Aim Current literature lacks a definitive threshold of idiopathic premature ventricular complex (PVC) burden for predicting cardiomyopathy (CMP). The main objective of the present study was to evaluate relationship between the PVC burden and left ventricular ejection fraction (LVEF). Method This multicenter, cross‐sectional study included 341 consecutive patients with more than 1,000 idiopathic PVC in 24 hr of Holter monitoring admitted to the cardiology clinics between January 2019 and May 2019 in the nineteen different centers. The primary outcome was the LVEF measured during the echocardiographic examination. Result Overall, the median age was 50 (38–60) and 139 (49.4%) were female. Percentage of median PVC burden was 9% (IQR: 4%–17.4%). Median LVEF was found 60% (55–65). We used proportional odds logistic regression method to examine the relationship between continuous LVEF and candidate predictors. Increase in PVC burden (%) (regression coefficient (RE) −0.644 and 95% CI −1.063, –0.225, p < .001), PVC QRS duration (RE‐0.191 and 95% CI −0.529, 0.148, p = .049), and age (RE‐0.249 and 95% CI −0.442, −0.056, p = .018) were associated with decrease in LVEF. This inverse relationship between the PVC burden and LVEF become more prominent when PVC burden was above 5%. A nomogram developed to estimate the individual risk for decrease in LVEF. Conclusion Our study showed that increase in PVC burden %, age, and PVC QRS duration were independently associated with decrease in LVEF in patients with idiopathic PVC. Also, inverse relationship between PVC burden and LVEF was observed in lower PVC burden than previously known.
Objective: This study investigated the proportion of silent venous obstruction in patients who underwent pacemaker or lead reimplantation for various reasons. We also investigated independent predictors or risk factor of venous obstruction in this patient population. Methods: Seventy-three patients who underwent pacemaker pulse generator and/or lead reimplantation in our institution between 2007 and 2010 were enrolled for this retrospective case-control study. Prior to procedure, patients underwent ipsilateral venography. Patients' venographies were classified as non-significant obstruction (stenosis ≤70%, including normal venogram), significant obstruction (stenosis >70%) and complete obstruction. Continuous and categorical data were compared with Mann-Whitney U test and Chi-square statistics respectively. Logistic regression analysis was used to identify independent predictors of venous obstruction. Results: Complete or significant silent central venous obstruction (CVO) proportion was detected as 9.5% (n=7). Basal characteristics of patients with or without CVO were comparable. Significantly increased pacemaker pocket erosion incidence (57% vs 0%, p=0.001, in groups with and without CVO respectively) and significantly higher mean pacemaker age (15.3±10.2 years vs 10.4±5.1 years, p=0.047, in groups with and without CVO respectively) were found in group with CVO. Pacemaker pocket erosion (OR 3.00; 95% CI 1.024-9.302; p=0.001), higher pacemaker age (OR 1.33; 95% CI 1.026-1.733; p=0.02) were found as independent CVO predictors in multiple logistic regression analysis. Correlation analysis also revealed a significant correlation between previous or current pacemaker pocket erosion and CVO (r=0.80, p=0.001). Conclusion: Ipsilateral venography is a useful procedure prior to pacemaker or lead reimplantation to detect CVO. In addition to the increased pacemaker age, current or past history of erosion and infection at pacemaker pocket are probable clinical conditions related to CVO. These clinical conditions create a predisposition to CVO with unknown mechanisms, according to the results of this preliminary study. (
An observational study of the effect of coronary artery disease severity on acute pacing threshold and lead impedance in patients with permanent pacemaker Kalıcı pacemaker'lı olgularda koroner arter hastalığı ciddiyetinin akut uyarı eşiği ve lead empedansı üzerine etkisini araştıran gözlemsel bir çalışma Original Investigation Özgün Araşt›rma ABSTRACTObjective: This study investigated the effect of coronary artery disease (CAD) severity, distribution and left ventricular ejection fraction (LVEF) on acute ventricular pacing threshold and lead impedance at the time of pacemaker implantation. Methods: One hundred and thirty-two patients who received a ventricular pacemaker or internal cardioverter-defibrilator (ICD) lead in our institution between 2007-2010 were included in this observational study. Patients were divided into ICD and anti-bradycardic pacemaker (PM) groups. Groups were compared for ventricular stimulation threshold, lead impedance and LVEF. Later, groups were sub-grouped according to the severity and distribution of CAD and subgroups were compared in both groups for ventricular stimulation threshold, lead impedance. Quantitative data of groups were compared by means of independent samples t-test.Results: Ventricular pacing thresholds were found significantly higher ICD group compared with PM group (p<0.05). Impedance and LVEF values were significantly lower in ICD group (p<0.05). Impedance and ventricular pacing thresholds were comparable in subgroups of ICD and PM groups. Our study does not confirm any relationship between pacing parameters and severity-distribution of CAD and LVEF. Conclusion: Patients with ventricular ICD lead had higher pacing thresholds but lower pacing impedance values comparing with PM group. This study did not find any significant relationship between pacing parameters at implantation and LVEF, severity and distribution of CAD. (
Objective: Pericardial effusion (PE) is a common clinical condition that can develop as a result of systemic or heart disease. In our study, we synthesized the cytopathological and clinical results of patients who underwent pericardiocentesis due to pericardial effusion. Method: A total of 213 patients who underwent percutaneous pericardiocentesis between 2007-2017 were included in the study: their cytologic and histopathologic diagnoses were noted and their relations were examined. Results: Hundred and thirty-two cases were male (61.9%), 81 were female (38.1%) and the mean of the study population age was 59.9 (min 13-max 97) years. Hundred and sixty-eight patients had benign (78.9%), 10 suspicious (4.6%), 3 non-diagnostic (1.4%) and 32 malignant cytologies (15.1%). Benign pericardial effusion was the most common diagnosis. Malignant cytology findings were interpreted as lung carcinoma (n=20: 62.5%), rhabdomyosarcoma (n=1: 3.1%), poorly differentiated adenocarcinoma (n=2: 6.2%), a gastrointestinal system carcinoma (n=4: 12.5%), undifferentiated epithelial tumor (n=1: 3.1%), breast carcinoma (n=1: 3.1%), and unspecified malignant tumor (n=3: 9%). Four (2.4%) of the 168 patients having diagnosis of benign cytology had previously received diagnosis of a malignant disease, however examination of cytological specimen. Did not reveal any malignancy. Three (30%) of the 10 patients with suspicious cytology, had received diagnosis of a malignant disease previously. Conclusion:In developed countries, it is reported that more than 50% of the PE's are idiopathic. The percentage of cancer-associated PE's is 10-25%. In our study, 78.9% of our cases had a benign diagnosis, and 15.1% had malignant PE consistent with the literature findings. Cytological sampling in pericardial fluid is a method that can shed light on the diagnosis of many diseases.
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