Evaluation of subclinical atherosclerosis in Egyptian psoriatic patients

Psoriasis [Ps] is a common, relapsing, immune-mediated, inflammatory skin disorder of unknown etiology. Ps is not single organ disease confined to the skin but it is systematic inflammatory condition analogous to other inflammatory immune disorders which are known to have increased risk of heart disease. On other hand, inflammation plays also an important role in the pathogenesis of atherosclerosis. So, there is striking similarity between molecular and inflammatory pathway in Ps and atherosclerosis. Was to assess the presence of subclinical atherosclerosis in patients with Ps by using carotid ultrasonography. 60 patients with Ps were enrolled in this study after exclusion of traditional cardiovascular risk factors and cardiovascular diseases [CVD]. In addition, 20 age and gender matched healthy persons served as controls. Patients were classified according to Ps area and severity index [PASI] score into group I [20 mild patients], group II [20 moderate] and group III [20 severe]. The average common carotid artery [CCA] intima media thickness [IMT], internal diameter [ID] and arterial wall mass index [AWMI] were measured using high resolution B- mode ultrasound. Psoriatic patients showed statistically significant increase in CCA-IMT [P value 0.001], AWMI [P value 0.010] and significant decrease in ID [P value 0.001], as compared to controls. Psoriasis patients could be suggested as a group with an increased atherosclerotic risk especially in older ages with longer duration of Ps. The carotid IMT, ID and AWMI can identify patients with subclinical atherosclerosis who need special follow up to reduce cardiovascular morbidity and mortality

Comparative study between real time three dimensional echocardiogram and angiography in evaluation of patent ductus arteriosus, single center experience

In this study we compared the real time three dimensional echocardiogram data in evaluation of patent ductus arteriosus with the gold standard angiography. This study included 25 patients with PDA referred to Tanta University Hospital for elective cardiac catheterization. The patients comprised seven males and 18 females, with a mean age of 3.7 +/- 0.36 years. The study duration was six months. All patients underwent full 2D echocardiogram as well as real time three-dimensional echocardiogram [RT3DE]. Essential measurements included the pulmonary end of the duct, duct length, aortic end and aortic ampulla as well as the anatomical type of the PDA. Data obtained by RT3DE were compared against 2D echocardiogram and angiography. There was no significant difference between 3D echocardiogram and angiography [P = 0.001] in the pulmonary end of the duct measurement. Neither were there any significant differences between the length of the duct or the aortic end measured by 3D echocardiogram and by angiography [P = 0.001 in both]. While there was adequate agreement between both 2D and 3D echocardiogram and angiography in determining the anatomical type of the PDA, 3D echocardiogram determined type A and type E ductus more accurately than 2D echocardiogram. The feasibility of Q lab analysis of PDA was 96%, while the feasibility of gated color flow 3D acquisitions in determining anatomical types was 64%.There was complete agreement on location, size, morphology and surrounding structure of PDA between 2D and 3D echocardiogram, and angiography. This result illustrates the need for the proper placement of the device in catheterization laboratories

NT-proBNP correlated with strain and strain rate imaging of the right ventricle before and after transcatheter closure of atrial septal defects

Atrial septal defects [ASD] account for 10% of all congenital heart lesions and represent the third most congenital cardiac defect seen in adults. Using strain and strain rate imaging [SRI] to assess right ventricular [RV] function in patients with ASD and correlate the results with the level of N-terminal pro-brain natriuretic peptide [NT-proBNP] before and after transcatheter closure. At the Hungarian Institute of Cardiology, 27 females and 18 males [mean age 21.53 years] were diagnosed with ASD and admitted for percutaneous closure. Echocardiography was done to assess the left ventricular [LV], RV and left atrial [LA] diameters. For assessment of systolic RV function, we measured Tricuspid annular plane systolic excursion [TAPSE], strain, and SRI. Amplatzer ASD closure was done under general anesthesia. NT-proBNP levels were measured before and three months after closure. ASD closure was achieved in all patients. The mean ASD diameter was 15.15 mm. The size of the occluder ranged from 10 to 24 mm. The mean LA diameter in the pre-closure group was significantly higher than the control; mean left ventricular end diastolic diameter [LVEDD] showed a non-significant difference from either the control group or the post-closure group, while the mean right ventricular end diastolic diameter [RVEDD] markedly reduced post-closure, and it was significantly higher than the control group. Global RV strain and peak systolic strain rate [PSSR] were significantly higher in ASD group than in the control. The NT-proBNP levels were found to be correlated with pulmonary arterial pressure [PAP], TAPSE, global RV strain and PSSR. Volume overload induced by ASD is associated with increased strain values, which return to normal after closure. NT-proBNP is a parameter which correlates to RV pressure, PAP and the amount of shunt volume caused by an ASD

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

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

Prevalence of carotid and renal artery stenosis in patients with significant coronary artery disease

Atherosclerosis as a vascular disease can involve any artery in the body including large and medium sized arteries. Only a few angiographic studies have correlated the presence and severity of coronary artery disease with atherosclerosis in other arteries. The aim of this study is to evaluate the prevalence of the carotid and renal artery stenosis in patients with documented coronary artery disease and the role of predisposing risk factors for such affection in Egyptian patients. This study included 100 patients with documented significant coronary artery disease. All were subjected to carotid and renal angiography. They were divided into: group I which included patients with significant carotid artery stenosis [>50%] either unilateral or bilateral, and group II which included patients with normal carotid. They divided again into: group A which included patients with significant renal artery stenosis [>50%], while group B included patients with normal renal angiography. For all patients, random blood sugar, serum urea, creatinine and complete lipid profile was assessed. Group I included 17 patients while Group II included 83 patients with documented significant coronary artery disease. There were significant correlations between either of age, hypertension, dyslipedemia, diabetes mellitus and presence of carotid artery stenosis. While there was no relation between carotid artery stenosis with neither gender nor smoking. Number of the affected coronary arteries was the significant multivariate predictor of significant carotid artery stenosis. While group A included 7 patients and group B included 93 patients with documented coronary artery disease. Hypertension and serum levels of both urea and creatinine were significantly univariate predictor of the presence of renal artery stenosis. The significant multivariate predictor of presence of renal artery stenosis was serum level of blood urea. The prevalence of significant carotid artery stenosis with significant coronary artery disease was found to be 17%. The prevalence of significant renal artery stenosis with significant coronary artery disease was found to be 7%. Carotid artery disease is more common in patients with old age, hypertension, dyslipidemia and with more than two vessel diseased coronaries. Renal artery disease is more common in hypertensive patients with elevated blood urea and serum creatinine levels and with more than two vessel diseased coronaries

Stress tissue doppler echocardiography, is it has any prognostic implication after acute myocardial infarction?

The index could be a predictor of both systolic and diastolic myocardial performance after acute myocardial infarction [AMI]. Low-dose dobutamine stress echocardiography identifies viability in patients with myocardial dysfunction, and predicts the reversibility of myocardial function after AMI. Pulsed wave -Doppler tissue imaging [DTI] allows measuring regional myocardial velocities, and changes of both systolic and diastolic myocardial function

Aim of the work: This study aimed to assess the prognostic implication of resting and stress tissue Doppler echocardiographic variables in patients with first acute uncomplicated anterior myocardial infarction

Patients and Methods: This study included 159 patients They were divided into two groups; patients group included 129 patients with first acute anterior MI treated with thrombolytic therapy and control group included 30 age- and sex- matched healthy subjects. All patients were subjected to baseline demographic characteristics include age, sex, obesity and clinical data analysis, also coronary risk factors were assessed. Complete resting echocardiographic evaluation and resting Doppler tissue imaging [DTI] study for measuring Tei index and low dose dobutamine stress echocardiography to assess myocardial viability were done in all patients. Pulsed-wave Doppler tissue imaging study before and during low dose dobutamine stress echocardiography and follow-up of major adverse cardiac events by resting conventional echocardiography at one month, was done for every patient

Results: Patients were sub-divided into two groups according to the myocardial functional improvement at follow up; group I: included 68 patients with no improvement of myocardial function, and group II: included 52 patients with improvement on follow up. There was significant correlation between group I and the resting echocardiographic data, and there was significant positive correlation between group II and the viability demonstrated with low dose dobutamine echocardiography [LDDE], DTI, or both techniques together. During follow-up, two patients died from non cardiac cause, the remaining patients had cardiac events, forming the event group [group A], and the non-event group [group B]. Patients in group A were significantly older than patients in group B [P<0.000]. However, there was significant positive correlation between non event group and the myocardial viability. Tei index was the most significant constant independent predictor of early cardiac events

Conclusion: Resting and stress tissue Doppler echocardiographic variables found to have a significant prognostic implication in patients with acute anterior myocardial infarction