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

Ankylosing spondylitis is a complex chronic disease that starts from the spine and sacroiliac joint, causes joint stiffness, and affects the quality of life. Aortic dilatation, aortic valve insufficiency, and heart block due to conduction system involvement are the leading accompanying cardiac pathologies. In this case report, we aimed to show a rare cardiac involvement of left atrial calcification, pericardial involvement, and formation of a calcified inflammatory mass that might be misdiagnosed as vegetation on the mitral valve in a late-stage ankylosing spondylitis patient, by using multimodality imaging and histopathological diagnosis.

Objective: Although the positive effects of statin therapy in cardiovascular diseases are known, current heart failure guidelines do not recommend statins. The aim of this study was to investigate the effect of statin on all-cause mortality in patients with ischemic or non-ischemic heart failure with low ejection fraction using real-life data.

Methods: In this study, 1144 patients with heart failure with low ejection fraction were included retrospectively.

Results: In the study cohort, 55.4% were ischemic heart failure patients and 42.4% of the patients were on statin therapy. The rate of patients using statins was 60.5% in the ischemic group and 20.2% in the non-ischemic group (P <.001). During the median 35-month follow-up, 337 deaths were observed. Mortality rates were similar in ischemic and non-ischemic groups (31.3% vs 26.9%, P =.092). When the statin usage status of the patients was examined, ischemic heart failure, all survivors, and survivors with ischemic heart failure were using statins at a higher rate (P <.001). In the Kaplan-Meier analysis of all patients, the mortality rate was 22.7% in statin users, while the mortality rate was significantly higher in those who did not use statins, 34.4% (P <001). All-cause mortality was significantly higher in patients with ischemic heart failure not using statins than in patients using statins (P <.001) but not in non-ischemic heart failure (P =.07). Using statin was an independent predictor of all-cause mortality in all patients (hazard ratio: 0.661, 95% CI: 0.518-0.843, P =.001) and ischemic heart failure patients (hazard ratio: 0.618, 95% CI: 0.456-0.838, P =.002).

Conclusion: Since statin use reduces all-cause mortality in patients with ischemic heart failure, it may be recommended to continue statin therapy.

Background: COVID-19 is associated with vascular thrombosis in critical patients. However, warfarin has not been adequately studied in patients with COVID-19. This study aimed to evaluate whether the use of warfarin, a potent oral anticoagulant, was of clinical benefit in patients with COVID-19.

Methods: This was a retrospective cohort study of COVID-19 patients diagnosed at 3 different centers in Turkey between April 2020 and April 2021. Patients were grouped by whether they were taking warfarin or not. Propensity score matching analysis was used to compare the dif ferences between the groups in mortality, hospitalization, and admission to the intensive care unit.

Results: A propensity score analysis was performed on 128 patients in the warfarin group and 372 patients in the control group. After matching, 84 pairs of patients were compared. The patients in the control group were more likely to be admitted to the intensive care unit (33.3% vs. 14.3%, respectively; P=.007) and had longer hospital stays than the warfarin group (7.1 vs. 14.1 days; P=.005). The warfarin group had a lower death rate compared to the control group (7.1% vs. 27.4%, respectively; P=.001), and surviving patients were sig nificantly more likely to be in the warfarin group than the control group (56.1% vs. 20.7%, respectively; P=.001). In patients on warfarin, there was a lower incidence of in-hospital death (log-rank test P=.005).

Conclusions: Warfarin therapy could provide clinical benefits in patients with COVID-19. The current data highlight the importance of potent anticoagulation in the treatment of COVID-19.

Background: This study aimed to assess the safety and tolerability of nebivolol in hypertensive patients with coronary artery disease and left ventricular ejection fraction ≥ 40% in a Turkish cohort.

Methods: A total of 1015 hypertensive patients and coronary artery disease with left ventricular ejection fraction ≥ 40% were analyzed from 29 different centers in Turkey. Primary outcomes were the mean change in blood pressure and heart rate. Secondary outcomes were to assess the rate of reaching targeted blood pressure (<130/80 mmHg) and heart rate (<60 bpm) and the changes in the clinical symptoms (angina and dyspnea). Adverse clinical events and clinical outcomes including cardiovascular mortality, cardiovascular hospital admissions, or acute cardiac event were recorded.

Results: The mean age of the study population was 60.3 ± 11.5 years (male: 54.2%). During a mean follow-up of 6 months, the mean change in blood pressure was -11.2 ± 23.5/-5.1 ± 13.5 mmHg, and the resting heart rate was -12.1 ± 3.5 bpm. Target blood pressure and heart rate were achieved in 76.5% and 37.7% of patients. Angina and functional classifications were improved by at least 1 or more categories in 31% and 23.2% of patients. No serious adverse events related to nebivolol were reported. The most common cardiovascular side effect was symptomatic hypotension (4.2%). The discontinuation rate was 1.7%. Cardiovascular hospital admission rate was 5% and hospitalization due to heart failure was 1.9% during 6 months' follow-up. Cardiovascular mortality rate was 0.1%.

Conclusion: Nebivolol was well tolerated and safe for achieving blood pressure and heart rate control in hypertensive patients with coronary artery disease and heart failure with preserved or mildly reduced ejection fraction.

Coronary bifurcation lesions account for 15%-20% of all percutaneous coronary interven tions and are associated with greater procedural complexity and consequently at higher risk for cardiac adverse events. Early clinical trials in the interventional approach to bifurcation lesions supported provisional stenting. However, the most recent randomized studies have indicated potentially superior results using a double-kissing crush technique, particularly for unprotected distal left main bifurcation lesions. Moreover, many operators recently favor double-kissing mini-culotte, nanocrush, and double-kissing nanocrush stenting techniques for bifurcation lesions. In this review, we describe the traditional and novel bifurcation stenting techniques and the current evidence for each and review general principles for bifurcation percutaneous coronary intervention.

Despite recent advances in its management, the outcome of cardiac arrest is often poor despite appropriate cardiopulmonary resuscitation. The arteriovenous perfusion gradient achieved dur ing cardiopulmonary resuscitation is associated with the successful return of spontaneous cir culation. Continuous balloon occlusion of the descending aorta is an experimental method that can occlude the "unnecessary" part of the circulation, thus diverting generated pressure and blood flow to the heart and brain. In this study, we present a case report of a patient unre sponsive to standard cardiopulmonary resuscitation, in whom constant intra-aortic balloon occlusion achieved a return of spontaneous circulation and successful survival.

Objective: Coronary artery calcification is a cornerstone marker for coronary atherosclerosis. Therefore, the calculation of the coronary artery calcium score has become a routine method in diagnosing coronary artery disease in recent years. Monocyte to high-density lipoprotein cholesterol ratio reflects proatherogenic and antiatherogenic balance, and this ratio is associated with coronary atherosclerosis and cardiovascular events. This study aimed to investigate the value of monocyte to high-densitylipoprotein cholesterol ratio in predicting coronary atherosclerosis, which coronary artery calcium score determines.

Methods: A total of 276 patients with chest pain who underwent coronary computed tomography angiography were enrolled in the study. The patients were divided into 3 groups according to coronary artery calcium score [coronary artery calcium score=0 for very low risk (n=121), coronary artery calcium score=1-99 for low risk (n=100), coronary artery calcium score ≥ 100 for moderate-high risk (n=55)]. The monocyte to high-density lipoprotein cholesterol ratio, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and plateletto-lymphocyte ratio were calculated from venous blood samples.

Results: Monocyte to high-density lipoprotein cholesterol ratio values were significantly higher in patients with moderate-high coronary artery calcium score (1.29 ± 0.59 vs 1.41 ± 0.56 vs 1.56 ± 0.58, P =.009). However, there were no differences between the groups in terms of other inflammatory markers (neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and platelet-to-lymphocyte ratio). Age (odds ratio: 1.178; 95% CI: 1.107-1.253; P < .001), dyslipidemia (odds ratio: 14.252; 95% CI: 5.459-37.211; P <.001), smoking (odds ratio: 2.893; 95% CI: 1.317-6.358; P=.008), and monocyte to high-density lipoprotein cholesterol ratio (odds ratio: 2.082 per 1-point increase; 95% CI: 1.016-4.268; P=.045) were independent predictors of coronary artery calcium score in multivariate analysis.

Conclusion: Our data showed that high monocyte to high-density lipoprotein cholesterol ratio is significantly associated with increased coronary artery calcium score. Monocyte to highdensity lipoprotein cholesterol ratio indicates that it can be applied easily and swiftly in clinics to help predicting the coronary artery disease.