Regression of electrocardiographic left ventricular hypertrophy or strain is associated with lower incidence of cardiovascular morbidity and mortality in hypertensive patients independent of blood pressure reduction – A LIFE review

Cornell product criteria, Sokolow–Lyon voltage criteria and electrocardiographic (ECG) strain (secondary ST-T abnormalities) are markers for left ventricular hypertrophy (LVH) and adverse prognosis in population studies. However, the relationship of regression of ECG LVH and strain during antihypertensive therapy to cardiovascular (CV) risk was unclear before the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study. We reviewed findings on ECG LVH regression and strain over time in 9193 hypertensive patients with ECG LVH at baseline enrolled in the LIFE study.The composite endpoint of CV death, nonfatal MI, or stroke occurred in 1096 patients during 4.8 ± 0.9 years follow-up. In Cox multivariable models adjusting for randomized treatment, known risk factors including in-treatment blood pressure, and for severity ECG LVH by Cornell product and Sokolow–Lyon voltage, baseline ECG strain was associated with a 33% higher risk of the LIFE composite endpoint (HR. 1.33, 95% CI [1.11–1.59]). Development of new ECG strain between baseline and year-1 was associated with a 2-fold increased risk of the composite endpoint (HR. 2.05, 95% CI [1.51–2.78]), whereas the risk associated with regression or persistence of ECG strain was attenuated and no longer statistically significant (both p > 0.05). After controlling for treatment with losartan or atenolol, for baseline Framingham risk score, Cornell product, and Sokolow–Lyon voltage, and for baseline and in-treatment systolic and diastolic blood pressure, 1 standard deviation (SD) lower in-treatment Cornell product was associated with a 14.5% decrease in the composite endpoint (HR. 0.86, 95% CI [0.82–0.90]). In a parallel analysis, 1 SD lower in-treatment Sokolow–Lyon voltage was associated with a 16.6% decrease in the composite endpoint (HR. 0.83, 95% CI [0.78–0.88]).The LIFE study shows that evaluation of both baseline and in-study ECG LVH defined by Cornell product criteria, Sokolow–Lyon voltage criteria or ECG strain improves prediction of CV events and that regression of ECG LVH during antihypertensive treatment is associated with better outcome, independent of blood pressure reduction.     

Subclinical coronary atherosclerosis and resting ECG abnormalities in an unselected general population

ObjectivesExposure to cardiovascular (CV) risk factors may result in coronary atherosclerosis and myocardial disease, which is reflected in the extent of coronary artery calcification (CAC) and resting ECG abnormalities, respectively. We studied the association of CAC with ECG abnormalities in a general population without myocardial infarction or revascularization.MethodsThe total cohort of 4814 subjects (45–75 years) were randomly selected from the general population for the Heinz Nixdorf Recall Study, an ongoing study designed to assess the prognostic value of modern risk stratification methods. In addition to measuring standard risk factors, digitized resting ECGs and the EBT-based Agatston score were obtained. Subjects were separated into those without (n = 1929) and with CV disease (CVD) or treated risk factors (tRF) (n = 2558).ResultsIn both groups, a positive CAC-score was more frequent and CAC-scores were higher in men and women with ECG abnormalities as compared to those with normal ECGs (p < 0.05 each). In persons without CVD/tRF, a CAC ≥75th percentile was more frequent in those with LVH (42.4%) and QTc >440 ms (34.2%) as compared to normal ECGs (23.0%, p < 0.01 for both). In persons with CVD/tRF, a CAC-score ≥75th percentile was found in subjects with A-Fib (46.3%), borderline-LVH (39.1%), ECG signs of MI (40.5%) and major ECG abnormalities (40.3%) versus 31.2% in those with normal ECGs (p < 0.03 for all). In multivariate analysis, LVH (p = 0.025) and major ECG abnormalities (p = 0.04) remained independently associated with CAC in subjects without and with CVD/tRF, respectively.ConclusionsECG-based evidence of myocardial disease is often associated with an elevated CAC burden, suggesting a link between epicardial and myocardial manifestations of risk factor exposure. The association of CAC burden with different ECG abnormalities in different clinical groups may have implications for the interpretation of the resting ECG and CAC burden in risk stratification.     

Combination of hyperuricemia and metabolic syndrome is an independent and powerful predictor for left ventricular hypertrophy in rural Chinese

ObjectivesTo investigate the influence of MetS (metabolic syndrome) in combination with hyperuricemia on left ventricular hypertrophy (LVH) in residents in the rural area of Northeast China.MethodsWe performed a cross-sectional baseline data analysis of 11,170 subjects (mean age: 54 ± 11 years) recruited from the rural area of China. Anthropometric indicators were measured according to standard methods. MetS was defined by the ATP III modified criteria. Hyperuricemia was defined according to sex-specific serum uric acid levels (SUA): SUA ≥ 7.0 mg/dL for male and ≥ 6.0 mg/dL for female. Four groups were listed: normouricemia non-MetS, hyperuricemia non-MetS, MetS normouricemia and hyperuricemia MetS.ResultsLeft ventricular mass index for height^2.7 (LVMH^2.7) in female was significantly higher in hyperuricemia MetS group than that in normouricemia non-MetS (52.43 ± 16.60 vs. 40.04 ± 10.72 g/m^2.7, P < 0.001) group. Similar result was observed in men (48.93 ± 13.17 g/m^2.7 vs. 43.63 ± 11.90 g/m^2.7, P < 0.001). The result of multiple regression analysis indicated that hyperuricemia MetS group had higher risk of LVH than other three groups (OR: 3.427 for female, P < 0.001, OR: 1.987 for male, P < 0.001). Moreover, female subjects in MetS normouricemia group [OR (95% CI): 2.313 (1.991–2.686)] had greater risk of LVH than that in hyperuricemia non-MetS group [OR (95% CI): 1.917 (1.166–3.151)]. Hyperuricemia non-MetS was found to be significantly and independently associated with LVH in women, but not in men.ConclusionOur study finds that the combination of hyperuricemia and MetS are independent and powerful predictor for LVH in rural area of Northeast Chinese. Women with MetS in combination with hyperuricemia have higher risk of LVH than men. It seems that MetS has greater effect on LVH than hyperuricemia does in women but not in men.     

Cynicism: Incident diabetes and worsening of metabolic syndrome in postmenopausal women

ObjectiveTo determine if self-reported cynical hostility predicted incident diabetes or increase in number of symptoms associated with metabolic syndrome in postmenopausal women.DesignProspective study of a subsample of women (n = 3,658) participating in the Women's Health Initiative Clinical Trial.MethodsSubjects: Postmenopausal women aged 50 to 79 years at baseline who were enrolled in the Women's Health Initiative Dietary Modification Trial, Hormone Trial or both. Measures: The Cynicism subscale of the Cook-Medley Hostility Questionnaire was used to assess cynical hostility at baseline. Incident diabetes was ascertained by self-report of treatment with insulin or oral hypoglycemic medication at one year. Metabolic syndrome was defined based on number of Adult Treatment Panel (ATP) III criteria met at one year. Statistical Analysis: The relationship between baseline cynical hostility and incident diabetes and worsening of metabolic syndrome was assessed from baseline to one year using multivariable Cox proportional hazards models and multivariable logistic regression models, respectively.ResultsIncident diabetes was 36% higher among women in the upper tertile for baseline cynical hostility compared to the lowest tertile (p-trend = 0.05). The odds of a worsening of metabolic syndrome was 27% greater in the highest cynical hostility tertile compared to the lowest tertile (p-trend = 0.04).ConclusionsCynical hostility may increase the risk for developing diabetes and worsening of the metabolic syndrome in postmenopausal women.     

Liver iron concentration in dysmetabolic hyperferritinemia: Results from a prospective cohort of 276 patients

Introduction and objectivesWe aimed to study the liver iron concentration in patients referred for hyperferritinemia to six hospitals in the Basque Country and to determine if there were differences between patients with or without metabolic syndrome.Patients and methodsMetabolic syndrome was defined by accepted criteria. Liver iron concentration was determined by magnetic resonance imaging.ResultsWe obtained the data needed to diagnose metabolic syndrome in 276 patients; a total of 135 patients (49%), 115/240 men (48%), and 20/36 women (55.6%) presented metabolic syndrome. In all 276 patients, an MRI for the determination of liver iron concentration (mean ± SD) was performed. The mean liver iron concentration was 30.83 ± 19.38 for women with metabolic syndrome, 38.84 ± 25.50 for men with metabolic syndrome, and 37.66 ± 24.79 (CI 95%; 33.44–41.88) for the whole metabolic syndrome group. In 141 patients (51%), metabolic syndrome was not diagnosed: 125/240 were men (52%) and 16/36 were women (44.4%). The mean liver iron concentration was 34.88 ± 16.18 for women without metabolic syndrome, 44.48 ± 38.16 for men without metabolic syndrome, and 43.39 ± 36.43 (CI 95%, 37.32–49.46) for the whole non-metabolic syndrome group. Comparison of the mean liver iron concentration from both groups (metabolic syndrome vs non-metabolic syndrome) revealed no significant differences (p = 0.12).ConclusionsPatients with hyperferritinemia and metabolic syndrome presented a mildly increased mean liver iron concentration that was not significantly different to that of patients with hyperferritinemia and non-metabolic syndrome.     

Presence and association of sub clinical hypothyroidism in subjects with metabolic syndrome

AimsTo determine the prevalence of subclinical hypothyroidism (SCH) among subjects with metabolic syndrome and to find out the relationship of subclinical hypothyroidism with different components of metabolic syndrome.Materials and methodsThe study was conducted in the Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka during the period of April 2008–March 2009. One hundred and seventy three subjects with metabolic syndrome (according to IDF criteria) aged 20–69 years were included in the study. After primary selection, FPG and lipid profile were done. Those who had FPG ≥ 100 mg/dl or dislipidemia were selected for routine investigations such as SGPT, S. creatinine, TC, DC, ESR, HB%, ECG, and Ultrasonography of whole abdomen to exclude liver disease, renal disease, acute illness and cardiac disease respectively. Patients having normal investigations were finally selected for serum level of FT₄ and TSH.ResultsA total of 173 subjects (105 male, and 68 female,) with metabolic syndrome were studied. Among them 14.3% (n = 15) of male and 19.1% (n = 13) of female had SCH. SCH was found more in obese subjects (BMI ≥ 25 kg/m² vs. BMI < 25 kg/m²). There was no significant difference among different parameters of metabolic syndrome in subjects with or without SCH. Although SCH was more prevalent in those who had hypertrigyceridemia and hypertension, there was no association between presence of fatty liver and SCH.ConclusionsAmong the study subjects 14.3% male and 19.1% female had SCH. SCH is more prevalent in 41–60 years age group. No significant association was found among different parameters of MetS with SCH, however, when they constitute metabolic syndrome; there was a significant association between MetS and SCH.     

A comparative study of ivabradine and atenolol in patients with moderate mitral stenosis in sinus rhythm

BackgroundBeta-blockers are frequently used in patients with mitral stenosis to control the heart rate and alleviate exercise-related symptoms. The objective of our study was to examine whether ivabradine was superior to atenolol for achieving higher exercise capacity in patients with moderate mitral stenosis in sinus rhythm. We also evaluated their effects on left ventricular myocardial performance index (MPI).Methods and resultsEighty-two patients with moderate mitral stenosis in sinus rhythm were randomized to receive ivabradine (n = 42) 5 mg twice daily or atenolol (n = 40) 50 mg daily for 6 weeks. Transthoracic echocardiography and treadmill test were performed at baseline and after completion of 6 weeks of treatment. Mean total exercise duration in seconds markedly improved in both study groups at 6 weeks (298.57 ± 99.05 s vs. 349.12 ± 103.53 s; p = 0.0001 in ivabradine group, 290.90 ± 92.42 s vs. 339.90 ± 99.84 s; p = 0.0001 in atenolol group). On head-to-head comparison, there was no significant change in improvement of exercise time between ivabradine and atenolol group (p = 0.847). Left ventricular MPI did not show any significant change from baseline and at 6 weeks in both drug groups (49.8% ± 8% vs. 48.3% ± 7% in ivabradine group, 52.9% ± 10% vs. 50.9% ± 10% in atenolol groups; p = 0.602).ConclusionIvabradine or atenolol can be used for heart rate control in patients with moderate mitral stenosis in sinus rhythm. Ivabradine is not superior to atenolol for controlling heart rate or exercise capacity. Left ventricular MPI was unaffected by either of the drugs.     

Imbalance between protective (adiponectin) and prothrombotic (Plasminogen Activator Inhibitor-1) adipokines in metabolic syndrome

AimsThe metabolic syndrome (MS) consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease (CVD) and diabetes mellitus (DM). Visceral adipose tissue actively produces a variety of adipokines that interact in various obesity related disorders such as metabolic syndrome, diabetes mellitus and heart diseases. Adiponectin has protective role in the vascular physiology while Plasminogen Activator Inhibitor-1 (PAI-1) has a prothrombotic and consequent deleterious effect on the endothelium. We attempted to assess the putative imbalance if any between these two mediators in subjects with metabolic syndrome in the Indian context.Materials and methodsWe enrolled 50 diagnosed case of metabolic syndrome as per International Diabetes Federation (IDF) criteria and 50 healthy volunteers as control. Clinical evaluation included anthropometric, routine biochemical analysis as well as adiponectin and PAI-1 measurement.ResultSubject with MS had significantly lower adiponectin (9.8 ± 1.0 vs 16 ± 1.1 μg/ml) and higher PAI-1 (232 ± 87 vs 185 ± 96 ng/ml). A statistically significant correlation was observed between adiponectin and HDL levels (r = 0.388, p = 0.005).ConclusionSubjects with MS have lower adiponectin and higher PAI-1 levels as compared to controls. The subsequent tilt toward a more prothrombotic and pro inflammatory milieu in the vascular endothelium may be pathognomonic of metabolic syndrome. This understanding of the still undiscovered subtle vascular alterations may help in the better management of obesity and MS.     

Arterial insulin resistance in Yucatan micropigs with diet-induced obesity and metabolic syndrome

AimMetabolic syndrome affects a large proportion of the population and increases cardiovascular disease risk. Because metabolic syndrome often co-exists clinically with atherosclerosis, it is difficult to distinguish the respective contributions of the components to vascular abnormalities. Accordingly, we utilized a porcine dietary model of metabolic syndrome without atherosclerosis to investigate early abnormalities of vascular function and signaling.MethodsThirty-two Yucatan micropigs were fed either a high-fat, high-simple-sugar, high-calorie (HFHS) or standard chow diet (STD) for 6 months. Neither diet contained added cholesterol. Blood pressure and flow-mediated vasodilatation were assessed at baseline and 6 months. Aortas were harvested at 6 months to assess histology, insulin signaling, and endothelial nitric oxide (eNOS) phosphorylation.ResultsHFHS pigs developed characteristics of metabolic syndrome including obesity, dyslipidemia, and insulin resistance, but without histologic evidence of atherosclerosis. Although arterial intima-media thickness did not differ between groups, vascular dysfunction in HFHS was manifest by increased blood pressure and impaired flow-mediated vasodilation of the femoral artery. Compared with STD, aortas from HFHS exhibited increased p85α expression and Ser307 IRS-1 phosphorylation, and blunted insulin-stimulated IRS-1-associated phosphatidylinositol (PI) 3-kinase activity. In the absence of insulin stimulation, aortic Akt Ser473-phosphorylation was greater in HFHS than in STD. With insulin stimulation, Akt phosphorylation increased in STD, but not HFHS. Insulin-induced Ser1177-phosphorylation of eNOS was decreased in HFHS, compared with STD.ConclusionsPigs with metabolic syndrome develop early vascular dysfunction and aortic insulin signaling abnormalities, and could be a useful model for early human vascular abnormalities in this condition.     

Association of metabolic syndrome with testosterone and inflammation in men

ObjectiveThere is limited data on the assessment of relationship between sex hormones, metabolic syndrome (MS) and inflammation. Therefore, our objective was to examine the relationship between metabolic syndrome, testosterone and inflammation.Patients and methodsIt was a cross-sectional study which included 309 subjects in the age range of 30–70 years. Blood was analyzed for plasma glucose, serum lipids, total testosterone (TT) and high-sensitivity C-reactive protein (hs-CRP).ResultsThere were 153 patients with metabolic syndrome and 156 without MS according to modified NCEP guidelines. Age, BMI, obesity, dyslipidaemia, smoking (OR = 2.35, CI = 1.35–4.09), LDL-Ch, low TT (OR = 0.76, CI = 0.38–1.52) and elevated hs-CRP (OR = 1.56, CI = 0.87–2.80) were significant independent predictors of MS (all P < 0.05).ConclusionsThe low testosterone and high hs-CRP levels are independent predictors of metabolic syndrome.     

Interrelations of serum leptin levels with adrenocorticotropic hormone,basal cortisol and dehydroepiandrosterone sulphate levels in patients with metabolic syndrome

ObjectivesThe aim of this study was to determine serum leptin levels, adrenocorticotropic hormone, basal cortisol and dehydroepiandrosterone sulphate levels in patients with metabolic syndrome.Material and methodsThe study was comprised of 35 female patients and who applied to Eskisehir Osmangazi University Medicine Faculty Endocrinology polyclinic due to the symptoms of obesity and diagnosed as having metabolic syndrome.ResultsPlasma adrenocorticotropic hormone and dehydroepiandrosterone sulphate levels of metabolic syndrome group were lower than controls (P < 0.001, P < 0.05, respectively). Serum basal cortisol, resistin and leptin levels of metabolic syndrome group were higher than control (P < 005, P < 0.01, P < 0.001, respectively).ConclusionsOur data suggest that hormonal changes in metabolic syndrome pathogenesis may be related with increased leptin levels and for that reason leptin may be an important marker in metabolic syndrome.     

Effects of a low glycemic load diet versus a low-fat diet in subjects with and without the metabolic syndrome

Background and aimAlthough many studies report benefits of low glycemic diets, the clinical effects as a whole are mixed. The study aim was to compare a low glycemic load (LGL) diet versus a low-fat diet in a trial with a moderately intense dietary intervention in subjects with varying degrees of metabolic syndrome.Methods and resultsMen and women aged 30–65 years, with a BMI of 28–40 kg/m² (28–35 for women) and at least one criterion of metabolic syndrome were randomized to the two diets. A total of 202 subjects were included, of which 126 (62%) had metabolic syndrome (≥3 criteria). The completion rate was 81%. At 3 months, weight loss was greater in the LGL group (?4.8 ± 3.9 kg versus ?3.8 ± 3.5 kg; P = 0.06) compared to the low-fat group. At 1 year, however, weight loss was similar in both groups (?4.0 ± 5.5 kg versus ?4.3 ± 6.2 kg; n.s.), but waist circumference reduction was less in the LGL group (?3.9 ± 5.3 cm versus ?5.8 ± 6.8 cm; P = 0.03). In contrast, diastolic blood pressure decreased significantly more in the LGL group (?4.0 ± 8.7 mmHg versus ?1.1 ± 8.5 mmHg; P = 0.02). We also observed a significant interaction between the presence of the metabolic syndrome and the effect of the two diets on waist circumference, with a less favorable effect of the LGL diet in subjects without the syndrome (P = 0.039).ConclusionAfter 12 months, both diets reduced body weight and the metabolic disturbances similarly, but the LGL diet appeared more suitable for subjects with metabolic syndrome, and was less effective in those without it.     

Ventricular hypertrophy amplifies transmural dispersion of repolarization by preferentially increasing the late sodium current in endocardium

BackgroundThe late sodium current (I_Na-L) contributes importantly to rate-dependent change in action potential duration (APD) and transmural dispersion of repolarization (TDR). However, little is known about the mechanisms of increased APD rate-dependence and amplified TDR in left ventricular hypertrophy (LVH) and failure. The purpose of this study was to investigate the role of I_Na-L in rate-adaptation of transmural APD heterogeneity.MethodsAPD, its rate-dependence and I_Na-L current were examined in myocytes isolated from the endocardium and epicardium of the control and LVH rabbits. AP was recorded using the standard microelectrode technique, and I_Na-L was recorded using the whole-cell patch clamp technique.ResultsEarly afterdepolarizations (EADs) were frequently recorded in the isolated myocytes of the LVH rabbits but not in those of controls. LVH prolonged APD more significantly in the endocardial myocytes than in the epicardium (31.7 ± 3.4 vs. 21.6 ± 1.5% n = 6, p < 0.05), leading to a marked increase in TDR. LVH endocardial myocytes exhibited a greater rate-dependent change in APD compared to the epicardial myocytes. I_Na-L densities were significantly increased in both LVH endocardium and epicardium. However, LVH increased the I_Na-L density preferentially in the endocardial myocytes compared to the epicardial myocytes (54.5 ± 4.8% vs. 39.2 ± 3.3%, n = 6, p < 0.05).ConclusionsOur results demonstrate that LVH increased the I_Na-L preferentially in the endocardium over the epicardium, which contributes importantly to the stronger rate-dependent change in repolarization and longer APD in the endocardium. This results in an amplified TDR capable of initiating EAD and ventricular arrhythmias.     

Metabolic syndrome in patients with systemic lupus erythematosus from South India

ObjectivesTo find the prevalence of metabolic syndrome in systemic lupus erythematosus (SLE) compared to controls and to identify association of metabolic syndrome with SLE disease activity and damage.MethodsA total of 82 SLE and 82 healthy controls were studied. Metabolic syndrome was defined by National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III), consensus definition for Asian Indian Adults and World Health Organisation (WHO) 1999 definition, and associations with lupus characteristics, disease activity, and damage were examined. Insulin resistance (IR) was estimated using the homeostasis model assessment for IR (HOMA-IR).ResultsMetabolic syndrome was present in 24.39% SLE and 12.19% controls (p < 0.04) by NCEP ATP III criteria; 29.26% SLE and 19.51% controls (p = 0.14) by consensus definition for Asian Indians; 18.2% SLE and 7.31% controls (p < 0.035) by WHO 1999 criteria.Hypertension and hypertriglyceridemia were more frequent in SLE than in controls. Mean body mass index, diastolic and systolic blood pressure, triglycerides, and total cholesterol were higher in SLE than in controls. HOMA-IR (median, range) was 1.31 (0.06–9.32) and 1.55 (0.01–7.92), p = 0.09 in SLE and controls, respectively. There was no association of metabolic syndrome with disease activity/damage and prednisolone use. SLE patients with metabolic syndrome had a significantly longer duration of disease compared to patients without metabolic syndrome.ConclusionSouth Indian SLE patients have higher prevalence of NCEP ATP III and WHO defined metabolic syndrome compared to healthy controls. SLE patients have an altered lipid profile, but there was no IR and no association of metabolic syndrome with disease activity or damage.     

Metabolic syndrome and acute pancreatitis

AimThe aim of our study was to investigate the influence of metabolic syndrome on the course of acute pancreatitis determined by disease severity, the presence of local and systemic complications and survival rate.Patients and methods609 patients admitted to our hospital in the period from January 1, 2008 up to June 31, 2015 with the diagnosis of acute pancreatitis were analyzed. The diagnosis and the severity of acute pancreatitis were made according to the revised Atlanta classification criteria from 2012.ResultsOf 609 patients with acute pancreatitis, 110 fulfilled the criteria for metabolic syndrome. Patients with metabolic syndrome had statistically significantly higher incidence of moderately severe (38.2% vs. 28.5%; p = 0.05) and severe (22.7% vs. 12.8%; p = 0.01) acute pancreatitis in comparison to those without metabolic syndrome, while patients without metabolic syndrome had higher incidence of mild acute pancreatitis in comparison to those patients with metabolic syndrome (58.7% vs. 39.1%; p < 0.001). Patients with metabolic syndrome had a higher number of local and systemic complications, and higher APACHE II score in comparison to patients without metabolic syndrome. In multivariable logistic regression analysis, the presence of metabolic syndrome was independently associated with moderately severe and severe acute pancreatitis. Comparing survival rates, patients suffering from metabolic syndrome had a higher death rate compared to patients without metabolic syndrome (16% vs. 4.5%; p < 0.001).ConclusionThe presence of metabolic syndrome at admission portends a higher risk of moderately severe and severe acute pancreatitis, as well as higher mortality rate.     

Valor pronóstico del intervalo Tpeak-Tend en el desarrollo de arritmias ventriculares subagudas intrahospitalarias en el síndrome de tako-tsubo

Introduction and objectivesThe clinical value of electrocardiogram (ECG) repolarization parameters associated with ventricular arrhythmias (VAs) in tako-tsubo syndrome is still under debate. We aimed to evaluate ECG predictors of subacute VAs, defined as those occurring after the first 48 hours from admission.MethodsThis single-center observational study enrolled patients admitted to the cardiology department between 2012 and 2018 with a confirmed diagnosis of tako-tsubo syndrome. Data collection included a 12-lead ECG on admission and at 48 hours, continuous telemetry monitoring, blood testing, transthoracic echocardiography, and coronary angiography during hospitalization. VAs events were defined as: premature ventricular contractions ≥ 2000 within a 24-hour window of telemetry monitoring, ventricular fibrillation, sustained ventricular tachycardia (VT), polymorphic VT, and non-sustained VT.ResultsA total of 87 patients (age 72 ± 12 years) were enrolled. During a median of 8 days of hospitalization, subacute VAs were documented in 22 patients (25%) after a median of 91 hours from admission. Subacute VAs were associated with an increase in mortality during hospitalization (P = .030). The corrected global (mean of the 12-lead ECG values) Tpeak-Tend interval at 48 hours from admission was an independent predictor of subacute VAs and was statistically superior to the standard corrected QT interval (Z test, P = .040). A cut-off of 108 msec for the corrected global Tpeak-Tend yielded a 71% sensitivity and 72% specificity for subacute VAs.ConclusionsIn patients with tako-tsubo syndrome, subacute VAs are associated with repolarization alterations that can be identified on conventional ECG using the Tpeak-Tend interval.     

Fasting insulin at baseline influences the number of cardiometabolic risk factors and R-R interval at 3 years in a healthy population: The RISC Study

AimThis was a cross-sectional and longitudinal study of factors contributing to the number of cardiometabolic risk factors, common carotid artery intima–media thickness (CCA-IMT) and R-R interval in clinically healthy subjects without diabetes.MethodsAnthropometric and cardiometabolic parameters were measured in the Relationship between Insulin Sensitivity and Cardiovascular Disease (RISC) Study cohort at baseline (n = 1211) and 3 years later (n = 974). At baseline, insulin sensitivity was assessed by the euglycaemic clamp technique. The CCA-IMT was echographically measured and the R-R interval was electrocardiographically evaluated at baseline and at the 3-year follow-up.ResultsHigher baseline BMI, fasting insulin and tobacco use as well as greater changes in BMI and fasting insulin but lower adiponectin levels, were associated with a greater number of cardiometabolic risk factors at the 3-year follow-up independently of insulin sensitivity (all P < 0.02). The CCA-IMT increased with the number of cardiometabolic risk factors (P = 0.008), but was not related to fasting insulin, whereas higher fasting insulinaemia and its 3-year changes were significantly associated with a smaller R-R interval (P = 0.005 and P = 0.002, respectively). These relationships were independent of baseline age, gender, BMI, adiponectin, insulin sensitivity, tobacco use and physical activity.ConclusionIn clinically healthy subjects, fasting insulinaemia, adiponectin and lifestyle parameters are related to the presence of one or two cardiometabolic risk factors before criteria for the metabolic syndrome are met. These results underline the importance of fasting insulinaemia as an independent cardiometabolic risk factor at an early stage of disease development in a healthy general population.     

L’hypertrophie ventriculaire gauche chez le sujet noir Africain hypertendu : résultats d’une enquête transversale,réalisée en milieu semi-rural au Sénégal

ObjectivesTo assess the prevalence of left ventricular hypertrophy according to electrocardiographic and echocardiographic criteria among hypertensive patients living in semi-rural Senegalese area.Patients and methodsAccording to the World Health Organization STEPSwise approach, we conducted, in November 2012, a cross-sectional and exhaustive study in the population aged at least 35 years old and living for at least six months in the semi-rural area of Guéoul. We researched electrocardiographic and echocardiographic left ventricular hypertrophy in hypertensive subjects. Data were analyzed with SPSS 18.0 software version. The significance level was agreed for a value of P < 0.05.ResultsWe examined 1411 subjects aged on average of 48.5 ± 12.7 years. In total, 654 subjects were hypertensive and screening of left ventricular hypertrophy (LVH) was effective in 515 of them. According to Sokolow-Lyon index, 86 subjects (16.7%) presented electrocardiographic LVH, more frequently in men (P = 0.002). According to Cornell index and Cornell product, LVH was founded respectively in 66 (12.8%) and 52 subjects (10.1%), more frequently in female (P = 0.0001; P = 0.004). It was more common in grade 3 of hypertension however criteria. In echocardiography, prevalence of LVH was 2.2% (13 cases) according to the left ventricular mass, 9.3% (48 cases) according to the left ventricular mass indexed to body surface area and 8.2% (42 cases) according to the left ventricular mass indexed to height^2.7. LVH was significantly correlated with the electrocardiographic LVH according to Sokolow-Lyon index (P < 0.0001) and the grade 3 of hypertension (P = 0.003).ConclusionAlthough rare in hypertensive Senegalese living in semi-rural area, left ventricular hypertrophy is correlated with severity of grade of hypertension. Screening by electrocardiogram will allow better follow-up of these hypertensive subjects.     

Association of physical activity with metabolic syndrome in a predominantly rural Nigerian population

AimsPhysical activity is an essential determinant of health. However, there is dearth of evidence regarding prevalence of physical activity in developing countries, especially its association with metabolic syndrome risk factors. This study assessed the association of physical activity with metabolic syndrome in a Nigerian population.Materials and methodsA cross-sectional study was carried out on apparently healthy persons who are ≥18 years old. The World Health Organisation (WHO) Global Physical Activity Questionnaire (GPAQ) was used to collect five domains of physical activity. Participants were classified as physically active or inactive based on meeting the cut-off value of 600 MET-min/week. Metabolic syndrome was diagnosed using the Joint Scientific Statement on Harmonizing the Metabolic Syndrome criteria.ResultsOverall prevalence of physically active individuals was 50.1% (CI: 45.6–54.7%). Physical inactivity is significantly more in females (p < 0.01) and among participants >40 years old (p < 0.0001). Whereas individuals with metabolic syndrome appeared more likely to be physically active (OR = 1.48, CI: 0.71–3.09); physical inactivity showed to exist more among participants who were living in urban area (OR = 6.61, CI: 3.40–12.85, p < 0.001). Participants with prediabetes (OR = 1.69, CI: 0.62–4.61) and diabetes (OR = 1.91, CI: 0.65–5.63) were more likely to be physically inactive as compared to other metabolic syndrome risk factors.ConclusionThe high prevalence of physical inactivity in this study population is a clear indication that concerted efforts to improve physical activity may be required. However, it seems that metabolic syndrome is not improved by being physically active. This suggests that interventions directed at physical activity alone may not produce optimal efficacy in this study population.