Relationship between metabolic syndrome and the presence of silent coronary artery disease in young adults

To assess the association of metabolic syndrome with the presence of ischemic heart disease in young asymptomatic adults. This study is a cross-sectional analytic study that was conducted in order to find out the relationship between metabolic syndrome and the presence of ischemic heart disease in asymptomatic young adults. One hundred young adults with metabolic syndrome diagnosed either according to the WHO criteria or NCEP criteria were included in the study. Exclusion criteria: Ischemic heart disease, Previous cerebrovascular stroke, impaired liver or renal functions, Patients with cardiomyopathy [hypertrophic, dilated or ischemic], and valvular or congenital heart disease. All patients included in the study were subjected to: Full history taking and complete general and local examination of the heart, chest and abdomen. 12 leads resting ECG. Laboratory investigations including: Blood sugar level, lipid profile, kidney and liver function. Complete echo-Doppler study of the heart for assessment of LV systolic and diastolic function and assessment of valves for exclusion. Exercise electrocardiography and carotid ultrasonography. Results of the study showed that 64 patients [64%] had metabolic syndrome according to the NCEP criteria and 71 patients [71%] had metabolic syndrome according to the WHO criteria. 35 patients [35%] fulfilled both the criteria of the NCEP and WHO. According to the diagnosis of NCEP and WHO criteria; there was no significant difference between the two groups regarding the different clinical and demographic parameters measured [P> 0.05]. Results of the current study showed that 46 patients [46%] had increased carotid intima-media thickness [CIMT] [defined as > 8 mm in any of the 3 measurements of the carotid artery] and 54 patients [54%] had normal IMT. There was no significant difference between the two groups regarding the intima media thickness measured at the common carotid artery, bulb and internal carotid artery [P> 0.05]. 21 patients [21%] had significant ST segment changes during exercise and 79 patients [79%] had non-significant ST segment changes. There was significant difference between the patients with positive exercise stress testing and those with negative stress testing regarding the intima media thickness measured at the common carotid artery, bulb and internal carotid artery [P < 0.05]. There was significant positive correlation between intima media thickness and age, fasting blood sugar and body I mass index [r=0.517, 0.680 and 0.678 respectively and P <0.001 for all correlations]. There was significant negative correlation between intima media thickness and METs and exercise duration [r=0.754, -0.761 respectively and P < 0.001]. Young adults with metabolic syndrome are at a high risk for the development of atherosclerotic diseases. Obese subjects with criteria of metabolic syndrome have to be evaluated for the presence of silent myocardial ischemia and risk factor reduction to prevent the progress of the atherosclerotic process. Carotid Intima-Media thickness is an early indicator for atherosclerotic coronary artery disease and could be used for evaluation of young adults with metabolic syndrome

Rr variability in patients with systolic and diastolic heart failure

This study aimed at determining the difference in heart rate variability [HRV] in patients with diastolic dysfunction as compared to patients with systolic dysfunction and normal subjects. This study is a case control analytic study that was conducted in the National Heart Institute in order to determine the heart rate variability in patients with diastolic heart failure in comparison to patients with systolic heart failure and normal healthy control. The study included the following 3 groups: Group I: 20 patients with diastolic heart failure with preserved lv systolic function [EF > 50%]. Group II: 20 patients with systolic heart failure [EF < 50%] and Group III: 10 healthy normal control subjects. Patients with hypertrophic obstructive cardiopmyopathy, atrial fibrillation, excessive ectopy and or cardiac pacing, significant valvular lesion and diabetes mellitus were excluded from the study. All patients included in the study were subjected to Full history taking with special emphasis on history of diabetes mellitus and cardiac history, full general and local examination of the heart, chest and abdomen, 12 leads resting HCG, 24 hours ambulatory ECG recording [Holter monitoring] using Burdick recorder [Spacelab Inc. USA] in order to measure the heart rate variability. The parameters measured for heart rate variability analysis and its definitions are summarized in the next table. Echocardiographic study was done using two dimensional echo with continuous and pulsed wave Doppler studies were performed using echocardiographic machine General Electric vivid 3 equipped with 2.5 and 3.5 Megahertz [MHz] probes. For assessment of LV systolic and diastolic function as well as assessment of any valvular lesion for exclusion. Patients with systolic heart failure had a lower NNS, NN mean, SDNN, SDNNIDX, rMSSD and PNN > 50 than the patients with diastolic heart failure [P < 0.05]. Patients with diastolic heart failure had a significantly lower time domain measurements than that of the normal control subjects [P < 0.05]. Patients with systolic heart failure had a lower RR MEAN, Total power, VLF power, LF power, HF power than the patients with diastolic heart failure [P < 0.05]. Patients with diastolic heart failure had a significantly lower frequency domain measurements than that of the normal control subjects [P < 0.05]. All the time domain and frequency domain parameters were significantly lower in the patients with systolic heart failure than those with diastolic heart failure [P < 0.0]. Patients with grade II and grade III diastolic dysfunction had a lower NNS, NN mean, SDNN, SDNNIDX, rMSSD and PNN >50 than the patients with grade I diastolic dysfunction [P < 0.05].Patients with grade II and grade III diastolic dysfunction had a lower RR MEAN, Total power, VLF power, LF power, HF power than the patients with grade I diastolic dysfunction [P < 0.05]. Patients with EF between 20-30% and patients with HF between 31-40% had a lower time domain par imeters than those with EF between 41 - <50% [P <0.05]. Patients with 3F between 2030% and patients with HF between 31- 40% had a lower frequency domain parameters than those with HF between 41 -< 50% [P < 0.05]. Patients with both systolic and diastolic heart failure or dysfunction had abnormal autonomic modulation of the heart rate as assessed by the different heart rate variability parameters as compared to normal subjects. Patients with systolic heart failure had a lower time domain and frequency domain parameters than patients with diastolic dysfunction that may reflect more autonomic neuropathy in systolic heart failure and contributes to the poor prognosis in systolic heart failure. Abnormalities in Heart rate variability parameters were correlated with the severity of both systolic and diastolic dysfunction

Effect of valve prosthesis - patient mismatch on short term outcome after aortic valve replacement

Small- size prostheses for aortic valve replacement can be too small in relation to the body size, thus causing valve prosthesis-patient mismatch [PPM] and abnormally high transvalvular pressure gradient. This study was planned to examine the relation between the PPM and the short term outcome after the operation. Baseline risk factors and short term outcome were analyzed in 23 patients, 19 [82.6%] males and 4[17.4%] females who underwent Aortic valve replacement. The indexed valve effective orifice area [IEOA] was estimated for each type and size of prosthesis implanted. PPM was defined as not clinically significant if patient IEOA is > 0.85 cm[2]/m[2] while clinically significant if patient IEOA is 0.85 cm[2]/m[2]]. There was no statistical difference between both groups regarding pre-operative patients' demographics. Operative characteristics were similar among patients in both groups with no statistical significance difference. ICU stay was 2.8 +/- 1.5 days in group A vs. 3.2 +/- 1.9 days in group B [p =0.08]. While total hospital stay was 12.5 +/- 9.8 days in Group A vs. 13.6 +/- 9.8 days in group B [p =0.59].The early mortality was encountered in two patients in group A and one patient in group B [p =0.59]. Prosthesis-Patient Mismatch has no significant effect on short term outcome in patients undergoing Aortic Valve Replacement