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Although methemoglobinemia is rare in adulthood, it may have fatal consequences if unnoticed. We planned to implant an implantable cardioverter defibrillator ICD in a 50-year-old male patient for primary prevention. Following sterile draping, prilocaine 5â mg/kg (400â mg) was injected subcutaneously for local anesthesia. We injected an additional dose of 200â mg due to pain during subclavian vein puncture. A DDD-R ICD was placed successfully within approximately 40 minutes. The patient complained of sudden chest pain and dyspnea 15 minutes after bed rest and was transferred to the coronary care unit due to cyanosis and deterioration of general status. Physical examination revealed blood pressure of 110/80 mmHg, pulse rate of 110 bpm, and otherwise unremarkable signs. Peripheral oxygen saturation was determined as 83% by pulse oximeter. Possible pneumothorax and cardiac perforation were excluded by emergency chest radiograph and echocardiography. Blood gas analyses was performed to assess for methemoglobinemia, which revealed pH 7.41, pCO2 40 mmHg, oxygen saturation 98.2%, and methemoglobin 7.9% that peaked to 12.3%. Methylene blue (1%) was slowly injected over 10 minutes at a dose of 1â mg/kg. Cyanosis waned and methemoglobin values decreased to 4.1%, 2.1%, and 1.1% at 2, 8, and 16 hours following the administration, respectively. The patient was safely discharged 2 days after implantation of pacemaker. Methemoglobinemia should be considered in cases presenting with cyanosis, non-diagnostic ECG, and a discrepancy in oxygen saturation between pulse oximetry and blood gas analyses.
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Left atrial function has an important role in determining optimal performance of the heart. Increase of left atrial dysfunction and volume are poor prognostic factors. In this study, we investigated independent determinants of left atrial function in non-diabetic patients with de novo hypertension. The study included 124 consecutive non-diabetic patients with de novo hypertension. Brachial artery flow-mediated dilatation, carotid intima-media thickness, transthoracic echocardiography, 24-h rhythm holter, and aortic stiffness measurements were recorded. In echocardiography, left atrial maximum (LAMaV) and minimum (LAMiV) volumes were calculated. Left atrium total emptying fraction (LATEF) and total emptying volume (LATEV) were divided into two groups according to the mean levels. Multivariate analysis was performed after correlation analysis for LATEV and LATEF mean levels. By logistic regression analysis, systolic blood pressure (OR 0.882, 95% CI 0.784-0.992, p = 0.036), percent of flow-mediated dilation (OR 0.747, 95% CI 0.595-0.938, p = 0.012), and presence of carotid plaque (OR 0.014, 95% CI 0.001-0.188, p = 0.001) were found as independent variables that determine LATEF. Age (OR 0.879, 95% CI 0.795-0.972, p = 0.012), smoking (OR 23.739, 95% CI 2.699-208.810, p = 0.004), left ventricular mass index (OR 1.052, 95% CI 1.012-1.094, p = 0.011), mitrale E-wave velocity (OR 1.108, 95% CI 1.031-1.191, p = 0.005) and LDL (low-density lipoprotein) cholesterol (OR 0.942, 95% CI 0.911-0.974, p = 0.001) were independent predictors of LATEV. In non-diabetic patients with de novo hypertension endothelial dysfunction, subclinical atherosclerosis and LDL cholesterol levels independently affect left atrial function.
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Función del Atrio Izquierdo , Remodelación Atrial , Arteria Braquial/fisiopatología , Enfermedades de las Arterias Carótidas/fisiopatología , LDL-Colesterol/sangre , Endotelio Vascular/fisiopatología , Hipertensión/fisiopatología , Vasodilatación , Adulto , Enfermedades Asintomáticas , Biomarcadores/sangre , Arteria Braquial/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/sangre , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Estudios de Casos y Controles , Estudios Transversales , Endotelio Vascular/diagnóstico por imagen , Femenino , Frecuencia Cardíaca , Humanos , Hipertensión/sangre , Hipertensión/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Placa Aterosclerótica , Pronóstico , Estudios Prospectivos , Rigidez VascularRESUMEN
Background: Visceral obesity is strongly associated with atherosclerosis. Even though waist circumference (WC) is the most common assessment method of total visceral adipose tissue and cardiometabolic risk, this method lacks direct measurement of adipose tissue and has better correlation to subcutaneous fat rather than visceral fat. We intended to investigate whether epicardial adipose tissue (EAT) is clinically superior to body mass index (BMI) and WC in predicting Framingham risk score (FRS) and carotid intima-media thickness (CIMT). Methods: Our study included 331 patients who were admitted to our outpatient clinic for risk factor assessment. We calculated BMI, FRS, and WC, and the patients underwent echocardiographic and carotid examinations to measure EAT and CIMT. The metabolic syndrome (MS) score was calculated by summing the MS risk factor scores. Results: The area under the curve values of EAT were similar to FRS and higher than those of weight, BMI, and WC for both increased CIMT and the presence of carotid plaque. Male gender, age, low-density lipoprotein-cholesterol level, and EAT thickness were independent predictors of CIMT, whereas male gender, age, WC, uric acid concentration, and EAT significantly predicted the presence of carotid plaque. Conclusions: This study demonstrated that epicardial adipose tissue (EAT) has a stronger correlation with CIMT than BMI and WC, and it was a significant predictor of increased CIMT and the presence of carotid plaque. Additional data are required to clarify the diagnostic and therapeutic role of EAT in managing obese patients, and to decrease their cardiometabolic risk.
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OBJECTIVE: To investigate the association of epicardial adipose tissue thickness with irritable bowel syndrome. METHODS: This case-control and observational study was conducted in Recep Tayyip Erdogan University between January and December 2014, and comprised patients of irritable bowel syndrome and healthy controls who underwent a complete transthoracic echocardiographic examination as well as measurements of epicardial adipose tissue. They were screened for psychiatric or organic bowel diseases for the sake of precise diagnosis. Epicardial fat thickness was measured perpendicularly in front of the right ventricular free wall at end-diastole.SPSS 15 was used to analyse the data. RESULTS: Of the 75 subjects, 44(59%) were patients and 31(41%) were controls. There was no statistically significant difference between the groups except epicardial adipose tissue thickness, which was significantly elevated in patients (p<0.001). C-reactive protein was significantly higher in patients (p=0.002). Epicardial adipose tissue (p<0.001) and haematocrit (p<0.05) were independent predictors of irritable bowel syndrome. CONCLUSIONS: Increased epicardial adipose tissue thickness, and accompanying low-grade inflammation appeared to be involved in irritable bowel syndrome pathogenesis.
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Tejido Adiposo/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico , Ecocardiografía/métodos , Síndrome del Colon Irritable/diagnóstico , Pericardio/diagnóstico por imagen , Adulto , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/etiología , Femenino , Estudios de Seguimiento , Humanos , Síndrome del Colon Irritable/sangre , Síndrome del Colon Irritable/complicaciones , Masculino , Persona de Mediana Edad , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: Nasal septum deformities (NSD) are one of the most common causes of upper airway obstruction. Heart rate variability (HRV) is a physiologic parameter that is affected by the balance between the sympathetic and parasympathetic tonus. OBJECTIVE: The aim of this study was to evaluate the effects of a septoplasty operation on HRV parameters as assessed by 24 hours ambulatory Holter recordings in patients with NSD. METHODS: The prospective study involved 54 consecutive patients (16 women and 38 men) who underwent septoplasty due to a marked C- or S-shaped NSD. Twenty-four-hour Holter monitoring was performed to all patients pre- and 2 months postseptoplasty operation. For the HRV analyses, the definitions of evaluated parameters were made according to the Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology on HRV. RESULTS: Low-frequency norm () (73 [68-86] versus 78 [70-81], Pâ=â0.039) values were significantly increased after septoplasty whereas changes in other parameters were not statistically significant. CONCLUSION: The authors' study showed that low-frequency norm values were significantly increased after septoplasty operation in patients with NSD which may be interpreted as a decreased sympathetic tone.
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Frecuencia Cardíaca , Obstrucción Nasal/fisiopatología , Obstrucción Nasal/cirugía , Tabique Nasal/cirugía , Rinoplastia , Adulto , Electrocardiografía Ambulatoria , Femenino , Humanos , Masculino , Tabique Nasal/anomalías , Estudios Prospectivos , Adulto JovenRESUMEN
BACKGROUND: Lichen planus (LP) carries the increased risk of cardiovascular events as it is a chronic inflammatory disease. This study aimed at determining the relationship between total atrial conduction time (TACT), P-wave dispersion, and the left atrium (LA) global strain in the patients with LP. METHODS: Forty people as a control group and 40 patients with LP were included in this study. Patient assessed global longitudinal LA strain by two-dimensional speckle-tracking strain echocardiography. RESULTS: The global peak systolic LA myocardium strain during the left ventricular systole (LAGLSRs) and the global peak negative LA myocardial strain rate during the early ventricular diastole (LAGLSRe) values were significantly lower in the patients with LP in proportion to the control group according to the strain measurements (1.7 ± 0.07 vs. 1.9 ± 0.1%, p = 0.001; 1.23 ± 0.04 vs. 1.2 ± 0.08 s-1, p = 0.001), respectively. TACT value was found to be significantly longer (102.6 ± 6.3 ms) in the patients with LP than the control group (96.3 ± 5.3 ms, p = 0.001), considering the terms of the artial conduction features. CONCLUSION: This study demonstrated that the subclinical cardiac involvement in LP can determine the prolonged TACT and the impaired left atrial myocardial deformation values.
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BACKGROUND: Prolonged QRS duration is associated with decreased left ventricular (LV) systolic function. However, the relation between LV restrictive filling pattern (RFP) and QRS duration has not been investigated yet. The purpose of our study was to assess this relationship. METHODS: We analyzed standard 12-lead surface electrocardiogram (ECG) of 155 consecutive patients. Mitral inflow and septal tissue velocities were obtained using the apical 4-chamber view with pulsed Doppler echocardiography. Patients were divided into 2 groups according to measured deceleration time (DT): restrictive (with DT ≤130 ms) or non-restrictive (with DT >130 ms). RESULTS: QRS duration was significantly longer in the restrictive group than in the non-restrictive group (0.101 vs. 0.090 s, p < 0.0001). QRS duration of >0.10 s was highly specific (82.6%), but modestly sensitive (64.7%), for the prediction of LV RFP. Multivariate analyses demonstrated that E/A ratio, peak E, peak A, septal e', and a' velocities were significantly associated with RFP. CONCLUSIONS: Prolonged QRS duration (>0.10 s) obtained from a standard resting 12-lead ECG is associated with LV RFP. However, the relationship of QRS duration with RFP was not independent of echocardiographic parameters.
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OBJECTIVE: Serum YKL-40 plays roles in inflammatory and vascular processes. Our aim was to evaluate serum YKL-40 levels in patients with ankylosing spondylitis (AS) and to investigate their potential relationship with arterial stiffness based on carotid-femoral pulse wave velocity (CF-PWV). METHODS: Forty-three patients with AS and 41 healthy controls with no history or current signs of cardiovascular disease were included in the study. All patients were administered nonsteroidal anti-inflammatory drugs (NSAIDs), and none were prescribed anti-tumor necrosis factor agents. Serum YKL-40 levels were measured. CF-PWV and intima-media thickness of the common carotid artery (IMT-C) were evaluated. RESULTS: The mean age of AS patients was 34.6 ± 10.2 years and of controls was 36.3 ± 9.0 years. CF-PWV was significantly higher in AS patients than in controls (8.2±2.7 vs.7.0±1.6 m/s, respectively; P=0.015). However, the IMT-C was not significantly different between AS patients and controls (0.6±0.3 vs. 0.5±0.2 mm, P=0.501). YKL-40 levels were significantly higher in AS patients than in controls (78.9±37.9 vs. 58.4±21.2 ng/mL, P=0.003) and were strongly correlated with CF-PWV (r=0.773, P < 0.001) and IMT-C (r=0.548, P < 0.001). A multiple linear regression analysis revealed that CF-PWV could be explained by serum YKL-40 levels and IMT-C (adjusted R²= 0.707, P=0.013 and P=0.001, respectively). AS patients with a higher disease activity score had higher YKL-40 levels, IMT-C, and CF-PWV than did those with a lower disease activity score (P < 0.001, P=0.008, and P < 0.001, respectively) Conclusion: AS patients had higher serum YKL-40 levels, CF-PWV, and IMT-C than did healthy controls. Additionally, there was an association between increased CF-PWV and serum YKL-40 levels. Therefore, we conclude that CF-PWV and YKL-40 levels may be used for early diagnosis of atherosclerosis in AS patients.
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Proteína 1 Similar a Quitinasa-3/sangre , Espondilitis Anquilosante/sangre , Espondilitis Anquilosante/fisiopatología , Rigidez Vascular , Adulto , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Femenino , Humanos , Masculino , Análisis de la Onda del Pulso , Espondilitis Anquilosante/complicacionesRESUMEN
BACKGROUND: Slow coronary flow (SCF) is an angiographic finding characterized with delayed opacification of epicardial coronary arteries without obstructive coronary disease. Urotensin II (UII) is an important vascular peptide, which has an important role in hypertension, coronary artery disease, and vascular remodeling in addition to potent vasoconstrictor effect. OBJECTIVES: We investigated UII levels, hypertension, and other atherosclerotic risk factors in patients with SCF, a variety of coronary artery disease. METHODS: We enrolled 14 patients with SCF and 29 subjects with normal coronary arteries without SCF. We compared the UII levels and the atherosclerotic risk factors between patients with SCF and control subjects with normal coronary flow. RESULTS: UII concentrations were significantly higher in patients with SCF compared to controls (711.0 ± 19.4 vs. 701.5 ± 27.2 ng/mL, p = 0.006). We detected a positive correlation between SCF and age (r = 0.476, p = 0.001), BMI (r = 0.404, p = .002), UII concentrations (r = 0.422, p = 0.006), and hypertension (r = 0.594, p = 0.001). CONCLUSION: We identified increased UII levels in patients with SCF. We think that UII concentrations may be informative on SCF pathogenesis due to relationship with inflammation, atherosclerosis, and vascular remodeling.
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BACKGROUND: Endothelial selectine molecules (ESMs) and Toll-like receptors (TLRs) were suggested to be associated with the pathogenesis of Behçet's disease (BD). 25(OH)D deficiency may be associated with endothelial and immune dysfunction. The aim of this study is to investigate the relationship between the 25(OH)D level, and ESMs and TLRs in BD patients. PATIENTS AND METHODS: BD patients were classified as 25(OH)D deficient (Group 1) and sufficient (Group 2) groups. Vitamin D replacement therapy was given to Group 1, after the last replacement dose blood was again collected. ESMs and TLRs levels were evaluated and compared both between Group 1 and Group 2, and pre- and post-treatment measurements of Group 1. RESULTS: The baseline plasma levels of ESMs were significantly higher in Group 1 than in Group 2 (p < 0.05). There were not any significant differences in baseline TLRs levels between Group 1 and Group 2. The mean plasma levels of ESMs were significantly lower in post-replacement assessments (p < 0.05). The mean plasma levels of TLRs were lower in post-replacement assessments, but not significantly (p > 0.05). The active stage disease rate was higher in pre-treatment group (36.3%) than post-treatment group (34.6%), but the difference was not significant (p > 0.05). CONCLUSION: Although vitamin D replacement in 25(OH)D deficient BD patients may have some beneficial effects on vascular dysfunction, it cannot be considered the primary treatment modality.
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Síndrome de Behçet/tratamiento farmacológico , Biomarcadores/sangre , Selectina E/sangre , Endotelio Vascular/efectos de los fármacos , Receptores Toll-Like/sangre , Deficiencia de Vitamina D/tratamiento farmacológico , Vitamina D/análogos & derivados , Adolescente , Adulto , Síndrome de Behçet/sangre , Cromatografía Líquida de Alta Presión , Endotelio Vascular/metabolismo , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vitamina D/uso terapéutico , Deficiencia de Vitamina D/sangreRESUMEN
BACKGROUND We planned to investigate the relationship of thrombus burden with SYNTAX score in patients with ST elevation myocardial infarction (STEMI). MATERIAL AND METHODS We retrospectively enrolled 780 patients who underwent PPCI in our clinic due to STEMI. Clinical, laboratory, and demographic properties of the patients were recorded. Angiographic coronary thrombus burden was classified using thrombolysis in myocardial infarction (TIMI) thrombus grades. RESULTS Patients with high thrombus burden were older, with higher diabetes prevalence longer pain to balloon time, higher leukocyte count, higher admission troponin, and admission CK-MB concentrations. SYNTAX score was higher and myocardial perfusion grades were lower in patients with high thrombus burden. Multivariate logistic regression analysis revealed SYNTAX score as the strongest predictor of thrombus burden. ROC analysis demonstrated a sensitivity of 75.5%, specificity of 61.2%, and cut-off value of >14 (area under the curve (AUC): 0.702; 95% confidence interval [CI]: 0.773-0.874;P<0.001) for high thrombus burden. CONCLUSIONS SYNTAX score may have additional value in predicting higher thrombus burden besides being a marker of coronary artery disease severity and complexity.
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Enfermedad de la Arteria Coronaria/patología , Trombosis/patología , Adulto , Anciano , Biomarcadores/sangre , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/patología , Infarto del Miocardio/cirugía , Intervención Coronaria Percutánea , Curva ROC , Estudios Retrospectivos , Trombosis/sangreRESUMEN
OBJECTIVE: Gilbert's syndrome (GS) is an autosomal recessive disease that is characterized by an increase in indirect bilirubin (IB). The incidence of atherosclerotic heart disease is decreased in GS. This study aimed to investigate the relation between pulse wave velocity (PWV) and the presence of GS. METHODS: The study included 58 GS patients (32 females, age; 27.12 ± 7.27 years, 26 males, age; 26.63 ± 5.84 years) admitted to the internal medicine clinic of the hospital. The control group included 58 healthy individuals (35 females [27.33 ± 8.06 years old, p=0.716] and 23 males [27.38 ± 6.91 years old, p=0.923]). PWV of both groups was measured from the right carotid and femoral arteries. RESULTS: Mean age of the GS group was 26.03 ± 8.22 years, while that of the healthy group was 26.60 ± 5.84 years. The GS group's diastolic blood pressure and PWV were significantly lower than those of the control group: 67.76 ± 8.59 mmHg vs 71.72 ± 7.28 mmHg; p=0.008, and 5.63 ± 1.12 m/s vs 6.18 ± 1.22 m/s; p=0.014 respectively. The GS group's high density lipoprotein (HDL) level was significantly higher than that of the control group: 1.4 ± 0.3 mmol/L vs 1.2 ± 0.3 mmol/L, p=0.029. CONCLUSION: This study found PWV among GS patients to be lower than that among non-smoking and aged-matched healthy controls.
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Aorta/fisiopatología , Bilirrubina/sangre , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de Gilbert , Adulto , Velocidad del Flujo Sanguíneo , Estudios de Casos y Controles , Enfermedad de la Arteria Coronaria/sangre , Estudios Transversales , Femenino , Humanos , Masculino , Flujo Pulsátil , Rigidez VascularRESUMEN
OBJECTIVE: Epicardial adipose tissue (EAT) secretes various pro-inflammatory and atherogenic mediators that have several endocrine and paracrine effects on heart. This study investigated the influence of EAT on QT and P wave dispersions (QTd, PWd), as simple, non-invasive tools of proarrhythmia on surface ECG. METHODS: This was a cross-sectional study and included 70 patients with normal coronary arteries who underwent 12-derivation electrocardiography, echocardiography and biochemical examinations in order for QTd, PWd, and EAT thickness to be measured. RESULTS: Median EAT thickness was 4.1 mm. Correlation analyses revealed that EAT was significantly associated with age (r=0.412, p<0.001), weight (r=0.262, p=0.028), body mass index (r=0.396, p<0.001), left atrium diameter (r=0.518, p<0.001), fasting plasma glucose (r=0.245, p=0.041), maximum P wave duration (r=0.343, p=0.004), minimum P wave duration (r=0.275, p=0.021) and PWd (r=0.265, p=0.026). No relation was found between study parameters and QTd. However, P wave dispersion was significantly related to EAT thickness (r=0.265, p=0.026), left atrium diameter (r=0.483, p<0.001), and the triglyceride levels (r=0.267, p=0.028). Multiple linear regression analyses revealed left atrial diameter as the only independent predictor of PWd. CONCLUSION: A significant association between EAT and PWd was demonstrated in the study. While EAT is related to both increased PWd and left atrial size, left atrial diameter seems to be more important than EAT for prediction of atrial fibrillation (AF) in patients with normal coronary arteries.
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Tejido Adiposo/diagnóstico por imagen , Fibrilación Atrial/diagnóstico , Electrocardiografía , Pericardio/diagnóstico por imagen , Tejido Adiposo/patología , Fibrilación Atrial/sangre , Angiografía Coronaria , Estudios Transversales , Femenino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Sistema de Conducción Cardíaco , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Pericardio/patología , Valor Predictivo de las Pruebas , Triglicéridos/sangreRESUMEN
OBJECTIVE: Catestatin has several cardiovascular actions, in addition to diminished sympatho-adrenal flow. Decreased plasma catestatin levels may reflect a predisposition for the development of hypertension and metabolic disorders. We planned to investigate the possible roles of catestatin in untreated hypertensive patients. As a secondary objective, we compared catestatin concentrations of healthy subjects with those of hypertensive patients in order to understand whether catestatin is increased reactively or diminished at onset. METHODS: Our study was cross-sectional and observational. The patient group, comprising 109 consecutive untreated hypertensive patients without additional systemic or coronary heart disease, underwent evaluations of plasma catestatin, waist circumference, lipid parameters, left ventricular mass, carotid intima-media thickness, and flow-mediated dilation of the brachial artery. Additionally, we measured catestatin concentrations of 38 apparently healthy subjects without any disease using a commercial enzyme-linked immunosorbent assay kit. RESULTS: We documented increased catestatin concentrations in previously untreated hypertensive patients compared to healthy controls (2.27±0.83 vs. 1.92±0.49 ng/mL, p=0.004). However, this association became insignificant after adjustments for age, gender, height, and weight. Within the patient group, catestatin levels were significantly higher in females. Among all study parameters, age, high-density lipoprotein cholesterol (HDL-C) correlated positively to plasma catestatin, whereas triglycerides, hemoglobin, and left ventricular mass correlated negatively to plasma catestatin. We could not detect an association between vascular parameters and catestatin. Catestatin levels were significantly elevated with increasing HDL-C (1.91±0.37, 2.26±0.79, and 3.1±1.23 ng/mL in patients with HDL-C <40, 40-60, and >60 mg/dL, respectively). Multiple linear regression analysis revealed age (beta: 0.201, p=0.041) and HDL-C (beta: 0.390, p<0.001) as independent correlates of plasma catestatin concentration. Additionally, male gender (beta:-0.330, p=0.001) and plasma catestatin (beta: 0.299, p=0.002) were significantly associated with HDL-C concentrations. CONCLUSION: We documented that plasma catestatin is an independent predictor of high-density lipoprotein cholesterol. In addition to antihypertensive effects, catestatin appears to be related to improved lipid and metabolic profiles. Coexistence of low catestatin levels with low HDL-C may provide a probable mechanism for the predictive value of low HDL-C for increased hypertension and cardiovascular events.
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HDL-Colesterol/sangre , Cromogranina A/sangre , Hipertensión/fisiopatología , Fragmentos de Péptidos/sangre , Adulto , Antropometría , Estudios Transversales , Femenino , Humanos , Hipertensión/sangre , Modelos Lineales , Masculino , Persona de Mediana Edad , Triglicéridos/sangreRESUMEN
BACKGROUND: Fragmented QRS (fQRS) complex is associated with increased sudden cardiac death, recurrent cardiovascular events, morbidity and mortality. However, the prognostic role of fQRS has not been comprehensively studied in patients undergoing coronary artery bypass graft (CABG) surgery. In this study, we planned to investigate the relationship of fQRS with prognostic markers and long-term major adverse cardiovascular events (MACEs) following isolated CABG surgery. METHODS: Two hundred and thirteen patients who underwent CABG surgery at our institution were enrolled consecutively. MACE was defined as cardiac death, recurrent myocardial infarction, decompensated heart failure and re-hospitalization. The patients were followed up for a mean duration of 26â±â10 months for MACE. RESULTS: Patients with fQRS had a higher rate of Q wave on ECG (30 vs. 10%, Pâ<â0.001), more prolonged QRS time (99â±â11 vs. 88â±â13âms, Pâ<â0.001), higher EUROSCORE (4.0â±â1.9 vs. 2.7â±â1.5, Pâ<â0.001) and lower left ventricular ejection fraction (44â±â12 vs. 56â±â12, Pâ<â0.001) in comparison with patients with non-fQRS. In addition, patients with fQRS had increased short-term and long-term MACE (17 vs. 4%, Pâ=â0.002; 23 vs. 6%, Pâ<â0.001, respectively) after discharge. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of fQRS for predicting MACE were 67, 71, 23, 94 and 70%, respectively. fQRS [odds ratio (OR) 3.110, 95% confidence interval (CI) 1.157-8.362, Pâ=â0.025] and prolonged QRS duration (>100âms) (OR 3.898, 95% CI 1.463-10.39, Pâ=â0.007) were the only independent predictors of long-term MACE in multivariate logistic regression analysis. However, QRS duration had a better association with MACE than the presence of fQRS. CONCLUSION: fQRS and prolonged QRS duration may have an additional value in predicting cardiac status and long-term prognosis. Fragmentations on admission ECG and prolonged QRS duration may be useful for identifying patients with higher long-term risk who will need more intense treatment and close follow-up after CABG surgery.
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Arritmias Cardíacas/complicaciones , Puente de Arteria Coronaria/efectos adversos , Anciano , Muerte Súbita Cardíaca/etiología , Electrocardiografía/métodos , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/etiología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Readmisión del Paciente/estadística & datos numéricos , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Recurrencia , Sensibilidad y EspecificidadRESUMEN
BACKGROUND AND OBJECTIVES: Left ventricular hypertrophy (LVH), a sign of subclinical cardiovascular disease, is an important predictor of cardiovascular morbidity and mortality. The aim of our study was to determine the association of left ventricular mass (LVM) with possible causative anthropometric and biochemical parameters as well as carotid intima-media thickness (CIMT) and brachial flow-mediated dilation (FMD) as surrogates of atherosclerosis and endothelial dysfunction, respectively, in previously untreated hypertensive patients. SUBJECTS AND METHODS: Our study included 114 consecutive previously untreated hypertensive patients who underwent echocardiography and ultrasonography to evaluate their vascular status and function via brachial artery CIMT and FMD. RESULTS: Among all study parameters, age, systolic blood pressure (BP), diastolic BP, pulse pressure, plasma glucose, uric acid, total bilirubin, direct bilirubin, hemoglobin, and CIMT were positively correlated with the LVM index. Multiple logistic regression analysis revealed that office systolic BP, age, male gender, and total bilirubin were independent predictors of LVH. CONCLUSION: Bilirubin seems to be related to LVM and LVH. The positive association of bilirubin with these parameters is novel and requires further research.
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AIM: : To evaluate carotid-femoral pulse wave velocity (CF-PWV) values of patients with pseudoexfoliation (PEX) glaucoma in comparison with healthy subjects. METHODS: Twenty-five consecutive patients with PEX glaucoma (PEXG group) and 25 controls (control group) were included in the study. CF-PWV was assessed by a noninvasive device by the measurements of pulse transmit time and the distance between 2 recording sites. RESULTS: The mean age was 64.7±7.3 (range, 55 to 79) years the in PEXG group and 63.8±6.6 (range, 51 to 77) years in the control group. There were 8 men (32%) and 17 women (68%) in the PEXG group and 11 men (44%) and 14 women (56%) in the control group. The CF-PWV of the PEX group was significantly higher than that of the control group (P<0.001). CONCLUSIONS: We have revealed an association between PEXG and increased CF-PWV. Also, increased CF-PWV may be considered as a risk factor for the development of PEXG.
Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Síndrome de Exfoliación/fisiopatología , Rigidez Vascular/fisiología , Anciano , Presión Sanguínea/fisiología , Índice de Masa Corporal , Arterias Carótidas/fisiología , Femenino , Arteria Femoral/fisiología , Frecuencia Cardíaca/fisiología , Humanos , Lípidos/sangre , Masculino , Persona de Mediana Edad , Flujo Pulsátil/fisiología , Análisis de la Onda del Pulso , Factores de RiesgoRESUMEN
OBJECTIVE: Atherosclerotic heart diseases are less frequently seen in patients with Gilbert's syndrome (GS). We aimed to investigate whether serum adiponectin (APN) and epicardial adipose tissue (EAT) thickness have an effect beside the antioxidant effect of bilirubin in lowering the incidence of the atherosclerotic process. METHODS: Sixty-eight patients diagnosed with GS (39 females and 29 males) who had applied at the internal medicine clinic of the hospital were included in this cross-sectional, observational study. The control group included 63 healthy people (39 females and 24 males). EAT thickness was measured by echocardiography. The serum APN levels were also checked. Statistical analysis was performed by using independent sample t-test, Pearson correlation and linear regression analyses. RESULTS: The mean age of the GS group was 28 ± 9 years, and the average EAT thickness was found to be 2.5 ± 0.1 mm. The mean age of the control group was 26 ± 6 years, and the average EAT thickness was found to be 4.2 ± 0.5 mm. When comparing the two groups, the EAT thickness of the GS group was found to be significantly lower (p<0.001) than that of the control group. In the GS group the APN was 14.9 ± 4.2 mg/L, and in the control group the APN was 12.6 ± 4.5 mg/L (p<0.022). We found that total bilirubin (ß=-1,607, p<0,001) and indirect bilirubin (ß=1,086, p<0,001) have an independent association with decreased EAT thickness. CONCLUSION: EAT thickness is associated with coronary atherosclerosis. Low EAT thickness may be related with low release of proinflammatory cytokine. High levels of APN may be related high anti-inflammatory effect. Therefore, low EAT thickness and high levels of APN may demonstrate protective effect on atherosclerotic heart diseases in GS patients.