Arterial stiffness and cardiac functions in patients with chronic venous disease.

AIM: Although the venous system is in direct continuity with the heart and the arterial system, it is not known whether chronic venous disease (CVD) has any impact on either of these. The aims of this study were to investigate the global functions of the left and right heart, and also arterial stiffness parameters in patients with CVD. METHODS: Forty-eight patients with primary stage C4-C6 CVD were enrolled into the study. The control group consisted of 39 age/sex and Body Mass Index matched healthy volunteers. All of the patients underwent detailed echocardiographic examination with further focus on Doppler and tissue Doppler (TD) parameters of the left and right ventricle. Arterial stiffness was evaluated via applanation tonometry in each patient. RESULTS: The left atrial area (LAA) and interventricular septum thickness were slightly increased in patients with CVD. Regarding Doppler and tissue Doppler measurements of the LV, all of the parameters were similar among the groups, while RV tissue Doppler systolic velocity and TAPSE were higher in patients with CVD. Among the arterial stiffness parameters, central aortic pressure, augmentation index, and pulse wave velocity were slightly higher in patients with CVD. CONCLUSION: The results of this study indicated that CVD may be associated with a subclinical disease state in the arterial system and also in the heart. Further studies are needed to confirm this association and to describe the possible mechanisms.

Dissection of the ascending aorta due to metastatic carcinoma.

The association of aortic dissection with a malignancy is a rare finding and previous reports are usually those of primary aortic sarcomas. In this report we present a case with typical ascending aorta dissection associated with metastatic carcinoma originating from the lungs. The metastatic infiltration of the vasovasorum of the aorta by carcinoma cells may have caused aortic dissection by decreasing medial strength and integrity. This is a mechanism of aortic dissection that we have not encountered in previous reports.

Value of QT dispersion in diagnosis of restenosis after intracoronary stent implantation.

We studied the ECGs of patients with single vessel disease before and after (long term) coronary stent implantation. The interlead variability of the QT interval, known as QT dispersion (QTd), is believed to reflect the regional variations in ventricular repolarization and, thus, may provide an indirect marker of arrhythmogenicity. There are no reliable noninvasive markers of significant restenosis after stent implantation. The effect of coronary revascularization on QTd in patients who underwent coronary stenting has not been investigated extensively. The aim of this study was to evaluate the value of QTd in predicting restenosis after intracoronary stent implantation. QTd with 12 lead surface ECG was measured in 48 patients (21 with restenosis and 27 without restenosis; 33 male; mean age, 58+/-10.8 years) before the procedure and after long-term follow-up (mean, 6.8+/-3.2 months). All patients had coronary angiographic control at the end of the follow-up period. QTd (as the difference between the maximum and minimum QT interval measured from 12 lead ECG) and rate-corrected QT (QTcd) were evaluated at rest. In 27 patients without restenosis, QTd and QTcd decreased from 58+/-14.4 and 62.8+/-20.4 ms to 26.3+/-9.2 and 29.6+/-10.6 ms in the long term follow-up, respectively (P<0.001). However, in 21 patients with restenosis, there was no significant change in QTd and QTcd intervals and they were still increased at the end of the long-term follow-up (P>0.05). In conclusion, increased QT interval dispersion may be an inexpensive and simple marker of restenosis after intracoronary stent implantation.

A fistula connecting the right coronary artery to the right atrium: a hitherto undescribed association.

A case of double right coronary artery accompanying a fistulous connection is presented. An additional right coronary artery is an extremely rare congenital abnormality. In this case, the second right coronary artery was draining into a cardiac chamber via a fistulous connection. This is the first case in the literature to present these abnormalities coexisting in the same patient.

Heart rate variability, late potentials and QT dispersion as markers of myocardial involvement in patients with Behçet's disease.

BACKGROUND: Myocardial involvement in Behçet's disease has been reported to be relatively rare. OBJECTIVE: To evaluate myocardial involvement noninvasively in patients with Behçet's disease by measuring signal-averaged electrocardiography (SAECG), QT dispersion and heart rate variability (HRV). PATIENTS AND METHODS: The study group comprised 28 eligible patients (16 male, mean age 37+/-13 years) of 33 patients with Behçet's disease, and 25 age- and sex-matched control subjects. RESULTS: The echocardiographic left ventricular measurements were within normal limits and similar in both groups except the E/A ratio, which was significantly lower in patients with the disease than in control patients. Minimal pericardial effusion was detected in four patients. Considering the SAECG recordings, values of root mean square voltage in the last 40 ms were 30+/-18 microV and 38+/-18 microV in patients with Behçet's disease and in the control group, respectively. The number of cases with a value less than 20 microV was seven (25%) and one (4%) in the same groups, respectively. Both QT dispersion and the corrected QT interval dispersion were significantly increased in patients with Behçet's disease compared with the control patients (50.2+/-16.6 versus 20.4+/-18.8, P<0.01). Although all HRV measures appeared to be decreased in the Behçet's group, only the standard deviation of all filtered RR intervals in the entire 24 h ECG recordings and the percentage of differences between adjacent filtered RR intervals that are greater than 50 ms for the whole analysis values differed significantly between the groups (P<0.05). No significant difference was observed in frequency domain parameters. In the Holter ECG recording, grade 2 or greater premature ventricular complexes were observed in seven patients from the Behçet's group (25%) but in only one subject from the control group (4%) (P<0.05). CONCLUSIONS: Patients with Behçet's disease appeared to have significantly increased QT dispersion, a left ventricular diastolic dysfunction pattern in echocardiography, a high incidence of positive late potentials and more complex ventricular arrhythmias, suggesting myocardial involvement and the existence of an arrhythmogenic substrate, whereas the HRV measures do not suggest a clear autonomic abnormality in Behçet's disease.