Electrocardiographic signs of atrial myopathy in patients with rheumatoid arthritis: results from the multicenter prospective EDRA study

Background

Atrial myopathy is a complex condition due to a variety of causes resulting in mechanical and/or electrical remodeling and dysfunction. This can lead to arrhythmias (e.g. atrial fibrillation – AF) and/or heart failure (HF) symptoms. Surface 12-lead electrocardiogram (ECG) may provide the first clues about the presence of left atrial (LA) abnormalities. Interatrial blocks (IAB, partial – pIAB or advanced - aIAB) and abnormal P wave terminal force in lead V1 (aPtfV1) are recognized markers of electromechanical LA dysfunction. Chronic systemic inflammatory diseases are associated with increased cardiovascular risk. An increased incidence of AF has been reported in patients with rheumatoid arthritis (RA). However, the role of ECG with its markers of atrial myopathy in the context of RA have been never investigated so far.

Purpose

This observational cross-sectional study aimed to investigate: 1) the prevalence of ECG signs of atrial myopathy in RA and to compare it with that found in a selected cohort of control subjects; and 2) to assess the independent determinants of the presence of ECG features of atrial myopathy.

Methods

Two-hundred and eighteen patients with RA and 109 controls matched by age, gender and overall cardiovascular-risk profile underwent clinical evaluation and 12-lead ECG. The presence of IAB and or aPtfV1 was carefully investigated in all the ECG tracings. Patients with previous cardiovascular diseases and atrial fibrillation were excluded from the present study.

Results

Mean duration of the P wave on ECG was significantly longer in patients with RA than in controls (118±12 msec vs 112±10 msec, p<0.001). Similarly, pIAB was present in 43% of RA patients vs 21% of controls (p<0.001). The presence of aIAB was a rare finding being present only in 2 patients with RA. An abnormal PtfV1 was more frequently found in RA (27% vs 10%, p<0.001). Overall ECG features of atrial myopathy (i.e. aIAB or pIAB + abnormal PtfV1) were highly prevalent (15% vs 4%, p=0.003) in the RA group. There was a higher percentage of males in the subgroup of patients with RA and atrial myopathy (50% vs 28%, p=0.013). We did not find any relationship between RA disease duration and ECG features of atrial myopathy. On multivariate regression analysis male gender (OR [95% CI] = 3.07 [1.47–6.41], p=0.003) and RA (OR [95% CI] = 4.76 [1.51–14.4], p=0.006) were the only independent predictors of the presence of atrial myopathy on ECG.

Conclusions

ECG signs of atrial myopathy are highly prevalent in patients with RA compared to controls. A low-cost and easily available tool such as surface 12-lead ECG should be used in RA for the investigation and possibly early identification of LA myopathy. Further studies with advanced imaging techniques and specific laboratory markers could confirm these preliminary findings and help clarify the underlying pathophysiological mechanisms and the clinical correlates.

Funding Acknowledgement

Type of funding sources: None.

P3580Impact of glucose-6-phosphate dehydrogenase deficiency on the extent and severity of coronary atherosclerosis in patients with acute coronary syndrome

Background

Studies in animal models and humans suggested that glucose-6-phosphate dehydrogenase (G6PD) deficiency, a genetically inherited condition causing haemolytic anemia, may be considered a risk factor for cardiovascular disease. It is currently unknown whether enzymatic activity may impact the extent and severity of coronary atherosclerosis in patients with acute myocardial infarction. This hypothesis was tested in a cohort of acute coronary syndrome (ACS) patients undergoing invasive management from Northern Sardinia, where the population prevalence of G6PD deficiency is the highest in the Mediterranean area.

Methods

The study was based on a prospective single-centre registry of consecutive ACS patients undergoing coronary angiography and subsequent percutaneous revascularization between January 2017 and December 2018, in which G6PD activity has been measured quantitatively using a biochemical assay based on G6PD/6GPD ratio in erythrocytes. Subjects were defined as deficient when the ratio was <0.80. The primary endpoint of the study was the severity of coronary artery disease as assessed by the SYNTAX I score at baseline angiography.

Results

Among the 466 enrolled patients, 41 (9%) showed G6PD deficiency. Patients with G6PD deficiency were less likely to have a history of dyslipidemia (27% vs 50%; p=0.005) or diabetes (12% vs 21%; p=0.105). As expected, at admission patients with deficiency had lower hemoglobin level (12.1 vs 13.7 g/dL; p=0.005) as compared with those without. By angiography, SYNTAX score resulted as 19±9 and 16±9 (p=0.039) in patients with and without G6PD deficiency; while the number of diseased (with >50% stenosis) vessels was 1.9 vs 1.6 (p=0.089) in the 2 study groups. Left main disease was detected in 15% and 7% (p=0.06) patients, respectively. G6PD deficiency emerged as an independent predictor of high SYNTAX score (OR=2.16, 95% CI 1.1–4.5; p=0.037). Angioplasty with coronary stenting of the culprit vessel was performed in all patients, while GP IIb/IIIa inhibitors were used in 30% and 14% (p=0.009) of patients with and without G6PD deficiency. Finally, in-hospital events were similar between the 2 study groups.

Conclusions

An increased extent and severity of coronary artery disease was observed in ACS patients with G6PD deficiency as compared with those without, despite the lower prevalence of “classic” cardiovascular risk factors.

Fatigue in patients undergoing radiation therapy: an observational study

AIM

Fatigue can be defined as an unpleasant feeling of tiredness, weakness and lack of energy. It is found in about 80% of the patients receiving radiation therapy and has a significant impact on quality of life. The aim of this paper was to assess the frequency, severity and changes of fatigue before, during and after administration of a nutraceutical (mixture of whey protein with an high biological value, with an high content in native cysteine, albumin and lactoferrin in patients undergoing treatment for breast and prostate cancer.

METHODS

Thirty patients (20 breast and 10 prostate ones) were enrolled in our test and they received a questionnaire about Fatigue developed by the University of Texas, MD Anderson Cancer Center, 1999. The patients who achieved a score between 4 and 6 were administered the nutraceutical (Prother) at a dose of 20 g / day for the first 10 days of radiation treatment and then 10 g/day for the following 20 days without considering the terms of the radiation oncology treatment [corrected]. Each patient was reassessed using the same Fatigue test after 10 and 30 days from the start of the administration of nutraceutical. We enrolled 30 control patients who did not receive Prother.

RESULTS

The results showed the effectiveness of Prother in all patients with moderate-to-mild fatigue.

CONCLUSION

The administration of Prother has therefore been effective in terms of both improving the compliance of the radiation treatment and the quality of life.

Different basic fibroblast growth factor and fibroblast growth factor-antisense expression in eutopic endometrial stromal cells derived from women with and without endometriosis

In all species studied, the basic fibroblast growth factor (bFGF) gene is transcribed into multiple mRNAs, one of which is an antisense RNA (1B FGF-AS) probably involved in regulating the stability of the sense transcript. In this study we investigated whether the regulatory mechanisms of bFGF expression might be altered in endometrial stromal cells derived from women with endometriosis. bFGF and 1B FGF-AS mRNA levels were quantified in primary cultures of eutopic endometrial stromal cells derived from 29 women without endometriosis and 24 patients affected by the disease. When the data were analyzed according to the phase of the menstrual cycle, endometrial stromal cells derived from patients in the late proliferative phase showed significantly higher bFGF mRNA values and significantly lower 1B FGF-AS mRNA levels compared with control samples. Furthermore, the mean bFGF/1B FGF-AS mRNA ratio was significantly higher in endometrial stromal cells derived from patients compared with that in controls (mean +/- SEM, 2.31 +/- 0,55 and 0.77 +/- 0.14, respectively; P = 0.009). Moreover, for bFGF expression the differences existing at the mRNA level were maintained at the protein level. These findings support the hypothesis that 1B FGF-AS mRNA could regulate the expression of the sense transcript and suggest that in endometrial cells derived from patients, the presence of higher bFGF levels could improve their ability to proliferate at the ectopic site.

Intercellular adhesion molecule-1 (ICAM-1) gene polymorphisms in endometriosis

Endometriosis is a gynaecological disease with a certain genetic background, but the locations of possible genomic aberrations are still poorly clarified. Intercellular adhesion molecule-1 (ICAM-1), which is a surface glycoprotein that promotes adhesion in immunological and inflammatory reactions, seems to play a role in this condition. The aim of this study was to examine the potential associations of ICAM-1 gene polymorphisms with endometriosis and its severity. Specifically, we have studied two polymorphic sites located in codons 241 (G/R241) and 469 (E/K469) of the ICAM-1 gene. Three hundred and sixty-three Italian Caucasian women of reproductive age who underwent laparoscopy for benign pelvic conditions were enrolled in the study. Endometriosis was documented and staged in 188 women while 175 subjects, in whom endometriosis was laparoscopically ruled out, served as the control group. The frequency of the R241 allele was only marginally higher in endometriosis patients than in controls [5.8 versus 2.9%, P = 0.05; odds ratio (OR), 2.1; 95% confidence interval (CI), 1-4.5]. However, a strikingly high frequency of this allele was found in patients with Stage IV endometriosis versus controls (8.6 versus 2.8%, P = 0.008; OR, 3.2; 95% CI, 1.3-7.9). In contrast, the allele and genotype frequencies of the E/K469 polymorphism did not differ significantly between endometriosis and control groups. While the functional correlate of the G/R241 polymorphism remains unclear, this finding indicates that a genetic polymorphism in the ICAM-1 gene domain may contribute to the susceptibility to endometriosis.

The A19G polymorphism in the 5' untranslated region of the human obese gene does not affect leptin levels in severely obese patients

Recently, the presence of different polymorphisms in the regulatory region of the ob gene has been associated with variations in leptin levels. However, the results of these studies are still contradictory. The aim of the present investigation was to evaluate the presence of the A19G polymorphism in an Italian population of obese patients and to verify its association with leptin levels and anthropometric, metabolic, and clinical parameters. Two hundred five obese patients [body mass index (BMI) > 36 kg/m2; 135 women and 70 men; mean age, 46.9+/-14.23 yr] were screened for presence of the polymorphism; 61 normal-weight controls (mean BMI, 21.05 kg/m2; 53 women, 8 men) were also screened to compare polymorphism frequency. For obese patients, BMI, waist-to-hip ratio, resting energy expenditure, body composition, fasting leptin, total cholesterol, high-density lipoproteins, triglycerides, and caloric intake were determined. Genotype frequencies in obese and control subjects were compared using the contingency table chi-square test; in obese subjects an ANOVA was performed to evaluate association between the polymorphism and several clinical parameters. No significant differences in genotype distribution between control and obese subjects were found. No significant correlations were found between this polymorphism and serum leptin levels and the other parameters considered. These findings confirm the results obtained in both a Finnish and a French population; taken together, these observations might rule out a significant role for the A19->G polymorphism in the regulation of leptin levels and other clinical, anthropometric, and metabolic parameters.

Physical map of the D6S149-D6S193 region on chromosome 6Q27 and its involvement in benign surface epithelial ovarian tumours

A detailed long range restriction map of the region defined by markers D6S149 and D6S193 on chromosome 6q27 has been constructed. This was achieved by YAC cloning and contig assembling of the same region. Seven YAC clones were found to span the almost 1000 Kb region flanked by the two markers which on the genetic map resulted to be 1.9 cM apart. With some of the characterized YAC clones we undertook a molecular cytogenetic analysis of 20 benign ovarian tumors. The rationale for this was the recent mapping to a region of chromosome 6q27, flanked by markers D6281 and D6S133, of a locus for the SV40-mediated immortalization of human cells (SEN6 gene). Noteworthy we found that the the D6S149-D6S193 region (comprised in the larger D6S281-D6S133 physical interval) was altered in all samples analysed adding support to the occurrence of a immortalization step in this type of tumors.