Carotid intima-media and epicardial adipose tissue thickness in adult patients with epilepsy taking anti-seizure medication and its long-term significance.

OBJECTIVES: We investigated epicardial adipose tissue thickness (EATT), carotid intima-media thickness (CIMT), and lipid profile in adult patients with epilepsy (PWE) taking anti-seizure medication(s) (ASM) and compared with those of the healthy population. We also investigated whether duration of follow-up and number of ASM(s) (mono- vs. polytherapy) affect these risk factors. METHODS: Twenty PWE older than 18 years of age were recruited at the outpatient epilepsy clinic and compared to twenty controls. Patients who were 18 years old and younger, those with cardiovascular risk factors, and patients with follow-up duration less than 2 years were excluded from the study. RESULTS: Epicardial adipose tissue thickness and CIMT were thicker compared to controls. While patients' low-density lipoprotein (LDL) levels were higher than controls, and high-density lipoprotein (HDL) levels were lower, the levels were in normal ranges. Those patients with duration of follow-up more than five years had thicker EATT. The 5-year LDL was in normal ranges while HDL was abnormally low. Number of ASM(s) was not associated with increased risks of atherosclerosis. Increased CIMT in patients taking ASM(s) was independent of their lipid profile. CONCLUSION: Anti-seizure medications contribute to accelerated atherosclerosis in people with epilepsy. Chronic use of ASMs may increase this chance. It is appropriate to use ASM(s) with lower chances of atherosclerosis in people with epilepsy and encourage them to change their lifestyle in order to modify cardiovascular risk factors. Meantime, it is reasonable to assess the risk of atherosclerosis periodically in these patients by noninvasive methods including lipid profile, CIMT, and EATT.

Asociación entre la morfología de la válvula aórtica bicúspide y de la aorta ascendente / Association Between Bicuspid Aortic Valve and Ascending Aorta Morphology

RESUMEN Introducción: La válvula aórtica bicúspide (VAB) aparece en el 2% de la población y se divide en 3 grupos morfológicos: fusión de cúspide coronaria derecha e izquierda (DI), fusión de cúspide coronaria derecha y no coronaria (DN) y fusión de cúspide izquierda y no coronaria (NI). Objetivo: Evaluar la asociación entre la morfología de la válvula aórtica bicúspide con la morfología de la aorta ascendente. Material y métodos: Estudio descriptivo-analítico realizado en 200 pacientes. Las variables y los hallazgos ecocardiográficos se recogieron en un cuestionario. SPSS.22 se usó para el análisis estadístico. Resultados: Este estudio incluyó 139 (69,5%) hombres y 61 (30,5%) mujeres. La fusión de cúspide coronaria derecha e izquierda (69%) fue la morfología más habitual. La dilatación total de la aorta ascendente fue la morfología más común (44,5%). Conclusión: La morfología de fusión de cúspide coronaria derecha e izquierda fue la más común. La dilatación total de la aorta y la afectación funcional de la válvula aórtica fueron más comunes en la DI.

ABSTRACT Background: Bicuspid aortic valve (BAV) occurs in 2% of the population, and is divided into 3 morphological groups: right and left coronary cusp (RL), right coronary and non-coronary cusp (RN), and left coronary and non-coronary cusp (LN) fusion patterns. Objective: The aim of the study was to evaluate the association between bicuspid aortic valve morphology and ascending aorta morphology. Methods: This was a descriptive-analytical study carried out in 200 patients. A questionnaire collected echocardiographic findings and variables. SPSS 22 was used for statistical analysis. Results: The study enrolled 139 men (69.5%) and 61 women (30.5%). Right and left coronary cusp fusion (69%) and total dilation of the ascending aorta (44.5%) were the most common morphologies. Conclusion: Right and left coronary cusp fusion was the most prevalent morphology and total dilation of the aorta and abnormal aortic valve function were more frequent in RL cusp fusion.

Prognostic Value of Cardiac Biomarkers Assessment in Combination with Myocardial 2D Strain Echocardiography for Early Detection of Anthracycline-Related Cardiac Toxicity.

BACKGROUND: Anthracyclines, a widely used chemotherapy agent with a definite survival improvement, can result in cardiac toxicity presenting with HF (heart failure). OBJECTIVE: We aim to assess the predictive value of cardiac biomarkers assessment in combination with myocardial two-dimensional strain echocardiography for early detection of cardiac toxicity in patients who underwent Anthracycline-based chemotherapy. METHODS: Fifty-two consecutive adult patients scheduled to undergo the first course of Anthracycline-based chemotherapy were subjected to the study. All the patients underwent highly sensitive 2D echocardiographic evaluation before the treatment, 4 and 12 weeks after completion of first-course chemotherapy. Longitudinal and segmental strains were measured. Serum levels of High-sensitive cardiac troponin I (hscTn-I) and N-terminal-pro-BNP (NT-proBNP) were also assessed before the initiation and 3 weeks after completion of first-course chemotherapy. RESULTS: Fifteen patients (28.8%) revealed a decrease in LVEF (Left Ventricular Ejection Fraction) throughout the evaluations, while just 5 patients met the criteria of cardiac toxicity (9.6%). AUC for Global Longitudinal Strain (GLS) ROC curve at 4 weeks of follow-up was calculated to be 0.968. Inferoseptal Systolic Longitudinal Strain (SLS) had the highest AUC value (AUC: 0.934) among different wall SLS. LVESD (Left Ventricular End-Systolic Diameter) at first and second evaluation could predict the risk of cardiac toxicity among LVESD, LVEDD (Left Ventricular End Diastolic Diameter) and LVEDV (Left Ventricular End-Diastolic Volume). Among cardiac biomarkers, hscTnI had higher sensitivity, while NT-proBNP had higher specificity for cardiac toxicity. CONCLUSION: This study has shown that hs-cTnI with good sensitivity can predict cardiac toxicity in Anthracycline-based chemotherapy receiver. The use of strain with speckle echocardiography method has a prognostic value; however, both longitudinal and segmental strain should be assessed. Lateral and inferoseptal SLS (Segmental Longitudinal Strain) are specific markers of cardiac toxicity in the course of anthracycline-related cardiac toxicity.

The effect of opium addiction on arrhythmia following acute myocardial infarction.

The effect of opium addiction on the appearance of different types of arrhythmias after acute myocardial infarction (AMI) has been assessed in few studies. This study is aimed to determine the effect of opium on post-MI arrhythmia and also to address the differences in the appearance of different types of arrhythmias after AMI between opium addicted and non-addicted patients. In this comparative study, participants were classified into two groups with opium addiction (n=94) and without opium addiction (n=106). Post-MI arrhythmias were determined among each group. Study populations were included all patients with first AMI admitted within 6 hours of the onset of chest pain to coronary care units (CCU) of two teaching hospitals affiliated to Kerman University of Medical Sciences (KUMS) in the city of Kerman, Iran. Opium addicted subjects had significantly more frequency of arrhythmia than non-opium addicted subjects (80.9% vs. 22.6%, respectively; P<0.001). Opium addiction was a strong predictor for the occurrence of post-MI arrhythmias in two models of crude analysis (crude OR=14.4, P<0.001) and after adjusting for potential confounder factors (adjusted OR = 21.9, P<0.001). The prevalence of sinus tachycardia, sinus bradycardia and atrial fibrillation in opium addicts were significantly higher than non opium addicts (P<0.05). The results of our study showed that opium addiction is a potential and strong risk for occurring post-MI arrhythmias.