Search results for: myocardial ischemia

Authors: Santanu Chattopadhyay, Gautam Sarkar, Arabinda Das

Abstract:

This paper presents wavelet based classification of various heart diseases. Electrocardiogram signals of different heart patients have been studied. Statistical natures of electrocardiogram signals for different heart diseases have been compared with the statistical nature of electrocardiograms for normal persons. Under this study four different heart diseases have been considered as follows: Myocardial Ischemia (MI), Congestive Heart Failure (CHF), Arrhythmia and Sleep Apnea. Statistical nature of electrocardiograms for each case has been considered in terms of kurtosis values of two types of wavelet coefficients: approximate and detail. Nine wavelet decomposition levels have been considered in each case. Kurtosis corresponding to both approximate and detail coefficients has been considered for decomposition level one to decomposition level nine. Based on significant difference, few decomposition levels have been chosen and then used for classification.

Keywords: Arrhythmia, congestive heart failure, discrete wavelet transform, electrocardiogram, myocardial ischemia, sleep apnea.

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Authors: A. Ben Abdallah, H. Essabbah, M. H. Bedoui

Abstract:

The myocardial sintigraphy is an imaging modality which provides functional informations. Whereas, coronarography modality gives useful informations about coronary arteries anatomy. In case of coronary artery disease (CAD), the coronarography can not determine precisely which moderate lesions (artery reduction between 50% and 70%), known as the “gray zone", are haemodynamicaly significant. In this paper, we aim to define the relationship between the location and the degree of the stenosis in coronary arteries and the observed perfusion on the myocardial scintigraphy. This allows us to model the impact evolution of these stenoses in order to justify a coronarography or to avoid it for patients suspected being in the gray zone. Our approach is decomposed in two steps. The first step consists in modelling a coronary artery bed and stenoses of different location and degree. The second step consists in modelling the left ventricle at stress and at rest using the sphercical harmonics model and myocardial scintigraphic data. We use the spherical harmonics descriptors to analyse left ventricle model deformation between stress and rest which permits us to conclude if ever an ischemia exists and to quantify it.

Keywords: Spherical harmonics model, vascular bed, 3D reconstruction, left ventricle, myocardial scintigraphy.

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Authors: K. Gauthaman, T.S. Mohamed Saleem, V. Ravi, Sita Sharan Patel, S. Niranjali Devaraj

Abstract:

The present study was designed to investigate the cardio protective role of chronic oral administration of alcoholic extract of Terminalia arjuna in in-vivo ischemic reperfusion injury and the induction of HSP72. Rabbits, divided into three groups, and were administered with the alcoholic extract of the bark powder of Terminalia arjuna (TAAE) by oral gavage [6.75mg/kg: (T1) and 9.75mg/kg: (T2), 6 days /week for 12 weeks]. In open-chest Ketamine pentobarbitone anaesthetized rabbits, the left anterior descending coronary artery was occluded for 15 min of ischemia followed by 60 min of reperfusion. In the vehicle-treated group, ischemic-reperfusion injury (IRI) was evidenced by depression of global hemodynamic function (MAP, HR, LVEDP, peak LV (+) & (- ) (dP/dt) along with depletion of HEP compounds. Oxidative stress in IRI was evidenced by, raised levels of myocardial TBARS and depletion of endogenous myocardial antioxidants GSH, SOD and catalase. Western blot analysis showed a single band corresponding to 72 kDa in homogenates of hearts from rabbits treated with both the doses. In the alcoholic extract of the bark powder of Terminalia arjuna treatment groups, both the doses had better recovery of myocardial hemodynamic function, with significant reduction in TBARS, and rise in SOD, GSH, catalase were observed. The results of the present study suggest that the alcoholic extract of the bark powder of Terminalia arjuna in rabbit induces myocardial HSP 72 and augments myocardial endogenous antioxidants, without causing any cellular injury and offered better cardioprotection against oxidative stress associated with myocardial IR injury.

Keywords: Antioxidants, HSP72, Ischemic reperfusion injury, Terminalia arjuna.

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Authors: Syed Dawood Md. Taimur, Md. Hasanur Rahman, Syeda Fahmida Afrin, Farzana Islam

Abstract:

The concept of myocardial injury, although first recognized from animal studies, is now recognized as a clinical phenomenon that may result in microvascular damage, no-reflow phenomenon, myocardial stunning, myocardial hibernation and ischemic preconditioning. The final consequence of this event is left ventricular (LV) systolic dysfunction leading to increased morbidity and mortality. The typical clinical case of reperfusion injury occurs in acute myocardial infarction (MI) with ST segment elevation in which an occlusion of a major epicardial coronary artery is followed by recanalization of the artery. This may occur spontaneously or by means of thrombolysis and/or by primary percutaneous coronary intervention (PCI) with efficient platelet inhibition by aspirin (acetylsalicylic acid), clopidogrel and glycoprotein IIb/IIIa inhibitors. In recent years, percutaneous coronary intervention (PCI) has become a well-established technique for the treatment of coronary artery disease. PCI improves symptoms in patients with coronary artery disease and it has been increasing safety of procedures. However, peri- and post-procedural myocardial injury, including angiographical slow coronary flow, microvascular embolization, and elevated levels of cardiac enzyme, such as creatine kinase and troponin-T and -I, has also been reported even in elective cases. Furthermore, myocardial reperfusion injury at the beginning of myocardial reperfusion, which causes tissue damage and cardiac dysfunction, may occur in cases of acute coronary syndrome. Because patients with myocardial injury is related to larger myocardial infarction and have a worse long-term prognosis than those without myocardial injury, it is important to prevent myocardial injury during and/or after PCI in patients with coronary artery disease. To date, many studies have demonstrated that adjunctive pharmacological treatment suppresses myocardial injury and increases coronary blood flow during PCI procedures. In this review, we highlight the usefulness of pharmacological treatment in combination with PCI in attenuating myocardial injury in patients with coronary artery disease.

Keywords: Coronary artery disease, Percutaneous coronary intervention, Myocardial injury, Pharmacology.

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Authors: Yusoff Y. S., Streftaris, G., Waters, H. R

Abstract:

Death within 30 days is an important factor to be looked into, as there is a significant risk of deaths immediately following or soon after, myocardial infarction (MI) or stroke. In this paper, we will model the deaths within 30 days following a myocardial infarction (MI) or stroke in the UK. We will see how the probabilities of sudden deaths from MI or stroke have changed over the period 1981-2000. We will model the sudden deaths using a generalized linear model (GLM), fitted using the R statistical package, under a Binomial distribution for the number of sudden deaths. We parameterize our model using the extensive and detailed data from the Framingham Heart Study, adjusted to match UK rates. The results show that there is a reduction for the sudden deaths following a MI over time but no significant improvement for sudden deaths following a stroke.

Keywords: Sudden deaths, myocardial infarction, stroke, ischemic heart disease.

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Authors: M. D. Prokhorov, A. R. Kiselev, A. S. Karavaev, O. M. Posnenkova, V. I. Gridnev, V. I. Ponomarenko

Abstract:

Synchronization between 0.1 Hz oscillations in heart rate and blood pressure is studied and its change during vertical tilt is evaluated in 37 myocardial infarction patients. Two groups of patients are identified with decreased and increased, respectively, synchronization of the studied oscillations as a response to a tilt test. It is shown that assessment of synchronization of 0.1 Hz oscillations as a response to vertical tilt can be used as a guideline for selecting optimal dose of beta-blocker treatment in post-myocardial infarction patients.

Keywords: Cardiovascular system, heart rate variability, synchronization.

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Authors: M. Hakami, A. Jammaly, I. Attafi, M. Oraiby, M. Jeraiby

Abstract:

We reviewed an unusual case of a 65-year-old male taking an herbal mixture containing compounds with anticholinesterase activity for a long period of time, presented with acute my myocardial infarction and multiple organ dysfunction syndrome followed by death. Clinically, there are findings correlated with anticholinesterase activity, such as bilateral miosis, diaphoresis, vomiting and fasciculation without a history of any toxic ingestion or exposure. Gas chromatography–mass spectrometry screening studies identified the presence of thymol, anethole in the herbal extract and butylated hydroxytoluene in the blood sample. Hence, with this case report, we intend to highlight the necessity of evaluating the long-term use of the herbal mixture.

Keywords: Cholinesterase inhibitors, thymol, anethole, butylated hydroxytoluene, cardiac toxicity and myocardial infarction.

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Authors: Tahseen A. Jilani, Huda Yasin, Madiha Yasin, C. Ardil

Abstract:

In this paper we use data mining techniques to investigate factors that contribute significantly to enhancing the risk of acute coronary syndrome. We assume that the dependent variable is diagnosis – with dichotomous values showing presence or  absence of disease. We have applied binary regression to the factors affecting the dependent variable. The data set has been taken from two different cardiac hospitals of Karachi, Pakistan. We have total sixteen variables out of which one is assumed dependent and other 15 are independent variables. For better performance of the regression model in predicting acute coronary syndrome, data reduction techniques like principle component analysis is applied. Based on results of data reduction, we have considered only 14 out of sixteen factors.

Keywords: Acute coronary syndrome (ACS), binary logistic regression analyses, myocardial ischemia (MI), principle component analysis, unstable angina (U.A.).

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Authors: Lina Paola Orozco-Marín, Yuliet Montoya, John Bustamante

Abstract:

Ischemic events can culminate in acute myocardial infarction with irreversible cardiac lesions that cannot be restored due to the limited regenerative capacity of the heart. Tissue engineering proposes therapeutic alternatives by using biomaterials to resemble the native extracellular medium combined with healthy and functional cells. This research focused on developing a natural thermosensitive hydrogel, its physical-chemical characterization and in vitro biocompatibility determination. Hydrogels’ morphological characterization was carried out through scanning electron microscopy and its chemical characterization by employing Infrared Spectroscopy technic. In addition, the biocompatibility was determined using fetal human ventricular cardiomyocytes cell line RL-14 and the MTT cytotoxicity test according to the ISO 10993-5 standard. Four biocompatible and thermosensitive hydrogels were obtained with a three-dimensional internal structure and two gelation times. The results show the potential of the hydrogel to increase the cell survival rate to the cardiac cell therapies under investigation and lay the foundations to continue with its characterization and biological evaluation both in vitro and in vivo models.

Keywords: cardiac cell therapy, cardiac ischemia, natural polymers, thermosensitive hydrogel

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Authors: S. Dabiran

Abstract:

Chest pain is one of the most prevalent complaints among adults that cause the people to attend to medical centers. The aim was to determine the prevalence and risk factors of chest pain among over 30 years old people in Tehran. In this cross-sectional study, 787 adults took part from Apr 2005 until Apr 2006. The sampling method was random cluster sampling and there were 25 clusters. In each cluster, interviews were performed with 32 over 30 years old, people lived in those houses. In cases with chest pain, extra questions asked. The prevalence of CP was 9% (71 cases). Of them 21 cases (6.5%) were in 41-60 year age ranges and the remainders were over 61 year old. 19 cases (26.8%) mentioned CP in resting state and all of the cases had exertion onset CP. The CP duration was 10 minutes or less in all of the cases and in most of them (84.5%), the location of pain mentioned left anterior part of chest, left anterior part of sternum and or left arm. There was positive history of myocardial infarction in 12 cases (17%). There was significant relation between CP and age, sex and between history of myocardial infarction and marital state of study people. Our results are similar to other studies- results in most parts, however it is necessary to perform supplementary tests and follow up studies to differentiate between cardiac and non-cardiac CP exactly.

Keywords: Chest pain, myocardial infarction, risk factor, prevalence

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Authors: K. Jyothi, T. S. Mohamed Saleem, L. Vineela, C. Gopinath, K. B. Yadavender Reddy

Abstract:

Objective: Acute coronary syndrome is a clinical condition encompassing ST segments elevation myocardial infraction, Non ST segment is elevation myocardial infraction and un stable angina is characterized by ruptured coronary plaque, stress and myocardial injury. Angina pectoris is a pressure like pain in the chest that is induced by exertion or stress and relived with in the minute after cessation of effort or using sublingual nitroglycerin. The present research was undertaken to study the drug utilization pattern of antiplatelet drugs for the ischemic heart disease in a tertiary care hospital. Method: The present study is retrospective drug utilization study and study period is 6months. The data is collected from the discharge case sheet of general medicine department from medical department Rajiv Gandhi institute of medical sciences, Kadapa. The tentative sample size fixed was 250 patients. Out of 250 cases 19 cases was excluded because of unrelated data. Results: A total of 250 prescriptions were collected for the study according to the inclusion criteria 233 prescriptions were diagnosed with ischemic heart disease 17 prescriptions were excluded due to unrelated information. out of 233 prescriptions 128 are male (54.9%) and 105 patients are were female (45%). According to the gender distribution, the prevalence of ischemic heart disease in males are 90 (70.31%) and females are 39 (37.1%). In the same way the prevalence of ischemic heart disease along with cerebrovascular disease in males are 39 (29.6%) and females are 66 (62.6%). Conclusion: We found that 94.8% of drug utilization of antiplatelet drugs was achieved in the Rajiv Gandhi institute of medical sciences, Kadapa from 2011-2012.

Keywords: Angina pectoris, aspirin, clopidogrel, myocardial infarction.

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Authors: Elie H. Karam, Antoine B. Abche

Abstract:

It is known that the heart interacts with and adapts to its venous and arterial loading conditions. Various experimental studies and modeling approaches have been developed to investigate the underlying mechanisms. This paper presents a model of the left ventricle derived based on nonlinear stress-length myocardial characteristics integrated over truncated ellipsoidal geometry, and second-order dynamic mechanism for the excitation-contraction coupling system. The results of the model presented here describe the effects of the viscoelastic damping element of the electromechanical coupling system on the hemodynamic response. Different heart rates are considered to study the pacing effects on the performance of the left-ventricle against constant preload and afterload conditions under various damping conditions. The results indicate that the pacing process of the left ventricle has to take into account, among other things, the viscoelastic damping conditions of the myofilament excitation-contraction process.

Keywords: Myocardial sarcomere, cardiac pump, excitationcontraction coupling, viscoelasicity

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Authors: Yasuyuki Takahashi, Hayato Ishimura, Masao Miyagawa, Teruhito Mochizuki

Abstract:

Quantitative measurement of myocardium perfusion is possible with single photon emission computed tomography (SPECT) using a semiconductor detector. However, accumulation of ^99mTc-tetrofosmin in the liver may make it difficult to assess that accurately in the inferior myocardium. Our idea is to reduce the high accumulation in the liver by using dynamic SPECT imaging and a technique called time subtraction. We evaluated the performance of a new SPECT system with a cadmium-zinc-telluride solid-state semi- conductor detector (Discovery NM 530c; GE Healthcare). Our system acquired list-mode raw data over 10 minutes for a typical patient. From the data, ten SPECT images were reconstructed, one for every minute of acquired data. Reconstruction with the semiconductor detector was based on an implementation of a 3-D iterative Bayesian reconstruction algorithm. We studied 20 patients with coronary artery disease (mean age 75.4 ± 12.1 years; range 42-86; 16 males and 4 females). In each subject, 259 MBq of ^99mTc-tetrofosmin was injected intravenously. We performed both a phantom and a clinical study using dynamic SPECT. An approximation to a liver-only image is obtained by reconstructing an image from the early projections during which time the liver accumulation dominates (0.5~2.5 minutes SPECT image-5~10 minutes SPECT image). The extracted liver-only image is then subtracted from a later SPECT image that shows both the liver and the myocardial uptake (5~10 minutes SPECT image-liver-only image). The time subtraction of liver was possible in both a phantom and the clinical study. The visualization of the inferior myocardium was improved. In past reports, higher accumulation in the myocardium due to the overlap of the liver is un-diagnosable. Using our time subtraction method, the image quality of the ^99mTc-tetorofosmin myocardial SPECT image is considerably improved.

Keywords: 99mTc-tetrofosmin, dynamic SPECT, time subtraction, semiconductor detector.

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Authors: Elie H. Karam, Antoine B. Abche

Abstract:

It is known that the heart interacts with and adapts to its venous and arterial loading conditions. Various experimental studies and modeling approaches have been developed to investigate the underlying mechanisms. This paper presents a model of the left ventricle derived based on nonlinear stress-length myocardial characteristics integrated over truncated ellipsoidal geometry, and second-order dynamic mechanism for the excitation-contraction coupling system. The results of the model presented here describe the effects of the viscoelastic damping element of the electromechanical coupling system on the hemodynamic response. Different heart rates are considered to study the pacing effects on the performance of the left-ventricle against constant preload and afterload conditions under various damping conditions. The results indicate that the pacing process of the left ventricle has to take into account, among other things, the viscoelastic damping conditions of the myofilament excitation-contraction process. The effects of left ventricular dimensions on the hemdynamic response have been examined. These effects are found to be different at different viscoelastic and pacing conditions.

Keywords: Myocardial sarcomere, cardiac pump, excitationcontractioncoupling, viscoelasicity

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Authors: Paria Soleimani, Arezoo Neshati

Abstract:

Myocardial infarction is one of the leading causes of death in the world. Some of these deaths occur even before the patient reaches the hospital. Myocardial infarction occurs as a result of impaired blood supply. Because the most of these deaths are due to coronary artery disease, hence the awareness of the warning signs of a heart attack is essential. Some heart attacks are sudden and intense, but most of them start slowly, with mild pain or discomfort, then early detection and successful treatment of these symptoms is vital to save them. Therefore, importance and usefulness of a system designing to assist physicians in early diagnosis of the acute heart attacks is obvious. The main purpose of this study would be to enable patients to become better informed about their condition and to encourage them to seek professional care at an earlier stage in the appropriate situations. For this purpose, the data were collected on 711 heart patients in Iran hospitals. 28 attributes of clinical factors can be reported by patients; were studied. Three logistic regression models were made on the basis of the 28 features to predict the risk of heart attacks. The best logistic regression model in terms of performance had a C-index of 0.955 and with an accuracy of 94.9%. The variables, severe chest pain, back pain, cold sweats, shortness of breath, nausea and vomiting, were selected as the main features.

Keywords: Coronary heart disease, acute heart attacks, prediction, logistic regression.

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Authors: Young-Seok Choi

Abstract:

This work assesses the cortical and the sub-cortical neural activity recorded from rodents using entropy and mutual information based approaches to study how hypothermia affects neural activity. By applying the multi-scale entropy and Shannon entropy, we quantify the degree of the regularity embedded in the cortical and sub-cortical neurons and characterize the dependency of entropy of these regions on temperature. We study also the degree of the mutual information on thalamocortical pathway depending on temperature. The latter is most likely an indicator of coupling between these highly connected structures in response to temperature manipulation leading to arousal after global cerebral ischemia.

Keywords: Spiking activity, entropy, mutual information, temperature modulation.

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Authors: M. D. Prokhorov, V. I. Ponomarenko, A. S. Karavaev, A. R. Kiselev, V. I. Gridnev

Abstract:

Synchronization between the slow oscillations of heart rate and blood pressure having in humans a basic frequency close to 0.1 Hz is investigated. A method is proposed for quantitative estimation of synchronization between these oscillating processes based on calculation of relative time of phase synchronization of oscillations. It is shown that healthy subjects exhibit in average substantially longer epochs of synchronization between the slow oscillations in heart rate and blood pressure than patients after acute myocardial infarction

Keywords: Cardiovascular system, slow oscillating processes, synchronization.

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Authors: C. C. D. Kulathilake, M. Jayatilake, T. Takahashi

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The myocardium is composed of specialized muscle which relies mainly on fatty acid and sugar metabolism and it is widely contribute to the heart functioning. The changes of the cardiac energy-producing system during heart failure have been proved using autoradiography techniques. This study focused on evaluating sugar and fatty acid metabolism in myocardium as cardiac energy getting system using heart-accumulated radiopharmaceuticals. Two sets of autoradiographs of heart cross sections of Lewis male rats were analyzed and the time- accumulation curve obtained with use of the MATLAB image processing software to evaluate fatty acid and sugar metabolic functions.

Keywords: Autoradiographs, fatty acid, radiopharmaceuticals and sugar.

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Authors: Marcos A. Dullius, Ramon C. Fernandes, Divanízia N. Souza

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The aim of this study was to develop a dynamic cardiac phantom for quality control in myocardial scintigraphy. The dynamic heart phantom constructed only contained the left ventricle, made of elastic material (latex), comprising two cavities: one internal and one external. The data showed a non-significant variation in the values of left ventricular ejection fraction (LVEF) obtained by varying the heart rate. It was also possible to evaluate the ejection fraction (LVEF) through different arrays of image acquisition and to perform an intercomparison of LVEF by two different scintillation cameras. The results of the quality control tests were satisfactory, showing that they can be used as parameters in future assessments. The new dynamic heart phantom was demonstrated to be effective for use in LVEF measurements. Therefore, the new heart simulator is useful for the quality control of scintigraphic cameras.

Keywords: sheart, nuclear medicine, phantom

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Authors: Roman Major, Klaudia Trembecka-Wojciga, Juergen Markus Lackner, Boguslaw Major

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The future and the development of science is therefore seen in interdisciplinary areas such as biomedical engineering. Selfassembled structures, similar to stem cell niches would inhibit fast division process and subsequently capture the stem cells from the blood flow. By means of surface topography and the stiffness as well as microstructure progenitor cells should be differentiated towards the formation of endothelial cells monolayer which effectively will inhibit activation of the coagulation cascade. The idea of the material surface development met the interest of the clinical institutions, which support the development of science in this area and are waiting for scientific solutions that could contribute to the development of heart assist systems. This would improve the efficiency of the treatment of patients with myocardial failure, supported with artificial heart assist systems. Innovative materials would enable the redesign, in the post project activity, construction of ventricular heart assist.

Keywords: Bio-inspired materials, electron microscopy, haemocompatibility, niche-like structures, thin coatings.

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Authors: Gabi N. Nehme

Abstract:

Below-knee amputees commonly experience asymmetrical gait patterns. It is generally believed that ischemia is related to the formation of pressure sores due to uneven distribution of forces. Micro-vascular responses can reveal local malnutrition. Changes in local skin blood supply under various external loading conditions have been studied for a number of years. Radionuclide clearance, photo-plethysmography, trans-cutaneous oxygen tension along with other studies showed that the blood supply would be influenced by the epidermal forces, and the rate and the amount of blood supply would decrease with increased epidermal loads being shear forces or normal forces. Several cases of socket designs were investigated using Finite Element Model (FEM) and Design of Experiment (DOE) to increase flexibility and minimize the pressure at the limb/socket interface using ultra high molecular weight polyethylene (UHMWPE) and polyamide 6 (PA6) or Duraform. The pressure reliefs at designated areas where reducing thickness is involved are seen to be critical in determination of amputees’ comfort and are very important to clinical applications. Implementing a hole between the Patellar Tendon (PT) and Distal Tibia (DT) would decrease stiffness and increase prosthesis range of motion where flexibility is needed. In addition, displacement and prosthetic energy storage increased without compromising mechanical efficiency and prosthetic design integrity.

Keywords: Patellar tendon, distal tibia, prosthetic socket, relief areas, hole implementation.

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Authors: V. Thulasi Bai, Srivatsa S. K.

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Deaths from cardiovascular diseases have decreased substantially over the past two decades, largely as a result of advances in acute care and cardiac surgery. These developments have produced a growing population of patients who have survived a myocardial infarction. These patients need to be continuously monitored so that the initiation of treatment can be given within the crucial golden hour. The available conventional methods of monitoring mostly perform offline analysis and restrict the mobility of these patients within a hospital or room. Hence the aim of this paper is to design a Portable Cardiac Telemedicine System to aid the patients to regain their independence and return to an active work schedule, there by improving the psychological well being. The portable telemedicine system consists of a Wearable ECG Transmitter (WET) and a slightly modified mobile phone, which has an inbuilt ECG analyzer. The WET is placed on the body of the patient that continuously acquires the ECG signals from the high-risk cardiac patients who can move around anywhere. This WET transmits the ECG to the patient-s Bluetooth enabled mobile phone using blue tooth technology. The ECG analyzer inbuilt in the mobile phone continuously analyzes the heartbeats derived from the received ECG signals. In case of any panic condition, the mobile phone alerts the patients care taker by an SMS and initiates the transmission of a sample ECG signal to the doctor, via the mobile network.

Keywords: WET, ECG analyzer, Bluetooth, mobilecellular network, high risk cardiac patients.

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Authors: I. Boroňová, J. Bernasovská, J. Kmec, E. Petrejčíková

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Dilated cardiomyopathy (DCM) is a severe cardiovascular disorder characterized by progressive systolic dysfunction due to cardiac chamber dilatation and inefficient myocardial contractility often leading to chronic heart failure. Recently, a genome-wide association studies (GWASs) on DCM indicate that the ZBTB17 gene rs10927875 single nucleotide polymorphism is associated with DCM. The aim of the study was to identify the distribution of ZBTB17 gene rs10927875 polymorphism in 50 Slovak patients with DCM and 80 healthy control subjects using the Custom Taqman®SNP Genotyping assays. Risk factors detected at baseline in each group included age, sex, body mass index, smoking status, diabetes and blood pressure. The mean age of patients with DCM was 52.9±6.3 years; the mean age of individuals in control group was 50.3±8.9 years. The distribution of investigated genotypes of rs10927875 polymorphism within ZBTB17 gene in the cohort of Slovak patients with DCM was as follows: CC (38.8%), CT (55.1%), TT (6.1%), in controls: CC (43.8%), CT (51.2%), TT (5.0%). The risk allele T was more common among the patients with dilated cardiomyopathy than in normal controls (33.7% versus 30.6%). The differences in genotype or allele frequencies of ZBTB17 gene rs10927875 polymorphism were not statistically significant (p=0.6908; p=0.6098). The results of this study suggest that ZBTB17 gene rs10927875 polymorphism may be a risk factor for susceptibility to DCM in Slovak patients with DCM. Studies of numerous files and additional functional investigations are needed to fully understand the roles of genetic associations.

Keywords: Dilated cardiomyopathy, SNP polymorphism, ZBTB17 gene.

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Authors: James Patrick A. Diaz, Raul E. Ramboyong

Abstract:

Background: Hypertensive response during maximal exercise test provides important information on the level of blood pressure control and evaluation of treatment. Method: A single center retrospective descriptive study was conducted among 117 young (aged 20 to 40) and middle age (aged 40 to 65) hypertensive patients, who underwent treadmill stress test. Currently on maintenance frontline medication either monotherapy (Angiotensin-converting enzyme inhibitor/Angiotensin receptor blocker [ACEi/ARB], Calcium channel blocker [CCB], Diuretic - Hydrochlorthiazide [HCTZ]) or combination therapy (ARB+CCB, ARB+HCTZ), who attained a maximal exercise on treadmill stress test (TMST) with hypertensive response (systolic blood pressure: male >210 mm Hg, female >190 mm Hg, diastolic blood pressure >100 mmHg, or increase of >10 mm Hg at any time during the test), on Bruce and Modified Bruce protocol. Exaggerated blood pressure response during exercise (systolic [SBP] and diastolic [DBP]), peak exercise blood pressure (SBP and DBP), recovery period (SBP and DBP) and test for ischemia and their antihypertensive medication/s were investigated. Analysis of variance and chi-square test were used for statistical analysis. Results: Hypertensive responses on maximal exercise test were seen mostly among female population (P < 0.000) and middle age (P < 0.000) patients. Exaggerated diastolic blood pressure responses were significantly lower in patients who were taking CCB (P < 0.004). A longer recovery period that showed a delayed decline in SBP was observed in patients taking ARB+HCTZ (P < 0.036). There were no significant differences in the level of exaggerated systolic blood pressure response and during peak exercise (both systolic and diastolic) in patients using either monotherapy or combination antihypertensives. Conclusion: Calcium channel blockers provided lower exaggerated diastolic BP response during maximal exercise test in hypertensive middle age patients. Patients on combination therapy using ARB+HCTZ exhibited a longer recovery period of systolic blood pressure.

Keywords: Antihypertensive, exercise test, hypertension, hypertensive response.

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Authors: M. J. Reis Lima, J. Oliveira, M. Brito, C. Lemos, A. Mascarenhas, E. Teixeira Lemos

Abstract:

Hypertension is a common condition causing cardio and cerebrovascular complications. Portugal has one of the highest mortality rates from stroke and a high prevalence of hypertension. Systolic Blood Pressure (SBP) is an important risk factor for cardiovascular events (myocardial infarction and stroke) and premature mortality, particularly in the elderly population. The present study aims to estimate the prevalence of hypertension in a Portuguese population living in a coastal city and to identify some of its determinants (namely gender, age, the body mass index and physical activity frequency). A total of 91 adults who attended three pharmacies of a coastal city in the center of Portugal, between May and August of 2013 were evaluated. Attendants who reported to have diabetes or taking antihypertensive drugs in the 2 previous weeks were excluded from the study. Sociodemographic factors, BMI, habits of exercise and BP were assessed. Hypertension was defined as blood pressure ≥140/90 mmHg. The majority of the studied population was constituted by women (75.8%), with a mean age of 54.2±1.6 years old, married or living in civil union and that had completed secondary school or had higher education (40%). They presented a mean BMI of 26.2±4.76 Kg/m2., and were sedentary. The mean BP was 127.0±17.77mmHg- 74.69 ± 9.53. In this population we found 4.3% of people with hypertension and 16.1% with normal high blood pressure. Men exhibit a tendency to present higher systolic blood pressure values than women. Of all the factors considered, SBP values also tended to be higher with age and higher BMI values. Despite the fact that the mean values of SBP did not present values higher than 140 mmHg we must be concerned because the studied population is undiagnosed for hypertension. Although this is a preliminary study, it might be a prelude to the upcoming research about the underlying factors responsible for the occurrence of SBP.

Keywords: Hypertension, age, exercise, obesity, gender.

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Authors: Orkide Donma, Mustafa M. Donma

Abstract:

Childhood obesity, which may lead to increased risk for heart diseases in children as well as adults, is one of the most important health problems throughout the world. Prevalences of morbid obesity and metabolic syndrome (MetS) are being increased during childhood age group. MetS is a cluster of metabolic and vascular abnormalities including hypercoagulability and an increased risk of cardiovascular diseases (CVDs). There are also some relations between some components of MetS and leukocytes. The aim of this study is to investigate complete blood cell count parameters that differ between morbidly obese boys and girls with MetS diagnosis. A total of 117 morbid obese children with MetS consulted to Department of Pediatrics in Faculty of Medicine Hospital at Namik Kemal University were included into the scope of the study. The study population was classified based upon their genders (60 girls and 57 boys). Their heights and weights were measured and body mass index (BMI) values were calculated. WHO BMI-for age and sex percentiles were used. The values above 99 percentile were defined as morbid obesity. Anthropometric measurements were performed. Waist-to-hip and head-to-neck ratios as well as homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Components of MetS (central obesity, glucose intolerance, high blood pressure, high triacylglycerol levels, low levels of high density lipoprotein cholesterol) were determined. Hematological variables were measured. Statistical analyses were performed using SPSS. The degree for statistical significance was p ≤ 0.05. There was no statistically significant difference between the ages (11.2±2.6 years vs 11.2±3.0 years) and BMIs (28.6±5.2 kg/m² vs 29.3±5.2 kg/m²) of boys and girls (p ≥ 0.05), respectively. Significantly increased waist-to-hip ratios were obtained for boys (0.94±0.08 vs 0.91±0.06; p=0.023). Significantly elevated values of hemoglobin (13.55±0.98 vs 13.06±0.82; p=0.004), mean corpuscular hemoglobin concentration (33.79±0.91 vs 33.21±1.14; p=0.003), eosinophils (0.300±0.253 vs 0.196±0.197; p=0.014), and platelet (347.1±81.7 vs 319.0±65.9; p=0.042) were detected for boys. There was no statistically significant difference between the groups in terms of neutrophil/lymphocyte ratios as well as HOMA-IR values (p ≥ 0.05). Statistically significant gender-based differences were found for hemoglobin as well as mean corpuscular hemoglobin concentration and hence, separate reference intervals for two genders should be considered for these parameters. Eosinophils may contribute to the development of thrombus in acute coronary syndrome. Eosinophils are also known to make an important contribution to mechanisms related to thrombosis pathogenesis in acute myocardial infarction. Increased platelet activity is observed in patients with MetS and these individuals are more susceptible to CVDs. In our study, elevated platelets described as dominant contributors to hypercoagulability and elevated eosinophil counts suggested to be related to the development of CVDs observed in boys may be the early indicators of the future cardiometabolic complications in this gender.

Keywords: Children, complete blood count, gender, metabolic syndrome.

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