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INTRODUCTION:The ratio of early diastolic transmitral velocity to early mitral annular diastolic velocity (E/Ea) can be used to group patients according to filling pressures. However this relationship has not been validated in the intermediate group (E/Ea = 8-15). The time difference between the onset of E and Ea also correlates with left ventricular (LV) filling pressures. The purpose of our study was to evaluate the correlation between the time interval difference of isovolumic relaxation (T[IVRT-IVRTa]) and N-terminal pro-brain natriuretic peptide (NTpro-BNP) in patients with an intermediate E/Ea ratio.
METHODS:Echocardiography was performed simultaneously with NTpro-BNP measurement in 60 consecutive patients who had an intermediate E/Ea and were in sinus rhythm. Ea and the isovolumic relaxation time (IVRTa) at the septal and lateral sites of the mitral annulus were measured using pulsed tissue Doppler and the average was utilised. Pulsed Doppler was used to measure E and IVRT. E/Ea and IVRT-IVRTa (T[IVRT-IVRTa]) were calculated.
RESULTS:We demonstrated significant correlations between T[IVRT-IVRTa] and NTpro-BNP (r = -0.72, p<0.001), maximal systolic velocity of the mitral annulus (Sa: r = -0.50, p < 0.001), pulmonary artery systolic pressure (r = 0.42, p = 0.002), IVRTa (r = -0.27, p = 0.03), LV ejection fraction (LVEF: r = -0.26, p = 0.04), IVRT (r = -0.24, p = 0.04). We were unable to demonstrate significant relationships between NTpro-BNP and E deceleration time, left atrial diameter/area/volume, Ea or E. By a multiple linear regression analysis, including T[IVRT-IVRTa], IVRT, IVRTa, E/Ea, LVEF, pulmonary artery systolic pressure and Sa as potential determinants, TIVRT-IVRTa (= -0.57, p < 0.001) was shown to be the best independent predictor of NTpro-BNP (r 2 = 0.68, p < 0.001).
CONCLUSIONS:
T[IVRT-IVRTa] correlates strongly with NTpro-BNP levels in patients with intermediate E/Ea, and could be used as a simple echocardiographic index, with reasonable accuracy.

Polymorphic ventricular tachycardia in the form of torsade des pointes occurred in a patient on chronic therapy with amiodarone and a baseline prolonged QT interval, only when ciprofloxacin was added for treatment of urinary tract infection and did not recur after discontinuation of the antibiotic.

Hypertension has been recognized as a major public health issue. The association of hypertension with cardiovascular (CV) morbidity and mortality is well established. Abundant epidemiological data have shown that the risk of CV disease rises with increasing blood pressure (BP) levels, starting at ≥115/75 mm Hg, in a strong, independent, graded and continuous manner. Traditionally the ultimate goal of antihypertensive therapy is the prevention of atherosclerotic cardiovascular (CV) and renal complications and there is no doubt that antihypertensive therapy reduces CV risk. Numerous clinical trials have shown that lowering blood pressure (BP) reduces CV risk by 20% -25% for myocardial infarction, 35%-40% for stroke and by 50% for heart failure. The medical society cannot be proud for this low reduction. It is obvious that a better protection is needed. Today a target of 65 % risk reduction in hypertensives as well as an 80 % in general population seems feasible. Yet, the precise physiologic mechanisms by which hypertension increases CV risk, and antihypertensive therapy lowers the risk, remain unclear 1,2,3 .

at the end of the article Καρδιακή ανεπάρκεια σε ηλικιωμένους Ιδιαίτερα κλινικά και θεραπευτικά προβλήματα Η καρδιακή ανεπάρκεια, με διατηρημένη ή μη συστολική λειτουργία, είναι συχνή σε ηλικιωμένους, ενώ η πρόγνωση του συνδρόμου είναι πτωχή και συνεπάγεται τεράστιο οικονομικό και κοινωνικό κόστος. Δεν υπάρχουν επαρκή βιβλιογραφικά δεδομένα ως προς την παθοφυσιολογία και την αντιμετώπιση του συνδρόμου στη συγκεκριμένη ομάδα των ασθενών, με αποτέλεσμα ο κλινικός ιατρός να αντιμετωπίζει καθημερινά διάφορα διλήμματα. Γενικά, φαίνεται ότι οι ηλικιωμένοι υποθεραπεύονται και αυτό είναι βέβαιο όσον αφορά στην αρτηριακή υπέρταση, η οποία και αποτελεί τον ισχυρότερο τροποποιήσιμο παράγοντα κινδύνου πρόληψης της καρδιακής ανεπάρκειας. Η αυξημένη νοσηρότητα και θνητότητα του συνδρόμου στους ηλικιωμένους επηρεάζονται σημαντικά από τη συνύπαρξη και άλλων νόσων και ειδικά νεφρών και πνευμόνων, καθώς και από την πολυφαρμακία. Επίσης, η παρουσία κοινωνικών προβλημάτων συμβάλλει στην πλημμελή αντιμετώπιση και πρόγνωση των εν λόγω ασθενών και αυτό επιβάλλει μια πολυπαραμετρική παρέμβαση ή συμμετοχή σε προγράμματα αποκατάστασης.

Aim of this study was to investigate the significance of cardiac rehabilitation (CR) on Health Related Quality of Life ( HRQoL) in post acute myocardial infarction (AMI) patients.
Methods. A total number of 110 individuals divided in 3 groups was included in the study. Group A consisted of 60 post-AMI patients participating in a CR program. It was a multidisciplinary rehabilitative approach including supervised bike exercise, with parallel education, counselling, psychological and social support, performed 3 times per week for 2 months after AMI. Group B consisted of 40 post-AMI patients not participating in any CR program while the control group C consisted of 10 apparently healthy people. HRQoL was evaluated by the Velasco-Del Barrio questionnaire. Questions on this questionnaire are refered to 9 categories (health, sleep and rest, emotional behavior, concerns for the future, mobility, social interaction, alertness behavior, communication, work and leisure time). A 5-point scale (1=all of the time, 5=none of the time) and a special (1 to 8 coefficient for each parameter were used for the evaluation of each parameter. The highest score of 220 indicates the poorest QL.Results. Group A patients had better score of HRQoL as compared to Group B (94?±3 vs 114?±3, p < 0.001) and slightly worse than Group C patients (94?±4 vs 69?±3, p < 0.01). Significant difference was found among Group A and B patients regarding the most important evaluated parameters such as symptoms (17 ?±6.8 vs 22?±6.5, p < 0.001) and social behavior (21?±4.2 vs 23?±5.5, p < 0.0001). Conclusion. It is concluded that participation in a multidisciplinary CR program significantly improves HRQoL in post AMI patients. All these patients must urged to take part in such programs. Hippokratia 2006; 10 (4): 176-181

at the end of the article Καρδιακή ανεπάρκεια σε ηλικιωμένους Ιδιαίτερα κλινικά και θεραπευτικά προβλήματα Η καρδιακή ανεπάρκεια, με διατηρημένη ή μη συστολική λειτουργία, είναι συχνή σε ηλικιωμένους, ενώ η πρόγνωση του συνδρόμου είναι πτωχή και συνεπάγεται τεράστιο οικονομικό και κοινωνικό κόστος. Δεν υπάρχουν επαρκή βιβλιογραφικά δεδομένα ως προς την παθοφυσιολογία και την αντιμετώπιση του συνδρόμου στη συγκεκριμένη ομάδα των ασθενών, με αποτέλεσμα ο κλινικός ιατρός να αντιμετωπίζει καθημερινά διάφορα διλήμματα. Γενικά, φαίνεται ότι οι ηλικιωμένοι υποθεραπεύονται και αυτό είναι βέβαιο όσον αφορά στην αρτηριακή υπέρταση, η οποία και αποτελεί τον ισχυρότερο τροποποιήσιμο παράγοντα κινδύνου πρόληψης της καρδιακής ανεπάρκειας. Η αυξημένη νοσηρότητα και θνητότητα του συνδρόμου στους ηλικιωμένους επηρεάζονται σημαντικά από τη συνύπαρξη και άλλων νόσων και ειδικά νεφρών και πνευμόνων, καθώς και από την πολυφαρμακία. Επίσης, η παρουσία κοινωνικών προβλημάτων συμβάλλει στην πλημμελή αντιμετώπιση και πρόγνωση των εν λόγω ασθενών και αυτό επιβάλλει μια πολυπαραμετρική παρέμβαση ή συμμετοχή σε προγράμματα αποκατάστασης.

Various electrocardiography (ECG) abnormalities have been reported in patients who present with pulmonary embolism (PE). Severe sepsis is also associated with ECG changes that may mimic ST elevation myocardial infarction. We report a case of an elderly patient with PE and septic shock associated with striking ECG changes. (Korean Circ J 2011;41:692-693)

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Random Walks (RWs) have been considered for information dissemination in large scale, dynamic and unstructured environments, as they are scalable, robust to topology changes and do not require topology information. Nevertheless, they are relatively slow in reaching out to the network nodes, particularly when applied to wireless networks (such as Wireless Sensor Networks (WSNs)), where the steps of the walk are of limited range, they reach only physically-close neighbours and are unable to move the walker far away from just covered area; as a consequence, time and resources are wasted in revisits of already covered nodes. In this paper we develop an innovative mechanism (referred to as the Jumping Random Walk (J-RW)) that alleviates drastically the aforementioned problems and is shown to improve substantially (compared to the RW) the cover time/overhead or coverage of WSNs modelled as a random geometric graph.

Wireless Sensor Networks are typically bound to operate autonomously on a field, under severe energy constraints and without any centralized control. It is thus essential to develop self-organization protocols/algorithms which enable the autonomous, distributed and energy efficient network selforganization. Budget-based clustering approaches have recently been proposed for this purpose, by specifying rules for distributing a given budget of tokens to neighbors. In this paper, two strictly localized, budget-based clustering algorithms are proposed: the Directed Budget-Based (DBB) and Directed Budget-Based with Random Delays (DBB-RD). The basic, innovative idea is to utilize clustering status information that can be readily available (e.g. through the HELLO exchanges) to reduce or eliminate token distribution contentions (both intra-and intercluster) that severely limit the effectiveness of earlier budgetbased approaches. Simulation results are presented demonstrating a substantial improvement over the earlier approaches with respect to the achieved clustersizes and time to complete network decomposition.

The information dissemination problem in large-scale networking environments like wireless sensor networks and ad hoc networks is studied here considering random geometric graphs and random walk based approaches. A new type of random walk based agent is proposed in this paper and an analytical expression with respect to coverage (i.e., the proportion of the network nodes visited by the random walk agent) as a function of the number of the agent movements is derived. It is observed that the cover time of many of already existing random walk based variants is large in random geometric graphs of low degree (as it is commonly the case is wireless environments). As this inefficiency is attributed (as discussed in the paper) to the inability of existing random walk based solutions to move away from already likely covered areas, a mechanism for directional movement (i.e., jumping) of the random walk based agent is proposed and studied, that allows the agent to jump to different network areas, most likely not covered yet. The proposed mechanism (Jumping Random Walk) is studied analytically and via simulations and the parameters (of the network topology and the mechanism) under which the proposed scheme outperforms existing random walk based variations are determined.

Random Walks have been proposed for information dissemination/discovery in Wireless Sensor Networks. In this work we propose the Random Walk with Jumps model as an improvement on the Random Walk without Jumps for sparse graphs. Our proposal features the incorporation of 'jumps' (with random direction and length) in the otherwise simple random walk movement throughout the graph of sensor nodes. Our proposal is tested via simulations and is shown to outperform the Random Walk without Jumps both in the average number of steps required to partially cover the network and in the overall energy consumption of the nodes in the network.

The design of efficient information dissemination mechanism is a challenging problem in large-scale network with respect to the number of messages and termination time. In this paper, advertisement and searching -the two basic ingredients of information dissemination -are investigated and certain criteria are proposed with respect to the correctness, promptness and fairness of the approach. Based on the complementarity of both advertisement and searching, the aforementioned criteria can be satisfied under certain conditions, which form the baseline of design principles for efficient information dissemination, as analytically -also using numerical results -is investigated here.

A mobile sink is widely considered to facilitate the data collection from energy constrained sensor fields, by having the sink come close to the sensors and conserving precious sensor node energy. The effectiveness of such a data collection approach can be measured in terms of the sensor energy conserved and the time required to collect the sensor data from the field (or, equivalently, the length of the trajectory implemented by the mobile sink).