The aim of this study was to examine the Tpeak-Tend (Tpe/corrected Tpe) interval, which is an indicator of transmural myocardial repolarization, measured non-invasively via electrocardiogram in patients with acute pulmonary embolism (PE), and to investigate the relationship with 30-day mortality and morbidity. The study included 272 patients diagnosed with acute PE, comprising 154 females and 118 males, with a mean age of 63.1 ± 16.8 years. Tpe/cTpe intervals were calculated from the electrocardiograms with a computer program after using a ruler or vernier caliper manual measuring tool to obtain highly sensitive measurements. The relationship between the electrocardiogram values and 30-days mortality and morbidity were measured. The study group was divided into three groups according to cTpe intervals: Group 1, < 113 ms; Group 2, 113–133 ms; and Group 3, > 133 ms. White blood cell count and troponin T levels, corrected QT intervals with QRS complex durations, percentage of right ventricle dilatation with right/left-ventricular ratio, 30-day death, and combinations of these values were seen at a higher rate in Group 3 patients compared to the other groups. Kaplan–Meier analysis showed that the cTpe interval measured at > 126 ms could be used as a cut-off value in the prediction of mortality and morbidity. The cTpe cut-off values of 126 ms had sensivity, specificity, negative predictive value, and positive predictive value of 80.56 %, 59.32 %, 95.2 %, and 23.2 %, respectively. cTpe interval could be a useful method in early risk stratification in patients with acute PE.
Background: The albumin–bilirubin (ALBI) score, initially a hepatic function marker, may also reflect systemic inflammation and oxidative stress, both linked to the no-reflow phenomenon (NRP). This study investigates the ALBI score’s predictive value for the NRP and compares it with conventional risk models. Methods: This retrospective, single-center study included 1563 NSTE-ACS patients who underwent PCI between January 2023 and February 2024. Two predictive models were developed: (i) a fitted model with variables selected based on the XGBoost algorithm and SHapley Additive ExPlanations (SHAP) values, and (ii) an ALBI model including the ALBI score. Machine learning via the XGBoost algorithm was used for modeling, with SHAP applied to assess the significance of predictors. Results: The NRP occurred in 14.8% (231/1563) of patients. The ALBI score emerged as an independent predictor (OR = 12.10, 95% CI: 7.75–18.89, p < 0.001). The ALBI model demonstrated superior predictive power compared to the fitted model (C-index: 0.860 vs. 0.799), with significant improvements in discrimination (11.1%, p < 0.001) and reclassification (14.5%, p = 0.002). SHAP analysis ranked the ALBI score (1.025) as the strongest predictor, followed by hs-TnI (0.814), e-GFR (0.582), and pre-dilatation (0.283). The ALBI model exhibited better specificity (AUC: 0.860 vs. 0.798), calibration (Brier score: 0.088 vs. 0.102), and model fit (AIC: 964.7 vs. 1098.3) compared to the fitted model, indicating superior overall performance. Conclusions: The ALBI score significantly enhances the prediction of the NRP in NSTE-ACS patients undergoing PCI, outperforming traditional risk models. Incorporating the ALBI score into predictive frameworks may improve early risk stratification and guide clinical decision-making.
Background: Right atrial pressure (RAP) is an important prognostic criterion in pulmonary hypertension. Elevated mean RAP measured by cardiac catheterization is an independent risk factor for mortality. Accurate bedside assessment of congestion in the management of patients with PH remains challenging. As a continuous conduit of circulating fluid, systemic congestion represented by high RAP may be reflected by peripheral venous pressure (PVP). We evaluated the reliability of PVP measurements for assessing congestion beyond conventional clinical assessments. Methods: We performed conventional congestion assessments and PVP measurements in 138 patients undergoing right heart catheterization. PVP was measured via the 16-gauge peripheral venous access placed in the upper extremity. Results: The mean RAP and PVP were 8.7 ± 4.2 mm Hg and 10.7 ± 4.3 mm Hg, respectively. PVP exhibited a strong linear correlation with RAP (Pearson R = 0.839; P < .001). PVP demonstrated significant discriminatory power for both RAP < 8 mm Hg (area under the curve: 0.91 [95% confidence interval: 0.86 to 0.96]; sensitivity: 72%; specificity: 94% cutoff: 8.5 mm Hg) and RAP ≥ 12 mm Hg (area under the curve: 0.92 [0.87 to 0.97]; sensitivity: 82%; specificity: 89% cutoff: 12.5 mm Hg). Conclusion: PVP measured via peripheral venous access strongly correlates with invasively obtained RAP. PVP measurements may improve current bedside assessments of congestion.
1 January 2025 in International Journal Of Clinical Practice
Background: Increased rates of cardiac events at the time of natural disasters have been reported. However, the relationship between myocardial infarctions and earthquakes is less clear. We report on the rate of myocardial infarction with no obstructive coronary artery (MINOCA) disease during the 2023 Turkiye earthquakes. Methods: All patients with a positive troponin undergoing a coronary angiogram at the Adana City Training and Research Hospital 2 months prior and 2 months subsequent to the February 6 th , 2023, Turkiye earthquakes were included. Patients with MINOCA were identified. Multivariate logistic regression analysis was performed to determine variables associated with a diagnosis of MINOCA. Results: 619 patients underwent angiography during the study period—479 prior and 140 subsequent to the earthquake. The median age was 61 years and 73% male. MINOCA was diagnosed in 7.8% of the cohort. MINOCA was higher in the postearthquake period (pre: 3.8% vs. post: 21.4%; p < 0.001). The time period after the earthquake had the highest odds of a diagnosis of MINOCA (odds ratio: 5.76; 95% confidence interval: 2.90–11.44). Survival to hospital discharge was higher in the postearthquake period (pre: 89.4% vs. post: 97.9%; p < 0.001). Conclusion: The rate of MINOCA increased after the Turkiye earthquakes on February 6 th , 2023. This knowledge provides new insight into the spectrum of myocardial infarction after natural disasters. Our work also highlights a potential survivorship bias, which may confound studies reporting on cardiac events after natural disasters. Future work to assess the potential long‐term adverse consequences of MINOCA in this population is suggested.