A 55-year-old woman with stable angina pectoris who had undergone elective coronary catheterization five years ago, no coronary artery disease had been reported at that time. Recent noninvasive stress testing was performed and the result was positive. Coronary angiography was repeated by using iodinated contrast medium. At catheterization, no angiographically significant coronary stenoses was found. About 36 hours after coronary angiography she presented to the emergency department for swelling of face and throat bilaterally. Her parotid glands were diffusely and symmetrically enlarged to twice the normal size and glands were firm and non-tender. This case had taken iodinated contrast medium before and she had the same symptoms. So she might be an example of recurrent parotitis caused by repeated iodide exposure. (Hong Kong j.emerg.med. 2011;18:421-423)

Background/Objectives: Behçet’s disease (BD) is a chronic multisystem inflammatory vasculitis associated with an increased risk of ventricular arrhythmias and sudden cardiac death. The index of cardiac electrophysiological balance (iCEB) and its corrected form (iCEBc) are novel electrocardiographic markers reflecting the balance between ventricular depolarization and repolarization and have been proposed as indicators of arrhythmic risk. This study aimed to evaluate iCEB and iCEBc in patients with BD and to investigate their associations with disease duration and inflammatory activity. Methods: This observational, cross-sectional study included 81 patients with clinically inactive BD (Behçet’s Disease Current Activity Form score 0–1) and 84 age- and sex-matched healthy controls. All participants underwent laboratory testing, transthoracic echocardiography and standard 12-lead electrocardiography. QT, QTc, QRS, iCEB (QT/QRS), and iCEBc (QTc/QRS) values were calculated. Correlation analyses were performed to evaluate the relationships between disease duration and QTc, iCEB, iCEBc, and CRP levels in the Behçet group. Disease duration, age, and CRP levels were subsequently entered into a multivariable linear regression model to identify independent predictors of iCEBc. Results: Patients with BD exhibited significantly higher QTc (431.41 ± 24.18 vs. 410.60 ± 18.65 ms, p < 0.001), iCEB (4.49 ± 0.33 vs. 4.36 ± 0.35, p = 0.016), and iCEBc (5.20 ± 0.47 vs. 4.93 ± 0.33, p < 0.001) values compared with healthy controls. CRP levels were also significantly elevated in the Behçet group (23.34 ± 34.05 vs. 6.07 ± 4.57 mg/L, p < 0.001). Disease duration demonstrated significant positive correlations with QTc (r = 0.539, p < 0.001), iCEB (r = 0.447, p < 0.001), iCEBc (r = 0.747, p < 0.001), and CRP levels (r = 0.419, p < 0.001). In multivariable linear regression analysis, disease duration emerged as the sole independent predictor of iCEBc (β = 0.077, 95% CI: 0.057–0.097, p < 0.001), whereas CRP was not independently associated with iCEBc (p = 0.286). Conclusions: Patients with BD have significantly increased iCEB and iCEBc values, indicating impaired cardiac electrophysiological balance. The strong association between disease duration and iCEBc suggests a relationship between disease duration and electrophysiological alterations associated with ventricular arrhythmia risk. iCEBc may serve as a simple and noninvasive electrocardiographic marker of electrophysiological alterations associated with ventricular arrhythmia risk in patients with BD.

Background/Objectives: Metabolic syndrome (MS) has been demonstrated to be associated with subclinical myocardial dysfunction, which develops in the early stages. It has been hypothesised that traditional echocardiographic parameters may be insufficient in detecting these changes. The frontal QRS-T angle is an electrocardiographic parameter that is easily obtained and that reflects ventricular electrical heterogeneity. This study aimed to examine the relationship between the frontal QRS–T angle and left ventricular myocardial deformation, as assessed by four-dimensional strain echocardiography (4DSE), in patients with MS. Methods: The present cross-sectional study comprised 70 patients diagnosed with MS and 61 healthy individuals matched for age and gender. All participants underwent standard transthoracic and 4DSE examination and 12-lead electrocardiography. The values of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and global area strain (GAS) were analysed. The frontal QRS-T angle was calculated as the absolute difference between the QRS and T axes. The interrelationships between the variables were assessed using correlation and multivariate linear regression analyses. Results: Despite comparable left ventricular ejection fraction (LVEF) between the groups, 4DSE-derived myocardial deformation parameters, including GLS, GCS, GAS, and GRS, were significantly impaired in the MS group. The frontal QRS-T angle was found to be significantly higher in patients diagnosed with MS in comparison to the control group (p < 0.001). A significant correlation was identified between the frontal QRS-T angle and GLS (r = 0.498, p < 0.001). In multivariable linear regression analysis, the frontal QRS–T angle was independently associated with GLS (standardized β = 0.501, p < 0.001). In exploratory receiver operating characteristic (ROC) analysis, the frontal QRS–T angle showed moderate discriminatory ability for GLS-defined impaired myocardial deformation area under the curve (AUC) = 0.720). Conclusions: An increased frontal QRS–T angle in individuals with metabolic syndrome was independently associated with subclinical LV dysfunction despite preserved ejection fraction (EF). These findings suggest that the frontal QRS–T angle may serve as a simple and readily available electrocardiographic marker associated with impaired myocardial deformation, warranting further validation in larger prospective studies.