Relation between non-alcoholic fatty liver disease and epicardial fat in metabolic syndrome

Background: Non-alcoholic fatty liver disease [NAFLD] is becoming recognized as a component of the metabolic syndrome and insulin resistance. There has been recent interest in the association between epicardial fat and atherosclerotic disease with increased risk of cardiovascular mortality and morbidity

Aim of the work: In this study we investigated the relationship between the metabolic syndrome with liver involvement and epicardial fat

Patients and methods: 85 patients who had the criteria of metabolic syndrome are subjected to thorough clinical evaluation. Abdominal circumference, body mass indexand waist/hip ratio were recorded for all patients. Laboratory investigations including urine, complete blood picture, fasting and postprandial blood glucose, uric acid, blood urea and creatinine,C-reactive protein [CRP], lipid profile, liver enzymes and bilirubin were done to all patients. Ultrasonography was used to grade fatty liver and measure the thickness of epicardial fat. Results: Patients with high ALT levels have significantly higher [p<0.01] AST, fasting blood glucose [FBG], uric acid, triglyceride [TG] level, more epicardial fat and waist circumference [p<0.05] compared to those with normal levels. Patients with high grade of fatty liver have significantly higher total cholesterol, TG, FBG, AST, ALT, uric acid levels, more epicardial fat and waist circumference [p<0.01] compared to those with mild and moderate. ALT, FBG and TG are significantly higher in patients with detectable epicardial fat than those without [p<0.01]. There were significant direct correlations between epicardial fat thickness with FBG [r= 0.324; p<0.01], TG [r= 0.217; p<0.05], AST [r= 0.493; p<0.01], ALT [r= 0.561; p<0.01], and grade of fatty liver [r= 0.479; p<0.01]. Also there were significant direct correlations between FBG with waist circumference [r= 0.422; p = 0.01], TG level [r = 0.370; p<0.01], HDL-C [r = 0.284; p<0.05] and grade of fatty liver [r = 0.533; p = 0.01]. There were significant direct correlations between grade of fatty liver with waist circumference [r= 0.264; p<0.05], TG [r= 0.407; p<0.01], uric acid [r= 0.288; p<0.05], and AST levels [r= 0.642 p<0.01]. CRP was found correlated only with liver enzymes [r = 0.481;p<0.05]. Simple logistic regression analysis revealed that epicardial fat thickness [mm] showed a trend in patients with NAFLD and metabolic syndrome

Conclusion: Echocardiographic assessment of epicardial adipose tissue, abdominal ultrasound assessment of NAFLD and transaminase level might serve as a reliable marker of visceral adiposity and more severe degree of metabolic syndrome

Non traditional risk factors of carotid atherosclerosis in rheumatoid arthritis

Cardiovascular events are markedly increased in rheumatoid arthritis, and they remain poorly understood. To investigate inflammatory markers, markers of endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis-related factors as non traditional risk factors for occurrence of carotid atherosclerosis in rheumatoid arthritis patients. Thirty RA patients were included in this study. All of them were females and their ages ranged from 23 to 62 years with a mean of 43.95 +/- 7.2 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment, bone erosion assessment by Modified Larsen score and functional assessment by health assessment questionnaire [HAQ] score. Carotid Duplex was done to measure the intima-media thickness [IMT] and carotid plaques. The patients who proved to have carotid atherosclerosis by ultrasound were subjected to ultrasound examination of brachial artery flow mediated dilatation [FMD] to confirm presence of endothelial dysfunction in those patients. Ten out of 30 RA patients [33.3%] had carotid atherosclerosis in whom there was impaired FMD denoting endothelial dysfunction. Among those patients, the risk factors that associated with occurrence of carotid atherosclerosis included higher levels of inflammatory markers [CRP, ESR and IL-6] and VCAM-1 [a marker of endothelial dysfunction], lower levels of antioxidant vitamins A and E, and RA-related factors as longer duration of disease, increased RF titer, increased HAQ-score, bone erosion, duration of prednisone use and prednisone cumulative dose. The prevalence of carotid atherosclerosis in rheumatoid arthritis patients was 33.3%. Among those patients, a statistically significant association was found between occurrence of carotid atherosclerosis and inflammatory markers, endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis related factors

Non-traditional risk factors of carotid atherosclerosis in rheumatoid arthritis

To investigate inflammatory markers, markers of endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis-related factors as non traditional risk factors for occurrence of carotid atherosclerosis in rheumatoid arthritis patients. Thirty RA patients were included in this study all of them were females and their ages ranged from 23 to 62 years with a mean of 43.95 +/- 7.2 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment, bone erosion assessment by Modified Larsen score and functional assessment by Health assessment questionnaire [HAQ] score. Carotid Duplex was done to measure the intima- media thickness [IMT] and carotid plaques. The patients who proved to have carotid atherosclerosis by ultrasound were subjected to ultrasound examination of brachial artery flow mediated dilatation [FMD] to confirm presence of endothelial dysfunction in those patients. Ten out of 30 RA patients [33,3%] had carotid atherosclerosis in whom there was impaired FMD denoting endothelial dysfunction. Among those patients, the risk factors that associated with occurrence of carotid atherosclerosis included higher levels of inflammatory markers [CRP, ESR and IL-6] and VCAM-1 [a marker of endothelial dysfunction], lower levels of antioxidant vitamins A and E, and RA-related factors as longer duration of disease, increased RF titer, increased HAQ-score, bone erosion, duration of prednisone use and prednisone cumulative dose. The prevalence of carotid atherosclerosis in rheumatoid arthritis patients was 33.3%. Among those patients, a statistically significant association was found between occurrence of carotid atherosclerosis and inflammatory markers, endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis related factors

Percutaneous carotid intervention in patients combined carotid and coronary artery disease

Cerebrovascular accidents [CVA] are the third leading cause of death world wide. Carotid stenosis accounts for 20% to 30% of all CVAs. Thromboembolization of the atherosclerotic stenotic carotid arteries leads to cerebrovascular strokes and transient ischemic attacks [TIAs]. By far the most common lesion found in patients with intracranial cerebral vascular disease is an atherosclerotic plaque at carotid bifurcation. Recently carotid angioplasty and stent implantation appears to be a feasible method for the treatment of carotid stenosis. To assess safety and feasibility of percutaneous intervention in the treatment of carotid artery stenosis in patients with concomitant coronary artery disease. Forty patients with concomitant coronary and carotid artery disease were enrolled in this study, their carotid lesions were managed by carotid artery stenting [CAS] and distal protection devices [filter type] were used. Twenty seven males [67.5%] and 13 females [32.5%] were enrolled in this study their age ranged from 49-82 with the mean of 64.3 years, all had ischemic heart disease and internal carotid artery [1CA] stenosis that ranged from 60 to 99% with the mean of 82.4% +/- 10.5. Optimal results were obtained in 38 patients [95%] and the procedure was incomplete in 2 patients [5%]. Mean stenosis post stenting was 6% +/- 4. In recent outcome, mortality rate was 0% while 5 patients [12.5%] developed minor strokes, and 5 patients [12.5%] developed TIAs. In 18 months follow up, 31 patients [81%] were free from major cerebro-vascular events. Coronary artery stenting [CAS] resulted in reduction of neurological symptoms and major cerebral insult and found to be feasible and safe especially in high risk patients [those with severe coronary artery disease] for surgical interventions

Color M-mode for the assessment of left ventricular diastolic function

During the last two decades, Doppler echocardiography has emerged as the principal clinical tool for the assessment of left ventricular [LV] diastolic function. Trans-mitral and pulmonary venous Doppler flow indices have been used to evaluate different parameters of diastolic function, but it is difficult to use these modalities in differentiation between a normal filling pattern and a pseudo-normal filling pattern. Recently, color M-mode [CMM] of LV inflow and tissue Doppler imaging [TDI] of mitral annulus have provided additional insights in the assessment of diastolic function. Aim of the work: was to correlate the new parameter CMM of LV inflow with trans-mitral flow [TMF] in different patterns of diastolic performance to evaluate its clinical utility. 70 patients [46 males, and 24 females] who are having diseases known to affect diastolic function and 10 normal individuals as a control group were included in the study. The 70 patients were divided into 3 groups according to their LV diastolic filling pattern based on the conventional TMF pattern and included, group I [impaired relaxation pattern, IR], group 2 [pseudo-normal pattern, PN] and group 3 [restrictive filling pattern. RFP]. All of them were subjected to trans-thoracic Doppler echocardiography [TTE] with TMF and CMM examinations. In group I [IR], flow propagation velocity [VP] was lower than that in PN and control groups but higher than that in RFP group. Time delay [TD] and E/VP ratio were lower than those in PN and RFP groups but higher than those in control group. In group 2 [PN], VP and TD were higher than those in IR and RFP groups but lower than those in control group. E/VP was higher than that in IR and control groups but lower than that in RFP. In group 3 [REP], VP was lower than that in all other groups. TD and E/VP were higher than those in all other groups. Tei index was significantly higher in group 2 and 3 as compared to the control group but did not show significant change between group 1 and the control group. Also there was statistically significant correlation between E/VP ratio with, E, TD and Tei index. While statistically significant negative correlation was recorded between E/VP ratio with EDT, IVRT and VP. The new modality CMM is helpful in differentiation of PN pattern from normal pattern and can be complementary to TMF to give an idea non-invasively about diastolic parameters