Effect of trimetazidine on exercise performance in patients with coronary artery ectasia

Coronary artery ectasia (CAE) is a rare form of coronary artery disease. It has previously been shown that nitrate derivatives induce exertional angina in patients with CAE. Furthermore, there is limited data about the effects of other anti-ischemic agents in CAE. The aim of this study was to investigate the effect of trimetazidine on exercise performance in patients with CAE. The study population consisted of 56 patients with isolated CAE (32 males, mean age: 58 9 years). The presence of myocardial ischemia was evaluated by treadmill exercise test. The exercise test was positive in 49 patients at baseline and in 27 patients during trimetazidine therapy (P < 0.01). The exercise test induced angina in all of the patients who have had a positive test result. Significant ST depressions were observed in 42 and 23 patients before and after the treatment, respectively (P < 0.01). The extent of ST depression at peak exercise was significantly lower on trimetazidine (0.9 +/- 0.5 vs 1.5 +/- 0.6 mm, P < 0.01). With trimetazidine, the exercise duration increased from 7.8 +/- 2.1 to 8.7 +/- 2.4 min (P = 0.04) and cardiac work-load also increased from 8.9 +/- 2.3 to 10.4 +/- 2.1 mets (P < 0.01). The results suggest that trimetazidine can relieve exercise-induced angina and improve exercise performance in patients with CAE

Does impaired left ventricular relaxation affect P wave dispersion in patients with hypertension?

Objective: P wave dispersion (PD) is considered to reflect the heterogeneous conduction in atria. We investigated whether there was a correlation between the left ventricular (LV) relaxation and PD

Evaluation of overall fibrinolytic activity in patients with coronary artery ectasia: Global fibrinolytic capacity

Objective: Since the role of fibrinolytic activity is unclear in coronary artery ectasia, we investigated the entire fibrinolytic activity by a new test, global fibrinolytic capacity (GFC) in the ectasia patients. Methods and results: Thirty-four ectasia patients (18 male, mean age: 58 +/- 8 years) presenting with acute coronary syndrome and 25 controls (14 male, mean age: 56 +/- 9 years) with normal coronary artery were evaluated. GFC, D-dimer and other hemostatic factors were assessed. Clinical characteristics were comparable in both groups. Serum GFC (4.6 +/- 2.1 vs. 3.1 +/- 2.1 mug/ml, p = 0.03) and D-dimer levels (0.69 +/- 0.42 vs. 0.41 +/- 0.38 ng/ml, p = 0.02, respectively) were significantly higher in ectasia patients than in controls. They were also higher in subgroup of patients with myocardial infarction (four patients) compared with other ectasia patients and controls (p = 0.04, 0.01, respectively). Other hemostatic factors were not different in both groups. GFC was correlated with D-dimer (r = 0.76, p = 0.01). Conclusion: Our results suggest that fibrinolytic system activation may develop in ectasia patients with acute coronary syndrome. It can be induced by thrombus formation in ectatic segment of coronary artery

A comparison of P-wave duration and dispersion in patients with short-term and long-term atrial fibrillation

This study compared P-wave duration and dispersion (PD) in patients with short-term (less than or equal to48 hours) and long-term (>48 hours) atrial fibrillation (AF) after cardioversion. We studied 96 consecutive patients with short-term (group A; n:51, age: 61 +/- 11 years) and long-term AF (group B; n:45, age: 64 10 years). P-wave measurements were calculated from 12-lead electrocardiogram. There was no difference related to clinical characteristics. Left atrial dimension was significantly higher in group B (P = .003). P maximum (124 +/- 12 vs. 113 +/- 11 ms, P = .001) and PD (57 +/- 8 vs. 49 +/- 9 ms, P =.001) were also significantly longer in group B compared with group A, but P minimum did not. In univariate analysis, PD were related to AF duration (P = .002) and left atrial size (P = .02). This relation remained in multivariate analysis (P = .01, P = .02, respectively). P maximum >112 ms and PD >47 ms had accuracy values of 74% and 83% respectively for separating group B. Our results suggest that P wave duration and dispersion is prolonged in patients with long-term AF compared to short-term AF

Predictors of exercise induced myocardial ischemia in patients with isolated coronary artery ectasia

The aim of this study was to investigate the angiographic predictors of exercise induced ischemia in patients with isolated coronary ectasia. We have prospectively analysed coronary angiograms of 1521 consecutive patients undergoing cardiac catheterisation. The overall incidence of coronary ectasia was 6.7% (102 patients). Forty-six patients (3%) with non-obstructive, diffuse or segmental coronary ectasia (i.e. isolated coronary ectasia) constituted the main study group. Coronary angiograms were reviewed for stigmata of an impaired coronary blood flow such as 'slow flow', 'segmental backflow phenomenon' and stasis. 'Slow flow' was quantified with frame counting. An ectasia-jeopardy score was also described in order to assess the effect of the extent of coronary ectasia on exercise induced ischemia. Exercise induced ischemia was observed in 24 patients (52%). Exercise test was abnormal in 70% of the patients with diffuse ectasia and 26% of patients with segmental ectasia (p = 0.003). The frame count of the arteries of the study group was higher than the control group but the correlation between the frame count of the ectatic vessels and exercise induced ischemia was not significant. Stasis of the dye also did not correlate with ischemia. There was a significant correlation between exercise induced ischemia and backflow phenomenon in left anterior descending artery (LAD) (r = 0.56, p = 0.0001). Exercise induced ischemia was best correlated with the ectasia-jeopardy score (r = 0.77, p = 0.0001) and a score of greater than or equal to4 identified the patients at risk with 90% sensitivity and 80% specificity. In conclusion, the extent of the ectasia within the coronary tree, diffuse ectasia and backflow-phenomenon in LAD were identified as the most important predictors of exercise induced ischemia

Efficacy of propafenone for maintaining sinus rhythm in patients with recent onset or persistent atrial fibrillation after conversion: a randomized, placebo-controlled study

Objective -The aim of this study was to investigate the efficacy and safety of propafenone in the prevention of atrial fibrillation (AF) relapse after restoration of sinus rhythm

Tilt training, for recurrent neurocardiogenic syncope - Effectiveness, patient compliance, and scheduling the frequency of training sessions

Unsatisfactory results obtained with medical therapy and dual-chamber pacing for prevention of recurrent neurocardiogenic syncope necessitated the development of new treatment modalities. Tilt-training, a novel treatment for recurrent neurocardiogenic syncope based on exercise sessions with prolonged upright posture (either oil a tilt-table or standing on foot against a wall), was shown to be effective in preventing the recurrence of neurocardiogenic syncope. The purpose of this study was to demonstrate the long-term beneficial effects of a transient tilt training program lasting 2 months

Use of tissue Doppler echocardiography in early detection of left ventricular systolic dysfunction in patients with mitral regurgitation

Objective: Left ventricular ejection fraction (EF) and left ventricular (LV) end-systolic diameter measurements are the most widely accepted and utilized methods to demonstrate LV dysfunction in patients with mitral regurgitation (MR). However, these parameters still have many drawbacks in predicting early LV dysfunction. This study investigates the clinical usefulness of tissue Doppler echocardiography technique in detecting early disturbance of myocardial contractility in asymptomatic patients with chronic, severe MR and normal LV ejection fraction values. Methods and Results: Regional systolic peak velocities of mitral annular motion during the ejection phase of systole ( SW2) were obtained at the mitral annuli of the ventricular septal, lateral, anteroseptal, posterior, anterior and inferior wall sites in the long axis in 31 asymptomatic patients with severe MR ( with a regurgitant volume of more than 50 ml) and with EFs more than 60%. The patients were grouped according to their dP/dt values ( more or less than 1300 mmHg/s) estimated non-invasively by using continuous Doppler wave of MR SW2 measurements of Group I were higher than Group II in all of the analyzed segments. The difference was statistically significant for all of the segments. SW2 values of the whole study group was moderately correlated with dP/dt measurements in all of the analyzed segments other than the interventricular septum. Conclusion: SW2 measurements in the long axis, which are considered to be relatively independent from afterload conditions may be helpful in early detection ( while EF is still in normal range) of LV systolic dysfunction during the follow-up of patients with chronic MR