Fragmented QRS complexes are associated with left ventricular systolic and diastolic dysfunctions in patients with metabolic syndrome

Background: Metabolic syndrome (MetS) is found to be associated with deterioration of the left ventricular (LV) systolic and diastolic functions. One of the factors for this impairment is myocardial fibrosis. Fragmented QRS (fQRS) complexes are found to be associated with myocardial fibrosis. The aim of the study was to evaluate if the presence of fQRS on electrocardiogram (ECG) can detect pronounced impairment in the LV systolic and diastolic functions in MetS patients. Methods: The study included 111 (mean age 47 ± 9, 49.5% male) MetS patients and 96 (mean age 45 ± 9, 58.3% male) control subjects without MetS. ECG was evaluated for the presence of fQRS. Each patient underwent conventional echocardiography and tissue Doppler imaging. Results: Fragmented QRS was more common among MetS patients (26.1% vs. 14.6%, p = 0.041). MetS was associated with subclinical LV systolic and LV diastolic dysfunctions. In subgroup analyses of MetS patients, the presence of fQRS on ECG had a higher E/E’ ratio and lower E’ velocity, indicating pronounced diastolic dysfunction, as well as lower isovolumic acceleration (IVA), indicating profound subclinical LV systolic dysfunction. E/E’ ratio and IVA were independent predictors of fQRS presence in patients with MetS. Conclusions: Fragmented QRS is more common among MetS patients compared to non-MetS patients. The presence of fQRS is associated with pronounced subclinical LV systolic and diastolic dysfunctions in MetS patients

The diagnostic value of serum copeptin levels in an acute pulmonary embolism

Background: Acute pulmonary embolism (APE) is a common disease which is associated with high mortality and morbidity. Circulating level of copeptin, which was demonstrated to be elevated in heart failure, acute myocardial infarction and pulmonary arterial hypertension, were reported to be independent predictors of poor outcome in recent studies. The aim of the present study was to investigate the clinical utility of copeptin in the diagnosis of APE. Methods: A total of 90 consecutive patients, admitted to emergency service due to acute chest pain and/or dyspnea and who underwent pulmonary computerized tomography angiography (CTA) due to suspicion of APE, were included in this prospective study. The patients diagnosed with APE were defined as APE (+) group and the remaining individuals with normal pulmonary CTA result were defined as APE (–) group. Results: Copeptin levels (7.76 ± 4.4 vs. 3.81 ± 1.34 ng/dL; p < 0.001) were higher in the APE (+) group as compared to the APE (–) group. Copeptin was significantly positively correlated with B-type natriuretic peptide (r = 0.434, p < 0.001), D-dimer (r = 0.315, p = 0.003) and troponin I (r = 0.300, p = 0.004) and inversely correlated with arterial oxygen saturations (r = –0.533, p < 0001). When the correlation of copeptin with right ventricular dysfunction parameters was investigated, it was significantly inversely correlated with the tricuspid annular plane systolic excursion (r = –0.521, p < 0.001) and positively correlated with right to left ventricle ratio (r = 0.329, p = 0.024). Copeptin (OR 1.836, 95% CI 1.171–2.878, p = 0.008) was found as a significant independent predictor of APE in a multivariate analysis, after adjusting for other risk parameters.  Conclusions: Copeptin is a promising new biomarker, which may be used to support the need for further investigations and to improve the diagnosis of patients with APE.

Assessment of sustained effects of levosimendan and dobutamine on left ventricular systolic functions by using novel tissue Doppler derived indices in patients with advanced heart failure

Background: Previous studies comparing levosimendan vs. dobutamine have revealed that levosimendan is better in relieving symptoms. Echocardiographic studies have been done using second measurements immediately following a dobutamine infusion or while it was still being administered. The aim of our study was assessment of sustained effects of 24 h levosimendan and dobutamine infusions on left ventricular systolic functions. Methods: A total of 61 patients with acutely decompensated heart failure with New York Heart Association (NYHA) class III or IV symptoms were randomized to receive either levosimendan or dobutamine 2:1 in an open label fashion. Before and 5 days after the initiation of infusions, functional class was assessed, N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels and left ventricular ejection fraction (LVEF), mitral inflow peak E and A wave velocity, and E/A ratios were measured; using tissue Doppler imaging, isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), early (E’) and late (A’) diastolic velocities, and E’/A’ and E/E’ ratios were measured. Results: The NYHA class improved in both groups, but improvements were prominent in the levosimendan group. NT-proBNP levels were significantly reduced in the levosimendan group. Improvements in LVEF and diastolic indices were significant in the levosimendan group. Tissue Doppler-derived systolic indices of IVV and IVA increased significantly in the levosimendan group. Conclusions: Improvements in left ventricular systolic and diastolic functions continue after a levosimendan infusion.

Evaluation of the effect of L-thyroxin therapy on cardiac functions by using novel tissue Doppler-derived indices in patients with subclinical hypothyroidism

Objectives Subclinical hypothyroidism (SH) is characterized by normal serum free T4 (fT4), free T3 (fT3) levels and increased serum thyroid stimulating hormone (TSH) levels. The aim of this study was to assess the validity of tissue Doppler imaging (TDI) in evaluating cardiac effects of SH and to demonstrate the improving effects of L-thyroxin(L-T4) on TDI parameters

Wpływ lewosimendanu na czynność prawej komory oceniany na podstawie wskaźników mierzonych metodą tkankowej echokardiografii doplerowskiej u chorych z niedokrwienną niewydolnością lewej komory

Background: Right ventricular (RV) dysfunction complicates advanced left ventricular (LV) heart failure (HF) and contributes to a poor prognosis. Levosimendan is a positive inotropic agent improving cardiac contractility without increasing myocardial oxygen consumption in HF.Aim: To evaluate the effect of levosimendan therapy on RV systolic function, by using derived tissue Doppler imaging (TDI) in patients with ischaemic HF.Methods: The study consisted of 30 patients with HF who were admitted to our hospital due to new onset of decompensated HF, having LV ejection fraction < 40%, with functional status class III–IV, according to the New York Heart Association (NYHA). TDI-derived systolic velocities of tricuspid annulus (isovolumic myocardial acceleration [IVA], peak myocardial velocity during isovolumic contraction [IVV], peak systolic velocity during ejection period [Sa]) and diastolic indices (early [Ea] and late diastolic [Aa] velocities, Ea/Aa, E/Ea ratios and myocardial performance index [Tei index]) were measured. 72 hours after treatment, all measurements were re-evaluated.Results: Considering TDI-derived systolic indices of the RV, IVA and IVV increased significantly, whereas Tei index decreased, after the therapy. Also, there was a significant decrease in serum levels of B-type natriuretic peptide. No significant change was observed in TDI derived diastolic indices of the RV.Conclusıons: Levosimendan improves RV systolic function as expressed by TDI-derived parameters in patients with acutedecompensated HF.Wstęp: Dysfunkcja prawej komory (RV) jest powikłaniem zaawansowanej lewokomorowej (LV) niewydolności serca (HF) i wiąże się ze złym rokowaniem. Lewosimendan to lek o działaniu inotropowym dodatnim, który u chorych z HF poprawia kurczliwość serca, nie zwiększając zużycia tlenu przez miokardium.Cel: Celem niniejszej pracy była ocena wpływu leczenia lewosimendanem na czynność skurczową RV u chorych z niedokrwienną HF na podstawie badania z zastosowaniem doplera tkankowego (TDI).Metody: W badaniu uczestniczyło 30 chorych z HF hospitalizowanych w ośrodku autorów z powodu pojawienia się objawów niewyrównanej HF, u których frakcja wyrzutowa LV wynosiła poniżej 40% i których zakwalifikowano do III–IV klasy czynnościowej wg New York Heart Association (NYHA). Za pomocą TDI zmierzono prędkości pierścienia zastawki trójdzielnej w czasie skurczu [akceleracja (IVA) i maksymalna prędkość miokardium w czasie skurczu izowolumetrycznego (IVV) oraz maksymalna prędkość miokardium w czasie fazy wyrzutowej (Sa)] i wskaźniki czynności rozkurczowej [prędkości wczesno- (Ea) i późnorozkurczowe (Aa), współczynniki Ea/Aa i E/Ea oraz wskaźnik Tei]. Wszystkie pomiary powtórzono 72 h po przyjęciu leku.Wyniki: Po zakończeniu leczenia oceniane za pomocą TDI wskaźniki czynności skurczowej RV, IVA i IVV istotnie się zwiększyły, natomiast wartość wskaźnika Tei zmniejszyła się. Ponadto stwierdzono istotne obniżenie stężenia peptydu natriuretycznego typu B w surowicy. Nie zaobserwowano istotnych zmian we wskaźnikach czynności rozkurczowej RV ocenianych za pomocą TDI.Wnioski: U pacjentów z ostrą niewyrównaną HF lewosimendan poprawia czynność skurczową RV ocenianą na podstawie parametrów mierzonych metodą TDI

Evaluation of the effect of L-thyroxin therapy on endothelial functions in patients with subclinical hypothyroidism

Subclinical hypothyroidism (SH) is characterized by normal serum free T4 (FT4), free T3 (FT3) levels and increased serum thyroid-stimulating hormone (TSH) levels. Endothelial dysfunction, which is an early step of atherosclerosis, has been reported in patients with subclinical hypothyroidism. The aim of this study is to evaluate endothelial functions and the effect of L-thyroxin (L-T4) therapy on endothelial functions in SH. Twenty-seven patients with SH and 22 healthy controls were evaluated in terms of endothelial functions, using brachial artery Doppler ultrasonography. After restorating euthyroidism, measurements were repeated. Baseline and nitroglycerin induced diameter (NID) of brachial artery were similar in patients with SH and the control group. Compared to the control group, the patients with SH showed significantly reduced flow-mediated diameter (FMD). Baseline and NID values were significantly higher after LT4 therapy in SH group. FMD also significantly increased after LT4 therapy. Hypothyroidism accelerates atherogenesis through modification of athero-sclerotic risk factors and direct effects on the blood vessels. In this study, we observed marked improvement in endothelial functions after L-T4 therapy in SH patients. We suggest that thyroid hormone replacement therapy may help to prevent atherosclerosis in this group of patients

Orbital apex syndrome in herpes zoster ophthalmicus.

Orbital apex syndrome is a rare manifestation of Herpes Zoster Ophthalmicus. Herein we report on a case of orbital apex syndrome secondary to Herpes Zoster Ophthalmicus. A 75 year-old male complained of vision loss, conjunctival hyperemia and proptosis on the left eye, was referred to our clinic. Visual acuity was 5/10 Snellen lines and he had conjunctival hyperemia, chemosis, minimal nuclear cataract and proptosis on the left eye. A diagnosis of orbital pseudotumor was demonstrated firstly. The patient received oral and topical corticosteroids, antiinflammatory and antibiotic agents. On day 2, vesiculopustular lesions were observed, Herpes Zoster Ophthalmicus was diagnosed and corticosteroid treatment stopped, oral acyclovir treatment initiated. Two days later, total ophthalmoplegia, ptosis and significant visual loss were observed on the left. The diagnosis of orbital apex syndrome was considered and the patient commenced on an intravenous acyclovir treatment. After the improvement of acute symptoms, a tapering dose of oral cortisone treatment initiated to accelarate the recovery of ophthalmoplegia. At 5-month follow-up, ptosis and ocular motility showed improvement. VA did not significantly improve because of cataract and choroidal detachment on the left. We conclude that ophthalmoplegia secondary to Herpes Zoster Ophthalmicus responds favourably to intravenous acyclovir and steroids

Analiza porównawcza całkowitej liczby leukocytów i określonego typu leukocytów między grupami pacjentów z izolowanym nadciśnieniem skurczowym, nadciśnieniem skurczowo-rozkurczowym i prawidłowym ciśnieniem tętniczym

Background: Isolated systolic hypertension (ISHT) is a subtype of hypertension (HT) that often exhibits wide pulse pressure, and pulse pressure has a strong predictive value for future adverse cardiovascular events. Previous studies have shown the effects of leukocyte count on the prognosis of ischaemic heart disease and HT. Aim: Thus, in this cross-sectional study, we analysed the relationship between leukocyte counts and subtypes in HT and non-HT groups. Methods: The study population consisted of 960 consecutive patients who were admitted to the outpatient clinic of our hospital. After ambulatory blood pressure values were assessed, the participants were divided into three groups: ISHT (n = 98), systo-diastolic hypertensives (SDHT, n = 405), and non-hypertensives (non-HT, n = 457). Results: The subjects in the ISHT group were older than those in the SDHT and non-HT groups (64 ± 10, 53 ± 12, and 52 ± 13, respectively; p < 0.001). The leukocyte and neutrophil counts and neutrophil/lymphocyte (NL) ratios were significantly different in all groups. In subgroup analysis, the leukocyte count, neutrophil count, and N/L ratio were higher in the ISHT and SDHT groups than in the non-HT group (p < 0.001 for all). The leukocyte count, neutrophil count, and N/L ratio were significantly higher in the ISHT group than in the SDHT group (p = 0.023, p = 0.007, p = 0.010, respectively). Neutrophil count (p = 0.012; OR = 1.229, 95% CI 1.046–1.444) was an independent risk factor for ISHT in multivariate logistic regression analysis. Conclusions: The leukocyte and neutrophil counts and N/L ratios were higher in the ISHT group than in the SDHT and non-HT groups. High neutrophil count was an independent predictor of ISHT. Wstęp: Izolowane nadciśnienie tętnicze (ISHT) jest typem nadciśnienia tętniczego (HT), w którym często występuje wysokie ciśnienie tętna. Ciśnienie tętna ma dużą wartość predykcyjną w odniesieniu do przyszłych niepożądanych zdarzeń sercowych. Wcześniejsze badania wykazały, że liczba leukocytów wpływa na rokowanie dotyczące choroby niedokrwiennej serca oraz HT. Cel: Celem badania było przeanalizowanie zależności między liczbą leukocytów i liczbą określonego typu leukocytów u osób zakwalifikowanych do grup z HT lub grupy bez HT. Metody: Do badania włączono 960 kolejnych pacjentów przyjętych do poradni przyszpitalnej. Po ambulatoryjnym pomiarze ciśnienia tętniczego uczestników podzielono na trzy grupy: osoby z ISHT (n = 98), osoby ze skurczowo-rozkurczowym HT (n = 405) i osoby z prawidłowym ciśnieniem tętniczym (n = 457). Wyniki: Pacjenci z grupy ISHT byli starsi niż osoby ze skurczowo-rozkurczowym HT oraz osoby z prawidłowym ciśnieniem tętniczym (bez HT) (odpowiednio 64 ± 10, 53 ± 12 i 52 ± 13; p < 0,001). Liczba leukocytów, liczba neutrofili i współczynniki N/L różniły się istotnie między grupami. W analizie podgrup wykazano, że liczba leukocytów, liczba neutrofili i współczynnik N/L były wyższe w grupach osób z ISHT oraz skurczowo-rozkurczowym HT niż u pacjentów z prawidłowym ciśnieniem tętniczym (p < 0,001 dla wszystkich porównań). Liczba leukocytów, liczba neutrofili i współczynniki N/L były istotnie wyższe w grupie z ISHT niż w grupie ze skurczowo-rozkurczowym HT (odpowiednio: p = 0,023; p = 0,007; p = 0,010). Liczba neutrofili (p = 0,012; OR = 1,229; 95% Cl 1,046–1,444) była niezależnym czynnikiem ryzyka ISHT w wieloczynnikowej analizie regresji logistycznej. Wnioski: Liczba leukocytów, liczba neutrofili i współczynnik N/L były większe w grupie ISHT niż w grupach ze skurczowo-rozkurczowym HT i z prawidłowym ciśnieniem tętniczym. Duża liczba neutrofili była niezależnym czynnikiem predykcyjnym ISHT.