Muhammet Dural

Effects of heart rate reduction with ivabradine on the international ındex of erectile function (IIEF-5) in patients with heart failure

Abstract Introduction: The presence of concomitant erectile dysfunction (ED) with heart failure (HF) is not surprising, because endothelial dysfunction is pathophysiologic signature of both ED and HF. ED significantly and adversely affects quality of life in patients with HF. It was demonstrated that ivabradine treatment can improve endothelial function and ED in experimental models. In this study, we aimed to determine the effect of ivabradine treatment on ED in patients with HF via International Index of Erectile Function (IIEF-5) questionaire. Material and methods: Consequently, 29 patients, between 18 and 70 years of age, male with chronic HF known for at least 1 year, New York Heart Association functional class I–II, left ventricule ejection fraction less than 40%, in sinus rhythm with a resting HR of at least 70 beats per minute (b.p.m.), who were intended to be treated with ivabradine according to the decision of their physicians were evaluated to determine ED. We used the Turkish version of the IIEF-5 questionnaire to evaluate ED on the last 6-month period. Twenty-four of 29 patients who scored ≤21 were considered to have ED and included to the study. IIEF-5 scores for each question and domains were calculated for all responders at baseline and at 6-month follow-up visit in order to determine any effect of ivabradine treatment on ED in patients with HF. Results: According to the data of survey, Cronbachs alpha coeffient for all of the patients who were included into the study were 0.84 and detected highly reliable. IEFF-5 questionnaire scores increased significantly (p = .003) after the ivabradine treatment, on the contrary, significant decrease in HR was revealed as expected. HR is decreased steadily after ivabradine treatment and mean decrease in HR was 11.5 ± 9.4 in this study population. Likewise, negative correlation was demonstrated between decrease in HR (p < .001) and increase in IEFF-5 scores (p = .003). Conclusion: Although lack of patients with HF have been evaluated in this study population, initial results seem promising that ivabradine has favorable effects on ED. These findings were postulated to be dependent exclusively on HR reduction. As a sequel, cardiologist should avoid neglecting ED to improve medical compliance as well as quality of life in patients with heart failure. This pilot study provide some data for further randomized controlled studies.

Monocyte to High-Density Lipoprotein Ratio Predicts Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome

Contrast-induced nephropathy (CIN) is associated with worse prognosis in patients with acute coronary syndrome (ACS). Early identification and intervention for patients with a high risk of CIN are very important to improve clinical outcomes. Inflammation plays important role in the development of CIN in the setting of ACS. The monocyte to high-density lipoprotein ratio (MHR) is a novel inflammatory marker. Bleeding is also associated with worse prognosis in such patients. We aimed to investigate whether the preprocedural MHR had a predictive role for CIN development in such patients. In addition, using the thrombolysis in myocardial infarction classification, we aimed to assess whether there was any relationship between bleeding and CIN. A total of 647 patients (496 males; age: 63.3 ± 12.7 years) with ACS who underwent percutaneous coronary intervention (PCI) were included in the study. Seventy patients (10.8%) had developed CIN. Age, diabetes mellitus, contrast volume, estimated glomerular filtration rate, and MHR were independent predictors for CIN. Preprocedural MHR may be used as a simple marker of CIN. It may help with the early identification of patients with ACS who underwent PCI who are at high risk of CIN thus allowing the planning of protective measures.

Effects of creatine supplementation on cardiac autonomic functions in bodybuilders: MERT et al .

Bodybuilder‐type workouts may affect heart rate variability (HRV), which has considerable potential to assess the role of autonomic nervous system (ANS). A scientifically designed approach is necessary for bodybuilders to achieve better results while protecting their health. In this study, we aimed to investigate HRV parameters in bodybuilders compared to healthy control subjects and effects of creatine supplementation. A total of 48 male participants (16 controls, 16 supplement (–), 16 supplement (+)) were evaluated in our study. Bodybuilders who were taking creatine supplementation were enrolled in supplement (+) group. HRV parameters were measured from 24‐hour Holter recordings of all participants.

Fracture of the distal part of an implantable cardioverter-defibrillator lead two months after implantation

Address for correspondence: Dr. Muhammet Dural, Eskisehir Osmangazi University, Cardiology Department, Büyükdere Mahallesi, 26040 Odunpazarı/Eskişehir, 26040 Eskisehir, Turkey, e-mail: muhammetdural@yahoo.com Conflict of interest: none declared Kardiologia Polska Copyright

Questioning reliability of observational study: MERT et al .

The authors greatly appreciate Cekic et al. for their insightful comments with regard to our manuscript titled “Effects of creatine supplementation on cardiac autonomic functions in bodybuilders.”1 In this study, we aimed to investigate heart rate variability (HRV) parameters of cardiac autonomic functions in bodybuilders compared to healthy control subjects and evaluate effects of creatine supplementation on HRV parameters. The study was designed as a cross-sectional study which is a type of observational study usually usedwhen a randomized controlled trials or cohort study is going to be difficult. Furthermore, evaluation of HRV in the Holter recordings yields a useful index of cardiac autonomic functions.2 We take a “snapshot” of autonomic functions by using Holter recordings in this reliable methodology. Unlike the experimental design, cross-sectional designs focus on studying and drawing inferences from existing differences between cases. Undoubtedly, there is no methodological mistake in our observational study. However, it is difficult to determine whether the outcome followed exposure in time or exposure resulted from the outcome with cross-sectional design.3 Hence, it was clearly demonstrated as an attenuation of vagal dominance in HRV as a result of supplementation but this cannot be distinguished from the effects of overtraining syndrome. As it was mentioned in the limitation part of the article,1 the study can be more durable with the prospective evaluation of supplementation quantity, overtraining parameters, athletic conditioning levels, and exercise intensity of each individual. Majority of bodybuilders take supplements based on the belief that their performance will improve, without proven scientific evidence or anymedical support. Further studies with prospectively well-designed protocol are needed to settle a scientifically designed approach for bodybuilders to achieve better results while protecting their health.

The management of ventricular arrhythmias in the elderly - are there differences?

Sudden cardiac deaths (SCD) are most often caused by ventricular arrhythmias (VA). Among all cause mortality in the elderly, the rate of SCD due to VA is decreasing. The choice of antiarrhythmic drug in elderly patients is not different according to younger patients. Treatment goals, patient compliance, drug interaction risk, liver and kidney function should be considered in the selection of antiarrhythmic drugs. ICD implantation provides mortality reduction in the elderly when appropriate patient selection is made. In older people with minimal comorbid disease and at high risk for arrhythmic death, the ICD has a higher benefit rate.

Evaluation of Increase in Intraventricular Gradient and Dynamic Obstruction During Exercise-Stress Test in Competetive Runners

OBJECTIVE Sudden cardiac death in athletes is one of the most tragic health events seen both in our country and all over the world. In some of those athletes, there is no obvious structural abnormality. Dynamic changes in intracardiac hemodynamics during exercise may be a cause for sudden death in these athletes, the impact of exercise on intracardiac gradient and cardiac hemodynamic parameters in athletes was compared with healthy controls. METHODS A total of 21 professional male athletes and 21 healthy male controls were included in the study. Transthoracic echocardiography was performed in all participants both at rest and maximal exercise level to assess the intraventricular gradient (IVG) and cardiac systolic and diastolic functions. Abnormal IVG was defined as gradient of >30 mm Hg at peak exercise level. RESULTS Both groups reached the level of predicted maximum exercise. There was no exercise limiting symptom among participants during exercise test. The athletes revealed a higher maximum peak systolic IVG at baseline and after exercise in comparison with the control group. None of the participants showed an abnormal IVG level. CONCLUSION Our results showed that there was no dynamic intraventricular obstruction with aerobic exercise in subjects with a structurally normal heart.

Electromagnetic interference of mobile phones: insight into heart rate variability

We read with great interest the recent article by Ekici et al. (1) entitled “The effects of the duration of mobile phone use on heart rate variability parameters in healthy subjects” published in Anatol J Cardiol 2016; 16: 833-8, documenting the role of mobile phone (MP) use in healthy subjects. Although it is an original concept, we want to address some points that merit more attention. The rate at which energy is absorbed by the human body is measured by the specific absorption rate (SAR). As authors mentioned in the limitations section, the SAR values were not analyzed. Therefore, the statistical analyses could be affected by different MP models used in this study. Moreover, MP is a potential source of electromagnetic field (EMF) that can affect the reliability of medical devices. The electromagnetic interference (EMI) on medical devices by MP depends on various factors, including power emitted by MP, the frequency of operation, the distance between MP and the medical device, mode of operation of MP, and the immunity of the medical device concerned (2). Furthermore, there is compelling evidence that MPs may produce EMI that adversely affects the operation of ECG systems and may lead to the inability to properly interpret ECG results (3). Ekici et al. (1) used 24-h Holter ECG records to evaluate the heart rate variability (HRV). HRV is commonly defined by the standard deviation of intervals between successive R waves of the cardiac cycle. The distance between the medical device and MP during ECG recording of the patient alters the QRS complexes (4). The data are presumably uncorrected for type and proximity of MP. Thus, it is extremely difficult to evaluate the results without any interference on Holter monitoring due to MPs. On the other hand, some users of mobile handsets have reported feeling several unspecific symptoms during and after its use, such as fatigue, headaches, tachycardia, etc. All these symptoms can also be attributed to stress and that current knowledge cannot separate the symptoms from nocebo effects. Moreover, cardiac-vagal spectral component of HRV may be sensitive to the recent experience of emotional stress (5). Increased environmental stress can make people use their MPs more often than usual and increased number of telephone calls can also cause stress. Therefore, it is difficult to isolate the leading cause of HRV differentiation in the study. Nowadays, MPs are being used not only for calling but also for other services, such as text messaging, email, internet access, video communication, gaming, listening to music, photography, and watching movies, etc. At the same time, MP emits a peak amount of power not only during the ringing phase but also during its standby mode (4). Calculation formula for daily durations of MP use only exists duration/number of telephone calls in the manuscript (1). Therefore, this calculation cannot reflect the EMF exposure in this study population. Overall, it is an uneasy piece of work that performing this type original clinical research is extremely challenging. Data could be interrupted by several interfering environmental electromagnetic pollution these days. Further randomized studies are recommended with more clear protocols.

Evaluation of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with mitral valve stenosis before and after balloon valvuloplasty

Objective: Sympathetic activity increases in patients with mitral stenosis (MS). The association between prolonged Tpeak-Tend (Tp-e) interval and increased sympathetic activity has been demonstrated. This study aimed to evaluate Tp-e interval, Tp-e/QT ratio, and Tp-e/corrected QT interval (QTc) ratio in patients with MS before and after balloon valvuloplasty. Methods: Thirty patients with severe MS and 30 sex-, body mass index-, and and age-matched healthy control subjects were enrolled. The severity of MS was defined following clinical, transthoracic, and transesophageal echocardiographic examinations. All patients underwent successful mitral balloon valvuloplasty. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured using 12-lead electrocardiogram. First, the abovementioned parameters were compared between patients with MS and healthy control subjects. Second, these parameters were compared before and after balloon valvuloplasty in patients with MS. Results: The mean Tp-e interval was significantly prolonged in patients with MS compared with healthy control subjects (85.02±9.12 ms vs. 75.38±6.04 ms; p<0.001). In addition, Tp-e/QT ratio and Tp-e/QTc ratio were significantly higher in patients with MS than in healthy control subjects (0.217±0.025 vs. 0.196±0.02 and 0.203±0.02 vs. 0.184±0.019; p<0.001).The mean valve area significantly increased after balloon valvuloplasty compared with that before balloon valvuloplasty (1.83±0.32 cm2 vs. 1.18±0.15 cm2; p<0.001). Compared with those before balloon valvuloplasty, Tp-e interval (85.02±9.12 ms vs. 78.06±9.2 ms; p<0.001), Tp-e/QT ratio (0.217±0.02 vs. 0.201±0.02; p<0.001), and Tp-e/QTc ratio (0.203±0.02 vs. 0.184±0.02; p<0.001) decreased after balloon valvuloplasty. Conclusion: We revealed that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio increased in patients with severe MS. Furthermore, balloon valvuloplasty had a favorable effect on parameters associated with myocardial repolarization.