Detection of occult cor-Pulmonale using dobutamine stress echocardiography in patients with schistosomal hepatic fibrosis

The presence of early diastolic dip of the ventricular septum has been reported to be able accurately diagnose occult cor-pulmonale during cycle ergo meter exercise test in patients with chronic obstructive pulmonary disease [COPD]. This study was conducted to test the ability of dobutamine stress echocardiognaphy [DSE] to detect cases of occult corpulmonale among patients with hepatosplenic schistosomiasis. The study included 25 patients aged 35.6+/=l2.7 years with hepatosplenic schistosomiasis [group 1, 15 males and 10 females] compared to 25 age- and sex-matched patients with COPD [group II]. M-mode echocardiognaphic ventricular septal motion, left ventricular shape [determined by short-axis 2-dimensional echocandiography], and pulmonary artery [PA] acceleration time [determined by pulsed Doppler echocardiognaphy] were measured at rest and during DSE. The ventricular septal motion and PA acceleration time were normal at rest in all patients. In gnoup 1, 22 patients [88%] reported marked downward ventricular septal motion in early diastole during DSE, indicating distortion of left ventricular shape. In group II, only 11 patients [44%] showed the same change during DSE. There is significant decrease in PA acceleration time in patients who showed septal dip in both groups from rest to DSE. It could be concluded that occult cor pulmonale can be diagnosed by the appearance of an early diastolic dip of the ventricular septum and distorted left ventricular shape during DSE in patients with hepatosplenic schistosomiasis. This method may be useful in selecting cases for medical treatment for early cor-pulmonale

Relation of angiotensin converting enzyme activity and gene polymorphism to restenosis after percutaneous transluminal coronary angioplasty

Early restenosis in up to 30% of cases limits the benefits of percutaneous transluminal coronary angioplasty [PTCA]. The mechanisms that underlie restenosis are uncertain, although experimental evidence suggests that the renin-angiotensin system is involved in the vascular response to angioplasty. The ACE gene is one of the major genes of the renin-angiotensin and kallikrein-kinin systems and is a candidate gene for several cardiovascular diseases for which a genetic predisposition has been established. The ACE gene contains a common insertion deletion polymorphism termed I and D, respectively. The three possible genotypes are DD, ID and II, and the plasma level of ACE is highest with the DD genotype. This work aimed to investigate whether ACE gene polymorphism influences the risk of restenosis after PTCA to explore a relation between the total ACE level and restenosis and to compare the ACE genotypes of the patients of the study with those of a control group of healthy subjects. This study included 53 patients with CAD, 48 males and 5 females, their age ranged from 36 to 63 years. All patients were compared to 46 control subjects with age and sex matched. The patients were divided into two groups: group [A][40 patients with no restenosis] and group [B][13 patients with restenosis]. All patients were subjected to: full history and clinical examination, laboratory investigations which include estimation of serum angiotensin converting enzyme levels and detection of genotypes of the ACE gene I/D polymorphism, 12-lead electrocardiogram, treadmill exercise stress testing, coronary angiography and PTCA. The distribution of ACE genotype [DD] was not significantly different in-group B patients with restenosis compared with group A patients with no restenosis [8 out of 13, versus 15 out of 40 respectively, P> 0.05]. Plasma ACE levels did not differ between patients and control subjects [P value > 0.05]. Although plasma ACE levels were significantly higher in relation to ACE genotypes [P value < 0.05], plasma ACE levels were insignificant in relation to restenosis [P value > 0.05]. Since there was no evidence that variation at the ACE gene defined by the I/D polymorphism influences the extent of restenosis, it could be concluded that determination of ACE I/D genotypes is unlikely to be useful in identifying patients at higher risk of restenosis after PTCA and continued studies with clinically different subsets of patients is warranted

Serum soluble fas in children with idiopathic dilated cardiomyopathy

The present study aimed to evaluate the role of serum soluble Fas [sFas] "APO-l receptor", as an inhibitor of apoptosis [programmed cell death] in children patients suffering from idiopathic dilated cardiomyopathy [IDCM] and its association to New York Heart Association [NYHA] Functional class. The study included 20 children patients aged 5-13 years, suffering from IDCM and 20 age and sex matched control subjects. Serum level of sFas was measured by enzyme linked immunosorbent assay [ELIZA] which showed that sFas is increased significantly with increased NYHA functional class. However, serum levels of sFas were similar in normal subjects and patients with functional class I, but there were significant differences between functional classes II, III and IV. Serum levels of sFas were significantly higher in patients with an elevated Pulmonary Capillary Wedge Pressure [PCWP] > 18 mm Hg than in those with values <18 mm Hg. Six months later, all patients were re-evaluated for their functional class and serum sFas levels. Serum levels of sFas decreased in four patients with clinical improvement but were similar in patients with no change in functional class. The increase in sFas may play an important role in the pathophysiologic mechanisms of IDCM in children