ABSTRACT
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
ABSTRACT
OBJECTIVE: To test whether long-term antihypertensive treatment with metoprolol succinate (a ß1-adrenoceptor blocker) or olmesartan medoxomil (an angiotensin II AT1-receptor blocker) reverses microvascular dysfunction in hypertensive patients. METHODS: This study included 44 hypertensive outpatients and 20 age and sex-matched healthy controls. We used skin capillaroscopy to measure capillary density and recruitment at rest and during PORH. Endothelium-dependent vasodilation of skin microcirculation was evaluated with a LDPM system in combination with ACh iontophoresis, PORH, and LTH. RESULTS: Pretreatment capillary density in hypertensive patients was significantly reduced compared with controls (71.3 ± 1.5 vs. 80.6 ± 1.8 cap/mm²; p < 0.001), as was PORH (71.7 ± 1.5 vs. 79.5 ± 2.6 cap/mm²; p < 0.05). After treatment for six months, capillary density increased to 75.4 ± 1.1 cap/mm² (p < 0.01) at rest and 76.8 ± 1.1 cap/mm² during PORH. During LTH, CVC in perfusion units (PU)/mmHg was similar in patients (1.71 [1.31-2.12]) and controls (1.60 [1.12-1.91]) and increased significantly (1.82 [1.30-2.20]) after treatment. Maximal CVC during PORH was reduced in hypertensive patients (0.30 [0.22-0.39]) compared to controls (0.39 [0.31-0.49], p < 0.001) and increased (0.41 [0.29-0.51], p < 0.001) after treatment. CONCLUSIONS: Capillary rarefaction and microvascular endothelial dysfunction in hypertensive patients responded favorably to long-term pharmacological treatment.
Subject(s)
Adrenergic beta-1 Receptor Antagonists/administration & dosage , Angiotensin II Type 1 Receptor Blockers/administration & dosage , Capillaries/physiopathology , Hypertension , Imidazoles/administration & dosage , Metoprolol/analogs & derivatives , Microcirculation/drug effects , Skin , Tetrazoles/administration & dosage , Adult , Female , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Male , Metoprolol/administration & dosage , Middle Aged , Olmesartan Medoxomil , Skin/blood supply , Skin/physiopathologyABSTRACT
BACKGROUND: Early recognition of heart disease in diabetics is a highly desirable goal, and diastolic dysfunction, one of its earliest manifestations, can be readily assessed by tissue Doppler imaging. We tested in normotensive diabetics without signs of coronary artery disease whether tissue Doppler imaging would improve the diagnosis of diastolic dysfunction beyond classical criteria and identify patients already presenting impaired cardiac performance. METHODS: We studied 79 patients (56 males, 55 type-2 diabetes mellitus) who underwent Doppler echocardiography, and exercise testing. Diastolic dysfunction was diagnosed either based on European Study Group on Diastolic Heart Failure guidelines or by tissue Doppler imaging provided that both of the following criteria were met: Em/Am ratio <1; and Em < 8.5 cm/sec. RESULTS: Tissue Doppler imaging identified diastolic dysfunction in 26.6% of diabetics, while classical criteria did so in 40.5% of the cases. The group identified by classical criteria did not differ significantly from patients without diastolic dysfunction, while in the group identified by Tissue Doppler imaging, significant differences were highlighted, including worse exercise tolerance and higher left ventricular mass index. Moreover, in multiple regression analysis, Em myocardial velocity and body mass index were the only variables independently related to exercise tolerance. CONCLUSION: Differently from classical criteria based on pulsed Doppler, Tissue Doppler imaging identifies a group of asymptomatic normotensive diabetics with diastolic dysfunction and reduced exercise tolerance. Confirmation of the prognostic importance of our findings could justify the use of Tissue Doppler imaging for diastolic function assessment in diabetics with otherwise healthy hearts.
