Hakki Simsek

The effects of iron deficiency anemia on p wave duration and dispersion

OBJECTIVES: The association between P wave dispersion and iron deficiency anemia has not been documented in the literature. In this study, we evaluated P wave dispersion in patients with iron deficiency anemia and the possible relationships between P wave dispersion and other echocardiographic parameters. INTRODUCTION: The iron status of an individual may play an important role in cardiovascular health. Anemia is an independent risk factor for adverse cardiovascular outcomes. P wave dispersion is a simple electrocardiographic marker that has a predictive value for the development of atrial fibrillation. Apart from cardiovascular diseases, several conditions, such as seasonal variation, alcohol intake and caffeine ingestion, have been demonstrated to affect P wave dispersion. METHODS: The study included 97 patients who had iron deficiency anemia and 50 healthy subjects. The cases were evaluated with a clinical examination and diagnostic tests that included 12‐lead electrocardiography and transthoracic echocardiography. RESULTS: Compared to the control group, patients with iron deficiency anemia showed significantly longer maximum P wave duration (Pmax) (91.1±18.0 vs. 85.8±6.7 msec, p = 0.054), P wave dispersion (PWD) (48.1±7.7 vs. 40.9±5.6 msec, p<0.001), mitral inflow deceleration time (DT) (197.5±27.9 vs. 178.8±8.9 msec, p<0.001) and isovolumetric relaxation time (IVRT) (93.3±9.2 vs. 77.4±8.2 msec, p<0.001); they also showed increased heart rate (85.7±16.1 vs. 69.0±4.4, p<0.001) and frequency of diastolic dysfunction (7 (7.2%) vs. 0). Correlation analysis revealed that PWD was significantly correlated with IVRT, DT, heart rate, the presence of anemia and hemoglobin level. CONCLUSIONS: Iron deficiency anemia may be associated with prolonged P wave duration and dispersion and impaired diastolic left ventricular filling.

Regional functions of the left ventricle in patients with coronary slow flow and the effects of nebivolol

Background: Microvascular and endothelial dysfunction have been implicated for coronary slow flow (CSF). Nebivolol, besides its beta-receptor blocking activity, causes an endothelium-dependent vasodilatation through increased nitric oxide release. Methods: This study included 27 patients with CSF and 27 subjects with normal coronary arteries. Segmental functions of the left ventricle (LV) were assessed using myocardial tissue Doppler velocities before and 3 months after treatment with nebivolol 5 mg/day. Results: Compared with the control group, mitral deceleration time (DT) was significantly longer, and E/A ratio, systolic velocity of lateral mitral annulus (Sm) and regional myocardial peak systolic and early diastolic velocities (V s, Vd) were significantly lower in patients with CSF. The reason for coronary angiography was typical angina in 21 (77.8%) and positive treadmill test in six (22.2%) CSF patients. There were significant correlations between presence of CSF in left anterior descending artery (LAD) with S m (r =-0.404, p =0.002) and Vs in anterior (r =-0.531, p < 0.001 ) and lateral (r =-0.495, p < 0.001 ) segments and between presence of CSF in RCA and Vs in posterior segments (r =-0.501, p < 0.001). Treatment with nebivolol significantly decreased blood pressures (128.5±12.5/82.5±8.8 to 119.8± 12.6/76.4± 7.4 mmHg, p < 0.001), DT (252.3±53.6 to 222.0±41.0 ms, p < 0.001 ) and IVRT (115.7±19.9 to 103.3±17.0 ms, p <0.001), and increased exercise capacity (8.7±1.3 to 10.4±0.9 METs, p < 0.001), E/A ratio (0.87±0.26 to 1.08±0.23, p <0.001) and myocardial velocities (p < 0.001). All the patients were free of angina after treatment. Patients with CSF had impaired diastolic and regional LV functions. Conclusions: Nebivolol may therefore be useful in improving angina, exercise capacity and LV functions in patients with CSF.

Increased Risk of Atrial and Ventricular Arrhythmia in Long-Lasting Psoriasis Patients

Background. Several reports have demonstrated an association between psoriasis and cardiovascular diseases. P wave dispersion (PWD) is the most important electrocardiographic (ECG) markers used to evaluate the risk of atrial arrhythmias. QT dispersion (QTD) can be used to assess homogeneity of cardiac repolarization and may be a risk for ventricular arrhythmias. Aim. To search PWD and QTD in patients with psoriasis. Methods. Ninety-four outpatient psoriasis patients and 51 healthy people were evaluated by physical examination, 12-lead ECG, and transthoracic echocardiography. Severity of the psoriasis was evaluated by psoriasis area and severity index (PASI). Results. Mean disease duration was 129.4 ± 83.9 (range, 3–360) months and PASI ranged from 0 to 34.0 (mean ± SD; 7.6 ± 6.7). Compared to control group, psoriatic patients had significantly shorter Pmax and Pmin durations, longer QTcmax, and greater PWD and QTcD. Transmitral deceleration time (DT) and isovolumetric relaxation time (IVRT) were significantly longer among psoriasis patients. QTcD and PWD were significantly correlated with disease duration (r = 0.693, P < 0.001, and r = 0.368, P = 0.003, resp.). Conclusions. In this study, we found that both PWD and QTcD are increased in psoriasis patients compared to healthy subjects. In addition, they had longer DT and IVRT.

Comparison of the effects of quinapril and irbesartan on P-wave dispersion in hypertensive patients.

IntroductionP-wave dispersion (PWD) has been shown to be a non-invasive electrocardiographic predictor for development of atrial fibrillation (AF). Thus, it may be possible to attenuate AF risk through improvement of PWD. In this study, we compared the effects of an angiotensin-converting enzyme (ACE) inhibitor, quinapril, and an angiotensin receptor blocker (ARB), irbesartan, on PWD.MethodsA total of 38 newly diagnosed hypertensive patients were enrolled in the study. The patients were randomly assigned to receive treatment with either irbesartan (150–300 mg) or quinapril (20–40 mg). P-wave durations and PWD were measured at baseline and after 6 and 12 months of treatment. Echocardiographic examinations were performed at baseline and after 12 months of treatment.ResultsBoth drugs significantly reduced blood pressure to a similar degree (P<0.001). Deceleration time (both P<0.001) and isovolumetric relaxation time (both P=0.007) were also significantly reduced, whereas there was no significant change in the early diastolic flow/atrial contraction signal ratio. Both irbesartan and quinapril significantly decreased maximum P-wave duration (Pmax) (P<0.001 and P=0.002, respectively) and PWD (from 68.0±22.1 to 41.0±25.1 msec for irbesartan, and from 70.5±20.4 to 46.6±13.3 msec for quinapril; both P<0.001). Baseline and follow-up blood pressure, heart rate, echocardiographic findings, and P-wave values were not significantly different between the irbesartan and quinapril groups. No patient developed AF during follow-up. There was no significant correlation between PWD and blood pressure or diastolic function parameters.ConclusionAntihypertensive treatment with either irbesartan or quinapril is associated with significant reductions in Pmax and PWD.

Association of epicardial adipose tissue thickness and inflammation parameters with CHA2DS2-VASASc score in patients with nonvalvular atrial fibrillation.

Background Epicardial adipose tissue (EAT), mean platelet volume (MPV), platelet-to- lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) have been shown to be helpful in predicting adverse cardiovascular events. However, to date, in the literature, there have been no studies demonstrating the relationship between EAT, MPV, PLR, NLR, and thromboembolism risk in atrial fibrillation (AF). Therefore, we examined the relationship between EAT, MPV, PLR, NLR, and CHA2DS2-VASc score used for the evaluation of thromboembolism risk in patients with AF. Methods The study included 96 consecutive patients with AF and 52 age- and sex-matched control subjects. We calculated CHA2DS2-VASc risk score for each patient and measured baseline EAT thickness, MPV, PLR, NLR, left atrial volume index, and left ventricular ejection fraction. Results The group with high CHA2DS2-VASc score had higher EAT (7.2±1.5 vs 5.9±1.2 mm, P<0.001), MPV (9.1±1.1 vs 8.4±1.0 fL, P=0.004), PLR (152.3±28.4 vs 126.7±25.4, P=0.001), and NLR (4.0±1.6 vs 3.2±1.3, P<0.001) compared to group with low-intermediate CHA2DS2-VASc score. Moreover, CHA2DS2-VASc score was found to be positively correlated with EAT (r=0.623, P<0.001), MPV (r=0.350, P=0.004), PLR (r=0.398, P=0.001), and NLR (r=0.518, P<0.001). Conclusion Our study results demonstrated that EAT thickness, MPV, PLR, and NLR were associated with the thromboembolic risk exhibited by CHA2DS2-VASc score in patients with nonvalvular AF.

Increased P-wave dispersion in patients with newly diagnosed lichen planus

OBJECTIVE: Lichen planus is a chronic inflammatory autoimmune mucocutaneous disease. Recent research has emphasized the strong association between inflammation and both P-wave dispersion and dyslipidemia. The difference between the maximum and minimum P-wave durations on an electrocardiogram is defined as P-wave dispersion. The prolongation of P-wave dispersion has been demonstrated to be an independent risk factor for developing atrial fibrillation. The aim of this study was to investigate P-wave dispersion in patients with lichen planus. METHODS: Fifty-eight patients with lichen planus and 37 age- and gender-matched healthy controls were included in this study. We obtained electrocardiographic recordings from all participants and used them to calculate the P-wave variables. We also assessed the levels of highly sensitive C-reactive protein, which is an inflammatory marker, and the lipid levels for each group. The results were reported as the means ± standard deviations and percentages. RESULTS: The P-wave dispersion was significantly higher in lichen planus patients than in the control group. Additionally, highly sensitive C-reactive protein, LDL cholesterol, and triglyceride levels were significantly higher in lichen planus patients compared to the controls. There was a significant positive correlation between highly sensitive C-reactive protein and P-wave dispersion (r = 0.549, p<0.001) in lichen planus patients. CONCLUSIONS: P-wave dispersion increased on the surface electrocardiographic measurements of lichen planus patients. This result may be important in the early detection of subclinical cardiac involvement. Increased P-wave dispersion, in terms of the tendency for atrial fibrillation, should be considered in these patients.

Does isotretinoin therapy have any effects on electrocardiography, heart rate and blood pressure?

Abstract Background: Isotretinoin therapy is associated with numerous adverse effects of various systems. Although some cases have been reported, cardiac side effects are rare following isotretinoin treatment. Objective: To investigate the effects of isotretinoin on the cardiovascular system. Methods: Seventy patients with acne vulgaris were enrolled in the study. The patients were treated with a dose of 0.5–1.0 mg/kg per day of isotretinoin. Screening for biochemical and hematologic parameters, heart rate, blood pressure and electrocardiographic parameters were done before treatment and after 3 months of isotretinoin treatment. Results: Heart rate, systolic/diastolic tension and electrocardiographic parameters (P-wave duration and QTc duration) were not statistically different before compared with after treatment. Conclusion: As far as we know, there is no study researching the effect of isotretinoin on P- and QT-wave measurements in the literature. We found that isotretinoin did not affect P- and QT-wave measurement. Further studies with longer periods of follow-up are needed to understand the effect of isotretinoin on the cardiovascular system.

Peripartum cardiomyopathy in Turkey: Experience of three tertiary centres

We conducted this study to determine demographic details, and clinical presentations in patients with peripartum cardiomyopathy (PPCMP) of Turkish origin. The study population consisted of 58 patients with PPCMP treated at 3 major hospitals in Turkey, retrospectively. In this study, demographic details and initial echocardiographic data were recorded and long-term clinical status was evaluated. The mean age for the patient cohort was 31.47 ± 6.31 years. Thirty-eight patients (73.1%) were multigravida and seven patients had multifetal pregnancy (13.7%). The mean follow-up left ventricular (LV) ejection fraction increased from 31 ± 7 to 38 ± 19. A minority of patients were defined as improvers according to our pre-specified criteria. The average survival period after diagnosis of PPCMP was 20.66 ± 14.44 months. Initial values for LV end-diastolic diameter and urea were higher in the deceased patients compared with the surviving patients, respectively. Twenty-eight (48%) patients with PPCMP showed improvement in the follow-up period. Of the 58 PPCMP patients, 9 (15%) died during a mean follow-up of 32 ± 22 months.

Effects of lowered dialysate sodium on left ventricle function and brain natriuretic peptide in maintenance of hemodialysis patients.

Introduction: Impaired diastolic flow is characterized by decreased left ventricular (LV) filling diastole, abnormal LV distensibility, or delayed relaxation. B-Type natriuretic peptide (BNP) is an indicator of various cardiovascular diseases and body volume status. The aim of this study was to determine whether the lowering of dialysate sodium (Na) levels is effective on LV systolic and diastolic parameters and BNP in the maintenance of hemodialysis patients. Materials and Methods: The study included 49 chronic hemodialysis patients. Left atrium (LA) diameter and LV ejection fraction, LV systolic and diastolic diameter, deceleration time (DT), pulmonary artery pressure (PAP), inferior vena cava diameter (IVCD), early diastolic transmitral flow (E) and late diastolic transmitral flow (A) velocities, E/A ratio, isovolumic relaxation time, peak early diastolic velocity (E′), late diastolic velocity (A′) of tissue Doppler mitral annulus, and flow propagation velocity of mitral inflow (V p) were measured before and 6 months after hemodialysis with low Na dialysate. Results: Six months after low Na hemodialysis, a decrease was observed in echocardiographic parameters such as PAP and IVCD (p < 0.05, p < 0.001, and p < 0.001, respectively). However, a significant difference was not observed in LA diameter. In LV diastolic measurement of E and A waves, E/A ratio, DT, V p, septal E′ and A′, and lateral E′ and A′ exhibited significant improvement by low Na HD. BNP level was significantly reduced (p < 0.001). Conclusions: Lowered dialysate Na concentration improves PAP, IVCD, and LV diastolic properties assessed by mitral inflow filling, tissue Doppler velocity, and mitral inflow velocity propagation.

Decreased risk of ventricular arrhythmias with treatment of nebivolol in patients with coronary slow flow.

BACKGROUND Coronary slow-flow (CSF) is an angiographic phenomenon characterised by delayed opacification of vessels in the absence of any evidence of obstructive epicardial coronary disease. QT interval dispersion (QTD) reflects regional variations in ventricular repolarisation and cardiac electrical instability and has been reported to be longer in patients with CSF. AIM To examine QT duration and dispersion in patients with CSF and the effects of nebivolol on these parameters. METHODS The study population included 67 patients with angiographically proven normal coronary arteries and CSF, and 38 patients with angiographically proven normal coronary arteries without associated CSF. The patients were evaluated with 12-lead electrocardiography, and echocardiography before and three months after treatment with nebivolol. RESULTS Compared to the control group QTcmax and QTcD were significantly longer in patients with CSF (p = 0.036, p = 0.019, respectively). QTcD significantly correlated with the presence of CSF (r = 0.496, p < 0.001). QTcmax (p = 0.027), QTcD (p = 0.002), blood pressure (p = 0.001), and heart rate (p < 0.001) values significantly decreased after treatment with nebivolol. CONCLUSIONS Coronary slow flow is associated with increased QTD. Nebivolol reduced increased QTD in patients with CSF after three months.