Prognostic significance of declining ankle-brachial index values in patients with suspected or known peripheral arterial disease.

BACKGROUND: Peripheral arterial disease (PAD) is a risk factor for cardiovascular events. This study assessed the prognostic significance of repeated ankle-brachial index (ABI) measurements at rest and after exercise in patients with PAD receiving conservative treatment. METHODS: In a cohort study of 606 patients (mean age 62+/-12 years, 68% male), ABI at rest and after exercise was measured at baseline and after 1 year. Patients with reductions in ABI were divided into three equally-sized groups (minor, intermediate and major reductions) and were compared to patients without reductions. During a mean follow-up of 5+/-3 years, all-cause mortality, cardiac events, stroke and progression to kidney failure were noted. RESULTS: Death was recorded in 83 patients (14%) of which 49% were due to cardiac causes. Non-fatal myocardial infarction occurred in 38 patients (6%), stroke in 46 (8%) and progression to kidney failure in 35 (6%). By multivariate analysis, patients with major declines in resting (>20%) and post-exercise (>30%) ABI were at increased risk of all-cause mortality (HR: 3.3, 95% CI: 1.5-7.2, HR: 3.0, 95% CI: 1.4-6.4, respectively), cardiac events (HR: 3.1, 95% CI: 1.3-7.2, HR: 2.4, 95% CI: 1.1-5.6, respectively), stroke (HR: 4.2, 95% CI: 1.6-10.4, HR: 3.9, 95% CI: 1.4-10.2, respectively) and kidney failure (HR: 2.7, 95% CI: 1.1-7.5, HR: 6.9, 95% CI: 1.5-31.5, respectively), compared to patients with no declines in ABI. CONCLUSIONS: This study shows that major 1-year declines in resting and post-exercise ABI are associated with all-cause mortality, cardiac events, stroke and kidney failure in patients with PAD.     

Evaluation of two prediction models for digoxin dosing

The relationship between the digoxin elimination parameter (A%) and creatinine clearance (CL_Cr) was determined, from blood level data of 160 hospital patients receiving digoxin tablets. The linear regression equation obtained, which varied only slightly from that reported by Jelliffe previously, was used to predict serum digoxin concentrations in 140 patients of four age groups (50–60, 60–70, 70–80 and 80–90 years). The predictions made were found to be less biased and more precise, irrespective of the age of the patients, than those produced using another predictive method known as Dobbs method. However, correlation coefficients of predicted versus measured serum digoxin concentrations for each method did not differ significantly and frequency distribution analyses of prediction errors gave poor results (up to 63% only). Therefore, neither method can be considered to be superior to the other nor can they be said to ensure accurate predictions of serum digoxin concentrations.     

Child neurology

Poster Session 1

Child neurology     

Comparative study of ECG and echocardiographic parameters indicative of cardiac hypertrophy in athletes

The identification of left ventricular hypertrophy (LVH) through electrocardiographic voltage criteria has been widely studied in patients. However, their validity in “athlete’s heart” remains quite unknown. The aim of this study was to evaluate the most common electrocardiographic indices indicative of LVH compared to the known echocardiographic ones in athletes. The study group comprised 150 male adult competitive athletes (group A) and 50 sedentary participants (group B). Thirteen accepted electrocardiographic voltage criteria indicative of LVH were calculated and correlated with the common echocardiographic indices of left ventricular mass (LVM). Nine of the 13 ECG voltage criteria were significantly increased in athletes compared to controls. Statistically, the Sokolow–Lyon index, which is the most commonly used voltage index was found to be affected by the body mass index (10.7 %, p < 0.05), the group (7.3 %, p < 0.05) and systolic blood pressure (4.5 %, p < 0.05) in total variance of 16.6 % (p < 0.05). No electrocardiographic voltage criterion was significantly correlated with any echocardiographic index, except for the Cornell index that was correlated with end-diastolic volume index (r = 0.29, p < 0.05) and the Sokolow index (V6) with LVMI (r = 0.26, p < 0.05) in group A. We suggested that ECG voltage indices should not be considered valid when assessing LVH in athletes. Thus, the echocardiographic study is preferable in studying training-induced structural cardiac changes.     

Non-invasive cardiac electrophysiological indices in soccer players with mitral valve prolapse.

BACKGROUND: Cardiac disorders constitute the most common causes of sudden cardiac death (SCD) and mitral valve prolapse (MVP) is one of the cardiac structural causes in young populations. The aim of this study was to evaluate some reliable non-invasive electrophysiological variables of SCD in young athletes with mild or moderate MVP and to compare them with their cardiorespiratory adaptations. DESIGN: The study population comprised of 40 amateur male soccer players, who were equally subdivided into those with (group A, aged 20.4+/-4.5 years) and without (group B, 18.4+/-2.4 years) MVP and 20 healthy age-matched sedentary individuals (group C). METHODS: All subjects underwent echo study for left ventricular mass index (LVMI) estimation, treadmill spiro-ergometric test for maximal oxygen uptake (VO2max) measurement and continuous ambulatory 24-h ECG recordings for arrhythmias detection and heart rate variability (HRV) analysis. Furthermore, groups A and B were also submitted to signal-averaged electrocardiogram for late potentials (LP) assessment and to submaximal exercise test for T-wave alternans (TWA) detection. RESULTS: Maximal oxygen uptake, LVMI and HRV index were enhanced in all athletes compared to group C (P<0.05). Resting QTc interval was significantly prolonged only in group B (by 3.7%) compared to C (P<0.05), whereas no significant difference was found between A and B. No positive LP or TWA were observed in all subjects. Significant correlation was found only between HRV index and VO2max in all groups. CONCLUSIONS: Athletes with mild or moderate MVP do not present any significant difference in non-invasive cardiac electrophysiological indices as well as in cardiorespiratory performance, compared to healthy ones. It seems that long-term exercise induced adaptations overlap any cardiac autonomic disorders in cases of mild-to-moderate MVP severity.     

Peripheral arterial embolism due to a left ventricular diverticulum in a young adult

A 32-year-old man was admitted to the emergency department of our hospital after experiencing a peripheral arterial embolism. Investigation of the possible embolic sources in an otherwise asymptomatic patient revealed the existence of a left ventricular diverticulum. The left ventricular diverticulum is a rare congenital anomaly, either isolated or as a part of a syndrome including other congenital malformations. The treatment of choice, especially in symptomatic patients, is surgical resection, while in asymptomatic patients anticoagulation therapy is indicated.