Evaluation of frontal QRS-T angle values in electrocardiography in patients with chronic rhinosinusitis.

BACKGROUND: Chronic Rhinosinusitis (CRS) refers to inflammation of the paranasal sinuses and nasal mucosa. Electrocardiographic indicators of ventricular repolarization have been shown to correlate with systemic inflammation parameters. Recently, the frontal QRS-T (fQRS-T) angle has been accepted as a new indicator of ventricular depolarization and repolarization heterogeneity. The (fQRS-T) angle is recommended in predicting the risk of malignant ventricular arrhythmia. In this study, we aimed to evaluate the ventricular arrhythmia potential in patients with chronic rhinosinusitis by examining the relationship between fQRS-T angle on ECG and inflammation markers. METHODS: Inflammatory markers as well as electrocardiographc (ECG) f(QRS-T) angle, QRS duration, QT interval and corrected QT interval were examined in 54 patients with CRS versus 56 healthy control subjects. RESULTS: The f(QRS-T) angle was significantly higher in CRS patients than in healthy controls (p < .001). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) were significantly higher in CRS patients compared to healthy controls (p < .001, for all). Based on correlation analysis, NLR and f(QRS-T) angles were highly correlated (r = .845, p < .001), and according to the results of linear regression analysis, NLR was independently associated with the f(QRS-T) angle (t = 5.149, Beta = 0.595, p = < 0.001). CONCLUSION: Both f(QRS-T) angle and NLR are significantly increased in CRS patients compared to healthy controls, with increases in NLR also independently associating with increases in f(QRS-T) angle. While the increases in f(QRS-T) angle did not result in clinically alarming absolute values for f(QRS-T), CRS patients might nonetheless be at relatively higher risk for malignant cardiac arrhythmias.

Evaluation of index of cardiac-electrophysiological balance in patients with subarachnoid hemorrhage.

BACKGROUND: Various electrocardiographic (ECG) changes occur after subarachnoid hemorrhage (SAH). Prolonged QT and corrected QT (QTc) intervals are notable changes. QT, QTc, T peak-to-end T(p-e) intervals, and Tp-e/QTc ratio are used as ventricular arrhythmia indices. In recent publications, the cardiac electrophysiological balance index (ICEB), which provides more information than other ECG parameters (QT, QTc, etc.), is recommended in predicting the risk of ventricular arrhythmia. This study aims to assess ICEB in aneurysmal SAH patients. METHODS: The study included 50 patients diagnosed with aneurysmal SAH and 50 patients diagnosed with hypertension without end-organ damage as the control group. All patients' Fisher scores and Glasgow Coma Scale (GCS) scores were recorded. Both groups were given 12-lead ECGs. QT, QTc, Tp-e intervals, QRS duration, ICEB (QT/QRS), ICEBc (QTc/QRS), and T(p-e)/QTc values were calculated and analyzed between groups. RESULTS: Compared to the control group; QT (426,64 ± 14,62 vs. 348,84 ± 12,24 ms, p < 0,001), QTc (456,24 ± 28,84 vs. 392,48 ± 14,36 ms, p < 0,001), Tp-e (84,32 ± 3,46 vs. 70,12 ± 3,12, p < 0,001), Tp-e/QTc (0,185 ± 0,08 vs. 0,178 ± 0,02, p < 0,001), ICEB (4,53 ± 0,78 vs. 3,74 ± 0,28, p < 0,001) and ICEBc (4,86 ± 0,86 vs. 4,21 ± 0,24, p < 0,001) were significantly higher in patients with aneurysmal SAH. QT, QTc and Tp-e interval, Tp-e/QTc ratio, ICEB (QT/QRS) and ICEBc (QTc/QRS) were positively correlated with the Fisher score and were negatively correlated with the GCS. According to linear regression analyses, the ICEBc (QTc/QRS) found to be independently associated with the Fisher score. CONCLUSION: The values of the ICEB and ICEBc were significantly increased in patients with aneurysmal SAH. The severity of SAH was positively correlated with the ICEB and ICEBc. The ICEBc (QTc/QRS) independently associated with the Fisher score. This may that SAH suggest may predispose to malignant ventricular arrhythmias.

Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation / Efeito da septoplastia no desempenho miocárdico ventricular esquerdo em pacientes com desvio de septo nasal

Abstract Introduction: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. Objective: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. Methods: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. Results: Significantly higher left ventricular myocardial performance index (0.52 ± 0.06 vs. 0.41 ± 0.04, p < 0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p < 0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p < 0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p = 0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p = 0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p < 0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p =0.224). Conclusion: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Resumo Introdução: O desvio do septo nasal é a principal causa de obstrução das vias aéreas superiores. A obstrução crônica das vias aéreas superiores pode causar lesão miocárdica devido à hipóxia crônica. Os efeitos da septoplastia nas funções diastólica e sistólica do ventrículo esquerdo não são bem conhecidos. O índice de desempenho miocárdico é um parâmetro confiável e fácil de aplicar que reflete as funções cardíacas sistólica e diastólica. Objetivo: Investigar o efeito da septoplastia nasal no índice de desempenho miocárdico em pacientes com desvio de septo nasal. Método: Este estudo prospectivo consistiu em 50 pacientes consecutivos submetidos a septoplastia devido a desvio de septo nasal significativo sintomático em S ou C. A ecocardiogarfia transtorácica foi feita em todos os pacientes antes e 3 meses após a septoplastia. Os índices de desempenho miocárdico calculados foram comparados. Resultados: Um valor de indice de desempenho miocárdico ventricular esquerdo significantemente maior (0,52 ± 0,06 vs. 0,41 ± 0,04, p < 0,001), tempo mais longo de relaxamento isovolumétrico (95,0 ± 12,5 vs. 78,0 ± 8,6 ms, p < 0,001), tempo mais longo de contração isovolumétrica (45,5 ± 7,8 vs. 39,5 ± 8,6 ms, p < 0,001), tempo de desaceleração mais longo (184,3 ± 32,5 vs. 163,6 ± 45,4 ms, p = 0,004), maior razão de pico de velocidade transmitral precoce e tardia (E / A) (1,42 ± 0,4 vs. 1,16 ± 0,2, p = 0,006) e menor tempo de ejeção (270,1 ± 18,3 vs. 286,5 ± 25,8 ms, p < 0,001) foram observados antes da septoplastia quando comparados aos valores obtidos 3 meses após a septoplastia. A fração de ejeção sistólica do ventrículo esquerdo foi semelhante antes e após a septoplastia (63,8 ± 2,8% vs. 64,6 ± 3,2%, p = 0,224). Conclusão: A cirurgia de septoplastia não apenas reduz os sintomas em pacientes com desvio de septo nasal, mas também pode melhorar o desempenho ventricular esquerdo. Assim, o tratamento precoce do desvio de septo nasal é sugerido para prevenir possíveis eventos cardiovasculares futuros.

Evaluation of myocardial performance index in patients with COVID-19: An echocardiographic follow-up study.

Introduction and Objectives: Myocardial performance may be impaired in cytokine-mediated immune reactions. The myocardial performance index (MPI) is a practical parameter that reflects systolic and diastolic cardiac function. We aimed to assess the MPI in patients with COVID-19. Methods: The study population consisted of 40 healthy controls and 40 patients diagnosed with COVID-19 who had mild pneumonia and did not need intensive care treatment. All participants underwent echocardiographic examination. First, the MPI and laboratory parameters were compared between healthy controls and patients in the acute period of infection. Second, the MPI and laboratory parameters were compared between the acute infection period and after clinical recovery. Results: Compared with healthy controls, patients with COVID-19 had a significantly higher MPI (0.56±0.09 vs. 0.41±0.06, p<0.001), longer isovolumic relaxation time (IRT) (112.3±13.4 vs. 90.6±11.2 ms, p<0.001), longer deceleration time (DT) (182.1±30.6 vs. 160.8±42.7 ms, p=0.003), shorter ejection time (ET) (279.6±20.3 vs. 299.6±34.7 ms, p<0.001) and higher E/A ratio (1.53±0.7 vs. 1.21±0.3, p<0.001). Statistically significantly higher MPI (0.56±0.09 vs. 0.44±0.07, p<0.001), longer IRT (112.3±13.4 vs. 91.8±12.1 ms, p<0.001), longer DT (182.1±30.6 vs. 161.5±43.5 ms, p=0.003), shorter ET 279.6±20.3 vs. 298.8±36.8 ms, p<0.001) and higher E/A ratio (1.53±0.7 vs. 1.22±0.4, p<0.001) were observed during the acute infection period than after clinical recovery. Left ventricular ejection fraction was similar in the controls, during the acute infection period and after clinical recovery. Conclusions: Subclinical diastolic impairment without systolic involvement may be observed in patients with COVID-19. This impairment may be reversible on clinical recovery.

Introducão e objetivos: O desempenho miocárdico pode ser prejudicado em reações imunes mediadas por citocinas. O índice de performance miocárdico (IPM) é um parâmetro que reflete a função cardíaca sistólica e diastólica. O nosso objetivo foi avaliar o IPM em doentes com COVID-19. Métodos: O presente estudo consistiu em analisar 40 casos controlo saudáveis e 40 doentes com diagnóstico de COVID-19 que apresentavam pneumonia ligeira e não necessitavam de tratamento intensivo. Todos os participantes foram submetidos a avaliação ecocardiográfica. Primeiro, o IPM e os parâmetros laboratoriais foram comparados entre os casos controlo saudáveis e os doentes com período agudo de infeção. Em segundo lugar, o IPM e os parâmetros laboratoriais foram comparados entre o período agudo de infeção e após a recuperação clínica. Resultados: Em comparação com os casos controlo saudáveis, os doentes com COVID-19 tiveram um IPM significativamente maior (0,56±0,09 versus 0,41±0,06, p<0,001), tempo de relaxamento isovolumétrico (TRI) mais longo (112,3±13,4 versus 90,6±11, 2 ms, p<0,001), tempo de desaceleração maior (TD) (182,1±30,6 versus 160,8±42, 7 ms, p=0,003), tempo de ejeção (TE) menor (279,6±20,3 versus 299,6±34, 7 ms, p<0,001) e razão E/A maior (1,53±0,7 versus 1,21±0,3, p<0,001). Um IPM superior estatisticamente significativo (0,56±0,09 versus 0,44±0,07, p<0,001), um TRI mais longo (112,3±13,4 versus 91,8±12, 1 ms, p<0,001), um TD mais longo (182,1±30,6 versus 161,5±43,5 ms, p=0,003), um TE mais curto (279,6±20,3 versus 298,8±36,8 ms, p<0,001) e razão E/A mais elevada (1,53±0,7 versus 1,22±0,4, p<0,001) foram observados durante o período agudo de infeção em comparação com aqueles após a recuperação clínica. A fração de ejeção do ventrículo esquerdo foi semelhante nos casos controlo saudáveis, período agudo de infeção e após a recuperação clínica. Conclusão: A disfunçao diastólica subclínica sem difunção sistólica pode ser observada em doentes com COVID-19. Esta deficiência pode ser reversível na recuperação clínica.

Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation.

INTRODUCTION: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. OBJECTIVE: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. METHODS: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. RESULTS: Significantly higher left ventricular myocardial performance index (0.52 ±â€¯0.06 vs. 0.41 ±â€¯0.04, p <  0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p <  0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p <  0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p =  0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p =  0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p <  0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p  = 0.224). CONCLUSION: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Fibrinogen-to-albumin ratio predicts mortality in COVID-19 patients admitted to the intensive care unit.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is an inflammatory disease, and serum albumin and fibrinogen are two important factors in systemic inflammation. We aimed to investigate the relationship between the fibrinogen-to-albumin ratio (FAR) and in-hospital mortality in COVID-19 patients admitted to the intensive care unit (ICU). MATERIAL AND METHODS: Patients diagnosed with COVID-19 admitted to the Adiyaman Training and Research Hospital from August to November 2020 were enrolled in this retrospective cohort study. They were divided into 2 groups based on in-hospital mortality: a survivor group (n = 188) and a non-survivor group (n = 198). FAR was calculated by dividing the fibrinogen value by the albumin value. Mortality outcomes were followed up until December 15, 2020. RESULTS: The average age of the patients was 71.2 ± 12.9 years, and 54% were male. On multivariate logistic analysis, diabetes mellitus (OR: 1.806; 95% CI: 1.142-2.856; p = 0.011), troponin I levels (OR: 1.776; 95% CI: 1.031-3.061; p = 0.038), and FAR (OR: 1.004; 95% CI: 1.004-1.007; p = 0.010) at ICU admission were independent predictors of in-hospital mortality in patients with COVID-19. CONCLUSIONS: The FAR at admission was associated with mortality in patients infected with SARS-CoV-2 in the ICU.

The relationship between coronary artery disease and SIRT1 protein.

Endothelial cell dysfunction proceeding with increased inflammation and monocyte increase is one of the main causes of vessel injury in CAD. SIRT1 (Sirtuin 1) protein plays an important role in the regulation of cellular physiological mechanisms. SIRT1 has roles in regulating angiogenesis and preventing endothelial dysfunction and reperfusion injury due to ischemia. Suppression of SIRT1 causes monocyte affinity due to endothelial dysfunction. Sirtuins activators are involved in pathologies of many diseases with promising treatments. The objective of this review is to summarize the current progress and future directions of sirtuin protein in the field of CAD.

Prognostic value of C-reactive protein/albumin ratio in ST-segment elevation myocardial infarction.

Serum C-reactive protein (CRP)/albumin ratio (CAR) is demonstrated as a more precise marker in determining the prognosis of critical diseases than albumin and CRP levels, separately. Recently, inflammatory biomarkers are increasingly used for both screening and prognosis of coronary artery disease (CAD). As an ischemia-dependent risk index, CAR is an independent marker of in-hospital and long-term all-cause mortality in ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention. The results indicate that CAR is a more effective prognostic marker than either CRP or albumin.

Rationale, Design, and Methodology of the APOLLON trial: A comPrehensive, ObservationaL registry of heart faiLure with midrange and preserved ejectiON fraction.

OBJECTIVE: Although almost half of chronic heart failure (HF) patients have mid-range (HFmrEF) and preserved left-ventricular ejection fraction (HFpEF), no studies have been carried out with these patients in our country. This study aims to determine the demographic characteristics and current status of the clinical background of HFmrEF and HFpEF patients in a multicenter trial. METHODS: A comPrehensive, ObservationaL registry of heart faiLure with mid range and preserved ejectiON fraction (APOLLON) trial will be an observational, multicenter, and noninterventional study conducted in Turkey. The study population will include 1065 patients from 12 sites in Turkey. All data will be collected at one point in time and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT03026114). RESULTS: We will enroll all consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had New York Heart Association class II, III, or IV HF, elevated brain natriuretic peptide levels within the last 30 days, and an left ventricular ejection fraction (LVEF) of at least 40%. Patients fulfilling the exclusion criteria will not be included in the study. Patients will be stratified into two categories according to LVEF: mid-range EF (HFmrEF, LVEF 40%-49%) and preserved EF (HFpEF, LVEF ≥50%). Regional quota sampling will be performed to ensure that the sample was representative of the Turkish population. Demographic, lifestyle, medical, and therapeutic data will be collected by this specific survey. CONCLUSION: The APOLLON trial will be the largest and most comprehensive study in Turkey evaluating HF patients with a LVEF ≥40% and will also be the first study to specifically analyze the recently designated HFmrEF category.

An extensive caseous calcification of the mitral annulus complicated with severe mitral regurgitation.

Caseous calcification of the mitral annulus (CCMA) is considered a rare variant of mitral annular calcification (MAC) due to caseous transformation of the inner material and prevalence of CCMA, about 0.63% of all MAC cases and 0.06%-0.07% of the population. The precise pathophysiology of CCMA is still unknown. It is a chronic degenerative disorder common in the elderly, particularly in women. Caseous calcification of the mitral annulus (CCMA) is a soft peri-annular extensive calcification, resembling cardiac tumors, abscesses, vegetation, or calcified thrombus, which is composed of an admixture of calcium, fatty acids, and cholesterol with a toothpaste-like texture. In the characteristic appearance on echocardiography, the calcification is a round, large, soft mass with a central echo dense area, typically located at the basal area of the posterior mitral valve. It usually carries a benign prognosis but rarely may be complicated with mitral valve dysfunction (valve stenosis/mitral regurgitation) or systemic embolization. The current data suggest conservative medical therapy and clinical follow-up for management of CCMA unless there is a need of cardiac surgery for severe mitral stenosis and/or regurgitation. We present a case, complicated with severe mitral regurgitation, and need surgical resection of the CCMA because of the CCMA-induced symptomatic severe mitral regurgitation despite optimal medical therapy. Macroscopic and microscopic examination of caseous material also demonstrated the characteristic appearance of CCMA.

Association between restless leg syndrom and slow coronary flow.

OBJECTIVE: Restless legs syndrome (RLS) is a common sleep disorder in which patients feel unpleasent leg sensations and urge to move the legs during rest, especially at night, and symptoms are improved by leg movement. Prior studies analyzing the associations between cardiovascular disease and restless legs syndrome has shown controversial results. The goal of the study was to estimate the relationship between restless legs syndrome and slow coronary flow (SCF). METHODS: The present study was cross-sectional and observational and consists of 176 individuals who underwent coronary angiography and had angiographically normal coronary arteries of varying coronary flow rates. The study included 86 patients with isolated SCF and 90 control participants with normal coronary flow (NCF). RLS was assessed the day after the coronry flow was evaluated, using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The following question was asked: "Do you have unpleasant leg sensations (like crawling, paraesthesia, or pain) combined with motor restlessness and an urge to move?" The possible responses were as follows: no, less than once/month, 2-4 times/month, 5-14 times/month, and 15 or more times per month. Those who answered that they had these feelings were asked the following two more questions: 1) "Do these symptoms occur only at rest and does moving improve them?" and 2) "Are these symptoms worsen in the evening/at night compared with the morning?" RLS is considered to be probable if the participant has answered "yes" for all three of the above questions, and has a frequency of ≥5 times/month. Student's t-test, Mann-Whitney U test, multiple logistic regression analysis were used for statistical analysis. RESULTS: The prevalence of restless legs syndrome was 48 (27%) and increased significantly with age. Patients with SCF have more likely had RLS than the control group (p<0.001). The age-adjusted prevalence odds of SCF were 3.11 times higher (95% CI: 1.54-6.29; P<0.001) among patients with RLS symptoms. Significant associations between RLS and SCF did not materially change after further adjustment for other potential covariates, such as sex, BMI, BMI squared, smoking. CONCLUSION: Our study concluded that there is a strong link between SCF and RLS.

Congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery: an interesting case report.

Intercoronary communication is a very rare coronary artery anomaly. It is defined as an open-ended circulation with bidirectional blood flow between two coronary arteries. Coronary artery fistulas are abnormal communications between a coronary artery and a cardiac chamber or major vessel. A 62-year-old man was admitted to our hospital with sudden development of general weakness, dizziness and a sensation of compression in his chest. At presentation his blood pressure was 80/40 mmHg and heart rate was 65 beats/min. The ECG revealed sinus rhythm and 1-2 mm ST elevation in the anterior leads. The patient was taken to the catheterization laboratory for percutaneous coronary intervention. The left main and left circumflex coronary arteries were normal. Coronary angiography showed a communication between the left main and the diagonal branch of the left anterior descending and a fistula between the intercoronary connection and the left atrium. The other coronary arteries were normal. Laboratory test results, including cardiac troponin I and creatine kinase-MB levels, were normal. The angina symptoms disappeared and the ST elevation resolved within four hours. We report an interesting case of congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery presenting as an acute coronary syndrome. To the best of our knowledge, this is the first case in the literature involving a coronary artery fistula in an intercoronary communication.

The relationship between acute coronary syndrome and sildenafil.

Sildenafil is a drug used for male erectile dysfunction. Sildenafil's fatal cardiac effects except due to hypotension with simultaneous nitrate use have not been reported.We reported in this case a 70-year-old man admitted to the emergency service with chest pain, which occurs in an hour after sildenafil use. Electrocardiogram showed inferoposterior ST-segment elevation. In angiography, total circumflex artery occlusion has been seen.

Heart rate variability and heart rate recovery in patients with type 1 diabetes mellitus.

OBJECTIVE: Patients with diabetes mellitus (DM) are at an increased risk of sudden cardiac death (SCD) partly explained by cardiac autonomic neuropathy (CAN). There have been fewer studies to evaluate CAN using heart rate variability (HRV) and heart rate recovery (HRR) in patients with type 2 DM.To our knowledge, there has been no study to investigate the association between HRR, HRV and type 1 DM. The purpose of this study was to examine the changes in HRR and HRV measurements in type 1 diabetic patients. METHODS: The study population consisted of 35 consecutive patients with type 1 diabetes and 35 sex- and age-matched non-diabetic controls. We performed electrocardiography, echocardiography, Holter analysis, exercise stress test, routine biochemical tests including haemoglobin Ale, high-sensitivity C-reactive protein and evaluated the clinical characteristics. HRR was calculated by subtracting the heart rate values at the first minute of the recovery phase from the peak heart rate. Abnormal HRR was defined as HRR < or = 18 beats.The HRV analysis was performed in both time domain and frequency domain. RESULTS: In HRV analysis, type 1 diabetic patients had significantly lower time domain [SDNN (P=0.041), SDANN (P=0.016), r-MSSD (P<0.001), pNN50 (P<0.001)] and frequency domain [total power (P=0.002), VLF (P<0.001), LF (P<0.001), HF (P=0.001), LF/HF (P=0.034)] HRV parameters as compared to controls. In logistic regression analysis, the HRR (OR 0.927, 95% CI 0.872 to 0.985, P= 0.014), METs (OR 0.562, 95% CI 0.355 to 0.890, P= 0.014), pNN50 (OR 0.729, 95% CI 0.566 to 0.941, P= 0.015) and HF (OR 0.952, 95% CI 0.911 to 0.994, P= 0.027) were independently associated with type 1 DM. CONCLUSION: The results of this study showed that HRV parameters and HRR were significantly reduced in patients with type 1 versus healthy controls. We found that HRV parameters correlated with HRR in type 1 diabetic patients. There is a relationship between CAN and inflammation and also, there may be a relationship between CAN and intensive glycaemic control according to this study.