ABSTRACT
Overproduction of thyroid hormones leads to structural as well as functional cardiac changes. Conventional echocardiography but also recently developed sophisticated two-dimensional echocardiography speckle (2D-STE) tracking allow elaborate evaluation of these changes. Our purpose was to investigate the effects of thyroid hormones overproduction on the heart in patients with Graves' disease and changes that occur after 6 months thyrostatic therapy. We conducted a prospective, case-control study of 6 months duration. Full echocardiographic assessment at diagnosis and after 6 months of thyrostatic therapy were performed in 44 patients with Graves' disease, aged 37.6 ± 9.1 years. Additionally, 43 euthyroid controls were studied for the same time period. Left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) were higher in the patient group while triscupid annular plane systolic excursion (TAPSE) was lower in the patient group. Moreover, left ventricular (LV) mass index and left atrium (LA) volume index were higher in the Graves' disease group. Diastolic impairment as assessed with conventional echocardiography including tissue Doppler was present in the patient group (E/A ratio 0.87 ± 0.10,). 2D-STE analysis, revealed an increase in the strain rate at the isovolumic relaxation time (SRIVRT, 0.310 ± 0.07 patients versus 0.298 ± 0.09 s-1 controls). Improvement in diastolic and right systolic function as well as in left ventricular structural parameters was observed after restoration of euthyroidism (E/A ratio from 0.87 ± 0.10 versus 0.9 ± 0.08, p < 0.05). Patients with newly diagnosed Graves' showed an improvement in diastolic function, right systolic function and structural parameters after 6 months of thyrostatic treatment.
Subject(s)
Echocardiography, Doppler/methods , Graves Disease/complications , Hypertrophy, Left Ventricular/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Function, Left , Adult , Antithyroid Agents/therapeutic use , Case-Control Studies , Female , Graves Disease/diagnosis , Graves Disease/drug therapy , Humans , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/physiopathology , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Recovery of Function , Risk Factors , Time Factors , Treatment Outcome , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left/drug effectsABSTRACT
UNLABELLED: The purpose of the study is the predictive value of determination of Tr-T in diagnosis of unstable angina. METHODS: 35 pts (24 male, 11 female, mean age 53.4 +/- 5 years) were studied. Group A: 20 pts (15 male, 5 female, mean age 50 +/- 6 years) with unstable angina. Group B: 15 pts (9 male, 6 female, mean age 56.4 +/- 4 years) with stable angina RESULTS: pts with stable angina (group B) had normal value of CPK-MB, SGOT, LDH, Tr-T. Eight pts with unstable angina (group A) had increased value of Tr-T with normal value of CPK-MB, SGOT, LDH. In conclusion the determination of Tr-T is helpful in diagnosis of unstable angina and it may be useful in the prognosis of these pts.
Subject(s)
Angina, Unstable/diagnosis , Troponin/blood , Biomarkers/blood , Electrocardiography , Female , Humans , Male , Middle Aged , Troponin TABSTRACT
UNLABELLED: The aim of this study is to investigate the effects of HR changes, induced by a variety of causes, on left ventricular performance as assessed by the first derivative of apexcardiogram indices. Ten males, mean age 29.6 +/- 8.1 years, without evidence of heart disease were studied. In all subjects tachycardia was induced by 1) administration of atropine (1 mg bolus IV), 2) administration of isoprenaline (0.5-0.25 micrograms/min IV) and 3) treadmill exercise test according to Bruce protocol. The blood pressure (BP) was determined before and every 60 sec during each test. Drawings of the first derivative of apexcardiogram were obtained before and at the peak of HR and the indices a/b, ef/ZN and b/ef were determined. RESULTS: the increase of HR was similar (about 30% from baseline) in each test. Exercise test caused more pronounced increase of BP compared to the administration of isoprenaline while administration of atropine was not followed by significant changes of BP. Administration of isoprenaline caused similar but more vigorous alterations of the first derivative of apexcardiogram indices (significant increase of b/ef and decrease of a/b and ef/ZN indices) compared with the exercise test. Administration of atropine caused no significant changes of these indices. CONCLUSIONS: in this study it was found that the effects of various causes of tachycardia on LV performance, as assessed by the indices studied, are not uniform; this may reflect different mechanisms involved in the induction of tachycardia by different causes. These results suggest that the alterations of the indices assessed in this study can detect dysfunction(s) of the LV; it is also possible that the type of alteration induced, could provide information regarding causal relationships of this impairment.
