f(QRS-T) angle may be used as a beneficial tool for determining high risk patients in acute STEMI. Unlike previous studies, we showed for the first time that that post-procedural f(QRS-T) can predict in-hospital mortality and TT failure.

BackgroundQRS fragmentation (fQRS) is classically defined as the presence of slurred QRS morphology in at least two contiguous leads, and its prognostic importance has been shown in ST elevation myocardial infarction (STEMI). However, no study has investigated the significance of single lead fQRS (sl-fQRS) in surface electrocardiography (ECG).ObjectivesTo evaluate whether sl-fQRS is as valuable as classical fQRS in patients with acute STEMI who had successful revascularization with primary percutaneous coronary intervention (pPCI).MethodsWe included 330 patients with a first STEMI who had been successfully revascularized with pPCI. The patient’s electrocardiography was obtained in the first 48 hours, and the patients were divided into three groups according to the absence of fQRS (no-fQRS); fQRS presence in a single lead (sl-fQRS); and ≥2 leads with fQRS (classical fQRS).ResultsIn-hospital mortality was significantly higher both in patients with sl-fQRS and in patients with ≥ 2 leads with fQRS compared to patients with no-fQRS. In ROC curve analysis, ≥ 1 leads with fQRS yielded a sensitivity of 75% and specificity of 57.4% for the prediction of in-hospital mortality. Multivariate analysis showed that sl-fQRS is an independent predictor of in-hospital mortality (OR: 3.989, 95% CI: 1.237-12.869, p = 0.021).ConclusionsAlthough the concept of at least two derivations is mentioned for the classical definition of fQRS, our study showed that fQRS in only one lead is also associated with poor outcomes. Therefore, ≥1 leads with fQRS can be useful when describing the patients under high cardiac risk in acute STEMI.

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BACKGROUND Surgical risk in patients after transcatheter aortic valve implantation (TAVI) is determined by conventional scoring systems. However, these risk scores were developed to predict surgical mortality. Due to their insufficient predictive ability in patients after TAVI, novel risk scores are needed to predict long -term mortality in this population. AIMS The study aimed to investigate the value of conventional risk scores in predicting long -term mortality. Additionally, the impact of laboratory parameters on long -term mortality was evaluated. METHODS Our study included 121 patients who underwent transfemoral TAVI. RESULTS The mean (SD) logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, and the Society of Thoracic Surgeons (STS) risk score were 27.4 (9.7), 7.9 (4.6), and 4.6 (2.4), respectively. In -hospital mortality rate was 1.7%. None of the risk scoring systems predicted in -hospital mortality correctly. The STS score corresponded with the mortality rate of approximately 2 months, EuroSCORE II, with 6 months, and logistic EuroSCORE, with 30 months. Male gender (odds ratio [OR], 5.668; 95% CI, 1.055-30.446; P = 0.04) and low albumin levels before TAVI (OR, 0.109; 95% CI, 0.018-0.654; P = 0.02) were found to be the independent predictors of long -term mortality. CONCLUSIONS Although all conventional risk scores overestimated in -hospital mortality, the STS risk score predicted 2-month, EuroSCORE II, 6-month, and logistic EuroSCORE, 30-month mortality. The independent predictors of long -term mortality were male gender and low blood albumin levels before the TAVI procedure. KEY WORDSalbumin level, frailty, surgical risk scores, transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) with self-expandable Medtronic CoreValve (MCV; Medtronic, Minneapolis, MN) or balloon-expandable Edwards SAPIEN XT valve (ESV; Edwards Lifesciences, Irvine, CA) has been widely used for treatment of high-risk patients with severe aortic stenosis (AS). There is limited data comparing the long-term hemodynamic performance of these two valves. Therefore, this study aimed to compare the short and long-term hemodynamic performance of TAVI with either MCV or ESV. A total of 78 patients who underwent TAVI in our center between June 01, 2012 and January 01, 2014 were enrolled in this retrospective study. For each of the patients we recorded the preprocedural echocardiographic data as well as the post-TAVI echocardiographic outcomes at day one, 6 months and 1 year. The MCV group had lower transaortic gradients than the ESV group, with respect to both maximum (13.4 ± 5.8 vs 18.7 ± 8.1 mmHg, p = 0.001) and mean values (6.5 ± 3.2 vs 9.4 ± 4.3 mmHg, p < 0.001) at post-TAVI day one. These values continued to be significantly lower in the MCV group during post-TAVI 6 months (p < 0.001) and post-TAVI 1 year follow-up (p < 0.05). A paravalvular leak (PVL, grade ≥2) was observed in 6.4 % of patients after TAVI; however, this value decreased over time, and there was no significant difference between the MVC and ESV groups (8.2 vs 3.4 %, p = 0.646). The MCV bioprosthesis was associated with lower transaortic gradients than those of the ESV throughout 1 year of follow-up. The incidence of PVL grade ≥2 in MCV and ESV was comparable.