Spirometric plus left ventricular and pulmonary blood flow echocardiographic findings in patients with scleroderma before and after sildenafil

Systemic sclerosis [scleroderma] is a chronic debilitating disease that is caused by the occurrence of fibrotic changes and vascular abnormalities at various levels such as: Skin, lungs, kidneys or heart. Lung involvement in scleroderma is one of the leading causes of mortality in this disease. Sildenafil inhibits phosphodiesterase type 5, an enzyme that metabolizes cyclic guanosine monophosphate, thereby enhancing the cyclic guanosine monophosphate-mediated relaxation and growth inhibition of vascular smooth-muscle cells, including those in the lung. We hypothesized that chronic oral administration of the phosphodiesterase-5 inhibitor sildenafil could improve the pulmonary haemodynamics in Systemic sclerosis [Ssc] patients. To investigate the use of sildenafil, detect the effect of sildenafil on the left ventricular function and the pulmonary blood flow echocardiographic parameters and pulmonary functions in a series of SSc patients. Twenty three systemic sclerosis cases were selected for the study. All patients were subjected to clinical evaluation, laboratory investigations, plain chest X-ray, ECG, basal pulmonary function tests and basal echocardiographic assessment. One week of therapy with oral sildenafil 75mg/day in three divided doses was given to the patients, after which they were subjected to a second assessment of respiratory function tests and echocardiography. Sildenafil therapy resulted in the following changes: Mitral E/A was significantly increased [p<0.05]. This was further supported by a significant drop of the pre-ejection period [p<0.001] after using sildenafil. There was a significant rise in acceleration time and the ratio between it and ejection time in both aortic and pulmonary Doppler. Also there was a significant decrease in pulmonary artery diameter [p<0.001], maximal pulmonary flow velocity [p<0.001], pulmonary integral area under the curve [p<0.001] and mean acceleration [p=0.007]. Some ventricular contractility indices as the posterior wall excursion [p=0.001], inter-ventricular septal excursion [p=0.043], velocity of posterior wall excursion [p<0.001], velocity of interventricular septal excursion [p<0.001] showed statistically significant increase. The left ventricular internal dimensions and volume in diastole showed a significant drop [p=0.001, p=0.002 respectively], there was a significant increase in the interventricular septum thickness in systole and diastole [p<0.05] with a borderline significant increase in posterior wall thickness in systole [p=0.05]. Spirometric studies showed a statistically significant increase in FEV[25-75] after the use of sildenafil, [p<0.05] which denotes improvement of airway obstruction. Sildenafil improved left ventricular systolic and diastolic functions and may improve pulmonary blood flow in patients with systemic sclerosis. PDE-5 inhibitors are efficacious in scleroderma-associated pulmonary hypertension

value of pulsed tissue doppler study in the early diagnosis of diastolic dysfunction in type 2 diabetes mellitus

Cardiovascular disease is the most important cause of mortality and morbidity among patients with type 2 diabetes. Diastolic dysfunction represents the earliest preclinical manifiestataion of diabetic cardiomyopatahy that can progress to sympotomatic heart failure. Transmitral flow Doppler echocardiography is widely used to non-invasively evaluate diastolic function in type 2 diabetic patients, however, this method may give misleading results. Recently, Pulsed Tissue Doppler Imaging [TDIK] has emerged as a new non invasive imaging modality that allows direct online measurement of myocardial velocities throughout the cardiac cycle. The aim of this work is to evaluate the usefulness of pulsed tissue Doppler study of mitral annulus versus transmitral flow Doppler in assessing the diastolic function in type 2 diabetic patients. This study included 4 subjects divided into: 15 patients with type 2 DM having diastolic dysfunction diagnosed by conventional Doppler [group I], and another 15 diabetic patients with normal diastolic function by conventional Doppler [group II], in addition to 10 normal controls [GROUP III]. All patients were subjected to clinical evaluation, laboratory investigations, ECG, echocardiographic assessment and Pulsed Tissue Doppler Imaging of the mitral inflow and mitral annulus with assessment of the transmitral flow veloctities. All partients with diastolic dysfunction diagnosed by conventiaonal Deoppler showed the same abnormality on using TDI, moreover the use of the ratio E[TDI]/A[TDI] by TDI diagnosed 33.33% of group 2 patients to have diastolic dysfunction while they were having normal patterns by conventional Doppler. There were no values in the control group of E[TDI]/A[TDI]<1. Higher values of FBS, PP, HbA1c and triglycerides were associated with impaired LV diastolic performance. Diastolic dysfunction is common in type 2 DM patients specially those with worse glycaemic control. Pulsed TDI of the mitral annulus is more sensitive than conventional Doppler in identifying early LV diastolic dysfunction in type 2 DM patients