Evaluation of index of cardiac electrophysiological balance in COVID-19 patients

AIM

The aim of the current study was to evaluate the index of Cardiac Electrophysiological Balance (iCEB) in hospitalized COVID-19 patients receiving Hydroxychloroquine / azithromycin (HCQ / AZ) combination therapy to determine the susceptibility to ventricular arrhythmia among these patients.

METHOD

Sixty-seven COVID-19 patients admitted to the ward were included in the study. Electrocardiograms (ECGs) were obtained from all patients before the initiation of treatment and on treatment day 5. QT/QRS (iCEB) and QTc/QRS (iCEBc) ratios were calculated.

RESULTS

QRS, QT and QTc intervals were significantly prolonged on day 5 measurements compared to pre-treatment period (p <0.05). Overall, mean iCEB was 3.6±0.4 before treatment and 3.8±0.4 on day 5 in the study population (p <0.001). Considering the iCEBc values, a significant increase was observed in patients receiving HCQ/AZ treatment compared to pre-treatment period (4.1±0.5 vs 4.4±0.6; p <0.001).

CONCLUSIONS

To the best of our knowledge, this was the first study to investigate iCEB and iCEBc parameters in patients with COVID-19 on HCQ/AZ therapy. In this study, we demonstrated significantly increased iCEB and iCEBc values following HCQ/AZ treatment in COVID-19 patients. iCEB and iCEBc may serve as a noninvasive, simple, and novel biomarker for detecting increased pro-arrhythmia risk in COVID-19 patients (Tab. 3, Fig. 3, Ref. 36).

Aortic flow propagation velocity and neutrophil-to-lymphocyte ratio in coronary slow flow

AIM

A useful tool for determining the presence of systemic inflammation is the neutrophil-to-lymphocyte ratio (NLR). Chronic inflammation causes more microvascular resistance, which is known to be involved with coronary slow flow (CSF). Aortic flow propagation velocity (APV) can be used to evaluate the aorta's rigidity. We hypothesized that NLR and APV might be related to CSF. Therefore, we aimed to evaluate the NLR and APV in CSF patients.

METHOD

Eighty-six CSF patients and 43 subjects with normal coronary flow were enrolled in this study. We utilized the Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) method for determining each enrolled patient's coronary flow rate. APV values were determined via color M-mode Doppler echocardiography. Differences in NLR and APV values were determined in CSF and control groups.

RESULTS

Patients with CSF had lower APV values and higher NLR values than the normal controls (39.9±11.4 vs 48.0±10.6, p<0.01; 3.3±2.8 vs 2.3±1.2, p=0.03). TFC was significantly higher in CSF patients compared to controls (29.8±5.0 vs 12.9±2.6; p<0.01). TFC and APV were negatively correlated in CSF patients (r=-0.338 p=0.001). APV was independently associated with CSF (OR: 1.164, CI: 1.078-1.257, p=0.001).

CONCLUSIONS

APV was significantly associated with TFC, and it is independently associated with CSF (Tab. 4, Fig. 3, Ref. 30). Text in PDF www.elis.sk Keywords: coronary slow flow, neutrophil-to-lymphocyte ratio, aortic flow propagation velocity, atherosclerosis, inflammation.

Zwolle risk score predicts contrast-induced acute kidney injury in STEMI patients undergoing PCI

OBJECTIVE

Contrast-induced acute kidney injury (CI-AKI) is a common complication in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The Mehran risk score was defined originally in elective PCI and may be predictive of CI-AKI. The aim of the present study was to investigate whether the Zwolle score predicts CI-AKI in patients with acute STEMI undergoing primary PCI.

PATIENTS AND METHODS

We analyzed the data of 314 consecutive patients (mean age 56.3 ± 11.4 years) with acute STEMI undergoing primary PCI. The study population was divided into two groups according to CI-AKI development. The Mehran score, Zwolle score, baseline characteristics, and in-hospital outcomes were recorded.

RESULTS

Patients with CI-AKI had higher Mehran and Zwolle scores. In a receiver operating characteristic (ROC) curve analysis, high area under the curve (AUC) values were determined for Zwolle and Mehran scores (0.85 and 0.79, respectively) for CI-AKI development. A Zwolle score greater than  2 predicted CI-AKI with a sensitivity of 76.3 % and a specificity of 75.4 %. A Mehran score greater than 5 predicted CI-AKI with a sensitivity of 71.1 % and a specificity of 73.6 %.

CONCLUSION

Zwolle score predicts CI-AKI slightly better than the Mehran score in patients with STEMI undergoing primary PCI. This simple score can be used at the catheterization laboratory for risk stratification for the development of CI-AKI.