P wave dispersion (P dispersion), defined as the difference between the maximum and the minimum P wave duration, and maximum P wave duration (P maximum) are electrocardiographic (ECG) markers that have been used to evaluate the discontinuous propagation of sinus impulses and the prolongation of atrial conduction time, respectively. To study the effects of myocardial ischemia on P dispersion and P maximum, 95 patients with coronary artery disease (CAD) and typical angina pectoris and 15 controls with angina like symptoms underwent 12-lead surface ECG during and after the relief of pain. During pain and during the asymptomatic period, P maximum and P dispersion were calculated from the averaged complexes of all 12 leads. P dispersion increased significantly during spontaneous angina (45+/-17 ms) compared to the asymptomatic period (40+/-15 ms), P < 0.001 only in the patient group. Both P maximum and P dispersion showed higher values during angina in those patients who developed diffuse ischemia, as estimated with ST segment changes in multiple ECG leads. P dispersion showed higher values during the anginal episode in patients with left ventricular dysfunction, independently of the presence of a previous myocardial infarction. Atrial conduction abnormalities, as estimated with P maximum and particularly P dispersion, are significantly influenced by myocardial ischemia in patients with CAD and spontaneous angina.

Aim: To investigate the effect of a new inotropic drug, levosimendan compared with dobutamine on levels of brain natriuretic peptide (BNP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-a), and malondialdehyde (MDA) in patients with severe decompensated heart failure. Methods and results: Twenty-nine consecutive patients (22 males and 7 females), mean age 70.5 F 9.9 years, with decompensated heart failure on standard medical therapy, were randomised to receive either a 24 h infusion of levosimendan (n = 15) or dobutamine (n = 14). Blood samples were drawn at baseline, 48 h and 5 days post infusion. Levosimendan produced a significant reduction in BNP compared to baseline, at both 48 h (744.1 F100 vs 1136.3 F 93.7 pg/ml, p = 0.04) and 5 days (446 F 119.3 vs 1136.3 F 93.7 pg/ml, p = 0.03), while IL-6 values decreased after 5 days (4.8 F 1.3 vs 8.6 F 1.5 pg/ml, p = 0.01). MDA levels were significantly lower 5 days after levosimendan compared to baseline (2.3 F 0.2 vs 3 F 0.3 AM, p = 0.01). TNF-a levels did not differ between the groups. The comparison of percentage alteration compared to baseline showed that BNP (À44.5 F 7.6% vs 4.8 F 18.7%, p = 0.025), MDA (À21.8 F 5.1% vs 14.9 F 8.5%, p = 0.001) and IL-6 (À38.8 F 12.5% vs 70.2 F 24%, p = 0.001) levels were significantly lower in the levosimendan group 5 days after treatment compared to the dobutamine group. Conclusions: Treatment with levosimendan in advanced decompensated heart failure exerts a beneficial hemodynamic, anti-inflammatory and antioxidant effect. These findings may give an insight into the favourable impact on mortality that levosimendan appears to have in published multicenter trials.

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Background: Cigarette smoking is strongly related to decreased vagal cardiac activity and increased cardiac death. We sought to examine the short-term effects of smoking on heart rate variability (HRV) in healthy young subjects in the sitting position to investigate the influence of smoking on autonomic cardiac control.Methods: Thirty-two healthy volunteers (18 males, 14 females, 21 habitual smokers and 11 nonsmokers, mean age 30 2 3 years, range 24-36 years) were studied. Smokers were asked not to smoke for 8 hours prior to examination. Mean, SDNN, rMSSD, pNN50, total power, LF, HF, and LF/HF ratio were measured for 30 minutes, divided into six periods of 5 minutes each. Smoking of a single cigarette took place during the second period.Results: Smoking caused a significant increase of the LF/HF ratio and of the normalized values of the LF component. A significant decrease in absolute values of total power, LF, and HF components was noticed. All time-domain indices were significantly decreased. We also noticed that although the changes appeared during smoking (second period) the maximal changes were documented 5 to 10 minutes after smoking cessation (third and fourth periods). Conclusions: Cigarette smoking in the sitting position causes a transient decrease in vagal cardiac control and a moderate sympathetic activation. These changes last for at least 30 minutes and are compatible with a modulation of the autonomic control of the sinoatrial node toward sympathetic predominance. Despite the differences concerning the baseline HRV measures between nonsmokers and habitual smokers, an almost identical pattern of sympathovagal modulation was observed.

Aim To evaluate ventricular-arterial coupling in preclinical cardiovascular disease, we used a new wave intensity approach and tissue Doppler in patients with and without type 2 diabetes mellitus (DM). Methods Sixty-five type 2 diabetes patients and 57 control individuals with normal systolic left ventricular function and without overt coronary or peripheral artery disease were assessed by tissue Doppler for myocardial velocities and by a combined Doppler and echo-tracking system (Aloka SSD-5500, Tokyo) for local arterial stiffness (epsilon, pulse wave velocity) and the characteristic peaks W1 and W2 of pulse wave intensity. Results Diabetes patients had significantly higher systolic blood pressure and pressure derivates (p<0.002). Diastolic myocardial velocity (Ve) was decreased (p<0.001). Epsilon and pulse wave velocity (p<0.001) were higher and so was W1 (11785±7491 vs. 9191±4299, p<0.04) but not W2. In the pooled data, independent predictors for Ve were age, septal wall thickness, Vs and HbA1C (R2 duration of diabetes (R2 0.479). 0.426) and for W1 systolic blood pressure, Vs, W2 and duration of diabetes (R2 0.479). Conclusion In type 2 diabetes pump function is preserved and maintained against increased arterial stiffness and impedance at the expense of increased myocardial oxygen requirements. Tissue Doppler and wave intensity measurements may be useful for therapeutic monitoring.