[Coexistence of anomalous sinus node artery originating from the left anterior descending artery and agenesis of the right coronary artery]. / Sol ön inen arterden çikan sinüs nod arteri ile sag koroner arter agenezisi birlikteligi.

Sinus node artery originates from the proximal segment of the right coronary artery, left circumflex artery, or from both. We present a 55-year-old man who underwent coronary angiography for exercise-induced chest pain localized in the epigastric region that resolved within several minutes of resting. He had an anomalous sinus node artery originating from the left anterior descending artery and right coronary artery agenesis. To our knowledge, this is the first reported case of coexistence of these two rare coronary anomalies.

Split right coronary artery: a report of two cases.

Split right coronary artery (RCA) is a congenital anomaly of the coronary arteries where either two separate arteries arise from the aortic trunk or RCA bifurcates into two major arteries immediately after its origin from the right sinus of Valsalva. We present two cases (59-year-old male, 50-year-old female) who sought treatment for exercise-induced angina pectoris. Coronary angiography revealed a split RCA in both cases. In the first case, the RCA consisted of two well-developed arteries bifurcating immediately after its origin from the sinus of Valsalva. In the second case, the RCA split from adjacent ostia into two major arteries almost identical in size. In both cases, the split RCAs had a parallel course. Both patients were scheduled to receive medical treatment and had an uneventful follow-up of 15 and 11 months, respectively.

Tirofiban as adjunctive therapy for acute coronary syndromes and percutaneous coronary intervention: a meta-analysis of randomized trials.

AIMS: To perform a thorough and updated systematic review of randomized clinical trials comparing tirofiban vs. placebo or vs. abciximab. METHODS AND RESULTS: We searched for randomized trials comparing tirofiban vs. placebo or any active control. Odds ratios (OR) were computed from individual studies and pooled with random-effect methods. Thirty-one studies were identified involving 20,006 patients (12 874 comparing tirofiban vs. heparin plus placebo or bivalirudin alone, and 7132 vs. abciximab). When compared with placebo, tirofiban was associated at 30 days with a significant reduction in mortality [OR = 0.68 (0.54-0.86); P = 0.001] and death or myocardial infarction (MI) [OR = 0.69 (0.58-0.81); P < 0.001]. The treatment benefit persisted at follow-up but came at an increased risk of minor bleedings [OR = 1.42 (1.13, 1.79), P = 0.002] or thrombocytopenia. When compared with abciximab, mortality at 30 days did not differ [OR = 0.90 (0.53, 1.54); P = 0.70], but in the overall group tirofiban trended to increase the composite of death or MI [OR = 1.18 (0.96, 1.45); P = 0.11]. No such trend persisted at medium-term follow-up or when appraising studies testing tirofiban at 25 microg/kg bolus regimen. CONCLUSION: Tirofiban administration reduces mortality, the composite of death or MI and increases minor bleedings when compared with placebo. An early ischaemic hazard disfavouring tirofiban was noted when compared with abciximab in studies based on 10 but not 25 microg/kg tirofiban bolus regimen.

Sinoatrial node artery arising from posterolateral branch of right coronary artery: definition by screening consecutive 1500 coronary angiographies.

OBJECTIVE: Sinoatrial node (SAN) artery originates from proximal segment of right coronary artery (RCA) or from left circumflex artery. Sinoatrial node artery artery originating from posterolateral (PL) branch of RCA is very rare. Only several cases have been reported. The study was performed to seek the frequency of this variation, evaluate clinical relevance, and describe electrocardiographic, angiographic characteristics of patients. METHODS: Consecutive 1500 coronary angiography were screened to detect specifically SAN artery originating from PL branch of RCA. Patients with this variation were followed-up for one year regarding the arrhythmic events. RESULTS: The origin of SAN artery was proximal RCA in 1280 (85%), circumflex artery in 208 (14%), and PL branch of RCA in 12 (0.8%) patients (8 male, 4 female, mean age 64+/- 9 years). There was no history of arrhythmia in all patients. One patient presented with atrioventricular block. Indications of angiography were stable angina in 5, unstable angina in 5, and acute myocardial infarction in 2 patients. The patient with inferior myocardial infarction due to RCA total occlusion did not develop bradycardia or conduction defect. In four patients (33%) there was another artery originating from proximal RCA, ending at same territory with the variant artery suggesting dual blood supply. During one-year follow-up none of the patients experienced arrhythmic event. CONCLUSIONS: Sinoatrial node artery originating from distal RCA is very rare. This variation, even in patients with severe RCA disease is not associated with severe arrhythmia. Dual blood supply may be a protective factor in this subgroup of patients from arrhythmic events. To be aware of the origin and course of variant SAN artery may provide safe approach to interventional cardiologist and cardiac surgeon during percutaneous and surgical coronary and atrial interventions.

Quadricuspid aortic valve without severe dysfunction despite advanced age.

We report the case of a 75-year-old woman who presented with stable angina and with a quadricuspid aortic valve, which consisted of 4 equal-sized leaflets that were diagnosed incidentally upon coronary angiography. Despite the patient's advanced age, the abnormal valve was functioning almost normally.

[Drug-eluting stents in multivessel coronary artery disease: Was one of the important fortresses of surgery conquered?]. / Cok damar koroner arter hastaliginda ilaç salinimli stentler: Cerrahinin önemli kalelerinden biri fethedildi mi?

Since the drug eluting stents have provided better results concerning restenosis and repeat revascularization comparing to bare metal stents, percutaneous coronary interventions are performing increasingly in more complex stenoses. However, drug eluting stents did not show any advantage on prevention of myocardial infarction and survival. Currently there is no any completed controlled randomized study showing the superiority or equality of drug eluting stents over coronary bypass surgery by means of efficacy and safety. While the long-term results of drug eluting stents still unclear, everyday progressively more patients with multivessel disease are undergoing percutaneous coronary intervention with drug eluting stent implantation. The aim of this review is to discuss the efficacy and safety of drug eluting stents in patients with multivessel disease.

An electrocardiographic algorithm for determining the location of pacemaker electrode in patients with right bundle branch block configuration during permanent ventricular pacing.

The expected morphology of right ventricular pacing is a left bundle branch block (LBBB) pattern. However, right bundle branch block (RBBB) can also be seen during permanent right ventricular pacing. The aim of this study was to develop an electrocardiographic algorithm to differentiate this benign condition from septal and free wall perforation with subsequent left ventricular pacing. Three hundred consecutive patients who had permanent ventricular or dual-chamber pacemaker implantation between 1999 and 2000 were screened and 25 patients (8.3%) who exhibited RBBB configuration were included in the study. Echocardiograms and chest radiographs were evaluated in order to identify the pacing lead location in this group. The authors formed a study group with their own 25 patients and 22 cases of RBBB with permanent pacemaker from previous publications (total 47 patients). Frontal axis, QRS morphology in lead V(1), and the precordial transition point, which is defined as the precordial lead where R wave amplitude is equal to S wave amplitude, were examined. Placement of precordial leads V(1) and V(2) 1 interspace lower than the standard location (Klein maneuver) eliminated the RBBB pattern in 12 patients. RBBB pattern with "true right ventricular pacing" was detected in 24 of the 25 patients, and in 11 of the 22 patients reported in the literature (total 35 patients). Right ventricular pacing was correctly identified in 34 of 35 patients with use of criteria including left superior axis deviation, RS or qR morphology in lead V(1), and precordial transition at lead V(3) with a high sensitivity and specificity. A simple surface electrocardiogram can accurately predict the lead location in patients having RBBB morphology with right ventricular pacing.

Level of Selvester QRS score is predictive of ST-segment resolution and 30-day outcomes in patients with acute myocardial infarction undergoing primary coronary intervention.

BACKGROUND: The presence of Q waves at presentation with a first acute ST-segment elevation myocardial infarction (STEMI) reflects a more advanced stage of the infarction. Resolution of ST-segment elevation indicating successful myocyte reperfusion may differ according to how far the infarction process has progressed. The Selvester QRS score measures infarct size. The purpose of this study was to evaluate the predictive value of QRS score on ST-segment resolution and 30-day clinical outcomes in patients with acute STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS: We conducted a prospective cohort study in 112 consecutive patients (mean age 57 +/- 11 years, 94 men, 18 women) with first acute STEMI of <12-hour onset who underwent successful (TIMI-3 flow) primary PCI. The Selvester QRS score was estimated on the first electrocardiogram (ECG) after hospital admission. Sum of ST-segment elevation amount in millimeters was obtained immediately before angioplasty and 60 minutes after the restoration of TIMI-3 flow. The difference between 2 measurements was accepted as the amount of ST-segment resolution and expressed as summation sigmaSTR. summation sigmaSTR <50% was accepted as ECG sign of no-reflow phenomenon. Follow-up to 30-day was performed. RESULTS: The no-reflow phenomenon was more often observed in patients with high QRS score (> or = 4) than in those with low QRS score (34.4% and 6.3%, P < .001). Thirty-day composite major adverse cardiac event (MACE) rate was 14% in patients with high QRS score versus 0% in low QRS score group (P = .007). After adjusting for baseline characteristics, high QRS score remained a strong independent predictor of no-reflow (OR 4.1, 95% CI 1.5-10.7, P = .005) and MACE (OR 1.8, 95% CI 1.1-2.9, P = .011). CONCLUSIONS: The presence of high QRS score is an independent predictor of incomplete ST recovery and 30-day MACE in STEMI treated with primary PCI.

Impacts of glycoprotein IIb/IIIa inhibition on QT dispersion after successful percutaneous coronary intervention.

Coronary ischemia augments inhomogeneity in ventricular repolarization. Decrease in the QT dispersion (QTd) following restoration of coronary blood flow to the ischemic myocardium by successful percutaneous coronary intervention (PCI) is an expected outcome. The purpose of the study was to seek whether glycoprotein IIb/IIIa (GP IIb/IIIa) inhibition has additional beneficial effects on QT dispersion after angiographically successful PCI. The study involved 111 consecutive patients scheduled for elective coronary balloon angioplasty with or without stent implantation. Sixty patients (mean age 58 +/-9) were randomized to receive standard therapy including preprocedural aspirin, ticlopidine, and IV heparin, and 51 patients (mean age 54 +/-10) were randomized to receive additional IV tirofiban infusion before the lesion was crossed with the guidewire. Standard 12-lead simultaneous ECG recordings for the measurement of QTd and corrected QTd (QTcd) (calculated by using Bazett's formula) were obtained before and immediately after the procedure, and at the 6th, and 24th hours. Blood samples for detection of postprocedural myocardial damage (CK-MB and cTn-I) were taken before and immediately after the procedure, at the 6th, 12th, and 24th hours. In total, 128 stenoses were treated with PCI. Seventy of these lesions were in the standard therapy group and 58 in the tirofiban group. QTd and QTcd were not statistically different between the 2 groups before and immediately after the procedure and at the 6th hours, but at the 24th hour QTd and QTcd were significantly longer in the standard therapy group (p=0.047 and p=0.001, respectively). Postprocedural troponin-I elevation (B=0.692, p=0.037), maximum inflation pressure (B=0.182, p=0.001), and previous myocardial infarction (MI) (B=0.885, p=0.004) were defined as the predictors of the final QT dispersion at the 24th hour. QT dispersion significantly decreased after successful percutaneous coronary intervention. GP IIb/IIIa inhibition therapy was not superior by means of recovery of increased QT dispersion during the early hours of the intervention, but it prevented minor myocardial necrosis and provided more long-lasting recovery in QT dispersion as compared with heparin therapy. This impact of GP IIb/IIIa receptor inhibition on QTd may be a possible mechanism by which these drugs reduce cardiovascular events after PCI.

Influence of weight loss on myocardial performance index.

Obese patients may have a phase of asymptomatic left ventricular dysfunction. A combined myocardial performance index (MPI) has been demonstrated to be a useful index to estimate left ventricular function and to predict the prognosis of patients with heart failure. The objective of the study was to determine the influence of weight loss on MPI. A total of 18 obese patients (3 men, 15 women, mean age 49.6 +/- 5.5 years, body mass index [BMI] >30 kg/m(2)) were investigated in the study. All patients were treated with a multidisciplinary approach consisting of a hypocaloric diet and orlistat therapy (120 mg three times daily), and all of them underwent two-dimensional and Doppler echocardiographic examination two times before starting the study and after a period of weight loss. Using echo-Doppler methods, ejection fraction, peak velocities of early (E) and late (A) diastolic filling, the E/A ratio, deceleration time (DT), isovolumic contraction time (IVCT), isovolumic relaxation time, ejection time, and MPI were measured. The MPI was obtained by subtraction ejection time from the interval between cessation and onset of the mitral flow. All patients lost at least 10% of their initial body weight, with a mean decrease of 10.8 +/- 3.7 kg. This was associated with significant reductions in BMI with a mean decrease 4.5 +/- 1.4 kg/m(2). Compared with baseline, after weight loss the E/A ratio of 1.01 +/- 0.22 before treatment increased to 1.17 +/- 0.26 (P = 0.012), left ventricular mass index decreased from 88 +/- 23 to 82 +/- 19 g/m(2) (P = 0.028), IVCT from 71 +/- 20 to 53 +/- 30 ms (P = 0.004), DT from 233.65 +/- 38.14 to 196.72 +/- 47.73 s (P = 0.004), and MPI from 0.63 +/- 0.13 to 0.50 +/- 0.13 (P = 0.0001). Weight loss ameliorates MPI and seems to be a clinically relevant measurement of left ventricular global function, and may prove to be a valuable tool in assessing the risk of developing heart failure.

Cardiac troponin I increase after successful percutaneous coronary angioplasty: predictors and long-term prognostic value.

After successful percutaneous coronary interventions (PCI), elevations of cardiac enzymes are not rare, but it is still not clear whether those elevations are associated with adverse late outcome. The purpose of the study was to investigate the relation between cardiac troponin I (cTn-I) increase after successful percutaneous intervention and late outcome. The study consisted of 100 consecutive patients (mean age 56 +/-9.8, 84% male) who had successful elective coronary balloon angioplasty with or without stent implantation. Patients with stable angina (n=54) and unstable angina (n=46) were included in the study. Blood samples for measurement of cTn-I were taken before and immediately after the procedure, and every 6 hours for the first 24 hours. Patients with preprocedural cTn-I elevation were excluded from the study. Postprocedural cTn-I elevation was detected in 34 patients (34%, troponin (+) group) and cTn-I levels were normal in 66 patients (66%, troponin (-) group). Logistic regression analysis showed that intervention in patients with unstable angina, stent implantation following balloon dilation, and maximal inflation pressure were the predictors of cTn-I elevation (p=0.035, p=0.038, and p=0.014, respectively). During the prospective follow-up period for 21 +/-7.5 months, the incidence of major cardiac events including recurrent angina, acute myocardial infarction, death, and revascularization were not different in patients with and without cTn-I elevation. Overall, major cardiac events occurred in 9 patients (26%) in the troponin (+) group and in 13 patients (20%) in the troponin (-) group. Kaplan-Meier survival analysis showed that cTn-I elevation was not an important correlate of overall cardiac events (log-rank: 1.66, p=0.19). The authors conclude that postprocedural cTn-I elevation is related to unstable angina, stent implantation following predilation, and inflation pressure, and there is no association with minor myocardial injury occurring after successful percutaneous coronary intervention and late adverse cardiac events.

Effects of anxiety on QT dispersion in healthy young men.

OBJECTIVE: QT dispersion (QTd) is the maximal interlead difference in QT interval on the surface 12-lead electrocardiogram (ECG). An increase in QTd is found in various cardiac diseases and reflects cardiac autonomic imbalance. It has recently been associated with increased anxiety levels, thereby predisposing affected individuals to fatal heart disease. This is the biggest study to assess QTd in anxiety, as a marker of anxiety-induced cardiac dysregulation. METHODS AND RESULTS: QTd and rate-corrected QTd (QTcd) were measured in 726 physically and mentally healthy male volunteers, aged 21.23 +/- 1.25 years (range 20-26). The Spielberger State-Trait Anxiety Inventory (STAI) was scored concomitantly. The intra- and inter-observer reproducibilities of QTd were highly correlated (r = 0.92, p < 0.001; r = 0.93, p < 0.001, respectively). QTd and QTcd significantly correlated with the STAI-I subscale (State Anxiety Scale) (r = 0.529, p < 0.001; r = 0.518, p < 0.001, respectively) and STAI-2 subscale (Trait Anxiety Scale) (r = 0.601, p < 0.001; r = 0.563, p < 0.001, respectively). CONCLUSIONS: The State Anxiety Scale and the Trait Anxiety Scale are associated with an increase in QTd. This association may result from sudden and prolonged anxiety and, in turn, a decrease in vagal modulation and/or increase in sympathetic modulation. This is the first study that shows that increased QTd can serve as a state/trait marker. But further large-scale epidemiological studies are needed to determine if increased QTd is a risk factor for sudden cardiac death in patients with anxiety.

Effect of tirofiban therapy on ST segment resolution and clinical outcomes in patients with ST segment elevated acute myocardial infarction undergoing primary angioplasty.

BACKGROUND: In our study, we assessed the effect of glycoprotein (GP) IIb/IIIa receptor inhibition on microvascular flow after acute coronary occlusion using the early sum of ST segment resolution in electrocardiography. Platelets may play a major role in the dissociation of epicardial artery recanalization and tissue level reperfusion, referred to as the 'no-reflow phenomenon'. Therefore, GP IIb/IIIa receptor inhibition might improve myocardial reperfusion, distinct from its effects on epicardial patency. METHODS AND RESULTS: One hundred and fifteen patients (mean age 57.7 +/- 12.2 years, 96 males, 19 females) with < or = 12-hour acute ST segment elevation myocardial infarction who underwent successful primary percutaneous coronary intervention were retrospectively enrolled into the study. Patients were grouped according to whether they received tirofiban therapy or not. Clinical and electrocardiographic parameters were evaluated. The first sum of ST segment elevation amounts in millimeters was obtained immediately before angioplasty and the second 60 min after restoration of thrombolysis in myocardial infarction III flow. The difference between the two measurements was accepted as resolution of the sum of ST segment elevation and expressed as SigmaSTR. There were no significant differences between the groups regarding age, gender, cardiovascular risk factors, and laboratory parameters, duration from angina onset to the emergency unit, and from door to angioplasty. SigmaSTR was higher in patients who received tirofiban than in those who did not (7.2 +/- 2.8 and 4.2 +/- 2.6 mm, respectively; p < 0.001). There was a significant and positive correlation between GP IIb/IIIa inhibition and SigmaSTR (r = 0.336, p < 0.001), as well as between ejection fraction and SigmaSTR (r = 0.310, p < 0.001). GP IIb/IIIa inhibition was the only independent determinant of SigmaSTR in a multivariate linear regression model which contains 10 variables (p < 0.001). The incidence of in-hospital post-myocardial infarction refractory angina, reinfarction, and heart failure was significantly lower in the tirofiban group (p < 0.05, p < 0.05, and p < 0.05, respectively). Additionally, after 30 days, reinfarction and heart failure were lower in the tirofiban group (p < 0.05 and p < 0.05, respectively). CONCLUSIONS: It is well known that SigmaSTR determines microvascular perfusion. This study shows that GP IIb/IIIa inhibition with tirofiban is of value in preserving microvascular perfusion after restoring coronary thrombolysis in myocardial infarction III flow.

Acute alcohol intake and P-wave dispersion in healthy men.

OBJECTIVE: P-wave dispersion (Pd), defined as the difference between the maximum and the minimum P-wave duration (Pmin), and maximum P-wave duration (Pmax) are electrocardiographic (ECG) markers that have been used to evaluate the discontinuous propagation of sinus impulses and the prolongation of atrial conduction time, respectively. The incidence of cardiac arrhythmias, particularly atrial fibrillation (AF), following acute alcohol intake has been previously reported. Prolonged P-wave duration and Pd have been reported to represent an increased risk for AF. However, the association between Pd and acute alcohol intake has not been studied previously in normal subjects. METHODS: In a randomized crossover study, 10 healthy male volunteers, aged 30.0+/-2.1 years (range 25-33 years) received either ethanol and/or placebo (juice). Alcohol group drank moderate dose ethanol; 0.97+/-0.12 g/kg body weight (range 0.80-1.25 g/kg), and the other group consumed same amount of juice in one-hour period. After 48-hours washout period, alcohol group took juice and juice group drank alcohol. Pmax, Pmin and Pd were measured as milliseconds (ms) on baseline ECG, after alcohol period (AP) and after juice period (JP). RESULTS: In comparison with baseline, Pmax values were significantly prolonged after AP but not after JP (baseline: 95.3+/-5.3 ms, after AP: 103.7+/-9.5 ms, after JP: 94+/-7 ms, p=0.027, p=0.102, respectively). Pmin values did not change significantly. And also, in comparison with baseline, Pd values were significantly prolonged after AP but not after JP (baseline: 27.0+/-7.6 ms, after AP: 42.7+/-12.8 ms, after JP: 27.0+/-6.7 ms, p=0.021, p=0.891, respectively). CONCLUSION: Acute moderate dose of alcohol intake in short time is associated with an increase in Pmax and Pd.

Acute alcohol intake and QT dispersion in healthy subjects.

OBJECTIVE: QT dispersion (QTd) is the maximal interlead difference in the QT interval on the surface 12-lead electrocardiogram (ECG). An increase in QTd is found in patients with various cardiac diseases and reflects cardiac autonomic imbalance. Variability of QT duration among the 12 surface ECG leads expresses electrical instability and greater susceptibility to malignant ventricular arrhythmias. Electrophysiological studies have shown that heavy episodic drinking facilitates the induction of ventricular tachyarrhythmias in some heavy drinkers. However, the association between QTd and acute alcohol intake has not been studied previously in healthy subjects. METHOD: In a randomized crossover study, 10 healthy male volunteers (average [SD] age 30 [2.1] years, range: 25-33) received either alcohol (six 12-oz cans of beer) or placebo (juice). The alcohol group consumed 0.97 [0.12] g/kg body weight ethanol, and the placebo group consumed the same amount of juice in a 1-hour period. After a 48-hour washout period, the alcohol group drank juice, and the juice group drank alcohol. QTd and corrected QTd (cQTd) were measured in a baseline ECG after the alcohol period (AP) and after the juice period (JP). RESULTS: In comparison with baseline ECG (31.7 [9.4] ms), QTd values after AP (42.1 [10.8] ms) were significantly prolonged (p = .027), but this was not so after JP (33.8 [7.1] ms; p = NS). Also in comparison with baseline ECG (35.7 [11.1] ms), cQTd values after the AP (49.8 [12.7] ms) were significantly prolonged (p = .005), but again, this was not so after the JP (36.8 [7.3] ms; p = NS). CONCLUSIONS: Heavy episodic drinking is associated with an increase in QTd and cQTd.

QT dispersion in sarcoidosis.

STUDY OBJECTIVES: QT dispersion (QTd) is the maximal interlead difference in QT interval on surface 12-lead ECG. An increase in QTd is found in various cardiac diseases. Sarcoidosis augments inhomogeneity in ventricular repolarization by sarcoid granuloma, which significantly correlates with ventricular fibrillation. Changes in QTd in the course of sarcoidosis have not been investigated previously. DESIGN: The study included 35 patients with systemic sarcoidosis. The diagnosis of systemic sarcoidosis was made by biopsy. Thallium scintigraphy was performed in all patients with systemic sarcoidosis. Cardiac sarcoidosis was diagnosed in 16 patients based on abnormal thallium scintigraphy and normal coronary arteriography results. QTd, corrected QTd (cQTd), maximum QT (QTmax), maximum corrected QT (cQTmax), minimum QT, and minimum corrected QT intervals were measured. Twenty-four healthy subjects represented the control group for QT interval analysis. MEASUREMENTS AND RESULTS: In the cardiac sarcoidosis group, mean QTd (+/- SD) was significantly greater than in the noncardiac sarcoidosis group and control group (49.50 +/- 10.86 ms, 28.14 +/- 11.02 ms, and 27.08 +/- 10.41 ms, respectively; p < 0.001). cQTd was significantly greater in the cardiac sarcoidosis group than in the noncardiac sarcoidosis group and control group (53.17 +/- 10.44 ms, 30.61 +/- 10.94 ms, and 29.01 +/- 10.52 ms, respectively; p < 0.001). QTmax (440 +/- 15.01 ms, 409 +/- 14.86 ms, and 410 +/- 13.21 ms; p < 0.001) and cQTmax (449 +/- 16.31 ms, 417 +/- 12.51 ms, and 418 +/- 11.76, respectively; p < 0.001) were also significantly greater in patients with cardiac sarcoidosis. In a limited follow-up group (11 cardiac and 9 noncardiac sarcoidosis patients), the incidence of premature ventricular contraction (PVC) on ECG was greater in the cardiac sarcoidosis group than in the noncardiac sarcoidosis group (36% and 0%, respectively; p < 0.05). A medium correlation existed between QTd and PVC (r = 0.331, p < 0.05). CONCLUSIONS: QTd, cQTd, QTmax, and cQTmax are prolonged in patients with cardiac sarcoidosis compared to the patients with noncardiac sarcoidosis and control subjects. The incidence of PVC on ECG was greater in the cardiac sarcoidosis group than in the noncardiac sarcoidosis group.

Tricuspid valve perforation by permanent pacemaker lead--a case report.

Tricuspid valve perforation with pacemaker lead is one of the extremely rare complications of transvenous pacemaker implantation. Approximately all reported cases have been diagnosed at autopsy. The authors present a case of tricuspid valve perforation caused by pacemaker lead that was diagnosed during cardiac surgery and treated successfully by removing the lead and suturing the tricuspid valve.

Anxiety and P wave dispersion in a healthy young population.

BACKGROUND: P wave dispersion (P(d)), defined as the difference between the maximum (P(max)) and the minimum P wave duration (P(min)), and P(max) are electrocardiographic (ECG) markers that have been used to evaluate the discontinuous propagation of sinus impulses and the prolongation of atrial conduction time. P(d) in normal subjects has been reported to be influenced by the autonomic tone, which induces changes in atrial size and the velocity of impulse propagation. However, the association between P(d) and anxiety has not been studied in normal subjects. METHODS AND RESULTS: P(max), P(min) and P(d) were measured in 726 physically and mentally healthy young male volunteers, aged 21.23 +/- 1.25 years (range 20-26). The Spielberger State-Trait Anxiety Inventory (STAI) was scored concomitantly. Blinded intra- and interobserver reproducibility of the P wave duration and P(d) measurement were evaluated, and comparison revealed a Pearson correlation coefficient of 0.87 and 0.89 for the P wave duration, and 0.93 and 0.90 for P(d), respectively (p < 0.001). P(max) and P(d) were significantly correlated with the state anxiety (STAI-1) subscale (r = 0.662, p < 0.001, and r = 0.540, p < 0.001, respectively) and the trait anxiety (STAI-2) subscale (r = 0.583, p < 0.001, and r = 0.479, p < 0.001, respectively). P(min) did not show any significant correlation with anxiety. Across 3 variables included in a multiple linear regression analysis, STAI-1 and STAI-2 were the significant independent determinants of P(max) and P(d). Beta coefficients indicated that the contribution of STAI-1 to P(max) (66.3 and 33.7%) and P(d) (65 and 35%) was much greater than that of STAI-2. CONCLUSIONS: STAI-1 and STAI-2 are associated with an increase in P(max) and P(d). The association of P(d) resulted from an augmentation of P(max). This is the first study to show the relation between P(max), P(d) and anxiety.