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Abstract Background The prevalence of diabetes is increasing, and several new drug groups have been authorized and used successfully in the treatment of diabetes, while older drug groups are still in use. Our aim was to assess the utilization tendencies and regional differences in antidiabetic medication consumption in Hungary between 2015 and 2021 and to identify the possible determinants of regional differences in antidiabetic medication use. Methods For this retrospective drug utilization study, yearly wholesale database was used, which provides total coverage for ambulatory antidiabetic drug sales in Hungary, including both reimbursed and non-reimbursed medications. Data were expressed as Defined Daily Dose per 1000 inhabitants per day (DDD/TID), percentage of total use and the ratio of the highest and lowest utilization values among the counties (max/min ratio). To assess the potential reasons for regional differences in antidiabetic drug use, we analyzed the associations between regional drug utilization data and possible determinants. Results The total national antidiabetic medication use has increased by 7.6% and reached 94.8 DDD/TID in 2021. Regarding antidiabetic subgroups, the use of metformin and novel antidiabetics (DPP4Is, GLP1As and SGLT2Is) and their combinations increased in all counties, while sulfonylurea consumption decreased, and insulin use was stable. In 2021, 19.2–24.1% of the total antidiabetic medication consumption was novel antidiabetics, 39.1–47.2% metformin, 14.8–25.8% sulfonylureas and 23.6–30.5% were insulins. Regional differences in antidiabetic medication consumption were considerable mainly in the case of GLP1As (max/min ratio:3.00), sulfonylureas (2.03) and SGLT2Is (1.92) in 2021. The association between antidiabetic medication use and possible determinants was confirmed in the case of unemployment rate and sulfonylurea use, the number of public medical card holders per ten thousand inhabitants and human insulin and sulfonylurea use. GLP1As were the only antidiabetic drug group that did not correlate with any of the investigated factors. Conclusions Although novel antidiabetic drug use was growing dynamically in Hungary, sulfonylurea use is still considerable. Differences in antidiabetic drug consumption were substantial between the regions.

IntroductionA higher incidence of neural dysfunction in people with obesity has been described. We determined the prevalence of neuropathic lesions in obese women and evaluated their potential association with anthropometric and laboratory parameters.Patients and methodsIn our cross-sectional study, we enrolled female patients with obesity and without diabetes before obesity treatment. Voluntary female subjects were controls with a normal body mass index (BMI). Autonomic function was assessed by Ewing’s cardiovascular reflex tests, while comprehensive peripheral neuropathic assessments were conducted utilizing the Neurometer®, Tiptherm®, Monofilament®, and Rydel-Seiffer tuning fork tests. Sudomotor function was assessed by the Neuropad®-test. Body composition was examined using the InBody 770.Results71 patients (mean ± SD; age: 36.1 ± 8.3 years; BMI: 40.2 ± 8.5 kg/m2) and 36 controls (age: 36.4 ± 13.3 years; BMI: 21.6 ± 2.1 kg/m2) were enrolled. Patients had significantly higher systolic (patients vs. controls; 137.5 ± 16.9 vs. 114.6 ± 14.8 mmHg, p

Metabolic syndrome (MetS) is a complex of interrelated risk factors, associated with several serious chronic diseases like diabetes. The goal of this study was to find dietary factors of successful weight loss for MetS outpatients. We performed a 90-day dietary intervention in a telemedically supported, pre- and post-test, controlled trial in Hungary involving 132 MetS patients; 67 were in the intervention, and 65 were in the control group. Patients in the intervention group used wireless smart devices, a dietary logger, and a lifestyle app. During the trial, we recorded the patients’ weight loss and diet composition. For analysis, t-tests were used, and the temporal trends of diet composition in the intervention group were analyzed between two sub-groups according to weight loss success. Correlation and regression models were used to find predictors of success. The intervention group achieved more weight loss, and the success in this group was linked with more consumption of raw fruits/vegetables, poultry and potato dishes, while age had a negative effect. We conclude that telemedically supported dietary coaching is an efficient alternative for interventions directed at weight loss. Future trials should investigate the therapeutic application of diets rich in raw fruits, especially apples, and vegetables, as well as poultry dishes.

Introduction: In systole, when the left ventricle (LV) twists, the left atrium (LA) behaves like a reservoir, having a special wall contractility pattern opposite to that of the LV wall. Accordingly, the objective of the present study was to investigate the associations between LV rotational mechanics and LA peak (reservoir) strains as assessed simultaneously by three-dimensional speckle-tracking echocardiography (3DSTE) under healthy conditions. Methods: In the present study, 157 healthy adults (mean age: 33.2 ± 12.7 years, 73 men) were involved. Complete two-dimensional Doppler echocardiography with 3DSTE-derived data acquisition were performed in all cases. The 3DSTE-derived LV rotational and LA strain parameters were determined at a later date. Results: Global LA peak reservoir circumferential (22.7 ± 6.4% vs. 27.6 ± 6.8%, p < 0.05) and area (57.8 ± 20.0% vs. 66.0 ± 22.7%, p < 0.05) strains proved to be reduced in the case of the highest vs. lowest basal LV rotation; other LA peak reservoir strains were not associated with increasing basal LV rotation. Global LA peak radial strain was highest in the case of the lowest vs. highest apical LV rotation (−19.2 ± 9.4% vs. −13.0 ± 8.2%, p < 0.05). Global LA peak reservoir 3D strain was lowest in the case of the highest vs. lowest apical LV rotation (−9.9 ± 6.8% vs. −5.0 ± 4.2%, p < 0.05). Only apical LV rotation proved to be significantly reduced in the case of the highest vs. lowest global LA peak reservoir 3D strain (8.12 ± 3.23° vs. 10.50 ± 3.44°, p < 0.05). Other global LA peak reservoir strains were not associated with basal and apical LV rotations. Conclusions: In LV systole, LV rotational mechanics is associated with LA deformation represented by LA peak (reservoir) strains even in healthy circumstances. While basal LV rotation is associated with LA widening, apical LV rotation is associated with LA thinning, suggesting the close cooperation of the LV and LA in systole even in healthy adults.

Introduction: The right ventricle (RV) lies on the left ventricle (LV), and their shapes and movements are characteristic and significantly different. The aim of the present study was to investigate the relationship between three-dimensional speckle-tracking echocardiography (3DSTE)-derived LV strains, which represent LV contractility as quantitative features, and tricuspid annular plane systolic excursion (TAPSE) as determined by M-mode echocardiography, which represents the longitudinal movement of the RV, in healthy adults. Methods: A total of 79 healthy adults (mean age: 28.1 ± 6.3 years; 33 men) were enrolled in the present study. After two-dimensional Doppler echocardiography, 3DSTE-derived data acquisition was carried out in all cases, and detailed 3DSTE-based analysis was performed offline at a later date. Results: Reduced TAPSE was associated with increased global and basal LV radial strain (RS). Increased TAPSE was also associated not only with increased global and basal LV-RS but also with global LV longitudinal strain (LS). An increase in global LV-RS and global LV circumferential strain (CS) showed associations with other strains except for global LV-LS. An increase in global LV-LS did not show associations with other strains. Increased global LV-RS was associated with reduced TAPSE, while the degree of global LV-LS and global LV-CS did not show associations with TAPSE. Conclusions: Three-dimensional speckle-tracking echocardiography-derived LV-RS and LV-LS are associated with the longitudinal shortening of the RV represented by TAPSE in healthy adults.

Introduction: During the heart cycle, left ventricular (LV) contractility is characterized by complex deformation and rotational mechanics, resulting in LV ejection. The present study seeks to expand our knowledge by examining dependence of LV strains representing LV deformation on left atrial (LA) volumes in healthy circumstances. Therefore, the aim of this study was to evaluate the associations between LA volumes and LV strains as assessed simultaneously by three-dimensional speckle-tracking echocardiography (3DSTE) in normal healthy adults. Methods: The present study consisted of 302 healthy adults, but according to exclusion criteria, 137 subjects were excluded due to inferior image quality. The final population comprised 165 individuals (mean age: 33.1 ± 12.3 years, 75 males) who were voluntarily recruited for screening. Two-dimensional echocardiography extended with 3DSTE was performed in all subjects for detailed LV/LA analysis. Results: Overall feasibility for simultaneous assessment of LV strains and LA volumes proved to be 55 % with excellent intra- and interobserver correlations. All global LV strains were similar, regardless of the LA volumes examined. All LA volumes and volume-based functional properties respecting the cardiac cycle were similar, regardless the global LV strains examined. Conclusions: LV strains and LA volumes can be simultaneously assessed by 3DSTE. Global LV strains and LA volumes are not associated in healthy adults.

Background: The left ventricular (LV) rotational mechanics are of particular importance in the function of the LV. The rotational movement is the consequence of the arrangement of the subepicardial and subendocardial muscle fibers. These muscle fibers are perpendicular to each other, their contraction creates a characteristic motion. The aim of the present study was to examine the prognostic impact of LV twist assessed by three-dimensional speckle-tracking echocardiography (3D-STE) in healthy circumstances. Methods: 302 healthy adults participated in the study, 181 subjects were excluded due to certain reasons (LV could not be analysed during 3D-STE, subjects were unidentifiable, or lost to follow-up). 121 subjects were involved in the final analysis (mean age of 33.1 ± 12.3 years, 75 males), who were willing to be examined on a voluntary basis. Results: During a mean follow-up of 7.93 ± 4.21 years, 11 healthy adults suffered a cardiovascular event including 2 cardiac deaths. Using receiver operating characteristic analysis, LV twist ≥14.65 degrees as assessed by 3D-STE proved to be significantly predictive regarding the cardiovascular event-free survival (area under the curve 0.70, specificity 70%, sensitivity 65%, p = 0.028). Subjects with LV twist ≥14.65 degrees had higher basal and apical rotations and a significantly higher ratio of these individuals developed cardiovascular events compared to cases with LV twist

To understand the large inter-species variations in drug effects on repolarization, the properties of the rapid (IKr) and the slow (IKs) components of the delayed rectifier potassium currents were compared in myocytes isolated from undiseased human donor (HM), dog (DM), rabbit (RM) and guinea pig (GM) ventricles by applying the patch clamp and conventional microelectrode techniques at 37 °C. The amplitude of the E-4031-sensitive IKr tail current measured at −40 mV after a 1 s long test pulse of 20 mV, which was very similar in HM and DM but significant larger in RM and GM. The L-735,821-sensitive IKs tail current was considerably larger in GM than in RM. In HM, the IKs tail was even smaller than in DM. At 30 mV, the IKr component was activated extremely rapidly and monoexponentially in each studied species. The deactivation of the IKr component in HM, DM, and RM measured at −40 mV. After a 30 mV pulse, it was slow and biexponential, while in GM, the IKr tail current was best fitted triexponentially. At 30 mV, the IKs component activated slowly and had an apparent monoxponential time course in HM, DM, and RM. In contrast, in GM, the activation was clearly biexponential. In HM, DM, and RM, IKs component deactivation measured at −40 mV was fast and monoexponential, while in GM, in addition to the fast component, another slower component was also revealed. These results suggest that the IK in HM resembles that measured in DM and RM and considerably differs from that observed in GM. These findings suggest that the dog and rabbit are more appropriate species than the guinea pig for preclinical evaluation of new potential drugs expected to affect cardiac repolarization.

Introduction. Three-dimensional (3D) speckle-tracking echocardiography (STE) combines the advantages of STE and volumetric 3D echocardiography, which shows the left ventricle (LV) in 3D during the cardiac cycle and is also suitable for accurate strain measurements in addition to volumetric assessments using the same virtual 3D LV cast. The present study aimed to confirm the prognostic impact of 3DSTE-derived LV global longitudinal strain (GLS) in healthy adults during a 12-year follow-up period. Patients and methods. The current study comprised 124 healthy individuals with a mean age of 31.0 ± 11.7 years (64 males) at the time of complete two-dimensional Doppler echocardiography (2DE) and 3DSTE. Results. During a mean follow-up of 8.01 ± 4.12 years, 10 healthy individuals suffered cardiovascular events, including 2 cardiac deaths. Using ROC analysis, 3DSTE-derived LV-GLS ≥ 14.77% was found to be a significant predictor for cardiovascular event-free survival (sensitivity 70%, specificity 71%, area under the curve 76%, p = 0.007). Using 2DE, higher LV end-diastolic and end-systolic volumes, a larger LV end-systolic diameter and a lower LV ejection fraction could be detected in subjects with LV-GLS < 14.77% as compared to cases with LV-GLS ≥ 14.77%. Subjects with events had thicker interventricular septa, a larger LV mass and lower 3DSTE-derived LV-GLS and a higher ratio of cases had LV-GLS < 14.77%. From subjects with LV-GLS < 14.77%, seven individuals (18%) had events. Multivariate regression analysis identified age and LV-GLS as independent predictors of event-free survival. Conclusions. 3DSTE-derived LV-GLS is a strong independent predictor of cardiovascular survival in healthy adults.

Introduction. Acromegaly is an endocrine pathology characterized by the overproduction of human growth hormone. The present study aimed to analyze three-dimensional speckle-tracking echocardiography (3DSTE)-derived tricuspid annular (TA) properties in detail in patients with acromegaly and to compare the findings to those of matched healthy controls. Methods. The present study consisted of 29 patients with acromegaly (mean age: 55.9 ± 14.5 years, 21 males), of which 13 had an active disease. The control population comprised 57 healthy subjects (mean age: 53.2 ± 8.4 years, 38 males). Results. In the presence of acromegaly, left atrial and end-diastolic left ventricular (LV) sizes were dilated, and LV ejection fraction was increased, which was accompanied by thickened interventricular septum and LV posterior wall as compared with matched healthy controls. The presence of grade 1 mitral (MR) and tricuspid (TR) regurgitations were more frequent in acromegaly than in controls, regardless of disease activity. Higher than grade 1 MR/TR was uncommon in acromegaly. The 3DSTE-derived all end-diastolic (2.47 ± 0.27 cm vs. 2.23 ± 0.27 cm; 8.73 ± 1.77 cm2 vs. 6.67 ± 1.40 cm2; 11.56 ± 1.34 cm vs. 10.20 ± 1.10 cm, p < 0.001 for all) and end-systolic (1.97 ± 0.27 cm vs. 1.77 ± 0.28 cm; 6.24 ± 1.61 cm2 vs. 5.01 ± 1.42 cm2; 9.80 ± 1.35 cm vs. 8.72 ± 1.10 cm, p < 0.001 for all) TA diameters, areas, and perimeters proved to be dilated, while TA functional parameters including TA fractional area change (28.77 ± 9.80% vs. 27.64 ± 15.34%, p = 0.720) and fractional shortening (20.60 ± 9.08% vs. 20.51 ± 8.81%, p = 0.822) were normal in acromegaly regardless of whether acromegaly was active or not. RA volumes respecting the cardiac cycle were dilated in acromegaly as compared with those of healthy controls regardless of disease activity and were associated with respective changes in TA dimensions. Conclusions. In the presented acromegaly patients, significant TA dilation with preserved function could be detected regardless of disease activity. RA volumes and TA dimensions are correlated in acromegaly.

ObjectivesEmerging results indicate that, in COVID-19, thromboembolic complications contribute to the high mortality and morbidity. Previous research showed that the prevalence of pulmonary embolism (PE) is between 25-50% in COVID-19 patients, however, most of these reports are based on data from patients with severe pneumonia, treated in intensive care units.Materials and methodsWe conducted a retrospective, single-center, observational study to estimate the prevalence of PE in COVID-19 patients who underwent CT angiography and to identify the most important predictors. Adult outpatients with COVID-19, who presented at our COVID Outpatient Clinic between 1st and 31st of March in 2021 and underwent CTA examination were included in this study. Multiple linear regression analysis was used to identify predictors of PE in COVID-19 patients. The predictors were: age, gender, disease duration, CT severity index and log-transformed quantitative D-dimer (logQDDIM) value.Results843 COVID-19 patients were included into the study. 82.56% (693 patients) of the infected patients had a pulmonary CTA examination and D-dimer levels (mean age: 59.82 years ± 15.66). 7.61% (53 patients) of the patients had PE. 2.02% (14 patients) of the patients had main branch or lobar PE. The multiple regression analysis found that only logQDDIM was a significant predictor. A logQDDIM cut-off value of 0.0169 (1.0171 ug/ml serum D-dimer) predicted PE with 99% sensitivity (pConclusionsWe demonstrated in a large cohort of COVID-19 patients that a cut-off value of QDDIM of 1ug/ml can exclude pulmonary embolism in an outpatient setting, implicating that QDDIM might potentially supersede CTA as a screening approach in COVID-19 outpatient clinics.

IntroductionThe tricuspid valve and its annulus (TA) and the right atrium (RA) play a significant role in regulating blood flow in the right heart. However, their effect on each other is not fully understood even in normal circumstances. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is able to simultaneously assess TA and RA at the same time in a non-invasive way. The present study aimed to examine associations between tricuspid annular (TA) dimensions and right atrial (RA) volumes in healthy adults by 3DSTE.MethodsThe present study comprised 144 healthy subjects (mean age: 34.4 ± 12.6 years, 72 males), who participated in this study on a voluntary basis for screening between 2011 and 2015. In all subjects, electrocardiography, two-dimensional Doppler echocardiography and 3DSTE have been performed.ResultsWith increasing end-systolic maximum RA volume, all end-systolic and end-diastolic TA dimensions showed simultaneous increase, but in various degrees resulting in (non-significant) reduction of TA functional properties. Similarly, with increasing diastolic pre-atrial contraction and minimum RA volumes, TA dimensions increased simultaneously (except end-diastolic TA diameter), but in various degrees resulting in reduced TA fractional shortening and fractional area change. With increasing RA dimensions, end-systolic and end-diastolic TA dimensions showed simultaneous increase, but in different, sometimes not significant degrees. While RA stroke volumes showed increasing pattern with TA dilation, RA emptying fractions have not changed substantially.Conclusions3DSTE is suitable for non-invasive assessment of TA dimensions and RA volumes at the same time using the same 3D echocardiographic dataset. Significant associations between TA size and RA volumes exist in healthy circumstances. Strong associations in case of dilation of TA in the presence of higher RA volumes could partly explain functional tricuspid regurgitation later developing in subjects in sinus rhythm.

IntroductionVascular complications and neuropathy may develop in the presence of metabolic syndrome. The aim of our study was to measure the cardiovascular autonomic function following physical training in patients with metabolic syndrome with and without diabetes.Subjects and methods56 patients with metabolic syndrome (32 men/24 women, 40 non-diabetic patients (NDMetS)/16 diabetic patients (DMetS) [mean ± SD]: age: 50.35 ± 8.03 vs. 56.8 ± 9.30 years, p=0.023; baseline BMI: 32.2 ± 7.03 vs. 32.8 ± 5.94 kg/m2, p=0.739) were involved in our study. All tests and measurements were carried out before and following a 3-month physical training period. Autonomic function was assessed by means of five standard cardiovascular reflex tests. ECG repolarization parameters, including short-term QT variability and stress-ECG were also measured.ResultsIn the whole population, Valsalva-ratio (VR) and the autonomic score (AS) improved following training (VR: 1.49 ± 0.24 vs. 1.64 ± 0.34, p=0.001; AS: 2.05 ± 1.73 vs. 1.41 ± 1.36, p=0.015) accompanied by the significant decrease of the systolic (150.3 ± 16.12 vs. 134.1 ± 16.67 mmHg, p

Introduction: Cardiac haemodynamics is described by the Frank-Starling law, which states that the strength of the left ventricular (LV) systolic contraction is related to the LV diastolic filling, with other words LV stroke volume increases as LV volume increases due to the stretching of the myocyte. The purpose of the present study was to examine how the increasing LV volumes affect LV contractility represented by three-dimensional (3D) speckle-tracking echocardiography (3DSTE) -derived LV strains in healthy adults. Methods: This is post-hoc analysis of the MAGYAR-Healthy Study employing a novel method for technical analysis of echocardiographic datasets. The present study consisted of 301 healthy adults. Due to inferior image quality, 127 subjects have been excluded, therefore the remaining population included 174 subjects (mean age: 32.9 ± 12.1 years, 80 males). All cases have undergone complete two-dimensional Doppler echocardiography extended with 3DSTE. Results: LV global longitudinal (gLS) and area (gAS) strains were lowest in case of the highest LV end-diastolic volume (EDV). LV global radial (gRS) and 3D (g3DS) strains tendentiously increased with increasing LV-EDV. When segmental analysis was performed, increased LV-EDV was associated with increase of basal LV-RS and LV-3DS. Increased LV strains were associated with increased LV ejection fraction (EF) due to higher LV-EDV for LV-gRS (and LV-g3DS), lower LV-ESV for LV-gCS and lower LV-EDV and LV-ESV for LV-gLS (and LV-gAS). With increasing LV-gRS, LV-gCS and LV-g3DS, all LV strains increased except LV-gLS. With increasing LV-gLS, LV-gRS did not show any increase, LV-gCS and LV-g3DS were the highest when LV-gLS was the highest, while LV-gAS increased simultaneously. With increasing LV-gAS, all LV strains increased. Conclusions: There is a complex contractility pattern of LV segments/regions in response to elevated LV volumes in healthy circumstances.

Introduction: The left ventricle (LV) not only contracts, but its rotational mechanics have a significant role in systolic ejection, whereas the right ventricle (RV) is substantially different in shape and function, and its contractility is not accompanied by rotational features. Simple M-mode echocardiography-based tricuspid annular plane systolic excursion (TAPSE) reflects RV longitudinal contraction or shortening. The aim of the present study was to examine the relationship between the parameters characterizing the rotational mechanics of the LV as assessed by three-dimensional speckle-tracking echocardiography (3DSTE) and the TAPSE. The effects of different degrees of these parameters on each other were also examined. Methods: The present retrospective analysis evaluated the results of 80 healthy adult individuals with an average age of 28.1 ± 6.3 years (33 males) with LV rotational mechanics being directed normally. All cases have undergone complete two-dimensional Doppler echocardiography with the measurement of TAPSE and 3DSTE. Results: None of the LV volumes and rotational parameters showed any differences in healthy cases with TAPSE 18–21 mm vs. TAPSE >22 mm. Similarly, right atrial (RA) volumetric parameters did not differ either. TAPSE showed no associations with the degree of basal LV rotation. RA volumes were slightly increased with higher basal LV rotation. Similar to basal LV rotation, TAPSE did not change with the degree of apical LV rotation and a tendentious increase of RA volumes could be demonstrated with increasing apical LV rotation. No correlation could be demonstrated between apical and basal LV rotations and TAPSE. Conclusions: 3DSTE-derived LV rotational parameters and TAPSE are not associated suggesting that LV twist is independent of RV longitudinal shortening in healthy circumstances.

Background and Objectives: It would be important to know what happens to the volume and volume-based functional properties of one atrium if the size of the other atrium is larger or smaller than the average. Therefore, the present study aimed to perform three-dimensional speckle-tracking echocardiography (3DSTE)-derived quantification of left atrial (LA) and right atrial (RA) volumes and volume-based functional properties to examine these associations in healthy adults with mean and lower or higher than mean atrial volumes. Materials and Methods: The present study consisted of 179 healthy volunteers with a mean age of 32.3 ± 12.3 years (92 males). Three-dimensional speckle-tracking echocardiography-derived LA and RA volumes and volume-based functional properties were determined in all cases. Results: When different LA or RA volume groups were evaluated, both LA and RA showed the same pattern of volume changes in all phases of atrial function with higher LA or RA volumes. In case of low and mean LA volumes, RA volumes were higher compared to their LA counterpart. In case of mean and high RA volumes, RA volumes proved to be higher as well. In case of mean LA or RA volumes, differences between LA and RA stroke volumes (SVs) could not be detected, but all atrial emptying fractions (EFs) were lower for RA than for LA. Some differences were detected in counterpart LA/RA total, passive, and active atrial SVs and EFs values in the presence of lower/higher than mean LA/RA volume. Conclusions: In case of mean LA or RA volumes, RA volumes are higher compared to their LA counterpart, LA-SVs and RA-SVs are similar, but atrial EFs are lower for RA than for LA. If lower/higher than mean LA or RA volumes are present, some differences in patterns of changes in counterpart atrial volumes—SVs and EFs—could be detected.

Introduction. The tricuspid valve is an atrioventricular valve located on the right side of the heart, which consists of the fibrous tricuspid annulus (TA), three valvular leaflets and a supporting apparatus, the papillary muscles and the tendinous chords. The TA is an oval-shaped three-dimensional (3D) fibrous structure with a complex spatial movement during the cardiac cycle. Three-dimensional echocardiography (3DE) could help during “en-face” assessment of TA dimensions and related functional properties featuring its “sphincter-like” function. TA plane systolic excursion (TAPSE) is a displacement of the lateral edge of the TA toward the apex in systole measured in apical long-axis using M-mode echocardiography (MME). The aim of this study was to determine potential relationships between TA size and its “sphincter-like” and “longitudinal” functions in healthy adults with no functional tricuspid regurgitation. Methods. The present study consisted of 119 healthy patients (age: 34.6 ± 11.5 years, 70 men) who underwent routine echocardiography with M-mode-derived TAPSE measurement and 3DE. Two subgroups of healthy subjects were compared with each other. A total of 29 subjects with TAPSE between 17 and 21 mm were compared with 90 cases with TAPSE ≥ 22 mm. Results. Subjects with TAPSE of 17–21 mm had tendentiously dilated TA dimensions compared with subjects with TAPSE ≥ 22 mm. Significant differences could be detected in the end-systolic TA area (5.85 ± 1.90 cm2 vs. 3.70 ± 1.22 cm2, p < 0.05), leading to impaired TAFAC (24.8 ± 9.0% vs. 35.1 ± 9.1%, p < 0.05) in subjects with lower TAPSE (17–21 mm) compared with subjects with TAPSE ≥ 22 mm. TAPSE did not show correlations with any TA size or “sphincter-like” functional parameters as determined using 3DE. Conclusions. Three-dimensional echocardiography is capable of measuring TA dimensions and functional “sphincter-like” properties, which are associated with MME-derived TAPSE, suggesting a sensitive and harmonic TA function in healthy adults without functional tricuspid regurgitation.

BackgroundMetabolic Syndrome (MetS) increases the risk of cardiovascular diseases (CVD) and affects around one fourth of the population worldwide. In the prevention and treatment regular exercise trainings are inevitable. Providing personal supervision in out/inpatient care settings for such a large target population challenges the healthcare systems, but using telemonitoring of the home-performed trainings could be a promising and widely available option.ObjectivesThe aim of this study was to evaluate the physiological and psychological effects of a 12-week home-based physical training program, telemonitored by widely available fitness devices on parameters of MetS patients.MethodsA total of 55 MetS patients (mean age 49.19 ± 7.93 years) were involved in the study. They were asked to perform 3–5 sessions of exercise activity (min. 150 min) each week for 12 weeks. Trainings were monitored off-line by heart rate sensors, a fitness application and a cloud-based data transfer system. Physiotherapists supervised, coached, and feedback the trainings through an online coach system. We investigated different anthropometric parameters, maximum exercise and functional capacity levels, laboratory parameters, the level of depression, insomnia, vital exhaustion, and wellbeing as well.ResultsThe average weekly training time was 152.0 ± 116.2 min. Out of the 55 participants who completed the program, 22 patients (40%) performed the recommended 150 min or more weekly. Patients showed statistically significant changes in: all the measured waist and hip circumferences; 6-min walk distance (6MWD; from 539.69 ± 78.62 to 569.72 ± 79.96 m, p < 0.001); maximal exercise capacity (11.02 ± 2.6 to 12.14 ± 2 MET, p < 0.001), stress-electrocardiogram duration time (13.74 ± 3.29 to 15.66 ± 2.64 min, p < 0.001); body weight (98.72 ± 21.7 to 97.45 ± 21.76 kg, p = 0.004); high-density lipoprotein cholesterol (n = 45, 1.28 ± 0.31 to 1.68 ± 0.36 mmol/L, p < 0.001); fasting plasma glucose (FPG; n = 47, 6.16 ± 1.26 to 5.44 ± 1.31 mmol/L, p = 0.001); glycated hemoglobin A1c (HbA1c; n = 41, 6.22 ± 0.68 to 5.87 ± 0.78%, p = 0.01). Out of the 55 patients who finished the program 38 patients (70%) completed all the psychological questionnaires. We found statistically significant decrease of the overall scores of the Maastricht Vital Exhaustion Questionnaire, from 3.37 ± 2.97 points to 2.63 ± 2.70 points (p < 0.05) and a significant increase of the overall scores of the WHO Wellbeing Scale from 9.92 ± 2.59 points to 10.61 ± 2.76 points (p < 0.05). We have not found any statistically significant changes in the scores of the Beck Depression Inventory and the Athens Insomnia Scale.ConclusionA 12-week home-based telemonitored training supported by an affordable, commonly available device system produces positive, statistically significant changes in many core components in MetS patients. Telemonitoring is a cheap method for coaching and feeding back the home-based interventions.

Abstract Background There is a paucity of global data on cardiovascular disease (CVD) prevalence in people with type 2 diabetes (T2D). The primary objective of the CAPTURE study was to estimate the prevalence of established CVD and its management in adults with T2D across 13 countries from five continents. Additional objectives were to further characterize the study sample regarding demographics, clinical parameters and medication usage, with particular reference to blood glucose-lowering agents (GLAs: glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors) with demonstrated cardiovascular benefit in randomized intervention trials. Methods Data were collected from adults with T2D managed in primary or specialist care in Australia, China, Japan, Czech Republic, France, Hungary, Italy, Argentina, Brazil, Mexico, Israel, Kingdom of Saudi Arabia, and Turkey in 2019, using standardized methodology. CVD prevalence, weighted by diabetes prevalence in each country, was estimated for the overall CAPTURE sample and participating countries. Country-specific odds ratios for CVD prevalence were further adjusted for relevant demographic and clinical parameters. Results The overall CAPTURE sample included 9823 adults with T2D (n = 4502 from primary care; n = 5321 from specialist care). The overall CAPTURE sample had median (interquartile range) diabetes duration 10.7 years (5.6–17.9 years) and glycated hemoglobin 7.3% (6.6–8.4%) [56 mmol/mol (49–68 mmol/mol)]. Overall weighted CVD and atherosclerotic CVD prevalence estimates were 34.8% (95% confidence interval [CI] 32.7–36.8) and 31.8% (95% CI 29.7–33.8%), respectively. Age, gender, and clinical parameters accounted for some of the between-country variation in CVD prevalence. GLAs with demonstrated cardiovascular benefit were used by 21.9% of participants, which was similar in participants with and without CVD: 21.5% and 22.2%, respectively. Conclusions In 2019, approximately one in three adults with T2D in CAPTURE had diagnosed CVD. The low use of GLAs with demonstrated cardiovascular benefit even in participants with established CVD suggested that most were not managed according to contemporary diabetes and cardiology guidelines. Study registration NCT03786406 (registered on December 20, 2018), NCT03811288 (registered on January 18, 2019).

Introduction: Early onset of cardiomyopathy represented by myocardial volumetric and deformation properties is a major concern for patients with type 1 diabetes mellitus (T1DM). Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel methodology with capability of 3D assessment of the right atrium (RA) via virtual models. The present study was designed for detailed comparative analysis of T1DM-associated RA volumetric and functional abnormalities to those of matched healthy controls to be examined by 3DSTE. Methods: The present study comprised of 17 patients with typical features of T1DM (mean age: 36.4 ± 13.0 years, 59% males). Their results were compared to those of 31 age- and gender-matched healthy controls (mean age: 35.0 ± 2.9 years, 61% males). Results: 3DSTE-derived RA volumes respecting the cardiac cycle and RA stroke volumes and emptying fractions did not show differences between young T1DM patients and matched controls. From peak RA strains representing RA reservoir function, mean segmental RA 3D strain proved to be significantly increased. Some regional basal/midatrial end-systolic peak RA strains were found to be significantly increased as well in T1DM patients as compared to controls. T1DM duration and HbA1c correlated with certain RA strains and RA volume-based functional properties. Conclusions: In young patients with T1DM, preserved RA volumes respecting the cardiac cycle are accompanied with increase in certain regional end-systolic peak RA strains, which seems to be associated with T1DM duration and HbA1c.

Introduction and Objective: Acromegaly is a rare, chronic and slowly developing endocrine disorder caused by hypersecretion of human growth hormone and consequently of insulin-like growth factor-1 during adulthood. The present study was conducted to assess mitral annular (MA) size and function between acromegalic patients and age- and gender-matched healthy controls by three-dimensional speckle-tracking echocardiography (3D-STE). It also aimed to examine whether activity of the disease has any effect on MA parameters. Methods: This study included 27 patients with acromegaly, three of whom were excluded due to inferior image quality. The mean age of the remaining 24 patients was 55.7±14.0 years and seven were male. Complete two-dimensional Doppler echocardiography and 3D-STE were performed in all cases. Results: Significantly increased end-diastolic and end-systolic MA diameter (2.81±0.36 cm vs. 2.44±0.34 cm and 2.00±0.32 cm vs. 1.65±0.37 cm, respectively), area (9.67±2.33 cm2 vs. 7.38±1.93 cm2 and 5.14±1.62 cm2 vs. 3.74±1.19 cm2, respectively) and perimeter (11.76±1.42 cm vs. 10.27±1.33 cm and 8.61±1.23 cm vs. 7.36±1.10 cm, respectively) were demonstrated in acromegalic patients compared with control subjects. MA functional parameters were not significantly altered compared to those of healthy individuals. Conclusions: MA dilation could be seen in acromegaly regardless of its activity. Acromegaly is not associated with MA functional impairment. Resumo: Introdução e Objectivo: A acromegalia é uma doença endócrina rara, crónica e de desenvolvimento lento, causada pela hipersecreção da hormona do crescimento humano e, consequentemente, do fator de crescimento semelhante à insulina-1 durante a idade adulta. O presente estudo foi conduzido para avaliar o tamanho e a função do anel mitral (MA) nos doentes com acromegalia e controles saudáveis emparelhados por idade e sexo, por meio de ecocardiografia tridimensional com speckle-tracking (3DSTE). O objetivo foi também examinar se a atividade da doença tem algum efeito nos parâmetros da MA. Métodos: Este estudo incluiu 27 pacientes com acromegalia, três dos quais tiveram de ser excluídos devido à qualidade inferior de imagem. A média de idade dos 24 pacientes restantes foi de 55,7 ± 14,0 anos (7 homens). Foram realizados em todos os casos uma ecocardiografia Doppler bidimensional completa e um 3DSTE. Resultados: Quando comparados com os controlos, os doentes acromegálicos apresentaram diâmetros diastólico e sistólico finais significativamente dilatados (2,81 ± 0,36 cm versus 2,44 ± 0,34 cm e 2,00 ± 0,32 cm versus 1,65 ± 0,37 cm, respetivamente), assim como a área valvular (9,67 ± 2,33 cm2 versus 7,38 ± 1,93 cm2 e 5,14 ± 1,62 cm2 versus 3,74 ± 1,19 cm2, respetivamente) e o perímetro (11,76 ± 1,42 cm versus 10,27 ± 1,33 cm e 8,61 ± 1,23 cm versus 7,36 ± 1,10 cm, respetivamente) Os parâmetros funcionais da MA não estavam significativamente alterados em comparação com indivíduos saudáveis. Conclusões: A dilatação do MA pode ser observada na acromegalia, independentemente de sua atividade. A acromegalia não está associada ao comprometimento funcional da MA.

Introduction: Acromegaly is a relatively rare chronic hormonal disease resulting in disfigurement. In 90% of cases, acromegaly is caused by a benign pituitary monoclonal human growth hormone-secreting tumor. The aim of the present study was to determine the presence of left ventricular (LV) deformation abnormalities using three-dimensional speckle-tracking echocardiography in a group of acromegalic patients. Methods: Thirty-eight acromegalic patients were involved in the study. Thirteen patients were excluded due to inadequate image quality. The mean age of the remaining patients was 57.2±13.6 years and seven were male. Their data were compared to an age- and gender-matched control population, which consisted of 34 healthy volunteers (mean age: 52.7±4.9 years, 15 male). Results: Global and mean segmental LV radial strain (RS) (33.2±13.4% vs. 25.2±10.8%, p=0.01 and 36.0±12.1% vs. 28.2±10.0%, p=0.009, respectively) proved to be significantly higher in acromegaly compared to controls. Active acromegalic patients had significantly higher global and mean segmental LV-RS (35.5±14.4% vs. 25.2±10.8%, p=0.03 and 37.9±13.3% vs. 28.2±10.0%, p=0.03, respectively) compared to controls. Between the active and inactive acromegaly groups, only basal LV circumferential strain (-30.2±4.8% vs. -26.7±4.1%, p=0.02) was found to be significantly different. Conclusion: The presented clinical, demographic, therapeutic and echocardiographic features demonstrate that active acromegaly is associated with enhanced LV RS as compared to healthy controls and those with inactive acromegaly. Resumo: Introdução: A acromegalia é uma doença hormonal crónica relativamente rara, associada a dismorfismos somáticos. Em 90% dos casos, ela é causada por um tumor benigno monoclonal da hipófise, secretor de hormona do crescimento. O objetivo do presente estudo foi detetar a presença de alterações da deformação miocárdica do ventrículo esquerdo (VE) através de ecocardiografia tridimensional por speckle tracking num grupo de doentes portadores de acromegalia. Métodos: Foram incluídos 38 doentes portadores de acromegalia. Treze foram excluídos devido à má qualidade de imagem. A idade média dos restantes foi de 57,2±13,6 anos (7 homens). Os seus dados foram comparados com uma população controlo emparelhada por idade e género, que compreendeu 34 voluntários saudáveis (idade média: 52,7±4,9 anos, sendo 15 indivíduos do sexo masculino). Resultados: O strain radial (SR) global e segmentar VE (respetivamente 33,2±13,4% versus 25,2±10,8%, p=0,01 e 36,0±12,1% versus 28,2±10,0%, p=0,009) foi significativamente superior nos casos de acromegalia em relação aos casos controlo. Os doentes portadores de acromegalia ativa tiveram um SR global e segmentar significativamente superior (35,5±14,4% versus 25,2±10,8%, p=0,03 e 37,9±13,3% versus 28,2±10,0%, p=0,03, respetivamente), quando comparados com os grupos controlo. Entre os grupos portadores de acromegalia ativos e inativos, só foi considerado significativamente diferente o strain circunferencial basal VE (-30,2±4,8% versus -26,7±4,1%, p=0,02). Conclusões: Com base nas características clínicas, demográficas, terapêuticas e ecocardiográficas apresentadas, a acromegalia ativa apresenta SR-VE aumentado em relação à população saudável e ao grupo de portadores de acromegalia inativa.

BackgroundSeasonal variations in the ambient temperature may affect the exacerbation of cardiovascular diseases. Our primary objective was to evaluate the seasonality of the monthly proportion of cardiac surgeries associated with diabetes, smoking and/or elderly age at a tertiary-care university hospital in East-Central Europe with a temperate climate zone. As a secondary objective, we also assessed whether additional factors affecting small blood vessels (smoking, aging, obesity) modulate the seasonal variability of diabetes.MethodsMedical records were analyzed for 9838 consecutive adult patients who underwent cardiac surgery in 2007-2018. Individual seasonal variations of diabetes, smoking, and elderly patients were analyzed monthly, along with the potential risk factors for cardiovascular complication. We also characterized whether pairwise coexistence of diabetes, smoking, and elderly age augments or blunts the seasonal variations.ResultsSeasonal variations in the monthly proportion of cardiac surgeries associated with diabetes, smoking and/or elderly age were observed. The proportion of cardiac surgeries of non-elderly and smoking patients with diabetes peaked in winter (amplitude of change as [peak-nadir]/nadir: 19.2%, pConclusionsScheduling regular cardiovascular control in accordance with periodicities in diabetes, elderly, and smoking patients more than once a year may improve patient health and social consequences.Trial registrationNCT03967639.

Introduction: Hypopituitarism is a rare, often underdiagnosed, complex hormonal disease caused by the decreased secretion of one or more hormones in the pituitary gland. The present study was designed to assess left ventricular (LV) rotational mechanics in patients with treated hypopituitarism. It was also aimed to find possible differences in these parameters according to the origin of hypopituitarism (congenital vs. acquired).Methods: The present prospective study involved 35 treated patients with hypopituitarism; however, 4 patients had to be excluded due to inferior image quality. The mean age of the remaining 31 cases was 56.3 ± 13.2 years (18 males). The control group consisted of 29 age- and sex-matched healthy volunteers (mean age: 55.3 ± 4.8 years, 14 males). In all cases a complete two-dimensional echocardiography examination was performed followed by three-dimensional speckle-tracking echocardiography.Results: No significant differences could be found in LV volumes between the controls and patients with hypopituitarism and hypopituitary subgroups. LV apical rotation (8.1 ± 5.1° vs. 10.6 ± 3.5°, p < 0.05) and LV twist (11.9 ± 5.3° vs. 15.1 ± 3.8°, p < 0.05) were impaired in the hypopituitary group with normally directed LV rotational mechanics as compared to the healthy controls. However, 13% of patients showed a near absence of LV twist called LV “rigid body rotation” (LV-RBR). There were no significant differences regarding LV apical and basal rotations and twist between acquired and congenital hypopituitary subgroups.Conclusions: Impaired LV apical rotation and twist could be demonstrated in hypopituitarism regardless of its origin. In the present study with small number of patients with hypopituitarism, LV-RBR was present in 13% of cases.

Background and objectives: In the last couple of years, pharmacological management of patients with type 2 diabetes mellitus (T2DM) have been markedly renewed. The aim of this study was to analyse the changes in prescribing patterns of antidiabetic drugs for treating patients with T2DM in Hungary between 2015 and 2020. Material and Methods: In this retrospective, nationwide analysis, we used the central database of the National Health Insurance Fund. We present annual numbers and their proportion of T2DM patients with different treatment regimens. Results: In the period of 2015–2020, the number of incident cases decreased from 60,049 to 29,865, while prevalent cases increased from 682,274 to 752,367. Patients with metformin (MET) monotherapy had the highest prevalence (31% in 2020). Prevalence of insulin (INS) monotherapy continuously but slightly decreased from 29% to 27% while that of sulfonylurea (SU) monotherapy markedly decreased from 37% to 20%. Dipeptidyl peptidase (DPP-4) inhibitors remained popular in 2020 as monotherapy (5%), in dual combination with MET (12%) and in triple combination with MET and SU (5%). The prevalence of patients with sodium-glucose co-transporter-2 (SGLT-2) inhibitors increased from 1% to 4% in monotherapy, from Conclusions: In the period of 2015–2020, we documented important changes in trends of antihyperglycaemic therapeutic patterns in patients with T2DM which followed the new scientific recommendations but remained below our expectations regarding timing and magnitude. More efforts are warranted to implement new agents with cardiovascular/renal benefits into therapeutic management in time, in a much larger proportion of T2DM population, and without delay.

IntroductionThe prevalence of neuropathic lesions in young patients with type 1 diabetes mellitus (T1DM) at the time of transition from pediatric care to adult-oriented diabetes care is poorly studied. A comparative study with healthy volunteers to assess the possible neuropathic condition of this special population and to identify the potential early screening needs has not been performed yet. The results may provide important feedback to pediatric diabetes care and a remarkable baseline reference point for further follow up in adult diabetes care.Patients and MethodsTwenty-nine young patients with T1DM [age: 22.4 ± 2.9 years; HbA1c: 8.5 ± 2.1%, diabetes duration: 12.2 ± 5.8 years; (mean ± SD)] and 30 healthy volunteers (age: 21.5 ± 1.6 years; HbA1c: 5.3 ± 0.3%) were involved in the study. Autonomic function was assessed by standard cardiovascular reflex tests. Complex peripheral neuropathic testing was performed by Neurometer®, Neuropad®-test, Tiptherm®, Monofilament®, and Rydel-Seiffer tuning fork tests.ResultsT1DM patients had significantly higher diastolic blood pressure than controls (80 ± 9 vs. 74 ± 8 mmHg, p < 0.01), but there was no significant difference in systolic blood pressure (127 ± 26 vs. 121 ± 13 mmHg). Cardiovascular reflex tests had not revealed any significant differences between the T1DM patients and controls. No significant differences with Neurometer®, Neuropad®-test, and Monofilament® were detected between the two groups. The vibrational sensing on the radius on both sides was significantly impaired in the T1DM group compared to the controls with Rydel-Seiffer tuning fork test (right: 7.5 ± 1.0 vs. 7.9 ± 0.3; left: 7.5 ± 0.9 vs. 7.9 ± 0.3, p < 0.05). The Tiptherm®-test also identified a significant impairment in T1DM patients (11 sensing failures vs. 1, p < 0.001). In addition, the neuropathic complaints were significantly more frequently present in the T1DM patient group than in the controls (9 vs. 0, p < 0.01).ConclusionIn this young T1DM population, cardiovascular autonomic neuropathy and cardiac morphological alterations could not be found. However, Rydel-Seiffer tuning fork and Tiptherm®-tests revealed peripheral sensory neurological impairments in young T1DM patients at the time of their transition to adult diabetes care.

Purpose. Diabetic retinopathy (DR) is the leading cause of vision loss among active adults in industrialized countries. We aimed to investigate the prevalence of diabetes mellitus (DM), DR and its different grades, in patients with DM in the Csongrád County, South-Eastern region, Hungary. Furthermore, we aimed to detect the risk factors for developing DR and the diabetology/ophthalmology screening patterns and frequencies, as well as the effect of socioeconomic status- (SES-) related factors on the health and behavior of DM patients. Methods. A cross-sectional study was conducted on adults (>18 years) involving handheld fundus camera screening (Smartscope Pro Optomed, Finland) and image assessment using the Spectra DR software (Health Intelligence, England). Self-completed questionnaires on self-perceived health status (SPHS) and health behavior, as well as visual acuity, HbA1c level, type of DM, and attendance at healthcare services were also recorded. Results. 787 participants with fundus camera images and full self-administered questionnaires were included in the study; 46.2% of the images were unassessable. T1D and T2D were present in 13.5% and 86.5% of the participants, respectively. Among the T1D and T2D patients, 25.0% and 33.5% had DR, respectively. The SES showed significant proportion differences in the T1D group. Lower education was associated with a lower DR rate compared to non-DR (7.7% vs. 40.5%), while bad/very bad perceived financial status was associated with significantly higher DR proportion compared to non-DR (63.6% vs. 22.2%). Neither the SPHS nor the health behavior showed a significant relationship with the disease for both DM groups. Mild nonproliferative retinopathy without maculopathy (R1M0) was detected in 6% and 23% of the T1D and T2D patients having DR, respectively; R1 with maculopathy (R1M1) was present in 82% and 66% of the T1D and T2D groups, respectively. Both moderate nonproliferative retinopathy with maculopathy (R2M1) and active proliferative retinopathy with maculopathy (R3M1) were detected in 6% and 7% of the T1D and T2D patients having DR, respectively. The level of HbA1c affected the attendance at the diabetology screening (HbA1c>7% associated with >50% of all quarter-yearly attendance in DM patients, and with 10% of the diabetology screening nonattendance). Conclusion. The prevalence of DM and DR in the studied population in Hungary followed the country trend, with a slightly higher sight-threatening DR than the previously reported national average. SES appears to affect the DR rate, in particular, for T1D. Although DR screening using handheld cameras seems to be simple and dynamic, much training and experience, as well as overcoming the issue of decreased optic clarity is needed to achieve a proper level of image assessability, and in particular, for use in future telemedicine or artificial intelligence screening programs.

Background: Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is one of the newest development in non-invasive imaging offering simultaneous 3D evaluation of atria and valvular annuli. 3DSTE was used to analyze correlations between left atrial (LA) volume changes and mitral annular (MA) dimensions and functional properties in healthy adult subjects. Methods: A total of 297 healthy subjects were enrolled in this retrospective cohort study, from which insufficient quality of images was responsible for the exclusion of 98 cases (33%). The remaining study population consisted of 199 healthy adults without valvular regurgitation/stenosis in sinus rhythm (mean age: 33.5 ± 12.7 years, 104 males, body mass index: 24.7 ± 1.2 kg/m2, systolic and diastolic blood pressure: 118.2 ± 3.4 mmHg and 78.3 ± 4.5 mmHg, respectively). Two-dimensional Doppler echocardiography and 3DSTE were performed in all cases. Results: Larger LA volumes were associated with more dilated MA dimensions with its reduced function. Elevated LA stroke volumes could be demonstrated only in systole and end-diastole, while increased LA emptying fraction was present only in end-diastole. Reduced MA fractional area change was associated with larger diastolic LA volumes, smaller early diastolic LA stroke volume, in addition all LA emptying fractions were smaller as well. Correlations could be demonstrated between LA and MA parameters. Conclusions: 3DSTE is suitable not only for chamber quantifications, but also for the assessment of valvular annular dimensions. Strong relationship exists between LA volumes and MA dimensions and functional properties.

IntroductionRe-entry is a basic mechanism of ventricular fibrillation, which can be elicited by extrasystolic activity, but the timing of an extrasystole can be critical. The action potential duration (APD) of an extrasystole depends on the proximity of the preceding beat, and the relation between its timing and its APD is called electrical restitution. The aim of the present work was to study and compare the effect of several antiarrhythmic drugs on restitution in preparations from undiseased human ventricular muscle, and other mammalian species.MethodsAction potentials were recorded in preparations obtained from rat, guinea pig, rabbit, and dog hearts; and from undiseased human donor hearts using the conventional microelectrode technique. Preparations were stimulated with different basic cycle lengths (BCLs) ranging from 300 to 5,000 ms. To study restitution, single test pulses were applied at every 20th beat while the preparation was driven at 1,000 ms BCL.ResultsMarked differences were found between the animal and human preparations regarding restitution and steady-state frequency dependent curves. In human ventricular muscle, restitution kinetics were slower in preparations with large phase 1 repolarization with shorter APDs at 1000 ms BCL compared to preparations with small phase 1. Preparations having APD longer than 300 ms at 1000 ms BCL had slower restitution kinetics than those having APD shorter than 250 ms. The selective IKr inhibitors E-4031 and sotalol increased overall APD and slowed the restitution kinetics, while IKs inhibition did not influence APD and electrical restitution. Mexiletine and nisoldipine shortened APD, but only mexiletine slowed restitution kinetics.DiscussionFrequency dependent APD changes, including electrical restitution, were partly determined by the APD at the BCL. Small phase 1 associated with slower restitution suggests a role of Ito in restitution. APD prolonging drugs slowed restitution, while mexiletine, a known inhibitor of INa, shortened basic APD but also slowed restitution. These results indicate that although basic APD has an important role in restitution, other transmembrane currents, such as INa or Ito, can also affect restitution kinetics. This raises the possibility that ion channel modifier drugs slowing restitution kinetics may have antiarrhythmic properties by altering restitution.

Introduction and Objective: Three-dimensional (3D) speckle tracking echocardiography (3DSTE) is a novel method for assessment of left atrial (LA) volumes and function without geometrical assumptions. 3DSTE allows detailed assessment of LA features including volume measurements, strain assessments and calculation of LA ejection force (LAEF). LA strain and volume-based functional parameters originate from the same 3D dataset, but assessment of LAEF requires more data including measurement of mitral annular dimensions and Doppler-derived inflow velocities. The present study was designed to find correlations between LAEF and 3DSTE-derived LA volume-based functional properties and strain parameters in healthy subjects. Methods: The study population comprised 34 randomly selected healthy subjects (age 36.1±11.2 years, 15 men) in sinus rhythm, all of whom had undergone standard two-dimensional transthoracic Doppler echocardiographic study extended with 3DSTE. Results: Mitral annulus diameter-based LAEF correlated with global LA peak circumferential (r=0.39, p=0.02), longitudinal (r=0.32, p=0.05) and area (r=0.43, p=0.01) strain, total atrial stroke volume (r=0.30, p=0.05) and total atrial emptying fraction (r=0.31, p=0.05) characterizing (systolic) LA reservoir function and global LA 3D strain at atrial contraction (r=−0.44, p=0.01) and active atrial emptying fraction (r=0.36, p=0.04) characterizing (diastolic) LA contraction function (booster pump phase). Conclusions: Complex LA functional assessment can be provided by 3DSTE, including calculation of LAEF and volume-based and strain functional properties, with significant correlations between these parameters. Resumo: Introdução e objetivos: A ecocardiografia tridimensional (3D) com speckle tracking (E3DST) é um novo método para avaliação do volume e da função da aurícula esquerda (AE) sem pressupostos geométricos. A E3DST permite a avaliação detalhada das características da AE, incluindo as medições volumétricas, as avaliações da pressão e o cálculo da força de ejeção da AE (FEAE). A força da AE e os parâmetros funcionais baseados no volume são provenientes dos mesmos dados 3D, mas a avaliação da FEAE requer mais dados incluindo a medição das dimensões do anel mitral e das velocidades do fluxo derivado do Doppler. Este estudo foi concebido para encontrar correlações entre a FEAE e a E3DST derivadas das propriedades funcionais baseadas no volume da AE e nos parâmetros de pressão em indivíduos saudáveis. Métodos: Este estudo incluiu 34 indivíduos saudáveis selecionados aleatoriamente (36,1 ± 11 anos, 15 homens) em ritmo sinusal, submetidos a estudo ecocardiográfico Doppler bidimensional transtorácico padrão associado a E3DST. Resultados: A FEAE no anel mitral baseada no diámetro correlacionada com o pico global da AE circunferencial (r = 0,39, p = 0,02), longitudinal (r = 0,32, p = 0,05) e área (r = 0,43, p = 0,01) força, volume arterial total de acidente vascular cerebral (r = 0,30, p = 0,05) e fração auricular total de esvaziamento (r = 0,31, p = 0,05) caracterizando a função de reservatório da AE (sistólica) e a força 3D da AE na contração auricular (r = 0,44, p = 0,01) e fração auricular de esvaziamento ativa (r = 0,36, p = 0,04) caracterizando a função da contração da AE (diastólica) (fase da bomba de reforço). Conclusões: A E3DST podia providenciar a avaliação funcional complexa da AE incluindo o cálculo da FEAE e das propriedades funcionais baseadas no volume e na força com correlações significativas entre estes parâmetros. Keywords: Correlation, Ejection force, Left atrium, Function, Three-dimensional, Speckle tracking echocardiography, Palavras-chave: Correlação, Força de ejeção, Aurícula esquerda, Função, Tridimensional, Ecocardiografia de speckle tracking

IntroductionThe oxidative stress associated with glucose variability might be responsible for neuronal damage while autonomic neuropathy (AN) has a detrimental effect on metabolism. The aim of the study was to find relationship between AN and GV in type 1 diabetic patients and to identify further factors that affect GV.Patients and methodsTwenty type 1 diabetic patients were involved (age: 39.5 ± 3.4 years, duration of diabetes: 17.5 ± 2.5 years; HbA1c: 8.1 ± 0.2%, mean ± SE). AN was assessed by the cardiovascular reflex tests. The interstitial glucose levels were determined following insertion of a subcutaneous electrode during the continuous glucose monitoring (CGM) method on six consecutive days. GV was characterized by calculation of four parameters.ResultsSD of interstitial glucose values correlated positively with the overall AN score and the degree of the orthostatic reduction of systolic blood pressure (AN-score-SD ρ = 0.47, p

Prediabetic states and diabetes are important risk factors for cardiovascular morbidity and mortality. Determination of short-term QT interval variability (STVQT) is a non-invasive method for assessment of proarrhythmic risk. The aim of the study was to evaluate the STVQT in patients with impaired glucose tolerance (IGT). 18 IGT patients [age: 63 ± 11 years, body mass index (BMI): 31 ± 6 kg/m2, fasting glucose: 6.0 ± 0.4 mmol/l, 120 min postload glucose: 9.0 ± 1.0 mmol/l, hemoglobin A1c (HbA1c): 5.9 ± 0.4%; mean ± SD] and 18 healthy controls (age: 56 ± 9 years, BMI: 27 ± 5 kg/m2, fasting glucose: 5.2 ± 0.4 mmol/l, 120 min postload glucose: 5.5 ± 1.3 mmol/l, HbA1c: 5.4 ± 0.3%) were enrolled into the study. ECGs were recorded, processed, and analyzed off-line. The RR and QT intervals were expressed as the average of 30 consecutive beats, the temporal instability of beat-to-beat repolarization was characterized by calculating STVQT as follows: STVQT = Σ|QTn + 1 − QTn| (30x√2)−1. Autonomic function was assessed by means of standard cardiovascular reflex tests. There were no differences between IGT and control groups in QT (411 ± 43 vs 402 ± 39 ms) and QTc (431 ± 25 vs 424 ± 19 ms) intervals or QT dispersion (44 ± 13 vs 42 ± 17 ms). However, STVQT was significantly higher in IGT patients (5.0 ± 0.7 vs 3.7 ± 0.7, P

Cardiovascular diseases, including ventricular arrhythmias are responsible for increased mortality in patients with acromegaly. Acromegaly may cause repolarization abnormalities such as QT prolongation and impairment of repolarization reserve enhancing liability to arrhythmia. The aim of this study was to determine the short-term beat-to-beat QT variability in patients with acromegaly. Thirty acromegalic patients (23 women and 7 men, mean age±SD: 55.7±10.4 years) were compared with age- and sex-matched volunteers (mean age 51.3±7.6 years). Cardiac repolarization parameters including frequency corrected QT interval, PQ and QRS intervals, duration of terminal part of T waves (Tpeak-Tend) and short-term variability of QT interval were evaluated. All acromegalic patients and controls underwent transthoracic echocardiographic examination. Autonomic function was assessed by means of five standard cardiovascular reflex tests. Comparison of the two groups revealed no significant differences in the conventional ECG parameters of repolarization (QT: 401.1±30.6 ms vs 389.3±16.5 ms, corrected QT interval: 430.1±18.6 ms vs 425.6±17.3 ms, QT dispersion: 38.2±13.2 ms vs 36.6±10.2 ms; acromegaly vs control, respectively). However, short-term beat-to-beat QT variability was significantly increased in acromegalic patients (4.23±1.03 ms vs 3.02±0.80, P

BACKGROUND: Sudden cardiac death in competitive athletes is rare but it is significantly more frequent than in the normal population. The exact cause is seldom established and is mostly attributed to ventricular fibrillation. Myocardial hypertrophy and slow heart rate, both characteristic changes in top athletes in response to physical conditioning, could be associated with increased propensity for ventricular arrhythmias. We investigated conventional ECG parameters and temporal short-term beat-to-beat variability of repolarization (STV(QT)), a presumptive novel parameter for arrhythmia prediction, in professional soccer players. METHODS: Five-minute 12-lead electrocardiograms were recorded from professional soccer players (n = 76, all males, age 22.0±0.61 years) and age-matched healthy volunteers who do not participate in competitive sports (n = 76, all males, age 22.0±0.54 years). The ECGs were digitized and evaluated off-line. The temporal instability of beat-to-beat heart rate and repolarization were characterized by the calculation of short-term variability of the RR and QT intervals. RESULTS: Heart rate was significantly lower in professional soccer players at rest (61±1.2 vs. 72±1.5/min in controls). The QT interval was prolonged in players at rest (419±3.1 vs. 390±3.6 in controls, p