Aim: This work was designed to investigate the relationship between cardiac outcomes and Naples Prognostic Score (NPS) among heart failure (HF) patients. Materials & methods: This retrospective observational study enrolled 298 consecutive individuals hospitalized for New York Heart Association class 3–4 HF. The primary outcome was all-cause mortality. Secondary outcomes were rehospitalization and in-hospital death. Results: The high NPS group had a statistically greater rate of all-cause mortality (p < 0.001). In Cox regression analysis, integrating NPS considerably improved the performance of the full model over the baseline model (adjusted hazard ratio = 2.28; p = 0.004). Based on time-dependent receiver operating characteristic curve analysis, the NPS model outperformed the baseline and CONUT score models in discriminatory power in predicting the probability of survival. Conclusion: NPS was associated with short- and midterm mortality as well as rehospitalization.

There is a lack of evidence regarding the short-term predictive value of serum albumin to creatinine ratio (sACR) in patients with ST-segment elevation myocardial infarction (STEMI). This study aims to investigate the relationship between sACR and short-term outcomes in these patients. We retrospectively enrolled 3057 patients with STEMI who underwent primary percutaneous coronary interventions (PCI) (median age was 58 years, and 74.3% were male). In-hospital mortality occurred in 114 (3.7%) patients. Contrast-induced nephropathy (CIN) was reported in 381 (12.4%) patients. During a 30-day follow-up, stent thrombosis (ST) occurred in 28 (.9%) patients and 30-day death in 147 (4.8%) patients. Multivariable logistic regression analysis reported that sACR was inversely associated with 30-day mortality (adjusted odds ratio (aOR): .51, 95% confidence interval (CI) .31–.82, P < .001). The sACR was also inversely associated with in-hospital mortality (aOR: .71, 95% CI .56–.90, P = .009), CIN (aOR: .60, 95% CI .52–.68, P < .001), congestive heart failure (CHF) (aOR: .64, 95% CI .47–.87, P = .007), and ST (aOR .61, 95% CI .41–.92, P = .001) at 30 days. Our findings suggest that sACR is inversely associated with short-term clinical outcomes in patients with STEMI after PCI.

We have some criticism regarding some technical issues. Mixed models have begun to play a pivotal role in statistical analyses and offer many advantages over more conventional analyses regarding repeated variance analyses. First, they allow to avoid conducting multiple t-tests; second, they can accommodate for within-patient correlation; third, they allow to incorporate not only a random coefficient, but also a random slope, typically ‘linear’ time in longitudinal case series when there are enough data and patients’ trajectories vary a lot and improving model fit.

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Background Left ventricular systolic dysfunction (LVSD) may develop without coronary artery disease, hypertension (HT), or valvular pathologies in patients with diabetes mellitus (DM), which is defined as diabetic cardiomyopathy (DCM) and its pathophysiology is still unclear. Diabetic retinopathy (DR) is a microvascular complication of DM, and patients with DR have increased risk for the development of heart failure (HF). Two-dimensional speckle tracking echocardiography (2D-STE) evaluates longitudinal deformation in left atrium (LA) myocardium and previous studies utilizing 2D-STE have revealed the detrimental effects of DM on LA functions. Although some studies have shown the association between DR and left ventricle (LV) systolic functions, as far as the researchers of this study investigated, there is no study evaluating the relationship between LA deformation parameters and DR. Hence, we aimed to investigate the relationship between the presence and the degree of DR and LA deformation parameters. Results LA deformation parameters were analyzed in terms of LA reservoir, conduit, and contractile functions according to the degree of DR. LA reservoir strain value was 14.2 ± 3.6 in normal retina group, 12.2 ± 4.1 in non-proliferative diabetic retinopathy (NPDR) group, and 13 ± 3.7 in proliferative diabetic retinopathy (PDR) group (P = 0.04). LA contractile strain was 15.9 ± 6.8 in normal retina group, 13.1 ± 47.4 in NPDR group, and 9.9 ± 4.7 in PDR group (P < 0.001). LA conduit strain was 30.1 ± 6.6 in normal retina group, 25.3 ± 6.5 in NPDR group, and 22.9 ± 4.9 in PDR group (P < 0.001). Proportional odds regression for association between clinical data, echocardiographic parameters, and LA contractile strain function showed that increasing creatinine (from 0.7 to 1.0; OR 0.71; 95% CI 0.51–0.99; P = 0.04), DR presence (OR 0.24; 95% CI 0.11–0.50; P = 0.001), and increasing left atrial volume index (LAVI) (from 33.5 to 52.6; OR 0.62; 95% CI 0.43–0.89; P = 0.01) were associated with decreasing LA function; however, other variables indicated no association. Conclusions Our results showed the relationship between LA deformation parameters and DR, although microvascular involvement is not a certainly defined cardiovascular risk factor. Further prospective studies are needed to determine the clinical importance of DR presence and its degree for deformation parameters.

Stent under-expansion is a predictor of restenosis and stent thrombosis. It remains uncertain whether enhanced stent imaging (ESI) (CLEARstent) guidance can improve stent under-expansion. Our aim was to assess the effect of using ESI on stent under-expansion, after percutaneous coronary intervention (PCI) in a single center, cross-sectional observational study. Participants attending our cardiology clinic with stable angina or acute coronary syndrome, from March to September 2020 were recruited. A total of 164 patients who underwent post-PCI ESI (CLEARstent) were compared with 77 age- and sex-matched control patients. Post-procedural minimal lumen diameter (MLD) was calculated. The patients in the ESI-guided PCI group, had a median age of 61 (54–69 IQR 25-75) years and 76.8% (n = 126) were males. The patients in ESI-guided PCI group had a greater minimal lumen diameter compared with the X-ray guided PCI group (βeta coefficient:2.88 (95% CI:2.58–2.99) vs βeta coefficient 2.55 (95% CI 2.34–2.63), P < .001). Our finding supports the use of the ESI system to optimize stent placement as expressed by the MLD.

Objectives: Malnutrition is a serious public health problem that is associated with adverse outcomes in a broad range of disease including cardiovascular disease and diabetes mellitus. Malnutrition is demonstrated to be accompanying to several disease, yet there is a lack of evidence on the impact of malnutrition on cardiac functions in patients with diabetic patients with diabetic retinopathy. Herewith our primary goal was to evaluate the relation between any degree malnutrition with left atrial strain in relevant patient group. Patients and Methods: Patients with diabetes mellitus with retinopathy, who were referred to the outpatient cardiology clinic were assessed. Those who had sinus rhythm, had no findings of significant valvular heart disease and coronary artery disease underwent to 2-dimensional speckle tracking echocardiography and assessed for malnutrition in their prior examinations were included to the study. Hundred and seventy patients met the inclusion criteria. Malnutrition scores such as CONUT score, NRI, and PNI were used to evaluate nutrition condition of the patients. Results: Thirty percent of all diabetic patients were demonstrated to have malnutrition according to the CONUT score. Left atrial conduit strain was demonstrated to decrease [ß: -7.5 (CI 95%, -10.7, -4.3 p<0.001)], Left atrial reservoir strain was demonstrated to increase [ß: 2.48(CI 95%,0.83- 4.13 p<0.03)] and Left atrial contractile strain was demonstrated to decrease [ß: -4.21(CI 95%, -2.21, -6.01 p<0.001)] in the presence of any degree malnutrition. Conclusion: In this study we have demonstrated that malnutrition is an important entity in patients with diabetes mellitus and also has a significant impact on Left atrial strain.

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