SUMMARY OBJECTIVE: We aimed to demonstrate the clinical utility of CHA2DS2-VASc and anticoagulation and risk factors in atrial fibrillation risk scores in the assessment of one year mortality in patients with abdominal aortic aneurysm. METHODS: We designed a retrospective cohort study using data from Suleyman Demirel University Hospital for the diagnosis of abdominal aortic aneurysm. The study included 120 patients with abdominal aortic aneurysm who underwent aortic computed tomography. Patients were divided into two groups according to presence of abdominal aortic aneurysm and the development of mortality. Predictors of mortality were determined by multiple logistic regression analysis. RESULTS: Multivariate regression analysis showed that CHA2DS2-VASc score, advanced age, female gender and elevated white blood cell counts were independent predictors of abdominal aortic aneurysm development while CHA2DS2-VASc score and elevated glucose levels were independent predictors of one year mortality in patients with abdominal aortic aneurysm. The concordance statistics for anticoagulation and risk factors in atrial fibrillation risk Score and CHA2DS2-VASc risk score respectively were 0.96 and 0.97 and could significantly predict one year mortality in patients with abdominal aortic aneurysm (p<0.001, and p<0.001, respectively). CONCLUSIONS: CHA2DS2-VASc and anticoagulation and risk factors in atrial fibrillation risk scores are easily obtained in an emergency setting and can accurately predict one year mortality as a noninvasive follow-up in patients with abdominal aortic aneurysm. These simple scores could be used as a point of care decision aid to help the clinician in counseling patients presenting with abdominal aortic aneurysm and their families on treatment protocols.

RESUMO OBJETIVO: A fibrilação atrial pós-operatória de início recente (Poaf) é a arritmia mais comum após a cirurgia de revascularização do miocárdio (CABG) e associada a hospitalização prolongada, acidente vascular cerebral e mortalidade. O ângulo QRS-T [f(QRS-T)] do plano frontal, que é definido como o ângulo entre as direções da despolarização ventricular (eixo-QRS) e repolarização (eixo-T), é um novo marcador da heterogeneidade da repolarização ventricular. O ângulo f(QRS-T) está associado a desfechos cardíacos adversos. À luz desses achados, neste estudo, objetivamos investigar a relação potencial entre o ângulo f(QRS-T) e a Poaf. MéTODOS: Cento e oitenta pacientes submetidos a CABG entre agosto de 2017 e setembro de 2018 foram incluídos no estudo retrospectivamente. Dois grupos foram estabelecidos como pacientes com ritmo sinusal pós-operatório (n=130) e com Poaf (n=50). O ângulo f(QRS-T) e todos os dados foram comparados entre os grupos. RESULTADOS: Ângulo f(QRS-T) (p<0,001), escore Syntax (p=0,039), níveis séricos de PCR de alta sensibilidade (p=0,026), idade média (p<0,001), taxa de hipertrofia ventricular esquerda eletrocardiográfica (LVH) (p=0,019) e taxa de hipertensão (p=0,007) foram maiores; a fração de ejeção média do ventrículo esquerdo (LVEF) (p<0,001) foi menor no grupo com Poaf. As análises de regressão logística multivariável demonstraram que menor LVEF (p=0,004), LVH (p=0,041), maior idade (p=0,008) e maior ângulo f(QRS-T) (p<0,001) foram independentemente associados à Poaf. CONCLUSÕES: Níveis de ângulo altos f(QRS-T) estão intimamente associados à Poaf. O ângulo f(QRS-T) pode ser um indicador potencial de Poaf.

SUMMARY BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. METHODS: 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. RESULTS: The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. CONCLUSIONS: High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.

Abstract Objective: The aim of this study was to evaluate the value of CHA2DS2-VASc and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) risk scores for prediction of postoperative atrial fibrillation (AF) development in patients undergoing coronary artery bypass grafting (CABG) operation. Methods: The population of this observational study consisted of 370 patients undergoing CABG operation. CHA2DS2-VASc and ATRIA risk scores were calculated for all patients and their association with postoperative AF (AF episode lasting > 5 min) were evaluated. Predictors of postoperative AF were determined by multiple logistic regression analysis. Results: During follow-up, 110 patients (29.7%) developed postoperative AF. With multiple logistic regression analysis, risk factors for postoperative AF were determined: ATRIA risk score (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.11-1.36; P<0.001), fasting glucose level (OR 1.006; 95% CI 1.004-1.009; P<0.001), and 24-hour drainage amount (OR 1.002; 95% CI; 1.001-1.004; P<0.001). Receiver operating characteristic curve analyses showed that CHA2DS2-VASc and ATRIA risk scores were significant predictors for new-onset AF (C-statistic 0.648; 95% CI 0.59-0.69; P<0.001; and C-statistic 0.664; 95% CI 0.61-0.71; P<0.001, respectively). Conclusion: CHA2DS2-VASc and ATRIA risk scores predict new AF in patients undergoing CABG.

RESUMO OBJETIVO Este estudo teve como objetivo investigar o valor preditivo da recém-definida relação entre Proteína C-Reativa (PCR) e Albumina (CAR) na determinação do desenvolvimento de Fibrilação Atrial (FA) em comparação com outros marcadores inflamatórios, como proporção de Neutrófilos para Linfócitos (N/L) e relação Plaquetas/Linfócitos (P/L) em pacientes submetidos à Cirurgia de Revascularização do Miocárdio (CRM). MÉTODOS A população deste estudo observacional foi composta por 415 pacientes submetidos à cirurgia de revascularização do miocárdio. A coorte do estudo foi subdividida em dois grupos de acordo com o desenvolvimento da FA. Contagens sanguíneas completas, PCR sérica e albumina sérica foram obtidas antes da CRM. Os valores de CAR, relação N/L e relação P/L foram calculados. Os preditores de FA pós-operatória foram determinados por análise de regressão logística múltipla. RESULTADOS Durante o acompanhamento, 136 pacientes (32,8%) desenvolveram FA pós-operatória. Com análise de regressão logística múltipla, foram determinados os fatores de risco para FA pós-operatória: glicemia de jejum (OR: 1,01; IC 95%: 1,00-1,01, p<0,001), idade (OR: 1,12; IC 95%: 1,07-1,17, p<0,001), fração de ejeção do ventrículo esquerdo (OR: 0,90; IC 95%: 0,87-0,94, p<0,001), sexo masculino (OR: 3,32; IC 95%: 1,39-7,90, p=0,007), quantidade de drenagem de 24 horas (OR: 1,004; IC 95%: 1,002-1,005, p<0,001), CAR (OR: 1,82; IC 95%: 1,53-2,16, p<0,001). A análise da curva de características operacionais do receptor mostrou que o CAR (estatística C: 0,75; IC 95%: 0,71-0,79, p<0,001) foi um preditor significativo de FA. CONCLUSÃO O novo marcador inflamatório CAR é confiável para prever o desenvolvimento de FA após a operação de revascularização miocárdica.

SUMMARY OBJECTIVE This study aimed to investigate the predictive value of the newly defined C-Reactive Protein (CRP)/Albumin Ratio (CAR) in determining the development of atrial fibrillation (AF) in comparison with other inflammatory markers, such as Neutrophil/Lymphocyte (N/L) Ratio and Platelet/Lymphocyte (P/L) Ratio, in patients undergoing Coronary Artery Bypass Grafting (CABG) surgery. METHODS The population of this observational study consisted of 415 patients undergoing CABG. The study cohort was subdivided into two groups based on the development of AF. Complete blood counts, serum CRP, and serum albumin levels were evaluated before the CABG. The CAR, N/L, and P/L ratios of all the patients were calculated. Predictors of postoperative AF were determined by multiple logistic regression analysis (MLRA). RESULTS During follow-up, 136 patients (32.8%) developed postoperative AF. With MLRA, independent risk factors for postoperative AF were determined as follows: fasting glucose level (OR: 1.01; 95 % CI: 1.00-1.01, P <0.001), age (OR: 1.12; 95 % CI: 1.07-1.17, P <0.001), left ventricle ejection fraction (OR: 0.90; 95 % CI: 0.87-0.94, P <0.001), male gender (OR: 3.32; 95 % CI: 1.39-7.90, P = 0.007), 24-hour drainage amount (OR: 1.004; 95 % CI: 1.002-1.005, P <0.001), and CAR (OR: 1.82; 95 % CI: 1.53-2.16, P <0.001). Receiver Operating Characteristic curve analysis showed that CAR (C-statistic: 0.75; 95% CI: 0.71-0.79, p< 0.001) was a significant predictor of AF. CONCLUSION Novel inflammatory marker CAR can be used as a reliable marker to predict the development of AF following CABG.

RESUMO OBJETIVO Este estudo teve como objetivo investigar o valor preditivo da recém-definida relação entre Proteína C-Reativa (PCR) e Albumina (CAR) na determinação do desenvolvimento de Fibrilação Atrial (FA) em comparação com outros marcadores inflamatórios, como proporção de Neutrófilos para Linfócitos (N/L) e relação Plaquetas/Linfócitos (P/L) em pacientes submetidos à Cirurgia de Revascularização do Miocárdio (CRM). MÉTODOS A população deste estudo observacional foi composta por 415 pacientes submetidos à cirurgia de revascularização do miocárdio. A coorte do estudo foi subdividida em dois grupos de acordo com o desenvolvimento da FA. Contagens sanguíneas completas, PCR sérica e albumina sérica foram obtidas antes da CRM. Os valores de CAR, relação N/L e relação P/L foram calculados. Os preditores de FA pós-operatória foram determinados por análise de regressão logística múltipla. RESULTADOS Durante o acompanhamento, 136 pacientes (32,8%) desenvolveram FA pós-operatória. Com análise de regressão logística múltipla, foram determinados os fatores de risco para FA pós-operatória: glicemia de jejum (OR: 1,01; IC 95%: 1,00-1,01, p<0,001), idade (OR: 1,12; IC 95%: 1,07-1,17, p<0,001), fração de ejeção do ventrículo esquerdo (OR: 0,90; IC 95%: 0,87-0,94, p<0,001), sexo masculino (OR: 3,32; IC 95%: 1,39-7,90, p=0,007), quantidade de drenagem de 24 horas (OR: 1,004; IC 95%: 1,002-1,005, p<0,001), CAR (OR: 1,82; IC 95%: 1,53-2,16, p<0,001). A análise da curva de características operacionais do receptor mostrou que o CAR (estatística C: 0,75; IC 95%: 0,71-0,79, p<0,001) foi um preditor significativo de FA. CONCLUSÃO O novo marcador inflamatório CAR é confiável para prever o desenvolvimento de FA após a operação de revascularização miocárdica.

SUMMARY OBJECTIVE This study aimed to investigate the predictive value of the newly defined C-Reactive Protein (CRP)/Albumin Ratio (CAR) in determining the development of atrial fibrillation (AF) in comparison with other inflammatory markers, such as Neutrophil/Lymphocyte (N/L) Ratio and Platelet/Lymphocyte (P/L) Ratio, in patients undergoing Coronary Artery Bypass Grafting (CABG) surgery. METHODS The population of this observational study consisted of 415 patients undergoing CABG. The study cohort was subdivided into two groups based on the development of AF. Complete blood counts, serum CRP, and serum albumin levels were evaluated before the CABG. The CAR, N/L, and P/L ratios of all the patients were calculated. Predictors of postoperative AF were determined by multiple logistic regression analysis (MLRA). RESULTS During follow-up, 136 patients (32.8%) developed postoperative AF. With MLRA, independent risk factors for postoperative AF were determined as follows: fasting glucose level (OR: 1.01; 95 % CI: 1.00-1.01, P <0.001), age (OR: 1.12; 95 % CI: 1.07-1.17, P <0.001), left ventricle ejection fraction (OR: 0.90; 95 % CI: 0.87-0.94, P <0.001), male gender (OR: 3.32; 95 % CI: 1.39-7.90, P = 0.007), 24-hour drainage amount (OR: 1.004; 95 % CI: 1.002-1.005, P <0.001), and CAR (OR: 1.82; 95 % CI: 1.53-2.16, P <0.001). Receiver Operating Characteristic curve analysis showed that CAR (C-statistic: 0.75; 95% CI: 0.71-0.79, p< 0.001) was a significant predictor of AF. CONCLUSION Novel inflammatory marker CAR can be used as a reliable marker to predict the development of AF following CABG.

Abstract Objective: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). Methods: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. Results: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. Conclusion: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.

Abstract Introduction: Metabolic syndrome (MetS) is defined as an association between diabetes, hypertension, obesity and dyslipidemia and an increased risk of cardiovascular disease. Mitral annular calcification (MAC) is associated with several cardiovascular disorders, including coronary artery disease, atrial fibrillation (AF), heart failure, ischemic stroke and increased mortality. The CHA2DS2-VASc score is used to estimate thromboembolic risk in AF. However, the association among MAC, MetS and thromboembolic risk is unknown and was evaluated in the current study. Methods: The study group consisted of 94 patients with MAC and 86 patients with MetS. Patients were divided into two groups: those with and those without MAC. Results: Patients with MAC had a higher MetS rate (P<0.001). In patients with MAC, the CHA2DS2-VASc scores and the rate of cerebrovascular accident and AF were significantly higher compared to those without MAC (P<0.001, for both parameters). The results of the multivariate regression analysis showed that history of smoking, presence of MetS and high CHA2DS2-VASc scores were associated with the development of MAC. ROC curve analyses showed that CHA2DS2-VASc scores were significant predictors for MAC (C-statistic: 0.78; 95% CI: 0.706-0.855, P<0.001). Correlation analysis indicated that MAC was positively correlated with the presence of MetS and CHA2DS2-VASc score (P=0.001, r=0.264; P<0.001, r=0.490). Conclusion: We have shown that CHA2DS2-VASc score and presence of MetS rates were significantly higher in patients with MAC compared without MAC. Presence of MAC was correlated with CHA2DS2-VASc score, presence of MetS, AF and left atrial diameter and negatively correlated with left ventricular ejection fraction.