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

Evaluation of the effect of mitral stenosis severity on the left ventricular systolic function using isovolumic myocardial acceleration

Background: Isovolumic acceleration (IVA) is a new tissue Doppler parameter in the as­sessment of systolic function of both left and right ventricles. It remains unaffected with the changes in pre- and after-load within the physiological range. The aim of our study was to assess the effect of mitral stenosis degree, which is determined by echocardiography, on the left ventricular (LV) function using IVA. Methods: A total number of 62 patients with mitral stenosis (MS) and 32 healthy controls were examined. The severity of MS (mild, moderate, and severe) was determined on the basis of mitral valve area (MVA) and the mean diastolic mitral gradient findings. The peak myocardial velocities during isovolumic contraction, systole, early diastole and late diastole were measured by using tissue Doppler imaging (TDI). Results: All TDI-derived global LV basal wall systolic (peak myocardial isovolumic contra­ction velocity, peak myocardial systolic velocity and IVA), and diastolic velocities (peak early and late diastolic velocities) were significantly decreased in the patients with MS, compared to the healthy patients (p < 0.001, for all). However, IVA was not different when the degree of MS was evaluated (p = 0.114). In addition, IVA was not correlated with the MVA (r = 0.185, p = 0.150). Conclusions: Left ventricular function is impaired in patients with MS regardless of the severity of the disease.

Decreased neurotensin levels as a biomarker in resistant hypertension

Objective: Although neurotensin is found throughout the body including cardiovascular structures, the correlation of plasma neurotensin levels with resistant hypertension (RH) has never been examined. Therefore, we aimed to compare plasma neurotensin concentration, between patients with RH and those with controlled hypertension (CH). Methods: Forty-one patients with RH and 45 patients with CH who had undergone outpatient ambulatory blood pressure measurements were prospectively recruited. RH was defined as uncontrolled blood pressure despite using three antihypertensive agents including a diuretic or need of four or more drugs to control blood pressure. The demographic properties, medications, laboratory parameters including neurotensin levels, and echocardiographic parameters were recorded. Results: There was no significant difference among groups in terms of age, sex, smoking or body mass index. Office and ambulatory blood pressures and mean number of antihypertensive drugs used were significantly higher in patients with RH compared to patients with CH. Plasma neurotensin levels were significantly lower in patients with RH (median: 0.380 ng/ml; interquartile range: 0.292–0.471) than in the patients with controlled blood pressure (median: 0.638 ng/ml; interquartile range: 0.483–0.783). Multivariate and receiver-operating characteristics curve analyses showed that neurotensin is an independent predictor for RH and the optimal cut-off value of neurotensin for RH was lower than 0.509 ng/ml, with a sensitivity of 85.4% and a specificity of 73.3% (area under the curve = 0.793, 95% CI: 0.691–0.894, p < .001) Conclusion: This study is the first to show a correlation between lower neurotensin levels and RH

A new gap in the novel anticoagulants' era: undertreatment

After long years of using warfarin for atrial fibrillation, new oral anticoagulants (NOACs) became available for decreasing the risk of ischemic stroke. Our aim was to observe the physicians prescribing patterns of NOACs. This prospective observational study included patients using NOACs applying consecutively to our outpatient clinic. Physical examination was performed, and patient history, electrocardiogram, transthoracic echocardiography, and biochemical results were collected. Bleeding and ischemic stroke risk scores (HAS-BLED and CHA(2)DS(2)-VASc scores) were calculated. We evaluated patients' characteristics, risk factors, concomitant drug usage, and physicians' choices. The study consisted of 174 patients using NOACs (dabigatran 113 patients, rivaroxaban 61 patients), with a mean age of 70.7 +/- 8.8 years. The mean HAS-BLED score was 1.74 +/- 0.9 and the mean CHA(2)DS(2)-VASc score was 3.7 +/- 1.2. Fifty-three (30.4%) patients were prescribed low-dose NOAC according to the optimal dose, and 12 (6.8%) patients were prescribed high-dose NOAC according to the optimal dose. We compared optimal dose and undertreatment groups to find out if there was any predicting factor for physicians to use low dose of NOACs, but there was no significant difference between the two groups for age, sex, concomitant chronic disease, and CHA(2)DS(2)-VASc and HAS-BLED scores. NOACs were prescribed to patients mostly with high CHA(2)DS(2)-VASc score and low HAS-BLED score. Low-dose NOAC usage according to the optimal dose was frequent. Frequent coagulation monitoring and drug incompliance are big deficiencies at atrial fibrillation in use of warfarin. NOACs overcome these difficulties; however, physicians' hesitation to use NOACs with the optimal dosage may be another limitation in real-world practice. Copyright (c) 2015 Wolters Kluwer Health, Inc. All rights reserved

Hypervolemia rather than arterial calcification and extracoronary atherosclerosis is the main determinant of pulse pressure in hemodialysis patients

Pulse pressure (PP) has been reported as an independent predictor of cardiovascular mortality in hemodialysis patients. In this study, we aimed to investigate association of PP with echocardiographic and vascular structural changes such as atherosclerosis and arterial calcifications in HD patients

QT dispersion predicts mortality and correlates with both coronary artery calcification and atherosclerosis in hemodialysis patients

QT dispersion (QTd) was shown to be an independent predictor of mortality in hemodialysis (HD) patients. It may be hypothesized that coronary artery calcification is related to QTd in HD patients because widespread calcification may also involve the cardiac conducting system in these patients. In this study, we aimed to investigate the relationships of corrected QTd (QTcd) with coronary artery calcification score (CACS), carotid plaque score (CPS) and possible influence of these parameters on survival of HD patients

Wartość prognostyczna stosunku średniej objętości do liczby płytek krwi przy przyjęciu do szpitala u pacjentów z zawałem serca z uniesieniem odcinka ST poddanych pierwotnej przezskórnej angioplastyce wieńcowej

Background: Mean platelet volume to platelet count (MPV/Plt) ratio has been demonstrated to be a good indicator of long-term mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). However, the prognostic value of MPV/Plt in ST-elevation myocardial infarction (STEMI) is not reported. Aim: To determine whether the MPV/Plt ratio on admission has any predictive value for major adverse cardiac events includ­ing short- and long-term mortality in STEMI. Methods: In this prospective study, 470 STEMI patients who underwent primary percutaneous coronary intervention (PCI) were enrolled. The patients were divided into three tertiles based on the MPV/Plt ratio on admission. The first tertile (n = 149) was defined as MPV/Plt ratio ≤ 0.029, second tertile (n = 154) 0.029–0.038, and third tertile (n = 159) ≥ 0.038. Primary clinical outcomes consisted of the sum of cardiovascular (CV) mortality, non-fatal re-infarction, and stroke. Secondary clini­cal outcomes were CV mortality, non-fatal re-infarction, target-vessel revascularisation, stroke, and advanced heart failure. Results: There was no difference between study groups regarding the primary (p &gt; 0.05) and the secondary outcomes (p &gt; 0.05) except for one-year non-fatal re-infarction rate, which was found to be significantly higher in the highest MPV/Plt ratio group (p = 0.045). Age, Killip class &gt; 1, and left ventricular ejection fraction were found to be independent predictors of long-term CV mortality in multivariate analysis (p = 0.009, p = 0.035, and p &lt; 0.001, respectively). Conclusions: While the MPV/Plt ratio was demonstrated to be associated with one-year non-fatal re-infarction, it was not related to in-hospital, one-month, and one-year CV mortality in patients with STEMI, who underwent primary PCI.Wstęp: Wykazano, że stosunek średniej objętości do liczby płytek krwi (MPV/Plt) jest dobrym wskaźnikiem śmiertelności w obserwacji długookresowej u pacjentów z zawałem serca bez uniesienia odcinka ST. Jednak brakuje doniesień na temat wartości prognostycznej współczynnika MPV/Plt u chorych z zawałem serca z uniesieniem odcinka ST (STEMI). Cel: Celem badania było ustalenie, czy współczynnik MPV/Plt przy przyjęciu do szpitala ma wartość prognostyczną w odnie­sieniu do poważnych zdarzeń sercowych, w tym śmiertelności wczesnej i odległej u pacjentów z STEMI. Metody: Do tego prospektywnego badania włączono 470 chorych z STEMI, których poddano pierwotnej przezskórnej an­gioplastyce wieńcowej (PCI). Chorych podzielono na tercyle w zależności od wartości współczynnika MPV/Plt przy przyjęciu do szpitala. Pierwszy tercyl (n = 149) definiowano jako współczynnik MPV/Plt o wartości ≤ 0,029, drugi tercyl (n = 154) — 0,029–0,038, a trzeci tercyl (n = 159) — ≥ 0,038. Główny kliniczny punkt końcowy obejmował zgony sercowo-naczyniowe (CV) oraz zawał serca i udar mózgu niezakończone zgonem. Do drugorzędowych klinicznych punktów końcowych należały: zgon CV, ponowny zawał serca niezakończony zgonem, rewaskularyzacja docelowego naczynia, udar mózgu i zaawansowana niewydolność serca. Wyniki: Nie stwierdzono różnic między grupami pod względem punktów końcowych, głównego (p &gt; 0,05) i drugorzędowych (p &gt; 0,05), oprócz częstości ponownych zawałów serca niezakończonych zgonem w ciągu roku, która była istotnie wyższa w grupie z najwyższym współczynnikiem MPV/Plt (p = 0,045). W analizie wieloczynnikowej wykazano, że wiek, klasa Kil­lipa &gt; 1 i frakcja wyrzutowa lewej komory były niezależnymi czynnikami prognostycznymi śmiertelności CV w obserwacji długookresowej (odpowiednio p = 0,009; p = 0,035 i p &lt; 0,001). Wnioski: Współczynnik MPV/Plt wiązał się z roczną częstością ponownych niezakończonych zgonem zawałów serca, jednak nie był związany z wewnątrzszpitalną, miesięczną ani roczną śmiertelnością u chorych z STEMI poddanych pierwotnej PCI