Effect of hunger strike on electrocardiographic parameters.

OBJECTIVE: This study is a comparison of the electrocardiogram (ECG) findings of detainees and convicts who participated in a hunger strike recorded at the end of the strike and 2 months later. METHODS: A total of 81 male detainees and convicts (mean age 41±9.4 years) who participated in a hunger strike between September 2012 and November 2012 were included in this study. The mean duration of the fast was 45±9.6 days. Measurements of blood pressure, body weight, and serum electrolytes (sodium, potassium, calcium) obtained on the last day of the hunger strike and 2 months later were compared, as well as 12-lead ECG readings obtained at the same intervals, which were scanned and transferred to a high-resolution electronic format and evaluated. RESULTS: The mean weight loss for the 81 patients during the hunger strike was 6±3.7 kg. Early repolarization (ER) (inferior: 10, lateral: 5, inferolateral: 1) was detected in 16 (19.7%) ECGs taken on the last day of fasting, and in 4 (4.9%) (inferior: 3, lateral: 1) of those measured 2 months after the strike (p<0.001). A significant difference was observed in the PR interval (157±75 ms vs. 153±23 ms; p=0.035) and QRS duration (95±73 vs. 92±11; p=0.001), whereas there was no significant difference in heart rate (p=0.068). Additionally, there was no significant difference in terms of electrolyte levels between the last day of the hunger strike and 2 months after its conclusion. CONCLUSION: This is the first time long-term lack of nutrition was demonstrated to be associated with ER.

Clinical usefulness of epicardial adipose tissue in patients with high-intermediate pre-test probability for coronary artery disease.

BACKGROUND: Epicardial adipose tissue (EAT) is thought to be associated with the extension and severity of coronary artery disease (CAD), and echocardiographic measurement of EAT thickness is considered to be a possible cardiovascular risk indica-tor. The European Society of Cardiology Task Force recommends further non-invasive testing in patients with an intermediate pre-test probability (PTP) for the diagnosis of CAD. AIM: We sought to evaluate the clinical usefulness of performing EAT measurements in patients with a high-intermediate PTP. METHODS: Patients referred to an outpatient clinic with stable chest pain symptoms, with PTP for CAD between 66% and 85%, were included in the study. Echocardiographic measurement of the EAT was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium. Single-photon emission computed tomography (SPECT) was performed in all patients. The diagnosis of CAD was based on the presence of reversible perfusion defects on SPECT. RESULTS: A total of 126 patients (76 men, 60.3%) with a mean age of 65.3 ± 9.1 years were recruited. The EAT thickness was 7.3 ± 0.7 mm in patients with positive SPECT and 6.2 ± 0.6 mm in patients with negative SPECT (p < 0.001). Multivariable analysis revealed higher rates of positive SPECT in patients with higher EAT (odds ratio [OR] 9.80; 95% confidence interval [CI] 3.72-25.79; p < 0.001), and receiver operating characteristic curve analysis showed that the greatest specificity was obtained when the cut-off value of EAT thickness was 6.75 mm (sensitivity 76%; specificity 74%). CONCLUSIONS: In patients with high-intermediate PTP, EAT is a useful measurement that may assist in risk stratification.