The systemic immune inflammation index (SII; platelet count x neutrophil-lymphocyte ratio), a new marker, predicts adverse clinical outcomes in many conditions, including acute and chronic coronary syndromes, pulmonary embolism, cancers, and contrast nephropathy. The aim of this study was to determine the relationship between SII and microvascular dysfunction in patients with Cardiac Syndrome X (CSX); 105 patients with CSX and 105 patients with normal coronary arteries were included. Microvascular dysfunction was determined angiographically using myocardial blush grade (MBG) and total myocardial blush score (TMBS). We observed that the SII levels were higher in the CSX (+) group (687 [355–2211] vs 418 [198–1614], P<.001). The SII levels were also found to be significant independent predictors for CSX in multiple regression analysis ( P=.001). SII levels >440 had 83.8% sensitivity and 55.2% specificity (area under the curve [AUC]: .923, 95% CI: .895–.999, P<.001) for predicting CSX. There is a significant correlation between SII levels and CSX.

Ivabradine is a novel specific heart rate (HR)-lowering agent that improves event-free survival in patients with heart failure (HF). We aimed to evaluate the effect of ivabradine on time domain indices of heart rate variability (HRV) in patients with HF. Forty-eight patients with compensated HF of nonischemic origin were included. Ivabradine treatment was initiated according to the latest HF guidelines. For HRV analysis, 24-h Holter recording was obtained from each patient before and after 8 weeks of treatment with ivabradine. The mean RR interval, standard deviation of all normal to normal RR intervals (SDNN), the standard deviation of 5-min mean RR intervals (SDANN), the mean of the standard deviation of all normal-to-normal RR intervals for all 5-min segments (SDNN index), the percentage of successive normal RR intervals exceeding 50 ms (pNN50), and the square root of the mean of the squares of the differences between successive normal to normal RR intervals (RMSSD) were low at baseline before treatment with ivabradine. After 8 weeks of treatment with ivabradine, the mean HR (83.6 ± 8.0 and 64.6 ± 5.8, p < 0.0001), mean RR interval (713 ± 74 and 943 ± 101 ms, p < 0.0001), SDNN (56.2 ± 15.7 and 87.9 ± 19.4 ms, p < 0.0001), SDANN (49.5 ± 14.7 and 76.4 ± 19.5 ms, p < 0.0001), SDNN index (24.7 ± 8.8 and 38.3 ± 13.1 ms, p < 0.0001), pNN50 (2.4 ± 1.6 and 3.2 ± 2.2 %, p < 0.0001), and RMSSD (13.5 ± 4.6 and 17.8 ± 5.4 ms, p < 0.0001) substantially improved, which sustained during both when awake and while asleep. Our findings suggest that treatment with ivabradine improves HRV in nonischemic patients with HF.

Kounis Syndrome is the development of acute coronary syndrome (ACS) because of allergic reactions; allergens, such as foods, insect venom, iodine contrast agent or drugs can cause this syndrome. Hirudotherapy (leech therapy) is increasingly used as a useful therapeutic option in a variety of medical and surgical procedures, and potential complications related to this therapy include Aeromonas species infections, bleeding, anemia and allergic reactions. Here, we present a patient diagnosed as Type 1 Kounis Syndrome after using hirudotherapy for her knee aches. 41-year-old woman admitted to emergency department with sudden onset of face edema, shortness of breath and chest pain complaints and diagnosed as an allergic reaction and anaphylaxis due to leech therapy. Kounis Syndrome should be considered in acute coronary syndrome patients who were admitted to emergency department with anaphylaxis clinic.