Turkan Seda Tan

Background: Conventional echocardiographic improvements after sodium–glucose cotransporter-2 (SGLT2) inhibitor therapy have been reported in heart failure with preserved ejection fraction (HFpEF), but data on novel composite indices of atrial mechanics, particularly the left atrial (LA) stiffness index and the left atrioventricular coupling index (LACI), remain poorly characterized. The authors evaluated early changes in conventional diastolic parameters and atrial mechanics following initiation of SGLT2 inhibitor therapy. Methods: In this prospective, single-center observational cohort study, patients with HFpEF in sinus rhythm who were naive to SGLT2 inhibitors received empagliflozin or dapagliflozin. Clinical assessment, laboratory testing, and comprehensive echocardiography were performed at baseline and after 3 months. Echocardiographic evaluation included LA reservoir and pump strain, the LA stiffness index (E/e′/LA reservoir strain), and LACI (minimum LA volume/LV end-diastolic volume ×100). Results: Fifty patients completed follow-up (70% women; mean age, 63.9 ± 8.1 years). New York Health Association functional class improved and N-terminal pro–brain natriuretic peptide levels decreased significantly (347 [134.8-524.8] vs. 257 [161.3-427.5] pg/mL; P = .007). Left atrial volume index and E/e′ decreased significantly (34.6 ± 5.5 to 32.6 ± 5.7 mL/m2 and 12.1 ± 3.2 to 9.8 ± 2.8, respectively; both P < .001). Left atrial reservoir and pump strain increased, whereas the LA stiffness index and LACI decreased significantly (all P < .001). Conclusions: In this prospective observational cohort of patients with HFpEF, initiation of SGLT2 inhibitor therapy was associated with early changes in conventional diastolic parameters and LA mechanics. Composite atrial indices, particularly the LA stiffness index and LACI, changed in parallel with established clinical and echocardiographic markers, suggesting that they may provide complementary information for monitoring early atrial remodeling during SGLT2 inhibitor therapy.

Ventricular arrhythmias (VA) are a major cause of sudden cardiac death (SCD) in heart failure patients. It is not known whether readily available clinical markers are of any clinical yield in detecting a subclinical inflammation that may be inflicted in acute arrhythmogenesis. This study aimed to evaluate the prognostic value of inflammatory markers in patients undergoing ventricular tachycardia (VT) catheter ablation and to compare characteristics between those with electrical storm (ES) and elective ablation (EL). This retrospective observational study included patients with structural heart disease undergoing VT ablation. Inflammatory markers (CRP, blood leukocyte, neutrophil, platelet, lymphocyte counts and systemic immune-inflammatory index (SII)) were assessed pre-procedurally. We analyzed procedural outcomes, VT recurrence, mid-term mortality and presence of an electrical storm, correlating these with inflammatory markers. p < 0.05 was considered significant in all analyses. Of 140 patients analyzed (median age 65 ± 15 years; 87.1% males), 63 (45%) had ES and 77(55%) underwent elective ablation. The median ejection fraction was 25%±15.The ES group had significantly higher neutrophil counts and systemic immune-inflammation index (SII) compared to the EL group (p = 0.010 and p = 0.013, respectively). On univariate analysis, elevated SII was associated with mid-term mortality (HR 3.487, p = 0.016), alongside age > 70 years and history of coronary artery bypass grafting (CABG). SII and history of CABG were independent predictors of death on multivariate analysis (HR 1.879, p = 0.018) and (HR: 4.891, p = 0.003), respectively. SII is notably higher in those experiencing ES and is a predictor of mid-term mortality.

Background: Ventricular fibrillation (VF) is a poorly understood arrhythmia that is one of the main mechanisms of sudden cardiac death in patients with structural heart disease (SHD). Fascicular and Purkinje tissue (FPT) has been implicated in VF. Objective: In this study, we sought to analyze the involvement of FPT colocalized with the scar area of SHD. Additionally, we aimed to investigate outcomes of FPT and scar substrate ablation in SHD VF patients and compare outcomes with VT ablation patients. Methods: This is a retrospective observational study. Clinical and procedural data were collected. Results: Sixteen patients undergoing VF ablation were assigned to the VF group, and their outcomes were compared to those of 170 patients who underwent structural VT ablation. In 15 patients, FPT targets colocalized with low voltage area, LPs, and/or LAVAs. Septal Purkinje and left posterior fascicle were most commonly involved. Procedural metrics were similar with patients undergoing VT ablation. During median follow‐up of 5.5 months (interquartile range [IQR]: 3.5–10), VF recurred in two patients. Conclusion: This study has shown frequent colocalization of FPT with electrophysiologic substrate (late potentials [LPs], low voltage area, etc.) in patients with SHD and VF. We have shown the feasibility of FTP and substrate ablation with good mid‐term outcomes in a small group of patients. Larger studies are necessary for definitive evidence.

Aims: Acute heart failure (AHF) is the leading cause of hospital admissions among adults ≥65. Loop diuretics are the mainstay of treatment of congestion in AHF. Response to loop diuretics is closely related to morbidity and mortality. In this study, we aimed to investigate (1) the clinical determinants of diuretic efficiency (DE) by using three separate indicators for assessing DE and (2) the prognostic effect of diuretic efficiency in acutely decompensated heart failure patients. Methods: 42 consecutive patients admitted to the hospital for acutely decompensated heart failure were included. Early diuretic response, spot urine sodium excretion (UNa), and hemoconcentration were evaluated individually to predict loop diuretic efficiency. Results: Good early diuretic response (EDR) was associated with higher diastolic blood pressure on admission and eGFR, atrial fibrillation, and bolus dosing of intravenous furosemide. Hypertension and low systolic blood pressure on admission were inversely related to hemoconcentration. Conclusion: Diuretic efficiency is strongly influenced by the heart rhythm, renal function, blood pressure, prevalence of hypertension, and schedule of furosemide administration. We developed a novel, 3-variable index called DES (diuretic efficiency score) that predicts mortality in AHF patients. Future research in larger cohorts is needed to validate DES as a predictor of mortality in heart failure.

Percutaneous coronary intervention (PCI) to chronic total occlusion (CTO) is still a subject of debate. The primary goal of revascularization is to provide symptomatic relief and enhancing left ventricular (LV) functions. Global longitudinal strain (GLS) is proven to be more sensitive than ejection fraction (EF), especially for subtle ischemic changes. The purpose of this study was to investigate the improvement in LV GLS after revascularization of symptomatic stable coronary patients with single-vessel CTO, categorized according to their collateral supply grades. 69 patients with successful CTO PCI were grouped according to their collateral supply grades, as well-developed (WD) and poor collateral groups and followed-up for 3 months. Basal characteristics were similar for both groups, except for lower EF (p=0.04) and impaired GLS (p<0.0001) in the poor collateral group. At the end of 3 months follow-up symptomatic relief was similar in both groups (p=0.101). GLS improvement reached statistical significance only for the poor collateral, not for the WD group (p<0.0001 and p=0.054, respectively). EF did not change significantly in both groups. Poorly collateralized CTO lesion may not only result in baseline LV dysfunction, but also appear to carry potential for recovery after revascularization. This may not be the case for WD collaterals.

Aims Previous studies demonstrated that remodeling after successful percutaneous coronary intervention (PCI) depends on the inflammatory response triggered by myocardial infarction (MI). The systemic immune-inflammation index (SII) is a novel inflammation index strongly associated with coronary artery disease. In our study, we sought to determine whether SII could predict Post-MI LV remodeling. Methods and results The study population included 528 patients (mean age 62.5 ± 10.2, 73% male) diagnosed with STEMI. Based on the increase in LVEDV within the first 12 months after STEMI, patients were divided into two groups. We categorized the ≥ 20% increase in LVEDV among remodelers (257 patients, 49%), and the other 271 patients (51%), as non-remodelers. To determine the relationship between laboratory parameters and LV remodeling, univariate and multivariate logistic regression models were used. In a univariate model, higher hs-CRP and SII values were associated with increased LVEDV. In a multivariate analysis, SII independently correlated with LV remodeling A cut-off value of 613.3 or higher for SII was significantly correlated with LV remodeling based on ROC analysis. Conclusion SII provides an easy-to-calculate and affordable biomarker for cardiovascular diseases. It may be used as a new biomarker to predict LV remodeling in patients with STEMI.

Aims: Chronic coronary syndrome is associated with several risk factors, such as dyslipidemia and hypertension. The atherogenic index of plasma (AIP) has been demonstrated to be a biochemical risk factor for coronary artery disease (CAD). This study aimed to determine whether the AIP is an effective parameter for estimating obstructive CAD. Methods and Results: A total of 345 patients (with a mean age of 62.2 ± 10.3; 63% male) who underwent coronary angiography were included in this study. Obstructive CAD is defined as having one or more vessels with a stenosis level of ≥50%. Depending on the presence of obstructive CAD, all patients were divided into two groups. The mean AIP value was found to be 0.538 ± 0.26 in the study group. The AIP values were significantly higher in the obstructive coronary artery group (AIP; 0.49 ± 0.26 vs. 0.58 ± 0.27, p = 0.002). According to a univariable analysis, AIP values were significantly associated with obstructive coronary artery disease [OR: 3.74 (CI 95% 1.62–8.64), p = 0.020]. The AIP was further adjusted for confounding risk factors in three multivariable analysis models and, all three models showed a significant association. According to an ROC analysis, 0.49 is the cut-off value for AIP, and a value above 0.49 indicates 50% coronary artpery stenosis. Conclusions: The AIP may be used in the assessment of cardiovascular risk for patients with stable angina pectoris, and it may also be used to estimate obstructive CAD.

COVID-19,echocardiography,2-dimensional speckle tracking imaging

Cardioneuroablation is one of the emerging therapies in vasovagal syncope. In this study, we present a simple method of cardioneuroablation performed via a right-sided approach, targeting anterior-right and right-inferior ganglionated plexi, along with procedural and follow-up data. Patients who had underwent cardioneuroablation between March 2018 and September 2019 with vasovagal syncope in 2 clinics were enrolled in the study. All patients underwent radio-anatomically guided radiofrequency ablation targeting anterior-right ganglionated plexi and right-inferior ganglionated plexi. Syncope and symptom burden, 24-hour ambulatory electrocardiogram data at presentation, and at follow-up were assessed along with procedural data. A total of 23 patients underwent modified right-sided cardioneuroablation. Mean basal cycle length decreased significantly from 862.3 ± 174.5 ms at the beginning of the procedure 695.8 ± 152.1 ms following the final radiofrequency ablation (P < .001). Mean 24-hour ambulatory heart rate increased significantly from 66.4 ± 10.7 bpm at baseline to 80 ± 7.6 bpm at follow-up (P < .001). Only 1 patient had 1 episode of syncope following the procedure at the mean follow-up period of 10 ± 2.9 months. The same patient had recurrent presyncope. The right-sided cardioneuroablation approach was found to be an effective treatment for vasovagal syncope and may be regarded as a default initial cardioneuroablation technique.