Increased masked hypertension prevalence in patients with polycystic ovary syndrome (PCOS).

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common disorder with important clinical consequences. Many studies have proven that hypertension is one of the most important comorbid disorders in PCOS. Masked hypertension is defined as a presence of normal office blood pressure together with abnormal results in 24-h ambulatory blood pressure monitoring (ABPM). The prevalence of this condition in patients with PCOS is not well defined. The aim of this study was to evaluate the prevalence of masked hypertension in PCOS compared to control subjects. METHODS: Sixty patients with PCOS and 60 control subjects were enrolled in the study. All patients with PCOS and controls without a history of hypertension underwent physical examination including office blood pressure measurement, ABPM, and measurement of laboratory and anthropometric parameters. RESULTS: Mean age was 30.5 ± 6.6 in control group and 26.4 ± 7.1 year in patients with PCOS (p = .001). Twenty-four patients (40%) had masked hypertension in PCOS group whereas 11 patients (18.3%) in the control group (p = .009). Twenty-four-hour diastolic blood pressure (p = .03), daytime systolic (p < .001), and daytime diastolic blood pressure (p = .01) and nighttime systolic blood pressure (p = .01) were significantly higher in patients with PCOS compared with control group. CONCLUSIONS: This study demonstrates increased masked hypertension prevalence in patients with PCOS. We suggest that all patients with PCOS should undergo ambulatory blood pressure monitoring for detecting masked hypertension.

A possible cause of epistaxis: increased masked hypertension prevalence in patients with epistaxis / Uma possível causa de epistaxe: maior prevalência de hipertensão mascarada em pacientes com epistaxe

Abstract Introduction Epistaxis and hypertension are frequent conditions in the adult population. Masked hypertension is defined as a clinical condition in which a patient's office blood pressure level is <140/90 mmHg, but the ambulatory or home blood pressure readings are in the hypertensive range. Many studies have proved that hypertension is one of the most important causes of epistaxis. The prevalence of this condition in patients with epistaxis is not well defined. Objective This study aimed to evaluate the prevalence of masked hypertension using the results of office blood pressure measurement compared with the results of ambulatory blood pressure monitoring. Methods Sixty patients with epistaxis and 60 control subjects were enrolled in the study. All patients with epistaxis and controls without history of hypertension underwent physical examination, including office blood pressure measurement, ambulatory or home blood pressure, and measurement of anthropometric parameters. Results Mean age was similar between the epistaxis group and the controls – 21–68 years (mean 42.9) for the epistaxis group and 18–71 years (mean 42.2) for the control group. A total of 20 patients (33.3%) in the epistaxis group and 7 patients (11.7%) in the control group (p = 0.004) had masked hypertension. Night-time systolic blood pressure was significantly higher in patients with epistaxis than in the control group (p < 0.005). However, no significant difference was found in daytime systolic blood pressure between the control group and the patients with epistaxis (p = 0.517). Conclusion This study demonstrates increased masked hypertension prevalence in patients with epistaxis. We suggest that all patients with epistaxis should undergo ambulatory or home blood pressure to detect masked hypertension, which could be a possible cause of epistaxis.

Resumo Introdução Epistaxe e hipertensão são condições frequentes na população adulta. Hipertensão mascarada é definida como uma condição clínica em que o nível da pressão arterial do paciente no consultório é < 140/90 mm Hg, mas as leituras da pressão arterial ambulatorial ou em casa se encontram na faixa hipertensiva. Muitos estudos demonstraram que a hipertensão é uma das causas mais importantes de epistaxe. Ainda não está devidamente definida a prevalência dessa condição em pacientes com epistaxe. Objetivo Avaliar a prevalência de HM com o uso dos resultados de mensurações da pressão arterial no consultório, em comparação com os resultados da MAPA. Método Foram recrutados 60 pacientes com epistaxe e 60 indivíduos para controle. Todos os pacientes com epistaxe e os controles sem histórico de hipertensão passaram por exame físico, inclusive determinação da pressão arterial no consultório, MAPA e mensuração dos parâmetros antropométricos. Resultados A média de idade foi similar entre o grupo com epistaxe e os controles: de 21 a 68 (média 42,9) anos para o grupo com epistaxe e de 18 a 71 (média 42,2) anos para o grupo controle. No total, 20 pacientes (33,3%) no grupo com epistaxe e sete (11,7%) no grupo controle (p = 0,004) apresentaram hipertensão mascarada. A pressão arterial sistólica noturna foi significantemente mais alta em pacientes com epistaxe, em comparação com o grupo controle (p < 0,005). No entanto, não foi observada diferença significante na pressão arterial sistólica obtida durante o dia entre o grupo controle e os pacientes com epistaxe (p = 0,517). Conclusão O presente estudo demonstra maior prevalência de hipertensão mascarada em pacientes com epistaxe. Sugerimos que todos os pacientes com epistaxe devam ser submetidos à monitoração da pressão arterial caseira ou em consultório com o objetivo de detectar hipertensão mascarada, que pode ser uma causa possível de epistaxe.

Should screening for colorectal neoplasm be recommended in patients at high risk for coronary heart disease: a cross-sectional study.

Colorectal neoplasm (CRN) and coronary heart disease (CHD) share common risk factors. We aimed to assess the risk for CRN in patients who are at high risk for developing CHD determined by measurements, which are independent from the risk factors for CRN.This study was conducted on individuals who underwent total colonoscopic examination and were without history of CHD. Two-hundred thirty-five subjects (82 with CRN and 153 with normal colonoscopic findings) participated in the study. Colorectal carcinoma (CRC) was defined as the presence of adenocarcinoma. We measured carotid intima media thickness (CIMT), flow-mediated dilation (FMD), and calculated Framingham risk score (FRS) for all participants. An increased CIMT (≥1.0 mm), a decreased FMD (<10%), and a high FRS (>20%) were defined as high risks for developing CHD. The risk and the prevalence of CRN were analyzed in relation to the risk for developing CHD.The ratio of the patients with overall-CRN and CRC was significantly higher in individuals who are at high risk for developing CHD compared with individuals who are at low risk for developing CHD by each 3 risk estimation method (P < 0.05 for all). An increased CIMT, a decreased FMD, and a high FRS score were significantly associated with the high risk for the presence of CRC (odds ratio [OR]: 6.018, OR: 3.699, and OR: 4.120, respectively). An increased CIMT, a decreased FMD, and an intermediate FRS were significantly associated with the risk for the presence of overall-CRN (OR: 3.607, OR: 1.866 and OR: 2.889, respectively).The risk for CRN increases as the risk for developing CHD increases. It can be suggested that screening for CRN can be recommended for individuals who are at high risk for developing CHD.

The Comparison of the Effects of Epidural Bupivacaine and Levobupivacaine on the Autonomic Nervous System and Cardiac Arrhythmia Parameters in Inguinal Hernia Surgeries.

OBJECTIVE: The aim of this study is to investigate the effects of bupivacaine and levobupivacaine, used to create epidural anaesthesia in inguinal hernia operations, on heart rate variability and cardiac arrhythmia parameters. METHODS: Sixty male patients of the American Society of Anesthesiology (ASA) I-II group, scheduled to be operated on for inguinal hernia surgery with epidural anaesthesia, were randomly divided into two groups. The patients, with a 12-channel Holter recorder (Rozinn RZ153+12-USA) attached 1 hour before the operation to record until the end of the surgery, were taken into the preparation room and anaesthetised. In group L (n=30), 17 mL of 0.5% levobupivacaine (Chirocain 0.5%-Abbot, El-verum, Norway) was given into the epidural space within 10 minutes, versus 17 mL of 0.5% bupivacaine in (Marcain 0.5%, Astra Zeneca, Istanbul, Turkey) group B (n=30). After 30 minutes, when there was enough block, the operation had been started. Holter recordings, starting 1 hour before the anaesthetic procedure and completed by the end of the operations, were transferred to the computer. The records were evaluated by the cardiologists. RESULTS: When analysing the frequency effect measurement results of the heart rate variability, it was seen that neither of the medications created any statistically significant change in or among the groups in total, very-low-frequency (VLF), low-frequency (LF), high-frequency (HF) and LF/HF ratio levels. Only normalised low-frequency band was significantly lower in Group L (p=0.013). CONCLUSION: In the volumes and concentrations that were used in our study, levobupivacaine and bupivacaine created sensory blockade at the same level on average and did not reduce heart rate variability at the levels of these blockages.

Decreased parasympathetic activity in patients with functional dyspepsia.

OBJECTIVE: Functional dyspepsia (FD) can be described as the presence of symptoms such as bothersome postprandial fullness, early satiation, epigastric pain, and burning without any evidence of structural disease. The aim of this study was to evaluate the autonomic nervous system using heart rate variability (HRV) in patients with postprandial distress syndrome and epigastric pain syndrome. PATIENTS AND METHODS: The study population included 64 consecutive patients with a diagnosis of FD and 62 age-matched and sex-matched healthy control individuals with no clinical evidence of gastrointestinal, systemic, or cardiovascular diseases. All patients underwent upper gastrointestinal endoscopy and 24 h Holter monitoring. RESULTS: There were 30 patients with postprandial distress syndrome and 34 with epigastric pain syndrome. Twenty-four hour square root of the mean squared differences of the successive normal to normal intervals (RMSSD) (30.5 ± 12.4, 35.8 ± 13.9; P=0.047), 24 h proportion derived by dividing the number of interval differences of successive normal to normal intervals greater than 50 ms (PNN50) (9.8 ± 3.9, 14.1 ± 7.3; P=0.017), daytime PNN50 (6.8 ± 1.6, 18.4 ± 13.8; P<0.001), night SD of the normal to normal intervals (SDNN) (111.4 ± 39.9, 133.4 ± 29.8; P=0.001), and night RMSSD (31.7 ± 12.4, 38.2 ± 17.5; P=0.019) were significantly lower in patients with FD than controls. Other HRV parameters were not significantly different between the two groups. Changes in these parameters showed a decreased parasympathetic tone and discordance in sympathovagal activity in FD. CONCLUSION: Our study showed decreased parasympathetic activity in the patients with FD. Further studies are required to evaluate the significance of HRV parameters and to clarify the mechanism of decreased parasympathetic activity in patients with FD.

C-reactive protein levels are raised in stable Chronic obstructive pulmonary disease patients independent of smoking behavior and biomass exposure.

BACKGROUND: The aim of this case control study is to assess the relationship between serum C-reactive protein (CRP) levels and well-known clinical parameters in Chronic obstructive pulmonary disease (COPD) considering the impact of smoking behavior, biomass exposure and accompanying clinical entities, namely pulmonary hypertension, systemic hypertension and diabetes mellitus. METHODS: Spirometry, echocardiography, arterial oxygen saturation (SpO2) measurements, BODE scores and serum CRP levels were investigated in stable COPD patients. Associations between CRP levels and clinical parameters were evaluated. RESULTS: CRP levels are significantly higher in COPD patients than in healthy controls. CRP levels were not significantly different between COPD patients treated with inhaled corticosteroids and those not treated. CRP levels significantly correlated with age, FEV1% predicted, FVC% predicted, SpO2, MMRC, 6 minute walk distance, BODE scores and haemoglobin levels. In multivariate analysis BODE scores and concomitant systemic hypertension manifested the strongest association with CRP levels. CRP levels in COPD patients with and without pulmonary hypertension were significantly different. CRP levels did not differ significantly according to smoking status or biomass exposure, moreover COPD cases due to biomass exposure who never smoked also had higher CRP levels compared to healthy controls. CONCLUSIONS: Systemic inflammation is inherent to COPD independent of ever-smoking status and correlates with disease severity, concomitant systemic hypertension and pulmonary hypertension.

Serum 25-hydroxyvitamin D levels are correlated with mitral valve calcification score in patients with rheumatic mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: Rheumatic mitral stenosis (RMS) is a chronic disease related to autoimmune heart valve damage after streptococcal infection. Epidemiological evidence supports an association between vitamin D and the susceptibility and severity of autoimmune disorders. The study aim was to assess the serum levels of 25-hydroxyvitamin D and their correlation with Wilkins calcification score in patients with RMS. METHODS: Thirty-four patients with RMS and 29 healthy age- and gender-matched controls were enrolled in the study. All subjects underwent transthoracic echocardiography after a complete medical evaluation and laboratory examination. The planimetric mitral valve area and Wilkins score were evaluated for all patients, and biochemical parameters and serum levels of 25-hydroxyvitamin D and calcitriol were determined. RESULTS: The mean patient age was similar in the RMS and control groups (50 +/- 10 versus 52 +/- 10 years; p = NS). The serum level of 25-hydroxyvitamin D was significantly lower in RMS patients than in controls (8.6 ng/ml; range: 4.9-26.3 ng/ml versus 12.3 ng/ml; range: 4-158 ng/ml; p = 0.031). A significantly moderate inverse correlation was identified between the serum 25-hydroxyvitamin D level and the Wilkins score (r = -0.567, p < 0.001), but no correlation was identified between 25-hydroxyvitamin D levels and other echocardiographic parameters of mitral stenosis. The serum level of calcitriol was also significantly lower in RMS patients than in controls (19.8 pg/ml; range: 16.0-54.6 pg/ml versus 26.1 pg/ml; range: 13.2-47.0 pg/ml; p = 0.013). CONCLUSION: The study results showed that serum levels of 25-hydroxyvitamin D were significantly lower in RMS patients than in controls, and also correlated with the Wilkins calcification score. Thus, a link may exist between 25-hydroxyvitamin D and the calcification process in RMS.

Parasympathetic overactivity in patients with nasal septum deformities.

Nasal septum deformities (NSD) are one of the most frequent reasons for nasal obstruction presented with a reduction in nasal airflow and chronic mucosal irritation. Nasocardiac reflex which includes afferent stimulus with maxillary division of the trigeminal nerve and the efferent pathway of the heart via the vagus nerve is not a well-known part of autonomic nervous system (ANS). Heart rate variability (HRV) is a parameter reflecting the ANS activity on heart. The purpose of this study is to evaluate ANS functions in patients with NSD by HRV analysis. Twenty-nine patients with NSD and 26 control subjects were included in the study. The diagnosis of NSD was made with history, symptoms, anterior rhinoscopy, and nasal endoscopic examination. 24-h ambulatory electrocardiographic recording was performed by a 3-channel recorder. HRV parameters were obtained by analyzing these parameters. Baseline features were similar in patients and controls (mean age: 31 ± 8 in the patients, 32 ± 9 in control subjects; P = NS). Night-RMSSD (the square root of square of mean square differences of successive NN intervals) (47 ± 21, 34 ± 13; P = 0.008), night-PNN50 (the number of interval differences of successive NN intervals greater than 50 ms) (24 ± 16, 14 ± 10; P = 0.007), 24-h-RMSSD (39 ± 18, 27 ± 12; P = 0.004), and 24-h-PNN50 (16 ± 12, 9 ± 7; P = 0.016) were significantly higher in patients than controls. Other HRV parameters were not significantly different between two groups. Changes in these parameters demonstrated an increased parasympathetic tone and discordance in sympatho-vagal activity in NSD.

Addition of rituximab to chop does not increase the risk of cardiotoxicity in patients with non-Hodgkin's lymphoma.

BACKGROUND: The addition of rituximab to doxorubicin-containing standard chemotherapy significantly improves response to therapy and reduces the risk of death in B-cell non-Hodgkin's lymphoma (NHL) patients. However, the impact of this approach on doxorubicin-induced cardiotoxicity has not been elucidated. METHODS: Patients who had been planned to receive CHOP or rituximab plus CHOP (R-CHOP) combination chemotherapy with a diagnosis of NHL were included in the study. In all patients, systolic and diastolic parameters were measured by using conventional and pulsed-wave tissue Doppler echocardiography, which is more sensitive than conventional lead-dependent techniques, both before and in the sixth month of therapy. RESULTS: There were 28 (M/F; 14/14) patients on CHOP and 33 (M/F; 16/17) patients on R-CHOP. Median age in CHOP and R-CHOP was 49 and 50 years (P = 0.44), respectively. Cumulative doxorubicin doses were 280 and 286 mg/m(2) on CHOP and R-CHOP (P = 0.65), respectively. None of the patients developed clinically evident congestive heart failure. Parameters of systolic function such as LVEF and FS did not significantly change in any patients. In both arms, tissue Doppler parameters of diastolic function such as lateral E and septal E velocity of mitral annulus decreased significantly after therapy (P < 0.001). However, the decrease in diastolic function was similar in both arms (P > 0.05). Conventional Doppler echocardiography yielded consistent findings. CONCLUSION: Both CHOP and R-CHOP cause diastolic dysfunction in the early period following their administration. The addition of rituximab to CHOP chemotherapy does not significantly increase the risk of doxorubicin-induced cardiotoxicity during this period.

The role of surface ECG and transthoracic echocardiography for predicting postoperative atrial fibrillation after coronary artery bypass surgery.

OBJECTIVE: To evaluate the roles of surface electrocardiogram (ECG) and transthoracic echocardiography (ECHO) for prediction of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). METHODS: This study was conducted from 2002-2004 at the Cardiovascular Department of Hacettepe University, Ankara, Turkey. Seventy consecutive patients were enrolled in this study that underwent elective CABG. A 12-lead ECG was recorded one day before cardiac surgery and was repeated during the 5 days after CABG. P-wave dispersion (PWD) was defined as the difference between maximum and minimum P-wave duration. Differences in P-wave duration were compared between the pre- and postoperative 12-lead ECG measurements. RESULTS: Postoperative AF developed in 17 (24%) cases of 70 patients. The PWD was found to be significantly higher in patients with AF preoperatively (60+/-19 versus 47+/-13, p=0.003), postoperative first day (56+/-12 versus 44+/-11, p<0.002) and fifth day (51+/-29 versus 41+/-11, p<0.001). Patients with AF were significantly older, the mean age of the AF group was (68+/-7) years and of the sinus rhythm (SR) group was (59+/-10 years) (p<0.001). The AF group had left ventricular systolic dysfunction (56+/-13% versus 56+/-8%, p=0.042, preoperatively; 49+/-8% versus 60+/-10%, p=0.001, postoperatively) and a larger left atrium (46+/-5 versus 39+/-5 mm, p<0.001, preoperatively and 44+/-7 versus 39+/-5 mm, p=0.046, postoperatively) than the SR group. CONCLUSION: This prospective study demonstrated that PWD on surface ECG and additional echocardiographic parameters are simple and reliable indexes to predict the development of AF after CABG.

Assessment of endothelial function in Alzheimer's disease: is Alzheimer's disease a vascular disease?

OBJECTIVES: To compare endothelial function of people with Alzheimer's disease (AD) with that of people without. DESIGN: Case-control study. SETTING: Geriatric medicine outpatient clinic of a university hospital. PARTICIPANTS: Twenty-five patients with AD who were free of vascular risk factors and 24 healthy elderly controls were enrolled. Exclusion criteria were diabetes mellitus, hypertension, dyslipidemia, evident stroke, smoking, documented coronary artery disease, history of myocardial infarction, heart failure, acute or chronic infection, malignancy, peripheral artery disease, renal disease, rheumatologic diseases, alcohol abuse, and certain drugs that may affect endothelial function. Both groups underwent comprehensive geriatric assessment and neuropsychiatric assessment. MEASUREMENTS: Endothelial function was evaluated according to flow-mediated dilation (FMD) from the brachial artery. RESULTS: Mean age +/- standard deviation was 78 +/- 5.9 in the group with AD (11 female and 14 male) and 72.1 +/- 5.8 in the control group (9 female and 11 male). Multiple linear regression analysis revealed that FMD was significantly lower in patients with AD (median 3.45, range 0-7) than controls (median 8.41, range 1-14) (P < .001), independent of age. It was also found that FMD values were inversely correlated with the stage of the disease as determined according to the Clinical Dementia Rating scale (r=-0.603, P < .001). CONCLUSION: Endothelial function is impaired in patients with AD. Endothelial function was worse in patients with severe AD. These findings provide evidence that vascular factors have a role in the pathogenesis of AD.

B-type natriuretic peptide (BNP) levels in female systemic lupus erythematosus patients: what is the clinical significance?

Cardiovascular disease is a major cause of death in patients with systemic lupus erythematosus (SLE) especially during the late phase of the disease. This study was conducted to evaluate B-type natriuretic peptide (BNP) levels in female SLE patients without cardiac symptoms and to investigate whether BNP levels correlated with echocardiographic findings. We studied 59 women with SLE and 33 healthy women. SLE patients with history of cardiac disease, diabetes mellitus, hypertension, and other inflammatory diseases were excluded from the study. All subjects had a complete history and physical examination. Overall disease activity assessment in SLE patients at the time of the study were derived by calculation of SLE disease activity index (SLEDAI). BNP levels were determined, and transthoracic echocardiography were performed in all subjects. There was no difference between SLE patients and controls in terms of age, blood pressure, smoking status, plasma glucose, creatinine levels, and lipid profiles. Nine patients had SLEDAI score greater than 5. All subjects had an EF greater than 55%. Diastolic dysfunction was more frequent in lupus patients than in controls (15 [25.4%] vs. 2 [6%]; p = 0.022). BNP levels of SLE patients were significantly higher than controls (median 17.9 range [5-211] pg/ml vs. median 14.7 range [5-39.7] pg/ml; p = 0.033). Twenty-seven of the SLE patients (46%) and seven of the controls (21%) had BNP levels greater than or equal to 20 pg/ml (p = 0.019). There were no differences in BNP levels of SLE patients with and without diastolic dysfunction (median 17.8 range [5-117] pg/ml vs. median 18.5 range [5-211] pg/mL; p = NS). BNP levels were positively correlated with left atrium diameter (r (2) = 0.39, p = 0.001). BNP levels did not correlate with erythrocyte sedimentation rate/C-reactive protein levels, SLEDAI scores, total steroid dosage used, or other echocardigraphic parameters. BNP levels were increased in female SLE patients without cardiac symptoms as compared to healthy controls. Although none of the SLE patients in our study had clinical signs of ischemic heart disease, increased levels of BNP in SLE patients might be a reflection of a ischemic myocardial tissue.

Novel cardiovascular risk factors and cardiac event predictors in female inactive systemic lupus erythematosus patients.

Systemic lupus erythematosus (SLE) is associated with severe and premature cardiovascular disease, which cannot be explained by traditional risk factors alone. This study aims to investigate novel cardiovascular risk factors and cardiac event predictors in inactive SLE female patients who do not have any major cardiovascular risk factors. Twenty-five inactive (SLE disease activity index score <4) SLE female patients and 22 healthy control women were studied. SLE patients with a history of diabetes mellitus, hypertension, hyperlipidemia, smoking, or coronary artery disease (CAD) were excluded. Venous blood samples were analyzed for lipid subfractions and novel cardiovascular risk factors such as lipoprotein (a), homocysteine, fibrinogen, high-sensitivity C-reactive protein (hs-CRP), and serum amyloid A (SAA) levels. Endothelial dysfunction was assessed by flow-mediated dilatation (FMD) from the brachial artery at baseline and during reactive hyperemia. SLE patients and controls were similar in terms of age (40+/-10 years vs 38+/-10 years, p = NS). No significant difference was found between the groups regarding family history of premature CAD, blood pressure, body mass index, lipoprotein (a), homocysteine, fibrinogen, SAA, apoprotein A-1 and B levels. Compared with the controls, SLE patients had higher levels of hs-CRP [median (range): 1.82 (0.02-0.98) vs 0.68 (0.02-0.35), p=0.04]. FMD was lower in SLE patients than controls (7.1+/-2.1 vs 11.4+/-1.2%, p<0.001). Increased levels of hs-CRP and decreased FMD were found in inactive SLE patients. Increased hs-CRP levels may reflect ongoing low-grade inflammation that could be a cause of impaired FMD in SLE patients. These findings suggest that SLE patients without traditional major cardiovascular risk factors may have increased risk of cardiovascular disease and future cardiac events.

Increased myocardial vulnerability and autonomic nervous system imbalance in obstructive sleep apnea syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is characterized by the repeated episodes of upper airway obstruction during sleep, leading to significant hypoxia. Noninvasive evaluation of autonomic nervous system (ANS) and myocardial vulnerability may help determination of OSAS patients who are under high risk of malignant cardiac arrhythmias. The aim of this study was to show the effects of OSAS on predictors of arrhythmias by the evaluation of heart rate turbulence (HRT), heart rate variability (HRV) and QT dynamicity reflecting the ANS balance and myocardial vulnerability. METHODS: After polysomnographic study, 80 patients with OSAS and 55 age matched OSAS (-) subjects were included in the study. Twenty-four-hour Holter monitoring was performed in all subjects. HRT, HRV and QT dynamicity parameters were calculated. RESULTS: Turbulence slope was significantly decreased in OSAS patients whereas turbulence onset was increased (P<0.001). QT/RR slopes were significantly increased for QT end and QT apex (P<0.001). In HRV analysis, autonomic balance changed in favor of sympathetic system at night in OSAS patients. Furthermore, HRT and QT dynamicity parameters are found to be correlated with Apnea-Hypopnea Index (AHI). CONCLUSION: OSAS is associated with a significant worsening in HRV, HRT, and QT dynamicity parameters. Our results may indicate that HRV and QT dynamicity parameters can be useful noninvasive methods that may detect autonomic nervous system activity and ventricular vulnerability in OSAS.

Coronary artery bypass grafting is associated with a significant worsening of QT dynamicity and heart rate variability.

BACKGROUND: Imbalance in autonomic nervous system and impaired myocardial repolarization has been shown to increase the risk for arrhythmias in patients with coronary artery disease. This study evaluated the effects of coronary artery bypass grafting (CABG) on heart rate variability and QT interval dynamicity in subjects with coronary artery disease undergoing elective CABG surgery. METHODS: The study group consisted of 68 consecutive patients (mean age +/-SD: 61 +/- 9 years) with coronary artery disease who underwent elective CABG. Twenty-four-hour Holter monitoring was performed 2-5 days before cardiac surgery and was repeated 10 days after CABG. ELATEC holter software was used to calculate heart rate variability and QT dynamicity parameters. All subjects had a complete history, laboratory examination and transthoracic echocardiography. RESULTS: All patients had beta-blocking agent medication pre- and postoperatively. Standard deviation of all NN intervals for a selected time period, square root of the mean of the sum of the squares of differences between adjacent RR intervals, the proportion of differences in successive NN intervals greater than 50 ms, normalized low-frequency power, and normalized high-frequency power were significantly decreased after CABG surgery, whereas low-frequency/high-frequency ratio was significantly increased after CABG. QT/RR slopes over 24 h were significantly increased after CABG surgery for QT end and QT apex (QTapex/RR: 0.16 +/- 0.13 vs. 0.28 +/- 0.19, p < 0.001; QTend/RR: 0.18 +/- 0.13 vs. 0.36 +/- 0.23, p < 0.001). CONCLUSION: This prospective study showed for the first time that CABG was associated with a significant worsening of heart rate variability and QT dynamicity parameters in the postoperative period.

Recurrent syncope in a case of metastatic malignant melanoma--an unusual presentation of an uncommon disease.

Cardiac tumours may be rare causes of syncope. Here we report a malignant melanoma that metastasized to the right atrium as an intracavitary mass that intermittently obstructed the tricuspid valve producing syncope episodes.