Effect of bone marrow transplantation on diastolic function indices.

INTRODUCTION: High-dose chemotherapy and bone marrow transplantation result in direct and indirect changes in cardiac function. the finding suggests a decreased left ventricular diastolic compliance after high-dose cyclophosphamide treatment, but the effects of bone marrow transplantation (BMT) on cardiac diastolic function are less studied. We aimed to evaluate changes before and after the procedure in cardiac diastolic function in patients undergoing BMT. DESIGN AND METHODS: We designed this study to evaluate the effects of BMT on diastolic cardiac function. Patients with lymphoma (Hodgkin's and non-Hodgkin's), multiple myeloma, and solid tumors who were candidates for autologous BMT were selected for the study. The patients underwent a cardiac consultation and echocardiography before their admission for BMT. E-wave velocity and time to relaxation by tissue Doppler echocardiography in the septal, lateral, anterior, inferior, anteroseptal, and posterior wall; and the E-wave velocity of the right ventricle (RV) were measured before and after BMT. RESULT: Thirty patients fulfilled our inclusion criteria and entered the study. The mean diastolic function measures were calculated before and after BMT. E-wave velocity in the septal, lateral, anterior, inferior, anteroseptal and posterior walls after transplantation decreased by 19.2% (p=0.008), 14.5% (p=0.008), 22.19% (p=0.3), 18.9% (p<0.001), 21.9% (p=0.01), and 7.5% (p=0.01), respectively. The time to relaxation decreased by 13.5%, 13.7%, 12.4%, 11.4%, 11.1%, and 13.1%, respectively, after transplantation (p<0.001). E-wave velocity of RV decreased 15.6% after BMT (p=0.02). CONCLUSION: Data regarding alterations in diastolic functioning after BMT are scarce. This study suggests that diastolic function alters after BMT.

Correlation between anterior mitral leaflet concavity area and ischemic induced mitral regurgitation severity by echocardiography.

Functional mitral regurgitation (MR) results from left ventricular remodeling, leaflet tethering or tenting. Coronary artery disease is one of the important causes of functional MR due to tethering. Detection of functional MR and its severity are important factors in patient prognosis. There are different methods for detection of functional MR and its severity, including anterior mitral leaflet concavity area (AMLCA). In this cross sectional study 32 patients, 19 male with three vessel disease (3VD) who were candidate for coronary artery bypass grafting (CABG) with or without mitral valve replacement were selected. The patients had functional MR in ventriculography. AMLCA was determined by long axis view of transthorasic echocardiography (TTE). In this study 32 patients with 3VD and MR were selected (15 mild, 15 moderate and 2 cases with severe MR). The mean age was 62 ± 12 years. In these patients AMLCA were 0.1- 0.43 cm2 in transthorasic echocardiography. The findings of this study showed strong association between anterior mitral leaflet concavity area and functional MR severity (r=0.89) in parasternal long axis (LAX) view of TTE. According to these findings the relation between functional MR and AMLCA was a linear relationship and increase in severity of functional MR was in concordance with increasing of anterior mitral leaflet concavity area (P=0.001). Mitral leaflet concavity area in the parasternal LAX view provides rapid and reliable recognition of functional MR due to coronary artery disease and is quantitatively related to the degree of such MR. We recommend further study with more subjects and ischemic functional MR and AMLCA.

Effect of taurine supplementation on exercise capacity of patients with heart failure.

BACKGROUND: Taurine (2-aminoethanesulfonic acid) is a semi-essential amino acid found in mammalian tissues that is not involved in protein synthesis. The function of taurine is not completely understood. Some studies have demonstrated that taurine supplementation reduces death rate in rabbits with heart failure (HF) and diminishes HF severity in human models of congestive HF. In this study we have evaluated the effect of taurine supplementation on exercise capacity of patients with HF. METHODS: A randomized single-blind placebo-controlled clinical trial was conducted on 29 patients with HF with left ventricular ejection fraction (LVEF) less than 50% who were in functional class II or III according to New York Heart Association classification. A total of 15 patients received taurine supplementation 500 mg three times a day while the remaining 14 patients received placebo for 2 weeks. All patients performed exercise tolerance test before and after taurine and placebo supplementation. RESULTS: The mean age of patients was 60.57 ± 6.54 years, they were mostly male (26 of 29), and had mean LVEF of 29.27 ± 6.97%. There were no significant differences in terms of LVEF, body mass index, and also exercise time, metabolic equivalents (METS) and exercise distance before supplementation. Exercise time, METS, and exercise distance increased significantly in patients who received taurine supplement for 2 weeks (p-value<0.0001 for all), but did not increase significantly in patients who received placebo (p-values 0.379, 0.244, and 0.577 respectively). CONCLUSION: Taurine supplementation in patients with HF who are taking standard medical treatment can increase their exercise capacity.