Anatolian Journal of Cardiology最新文献

Background: The aim of this study was to assess the adherence to the current European Society of Cardiology dyslipidemia guidelines, the ratio of reaching target values according to risk groups, and the reasons for not reaching LDL-cholesterol (LDL-C) goals in patients on already statin therapy in a cardiology outpatient population.

Methods: The AIZANOI study is a multi-center, cross-sectional observational study including conducted in 9 cardiology centers between August 1, 2021, and November 1, 2021.

Results: A total of 1225 patients (mean age 62 ± 11 years, 366 female) who were already on statin therapy for at least 3 months were included. More than half (58.2%) of the patients were using high-intensity statin regimens. Only 26.2% of patients had target LDL-C level according to their risk score. Despite 58.4% of very high-risk patients and 44.4% of high-risk patients have been using a high-intensity statin regimen, only 24.5% of very-high-risk patients and only 34.9% of high-risk patients have reached guideline-recommended LDL-C levels. Most prevalent reason for not using target dose statin was physician preference (physician inertia) (40.3%).

Conclusion: The AIZANOI study showed that we achieved a target LDL-C level in only 26.2% of patients using statin therapy. Although 58.4% of patients with a very high SCORE risk and 44.4% of patients with a high SCORE risk were using a target dose statin regimen, we were only able to achieve guideline-recommended LDL-C levels in 24.5% and 34.9% of them, respectively, in cardiology outpatients clinics. Physician inertia is one of the major factors in non-adherence to guidelines. These findings highlight that combination therapy is needed in most of the patients.

Background: Right ventricular dysfunction (RVD) is the main determinant of mortality in patients with pulmonary embolism (PE). Thus, guidelines recommend the assessment of RVD with transthoracic echocardiography (TTE) or computed tomography pulmonary angiography (CTPA) among these patients. In this study, we investigated the agreement between TTE and CTPA for the detection of RVD.

Methods: This single-center retrospective study included patients who were diagnosed with CTPA and underwent TTE within the first 24 hours following the diagnosis.

Results: Two hundred fifty-eight patients met the inclusion criteria. In 71.3% (184) of them, CTPA and TTE agreed on both the presence and absence of RVD. There was a moderate agreement between the 2 tests (Cohen's kappa = 0.404, P <.001). The agreement between right ventricle dysfunction on TTE and the increased right ventricle/left ventricle (RV/LV) on CTPA was fair (Cohen's kappa = 0.388, P <.001). Three patients died due to PE, and another 5 patients required urgent reperfusion therapy. Overall, adverse outcomes occurred in 4% (8) of patients. The sensitivity of modalities in the detection of adverse outcomes was 100%. Transthoracic echocardiography was more specific compared to CTPA (43% vs. 28%). Statistically, flattening/bulging of the interventricular septum on TTE was significantly associated with adverse outcomes. No individual CTPA parameter was related to adverse outcomes.

Conclusion: Both CTPA and TTE are reliable imaging modalities in the detection of RVD. However, TTE is more specific, and this may help in the identification and appropriate management of patients at higher risk of decompensation. A combination of CTPA parameters rather than individual RV/LV ratios increases the sensitivity of CTPA.

Background: We aimed to examine the effects of COVID-19 infection versus vaccination within the month prior to acute coronary syndrome (ACS) diagnosis with respect to their impact on the development of mortality or major adverse cardiovascular events (MACE).

Methods: This retrospective cohort study included patients hospitalized with a diagnosis of ACS between June 2020 and December 2022. Patients diagnosed with ACS were grouped according to the presence of COVID-19 infection (post-COVID), vaccination (post-vaccine), or non-exposure during the month prior to ACS diagnosis. Patients with and without MACE were also compared separately.

Results: We analyzed 1890 ACS patients (mean age 57.43 ± 11.53 years, 79.15% males). Of these, 319 (16.88%) were in the post-vaccine group, and 334 (17.67%) were in the post-COVID group. Major adverse cardiovascular events occurred in 569 (30.11%) patients. Mortality was recorded in 271 (14.34%) patients. In the post-COVID group, the frequencies of MACE and mortality and length of stay in hospital were significantly higher (vs. post-vaccine and vs. non-exposure groups; both P <.001). High age, ST-elevation myocardial infarction, having suffered from Post-COVID ACS, and high glucose were independently associated with increased MACE risk; whereas, hyperlipidemia, 3 or more COVID vaccinations, receipt of the Biontech vaccine, and high estimated glomerular filtration rate were independently associated with decreased MACE risk.

Conclusion: Acute coronary syndrome patients who have recently had COVID-19 infection may have a worse prognostic course compared to those with recent vaccination, necessitating continuing care for pandemic-related risk factors as well as previously known factors impacting MACE and prognosis.

Background: The aim was to analyze the correlation between serum microRNA (miR)-18a level, endothelial function, and prognosis in female coronary heart disease (CHD) patients.

Methods: One hundred sixtyfemale patients admitted to our hospital for the first occurrences of chest pain and tightness were divided into CHD and non-CHD groups based on the coronary angiography results. Clinical data, laboratory indexes, serum miR-18a level, and endothelial function [flow-mediated dilation (FMD) function, endothelin 1 (ET-1), and nitric oxide (NO)] were compared.

Results: There were no significant differences in clinical data (except CHD family history) between 2 groups. Coronary heart disease group had significantly lower levels of NO and FMD, while significantly higher levels of miR-18a and ET-1 than non-CHD group (P <.05). Pearson correlation showed that serum miR-18a level was positively correlated with ET-1 (r = 0.492, P <.001), and negatively correlated with NO and FMD (r = -0.504, -0.307, P <.001). The receiver operating characteristic) curve showed that the area under the curve of serum miR-18a level in predicting the occurrence of CHD in women was 0.878 (95% CI:  0.828-0.928). Compared with good prognosis group, poor prognosis group had signifi-cantly lower NO, and FMD levels, while higher proportions of acute coronary syndrome, multivessel disease, miR-18a, and ET-1 levels (P <.05).

Conclusion: The expression of serum miR-18a in female CHD patients was high, which was related to endothelial function. The increase in serum miR-18a level was a risk factor for the occurrence of MACE in female CHD patients during follow-up, and the serum miR-18a level could effectively predict the occurrence of CHD in female patients.