Incidence and clinical predictors of left atrial appendage thrombosis risk markers in end stage renal disease patients on maintenance haemodialysis

The incidence of intracardiac thrombosis and its risk markers in haemodialysis patients has not been sludied in the Egyptian population. This study was designed to determine the incidence of left atrial appendage [LAA] thrombosis and its risk markers as well as its clinical predictors in patients on maintenance haemodialysis in Suez Canal area in the period from 2003-2004. Transoesphageal echocardiography [TEE] was performed in 55 haemodialysis patients, 34 [62%] were males, the mean age was 46 +/- 10 years with mean dialysis duration b8 +/- b months. Any potential candidate with current or past chronic or intermittent atria] fibrillation or with cardiovascular diseases was excluded from the study. LAA abnormalities were defined as the presence of LAA thrombus, spontaneous echo contrast [SEC], LAA emplying or filling Doppler velocities <25cm/s, or LAA area 5 cm[2] Nothrombi were found in the LAA, but SEC detected in 4 [7%] patients, LAA velocities <25cm/s in 12 [22%] palients, and LAA area >5cm2 in 15 [27%] patients. On multe-variate analysis; older age, hypertension, diabetes mellitus, cigarette smoking, low haematocrit <30%, and left venlridilar mass index [LVM1] >116gm/m2 were the only ilinical variables independently associated with LAA abnormalities predisposing to thrombosis. Patients on maintenance haemodialysis in Suez Canal area are at low risk for LAA thrombosis. However, I.AA abnormalities predisposing to thrombosis can still be detected and correlated with older age, hypertension, diabetes incllilus, cigarette smoking, low haematocrit, and increased LVMI>116gin/m2.

Predictors of multivessel coronary artery disease using dobutamine stress echocardiography

The detection of multivessel coronary artery disease [MVD] is of paramount importance to cardiologists as such group of patients carry a poor prognosis and benefit to a great extent from more aggressive treatment strategies. The value of Dobutamine stress echocardiography [DSE] has been evaluated in the diagnosis of coronary arty disease [CAD], but few studies have been performed to assess the predictors of MVD during this test. this study was designed to determine the clinical, electrocardiographic predictors of MVD during DSE. this study included 51 patients with suspected CAD who underwent clinically indicated coronary arteriography, with DSE performed within 8 weeks of the angiographic study. Different clinical, electrocardiographic and echocardiographic predictors of MVD were assessed using multivariate analysis. Diabetes mellitus [DM], hypertension [HTN], and dyslipideamia were the most prevalent risk factors among patients with MVD. Coronary angiography revealed that 17.5% of patients had normal or non-significant lesion, 39.4%had single vessel disease [SVD], 19.6% had two-vessel disease [2VD] while 23.5% had MVD. DSE had a sensitivity of 96% and 68% for MVD and SVD respectively while the specificity was 85% and 53% respectively. Multivariate analysis showed 5 variables to be independent predictors of multivessel CAD including: History of DM [p=0.031], history of previous myocardial infarction [MI] [p=0.013], electrocardiographic ST-T changes in more than one vascular territory [p=0.0001], segment wall motion [SWM] abnormalities in more than one vascular territory [p=0.008], and SWM score index more than 1.7 [p=0.010]. DSE is a reasonably sensitive and specific non-invasive tool for the diagnosis of CAD, particularly MVD. History of DM, history of previous MI, electrocardiographic ST-T changes in more than one vascular territory, SWN abnormalities in more than one vascular territory, and SWM score index more than 1.7 are all independent predictors of MVD