RESUMO
First-degree Atrioventricular (AV) block can lead to symptoms of heart failure, due to AV dyssynchrony. We report a case of 40-year-old male with symptomatic 2:1 AV block with intermittent first-degree AV block who was implanted with dual chamber pacemaker with conduction system pacing (CSP). With conventional programming of managed ventricular pacing (MVP) and long AV delays, patient developed dyspnea due to diastolic mitral regurgitation because of AV dyssynchrony. Hence, AV delay optimization was done, and the patient became asymptomatic with atrial sensing and 100 % ventricular pacing. This report emphasizes the importance of AV delay optimization in CSP for symptomatic benefit.
RESUMO
OBJECTIVE: To find the serum hsCRP (high sensitive C reactive protein) levels in type 2 Diabetes Mellitus (DM) patients and compare its level between type 2 DM patients and healthy control subjects. To find the relationship of hsCRP levels in type 2 DM with and without vascular complications. To find the correlation of hsCRP with HbA1c and duration of type 2 DM among cases and to find the optimum cut-off value for hsCRP among type 2 DM patients. METHODS: The study was conducted on type 2 DM patients with or without microvascular or macrovascular complications and nondiabetic healthy controls from April 2017 to July 2018. Fasting plasma glucose, postprandial plasma glucose, HbA1C, and hsCRP were estimated. Duration of diabetes was noted. SPSS for Windows version22 software was used for statistical analysis. Chi2 or Fisher's exact test was applied to compare frequency distribution. The student t-test was applied to compare two independent means. Test of normality was performed before applying the statistical test for significance. The area under the curve (AUC) and sensitivity and specificity of HSCRP levels in DM2 at various cut-off values were calculated. RESULTS: The mean age of the patients 53.46±12.01 years with 49% among the age group 45 - 64 years and 62% were females. The mean value of hsCRP among diabetic subjects comes out to be 4.06 ± 2.59 mg/l, while among healthy controls is 0.93 ± 0.81 mg/l (p<0.0001). The mean duration of diabetes in our study is 6.90 ± 5.89 years with maximum cases had duration of diabetes between 1-5 years and a positive linear correlation with hsCRP (r=0.20; p=0.044). A positive linear correlation between hsCRP and HBA1C is found (r = 0.0507; p<0.0001). Among 100 cases, 71 cases were with overt complications of diabetes as either microvascular or macrovascular complications. Of these 71 cases with overt complications, 61.97% cases were with high risk levels of hsCRP (>3.0 mg/l). The mean value of hsCRP among cases with complications is 4.45 ± 2.74 mg/l while among cases without complications is 3.11 ± 1.89 mg/l (p=0.0176). The most common complication associated among the cases are microvascular complication in the form of diabetic retinopathy with mean hsCRP 4.61± 2.88 while the mean hsCRP was highest among the cases associated with cardiovascular complication as 5.37±3.10. In this study on 100 participants with type 2 diabetes mellitus, the maximum value of sensitivity of 89.00 % and specificity of 87.00% is found in diabetes at the best cut-off of serum hsCRP levels greater than 1.21 mg/L. CONCLUSION: hsCRP levels were high in type 2 diabetes mellitus with higher risk levels associated with macrovascular complications compared to microvascular complications. The levels of hsCRP correlated with duration of diabetes and HbA1c. Routine screening for future cardiovascular events in diabetes patients can be done with best cut-off value of hsCRP at 1.21 mg/L.
