Effect of insulin resistance on left ventricular structural changes in hypertensive patients

Both left ventricular (LV) hypertrophy and insulin resistance (IR) have often been demonstrated in patients with essential hypertension (EH). Insulin may exert a direct growth promoting effect on cardiomyocytes rather than affecting the LV internal diameter. The purpose of this study was to examine the effect of IR on LV geometry. We enrolled 105 patients (71 females, mean age, 49.2 ± 13.6 years) with recently diagnosed and untreated hypertension (blood press > 140 and/or 90 mmHg, fasting glucose < 110 mg/dL), and grouped them as normal (N) (39 patients, 26 females, mean age, 48.5 ± 14.7 years) if all M-mode echocardiographic measurements were within normal limits, concentric remodeling (CR) (22 patients, 15 females, mean age, 50.5 ± 14.8 years) if relative wall thickness was increased but left ventricular mass index (LVMI) was normal, concentric hypertrophy (CH) (13 patients, 9 females, mean age, 50.3 ± 10.8 years) if both ventricular thicknesses and the LVMI were increased, and eccentric hypertrophy (EH) (31 patients, 21 females, mean age, 48.6 ± 12.9 years) if ventricular thicknesses were normal, but LVMI was increased. Transthoracic echocardiography was performed in all subjects, and interventricular septal thickness (IVS), posterior wall thickness (PWT), sum of wall thickness (SWT), left ventricular end-diastolic internal diameter (LVED), relative wall thickness (RWT), and LVMI were recorded. Blood samples for routine biochemical examination and fasting insulin levels were obtained and then the homeostasis model assessment (HOMA) index was calculated by the formula: HOMA Index = Fasting Blood Glucose (mg/dL) × Immunoreactive Insulin (μU/mL)/405, for the assessment of IR. There were no significant differences among the groups with respect to age, blood pressure (BP) levels, fasting blood glucose (FBG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), total cholesterol (TC), or triglyceride (TG) levels. Insulin levels were significantly higher in the CR and CH groups in comparison with the N group (P = 0.004), and the HOMA index was higher in the CH group compared to the N group (P = 0.024). In Pearson's correlation analysis, insulin was found to be directly correlated with IVS (r = 0.29, P = 0.002), SWT (r = 0.25, P = 0.009), and RWT (r = 0.33, P = 0.0001). The HOMA index was also directly correlated with IVS (r = 0.33, P = 0.001), SWT (r = 0.29, P = 0.002), and RWT (r = 0.29, P = 0.003). Cardiac changes in hypertensive patients include increased LVMI and altered LV geometry. The concentric LV geometry seen in hypertensive patients might be mediated, at least in part, by increased insulin levels and the HOMA index. Copyright © 2006 by the International Heart Journal Association

Impact of obstructive sleep apnoea on left ventricular mass and global function

Obstructive sleep apnoea syndrome (OSAS) might be a cause of heart failure. The present study aimed to assess left ventricular mass and myocardial performance index (MPI) in OSAS patients. A total of 67 subjects without any cardiac or pulmonary disease, referred for evaluation of OSAS, had overnight polysomnography and echocardiography. According to apnoea-hypopnoea index (AHI), subjects were classified into three groups: mild OSAS (AHI: 5-14; n=16), moderate OSAS (AHI: 15-29; n=18), and severe OSAS (AHI: ≥30; n=33). Thickness of interventricular septum (IVS) and posterior wall (LVPW) were measured by M-mode, along with left ventricular mass (LVM) and LVM index (LVMI). Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Döppler echocardiography. There were no differences in age or body mass index among the groups, but blood pressures were higher in severe OSAS compared with moderate and mild OSAS. In severe OSAS, thickness of IVS (11.2 ± 1.1 mm), LVPW (11.4 ± 0.9 mm), LVM (298.8 ± 83.1 g) and LVMI (144.7 ± 39.8 g·m-2) were higher than in moderate OSAS (10.9 ± 1.3 mm; 10.8 ± 0.9 mm; 287.3 ± 74.6 g; 126.5 ± 41.2 g·m-2, respectively) and mild OSAS (9.9 ± 0.9 mm; 9.8 ± 0.8 mm; 225.6 ± 84.3 g; 100.5 ± 42.3 g·m-2, respectively). In severe OSAS, MPI (0.64 ± 0.14) was significantly higher than in mild OSAS (0.50 ± 0.09), but not significantly higher than moderate OSAS (0.60 ± 0.10). In conclusion, severe and moderate obstructive sleep apnoea syndrome patients had higher left ventricular mass and left ventricular mass index, and also left ventricular global dysfunction. Copyright©ERS Journals Ltd 2005

How Do Patients Understand Safety for Cardiac Implantable Devices? Importance of Postintervention Education

This study was designed to assess the effect of patient education on the knowledge of safety and awareness about living with cardiac implantable electronic devices (CIEDs) within the context of phase I cardiac rehabilitation. Methods. The study was conducted with 28 newly implanted CIED patients who were included in "education group (EG)". Patients were questioned with a survey about living with CIEDs and electromagnetic interference (EMI) before and 1month after an extensive constructed interview. Ninety-three patients who had been living with CIEDs were included in the "without education group (woEG)". Results. Patients in EG had improved awareness on topics related to physical and daily life activities including work, driving, sports and sexual activities, EMI of household items, harmful equipment, and some of the medical devices in the hospital setting (p<0.05). Patients in EG gave significantly different percent of correct answers for doing exercise or sports, using the arm on the side of CIEDs, EMI of some of the household appliances, medical devices, and all of the harmful equipment compared to woEG (p<0.05). Conclusion. It was demonstrated that a constructed education interview on safety of CIEDs and living with these devices within the context of phase I cardiac rehabilitation is important for improving the awareness of patients significantly. Thus, patients might achieve a faster adaptation to daily life and decrease disinformation and misperceptions and thus promote the quality of life after the device implantation

Left ventricular non-compaction in pregnancy

Left-ventricular non-compaction (LVNC) represents an arrest in the normal process of myocardial compaction, resulting in multiple, prominent, persistant trabeculations and deep inter-trabecular recesses communicating with the ventricular cavity. LVNC is a rarely encountered cardiomyopathy and few cases have been reported in pregnancy. In this case report we present a patient who referred to our clinic with symptoms of heart failure during pregnancy and whose echocardiographic examination revealed prominent trabeculations in the left ventricle

Evaluation of biventricular myocardial performance index in patients with Behçet's disease

Objective: The global function of both left ventricular (LV) and right ventricular (RV) functions were compared in patients with Behçet's disease (BD) versus healthy controls. Methods: Biventricular function was evaluated by measurement of the myocardial performance index (MPI) evaluated from tissue Doppler echocardiographic measurements in 24 BD patients and was compared with measurements in 24 age- and sex-matched healthy controls. Results: Significantly higher MPI values were associated with ventricular dysfunction. The study demonstrated impaired RV function in patients with BD compared with healthy controls, whereas normal LV function was observed both in patients with BD and in healthy controls. Conclusion: Early noninvasive evaluation of the properties of BD during the asymptomatic phase of this inflammatory disease may have prognostic value in the management of patients. © 2012 Field House Publishing LLP

Evaluation of heart rate variability in patients with coronary artery ectasia and coronary artery disease

Objective: The present study compared heart rate variability (HRV) parameters in patients with coronary artery ectasia (CAE) and coronary artery disease (CAD). Methods: The study population consisted of 60 consecutive patients with CAE (14 women; mean age 51.63±7.44 years), 60 consecutive patients with CA (15 women; mean age 53.67±9.31 years), and 59 healthy individuals (13 women; mean age 52.85±8.19 years). Electrocardiograms, 24-hour Holter analyses, and routine biochemical tests were performed, and clinical characteristics were evaluated. Coronary angiography images were analyzed. Time-domain HRV parameters, including the standard deviation (SD) of normal-to-normal intervals (SDNN) and the root mean square of difference in successive normal-tonormal intervals (RMSSD) were evaluated, as were frequencydomain HRV parameters including low-frequency (LF), very lowfrequency (VLF), high-frequency (HF), the proportion derived by dividing low- and high-frequency (LF/HF), and total power (TP). Results: SDNN was lower in both the CAE and CAD groups, compared to the healthy group (140.85±44.21, 96.51±31.28, and 181.05±48.67, respectively). A significant difference in RMSSD values among the groups was determined (p=0.004). Significantly decreased VLF and HF values were found in the CAE group, compared with the healthy group (VLF p<0.001; HF, p=0.007). TP, VLF, and HF values were significantly lower (p<0.001, p<0.001, and p<0.001, respectively), but LF and LF/ HF values were significantly higher (p<0.001 for both) in the CAD group than in the healthy group. TP values were significantly higher (p<0.001), and LF and LF/HF values were lower in the CAE group, compared with the CAD group (p<0.001 for both). Conclusion: A decrease in vagal modulation or an increase in sympathetic activity of cardiac function, assessed by HRV analysis, is worse in patients with CAD than in patients with CAE. © 2016 Turkish Society of Cardiology

Manual thrombus aspiration and the improved survival of patients with unstable angina pectoris treated with percutaneous coronary intervention (30 months follow-up)

The clinical effect of intracoronary thrombus aspiration during percutaneous coronary intervention in patients with unstable angina pectoris is unknown. In this study, we aimed to assess how thrombus aspiration during percutaneous coronary intervention affects in-hospital and 30-month mortality and complications in patients with unstable angina pectoris. We undertook an observational cohort study of 645 consecutive unstable angina pectoris patients who had performed percutaneous coronary intervention from February 2011 to March 2013. Before intervention, 159 patients who had culprit lesion with thrombus were randomly assigned to group 1 (thrombus aspiration group) and group 2 (stand-alone percutaneous coronary intervention group). All patients were followed-up 30 months until August 2015. Thrombus aspiration was performed in 64 patients (46%) whose cardiac markers (ie, creatinine kinase [CK-MB] mass and troponin T) were significantly lower after percutaneous coronary intervention than in those of group 2 (CK-MB mass: 3.801.11 vs 4.230.89, P=0.012; troponin T: 0.0120.014 vs 0.0180.008, P=0.002). Left ventricular ejection fraction at 6, 12, and 24 months postintervention was significantly higher in the group 1. During a mean followup period of 28.876.28 months, mortality rates were 6.3% in the group 1 versus 12.9% in the group 2. Thrombus aspiration was also associated with significantly less long-term mortality in unstable angina pectoris patients (adjusted HR: 4.61, 95% CI: 1.16-18.21, P=0.029). Thrombus aspiration in the context of unstable angina pectoris is associated with a limited elevation in cardiac enzymes during intervention that minimises microembolization and significantly improves both of epicardial flow and myocardial perfusion, as shown by angiographic TIMI flow grade and frame count. Thrombus aspiration during percutaneous coronary intervention in unstable angina pectoris patients has better survival over a 30-month follow-up period. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved

Mitral valve prolapse syndrome: Orthostatic hypotension and physiopathology of its clinical symptomatholgies

Although several investigations on mitral valve prolapse syndrome (MVPS) have been performed, clinical symptoms of this syndrome are not yet clarified. Atypical chest pain, palpitations, fatigue, dyspnea and anxiety are the most frequent symptoms associated with this syndrome. However, dizziness and syncope may be serious symptoms in MVPS. Dizziness and syncope are related to cardiac arrhythmias and are proposed to distinguish types, frequency of arrhythmias and relation to the symptomes. Orthostathic hypotension and tachcardia rarely occur in MVPS. The physiopathological mechanisms of these symptoms are not known clearly, but multifactorial causes are thought to be responsible including autonomic dysfunction, hyperadrenergic state, abnormalities in regulation of baroreceptors, parasympathetic derangements, decrease of intravascular volume, abnormal renin-aldosterone response to depletion of intravascular volume and abnormal release of atrial natriuretic factor