Detection of occult cor-Pulmonale using dobutamine stress echocardiography in patients with schistosomal hepatic fibrosis

The presence of early diastolic dip of the ventricular septum has been reported to be able accurately diagnose occult cor-pulmonale during cycle ergo meter exercise test in patients with chronic obstructive pulmonary disease [COPD]. This study was conducted to test the ability of dobutamine stress echocardiognaphy [DSE] to detect cases of occult corpulmonale among patients with hepatosplenic schistosomiasis. The study included 25 patients aged 35.6+/=l2.7 years with hepatosplenic schistosomiasis [group 1, 15 males and 10 females] compared to 25 age- and sex-matched patients with COPD [group II]. M-mode echocardiognaphic ventricular septal motion, left ventricular shape [determined by short-axis 2-dimensional echocandiography], and pulmonary artery [PA] acceleration time [determined by pulsed Doppler echocardiognaphy] were measured at rest and during DSE. The ventricular septal motion and PA acceleration time were normal at rest in all patients. In gnoup 1, 22 patients [88%] reported marked downward ventricular septal motion in early diastole during DSE, indicating distortion of left ventricular shape. In group II, only 11 patients [44%] showed the same change during DSE. There is significant decrease in PA acceleration time in patients who showed septal dip in both groups from rest to DSE. It could be concluded that occult cor pulmonale can be diagnosed by the appearance of an early diastolic dip of the ventricular septum and distorted left ventricular shape during DSE in patients with hepatosplenic schistosomiasis. This method may be useful in selecting cases for medical treatment for early cor-pulmonale

New biochemical markers in chronic heart failure

We investigated the plasma levels of tumour necrosis factor-alpha [TNF-alpha], leptin and insulin, and their relation to body mass index [BMI] in 80 male patients who presented with chronic heart failure [mean age: 47 +/- 4 years] at Tanta University Hospital. Plasma leptin, TNF-alpha and insulin were significantly increased and BMI significantly decreased in New York Heart Association classes III and IV patients. TNF-alpha, leptin and insulin were positively correlated, and TNF-alpha and BMI and leptin and BMI were negatively correlated in stages III and IV of heart failure. We conclude that cytokine neuroendocrine activation may form part of advanced stage heart failure. It may also be responsible for worsening cachexia, and can be used as a marker to determine disease severity