The relationship between serum levels of hs-CRP and coronary lesion severity.

BACKGROUND AND AIM: It is very important to know the risk factors of coronary artery disease and the role of inflammatory markers. One of these markers is hs-CRP that has been indicated to increase in patients with coronary artery atherosclerosis. The main objective of this study was to determine the relationship between serum levels of hs-CRP and coronary lesion severity. METHODS: In the current study, we evaluated the role of hs-CRP in coronary artery disease and measured the relationship between serum hs-CRP levels and the severity of coronary lesions in 102 patients who referred to Imam Khomeini Hospital, Iran. The number of involved coronary arteries was measured. The severity of coronary lesions was evaluated by Gensini scoring method and the association between severity of coronary artery lesions and serum hs-CRP levels and other risk factors were examined. RESULTS: No significant difference was found between the two groups in terms of gender. Severity of lesions had no significant difference according to Gensini score in women compared with men. Mean Gensini score was significant between the two groups (66.79±48.12 in hs-CRP positive group versus 21.09±26.25 in negative ones, p<0.05). In addition, diabetic patients were significantly more in hs-CRP positive group than negative hs-CRP group (P<0.05). In terms of smoking, there was a significant difference between the two groups. Percentage of patients with hypercholesterolemia was significantly higher in hs-CRP negative group. There was a significant difference in severity of lesions between smokers and non-smokers. CONCLUSION: No significant correlation was observed between serum levels of hs-CRP and severity and angiographic extent on coronary arteries in our study. Considering the potential risk of coronary inflammatory process as a new variable, it can help discover new cases of coronary lesions and follow-up and control of the selected cases.

Association of cardiac autonomic neuropathy with arterial stiffness in type 2 diabetes mellitus patients.

BACKGROUND: Diabetic patients are at the risk of cardiac autonomic neuropathy (CAN) and arterial stiffness. This study aimed to investigate the association of heart rate variability (HRV) as an index for CAN and pulse wave velocity (PWV) as an index for arterial stiffness. METHODS: Uncomplicated diabetes type-2 patients who had no apparent history of cardiovascular condition underwent HRV and PWV measurements and the results were compared with the control group consisting of non-diabetic peers. Also, the findings were adjusted for the cardiovascular risk factors and other confounding factors. RESULTS: A total of 64 diabetic patients (age= 52.08±8.50 years; males=33 [51.6%]) were compared with 57 controls (age= 48.74±6.18 years; males=25 [43.9%]) in this study. Hypertension, dyslipidemia, and thereby systolic blood pressure and statin use were significantly more frequent in the diabetic group, while the serum levels of cholesterol, HDL-C and LDL-C were significantly higher in the controls. Pulse wave was significantly increased in the diabetic patients (p<0.001). Main HRV parameters were significantly lower in diabetics than in controls. After adjustment for the confounders, PWV and HRV remained significantly different between the groups (p=0.01 and p=0.004, respectively). Multiple logistic regression of the association between pulse wave velocity and HRV index was independently significant both in diabetics and controls. CONCLUSIONS: There exists a significant relationship between heart rate variability and arterial stiffness as a measure for atherosclerosis in diabetic patients, although the role of the confounding factors is noteworthy.

Spontaneous alternans in Brugada ECG morphology.

A 23-year-old man presented with sick sinus syndrome and Brugada-like ECG pattern. Coved type ECG (type 1) converted to saddleback configuration (type 2) when R-R interval decreased and it changed to coved type pattern with increasing R-R cycle length. During stable heart rate, there was no change in Brugada ECG pattern. The R-R interval effect on these patterns can be explained by intensity or kinetics of ion currents and autonomic tone.

Prevalence and predictors of electrical storm in patients with implantable cardioverter-defibrillator.

Identifying predictors of electrical storm in patients with implantable cardioverter-defibrillators (ICDs) could help identify those at risk and reduce the incidence of this emergency situation, which has a detrimental effect on mortality and morbidity in patients with ICDs. This retrospective study sought to determine the prevalence and predictors of electrical storm in patients with ICDs. One hundred sixty-two patients (126 men; mean age 58 +/- 13 years) who received ICDs from January 2001 to January 2005 were included in the study. Clinical, electrocardiographic, and ICD stored data and electrograms were collected and analyzed. Twenty-two patients (14%) developed electrical storm during a mean follow-up of 14.3 +/- 10 months. Using Cox multiple regression analysis, it was found that an ejection fraction <25% (p = 0.007), QRS width > or =120 ms (p = 0.002), and a lack of adjunctive angiotensin-converting enzyme inhibitor and beta-blocker therapy (both p < 0.001) were correlated with a greater probability of electrical storm. Adjunctive amiodarone and digoxin therapy, indication of ICD implantation, and age were not correlated with the occurrence of electrical storm during follow-up (all p = NS). In conclusion, electrical storm is not uncommon in patients with ICDs. Optimum medical therapy with beta blockers and angiotensin-converting enzyme inhibitors could reduce the occurrence of electrical storm, and this especially should be considered in those at greater risk for this complication (i.e., those with left ventricular ejection fractions <25% and QRS widths > or =120 ms).