Body composition indices and electromechanical durations in metabolic syndrome

Aim: To examine electromechanical delay (EMD) a predictive of atrial fibrillation (AF) risk, in obese and non-obese metabolic syndrome (MS) patients and to research the relationship between EMD and the new body composition indices. Method: 118 overweight (body mass index (BMI)>26 kg/m2) individuals with MS meeting the criteria for IDF and ATP III were included in the study. The subjects were divided into two groups: Group 1; 54 obese persons with MS (33 females; mean age 46.2±14.1) while Group 2 included 64 non-obese persons with MS (33 females; mean age 41.4±13.2). In addition to laboratory findings, body composition indices, conventional and tissue Doppler imaging were obtained. Atrial EMD was defined as the time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the late diastolic A wave. Inter, intra and left atrial EMD’s were measured from the data obtained. Results: Inter, intra and left atrial EMDs were significantly greater in the obese group compared to the non-obese group. There was a significant correlation between interatrial EMD and left atrial EMD and all body composition indices except body surface index. The strongest correlation was between body roundness index (BRI) and interatrial and left atrial EMD (r=0.46; p<0.001, r=0.39; p<0.001, respectively). Conclusions: EMD intervals were more prolonged in obese subjects with MS than in non-obese subjects with MS. The parameter most relevant to EMD was BRI. BRI is the body composition index most correlated with increased risk for AF in persons with MS. &nbsp

Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome

Objective: To investigate the relationship between maternal vitamin D status and glucose intolerance, and its impact on pregnant women and their newborns. Methods: A cohort of pregnant women were divided into three groups: women with gestational diabetes mellitus, ones with normal results both after the 50 gr and 100 gr OGTT (CG-1) and ones having a positive result after the 50 gr OGTT screening but negative results for gestational diabetes mellitus (GDM) after the 100 gr OGTT (CG-2) Results: The newborn length in CG-1 was greater than in GDM and CG-2 (p= 0.002 and p= 0.02). Fasting blood glucose and insulin resistance (IR) were negatively correlated with length of the newborns (r=-0.3, p=0.03 and r=-0.3, p=0.01). The newborns of women with GDM had lower APGAR-1 and 5 scores than those of CG-1 and CG-2 (APGAR-1 p= 0.001 and p= 0.004, APGAR-5 p=0.005 and p=0.007, respectively). APGAR scores were correlated negatively with IR (APGAR-1 r=- 0.32, p=0.01, APGAR-5 r=-0.3, p=0.03) and positively with 25OHD levels (APGAR-1 r=0.3, p=0.01, APGAR-5 r=0.3, p=0.02). Conclusion: Vitamin D deficiency, gestational diabetes and insulin resistance are interrelated. Severe vitamin D deficiency during pregnancy is associated with poor pregnancy and neonatal outcome

Left ventricular volume: an optimal parameter to detect systolic dysfunction on prospectively triggered 64-multidetector row computed tomography: another step towards reducing radiation exposure

In this study, we define the correlation between LV volumes (both LV end-diastolic volume [LVEDV] and LV end-systolic volume [LVESV]) and ejection fraction (EF) on 64 slice multi-detector computed tomography (MDCT). We also determine the accuracy of all the LV volume (LVV) parameters to detect LV systolic dysfunction (LVSD) and investigate the feasibility of using LVV as a surrogate of LVSD on prospectively gated imaging to prevent the radiation exposure of retrospective imaging. 568 patients undergoing 64-detector MDCT were divided into 2 groups: Group 1—subjects without any heart disease and LVEF ≥ 50%; and Group 2—patients with coronary artery disease and LVEF < 50% (defined as LVSD). The LVV (LV cavity only) and Total LV volume (cavity + LV mass) at end-systole and end-diastole (LVESV, Total LVESV, LVEDV and Total LVEDV) were measured. The upper limit values (mean + 2 SD) of all LVV parameters in Group 1 were used as the reference criterion to diagnose LVSD in Group 2. An exponential correlation was found between LVEF and all the LVV parameters. The specificity to detect LVSD in Group 2 was >90% and the sensitivity was 88.9, 83.3, 61.3 and 74.9% by using LVESV, Total LVESV, LVEDV and Total LVEDV, respectively. Systolic and diastolic LV volumes had a high correlation with LVEF and a high accuracy to detect LVSD. Thus, on prospectively triggered imaging, ventricular volumes can predict patients with reduced LVEF, and appropriate referrals can be made

Non-contrast cardiac computed tomography can accurately detect chronic myocardial infarction: Validation study

BackgroundThis study evaluates whether non-contrast cardiac computed tomography (CCT) can detect chronic myocardial infarction (MI) in patients with irreversible perfusion defects on nuclear myocardial perfusion imaging (MPI).MethodsOne hundred twenty-two symptomatic patients with irreversible perfusion defect (N = 62) or normal MPI (N = 60) underwent coronary artery calcium (CAC) scanning. MI on these non-contrast CCTs was visually detected based on the hypo-attenuation areas (dark) in the myocardium and corresponding Hounsfield units (HU) were measured.ResultsNon-contrast CCT accurately detected MI in 57 patients with irreversible perfusion defect on MPI, yielding a sensitivity of 92%, specificity of 72%, negative predictive value (NPV) of 90%, and a positive predictive value (PPV) of 77%. On a per myocardial region analysis, non-contrast CT showed a sensitivity of 70%, specificity of 85%, NPV of 91%, and a PPV of 57%. The ROC curve showed that the optimal cutoff value of LV myocardium HU to predict MI on non-contrast CCT was 21.7 with a sensitivity of 97.4% and specificity of 99.7%.ConclusionNon-contrast CCT has an excellent agreement with MPI in detecting chronic MI. This study highlights a novel clinical utility of non-contrast CCT in addition to assessment of overall burden of atherosclerosis measured by CAC

Determination and distribution of left ventricular size as measured by noncontrast CT in the Multi-Ethnic Study of Atherosclerosis

BackgroundLeft ventricular (LV) volume and mass have prognostic relevance. Overall size of the left ventricle as it appears in noncontrast CT is a composite of the ventricular volume and myocardial mass. We describe a method to estimate the LV size using a single cross-section in noncontrast CT and determined normal ranges on the basis of a large population cohort.MethodsThe Multi-Ethnic Study of Atherosclerosis with 6814 participants from 4 ethnicities who were free of known cardiovascular disease and enrolled between 2000 and 2002 form the basis of our analysis. LV size was calculated from a single cross-sectional slice obtained by either nonenhanced electron beam or multidetector CT. LV size was adjusted to body surface area to obtain the LV size index, which was adjusted for age, sex, race or ethnicity, hypertension, hyperlipidemia, and diabetes.ResultsThere were significant differences in LV size index by race which were further influenced by age and sex. Higher values were noted in men in all ethnic groups across all age groups. Similarly, LV size index uniformly decreased with age across all ethnic and sex categories. Caucasians had the lowest and African Americans had the highest LV size index across all age and sex categories. In multivariate regression analyses adjusted for age, sex, race or ethnicity, hypertension, hyperlipidemia, smoking, and diabetes mellitus, the significant differences were noted between male vs female (median difference, 17.5 cc/m(2); P &lt; .001), ethnic groups (Caucasian, reference group; Asian, 3.7 cc/m(2); African American, 8.3 cc/m(2); and Hispanic, 5.6 cc/m(2); P &lt; .001), and age groups (45-54 years, reference group; 55-64 years, -5.2 cc/m(2); 65-74 years, -11.4 cc/m(2); and 74-84 years, -12.5 cc/m(2)).ConclusionsThis study provides normative values for LV size as determined from a single, nonenhanced CT cross-section and indexed to body surface area, and it demonstrates that the LV size index varies by age, sex, and ethnic background

Metabolic syndrome and Visceral Adiposity Index in non-functional adrenal adenomas

ABSTRACT Objective: We aimed to identify metabolic dysfunction in non-functioning adrenal adenomas (NFAAs) and Visceral Adiposity Index (VAI) predictability in the practical estimation of metabolic syndrome (MetS) in NFAAs. Subjects and methods: 134 NFAA patients and 68 control subjects matched for age, sex, and body mass index (BMI) were included in the study. After physical, biochemical, and endocrine evaluation, IDF and NCEP ATP III criteria were used to determine MetS. HOMA-IR and VAI were calculated for both study group subjects. Results: MetS was significantly higher in the NFAA patients. The incidence of MetS by IDF and NCEP criteria was 52.9%,48.5% in the NFAI and 32.3%,30.8% in the control group (p < 0.01, p = 0.02). The risk of MetS was increased in NFAA (75.6 vs. 24.4%, p = 0.017, OR = 1.34, 95% CI = 1.06-1.68). Glucose, HOMA IR, hypertension, and VAI were significantly increased in NFAA patients. The risk of MetS was independently associated with high VAI (79.2 vs. 20.8%, p = 0.001, OR = 2.22; 95% CI = 1.70-2.91). Conclusion: MetS, insulin resistance, and VAI are more prevalant in NFAA patients than in healthy individuals. VAI can be used with high specificity to estimate MetS in NFAA patients

C-REACTIVE PROTEIN/ALBUMIN RATIO IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Type 2 diabetes mellitus (T2DM) is an inflammatory condition. C-reactive protein (CRP) is a well-known inflammatory marker for demonstrating systemic inflammation in T2DM. We aimed to compare the diagnostic value of CRP and C-reactive protein to albumin ratio (CAR) in discriminating T2DM patients and healthy controls and to investigate the association of CAR and glycemic control markers. This cross-sectional retrospective study included 173 T2DM patients and 104 healthy control subjects. Serum albumin and CRP levels were measured with spectrophotometric and nephelometric methods, respectively. CAR was calculated by dividing CRP level by albumin level. The median (interquartile range, IQR) CAR in the T2DM patients was significantly higher than those in the controls (0.15 (0.26) vs. 0.06 (0.20), p = 0.002, respectively). In receiver operating characteristics curve analysis (ROC), CAR > 0.0653 had 77.21% sensitivity and 52.44% specificity in discriminating T2DM. The area under ROC curve for CAR was 0.623 (95% CI =0.544-0.701, p=0.002), which was similar to CRP. A positive correlation was found between CAR and body mass index, fasting blood glucose and HbA1c levels. As a result, CAR demonstrated poor sensitivity and specificity for discriminating T2DM patients from healthy subjects and it has little diagnostic utility in diabetes

Measurment of Ankle-Brachial Pressure Index, Homocystein Level, and Evaluation of Coronary Artery Disease Association with Other Macrovascular Diseases in Patients with Myocardial Infarction

We aimed to measure ankle-brachial pressure index (ABPI) and homocysteine levels, and to evaluate frequency of cerebrovascular disease (CVD) and/or peripheral arterial disease (PAD) combination of patients with myocardial infarction (MI). 39 patients (26 males, 13 females) with acute or subacute MI and 36 control cases (9 male, 27 female) were included in the study. ABPI and homocysteine levels were measured, and bilateral carotid-vertebral and bilateral lower extremity arterial Doppler ultrasonography, and coronary angiography were examined. Homocysteine was significantly higher in patient group than control group (p=0.0001). The ABPI was not significantly different in two groups (p=0.428). However the frequency of patients with lower ABPI (&#8804;0.9) was significantly higher compared to the frequency of control patients with lower ABPI (25.6% and 3%, respectively; p=0.02). The combination of the atherosclerotic findings in the carotid artery and coronary artery disease (CAD) were found significantly higher compared to that of the bilateral lower extremity (59%, 25.6%). Screening of CVD should be done in patients with MI history. Determining carotid arterial lesions may be useful for the early diagnosis and treatment of any possible CVD in cases with CAD. Studies with larger numbers of cases are needed. [Med-Science 2013; 2(4.000): 896-906