Funding Acknowledgements Type of funding sources: None. Inotroduction . CHA₂DS₂-VASc scoring system, which includes traditional risk factors of coronary artery disease, is actually created to determine the risk of thromboembolism in patients with atrial fibrillation. In this study; the value of CHA₂DS₂-VASc score, which can be calculated easily on admission, was evaluated for predicting in-hospital adverse outcomes in ST elevation miyocardial infarction (STEMI) patients without atrial fibrillation. Method This was a single center cross-sectional study. 1933 STEMI patients enrolled to the study. Primary end points include in-hospital death, cardiopulmonary arrest and cerebrovascular accident and were identified as MACE Results MACE rate was 10% (193 patients), in-hospital mortality rate was 9% (169 patients).In proportional logistic regression analysis, CHA₂DS₂-VASc score was an independent predictor for MACE (OR and CI 95%, 2.31[1.37-3.90]; p value:0.0016). In the regression analysis, the CHA₂DS₂-VASc score was taken as an uncatagorized continuous variable, and the relationship between the CHA₂DS₂-VASc score and MACE was observed to be linear. Additionally heart rate (OR and 95% CI, 1.56 [0.97- 2.50]; p value: 0.0242), killip class on admission (OR and 95% CI, 24.19[10.74-54.46]; p value <0.0001), creatinine level on admission (OR and 95% CI, 1.54 [1.10-2.16]; p value: 0.0024), peak CK-MB level (OR and 95% GA, 1.63 [0.98-2.70]; p value: 0.0001) and presence of no-reflow (OR and 95% CI, 2.45 [1.25-4.80]; p value: 0.0085) were indendified as other independent predictors of MACE. Conclusion CHA₂DS₂-VASc score was observed as an indepented predictor for MACE in STEMI patients. To evaluate the relationship between CHA₂DS₂-VASc score and outcomes, the linear analysis of the CHA₂DS₂-VASc score without categorization in prediction model is used and this is the main difference of our study from others. Table-1 Variables Odss Ratio (OR) and 95% CI p value CHA₂DS₂-VASc ( 0 to 3) 2.31 (1.37-3.90) p = 0,0016 Heart Rate (Beats per minute) ( 68 to 94) 1.56 (0.97-2.50) p =0.0242 Systolic Blood Pressure (mmHg) ( 115 to 156) 0.83 (0.51-1.34) p = 0.3523 Killip Class ( I to IV) 24.19 (10.74-54.46) p < 0.0001 Hemoglobin (g/dL) ( 12 to 15) 0.96 (0.54-1.70) p = 0.4066 Creatinine ( mg/dL) (0.74 to 1.0) 1.54 (1.10-2.16) p = 0.0024 Peak CK-MB (IU/L) (40.8 to 165.1) 1.63 (0.98-2.70) p = 0.0001 No-reflow (yes) 2.45 (1.25-4.80) p = 0.0085 Independent predictors of MACE in STEMI patients according to penalized proportional odds logistic regression analysis Abstract Figure. Partial impact plots of predictors
Funding Acknowledgements Type of funding sources: None. Ebstein anomaly is an extremely rare anomaly of <1% among all congenital heart diseases. Pathologically, the septal and / or posterior leaflet of the tricuspid valve has abnormal locations towards the right ventricular apex. Ebstein anomaly is especially accompanied by atrial septal defect, patent ductus arteriosus, wolf parkinson white syndrome and pulmonary atresia. Defects located in the interventricular septum are called the ventricular septal defect (VSD). They can be single or multiple and congenital or acquired. Isolated VSDs are the most common congenital anomaly in childhood and constitute 20-30% of all congenital heart diseases. VSD can be a part of major congenital malformations ,such as, fallot tetralogy, transposition of the major arteries, double ventricular right ventricle. Left ventricular noncompaction (LVNC) is a relatively common genetic cardiomyopathy, characterized by prominent trabeculations with deep intertrabecular recesses in mainly the left ventricle. Although LVNC often occurs in an isolated entity, it may also be present in various types of congenital heart disease . A combination of Ebstein anomaly, hypertrabeculation and ventricular septal defect is a rare condition. Case Report A 49-year-old male patient presented to the emergency room with shortness of breath and swelling of the legs. The patient had diagnosed an Ebstein anomaly while the military examination in 1988. Already it ‘s known that he has gout disease and uses colchicine but no family history of any disease. On examination of the patient, bilateral ral in respiratory sounds and +++ / +++ pretibial edema in the lower extremity were detected. On his electrocardiogram, the sinus rhythm with first-degree atrioventricular block was observed. The findings on his echocardiographic examination are ejection fraction 30-35% with global left ventricular hypokinesia, Ebstein anomaly (Figure ), perimembranous type VSD, atrial septal aneurysm type 2 and left ventricular hypertrabeculation. His blood table was normal. Medical treatment of heart failure was started for the patient who was interneed to the service. After getting clinical relief, the patient was discharged under medical treatment. Genetic tests were studied while following up at the heart failure outpatient clinic. In the MYH7 gene, splice-acceptor-2 (PVS1) variation heterozygous was detected. This variant has not been seen in national data banks of genetics. Conclusion The MYH7 gene, localized on chromosome 14p12, is composed of 41 exons and encodes the b-myosin heavy chain, expressed in cardiac muscle. Mutations in the MYH7 gene have been identified in association with left ventricular hypertrabeculation and Ebstein anomaly. In conclusion, this is the first known report of Ebstein anomaly associated with the splice-acceptor-2 variation heterozygous of the MYH7 gene. Abstract Figure
We assessed the ability of predicting mortality and total in-hospital bleeding and adverse outcomes by the Academic Research Consortium High Bleeding Risk (ARC-HBR) criteria in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). A total of 1441 STEMI patients were recruited: HBR group 354 (25%) patients and non-HBR group of 1087 (75%) patients. A total of 131 patients (9%) had a bleeding complication during hospitalization. The bleeding complications were also categorized according to other conventional bleeding scores. According to these conventional scores, all bleeding categories were associated with HBR. In univariate logistic regression analysis, female gender, diabetes mellitus, hypertension (HT) and HBR were associated with in-hospital bleeding. However, in multivariable analysis only HT (Odds Ratio [OR] 1.528, 95% CI 1.020–2.290; P = .040) and HBR (OR 1.612, 95% CI 1.075–2.428; P = .022) independently predicted total in-hospital bleeding complications. Hospital duration was longer and mortality rate was significantly higher in patients with HBR (OR 8.755, 95% CI 5.864–13.074; P < .01). The ARC-HBR criteria may predict in-hospital bleeding events and adverse outcomes in STEMI patients undergoing pPCI.
Background Since there is no proven treatment to reduce mortality in heart failure with preserved ejection fraction patients, to identify the predictors of decompensation are important in these patients. Purpose In this study, we aimed to evaluate the left atrium (LA) mechanical functions in patients with left ventricular hypertrophy (LVH) presenting with dyspnea and to investigate the predictors of pulmonary edema (PE). Methods This study was designed as a single-center cross-sectional study. Patients with LVH who presented to the emergency department with dyspnea were divided into two groups as PE (n=30) and non-PE (n=100). Mechanical functions of the LA were evaluated by speckle-tracking echocardiography. As a statistical method, diagnostic modelling was performed to demonstrate the relationship between demographic and echocardiographic features with the diagnosis of the patient (with or without PE). First, a basal model was created consisting of age, gender, body mass index (BMI), left ventricular mass index (LVMI), creatinine (Model 0). Then, different models were created by adding reservoir strain (S) (Model 1), conduit S, pump S, reservoir strain rate (SR), conduit SR and pump SR to the basal model, respectively. It was analyzed how each model made changes in performance criteria compared to the basal model. Results When the relationship between left atrial strain parameters and PE were analyzed, LA reservoir S (OR: 1.74 (1.14–2.64); p: 0.003) and LA pump SR (OR: 1.69 (1.07–2.64); p: 0.023) had found to be significantly associated with the development of PE. Another parameter associated with PE was admission creatinine value (OR: 1.52 (1.08–2.15), p-value: 0.016). In our study, LVMI is not a predictor for PE but, when the interaction of LA reservoir S and LVMI was considered, it is observed that decreased LA reservoir S is associated with more PE, especially in individuals with higher LVMI. Conclusion In this study, we found that the LA reservoir S is significantly associated with the development of PE in patients with LVH, especially in individuals with higher LVMI. Interaction of reservoir S and LVMI Funding Acknowledgement Type of funding source: None
<b><i>Aim:</i></b> The relationship between heme oxygenase-1 (HO-1) levels and atherosclerosis was investigated in multiple studies. The aim of this study was to establish the relationship between HO-1 levels and coronary SYNergy between percutaneous coronary intervention with TAXus and Cardiac Surgery (SYNTAX) score in patients with stable coronary artery disease (CAD). <b><i>Methods:</i></b> Patients who had been planned to undergo invasive coronary angiography due to a suspected CAD, between the dates of September and December 2019, were included in the study. Serum HO-1 levels were measured from peripheral venous blood. The SYNTAX score was calculated using standard coronary angiography images. Regression analysis was performed to establish the relationship between HO-1 levels and the SYNTAX score. <b><i>Results:</i></b> In total, 137 patients were included. The median age was 63 years (IQR: 15), and most of the patients were male (75.2%). The median HO-1 level was 1.44 (IQR: 0.88) ng/mL, and the median SYNTAX score was 6 (IQR: 13). Regression analysis showed that HO-1 is the single most important variable associated with the SYNTAX score (HO-1 levels from 1.01 to 1.87 ng/mL, OR: 6.77, 95% confidence interval 5.18–8.36, <i>p</i> < 0.0001). <b><i>Conclusion:</i></b> In this study, serum HO-1 levels were significantly associated with the coronary SYNTAX score.
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