Independent predictor factors of supine tachycardia in patients with type 2 diabetes mellitus.

INTRODUCTION: Supine tachycardia, frequently encountered in diabetic patients, is usually considered as an isolated diabetic complication in cardiac autonomic neuropathy. The objective of this study was to determine independent predictor factors of supine tachycardia among the clinical characteristics of type 2 diabetes mellitus. METHODS: This prospective study included type 2 diabetic patients. Supine tachycardia was considered as 10 minutes resting heart rate equal or higher than 80 beats/minutes. According to presence or not of supine tachycardia, two groups were identified: tachycardia diabetic patients and none tachycardia diabetic patients. Cardiovascular autonomic tests: deep breathing, hand-grip, and mental stress tests and blood tests were performed in all patients. Statistical analysis was done using the Student's t-test, and univariate and multivariate logistic regression analysis. RESULTS: We included 91 patients. The vagal response measured by the deep breathing test was 24.5 ± 5.7% in tachycardia diabetic patients vs 35.6 ± 6.8% in none tachycardia diabetic patients (P=0.007). The odds of supine tachycardia increased with serum creatinine (OR=1.350, 95% CI: 1.065-1.712, P=0.013) and serum uric acid levels (OR=1.034, 95% CI: 1.005-1.064, P=0.02) respectively, in diabetic patients. The prevalence of moderate renal failure was 45.5% in tachycardia diabetic patients vs. 21.6% in none tachycardia diabetic patients (P=0.034). CONCLUSION: A high frequency of supine tachycardia in type 2 diabetic patients was significantly related with an impairment of the parasympathetic nervous system but other independent predictor factors were associated to the occurrence of this supine tachycardia, such as higher levels of serum creatinine and uric acid and moderate renal failure.

Kinetics of orthostatic blood pressure in primary hypertension.

BACKGROUND: Primary Hypertension (HT) is the most prevalent cardiovascular disorder worldwide and is accompanied by significant morbidity and mortality. OBJECTIVES: The present study aimed to investigate the kinetics of orthostatic Blood Pressure (BP) in primary hypertensive patients during the change from supine position to standing position as well as during the standing position using the Orthostatic Test (OT). PATIENTS AND METHODS: This prospective study included a group of 107 primary hypertensive patients (mean age: 55.82 ± 11.35 years, ranging from 39 to 80 years). Orthostatic systolic BP (Ortho SBP) was recorded for 10 minutes at the rhythm of 3 measurements per minute and was compared to the values of supine systolic preorthostatic (Preortho SBP). According to the changes in Ortho SBP, three subgroups of primary hypertensive patients were selected as follows: Subgroup A: Ortho SBP was higher than mean Preortho SBP by 10 mmHg or more. Subgroup B: Ortho SBP was lower than mean Preortho SBP by 20 mmHg or more. Subgroup C: -20 mmHg < (Ortho SBP - Preortho SBP) < + 10 mmHg. The kinetics of each group was then recorded. RESULTS: In this study, the prevalence of subgroups A, B, and C was 27.1%, 15.9%, and 57.0%, respectively. In subgroup A, the adrenergic peripheral sympathetic alpha response was 20% during the OT. CONCLUSIONS: Hypertensives with very similar supine SBP behavior could exhibit widely different Ortho SBP. Thus, careful and effective treatment of hypertensives requires careful consideration and assessment of orthostatic BP.

Insights from magnetic resonance imaging of left ventricular non-compaction in adults of North African descent.

BACKGROUND: Left ventricular non-compaction (LVNC) is a recently recognized rare disorder. Magnetic resonance imaging (MRI) may help to clarify the uncertainties related to this genetic cardiomyopathy. Despite the fact that many articles have been published concerning the use of MRI in the study of LVNC, there is a lack of data describing the disease in the North African population. The aim of our study is to clarify MRI findings of LVNC in North African patients. METHODS: In our retrospective cohort, twelve patients (7 male, mean age 53 ± 8 years) underwent MRI for suspected LVNC. Correlations were investigated between the number of non-compacted segments per patient and left ventricular ejection fraction (LVEF), then between the number of non-compacted segments and left ventricular end diastolic diameter. The presence or absence of late gadolinium enhancement (LGE) was qualitatively determined for each left ventricular myocardial segment. RESULTS: Non-compaction was more commonly observed at the apex, the anterior and the lateral walls, especially on their apical and mid-cavity segments. 83% of patients had impaired LVEF. There was no correlation between the number of non-compacted segments per patient and LVEF (r = -0.361; p = 0.263), nor between the number of non-compacted segments per patient and left ventricular end diastolic diameter (r = 0.280; p = 0.377). LGE was observed in 22 left ventricular segments. No association was found between the pattern of fibrosis and non-compaction distribution (OR = 2.2, CI [0.91-5.55], p = 0.076). CONCLUSION: The distribution of LVNC in North African patients does not differ from other populations. Ventricular dysfunction is independent from the number of non-compacted segments. Myocardial fibrosis is not limited to non-compacted areas but can extend to compacted segments.

Use of magnetic resonance imaging in assessment of constrictive pericarditis: a Moroccan center experience.

BACKGROUND: The diagnosis of constrictive pericarditis continues to be a clinical challenge. Magnetic resonance imaging provides excellent visualization of the pericardium. The aim of our study is to clarify the contribution of this non invasive exploration in the diagnosis of constrictive pericarditis in our center. METHODS: we conducted a prospective study over a period of two years, since 2008, covering a series of patients (n = 11), mean age 44 ± 15 years, in whom constrictive pericarditis was suspected clinically and on transthoracic echocardiography. We studied its characteristics on magnetic resonance imaging. RESULTS: Magnetic resonance imaging confirmed the diagnosis showing pericardial thickening in all cases, measuring 8.2 +/- 2.6 mm on average, circumferential in 64%, and localized in 36%. The imaging data, particularly pericardial thickening and its topography, were confirmed by surgical exploration, and results were concordant in all cases. CONCLUSION: Magnetic resonance imaging is a powerful tool to establish constrictive pericarditis diagnosis.