The effects of combination treatment with LT4 and LT3 on diastolic functions and atrial conduction time in LT4-treated women with low T3: a short term follow-up study.

PURPOSE: To investigate the effects of combination treatment with levothyroxine (LT4) and l- triiodothyronine (LT3) on left atrial volume (LAV), diastolic functions, and atrial electro-mechanical delays in LT4-treated women with low triiodothyronine (T3) levels. METHODS: This prospective study consisted of 47 female patients between 18 and 65 years old treated at an Endocrinology and Metabolism outpatient clinic between February and April 2022 due to primary hypothyroidism. The study included patients with persistently low T3 levels in at least three measurements, despite LT4 treatment (1.6-1.8 mcg/kg/m2) for 23.13 ± 6.28 months with normal thyrotropin (TSH) and free tetraiodothyronine (fT4) levels. The combination therapy dose was as follows: the fixed LT4 dose (25 mcg) was removed from patients' usual LT4 treatment [100 mcg (min-max, 75-150)], and a fixed LT3 dose (12.5 mcg) was added. Biochemical samples were taken, and an echocardiographic assessment was performed for patients upon their first admission, and after 195.5 ± 12.8 days of receiving LT3 (12.5 mcg) treatment. RESULTS: There was a statistically significant reduction at left ventricle (LV) end-systolic diameter (27.69 ± 3.14, 27.13 ± 2.89, p = 0.035), left atrial (LA) maximum volume (14.73 ± 3.22, 13.94 ± 3.15, p = 0.009), LA minimum volume (7.84 ± 2.45, 6.84 ± 2.30, p < 0.001), LA vertical diameter (44.08 ± 6.92, 34.60 ± 4.31, <0.001), LA horizontal diameter (45.65 ± 6.88, 33.43 ± 4.51, p < 0.001), LAVI (50.73 ± 18.62, 41.0 ± 13.02, p < 0.001), total conduction time (103.69 ± 12.70, 79.82 ± 18.40, p < 0.001) after LT3 replacement (respectively pre-post- treatment and p value). CONCLUSION: In conclusion, the findings of this study suggest that the addition of LT3 to LT4 treatment may lead to improvements in LAVI and atrial conduction times in patients with low T3. However, further research with larger patient groups and exploration of different LT4 + LT3 dose combinations is needed to better understand the effects of combined hypothyroidism treatment on cardiac functions.

Is the Naples prognostic score useful for predicting heart failure mortality.

Aim    The Naples prognostic score (NPS) simultaneously evaluates inflammation and malnutrition, which are two main factors that play a role in the pathophysiology and prognosis of heart failure (HF). In this study, we aimed to examine the relationship of NPS with in-hospital mortality of hospitalized patients with a diagnosis of HF.Material and Methods    A total of 496 hospitalized HF patients included in this study. The patients were divided into two groups as deceased and living. The clinical and demographic characteristics of each patient were recorded. NPS of each patient was calculated.Results    NPS was significantly higher in the deceased group compared to the living group (3.6±0.61, 3.21±0.97, respectively; p=0.003). According to multivariate regression analysis: NPS (OR: 1.546, 95 % CI: 1.027-2.327; p=0.037), systolic blood pressure (OR: 0.976, 95 % CI: 0.957-0.995; p=0.015), and white blood cell count (OR: 1.072, 95 % CI: 1.007-1142; p=0.03) are independent predictors for in-hospital mortality in HF patients.Conclusion    This study demonstrated a strong correlation between NPS and mortality in HF. This new score can be used to predict the prognosis of HF as it shows both the level of inflammation and nutrition.

The effect of heart failure on gut microbial richness and diversity.

INTRODUCTION AND OBJECTIVE: With recent advances in genome sequencing technology, a large body of evidence has accumulated over the last few years linking alterations in microbiota with cardiovascular disease. In this study, we aimed to compare gut microbial composition using 16S ribosomal DNA (rDNA) sequencing techniques in patients with coronary artery disease (CAD) and stable heart failure (HF) with reduced ejection fraction and patients with CAD but with normal ejection fraction. We also studied the relationship between systemic inflammatory markers and microbial richness and diversity. METHODS: A total of 40 patients (19 with HF and CAD, 21 with CAD but without HF) were included in the study. HF was defined as left ventricular ejection fraction <40%. Only stable ambulatory patients were included in the study. Gut microbiota were assessed from the participants' fecal samples. The diversity and richness of microbial populations in each sample were assessed by the Chao1-estimated OTU number and the Shannon index. RESULTS: The Chao1-estimated OTU number and Shannon index were similar between HF and control groups. There was no statistically significant relationship between inflammatory marker levels (tumor necrosis factor-alpha, interleukin 1-beta, endotoxin, C-reactive protein, galectin-3, interleukin 6, and lipopolysaccharide-binding protein) and microbial richness and diversity when analyzed at the phylum level. CONCLUSION: In the current study, compared to patients with CAD but without HF, stable HF patients with CAD did not show changes in gut microbial richness and diversity. At the genus level Enterococcus sp. was more commonly identified in HF patients, in addition to certain changes in species levels, including increased Lactobacillus letivazi.

Predicting the Severity of Coronary Artery Disease: Can the Leukocyte Glucose Index be Used?

OBJECTIVE: To investigate the usability of leuko-glycemic index (LGI) at chronic coronary syndromes (CCS) class 1 for determining the extent and severity of coronary artery disease (CAD). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Cardiology, University of Pamukkale University Hospital, Turkey, between September 2021 and January 2022. METHODOLOGY: One hundred and thirty-four patients, whose myocardial perfusion scintigraphy (MPS) was requested due to CCS class 1, and on whom a coronary angiogram (CAG) was performed due to evidence of ischemia, were analysed. Blood samples were taken from the patients during their hospitalisation before CAG. LGI was calculated as mg/dl.mm3 by multiplying both values and dividing by a thousand. The patients were analysed in two groups according to the critical stenosis and non-critical stenosis detected in the coronary arteries. RESULTS: The LGI was recorded as 480 mg/dl.mm3 (407-603) vs. 572 mg/dl.mm3 (433-877), p=0.006, and the Gensini score (6 (3-10) vs 40 (23-60), p<0.001) was significantly higher in the critical CAD group. A significant relationship has detected the increase in LGI and the extensity and severity of CAD (Unadjusted; OR (95% CI); 1.003 (1.001 - 1.004) p=0.002, adjusted; OR (95% CI); 1.002 (1.001 - 1.004) p=0.004). CONCLUSION: A high LGI was a predictor of CAD severity among CCS class 1 patients and was found to correlate with the Gensini score. The use of this simple and inexpensive index, together with other non-invasive tests before CAG, may provide some knowledge about the severity of CAD. KEY WORDS: Coronary artery disease, Leukocyte glucose index, Myocardial perfusion scintigraphy.

Assessment of triglyceride/glucose index with respect to coronary slow flow.

BACKGROUND: Coronary slow flow (CSF) is determined by delayed opacification of the epicardial coronary arteries without obstructive disease. The triglyceride glucose index (TGI) has been suggested as a useful marker of insulin resistance. Previous studies have shown that TGI is associated with cardiovascular disease, but no study has examined the relationship between TGI and CSF. OBJECTIVES: Therefore, the primary objective of the present study was to investigate the relationship between TGI and CSF. METHODS: This study retrospectively evaluated patients who were admitted to our clinic with complaints of chest pain and underwent coronary angiography between January and December 2018. A total of 1100 coronary angiography images were assessed, and 72 patients with CSF were detected. Coronary flow was quantified objectively using the TIMI (thrombolysis in myocardial infarction) frame count (TFC) method as described by Gibson et al. TGI was calculated as follows: ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. RESULTS: The CSF group had significantly higher glucose levels (mg/dl) [ (114.92±30.92), (125.61±33.22), than the control and CSF groups, respectively, p=0.0001], TGI [ (9.02±0.56), (9.26±0.54), p=0.0001], and triglyceride levels (mg/dl) [ (170.67±110.81), (201.19±136.93), p=0.002]. There was no statistically significant correlation between TGI and left anterior descending artery TFC, circumflex artery TFC, right coronary artery TFC (r/p values; 0.24/0.06; 0.32/0.08; 0.18/0.36, respectively). TGI, HDL, HT, age, and sex were examined with a multiple logistic model, and TGI was found to be statistically significant for the risk of CSF (p=0.0001; O.R:7.459). CONCLUSION: TGI was statistically significantly higher in the CSF group than the control group. According to the multivariate logistic regression analysis, only TGI was independently associated with the risk of CSF, but higher TGI did not predict more slow coronary flow. Prospective studies are needed to clarify the prognostic relationship of TGI and CSF in terms of future cardiovascular events (Tab. 2, Fig. 1, Ref. 19).

The Relationship Between Mitral Annular Calcification and Controlling Nutritional Status Score.

INTRODUCTION: The relationship between mitral annular calcification (MAC) and the controlling nutritional status (CONUT) score has not been previously studied. In this study, we investigated the relationship between MAC and CONUT score to evaluate the nutritional status of patients with MAC. METHODS: A total of 275 patients, including 150 patients with MAC and 125 patients without MAC, who presented to a cardiology outpatient clinic were enrolled in the study. RESULTS: There was no difference in the CONUT score between the two groups. Correlation analysis indicated that CONUT score was positively correlated with left atrial (LA) diameter (r=0.190, P=0.020) and interventricular septum thickness (r=0.179, P=0.028) in the MAC+ group. In multivariate regression analysis, only LA diameter (odds ratio 95% confidence interval = 1,054-1,189, P=0.0001) was independently associated with MAC. CONCLUSION: The present study investigated the relationship between CONUT score and MAC for the first time in the literature. We demonstrated that CONUT score was not significantly higher in patients with MAC without chronic diseases. However, CONUT score was correlated with LA diameter in patients with MAC. We therefore conclude that, for patients admitted with MAC and high LA diameter, CONUT is a valuable nutritional and inflammatory status index.

Relationship between Systemic Immune-Inflammation Index and Coronary Collateral Circulation in Patients with Chronic Total Occlusion. / Relação entre o Índice Imune-inflamação Sistêmico e Circulação Colateral Coronariana em Pacientes com Oclusão Total Crônica.

BACKGROUND: Inflammation plays a key role in the initiation and progression of coronary artery disease (CAD). The systemic immune-inflammation index (SII) is a novel inflammatory parameter that has been shown to be associated with CAD. OBJECTIVE: This study aimed to investigate the relationship between SII and coronary collateral circulation (CCC) in patients with stable CAD and chronic total occlusion (CTO). METHODS: The patients were divided into two groups, with poor CCC and good CCC, according to the Rentrop Classification. Ninety-four patients had poor CCC, and 81 patients had good CCC. Inflammation parameters were calculated from the laboratory results. The statistical significance level applied was 0.05. RESULTS: High SII level (OR: 1.003, 95% CI: 1.001-1.004, p<0,001), absence of CTO in RCA (OR: 0.204, 95% CI: 0.096-0.436, p<0,001) and low Gensini score (OR: 0.980, 95% CI: 0.962-0.998, p=0,028) were significantly associated with poor CCC. The cutoff value of SII was 679.96 for the highest predictive power of poor CCC, with a sensitivity of 74.5% and specificity of 43.2%. Mortality rates were similar between the two groups during a mean follow-up of 21.5±10.8 months (p=0.107). CONCLUSIONS: High SII level, the absence of CTO in the right coronary artery, and low Gensini score were significantly related to poor CCC. The rapid and cost-effective use of new inflammatory markers in clinical practice guides the prognosis of CAD.

FUNDAMENTO: A inflamação desempenha um papel fundamental no início e na progressão da doença arterial coronariana (DAC). O Índice Imune-inflamação Sistêmico (SII) é um novo parâmetro inflamatório que demonstrou estar associado à DAC. OBJETIVOS: Este estudo teve como objetivo investigar a relação entre o SII e a circulação colateral coronariana (CCC) em pacientes com DAC estável e oclusão crônica total (OTC). MÉTODOS: Os pacientes foram divididos em dois grupos, com CCC deficiente e CCC boa, de acordo com a Classificação Rentrop. Noventa e quatro pacientes apresentavam CCC deficiente e 81 pacientes CCC boa. Os parâmetros de inflamação foram calculados a partir dos resultados laboratoriais. O nível de significância estatística aplicado foi de 0,05. RESULTADOS: Alto nível de SII (OR: 1,003, IC 95%: 1,001-1,004, p<0,001), ausência de OTC na ACD (artéria coronária direita) (OR: 0,204, IC 95%: 0,096-0,436, p<0,001) e baixo escore de Gensini (OR: 0,980, IC 95%: 0,962-0,998, p=0,028) foram significantemente associados com CCC deficiente. O valor de corte do SII foi de 679,96 para o maior poder preditivo de CCC deficiente, com sensibilidade de 74,5% e especificidade de 43,2%. As taxas de mortalidade foram semelhantes entre os dois grupos durante um seguimento médio de 21,5±10,8 meses (p=0,107). CONCLUSÕES: Alto nível de SII, ausência de OTC na artéria coronária direita e baixo escore de Gensini foram significantemente relacionados à CCC deficiente. O uso rápido e custo-efetivo de novos marcadores inflamatórios na prática clínica orienta o prognóstico da DAC.

Relação entre o Índice Imune-inflamação Sistêmico e Circulação Colateral Coronariana em Pacientes com Oclusão Total Crônica / Relationship between Systemic Immune-Inflammation Index and Coronary Collateral Circulation in Patients with Chronic Total Occlusion

Resumo Fundamento A inflamação desempenha um papel fundamental no início e na progressão da doença arterial coronariana (DAC). O Índice Imune-inflamação Sistêmico (SII) é um novo parâmetro inflamatório que demonstrou estar associado à DAC. Objetivos Este estudo teve como objetivo investigar a relação entre o SII e a circulação colateral coronariana (CCC) em pacientes com DAC estável e oclusão crônica total (OTC). Métodos Os pacientes foram divididos em dois grupos, com CCC deficiente e CCC boa, de acordo com a Classificação Rentrop. Noventa e quatro pacientes apresentavam CCC deficiente e 81 pacientes CCC boa. Os parâmetros de inflamação foram calculados a partir dos resultados laboratoriais. O nível de significância estatística aplicado foi de 0,05. Resultados Alto nível de SII (OR: 1,003, IC 95%: 1,001-1,004, p<0,001), ausência de OTC na ACD (artéria coronária direita) (OR: 0,204, IC 95%: 0,096-0,436, p<0,001) e baixo escore de Gensini (OR: 0,980, IC 95%: 0,962-0,998, p=0,028) foram significantemente associados com CCC deficiente. O valor de corte do SII foi de 679,96 para o maior poder preditivo de CCC deficiente, com sensibilidade de 74,5% e especificidade de 43,2%. As taxas de mortalidade foram semelhantes entre os dois grupos durante um seguimento médio de 21,5±10,8 meses (p=0,107). Conclusões Alto nível de SII, ausência de OTC na artéria coronária direita e baixo escore de Gensini foram significantemente relacionados à CCC deficiente. O uso rápido e custo-efetivo de novos marcadores inflamatórios na prática clínica orienta o prognóstico da DAC.

Abstract Background Inflammation plays a key role in the initiation and progression of coronary artery disease (CAD). The systemic immune-inflammation index (SII) is a novel inflammatory parameter that has been shown to be associated with CAD. Objective This study aimed to investigate the relationship between SII and coronary collateral circulation (CCC) in patients with stable CAD and chronic total occlusion (CTO). Methods The patients were divided into two groups, with poor CCC and good CCC, according to the Rentrop Classification. Ninety-four patients had poor CCC, and 81 patients had good CCC. Inflammation parameters were calculated from the laboratory results. The statistical significance level applied was 0.05. Results High SII level (OR: 1.003, 95% CI: 1.001-1.004, p<0,001), absence of CTO in RCA (OR: 0.204, 95% CI: 0.096-0.436, p<0,001) and low Gensini score (OR: 0.980, 95% CI: 0.962-0.998, p=0,028) were significantly associated with poor CCC. The cutoff value of SII was 679.96 for the highest predictive power of poor CCC, with a sensitivity of 74.5% and specificity of 43.2%. Mortality rates were similar between the two groups during a mean follow-up of 21.5±10.8 months (p=0.107). Conclusions High SII level, the absence of CTO in the right coronary artery, and low Gensini score were significantly related to poor CCC. The rapid and cost-effective use of new inflammatory markers in clinical practice guides the prognosis of CAD.

Pulmonary embolism initially misdiagnosed as perimyocarditis in a young patient.

Pulmonary embolism is a common cardiovascular emergency. In case of delayed diagnosis and treatment morbidity and mortality is high. In this report, we presented a case of pulmonary embolism without apparent risk factors, which was initially misdiagnosed as peri/myocarditis.

Assessment of Pulmonary Pulse Transit Time with Respect to Diastolic and Left Atrial Functions.

Background and Aim: Pulmonary pulse transit time (pPTT) is a new marker of pulmonary hypertension (PH), which shows the time needed for the pulse wave to propagate from the right ventricular outflow tract to the left atrium (LA), but the relationship between pPTT and diastolic-LA function is almost unknown. In this study, we investigated the relationship between pPTT and LA-diastolic functions without PH. Materials and Methods: One hundred and fifty-six patients were included in this prospectively designed study. Comprehensive echocardiographic evaluation was performed and pPTT was recorded as the time from the beginning of the R-wave on the electrocardiogram to the peak of the S-wave in the pulmonary veins. Results: We found a statistically significant correlation between LA total stroke volume, passive stroke volume, LA max area, LA volume (LAV) max and LA volume index (LAVi) max, and pPTT (r = 0.263** P = 0.003, r = 0.240** P = 0.007, (r = 0.339** P < 0.001, r = 0.307** P < 0.001 r = 0.199*, P = 0.024, LA total stroke volume, passive stroke volume, LA max area, LAV max, LAVi max respectively). Heart rate (HRt) and LAVi were detected as independent predictors of pPTT (hazard ratio: -2.290 P < 0.001, 95% confidence interval (CI): -3.274-1.306, HR: 0.461, P = 0.028, 95% CI: 0.050-0.873, HRt and LAVi, respectively). Conclusion: LAVi and HRt also affected pPTT. The dominant effect of HRt on pPTT should be considered in future studies. Larger studies are needed to determine the change and clinical significance of pPTT in left heart disease.

Concomitant Multiple Coronary Artery Embolizations and Bilateral Lower Limb Ischemia due to Dislodged Left Atrial Myxoma-Like Thrombus.

The differential diagnosis of intracardiac masses is challenging. Cardiac myxomas are benign primary heart tumors and most often are confused with thrombi in diagnosis. In some cases, the embolic complication of intracardiac masses can be fatal. We present a patient who had two nightmare complications simultaneously. A mobile left atrial mass detected and decided surgical excision. But the mass had vanished one day after and caused ST-elevation myocardial infarction (STEMI) and bilateral lower limb ischemia.

Ticagrelor improves systemic immune-inflammation index in acute coronary syndrome patients.

OBJECTIVE: Inflammation plays a critical role in atherosclerosis. This study examines the effects of ticagrelor and clopidogrel on inflammatory parameters, obtained from complete blood count (CBC) and biochemical measurements, in patients with acute coronary syndrome. METHODS AND RESULTS: One hundred acute coronary syndrome (ACS) patients were included in the study and grouped according to clopidogrel (n = 50) or ticagrelor (n = 50) usage as an anti-aggregant (with acetylsalicylic acid). All patients underwent percutaneous coronary intervention. On admission, at third- and sixth-month after ACS, white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-high-density lipoprotein ratio (MHR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated from the CBC and biochemical measurements. NLR, PLR, and SII were significantly lower in the ticagrelor group (p < 0.001, at 3rd and 6th month). Also, MHR was lower in the ticagrelor group (p < 0.05). Conversely, WBC count was higher in the ticagrelor group (p < 0.001). CONCLUSIONS: NLR, MHR, PLR, and SII levels were lower in ACS patients treating with ticagrelor. Ticagrelor may improve these inflammatory parameters in percutaneous coronary intervention (PCI)-treated ACS patients compared to clopidogrel.

The Effects of Laparoscopic Sleeve Gastrectomy on Cardiac Diastolic Function, Aortic Elasticity, and Atrial Electromechanics Delay.

BACKGROUND: Obesity is a well-known risk factor for cardiovascular diseases. The aim of this study was to prospectively investigate the short-term effects of laparoscopic sleeve gastrectomy (LSG) on cardiac functions. METHODS: Forty-four morbidly obese patients who underwent LSG were included in the study. The aortic systolic and diastolic diameters, left ventricular (LV) diameter, LV cardiac output and cardiac index, LV ejection fraction, LV septal and lateral wall velocities, deceleration time of the E wave, the LA volume index and atrial mechanic functions, and atrial conduction times were evaluated. RESULTS: The patients' aortic stiffness index showed a significant improvement at postoperative control: 3.23 ± 0.58, 2.49 ± 0.36; p<0.001 for preoperative and postoperative aortic stiffness index, respectively. A significant reduction was observed in the LV mass and relative wall thickness (RWT) of the patients: 182.41 ± 36.87 g, 154.85 ± 24.32 g; p<0.001 and 0.42 ± 0.07, 0.39 ± 0.05; p=0.010 for the preoperative and postoperative LV mass and RWT, respectively. A statistically significant decrease was observed in total atrial conduction time and interatrial and intraatrial conduction time in the postoperative period: 120.95 ± 22.27 ms, 106.57 ± 20.46 ms; p=0.001; 13.82 ± 8.21 ms, 10.66 ± 6.78 ms; p=0.038, and 29.64 ± 14.18 ms, 24.09 ± 10.95 ms; p=0.047 for preoperative and postoperative total atrial conduction time, intraatrial electromechanical delay, and interatrial electromechanical delay, respectively. CONCLUSIONS: Weight loss reduced aortic stiffness, IVS and posterior wall thickness, LAV, LAVi, LA passive emptying fraction, and atrial electromechanical delays in morbidly obese patients.

Association between endometriosis and increased arterial stiffness.

BACKGROUND: Endometriosis is a common gynecologic disease associated with systemic inflammation and atherogenic risk factors. Therefore, women with endometriosis may have increased cardiovascular risk. AIMS: We aimed to evaluate arterial stiffness using cardio-ankle vascular index (CAVI) in women with and without endometriosis. METHODS: We enrolled 44 patients with endometriosis and 76 age­matched controls without endometriosis.Endometriosis was diagnosed based on histopathologic examination or magnetic resonance imaging. Arterial stiffness was evaluated using CAVI in all study participants. RESULTS: No differences were observed between patients and controls in terms of age (median [interquartile range, IQR], 30 [24.25-5] years and 26 years [24-35] years, respectively), body mass index (median [IQR], 23.31 [20.82-24.98] kg/m2 and 23.74 [21.13-26.78] kg/m2, respectively), or waist circumference (median [IQR], 69 [64-75] cm and 72 [65-81.25] cm, respectively). C­reactive protein levels were higher in women with endometriosis than in controls (median [IQR], 0.27 [0.14-0.68] mg/dl vs 0.12 [0.06-0.24] mg/dl; P <0.001). Left ventricular ejection fraction, left ventricular mass index (LVMI), relative wall thickness, as well as systolic and diastolic blood pressures were similar in both groups. Women with endometriosis had higher CAVI than controls (mean [SD], 5.961 [0.644] vs 5.554 [0.654]; P = 0.001). Elevated arterial stiffness was observed in the endometriosis group also after adjustment for age and LVMI. CONCLUSIONS: Our results indicate increased arterial stiffness measured by CAVI in women with endometriosis. Therefore,clinicians should be aware that these patients may be at increased cardiovascular risk.

Incidence and predictors of complete atrioventricular conduction recovery among patients with heart block.

Aim: In this study, our aim was to determine clinical factors related to the recovery of the conduction system in patients presenting with atrioventricular (AV) block. Materials & methods: A total of 178 patients who were hospitalized at a tertiary center due to second- or third-degree AV block were retrospectively analyzed. Results: During hospital follow-up, 19.1% of patients had fully recovered from AV block. According to a logistic regression analysis; younger age (odds ratio [OR]: 0.950; 95% CI: 0.932-0.967; p < 0.001), presenting with acute coronary syndrome (OR: 18.863; 95% CI: 3.776-94.222; p < 0.001), ß-blocker usage (OR: 12.081; 95% CI: 3.498-41.726; p < 0.001), high serum creatinine levels (OR: 4.338; 95% CI: 2.110-8.918; p < 0.001) and no calcification at the aortic valve (OR: 0.189; 95% CI: 0.050-0.679; p = 0.011) were found to be related to resolution of AV block. Conclusion: It is crucial to know the reversible causes of AV block to prevent unnecessary permanent pacemaker implantation.

Effects of Nasal Septum Deviation and Septoplasty on Cardiac Arrhythmia Risk.

OBJECTIVE: Upper airway obstruction (UAO) can result in cardiac complications, including arrhythmias and sudden cardiac death. Nasal septum deviation (NSD) is a common cause of UAO. The aim of this study was to assess the risk of cardiac arrhythmias in patients with NSD. To assess this risk, we measured noninvasive indicators of atrial arrhythmia (P-wave dispersion [Pd]) and ventricular arrhythmia (corrected QT dispersion [QTcd]) and compared these values between NSD patients and healthy subjects. STUDY DESIGN: Prospective study. SETTINGS: Tertiary referral center. SUBJECTS AND METHODS: This study included 53 consecutive patients who had underwent septoplasty due to marked NSD. Electrocardiographic records were used to determine Pd and QTcd values preoperatively and 6 months postoperatively. Fifty-three consecutive age- and sex-matched subjects without any UAO were also examined as a control group. RESULTS: Preoperative Pd and QTcd values were significantly higher in NSD patients than in the control group (Pd: 57.40 ± 14.21 vs 34.11 ± 7.12 milliseconds, P < .001; QTcd: 81.77 ± 16.39 vs 50.25 ± 11.51 milliseconds, P < .001, respectively). In addition, Pd and QTcd values were significantly greater in preoperative NSD patients when compared with the same patients postoperatively (Pd: 57.40 ± 14.21 vs 36.32 ± 8.9 milliseconds, P = .013; QTcd: 81.77 ± 16.39 vs 55.76 ± 11.4 milliseconds, P = .012, respectively). CONCLUSION: In conclusion, NSD patients are at risk for both atrial and ventricular cardiac arrhythmias; however, septoplasty in these patients can relieve UAO and reduce the risk of arrhythmias.