Ischemic Modified Albumin Predicts Critical Coronary Artery Disease in Unstable Angina Pectoris and Non-ST-Elevation Myocardial Infarction

Normally, lead augmented vector right (aVR) has a negative T wave polarity (TaVR) in the electrocardiography (ECG). Positive TaVR and ST segment deviation in lead aVR (STaVR) have negative effects on mortality in heart failure with reduced ejection fraction patients. Our aim was to investigate the relationship between lead aVR changes and mortality in heart failure with preserved ejection fraction (HFpEF) patients. We retrospectively examined 249 patients in 2011-2015 years (mean age 70.8±11.9 years and follow-up period 38.3±9.6 months). ECG, echocardiographic, and laboratory findings were recorded and compared in the study. Existence of positive TaVR, STaVR, and quantitative TaVR values were recorded and the absolute numerical values of TaVR and STaVR were recorded from the 12-lead surface ECG (T/STaVR ratio or vice versa). The patients were divided into two groups: living (171) and deceased (78). Age, systolic blood pressure, left atrial diameter, QRS duration, positive TaVR frequency, STaVR, absolute value of TaVR, and ratio were significantly higher in the deceased group. Age (OR: 1.106), STaVR (OR: 2.349), TaVR (OR: 1.612), and T/STaVR ratio (OR: 5.156) were determined as independent predictors for mortality. ST segment and T wave polarity changes in lead aVR closely associated with mortality in patients with HFpEF.

Introduction: There is not enough data on the effects of primary hyperparathyroidism (pHPT) on morning blood pressure surge (MBPS) in the literature. We aimed to determine whether there was any change in MBPS value in patients with hypertensive pHPT and to determine the parameters related to MBPS. Method: 80 patients with newly diagnosed pHPT with hypertension (HT) and 80 controls with newly diagnosed hypertension were included. Routine laboratory examinations and ambulatory blood pressure monitoring (ABPM) were performed in all patients. Results: In patients with pHPT, blood urea nitrogen (BUN), triglyceride, hs-CRP, uric acid, serum calcium (Ca), parathormone (PTH), daytime SBP and MBPS levels are higher than others (p < 0.05). Body mass index (BMI) and Ca level were independently associated with MBPS. In patients with MBPS ≥ 25 mmHg, BMI, BUN, creatinine, uric acid, Ca and PTH levels were found to be higher than others. BMI values and Ca levels determine the patients with MBPS ≥ 25 mmHg (p < 0.05) independently. According to this analysis, increase in BMI (for each 1 unit) and Ca level (for each 0.1 mg/dL) was found to increase the probability of MBPS ≥ 25 mmHg by 17.8% and 7.7%, respectively. When the cut-off value for Ca was taken as 10 mg/dL, the patients with MBPS ≥ 25 mmHg were determined with 73.5% sensitivity and 73.1% specificity. Conclusion: MBPS significantly increases in patients with newly diagnosed hypertensive pHPT. This increase in MBPS is closely associated with increased Ca levels. In patients with pHPT, lowering the Ca level below 10 mg/dL may have clinical implications.

Introduction: There is no study evaluating the Tp-e/QT and Tp-e/QTc ratios with T wave peak to end interval (Tp-e interval) used for evaluation of cardiac arrhythmia risk and ventricular repolarization changes in patients with primary aldosteronism (PA). We aimed to investigate whether there was a change in Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in patients with PA. Method: Thirty patients with newly diagnosed hypertension (HT) and PA and 30 patients with primary HT were included. Twelve-lead electrocardiography (ECG) was performed in all patients. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were measured in addition to routine measurements in ECG. Results: Sodium, potassium, and plasma renin activity (PRA) were significantly lower in patients with PA; systolic and diastolic blood pressure, plasma aldosterone, plasma aldosterone/PRA were significantly higher in patients with PA (p < .05 for each one). When ventricular repolarization parameters were examined; while QT and QTc interval were similar between two groups, Tp-e interval, Tp-e/QT and Tp-e/QTc ratio values were significantly higher in patients with PA (p < .05 for each one). Tp-e interval, Tp-e/QT and Tp-e/QTc ratio values were positively correlated with the serum calcium, aldosterone, and aldosterone/PRA levels and negatively correlated with serum sodium, potassium, renin levels (p < .05 for each one). In linear regression analyses, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were independently associated with the aldosterone/PRA ratio. Conclusion: Tp-e interval, Tp-e/QT and Tp-e/QTc were increased in hypertensive patients with PA and were independently associated with aldosterone/PRA levels. This may be related to the changing neuroendocrine state in patients with PA.

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.