Evaluation of right and left ventricular systolic and diastolic function in patients with type I diabetes using echocardiography and tissue doppler imaging

Impairment of cardiac function in patients with type 1 DM represents one of the serious complications and, if present, may affect the quality of life and prognosis of the disease. Conventional and tissue Doppler echocardiographic imaging can predict early stage and progression of diabetic cardiomyopathic changes. The aim of this study is to assess the effect of type 1 diabetes on cardiac systolic and diastolic functions in both ventricles in patients without evidence of coronary artery disease or hypertension. The study included 30 patients with type 1 DM [18 females and 12 males] and 10 healthy individuals, their age 14.2 +/- 2.4 years, and diabetes duration of 5 years or more. Cardiac functions were assessed by conventional echocardiography, and tissue Doppler imaging studies. The study showed that there is statistically significant difference as regard end diastolic volume [EDV], right ventricular wall thickness [RVWT], Peak systolic myocardial velocity [Sm] velocity of inferior and septal segments of LV, Peak late diastolic myocardial [Am] velocity and Em/Am ratio of lateral segment of RV, between diabetic and non diabetic population. Also, there is significant negative correlation of diabetes duration to Peak early diastolic myocardial velocity [Em] of anterior segment [r = -0.492, p<0.006], Am of anterior segment [r = -0.355, p<0.048] and Em of septal segment of the left ventricle in patient group [r = -0.448, p<0.013]. No significant correlation between diabetes duration and all other echo-cardiographic parameters, age or HgAlc level. Ventricular interaction was also demonstrated since significant relations were found between right and left ventricular, diastolic and systolic, functional indices, as regards [1] positive correlation between the mitral and tricuspid [E,A] velocities in diabetic patients [r=0.371, p<0.044], [r=0.438, p<0.015] respectively, [2] positive correlation of Em/Am ratio of the lateral segment of the RV to Em/Am ratio of the septal segment of LV [r =0.465, p< 0.010], [3]positive correlation of right ventricular end-diastolic diameter [RVEDd] to interventricular septum systolic diameter [IVSs], [r = 0.401, p<0.028], posterior wall thickness at end systole [LVPWTs], [r=0.443, p<0.014] and [EDV] of LV [r=0.366, p<0.047]. There were no significant correlation between age and HgAlc blood level with Doppler [E/A ratios] and pulsed tissue Doppler [Em/Am ratios] of both ventricles in diabetic population studied. Patients with type 1 DM have impaired diastolic function, in both ventricles before the development of myocardial systolic dysfunction when assessed with either conventional or tissue Doppler imaging. These alterations in myocardial function were related to the duration of DM and may be attributed to ventricular interdependence as well as the uniform effect of diabetes on cardiac function. Serial echocardiographic assessment, and particularly tissue Doppler imaging, are warranted in patients with type 1 DM to follow the progression from ventricular subclinical involvement to the development of symptomatic ventricular dysfunction

Clevidipine for deliberate hypotention in functional endosopic sinus surgery [FESS]

Clevidipine or nitroglycerine was used to induce controlled hypotension in patients undergoing functional endoscopic sinus surgery [FESS]. Objective: Evaluation of clevidipine as a hypotensive agent in comparison to nitroglycerine in FESS. Method: Forty patients were randomly assigned to the clevidipine or nitroglycerine group. All patients received standard anaesthetic technique. A target mean arterial pressure [60 mm Hg] was achieved by adjusting infusion rate of the hypotensive agent. The two groups were compared with reference to heart rate [HR], mean arterial blood pressure [MAP], cardiac index [Cl], stroke index [SI], and systemic vascular resistance index [SVRI]. Quality of surgical field was compared using average category scale [ACS]. Results: Mean HR was significantly higher in nitroglycerine group during steady state hypotension [p = 0.009].Reflex tachycardia was more frequent in nitroglycerine group [45% vs 10%]. Mean SVRI was significantly lower in clevidipine group [p < 0.001]. ACS was better in clevidipine group. Clevidipine was effective in inducing controlled hypotension in FESS and it offered better surgical field than nitroglycerine

Clinical characteristics and autonomic dysfunction in hypotension

This study aimed to describe hypotension, its associated symptoms, important laboratory findings, cardiovascular autonomic functions and echocardiographic findings. This descriptive cross sectional study was done to survey hypotension in 1128 patients. Only 5.2% [59/1128] of patients were hypotensives, i.e. BP=100/60 mmHg. Hypotensives [n=50] are compared to age [mean 28.5 years] and sex [male/female ratio 0.85] matched normotensives [n=50]. From the results obtained, it was concluded that hypotension may be considered as a disease entity. It may present with different symptoms and signs including abnormal cardiovascular autonomic functions which should be performed in routine examination

Prediction of risk of hypertension in offspring of hypertensive subjects

The offspring of hypertensive patients has a tendency to develop hypertension, so the question of prediction of susceptible individuals is unclear. This Cross-sectional comparative study was designed to clarify some predictors of hypertension in offspring of hypertensive patients. The study included 100 subjects [12 to 18 year old, male and female]; 50 offspring of hypertensive parents [group I] and 50 offspring of normotensive parents [Group II]. They were subjected to full medical history and clinical examination including blood pressure record at rest and after exercise. Also anthropometric assessment was performed. Biochemical assessment for fasting C-peptide insulin level, and plasma level of norepinephrin [NE] were recorded. In group I. the mean resting systolic blood pressure [SBP] was 101.8 +/- 9mmHg, the mean peak SBP 197.2 +/- 27mmHg, the mean resting distolic blood pressure [DBP] was 76.5 +/- 7.5mmHg, the mean peak DBP 71 +/- 9.5mmHg. The mean resting heart rate [HR] was 83.6 +/- 8.7 Beat/min. the mean peak HR was 193.5 +/- 9.I Beat/min. The mean metabolic equivalent [METs] was 12.5 +/- 1.8 MEq. The mean body mass index [BMI] was 30 +/- 5.1 kg/m2. The mean serum insulin level was 23.5 +/- 15.7 micro U/dl and the mean serum NE level was 344.7 +/- 57.1 ng/dl. In group II, the mean resting SBP was 95.1 +/- 16.22mmHg, the mean peak SBP was 172.5 +/- 17.8mmHg; the mean resting DBP was 66.7 +/- 7.7mmHg, the mean peak DBP was 63.4 +/- 6.9mmHg. The mean resting HR was. 80.1 +/- 11.4 Beat/min, the mean peak HR was 188.7 = 6.2 Beat/min. The mean METs was 13.2 +/- 1.8 MEq. The mean BMI was 26.8 +/- 3.6 +/- 5.8 kg/m[2]. The mean serum insulin was 14.7 +/- 15.7 micro U/dl, and mean serum NE was 286.3 +/- 57.1 ng/dl. Both SBP and DBP were within normal limits but were significantly greater in group I than group II. Function capacity was significantly lesser in group I than group II. BMI was significantly greater in group 1 than group II. Serum insulin and NE were significantly increased in group I than group II. However the long-term effect of these risk factors on the cardiovascular system including the coronary arteries need more research

Pro-collagen peptides in essential hypertension and its relation to cardiac structure and functions before and after antihypertensive therapy

A significant increase in fibrillar collagen content, type I and type III, has been observed in the cardiac ventricles of both animals and humans with arterial hypertension. The serum concentrations of procollagen type I carboxy terminal peptide [PIP] and procollagen type III amino terminal peptide [PIIIP] have been proposed as a useful markers of collagen types I and III synthesis. We evaluated fibrogenic activity in patients with essential hypertension by measuring serum concentrations of PIP and PIIIP as markers of tissue synthesis of collagen type I and type III, and its relation to parameters of left ventricular [LV] structure and functions in those patients. The effect of treatment with ACE inhibitor [captopril] for 6 months on serum concentrations of both PIP and PIIIP was also studied. The study included 79 patients with newly diagnosed mild to moderate hypertension and 50 normotensive subjects. Ages ranged between 35 to 60 years. Careful blood pressure measurement was obtained in all subjects. M-mode, two dimensional, and pulsed Doppler were performed to get baseline LV anatomy and function. Serum PIP and PIIIP were measured by radioimmunoassay. Both echocardiography and biochemical studies were repeated for all hypertensives after 6 months treatment with captopril. Serum PIP and PIIIP were significantly higher in hypertensive patients compared with normotensive subjects. PIP was 258 +/- 57mg/L in hypertensives vs. 167 +/- 70mg/L in normotensives. PIIIP was 3.73 +/- 2.2mg/L in hypertensives vs. 1.9 +/- 1.4mg/L in normotensives. In addition, PIP and PIIIP were significantly higher in hypertensives with LV hypertrophy [LVH] than those with normal LV mass. Moreover, serum concentration of PIP was directly correlated with LV mass index. On the other hand, PIIIP was inversely correlated with VE/VA ratio. After treatment, significant echocardiographic and biochemical improvements were observed. LVH regressed in 13 out of 68 patients [19%], LV mass index was normalized in 17 out of 58 patients [29%], and diastolic dysfunction was normalized in 10 out of 44 patients [23%]. Serum PIP and PIIIP were significantly reduced in hypertensives. Serum concentrations of both PIP and PIIIP are significantly increased in hypertensives and this was more pronounced among patients with LVH. This was correlated with structural and functional LV changes in the form of LVH and diastolic dysfunction. All changes demonstrated significant improvement after treatment with captopril