[Study of the relation between indices of ventricular function and pulmonary vascular resistance [PVR]]

Pulmonary vascular resistance [PVR] index is an important hemodynamic variable in determining the severity of cardiopulmonary diseases. This study was done to define the relationship of echocardiographic parameters of ventricular function with PVR. Mean PVR of 40 patients with cardiac disease was compared with the left ventricle diastolic function indices [LVEF] and the Systolic Pulmonary Arterial Pressure, [SPAP]. Results were analyzed by Linear Regression Test; also right ventricle TAPSE index was compared with mean PVR by Mann- Whitney Test, using SPSS Ver. 15. The comparison between PVR and TAPSE showed that the mean PVR reduces significantly with increase of TAPSE [cut off point 1.8; p= [0.0 26]. The study of the relation between SPAP and PVR made it clear that an increase in SPAP [mean PAP>25 mmHg] will cause the PVR to increase significantly [P<0.0001]. The study of LVEF and PVR showed that PVR decreases significantly parallel with an increase in EF [P= 0.004]. The study of mean PVR in LV Diastolic dysfunction groupings showed that the mean PVR difference in Restrictive Pattern was significantly higher than the Normal grouping [P<0.0001]. Measurement of right and left ventricles function indices by echocardiography is a reliable and accessible instrument for PVR estimation and monitoring. Noting the significance of PVR measurement in the process of treating cardiovascular diseases, we recommend use of echocardiography as a simple, accessible and noninvasive method for determining PVR, and an also as an index for estimating prognosis

[Evaluation of anterior mitral leaflet concavity area by 2D echocardiography in ischemic induced mitral regurgitation]

Functional mitral regurgitation [FMR] results from left ventricular remodeling, anterior leaflet tethering or tenting. Coronary artery disease is one of the important causes of FMR due to tethering. Detection of FMR and its severity is one of important factors in patient prognosis. There are different methods for detection of FMR and its severity, including anterior mitral leaflet concavity area [AMLCA]. In this cross sectional study 32 patients were selected, 19 of them were male with three vessel disease [3VD] and were candidate for coronary bypass graft surgery [CABG] with or without mitral valve surgery. They had FMR in ventriculography. Anterior mitral leaflet concavity area [AMLCA] was determined by long axis view [LAX] of transthorasic echocardiography [TTE]. Relation between severity of MR and AMLCA determined with Spearman's correlation coefficient and according to Roc curve study cut-off point was 0.1 cm[2]. Statistical analysis was performed using SPSS Version 15. In studied patients, AMLCA were 0.1-0.43 cm[2] in transthorasic echocardiography [cutoff point was 0.1 cm[2]]. A strong correlation was seen between AMLCA and FMR severity with LAX view of TTE [r=0.89]. Relation between FMR and AMLCA was a simple linear relationship. The results showed that AMILCA in the parasternal LAX view provides rapid and reliable diagnosis of FMR due to coronary artery disease and is quantitatively related to the severity of MR. In this regard, further studies with more subjects are recommended

Measurement of apelin in patients with lone AF

Atrial fibrillation is one of the most common arrhythmias and it is a risk factor for stroke, heart failure, morbidity and mortality. Apelin is a protein with multiple effects on cardiovascular system such as, endothelium-dependent vasodilation, positive inotropy, declining ventricular preload and afterload and increases cardiac contractility. Plasma level of apelin which is a good guiding for evaluation of the severity and treatment of heart failure can be a good prognostic factor in lone AF. In this case-control study, 26 patients with lone AF without any other important disease and 27, age and gender matched controls from 30 to 70 years old were evaluated. Measurement of apelin in serum was performed by ELISA method. There were 26 patients aged 30 to 70 years from both genders and 27 controls. The level of apelin in patients group under 60 years old was 1.88+1.07 ng/ml and in controls group was 1.29+ 0.50 ng/ml and for older than 60 years old, 1.007+ 0.56 ng/ml and 1.41+ 0.93 ng/ml, respectively. Data of this study showed no reduction of apelin in lone AF group under 60 years old, but there is significant reduction in patients older than 60 years old. There is no relationship between sex and apelin level

Correlation between 64-slice CT angiography and conventional coronary angiography

64-slice CT coronary angiography is now available as a valuable technology in evaluating patients, both with and without symptoms for the detection of coronary lesions and in making decision whether or not further invasive testing is needed. The aim of our study was to evaluate the diagnostic performance of 64-slice CT angiography for detection of significant coronary artery stenoses in comparison with conventional coronary angiography. During a period of 20 months [April 2007-November 2008] we studied 565 patients with 64-slice CT angiography of coronary arteries who fulfilled following criteria; having a positive stress test such as thallium-scan or stress echocardiography if symptomatic, sinus heart rhythm and able to hold breath for 15 seconds. We scheduled coronary angiography for 58 of these patients with mean age of 52 +/- 10.5 years [37 men and 21 women] who have one or more significant stenoses of coronary arteries. A significant lesion was assumed if the diameter reduction of vessel was = 50%. The overall sensitivity and specificity of 64-slice CT for detection of significant coronary artery stenoses in this study were 95% and 94% respectively. The positive predictive value was 85% and negative predictive value was 94%. We found that 64-slice CT correctly identified all patients with three vessel disease. This technique was reliable to classify 90% of patients [52/58] as having one, two or three vessel disease correctly. In conclusion 64-slice CT coronary angiography has a high degree of both sensitivity and specificity in detection of significant coronary artery stenoses

Heart trauma

To report five cases of heart trauma, managed in a civil trauma surgery ward in one year and to carry out a review of literature .Three young male patients have been transferred to our center after direct stab wound to their upper chest at the left side. Another one was a sixty years old man who was trapped between two parts of an elevator door and the fifth case was an iatrogenic trauma during bone marrow biopsy in a fifty five years old patient. All of them underwent emergency left sided anterior thoracotomy because of the positive signs of cardiac tamponade and circulatory instability. The exploration revealed cardiac tamponade in all cases due to three perforations in right ventricle, one perforation in left ventricle at the apex and one perforation at the root of aorta. Echocardiography was performed in one case and revealed cardiac tamponade. In all cases repair of perforation in the beating heart was performed. Four patients survived. Heart trauma is an emergent and life threatening situation which needs immediate surgical intervention without any unnecessary workup. The outcome of surgery depends on several factors including trauma surgery team expertise

alternative method for perioperative estimation of pulmonary artery systolic pressure by echocardiography

In the perioperative setting, pulmonary hypertension may be due to ischemic, left-sided valvular regurgitation and stenosis, residual shunt, pulmonary emboli or pericardial effusion. We purposed this study to determine whether tricuspid annular plane systolic excursion [TAPSE] and isovolumic relaxation time [IVRT] and S-wave velocity obtained by tissue Doppler imaging [TDI] could be used as an index of pulmonary systolic pressure in perioperative setting. Simultaneously, tricuspid annular plane systolic excursion and TDI by Echocardiography and right heart catheterization by Swan-Ganz catheter were performed in 55 patients [mean age 46 years,30 were male] with left -sided valvular disease [n=25], ischemic heart disease [n= 15] and adult-congenital heart disease [n= 10]. The TAPSE index S wave velocity from tricuspid annulus were measured by TDI. We also measured pulmonary artery systolic pressure [PASP] by right cardiac catheterization. In patients with moderate and severe pulmonary hypertension [PASP>45mmHg] the TAPSE value was [15.5 +/- 2.3mm]with sensivity of 90%and specifity of 80%. S wave velocity <11cm/s with sensivity of 90% and specifity of 86% and IVRT >79ms with sensivity of 93% and specifity of 95% [p<0.001]. Some factors such as underlying diseases [left-sided valvular disease, ischemic heart disease [IHD], congenital heart disease] had no effect on this correlation. We conclude that the evaluation of TAPSE index and IVRT and S-wave velocity by echocardiography provides a simple, rapid method for estimating of systolic pulmonary pressure in perioperative setting

Measurement of NT- ProBNP in patients with heart failure

Heart failure is the final complication of many diseases and an important cause of morbidity and mortality. N-Terminal B-Type Natriuretic Peptide [NT-ProBNP] is a new diagnostic tool for evaluation of the severity of heart failure and for differentiation between systolic function of left and right heart. In addition, plasma level of NT-ProBNP serves as a good guide in the management and follow-up of patients under treatment for heart failure. Patients with left side heart failure who referred to Taleghani hospital were consecutively recruited for this study. Diagnosis of heart failure was done through clinical evaluation and echocardiographic procedure. The severity of heart failure was determined according to New York heart association [NYHA] classification and clinical stage for each patient. Three ml citrated venous blood was obtained from the subjects and all samples were sent to the Endocrine and Metabolism research center laboratory of Shahid Beheshti Medical University for evaluation of plasma NT-ProBNP level by enzyme multiplied immunoassay technique [ELISA]. Patients with acute coronary syndrome, severe valvular stenosis, severe lung disease, liver cirrhosis, primary hyperaldesteronism, hyperthyroidism, acute respiratory distress syndrome [ARDS], and candidates for heart transplantation were excluded. Plasma level of NT-ProBNP for each classification of NYHA and clinical stages and left ventricular ejection fraction [LVEF] were evaluated. Seventy nine patients, with a mean age of 63.1+ 14 years were included in the study. Fifty-five [69.6%] subjects were male. Forty-eight patients [60.8%] were hypertensive, twenty- two patients [27.8%] were diabetic and sixty- four patients [81.0%] suffered from ischemic heart disease [IHD]. The mean plasma level of NT-ProBNP in subjects aged 60 years or more was higher than younger subjects, [485.8 +/- 418.6 versus 308.7 +/- 300.5], [P= 0.033]. The evaluation of NT- Pro BNP plasma levels showed correlation with decreased ejection fraction [P= 0.013], clinical stages [P< 0.001], and function class according to NYHA classification [P< 0.001]. In this study plasma levels of NT-ProBNP were elevated proportional to decrease in ejection fraction and systolic function of left ventricle in patients with heart failure. Measurement of NT-ProBNP is a good laboratory indicator for detection of left ventricular failure and its severity

Long segment, one-step thoracoabdominal aortic stent grafting

To report a case of painful and voluminous, Crawford type 1 thoracoabdominal aortic aneurysm, in a 87 years old man treated successfully with a long tube stent graft, using endovascular techniques, without any complication in the follow up. The proximal end was located just distal to the left subclavian artery, and the stent was placed to the region of the celiac axis

Intracardiac shunts and role of tissue Doppler Imaging in diagnosis and discrimination

We sought to assess right ventricular [RV] systolic and diastolic functions via tissue Doppler imaging [TDI] in order to discriminate right-to-left [bidirectional] from left-to-right intracardiac shunts. A tissue Doppler velocity study via Doppler echocardiography was performed in 20 patients with left-to-right shunt [without evidence of significant pulmonary hypertension] and 20 patients with right-to-left shunt or bidirectional shunt [with significant pulmonary hypertension] or Eisenmenger?s complex and 20 healthy subjects as the control group. RV myocardial performance index [MPI], S wave velocity, E wave velocity, isovolumic relaxation time [IVRT], and isovolumic contraction time [IVCT] from the lateral tricuspid annulus were measured using TDI. In the patients with left-to-right shunt, the tissue Doppler parameters showed higher S-wave, peak systolic[Sa]/early contraction[Ea], Sa/IVRT, and Sa/IVCT values; and in the patients with right-to-left or bidirectional shunt tissue, the Doppler parameters showed higher MPI and MPI/Sa value with a high specificity and sensitivity. We conclude that an evaluation of MPI, S wave, E wave, IVRT, and IVCT via tissue Doppler echocardiography is a useful index for the discrimination of right-to-left from left-to-right and bidirectional intracardiac shunts