Modification of cardiac function in cirrhotic patients with and without ascites.

OBJECTIVES: Abnormalities in cardiac function have been reported in liver cirrhosis, suggesting a latent cardiomyopathy in these patients. In this study we investigated cardiac function in cirrhotic patients and in controls. METHODS: A total of 20 cirrhotic patients without previous or ongoing ascites, 20 cirrhotic patients with moderate-to-severe ascites, and 10 healthy controls were studied by two-dimensional Doppler echocardiography. Cardiac dimensions and left and right ventricular function were evaluated. The left ventricular geometric pattern was calculated according to Ganau's criteria. Diastolic function was evaluated by the peak filling velocity of E wave and A wave, E/A ratio, and deceleration time of E wave. The pulmonary systolic arterial pressure was also estimated in patients with tricuspid insufficiency. RESULTS: Right and left atrium and right ventricle diameters were significantly enlarged in cirrhotic patients versus controls. E/A ratio was decreased (p < 0.05) in patients with ascites (0.9 +/- 0.2) versus those without ascites (1.3 +/- 0.4) and controls (1.3 +/- 1). The estimated pulmonary systolic arterial pressure was slightly elevated in patients with ascites (35 +/- 5 mm Hg, six patients) versus those with no ascites (28 +/- 5, 10 patients) and controls (27 +/- 8, 6 controls, analysis of variance, p < 0.05). The pattern of left ventricular geometry was normal in the majority of patients. Nitrite and nitrate levels were increased in cirrhotics irrespective of the presence of ascites. CONCLUSIONS: Liver cirrhosis is associated with enlarged right cardiac chambers. Diastolic dysfunction and mild pulmonary hypertension are evident in cirrhotic patients with ascites. These changes do not depend on variations in the left ventricular geometry.

Color-Doppler sonography in ophthalmology.

BACKGROUND: With the present study we considered ocular blood flow by the use of color Doppler ultrasound. We compared the most clinically important arteries of both eyes. We valued the central retinal artery, the posterior long ciliary arteries, the posterior brief ciliary arteries and the central retinal vein. METHODS: We submitted to an ecd examination of the ophthalmic arteries 50 patients, of whom 30 were healthy, 4 presented a pallor of the optic disk, 6 were affected by chronic simple glaucoma and 10 were affected by arterial hypertension. RESULTS: This study has allowed us to define the normal and pathologic anatomic findings at the ecd tracing therefore qualitative and quantitative standards of this examination, repeatable and comparable. CONCLUSIONS: Currently the different techniques used to study ocular blood flow, do not allow its exact detection, but only a morphological evaluation of the eye artero-venous system. Acquisition of morphological and velocimetric data, at the same time, allows a more exact evaluation of the pathology. Therefore the ecd is a simple rapid and non-invasive approach, useful in the acquisition of important data concerning diagnostic confirmation, prognosis, and above all pharmacological follow-up of many pathologies such as diabetes, glaucoma and arterial hypertension. The diagnosed vascular alterations are correlated to the degree retinopathy and to the effectiveness of the pharmacological treatment.