Cardiotoxicity of trastuzumab emtansine (T-DM1): a single-center experience.

OBJECTIVE: New anti-cancer drugs promise to increased survival benefits and reduce adverse events. Trastuzumab emtansine (T-DM1) is a novel anti-human epidermal growth factor receptor 2 agent that has shown minimal cardiotoxicity in clinical trials. However, data on real-life outcomes are required. METHODS: A retrospective review of our center's medical records was performed, including female patients aged ≥18 years with a diagnosis of metastatic breast cancer who were treated with T-DM1. Descriptive statistics were used to investigate clinical features that could increase the risk of cardiotoxicity. Cardiotoxicity was determined by comparing pre and post-T-DM1 echocardiogram results and was defined as a decrease in the left ventricular ejection fraction (LVEF) >10% to below 55%. RESULTS: Data from 41 female patients with a mean age of 52 ± 11.5 years were evaluated. A significant LVEF decrease (from 59% to 33%) was observed in one patient during T-DM1 treatment. Further investigation showed that this decrease was due to underlying coronary artery disease, and LVEF recovered to the baseline value after coronary revascularization. CONCLUSION: T-DM1 seems to be safe in terms of cardiotoxicity. Real-life data with a larger sample size are still needed to confirm the cardiac safety of T-DM1.

Coronary lesion type, location, and characteristics of acute ST elevation myocardial infarction in young adults under 35 years of age.

OBJECTIVE: In the present study, we attempted to analyze the coronary artery lesion characteristics of acute ST elevation myocardial infarction (STEMI) in young patients (aged less than 35 years). METHODS: We retrospectively surveyed 25 038 coronary angiography procedures, which were carried out at The Baskent University Adana Hospital from 1998 to present, to discover acute STEMI in young patients. We studied clinical risk factors and angiographic characteristics in 42 consecutive patients who underwent primary coronary angiography for acute STEMI. Control group (n=42) had no history of coronary artery disease and had angiographically proven normal coronary arteries. All patients were under 35 years of age. Angiographic features for STEMI group were collected and both groups were compared for coronary risk factors. RESULTS: Male sex was more prevalent in acute STEMI group when compared with control participants (83 vs. 59%, respectively; P=0.01). A significant difference was found in cigarette smoking (62 vs. 36%, respectively; P=0.007) and family history (33 vs. 16%, respectively; P=0.03) between the two groups. No statistical significance was observed between the groups in terms of hypertension, diabetes mellitus, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels. Mean high-density lipoprotein cholesterol level was 33+/-8 mg/dl in STEMI group and 39+/-12 mg/dl in control participants (P=0.02). Young patients with acute STEMI showed a preponderance of single-vessel disease (69%) and acute anterior STEMI (60%) owing to occluded left anterior descending artery (P<0.001). CONCLUSION: We observed risk factors such as family history, smoking, and low high-density lipoprotein cholesterol levels in young adults. Acute anterior STEMI owing to occluded left anterior descending artery was more frequent. Coronary atherosclerosis was characterized by higher presence of type B and proximal lesions. The handling selection was percutaneous coronary intervention in more than half of the patients.

Mean platelet volume is elevated during paroxysmal atrial fibrillation: a marker of increased platelet activation?

Paroxysmal atrial fibrillation might be a risk factor for stroke such as chronic atrial fibrillation. We examined the relation between mean platelet volume and paroxysmal atrial fibrillation to determine the effect of paroxysmal atrial fibrillation on the thrombotic state via elevated mean platelet volume. Mean platelet volume is a marker of platelet size, function, and activation. Increased mean platelet volume reflects active and large platelets that release more thromboxane A2 than smaller ones. We hypothesized that mean platelet volume is elevated in patients with paroxysmal atrial fibrillation. The study population comprised 103 consecutive patients who were detected to have paroxysmal atrial fibrillation by 24-h Holter monitoring and 87 control individuals with normal Holter monitoring. Mean platelet volume and inflammatory parameters were measured. Comprehensive clinical and echocardiographic data were collected. Patients with aortic and mitral stenosis, hyperthyroidism, hypothyroidism, malignancy, infection, and pregnancy were excluded from the study. Mean age of the patients was 63 +/- 11 vs. 45 +/- 14 years (P < 0.001) in paroxysmal atrial fibrillation and control groups, respectively. Fifty-seven patients (55%) in paroxysmal atrial fibrillation and 19 (21%) (P < 0.001) patients in control group were men. Mean platelet volume was significantly higher in the paroxysmal atrial fibrillation group when compared with control group (10.0 +/- 2.0 vs. 8.3 +/- 1.5 fl, respectively; P < 0.001). C-reactive protein (18.5 +/- 28 vs. 3.8 +/- 2 mg/l, respectively; P = 0.004) and erythrocyte sedimentation rate (21 +/- 21 vs. 12 +/- 7 mm/h, respectively; P = 0.01) were also higher in the paroxysmal atrial fibrillation group. There was no difference in white blood cell and platelet counts between groups. In a multivariate analysis, elevated mean platelet volume was associated with the occurrence of paroxysmal atrial fibrillation before and after adjustment for age and sex. Our results indicate that inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate and the marker of platelet size and activity mean platelet volume are elevated in patients with paroxysmal atrial fibrillation.

Value of preoperative echocardiography in the prediction of postoperative atrial fibrillation following isolated coronary artery bypass grafting.

The value of echocardiography, especially tissue Doppler imaging (TDI), in the assessment of risk of postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is not clear. One hundred two consecutive patients (80 men; mean age 61 +/- 10 years) who underwent elective isolated CABG were included in the study. All patients underwent conventional transthoracic echocardiography and TDI of the left and right heart before surgery. Also, 24-hour Holter recordings were obtained for all patients. The study end point was the development of postoperative AF. The surgical mortality rate was 2%. Postoperative AF occurred in 18 patients (18%). Patients with postoperative AF have been significantly older than patients without postoperative AF (73 +/- 7 vs 58 +/- 9 years, respectively; p <0.001). Compared with patients without postoperative AF, a significantly higher proportion of patients with postoperative AF experienced paroxysmal AF before surgery (6% vs 33%, respectively; p = 0.001). Patients with postoperative AF had a significantly larger mean left atrial diameter compared with patients without postoperative AF (37 +/- 3 vs 35 +/- 3 mm, respectively; p = 0.012). Multivariate logistic regression analysis identified age as the most significant predictor of postoperative AF (odds ratio 1.254, 95% confidence interval 1.127 to 1.396; p <0.001). Of the echocardiographic variables, only left atrial diameter was identified as a significant predictor of postoperative AF (odds ratio 1.250, 95% confidence interval 1.055 to 1.562; p = 0.047). In conclusion, in the prediction of postoperative AF after isolated CABG, preoperative transthoracic echocardiography, including both conventional echocardiography and TDI, is of little value.

Intima-media thickness in patients with rheumatic mitral stenosis.

The aim of the study was to determine carotid artery intima-media thickness (IMT) in patients with rheumatic mitral stenosis (RMS). Between January 2001 and December 2003, 112 consecutive patients who had been diagnosed with RMS were screened. Patients with known cerebrovascular disease, coronary artery disease, diabetes, hypertension, left ventricular hypertrophy, hyperlipidemia, abnormal laboratory results, smoking, or age over 50 years were excluded. Forty-eight patients (43 women, 5 men, mean age 39.7 +/-8.3 years) with RMS without risk factors were enrolled in the study. Age- and sex-matched healthy individuals (n = 48; 43 women, 5 men, mean age 39.6 +/-8.6 years) with normal echocardiographic findings constituted the control group. Carotid IMT was determined by using a high-resolution ultrasound system equipped with a 7-MHz imaging probe (Acuson 128 XP CI) with a computer measurement software. The mean common carotid artery IMT thicknesses both in the right (0.604 +/-0.112 mm vs 0.521 +/-0.072 mm) and in the left side (0.581 +/-0.097 mm vs 0.516 +/-0.065 mm) were significantly higher in patients with RMS than in the control group (p < 0.001). Backward stepwise logistic regression analysis identified RMS as independent predictors of increased IMT (OR, 17.25 (CI, 3.99 to 76.28), p <0.001). The present study demonstrated that RMS is associated with increased IMT. The findings indicate that in patients with RMS not only valvular but also systemic endothelium is damaged.

An experience on radial versus femoral approach for diagnostic coronary angiography in Turkey.

OBJECTIVE: The radial approach has been increasingly used as an alternative to femoral access. The purpose of the present study was to assess the feasibility, success, and safety of the transradial approach (TRA) for diagnostic coronary angiography, and to describe the difficulties associated with the technique as compared with transfemoral approach (TRF). METHODS: A series of 180 consecutive patients were divided to TRA or TFA groups by two operators. We compared the groups regarding procedural time, access time, fluoroscopy time, procedural failure, complications, contrast volume, length of hospital stay, and number of used coronary catheters. RESULTS: The number of used coronary catheters was not different between the two groups (p = 0.6). Total hospital length of stay was significantly shorter in the radial group (p <0.0001) than in femoral one. We found differences between the radial and femoral groups in the success rate (p<0.0001), contrast volume (p = 0.012), procedural time (p<0.0001), access time (p<0.0001), and fluoroscopy time (p<0.0001). We did not find any major complication in the radial group. There was a major bleeding in the femoral group. CONCLUSION: The TRA is a safe alternative to femoral catheterization although with lesser procedural success, longer procedural access, and radiation time, and more contrast volume.

Beta blocker effects on plasma homocysteine levels in patients with hypertension.

Recent studies have shown that hyperhomocysteinemia might play a role in the pathogenesis of hypertension. The effects of antihypertensive agents on plasma homocysteine levels have not been tested extensively. We investigated the effects of beta-blocker therapy on homocysteine levels in patients with hypertension. In the study, 120 patients with newly diagnosed hypertension were enrolled. All patients received metoprolol succinate 100 mg/day initially. If blood pressure was above normal on the 15th day of follow-up, the metoprolol dosage was doubled. Before initiation of the antihypertensive medication and after the fourth month of treatment, homocysteine levels were measured. Of the 120 patients enrolled, 39 could not complete the study. Homocysteine levels decreased significantly by the end of the fourth month when compared with basal values (13.5+/-4.5 micromol/l versus 12.4+/-4.9 micromol/l; P = 0.001). There was no relation between homocysteine level and blood pressure control. There was a significant decrease in homocysteine levels in the women treated in this study (P = 0.001); however, this effect was absent in men (P = 0.185). We demonstrate that metoprolol succinate treatment significantly decreases plasma homocysteine levels in patients with hypertension, especially in women.

Effect of coronary artery bypass grafting and aneurysmectomy on QT dispersion in moderate or severe left ventricular dysfunction.

BACKGROUND: The aim of the study was to evaluate the effect that coronary artery bypass grafting (CABG) and aneurysmectomy in the same session have on QT dispersion (QTd) in moderate or severe left ventricular dysfunction. METHODS: Forty-four patients underwent QT interval analyses before and 1 month after aneurysmectomy and CABG. QT interval and QTd were corrected for heart rate using the square root formula of Bazett (QTCB), the cubic root formula of Fridericia (QTCF), and the linear formula of Sagie et al (QT CS ). RESULTS: The mean pre- and postsurgery QTd results were 65.29 +/- 29.25 and 51.76 +/- 18.49 milliseconds, respectively; the corresponding findings for QT CF were 68.06 +/- 31.26 and 55.16 +/- 24.56 milliseconds; and the corresponding findings for QT CS were 66.53 +/- 32.22 and 51.10 +/- 18.29 milliseconds. With these 3 methods, the postoperative findings were significantly lower than the preoperative findings ( P < .05 for all). In contrast, the opposite was true with the QT CB method (preoperative 71.1 +/- 65.80 vs postoperative 76.43 +/- 7.96 milliseconds, P < .05). CONCLUSION: The study showed that based on the methods of Fridericia (QT CF ) and Sagie et al (QT CS ), QT intervals are significantly decreased after CABG and aneurysmectomy.

Comparison of carotid intima-media thickness in patients with stable angina pectoris versus patients with acute coronary syndrome.

In this study, we found that carotid intima-media thickness (IMT) was significantly increased and carotid artery atherosclerotic plaques were detected more frequently in patients who had early-onset coronary artery disease compared with control subjects (0.73 +/- 0.10 vs 0.60 +/- 0.10 mm, p <0.001, and 40% vs 11%, p <0.001, respectively). Further, patients who had coronary artery disease and presented with an acute coronary syndrome were found to have significantly increased carotid IMT compared with patients who had stable angina pectoris (0.76 +/- 0.10 vs 0.70 +/- 0.10 mm, p <0.05). The IMT was greater in the patients who had acute coronary syndrome than in those who had stable angina pectoris.

[Echocardiographic evaluation of associated valve lesions in mitral stenosis]. / Mitral Darligina Eslik Eden Diger Kapak Lezyonlarinin Ekokardiyografik Olarak Degerlendirilmesi.

OBJECTIVE: When mitral stenosis is associated with other valve lesions, diagnosis, prognosis and the treatment strategies are affected. Mitral valve prolapse may occur in some pathological settings that affect mitral apparatus. We investigated the incidence of valve lesions including mitral valve prolapse that accompany mitral stenosis and assessed the relation between echocardiographic measures. METHODS: Two hundred and one patients (31 male, 170 female) between 16 and 72 years of age (mean age 40.9+/-11.4 years) with mitral stenosis were included in the study. Patients were divided into three groups according to the mitral valve area obtained by echocardiography using planimetric method as Group I (MVA<1.1 cm(2)), Group II (MVA -1.1-1.5 cm(2)) and Group III (MVA >1.5 cm2). RESULTS: Mitral stenosis with mitral regurgitation, aortic regurgitation, aortic stenosis, combined aortic valve disease, tricuspid regurgitation and tricuspid stenosis were found in 117 (58.2%), 84 (41.8%), 18 (9%), 9 (4.5%), 62 (30.8%) and 6 (3%) patients, respectively. Twenty- three patients (11.4%) had mitral valve prolapse in only anterior leaflet. Nobody of patients had mitral valve prolapse of posterior mitral valve leaflet. Age, gender, rhythm, degree of stenosis, degree of mitral and aortic regurgitations, mean pressure gradient, left atrial diameter, ejection fraction and valve score did not differ in patients with and without mitral valve prolapse. CONCLUSION: Our study has shown that valve lesions including mitral valve prolapse frequently accompany mitral stenosis and the incidence of mitral valve prolapse in patients with mitral stenosis is high.

Relationship between parathyroid hormone and depression in heart failure.

BACKGROUND: Depression has been found to be a predictor of rehospitalization and mortality in heart failure (HF). Parathyroid hormone (PTH) is a novel promising biomarker that can predict hospitalization, functional status and mortality in HF. OBJECTIVE: We aimed to investigate the association of depression with serum PTH levels in patients with systolic HF. METHODS: A total of consecutive 100 outpatients with systolic HF having left ventricular ejection fraction (LVEF) < 40%, were prospectively studied. All patients underwent laboratory tests, including brain natriuretic peptide (BNP) and PTH analyses. The patients were asked to complete the Beck Depression Inventory- II (BDI). RESULTS: Fifty-one patients (51%) were shown to have poor BDI score (BDIS > 18). Patients with poor BDI score had significantly higher PTH levels compared to those with good BDIS (133 ± 46 pg/ml vs. 71 ± 26 pg/ml, p < 0.001). In multivariable logistic regression model, PTH level (Odds ratio (OR) = 1.035, p = 0.003), LVEF (OR = 0.854, p = 0.004), NYHA functional class III/IV (OR = 28.022, p = 0.005), C-reactive protein (CRP) (OR = 1.088, p = 0.020), and presence of pretibial edema (OR = 12.341, p = 0.033) were found to be independent predictors of moderate to severe depression after adjustment of other potential confounders. CONCLUSION: Systolic HF patients with moderate to severe depression had higher serum levels of PTH and CRP, poor functional status and lower LVEF. The association of depression with such parameters might explain the contribution of depression to hospitalization and mortality in HF.

Echocardiographic features of patients with paroxysmal atrial fibrillation.

BACKGROUND: There are several risk factors for the initiation of paroxysmal atrial fibrillation (PAF) and the underlying mechanisms are multifactorial. Our study aims to explore the echocardiographic parameters that can identify in patients with PAF compared to normal subjects. METHODS: Eighty consecutive patients who were with PAF detected by 24-h Holter monitoring (HM) were assigned in our study. The control group (n = 80) consisted individuals with no PAF on HM. Indication for HM was palpitations at rest. All patients underwent routine echocardiographic evaluation. Patients with aortic and mitral stenosis, hyperthyroidism, and hypothyroidism were excluded from the study. Comprehensive clinical data were collected. RESULTS: Mean age of the patients with PAF was 63 +/- 11 years and of those 42% were male subjects. There was no difference in the prevalence of hypertension in both groups. Mean left ventricular ejection fraction (LVEF) was 57 +/- 15% in PAF group and 64 +/- 2% in control subjects (p < 0.001). Mean values of left atrial (LA) diameter for PAF and control groups were 3.7 +/- 0.6 cm vs. 3.1 +/- 0.4 cm (p < 0.001), respectively. Patients with PAF had more severe valve insufficiency, higher values of mean pulmonary artery systolic pressures (PAP) (29 +/- 10 mmHg vs. 25 +/- 2 mmHg, respectively; p = 0.001) and deteriorated MV inflow velocities (E:A ratio 0.9 +/- 0.4 vs. 1.1 +/- 0.3, respectively; p = 0.008) when compared to control group. In multivariate logistic regression analysis, LA diameter predicted the development of PAF after adjusted for age and gender. CONCLUSION: Our results indicate that LA diameter predicts the development of PAF.

Relação entre o Paratormônio e Depressão na insuficiência cardíaca / Relationship between parathyroid hormone and depression in heart failure

FUNDAMENTO: Tem-se observado que a depressão é preditora de reinternação e mortalidade na insuficiência cardíaca. O hormônio da paratireoide é um biomarcador novo e promissor que pode predizer a internação, a capacidade funcional e a mortalidade na insuficiência cardíaca. OBJETIVO: Nosso objetivo foi investigar a associação da depressão aos níveis séricos de hormônio da paratireoide em pacientes com insuficiência cardíaca sistólica. MÉTODOS: Cem pacientes ambulatoriais consecutivos com IC sistólica com fração de ejeção do ventrículo esquerdo < 40% foram examinados prospectivamente. Todos os pacientes foram submetidos a exames laboratoriais, incluindo análises de peptídeo natriurético cerebral e de hormônio da tireoide. Os pacientes foram convidados a completar o Inventário de Depressão de Beck-II. RESULTADOS: Cinquenta e um pacientes (51%) apresentavam escore de BDI ruim (escore de BDI > 18). Esses pacientes apresentavam níveis de hormônio da paratireoide significativamente mais elevados em comparação com aqueles com bons escores de BDI (133 ± 46 pg/ml versus 71 ± 26 pg/ml, p < 0,001). No modelo de regressão logística multivariada, constatou-se que o nível do hormônio da tireoide (razão de chances (OR) = 1.035, p = 0,003), fração de ejeção do ventrículo esquerdo (OR = 0,854, p = 0,004), classe funcional III / IV (OR = 28,022, p = 0,005), C-reactive protein (CRP) (OR = 1,088, p = 0,020) e presença de edema pré-tibial (OR = 12,341, p = 0,033) constituíam preditores independentes de depressão moderada a importante após o ajuste de outros possíveis fatores de confusão. CONCLUSÃO: Pacientes com insuficiência cardíaca sistólica com depressão moderada a importante apresentavam níveis séricos elevados de hormônio da tireoide e CRP, capacidade funcional ruim e fração de ejeção do ventrículo esquerdo mais baixa. A associação da depressão com esses parâmetros pode explicar a contribuição da depressão para a internação e a mortalidade na insuficiência cardíaca.

BACKGROUND: Depression has been found to be a predictor of rehospitalization and mortality in heart failure (HF). Parathyroid hormone (PTH) is a novel promising biomarker that can predict hospitalization, functional status and mortality in HF. OBJECTIVE: We aimed to investigate the association of depression with serum PTH levels in patients with systolic HF. METHODS: A total of consecutive 100 outpatients with systolic HF having left ventricular ejection fraction (LVEF) < 40%, were prospectively studied. All patients underwent laboratory tests, including brain natriuretic peptide (BNP) and PTH analyses. The patients were asked to complete the Beck Depression Inventory- II (BDI). RESULTS: Fifty-one patients (51%) were shown to have poor BDI score (BDIS > 18). Patients with poor BDI score had significantly higher PTH levels compared to those with good BDIS (133 ± 46 pg/ml vs. 71 ± 26 pg/ml, p < 0.001). In multivariable logistic regression model, PTH level (Odds ratio (OR) = 1.035, p = 0.003), LVEF (OR = 0.854, p = 0.004), NYHA functional class III/IV (OR = 28.022, p = 0.005), C-reactive protein (CRP) (OR = 1.088, p = 0.020), and presence of pretibial edema (OR = 12.341, p = 0.033) were found to be independent predictors of moderate to severe depression after adjustment of other potential confounders. CONCLUSION: Systolic HF patients with moderate to severe depression had higher serum levels of PTH and CRP, poor functional status and lower LVEF. The association of depression with such parameters might explain the contribution of depression to hospitalization and mortality in HF.

Atherosclerosis in haemodialysis patients without significant comorbidities: determinants of progression.

AIM: The aim of this prospective study was to assess the determinants of the progression of carotid artery intima-media thickness (CA-IMT) for 1 year in haemodialysis (HD) patients without significant comorbidities. METHODS: Fifty-four HD patients younger than 55 years, without diabetes, obesity and any clinical evidence of cardiovascular disease (29 men, 25 women; mean age 33.3 +/- 10 years; mean time on HD 49.4 +/- 43 months) were included in the 1-year study. CA-IMT was assessed at baseline and after 12 months. The difference in IMT between these two points of time was calculated (DeltaCA-IMT). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), haematocrit-corrected ESR, beta-2 microglobulin, cardiac troponin I, lipid profile, fibrinogen, homocysteine, CaXP product, intact parathyroid hormone, haematocrit, albumin, uric acid levels, anthropometric parameters (age, body mass index), smoking, hypertension and left ventricular hypertrophy were recorded at baseline. RESULTS: The mean value for CA-IMT at baseline (0.59 +/- 0.05 mm) was significantly lower than that at 12 months (0.64 +/- 0.07 mm) (P < 0.001). CA-IMT had increased in 41 patients (75.9%). Age (P = 0.02), CRP (P = 0.03), beta-2 microglobulin (P = 0.001) and left ventricular hypertrophy (P = 0.01) were independently related with CA-IMT at baseline. Age (P = 0.003) and CRP (P = 0.04) were the independent variables related with CA-IMT, measured at 12 months. DeltaCA-IMT correlated positively with age (r = 0.31, P < 0.05). Age and sex were independent predictors of DeltaCA-IMT (R(2) for the model 0.56). CONCLUSION: In addition to age and male sex, non-specific inflammation may have a possible role in the progression of atherosclerosis in HD patients without significant comorbidities.

Slow coronary flow is associated with carotid artery dilatation.

Slow coronary flow (SCF) in a normal coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. Carotid intima-media thickness (CIMT) is a noninvasive marker of atherosclerosis. The aim of this study was to investigate the CIMT and diameter of carotid and coronary artery in relation to SCF. Twenty-four patients with angiographically diagnosed SCF (51 +/- 7 years), and 26 age-matched subjects with normal coronary flow (NCF) (52 +/- 8 years) in the coronary angiography were enrolled. Coronary flow rates were documented by thrombolysis in myocardial infarction (TIMI) frame count (TFC), a simple method for evaluating coronary blood flow. Carotid and coronary artery diameters and CIMT were measured. Mean TFC was significantly higher in patients with SCF than in patients with NCF (p < 0.001). There were no significant differences regarding maximum (p = 0.84) and mean CIMT (p = 0.61). On the other hand, carotid lumen (p = 0.03) and coronary artery diameters (p = 0.001) were significantly greater in patients with SCF than in subjects with NCF. There was a significant relation between mean coronary artery diameter and TFC (p = 0.004, 95% CI for OR: 1.61-11.87). In conclusion, these findings suggest that CIMT is not altered in patients with SCF as compared with those with NCF. However, carotid and coronary artery diameters are increased in patients with SCF as compared to those with NCF. Because the common carotid artery can be assessed in nearly every patient, carotid artery dilatation may be used as an early indicator for SCF.

Simvastatin improves the attenuated heart rate recovery of type 2 diabetics.

Heart rate recovery at 1min (HRR1) is a strong predictor of all-cause mortality. The effects of statins on the autonomic nervous system may account for their beneficial effects in survival. Our aim was to determine if statin therapy improves heart rate recovery in hypercholesterolemic patients with type 2 diabetes mellitus. Thirty type 2 diabetic patients without known coronary artery disease and low density lipoprotein cholesterol>100mg/dl and 30 age and sex matched non-diabetic controls were included in a prospective study. Patients with diabetes were treated with simvastatin 40mg/day for 1 year. No lipid-lowering therapy was administered to the control group. Exercise testing with 2min cool-down period was performed at baseline, 6, 12 weeks and at 1 year. The diabetics had significantly lower HRR1 compared with non-diabetics at baseline (19.2+/-5.4bpm versus 24.2+/-4bpm, p<0.0001). Simvastatin therapy significantly improved HRR1 after 12 weeks compared to baseline (19.2+/-5.4bpm versus 24+/-5bpm, p<0.0001) and this improvement remained significant at 1 year (26+/-4.4bpm, p<0.0001 compared to baseline). HRR1 did not change in the control group (p=0.39 by ANOVA). This study demonstrates that treatment with simvastatin might improve the attenuated heart rate recovery of diabetic subjects. In patients with diabetes, the mortality benefit provided by statins might involve their effects on the autonomic nervous system.

Cardiac troponin I and beta 2 microglobulin as risk factors for early-onset atherosclerosis in patients on haemodialysis.

AIM: To investigate the associations of different risk factors with carotid artery intima-media thickness (C-IMT) in non-diabetic haemodialysis (HD) patients who had no clinical evidence of atherosclerosis. METHODS: Seventy-two HD patients (43 men, 29 women; mean age: 34.5 +/- 10.6 years; mean time on HD: 47.9 +/- 40.0 months) and 40 age- and sex-matched healthy controls (26 men, 14 women; mean age: 35.5 +/- 7.1 years) participated in the study. The relationship between C-IMT and haematocrit-corrected erythrocyte sedimentation rate (Hct-corrected ESR), beta 2 microglobulin (beta2M) and serum cardiac troponin I (cTnI) levels beyond C-reactive protein (CRP), lipid profile and lipoprotein(a), fibrinogen, homocysteine and left ventricular hypertrophy (LVH) were examined. RESULTS: Mean C-IMT of the HD patients was significantly greater than that of the control subjects (0.59 +/- 0.06 vs 0.53 +/- 0.07 mm, P = 0.002). C-IMT of patients was positively correlated with age (r = 0.33), body mass index (r = 0.40), Hct-corrected ESR (r = 0.37), CRP (r = 0.34), beta2M (r = 0.34), cTnI (r = 0.26), triglyceride (r = 0.26) and fibrinogen (r = 0.28) levels (P < 0.05 for all). The mean C-IMT was significantly greater in patients with LVH than it was in those without LVH (P = 0.004). In multivariate regression analysis, age (P = 0.02), beta2M (P = 0.001), log-transformed CRP (P = 0.03) and LVH (P = 0.01) were independently related with C-IMT. CONCLUSION: Besides well-known cardiovascular (CV) risk factors, cTnI and beta2M were related with C-IMT in that they may have important roles in early-onset atherosclerosis in this high-risk population.

Decreased heart rate recovery in patients with heart failure: effect of fluvastatin therapy.

Heart rate recovery is the difference in heart rate at peak exercise and at a specific time interval following the onset of recovery. Attenuated heart rate recovery is an independent predictor of mortality in patients with a history of coronary artery disease. The aim of the present study was to evaluate the effect of a statin on heart rate recovery, particularly in patients with ischemic heart failure and hyperlipidemia. Twenty-nine consecutive hyperlipidemic, stable coronary artery disease patients with heart failure and 19 healthy subjects were enrolled. Heart rate recovery values at the 1st and 3rd minutes and lipid profiles of the patients were evaluated at baseline and following 3 months of treatment with fluvastatin. Compared with healthy subjects, the heart rate recovery values were significantly lower in the heart failure patients in both the 1st and 3rd minutes, respectively (31 +/- 6 versus 19 +/- 7, P < 0.0001; 66 +/- 7 versus 47 +/- 8, P < 0.0001). Heart rate recovery in the 1st and 3rd minutes increased from 19 +/- 7 to 24 +/- 9 and 47 +/- 8 to 57 +/- 11, respectively, following treatment (P < 0.001, P < 0.001). There were no significant correlations among the changes in lipid parameters or HRR in the first and third minutes in the recovery period. The results revealed an improvement in heart rate recovery in heart failure patients by fluvastatin treatment. If this association can be confirmed by other studies, it would be interesting to perform further studies into the mechanism underlying this finding.