Is off-pump coronary artery bypass surgery superior to on-pump coronary artery bypass surgery on postoperative paradoxical ventricular septal motion?

BACKGROUND: The aims of this study were to investigate the appearance of paradoxical ventricular septal motion (PSM) after coronary artery bypass graft (CABG) surgery and to identify factors that might be related to this abnormality. METHODS: This prospective study included 119 consecutive patients (38 women, 81 men) who underwent CABG. Patients who underwent on-pump surgery (22 women, 45 men) and patients who underwent off-pump surgery (16 women, 36 men) were studied separately. All subjects underwent preoperative angiographic septal perfusion evaluation, pre- and postoperative echocardiography, and standard electrocardiographic and laboratory investigations, including troponin I and CK-MB levels. Multivariate logistic regression analysis was also performed for a variety of related parameters. RESULTS: Significant differences in EuroSCORE, length of intensive care unit stay, length of hospital stay, PSM (assessed using echocardiography), septal perfusion (observed using preoperative angiography), postoperative pleural effusion, and intensive care unit recidivism were observed between the two groups (P < .05). Moreover, postoperative PSM was correlated with septal perfusion (r = -0.687**, P < .001), type of operation (r = -0.194*, P = .035), diabetes mellitus (r = 0.273**, P = .003), carotid stenosis (r = 0.235*, P = .011), the number of distal anastomoses (r = 0.245**, P = .008), pleural effusion (r = 0.193*, P = .037), and intensive care unit recidivism (r = 0.249**, P = .007). However, multivariate analysis demonstrated that only preoperative septal perfusion (odds ratio: 0.037; 95% confidence interval: 0.011-0.128; P < .05) constitutes an independent risk factor for PSM (P < .05). CONCLUSIONS: This study demonstrated that preoperative septal perfusion deficiency represents an independent risk factor for postoperative PSM in patients undergoing CABG. Further investigations addressing the timing of the appearance of PSM and the correlation of this finding with perfusion imaging studies may provide new details concerning the mechanisms that underlie this abnormality.

Decreased aortic root elasticity-as a novel systemic manifestation of the pseudoexfoliation syndrome: an observational study.

OBJECTIVE: To assess the aortic root function in patients with pseudoexfoliation syndrome (PEXS). METHODS: In this case- controlled observational study, aortic root function in 31 PEXS patients (mean age 71 ± 9 years) and 29 controls of similar ages (mean age 69 ± 9 years) were evaluated by M-mode transthoracic echocardiography. Aortic cross-sectional compliance (CSC), Peterson's elastic modulus (index beta), aortic stiffness index (ASI) and aortic root distensibility (ARD) were calculated by M-mode echocardiography to evaluate the aortic root function. The findings of two groups of patients were compared by Mann-Whitney U test. RESULTS: The CSC and ARD were significantly decreased in patients with PEXS. The CSC was 12.2 ± 6.3 cm²/mmHg in patients with PEXS and 17.5 ± 11.6 cm²/mmHg in the control group (p=0.015). The ARD was 1.56 ± 0.80 cm²/dyne in patients with PEXS and 2.23 ± 1.48 cm²/dyne in the control group (p=0.021). The other two indices of aortic root function were not significantly different between the two groups. CONCLUSION: Aortic root function decreases in patients with PEXS. PEXS may be regarded as a risk factor for cardiovascular and cerebrovascular events.

Isotretinoin does not prolong QT intervals and QT dispersion in patients with severe acne: a surprising finding for a drug with numerous side effects.

BACKGROUND: Isotretinoin is a widely prescribed drug for the treatment of severe acne. Several adverse cardiac effects due to isotretinoin have been previously reported. However, no data exist on the effects of isotretinoin therapy on QT intervals. OBJECTIVE: To investigate the effects of isotretinoin therapy on QT intervals and QT dispersion, and also to see if it is related to serum lipids, homocysteine and lipoprotein (a) or not. METHODS: Forty-five patients with severe acne (mean age 21±6 years, range 14-38 years; 26 female) were included in the study. Twelve-lead surface electrocardiograms (ECGs) were acquired at three stages: before therapy and at the ends of the first and sixth months of 0.8 mg/kg/day of isotretinoin therapy. Serum levels of triglycerides, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, very low density lipoprotein cholesterol, homocysteine and lipoprotein (a) were also measured at the day of ECG recordings. Minimum and maximum QT intervals were measured and QT dispersion was calculated. RESULTS: Mean heart rates were similar throughout the isotretinoin therapy. Serum levels of lipids, homocysteine and lipoprotein (a) all increased significantly at the end of the first month and remained significantly elevated at the end of sixth month (P is less than 0.05 for both stages). QT intervals and QT dispersion did not differ significantly throughout the six months of isotretinoin therapy (P is greater than 0.05). CONCLUSIONS: In patients with severe acne, six months of 0.8 mg/kg/day of isotretinoin therapy neither prolongs QT interval, nor increases QT dispersion. This effect is not related to blood lipids, homocysteine or lipoprotein (a) levels. Our findings indicate that from the point of polymorphic ventricular tachycardia risk, 0.8 mg/kg/day of isotretinoin therapy is a safe choice in acne treatment.

Anomalous right coronary artery from the left sinus of Valsalva presenting a challenge for percutaneous coronary intervention.

A 41-year-old man presented with worsening angina. Coronary angiography showed 70% narrowing in the middle segment of the left anterior descending (LAD) coronary artery. Selective cannulation of the right coronary artery (RCA) could not be achieved with Judkins right 3.5- and 4.0-cm curve diagnostic catheters. Nonselective injection into the aortic root revealed an anomalous RCA originating from the left sinus of Valsalva and 80% narrowing just proximal to the right ventricle branch. Initial percutaneous coronary intervention (PCI) was directed to the LAD and an adequate angiographic result was achieved. One week later, PCI was performed for the RCA. Cannulation of the RCA was not possible with Judkins curve guiding catheters (right 4 and 5 cm; left 4, 5, and 6 cm). Eventually, selective cannulation was achieved with a 7-F multipurpose Hockey Stick guiding catheter and stent placement was accomplished. The patient had an uneventful recovery. The use of a multipurpose Hockey Stick catheter may be considered when the usual techniques fail to cannulate an anomalous RCA.

Sildenafil citrate does not affect QT intervals and QT dispersion: an important observation for drug safety.

BACKGROUND: Sildenafil is an effective and widely used therapeutic agent for erectile dysfunction. Deaths have been reported due to sildenafil use and most of them are attributed to concurrent use of nitrates. However, the effects of sildenafil on QT intervals, QT dispersion, and the possible risk of ventricular arrhythmia have not been studied before. Our aim in this study was to evaluate the effect of sildenafil citrate on QT intervals and QT dispersion. METHODS: Thirty-six patients with erectile dysfunction were included in this study. Twenty-one patients had coronary artery disease whereas 12 of them also had accompanying diabetes mellitus. Standard 12-lead electrocardiograms (ECG) were recorded three times: before, and at the first and fourth hours of 50 mg sildenafil citrate ingestion. All QT parameters were corrected for heart rate. RESULTS: Mean age of the patients was 54 +/- 12 years. The mean heart rate did not differ significantly between the three ECG examinations. The corrected and uncorrected maximum and minimum QT intervals were not significantly different between the three ECG examinations. The QT dispersion and corrected QT dispersion before and 1 hour and 4 hours after sildenafil ingestion were 31 +/- 9 ms, 36 +/- 10 ms; 32 +/- 11 ms, 37 +/- 14 ms; 27 +/- 8 ms, 32 +/- 9 ms, respectively (P > 0.05). CONCLUSIONS: Sildenafil does not prolong QT intervals or increase QT dispersion in patients with erectile dysfunction. Our results suggest that the risk of ventricular arrhythmia does not increase with ingestion of 50 mg sildenafil.

The short-term effects of different regimens of hormone replacement therapy on left ventricular structure and performance in healthy postmenopausal women. A prospective, controlled echocardiographic study.

OBJECTIVE: To compare the short-term effects of different hormone replacement therapy (HRT) regimens on left ventricular structure and function in healthy postmenopausal women. METHODS: Forty-two apparently healthy postmenopausal women were evaluated prospectively in this controlled study. Subjects were divided into 4 groups. Ten subjects, who did not accept HRT or any other treatments, formed the control group. The remaining subjects were assigned to receive oral estradiol (2 mg/day) + norethisterone acetate (1 mg/day) (n = 11), transdermal estradiol (0.05 mg) + norethisterone acetate (0.25 mg) (n = 11) or tibolone (2.5 mg/day) (n = 10) therapy during 12 weeks. Echocardiography and Doppler techniques were used to assess the cardiac effects of different HRT regimens. RESULTS: After 12 weeks of treatment, there were significant increases in left ventricular ejection fraction (transdermal group: p = 0.008, oral group: p = 0.003, tibolone group: p = 0.005) and cardiac output (transdermal group: p = 0.003, oral group: p = 0.003, tibolone group: p = 0.021) in all treatment groups. In addition, in the transdermal group, a slight increase in left ventricular end-diastolic volume was significant (p = 0.046). CONCLUSION: These data suggest that oral and transdermal HRT regimens and tibolone may contribute to the improvement in left ventricular systolic function without having an effect on left ventricular structure after short-term administration in healthy postmenopausal women.

[Left ventricular hypertrophy increases the frequency of ventricular arrhythmia in hypertensive patients]. / Sol Ventrikül Hipertrofisi Hipertansif Hastalarda Ventriküler Aritmi Sikligini Arttiriyor.

OBJECTIVE: To evaluate the relationship between left ventricular hypertrophy (LVH) and geometrical structure of the left ventricle with the risk of arrhythmia and QT dispersion (QTd) in hypertensive patients. METHODS: Eighty patients were included (mean age 53 +/- 11 years, 45 women) in the study. Among them, concentric LVH was present in 30, concentric remodelling in 15 and normal left ventricular geometry in 35 patients. Twenty-four hours electrocardiographic monitoring and QTd calculation were performed for all patients. RESULTS: Lown grade 2-3 ventricular arrhythmia was found in 30 patients (37%) and Lown grade 4a-4b ventricular arrhythmia was documented in 17 patients (21%). The frequency of >Lown 2 ventricular arrhythmia in patients with concentric LVH was significantly higher than those of the subjects with concentric remodelling or normal geometry (p<0.01). The percentage of >Lown 2 ventricular arrhythmias were 80% in patients with LVH and 10% in patients without LVH. QT and QTc dispersions in patients with concentric hypertrophy were significantly longer than those of the patients with concentric remodelling and normal geometry. Additionally, QT and QTc dispersions in patients with ventricular arrhythmias were more frequent than in those without (p<0.001). The left ventricular mass index correlated positively both with the QTd and the QTc dispersions (r=0.33, p=0.007, r=0.26, p= 0.03, respectively). The left ventricular mass index also correlated significantly with both grades (Lown 2-3 and Lown 4a-4b) of ventricular arrhythmia (r=0.59, p=0.001; r=0.53, p=0.001, respectively). CONCLUSION: In hypertensive patients, especially in those with concentric LVH, the incidence of ventricular arrhythmia increases in relation with QT dispersion.

QT dispersion in patients with polycystic ovary syndrome.

Cardiac risk factors are observed more frequently in patients with polycystic ovary syndrome (PCOS). On the other hand, increased QT dispersion, which is a risk factor for cardiac arrhythmias and sudden death, has not been investigated in this syndrome. In this study, we evaluated QT dispersion in PCOS patients without overt heart disease. Thirty-six consecutive women with PCOS (mean age 24+/-5 years) and 36 healthy women of similar ages (mean age 24+/-4 years) participated in this study. PCOS was diagnosed if there were polycystic ovaries by ultrasound (enlarged ovaries with > or =8 cysts 2-8 mm in diameter), oligoamenorrhea (intermenstrual interval >35 days), hirsutism (Ferriman-Gallwey score, > or =7) and elevated serum levels of testosterone (> or =2.7 nmol/L). Electrocardiograms were recorded at a paper speed of 50 mm/s. QT intervals were manually measured by a cardiologist. All intervals were corrected for heart rate according to Bazett's formula: QTc interval=QT interval/square root of the RR interval. Mean values of body mass index, heart rate, and blood pressure were not significantly different between the two groups (P>0.05). No significant differences in QT intervals (maximum QT, minimum QT, QT dispersion, minimum corrected QT, maximum corrected QT, and corrected QT dispersion) were observed between the two groups (P>0.05). Our results suggest that the risk of ventricular arrhythmias or sudden cardiac death is not increased in PCOS patients.

Anomalous origin of right coronary artery above the sinus of Valsalva: observation by transthoracic echocardiography.

We describe a 60-year-old woman with an anomalous right coronary artery originating from the tubular portion of the ascending aorta. The anomaly was diagnosed incidentally by transthoracic echocardiography.