Evaluation of dexrazoxane effect on preventing acute cardiac arrhythmia in patients with breast cancer treated with neoadjuvant/adjuvant anthracycline-based chemotherapy.

INTRODUCTION: Adding dexrazoxane to the treatment during neoadjuvant/adjuvant anthracycline-based chemotherapy in patients with breast cancer prevents the development of heart failure. In this study, we investigated whether dexrazoxane has a protective effect on arrhythmia resulting from chemotherapy. METHODS: Patients with breast cancer who received neoadjuvant/adjuvant anthracycline-based chemotherapy in the medical oncology polyclinic between 2017 and 2020 were included in the study. To investigate the effect of dexrazoxane on arrhythmia, this retrospective study included 70 patients, whose 12-lead surface electrocardiograms (ECGs) and echocardiography were obtained before receiving anthracycline-based treatment and after receiving four cycles of chemotherapy. Thirty-two patients received anthracycline only, and 38 patients received anthracycline and dexrazoxane. Arrhythmia parameters such as QT interval, QTc interval, Tp-e interval, Tp-e/QT, Tp-e/QTc and frontal QRS-T angle were calculated from 12-lead ECGs. RESULTS: Arrhythmia parameters such as frontal QRS-T angle , QT , QTc and heart rate were significantly increased after chemotherapy in both the groups that received dexrazoxane and did not receive dexrazoxane (P < .05). Contrary to the ECG parameters, ejection fraction was decreased in the dexrazoxane group (60.5 ± 2.2 vs 60.1 ± 2.0; P = .038) and the other group (60.4 ± 1.3 vs 60.0 ± 2.6; P = .043) after the chemotherapy. CONCLUSION: This study demonstrated that dexrazoxane may not have a protective effect on ECG parameters which are predictors of arrhythmia, at breast cancer patients who received anthracyclines.

Relationship of Autophagy and Apoptosis with Total Occlusion of Coronary Arteries.

BACKGROUND The primary aim of this study was to evaluate the level of autophagy and apoptosis enzymes in patients with coronary artery disease (CAD). Furthermore, we investigated the role of autophagy and apoptosis in the progression of coronary collateral and coronary total occlusion (TO). MATERIAL AND METHODS We enrolled 115 patients in this prospective, observational, controlled study, who were categorized into 3 groups as follows: group 1, patients with chronic TO (n=49); group 2, patients with acute TO such as myocardial infarction (n=36); and group 3, healthy control patients (n=30). We used the enzyme-linked immunosorbent assay (ELISA) kit for autophagy-related protein 5 (ATG5) and apoptosis (M30) in the plasma for these 3 groups. RESULTS Autophagy levels significantly varied among the groups (13.7±5.3 ng/mL, 11.7±3.4 ng/mL, and 7.5±3, respectively; P<0.001). In addition, apoptosis levels significantly varied among the groups (78.6±33.4 ng/mL, 64.9±30.6 ng/mL, and 47.6±18.2, respectively; P<0.001). The subgroup analysis revealed significant positive correlations between the autophagy level and the Rentrop score in contrast to apoptosis in group 1 (r=0.463; P<0.001). CONCLUSIONS This study determined that autophagy and apoptosis levels were higher in patients with CAD than in healthy controls. In contrast to the serum apoptosis level, serum autophagy levels demonstrated a significant positive correlation with the Rentrop score. Hence, an elevated autophagy level might be a potential activator and marker of the process by which the body protects itself in CAD.

Treatment of ineffective endocardial defibrillation with subcutaneous array: a case report.

Defibrillation threshold (DFT) testing is an important part of ICD implantation. After placement of the ICD generator, a DFT test is performed to evaluate the integrity of the ICD system and to confirm a successful defibrillation safety margin. More than 6% of ICDs implanted are not within the DFT safety margin. Presently described is the case of a patient with a high DFT and some of the methods that can be used to manage this circumstance, including the use of a subcutaneous array.

An investigation of the usability of sound recognition for source separation of packaging wastes in reverse vending machines.

In this study, we investigate the usability of sound recognition for source separation of packaging wastes in reverse vending machines (RVMs). For this purpose, an experimental setup equipped with a sound recording mechanism was prepared. Packaging waste sounds generated by three physical impacts such as free falling, pneumatic hitting and hydraulic crushing were separately recorded using two different microphones. To classify the waste types and sizes based on sound features of the wastes, a support vector machine (SVM) and a hidden Markov model (HMM) based sound classification systems were developed. In the basic experimental setup in which only free falling impact type was considered, SVM and HMM systems provided 100% classification accuracy for both microphones. In the expanded experimental setup which includes all three impact types, material type classification accuracies were 96.5% for dynamic microphone and 97.7% for condenser microphone. When both the material type and the size of the wastes were classified, the accuracy was 88.6% for the microphones. The modeling studies indicated that hydraulic crushing impact type recordings were very noisy for an effective sound recognition application. In the detailed analysis of the recognition errors, it was observed that most of the errors occurred in the hitting impact type. According to the experimental results, it can be said that the proposed novel approach for the separation of packaging wastes could provide a high classification performance for RVMs.

Is galectin-3 a biomarker, a player-or both-in the presence of coronary atherosclerosis?

Atherosclerosis is a complex process mediated by leukocytes, macrophages and various inflammatory markers. Galectin-3 is secreted by activated macrophages and is involved in cardiac fibrosis, cardiac remodeling, and inflammation. The present study aimed to determine the relationship between the presence and severity of coronary artery disease (CAD) and serum galectin-3 levels. The study included 82 patients with CAD confirmed via coronary angiography and 82 healthy participants as control group. Angiographic CAD was defined as ≥50% luminal diameter stenosis of at least one major epicardial coronary artery. The severity of CAD was determined by the Gensini score; and the serum galectin-3 levels were measured via ELISA. Serum galectin-3 levels were significantly higher in the patient group with CAD than in the control group (12.96±4.92 vs 5.52±1.9 ng/mL, p<0.001). In the correlation analysis, serum galectin-3 showed significant correlation with the Gensini score (r=0.715, p<0.001), number of diseased vessels (r=0.752, p<0.001) and serum hs-CRP level (r=0.607, p<0.001). In addition, multivariate logistic regression analysis showed that the serum galectin-3 levels were significant and independent predictors of the presence of angiographic CAD (OR=3.933, 95% CI 2.395 to 6.457; p<0.001). In the present study, the serum galectin-3 levels were higher in the patients with CAD than in healthy controls. Also, serum galectin-3 levels showed a significant positive correlation with the severity of CAD. An increased serum galectin-3 level may be considered an important activator and a marker of the atherosclerotic inflammatory process in CAD.

Evaluation of Electrocardiographic T-peak to T-end Interval in Subjects with Increased Epicardial Fat Tissue Thickness / Avaliação Eletrocardiográfica do Intervalo Tpeak-Tend em Indivíduos com Espessura Aumentada do Tecido Adiposo Epicárdico

Abstract Background: The association between periatrial adiposity and atrial arrhythmias has been shown in previous studies. However, there are not enough available data on the association between epicardial fat tissue (EFT) thickness and parameters of ventricular repolarization. Thus, we aimed to evaluate the association of EFT thickness with indices of ventricular repolarization by using T-peak to T-end (Tp-e) interval and Tp-e/QT ratio. Methods: The present study included 50 patients whose EFT thickness ≥ 9 mm (group 1) and 40 control subjects with EFT thickness < 9 mm (group 2). Transthoracic echocardiographic examination was performed in all participants. QT parameters, Tp-e intervals and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. Results: QTd (41.1 ± 2.5 vs 38.6 ± 3.2, p < 0.001) and corrected QTd (46.7 ± 4.7 vs 43.7 ± 4, p = 0.002) were significantly higher in group 1 when compared to group 2. The Tp-e interval (76.5 ± 6.3, 70.3 ± 6.8, p < 0.001), cTp-e interval (83.1 ± 4.3 vs. 76±4.9, p < 0.001), Tp-e/QT (0.20 ± 0.02 vs. 0.2 ± 0.02, p < 0.001) and Tp-e/QTc ratios (0.2 ± 0.01 vs. 0.18 ± 0.01, p < 0.001) were increased in group 1 in comparison to group 2. Significant positive correlations were found between EFT thickness and Tp-e interval (r = 0.548, p < 0.001), cTp-e interval (r = 0.259, p = 0.01), and Tp-e/QT (r = 0.662, p < 0.001) and Tp-e/QTc ratios (r = 0.560, p < 0.001). Conclusion: The present study shows that Tp-e and cTp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in subjects with increased EFT, which may suggest an increased risk of ventricular arrhythmia.

Resumo Fundamento: A associação entre a adiposidade periatrial e arritmias atriais foi demonstrada em estudos anteriores. No entanto, não há dados disponíveis suficientes sobre a associação entre a espessura do tecido adiposo epicárdico (TAE) e parâmetros de repolarização ventricular. Assim, objetivou-se avaliar a associação da espessura do TAE com índices de repolarização ventricular usando o intervalo Tpeak-Tend (Tp-e) e a relação Tp-e/QT. Métodos: O presente estudo incluiu 50 pacientes com espessura do TAE ≥ 9 mm (grupo 1) e 40 indivíduos do grupo controle cuja espessura do TAE era < 9 mm (grupo 2). O exame ecocardiográfico transtorácico foi realizado em todos os participantes. Os parâmetros QT, os intervalos Tp-e e a relação Tp-e/QT foram medidos a partir do eletrocardiograma de 12 derivações. Resultados: QTd (41,1 ± 2,5 vs. 38,6 ± 3,2, p < 0,001) e QTd corrigido (46,7 ± 4,7 vs 43,7 ± 4, p = 0,002) foram significativamente maiores no grupo 1 quando comparados com o grupo 2. O intervalo Tp-e (76,5 ± 6,3, 70,3 ± 6,8, p < 0,001), intervalo cTp-e (83,1 ± 4,3 vs. 76 ± 4,9, p < 0,001), as relações Tp-e/QT (0,20 ± 0,02 vs. 0,02 ± 0,2, p < 0,001) e Tp-e/QTc (0,2 ± 0,01 vs. 0,18 ± 0,01, p < 0,001) estavam aumentados no grupo 1 em comparação ao grupo 2. Correlações positivas significativas foram encontrados entre a espessura do TAE e o intervalo Tp-e (r = 0,548, p < 0,001), intervalo cTp-e (r = 0,259, p = 0,01), e as relações Tp-e/QT (r = 0,662, p < 0,001) e Tp-e/QTc (r = 0,560, p < 0,001). Conclusão: O presente estudo mostra que os intervalos Tp-e e cTp-e, e as relações Tp-e/QT e Tp-e/QTc estavam elevados nos indivíduos com TAE aumentado, o que pode sugerir um maior risco de arritmia ventricular.

Evaluation of Electrocardiographic T-peak to T-end Interval in Subjects with Increased Epicardial Fat Tissue Thickness.

BACKGROUND: The association between periatrial adiposity and atrial arrhythmias has been shown in previous studies. However, there are not enough available data on the association between epicardial fat tissue (EFT) thickness and parameters of ventricular repolarization. Thus, we aimed to evaluate the association of EFT thickness with indices of ventricular repolarization by using T-peak to T-end (Tp-e) interval and Tp-e/QT ratio. METHODS: The present study included 50 patients whose EFT thickness ≥ 9 mm (group 1) and 40 control subjects with EFT thickness < 9 mm (group 2). Transthoracic echocardiographic examination was performed in all participants. QT parameters, Tp-e intervals and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. RESULTS: QTd (41.1 ± 2.5 vs 38.6 ± 3.2, p < 0.001) and corrected QTd (46.7 ± 4.7 vs 43.7 ± 4, p = 0.002) were significantly higher in group 1 when compared to group 2. The Tp-e interval (76.5 ± 6.3, 70.3 ± 6.8, p < 0.001), cTp-e interval (83.1 ± 4.3 vs. 76±4.9, p < 0.001), Tp-e/QT (0.20 ± 0.02 vs. 0.2 ± 0.02, p < 0.001) and Tp-e/QTc ratios (0.2 ± 0.01 vs. 0.18 ± 0.01, p < 0.001) were increased in group 1 in comparison to group 2. Significant positive correlations were found between EFT thickness and Tp-e interval (r = 0.548, p < 0.001), cTp-e interval (r = 0.259, p = 0.01), and Tp-e/QT (r = 0.662, p < 0.001) and Tp-e/QTc ratios (r = 0.560, p < 0.001). CONCLUSION: The present study shows that Tp-e and cTp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in subjects with increased EFT, which may suggest an increased risk of ventricular arrhythmia.

Ivabradine Improves Heart Rate Variability in Patients with Nonischemic Dilated Cardiomyopathy / Ivabradina Melhora a Variabilidade da Frequência Cardíaca em Pacientes com Cardiomiopatia Dilatada Não Isquêmica

Background: Ivabradine is a novel specific heart rate (HR)-lowering agent that improves event-free survival in patients with heart failure (HF). Objectives: We aimed to evaluate the effect of ivabradine on time domain indices of heart rate variability (HRV) in patients with HF. Methods: Forty-eight patients with compensated HF of nonischemic origin were included. Ivabradine treatment was initiated according to the latest HF guidelines. For HRV analysis, 24-h Holter recording was obtained from each patient before and after 8 weeks of treatment with ivabradine. Results: The mean RR interval, standard deviation of all normal to normal RR intervals (SDNN), the standard deviation of 5-min mean RR intervals (SDANN), the mean of the standard deviation of all normal-to-normal RR intervals for all 5-min segments (SDNN index), the percentage of successive normal RR intervals exceeding 50 ms (pNN50), and the square root of the mean of the squares of the differences between successive normal to normal RR intervals (RMSSD) were low at baseline before treatment with ivabradine. After 8 weeks of treatment with ivabradine, the mean HR (83.6 ± 8.0 and 64.6 ± 5.8, p < 0.0001), mean RR interval (713 ± 74 and 943 ± 101 ms, p < 0.0001), SDNN (56.2 ± 15.7 and 87.9 ± 19.4 ms, p < 0.0001), SDANN (49.5 ± 14.7 and 76.4 ± 19.5 ms, p < 0.0001), SDNN index (24.7 ± 8.8 and 38.3 ± 13.1 ms, p < 0.0001), pNN50 (2.4 ± 1.6 and 3.2 ± 2.2 %, p < 0.0001), and RMSSD (13.5 ± 4.6 and 17.8 ± 5.4 ms, p < 0.0001) substantially improved, which sustained during both when awake and while asleep. Conclusion: Our findings suggest that treatment with ivabradine improves HRV in nonischemic patients with HF. .

Fundamento: A ivabradina é um novo agente redutor específico da frequência cardíaca (FC) que melhora a sobrevida livre de eventos de pacientes com insuficiência cardíaca (IC). Objetivo: Avaliar o efeito da ivabradina nos índices temporais da variabilidade da frequência cardíaca (VFC) em pacientes com IC. Métodos: Quarenta e oito pacientes com IC compensada de etiologia não-isquêmica foram incluídos no estudo. O tratamento com ivabradina foi iniciado de acordo com as recomendações mais recentes para a IC. O Holter de 24 horas foi utilizado para analisar os índices da VFC em cada paciente antes e após 8 semanas de tratamento com ivabradina. Resultados: Todos os índices da VFC, o intervalo RR médio, o desvio padrão de todos os intervalos RR normais (DPNN), o desvio padrão de intervalos RR médios de 5 minutos (DPNNM), a média do desvio padrão de todos os intervalos RR normais para todos os segmentos de 5 minutos (índice DPNN), porcentagem de intervalos RR normais sucessivos superiores a 50 milissegundos (pNN50), e a raiz quadrada da média dos quadrados das diferenças entre intervalos RR sucessivos (RMQQD) apresentaram redução no ínicio do estudo, antes do tratamento com ivabradina. Após 8 semanas de tratamento com ivabradina, as médias das FC (83,6 ± 8,0 e 64,6 ± 5,8, p < 0,0001) e todos os índices da VFC, médias dos intervalos RR (713 ± 74 e 943 ± 101 ms, p < 0,0001), DPNN (56,2 ± 15,7 e 87,9 ± 19,4 ms, p < 0,0001), DPNNM (49,5 ± 14,7 e 76,4 ± 19,5 ms, p < 0,0001), índice DPNN (24,7 ± 8,8 e 38,3 ± 13,1 ms, p < 0,0001), pNN50 (2,4 ± 1,6 e 3,2 ± 2,2%, p < 0,0001) e RMQQD (13,5 ± 4,6 e 17,8 ± 5,4 ms , p < 0,0001), foram substancialmente melhorados, e permaneceram nestas ...

Ivabradine improves heart rate variability in patients with nonischemic dilated cardiomyopathy.

BACKGROUND: Ivabradine is a novel specific heart rate (HR)-lowering agent that improves event-free survival in patients with heart failure (HF). OBJECTIVES: We aimed to evaluate the effect of ivabradine on time domain indices of heart rate variability (HRV) in patients with HF. METHODS: Forty-eight patients with compensated HF of nonischemic origin were included. Ivabradine treatment was initiated according to the latest HF guidelines. For HRV analysis, 24-h Holter recording was obtained from each patient before and after 8 weeks of treatment with ivabradine. RESULTS: The mean RR interval, standard deviation of all normal to normal RR intervals (SDNN), the standard deviation of 5-min mean RR intervals (SDANN), the mean of the standard deviation of all normal-to-normal RR intervals for all 5-min segments (SDNN index), the percentage of successive normal RR intervals exceeding 50 ms (pNN50), and the square root of the mean of the squares of the differences between successive normal to normal RR intervals (RMSSD) were low at baseline before treatment with ivabradine. After 8 weeks of treatment with ivabradine, the mean HR (83.6 ± 8.0 and 64.6 ± 5.8, p < 0.0001), mean RR interval (713 ± 74 and 943 ± 101 ms, p < 0.0001), SDNN (56.2 ± 15.7 and 87.9 ± 19.4 ms, p < 0.0001), SDANN (49.5 ± 14.7 and 76.4 ± 19.5 ms, p < 0.0001), SDNN index (24.7 ± 8.8 and 38.3 ± 13.1 ms, p < 0.0001), pNN50 (2.4 ± 1.6 and 3.2 ± 2.2 %, p < 0.0001), and RMSSD (13.5 ± 4.6 and 17.8 ± 5.4 ms, p < 0.0001) substantially improved, which sustained during both when awake and while asleep. CONCLUSION: Our findings suggest that treatment with ivabradine improves HRV in nonischemic patients with HF.

The effect of exercise and antioxidant enzyme levels in syndrome X and coronary slow flow phenomenon: an observational study.

OBJECTIVE: In this study the antioxidant enzyme [catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx) ] levels at rest in patients with syndrome X and coronary slow flow are measured. Then it has been investigated whether there is any enzymatic difference between the normal controls and syndrome X patients or patients with coronary slow flow and ascertain if exercise has any effects on the antioxidant enzyme levels. METHODS: Fifty-five patients were included in this prospective observational controlled study. Patients were divided into 3 groups: Group 1- normal controls (n=20); Group 2-patients with coronary slow flow (n=20); and Group 3-patients diagnosed with syndrome X (n=15). In all patients, blood samples were collected at rest and after maximal exercise. The antioxidant enzymes (SOD, CAT, Gpx) in the erythrocytes were studied for these three groups of blood sample. Statistical analysis was performed using Student t-test, Mann-Whitney U and Chi-square tests, Kruskal-Wallis variance analysis and ANOVA. RESULTS: Under basal conditions the lowest SOD and GPx levels were measured in the 2nd Group, whereas significant differences in paired comparisons were observed only between the 2nd and 3rd Groups (p=0.024 vs. p<0.01, respectively) during paired comparisons. The post-exercise SOD levels were decreased significantly in the 3rd Groups when compared with the basal concentrations (p=0.014), however no significant pre- and post-exercise differences were observed in the CAT and GPx concentrations (p>0.05). CONCLUSION: The post-exercise SOD level when compared with basal SOD levels were decreased significantly in the syndrome X group, however no differences were observed between the other groups. This can be interpreted as the reduction in the exercise related symptoms and ischemic findings are resulting from the decrease of SOD activity.

Evaluation of left atrial functions by color tissue Doppler imaging in adults with body mass indexes >or=30 kg/m(2) versus those <30 kg/m (2).

Evaluation of atrial function has received less attention than that of the ventricle although normal atrial function is required for optimal overall cardiac function. Obesity is associated with increased cardiovascular morbidity and mortality. In this study, we compared left atrial functions in obese adults (body mass index = BMI >or=30 kg/m(2)) with those in non-obese adults (BMI <30 kg/m(2)) by color tissue Doppler parameters. There were 37 adults with BMI >or=30 kg/m(2) (mean age 36 +/- 11 years) and 26 adults with BMI <30 kg/m(2) (mean age 35 +/- 5 years). Mean BMI was 38 +/- 6 kg/m(2) in the obese group whereas that was 24 +/- 2 kg/m(2) in the non-obese group. For color tissue Doppler imaging, sample volumes were placed on the mid left atrium at the septum, lateral, inferior, and anterior walls. The peak systolic strain (S(s)), peak systolic strain rate (SR(s)), peak early diastolic SR (SR(e)), peak late diastolic SR (SR(a)), peak systolic tissue velocity (TV(s)), peak early diastolic TV (TV(e)) and peak late diastolic TV (TV(a)) values were measured. For each measurement, values in three consecutive cardiac cycles were measured and then averaged. To simplify the analysis, the values at each wall were combined and averaged to obtain mean values. All left atrial systolic function parameters (S(s), SR(s), TV(s)) were similar between the groups. In addition, there was no statistically significant difference at left atrial diastolic function parameters (SR(e), SR(a), TV(e), TV(a)). We could not find any significant difference between obese and non-obese adults at left atrial functions assessed by color tissue Doppler parameters.