Diagnostic value of ischaemia-modified albumin for predicting myocardial ischaemia during myocardial perfusion scintigraphy.

During acute ischaemia the N-terminal site of albumin is altered, reducing its binding capacity; the modified protein is termed ischaemia-modified albumin (IMA). IMA is a sensitive marker of acute myocardial ischaemia but its diagnostic value in chronic angina pectoris patients is unclear. We investigated changes in blood levels of IMA during myocardial perfusion scintigraphy in patients with chronic angina pectoris in a study including 26 male and 20 female patients, with mean age 60 years. Technetium 99m perfusion imaging detected myocardial ischaemia in 26 patients. Coronary angiography was carried out in these 26 ischaemic patients. Mean IMA values at rest and peak exercise were significantly higher in the ischaemic than the nonischaemic group. All IMA values were considered negative for cardiac ischaemia. Peak exercise IMA was significantly lower than the pre-exercise level only in the non-ischaemic group. IMA measurements during myocardial perfusion scintigraphy are not helpful in the diagnosis of myocardial ischaemia in patients with stable angina pectoris.

P-wave dispersion is increased in pregnancy due to shortening of minimum duration of P: does this have clinical significance?

Most pregnant women complain of palpitation, and various kinds of arrhythmias can be observed during pregnancy. We investigated P-wave and QT dispersion during pregnancy. Healthy pregnant women (n=162) and healthy age-matched, non-pregnant women (n=150) were included. We performed electrocardiography and transthoracic echocardiography and determined serum oestradiol levels in both groups, and performed Holter monitoring in the pregnant group only. Resting heart rate, P-wave dispersion, left ventricular diastolic diameter, left atrial diameter and serum oestradiol levels in the pregnant group were significantly higher than in the control group. Minimum P-wave duration was shorter in the control group than in the pregnant group; however, there was no statistically significant difference in maximum P wavelength and corrected QT dispersion between the groups. No atrial fibrillation was detected in the pregnant group during Holter monitoring. Shortening of the minimum P-wave duration leads to increased P-wave dispersion during pregnancy. In contrast to other pathologies with increased P-wave dispersion, paroxysmal atrial fibrillation is absent in pregnant women; this may be a result of the stable maximum P wavelength that is present during pregnancy.

Assessment of interventricular septal motion using colour tissue Doppler imaging in adult patients with atrial septal defect.

We aimed to characterize changes in interventricular septum (IVS) motion and any relationship between them and the pulmonary-to-systemic flow ratio (Qp/Qs) in adult patients with atrial septal defect (ASD). Patients and controls were studied using colour tissue Doppler imaging (TDI). The septum length (SL) and distance from the colour change point (CCP) on the IVS to the aortic valve (the CCP distance) were measured on parasternal long axis views. Values normalized for body surface area, and the CCP distance to SL ratio, were calculated. Qp/Qs values were correlated with CCP distance, normalized CCP distance and CCP distance:SL ratio. Statistically significant differences in CCP distance, normalized CCP distance and CCP distance:SL ratio were found between the two groups. In the ASD group, there was no correlation between Qp/Qs and the echocardiographic measurements. The point between the motions in two different directions from the IVS shifted toward the apex in ASD patients compared with controls, and may be a mechanism involved in paradoxical septal motion.

Wellens' syndrome: a case report.

The pattern of clinical findings and electrocardiography (ECG) changes known as Wellens' syndrome is associated with significant stenosis of the proximal left anterior descending coronary artery. Cases can be classified according to the ECG pattern into type 1 (biphasic T waves) or type 2 (deeply inverted T waves, especially in leads V2 and V3). We present here an unusual case of Wellens' syndrome in which the ECG pattern changed from type 2 to type 1 during observation, and in which the coronary lesion was in the middle rather than the proximal part of the left anterior descending artery.

Role of homocysteine for thromboembolic complication in patients with non-valvular atrial fibrilation.

Thromboembolism is the most important complication in patients with atrial fibrilation (AF). Homocysteine is a toxic amino acid that has been recently accepted as a risk factor for atherosclerosis and stroke. The aim of the present study is to show whether there is a relation between hyperhomocysteinemia and thromboembolic complications in patients with non-valvular AF. We admitted 38 patients with non-valvular AF. The patients were divided into two groups: group A (n = 20; mean age, 75.7 +/- 10.4 years; three males/17 females), and group B (n = 18; mean age, 68.0 +/- 10.6 years; 11 males/seven females). While group A consisted of the patients with AF and stroke, group B was composed of the patients with AF but without stroke. The patients having sinus rhythm (15 subjects) were used as the reference group to obtain the cut-off value. Homocysteine was measured by the immunoassay method. The means of the homocysteine levels were 12.4 +/- 3.3 micromol/l in group A, 8.3 +/- 2.3 micromol/l in group B and 9.3 +/- 1.8 micromol/l in the reference group. The cut-off value was 10.6 micromol/l. Group A had a statistically higher homocysteine level than not only group B, but also the reference group (P < 0.05). While 60% of group A (n = 12) had the elevated homocysteine level, the rate was only 22% for group B (n = 4). In conclusion, hyperhomocysteinemia may be one of the explanations for the increased rate of thromboembolic complications in older patients with AF.