Left ventricular diastolic dysfunctions in chronic renal failure patients on healmoodilysis

Left ventricular structure and function abnormalities are frequent in individuals with chronic uremia. This disorders are frequent in patients who has increased risk of cardiovascular diseases. The aim of this study is to study the leading alteration in left ventricular diastolic function and factors related to it, using simple indices of diastolic function obtained with pulsed Doppler studies. This study was conducted on -40 patients who had end stage renal disease. They were on regular maintenance haemodialysis 3 times / week compared to 29 age and sex matched healthy subject, served as control group. All of them were subjected to the following:- full history and clinical examination including age, sex, duration of dialysis, causes of renal failure laboratory investigations were done and include: renal functions [urea, creatinine], full blood, picture blood, sugar, serum inorganic phosphorous, parathyroid hormone [PTH], alkaline phosphatase, serum albumin and total protein. Echo cardiography for assessment of left ventricular end diastolic dimension [LVEDD], left ventricular end systolic dimension [LVESD], posterior wall thickness in diastole [PWT], inter ventricular wall thickness in diastole [IVS], fraction shortening [FS%], ejection fraction [EF%]. Echo doppler examination including peak flow velocity in early diastole [E-wave], peak flow velocity in late systole [A-wave] E/A ratio, acceleration time [AT], deceleration time [D.T], and isovolumic relaxation time. Result showed that: there were a significant increase in left atrial diameter [P<0.01], left ventricular posterior wall thickness, [p <0.01] interventricular septum thickness, [p<0.001] left ventricular mass [p<0.001] in ESRD patients when compared with control group. There were highly significant increase in A-wave [p<0.01] deceleration time [p<0.05] and isovolumic relaxation time [p<0.01] while there were no significant difference in aortic root diameter, left ventricular end systolic dimension, E wave, fractional shortening and ejection fraction, in patients compared with control group. There were significant positive correlation between left atrial diameter and systolic blood pressure, positive correlation between left ventricular mass and both systolic and diastolic blood pressure, positive correlation between parathyroid hormone level and E-wave, negative correlation between left vetricular end diastolic dimension and hemoglobin concentration, negative correlation between left ventricular posterior wall thickness and hemoglobin concentration and negative correlation between parathyroid hormone level and ejection fraction. Cardio vascular complications are frequent in patients with ESRD. Echo cardiography and echo doppler cardiography are recommended in all patients with ESRD

Cardiac troponin T and Oreactive protein in early risk stratificationand therapeutic implications of patients withacute coronary syndromes

Early risk stratification of patients with acute coronary syndromes [ACS] is pivotal for correct allocation of health resources and for maximizing the benefit of available treatment modalities. Clinical and electrocardiographic indicators of high risk score lack sufficient sensitivity for the detection of major cardiac events. The complementary information provided by the measurement of different biomarkers of myocardial damage is believed to be very useful, specifically cardiac troponins which are strongly associated with a high-risk profile.In this study, we have evaluated the early prognostic values of cardiac troponin T [cTnT], CRP and CK-MB independently and in combination, in patients with ACS at time of admission to the coronary care unit, which occurred within 7.24 +/- 4.5 hrs from the onset of symptoms of myocaMial ischaemia. We have also assessed ifflie association of these markers to the clinical risk scoring.Sixty patients with ACS were enrolled in, 30 with ST segment elevation on admission ECG [acute myocardial infarction [AMI], group I] and 30 without STelevation [23 with unstable angina [UA] and 7 with non-Q-wave MI, group II]. 20 apparently healthy subjects were studied as controls.Cardiac TnT, CRP and CK-MB were significantly increased in both patient groups, compared to controls, with more significant increase in group I than in group II ACS. They did not differ significantly between patients with low and high clinical risk score in either groups. CRP was the only marker associated with positive adverse outcomes in ST-elevation ACS [PO.05], whereas cTnT was the only marker associated with positive adverse events in non-ST elevation ACS [PO.02]. cTnT was the most sensitive discriminative parameter between patient groups and 'controls, followed by CRP and lastly CIC-MB. It was also the most significant discriminator between both patient groups; they showed '[86.67%, 83.33% arid 7333% efficacy, respectively], although the overall diagnostic performance of CRP between patient groups was higher than cTnT, as represented by the area under curve [AUC] in the Receiver Operator Characteristics[ROC curve[0.8 vs 0,733].The sensitivity of cTnT [>/=0.4 ng/ml] and CRP [>/=1.6 ng/dl] independently and in combination with each other to predict positive outcomes after 30 days, were best shown in group I than group II [93.75% for cTnT, 100% for CRP and 93.75 when combined together], compared to [20%, 26.67% and 0%, respectively]. On the other hand, cTnT <0.4 ng/ml was the mostspecific independent indicator to exclude the occurrence of future adverse events in both groups of ACS [85.71% and 100% specificity, respectively].In conclusion, cTnT is a powerful specific and sensitive diagnostic marker for myocardial damage and a significant discriminator between patients with and without ST elevation ACS. It is significantly associated with adverse outcomes in non-ST elevation ACS, while CRP is associated with such events in ST elevation ACS. On the contrary, CK-MB is a poor predictor for future outcomes. None of them were associated with the clinical risk scoring. However, the predictive accuracy of cTnT and CRP in both patient groups is contradicting and this may be attributed to several clinical and technical factors which must be taken into consideration when studying the prognostic values of both parameters in such groups with different pathophysiological characters