Negativity of the electromechanical window: relation to frequent premature ventricular complexes.

OBJECTIVE: The electromechanical window (EMW) was investigated as a new predictor of arrhythmia in the presence of long QT. However, the use of EMW to predict idiopathic frequent ventricular premature complexes (PVCs) in those with normal QT intervals has not been clarified. PATIENTS AND METHODS: This single-center study included consecutive patients who presented to the Cardiology Clinic with palpitations and were found to have idiopathic PVC on 24-hour Holter monitoring. Those with a PVC/24-hour frequency of < 1% were defined as group 1, 1-10% as group 2, and > 10% as group 3. The EMW was defined as the time difference (in ms) between the aortic valve closure and the end of the QT interval, measured from an ECG on the concurrent echocardiogram. RESULTS: A total of 148 patients were included in the study, 64% (n = 94) of which were female. The patients' mean age was 50.11 ± 14.7. The groups were similar in terms of the patients' age, BMI, and comorbidities. There was a statistically significant difference between the three groups in terms of the EMW measurements (group 1: 3.78 ± 19.6, group 2: -7 ± 30.9, group 3: -34.83 ± 55.2 ms: p < 0.001). In the multivariate regression analysis, the EMW (OR 0.971, p = 0.007) and every 10-ms decrease in the EMW (OR 1.254, p = 0.011) were thus determined to be independent predictors of PVC > 10%. An EMW value of ≤ -15 ms was associated with the frequency of 24-h PVC > 10%, with a sensitivity of 70% and a specificity of 70% (AUC 0.716, 95% CI: 0.636-0.787 p < 0.001). CONCLUSIONS: The results showed that a negative increase in the EMW may be associated with frequent idiopathic PVCs.

Importance of serum anticardiolipin antibody levels in coronary heart disease.

During the past 10 years it has been shown that some patients with antibodies to phospholipids develop recurrent venous and arterial thromboses, repeated fetal loss, and thrombocytopenia. The aim of this study is to determine the importance of levels of serum anticardiolipin antibodies (ACA) in patients with coronary heart disease (CHD). The study population consisted of 76 CHD patients (Group 1) and 22 healthy subjects (Group 2). Group 1 comprised three subgroups: (1a) 32 patients with acute myocardial infarction (MI), (1b) 22 patients with chronic CHD and a history of MI, and (1c) 22 patients with CHD but without previous MI. Immunoglobulin G anticardiolipin antibodies (IgG ACA) and immunoglobulin M anticardiolipin antibodies (IgM ACA) were detected by ELISA. High IgG ACA levels were found in 36 patients (47%) in Group 1, but no high levels were found in the control group. IgM ACA levels showed no significant difference between the two groups. The ACA (IgG and IgM) levels showed no correlation with age, gender, risk factor profiles, platelet counts, coronary artery lesions, left ventricular function, and morbidity and mortality rates during the follow-up period of 22 months. As a result, measurement of ACA in CHD patients is unlikely to yield information that is diagnostically or prognostically important. The importance of serum anticardiolipin antibody levels in the natural history and prognosis of CHD is still undetermined and remains to be clarified.

The value of captopril renal scintigraphy in assessing the results of percutaneous transluminal renal angioplasty and in following up renovascular hypertension--a case report.

Percutaneous transluminal renal angioplasty (PTRA) was performed in a patient with bilateral renal artery stenoses diagnosed noninvasively by captopril renal scintigraphy and confirmed by renal arteriography. The captopril renal scintigraphy parameters returned to normal in correlation with improved blood pressure response fifteen days after PTRA. Five months later hypertension reappeared and the repeated captopril renal scintigraphy suggested left renal artery stenosis. PTRA was repeated and a stent was implanted with reversal of blood pressure, and captopril renal scintigraphy findings returned to normal levels. Six months after second PTRA, the blood pressure increased to hypertensive levels, and captopril renal scintigraphy indicated left renal artery stenosis. The renal arteriography, however, revealed a new stenosis at the left renal artery ostium. The PTRA with a second stent implantation was performed successfully. The captopril renal scintigraphic parameters and the blood pressure were again normalized after the last intervention and remained normal for thirteen months of follow-up.

Emery-Dreifuss muscular dystrophy with unusual features.

Two families with Emery-Dreifuss muscular dystrophy (EMD) are described. Several unusual features for EMD are emphasized. One of the patients had severe neuromuscular disability with inability to walk during early childhood. This patient also had mild bifacial paresis. His brothers had the typical slow progression of EMD. In some of the patients, muscle weakness distribution was more widespread than has usually been reported, with prominent involvement of finger extensors. It is suggested that there is a wide phenotypic spectrum in EMD. In both families, the disease segregated with markers spanning the EMD locus in Xq28.

The effects of slow-release verapamil on blood pressure and cardiovascular system in essential hypertension.

The study consisted of 26 patients (15 female, 11 male; mean age 43 +/- 10 years) with mild to moderate essential hypertension (EH). They were followed for a 2-week washout period and then for another 2-week single-blind placebo phase. Four patients receiving placebo dropped out of the study. Patients qualified for active medication if their sitting diastolic blood pressures (BPs), the median of three readings, were between 95 and 115 mm Hg at the end of the placebo period. Slow-release verapamil 240 mg was given once or twice daily as the sole antihypertensive agent and was continued for 6 weeks. Two patients (9%) were excluded from the trial due to early side effects. A target diastolic BP of less than 90 mm Hg was obtained in the remaining 20 patients. At the end of the study, the mean value of sitting BP was reduced from an initial 170/103 (125) mm Hg to 130/81 (98) mm Hg (p less than 0.001) and the mean standing BP was decreased from 167/103 (125) mm Hg to 130/81 (98) mm Hg (p less than 0.001). The drug had no significant effects on the laboratory data, left ventricular performance as assessed by echocardiography and systolic time intervals, and the electrocardiogram parameters with the exception of PR prolongation (p less than 0.05). Adverse effects were noted in only three patients (14%). We conclude that slow-release verapamil is an effective, safe, and well-tolerated drug in treating EH.