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1.
J Cardiovasc Electrophysiol ; 33(1): 117-122, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34674347

RESUMEN

INTRODUCTION: Single-center observational studies have shown promising results with fragmented electrogram (FE)-guided ganglionated plexus (GP) ablation in patients with vagally mediated bradyarrhythmia (VMB). We aimed to compare the acute procedural characteristics during FE-guided GP ablation in patients with VMB performed by first-time operators and those of a single high-volume operator. METHODS AND RESULTS: This international multicenter cohort study included data collected over 2 years from 16 cardiac hospitals. The primary operators were classified according to their prior GP ablation experience: a single high-volume operator who had performed > 50 GP ablation procedures (Group 1), and operators performing their first GP ablation cases (Group 2). Acute procedural characteristics and syncope recurrence were compared between groups. Forty-seven consecutive patients with VMB who underwent FE-guided GP ablation were enrolled, n = 31 in Group 1 and n = 16 in Group 2. The mean number of ablation points in each GP was comparable between groups. The ratio of positive vagal response during ablation on the left superior GP was higher in Group 1 (90.3% vs. 62.5%, p = .022). Ablation of the right superior GP increased heart rate acutely without any vagal response in 45 (95.7%) cases. The procedure time was longer in group 2 (83.4 ± 21 vs. 118.0 ± 21 min, respectively, p < .001). Over a mean follow-up duration of 8.0 ± 3 months (range 2-24 months), none of the patients suffered from syncope. CONCLUSION: This multi-center pilot study shows for the first time the feasibility of FE-guided GP ablation across a large group of procedure-naïve operators.


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Fibrilación Atrial/cirugía , Bradicardia/cirugía , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Estudios de Cohortes , Humanos , Proyectos Piloto , Resultado del Tratamiento , Nervio Vago/cirugía
2.
J Clin Ultrasound ; 50(9): 1242-1248, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36074078

RESUMEN

PURPOSE: Cardiac involvement in limb-girdle muscular dystrophy (LGMD)2A and LGMD2B, the most common subgroups of LGMD, is controversial. Our study aims to determine whether myocardial dysfunction develops in LGMD2A and LGMD2B patients. METHODS: The study included 16 LGMD2A, 12 LGMD2B patients, and 48 healthy individuals. Comparisons included demographic, clinical, and laboratory parameters of LGMD2A and LGMD2B subgroups and traditional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE) parameters with the normal population. RESULTS: The median age was 33 (22-39 interquartile range [IQR]) in the LGMD2A group, 33 (27-38 IQR) in the LGMD2B group, and 28 (25-35 IQR) in the control group. The left ventricular (LV) ejection fraction of both LGMD2A and LGMD2B groups was similar to the control group (p = 0.296 and p = 0.918). Apical 4-chamber longitudinal strain (LS), Apical 2-chamber LS, Apical 3-chamber LS, left ventricular global longitudinal strain (LVGLS)-mid-myocardial, LVGLS-endocardium, and LVGLS-epicardium were lower (less negative) in the LGMD2B group compared to the control group (p = 0.006, p = 0.001, p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSION: LV 2D-STE parameters of LGMD2A patients were similar to the control group, while they decreased significantly (less negative) in LGMD2B patients, indicating that LV subclinical myocardial dysfunction may develop in LGMD2B patients.


Asunto(s)
Cardiomiopatías , Distrofia Muscular de Cinturas , Disfunción Ventricular Izquierda , Humanos , Adulto , Distrofia Muscular de Cinturas/complicaciones , Distrofia Muscular de Cinturas/diagnóstico por imagen , Ecocardiografía/métodos
3.
J Electrocardiol ; 66: 43-47, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33770646

RESUMEN

OBJECTIVE: It is known that increased frontal QRS-T angle, which is a new ventricular repolarization marker is associated with adverse cardiac outcomes. It has been observed that the coronary slow-flow (CSF) phenomenon can cause arrhythmias and sudden cardiac death. The aim of our study is to investigate the relationship between CSF in patients and the frontal QRS-T angle. MATERIAL AND METHOD: A total of 200 patients, 97 of who had CSF and 103 with the normal coronary flow (NCF), were included in our study. The CSF group was divided into two groups; single-vessel CSF and multi-vessel CSF. The TIMI-frame count was calculated from the coronary angiography images of each patient. 12-lead electrocardiography (ECG) records were examined. The frontal QRS-T angle was obtained from the automated reports of the ECG device. RESULTS: The mean age of the study population was 50.7 ± 9.5 and 102 (51%) of patients were female. The frontal QRS-T angle was significantly higher in patients with CSF compared to the NCF group [48(31-64) vs 37(25-46), p = 0.001]. A positive correlation was observed between the frontal QRS-T angle and TIMI-frame count in the correlation analysis performed separately for LAD, Cx, RCA patients with CSF (respectively; r = 0.340 and p < 0.001, r = 0.262 and p = 0.002, r = 0.247 and p = 0.003). The frontal QRS-T angle was higher in patients with multi-vessel CSF than in patients with single-vessel CSF [53.5(41.5-76.5) vs 43.0(23.5-60.5), p = 0.039]. CONCLUSION: There is a positive correlation between frontal QRS-T angle and TIMI-frame count. The frontal QRS-T angle is higher in patients with CSF. Also, frontal QRS-T angle was higher in the multi-vessel CSF group.


Asunto(s)
Arritmias Cardíacas , Electrocardiografía , Angiografía Coronaria , Muerte Súbita Cardíaca , Femenino , Corazón , Humanos
4.
J Electrocardiol ; 67: 13-18, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33984570

RESUMEN

INTRODUCTION: The impact of cardioneuroablation (CNA) on ventricular repolarization by using corrected QT interval (QTc) measurements has been recently demonstrated. The effects of cardiac pacing (CP) on ventricular repolarization have not been studied in patients with vasovagal syncope (VVS). We sought to compare ventricular repolarization effects of CNA (group 1) with CP (group 2) in patients with VVS. METHODS: We enrolled 69 patients with age 38 ± 13 years (53.6% male), n = 47 in group 1 and n = 22 in group 2. Clinical diagnosis of cardioinhibitory type was supported by cardiac monitoring or tilt testing. QTc was calculated at baseline (time-1), at 24 h after ablation (time-2), and at 9-12 months (time-3) in the follow-up. RESULTS: In the group 1, from time-1 to time-2, a significant shortening in QTcFredericia (from 403 ± 27 to 382 ± 27 ms, p < 0.0001), QTcFramingham (from 402 ± 27 to 384 ± 27 ms, p < 0.0001), and QTcHodges (from 405 ± 26 to 388 ± 24 ms, p < 0.0001) was observed which remained lower than baseline in time-3 (373 ± 29, 376 ± 27, and 378 ± 27 ms, respectively). Although the difference between measurements in time-1 and time-2 was not statistically significant for QTcBazett, a significant shortening was detected between time-1 and time-3 (from 408 ± 30 to 394 ± 33, p = 0.005). In the group 2, there was no time-based changes on QTc measurements. In the linear mixed model analysis, the longitudinal reduction tendency in the QTcFredericia and QTcFramingham was more pronounced in group 1. CONCLUSIONS: Our results demonstrate that CNA reduces QTc levels through neuromodulation effect whereas CP has no effect on ventricular repolarization in patients with VVS.


Asunto(s)
Ablación por Catéter , Síncope Vasovagal , Adulto , Electrocardiografía , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Síncope Vasovagal/cirugía , Pruebas de Mesa Inclinada
5.
Ann Noninvasive Electrocardiol ; 25(2): e12702, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31542896

RESUMEN

AIM: Current literature lacks a definitive threshold of idiopathic premature ventricular complex (PVC) burden for predicting cardiomyopathy (CMP). The main objective of the present study was to evaluate relationship between the PVC burden and left ventricular ejection fraction (LVEF). METHOD: This multicenter, cross-sectional study included 341 consecutive patients with more than 1,000 idiopathic PVC in 24 hr of Holter monitoring admitted to the cardiology clinics between January 2019 and May 2019 in the nineteen different centers. The primary outcome was the LVEF measured during the echocardiographic examination. RESULT: Overall, the median age was 50 (38-60) and 139 (49.4%) were female. Percentage of median PVC burden was 9% (IQR: 4%-17.4%). Median LVEF was found 60% (55-65). We used proportional odds logistic regression method to examine the relationship between continuous LVEF and candidate predictors. Increase in PVC burden (%) (regression coefficient (RE) -0.644 and 95% CI -1.063, -0.225, p < .001), PVC QRS duration (RE-0.191 and 95% CI -0.529, 0.148, p = .049), and age (RE-0.249 and 95% CI -0.442, -0.056, p = .018) were associated with decrease in LVEF. This inverse relationship between the PVC burden and LVEF become more prominent when PVC burden was above 5%. A nomogram developed to estimate the individual risk for decrease in LVEF. CONCLUSION: Our study showed that increase in PVC burden %, age, and PVC QRS duration were independently associated with decrease in LVEF in patients with idiopathic PVC. Also, inverse relationship between PVC burden and LVEF was observed in lower PVC burden than previously known.


Asunto(s)
Volumen Sistólico , Disfunción Ventricular Izquierda/fisiopatología , Complejos Prematuros Ventriculares/fisiopatología , Adulto , Estudios Transversales , Ecocardiografía , Electrocardiografía Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nomogramas
6.
J Electrocardiol ; 63: 115-119, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33181454

RESUMEN

BACKGROUND: The effect of favipiravir on the QTc interval during the treatment of Coronavirus Disease 2019 (COVID-19) patients is unclear. Thus, the current study objective was to evaluate any change in the QTc interval in patients who were hospitalized due to COVID-19 receiving favipiravir treatment. METHOD: Patients hospitalized with COVID-19 were assessed in this single-center retrospective study. 189 patients, whose diagnosis was confirmed using real-time PCR, were included in the study. The patients were divided into three groups: those using hydroxychloroquine (Group 1, n = 66), hydroxychloroquine plus favipiravir (Group 2, n = 66), and favipiravir only (Group 3, n = 57). The QTc interval was measured before treatment (QTc-B) and 48 h after (i.e., the median) starting treatment (QTc-AT). RESULTS: The median age was 53 (39-66 IQR) and 97 (51%) of patients were female. The median QTc(Bazett)-change was 7 ms (p = 0.028) and 12 ms (p < 0.001) and in Group 1 and 2, respectively. In Group 3, the median QTc(Bazett)-change was observed as -3 ms and was not statistically significant (p = 0.247). In multivariable analysis, while there was a significant relationship between QTc-AT(Bazett) and hydroxychloroquine (ß coefficient = 2687, 95%CI 2599-16,976, p = 0,008), there was no significant relationship with favipiravir (ß coefficient = 0,180, 95% CI -6435-7724, p = 0,858). Similarly, there was a significant relationship between the QTc-AT interval calculated using the Fredericia formula and hydroxychloroquine (ß coefficient = 2120, 95% CI 0,514-14,398, p = 0,035), but not with favipiravir (ß coefficient = 0,111, 95% CI -6450- 7221, p = 0,911). CONCLUSION: In the ECG recordings received in the following days after the treatment was started in COVID-19 patients, there was a significant prolongation in the QTc interval with hydroxychloroquine, but there was no significant change with favipiravir.


Asunto(s)
Amidas/uso terapéutico , Antivirales/uso terapéutico , Tratamiento Farmacológico de COVID-19 , Hidroxicloroquina/uso terapéutico , Síndrome de QT Prolongado/inducido químicamente , Pirazinas/uso terapéutico , Adulto , Anciano , Prueba de COVID-19 , Electrocardiografía , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SARS-CoV-2
7.
Med Princ Pract ; 29(6): 572-579, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32344397

RESUMEN

OBJECTIVE: Acute kidney injury (AKI), which is prevalent in ST-segment elevated myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. As high pulse pressure (PP) is associated with adverse cardiovascular events, the present study's aim was to evaluate the relationship between fractional PP (PPf) and AKI in patients with STEMI who underwent primary PCI. SUBJECTS AND METHODS: All laboratory findings as well as echocardiographic and angiographic data of 1,170 consecutive STEMI patients were retrospectively screened. PPf was calculated from the pressures invasively measured after sheath insertion and before performing coronary angiography. RESULTS: From 1,170 eligible STEMI patients (mean age 56 years, 18.2% female), AKI developed in 143 (12.2%) patients. The PPf and pulsatility index were significantly higher in patients with AKI than those without (0.53 ± 0.10 vs. 0.61 ± 0.10, p < 0.001, and 0.80 ± 0.03 vs. 0.82 ± 0.03, p < 0.001, respectively). PPf was also found to be associated with AKI in univariable (OR 2.183, 95% CI 1.823-2.614, p< 0.001) and multivariable (OR 1.874, 95% CI 1.513-2.322, p < 0.001) analysis. In-hospital mortality was higher in patients with AKI than those without. CONCLUSION: Invasively measured PPf, which can be easily measured and has no additional cost in STEMI patients undergoing coronary intervention, is an independent predictor of AKI. In addition, PPf is superior to other blood pressure values and derivatives in AKI prediction.


Asunto(s)
Lesión Renal Aguda/etiología , Presión Sanguínea/fisiología , Intervención Coronaria Percutánea/efectos adversos , Infarto del Miocardio con Elevación del ST/cirugía , Adulto , Anciano , Angiografía Coronaria , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/métodos , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/mortalidad
8.
J Electrocardiol ; 55: 138-143, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31185366

RESUMEN

BACKGROUND: Multi-vessel coronary artery disease (CAD) is associated with worse outcome in non-ST segment elevation myocardial infarction (NSTEMI) patients. Depending on the severity of CAD, there may be prolongation of atrial depolarization time as a result of left ventricular dysfunction and atrial ischemia. Therefore, we aimed to study whether the severity of CAD can be predicted with the P wave peak time (PWPT) in the electrocardiography (ECG) obtained during the diagnosis in NSTEMI patients. METHOD: A total of 162 patients were included. The coronary angiography records of all patients were analyzed and SYNTAX scores were calculated. Patients were divided into two groups, according to CAD severity. In addition to well-known P wave parameters, PWPT, defined as the time from the beginning of the P wave to its peak, was measured in the leads DII and V1. RESULTS: The PWPTs in the leads DII and V1 were significantly longer in the group with severe CAD (71 ±â€¯13 vs. 61 ±â€¯12, p < 0.001, 63 ±â€¯24 vs. 53 ±â€¯18, p = 0.024, respectively). PWPT was found to be an independent predictor of severe CAD and the best cut-off value of PWPT in the lead DII was 69.6 ms with sensitivity of 58.3% and specificity of 78.9%. CONCLUSION: Our findings show that prolonged PWPT, which is a parameter easily obtainable from the ECG, is associated with severe CAD. Recognition of NSTEMI patients with severe CAD at the time of diagnosis before performing coronary angiography may be important for the planning of treatment.


Asunto(s)
Enfermedad de la Arteria Coronaria , Infarto del Miocardio sin Elevación del ST , Infarto del Miocardio con Elevación del ST , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Electrocardiografía , Humanos , Infarto del Miocardio sin Elevación del ST/diagnóstico
9.
Turk J Med Sci ; 49(1): 212-216, 2019 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-30761885

RESUMEN

Background/aim: The number of patients with heart transplantation has dramatically increased in the last decade. Considerable studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. We analyzed the dispersion of myocardial repolarization using electrocardiographic Tp-e interval and Tp-e/QTc ratio in patients with heart transplantation. Materials and methods: This observational study included 38 patients (12 female and 26 male) with heart transplantation and 38 well-matched controls. From electrocardiograms, Tp-e interval and Tp-e/QTc ratio were calculated and compared between the 2 groups. Results: Noninvasive arrhythmia indicators including Tp-e interval (84.63 ± 14.17 ms vs 71.82 ± 7.47 ms, P < 0.001), Tp-e/QTc ratio (0.19 ± 0.04 vs 0.16 ± 0.02, P < 0.001) and QTc interval except QT interval were significantly higher in transplanted hearts compared to normal hearts. Conclusion: Patients with heart transplantation have increased myocardial dispersion of repolarization.


Asunto(s)
Arritmias Cardíacas/epidemiología , Sistema de Conducción Cardíaco/fisiopatología , Trasplante de Corazón/efectos adversos , Trasplante de Corazón/estadística & datos numéricos , Adulto , Estudios Transversales , Electrocardiografía/estadística & datos numéricos , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Turquía/epidemiología
11.
Perfusion ; 31(3): 232-9, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26205807

RESUMEN

UNLABELLED: Excessive haemodilution and the resulting anaemia during CPB is accompanied by a decrease in the total arterial oxygen content, which may impair tissue oxygen delivery. Hyperoxic ventilation has been proven to improve tissue oxygenation in different pathophysiological states of anaemic tissue hypoxia. The aim of this study was to examine the influence of arterial hyperoxaemia on tissue oxygenation during CPB. Records of patients undergoing isolated CABG with CPB were retrospectively reviewed. Patients with nadir haematocrit levels below 20% during CPB were included in the study. Tissue hypoxia was defined as hyperlactataemia (lactate >2.2 mmol/L) coupled with low ScVO2 (ScVO2 <70%) during CPB. One hundred patients with normoxaemia and 100 patients with hyperoxaemia were included in the study. Patients with hyperoxaemia had lower tissue hypoxia incidence than patients with normoxaemia (p<0.001). Compared with patients without tissue hypoxia, patients with tissue hypoxia had significantly lower PaO2 values (p<0.001) and nadir haematocrit levels (p<0.001). Nadir haematocrit levels <18% (OR: 5.3; 95% CI: 2.67-10.6; p<0.001) and hyperoxaemia (OR: 0.28; 95% CI: 0.14-0.56; p<0.001) were independently associated with tissue hypoxia. CONCLUSIONS: Hyperoxaemia during CPB may be protective against tissue hypoxia in patients with nadir haematocrit levels <20%.


Asunto(s)
Puente Cardiopulmonar/métodos , Hiperoxia/sangre , Respiración Artificial/efectos adversos , Anciano , Femenino , Hematócrito , Humanos , Hiperoxia/etiología , Masculino , Persona de Mediana Edad , Respiración Artificial/métodos
12.
BMC Cardiovasc Disord ; 15: 10, 2015 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-25885120

RESUMEN

BACKGROUND: Despite the advances in medical and interventional treatment modalities, some patients develop epicardial coronary artery reperfusion but not myocardial reperfusion after primary percutaneous coronary intervention (PCI), known as no-reflow. The goal of this study was to evaluate the safety and efficacy of intracoronary epinephrine in reversing refractory no-reflow during primary PCI. METHODS: A total of 248 consecutive STEMI patients who had undergone primary PCI were retrospectively evaluated. Among those, 12 patients which received intracoronary epinephrine to treat a refractory no-reflow phenomenon were evaluated. Refractory no-reflow was defined as persistent TIMI flow grade (TFG) ≤ 2 despite intracoronary administration of at least one other pharmacologic intervention. TFG, TIMI frame count (TFC), and TIMI myocardial perfusion grade (TMPG) were recorded before and after intracoronary epinephrine administration. RESULTS: A mean of 333 ± 123 mcg of intracoronary epinephrine was administered. No-reflow was successfully reversed with complete restoration of TIMI 3 flow in 9 of 12 patients (75%). TFG improved from 1.33 ± 0.49 prior to epinephrine to 2.66 ± 0.65 after the treatment (p < 0.001). There was an improvement in coronary flow of at least one TFG in 11 (93%) patients, two TFG in 5 (42%) cases. TFC decreased from 56 ± 10 at the time of no-reflow to 19 ± 11 (p < 0.001). A reduction of TMPG from 0.83 ± 0.71 to 2.58 ± 0.66 was detected after epinephrine bolus (p < 0.001). Epinephrine administration was well tolerated without serious adverse hemodynamic or chronotropic effects. Intracoronary epinephrine resulted in significant but tolerable increase in heart rate (68 ± 13 to 95 ± 16 beats/min; p < 0.001) and systolic blood pressure (94 ± 18 to 140 ± 20; p < 0.001). Hypotension associated with no-reflow developed in 5 (42%) patients. During the procedure, intra-aortic balloon pump counterpulsation was required in two (17%) patients, transvenous pacing in 2 (17%) cases, and both intra-aortic balloon counterpulsation and transvenous pacing in one (8%) patients. One patient (8%) died despite all therapeutic measures. CONCLUSION: Intracoronary epinephrine may become an effective alternative in patients suffering refractory no-reflow following primary PCI.


Asunto(s)
Agonistas Adrenérgicos beta/administración & dosificación , Epinefrina/administración & dosificación , Fenómeno de no Reflujo/tratamiento farmacológico , Intervención Coronaria Percutánea , Agonistas Adrenérgicos beta/efectos adversos , Presión Sanguínea/efectos de los fármacos , Angiografía Coronaria , Epinefrina/efectos adversos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/cirugía , Fenómeno de no Reflujo/diagnóstico por imagen , Estudios Retrospectivos , Ultrasonografía
13.
Ann Noninvasive Electrocardiol ; 20(3): 253-7, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25201342

RESUMEN

BACKGROUND: Cardiovascular complications are the leading causes of premature deaths in hemodialysis patients. Due to rapid changes in volume and electrolyte concentration following dialysis, the some electrocardiographic (ECG) changes or arrhythmias might be seen. OBJECTIVE: To investigate the acute effects of hemodialysis on the ECG parameters in patients with chronic end-stage renal disease (ESRD). METHOD: We included the consecutive ESRD patients who underwent a hemodialysis. Before and after hemodialysis, some 12 lead ECG parameters were analyzed by two different cardiologists by using electronic digital caliper device. RESULTS: A total of 62 patients (mean 52 ± 15 years; 65% male) with ESRD undergoing hemodialysis were recruited to the study. P-wave amplitude, QRS amplitude, QRS duration, QTc dispersion, the sum of amplitudes in V1S + V5R derivations, total QRS amplitude, and duration were significantly greater in posthemodialysis patients compared to the prehemodialysis ones. However, T-wave amplitude and QTc duration were significantly lower in posthemodialysis patients. CONCLUSION: The ECG changes including prolangated QRS and increased QTc interval after hemodialysis should be kept in mind and assessed carefully in ESRD patients. Prolongation of these parameters may prove to be a further noninvasive marker of susceptibility to ventricular arrhythmias.


Asunto(s)
Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , Electrocardiografía , Fallo Renal Crónico/complicaciones , Diálisis Renal/efectos adversos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
14.
Heart Surg Forum ; 17(6): E302-7, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25586280

RESUMEN

BACKGROUND: Hyperglycemia is common after cardiac surgery in both diabetic and nondiabetic patients and is associated with increased morbidity and mortality. Association between nadir hematocrit levels on cardiopulmonary bypass (CPB) and postoperative hyperglycemia is not clear. This study was carried out to determine the relationship between nadir hematocrit during CPB and postoperative hyperglycemia in nondiabetic patients. METHODS: Records of 200 nondiabetic patients undergoing coronary artery bypass grafting operation were retrospectively reviewed. In the first analysis, patients were divided into two subgroups according to the presence or absence of hyperglycemia. Further analysis was made after dividing the patients into 3 subgroups according to nadir hematocrit levels on CPB (less than 20%; 20% to 25%; greater than or equal to 25%). RESULTS: Compared to patients without hyperglycemia, patients with postoperative hyperglycemia had significantly lower preoperative hematocrit levels (p = 0.004) and were associated with lower nadir hematocrit levels during CPB (p= 0.002). Peak intensive care unit blood glucose levels and number of blood transfusions were significantly higher in patients with nadir hematocrit levels less than 20. (p<0.001 and p<0.001 respectively). Logistic regression analysis demonstrated that nadir hematocrit levels less than 20% (OR 2.9, p=0.009) and allogenic blood transfusion (OR 1.5, p=0.003) were independently associated with postoperative hyperglycemia. CONCLUSIONS: Nadir hematocrit levels on CPB less than 20% and allogenic blood transfusions were independently associated with postoperative hyperglycemia in nondiabetic patients. Patients with a nadir hematocrit levels less than 20 % during CPB should be closely monitored for hyperglycemia in the perioperative period.


Asunto(s)
Puente Cardiopulmonar/efectos adversos , Hematócrito/métodos , Hiperglucemia/diagnóstico , Hiperglucemia/etiología , Anciano , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/diagnóstico , Femenino , Humanos , Hiperglucemia/sangre , Masculino , Persona de Mediana Edad , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Resultado del Tratamiento
15.
Turk Kardiyol Dern Ars ; 42(2): 178-81, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24643151

RESUMEN

We report a 68-year-old man who presented with heart failure and atrial fibrillation (AF) with rapid ventricular response and wide QRS complexes. Tachycardia-induced cardiomyopathy (TIC) due to persistent AF developing on the basis of Wolff-Parkinson-White (WPW) syndrome was considered. Signs and symptoms of heart failure improved with restoration of sinus rhythm. This case suggested that persistent AF in a patient with WPW syndrome is one of the rare causes of TIC.


Asunto(s)
Fibrilación Atrial/fisiopatología , Taquicardia/fisiopatología , Síndrome de Wolff-Parkinson-White/fisiopatología , Anciano , Electrocardiografía , Humanos , Masculino
16.
J AOAC Int ; 96(4): 864-9, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24000761

RESUMEN

Sequential selective extraction techniques are commonly used to fractionate the solid-phase forms of metals in soils. This procedure provides measurements of extractable metals from media, such as acetic acid (0.11 M), hydroxyl ammonium chloride (0.1 M), hydrogen peroxide (8.8 M) plus ammonium acetate (1 M), and aqua regia stages of the sequential extraction procedure. In this work, the extractable Pb, Cu, Mn, Sr, Ni, V, Fe, Zn, and Cr were evaluated in street dust samples from Sakarya, Turkey, between May and October 2009 using the three-step sequential extraction procedure described by the Community Bureau of Reference (BCR, now the Standards, Measurements, and Testing Programme) of the European Union. The sampling sites were divided into 10 categories; a total of 50 street dusts were analyzed. The determination of multielements in the samples was performed by inductively coupled plasma-optical emission spectrometry. Validation of the proposed method was performed using BCR 701 certified reference material. The results showed good agreement between the obtained and the certified values for the metals analyzed.


Asunto(s)
Polvo/análisis , Metales Pesados/análisis , Espectrofotometría Atómica/métodos , Metales Pesados/aislamiento & purificación
17.
Turk Kardiyol Dern Ars ; 41(1): 45-50, 2013 Jan.
Artículo en Turco | MEDLINE | ID: mdl-23518938

RESUMEN

OBJECTIVES: The aim of this study was to assess the relationship between mean platelet volume (MPV) and the presence and extent of coronary artery disease (CAD) in patients who underwent coronary angiography for stable chest pain. STUDY DESIGN: A total of 540 patients (350 male, 190 female; mean age: 59.6±11.4 years) were consecutively included in the study. The patients were divided into four groups according to the presence and extent of their CAD as follows: Group 1 - patients with no significant CAD, group 2 - one vessel disease, group 3 - two vessel diseases, and group 4 - three vessel disease. Also, the Gensini score of each coronary angiogram was calculated. RESULTS: There were 159 patients in group 1, 169 in group 2, 110 in group 3, and 102 in group 4. As expected, we found significant differences among the groups regarding mean age and other coronary risk factors including gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. However, there were no significant differences among the groups regarding platelet counts and MPV values (8.5±0.1 fl, 8.5±1.2 fl, 8.6±0.9 fl and 8.6±0.9 fl, MPV values of groups 1-4, respectively). Although the Gensini score was found to be significantly correlated with age, plasma uric acid level, white blood cell count, hemoglobin level, fasting blood glucose, and high density lipoprotein level, no significant association was detected between MPV and Gensini score values. CONCLUSION: This study is one of the largest studies assessing the relationship between MPV and the extent of coronary atherosclerosis in patients with stable CAD to date. However, we found no association between MPV and the presence and extent of coronary atherosclerosis.


Asunto(s)
Enfermedad de la Arteria Coronaria , Volúmen Plaquetario Medio , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/sangre , Diabetes Mellitus , Humanos , Hipertensión
18.
J Interv Card Electrophysiol ; 66(3): 621-627, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-36121541

RESUMEN

BACKGROUND: Annotation of earliest depolarization which depends on maximum dV/dt of unipolar-electrograms and unipolar QS morphology identify site of origin for ventricular premature contractions (VPC). However, identification of unipolar QS morphology has limitations due to low spatial resolution. This study aims to compare electrogram characteristics at successful ablation site in patients with outflow tract (OT) VPC. METHODS: Local activation time (LAT), duration, and voltage data of each bipolar- and unipolar-electrogram at the successful ablation sites from the right ventricle OT (RVOT) and the left ventricle OT (LVOT) cases were analyzed. RESULTS: Forty-four of 60 (73%) of patients were ablated from RVOT and in 16/60 (27%) required ablation from both sides. All patients had acute VPC suppression. Bipolar-electrogram-QRS onset was earlier (36.4 ± 14.5 ms vs 26.3 ± 7.4 ms, p = 0.01), duration of bipolar-electrogram was shorter (56.9 ± 18.9 ms vs 78.9 ± 21.8 ms, p = 0.002), and bi-voltage amplitude was higher (3.2 ± 2.3 mV vs 1.4 ± 1.1 mV, p = 0.07) for patients with RVOT-only ablation. Mean bipolar-unipolar-electrogram difference was 4.4 ± 4.5 ms in the RVOT group vs 12.8 ± 4.9 ms in RVOT + LVOT group (p < 0.001). Unipolar QS morphology was recorded in 3.0 ± 3.9 vs 3.6 ± 1.8 cm2 in RVOT and RVOT + LVOT group, respectively (p = 0.41). Unipolar-electrogram revealed W pattern in 3/44 of RVOT vs 5/16 of RVOT + LVOT group, respectively (p = 0.01). In 18/60 (30%) of patients, unipolar QS was not identified at successful ablation site. CONCLUSION: QS in unipolar-electrogram was not a perfect predictor for successful ablation sites. Analysis of bipolar voltage amplitude and duration with bipolar-unipolar-electrogram time difference may identify presence of a deeper source.


Asunto(s)
Ablación por Catéter , Taquicardia Ventricular , Complejos Prematuros Ventriculares , Humanos , Técnicas Electrofisiológicas Cardíacas , Ventrículos Cardíacos/cirugía , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/cirugía , Taquicardia Ventricular/cirugía , Electrocardiografía
19.
Anatol J Cardiol ; 27(7): 375-389, 2023 07 03.
Artículo en Inglés | MEDLINE | ID: mdl-37284828

RESUMEN

Obstructive sleep apnea is common in adults with cardiovascular disease. Accumulating evidence suggests an association between obstructive sleep apnea and cardiovascular disease independent of the traditionally recognized cardiovascular disease risk factors. Observational studies indicate that obstructive sleep apnea is a risk factor for development of cardiovascular disease and that alleviation of obstructive events with positive airway pressure may improve cardiovascular disease outcomes. However, recent randomized controlled trials have not supported the beneficial effect of positive airway pressure in cardiac populations with concomitant obstructive sleep apnea. Some evidence suggests that the relationship between obstructive sleep apnea and traditionally recognized cardiovascular disease risk factors is bidirectional, suggesting that patients with cardiovascular disease may also develop obstructive sleep apnea and that efficient treatment of cardiovascular disease may improve obstructive sleep apnea. Recent data also indicate that the apnea-hypopnea index, which is commonly used as a diagnostic measure of obstructive sleep apnea severity, has limited value as a prognostic measure for cardiovascular disease outcomes. Novel markers of obstructive sleep apnea-associated hypoxic burden and cardiac autonomic response seem to be strong predictors of adverse cardiovascular disease outcomes and response to treatment of obstructive sleep apnea. This narrative review and position paper from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to update the current evidence about the relationship between obstructive sleep apnea and cardiovascular disease and, consequently, raise awareness for health professionals who deal with cardiovascular and respiratory diseases to improve the ability to direct resources at patients most likely to benefit from treatment of obstructive sleep apnea and optimize treatment of the coexisting cardiovascular diseases. Moreover, the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to contribute to strengthening the efforts of the International Collaboration of Sleep Apnea Cardiovascular Trialists in this context.


Asunto(s)
Enfermedades Cardiovasculares , Sistema Cardiovascular , Síndromes de la Apnea del Sueño , Apnea Obstructiva del Sueño , Adulto , Humanos , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/terapia , Síndromes de la Apnea del Sueño/complicaciones , Factores de Riesgo , Presión de las Vías Aéreas Positiva Contínua/efectos adversos
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