Impact of Naples Prognostic Score at Admission on In-Hospital and Follow-Up Outcomes Among Patients with ST-Segment Elevation Myocardial Infarction

The Naples prognostic score (NPS) consists of cholesterol level, albumin concentration, lymphocyte-to-monocyte and neutrophil-to-lymphocyte ratios and reflects systemic inflammation, malnutrition, and survival for various conditions. We investigated the relationship of NPS at admission with in-hospital and follow-up outcomes among ST-segment elevation myocardial infarction (STEMI) patients. This retrospective study included 1887 consecutive patients diagnosed with STEMI and who underwent primary percutaneous coronary intervention between March 2020 and May 2022. The study population was divided by NPS into 2; low (0-1-2) and high (3-4). In-hospital adverse events and all-cause mortality rates during follow-up were extracted from the registry. The Median follow-up time was 15 months. The overall mortality rate was 14.6%. The proportions of in-hospital events that included acute respiratory failure, acute kidney injury, malignant arrhythmia, and mortality were significantly higher in the high NPS group than in the low NPS group. Compared with the baseline model, in the full model of Cox regression analysis; NPS was an independent predictor of all-cause mortality (adjusted hazard ratio (aHR): 2.49, 95%CI, 1.75-3.50, P < .001), with a significant improvement in model performance (likelihood ratio χ2, P < .001) and better calibration. In conclusion, we found an association between NPS and in-hospital and follow-up outcomes in STEMI patients.

Short- and long-term outcomes of percutaneous coronary interventions of high-risk vs. low-risk lesions performed at a hospital without an on-site cardiac surgery unit

Aim    Widespread utilization of technology has led to the construction of a growing number of facilities with coronary angiography units and percutaneous coronary intervention (PCI) capability. Some of these centers do not have cardiovascular surgery (CVS) on site. Studies regarding the efficacy and safety of PCIs performed at these hospitals have been conducted. However, to date, high-risk procedures in this context have not been evaluated. The present study compares the outcomes of PCI procedures performed on high- and low-risk lesions groups in a center without CVS back-up.Material and methods    A total of 999 patients treated with PCI with diagnoses other than ST elevation myocardial infarction were included in this study. Patients with SYNTAX scores 22 or higher, bifurcation lesions, chronic total occlusions, left main coronary artery lesions and saphenous graft lesions were classified as a high-risk group. In contrast, patients with SYNTAX scores lower than 22 were included in the low-risk group. Coronary lesions were classified as Type-A, B, and C. The 30‑day major adverse cardiac events (MACE) and 1‑year target vessel revascularization (TVR) rates were compared.Results    There was no significant difference between the groups in terms of the rates of MACE (2 (0.9 %) vs 5 (0.6 %); p=0.64) and TVR (9 (4.2 %) vs 25 (3.2 %); p=0.52). Analysis regarding the lesion type also revealed no significant difference between the MACE and TVR rates (p=0.56 and p=0.43, respectively).Conclusions    The findings in this study demonstrated that, similar to low-risk procedures, complex and high-risk coronary interventions can safely and effectively be conducted in hospitals without a CVS unit.

Comparison of ventricular repolarization parameters of Covid-19 patients diagnosed with chest CT and RT-PCR

BACKGROUND AND OBJECTIVES

The aim of the comparison is to evaluate the marker of ventricular repolarization parameters such as QT, QTc, cQT, Tp-e, Tp-e/QT, Tp-e/QTc, Tp-e/JT and Tp-e/JTc ratios and the risk of ventricular arrhtythmias in patients with newly diagnosed Covid-19.

METHODS

The study included 2 separate groups. The first one consisted of 96 positive reverse transcriptase polymerase chain reaction (RT-PCR) Covid-19 patients and the second one of 106 patients with negative PCR but positive chest computed tomography (CT) findings consistent with Covid-19. We measured QTmax, QTmin, QRS, JT and Tp-e intervals and estimated Tp-e/QT max, Tp- e/QTc max, Tp-e/JT and Tp-e/JTc rates and QTc max, QTc min, cQTd and JTc intervals.

RESULTS

QT max, QT min, JT, cQTd, Tp-e, Tp-e/QT max, Tp-e/QTc max, Tp-e/JT, Tp-e/JTc values were significantly higher in RT-PCR Covid-19 patient group.

CONCLUSION

Positive RT-PCR Covid-19 patients should be followed more closely, in terms of high ventricular repolarization parameters and preventing ventricular arrhythmias that may develop due to this.

Impact of surgical weight loss on novel P-wave-related variables which are nominated as predictors of atrial arrhythmias

BACKGROUND

Bariatric surgery has been associated with reduced cardiovascular mortality and morbidity in obese patients. In this study, we aimed to evaluate the alterations of novel P-wave related atrial arrhythmia predictors in patients who achieved effective weight loss with bariatric surgery.

METHODS

The study included 58 patients who underwent bariatric surgery. We measured heart rate, PR, P wave (PW) max, PW min, Average P axis, P wave peak time (PWPT) in lead D2 and lead V1, terminal force in lead V1 (V1TF), and we estimated P wave dispersion (PWdis) interval both pre-operation and 6 months after operation.

RESULTS

Heart rate, PR, PW max, PW min, PWdis, Average P axis, PWPTD2, PWPTV1 and V1TF values, which were close to the upper limit in the pre-op period, showed statistically significant decreases at 6 months after the operation. The most prominent changes were observed in PW dis (51.15 ± 9.70 ms vs. 48.79 ± 9.50 ms, p = .010), PWPTD2 (55.75 ± 6.91 ms vs. 50.59 ± 7.67 ms, p < .001), PWPTV1 (54.10 ± 7.06 ms vs. 48.05 ± 7.64 ms, p < .001) and V1TF (25 [43.1%] vs. 12 [20.7%], p < .001).

CONCLUSIONS

The results of our study indicated that bariatric surgery has positive effects on the regression of ECG parameters which are predictors of atrial arrhythmias, particularly atrial fibrillation (AF).

Analysis of corrected QT dispersion, tp-e values in small heart syndrome patients

Funding Acknowledgements

Type of funding sources: None.

Background and objectives

We aimed to evaluate the marker of ventricular arrhythmias such as Tp-e/QT, Tp-e/QTc, Tp-e/JT and Tp-e/JTc ratios in ‘Small Heart Syndrome’ female patients and also aimed to evaluate the association between ‘small heart syndrome’ and fibromyalgia in female patients.

Methods

A total of 94 female, including 47 small-heart and 47 normal-heart patients, who applied from March 2018 to February 2020 and who were examined by a physical therapy and rehabilitation specialist, were included in the study by calculating their cardiothoracic ratios (CTR) from the chest x-ray. QTmax, QTmin,QRS, JT and Tp-e intervals were measured. In addition, Tp-e/QTmax, Tp-e/QTc max, Tp-e/JT and Tp-e/JTc rates and QTc max, QTc min, cQTd and JTc intervals were calculated.

Results

cQTd (24,246 ± 9,046 ms vs. 35,495 ± 14,358 ms, p &lt; 0.001), Tp-e (67,32 ± 11,661 ms vs. 72,67 ± 11,028 ms, p = 0.04), Tp-e/QTc max (0,166 ± 0.028 vs. 0.181 ± 0.027, p = 0,012), Tp-e/JTc (0,214 ± 0.038 vs. 0.232 ± 0.034, p = 0,022) values were significantly higher in small heart patient group. QT min (330,68 ± 26,611 ms vs. 323,04 ± 30,829 ms, p = 0,202) values were significantly lower in patient group.

Conclusion

Compared to control group potential ECG repolarization predictors were significantly increased in ‘Small Heart Syndrome’ patients. TableElectrocardiographic findings o Control group(n = 47) Patient group(n = 47) P value Heart rate, bpm 87,81 + 15,532 83,81 + 14,372 0,223 QRS; ms 83,23 + 6,948 81,91 + 10,052 0,206 QT max; ms 354,93 + 26,796 358,54 + 28,434 0,528 QT min; ms 330,68 + 26,611 323,04 + 30,829 0,202 JT; ms 265,7 + 25,16 271,88 + 23,104 0,218 QTc max; ms 403,59 + 18,208 400,20 + 18,336 0,371 QTc min; ms 379,34 + 20,064 364,71 + 23,149 0,004* JTc; ms 314,37 + 21,325 313,55 + 22,526 0,856 cQTd; ms 24,246 + 9,046 35,495 + 14,358 &lt;0,001* Tp-e; ms 67,32 + 11,661 72,67 + 11,028 0,040* Tp-e/QT max 0,190 + 0,034 0,203 + 0,031 0,063 Tp-e/QTc max 0,166 + 0,028 0,181 + 0,027 0,012* Tp-e/JT 0,255 + 0,047 0,267 + 0,036 0,295 Tp-e/JTc 0,214 + 0,038 0,232 + 0,034 0,022*

Evaluation of Changes in Ventricular Repolarization Parameters in Morbidly Obese Patients Undergoing Bariatric Surgery

BACKGROUND

Weight loss after bariatric surgery has been associated with reduced cardiovascular mortality and overall mortality in obese patients. In this study, we aimed to analyze the changes between pre-operation and post-operation ventricular arrhythmia predictors in patients who underwent bariatric surgery.

MATERIALS AND METHODS

The study included 58 patients who underwent bariatric surgery. We measured QT max, QT min, QRS, JT, and Tp-e intervals, and we estimated Tp-e/QT max, Tp-e/QTc max, Tp-e/JT, Tp-e/JTc rates, QTc max, QTc min, cQTd, and JTc intervals both pre-op and 6 months post-op.

RESULTS

Heart rate, PR, QT max, QTc max, QTc min, cQTd, JTc, Tp-e, Tp-e/QT max, Tp-e/QTc max, Tp-e/JT, and Tp-e/JTc values, which were close to the upper limit in the pre-op period, showed statistically significant decreases at 6 months post-op.

CONCLUSION

The results of our study showed that bariatric surgery had positive effects on the regression of ventricular repolarization parameters and the possible development of ventricular arrhythmia.

Outcomes of the novolimus-eluting bioresorbable vascular scaffold in real world clinical practice

BACKGROUND

Most of the current data regarding the use of bioresorbable scaffolds (BRS) come from everolimus-eluting stent platforms. Adverse events with the everolimus-eluting BRSs which are the most comprehensively characterized BRS, hampered the clinical use of other BRS. There is paucity of published data regarding long term use of novolimus-eluting BRS.

METHODS

This study sought to evaluate the performance of novolimus-eluting BRS device at midterm follow-up in real world clinical practice. One hundred and forty-four patients (mean age 57.5±9.7 years, 78.5% male) treated with 206 scaffolds between October 2015 and December 2017 were enrolled. A device-oriented composite endpoint (DOCE) comprising cardiac death, target vessel myocardial infarction (TV-MI), clinically driven target lesion revascularization (TLR) and rate of scaffold thrombosis were investigated.

RESULTS

During a mean follow-up of 33±9 months, DOCE occurred in 9 patients (6.3%) of which cardiac death occurred in 2 patients (1.4%), and clinically driven TLR in 7 patients (4.9%), TV-MI in one patient. Target vessel revascularization (TVR) was observed in nine patients. None of the patients experienced scaffold thrombosis.

CONCLUSIONS

The use of novolimus-eluting BRS in this real-world population achieved good clinical outcomes.

Outcomes of the novolimus-eluting bioresorbable vascular scaffold in real world clinical practice

BACKGROUND

Most of the current data regarding the use of bioresorbable scaffolds (BRS) come from everolimus-eluting stent platforms. Adverse events with the everolimus-eluting BRSs which are the most comprehensively characterized BRS, hampered the clinical use of other BRS. There is paucity of published data regarding long term use of novolimus-eluting BRS.

METHODS

This study sought to evaluate the performance of novolimus-eluting BRS device at midterm follow-up in real world clinical practice. One hundred and forty-four patients (mean age 57.5±9.7 years, 78.5% male) treated with 206 scaffolds between October 2015 and December 2017 were enrolled. A device-oriented composite endpoint (DOCE) comprising cardiac death, target vessel myocardial infarction (TV-MI), clinically driven target lesion revascularization (TLR) and rate of scaffold thrombosis were investigated.

RESULTS

During a mean follow-up of 33±9 months, DOCE occurred in 9 patients (6.3%) of which cardiac death occurred in 2 patients (1.4%), and clinically driven TLR in 7 patients (4.9%), TV-MI in one patient. Target vessel revascularization (TVR) was observed in nine patients. None of the patients experienced scaffold thrombosis.

CONCLUSIONS

The use of novolimus-eluting BRS in this real-world population achieved good clinical outcomes.

Adjusting the QRS Duration by Body Mass Index for Prediction of Response to Cardiac Resynchronization Therapy: Does One QRS Size Fit All?

BACKGROUND

QRS duration (QRSd) is known to be affected by body weight and length. We tested the hypothesis that adjusting the QRSd by body mass index (BMI) may provide individualization for patient selection and improve prediction of cardiac resynchronization therapy (CRT) response.

METHODS

A total of 125 CRT recipients was analyzed to assess functional (≥1 grade reduction in NYHA class) and echocardiographic (≥15% reduction in LVESV) response to CRT at 6 months of implantation. Baseline QRSd was adjusted by BMI to create a QRS index (QRSd/BMI) and tested for prediction of CRT response in comparison to QRSd.

RESULTS

Overall, 81 patients (65%) responded to CRT volumetrically. The mean QRS index was higher in CRT responders compared to nonresponders (6.2 ± 1.1 vs 5.2 ± 0.8 ms.m(2) /kg, P < 0.001). There was a positive linear correlation between the QRS index and the change in LVESV (r = 0.487, P < 0.001). Patients with a high QRS index (≥5.5 ms.m(2) /kg, derived from the ROC analysis, AUC = 0.787) compared to those with a prolonged QRSd (≥150 ms, AUC = 0.729) had a greater functional (72% vs 28%, P < 0.001) and echocardiographic (80% vs 44%, P < 0.001) improvement at 6 months. QRS index predicted CRT response at regression analysis.

CONCLUSIONS

Indexing the QRSd by BMI improves patient selection for CRT by eliminating the influence of body weight and length on QRSd. QRS index is a novel indicator that provides promising results for prediction of CRT response.