Use of QT intervals for a more accurate diagnose of syncope and evaluation of syncope severity.

BACKGROUND: This study aimed to evaluate the use of QT intervals, their diagnostic predictive value in patients with syncope and their relationship with syncope severity. METHODS: One hundred and forty nine patients with a diagnosis of syncope were admitted to Internal Medicine departments at the University of Palermo, Italy, between 2006 and 2012, and 140 control subjects hospitalised for other causes were enrolled. QT maximum, QT minimum, QTpeak, QT corrected, QT dispersion and Tpeak-to-Tend interval were compared between two groups. The paper medical records were used for scoring with San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in SYncope Study (EGSYS) score and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score. RESULTS: Mean QTc (p < 0.0005), mean QTmax (p < 0.0005), mean QTdisp (p < 0.0005), mean QTpeak (p = 0.005) and mean TpTe (p = 0.018) were significantly longer in patients with syncope compared with control subjects. A QTc > 424.8 ms (sensibility: 81.88 - specificity: 57.86) showed the greatest predictive value for diagnosis of syncope. On the EGSYS score and on the OESIL score, QTc was significantly prolonged in high-risk patients compared with low-risk patients. On the San Francisco Syncope Rule, QTc and QTdisp were significantly prolonged in high-risk patients compared with low-risk patients. CONCLUSION: Mean QTc, mean QTdisp, mean TpTe, mean QTmax and mean QTpeak were significantly longer in patients with syncope compared with control subjects. Furthermore, prolonged QTc and QTdisp were associated with major severe syncope according to San Francisco Syncope Rule, EGSYS and OESIL risk scores.

Metabolic and anti-inflammatory effects of a home-based programme of aerobic physical exercise.

AIMS: Regular exercise demonstrated the ability to provide enormous benefits to many diseases, atherosclerotic-based, degenerative and neoplastic, but also to grant anti-inflammatory actions, assessed by various authors in different populations. Despite of these clear benefits, many patients are unable to attain long-term results through chronic physical activity for different causes. On this basis, the aim of our study was to assess the metabolic and anti-inflammatory effects of a home-based programme of fast walking in patients affected by metabolic syndrome (MS). MATERIALS AND METHODS: We enrolled 176 subjects with MS as stated by ATP III criteria. Patients were invited to walk for 1 h every day 5 days a week for 24 weeks. The walking velocity was required higher than the one retained 'comfortable' by the patient, previously assessed in the run-in visit. Monitoring of physical activity was carried out through an OMRON step counter type Walking Style II. All the subjects enrolled completed the training period. RESULTS: After the 24 weeks of intervention body mass index changed from 31.59 to 29.23 (p < 0.001); mean waist circumference passed from 105.19 to 100.06 cm (p < 0.001); mean fasting glucose changed from 119.76 to 114.32 mg/dl (p < 0.001); for diabetic population (n = 70) mean glicated haemoglobin levels changed from 7.38% to 6.86% (p < 0.001); total cholesterol levels from 192.15 to 185.78 mg/dl (p < 0.001); HDL cholesterol levels raised from 44.03 to 47.63 mg/dl (p < 0.001); triglycerides levels lowered from 148.29 to 135.20 mg/dl (p < 0.001); WBC changed from 7361.08 to 7022.56/mm(3) (p < 0.001); hs-CRP from 0.55 to 0.28 mg/dl (p < 0.001); fibrinogen serum levels lowered from 339.68 to 314.86 mg/dl (p < 0.001). CONCLUSIONS: A long-term home-based programme of aerobic physical activity improves metabolic asset and reduces systemic inflammation in sedentary people.