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The cardiac toxicity of LV5FU2 (de Gramont) regimen which is a widely used chemotherapy regimen in gastrointestinal system cancers is not well defined. We aimed to evaluate the impact of this regimen on cardiac rhythm. Two Holter ECG recordings were obtained in all patients with gastrointestinal system cancers treated with LV5FU2 regimen as first-line chemotherapy (one before and the second during the first 24 h of chemotherapy). Records were reviewed for the heart rate, rhythm, atrial premature complexes (APC), ventricular premature complexes (VPC), grades according to Lown-Wolf grading system and ST segment changes. Holter ECG recordings were evaluated in 27 patients. In the baseline evaluation, neither clinical symptom nor ST segment changes were observed. During the treatment period, chest pain was observed in two patients without any cardiac enzyme and ST segment changes. Moreover, a decrease in mean heart rate, and an increase in the number and complexity of premature complexes secondary to treatment were observed. The mean heart rate, APC per hour and VPC per hour (+/-SD) before vs. during treatment were, respectively, 93.1+/-16.4 vs. 81.6+/-12.7 (p=0.001), 18.9+/-54.0 vs. 45.3+/-53.8 vs. (p=0.049) and 12.7+/-29.6 vs. 38.1+/-42.1 (p=0.002). LV5FU2 regimen leads to a decrease in mean heart rate and a significant increase in APC and VPC which may lead to serious arrhythmias. These effects must be better understood for a safer administration of this useful and widely used drug regimen.

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SUMMARYThe aim of this study was investigate the effects of carvedilol therapy on ventricular repolarization characteristics as assessed by QT dispersion (QTd) and heart rate variability (HRV) in patients with heart failure.Thirty-one patients with heart failure (mean age, 63.9 years) were included in the study. Carvedilol was administered in addition to standard therapy for CHF at a dose of 6.25 mg/day and uptitrated to the maximum tolerated dose. Control group consisted of 14 patients with heart failure (mean age, 69.4 years) who could not take carvedilol due to several reasons. All patients were followed-up 6 months. QT dispersion (QTd), and corrected QTd (QTcd) values were calculated at baseline and at the end of follow-up. Time domain and frequency domain heart rate variability analysis were performed with ambulatory Holter ECG.Mean carvedilol dose was 23.9 ± 13.9 mg. Significant reductions were observed in the QTd (P = 0.016) and QTcd (P = 0.001) with carvedilol therapy, whereas QTd (P = 0.47) and QTcd (P = 0.43) did not change significantly in the control group. The QT maximum value did not change significantly but the QT minimum value (P = 0.03) was significantly increased after carvedilol therapy. Although the mean SDANN value was improved (P = 0.039), other HRV parameters such as mean SDNN (P = 0.32), rMSSD (P = 0.74), and the LF/HF ratio (P = 0.35) did not change significantly after carvedilol therapy.This prospective controlled study shows that carvedilol therapy decreased QT dispersion and improved ventricular repolarization characteristics but did not change autonomic dysfunction in patients with heart failure. (Int Heart J 2006; 47: 565-573)

Amaç: Atriyal fibrilasyonda sol atriyal trombüs oluşması açısından koagülasyon parametrelerinin rolü yeterince araştırılmamıştır. Atriyal fibrilasyonlu hastalarda sol atriyal trombüs ile veya onun öncüsü olduğu düşünülen spontan eko-kontrast varlığı (SEK) ile beta fibrinojen gen polimorfizmi ile trombosit glikoprotein IIIa gen polimorfizmi arasındaki ilişkiyi araştırmayı amaçladık. Yöntemler: Transözofageal ekokardiyografi yapılan atriyal fibrilasyonlu 47 hasta enine kesitsel gözlemsel çalışmamıza dahil edildi. Hastalar 2 gruba ayrıldı. Sol atriyal trombüsü olanlar Grup 1'i (n=24) ve trombüsü olmayanlar grup 2'yi (n=23) oluşturdu. Beta fibrinojen gene polimorfizm veya glikoprotein IIIa gen polimorfizmlerini saptamak için genetik analizler yapıldı. İstatistiksel analizde Mann Whitney U ve Ki-kare testleri kullanıldı. Bulgular: Demografik ve klinik özellikler bakımından gruplar arasında fark saptanmadı. Beta fibrinojen 455 G/A gen polimorfizm sıklığı grup 1'de (%37.5) grup 2'ye göre (%15) istatistiksel anlamlılığa ulaşmayacak şekilde (p=0.23) daha yüksek saptandı. Çalışma grubuna ciddi SEK'i olan hastalar da eklendiğinde (trombüs ve ciddi SEK n=27) 2 grup arasındaki fark (%44.4-%10) istatistiksel anlamlılığa ulaşmaktaydı (p=0.01). Glikoprotein IIIa Pl A1/A2 polimorfizmi ise gruplar arasında (p=0.73) SEK eklense de (p=0.82) farklı bulunmadı. Grup I'de grup II'ye göre mitral yetmezliği skoru daha düşük olma eğiliminde (p=0.08), SEK skoru ise anlamı olarak daha yüksek idi (p=0.03). ÖZETOb jec ti ve: The role of coagulation parameters left atrial thrombus formation in atrial fibrillation has not been investigated before. We aimed to investigate the association between the beta-fibrinogen gene polymorphism or glycoprotein IIIa gene polymorphism and presence of left atrial (LA) thrombus or spontaneous echo contrast (SEC) in patients with atrial fibrillation (AF). Methods: Forty-seven patients with AF, in whom transesophageal echocardiography was performed, were included to this cross-sectional observational study. Patients were divided in two groups; those with LA thrombus (n=24) were assigned to group 1 and those without thrombusin group 2 (n=23). DNA analysis was conducted to determine gene polymorphism in all patients. Mann-Whitney U test or Chi-square tests were used for statistical analysis Results: There were no significant differences between groups regarding to demographic and clinical characteristics. The frequency of betafibrinogen 455 G/A polymorphism was higher (37.5%) in group 1 as compared to group 2 (15.1%) but it did not reach statistical difference (p=0.23). When we added patients with severe SEC in the study group (patients with severe SEC and/or thrombus n=27) the difference (44.40%-10%) reached the statistical difference (p=0.01). Glycoprotein IIIa Pl A1/A2 polymorphism was not different between groups with (p=0.82) or without SEC (p=0.73). Conclusion: In patients with atrial fibrillation, beta-fibrinogen 455 G/A gene polymorphism is associated with the presence of left atrial thrombus and severe SEC...

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Restoration of sinus rhythm by electrical cardioversion is a therapeutic option in appropriately selected patients with atrial fibrillation. It is important to determine predictors of electrical cardioversion outcome in patients with atrial fibrillation. Predictive value of clinical and conventional echocardiographic parameters for predicting cardioversion outcome is limited. The role of left atrial appendage (LAA) function, which may reflect left atrial contractile function, for prediction of cardioversion outcome remains unclear. We conducted a single center prospective study to evaluate the role of LAA function for prediction of cardioversion success in patients with atrial fibrillation. One hundred sixty three patients with atrial fibrillation underwent transthoracic and transesophageal echocardiography (TEE) before electrical cardioversion. LAA functions, including LAA peak flow velocity, LAA area and LAA ejection fraction, were examined. Cardioversion was successful in 133 patients and unsuccessful in 30 patients. Mean LAA peak emptying flow velocity was significantly higher in the patients with successful cardioversion than in those with unsuccessful cardioversion (0.34 ± 0.14 vs 0.27 ± 0.1 m/sec; p = 0.013). At multivariate logistic regression analysis, only LAA flow velocity (> 0.28 m/sec, odds ratio = 2.8 ; p = 0.03) proved to be an independent predictor of cardioversion success. LAA area ( p = 0.18) and LAA ejection fraction ( p = 0.52) were not different between successful and unsuccessful cardioversion groups. Therefore, measurement of LAA flow velocity provides valuable information for prediction of cardioversion outcome in patients with atrial fibrillation before TEE guided cardioversion.cardioversion; left atrial appendage (LAA) function; atrial fibrillation

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