Alaettin Avsar

Cardiac autonomic dysfunction in hemodialysis patients: The value of heart rate turbulence

Patients with end‐stage renal disease (ESRD) are likely to have cardiac autonomic dysfunction, which is related with an increased risk of sudden death. The aim of this study is to detect cardiac autonomic dysfunction in patients with ESRD and to evaluate the possible acute effects of hemodialysis (HD) on cardiac autonomic functions measured by heart rate variability (HRV) and heart rate turbulence (HRT). Thirty‐one (mean age 50 ± 13 years, 15 males) with ESRD on regular HD program and 31 healthy volunteers (mean age 51 ± 12 years, 15 males) were included in the study. Twenty‐four‐hour ambulatory electrocardiogram recordings were taken from the subjects before and after HD and from the control group. Heart rate variability and HRT parameters were calculated from these recordings. All of the HRV and HRT parameters were found to be significantly blunted in patients in comparison with healthy individuals. There were significant differences in HRV after HD, but similar differences were not observed in HRT parameters. Cardiac autonomic functions were significantly altered in patients with ESRD. Heart rate turbulence parameters seemed to be less affected from HD and may be more useful in the evaluation of cardiac autonomic functions in the ESRD population.

Cardiac autonomic function evaluated by the heart rate turbulence method was not changed in obese patients without co-morbidities.

Obese subjects are more prone to sudden deaths and arrhythmias than non-obese subjects. Heart rate turbulence (HRT) impairment reflects cardiac autonomic dysfunction, in particular impaired baroreflex sensitivity and reduced parasympathetic activity. Our aim was to evaluate the cardiac autonomic function in obesity by the HRT method. Ninety obese subjects and 112 healthy subjects were included in the study. Twenty-four hours ambulatory electrocardiograms were recorded and Holter recordings were analyzed. HRT parameters, turbulence onset (TO) and turbulence slope (TS), were calculated with HRT View Version 0.60-0.1 software program. HRT were calculated in 43 obese and 43 control subjects who had at least one ventricular premature beat in their Holter recordings. We excluded 47 obese patients and 69 control subjects who showed no ventricular premature beats in their Holter recordings from the statistical analysis. There were no significant differences in TO and TS between obese and control subjects (TO obese: -1.6±2.2%, TO control: -2.1±2.6%, p>0.05; TS obese: 8.2±5.2, TS control: 10.1±6.7, p>0.05, respectively). HRT parameters seem to be normal in obese patients without comorbidities.

The effect of sleep apnea severity on cardiac autonomic activity during night time in obstructive sleep apnea patients

CONTEXT AND OBJECTIVE Impaired autonomic cardiac function is an important consequence of obstructive sleep apnea (OSA). This impairment is mainly due to intermittent hypoxia episodes following apneas. However, the impact of apnea severity on autonomic cardiac function remains unclear. The aim of this study was to evaluate the relationship between the severity of sleep apnea and heart rate turbulence (HRT) and heart rate variability (HRV) in OSA. DESIGN AND SETTING Observational cross-sectional study conducted in the Departments of Cardiology and Pulmonary Diseases, Afyon Kocatepe University, Turkey. METHODS 106 patients with OSA and 27 healthy volunteers were enrolled. Based on apnea hypopnea index (AHI) values, obstructive sleep apnea severity was classified as follows: mild OSA (AHI ≥ 5 and < 15), moderate OSA (AHI ≥ 15 and ≤ 30) and severe OSA (AHI > 30). HRV and HRT parameters were assessed via 24-hour digital Holter electrocardiogram recordings for all subjects. RESULTS HRV and HRT results were significantly lower among OSA patients than among control subjects (P < 0.05). However, there were no significant differences in HRT and HRV between the three patient subgroups. Correlations did emerge between AHI and the NN-interval parameter RMSSD and between oxygen desaturation and turbulence slope (respectively: r = -0.22, P = 0.037; and r = -0.28, P = 0.025). CONCLUSION HRT and HRV results deteriorate in OSA. Correlations between apnea severity and these parameters seem to be present.

Heart rate variability and heart rate turbulence in patients with polycystic ovary syndrome

Objective: Cardiac autonomic dysfunction may develop in patients with polycystic ovary syndrome (PCOS). Heart rate variability (HRV) and heart rate turbulence (HRT) are used in assessing cardiac autonomic functions. The goal of this study was to compare the cardiac autonomic functions in patients with PCOS and healthy controls. To our knowledge, this is the first study evaluating cardiac autonomic functions in patients with PCOS with respect to both HRV and HRT. Methods: Twenty-three patients with PCOS (mean age 22.8±3.9 years) and 25 healthy female volunteers who were matched for age and body mass index (BMI) (mean age 23.5±6.2 years) were enrolled in this as case-control study. Twenty-four hour ambulatory electrocardiogram recordings of all participants were taken using Pathfinder software. The time domain parameters of HRV and HRT, including turbulence onset (TO) and turbulence slope, were calculated. Diagnosis of PCOS was made with physical and laboratory findings of hirsutism or biochemical hyperandrogenism and chronic anovulation. Diabetes mellitus, other hormon disorders or hormon therapy, pregnancy, atrial fibrilation, obesite, chronic diseases, disorders of the autonomic nervous system, a history of drug use affecting the autonomic nervous system were excluded. Results: There were no significant differences in HRV and HRT parameters between the two groups. Cardiovascular risk factors, such as BMI, blood pressure, fasting blood glucose, and lipid parameters, were also similar. Triangular index measure of HRV was negatively correlated with high density lipoprotein cholesterol levels (r=-0.47, p<0.05), while age and BMI were significantly correlated with TO (r=0.31 and 0.47, respectively; p<0.05 for all). Conclusion: Cardiac autonomic functions were not found to be altered in patients with PCOS in comparison with healthy controls. These results may be explained with the absence of concomitant cardiovascular risk factors with the patients being in the early stage of the disease.

Heart rate turbulence analysis in female patients with fibromyalgia

OBJECTIVE: Fibromyalgia is characterized by diffuse musculoskeletal pain and discomfort. There are several reports regarding autonomic nervous system dysfunction in patients with fibromyalgia. Heart rate turbulence is expressed as ventriculophasic sinus arrhythmia and has been considered to reflect cardiac autonomic activity. Heart rate turbulence has been shown to be an independent and powerful predictor of sudden cardiac death in various cardiac abnormalities. The aim of this study is to determine whether heart rate turbulence is changed in female patients with fibromyalgia compared with healthy controls. METHODS: Thirty-seven female patients (mean age, 40±11 years) with fibromyalgia, and 35 age- and sex-matched healthy female control subjects (mean age, 42±9 years) were included. Twenty-four hours of ambulatory electrocardiography recordings were collected for all subjects, and turbulence onset and turbulence slope values were automatically calculated. RESULTS: The baseline clinical characteristics of the two groups were similar. There were no significant differences in turbulence onset and turbulence slope measures between patients and control subjects (turbulence onset: −1.648±1.568% vs. −1.582±1.436%, p ϝ 0.853; turbulence slope: 12.933±5.693 ms/RR vs. 13.639±2.505 ms/RR, p ϝ 0.508). Although body mass index was negatively correlated with turbulence slope (r ϝ −0.258, p ϝ 0.046), no significant correlation was found between body mass index and turbulence onset (r ϝ 0.228, p ϝ 0.054). CONCLUSION: To the best of our knowledge, this is the first study to evaluate heart rate turbulence in patients with fibromyalgia. It appears that heart rate turbulence parameters reflecting cardiac autonomic activity are not changed in female patients with fibromyalgia.

Presence of Angina Pectoris Is Related to Extensive Coronary Artery Disease in Diabetic Patients

Due to sensorial autonomic neuropathy, the type and severity of angina pectoris in patients with diabetes mellitus (DM) may be rather different from the type and severity of angina pectoris in patients without DM.

The Genetic Determination of the Differentiation Between Ischemic Dilated Cardiomyopathy and Idiopathic Dilated Cardiomyopathy

AIMS Most dilated cardiomyopathies are either an ischemic dilated cardiomyopathy (IsDC) or an idiopathic dilated cardiomyopathy (IdDC). The treatments for both IsDC and IdDC are of a similar nature (upwards of 90%). Coronary revascularization, however, is only feasible for IsDC. The purpose of this study was to determine if microRNAs (miRNAs) could be used as biomarkers to distinguish between IsDC and IdDC. MATERIALS AND METHODS Patients were divided into two groups: IsDC and IdDC, with 25 patients in each group, and 10 healthy persons serving as a control group. In our study, the following miRNA expressions were detected using the Rotor Gene Q real-time polymerase chain reaction cycler (Qiagen) for all IsDC and IdDC subjects: let-7b-5p, let-7c-5p, miR-1-3p, miR-15b-5p, miR-17-5p, miR-19a-3p, miR-19b-3p, miR-20a-5p, miR-20b-5p, miR-23a-3p, miR-24-3p, miR-27a-3p, miR-28-5p, miR-30e-5p, miR-99b-5p, miR-100-5p, miR-101-3p, miR-103a-3p, miR-106a-5p, miR-125b-5p, miR-126-3p, miR-126-5p, miR-140-5p, miR-191-5p, miR-195-5p, miR-199a-3p, miR-214-3p, miR-222-3p, miR-342-3p, and miR-378a-3p. RESULTS We found that miR-24-3p, miR-28-5p, miR-100-5p, miR-103-3p, miR-125b5p, miR-214-3p, let-7b-5p, and let-7c-5p were each overexpressed by more than twofold in both the IsDC and IdDC groups when compared to the controls. We also found that miR-15b-5p and miR-106a-5p may be used to distinguish between patients with IsDC and IdDC. CONCLUSIONS Our study has demonstrated that miR-15b-5p and miR-106a-5p expression levels could potentially serve as useful biomarkers for distinguishing between IsDC and IdDC.

Ocena zależności między ciśnieniem centralnym w aorcie a zesztywniającym zapaleniem stawów kręgosłupa

Introduction . Ankylosing spondylitis (AS) is a chronic inflammatory disease with an unknown etiology that belongs to the group of spondyloarthropathies. Patients with AS have an increased cardiovascular mortality but the reason is controversial. Central aortic pressure (CAP) is defined as the blood pressure in the aortic root and can be measured non-invasively via arteriography. Inflammation in the aortic root, which also causes aortic regurgitation in late sta ges of AS, possibly causes increased levels of central aortic pressure and this may explain the increased mortality rates from cardiovascular events in patients with AS. We investigated the CAP levels in patients with AS compared to healthy age- and sex-matched control group in this novel study. Material and methods . This is an observational case-control study composed of 30 patients with ankylosing spondylitis without conventional cardiovascular risk factors (such as known diabetes, hypertension, and smoking) or heart failure, peripheral or coronary artery disease. The peripheral blood pressures and CAP measurements were obtained with ‘arteriograph’ (TensioMed, Budapest, Hungary).Pulse wave velocity (PWV), peripheral and central augmentation index (pAIx and cAIx) and systolic central aortic pressure (sCAP) of both the AS and control group were compared. Results . There was no statistically significant difference between the groups for pAIx, cAIx, PWV or PP. Patient with AS had higher sCAP values but there wasn’t any statistically significant difference for sCAP. Conclusion . Our objective was to investigate the relationship between the AS and sCAP. There was an increase in sCAP in AS group compared to controls. But this was not statistically significant. This result can be due to the small population size and should be verified in larger population.

We Perform Vasoreactivity Test in Pulmonary Hypertension, but Reproducibility?

Sarcoidosis is a chronic, granulomatous disease that it can affect all organs. Pulmonary hypertension (PH) is one of the most important complications of sarcoidosis and indicates poor prognosis. PH is determined by right cardiac catheterization and mean pulmonary artery pressure is ≥25 mmHg at rest. Vasoreactivity test is recommended to this patients, to determine vasodilator drugs to response of pulmonary vascular bed. Calcium channel blockers are used in patients with a positive test vasoreactivity. We presented a case in this article whose vasoreactivity test was positive initially, but negative in follow-up.