Circadian blood pressure variability in normo and hypertensive diabetic patients

Diabetic patients have a higher prevalence of non-dipping pattern in blood pressure [BP] than general population. Non-dipping arterial pressure pattern is associated with increased cardiovascular risk. The objective of this study was to investigate the association between the clinical and paraclinical characteristics of the diabetic patients with circadian BP variability. This cross-sectional study included 114 diabetic patients [more than 18 years old] recruited by consecutive sampling. The patients were divided into two groups according to the results of systolic blood pressure dipping from day to night. Mean age was 58.3 +/- 9.6 years; and 63% of the study population was male. Also, 80.7%, 78.1%, and 78.9% of the patients had non-dipper patterns in systolic, diastolic, and mean BP respectively. The dipping pattern did not have any significant association with baseline or clinical characteristics of the patients [p > 0.05]. The characteristics of the patients do not assist finding diabetic persons who are more likely to have non-dipping arterial pressure pattern. As such, ABPM is an essential tool for proper risk stratification in diabetic patients

[Correlation between assymetric dimethyl arginine [ADMA] and coronary atherosclerosis and severity of coronary artery stenosis]

Cardiovascular diseases are among important causes of mortality and it is essential to identify different factors that are associated with it. One of the factors that have been studied in recent years is asymmetric dimethylarginine [ADMA]. The aim of this study was to measure ADMA in atherosclerotic patients and to compare it with controls. In a case-control study, 70 patients with documented coronary stenosis, and 70 controls, without coronary disease, were chosen. Patients and controls aged between 40 and 70 years, and were of both genders. The serum level of ADMA was measured, using Cusabio Brand ELISA Kits, Wuhan Huamei Biotech, Inc, China. Analysis of data were done by ANOVA and T Test. The data were collected from 70 patients, and 70 matched controls. The mean level of serum ADMA in patients was 94.7 +/- 37 ng/ml while it was 51.5 +/- 33.6 ng/ml in controls; this difference was statistically significant [P<0.001]. The mean level of ADMA in patient with mild, moderate and severe stenosis, were 55.6 +/- 3.3, 79.5 +/- 9.2 and 108.9 +/- 35.7 ng/ml, respectively; the difference among these groups were statistically significant [P<0.001]. Data of this study showed that there was significant correlation between ADMA and atherosclerosis. In addition, there was a significant correlation between ADMA serum level and severity of coronary artery stenosis

[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

Correlation between anterior mitral leaflet concavity area and ischemic induced mitral regurgitation severity by echocardiography

Functional mitral regurgitation [MR] results from left ventricular remodeling, leaflet tethering or tenting. Coronary artery disease is one of the important causes of functional MR due to tethering. Detection of functional MR and its severity are important factors in patient prognosis. There are different methods for detection of functional MR and its severity, including anterior mitral leaflet concavity area [AMLCA]. In this cross sectional study 32 patients, 19 male with three vessel disease [3VD] who were candidate for coronary artery bypass grafting [CABG] with or without mitral valve replacement were selected. The patients had functional MR in ventriculography. AMLCA was determined by long axis view of transthorasic echocardiography [TTE]. In this study 32 patients with 3VD and MR were selected [15 mild, 15 moderate and 2 cases with severe MR]. The mean age was 62 +/- 12 years. In these patients AMLCA were 0.1-0.43 cm[2] in transthorasic echocardiography. The findings of this study showed strong association between anterior mitral leaflet concavity area and functional MR severity [r=0.89] in parasternal long axis [LAX] view of TTE. According to these findings the relation between functional MR and AMLCA was a linear relationship and increase in severity of functional MR was in concordance with increasing of anterior mitral leaflet concavity area [P=0.001]. Mitral leaflet concavity area in the parasternal LAX view provides rapid and reliable recognition of functional MR due to coronary artery disease and is quantitatively related to the degree of such MR. We recommend further study with more subjects and ischemic functional MR and AMLCA

[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

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