Korelacja odsetka hemoglobiny glikowanej z ciężkością choroby wieńcowej występująca u młodych osób niezależnie od tradycyjnych czynników ryzyka

Introduction: In this study, we aimed to investigate the relationship between glycated haemoglobin (HbA1c) levels and the severity of coronary artery disease (CAD) in < 40 years old patients. Material and methods: The study population consisted of 211 premature coronary atherosclerotic patients (pCAP) (aged 36.4 &#177; 2.5 years) and 160 control subjects (36.4 &#177; 2.4 years). The severity of CAD was evaluated by the Gensini scoring system. HbA1c levels and the other basic biochemical parameters were analysed, and relations with severity of CAD were evaluated. Results: There were statistically significant differences in serum HbA1c levels between the two groups (pCAP = 6.1 &#177; 1.8%, control = 4.7 &#177; 1.2%, p < 0.001). HbA1c levels significantly positively correlated with the Gensini score in pCAP (r = 0.662, p < 0.001). In linear multivariate regression analysis (including age, sex, HbA1c, smoking, diabetes mellitus and hypertension as dependent parameters), only HbA1c was found to be an independent risk factor for the presence of severe CAD (Beta = 0.374, p < 0.001). In ROC curve analysis, the optimal cut-off value of HbA1c to predict severe CAD was 6.52%, with 74.4% sensitivity and 75.1% specificity (area under the curve 0.781, 95% confidence interval 0.661 to 0.901, p < 0.001). Conclusions: HbA1c levels were found to be correlated with the Gensini score in pCAP with and without diabetes. In this respect, glucose metabolism abnormalities, indicated by HbA1c, may play an important role in premature CAD. (Endokrynol Pol 2012; 63 (5): 367-371)Wstęp: Niniejsze badanie przeprowadzono w celu oceny zależności między odsetkiem hemoglobiny glikowanej (HbA1c) a ciężkością choroby wieńcowej (CAD) u chorych w wieku < 40 lat. Materiał i metody: Badana populacja składała się z 211 chorych z przedwczesną miażdżycą tętnic wieńcowych (pCAP) (w wieku 36,4 &#177; 2,5 roku) i 160 osób stanowiących grupę kontrolną (36,4 &#177; 2,4 roku). Ciężkość CAD określano na podstawie wartości wskaźnika Gensiniego. Przeanalizowano odsetek HbA1c oraz inne wyjściowe parametry biochemiczne i oceniono ich zależności z ciężkością CAD. Wyniki: Stwierdzono statystycznie istotne różnice między grupami w zakresie stężeń HbA1c w surowicy (pCAP = 6,1 &#177; 1,8%, grupa kontrolna = 4,7 &#177; 1,2%; p < 0,001). Wartości HbA1c były istotnie skorelowane z wartościami wskaźnika Gensiniego u chorych z pCAP (r = 0,662; p < 0,001). W wieloczynnikowej analizie regresji liniowej (w której uwzględniono wiek, płeć, stężenie HbA1c, palenie tytoniu, cukrzycę i nadciśnienie tętnicze jako zmienne zależne) jedynie stężenie HbA1c okazało się niezależnym czynnikiem ryzyka wskazującym na występowanie ciężkiej CAD (Beta = 0,374; p < 0,001). Jak wykazano w analizie krzywych ROC, optymalny punkt odcięcia wartości HbA1c pozwalający prognozować ciężką CAD wynosi 6,52%, przy czułości metody 74,4% i swoistości 75,1% (pole pod krzywą 0,781, 95-proc. przedział ufności 0,661&#8211;0,901; p < 0,001). Wnioski: U osób z pCAP, zarówno chorych na cukrzycę, jak i bez tej choroby, stwierdzono korelacje między wartościami HbA1c i wskaźnikiem Gensiniego. Jak wynika z powyższych obserwacji, zaburzenia metabolizmu glukozy, których wyznacznikiem jest odsetek HbA1c, mogą odgrywać ważną rolę w rozwoju przedwczesnej CAD. (Endokrynol Pol 2012; 63 (5): 367-371

The effect of metabolic syndrome on heart rate turbulence in non-diabetic patients

Background: Metabolic syndrome (MetS), which includes a cluster of risk factors, is being increasingly recognized as a new risk factor for cardiovascular disease. Heart rate turbulence (HRT) is a Holter-based non-invasive method for detecting cardiac autonomic imbalance and is an independent, powerful predictor of cardiac arrhythmias and sudden cardiac death in different patient groups. This study evaluated the effect of MetS on HRT in non-diabetic patients. Methods: This study included 80 non-diabetic MetS subjects and 50 healthy subjects. All 130 subjects underwent a 24-h ambulatory Holter electrocardiogram recording. Two indices of HRT were analyzed: turbulence onset (TO) and turbulence slope (TS). HRT values were classified into 3 categories for risk stratification: 1) Category 0, TO and TS were normal; 2) Category 1, either TO or TS was abnormal; 3) Category 2, both TO and TS were abnormal. Results: When we compared MetS rates in the HRT risk stratification groups, there were significant differences for all groups as compared with the controls (Category 0 = MetS 28.8%, n = 15, Control 71.2%, n = 37, p < 0.001; Category 1 = MetS 80.8%, n = 42, Control 19.2%, n = 10, p < 0.001; Category 2 = MetS 88.5%, n = 23, Control 11.5%, n = 3, p < 0.001). In addition, TO and TS abnormalities were correlated with the number of MetS components (r = 0.608, p < 0.001; r = -0.388, p < 0.001, respectively). Conclusions: To our knowledge, this is the first study to establish a relationship between HRT and MetS. These findings suggest that MetS adversely affects HRT scores. In addition, the number of MetS components is related to impaired HRT scores. (Cardiol J 2012; 19, 5: 507-512

Laboratory performance of x-ray detector on 2U cubesat beeaglesat

A CdZnTe based semiconductor X-ray detector (XRD) and its associated readout electronics has been developed by the Space Systems Design and Testing Laboratory of Istanbul Technical University and the High Energy Astrophysics Detector Laboratory of Sabanci University along with an SME partner. The XRD will be the secondary science mission on board BeEagleSat, which is developed as one of the double CubeSats for the QB50 project. QB50 is a European Framework 7 project carried out by a number of international organizations led by the von Karman Institute of Belgium. The heart of the XRD is a 2.5 mm thick, 15 mm x 15 mm CdZnTe crystal with orthogonal electrode strips on top and bottom for position resolution on the crystal. There are 3 sets of steering electrodes in between anodes. A commercial off the shelf (COTS) high voltage source provides necessary potential difference to transport electrons and holes towards electrodes. The signals from each strip are read by a COTS ASIC, RENA-3b, controlled my MSP 430. The XRD board (single ~10 cm x 10 cm board) also carries the necessary power regulators and 7 COTS batteries. In a previous paper presented at the IAC 2014, we discussed the main design of the XRD and provided results from some of the early vibration tests of the mechanical design. At the time, the CdZnTe crystal has not been attached, and the readout electronics and software were still in development phase. In this paper, we present the laboratory performance of the electronic readout system and discuss the current phase of the XRD development

Initial syncope associated with alternating attacks of supraventricular tachycardia and atrioventricular block long after surgical correction of tricuspid atresia

The Fontan procedure has become a generic term to define a surgical procedure that orients the systemic venous return directly to the pulmonary arteries, and has been used as a palliative operation for pulmonary atresia, tricuspid atresia, double inlet ventricle and complex single ventricle. The earliest type of Fontan procedure was a simple atriopulmonary anastomosis between the right atrium and the pulmonary artery. Atrial arrhythmias, particularly atrial flutter and sinus node dysfunction may occur in the early and late postoperative period after simple atriopulmonary anastomosis. The case presented here represents a much delayed occurrence of an initial syncope due to alternating attacks of SVT (supraventricular tachycardia) and second degree heart block on admission 21 years after simple atriopulmonary anastomosis performed for the correction of tricuspid atresia. (Cardiol J 2008; 15: 186-188

The effect of smoking on cardiac diastolic parameters including Vp, a more reliable and newer parameter

Background: Previous studies have focused mainly on the acute effects of smoking on the diastolic function of the heart. The present study was conducted to demonstrate the chronic effects of smoking on the diastolic functional parameters of the heart, including transmitral M- mode coloured flow propagation velocity (Vp), among relatively younger asymptomatic adults. Method: Hundred smokers with histories of incessant smoking for at least one year prior to the time of the investigation were included in the prospectively designed study as group I. Group II consisted of 35 non-smokers, matched for age and gender. Addiction to smoking was graded according to the modified Fagerström test for nicotine dependence (M-FNDT). Each smoker was designated by a nicotine dependence index (NDI) according to the M-FNDT. Groups I and II were compared with respect to major diastolic functional parameters on transthoracic echocardiography (TTE), including the E/A ratio, deceleration time (DT), isovolumic relaxation time (IVRT) and Vp, along with basic clinical and echocardiographic parameters. Results: Thirty one smokers in group 1 and 5 non-smokers in group 2 were excluded from the study according to the pre-defined exclusion criteria. Therefore 69 smokers (mean age: 30 &#177; 4.9 years, M/F: 32/37) in group I were compared with 30 non-smokers (mean age: 31.4 &#177; 4.8 years, M/F: 15/15) in group II. In group I the mean values of E/A and Vp were significantly lower (p < 0.001), whereas the mean values of IVRT and DT were significantly higher (p < 0.001) than in group II. In group I the value of NDI was positively correlated with the values of DT and IVTR (p < 0.001) and negatively correlated with the value of Vp (p < 0.001). Conclusion: Conventional and relatively new parameters of cardiac diastolic function, in particular Vp, were found to be impaired in smokers demonstrating the chronic adverse effects of smoking on the diastolic function of the heart. The severity of this impairment was closely correlated with the degree of addiction to smoking. (Cardiol J 2007; 14: 281-286

The importance of the mean platelet volume in the diagnosis of supraventricular tachycardia

This retrospective study aimed to investigate the diagnostic relation between the mean platelet volume (MPV) and supraventricular tachyarrhythmia (SVT) in patient with documented atrial tachyarrhythmia in the emergency department (ED). Two study groups were compared; a SVT group with arrive at the ED with documented SVT (n=122) and 100 healthy adult without any palpitation symptom, arrhythmic disease, and with normal physical examination results that were brought for checkups to the cardiology polyclinic were classified as control group. Blood samples were obtained from all patients for determining the hematologic counts and MPV during first hour in ED period. In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p &gt; 0.05). MPV in the SVT group was signifi cantly higher than in the control group (9.12±1.22 fl vs 8.64±0.89 fl , p &lt; 0.001). Multivariate logistic regression analysis showed that just MPV was independent predictor of SVT in patients with palpitation in ED (odds ratio [OR] 8.497, 95% confidence interval (6.181 to 12.325), p=0.012). The present study described that MPV is helpful parameter for the diagnosis of SVT in emergency department, for the first time in the literature.Keywords: mean platelet volume, inflammation, palpitation, supraventricular tachycardia, diagnosticAfrican Health sciences Vol 14 No. 1 March 201

Evaluation of left ventricular systolic asynchrony in patients with subclinical hypothyroidism

Background: The heart was very sensitive to fluctuating thyroid hormone levels. To assess intra-left ventricular (LV) systolic asynchrony in patients with subclinical thyroid dysfunction. Methods: Fifty patients with subclinical hypothyroidism and 40 controls were included. A diagnosis of subclinical hypothyroidism was reached with increased TSH and normal free T4. All subjects were evaluated by echocardiography. Evaluation of intra-LV systolic asynchrony was performed by tissue synchronization imaging (TSI), and four TSI parameters of systolic asynchrony were calculated. LV asynchrony was defined by these parameters. Results: All of the groups were similar in terms of demographic findings and conventional and Doppler echocardiograpic parameters except peak systolic velocity and early diastolic velocity. LV systolic asynchrony parameters of TSI including; standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any 2 of the 12 LV segments (Ts-12), standard deviation of TS of the 6 basal LV segments (Ts-SD-6), maximal difference in Ts between any of the 6 basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism than controls (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The prevalence of LV asynchrony was significantly higher in patients with subclinical hypothyroidism than control. Conclusions: Patients with subclinical hypothyroidism present evidence of LV asynchrony by TSI. LV systolic asynchrony could be a warning sign of the early stage in cardiac systolic dysfunction in subclinical hypothyroid patients

Evaluation of left atrial mechanical functions and atrial conduction abnormalities in patients with clinical hypothyroid

Background: The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical delay and P wave dispersion in hypothyroid patients. Methods: Thirty-four patients with overt hypothyroid and thirty controls were included. A diagnosis of overt hypothyroid was reached with increased serum TSH and decreased free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay (EMD) were measured by tissue Doppler imaging (TDI). P wave dispersion was calculated by 12 lead electrocardiograms. Results: LA diameter were significantly higher in patients with overt hypothyroid (p = 0.021). LA passive emptying volume and LA passive emptying fraction were significantly decreased with hypothyroid patients (p = 0.002 and p < 0.001). LA active emptying volume and LA active emptying fraction were significantly increased with hypothyroid patients (p < 0.001 and p < 0.001). Intra- and interatrial EMD, were measured significantly higher in hypothyroid patients (30.6 &#177; 6.1 vs 18.0 &#177; 2.7, p < 0.001; and 10.6 &#177; 3.4 vs 6.9 &#177; 1.4, p < 0.001, respectively). P wave dispersion were significantly higher in hypothyroid patients (48.8 &#177; 6.2 vs 44.3 &#177; 7.2, p = 0.022). In stepwise regression analysis demonstrated that, interatrial EMD and LA active emptying fraction related with TSH and fT4. Conclusions: This study showed that impaired LA mechanical and electromechanical function in hypothyroid patients. TSH and T4 were independent determinant of interatrial EMD and LA active emptying fraction

Ocena zaburzeń przewodzenia przedsionkowego i czynności mechanicznej lewego przedsionka u chorych z subklinicznymi zaburzeniami czynności tarczycy

Introduction: Changes of thyroid hormones levels may lead to effects, not only in ventricular function, but also atrial function. The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical coupling and P wave dispersion in patients with subclinical thyroid disorders. Material and methods: Eighty patients with subclinical thyroid disorders and forty controls were included. A diagnosis of subclinical thyroid disorders were reached with increased or decreased serum TSH and normal free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay were measured by tissue Doppler imaging (TDI). Results: All groups had similar demographic findings. LA mechanical functions significantly impaired in subclinical thyroid disorders than control group. Intra- and Interatrial delay, were measured significantly higher in patients with subclinical thyroid disorders than control group. PA lateral and interatrial delay were positively correlated with TSH (r = 0.507, p = 0.006 and r = 0.455, p = 0.015, respectively) in subclinical hypothyroid patients. There was negative correlation between TSH and interatrial delay (r = &#8211;0.492, p = 0.006) in subclinical hyperthyroid patients. Linear multivariate regression analysis demonstrated that, TSH was the only an independent factor of interatrial delay in patients with subclinica tlhyroid disorders. Conclusions: This study showed that impaired LA mechanical and electromechanical function in subclinical thyroid disorders. TSH was an independent determinant of interatrial delay. Prolonged atrial electromechanical coupling time and impaired mechanical atrial functions may be related to the increased incidence of arrhythmias.Wstęp: Zmiany stężeń hormonów tarczycy mogą wpływać nie tylko na czynność komór serca, ale również na czynność przedsionków. Niniejsze badanie przeprowadzono w celu oceny czynności mechanicznej lewego przedsionka (LA), sprzężenia elektromechanicznego i dyspersji załamka P u chorych z subklinicznymi zaburzeniami czynności tarczycy. Materiał i metody: Do badania włączono 80 chorych z subklinicznymi zaburzeniami czynności tarczycy i 40 osób stanowiących grupę kontrolną. Zaburzenia czynności tarczycy rozpoznawano na podstawie obniżonego lub podwyższonego stężenia TSH w surowicy i prawidłowego stężenia wolnej T4 (fT4). Zmierzono objętości LA, posługując się dwupłaszczyznową metodą area-lenght (pole&#8211; wymiar podłużny). Obliczono również objętości i frakcje aktywnego i biernego opróżniania LA. Do pomiaru opóźnienia przewodnictwa wewnątrzi międzyprzedsionkowego zastosowano technikę doplera tkankowego. Wyniki: Grupy nie różniły się pod względem charakterystyki demograficznej. W grupie z zaburzeniami czynności tarczycy mechaniczna funkcja przedsionków była istotnie upośledzona w porównaniu z osobami z grupy kontrolnej. Opóźnienie przewodnictwa wewnątrzi międzyprzedsionkowego stwierdzano istotnie częściej u osób z zaburzeniami czynności tarczycy. Stwierdzono dodatnią korelację miedzy opóźnieniem elektromechanicznym (PA lateral) i opóźnieniem przewodzenia międzyprzedsionkowego a TSH (odpowiednio r = 0,507; p = 0,006 i r = 0,455; p = 0,015) u osób z subkliniczną niedoczynnością tarczycy. Z kolei u osób z subkliniczną nadczynnością tarczycy zaobserwowano ujemną korelację między TSH i opóźnieniem przewodzenia międzyprzedsionkowego (r = &#8211;0,492; p = 0,006). W wieloczynnikowej analizie regresji liniowej wykazano, że stężenie TSH było jedynym parametrem niezależnie związanym z opóźnieniem przewodzenia międzyprzedsionkowego u chorych z subklinicznymi zaburzeniami czynności tarczycy. Wnioski: W niniejszym badaniu wykazano upośledzoną czynność mechaniczną i elektromechaniczną LA u chorych z subklinicznymi zaburzeniami czynności tarczycy. Stężenie TSH było niezależnym czynnikiem determinującym opóźnienie przewodzenia międzyprzedsionkowego. Wydłużenie czasu sprzężenia elektromechanicznego i upośledzenie mechanicznej czynności przedsionków mogą się wiązać ze zwiększoną zapadalnością na zaburzenia rytmu