The American Heart Association's Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations established estimated glomerular filtration rate (eGFR) as a component of cardiovascular risk assessment. However, the anatomical substrate underlying this risk-coronary atherosclerotic burden-remains inadequately characterized across renal function spectrum. This retrospective study included 1181 patients (mean age: 60.2 ± 8.9 years, 65.7% male) undergoing elective coronary angiography. Patients divided groups using eGFR; eGFR ≥90 (n = 596), 60 to 89 (n = 497), and 30 to 59 mL/min/1.73 m2 (n = 88) were evaluated by stratification. Coronary atherosclerotic burden was determined using Gensini score. eGFR demonstrated a strong correlation with Gensini score (ρ = -0.352, P < .001). Each 10 mL/min/1.73 m2 eGFR decline conferred 40% increased odds of severe coronary atherosclerosis (odds ratio [OR] = 0.960, 95% CI: 0.951-0.970, P < .001). Patients with eGFR 30 to 59 mL/min/1.73 m2 exhibited 6-fold higher odds compared with preserved renal function (OR 6.073, 95% CI: 3.352-11.005, P < .001), independent of traditional risk factors. This study provides an anatomical validation for incorporating eGFR into cardiovascular risk assessment. Our angiographic evidence demonstrates that even mild renal dysfunction is accompanied by increased atherosclerotic burden. These findings bridge the gap between epidemiological risk prediction and pathophysiological reality, reinforcing the cardiovascular-kidney-metabolic health continuum and supporting aggressive risk modification strategies in patients with declining renal function, particularly among diabetic women.

Background Stroke, the most feared complication in patients with atrial fibrillation (AF), is still an important cause of mortality and morbidity. In our study, we aimed to investigate the frequency of stroke and related parameters in patients with atrial fibrillation, for whom 24-h ambulatory blood pressure monitoring (ABPM) was performed. Method: A total of 282 patients with permanent AF were included in this study. 24-h ABPM was performed in all patients. Morning blood pressure surge (MBPS) was defined as the difference between the mean SBP in the first 2 h after awakening and the lowest blood pressure (BP) at night. We evaluated parameters associated with stroke in patients with atrial fibrillation using univariate and multivariate Cox regression analysis. Result Patients were followed for 19 ± 9.3 months and 22 ischemic strokes were detected during the follow-up period. Also, strokes were significantly lower in atrial fibrillation patients with a dipper BP pattern, whereas strokes were significantly higher in atrial fibrillation patients with a reverse-dipper BP pattern. In multivariate analysis, a history of hypertension (P = 0.020), BP pattern (P < 0.001) and MBPS (P < 0.001) were found to be significantly related to stroke. MBPS levels >32.5 mmHg predicted stroke with a sensitivity of 77% and a specificity of 60% (AUC, 0.741; 95% CI, 0.647–0.834; P < 0.001). Conclusion MBPS, BP pattern and presence of hypertension as an independent risk factor in predicting stroke in patients with atrial fibrillation. The reduction of the MBPS may be a new therapeutic target for preventing stroke.

Objective Non high density lipoprotein cholesterol (non HDL-C) covers all aterojenic lipoproteins and correlates with C reactive protein (CRP) which is reliable marker of inflammation. CRP is related to poor angiographic coronary collateral circulation (CCC). We aimed to show whether non HDL-C is associated with CCC.Methods Patients who underwent coronary angiography for stable coronary artery disease and at least one epicardial coronary artery occluded in the proximal or middle region were included in the study. Accrording to the Rentrop scoring system Rentrop 0 and 1 were considered to be poor CCC, and Rentrop 2 and 3 were considered to be good CCC. Non-HDL-C was calculated by subtracting HDL-C from total cholesterol (TC).Results 84 patients were included in the study. While 44 patients (52%) had good CCC, 40 patients (48%) had poor CCC. TC was found to be higher in the poor CCC group than in the good CCC group (224.3 ± 35.6 vs 179.2 ± 25.5 p = 0.000). HDL-C levels were found to be lower in the poor CCC group than in the good CCC group (37.3 ± 9.8 vs 44.1 ± 8.6 p = 0.001). Non-HDL-C cholesterol levels were higher in the group with poor CCC (185.7 ± 39.2 vs 132.8 ± 28.1 p = 0.000). CRP levels were found to be higher in the poor CCC group (3.73 ± 2.5 vs 1.67 ± 1.4 p = 0,000).Conclusion Non-HDL-C is independent predictors of poor CCC.

Background: The aim of this study was to investigate whether there is a relationship between coronary collateral circulation (CCC) and contrast associated nephropathy (CAN) in very elderly patients. Methods: Patients aged 90 years or older with at least one major occlusion of the coronary artery proximal or mid-section were included in the study. CCC was graded according to the Rentrop classification. CAN was defined as an increase in blood creatinine value of 25% or more on the second day after coronary angiography. Results: Thirty-six patients who met the study criteria were included in the study. In the study group, CAN developed in 12 patients (CAN (+) group), 24 patients did not develop CAN (CAN (−) group). The creatinine levels before coronary angiography were 1.05 ± 0.12 in the CAN (−) group and 1.22 ± 0.14 in the CAN (+) group. Baseline creatinine values were significantly higher in the CAN (+) group (p = 0.001). The contrast agent used in the CAN (+) group was significantly higher (p = 0.001). In the CAN (+) group, nine patients (43%) had poor collateral circulation, whereas only three patients (20%) had well-developed collateral circulation. In a logistic regression analysis, the collateral class was not a risk factor for CAN, whereas contrast agent volume and basal creatinine were independent predictors of CAN. Conclusion: We found that CCC grade was not associated with the development of CAN in very old patients, but the amount of contrast agent and pre-procedure creatinine values were independent variables in the development of CAN.

BACKGROUND: Contrast induced nephropathy (CM) is defined as a temporary renal failure follov,ing the administration of radiocontrast agent during the coronary angiography. It is associated with increases in morbidity and mortality in patients with acute coronary syndrome (ACS). The aim of this study is to evaluate the relationship between CCC and CIN in patients with non-ST elevation myocardial infarction (NSTEMI). METHODS: CIN was diagnosed with a 25% or 0.5 g/dL increase in blood creatinine levels after 48-72 hours following the administration of contrast agent during the coronary angiography. For the purpose of evaluating the coronary collaterals, the Rentmp classification was used. RESULTS: A total 269 patients were participated in the study population (55 in CIN(+) group, 214 in CIN(-) group). The blood creatinine levels were significantly higher in the CIN(+) group on the 48-72 hours following the coronary angiography. In the studied population, 70 out of 269 patients had a good CCC according the Rentrop classification (64 patients [30%] in the CIN(-) group, six patients [16%] in the CIN(+) group). The frequency of the well-developed coronary collaterals were significantly higher in the CIN(-) group (P<0.001). The logistic regression analysis indicated that the presence of poor-developed coronary collaterals is an independent risk factor for the development of CIN in our study population. CONCLUSIONS: The presence of well-developed coronary collaterals was associated with decreased frequency of CIN in patients with NSTEMI on the 48-72 hours following the coronary angiography.

Background and Objectives: The aim of this study was to investigate the prognostic value of soluble ST2 (sST2) in predicting postoperative adverse events in patients with impaired left ventricular (LV) function undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: This study included 80 consecutive patients with stable coronary artery disease (CAD) and impaired LV function (ejection fraction ≤ 45%) undergoing on-pump coronary artery bypass graft surgery. The patients were divided into the “high” or “low” group according to their ST2 levels (≥35 or <35 ng/mL). Results: Postoperative adverse events were more common in patients with high sST2 levels than in patients with low sST2 levels (100% vs 26%, p < 0.0001). Multivariate analysis showed that sST2 level was an independent predictor of the presence of postoperative adverse events (OR: 1.117 (95% CI: 1.016–1.228), p = 0.022). The receiver operating characteristic curve (ROC) analysis of sST2 revealed an area under the curve (AUC) of 0.812 (95% CI: 0.710–0.913, p < 0.001) in predicting postoperative adverse events. An sST2 level of 26.50 ng/ml was identified as the optimal cut-off value, with a sensitivity and specificity of 74.1% and 75.3%, respectively. Conclusion: Higher sST2 levels were associated with adverse outcomes after CABG in patients with impaired LV and stable CAD.

OBJECTIVE: Fragmented QRS (fQRS) complexes on electrocardiography (ECG) signify areal scar and fibrosis in the myocardium. Our aim was to investigate association between fragmented QRS and blood pressure pattern in hypertensive patients.MATERIAL AND METHODS: Patients underwent ambulatory blood pressure were studied retrospectively. Patients whose systolic blood pressure was 10-20% lower during the night when compared to the day were grouped as “dipping group”, while those who had a decrease less than 10% during the night were grouped as “non-dipping group”. The fQRS was defined as the presence of a second R wave, notching of R or S wave or fragmentation in two contiguous leads on ECG corresponding to epicardial major coronary artery region.RESULTS: The dipping group had 98 patients, while the non-dipping group had 89 patients. The groups were similar in terms of age, sex, body mass index, lipid profile and antihypertensive drugs. The fQRS was observed in 14 patients in the dipper group and 27 patients in the non-dipping group (p=0.008). The fQRS on ECG was found to be an independent predictor of non-dipping blood pressure pattern (p=0.046, odds ratio=2.27).CONCLUSIONS: The presence of fQRS was more than in hypertensives with non-dipping pattern compared with dipping pattern and this variable was a predictor of non-dipping pattern.

OBJECTIVE: We aimed to determine whether the combination of a CHA2DS2-VASe score (C: Congestive Heart Failure, H: Hypertension, A2: Age a 75 years, D: Diabetes mellitus, S: Stroke history, V: Vascular disease, A: Age a 65 years, Sc: Sex category) and pre-percutaneous coronary intervention (PCI) thrombus load score was more sensitive at detecting the no-reflow phenomenon compared to the CHA2DS2-VASc score alone or to the thrombus load score alone in patients with acute ST-elevation myocardial infarction (STEMI) who had underwent primary PCI (PPCI). PATIENTS AND METHODS: 497 patients with acute STEMIs were divided into two groups: no-reflow group (n: 194) and control group (n: 303). The Thrombolysis In Myocardial Infarction (TIMI) flow grading and Myocardial Blush Grade (MBG) were used together to define angiographic no-reflow as TIMI flow < 3 (with any MBG grade) or TIMI flow 3 with MBG 0 or 1. Successful reperfusion was defined as TIMI flow 3 with MBG 2 or 3. RESULTS: CHA2DS2-VASc score was significantly higher in the no-reflow group than in the control group (2 [1-4] vs. 1 [0-3], p < 0.001]. Compared with the control group, the no-reflow group had a higher pre-PCI thrombus score (5 [4-5] vs. 4 [3-5], p = 0.001]. Compared with the CHA2DS2-VASc score alone, the combined use of the prePCI thrombus score and the CHA2DS2-VASc score was associated with significant improvements in the ability to predict no-reflow (AUC) (0.65 vs. 0.60, p < 0.05). The addition of the prePCI thrombus score to the CHA2DS2-VASe score was related to a significant net reclassification improvement of 6.7% (p = 0.047) and an integrated discrimination improvement of 0.036 (p < 0.05). CONCLUSIONS: We have found that the combination of a CHA2DS2-VASc score and a prePCI thrombus load score was more sensitive in detecting the no-reflow phenomenon than only a CHA2DS2-VASc score in patients who underwent PPCIs for STEMIs.

Our aim in this study was to investigate morning blood pressure surge (MBPS) in patients of reproductive age with polycystic ovary syndrome (PCOS) and its relation to insulin resistance (IR).

Objective: Foramen ovale is an opening between the left and right atria during intrauterine life and usually closes after birth. The incomplete closure of this opening is called patent foramen ovale (PFO). It has been shown that patients with PFO have high atrial fibrillation (AF) frequency, but the relationship between atrial premature contraction (APC) and PFO has not been investigated. Some studies have reported that increased APC increases AF risk in patients with atrial septal defects. The aim of the study is to investigate whether the frequency of APC is increasing in healthy young subjects with PFO.

The prognostic significance of changes in mean platelet volume (MPV) during hospitalization in ST segment elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (pPCI) has not been previously evaluated. The aim of this study was to determine the association of in-hospital changes in MPV and mortality in these patients.

Women with polycystic ovary syndrome are more likely to suffer from obesity, insulin resistance, and chronic low-grade inflammation. In fact, the excessive activation of monocytes exacerbates oxidative stress and inflammation. However, high-density lipoprotein cholesterol neutralizes the pro-inflammatory and pro-oxidant effects of monocytes. The aim of this study is to investigate whether monocyte counts to high-density lipoprotein cholesterol ratio can predict the inflammatory condition in patients with polycystic ovary syndrome.

Background A high red cell distribution width (RDW), which indicates ongoing inflammation, and low levels of high-density lipoprotein-cholesterol (HDL-C) are associated with increased mortality and morbidity in patients with coronary artery disease (CAD). Recent studies have suggested that HDL-C possesses anti-inflammatory and antioxidant effects, which may explain its anti-atherogenic properties. This study aims to determine the relationship between HDL-C levels and RDW in patients with CAD. Materials and methods This cross-sectional study was performed on 120 patients with CAD from July 2020 to June 2021 in the Hematology Department of Chughtai Lab Lahore. Patients were graded according to the degree of coronary artery stenosis as follows: Grade 1,30%-50%; Grade 2, 51%-70%; and Grade 3,>70%. The HDL-C level was measured from venous blood samples by a fully automated Abbot Alinity analyzer. The RDW was measured by Sysmex XN-5000. The sample size was calculated using the Select Statistics calculator. The mean RDW and HDL-C of the patients were calculated, and correlation analyses were performed using the Pearson correlation coefficient. Results The HDL-C level was inversely related to the RDW. Of the 120 patients, 38, 44, and 38 had Grade 1, Grade 2, and Grade 3 stenosis, respectively. The mean HDL-C level and RDW were 30.58 ±3.77 mg/dL and 16.04% ±1.66%, respectively. The value of r was −0.8622 (strongly negative). Data were stratified based on the degree of stenosis. The values of r in Grades 1, 2, and 3 were −0.43 (moderately negative), −0.604 (moderately negative), and −0.27 (weakly negative), respectively. Conclusion The RDW can be used as an additional marker to determine the disease status in CAD patients.

Morning surge (MS) is defined as the difference between the mean systolic blood pressure (SBP) within two hours after awake in the morning and the lowest SBP at night. It has been reported that morning surge (MS) is an independent predictor of cardiovascular events. Fasting glucose in the range of 100-125 mg/dl is called as prediabetes and the incidence of both coronary and cerebrovascular events in prediabetic patients increase when compared to those with fasting blood glucose <100 mg/dl. Our aim in this study is to investigate the relationship between MS and prediabetes in patients with newly diagnosed hypertension.

Background/Aims: Contrast-induced nephropathy (CIN) is a typically reversible type of acute renal failure that develops after exposure to contrast agents; underlying endothelial dysfunction is thought to be an important risk factor for CIN. Although the mechanism of coronary collateral circulation (CCC) is not fully understood, a pivotal role of the endothelium has been reported in many studies. The aim of this study was to investigate whether there is a relationship between CCC and CIN. Methods: Patients with at least one occluded major coronary artery and blood creatinine analyses performed before and on the second day after angiography were included in the study. CIN was defined as a 25% or greater elevation of creatinine on the second day after exposure to the contrast agent. Collateral grading was performed according to the Rentrop classification. Patients were grouped according to whether they developed CIN or not, i.e., CIN(-) and CIN(+) group. Results: A total of 214 patients who met the inclusion criteria were included in the study. CIN was diagnosed in 43 patients (20.1%) in the study population. Good CCC was identified in 112 patients (65.5%) in the CIN(-) group, whereas it was identified in 13 patients (30.2%) in the CIN(+) group. In the CIN(-) group, good CCC was significantly more frequent (p < 0.001). Furthermore, collateral circulation was an independent predictor of CIN. Conclusion: Good collateral circulation was associated with a lower frequency of CIN, and poor collateral circulation was an independent predictor of CIN.

Summary Introduction: Previous studies have predicted an independent relationship between red cell distribution width (RDW) and the risk of death and cardiovascular events in patients with coronary artery disease (CAD). The aim of this study was to investigate the relationship between RDW and extensiveness of CAD in patients with diabetes mellitus (DM). Methods: Two hundred and thirty-three diabetic patients who underwent coronary angiographies at our centre in 2010 were included in the study. All of the angiograms were re-evaluated and Gensini scores were calculated. Triple-vessel disease wasdiagnosed in the presence of stenosis > 50% in all three coronary artery systems. Result: RDW was significantly higher in diabetic CAD patients (p < 0.001). Patients with CAD who had a RDW value above the cut-off point also had higher Gensini scores, higher percentages of obstructive CAD and triple-vessel disease (p ≤ 0.001 for all). According to the cut-off values calculated using ROC analysis, RDW > 13.25% had a high diagnostic accuracy for predicting CAD. RDW was also positively correlated with Gensini score, obstructive CAD and triple-vessel disease (r < 0.468 and p < 0.001 for all). Conclusion: RDW values were found to be increased in the diabetic CAD population. Higher RDW values were related to more extensive and complex coronary lesions in patients with DM.