Relation of microalbuminuria to the left ventricular mass and cardiovascular risk factors in hypertension and type 2 diabetes mellitus

The presence of microalbuminuria was associated with a relative risk of all cause mortality 2-8 times higher than that in similar individuals without microalbuminuria and the cardiovascular mortality and morbidity was 2-4 times higher than in persons without microalbuminuria and left ventricular hypertrophy [LVH] represents a risk factor of cardiovascular disease, independent of systolic blood pressure, as well as of age, smoking and cholesterol. We aimed in this study to find out relation of microalbuminuria to left ventricular mass [LVM] and cardiovascular risk factors among hypertensive patients with or without type 2 diabetes mellitus. This study included 10 healthy volunteers [group I] as a control group with age ranged from 20-60 years and 40 hypertensive patients with or without type 2 diabetes mellitus and were classified into; Group II: included 10 patients with isolated hypertension with age ranged 35-74 years and duration of hypertension ranged from 1- 15 years, 6 patients with positive microalbuminuria. Group III: included 10 hypertensive patients with type 2 diabetes mellitus without microalbuminuria with age ranged from 35-62 years and duration of both hypertension and D. M. ranged from 1-15 and 1-10 years respectively. Group IV: Included 10 hypertensive patients with type 2 diabetes mellitus associated with microalbuminuria with age ranged from 36-70 years and duration of hypertension ranged from 1-10 years and duration of D. M. ranged from 2-17 years. All individuals were subjected to the following:-Complete history taking and thorough clinical examination, routine laboratory tests [CBC, urine analysis, renal function tests, LFT, FBS and PPBS, Lipogram and detection of microalbuminuria], resting 12 leads electrocardiography and plain chest X-ray, body weight, height and body surface area [BSA] and finally echocardiographic study. The mean values of left ventricular mass index [LVMI] in different groups were: 74.8 +/- 21.1, 131.9 +/- 43.2, 118.5 +/- 48.2 and 121.0 +/- 26.9 respectively with a highly significant difference [F = 4.72 and P <0.01] between different groups. LVMI was significantly higher in groups II, III, and IV in comparison to group I [P <0.05], also there was a significantly higher value in group II in comparison to both group III and II [P <0.05], there was no significant difference between group III and IV. The mean values of microalbuminuria [UAE] in different groups were: 8.4 +/- 4.0, 73.3 +/- 32.2, 8.4 +/- 4.0 and 150.0 +/- 52.7 mg/L respectively with a highly significant difference [F = 35.88 and P <0.01] between the different groups. Microalbuminuria was significantly higher in both group II and IV in comparison to both group I and III [P <0.05], also there was significantly higher value in group IV in comparison to group 11 [P <0.05], there was no significant difference between group I and III. There was a highly significant positive correlation between microalbuminuria and systolic blood pressure[r=0.678, P < 0.01], there was no significant correlation between microalbuminuria and diastolic blood pressure [r=0.133], Also there was a significant positive correlation between microalbuminuria and both FBS [r-0.201, P < 0.05] and PPBS [r=0.218, P < 0.05]. In correlating microalbuminuria and the lipid profile, we found a significant positive correlation between microalbuminuria and total cholesterol [r=0.443, P < 0.05], a significant negative correlation between micaoalbuminuria and HDL-C [r=-.319, P < 0.05], while there was no significant correlation between microalbuminuria and both triglyceride and LDL-C [r= 0.179 and 0.134 respectively]. There was a significant correlation between LVMI and microalbuminuria in the patients with positive microalbuminuria [r = 0.462, P <0.05]. We concluded that the presence of microalbuminuria related closely to the LVMI in both hypertensive and hypertensive diabetic patients, and its presence associated with various potentially reversible risk factors including systolic hypertension, altered lipid profile and poor glucose control. So, increased attention has been given to the role of microalbuminuria as a cardiovascular risk indicator, particularly in patients with diabetes and hypertension

Prevalence of stress induced myocardial Ischemia in young hypertensive Egyptians

Objective: The present work aimed to study the sensitivity of exercise stress ECG in determining the prevalence of stress induced myocardial ischemia in young hypertensive Egyptian patients

Methods: 100 hypertensive patients with age range between 16-35 years and 20, healthy adult with the same age wee subjected to thorough clinical- examination, resting ECG, chest-x -ray complete echocardiographic study including LV mass index calculation and Doppler study. They also were subjected to laboratory tests to assess their lipid profile. Exercise stress testing according to bounce protocol was done for all subjects

Results: The results showed that five patients out of 40 patients with LVH had ST-segment depression >2mm while no one in patients without LVH, and control group had there changes. There was a significant dyslipidemia in hypertensive patients as compared to control group. There was a significant diastolic dysfunction in hypertensive patient as compared with control group and it was more significantly compared in those with LVH than those without LVH. The HR, blood pressure response to exercise was significantly impaired in hypertensive patients in comparison to control subjects and this response was more significantly impaired in those with LVH as compared with those without LVH

Conclusion: 1. Exercise stress test may be of great value in assessment of young hypertensive patients. 2. Hypertension is usually associated with dyslipidemia. 3. Left ventricular hypertrophy is an important factor in inducing stress ST- segment depression. 4. The hemodynamic response of hypertensive patients was significantly impaired

Diagnostic value of left ventricular atrioventricular plane displacement in assessment of L.V. systolic function

Several echocardiographic indices applied to evaluate LV function may be not reliable when LV contraction is asymmetrical and require good image quality. Determination of the left ventricular atrioventricular plane displacement [AVPD] has several advantages over traditional methods for the evaluation of left ventricular function. This study aimed to evaluate the left ventricular atrioventricular plane displacement as a new index for assessment of left ventricular systolic function, especially in patients with asymmetrical contraction and to correlate these methods with other echocardiographic-derived LV systolic function indices. This study included 60 patients divided into the following groups: Group A included 20 healthy persons as a control group, 16 males and 4 females with a mean age of 38 +/- 2 9.7 years; group B included 20 patients with ischemic heart disease, 17 males and 3 females with a mean age of 53 +/- 6.9 years and group C included 20 patients with dilated cardiomyopathy, 17 males and 3 females with a mean age of 48 +/- 13-20 years. Multip1e echocardiograms were recorded and selected on the basis of clarity. Measurements included left ventricular AVPD, end diastolic diameter [EDD], end systolic diameter [ESD], FS and EF by Teickholtz and Simpson methods. The study found that systolic atrioventricular plane displacement [AVPD] is an effective index for assessment of both segmental and global left ventricular systolic function and that an AVPD > 10 mm correlates with normal left ventricular systolic function [EF > 50%]. So, the AVPD is a rapid, simple, valuable and noninvasive echocardiographic method for evaluation of left ventricular systolic function

Morphofunctional characteristics of the interatrial septum in cardiac diseases transesophageal echocardiographic study

Both the morphology and the functions of the interatrial septum in different clinical situations have been addressed only in a few studies, where the attention has been focused particularly on its congenital abnormalities. Our purpose was to study whether the changes of thickness and thinning of the interatrial septum may be related to the age, left atrial dimension and left ventricular functions. So we studied these changes using the transesophageal echocardiography in [60] patients of four groups of cardiovascular discuses. These groups were: Group I: Ischemic heart disease 20 patients. Group II: Dilated cardiomyopathy 20 patients. Group III: Hypertension with stroke 8 patients. Group IV: Corpulmonale 12 patients. All the patients were subjected to thorough clinical examination, 12 leads resting electrocardiography, chest X-ray postero-anterior view and echocardiography in which we made both transthoracic and esophageal approach for each patients. The interatrial septum thinning was calculated as the difference between the thickness of the IAS at atrial systolic phase and the thickness of the IAS at end-ventricular systolic phase. The value was expressed also as percentage of thinning at the end of ventricylar systolic phase. The IAS thickness increases with the age while there is no significant increase in thinning and thinning percentage. The IAS thickness increases in patients of left ventricular dysfunction e.g. [dilated cardiomyopathy, ischemic heart diseases, and hypertensive patients] also it increases in patients of corpulmonale. There is a negative correlation between the IAS thickness and the left atrial dimension, but there is a positive correlation between the IAS thinning and IAS thinning percentage with the left atrial dimension. Patients with prolonged deceleration time of E and isovolumic relaxation time and decreased E/A with or without lower ejection fraction and fractional shortening had less IAS thinning%. On the other hand, patients with shorter deceleration time of E and isovolumic relaxation time and increased E/A with or without lower ejection fraction and fractional shortening had a comparable IAS thinning%.

Optimal criteria for coronary artery disease evaluation by dobutamine stress echocardiography

The diagnosis of coronary artery disease [CAD] on the basis of inducible wall motion abnormalities [WMA] as well as Doppler-derived indices rather than WMA alone was suggested to improve specificity of dobutamine stress echocardiography [DSE]. This study aimed to find out the impact of using these criteria together on accuracy and sensitivity of high dose [DSE] test in the evaluation of CAD. Thirty patients with chronic stable angina or old MI were classified according to the results of coronary angiography into two groups: Group I included 17 patients with a significant CAD and Group II included 13 patients with normal coronaries. The studied groups were well matched regarding basal characteristics