Very Low Frequency of PAD in People with CHD in Six Middle Eastern Countries

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We read with interest the article by Al-Thani et al. [1] reporting a very low frequency (2.6%) of peripheral arterial disease (PAD) in people with acute coronary syndrome in a multicenter study conducted in six Middle Eastern countries. A recent multicenter study in Turkey showed 20 % prevalence of PAD in people with established cardiovascular disease or who were at risk for atherosclerotic diseases [2]. Diabetes that was present in 70 % of the participants in their study is actually a major cause of arterial stiffness or calcification, which frequently results in misclassification of diabetics in ankle brachial index (ABI) testing by causing paradoxically high values [3]. In this context, it would be utmost helpful if the authors could provide some dat

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Preoperative exercise heart rate recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery

WOS: 000309432200007PubMed: 22986319Study Objective: To assess the predictive role of heart rate (HR) recovery in the detection of intraoperative hypotension in patients undergoing noncardiac surgery. Design: Prospective, observational study. Setting: Department of cardiology and operating rooms of university hospitals. Patients: 160 ASA physical status 1 and 2 patients scheduled for elective noncardiac surgery. Measurements: All patients underwent exercise stress testing. Maximum HRs and metabolic equivalent levels were recorded. Heart rate recovery at the first, second, and third minutes were calculated by subtracting HRs one, two, and three minutes into the recovery period from the maximal HR at peak exercise. A decrease in mean arterial pressure (MAP) of greater than 30% was defined as intraoperative hypotension and recorded. Patients were classified to two groups according to whether they had intraoperative hypotension. Main Results: Hypotensive episode was observed in 31 patients (19.7%) during the operation. The presence of diabetes mellitus was higher in patients with intraoperative hypotension (22.6% vs 7.1%, P = 0.019). Mean HR recovery at the first, second, and third minutes was significantly lower in the intraoperative hypotension group (P = 0.001, P = 0.004, and P = 0.031, respectively). Heart rate recovery at the first, second, and third minutes was a good predictor of intraoperative hypotension, but only HR recovery at the first minute (OR 0.82, 95% CI 0.73 to 0.92, P = 0.001) and HR recovery at the second minute (OR, 0.90; 95% CI, 0.82 to 0.98; P = 0.019) were independent predictors of intraoperative hypotension. A higher negative correlation was noted between the degree of MAP reduction and HR recovery at the first minute (r = -0.797, P = 0.001). Conclusions: Abnormal preoperative exercise HR recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery. Given the importance of intraoperative hypotension, preoperative use of exercise testing might be considered. (c) 2012 Elsevier Inc. All rights reserved

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The relationship between nutritional status and heart rate variability in elderly patients

Aim: Malnutrition is a common health problem in elderly patients. Prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) are two easily calculable indexes developed as indicators of nutritional status, showing prognosis relationships with some diseases. We planned a study to define the relation- ship between PNI, GNRI, which indicates nutritional status and is also a criterion of frailty, and heart rate variability (HRV), which is a cardiovascular risk marker. Material and Methods: A total of 96 patients over 65 years of age who had no known chronic disease other than controlled hypertension and regulated diabetes and who underwent rhythm holter monitoring were evaluated. Framingham risk scores (FRS), PNI, GNRI of the patients were calculated. HRV parameters were recorded. Results: The root mean square of successive differences (rMSSD) (p:0.02) and percentage of adjacent RR intervals with a difference of duration >50ms (pNN50) (p:0.035) were significantly lower in the patient group with low PNI. HRV frequency domain parameters, low-frequency/high-frequency (LF/HF) (p:0.048) and total power (TP) (p:0.044) were significantly higher in the patient group with low PNI. There was no significant relationship between GNRI and HRV parameters. Discussion: PNI is a simple indicator of decreased HRV and increased cardiac risk in elderly patients. PNI is more valuable than GNRI in predicting increased cardiac risk related to HRV in elderly patients. The results of our study support the effect of adequate nutrition on cardiac autonomic modulation in the elderly and confirm that nutrition in this age group is a correctable cardiac risk factor