Aortic elastic-properties in offspring of hypertensive patients

The main objective of this study is to detect the changes might affect the elastic properties of large central arteries in normotensive offspring of known hypertensive parents, and to compare these changes to normal age-matched offspring of normal individuals. Also, to correlate age and gender effects on the results obtained. Arterial stiffening is associated with a number of known cardiovascular disease risk factors, raising the possibility that increased arterial stiffness may be a marker for advanced atherosclerotic vascular disease. The vascular dynamics of children with a parental history of hypertension is a cornerstone of early detection of functional and morphologic abnormalities of the arterial wall that may be responsible for many cardiovascular and cerebro-vascular complications in their future life. The study includes sixty subjects [ages 15-30 years], all were clinically healthy by applying exclusion criteria, full history and clinical examination. They are divided based on their family history of hypertension into two groups, group-I 30 offspring with a parental history of hypertension and group-Il 30 off-spring of normotensive parents. All subjects were evaluated to obtain systolic, diastolic and pulse pressure readings then, M-mode echocardiography is done to study their aortic elastic properties. After collection of both clinical [blood-pressure] and Echocardiographic data, analyses of the results revealed a significant elevation of all blood pressure parameters in group-I than group-Il with systolic Bp of mean +/- SD [118.5 +/- 9.7 in group-I versus 106 +/- 4.9 mmhg in group-Il], diastolic Bp [66.8 +/- 5.7 for group-I versus 62.8 +/- 8.0 mmhg in group-II] and a net increase in pulse pressure in group-I than group-Il [51.6 +/- 10.5 versus 43.1 +/- 6.2]. Comparing aortic diameters of two groups revealed that, a non-significant increase in systolic diameter in group-I [p=non-significant], significant increased diastolic diameter in group-I with mean +/- SD [29.8 +/- 2.3 versus 28.0 +/- 1.3 mm in group-II, p=0.01]. Group-Il subjects exhibit an increased Ao-diameter change property with mean +/- SD [3.7 +/- 0.4 versus [2.6 +/- 0.5 mm in group-I] reflecting impression of enhanced their aortic elastic feature. Comparing aortic stiffness parameters in between the two groups revealed a significant [p=0.001] difference in all parameters. Group-I showed decreased aortic strain, decreased distensibility and increased aortic stiffness in relation to group-II with Ao-strain of mean +/- SD [8.9 +/- 1.8 in group I versus 13.4 +/- 1.6 for group-II], Ao-distensibility [3.1 +/- 0.8 in group-I versus 5.0 +/- 1.1 cm2 dyne-1 in group-Il], and Ao-stiffness is [0.21 +/- 0.02 in group-I versus 0. 12 +/- 0.02] in group-Il. In a trial to study the effect of blood pressure on aortic stiffness, It was found that, systolic blood pressure is positively correlated to increased aortic stiffness, with p-value of 0.001 and coeffIcient correlation r 0.66 and is negatively correlated to both aortic strain and distensibility [p value 0.001, r - 0.61 and p 0.001 and r - 0.57] respectively. Correlation made to study the effect of age and gender on Ao elastic properties revealed that, there's a positive age related increased aortic stiffness [p value = 0.02, r 0.28] and a negative correlation to aortic distensibility [p = 0.01, r - 0.32]. Detection of the effect of gender variation on the results was obvious in group-I as males were found to have a significantly [p=0.001] higher Ao stiffness than females with mean +/- SD [0.20 +/- 0.002] in males versus [0.14 +/- 002] in females. Females are found to have a significant higher aortic strain and distensibility [p=0.001 for strain and 0.03 for distensibility] with mean +/- SD Ao strain [12.2 +/- 2.3 for females and 9.7 +/- 2.9 for males], however, Ao distensibility was [4.4 +/- 0.9 for females and 3.6 +/- 1.7 for males]. Group-I was found to have a higher PP and less change in Ao diameters between systole and diastole, and this is reflected on increased Ao stiffness parameters in their results with lower distensibility and strain. Age is found to be highly correlated to increased Ao stiffness and decreased distensibility. Also, males possessing a higher than females Ao stiffness results

Left ventricle geometry in normotensive type-II diabetic patients

The study based on assessment of changes in left ventricular dimensions and mass in Type-II diabetic patients and to correlate the effect of plasma insulin and serum glucose levels on changes might affect the Lv in absence of increased systemic blood-pressure Hyperglycemia, insulin resistance, cytokines, and vasoactive hormones are the most important factors that lead to advance and progression of abnormal cell growth. Like hypertension, diabetes can cause fibrosis of the myocardium and increased collagen deposition in absence of systemic hypertension or other causes of Lv hypertrophy. The study includes 44 patients previously diagnosed as normotensives type-Il diabetis and after applying exclusion criteria, they are divided into Four-groups based on the treatment protocol [orall or insulin] and the state of glycemic control [controlled or uncontrolled]. Group-I [controlled diabetics on oral theray], included 10 patients with their age of mean +/- SD [44.0 +/- 5.2], Group-Il, [uncontrolled orally treated diabetics], included 12 patients with age of mean +/- SD [46 +/- 4.2], Group-Ill [controlled diabetic on insulin therapy], included 9 patients with their age of mean +/- SD [45 +/- 4.1], and Group-IV [uncontrolled insulin treated diabetics], included 13 patients with age of mean +/- SD [45 +/- 3.8]. All patients in all groups were subjected to [full clinical evaluation and routine examination, laboratory assessment of basal glucose and insulin serum levels after 8-hours of no calorie intake, estimation of insulin-resistance indices by Glucose/Insulin ratio and HOMA test was meticulously analyzed, then M-mode Echocardiographic assessment of Lv-diastolic dimensions to estimate Lv-mass and mass index in relation to their body surface area]. After collection of both laboratory and Echocardiographic data, analyses of the results revealed that, in demographic features there's no significant variation of age in between all groups, however, body weight was significantly increased in group III than other groups with [p=0.001], and no significant variation of body height and BSA among all groups. Comparing the laboratory data between group I to group III- [controlled diabetics] revealed that, there's a significant variation in all laboratory data between both groups in the form of; higher FBG, basal insulin, HBA1C, and HOMA with significant lower G/I in group III versus group I with p=0.001 for all apart from p=0.05 for HBA1C only. Moreover, comparing laboratory data between uncontrolled-diabetic groups [group II and IV] revealed that, there's a significant variation in all laboratory data between both groups in the form of; higher FBG, basal insulin, HBA1C, and HOMA with significant lower G/l in group IV versus group II with p=0.001 for all results. Comparing Echocardiographic data revealed that, there's no significant variation in all Echocardiographic data between controlled diabetic groups [group I and III] with septal thickness, [0.9 +/- 0.22 in group I vs 0.93 +/- 0.11 in group III], LVEDD [45.4 +/- 6.6 in group I vs 48.5 +/- 1.5 in group III], posterior wall thickness [0.97 +/- 0.21 in group I vs 0.86 +/- 0.01 in group III], Lv mass [168.8 +/- 21.17 in group I vs 179.1 +/- 32.4 in group III] and Lv mass Index [91.2 +/- 10.8 in group I vs 85.4 +/- 17.5 in group III]. However, comparison between uncontrolled groups [group II and IV] revealed that, in spite of there's no significant variation in relation to LVEDD and PWT. there's a significant [p=0.03] increased septal thickness in group IV than group II [0.9 +/- 0.17 in group II vs 1.15 +/- 0.11 in group IV] and a significant [p=0.03] increased Lv mass and mass index in group IV [lv mass 196.5 +/- 25.4 in group II vs 232.4 +/- 27.8 in group IV Lv mass index was 101.3 +/- 15.0 in group II vs 120.4 +/- 13.5 in group IV]. Correlation of laboratory data to Echocardiographic findings between controlled and un-controlled groups revealed that, there's a positive correlation of increased Lv-mass and mass index with higher basal glucose [P 0.018 and r 0.355] and insulin levels [P 0.001 and r 0.48]. Also, positive correlation with elevated HBA1C [P 0.001 and r 0.71], elevated HOMA level [P 0.001 and r 0.477]. However, negative correlation with G/I Ratio [P 0.02 and r - 0.34]. Laboratory data revealed a significant variation in all parameters between controlled and uncontrolled diabetics in relation to basal levels of glucose and insulin and more evidenced insulin resistance in uncontrolled groups, which means that, in uncontrolled glycemic state there's more increase in glucose and insulin levels with resultant more insulin resistance whatever the mode of treatment [oral or insulin]. Echocardiographic data revealed that, no differences in between controlled diabetics but, a significant increased septal wall thickness is observed in uncontrolled groups with resultant increased in their Lv mass and mass index and this conclude that, in uncontrolled glycemic state, their a tendency to increased Lv mass in spite of the mode of treatment [either oral or insulin]. Elevated fasting blood glucose, basal insulin, HBA1C, HOMA and reduced glucose/insulin ratio are highly correlated to increased Lv mass and mass index and this is not related to either controlling blood glucose or the mode of treatment oral or insulin

Performance of cardiac imaging and a new cardiomarker assay for early detection of myocardial injury in asphyxiated term neonates

Myocardial ischemia of newborns is a well known syndrome and is usually related to perinatal asphyxia. Recognition of myocardial ischaemia is more difficult in neonates than adults; it can be clinically occult, especially when hypoxia is mild. Cardiac troponin T [cTnT] is a cardiac specific marker that can be used for early detection of myocardial injury. This prospective observational study aimed to investigate the diagnostic values of cardiac troponin T [cTnT], electrocardiography [ECG] and echocardiography in early detection of myocardial injury in term asphyxiated neonates. This study included 44 term infants [24 neonates with asphyxia and 20 controls]. Term neonates with asphyxia had significantly higher cardiac troponin t concentration than control healthy neonates of 0.20 +/- 0.09 versus 0.04 +/- 0.02 ng/ml [p<0.05] respectively. Finally, five out of 24 asphyxiated term group [20.8%] died during the first week of life. Significant negative correlations were found between cardiac troponin t and umbilical blood pH, base excess and Apgar score [r = -0.67, -0.83, -0.79, respectively; p < 0.01]. ECG changes of grades 3 and 4 suggestive of myocardial ischemia are present only in asphyxiated group with incidence of 50%. Four out of five patients died had grade 4 and one had grade 3 ECG changes. However, in control group, normal ECG was found in 90% and only grade 1 ECG alterations in 10%. Regarding, echocardiographic findings, fractional shortening [FS] was significantly lower in asphyxiated neonates than the control group. There was no significant difference between both groups as regards to cardiac index and cardiac output. Tricuspid regurgitation was observed in 12 neonates [50%]. Seven [29%] asphyxiated neonates developed clinical signs of heart failure. A significantly higher serum cTnT was found in asphyxiated neonates with heart failure than those without heart failure [P < 0.05]. The sensitivity and specificity of serum cTnT in detecting myocardial injury presenting with heart failure was 71.4% and of 33.3%, respectively. It is concluded that Serum cTnT is a useful new cardiac biomarker that can be used for early detection and estimation of the incidence of myocardial injury in asphyxiated term neonates. Reduced fractional shortening and tricuspid insufficiency in Echocardiography and grades 3 and 4 ECG changes are important indicators of severe myocardial damage

Rotational versus standard quantitative coronary angiography: a comparative study

Standard coronary angiography [SA] has some limitations and complications. Technology has been developed to perform rotational coronary angiography [RA] that may overcome SA limitations and complications while keeping the diagnostic accuracy. RA is a technique that provides with one contrast injection, a panoramic or dynamic cineangiogram of the coronary tree, during up to 180 rotation of the gantry. The purpose was to compare RA and SA regarding diagnostic accuracy and patient safety. Our study included 20 patients with a clinical indication for diagnostic coronary angiography [CA] at Cardiology Department, El Minia University Hospital. Patients were subjected to: SA [4 fixed projections for LCA and 2 for RCA] and RA [2 projections for LCA [RAO 60- LAO 60- caudal and cranial] and [1 projection for RCA [RAO 30- LAO 90- cranial]]. Acquisition of additional static angiographic projections was done for better diagnostic assessment whenever needed after SA and/or RA. QCA analyses were performed on two views [first from SA and second from RA] showing a significant lesion. Radiation dose [RD], contrast volume [CV], total number of frames [TNF], total number of image acquisitions [TNIA], additional projections [AP], reference vessel diameter [RVD], minimal lumen diameter [MLD], lesion percent stenosis [LPS] and lesion length [LL] were evaluated and compared between the two angiographic techniques. We analyzed 38 lesions. Their distributions were: 19[50%] in LAD, 9[23.68%] in RCA, 7[18.42%] in circumflex and 3 [7.89%] in the diagonals. There were no statistically significant differences between SA and RA derived QCA data in MLD[1.197 +/- 0.651 Vs 1.175 +/- 0.642], RVD[2.8l9 +/- 0.961 Vs 2.752 +/- 0.99], LPS [65.495 +/- 16.225 Vs 64.989 +/- 16.426], and in LL [12.575 +/- 6.392 Vs 12.406 +/- 6.338], p ns for all. At the same time, RA derived QCA data strongly correlated with SA derived QCA data with correlation coefficient, 0.99 1, 0.975, 0.994, and 0.996 respectively. On the other hand, RD was 44% less [245.83 +/- 132.17 Vs. 442.23 +/- 272.55 mGy], CV was 45% lower. [24.28 +/- 10.78 Vs. 43.98 +/- 20.77 ml], TNF was 45% fewer [162 +/- 65.54 vs. 293.21 +/- 142.83], TNIA was 59% lower [1.82 +/- 0.67 vs. 4.46 +/- 1.88], and AP was 82% lower beyond the pre specified protocol [0.21 +/- 0.49 vs. 1.179 +/- 1.249] in the RA compared to the SA technique, p<0.0001 for all. RA-derived QCA has similar diagnostic accuracy and strongly correlates with SA derived QCA. Furthermore, RA has better safety as it leads to a significant reduction in radiation exposure and contrast use. In the future therefore, RA may replace SA and should be compared with MSCT CA in diagnosis of CAD especially if coupled with minimally invasive approaches such as radial access and use of 4 French devices

Study of changes in P wave dispersion and duration as predictors of AF in patients with primary dilated cardiomyopathy

Background: P wave duration on signal averaging ECG [PD SAECG] and P wave dispersion [PWD] on standard ECG are non invasive markers of intra-atrial conduction time disturbances, the major electrophysiological cause of atrial fibrillation [AF]. P wave abnormalities have been previously studied in some cardiac conditions, however little data are available in patients with primary dilated cardiomyopathy [DCM]

Objectives: to study changes in PD and PWD as predictors of AF among patients with primary DCM and to correlate these changes with degree of severity of CHF

Patients and Methods: Surface ECG, SAECG and Transthoracic [TTE] echo were performed in 33 patients with primary DCM [Group I] and 30 age and sex matched healthy controls [Group II]. We measured heart rate [HR], minimal p wave [P min], maximal p wave [P max], P wave dispersion [difference between P min and P max = PWD] in surface ECG, P wave duration [PD] in SAECG, Left atrial maximal [LAMX], minimal [LAMN], LA volume at onset of p-wave [LAV p], LA ejection fraction [LA EF], and left ventricular ejection fraction [LV EF] by TTE

Results: There was no significant difference between groups regarding age [42.06 +/- 12.9 Vs 38.5 +/- 10.9, p=0.25] or sex distribution [24/33 [72.7%] Vs 21/30 [70%] males, p=0.81]. Patients with primary DCM showed significantly increased HR, P max and P mm, prolonged PD, and increased PWD, [p<0.0001 for all]. They showed also significantly depressed LV EF and LA EF, with a significantly increased LAMX and LAMN volume, and LAV p, [p<0.0001 for all]. Patients with DCM showed significant positive correlation between PD; and LAMX volume, LAMN volume, and LAVP, [p<0.0001 for all] and significant negative correlation between PD and both LV EF [p<0.0001] and LA EF [p=0.002]. They showed significant positive correlation between PWD; and LAMX, LAMN volume, and LAV p, [p<0.0001] and significant negative correlation between PWD and both LVEF and LAEF [p<0.0001]. Patients with severe DCM [LV EF<25%] showed significantly prolonged P max [p=0.004], P min [p=0.002], PD [p<0.0001] and increased PWD [p=0.004] compared to those with less severe form of the disease [LVER >/= 25%]

Conclusion: The prolonged P-wave duration and increased P-wave dispersion were significantly associated with the increased left atrial volumes, depressed left atrial and left ventricular systolic functions in patients with primary DCM