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Objective: Although there is sufficient data supporting the increased cardiovascular risk in patients with advanced stage of primary hyperparathyroidism (pHPT), it is not clear whether same is valid for patients with subclinical forms of this disease. In this study we aimed to evaluate coronary atherosclerosis burden of asymptomatic pHPT patients by using tomographic coronary calcification scoring.Patients and Methods: Thirty-one mild asymptomatic pHPT patients (28 female, 3 male; mean age: 54.4 +/- 12.1 years) and 19 gender- and age-matched normotensive healthy controls (17 female, 2 male; mean age: 50.6 +/- 5.8) constituted our study population. Asymptomatic pHPT patients were subdivided according to presence of hypertension (19 hypertensive and 12 non-hypertensive patients). All subjects in study population underwent tomographic coronary calcification scoring by using 16-multidetector computed tomography (16-MDCT).Results: Median tomographic coronary calcification score was comparable between the whole group of pHPT patients [0.0 (Interquartile Range, IQR:18.70] and the controls [0.0 (IQR: 0.90). Median tomographic coronary calcification scores of pHPT patients with hypertension was 0.90 (IQR: 75.0) HU, whereas no calcification was noted in coronary arteries of normotensive pHPT patients. Calcification scores of hypertensive pHPT patients were significantly higher than both normotensive pHPT patients (P = 0.014) and controls (P = 0.046). There was no significant difference regarding calcification scores of normotensive pHPT patients versus controls. In the binary logistic regression model, only the presence of hyperlipidemia was found to be independently associated with presence of calcification on coronary arteries (relative risk 6.56, 95% CI 1.18-36.56, P = 0.032).Conclusion: These results suggest that mild asymptomatic pHPT with serum calcium levels in the high-normal range does not constitute an independent risk factor for coronary atherosclerosis. The combined presence of classic cardiovascular risk factors determines the severity of coronary atherosclerosis in these patients. [ABSTRACT FROM AUTHOR]

Purpose: Vasovagal syncope is a common and challenging problem that may result in injury and causes substantial anxiety among patients and their relatives. However, treatment of vasovagal syncope with standard pharmacologic approaches is not satisfactory. The aim of this study is to investigate the effect of amitriptyline, a tricyclic antidepressant drug, by using its anticholinergic effects in preventing syncopal episodes in patients with vasovagal syncope.Methods: In this study, 74 patients (mean age 24 +/- 1.9 years, 26 male) with a history of recurrent syncope and baseline positive head-up tilt table test (syncope or presyncope) were included. Oral amitriptyline treatment was given to all patients, with a starting dose of 10 mg once a day. Head-up tilt table test was performed in all patients 4 weeks after the treatment started. Patients were followed up clinically for 6 months.Results: After 4 weeks, during head-up tilt table test in 69 patients (93%), syncope or presyncope was not seen and test was assumed as negative. At the end of the 6th month, 67 patients (91%) were free of symptoms. Only two patients (0.3%) did not tolerate amitriptyline due to side effects.Conclusions: Oral amitriptyline can be used in the prevention of recurrent episodes of vasovagal syncope safely. However, randomized controlled studies are essential to assess the real effectiveness of this therapy. [ABSTRACT FROM AUTHOR]

Objective: To explore the association between in-hospital haemoglobin decline and long-term mortality and major adverse cardiovascular and cerebrovascular events (MACCE) among ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI)., Methods: This retrospective analysis included adult patients who underwent primary PCI for STEMI. Haemoglobin levels were recorded at admission and 48-72 h later. Patients were divided into two groups based on the extent of haemoglobin decline: low (<3 g/dl or no decline) and high (≥3 g/dl). The primary endpoint was all-cause mortality at long-term follow-up. The secondary endpoint was MACCE., Results: Patients were divided into two groups: low group ( n  = 665) and high group ( n  = 111). The mortality rate was significantly higher in the high group (72 of 111 patients; 65%) than in the low group (185 of 655 patients; 28%). Propensity score matching confirmed this association, with higher mortality (41 of 79 patients [52%] versus 25 of 79 patients [32%]) and MACCE rates (56 of 79 patients [71%] versus 41 of 79 patients [52%]) in the high group compared with the low group, respectively., Conclusion: There was a significant association between in-hospital haemoglobin decline, even without visible bleeding, and increased long-term mortality and MACCE in STEMI patients undergoing primary PCI., Competing Interests: Declaration of conflicting interestThe authors declare that there are no conflicts of interest.

Aims: We aimed to determine the use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and to identify clinical factors associated with their use in patients with heart failure (HF) in a real-life setting., Methods: Real-world data on Empagliflozin and Dapagliflozin use in patients with HEART failure: The RED-HEART study is a multicentre, cross-sectional and observational study that included HF patients in the outpatient setting regardless of ejection fraction from 19 cardiology centres between August 2023 and December 2023., Results: The study population consisted of 1923 patients with HF, predominantly men (61.2%), with a median age of 66 (range: 19-101) years. Overall, 925 patients (48.1%) were receiving SGLT2is. Among the study population, 22.1% had HF with preserved ejection fraction, 21.5% had HF with mildly reduced ejection fraction, 56.4% had HF with reduced ejection fraction and the use of SGLT2is was 42.0%, 47.9% and 50.6% in each group, respectively (P = 0.012). The use of SGLT2is was 76.6% in patients with HF and diabetes, 19.8% in patients with HF and chronic kidney disease and 26.8% in patients without diabetes and chronic kidney disease (P < 0.001). Higher education level [odds ratio (OR): 1.80; 95% confidence interval (CI): 1.06-3.05; P = 0.027], higher household income (OR: 3.46; 95% CI: 1.27-9.42; P = 0.015), New York Heart Association functional class IV (OR: 2.72; 95% CI: 1.16-6.35; P = 0.021), diabetes (OR: 9.42; 95% CI: 6.72-13.20; P < 0.001), the use of angiotensin receptor-neprilysin inhibitors (ARNis) (OR: 4.09; 95% CI: 2.39-7.01; P < 0.001), the use of mineralocorticoid receptor antagonists (MRAs) (OR: 2.02; 95% CI: 1.49-2.75; P < 0.001), the use of loop diuretics (OR: 1.62; 95% CI: 1.18-2.22; P = 0.003) and the use of thiazide diuretics (OR: 1.72; 95% CI: 1.30-2.29; P < 0.001) were independently associated with the use of SGLT2is. Conversely, atrial fibrillation (OR: 0.63; 95% CI: 0.45-0.88; P = 0.008), chronic kidney disease (OR: 0.53; 95% CI: 0.37-0.76; P = 0.001), the use of dihydropyridine calcium channel blockers (OR: 0.68; 95% CI: 0.48-0.98; P = 0.042) and the use of statins (OR: 0.67; 95% CI: 0.49-0.91; P = 0.010) were independently associated with the non-use of SGLT2is., Conclusions: The RED-HEART study provided comprehensive real-world data about implementing SGLT2is in patients with HF. These results suggest that there is a need for organized action and close collaboration between healthcare providers to improve the implementation of SGLT2is, especially in patients with HF with preserved ejection fraction and chronic kidney disease., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: The coexistence of clinical atrioventricular nodal reentrant tachycardia (AVNRT) and drug-induced type 1 Brugada pattern (DI-Type 1 BrP) has been previously reported. The present study was designed to determine the 12-lead ECG characteristics at baseline and during AVNRT and to identify a subset of 12-lead ECG variables of benefit associated with underlying Brugada syndrome (BrS)/DI-Type 1 BrP among patients with slow/fast AVNRT., Methods: A total of 40 (11 numerical/29 categorical) 12-lead ECG parameters were analyzed and compared between patients with ( n  = 69) and without ( n  = 104) BrS/DI-Type1-BrP matched for age, female gender, body mass index, left ventricular ejection fraction and comorbid conditions. Five distinct types of ECG pattern (Type A/B/C/D/E) in V1-V2 leads during AVNRT were defined., Results: A total of nine electrocardiographic variables, four at baseline, and five during AVNRT were identified. At baseline, patients with BrS/DI-Type 1 BrP had higher prevalence of interatrial block, leftward shift of frontal plane QRS axis, the absence of normal QRS pattern (the presence of rSr' pattern or type 2/3 Brugada pattern) in V1-V2 and QRS fragmentation in inferior leads compared to patients without BrS/DI-Type 1 BrP. During AVNRT, patients with BrS/DI-Type 1 BrP had higher prevalence of Type A ECG pattern ("coved-type" ST-segment elevation) in V1-V2, Type C ECG pattern (pseudo-r' deflection in V 1 and "RBBB-like" pattern in V 2 ), pseudo-r' deflection in V 1 , QRS fragmentation in inferior leads and "isolated" QRS fragmentation/notching/slurring in aVL compared to patients without BrS/DI-Type 1 BrP., Conclusions: We identify several electrocardiographic variables that point to an underlying type 1 BrP among patients with slow/fast AVNRT., Competing Interests: The authors declare no conflict of interest for this article., (© 2022 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.)

The peripheral vascular effects of continuous-flow left ventricular assist device (CF-LVAD) implantation are still unclear. The aim of the current study was to determine peripheral vascular function before and after implantation of CF-LVAD in patients with end-stage heart failure (HF), and to compare this data to age- and sex-matched chronic heart failure with reduced ejection fraction (HFrEF) patients. Forty-three consecutive end-stage HF patients (New York Heart Association [NYHA] class III/IV; three women and 40 men; mean age 53 ± 11 years) who planned to receive CF-LVAD implantation comprised the LVAD patient population, and their clinical characteristics, preoperative and third postoperative month peripheral vascular function assessment data including flow-mediated dilation (FMD) and pulsatility index (PI) assessed by ultrasound Doppler in brachial artery were compared to age- and sex-matched chronic, stable HFrEF patients (NYHA class II; five women and 30 men; mean age 51 ± 10 years). After CF-LVAD implantation, median FMD decreased from 5.4 to 3.7% (p < 0.001), and median PI decreased from 6.9 to 1.4 (p < 0.001). In patients with end-stage HF before CF-LVAD implantation, FMD and PI were significantly lower compared to the chronic HFrEF patients (FMD: 5.4% ± 0.9% vs. 7.6% ± 1.1%; p < 0.001, respectively) and (PI: 6.9 ± 1.3 vs. 7.4 ± 1.2; p = 0.023, respectively). The current study revealed impaired peripheral vascular function in the end-stage HF patients compared to stable HFrEF patients, and documented the deterioration of peripheral vascular function after CF-LVAD implantation. These results suggest that impaired peripheral vascular function in the CF-LVAD patients compared to preoperative assessment is a consequence of the nonpulsatile blood flow due to the continuous-flow mechanical support., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © ASAIO 2021.)

Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality worldwide. The coronary atherosclerotic process involves different pathological mechanisms; inflammation is one of the major triggers for the development of atherosclerotic plaque. Although several studies showed the favorable effects of melatonin on the cardiovascular system (CVS), melatonin seems not to take its rightful place in today's clinical practice. This review aims to point out the role of melatonin on cardiovascular disease (CVD) and its' risk factors. All data were obtained via PubMed, Wikipedia, and Google., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Ozkalayci et al.)

Introduction: We have previously reported high 1-year prevalence of migraine in patients with atrial arrhythmias associated with DI-type 1 BrP. The present study was designed to determine the lifetime prevalence of migraine in patients with Brugada syndrome (BrS) or drug-induced type 1 Brugada pattern (DI-type 1 BrP) and control group, to investigate the demographic and clinical characteristics, and to identify clinical variables to predict underlying BrS/DI-type 1 BrP among migraineurs., Methods and Results: Lifetime prevalence of migraine and migraine characteristics were compared between probands with BrS/DI-type 1 BrP (n = 257) and control group (n = 370). Lifetime prevalence of migraine was 60.7% in patients with BrS/DI-type 1 BrP and 30.3% in control group (p = 3.6 × 10 -14 ). On stepwise regression analysis, familial migraine (odds ratio [OR] of 4.4; 95% confidence interval [CI]: 2.0-9.8; p = 1.3 × 10 -4 ), vestibular migraine (OR of 5.4; 95% CI: 1.4-21.0); p = .013), migraine with visual aura (OR of 1.8; 95% CI: 1.0-3.4); p = .04) and younger age-at-onset of migraine (OR of 0.95; 95% CI: 0.93-0.98); p = .004) were predictors of underlying BrS/DI-type 1 BrP among migraineurs. Use of anti-migraine drugs classified as "to be avoided" or "preferably avoided" in patients with BrS and several other anti-migraine drugs with potential cardiac I Na /I Ca channel blocking properties was present in 25.6% and 26.9% of migraineurs with BrS/DI-type 1 BrP, respectively., Conclusion: Migraine comorbidity is common in patients with BrS/DI-type 1 BrP. We identify several clinical variables that point to an underlying type-1 BrP among migraineurs, necessitating cautious use of certain anti-migraine drugs., (© 2020 Wiley Periodicals LLC.)

Background: Thrombolytic therapy is recommended for patients with acute ST-segment elevation myo- cardial infarction (STEMI) who cannot undergo primary percutaneous coronary intervention within the first 120 min. The aim of this study was to demonstrate the value of CHA2DS2-VASc and CHA2DS2- -VASc-HS scores in predicting failed reperfusion in STEMI patients treated with thrombolytic therapy., Methods: A total of 537 consecutive patients were enrolled in the study; 139 had failed thrombolysis while the remaining 398 fulfilled the criteria for successful thrombolysis. Thrombolysis failure was defined with the lack of symptom relief, < 50% ST resolution-related electrocardiography within 90 min from initiation of the thrombolytic therapy, presence of hemodynamic or electrical instability or in-hospital mortality. CHA2DS2-VASc and CHA2DS2-VASc-HS scores, which incorporate hyperlipi- demia, smoking, switches between female and male gender, were previously shown to be markers of the severity of coronary artery disease (CAD)., Results: History of hypertension, diabetes mellitus, hyperlipidemia, heart failure, smoking, and CAD were significantly common in failed reperfusion patients (for all; p < 0.05). For prediction of failed rep- erfusion, the cut-off value of CHA2DS2-VASc score was ≥ 2 with a sensitivity of 80.90% and a specificity of 41.01% (area under curve [AUC] 0.660; 95% confidence interval [CI] 0.618-0.700; p < 0.001) and the cut-off value of CHA2DS2-VASc-HS score was ≥ 3 with a sensitivity of 76.13% and a specificity of 67.63% (AUC 0.764; 95% CI 0.725-0.799; p < 0.001). The CHA2DS2-VASc-HS score was found to be statistically and significantly better than CHA2DS2-VASc score to predict failed reperfusion (p < 0.001)., Conclusions: The findings suggest that the CHA2DS2-VASc and especially CHA2DS2-VASc-HS scores could be considered as predictors of risk of failed reperfusion in STEMI patients.

Background: Atrial arrhythmias, particularly atrioventricular nodal reentrant tachycardia, can coexist with drug-induced type 1 Brugada electrocardiogram (ECG) pattern (DI-Type1-BrP). The present study was designed to determine the prevalence of DI-Type1-BrP in patients with atrioventricular accessory pathways (AV-APs) and to investigate the clinical, electrocardiographic, electrophysiologic, and genetic characteristics of these patients., Methods: One-hundred twenty-four consecutive cases of AV-APs and 84 controls underwent an ajmaline challenge test to unmask DI-Type1-BrP. Genetic screening and analysis was performed in 55 of the cases (19 with and 36 without DI-Type1-BrP)., Results: Patients with AV-APs were significantly more likely than controls to have a Type1-BrP unmasked (16.1 vs 4.8%, P = 0.012). At baseline, patients with DI-Type1-BrP had higher prevalence of chest pain, QR/rSr' pattern in V 1 and QRS notching/slurring in V 2 and aVL during preexcitation, rSr' pattern in V 1 -V 2 , and QRS notching/slurring in aVL during orthodromic atrioventricular reentrant tachycardia (AVRT) compared to patients without DI-Type1-BrP. Abnormal QRS configuration (QRS notching/slurring and/or fragmentation) in V 2 during preexcitation was present in all patients with DI-Type1 BrP. The prevalence of spontaneous preexcited atrial fibrillation (AF) and history of AF were similar (15% vs 18.3%, P = 0.726) in patients with and without DI-Type1-BrP, respectively. The prevalence of mutations in Brugada-susceptibility genes was higher (36.8% vs 8.3%, P = 0.02) in patients with DI-Type1-BrP compared to patients without DI-Type1-BrP., Conclusions: DI-Type1-BrP is relatively common in patients with AV-APs. We identify 12-lead ECG characteristics during preexcitation and orthodromic AVRT that point to an underlying type1-BrP, portending an increased probability for development of malignant arrhythmias., (© 2018 Wiley Periodicals, Inc.)

Background: It is widely believed that ST-elevated myocardial infarction (STEMI) generally occurs at the site of mild to moderate coronary stenosis. The aim of this study was to determine the degree of stenosis of infarct-related artery (IRA) in STEMI patients who underwent coronary angiography (CAG) after successful reperfusion with thrombolytic therapy (TT)., Methods: A total of 463 consecutive patients between January 2008 and December 2013 with acute STEMI treated with TT were evaluated retrospectively. The patients in whom reperfusion failed (n = 120), death occurred before CAG (n = 12), IRA cannot be determined (n = 10), and CAG was not performed in index hospitalization (n = 54) were excluded from the study. To determine the severity of stenosis of IRA, two experienced cardiologists who were unaware of each other used quantitative CAG analysis. Significant stenosis was defined as a ≥ 50% stenosis in the coronary artery lumen. A total of 267 patients who were successfully reperfused with TT and in whom CAG was performed during hospitalization with median 8 (1 - 17) days after myocardial infarction were included in the study., Results: The mean age of patients was 55.7 ± 10.8 years (85.5% male). Most of the patients had a significant stenosis in IRA ( ≥ 50%, n = 236, group 1) after successful TT; whereas only 11.6% had stenosis < 50% (n = 31, group 2). In addition, majority of the patients had ≥ 70.4% (n = 188, 70.4%) stenosis in IRA. Average of stenosis in IRA was 74±16%., Conclusions: In contrast to the general opinion, we detected that majority of STEMI patients had a significant stenosis in IRA.

Extract: A 28-year-old asymptomatic woman was referred to ourclinic for evaluation of a heart murmur. Transthoracic echocardiography (TTE) demonstrated ventricular hypertrophy with septal thickness of 26 mm., consistent with hypertrophic cardiomyopathy (HCM). The diagnosis of HCM was confirmed by contrast-enhanced magnetic resonance imaging, and late gadolinium enhancement was observed in the anterior wall ..., (© 2016 The authors.)

Background: We evaluated whether left atrial (LA) phasic functions, P-wave dispersion (PWD), and plasma NT-proBNP levels could predict future development of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM)., Methods: Seventy patients with HCM were evaluated. The LA phasic functions including the LA total emptying volume (LATEV), LA total emptying fraction (LATEF), LA active emptying volume (LAAEV), LA active emptying fraction (LAAEF), LA passive emptying volume (LAPEV), and LA passive emptying fraction (LAPEF) were evaluated. P-wave dispersion was calculated. Plasma NT-proBNP levels were measured on the same day with echocardiographic study., Results: Patients were followed up 53.09 ± 1.87 months. Patients who developed AF (n = 18) had significantly higher PWD values, NT-proBNP levels, LAVI, E/E' av, and resting LVOT gradients and significantly lower LATEF and LAAEF. In multivariate analysis, LATEF (P = 0.002), LAAEF (P = 0.007), logNT-proBNP level (P = 0.022), and PWD (P = 0.018) were associated with AF development. The results of receiver operating characteristic analysis revealed that a LATEF cutoff value 49% with 72% sensitivity and 81% specificity, a LAAEF cutoff value of 36% with 72% sensitivity and 71% specificity, and an NT-proBNP cutoff value of 720 pg/mL predicted future AF development with 72% sensitivity and 60% specificity. A PWD cutoff value of 47.5 msecond predicted future AF development with 78% sensitivity and 72% specificity., Conclusion: In patients with HCM, LA phasic functions, PWD, and NT-proBNP levels predict future development of AF. Assessment of LA phasic functions during routine echocardiographic evaluation and measuring NT-proBNP levels and PWD values of patients with HCM during daily practice may provide important data in predicting those at high risk of AF occurrence., (© 2015, Wiley Periodicals, Inc.)

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) may coexist with Brugada syndrome (BrS)., Objectives: The present study was designed to determine the prevalence of drug-induced type 1 Brugada ECG pattern (concealed BrS) in patients presenting with clinical spontaneous AVNRT and to investigate their electrocardiographic, electrophysiological, and genetic characteristics., Methods: Ninety-six consecutive patients without any sign of BrS on baseline electrocardiogram undergoing electrophysiological study and ablation for symptomatic, drug-resistant AVNRT and 66 control subjects underwent an ajmaline challenge to unmask BrS. Genetic screening was performed in 17 patients displaying both AVNRT and BrS., Results: A concealed BrS electrocardiogram was uncovered in 26 of 96 patients with AVNRT (27.1%) and in 3 of 66 control subjects (4.5%) (P ≤ .001). Patients with concealed BrS were predominantly female patients (n=23 [88.5%] vs n=44 [62.9%], P = .015), had higher prevalence of chest pain (n=10 [38.5%] vs n=13 [18.6%], p=0.042), migraine headaches (n=10 [38.5%] vs n=10 [14.2%], p=0.008), and drug-induced initiation and/or worsening of duration and/or frequency of AVNRT (n=4 [15.4%] vs n=1 [1.4%], p=0.006) as compared to patients with AVNRT without BrS. Genetic screening identified 19 mutations or rare variants in 13 genes in 13 of 17 patients with both AVNRT and BrS (yield = 76.5%). Ten of these 13 genotype-positive patients (76.9%) harbored genetic variants known or suspected to cause a loss of function of cardiac sodium channel current (SCN5A, SCN10A, SCN1B, GPD1L, PKP2, and HEY2)., Conclusion: Our results suggest that spontaneous AVNRT and concealed BrS co-occur, particularly in female patients, and that genetic variants that reduce sodium channel current may provide a mechanistic link between AVNRT and BrS and predispose to expression of both phenotypes., (Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: We evaluated the associations among the well-known atrial fibrillation (AF) predictors including P-wave dispersion (PWD), intra- and inter-atrial electromechanical dyssynchrony (EMD), left atrial (LA) phasic functions, and plasma N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels, in patients with hypertrophic cardiomyopathy (HCM)., Methods: Seventy patients with HCM and age and sex matched 70 subjects were enrolled. PWD, LA total emptying fraction (LATEFr), active emptying fraction (LAAEFr), passive emptying fraction (LAPEFr), expansion index (LAEI) intra- and inter-atrial EMD were calculated. Levels of NT-proBNP of all subjects were determined., Results: Higher PWD (p = 0.006), significantly decreased LAEI (p < 0.001), LATEFr, and LAPEFr (both p values < 0.001) values and significantly increased inter-atrial (p < 0.001), LA (p = 0.001), and right atrial dyssynchrony (p < 0.001) were observed in the HCM group compared to controls. PWD was negatively correlated with LAEI (r = -0.236, p = 0.005) and LATEFr (r = -0.242, p = 0.04), however not with LAPEFr (p = 0.7), or LAAEFr (p = 0.3). Except for the LA lateral wall PA' (r = 0.283, p = 0.02), PWD was not correlated with any atrial EMD parameter. Inter-atrial dyssynchrony was related to LAEI (r = -0.272, p = 0.001), LATEFr (r = -0.256, p = 0.03), and LAPEFr (r = -0.332, p = 0.006), but not, however, to LAAEFr (p = 0.4). The plasma NT-proBNP levels of patients were not correlated with either PWD (p = 0.927) or inter-atrial dyssynchrony (p = 0.102)., Conclusions: PWD and inter-atrial dysynchrony seem to independently promote AF, although both are associated with LA reservoir function in HCM populations. The NT-proBNP level is not associated with these two AF predictors in patients with HCM. NT-proBNP seems to be a poor marker of atrial electrical remodeling in HCM patients.

Background: Although predictive value of heart rate recovery (HRR) has been tested in large populations, the reproducibility of HRR in treadmill exercise test has not been assessed prospectively. This prospective study examined whether HRR index has test-retest stability in the short term., Methods: A total of 52 healthy volunteers without cardiovascular risk factors (mean age, 30 ± 10 years, 30 females) underwent standardized graded treadmill exercise test, and the test was repeated on the 7th and the 30th days. The subjects' maximal heart rates and the decrease of heart rate from the peak exercise level to the level of 1, 2, 3, 4, and 5 minutes after the termination of the exercise were examined on each test, and heart rates for each minute from the first, second, and third tests were compared for each individual., Results: The maximal heart rates on the 1st, 7th, and the 30th days were 179 ± 11, 177 ± 10, 178 ± 10 beats/min, respectively [P = 0.07, intraclass correlation coefficient (ICC) = 0.92], and the 1st minute HRR indices after peak exercise were 33 ± 10, 33 ± 10, 33 ± 11, respectively (P = 0.66, ICC = 0.88). There was no statistical difference in the 2nd, 3rd, 4th, and 5th minute heart rates of the recovery phase among the 1st, 7th, and 30th day treadmill exercise tests, either., Conclusion: Maximal heart rates and the decline of heart rate to the 5th minute on recovery phase after treadmill exercise test have short-term reproducibility., (©2011, Wiley Periodicals, Inc.)

Objectives: This study aimed to demonstrate that irbesartan is successful in reducing diastolic blood pressure (BP) even following a missed dose after 6-8-weeks' treatment as measured by 24-hour ambulatory BP monitoring (ABPM)., Methods: Eighty-eight patients (64 females, mean age: 53.4 +/- 10.6 years) with primary hypertension were included in this national, single-center, single-arm, open-label, prospective clinical study. Irbesartan (150 or 300 mg/day) was administered for 8 weeks. All patients were asked to cease treatment for 1 day during weeks 6-8. Changes in diastolic and mean 24-hour BP on the day of cessation and diastolic BP values during visits were efficacy parameters. Adverse events were also recorded., Results: Systolic, diastolic, and mean BP values measured via ABPM before and on the day of a missed dose did not differ significantly. Irbesartan effectively controlled BP of the patients. BP normalization rates were 54% for 150 mg/day irbesartan only and 77% for both doses (150 or 300 mg/day) of irbesartan. None of the patients experienced serious adverse events throughout the study period., Conclusions: Irbesartan is successful and safe in the control of BP levels even following a missed dose at the end of a 6-8-week treatment period.

Background: There is limited information regarding myocardial alterations in patients with obstructive sleep apnea syndrome (OSAS) in the absence of pulmonary and cardiac comorbidity. In this study, we aimed to evaluate potential myocardial alterations of these patients and investigate the possible effects of OSAS-related pathological variations on left and right ventricular functions., Methods: We studied 107 consecutive patients who were referred to our sleep laboratory for clinically suspected OSAS and 30 controls without any history or symptoms of sleep-related disorders. Severity of OSAS was quantified by polysomnography. Patients with apnea-hypopnea index (AHI) < 5 were included in the OSAS (-) group (Group 1, n = 22). Subjects with AHI > or = 5 were considered as OSAS and classified according to their AHI as mild-to-moderate (AHI > or = 5 and AHI < 30) (Group 2, n = 45) and severe (AHI > or = 30) OSAS groups (Group 3, n = 40). Conventional M-mode, 2D, and Doppler mitral inflow parameters, tissue Doppler velocities, myocardial peak systolic strain, and strain rate values of various segments were measured and compared between groups., Results: Patients with OSAS displayed impairment of left ventricular diastolic function compared with controls. There were no significant differences between groups regarding parameters reflecting left ventricular systolic function. Myocardial strain analysis demonstrated significant decrement regarding apical right ventricular longitudinal peak systolic strain and strain rate values between groups in relation to the severity of OSAS., Conclusions: Patients with OSAS display a regional pattern of right ventricular dysfunction correlated with the severity of disease.

The aim of this study was to assess the plasma levels of von Willebrand factor antigen and ristocetin cofactor activity, which are well-known markers of endothelial function, in atrial fibrillation (AF) with or without mitral stenosis (MS). Forty-two patients (16 patients with MS and AF [MS(+)AF(+)], 13 patients with nonvalvular AF [MS(-)AF(+)], and 13 patients with MS and sinus rhythm [MS(+)AF(-)]) were included. Von Willebrand factor antigen levels and ristocetin cofactor activities in all participants were assessed. Overall, von Willebrand factor antigen levels and ristocetin cofactor activities in the AF(+) patients were higher than in the AF(-) patients (P = .003 and P = .002, respectively). Von Willebrand factor antigen levels and ristocetin cofactor activities in the 3 groups were found to be different (P = .012 and P = .01, respectively). Von Willebrand factor antigen levels were similar between the MS(+)AF(+) and MS(-)AF(+) groups and were higher than that of the MS(+)AF(-) group. Ristocetin cofactor activity in the MS(-)AF(+) group was significantly higher than in the other 2 groups. The ristocetin cofactor activity and von Willebrand factor antigen levels were significantly higher in diabetic or hypertensive patients than in nondiabetic or normotensive patients. According to the results of this study, circulating von Willebrand factor antigen levels and plasma ristocetin cofactor activities are affected by the presence of AF, MS, and associated comorbidities including type 2 diabetes mellitus and systemic hypertension. Further studies are needed to assess the role of von Willebrand factor antigen and ristocetin cofactor activity in predicting vascular thrombotic events in AF, MS, systemic hypertension, and diabetes mellitus.

Aim: This study was conducted to evaluate whether left atrial strain and strain rate correlate well with transesophageal parameters of stunning after atrial fibrillation., Methods and Results: Twenty-two consecutive patients with chronic atrial fibrillation >/=3 months and <1 year were enrolled in the study. Transthoracic (TTE) and transesophageal (TEE) echocardiography with color Doppler myocardial imaging were performed before, 1 day after and 10 days after successful cardioversion. Left atrial transthoracic strain (S) and strain rate (SR) from lateral, inferior and anterior atrial walls, left atrial appendage tissue velocities, strain and strain rate values were measured with offline analysis. Left atrial appendage emptying (LAAEV) and filling (LAAFV) velocities were obtained from transesophageal echocardiography. Left atrial transthoracic, and left atrial appendage strain and strain rates were significantly lower following 1 day after cardioversion (TTE S/SR, 5.0 +/- 2.8%/2.3 +/- 1.0; TEE (septal) S/SR, 7.6 +/- 3.6%/1.6 +/- 0.7). There was a good correlation between these parameters and LAAEV (LA systolic strain and LAAEV, r = 0.73, P = 0.007). Left atrial and LAA strain and strain rate values improved over time, and correlated well with LAAEV, measured 10 days after cardioversion., Conclusions: Transthoracic atrial and TEE LAA strain and strain rate, which are quantitative measures of atrial function, are reduced after cardioversion, and recover subsequently. The good correlation between LAA function and TTE strain and strain rate suggests that TTE atrial parameters may help determine duration of anticoagulation.