Effect of obesity on atrial size in older women with non-valvular paroxysmal atrial fibrillation.

BACKGROUND AND AIMS: Atrial fibrillation (AF) typically prevails on male sex in all decades of life. Thus, prevalence rate of AF in older women is elevated, mainly due to their longer survival. The aim of this study was to evaluate the effect that obesity has on atria dimensions of older women with paroxysmal atrial fibrillation (PAF). METHODS: The study population consisted of older women who were admitted to our cardiology department due to an episode of PAF and cardioverted to sinus rhythm within 48 hours. A total of 48 patients were included and divided in two groups according the presence (30) or the absence (18) of obesity, considering obesity as a body mass index (BMI) greater or equal to 30 kg /cm2. RESULTS: Obese women had a mean atrial size of 45.1+/-3.9 mm and non-obese women had a mean atrial size of 39.8+/-2.6 mm, p<0.001. BMI was positively correlated with atrial enlargement in a statistically significant way even after multiple adjustments. CONCLUSIONS: Among the elderly female population with an episode of PAF, obese women seem to have greater risk for the perpetuation and the stabilization of this arrhythmia due to the enlargement of their atrial size.

The prognostic significance of serum glucose levels after the onset of ventricular arrhythmia on in-hospital mortality of patients with acute coronary syndrome.

BACKGROUND: Several studies have illustrated the role played by serum glucose levels in cardiovascular morbidity and mortality in general and, more particularly, after an acute coronary event. AIM: The aim of this study was to evaluate the impact of serum potassium and glucose levels on in-hospital mortality in patients with ischemic heart disease, who exhibited severe ventricular arrhythmia. METHODS: We enrolled 162 consecutive patients who were referred to our institution for an acute coronary event and presented with sustained ventricular tachycardia or ventricular fibrillation during the first 24 hours of hospitalization. Serum potassium and glucose levels were measured in all patients at the onset of tachycardia and after 2, 4, 6, 12, 36, 48 hours. RESULTS: During hospitalization, 23 out of 162 patients died (61% males). Serum glucose levels at the onset of the arrhythmia, as well as after 2, 12, 36 and 48 hours, were higher in the deceased (onset: 228.8 +/- 108 vs. 158 +/- 68 mg/dl, p = 0.0001, 2 h: 182 +/- 109 vs. 149 +/- 59 mg/dl, p = 0.03, 12 h: 155.5 +/- 72 vs. 128 +/- 48 mg/dl, p = 0.025, 36 h: 163.8 +/- 63 vs.116 +/- 42 mg/dl, p = 0.002, and 48 h: 138 +/- 64 vs. 122 +/- 42 mg/dl, p = 0.05, respectively), even after adjustment for age, sex, diabetes, left ventricular ejection fraction, type of acute coronary syndrome and site of infarction and medication intake. There was no difference in serum potassium levels between the deceased and survivors. CONCLUSION: Serum glucose levels at the onset of arrhythmia and 2, 36 and 48 hours later seem to have prognostic significance for in-hospital mortality in patients hospitalized for an acute coronary event, who exhibit severe ventricular arrhythmia.

Impact of the metabolic syndrome on atrial size in patients with new-onset atrial fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia, and it is strongly related to atrial enlargement. Metabolic syndrome (MetSyn) is associated with increased cardiovascular morbility and mortality. However, the impact of the MetSyn on cardiac arrhythmias is poorly elucidated. The aim of this study was to compare atrial dimensions in patients suffering from nonvalvular paroxysmal AF, with and without MetSyn, trying to identify structural differences that could favor the occurrence of this arrhythmia. The study population consisted of 60 patients who presented with at least 1 episode of paroxysmal AF. From these, 26 patients fulfilled the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) definition of MetSyn, while the remaining 34 patients did not. Left atrial size was assessed by 2-dimensional echocardiography. Patients with MetSyn had a mean atrial size of 46.2 -/+ 4.3 mm and those without MetSyn had a mean atrial size of 41.6 -/+ 1.9 mm, p < 0.011. MetSyn may favor the occurrence of paroxysmal AF by increasing atrial size. This concept deserves more research.

The clinical value of mitral A-wave deceleration time in the prediction of a long-term adverse outcome in patients with myocardial infarction.

INTRODUCTION: Mitral A-wave deceleration time (Adt) is a promising Doppler parameter for the evaluation of left ventricular (LV) diastolic function. The aim of the present study was to investigate the long-term prognostic value of Adt in relation to the development of heart failure and cardiac death in the setting of the first acute myocardial infarction (MI). METHODS: Conventional Doppler echocardiographic study and Adt measurements were performed in 105 patients (age 60 +/- 10 years, 77 men) 8.07 +/- 0.96 days post MI. Patients were divided into three groups according to Adt duration: group 1 with Adt > or =70 ms, group 2 with 70 ms < Adt <115 ms, and group 3 with Adt > or =115 ms. RESULTS: Patients of groups 1 (Adt: 64 +/- 5 ms, n=11) and 3 (Adt: 123 +/- 8 ms, n=38) presented characteristics of restrictive physiology or impaired relaxation, respectively, while patients of group 2 (Adt: 92 +/- 9 ms, n=56) had near to normal LV filling characteristics. Patients were followed up for a mean of 44.7 months. Heart failure was found in 4 patients (36%) in group 1 and 6 (16%) in group 3, whereas the patients in group 2 were free of heart failure. Cardiac death occurred in 4 patients (36%) in group 1, 3 (7.9%) in group 3 and 2 (3.6%) in group 2. Kaplan-Meier survival curves indicated that patients with Adt < or =70 ms or Adt > or =115 ms had more frequent cardiac events and a significantly shorter event-free survival period in comparison with those with 70 ms < Adt < 115 ms (p = 0.0017). Cox analysis showed that Adt < or =70 ms (p = 0.002), Adt > or =115 ms (p = 0.02), restrictive LV filling pattern (p = 0.003), anterior wall MI (p = 0.02), ejection fraction (p = 0.03), age (p = 0.04), and treatment with angiotensin converting enzyme inhibitors (p = 0.009) were independent predictors of outcome. CONCLUSIONS: Adt appears to be a strong and independent predictor of heart failure or cardiac death following a MI. A shortened Adt < or =70 ms is associated with higher rates of both cardiac death and heart failure, while a prolonged Adt > or =115 ms is associated with heart failure only.

The influence of thrombolytic therapy on C-reactive protein in ST-segment elevation acute myocardial infarction.

BACKGROUND: Inflammation plays a crucial role in atherosclerotic processes and in acute coronary syndromes (ACS). Strong evidence of this is the elevation of C-reactive protein (CRP) serum levels during an ACS and its short- and long-term prognostic potency. The present study aimed to assess the relation between CRP serum levels and the elevation of cardiac markers in patients with ST elevation acute myocardial infarction (STEMI) as well as the effect of intravenous thrombolysis on a time series of CRP values. METHODS: Thirty-six patients with STEMI were enrolled in the study. Twenty-eight of them received intravenous thrombolysis successfully and 8 did not receive thrombolysis. We measured serum concentrations of CRP, troponin I, creatine kinase, creatine kinase isoenzyme and lactate dehydrogenase in all patients on admission, 24 and 48 hours later. CRP serum values were obtained using the turbidimetric method. Coronary angiography was performed in all patients to estimate disease severity and culprit vessel flow after treatment. RESULTS: Patients who were thrombolysed had lower CRP values on admission (p < 0.05), at 24 hours (p < 0.001) and 48 hours later (p < 0.05), compared to those without thrombolysis. CRP values on admission had a positive correlation with markers of cardiac myocyte necrosis and a negative correlation with TIMI flow. CONCLUSION: Thrombolytic therapy in patients with STEMI is associated with a less pronounced response of CRP during the first 48 hours. The close relation of CRP with cardiac enzymes and troponin I on admission adds to the proven value of this inflammatory marker and suggests directions for further research.