Effect of [urografin] on left ventriular diastolic and renal functions after cardiac catheterization

is to evaluate the effects of iodinated contrast media "urografin" on kidney functions and left ventricular diastolic function indices in patients underwent coronary angiography. It included 100 patients with normal kidney function 57 male [57%] and 43 female [43%]. The patients are classified into four groups:- group A: diabetic hypertensive patients, group B: only diabetic patients, group C: only hypertensive patients and group D: non diabetic, non-hypertensive patients. For all patients history taking and clinical examination, standard 12 lead ECG, abdominal ultrasonography to exclude renal medical diseases, Echo-Doppler study before, immediately and 7 days after cardiac catheterization for assessment of left ventricular diastolic functions, and kidney function tests before cardiac catheterization, immediately, 3 days and 7 days after cardiac catheterization. We found an increase in blood urea, serum creatinine and decrease in creatinine clearance [not reaching the significant level] at the first day after contrast administration [P> 0.05]; However, the maximal significant effect of these contrast agent on kidney functions was reached at the third day [P< 0.05] and return to normal at the seventh day [P< 0.05]. Also we found that the level of serum creatinine is maximally changed after three days of contrast administration, where the mean values were 1.11 +/- 0.19 before coronary angiography changed to 1.24 +/- 0.17 immediately after coronary angiography and 1.79+0.13 three days after coronary angiography and 1.27+0.12 after seven days of coronary angiography. It was noted that the level of serum creatinine is increased by 25% or > 0.5 mg/dl from the base line value and decline to nearly normal level after seven days of coronary angiography. The effects of contrast agents on kidney functions were significantly higher in groups [A] and [B] than that of groups [C] and [D] and there was a significant positive correlation between the dose of contrast media and the effect on kidney functions [P< 0.05]. Also, there was a non-significant effect of the radio contrast media on the left ventricular diastolic function indices in the four studied groups [P> 0.05] immediately after and seven days after radio contrast administration. However, there was a non-significant correlation between the dose of contrast media and diastolic function parameters immediately after and seven days after coronary angiography [P> 0.05]. So the effect of radiocontrast agents after coronary angiograpghy on kidney functions is benign and transient starting within 1-2 days reaching the peak at 3-5 days and then returning to base line within 7-10 days. This effect is significantly higher in diabetic hypertensive patients than that in non-diabetic, non-hypertensive patients with positive correlation between the dose of contrast media and kidney functions. However, the ionic contrast media exerts negligible alterations on left ventricular diastolic functions indices

Diagnostic and prognostic value of ST segment elevation in lead III greater than in lead II in patients with acute inferior wall myocardial infarction

To evaluate the diagnostic and prognostic value of ST segment elevation in lead III greater than lead II in patients with acute inferior myocardial infarction for predicting in hospital mortality and associated RV myocardial infarction, 40 patients with acute inferior myocardial infraction were included in this study. ECG, echocardiography and coronary angiography were performed for all patients. The presence o f ST-segment elevation in lead III lead > II from admission ECC defined the presence of RV infarction with sensitivity of 85.7% and specificity of 89.5%. During the hospital course, the prevalence of heart failure, post infarction angina, conduction defects and mortality were higher in patients with ST-segment elevation in lead III > lead II. The study concluded that ST-segment elevation in lead III more than lead II is more sensitive and specific than V3R, V4R in diagnosis RVMI. It is an excellent screening tool for RVMI given its universal availability on all electrocardiograms. Moreover, ST-segment elevation in lead III more than lead II is a significant predictor of in-hospital mortality and post-MI complications

Morphofunctional characteristics of the interatrial septum in cardiac diseases transesophageal echocardiographic study

Both the morphology and the functions of the interatrial septum in different clinical situations have been addressed only in a few studies, where the attention has been focused particularly on its congenital abnormalities. Our purpose was to study whether the changes of thickness and thinning of the interatrial septum may be related to the age, left atrial dimension and left ventricular functions. So we studied these changes using the transesophageal echocardiography in [60] patients of four groups of cardiovascular discuses. These groups were: Group I: Ischemic heart disease 20 patients. Group II: Dilated cardiomyopathy 20 patients. Group III: Hypertension with stroke 8 patients. Group IV: Corpulmonale 12 patients. All the patients were subjected to thorough clinical examination, 12 leads resting electrocardiography, chest X-ray postero-anterior view and echocardiography in which we made both transthoracic and esophageal approach for each patients. The interatrial septum thinning was calculated as the difference between the thickness of the IAS at atrial systolic phase and the thickness of the IAS at end-ventricular systolic phase. The value was expressed also as percentage of thinning at the end of ventricylar systolic phase. The IAS thickness increases with the age while there is no significant increase in thinning and thinning percentage. The IAS thickness increases in patients of left ventricular dysfunction e.g. [dilated cardiomyopathy, ischemic heart diseases, and hypertensive patients] also it increases in patients of corpulmonale. There is a negative correlation between the IAS thickness and the left atrial dimension, but there is a positive correlation between the IAS thinning and IAS thinning percentage with the left atrial dimension. Patients with prolonged deceleration time of E and isovolumic relaxation time and decreased E/A with or without lower ejection fraction and fractional shortening had less IAS thinning%. On the other hand, patients with shorter deceleration time of E and isovolumic relaxation time and increased E/A with or without lower ejection fraction and fractional shortening had a comparable IAS thinning%.

Re-evaluation of echocardiographic score in patients undergoing balloon mitral valvuloplasty

Current study was designed to determine the important predictors of immediate and late [3 months] outcome of PBMV [percutaneous balloon mitral valvuloplasty]. The study was conducted on 49 patients with rheumatic mitral stenosis undergoing PBMV using Inoue Balloon technique. They were subjected to: clinical evaluation, echocardiographic study the day before, 24 hours and 3 months after PBMV, and cardiac catheterization study immediately before and after the procedure. A simple comparison of mean values of data showed that patients with optimal results [> 75% increase in mitral valve area, MVA] had smaller pre-PBMV MVA, higher systolic pulmonary artery pressure, better leaflet mobility and younger age. Stepwise multiple regression analysis showed that better leaflet mobility and higher diastolic pulmonary artery pressure are the most important predictors for percentage of change in MVA 24 hours after PBMV. Leaflet thickness was only weak predictor for PBMV outcome, while total echocardiographic score, valve calcification and subvalvular disease were not. After 3 months, the subvalvular disease and low left atrial pressure were the most important predictors for the percentage of change of MVA. Hence, although echocardiographic mitral valve morphology is very useful in pre-PBMV evaluation of patients, it should not be used alone in the selection of cases for this procedure