Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation / Efeito da septoplastia no desempenho miocárdico ventricular esquerdo em pacientes com desvio de septo nasal

Abstract Introduction: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. Objective: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. Methods: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. Results: Significantly higher left ventricular myocardial performance index (0.52 ± 0.06 vs. 0.41 ± 0.04, p < 0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p < 0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p < 0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p = 0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p = 0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p < 0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p =0.224). Conclusion: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Resumo Introdução: O desvio do septo nasal é a principal causa de obstrução das vias aéreas superiores. A obstrução crônica das vias aéreas superiores pode causar lesão miocárdica devido à hipóxia crônica. Os efeitos da septoplastia nas funções diastólica e sistólica do ventrículo esquerdo não são bem conhecidos. O índice de desempenho miocárdico é um parâmetro confiável e fácil de aplicar que reflete as funções cardíacas sistólica e diastólica. Objetivo: Investigar o efeito da septoplastia nasal no índice de desempenho miocárdico em pacientes com desvio de septo nasal. Método: Este estudo prospectivo consistiu em 50 pacientes consecutivos submetidos a septoplastia devido a desvio de septo nasal significativo sintomático em S ou C. A ecocardiogarfia transtorácica foi feita em todos os pacientes antes e 3 meses após a septoplastia. Os índices de desempenho miocárdico calculados foram comparados. Resultados: Um valor de indice de desempenho miocárdico ventricular esquerdo significantemente maior (0,52 ± 0,06 vs. 0,41 ± 0,04, p < 0,001), tempo mais longo de relaxamento isovolumétrico (95,0 ± 12,5 vs. 78,0 ± 8,6 ms, p < 0,001), tempo mais longo de contração isovolumétrica (45,5 ± 7,8 vs. 39,5 ± 8,6 ms, p < 0,001), tempo de desaceleração mais longo (184,3 ± 32,5 vs. 163,6 ± 45,4 ms, p = 0,004), maior razão de pico de velocidade transmitral precoce e tardia (E / A) (1,42 ± 0,4 vs. 1,16 ± 0,2, p = 0,006) e menor tempo de ejeção (270,1 ± 18,3 vs. 286,5 ± 25,8 ms, p < 0,001) foram observados antes da septoplastia quando comparados aos valores obtidos 3 meses após a septoplastia. A fração de ejeção sistólica do ventrículo esquerdo foi semelhante antes e após a septoplastia (63,8 ± 2,8% vs. 64,6 ± 3,2%, p = 0,224). Conclusão: A cirurgia de septoplastia não apenas reduz os sintomas em pacientes com desvio de septo nasal, mas também pode melhorar o desempenho ventricular esquerdo. Assim, o tratamento precoce do desvio de septo nasal é sugerido para prevenir possíveis eventos cardiovasculares futuros.

Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation.

INTRODUCTION: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. OBJECTIVE: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. METHODS: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. RESULTS: Significantly higher left ventricular myocardial performance index (0.52 ±â€¯0.06 vs. 0.41 ±â€¯0.04, p <  0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p <  0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p <  0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p =  0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p =  0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p <  0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p  = 0.224). CONCLUSION: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Plasma atherogenic indices are independent predictors of slow coronary flow.

BACKGROUND: Although the pathophysiology of coronary slow flow (CSF) has not been fully elucidated, emerging data increasingly support potential role for subclinical diffuse atherosclerosis in the etiology of CSF. We aimed to investigate relationship between atherogenic indices and CSF. METHODS: 130 patients with CSF diagnosed according to Thrombolysis in Myocardial Infarction (TIMI)-frame count (TFC) method and 130 controls who had normal coronary flow (NCF) were included in this retrospective study. Atherogenic indices (atherogenic index of plasma [AIP], Castelli risk indices I and II [CRI-I and II]) were calculated using conventional lipid parameters. RESULTS: The logistic regression analyses demonstrated that AIP (OR, 5.463; 95% confidence interval [CI], 1.357-21.991; p = 0.017) and CRI-II (OR, 1.624; 95% CI, 1.138-2.319; p = 0.008) were independent predictors of CSF. Receiver operating characteristic analysis showed that the optimal cutoff value to predict the occurrence of CSF was 0.66 for AIP (sensitivity, 59%; specificity, 73%; area under curve [AUC], 0.695; p < 0.001) and 3.27 for CRI-II (sensitivity, 60%; specificity, 79%; AUC, 0.726; p < 0.001). CONCLUSIONS: AIP and CRI-II levels were independent predictors of CSF. Prospective studies in larger cohorts of patients may elucidate the role of atherogenic dyslipidemia in the pathophysiology of CSF.

Evaluation of Tp-e interval, Tp-e/QT ratio and index of cardiac-electrophysiological balance in patients with tinnitus.

BACKGROUND: Tinnitus is a common auditory symptom. Dysfunction in the autonomic nervous system (ANS) is an essential part of the etiopathogenesis of tinnitus. ANS regulates heart rate and heart rhythm and can lead to ventricular repolarization changes, which can cause malignant ventricular arrhythmias. T wave peak-to-end T(p-e) interval and T(p-e)/QT ratio are known ventricular arrhythmia indexes, and the index of cardiac-electrophysiological balance (iCEB) is a novel index that can be used to predict the risk of malignant ventricular arrhythmia. The goal of the study was to investigate these ventricular arrhythmia indexes in patients with tinnitus. METHODS: The study population consisted of 240 patients with tinnitus and 240 healthy subjects. A standard 12-channel surface electrocardiogram was applied to both groups. T(p-e) interval, QT interval and QRS duration were determined. Corrected QT (QTc) was determined via Bazett's formula. To predict ventricular arrhythmia, iCEB (QT/QRS), T(p-e)/QT, corrected iCEB (QTc/QRS) and T(p-e)/QTc values were determined and compared between groups. RESULTS: Compared to the control group, QT (376.46 ± 36.54 vs 346.52 ± 24.51 ms), QTc (426.68 ± 24.68 vs 390.42 ± 24.04 ms), T(p-e) (75.86 ± 14.68 vs 62.42 ± 8.64 ms), T(p-e)/QT (0.201 ± 0.06 vs 0.180 ± 0.01) and T(p-e)/QTc (0.177 ± 0.06 vs 0.159 ± 0.02) were significantly higher in patients with tinnitus (p < 0.001 for all). QT/QRS (3.92 ± 0.68 vs 3.56 ± 0.32) and QTc/QRS (4.44 ± 1.03 vs 4.01 ± 0.64) were also significantly higher in patients with tinnitus (p = 0.018 and p = 0.008, respectively). In addition, significant positive correlations were found between T(p-e), T(p-e)/QTc ratio and disease duration (r = 0.792, p < 0.001; r = 0.500, p < 0.001, respectively). CONCLUSION: As a result, patients with tinnitus may have an increased risk of malignant ventricular arrhythmia.

Correction to: Evaluation of Index of Cardio-Electrophysiological Balance in Patients With Atrial Fibrillation on Antiarrhythmic-Drug Therapy.

[This corrects the article DOI: 10.14740/cr1185.].

Evaluation of Index of Cardio-Electrophysiological Balance in Patients With Atrial Fibrillation on Antiarrhythmic-Drug Therapy.

BACKGROUND: Index of cardio-electrophysiological balance (iCEB) has been described as a novel risk marker for predicting malignant ventricular arrhythmia. There remains limited evidence on the effects of amiodarone and propafenone used for sinus rhythm maintenance on iCEB in patients with atrial fibrillation (AF). The aim of this study was to evaluate iCEB in patients with AF on antiarrhythmic-drug therapy. METHODS: A total of 108 patients with AF (68 patients using amiodarone and 40 patients using propafenone) and 50 healthy subjects were included in the study. All groups underwent a standard 12-lead surface electrocardiogram. QRS duration, QT, T wave peak-to-end (Tp-e) intervals, iCEB (QT/QRS) and iCEBc (heart rate-corrected QT (QTc)/QRS) rates were calculated from the electrocardiogram and compared between groups. RESULTS: QT, Tp-e intervals and Tp-e/QT ratio were significantly longer in the amiodarone group than the propafenone and control groups (P < 0.001, for all). iCEB was similar in the amiodarone and control groups (4.4 ± 0.6 and 4.2 ± 0.4; P > 0.05), while iCEB values in the propafenone group were significantly lower than the amiodarone group and control groups (3.9 ± 0.5; P < 0.001). There was a significantly difference in iCEBc values among the amiodarone, control and propafenone groups (4.8 ± 0.6, 4.6 ± 0.4 and 4.3 ± 0.6; P < 0.001, respectively). CONCLUSIONS: In this study, higher iCEBc parameters were observed in patients using amiodarone, while iCEBc values were lowest among patients with AF using propafenone. Further studies are needed to determine whether these electrophysiological changes are associated with ventricular arrhythmias for patients with AF on antiarrhythmic-drug therapy.

Is dipyridamole useful in improving left ventricular systolic and diastolic function in patients with coronary slow flow?

BACKGROUND: Coronary slow flow (CSF) is an angiographic finding characterized by delayed opacification of epicardial coronary arteries without obstructive coronary disease. Previous studies have shown greater impairment of left ventricular (LV) systolic and diastolic function in patients with CSF. We aimed to examine the effect of dipyridamole on these functions. METHODS: Our study included 40 patients with CSF and 40 subjects with normal coronary arteries. Conventional echocardiography Doppler imaging (CDI) and tissue Doppler echocardiography imaging (TDI) were used to evaluate LV systolic and diastolic function before and 2 months after treatment with dipyridamole. RESULTS: Using CDI, we observed that early diastolic velocity (E) was significantly lower in patients with CSF, while late diastolic velocity (A), E/A ratio, isovolumic relaxation time, and myocardial performance index (MPI) were significantly higher in CSF patients compared with controls. Similarly, while early myocardial velocity (Em) was significantly lower, late myocardial velocity (Am), Em/Am ratio, isovolumic relaxation time (IRT), and MPI were significantly higher in CSF patients according to TDI measurements. Although there was no significant improvement in conventional Doppler parameters, there was significant normalization in tissue Doppler parameters after treatment with dipyridamole. CONCLUSION: Left ventricular systolic and diastolic function may be negatively affected by CSF. Dipyridamole may improve these functions, especially at the tissue level.

The effect of trimetazidine on ventricular repolarization indexes and left ventricular diastolic function in patients with coronary slow flow.

OBJECTIVES: Coronary slow flow (CSF) is associated with an increased incidence of adverse cardiovascular events. Previous studies have shown increases in P wave dispersion, QT dispersion, and the Tp-e/QT ratio, and a prolonged Tp-e interval, as well as left ventricular diastolic dysfunction in patients with CSF. We aimed to examine the effect of trimetazidine (TMZ) on these arrhythmia predictors and diastolic function of the left ventricle. METHODS: Our study included 30 patients with CSF and 30 individuals with normal coronary arteries. Twelve-lead ECG and echocardiography were used to evaluate patients before and 4 weeks after treatment with TMZ. RESULTS: Compared with the control group, corrected Pd (29.3±9.1 vs. 22.9±11.6, P=0.022), corrected QT dispersion (32.3±11.1 vs. 27.4±6.8, P=0.032), corrected Tp-e interval (103.1±18.6 vs. 93.4±11.5, P=0.017), and Tp-e/QT ratio (0.236±0.03 vs. 0.210±0.02, P=0.001) were significantly longer, and the E/A ratio (0.905±0.16 vs. 0.986±0.12, P=0.037) and the mean Em/Am ratio (0.918±0.19 vs. 1.095±0.20, P=0.006) were lower in patients with CSF. Corrected Pd, corrected Tp-e interval, and the Tp-e/QT ratio were significantly decreased (29.3±9.12 vs. 22.5±9.20, P=0.022; 97.3±16.6 vs. 88.2±16.4, P=0.031; 0.22±0.03 vs. 0.20±0.31, P=0.042 respectively), and left ventricle mitral annular mean Em/Am velocity was significantly increased (0.918±0.19 vs. 1.095±0.20, P=0.017) after treatment with TMZ. CONCLUSION: CSF may be related to increased P wave and QT dispersion, a prolonged Tp-e interval, and Tp-e/QT ratio, in addition to impaired diastolic filling. TMZ may be useful in restoring these findings.

Evaluation of serum prolidase activity in patients with slow coronary flow.

INTRODUCTION: Slow coronary flow (SCF) is described as the slow passage of contrast to distal coronaries despite anatomically normal coronary arteries. It has been shown that increased serum prolidase activity (SPA) correlates with collagen turnover. Increased collagen turnover might be associated with the development of atherosclerotic plaques. AIM: To investigate the relationship between serum prolidase activity and slow coronary flow. MATERIAL AND METHODS: This cross-sectional study included 40 SCF patients (mean age: 55.0 ±9.5 years, 20 females) and 40 controls (mean age: 53.9 ±8.2 years, 21 females) with normal coronary anatomy and normal coronary flow. The Thrombolysis in Myocardial Infarction (TIMI) frame-count (TFC) method was used for SCF diagnosis. Serum prolidase activity was measured spectrophotometrically, and the relevant parameters were compared between the groups. RESULTS: There were no statistically significant differences between the SCF and control groups in terms of basic demographic, clinical, and laboratory data. However, the SPA was significantly higher in the SCF group compared to the control (702.7 ±13.8 and 683.9 ±13.2 respectively, p<0.001). Serum prolidase activity was significantly correlated with the mean TFC (r=0.463, p<0.001). The overall findings of this study support the predictive accuracy of the serum prolidase activity in our cohort, with a statistically significant ROC value of 681.3. CONCLUSIONS: Our study showed that SPA was increased in SCF patients. The activity of this enzyme was significantly correlated with the mean TFC.

Negative effects of acute sleep deprivation on left ventricular functions and cardiac repolarization in healthy young adults.

BACKGROUND: Sleep deprivation (SD) is associated with an increased incidence of adverse cardiovascular events, we aimed to determine the impact of acute SD on structural and functional alterations of the left ventricle (LV) and on electrocardiogram (ECG) markers including T wave peak-to-end interval (TpTe), QT interval, and TpTe/QT ratio in healthy subjects after a night of SD. METHODS: The study population consisted of 40 healthy young adults (19 males, 21 females; mean age: 28.2 ± 3.86 years). Echocardiographic images and ECGs were obtained from the participants after a night of regular sleep (RS) and SD. The average sleep time of the subjects was 6.67 ± 1.76 hours during RS and 1.25 ± 0.74 hours during a night of SD. RESULTS: The myocardial performance index, isovolumic relaxation time, and deceleration time values were significantly higher after SD. In addition, the corrected TpTe interval, corrected QT interval (QTc) max, and TpTe/QT ratio were significantly increased after a night of SD when compared with a night of RS (78.5 ± 6.8 ms vs 70.7 ± 7.6 ms, P < 0.001; 407.5 ± 18.6 ms vs 395.07 ± 21.3 ms, P = 0.001; and 0.189 ± 0.014 ms vs 0. 0.179 ± 0.016 ms, P < 0.001, respectively). However, subjects had similar QTp interval values (defined as beginning of the QRS complex to peak of the T wave) after a night of SD as a night of RS (294.6 ± 19.0 vs 291.9 ± 18.5, P = 233). CONCLUSION: Our crossover study revealed the presence of subclinical LV diastolic functional changes and increased QT intervals, TpTe intervals, and TpTe/QT ratios in healthy young adults after one night SD. Therefore, the increased QT interval occurred secondary to the increased TpTe interval in this population.

Coronary sinus dilatation is a sign of impaired right ventricular function in patients with heart failure.

OBJECTIVE: The coronary sinus (CS) has been largely ignored by physicians due to a lack of adequate data about the importance of CS enlargement in patients with heart failure (HF). We aimed to assess whether CS dilatation develops in patients with HF and to demonstrate its relation with global myocardial function of the right ventricle (RV). METHODS: In this cross-sectional study, 45 healthy subjects and 95 HF patients exhibiting left ventricular systolic dysfunction on echocardiographic examination (EF <45%) secondary to ischemic (n=56) or idiopathic dilated cardiomyopathy (DCM) (n=39) were enrolled. Patients with severe renal dysfunction and/or valve disease were excluded. CS was measured by echocardiography from the posterior atrioventricular groove in the apical four-chamber view. The RV myocardial performance index (MPI), which reflects both systolic and diastolic function of the ventricle, was detected using tissue Doppler imaging, and patients with an RV MPI >0.55 were defined as having impaired RV myocardial function. ANOVA, Kruskal-Wallis, Pearson's correlation, and multivariate logistic regression analyses were used for the statistical analysis. RESULTS: The CS and RV MPI values were significantly greater both in patients with ischemic and idiopathic DCM than in controls (8.79±1.7 mm and 8.33±2.1 mm vs. 5.74±0.6 mm, and 0.64±0.07 and 0.62±0.08 vs. 0.43±0.02; p<0.001 for both, respectively). For the prediction of HF patients with impaired RV function, the cut-off value for the diameter of the CS was 7.35 mm, with a sensitivity of 83% and a specificity of 79%. CONCLUSION: The CS diameter can be used as a novel echocardiographic marker that provides information about impaired RV function in patients with HF.

Aripiprazole induced non-cardiogenic pulmonary edema: a case report.

Aripiprazole is a second-generation antipsychotic drug with partial dopamine agonistic activity. Although the adverse cardiovascular effects of both typical and atypical antipsychotics are well known, similar data on aripiprazole, which was recently introduced, are scarce. Herein we report a 35-year-old female that presented to our emergency department with non-cardiogenic pulmonary edema. Chest X-ray and thoracic CT showed pulmonary edema and bilateral pleural effusion. Anamnesis showed that she had been taking sertraline 200 mg d-1 for obsessive-compulsive disorder for a long time and that aripiprazole10 mg d-1 was added for augmentation 2 months prior to presentation. We think that the CYP 2D6 inhibitor sertraline might have played a role in increasing the plasma concentration and toxicity of aripiprazole in the presented patient.

Neutrophil to lymphocyte ratio predicts poor functional capacity in patients with heart failure.

OBJECTIVES: We aimed to assess the relationship between neutrophil to lymphocyte ratio (N/L ratio) and functional capacity (FC) of patients with compensated heart failure (CHF). STUDY DESIGN: A total of 94 consecutive CHF patients and age-gender matched 70 subjects with normal echocardiographic examination were enrolled. Peripheral venous blood samples were drawn before echocardiography examination and treadmill test in all study population. The treadmill test based on modified Bruce protocol was used to determine the functional status of CHF patients. Poor FC was defined as <5 metabolic equivalant (MET) in the exercise test. Afterwards, patients with CHF were divided into two groups with respect to the top and bottom 3 of the N/L ratio. RESULTS: FC (3.2 ± 2.05 MET vs. 6.1 ± 2.04 MET, p<0.001), ejection fraction (%31.5 ± 7.64 vs. %34.8 ± 6.82, p=0.028) were found to be lower and N-terminal pro-brain natriuretic peptide (NT-proBNP) level (3360 ± 2742 pg/dl vs. 1613 ± 1334 pg/dl, p<0.001) pulmonary artery pressure (46.3 ± 11.50 mmHg vs. 41.5 ± 9.45 mmHg, p=0.049), left atrial diameters (4.6 ± 0.52 cm vs. 4.3 ± 0.43 cm, p=0.005), E/Ea ratio (12.2 ± 4.37 vs. 9.2 ± 3.20, p<0.001) were found to be higher in CHF patients with an N/L ratio >3 than with an N/L ratio <3. The N/L ratio, and log-NT-proBNP level were determined to be a predictive factor of poor FC (odds ratio [OR]=3.085, 95% confidence interval [CI]= 1.520-6.260, p=0.002 and OR=1.585, 95% CI=1.201-2.091, p=0.001, respectively). A cut-off point of 2.74 for the N/L ratio had 79.4% sensitivity and 80% specificity in predicting poor FC. CONCLUSION: N/L ratio can be used to predict poor FC in patients with CHF.

[The effects of smokeless tobacco "Maras powder" and smoking on aortic elasticity in young adults]. / Genç eriskinlerde dumansiz tütün "Maras otu" ve sigaranin aort esnekligi üzerine etkileri.

OBJECTIVES: Stiffness index beta (SIB), aortic strain (AS) and distensibility (AD) are the parameters used to assess elasticity of the aorta, and can be measured by non-invasive method such as echocardiography. In this study, we aimed to analyse the effects of Maras powder and smoking on aortic stiffness by comparing young individuals. STUDY DESIGN: The study included 90 male subjects aged 18-40 years. 30 subjects were Maras powder users (mean age; 32±2), 30 were smokers (mean age: 28±2) and 30 were healthy volunteers (mean age: 29±2). After detailed physical examination, all subjects underwent transthoracic echocardiography. Systolic and diastolic diameters of the aorta were measured from the ascending aorta at modified parasternal long axis views by M-mode echocardiography. AS, AD, and SIB were calculated using standard formulae. Group parameters were then compared to each other. RESULTS: There was no significant difference between the groups in terms of demographic and clinical features, including blood pressures, lipid profile and serum creatinine (p>0.05). Although AS and AD were lower, and SIB was higher in the Maras powder and smoking groups compared to the control group, the difference between groups was not statistically significant (for AS: 17.61±2.22, 17.75±1.93, 18.48±2.02 respectively, for AD: 9.03±1.12, 9.14±0.96, 9.9±1.12, respectively, for SIB: 2.72±1.07, 2.59±0.88, 2.37±0.71 respectively, for all p>0.05). CONCLUSION: Our study revealed that smoking and Maras powder did not lead to a significant change in elasticity of the aorta in individuals under the age of 40.

Heart rate variability in familial Mediterranean fever patients.

OBJECTIVE: Familial Mediterranean fever (FMF) is an autosomal recessive autoimmune disease, presenting with the attacks of fever and inflammation of serous membranes. One of the leading causes of death in autoimmune rheumatologic diseases is cardiovascular events. The purpose of this study is to evaluate the effects of FMF on the autonomic nerve and cardiovascular systems by measuring the indices of heart rate variability (HRV). MATERIAL AND METHODS: Thirty FMF patients and the same number of healthy volunteers were enrolled to the study. Standard deviation of all R-R intervals (SDNN), the square root of the sum of the square of the differences between successive R-R intervals (RMSSD), standard deviation of 5-minute mean values of R-R interval (SDANN), low frequency (LF), and high frequency (HF) were measured. RESULTS: Time domain indices (SDNN, SDANN, and RMSSD) were: 124.67±40.79, 129.87±36.43 (p=0.605); 11.43±38.41, 11.23±38.98 (p=0.984); and 33.43±17.39, 38.17±12.8 (p=0.235) for FMF patients and controls, respectively, and similar in both groups. Frequency domain indices (HF, LF, and LF/HF) were: 290.41±290.25, 322.20±222.54 (p=0.639); 596.16±334.07, 805.80±471.00 (p=0.051); and 3.57±2.57, 3.05±1.40 (p=0.338) for FMF patients and controls, respectively, and similar in both groups. CONCLUSION: The HRV parameters were similar in both groups. However, studies including larger populations and using different methods are required to clarify if autonomic dysfunction exists in patients with FMF.

Relation of epicardial fat thickness with carotid intima-media thickness in patients with type 2 diabetes mellitus.

Aims. The aim of this study was to investigate the relationship of echocardiographic epicardial fat thickness (EFT) with carotid intima-media thickness (CIMT), in patients with type 2 diabetes mellitus (T2DM). Methods and Results. A total of 139 patients with T2DM (mean age 54.3 ± 9.2 and 49.6% male) and 40 age and sex-matched control subjects were evaluated. Echocardiographic EFT and ultrasonographic CIMT were measured in all subjects. Patients with T2DM had significantly increased EFT and CIMT than those of the controls (6.0 ± 1.5 mm versus 4.42 ± 1.0 mm, P < 0.001 and 0.76 ± 0.17 mm versus 0.57 ± 0.14 mm, P < 0.001, resp.). EFT was correlated with CIMT, waist circumference, BMI, age, duration of T2DM, HbA1c in the type 2 diabetic patients. Linear regression analysis showed that CIMT (ß = 3.52, t = 3.72, P < 0.001) and waist circumference (ß = 0.36, t = 2.26, P = 0.03) were found to be independent predictors of EFT. A cutoff high risk EFT value of 6.3 mm showed a sensitivity and specificity of 72.5% and 71.7%, respectively, for the prediction of subclinical atherosclerosis. Conclusion. We found that echocardiographic EFT was significantly higher in patients with T2DM. Our study also showed that EFT was strongly correlated with waist circumference and CIMT as being independent of sex.

Effects of slow coronary artery flow on P-wave dispersion and atrial electromechanical coupling.

AIM: Slow coronary flow (SCF) is characterized by angiographically normal coronary arteries with delayed opacification of the distal vasculature. The purpose of this study was to evaluate atrial electromechanical couplings and P-wave dispersion (Pd) reflecting intraatrial and interatrial conduction delays in SCF patients and the relationship between these parameters and Thrombolysis in Myocardial Infarction (TIMI) frame count. METHODS: Thirty-four patients with SCF and 40 controls were enrolled. From 12-lead surface electrocardiograms, Pd was calculated. Atrial electromechanical coupling (PA), intraatrial, and interatrial electromechanical delay were measured with tissue Doppler imaging. RESULTS: Maximum P-wave duration (Pmax) and Pd were higher in SCF patients than those of controls (109.2 +/- 9.3 vs 92.3 +/- 13.5 milliseconds; P < .0001 and 50.4 +/- 9.4 vs 34.4 +/- 8.9 milliseconds; P < .0001). Atrial electromechanical coupling at the left lateral mitral annulus (lateral PA), septal mitral annulus (septal PA), and right ventricular tricuspid annulus (RV PA) were significantly higher in SCF patients than controls (68.1 +/- 8.1 vs 52.6 +/- 7.3 milliseconds; P < .0001; 49.3 +/- 9.8 vs 38.2 +/- 5.3 milliseconds; P < .0001; 47.5 +/- 9.0 vs 37.6 +/- 4.6 milliseconds, P < .0001, respectively). Interatrial electromechanical delay (lateral PA - RV PA) was significantly longer in SCF patients (20.6 +/- 9.1 vs 15.0 +/- 6.0 milliseconds; P = .0002). A positive correlation was detected between circumflex coronary artery TIMI frame count and interatrial electromechanical delay (r = 0.45; P < .01). CONCLUSIONS: Prolongation of interatrial electromechanical delay, Pmax, and Pd suggest that SCF might contribute to development of adverse functional and electrophysiologic atrial characteristics in these patients.