Effect of [urografin] on left ventriular diastolic and renal functions after cardiac catheterization

is to evaluate the effects of iodinated contrast media "urografin" on kidney functions and left ventricular diastolic function indices in patients underwent coronary angiography. It included 100 patients with normal kidney function 57 male [57%] and 43 female [43%]. The patients are classified into four groups:- group A: diabetic hypertensive patients, group B: only diabetic patients, group C: only hypertensive patients and group D: non diabetic, non-hypertensive patients. For all patients history taking and clinical examination, standard 12 lead ECG, abdominal ultrasonography to exclude renal medical diseases, Echo-Doppler study before, immediately and 7 days after cardiac catheterization for assessment of left ventricular diastolic functions, and kidney function tests before cardiac catheterization, immediately, 3 days and 7 days after cardiac catheterization. We found an increase in blood urea, serum creatinine and decrease in creatinine clearance [not reaching the significant level] at the first day after contrast administration [P> 0.05]; However, the maximal significant effect of these contrast agent on kidney functions was reached at the third day [P< 0.05] and return to normal at the seventh day [P< 0.05]. Also we found that the level of serum creatinine is maximally changed after three days of contrast administration, where the mean values were 1.11 +/- 0.19 before coronary angiography changed to 1.24 +/- 0.17 immediately after coronary angiography and 1.79+0.13 three days after coronary angiography and 1.27+0.12 after seven days of coronary angiography. It was noted that the level of serum creatinine is increased by 25% or > 0.5 mg/dl from the base line value and decline to nearly normal level after seven days of coronary angiography. The effects of contrast agents on kidney functions were significantly higher in groups [A] and [B] than that of groups [C] and [D] and there was a significant positive correlation between the dose of contrast media and the effect on kidney functions [P< 0.05]. Also, there was a non-significant effect of the radio contrast media on the left ventricular diastolic function indices in the four studied groups [P> 0.05] immediately after and seven days after radio contrast administration. However, there was a non-significant correlation between the dose of contrast media and diastolic function parameters immediately after and seven days after coronary angiography [P> 0.05]. So the effect of radiocontrast agents after coronary angiograpghy on kidney functions is benign and transient starting within 1-2 days reaching the peak at 3-5 days and then returning to base line within 7-10 days. This effect is significantly higher in diabetic hypertensive patients than that in non-diabetic, non-hypertensive patients with positive correlation between the dose of contrast media and kidney functions. However, the ionic contrast media exerts negligible alterations on left ventricular diastolic functions indices

Differentiation between transmural and non transmural myocardial infarction using tissue doppler imaging

The natural history and outcome of transmural [TM] and nontransmural myocardial infarction [N TM MI] was known to be significantly different many years ago. However, Neither M-mode nor 2-D Echocardiography can provide information regarding TM distribution of contractile performance. Tissue Doppler Echocardiography [TDE] provides new indices of myocardial functions such as myocardial velocity gradient [MVG] which was found to be an accurate method in the experimental assessment of TM. and N. TM. MI. The present work aims to study myocardial velocities in subendocardial and epicardial layers of the infarct segments by pulsed wave [PW] and tissue Doppler echocardiography in order to investigate the value of systolic and diastolic myocardial velocity gradient in distinguishing transmural myocardial infractions from nontransmural one. Forty patients with first attack acute myocardial infarction [MI] and significant single coronary artery disease [> 70% stenosis] were studied with conventional clinical assessment and trans thoracic Echocardiography [TTE] to assess systolic and diastolic left ventricular function, wall motion abnormalities and tissue Doppler imaging [TDI] parameters for assessment of myocardial velocities [including systolic, diastolic and myocardial velocity gradient] in the epicardial and endocardial layers of myocardium. We found a statistically significant difference in the TDI parameters in the endocardial area between the normal and the infarcted segments in patients with transmural and non transmural myocardial infarction. While in the epicardial area there is a statistical significant difference between the infarcted and the normal segments in patients with Q wave myocardial infarction but there is no significant difference in patients with non Q wave myocardial infarction. This means that TDI can detect the non-uniformity of transmural velocity denoting the presence of viable part [epicardial area] in the hypokinetic segments in the nontransmural myocardial infarction. We also found that there is significant difference in TDI parameters in the infarcted segments [either endocardial or epicardial area] between both groups with more depression of the myocardioal velocity in group I [with non Q wave myocardial infarction]. This could be explained by the presence of more viable myocardium in the area with non transmural infarction with less affection of the velocity. We conclude that TDE might be an applicable and noninvasive modality that can detect the non uniformity of transmural velocity differentiating between transmural and nontransmural MI suggesting that aggressive approaches should be taken to salvage myocardium in such patient

Assessment of myocardial perfusion by harmonic power doppler intermittent imaging and real time Coherent imaging: comparison with SPECT imaging

In this study, 41 patients with suspected or known coronary artery disease were examined by myocardial contrast echocardiography [MCE] using randomly either harmonic power Doppler with intermittent imaging [27 patients] or real time coherent imaging [14 patients] using intravenous Levovist infusion. All patients underwent single photon emission computed tomography [SPECT] after the injection of technetium-99m [Tc-99m] sestamibi or thallium-201 [Th 201] at rest within one to three days of MCE. Both echocardiographic and scintigraphic images were analyzed by two experienced cardiologists in a blinded manner using the same 16-segment model of the left ventricle and the same scale used for perfusion grading. The concordance between MCE [harmonic power Doppler intermittent imaging [HPDI] or real time imaging [RTI]] and SPECT for the detection of segments with normal or abnormal perfusion was analyzed