Rantes in rheumatic pulmonary hypertension: a target for therapeutic decisions

Pulmonary arterial hypertension [PAH] is an important risk factor for morbidity and mortality in patients with mitral valve disease. Recent studies highlighted the possible influence of inflammatory mechanisms in several types of PAH but data about PAH in rheumatic heart disease [RHD] are lacking. The aim of this study was to investigate the circulating level of the chemokine regulated upon activation, normal T-cell expressed and secreted [RANTES] and the cytokine interleukine-6 [IL-6] in patients with rheumatic mitral valve disease associated with pulmonary hypertension. Serum'level of [RANTES] and [IL-6] were measured by enzyme-linked immunosorbent assay [ELISA] in 18 patients with mitral valve disease and 10 matched healthy subjects [control group], All patients had PAH and 7 only [38.9%] had severe pulmonary hypertension. The serum level of RANTES in the patients' group was not statistically different from that in the control group. However, patients with severe pulmonary hypertension have a mean serum level of RANTES of [6138.6 +/- 1572.5 pg/ml] that is significantly greater than that of patients without severe pulmonary hypertension [1818.2 +/- 153,6 pg/ml] [p=0.029]. On the other hand, the serum level of lL-6 in the patients was statistically different from that-of the control [378 +/- 12.7 vs. 262 +/- 28.6 respectively, p<0.005]. Comparison of IL-6 serum level in patients with and without severe pulmonary hypertension showed that the level is higher in patients with severe pulmonary hypertension but without statistical significance [410 +/- 5.77 vs. 370 +/- 15.1 pg/ml respectively p=0.71]. Clarification of the role of inflammatory mediators in the pathobiology of pulmonary hypertension in RHD is required in other studies on a wide scale. Despite of the multifactorial nature and complex mechanisms of pulmonary hypertension in RHD, RANTES and IL-6 should be investigated as potential therapeutic targets in the control of rheumatic severe pulmonary hypertension

Relation between cardiomyopathy and exercise capacity multicenter trial

The six-minute walk test [6MW lest] is a safe and simple method to assess exercise capacity in patients with left ventricular [LV] dysfunction. Recent studies confirmed its prognostic significance. The aim of this Study: Was to identify determinants of exercise capacity in patients with LV dysfunction as assessed by 6MW test. and 116 Patients with LV dysfunction caused by ischemic heart disease or idiopathic dilated cardiomyopathy [NYHA class l-IIl] underwent 6MW test, M-mode, two dimensional and Doppler transthoracic echocardiographic studies. 115 Patients were able to perform the 6MW test. The mean distance walked was 277 +/- 114m. Univariate analysis revealed that heart rate, systolic and diastolic arterial pressures, NYHA class, left atrial size, LV myocardial mass index, end-systolic and end-diastolic volume indices, ejection fraction, isovolumic relaxation time, peak early [PE] and peak atrial [PA] wave velocities of LV diastolic filling, PE/PA ratio and deceleration nine of early filling were all significantly related lo 6MW test distance [p<0.05]. Multivariate step-wise regression analysis showed that the only independent determinants of 6 MW test distance were PA wave velocity [F to enter 192.71, multiple r=0.79], PE/PA ratio [F to enter 115.22, multiple r=-0.37], and heart rate [F to enter 80.98, multiple r=-0.12]. Doppler-derived indices of LV diastolic function [PA wave velocity and PE/PA ratio] and heart rate are the main determinants of exercise capacity in patients with LV dysfunction as assessed by 6MW test

Accuracy of low dose dobutamine echocardiography in detection of myocardial viability experience of menofia university

The identification of severely dysfunctional but viable myocardium is of particular importance for the selection of patients with depressed left ventricular function who will benefit from coronary revascularization. Assessment of inotropic reserve with dobutamine has recently been used for this purpose. Aim of the Study: Detecting the accuracy of low-dose dobutamine echocardiography [DSE] for the identification of viable myocardium in patients with previous myocardial infarction. Resting and low-dose dobutamine [7.5ag/kg/min] echocardiography [R and DSE] and resting post-revascularization echocardiography [PRecho] [3 months later] were prospectively studied in 33 patients with previous myocardial infarction and severely depressed regional function. Revascularization had been done either by CABG or PTCA for all patients. Wall motion assessment was done using 4 point score with 1 normal and 4 dyskinetic and viable tissue was diagnosed by presence of contractile response [CR] during LDD infusion in echocardiography using 17 segment model. Out of the 561 myocardial segments resting echo [IR] revealed 367 segments with normal wall motion [NWM], 109 hypokinetic with [CR] in 83, 52 akinetic with [CR] in 24,33 dyskinetic with CR in 3. Post-revascularization echo. revealed 476 segments with NWM, 26 hypo, 28 ak., and 30 dyskinetic. Compared to PR DSE., degree of matching was S5.6%. Sensitivity and specificity for detection of viability was 79.6% and 100% respectively. DSE can be used accurately for detection of clinical viability and predicting early functional recovery post-revascularization.

Late tricuspid regurgitation following mitral valve surgery: prevalence and possible risk factors

Tricuspid regurgitation [TR] may progress or newly develop late after mitral valve surgery without significant mitral stenosis, regurgitation or other causes of left heart failure. The aim of this work was to study the prevalence and the possible risk factors for significant TR late after mitral valve replacement, as assessed both clinically and echocardiographically. A total of 145 patients [87 women, 58 men; mean age 27.9 +/- 8.53 years] who underwent mitral valve replacement were studied. Analysis was based on preoperative and last postoperative Doppler echocardiographic evaluation. Significant TR was defined echocardiographically by grade 3+ or 4+ TR, Preoperative and intraoperative variables were used to evaluate predictors of TR development by multivariate logistic regression model. Echocardiography revealed significant late TR [3 +/- or more] in 19 patients [13.1%] during the follow-up period. In univariate analysis, female gender, atrial fibrillation, huge left atrium, preoperative severe pulmonary hypertension and preoperative 2+ TR were significant risk factors for TR development multivariate logistic regression model identified female gender, atrial fibrillation, preoperative severe pulmonary hypertension and, preoperative 2+ TR as statistically significant predictors for late TR after mitral valve surgery. Significant TR late after mitral valve surgery occurs in 13.1% of patients Therefore, a lower threshold for tricuspid valve repair should be considered at the time of initial surgery particularly in female patients with severe pulmonary hypertension or atrial fibrillation, evently preoperative TR is 2+. Echo Doppler study can be considered the elective approach for preoperative evaluation of tricuspid involvement in patients with mitral valve disease