Usefulness of Tei index in patients with rheumatic mitral regurgitation and apparently normal left ventricular ejection fraction

Rheumatic mitral regurgitation is rather common in developing countries. It usually progresses insidiously, because the heart compensates for increasing regurgitant volume by left-atrial enlargement, causes left-ventricular overload and dysfunction, and yields poor outcome when it becomes severe. Doppler-echocardiographic methods can be used to quantify the severity of mitral regurgitation. It is known that ejection fraction underestimates the presence of left ventricular dysfunction in these patients. This study aimed to study global cardiac function of these patients by using LV Tei index. One hundred patients with rheumatic mitral regurge predominantly were included [40 males and 60 females; aged 10-24 years, median 20.6 years]. All participants were subjected to full echocardiographic study including total isovolumic index [Tei index =isovolumic relaxation time IRT +isovolumic contraction time ICT/ejection time ET] for the left ventricle. Special attention was paid to grading of severity of the mitral regurgitation. LV ejection fraction was preserved in all cases but, however, the total left isovolumic index was prolonged 0.56 +/- 3 in 64 of them [34 females and 30 males] denoting masked LV dysfunction P <.00001. There was a correlation of increasing severity of dysfunction with the degree of mitral regurgitation. Ejection fraction underestimates the presence of left ventricular dysfunction in these patients. However, this was unmasked by the Tei index which could be an additive data for detecting early left ventricular dysfunction

Insulin resistance, the metabolic syndrome and global right and left myocardial performance index

Cardiovascular dysmetabolic syndrome [CDS], dysmetabolic syndrome, syndrome X, DROP syndrome [dyslipidemia, insulin resistance [IR], obesity, and high blood pressure] and IR syndrome are all synonymies for the syndrome characterized by four critical elements: atherogenic dyshpidemia, IR, central obesity, and high blood pressure. The aim of the study was to describe the global right and left myocardial function, in patients with metabolic syndrome [MS], defined according to the criteria proposed by NCEP-ATP III. A descriptive, cross-sectional, hospital based study in which, 730 patients, mean age [54 years + 6], [430 men and 300 women] who attended Suez Canal university [SCU] outpatient, clinic of cardiology and diabetes were screened for CDS criteria of whom 150 were diagnosed [63 men and 87 women]. Those who met the dysmetabolic syndrome criteria were subjected to careful history taking, blood pressure measurement anthropometric measures [Height and weight, body mass index, waist circumference], ECG and blood samples: [Na and K, Fasting blood sugar [FBS], fasting plasma insulin [FPI] [normal values from 5-15 micro IU/ml], serum creatinine [S.Cr.], serum uric acid and Lipids were measured. HOMA-IR was assessed according to the level of FBS and which was measured with electrochemiluminescence immunoassay method Serum intact pro-insulin was measured by using a highly specific solid phase enzyme linked immunosorbant assay based on sandwich principle. All participants were subjected to full echocardiographic study including right and left ventricular diastolic and systolic ftmction, and the combined index of myocardial performance [Tei index = IRT + ICT/ET]. Most of parameters of insulin resistance [IR] were higher in females than males, fasting plasma insulin, PPBS and HOMA-IR [27 vs. 21 micro IU/mL]. [162 vs. 151 mg/dl], and [10 vs. 8.5] respectively, [P value < 0.05]. In addition, waist circumference and BMI were higher in females than males, [130 vs. 127 cm] and [44 vs. 39 kg/m2] respectively, [P value < 0.05]. HDL were higher in females than males [43 vs. 39 mg/dl] respectively, with statistical significant difference [P value < 0.05]. Total body obesity [[BMI] and central obesity [waist circumference] had a statistically significant direct correlation relation with fasting plasma insulin, HOMA-IR, HDL, TG, FBS and PPBS. Central obesity alone had a statistically significant direct correlation relation with serum uric acid. Participants with the MS had greater left ventricular [LV] dimension, mass, and relative wall thickness, and left atrial diameter [all p < 0.01]. and a higher prevalence of LV hypertrophy [p <0.001], with lower ejection fraction [p <0.05], and mitral E/A ratio [p < 0.05] than participants who did not have the MS. Regarding the left ventricular global function there was significant difference between the groups. On the other hand there is non significant difference regarding right ventricular function between them. HOMA-IR was a predictor of incident global myocardial left ventricular dysfunction. The metabolic syndrome is associated with a global left rather than right ventricular dysfunction and HOMA-IR is a predictor. There is a pressing need for a national preventive program to combat obesity, diabetes and related comorbidities by general practitioners and diabetologists

study of hepatopulmonary syndrome among cirrhotic patients using different cut off values for Hypoxaemia

Introduction: Hepatopulmonary syndrome [HPS] is characterized by the clinical triad of liver disease, arterial deoxygenation, and widespread pulmonary vascular dilatation. Various threshold values defining arterial hypoxaemia have been recommended and used in previous publications: PaO2 <70 mm Hg, PaO2 <80 mm Hg, AaDO2 >15 mm Hg, and AaDO2 >20 mm Hg. These different threshold values may result in a different prevalence of HPS

The aims of our study are: [l] to clarify how the prevalence of HPS in a sample of patients with chronic liver disease varies according to previously used different cut off values for arterial hypoxaemia; and [2] to determine the predictive value of those out off values in the diagnosis of HPS

Patients and Methods: Nighty patients with liver cirrhosis were studied for the presence of HPS using two-dimensional transthoracic air contrast echocardiography, pulmonary function tests, and arterial blood gas analysis. Those patients in whom contrast echocardiogram showed intrapulmonary vascular dilatations were classified as the positive group while others were labeled as the negative group

Results: Among the studied group, 24 [26.66%] had a positive contrast echocardiography; 12 [13.33%] of them were found to have PaO2<70 mmHg and were qualified for the diagnosis of [clinically significant] HPS; and the other 12[13.33%] with PaO2>70 mmHg were diagnosed as [subclinical HPS]. Using an increased alveolar-arterial difference for the partial pressure oxygen [AaDO2] as an indication of hypoxaemia, the prevalence of HPS was considerably higher [26.66% at > 15 mgHg and 22.22% at > 20mmHg]; than when using partial pressure of arterial oxygen [PaO2] as an indicator [20% at <80 mmHg and 13.33% at <70 mmHg]. For AaDO2 as the indicator, the positive predictive value for a diagnosis of HPS was low at both out vaiues [35.29%, and 38.46% respectively]. In contrast, PaO2 as an indicator had considerably higher positive predictive values [52.94%, and 75% respectively]. Introducing PaO2 <60 mm Hg as the cut off, the positive predictive value increased 100%. Dyspnoea was more oRen present in patients with [clinically significant] HPS [100%] compared with [subclinical PS] [50%], and patients without HPS [42.4%]. Cyanosis [p=0.000], clubbing [p=0.000] and orthodeoxia [p=0.000] were significantly commoner in the12 patients of clinically significant HPS. Presence of spider naevi was significantly related to the presence of subclinical HPS [intrapulmonary vascular dilatations]. The Child-Pugh score correlated signihcantly with the severity of HPS

Impact of leptin levels upon left ventricular structural abnormalities in non insulin dependent diabetics

Non-insulin-dependent diabetes mellitus adversely affects left ventricular [LV] structure. Recent studies have showed that leptin increases in insulin-resistant states, such as obesity and hypertension. The levels of plasma leptin have been found to be associated with LV myocardial growth. This study aimed to assess fasting serum leptin concentrations in the type 2 diabetic patients and to find the correlation between fasting serum leptin concentrations and the LV structural changes in the type 2 diabetic patients. Twenty four type 2 diabetic patients aged 51.1 +/- 7.2 years with LV structural changes defined as fasting plasma glucose >/= 126mg/di. Twenty four type 2 diabetic patients without LV structural changes, aged 47.6 +/- 9.0 years, were the controls. The following LV structural parameters were assessed by Two-dimensional echocardiography: left ventricular end-diastolic [LVEDD], left ventricular end-systolic diameter [LVESD], interventricular septal thick-ness [IVST], left ventricular posterior wall thickness [PWT], relative wall thickness [RWT] and left ventricular mass index [LVMI]. Left atrium [LA] and aortic root [Ao] dimensions were also assessed. Fasting serum leptin and insulin, fasting blood sugar [FBS] and glycosylated hemoglobin [HbAlc] were assessed. The correlations of leptin to LV structural parameters were statistically analyzed. Body mass index [BMI], FBS and fasting serum concentrations of leptin and insulin were significantly greater in the case patients than in the controls. Three were statistically significant differences between groups in all echocardiographic parameters apart from LVEDD, LVESD, RWT, LA and AO. In the case group, Leptin was positively correlated with FBS and insulin. Also, a significant correlation was found between serum leptin and the following echocardiographic parameters: PWT, IVST, SWT and LVME in the case group. Hyperleptinemia in type 2 diabetic patients with LV structural changes and the association of leptin with indexes of LV structure may reflect its role in the development of myocardial wall thickening in non-insulin dependent diabetes mellitus

Impact of leptin levels upon cardiac systoloc; diastolic global myocardial and autonomic function in patients with non insulin dependent diabetes

The increased cardiovascular burden associated with diabetes mellitus [DM], is due to structural or functional abnormalities induced by DM only or by hyperinsulinemia and insulin resistance associated with metabolic disorders. Recent studies have shown that leptin increases in insulin-resistant states, such as obesity and hypertension. On the basis of evidence of plasma leptin effect on cardiovascular system, we assessed possible Impact of leptin upon cardiac function whether systolic or diastolic, also the impact upon global myocardial function assessed by a Doppler-derived myocardial performance index [Tei index] as well as cardiac autonomic function [CAN] in type 2 diabetic patients. Twenty four type 2 diabetic patients aged 51.1 +/- 7.2 years with LV functional changes defined as fasting plasma glucose >/= 126mg/dl without hypertension. Twenty four type 2 diabetic patients without LV functional changes, aged 47.6 +/- 9.0 years, were the control. ESG was performed and QTc dispersion [QTcd] was calculated for detection of CAN Ejection fraction [EF], fractional shortening [FS], E velocity, E/A ratio, isovolumetric relaxation time [IRT], isovolumetric contraction time [ICT], ejection time [ET], and the combined index of myocardial performance [Tei index = IRT + ICT/ET], were calculated by echocardiography Doppler. Fasting serum leptin and insulin were assessed. Fasting blood sugar [FBS] and glycosylated of hemoglobin [HbAlc] were also assessed. The correlations of leptin to QTcd, EF, FS, E/A ratio and Tei index were statistically analyzed. BMI, FBS, fasting serum leptin and insulin were significantly greater in the cases than in the control. QTcd, EF and FS showed non-significant difference between groups. There were statistically significant differences between groups in E/A ratio and Tei index. In the case group, leptin was significantly correlated with FBS and fasting serum inslin. Leptin was not significantly correlated with QTcd. Leptin was negatively correlated with E/A ratio and positively correlated with Tei index in the case group. It can be concluded that in conjunction with hyperglycemia, increased free fatly acids, insulin resistance and cardiac autonomic neuropathy, serum leptin is another risk factor associated with the development of diabetic cardiomyopathy