Left Ventricular Diastolic Function in a Predialysis Patient Population

BACKGROUND: Diastolic dysfunction is common in chronic kidney disease (CKD) accounting for 40-66of cardiovascular complications. OBJECTIVE: To determine the prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in adult Nigerians with CKD at presentation and to compare findings with those of hypertensive patients with normal renal function. METHODS: Eighty-six consecutive patients with CKD were studied; comprising 43 hypertensives and 43 age- and sexmatched healthy subjects as controls. Clinical; laboratory; and echocardiographic variables were measured. RESULTS: Left ventricular diastolic dysfunction was present in 62.8of CKD patients; 79.1of hypertensive patients and 25.6of normal controls (p 0.001. There was a positive correlation between left ventricular diastolic function (LVDF) and systolic blood pressure (SBP); diastolic blood pressure (DBP); mean arterial pressure (MAP); severity of SBP; severity of DBP in CKD patients but not in hypertensive patients. There was a negative correlation between LVDF and age in CKD patients and hypertensive patients. Linear multiple regression analysis showed age as the only predictor of LVDD. CONCLUSION: There is a high prevalence of diastolic dysfunction in CKD patients at first presentation to a nephrologist in Nigeria

Takotsubo Cardiomyopathy : an Acute and Reversible Cardiomyopathy Mimicking Acute Myocardial Infarction

Takotsubo cardiomyopathy is an acute; reversible form of left ventricular dysfunction precipitated by emotional or physical stress. The condition is important to recognise as it mimics acute myocardial infarction and acute coronary syndrome. Most patients are female and postmenopausal. Presenting symptoms include severe chest pain; acute dyspnoea; hypotension or even cardiogenic shock. The ECG changes are suggestive of an acute coronary syndrome with T-wave inversion with / without ST elevation; most often in the precordial leads. The syndrome is characterised by a sudden onset of transient extensive akinesia of the left ventricle; often involving all three major coronary artery territories; in the absence of significant coronary artery stenosis. The wall motion typically involves the apex of the left ventricle with hyperkinesis of the base of the heart. Variant forms have recently been described where the wall motion abnormality involves the mid-ventricular wall with hyperkinesis of the base and apex; or the base of the heart with hyperkinesis of the apex. Characteristically; there is only a limited release of cardiac enzymes disproportionate to the extent of regional wall motion abnormality. Transient right ventricular dysfunction may occur and is associated with more complications; longer hospitalisation and worse left ventricular systolic dysfunction. Serial echocardiography is useful to document improvement in cardiac function. The pathogenesis is unclear. Transient mid-cavity obstruction has been invoked with subsequent myocardial stunning in the akinetic segments. Treatment is supportive. The most effective long-term management remains to be defined. Although the prognosis is good with recovery of ventricular function at about three weeks; some patients have died. The syndrome may recur

"L'insuffisance ventriculaire gauche a Bamako : Approche epidemiologique; etiologique et evolutive (A propos de 51 cas observes dans le Service de Cardiologie de l'Hopital du Point ""G"""

"L'auteur rapporte les resultats d'une retrospective sur l'insuffisance ventriculaire gauche dans le Service de Cardiologie de l'Hopital du Point ""G"". Elle constitue 41;1 pour cent de l'ensemble des insuffisances cardiaques. Les hommes sont plus souvent touches (64;7 pour cent) que les femmes(35;3 pour cent) avec predominance de 2 etiologies : hypertension arterielle 70;6 pour cent; et valvulopathies (15;7 pour cent). Enfin l'evolution sous traitement medical est favorable dans la majorite des cas (90 pour cent)."