Assessment of QRS duration and presence of fragmented QRS in patients with celiac disease.

Background: Celiac Disease (CD) is characterized by small intestine involvement. However, cardiac manifestations may also be seen in the clinical course. The significance of the QRS prolongation and the presence of QRS fragmentation (fQRS) has been previously studied in many chronic inflammatory disorders as an independent predictor of cardiac manifestations. The study aimed to evaluate the QRS duration and presence of fQRS in patients with CD. Methods: 164 patients with CD and 162 healthy controls were included in the present study. QRS duration and presence of fQRS were calculated from the 12-lead electrocardiogram and compared between groups. The association between these parameters and disease duration was also evaluated. Results: QRS duration was found to be higher in the CD group compared to the control group (83 (76.8-93) vs. 91 (84-94), p<0.001). The presence of fQRS was demonstrated to be higher in the CD group (n=68 (41.5%) vs n=42 (25.9%), p=0.003). Notably, QRS duration was positively correlated with disease duration (Spearman's Rho= 0.47, p<0.001). In addition, disease duration was significantly higher in the fQRS (+) group (60 (23,5-144) vs. 28,5 (15-71,5), p=0.002). Conclusion: This study revealed that QRS prolongation and the presence of fQRS were higher in patients with CD. The presence of these findings may be an indicator of early subclinical cardiac involvement, especially in those with long disease duration. Thus, patients with these ECG findings can be considered for further cardiac evaluation.

Predictors of length of hospital stay and in-hospital adverse events in patients with acute decompensated heart failure: in-hospital 24-hour blood pressure monitoring data.

OBJECTIVE: Neurohumoral alterations in heart failure (HF) affect blood pressure variability (BPV) and vascular compliance, but little is known about this subject among patients admitted to the hospital with decompensated HF. This study sought to investigate in-hospital 24-h blood pressure monitoring (BPM)-derived BPV parameters and vascular compliance in patients with decompensated HF and explore the association of these parameters with hospitalization length and in-hospital adverse events. METHODS: A 24-h BPM was applied during the first 6 h of admission to the hospital in patients with decompensated HF. Circadian patterns were determined by the study patients. Average real variability (ARV), pulse pressure index (PPI), pulse stiffening ratio (PSR), and ambulatory arterial stiffness index (AASI) values were calculated from in hospital 24-h BPM recordings. Admission and discharge N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, length of hospitalization, and in-hospital adverse events were recorded. RESULTS: A total of 167 patients with decompensated HF were included in the study. The dipper group exhibited a greater NT-proBNP decrease with the treatment than the non-dipper group and reverse dipper group. Hospitalization length was shorter in the dipper group than in the non-dipper and reverse dipper groups. Although ARV, AASI, and PSR were independently associated with the length of hospitalization, ARV, AASI, and PPI were independently associated with in-hospital adverse events. CONCLUSION: The post-admission in hospital 24-h BPM-derived parameters (dipper pattern, ARV, PPI, PSR, and AASI) of patients admitted to hospital with decompensated HF provide important prognostic information and predict the length of hospital stay.

Evaluation of QRS duration and presence of fragmented QRS in patients with inflammatory bowel disease.

Background: Inflammatory Bowel Disease (IBD) is mostly characterized by gastrointestinal tract involvement, however can also be accompanied with cardiac manifestations. QRS prolongation and the presence of QRS fragmentation (fQRS) have been previously evaluated in many chronic inflammatory diseases, as an independent predictor of cardiac events. In this study, we aimed to evaluate the QRS duration and fQRS in patients with IBD. Methods: The presented study was designed as a single-center retrospective cohort study. The study population consisted of 217 patients with IBD and 195 healthy controls. QRS duration and presence of fQRS were evaluated using a 12-lead electrocardiogram. These parameters were compared between groups. Results: QRS duration was demonstrated to be higher in the IBD group compared to the control group (92 (86-98) vs. 82 (75-90), p<0.001). The presence of fQRS was significantly higher in the IBD group (n=101 (47%) vs n=59 (30%), p=0.006). In addition, a positive correlation was demonstrated between QRS duration and disease duration (Spearman's Rho= 0.4, p<0.001). Notably, disease and QRS duration were significantly higher in the fQRS (+) group (102 (56.5-154) vs. 55 (24.3-118.3), <0.001; 94 (86-100) vs. 92 (84-96), 0.016; respectively). Conclusion: Our results demonstrated that QRS prolongation and the presence of fQRS (+) were more common in IBD patients, and associated with longer disease duration. These findings may indicate subclinical cardiac involvement in IBD. Therefore, IBD patients, especially those with long-standing disease, should be followed more closely in terms of cardiac manifestations.

Evaluation of Tp-e interval and Tp-e/QTc ratio in patients with inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD), a multisystemic inflammatory disorder, has been associated with increased risk of cardiovascular problems, including complications such as conduction defects and arrhythmias. Therefore, the early assessment of the risk factors predisposing to ventricular arrhythmias is crucial, since it can improve clinical outcomes. The objective of the present study is to evaluate ventricular repolarization by using Tp­e interval and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with IBD. METHODS: The presented study was designed as a single-center prospective cohort study. The study population consisted of 175 patients with IBD and 175 healthy volunteers. The Tp­e interval, corrected QT (QTc), and Tp-e/QTc ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups. RESULTS: The groups were similar in terms of electrocardiographic findings such as heart rate, QRS interval, and QTc interval. However, Tp­e interval (87.0 ms, interquartile range, IQR 81.0-105.0 ms vs. 84.0 ms, IQR 74.0-92.0 ms; p < 0.001) and Tp-e/QTc ratio (0.21 ± 0.04 vs. 0.19 ± 0.05; p < 0.001) were significantly increased in IBD patient group compared to control group. Notably, a positive correlation was demonstrated between Tp­e interval, Tp-e/QTc ratio and disease duration (Spearman's Rho = 0.36, p < 0.001 for Tp­e; Spearman's Rho = 0.28, p < 0.001 for Tp-e/QTc). CONCLUSION: This study demonstrated that IBD patients are at increased risk of disrupted ventricular repolarization (increased Tpe, Tpe/QTc ratio). In addition, a positive correlation was demonstrated between Tp­e interval, Tp-e/QTc ratio, and disease duration. Therefore, IBD patients, especially those with long-standing diseases, should be more closely screened for ventricular arrhythmias.

Visceral Adiposity Index Is Associated with the Increased Syntax Score in Patients with Type 2 Diabetes Mellitus.

Background: The visceral adipose tissue excess in patients with diabetes mellitus (DM) is one of the mechanisms that plays role in the development of coronary atherosclerosis. Our study aimed to investigate the relationship between visceral adiposity index (VAI), an indicator of visceral adiposity, and Syntax score (SxS), a predictor of the severity of coronary artery disease (CAD), in patients with stable angina pectoris (SAP) and type 2 DM. Methods: A total of 253 patients with SAP and type 2 DM were included in this cross-sectional study. The patients were divided into three risk groups (low risk <22, 32 ≥ intermediate risk ≥22, high risk ≥33) according to the SxS based on invasive coronary angiography. Several adiposity indexes such as body mass index, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI), and lipid accumulation product index (LAPI) were calculated using relevant formulas. In addition, VAI scores for each patient were calculated. Results: There were no statistically significant differences between the low-, intermediate-, and high-risk groups for WHtR, BAI, and LAPI. WHR was found significantly lower in the low SxS group (P = 0.0038), and VAI was found significantly higher (P = 0.021) in the high SxS group. Besides, in multivariate logistic regression analysis, the VAI (odds ratio: 2.455; 95% confidence interval: 1.244-4.845; P = 0.010) was an independent predictor of high SxS. In the receiver operating characteristic curve analysis, VAI with an optimal cutoff value of 2.048 predicted the severe coronary lesion with a sensitivity of 60.8% and a specificity of 61.5%. Conclusion: This study showed that VAI was an independent predictor in estimating CAD severity in patients with SAP and type 2 DM.

Analysis of ambulatory blood pressure monitoring data in patients with ankylosing spondylitis without clinically evident cardiovascular disease.

Ankylosing spondylitis (AS) is associated with an increased risk of cardiovascular morbidity and mortality. Parameters, such as non-dipper, average real variability (ARV), pulse pressure index (PPI), and ambulatory arterial stiffness index (AASI) obtained from ambulatory blood pressure monitoring (ABPM), provide information about adverse cardiovascular outcomes. In this study, these indexes were evaluated in patients with AS. Sixty-five patients with AS and 65 control subjects were included in this study. Non-dipper pattern, ARV, PPI, and AASI parameters were assessed using 24-h ABPM recordings. Twenty-four-hour systolic, diastolic, mean standard deviation, PPI, ARV, and AASI were higher in patients with AS (p < 0.05 all parameters). Non-dipper (43.1% vs. 21.5%, p = 0.007) and reverse dipper (10.8% vs. 0%, p = 0.013) patterns were more common in patients with AS. In addition, disease duration was moderately correlated with AASI and ARV (r = 0.36, p = 0.003; r = 0.31, p = 0.012, respectively). This study showed that PPI, AASI, ARV, and dipper pattern were impaired in patients with AS evaluated with ABPM.

Gamma-glutamyl transferase to albumin ratio can predict severity of coronary artery disease detected by coronary computed tomography angiography.

OBJECTIVE: Gamma-glutamyl transferase (GGT) to albumin ratio (GAR) has been shown to be helpful to diagnose and determine the severity of coronary artery disease (CAD). Coronary computed tomography angiography (CCTA) is a guide recommended non-invasive test that provides information about the presence, severity, and morphology of coronary plaques. In this study, our main aim was to investigate the relationship between the presence, morphology, and severity of coronary plaques detected via CCTA and GAR in patients with low to moderate risk for undiagnosed CAD. METHODS: Nine hundred and sixty six patients were included who underwent CCTA. The severity of CAD and plaque morphology were investigated. CT-adapted Leaman score (CT-LeSc) was calculated to determine the extent of the CAD. The study population was further evaluated in three groups according to tertiles of GAR. RESULTS: Atherosclerotic plaques were more common in the male gender and older patients with conventional cardiovascular risk factors. GAR was significantly lower in patients with normal CCTA than in patients with a non-obstructive plaque or obstructive plaque on CCTA. Patients in upper GAR tertiles had a higher coronary calcium score (CACS) and CT-LeSc. GAR was one of the independent predictors to predict severe stenotic plaque and high CACS. CONCLUSION: GAR can independently predict the presence, extent, and severity of CAD determined by CT-LeSc. We believe as a cheap, safe, and widely available tool, GAR would be useful in the diagnosis of CAD.

Relationship Between Systemic Immune-Inflammation Index (SII) and the Severity of Stable Coronary Artery Disease.

Systemic immune-inflammation index (SII; platelet count × neutrophil-to-lymphocyte ratio), a novel marker, predicts adverse clinical outcomes in coronary artery diseases (CAD). We hypothesized that SII could provide more valuable information in assessing the severity of CAD than ratios obtained from other white blood cell subtypes. Patients (n = 669) who underwent coronary angiography were analyzed in this retrospective study. We analyzed the relation between the SII and the angiographic severity of CAD. The severity of coronary atherosclerosis was determined by the SYNTAX score (SxS). Patients with CAD were divided into 3 groups according to the SxS. Multivariate logistic analysis was used to assess risk factors of CAD. In multivariate logistic regression analysis, the SII (odds ratio: 1.004; 95% CI: 1.001-1.007; P = .015) was an independent predictor of high SxS. Additionally, there was a positive correlation between SII and SxS (Rho: 0.630, P ≤ .001). In the receiver-operating characteristic curve analysis, SII with an optimal cutoff value of 750 × 103 predicted the severe coronary lesion with a sensitivity of 86.2% and specificity of 87.3%. The SII, an inexpensive and easily measurable laboratory variable, was significantly associated with the severity of CAD and high SxS in patients with stable angina pectoris.

Determination of Myocardial Scar Tissue in Coronary Slow Flow Phenomenon and The Relationship Between Amount of Scar Tissue and Nt-ProBNP. / Determinação do Tecido Cicatricial do Miocárdio no Fenômeno de Fluxo Coronário Lento e a Relação entre a Quantidade de Tecido Cicatricial e o Nt-ProBNP.

BACKGROUND: Pathophysiology and prognosis are not clearly determined in patients with the coronary slow flow phenomenon (CSFP). These patients present with various clinical conditions ranging from being asymptomatic to being admitted with sudden cardiac death. OBJECTIVES: We aimed at assessing the findings of late gadolinium enhancement (LGE) in cardiac magnetic resonance imaging (CMR) as an indicator of myocardial fibrosis. We also aimed at determining the relationship between the presence of myocardial fibrosis and NT-proBNP levels in patients with CSFP in the left anterior descending coronary artery (LAD). METHODS: A total of 35 patients were enrolled within an age range of 31-75. The study patients (n=19) had normal epicardial coronary arteries at angiography, but they presented with CSFP in the LAD. The control group patients (n=16) had normal epicardial coronary arteries and TIMI scores at normal levels in angiography. In both groups, the patients were examined with CMR for the presence of myocardial fibrosis. In addition, plasma NT-proBNP levels were measured. A p-value < 0.05 was considered significant. RESULTS: The rate of myocardial fibrosis was significantly higher in CMR in the patients with CSFP (p=0.018). A variable amount of myocardial scar tissue was detected at the left ventricular apex in 7 patients and at the inferior and inferolateral regions in 3 patients. There was no difference in the level of NT-proBNP in patients with CSFP. However, the NT-proBNP levels were higher in patients with CSFP, who had scar tissue in CMR (p=0.022). CONCLUSIONS: In conclusion, LGE in CMR showed that ischemic myocardial scarring may exist in patients with CSFP. These results indicate that CSFP may not always be innocent. (Arq Bras Cardiol. 2020; 114(3):540-551).

FUNDAMENTO: A fisiopatologia e o prognóstico não estão claramente determinados nos pacientes com fenômeno do fluxo coronário lento (FCL). Esses pacientes apresentam várias condições clínicas, que variam desde quadro assintomático até internação hospitalar com morte cardíaca súbita. OBJETIVOS: Nosso objetivo foi avaliar os achados da ressonância magnética cardíaca (RMC) com o realce tardio pelo gadolínio (RTG), como um indicador de fibrose miocárdica. Também buscamos determinar a relação entre a presença de fibrose miocárdica e os níveis de NT-proBNP em pacientes com FCL na artéria coronária descendente anterior esquerda (DAE). MÉTODOS: Ao todo, 35 pacientes, entre 31 e 75 anos de idade, foram incluídos. Os pacientes estudados (n=19) apresentaram artérias coronárias epicárdicas normais na angiografia, mas tinham FCL na DAE. O grupo controle de pacientes (n=16) apresentou artérias coronárias epicárdicas normais e níveis de escore TIMI normais na angiografia. Em ambos os grupos, os pacientes foram examinados com RMC para a detecção de presença de fibrose miocárdica. Além disso, níveis plasmáticos de NT-proBNP foram medidos. Valores de p < 0,05 foram considerados significativos. RESULTADOS: A taxa de fibrose miocárdica foi significativamente maior na RMC para os pacientes com FCL (p=0.018). Uma quantidade variável de tecido cicatricial foi detectada no ápice ventricular esquerdo em 7 pacientes e nas regiões inferior e inferolateral em 3 pacientes. Não foram observadas diferenças nos níveis de NT-proBNP nos pacientes com FCL. Entretanto, os níveis de NT-proBNP foram maiores nos pacientes com FCL, que apresentaram fibrose miocárdica na RMC (p=0.022). CONCLUSÕES: Em suma, o RTG na RMC mostrou que a cicatriz miocárdica isquêmica pode estar presente nos pacientes com FCL. Esses resultados indicam que o FCL pode nem sempre ser inofensivo. (Arq Bras Cardiol. 2020; 114(3):540-551).

Evaluation of cardiac autonomic nervous system in patients with ankylosing spondylitis using 12-lead electrocardiography and Holter monitoring.

OBJECTIVES: Ankylosing spondylitis (AS) is associated with increased risk of cardiovascular problems, including complications such as conduction defects and arrhythmias, which might lead to increased morbidity and/or mortality. The objective of the present study is to evaluate the electrocardiographic (ECG) parameters, including T-peak to T-end intervals (Tpe), Tpe/corrected QT (QTc) ratio, heart rate variability (HRV), and heart rate turbulence (HRT) in AS patients. METHODS: Seventy-six AS patients and 55 control subjects were included in the study. 12-lead ECG and 24-h Holter monitoring recordings were obtained. Tpe and Tpe/QTc were measured using the 12-lead ECG and HRV and HRT parameters were assessed using 24-h Holter ECG recordings. Subjects were assigned into three groups based on their HRT parameters (Tonset (TO) and Tslope (TS)) (HRT-0, normal TO or TS; HRT-1, abnormal TO or TS; HRT-2, abnormal TO and TS). RESULTS: Tpe was prolonged and Tpe/QTc ratio was higher in AS patients (p < 0.001 for both). Moreover, Tpe and Tpe/QTc ratio significantly correlated with disease duration. All HRV parameters (VLF, LF, HF, SDNN, SDANN, ASDNN, rMSSD, pNN50) were decreased in AS patients in comparison with those in control subjects (p < 0.05 for all parameters). Controls were significantly more likely to have normal TO and TS (82% vs 53%, p < 0.001). There was negative correlation between Holter parameters and disease duration, as well as Tpe and Tpe/QTc ratio (p < 0.05 for all parameters). CONCLUSIONS: This study demonstrated that AS patients have disrupted ventricular repolarization (increased Tpe, Tpe/QTc ratio). Results suggest a decreased cardiac impact of the parasympathetic system in AS patients. Key Points • This study demonstrated that AS patients have disrupted ventricular repolarization. • The study also finds that heart rate turbulence and heart rate variability are impaired in AS patients. • Impaired Holter and ECG parameters may be one of the high cardiovascular risk factors in AS patients.

Determinação do Tecido Cicatricial do Miocárdio no Fenômeno de Fluxo Coronário Lento e a Relação entre a Quantidade de Tecido Cicatricial e o Nt-ProBNP / Determination of Myocardial Scar Tissue in Coronary Slow Flow Phenomenon and The Relationship Between Amount of Scar Tissue and Nt-ProBNP

Resumo Fundamento A fisiopatologia e o prognóstico não estão claramente determinados nos pacientes com fenômeno do fluxo coronário lento (FCL). Esses pacientes apresentam várias condições clínicas, que variam desde quadro assintomático até internação hospitalar com morte cardíaca súbita. Objetivos Nosso objetivo foi avaliar os achados da ressonância magnética cardíaca (RMC) com o realce tardio pelo gadolínio (RTG), como um indicador de fibrose miocárdica. Também buscamos determinar a relação entre a presença de fibrose miocárdica e os níveis de NT-proBNP em pacientes com FCL na artéria coronária descendente anterior esquerda (DAE). Métodos Ao todo, 35 pacientes, entre 31 e 75 anos de idade, foram incluídos. Os pacientes estudados (n=19) apresentaram artérias coronárias epicárdicas normais na angiografia, mas tinham FCL na DAE. O grupo controle de pacientes (n=16) apresentou artérias coronárias epicárdicas normais e níveis de escore TIMI normais na angiografia. Em ambos os grupos, os pacientes foram examinados com RMC para a detecção de presença de fibrose miocárdica. Além disso, níveis plasmáticos de NT-proBNP foram medidos. Valores de p < 0,05 foram considerados significativos. Resultados A taxa de fibrose miocárdica foi significativamente maior na RMC para os pacientes com FCL (p=0.018). Uma quantidade variável de tecido cicatricial foi detectada no ápice ventricular esquerdo em 7 pacientes e nas regiões inferior e inferolateral em 3 pacientes. Não foram observadas diferenças nos níveis de NT-proBNP nos pacientes com FCL. Entretanto, os níveis de NT-proBNP foram maiores nos pacientes com FCL, que apresentaram fibrose miocárdica na RMC (p=0.022). Conclusões Em suma, o RTG na RMC mostrou que a cicatriz miocárdica isquêmica pode estar presente nos pacientes com FCL. Esses resultados indicam que o FCL pode nem sempre ser inofensivo. (Arq Bras Cardiol. 2020; 114(3):540-551)

Abstract Background Pathophysiology and prognosis are not clearly determined in patients with the coronary slow flow phenomenon (CSFP). These patients present with various clinical conditions ranging from being asymptomatic to being admitted with sudden cardiac death. Objectives We aimed at assessing the findings of late gadolinium enhancement (LGE) in cardiac magnetic resonance imaging (CMR) as an indicator of myocardial fibrosis. We also aimed at determining the relationship between the presence of myocardial fibrosis and NT-proBNP levels in patients with CSFP in the left anterior descending coronary artery (LAD). Methods A total of 35 patients were enrolled within an age range of 31-75. The study patients (n=19) had normal epicardial coronary arteries at angiography, but they presented with CSFP in the LAD. The control group patients (n=16) had normal epicardial coronary arteries and TIMI scores at normal levels in angiography. In both groups, the patients were examined with CMR for the presence of myocardial fibrosis. In addition, plasma NT-proBNP levels were measured. A p-value < 0.05 was considered significant. Results The rate of myocardial fibrosis was significantly higher in CMR in the patients with CSFP (p=0.018). A variable amount of myocardial scar tissue was detected at the left ventricular apex in 7 patients and at the inferior and inferolateral regions in 3 patients. There was no difference in the level of NT-proBNP in patients with CSFP. However, the NT-proBNP levels were higher in patients with CSFP, who had scar tissue in CMR (p=0.022). Conclusions In conclusion, LGE in CMR showed that ischemic myocardial scarring may exist in patients with CSFP. These results indicate that CSFP may not always be innocent. (Arq Bras Cardiol. 2020; 114(3):540-551)

Assessing Autonomic Nervous Function by Heart Rate Variability and Heart Rate Turbulence in Patients with Acute Ischemic Stroke.

BACKGROUND: Acute ischemic stroke (AIS) induces adverse effects on the cardiovascular system by affecting the autonomic nervous system (ANS). OBJECTIVES: This study aimed to determine whether the parameters of heart rate variability (HRV) and heart rate turbulence (HRT) differed in patients with AIS as compared to that in the control group. Furthermore, we aimed to determine the differences in the involvement of the ANS between right and left hemisphere (LH) strokes. METHODS: A total of 148 [74 right hemispheres (RH) and 74 left hemispheres] patients with AIS and 80 control subjects were included in the study. The Holter device was used to obtain elcctrocardiogram readings for over 20 h from all patients. Results of HRV and HRT parameters [Tonset (TO) and Tslope (TS)] were acquired through an automatic analysis of the program. RESULTS: All HRV parameters were found to be low in patients with AIS (P < 0.05, for all parameters). TO and TS were disrupted in 99 patients with AIS (66.8%) and in 15 control subjects (18.7%) (HRT-1 and HRT-2 groups, P = <0.001). HRV parameters were detected to be similar in patients, irrespective of the left or right infarct. TO and TS were normal in 31 patients (41.9%) with left hemisphere localization and in only 18 patients (24.3%) with right hemisphere localization. CONCLUSIONS: Combined evaluation of HRV and HRT parameters may provide important information regarding the alterations in the ANS in patients with AIS. The utility of HRT in the determination of ANS alterations in patients with AIS should be investigated in larger future prospective studies.

An old friend: uric acid and its association with fractional flow reserve

Background/aim: The aim of this study was to investigate the importance of preprocedural uric acid (UA) level in predicting fractional flow reserve (FFR) results of intermediate coronary lesions in patients with stable coronary artery disease undergoing coronary angiography. Materials and methods: We retrospectively analyzed 293 patients who underwent FFR measurement to determine the significance of intermediate coronary stenosis detected by conventional coronary angiography. Patients were divided into 2 groups: Group 1 (n = 127) included patients with FFR of <0.80 (hemodynamically significant lesions), and Group 2 (n = 169) consisted of patients with FFR of >0.80 (hemodynamically nonsignificant lesions). Uric acid levels were assessed in both groups with the enzymatic colorimetric method by clinical chemistry autoanalyzer. Results: The mean UA level was significantly higher in patients whose FFR indicated hemodynamically significant coronary lesions (UA: 5.43 ± 1.29 mg/dL in Group 1 vs. 4.51 ± 1.34 mg/dL in Group 2, P < 0.001). Conclusion: Elevated UA levels are associated with hemodynamically significant coronary lesions measured with FFR. Uric acid may be used as a predictor of hemodynamically compromised coronary lesions before FFR procedures.