Coronary artery disease pattern in various cardiovascular risk factors

Cardiovascular disease [CVD] remains a leading cause of morbidity and mortality worldwide. Cardiovascular risk factors play significant role in the pathogenesis of atherosclerosis. The aim of this study is to define the features of coronary artery disease in different cardiovascular risk factors. From February 2009 to March 2010, 101 saudi patients Suspected to have ischemic heart disease were included in the study. Coronary angiography +/- percutaneous coronary intervention were done for all patients. There are positive correlation between level of fasting blood sugar, total cholesterol, LDL, and triglyceride levels and number of diseased vessels while there is negative correlation between hdland number of diseased vessels. Thereare significant association between various types of risk factors [DM, HTN, Dyslipidemia and smoker] and number of vessel diseased [P < 0.01, P<0.01, P<0.001, and P< 0.01 respectively] for all variables. As regard type of coronary vessel affected in different risk factors, there are no significant differences between different categories [gender, nationality, smoking and dyslipidemia] and type of coronary artery disease [LAD, RCA, LCX and left main arteries]. There is more affection of LAD in hypertensive group vs non-hypertensive group [P< 0.02]. There is large number of diabetic group have LAD lesions [57 patient out of 62, 91.9%] comparing with non-diabetic group [31 patient out of 39, 79.5%] inspite of non significant difference [P = 0.069]. Our data demonstrates the association between diabetes mellitus and hypertension as A cardiovascular risk factors and more affection of left anterior descending coronary artery. Also, it demonstrates the positive correlation between various risk factors and number of coronary arteries affected with very high prevalence of diabet es,smoking,hypertension and dyslipidemia among Saudi patients with CAD

Regional left ventricular diastolic function analysis in hypertensive patients using pulsed wave Doppler tissue imaging

Introduction: Doppler tissue imaging is a new ultrasound tool can provide quantitative assessment of the systolic and diastolic motion of the left ventricular walls

Aim: our aim is to study the regional diastolic function in hypertensive patients with and without left ventricular hypertrophy by pulsed Doppler tissue imaging

Patients and Methods:-The studied population grouped into Group1 [normotensive lo], Group2 [hypertensive patients without left ventricular hypertrophy 20] and Group3 [hypertensive patients with left ventricular hypertrophy 20]. All patients underwent conventional Echocardiography to asses all routine transmitral diastolic indices, also Doppler tissue imaging applied to asses regional myocardial diastolic function at five regions of interest [basal and mid septum, basal and mid lateral in addition to infero-posterior wall], where the following parameters were obtained in each segment [regional early diastolic wave peak velocity Em, regional late diastolic wave peak velocity Am, regional Em /Am velocity ratio, early diastolic wave peak velocity deceleration time, the isovolumic relaxation time , and time velocity integral of late diastolic wave with time velocity integral of total diastole

Results: in our results by conventional Echo-Doppler study the transmitral diastolic indices had a highly significant difference among the three groups meanwhile A wave was with no significant difference in between the two hypertensive groups but E wave had a significant difference among them. The diastolic indices by pulsed Doppler tissue imaging at basal septum showed significant variations among groups except for peak myocardial late diastolic wave in between the two hypertensive groups ,while indices of other regions of interest can not differentiate the two hypertensive groups from each others as there was no statistically significant difference [p>0.05]. When we compared basal septal diastolic indices in hypertensive patients with left ventricular hypertrophy and indices of other regions, the passive diastolic properties were impaired more in basal septum than other regions of interest

Conclusion: by using pulsed Doppler tissue imaging the diastolic indices of hypertensive patients without left ventricular hypertrophy founded to be uniformly impaired a long left ventricular walls, but when hypertension is associated with left ventricular hypertrophy diastolic abnormalities become more evident at the basal septum

Clinical implication: Diastolic abnormalities detected using Doppler tissue imaging particularly in basal septal segment might lead to identification of early markers of left ventricular diastolic dysfunction in hypertensive patients with left ventricular hypertrophy that may be a proper guide for optimal management of hypertension to break the substantial link between it and the development of heart failure

Right ventricular dysfunction type in idiopathic and Ischemic cardiomyopathy: Assessment by tricuspid annular velocities

Impaired right ventricular [RV] function can occurred in patients with left ventricular [LV] dysfunction. Tissue Doppler derived tricuspid annular velocities [TAV] permits assessment of systolic and diastolic RV function. The current study aimed to identify the cause of LV dysfunction whether idiopathic cardiomyopathy [DCM] or ishemic cardiomyopathy [ICM] on the basis of RV dysfunction type assessed by TAV. Fifty seven patients with LV ejection fraction <45% and dilated both ventricles were subgrouped according to the finding of coronary angiography into 30 patients with normal coronaries [DCM group], 15 patients with left coronary artery disease [CAD] [ICM[L] group] and 12 patients with proximal right CAD in addition [ICM[LR]] group]. Fourteen control subjects were also studied. Beside the routine echocardiographic assessment of LV and RV functions, peak systolic[s[m]] and peak early [E[m]] and late diastolic [A[m]] TAV were recorded. RV systolic dysfunction was defined as TA S[m] <10 cm/sec, while RV diastolic dysfunction was defined as TA E[m]/A[m] <1 Patients of DCM and ICM were matched regarding the global LV dysfunction [p>0.05]. ICM groups showed more frequent electrocardiographic Q wave, regional wall motion abnormalities, abnormal LV filling and RV systolic and diastolic dysfunction [TA S[m] <10cm/sec and TA E[m]/A[m] <1].While DCM group showed RV systolic dysfunction only [TA S[m] <10 cm/sec and TA E[m]/A[m] >1] [p<0.001]. Optimized detection of ICM [sensitivity 100%, specificity 100% and accuracy 100%] was achieved depending on the presence of TA E[m]/A[m]8.2 cm/sec could discriminate ICM[L] from ICM[LR] with sensitivity 100%, specificity 100% and accuracy 100%.In the presence of systolic dysfunction of both ventricles, the salient feature of ICM as compared to DCM is the TA derived RV diastolic dysfunction. In addition the marked RV systolic dysfunction in ICM favour left and right CAD

Plasma homocysteine level in patients of coronary artery disease and its relation to vitamin B[12], folic ACID and other lipid risk factors

This study was planned to clarify the role of Homocysteine level in patients with coronary artery disease [CAD] in relation to folic acid and vitamin B[12], deficiency. The study included 90 persons; 20 healthy control, and 70 patients with [CAD], whom classified into [subgroup-1] included 25 cases of AMI, [subgroup-2] included 25 patients of unstable angina, and [subgroup-3] included 20 cases of stable angina. All cases in different groups and subgroups were underwent to coronary angiography at cardiology department of Al-Hussein university Hospital. Blood samples from all patients and control groups were analyzed at clinical pathology department at the same hospital for: 1 - Serum total Homocysteine. 2-Serum vitamin B[12] and folic acid- 3-Serum total cholesterol, Triglyceride, LDL, HDL, CK, CK-MB and LDH. The study revealed that there was high significance difference between control group and each subgroup as regard elevation of homocysteine and reduction of folic acid and vitamin B[12]; P-value <0.0001. There was correlation between elevation of homocysteine and folic acid deficiency in all subgroups, p-value<0.05- Also, there was correlation between elevation of homocysteine and vitamin B[12] deficiency in all subgroups, P-value<0.05. There is direct relation between hyper-homocysteinemia, folic acid, vitamin B[12] deficiency and coronary artery disease. We advice administration combined therapy with folic acid and vitamin B[12] to high risk individual of CAD

Left ventricular geometric abnormality and urinary albumin excretion relationship in hypertensive elderly patients with an ECG- documented left ventricular hypertrophy

The relationship between blood pressure load, the specific LV Geometric patterns and urinary albumin excretion remains rather unclear. To evaluate such relation; this study was conducted to evaluate the relationships among left ventricular geometric patterns abnormality and urinary albumin excretion in elderly patients with hypertension and electrocardiographic [ECG] documented LV hypertrophy. In 143 patients with hypertension, 24 h. Ambulatory blood pressure monitoring, single urine albumin determination, and echocardiography were performed after 14 days of stopping all medications, to be maintained only on a life style modification regimen. The cases were grouped according to the left ventricular geometric patterns into: normal, concentric remodelling, concentric hypertrophy and eccentric hypertrophy [the number of cases was; 24, 17, 28 and 63 respectively]. Also were grouped according to urinary albumin excretion into; normal albuminuric, micro and macro- albuminuric [the number of cases was; 78, 26 and 6 respectively]. Ambulatory BP, but not office BP, was higher among albuminuric compared to normal-albuminuric patients. In patients with established hypertension, day-time pulse pressure and office BP were different in the four LV geometric patterns, with the highest pressure in those with abnormal geometry. Furthermore, micro-albuminuria was more frequent in hypertensive patients with LV hypertrophy than in those with either normal geometry or concentric remodelling. White coat hypertensive [10%] showed lower LVMI and no micro-albuminuria compared to patients with established hypertension. There were no differences in the prevalence of nondippers among the four LV geometric patterns or in micro-albuminuria. In conclusion, increased office BP and day-time pulse pressure and were associated with an increased prevalence of an abnormal LV geometry. Micro-albuminuria was more frequent in groups with concentric and eccentric LV hypertrophy. Ambulatory BP, but not office BP was higher in albuminuric than normo-albuminuric patients. In patients with micro-albuminuria; 24- h Ambulatory BP did not provide an additional information beyond office BP