An invasive but simple and accurate method for ascending aorta-femoral artery pulse wave velocity measurement.

INTRODUCTION: Pulse wave velocity (PWV) is an emerging predictor in the assessment of cardiovascular risk in diseased and healthy populations. We suggest a novel method for the accurate measurement of PWV. METHOD: PWV is calculated from pulse transit time using two separate pulse recordings over a known distance. 8F sheaths were placed in the right femoral arteries and routine coronary angiographies were performed with 5F diagnostic catheters. Ascending aorta pressures were measured with right diagnostic catheter tip in the ascending aorta and synchronous femoral artery pressures were measured with the sheath in the femoral artery. The distance between the two pressure sites was calculated as follows: total length of the right diagnostic catheter-length of the catheter outside the sheath-Sheath length. RESULTS: We evaluated the PWV measured using the catheter method in 24 subjects. PWV correlated positively and independently with age (p = 0.004), coronary artery disease (p = 0.04), ascending aorta systolic pressure (p = 0.006), femoral artery systolic pressure (p = 0.008), ascending aorta pulse pressure (p = 0.003) and femoral artery pulse pressure (p = 0.04). In coronary artery disease patients, the mean PWV value was significantly higher than in patients with normal coronary arteries (12.61 ± 6.31 m/s vs 7.58 ± 2.26 m/s p = 0.04). CONCLUSION: We describe a novel and accurate but invasive method for measurement of PWV. Our results may serve as a reference for non-invasive assessment of aorta-femoral artery PWV.

Comparison between primary angioplasty and thrombolytic therapy on erectile dysfunction after acute ST elevation myocardial infarction.

Acute ST elevation myocardial infarction has high mortality and morbidity rates. The majority of patients with this condition face erectile dysfunction in addition to other health problems. In this study, we aimed to investigate the effects of two different reperfusion strategies, primary angioplasty and thrombolytic therapy, on the prevalence of erectile dysfunction after acute myocardial infarction. Of the 71 patients matching the selection criteria, 45 were treated with primary coronary angioplasty with stenting, and 26 were treated with thrombolytic agents. Erectile function was evaluated using the International Index of Erectile Function in the hospital to characterize each patient's sexual function before the acute myocardial infarction and 6 months after the event. The time required to restore blood flow to the artery affected by the infarct was found to be associated with the occurrence of erectile dysfunction after acute myocardial infarction. The increase in the prevalence of erectile dysfunction after acute myocardial infarction was 44.4% in the angioplasty group and 76.9% in the thrombolytic therapy group (P=0.008). In conclusion, this study has shown that reducing the time of reperfusion decreases the erectile dysfunction prevalence, and primary angioplasty is superior to thrombolytic therapy for decreasing the prevalence of erectile dysfunction after acute myocardial infarction.

Relationship of brain natriuretic peptide with metabolic syndrome parameters: an observational study.

OBJECTIVE: Metabolic syndrome (MS) was independently associated with increased risk of incident heart failure and coronary artery disease. In this study, we sought to identify whether there is an association between metabolic syndrome components and left ventricular diastolic functions and brain natriuretic peptide (BNP) levels. METHODS: This study is a cross-sectional, observational study. Two hundred consecutive patients with MS were selected to form the study population. Echocardiographic parameters and BNP were determined. Mann-Whitney U test and Kruskal-Wallis test were used to compare BNP levels in categorical variables. Spearman rank correlation analysis was used to investigate the correlation between BNP level and other numerical variables. Linear regression analysis was used to find the variables affecting the BNP level. RESULTS: BNP level was higher in females than males [11.14 (0.12-87) vs 7.49 (0.01-99) pg/dl, p=0.04]. None of the MS parameters affects the BNP level in MS patients. MS criteria number that the patient had was not related to BNP level. Sixty seven percent of patients had left ventricular (LV) diastolic dysfunction. BNP was independent from LV diastolic function. Multiple linear regression analysis demonstrated that having diabetes mellitus increases BNP level by 7.73 unit (ß=7.73, 95% CI - 2.321 - 13.149, p=0.006). CONCLUSION: None of the MS parameters affects the BNP level in MS patients. Diastolic dysfunction existence did not affect the BNP level of MS patients. There is an association between diabetes mellitus and BNP, independent of left ventricle diastolic functions.

Impaired right ventricular functions in metabolic syndrome patients with preserved left ventricular ejection fraction.

OBJECTIVES: Metabolic syndrome (MetS) has been shown to be independently associated with increased risk for incident heart failure and coronary artery disease. We investigated whether there was deterioration in right ventricular functions in MetS patients with preserved left ventricular functions and its association with the number of MetS components. STUDY DESIGN: The study included 192 consecutive patients (148 women, 44 men; mean age 54.3 ± 8.5 years) with the diagnosis of MetS based on the NCEP-ATP III criteria and 20 healthy controls (12 women, 8 men; mean age 51.6 ± 8.4 years). All subjects underwent conventional and tissue Doppler (TDI) echocardiography to assess left and right ventricular functions, including right ventricular myocardial performance index (MPI) and tricuspid annular plane systolic excursion (TAPSE). RESULTS: The number of MetS components were three in 43.8%, four in 31.3%, and five in 25% of the patients. Right ventricular TDI-derived MPI was higher in patients with MetS compared to controls [median 0.5 (range 0.2-3.3) vs. 0.3 (0.1-0.7), p=0.000]. This was possibly due to significantly shortened right ventricular ejection time in MetS patients (p<0.05). Although TAPSE was within the normal range in MetS patients, it was significantly decreased compared to controls (p=0.000), accompanied by significantly lower TDI-derived S wave, E wave, and E/A ratio (p=0.000). None of the MetS components were significantly correlated with right ventricular TDI-derived MPI. There was no association between the number of MetS components and echocardiographic parameters. CONCLUSION: Our findings show that, despite preserved left ventricular systolic functions, both systolic and diastolic functions of the right ventricle deteriorate in MetS patients.

Thymosin beta 4 is associated with collateral development in coronary artery disease.

OBJECTIVES: Thymosin beta 4 (Tß4) plays an essential role in cardiac vessel development and is currently being developed as a therapeutic agent for the treatment of coronary artery disease (CAD) in some experimental studies. Thus, we aimed to investigate the association of serum Tß4 levels and collateral formation in patients presenting with severely stenotic CAD. METHODS: Thirteen patients with poor collateral development and 16 age- and sex-matched patients with good collateral development who had ≥ 95% stenosis in at least one major coronary artery on coronary angiogram (CAG) were enrolled in the study. The Gensini score was calculated for each patient by using CAG results. Collateral development was classified according to the Cohen-Rentrop method. Serum Tß4 levels were measured with enzyme-linked immune sorbent assay. RESULTS: There were no statistically significant differences between the two groups in regard to clinical and laboratory characteristics of the patients except for Tß4 levels. The Tß4 levels in the well-collateralized study group were found to be significantly higher than those of the poorly collateralized study group and serum Tß4 levels were positively correlated with the collateral development. CONCLUSIONS: Our findings suggest that serum Tß4 levels are significantly associated with the collateral development in severe CAD.

Association between plasma asymmetrical dimethylarginine activity and severity of aortic valve stenosis.

OBJECTIVES: Aortic valve stenosis is the most common valvular heart disease in the Western world. The most common cause of aortic valve stenosis in adults is calcification of a normal trileaflet or congenital bicuspid valve. Calcific aortic valve stenosis is an active disease process characterized by mechanical stress, endothelial damage, lipid accumulation, inflammation, synthesis of extracellular matrix proteins, and calcification, reminiscent of atherosclerosis in many aspects. Asymmetrical dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase which reduces the bioavailability of nitric oxide and begets endothelial dysfunction. The goal of this study was to examine the association between ADMA activity and severity of aortic valve stenosis. METHODS: One hundred and nine patients were included in this study. Patients were grouped as those with mild aortic stenosis (42 patients, group 1), moderate aortic stenosis (36 patients, group 2), and severe aortic stenosis (31 patients, group 3). ADMA activity was measured by ELISA kit. RESULTS: Mean ADMA activity in group 3 was significantly higher than that in groups 1 and 2 (1.94 ± 0.45 vs. 0.87 ± 0.37 micromol/l, P < 0.001 and 1.94 ± 0.45 vs. 1.34 ± 0.52 micromol/l, P < 0.001, respectively). Serum ADMA activity was positively correlated with mean aortic gradient and maximum aortic gradient and negatively correlated with aortic valve area. CONCLUSION: Our results showed that serum ADMA activity is higher in patients with severe aortic valve stenosis. ADMA activity is positively correlated with aortic valve stenosis severity. Serum ADMA level may be used as a precious marker to evaluate and follow up the severity of aortic valve stenosis.

Stent thrombosis: nightmare of the interventional cardiology era.

Coronary stents have marked an era in the interventional cardiology and have significantly decreased the rates of acute restenosis. Although diminished rates of restenosis have been observed with stents with respect to balloon angioplasty, restenosis is still a major problem of the interventional procedures. Stent thrombosis (ST) after percutaneous coronary intervention (PCI) is a rare and usually poor prognostic event that might result in myocardial infarction (MI) and sudden death. We wanted to summarize the main features of the issue.

Thymosin beta4 levels after successful primary percutaneous coronary intervention for acute myocardial infarction.

OBJECTIVES: Thymosin beta4 (Tß4) has been shown to have an important role in healing of damaged tissues and promoting cardiomyocyte survival in acute coronary syndromes. We evaluated endogenous Tß4 levels in patients presenting with ST-elevation acute myocardial infarction (STEMI) before and after successful primary percutaneous coronary intervention (PCI). STUDY DESIGN: The study included 24 consecutive patients (7 females, 17 males; mean age 55.0±10.9 years) who underwent successful primary PCI for STEMI and 24 age- and sex-matched healthy controls (13 females, 11 males; mean age 57.5±11.7 years) with angiographically normal coronary arteries. To determine Tß4 levels, blood samples were obtained from STEMI patients on admission and 48 hours after successful PCI, and from controls immediately after coronary angiography. RESULTS: Compared to controls, baseline levels of high-density lipoprotein cholesterol (46.2±8.9 vs. 34.2±7.2 mg/dl, p<0.001) and Tß4 (2.9±1.5 vs. 1.5±1.0 µg/ml, p<0.001) were significantly lower, and white blood cell counts (7.6±2.2 vs. 11.4±3.0 10³/µl, p<0.001) were significantly higher in the STEMI group. After 48 hours of PCI, the mean Tß4 level increased significantly to 2.3±0.8 µg/ml (p<0.001) and became similar to that of the control group (p=0.068). There was a significant negative correlation between serum Tß4 and white blood cell count (r=-0.347, p=0.016). CONCLUSION: Considering the significant increase in serum Tß4 levels following successful primary PCI in patients with STEMI, Tß4 may prove to be a new marker in the assessment of reperfusion success in addition to those used currently.

Paraoxonase activity might be predictive of the severity of aortic valve stenosis.

BACKGROUND AND AIM OF THE STUDY: Aortic valve stenosis (AS) is the most common valvular heart disease in the western world, and in adults is invariably caused by the calcification of a normal tricuspid or congenital bicuspid valve. Calcific AS, as an active disease process, is characterized by lipid accumulation, inflammation and calcification that mimic atherosclerosis. Paraoxonase-1 (PON-1) is a high-density lipoprotein (HDL)-bound enzyme that exerts antiatherogenic properties by protecting low-density lipoprotein (LDL)-cholesterol from oxidative modification. The study aim was to examine the association between PON-1 activity and AS. METHODS: A total of 93 patients with angiographically normal coronary arteries was enrolled into the study. Transthoracic echocardiography was used to diagnose and grade the AS before the patients underwent selective coronary angiography. The patients were allocated to three groups of mild AS (n = 34), moderate AS (n = 31) and severe AS (n = 28). Paraoxonase activity was measured using a spectrophotometric technique. RESULTS: The mean PON-1 activity in patients with severe AS (64.4 +/- 29.8 U/l) was significantly lower than that in patients with mild and moderate AS (97.1 +/- 72.6 and 146.8 +/- 133.9 U/l; p = 0.03 and p = 0.002, respectively). Typically, PON-1 activity tended to be lower in moderate AS than in mild AS (p = 0.07). The serum PON-1 activity correlated positively with the aortic valve area, but negatively with the aortic mean and maximum gradients. CONCLUSION: The study results showed that PON-1 activity is lower in patients with calcific AS. In addition, PON-1 activity was inversely correlated with the severity of AS.

Effect of reperfusion therapy on index of myocardial performance in acute myocardial infarction: thrombolytics versus primary angioplasty.

It is known that primary angioplasty is more effective than thrombolytic therapy for the treatment of ST-segment elevation acute myocardial infarction. The aim of the present study is to compare the effects of the two strategies on the left ventricular functions using the Tei index (a combined myocardial performance index). Of 81 patients (11 female, mean age 52.7 +/- 11.9 years, and 70 male, mean age 54.8 +/- 11.5 years) matching the selection criteria, 41 patients were treated by primary percutaneous transluminal coronary angioplasty and stenting (group A, 41 patients) and 40 patients were treated by thrombolytic agents (streptokinase) (group B, 40 patients). All patients underwent a complete two-dimensional transthoracic echocardiographic and Doppler study in the left lateral decubitus position from multiple windows. There was no significant difference between the two groups in isovolumetric contraction time and ejection time. Isovolumetric relaxation time was 95.2 +/- 18.4 in group A and 116.2 +/- 28.1 in group B (P = 0.001) and the Tei index was 0.51 +/- 0.12 in group A and 0.59 +/- 0.16 in group B (P = 0.019). Isovolumetric relaxation time and Tei index were significantly higher in group B. Primary angioplasty is superior to thrombolytic therapy as assessed by the Tei index even in the first 3 h, with no apparent change in systolic function.

[Transient subclavian artery spasm observed during percutaneous coronary intervention for acute myocardial infarction]. / Akut miyokart enfarktüsü nedeniyle yapilan perkütan koroner girisim sirasinda izlenen geçici subklavyen arter spazmi.

A 68-year-old man with a history of two coronary artery bypass operations was admitted with acute inferior myocardial infarction (AMI) and cardiogenic shock. The electrocardiogram showed ST-segment elevation in leads D2, D3, and aVF. Coronary angiography demonstrated a 75% thrombotic stenosis in the right coronary artery (RCA), 90-99% stenosis in the intermediate coronary artery, and plaques in the circumflex artery. While assessing the patency of bypass grafts, a 99% stenosis was noted in the distal subclavian artery. The culprit artery was deemed to be the RCA, and after direct stenting, TIMI III flow was achieved. Ten days later, stent implantation was performed for the intermediate coronary artery, at which time distal subclavian artery stenosis was not observed. Distal subclavian artery spasm was thought to occur during AMI.

Association between plasma asymmetrical dimethylarginine activity and saphenous vein graft disease in patients with coronary bypass.

BACKGROUND: Coronary vein graft disease is an important contributor to the morbidity after coronary artery bypass graft surgery. Graft occlusion is a serious complication, which limits the use of the saphenous vein as a coronary bypass conduit. Asymmetrical dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and it reduces the bioavailability of nitric oxide and begets endothelial dysfunction. The goal of this study was to examine the association between plasma ADMA activity and saphenous vein graft disease. METHODS: One hundred and three patients were enrolled in this study. Group 1 consisted of 42 patients (13 female, 29 male) who had diseased saphenous vein grafts and group 2 consisted of 61 patients (10 female, 51 male) with nondiseased saphenous vein grafts. ADMA activity was measured by the enzyme-linked immunosorbent assay kit. RESULTS: Mean ADMA activity in group 1 was significantly higher than in group 2 (2.0+/-0.6 vs. 1.1+/-0.5 micromol/l, P<0.001, respectively). Mean platelet volume was also significantly higher in group 1 than in group 2 (8.7+/-1.5 vs. 8.2+/-0.6 fl, P=0.03, respectively). In a multivariate linear regression analysis, ADMA activity (beta=2.902, P<0.001) and mean platelet volume (beta=0.595, P=0.03) were found to be independent predictors of saphenous vein graft disease. CONCLUSION: Our results showed that ADMA activity was higher in patients with saphenous vein graft disease. Increased ADMA activity might lead to the acceleration of saphenous vein graft disease. ADMA may be a precious marker for detecting late saphenous vein graft patency.

Association between paraoxonase activity and late saphenous vein graft occlusion in patients with coronary artery bypass grafting.

BACKGROUND: Coronary vein graft disease is an important contributor to the morbidity after coronary artery bypass grafting (CABG). Late occlusion of the graft is a serious complication that limits the use of the saphenous vein as a coronary bypass conduit. It is frequently encountered in old, degenerated vein grafts with advanced atherosclerotic plaque formation. Paraoxonase-1 (PON-1) is an HDL-bound enzyme which has anti-atherogenic properties and protects LDL cholesterol from oxidative modification. AIM: To examine the association between PON-1 activity and late saphenous vein graft occlusion. METHODS: Thirty-eight patients who had at least one occluded saphenous vein graft (group 1; 12 females, 26 males) and 41 patients who had a patent saphenous vein graft (group 2; 7 females, 34 males) were enrolled in this study. Paraoxonase activity was measured spectrophotometrically. RESULTS: The mean PON-1 activity in group 1 was significantly lower than in group 2 (74.1 +/- 52.1 vs. 114.4 +/- 90.9 U/l, p = 0.02). The mean platelet volume was significantly higher in group 1 than group 2 (8.8 +/- 1.6 vs. 8.2 +/- 1.1 fl, p = 0.04). Multiple logistic regression analysis showed that only PON-1 activity (beta = 0.011, p = 0.042) was an independent predictor of late occlusion of a saphenous vein graft. CONCLUSIONS: Our results show that PON-1 activity is lower in patients with late saphenous vein graft occlusion. Reduced PON-1 activity may lead to acceleration of saphenous vein graft occlusion.

Influence of heavy cigarette smoking on heart rate variability and heart rate turbulence parameters.

BACKGROUND: Cigarette smoking increases the risk of cardiovascular events related with several mechanisms. The most suggested mechanism is increased activity of sympathetic nervous system. Heart rate variability (HRV) and heart rate turbulence (HRT) has been shown to be independent and powerful predictors of mortality in a specific group of cardiac patients. The goal of this study was to assess the effect of heavy cigarette smoking on cardiac autonomic function using HRV and HRT analyses. METHODS: Heavy cigarette smoking was defined as more than 20 cigarettes smoked per day. Heavy cigarette smokers, 69 subjects and nonsmokers 74 subjects (control group) were enrolled in this study. HRV and HRT analyses [turbulence onset (TO) and turbulence slope (TS)] were assessed from 24-hour Holter recordings. RESULTS: The values of TO were significantly higher in heavy cigarette smokers than control group (-1.150 +/- 4.007 vs -2.454 +/- 2.796, P = 0.025, respectively), but values of TS were not statistically different between two groups (10.352 +/- 7.670 vs 9.613 +/- 7.245, P = 0.555, respectively). Also, the number of patients who had abnormal TO was significantly higher in heavy cigarette smokers than control group (23 vs 10, P = 0.006). TO was correlated with the number of cigarettes smoked per day (r = 0.235, P = 0.004). While LF and LF/HF ratio were significantly higher, standard deviation of all NN intervals (SDNN), standard deviation of the 5-minute mean RR intervals (SDANN), root mean square of successive differences (RMSSD), and high-frequency (HF) values were significantly lower in heavy smokers. While, there was significant correlation between TO and SDNN, SDANN, RMSSD, LF, and high frequency (HF), only HF was correlated with TS. CONCLUSION: Heavy cigarette smoking has negative effect on autonomic function. HRT is an appropriate noninvasive method to evaluate the effect of cigarette on autonomic function. Simultaneous abnormal HRT and HRV values may explain increased cardiovascular event risk in heavy cigarette smokers.

Resolution of late sirolimus-eluting stent thrombosis after tirofiban treatment.

A 40-year-old male patient was admitted to the hospital with acute chest pain. A sirolimus-eluting stent (SES) had been deployed to the circumflex artery (Cx) 3 years before. Now, inferior ST-segment elevations were observed and coronary angiography revealed stent thrombosis with distal TIMI 3 grade flow in the Cx. Tirofiban infusion was administered and the control angiography 2 days later revealed complete resolution of the thrombus. Stent thrombosis is a rare but usually poor prognostic event, frequently associated with large myocardial infarction (MI) or death. Very late drug-eluting stent (DES) thrombosis remains a major problem of interventional cardiology due to its high morbidity and mortality. We conclude that tirofiban may be an interesting candidate drug for treatment of very late stent thrombosis.

Right ventricular function in ST elevation myocardial infarction: effect of reperfusion.

PURPOSE: To investigate right ventricle function in successfully reperfused ST elevated myocardial infarction (STEMI) and to compare reperfusion strategies. METHODS: From January 2007 to August 2008, 33 patients with anterior myocardial infarction (MI) and 48 patients with non-anterior myocardial infarction were enrolled in this study. Patients were treated with thrombolytic therapy (TT) or primary percutanaeous coronary intervention (PPCI) (Primary intervention: 16 and 25 patients (anterior and non-anterior consecutively), thrombolytic therapy: 17 and 23 patients (anterior and non-anterior consecutively)). Right ventricle (RV) function was analyzed using tissue Doppler investigation (TDI) after 72 hr of successful reperfusion. RESULTS: There was no difference in right ventricle function assessed by right ventricle TDI Tei index between the PPCI and TT group (0.39+/-0.20 vs. 0.39+/-0,17). RV TDI Tei index increased in anterior MI patients treated with either PPCI or TT compared with control group (0.39+/-0.11 vs. 0.27+/-0.16, P=0.015 and 0.43+/-0.18 vs. 0.27+/-0.16 , P= 0.014 respectively). RV TDI Tei index did not differ between non-anterior MI patients treated with either PPCI or TT and control group (0.38+/-0.23 vs. 0.27+/-0.16, and 0.37+/-0.16 vs. 0.27+/-0.16, respectively). CONCLUSIONS: RV function deteriorated in STEMI compared with healthy controls. Contrary to the expectation, RV dysfunction was observed in anterior STEMI, but not in non anterior MI. There was no difference in RV function between the two treatment modalities.

P-wave dispersion increases in prehypertension.

BACKGROUND: Prolongation of P-wave durations and increased P-wave dispersion are independent predictors of atrial fibrillation (AF). AF is the most common arrhythmia of the general population. Prehypertension, including those with systolic blood pressure ranging from 120-139 mmHg or diastolic blood pressure ranging from 80-89 mmHg was described by JNC7. Prehypertension is the predictor of development of hypertension in the future. Prehypertension is associated with excess cardiovascular morbidity and mortality. In this study, we evaluated relationship between prehypertension and P-wave dispersion. METHODS: Seventy-eight prehypertensive patients (group 1: mean age 44.6+/-11.2 years; 45 male) and 78 normotensive patients (group 2: mean age 43.3+/-7.0 years; 43 male) were enrolled in this study. Standard 12-lead ECGs were recorded in all patients using a paper speed of 50 mm/s. In all patients, transthoracic echocardiographic examination was performed. RESULTS: Pmax and P-wave dispersion were significantly higher in group 1 compared with group 2 (103.59+/-19.8 ms vs 93.59+/-13.4 ms, p<0.001; 50.51+/-18.6 ms vs 39.85+/-10.6 ms, p<0.001, respectively). CONCLUSION: Pmax and P-wave dispersion increase in prehypertensive patients compared with normotensive patients. This data might show increased risk of AF in prehypertension.

Asymmetric dimethylarginine levels in patients with coronary artery ectasia.

BACKGROUND: Endothelial dysfunction might be one of the pathophysiological mechanisms in the development of coronary artery ectasia (CAE) although the exact mechanisms have not yet been demonstrated. Asymmetric dimethylarginine (ADMA), an endogenous competitive inhibitor of nitric oxide synthase, is also related to endothelial and structural dysfunction. AIM: To asses the relationship between CAE and ADMA plasma concentrations. METHODS: Thirty patients with CAE in a mean age of 55.5 +/- 3.6 years and 40 patients with normal coronary arteries in a mean age of 53.3 +/- 11.6 years were studied. The ADMA levels of all patients were analysed by ELISA method. RESULTS: The mean ADMA level in the CAE group was found to be significantly higher than the mean ADMA level in the normal coronary artery group (2.26 +/- 0.47 vs. 1.43 +/- 0.40 micromol/l, p < 0.001). The elevated ADMA level (> 1.80 micromol/l) was present in 83.0% of patients from the CAE group and 25.0% of patients from the normal coronary artery group (p < 0.001). Having an increased ADMA level enhanced the risk of CAE 15-fold. The multiple-adjusted OR of the risk of CAE was 18.71 (95% CI 4.95-70.68) for the higher ADMA level compared to the lower level. CONCLUSION: Asymmetric dimethylarginine level is significantly associated with the presence of coronary artery ectasia. These findings suggest that increased ADMA level may be associated with endothelial dysfunction leading to the development of coronary artery ectasia.

Heart rate turbulence and heart rate variability in patients with atrial synchronous ventricular pacing.

BACKGROUND: Heart rate turbulence (HRT) and heart rate variability (HRV) have been shown to be independent and powerful predictors of mortality in a specific group of cardiac patients. Pacing has unfavorable effects on autonomic function. Our aim is to investigate autonomic responses to atrial synchronous ventricular pacing (VDD) by evaluating HRT and HRV parameters. METHODS AND RESULTS: The study groups comprised 12 control and 12 patients without organic heart disease and with normal sinus function who were implanted with a permanent VDD pacing system for high-degree atrioventricular block. The HRV and HRT analysis were assessed from a 24-hour Holter recording. There was no statistically significant difference between the two groups for HRV parameters. When HRT parameters were compared, turbulence onset was significantly higher in the cardiac paced group than the controls group (2.729 +/- 8.818 vs -1.565 +/- 8.301, P = 0.006), but no statistically significant difference was found between the two groups for turbulence slope (11.166 +/- 10.034 vs 31.675 +/- 28.107, P = 0.68). The number of patients who had abnormal HRT onset was significantly higher in the paced group than controls (9 vs 2, P = 0.004). CONCLUSION: Atrial synchronous pacing has unfavorable effects on autonomic function. Altered ventricular depolarization sequence may lead to changes in autonomic response. Although we found no difference in HRV parameters between the control and VDD patient groups, the HRT onset and number of patients with abnormal HRT onset was significantly higher in VDD patients. HRT onset can be a better way of noninvasive autonomic response predictor in VDD patients.