Stress tissue doppler echocardiography, is it has any prognostic implication after acute myocardial infarction?

The index could be a predictor of both systolic and diastolic myocardial performance after acute myocardial infarction [AMI]. Low-dose dobutamine stress echocardiography identifies viability in patients with myocardial dysfunction, and predicts the reversibility of myocardial function after AMI. Pulsed wave -Doppler tissue imaging [DTI] allows measuring regional myocardial velocities, and changes of both systolic and diastolic myocardial function

Aim of the work: This study aimed to assess the prognostic implication of resting and stress tissue Doppler echocardiographic variables in patients with first acute uncomplicated anterior myocardial infarction

Patients and Methods: This study included 159 patients They were divided into two groups; patients group included 129 patients with first acute anterior MI treated with thrombolytic therapy and control group included 30 age- and sex- matched healthy subjects. All patients were subjected to baseline demographic characteristics include age, sex, obesity and clinical data analysis, also coronary risk factors were assessed. Complete resting echocardiographic evaluation and resting Doppler tissue imaging [DTI] study for measuring Tei index and low dose dobutamine stress echocardiography to assess myocardial viability were done in all patients. Pulsed-wave Doppler tissue imaging study before and during low dose dobutamine stress echocardiography and follow-up of major adverse cardiac events by resting conventional echocardiography at one month, was done for every patient

Results: Patients were sub-divided into two groups according to the myocardial functional improvement at follow up; group I: included 68 patients with no improvement of myocardial function, and group II: included 52 patients with improvement on follow up. There was significant correlation between group I and the resting echocardiographic data, and there was significant positive correlation between group II and the viability demonstrated with low dose dobutamine echocardiography [LDDE], DTI, or both techniques together. During follow-up, two patients died from non cardiac cause, the remaining patients had cardiac events, forming the event group [group A], and the non-event group [group B]. Patients in group A were significantly older than patients in group B [P<0.000]. However, there was significant positive correlation between non event group and the myocardial viability. Tei index was the most significant constant independent predictor of early cardiac events

Conclusion: Resting and stress tissue Doppler echocardiographic variables found to have a significant prognostic implication in patients with acute anterior myocardial infarction

Early detection of doxorubicin-induced cardiotoxicity in children with hematological malignancies

This study aimed to investigate the value of conventional Doppler-echocardiography, Doppler tissue imaging [DTI], and serum cardiac troponin I [cTni] as early predictors of cardiotoxicity in children treated with doxorubicin for different hematological malignancies and to evaluate their feasibility as early screening tests in assessing the left as well as the right ventricular systolic and diastolic functions. This study included 19 clinically asymptomatic children aged 4.9 +/- 2.1 years with normal systolic function who were receiving doxorubicin chemotherapy [cumulative dose= 122.4 +/- 59.9 mg/m2] for different malignant neoplasms [16 children having acute lymphoblastic leukemia, 2 having acute myeloid leukemia and I having leukemic phase of lymphoma]. They were subjected to Doppler-echocardiographic and DTI examination of the right ventricular [RV] and left ventricular [LV] systolic and diastolic functions as well as estimation of serum levels of cTni by sandwich immunoassay after the last dose of doxorubicin during the induction-remission therapy. Another 20 healthy normal children were taken as a control group. Results showed that the LV systolic functions as well as LV and RV diastolic functions [assessed by Doppler study of mitral and tricuspid inflow, and mitral flow propagation velocity [MPW and myocardial performance index [MPI] were impaired in patients compared with controls. DTI study confirmed and disclosed such impairment in LV and RV systolic [decreased lateral mitral and tricuspid annulus systolic [Sa] velocities] and diastolic functions [decreased early diastolic tricuspid and lateral and septal mitral annulus [Ea] velocities and mitral Ea/Aa] in patients compared with controls. Serum cTni was statistically significantly increased in-patient as compared with the control group. There was a significant negative correlation between serum levels of cTni and Ea/Aa. On the other-hand, cumulative dose of doxorubicin was not correlated with either serum cTni or any systolic or diastolic cardiac functions

Conclusion: DTI confirmed and disclosed abnormal RV and LV systolic and diastolic functions reported by conventional Doppler-echocardiography in asymptomatic doxorubicin-treated children. DTI had more ability to detect abnormal RV and LV systolic and diastolic functions than conventional Doppler-echocardiography. Serum cTni, which is considered as a marker for myocardial cell injury significantly, correlates with the degree of diastolic dysfunction detected only by DTI [Ea/Aa]. The repetitive measurements of the new DTI-derived velocities, Doppler-derived indices [MPI], M-mode- derived MPV and serum cTni could add significant value in the early defection of doxorubicin-induced cardiotoxicity and enhance several studies to find suitable cardio protective free radical scavengers which can reduce the cardio toxic effects of doxorubicin including; dexrazoxane, exogenous melatonin, phosphodiesterase inhibitors type 4 or induction of metallothionein by zinc

Glycoprotein III a PI A1/A2 polymorphism in patients with acute coronary syndromes

Recent data suggest that inherited prothrombotic risk factors are associated with acute coronary syndromes. Glycoprotein III a [GP III a] is part of the platelet fibrinogen receptors, the common final pathway of platelet aggregation. PI A1/A2 genetic polymorphism in GP III a, due to a leucine to proline amino-acid substitution at residue 33, has become a fashionable candidate polymorphism in coronary artery disease [CAD]. The aim of the study was to investigate the potential importance of PI A2 [Pro 33] allele as a risk factor for acute coronary syndromes. the study included 90 patients [aged 45 +/- 7 years], with angiographically documented CAD, 39 patients with acute myocardial infarction [MI] 3 with non-Q wave MI, and 48 with unstable angina. Patients underwent complete clinical, ECG, and enzymatic assessment, in addition to coronary angiography. Patients were compared to 48 age- and sex-matched controls. PI Al allele was assessed with the aid of polymerase chain reaction for all patients and controls. The PI A2 allele was present in 24 patients [26.7%] II with acute MI [28.2%] and 13 with unstable angina [27.1%], [P > 0.05]. Yet, it was present in 10 controls [20.8%, P > 0.05]. PI A1/A2 polymorphism has no association to the extent of angiographic findings. This study demonstrated that PI A1/A2 polymorphism might be associated with an increased risk for acute coronary syndromes. Patients who possess PI A2 allele may be at increased risk of coronary thrombotic events. The attractive possibility remains that such polymorphism might identify a subset of individuals who would respond better to a particular therapy

Normalization of left ventricular systolic and diastolic asynchrony after valve replacement for aortic stenosis

The aim of the present study was to evaluate left ventricular wall thickness, systolic and diastolic asynchrony in pressure overload hypertrophy due to aortic stenosis. Twenty five patients were included in the present study. 15 patients with severe aortic stenosis were studied preoperatively as well as early [6 +/- 2 months] and late [36 +/- 12 months] after aortic valve replacement [AVR] using left ventricular biplane angiogram, high-fidelity pressure measurements and echocardiography. Ten normal subjects served as controls. LV systolic function was assessed from biplame ejection fraction and M-Mode echocardiography and diastolic function from the time constant of relaxation, the peak filling rate and the constant of myocardial stiffness. Non uniformity was evaluated. from the coefficient of variation of the time to end-systole [systolic asynchrony] and peak filling rate [diastolic asynchrony] of 12 regions in right and left anterior oblique projections. Ejection fraction was comparable in patients with aortic stenosis and in control, whereas preoperatively diastolic dysfunction with prolonged relaxation by cardiac catheterization and reversed E/A ratio as evidenced by echo-Doppler study was present in patients with aortic stenosis and was normalized late after AYR. Left ventricular hypertrophy also normalized late after AYR [36 months]. L Y systolic asynchrony was present [>2 SD of control] in ten patients and diastolic asynchrony in all patients [15] with aortic stenosis. Systolic asynchrony was normalized in most of our patients [14 of 15 patients] early as well as late after AYR. On the other hand, diastolic asynchrony was present early after AYR in all patients, although there was a significant improvement in comparison to the preoperative evaluation Late after AYR, there was a normalization of diastolic asynchrony in 14 out of 15 patients with aortic stenosis. Systolic asynchrony is normalized early after AYR probably due to reduction of file after load, whereas, diastolic asynchrony persists probably due to residual LV hypertrophy with myocardial stiffness and interstitial fibrosis. Late after AYR, diastolic asynchrony is normalized due to structural remodeling with regression of both myocardial hypertrophy and interstitial fibrosis

Human leucocytic antigen-B system in Egyptian rheumatic patients with infective endocarditis

The objects of this work were to study the relationship between human leucocytic antigen [HLA]-B system and infective endocarditis in Egyptian patients with rheumatic heart disease and to evaluate the immune status in such patients. 20 patients with infective endocarditis on top of rheumatic heart lesion [group I], 12 patients with prosthetic valve endocarditis [group II], 17 patients with rheumatic heart disease [group III], and 200 age- and sex-matched healthy disease free subjects [control group] were studied. Diagnosis of infective endocarditis was confirmed by clinical examination and laboratory investigations. A significant difference of HLA-B35 frequency between patients with infective endocarditis [group I] and healthy controls was noted. This significant difference was, also, found in patients with late prosthetic endocarditis. HLA-B35 was not demonstrated in rheumatic patients with no history of infective endocarditis. Group I patients showed, also, a significant decrease in T helper T-suppressor ratio