Right versus left ventricular diastolic function in coronary artery disease

To evaluate the right ventricular function in patients with coronary artery disease [CAD] and to find whether there is a correlation between right and left ventricular diastolic function. 41 patients with CAD [group I] and 14 normal subjects [group II] served as control were included in this study. Patient with CAD were subdivided into 3 subgroups, group 1A, including 13 patients with chronic stable angina, group 1B, including 13 patients with unstable angina and group 1C, containing 15 patients with old myocardial infarction. These patients were subclassified again according to coronary angiography into group Is containing 16 patients with single vessel disease [LAD artery], group Id, including 11 patients with double vessel disease [RCA and CX] and group Im, including 14 patients with multiple vessel disease. Seven echo-doppler variables were measured at the left and right ventricular inflow tracts: E wave, A wave, A/E ratio, AI/TVI ratio, deceleration time [DT], acceleration time [AT] and early driving force [EDF]. There was a significant decrease in LVEF and LVFS in patients with CAD, while there was no significant difference in the RVEF between patients and control. The E waves of both mitral and tricuspid valves flow were significantly decreased in patients compared to control [57 +/- 12 VS 79 +/- 10 cm/S, P < 0.01 and 44 +/- 8 VS 54 +/- 12 cm/S P < 0.01, respectively], while there were no significant differences in A waves of both mitral and tricuspid valves flow between patients and control. The A/E ratios of both left and right ventricular filling were significantly increased in patients [1.13 +/- 0.29 VS 0.77 +/- 0.11, P < 0.01 and 1.08 +/- 0.25 VS 0.75 +/- 0.08, P < 0.01, respectively], and also AI/TVI ratios [0.49 +/- 0.11 VS 0.39 +/- 0.06, P < 0.01 and 0.52 +/- 0.07 VS 0.4 +/- 0.04, P < 0.01 respectively]. There were significant prolongation of DT of both valves flow in patients with CAD [153 +/- 23 VS 134 +/- 13 msec, P < 0.01 and 145 +/- 40 Vs 120 +/- 35 msec, P < 0.01, respectively], while no significant differences could be observed as regard AT except in group 1B [patients with unstable angina] whom showed significant increase in AT of E wave of tricuspid valve flow. Lastly, there were a significant lower values of EDF of the left and right sides of the heart in patients [9.7[-6] +/- 4.5[-6] VS 2.6[-5] +/- 2.2[-5], P < 0.01 and 6[-6] +/- 3[-6] VS 1[-5] +/- 4.9[-6], P < 0.01, respectively]. As regards Doppler derived parameters of ventricular filling in patients with CAD classified according to coronary angiography, the right ventricular diastolic function was more impaired in patients with RCA and circumflex artery disease [group 1d] than patients with multiple vessel disease [group Im] and single vessel disease [group 1S]. The magnitude of E and A waves measured at the mitral valve annulus were higher than those measured at the tricuspid valve annulus. The EDF was higher in mitral valve flow than in tricuspid valve flow. On the other hand, there were no significant differences in A/E, AI/TVI ratios, DT measured at both mitral and tricuspid annuli. There was no correlation between Doppler derived parameters of left and right ventricular fillings. The result of the present study indicate that both right and left ventricular filling parameters derived by echo-Doppler may be impaired in patients with CAD. The RV diastolic functions more impaired in RCA and multiple vessel disease than with LAD artery disease. Also, this study does not show correlation between Doppler- derived parameters of left and right ventricular fillings in patients with CAD

Beta-Endorphin release in patients with acute myocardial infarction

The present work aims to study beta-endorphin profile and its correlations with different hemodynamic states in acute myocardial infarction-AMI. Twenty cases of AMI-18 males and 2 females with age range of 40-67 years with mean of 51.5 +/- 10.5 and 10 healthy subjects -6 males and 4 females- matching in age the patients group, represented the population of this study. The results showed that admission beta-endorphin level was significantly increased in 85% of patients with AMI. Beta-endorphin curve followed that of the CPK in peaking between 6-12 hs and gradual decline to the initial levels. In patients complicated by left ventricular failure, beta-endorphin level was significantly elevated in all samples in relation to noncomplicated cases. Also, it was found to be increased in patients presenting with initial hypotension and prolonged severe pain. A significant positive correlations were found between beta endorphin and CPK and heart rate changes on one hand and a negative correlation with the mean blood pressure on the other hand. Finally, admission beta-endorphin may predict the next CPK reading better the admission CPK

Echocardiographic assessment of systolic and diastolic functions in athletic hearts

To evaluate the effects of relatively long term, minimum 3 years physical training on left ventricular [LV] systolic and diastolic functions, a total of 80 subjects [S] with age ranging between 18-40 years, were classified into 4 groups [G] and studied. GI, isometric exercise [20] S, GII, isotonic exercise [20] S, GIII, subjects retired for 3 years from endurance sporting program for at least 33 years. GIIIa, retired from isometric exercise [10] S, GIIIb, retired from isotonic exercise [10] Ss, IV, control [20] S. Clinical, ECG and Echo-Doppler examinations were done. Compared to the control G, GI and GII has significantly decreased heart rates, GI had significant increase in LV posterior wall thickness, while GII and IIb had significant increase in end diastolic dimensions or EDD. Left atrial size, LV mass, pulmonary peak velocity [PFV] and average acceleration were significantly increased in GI, II and III. Ejection fraction [EF] and mitral deceleration half-time were significantly increased in GII. Compared to GIIIa, PFV, mitral peak velocity; time velocity integral; deceleration time and deceleration half time as well as aortic time velocity itegral and average acceleration were significantly increased in GI. Compared to GIIIb, only tricuspid peak E. velocity was significantly increased in GII. In conclusion, the changes in systolic function in athletes in practice, GI and II are minimal except for EF which was increased in GII secondary to an increase in FDD. The changes in diastolic function are due probably to the increase in LV mass. Both of them did not return to the pre-exercise levels especially in GIIIb