Levels of soluble cell adhesion molecules in type 2 diabetes mellitus patients with macrovascular complications.

OBJECTIVE: Type 2 diabetes mellitus (T2DM) is a main risk factor for development of cardiovascular diseases (CVDs) and endothelial dysfunction. This study aimed to investigate serum levels of soluble vascular cell adhesion molecule 1 (sVCAM-1), intercellular adhesion molecule 1 (sICAM-1), and endothelium selectin (sE-selectin) in T2DM patients with macrovascular complications. METHODS: A cross-sectional study of 21 controls, 30 T2DM patients without CVDs, and 30 T2DM patients with CVDs was conducted. Serum levels of soluble adhesion molecules including sVCAM-1, sICAM-1, and sE-selectin were determined using ELISA. RESULTS: Serum levels of sVCAM-1, sICAM-1, and sE-selectin were higher in T2DM patients than in controls. Levels of serum sVCAM-1 were higher in T2DM patients with CVDs compared with T2DM patients without CVDs. In T2DM patients with CVDs, significant positive associations were observed between sVCAM-1, sICAM-1, and sE-selectin levels (r = 0.575, p = 0.001 and r = 0.378, p = 0.040). CONCLUSIONS: Circulating levels of soluble adhesion molecules were elevated in T2DM patients, regardless of whether the patients had cardiovascular complications. Only sVCAM-1 was considered a useful marker for the prediction of CVDs in T2DM patients.

Heart rate variability in patients with mitral stenosis: a study of 20 cases from King Abdulaziz University Hospital.

BACKGROUND: Left atrial enlargement in mitral stenosis predisposes to atrial fibrillation (AF). Analysis of heart rate variability (HRV) prior to the onset of an arrhythmia may show alterations in autonomic balance that are known to predispose to the development of AF. The aim of this study was to determine whether HRV in patients with rheumatic mitral stenosis (MS) is abnormal in comparison to normal controls, and to find the relationship between left atrial size and HRV in patients with MS in sinus rhythm and in AF. SUBJECTS AND METHODS: A series of 24-hour ambulatory Holter electrocardiogram recordings were obtained for 10 consecutive, newly diagnosed untreated subjects with pure mitral stenosis in sinus rhythm, 10 with mitral stenosis complicated by atrial fibrillation and 10 age-matched normal controls. Digitized records were processed using time domain and power spectral analysis. RESULTS: In patients with mitral stenosis in sinus rhythm, we observed significant decrease of the standard deviation of the RR intervals (SDRR), as well as of the root mean square of successive RR interval differences (RMSSD) and Edinburgh index (sNN50), while in patients with AF, the RMSSD and sNN50 were much larger than those in normal. The areas under all spectral bands were markedly increased in patients with AF compared with normal. Furthermore, the high low frequency/high frequency (HLF/HF ratio) ratio was very small compared to normal. HRV measures were independent of atrial size in both groups. CONCLUSION: Decreased HRV in mitral stenosis patients with sinus rhythm suggests increased sympathetic activity in patients prone to atrial fibrillation, while marked increased of HRV in patients with AF may indicate that parasympathetic activity modulates the intrinsic behavior of the atrioventricular node during atrial fibrillation. The evaluation of HRV may be a useful tool for the identification of patients predisposed to AF.