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   Table of Contents - Current issue
April-June 2021
Volume 7 | Issue 2
Page Nos. 33-61

Online since Monday, July 5, 2021

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Comparative performance of CHA2DS2VASc and anticoagulation and risk factors in atrial fibrillation risk scores for predicting mortality in patients with COVID-19 p. 33
Dilay Karabulut, Ersan Oflar
Background: The AnTicoagulation and Risk factors in Atrial fibrillation (ATRIA) and CHA2DS2VASc risk scores used to detect the thromboembolic and hemorrhagic risk in atrial fibrillation (AF) patients has been shown recently to predict poor clinical outcomes varies clinical settings, regardless of having AF. We aimed to examine the potential utility of admission CHA2DS2VASc and ATRIA scores for predicting in-hospital mortality in patients with coronavirus disease 2019 (COVID-19). Methods: In this retrospective study hospitalized 134 COVID-19 patients who diagnosed with a positive polymerase chain reaction test, were included. Patients were divided into two groups who were died and survivors, both the groups were compared according to clinical, laboratory, and demographic features, including the CHA2DS2VASc and ATRIA risk score. Predictors of mortality were determined by logistic regression analysis. Results: ATRIA and CHA2DS2VASc risk scores were predicting mortality in COVID-19 patients. Logistic regression analysis showed that ATRIA risk score, AF and chronic obstructive pulmonary disease were an independent predictor of mortality. For an ATRIA score cut off value of 3, the sensitivity was 77.78%, specificity 57.94%, positive predictive value 31.80, and negative predictive value 91.20. For a CHA2DS2VASc score cut-off value of 4, the sensitivity was 44.44%, specificity 83.18%, positive predictive value 40, and negative predictive value 85.60. Conclusion: CHA2DS2-VASc and ATRIA scores can be used as a novel, simple tool for predicting mortality in COVID-19 patients.
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Immediate and short-term outcomes of percutaneous transvenous mitral commissurotomy on global and regional right ventricular strain by speckle-tracking echocardiography p. 39
Deepak Maheshwari, Sahil Sareen, Himanshu Mahla, Shashi Mohan Sharma
Objectives: The study aimed to determine short- and long-term improvement on global and regional right ventricular (RV) strain after successful treatment by percutaneous transvenous mitral commissurotomy (PTMC). Furthermore, we endeavored to define the normal values of RV strain in a healthy age- and sex-matched population that may serve as reference for future investigators. Methods: The interventional case–control study was done on consecutive patients who were admitted in the department of cardiology for balloon mitral valvotomy (BMV) from April 2018 to July 2019. One hundred and forty-eight patients with isolated severe mitral stenosis (MS) in sinus rhythm were assessed for RV function by two-dimensional speckle tracking calculating RV global longitudinal strain (GLS-RV) and longitudinal strain of the free wall (GLS-RVFW) before and after BMV and compared with seventy-two healthy age-matched controls for a 6-month follow-up. Results: At baseline, the GLS of the right ventricle and free wall strain was significantly less among cases as compared to controls (GLS-RV median 20 vs. 23.3, P < 0.0001 and GLS-RVFW median 23 vs. 27, P < 0.0001). Post-PTMC, the global and regional longitudinal RV strain improved significantly at 24 h and 6 months post procedure and became comparable to that of the control population at 6-month follow-up (cases vs. controls: median GLS-RV [23 vs. 23.3, P = 0.774] and GLS-RVFW [27 vs. 27, P = 0.558]). Conclusions: PTMC causes significant immediate and long-term improvement in the RV strain and can serve as a good prognostic marker for the outcomes in patients with isolated MS.
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Demographic, clinical characteristics and medications of rehospitalized patients for acute coronary syndrome: boomerang study p. 45
Tugba Kemaloglu Oz, Tarik Kivrak, Abdallah Almaghraby, Mahmoud Abdelnabi, Onur Tasar, Begum Uygur, Emrah Aksakal, Gobinda Kanti Paul, Seyyad Farshad Sadri, Fatemeh Nikroo, Yagoub Musa, Batur Kanar, Hakki Kaya, Fady Gerges, Yusuf Cekici, Arash Hashemi, Bilal Cuglan, Lutfu Bekar, Irina Kotlar, Mustafa Yenercag, Mesut Gitmez, Aysel Akhundova, Sinan Inci, Mehtap Yeni, Mustafa Dogdus, Meltem Altinsoy, Ayman Helal, Shafa Shahbazova, Fatih Tamnik, Patrick W J Tiau, Ibrahim Ersoy, Fadime Bozdurman, Mehdi Zoghi
Background: Rehospitalizations with acute coronary syndromes (ACSs) have declined over the last years, but there is a remaining need for potential further reduction of rehospitalization after ACS to determine the most predominant predictors that can guide strategies to reduce re-hospitalizations burden. Aim: This multi-center study aimed to evaluate the demographic, clinical characteristics, and medications of rehospitalized patients who suffered a new cardiac event in 12 months after admission due to ACS. Material and Methods: Patients age >18 years who have been hospitalized between November 1 2017, and April 1 2018, for ACS within12 months before the readmission for a new acute coronary event were enrolled. Results: The present study included a total of 628 (65.9% from Turkey) consecutive patients rehospitalized with ACS (ST-elevation myocardial infarction [STEMI], 23.0%; ACS without ST-elevation [NSTE-ACS], 76.9%) from 15 different countries. The majority of the rehospitalized patients were men (67.9%), and the mean age was 63.1 ± 12.53 years. 406 (64.6%) had typical, 209 (33.2%) of patients had atypical chest pain and 13 (2.07%) had not any chest pain complaint during readmission. 304 (48.41%) of patients were discharged from hospital earlier than 3 days and 107 (17.04%) of patients stayed more than 7 days. The subcategories of first index diagnosis were 227 (36.1%) STEMI; 401 (63.8%) NSTE-ACS. The mean time from index discharge to rehospitalization was 189.25 ± 118 days. 248 (39.4%) patients were re-hospitalized more than once after index discharge. The most common risk factors were diabetes mellitus (471, 75.0%). 175 (27.87%) of patients stopped taking medication before re-hospitalization. Most of the patients (69.4%) had multivessel disease. Conclusion: Several factors identify patients at higher risk of rehospitalization with ACS. Understanding and preventing these causes can prevent rehospitalization and improve their outcome.
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A new predictor of in-stent restenosis in patients undergoing elective percutaneous coronary İntervention: triglyceride glucose İndex p. 50
Muhsin Kalyoncuoglu, Alev Arat Ozkan, Aysem Kaya, Yasin Yuksel, Nafi Dogan, Aziz Tevfik Gurmen
Objective: This study aimed to investigate whether triglyceride glucose (TyG) index predicts the development of in-stent restenosis (ISR) in patients undergoing percutaneous coronary intervention (PCI) for de novo lesions. Materials and Methods: This was a prospective case controlled study and includes 124 patients with a mean age of 57 ± 9.1. Control coronary angiography was performed in all patients enrolled in the study 6–12 months after the PCI. Blood sample triglycerides (TGs) and blood glucose concentrations were collected after at least 8 h of fasting. The TyG index was calculated as follows: log (serum TGs [mg/dL] × plasma glucose [mg/dL]/2). The study cohort was divided into two groups as those with and without restenosis. Angiographically, stent restenosis, defined as the presence of ≥50% diameter narrowing either within the stent or within 5 mm proximally or distally to the stent margin. Results: The median follow-up time was 7.17 months (±2.01). Forty-eight patients (38.7%) had restenosis. Patients with ISR had more diabetes (P < 0.01) and CAD (P = 0.03). These also had higher TyG index (P = 0.04) and less drug-eluting stent implantation (P = 0.04). Diabetes (odds ratio [OR]: 1.927, P = 0.03), stent type (OR: 0.342, P = 0.02), and TyG index (OR: 4.144, P = 0.01) significantly predicted ISR. The receiver operating characteristics curve analysis revealed a cutoff value of TyG index >4.71 predicts the development of ISR. Conclusion: A TyG above 4.71 was found a risk factor for ISR during 1-year follow-up period after index elective PCI.
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Comparison between preoperative loading dose of ticagrelor versus clopidogrel on myocardial perfusion in type ii diabetic patients presenting with anterior wall myocardial infarction p. 55
Emad Effat Fakhry, Adel Mohammed El Etriby, Ahmed Elmahmoudy Nayel
Background: Diabetes mellitus is recognized as an independent risk factor for the development of Coronary No Reflow. Ticagrelor has a faster onset of action and a stronger antiplatelet effect as compared to clopidogrel. The aim of this study is to compare between ticagrelor and clopidogrel loading doses before primary percutaneous coronary intervention (PCI) in Type II diabetic patients presenting with anterior wall ST-Segment Elevation Myocardial Infarction (STEMI) and their different effect on myocardial perfusion and in-hospital Major Adverse Cardiac Events. Methods: The study included 170 patients with Type II diabetes, who presented with acute anterior wall STEMI who underwent primary PCI. They were randomized into two groups, the1st group 85 patients received clopidogrel loading dose (600 mg) and the 2nd group 85 patients received ticagrelor loading dose (180 mg). Postinterventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded as well as in-hospital outcomes. Results: In the clopidogrel group, 80% of the patients had TIMI III flow score, 15.3% had TIMI II flow score and 2.4% had TIMI I and TIMI 0 flow score. In the ticagrelor group, 95% of the patients had TIMI III flow score, 2.4% had TIMI II flow score and 1.2% had TIMI I and TIMI 0 flow score (P = 0.01). Regarding MBG, in the clopidogrel group, 64.7% of the patients had MBG III, 13% had MBG II flow score, 2.3% had MBG 1, and 20% had MBG 0. In the ticagrelor group, 93% of the patients had MBG III, 1.1% had MBG II flow score, 1.1% had MBG 1, and 4.8% had MBG 0 (P = 0.007). In the clopidogrel group there were 3.5% in-hospital mortality, while in ticagrelor 2.4% in-hospital mortality (2.4%) (P = 0.47). In the Clopidogrel group, in-hospital MACE was 5.8% versus 3.5% in the ticagrelor group (P = 0.65). In the Clopidogrel group, in-hospital bleeding was 3.5% versus 4.7% in the ticagrelor group (P = 0.7). Conclusion: Ticagrelor loading before primary PCI resulted in improved TIMI flow and MBG in Type II diabetic patients presenting with anterior wall myocardial infarction.
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Living with a pericardial hydatid cyst for 50 years p. 60
Sinan Sahin, Ahmet Ozderya, Gulay Uzun, Muhammet Rasit Sayin
Isolated cardiac location is an uncommon presentation of echinococcosis and involvement of the pericardium is even rarer. It may lead to various complications or remain asymptomatic for a long time. We report a case of a 71-year-old woman with isolated pericardial hydatid cyst (without myocardial involvement) that observed with incidentally.
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