Early detection of asymptomatic myocardial dysfunction in patients with rheumatoid arthritis

This study was designed to investigate and detect early asymptomatic myocardial dysfunction in patients with rheumatoid arthritis [RA] without clinically evident cardiovascular manifestations by means of standard echocardiography and the novel tissue Doppler Echocardiographic Techniques [TDE], and to detect correlation between diastolic dysfunction and the disease duration, and other parameters of rheumatoid arthritis such as, rheumatoid factor, rheumatoid nodule and extraarticular manifestations on the degree of myocardial dysfunction among patients. Thirty consecutive patients diagnosed as RA according to American Rheumatism Association criteria free of any clinically documented cardiac disease were prospectively studied. The patients were divided into two groups according to the duration being diagnosed as RA [group I- early onset less than two years] and [group II -late onset more than two years]. Fifteen patients in each group [III] compared to the same number of age and sex matched normal individuals group [III]. All patients and the control group were evaluated by M-mod, two-dimensional, conventional Doppler echocardiography and, Tissue Dopper Echocardiographic [TDE]. In patients with RA, group I [mean age 40.4 +/- 10.3yrs, disease duration 11.7 +/- 4.2 years]. Mean disease activity score was [4.3 +/- 1.6]. Comparison of patients with normal controls [group III] resulted in no significant differences between both groups in relation to cardiac dimensions and systolic functions but, there's a statistically significant increase in atrial filling velocity [Am]-[7.5 +/- 0.34 vs 5.5 +/- 0.4], p=0.001, decreased [Em] velocity [7.8 +/- 0.25 vs 8.4 +/- 0.3], p=0.001, decreased [E/A]-ratio [1.0 +/- 0.04 vs 1.5 +/- 0.1], p=0.001 and prolongation of DT [176. +/- 7.2 vs 158.4 +/- 4.5], p=0.001. In patients with group II, mean disease activity score of [4.1 +/- 1.4], mean age [50.4 +/- 8.6 yrs] and disease duration [13.5 +/- 3.8 years]. Comparison of group II to group III resulted in also no differences in internal cardiac dimensions and systolic function namely EF and FS percents but, exhibit significant increase in both LA and Lv masses being LA [40.2 +/- 1.0 vs 29.0 +/- l.l],p=0.001 and Lv was [153.2 +/- 7.4 vs 111.2 +/- 6.2] ,p=0.001. In addition to reduction in systolic velocity [Sm] in group II [6.5 +/- 0.4 vs 8.4 +/- 0.3],p=0.001 and more pronounced deterioration of diastolic properties, namely decreased [Em]-[6.5 +/- 0.2 vs 7.8 +/- 0.2]],p=0.001 - decreased ratio [E/A]-[0.9 +/- .006 vs 1.0 +/- 0.004],p=0.001 and prolongation of deceleration time being [217.4 +/- 9.3 vs 176.1 +/- 7.2], p=0.001. The same results with much magnification also detected when compare group I to group II. A correlations was made as regard the effect of disease duration to both group I and group II patients and resulted in a positive correlation of prolonged DT time [Pearson correlation, r equal 0.95, p-value 0.001] and a negative correlation to E/A ratio [Pearson correlation, r equal -0.56, p-value 0.001] among all patients with RA indicating deterioration of diastolic dysfunction with increasing duration of the disease, in spite, no correlation was found regarding rheumatoid nodule, rheumatoid factor, extraarticular manifestations and disease activity score [DAS]. At present, it is concluded that RA patients, in the absence of clinical evidence of heart disease, show myocardial dysfunction characterized by decreased E/A ratio and prolonged DT. The relation between diastolic dysfunction and disease duration suggests a subclinical myocardial progressive deterioration, however, no effect of rheumatoid nodule, rheumatoid factor, extra-articular manifestations and DAS on the degree of myocardial involvement

Ventricular late potentials: pattern in normal and different cardiac congenital abnormalities

Pediatric mortality represents a major problem all over the world. During infancy, arrhythmia may be an important factor in the pathogenesis of some of these life-threate ling events. Congenital heart diseases increase the liability for many cardiac arrhythmias. Ventricular late potentials have shown to be markers for risk of ventricular arrhythmias. There is only limited data on normal reference values for signal- averaged electrocardiogram [SFECG] in pediatric population. In this sturdy, we tried to establish ranges for SAECG parameters in normal children and in patients with congenital cardiac defects. One hundred and fifty infant's and children were the study population. Fifty [50] children had congenital a cyanotic heart disease, 29 were males with a mean age +/- SD of 18.75 +/- 13.9 months and 50 children had congenital cyanotic heart diseases, 18 were males with a mean age of 5.62 +/- 3.0 months. 50 age- and sex- matched healthy individuals were served as controls. The SAECG parameters include QRS duration in milliseconds [msec], Root Mean Square voltage [RMS] in microvolts [micro v], Root Mean Square of the last 40 millisecond of the QRS comply [RMS 40] in micro V and the duration of low amplitude signal [< 40 micro V] at the terminal QRS [LAS] in msec. The results showed that, in normal subjects, the QRS duration ranged iron 80.5 to 100.5 msec, RMS voltage ranged from 158.6 to 240.0 micro V, RMS-4O voltage ranged from 44.5 to 126.1 micro V and the duration of LAS ranged from 2.7 to 10.3 msec. In acyanotics, the mean +/- SD for QRS duration was 101.2 +/- 85.2 msec, for RMS was 197.9 +/- 92.7 micro V, for RMS-40 was +/- 79.9 + 118.0 micro V and for LAS was 10.5 +/- 7.4 msec. In cyanotic, QRS duration was 127. +/- 11.8 msec, RMS was 128.5 +/- 60.1 micro V, RMS-40 was 35.34 + 2.4 micro V and LAS was 22.8 + 2.3 msec. Cyanotic patients had a significantly wide QRSD 8 LAS and significantly low RMS and RMS-40 than a cyanotic [p > 0.05]

Conclusion: our result; provide a basis for interpretation of SAECG in Children. Normal ranges for the various parameters were determined. In cyanotic, the late potentia3 are markedly abnormal in comparison to the little change in cyanotic rendering patients with cyanotic heart defects are highly susceptible for arrhythmia and arrhythmia-induced complications