HOLTER ECG MONITORING IN PATIENTS WITH MEDIAL CALCINOSIS
Introduction: Medial calcinosis is a degenerative and apparently non-inflammatory disease in which the media of small and medium-sized muscular arteries becomes calcified independently of atherosclerosis. The disease is frequently related to diabetes mellitus, aging, male gender, autonomic neuropathy, osteoporosis, chronic kidney disease, smoking, hyperparathyroidism and hyperuricaemia. Decreased ankle-brachial pressure index (ABI) is a well-known cardiovascular risk marker. But also ABI>1.3 in the presence of medial calcinosis is associated with increased cardiovascular morbidity and mortality.
Aim of the study: To determine the incidence of cardiac dysrhythmias and ischemia with the use of Holter ECG monitoring in the group of patients with medial calcinosis.
Patients and methods: 22 individuals (10 men and 12 women) with the mean age of 59 years (range 50-85) were examined. 6 patients used oral hypoglycemic agents and 8 patients were treated with insulin because of diabetes mellitus. 9 patients had signs of chronic renal disease of which five were in the 4th stage according K/DOQI classification. During 1 year follow-up 3 patients died at home. An autopsy was not performed. Holter ECG monitoring with an average duration od 22,16 hours was carried out using Marquette-Hellige General Electric devices with three channel electrodes system and MARS analyzing software. Medial calcinosis was defined using the handheld Doppler probe as ankle-brachial pressure index with a value of 1.3 and more.
Results: Only 2 patients (9 %) had normal Holter ECG record. All other members of the investigated group (91 %) had cardiac dysrhythmia and/or myocardial ischemia. Complex form of dysrhythmia type Lown III B was found in 6 records and type Lown IV A in 5 records. Myocardial ischemia was present in 6 records (27 %).
Conclusions: In our study we found high incidence of cardiac dysrhythmia and myocardial ischemia (91 %). Patients with medial calcinosis are in risk of serious cardiac complications. Therefore interdisciplinary approach to patients is crucial, ABI examination can unveil the person with increased cardiovascular risk.