Comprehensive evaluation of right ventricular function in acute myocardial infarction by tissue doppler echocardiography. Does ventricular interdependence exist?

The involvement of the right ventricle in acute myocardial infarction [AMI] has been shown to be associated with an increased risk of life-threatening arrhythmias and sudden cardiac death. The study aimed at investigating the right ventricular function in AMI and the interaction between left and right ventricles using Doppler tissue imaging [DTI]. The study included 125 patients admitted to coronary care units and diagnosed as AMI at all sites [anterior and inferior] [100 males and 25 females] with age ranging from 36 to 82 years. They were classified according to clinical, ECG and angiographic data into: group I included 52 patients with RV myocardial infarction [RVMI], group II: included 73 AMI patients without RVMI. They were compared to 25 age and sex matched healthy individuals as a control group. Conventional Doppler mitral and tricuspid inflow velocities and tricuspid annulus systolic excursion using 2D echocardiography were used to evaluate LV and RV functions. Also, Peak systolic and peak early and late diastolic velocities [S,E,A, E/A], contraction time [CT], pre-contraction [PCT], acceleration [AT] and deceleration time [DT] of S velocity were acquired from the apical four-chamber view at the lateral side of tricuspid annulus[ta], the septal, lateral, anterior and inferior sides of the mitral annulus [ma] using DTI. RV function using DTI; S[ta] PCT[ta] IRT[ta] were significantly impaired in group I compared to group II and control [9.2 +/- 1.4 vs 12.3 +/- 1.96 vs 14.6 +/- 2.2], [103.5 +/- 16.5, vs 84.6 +/- 24.3 vs 78.4 +/- 16] and [110.6 +/- 18.7 vs 84.9 +/- 30.2 vs 56 +/- 18.9] respectively. [P< 0.001]. Similarly, TASE was significantly lower in group I vs II and group II vs control [7.2 +/- 2.6 vs 12.4 +/- 4.9 vs 15.7 +/- 5.3 respectively [P<0.001]. LV functions S[ma], PCT[ma], CT[ma], E[ma], E[ma]/A[ma], were significantly decreased in group I and II compared to control [P< 0.001] but no significant difference of LV functions between patients with or without RV infarction. Almost all DTI parameters used in evaluation of systolic and diastolic RV functions showed strong direct correlation to the corresponding LV parameters [P<0.001]. RV end diastolic pressure was passively correlated to S[ta] but not E/E[ta] of the RV in all AMI patients. The interaction between the two ventricles can be identified using DTI which now plays a relevant role in clinical scenarios. In AMI, despite the proved increased risk of morbidity and mortality in RVMI, LV dysfunction adversely affects RV function even in absence of RV infarction

Value of measuring anti-cyclic citrullinated peptide antibody [ACCP2] in rheumatoid arthritis

To assess the value of the second test generation A-CCP2 compared with rheumatoid factor isotypes [IgG-RF and IgM-RF] in RA patients. Also to test the additional diagnostic value of combined measurement of both A-CCP2 and RF, and to clarify the relation between anti-CCP2 and disease activity, disease duration and joint destruction. Ninety RA patients, 40 patients with other different connective tissue diseases or vasculitis and 50 healthy normal controls were included in the study. After thorough history, clinical assessment of RA was done. Erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP], as laboratory parameters of disease activity were measured. Radiological evaluation was done. Then RF isotypes [both IgG and IgM] and A-CCP2 were assessed. A-CCP2 was less sensitive than RF [sensitivity = 60.0% vs. 80.0% respectively], but A-CCP2 showed a better specificity than RF [96.0% in A-CCP2 vs. 92.0% in RF]. Best sensitivity [88.9%], specificity [98.0%] and test accuracy [90.7%] were recorded in combined RF and A-CCP2 measurement. A-CCP2 could detect 44.4% more cases of RA that were negative when tested with RF, 25% were early within 1 year. There is significant association between A-CCP2 positivity and increased score of disease activity, either clinically [X[2]=9.0, p<0.05] or laboratory wise [t=11.4, p<0.001 for ESR and t=18.9, p<0.001 for CRP]. Also showed more frequent positivity with increased score of X-ray grading [X[2]=8.35, p<0.05], but no relation with disease duration [t=1.6, p>0.05]. A-CCP2 has a higher specificity and RF has a higher sensitivity. Best sensitivity, specificity and accuracy were recorded in combined RF and A-CCP2 measurement. The additional diagnostic value of A-CCP2 is even more impressive in the early course of disease, in patients with severe joint destruction, and in patients with very active disease. Its presence is indicative for poorer radiological outcome. We recommend adding A-CCP2 measurement to the routinely used RF tests

Prevalence of macrovascular disease in systemic sclerosis

To detect the prevalence of macrovascular disease in systemic sclerosis. Thirty patients with systemic sclerosis and ten normal controls matched in age and sex were included in the study. All subjects were screened for atherosclerosis risk factors and non-invasive vascular assessment as carotid duplex scanning and measurement of ankle brachial blood pressure index. There was no significant difference in risk factors as cigarette smoking, systolic, diastolic blood pressure, cholesterol, triglycerides and glucose levels between patients and controls groups. Twenty three out of 30 patients [76.7%] had carotid artery disease compared to [30%] of normal controls with a highly significant difference. Macrovascular disease is a common finding in systemic sclerosis. Early identification allows early intervention and treatment with better control of high rate of cardiovascular mortality

Soluble thrombomodulin [STM] and human adrenomedullin [AM] in systemic lupus erythematosus [SLE] and their relation to disease activity and renal affection

To study the status of endothelial markers as plasma soluble thrombomodulin [sTM] and adrenomedullin [AM] in systemic lupus erythematosus [SLE] patients versus control subjects. Also, to clarify their relation to renal affection in these patients and to highlight their association with disease activity as evaluated with SLE-disease activity index [SLEDAI] and other laboratory parameters of disease activity. We recruited forty five SLE patients and twenty healthy matched controls. After thorough history taking, clinical examination and laboratory investigations were done, we assessed disease activity and looked for clinical and laboratory parameters of renal affection. Then we measured plasma sTM with ELISA and AM with RIA techniques. Thrombomodulin [sTM] and adrenomedullin [AM] were found to be significantly higher in SLE patients group than control group. On dividing our patients according to disease activity and comparing both groups, we found that sTM and AM were significantly more in the active than in the inactive group. The group of renal affection included 14 cases [31.1%], and on comparing them with the rest of SLE patients, we found a significant difference regarding sTM and AM, being higher in the patients with renal disease. sTM and AM were also found to be correlated with SLEDAI, laboratory parameters of disease activity as ESR, Hb% and anti-ds-DNA; Also with parameters of kidney affection as C3c, serum albumin, 24-h urinary protein, BUN and serum creatinine. Both sTM and AM showed a significant positive intercorrelation. Thrombomodulin [sTM] and adrenomedullin [AM] are elevated in SLE patients and correlated with disease activity and with renal affection. They are involved in the pathophysiology of SLE and reflect a state of persistent endothelial cell activation. They may help as indicators for early and more aggressive treatment

Hyaluronate as a biomarker for rheumatiod arthritis activity

Hyaluronic Acid [HA] in synovial tissue may leak into the circulation during synovial inflammation. So serum HA levels are expected to be elevated in rheumatic diseases with synovial involvement such as rheumatoid arthritis. To study the clinical specificity of HA for rheumatoid arthritis [RA] as a possible biomarker related to cartilage and bone turnover and its relation to disease activity. Serum samples from 50 RA were tested. 20 serum samples from healthy blood donors were used as controls. HA serum level in ng/ml was determined using an ELISA-based assay, and correlated with the clinical and laboratory variables. RA patients had mean age 45.9 +/- 7.8 SD years and duration of disease was 2.4 +/- 1.2 years. The study showed significant correlations between the serum HA level and the indices of disease activity, joint swollen scores [R=0.77, p<0.05], morning stiffness [R=0.67, p<0.05], erythrocyte sedimentation rate [ESR] [R = 0.78, p<0.05], C-reactive protein [CRP] [R=0.79, p<0.05] in RA patients. There was significant correlation with disease duration [R=0.68, p<0.05] and Ritchie articular index [RAI] [R=0.82, p<0.05]. No significant correlation of HA level with age of RA patients was observed [R=-0.28, p>0.05]. Serum HA level is a useful marker for the activity and severity of disease in RA patients