Early detection strain/strain rate and time to strain/strain rate abnormalities for left atrial mechanical function in hypertensive patients.

OBJECTIVE: To evaluate left atrial (LA) deformation parameters strain (S)/strain rate (SR) and time to peak S/SR obtained by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension for three LA mechanical phases and to compare them with the same indices in the control subjects. METHODS: Fifty-five patients with hypertension (HT) and 29 healthy controls were included in the study. All patients had normal LA poster-anterior diameter, LA and left ventricular ejection fractions (LVEF >50%) in two-dimensional echocardiography (2-DE). The peak S/SR values (PS/PSR), the time to peak S/SR (TPS/TPSR) were measured using the 12-segment model for the left atrium during contractile (CP) reservoir (RP) and conduit period (COP) of the LA cycle. RESULTS: For two periods (RP and COP), all of the PS and PSR values were significantly lower in hypertensive patients with preserved LAEF and LVEF compared to those in the controls, except for the CP. Similarly, hypertensive patients had significantly higher TPS and TPSR than those in the controls for the RP and COP in the LA wall, except for the CP. CONCLUSION: LA mechanical function was impaired in hypertensive patients with preserved LA and LV ejection fraction compared to the controls. Although the PS and PSR were decreased for the RP and COP of LA mechanical phases, the TPS/TPSR were prolonged in the HT patients compared to the controls. This might be additional diagnosis criteria to detect the LA myocardial dysfunction and might be a predisposing factor for atrial arrhythmia formation in the hypertensive patients.

Assessment of cardiac autonomic functions by heart rate variability in patients with restless leg syndrome.

OBJECTIVE: The aim of the present study was to investigate cardiac autonomic effects in restless leg syndrome (RLS) using heart rate variability (HRV). METHODS: A total of 35 patients with RLS and 35 healthy individuals were enrolled in the study. The severity of RLS symptoms was assessed using the International Restless Legs Syndrome Study Group rating scale (IRLS). The correlation between the severity of RLS symptoms and HRV parameters measured on an electrocardiogram was analyzed. RESULTS: There were no statistically significant differences between the 2 groups with respect to age, gender, or body mass index. The mean heart rate was 85±7.1 bpm in the RLS group compared with 79.6±5.5 bpm in the control group (p=0.001). The standard deviation (SD) of all normal to normal (NN) intervals (SDNN), the mean of the deviation of 5-minute NN intervals over the entire recording (SDNN index), and the SD of the average NN intervals calculated over a 5-minute period of the entire recording (SDANN) were significantly lower in the RLS group compared with the control group (p<0.05 for all). There were no statistically significant differences between the 2 groups in the square root of the mean squared differences of successive NN intervals (RMSSD) and the proportion of adjacent RR intervals differing by >50 milliseconds in the 24-hour recording (pNN50) values (p=0.119 and p=0.07, respectively). In patients with RLS, the low frequency (LF) power and LF/high frequency (HF) ratio were significantly higher than those in the control group (2248.6±245.6 vs 712.1±346.3, 10.7±3.7 vs 2.9±1.8; p<0.0001 and p<0.0001, respectively). Compared with the control group, the RLS group had lower values for HF power, but the difference was not statistically significant (p=0.07). The severity of RLS symptoms was negatively correlated with the SDNN, SDANN index, and pNN50 (r=-0.453 and p=0.009, r=-0.340 and p=0.046, r=-0.446 and p=0.007, respectively), and positively correlated with LF power (r=0.681 and p<0.0001). CONCLUSION: The study data demonstrated that cardiac autonomic impairment is associated with RLS.

Anomalous the Left Main Coronary Artery Originating from the Right Coronary Artery.

The coronary anomalies are rarely seen in clinical practice. A 47-year-old female patient presented to hospital with chest pain on exertion. The coronary angiography and cardiac tomography showed the anomalous origin of the left main from the right coronary artery.

Concomitant anterior and inferior myocardial infarctions.

Acute multicoronary occlusion is an extremely rare clinical and angiographic finding. Prompt diagnosis and treatment are extremely important. Herein, we present a 38-year-old man suffering from concomitant anterior and inferior myocardial infarctions due to simultaneous total occlusion of both the left anterior descending and right coronary arteries.

Heart Rate Turbulence Analysis in Subclinical Hypothroidism Heart Rate Turbulence in Hypothyroidism.

BACKGROUND: Heart rate turbulence (HRT) is a baroreflex-mediated biphasic reaction of heart rate in response to premature ventricular beats. Abnormal HRT identifies patients with autonomic dysfunction or impaired baroreflex sensitivity. The aim of the present study was to demonstrate the effect of subclinical hypothyroidism (SCH) on cardiac autonomic function using HRT parameters. METHODS: The study sample consisted of 25 patients (10 men, 15 women with a mean age of 39.7 ± 15.5 years) who were diagnosed with SCH and 35 euthyroid patients (13 males, 22 females with a mean age 38.4 ± 11.7 years). All patients underwent 24 h ambulatory electrocardiography monitorization. The study calculated two HRT parameters, turbulence slope (TS) and turbulence onset (TO), and these HRT parameters were compared between the groups to examine the relationship between HRT and thyroid-stimulating hormone (TSH) levels. RESULTS: The characteristics of SCH patients and control cases were similar with regard to age, sex except for TSH levels. Serum TSH levels were significantly higher in SCH patients than in the controls (7.3 ± 1.8 µIU/ml vs. 2.4 ± 1.0 µIU/ml, p < 0.001). TO was significantly higher in SCH patients compared with controls (-1.51 ± 0.5 vs. -2.2 ± 1.0, p = 0.002). SCH patients had lower TS values than controls (7.6 ± 2.4 vs. 10.8 ± 3.4, p < 0.001). TO was positively correlated with serum TSH levels (r = 0.276, p = 0.033). There was also a negative correlation between TS and serum TSH levels (r = -0.437, p < 0.001). CONCLUSIONS: The results of our study indicated that cardiac autonomic function is impaired in patients with SCH. KEY WORDS: Heart rate; Holter electrocardiography; Hypothyroidism.

Baseline SYNTAX score and long-term outcome in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

OBJECTIVES: The SYNTAX score (SXscore) has emerged as a reproducible angiographic tool to quantify the extent of coronary artery disease based on the location and complexity of each lesion. The aim of this study was to evaluate whether the SXscore is an independent predictor of long-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 2993 patients with acute STEMI who underwent primary PCI were stratified into the 4 groups according to the SXscore quartiles; quartile 1(Q1, SXscore ≤ 9, n = 819), Q2 (9 < SXscore < 16, n = 715), Q3 (16 ≤ SXscore < 20, n = 710), and Q4 (SXscore ≥ 20, n = 749). RESULTS: There were significant differences among the quartiles with respect to age, basal creatinine and glucose levels, and the incidences of diabetes mellitus, Killip ≥2, and anemia. From Q1 to Q4, there were increasing rates of culprit left anterior descending lesion (P < .001), multivessel disease (P < .001), chronic total occlusion (P < .001), and proximal lesion localization (P < .001). At long-term follow-up, all-cause mortality, nonfatal myocardial infarction, stroke, rehospitalization due to heart failure, and the need of revascularization were significantly more frequent among the patients in the highest SXscore quartile. In multivariate analysis, after including the SXscore as a numerical variable into the model, every point of increase was determined as an independent predictor for long-term mortality (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = .008) and for overall major adverse cardiac events (MACEs; HR 1.02, 95% CI 1.01-1.04, P < .001). CONCLUSION: The SXscore is an independent predictor of both in-hospital and long-term mortality and MACE in patients with acute STEMI undergoing primary PCI.

Preprocedural red blood cell distribution width predicts bare metal stent restenosis.

BACKGROUND: It has been shown that increased red blood cell distribution width (RDW) predicts adverse outcomes in cardiovascular disease and in patients undergoing a percutaneous coronary intervention. The aim of the present study was to assess the predictive value of preinterventional RDW on the development of in-stent restenosis (ISR) in patients undergoing stent implantation. MATERIALS AND METHODS: In this retrospective study, we compared 131 patients with ISR and 138 patients without ISR who had undergone bare metal stent implantation. RESULTS: Preprocedural RDW was significantly higher in patients with ISR than those without restenosis (14.6±3.2 vs. 13.4±1.6%, P<0.001). Stent length was significantly longer in patients with than those without restenosis (17.9±5.6 vs. 16.2±5.2 mm, respectively, P=0.03). Compared with patients with restenosis, patients without restenosis had a lower rate of diabetes (28 vs. 61 patients, P=0.001), a significantly short period between two coronary angiographies (9.8±9.3 vs. 12.9±11.6 months, respectively, P=0.02), and lower triglyceride levels (133±53 vs. 198±121 mg/dl, respectively, P=0.05). In multivariate logistic regression analysis, diabetes mellitus, stent length, preprocedural RDW, and current smoking independently predicted ISR. CONCLUSION: Increased preinterventional RDW significantly predicts bare metal stent restenosis and might represent a useful screening tool to stratify patients according to a higher or a lower risk of ISR after stent implantation in patients with stable and unstable angina pectoris.

The incidence of coronary anomalies on routine coronary computed tomography scans.

OBJECTIVE: This study aimed to assess the incidence of coronary anomalies using 64-multi-slice coronary computed tomography (MSCT). METHODS: The diagnostic MSCT scans of 745 consecutive patients were reviewed. RESULTS: The incidence of coronary anomalies was 4.96%. The detected coronary anomalies included the conus artery originating separately from the right coronary sinus (RCS) (n = 8, 1.07%), absence of the left main artery (n = 7, 0.93%), a superior right coronary artery (RCA) (n = 7, 0.93%), the circumflex artery (CFX) arising from the RCS (n = 4, 0.53%), the CFX originating from the RCA (n = 2, 0.26%), a posterior RCA (n = 1, 0.13%), a coronary fistula from the left anterior descending artery and RCA to the pulmonary artery (n = 1, 0.13%), and a coronary aneurysm (n = 1, 0.13%). CONCLUSIONS: This study indicated that MSCT can be used to detect common coronary anomalies, and shows it has the potential to aid cardiologists and cardiac surgeons by revealing the origin and course of the coronary vessels.

Effect of black cumin (Nigella sativa) on heart rate, some hematological values, and pancreatic beta-cell damage in cadmium-treated rats.

This study was designed to investigate the effect of Nigella sativa (NS) on the heart rate, some hematological values, and pancreatic beta-cell damage in cadmium (Cd)-treated rats. The rats were randomly grouped into one of three experimental groups: Control, Cd treated, and Cd + NS treated. Each group contained 10 animals. The Cd-treated and Cd + NS-treated groups were injected subcutaneously daily with CdCl2 dissolved in isotonic NaCl in the amount of 2 mL/kg for 30 d, resulting in a dosage of 0.49 mg Cd/kg/d. The control group was injected with only isotonic NaCl (2 mL/kg/d) throughout the experiment (for 30 d). Three days prior to administration of CdCl2, the Cd + NS-treated group received the daily intraperitoneal (ip) injection of 2 mL/kg NS until the end of the study; animals in all three groups were fasted for 12 h and blood samples were taken for the determination of the glucose and insulin levels, red blood cell (RBC) and white blood cell (WBC) counts, packet cell volume (PCV), and hemoglobin (Hb) concentration. The heart rates of rats were also measured by a direct writing electrocardiograph before the blood withdrawals. It was found that NS treatment increased the lowered insulin levels, RBC and WBC counts, PCV, and neutrophil percentage in Cd-treated rats. However, the WBC count of Cd-treated rats with NS treatment was still lower than those of control values. NS treatment also decreased the elevated heart rate and glucose concentration of Cd-treated rats. Pancreatic tissues were also harvested from the sacrificed animals for morphological and immunohistochemical examinations. Cd exposure alone caused a degeneration, necrosis, and weak degranulation in the beta-cells of the pancreatic islets. In Cd + NS-treated rats, increased staining of insulin and preservation of islet cells were apparent. It is concluded that NS treatment might decrease the Cd-treated disturbances on heart rate, some hematological values, and pancreatic beta-cell.