Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology最新文献

Objective: Cardiac biomarkers can help diagnose and predict heart failure prognosis. High-sensitivity troponin T has frequently been investigated in ischemic heart failure studies. However, the relation between high-sensitivity troponin T and mortality in nonischemic heart failure and its level indicating poor prognosis remain unclear. This study aimed to show whether high-sensitivity troponin T is a predictor of all-cause mortality and the cut-off value for high-sensitivity troponin T in patients with nonischemic heart failure with reduced ejection fraction.

Methods: We included 249 nonischemic heart failure patients with left ventricular ejection fraction ≤ 40%, age ≥ 18 years, and high-sensitivity troponin T level known.

Results: Of the patients, 59.8% were male, 73.5% were New York Heart Association I or II, and the median age was 64. High-sensitivity troponin T value of the patients was 18 ng/L [inter-quartile range, 10-34]. The cut-off value of high-sensitivity troponin T for all-cause mortality was 21.5 ng/L, with 72.6% sensitivity and 69.9% specificity (area under the curve: 0.760, 95% CI: 0.692-0.828, P < 0.001). Patients were compared according to the 21.5 ng/L high-sensitivity troponin T cut-off value. At 30-month follow-up, all-cause mortality was 29.3%. According to the Kaplan-Meier analysis, the mortality rate was 14% in the high-sensitivity troponin T < 21.5 ng/L group, while the mortality rate was 50% in the high-sensitivity troponin T ≥ 21.5 ng/L group (P < 0.001, log-rank test). Baseline high-sensitivity troponin T was inde-pendently associated with all-cause mortality in nonischemic heart failure with reduced ejection fraction when adjusted for estimated glomerular filtration rate, hemoglobin, N-terminal pro-brain natriuretic peptide, body mass index, and left atrial diameter (hazard ratio: 1.012, 95% confidence interval: 1.003-1.020, P = 0.005).

Conclusion: The high-sensitivity troponin T cut-off value was 21.5 ng/L to predict a worse prognosis in nonischemic heart failure with reduced ejection fraction. There was an independent association between high-sensitivity troponin T and all-cause mortality.

Objective: Whether modified Glasgow prognostic score predicts prognosis in patients with cardiac resynchronization therapy with defibrillation is unknown. Our aim was to investigate the association of modified Glasgow prognostic score with death and hospitalization in cardiac resynchronization therapy with defibrillation patients.

Methods: A total of 306 heart failure with reduced ejection fraction patients who underwent cardiac resynchronization therapy with defibrillation implantation were categorized into 3 groups based on their modified Glasgow prognostic score categorical levels. C-reactive protein >10 mg/L or albumin <35 g/L was assigned 1 point each and the patients were classified into 0, 1, and 2 points, respectively. Remodeling was determined according to the clinical event and myocardial remodeling criteria. Major adverse cardiac events were defined as mortality and/or hospitalization for heart failure.

Results: Age, New York Heart Association functional class, modified Glasgow prognostic score prior to cardiac resynchronization therapy with defibrillation, sodium levels, and left atrial diameter were higher in the major adverse cardiac events(+) group. Age, left atrial diameter, and higher modified Glasgow prognostic score were found to be predictors of heart failure hospitalization/death in multivariable penalized Cox regression analysis. Besides, patients with lower modified Glasgow prognostic score showed better reverse left ventricular remodeling demonstrated by increase in left ventricle ejection fraction and decline in left ventricle end systolic volume.

Conclusion: Modified Glasgow prognostic score prior to cardiac resynchronization therapy with defibrillation can be used as a predictor of long-term heart failure hospitalization and death in addition to age and left atrial diameter. These results can guide the patient selection for cardiac resynchronization therapy with defibrillation therapy and highlight the importance of nutritional status.

Computed tomography-derived fractional flow reserve decreases from the proximal to the distal with coronary stenosis. According to the principles of fluid dynamics, paradoxical computed tomography-derived fractional flow reserve changes require an unconventional vessel mor-phology and specific site of the vessels with a high driving force. Therefore, only a few articles have reported a paradoxical increase of computed tomography-derived fractional flow reserve. We present a case report of marked computed tomography-derived fractional flow reserve elevation in the middle left anterior descending artery with a severe coronary stenosis. Computed tomography-derived fractional flow reserve was 0.94 just proximal to the stenotic lesion and decreased to 0.65 at the maximum stenosis area but recovered to 0.80 in the distal segment. We speculated that the vessel morphology could have caused a pressure recovery phenomenon, resulting in paradoxical computed tomography-derived fractional flow reserve changes.

The development of pulmonary arterial hypertension after bone marrow transplantation (BMT) is a rare but serious complication. In this case report, we presented the development of pulmonary arterial hypertension in a 22-year-old woman who underwent BMT due to aplastic anemia. Her symptoms on admission included shortness of breath, palpitations and fatigue. Pulmonary hypertension was classified with right heart catheterization as pul monary arterial hypertension. The patient's laboratory, echocardiographic and hemodynamic findings improved with pulmonary arterial hypertension-specific treatment. Pul monary arterial hypertension should be considered in the differ ential diagnosis of BMT patients with 'unexplained' hypoxemia or respiratory distress.

Primary cardiac tumors, which are uncommon types of tumors, can be presented with a variety of clinical signs and symptoms, depending on their location. We present a case of a 57-year-old female patient with a severe right-sided heart failure. Examination using 2-dimensional transthoracic and 3-dimensional transoesophageal echocardiography detected a large, oval, tumor-like formation within the right atrium, which compromised the blood flow from the superior and inferior vena cava. It appeared to have an irregular echo-free space in its central part, probably due to necrosis. Thoracic multislice computed tomography revealed a heterogeneous, expansive, tumor-like mass in the right atrium, with signs of bleeding in its center. Although there were no signs of metastatic dissemination, it could not be excluded that the tumor-like mass originated outside of the heart. The patient underwent surgical resection of the tumor. The surgery was accompanied with bleeding complications that developed due to the central necrosis with local infiltration. During the postoperative period, severe systemic inflammatory response syndrome developed and the patient died. Pathologists diagnosed undifferentiated pleomorphic cardiac sarcoma for which the prognosis is usually poor. The median survival of patients with this type of diagnosis is less than 1 year, even with surgical resection and further adjuvant therapy.