E. Demiri

The relationship between circadian blood pressure pattern and ventricular repolarization dynamics assessed by QT dynamicity.

ObjectiveThe aim of the present cross-sectional study was to evaluate ventricular repolarization dynamics by QT dynamicity in normotensive and hypertensive individuals with either a non-dipper-type or a dipper-type circadian rhythm of blood pressure (BP). MethodsA total of 103 patients were allocated into four groups as follows: (i) normotensive/dipper, n=28; (ii) normotensive/nondipper, n=26; (iii) hypertensive/dipper, n=25; and (iv) hypertensive/nondipper, n=24. The linear regression slopes of the QT interval measured to the apex and to the end of the T wave plotted against R–R intervals (QTapex/R–R and QTend/R–R slopes, respectively) were calculated from 24-h ambulatory ECG recordings using a dedicated algorithm. ResultsQTapex/R–R and QTend/R–R slopes were higher in the nondipper subgroup of normotensive cases with respect to the dipper subgroup of normotensive cases (QTapex/R–R=0.171±0.017 vs. 0.127±0.023, P=0.001; QTend/R–R=0.159±0.015 vs. 0.133±0.025, P=0.001). QTapex/R–R and QTend/R–R slopes were higher in the nondipper subgroup of hypertensive cases with respect to the dipper subgroup of hypertensive cases (QTapex/R–R=0.187±0.019 vs. 0.133±0.019, P=0.001; QTend/R–R=0.183±0.018 vs. 0.147±0.022, P=0.001). Pearsons correlation analyses revealed a higher negative correlation between night-time decline in BP and QTapex/R–R (r=−0.638, P=0.001). There was also a moderate negative correlation between night-time decline in BP and QTend/R–R (r=−0.504, P=0.001). The correlation coefficients for degree of night-time dipping and QT dynamicity indices were higher in hypertensive groups than in the normotensive groups. ConclusionBlunting of the nocturnal fall in BP associates with impaired QT dynamicity indices in both normotensive and hypertensive groups.

Are the conventional cutoff values adequate to define hypertension in young women

BackgroundWomen have lower systolic blood pressure (SBP) levels than men during early adulthood. Diastolic blood pressure (DBP) tends to be just marginally lower in women than men regardless of age. ObjectiveAims of this study were (i) to determine 95th percentile value of SBP, DBP, and mean arterial blood pressure in healthy women, and (ii) to evaluate the effects of basal demographic and anthropometric features on blood pressure. MethodsSix hundred and fifty-four consecutive participants (18–35 years old) were initially enrolled in the study but among them 54 (8.2%) cases were excluded. Demographic features, relevant personal and family history data about hypertension, smoking habits, and use of medications were interviewed using a questionnaire. Blood pressure, height, weight, and waist circumference of every case were measured. ResultsOf the 600 patients (mean age, 24.6±4.0 years), 124 (20.7%) were currently smokers, 20 (3.3%) had history of hypertension during pregnancy, and 291 (48.5%) had family history of hypertension in women (mean age, 61.0±9.51 years). Reference ranges of 5th and 95th percentile values for SBP were determined as 74 and 115 mmHg, for mean arterial blood pressure as 57 and 85 mmHg, for DBP as 45 and 72 mmHg, respectively. ConclusionIn conclusion, cutoff values of hypertension in healthy women, which were determined by our study, are lower than the standard cutoff values for definition of hypertension in adults. However, clinical importance of these findings should be investigated in further studies involving larger population with prospective follow-up.

New insights into the mechanisms of diastolic dysfunction in patients with type 2 diabetes

Abstract Background. Little is known about the role of advanced glycation end products (AGEs) and their receptor (RAGE) in diabetic cardiovascular complications. Therefore, we aimed to evaluate the association of serum soluble RAGE (sRAGE) levels and left ventricular (LV) diastolic dysfunction in patients with type 2 diabetes. Methods. Our study consisted of 40 patients with type 2 diabetes and 40 age- and sex-matched healthy control group. Subjects with age ≥ 50 years old and any cardiovascular risk factors or conditions were excluded from the study. Serum sRAGE levels determined by enzyme-linked immunosorbent assay and LV diastolic dysfunction were evaluated according to current American Society of Echocardiography guidelines. Results. Baseline characteristics were similar between groups except body mass index, waist–hip ratio, and fasting glucose levels. Serum sRAGE level was significantly lower in diabetic group compared with control group (676 ± 128 vs. 1044 ± 344, p < 0.05). Diastolic dysfunction was observed in 50% of diabetic patients (40% grade I and 10% grade II). Correlation analysis showed that serum sRAGE was negatively correlated with duration of diabetes, septal E’/A’, lateral E’/A’, and average E/E’. In multivariate regression analysis, serum sRAGE level was strongly associated with diastolic dysfunction in patients with type 2 diabetes. Conclusion. Our study showed that serum sRAGE level was significantly lower in type 2 diabetic patients aged < 50 years old. Also, sRAGE has negative correlation with the duration of diabetes and it was significantly associated with the presence of diastolic dysfunction in type 2 diabetes.

OP-093 PREDICTIVE VALUE OF FRAGMENTED QRS IN NONISCHEMIC DILATED CARDIOMYOPATHY PATIENTS WHO RECEIVE IMPLANTABLE CARDIOVERTER DEFIBRILLATORS FOR PRIMARY PREVENTION

dialysis ECG was significantly correlated with the ultrafiltration volume (b =0.282, 0.041). Conclusion: Increased dispertion of QTc and P wave may indicate abnormally increased inhomogeneity of electrical activity of myocardium and atrium which could precede sustained arrhythmia. In patients with dialysis, older ages over 40 years and presence of ischemic heart disease may lead increased dispertion of QTc and also probability of ventricular arrhythmia. Additionally usage of Ca antagonists was positively and beta blockers was negatively correlated with QTcd. Positive correlation of Increased P wave dispertion to ultrafiltration volume support the volume overload may increase the tendency to atrial arrhythmia via increase P wave dispertion.

OP-054 THE RELATIONSHIP BETWEEN HSCRP LEVELS AND P WAVE DURATION IN LONE PAROXYSMAL ATRIAL FIBRILLATION PATIENTS

LA thrombus prior to DC cardioversion were identified from our department. A CHA2DS2-VASc score was calculated for each patient. 3D TEE examination were performed for the presence of LA thrombus and LAA volume evaluation. Results: The mean CHA2DS2-VASc score was 3.7±1.5. among 64 patients with nonvalvular atrial fibrillation only 32% had been taken oral anticoagulants. From all patients 81.8% of patients with stroke were under 65 years old. Hypertension was present in 81%, diabetes mellitus in 32%, CAD in 20%, Stroke in 25%, PAH in 12%, and congestive heart failure was present in 21% of patients with AF. The mean LAA volume (3mm) was 9.3±2.6. A significant association was present between CHA2DS2-VASc score and LAA volume (p < 0.001). There were 5 patients with low CHA2DS2VASc score (0–1), 37 patients with intermediate score (2–4), and 22 patients with high (5–9) score. The volume of LAA in low, intermediate and high CHA2DS2-VASc score groups was 8.8±1.1, 8.7±2.3, 10.8±2.6, respectively. Conclusion: High CHA2DS2-VASc score is significantly associated with LAA volume in patients with non valvular AF.

PP-284 CONCOMITANTLY FOUND SINGLE CORONARY OSTIUM AND MITRAL VALVE PROLAPSUS IN A YOUNG FEMALE WITH ALPORT SYNDROME

Objective: Alport syndrome (AS) is a rare inherited disorder characterized by involvement of the kidneys because of the defect in the genes encoding a connective tissue protein, one of several subunits of collagen (particularly type IV) ultimately leading to renal failure at an early age. Cardiac involvement have been reported rarely which most commonly includes conduction system abnormalities. Valvular abnormalities in AS have not been reported previously. In our case, concomitant occurrence of previously unreported AS with MVP may be due to mutation at the level of collagen synthesis. Also single coronary ostium may contribute to this association coincidentally. Methods: A 23-year-old female with chronic renal failure because of Alport syndrome (AS) consulted for cardiac evaluation before renal transplantation. She described dyspnea with minimal effort and atypical chest pain. Past medical history includes AS, hypertension and chronic renal failure for 4 years. She was taking carvedilol and amlodipine for hypertension.