Relationship Between Autonomic Nervous System Activity and Recurrence after Cryoballoon Ablation in Patients with Paroxysmal Atrial Fibrillation.

Objectives: In this study, we aimed to investigate the relationship between autonomic dysfunction (AD) determined according to the blood pressure (BP) and heart rate (HR) response in exercise treadmill test (ETT) prior to cryoballoon ablation (CBA), and the recurrence of atrial fibrillation (AF) after CBA in patients with paroxysmal AF. Patients and Methods: Seventy-six patients (mean age 53±11 years, 61.8% male) with paroxysmal AF who underwent CBA were enrolled. Before CBA the ETT was performed by all patients. BP and HR response in ETT were compared between patients with and without AF recurrence. Results: AD rate was significantly higher in the group with recurrence compared to the non- recurrent group (p<0.001). In addition to AD, age, female gender and lower exercise capacity were also associated with post-CBA AF recurrence ( p>0.05 for all ). Examining AD parameters, systolic blood pressure at peak exercise (SBPpeak) (p<0.001) and diastolic blood pressure at peak exercise (DBPpeak) (p<0.001), slow heart rate recovery (HRR) (p<0.001) were significantly higher in the recurrent group. Conclusion: AD may associated with AF recurrence after CBA in patients with paroxysmal AF. SBPpeak, DBPpeak and slow HRR appear to be predictors of AF recurrence after ablation.

Walking-induced endothelial dysfunction predicts ischemic cardiovascular events in patients with intermittent claudication

Endothelial dysfunction, evaluated by flow-mediated dilatation (FMD), predicts adverse cardiovascular events in patients with intermittent claudication (IC). IC is an example of repeated ischemia/reperfusion injury that may contribute to the progression of vascular disease by worsening endothelial function, a trigger for acute cardiovascular events. The predictive value of effort-induced endothelial dysfunction for cardiovascular events in patients with IC has not been studied previously. The objective of this study was to assess whether exercise-induced endothelial dysfunction is predictive of adverse cardiovascular outcome in IC. In 44 patients with IC, we measured brachial artery FMD by B-mode ultrasonography at rest and 10 minutes after a maximal treadmill exercise. Treadmill exercise halved the FMD (from 3.5 ± 0.6% to 1.45 ± 0.46%, p < 0.05). After a follow-up period of 85 (72–98) months, a total of 20 major cardiovascular events occurred. In a multivariate analysis, a post-exercise reduction of brachial FMD > 1.3% was predictive for cardiovascular events. Maximal exercise-induced endothelial dysfunction is predictive of cardiovascular events in patients with IC.

Study of exercise treadmill test in type 2 diabetes mellitus patients

Background: The aim of this study was to assess the prevalence and clinical predictors of silent myocardial ischemia in patients with type 2 diabetes mellitus, and the early diagnosis of coronary artery disease.Methods: A cross sectional prospective study was conducted including all confirmed diabetic patients in the age group between 40-60 in Bharati medical college hospital Pune in western Maharashtra. A detailed clinical examination and history was taken and relevant laboratory investigations, Electrocardiogram and Treadmill Stress test was done using Bruce protocol. The quantitative data was represented as their mean ± SD. Categorical and nominal data was expressed in percentage. All analysis was carried out by using SPSS software version 21.Results: Male preponderance was seen in the study with 64% of the study subjects. The mean age of the study subjects was 50.67±5.51 years. A p<0.001 was obtained showing positive correlation between BMI and TMT positivity. TMT positivity steadily increased with the duration of diabetes mellitus. Obtained p<0.001. The correlation between dyslipidemia and TMT positivity was significant, with a p=0.007. Correlation of Fasting as well as Post-prandial blood glucose levels with TMT positivity proved to be statistically significant, with a p<0.001.Conclusions: Exercise Treadmill test in diabetic patients has a significant role in screening diabetic individuals for coronary ischemia. The results obtained clearly indicate that an exercise treadmill test may be proposed as the first test for screening for coronary ischemia in diabetic population as it is safer, cheaper and non-invasive.

Severity of Myocardial Ischemia Is Related to Career Length Rather Than Age Among Professional Firefighters

Background: Ischemic heart disease (IHD) is the major cause of duty-related fatalities in the fire service. Age and career length are not only important risk factors associated with IHD, but are also highly correlated. The aim of this secondary analyses was to assess the relationship between age, career length, and IHD, based on ischemic severity, to identify whether age or career length had a stronger relationship to IHD. Methods: This was a secondary, correlational analysis of on-duty firefighters without known cardiovascular or respiratory disease who underwent exercise treadmill testing with 12-lead electrocardiography. Ischemia was defined based on current guidelines. Maximum ST-segment depression was measured to determine IHD ischemic severity. Age, years of employment, demographics, weight, blood pressure were recorded. Multiple correlations were computed between age, career length, and IHD. Findings: Twenty-two firefighters were included (96% male, 82% White, 82% overweight or obese, 77% hypertensive). The partial correlation between maximum ST-segment depression and age controlled for career length was not significant ( r = –.392, p = .079). The partial correlation between maximum ST-segment depression and career length controlled for age was statistically significant ( r = .466, p = .033). Conclusion/Application to Practice: Career length, not age, moderately correlates with IHD ischemic severity among firefighters. Career length is a proxy measure of occupational exposures which contributes to IHD. When assessing IHD risk in firefighters, health practitioners should consider incorporating the occupational exposure history (i.e., career length) in addition to age when providing risk reduction services.