Diagnostic accuracy of Apple Watch Series 6 recorded single-lead ECGs for identifying supraventricular tachyarrhythmias: a comparative analysis with invasive electrophysiological study.

BACKGROUND: The advancements in wearable technology have made the detection of arrhythmias more accessible. While smartwatches are commonly used to detect patients with atrial fibrillation, their effectiveness in the differential diagnosis of supraventricular tachycardias (SVT) lacks consensus. METHODS: A study was conducted on 47 patients with documented SVTs on a 12-lead ECG. All patients in the cohort underwent electrophysiology study with induction of SVT. A 6th generation Apple Watch was used to record ECG tracings during baseline sinus rhythm and during induced SVT. Cardiology residents and attending cardiologists evaluated these recordings to diagnose the differential diagnosis of SVT. RESULTS: The evaluation revealed 27 cases of typical atrioventricular nodal reentrant tachycardia (AVNRT), 11 cases of atrioventricular reentrant tachycardia (AVRT), and 9 cases of atrial tachycardia/atrial flutter (AT/AFL) among the induced tachycardias. Attending physicians achieved an accuracy of 66.0 to 76.6%, and residents demonstrated accuracy rates between 68.1 and 74.5%. Interrater reliability was assessed using Fleiss's Kappa method, resulting in a moderate level of agreement between residents (Kappa = 0.465, p < 0.001, 95% CI 0.30-0.63) and attendings (Kappa = 0.519, p < 0.001, 95% CI 0.35-0.68). The overall Kappa value was 0.417 (p < 0.001, 95% CI 0.34-0.49). CONCLUSIONS: Smartwatch recordings demonstrate moderate feasibility in diagnosing SVT when following a pre-specified algorithm. However, this diagnostic performance was lower than the accuracy obtained from 12-lead ECG tracings when blinded to procedure outcomes.

Assessment of atrial electromechanical delay and P wave dispersion in patients with chronic obstructive pulmonary disease.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is associated with atrial fibrillation (AF) and reduced forced expiratory volume (FEV1) is an independent predictor for new onset AF. The aims of this study were (1) to analyze the atrial electromechanical delay (AEMD) and P wave dispersion which are two predictors of AF development in patients with COPD and without any cardiovascular disease, and (2) to assess the relationship of those with pulmonary functions as quantified by FEV1 measurements. METHODS: The study included 41 patients with COPD (33 male; mean age: 51 years) and 32 healthy controls. P wave dispersion was calculated as the difference between the maximum and minimum P wave duration in a 12-lead surface electrocardiography (ECG) recording. AEMD, defined as the time interval from the P wave onset on the ECG to the initiation of the late diastolic (Am) wave using a tissue Doppler examination, was measured from the lateral mitral annulus (LAEMD), septal annulus (SAEMD), and tricuspid lateral annulus (TAEMD). RESULTS: P wave dispersion was significantly longer in the COPD group than those in the controls (76±19 ms vs. 45±10 ms; p<0.001). All of the AEMD measurements demonstrated significant prolongation in patients with COPD (LAEMD: 74±9 ms vs. 64±11 ms; SAEMD: 66±10 ms vs. 57±12 ms; and TAEMD: 65±9 ms vs. 46±7 ms; p<0.001 for all). The only correlation with FEV1 was observed in the TAEMD values of the COPD group (rs: -401; p<0.009). CONCLUSION: Both P wave dispersion and AEMD parameters were significantly longer in COPD patients without any established structural or functional cardiac abnormalities, indicating an increased tendency for AF development, beginning from the initial stages of the disease.

The Prevalence of Fabry Disease Among Turkish Patients with Non-Obstructive Hypertrophic Cardiomyopathy: Insights from a Screening Study

Aims: Fabry disease is an X-linked lysosomal storage disorder due to a deficiency of the α-galactosidase A enzyme. Cardiac involvement is present in over 60% of adult cases of Fabry disease. Hypertrophic cardiomyopathy without left ventricular outflow tract obstruction is the most common phenotype. The aim of the study was to screen adult patients with hypertrophic cardiomyopathy without left ventricular outflow tract. Methods: A total of 80 patients between the ages of 18 and 65 years old, were referred to a tertiary center for trans-thoracic echocardiography for various clinical indications. They were investigated for the presence of idiopathic left ventricular hypertrophy without resting or dynamic left ventricular outflow tract obstruction. Plasma α-galactosidase A enzyme activity and α-galactosidase GLA gene mutations were investigated. Results: The mean age was 41.5±12.7 years and 66.25% of patients were males. The mean echocardiographic parameters were as follows: left ventricular ejection fraction 60.7±7.4%, interventricular septum thickness 18.2±4.4 mm, left ventricular posterior wall 13.5±2.1 mm, left ventricular end-diastolic diameter 47.4±6.2 mm, left ventricular end-systolic diameter 27.8±6.5 mm, and left ventricular mass index 171.05±48.5 g/m². Hemizygous mutations associated with Fabry disease were detected in two male patients (2.50% of the screened population): NM_000169.2:c.334C>T(p.Arg112Cys), NM_000169.2:c.902G>A(p.Arg301Gln). Conclusion: Fabry disease should be considered in the differential diagnosis in a highly selected patient population with unexplained left ventricular hypertrophy. The cardiologist may play an important role in the screening and diagnosis of the disease.

[Sexual life in elderly patients with cardiovascular disease]. / Yasli kardiyovasküler hastalarda cinsel yasam.

Sexual activity is an important component of patient and partner quality of life for men and women with cardiovascular disease, including many elderly patients. Older adults desire sexual intimacy when there is a partner and a health status that allows sexual relationships. Older individuals desire to love and enjoy sexual activity in relation to personal circumstances, and when health status allows them to experience close relations, most often within marriage especially in our country. Normal changes occur in the phases of sexual cycle with aging, male erectile dysfunction and female sexual dysfunction increase with age. Elderly patients are often affected by multiple organic diseases which can interfere with sexual function especially cardiovascular disease. Treating those disorders or modifying lifestyle-related risk factors may help prevent sexual dysfunction in the elderly. Sexuality is important for older adults and physicians should give their patient's opportunity to voice their concerns with sexual function and offer them alternatives for evaluation and treatment. Asking about sexual health remains difficult or embarrassing for many physicians; in addition, many patients find it difficult to raise sexual issues with their doctor.

Cardioprotective effects of zofenopril, enalapril and valsartan against ischaemia/reperfusion injury as well as doxorubicin cardiotoxicity.

OBJECTIVE: The aim of this study is to compare possible protective effects of zofenopril, enalapril and valsartan against both ischaemia/reperfusion injury as well as acute doxorubicin cardiotoxicity. All three agents have never been compared in this setting before. METHODS AND RESULTS: Sixty-four male rats were divided into eight groups by computer-generated random numbers and each group included 8 rats. Groups 1, 2, 3 and 4, respectively, received 0.5 ml distilled water, 15 mg/kg/day zofenopril, 2 mg/kg/day enalapril, and 30 mg/kg/day valsartan intragastrically for 7 days. Groups 5, 6, 7, and 8 underwent the same procedures as groups 1, 2, 3 and 4. On the 7th day, groups 1-4 and groups 5-8, respectively, were injected with serum saline or 20 mg/kg doxorubicin intraperitoneally. On the 9th day, isolated rat hearts were perfused in the Langendorff perfusion system. At the end of each Langendorff experiment, the rat hearts were kept for histological analysis. Left ventricular systolic pressures were negatively affected by doxorubicin with ischaemia (group 5 initially: 61.4 +/- 13.6 mmHg--post-ischaemic (PI): 20.7 +/- 17.5 mmHg (P = 0.0002), group 6 initially: 63 +/- 18.2 mmHg--PI: 24.2 +/- 24.3 mmHg (P = 0.0135), group 7:82 +/- 26 mmHg--PI: 14.3 +/- 12.1 mmHg (P < 0.0001), group 8:73.1 +/- 27.8 mmHg--PI: 20.4 +/- 27.3 mmHg (P < 0.0001). The lowest troponin I levels (group 2: 0.3 +/- 0.2 ng/ml, group 6:0.2 +/- 0.1 ng/ml (P = 0.003) versus the groups' baseline value) were recorded in the groups of zofenopril in the coronary perfusate during post-ischaemic period. Light microscopic evaluation revealed marked cardiac damage with doxorubicin, since zofenopril treatment prevented a doxorubicin induced increase in the histopathological scores. CONCLUSIONS: In respect of our results zofenopril could be considered more effective than enalapril and valsartan in protecting against both ischaemia/reperfusion injury as well as doxorubicin induced-cardiotoxicity.

[Primary prevention of cardiovascular diseases with statins in women]. / Kadinlarda statinlerle kardiyovasküler hastaliklardan birincil korunma.

Cardiovascular disease is one of the leading causes of mortality and morbidity in postmenopausal women. Menopausal changes have been shown to be related with an atherogenic lipid profile. The efficiency of statins in reducing the incidence of cardiovascular diseases has been well-documented in a variety of randomized, placebo-controlled trials. This review outlines the effectiveness of statins both in cardiac events and in some noticeable indications in postmenopausal women.

Effect of seven different modalities of antihypertensive therapy on pulse pressure in patients with newly diagnosed stage I hypertension.

In this study, we investigated the effect of different antihypertensive agents on pulse pressure (PP). The study was designed in a prospective manner and patients were sequentially allocated to one of the seven different therapy groups, according to the order of enrollment (every first patient to group I, every second patient to group II, and etc). Patients in group I received 10 mg of lisinopril, in group II 10/6.25 mg of lisinopril/hydrochlorothiazide, in group III 80 mg of valsartan, in group IV 80/6.25 mg of valsartan/hydrochlorothiazide, in group V 5 mg of amlodipine, in group VI 1.25 mg of indapamide, and finally those in group VII received 50 mg of atenolol. The reduction in PP was more significant in patients receiving lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide, when compared with patients receiving indapamide, atenolol, and amlodipine (P < 0.05 for each group). Factors such as age, gender, and body mass index were not found to significantly influence the effectiveness of antihypertensive agents on PP. The reduction in PP was more apparent with lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide in diabetic patients, when compared with those without diabetes (P < 0.001, P < 0.05). And also patients on therapy with 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors had a greater reduction in PP with lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide (P < 0.001, P < 0.05).

[A survey of heart tumors: clinical and echocardiographic approach]. / Kalp tümörlerine genel bakis: Klinik ve ekokardiyografik yaklasim.

Heart tumors can be primary in origin, can develop from direct extension of a neighboring tumor or they can be the manifestation of metastasis of a distant tumor. Myxomas are the most frequently encountered primary benign cardiac tumors. Primary malignant tumors of the heart are rare, and they are mostly sarcomatous in structure. Secondary heart tumors constitute a wide spectrum, nevertheless they most frequently originate from lung cancer, breast cancer and hematological malignancies. Heart tumors may involve myocardium, endocardium, epicardium, pericardium, or any combination of the aforementioned layers. On the other hand, the usual site for metastasis to the heart is the pericardium. These tumors do not have a well- established classification. Clinical findings are usually non-specific and transient in nature and frequently present late in the disease process. Transthoracic and transesophageal echocardiography are the most widely used diagnostic modalities. Magnetic resonance imaging and computerized tomography may be helpful for selected cases. Surgery is the principal therapeutic option in benign tumors and when recurrences are not taken into account, they have favorable prognoses. Since surgical resection is usually incomplete in malignant tumors, therapy must be individualized for each patient; even with adjuvant chemotherapy, postoperative survival is usually short. Metastases to the heart are usually approached symptomatically except for exceptional cases.

Unusual case of aortic valve involvement in patient with Löffler's endomyocarditis: management, follow-up and short review of the literature.

Idiopathic hypereosinophilic syndrome (IHES) is an uncommon systemic disease which is characterised by blood eosinophilia and multiple clinical presentations. Cardiac involvement is the major cause of mortality and morbidity. Here we describe a 59-year-old man with symptoms of progressive dyspnea on exertion, and productive cough as an unusual case of Löffler endomyocarditis with a mass on the aortic valve which showed regression with treatment.

Relationship between insulin resistance and end-organ damage in white coat hypertension.

BACKGROUND: End-organ damage is seen in some patients suffering from white coat hypertension (WCH). It remains unclear which patients elude the risk of end-organ damage. A relationship between end-organ damage and insulin resistance was hypothesized. METHODS: This hypothesis was tested by comparing two groups of patients with WCH: those presenting with end-organ damage and those without end-organ damage. Both groups were tested for the presence of insulin resistance. The study was conducted in the outpatient clinics of the Internal and Family Medicine Departments of Cerrahpasa Medical School, Istanbul University. In this study 290 patients were screened for WCH, of which 75 were included in the study. The WCH was defined as an office blood pressure (BP) >/=140/90 mm Hg and mean daytime BP <135/85 mm Hg. The patients were divided into two groups according to the presence of end-organ damage. All patients received 24-h ambulatory BP monitoring. End-organ damage was diagnosed by revealing left ventricular hypertrophy on echocardiographic examination or retinopathy with fundoscopic examination. The homeostasis model assessment insulin resistance index (HOMA-IR) was used to assess insulin resistance. RESULTS: Among 75 patients with WCH, hypertensive retinopathy was detected in 25 patients, left ventricular hypertrophy in 15 patients, and both retinopathy and left ventricular hypertrophy simultanously in 6 patients. There were no significant differences between the groups regarding age, sex, lipid profile, and glucose levels. The HOMA-IR values in the patients with WCH and end-organ damage (4.2 +/- 1.7) were significantly higher (P < .0001) than those determined in patients with WCH but without end-organ damage (2.6 +/- 1.8). In patients with WCH with HOMA-IR values above 3 the risk of end-organ damage was found to be higher. CONCLUSIONS: A possible relationship between end-organ damage and insulin resistance in patients with WCH exists.