A new method for evaluation of the autonomic nervous system in patients with idiopathic hyperhidrosis: systolic blood pressure and heart rate recovery after graded exercise.

BACKGROUND: Idiopathic hyperhidrosis (IH) is characterized by excessive and uncontrolled production of sweat, mainly localized to the soles, palms, axillae and craniofacial area. Although IH is a disease concerning the autonomic nervous system, it is not clear yet whether this dysfunction is local or systemic. OBJECTIVE: To evaluate the autonomic control of cardiovascular system by measuring values of heart rate recovery (HRR) and systolic blood pressure recovery (SBPR) obtained at various time intervals after maximal graded exercise treadmill testing in patients with IH compared with controls. METHODS: The study population comprised 36 patients with IH (20 men, 16 women; mean age 25 ± 7 years) and 36 healthy controls (HCs) (12 men, 24 women; mean age 27 ± 5 years). All patients were selected from young, nonobese and healthy sedentary individuals. RESULTS: Peak HR values reached in patients with IH were significantly higher compared with the HC group (P < 0.001). The obtained HRR values at minutes 3, 4 and 5 were significantly lower in the IH than the HC group [57 ± 16 vs. 64 ± 9 (P = 0.03); 61 ± 14 vs. 68 ± 9 (P = 0.03); 64 ± 12 vs. 70 ± 7 (P < 0.01)]. In addition, calculated mean values for SBPR1 and SBPR2 were > 1 in patients with IH (1.04 ± 0.15 vs. 0.98 ± 0.08 and 1.0 ± 0.12 vs. 0.94 ± 0.06, respectively) and these were statistically significant compared with the HC group (P = 0.04 and P = 0.03, respectively). CONCLUSIONS: The significantly impaired SBPR and decreased HRR values we observed in patients with IH may indicate that the autonomic dysfunction in IH is a systemic disorder with cardiovascular effects, rather than a merely local disease. Both HRR and SBPR values may provide additional information about predicting adverse cardiovascular events in the future even in apparently healthy young patients with IH.

Coronary subclavian steal syndrome: a case-based review.

Internal mammary artery (IMA) grafts have been shown to be superior to saphenous vein grafts in terms of rare atherosclerotic involvement, biochemical and physical qualities, and long-term patency rates. The IMA originates from the subclavian artery, just distal to the vertebral artery, and an occlusion or a hemodynamically significant stenosis proximal to the IMA ostium would cause a pressure drop distally and a reversal of flow from the coronary arteries to the IMA in patients with this graft. This condition is referred to as "coronary subclavian steal syndrome" (CSSS). In most cases, the cause of this syndrome is atherosclerotic disease; however, other causes of subclavian artery stenosis (SAS) have the potential to lead to CSSS. Patients with CSSS present with the symptoms of myocardial ischemia due to coronary steal, vertebrobasilar insufficiency, or limb ischemia. Discrepancy in the blood pressure (BP) measurements in two arms should warn the clinician of SAS. A diminished pulse or the bruit of jet flow on the lesion side can be noticed. Doppler ultrasonography, computed tomography angiography, and magnetic resonance angiography are safe and accurate noninvasive modes of diagnosis. Treatment can be surgical or percutaneous.

Circulating adhesion molecules and arterial stiffness.

AIM: VCAM-1 and ICAM-1 are two important members of the immunoglobulin gene superfamily of adhesion molecules, and their potential role as biomarkers of diagnosis, severity and prognosis of cardiovascular disease has been investigated in a number of clinical studies. The aim of the present study was to determine the relationship between circulating ICAM-1 and VCAM-1 levels and aortic stiffness in patients referred for echocardiographic examination. METHODS: Aortic distensibility was determined by echocardiography using systolic and diastolic aortic diameters in 63 consecutive patients referred for echocardiography. Venous samples were collected in the morning after a 12-hour overnight fast, and serum concentrations of ICAM-1 and VCAM-1 were measured using commercial enzyme immunoassay kits. RESULTS: Data of a total of 63 participants (mean age 55.6 ± 10.5 years, 31 male) were included in the study. Circulating levels of adhesion molecules were VCAM-1: 12.604 ± 3.904 ng/ml and ICAM-1: 45.417 ± 31.429 ng/ml. We were unable to demonstrate any correlation between indices of aortic stiffness and VCAM-1 and ICAM-1 levels. CONCLUSION: The role of soluble adhesion molecules in cardiovascular disease has not been fully established and clinical studies show inconsistent results. Our results indicate that levels of circulating adhesion molecules cannot be used as markers of aortic stiffness in patients.

Evaluation of biventricular myocardial performance index in patients with Behçet's disease.

OBJECTIVE: The global function of both left ventricular (LV) and right ventricular (RV) functions were compared in patients with Behçet's disease (BD) versus healthy controls. METHODS: Biventricular function was evaluated by measurement of the myocardial performance index (MPI) evaluated from tissue Doppler echocardiographic measurements in 24 BD patients and was compared with measurements in 24 age- and sex-matched healthy controls. RESULTS: Significantly higher MPI values were associated with ventricular dysfunction. The study demonstrated impaired RV function in patients with BD compared with healthy controls, whereas normal LV function was observed both in patients with BD and in healthy controls. CONCLUSION: Early noninvasive evaluation of the properties of BD during the asymptomatic phase of this inflammatory disease may have prognostic value in the management of patients.

Impact of obstructive sleep apnoea on left ventricular mass and global function.

Obstructive sleep apnoea syndrome (OSAS) might be a cause of heart failure. The present study aimed to assess left ventricular mass and myocardial performance index (MPI) in OSAS patients. A total of 67 subjects without any cardiac or pulmonary disease, referred for evaluation of OSAS, had overnight polysomnography and echocardiography. According to apnoea-hypopnoea index (AHI), subjects were classified into three groups: mild OSAS (AHI: 5-14; n = 16), moderate OSAS (AHI: 15-29; n = 18), and severe OSAS (AHI: > or = 30; n = 33). Thickness of interventricular septum (IVS) and posterior wall (LVPW) were measured by M-mode, along with left ventricular mass (LVM) and LVM index (LVMI). Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Döppler echocardiography. There were no differences in age or body mass index among the groups, but blood pressures were higher in severe OSAS compared with moderate and mild OSAS. In severe OSAS, thickness of IVS (11.2+/-1.1 mm), LVPW (11.4+/-0.9 mm), LVM (298.8+/-83.1 g) and LVMI (144.7+/-39.8 g x m(-2)) were higher than in moderate OSAS (10.9+/-1.3 mm; 10.8+/-0.9 mm; 287.3+/-74.6 g; 126.5+/-41.2 g x m(-2), respectively) and mild OSAS (9.9+/-0.9 mm; 9.8+/-0.8 mm; 225.6+/-84.3 g; 100.5+/-42.3 g x m(-2), respectively). In severe OSAS, MPI (0.64+/-0.14) was significantly higher than in mild OSAS (0.50+/-0.09), but not significantly higher than moderate OSAS (0.60+/-0.10). In conclusion, severe and moderate obstructive sleep apnoea syndrome patients had higher left ventricular mass and left ventricular mass index, and also left ventricular global dysfunction.

QT interval dispersion in obstructive sleep apnoea syndrome patients without hypertension.

QT interval dispersion (QT(d)) reflects inhomogeneity of repolarisation. Delayed cardiac repolarisation leading to the prolongation of the QT interval is a well-characterised precursor of arrhythmias. Obstructive sleep apnoea syndrome (OSAS) can cause cardiovascular complications, such as arrhythmias, myocardial infarction, and systemic and pulmonary hypertension. The aim of this study was to assess QT(d) in OSAS patients without hypertension. A total of 49 subjects without hypertension, diabetes mellitus, any cardiac or pulmonary diseases, or any hormonal, hepatic, renal or electrolyte disorders were referred for evaluation of OSAS. An overnight polysomnography and a standard 12-lead ECG were performed in each subject. According to the apnoea-hypopnoea index (AHI), subjects were divided into control subjects (AHI <5, n = 20) and moderate-severe OSAS patients (AHI > or =15, n = 29). QT(d) (defined as the difference between the maximum and minimum QT interval) and QT-corrected interval dispersion (QT(cd)) were calculated using Bazzet's formula. In conclusion, the QT(cd) was significantly higher in OSAS patients (56.1+/-9.3 ms) than in controls (36.3+/-4.5 ms). A strong positive correlation was shown between QT(cd) and AHI. In addition, a significantly positive correlation was shown between QT(cd) and the desaturation index (DI). The AHI and DI were significantly related to QT(cd) as an independent variable using stepwise regression analysis. The QT-corrected interval dispersion is increased in obstructive sleep apnoea syndrome patients without hypertension, and it may reflect obstructive sleep apnoea syndrome severity.

The effect of myocardial surgical revascularization on left ventricular late potentials.

BACKGROUND: The presence of ventricular late potentials (LP) is an important indicator for the development of ventricular tachyarrhythmias due to ischemic heart disease. The effect of myocardial revascularization on LP has remained controversial. The purpose of this study was to determine whether complete myocardial surgical revascularization (CABG) documented by myocardial perfusion scintigraphy might alter the substrate responsible for LP. METHODS: Prospectively, enrolled patients undergoing elective CABG were evaluated with thallium-201 myocardial perfusion scintigraphy and signal- averaged ECG pre- and postoperatively. SAECG recordings were obtained serially: before, 48-72 hours and 3 months after CABG. LPS were defined as positive if SAECG met at least two of Gomes criteria. Scintigraphies were performed pre- and 3 months postoperatively for determination of the success of revascularization. Changes observed in SAECG recordings after CABG were compared between those with and without successful revascularization. RESULTS: CABG resulted in successful revascularization in 23 patients and was unsuccessful in 17 (no change or deterioration of the perfusion defects). Preoperative SAECG values were not different between groups except for RMS values. The incidence of LP decreased significantly postoperatively in patients with improved myocardial perfusion, whereas there were no changes in patients who did not have postoperative perfusion improvement (McNemar test, P < 0.05). CONCLUSIONS: LPs disappear following the elimination of myocardial ischemia by complete surgical revascularization. Persistence of ischemia following CABG usually results in the persistence of late potentials. The incidence of ventricular arrhythmias is expected to be unchanged in these patients and they should be reevaluated for reinterventions.