Cardiac involvement in primary sjogren's syndrome patients detected with echocardiography

To determine a pattern of cardiac involvement in primary Sjogren's syndrome patients and to evaluate these cardiac abnormalities in asymptomatic patients. The study was carried out on 20 primary Sjogren's syndrome patients [PSS] as well as 10 healthy controls matched in age and sex. None of the patients had evidence of cardiac symptoms. All subjects had complete history, clinical examination, laboratory tests [Rh F, ANA and anti Ro and anti La], chest X-ray, ECG and echocardiography. Cardiac abnormalities were detected in 7 [35%] primary Sjogren's syndrome patients out of 20 [PSS] patients examined with echocardiography. Seven [35%] presented with left ventricle diastolic dysfunction and 6 [30%] presented with pulmonary hypertension but only [15%] showed left ventricle hypertrophy, there were 2 patients with mitral regurge and only 1 patient with mitral stenosis and prolapse and also, 1 [5%] presented with aortic regurge and 1 [5%] patient by tricuspid regurge. There was significant difference between PSS patients and control subjects as regards to diastolic functions [E peak, A peak, E/A and DFT] and there was no correlation between the occurrence of these silent cardiac abnormalities and the clinical and laboratory findings. Cardiac involvement is common in PSS but clinically with silent manifestations. Thus, echocardiography should be done for all patients with PSS to detect any cardiac abnormalities

Usefulness of transoesophageal echocardiography in selection of low risk patients with atrial fibriliation for immediate cardioversion

Despite exclusion of left atrial thrombi by transoesophageal echocardiography [TEE], cardioversion related thromboembolism has been reported in atrial fibrillation [A.F.]. The aim of this work is to define low risk group of patients with A.F. for cardioversion without previous anticoagulation. Patients were selected for immediate cardioversion if there were no thrombi, no spontaneous echo contrast, and the outflow velocity of left atrial appendage [LAA] was >/= 0.25 cm/sec. on TEE. Sixty patients with A.F. lasting more than 2 days without previous anticoagulation were examined with TEE and included in this study. Patients who are eligible for immediate cardioversion after TEE were anticoagulated with I.V. heparin together with warfarin prior to cardioversion. Heparin was continued until the patient has reached the therapeutic prothrombin value then D.C. shock was given to convert A.F. into sinus rhythm. Based on TEE findings, the patients were divided into two groups:- Immediate cardioversion, group A with mean age of 36.6 +/- 8.3 years [n=42]: and conventional warfarin treatment before cardioversion, group B with mean age of 65.4 +/- 6.8 years [n=18].We found non significant difference between two groups regarding the aetiology of A.F. except hypertension which was more common in group B [p<0.05]. Echocardiography revealed thrombi in 5 patients in group B representing 8.3% of all TEE examined patients. Left atrial dimension [LAD] was significantly larger, fractional shortening was lower, impaired L.V. function was more common and LAA outflow and inflow velocities were lower in group B compared to group A [p<0.001]. Age, duration of A.F. and impaired L.V. function were independent negative predictors for immediate cardioversion. No thromboembolic events occurred at or after cardioversion in any of the patients. One-month follow-up maintenance of sinus rhythm was found in 3 1/42 [73.6%] patients in group A compared to 5/18 [27.8%] patients in group B [p<0.01]. After using these TEE exclusion criteria [No thrombi, No spontaneous echo contrast and LAA outflow velocity >/= 25 cm/sec.] immediate cardioversion can safely be performed in about 88% of patients with A.F. lasting more than 48 hours without incrased risk of thromboembolism. These patients maintained sinus rhythm significantly better after one month compared to patients with conventional warfarin therapy before cardioversion

Significance of persistent left ventricular dysfunction during recovery after dobutamine stress echocardiography

This study was designed to assess the duration of new or worsening left ventricular regional wall motion abnormalities [RWMA] after dobutamine stress echocardiography [DSE] and their relation to the extent of coronary artery disease [CAD]. This study included 34 patients with positive results on DSE and angiographically documented CAD. Patients were classified into groups I, II and III according to the presence of one, two or three-vessel disease on coronary angiography, respectively. All patients had at least one ischemic region during DSE. The disappearance of ECG changes after DSE was faster than the disappearance of RWMAs and all ECG changes disappeared within 20 minutes, while RWMAs disappeared after 25 minutes. Patients with three-vessel disease had a longer time for ECG and RWMAs disappear than patients with one or two-vessel disease. The mean recovery time of RWMA was 7.1 +/- 2.6, 11.5 +/- 4.6 and 13.1 +/- 3.9 minutes in groups I, II and III, respectively. Normalization of RWMA after DSE occurred after the resolution of symptoms and ECG changes during recovery. The time to recovery was related to the extent of CAD and myocardial ischemia