Effect of dobutamine on the left ventricular combined myocardial performance index and B-type natriuretic peptide in symptomatic heart failure patients

Congestive heart failure is related to contraction and relaxation abnormalities of the ventricle. Isolated analysis of either mechanism may not be reflective of overall cardiac dysfunction: [Recently, a new non invasive Doppler derived index; myocardial performance index [MPI] or total ejection isovolumic index [TEI], which incorporates both systolic and diastolic myocardial performance has been proposed]. It is defined as the sum of isovolumic contraction time [ICT]and isovolumic relaxation time [IRT]divided by ejection time [ET]. In the present study, TEI index was compared with conventional echocardiographic/ Doppler parameters .and plasma B-type natriuretic peptide [BNP] levels in 30 patients with NYHA class 11-1V heart failure, before and after low dose dobutamine stress echocardiography [DSE], which has become accepted in the evaluation of cardiac functional reserve. The mean resting value of the TEI index was significantly higher in patients with advanced NYHA functional class IV [0.94 +/- 0.14] compared with those in class 111[0.78 +/- 0.2] and class 11 [0.61=0.02]. There was a significant negative correlation between TEI index with LVEF [r= -0.39, p< 0.05] and FS [r= -0.34, p<0.05]. The mean resting value of BNP in HF patients was significantly higher than that in controls, and its highest value was in patients in NYHA functional class IV [288 +/- 137.9pg/ml]. Inotropic challenge with dobutamine resulted in a marked improvement of the TEI index [% change -19.9; p< 0.05], and a shortening of the ICT [% change -17.31; p < 0.05] and the IRT [% change -17.01; P<0.05] and an insignificant increase of the ET. The myocardial contractile reserve [MCR] - defined as increment of more than 20% of resting left ventricular ejection fraction - showed significant improvement [% change +23.25; p< 0.05]. We concluded that TEI index is a simple and reproducible measure of cardiac function. It is a sensitive indicator of the effect of inotropic stimulation on global left ventricular function. Larger scale use of this protocol that combined TEI index, BNP and low dose DSE might be useful in HF, as it complements the information provided by other variables used in the diagnosis and functional assessment of heart failure

role of tumor necrosis factor alpha and its soluble receptors in infection complicating acute leukemia

This study aimed to examine the changes that occur in the levels of tumor necrosis factor [TNF-alpha] and its soluble receptors in infection in patients with acute myeloid leukemia [AML] and the changes that occur in these parameters during the neutropenic state. Forty-seven patients of newly diagnosed AML [with age range 12-60 years] as well as 25 age and sex matched healthy subjects were included in this study. The patients group was subdivided into four subgroups according to the presence or absence of fever and neutropenia. It was concluded that the levels of soluble receptors of TNF-alpha in the serum may reflect the inflammatory status better than TNF-alpha levels and the rise in their levels is correlated with the severity of sepsis

Study of antioxidants defense system, lipid pattern and left ventricular geometry in hypertensive patients

Free radical activity oxidative stress has been implicated in the pathogenesis of a variety of human diseases. In an attempt to define the role of oxidative stress, dyslipidemia and geometric changes in hypertensive patients [HT], we studied 44 patients, 20 [45.5%] Essential hypertensive [EH], 14 [31.8%] diabetic hypertensive [DH] and 10[22.7%] renal hypertensive [RH]. They were assessed by measurement of some free radicals and antioxidants, serum lipids and echocardiography, the data was compared with 10 age and sex matched normal subjects. There was a significant decrease in important natural antioxidant vitamins C, E, A and reduced glutathione [RG] and a significant increase in lipid peroxide level [LPO] in all groups of hypertensive patients as compared to control. The mean value of cholesterol [C] concentrations in all the hypertensive patients was significantly higher than in controls [P<0.001] Triglycerides [TG] were significantly higher in diabetic hypertensive patients in comparison to controls [P<0.001], HDL-C mean values were reduced significantly in [EH], [RH] groups. LDL-C mean values in all groups of hypertensive were significantly increased [P<0.01]. 38.6% of our patients had concentric left ventricular hypertrophy [CLVH], 13.6% had eccentric left ventricular hypertrophy [ELVH], 13.6% had concentric remodeling [CR] and 34% had normal geometry. We conclude that oxidative stress was observed in all groups of hypertensive patients and we recommend the use of antioxidants as an adjunct to antihypertensive therapy

Study of some parameters of endothelial dysfunction and coagulopathies in schistosomal cor pulmonale patients

Shistosomal cor-pulmonale [SCP] is one of the most important causes of vascular cor-pulmonale in Egypt. The aim of the work was to study the role of endothelial coagulation interaction in the initiation and /or progression of SCP. The study was carried out on 26 male schistosomal patients. They were divided into 2 groups: Group I [GI]: 16 patients with SCP. Group II [GII]: 10 schistosomal non-corpulmonale patients of matched age. All patients were subjected to cardiac Echo-Doppler study and right heart catheterization for measurement of blood pressure in the pulmonary artery and right ventricle. Blood samples obtained from the pulmonary artery were utilized for measurement of: - Fibrinogen. - vWF activity.-Platelet aggregation index.- Fibrin monomers. vWF activity was significantly higher in GI[173.4 +/- 58%] compared with GII [109.8 +/- 17.3%] and there was a statistically significant positive correlation between vWF activity and systolic pulmonary artery pressure [SPAP] [r = 0.654],P = 0.006] and a statistically significant negative correlation between vWF activity and platelet aggregation index [r = -0.6557,P 0.006]. Fibrinogen level was found to be significantly lower in GI [149 +/- 25.2 mg%] compared with GII [269 +/- 36.3 mg%]. Several signs indicating intra-vascular coagulopathy have been observed in GI since platelet aggregation index in that group [0.69 +/- 0.09] was markedly lower than its value in GII [0.95 +/- 0.02], signifying the increased propensity for thrombosis inside the pulmonary artery in GI compared with GII. Moreover, fibrin monomers have been detected in the pulmonary artery in 87% of cases of GI while they were not detected in any case in GII. We conclude that endothelial dysfunction and local coagulopathy in lung vasculature of SCP patients are important to proggression, if not initiation, of pulmonary hypertension

Study of some acute phase reactants and cardiac troponin T in patients with acute coronary syndromes

In an attempt to clarify the occurrence of inflammation in acute coronary syndromes, this study was performed on 20 patients with unstable angina [UA] and 20 patients with myocardial infarction [MI]. Twenty healthy volunteers were taken as controls. All studied patients and controls were subjected to full clinical examination and standard 12 lead ECG. Laboratory investigations included serum creatine kinase [CK], CK-MB, Troponin T [TnT], C-reactive protein [CRP], alpha 1-acid glycoprotein [AGP] and sialic acid. Complete Selvester ECG scoring was done for MI patients. Holter monitoring for 24 hours starting immediately after hospital admission was done for UA group. CK, CK-MB and TnT were significantly elevated in MI group [P<0.05], while CRP, AGP and sialic acid were elevated in both UA and MI groups [P<0.05]. ST-episodes were detected in 10 patients with UA [50%]. All of them had CRP above the cut off value of 10 ug/ml while 6 of these patients had measurable TnT above a cut off value of 0.2 ug/ml. In UA group CRP showed the highest sensitivity [70%] followed by AGP [45%] and TnT [30%]. Meanwhile, TnT showed 95% sensitivity, 100% specificity in MI and was positively correlated with QRS score [r = 0.813, P<0.001]. Sialic acid and AGP were positively correlated with ST ischemic changes in UA group [r= 0.75 and 0.574 respectively]. It was observed that the 4 patients with UA who developed cardiac C Vents [20%] showed marked elevation in both CRP and AGP on hospital admission. Meanwhile, they had measurable TnT and showed ST ischemic changes on Holter monitoring. We conclude that acute phase reactants, cardiac specific troponins as well as Holter monitoring are useful prognostic indicators in patients with acute coronary syndrome

Study of pancreatic size in patients with different types of diabetes

There had been contineous evolution in the understanding of etiology, pathogenesis and complications of diabetes since its discovery. Insulin is secreted by the B-cells of islets of Langnhan's and in IDDM there is marked reduction in the content of B-cells while in NIDDM, there is considerable reduction of its mass. The aim of this work was to study changes in pancreatic size in diabetic patients as detected by both U/S and CT studies. It was noted that there is considerable reduction in pancreatic size in those patients of IDDM group, while in NIDDM patients the size reduction was less marked and it was evident more in those under insulin therapy than those controled by oral hypoglycaemic drugs. The head was less affected than the body in NIDDM patients while in IDDM all segments were affected