The effect of hemodialysis on electrocardiographic parameters.

BACKGROUND: Cardiovascular complications are the leading causes of premature deaths in hemodialysis patients. Due to rapid changes in volume and electrolyte concentration following dialysis, the some electrocardiographic (ECG) changes or arrhythmias might be seen. OBJECTIVE: To investigate the acute effects of hemodialysis on the ECG parameters in patients with chronic end-stage renal disease (ESRD). METHOD: We included the consecutive ESRD patients who underwent a hemodialysis. Before and after hemodialysis, some 12 lead ECG parameters were analyzed by two different cardiologists by using electronic digital caliper device. RESULTS: A total of 62 patients (mean 52 ± 15 years; 65% male) with ESRD undergoing hemodialysis were recruited to the study. P-wave amplitude, QRS amplitude, QRS duration, QTc dispersion, the sum of amplitudes in V1S + V5R derivations, total QRS amplitude, and duration were significantly greater in posthemodialysis patients compared to the prehemodialysis ones. However, T-wave amplitude and QTc duration were significantly lower in posthemodialysis patients. CONCLUSION: The ECG changes including prolangated QRS and increased QTc interval after hemodialysis should be kept in mind and assessed carefully in ESRD patients. Prolongation of these parameters may prove to be a further noninvasive marker of susceptibility to ventricular arrhythmias.

[Mean platelet volume and the extent of coronary atherosclerosis in patients with stable coronary artery disease]. / Kararli anjinasi olan koroner arter hastalarinda ortalama trombosit hacmi ve koroner aterosklerozun yayginligi

OBJECTIVES: The aim of this study was to assess the relationship between mean platelet volume (MPV) and the presence and extent of coronary artery disease (CAD) in patients who underwent coronary angiography for stable chest pain. STUDY DESIGN: A total of 540 patients (350 male, 190 female; mean age: 59.6±11.4 years) were consecutively included in the study. The patients were divided into four groups according to the presence and extent of their CAD as follows: Group 1 - patients with no significant CAD, group 2 - one vessel disease, group 3 - two vessel diseases, and group 4 - three vessel disease. Also, the Gensini score of each coronary angiogram was calculated. RESULTS: There were 159 patients in group 1, 169 in group 2, 110 in group 3, and 102 in group 4. As expected, we found significant differences among the groups regarding mean age and other coronary risk factors including gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. However, there were no significant differences among the groups regarding platelet counts and MPV values (8.5±0.1 fl, 8.5±1.2 fl, 8.6±0.9 fl and 8.6±0.9 fl, MPV values of groups 1-4, respectively). Although the Gensini score was found to be significantly correlated with age, plasma uric acid level, white blood cell count, hemoglobin level, fasting blood glucose, and high density lipoprotein level, no significant association was detected between MPV and Gensini score values. CONCLUSION: This study is one of the largest studies assessing the relationship between MPV and the extent of coronary atherosclerosis in patients with stable CAD to date. However, we found no association between MPV and the presence and extent of coronary atherosclerosis.

Recent insights into the relationship between inflammatory liver diseases and atherosclerosis.

Atherosclerosis is a dynamic process in the human body. Many studies have evaluated atherosclerosis and its relationship with other systems in the body. Our perception of its pathogenesis is evolving with the introduction of new players in the game. It is no longer possible to consider the atherosclerosis as an independent process, unaffected by the liver and its function. Although several tasks performed by the liver, such as lipid metabolism, have been implicated in the pathogenesis of atherosclerosis, the role of other disorders of the liver (autoimmune diseases, viral hepatitis, and cirrhosis) are not fully understood. In this review, the most commonly encountered inflammatory liver diseases and their effects on atherosclerosis are discussed.

Hepatitis C infection is associated with increased coronary artery atherosclerosis defined by modified Reardon severity score system.

BACKGROUND: The link between arteriosclerotic disease in the carotid or coronary artery and chronic hepatitis C virus (HCV) infection has been shown in some studies although other studies have produced contrary results. However, the effect of chronic HCV infection on the extension or severity of coronary artery disease (CAD) has not been determined so the aim of the present study was to determine the effect of HCV infection on the severity of CAD. METHODS AND RESULTS: The study group comprised 139 HCV seropositive and 225 HCV seronegative patients with angiographically documented CAD. A modified scoring system of Reardon et al was used. There were no significant differences between groups in terms of sex, age, hypertension, diabetes mellitus, smoking or family history. Levels of C-reactive protein and fibrinogen were significantly higher in the HCV seropositive group (p<0.001) and the Reardon severity score was higher (8.75+/-1.69 vs 6.01+/-1.80, p<0.001). After adjustment, HCV seropositivity still represented an independent predictor for severity of coronary atherosclerosis demonstrated by higher Reardon severity score with an odds ratio of 2.018 (95% confidence interval 1.575-2.579, p<0.001). CONCLUSION: HCV infection is an independent predictor for increased coronary atherosclerosis, as demonstrated by higher Reardon severity score.

[A rare cause of pulmonary hypertension: pulmonary Langerhans cell granulomatosis]. / Pulmoner hipertansiyonunun nadir bir nedeni: Pulmoner Langerhans hücreli granülomatozis.

Pulmonary Langerhans cell granulomatosis (PLCG) is a smoking-related interstitial lung disease characterized by hyperinflation and/or obstructive pulmonary disease. Pulmonary hypertension is a late complication of advanced pulmonary disease and often portends a poor prognosis. A 24-year-old male patient who had been receiving diltiazem and corticosteroid treatment with the diagnosis of PLCG for four years was examined by the cardiology clinic due to dyspnea and deterioration in his functional capacity. He was in New York Heart Association class III. The electrocardiogram showed sinus rhythm and right bundle branch block. Systolic pulmonary artery pressure (SPAP) was estimated as 80 mmHg with continuous-wave Doppler echocardiography. During right heart catheterization, SPAP was 70 mmHg and the mean pulmonary artery pressure (MPAP) was 44 mmHg. Vascular pulmonary reactivity test with adenosine did not result in a significant change in MPAP. Based on these findings, medical treatment was scheduled for the patient.