SUMMARY OBJECTIVE: Premature ventricular complexes are common in healthy individuals’ ambulatory monitoring. The index of cardiac-electrophysiological balance may predict malignant ventricular arrhythmias. This study investigated the relation between Premature ventricular complex burden and index of cardiac-electrophysiological balance in 24-h Holter monitoring. METHODS: A total of 257 patients who were admitted to a cardiology outpatient clinic without structural heart disease and underwent 24-h Holter monitoring were included in the study. Demographic features, laboratory parameters, and electrocardiographic and echocardiographic values of all patients were obtained from the hospital database. Patients were categorized into the following four groups according to their premature ventricular complex burden: ≤5% premature ventricular complexes as group 1, >6 and ≤10% premature ventricular complexes as group 2, >11 and ≤20% premature ventricular complexes as group 3, and >20% premature ventricular complexes as group 4. QRS, QT, and T peak to end interval were measured by resting electrocardiography. QT interval was corrected using Bazett’s formula. T peak to end interval/QT, T peak to end interval/corrected QT interval, index of cardiac-electrophysiological balance, and corrected index of cardio-electrophysiological balance ratios were calculated. RESULTS: There was no significant difference between groups regarding cardiovascular risk factors. In group 4, beta-blocker usage was significantly higher, and the serum magnesium levels were significantly lower than in other groups. There was no difference in QT duration or index of cardiac-electrophysiological balance values; however, corrected index of cardio-electrophysiological balance was significantly lower in the highest premature ventricular complex group (5.1, 5.1, 4.8, 4.7, p=0.005). In multivariate backward logistic regression analyses, it was found that lower corrected index of cardio-electrophysiological balance, lower serum magnesium levels, lower serum creatinine levels, larger left atrium size, and higher T peak to end interval were associated with higher premature ventricular complexes. CONCLUSION: Corrected index of cardio-electrophysiological balance is a novel and noninvasive marker that can predict premature ventricular complex burden in patients with structurally normal hearts.

SUMMARY BACKGROUND: The CHA2DS2-VASc score is used to determine thromboembolic risk in cases of atrial fibrillation. The predictive value of this score in predicting coronary collateral circulation in chronic total occlusion is unknown. OBJECTIVE: The aim of this study was to investigate the relationship between the CHA2DS2-VASc score and coronary collateral circulation in patients with chronic total occlusion. METHODS: A total of 189 patients, who underwent coronary angiography and had a chronic total occlusion in at least one coronary artery, were enrolled in this study. The Rentrop scoring system was used for grouping the patients, and patients were classified as having poorly developed coronary collateral circulation (Rentrop grade 0 or 1) or well-developed coronary collateral circulation (Rentrop grade 2 or 3). RESULTS: The CHA2DS2-VASc score of the good coronary collateral circulation group was significantly lower than the other group (3.1±1.7 vs. 3.7±1.7, p=0.021). During the follow-up period, 30 (32.2%) patients in the poorly developed coronary collateral circulation group and 16 (16.7%) patients in the well-developed coronary collateral circulation group died (p=0.028). According to the multivariable Cox regression model, the CHA2DS2-VASc score [hazard ratio (HR): 1.262, p=0.009], heart rate (HR: 1.049, p=0.003), LVEF (HR: 0.975, p=0.039), mean platelet volume (HR: 1.414, p=0.028), and not taking acetylsalicylic acid during admission (HR: 0.514, p=0.042) were independently associated with a higher risk of mortality. CONCLUSIONS: The CHA2DS2-VASc score is closely related to coronary collateral development and predicts mortality in patients with chronic total occlusion.

Resumo Fundamento A inflamação desempenha um papel fundamental no início e na progressão da doença arterial coronariana (DAC). O Índice Imune-inflamação Sistêmico (SII) é um novo parâmetro inflamatório que demonstrou estar associado à DAC. Objetivos Este estudo teve como objetivo investigar a relação entre o SII e a circulação colateral coronariana (CCC) em pacientes com DAC estável e oclusão crônica total (OTC). Métodos Os pacientes foram divididos em dois grupos, com CCC deficiente e CCC boa, de acordo com a Classificação Rentrop. Noventa e quatro pacientes apresentavam CCC deficiente e 81 pacientes CCC boa. Os parâmetros de inflamação foram calculados a partir dos resultados laboratoriais. O nível de significância estatística aplicado foi de 0,05. Resultados Alto nível de SII (OR: 1,003, IC 95%: 1,001-1,004, p<0,001), ausência de OTC na ACD (artéria coronária direita) (OR: 0,204, IC 95%: 0,096-0,436, p<0,001) e baixo escore de Gensini (OR: 0,980, IC 95%: 0,962-0,998, p=0,028) foram significantemente associados com CCC deficiente. O valor de corte do SII foi de 679,96 para o maior poder preditivo de CCC deficiente, com sensibilidade de 74,5% e especificidade de 43,2%. As taxas de mortalidade foram semelhantes entre os dois grupos durante um seguimento médio de 21,5±10,8 meses (p=0,107). Conclusões Alto nível de SII, ausência de OTC na artéria coronária direita e baixo escore de Gensini foram significantemente relacionados à CCC deficiente. O uso rápido e custo-efetivo de novos marcadores inflamatórios na prática clínica orienta o prognóstico da DAC.

Abstract Background Inflammation plays a key role in the initiation and progression of coronary artery disease (CAD). The systemic immune-inflammation index (SII) is a novel inflammatory parameter that has been shown to be associated with CAD. Objective This study aimed to investigate the relationship between SII and coronary collateral circulation (CCC) in patients with stable CAD and chronic total occlusion (CTO). Methods The patients were divided into two groups, with poor CCC and good CCC, according to the Rentrop Classification. Ninety-four patients had poor CCC, and 81 patients had good CCC. Inflammation parameters were calculated from the laboratory results. The statistical significance level applied was 0.05. Results High SII level (OR: 1.003, 95% CI: 1.001-1.004, p<0,001), absence of CTO in RCA (OR: 0.204, 95% CI: 0.096-0.436, p<0,001) and low Gensini score (OR: 0.980, 95% CI: 0.962-0.998, p=0,028) were significantly associated with poor CCC. The cutoff value of SII was 679.96 for the highest predictive power of poor CCC, with a sensitivity of 74.5% and specificity of 43.2%. Mortality rates were similar between the two groups during a mean follow-up of 21.5±10.8 months (p=0.107). Conclusions High SII level, the absence of CTO in the right coronary artery, and low Gensini score were significantly related to poor CCC. The rapid and cost-effective use of new inflammatory markers in clinical practice guides the prognosis of CAD.

Resumo Fundamento: As contrações ventriculares prematuras (CVPs) podem provocar arritmias ventriculares letais em pacientes com doença cardíaca estrutural, no entanto o papel das CVPs em indivíduos saudáveis permanece controverso, já que não há muitos estudos clínicos disponíveis. Recentemente, alguns marcadores de repolarização do miocárdio, tais como o intervalo Tp-e e as relações Tp-e/QT e Tp-e/QTc, foram relatados como úteis para prognosticar arritmias ventriculares letais em diversos transtornos clínicos sem doença cardíaca estrutural. Objetivo: Neste estudo, o objetivo foi investigar a relação entre os marcadores de repolarização do miocárdio e as CVPs frequentes em indivíduos sem doença cardíaca estrutural. Métodos: Este estudo incluiu 100 pacientes com queixas de tonturas e palpitações. Eletrocardiografia de 12 derivações e registros de Holter ambulatorial de 24 horas foram obtidos de todos os pacientes. A carga de CVP foi calculada como o número total de CVPs dividido pelo número de todos os complexos de QRS no tempo de registro total. Foram considerados significativos valores p < 0,05. Resultados: O intervalo Tp-e e a relação Tp-e/QTc foram significativamente mais altos em pacientes com carga de CVP mais alta do que nos pacientes com carga de CVP inferior, e encontrou-se correlação positiva entre esses marcadores e a carga de CVP. Tp-e (β = 1,318, p = 0,043) e Tp-e/QTc (β = -405,136, p = 0,024) na derivação V5 foram identificados como preditores independentes da carga de CVP aumentada. Conclusões: O intervalo Tp-e e a razão Tp-e/QTc foram mais altos em pacientes com um valor mais alto de CVP. Nosso estudo mostrou que CVPs podem ter um efeito negativo na repolarização do miocárdio. Essa interação pode resultar em risco aumentado de arritmias malignas.

Abstract Background: Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease. Objective: In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease. Methods: This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant. Results: Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden. Conclusions: Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias.