Changes in early and late diastolic filling pattern in patients with B-thalassemia major before and after captopril therapy

Diastolic left ventricular function has been assessed by echo- Doppler examination in 23 patients [mean age = 11.6 years] with B- thalassemia major. The results were compared with those obtained from 10 normal age-matched control individuals. Parameters showed statistically significant difference between patients and controls were peak flow velocity in late diastole [A], ratio of peak flow velocity in early to late diastole [E/A], isovolumic relaxation time [IVRT], left atrial [LA] and aortic root [Ao] dimensions, left ventricular posterior wall thickness in diastole [LPWdiast], interventricular septal thickness [IVS], left ventricular end diastolic [LVEDD] and end systolic [LVESD] dimensions. Captopril [Capoten], an angiotensin converting enzyme inhibitor, was given to these patients in the therapeutic dose [0.5-1 mg/kg body weight/24 hours]. A follow up study was done for 15 patients after 10-30 days [intermediate study]. The effect of captopril appeared in the form of decrease of A wave with an increase of E/A ratio, which probably suggest improved myocardial diastolic function. Furthermore, left ventricular end diastolic dimension displayed statistically significant decrease

Modification of frequency and severity of myocardial ischemia during hemodialysis by transdermal application of nitroglycerine in patients with end stage renal disease

Previous reports demonstrated that hemodialysis [HD] may predisprose to myocardial ischemia by simultaneous interplay of hypotension, hypovolemia, hypoxia and tachycardia. 12 patients were studied with coronary heart disease [CHD] and end stage renal disease [ESRD] by ambulatory ECG recording HD both before and after transdermal application of 5 mg nitroglycerine [NG] patches [Nitroderm, Ciba]. Application of NG 2 hours before HD resulted in reduction of number of painful ischemic episodes [from 2.25 +/- 1.81 to 1.16 +/- 1.4, p=NS], number of silent ischemic episodes [from 9.08 +/- 7.45 to 1.41 +/- 2.81, p <0.003], maximum ST depression [from 2.08 +/- 0.99 to 0.83 +/- 0.93 m2] p <0.0001], maximum ST elevation [from 1.66 +/- 0.77 to 1.25 +/- 0.62 mm, p=NS], total ischemia time [from 71.9 +/- 92.7 to 11.5 +/- 31.8 minutes, p <0.03], duration of longest ST shift [from 15.6 +/- 15.5 to 5 +/- 0.1 minutes, P <0.03], while there was no difference in mean blood pressure [from 100 +/- 7 to 98 +/- 6 mmHg, p=NS] or mean heart rate from 96 +/- 9 to 92 +/- 10, P=NS]. It was concluded that total ischemic burden [symptomatic and silent episodes] is decreased considerably in patients with CHD and ESRD by application of 5 mg transdermal NG 2 hours before HD without considerable side effects

Resting electrocardiography changes in patients with severe beta thalassemia and chronic iron overload

21 patients with thalassemia major on long term transfusion-chelation therapy and 10 age-matched controls were examined to study the effect of age of the patient, hemoglobin and serum ferritin level, and transfusion load on the resting electocardiographic [ECG] changes in those patients. Results showed that all patients were in sinus rhythm [100%]. 3 patients [14%] had first degree AV block, and 2 patients [9%] had abnormally long QTc interval. Thalassemia children generally had longer QTc interval than controls [p <0.02] which was related to the hemoglobin level [p <0.02]. More leftward QRS axis was related to a large end diastolic volume index [p <0.04] and a high serum ferritin level [p <0.02]. The age of patients and the transfusion did not correlate with any of the ECG parameters. It is concluded that ECG data are insensitive as early markers of cardiac dysfunction in patients with beta-thalassemia