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Editorial

The Role of the Naples Prognostic Score in the Evaluation of SVG Patency Following CABG Surgery

Cardiovascular diseases are responsible for approximately one-third of deaths worldwide, and ischemic heart disease is the most common form. Coronary artery bypass grafting (CABG) is a common procedure performed in the management of coronary artery disease, but the lower patency rates of grafts are the major limitations during the short and long-term follow-up. The graft failure ranges from 10%–50%, depending upon the type of conduit used, with the highest incidence found in saphenous vein grafts (SVGs).

Inflammatory mediators play essential roles in the development of atherosclerosis and have been extensively studied in various cardiac and noncardiac disorders.^, The Naples Prognostic Score (NPS) is a novel score developed according to the inflammatory and nutritional status that has been frequently studied in oncology, especially gastrointestinal cancers. It has also been proposed as an inflammatory biomarker and potential predictor of risk and prognosis in patients with coronary artery disease, including ST-elevation myocardial infarction (STEMI). NPS may provide information about a patient’s inflammatory and nutritional condition, including lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), total cholesterol (TC), and serum alpha levels. TC and serum albumin reflect the body’s nutritional status, whereas NLR and LMR represent its immunoinflammatory condition. This permits a more thorough assessment of the patient’s physical state.

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Original Article

Could Zonulin and Presepsin Be Biomarkers and Therapeutic Targets for Acute Myocarditis?

Kenan Toprak et al. Mehmet Inanır Tolga Memioğlu Mustafa Kaplangoray … Ali Palice Mustafa Begenc Tascanov

Abstract

Background

The diagnosis of acute myocarditis is usually made with clinical and laboratory parameters. This can sometimes be mixed up with diseases that have similar clinical features, making the diagnosis difficult. Therefore, the use of more specific biomarkers, in addition to the classically used biomarkers such as troponin, will accelerate the diagnosis. In addition, these biomarkers may help us to understand the mechanism of myocarditis development and thus predict unpredictable clinical outcomes.

Objective

This study aims to reveal the possible relationship between intestinal permeability and acute myocarditis.

Methods

In this study, we wanted to evaluate serum levels of zonulin and presepsin in 138 consecutive subjects, including 68 patients with myocarditis and another 70 as the control group, matched for age, gender, and cardiovascular risk factors. P-values <0.05 were considered to be statistically significant.

Results

Compared to the control group, zonulin and presepsin were significantly higher in the patient group with myocarditis (p < 0.001, for all). Zonulin levels were positively correlated with presepsin, peak CK-MB, and peak troponin levels (r = 0.461, p < 0.001; r = 0.744, p < 0.001; r = 0.627, p < 0.001; respectively). In regression analysis, presepsin and zonulin were determined as independent predictors for myocarditis (OR 1.002, 95% CI 1.001-1.003, p = 0.025; OR 12.331, 95% CI 4.261-35.689; p < 0.001; respectively). The predictive value of acute myocarditis of presepsin and zonulin in ROC curve analysis was statistically significant (p < 0.001, for both).

Conclusion

This study showed that zonulin and presepsin could be biomarkers that can be used in the diagnosis of myocarditis, and they can also be therapeutic targets by shedding light on the developmental mechanism of myocarditis.