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    Can the Glasgow prognostic score predict ischemic stroke in patients with infective endocarditis?
    (Assoc Medica Brasileira, 2024) Aydin, Cihan; Demirkiran, Aykut; Aykac, Huseyin; Uslu, Nurullah; Alpsoy, Seref
    OBJECTIVE: The Glasgow prognosis score is a simple parameter calculated using serum levels of albumin and C-reactive protein. The aim of this study was to examine whether this parameter may predict ischemic stroke in patients with infective endocarditis. METHODS: A total of 80 patients who were diagnosed with definitive infective endocarditis according to Duke criteria between 2016 and 2023 were included in the study. Glasgow prognosis score was based on serum levels of albumin and C-reactive protein. In imaging methods, patients were divided into two groups according to whether they had a stroke or not. These two groups were compared in terms of biochemical parameters, and infective endocarditis findings on echocardiography and Glasgow prognosis score. RESULTS: We found that the results were statistically similar except for serum C-reactive protein (Group 1: 54.9 +/- 71.1 and Group 2: 39 +/- 70.7; p=0.03), neutrophil (Group 1: 19.8 +/- 10.8*10(9)/L and Group 2: 13.3 +/- 7.3*109/L; p=0.014), albumin (Group 1: 2.3 +/- 0.6 and Group 2: 2.8 +/- 0.5; p=0.03), and Glasgow prognosis score (Group 1: median 2, min.-max. (1-2) and Group 2: median 1, min.-max. (0-1); p=0.004). In the receiver operating characteristics analysis, Glasgow prognosis score had 82.4% sensitivity and 58.3% specificity in predicting ischemic stroke if the Glasgow prognosis score cutoff was >= 1. In multivariate logistic regression analysis, chronic renal failure [odds ratio (OR): 1.098; 95% confidence interval: 1.054-1.964; p=0.044], age (OR: 1.050; 95%CI 1.006-1.096; p=0.024), and Glasgow prognosis score (OR: 0.695; 95%CI 0.411-0.949; p=0.035) were independent variables in predicting ischemic stroke. CONCLUSION: High Glasgow prognosis score is an independent predictor of ischemic stroke in patients with infective endocarditis. Glasgow prognosis score, determined using albumin and C-reactive protein levels, is a simple and practical index for predicting the prognosis of patients hospitalized with infective endocarditis.
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    NATRIURETIC PEPTIDE CONCENTRATIONS AND ECHOCARDIOGRAPHY FINDINGS IN PATIENTS WITH MICRO-ATRIAL FIBRILLATION
    (Russian Heart Failure Soc, 2024) Aykac, Huseyin; Aydin, Cihan; Demirkiran, Aykut; Uslu, Nurullah; Alpsoy, Seref
    Aim Atrial fibrillation (AF) is a rhythm disorder characterized by very rapid and disorganized atrial-derived electrical activations with uncoordinated atrial contractions. Very short periods of AF-like activity (micro-AF) may be precursors of undetected, silent episodes of atrial fibrillation. Here, we examined the relationship between natriuretic peptide concentrations and echocardiography findings in patients with micro-AF. Material and methods The electrocardiograms (ECGs) of patients complaining of palpitations were recorded with a 24-hour Holter monitor, and the patients were consecutively included in the study. Micro-AF was defined as sudden, irregular atrial tachycardia lasting less than 30 sec with episodes of >= 5 consecutive supraventricular depolarizations with the absolute absence of p-waves. After a G-power test, patients were consecutively included in the study: 45 patients in the micro-AF group and 45 patients in the control group. Laboratory parameters, ECG and echocardiographic findings of the two groups were compared. Results N-terminal pro B-type natriuretic peptide (Pro-BNP) and serum troponin T concentrations were higher in the micro-AF group, (375.5 +/- 63.6 pg / ml vs. 63.1 +/- 56.8 pg / ml, p<0.001; 13 +/- 11.4 ng / dl vs. 4.4 +/- 2.4 ng / dl, p<0.001 respectively.) Each 1 pg / ml increase in serum Pro-BNP increased the risk of micro-AF by 1.8 %. In the ROC analysis, the cut-off value of Pro-BNP for the diagnosis of micro-AF was 63.4 pg / ml, with a sensitivity of 91.1 % and a specificity of 73.3 %. Atrial electro-mechanical delay durations were significantly higher in the micro-AF group. To predict micro-AF, the inter-annulus plane electromechanical delay time (inter-annulus plane AEMD) had a cut-off value of 18.5 sec, with a sensitivity of 93.3 % and a specificity of 91.1 %. Left intra-annulus plane electro-mechanical delay time (intra-annulus AEMD LEFT) had a cut-off value of 11.5 sec with a 95.6 % sensitivity and 75.6 % specificity. In the ECG evaluation, maximum P wave duration (Pmax) (113.+/- 10.2 ms vs. 98 +/- 10.4 ms; p<0.001), minimum P wave duration (Pmin) (73.8 +/- 5.5 ms vs.70 +/- 6.3 ms; p<0.001) and P wave dispersion (PWD) (39.1 +/- 7.9 ms vs.28 +/- 7.6 ms; p<0.001) were longer in the micro-AF group. Conclusions Micro-AF in patients may be predicted by evaluating ECG, echocardiographic, and serum natriuretic peptide data.