predictive value of thrombocytopenia for bleeding or liver decompensation following percutaneous radiofrequency ablation therapy of hepatocellular carcinoma in patients with liver cirrhosis

To assess if thrombocytopenia has a predictive value for bleeding and/or liver decompensation following percutaneous radiofrequency ablation [RFA] therapy of hepatocellular carcinoma [HCC] in patients with liver cirrhosis. 64 consecutive patients with cirrhosis complicated by hepatocellular carcinoma, and associated with mild thrombocytopenia ranged from 37 to 99 x 10[9] platelets/L, and had undergone percutaneous RFA for treatment 86 hccs, were retrospectively studied. Nine possible factors were analyzed for their ability to predict bleeding or liver decompensation using the Cox proportional hazards regression model; Age, sex, Child-Pugh class, etiology of cirrhosis, platelet count, prothrombin activity, number of tumors, maximum size of the tumor, and type of electrode. It was shown that platelet threshold of 37 x 10[9]/L and the other variables were not significant risk factors of bleeding. Statistical [univariante and multivariente] analysis revealed that liver decompensation was clearly linked to prothrombin activity [p = 0,010 and p = 0.006, respectively] and < 63% of prothrombin activity was found to be a significant threshold for the occurrence of liver decompensation [p = 0.003] confirmed by Cox model [p = 0.05] Mild thrombocytopenia > 37 x 109/L is not an independent risk factor of bleeding or liver decompensation after RFA therapy of HCC in patient with cirrhosis. However, in such situation a significant higher risk of liver decompensation followed the procedure was found in cases of prothrombin activity < 63%.Radiofrequency ablation, hepatocellular carcinoma, thrombocytopenia, prothrombin activity, liver cirrhosis RFA= radiofrequency ablation, HCC = hepatocellular carcinoma, US = ultrasonography, CT = computed tomography

Is mitral deceleration time can predict successful reperfusion?

Background Ventricular remodeling has emerged as one of the dominant factors that determine the long-term survival of post-infarction patients. It is also estimated that left ventricular enlargement after myocardial infarction increases the likelihood of an adverse outcome

Aim of the work: The aim of this study is to determine whether the early assessment of mitral deceleration time may predict left ventricular remodeling after successfully reperfused acute anterior myocardial infarction

Subjects and methods This study included 100 patients who were admitted to CCU with documented first anterior MI. Patients included in the study were in the proper time window for initiating reperfusion therapy, i.e. less than 12 hours from the beginning of symptoms. All patients included in the study were subjected to the following Complete History Taking, Thorough Clinical Examination; Electrocardiography, Laboratory Investigations and Echocardiography [Left Ventricular Dimensions, Systolic Function, Left Ventricular Wall Motion Score Index [WMSI] and Left Ventricular Diastolic Function Parameters

Conclusion: The most powerful predictor of LV remodeling, and LV dilation is related to the severity of impairment of LV filling. Patients with restrictive MV flow pattern [DT < 130 mSec.] had a higher level of peak serum level of CK enzyme, suggesting a larger infarction area. There was a strong correlation between DT and measures of LV systolic functions, as LVEDV, LVESV and EF. Also, there was a strong correlation between DT and E/A ratio

Prognostic value of cardiac troponin T [CTnT] elevation in chronic renal failure patients on haemodialysis

Increased plasma treponin T [CTnT] is frequently observed in end-stage renal failure patients. patients with end-stage renal disease have a high risk of premature death, mainly as a result of cardiovascular disease [CVD], which is not sufficiently explained. The objective of this study was to study the extent and pattern of increased cardiac treponin T [CTnT] in end stage renal failure patients on regular hemodialysis and to evaluate the usefulness and the prognostic value of CTnT as a predictor of subsequent cardiac events in those patients. This study was carried on [80] patients on regular hemodialysis [50] of them have no evidence of ischemic heart disease and [30] proved to have cardiac diseases, patients were followed up for 6 months and one year for any cardiac events. a] There is no correlation between CTnT level and blood urea, serum creatinine and blood sugar. b] CTnT levels are higher in ischemic group [mean level 0.11 microg/L] than in non ischemic group [mean level 0.08 microg/L]. c] More cardiac complications were observed in the cardiac group versus non cardiac patients. These complications were associated with higher levels of CTnT, in the cardiac group during the period of follow up 6 patients [20%] died, 3 [10%] suffer frequent anginal attacks, 4 [13.3%] suffer heart failure and 3 [10%] suffer myocardial infarction. In the non cardiac group during the period of follow up 9 patients [18%] died, 7 [14%] patients show ischemic changes in E-C-G follow up, 8 [l6%]suffer heart failure and 1 [2%] patients suffer myocardial infarction. Increased plasma cardiac treponin T [CTnT] is frequently observed in end stage renal disease patients without acute coronary disease. Increased [CTnT] appears to predict cardiac complications and predicts long and short term all cause mortality in hemodialysis patients. The CTnT predicts death and cardiovascular outcomes in clinically stable patients with end-stage renal disease. Because this protein is synthesized exclusively in myocardial cells, its predictive power for these outcomes may be because it reflects, besides cardiac ischemia, left ventricular [LV] mass, which is a strong predictor of cardiovascular death in this population per se

Evaluation of extracorporeal ultrafiltration in the management of refractory congestive heart failure

Refractory congestive heart failure [CHF] usually represents the end stage of cardiac disease in which hypotension and oliguria lead to progressive generalized edema. The aim of the present work was to assess the symptomatic response, hemodynamic benefits and side effects of extra-corporeal ultrafiltration [ECUF] therapy in patients with refractory CHF who failed to respond to conventional anti-failure measures. Sixteen patients with refractory CHF who belonged to class IV of the New York Heart Association [NYHA] classification were included in this study. They were 7 men and 9 women with ages ranging from 32 to 63 yr [mean 47 +/- 9 yr]. The causes of heart failure were: ischemic heart disease in 3 patients, rheumatic heart disease in 5 and dilated cardiomyopathy in 8. All patients had ECUF therapy, 1-6 sessions/patient, each lasting 4-6 hr with an average amount of ultrafiltrate 2.6 +/- 0.4 L/session. All patients had serial: echocardiography, hemodynamic monitoring, chest X-ray, serum electrolyte and hematocrit estimation in addition to routine laboratory tests both pre- and post ECUF. Response to ECUF was considered according to improvement of patients' clinical status, and cardiac and renal functions. Eleven patients were responders [68.5%], 3 were partial responders [18.5%] while 2 were non-responders [13%]. In responder group, edema disappeared, 5 patients [31%] became NYHA class III, with significant diuresis and decrease of body weight. In addition, there was a significant reduction in heart rate, central venous pressure and radiographic cardiothoracic ratio. After ECUF there was a significant increase of serum sodium concentration whereas no-significant changes were observed in serum calcium, potassium, urea or creatinine. By echo cardiography there was a significant reduction in all cardiac chamber dimensions with significant improvement of left ventricular contractility. ECUF offers a reasonably effective and relatively safe method in the therapeutic options of refractory CHF

Functional cardiac abnormalities in cirrhotic patients with and without ascitis

Abnormalities in cardiac function have been reported in patients with liver cirrhosis, suggesting latent cardiomyopathic changes in these patients. In this study we investigated cardiac function and morphology in patients with liver cirrhosis with and without ascites. A total of 60 patients with liver cirrhosis [divided into three groups each with 20 patient; group I without ascitis, group II with mild and moderate ascitis and group III with tense ascitis] and 20 normal healthy control subjects were studied by two dimensional Doppler echocardiography. Cardiac dimensions and left and right ventricular systolic [ejection fraction, isovolumic contraction time and peak flow velocity of the aortic and pulmonary flow] and diastolic [the peak flow velocity in early diastole E cm/sec, the peak flow velocity in late diastole A cm/sec, and the E/A ratio and the deceleration time of the E wave, the isovolume relaxation time of the left ventricle] functions were evaluated. Our study showed that the EF is significantly low in all patient groups versus the control subjects and in the ascitic patients versus the non-ascitic group [P<0.01] but no significant difference between the patients with mild and moderate ascitis versus the nonascitic patients. The LVET was significantly shorter in patients with tense ascitis [G.3] as compared to non-ascitic patients[G.1] [P0.04]. also the IVCTL/LVET was significantly lower in all patient groups compared to the controls [P<0.006], and in ascitic patients versus non-ascitics[P<0.02]. For the right ventricular systolic function; the VmaxR was significantly decreased in nonascitic patients compared to controls [P<0.03], the RVET was significantly shorter in all patients groups compared to controls [P<0.004]. The E/A ratio was significantly decreased in ascitic patients versus controls [P<0.001 and in ascitics versus nonascitics [P<0.002]. The deceleration time of the E wave was significantly prolonged in ascitic versus controls [P<0.001] and in ascitics versus non-ascitics [P<0.01]. Also, the IVRT was significantly prolonged in all patient groups versus the controls. Both atria and right ventricle were significantly enlarged in cirrhotic patients versus controls and in cirrhotics with ascitis versus those without ascitis. Liver cirrhosis is associated with enlarged right cardiac chambers. Systolic and diastolic dysfunction were evident in cirrhotic patients and more in those with ascites. Our data confirm the presence of cirrhotic cardiomyopathy rather than secondary cardiac adaptation to circulatory changes in liver cirrhosis

clinical and prognostic significance of early retinal microvascular changes in untreated essental hypertensives

The clinical and prognostic significance of initial retinal changes in hypertensive patients remains controversial. So, we assessed the relationship of microvascular abnormalities with prognostically validated markers of target organ damage [TOD], such as left ventricular mass [LVM], carotid intima-media thickness [IMT] and microalbuminuria, in early stages of untreated essential hypertension. A total of 280 consecutive, never-treated patients with grade 1 or 2 essential hypertension, referred to outpatient clinic, underwent the following procedures: [1] clinical and routine laboratory examinations, [2] 24-h ambulatory blood pressure monitoring, [3] 24-h urine collection for microalbuminuria, [4] transthoracic echo-Doppler evaluation, [5] carotid ultrasonography, [6] mydriatic retinography. Patients were divided into three groups; group I, with normal retinal pattern [n =67, 24%], group II arteriolar narrowing [n = 93, 32.2%] and group III with arteriovenous crossings [n =120, 42.9%]. The three groups were similar for gender, body mass index, smoking habit, heart rate, clinic and ambulatory blood pressure [BP] values, while mean age was slightly but significantly higher in group III than in group I[47.6 +/- 10.7 versus 43.6 +/- 11.5 years, P = 0.03]. slight but significant differences occurred between group III and group I in LVM index [112.5 +/- 19 versus 102.1 +/- 11 g/m2, p<0.04], carotid IMT 0.78 +/- 0.18 versus 0.64 +/- 0.12 mm, p<0.05], urinary albumin excretion rate [18.4 +/- 28.4 versus 12.6 +/- 26 mg/ 24h, p<0.05] as well as in the prevalence of LV hypertrophy [15.3 versus 8.10%, p<0.006], IM thickening and plaques [28.78, 23.54% versus 15.6 and 13.5%, p<0.008, 0.006] both defined according to 2003 ESH-ESC guidelines]. These results show that: [1] a large fraction [more than 76%] of untreated, recently diagnosed hypertensive patients have initial retinal microvascular abnormalities detectable by mydriatic retinography, [2] the presence of diffuse arteriolar narrowing is not associated with more prominent cardiac and extracardiac TOD, while the presence of arteriovenous crossings are associated, [3] fundoscopic examination has a valuable clinical value to detect widespread organ involvement in grade 1 and 2 recently diagnosed hypertension