Optimization of coronary sinus lead position in cardiac resynchronization therapy guided by three dimensional Echocardiography

Background: Cardiac resynchronization therapy [CRT] is now an established effective treatment for patients with advanced heart failure. One approach to improve CRT outcome may be determination of the degree of dsynchrony before CRT as a predictor for CRT response. Conversely, the focus may be on an improved positioning of CRT left ventricular [LV] lead

Aim of the study: We aimed at our study to define the rule of three-dimensional echocardiography in determining the optimal site of LV pacing lead

Patients and Methods: The current study was conducted on 30 patients with heart failure who had received CRT in Ain Shams University Hospitals in the period from 2012 to 2014. All patients were subjected to thorough history taking, complete general and local examination, conventional 2D echo and 3D echo analysis. The latest wall to reach the minimal volume was determined. The patients were classified after CRT insertion into group A with concordance between the delayed LV area and LV lead position and group B with discordance between them. Our patients were followed up for 6 months duration

Results: Our findings demonstrated that the response to CRT resulted in improvement of NYHA class [p-value 0.04], LV EF by 2D and 3D echocardiography [P value <0.001 for both] with significant increase in LV 3D SV [p value 0.001], and significant reduction of LA diameter [p-value 0.03], LVESD diameter, 2D and 2D LVESV [P value 0.026, 0.026 respectively], however there was no any statistically significant difference between both groups

Conclusions: No additional benefit of selecting LV lead position pre CRT insertion to be concordant with the latest myocardial segment in reaching the minimal systolic volume assessed by 3D echocardiography

N-acetyl-beta-d glucosaminadase and retinol-binding protein versus albuminuria in insulin dependent diabetic children.

Markers of tubular dysfunction [N-acetyl-beta-D-glucosaminidase and retinol binding protein], markers of glomerular dysfunction [glomerular filtration rate, urinary albumin excretion, blood urea and serum creatinine]and blood pressure were estimated in 32 insulin dependent diabetic children [IDDM] [16 males and 16 females] aged from 7 to 15 years, who had negative reagent strip test for proteinuria and in 10 age and sex matched healthy control children [6 males and 4 females]. Ultrasonography of the kidneys and fundus examination for the detection of retinopathy were done for all cases. The results indicated that tubular dysfunction, as evidenced by RBP and NAG, is more sensitive and precedes glomerular dysfunction in insulin dependent diabetics. However, RBP is a convenient, more sensitive, specific and early diagnostic tool for the detection of tubular affection than NAC. Albuminuria and increased GFR are early markers of glomerular dysfunction preceding the elevations of blood urea and serum creatinine. A reduction in hyperfiltration or GFR with increased albumin excretion is a marker of progression of renal disease. Hypertension is a feature of diabetic nephropathy after the appearance of microalbuminuria. However, the role of dietary modification programs and blood pressure control in normalization of kidney function in IDDP remains to be evaluated