ABSTRACT
The importance of right ventricalar function in acute and chronic cardiac affection is well established. Is to assess the value of pulse wave Doppler tissue imaging [PWTDI] during dobutamine stress echocardiography in detection of right coronary artery narrowing. 40 subjects were divided into two groups according to the presence [patient group] or absence [control group] of significant > 70% isolated right coronary artery narrowing proved by coronary angiography. All patients studied had right coronary artery dominance, they were subjected to the following: complete history taking and thorough clinical examination, 12 leads resting surface electrocardiography, resting standard echo Doppler study, coronary angiography, doubtamine-atropine stress echocardiography with pluse-wave Doppler tissue sampling. There was no statistically significant difference between the two groups as regard to early [E] and late diastolic [A] velocity in cm/sec by pulse wave tissue Doppler at rest, low dose and high dose dobutamine. p > 0.05. Regarding the ejection phase velocity in cm/sec. [EJ] by pulse-wave Doppler tissue there was no statistically significant difference between the control and the patient groups at rest and low dose dobutamine p > 0.05., however at higdose dubutamine there was a highly statistically significant difference [p < 0.01] and it was found that a progressive increase of the ejection phase velocity [EJ], expressed by a more than 25% increase from 10 microg/kg/min [low dose] to peak dobutamine stress was predictive of normal or insignificantly narrowed right coronary artery [RCA]. Whereas a blunted increase, expressed by < 25% increase of velocity, was predictive of a significantly narrowed RCA. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of pulse-wave Doppler tissue sampling in detection of right coronary artery narrowing was 80%, 75%, 79.2%, 76.9% and 78% respectively. Analysis of the right ventricular wall was accessible using the pulsed wave tissue Doppler sampling in all cases while visual assessment was not. Pulsed wave tissue Doppler sampling is a valuable tool to detect right coronary artery narrowing when combined with dobuta-mine-atropine stress echocardiography
Subject(s)
Humans , Male , Female , Echocardiography, Stress/methods , Coronary Angiography/methodsABSTRACT
Objective: the aim of this work is to study HRV parameters in patients with unstable angina
Materials and Methods: the study comprised 50 patients with unstable angina; 35 males and 15 females with mean age 45 +/- 94 yrs. beside ten healthy control subjects. All patients and control subjects were subjected to thorough history taking, full clinical examination, electrocardiography, routine laboratory investigations, assessment of heart rate variability [HRV] using time domain [NN 50 and RMSSD] for non-spectral analysis and frequency domain [LF, HF and LF / HF ratio] for spectral analysis, echocardiographic examination and coronary angiography
Results: there was significant global reduction in HRV parameters in patients with unstable angina compared to control group as mean NN 50 was 3.2 ms in patients compared to 20.1 ms in control group [P < 0.01]. Mean RMSSD was 10.1 ms in patients us 42.1 ms in control group [P < 0.01], HF was 50 ms2 in patients us 350 ms2 in control group and HF was 32.5 ms2 in patients compared to 246 ms2 in control group. However, there was no significant difference between the patients and controls as regards LF/HF ratio [P > 0.05]. Mean W H F ratio was significantly higher. Among patients who experienced recurrent chest pain during hospitalization as the mean LF/HF ratio among five patients who developed recurrent chest pain was 1.9 vs 1.5 in other patients [P < 0.05]. There was significant correlation between HRV and both EF [r = 0.8, P < 0.05] and severity of coronary artery disease [r = 0.7, P < 0.05]. There was no significant correlation between HRV and age [r = 0.2, P > 0.05, end systolic diameter [r = 0.3, P > 0.05] and end diastolic diameter [r = 0.02, P > 0.05] of the left ventricle
Conclusion: all parameters of HRV except LF/H.F ratio were significantly lower among patients with unstable angina compared to control group. HF/HF ratio in particular was significantly lower among patients who experienced recurrent chest pain during hospitalization. Finally there was positive correlation between HRV parameters .and both EF and severity of coronary heart disease
Comment: HRV can be a useful parameter for risk stratification of patients with unstable angina
ABSTRACT
Aim: to study the value of pulsed wave Doppler tissue imaging in comparison to Doppler echocardiogram for better evaluation of diastolic dysfunction in HCM
Material and Results: twenty patients with HCM were selected in this study and were compared to matched twenty controls using Doppler echocardiogram and tissue Doppler. In comparison of E, A, E/A ratio and E deceleration time in Doppler echocardiogram only E deceleration time was significant more prolonged in HCM than controls, when we compare by DTI there were highly significant difference as regard septal mitral annular velocity parameters [Ea, Ea/Aa ratio and significant difference as regard septal Aa and Ea deceleration time. In addition, there were highly significant difference as regards lateral mih-a1 annular velocity parameters [Ea, Ea deceleration time, Ea/Aa] and no significance as regard [Ad. When we correlate E/Ea in both septal and lateral sites to grade of dyspnea. We found E/Ea [lateral] highly correlated than E/Ea [septal] and this was correlated to higher NYHA grade of dyspnea
Conclusion: early septal and lateral mitral annular velocity [Ea] by DTI can detect diastolic dysfunction better than conventional Doppler echocardiogram in HCM, also E/Ea ratio [lateral best than septal] correlated with NYHA grade of dyspnea
ABSTRACT
Background: acute coronary syndrome has been recognized in young age groups more frequently in recent years. It may differ from that of elderly in some demographic and angiographic data
Aim: the aim of this work is to study the characteristic features, traditional risk factors for coronary artery disease and angiographic criteria in young Egyptian patients who was presented with acute coronary syndrome compared with clinical outcome of old patients with acute coronary syndrome
Methods: 60 male and female patients with acute coronary syndrome [ACS] were selected. Patients were divided into two groups: group I below 40 years and group II above 40 years. All patients were subjected to careful history taking, clinical examination, electrocardiography, echocardiography and coronary angiography
Results: among young adults with ACS, cigarette smoking and dyslipidemia were the most prevalent risk factors. ST elevation myocardial infarction was the most common presentation and among those, inferior myocardial infarction was the most common type of infarction. Single vessel disease md normal coronary angiography were the most common findings
Conclusion: the clinical criteria and angiographic features of young adults with ACS are different n some aspects from older one
ABSTRACT
Objective: the aim of this work is to evaluate the impact of subtle left ventricular systolic dysfunction in patients with left ventricular diastolic dysfunction
Materials and methods: this study included 40 male and female patients who were divided into two and equal groups and 10 healthy control persons. Group I included patients with systolic heart failure and group II included and patients with left ventricular diastolic dysfunction. All patients were subjected to thorough history taking, full clinical examination reseing ECG, and echocardiography with assessment of left ventricular systolic function, left ventricular diastolic function, tissue Doppler study; and left ventricular A-V plane displacement
Results: left ventricular systolic A-V plane displacement was significantly lower in patients with diastolic dysfunction than control subjects [8.3 +/- 0.7] mm versus [1 4.5 +/- 2.37] mm respectively and 'the mean velocity of Sm wave by DMI was significantly lower-in DHF group than control group [7.24 +/- 1.4 1] mm versus [9.04 +/- 154] mm respectively
Conclusion: in patients with DHF, there was some degree of te2 ventricular systolic dysfunction Diastolic heart failure appears, to be a part of continuum between normal and severely impaired LVSF