https://vincentbourquin.files.wordpress.com/2009/11/broad-spectrum.pdf

Increased Central Venous Pressure Is Associated With Impaired Renal Function and Mortality in a Broad Spectrum of Patients With Cardiovascular Disease

Numerous studies addressed the predictive value of the nighttime blood pressure (BP) as captured by ambulatory monitoring. However, arbitrary cutoff limits in dichotomized analyses of continuous variables, data dredging across selected subgroups, extrapolation of cross-sectional studies to prospective outcomes, and lack of comprehensive adjustments for confounders make interpretation of the literature difficult. We reviewed prospective studies with total mortality or a composite cardiovascular end point as an outcome in relation to the level and the circadian profile of systolic BP. We analyzed studies in hypertensive patients (n=23 856) separately from those in individuals randomly recruited from populations (n=9641). We pooled summary statistics and individual subject data, respectively. In both patients and populations, in analyses in which nighttime BP was additionally adjusted for daytime BP and vice versa, nighttime BP was a stronger predictor than daytime BP. With adjustment for the 24-hour BP, both the night-to-day BP ratio and dipping status remained significant predictors of outcome but added little prognostic value over and beyond the 24-hour BP level. In the absence of conclusive evidence proving that nondipping is a reversible risk factor, the option whether or not to restore the diurnal blood pressure profile to a normal pattern should be left to the clinical judgment of doctors and should be individualized for each patient. Current guidelines on the interpretation of ambulatory BP recording need to be updated.

Predictive Role of the Nighttime Blood Pressure

Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus.

Tortuous arteries and veins are commonly observed in humans and animals. While mild tortuosity is asymptomatic, severe tortuosity can lead to ischemic attack in distal organs. Clinical observations have linked tortuous arteries and veins with aging, atherosclerosis, hypertension, genetic defects and diabetes mellitus. However, the mechanisms of their formation and development are poorly understood. This review summarizes the current clinical and biomechanical studies on the initiation, development and treatment of tortuous blood vessels. We submit a new hypothesis that mechanical instability and remodeling could be mechanisms for the initiation and development of these tortuous vessels.

/pdf/twisted-blood-vessels-symptoms-etiology-and-biomechanical-r2amht2di0.pdf

Twisted Blood Vessels: Symptoms, Etiology and Biomechanical Mechanisms

OBJECTIVE To estimate and compare associations of alanine aminotransferase (ALT) and γ-glutamyltransferase (GGT) with incident diabetes. RESEARCH DESIGN AND METHODS ALT and GGT were studied as determinants of diabetes in the British Women9s Heart and Health Study, a cohort of 4,286 women 60–79 years old (median follow-up 7.3 years). A systematic review and a meta-analysis of 21 prospective, population-based studies of ultrasonography, which diagnosed nonalcoholic fatty liver disease (NAFLD), ALT, and GGT as determinants of diabetes, were conducted, and associations of ALT and GGT with diabetes were compared. RESULTS Ultrasonography-diagnosed NAFLD was associated with more than a doubling in the risk of incident diabetes (three studies). ALT and GGT both predicted diabetes. The fully adjusted hazard ratio (HR) for diabetes per increase in one unit of logged ALT was 1.83 (95% CI 1.57–2.14, I 2 = 8%) and for GGT was 1.92 (1.66–2.21, I 2 = 55%). To directly compare ALT and GGT as determinants of diabetes, the fully adjusted risk of diabetes in the top versus bottom fourth of the ALT and GGT distributions was estimated using data from studies that included results for both markers. For ALT, the HR was 2.02 (1.59–2.58, I 2 = 27%), and for GGT the HR was 2.94 (1.98–3.88, I 2 = 20%), suggesting that GGT may be a better predictor ( P = 0.05). CONCLUSIONS Findings are consistent with the role of liver fat in diabetes pathogenesis. GGT may be a better diabetes predictor than ALT, but additional studies with directly determined liver fat content, ALT, and GGT are needed to confirm this finding.

/pdf/alanine-aminotransferase-g-glutamyltransferase-and-incident-1gou57kogi.pdf

Alanine Aminotransferase, γ-Glutamyltransferase, and Incident Diabetes: The British Women's Heart and Health Study and meta-analysis

New prognostic markers in pulmonary arterial hypertension: CRP to albumin ratio and uric acid

Myxoma is the most frequently encountered primary tumour of the heart, comprising more than 50% of all benign cardiac tumours. The case presented here was diagnosed as having dextrocardia with situs inversus and concomitant left ventricular outflow tract myxoma which has been very rarely encountered, particularly consistent with the scarcity of reported cases.

Left ventricular outflow tract myxoma accompanied by dextrocardia with situs inversus: a case report.

Coronary collateral circulation determines the severity of ischemic myocardial damage. Increased P-wave dispersion is an independent predictor for atrial fibrillation. Consistent evidence is little about the relation between coronary collateral circulation and arrhythmia risk. In this article, the effect of coronary collateral circulation on P-wave dispersion was evaluated. Collateral grade and P-wave dispersion were ascertained in 100 patients with ≥85% diameter stenoses in left anterior descending or right coronary arteries. Left ventricular function score was also determined in all patients. Coronary collateral circulation was absent in 32 patients, whereas 68 patients had coronary collateral circulation. Patients with collateral grade ≥1 had greater left ventricular function score than did patients with collateral grade 0 (P = .048). However, there was no significant difference between P-wave dispersion of patients with and without coronary collateral circulation (P = .45). The presence of coronary co...

Coronary collateral circulation: any effect on P-wave dispersion?

Objective: In our study we aimed to determine the frequency of
arrhythmias that we believe may affect driving safety. Methods and Results: Two
hundred drivers were randomly selected from the heavy vehicle driver population
(82 bus and 118 truck drivers, p = 0.08, q = 0.92, N = 1200, α = 0.01,
d = 0.045). A questionnaire was completed via face to face interviews with
the individuals including questions about their personal socio-demographic
characteristics and symptoms for arrhythmias. An electrocardiography (ECG) was
taken of the study participants using the Cardioline Delta 3 Plus Digital ECG
machine. The cardiologist at the clinic evaluated the questionnaire and ECG for
presence of arrhythmias. When indicated, ambulatory electrocardiography
(Holter Monitoring) was performed for 24 hours in 133 individuals (71 driver
and 62 control). In cases that had Holter
examination; ventricular ectopy was identified in 25.4% and 22.6%, and supra-ventricular
ectopy in 45.1% and 35.5% in the driver and the control groups; respectively.
Ventricular tachycardia was detected in 2 patients. Arrhythmia frequencies were
59.1%, 54.8% and 57.1% in drivers, control and both groups respectively.
Statistical differences between drivers and control group for rhythm disorders
were not detected. Conclusions: Arrhythmias with lethal and devastating
potential; need to be diagnosed and treated in professional drivers with
extreme caution. The follow up and screening for heart diseases has a crucial
role in preventing accidents and occupational diseases in drivers.

/pdf/prevalence-of-arrhythmias-in-heavy-vehicle-drivers-1b2oqzfnzv.pdf

Prevalence of arrhythmias in heavy vehicle drivers

Study design: A 22-item questionnaire was developed to measure the knowledge of patients about cardiovascular procedures. After validation in a group of 10 volunteer patients, the questionnaire was administered to 200 participants (115 males, mean age 53 years; 85 females, mean age 49 years). The patients were inquired about their knowledge of electrocardiography (ECG), Holter, exercise stress test, echocardiography, coronary angiography (CAG), percutaneous coronary interventions (PCI), electrophysiological study, and pacemaker implantation.

Okan Onur Turgut

Papers

New prognostic markers in pulmonary arterial hypertension: CRP to albumin ratio and uric acid

Left ventricular outflow tract myxoma accompanied by dextrocardia with situs inversus: a case report.

Coronary collateral circulation: any effect on P-wave dispersion?

Prevalence of arrhythmias in heavy vehicle drivers

Evaluation of the patients’ level of knowledge about diagnostic and therapeutic procedures in cardiology