OBJECTIVE: Lichen planus is a chronic inflammatory autoimmune mucocutaneous disease. Recent research has emphasized the strong association between inflammation and both P-wave dispersion and dyslipidemia. The difference between the maximum and minimum P-wave durations on an electrocardiogram is defined as P-wave dispersion. The prolongation of P-wave dispersion has been demonstrated to be an independent risk factor for developing atrial fibrillation. The aim of this study was to investigate P-wave dispersion in patients with lichen planus. METHODS: Fifty-eight patients with lichen planus and 37 age- and gender-matched healthy controls were included in this study. We obtained electrocardiographic recordings from all participants and used them to calculate the P-wave variables. We also assessed the levels of highly sensitive C-reactive protein, which is an inflammatory marker, and the lipid levels for each group. The results were reported as the means ± standard deviations and percentages. RESULTS: The P-wave dispersion was significantly higher in lichen planus patients than in the control group. Additionally, highly sensitive C-reactive protein, LDL cholesterol, and triglyceride levels were significantly higher in lichen planus patients compared to the controls. There was a significant positive correlation between highly sensitive C-reactive protein and P-wave dispersion (r = 0.549, p<0.001) in lichen planus patients. CONCLUSIONS: P-wave dispersion increased on the surface electrocardiographic measurements of lichen planus patients. This result may be important in the early detection of subclinical cardiac involvement. Increased P-wave dispersion, in terms of the tendency for atrial fibrillation, should be considered in these patients.

FUNDAMENTO: A função endotelial braquial tem sido associada ao fluxo lento coronário (FLC). O aumento do fluxo sanguíneo para a artéria braquial faz com que o endotélio libere óxido nítrico (ON), com subsequente vasodilatação. Além de sua atividade com betabloqueador, o nebivolol provoca vasodilatação, aumentando a liberação endotelial de ON. OBJETIVO: Avaliar os efeitos do nebivolol na função endotelial vascular em pacientes com FLC. MÉTODOS: 46 pacientes com FLC e 23 indivíduos com artérias coronárias epicárdicas normais foram examinados com ecocardiografia transtorácica e ultrassonografia da artéria braquial. Os pacientes foram reavaliados dois meses após o tratamento com aspirina ou aspirina e nebivolol. RESULTADOS: Os pacientes com FLC apresentaram maior índice de massa corporal (26,5 ± 3,3 vs. 23,8 ± 2,8, p < 0,001), tempo de relaxamento isovolumétrico (TRIV) de influxo mitral (114,9 ± 18,0 vs. 95,0 ± 22,0 mseg, p < 0,001), menor fração de ejeção do ventrículo esquerdo (FEVE) (63,5 ± 3,1% vs. 65,4 ± 2,2, p = 0,009), colesterol HDL (39,4 ± 8,5 vs. 45,8 ± 7,7 mg/dL, p = 0,003) e dilatação fluxo-mediada da artéria braquial (DFM) (6,1 ± 3,9% vs. 17,6 ± 4,5%, p <0,001). Houve correlações significativas entre a DFM e a presença de FLC (r = 0,800, p < 0,001) e o colesterol HDL (r = 0,349, p = 0,003). Dos pacientes com FLC, apesar de os valores médios de DFM em pré-tratamento terem sido semelhantes (6,1 ± 4,3% vs. 6,0 ± ,6%, p = 0,917), em comparação com a DFM do grupo em pós-tratamento apenas com aspirina, a DFM apresentou valores significativamente maiores do que os pacientes tratados com aspirina e nebivolol (6,0 ± 3,5% vs. 8,0 ± 2,9%, p = 0,047). Constatou-se que o tratamento com nebivolol está associado a um significativo aumento na DFM (6,0 ± 3,6 a 8,0 ± 2,9 %, p = 0,030), ao passo que o tratamento apenas com aspirina não apresentou a mesma associação. CONCLUSÃO: A função endotelial pode ser comprometida nas artérias coronárias e braquiais em pacientes com FLC, e o nebivolol pode ser eficaz na melhora da função endotelial em pacientes com FLC.

BACKGROUND: Brachial endothelial function has been associated with coronary slow flow (CSF). Increasing blood flow to brachial artery provokes endothelium to release nitric oxide (NO) with subsequent vasodilatation. Besides its β1-blocker activity, nebivolol causes vasodilatation by increasing endothelial NO release. OBJECTIVE: To assess the effects of nebivolol on vascular endothelial function in patients with CSF. METHODS: Forty-six patients with CSF and 23 individuals with normal epicardial coronary arteries were examined with transthoracic echocardiography and brachial artery ultrasonography. The patients were reevaluated two months after treatment with aspirin or aspirin plus nebivolol. RESULTS: Patients with CSF had higher body mass index (26.5 ± 3.3 vs. 23.8 ± 2.8, p < 0.001), mitral inflow isovolumetric relaxation time (IVRT) (114.9 ± 18.0 vs. 95.0 ± 22.0 msec, p < 0.001) and lower left ventricular ejection fraction (LVEF) (63.5 ± 3.1% vs. 65.4 ± 2.2, p = 0.009), HDL-cholesterol (39.4 ± 8.5 vs. 45.8 ± 7.7 mg/dL, p = 0.003) and brachial flow-mediated dilatation (FMD) (6.1 ± 3.9% vs. 17.6 ± 4.5%, p < 0.001). There were significant correlations between FMD and the presence of CSF (r = 0.800, p < 0.001) and HDL-cholesterol (r = 0.349, p = 0.003). Among Patients with CSF, although pretreatment mean FMD values were similar (6.1 ± 4.3% vs. 6.0 ± ,6%, p = 0.917) compared to aspirin alone group, posttreatment FMD was significantly higher in patients treated with aspirin plus nebivolol (6.0 ± 3.5% vs. 8.0 ± 2.9%, p = 0.047). Treatment with nebivolol was associated with a significant increase in FMD (6.0 ± 3.6 to 8.0 ± 2.9 %, p = 0.030) whereas treatment with aspirin alone was not. CONCLUSION: Endothelial function may be impaired in both coronary and brachial arteries in patients with CSF and nebivolol may be effective in the improvement of endothelial function in patients with CSF.

OBJECTIVES: The association between P wave dispersion and iron deficiency anemia has not been documented in the literature. In this study, we evaluated P wave dispersion in patients with iron deficiency anemia and the possible relationships between P wave dispersion and other echocardiographic parameters. INTRODUCTION: The iron status of an individual may play an important role in cardiovascular health. Anemia is an independent risk factor for adverse cardiovascular outcomes. P wave dispersion is a simple electrocardiographic marker that has a predictive value for the development of atrial fibrillation. Apart from cardiovascular diseases, several conditions, such as seasonal variation, alcohol intake and caffeine ingestion, have been demonstrated to affect P wave dispersion. METHODS: The study included 97 patients who had iron deficiency anemia and 50 healthy subjects. The cases were evaluated with a clinical examination and diagnostic tests that included 12-lead electrocardiography and transthoracic echocardiography. RESULTS: Compared to the control group, patients with iron deficiency anemia showed significantly longer maximum P wave duration (Pmax) (91.1±18.0 vs. 85.8±6.7 msec, p=0.054), P wave dispersion (PWD) (48.1±7.7 vs. 40.9±5.6 msec, p<0.001), mitral inflow deceleration time (DT) (197.5±27.9 vs. 178.8±8.9 msec, p<0.001) and isovolumetric relaxation time (IVRT) (93.3±9.2 vs. 77.4±8.2 msec, p<0.001); they also showed increased heart rate (85.7±16.1 vs. 69.0±4.4, p<0.001) and frequency of diastolic dysfunction (7 (7.2%) vs. 0). Correlation analysis revealed that PWD was significantly correlated with IVRT, DT, heart rate, the presence of anemia and hemoglobin level. CONCLUSIONS: Iron deficiency anemia may be associated with prolonged P wave duration and dispersion and impaired diastolic left ventricular filling.

FUNDAMENTO: A variabilidade da frequência cardíaca (VFC) está associada com aumento do fator de risco cardíaco em várias condições. As concentrações de ferro apresentadas por um indivíduo podem ter um papel importante na saúde cardiovascular. OBJETIVO: Avaliar a VFC em pacientes com anemia ferropriva. MÉTODOS: Vinte e três pacientes com anemia ferropriva (hemoglobina (Hb) média = 8,6±2,2 g/dl) e 10 indivíduos saudáveis ( Hb média = 13,9±1,2 g/dl) foram avaliados através de monitoramento ambulatorial por 24 horas (Sistema Holter) durante estadia hospitalar com atividade física limitada. RESULTADOS: Embora a frequência cardíaca (FC) média tenha sido significantemente mais alta em pacientes com anemia, não houve diferença significativa em relação aos parâmetros da VFC quando comparados ao grupo saudável. CONCLUSÃO: Não há diferença significativa nos parâmetros da VFC entre pacientes com anemia ferropriva e indivíduos saudáveis.

BACKGROUND: Heart rate variability (HRV) is associated with increased cardiac risk factor in several conditions. The iron status of an individual may play an important role in cardiovascular health. OBJECTIVE: To evaluate heart rate variability in patients with iron deficiency anemia. METHODS: Twenty-three patients with iron deficiency anemia (mean hemoglobin (Hb) 8.6±2.2 g/dl) and 10 healthy people (mean Hb 13.9±1.2 g/dl) were assessed with 24-hour ambulatory Holter recordings during in hospital course having limited physical activity. RESULTS: Although mean heart rate was significantly higher in patients with anemia, there was no significant difference regarding HRV parameters compared to the healthy group. CONCLUSION: There was no significant difference in HRV parameters between patients with iron deficiency anemia with limited physical activity and healthy ambulatory people.

FUNDAMENTO: La variabilidad de la frecuencia cardiaca (VFC) está asociada al aumento del factor de riesgo cardiaco en varias condiciones. Las concentraciones de hierro presentadas por un individuo pueden ejercer un rol importante para la salud cardiovascular. OBJETIVO: Evaluar la VFC en pacientes con anemia ferropriva. MÉTODOS: Se evaluaron a 23 pacientes con anemia ferropriva (hemoglobina [Hb] media = 8,6±2,2 g/dL) y a 10 individuos sanos (Hb media = 13,9±1,2 g/dL) por medio de monitoreo ambulatorio por 24 horas (Sistema Holter) durante estadía hospitalaria con actividad física limitada. RESULTADOS: Aunque la frecuencia cardiaca (FC) media fue significantemente más alta en pacientes con anemia, no hubo diferencia significante respecto a los parámetros de la VFC en comparación con el grupo de individuos sanos. CONCLUSIONES: No hay diferencia significante en los parámetros de la VFC entre pacientes con anemia ferropriva e individuos sanos.

FUNDAMENTO: Devido à sobreposição de sintomas e inadequada capacidade de exercícios, o diagnóstico não-invasivo da doença arterial coronariana (DAC) pode ser sub ou superestimado em pacientes com doença pulmonar obstrutiva crônica (DPOC). OBJETIVO: Avaliar os resultados de angiografias coronarianas em pacientes com DPOC dependendo das características clínicas basais. MÉTODOS: Os registros médicos de 157 pacientes com DPOC e 157 pacientes sem DPOC pareados por características clínicas basais, que haviam sido submetidos a angiografia coronariana diagnóstica pela primeira vez, foram revisados, retrospectivamente. RESULTADOS: A frequência de DAC era significantemente mais baixa em pacientes com DPOC do que no grupo controle (52,8% vs. 80,2%, p<0,001). As frequências dos fatores de risco para DAC (idade avançada, hipertensão, diabete, histórico de fumo) eram significantemente mais comuns entre os pacientes com DPOC que tinham DAC significativa. Entre os pacientes que reportavam angina pectoris estável, DAC significativa foi detectada em 32,7% dos pacientes com DPOC e em 71,0% dos pacientes sem DPOC (p<0,001). Entretanto, para os pacientes com diagnóstico de angina pectoris instável, DAC significativa foi detectada em 87,5% dos pacientes com DPOC e 90,2% dos pacientes sem DPOC (p=0,755). CONCLUSÃO: O diagnóstico de DAC pacientes com DPOC através da sintomatologia, somente, pode ser difícil. Entretanto, o diagnóstico clínico de DAC no quadro de angina instável é acurado na maioria dos pacientes com DPOC. Assim, outros métodos diagnósticos não-invasivos ou seguimento cuidadoso podem ser mais apropriados para pacientes com DPOC que reportam angina pectoris estável.

BACKGROUND: Due to overlapping symptoms and inadequate exercise capacity, noninvasive diagnosis of coronary artery disease (CAD) may be under- or overestimated in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To assess outcomes of coronary angiography in COPD patients depending on baseline clinical characteristics. METHODS: Medical records of 157 patients with COPD and 157 patients without COPD matched for baseline clinical characteristics who had undergone diagnostic coronary angiography for the first time were reviewed retrospectively. RESULTS: The frequency of significant CAD was significantly lower in COPD patients than in the control group (52.8% vs. 80.2%, p<0.001). Frequencies of CAD risk factors (older age, hypertension, diabetes, smoking history) were significantly more frequent among COPD patients having significant CAD. Among patients reporting stable angina pectoris, significant CAD was detected in 32.7% of COPD patients and 71.0% of non-COPD patients (p<0.001). However, among the patients with a diagnosis of unstable angina pectoris, significant CAD was detected in 87.5% of COPD patients and 90.2% of non-COPD patients (p=0.755). CONCLUSION: Diagnosis of CAD in COPD patients by symptomatology may be difficult. However, clinical diagnosis of CAD in the setting of unstable angina is accurate in most of the COPD patients. Therefore, further noninvasive diagnostic methods or careful follow up may be more appropriate for COPD patients reporting stable angina pectoris.

FUNDAMENTO: A causa de la superposición de síntomas e inadecuada capacidad de ejercicios, el diagnóstico no-invasivo de la enfermedad arterial coronaria (EAC) se puede sub o superestimar en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). OBJETIVO: Evaluar los resultados de angiografías coronarias en pacientes con EPOC dependiendo de las características clínicas basales. MÉTODOS: Se revisaron retrospectivamente los registros médicos de 157 pacientes con EPOC y 157 pacientes sin EPOC distribuidos en grupos según características clínicas basales, que se habían sometido a angiografía coronaria diagnóstica por primera vez. RESULTADOS: La frecuencia de EAC era significantemente más baja en pacientes con EPOC que en el grupo control (52,8% vs. 80,2%, p<0,001). Las frecuencias de los factores de riesgo para EAC (edad avanzada, hipertensión, diabetes, histórico de fumo) eran significantemente más comunes entre los pacientes con EPOC que tenían EAC significante. Entre los pacientes que reportaban angina de pecho estable, se detectó EAC significante en un 32,7% de los pacientes con EPOC y el 71,0% de los pacientes sin EPOC (p<0,001). Sin embargo, para los pacientes con diagnóstico de angina de pecho inestable, se detectó EAC significante en un 87,5% de los pacientes con EPOC y un 90,2% de los pacientes sin EPOC (p=0,755). CONCLUSIONES: El diagnóstico de EAC pacientes con EPOC solamente mediante la sintomatología puede ser difícil. Sin embargo, el diagnóstico clínico de EAC en el cuadro de angina inestable resulta preciso en la mayoría de los pacientes con EPOC. Así, otros métodos diagnósticos no-invasivos o seguimiento cuidadoso pueden ser más apropiados para pacientes con EPOC que refieren angina de pecho estable.