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Comorbid conditions are known to be associated with poor prognosis in coronavirus disease 2019. This study aimed to investigate the effects of comorbidity burdens of inpatients, identified by the Charlson Comorbidity Index, on their mortalities.A total of 150 patients who presented to the emergency department of our hospital with various complaints and symptoms were diagnosed with coronavirus disease 2019 as a result of the testing and received inpatient treatment (87 males, mean age 61.6 ± 13.8 years) were included in the study. Charlson Comorbidity Index scores were calculated. Patients were classified into 2 groups based on the state of exitus: group 1, those who did not survive; 33 patients, 19 males; 68.3 ± 11.8 years and group 2, those who survived; 117 patients, 68 males; 59.7 ± 13.8 years.In all patients, the exitus rate was 22%, the rate of intensive care follow-up was 46%, and the intubation rate was 37.3%. The Charlson Comorbidity Index scores were significantly higher in group 1 compared to group 2. Multivariate logistic regression analyses demonstrated that the Charlson Comorbidity Index score was an independent predictor of in-hospital mortality (odds ratio: 1.990, 95% CI: 1.314-3.015, P = .001). The cut-off value for the Charlson Comorbidity Index to predict in-hospital mortality was 5.5, with 81.8% sensitivity and 73.5% specificity.The Charlson Comorbidity Index score, which can be obtained at the time of admission, could be associated with the prognosis of coronavirus disease 2019 patients. Those with a Charlson Comorbidity Index score greater than 5.5 could be more associated with negative outcomes and mortality.

Background: Aortic knob width (AKW) is the measurement of the radiographic configuration composed of the foreshortened aortic arch and a part of the descending aorta. We investigated the relationship between the non-dipper pattern and AKW. Materials and methods: All patients’ office blood pressure measurements and 24-hour ambulatory blood pressure readings were recorded. A blood pressure drop of less than 10% is defined as non-dipper blood pressure. The patients were grouped into Group 1; dipper pattern, (37 patients; 22F, and mean age 49.2±11.7 yrs) and Group 2; non-dipper pattern, (64 patients; 37F, and mean age 53.7±13.1 yrs). On posteroanterior chest radiography, the widest point of the aortic knob was measured along the straight imaginary line from the lateral edge of the trachea to the left lateral wall of the aortic arch. Results: AKW were significantly higher in Group 2 compared to group 1 (36.7±5.7 vs 30.7±4.5 mm, p

BACKGROUND It is known that non-dipper pattern (NDP) is associated with adverse outcomes in hypertensive patients. However, there is insufficient data on the outcome of NDP in normotensive individuals. Using myocardial work (MW) analysis, as a new echocardiographic examination method, this study aimed to determine the early myocardial effects of NDP in normotensive individuals. METHODS This study included 70 normotensive individuals who were followed by ambulatory blood pressure monitoring (ABPM). The subjects were divided into two groups according to dipper pattern (DP) and NDP. Conventional, strain, and MW findings were compared between the groups by making echocardiographic evaluations. RESULTS The demographic characteristics, laboratory parameters, and measurements of cardiac chambers, and left ventricular (LV) walls were similar between the groups. There was no statistical difference between the groups in terms of LV 3-2-4 chambers strains and global longitudinal strain (GLS) values. LVMW parameters, global work index (GWI), and global constrictive work (GCW) were not statistically different between groups (2012 ± 127, 2069 ± 137, p = 0.16; 2327 ± 173, 2418 ± 296, p = 0.18, respectively). However, global waste work (GWW) and global work efficiency (GWE) parameters were different between the groups (144 ± 63.9, 104 ± 24.8, p

Aim: To examine electromechanical delay (EMD) a predictive of atrial fibrillation (AF) risk, in obese and non-obese metabolic syndrome (MS) patients and to research the relationship between EMD and the new body composition indices. Method: 118 overweight (body mass index (BMI)>26 kg/m2) individuals with MS meeting the criteria for IDF and ATP III were included in the study. The subjects were divided into two groups: Group 1; 54 obese persons with MS (33 females; mean age 46.2±14.1) while Group 2 included 64 non-obese persons with MS (33 females; mean age 41.4±13.2). In addition to laboratory findings, body composition indices, conventional and tissue Doppler imaging were obtained. Atrial EMD was defined as the time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the late diastolic A wave. Inter, intra and left atrial EMD’s were measured from the data obtained. Results: Inter, intra and left atrial EMDs were significantly greater in the obese group compared to the non-obese group. There was a significant correlation between interatrial EMD and left atrial EMD and all body composition indices except body surface index. The strongest correlation was between body roundness index (BRI) and interatrial and left atrial EMD (r=0.46; p

Background: Malnutrition is closely associated with heart failure, and known to be closely associated with mortality and morbidity in these patients. Aims: We investigated the relationship of the prognostic nutritional index (PNI), which is a criterion of nutritional status in patients with heart failure with reduced ejection fraction (HFrEF), with prognosis and parameters indicating inflammation. Methods: 139 patients admitted to the coronary intensive care unit with symptoms of decompensated congestive heart failure were included to the study. Patients were with heart failure with ejection fraction 9/L). Results: PNI was significantly lower in group 1. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic inflamatory index values were significantly higher in group 1. PNI was significantly associated with these parameters. Conclusion: Low PNI scores in HFrEF patients may be associated with a worse prognosis and hematological parameters indicating more negative inflammation. PNI was found to be an independent predictor of mortality.

Background and aims It is still unclear which anthropometric parameter is most associated with significant coronary artery disease (CAD). We examined the relationship of the prevalence and severity of coronary artery disease with body composition indices. Methods and results Patients aged 18–80 years who were admitted to the cardiology outpatient clinic with any complaints, and were indicated for coronary angiography as a result of the examinations, were included in this study and divided into two groups. Group 1 had significant stenosis (161 patients, 104 males, mean age: 64.1 ± 10.5 years), while Group 2 had non-significant stenosis (75 patients, 48 males, mean age: 58.9 ± 11.8 years). Significant stenosis was defined as narrowing of 50% or more of the arterial lumens in any vessel or its lateral branch. Height, weight, waist and hip circumferences and body composition indices of all patients were measured. The SYNTAX and Gensini scores were calculated for all patients undergoing angiography. Group 1 had significantly higher waist circumferences (WC), body roundness indices (BRI), body fat percentages, and waist/height ratios than Group 2. In the correlation analysis, WC, BRI, waist/hip ratio and waist/height ratio were significantly correlated with the Gensini score. WC, hip circumference, BRI, body fat percentage and waist/height ratio were significantly correlated with the SYNTAX score. In the multivariate regression analysis, BRI was the parameter best related to significant CAD. Conclusion BRI, body fat percentage, waist circumference and waist/height ratio were higher in patients with significant stenosis. BRI was the parameter most closely related to the Gensini and SYNTAX scores and to significant CAD.

Introduction:In this study, we aimed to evaluate whether atrial electromechanical delay (EMD) and epicardial adipose tissue (EAT) thickness differed between ankylosing spondylitis (AS) patients and healthy subjects.Methods:This prospective, cross-sectional study included 43 consecutive AS patients followed up in the Physical Medicine and Rehabilitation Department of the University of Health Sciences Turkey, İstanbul Training and Research Hospital, between June 2019 and January 2020. The control group consisted of 42 age-and gender-matched healthy participants. The PA atrial EMD was accepted as the beginning of the P wave on the electrocardiograph and the begining of late diastolic wave (Am wave) on the tissue Doppler obtained by transthoracic echocardiography, and all EMD parameters, including lateral mitral annulus (lateral PA), septal mitral annulus (septal PA) and right ventricular tricuspid annulus (tricuspid PA), were calculated. The thickness of EAT was obtained from the thickest part of the right ventricular free wall at the end of diastole in the parasternal long axis window.Results:In AS patients, tissue Doppler measurements of PA lateral, PA septal and PA tricuspid were longer than the measurements in the control group. In addition, EAT thickness was significantly higher in AS patients than in the control group. There was a moderate correlation between interatrial EMD and C-reactive protein (r=0.445, p

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Background: Infective endocarditis is a challenging clinical situation that causes numerous complications. Multi-valvular endocarditis, which is seen less frequently than single valvular endocarditis, is often a fatal disease. In this article, we present a case of endocarditis with native mitral and tricuspid valve involvement in a patient without any underlying predisposing factors. Case report:A 62-year-old patient was admitted to hospital with shortness of breath without any underlying predisposing factors. Covid-19 PCR swab was negative. Transthoracic echocardiography revealed bi-sided valve endocarditis with mitral and tricuspid valve involvement. The patient was taken to the intensive care unit. Transthoracic and transesophageal echocardiography revealed valvular involvement, flail mitrale with severe regurgitation on both valvules. The patient and patient's relatives refused the valvular operation because of the higher risk. Despite the antibiotic treatment, the general condition of the patient deteriorated and died. Conclusion:Multi-valvular endocarditis is a serious disorder with high mortality. In diagnosis, imaging procedures should be utilized as early as possible. Staphylococci are the most common pathogens in such cases, in which early diagnosis and treatment, particularly using a surgical approach, are appropriate.

This study was designed to evaluate the impact of septoplasty on cardiopulmonary functions in patients with nasal septal deviation (NSD). A total of 30 consecutive adult patients (mean [standard deviation] age: 33.7 [10.9] years, 56.7% were males) who underwent septoplasty due NSD were included. Visual analog scale scores, nose obstruction symptom evaluation scale scores, serum N-terminal Pro BNP levels, and cardiologic examination findings on electrocardiogram, transthoracic echocardiography, and exercise treadmill testing were evaluated both 7 days before and 3-months after septoplasty operation. A significant decrease was noted in mean (standard deviation) visual analog scale scores (8.27 [0.83] versus 1.87 [0.73], P

Aim: To investigate the position of the heart after pneumonectomy and, also to find out how the changes in the electrical axis of the heart contribute for the possible electrocardiographic and echocardiographic changes. Methods: Ninety-eight patients with pneumonectomy were included to this observational study. To calculate the rotation of the heart and angle measurement two perpendicular lines, one septal and another atrioventricular, were drawn on the images acquired from thoracic computed tomography. Thoracic CT were taken at every 3 months for the first two years. On electrocardiograms net QRS vectors, amplitudes of p waves, findings of right and left ventricular hypertrophy, and other possible changes were recorded. Results: The mean age of all patients was 55.51 ± 8.9. Right pneumectomy was performed in 40 (57%) and left pneumonectomy in 30 cases (43%) cases. There was no significant change regarding both the angle of rotation and the amount of pleural effusion between the findings of the second and first year after the operation. The QRS shift was significantly more pronounced in patients with left pneumonectomies than right pneumonectomies. On echocardiography these cases showed right ventricular hypertrophy and increased pulmonary artery pressures in the second year when compared to the preoperative period. Conclusions: The current study showed that many significant changes occurred in the electrocardiographic and echocardiographic parameters of the heart after pneumonectomy.

Iatrogenic left main coronary artery (LMCA) dissection is a rare but potentially life-threatening complication of invasive coronary procedures. The technique for managing LMCA dissection varies and depends on the patient’s comorbidities and degree of hemodynamic stability. Here, we report the case of a 51-year-old patient with iatrogenic LMCA dissection who was successfully treated using the reverse crush bifurcation technique.

Contrast-induced acute kidney injury (CI-AKI) can occur after coronary interventions despite protective measures. We evaluated the effect of urinary system contrast blush grading for predicting post-procedure CI-AKI in 486 patients with chronic coronary artery disease. Patient characteristics and blood samples were collected. Urinary system contrast blush grade was recorded during the coronary angiography and interventions. Post-procedure third to fourth day blood samples were collected for diagnosis of CI-AKI. The median age of the patients was 61 years (53-70, interquartile range), and 194 (39.9%) participants were female. Contrast-induced acute kidney injury occurred in 78 (16%) patients. By comparing full and reduced models with the likelihood ratio test, it was observed that in the reduced model, factors such as age, diabetes mellitus, body weight–adapted contrast media (CM), hemoglobin, and urinary system blush were associated with CI-AKI presence. The probability of CI-AKI presence increased slightly from grade 0 to 1 blush, but it increased sharply grade from 1 to 2 blush. According to our results, an increase in body weight–adapted CM and urinary blush grading were the main predictors of CI-AKI. These findings suggest that when body weight–adapted CM ratio exceeds 3.5 mL/kg and urinary contrast blush reaches grade 2, the patients should be followed up more carefully for the development of CI-AKI.

Background Malnutrition reflects the general condition of a patient including physical condition, protein turnover and immune-competence. Contrast induced acute kidney injury (CI-AKI) is a disorder that adversely affects the prognosis of older adults. In our study we aimed to show the relationship between CI-AKI and malnutrition status in the elderly patients over 65 years of age with chronic coronary artery disease (CAD). Methods Study enrolled 360 consecutive patients with coronary angiography performed due to chronic coronary artery disease. Patients pre-procedural and post-procedural blood samples were taken and prognostic nutritional index (PNI), controlling nutritional status (CONUT) score and geriatric nutritional risk index (GNRI) malnutrition scores were calculated . Results The median age of the patients included in the study was 69 (67-72, IQR) , CI-AKI was seen in 91 (25.2%) patients. Univariate regression analysis showed that age, diabetes mellitus, baseline creatinine, body weight-adapted contrast agent, haemoglobin, left ventricular ejection fraction, CONUT score, PNI score, and GNRI score were independent predictors of CI-AKI. in model 1, increase in CONUT score (2 to 5) (OR: 3.21 (2.11-4.88), in model 2 increase of PNI score (37.4 to 45 ) (OR: 0.34, (0.24 - 0.49 ), and in model 3 increase of GNRI score (89.5 to 103.8) (OR: 0.55 , (0.38 - 0.81)) were independently associated with the presence of CI-AKI. PNI showed better results than other models in discriminating the predictable capability for CI-AKI. Conclusion Malnutrition assessment of elderly patients before performing diagnostic or interventional coronary procedures could help clinicians to identify patients with elevated risk for CI-AKI.

Objective Increased thickness of epicardial adipose tissue (EAT) and the total coronary artery calcium score (TCACS) are independent predictors of atherosclerosis. The aim of this study was to investigate whether EAT thickness, measured using thoracic computed tomography, and TCACS were greater in patients with sarcoidosis. Methods This was a retrospective study. The details of participants who presented at the cardiology and pulmonology outpatient clinics between January 2011 and December 2018 with dyspnea, chest pain, or palpitations from the hospital data system were reviewed. Patients with transthoracic echocardiography and thorax computed tomography (CT) (CT) records were identified, and those who were diagnosed with sarcoidosis, had no other health problems, and did not take any medication were included in the study. Results A total of 45 controls and 78 sarcoidosis patients were enrolled. The mean age of the controls was 46.15±13.1 years, while it was 46.26±12.37 years in the sarcoidosis group, which represented no significant difference between the groups (p>0.05). When the groups were compared in terms of a fasting blood test, erythrocyte sedimentation rate (ESR), TCACS, EAT thickness, levels of C-reactive protein (CRP), total cholesterol, low-density lipoprotein (LDL), and triglycerides, it was observed that CRP and EAT thickness were higher in the sarcoidosis group. Conclusion The results of this study indicated that the thickness of EAT calculated using thorax CT was greater in sarcoidosis patients; however, the TCACS was similar in both groups. In addition, there was a positive correlation between EAT thickness and the level of total cholesterol, LDL, triglycerides, CRP, and the sedimentation rate. These findings suggest that atherosclerosis may start earlier in those with sarcoidosis than in the healthy population.

Background The relation between body mass index (BMI) and coronary artery disease (CAD) extension remains controversial. A new score was developed to estimate body fat percentage (BFP) known as Relative Fat Mass (RFM) Index. This study aimed to evaluate the value of RFM Index in predicting the severity of the CAD, compared with other anthropometric measurements. Methods A total of 325 patients with chronic CAD were investigated. RFM, BFP, BMI and other anthropometric characteristics of patients were measured before angiography. CAD severity was determined by SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery trial (SYNTAX) Score. The association between SYNTAX Score and variables was evaluated using linear regression models. In order to compare the model performance, R-squared (R2), Akaike’s information criterion, Bayesian information criterion and root mean square error were used. Results Univariate linear regression outcome variable, SYNTAX was used to determine whether there was any relationship between variables. Independent variables were included in the multivariable linear logistic regression models. The analysis showed that in model 1, RFM (β coefficient: 2.31 (0.90 to 3.71), p=0.001)), diabetes mellitus (β coefficient: 3.72 (1.67 to 3.76), p=0.004)), haemoglobin (β coefficient: −2.12 (−3.70 to −0.53), p=0.03) and age (β coefficient: 1.83 (0.29 to 3.37), p=0.02)) were statistically significant. The adjusted R2 values in model 1 were higher than model 2 (BFP) and model 3 (BMI) (0.155, 0.137 and 0.130, respectively), and χ2 values of RFM were higher than BFP and BMI (10.5, 3.4 and 1.0, respectively). Conclusion RFM Index is a more reliable and compatible marker of obesity in showing the severity of CAD compared to BMI.

INTRODUCTION In the current literature, several studies show that PAS (pulmonary artery stiffness) is associated with RV (right ventricular) dysfunction, PAH (pulmonary arterial hypertension), and disease severity in subjects with structural cardiac disease, HIV (human immunodeficiency virus), and chronic lung disease. Hence, our main aim was to use PAS to show the early changes in the pulmonary vascular region in subjects with cirrhosis. MATERIAL AND METHODS In this prospective cross-sectional study, 39 subjects who were being followed up with cirrhosis and 41 age- and sex-matched healthy subjects were included in this study. For each case, the PAS value was obtained by dividing mean peak velocity of the pulmonary flow by the PfAT (pulmonary flow acceleration time). RESULTS The measured PAS was 23.62 ± 5.87 (Hz/msn) in cirrhotic participants and 19.09 ± 4.16 (Hz/msn) in healthy cases (P < .001). We found a positive statistical significance between PAS and RVSP (right ventricle systolic pressure)/sPAP (systolic pulmonary arterial pressure) (r = .395; P = .013). PAS was an independent predictor that was associated with cirrhosis disease according to multivariate LR (logistic regression) analysis (OR: 1.209; 95% CI: 1.059-1.381; P = .005). CONCLUSION Based on the study results, we consider that PAS may help in the early detection of findings in the pulmonary vascular area, even if the RV function findings or sPAP is within the normal range.

Background Synthetic cannabinoids are part of a group of drugs called new psychoactive substances. The increase in substance use among young adults is becoming a major problem in the world. In this study we aimed to investigate the effects of synthetic cannabinoid drugs (BONSAI by in name Turkey) to electrocardiographic (ECG) parameters, in patients who were admitted to emergency service with self-reported usage of bonsai. Methods Seventy-two patients (68 males; mean age 33.8 ± 11.8) with self-reported use of bonsai and 27 (22 males; mean age 37.1 ± 8.7) age and sex-matched healthy control group enrolled the study. ECG parameters and rhythm holter were measurements calculated in both groups. Results Groups were age and sex-matched. Glucose, potassium , white blood cell count, heart rate end smoking status was significantly different in patients compared to control group. P wave max time, P wave min. time, P wave dispersion, QT max. time QT dispersion, QT corrected time and iCEB measurements (Index of Cardiac-Electrophysiological Balance) were significatly different in patient group. A multivariate logistic regression analysis was used to determine independent predictors of ≥30 VPB(Ventricular premature beat)/h using parameters found to be associated with ≥30 VPB/h in a univariate analysis (potassium, QT max.time, QTc, QRS time, iCEB).In a multivariate analysis, independent predictors of ≥30 VPB/h were potassium (Odds ratio [OR]: 0.107, 95% CI: 0.024-0.481;P= 0.004) and iCEB (OR: 4.474, 95% CI: 1.752-11.429;P= 0.002). In generalize linear model β-coefficient value of interaction terms between K*iCEB has no important effect on ventricular premature beats. Conclusions If the results are confirmed in further studies, iCEB seems to be a simple, easily measurable and non-invasive marker to predict cannabinoid-induced ventricular arrhythmias.

Introduction In this study, we aimed to investigate the usefulness of P wave peak time (PWPT), a novel ECG parameter, in patients who were diagnosed with acute ischaemic stroke (IS) and had paroxysmal atrial fibrillation (PAF) on Holter monitoring. Materials and methods In this retrospective cohort study, we included 90 consecutive patients with acute IS who were admitted to our hospital between January 2017 and July 2019. PWPT was described as the time from the beginning of the P wave to its peak, and it was measured from leads DII and VI. The PAF diagnosis was confirmed if it was detected on the ECG during palpitation or in rhythm during the Holter recordings. Results In this study, 34 (37.7%) patients with acute IS were diagnosed with PAF. In multivariate analyses, the independent predictors of PAF were age, PWPT in lead VI and PWPT in lead DII (OR: 1.34, 95% CI 1.15 to 1.56; p Conclusion To the best of our knowledge, this is the first study to demonstrate a significant relationship between PWPT in lead DII and PAF among patients with acute IS.

Among hypertensive subjects, the lack of physiological blood pressure drop as part of diurnal blood pressure variations is termed as non-dipper blood pressure. Herein, we investigated the relationship between hypertension character and body composition indices. This study included a total of 104 patients (54 M, mean age: 47.6 ± 12.1 years). Patients' heights, weights, and waist and hip circumferences were measured, and body composition indices were calculated. All patients' office blood pressure measurements and 24-hour ambulatory blood pressure readings were recorded. A blood pressure drop of at least 10% compared with daytime blood pressure readings is called dipper blood pressure, while a drop of less than 10% is termed as non-dipper blood pressure. Based on ambulatory blood pressure readings, the patients were grouped into Group 1 (dipper pattern; 51 pts, 34 M, mean age 45.6 ± 12.3) and Group 2 (non-dipper pattern, 53 pts; 20 M, mean age 49.6 ± 11.6). The proportion of females and smokers were significantly lower in Group 1 than Group 2. BRI, BAI, waist-to-height ratio, and waist circumference were significantly higher in Group 2 than Group 1. There were significant positive correlations between body roundness index (BRI), body adiposity index (BAI), waist-to-weight ratio, and WC and nocturnal mean systolic and diastolic blood pressure readings. Percent systolic nocturnal drop was significantly correlated with waist-to-height ratio, BAI, and BRI. Similarly, percent diastolic nocturnal drop and waist-to-height ratio, BAI, and BRI were correlated. In conclusion, the relatively new body composition indices, namely BRI and BAI, are more closely related to nocturnal blood pressure readings among non-dipper subjects.

Objectives: The objective of this study is to investigate the effect of comorbid conditions [Charlson comorbidity index (CCI)] on stent restenosis who underwent coronary angioplasty earlier. Methods: Patients were divided into two groups; patients with critical restenosis [recurrent diameter stenosis >50% at the stent segment or its edges (5-mm segments adjacent to the stent) (Group 1; n = 53, mean age: 63.8 ± 9.9 years)] and patients with no critical restenosis [

Background: In this study, whether ischemia modified albumin (IMA) has a role in showing severity or criticality of coronary arteries in patients with unstable angina pectoris (USAP)/non-ST-elevation myocardial infarction (NSTEMI) was assessed. Methods: A total of 65 patients (40 male (M) and 25 female (F) patients; mean age 59.7 ± 12.1 years) with the initial diagnosis of USAP/NSTEMI were included in this study. The levels of IMA, troponin T, creatine kinase MB (CK-MB), C-reactive protein (CRP), brain natriuretic peptide (BNP), creatinine, lipid panel, and whole blood count were measured from venous blood obtained from each patient within 3 h after the onset of symptoms. A 50% or greater coronary lumen stenosis of any coronary vessel or lateral branch was considered as critical stenosis. The severity of coronary artery disease (CAD) was assessed using the Gensini scoring system. Results: IMA was significantly higher in patients with critical coronary artery stenosis (median, 206 vs. 23; P < 0.001). There was a weak correlation between the Gensini score and IMA; whereas there was a moderate correlation between the Gensini score and BNP levels (r = 0.44, P = 0.02). Conclusion: The level of IMA can predict the criticality of CAD; however, it cannot predict the severity of CAD according to Gensini score in patients with USAP/NSTEMI. J Clin Med Res. 2018;10(7):570-575 doi: https://doi.org/10.14740/jocmr3417w

The symptoms of aortic dissection (AD) may be highly variable and may mimic other much common conditions. Thus, a high index of suspicion should be maintaned, especially when the risk factors for AD are present or signs and symptoms suggest this possibility. However, sometimes AD may be asymptomatic or progression may be subclinical. Various electrocardiographical (ECG) changes may be seen in AD patients such as ST segment elevation in aVR as well as ST segment depression and T-wave inversion. In this case report, we reported a patient with acute AD whose ECG revealed ST segment elevation in aVR lead in addition to diffuse ST segment depression in other leads. © 2018 The Author(s) 2-s2.0-85064706955

CONTEXT: Obstruction of the right ventricular outflow tract due to metastatic disease is rare. Clinical recognition of cardiac metastatic tumors is rare and continues to present a diagnostic and therapeutic challenge. CASE REPORT: We present the case of a patient who had severe respiratory insufficiency and whose clinical examinations revealed a giant tumor mass extending from the right ventricle to the pulmonary artery. We discuss the diagnostic and therapeutic options. CONCLUSION: In patients presenting with acute right heart failure, right ventricular masses should be kept in mind. Transthoracic echocardiography appears to be the most easily available, noninvasive, cost-effective and useful technique in making the differential diagnosis. RESUMO CONTEXTO: A obstrução da via de saída do ventrículo direito devido a doença metastática é rara. O reconhecimento clínico de tumores cardíacos metastáticos é raro e continua a apresentar um desafio diagnóstico e terapêutico. RELATO DO CASO: Apresentamos o caso de um paciente com insuficiência respiratória grave e cujos exames clínicos revelaram massa de tumor gigante, estendendo-se desde o ventrículo direito até a artéria pulmonar. Discutimos as opções diagnósticas e terapêuticas. CONCLUSÃO: Em pacientes com insuficiência cardíaca direita aguda, massas do ventrículo direito devem ser mantidas em mente. Ecocardiografia transtorácica parece ser a técnica mais facilmente disponível, não invasiva, custo-efetiva e útil no diagnóstico diferencial.

Objective: Obesity is correlated with left ventricular mass (LVM) and insulin resistance (IR) and is an independent predictor of LVM in nondiabetic, non-hypertensive, obese people. Our aim was to investigate the relationship of body mass index (BMI) and IR with left venticular mass index (LVMI) in obese and nonobese, normotensive, nondiabetic women.Methods: 81 obese, normotensive, nondiabetic women and 36 healthy women of normal weight were included in the study. We compared the demographic features, biochemical values, insulin and HOMA-IR values, heart rate, blood pressure, and echocardiographic parameters of the obese and nonobese subjects.Results: The mean age was 39.3±11.2 years and the mean BMI was 39.5±5.7 kg/m2 in the obese group; the mean age was 38.4±9.5 years and the mean BMI was 22.5±1.9 kg/m2 in the control group. Hyperinsulinemia (19.3±10.4 μU/mL) and IR (HOMA-IR: 4.6±2.9) were correlated with obesity. Insulin levels and IR were associated with LWM, LWMI, aortic diameter (AD), left atrial diameter (LAD), interventricular wall thickness (IVWT), left ventricular end diastolic diameter (IVEDD), and left ventricular posterior wall thickness (LVPWT). Age, insulin value, and BMI were determinants of LVMI (p

Introduction: The etiological and pathogenic factors responsible for coronary artery ectasia (CAE) are unclear. Therefore, we aimed to compare subjects with and without CAE with respect to resistin levels and determine whether resistin plays a role in the aetiology or pathogenesis of CAE. Patients and Methods: This study enrolled a total of 81 subjects, of whom 42 had CAE [15 female (F), mean age 60.4 ± 9.0 years] and 39 had a normal coronary anatomy (22 F, mean age 56.2 ± 10.7 years). Using coronary artery diameters of the control group as reference, subjects having coronary artery dilatation that was at least 1.5 times larger than the normal adjacent segments were considered to have CAE. Resistin levels were measured from blood samples obtained on the day of the coronary angiography. Results: Both the groups had similar baseline characteristics. Serum resistin levels were significantly higher in the CAE group [mean 703.5 ± 828.1 ng/L, median 379.5 (40-4092) ng/L] than in the control group [mean 313.5 ± 252.6 ng/L, median 256 (30-1244) ng/L] (p= 0.001). Conclusion: CAE and atherosclerosis share common histopathological and clinical characteristics. Resistin, a polypeptide with a known role in the development and clinical presentation of atherosclerosis, may also mediate the formation of CAE. There is a need for future studies with a larger sample size to better delineate the effect of resistin on the development of CAE.

Background/Aims: The aim of this study was to investigate atrial conduction times and left atrial mechanical functions, the noninvasive predictors of atrial fibrillation, in prediabetic patients with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Methods: Study included 59 patients (23 males, 36 females; mean age 52.5 ± 10.6 years) diagnosed with IFG or IGT by the American Diabetes Association criteria, and 43 healthy adults (22 males, 21 females; mean age 48.5 ± 12.1 years). Conventional and tissue Doppler echocardiography were performed. The electromechanical delay parameters were measured from the onset of the P wave on the surface electrocardiogram to the onset of the atrial systolic wave on tissue Doppler imaging from septum, lateral, and right ventricular annuli. The left atrial volumes were calculated by the disk method. Left atrial mechanical functions were calculated. Results: The mitral E/A and E’/A’ ratios measured from the lateral and septal annuli were significantly lower in the prediabetics compared to the controls. The interatrial and left atrial electromechanical delay were significantly longer in prediabetic group compared to the controls. Left atrial active emptying volume (LAAEV) and fraction (LAAEF) were significantly higher in the prediabetics than the controls. LAAEV and LAAEF were significantly correlated with E/A, lateral and septal E’/A’. Conclusions: In the prediabetic patients, the atrial conduction times and P wave dispersion on surface electrocardiographic were longer before the development of overt diabetes. In addition, the left atrial mechanical functions were impaired secondary to a deterioration in the diastolic functions in the prediabetic patients. © 2017 The Korean Association of Internal Medicine.

The presence of vitamin D, and parathyroid hormone receptors has been demonstrated in the vascular endothelium. Variations in vitamin D, and parathyroid hormone levels may affect coronary flow and cause the coronary slow-flow phenomenon (CSF). Methods: We enrolled 93 patients who had undergone coronary angiography and had near-normal coronary arteries. Blood samples were taken to determine the calcium, phosphorus, 25-hydroxy vitamin D, and parathyroid hormone levels. Vitamin D deficiency was defined as a serum 25-hydroxy vitamin D level of less than 20 ng/mL. We divided the study population into two groups according to thrombolysis in myocardial infarction frame count (TFC) levels. Results: Patients with TFC ?27 were in the control group (n = 39), and those with TFC >27 were in the CSF group (n = 54). 25-Hydroxy vitamin D levels were similar in both groups: 17.5 [3.3-36.1] ng/ml in the CSF group and 15.2 [5.3-34] ng/ml in the control group (P = 0.129). When we analyzed TFC for each of the coronary arteries, we found a weak negative correlation between vitamin D level and TFC of the right coronary artery in the CSF group (r = -0.314, P = 0.021). Parathyroid hormone levels were similar in both groups: 48 [16-140] pg/ml in the CSF group and 52 [25-125] pg/ml in the control group (P = 0.297). Conclusion: The study failed to demonstrate a relationship between serum parathyroid hormone level and CSF. However, a weak negative correlation was found between vitamin D level and TFC of the right coronary artery. © 2019 Nigerian Journal of Clinical Practice | Published by Wolters Kluwer - Medknow.

WOS: 000458635000006, PubMed: 30570067, Background: A subset of patients who take antiplatelet therapy continues to have recurrent cardiovascular events which may be due to antiplatelet resistance. The effect of low response to aspirin or clopidogrel on prognosis was examined in different patient populations. Objective: We aimed to investigate the prevalence of poor response to dual antiplatelet therapy and its relationship with major adverse cardiovascular events (MACE) in young patients with ST-elevation myocardial infarction (STEMI). Methods: In our study, we included 123 patients under the age of 45 with STEMI who underwent primary percutaneous intervention. A screening procedure to determine both aspirin and clopidogrel responsiveness was performed on the fifth day of admission. We followed a 2x2 factorial design and patients were allocated to one of four groups, according to the presence of aspirin and/or clopidogrel resistance. Patients were followed for a three-year period. A p-value less than 0.05 was considered statistically significant. Results: We identified 48% of resistance against one or more antiplatelet in young patients with STEMI. More MACE was observed in patients with poor response to dual platelet therapy or to clopidogrel compared those with adequate response to the dual therapy (OR: 1.875, 1.144-3.073, p < 0.001; OR: 1.198, 0.957-1.499, p = 0.036, respectively). After adjustment for potential confounders, we found that poor responders to dual therapy had 3.3 times increased odds for three-year MACE than those with adequate response to the dual therapy. Conclusion: Attention should be paid to dual antiplatelet therapy in terms of increased risk for cardiovascular adverse events especially in young patients with STEMI.

WOS: 000370919200005, Background: We investigated whether fetuin-A (a hepatic secretory protein that prevents arterial calcification) was related to revascularization in patients who had previously undergone coronary revascularization (percutaneous coronary intervention and/or coronary artery bypass grafting operation). Methods: This study included 71 patients who had previously undergone any revascularization procedure. All patients presented to the cardiology outpatient clinic with angina or angina equivalent and underwent coronary angiography upon findings of preliminary tests. The patients were grouped on the basis of the presence of restenosis on angiography: Group 1 consisted of 44 subjects with restenosis on angiography (30 male, 14 female; mean age 64.2 +/- 4.2 years) and group 2; 30 subjects without restenosis on angiography (20 male, 10 female; 61.2 +/- 13.1 years). In addition to routine biochemical tests and lipid panel, all patients underwent C-reactive protein, and fetuin-A measurements. Results: The groups were not significantly different with respect to age, sex, systolic and diastolic blood pressure. As compared to Group 2, Group 1 had a significantly lower fetuin-A level (383.8 +/- 76.2 vs. 416.3 +/- 49.3 ng/mL; p = 0.029). There was a significantly negative correlation between fetuin-A and age; and a significantly positive correlation between fetuin-A and calcium. Conclusions: Fetuin-A levels were significantly lower in patients detected to have restenosis. Lower fetuin-A levels may contribute to restenosis by directly increasing calcium-phosphate precipitation.

Nonkompaksiyon kardiyomiyopati ventrikülde art- mış derin trabekülasyonlarla karakterize nadir görülen do- ğumsal bir kardiyomiyopatidir. Sol ventrikülün apeksi en sık etkilenen segmenttir ancak sol ventrikül bazal segmenti, biventriküler tutulum ve sağ ventrikülün baskın olarak tu- tulduğu olgularda tanımlanmıştır. Sistemik sklerozda bazı nöromüsküler anomaliler ve miyopatiler tanımlanmıştır. Ancak kronik enflamatuvar hastalıklarla nonkompaksiyon kardiyomyopati birlikteliği net değildir. Biz bu yazıda 40 yaşında diffüz kutanöz sistemik sklerozu olan bir kadında ciddi sistolik ve diyastolik fonksiyon bozukluğuna neden olan biventriküler nonkompaksiyon kardiyomiyopatili olgu- yu sunduk., Non-compaction cardiomyopathy (NCM) is a rare congenital cardiomyopathy characterized by deep increased trabeculation in one or more segments of the ventricle. The apical segment of the left ventricle is most commonly affected, but left ventricular basal segment, bi- ventricular involvement or right ventricle predominance have also been described. While some neuromuscular anomalies and myopathies had been described in systemic sclerosis patients, coexistence of chronic inflammatory dis- orders and NCM is unclear. This paper presents a case of biventricular NCM with severe systolic and diastolic dys- function in a 40-year-old female diffuse cutaneous systemic sclerosis patient.

Aim: In this study, we aimed to investigate the relationship between AKW and the severity of CAD in patients with stable CAD. Stable coronary artery disease (CAD) patients coronary artery disease severity is determined invasive coronary angiography scoring systems as SYNTAX and Gensini scores. Therefore, there is a need for noninvasive and easy to apply methods for determining the severity of the disease in stable CAD. Aortic knob width (AKW) is a measurable radiographic structure from chest X-ray.Material and Methods: The study included 168 patients with stable CAD ranging from 18 to 70 years old after exclusions criteria applied 114 patients examined. Patients grouped according to coronary artery vessel diameter narrowing above and below 70%. Patients Baseline characteristics, physical examination, medical treatments and laboratory findings recorded. The severity of CAD was evaluated by SYNTAX and Gensini scores. AKW measurement was also evaluated. Results: The two groups were statistically similar with respect to demographic properties and laboratory findings. Prior medications were similar between the groups. Furthermore percentage of diabetes mellitus and CRP levels were significantly different between groups (48.4%, 22% p:0.004 , 6.3±12, 2.4±4 p:0.049 respectively). AKW was significantly higher in group 1 compared to group 2 (41.1±6.2, 37.3±5.2; p=0.007). AKWs were correlated with Gensini and SYNTAX scores (r=0.25;p=0.007 and r=0.26;p=0.006 respectively). In a ROC analysis, the area under the curve value of AKW for CAD was 0.648 (95% CI: 0.544-0.752, p 22 were; DM (Odds ratio [OR]: 6,088, 95% CI: 1.617-22.927; P= 0.008) , AKW (OR: 1.122, 95% CI: 1.024-1.229;P= 0.013).Conclusion: To demonstrate the severity and complexity of coronary artery disease in stable coronary artery disease, noninvasive and simply calculated AKW can be used instead of invasively calculated the calculated SYNTAX and Gensini scores.

Tuberculosis-associated pericardial disorders are an excessively rare manifestation of extrapulmonary tuberculosis. The patients may present with constrictive pericarditis or pericardial fluid accumulation leading to cardiac tamponade. This paper reports a case of tuberculosis-associated pericardial effusion with dense fibrinous material not causing tamponade in a foreigner presenting with nonspecific symptoms. It also provides a discussion about the diagnostic and therapeutic methods as well as interesting echocardiographic images of the patient.

The primary goal of coronary artery bypass grafting is to achieve complete revascularization with grafts that will remain patent throughout the patient's lifetime. This study investigated the association between bypass graft patency and comorbidity burden determined by Charlson comorbidity index (CCI) among patients with previous bypass operation who underwent a control angiography. One-hundred and two patients who had undergone CABG in the past were included to the study. Critical stenosis was defined as 50% or greater coronary luminal obstruction of any coronary vessel or its lateral branch. Patients were divided into 2 groups group 1; critical graft stenosis; (54 pts; 41M, mean age 66.5 ± 7.8 years), group 2; graft patent (48 pts; 31M, mean age; 65.9 ± 8.2 years). Charlson comorbidity index (CCI) and modified CCI scores were used for detecting comorbidities. The comparison of continuous variables between the control and critical CAD groups was performed by the independent sample test. A p value less than 0.05 was considered statistically significant. The two groups were statistically similar with respect to demographic properties, time since bypass operation, cardiovascular risk factors, systolic blood pressure, heart rate, medications used, complete blood counts parameters, and lipid profiles. CCI was significantly higher in Group 1 compared to Group 2 (7.14 ± 2.02 vs 4.72 ± 1.58; p < 0.001). Modified CCI scores were also higher in Group 1 than in Group 2 (6.14 ± 2.02 vs 3.73 ± 1.60; p < 0.001). Graft occlusion was more common among patients with a high comorbidity burden. CCI scoring system may be helpful for determining patients at increased risk at both the preoperative and postoperative periods.

Hyponatremia is the most common electrolyte disorder among hospitalized patients and in the clinical setting. Patients with hyponatremia may develop a variety of symptoms, primarily neurological and gastrointestinal. Hyponatremia is more frequently encountered in patients with an underlying heart disease, particularly in the elderly. We hereby present a case of complete atrioventricular block in an elderly patient who had undergone aortic valve replacement and had been using thiazide. Complete atrioventricular block improved after sodium replacement therapy and no other cause of electrolyte disorder was documented. © 2018 Universitatea de Medicina si Farmacie Iuliu Hatieganu.

Background: Ghrelin has recently been reported to have beneficial effects on cardiac contractile functions and coronary blood flow. The main purpose of this study was to investigate the role of ghrelin in the pathogenesis of coronary slow flow (CSF) together with endothelial functions. Methods: Twenty-five patients having normal coronary arteries with CSF and 25 controls with normal coronary flow were included into the study. The quantitative measurement of coronary blood flow was performed for each coronary artery using the thrombolysis in myocardial infarction (TIMI) frame count (TFC) method. Ghrelin levels were measured using the enzyme-linked immunosorbent assay method from venous blood samples. Endothelial functions were evaluated from the brachial artery with the flow-mediated dilation (FMD) and nitrate-related dilation methods. Results: There was a significant difference in terms of mean TFC values between the control and CSF groups (p < 0.001 for all coronary arteries). The mean FMD percentage among patients with CSF was lower than that of the control group (5.9 ± 0.8 vs. 10.7% ± 1.1%; p < 0.001). A moderate negative correlation was observed between the FMD percentages and the TFCs. There was no relationship between the TFC and ghrelin levels. Conclusion: Plasma ghrelin levels seem to be uninfluential while impaired endothelial functions play an important role in the etiopathogenesis of CSF. © 2017 The Author(s).

The heart is one of the most affected organs during electric injuries. In electrical injuries, mechanical complications such as myocardial rupture, valvular rupture, pericardial effusion as well as a variety of arrhythmias ranging from electrocardiographic changes to ventricular fibrillation may occur. In this paper, we have presented a female patient with twin pregnancy at the 26th week of gestation, in whom syncope due to electric shock occurred and atrial fibrillation was detected on admission to the emergency department and have discussed treatment methods.

Objectives. Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Easy-to-perform and reliable parameters are needed to predict the presence and severity of CAD and to implement efficient diagnostic and therapeutic modalities. We aimed to examine whether the Framingham risk scoring system can be used for this purpose. Methods. A total of 222 patients (96 women, 126 men; mean age, 59.1±11.9 years) who underwent coronary angiography were enrolled in the study. Presence of >%50 stenosis in a coronary artery was assessed as critical CAD. The Framingham risk score (FRS) was calculated for each patient. CAD severity was assessed by the Gensini score. The relationship between the FRS and the Gensini score was analyzed by correlation and regression analyses. Results. The mean Gensini score was 18.9±25.8, the median Gensini score was 7.5 (0-172), the mean FRS was 7.7±4.2, and the median FRS was 7 (0-21). Correlation analysis revealed a significant relationship between FRS and Gensini score (r=0.432, p

BACKGROUND: Although the prevalence of coronary artery anomalies varies in different series, the precise population frequency is unknown. MATERIALS AND METHODS: The medical records of all patients who underwent coronary angiography between January 2002 and August 2012 were retrieved, and 238 cases with coronary anomalies were evaluated. Unlike other studies, we compared several angiographic parameters (fluoroscopy time, number of images, and catheters used) in addition to frequency and sex data. RESULTS: The angiographic frequency of coronary artery anomalies was 0.94%. The most common coronary anomaly was a left anterior descending-circumflex artery originating from separate ostia (0.29%). The second most common anomaly was a right coronary artery (RCA) originating from the left sinus of Valsalva (sV) (0.23%). Overall, coronary artery anomalies (1.28 vs. 0.80%; P

JUSTIFICATIVA E OBJETIVOS: Investigar o efeito de esmolol, lidocaína e fentanil na dispersão da onda P (DP), durações dos intervalos QT e QT corrigido (QTc) e as respostas hemodinâmicas à intubação endotraqueal durante a indução com propofol. MÉTODOS: Foram incluídos 80 pacientes adultos, estado físico ASA I ou II, idade entre 18 e 60 anos, neste estudo prospectivo, randômico e duplo-cego. Todos os pacientes foram submetidos a exame eletrocardiográfico (ECG) antes da indução da anestesia. Os pacientes foram randomicamente alocados em quatro grupos iguais. O grupo controle (Grupo C) recebeu 5 mL de solução salina; o grupo esmolol (Grupo E) recebeu 0,5 mg.kg-1 de esmolol; o grupo fentanil (Grupo F) recebeu 2 µg.kg-1 de fentanil e o grupo lidocaína (Grupo L) recebeu 1,5 mg.kg-1 de lidocaína antes da indução anestésica. A anestesia foi induzida com propofol. ECG foi feito em todos os pacientes durante o primeiro e o terceiro minutos de indução, 3 minutos após a administração de relaxante muscular e 5 e 10 minutos após intubação. A DP e intervalos QT foram medidos em todos os ECGs. Os intervalos QTc foram determinados com o uso da fórmula de Bazett. Frequência cardíaca (FC) e pressão arterial média (PAM) foram registradas antes e depois da indução anestésica, imediatamente após a intubação e em 1, 3, 5, 7 e 10 minutos após a intubação. RESULTADOS: Após a intubação, a FC aumentou significativamente nos Grupos C, L e F em comparação com o grupo controle. Porém, não houve diferença significativa nos valores da FC após a intubação entre os grupos E e controle. Nos Grupos C e L, a PAM aumentou significativamente após a intubação em comparação com o grupo controle. No entanto, nos Grupos L, F e E não houve diferença significativa entre os valores da PAM após a intubação em comparação com o grupo controle. A DP foi significativamente mais longa no Grupo C após a intubação em comparação com o grupo controle. Porém, nos grupos L, F e E não houve diferença significativa entre os valores de DP após a intubação em comparação com o grupo controle. A duração do intervalo QTc foi significativamente maior nos grupos C e L após a intubação em comparação com o grupo controle. Porém, não houve diferença significativa na duração do QTc nos grupos F e E após a intubação em comparação com o grupo controle. CONCLUSÃO: Concluímos que a administração de esmolol antes da intubação previne a taquicardia, o aumento da PAM e as durações da onda P e intervalo QTc causados pela laringoscopia e intubação traqueal. BACKGROUND AND OBJECTIVES: In our study we aimed to investigate the effect of esmolol, lidocaine and fentanyl on P-wave dispersion (Pwd), QT and corrected QT (QTc) durations and hemodynamic responses to endotracheal intubation during propofol induction. METHODS: A total of eighty adult patients, American Society of Anesthesiologists (ASA) Physical Status I or II aged 18 to 60 years were included in this prospective, randomised, double-blind study. All patients had control electrocardiograms (ECGs) done before anesthesia induction. The patients were randomised into four equal groups. The control group (Group C) received saline 5 mL, the esmolol group (Group E) received esmolol 0.5 mg.kg-1, the fentanyl group (Group F) received fentanyl 2 µg.kg-1 and the lidocaine group (Group L) received lidocaine 1.5 mg.kg-1 before anesthesia induction. Anesthesia was induced with intravenous propofol. ECGs for all patients were performed during the 1st and 3rd minutes of induction, 3 minutes after administration of muscle relaxant, and at 5 minutes and 10 minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. Heart rate (HR) and mean arterial pressure (MAP) were recorded before and after induction of anesthesia, immediately after intubation, and 1, 3, 5, 7 and 10 minutes after intubation. RESULTS: Compared with control, HR significantly increased in Group C, Group L and Group F after intubation. However, in Group E, there was no significant difference in HR values between control and after intubation. Compared with control, MAP significantly increased in Group C and Group L after the intubation. However, in Group E and Group F, there was no significant difference in MAP values between control and after the intubation. Compared with control, Pwd significantly increased in Group C after intubation. In Group L, Group F and Group E, there was no significant difference in Pwd values between control and after the intubation. Compared with control, QTc duration significantly increased in Group C and L after the intubation. In Group F and Group E, there was no significant difference in QTc durations between control and after the intubation. CONCLUSION: We concluded that administration of esmolol before intubation prevents tachycardia and an increase in MAP, Pwd and QTc duration caused by laryngoscopy and tracheal intubation. JUSTIFICATIVA Y OBJETIVOS: Investigar el efecto del esmolol, lidocaína y fentanilo en la dispersión de la onda P (DOP), duraciones de los intervalos QT y QT corregido (QTc) y las respuestas hemodinámicas a la intubación endotraqueal durante la inducción con propofol. MÉTODOS: En este estudio prospectivo, aleatorio y doble ciego, fueron incluidos 80 pacientes adultos, con estado físico ASA I o II, y edad entre 18 y 60 años. Todos los pacientes se sometieron al examen electrocardiográfico (ECG) antes de la inducción de la anestesia. Los pacientes fueron aleatoriamente divididos en cuatro grupos iguales. El grupo control (Grupo C) recibió 5 mL de solución salina; el grupo esmolol (Grupo E) recibió 0,5 mg.kg-1 de esmolol; el grupo fentanilo (Grupo F) recibió 2 µg.kg-1 de fentanilo y el grupo lidocaína (Grupo L) recibió 1,5 mg.kg-1 de lidocaína antes de la inducción anestésica. La anestesia fue inducida con propofol. El ECG se hizo en todos los pacientes durante el primero y el tercer minuto de inducción, 3 minutos después de la administración del relajante muscular y 5 y 10 minutos después de la intubación. La DOP y los intervalos QT se midieron en todos los ECGs. Los intervalos QTc fueron determinados con el uso de la fórmula de Bazett. La frecuencia cardíaca (FC) y la presión arterial promedio (PAP) fueron registradas antes y después de la inducción anestésica, inmediatamente después de la intubación y en 1, 3, 5, 7 y 10 minutos después de la intubación. RESULTADOS: Después de la intubación, la FC aumentó significativamente en los Grupos C, L y F en comparación con el grupo control. Sin embargo, no hubo diferencia significativa en los valores de la FC después de la intubación entre los grupos E y control. En los Grupos C y L, la PAP aumentó significativamente después de la intubación en comparación con el grupo control. Sin embargo, en los Grupos L, F y E no hubo diferencia significativa entre los valores de la PAP posteriormente a la intubación en comparación con el grupo control. La DOP fue significativamente más larga en el Grupo C después de la intubación en comparación con el grupo control. No obstante, en los grupos L, F y E no hubo diferencia significativa entre los valores de DOP después de la intubación en comparación con el grupo control. La duración del intervalo QTc fue significativamente mayor en los grupos C y L después de la intubación en comparación con el grupo control. Sin embargo, no hubo diferencia significativa en la duración del QTc en los grupos F y E después de la intubación en comparación con el grupo control. CONCLUSIONES: Llegamos entonces a la conclusión, de que la administración del esmolol antes de la intubación previene la taquicardia, el aumento de la PAP y las duraciones de la onda P e intervalo QTc causados por la laringoscopia y por la intubación traqueal.