An isolated congenital absence of right pulmonary artery associated with pulmonary hypertension with coronary collaterals: A case report.

Unilateral absence of pulmonary artery (UAPA) resulting from a defect in the aortic arch's embryogenesis. Patients who survive into adulthood is rare. Herein, we presented a case of UAPA with pulmonary hypertension in a 49-year old female.

Serum vaspin levels and carotid intima-media thickness in predialysis patients.

BACKGROUND AND OBJECTIVE: Visceral adipose tissue-derived serine proteinase inhibitor (vaspin) is an adipokine that correlates with insulin resistance and obesity in human beings. Previous studies have evaluated the serum vaspin levels in several diseases such as chronic haemodialysis patients and coronary artery disease. To our knowledge, serum vaspin levels have not yet been reported in predialysis patients. Carotid intima-media thickness (CIMT) is a noninvasive procedure to detect early atherosclerotic changes. The aim of this study was to evaluate serum vaspin levels in predialysis patients and their relationships with glomerular filtration rate and CIMT levels. METHODS: A total of twenty-five predialysis patients (14 females and 11 males) and 22 healthy subjects (8 females and 14 males) were enrolled in the study. Serum samples were subjected to the human vaspin RIA system. CIMT was measured by B-mode ultrasonography. RESULTS: Serum vaspin levels were significantly lower in predialysis patients than control subjects (P < .05), while CIMT levels were significantly higher (P < .001). Serum vaspin levels were found to be significantly correlated with glomerular filtration rate (r = 0.42, P < .001) and CIMT (r = -0.47, P < .05) in predialysis patients. CONCLUSIONS: This is the first report to describe the association between serum vaspin levels and CIMT in predialysis patients. We concluded that serum vaspin levels were decreased in predialysis patients than control subjects. In addition, serum vaspin levels were found to be significantly correlated with glomerular filtration rate and CIMT.

Aortic-flow propagation velocity is associated with proteinuria and left ventricular hypertrophy in newly diagnosed hypertensive patients.

OBJECTIVE: Subclinical target organ damage (TOD) is an important long-term complication of hypertension and is associated with cardiovascular events and death. Aortic-flow propagation velocity (APV) is one of the arterial stiffness parameters. The aim of this study was to investigate the predictive value of APV on left ventricular hypertrophy (LVH) and proteinuria. METHODS: A total of 149 newly diagnosed HT patients were included in the study. Urine samples and blood tests were obtained from each patient for diagnosis of proteinuria. All patients underwent echocardiographic examination. All patients' APV measurements, carotid intima-media thicknesses (CIMT), and ankle-brachial indexes (ABI) were measured and recorded. RESULTS: The LVH (+) group consisted of 47 patients, and the LVH (-) group consisted of 102 patients. The proteinuria (+) group consisted of 32 patients, and the proteinuria (-) group consisted of 117 patients. Average CIMT was significantly higher in both proteinuria (+) and LVH (+) groups compared with the (-) groups. ABI and APV were significantly lower in both proteinuria (+) and LVH (+) groups compared with the (-) groups. APV was negatively correlated with LVH, proteinuria, and CIMT and positively correlated with ABI. In the multivariate binary logistic regression analysis, APV was the significant independent predictor of proteinuria. Additionally, APV and ABI were found to be independent predictors of LVH or/and proteinuria. CONCLUSION: Hypertensive patients who had TOD had worse consequences of APV, CIMT, and ABI. APV had a powerful predictive value to identify the patients with higher risk of TOD among newly diagnosed hypertensive patients.

Serum vaspin levels and carotid intima media thickness in pre dialysis patients.

BACKGROUND AND OBJECTIVE: Vaspin is a molecule belonging to adipokine family which is associated with insulin resistance and obesity in humans. Several studies have evaluated the serum levels of vaspin in various conditions including coronary artery disease and chronic hemodialysis patients. To our best knowledge, serum vaspin levels have not yet been studied in pre dialysis patients. Carotid intima-media thickness (CIMT) is a noninvasive procedure used to diagnose the extent of carotid atherosclerotic vascular disease. The objective of this study is to evaluate serum vaspin levels in pre dialysis patients and their relationships with glomerular filtration rate and CIMT levels. METHODS: A total of twenty-five pre dialysis patients (14 female and 11 male) and 22 healthy controls (8 female and 14 male) were included in the study. CIMT was measured through B-mode ultrasonography. RESULTS: Serum vaspin levels were significantly lower (p<0.05) and CIMT levels were significantly higher (p<0.001) in pre dialysis patients than in control subjects. Serum vaspin levels were found to be significantly correlated with glomerular filtration rate (r=0.42, p<0.001) and CIMT (r=-0.47, p<0.05) in pre dialysis patients. CONCLUSIONS: This is the first report to describe the correlation between serum vaspin levels and CIMT in pre dialysis patients. We concluded that serum vaspin levels were decreased in pre dialysis patients compared to the control subjects. In addition, serum vaspin levels were found to be significantly correlated with glomerular filtration rate and CIMT. This article is protected by copyright. All rights reserved.

Peripartum cardiomyopathy in Turkey: Experience of three tertiary centres.

We conducted this study to determine demographic details, and clinical presentations in patients with peripartum cardiomyopathy (PPCMP) of Turkish origin. The study population consisted of 58 patients with PPCMP treated at 3 major hospitals in Turkey, retrospectively. In this study, demographic details and initial echocardiographic data were recorded and long-term clinical status was evaluated. The mean age for the patient cohort was 31.47 ± 6.31 years. Thirty-eight patients (73.1%) were multigravida and seven patients had multifetal pregnancy (13.7%). The mean follow-up left ventricular (LV) ejection fraction increased from 31 ± 7 to 38 ± 19. A minority of patients were defined as improvers according to our pre-specified criteria. The average survival period after diagnosis of PPCMP was 20.66 ± 14.44 months. Initial values for LV end-diastolic diameter and urea were higher in the deceased patients compared with the surviving patients, respectively. Twenty-eight (48%) patients with PPCMP showed improvement in the follow-up period. Of the 58 PPCMP patients, 9 (15%) died during a mean follow-up of 32 ± 22 months.

An epidemiological study to evaluate the use of vitamin K antagonists and new oral anticoagulants among non-valvular atrial fibrillation patients in Turkey- AFTER-2 study design.

OBJECTIVES: Atrial fibrillation (AF) is one of the most common causes of preventable ischemic stroke and is related to increased cardiovascular morbidity and mortality. There is a lack of data in Turkey on the use of new oral anticoagulants (NOACs), and time in therapeutic INR range (TTR) in vitamin K antagonist users and AF management modality. In this multi-center trial, we aimed to analyze, follow and evaluate the epidemiological data in non-valvular AF patients. STUDY DESIGN: Four thousand one hundred consecutive adult patients from 42 centers with at least one AF attack identified on electrocardiography will be included in the study. Patients with rheumatic mitral valve stenosis and prosthetic valve disease will be excluded from the study. At the end of one year, the patients will be evaluated in terms of major cardiac end points (death, transient ischemic attack, stroke, systemic thromboembolism, major bleeding and hospitalization). RESULTS: First results are expected in June 2015. Data about major cardiovascular end-points will be available in January 2016. CONCLUSION: The rates and kind of oral anticoagulant use, TTR in vitamin K antagonist users and main management modality applied in non-valvular AF patients will be determined by AFTER-2 study. In addition, the rate of major adverse events (MACEs) and the independent predictors of these MACEs will be detected (AFTER-2 Study ClinicalTrials.gov number, NCT02354456.).

A novel echocardiographic method for the detection of subclinical atherosclerosis in newly diagnosed, untreated type 2 diabetes.

BACKGROUND: Diabetes accelerates the natural process of atherosclerosis and is a predictor for progression of atherosclerotic lesions. To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Recently, it has been shown that the color M-mode-derived propagation velocity of the descending thoracic aorta (aortic velocity propagation [AVP]) was associated with coronary and carotid atherosclerosis. METHODS: Carotid intima-media thickness (CIMT) and AVP were measured in 72 patients with newly diagnosed type 2 diabetes and 44 healthy people. Individuals who had previously used oral hypoglycemic agents or insulin treatment or had a history of hyperlipidemia, cigarette smoking, hypertension, and cardiovascular disease were excluded from this study. RESULTS: Compared with control group, patients with type 2 diabetes had significantly lower AVP (39.9 ± 6.5 vs. 58.4 ± 6.7 cm/sec, P < 0.001) and higher CIMT (1.1 ± 0.1 vs. 0.95 ± 0.12 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r = -0.835, P < 0.001), AVP and fasting plasma glucose (r = -0.796, P < 0.001)), AVP and HbA1 c (r = -0918 P < 0.001). CONCLUSIONS: Diabetes mellitus may be associated with subclinical atherosclerosis assessed by measurement of AVP and CIMT. These simple methods might improve patient selection for primary prevention atherosclerotic progression.

Increased risk of atrial and ventricular arrhythmia in long-lasting psoriasis patients.

BACKGROUND: Several reports have demonstrated an association between psoriasis and cardiovascular diseases. P wave dispersion (PWD) is the most important electrocardiographic (ECG) markers used to evaluate the risk of atrial arrhythmias. QT dispersion (QTD) can be used to assess homogeneity of cardiac repolarization and may be a risk for ventricular arrhythmias. AIM: To search PWD and QTD in patients with psoriasis. METHODS: Ninety-four outpatient psoriasis patients and 51 healthy people were evaluated by physical examination, 12-lead ECG, and transthoracic echocardiography. Severity of the psoriasis was evaluated by psoriasis area and severity index (PASI). RESULTS: Mean disease duration was 129.4 ± 83.9 (range, 3-360) months and PASI ranged from 0 to 34.0 (mean ± SD; 7.6 ± 6.7). Compared to control group, psoriatic patients had significantly shorter Pmax and Pmin durations, longer QTcmax, and greater PWD and QTcD. Transmitral deceleration time (DT) and isovolumetric relaxation time (IVRT) were significantly longer among psoriasis patients. QTcD and PWD were significantly correlated with disease duration (r = 0.693, P < 0.001, and r = 0.368, P = 0.003, resp.). CONCLUSIONS: In this study, we found that both PWD and QTcD are increased in psoriasis patients compared to healthy subjects. In addition, they had longer DT and IVRT.

[A case of idiopathic ventricular tachycardia in a 14-year-old obese patient due to golden berry fruit extract pills for weight loss]. / Zayiflama amaciyla altin çilek meyve özü hapi kullanan 14 yasinda obez hastada gelisen bir idiyopatik ventriküler tasikardi olgusu.

Several studies have determined an association between obesity and increased risk of cardiac arrhythmia. Currently, due to the increased frequency of obesity, food-, plant-, and drug-based therapies for weight loss have gained great attention. A 14-year-old female patient presented with complaints of palpitation of one-hour onset. Blood pressure was 110/70 mmHg and peripheral pulses were present. She had been using golden berry extract pill three times a day for 10 days. The electrocardiogram showed nonsustained monomorphic ventricular tachycardia (VT). Echocardiographic examination and cardiac magnetic resonance imaging (MRI) were normal. She returned to sinus rhythm following amiodarone infusion. She refused the electrophysiologic study, which plays a vital role in the diagnosis and establishment of the appropriate therapy. Although there was no decrease in body mass index (BMI) of the patient during the two-year follow-up, she had no complaint or evidence of VT on intermittent rhythm Holter studies. This case suggests the primary role of golden berry extract use in the development of VT, rather than obesity.

Clinical and echocardiographic follow-up in pregnant patients with valvular heart disease.

OBJECTIVES: Pregnancy associated cardiovascular changes may result in a significant hemodynamic burden and can lead to morbidity and even mortality in women with cardiac disease. The present study aimed to evaluate clinical and echocardiographic follow-up in pregnant patients with valvular heart disease (VHD). STUDY DESIGN: The medical records of pregnant patients diagnosed with VHD from January 2004 to January 2011 were screened. Demographic characteristics including history of cardiac intervention performed during pregnancy, pulmonary edema, and maternal and fetal mortality, and cesarean section (C/S) history were collected from the hospital database and clinical records of the cardiology and obstetrics departments. The echocardiographic examination was carried out at presentation, 3rd trimester, and 1 month after delivery. The outcomes evaluated were cardiac intervention, pulmonary edema, and both fetal and maternal mortality during pregnancy and C/S. RESULTS: We evaluated the outcomes of 884 pregnant patients with VHD. Adverse clinical outcomes including death, pulmonary edema, and valvular interventions were frequent among patients with severe VHD, whereas no adverse clinical outcome was observed in patients with mild-moderate VHD (n=49, 5.5% vs. n=0, 0%, p<0.001). In patients with severe VHD, clinical outcomes were frequent among patients with valve stenosis, but lower among patients with regurgitation [death 4 (0.45%) vs. 0 (0%); pulmonary edema (15 (1.7%) vs. 13 (1.5%); valvular intervention 11 (1.2%) vs. 6 (0.7%); respectively). CONCLUSION: Valvular heart disease is associated with fetal/maternal morbidity and mortality. Pregnant with severe VHD constitute a high-risk group in which life-threatening complications are likely to occur in the course of pregnancy.

The effects of perindopril on QT duration and dispersion in patients with coronary slow flow.

Coronary slow flow (CSF) is characterized by delayed opacification of coronary arteries in the absence epicardial occlusive disease. QT duration and dispersion have been reported to be longer in patients with CSF. ACE inhibitors may improve CSF through positive effects on endothelial function. The study included 32 patients having CSF and 25 subjects having normal coronary arteries in coronary angiography. The patients were evaluated with 12-leads electrocardiography and echocardiography before and 3 months after treatment with perindopril. Compared to the control group, maximum corrected QT duration (QTcmax) (432.0 ± 28.9 vs. 407.0 ± 39.1 ms, p = 0.008) and QT dispersion (QTcD) (64.0 ± 16.5 vs. 37.3 ± 12.1 ms, p < 0.001), mitral inflow deceleration time (DT) (251.3 ± 49.4 vs. 218.8 ± 44.5 ms, p = 0.013), and isovolumetric relaxation time (IVRT) (115.8 ± 18.4 vs. 107.2 ± 22.9 ms, p < 0.001) were significantly longer and E/A ratio 0.85 ± 0.2 vs. 1.1 ± 0.3, p = 0.004) was lower in patients with CSF. QTcmax (to 407.0 ± 28.0 ms, p = 0.001), QTcD (to 44.5 ± 11.4 ms, p < 0.001), DT (to 221.6 ± 37.7 ms, p < 0.001) and IVRT (to 103.8 ± 16.1 ms, p < 0.001) were significantly decreased and E/A ratio (to 0.98 ± 0.3, p < 0.001) was significantly increased after treatment with perindopril. Coronary slow may be associated with prolonged QT interval and increased QT dispersion and impaired diastolic filling. Perindopril may be helpful in restoration of these findings.

The relation between the color M-mode propagation velocity of the descending aorta and coronary and carotid atherosclerosis and flow-mediated dilatation.

BACKGROUND: To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) have correlated with coronary atherosclerosis. Recently, the color M-mode-derived propagation velocity of descending thoracic aorta (AVP) was shown to be associated with coronary artery disease (CAD). METHODS: CIMT, FMD, and AVP were measured in 92 patients with CAD and 70 patients having normal coronary arteries (NCA) detected by coronary angiography. Patients with acute myocardial infarction, renal failure or hepatic failure, aneurysm of aorta, severe valvular heart disease, left ventricular ejection fraction <40%, atrial fibrillation, frequent premature beats, left bundle branch block, and inadequate echocardiographic image quality were excluded. RESULTS: Compared to patients with normal coronary arteries, patients having CAD had significantly lower AVP (29.9 +/- 8.1 vs. 47.5 +/- 16.8 cm/sec, P < 0.001) and FMD (5.3 +/- 1.9 vs. 11.4 +/- 5.8%, P < 0.001) and higher CIMT (0.94 +/- 0.05 vs. 0.83 +/- 0.14 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r =-0.691, P < 0.001), AVP and FMD (r = 0.514, P < 0.001) and FMD and CIMT (r =-0.530, P < 0.001). CONCLUSIONS: The transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple practical method and correlates well with the presence of carotid and coronary atherosclerosis and brachial endothelial function.

Noninvasive assessment of atherosclerosis in patients with isolated hypertension.

BACKGROUND: Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been used to assess endothelial dysfunction. An impaired FMD response may reflect a vascular phenotype prone to atherosclerosis. The thickness of the common carotid intima-media (CIMT) as measured by ultrasound represents a marker of structural atherosclerosis. Recently, it has been shown that color M-mode propagation velocity measured along the origin of descending thoracic aorta (AVP) may reflect atherosclerosis. In this study, the effects of isolated hypertension on these atherosclerosis markers are investigated. METHODS: Fifty patients with newly diagnosed hypertension and forty healthy people were enrolled. Patients were evaluated with transthoracic echocardiography. Diastolic functions were evaluated by transmitral filling parameters of deceleration time (DT), E/A ratio, and isovolumetric relaxation time (IVRT). Carotid intima-media thickness, FMD, and AVP were measured. RESULTS: Age, gender, and BMI of both groups were similar. Compared to control group CIMT, DT and IVRT values were significantly higher, and FMD and AVP values were significantly lower in hypertensive patients. There were significant correlations between AVP and CIMT (r =-0.699, P < 0.001), AVP and FMD (r = 0.400, P < 0.001), and FMD and CIMT (r =-0.600, P < 0.001). Carotid intima-media thickness, AVP, and FMD were significantly correlated with systolic and diastolic blood pressures and DT and IVRT. CONCLUSIONS: In patients with isolated hypertension, AVP and FMD decrease and CIMT increases. In addition, CIMT is inversely correlated with AVP and FMD, and AVP is directly correlated with FMD.

[Clinical and laboratory features of patients with pericardial effusion]. / Perikart efüzyonu olan hastalarin klinik ve laboratuvar özellikleri.

OBJECTIVES: We reviewed patients who were diagnosed to have pericardial effusion (PE) over a four-year period to determine the causes of PE, clinical and laboratory features, and treatment modalities. STUDY DESIGN: Medical records of 136 patients (81 women, 55 men; mean age 55.8±18.7 years; range 8 to 90 years) admitted to our department with PE from August 2005 to August 2009 were reviewed. The diagnosis of PE was made by transthoracic echocardiography. Medical history, physical examination, electrocardiography, echocardiography, and laboratory findings and treatment methods were recorded. RESULTS: The most frequent complaint was dyspnea (86.8%) and the most common physical examination finding was jugular venous distension (47.1%). The most common electrocardiographic and echocardiographic findings were tachycardia (47.8%) and mild PE (<1 cm) (63.2%), respectively. Chronic renal failure and malignant diseases were the primary causes of PE (25% and 22.8% respectively), followed by idiopathic cases (14%). Pericardial tamponade was detected in 34 patients (25%), of which the majority had malignant diseases (53%). Thirty-eight patients (27.9%) underwent interventional treatment (pericardiocentesis in 27, surgical drainage in 11), while 98 patients (72.1%) were followed-up with medical treatment. Mortality occurred in three patients with pericardial tamponade. CONCLUSION: The most common causes of PE in our cases were chronic renal failure and malignancies. The incidence of malignant PE is on the incline owing to increased life expectancy. Echocardiography is the primary imaging modality for the evaluation of PE.

QTc dispersion in hyperthyroidism and its association with pulmonary hypertension.

BACKGROUND: Several studies have reported that hyperthyroidism is associated with prolonged QT interval corrected by the heart rate (QTc) and pulmonary hypertension (PHT). METHODS: Forty-seven patients with newly diagnosed overt hyperthyroidism and 20 healthy people were enrolled in the study. Transthoracic echocardiography, 12-lead surface electrocardiogram, and thyroid hormone levels were studied at the time of enrollment and after achievement of euthyroid state with propylthiouracil treatment. RESULTS: Baseline clinical characteristics were similar. However, heart rate (90.5+/-19.6 vs 79.2+/-13.7 bpm, P = 0.024), pulmonary artery systolic pressure (PASP) (26.0+/-12.0 vs 10.6+/-4.0 mmHg, P < 0.001), E deceleration time (DT) (191.8+/-25.6 vs 177.0+/-10.7 ms, P = 0.016), isovolumetric relaxation time (IVRT) (91.38+/-12.3 vs 79.6+/-10.5 ms, P < 0.001), and QTc dispersion (QTcD) (50.3+/-17.2 vs 38.9+/-11.6 ms, P = 0.009) were significantly higher in hyperthyroid patients compared to control group. Heart rate (to 74.1+/-13.8, P < 0.001), QTcD (to 37.3+/-10.1 ms, P < 0.001), DT (to 185.3+/-19.7 ms, P = 0.008), IVRT (to 88.6+/-10.3 ms, P = 0.056), and PASP (23.1+/-10.1 mmHg P < 0.001) were significantly decreased after achievement of euthyroid state. Although PHT was present in 16 patients before treatment only six patients still had PHT during euyhyroid state. Compared to patients with normal PASP, QTcD was significantly longer in patients with PHT (56.5+/-15.8 vs 37.9+/-12.8 mmHg P < 0.001). There were also significant correlations between QTcD and presence of PHT (r = 0.516, P < 0.001) and PASP (r = 0.401, P = 0.009). CONCLUSIONS: Hyperthyroidism is a reversible cause of PHT and diastolic dysfunction. Increased QTcD observed in hyperthyroidism may be associated with PHT and diastolic dysfunction. These abnormal findings in hyperthyroidism often normalize with the achievement of euthyroid state.

P wave duration and dispersion in patients with hyperthyroidism and the short-term effects of antithyroid treatment.

BACKGROUND: Prolonged P wave duration and P wave dispersion (PWD) have been associated with an increased risk for atrial fibrillation (AF). Hyperthytodism is a frequent cause of atrial fibrillation (AF). METHODS: Forty-two patients with newly diagnosed overt hyperthyroidism and 20 healthy people were enrolled in the study. Transthoracic echocardiography, 12 lead surface ECG and thyroid hormone levels were studied at the time of enrollment and after achievement of euthyroid state with propylthiouracil treatment. RESULTS: Maximum P wave duration (Pmax) (97.4+/-14.6 vs. 84.2+/-9.5 msec, p<0.001), PWD (42.9+/-10.7 vs. 31.0+/-6.2 msec, p<0.001), deceleration (DT) (190.7+/-22.6 vs. 177.0+/-10.2 msec, p=0.013) and isovolumetric relaxation times (IVRT) (90.9+/-11.2 vs. 79.6+/-10.5 msec, p<0.001) were significantly higher in hyperthyroid patients compared to control group. Pmax and PWD were significantly correlated with the presence of hyperthyroidism. Pmax (97.4+/-14.6 to 84.3+/-8.6 msec, p<0,001) Pmin (54.1+/-8.6 to 48.1+/-8.5 msec, p=0.002), PWD (42.9+/-10.7 to 35.9+/-8.1 msec, p=0.002) and DT (190.7+/-22.6 to 185.5+/-18.3, p=0.036) were significantly decreased after achievement of euthyroid state in patients with hyperthyroidism. Diastolic dyfunction was seen in 5 patients at hyperthroid state but only in one patient at euthyroid state. CONCLUSIONS: Hyperthyroidism is associated with prolonged P wave duration and dispersion. Achievement of euthyroid state with propylthiouracil treatment results in shortening of P wave variables. Diastolic function may have a partial effect for the increased Pmax and PWD. Shortening of Pmax and PWD may be a marker for the prevention of AF with the anti-thyroid treatment.

Long-term follow-up of P-wave duration and dispersion in patients with mitral stenosis.

BACKGROUND: Patients with mitral stenosis have prolonged P-wave duration and increased P-wave dispersion (PWD) that have been associated with increased risk for atrial fibrillation. METHODS: Thirty mild-to-moderate mitral stenosis patients were followed for 38.4+/-10.7 (23-48) months. Baseline and last 12-lead electrocardiographic and transthoracic echocardiographic measurements were evaluated. Maximum and minimum P-wave durations (Pmax and Pmin) and PWD were calculated. RESULTS: Pmax and PWD were significantly higher in patients compared to control group. Left atrial (LA) size, mitral gradient, and pulmonary artery systolic pressure (PASP) were significantly increased and mitral valve area (MVA) was decreased during follow-up. There were significant increases in Pmax and PWD and significant decrease in Pmin (Pmax: 101.0+/-12.5 ms vs 105.0+/-16.5 ms, P=0.005; Pmin: 59.3+/-8.5 ms vs 55.0+/-12.3 ms P=0.004; PWD: 41.7+/-5.5 ms vs 50.0+/-6.2 ms, P<0.001). Baseline Pmax, Pmin, and PWD were significantly correlated with MVA (Pmax: r=-0.605, P<0.001, Pmin: r=-0.632, P<0.001, PWD: r=-0.402, P=0.0028) and mean mitral gradient (Pmax: r=0.412, P=0.024, Pmin: r=0.632, P=0.049, PWD: r=0.378, P=0.039). In addition to MVA and mean mitral gradient follow-up P-wave variables were significantly correlated with LA size (Pmax: r=0.573, P=0.001, Pmin: r=0.636, P=0.001, PWD: r=0.265, P=0.046) and PASP (Pmax: r=0.462, P=0.011, Pmin: r=0.472, P=0.008 PWD: r=0.295, P=0.047). CONCLUSIONS: P-wave duration and PWD increase progressively in accordance with the progression of mitral stenosis.

Comparison of the effects of quinapril and irbesartan on P-wave dispersion in hypertensive patients.

INTRODUCTION: P-wave dispersion (PWD) has been shown to be a non-invasive electrocardiographic predictor for development of atrial fibrillation (AF). Thus, it may be possible to attenuate AF risk through improvement of PWD. In this study, we compared the effects of an angiotensin-converting enzyme (ACE) inhibitor, quinapril, and an angiotensin receptor blocker (ARB), irbesartan, on PWD. METHODS: A total of 38 newly diagnosed hypertensive patients were enrolled in the study. The patients were randomly assigned to receive treatment with either irbesartan (150-300 mg) or quinapril (20-40 mg). P-wave durations and PWD were measured at baseline and after 6 and 12 months of treatment. Echocardiographic examinations were performed at baseline and after 12 months of treatment. RESULTS: Both drugs significantly reduced blood pressure to a similar degree (P<0.001). Deceleration time (both P<0.001) and isovolumetric relaxation time (both P=0.007) were also significantly reduced, whereas there was no significant change in the early diastolic flow/atrial contraction signal ratio. Both irbesartan and quinapril significantly decreased maximum P-wave duration (Pmax) (P<0.001 and P=0.002, respectively) and PWD (from 68.0+/-22.1 to 41.0+/-25.1 msec for irbesartan, and from 70.5+/-20.4 to 46.6+/-13.3 msec for quinapril; both P<0.001). Baseline and follow-up blood pressure, heart rate, echocardiographic findings, and P-wave values were not significantly different between the irbesartan and quinapril groups. No patient developed AF during follow-up. There was no significant correlation between PWD and blood pressure or diastolic function parameters. CONCLUSION: Antihypertensive treatment with either irbesartan or quinapril is associated with significant reductions in Pmax and PWD.

Decreased risk of ventricular arrhythmias with treatment of nebivolol in patients with coronary slow flow.

BACKGROUND: Coronary slow-flow (CSF) is an angiographic phenomenon characterised by delayed opacification of vessels in the absence of any evidence of obstructive epicardial coronary disease. QT interval dispersion (QTD) reflects regional variations in ventricular repolarisation and cardiac electrical instability and has been reported to be longer in patients with CSF. AIM: To examine QT duration and dispersion in patients with CSF and the effects of nebivolol on these parameters. METHODS: The study population included 67 patients with angiographically proven normal coronary arteries and CSF, and 38 patients with angiographically proven normal coronary arteries without associated CSF. The patients were evaluated with 12-lead electrocardiography, and echocardiography before and three months after treatment with nebivolol. RESULTS: Compared to the control group QTcmax and QTcD were significantly longer in patients with CSF (p = 0.036, p = 0.019, respectively). QTcD significantly correlated with the presence of CSF (r = 0.496, p < 0.001). QTcmax (p = 0.027), QTcD (p = 0.002), blood pressure (p = 0.001), and heart rate (p < 0.001) values significantly decreased after treatment with nebivolol. CONCLUSIONS: Coronary slow flow is associated with increased QTD. Nebivolol reduced increased QTD in patients with CSF after three months.

Effects of Trimetazidine on T Wave Alternans in Stable Coronary Artery Disease.

BACKGROUND AND OBJECTIVES: Studies reveal that the microvolt T wave alternans (MTWA) test has a high negative predictive value for arrhythmic mortality among patients with ischemic or non-ischemic cardiomyopathy. In this study, we investigate the effects of trimetazidine treatment on MTWA and several echocardiographic parameters in patients with stable coronary artery disease. SUBJECTS AND METHODS: One hundred patients (23 females, mean age 55.6±9.2 years) with stable ischemic heart disease were included in the study group. Twenty-five age- and sex-matched patients with stable coronary artery disease formed the control group. All patients were stable with medical treatment, and had no active complaints. Trimetazidine, 60 mg/day, was added to their current treatment for a minimum three months in the study group and the control group received no additional treatment. Pre- and post-treatment MTWA values were measured by 24 hour Holter testing. Left ventricular systolic and diastolic functions were assessed by echocardiography. RESULTS: After trimetazidine treatment, several echocardiographic parameters related with diastolic dysfunction significantly improved. MTWA has been found to be significantly improved after trimethazidine treatment (63±8 µV vs. 53±7 µV, p<0.001). Abnormal MTWA was present in 29 and 11 patients pre- and post-treatment, respectively (p< 0.001). CONCLUSION: Trimetazidine improves MTWA, a non-invasive determinant of electrical instability. Moreover, several echocardiographic parameters related with left ventricular functions also improved. Thus, we can conclude that trimetazidine may be an effective agent to prevent arrhythmic complications and improve myocardial functions in patients with stable coronary artery disease.