, but only CRP in prediction of high SS II. The CAR calculated from the admission blood samples could be a useful parameter for predicting CAD severity using SS and SS II. [ABSTRACT FROM AUTHOR]

Abstract: Background: The ratio of serum C‐reactive protein (CRP) to albumin has been proven to be a more accurate indicator than albumin and CRP levels alone in determining the prognosis of patients with cancer and critical illness. The aim of this study was to determine whether the CRP/albumin ratio (CAR) can be linked to imperfect reperfusion that can worsen the prognosis of ST‐elevation myocardial infarction (STEMI) in patients treated with primary percutaneous coronary intervention (pPCI). Materials and methods: A total of 1217 consecutive STEMI patients who achieved epicardial vessel patency with pPCI were recruited to this study. Results: The study population was divided into 2 groups: reflow (n = 874) and no‐reflow (NR) (n = 343) groups. The white blood cell count (WBC), neutrophil‐to‐lymphocyte ratio (NLR) and CAR (0.03 [0.01‐0.04] vs 0.06 [0.03‐0.12] (P < .001) were significantly higher in the NR group than in the reflow group, and these factors were found to be independent predictors of NR development. The best cut‐off value of CAR predicting NR was 0.59 with a sensitivity of 54.7% and specificity of 86.7. The predictive power of CAR surpassed that of CRP, albumin, WBC count and NLR in the receiver operator curve (ROC) curve comparison. Conclusion: No‐reflow can be predicted by systemic inflammation markers including WBC count, NLR and CAR measured from the blood sample obtained on admission. CAR has a higher clinical value than CRP, albumin level, WBC count and NLR in NR prediction. [ABSTRACT FROM AUTHOR]

Objective: T-peak-T-end (TPE) interval, which represents the dispersion of repolarization, is defined as the interval between the peak and end of the T-wave, and is associated with increased malignant ventricular arrhythmia and sudden cardiac death (SCD) in patients with ST elevation myocardial infarction (STEMI). Although prolonged TPE interval is associated with poor short- and long-term outcomes, even in patients with STEMI treated with successful primary percutaneous coronary intervention (pPCI), clinical, angiographic, and laboratory parameters that affect TPE remain to be elucidated. The aim of our study was to evaluate the potential relationship between prolonged TPE interval and reperfusion success using ST segment resolution (STR) in patients with STEMI undergoing pPCI. Methods: In the current study, 218 consecutive patients with STEMI who underwent pPCI were enrolled, after exclusion, 164 patients were included in the study population. Results: Patients were divided into two groups according to the presence of complete (STR%≥70) or incomplete (STR%<70) STR. Preprocedural corrected TPE (cTPEPRE;116±21 ms vs. 108±21 ms, p=0.027), postprocedural TPE (TPEPOST, 107±16 ms vs. 92±21 ms, p<0.001), and postprocedural cTPE (cTPEPOST, 119±19 ms vs. 102±17 ms, p<0.001) intervals were significantly longer in patients with incomplete STR than in patients with complete STR, whereas there was no statistically significant difference between the two groups in terms of pre- and postprocedural and corrected QT intervals. cTPEPRE and cTPEPOST were found to be independent predictors for incomplete STR. Conclusion: To our knowledge, this is the first study that evaluated the relationship between TPE interval and no-reflow defined by STR in patients with STEMI who were treated with pPCI. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 57-year-old male patient with acute anterior myocardial infarction. A guidewire-induced coronary perforation was noted and it was treated by stent implantation. Echocardiography result revealed minimal pericardial effusion without tamponade sign. The patient underhone fluoroscopy-guided pericardiosyntesis.

Head and neck tumors can rarely cause carotid sinus syndrome and this often resolves by surgical intervention or palliative chemoradiotherapy. If these modalities are not an option or are ineffective, the most preferred treatment is permanent pacemaker therapy. Here, we present the first case of cardioneuroablation treatment performed in patient with oropharyngeal squamous cell cancer who developed recurrent asystole and syncope attacks due to compression of the carotid sinus on neck movement. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the effects of branched chain amino acids (BCAAs) consumption on myocardium and coronary arteries, in rats subjected to regular and intense exercise. Eight-week old, 30 male rats were randomly divided into experimental- and controlgroups. For a total of 8 weeks, every other day, both groups were subjected to a ladder-climbing exercise on a 1.5 m long ladder, with 2.5 cm steps interval, at 70 degrees angle. The experimental group, besides the standard diet, was additionally fed BCAA-supplement at a dose of 1.5 mg/g/day. This study showed that, the experimental group had more frequent atherosclerotic lesions compared to the control group (61.5% vs. 21.4%; p=0.034). Although creatine kinase was similar between the groups, creatine kinase - myocardial band isoform (CK-MB) was significantly higher in the experimental group compared both to control and baseline levels. This is the first study that examines the effects of consuming BCAA supplements on myocardium and coronary arteries in rats subjected to prolonged exercise. We demonstrated that continuous and long-term consumption of BCAA supplement in endurance exercises was associated with coronary atherosclerotic process and myocardial injury. [ABSTRACT FROM AUTHOR]

Objectives: Acute limb threatening ischemia (ALTI) is one of the most widely seen emergent vascular interventions, and is highly associated with cardiovascular mortality and amputations. Despite successful endovascular treatment (EVT) strategies and surgical interventions mortality and morbidity rates still remain higher in patients with ALTI. In this study, we aimed to investigate the long term clinical outcomes which are amputation-free survival and mortality, in patients with ALTI who treated either with EVT or surgical embolectomy. Methods: Our study enrolled 86 consecutive patients who diagnosed with ALTI in our hospital retrospectively in between 2016-2020. The accurate diagnosis of ALTI was made by using color doppler ultrasonography or computed tomography angiography. Patients with acute infection who need antibiotics, chronic inflammatory disease, end-stage hepatic impairment, and malignancy were not included. Patients were divided into two groups as those who were treated with surgical method (group 1) and those who were revascularized by endovascular methods (group 2). Results: The mean follow-up period was 19 months (1-26). All-cause mortality and amputation rates of patients in surgery group and EVT group were statistically similar (14,3% vs. 27,3%, p:0,139 and 14,3% vs. 9,1%, p: 0,453 respectively). Kaplan-Meier survival analysis showed no significant difference in between EVT and surgery group in term of all-cause mortality and amputation. (log-rank p = 0.649). In multivariate logistic regression analysis, Rutherford stage, congestive heart failure and CRP/albumin ratio (CAR) was found to be an independent predictor of amputation and all-cause mortality even after adjusting for other confounding risk factors. Conclusions: In our study, we observed that EVT and surgical embolectomy had similar long-term outcomes in patients with acute limb threatening ischemia. We also observed that Rutherford clinical stage, congestive heart failure and high CAR may be an independent predictor of mortality and amputation. This data needs to be supported by larger and prospective studies. [ABSTRACT FROM AUTHOR]

Aim: Non ST segment elevation myocardial infarction (NSTEMI) is one of the most common presentations of coronary arterial disease (CAD). Syntax II score (SSII) is a recently developed scoring system consisting two anatomical and six clinical variables which is used to predict mortality of patients with complex CAD. Neutrophil/lymphocyte ratio (NLR) basically shows basal inflammatory response. The aim of our study was to evaluate the relationship between NLR and CAD severity using Syntax score (SS) and SSII in NSTEMI patients. Material and Method: Consecutive 271 NSTEMI patients who referred to Kafkas University between February 2015 and June 2016 and underwent coronary angiography have been included in this study. Peripheral venous blood samples were taken from all patients. Hemogram parameters including NLR, biochemical parameters and cardiac biomarkers were evaluated. SS and SSII were calculated from recorded coronary angiograms. Results: The study population consisted of 194 NSTEMI patients. Due to the fact that there was no definitive previous classification of SSII, the patients were divided into 2 groups according to median SSII value. (SSII<31.5 low score group [n=97] and >31.5 high score group [n=97]. NLR was significantly higher at SSII high score group than low score group 3.22 (2.30-4.86) vs 4.05 (2.83-7.21) p=0.004). While there was no correlation between NLR and SS (r=0.023, p=0.759), there was a correlation between NLR and SSII (r=0.218, p=0.002). Therefore correlation analysis was performed between NLR and SSII components. Our analysis demonstrated that there was a correlation between NLR and left ventricular ejection fraction (r=-0.161, p=0.026), as well as between NLR and creatinine clearance (r=-0.161, p=0.025). However, there was no correlation with other parametric components of SSII. Conclusion: Our study demonstrated that there was a correlation between NLR and SSII, but no correlation between NLR and SS. High NLR can predict that patients have high SSII scores, and this prediction is related to comorbidities rather than anatomical score system. [ABSTRACT FROM AUTHOR]

Moreover, transthoracic echocardiography showed large pericardial effusion and right ventricle diastolic collapse. E-page Original Image E-20 Autosomal dominant polycystic kidney disease with liver involvement and left ventricular noncompaction: An unusual coexistence A male patient aged 63 years was admitted to the emergency department with shortness of breath, chest pain, and confusion. Detailed transthoracic echocardiography was performed after pericardiocentesis and revealed mild pericardial effusion, left ventricular noncompaction (LVNC) (Fig. [Extracted from the article]

Objective: Acute kidney injury (AKI), which is prevalent in ST-segment elevated myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. As high pulse pressure (PP) is associated with adverse cardiovascular events, the present study's aim was to evaluate the relationship between fractional PP (PPf) and AKI in patients with STEMI who underwent primary PCI.Subjects and Methods: All laboratory findings as well as echocardiographic and angiographic data of 1,170 consecutive STEMI patients were retrospectively screened. PPf was calculated from the pressures invasively measured after sheath insertion and before performing coronary angiography.Results: From 1,170 eligible STEMI patients (mean age 56 years, 18.2% female), AKI developed in 143 (12.2%) patients. The PPf and pulsatility index were significantly higher in patients with AKI than those without (0.53 ± 0.10 vs. 0.61 ± 0.10, p < 0.001, and 0.80 ± 0.03 vs. 0.82 ± 0.03, p < 0.001, respectively). PPf was also found to be associated with AKI in univariable (OR 2.183, 95% CI 1.823-2.614, p< 0.001) and multivariable (OR 1.874, 95% CI 1.513-2.322, p < 0.001) analysis. In-hospital mortality was higher in patients with AKI than those without.Conclusion: Invasively measured PPf, which can be easily measured and has no additional cost in STEMI patients undergoing coronary intervention, is an independent predictor of AKI. In addition, PPf is superior to other blood pressure values and derivatives in AKI prediction. [ABSTRACT FROM AUTHOR]

Introduction and objectives: The aim of this study was to investigate the association of serum albumin (SA) level with long‐term prognosis in patients with acute pulmonary embolism (PE). Materials and methods: We retrospectively enrolled 269 patients with acute PE. The SA level was obtained within 12‐24 hours following admission. The primary endpoints were the incidence of short‐ and long‐term mortality in acute PE patients. The mean duration of the study follow‐up was 21 ± 19 months. Results: During the follow‐up period, short‐ and long‐term mortality rates were higher in patients who had low SA level compared to those who did not have. In multivariate Cox regression analysis, the SA level was found to be independently associated with long‐term mortality (HR: 0.47, 95%CI: 0.28‐0.78, P = 0.004). In receiver operating characteristics analysis, the SA level of ≤3.17 predicted long‐term mortality with a sensitivity of 77.5% and a specificity of 79.5% (area under the curve 0.82, 95%CI: 0.76‐0.87, P < 0.001). In addition, when the SA plus simplified pulmonary embolism severity index (sPESI) risk score compared to the sPESI risk score alone, it produced a net reclassification improvement of 0.22 with P < 0.001, that is a 22% improved classification. Conclusion: To the best of our knowledge, this is the first study to demonstrate that the low SA level is a strong and independent predictor for long‐term mortality in patients with acute PE. [ABSTRACT FROM AUTHOR]

Objective: An increased left atrial volume index (LAVI) is related to increased mortality in hemodialysis patients. In the present study, we evaluated the association between the LAVI and the P wave peak time (PWPT), a newly introduced electrocardiographic parameter, in hemodialysis patients.Methods: The study population was made up of 79 hemodialysis patients with a mean age of 53 ± 18 years (55.7% were males). These patients were divided into a normal LAVI (≤28 mL/m2) group (n = 45) and an increased LAVI (>28 mL/m2) group (n = 34). The demographic, clinical, laboratory, echocardiographic, and electrocardiographic variables of the groups were compared.Results: The P wave terminal force from lead V1, P wave dispersion and PWPTs obtained from leads V1 and D2 (PWPTD2) were significantly higher in the patients with increased LAVIs. In multivariable analysis, only the PWPTD2was an independent predictor of an increased LAVI (odds ratio = 1.117, 95% CI = 1.052-1.185, p < 0.001). The receiver-operating characteristic curve analysis showed that the best PWPTD2 cutoff value for predicting an increased LAVI was 60 ms, with a sensitivity of 76.5% and a specificity of 66.7% (area under the curve = 0.736, 95% CI = 0.625-0.829, p < 0.001).Conclusion: This study showed that a prolonged PWPTD2 was independently associated with an increased LAVI in hemodialysis patients. Therefore, measuring the PWPTD2 duration on an electrocardiogram may help define high-risk hemodialysis patients with increased LAVIs. [ABSTRACT FROM AUTHOR]