Background Alterations of heart rate variability (HRV) in epileptic patients were the field of interest of several studies for many reasons, particularly the contribution toward sudden unexpected death in epilepsy (SUDEP). Aim We aimed at evaluation of autonomic dysfunction in epileptic patients during awake and sleep in addition to studying the association between SUDEP risk with different Holter parameters. Patients and Methods The study included eighty epileptic patients (40 controlled epileptic patients and 40 refractory epileptic patients) compared to 30 volunteers as control group. They underwent detailed epileptic history, Chalfont seizure severity scale, sudden unexpected death in epilepsy (SUDEP)-7 risk score and 24 hour Holter monitoring to assess HRV parameters. Results Patients with refractory epilepsy had longer duration of epilepsy with increased number of used AEDs compared to controlled epileptic group. Both controlled and refractory epileptic patients had significantly higher average heart rate (AV.HR), sympatho-vagal ratio (low-frequency/high-frequency (LF/HF) ratio in 24 hours, daytime, and nighttime), and LF and HF values compared to controls. The rMSSD (the root mean square of difference between successive normal intervals), Tri.Index (triangular index), and pNN50 (percentage of the number of pairs of consecutive beat-to-beat intervals that varied by 50 ms) were significantly reduced in both epileptic groups compared to controls. Among refractory epileptic patients, patients with generalized epilepsy had significantly higher severity epileptic scale, average heart rate, minimum heart rate, and LF/HF night, in addition to lower rMSSD and pNN50 compared to patients with focal epilepsy. We found positive correlation between the following Holter indices (LF/HF 24, LF/HF day, and LF/HF night) and the duration of the epilepsy, while negative correlations between Tri.Index, LF, and HF and the epileptic duration were detected. SUDEP-7 risk was negatively correlated with pNN50 and rMSSD; meanwhile, it was positively correlated with LF/HF 24. The severity of epilepsy among refractory epileptic patients was positively correlated with average heart rate but negatively correlated with pNN50 and rMSSD. Using linear regression analysis, we found that pNN50 and rMSSD could predict SUDEP-7 risk and severity of epilepsy in refractory epileptic patients. Conclusion Epileptic patients (particularly refractory patients with generalized EEG findings and long duration) had reduced heart rate variability and hence impairment of parasympathetic activity with increased susceptibility for adverse outcomes. Moreover, pNN50 and rMSSD could be used as predictors for SUDEP-7 risk as well as severity of epilepsy in refractory epileptic patients.

BACKGROUND In many cardiovascular disorders, the contractile performance of the right ventricle (RV) is the primary determinant of prognosis. For evaluating RV volumes and function, 4 dimensional (4D)-echocardiography has become common. This research used 2D and 4D modalities to assess RV contractile performance in hypertensive patients. METHODS A total of 150 patients with essential hypertension were enrolled in this study, along with 75 age and sex-matched volunteers. Clinical evaluation and echocardiographic examination (including M-mode, tissue Doppler imaging, and 2D speckle tracking) were conducted on all participants. RV volumes, 4D-ejection fraction (EF), 4D-fractional area change (FAC), 4D-tricuspid annular plane systolic excursion (TAPSE), 4D-septal and free wall (FW) strain were all measured using 4D-echocardiography. RESULTS Hypertensive patients showed 2D-RV systolic and diastolic dysfunction (including TAPSE, 2D-right ventricular global longitudinal strain, RV-myocardial performance index and average E/EaRV) and 4D-RV impairment (including right ventricular EF, FAC, RV strain and TAPSE, right ventricular end-diastolic volume and right ventricular end-systolic volume) compared to the control group. We verified the prevalence of RV systolic dysfunction in hypertension patients using the following parameters: 1) 15% of them had 2D-TAPSE < 17 mm vs. 40% by 4D-TAPSE; 2) 25% of them had 2D-GLS < 19% vs. 42% by 4D-septal strain and 35% by 4D FW strain; 3) 35% of hypertensive patients had 4D-EF < 45%; and finally; 4) 25% of hypertensive patients had 2D-FAC < 35% compared to 45% by 4D-FAC. CONCLUSIONS The incidence of RV involvement was greater in 4D than in 2D-modality trans-thoracic echocardiography. We speculated that 4D-echocardiography with 4D-strain imaging would be more beneficial for examining RV morphology and function in hypertensive patients than 2D-echocardiography, since 4D-echocardiography could estimate RV volumes and function without making geometric assumptions.

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Objective: Despite the growing evidence that lipopolysaccharide binding protein (LBP) plays a major role in cardiovascular disease (CVD) pathophysiology and obesity, data regarding this association in children are rare. Therefore, our objectives were to assess whether there was a difference between overweight/obese and normal-weight children in plasma LBP levels and to assess the cardiovascular changes in both groups. Methods: In an observational, case-control study, a total of 30 children as obese and overweight children. Obese children with body mass index (BMI) above 95 th percentile, and overweight children with BMI between 85 th and 95 th percentile were recruited if they aged between 8-16 years old. A similar number of matched controls were included. Serum LBP was measured by enzyme-linked immunosorbent assay (ELISA) technique. Results: With regard to serum LBP, the mean LBP was significantly higher in obese children than in the control group (52.74 ± 17.25 versus 12.34 ± 2.67 µg/mL, respectively; p < 0.001). The ROC curve showed that the serum LBP, at a cutoff value of >19 µg/mL, was a significant discriminator of obesity with a sensitivity of 96.67% and specificity of 100%. The regression analysis showed that BMI was an independent predictor of serum LBP (B coefficient = 0.684; p = 0.024). The serum LBP correlated significantly with age (r = 0.58; p = 0.001), BMI (r = 0.834; p = 0.001), and LV longitudinal strain (r = 0.362; p = 0.05). Conclusion: In conclusion, our findings showed that obesity was associated with a worse lipid profile and cardiovascular function. LBP is a promising predictor of obesity in children.