Effects of lying position on p-wave dispersion in patients with heart failure

It was the aim of this study to investigate the effects of the right lateral decubitus, left lateral decubitus and supine lying position on P-wave dispersion [PWD] in patients with heart failure [HF]. Seventeen patients with HF whose ejection fraction was <35% were included in the study. Right lateral decubitus, left lateral decubitus and supine electrocardiogram [ECG] recordings were obtained. The recordings for each of the three positions were taken after the patients had maintained each position for 30 min to ensure a stabilized hemodynamic position. For the baseline recording, in supine position, there was no 30-min waiting period before the ECG. After the right lateral decubitus position, there was a statistically significant reduction in the longest P-wave duration [100.0 +/- 14.5 and 84.7 +/- 16.2 ms; p = 0.001] and a significant decrease in PWD [41.7 +/- 8.0 and 24.1 +/- 7.1 ms; p < 0.0001]. After the left lateral decubitus position, there was no significant change between the baseline PWD values [41.7 +/- 8.0 and 40.2 +/- 9.7 ms; p = 0.606]. After the supine position, there was no significant change between the baseline PWD values [41.7 +/- 8.0 and 39.7 +/- 9.4 ms; p = 0.427]. Our study revealed that patients' PWDs and maximum P-wave durations were lower in the right lateral decubitus lying position than in other positions. The clinical implication of this study needs to be further explored

Coronary sinus dilatation a simple additional echocardiographic indicator of severe rheumatic mitral and tricuspid valve disease

To evaluate the usefulness of examining the coronary sinus [CS] anatomic diameter as an additional surrogate marker of severity in chronic rheumatic valve disease [RVD]. In this cross-sectional observational study, we echocardiographically analyzed 88 patients with RVD, and 104 normal subjects in the Department of Cardiology, Gaziantep University Medical Faculty, Gaziantep, Turkey between February 2007 and April 2007. Echocardiographically all valve regurgitation, stenosis, left ventricular function, left/right atrial volume, and pulmonary artery pressure were obtained. Coronary sinus was assessed as a sonolucency in the posterior atrioventricular groove. Strong positive correlation was present between CS measurements and mitral mean gradient, mitral and tricuspid regurgitation grade, tricuspid stenosis gradient, pulmonary artery systolic pressure, left and right atrial volume, and New York Heart Association class. A statistically negative correlation was present between CS measurements and mitral valve area and ejection fraction. Only the mitral valve area, tricuspid regurgitation grade, and the right atrial volume were predictors of body surface area adjusted mean CS dilatation. In this preliminary study, we showed that echocardiographic assessment of dilated CS may provide useful additional information in predicting the severity of mitral/tricuspid RVD. Findings of this study needs to be confirmed in further studies