Impact of endothelial dysfunction on stable angina versus unstable angina

Endothelial dysfunction is a systemic disorder and a key variable in the pathogenesis of atherosclerosis and its complications. Current evidence suggests that endothelial status is not determined solely by the individual risk factor burden but rather, an integrated index of all atherogenic and atheroprotective factors present in an individual, including known as well as yet-unknown variables and genetic predisposition. The aim of the present study is to examine the relation of impaired endothelial dependent dilatation of the brachial artery which is a sensitive marker of endothelial dysfunction and occurs early during development of atherosclerosis with stable and unstable angina pectoris. One of those new techniques is assessment of the peripheral vascular endothelial function testing as a non invasive indicator of coronary artery disease using brachial artery ultrasound. This study was carried out in Zagazig University hospitals, and included 120 patients divided into three groups; group I: chronic stable angina pectoris, group II: unstable angina pectoris and group III: control group. All the results were analyzed statistically to detect their significance. The study showed that there was a significant correlation between the FMD and the results of the coronary angiography and both systolic and diastolic functions of the cit ventricle. It also showed significant correlations between the brachial artery flow-mediated dilation of the brachial artery and most of the cardiovascular risk factors. The results support the notion that evaluation of peripheral vascular endothelial function can accurately exclude CAD in subjects undergoing noninvasive assessment for atherosclerosis. Determination of peripheral endothehial function can confirm a low probability of CAD in low-risk individuals and, thus, may obviate the need for more elaborate testing. Systemic endothelium-dependent vasoreactivity predicts recurrence of instability and cardiovascular event rates in patients with ACS. Assessment of systemic vasoreactivity measured by a minimally invasive test, provides important prognostic information in addition to that derived from traditional risk factor assessment in patients with ACS. Also, endothelium-dependent dilation of the brachial artery is a strong in dependent predictor of adverse outcome in survivors of ACS without ST-segment elevation

Significance of stress induced myocardial ischemia in young hypertensive Egyptians

Normal ECG does not exclude significant coronary artery disease or left ventricular hypertrophy. Silent ischemia is common in hypertensive patients. Nowadays there is increase in the prevalence of essential hypertension in young adults. Is to test the significance of exercise ECG in detection of CAD, and its prevalence in young hypertensive patients. This study included 100 patients with age range between 16-35 year. A control group of 20 healthy adult volunteers of the same age range. All patients were subjected to thorough History taking, Clinical assessment, Laboratory investigations [FBS, Lipid profile], Baseline ECG, Echocardiographic study, Exercise stress testing. The resting systolic blood pressure, mean maximum systolic blood pressure and The recovery heart rate were significantly correlated with LV mass in hypertensive patients. There was a significant dyslipidemia and impaired diastolic function in hypertensive patients, and this dyslipidemia correlated with LV mass. LV mass, dyslipidemia, and diastolic dysfunction were the most determine, related to abnormal exercise response in hypertensive patients. Patients with ST-segment depression showed a sign of increased LV mass, increased recovery heart rate and dyslipidemia

Prevalence of stress induced myocardial Ischemia in young hypertensive Egyptians

Objective: The present work aimed to study the sensitivity of exercise stress ECG in determining the prevalence of stress induced myocardial ischemia in young hypertensive Egyptian patients

Methods: 100 hypertensive patients with age range between 16-35 years and 20, healthy adult with the same age wee subjected to thorough clinical- examination, resting ECG, chest-x -ray complete echocardiographic study including LV mass index calculation and Doppler study. They also were subjected to laboratory tests to assess their lipid profile. Exercise stress testing according to bounce protocol was done for all subjects

Results: The results showed that five patients out of 40 patients with LVH had ST-segment depression >2mm while no one in patients without LVH, and control group had there changes. There was a significant dyslipidemia in hypertensive patients as compared to control group. There was a significant diastolic dysfunction in hypertensive patient as compared with control group and it was more significantly compared in those with LVH than those without LVH. The HR, blood pressure response to exercise was significantly impaired in hypertensive patients in comparison to control subjects and this response was more significantly impaired in those with LVH as compared with those without LVH

Conclusion: 1. Exercise stress test may be of great value in assessment of young hypertensive patients. 2. Hypertension is usually associated with dyslipidemia. 3. Left ventricular hypertrophy is an important factor in inducing stress ST- segment depression. 4. The hemodynamic response of hypertensive patients was significantly impaired

Impact of doppler tissue imaging in the assessment of regional wall motion abnormalities in patients with old myocardial infarction

Doppler Tissue Imaging [DTI] is an emerging non-invasive ultrasound technique, which allows measuring velocities at any point of the ventricular wall during the cardiac cycle.To evaluate the clinical feasibility of DTI as a new method for detection and quantification of regional Wall Motion Abnormalities [WMA] in patients with old Myocardial Infarction [MI].Fourty patients with old MI who had angiographically-documented significant stenotic lesion in the infarct-related artery and WMA in the infarcted area were evaluated in addition to twenty healthy subjects[control group].Regional wall motion of each of the anterior and inferior wall segments of the left ventricle was assessed by conventional 2-D echocardiography and pulsed wave DTI. The later includes the measurement of Peak Myocardial Velocity [PMV] and Myocardial Velocity Gradient [MVG].The peak MV and MVG in the studied myocardial segments of control subjects ranged between 4 to 15 cm/s and 1 to 3.85 cms.[-l] respectively. In patients group, Myocardial segments supplied by diseased coronary vessel in the infarcted area were found to have highly significant reduction of both MV and MVG compared to the same segments in control subjects [p<0.001]. The sensitivity for detection of WMA was markedly improved by DTI studies [92.5% for MV and 100% for MVG versus 52.5% for 2-D echo] with retaining the high specificity inherited by conventional echocardiography .Compared to conventional 2-D echo, pulsed wave DTI is an accurate, highly sensitive non-invasive method to detect and quantify regional WMA induced by coronary artery disease. It is almost as accurate as contrast ventriculography in this regard, so it may be the best imaging technique for detection of WMA at rest and with different cardiovascular stresses

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%.

Predictive value of end-diastolic wall thickness for myocardial viability in patients with coronary artery disease with left ventricular dysfunction

early pathologic studies have demonstrated that myocardial thinning occurs in areas of myocardial necrosis, so preservation of wall thickness may be a sign of viability in coronary artery disease [CAD]. to assess the accuracy of end-diastolic wall thickness [EDWT], measured by resting echocardiography, as a marker of myocardial viability in patients with CAD and to compare it with dobutamine stress echocardiography [DSE] and thalium-201 scan [T-201 scan].20 patients with CAD associated with left ventricular [LV] dysfunction and c and idates for surgical revascularisation [SRV] were eligible for the study. Resting echo-Dopplar study, with special attention to EDWT measurement in each ischemic segment was performed before SRV together with DSE and T-201 scan. Another resting ech-Doppler study and T-201 scan were perforemed at a mean of 6 weeks after SRV. DSE showed that 112 out of 155 hypokinetic segments had improved after SRV and their resting EDWT was. 95 +/- . 2 vs. 6 +/- 1 cm in the 43 not-improved segments [P<.001] and 28 out of 66 akinetic segment had improved after SRV and their resting EDWT was. 8 +/- .l vs. 56 +/- .l cm in the 38 not-improved segments [P<.001]. T-201 scan showed that 107 out of 155 hypokinetic segments had improved after SRV and their EDWT was. 94 +/- .1 vs. 61 +/- 14 cm in 48 the not-improved segment [P<.01]; and 28 out of 66 akinetic segment had improved after SRV and their EDWT was. 83 +/- 1 vs 0.61 +/- 1 in the 38 not-improved segments [P<.001]. The sensitivity of EDWT >/= 7 cm for prediction of vialility in hypokinetic segments was 94% vs 100% by T-201 scan and 96% by DSE; and was 96% in akinetic segments vs 93% by T-201 scan and DSE. The specificity of EDWT in hypokinetic segments was 48% vs 22% by T-201 and 52% by DSE; and was 86% in akinetic segments vs 61% by T-201 and 95% by DSE. The positive predictive value of EDWT in hypokinetic segments was 75% vs 77% by T-201 scan and 84% by DSE, and was 58% in akinetic segments vs 64% by T-201 scan and 96% by DSE. The negative predictive value of EDWT was 85% in hypokinetic segments vs 100% by T-201 scan and 82% by DSE; and was 92% in.akinetic segments vs 92% by T-201 scan and 95% by DSE. Wall motion scor index decreased significantly from 1.8 +/- . 26 before SRV to 1.4 +/- 2 after SRV and 1.3 +/- 4 on DSE [P<.001]. Ejection fraction increased significantly from 3 7 +/- 11.9 before SRV to 44 +/- 11.1 after SRV and 45 +/- 11.3 on DSE [P<.001]. we concluded that EDWT >/= 7 cm is measured by resting echocardiography is a simple and reproducible marker ofmyocardial vilability. Its accuracy is comparable to that of DSE and thallium 201-scan