ABSTRACT
Introduction: Left ventricular (LV) diastolic dysfunction is common on preoperative screening among patients undergoing surgery. There is no simple screening test at present to suspect LV diastolic dysfunction. This study was aimed to test the hypothesis, whether elastic recoil signal (ERS) on tissue Doppler imaging of mitral annulus (MA TDI) can be used as a qualitative test to differentiate patients from normal LV diastolic function versus patients with LV diastolic dysfunction. Methods: This was a prospective cross-sectional observational study of patients admitted for elective surgeries. Normal diastolic function and categorization of LV diastolic dysfunction into severity grades I, II, or III were performed as per the American Society of Echocardiography/ European Associationof Cardio Vascular Imaging (ASE/EACVI) recommendations for LV diastolic dysfunction. Results: There were 41 (61%) patients with normal LV diastolic function and 26 (39%) patients with various grades of LV diastolic dysfunction. In 38 out of 41 patients with normal LV diastolic function, the characteristic ERS was identified. The ERS was absent in all the patients with any grade of LV diastolic dysfunction. Consistency of identification of ERS on echocardiography was tested with a good interobserver variability coefficient of 0.94 (P-value <0.001). The presence of ERS demonstrated an excellent differentiation to rule out any LV diastolic dysfunction with an area under the receiver operating characteristics curve (AUROC) of 0.96 (CI 0.88�99; P value <0.001). Conclusions: To conclude, in a mixed surgical population, the anesthetist could successfully assess LV diastolic dysfunction in the preoperative period and the characteristic ERS on MA TDI signal can be used as a qualitative test to differentiate patients from normal LV diastolic function versus patients with LV diastolic dysfunction using the transthoracic echocardiography (TTE).
ABSTRACT
Background and Aims:Left ventricular (LV) systolic dysfunction is a common cause of hemodynamic disturbance perioperatively and is associated with increased morbidity and mortality. Echocardiographic evaluation of left ventricular systolic function (LVSF) has great clinical utility. This study was aimed to test the hypothesis that LVSF assessed by an anesthetist using mitral valve E Point Septal Separation (EPSS) has a significant correlation with that assessed using modified Simpson’s method perioperatively. Methods: This prospective observational study included 100 patients scheduled for elective surgeries. Transthoracic echocardiography (TTE) was performed preoperatively within 24 hours of surgery by an anesthetist as per American Society of Echocardiography (ASE) guidelines.EPSS measurements were obtained in parasternal long?axis view while volumetric assessment of LV ejection fraction (EF) used apical four?chamber view.Bivariate analysis of EPSS and LV EF was done by testing Pearson correlation coefficient.Receiver Operating Characteristic (ROC) curve constructed to obtain area under curve (AUC) and Youden’s Index. Results: The mean value of mitral valve EPSS was 7.18 ± 3.95 mm. The calculated mean LV EF value using volumetric analysis was 56.31 ± 11.92%. LV dysfunction as per ASE guidelines is present in 28% of patients. EPSS was statistically significantly related to LV EF negatively with a Pearson coefficient of ?0.74 (P < 0.0001).AUC of ROC curve 0.950 (P < 0.0001) suggesting a statistically significant correlation between EPSS and LV EF.Youden’s index of EPSS value 7 mm was obtained to predict LV systolic dysfunction. Conclusion: Mitral valve EPSS shows a significant negative correlation with gold standard LVEF measurement for LVSF estimation. It can very well be used to assess LVSF perioperatively by anesthetists with brief training.
ABSTRACT
Background: There are reports that Helicobacter pylori (H. pylori) infection leads to changes in serum lipid profile and high sensitivity C-reactive protein (hsCRP) levels, but role of H. pylori in causing increased risk of cardiovascular disease remains a topic of debate. Methods: A case control study was conducted, in subjects without pre-existing atherosclerotic disease. We studied 72 otherwise healthy subjects in the age group of 20 to 60 years. All subjects underwent gastroduodenoscopy and H. pylori infection status was assessed by rapid urease test. Results: There were no statistical differences in serum total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol levels or total cholesterol/HDL cholesterol ratios between cases and controls. However, serum hsCRP (high sensitivity C-reactive protein) levels were significantly higher in cases as compared to controls (P <0.05). Conclusion: The results of this study showed that H. pylori infection does not modify serum lipid levels; however, it leads to a rise in hsCRP, an important risk factor for atherosclerosis. It can be concluded that H. pylori infection may contribute to atherogenesis through the state of chronic inflammation, which is evidenced by elevated hsCRP levels.