Twenty-four hour Holter ECG in normocalcemic and hypercalcemic patients with hyperparathyroidism.

PURPOSE: To investigate the occurrence of arrhythmias in patients with normocalcemic (NC) primary hyperparathyroidism (PHPT) compared to both hypercalcemic PHPT patients and control subjects by means of 24-h Holter ECG. METHODS: Thirteen NCPHPT postmenopausal patients were enrolled and age-matched with 13 hypercalcemic PHPT patients and 13 controls. Every subject underwent basal ECG, 24-h Holter ECG and mineral metabolism biochemical evaluation. RESULTS: PHPT patients had higher mean serum calcium levels compared to both NCPHPT and controls; there was no difference in mean serum calcium levels between NCPHPT and controls. Both NCPHPT and PHPT patients had significantly higher mean PTH levels compared with controls. There were no differences in ECG parameters between the three groups, except for QTc interval. PHPT patients had normal QTc interval values, but significantly shorter mean values compared with those of controls and NCPHPT patients. During 24-h Holter ECG recording, 100% of PHPT patients had supraventricular premature beats (SVPBs), compared to 46% of NCPHPT (p = 0.005) and to 53% of controls (p = 0.01). PHPT patients experienced ventricular premature beats (VPBs) (69.2%) vs 15% of NCPHPT patients (p = 0.01) and 23% of controls (p = 0.04). There was no difference between NCPHPT and controls subjects concerning occurrence of both VPBs and SVPBs. CONCLUSIONS: NCPHPT patients did not experience an increased occurrence of arrhythmias compared to controls, while PHPT patients showed an increased occurrence compared to both controls and NCPHPT. Our findings are most probably related to the short QTc interval caused by hypercalcemia observed in PHPT patients, but not in NCPHPT.

Progranulin, sICAM-1, and sVCAM-1 May Predict an Increased Risk for Ventricular Arrhythmias in Patients with Systemic Sclerosis.

In systemic sclerosis (SSc), fibrosis of the myocardium along with ongoing autoimmune inflammation can alter the electric function of the cardiac myocytes, which may increase the risk for ventricular arrhythmias and sudden cardiac death. We analyzed the electrocardiographic (ECG) variables describing ventricular repolarization such as QT interval, QT dispersion (QTd), T wave peak-to-end interval (Tpe), and arrhythmogeneity index (AIX) of 26 patients with SSc and 36 healthy controls. Furthermore, echocardiographic and laboratory parameters were examined, with a focus on inflammatory proteins like C-reactive ptotein (CRP), soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular adhesion molecule-1 (sVCAM-1), and progranulin (PGRN). The CRP, sICAM-1, and sVCAM-1 levels were positively correlated with the length of the QT interval. Although the serum PGRN levels were not increased in the SSc group compared to the controls, in SSc patients, the PGRN levels were positively correlated with the QT interval and the AIX. According to our results, we conclude that there may be a potential association between autoimmune inflammation and the risk for ventricular arrhythmias in patients with SSc. We emphasize that the measurement of laboratory parameters of inflammatory activity including CRP, PGRN, sVCAM-1, and sICAM-1 could be helpful in the prediction of sudden cardiac death in patients with SSc.

Correlation of epicardial adipose tissue and inflammatory indices in patients with STEMI and implications for atrial arrhythmias.

BACKGROUND: Epicardial adipose tissue(EAT) is associated with inflammation in previous studies but is unknown in patients with ST-segment elevation myocardial infarction(STEMI).This study investigated the correlation between epicardial fat and inflammatory cells obtained by cardiac magnetic resonance (CMR) and the effect on atrial arrhythmias in patients with STEMI. METHODS: This was a single-center, retrospective study. We consecutively selected patients who all completed CMR after Percutaneous Coronary Intervention (PCI) from January 2019 to December 2022 and then had regular follow-ups at 1, 3, 6, 9, and 12 months. The enrolled patients were grouped according to the presence or absence of atrial arrhythmia and divided into atrial and non-atrial arrhythmia groups. RESULTS: White blood cell, neutrophil, lymphocyte, C-reactive protein, EATV, LVES, LVED were higher in the atrial arrhythmia group than in the non-atrial arrhythmia group, and LVEF was lower than that in the non-atrial arrhythmia group (p < 0.05); EATV was significantly positively correlated with each inflammatory indices (white blood cell: r = 0.415 p < 0.001, neutrophil:r = 0.386 p < 0.001, lymphocyte:r = 0.354 p < 0.001, C-reactive protein:r = 0.414 p < 0.001); one-way logistic regression analysis showed that risk factors for atrial arrhythmias were age, heart rate, white blood cell, neutrophil, lymphocyte, C-reactive protein, EATV, LVES, LVED; multifactorial logistic regression analysis showed that neutrophil, lymphocyte, C-reactive protein, EATV, and LVES were independent risk factors for atrial arrhythmias; ROC analysis showed that the area under the curve (AUC) for neutrophil was 0.862; the AUC for lymphocyte was 1.95; and the AUC for C-reactive protein was 0.862. reactive protein was 0.852; AUC for LVES was 0.683; and AUC for EATV was 0.869. CONCLUSION: In patients with STEMI, EAT was significantly and positively correlated with inflammatory indices; neutrophil, lymphocyte, C-reactive protein, EATV, and LVES were independent risk factors for atrial arrhythmias and had good predictive value.