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Background: This pilot study revealed a relationship between the results of flow mediated skin fluorescence (FMSF) and of ECG-Holter-based estimated apnea/hypopnea index (eAHI) in asymptomatic individuals. The aim was to test whether the results of FMSF show a relationship with the eAHI in patients with coronary artery disease or aortic stenosis. Methods: Twenty-one patients (12 coronary disease, 9 aortic stenosis) and 37 healthy volunteers were included in this study. FMSF was assessed before, during and after the pressure occlusion of the brachial artery, using a prototype device allowing the quantification of skin fluorescence. The values of FMSF expressed as baseline (BASE), maximum (MAX), and minimum (MIN) were analyzed. The percentages of ischemic response (IR) and hyperemic response (HR) were calculated. The eAHI was assessed from night ECG-Holter recordings. Differences between the groups and the relationships between the parameters were analyzed statistically. Results: Mean ± standard deviation of BASE, MAX, MIN and IR were not significantly different in both groups (p > 0.05). HR was significantly lower in cardiac patients (14.7 ± 7.5 vs. 11.8 ± 5.1; p = 0.048), whose eAHI was significantly higher (11.0 ± 7.4 vs. 36.3 ± 16.5; p < 0.01). Negative correlation for MAX and eAHI was found in volunteers and patients: r = –0.38, p = 0.02 and r = –0.47, p = 0.03, respectively. In volunteers, HR had a negative correlation with eAHI: r = –0.34, p = 0.04. Conclusions: This pioneer study confirms that FMSF can be used to detect the negative correlation between MAX fluorescence and eAHI not only among healthy volunteers, but also among cardiac patients with coronary artery disease or aortic stenosis.

Introduction. Obstructive sleep apnea (OSA) is one of the most common sleep disorders, which affects 4% of men and 2% of women in the world population. The disorder can be diagnosed in men and women of all ages; however, its incidence increases with age. Patients with OSA experience increased levels of sympathetic nervous system activity, which is evidenced by the increased catecholamines secretion. They are at an increased risk of developing complications of coronary heart disease (CHD). The aim of the study was to evaluate the influence of results of screening for OSA on the activity of the sympathetic and parasympathetic nervous systems within the scope of selected heart rate variability (HRV) parameters (time-domain and frequency-domain analyses of the HRV) in patients with CHD. Material and methods. Holter recordings of 146 patients aged 43–78 (106 of whom were men) were analysed retrospectively. The patients were divided into four groups on the basis of the estimated apnea–hypopnea index (eAHI), assessed by means of 24-hour recordings of electrocardiogram with Lifescreen Apnea software: < 5 (control group), from 5 to < 15 (mild), from 15 to < 30 (moderate) and ≥ 30 episodes (severe). For each patient, a profile of power spectrum alterations was developed for low frequency (LF) and high frequency (HF) in 60-minute periods between 10 p.m. and 6 a.m. and standard deviation of RR intervals (SDNN) and root mean square of successive differences (rMSSD) values were calculated. The power spectrum in the consecutive one-hour periods was averaged in both groups. In view of the right-skewed distribution of data, the average power spectra were converted into natural logarithms. In order to assess the significance of variations, the natural logarithms of the average values were compared using the univariate analysis of variance (ANOVA). Results. In the examined groups, there were statistically significant differences in the HF band of power spectrum between the control group and the group of patients with mild OSA (p < 0.01), those with severe OSA (p < 0.01) and also between the group with mild and moderate OSA (p < 0.01). In the LF band of power spectrum, the only difference was seen between the group of patients with mild OSA and those with moderate OSA (p < 0.01). In the time-domain analysis of HRV (SDNN, rMSSD), no statistically significant differences between the groups were observed. Conclusions. High frequency band of power spectrum [HF] in frequency-domain HRV analysis could be a more effective parameter to distinguish patients with mild OSA (from 5 to < 15) and severe OSA (≥ 30) in patients suffering from CHD, than the power spectrum for LF or SDNN and rMSSD.

Introduction. Sleep-disordered breathing (SDB) affects approximately 2–12% of the general population and the prevalence among patients with heart failure due to left ventricular dysfunction (LV–HF) is even higher. SDB is an important determinant of worse clinical outcomes in such patients. In contrast, the prevalence of SDB in pulmonary arterial hypertension (PAH) and its implications remain unclear. The purpose of this study was to compare relations between estimated apnea-hypopnoea index (eAHI) and clinical parameters in patients with LV–HF and PAH, with particular attention to the consequences of SDB. Material and methods. Eighty-one patients were screened for SDB using commercial Holter electrographic monitoring software that allowed evaluation of eAHI. The study population consisted of 39 LV–HF patients and 42 PAH patients. Results. While similar N-terminal pro B-type natriuretic peptide (NT-proBNP) levels were noted in both groups, LV–HF patients were characterized by higher age (63 vs. 50 years, respectively, p 15, was 64% in the LV–HF group and 36% in the PAH group. Parameters of time domain heart rate variability (HRV) analysis were lower in PAH vs. LV–HF. Patients with LV–HF had more ventricular arrhythmias than patients with PAH. In the LV–HF group, eAHI correlated positively with NT-proBNP level, and negatively with left ventricular ejection fraction and the mean heart rate. The median eAHI was 18.7, and patients with eAHI above the median had more supraventricular arrhythmias. In the PAH group, a negative correlation between eAHI and age was found. In the subgroup with eAHI < 15, rMSSD values were higher and idiopathic PAH predominated. The median eAHI was 8.4, and patients with eAHI above the median were younger and had higher BMI values. Conclusions. Sleep-disordered breathing was more frequent and eAHI was higher in patients with LV–HF compared to those with PAH, although it was present in more than one third of patients in the latter group. Higher eAHI values indicated more severe hemodynamic dysfunction in patients with LV–HF. In the PAH group, higher eAHI was associated with clinical presentation at a younger age. Patients with PAH seem to have worse HRV parameters compared to patients with left ventricular dysfunction.

Opisano wyniki waznego badania HOPE-3 (Heart Outcomes Prevention Evaluation), w ktorym testowano efekty leczenia stalą dawką leku hipolipemizującego (rosuwastatyna 10 mg) i polączenia kandesartanu i hydrochlorotiazidu o dzialaniu hipotensyjnym w grupie pacjentow cechujących sie średnim ryzykiem sercowo-naczyniowym. Wyniki potwierdzają bezpieczenstwo i skutecznośc obnizenia stezenia cholesterolu frakcji LDL statyną, a korzyści z terapii hipotensyjnej, zgodnie z oczekiwaniami, byly zawezone do jedynie 1/3 pacjentow z wyzszymi wartościami ciśnienia tetniczego.

Purpose Speckle tracking echocardiography is widely used for the analysis of myocardial function. Recently, circumferential strain (CS) of carotid arteries was postulated as novel indicator of vascular function. Our aim was to characterize and compare CS of carotid arteries in patients with advanced coronary artery disease and controls without significant coronary stenoses. Patients/methods We compared CS of both common carotid arteries (CCA) in the 25 patients with three-vessel coronary artery disease (3VD) (mean age 69 ± 9 years, 9 male) and in 16 age-matched subjects without significant coronary lesions (C) (69 ± 8 years, 7 male). Additionally in 11 patients we estimated pulse wave velocity (PWV) and assessed the correlation between PWV and CS. Short-axis images of arteries were acquired for strain analysis with linear probe of echocardiograph. The assessment of CS was performed off-line by two observers. Results The intraobserver variability for the CS (coefficient of variation) were 4.9 and 5.4% for left and right CCA and interobserver variability were 11.7% and 12.5%, respectively. The mean CS for left and right CCA did not differ between compared groups. We did not find correlation between CS strain and PWV. The only difference was related to the more prevalent plaque presence and thicker intima-media complex (IMT) in 3VD ( p = 0.0039 for IMT of left CCA and p = 0.016 for IMT of right CCA). Conclusions The global CS of CCA, contrary to IMT, did not allow for differentiation between 3VD and C subjects. Despite good feasibility and concordance of CS measurements its clinical significance remains to be established.

Takotsubo cardiomiopathy (TTC) (known also as "ampulla cardiomyopathy," "apical ballooning" or "broken heart syndrome") is connected with a temporary systolic left ventricular dysfunction without the culprit coronary lesion. Takotsubo cardiomyopathy was first described in 1990 in Japan after octopus trapping pot with a round bottom and narrow neck similar in shape to left ventriculogram in TTC patients. The occurrence of TTC is usually precipitated by a stressful event with a clinical presentation mimicking myocardial infarction: chest pain, ST-T segment elevation or T-wave inversion, a rise in cardiac troponin, and contractility abnormalities in echocardiography. A left ventricular dysfunction is transient and improves within a few weeks. Takotsubo cardiomyopathy typically occurs in postmenopausal women and the postulated mechanism is catecholamine overstimulation. Moreover, the distribution of contractility impairments usually does not correspond with typical region supplied by a single coronary artery. Therefore, the assessment of regional pattern of systolic dysfunction with speckle-tracking echocardiography and automated function imaging (AFI) technique may be important in diagnosis of TTC and may improve our insight into its patophysiology. We described a 55-year-old female teacher with TTC diagnosed after acute psychological stress in workplace. The provoking factor related with occupational stress and pattern of contraction abnormalities documented with AFI technique including basal segments of left ventricle make this case atypical.

Aims To evaluate the relationship between left atrial (LA) structure and deformation obtained by two-dimensional speckle tracking echocardiography (2DSTE): peak longitudinal systolic strain (LAs), peak longitudinal systolic strain rate (LAS-SR), peak longitudinal early diastolic strain rate (LAE-SR), peak longitudinal late diastolic strain rate (LAA-SR), and sleep-disordered breathing (SDB) estimated by means of apnea–hypopnea index (eAHI). Methods Thirty-two individuals with ischemic heart disease (IHD) and impaired left ventricular ejection fraction (EF

We report a case of 26-year-old woman, with arrhythmic manifestation of peripartum cardiomyopathy with moderate heart failure. Ventricular arrhythmia recorded in ambulatory Holter ECG (premature ventricular contractions) was most severe during pregnancy, reduced when beta-blocker therapy was initiated and almost completely resolved after delivery. Then, 1 year after hospitalization in Cardiology Department, recurrence was observed with recorded short episode of nonsustained ventricular tachycardia.

Background: Pulmonary arterial hypertension (PAH) is a rare disease with a very serious prognosis. It seems that mutations in genes related to transforming growth factor-b signalling pathway are often related to the development of the disease. No study covers this problem in a Polish population. Aim: To screen for genetic mutations in a Polish cohort of patients with pulmonary hypertension, especially with idiopathic PAH, treated in a single hospital in Poland. Methods: DNA sequencing method was used. Samples from 50 patients with pulmonary hypertension were screened for mutations in type 2 bone morphogenetic protein receptor of the transforming growth factor-b superfamily gene (BMPR2). Samples from 20 patients with idiopathic PAH (11 men, mean age 55 years) were also screened for mutations in activin A receptor-like type 1 gene (ALK1) and endoglin gene (ENG). Results: No genetic variations were found for the BMPR2 gene. In all 20 samples from idiopathic pulmonary hypertension patients we found heterozygosity of single nucleotide polymorphism (SNP) rs 372023206 in ALK1 gene. Three samples from these patients showed variations of ENG gene: we found one sample with heterozygosity of SNP rs 200525684, one with heterozygosity of SNP rs 3739817, and one with both. Conclusions: We detected benign polymorphisms or genetic variants of unknown importance. It is possible that the Polish population of PAH patients differs from the previously described populations of other countries in terms of the frequency and importance of mutations in BMPR2, ALK1 and ENG genes.

Aims Diabetes (DM) is a strong cardiovascular risk factor modifying also the left ventricular (LV) function that may be objectively assessed with echocardiographic strain analysis. Although the impact of isolated DM on myocardial deformation has been already studied, few data concern diabetics with coronary artery disease (CAD), especially in all stages of dobutamine stress echocardiography (DSE). We compared LV systolic function during DSE in CAD with and without DM using state-of-the art speckle-tracking quantification and assessed the impact of DM on LV systolic strain. Methods and results DSE was performed in 250 patients with angina who afterwards had coronarography with ≥50% stenosis in the left main artery and ≥70% in other arteries considered as significant. In this analysis, we included 127 patients with confirmed CAD: 42 with DM [DM(+); mean age 64 ± 9 years] and 85 patients without DM [DM(-); mean age 63 ± 9 years]. The severity of CAD and LV ejection fraction (EF) were similar in both groups. Global and regional LV peak systolic longitudinal strain (PSLS) revealed in all DSE phases lower values in DM(+) group: 14.5 ± 3.6% vs. 17.4 ± 4.0% at rest; P = 0.0001, 13.8 ± 3.9% vs. 16.7 ± 4.0% at peak stress; P = 0.0002, and 14.2 ± 3.1% vs. 15.5 ± 3.5% at recovery; P = 0.0432 for global parameters, although dobutamine challenge did not enhance further resting differences. LV EF, body surface area, and diabetes were independent predictors for strain in 16-variable model (R2 = 0, 51, P

Background: Whether non-invasive electrocardiographic parameters may be of similar relevance in pulmonary arterial hy­pertension (PAH) as in left ventricular heart failure (LVHF) remains unclear. Aim: To examine a profile of electrocardiographic parameters in PAH and to determine their prognostic significance. Com­parison of profile in patients with pulmonary hypertension secondary to left ventricular dysfunction was planned in order to put PAH group results into context. Methods: We included 41 patients with type 1.1/1.4.4 (according to the European Society of Cardiology) PAH and 31 patients with LVHF and type 2.1 pulmonary hypertension. All patients underwent 24-h ambulatory electrocardiography monitoring. Results: Among heart rate variability parameters, only RMSSD was different (mean, 75 ms [PAH] vs. 112 ms [LVHF], p = 0.016). In PAH, fewer patients had ventricular tachycardia (15% vs. 48%, p = 0.004), abnormal deceleration capacity (54% vs. 84%, p = 0.011), positive heart rate turbulence (11% vs. 48%, p = 0.003), severe autonomic failure (10% vs. 39%, p = 0.005), and ventricular late potentials (LP) (19% vs. 62%, p = 0.001). In PAH, four deaths occurred in 42 months. In univariate analysis, the risk factors for death were: LP (hazard ratio 13.55, 95% confidence interval 1.41–130.72; p = 0.024), age, N-terminal prohormone of B-type natriuretic peptide, while the protective factors were minimal and mean heart rate, as well as the six-minute walk test (6MWT) distance. In multivariate analysis, the influence of LP and the 6MWT distance remained significant. Conclusions: Ventricular LP were present in 19% of PAH patients and were the most powerful risk factor of mortality .

Background In patients with systolic heart failure (HF), coexisting sleep apnea may promote arrhythmia. Ambulatory Holter electrocardiogram (ECG) monitoring (AECG) is a method of arrhythmia and apnea evaluation. We hypothesized that 24-hour AECG in patients with HF who have a high risk of serious arrhythmia may be less accurate than AECG extended to 48 hours and that, moreover, arrhythmia may be related to apnea. Methods Eighty-four recordings of 48-hour AECG in 84 patients with ischemic HF (mean ejection fraction 34 ± 7%) were analyzed. Day 1, Day 2 were checked for ventricular tachycardia (VT) and supraventricular tachycardia (SVT). Estimated apnea-hypopnea index (est.AHI) was calculated using Holter, monitoring where est.AHI >15 indicates apnea. Results In 48-hour AECG, VT occurred in 34 patients (40.5%) whereas SVT in 17 patients (20.2%), and patients with est.AHI > 15 had higher VT occurrence. In two-sample one-sided test for proportions, 24-hour AECG from Day 1 showed a significantly lower percentage of patients with detected VT than 48-hour AECG—it was 23.8% (20 patients), meaning a significant underestimation with P = 0.0089. We assessed VT underestimation in the subgroups with regard to est.AHI, and found that it was present in Day 1 monitoring in the subgroups with est.AHI > 15. It was absent in the subgroups with est.AHI ≤ 15 and also in Day 2 monitoring. Conclusions In patients with systolic HF, 24-hour AECG may have insufficient sensitivity regarding serious arrhythmia occurrence. If significant apnea was detected in the first day, extending the monitoring may be recommended.

The prevalence of coronary artery anomalies (CAA) is reported to be 1% in the general population [1]. The symptoms vary from clinically silent course to angina pectoris, syncope, arrhythmias, myocardial infarction and sudden cardiac death. Although coronary angiography remains a gold standard for the evaluation of coronary anatomy, modern echocardiography offers additional diagnostic opportunities, including assessment of proximal coronary anatomy, flow and coronary flow reserve in a variety of clinical conditions [2–6]. However, experience with echocardiography in patients with concomitant coronary anomalies and atherosclerotic diseases is rather limited. We report a case of a 69-year-old man, with angina and ventricular arrhythmia, in whom we successfully applied echocardiographic imaging modalities to demonstrate an abnormal course of the circumflex coronary artery and identify coronary stenosis-related flow abnormalities. A 69-year-old man was admitted to our hospital in February 2007 with chest pain on minor exertion, radiating to left arm and to the back, aggravating over the last month. Similar, less intense pain had been observed for 3 months. Concomitant history included pharmacologically controlled hypertension, type 2 diabetes mellitus with polyneuropathy, hypercholesterolaemia, peripheral artery disease, depression and benign prostatic hypertrophy. Admission ECG was unremarkable except for a few ventricular premature beats. Admission blood pressure was 130/85. Echocardiography revealed a minor systolic dysfunction: hypokinesis of mid- and apical segments of the lateral and posterior wall, with left ventricular ejection fraction of 58%. The left atrium was enlarged to 45 mm and the left ventricular mass index was increased to 141 g/m2. Mitral inflow was pseudonormal with E/A ratio 1.2. There was a mild commissural fusion of the aortic valve cusps, without significant motion impairment, a peak velocity of 1.7 m/s and trace of regurgitation. Serum concentrations of troponin I and CK-MB were within normal limits. Exercise treadmill test (Bruce procedure) elicited no angina but was electrographically positive with ST segment depression in leads V4-6 at 7 METS workload. In 24-h Holter ECG monitoring 6518 ventricular premature beats but neither complex arrhythmia nor significant ST segment changes were recorded. Transthoracic echocardiography (GE, Vivid 7 Dimension; transducer M4S) of coronary arteries showed abnormal findings in the left coronary ostium, with calcifications and accelerated turbulent flow consistent with high-degree stenosis (Figure 1). Diastolic flow was accelerated to 1.3 m/s. Non-invasive Doppler transthoracic coronary flow reserve (CFR) was measured according to the standard technique, in the distal left anterior descending (LAD) coronary artery during 12 mg adenosine injection, yielding an abnormally low value of 1.4. Figure 1 The arrows indicate stenosis of the left coronary ostium, detected in angiography and transthoracic echocardiography. In the panel below – normal distal left anterior descending coronary artery LAD – left anterior descending coronary artery, ... Subsequently, the abnormal coronary artery ostium was visualized in the right sinus of Valsalva, continuous with a vessel running retroaortically, consistent with the anomalous circumflex coronary artery course (Figure 2). Distal circumflex stenosis was not detectable using transthoracic echocardiography (TTE). Figure 2 The arrows show anomalous circumflex coronary artery running retroaortically, in the right panels the flow detected by Doppler echocardiography. Below: angiography of the circumflex coronary artery originating next to the right coronary artery and separate ... Coronary angiography revealed 90% ostial stenosis of the left coronary artery, with the absence of origin of the circumflex branch (CX); the distal LAD coronary artery was normal. The circumflex coronary artery originated next to the right coronary artery, running in an inferior direction, reaching its proper course after 3-4 cm; the CX was narrowed to 90%. The right coronary artery was narrow and tortuous.The patient was referred to cardiac surgery for coronary artery bypass grafting. Our report indicates that state-of-the-art, high-end TTE allows the evaluation of coronary anatomy and coronary flow reserve, facilitating the assessment of anomalous coronary arteries combined with advanced coronary artery disease. Non-invasive data are complementary to standard angiographic findings. Angiography remains a gold standard for the evaluation of coronary anatomy. However, in some cases, echocardiography may suggest an initial diagnosis. State-of-the-art transthoracic examination is nowadays powerful enough to aid in the assessment of coronary anomalies as the ostia and proximal course can usually be visualized [7–9]. Carefully performed investigation may identify coronary disease in clinically silent or unclear cases, especially in proximal arterial segments. Coronary artery anomalies may be clinically silent but often cause symptoms such as angina pectoris, syncope, arrhythmias, myocardial infarction, and sudden cardiac death. Importantly, coronary anomalies constitute the second most common cause of sudden cardiac death in young athletes. Particularly dangerous and potentially lethal variants involve Bland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery), with 80-85% mortality in the first year of life or CX coursing between the aorta and pulmonary trunk as well as the right coronary artery originating from the left sinus of Valsalva. Circumflex branch originating from the right coronary artery (RCA) or the right sinus of Valsalva is the most common CAA, found in 0.48% of the population of patients undergoing angiography [10]. Abnormal CX may begin with a separate (37%) or common (23%) origin with the RCA or arise from a proximal segment of the RCA (40%) [11]. Abnormal retroaortic segment of the vessel seems to be particularly predisposed to atherosclerosis but may be successfully treated with coronary angioplasty. On the other hand, CX origin from non-coronary sinus is a unique anomaly, detectable by transoesophageal echocardiography, which has been reported as a useful method allowing tomographic visualization of proximal coronary arteries. Preliminary diagnosis of coronary artery anomaly on the basis of echocardiographic examination allows one to reduce contrast and radiation exposure during angiography and thus possibly avoid some complications including contrast-induced nephropathy [12]. Patients with clinically significant type of CAA may benefit from appropriate medical or surgical treatment. Transthoracic echocardiography may be used for efficient postoperative outcome evaluation and long-term follow-up. High-quality echocardiographic visualization of the stenotic arterial site allows quantification based on turbulent flow detection, velocity [13, 14] and lumen diameter measurement, and functional tests (stress echocardiography). Transthoracic examination is proven to be an accurate method to evaluate coronary artery diameter in patients with healthy coronary arteries [15]. At least doubling of maximal flow velocity within stenosis with regard to maximal flow velocity proximal to stenosis or local maximal flow velocity > 1.5 m/s is proposed to be a reliable sign of > 50% coronary artery stenosis. When coronary angiography reveals LAD stenosis of intermediate severity, the measurement of CFR using transthoracic Doppler provides assessment of its functional importance with CFR value > 2 justifying postponement of interventional treatment. Coronary flow reserve is thus a useful method for functional assessment of complex coronary pathophysiology. The limitations of our report include the lack of invasive assessment of fractional flow reserve (FFR) in the LAD and CX, which would be interesting to compare with echocardiographic CFR measurements. It must be noted that distal CX stenosis was not detectable in transthoracic echocardiography. In conclusion, coronary angiography remains a gold standard for the evaluation of coronary anatomy. Nevertheless, carefully performed transthoracic echocardiographic examination of coronary arteries may be considered as a complementary non-invasive method providing extended physiological information and enabling non-invasive follow-up in selected patients.

We present the case of a woman treated with coronary angioplasty due to non-ST segment elevation myocardial infarction,then again because of restenosis, who continued to complain of chest pain and syncope. Holter electrocardiogram recording revealed atrioventricular block related to ST-segment elevations and variant angina was diagnosed. Despite administered medications, the patient required pacemaker implantation.

Toxic myocardial injury can be misdiagnosed as a myocardial infarction, resulting in the patient undergoing standard treatment for cardiac rehabilitation. However, such inadequate therapeutic strategies can lead to cardiovascular complications including dilated cardiomyopathy. This study presents a case of a 65-year-old man after accidental ingestion of organic solvents (toluene and xylene), whose condition demonstrated all the criteria for diagnosis of myocardial infarction. The qualitative determinations of the above mentioned volatile organic compounds (VOCs) in whole blood were carried out using a headspace sampling by means of gas chromatography. Cardiac catheterization revealed no specific coronary lesions, only a muscular bridge causing a 30-50% stenosis in the middle of the circumflex branch of the left coronary artery.

Background We assessed the impact of morbid obesity on systolic and diastolic heart function in severely obese, but otherwise healthy subjects and age-matched controls. Methods Overall, 27 obese patients: 19 female (F) and 8 male (M) mean age 37 ± 9, mean body mass index (BMI) 46 ± 6 and 27 control subjects: mean age 36 ± 10, mean BMI 23 ± 3 were examined by transthoracic echocardiography, including tissue Doppler echocardiographic (TDE) assessment and speckle tracking echocardiography to measure left ventricular longitudinal, circumferential, and radial strain (S) and strain rate (SR) during systolic and early diastolic phase. Results Obese patients presented with enlargement of both ventricles and the left atrium, and thicker left ventricular wall. Although left ventricular ejection fraction (EF) as well as amplitude of tricuspid annulus plane systolic excursion (TAPSE) was similar, the amplitude of mitral annulus plane systolic excursion (MAPSE) and ventricular systolic and early diastolic velocities measured by TDE were significantly lower for both ventricles in the obese group. (RV S′ 13 ± 3 cm/sec vs. 15 ± 2 cm/sec, P = 0.0057; LV S′ lat 8.5 ± 1.6 cm/sec vs. 12.1 ± 2.8, P

We hypothesised that melatonin may represent a safe somniferous drug for cardiac patients, and assessed the effects of administering 5 mg of melatonin daily before bedtime for 30 days in patients with coronary artery disease (CAD) regarding changes in the nocturnal breathing pattern.Sixty patients with CAD (aged 48-80 years) were randomised to melatonin/placebo treatment in a 2:1 ratio. A Holter ECG-based method (Lifescreen Apnea software) which has been validated as a screening tool for sleep-disordered breathing was used to estimate the apnoea/hypopnoea index (AHI). A 24-h Holter ECG was used to detect nocturnal breathing abnormalities at the beginning and at the end of the observation. The values of estimated AHI (eAHI) ≤ 15 were classified as optimal (Opt) and those 〉 15 - as pathological (Pat). A change of the breathing pattern was classified on the basis of the transition between the initial and final eAHI status (Opt→Opt; Opt→Pat; Pat→Pat, Pat→Opt). The mean initial and final value of eAHI and the percent of Opt and Pat values of eAHI in the initial and final assessment were compared between the melatonin and the placebo groups.The breathing pattern was not affected by melatonin - the mean initial value of the eAHI in the melatonin group was 18.2 ± 9.4, and in the placebo group 19.6 ± 12.3 (p = 0.64), whereas at the end of the observation in the melatonin group it increased by 1.2 ± 11.3, and in the placebo group - by 1.0 ± 9.0 (p = 0.44).Hypnagogic treatment with melatonin did not worsen the eAHI in patients with CAD.

Purpose: The current concept of myocardial function incorporates complex rotational mechanics. Speckle Tracking Echocardiography (STE) allows for left ventricular (LV) twist deformation assessment, but quantitative data are often variable and little is known of torsional timing. The aim was to evaluate the LV twist angle and sequence of rotation in severe systolic dysfunction, less pronounced disease and in normal conditions. Methods: 101 subjects were studied (mean age 48.1±15 years, 46% women). Of these, 33 patients (PTS) demonstrated severe LV systolic dysfunction with EF ranging from 14 to 34%, mean 26.7% (Group 3); 33 PTS showed LV EF ranging from 37 to 69%, mean 55.5% (Group 2); and 35 subjects were healthy volunteers with EF between 62 and 67%, mean 65.2% (Group 1). Concurrent net LV twist angle was calculated using two-dimensional STE short axis images as the absolute apex-to-base difference in LV rotation at time of aortic valve closure (AVC). Time to peak apical and basal rotation was also measured as well as AVC independent peak LV twist angle, indicating the maximal torsional deformation without isochronal occurrence. Results: LV twist angle at AVC was significantly lowest in Group 3, showing a mean value of 5.6±5.0° (p

Introduction The endothelium and sympathetic nervous system play an important role in the pathogenesis of acute coronary syndrome (ACS). Objectives The aim of our study was to evaluate correlations between noninvasive markers of the endothelial function and the sympathetic nervous system in patients with a recent ACS. Patients and methods The study included 52 patients who experienced an ACS within the previous 3 to 6 months. Endothelial function was expressed as the reactive hyperemia index (RHI), and the activity of the sympathetic nervous system--as latency and amplitude of sympathetic skin response (SSR) potentials from the 4 limbs. Linear and partial correlations between the RHI and SSR were calculated. Results There were significant correlations between the RHI and the latency of the SSR in the upper limbs (r = 0.34, P = 0.02 for the right limb; and r = 0.34, P = 0.01 for the left limb). After eliminating the effects of age, sex, weight, and glomerular filtration rate, the partial correlation between the RHI and the latency of the SSR in the upper limbs remained statistically significant (r = 0.41, P = 0.004 for the right limb, and r = 0.42, P = 0.004 for the left limb). There was no correlation between the RHI and latency of the SSR during the stimulation of the lower limbs. Conclusions Our study confirmed the correlations between the sympathetic autonomic nervous system and endothelium in patients with ACS. The correlation of the RHI with the latency of the SSR was observed only in the upper limbs.