Circadian rhythm of spectral indices of heart rate variability in healthy subjects.

Circadian pattern of heart rate variability spectral indices, including hourly, 24-hour, night, day, morning, and sex-adjusted measures of low frequency (LF), high frequency (HF), and LF/HF, was evaluated in healthy persons in 24-hour 3-lead electrocardiogram. HF showed circadian pattern with the greatest night values and LF/HF with the smallest night values. Peaks of hourly LF were found between 5 and 9 am and between 4 and 6 pm. The smallest LF was between 11 pm and 3 am. Hourly HF peaked between 11 pm and 5 am. The smallest HF was observed between midday and 2 pm. LF/HF peaked between 6 and 9 am as well as between 4 and 6 pm with the smallest values between midnight and 5 am. Sex adjustment was of no significance. In healthy subjects, HF and LF/HF have circadian pattern. Evaluation of all 5-minute intervals of 24-hour period seems to be a precise method of heart rate variability analysis.

[Cardiovascular abnormalities in patients with obstructive sleep apnoea syndrome]. / Zaburzenia czynnosci ukladu sercowo-naczyniowego u chorych z zespolem obturacyjnego bezdechu sennego.

The activation of adrenergic and renin-angiotensin-aldosterone (RAA) systems observed in patients with obstructive sleep apnoea syndrome (OSA) strongly affects functional status of the cardiovascular system. In this paper we discuss the link between obstructive sleep apnoea syndrome and common cardiovascular diseases such as systemic and pulmonary hypertension, ischaemic heart disease, stroke, arrhythmia and ventricular hypertrophy. We also present the importance of early pharmacologic treatment in preventing cardiac hypertrophy and ventricular dysfunction in patients with obstructive sleep apnoea syndrome.

Circadian rhythm of the QT interval dispersion in healthy subjects. Correlation with heart rate variability circadian pattern.

Circadian variation of QT interval dispersion (QTd) and heart rate variability spectral indices was evaluated in healthy persons in 24-hour 3-lead electrocardiogram. Mean values, SD, and SD/mean were evaluated for 24 hours, each hour separately and in night, day, and morning periods. Table Curve 2D and multiple regression were applied to find correlations between parameters. In 50% of subjects, a significant negative correlation was revealed between QTd and HF. Also, in 50% of persons, a significant positive correlation was found between QTd and low frequency/high frequency. After adjustment for periods, correlations were only observed during morning hours. With Table Curve 2D, 2 models of correlations between QTd and HF were found. Multiple regression analysis revealed relations between mean QTd and R-R as well as mean QTd and HF. It is possible that it is sympathovagal balance, as reflected in heart rate variability, and not the tone of both autonomic components that affects QTd variability.

Hypertension, and not sex hormones or insulin resistance affects left ventricular mass in aging men.

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity and mortality. The aim of the study was to find which factors influence left ventricular mass (LVM) and whether relationships exist between sex hormones: testosterone (T), estradiol (E2), sex hormone binding globulin (SHBG) and insulin resistance (HOMA-IR) and LVM. The study group consisted of 107 males at the age of over 50 years (mean 60.1 +/- 7.0). Positive significant correlations between LVM or left ventricle mass index (LVMI) and hypertension (0.23; p = 0.015 and 0.23; p = 0.019 respectively) as well as between LVM and body weight (0.38; p < 0.001) were observed. LVM and LVMI were higher in hypertensive than in normotensive men (279.9 +/- 82.2 vs. 243.4 +/- 70.3 g, p = 0.015 and 144.6 +/- 41.5 vs. 127.4 +/- 33.1 g/m2, p = 0.019 respectively). Multiple regression analysis showed LVM to be independently associated with hypertension and body weight. For LVMI such correlation was found only with hypertension. No relationships were observed between LVM/LVMI and insulin/insulin resistance.

The influence of polarizing GIK mixture on the indicators of myocardial necrosis.

For the estimation of the role of GIK in diminishing post-infarction necrosis, the influence of GIK mixture on indicative enzymes (such as: CPK, CK-MB, ASPAT and ALAT) was checked. In a group of patients treated with GIK the increase of CPK and CK-MB activity after 24 hours was less pronounced, comparing to placebo group and differences between groups were at the borderline of statistical significance. Other parameters in both groups did not change in statistically significant way. A noted profitable change in CPK and CK-MB activity speaks in favour of GIK mixture and it is role in diminishing myocardial necrosis.

Dihydrotestosterone treatment in men with coronary artery disease. I. Influence on sex hormones, lipid profile, insulin resistance and fibrinogen.

The effects of three months' transdermal dihydrotestosterone treatment were assessed in eleven men with coronary artery disease. Concentration of total testosterone level significantly decreased (p < 0.01) as well as free testosterone (p < 0.05) and estradiol levels (p < 0.01), without changes of sex hormone binding globuline and estradiol/testosterone ratio. DHT regimen did not alter the parameters of lipid profile. No changes of blood glucose, insulin, insulin resistance (HOMA) and fibrinogen were observed in this group. The tendency towards higher levels of hemoglobin, erythrocyte count and hematocrit did not reach statistical significance. Short term DHT administration in aging males was safe for prostate.

Dihydrotestosterone treatment in men with coronary artery disease. II. Influence on myocardial ischemia and left ventricle.

The effect of transdermal dihydrotestosterone on left ventricle mass and its systolic and diastolic function as well as on the results of treadmill stress test was assessed in eleven males with coronary artery disease. DHT treatment for 3 months resulted in significant decrease in isovolumetric relaxation time (0.150+/-0.37 s vs. 0.135+/-0.03 s; p < 0.05) indicating the improvement of left ventricle diastolic function. Left ventricle mass and systolic function indices remained unchanged. There was improvement in myocardial ischemia, time to 1 mm ST segment depression increased (p < 0.05) and ST/HR slope decreased (p < 0.01). Correlation coefficients between testosterone concentration at the beginning of the study and differences in selected parameters of ECG stress test were as follows: for T and increased total exercise time (r= -0.83, p=0.002), for T and increased maximum workload (r= -0.84, p=0.001), for T and increased time to 1 mm ST segment depression (r= -0.75, p=0.009) and for T and decreased ST/HR slope (r=0.68, p=0.02).

[Insulin receptor gene polymorphism in myocardial infarction patients]. / Polimorfizm genu ludzkiego receptora insuliny (hINSR) u chorych z zawalem serca.

The aim of this study was the assessment of the association of human insulin receptor gene Nsil polymorphism with myocardial infarction in 100 patients and 140 healthy individuals. The polymorphism was studied using polymerase chain reaction. An association was found between N2 allele and myocardial infarction, particularly in patients with normal body weight and/or with positive family history.

[Analysis of association of human endothelial nitric oxide synthase gene polymorphism with myocardial infraction]. / Analiza zwiazku polimorfizmu genu sródblonkowej syntetazy tlenku azotu z zawalem miesnia sercowego.

The aim of this study was an assessment of association of human endothelial nitric oxide synthase gene Ban II polymorphism with the myocardial infarction in 178 patients and 136 healthy individuals. These polymorphism were studied using polymerase chain reaction (PCR) and Ban II restriction fragment length polymorphism (RFLP). It was found that TT and GT genotypes and allele T were associated with myocardial infarction patients under 50 years. We did not observed this association for older myocardial infarction patients. Allele T might be used as a genetic marker in the prophylaxis of myocardial infarction among people under 50 years.

G-protein beta3 subunit gene C825T polymorphism is associated with arterial hypertension in Polish patients with type 2 diabetes mellitus.

BACKGROUND: Diabetes mellitus type 2 results from a complex of hereditary and environmental factors. Genes encoding elements of the G-protein system are candidate genes in hypertension and obesity. Since insulin uses G-sensitive mechanisms to enhance tissue glucose uptake and vasodilatation, the GNB3 gene may be a candidate gene in type 2 diabetes. The goal of our research was to determine if the C825T polymorphism at the G-protein b3 subunit gene locus is associated with type 2 diabetes. MATERIAL/METHODS: The study population consisted of 172 Polish patients with type 2 diabetes and 172 healthy, age- and sex-matched controls. The C825T polymorphism was detected by PCR and RFLP. RESULTS: A higher frequency of genotypes containing the mutation (CT+TT) was observed among the diabetics than in the controls. The T825 variant occurred more often among hypertensive diabetics (71%) than among diabetics with normal blood pressure (42.5%). The OR for hypertension in diabetic subjects bearing CT+TT genotypes was higher than in patients with the CC genotype. Overweight and obesity were not associated with the T825 variant in either the experimental subjects or the controls. CONCLUSIONS: In this population, the T825 variant of the GNB3 gene was not associated with type 2 diabetes itself, nor with overweight and obesity, but was associated with diabetic hypertension. Upon confirmation of our results this variant may be useful as a genetic marker of susceptibility to hypertension and vascular complications in type 2 diabetes.

[Echocardiographic evaluation of right ventricular structure and diastolic function in patients with overweight and arterial hypertension]. / Echokardiograficzna ocena budowy i czynnosci rozkurczowej prawej komory serca u chorych z nadwaga i nadcisnieniem tetniczym.

The accelerated development of the left ventricular dysfunction due to increased preload and afterload is often observed in patients with systemic hypertension and concurrent overweight/obesity. Right ventricle is also influenced by systemic hypertension. The aim of the study was the echocardiographic assessment of the right ventricular structure and diastolic function in patients with systemic hypertension and overweight. The study group consisted of 31 subjects with untreated, mild to moderate systemic hypertension and overweight defined as a body mass index (BMI) above 26 kg/m2. Right ventricular diastolic diameter and right ventricular wall thickness were similar in study and control groups. In comparison with the controls patients with overweight demonstrated significantly shortened acceleration time of systolic flow in pulmonary artery, increased mean pulmonary artery pressure and decreased early to late filling wave velocity time integrals. These findings indicate that systemic hypertension associated with obesity does not cause additional morphological changes of the right ventricle compared to hypertensives with normal weight. Impaired right ventricular diastolic filling and pulmonary artery systolic flow indicate the presence of mild right ventricular dysfunction in subjects with overweight, however, diastolic and systolic parameters are within normal range both in patients with normal weight and overweight.

Angiotensin-converting enzyme gene insertion/deletion polymorphism in Polish patients with myocardial infarction.

UNLABELLED: Both environmental and genetic factors play an important role in the pathogenesis of coronary artery disease. In view of angiotensin-converting enzyme (ACE) role in physiology and pathology and benefits of ACE-inhibitors therapy, the gene coding this protein meets criteria for candidate gene for the susceptibility to cardiovascular disease including myocardial infarction. The goal of our research was to assess the association of ACE gene I/D polymorphism with myocardial infarction in Polish population regarding different variables related to the disease (smoking, concomitant hypertension, obesity, plasma cholesterol level and family history). To detect ACE I/D polymorphism method of Rigat with some modification was used. The study population consisted of 314 individuals of Polish origin. 178 of them suffered from acute myocardial infarction or have survived it. Another 136 people without apparent signs and symptoms of cardiovascular pathology or diabetes served as control subjects. No one from the control group reported positive family history. Both allele frequencies and genotype distribution did not differ substantially between study groups. They were similar to those reported in other Caucasian populations. Further analysis did not detect any important differences in allele and genotype frequencies between experimental and control subjects regarding body mass index, total plasma cholesterol level and concomitant arterial hypertension. Cigarette smoking status influenced allele frequencies and genotype distribution in the group of patients with premature myocardial infarction. DD genotype was observed more often among non-smoking patients who suffered from myocardial infarction before the age of 50. These differences had reached the level of statistical significance (p < 0.05). CONCLUSIONS: 1. Insertion/deletion polymorphism in ACE gene does not seem to be associated with myocardial infarction in the studied Polish population. 2. The obtained results suggest that DD genotype may be associated with smoking-dependent risk of myocardial infarction. Further studies are needed to prove this hypothesis.

The combined effect of systemic hypertension and obesity on biventricular diastolic function.

Left ventricular (LV) cardiomyopathy in hypertensive obese patients is a consequence of increased LV afterload due to systemic hypertension and increased LV pre-load subsequent to the augmentation of total blood volume in obese. However, little is known about right ventricular (RV) functional status and biventricular interaction in patients with systemic hypertension and concurrent obesity. The aim of our study was the echocardiographic assessment of left and right ventricular function and diastolic performance in hypertensive obese patients. The study group consisted of 31 subjects with BMI > 26 kg/m2 and mild to moderate systemic hypertension, patients with systemic hypertension and normal BMI served as a control group. M-mode echocardiographic measurements of left and right ventricles were performed. By pulsed Doppler echocardiography LV and RV recordings of diastolic filling and systolic flows in pulmonary artery were obtained. Hypertensive obese patients demonstrated significantly thicker posterior wall and enlarged left atrium, while no differences in RV structure were found between both groups. In obese subjects we showed significantly lower LV early to late filling wave velocity ratio and LV early to late filling wave velocity-time-integral ratio (p < 0.01). Only RV early to late filling wave velocity-time-integral ratio differentiated obese and lean subjects (p < 0.05). In obese subjects we demonstrated significantly increased mean pulmonary artery pressure. The results of our study indicate that RV is protected from the direct influence of hemodynamic changes observed in overweight/obesity better than the left ventricle and RV abnormalities in patients with systemic hypertension and obesity depend mainly on increased RV afterload, secondary to LV dysfunction.

The influence of nonsteroidal anti-inflammatory drugs abuse and chronic stress on the development of necrotizing fasciitis--case report.

In this report we present the case of a 19-year-old woman who was admitted to hospital due to an intense pain of the left gluteofemoral region and the symptoms of toxic shock. For 5 days before admission to hospital the patient had a strong pain and fever, up to 40 degrees C, treated with high doses of nonsteroidal anti-inflammatory drugs administered by oral and intramuscular routes. During the next 20 hours a large oedema of the left femoral region developed, the skin became purplish, and bullae filled with the hemorrhagic fluid appeared. On the group of typical skin changes, results of computed tomography and findings during surgical treatment necrotizing fasciitis was recognized. The patient was transferred by plane to the National Center of Hyperbaric Medicine Institute of Sea and Tropical Medicine where she was successfully treated with hyperbaric oxygen therapy. In this paper we discuss the problem of the association between the use of nonsteroidal anti-inflammatory drugs, chronic stress and the development of necrotizing fasciitis.

Prognostic value of the atrial pulsed Doppler recordings of transmitral flow in the assessment of left ventricular diastolic dysfunction.

Volume sample location is the most important factor influencing pulsed Doppler recordings of left ventricular (LV) diastolic filling. Transmitral diastolic flow velocities measured at the tips of mitral valve leaflets are usually higher than those obtained from atrial location. Nevertheless, independently of volume sample location, differences between early to late velocities ratio (E/A) are nonsignificant, so E/A became the most useful index of ventricular diastolic performance. In some patients, however, with E/A > 1 measured between the tips of mitral leaflets, the pattern of delayed LV relaxation, with diminished E and predominant A wave (E/A < 1), is often obtained from left atrial volume sample location. The aim of our study was to compare LV dimensions and wall thickness between patients with E/A > 1 recorded both at the tips of mitral valve leaflets and in the left atrium and patients with E/A > 1 at the tips of mitral valve leaflets and E/A < 1 in the left atrium. The study population consisted of 51 patients with E/A > 1 recorded between the tips of mitral valve (E/Avent) and excluded pseudonormalized filling pattern. The study population was divided into two groups based on Doppler profile recorded in the left atrium: group A--26 patients with E/A < 1 (E/Aatr) and group B--25 patients with E/Aatr > 1. Patients from group A were significantly older (55.6 +/- 12.8 vs 43.5 +/- 10.5 yrs, p < 0.001) and had increased body mass index (28.8 +/- 4.4 vs 25 +/- 4.1 kg/m2, p < 0.01) compared to subjects from group B. The average thickness of intraventricular septum was 13.5 +/- 2.8 mm in group A and 9.7 +/- 1.6 mm in group B, the average thickness of LV posterior wall was 11.6 +/- 1.7 and 9.2 +/- 1.8 mm, respectively. The results of this study suggest that abnormal atrial recordings of diastolic flows may reflect the earliest stage of left ventricular diastolic dysfunction in asymptomatic patients with echocardiographic signs of mild cardiac damage.