Diagonal ear-lobe crease is associated with carotid intima-media thickness in subjects free of clinical cardiovascular disease

BACKGROUND: The diagonal ear-lobe crease (ELC) has been suggested as a simple marker of cardiovascular disease in the general population. There is no knowledge concerning the relation between carotid intima-media thickness (IMT), an index of subclinical atherosclerosis, and diagonal ELC. The aim of our study was to assess this relation. METHODS AND RESULTS: The study population was prospectively selected from apparently healthy subjects. Sixty-five consecutive subjects with ELC and 65 age- and gender-matched control subjects without ELC were included in this study. These were examined by B-mode ultrasound to measure the IMT at the far wall of the common carotid artery. Subjects with ELC had significantly higher carotid IMT compared to control subjects without ELC (0.88+/-0.14 versus 0.69+/-0.14 mm, respectively, p=0.0001). The presence of ELC was independently associated with IMT in the multivariate logistic regression analysis. In addition, we detected a significant positive correlation between the presence of ELC and carotid IMT (r=0.558, p=0.0001). CONCLUSIONS: We have shown for the first time an association between increased carotid IMT and diagonal ELC in apparently healthy subjects.     

An unusual etiology of erythropoietin resistance: hyperthyroidism

Many possible causes of resistance to human recombinant erythropoietin (rh-EPO) have been reported in patients with renal failure. This case presents an unusual cause of erythropoietin-resistant anemia in a patient with chronic renal failure. A 61-year-old male patient who was on chronic hemodialysis program due to diabetic nephropathy for seven months developed erythropoietin resistant anemia. No iron deficiency was revealed by laboratory data, no megaloblastic anemia were found by biochemical investigation, and no inflammatory states including infection or neoplastic diseases were disclosed by abdominal ultrasonography, chest X-ray, bone marrow aspiration and biopsy, or other methods (normal C-reactive protein levels). This hemodialysis patient had epoetin-resistant anemia with primary autoimmune hyperthyroidism. The anti-thyroid therapy was effective not only against the hyperthyroidism but also against his epoetin resistant anemia.     

Acute effect of cigarette smoking on heart rate variability

Acute cigarette smoking enhances adrenergic activity and thus may be associated with hemodynamic changes in the cardiovascular system. In this study, the acute effect of cigarette smoking on heart rate variability (HRV) was studied. Fifteen subjects were included in the study. Time domain (the mean R-R interval, the standard deviation of R-R interval, and the root mean square of successive R-R interval differences) and frequency domain (high-frequency, low-frequency ratio, and low-frequency/high-frequency ratio) parameters of HRV were obtained from all participants for each 5-minute segment: 5 minutes before and 5, 10, 15, 20, 25, and 30 minutes after smoking a cigarette. The mean R-R interval, the standard deviation of R-R interval, and the root mean square of successive R-R interval differences significantly decreased within the first 5-minute period compared with baseline, and then the standard deviation of R-R interval increased within the 20- to 30-minute period. The low-frequency high-frequency ratio significantly decreased within the first 5 minutes after smoking and then remained unchanged throughout the study period. Similarly, low-frequency and high-frequency power increased within the first 5 minutes compared with baseline. Acute cigarette smoking alters HRV parameters, particularly within the first 5 to 10 minutes after smoking.     

Symptomatic lipoma in the interventricular septum

Cardiac lipomas, which are benign nonmyxomatous neoplasms of the heart, are rare and among those least often encountered. Because they normally cause no symptoms, diagnosis is often purely accidental. We report the case of a 24-year-old woman who presented with palpitations of recent onset and was found to have a lipoma attached to the left side of the interventricular septum (IVS). Transthoracic and transesophageal echocardiograms were performed and showed a mass in the left side of the IVS. During successful surgical excision of the mass, intraoperative histologic diagnosis showed the tumor was lipoma. Our review of the English literature revealed that our case is only the seventh of removal of lipoma in the IVS. The postoperative course was uneventful, and an echocardiogram taken 6 months after the operation showed no evidence of enlargement of the tumor tissue.     

Postoperative prophylactic peritoneal dialysis in neonates and infants after complex congenital cardiac surgery

Peritoneal dialysis after complex congenital cardiac surgery was introduced to a group of neonates and infants (n = 756; age, 0 to 1 year) between May 1993 and December 2005. Indications of peritoneal dialysis were determined as well as methods, prolonged dialysis, and its outcomes. Demographic characteristics, preoperative risk factors, intraoperative variables, and postoperative complications were compared in 756 cases with ages below 1 year. All cases underwent ultrafiltration during the perioperative stage. One hundred eighty-six cases (24.6% of total) required peritoneal dialysis. The cardiac pathology was transposition of great arteries in 133 cases, tetralogy of Fallot in 37, aorticopulmonary window associated with interrupted aortic arch in 4 and total anomalous pulmonary venous return in 5, and other complex pathology in 7 cases. Prolonged peritoneal dialysis was usually required in infants with low weight, with episodes of pulmonary hypertensive crisis (p < 0.05), and with preoperative renal dysfunction. No major complication was observed related to the peritoneal dialysis catheter. Of 186 patients, 23 (12.3%) had acute renal failure, and 4 of them died (2.15% of all patients underwent operation, 17.3% of those with acute renal failure). It has been demonstrated that the combination of peritoneal dialysis with perioperative ultrafiltration application was effective in providing the required postoperative negative fluid balance in especially complex congenital heart cases and affected survival positively.     

Assessment of left ventricular diastolic function and the Tei index by tissue Doppler imaging in patients with primary hyperparathyroidism

Background The aim of this study was to assess left ventricular (LV) systolic and diastolic function and myocardial performance (the Tei index) by tissue Doppler imaging (TDI) in patients with primary hyperparathyroidism (PHPT). Methods We prospectively evaluated 21 patients with PHPT [nine women, 12 men; aged 50 ± 11 years, serum calcium 2·9 ± 0·17 mmol/l, intact PTH (iPTH) 51·5 ± 52·1 pmol/l] and 27 healthy control subjects (13 women, 14 men; aged 49 ± 10 years, serum calcium 2·35 ± 0·12 mol/l, iPTH 2·9 ± 0·9 pmol/l). LV systolic and diastolic function was assessed by conventional echocardiography and by TDI. Early diastolic (Em), late diastolic (Am) and peak systolic (Sm) mitral annular velocities, the ratio Em/Am and the Tei index were calculated from TDI measurements. Mitral inflow velocities, colour M‐mode flow propagation velocity (Vp), relative wall thickness (RWT) and LV mass index (LVMI) were assessed by two‐dimensional echocardiography. Results Em and Em/Am were lower in patients with PHPT than in healthy controls (11·2 ± 1·5 cm/s vs. 13·5 ± 2·5 cm/s, P = 0·005; 0·94 ± 0·27 vs. 1·36 ± 0·44, P = 0·02, respectively). In patients with PHPT, the Tei index was significantly higher than that in controls (0·45 ± 13·6 vs. 0·33 ± 8·1, P = 0·02). Peak (E) velocity and the ratio of E to peak late (A) velocity (E/A) were lower in those with PHPT than in those without (59 ± 15 cm/s vs. 72 ± 19 cm/s, P = 0·02; 0·8 ± 0·15 vs. 1·1 ± 0·33, P = 0·001, respectively). Patients with PHPT had significantly higher RWT (0·50 ± 0·02 cm vs. 0·41 ± 0·02 cm, P = 0·0001), isovolumetric relaxation time (IVRT) (115 ± 13 ms vs. 103 ± 11 ms P = 0·04) and A velocity (79 ± 16 cm/s vs. 68 ± 13 cm/s P = 0·05) than controls. Vp was lower in PHPT patients than in healthy subjects (42 ± 9·98 cm/s vs. 54 ± 19·01 cm/s P = 0·04). There were no significant differences between the two groups regarding LV end‐diastolic and end‐systolic dimensions, LVMI, deceleration time of the mitral E wave, Am and Sm. Conclusion TDI analysis of mitral annular velocities, Em/Am and the Tei index is useful for assessing LV diastolic dysfunction in patients with PHPT. The parameters obtained from the lateral mitral annulus by TDI can be used for the identification of LV diastolic dysfunction in PHPT patients.     

Tissue Doppler echocardiography in evaluation of cardiac effects of subclinical hypothyroidism

Objective: Subclinical hypothyroidism (SH) is a mild form of thyroid failure, associated with initial signs of cardiovascular hypothyroidism. Tissue Doppler echocardiography (TDE) is a new and powerful method in evaluation of both regional and global systolic or diastolic ventricular function. We aimed to investigate the use of TDE in evaluation of cardiac effects of SH and affect of thyroid hormone replacement therapy (TRT) on tissue Doppler parameters of SH patients. Methods: Twenty-two patients who were diagnosed as SH and 22 healthy, age and sex-matched cases were included in the study. Conventional echocardiography and TDE were performed in all individuals. TRT was started in SH group. On the achievement of euthyroid state echocardiography were repeated. Results: Septal annulus relaxation time was significantly higher in SH group (82±21, 98±11 ms, p=0.024). Lateral annulus and myocardial relaxation times, precontraction/contraction ratios and precontraction times were also slightly higher. Septal lateral annulus and lateral myocardial relaxation times were decreased after TRT (98±11 vs. 81±12, p<0.001, 89±14 vs. 78±11, p=0.022, 90±16 vs. 80±14 ms, p=0.008, respectively). Precontraction times and precontraction/contraction ratios decreased after TRT but did not reach the significance level. There was a positive correlation between TSH and TDE relaxation times. Conclusions: TDE is a powerful tool in diagnosis and follow-up of SH patients and TRT inhibits adverse affects of SH on myocardium. Septal myocardium is the most affected region of left ventricle in SH. The relaxation time is the best criteria of cardiac involvement and monitoring the effect of TRT.