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Background: In patients with systolic heart failure (HF), coexisting sleep apnea may promote arrhythmia. Ambulatory Holter electrocardiogram (ECG) monitoring (AECG) is a method of arrhythmia and apnea evaluation. We hypothesized that 24-hour AECG in patients with HF who have a high risk of serious arrhythmia may be less accurate than AECG extended to 48 hours and that, moreover, arrhythmia may be related to apnea., Methods: Eighty-four recordings of 48-hour AECG in 84 patients with ischemic HF (mean ejection fraction 34 ± 7%) were analyzed. Day 1, Day 2 were checked for ventricular tachycardia (VT) and supraventricular tachycardia (SVT). Estimated apnea-hypopnea index (est.AHI) was calculated using Holter, monitoring where est.AHI >15 indicates apnea., Results: In 48-hour AECG, VT occurred in 34 patients (40.5%) whereas SVT in 17 patients (20.2%), and patients with est.AHI > 15 had higher VT occurrence. In two-sample one-sided test for proportions, 24-hour AECG from Day 1 showed a significantly lower percentage of patients with detected VT than 48-hour AECG-it was 23.8% (20 patients), meaning a significant underestimation with P = 0.0089. We assessed VT underestimation in the subgroups with regard to est.AHI, and found that it was present in Day 1 monitoring in the subgroups with est.AHI > 15. It was absent in the subgroups with est.AHI ≤ 15 and also in Day 2 monitoring., Conclusions: In patients with systolic HF, 24-hour AECG may have insufficient sensitivity regarding serious arrhythmia occurrence. If significant apnea was detected in the first day, extending the monitoring may be recommended., (©2012, Wiley Periodicals, Inc.)

Background: The interdependence between echocardiographic parameters of left ventricle function, severity of heart failure (HF) and exercise test duration has not been thoroughly examined., Methods: We compared echocardiographic data in patients after myocardial infarction divided according to NYHA class to mild (class I and II, group 1 = 24 subjects) and advanced HF group (III and IV, group 2 = 36) and assessed their correlation with exercise duration (ED) in a symptom-limited treadmill test. Then we tried to determine independent predictors of ED., Results: The group with advanced HF had lower left ventricle ejection fraction, shorter duration and deceleration times of both mitral inflow waves (Et and At, Edt and Adt) and higher E/A ratio (1.4 +/- 1.1 vs. 0.9 +/- 0.4; p < 0.05) with more frequent restriction and pseudonormalization pattern (56% vs. 12%). Also early wave propagation (21 +/- 7 vs. 29 +/- 11 cm/s; p < 0.001) and all tissue Doppler velocities were lower, but ratio of early wave peak velocity to early diastolic velocity of mitral annulus was higher (E/E' 10.5 +/- 5 vs. 6.1 +/- 1.3 for velocity ratio; p < 0.001) in subjects with more severe clinical symptoms. Significant negative correlation with ED was observed for difference between duration of pulmonary vein atrial reversal flow and atrial wave of mitral inflow (DeltaAt; r = -0.54) and for E/E' ratio (r = -0.48), the highest positive correlation for left ventricular ejection fraction and duration of mitral inflow atrial phase (EF; r = 0.48, At; r = 0.46). In multivariate stepwise regression analysis two independent predictors of ED were identified: age and DeltaAt (Art-At)., Conclusions: Diastolic parameters showing the strongest correlation with ED (DeltaAt and E/E') are connected with restrictive left ventricle physiology. The only independent predictors of exercise duration in patients after myocardial infarction were: age and DeltaAt.

Background: Heart rate turbulence (HRT) has been shown to predict the prognosis after myocardial infarction (MI), but its prognostic value in patients with chronic heart failure (CHF) has not yet been well established., Aim: To evaluate HRT in patients with CHF and assess the prognostic significance of HRT in this group., Methods: The study group consisted of 82 patients with CHF and left ventricular ejection fraction (LVEF) <35%. All the patients underwent 24-hour Holter monitoring (HM). The heart rate variability (HRV) and HRT parameters were assessed using HRT view software. Two HRT parameters - turbulence slope (TS) and turbulence onset (TO), were calculated. We analysed the clinical course and survival during a two-year follow-up (mean 25+/-9 months)., Results: The patients were divided into three groups according to the HRT parameters. Group 1 (23 patients) with both normal TO and TS (TO <0%, TS >2.5 m/s), group 2 (30 patients) with abnormal TO or TS, group 3 (29 patients) with abnormal TO and TS (TO >0% and TS <2.5 m/s). Patients from group 1 was significantly younger. There were no differences between patients in aetiology, treatment and the frequency of ventricular premature beats. Significant correlations between HRV and HRT parameters were observed. The correlation was the strongest between TS and SDNN and LF. During the follow-up 9 patients died and 15 were hospitalised for non-fatal infarction or worsening of CHF. Using a multivariate logistic regression model, it was shown that TS <2.5 ms/RR interval, and non-sustained ventricular tachycardia (VT) significantly increased the risk of a serious cardiac events in CHF patients., Conclusion: HRT parameters are often abnormal in patients with CHF. An abnormal turbulence slope (TS) and VT episodes are significantly associated with increased risk of cardiac complications in CHF.

Background and Aim: Patients after myocardial infarction (MI) differ according to the extend of myocardial damage and prognosis. Diastolic function impairment may have great impact on development of heart failure and outcomes. We evaluated the prognostic value of various echocardiographic measurements in 18-month and 3-year observation after MI. Methods: 60 patients after MI (44 male, mean age 60 ± 11) were examined by transthoracic echocardiography with the assessment of wide spectrum of parameters. Mortality and combined end points (cardiac deaths and heart failure exacerbation) were assessed after 18-month and 3-year observation and groups with and without end points were compared. Optimal cutoff values were estimated by receiver operating characteristic (ROC) analysis and resulting Kaplan–Meier curves were compared. Results and Conclusions: After 18 months, 11 deaths occurred and 20 subjects experienced hospitalization caused by heart failure exacerbation. Although the group with cardiac events showed a greater enlargement of the left ventricle and lower ejection fraction, the highest relative risk of poor outcome (RR = 5.0) was related to the left atrial enlargement above 44 mm. Although restrictive or pseudonormal inflows were connected with 2.1 relative risk of combined end point, all patients with E deceleration time ≤130 ms experienced heart failure exacerbation or death. Despite tissue Doppler and propagation parameters describing elevated end-diastolic pressure differed between groups with various outcomes in multivariate analysis, only enlarged left atrium was an independent predictor for both combined end point and cardiac death. Further 3-year follow-up solely confirmed the role of above described predictors. [ABSTRACT FROM AUTHOR]

We report a case of 26-year-old woman, with arrhythmic manifestation of peripartum cardiomyopathy with moderate heart failure. Ventricular arrhythmia recorded in ambulatory Holter ECG (premature ventricular contractions) was most severe during pregnancy, reduced when beta-blocker therapy was initiated and almost completely resolved after delivery. Then, 1 year after hospitalization in Cardiology Department, recurrence was observed with recorded short episode of nonsustained ventricular tachycardia. [ABSTRACT FROM AUTHOR]