The Effects of Ivabradine on Left Ventricular Synchronization and Tei Index in Patients with Systolic Heart Failure.

BACKGROUND: The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3 months effect of ivabradine on LV synchronization and Tei index in stable outpatients with systolic HF. METHODS: We evaluated prospectively 40 (30 males, 10 females) patients with HF. All patients were evaluated before and after treatment by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI) and tissue synchronization imaging (TSI). Standard deviation of Ts of the 12 LV segments (Ts-SD-12) is the most widely used parameter of intra-LV asynchrony. RESULTS: Thirty men and 10 women with mean ± SD age of 64.7 ± 9.9 years were included in this study. Most of the patients benefitted from some degree of clinical improvement, 12/16 (75.0%) from NYHA III to II and 18/24 (75.0%) from II to I, respectively. Resting heart rate was significantly reduced after ivabradine treatment (84.3 ± 11.4 vs. 66.5 ± 11.5 bpm, p < 0.001). E/E' and Tei index were significantly changed after ivabradine treatment (17.3 ± 9.0 vs. 14.8 ± 7.1, p = 0.02 and 0.86 ± 0.74 vs. 0.81 ± 0.69, p = 0.02). Intra-LV synchrony parameters Ts-SD-12 and Ts-12 were significantly reduced after ivabradine (46.8 ± 13.6 vs. 42.7 ± 13.1, p = 0.01 and 142.5 ± 44.0 vs. 128.5 ± 45.2, p = 0.009). CONCLUSIONS: The present study demonstrated that adding ivabradine to the standard therapy reduced HR and significantly improved LV ventricular asynchrony and Tei index in systolic HF patients.

A new diagnostic tool for masked hypertension: impaired sleep quality.

INTRODUCTION: The aim of this study was to evaluate the relationship between masked hypertension and impaired sleep quality. Additionally, we evaluated the diagnostic role and prevalence of poor sleep quality among patients with newly diagnosed masked hypertension. MATERIAL AND METHODS: A total of 112 individuals, 72 patients with newly diagnosed masked hypertension and 40 normotensive healthy volunteers, were included in this study. All patients underwent evaluation comprising 12-lead electrocardiography, transthoracic echocardiography, 24-hour Holter ECG, and basic laboratory tests. Additionally, all participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The total PSQI score was significantly higher in the masked hypertension group than in the normotensive healthy volunteers (4.13 ±2.43 vs. 2.33 ±1.67, p < 0.001). A PSQI score > 5 was found in 45.8% (n = 33) of patients in the masked hypertension group and 15% (n = 6) of patients in the normotensive group (p < 0.001). The non-dipper pattern was found in 17.5% of the healthy volunteer group and 59.94% (n = 41) of the masked hypertension group (p < 0.001). When we compared the dipping pattern of the masked hypertension groups, there was a significant difference in PSQI score between the dipper and non-dipper groups (4.87 ±3.21 vs. 3.58 ±2.33, p < 0.001). Multiple logistic regression analyses showed that masked hypertension, LV mass, and LV mass index score were independent predictors of poor PSQI. CONCLUSIONS: This study demonstrates impaired sleep quality in subjects with masked hypertension, particularly those with a non-dipper pattern. Additionally, this study indicates that impaired sleep quality may help diagnose masked hypertension, particularly in the non-dipper group.

Electrophysiological validation of total atrial conduction time measurement by tissue doppler echocardiography according to age and sex in healthy adults.

BACKGROUND: We sought to validate total atrial conduction time (TACT) measurement via tissue Doppler imaging (TDI) by comparing the electrophysiological study (EPS) measurements of healthy subjects, according to age and sex. METHODS: Eighty patients with normal EPS results were included. TACT was measured by EPS and TDI. For validation, the results of TDI were compared with those of EPS. TACT was assessed by measuring the time interval between the beginning of the P-wave on the surface ECG, and the peak A-wave on TDI from the left atrial lateral wall, just over the mitral annulus. Electrophysiological TACT was defined as the time from the high right atrial electrogram to the distal coronary sinus atrial electrogram around the left lateral portion of the mitral ring. RESULTS: EPS and TDI measurements of the TACT were significantly and positively correlated among men and women in 20-30 years (p=0.008, r=0.412; p>0.001, r=0.706, respectively), and those in the 30-40 years group (p=0.001, r=0.649; p=0.001, r=0.696). In contrast, EPS and TDI measurements of TACT were not significantly different among men and women in the 20-30 years and those in the 30-40 years group (p>0.05, for both). On univariate regression analyses, TACT was independently associated with age (ß=0.342, =0.001). CONCLUSIONS: When assessed according to the age and sex of healthy participants, TDI and EPS measurements during TACT assessments were similar and correlated with each other. The measurement of TACT via TDI may be used accurately and confidently than the measurement via EPS in healthy individuals.

The effects of ivabradine on left atrial electromechanical function in patients with systolic heart failure.

AIM: Heart rate (HR) reduction with ivabradine improves left ventricle filling by the prolongation of the diastolic time and increases stroke volume. But, it remains unclear what ivabradine's effect is on atrial conduction time and atrial mechanical functions. The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3 months effect of ivabradine on atrial conduction time and mechanical functions. METHOD: We evaluated prospectively 43 (31 males, 12 females) patients with HF. Before and after treatment, all patients were evaluated by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI), and LA volumes were obtained apical four-chamber views by a disc's method. LA maximum volume (Vmax) at the end-systolic phase, LA minimum volume (Vmin) at the end-diastolic phase, and LA volume before atrial systole (Vp) were evaluated. The LA function parameters were calculated as follows: LA passive emptying volume = Vmax - Vp; LA passive emptying fraction = [(Vmax - Vp)/Vmax] × 100%, LA active emptying volume = Vp - Vmin; LA active emptying fraction = [(Vp - Vmin)/Vp] × 100%. RESULTS: Thirty men and 13 women with mean ± SD age of 63.9 ± 10.1 years were included in this study. Resting heart rate was significantly reduced after ivabradine treatment. There were no significantly difference in LVEF, and E/A before and after ivabradine treatment. LA diameter and Vmin were similar before and after ivabradine treatment (p = 0.793 and p = 0.284). However, Vmax and Vp were significantly decreased after ivabradine treatment (p = 0.040 and p = 0.012). Moreover, LA active emptying volume and LA active emptying fraction were significantly decreased after ivabradine treatment (p = 0.030 and p = 0.008). The PA lateral, septal, and tricuspid durations were significantly reduced after ivabradine treatment (p < 0.001, p < 0.001, and p = 0.002, respectively). Interatrial electromechanical delay and right intra-atrial electromechanical delay were significantly decreased after ivabradine treatment (33.7 ± 12.7 vs 26.2 ± 10.1, p = 0.001; and 14.1 ± 6.1 vs 9.2 ± 6.8, p < 0.001). CONCLUSIONS: The present study demonstrated that adding ivabradine to the standard therapy reduced HR and improves significantly LA electrical and mechanical functions in systolic HF patients.

Cardiac autonomic function in healthy young smokers.

The present study examined the heart rate turbulence (HRT) and heart rate variability (HRV) parameters in healthy young smokers (<40 years) to assess the effects of smoking on cardiac autonomic function. The study included 75 smokers with a history of habitual smoking for at least 1 year (41 males and 34 females; mean age, 29.3 ± 7.3 years) and 30 nonsmokers (hospital staff; 16 males and 14 females; mean age, 29.0 ± 6.1 years). Addiction to smoking was evaluated using the modified Fagerström test for nicotine-dependence index (NDI). HRT, HRV, basic clinical and echocardiographic, and Holter test parameters were compared between groups. No significant differences between the two groups were found in the basic clinical and echocardiographic variables. Turbulence onset (TO) was significantly higher in the smoking group than in the controls, and turbulence slope was significantly lower in the smokers, than in the controls (p < 0.05). Standard deviation of all normal-to-normal (NN) interval index (SDNNI) was the only HRV parameter that was significantly different between the smoking and control groups (p < 0.05). The NDI was positively correlated with the TO (p < 0.05). Smoking impairs the baroregulatory function in healthy young smokers, particularly the HRT parameters and SDNNI. Our findings highlight the importance of complete smoking cessation.

The importance of the mean platelet volume in the diagnosis of supraventricular tachycardia.

BACKGROUND: The diagnosis of palpitation can be difficult in the emergency department (ED) and the waiting time for a first appointment with an arrhythmia clinic can be very long. The inflammation is sufficient to facilitate the initiation of supraventricular tachyarrhythmia (SVT). The increased mean platelet volume (MPV) is closely correlated with inflammation and to reflect inflammatory burden in different condition. OBJECTIVE: In this study, we aimed to investigate the relation between MPV and SVT in patient with documented atrial tachyarrhythmia in ED. METHODS: Two study groups were compared; a SVT group with arrive at the ED with documented SVT (n=122) and 100 healthy adult without any palpitation symptom, arrhythmic disease, and with normal physical examination results that were brought for checkups to the cardiology polyclinic were classified as control group. Blood samples were obtained from all patients for determining the hematologic counts and MPV during first hour in ED period. RESULTS: In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p>0.05). MPV in the SVT group was signifi cantly higher than in the control group (9.12±1.22 fl vs 8.64±0.89 fl , p<0.001). Multivariate logistic regression analysis showed that just MPV was independent predictor of SVT in patients with palpitation in ED (odds ratio [OR] 8.497, 95% confidence interval (6.181 to 12.325), p=0.012). CONCLUSIONS: Our study described that MPV is helpful parameter for the diagnosis of SVT in emergency department, for the first time in the literature.

The effects of a single dialysis session on atrial electromechanical conduction times and functions.

BACKGROUND/AIMS: Abnormalities in atrial electromechanical delay (EMD) times and mechanical functions are considered as independent predictors of atrial fibrillation. However, to date, effects of a single hemodialysis (HD) session and acute volume-preload changes on atrial-EMD functions have not been investigated by Tissue Doppler Echocardiography (TDE). The aim of the present study was to evaluate atrial-EMD times and mechanical functions in HD patients. METHODS: Thirty-five non-diabetic, normotensive HD patients and 35 healthy control subjects were enrolled in the study. Standard and TDE performed before mid-week dialysis session for hemodialysis group and on admission for control group. RESULTS: Interatrial and left-right intraatrial-EMD intervals and left atrial mechanical volumes were significantly longer in hemodialysis group compared to controls (all p<0.01) and were reduced after HD session. Furthermore, removed ultrafiltration volume was associated with reduction in atrial-EMD intervals and functional volumes. LA-passive emptying volume, ultrafiltration volume, LV-E/E' ratio, and Vp were independent predictors of interatrial-EMD. CONCLUSIONS: The present study confirms negative effects in HD patients of structural remodeling and reveals negative effects of electrical remodeling. Prolonged inter and intraatrial-EMD intervals should be the underlying pathophysiological factors of increased rate of atrial fibrillation in the HD population.

Hematological parameters and coronary collateral circulation in patients with stable coronary artery disease.

BACKGROUND: Although hematological parameters have been associated with prognosis in patients with various cardiovascular diseases, their relationship with coronary collateral (CC) circulation in patients with stable coronary artery disease (CAD) is unknown. OBJECTIVE: To investigate the relationship between hematological parameters and CC vessel development in patients with stable CAD. METHODS: A total of 96 patients who underwent coronary angiography were retrospectively enrolled. All study participants had at least one occluded major coronary artery. Development of CCs was classified using the method of Rentrop. Rentrop grades of 0 and 1 indicate poor CCs, whereas grades 2 and 3 indicate good CCs. Hematological parameters, including mean platelet volume (MPV) and neutrophil/lymphocyte (N/L) ratio, were measured. Multivariate logistic regression analysis was performed to identify independent variables. RESULTS: The MPV and N/L ratio were significantly higher in the poor CC group compared with the good CC group. Negative correlations were found in the analyses comparing Rentrop score with MPV and N/L ratio (r=-0.274; P=0.012 and r=-0.339; P=0.001, respectively). In multivariate analysis, the N/L ratio was independently related to CC circulation (OR 0.762 [95% CI 0.587 to 0.988]; P=0.04). CONCLUSION: The results suggest that N/L ratio and MPV are associated with poor CCs, and a high N/L ratio is a significant predictor of poor CC development in patients with stable CAD.

Detection of left ventricular asynchrony and its relationship with the Tei index in patients with coronary artery ectasia.

OBJECTIVE: To evaluate left ventricular (LV) systolic asynchrony and its relationship with the Tei index using tissue Doppler imaging (TDI); and to evaluate the relationship of thrombolysis in myocardial infarction frame count (TFC) and Tei index with LV asynchrony in patients with coronary artery ectasia (CAE). METHODS: A total of 50 CAE patients and 40 control subjects were evaluated. Diagnosis of CAE was made angiographically and TFC was calculated. LV systolic and diastolic function was assessed by conventional echocardiography and TDI. Evaluation of intra-LV systolic asynchrony was performed using tissue synchronization imaging (TSI). RESULTS: In patients with CAE, the Tei index was significantly higher than in controls (0.63±0.12 versus 0.52±0.12; P<0.001). LV systolic asynchrony parameters of TSI including SD of the peak tissue velocity (Ts) of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any two of the 12 LV segments (Ts-12), SD of the Ts of the six basal LV segments (Ts-SD-6), maximal difference in Ts between any of the six basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism compared with controls (P<0.001, P<0.001, P<0.001 and P<0.001, respectively). In addition, a positive correlation was found between Ts-SD-12 and the Tei index in patients with CAE (r=0.841; P<0.001) and mean TFC was positively correlated with Ts-SD-12 and the Tei index (r=0.345; P=0.013 and r=0.291; P=0.021, respectively). CONCLUSION: Patients with CAE exhibit evidence of LV systolic asynchrony according to TSI. LV systolic asynchrony is related to the Tei index and mean TFC. Furthermore, the Tei index is an independent risk factor for LV systolic asynchrony.

Bradycardia seen in children with Crimean-Congo hemorrhagic fever.

INTRODUCTION: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate. In clinical practice, we observed bradycardia in some pediatric patients with CCHF during the clinical course. So we aimed to report CCHF cases that presented bradycardia during the clinical course and the relation of bradycardia with the clinical findings and ribavirin therapy. METHODS: Charts of all hospitalized pediatric CCHF patients were reviewed with respect to age, sex, history of tick bite or history of removing a tick, other risk factors for CCHF transmission, and interval between the tick bite and the onset of symptoms. Outcomes and clinical and laboratory findings and medications were recorded for each patient. We searched the patient records for information regarding the existence of bradycardia. Bradycardia was accepted as the heart rate 2 standard deviations (SD) lower than the suspected heart rate based on age. RESULTS: Fifty-two patients (mean age 11.2 ± 4.4 years, 31 female) were enrolled into the study. Bradycardia was seen in seven patients. Six patients with bradycardia were male and only one was female, and the mean age was 13.1 ± 1.6 years. It was observed that male gender is frequent among patients with bradycardia, as compared with those without bradycardia (p=0.01). Bleeding was found to be more frequent in patients with bradycardia (p=0.02). There were significant differences between the bradycardia and nonbradycardia groups with regard to the requirements for fresh frozen plasma transfusion, the number of platelet suspension given, requirement for intravenous immune globulin (IVIG) and in the days of stay in hospital (p=0.01, p=0.03, p=0.03, p=0.04, respectively). CONCLUSION: Reversible bradycardia might be seen in the clinical course of pediatric CCHF patients, and the clinicians must be aware of this finding. The possibility that ribavirin may potentiate bradycardia cannot be assessed without a placebo-control study. So further studies may help to reveal the cause of the bradycardia, the disease itself, or the ribavirin therapy. Hence this study supports the need for a randomized, placebo-controlled study to assess intravenous ribavirin in treating CCHF and to support approval of the drug.

Torsades de Pointes due to ischemic stroke.

Cardiac and cerebrovascular illnesses are among the leading causes of mortality and morbidity today. Thromboembolic cases, which are the result of cardiac arrhythmia, are one of the important causes of cerebral stroke. However, various abnormalities, especially ST-T wave changes on electrocardiography can be seen in patients who do not have any heart disease history but had ischemic cerebral stroke. In this study, we have presented an interesting case of Torsades de Pointes due to ischemic cerebral stroke.

Assessment of the neutrophil to lymphocyte ratio in young patients with acute coronary syndromes.

OBJECTIVES: It is well known that inflammation plays a key role in both initiation and propagation of acute coronary syndrome (ACS). White blood cell (WBC) and its subtypes are an indicator of inflammation in patients with ACS. We aimed to evaluate the WBC and its subtypes in patients aged <45 year with acute coronary syndromes. STUDY DESIGN: We retrospectively analyzed WBC and its subtypes (including neutrophil and lymphocyte) in 84 patients (<45 year) who were admitted to the emergency department for chest pain suggestive of ACS (44 unstable angina pectoris, 40 non-ST-segment elevation myocardial infarction [NSTEMI]), and 40 healthy controls. RESULTS: Hypertension, diabetes mellitus, smoking, and family history were significantly higher in NSTE-ACS patients. Also, LDL levels was significantly higher and HDL levels was significantly lower in NSTE-ACS patients (p=0.041 and p=0.009). The difference in percent of lymphocytes between the groups was significant (p=0.048). N/L ratio was significantly different between all groups and between the NSTEMI and USAP (p<0.001 and p=0.041). Our results demonstrated that hypertension, percent of neutrophils, and N/L ratio was a significant independent predictor of NSTE-ACS (Beta=0.251, 95% CI=0.002-0.523, p=0.048; beta=0.561, 95% CI=0.008-0.137, p=0.028 and beta=0.260, 95% CI=0.042-0.438, p=0.018, respectively). CONCLUSION: N/L was found to be elevated in young patients with NSTE-ACS compared with control group. The inflammation assessed using WBC and its subtypes may be more important in young NSTE-ACS patients.

The diagnostic significance of NT-proBNP and troponin I in emergency department patients presenting with palpitations.

OBJECTIVE: This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations. METHODS: Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department. RESULT: The mean NT-proBNP levels were 207.74±197.11 in supraventricular tachyarrhythmia group and 39.99±32.83 pg/mL in control group (p<0.001). To predict supraventricular tachycardia, the optimum NT-proBNP threshold was 61.15 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a non-significant area under the ROC curve of 0.920 (95% CI, 0.86-0.97, p<0.001). The NT-proBNP cut-off for diagnosing supraventricular tachycardia had 81.6% sensitivity and 91.5% specificity. Supraventricular tachycardia was significantly more frequent in the patients with NT-proBNP levels ≥61.15 pg/mL (n = 44, 90.9%, p>0.001). The mean troponin I levels were 0.17±0.56 and 0.01±0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p<0.05). Of the 96 patients, 21 (21.87%) had troponin I levels ≥0.01: 2 (4.25%) in the control group and 19 (38.77%) in the supraventricular tachycardia group (p<0.001). CONCLUSION: Troponin I and, in particular, NT-proBNP peptide were helpful for differentiating supraventricular tachycardia from non- supraventricular tachycardia palpitations. Further randomized, large, multicenter trials are needed to define the benefit and diagnostic role of NT-proBNP and troponin I in the management algorithm of patients presenting with palpitations in emergency departments.

[Relation of neutrophil/lymphocyte ratio with the presence and severity of coronary artery ectasia]. / Nötrofil/lenfosit oraninin koroner ektazisi varligi ve yayginligi ile iliskisi.

OBJECTIVES: It has been shown that the neutrophil to lymphocyte ratio (N/L ratio) is associated with cardiovascular events and mortality. In this study, we investigated the N/L ratio in patients with coronary artery ectasia (CAE). STUDY DESIGN: Fifty patients diagnosed with CAE using coronary angiography were included in the study (29 male, 21 female; mean age, 51.1±7.1 years). The control group consisted of 28 patients who had normal coronary arteries as determined by coronary angiography (16 male, 12 female; mean age, 49.5±9.4 years). Basal characteristics were recorded. The number of ectatic segments was noted. Hematologic parameters were measured and the N/L ratio was calculated. RESULTS: The N/L ratio was significantly higher in the CAE group compared with control group (median [25-75% percentile] 2.2 [1.6-3.0] vs. 1.8 [1.4-2.0], p=0.014, respectively). The Spearman correlation analysis demonstrated that the N/L ratio positively correlated with number of ectatic segments (r=0.35; p<0.002). Multivariable logistic regression analysis showed an independent relationship between CAE and the N/L ratio (odds ratio 2.674, 95% confidence interval 1.184-6.039, p=0.018). CONCLUSION: The N/L ratio is higher in patients with CAE. This ratio is related to presence and severity of CAE.

Polymorphic ventricular tachycardia (Torsades de pointes) due to licorice root tea.

Longed QT syndromes are cardiac repolarization disorders characterized by longed QT intervals on ECG. This electrophysiological abnormality may lead to syncope or sudden cardiac death due to rapid, polymorphic ventricular tachycardia (VT). Licorice root (Glycyrrhizin glabra root) contains Glycyrrhizin, sterols and many flavones. Glycyrrhizin may have effects on cardiac repolarization and depolarization through the autonomic nervous system. We present a case of polymorphic VT (torsades de pointes) secondary to drinking 5-6 glasses of licorice root tea for constipation for 2 days prior to admission to emergency department. Licorice root consumption should be taken into account in all patients admitted to the hospital for cardiac arrhythmia. It may cause cardiac arrhythmia when consumed regularly and in excessive amounts.

[Anxiety levels and quality of life assessment in patients that underwent an electrophysiologic study due to unexplained palpitations]. / Açiklanamayan çarpinti nedeniyle elektrofizyolojik çalisma yapilan hastalarda yasam kalitesi ve kaygi düzeylerinin degerlendirilmesi.

OBJECTIVES: To compare the quality of life and anxiety levels of patients with normal and abnormal results detected during an electrophysiological study (EPS) that was performed due to undocumented palpitations. STUDY DESIGN: Patients (n=128) who underwent EPS without documented arrhythmia of unexplained palpitations were included in the study. The quality of life and anxiety levels of patients with abnormal EPS results were compared with those with normal results by using the 26-item short form of the World Health Organization quality of life scale and state-trait anxiety inventory. RESULTS: SVT was found in 72 patients by diagnostic EPS. Quality of life scores were significantly poorer in the SVT group than of the normal EPS group (p=0.000-0.001). Likewise, the anxiety scores of the patients in the SVT group were higher than normal in the EPS group (p=0.000). Age, physical quality of life, psychological quality of life, state anxiety and trait anxiety were found to be independent predictors of SVT in multivariate regression analysis. CONCLUSION: The level of anxiety was found to be higher and quality of life was found to be lower in patients with palpitations due to SVT. In clinical practice it should be kept in mind that noticed psychiatric symptoms may be secondary to an underlying arrhythmia in the evaluation of patients with palpitations.

Catheter ablation for atrial fibrillation results in greater improvement in cardiac function in patients with low versus normal left ventricular ejection fraction.

PURPOSE: It is still unknown whether left ventricular ejection fraction (LVEF) might affect the magnitude of improvement after atrial fibrillation (AF) ablation on cardiac function in persistent or longstanding persistent AF (CAF) patients. METHOD: We performed echocardiography in 35 patients with CAF before and after catheter ablation (CA). Patients were stratified by LVEF into two groups prior to CA-normal LVEF (≥50 % LVEF, N group, n = 24) and a low LVEF group (<50 % LVEF, L group, n = 11). Patients were followed at 1 month, 3 months, 6 months, 1 year, and 2 years after ablation. RESULTS: After 15.8 ± 7.4 months follow-up, the L group showed greater improvement in LVEF and left atrial ejection fraction (LAEF; N group vs L group: LVEF difference (%), 5 ±8 vs 20± 13, p < 0.01; LAEF difference (%), 11 ± 12 vs 21 ± 10, p < 0.05). LA maximal volume and E/e' showed the same tendency after ablation, although the extent of improvement was not statistically significant. Both groups showed almost the same time course of improvement up to 2 years, although the L group showed earlier recovery in LVEF. CONCLUSION: The greater improvement in several cardiac functions was seen in patients with greater LV dysfunction, after the CA for CAF.

The diagnostic significance of NT-proBNP and troponin I in emergency department patients presenting with palpitations

OBJECTIVE: This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations. METHODS: Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department. RESULT: The mean NT-proBNP levels were 207.74±197.11 in supraventricular tachyarrhythmia group and 39.99±32.83 pg/mL in control group (p<0.001). To predict supraventricular tachycardia, the optimum NT-proBNP threshold was 61.15 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a non-significant area under the ROC curve of 0.920 (95% CI, 0.86-0.97, p<0.001). The NT-proBNP cut-off for diagnosing supraventricular tachycardia had 81.6% sensitivity and 91.5% specificity. Supraventricular tachycardia was significantly more frequent in the patients with NT-proBNP levels ≥61.15 pg/mL (n = 44, 90.9%, p>0.001). The mean troponin I levels were 0.17±0.56 and 0.01±0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p<0.05). Of the 96 patients, 21 (21.87%) had troponin I levels ≥0.01: 2 (4.25%) in the control group and 19 (38.77%) in the supraventricular tachycardia group (p<0.001). CONCLUSION: Troponin I and, in particular, NT-proBNP peptide were helpful for differentiating supraventricular tachycardia from non- supraventricular tachycardia palpitations. Further randomized, large, multicenter trials are needed to define the benefit and diagnostic ...