Does Ramadan Fasting Affect Cardiac Functions In Patients Followed With Coronary Artery Disease?

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Ömer Furkan Demir, Fatih Levent, Enes İsmet Erkoç This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3830222/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aims: Ramadan fasting (RF) can affect the health status of patients with cardiovascular disease or risk factors. The aim of this study was to evaluate echocardiographic functions according to RF status in patients being followed up for clinically present coronary artery disease. Methods This single-centre, cross-sectional study included 49 patients who were being followed up with a diagnosis of coronary artery disease and had undergone stent placement at least 1 year previously. The patients were separated into 2 groups as those who were fasting during the month of Ramadan (RF (+), n = 24) and those who were not (RF (-), n = 25). Detailed echocardiographic evaluations were made. Analyses of the study data were performed using MedCalc software. Results The demographic and echocardiographic characteristics of the patients in both groups were similar at the start of the study. When all the patients were evaluated together, there were seen to be no significant changes in the echocardiographic diameter measurements, tissue doppler evaluations, tei index values, and global longitudinal strain values throughout the fasting month. When the fasting and non-fasting groups were compared separately, a statistically significant decrease was determined in the tei index value in the RF (+) group after 1 month of fasting (0.44 ± 0.14 vs. 0.40 ± 0.12) (p:0.025). Conclusions In this study, the effects of RF on cardiac functions were investigated in patients with coronary artery disease and a previous stent procedure. The results of the echocardiograph evaluation after one month of fasting showed a statistically significant decrease in the Tei index in the patient group fasting for Ramadan. This finding demonstrated positive effects of RF on cardiac functions. Ramadan fasting Tei index echocardigraphy coronary artery disease cardiovascular health Introduction The month of Ramadan is a period of fasting in the Islamic calendar when more than a billion Muslims worldwide refrain from eating and drinking between sunrise and sunset each day. This period lasts for 29-30 days. Those who fast during Ramadan make a temporary change to their lifestyle, affecting eating patterns, sleep duration, physical activity, and smoking habits (1). These changes can affect the health status of patients with cardiovascular diseases or risk factors (hypertension, diabetes, dyslipidemia, and imbalanced autonomous nerve activity) (2). Various studies have been conducted in recent years to investigate the effects of Ramadan fasting (RF) on physiological and cardiac performance. Due to positive effects on a healthy life and ageing, RF has been found to be linked to longer life expectancy (3). In a previous study, RF was associated with some cardiac benefits including a decrease in cardiac risk factors (4). However, the detailed effects of RF on cardiac echocardiographic functions in a population with pre-existing coronary artery disease are not clearly known. The main aim of this observational, case-controlled study was to evaluate the echocardiographic functions according to RF status in individuals followed up for clinical coronary artery disease. The effect of RF on cardiac functions in patients with coronary artery disease was examined by evaluating echocardiographic parameters before and after the month of fasting in groups fasting and not fasting for the month of Ramadan. Material And Methods Data Collection This single-centre, cross-sectional study included patients who presented at the Cardiology Polyclinic between February 2023 and March 2023, and had undergone coronary angiography and stent placement at least one year previously because of chronic coronary syndrome. The patients included in the study were separated into two groups as those who were fasting and not fasting for the month of Ramadan. The study exclusion criteria were defined as i) a coronary intervention made again within the last year, ii) the presence of symptoms thought to be of cardiac origin (palpitations, angina, dyspnea), iii) the use of a new drug or dose titration within the last month, iv) the presence of uncontrolled diabetes or another metabolic disease, v) the presence of arrhythmia that would cause suboptimal echocardiographic evaluation, and vi) non-echogenous chest structure. After the implementation of the exclusion criteria, a total of 74 patients were seen to be eligible for the study. The patients were given detailed information about the study, and written informed consent was provided by all the patients included. A record was made for each patient of demographic data, clinical findings and the drugs used. In the 72-hour period before the start of Ramadan on 23 March 2023, a detailed two-dimensional (2D) transthoracic echocardiographic (TTE) evaluation was performed for all the patients. The patients who intended to fast continuously for the 30 days of Ramadan were identified. A total of 25 patients were excluded as they did not fast regularly for the 30 days, or did not attend follow-up appointments, or had recently started new drug treatment. Finally, 49 patients were included in the analyses, separated into two groups as 24 patients who were fasting (RF (+)) and 25 patients who were not fasting (RF (-)). Echocardiographic Evaluation The 2D TTE procedure was performed by an experienced echocardiography specialist who was blinded to the clinical characteristics of the patients. An Epiq 7c Ultrasound System device with a 3.5 MHz transducer (Philips Medical System, Andover, MA, USA) was used in the procedure. In the measurement of the left ventricle parameters, the recommendations of the American Society of Echocardiography Committee were taken into consideration (5). The left ventricle ejection fraction (LVEF) and left ventricle end diastolic volume (LVEDV) values were measured with the modified Simpson method. The Tei index was calculated as the total of the isovolumetric contraction time and relaxation time divided by the LV ejection time (6). For the measurement of basal S’, the average was taken of the S’ waves measured with tissue Doppler pulse wave echocardiography in septum, lateral, anterior, and inferior wall basal segments in apical 2 chamber and apical 4 chamber windows. For the LV global longitudinal strain (GLS) procedure, Automated Cardiac Motion Quantification (aCMQ) software was used (Qlab 10; Philips Medical System, Andover, MA, USA). The digital cineloop images were recorded on frame rate 55 from the R wave peak at the end of expirium, on the apical 2 chamber, apical 3 chamber, and apical 4 chamber window images, respectively. Care was taken that the difference in heart rate between the loop recordings was <10%. Then, reference points were placed manually first on the mitral valve leaflet insertion, left ventricle outflow tract (LVOT), and apex endocardium of the apical 3 chamber recording, then on the left and right mitral valve leaflet insertion and apex endocardium of the apical 2 chamber and apical 4 chamber loop recordings (7). Ater the placement of the reference points on each loop recording, the region of iterest (ROI) was formed automatically by the software drawing endocardial borders. If any regions were incompatible between the line drawn and the endocardial border, they were corrected manually. The GLS score was obtained as the average of 3 strain scores obtained automatically by the software from each ROI on the final recordings. Three measurements were taken for each patient and the average of the measurements was calculated. The same measurements of all the patients in the study were taken again by the same echocardiography specialist within 24 hours of 21 April, which was the date of the end of the month of Ramadan according to the Islamic calendar. Statistical Analysis Data obtained in the study were analyzed statistically using MedCalc Version 20.014 software (MedCalc Software Ltd,Ostend, Belgium). Conformity of the data to normal distribution was assessed with the Kolmogorov-Smirnov test. Continuous data were stated as mean±standard deviation values if distribution was normal and as median and interquartile range (IQR 25 th -75 th ) values if not showing normal distribution. Categorical data were stated as number (n) and percentage (%). Comparisons between the two groups (RF+/RF-) were made using the Independent Samples t-test for continuous variables with normal distribution and the Mann Whitney U-test when distribution was not normal, and categorical variables were compared using the Chi-square test. Comparisons of the basal and final values of the echocardiographic parameters were made using the Paired Samples t-test (normal distribution of data) or the Wilcoxon test (non-normal distribution of data). To evaluate observer agreement of the LVEF, tei index, and GLS measurements, the root mean square method was used with the Intraclass Coefficient test on 10 patients selected at random. In all the tests, a value of p<0.05 was accepted as statistically significant. Results Evaluation was made of 49 patients, comprising 37 (75.5%) males and 12 (24.5%) females with a mean age of 62.8±7.9 years. No statistically significant difference was determined between the fasting and non-fasting patients in respect of age, gender, body mass index (BMI), smoking status, hypertension, diabetes mellitus, drugs used, laboratory values, residual syntax scores, and basal GLS values. The comparisons of the two groups are shown in Table 1. The BMI values of the RF (+) group were similar at baseline and at the end of the fasting month (31.8 ± 4.9 vs 31.3 ± 4.9 kg/m2, p:0.145). The intraobserver intraclass coefficients were calculated as 0.85 (0.43-0.96) for LVEF, 0.95 (0.78-0.98) for the tei index, and 0.94 (0.75-0.98) for GLS. No statistically significant difference was determined between the baseline values and the values at the end of Ramadan of the echocardiographic parameters of all the patients (Table 2). When all the patients were evaluated together, there were determined to be no significant changes in the echocardiographic diameter measurements, tissue Doppler evaluations, tei index values, and GLS values throughout the fasting month. When the fasting and non-fasting groups were compared separately, no significant change in the echocardiographic parameters was determined in the RF (-) group. In the RF (+) group, a statistically significant decrease was determined in the tei index value after 1 month of fasting (0.44±0.14 vs. 0.40±0.12, p:0.025). No significant change was determined in the other echocardiographic parameters in this group (Table 3). Discussion The aim of this study was to investigate the effects of fasting during the month of Ramadan on cardiac functions in patients with coronary artery disease who had previously undergone a stent procedure. The results of the echocardiographic evaluation after the fasting period showed a significant decrease in the tei index in the patients who fasted for the month of Ramadan. This shows that Ramadan fasting could have positive effects on cardiac functions. To the best of our knowledge, this is the first study in literature to have investigated the effect of Ramadan fasting on cardiac functions. When all the patients were evaluated at the end of the study, there was observed to be no significant change in the BMI values in both groups. There was expected to be a decrease in BMI in the RF (+) group as they had no food or water intake for the whole day. In previous studies on this subject, decreases in BMI values have been observed after RF (8). However, in other studies it has been shown that patients could gain weight after RF (9). That these values remained stable in the current study was thought to be due to weight gain being triggered by the wish to eat more because of the high level of hunger and thirst when breaking the fast and going to sleep after eating in the early hours at the start of the fast. The Tei index (Myocardial Performance Index -MPI) which includes both systolic and diastolic time intervals, was used by Tei et al. in 1995 to evaluate global cardiac function disorders (10). The tei index can be measured using continuous wave doppler and repeated measurements can be easily performed. This index can be used to evaluate right and left heart function and provides an estimation of combined systolic and diastolic function. The tei index is primarily used in cases of amyloidosis, dilated cardiomyopathy, ischaemic heart disease, and congestive heart failure. It has been documented in many studies that in patients in the supine position the tei index is independent of arterial pressure, heart rate, ventricular geometry, atrioventricular valve failure, after-load and pre-load, so standardisation of the tei index is not necessary (10-13). In previous studies related to the tei index, significant relationships have been determined between the prolongation of the duration of this index and poor results that could develop in the long term. Especially in a study by Kishore et al., the probability of end-stage heart failure and death occurring in a 2-year follow-up period was determined to be 5-fold greater in patients with Tei index >1.4, independently of all other causes (14). When the two groups in the current study who were fasting and not fasting during Ramadan were compared, the echocardiographic parameters were determined to be similar. A significant difference was determined only in the tei index between the patients. In the patients who were fasting during Ramadan, a significant decrease was determined in the tei index after 1 month of fasting. A previous study conducted with a drug that had an effect on energy metabolism, showed that the tei index values were significantly decreased during the follow up of patients who were taking the drug (15). This drug made changes in the energy metabolism by affecting fatty acid oxidation within the cell. Therefore, the changes in enegy metabolism occurring in the fasting group, the decrease in body fat ratio and the positive changes occurring in body composition (16) are thought to be responsible for the decrease in the tei index in this group. The results obtained in this study showed that RF had positive effects on the body together with a decrease in body fat, weight loss, and changes in body composition as in previous studies (16). However, there is no study in the literature that has evaluated the effects of RF on echocardiographic parameters in patients with coronary heart disease and coronary stent. From the results of this study, there was determined to be a significant decrease in the tei index of patients following RF. Thus, it can be considered that this study will shed light on future studies which aim to decrease the risk of adverse events that may develop in patients following RF. Conclusion In this study, the effects of RF on cardiac functions were investigated in patients with coronary artery disease and a previous stent procedure. The results of the echocardiograph evaluation after one month of fasting showed a statistically significant decrease in the tei index in the patient group fasting for Ramadan. This finding demonstrated that Ramadan fasting could have positive effects on cardiac functions. To the best of our knowledge, this is the first study to have evaluated the effect of Ramadan fasting on cardiac functions. Study Limitations As the study had to be conducted within the short period of the month of Ramadan, a greater number of patients could not be included. Despite the low number of patients, the study can be considered to make a very important mark. It was shown that the cardiac functions of patients improved with RF, which is a religious obligation undertaken by a significant proportion of Muslims. This study can be of guidance for further larger scale studies on this subject. Declarations Ethics Committee Approval All the procedures in this study including human participants were applied in compliance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and subsequent revisions or comparable ethical standards. No animals were used in this study. Approval for the study was granted by the Local Ethics Committee. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding There is no funding source for the research. Authors' contributions -EIE echocardiographic screening and recruitment of patients, -FL, collecting patients and entering statistical data - OFD, revealing the idea, literature review, statistical analysis of the data, transcribing the study Acknowledgements Not applicable. References Norouzy A, Salehi M, Philippou E, et al. Effect of fasting in Ramadan on body composition and nutritional intake: a prospective study. J Hum Nutr Diet. 2013;26(Suppl 1):97–104. 10.1111/jhn.12042 . Salim I, Al Suwaidi J, Ghadban W, Alkilani H, Salam AM. Impact of religious Ramadan fasting on cardiovascular disease: a systematic review of the literature. Curr Med Res Opin. 2013;29(4):343–54. 10.1185/03007995.2013.774270 . Persynaki A, Karras S, Pichard C. Unraveling the metabolic health benefits of fasting related to religious beliefs: A narrative review. Nutrition. 2017;35:14–20. 10.1016/j.nut.2016.10.005 . Nematy M, Alinezhad-Namaghi M, Rashed MM et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. Nutr J . 2012;11:69. Published 2012 Sep 10. 10.1186/1475-2891-11-69 . Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–63. 10.1016/j.echo.2005.10.005 . Voulgari C, Moyssakis I, Papazafiropoulou A, et al. The impact of metabolic syndrome on left ventricular myocardial performance. Diabetes Metab Res Rev. 2010;26(2):121–7. 10.1002/dmrr.1063 . Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79–108. 10.1016/j.euje.2005.12.014 . Zouhal H, Bagheri R, Triki R, et al. Effects of Ramadan Intermittent Fasting on Gut Hormones and Body Composition in Males with Obesity. Int J Environ Res Public Health. 2020;17(15):5600. 10.3390/ijerph17155600 . Published 2020 Aug 3. Lessan N, Ali T. Energy Metabolism and Intermittent Fasting: The Ramadan Perspective. Nutrients. 2019;11(5):1192. 10.3390/nu11051192 . Published 2019 May 27. Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function–a study in normals and dilated cardiomyopathy. J Cardiol. 1995;26(6):357–66. Møller JE, Søndergaard E, Poulsen SH, Appleton CP, Egstrup K. Serial Doppler echocardiographic assessment of left and right ventricular performance after a first myocardial infarction. J Am Soc Echocardiogr. 2001;14(4):249–55. 10.1067/mje.2001.111478 . Tei C, Dujardin KS, Hodge DO, Kyle RA, Tajik AJ, Seward JB. Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis. J Am Coll Cardiol. 1996;28(3):658–64. 10.1016/0735-1097(96)00202-1 . Møller JE, Poulsen SH, Egstrup K. Effect of preload alternations on a new Doppler echocardiographic index of combined systolic and diastolic performance. J Am Soc Echocardiogr. 1999;12(12):1065–72. 10.1016/s0894-7317(99)70103-3 . Harjai KJ, Scott L, Vivekananthan K, Nunez E, Edupuganti R. The Tei index: a new prognostic index for patients with symptomatic heart failure. J Am Soc Echocardiogr. 2002;15(9):864–8. 10.1067/mje.2002.120892 . Jatain S, Kapoor A, Sinha A, et al. Metabolic manipulation in dilated cardiomyopathy: Assessing the role of trimetazidine. Indian Heart J. 2016;68(6):803–8. 10.1016/j.ihj.2016.04.023 . Finch GM, Day JE, Razak, Welch DA, Rogers PJ. Appetite changes under free-living conditions during Ramadan fasting. Appetite. 1998;31(2):159–70. 10.1006/appe.1998.0164 . Tables Table-1: The baseline characteristics and laboratory investigations of all patients All patients (n:49) RF (-) (n:25) RF (+) (n:24) P value Demographic characteristics Age, mean ± SD 62.8 ± 7.9 63.5 ±7.3 62.2 ± 8.5 0.543 Male, n (%) 37 (75.5) 16 (64.0) 21 (87.5) 0.056 Baseline BMI, mean ± SD 31.1 ± 6.9 30.6 ± 8.5 31.66 ±4.9 0.606 Δ BMI, mean ± SD -0.25 ± 1.4 -0.02 ± 1.4 -0.5 ± 1.5 0.279 Comorbidities Diabetes, n (%) 17 (34.7) 11 (44.0) 6 (25.0) 0.162 Hypertension, n (%) 33 ( 67.3) 17 (68.0) 16 (66.7) 0.921 Smoking, n (%) 10 (20.4) 7 (28.0) 3 (12.5) 0.178 Medications ASA use, n (%) 39 (79.5) 19 (76.0) 20 (83.3) 0.524 Clopidogrel use, n (%) 17 ( 34.6) 11 (44.0) 6 (25.0) 0.162 Beta Blocker use, n (%) 45 (91.8) 22 (88.0) 23 (95.8) 0.609 ACE inh/ARB use, n (%) 40 (81.6) 20 (80.0) 20 (83.3) 0.763 Statin use, n (%) 43 (87.7) 21 (84.0) 22 (91.7) 0.667 Laboratory assessment Wbc, × 10 9 /l, mean ± SD 8.2 ± 1.6 8.3 ± 1.7 8.1 ± 1.6 0.558 Hemoglobin g/dl, mean ± SD 13.9 ± 1.5 13.9 ± 1.6 13.8 ± 1.3 0.793 Creatinine mg/dL, mean ± SD 0.9 ± 0.2 0.9 ± 0.2 0.8 ± 0.1 0.082 TSH mIU/L, median (25th-75th) 1.1 (0.6-1.9) 1.0 (0.5-1.9) 1.1 (0.7-1.9) 0.719 LDL-C mg/dl, mean ± SD 119.5 ± 41.0 115.4 ± 44.3 123.9 ± 37.6 0.476 Triglycerides, mg/dL, mean ± SD 185.1 ± 96.4 197.2 ± 101.7 172.6 ± 91.0 0.377 HDL-C, mg/dL, mean ± SD 45.9 ± 9.7 46.5 ± 11.1 45.2 ± 8.1 0.656 rSS median(25th-75th) 2 (0-4) 2 (0-5) 1.5 (0-3) 0.537 Baseline GLS %, mean ± SD 15.2 ± 2.1 15.1 ± 2.4 15.4 ± 1.7 0.590 Data are presented as median (interquartile range) or number (percentage) of patients. Abbreviations: ASA, asetilsalisilic asid; BMI, body mass index; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blockers; GLS, global longitudinal strain; HDL-C, high-density lipoprotein cholesterol; LDL-C, low‐density lipoprotein cholesterol; RF, ramadan fasting; rSS, residual syntax score; SD, standard deviation; TSH, thyroid stimulating hormone; Wbc, white blood cells Table-2: Comparison of the initial values of echocardiographic parameters of all patients and their values after ramadan fasting Variable Baseline Follow up P value LVEDD mm, mean ± SD 48.4 ± 5.1 48.0 ± 3.9 0.379 LVEDV ml mean ± SD 111.0 ± 26.2 107.4 ± 23.3 0.132 LVEF % mean ± SD 61.4 ± 5.6 61.7 ± 5.5 0.529 RV mm, mean ± SD 34.7 ± 5.5 35.1 ± 5.1 0,121 E/A, mean ± SD 0.9 ± 0.2 0.9 ± 0.2 0,826 EDT ms mean ± SD 220.5 ± 37.0 215.0 ± 31.1 0.071 Septal E’ cm/s mean ± SD 6.8± 1.4 7.0 ± 1.1 0.097 Septal S’ cm/s, mean ± SD 7.0 ± 1.3 7.1 ± 1.1 0.390 Lateral S’ cm/s, mean ± SD 8.1 ± 1.5 8.1 ± 1.4 0.736 Inferior S’ cm/s, mean ± SD 7.6 ± 1.5 7.6 ± 1.1 0.699 Anterior S’ cm/s, mean ± SD 7.4 ± 1.5 7.4 ± 1.2 0.940 Tei index , mean ± SD 0.44 ± 0.1 0.42 ± 0.1 0.104 GLS %, mean ± SD -15.2 ± 2.1 - 15.4 ± 2.4 0.522 Data are presented as median (interquartile range) or number (percentage) of patients. Abbreviations: EDT, E wave deceleration time; GLS, global longitudinal strain; IVS, intraventricular septum; LA, left atrium; LVEDD, left ventricular end-diastolic diameter; LVEDV, left ventricular end-diastolic volüme; LVEF, left ventricular ejection fraction; PW, posterior wall; RV, right ventricle Table-3: Separate comparison of the patients' echocardiographic parameters with their baseline values and values after the ramadan fasting month Ramadan Fasting (-) Group Variable Baseline Follow up P value LVEDD mm, mean ± SD 48.5 ± 5.2 48.1 ± 4.4 0.603 LVEDV ml mean ± SD 111.3 ± 30.1 109.6 ± 28.5 0.592 LVEF % mean ± SD 61.1 ± 6.0 60.7 ± 5.9 0.438 RV mm, mean ± SD 33.6 ± 5.8 34.4 ± 5.5 0.119 E/A, mean ± SD 0.9 ± 0,3 0.9 ± 0.3 0,990 EDT ms mean ± SD 216.4 ± 41.7 210.8 ± 35.9 0.143 Septal E’ cm/s mean ± SD 6.5 ± 1.5 6.7 ± 1.3 0.359 Septal S’ cm/s, mean ± SD 6.9 ± 1.4 6.9 ± 1.3 0,484 Lateral S’ cm/s, mean ± SD 7.8 ± 1.5 7.9 ± 1.5 0.851 Inferior S’ cm/s, mean ± SD 7.1 ± 1.4 7.3 ± 1.2 0.253 Anterior S’ cm/s, mean ± SD 7.1 ± 1,4 7.2 ± 1.2 0.602 Tei index , mean ± SD 0.43 ± 0.17 0.43 ± 0.14 0.960 GLS %, mean ± SD -15.1 ± 2.5 - 14.7 ± 2.3 0.276 Ramadan Fasting (+) Group Variable Baseline Follow up P value LVEDD mm, mean ± SD 48.4 ± 5.0 47.9 ± 3.2 0.474 LVEDV ml mean ± SD 110.7 ± 22.1 105.1 ± 16.6 0.126 LVEF % mean ± SD 61.7 ± 5.2 62.7 ± 5.0 0.154 RV mm, mean ± SD 35.9 ± 5.0 36.0 ± 4.6 0.597 E/A, mean ± SD 0.8 ± 0.2 0.9 ± 0.1 0.748 EDT ms mean ± SD 224.8 ± 31.7 219.4 ± 25.1 0.271 Septal E’ cm/s mean ± SD 7.1 ± 1.2 7.4 ± 0.9 0.145 Septal S’ cm/s, mean ± SD 7.1± 1.2 7.2 ± 0.9 0.615 Lateral S’ cm/s, mean ± SD 8.4 ± 1.5 8.2 ± 1.2 0.565 Inferior S’ cm/s, mean ± SD 8.1 ± 1.4 7.8 ± 0.9 0,068 Anterior S’ cm/s, mean ± SD 7.6 ± 1.6 7.5 ± 1.3 0.580 Tei index , mean ± SD 0.44 ± 0.14 0.40 ± 0.12 0.025 GLS %, mean ± SD -15.4 ± 1.7 - 16.1 ± 2.4 0.083 Data are presented as median (interquartile range) or number (percentage) of patients. Abbreviations: EDT, E wave deceleration time; GLS, global longitudinal strain; IVS, intraventricular septum; LA, left atrium; LVEDD, left ventricular end-diastolic diameter; LVEDV, left ventricular end-diastolic volüme; LVEF, left ventricular ejection fraction; PW, posterior wall; RV, right ventricle Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3830222","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":265111226,"identity":"8ec04754-f78c-4487-86d3-e04667b7909c","order_by":0,"name":"Ömer Furkan Demir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYDCCA2AEBMwHGBgbGBjkwIIPiNLClgDWYgwWTCCghQFZS2IDiINPC9/x7sTDFRXb5MzbeMw+zqi5kz4/7PBDoC12croN2LVInjm74eCZM7eNZY7xGM/ccOxZ7sbbaQZALcnGZgewazG4kbvhYGPb7cQZ8j3GjA/YDudunJ0A0nIgcRsuLfffgrXUz2DjAWr5dzjdcHb6B/xabvCCtSRIgLRsbDucIC+dg98WyTNAhzWcuW04g42tmHFm32HDDdI5BQcSDHD7he/42c0fGypuy0uwMW9m7Pl2WF5+dvrmDx8q7ORwacHiVLBKA2KVg4B8AymqR8EoGAWjYCQAAGgVbfNCZtb7AAAAAElFTkSuQmCC","orcid":"","institution":"Bursa Yuksek Ihtisas Egitim Ve Arastirma Hastanesi","correspondingAuthor":true,"prefix":"","firstName":"Ömer","middleName":"Furkan","lastName":"Demir","suffix":""},{"id":265111227,"identity":"790ab1ad-d54c-4509-b397-ad1eb5128bc7","order_by":1,"name":"Fatih Levent","email":"","orcid":"","institution":"Bursa Yuksek Ihtisas Egitim Ve Arastirma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Fatih","middleName":"","lastName":"Levent","suffix":""},{"id":265111228,"identity":"f9c83397-eea6-4af3-8058-0053a7fed704","order_by":2,"name":"Enes İsmet Erkoç","email":"","orcid":"","institution":"Bursa Yuksek Ihtisas Egitim Ve Arastirma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Enes","middleName":"İsmet","lastName":"Erkoç","suffix":""}],"badges":[],"createdAt":"2024-01-02 19:29:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3830222/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3830222/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54023838,"identity":"9fee5c4c-830b-46cf-b3e0-7b35ea9751b2","added_by":"auto","created_at":"2024-04-03 14:15:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":370726,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3830222/v1/192638fb-b718-436c-bf1e-41e30c3256a4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does Ramadan Fasting Affect Cardiac Functions In Patients Followed With Coronary Artery Disease?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe month of Ramadan is a period of fasting in the Islamic calendar when more than a billion Muslims worldwide refrain from eating and drinking between sunrise and sunset each day. This period lasts for 29-30 days. Those who fast during Ramadan make a temporary change to their lifestyle, affecting eating patterns, sleep duration, physical activity, and smoking habits (1). These changes can affect the health status of patients with cardiovascular diseases or risk factors (hypertension, diabetes, dyslipidemia, and imbalanced autonomous nerve activity) (2). Various studies have been conducted in recent years to investigate the effects of Ramadan fasting (RF) on physiological and cardiac performance. Due to positive effects on a healthy life and ageing, RF has been found to be linked to longer life expectancy (3). In a previous study, RF was associated with some cardiac benefits including a decrease in cardiac risk factors (4). However, the detailed effects of RF on cardiac echocardiographic functions in a population with pre-existing coronary artery disease are not clearly known.\u003c/p\u003e\n\u003cp\u003eThe main aim of this observational, case-controlled study was to evaluate the echocardiographic functions according to RF status in individuals followed up for clinical coronary artery disease. The effect of RF on cardiac functions in patients with coronary artery disease was examined by evaluating echocardiographic parameters before and after the month of fasting in groups fasting and not fasting for the month of Ramadan.\u0026nbsp;\u003c/p\u003e"},{"header":"Material And Methods","content":"\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis single-centre, cross-sectional study included patients who presented at the Cardiology Polyclinic between February 2023 and March 2023, and had undergone coronary angiography and stent placement at least one year previously because of chronic coronary syndrome. The patients included in the study were separated into two groups as those who were fasting and not fasting for the month of Ramadan. The study exclusion criteria were defined as i) a coronary intervention made again within the last year, ii) the presence of symptoms thought to be of cardiac origin (palpitations, angina, dyspnea), iii) the use of a new drug or dose titration within the last month, iv) the presence of uncontrolled diabetes or another metabolic disease, v) the presence of arrhythmia that would cause suboptimal echocardiographic evaluation, and vi) non-echogenous chest structure. After the implementation of the exclusion criteria, a total of 74 patients were seen to be eligible for the study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe patients were given detailed information about the study, and written informed consent was provided by all the patients included. A record was made for each patient of demographic data, clinical findings and the drugs used. In the 72-hour period before the start of Ramadan on 23 March 2023, a detailed two-dimensional (2D) transthoracic echocardiographic (TTE) evaluation was performed for all the patients. The patients who intended to fast continuously for the 30 days of Ramadan were identified. A total of 25 patients were excluded as they did not fast regularly for the 30 days, or did not attend follow-up appointments, or had recently started new drug treatment. Finally, 49 patients were included in the analyses, separated into two groups as 24 patients who were fasting (RF (+)) and 25 patients who were not fasting (RF (-)).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEchocardiographic Evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 2D TTE procedure was performed by an experienced echocardiography specialist who was blinded to the clinical characteristics of the patients. An Epiq 7c Ultrasound System device with a 3.5 MHz transducer (Philips Medical System, Andover, MA, USA) was used in the procedure. In the measurement of the left ventricle parameters, the recommendations of the American Society of Echocardiography Committee were taken into consideration (5). The left ventricle ejection fraction (LVEF) and left ventricle end diastolic volume (LVEDV) \u0026nbsp;values were measured with the modified Simpson method. The Tei index was calculated as the total of the isovolumetric contraction time and relaxation time divided by the LV ejection time (6). For the measurement of basal S\u0026rsquo;, the average was taken of the S\u0026rsquo; waves measured with tissue Doppler pulse wave echocardiography in septum, lateral, anterior, and inferior wall basal segments in apical 2 chamber and apical 4 chamber windows.\u003c/p\u003e\n\u003cp\u003eFor the LV global longitudinal strain (GLS) procedure, Automated Cardiac Motion Quantification (aCMQ) software was used (Qlab 10; Philips Medical System, Andover, MA, USA). The digital cineloop images were recorded on frame rate 55 from the R wave peak at the end of expirium, on the apical 2 chamber, apical 3 chamber, and apical 4 chamber window images, respectively. Care was taken that the difference in heart rate between the loop recordings was \u0026lt;10%. Then, reference points were placed manually first on the mitral valve leaflet insertion, left ventricle outflow tract (LVOT), and apex endocardium of the apical 3 chamber recording, then on the left and right mitral valve leaflet insertion and apex endocardium of the apical 2 chamber and apical 4 chamber loop recordings (7). Ater the placement of the reference points on each loop recording, the region of iterest (ROI) was formed automatically by the software drawing endocardial borders. If any regions were incompatible between the line drawn and the endocardial border, they were corrected manually. The GLS score was obtained as the average of 3 strain scores obtained automatically by the software from each ROI \u0026nbsp;on the final recordings. Three measurements were taken for each patient and the average of the measurements was calculated. The same measurements of all the patients in the study were taken again by the same echocardiography specialist within 24 hours of 21 April, which was the date of the end of the month of Ramadan according to the Islamic calendar. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData obtained in the study were analyzed statistically using MedCalc Version 20.014 software (MedCalc Software Ltd,Ostend, Belgium). Conformity of the data to normal distribution was assessed with the Kolmogorov-Smirnov test. Continuous data were stated as mean\u0026plusmn;standard deviation values if distribution was normal and as median and interquartile range (IQR 25\u003csup\u003eth\u003c/sup\u003e-75\u003csup\u003eth\u003c/sup\u003e) values if not showing normal distribution. Categorical data were stated as number (n) and percentage (%). Comparisons between the two groups (RF+/RF-) were made using the Independent Samples t-test for continuous variables with normal distribution and the Mann Whitney U-test when distribution was not normal, and categorical variables were compared using the Chi-square test. Comparisons of the basal and final values of the echocardiographic parameters were made using the Paired Samples t-test (normal distribution of data) or the Wilcoxon test (non-normal distribution of data). To evaluate observer agreement of the LVEF, tei index, and GLS measurements, the root mean square method was used with the Intraclass Coefficient test on 10 patients selected at random. In all the tests, a value of p\u0026lt;0.05 was accepted as statistically significant.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eEvaluation was made of 49 patients, comprising 37 (75.5%) males and 12 (24.5%) females with a mean age of 62.8\u0026plusmn;7.9 years. No statistically significant difference was determined between the fasting and non-fasting patients in respect of age, gender, body mass index (BMI), smoking status, hypertension, diabetes mellitus, drugs used, laboratory values, residual syntax scores, and basal GLS values. The comparisons of the two groups are shown in Table 1. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe BMI values of the RF (+) group were similar at baseline and at the end of the fasting month (31.8 \u0026plusmn; 4.9 vs 31.3 \u0026plusmn; 4.9 kg/m2, p:0.145). The intraobserver intraclass coefficients were calculated as 0.85 (0.43-0.96) for LVEF, 0.95 (0.78-0.98) for the tei index, and 0.94 (0.75-0.98) for GLS. No statistically significant difference was determined between the baseline values and the values at the end of Ramadan of the echocardiographic parameters of all the patients (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen all the patients were evaluated together, there were determined to be no significant changes in the echocardiographic diameter measurements, tissue Doppler evaluations, tei index values, and GLS values throughout the fasting month. When the fasting and non-fasting groups were compared separately, no significant change in the echocardiographic parameters was determined in the RF (-) group. In the RF (+) group, a statistically significant decrease was determined in the tei index value after 1 month of fasting (0.44\u0026plusmn;0.14 vs. 0.40\u0026plusmn;0.12, p:0.025). No significant change was determined in the other echocardiographic parameters in this group (Table 3).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to investigate the effects of fasting during the month of Ramadan on cardiac functions in patients with coronary artery disease who had previously undergone a stent procedure. The results of the echocardiographic evaluation after the fasting period showed a significant decrease in the tei index in the patients who fasted for the month of Ramadan. This shows that Ramadan fasting could have positive effects on cardiac functions. To the best of our knowledge, this is the first study in literature to have investigated the effect of Ramadan fasting on cardiac functions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen all the patients were evaluated at the end of the study, there was observed to be no significant change in the BMI values in both groups. There was expected to be a decrease in BMI in the RF (+) group as they had no food or water intake for the whole day. In previous studies on this subject, decreases in BMI values have been observed after RF (8). However, in other studies it has been shown that patients could gain weight after RF (9). That these values remained stable in the current study was thought to be due to weight gain being triggered by the wish to eat more because of the high level of hunger and thirst \u0026nbsp;when breaking the fast and going to sleep after eating in the early hours at the start of the fast.\u003c/p\u003e\n\u003cp\u003eThe Tei index (Myocardial Performance Index -MPI) which includes both systolic and diastolic time intervals, was used by Tei et al. in 1995 to evaluate global cardiac function disorders (10). The tei index can be measured using continuous wave doppler and repeated measurements can be easily performed. This index can be used to evaluate right and left heart function and provides an estimation of combined systolic and diastolic function. The tei index is primarily used in cases of amyloidosis, dilated cardiomyopathy, ischaemic heart disease, and congestive heart failure. It has been documented in many studies that in patients in the supine position the tei index is independent of arterial pressure, heart rate, ventricular geometry, atrioventricular valve failure, after-load and pre-load, so standardisation of the tei index is not necessary (10-13). In previous studies related to the tei index, significant relationships have been determined between the prolongation of the duration of this index and poor results that could develop in the long term. Especially in a study by Kishore et al., the probability of end-stage heart failure and death occurring in a 2-year follow-up period was determined to be 5-fold greater in patients with Tei index \u0026gt;1.4, independently of all other causes (14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen the two groups in the current study who were fasting and not fasting during Ramadan were compared, the echocardiographic parameters were determined to be similar. A significant difference was determined only in the tei index between the patients. In the patients who were fasting during Ramadan, a significant decrease was determined in the tei index after 1 month of fasting. A previous study conducted with a drug that had an effect on energy metabolism, showed that the tei index values were significantly decreased during the follow up of patients who were taking the drug (15). This drug made changes in the energy metabolism by affecting fatty acid oxidation within the cell. Therefore, the changes in enegy metabolism occurring in the fasting group, the decrease in body fat ratio and the positive changes occurring in body composition (16) are thought to be responsible for the decrease in the tei index in this group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results obtained in this study showed that \u0026nbsp;RF had positive effects on the body together with a decrease in body fat, weight loss, and changes in body composition as in previous studies \u0026nbsp;(16). However, there is no study in the literature that has evaluated the effects of RF on echocardiographic parameters in patients with coronary heart disease and coronary stent. From the results of this study, there was determined to be a significant decrease in the tei index of patients following RF. Thus, it can be considered that this study will shed light on future studies which aim to decrease the risk of adverse events that may develop in patients following RF.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, the effects of RF on cardiac functions were investigated in patients with coronary artery disease and a previous stent procedure. The results of the echocardiograph evaluation after one month of fasting showed a statistically significant decrease in the tei index in the patient group fasting for Ramadan. This finding demonstrated that Ramadan fasting could have positive effects on cardiac functions. To the best of our knowledge, this is the first study to have evaluated the effect of Ramadan fasting on cardiac functions.\u0026nbsp;\u003c/p\u003e"},{"header":"Study Limitations","content":"\u003cp\u003eAs the study had to be conducted within the short period of the month of Ramadan, a greater number of patients could not be included. Despite the low number of patients, the study can be considered to make a very important mark. It was shown that the cardiac functions of patients improved with RF, which is a religious obligation undertaken by a significant proportion of Muslims. This study can be of guidance for further larger scale studies on this subject.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Committee Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the procedures in this study including human participants were applied in compliance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and subsequent revisions or comparable ethical standards. No animals were used in this study. Approval for the study was granted by the Local Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no funding source for the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e-EIE echocardiographic screening and recruitment of patients,\u003c/p\u003e\n\u003cp\u003e-FL, collecting patients and entering statistical data\u003c/p\u003e\n\u003cp\u003e- OFD, revealing the idea, literature review, statistical analysis of the data, transcribing the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNorouzy A, Salehi M, Philippou E, et al. Effect of fasting in Ramadan on body composition and nutritional intake: a prospective study. J Hum Nutr Diet. 2013;26(Suppl 1):97\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jhn.12042\u003c/span\u003e\u003cspan address=\"10.1111/jhn.12042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalim I, Al Suwaidi J, Ghadban W, Alkilani H, Salam AM. Impact of religious Ramadan fasting on cardiovascular disease: a systematic review of the literature. Curr Med Res Opin. 2013;29(4):343\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1185/03007995.2013.774270\u003c/span\u003e\u003cspan address=\"10.1185/03007995.2013.774270\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePersynaki A, Karras S, Pichard C. Unraveling the metabolic health benefits of fasting related to religious beliefs: A narrative review. Nutrition. 2017;35:14\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.nut.2016.10.005\u003c/span\u003e\u003cspan address=\"10.1016/j.nut.2016.10.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNematy M, Alinezhad-Namaghi M, Rashed MM et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. \u003cem\u003eNutr J\u003c/em\u003e. 2012;11:69. Published 2012 Sep 10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1475-2891-11-69\u003c/span\u003e\u003cspan address=\"10.1186/1475-2891-11-69\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.echo.2005.10.005\u003c/span\u003e\u003cspan address=\"10.1016/j.echo.2005.10.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVoulgari C, Moyssakis I, Papazafiropoulou A, et al. The impact of metabolic syndrome on left ventricular myocardial performance. Diabetes Metab Res Rev. 2010;26(2):121\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/dmrr.1063\u003c/span\u003e\u003cspan address=\"10.1002/dmrr.1063\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79\u0026ndash;108. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.euje.2005.12.014\u003c/span\u003e\u003cspan address=\"10.1016/j.euje.2005.12.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZouhal H, Bagheri R, Triki R, et al. Effects of Ramadan Intermittent Fasting on Gut Hormones and Body Composition in Males with Obesity. Int J Environ Res Public Health. 2020;17(15):5600. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph17155600\u003c/span\u003e\u003cspan address=\"10.3390/ijerph17155600\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2020 Aug 3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLessan N, Ali T. Energy Metabolism and Intermittent Fasting: The Ramadan Perspective. Nutrients. 2019;11(5):1192. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu11051192\u003c/span\u003e\u003cspan address=\"10.3390/nu11051192\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2019 May 27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function\u0026ndash;a study in normals and dilated cardiomyopathy. J Cardiol. 1995;26(6):357\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026oslash;ller JE, S\u0026oslash;ndergaard E, Poulsen SH, Appleton CP, Egstrup K. Serial Doppler echocardiographic assessment of left and right ventricular performance after a first myocardial infarction. J Am Soc Echocardiogr. 2001;14(4):249\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1067/mje.2001.111478\u003c/span\u003e\u003cspan address=\"10.1067/mje.2001.111478\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTei C, Dujardin KS, Hodge DO, Kyle RA, Tajik AJ, Seward JB. Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis. J Am Coll Cardiol. 1996;28(3):658\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0735-1097(96)00202-1\u003c/span\u003e\u003cspan address=\"10.1016/0735-1097(96)00202-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026oslash;ller JE, Poulsen SH, Egstrup K. Effect of preload alternations on a new Doppler echocardiographic index of combined systolic and diastolic performance. J Am Soc Echocardiogr. 1999;12(12):1065\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0894-7317(99)70103-3\u003c/span\u003e\u003cspan address=\"10.1016/s0894-7317(99)70103-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarjai KJ, Scott L, Vivekananthan K, Nunez E, Edupuganti R. The Tei index: a new prognostic index for patients with symptomatic heart failure. J Am Soc Echocardiogr. 2002;15(9):864\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1067/mje.2002.120892\u003c/span\u003e\u003cspan address=\"10.1067/mje.2002.120892\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJatain S, Kapoor A, Sinha A, et al. Metabolic manipulation in dilated cardiomyopathy: Assessing the role of trimetazidine. Indian Heart J. 2016;68(6):803\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ihj.2016.04.023\u003c/span\u003e\u003cspan address=\"10.1016/j.ihj.2016.04.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFinch GM, Day JE, Razak, Welch DA, Rogers PJ. Appetite changes under free-living conditions during Ramadan fasting. Appetite. 1998;31(2):159\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1006/appe.1998.0164\u003c/span\u003e\u003cspan address=\"10.1006/appe.1998.0164\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable-1:\u003c/strong\u003e \u003cstrong\u003eThe baseline characteristics and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003elaboratory investigations\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of all patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll patients (n:49)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRF (-) (n:25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRF (+) (n:24)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eAge, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e62.8 \u0026plusmn; 7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e63.5 \u0026plusmn;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e62.2 \u0026plusmn; 8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eMale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e37 (75.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e16 (64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e21 (87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eBaseline BMI, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e31.1 \u0026plusmn; 6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e30.6 \u0026plusmn; 8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e31.66 \u0026plusmn;4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.606\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Delta; BMI, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e-0.25 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e-0.02 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e-0.5 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e17 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e11 (44.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e6 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e33 ( 67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e17 (68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e16 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eSmoking, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e10 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e7 (28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e3 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.178\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eASA use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e39 (79.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e19 (76.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e20 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eClopidogrel use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e17 ( 34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e11 (44.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e6 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eBeta Blocker use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e45 (91.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e22 (88.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e23 (95.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eACE inh/ARB use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e40 (81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e20 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e20 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.763\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eStatin use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e43 (87.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e21 (84.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e22 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eWbc, \u0026times; 10\u003csup\u003e9\u003c/sup\u003e/l, mean\u0026thinsp;\u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e8.2 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e8.3 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.558\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eHemoglobin g/dl, mean\u0026thinsp;\u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e13.9 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e13.9 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e13.8 \u0026plusmn; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eCreatinine mg/dL, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e0.9 \u0026plusmn; 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e0.9 \u0026plusmn; 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e0.8 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eTSH mIU/L, median (25th-75th)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 (0.6-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e1.0 (0.5-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 (0.7-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eLDL-C mg/dl, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e119.5 \u0026plusmn; 41.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e115.4 \u0026plusmn; 44.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e123.9 \u0026plusmn; 37.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.476\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eTriglycerides, mg/dL, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e185.1 \u0026plusmn; 96.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e197.2 \u0026plusmn; 101.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e172.6 \u0026plusmn; 91.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.377\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eHDL-C, mg/dL, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e45.9 \u0026plusmn; 9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e46.5 \u0026plusmn; 11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e45.2 \u0026plusmn; 8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003erSS median(25th-75th)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e2 (0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e2 (0-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e1.5 (0-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.537\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.831460674157306%\" valign=\"top\"\u003e\n \u003cp\u003eBaseline GLS %, mean \u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.792937399678973%\" valign=\"top\"\u003e\n \u003cp\u003e15.2 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088282504012842%\" valign=\"top\"\u003e\n \u003cp\u003e15.1 \u0026plusmn; 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003e15.4 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.593900481540931%\" valign=\"top\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as median (interquartile range) or number (percentage) of patients. Abbreviations: ASA, asetilsalisilic asid; BMI, body mass index; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blockers; GLS, global longitudinal strain; HDL-C, high-density lipoprotein cholesterol; LDL-C, low‐density lipoprotein cholesterol; RF, ramadan fasting; rSS, residual syntax score; SD, standard deviation; TSH, thyroid stimulating hormone; Wbc, white blood cells\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable-2: Comparison of the initial values of echocardiographic parameters of all patients and their values after ramadan fasting\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eLVEDD mm, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e48.4\u0026nbsp;\u0026plusmn;\u0026nbsp;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e48.0\u0026nbsp;\u0026plusmn;\u0026nbsp;3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.379\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eLVEDV ml mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e111.0\u0026nbsp;\u0026plusmn;\u0026nbsp;26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e107.4\u0026nbsp;\u0026plusmn;\u0026nbsp;23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eLVEF % mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e61.4\u0026nbsp;\u0026plusmn;\u0026nbsp;5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e61.7\u0026nbsp;\u0026plusmn;\u0026nbsp;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eRV mm, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e34.7\u0026nbsp;\u0026plusmn;\u0026nbsp;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e35.1\u0026nbsp;\u0026plusmn;\u0026nbsp;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0,121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eE/A, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e0.9\u0026nbsp;\u0026plusmn;\u0026nbsp;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e0.9\u0026nbsp;\u0026plusmn;\u0026nbsp;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0,826\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eEDT ms mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e220.5\u0026nbsp;\u0026plusmn;\u0026nbsp;37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e215.0 \u0026plusmn; 31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eSeptal E\u0026rsquo; cm/s mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e6.8\u0026plusmn;\u0026nbsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e7.0\u0026nbsp;\u0026plusmn;\u0026nbsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eSeptal S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e7.0 \u0026plusmn;\u0026nbsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e7.1\u0026nbsp;\u0026plusmn;\u0026nbsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.390\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eLateral S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e8.1\u0026nbsp;\u0026plusmn;\u0026nbsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e8.1\u0026nbsp;\u0026plusmn;\u0026nbsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.736\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eInferior S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e7.6\u0026nbsp;\u0026plusmn;\u0026nbsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e7.6\u0026nbsp;\u0026plusmn;\u0026nbsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.699\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eAnterior S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e7.4\u0026nbsp;\u0026plusmn;\u0026nbsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e7.4\u0026nbsp;\u0026plusmn;\u0026nbsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.940\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eTei index , mean \u0026plusmn;\u0026thinsp;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e0.44\u0026nbsp;\u0026plusmn;\u0026nbsp;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e0.42\u0026nbsp;\u0026plusmn;\u0026nbsp;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.33922261484099%\" valign=\"top\"\u003e\n \u003cp\u003eGLS %, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.964664310954063%\" valign=\"top\"\u003e\n \u003cp\u003e-15.2\u0026nbsp;\u0026plusmn;\u0026nbsp;2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.08833922261484%\" valign=\"top\"\u003e\n \u003cp\u003e- 15.4\u0026nbsp;\u0026plusmn;\u0026nbsp;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as median (interquartile range) or number (percentage) of patients. Abbreviations: EDT, E wave deceleration time; GLS, global longitudinal strain; IVS, intraventricular septum; LA, left atrium; LVEDD, left ventricular end-diastolic diameter; LVEDV, left ventricular end-diastolic vol\u0026uuml;me; LVEF, left ventricular ejection fraction; PW, posterior wall; RV, right ventricle\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable-3:\u003c/strong\u003e \u003cstrong\u003eSeparate comparison of the patients\u0026apos; echocardiographic parameters with their baseline values and values after the ramadan fasting month\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRamadan Fasting (-) Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eLVEDD mm, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e48.5\u0026nbsp;\u0026plusmn;\u0026nbsp;5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e48.1\u0026nbsp;\u0026plusmn;\u0026nbsp;4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eLVEDV ml mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e111.3\u0026nbsp;\u0026plusmn;\u0026nbsp;30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e109.6\u0026nbsp;\u0026plusmn;\u0026nbsp;28.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eLVEF % mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e61.1\u0026nbsp;\u0026plusmn;\u0026nbsp;6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e60.7 \u0026plusmn; 5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.438\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eRV mm, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e33.6\u0026nbsp;\u0026plusmn;\u0026nbsp;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e34.4\u0026nbsp;\u0026plusmn;\u0026nbsp;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eE/A, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e0.9\u0026nbsp;\u0026plusmn;\u0026nbsp;0,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e0.9\u0026nbsp;\u0026plusmn;\u0026nbsp;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0,990\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eEDT ms mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e216.4\u0026nbsp;\u0026plusmn;\u0026nbsp;41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e210.8\u0026nbsp;\u0026plusmn;\u0026nbsp;35.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eSeptal E\u0026rsquo; cm/s mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e6.5\u0026nbsp;\u0026plusmn;\u0026nbsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e6.7\u0026nbsp;\u0026plusmn;\u0026nbsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eSeptal S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e6.9\u0026nbsp;\u0026plusmn;\u0026nbsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e6.9\u0026nbsp;\u0026plusmn;\u0026nbsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0,484\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eLateral S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.9\u0026nbsp;\u0026plusmn;\u0026nbsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.851\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eInferior S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.1\u0026nbsp;\u0026plusmn;\u0026nbsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.3\u0026nbsp;\u0026plusmn;\u0026nbsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eAnterior S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.1\u0026nbsp;\u0026plusmn;\u0026nbsp;1,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.2\u0026nbsp;\u0026plusmn;\u0026nbsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eTei index , mean \u0026plusmn;\u0026thinsp;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e0.43\u0026nbsp;\u0026plusmn;\u0026nbsp;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e0.43\u0026nbsp;\u0026plusmn;\u0026nbsp;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.960\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eGLS %, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e-15.1\u0026nbsp;\u0026plusmn;\u0026nbsp;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e- 14.7\u0026nbsp;\u0026plusmn;\u0026nbsp;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRamadan Fasting (+) Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eLVEDD mm, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e48.4\u0026nbsp;\u0026plusmn;\u0026nbsp;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e47.9\u0026nbsp;\u0026plusmn;\u0026nbsp;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eLVEDV ml mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e110.7\u0026nbsp;\u0026plusmn;\u0026nbsp;22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e105.1 \u0026plusmn; 16.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eLVEF % mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e61.7\u0026nbsp;\u0026plusmn;\u0026nbsp;5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e62.7 \u0026plusmn; 5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eRV mm, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e35.9\u0026nbsp;\u0026plusmn;\u0026nbsp;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e36.0\u0026nbsp;\u0026plusmn;\u0026nbsp;4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eE/A, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e0.8\u0026nbsp;\u0026plusmn;\u0026nbsp;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e0.9\u0026nbsp;\u0026plusmn;\u0026nbsp;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.748\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eEDT ms mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e224.8 \u0026plusmn; 31.7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e219.4\u0026nbsp;\u0026plusmn;\u0026nbsp;25.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eSeptal E\u0026rsquo; cm/s mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.1 \u0026plusmn; 1.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.4\u0026nbsp;\u0026plusmn;\u0026nbsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eSeptal S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.1\u0026plusmn;\u0026nbsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.2\u0026nbsp;\u0026plusmn;\u0026nbsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eLateral S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e8.4 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e8.2 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eInferior S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.8\u0026nbsp;\u0026plusmn;\u0026nbsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0,068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eAnterior S\u0026rsquo; cm/s, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 1.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e7.5\u0026nbsp;\u0026plusmn;\u0026nbsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.580\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eTei index , mean \u0026plusmn;\u0026thinsp;\u0026thinsp;SD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e0.44\u0026nbsp;\u0026plusmn;\u0026nbsp;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e0.40\u0026nbsp;\u0026plusmn;\u0026nbsp;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.562913907284766%\" valign=\"top\"\u003e\n \u003cp\u003eGLS %, mean \u0026plusmn;\u0026thinsp;SD \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e-15.4\u0026nbsp;\u0026plusmn;\u0026nbsp;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.364238410596027%\" valign=\"top\"\u003e\n \u003cp\u003e- 16.1\u0026nbsp;\u0026plusmn;\u0026nbsp;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as median (interquartile range) or number (percentage) of patients. Abbreviations: EDT, E wave deceleration time; GLS, global longitudinal strain; IVS, intraventricular septum; LA, left atrium; LVEDD, left ventricular end-diastolic diameter; LVEDV, left ventricular end-diastolic vol\u0026uuml;me; LVEF, left ventricular ejection fraction; PW, posterior wall; RV, right ventricle\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ramadan fasting, Tei index, echocardigraphy, coronary artery disease, cardiovascular health","lastPublishedDoi":"10.21203/rs.3.rs-3830222/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3830222/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAims:\u003c/h2\u003e \u003cp\u003eRamadan fasting (RF) can affect the health status of patients with cardiovascular disease or risk factors. The aim of this study was to evaluate echocardiographic functions according to RF status in patients being followed up for clinically present coronary artery disease.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis single-centre, cross-sectional study included 49 patients who were being followed up with a diagnosis of coronary artery disease and had undergone stent placement at least 1 year previously. The patients were separated into 2 groups as those who were fasting during the month of Ramadan (RF (+), n\u0026thinsp;=\u0026thinsp;24) and those who were not (RF (-), n\u0026thinsp;=\u0026thinsp;25). Detailed echocardiographic evaluations were made. Analyses of the study data were performed using MedCalc software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe demographic and echocardiographic characteristics of the patients in both groups were similar at the start of the study. When all the patients were evaluated together, there were seen to be no significant changes in the echocardiographic diameter measurements, tissue doppler evaluations, tei index values, and global longitudinal strain values throughout the fasting month. When the fasting and non-fasting groups were compared separately, a statistically significant decrease was determined in the tei index value in the RF (+) group after 1 month of fasting (0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14 vs. 0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12) (p:0.025).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn this study, the effects of RF on cardiac functions were investigated in patients with coronary artery disease and a previous stent procedure. The results of the echocardiograph evaluation after one month of fasting showed a statistically significant decrease in the Tei index in the patient group fasting for Ramadan. This finding demonstrated positive effects of RF on cardiac functions.\u003c/p\u003e","manuscriptTitle":"Does Ramadan Fasting Affect Cardiac Functions In Patients Followed With Coronary Artery Disease?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-05 09:20:10","doi":"10.21203/rs.3.rs-3830222/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c007a67a-45e7-41bc-9606-19fcfb92ee54","owner":[],"postedDate":"January 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-06T09:14:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-05 09:20:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3830222","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3830222","identity":"rs-3830222","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}