Previous gestational diabetes history is associated with impaired coronary flow reserve.

BACKGROUND: Gestational diabetes mellitus (GDM) is a prediabetic state that is known to increase the risk of cardiovascular diseases. We have investigated coronary flow velocity reserve (CFVR) and epicardial fat thickness (EFT), and left ventricular diastolic function in patients with a history of previous GDM (p-GDM). METHODS: Ninety-three women with GDM history and 95 healthy women without GDM history were recruited. We used transthoracic Doppler echocardiography to assess CFVR, EFT, and left ventricular diastolic function. Insulin resistance of each subject was assessed with homeostasis model assessment insulin resistance (HOMA-IR). Hemoglobin A1c and high-sensitivity C-reactive protein (hsCRP) were also measured in all patients. RESULTS: CFVR values were significantly lower (2.34 ± 0.39 versus 2.80 ± 0.24, p < 0.001) and EFT values were significantly higher in patients with p-GDM than the control group (5.5 ± 1.3 versus 4.3 ± 1.1, p < 0.001). E/E' ratio (7.21 ± 1.77 versus 6.53 ± 1.38, p = 0.003), hemoglobin A1c (5.2 ± 0.4 and 5.0 ± 0.3, p = 0.001), HOMA-IR (2.8 ± 1.4 versus 1.7 ± 0.9, p = 0.04), and hsCRP levels were significantly higher in the p-GDM group than the control group. Multivariate analysis revealed that gestational diabetes history is independently associated with CFVR. CONCLUSION: Women with a GDM history may be at more risk regarding coronary microvascular dysfunction compared to the healthy ones.

Does gestational diabetes history increase epicardial fat and carotid intima media thickness?

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as glucose intolerance that has begun during pregnancy. Recent studies have proven that development of atherosclerosis may be established in this population even without presence of type 2 diabetes. For assessment of atherosclerosis, epicardial fat thickness (EFT) is recently being used as a surrogate marker. In this study, we aimed to prove that women with GDM history are more inclined to have higher EFT levels than women without GDM history. METHODS: Sixty-two patients with previous GDM and 33 age- and sex-matched controls were allocated. Epicardial fat thicknesses of the subjects were measured with transthorasic echocardiography and carotid intima media thickness (c-IMT) was measured with ultrasound. Insulin resistance (IR) of each subject was assessed with Homeostasis model of assessment-insulin resistance (HOMA-IR). RESULTS: Carotid IMT and EFT were significantly higher in previous GDM group than controls. Serum gamma-glutamyl transferase (GGT), uric acid, and high-sensitivity C-reactive protein (hs-CRP) levels were also found significantly higher in the patients with previous GDM as compared to the controls. We observed that carotid IMT (ß = 310, P = 0.003), total cholesterol (ß = 315, P = 0.002), BMI (ß = 308, P = 0.002), HbA1c (ß = 227, P = 0.018), and HOMA-IR (ß = 184, P = 0.049) were independently correlated with EFT. CONCLUSIONS: Although the number of patients included in this study is limited, high EFT results may indicate presence of atherosclerosis in women with previous GDM.

QT interval changes and reversibility of QT dispersion in patients with acute pancreatitis.

BACKGROUND/AIMS: QT dispersion is a sign of heterogeneity of ventricular myocardial wall and is associated with cardiac mortality and morbidity. Data regarding with the persistence of QT interval changes in cases with acute pancreatitis (AP) that required clinical follow-up, are insufficient. Therefore, in this study, we aimed to evaluate the QT interval changes during attack and after remission of the disease, in cases with AP. MATERIALS AND METHODS: The cases admitted to the Gastroenterohepatology Clinic with the diagnosis of AP were included into the study. Ranson's score parameters, electrocardiography and echocardiography of all patients included into the study were evaluated. Electrocardiographic changes were evaluated two times, during attack and after remission of the disease. RESULTS: A total of 134 subjects (F/M:54/80, 41/59%) diagnosed as AP were included into the study. Seventy two (54%) of the AP cases included into the study were biliary, 32 (24%) were alcohol dependant, 19 (14%) were idiopathic, 9 (7%) were hyperlipidemic and 2 (1%) were ERCP related cases. Mean age of the patents was 57.7±15 years old (range: 19-82 years old) and mean Ranson's score was 3.8±1.9 (range: 1-7), according to the numerical scoring system. We compared QT interval changes during the attack and after the remission of AP and found significant increase in QT dispersion levels during acute attack of AP (p<0,001). CONCLUSION: The most common electrocardiographic changes in AP patients are QT interval changes including QT dispersion. QT dispersion which was emerged during the attack recovered after the remission of the disease.

Left atrial remodeling in acute anterior myocardial infarction.

BACKGROUND: Our goal in this study was to examine the changes in the left atrial functions over a period of 3 months by using left atrial volume measurements in patients with anterior myocardial infarction (MI). METHODS AND RESULTS: Seventy-three patients with anterior MI who consulted our hospital in the first 12 hours starting from the onset of the chest pain and who exhibited ST elevation were enrolled in the study. The left atrial functions of the patients were evaluated by transthoracic echocardiography for a total number of four times; first at the time of the visit to the hospital, then in the first week, and then in the first and third months. Eight (10.95%) of the 73 patients included in the study died during the follow-up. The remaining 65 patients completed the 3-month study period. Of these 65 patients, primary percutaneous transluminal coronary angioplasty (PTCA) was performed for 24 (36.9%) patients and thrombolytic therapy was given to 13 (20%), whereas 28 (43.1%) patients were given only medical treatment. Left atrium (LA) maximum transverse diameter, LA maximum, minimum, and presystolic volume, LA active emptying volume and fraction were found to increase significantly in comparison to baseline detected for this parameter in the first and third months (P < 0.001). However, LA passive emptying volume and fraction was found to decrease significantly in comparison to baseline detected for this parameter in the first and third months (P < 0.001). CONCLUSIONS: An increase in the diameter, volume, and dimensions of LA during atrial remodeling was detected. LA passive emptying fraction was found to decrease, whereas atrial active emptying function was found to increase to compensate for this change.