The role of novel cytokines in inflammation: Defining peripheral artery disease among patients with coronary artery disease.

Coronary artery disease (CAD) patients with concomitant peripheral artery disease (PAD) experience more extensive and calcified atherosclerosis, greater lesion progression and more common coronary events compared to patients with CAD only. To characterize the distinct features of this aggressive atherosclerotic disease, we studied novel cytokines that code different stages of atherogenesis. One hundred and eighty consecutive subjects (60 patients into each group of CAD+PAD, CAD and controls) were recruited among patients with stable angina pectoris scheduled for coronary angiography. An ankle-brachial index (ABI) ≤0.9 was determined as occlusive PAD. Fasting serum tumor necrosis factor (TNF)-like antigen 1A (TL1A) and its receptor death receptor 3 (DR3), NOGO-B (reticulon 4B) and its receptor NUS1, high-sensitivity C-reactive protein (hsCRP), A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 1, 4, 5 and interleukin (IL) 6 levels were determined. Serum hsCRP and DR3/TL1A concentrations were similar and higher than controls in the CAD and CAD+PAD groups. Levels of NOGO-B and its receptor NUS1 were increased and ADAMTS-5 was decreased in patients with CAD+PAD. Independent predictors of ABI in multivariate analysis were smoking (B = -0.13, p = 0.04), NUS1 (B = -0.88, p < 0.001), ADAMTS-5 (B = 0.63, p < 0.001) and SYNTAX score (B = -0.26, p < 0.001). Similarly, smoking (OR = 5.5, p = 0.019), SYNTAX score (OR = 1.2, p < 0.001), NUS1 (OR = 14.4, p < 0.001), ADAMTS-5 (OR = 1.1, p < 0.001) and age (OR = 1.1, p = 0.042) independently predicted the involvement of peripheral vasculature in logistic regression. The diagnostic performance of these cytokines to discriminate CAD+PAD were AUC 0.79 ( p < 0.001) for NUS1 and 0.37 ( p = 0.013) for ADAMTS-5. We report herein that circulating cytokines can give clues to the ongoing atherosclerotic process and the extent of vascular involvement in which distinct features of ADAMTS-5 and NUS1 make them promising cytokines for future research.

Relationship between red cell distribution width and contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention.

OBJECTIVE: This study evaluated the relationship between contrast-induced nephropathy (CIN) and red cell distribution width (RDW) in patients who underwent primary percutaneous coronary intervention (PCI). METHODS: A total of 359 patients with ST elevation myocardial infarction (STEMI) who had undergone primary PCI were included in the study. An increase of 25% in serum creatinine value after 48 h, or an increase of >0.5 mg/dL in the basal value was defined as CIN. RESULTS: Of the patients included in the study, 49 (13.8%) developed CIN. Compared to the CIN-negative group, CIN-positive patients had increased RDW values (16.9 ± 2.00 and 14.8 ± 2.14 respectively, p<0.001). The latter were also older patients, and had increased age rates of diabetes mellitus, baseline creatinine, ∆-creatinine and amount of contrast media were higher and left ventricular ejection fraction and baseline glomerular filtration rate (GFR) were lower in the CIN-positive group than in the CIN-negative group. A statistically weak correlation was found between RDW and change in creatinine levels (∆-creatinine) (r=0.250, p=0.002). Diabetes mellitus (odds ratio [OR]: 3.252, 95% CI=1.184-8.951, p=0.022), high RDW (OR: 1.716, 95% CI=1.363-2.157, p<0.001), baseline low GFR (OR: 0.941, 95% CI=0.925-0.971, p<0.001), ∆-creatinine (OR: 1.197, 95% CI=1.061-2.986, p=0.006) and increased amount of contrast media (OR: 1.187, 95% CI=1.048-3.02, p=0.001) used were observed as independent predictors of CIN. CONCLUSION: The study found diabetes mellitus, high RDW, basal low GFR, ∆-creatinine and increased contrast amount used to be the independent predictors of CIN in STEMI patients who underwent PCI.

Can the development of atrial fibrillation in patients with ischemic heart failure with low ejection fraction be predicted?

OBJECTIVE: Our aim is to determine the triggering factors of paroxysmal atrial fibrillation (PAF) in ischemic heart failure (HF) patients with low ejection fraction (EF). METHODS: Sixty patients were included in this study. Echocardiography and 24-hours Holter monitoring were performed after measurement of serum NT-pro BNP concentration. The patients were classified into two groups concerning the occurrence of PAF on Holter recordings. Biochemical and echocardiographic parameters of patients with and without PAF were compared. RESULTS: PAF was detected in 28 (46%) patients. Patients with PAF demonstrated higher NT-pro BNP levels, mitral and aortic regurgitation velocities, E/A, E/E', pulmonary capillary wedge pressure, pulmonary artery systolic pressure, left atrial volume and volume indices. NT-pro BNP was established as the predictor of PAF (OR=1.23, 95% CI: 1.08-1.42; p=0.001). ROC analysis showed an NT-pro BNP value of 2188 pg/mL as cut-off value with 68% sensitivity and 84% specificity [Area under the ROC curve (AUC)=0.826, CI 95%: 0.724-0.927; p<0.001]. CONCLUSION: The triggering factors for AF are increased intracardiac pressures, left atrial dilatation and increased wall tension. As an indicator of increased wall tension, elevated levels of NT-pro BNP predict the development of PAF.

Tools to improve the diagnostic accuracy of exercise electrocardiograms in patients with atypical angina pectoris.

OBJECTIVE: Although frequently utilized, an exercise electrocardiogram (ECG) provides limited diagnostic accuracy in patients with atypical angina pectoris. The purpose of this study was to determine the possible incremental value of pretest probability (PTP) scores and exercise parameters in discriminating coronary artery disease (CAD) and to identify PTP cutoff values. METHODS: In a retrospective cohort of 207 patients with atypical angina (76 women, 131 men; mean age: 57.6±8.2 years) who underwent coronary angiography (CAG) after a positive exercise ECG, the PTP was calculated according to the CAD Consortium basic and clinical models along with exercise parameters of blood pressure (BP), heart rate (HR), exercise duration, maximal metabolic equivalents (METs), HR reserve, HR recovery, chronotropic index, BP reserve, BP recovery, and ST/HR ratio. Patients were categorized into true positive (TP) or false positive (FP) groups, depending on the ultimate determination of a presence of obstructive CAD. RESULTS: A TP result was associated with older age, male gender, hypertension, diabetes, hyperlipidemia, and higher basic and clinical PTP, as well as higher maximal BP, maximal ST deviation and ST/HR, but lower maximal METs, chronotropic index, and HR recovery. The basic and clinical PTP, and the chronotropic index could predict a TP test result irrespective of gender. Logistic regression analysis revealed that clinical PTP was the only independent predictor of TP results. A cutoff score of 18 for the basic and 21 for the clinical PTP were determined to discriminate CAD. CONCLUSION: This study has shown that, among various electrocardiographic and hemodynamic parameters, the clinical PTP and the chronotropic index are the most helpful tools to discriminate patients with CAD among patients with atypical angina.

Ruptured abdominal aortic aneurysm after resection of an infected cardiac myxoma.

A 12-year-old girl with a high fever underwent echocardiography and was found to have a myxoma that arose from the atrial side of the anterior mitral valve leaflet. The tumor was successfully excised. Histologic examination of the tumor showed myxoma cells and an organized thrombus with bacterial colonization. The patient was discharged from the hospital on antibiotic treatment. After remaining asymptomatic for 3 weeks, she was readmitted with acute abdomen. Ultrasonography and magnetic resonance angiography detected intra-abdominal hemorrhaging and a saccular aneurysm of the abdominal aorta. The patient underwent successful emergency surgery. To our knowledge, no other report has been published concerning an abdominal aortic aneurysm secondary to bacterial infection of a cardiac myxoma. Although complications this severe are rarely observed in patients who have endocarditis, early recognition and treatment can be life-saving.

Role of sympathetic cotransmitter galanin on autonomic balance in heart failure: an active player or a bystander?

OBJECTIVE: Galanin, a cotransmitter similar to neuropeptide Y (NPY), aggravates autonomic imbalance in systolic heart failure (HF) by attenuating vagal tonus after burst sympathetic activity. In animal HF models, galanin antagonists have improved cardiac function. To determine whether galanin is a promising therapeutic target in HF, we studied its concentrations in HF patients and evaluated its correlation with NPY, markers of humoral activity such as pro-BNP and copeptin, and echocardiographic parameters of HF severity. METHODS: After recording demographic and echocardiographic characteristics of 87 individuals (57 HF patients and 30 control subjects), fasting serum concentrations of galanin, NPY, copeptin, and pro-BNP were determined. RESULTS: Unlike pro-BNP, copeptin, and NPY, which were significantly elevated in HF patients (p<0.001, p<0.001, and p=0.001, respectively), galanin was similar in HF patients and control subjects (p=0.9). NPY correlated with the echocardiographic parameters of HF severity (r=-0.22, p=0.03 for EF; r=0.3, p=0.005 for Tei index of RV; r=-0.23, p=0.03 for TAPSE; and r=0.24, p=0.024 for E/e') and pro-BNP (r=0.22, p=0.046). NPY levels were also associated with beta blocker (BB) use, wherein BB significantly decreased NPY in both HF patients and control subjects. Galanin correlated with humoral biomarkers, pro-BNP and copeptin (r=0.39, p<0.001 and r=0.41, p<0.001, respectively). Although current smoking, BB therapy, pro-BNP, copeptin, and body mass index were associated with galanin in univariate analyses, the multiple linear regression model revealed that pro-BNP was the only significant determinant of galanin levels in HF patients. CONCLUSION: Our findings confirmed the role of NPY in autonomic balance and suggest that galanin is associated with the proadrenergic state, but its role in HF in humans remains unclear.

A Novel Deep Inspiration Maneuver for Difficult Transseptal Puncture.

Transseptal puncture (TSP) may not be possible in cases of an elastic, aneurysmal, or thickened interatrial septum (IAS). During deep inspiration (DI), the chest wall expands and the diaphragm descends. This makes intrapleural pressure to become more negative, which leads to movement of the IAS to the right side. The aim of this study was to verify prospectively the feasibility, safety, and outcome of DI associated with conventional TSP technique in patients with challenging IAS anatomy. From September 2012 to May 2016, 224 patients underwent TSP due to different indications. Patients were divided into 2 groups: 213 patients in whom the left atrium was successfully accessed in 3 attempts were grouped as conventional TSP group and 11 patients in whom left atrium access was failed after 3 conventional attempts were grouped as DI-TSP group. Conventional TSP was successful in 89.6% of patients with the first attempt. Second and third attempts were required in 4.1% and 1.4%, respectively. Septal puncture was achieved at the first attempt in 10 patients within a median of 1 second of DI maneuver (interquartile range, 1 to 3) and without any complications. Challenging IAS anatomy consisting of IAS aneurysm, a thick IAS, and an excessively mobile IAS were more frequent in the DI-TSP group (45% to 8%, 27% to 3%, and 21% to 5%, respectively, p <0.001). In conclusion, TSP by using the DI maneuver may be a reliable and safe method after failed conventional attempts. If there is any doubt about the correct location of the needle, additional imaging modalities have to be used.

The effects of short term (3 weeks) testosterone treatment on serum inflammatory markers in men undergoing coronary artery stenting.

OBJECTIVE: Inflammation markers can predict restenosis after successful intracoronary stenting. There is evidence that testosterone suppresses the expression of the inflammatory cytokines. We hypothesized that testosterone therapy after coronary stenting can reduce the inflammation markers. METHODS: We selected 41 men with coronary artery disease who underwent successful stent implantation for a >70% diameter stenosis of a major coronary artery. Patients, who had stable angina and positive exercise test results, were recruited after diagnostic coronary angiography. Twenty-five men were treated with 3 doses of i.m. testosterone administration once a week for 3 weeks following diagnostic angiography. Sixteen patients were recruited as a control group and they received standard therapy. First venous blood samples were obtained after angiography. Stents were implanted 3 weeks after diagnostic angiography. Second venous blood samples were taken 24 h after the coronary stenting. RESULTS: Baseline biochemical or hematological parameters were similar between the control and treatment groups. After coronary stenting, free testosterone, total testosterone, and sex hormone binding globulin were significantly elevated in the testosterone group (P<0.0001, P<0.0001 and P=0.02; respectively). After coronary stent implantation, there was a significant increase in IL-6 and CRP levels in the control group only (P=0.02 and P=0.038), while TNF-alpha levels were increased significantly in both groups (P=0.016 and P=0.014; respectively). Statistical analysis revealed that testosterone treatment prior to stent implantation attenuated IL-6 and hs-CRP levels significantly (P=0.042 and P=0.043; respectively). CONCLUSIONS: The present study shows that 3 weeks testosterone treatment prior to intracoronary stenting results in a significant suppression in hs-CRP and IL-6 levels after the stent implantation.

Current role of laser angioplasty of restenotic coronary stents.

Treatment of in-stent restenosis (ISR) with conventional percutaneous transluminal coronary angioplasty (PTCA) causes significant recurrent neointimal tissue growth in 30-85%. Therefore, laser ablation of intrastent neointimal hyperplasia before balloon dilation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed before balloon dilation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1+/-9.9 vs 13.6+/-9.1 mm; p = 0.034), more complex (36.5% type C stenoses vs 14.3%; p = 0.006), and more frequently had reduced distal blood flow (TIMI <3: 18.9% vs 4.8%; p = 0.025) compared to lesions in the PTCA group. Immediate angiographic results of PTCA and ELCA + PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA + PTCA, in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group vs 8.6% in PTCA group). The 1-year follow-up showed that the rates of major adverse cardiac events (MACE) were comparable in the 2 groups (37.3% in ELCA group vs 46.6% in PTCA group). The rates of target vessel revascularization (TVR) within 1 year after the intervention were also similar in the 2 groups (32.8% vs 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in the ELCA group, no increase in the rate of complications was registered.

Left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement with posterior mitral leaflet preservation.

We present a case of transient left ventricular outflow tract obstruction after mitral valve replacement with a high-profile bioprosthesis; only the posterior native mitral valve leaflet was preserved. A 76-year-old woman was admitted to our institution with pulmonary edema. Two weeks earlier, she had undergone mitral valve replacement at our hospital due to severe mitral stenosis and 2+ mitral regurgitation complicated by cardiac failure and atrial fibrillation. The patient was taking digoxin, furosemide, and warfarin at the time of readmission. Echocardiography showed a narrowed left ventricular outflow tract. Doppler echocardiography revealed a peak 64-mmHg gradient between the septum and the strut of the bioprosthesis. The patient was successfully treated medically. This case indicates that the risk of left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement is not always eliminated by removal of the anterior mitral valve leaflet when the posterior mitral leaflet is preserved.

Comparison of the short-term effects of salmeterol and formoterol on heart rate variability in adult asthmatic patients.

STUDY OBJECTIVES: We investigated the effects of beta2-adrenergic agonists salmeterol and formoterol on heart rate variability (HRV) in adult asthmatic patients using time-domain measures of HRV. PATIENTS: Thirty-nine adult patients with asthma were studied. All patients showed a mild-to-moderate decrease in baseline FEV1. Any diseases that might have influenced the autonomic function were excluded. All patients underwent a complete physical examination and medical history that revealed no cardiovascular disease or medication. METHODS: The beta2-adrenergic inhaled agonists salmeterol, 50 microg, and formoterol, 12 microg, were used in the study. HRV analysis was performed for each 5-min segment: 5 min and 10 min before inhalation of the study drug, and 5, 10, 15, 20, 25, and 30 min after inhalation. Time-domain parameters of HRV were calculated: (1) the SD all normal-to-normal intervals; (2) the SD of the mean of all normal-to-normal intervals in all 5-min segments of the entire recording; (3) the root mean square of differences between adjacent normal-to-normal intervals; (4) the mean of the SD of all normal-to-normal intervals in all the 5-min intervals; and (5) the SD of the SD of all normal-to-normal intervals in all the 5-min intervals. RESULTS: Baseline HRV parameters were not significantly different between formoterol and salmeterol groups. There were no significant differences in HRV parameters after formoterol and salmeterol inhalation. The HRV parameters in each 5-min segment in the formoterol group were not statistically significant different when compared to the same segment in the salmeterol group. CONCLUSION: Salmeterol and formoterol have no short-term adverse effects on HRV.

Comparison of the effects of desflurane and sevoflurane on the QTc interval and QT dispersion.

OBJECTIVE: The effects of desflurane and sevoflurane on QT interval and QT dispersion have been investigated in a prospective, double-blind, randomized study of patients undergoing noncardiac surgery. INTERVENTIONS: Sixty American Society of Anaesthesiologists physical status I-II adult patients were randomly assigned to two groups. Anaesthesia was induced with inhalation of desflurane (desflurane group) or sevoflurane (sevoflurane group) in increasing concentrations to 3 minimal alveolar concentration level. The maintenance of anaesthesia was provided with 2 minimal alveolar concentration agents in both groups until the end of the study. Electrocardiogram, heart rate and blood pressure were recorded as follows: before premedication, before induction, 1 and 3 min after the induction of anaesthesia, after the administration of vecuronium and after the tracheal intubation. The induction times and the complications were recorded. MEASUREMENTS AND RESULTS: The QTc interval was significantly more prolonged with desflurane than with sevoflurane at the first and third minute after the induction, and at the third minute after the administration of vecuronium. There were no significant differences in the QT dispersion between the two groups. Heart rate and blood pressure were found to be significantly higher in the desflurane group. CONCLUSION: The QTc interval was more prolonged with desflurane than sevoflurane, and QT dispersion was normal with both agents.

Plasma urotensin II and neurokinin B levels in acute myocardial infarction and stable coronary artery disease.

OBJECTIVE: This aim of the study is to investigate whether there are possible plasma urotensin-II (U-II) and neurokinin B (NKB) level changes in patients with acute myocardial infarction (AMI) or not and plasma urotensin-II (U-II) and neurokinin B (NKB) level changes in patients with acute myocardial infarction (AMI) and stable coronary artery disease (CAD) and to evaluate whether there is any relationship between these changes and the pathogenesis of these diseases. METHODS: This is a prospective case-control study. Three groups were formed from randomly admitted patients with AMI, stable CAD, and controls. Biochemical parameters and U-II and NKB levels were measured. Patients with congestive heart failure, chronic hepatic and renal failure, severe cardiac valve disease, and severe pulmonary hypertension were excluded from the study. The normality of the data was evaluated using the Kolmogorov-Smirnov test. We compared the three groups with one-way ANOVA and Tukey test (Kruskal-Wallis test and Mann-Whitney U test). RESULTS: Compared with controls (n=31) and CAD patients (n=32), AMI patients (n=32) had lower U-II and NKB levels. In cases of stable CAD, U-II and NKB levels were similar. A positive correlation was found between U-II and NKB (r=0.720; p=0.000). U-II and NKB were poorly correlated with left ventricle ejection fraction but not with C-reactive protein. CONCLUSION: We found that U-II and NKB levels were lower in patients with AMI in than those with CAD or the control group. According to our findings, the decreased U-II and NKB levels were related to complicated atherosclerotic events.

Clinical and echocardiographic predictors of left atrial appendage dysfunction in patients with mitral stenosis in sinus rhythm.

BACKGROUND: Mitral stenosis (MS) causes left atrial (LA) appendage (LAA) dysfunction resulting in reduced LAA flow velocities. Low LAA peak emptying velocity (PEV), determined by transesophageal echocardiography, is a risk for thrombus formation and systemic embolism. OBJECTIVE: We sought to investigate various clinical and echocardiographic predictors of low LAA blood flow velocities. METHODS: A total of 44 patients with newly diagnosed MS were classified into two groups on the basis of the presence of high (PEV > or = 46 cm/s) or low (PEV < 46 cm/s) LAA flow profile on Doppler transesophageal echocardiography. LAA flow velocities were measured to be 27.38 +/- 8.17 cm/s in patients with LAA dysfunction and 70.75 +/- 16.71 cm/s in high-flow profile (P <.0001). Simultaneous 12-lead electrocardiogram was used to measure P waves. RESULTS: P maximum, P dispersion, and LA diameter were significantly higher in patients with low LAA PEV (n = 32) than in those with high LAA PEV (111.87 +/- 16.93 vs 96.66 +/- 14.97, P =.0084; 73.12 +/- 20.7 vs 49.16 +/- 9.96, P <.0001; 46.06 +/- 4.384 vs 38.08 +/- 7.42 mm, P =.004; respectively). Patients with MS and low LAA blood flow had smaller mitral valve area compared with those with high LAA blood flow velocity (1.48 +/- 0.431 vs 1.85 +/- 0.442 cm(2), P =.02). Male sex, spontaneous echocontrast, and thrombus were more frequent in patients with low LAA PEV [7 [21.87%] vs 5 [41.66%], P =.026; 21 [65.62%] vs 4 [33.3%], P =.088; 4 [12.5%] vs none; respectively]. Mild MS was more frequent in patients with high blood flow velocity [6 [27.2%] vs 14 [63.6%], P =.03]. CONCLUSION: At linear regression analysis, only P-wave dispersion and LA diameter predicted the LAA mechanical dysfunction reflected as low LAA PEVs.

A case of successful six consecutive deliveries in a 41-year-old woman with Uhl's anomaly.

Uhl's anomaly, or parchment right ventricle is a myocardial disorder of unknown cause that mainly involves the right ventricle. Uhl's anomaly may represent a cause of right heart dilatation, failure, and premature sudden death due to ventricular arrhythmias. Although most of the cases of Uhl's anomaly end fatally in infancy or childhood, a limited number of cases have been reported in advanced ages. Also, in pregnant women, this situation increases the risk to both mother and baby and requires special management. This is the first report of six successful consecutive gestations and vaginal deliveries without special managements in a patient with Uhl's anomaly.

Aortic valve rupture due to high-voltage electrical injury: case report.

In the heart, the most common sequelae after electrical injury are myocardial contusion and arrhythmias. A case is presented of segmental ventricular dysfunction and severe aortic regurgitation due to laceration of the right coronary cusp of the aortic valve caused by electrical injury. To the authors' knowledge, this is the first reported case of valvular rupture due to electrical injury.

Transesophageal echocardiographic detection of a pulmonary artery aneurysm complicated by thrombus.

The incidence of aneurysms of the pulmonary artery is known to be very low. Although diagnosis and evaluation of pulmonary artery aneurysms may be difficult without angiography, computed tomography and MRI's have emerged as useful noninvasive techniques. However, a transthoracic echocardiogram may reveal a pulmonary artery aneurysm. To our knowledge, transesophageal echocardiographic findings of pulmonary artery aneurysm with thrombus have not been reported in detail. Here, a case of thrombosed aneurysm of the main pulmonary artery diagnosed by transesophageal echocardiography and confirmed by computed tomography and MRI is reported.

The chronic effect of rilmenidine on heart rate variability in patients with mild hypertension.

The purpose of this study was to evaluate the chronic effect of rilmenidine on time domain indexes of heart rate variability in patients with mild hypertension. Twenty patients (12 males, eight females; mean age, 47 yr; age range, 38-55 yr), with untreated and newly diagnosed mild hypertension were studied. There was no evidence of diseases other than hypertension. All patients received 1 mg of rilmenidine once daily. If the diastolic blood pressure was still greater than 90 mm Hg after 4 weeks of active treatment, the dose was increased to 2 mg once daily. Twenty-four hour ambulatory electrocardiograms were recorded before, and 4 and 12 weeks after the start of therapy. Time domain parameters of heart rate variability were calculated. Rilmenidine therapy determined a marked decrease in blood pressure. At 4 weeks, rilmenidine induced a significant reduction in systolic and diastolic blood pressure and a further reduction was observed after 12 weeks. At 4 and 12 weeks, time domain parameters of heart rate variability and heart rate were not significantly different in the data obtained before therapy. In conclusion, this study demonstrated that the administration of rilmenidine to patients with mild essential hypertension induced significant reductions in blood pressure, without any significant changes in time domain parameters of heart rate variability.

Heart rate recovery may predict the presence of coronary artery disease.

OBJECTIVE: We investigated whether post-exercise first minute abnormal heart rate recovery (HRR1) helps to predict the presence and severity of CAD, because of some confounding data. METHODS: A cross-sectional, retrospective study was performed. Two hundred individuals were included. Gensini scores and the number of coronary artery involvements were used to evaluate the severity of CAD. Student's t-test, Mann-Whitney U test and chi-square test were used for the analysis continuous and categorical data. Spearman's correlation analysis was used to determine whether there is correlation between Gensini scoring and HRR1. Univariate and multivariate logistic regression were used to determine predictors for abnormal HRR1. ROC curve analysis was performed to detect the best sensitivity and specificity value of HRR1 in predicting CAD presence. RESULTS: Seventy subjects (35%) did not have CAD, and CAD was present in 130 patients (65%). HRR1 ≤21 beats with ROC analysis was determined to be the best cut off point. After adjustment between the two groups in terms of age, gender, diabetes, hypertension, dyslipidemia or smoking (all p>0.05), there was relationship CAD presence and abnormal HRR1 (OR=2.1, 95% CI: 1.1-3.9, p=0.02), but not between CAD severity and HRR1 (r=-0.13, p=0.112). The sensitivity, specificity, and the positive and negative predictive values of abnormal HRR1 ≤21 beats at first minute for predicting CAD presence were 76.1%, 41.3% (AUC=0.588, CI 95%: 0.517-0,657, p=0.039), 70.7% and 48.3%, respectively. CONCLUSION: In the study abnormal HRR1 predicted the presence of CAD, but not the severity of it.

A new approach to the measurement of heart rate in patients with chronic heart failure-heart rate performance index: an observational study.

OBJECTIVE: In order to evaluate the utility of the heart rate performance index (HRPI), which is obtained by dividing HR mean by the difference of HR max and HR min in the context of Holter monitoring, we sought to determine whether there was any correlation or relationship between the HRPI and LVEF values as determined by echocardiography and to compare the HRPI between the study and control groups. METHODS: This study is a cross-sectional, controlled observational study. Thirty-two patients with symptomatic or asymptomatic left ventricular systolic dysfunction (LVEF <45%) were included as study group and 32 subjects without chronic heart failure (CHF) were included as a control group. In the study group, 10 patients were in NYHA class I (31.2%), 12 - were in NYHA class II (37.6%) and 10 - were in NYHA class III (31.2%). Heart rate analysis was measured using 24-hour Holter ambulatory electrocardiography. To determine the HRPI, the difference between maximum (HR max) and minimum heart rate (HR min) was divided by mean heart rate (HR mean) (beats/minute): HRPI=(HR max-HR min) / HR mean. Statistical analysis was performed using t-test for independent samples, Mann-Whitney U test, Chi-square test, Kruskal-Wallis test, Pearson's correlation and linear regression analyses. RESULTS: The HRPI index value was markedly decreased [0.83 (0.58-1.1) and 1.10 (0.74-1.3), p<0.001] in the study group as compared to the control group. The data collected for the study group and the control group (n=64) demonstrated a positive correlation between the HRPI and LVEF (r=0.62, p<0.001) as well as a negative correlation between the HR mean and LVEF (r=-0.39, p<0.003). The HR mean was higher (80.2±11.3 and 75.2±6.7, p<0.007) and HR max-HR min (67.9±11.6 and 83.3±14.3, p<0.001) were lower in the study group as compared to the control group. Linear regression analysis demonstrated no significant relationship between LVEF and HRPI and other heart rate derivatives (unstandardized ß=42.43 95% CI: 21.98-50.51, p=0.231). CONCLUSION: According to our findings, patients with CHF exhibited higher HR mean values, reduced HR max-min values and significantly decreased HRPI values. There is a positive correlation between HRPI and LVEF, a decreased HRPI is associated with a decreased LVEF, but there is no relationship between these two variables. Therefore, HRPI values may represent a viable option for assessing daily exercise activity and potentially sympathetic activation in patients with CHF. The assessment of HRPI may be helpful the evaluation of CHF patients, as well as resting HR.