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Pulse
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ISSN (Print) 2235-8676 - ISSN (Online) 2235-8668
Published by Karger

[120 journals]

Usefulness of Stress-Derived E/e’ Ratio in Asymptomatic Hypertensive
Patients
- Abstract: Purpose: We sought to investigate the usefulness of stress echocardiography-derived E/e’ in predicting subclinical atherosclerosis in asymptomatic hypertensive patients. Materials and Methods: 71 newly diagnosed untreated hypertensive patients (48 ± 13 years, 65% males) and 30 age- and sex-matched healthy controls were recruited. Resting and exercise echocardiography was performed to assess resting diastolic blood pressure and the diastolic stress parameters. Coronary flow reserve (CFR) was evaluated as well. Results: Based on CFR values, newly diagnosed, untreated hypertensives were stratified into hypertensives with microvascular dysfunction (MVD; 34 patients had CFR #x3c;2.0) and those without MVD (37 patients had CFR ≥2.0). Patients with MVD had a significantly higher C-reactive protein level (p #x3c; 0.05) and lower metabolic equivalent values (p #x3c; 0.05). With resting echocardiography, only the left atrial volume index (LAVI) was significantly increased in those with MVD compared with those without MVD and controls (p #x3c; 0.05). With exercise echo, the E/e’ was significantly increased in MVD patients compared with those without MVD and controls (p #x3c; 0.001). Importantly, the percentage of subjects with exercise E/e’ ≥15 was 76.5% (26 patients in the group with MVD), 4.1% (3 patients in the group without MVD), and 0% in controls. At univariate analysis, high-sensitivity C-reactive protein (p #x3c; 0.05), LAVI (p #x3c; 0.05), and exercise E/e’ (p #x3c; 0.001) were independently associated with reduced CFR. On the other hand, at multivariate analysis, only exercise E/e’ was the independent predictor of reduced CFR in newly diagnosed hypertensives. Conclusion: We have demonstrated significant associations between exercise-derived raised left ventricular pressure and coronary MVD in newly diagnosed untreated hypertensive patients. Herein, we supposed that exercise-derived E/e’ could predict subclinical atherosclerosis and might be a risk parameter for newly diagnosed untreated hypertensive patients.
  Pulse
  PubDate: Wed, 25 Nov 2020 07:48:01 +010
Publisher's Note
- Abstract:
  Pulse
  PubDate: Thu, 30 Jul 2020 10:33:07 +020
The Role of the Platelet/Lymphocyte Ratio and Neutrophil/Lymphocyte Ratio
in Predicting High-Risk Heart Score in Patients Admitted with Non-ST
Elevation Acute Coronary Syndrome
- Abstract: Background: For cardiologists, management of acute chest pain continues to be a challenge. Physicians struggle to avoid unnecessary admissions and at the same time not to miss high-risk patients needing urgent intervention. Therefore, diagnostic strategies focus on identifying patients in whom an acute coronary syndrome can be safely ruled out based on findings from history, physical examination, and early cardiac marker measurement. The HEART score, a clinical prediction rule, was developed to provide the clinician with a simple and reliable predictor of cardiac risk. Aim: This study aimed to investigate the role of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) as independent laboratory biomarkers when associated with the HEART risk score. Method: A cross-sectional study of 120 patients who attended the emergency department with acute chest pain. NLR and PLR were both measured. In addition, the HEART score was the valid instrument used in evaluating and risk stratifying patients into low-, intermediate-, and high-risk group. Results: There was a positive correlation between the HEART score and the mean PLR and NLR (p = 0.000*). PLR and NLR were found to be significantly higher in the high-risk HEART score group (p = 0.05 and 0.0001*, respectively). A PLR of 115.5 and above had a sensitivity of 73% and specificity of 78%, while an NLR of 3.95 and above had a sensitivity of 75% and specificity of 86% to detect high-risk HEART score patients. Conclusion: PLR and NLR proved to be a useful tool to identify high-risk patients when validated against the HEART score.
  Pulse
  PubDate: Tue, 28 Jul 2020 12:02:11 +020
Blood Pressure Variability and Atrial Fibrillation in Patients with Acute
ST Segment Elevation Myocardial Infarction: The Relation with Left Atrial
Electromechanical Delay – A 1-Year Follow-Up Study
- Abstract: Purpose: To investigate the association between 24-h blood pressure variability (BPV) and atrial electromechanical delay (EMD) in patients with ST segment elevation myocardial infarction (STEMI) who developed new-onset atrial fibrillation (NOAF). Materials and Methods: A total of 175 STEMI patients (age 56.6 ± 10.5 years) who underwent primary percutaneous coronary intervention were subjected to in-hospital 24-h ambulatory BP monitoring, comprehensive echocardiography, and assessment of atrial EMD. The parameters of BPV analyzed were: (a) 24-h standard deviation (SD), (b) the coefficient of variation, and (c) the average of the daytime and nighttime SDs weighted for the duration of the daytime and nighttime interval (SDdn). Results: Based on the median of BPV index (SDdn) = 9.5 mm Hg of all participants, patients were stratified into low and high variability groups (SDdn: 7.1 ± 1.5 vs.13.5 ± 2.9; p #x3c; 0.001). Of the 175 patients with STEMI, 29 (16.7%) patients developed NOAF; 26 (28.9%) were in the high variability group and 3.5% were in the low variability group (p #x3c; 0.001). Echocardiographic data showed that the left atrial volume index (p #x3c; 0.01) and E/e′ ratio (p #x3c; 0.001) were significantly higher in patients with high BPV. Inter and intra-atrial EMD were significantly increased in the high variability group compared to the low variability group (p #x3c; 0.001). With multiple linear analysis, there was significant correlation between SDdn and intra-left atrial and inter-atrial EMD (p #x3c; 0.001 and #x3c;0.01, respectively). Cox regression analysis revealed that SDdn and intra-atrial EMD were independent predictors for NOAF in patients with STEMI (OR = 3.75 and 02.72, respectively; p #x3c; 0.001). ROC analysis revealed that SDdn ≥12.8 was the optimal cut-off value for predicting NOAF during follow-up. Conclusions: Short-term BPV was associated with NOAF during the 1-year follow-up in patients with STEMI. In addition, BPV was correlated significantly with atrial EMD. Herein, BPV was predicted to be an early predictor of NOAF in patients with STEMI.
  Pulse
  PubDate: Wed, 10 Jun 2020 11:14:54 +020
Blood Pressure during Blood Collection and the Implication for Absolute
Cardiovascular Risk Assessment
- Abstract: Background: Blood collection and blood pressure (BP) measurements are routinely performed during the same consultation to assess absolute cardiovascular disease (CVD) risk. This study aimed to determine the effect of blood collection on BP and subsequent calculation of the absolute CVD risk. Methods: Forty-five participants aged 58 ± 9 years (53% male) had systolic BP (SBP) measured using clinical guideline methods (clinic SBP). Then, on a separate visit, BP was measured immediately before, during, and after blood collection. Absolute CVD risk scores were calculated (Framingham equation) using SBP from each measurement condition and compared. Results: The prevalence of low (#x3c;10%), moderate (10–15%), and high (≥15%) absolute CVD risks among the participants was 67%, 22%, and 11%, respectively, using clinic SBP. SBP values before and during blood collection were significantly higher compared to values after blood collection (130 ± 18 and 132 ± 19 vs. 126 ± 18 mm Hg; p = 0.010 and p = 0.003, respectively). However, there were no significant differences between clinic SBP (128 ± 18 mm Hg) and blood collection SBP (p = 0.99) or the absolute CVD risk scores (7.3 ± 6.5; 7.6 ± 5.9; 7.7 ± 6.1; and 7.1 ± 5.7%, respectively; p = 0.995 for all). The mean intraclass correlation (95% CI) indicated good agreement between absolute CVD risk scores calculated with clinic SBP and each blood collection SBP (0.86 [95% CI 0.74–0.92], 0.85 [95% CI 0.71–0.91], and 0.87 [95% CI 0.76–0.93], respectively; p #x3c; 0.001, for all). Conclusion: Absolute CVD risk calculation is not affected by use of SBP measurements recorded at the time of blood collection. Therefore, it is acceptable to collect blood and measure BP during the same consultation for absolute CVD risk assessment.
  Pulse
  PubDate: Tue, 02 Jun 2020 15:29:29 +020
Resting Left Ventricular Dyssynchrony and Mechanical Reserve in
Asymptomatic Normotensive Subjects with Early Type 2 Diabetes Mellitus
- Abstract: Background: Most diabetic patients have silent ischemia and cardiac dysfunction that is usually observed in the late phase of the disease when it becomes clinically obvious. We hypothesized that left ventricular dyssynchrony (LVdys) (or dispersion) is an early marker of myocardial involvement in asymptomatic early type 2 diabetes mellitus (T2DM) patients. Therefore, we aimed to detect early markers of myocardial dysfunction in early T2DM using LVdys and left ventricular mechanical reserve (LVMR). Methods: We examined 91 consecutive subjects with early T2DM with speckle tracking imaging to evaluate LVdys and with dobutamine stress to evaluate LVMR (defined as left ventricular mechanical reserve global longitudinal strain [LVMRGLS] ≥2%). Our patients were divided into two groups according to LVdys: group 1 with LVdys (n = 49), and group 2 without LVdys (n = 42). Results: We found that 49 (54%) subjects in our cohort had resting LVdys (standard deviation of tissue synchronization of the 12 left ventricular segments [Ts-SD-12] ≥34.2 ms). GLS and strain rate were comparable at rest between patients with and without LVdys. On the other hand, LVMR was blunted in those with LVdys (p #x3c; 0.001). We found that HbA1c, high-sensitivity C-reactive protein, and left atrial volume index were inversely correlated with LVMR. Multivariate analysis showed that LVdys was the strongest predictor (p #x3c; 0.001) of blunted LVMR. Using receiver operating characteristic curve analysis, we found that a Ts-SD-12 ≥36.5 ms was the best cutoff value to predict blunted LVMR (area under the curve = 0.89, p #x3c; 0.001). Conclusion: The LVdys (Ts-SD-12) cutoff ≥36.5 ms was the optimal value for prediction of impaired LVMR and might be an early marker of subclinical cardiac dysfunction and risk stratification of subjects with asymptomatic early T2DM with preserved left ventricular ejection fraction.
  Pulse
  PubDate: Tue, 02 Jun 2020 10:25:41 +020
Insight into Atrial Fibrillation in LVAD Patients: From Clinical
Implications to Prognosis
- Abstract: The use of left ventricular assist devices (LVADs), whether for destination therapy or bridge to transplantation, has gained increasing validation in recent years in patients with advanced heart failure. Arrhythmias can be the most challenging variables in the management of such patients but the main attention has always been focused on ventricular arrhythmias given the detrimental impact on mortality. Nevertheless, atrial fibrillation (AF) is the most common rhythm disorder associated with advanced heart failure and may therefore characterize the LVADs’ pre- and postimplantation periods. Indeed, the consequences of AF in the population suffering from standard heart failure may require a more comprehensive evaluation in the presence of or in sight of an LVAD, making the AF clinical management in these patients potentially complex. Several studies have been based on this subject with different and often conflicting results, leaving many questions unresolved. The purpose of this review is to summarize the main pieces of evidence about the clinical impact of AF in LVAD patients, underlining the main implications in terms of hemodynamics, thromboembolic risk, bleeding and prognosis. Therapeutic considerations about the clinical management of these patients are also made according to the latest evidence.
  Pulse
  PubDate: Tue, 28 Apr 2020 07:07:10 +020
Contents Vol. 7, 2019
- Abstract:
  Pulse 2019;7:I–II
  PubDate: Wed, 25 Mar 2020 07:44:21 +010
Clinical Classification of Arrhythmogenic Right Ventricular Cardiomyopathy
- Abstract: Introduction: Commonly accepted clinical classification of arrhythmogenic right ventricular cardiomyopathy (ARVC) is still not developed. Objective: To study the clinical forms of ARVC. Methods: Fifty-four patients (38.7 ± 14.1 years, 42.6% men) with ARVC. Follow-up period: 21 (6–60) months. All patients underwent electrocardiography, 24 h-Holter monitoring, echocardiography, and DNA diagnostic. Magnetic resonance imaging was performed in 49 patients. Results: According to the features of clinical course of ARVC, 4 clinical forms were identified. (I) Latent arrhythmic form (n = 27) – frequent premature ventricular contractions and/or nonsustained ventricular tachycardia (VT) in the absence of sustained VT and syncope; characterized by absence of fatal arrhythmic events. (II) Manifested arrhythmic form (n = 11) – sustained VT/ventricular fibrillation; the high incidence of appropriate implantation of cardioverter-defibrillator (ICD) interventions (75%) registered. (III) ARVC with progressive chronic heart failure (CHF, n = 8) as the main manifestation of the disease; incidence of appropriate ICD interventions was 50%, mortality rate due to CHF was 25%. (IV) Combination of ARVC with left ventricular noncompaction (n = 8); characterized by mutations in desmosomal or sarcomere genes, aggressive ventricular arrhythmias, appropriate ICD interventions in 100% patients. Described 4 clinical forms are stable in time, do not transform into each other, and they are genetically determined. Conclusions: The described clinical forms of ARVC are determined by a combination of genetic and environmental factors and do not transform into each other. The proposed classification could be used in clinical practice to determine the range of diagnostic and therapeutic measures and to assess the prognosis of the disease in a particular patient.
  Pulse
  PubDate: Tue, 11 Feb 2020 13:52:27 +010
The Role of Heart Rate Variability and Fragmented QRS for Determination of
Subclinical Cardiac Involvement in Beta-Thalassemia Major
- Abstract: Background: Iron accumulation leads to increased susceptibility to cardiovascular diseases in thalassemia major (TM) patients. Depressed heart rate variability (HRV) and development of arrhythmia are among the manifestations of subclinical cardiac involvement in TM cases. Determination of subclinical cardiac involvement is essential for preventive measures. Thus, we aimed to evaluate the best method for identification of subclinical cardiac dysfunction in TM cases. Materials and Methods: In this prospective study, 45 TM and 45 non-TM cases, who were referred for cardiac evaluation, were enrolled. Exclusion criteria included non-sinus rhythm and overt cardiac disease. TM cases underwent cardiac MRI, electrocardiography (ECG), and Holter monitoring. TM cases were divided into two groups of normal versus iron overload with a cardiac T2* of more or less than 20 ms, respectively. The non-TM cases underwent only ECG and Holter monitoring. Results: We observed no significant difference regarding HRV between normal versus iron overload TM and non-TM cases. Higher rates of premature atrial complex, low limb voltage, low atrial rhythm, as well as minimum and average HR with lower QRS duration and PR interval were detected in TM versus non-TM cases (p value #x3c;0.05). Conclusions: We observed a higher prevalence of low limb voltage and low atrial rhythm in TM cases versus non-TM cases. Indeed, the role of fragmented QRS (fQRS) for subclinical detection of cardiac disease in TM cases is still so controversial and needs more evaluation. Application of HRV and fQRS in this regard may need to be performed at the right time point after initiation of blood transfusion, but this needs to be determined.
  Pulse
  PubDate: Tue, 11 Feb 2020 10:11:55 +010