Electrocardiographic findings in patients >100 years of age without clinical evidence of cardiac disease

Centenarians have a higher incidence of atrial fibrillation, left-axis deviation, premature beats, first-degree atrioventricular block, and nonspecific ST-T changes. Fewer men live long enough to reach 100 years of age, and they tend to have more significant conduction defects and old myocardial infarcts than women.     

Non invasive evaluation of left ventricular performance in 294 diabetic patients without clinical heart disease

Summary The authors studied the modification of systolic time intervals (STI), pre-ejection period (PEP) and left ventricular ejection time (LVET _c ), before and after isometric exercise, in 294 diabetic patients without clinical evidence of cardiomyopathy and in good metabolic control compared to 132 normal subjects. The study was aimed at detecting preclinical alterations of left ventricular function. Diabetic patients considered together did not show any difference in STI in basal conditions or after isometric exercise compared to normal subjects. When diabetic patients were divided into sub-groups according to their treatment, the insulin-treated diabetics showed modification of STI after isometric exercise, which indicated an alteration of left ventricular function. Also subjects treated with oral hypoglycemic agents showed similar but less evident changes. In diabetic patients on diet only and in those with duration of diabetes of 6 months or less, STI was identical to that of normal subjects. These data do not explain the pathogenesis of myocardial involvement, although they are in accordance with studies which have laid emphasis on the alteration of compliance of the diabetic heart.     

Continuous ventricular tachyarrhythmia in patients without detectable organic heart disease: clinical and electrophysiologic findings

In 22 of 335 consecutive patients (6.6%) referred for evaluation and treatment of sustained ventricular tachyarrhythmias, hemodynamic and angiographic findings revealed no structural heart disease. Entry arrhythmia was ventricular fibrillation in 10 patients and sustained ventricular tachycardia in 12 patients. A subgroup of four young patients presented with slow recurrent (during 51 +/- 43 months) sustained ventricular tachycardias that were reproducibly terminated by intravenous application of verapamil. Programmed ventricular stimulation replicated the clinical arrhythmia in nine patients (75%) with ventricular tachycardia. In five patients (50%) with ventricular fibrillation no sustained ventricular arrhythmia could be induced, and only with three extrastimuli in four of the remaining five patients. On hospital discharge, 14 patients received type III antiarrhythmic agents, five patients received type I agents, and one patient received verapamil. Two patients were discharged without medical therapy. During the following 24 +/- 9 months, four patients had recurrent sustained ventricular tachycardia. No patient died suddenly during follow-up. We conclude that about 6% of all patients with ventricular tachyarrhythmias have apparently normal hearts. These idiopathic tachyarrhythmias seem to have a benign course, at least when treated. Slow, verapamil-sensitive tachycardias of young people may represent a unique entity.     

老年人糖尿病心脏病的临床及病理改变

目的进一步认识糖尿病对老年人心脏的影响。方法回顾性总结１９８４～１９９３年５１例老年糖尿病和同期８５例非糖尿病老人心脏的临床及尸检材料。结果糖尿病组的冠心病及心肌梗塞的患病率及心力衰竭的发生率均高于非糖尿病组。糖尿病组冠心病的发病年龄较非糖尿病组早５年。尸检表明，与非糖尿病组比较，糖尿病组冠状动脉病变严重，累及支数也多，且心肌内小冠状动脉壁增厚者明显地多。有１例病理诊断为糖尿病性心肌病。结论糖尿病对老年人心脏的影响主要表现为冠状动脉病变加重，心肌内小冠状动脉管壁增厚，心肌内灶性坏死和间质纤维化增多。这与糖尿病并发心力衰竭较多有关     

Ventricular premature beats in young subjects without evidence of cardiac disease: histological findings.

This report describes the results of right ventricle endomyocardial biopsies from 26 subjects (mean age 27 +/- 10 years) with premature ventricular beats and normal cardiac anatomy and mechanical function. Light microscopy examination revealed normal myocardium in 10 subjects (38%), acute myocarditis in two (7%), borderline myocarditis in one (3.5%), non-specific histological abnormalities including cellular hypertrophy, fibrosis and degenerative changes in 11 (42%), vasculitis in one (3.5%) and findings compatible with right ventricular dysplasia in the final subject (3.5%). The frequency of ventricular premature beats, as assessed by Holter monitoring, and the results of electrophysiological testing did not correlate with histopathological findings and their severity. These data indicate that some young subjects with premature ventricular beats of unknown origin have abnormal right ventricular biopsy findings. Adequate follow-up will probably demonstrate the clinical utility of these observations.     

Cardiovascular disease in diabetic women without cardiac symptoms

Cardiovascular disease is the main cause of cardiac death among diabetic patients. The myocardial ischemia is frequently asymptomatic, leading to late diagnosis and making prognosis worse. This is particularly true for women, for whom this diagnostic is possibility often disregarded. Appropriate screening can modify the coronary artery disease risk. The early diagnosis is highly beneficial, particularly regarding females. The decision of which non-invasive diagnostic method should be used in the initial evaluation is difficult. There are several diagnostic methods to make the preliminary investigation of coronary artery disease in diabetic women even without cardiac symptoms, but there is still no consensus about who should be investigated and when should the first cardiac evaluation start. The prevalence of the disease, as well as the cardiac risk, must be known in order to justify a broad survey, mainly in the female population.     

Transmural heterogeneity of myocardial integrated backscatter in diabetic patients without overt cardiac disease

It is important to detect early changes in diabetic myocardium, because some diabetic patients suffer from diabetic cardiomyopathy, especially those with poorer glycemic control or hypertension (HT). To clarify whether ultrasonic tissue characterization can noninvasively detect ultrastructural changes in diabetic myocardium, we analyzed the transmural heterogeneity in myocardial integrated backscatter (THIB) in 20 diabetic patients and 16 normal subjects. THIB was defined as the absolute value of difference of integrated backscatter between the endocardial and epicardial half of the myocardium. THIB in diabetic patients was significantly greater than that in normal subjects. In diabetic patients, there was a significant correlation between glycosylated hemoglobin and THIB, and the greater THIB was shown in patients with HT compared with those without HT. Early changes in the myocardium, related to increased interstitial collagen deposition or other occult cardiomyopathic changes, may be detected on the basis of quantitative analysis of THIB in diabetic patients.     

Apolipoprotein profile in type II diabetic patients with and without coronary heart disease

Summary Diabetes mellitus is frequently associated with lipid metabolism abnormalities. In the present study the lipid and apolipoprotein profiles have been compared in type II diabetic subjects with (n=30) and without (n=30) coronary heart disease (CHD). All subjects were studied after good metabolic control had been achieved. Significant differences in plasrna lipids and apolipoproteins were seen in diabetic patients with CHD in comparison with diabetics without CHD. Patients with CHD presented higher total cholesterol, triglyceride, LDL-cholesterol, apo B, apo C_II and apo C_III levels and total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol ratios and lower HDL-cholesterol values and apo A_I/o B ratio than the patients without CHD. The same findings were found in females; while male subjects with CHD had significantly increased total cholesterol, LDL-cholesterol and apo B levels and total cholesterol/HDL-cholesterol and LDL/cholesterol/HDL-cholesterol ratios and significantly decreased apo A_I/o B ratio compared with males without CHD. These findings support the concept that the apolipoprotein profile plays a remarkable role as risk factor for CHD in type II diabetes mellitus.     

The emerging concept of chronic kidney disease without clinical proteinuria in diabetic patients

The natural history of diabetic nephropathy was defined in the 1980s on the basis of longitudinal studies undertaken in patients with type 1 and type 2 diabetes. However, an increasing number of studies have indicated that certain diabetic patients do not present with the same evolution as was then defined: for example, some often have significant initial deterioration of glomerular filtration rate whereas, in others, microalbuminuria is reduced spontaneously. Chronic kidney disease (CKD) may be accompanied, rather than preceded, by macroalbuminuria, or it may develop in patients with microalbuminuria or even in those with albuminuria levels that revert to normal. CKD can also develop in patients whose albuminuria levels remain normal. Progression to macroalbuminuria is, in fact, less frequent than regression to normoalbuminuria or no change in microalbuminuria status in diabetic patients with microalbuminuria, especially in type 1 diabetes. Some experience progressive deterioration of renal function due to diabetes without developing significant proteinuria: this is seen fairly frequently and can affect 50% of patients with renal insufficiency. Such cases are more often older patients treated with renin-angiotensin system blockers who usually have a history of cardiovascular disease. Evolution to end-stage renal disease is slower in this subgroup of patients, although histological analyses may show surprisingly advanced glomerular lesions. The main parameters of surveillance remain regular monitoring of glycaemia, and control of blood pressure and the evolution of initial albuminuria levels. Nevertheless, why some patients exhibit conventional diabetic nephropathy while others have slower declines in renal function associated with normal albuminuria levels or microalbuminuria is unclear. It is hoped that the new pathological classification of diabetic nephropathy will help in our understanding of these discrepancies.     

Radionuclide angiographic evidence for early predominant right ventricular involvement in patients with Chagas' disease

Radionuclide angiography was used to study biventricular function in 11 noncardiac (group 1) and eight chronic cardiac chagasic patients (group 2). Results in chagasic patients were compared to those obtained in 10 normal subjects. Global ejection fraction and the standard deviation of peak (SDP) phase histogram were determined for each ventricle and qualitative evaluation of regional wall motion in both anterior and left anterior oblique projections was performed. Left ventricular dysfunction was markedly predominant in group 2, mean +/- SD ejection fraction 39.7 +/- 13.1% and SDP 29.8 +/- 15.6 degrees, as compared to group 1, in which these values were 56.7 +/- 9.9% (P less than 0.01) and 18.3 +/- 7.1 degrees (P less than 0.05), respectively. In contrast, severe right ventricular impairment was found equally in both groups: ejection fraction averaged 31.8 +/- 12.7 and 31.0 +/- 9.1%, and the mean SDP was 29.3 +/- 8.6 and 23.7 +/- 6.7 degrees, in groups 2 and 1, respectively. The qualitative analysis of segmental wall motion also showed apical and/or free-wall right dysynergy in all patients of group 1, while the same abnormalities were detected in six out of eight patients in group 2. These findings indicate that severe functional impairment of right ventricular performance is by far the most significant abnormality detected by radionuclide angiography in chagasic patients who are asymptomatic and have no other clinical sign of heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

糖尿病合并冠心病的临床护理分析

目的探讨糖尿病合并冠心病患者的临床护理措施。方法将我院收治的84例糖尿病合并冠心病患者随机分为两组,各42例,对照组采取常规护理干预,实验组给予全面护理。观察分析两组并发症发生情况与患者护理满意率。结果实验组并发症发生率明显低于对照组（P〈0．05）,实验组患者护理满意率明显高于对照组患者（P〈0．05）。结论对糖尿病合并冠心病患者采取全面护理干预,能够有效降低并发症发生率,提高患者护理满意率,值得临床推广使用。     

A study on QT interval in patients affected with inflammatory bowel disease without cardiac involvement

Cardiac involvement has been studied quite extensively in patients affected by inflammatory bowel disease but, as of now, there is no data regarding QT alterations which are well known to be linked to the risk of dangerous arrhythmias. In this study, QT parameters were digitally measured on standard 12-lead ECG in a population of 20 patients affected by inflammatory bowel disease (IBD), with no prior (recent or old) history of cardiac disease and no evidence of electrolyte imbalance. Eighteen healthy subjects formed the control group. The results obtained using non-parametric statistics (Wilcoxon–Mann–Whitney test) showed that heart rate corrected QT interval (QTc) and QTc dispersion (QTc d) values were both significantly higher in IBD patients than in the control group. QTc rank sum values in patients affected by inflammatory bowel disease were 469 versus 311 in healthy subjects (Z = 1.939, p = 0.0263). QTc d rank sum values were 460 in IBD patients versus 320 in controls (Z = 1.686 with p = 0.0459). Regardless of the cause of these QT alterations, it appears evident that accurate monitoring of QT parameters is required in these patients who often experience electrolyte disturbances and who may, in some cases, be undergoing treatment with potentially cardiotoxic drugs such as infliximab.     

Cardiac involvement in rheumatoid arthritis: evidence of silent heart disease

Background: Rlieumatoid arthritis (RA) is a systemic diseaseinvolving many organ systems and is frequently accompanied bycardiac alterations. However, there is considerable disagreementconcerning the cardiac abnormalities found in patients withRA. The purpose of our investigation was to determine, by a non-invasivemethod such as echocardiography, the nature and extent of cardiacinvolvement in RA patients with no symptoms of cardiac disease,in comparison with a control sample. Methods: We selected 35 patients affected by rheumatoid arthritis(five men, 30 women), aged 51 ± 11 years. No patienthad either symptoms of cardiac disease or extra cardiac complaint. As a control group we studied 52 volunteers, aged 51 ±12 years, randomly selected among a larger group of subjectswith no symptoms, signs and/or clinical findings of extra cardiacdiseases. All were in sinus rhythm and without any cardiac symptom. Standard two-dimensional, M-mode and Doppler echocardiographicexamination was carried out on each subject. Results: In RA patients we found a higher prevalence of severalabnormalities. We found no statistically significant differencesbetween the groups of RA patients based on the stage and durationof disease. We found no correlation between cardiac abnormalitiesand inflammatory indices or drug therapy. Discussion: At least three alterations seem to be typical ofRA patients in the absence of any symptom of cardiac disease:(1) posterior pericardial effusion, (2) aortic root alterationsand (3) valvular thickening. The prevalence of MVP is controversialand needs furtlier investigation. These alterations are variouslycombined in each patient, and for this reason we think thatit is possible to represent such a heart involvement as ‘silentrheumatoid heart disease’. Moreover the knowledge of the presence of unrecognised cardiacabnormalities can be very important for the correct assessmentand management of the RA patient.