The prevalence and correlates of T-wave inversion in lead III in non-obese men.

BACKGROUND: T-wave inversion in lead III was linked to displacement of the base of the heart due to abdominal adipose tissue in early electrocardiography (ECG) trials. The observation of T-wave inversion in lead III in some of the pathological and physiological conditions other than obesity suggests the possibilities of different mechanisms. We aimed to investigate the prevalence and correlates of T-wave inversion in lead III in non-obese men. METHOD: A total of 1240 men underwent ECG, blood pressure measurement, hepatic ultrasonography, and biochemical tests from January 2019 to December 2019. We excluded 220 subjects due to predetermined criteria. The eligible 105 non-obese men with T-wave inversion in lead III and 915 non-obese men without T-wave inversion in lead III were compared with each other in terms of clinical, demographic and laboratory parameters. RESULTS: The mean age was 27.9 years with a range of 20 to 46 years. The prevalence of T-wave inversion in lead III was 10.3%. Body mass index (BMI), blood urea nitrogen, creatinine, alanine aminotransferase, hematocrit, and the percentage of non-alcoholic fatty liver disease (NAFLD) were significantly higher in Group with T-wave inversion while alkaline phosphatase was significantly higher in Group without T-wave inversion. In multivariable analysis, NAFLD was the best independent correlate of inverted T-wave in lead III (ß = 6.215, p < 0.0001). BMI (ß = 1.448, p < 0.001) and hematocrit (ß = 1.179, p = 0.021) were the other independent correlates of T-wave inversion in lead III. CONCLUSION: We demonstrated the association of T-wave inversion in lead III with NAFLD, BMI, and hematocrit in non-obese men.

Deterioration of heart rate recovery index in patients with non-alcoholic fatty liver disease (NAFLD).

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has been considered as a benign disease often associated with central obesity and insulin resistance and, in general, with factors of the metabolic syndrome. Heart rate recovery after exercise is a function of vagal reactivation, and its impairment is an independent prognostic indicator for cardiovascular and all-cause mortality. The aim of our study was to evaluate the heart rate recovery index in patients with NAFLD. MATERIAL AND METHODS: The study population included 59 patients with NAFLD (mean age=42.3±9.3 years) and 22 healthy subjects as controls (mean age=40.7±6.5 years). Basal electrocardiography, echocardiography, and treadmill exercise testing were performed on all patients and controls. The heart rate recovery index was defined as the reduction in the heart rate from the rate at peak exercise to the rate at the 1st minute (HRR1), 2nd minute (HRR2), 3rd minute (HRR3), and 5th minute (HRR5) after stopping exercise stress testing. RESULTS: There were significant differences in HRR1 and HRR2 indices between patients with ED and the control group (19.9±8.2 vs. 34.1±9.6; p<0.001 and 24.3±5.4 vs. 40.5±9.1; p=0.006, respectively). Similarly, HRR indices after the 3rd and 5th minutes of the recovery period were significantly lower in patients with NAFLD compared with those indices in the control group (32.3±8.5 vs. 58.4±6.5; p=0.001 and 58±18.2 vs. 75.1±15.8; p<0.001). Effort capacity was markedly lower (11±1.9 vs. 12.5±1.5 METs; p=0.001) among the patients with NAFLD. CONCLUSIONS: The heart rate recovery index is deteriorated in patients with NAFLD. When the prognostic significance of the heart rate recovery index is considered, these results may help explain the increased occurrence of cardiac death. It points to the importance of the heart rate recovery index in the identification of high-risk patients.

Infective endocarditis and complications; a single center experience.

OBJECTIVES: The aim was to investigate the microbiological characteristics and complications of infective endocarditis (IE) in 119 patients treated in our center for IE, diagnosed by modified Duke criteria. STUDY DESIGN: The archive records of 119 patients (82 [69%] males; 37 [31%] females; mean age 39 ± 16 years) with a definite diagnosis of IE between January 1997 and November 2004 were systematically reviewed for clinical and microbiological properties and complications. RESULTS: The most common complaint of the patients was fever and malaise (102 patients, 85.7%, each). Culture was negative in 68 patients (57.1%), while Staphylococcus aureus was the most common etiological agent in culture positive cases. The aortic valve was the most common region of vegetation (43 patients, 36.1%). The frequency of surgical operation for valvular insufficiency due to IE was 75.6%, and the frequency of congestive heart failure was 53.8% (64 patients). CONCLUSION: IE is still an important disease considering its high morbidity and mortality rates, increased life expectancy of the patients, and increased number of valve replacement procedures.

Epicardial fat thickness is associated with non-dipper blood pressure pattern in patients with essential hypertension.

OBJECTIVE: Epicardial fat tissue reflects visceral adiposity and is a suggested cardiometabolic risk factor. Patients with abdominal obesity have an increased prevalence of the non-dipper blood pressure (BP) pattern, but it is unclear whether the same is true of patients with increased epicardial fat thickness (EFT). The association between EFT and circadian BP changes in patients with recently diagnosed essential hypertension was examined. METHODS: Sixty hypertensive patients underwent echocardiography, treadmill stress testing, and 24 hours of ambulatory BP monitoring. Epicardial fat thickness and left ventricular mass (LVM) index were measured by using transthoracic echocardiography. The patients were categorized into two groups according to their BP pattern (group 1, non-dippers; group 2, dippers). RESULTS: The mean EFT and LVM of patients in group 1 (n = 24) (EFT, 7.6 ± 2.1 mm; LVM, 130 ± 31.2 g/m(2)) were significantly greater than those of group 2 (n = 36) (EFT, 5.5 ± 1.2 mm, P = .0001; LVM, 107 ± 23.7 g/m(2), P = .002). The average systolic BP over 24 hours (BP(s) 24) and average diastolic BP over 24 hours (BP(d) 24) of group 1 (BP(s) 24, 151.1 ± 17.6 mm Hg; BP(d) 24, 94.1 ± 16.5 mm Hg) were significantly higher than those of group 2 (BP(s) 24, 136.7 ± 11.9 mm Hg, P = .0001; BP(d) 24, 84.6 ± 10.6 mm Hg; P = .008). Multivariate backward logistic regression analysis demonstrated that the non-dipper BP pattern was associated with EFT (standardized ß coefficient = 0.87, P = .005) and LVM (standardized ß coefficient = 0.43, P = .016). An EFT ≥ 7 mm was associated with the non-dipper BP pattern with 44% sensitivity and 94% specificity (receiver operating characteristic area under curve of 0.72, 95% CI [0.59-0.83], P = .0007). CONCLUSIONS: Epicardial fat thickness was above average in newly diagnosed, untreated hypertensive patients with non-dipper BP pattern. The echocardiographic measurement of EFT may be used to indicate increased risk of hypertension-related adverse cardiovascular events.

Telmisartan decreases atrial electromechanical delay in patients with newly diagnosed essential hypertension.

BACKGROUND: Atrial electromechanical delay (EMD) parameters predict the development of atrial fibrillation. We investigated the effect of telmisartan treatment on atrial EMD parameters in patients with newly diagnosed essential hypertension. METHODS: Thirty-six patients with essential hypertension were treated with telmisartan (80 mg/day) for 6 months. Baseline electrocardiographic P-wave measurements and echocardiographic atrial EMD parameters were compared with the 6-month follow-up. RESULTS: Pmax and Pd were significantly decreased (108.4 ± 6.1 vs 93.9 ± 6.2 milliseconds, 33.4 ± 8.6 vs 19.5 ± 7.0 milliseconds, respectively, P = .0001 for each) after 6-month telmisartan therapy. The atrial EMD parameters were decreased from baseline (mitral EMD, 68.9 ± 4.9 vs 53.8 ± 4.9 milliseconds; septum EMD, 51.6 ± 7.1 vs 42.6 ± 7. milliseconds1; tricuspid EMD, 48 ± 6.9 vs 39 ± 6.9 milliseconds; interatrial EMD, 20.9 ± 5.5 vs 14.8 ± 5.7 milliseconds; P = .0001 for each parameter). The reduction of interatrial EMD was correlated with the reduction in systolic BP nighttime and the increase in mitral E wave velocity/mitral A wave velocity ratio. CONCLUSION: Telmisartan decreased the atrial EMD parameters in patients with newly diagnosed essential hypertension.

[A late coronary aneurysm after sirolimus stent implantation which was treated with coronary graft stent]. / Sirolimus salinimli stent implantasyonu sonrasinda geç dönemde gelisen koroner arter anevrizmasinin greft stent ile tedavisi.

Drug eluting stents are being used frequently because of their less restenotic properties. However, their effect on preventing neo-intimal hyperplasia may cause many adverse effects such as coronary artery aneurysm (CAA). We report a case that presented with a CAA which was the latest developed CAA after the implantation of drug eluting stents in literature so far. A 57-year-old male presented with dyspnea and typical angina on effort. Coronary angiography was performed. A large CAA was detected at the site of a drug eluting stent which was implanted in the LAD artery 5.5 years ago. It was treated with a coronary stent graft successfully.

[The value of serum homocysteine in predicting one-year survival in patients with severe systolic heart failure]. / Serum homosistein düzeyinin ileri sistolik kalp yetersizligi olan hastalarda bir yillik sagkalimi öngörmedeki degeri.

OBJECTIVES: Heart failure (HF) is a major public health problem responsible for high morbidity and mortality rates. Thus, the importance of survival predictors in directing the treatment of HF is gradually increasing. In some recently published studies, plasma homocysteine has been presented as a newly recognized risk factor for development of HF. In the present study, we investigated the value of serum homocysteine levels in predicting the survival of patients with HF. STUDY DESIGN: Seventy HF patients (44 males, 26 females; mean age 60±12; range 28 to 83 years) with left ventricle ejection fractions <35% were included in our study. Clinical, echocardiographic, and biochemical parameters were measured at baseline, and all patients were followed. Cardiac death was established as the end point of the study. RESULTS: At the end of the 12 month follow-up period, 14 patients (20%) had died. Serum homocysteine levels were significantly higher in the deceased patients compared to the patients who survived (20.8±5.8 vs. 16.9±5.1 µmol/l, p=0.029). A serum homocysteine level of >17.45 µmol/l predicted death at the end of the first year with 71.4% specificity and 67.9% sensitivity (ROC area under curve: 0.855, CI 95% 0.792-0.965, p<0.001). Multivariate Cox regression analysis showed that the serum homocysteine level was the only parameter predicting survival. CONCLUSION: Serum homocysteine level may be an important predictor of mid-term mortality in patients with HF.

The epicardial fat thickness is associated with fragmented QRS in patients with newly diagnosed metabolic syndrome.

OBJECTIVE: The metabolic syndrome involves both metabolic and cardiovascular risk factors and is associated with cardiovascular mortality. Epicardial fat tissue plays a crucial role in deleterious effects of metabolic syndrome on the heart, including myocardial fibrosis. The fragmented QRS reflects heterogeneous depolarization of the myocardium and occurs as a result of fibrosis. Thus, we aimed to investigate whether there is an association between fragmented QRS and epicardial fat tissue in patients with metabolic syndrome. METHODS: This study enrolled 140 metabolic syndrome patients, of whom 35 patients with fragmented QRS (+) and 105 patients with fragmented QRS (-). The two groups were compared with respect to clinical, laboratory, electrocardiographic, and echocardiographic indexes. RESULTS: Fragmented QRS (+) patients had higher waist circumference, red cell distribution width, creatinine, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, QRS duration, and epicardial fat tissue compared with fragmented QRS (-) patients. Waist circumference, red cell distribution width, QRS duration, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, and epicardial fat tissue were significantly associated with the presence of fragmented QRS. The QRS duration and epicardial fat tissue were independently associated with the presence of fragmented QRS on surface electrocardiographic in metabolic syndrome patients. CONCLUSIONS: Epicardial fat tissue and QRS duration were independently associated with the presence of fragmented QRS. Basic echocardiographic and electrocardiographic parameters might be used for the risk stratification in metabolic syndrome patients.

Fragmented QRS in inferior leads is associated with non-alcholic fatty liver disease, body-mass index, and interventricular septum thickness in young men.

OBJECTIVE: Fragmented QRS (fQRS) has been shown to be related to coronary heart disease, heart failure, hypertension, cardiac arrhythmia, and metabolic syndrome. Although fQRS in lateral leads is shown to be associated with a poor outcome in patients with a known cardiac disease, the knowledge about the significance and prevalence of fQRS in inferior leads is scarce. This study aimed to investigate the prevalence and predictors of fQRS in inferior leads in healthy young men. METHODS: A total of 1,155 men underwent electrocardiography (ECG), hepatic ultrasonography, and routine biochemical tests. A total of 210 eligible men with fQRS in inferior leads (group 1) and 770 eligible men without fQRS in inferior leads (group 2) were compared with each other in terms of clinical, demographic, and laboratory parameters. RESULTS: The prevalence of fQRS in inferior leads was found to 21.4%. Body mass index (BMI), systolic blood pressure (BP), creatinine, and alanine aminotransferase levels; non-alcoholic fatty liver disease (NAFLD) percentage; and interventricular septum thickness (IVST) were significantly greater in group 1 than those in group 2. BMI, IVST, NAFLD, creatinine, ALT, and systolic BP were entered in a model of multiple regression analyses to predict fQRS, a dependent variable. NAFLD was the best independent predictor of fQRS (ß=6.115, p=0.001). BMI (ß=1.448, p=0.014) and IVST (ß=1.058, p=0.029) were the other independent predictors of fQRS in inferior leads. CONCLUSION: This study demonstrated the association of fQRS in inferior leads with NAFLD, BMI, and IVST in young men.

Assessment of atrial conduction time in patients with coronary artery ectasia.

BACKGROUND: Coronary artery ectasia (CAE) is associated with increased sympathetic activity, plasma levels of inflammatory markers, and oxidative stress. These factors can also cause arrhythmias such as atrial fibrillation. Atrial conduction abnormalities in patients with CAE have not been investigated in terms of atrial electromechanical delay obtained by tissue Doppler echocardiography. METHODS: Ninety patients with pure CAE (n = 30), nonobstructive coronary artery disease (NO-CAD) (n = 30), and angiographically normal coronary arteries "controls" (n = 30) were compared in terms of electrocardiographic P-wave measurements, echocardiographic atrial electromechanical coupling (AEC) parameters, and interatrial conduction delay. RESULTS: The mean left atrium diameter in the CAE group was similar to the NO-CAD group but significantly greater than the control group (3.62 ± 0.28 vs 3.46 ± 0.32 vs 3.41 ± 0.31 cm, P = 0.021). P maximum and P-wave dispersion were significantly increased in the CAE group compared to the NOCAD group and the control group (108.6 ± 6.6 vs 97.9 ± 6.6 vs 93.5 ± 6.2, P = 0.0001; 34.4 ± 7.6 vs 23.2 ± 7.8 vs 19.4 ± 7.7 ms, P < 0.0001). Mitral AEC, septal AEC, and tricuspid AEC were significantly higher in the CAE group than the NO-CAD group and the control group (68 ± 4.5 vs 57 ± 4.5 vs 53 ± 4.6 ms, P < 0.0001; 50.7 ± 7 vs 42.7 ± 7 vs 41.7 ± 7.2 ms, P = 0.0001; 47 ± 6.7 vs 39.1 ± 6.7 vs 38.1 ± 6.6 ms, P < 0.0001). Interatrial conduction delay was significantly increased in the CAE group compared to the NO-CAD group and the control group (21 ± 5.5 vs 17.8 ± 5.6 vs 15 ± 5.6 ms, P < 0.0001).The correlation analysis demonstrated that the interatrial conduction delay and P-wave dispersion (Pd) were positively correlated with number of ectatic segments (ESN) (r = 0.41, P = 0.024 vs r = 0.49, P = 0.006). Stepwise multiple linear regression analysis revealed that the ESN was the only independent determinants of interatrial conduction delay (P = 0.024). CONCLUSION: Pd and interatrial conduction delay are prolonged in patients with CAE compared to NO-CAD patients and the healthy controls.

Echocardiographic epicardial fat thickness is related to altered blood pressure responses to exercise stress testing.

OBJECTIVE: Hypertensive response at peak exercise and blunted blood pressure (BP) recovery, altered BP responses obtained from exercise stress testing, have been suggested as risk factors for future onset of hypertension in previous studies. Epicardial fat, a new cardiometabolic risk factor, has been linked to hypertension in some recent studies. In this study, we tested the primary hypothesis suggesting that the epicardial fat thickness (EFT) is related to altered BP responses to treadmill exercise testing. We also evaluated the sensitivity and specificity of the EFT as a predictor of hypertensive response to peak exercise. METHODS: Normotensive subjects underwent to treadmill stress testing and transthoracic echocardiography. Hypertensive response to peak treadmill exercise testing was defined as ≥ 210/105 mmHg and ≥ 190/105 mmHg at peak exercise in males and females, respectively. BP recovery index (BPRI) was defined as the ratio of the BP at the 3rd minute of the recovery phase to BP at peak exercise. EFT was measured by echocardiography. Thirty-two subjects with hypertensive response to peak exercise constituted Group 1 and 48 subjects with normal response constituted Group 2. RESULTS: The mean EFT of subjects in Group 1 was significantly higher (8.2 ± 1.1 mm vs 5.1 ± 1.5 mm; p = 0.0001) than subjects in Group 2. In correlation analysis performed in Group 1, EFT was found to be significantly correlated with BPRI (r = 0.51, p < 0.003). An EFT of ≥ 6.5 mm predicted the hypertensive response to peak exercise test with 68.8% sensitivity and 87.5% specificity (receiving operator characteristic area under curve: 0.879, 95% CI 0.793-0.965, p < 0.001). Patients with EFT ≥ 6.5 mm showed a significantly increased BPRI (0.89 ± 0.07 vs 0.74 ± 0.09, p < 0.0001) and peak systolic BP (198.4 ± 15.3 mmHg vs 169.4 ± 19.8 mmHg, p < 0.0001). There were significant differences in metabolic equivalents, maximum heart rate, homeostatic model assessment of insulin resistance, high-density lipoprotein-cholesterol, waist circumference and age values between two patients groups dichotomized according to the cut-off value of EFT. BPRI was the only independent variable related to EFT in the multivariate analysis (odds ratio = 1.4, 95% CI 2.75-7.16, p = 0.001). CONCLUSIONS: EFT was found to be related to altered BP responses to exercise stress testing. The echocardiographic measurement of EFT may serve as a useful non-invasive indicator of heightened risk of future hypertension.

Echocardiographic epicardial fat thickness is associated with carotid intima-media thickness in patients with metabolic syndrome.

BACKGROUND: Carotid intima-media thickness (CIMT) is a potential indicator of subclinical atherosclerosis in patients with metabolic syndrome (MetS). Epicardial fat thickness (EFT) is suggested as a new cardiometabolic risk factor. We investigated the association between EFT and CIMT in patients with MetS. METHODS: Forty patients with MetS were compared with 40 age- and sex-matched subjects without MetS in terms of echocardiographic EFT, CIMT, anthropometric measurements, and metabolic profile in this cross-sectional study. RESULTS: The waist circumference, total and LDL-cholesterol, fasting glucose, triglycerides, systolics and diastolic blood pressure levels, hs-CRP, and homeostasis model assessment index for insulin resistance (HOMA-IR) were significantly increased in patients with MetS. The EFT and CIMT were also increased significantly in patients with MetS compared to controls (7.2 ± 2 mm vs. 5.7 ± 1.9 mm; P = 0.001, 0.74 ± 0.1 mm vs. 0.59 ± 0.1 mm; P < 0.01, respectively). Echocardiographic EFT was the only independent predictor of CIMT in the multivariate analysis (standardized ß coefficient = 0.74, P < 0.001). CONCLUSION: EFT is associated with increased CIMT in patients with MetS.

The association of epicardial fat thickness with blunted heart rate recovery in patients with metabolic syndrome.

Epicardial fat tissue has unique endocrine and paracrine functions that affect the cardiac autonomic system. Epicardial fat thickness (EFT) and blunted heart rate recovery (HRR) are newly identified cardiovascular risk factors in patients with metabolic syndrome (MS). The objective of this study is to evaluate the association between EFT and HRR in patients with MS. Forty patients with MS and 36 healthy controls were included in the study. Echocardiographic EFT and HRR at 1min after exercise termination (HRR-1) are measured and compared between the two groups. HRR-1 equal to or lower than 18 beats is considered as blunted HRR. EFT was increased (7.2 ± 2 vs. 5.6 ± 1.8 mm; p = 0.001) and HRR-1 was significantly reduced in patients with MS compared to control group (21 ± 8 vs. 26 ± 9; p = 0.006). Among the MS patients, subjects with blunted HRR had increased EFT compared to patients without blunted HRR (8.5 ± 2.0 vs. 5.9 ± 1.1 mm, p < 0.001). In multivariate analysis, EFT was the only independent predictor of blunted HRR in patients with MS (95% confidence interval = 1.42-3.87, OR = 2.34, p = 0.001). Furthermore, EFT of equal to or thicker than 5.5 mm was associated with the blunted HRR with 84% sensitivity and 52% specificity (ROC area under curve: 0.84, 95% confidence interval = 0.70-0.96, p < 0.001). In conclusion, EFT is an independent predictor of blunted HRR, a novel cardiovascular risk factor, in patients with MS.

[Comparison of psychosocial risk factors between patients who experience acute myocardial infarction before and after 40 years of age]. / Kirk yas altinda ve üzerinde akut miyokart enfarktüsü geçiren hastalarda psikososyal risk faktörlerinin karsilastirilmasi

OBJECTIVES: Several studies have shown that psychosocial risk factors such as stress and depression make substantial contribution to the pathogenesis of coronary artery disease. This study aimed to investigate acute stress factors prior to acute myocardial infarction (AMI), and stress, depression, and anxiety levels during the subacute period in AMI patients aged ≤ 40 years, in comparison with AMI patients aged >40 years. STUDY DESIGN: The study included 200 first-time AMI patients aged ≤ 40 years (n=100; mean age 35 ± 4 years) and >40 years (n=100; mean age 54 ± 9 years). The DASS 21 scale (Depression Anxiety Stress Scales) was administered via face-to-face interviews in the early recovery period of AMI. The patients were also questioned whether they had experienced acute stress factors such as severe emotional or physical stressful events within two hours before the onset of chest pain. In addition, coronary angiography results were assessed based on the two age groups. RESULTS: Comparison of the two age groups showed significantly higher frequencies of family history of CAD and smoking in the younger group, and significantly higher frequencies of hypertension, diabetes mellitus, and dyslipidemia in the older group (p<0.05). History of acute stress factors was significantly more common (52% vs. 20%, p<0.01) and stress, depression, and anxiety scores of the DASS 21 scale were all significantly higher in the younger group (p<0.01). On coronary angiography, younger patients predominantly had normal coronary arteries and single-vessel disease, whereas multi-vessel disease was more prevalent in the older age group (p<0.01). CONCLUSION: Triggers of acute stress and psychosocial risk factors may contribute to the occurrence of AMI in individuals younger than 40 years.

Association of Mild Hyperbilirubinemia with Decreased ECG-Based Ventricular Repolarization Parameters in Young Men.

OBJECTIVE: Hyperbilirubinemia is associated with protection against various oxidative stress-mediated diseases. We aimed to investigate the association between bilirubin and novel electrocardiography (ECG)-based ventricular repolarization parameters. METHODS: We enrolled 201 healthy men with mild hyperbilirubinemia (group 1) and 219 healthy men with normal bilirubin levels (group 2). The Tpeak-Tend (Tp-e) interval (defined as the interval from the peak of the T wave to the end of the T wave), corrected (c) Tp-e interval, QT interval, cQT interval, and Tp-e interval/QT interval ratio were measured from leads V5 and V6 with 20 mm/mV amplitude and 50 mm/second rate. RESULTS: The Tp-e interval, cTp-e interval, and Tp-e interval/QT interval ratio were significantly lower in group 1 compared with group 2. The cTp-e interval showed a significant negative correlation with total bilirubin, conjugated bilirubin, and unconjugated bilirubin. The cTp-e interval (odds ratio [OR], 0.900; P =.002) and Tp-e interval/QT interval ratio (OR, 0.922; P =.04) were significantly associated with mild hyperbilirubinemia. CONCLUSION: We showed the association of mild hyperbilirubinemia with decreased novel ECG-based ventricular repolarization parameters.

Very late bare metal stent thrombosis: The role of restenosis.

Stent endothelization is complete after one month in the absence of radiation therapy. The incidence of late stent thrombosis associated with bare metal stents is low beyond this one month period. In this paper, we report on a case of very late acute stent thrombosis that occurred after 118 months of first bare metal stent implantation. A 55-year-old male patient was admitted with chest pain and was diagnosed to have acute anterior myocardial infarction. He had a history of bare metal stent implantation for a critical stenosis in the left anterior descending coronary artery. Immediate coronary angiography demonstrated occlusion of the stent in the left coronary artery. Thromboaspiration was not an available option, so a new bare metal stent was implanted and TIMI III flow was established after balloon angioplasty.

The epicardial fat thickness is associated with fragmented QRS in patients with newly diagnosed metabolic syndrome

SUMMARY OBJECTIVE: The metabolic syndrome involves both metabolic and cardiovascular risk factors and is associated with cardiovascular mortality. Epicardial fat tissue plays a crucial role in deleterious effects of metabolic syndrome on the heart, including myocardial fibrosis. The fragmented QRS reflects heterogeneous depolarization of the myocardium and occurs as a result of fibrosis. Thus, we aimed to investigate whether there is an association between fragmented QRS and epicardial fat tissue in patients with metabolic syndrome. METHODS: This study enrolled 140 metabolic syndrome patients, of whom 35 patients with fragmented QRS (+) and 105 patients with fragmented QRS (−). The two groups were compared with respect to clinical, laboratory, electrocardiographic, and echocardiographic indexes. RESULTS: Fragmented QRS (+) patients had higher waist circumference, red cell distribution width, creatinine, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, QRS duration, and epicardial fat tissue compared with fragmented QRS (−) patients. Waist circumference, red cell distribution width, QRS duration, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, and epicardial fat tissue were significantly associated with the presence of fragmented QRS. The QRS duration and epicardial fat tissue were independently associated with the presence of fragmented QRS on surface electrocardiographic in metabolic syndrome patients. CONCLUSIONS: Epicardial fat tissue and QRS duration were independently associated with the presence of fragmented QRS. Basic echocardiographic and electrocardiographic parameters might be used for the risk stratification in metabolic syndrome patients.

Relationship between exercise-induced heart rate increase and the formation of microbubbles and high-intensity transient signals in mechanical heart valve implanted patients.

INTRODUCTION: The formation and collapse of vapor-filled bubbles near a mechanical heart valve is called cavitation. Microbubbles can be detected in vivo by doppler ultrasonography (USG) as HITS (high intensity transient signals) in cranial circulation. We investigated the relationship between exercise induced heart rate increase and HITS formation in cranial circulation. MATERIAL AND METHODS: Thirty-nine mechanical heart valve implanted (8 aortic valve replacement (AVR) + mitral valve replacement (MVR), 9 AVR, 22 MVR) patients aged 18-80 years old were included in our study. Microbubbles were counted in the left ventricular cavity via transthoracic echocardiography at rest per cardiac cycle. Afterwards transcranial Doppler USG was performed and HITS were counted in each patient's middle cerebral artery at 5 min duration. Subsequently an exercise test according to the Bruce protocol was performed. After achieving maximal heart rate, microbubbles in the left ventricle and HITS were counted again. RESULTS: Microbubbles in the left ventricle and transcranial HITS increased after exercise significantly compared to resting values (15.79 ±10.91 microbubbles/beat vs. 26.51 ±18.00 microbubbles/beat, p < 0.001; 6.13 ±8.07 HITS/5 min vs. 13.15 ±15.87 HITS/5 min, p = 0.001). There was a significant correlation between microbubbles and HITS counts after peak exercise (r = 0.55, p < 0.001). CONCLUSIONS: In our study, we found that the microbubbles were increasing as the heart rate increased and more HITS were propelled to the cerebral circulation. As previously shown, HITS can alter cognitive functions. Therefore heart rate control is essential in mechanical heart valve patients to protect neurocognitive functions.