Decreased heart rate recovery may predict a high SYNTAX score in patients with stable coronary artery disease

An impaired heart rate recovery (HRR) has been associated with increased risk of cardiovascular events, cardiovascular, and all‐cause mortality. However, the diagnostic ability of HRR for the presence and severity of coronary artery disease (CAD) has not been clearly elucidated. Our aim was to investigate the relationship between HRR and the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score in patients with stable CAD (SCAD). A total of 406 patients with an abnormal treadmill exercise test and ≥50% coronary stenosis on coronary angiography were included. The HRR was calculated by subtracting the HR in the first minute of the recovery period from the maximum HR during exercise. The SYNTAX score ≥23 was accepted as high. Correlation of HRR with SYNTAX score and independent predictors of high SYNTAX score were determined. A high SYNTAX score was present in 172 (42%) patients. Mean HRR was lower in patients with a high SYNTAX score (9.8 ± 4.5 vs. 21.3 ± 9, p < 0.001). The SYNTAX score was negatively correlated with HRR (r: -0.580, p < 0.001). In multivariate logistic regression analysis, peripheral arterial disease (OR: 13.3; 95% CI: 3.120–34.520; p < 0.001), decreased HRR (OR: 0.780; 95% CI: 0.674–0.902; p = 0.001), peak systolic blood pressure (OR: 1.054; 95% CI: 1.023–1.087; p = 0.001), and peak HR (OR: 0.950; 95% CI: 0.923–0.977; p < 0.001) were found to be independent predictors of a high SYNTAX score. Our results showed that HRR is significantly correlated with the SYNTAX score, and a decreased HRR is an independent predictor of a high SYNTAX score in patients with SCAD

Prevalence of Fibromyalgia Syndrome and Its Correlations with Arrhythmia in Patients with Palpitations

Objective: It is aimed to determine the prevalence of fibromyalgia syndrome (FMS) and its correlations with arrhythmia in patients with palpitations. Material and Methods: Sixty-two patients who underwent electrophysiological study (EPS) due to palpitation complaints in Cardiology department and 40 healthy controls were included in the study. The precise diagnosis of arrhythmia was established using EPS. All participants were screened for FMS using American College of Rheumatology 2010 Fibromyalgia diagnostic criteria. Clinical assessments included measurement of severity of pain, fatigue and morning fatigue with visual analog scale (VAS), functional status with Fibromyalgia Impact Questionnaire (FIQ), and anxiety/depression with Hospital Anxiety and Depression Scale (HAD). Results: FMS was diagnosed in 22 of the 62 patients (36%), and 4 of the 40 healthy controls (10%) (p 0.05). EPS+ patients with FMS had higher fatigue levels, HAD and FIQ scores than EPS− patients, although statistically insignificant. HV durations were statistically longer in the EPS− subgroup (p < 0.05) but other EPS data were similar. Conclusion: FMS frequency and HAD anxiety scores were found to be higher in patients with palpitation complaints. However, we found no association between arrhythmia, EPS parameters and FMS. In our clinical practice we should keep in mind to carry out assessments in terms of FMS in patients with palpitation

Znaczenie wskaźnika HATCH w prognozowaniu skutecznego powrotu do rytmu zatokowego po kardiowersji elektrycznej z powodu migotania przedsionków

Background: The HATCH score predicts the development of persistent and permanent atrial fibrillation (AF) one year after spontaneous or pharmacological conversion to sinus rhythm in patients with AF. However, it remains unknown whether HATCH score predicts short-term success of the procedure at early stages for patients who have undergone electrical cardioversion (EC) for AF. Aim: The present study evaluated whether HATCH score predicts short-term success of EC in patients with AF. Methods: The study included patients aged 18 years and over, who had undergone EC due to AF lasting less than 12 months, between December 2011 and October 2013. HATCH score was calculated for all patients. The acronym HATCH stands for Hypertension, Age (above 75 years), Transient ischaemic attack or stroke, Chronic obstructive pulmonary disease, and Heart failure. This scoring system awards two points for heart failure and transient ischaemic attack or stroke and one point for the remaining items. Results: The study included 227 patients and short-term EC was successful in 163 of the cases. The mean HATCH scores of the patients who had undergone successful or unsuccessful EC were 1.3 ± 1.4 and 2.9 ± 1.4, respectively (p &lt; 0.001). The area of the HATCH score under the curve in receiver operating characteristics analysis was (AUC) 0.792 (95% CI 0.727–0.857, p &lt; 0.001). A HATCH score of two and above yielded 77% sensitivity, 62% specificity, 56% positive predictive value, and 87% negative predictive value in predicting unsuccessful cardioversion. Conclusions: HATCH score is useful in predicting short-term success of EC at early stages for patients with AF, for whom the use of a rhythm-control strategy is planned.  Wstęp: Skala HATCH umożliwia prognozowanie rozwoju przetrwałego i utrwalonego migotania przedsionków (AF) w ciągu roku po samoistnym lub spowodowanym leczeniem powrocie do rytmu zatokowego u chorych z AF. Nie wiadomo jednak, czy wskaźnik HATCH jest przydatny w określaniu prawdopodobieństwa powodzenia zabiegu w perspektywie krótkoterminowej we wczesnym stadium u pacjentów, których poddano kardiowersji elektrycznej (EC) z powodu AF. Cel: Celem pracy była ocena, czy wskaźnik HATCH umożliwia prognozowanie wczesnego powodzenia EC u chorych z AF. Metody: Do badania włączono chorych w wieku 18 i starszych, których w okresie od grudnia 2011 r. do października 2013 r. poddano EC z powodu AF występującego krócej niż 12 miesięcy. U wszystkich chorych obliczono wskaźnik HATCH. Akronim HATCH oznacza Hypertension (nadciśnienie tętnicze), Age (wiek, powyżej 75 lat), Transient ischaemic attack or stroke (przemijające niedokrwienie mózgu lub udar mózgu), Chronic obstructive pulmonary disease (przewlekła obturacyjna choroba płuc) i Heart failure (niewydolność serca). W tej skali niewydolność serca i przemijające niedokrwienie mózgu lub udar oznaczają 2 punkty, natomiast obecność każdego z pozostałych elementów — 1 punkt. Wyniki: W badaniu uczestniczyło 227 chorych. W przypadku 163 z nich odnotowano powodzenie EC we wczesnym okresie po zabiegu. Średnie wartości w skali HATCH u chorych, u których przeprowadzono skuteczną i nieskuteczną EC, wynosiły odpowiednio 1,3 ± 1,4 i 2,9 ± 1,4 (p &lt; 0,001). Pole pod krzywą (AUC) wskaźnika HATCH w analizie krzywych ROC wynosiło 0,792 (95% CI 0,727–0,857; p &lt; 0,001). Wskaźnik HATCH ≥ 2 pozwalał na prognozowanie niepowodzenia kardiowersji, przy czym czułość tego parametru wynosiła 77%, swoistość — 62%, wartość predykcyjna dodatnia — 56%, a wartość predykcyjna ujemna — 87%. Wnioski: Skala HATCH jest przydatna w prognozowaniu szans powodzenia EC we wczesnym okresie po zabiegu u chorych z AF, u których planuje się zastosowanie strategii kontroli rytmu serca.

Evaluation of subclinical myocardial dysfunction using speckle tracking echocardiography in patients with radiographic and non-radiographic axial spondyloarthritis

Objective: To evaluate whether there is any difference between radiographic axial spondyloarthritis (r-axSpA), also termed ankylosing spondylitis (AS), and non-radiographic (nr-) axSpA, with respect to subclinial myocardial dysfunction using speckle tracking echocardiography (STE).Methods: This was a cross-sectional case control study. We included 72 patients with AS, 38 patients with nr-axSpA, and 56 age-matched healthy subjects. Patients with cardiac disease and cardiac risk factors affecting STE were excluded. The disease burden evaluated by the BASDAI, BASFI, BAS-G, and ASAS-HI scores were comparable in both the r- and nr-axSpA groups. A detailed echocardiographic examination including the M-mode, Doppler, and STE was applied to whole study population.Results: Duration of the disease, the use of an anti-TNF? agent, and CRP levels were higher in patients with AS. Although the AS, nr-axSpA, and control groups had similar ejection fraction values (59±5.2, 60±4.6, 60±4.6, respectively, and p=0.499), the global longitudinal peak systolic strain (GLS) (20.5±3.3, 21.1±3.5, and 22.3±2.4, respectively, and p<0.05) was different between the groups. In a post-hoc analysis, GLS was not different between the nr-axSpA and control groups, and it was significantly lower in patients with AS. In the univariate analysis, peripheral arthritis (p=0.035) and age (p=0.032) were correlated with GLS. A multivariate regression analysis demonstrated that peripheral arthritis (p=0.009) was the only independent GLS predictor.Conclusion: Subclinical myocardial dysfunction as assessed by GLS was present in AS, but not in nr-ax-SpA patients. Thus, GLS could be used as a differentiating factor between radiographic and nr-axSpA patients

Türkiye’deki kardiyologların mevcut “malpraktis” sistemi ve alternatif “malpraktis” sistem önerisi hakkındaki görüşleri

WOS: 000418480800009PubMed ID: 28990944Objective: Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists' diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system. Methods: The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message. Results: A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients. Conclusion: The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.Amaç: Kardiyologlar birçok riskli hastanın teşhis, tedavi ve girişimsel tedavisiyle uğraşmaktadırlar. Bu çalışmada Türkiye’deki mevcut “malpraktis” sisteminin kardiyologların tanı ve tedavi yaklaşımlarını nasıl etkilediğini ve önerdiğimiz yeni hasta tazminat sistemine yaklaşımlarını inceledik. Yöntemler: Bu kesitsel çalışmada Türk sağlık sisteminin farklı seviyelerinde çalışan kardiyologların mesleki risk algılarının uygulamalarına etkisini araştırma amacıyla 24 soruluk bir anketi asistan, uzman ve öğretim üyelerine elektronik posta, basılı evrak ve cep telefonu mesajı ile gönderildi. Bulgular: Ankete toplam 253 kardiyolog cevap verdi. Bunların 29’una (%11.6) geçmişte malpraktis talepleri için dava açılmıştı. Dava edilen kardiyologların 2’sine (%6.9) maddi tazminat talebinde bulunuldu, 1’ine (%3.4) ihmal nedeniyle hapis cezası verildi. Bunun yanında 132 (%52.8) kardiyolog “malpraktis” korkusu nedeni ile pratiklerinde değişiklik yaptıklarını bildirmekteydi. Ayrıca 232 (%92.8) kardiyolog önerdiğimiz hasta tazminat sistemini tercihe değer buluyordu. Kardiyologların %78.8’i bilgisayarlı tomografik anjiyografi (BTA) veya perfüzyon sintigrafisi, %71.6’sı koroner anjiyografi, %20 ’si stent implantasyonu, %83.2’si ise yüksek riskli hastalardan kaçınma kararlarında malpraktisten kaçınmanın etkili olduğu kanaatindeydi. Sonuç: “Malpraktis” korkusu kardiyologlarda yüksek oranlarda gereksiz test isteme, girişim yapma veya yüksek riskli hastalardan kaçınma eğilimi yaratmaktadır. Önerdiğimiz yeni “malpraktis” sistemi çalışmaya katılan kardiyologların büyük çoğunluğu tarafından mevcut sisteme tercih edilir bulunmuştur.Cardiovascular Academy Society of TurkeyThis work was supported by the Cardiovascular Academy Society of Turkey

Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population: ECHO‐DOP‐TR Trial

Aim Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. Methods Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. Results A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity andE/Aratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular laterale ', septale ', and septals ' were higher in younger subjects and in females.E/e ' ratio was increased progressively with advancing decades. Right ventriculare ' ands ' were decreased buta ' was increased with increasing age. Septale ' lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. TheE/e ' ratio greater than 15 (and also 13) was not found. Conclusion This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials