Effect of [urografin] on left ventriular diastolic and renal functions after cardiac catheterization

is to evaluate the effects of iodinated contrast media "urografin" on kidney functions and left ventricular diastolic function indices in patients underwent coronary angiography. It included 100 patients with normal kidney function 57 male [57%] and 43 female [43%]. The patients are classified into four groups:- group A: diabetic hypertensive patients, group B: only diabetic patients, group C: only hypertensive patients and group D: non diabetic, non-hypertensive patients. For all patients history taking and clinical examination, standard 12 lead ECG, abdominal ultrasonography to exclude renal medical diseases, Echo-Doppler study before, immediately and 7 days after cardiac catheterization for assessment of left ventricular diastolic functions, and kidney function tests before cardiac catheterization, immediately, 3 days and 7 days after cardiac catheterization. We found an increase in blood urea, serum creatinine and decrease in creatinine clearance [not reaching the significant level] at the first day after contrast administration [P> 0.05]; However, the maximal significant effect of these contrast agent on kidney functions was reached at the third day [P< 0.05] and return to normal at the seventh day [P< 0.05]. Also we found that the level of serum creatinine is maximally changed after three days of contrast administration, where the mean values were 1.11 +/- 0.19 before coronary angiography changed to 1.24 +/- 0.17 immediately after coronary angiography and 1.79+0.13 three days after coronary angiography and 1.27+0.12 after seven days of coronary angiography. It was noted that the level of serum creatinine is increased by 25% or > 0.5 mg/dl from the base line value and decline to nearly normal level after seven days of coronary angiography. The effects of contrast agents on kidney functions were significantly higher in groups [A] and [B] than that of groups [C] and [D] and there was a significant positive correlation between the dose of contrast media and the effect on kidney functions [P< 0.05]. Also, there was a non-significant effect of the radio contrast media on the left ventricular diastolic function indices in the four studied groups [P> 0.05] immediately after and seven days after radio contrast administration. However, there was a non-significant correlation between the dose of contrast media and diastolic function parameters immediately after and seven days after coronary angiography [P> 0.05]. So the effect of radiocontrast agents after coronary angiograpghy on kidney functions is benign and transient starting within 1-2 days reaching the peak at 3-5 days and then returning to base line within 7-10 days. This effect is significantly higher in diabetic hypertensive patients than that in non-diabetic, non-hypertensive patients with positive correlation between the dose of contrast media and kidney functions. However, the ionic contrast media exerts negligible alterations on left ventricular diastolic functions indices

Progeostic value of restrictive filling pattern of left ventricle at peak in inferior wall myocardial infarction

The purpose of this research was to study the effect of dobutamine on left ventricular [LV] filling indices in patients suffering their first uncomplicated Acute myocardial infarc-tion restricted to the inferior wall of the LV [AMI-1], and to determine whether restrictive filling pattern [RFP] at peak stress has prognostic value and its utility for evaluation of CAD. METHODS: A total of 40 patients with uncomplicated inferior wall AMI were studied by Doppler echocardiography at rest and stress; RFP was defined as transmitral E:A ratio > or =1.0, isovolumic relaxation time [IRT] <80 ms, and E-wave deceleration time [Edt] <120 ms. A total of 24 of 40 had RPP at rest, which reverted to non-RFP at stress in 11 [group 2], but persisted in 13 [group 1]; 16 of 40 had non-RFP at rest and peak stress [group 3]. Systolic, diastolic and mean blood pressures were significantly decreased in group [1] compared to group [2] and group [3]. Congested neck veins and lung fields were significantly increased in group [1] compared to group [2] and group [3], and also in group [2] compared to group [3]. LVEDD and LVESD were significantly increased, while LVFS and LVEF were significantly decreased in group [1] compared to group [2] and group [3]. E wave and E/A ratio were significantly increased, while Edt, IRT and Tei index were significantly decreased in group [1] and group [2] compared to group [3], with no significant difference between group [1] and group [2]. CK and CKMB were significantly increased in group [1] compared to group [2] and group [3], and also in group [2] compared to group [3]. In addition, CRP and troponin T were significantly increased in group [1] compared to group [2] and group [3]. Post infarction angina, heart failure and conduction defects were significantly increased in group [1] compared to group [2] and group [3]. Arrhythmia were significantly increased in both group [1] and [2] compared to group [3], with no significant difference between group [1] and group [2].Three vessel disease was statistically more prevalent in group [1] compared to group [2] and group [3]. On the other hand, single vessel disease was statistically more prevalent in group [3] compared to group [1] and group [2]. LAD and LCX lesions were statistically more prevalent in group [1] compared to group [2] and group [3]. In patients suffering inferior infarction, persistence of restrictive filling during stress implies an important marker for increased morbidity and mortality. Stress echocardiography uniquely identifies those high-risk patients

Systolic left ventricular long axis function during stress echo-cardiography in coronary artery disease patients

No study has yet fully compared long axis systolic function [LASF] with wall motion analysis [WMA] of left ventricle [LV] which remains the routine method of patient evaluation despite being semi-subjective and particularly difficult to interpret in the presence of a myocardial infarction [MI] on the base line study. 1- To describe changes in LASF during dobutamine stress echocardiography [DSE] in patients with coronary artery disease [CAD]. 2- To test whether a change in LASF is more accurate than WMA for detection of significant CAD in patients with normal resting wall motion. 3- To see if LASF improves the detection of multi-vessel involvement in patients with a resting wall motion abnormality. A total of 134 subjects divided into 3 main groups; Group I: 68 patients with clinical suspicion of CAD undergoing coronary angiography; Group II: 46 patients had old MI undergoing coronary angiography; Group III: 20 normal subjects of same age and sex as a control group. They were subjected to: Clinical history taking, through physical examination, 12-leads surface ECG, chest X-ray, Echo -Doppler study at rest and during DSE for parameters of LASF of left ventricle, and coronary angiography. The mean ages, sex, heart rate of studied population were comparable with no significant difference among the three studied groups. The mean values of systolic and diastolic blood pressure presence of diabetes mellitus ejection fraction, resting wall motion abnormalities, and coronary angiography patterns were significantlly differe between patient groups and control one. In group I there were 42 [61.8%] patients had single vessel disease while in group II there were 11 [23.9%] patients had single vessel disease. There were 16 [23.5%] and 22 [47.8%] patients had two vessel disease in group I and 11 respectivelly. There were 10 [14.7%] and 13 [28.3%] patients had multi vessel disease in group I and II respectivelly. Patient groups had a highly significant group of LV reduction septal and lateral LASF parameters [amplitude, rate of shortening and Q-onset delay] than control group during DSE group I had a significant reduction of seplul and lateral LASE parameters of LV. Compared with group II during DSE. Patients had two vessel disease and patients had multiple vessel disease had a highly significant reduction in LASF parameters of LV compared with that of single vessel disease. And also, those with multiple vessel disease had a highly significant reduction in LASF parameters of LV compared with that of two vessel disease. Patients having resting wall motion abnormality had a highly significant reduction of septal and lateral walls LASF parameters compared to that patients having normal resting wall motion. 1- The LASF assessment is more reliable and accurate than WMA for the detection of CAD in our patients. 2- LASF parameters measurements were easy, reproducible with less intraobserver variations, specially in patients with poor endocardial delineation. 3- LASF parameters had a higher sensitivity, specificity and predictive values than WMA assessment in diagnosis of CAD. We recommend using of LASF parameters as a technique for detection of ischemia in patients having left bundle branch block by DSE

Double atrial potentials as a marker for isthmus block during ablation of atrial flutter

Assessment of success is an integral part in atrial flutter ablation. This work is concerned with evaluating the added value of recording double potentials along the ablation line induced to interrupt the macro-reentrant circuit of atrial flutter. Atrial flutter was ablated in 24 consecutive patients, 7 males and 7 females, their ages ranged from 10-65 years, with mean age of 37 +/- 12.5 years. The ablation was done through burning a continuous line across the cavo-tricuspid right atrial isthmus. In all patients pace-mapping indicated complete bidirectional isthmus block, we tried to record double potentials along the ablation line during pacing from the coronary sinus ostium. The patients were followed up for 6 months, recurrent cases were reablated. the acute success rate was 100% in both the initial and the second procedures. Nine recurrences [37.5%] occurred during the period of follow up, which were reablated; none of the reablated cases had any recurrence during six months of follow up, with overall late recurrences of nine patients out of 33 procedures [27%]. Whenever double atrial potentials were recorded along the ablation lines, there was no recurrence [specificity of 100%], but in cases in which these potentials were not recorded, it did not predict recurrence except in 40% of cases [sensitivity 60%]. Predictors of late recurrence, in this study, were age of the patient and Duration of symptoms. We compared between 4 and 8 mm tip ablation catheters, it turned to be that the recurrence and the procedure duration was lower with the use of 8 mm tip catheters. Patient with structural heart disease in this study were older, with more duration of symptoms and their procedures were longer. In conclusion, there was an added value of recording double atrial potentials to the conventional mapping technique used to identify bidirectional isthmus block in patients with atrial flutter. In addition, 8 mm tip catheters were considered safe and effective in the term of reducing the time of the procedure and recurrence rate specially when combined with SVC approach. Abbreviations: SVC: superior vena cava

Detection of significant left coronary artery stenosis by reduced transthoracic coronary sinus flow reserve

Currently available methods for measurement of coronary flow reserve are invasive, time consuming and need laboratory equipment and staff. So, the aim of this study was to demonstrate coronary sinus flow by transthoracic echocardiography and to determine the feasibility of using CSFR for the diagnosis of left coronary artery stenosis. This study comprised two groups; patients group which consisted of 30 patients with angiographically proven isolated LCA stenosis, and control group which consisted of 10 healthy volunteers. All patients and subjects were examined by echo Doppler to measure coronary sinus diameter and coronary sinus flow dynamics at baseline and again at peak dipyridamole infusion. CSFR was measured by both peak and volumetric methods. At baseline, the coronary sinus diameter and Doppler parameters showed insignificant difference between both groups [P> 0.05]. At peak dipyridamole, a significant increase in CS diameter was seen in both groups [P< 0.01] without significant difference in between [P > 0.05]. However, dipyridamole induced increase of velocity and volume characteristic of CS was marked in control group than in patients group [P< 0.001]. CSFRp and CSFRv showed a highly significant decrease in patients group than control group [P<0.001]. CSFR by peak or volumetric methods

Percutaneous transluminal angioplasty versus cononary artery bypass grafting in patients with depressed left ventricular function

The aim of this study was to compare clinical and functional status after coronary artery bypass grafting or percuraneous coronary angioplxty [PTCA]. The study included 96 patients; 86 patients were males and 10 patients were females with age ranged from 28 years to 66 years [mean of 29]. The patients were divided into two groups, group I undergoing CABG and group II undergoing PTCA. Assessment of global left ventricular function via measuring ejection fraction by modified Simpson's role technique and regional systolic function by dividing the left ventricular into 16 segments as documented by ASE was carried out. LV function indices improved slightly significant or non- significantly in CABG group than PTCA and both groups had the same survival rate. The need for intervention was more in PTCA group. In-hospital mortality was more in CABG group, anginal attacks and need for anti ischemic medications were more prevalent in PTCA group. There was no significant difference between both groups regarding quality of life. The study concluded that CABG does not appear to be associated with unacceptable morbidity. Patients with graftable vessels and reduced EF should not be denied CABG on the basis of their reduced LV function, for many of these patients CABG is probably the most appropriate treatment

Cardiac manifestations of systemic lupus erythematosus patients

The present study was performed on twenty-five SLE patients. They were classified according to Doppler Echocardiographic findings into 2 groups: Group I: included 17 patients [68%] [15F, 2M] who had cardiac affection. Their disease duration ranged from 6 months to 10 years while the range of SLEDAI score was 4-22 with a mean of 10.6 +/- 5.3. Group II: included 8 females without cardiac affection. The range of disease duration was from 8 months to 6 years while SLEDAI score ranged from 4 to 21 with a mean of 11.1 +/- 6.02. There was a statistical significant difference between the 2 groups [p<0.05] as regards arthritis, fever and CNS symptoms that were present in 2 patients of group II only. Also there were significant differences between the two groups [p<0.05] as regards the ESR, anti-DNA and lupus anticoagulant. But lipograms did not show any statistical difference between both groups [p>0.05]. There was a direct correlation between pericarditis and disease activity and anti-DNA titer, as well as a significant positive correlation between valvular affection and lupus anticoagulants but a negative correlation between systolic function and activity as well as anti-DNA titer. Lastly, no significant correlation was found between cardiac involvement and the duration of the disease or duration of steroid therapy used or with lipograms. So Doppler-Echocardiography was helpful in showing that cardiac involvement was frequent in SLE patients especially during disease activity. Again, lupus anticoagulant [LAC] is common is SLE with cardiac involvement. So cardiovascular system must be investigated well especially in patients with positive LAC for the importance of planning therapy and assessment of prognosis

Evaluation of left ventricular function and mass after acute myocardial infarction: short term study

This work studied 30 patients with extensive, uncomplicated first attack of acute transmural myocardial infarction [AMI]. The patients were classified into two groups: Group A [conventional therapy group] included 15 patients received the conventional medical therapy of AMI [nitrates, beta blockers, antiplatelets, heparin and a tranquilizer], while group B [combined therapy group] included 15 patients received the conventional therapy plus converting enzyme inhibitor [12.5-25 mg captopril TTS] started on admission to CCU and continued for six months after AMI. All patients were examined and investigated on admission to CCU, predischarge, three months and six months after AMI. On each sitting analysis of left ventricular function indices [systolic and diastolic], left ventricular wall motion and wall motion score index [LVWM and WMSI], left ventricular mass [LVM] and mass index [LVMI] were measured by echo-Doppler. The results were collected and statistically analyzed