[Show abstract][Hide abstract] ABSTRACT: Background: The aim of this cross-sectional study was to evaluate cardiac autonomic function by heart rate turbulence (HRT) indices in normotensive and hypertensive individuals with either non-dipper or dipper type circadian rhythm of blood pressure (BP). Methods: A total of 122 patients were allocated into four groups: normotensive/dipper, n = 33; normotensive/non-dipper, n = 31; hypertensive/dipper, n = 29; and hypertensive/non-dipper, n = 29. HRT indices (turbulence slope [TS] and turbulence onset [TO]) were calculated from 24-h ambulatory electrocardiographic recordings. Results: TS values were higher (TS = 10.0 ± 3.4 vs 8.0 ± 1.5, p = 0.004) and TO values were lower (TO = -2.9 [-3.6, -2.2] vs -2.0 [-2.3, -1.9], p = 0.037) in the dipper subgroup of normotensive cases than in the non-dipper subgroup of normotensive cases. Similarly, TS values were higher (TS = 8.4 ± 3.5 vs 6.2 ± 2.9, p = 0.012) and TO values were lower (TO = -2.1 [-3.4, -2.0] vs -1.6 [-1.9, -0.2], p = 0.003) in the dipper subgroup of hypertensive cases than in the non-dipper subgroup of hypertensive cases. Spearman's correlation analyses revealed a high positive correlation between percentage of dipping and TS (r = 0.600, p = 0.001) and a higher negative correlation between percentage of dipping and TO (r = -0.653, p = 0.001). Conclusions: Blunting of the nocturnal fall in BP is associated with impaired.
[Show abstract][Hide abstract] ABSTRACT: Valves, stenosis, and occlusion in the coronary sinus (CS) may affect the success of left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT). We present our experience in percutaneous CS intervention (PCSI) to facilitate LV lead implantation and stabilization.
Transvenous LV lead implantation was attempted for CRT in a total of 255 patients (mean age 61.0 ± 12.5 y; 60 female, 160 ischemic etiologies) from January 2005 to November 2010. Seventeen patients (6.7%) needed PCSI. PCSI indications were stenosis in 10 patients, CS valve in 5 patients, chronic venous occlusion in 1 patient, and LV lead stabilization in 1 patient. CS angioplasty was performed in 16 patients (6.2%) and stenting in 3 patients (1.2%) to facilitate LV lead placement. Two patients needed both balloon angioplasty and stenting. LV leads were successfully inserted in 15/17 (88.2%) of the patients who needed PCSI. There were no complications related to PCSI. The overall success rate of LV lead implantation increased from 238/255 (93.3%) to 253/255 (99.2%) with the use of PCSI.
PCSI is a useful and safe technique in transvenous LV lead placement in case of CS stenosis, valves, and lead instability.
No preview · Article · Apr 2012 · Journal of cardiac failure
[Show abstract][Hide abstract] ABSTRACT: The aim of the present cross-sectional study was to evaluate ventricular repolarization dynamics by QT dynamicity in normotensive and hypertensive individuals with either a non-dipper-type or a dipper-type circadian rhythm of blood pressure (BP).
A total of 103 patients were allocated into four groups as follows: (i) normotensive/dipper, n=28; (ii) normotensive/nondipper, n=26; (iii) hypertensive/dipper, n=25; and (iv) hypertensive/nondipper, n=24. The linear regression slopes of the QT interval measured to the apex and to the end of the T wave plotted against R-R intervals (QTapex/R-R and QTend/R-R slopes, respectively) were calculated from 24-h ambulatory ECG recordings using a dedicated algorithm.
QTapex/R-R and QTend/R-R slopes were higher in the nondipper subgroup of normotensive cases with respect to the dipper subgroup of normotensive cases (QTapex/R-R=0.171±0.017 vs. 0.127±0.023, P=0.001; QTend/R-R=0.159±0.015 vs. 0.133±0.025, P=0.001). QTapex/R-R and QTend/R-R slopes were higher in the nondipper subgroup of hypertensive cases with respect to the dipper subgroup of hypertensive cases (QTapex/R-R=0.187±0.019 vs. 0.133±0.019, P=0.001; QTend/R-R=0.183±0.018 vs. 0.147±0.022, P=0.001). Pearson's correlation analyses revealed a higher negative correlation between night-time decline in BP and QTapex/R-R (r=-0.638, P=0.001). There was also a moderate negative correlation between night-time decline in BP and QTend/R-R (r=-0.504, P=0.001). The correlation coefficients for degree of night-time dipping and QT dynamicity indices were higher in hypertensive groups than in the normotensive groups.
Blunting of the nocturnal fall in BP associates with impaired QT dynamicity indices in both normotensive and hypertensive groups.
No preview · Article · Dec 2011 · Blood pressure monitoring
[Show abstract][Hide abstract] ABSTRACT: Cardiac resynchronization therapy (CRT) has been shown to reduce heart failure-related morbidity and mortality. However, approximately one in three patients do not respond to CRT. The aim of the current study was to determine the parameter(s) which predict reverse remodeling and clinical improvement after CRT.
A total of 54 patients (43 male, 11 female; mean age 61.9 ± 10.5 years) with heart failure and New York Heart Association (NYHA) class III-IV symptoms and in whom left ventricular ejection fraction (LVEF) was £ 35% and QRS duration was ≥ 120 ms, despite optimal medical therapy, were enrolled. An echocardiographic examination was performed before, and six months after, CRT. An echocardiographic response was defined as a reduction of end-systolic volume ≥ 10% after six months, and a clinical response was defined as a reduction ≥ 1 in the NYHA functional class score.
An echocardiographic response was observed in 38 (70.4%) of the patients and a clinical response occurred in 41 (75.9%) of the patients. Of the dyssynchrony parameters, only the aortic pre-ejection interval (APEI) was observed to significantly predict the clinical response (p = 0.048) and echocardiographic response (p = 0.037). A 180.5 ms cut-off value for the APEI predicted the clinical response with a sensitivity of 92.3% and a specificity of 39%, and the echocardiographic response with a sensitivity of 93.0% and a specificity of 42%.
APEI derived from pulsed-wave Doppler, which is available in every echocardiography machine, is a simple and practical method that could be used to select patients for CRT.
Full-text · Article · Nov 2011 · Cardiology journal
[Show abstract][Hide abstract] ABSTRACT: Percutaneous closure of patent foramen ovale (PFO) has been increasingly performed for several indications; mostly due to cryptogenic stroke. In this study we aimed to evaluate the safety and efficacy of transthoracic echocardiographic (TTE) guidance during percutaneous closure of PFO in using the Amplatzer and Occlutech Figulla PFO occluder devices.
Between October 2005 and March 2011, 139 patients (74 male, mean age: 40.4 ± 10.3) underwent transcatheter PFO closure. In all patients transesophageal echocardiography performed subsequently to diagnose, assess the size and evaluate for suitability of the defect for percutaneous closure. During the procedure fluoroscopy and TTE were used for guidance.
Among 139 patients, Amplatzer PFO occluder was used in 74 patients and in 65 of them Occlutech Figulla device was selected for occlusion. The indications for PFO closure were ischemic stroke in 98 (70.5%), recurrent transient ischemic attacks (TIA) in 40 (28.7%), peripheral embolism in 1 (0.8%) of the patients. In all patients, percutaneous intervention was performed successfully under TTE guidance. There have been no neurologic (recurrent strokes or TIAs) and cardiovascular complications during the immediate and long-term follow-up period (2-67 months, median 29). There was significant difference between the mean fluoroscopic time from the beginning which is 8.6 ± 3.4 min in the former versus 3.4 ± 1.9 min in the latter (P < 0.05).
Our study confirms the efficacy and safety of TTE guidance during percutaneous closure of PFO, which shortens the procedural time and obviates the need for general anesthesia or endotracheal intubation.
No preview · Article · Oct 2011 · Echocardiography
[Show abstract][Hide abstract] ABSTRACT: Although predictive value of heart rate recovery (HRR) has been tested in large populations, the reproducibility of HRR in treadmill exercise test has not been assessed prospectively. This prospective study examined whether HRR index has test-retest stability in the short term.
A total of 52 healthy volunteers without cardiovascular risk factors (mean age, 30 ± 10 years, 30 females) underwent standardized graded treadmill exercise test, and the test was repeated on the 7th and the 30th days. The subjects' maximal heart rates and the decrease of heart rate from the peak exercise level to the level of 1, 2, 3, 4, and 5 minutes after the termination of the exercise were examined on each test, and heart rates for each minute from the first, second, and third tests were compared for each individual.
The maximal heart rates on the 1st, 7th, and the 30th days were 179 ± 11, 177 ± 10, 178 ± 10 beats/min, respectively [P = 0.07, intraclass correlation coefficient (ICC) = 0.92], and the 1st minute HRR indices after peak exercise were 33 ± 10, 33 ± 10, 33 ± 11, respectively (P = 0.66, ICC = 0.88). There was no statistical difference in the 2nd, 3rd, 4th, and 5th minute heart rates of the recovery phase among the 1st, 7th, and 30th day treadmill exercise tests, either.
Maximal heart rates and the decline of heart rate to the 5th minute on recovery phase after treadmill exercise test have short-term reproducibility.
No preview · Article · Oct 2011 · Annals of Noninvasive Electrocardiology
[Show abstract][Hide abstract] ABSTRACT: Introduction: Similar to the effect of systemic hypertension on left ventricular disease in which both supra-ventricular tachyarrhythmia and ventricular arrhythmias are more common, it has been postulated that structural changes and enlargement of the right atrium and right ventricle in pulmonary hypertension (PHTN) may predispose patients with PHTN to arrhythmias. The incidence and clinical relevance of supra-ventricular arrhythmias and ventricular arrhythmias in PHTN have not been thoroughly evaluated.
Methods: Using the Nationwide Inpatient Sample (NIS) 2007, patients aged 18 or more discharged with a diagnosis of PHTN were identified using ICD-9-clinical modification codes 415.0 and 416.x. All discharges with primary diagnosis of atrial fibrillation (AF), atrial flutter (AFL) and paroxysmal supra-ventricular tachycardia (PSVT) was also identified using appropriate ICD-9 codes. Multivariate logistic regression was performed using appropriate survey commands in STATA to find the frequency and association between the above arrhythmias and PHTN. The analysis was adjusted for age, sex, race, hyperthyroidism, congestive heart failure, coronary artery disease, hypertension, valvular disorders and other relevant co-morbid conditions related to supra-ventricular arrhythmias.
Results: In 2007, there were an estimated 575307 (1.76%) adult discharges with PHTN in NIS. Out of those, 199752 (34.7%) had AF, 19088 (3.3%) had AFL and 24667 (4.3%) with PSVT. The patients with PHTN had 3.6 times higher frequency for AF, 3.7 times higher frequency of AFL and 3.2 times higher frequency of PSVT when compared to those without PHTN.
This persisted even after adjustment for various factors described above. There was significantly higher frequency of AF (Odds Ratio (OR) 1.97; 95% Confidence Interval (CI) 1.92-2.03), AFl (OR 1.68; 95%CI 1.59-1.76) and PSVT (OR 1.36; 95%CI 1.30-1.43) in patients with PHTN.
AF was found to be independent predictor for mortality in patients with pulmonary hypertension (OR 1.13; 95%CI 1.06-1.23).
Conclusion: This observational study shows increased frequency of AF, AFL and PSVT in patients with PHTN. Further prospective studies are needed to evaluate the causal relation.
[Show abstract][Hide abstract] ABSTRACT: Atrial septal aneurysm (ASA) is a saccular deformity located in the atrial septum. Atrial arrhythmias are common in patients with ASA. Atrial electromechanical delay (AEMD) can be used to evaluate development of atrial arrhythmias in various settings. The aim of the study was to investigate the relationship between ASA, cardiac arrhythmias and AEMD. Seventy patients with ASA served as the study group (30 men; mean age, 33.6 ± 10.9 years) and 70 healthy volunteers served as the control group (34 men; mean age, 31.4 ± 7.8 years). ASAs were diagnosed by transthoracic echocardiography based on the criteria of a minimal aneurysmal base of ≥ 15 mm; and an excursion of ≥ 10 mm. Inter-AEMD and intra-AEMDs of both atrium were measured from parameters of tissue Doppler imaging. There was no significant difference between the study and control groups in terms of age, gender, left atrium diameter, and left ventricular ejection fraction. Inter-AEMD (50.7 ± 22.5 ms vs. 36.9 ± 12.0 ms) and intra-left AEMD (44.6 ± 17.4 ms vs. 30.7 ± 11.6 ms) were significantly higher in patients with ASA with respect to control group. Inter-AEMD (63.6 ± 20.1 ms vs. 45.1 ± 21.5 ms, P = 0.001), intra-left AEMD (55.3 ± 15.6 ms vs. 40.1 ± 16.2 ms, P = 0.001), diameter of the ASA (19.9 ± 3.6 mm vs. 17.1 ± 2.7 mm, P = 0.001) and P wave dispersion (18.5 ± 6.7 ms vs. 11.8 ± 7.3 ms, P = 0.001) were significantly greater in the subgroup with arrhythmias compared to the subgroup without arrhythmias. Inter-AEMD and intra-left AEMD were found to be significantly prolonged in patients with ASA. Being a non-invasive, inexpensive and simple technique AEMD may provide significant contributions to assess the risk for paroxysmal supraventricular arrhythmia in patients with ASA.
No preview · Article · Apr 2011 · The international journal of cardiovascular imaging