ABSTRACT
Aims: The prevalence of heart failure with preserved ejection fraction [HFpEF] has increased in the past two decades. Although it has been demonstrated that left ventricular [LV] diastolic and vascular functional abnormalities are generally observed in HFpEF, it remains to be clinically elucidated how an asymptomatic stage progresses to symptomatic HFpEF. We aimed to identify risk factors associated with incident HFpEF and to compare it with systolic heart failure [SHF]
Methods and Results: The study included 100 patients of heart failure, 50 patients were having ejection fraction /=50%. We included patients of heart failure who were admitted in coronary care unit of services hospital Lahore or they had more than one visit to the outpatient clinic of services hospital Lahore and had en echocardiographic report recorded. Patients with serum creatinine >/= 2.0 mg/dL and patients with significant valvular heart diseases were excluded from the study. Mean age of patients was 53 +/- 9Y. Mean hemoglobin of patients was 11+/-2g/dl.62% patients were smokers and 38% were nonsmoker. 57% patients were female and 43% were male. 63% of all patients were suffering from coronary artery disease and 37% patients were not.66% patients were obese and 34% patients were not obese. 65% patients were suffering from Diabetes mellitus and 35% patients were not. 54% patients were hypertensive and 46% patients were not suffering from hypertension. 43% patients had restrictive dysfunction on echocardiography and 43% patients had non restrictive pattern on echocardiography. Among those with EF>/= 50 80% patients were smokers and 20% were non smokers [P=>0.00]. 75% patients of EF>/= 50 were female and 25% patients were male [P=0.001]. 35% patients were diabetics and 65% patients were non diabetics. [P=9] 65% patients were hypertensive and 35% patients were not. [p=0.028]. 36% patients were suffering from coronary artery disease and 65% patients were not suffering from coronary artery disease [P=0.00]. 46% of these patients were having restrictive echocardiographic abnormalities on mitral valve inflow interrogation [p=0.00]. 26% of these patients were obese [P=0.00]. Multiple logistic regression analysis revealed that obesity, female gender, age, smoking, and impaired LV compliance and history of hypertension were independently associated with the prevalence of HFpEF whereas anemia and diabetes mellitus was not
Conclusions: Female gender, history of hypertension, age, smoking and obesity was independently associated with the prevalence of HFpEF whereas anemia diabetes mellitus was not
ABSTRACT
Objective: to determine the relationship of C- reactive protein with essential hypertension at 1st presentation and effect of angiotensin-11 receptor blockade on micro-inflammation
Material and Methods: twenty healthy controls and forty patients of stage 1 and stage 2 essential hypertension diagnosed at their 1st presentation at outpatient department of Services Hospital Lahore was studied. Blood of all patients was checked for CRP at 1st presentation and at the end of twelve weeks. Patients were divided in two groups A and B, group A received valsartan 80 to 160 mg per day and group B received amlodipine 5 to 20 mg per day. None of the patients required additional antihypertensive therapy
Results: the mean change in hsCRP was 0.09 mg/L among those allocated to amlodipine compared with 0.08 mg/L among those allocated to valsartan. When the means of hsCRP were compared in three groups, it was found that initial hsCRP levels were high in hypertensive group and after twelve week treatment with antihypertensive medicines there was significant drop in hsCRP levels [p<0.05]. Within the groups neither amlodipine nor valsartan showed the individual benefit on each other [p>0.05], both of them were equally effective in reducing hsCRP. No relationship was observed between hsCRP change and change of blood pressure
Conclusion: it is concluded that C-reactive protein is high in hypertensive patients and adequate control of blood pressure is required to prevent the vasculature from atherosclerotic damage
ABSTRACT
Objective: to assess the prevalence of systolic and diastolic dysfunction in patients of chronic renal failure on conservative management
Background: cardiovascular disease is the most common cause of mortality in patients with end-stage renal disease. Determining the spectrum of echocardiographic abnormalities in these patients can help the prevention of mortality in this group of chronically ill patients
Methods: 100 adult patients with chronic renal failure and 100 healthy controls who underwent echocardiography during November 2008 till March 2009 were enrolled. Complete 2-D, M-mode, Doppler and color Doppler study were performed for each patient and they were recorded. The left ventricular ejection fraction [EF] and fractional shortening [FS] were taken as measures of LV systolic function. Diastolic function was determined by measuring E/A ratio by spectral doppler LV inflow velocity
Results: the mean age of patients was 50 and 52% were female. The mean age of control was 48 and 54% were female Mean blood urea of patients was 61 +/- .38mg/dl, and mean serum creatinine was 3.8 +/- 2.38 mg/dl. Mean blood urea of controls was 24.9600 +/- .86 and serum creatinine of control population was 1.81 +/- 3.2. Echocardiographic abnormalities were observed in 93% patients of renal failure. The mean cardiac dimensions were right ventricular diastolic dimension: 18 +/- 0.05 mm, inter-ventricular septal dimension: 12 +/- 1.2 mm, end diastolic dimension: 52 +/- 10 mm, end systolic dimension: 38.79 +/- 9.4 mm and ejection fraction: 52 +/- 11. Mean ejection fraction was 52% , and ejection fractionless than 50% was observed in 45% patients. Mean fractional shortening was 29% in patients with chronic renal failure and 30% in control population. The mean E/A ratio in CRF group 0.86 and it was 1.2 in control group
Conclusion: echocardiographic abnormalities are very common in patients suffering from renal disease, so periodic echocardiographic examination for diagnosis and treatment of cardiac abnormalities is highly recommended
ABSTRACT
Diabetes mellitus affects every organ system in the body. Cutaneous manifestations in diabetes are varied, approaching to 100%. We conducted a study at our center to determine the prevalence of skin abnormalities in type 1 and type 2 diabetes mellitus. Two hundred patients of diabetes mellitus were observed for cutaneous manifestations. Twenty one [10.5%] patients were suffering from type 1 diabetes mellitus and 179 [89.5%] patients were suffering from type 2 diabetes mellitus. Mean duration of diabetes mellitus was 7.1+/-0.89 years and 6.8+0.84 years in type 1 and type 2 diabetes mellitus respectively. Two hundred patients [116 [58%] patients were found to have cutaneous abnormalities. Among these patients 57 [49%] were male and 59 patients [50.86%] were female. Thirteen patients [11.2%] were suffering from type 1 diabetes mellitus and 103 patients [88.7%] were suffering from type 2 diabetes mellitus. No significant effect of type of diabetes mellitus was observed on skin lesions [p=0.12]. It is concluded that skin disease is quite common in diabetes mellitus and it is equally prevalent in type 1 and type 2 diabetes mellitus
ABSTRACT
Diabetes mellitus is the most common endocrine disorders associated with disturbed metabolism. Glycosylated haemoglobin [HbA1c] is one parameter of checking blood glucose control in diabetics over the past 3 months. We concluded a study to look for skin disorders due to diabetes mellitus and to see correlation between control of blood sugar [HbA1c] and cutaneous manifestations. It was a cross sectional study. The study was carried out from 1[st] January 2003 to 31[st] March 2003 in the Department of Medicine and Dermatology, Shaikh Zayed Hospital, Lahore. A total of 200 patients of diabetes mellitus admitted as inpatient and attending Outpatient Department of Medicine were studied. Patient`s history, dermatological and systemic examination were recorded. Their blood was collected for estimation of random blood sugar, complete blood count, blood urea, serum creatinine, serum electrolytes, serum lipid profile whereas HbA1c was determined by chromatographic method. Normal range of HbA1c was taken as 5-7%. HbA1c of > 7% was taken as high and HbA1c value of <7% was taken as normal. Of 200 patients, 116 [58%] patients were found to have cutaneous abnormalities, 127 [63.5%] patients had high HbA1c value and 73 [36.5%] patients had normal HbA1c value. In patients having high HbA1c value, 90 [70%] patients had cutaneous disorders. Among those patients who had normal HbA1c, value 26 [35.6%] patients had skin abnormalities. This correlation was found to be statistically significant [P <0.002]. Prevalence of cutaneous disorders in diabetes mellitus is 58%. Cutaneous manifestations are more common in patients who have overall poor glycemic control which in turn is reflected by high HbA1c, value [Normal= 5-7%]