Ahmet Karabulut

Anxiety and P Wave Dispersion in a Healthy Young Population

Background: P wave dispersion (P_d), defined as the difference between the maximum (P_max) and the minimum P wave duration (P_min), and P_max are electrocardiographic (ECG) markers that have been used to evaluate the discontinuous propagation of sinus impulses and the prolongation of atrial conduction time. P_d in normal subjects has been reported to be influenced by the autonomic tone, which induces changes in atrial size and the velocity of impulse propagation. However, the association between P_d and anxiety has not been studied in normal subjects. Methods and Results: P_max, P_min and P_d were measured in 726 physically and mentally healthy young male volunteers, aged 21.23 ± 1.25 years (range 20–26). The Spielberger State-Trait Anxiety Inventory (STAI) was scored concomitantly. Blinded intra- and interobserver reproducibility of the P wave duration and P_d measurement were evaluated, and comparison revealed a Pearson correlation coefficient of 0.87 and 0.89 for the P wave duration, and 0.93 and 0.90 for P_d, respectively (p < 0.001). P_max and P_d were significantly correlated with the state anxiety (STAI-1) subscale (r = 0.662, p < 0.001, and r = 0.540, p < 0.001, respectively) and the trait anxiety (STAI-2) subscale (r = 0.583, p < 0.001, and r = 0.479, p < 0.001, respectively). P_min did not show any significant correlation with anxiety. Across 3 variables included in a multiple linear regression analysis, STAI-1 and STAI-2 were the significant independent determinants of P_max and P_d. Beta coefficients indicated that the contribution of STAI-1 to P_max (66.3 and 33.7%) and P_d (65 and 35%) was much greater than that of STAI-2. Conclusions: STAI-1 and STAI-2are associated with an increase in P_max and P_d. The association of P_d resulted from an augmentation of P_max. This is the first study to show the relation between P_max, P_d and anxiety.

Outcome of Primary Percutaneous Intervention in Patients With Infarct-Related Coronary Artery Ectasia

Data related to the incidence and clinical outcome of acute myocardial infarction (AMI) in patients with preexisting coronary artery ectasia (CAE) are limited. We assessed whether infarct-related artery ectasia (EIRA) indicates an untoward clinical outcome in patients with AMI undergoing primary percutaneous coronary intervention (pPCI). Consecutive patients (n = 643) who presented with AMI and were treated with pPCI were analyzed retrospectively; 31 patients (4.8%) had EIRA. Patients who had EIRA were significantly younger and had higher incidence of hypertension, previous stroke, smoking, inferior wall AMI, and Killip score >1. Infarct-related artery ectasia was more frequent in the right coronary artery (RCA). Impaired epicardial arterial flow, thrombus burden score of infarct-related artery (IRA), impaired Thrombolysis in Myocardial Infarction (TIMI) Myocardial Perfusion Grade, and distal embolization were significantly higher whereas ST-segment resolution and collateral vascular development were significantly lower in patients with EIRA. Infarct-related artery ectasia was an independent predictor of adverse outcome (odds ratio: 0.197; 95% confidence interval [CI]: 0.062-0.633; P = .006).

Effects of anxiety on QT dispersion in healthy young men

Objective — QT dispersion (QTd) is the maximal interlead difference in QT interval on the surface 12-lead electrocardiogram (ECG).An increase in QTd is found in various cardiac diseases and reflects cardiac autonomic imbalance. It has recently been associated with increased anxiety levels, thereby predisposing affected individuals to fatal heart disease. This is the biggest study to assess QTd in anxiety, as a marker of anxiety-induced cardiac dysregulation. Methods and results — QTd and rate-corrected QTd (QTcd) were measured in 726 physically and mentally healthy male volunteers, aged 21.23 ± 1.25 years (range 20-26). The Spielberger State-Trait Anxiety Inventory (STAI) was scored concomitantly. The intra- and inter-observer reproducibilities of QTd were highly correlated (r = 0.92, p < 0.001; r = 0.93, p < 0.001, respectively). QTd and QTcd significantly correlated with the STAI-1 subscale (State Anxiety Scale) (r = 0.529, p < 0.001; r = 0.518, p < 0.001, respectively) and STAI-2 subscale (Trait Anxiety Scale) (r = 0.601, p < 0.001; r = 0.563, p < 0.001, respectively). Conclusions — The State Anxiety Scale and the Trait Anxiety Scale are associated with an increase in QTd. This association may result from sudden and prolonged anxiety and, in turn, a decrease in vagal modulation and/or increase in sympathetic modulation. This is the first study that shows that increased QTd can serve as a state/trait marker. But further large-scale epidemiological studies are needed to determine if increased QTd is a risk factor for sudden cardiac death in patients with anxiety.

Removal without Replacement Strategy for Uncontrolled Prosthetic Tricuspid Valve Endocarditis Associated with Abortion Sepsis

Isolated tricuspid valve (TV) endocarditis associated with abortion is a rare entity with a poor prognosis. We report the case of a 22-year-old woman with a diagnosis of isolated prosthetic TV endocarditis secondary to recurrent abortion. The patient had progressed to multiorgan failure and disseminated intravascular coagulation during her clinical course. Because of the high operative risk and uncontrolled infection, we performed an unusual surgical approach that has not previously been reported. Resection of infected valvular tissue without replacement of the prosthesis led to a rapid convalescence period and complete cure.

ANXIETY AND P-WAVE DISPERSION IN HEALTHY YOUNG POPULATION

BACKGROUNDnP wave dispersion (P(d)), defined as the difference between the maximum (P(max)) and the minimum P wave duration (P(min)), and P(max) are electrocardiographic (ECG) markers that have been used to evaluate the discontinuous propagation of sinus impulses and the prolongation of atrial conduction time. P(d) in normal subjects has been reported to be influenced by the autonomic tone, which induces changes in atrial size and the velocity of impulse propagation. However, the association between P(d) and anxiety has not been studied in normal subjects.nnnMETHODS AND RESULTSnP(max), P(min) and P(d) were measured in 726 physically and mentally healthy young male volunteers, aged 21.23 +/- 1.25 years (range 20-26). The Spielberger State-Trait Anxiety Inventory (STAI) was scored concomitantly. Blinded intra- and interobserver reproducibility of the P wave duration and P(d) measurement were evaluated, and comparison revealed a Pearson correlation coefficient of 0.87 and 0.89 for the P wave duration, and 0.93 and 0.90 for P(d), respectively (p < 0.001). P(max) and P(d) were significantly correlated with the state anxiety (STAI-1) subscale (r = 0.662, p < 0.001, and r = 0.540, p < 0.001, respectively) and the trait anxiety (STAI-2) subscale (r = 0.583, p < 0.001, and r = 0.479, p < 0.001, respectively). P(min) did not show any significant correlation with anxiety. Across 3 variables included in a multiple linear regression analysis, STAI-1 and STAI-2 were the significant independent determinants of P(max) and P(d). Beta coefficients indicated that the contribution of STAI-1 to P(max) (66.3 and 33.7%) and P(d) (65 and 35%) was much greater than that of STAI-2.nnnCONCLUSIONSnSTAI-1 and STAI-2 are associated with an increase in P(max) and P(d). The association of P(d) resulted from an augmentation of P(max). This is the first study to show the relation between P(max), P(d) and anxiety.

Complete cure with medical treatment of prosthetic mitral valve endocarditis, which is initially diagnosed as mitral valve thrombus.

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