Gender equity imbalance in electrocardiology: A call to action.

Despite the increasing number of women entering the medical profession, senior positions and academic productivity in many fields of medicine remain to be men dominated. We explored gender equity in electrocardiology as perceived by recent academic productivity and also active participation (presidencies and board constituents) in both the International Society of Electrocardiology (ISE) and the International Society for Holter and Noninvasive Electrocardiology (ISHNE). Academic productivity was measured by authorship (first and senior) in the Journal of Electrocardiology (JECG) and the Annals of Noninvasive Electrocardiology (ANE) in 2015. The percentage of women ISE and ISHNE Presidents was 5.6% and 0%, respectively. Current women board constituents for each society was 12.1% for ISE, and 9.4% for ISHNE. JECG articles published in 2015 had considerably less women compared to men for both senior (16.3%) and first (25.3%) authorship. ANE articles published in 2015 followed the same trends in gender, having less women compared to men for both senior (9.4%) and first (19.3%) authorship. There is a gender equity imbalance in the field of Electrocardiology. Identifying a gender imbalance is important for understanding reasons behind these trends, and may also help improve gender equity in Electrocardiology.

Multiscale regularity analysis of the Heart Rate Variability: stratification of cardiac death risk.

Subjects with ischemic dilated cardiomiopathy tend to suffer episodes of sudden cardiac death, thus risk stratification is essential to establish an adequate therapy for the patients. In this work, a new methodology was proposed for the study of the heart rate variability by using a multiscale analysis based on the concept of entropy rates, for improving risk prediction in cardiac patients. Symbolic dynamics were applied to RR time series and sets of words in several scales were constructed. The multiscale regularity analysis was proposed by comparing the entropies, calculated using Shannon and Renyi definitions, of the series of words in different scales. The study considered the selection of the best parameters for the length of the words (l) and the order of the entropies (q). Statistical analysis with repeated measures and discriminant analysis revealed statistically significant differences (p-value<0.05) and a high percentage of well classified subjects in their different risk groups, with sensitivity, specificity and positive predictive values of 100%.

The cardiac safety of chloroquine phosphate treatment in patients with systemic lupus erythematosus: the influence on arrhythmia, heart rate variability and repolarization parameters.

Antimalarials are used to treat cutaneous and systemic lupus erythematosus (SLE). Even though cardiac damage is a rare complication, over the last decade several reports have raised the issue of cardiotoxicity associated with antimalarials. Therefore, the aim of study was to evaluate the influence of seven-month chloroquine treatment with a 250mg daily dose on arrhythmia, conduction disturbances as well as heart rate variability and repolarization parameters assessed in 24-hour Holter monitoring. The studied group included 28 SLE patients treated with chloroquine as a monotherapy. In all the patients standard 12 leads surface ECG (50 mm) and the 24-hour ECG Holter monitoring (Oxford Medilog Excel-2) were performed before and after chloroquine phosphate treatment. All subjects presented sinus rhythm both at the enrollment and after treatment. No episodes of paroxysmal arrhythmias or conduction disturbances were reported during the study. All the patients were characterized by tendency to tachycardia, but no significant differences in mean heart rate were found before and after chloroquine administration. Similarly, no changes in heart rate variability or repolarization parameters were observed.

Non-invasive cardiac evaluation in patients with systemic lupus erythematosus.

The aim of this study was non-invasive assessment of cardiac function in patients with systemic lupus erythematosus (SLE). In a group of 36 patients with SLE transthoracic echocardiography, standard ECG and the 24-hour ECG Holter monitoring were performed and the results were compared to a control group of 35 healthy volunteers. Significantly lower mean values of heart rate variability (HRV), the presence of late ventricular potentials and tendency to tachycardia were detected in SLE patients when compared to the control group. On echocardiography examination valvular lesions were found in 15 SLE patients but only in 5 of them were insignificant mitral or aortic regurgitant jets observed. Echocardiography did not reveal abnormalities in cardiac dimensions and left ventricle systolic function. Abnormal indexes of left ventricular filling were found in 3 patients. All SLE patients with antiphospholipid antibodies had some cardiovascular manifestation.

[Evaluation of early cardiovascular involvement in patients with systemic sclerosis]. / Ocena wczesnych zmian w ukladzie sercowonaczyniowym u pacjentów z twardzina ukladowa.

UNLABELLED: The aim of the study was to evaluate cardiac function in patients with systemic sclerosis by means of noninvasive methods in order to detect early dysfunction of cardiovascular system. MATERIAL AND METHODS: We studied a group of 19 patients (15 women, 4 men, aged 17-74 yrs, av. 51 +/- 11) with systemic sclerosis comparing the results with a group of 23 healthy volunteers (17 women, 6 men aged 21-69 yrs, av 53 +/- 15). All the patients with SSc were taking corticosteroids, immunosuppressants or vasodilators at the time of the study. In all the patients we performed 24-hour Holter monitoring for the evaluation of arrhythmias, conduction disturbances, ischaemia, heart rate variability (HRV) and late potentials (LP). The following parameters of HRV in time domain were analyzed: SDNN, SDANN, SDNNI, rMSSD, pNN50. Standard ECG was performed to assess QT interval (QT, QTc, QTd). In all the patients the echocardiography examination was performed (M-Mode, 2-D, Doppler echocardiography). The morphology of heart structures and haemodynamic function were analyzed. RESULTS: In patients with SSc Holter monitoring revealed tendency to tachycardia. The mean heart rate was 81 +/- 11 vs. 71 +/- 9 in controls. Conduction disturbances were observed in 3 pts. In 6 pts we found significant ventricular arrhythmia. Silent ischaemia episodes were detected in 6 pts. Concerning HRV analysis the significantly lower values were detected in pts with SSc vs. controls: SDNN 123 vs 170; SDNNI 51 vs 76; SDANN 110 vs 152; rMSSD 29.6 vs 54; pNN50 6.1 vs 21. Late potentials were present in one patient with SSc vs none in the control group. The mean values QT-371, QTc-419, QTd-40- did not exceed the ranges of normal values. No signs of systolic cardiac dysfunction were detected, while in 6 pts we recognized left ventricle diastolic dysfunction. Valvular lesions were observed in 8 pts, but only in 2 pts they were hemodynamically important. CONCLUSIONS: 24-hour Holter monitoring and ECHO examination are valuable methods, which allow to detect early dysfunction of cardiovascular system in patients with systemic scleroderma presenting no apparent cardiac impairment symptoms.

[Sex steroids versus lipid profile and the degree of coronary artery stenosis in men with angiographically documented coronary artery disease]. / Steroidy plciowe a profil lipidowy i zaawansowanie zmian miazdzycowych w naczyniach wiencowych u mezczyzn z udokumentowana angiograficznie choroba wiencowa.

The aim of the study was to assess the correlations between the levels of sex hormones and blood lipid profile as well as indexes of coronary artery stenosis in men with angiographically documented coronary artery disease. 111 men, aged 36-73 yrs (av. 55) were studied. In all the patients levels of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), estradiol (E), SHBG, LH and FSH were measured. The level of bioavailable testosterone (BT) was calculated knowing SHBG level. Total cholesterol (TCh), HDL-cholesterol, LDL-cholesterol and triglycerides (TG) levels were estimated as well as the degree of coronary artery stenosis was estimated by means of modified indexes. For statistics R-Spearman test was used. Summing coronary stenosis index correlated significantly with T-Ch and LDL-Ch levels. Positive correlation was found between blood level of E and TCh as well as between E and LDL-Ch. BT correlated partially with LDL-Ch level. No correlations were found between the levels of T, SHBG, DHEA-S, FSH, LH and lipid profile. The level of DHEA-s revealed negative correlation with age, while the level of SHBG increased with ageing leading to the decrease of the value of BT but not total T. None of studied hormones correlated with coronary indexes. Our results suggest that estradiol and BT may promote the formation of atherogenic lipid profile leading to atherosclerosis in men.