Exercise-induced myocardial ischemia in patients with coronary artery ectasia without obstructive coronary artery disease.

BACKGROUND: Aetiology, clinical significance and treatment options for coronary artery ectasia/aneurysm is not clear. OBJECTIVE: We sought to determine whether exercise can induce coronary ischemia in patients with coronary artery ectasia/aneurysm without significant coronary stenosis. METHODS: Coronary artery ectasia was defined as 1.5-2-fold, aneurysm as >2-fold luminal dilatation of the adjacent normal segment. The study patients could have irregularities with ectatic coronaries but they did not have stenotic lesions >50% with visual assessment of two blinded observers. Patients having coronary artery ectasia or aneurysm with prior myocardial infarction, dilated cardiomyopathy, valvular heart disease, bundle branch block, significant ST-T changes were excluded. The control group was formed from a well matched population of 32 patients with normal coronary arteries who have not performed a treadmill test before coronary angiography. The study group underwent a symptom limited treadmill test if they did not have one before coronary angiogram, all control patients underwent treadmill test. RESULTS: Thirty-three patients with coronary artery ectasia/aneurysm (ranging from one to three vessels) but without significant stenosis were derived from 4470 cardiac catheterization procedures between January 1998 and July 2000. In the study group, 17 of the patients had positive treadmill tests with respect to five patients in the control group (P = 0.004). In subgroup analysis, diffuse ectasia/aneurysm (involving 2-3 vessels) was found to be strongly related with ischemia (P = 0.005) with respect to local disease. CONCLUSION: Coronary artery ectasia/aneurysm may lead to exercise induced ischemia, especially in the diffuse form.

Preoperative and postoperative cardiac and clinical findings of patients with adenotonsillar hypertrophy.

OBJECTIVE: Our aim was to determine if there was any detectable clinical and cardiac changes in hypertrophied adenotonsillary disease with obstructive sleep apnea syndrome and to demonstrate the curative effect of adenotonsillectomy on these patients. METHODS: Thirty-three children with adenotonsillary hypertrophy and sleep related breathing disorders were included in this study group. There were 16 female and 17 male patients and the mean age was 6.9+/-2 years. Age and sex matched control group consisted of 33 children (16 female, 17 male) with a mean age of 6.3+/-2. Complete clinical and laboratory examinations were done for each patient. The results were analysed with the SPSS (statistical package for social sciences) computer program. The significance of changes was performed by means of the independent samples of one-tailed t-test. For categorical variables, chi-square analysis was performed. RESULTS: According to our snoring scale, snoring was mild in six patients (18.2%), moderate in 19 patients (57.5%) and severe in eight patients (24.3%). Severe apnea was not observed in any patients, moderate apnea in ten patients (30.3%) and mild apnea was observed in 23 patients (69.7%) preoperatively. Nine patients had Grade IV tonsils, 14 patients Grade III, seven patients Grade II, three patients Grade I. Twelve patients had 3+ (obstructive) adenoids, 21 patients had 2+ adenoids. Chest X-rays showed cardiomegaly in two patients with moderate degree of apnea. Electrocardiogram results were abnormal in four patients. When we compared echocardiographic results of study and control groups, we found several significant differences (RV: 1.6+/-0.3 vs 1.4+/-0.2; P<0.05, LVEDD: 3.6+/-0.5 cm vs 3.3+/-0.4; P<0.05, IVS: 6.8+/-1.4 mm vs 6.1+/-1.1 mm; P<0.05). Also a decreased left ventricular compliance measured by prolongation of deceleration time was found in patient group (DT: 173+/-44 vs. 126+/-22 ms; P<0.001). The echocardiographic results in postoperative group were similar to control group. CONCLUSION: This study illustrated that adenotonsillary disease with obstructive sleep apnea symptoms leaded to right and/or left ventricular enlargement, hypertrophy when compared with control subjects, which were recovered postoperatively.

Heart rate variability in hypertrophic obstructive cardiomyopathy: association with functional classification and left ventricular outflow gradients.

BACKGROUND: The aim of this study was to investigate cardiac autonomic control in patients with hypertrophic obstructive cardiomyopathy (HOCM) and to assess the indexes of heart rate variability (HRV) in relation to the clinical and echocardiographic features. METHODS AND RESULTS: Twenty-three patients (17 male, six female: mean age 43+/-11) with HOCM and 18 healthy volunteers were included. M-mode and two-dimensional echocardiography, pulsed and continuous-wave Doppler studies were obtained. All patients and volunteers underwent continuous 24-h ambulatory ECG monitoring. Time domain variables considered in this study were standard deviation of mean R-R intervals (SDNN), root mean-squared successive difference (RMSSD) and percentage of cycles differing from the preceding one by more than 50 ms (PNN 50%). Patients were compared to detect associations between indices of heart rate variability, left ventricular outflow tract obstruction and clinical status. Heart rate variability parameters were also correlated with the echocardiographic and clinical characteristics of the patients. Both New York Heart Association (NYHA) functional class I-II patients (group I) and NYHA III-IV patients (group II) had lower values of SDNN, RMSSD and PNN 50% when compared with the control group (P<0.001, P<0.05 and P<0.01, respectively, for group I and P<0.001, P<0.001 and P<0.001, respectively, for group II). Time domain heart rate variability parameters were found to be significantly correlated with the subaortic dynamic obstruction. CONCLUSION: Heart rate variability is reduced in HOCM and well correlated with the degree of subaortic obstruction. Heart rate variability indices are also sensitive markers of the functional status.

Left sided inferior vena cava with sinus venosus type atrial septal defect.

A patient with left sided inferior vena cava and sinus venosus type atrial septal defect is presented. The patient was situs solitus, had abnormal pulmonary venous drainage and the left sided inferior caval vein returned to its usual route after the renal vein junction.

Thrombus in the main pulmonary artery of a patient with thromboangiitis obliterans: observation by transthoracic echocardiography.

We describe a 45-year-old man with thromboangiitis obliterans. He had a large immobile wall-adherent thrombus located in the main pulmonary artery, which was detected by transthoracic echocardiography. The pulmonary arterial involvement in this patient may suggest that thromboangiitis obliterans is a generalized vascular disease. We conclude that pulmonary artery should be thoroughly examined for thrombi in thromboangiitis obliterans patients who present with signs and symptoms of right heart failure. Transthoracic echocardiography should be the initial mode of examination in these patients.

QT interval dispersion: non-invasive marker of ischemic injury in patients with unstable angina pectoris?

Prognostic assessment of unstable angina pectoris is a common clinical problem for physicians. Markers of myocardial cell injury, serial electrocardiographic findings and ST segment monitoring are mainly studied for prognosis. We investigated the relation between myocardial injury and the value of cardiac troponin T and QT interval dispersion in hospitalized unstable angina patients. This is a prospective study that includes adult patients admitted to an emergency department with Braunwald class IIIB unstable angina pectoris. Eighty-six patients were enrolled in the study (mean age of 57 +/- 12 years, 63 males and 23 females). Cardiac troponin T was assayed and QT dispersion calculated from surface ECG. Fifty-eight patients with troponin T < 0.1 ng/ml and 28 patients with troponin T levels > or = 0.1 formed group 1 and group 2, respectively. There were no significant differences in sex, age, history of coronary revascularization or ECG findings such as ST depression and T inversions between the two groups. The QT dispersion was significantly greater in patients with elevated cardiac troponin T levels (77 +/- 18 msec vs 38 +/- 13 mse; p < 0.014). Because QT interval dispersion exhibited an association with cardiac troponin T levels, it may be used as a non-invasive marker of ischemic injury in patients with unstable angina.