Evaluation of left ventricular systolic asynchrony in patients with subclinical hypothyroidism

Background: The heart was very sensitive to fluctuating thyroid hormone levels. To assess intra-left ventricular (LV) systolic asynchrony in patients with subclinical thyroid dysfunction. Methods: Fifty patients with subclinical hypothyroidism and 40 controls were included. A diagnosis of subclinical hypothyroidism was reached with increased TSH and normal free T4. All subjects were evaluated by echocardiography. Evaluation of intra-LV systolic asynchrony was performed by tissue synchronization imaging (TSI), and four TSI parameters of systolic asynchrony were calculated. LV asynchrony was defined by these parameters. Results: All of the groups were similar in terms of demographic findings and conventional and Doppler echocardiograpic parameters except peak systolic velocity and early diastolic velocity. LV systolic asynchrony parameters of TSI including; standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any 2 of the 12 LV segments (Ts-12), standard deviation of TS of the 6 basal LV segments (Ts-SD-6), maximal difference in Ts between any of the 6 basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism than controls (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The prevalence of LV asynchrony was significantly higher in patients with subclinical hypothyroidism than control. Conclusions: Patients with subclinical hypothyroidism present evidence of LV asynchrony by TSI. LV systolic asynchrony could be a warning sign of the early stage in cardiac systolic dysfunction in subclinical hypothyroid patients

Evaluation of left atrial mechanical functions and atrial conduction abnormalities in patients with clinical hypothyroid

Background: The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical delay and P wave dispersion in hypothyroid patients. Methods: Thirty-four patients with overt hypothyroid and thirty controls were included. A diagnosis of overt hypothyroid was reached with increased serum TSH and decreased free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay (EMD) were measured by tissue Doppler imaging (TDI). P wave dispersion was calculated by 12 lead electrocardiograms. Results: LA diameter were significantly higher in patients with overt hypothyroid (p = 0.021). LA passive emptying volume and LA passive emptying fraction were significantly decreased with hypothyroid patients (p = 0.002 and p < 0.001). LA active emptying volume and LA active emptying fraction were significantly increased with hypothyroid patients (p < 0.001 and p < 0.001). Intra- and interatrial EMD, were measured significantly higher in hypothyroid patients (30.6 &#177; 6.1 vs 18.0 &#177; 2.7, p < 0.001; and 10.6 &#177; 3.4 vs 6.9 &#177; 1.4, p < 0.001, respectively). P wave dispersion were significantly higher in hypothyroid patients (48.8 &#177; 6.2 vs 44.3 &#177; 7.2, p = 0.022). In stepwise regression analysis demonstrated that, interatrial EMD and LA active emptying fraction related with TSH and fT4. Conclusions: This study showed that impaired LA mechanical and electromechanical function in hypothyroid patients. TSH and T4 were independent determinant of interatrial EMD and LA active emptying fraction

Ocena zaburzeń przewodzenia przedsionkowego i czynności mechanicznej lewego przedsionka u chorych z subklinicznymi zaburzeniami czynności tarczycy

Introduction: Changes of thyroid hormones levels may lead to effects, not only in ventricular function, but also atrial function. The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical coupling and P wave dispersion in patients with subclinical thyroid disorders. Material and methods: Eighty patients with subclinical thyroid disorders and forty controls were included. A diagnosis of subclinical thyroid disorders were reached with increased or decreased serum TSH and normal free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay were measured by tissue Doppler imaging (TDI). Results: All groups had similar demographic findings. LA mechanical functions significantly impaired in subclinical thyroid disorders than control group. Intra- and Interatrial delay, were measured significantly higher in patients with subclinical thyroid disorders than control group. PA lateral and interatrial delay were positively correlated with TSH (r = 0.507, p = 0.006 and r = 0.455, p = 0.015, respectively) in subclinical hypothyroid patients. There was negative correlation between TSH and interatrial delay (r = &#8211;0.492, p = 0.006) in subclinical hyperthyroid patients. Linear multivariate regression analysis demonstrated that, TSH was the only an independent factor of interatrial delay in patients with subclinica tlhyroid disorders. Conclusions: This study showed that impaired LA mechanical and electromechanical function in subclinical thyroid disorders. TSH was an independent determinant of interatrial delay. Prolonged atrial electromechanical coupling time and impaired mechanical atrial functions may be related to the increased incidence of arrhythmias.Wstęp: Zmiany stężeń hormonów tarczycy mogą wpływać nie tylko na czynność komór serca, ale również na czynność przedsionków. Niniejsze badanie przeprowadzono w celu oceny czynności mechanicznej lewego przedsionka (LA), sprzężenia elektromechanicznego i dyspersji załamka P u chorych z subklinicznymi zaburzeniami czynności tarczycy. Materiał i metody: Do badania włączono 80 chorych z subklinicznymi zaburzeniami czynności tarczycy i 40 osób stanowiących grupę kontrolną. Zaburzenia czynności tarczycy rozpoznawano na podstawie obniżonego lub podwyższonego stężenia TSH w surowicy i prawidłowego stężenia wolnej T4 (fT4). Zmierzono objętości LA, posługując się dwupłaszczyznową metodą area-lenght (pole&#8211; wymiar podłużny). Obliczono również objętości i frakcje aktywnego i biernego opróżniania LA. Do pomiaru opóźnienia przewodnictwa wewnątrzi międzyprzedsionkowego zastosowano technikę doplera tkankowego. Wyniki: Grupy nie różniły się pod względem charakterystyki demograficznej. W grupie z zaburzeniami czynności tarczycy mechaniczna funkcja przedsionków była istotnie upośledzona w porównaniu z osobami z grupy kontrolnej. Opóźnienie przewodnictwa wewnątrzi międzyprzedsionkowego stwierdzano istotnie częściej u osób z zaburzeniami czynności tarczycy. Stwierdzono dodatnią korelację miedzy opóźnieniem elektromechanicznym (PA lateral) i opóźnieniem przewodzenia międzyprzedsionkowego a TSH (odpowiednio r = 0,507; p = 0,006 i r = 0,455; p = 0,015) u osób z subkliniczną niedoczynnością tarczycy. Z kolei u osób z subkliniczną nadczynnością tarczycy zaobserwowano ujemną korelację między TSH i opóźnieniem przewodzenia międzyprzedsionkowego (r = &#8211;0,492; p = 0,006). W wieloczynnikowej analizie regresji liniowej wykazano, że stężenie TSH było jedynym parametrem niezależnie związanym z opóźnieniem przewodzenia międzyprzedsionkowego u chorych z subklinicznymi zaburzeniami czynności tarczycy. Wnioski: W niniejszym badaniu wykazano upośledzoną czynność mechaniczną i elektromechaniczną LA u chorych z subklinicznymi zaburzeniami czynności tarczycy. Stężenie TSH było niezależnym czynnikiem determinującym opóźnienie przewodzenia międzyprzedsionkowego. Wydłużenie czasu sprzężenia elektromechanicznego i upośledzenie mechanicznej czynności przedsionków mogą się wiązać ze zwiększoną zapadalnością na zaburzenia rytmu

Korelacja odsetka hemoglobiny glikowanej z ciężkością choroby wieńcowej występująca u młodych osób niezależnie od tradycyjnych czynników ryzyka

Introduction: In this study, we aimed to investigate the relationship between glycated haemoglobin (HbA1c) levels and the severity of coronary artery disease (CAD) in < 40 years old patients. Material and methods: The study population consisted of 211 premature coronary atherosclerotic patients (pCAP) (aged 36.4 &#177; 2.5 years) and 160 control subjects (36.4 &#177; 2.4 years). The severity of CAD was evaluated by the Gensini scoring system. HbA1c levels and the other basic biochemical parameters were analysed, and relations with severity of CAD were evaluated. Results: There were statistically significant differences in serum HbA1c levels between the two groups (pCAP = 6.1 &#177; 1.8%, control = 4.7 &#177; 1.2%, p < 0.001). HbA1c levels significantly positively correlated with the Gensini score in pCAP (r = 0.662, p < 0.001). In linear multivariate regression analysis (including age, sex, HbA1c, smoking, diabetes mellitus and hypertension as dependent parameters), only HbA1c was found to be an independent risk factor for the presence of severe CAD (Beta = 0.374, p < 0.001). In ROC curve analysis, the optimal cut-off value of HbA1c to predict severe CAD was 6.52%, with 74.4% sensitivity and 75.1% specificity (area under the curve 0.781, 95% confidence interval 0.661 to 0.901, p < 0.001). Conclusions: HbA1c levels were found to be correlated with the Gensini score in pCAP with and without diabetes. In this respect, glucose metabolism abnormalities, indicated by HbA1c, may play an important role in premature CAD. (Endokrynol Pol 2012; 63 (5): 367-371)Wstęp: Niniejsze badanie przeprowadzono w celu oceny zależności między odsetkiem hemoglobiny glikowanej (HbA1c) a ciężkością choroby wieńcowej (CAD) u chorych w wieku < 40 lat. Materiał i metody: Badana populacja składała się z 211 chorych z przedwczesną miażdżycą tętnic wieńcowych (pCAP) (w wieku 36,4 &#177; 2,5 roku) i 160 osób stanowiących grupę kontrolną (36,4 &#177; 2,4 roku). Ciężkość CAD określano na podstawie wartości wskaźnika Gensiniego. Przeanalizowano odsetek HbA1c oraz inne wyjściowe parametry biochemiczne i oceniono ich zależności z ciężkością CAD. Wyniki: Stwierdzono statystycznie istotne różnice między grupami w zakresie stężeń HbA1c w surowicy (pCAP = 6,1 &#177; 1,8%, grupa kontrolna = 4,7 &#177; 1,2%; p < 0,001). Wartości HbA1c były istotnie skorelowane z wartościami wskaźnika Gensiniego u chorych z pCAP (r = 0,662; p < 0,001). W wieloczynnikowej analizie regresji liniowej (w której uwzględniono wiek, płeć, stężenie HbA1c, palenie tytoniu, cukrzycę i nadciśnienie tętnicze jako zmienne zależne) jedynie stężenie HbA1c okazało się niezależnym czynnikiem ryzyka wskazującym na występowanie ciężkiej CAD (Beta = 0,374; p < 0,001). Jak wykazano w analizie krzywych ROC, optymalny punkt odcięcia wartości HbA1c pozwalający prognozować ciężką CAD wynosi 6,52%, przy czułości metody 74,4% i swoistości 75,1% (pole pod krzywą 0,781, 95-proc. przedział ufności 0,661&#8211;0,901; p < 0,001). Wnioski: U osób z pCAP, zarówno chorych na cukrzycę, jak i bez tej choroby, stwierdzono korelacje między wartościami HbA1c i wskaźnikiem Gensiniego. Jak wynika z powyższych obserwacji, zaburzenia metabolizmu glukozy, których wyznacznikiem jest odsetek HbA1c, mogą odgrywać ważną rolę w rozwoju przedwczesnej CAD. (Endokrynol Pol 2012; 63 (5): 367-371

Evaluation of chromosomal abnormalities and common trombophilic mutations in cases with recurrent miscarriage

Background: Recurrent miscarriage (RM) is a frequent obstetric problem. Its’ pathophysiology is poorly understood. Infections, genetic, endocrine, anatomic and immunologic problems have been suggested as causes for RM. Objective: To evaluate the frequency of chromosomal abnormalities and 3 common thrombophilic mutations in couples with RM. Methods: A retrospective data collection was performed for the results of the cytogenetic analysis of the couples and Methylenetetrahydrofolate Reductase (MTHFR) C677T, Factor V Leiden (FVL) G1691A and Prothrombin (PTm) G20210A mutations of the mother in 142 couples suffering from RM. Results: Prevalence of FVL, MTHFR, and PTm gene mutations were similar between cases shaving 2 or ≥3 abortions (P=0.528; P=0.233; P=0.375). In patients with FVL, MTHFR and PTm gene mutations, the OR’s of having ≥3 abortions when compared to having 2 abortions were 1.515 (95% CI: 0.414-5.552), 0.573 (95% CI: 0.228-1.441), and 2.848 (95% CI: 0.355-22.871). All cases with PTm mutation had ≥3 abortions and all abortions occurred between 6-8 gestational weeks. Conclusion: Chromosomal abnormalities and thrombophilic mutations (especially PTm) seem to have an important role in RM. Additional larger studies involving investigation of more genes that may have a role in pregnancy are needed to assess this association

Alterations in placental pendrin expression in pre-eclampsia

oktay, murat/0000-0002-0893-4444;WOS: 000333583100007PubMed: 23941406Introduction: Pendrin is an integral membrane protein and plays a key role in extracellular fluid volume and blood pressure control. We aimed to investigate the relationship between pendrin immunostaining intensity in normal and pre-eclamptic placental tissue. Methods: Fifty-six placental tissues, of which 26 were in pre-eclamptic, and 30 were in control group were evaluated by immunohistochemical staining. Positive immunostaining was evaluated using a semiquantitative score: 0, negative; +, mild; ++, moderate; and +++, intense. Results: There was more positive immunstaining in the pre-eclamptic placenta compared to the controls (p<0.001). A significant positive correlation was observed between immunostaining level and diastolic blood pressure (r = 0.533, p = 0.005) in the pre-eclamptic group. However, no significant correlation was observed between any condition and immunostaining level in the control group. Conclusions: Placentas in the pre-eclamptic group were significantly more immunostained with pendrin than were those in the control group. In addition, a positive correlation between immunostaining intensity with pendrin and both systolic and diastolic blood pressure were observed. Pendrin may play a role in the mechanism of severe hypertension in women with pre-eclampsia

Diagnostic accuracy of P-wave dispersion in prediction of maintenance of sinus rhythm after external cardioversion of atrial fibrillation

WOS: 000287018600007PubMed: 21183416Objective: P-wave dispersion (PWD) is an electrocardiographic measurement, which reflects a disparity in an atrial conduction. In this study, we aim to demonstrate the diagnostic accuracy of PWD in predicting recurrence of atrial fibrillation (AF) in patients with sinus rhythm restoration after external cardioversion. Methods: This prospective, observational study consists of 26 patients, who underwent external cardioversion for non-valvular persistent AF and successfully cardioverted to sinus rhythm (13 men, mean age 58.1+/-11 years). Twelve-lead surface electrocardiogram of each patient was recorded immediately after the external cardioversion process to measure the P-wave duration. Recurrent AF was assessed for each patient during the 12-month follow-up after restoring the sinus rhythm. Patients were divided into the 2 groups with respect to the AF recurrence (recurrent AF group, (n=19), and sinus rhythm group, (n=7)) and variables that can affect AF development were compared between the two groups. Stepwise logistic regression analysis was used to identify the independent predictors of AF recurrence and ROC curve analysis was performed to determine the cut-off value of independent factors. Results: The two groups have similar demographic, clinical and echocardiographic features. Patients with recurrent AF had significantly higher PWD than those who continued to have a sinus rhythm (80+/-21 msec vs 53+/-11 msec, p=0.001, respectively). There is a positive correlation observed between the increase in PWD and the risk of AF recurrence (r=0.643; p<0.001). In logistic regression analysis, PWD was found to be an independent predictor of AF recurrence (OR 1.192 (95% Cl 1.032-1.375), p=0.013). Receiver operating characteristic analysis revealed that the best cut-off value of PWD for maintenance of sinus rhythm was 58 msec (sensitivity: 86%, specificity: 95%, AUC=0.917, 95% CI=0.785-1.05, p=0.001). Conclusion: This study suggests that PWD analysis after successful external cardioversion has diagnostic accuracy to predict the recurrence of AF (Anadolu Kardiyol Derg 2011 1: 34-8

Renal Biopsy Prognostic Findings in Children With Atypical Hemolytic Uremic Syndrome

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