Sex- and/or ethnic-appropriate echocardiographic reference values are indicated for many measurements of LA and LV size, LV mass, and EF. Reference values for LV volumes and mass also differ across the age range.

-wave dispersion (PD) is defined as the difference between the minimum (P min) and maximum (P max) P-wave durations on standard 12-lead electrocardiography (ECG). PD is a measure of heterogeneity of atrial refractoriness and prolongation of PD shows the intra-atrial and inter-atrial non-uniform conduction. 1 In previous studies it was shown that PD prolongation is an independent risk factor for development of atrial fibrillation (AF). 2,3 AF is the most frequently encountered rhythm disturbance in clinical practice and its frequency increases 2-fold in every decade after 55 years old. 4 Although AF is often associated with structural heart diseases, there is no detectable heart disease in a substantial portion of the cases. 5 It was shown in epidemiological studies that the rate of development of AF in diabetic cases is higher than normal cases. 6 The pathological mechanisms related to initiation and maintainance of AF in patients with diabetes mellitus (DM) has not been well described. In diabetic cases it is thought that myocardial ischemia as a result of coronary microcirculation disorders or metabolic stress on atrium can play a role. Hypertension and coronary artery diseases, which are important factors in development of AF, often accompany DM. No study evaluating PD in diabetic cases without hypertension and coronary artery disease has yet been published.In the current study we planned to investigate PD in noncomplicated diabetic patients. MethodsSeventy-six diabetic patients who had no coronary artery disease or hypertension (group1; mean age 48±9 years) and 40 healthy volunteer individuals (group2; mean age 46±13 years) were enrolled in the study. Patients with DM history, taking anti-diabetic medicine and patients whose fasting glucose level is 126mg/dl or above were accepted as diabetic. 7 Of the diabetic cases, 25 (33%) were receiving insulin (mean 26±6U/day) and 51 (67%) of the cases were receiving oral anti-diabetic treatment. The cases whose fundus examination showed retinopathy were not included in the study. Cases with history of myocardial infarction, angina pectoris or other clinical findings of coronary artery diseases were not included in the study. Resting 12-lead ECG and maximal treadmill exercise test (according to Bruce protocol) were performed in every case. Cases who had right bundle-branch block, left bundle-branch block, Wolff-Parkinson-White syndrome, intraventricular conduction defect in resting ECG and anginal chest pain or ischemic ECG changes during the exercise test were excluded from the study. Patients with a history of AF, having a permanent pacemaker, taking anti-arrhythmic medicine, having a thyroid disease, left ventricular hypertrophy, and/or left ventricular dysfunction were also excluded. The 24-h Holter ECG records of the cases were obtained. Holter WIN-PV plus program was used for these records.We paid attention to the patient's renal and hepatic functions and monitored the levels so they were kept in normal Background P-wave dispersion (PD), a measure of heterogeneit...

Circ J 2009; 73: 899 -904 lood pressure (BP) shows diurnal variation, reaching the highest level during the morning and then declining to reach a trough value at about midnight. In the early morning, an abrupt and steep acceleration in BP occurs, coincident with arousal and arising from overnight sleep. 1 However, there is considerable variation in the diurnal rhythm of BP in different individuals.In several studies of hypertensives, it has been shown that several abnormalities in BP circadian rhythm such as nondipping status (NDS), increased morning BP (MBP) and increased MBP surge (MBPS) have an association with cardiovascular (CV) target organ damage (TOD). [2][3][4][5] In normotensives, the relation between the abnormalities in BP circadian rhythm and TOD has not been examined sufficiently. 6,7 Therefore, in the present study, we have attempted to determine each effect of these abnormalities on TOD separately and to determine which abnormality in BP circadian rhythm (NDS, increased MBP or increased MBPS) is more closely related to TOD in normotensives. MethodsBetween December 2005 and December 2007, among the normotensives applying at the Cardiology Clinic of Meram Medical Faculty of Selcuk University who did not exhibit any significant cardiac pathology, 47 dipper subjects (28 women, mean age 45.8±9.3 years) and 32 non-dipper subjects (25 women, mean age 49.1±8.3 years) were included in the present study according to following criteria: (1) office BP <140/90 mmHg; and (2) average 24-h ambulatory BP <130/80 mmHg. 8 None of the subjects selected took antihypertensive medication or had a history of hypertension. Subjects with renal dysfunction (serum creatinine ≥2 mg/dl or macroalbuminuria >300 mg/24 h), hepatic failure, a history of coronary artery disease, stroke, heart failure, arrhythmia, diabetes mellitus, and/or those currently smoking were excluded. Those not smoking for at least last 2 years were accepted to be non-smokers. Subjects who reported in our post-ABPM questionnaire that their sleep was severely disturbed when wearing the ABPM were also excluded. Each was adequately informed about the aim of the present study before he/she was accepted to be enrolled.Office BP was measured using a calibrated mercury sphygmomanometer in an office setting after the subjects had rested at least 5 min in a seated position. Three measurements were taken at 2-min intervals, and the average of these measurements was used to define office systolic BP (SBP) and diastolic BP (DBP). Dyslipidemia was defined by a total cholesterol level >240 mg/dl or taking lipid-lowering agents. Body mass index (BMI) was calculated as weight (kg)/height (m) 2 . The body surface area was calculated according to the following formula in square meters: 0.007184 × weight (kg) 0.425 × height (cm) 0.725 . (Received October 6, 2008; revised manuscript received November 30, 2008; accepted December 25, 2008; released online March 18, 2009

SummaryDoppler-derived myocardial performance index (MPI) has been described as a noninvasive measurement of LV function. Our aim was to investigate the effect of hemodialysis related volume reduction and heart rate changes on the Doppler-derived LV MPI, and Doppler tissue imaging (DTI) derived left and right ventricular MPI.Method: The study group comprised 32 consecutive patients (mean age: 43 ± 18 yrs) undergoing hemodialysis. Patients underwent echocardiography before and immediately after hemodialysis session. Left and right ventricular MPI derived from conventional pulsed-wave Doppler and DTI was calculated. The difference in MPI, heart rate and body weight was calculated before and after hemodialysis.Results: Doppler-derived LV MPI, and right ventricular MPI obtained by DTI were increased (p = 0.05) but the LV MPI obtained by DTI was unchanged after hemodialysis. There is a significant positive correlation between the Doppler-derived LV MPI difference and volume reduction (r = 0.38, p = 0.032). The heart rate difference was correlated with Doppler-derived LV MPI difference, and DTI derived right ventricular MPI difference (r = 0.38, p = 0.034; r = 0.48, p = 0.006, respectively). Whereas, DTI derived LV MPI difference was not correlated with heart rate difference. By the multivariate analysis, there was no correlation between Doppler-derived LV MPI difference with heart rate difference, and volume reduction. Right ventricular MPI difference correlated with heart rate difference (r = 0.41, p = 0.021) but not with volume reduction. Doppler-derived MPI is partially influenced by preload and heart rate changes. However, DTI derived LV MPI is not influenced by preload and heart rate changes.

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