Mortality in patients after carotid artery stenting (CAS), a treatment approach for atherosclerotic carotid artery stenosis, is influenced by numerous factors. This study aimed to investigate the prognostic value of the Naples prognostic score (NPS), which reflects nutritional and inflammatory status, in CAS patients. We retrospectively included 697 patients who underwent CAS from January 2016 to December 2020 at our institute. The primary endpoint of the study was long-term all-cause mortality. The study population was divided into two groups based on the NPS value: low NPS (NPS 0-2) and high NPS (NPS 3-4). Univariable and multivariable Cox regression analysis was used to identify independent predictors of death. The median follow-up time was 60.8 (46.36-75.36) months. During the follow-up period, all-cause mortality was higher in the high-NPS group compared to the low-NPS group [54% (n = 88) vs. 24% (n = 128) p < 0.001]. Advanced age (p = 0.003), diabetes (p = 0.023), and NPS (hazard ratio: 1.83, confidence interval: 1.58-2.12, p < 0.001) were found to be independent predictors of all-cause mortality at long-term follow-up. Consequently, NPS as a marker of malnutrition and inflammation, was found to be associated with long-term mortality and serves as an independent predictor of long-term mortality in patients undergoing CAS.

Background: Hypothyroidism can cause a variety of manifestations, including cardiovascular disorders. The most frequent clinical signs are sinus bradycardia and pericardial effusion. The affected patient generally has significant symptoms. Hypothyroidism infrequently results in a complete atrioventricular block. Case presentation: A 19-year-old girl presented to our cardiology clinic with generalized tiredness, edema in her lower limbs and face, constipation, and a menstruation abnormality in the previous six months. With a normal ejection fraction on echocardiography, an electrocardiogram revealed complete atrioventricular block. When she was admitted, her laboratory testing showed that she had severely raised Thyroid Stimulating Hormone (TSH) levels, severe dyslipidemia with normal electrolytes, and normal liver and kidney function tests. The patient was treated with 50mg Thyroxine to her. She had significant improvement within two weeks of treatment. Up on the next follow-up (at one-month), her electrocardiogram returned to normal sinus rhythm without any evidence of atrioventricular block and that the lipid profile had returned to normal. Clinical discussion: In its first stages, hypothyroidism can not show any obvious symptoms. Untreated hypothyroidism over time can lead to a variety of health issues, including obesity, joint discomfort, infertility, and heart disease. This current case demonstrates how levothyroxine medication successfully managed a young female patient's severe hypothyroidism, difficult total heart block, severe hyperlipidemia, and long-standing menstrual irregularity. Conclusion: We found that overt hypothyroidism caused a complete atrioventricular block and severe dyslipidemia, and that thyroxin therapy completely corrected both conditions.

Demirel M. Korean Circ J. 2015 Dec;46:0223. https://doi.org/10.4070/kcj.2016.0223