Corrected QT interval as a predictor of mortality in elderly patients with syncope

Background: Prolonged corrected QT interval (QTc) holds independent prognostic importance in predicting mortality in patients with coronary artery disease, diabetes mellitus and congestive heart failure. However, its association with all cause or cardiac mortality in the general population remains unclear. We evaluated the relationship between prolonged QTc and total mortality among patients with syncope. Methods: This was a retrospective study of 348 patients presenting to the emergency department with syncope of any etiology over a period of one year. All patients with atrial fibrillation, left bundle branch block and cardiac devices (pacemaker/defibrillator) were excluded. Prolonged QTc interval was defined as QTc interval ≥ 440 ms. The primary end point for this study was total mortality in patients presenting with syncope. Results: There were 58 (16%) deaths in this population during a mean follow-up of 30 months. Patients with prolonged QTc interval had significantly higher mortality when compared to those with normal QTc interval (22% vs 11%; p = 0.004). This significance was not retained after adjustment for covariates in the Cox regression model, where we found that age ≥ 65 years (hazard ratio [HR] 7.9; 95% confidence interval [CI] 1.9–32.9; p = 0.004) and QTc interval ≥ 500 ms (HR 3.5; 95% CI 1.56–8.12; p = 0.002) were predictors of increased mortality among patients with syncope. Conclusions: In elderly patients presenting to the emergency department with syncope, QTc interval ≥ 500 ms helps identify patients at higher risk of adverse outcomes. (Cardiol J 2011; 18, 4: 395–400

Predictors of mortality in patients hospitalized for congestive heart failure with left ventricular ejection fraction ≥ 40%

Background: There are limited data regarding the predictors of mortality in patients with acute congestive heart failure (CHF) and left ventricular ejection fraction (LVEF) ≥ 40%. Methods: We evaluated clinical characteristics, mortality and prognostic factors in a sample of consecutive patients hospitalized for CHF with LVEF ≥ 40%. Multivariable Cox regression models were developed to predict mortality using baseline clinical characteristics and echocardiographic variables. Results: The study population consisted of 191 patients, mean age 70 ± 14.6 years (60% female) with average follow-up of 4.0 ± 2.8 years. Cumulative 5-year mortality was 58% in the entire population and it was 59% in men and 57% in women (p = 0.411). In multivariable analyses, predictors of mortality were the following: blood urea nitrogen (BUN) > 25 mg/dL (HR = 1.77; p = 0.002); absence of hypertension (HR = 1.58; p = 0.032), left ventricular end diastolic dimension (LVEDD) ≤ 4.1 cm (HR = 1.73; p = 0.011) and LVEF ≤ 45% (HR = 1.69; p = 0.027). Conclusions: Patients hospitalized for heart failure with LVEF ≥ 40% have very high mortality. Absence of hypertension, elevated BUN and lower LVEF ≤ 45% indicate increased risk of short- and long-term mortality. Lower LVEDD is an independent predictor of mortality in heart failure patients with LVEF ≥ 40%

Skorygowany odstęp QT jako czynnik prognostyczny zgonu w grupie osób w podeszłym wieku z omdleniem w wywiadzie

Wstęp: Wydłużony odstęp QT (QTc) jest niezależnym czynnikiem prognostycznym wzmożonej śmiertelności w grupie osób obciążonych chorobą wieńcową, cukrzycą i zastoinową niewydolnością serca. Jego związek z mechanizmami wszystkich zgonów z przyczyn sercowo-naczyniowych w populacji ogólnej pozostaje niejasny. W niniejszej pracy wykazano zależność między wydłużonym odstępem QT a całkowitą śmiertelnością w grupie osób z omdleniami. Metody: Badaniem retrospektywnie objęto grupę 348 pacjentów, którzy zgłosili się na oddział ratunkowy z powodu omdlenia z jakiejkolwiek przyczyny w ciągu ostatniego roku. Wykluczono osoby z migotaniem przedsionków, blokiem lewej odnogi pęczka Hisa oraz pacjentów z implantowanymi urządzeniami, jak stymulator/kardiowerter-defibrylator. Wydłużony odstęp QT zdefiniowano jako trwający co najmniej 440 ms. Pierwszorzędowy punkt końcowy w badanej grupie osób z omdleniami stanowił zgon. Wyniki: W obserwacji 30-miesięcznej odnotowano 58 zgonów (16%). W grupie pacjentów z wydłużonym odstępem QT odsetek zgonów był znacznie wyższy niż w grupie z prawidłowym odstępem (22% v. 11%; p = 0,004). Ta istotność nie została podtrzymana po dodaniu kowariancji w modelu regresji Coxa, gdzie wiek 65 lat i więcej [hazard względny (HR) 7,9; 95-procentowy przedział ufności (CI) 1,9–32,9; p = 0,004] i odstęp QTc wynoszący co najmniej 500 ms (HR 3,5; 95% CI 1,56–8,12; p = 0,002) łącznie były wskaźnikami prognostycznymi zgonu w grupie pacjentów z omdleniami. Wnioski: W grupie starszych osób zgłaszających się na oddział ratunkowy z powodu omdlenia odstęp QT ≥ 500 ms pozwala pomóc zidentyfikować pacjentów z grupy ryzyka wystąpienia nagłego incydentu sercowego. (Folia Cardiologica Excerpta 2011; 6, 4: 211–216

Proteomic identification and characterization of hepatic glyoxalase 1 dysregulation in non-alcoholic fatty liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. However, its molecular pathogenesis is incompletely characterized and clinical biomarkers remain scarce. The aims of these experiments were to identify and characterize liver protein alterations in an animal model of early, diet-related, liver injury and to assess novel candidate biomarkers in NAFLD patients. Methods: Liver membrane and cytosolic protein fractions from high fat fed apolipoprotein E knockout (ApoE−/−) animals were analyzed by quantitative proteomics, utilizing isobaric tags for relative and absolute quantitation (iTRAQ) combined with nano-liquid chromatography and tandem mass spectrometry (nLC-MS/MS). Differential protein expression was confirmed independently by immunoblotting and immunohistochemistry in both murine tissue and biopsies from paediatric NAFLD patients. Candidate biomarkers were analyzed by enzyme-linked immunosorbent assay in serum from adult NAFLD patients. Results: Through proteomic profiling, we identified decreased expression of hepatic glyoxalase 1 (GLO1) in a murine model. GLO1 protein expression was also found altered in tissue biopsies from paediatric NAFLD patients. In vitro experiments demonstrated that, in response to lipid loading in hepatocytes, GLO1 is first hyperacetylated then ubiquitinated and degraded, leading to an increase in reactive methylglyoxal. In a cohort of 59 biopsy-confirmed adult NAFLD patients, increased serum levels of the primary methylglyoxal-derived advanced glycation endproduct, hydroimidazolone (MG-H1) were significantly correlated with body mass index (r = 0.520, p < 0.0001). Conclusion: Collectively these results demonstrate the dysregulation of GLO1 in NAFLD and implicate the acetylation-ubquitination degradation pathway as the functional mechanism. Further investigation of the role of GLO1 in the molecular pathogenesis of NAFLD is warranted. Keywords: Non-alcoholic fatty liver disease, Glyoxalase, Methylglyoxal, Proteomics, iTRA

REPORTING AN UNUSUAL CASE OF INFERTILITY; ISOLATED BILATERAL TUBERCULOUS EPIDIDYMO-ORCHITIS

Tuberculosis may infect any part of the body. Tuberculous orchitis is a rare disease that usually occurs as a result of direct extension from the epididymis. Only a paucity of cases regarding epididymo-orchitis and scrotal involvement without renal or pulmonary involvement has been reported until today. Isolated tuberculous epididymo-orchitis presents with a clinical picture and radiographic illustrations mimicking a scrotal neoplasm; therefore, diagnosis can be challenging for physicians. We are presenting a case of isolated bilateral tuberculous epidymo-orchitis resulting in infertility and discharging scrotal sinuses which responded to 6 months anti – tuberculous therapy

Syncope in Young Women: Broadening the Differential Diagnosis

Syncope is defined as a sudden transient loss of consciousness (TLOC) with concomitant loss of postural tone followed by spontaneous recovery. It is a subset of a broader class of medical conditions, including postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and neurally mediated syncope (NMS), that may result in TLOC. The overlap of these clinical conditions leads to confusion regarding syncope classification that can hinder evaluation strategies, and pose challenges for diagnosis and treatment, particularly in young women. In this article, we review POTS, orthostatic hypotension, and NMS with an emphasis on NMS. These diverse orthostatic clinical entities may be associated with syncope and are frequently observed in young, healthy women. The importance of considering NMS as a diagnosis of exclusion cannot be overstated. We report a series of three young, otherwise healthy women, initially diagnosed with NMS, whose clinical course evolved over time into more sinister diagnoses that were overlooked and associated with devastating clinical outcomes. These cases highlight the importance of maintaining a broad differential diagnosis when considering the diagnosis of NMS. Each case synopsis provides key clinical features that must be considered to avoid overlooking more serious clinical conditions