The Forgotten Variable of Shear Stress in Mitral Annular Calcification: Whole Blood Viscosity

OBJECTIVE

The aim of this research was to assess the relationship between mitral annular calcification (MAC) and whole blood viscosity (WBV).

SUBJECTS AND METHODS

A total of 184 patients with MAC and 133 patients without MAC were enrolled in the study. The WBV was calculated with a confirmed formulation using the hematocrit and total plasma protein at a low shear rate (LSR) and high shear rate (HSR). Early diastolic mitral annular velocity (Ea) and late diastolic mitral annular velocity (Aa) were measured using pulse Doppler tissue echocardiography. Pearson's correlation analysis was performed to assess the relationship between WBV and mitral annular motion velocities. The effects of different variables on the occurrence of MAC were assessed in univariate and multivariate logistic regression analysis.

RESULTS

In patients with MAC, WBV values were significantly higher at HSR (18.04 ± 0.84 vs. 17.25 ± 0.96 208 s(-1), p < 0.001) and at LSR (78.0 ± 14.2 vs. 61.9 ± 17.1 0.5 s(-1), p < 0.001). The WBV at HSR and LSR were significantly correlated with Ea (r = -0.477, p < 0.001; r = -0.385, p < 0.001, respectively) and Aa (r = -0.544, p < 0.001; r = -0.323, p < 0.001, respectively). Multivariate analysis showed that WBV of both shear rates was an independent predictor of MAC. Using the ROC curve, a cut-off value of 70.1 for WBV at LSR had a sensitivity of 83.7% and a specificity of 73.7% (AUC 0.785, p < 0.001) and a WBV cut-off value of 17.5 at HSR had a sensitivity of 79.6% and a specificity of 71.4% (AUC 0.761, p < 0.001) for the prediction of MAC.

CONCLUSION

Patients with MAC had significantly higher WBV, which independently predicted the presence of MAC. WBV had an inverse correlation with mitral annular motion velocities, indicating that a higher WBV may lead to greater limitation in annular motion and, thus, more calcification.

Predictors of neurologically favorable survival among patients with out-of-hospital cardiac arrest: A tertiary referral hospital experience

OBJECTIVE

Despite recent advances in medical support and interventions, only 5% to 10% of patients with out-of-hospital cardiac arrest (OHCA) survive to discharge. In this study, factors related to neurologically favorable survival in patients with OHCA were analyzed.

METHODS

A total of 129 patients who were admitted to hospital with OHCA were retrospectively enrolled.

RESULTS

Sustained return of spontaneous circulation (ROSC) (ROSC lasting >20 min) was achieved in 29 (22.4%) patients. Percentage of cardiac arrests with ischemic etiology was significantly higher in successful ROSC group (p<0.001). In multivariate logistic regression analysis, cardiac arrest with ischemic etiology (p=0.004) and cardiopulmonary resuscitation (CPR) duration (p=0.013) were found to be independent predictors for ROSC. One-minute increment in CPR duration was associated with 1.202-fold increase in failure to achieve ROSC. Among patients with ROSC, 7 (5.4%) survived to hospital discharge, and 1-minute increment in CPR duration was associated with a 1.123-fold decrease in neurologically favorable survival (p=0.005).

CONCLUSION

In patients with OHCA, ischemic etiology is associated with better ROSC rate compared to other reasons for cardiac arrest, and patients with prolonged CPR are less likely to survive.

Comparison of the predictive accuracy of four different ECG algorithms in identification of true ablation site for the idiopathic right ventricular outflow tract tachycardias

BACKGROUND

We aimed to investigate the accuracy of four algorithms in prediction of right ventricular outflow tract (RVOT) tachycardias in patients who successfully underwent radiofrequency catheter ablation.

METHODS

Four algorithms; two with easy-applicability and having a memorable design (Dixit and Joshi), and two with more complex and detailed design (Ito and Zhang) were compared according to the predictive accuracy.

RESULTS

Among 99 patients (mean age 36.5 ± 8.5 years, 39.4% male), there were 51 (51.5%) septal-located and 48 (48.5%) free-wall located RVOT tachycardia. Comparison of the predictive accuracy of the algorithms showed that Zhang (91.9%) was the best algorithm for prediction of either septal or free-wall located tachycardia. The second best algorithm was the Ito (77.7%) compared to Dixit (75.8%) and Joshi (70.7%).

CONCLUSION

In patients with RVOT tachycardia, algorithms with a detailed design may predict the arrhythmia location better than the easy-applicable algorithms.

Lung metastases in patients with differentiated thyroid carcinoma and evaluation of response to radioiodine therapy

INTRODUCTION

The most common site of metastases in differentiated thyroid carcinomas is the lungs. In our study, we aimed to determine the ratios of lung metastases in patients with differentiated thyroid carcinoma and response to radioiodine therapy.

MATERIAL AND METHODS

A total of 542 patients with differentiated thyroid carcinoma who were admitted to our clinic were included in the study. High doses of (131)I were administered to the patients with lung metastases. Response to therapy were evaluated with (131)I scans and stimulated serum Tg levels were examined at least 6 months after therapy.

RESULTS

Lung metastases were detected in 17 (3.1%) of 542 patients with differentiated thyroid carcinoma. Of these patients to whom high doses of (131)I therapy were administered, complete response to therapy was obtained in 5 (29.4%), partial response was obtained in 3 (17.6%) and no response could be obtained in 9 (53%) patients.

CONCLUSION

Although lung metastases from differentiated thyroid carcinomas are rare, those are more common in advanced ages and in males. High doses of (131)I therapy may be partially beneficial in these patients. Thus repetition of therapy is frequently required.

Clinical Presentation, Electrocardiographic Findings, and Factors Related to the Hospitalization In Mad-Honey Intoxication

OBJECTIVES

Mad-honey intoxication (MHI) often presents with all kinds of bradyarrhythmias. Despite numerous publications focused on clinical findings, we aim to evaluate poor prognostic implications, ischemia likely electrocardiography (ECG) changes, and detailed ECG findings of MHI in the largest series.

METHODS

This is a retrospective single-center study of 117 MHI patients admitted to emergency service.

RESULTS

The study had 26 (22.2%) females (median 52.5 years) and 91 (77.8%) males (median 51.0 years). Fifty-six (47.9%) patients had ischemia likely changes on ECG. Multivariate model demonstrated that beta-blocker usage (odds ratio (OR): 52.871; 95% confidence interval (CI): 3.618-772.554 (p=0.004)), atrioventricular junctional rhythm (AVJR) (OR: 5.319; 95%CI: 1.090-25.949 (p=0.039)), and quantity of mad-honey consumption (OR: 1.035; 95% CI: 1.008-1.063 (p=0.011)) are predictors of hospitalization. ROC curve analysis showed cutoff value of mad-honey consumption quantity 24.79 g had 57% sensitivity and 68% specificity for predicting hospitalization (AUC: 0.7, 95% CI: 0.55-0.816, p=0.027). In addition, all hospitalized cases were male.

CONCLUSION

Our study has shown that male gender, AVJR, the quantity of mad-honey consumption, and beta-blocker usage are high-risk criteria for hospitalization in MHI patients. Furthermore, ischemia likely ECG changes is often observed with MHI even independently from hypotension or bradycardia.

Predictive Value of the Systemic Immune-Inflammation Index and CRUSADE Score for Bleeding and Mortality in Older Patients With Acute Coronary Syndrome

BACKGROUND

There are currently no adequate studies evaluating the relationship between the systemic immune-inflammation index (SII) and bleeding in older patients presenting with acute coronary syndrome (ACS). This study investigated the predictive value of SII for in-hospital bleeding and the CRUSADE Bleeding Score (CBS) for long-term mortality in older patients with ACS.

METHODS

The study included 367 older patients, aged 75 years and above, admitted with ACS between April 2015 and January 2023. Predictors of in-hospital bleeding were determined using multivariate logistic regression analysis. Survival curves were generated using the Kaplan-Meier method.

RESULTS

The patients' median age was 81 (77-85), and 179 (48.8%) were male. The median follow-up was 24 months (Q1-Q3: 5-47, maximum: 96). In-hospital bleeding was significantly elevated in patients in the high SII group (p = 0.005); all long-term mortality was significantly increased in those with a high CBS (p = 0.001). Multivariate logistic regression analysis revealed that the estimated glomerular filtration rate (eGFR) (odds ratio [OR]: 0.980, 95% confidence interval [CI]: 0.964-0.995, p = 0.009) and SII (OR: 1.001, 95% CI: 1.001-1.003, p = 0.001) were independent predictors of in-hospital bleeding. Kaplan-Meier analysis confirmed that the all-cause mortality rate in patients with high CBS (≥ 46) was significantly higher than that of patients with low CBS (Long Rank: 37.12, p = 0.001).

CONCLUSION

A high SII was an independent predictor of in-hospital bleeding, and a high CBS at admission was associated with increased long-term mortality in older patients with ACS.

F-18 FDG PET/CT imaging in the diagnostic work-up of thyroid cancer patients with high serum thyroglobulin, negative I-131 whole body scan and suppressed thyrotropin: 8-year experience

OBJECTIVE

Fluorodeoxyglucose positron emission tomography/computed tomography imaging in the follow-up of patients with differentiated thyroid carcinoma who have high serum thyroglobulin, negative iodine-131 whole body scan and suppressed thyrotropin.

PATIENTS AND METHODS

A total of 90 patients (31 male and 59 female) with differentiated thyroid carcinoma who have high serum thyroglobulin and negative iodine-131 whole body scan were included in the study between July 2006 and March 2014. All patients had undergone surgery (total thyroidectomy ± lymph node dissection) followed by iodine-131 ablation. Of the patients, 82 had papillary thyroid carcinoma and 8 follicular thyroid carcinoma. Serum thyrotropin was suppressed (< 2 μ IU/ml) during the Fluor-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging procedure.

RESULTS

The overall sensitivity of fluor-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging in the detection of metastasis of differentiated thyroid cancer was 84.8%, the specificity 79.1%, respectively. The sensitivity and specificity of fluor-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging in classic type of papillary cancer was 83.3% and 54.5%, respectively. The corresponding figures for the tall cell variant was 85.7% and 87.5%, respectively. The difference between the two histological subtypes was statistically significant (p < 0.05).

CONCLUSIONS

Our results suggest that fluor-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging could be a valuable test for the routine follow-up of patients with differentiated thyroid carcinoma.

Evaluation of the Atherogenic Index of Plasma to Predict All-Cause Mortality in Elderly With Acute Coronary Syndrome: A Long-Term Follow-Up

The Atherogenic Index of Plasma (AIP) is associated with coronary artery disease (CAD) and acute coronary syndrome (ACS), but the relationship between AIP and ACS in elderly patients remains unclear. We investigated the prognostic capability of AIP for in-hospital and long-term mortality in elderly patients with ACS undergoing coronary angiography (CA). We analyzed 627 patients with ACS over 75 years of age who were admitted to our clinic between April 2015 and December 2022 and underwent CA. The primary clinical endpoints were in-hospital, 30-day, 1-year, and long-term mortality. The median follow-up time was 27 months. AIP was defined as log (triglyceride/high-density lipoprotein cholesterol). In-hospital mortality rates for patients with AIP ≤.1 and AIP >.1 were 4.7% and 17.6% (P < .001), 30-day mortality rates were 8.7% and 32.2% (P = .01), 1-year mortality rates were 12.1% and 45.1% (P < .001), and long-term mortality rates were 47.3% and 67.5% (P < .001), respectively. Multivariate Cox regression analysis revealed AIP, age, left ventricle ejection fraction (LVEF), admission creatinine, and Killip ≥2 as independent predictors for long-term mortality. AIP can predict in-hospital and long-time all-cause mortality in elderly patients with ACS undergoing CA. Age, LVEF, admission creatinine, and Killip ≥2 are additional factors that predict long-term all-cause mortality.

Microvascular Dysfunction in COVID-19 Patients with Acute Coronary Syndrome

Objective

Coronavirus disease 2019 (COVID-19) is considered to deteriorate endothelial function through hyperinflammation. We aimed to investigate microvascular dysfunction using the angiographic parameters thrombolysis in myocardial infarction frame count (TFC) and myocardial blush grade (MBG), in COVID-19 patients with acute coronary syndrome (ACS).

Methods

One hundred and sixty-five patients presented with ACS (62.4% ST elevated myocardial infarction) and underwent percutaneous coronary intervention between March 1 and June 30, 2020, were enrolled in the study. The polymerase chain reaction test was performed in case of suggestive symptoms or typical computerized tomography findings.

Results

Twenty-six patients (15.7%) were tested positive for COVID-19. Significantly higher values were observed in TFC in patients with COVID-19 (p<0.001), whereas COVID-19 patients had significantly lower MBGs (Grade 0 and 1) (p<0.001). Peak troponin-I value was also higher in the COVID-19 group (27335 vs. 15959 ng/dL, p=0.006). Mortality risk was higher in COVID-19 patients (38.4% vs. 7.2%, p<0.001). TFC and ejection fraction may predict in-hospital mortality among COVID-19 patients with ACS according to logistic regression results. In correlation analysis, TFC correlated positively with C-reactive protein (r=0.340, p<0.001) and peak troponin-I value (r=0.369, p<0.001).

Conclusion

COVID-19 is associated with slow coronary flow and microvascular impairment in ACS.

Prognostic value of systemic immune-inflammation index in older patients with acute coronary syndrome

OBJECTIVES

Contemporary studies assessing the importance of the systemic immune-inflammation index (SII) in older patients presenting with acute coronary syndrome (ACS) are scarce. This study investigated the impact and prognostic value of the SII regarding long-term mortality in older patients with ACS.

METHODS

The study included 401 older patients aged 75 years and above admitted with ACS between May 2015 and December 2022. Predictors of mortality were determined using multivariate Cox regression analysis. Survival curves were generated using the Kaplan-Meier method.

RESULTS

The patients' median age was 81 (77-85) years, and 197 (49.1%) were male. The median follow-up was 23 months (Q1-Q3 : 4-43, maximum: 102). All short- and long-term deaths, including in-hospital deaths, were significantly high in patients with high SII (P = 0.001). Inflammatory variables, including C-reactive protein, SII, the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio, were positively correlated with the SYNTAX score (for SII; R = 0.492, P = 0.001). Multivariate Cox regression analysis revealed that age [hazard ratio (HR): 1.082, 95% confidence interval (CI): 1.051-1.114, P = 0.001], estimated glomerular filtration rate (HR: 0.988, 95% CI: 0.982-0.994, P = 0.001), SII (HR: 1.004, 95% CI: 1.001-1.006, P = 0.001), and left ventricular ejection fraction (HR: 0.959, 95% CI: 0.947-0.97, P = 0.001) were independent predictors of mortality in older patients with ACS. Kaplan-Meier analysis also showed that patients with high SII had a significantly higher mortality rate (P = 0.001).

CONCLUSION

A high SII is an independent predictor of long-term mortality in older patients with ACS.

A Novel Score for an Old Enemy: Atherogenic Plasma Index Predicts In-Stent Restenosis among Stable Angina Pectoris Patients

Objectives

Although the association of Atherogenic index of plasma (AIP) with coronary artery disease (CAD) and atherosclerosis is known, the relationship between AIP and in-stent restenosis (ISR) remains unclear. We aimed to investigate the relationship between AIP and ISR in patients with stable angina pectoris (SAP) treated with drug-eluting stent (DES).

Methods

Patients with a history of DES implantation following stable angina were evaluated between January 2015 and November 2019 in this observational and retrospective study. 608 eligible patients were dichotomized into ISR+ (n=241) and ISR- (n=367). ISR was defined as the presence of 50% or greater stenosis. AIP was defined as log [TG/HDL-C].

Results

AIP levels were significantly higher in patients who developed ISR compared with those who did not (0.33 [0.15-0.52] vs 0.06 [-0.08-0.21] respectively, p<0.001). The AUC value of AIP levels for predicting ISR was 0.746 (p<0.001). Multivariate logistic regression analysis revealed that AIP, diabetes mellitus, higher LDL-C levels and lower LVEF values were independently associated with ISR.

Conclusion

Multivariate analysis revealed that AIP was strongly independently associated with ISR. Using this novel inexpensive and easily calculable index may provide early recognition of ISR in patients with SAP who were treated with DES.

Blood-pool SPECT in addition to bone SPECT in the viability assessment in mandibular reconstruction

INTRODUCTION

The assessment of the postoperative viability of vascularized and non-vascularized grafts used in the reconstruction of mandibular defects due to trauma and surgical reasons is a major problem in maxillofacial surgery.

AIM

In the present study, we evaluated the feasibility and image quality of blood-pool SPECT, which is used for the first time in the literature here in the assessment of mandibular reconstruction, in addition to non-invasive bone scintigraphy and bone SPECT. We also evaluated whether it would be useful in clinical prediction.

PATIENTS AND METHODS

Micro-vascularized and non-vascularized bone grafts were used in 12 Syrian men with maxillofacial trauma. Between days 5-7 after surgery, three-phase bone scintigraphy, blood-pool SPECT and delayed bone SPECT scans were performed. After month 6, the patients were assessed by control CT scans.

RESULTS

Of the non-vascularized grafts, one graft was reported as non-viable at week one. At month 6, graft resorption was demonstrated on the CT images. The remaining non-vascularized grafts and all of the micro-vascularized grafts were considered to be viable according to delayed bone SPECT and blood-pool SPECT images. However, only the anterior and posterior ends could be clearly assessed on delayed SPECT images, while blood-pool SPECT images allowed the clear assessment of the entire graft.

CONCLUSIONS

The combined use of blood-pool and delayed SPECT scans could allow for better assessment of graft viability in the early period, and can provide more detailed information to clinicians about prognosis in the follow-up of patients undergoing mandibular graft reconstruction.