Objective:Current guidelines recommend a serum potassium (sK) level of 4.0-5.0 mmol/L in acute myocardial infarction patients. Recent trials have demonstrated an increased mortality rate with an sK level of >4.5 mmol/L. The aim of this study was to figure out the relation between admission sK level and in-hospital and long-term mortality and ventricular arrhythmias.Methods:Retrospectively, 611 patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention were recruited. Admission sK levels were categorized accordingly: <3.5, 3.5-<4, 4-<4.5, 4.5-<5, and ≥5 mmol/L.Results:The lowest in-hospital and long-term mortality occurred in patients with sK levels of 3.5 to <4 mmol/L. The long-term mortality risk increased for admission sK levels of >4.5 mmol/L [odds ratio (OR), 1.58; 95% confidence interval (CI) 0.42–5.9 and OR, 2.27; 95% CI 0.44-11.5 for sK levels of 4.5-<5 mmol/L and ≥5 mmol/L, respectively]. At sK levels <3 mmol/L and ≥5 mmol/L, the incidence of ventricular arrhythmias was higher (p=0.019).Conclusion:Admission sK level of >4.5 mmol/L was associated with increased long-term mortality in STEMI. A significant relation was found between sK level of <3 mmol/L and ≥5 mmol/L and ventricular arrhythmias.

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A b s t r a c tBackground: Heart failure (HF) is a fatal disease. Plasma osmolality with individual impacts of sodium, blood urea nitrogen (BUN), and glucose has not been studied prognostically in patients with HF. Aim:This study aims to investigate the impact of serum osmolality on clinical endpoints in HF patients. Methods:A total of 509 patients (383 males, 126 females) with HF with reduced ejection fraction in three HF centres were retrospectively analysed between January 2007 and December 2013. Follow-up data were completed for 496 patients. Plasma osmolality was calculated as (2 × Na) + (BUN/2.8) + (Glucose/18). Quartiles of plasma osmolality were produced, and the possible relationship between plasma osmolality and cardiovascular mortality was investigated. Results:The mean follow-up was 25 ± 22 months. The mean age was 56.5 ± 17.3 years with a mean EF of 26 ± 8%. The mean levels of plasma osmolality were as follows in the quartiles: 1 st % = 280 ± 6, 2 nd % = 288 ± 1, 3 rd % = 293 ± 2 (95% confidence interval [CI] 292.72-293.3), and 4 th % = 301 ± 5 mOsm/kg. The EF and B-type natriuretic peptide levels were similar in the four quartiles. Univariate and multivariate analyses in the Cox proportional hazard model revealed a significantly higher rate of mortality in the patients with hypo-osmolality. The Kaplan-Meier plot showed graded mortality curves with the 1 st quartile having the worst prognosis, followed by the 4 th quartile and the 2 nd quartile, while the 3 rd quartile was shown to have the best prognosis. Conclusions:Our study results suggest that normal plasma osmolality is between 275 and 295 mOsm/kg. However, being close to the upper limit of normal range (292-293 mOsm/kg) seems to be the optimal plasma osmolality level in terms of cardiovascular prognosis in patients with HF.

Admission hyperglycemia is associated with high inhospital and long-term adverse events in patients that undergo primary percutaneous coronary intervention (PCI). We aimed to evaluate whether hyperglycemia predicts inhospital mortality. We prospectively analyzed 503 consecutive patients. The patients were divided into tertiles according to the admission glucose levels. Tertile I: glucose <118 mg/dL (n ¼ 166), tertile II: glucose 118 to 145 mg/dL (n ¼ 168), and tertile III: glucose >145 mg/dL (n ¼ 169). Inhospital mortality was 0 in tertile I, 2 in tertile II, and 9 in tertile III (P < .02). Cardiogenic shock occurred more frequently in tertile III compared to tertiles I and II (10% vs 4.1% and 0.6%, respectively, P ¼ .01). Multivariate logistic regression analysis revealed that patients in tertile III had significantly higher risk of inhospital major adverse cardiac events compared to patients in tertile I (odds ratio: 9.55, P < .02). Admission hyperglycemia predicts inhospital adverse cardiac events in mortality and acute ST-segment elevation myocardial infarction in patients that underwent primary PCI.

A CDE endocarditis rate of 0.38% was demonstrated. It remains a rare but potentially lethal complication of device implantation.

Essential thrombocytosis is a myeloproliferative disorder of unknown etiology manifested clinically by the overproduction of platelets in the absence of a definable cause. Platelet dysfunction in essential thrombocytosis results in both hemorrhage and thrombosis. It is one of the rare causes of ischemic cardiovascular events. Fewer than 20 cases of essential thrombocytosis with involvement of coronary arteries leading to acute coronary syndromes or myocardial infarction have been reported. We report a case of multiple coronary thrombosis involving the left anterior descending artery and circumflex artery and stent implantation to the subtotally stenotic right renal artery in a women with unstable angina pectoris, essential thrombocytosis and previous history of renal artery trombosis.

Red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) have been found to be associated with cardiovascular diseases. Only a few trials have investigated the correlation of these parameters with postoperative atrial fibrillation (AF). However, the correlation of these parameters in non-valvular AF is still unclear. We retrospectively analyzed consecutive AF patients from medical records and included 117 non-valvular AF patients (103 paroxysmal and 14 chronic AF). All subjects underwent physical examination and echocardiographic imaging. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW, neutrophil and lymphocyte counts as well as mean corpuscular volume. Results of CBC tests within the previous year were also included and the averages were used. The demographic and echocardiographic properties of non-valvular AF group were comparable to the control group except for left atrial volumes which were increased in AF (median 33.1, IQR 26.3-41.1 cm(3) vs. median 26.4, IQR 24.2-28.9 cm(3); p = 0.01). RDW levels were significantly higher in the AF group (median 13.4 %, IQR 12.9-14.1 %) compared to the control (median 12.6 %, IQR 12.0-13.1 %; p = 0.01). NLR was not statistically different in the AF group and the controls (2.04 ± 0.94 vs. 1.93 ± 0.64, respectively; p = 0.32). Hs-CRP levels were higher in the AF group compared to the controls (median 0.84, IQR 0.30-1.43 mg/L vs. median 0.29, IQR 0.18-0.50 mg/L, respectively; p = 0.01). Multivariate logistic regression analysis revealed RDW (OR 4.18, 95 % CI 2.15-8.15; p = 0.01), hs-CRP (OR 3.76, 95 % CI 1.43-9.89; p = 0.01) and left atrial volume (OR 1.31, 95 % CI 1.06-1.21; p = 0.01) as the independent markers of non-valvular AF. Multivariate linear regression analysis revealed that hemoglobin levels (standardized β coefficient = -0.252; p = 0.01) and the presence of AF (standardized β coefficient = 0.336; p = 0.01) were the independent correlates of RDW levels. Elevated RDW levels, not NLR, may be an independent risk marker for non-valvular AF.

The elevated levels of plasma resistin were related to paroxysmal AF group and persistent AF group, but not to permanent AF group.