Background: The chronic kidney disease (CKD) is a major risk factor for coronary artery disease (CAD) and left ventricle systolic dysfunction. Left ventricular (LV) diastolic dysfunction in CKD patients frequently leads to the development of congestive heart failure. The interaction between diastolic dysfunction (DD) and renal function in subjects with preserved systolic function is not well defined. Objective: Our aim was to investigate whether renal insufficiency (RI) is associated with DD among patients with left ventricular ejection fraction (LVEF) > 50%, and to investigate whether there is a correlation between CKD and DD severity. Methods: Eighty four CKD patients, aged 35-79 were examined by standard echocardiography. Subjects were divided into 4 groups depending on their estimated glomerular filtration rate (eGFR: ml/min/BSA) as follows: group 1 (60-89 ml/min/BSA), group 2 (30-59 ml/min/BSA), group 3 (15-29 ml/min/BSA) and group 4 (less than 15 ml/min/BSA), between 1/2/2014 and 30/4/2015. Glomerular filtration rate (GFR) was estimated using the MDRD formula. Patients with impaired relaxation (grade I) were compared to those with pseudonormal (grade II) or restrictive (grade III-IV) DD. Results: Among 84 patients, 23 had GFR 60-89 ml/min/BSA; 16 had GFR 30-59 ml/min/BSA; and 19 had GFR 15-30 ml/min/BSA and 26 had GFR <15 ml/min/BSA. There was a significant correlation between worsening GFR and degree of diastolic dysfunction (DD) assessed by echo. Overall, 40.4% of the participants were female, 22 (26.1 %) had grade I, & 10 (11.9 %) had grade II, 16 (19%) had grade III and 36 (42.8%) had grade IV diastolic dysfunction. Almost all patients had some degree of diastolic dysfunction. With worsening of renal function, there was worsening of diastolic dysfunction seen. In patients with end stage renal disease many had grade IV diastolic dysfunction as compared to patients with early CKD. Grade I and II DD was commonly seen in group 1 and 2. But grade III and IV DD was commonly seen in group 3 and 4. Conclusion: Worsening renal function was associated with greater degree of diastolic dysfunction and adverse clinical outcomes. Our Study indicated a clear and independent association between RI and DD. The severity of RI also tends to correlate with the severity of DD. And that LV diastolic dysfunction was observed even in patients with early stages of chronic kidney dysfunction.
Introduction:The "awakening" of a contractile myocardium after restoration of blood flow referred to as hibernating myocardium has generated considerable interest with regard to survival advantage following revascularization. Thus, before embarking on revascularization in patients with severe LV dysfunction, it is important to carefully assess presence and extent of viable myocardium. Material and Methods: This is prospective and descriptive study conducted at tertiary care teaching hospital over a period of 1 year. The patients with coronary artery disease and severe LV dysfunction (with EF <35%) underwent nuclear scan (rest gated MIBI) to assess viability. Those patients in whom viability was detected underwent revascularization procedure either PTCA or CABG. The choice of revascularization was dependent on the nature of lesions. Results: At baseline mean EF was 29.24±2.94, wall motion score index was 1.91 ±0.19 Out of 37, 24 had CABG (64%) and only 13 (36 %) patients had PTCA. Mean EF improved from 29.2% from baseline to 31% after 1 month (p=NS). At the end of 6 months EF improved to 34.9% (p<0.01) and after 12 months improved to 38%, again p<0.01. Similarly, WMSI improved from 1.91 from baseline to 1.87 at the end of 6 months (p=NS) and 1.76 at the end of 6months (p<0.01). After 12 months WMSI improved further to 1.67 (p<0.01). PA pressure improvement was non-significant at 1, 6 and 12 months. At baseline 8 had moderate MR, but the end of 1month only 7 were found to have moderate MR. At the end 6 months 2 had moderate MR, but none after 12 months. At baseline 16 had mild MR, at one month 17 and after 6months 16 had mild MR. At the end of 12 months 12 were found to have mild MR. Overall improvement in MR was not found to be significant. Conclusion: Revascularization in patients with severe LV dysfunction and viable myocardium resulted in improvement in EF and WMSI at 6 and 12 months follow up.
Background: High blood pressure has been associated with elevated atherogenic blood lipid fractions. A better understanding of the relation between blood pressure and blood lipids may provide insight into the mechanisms where by hypertension is associated with increased risk of coronary heart disease. Methods: The serum lipid profiles of 100 hypertensive patients was studied and compared with those of healthy controls. The serum lipid profiles (TC, TGL.HDL, VLDL, LDL, TC/ HDL, LDL/HDL ratios) were studied with respect to various clinical profiles like age, sex, type, incidence etc. Study group consisted of patients with hypertension as identified by history, clinical examination, and other relevant examinations. Results: Serum TC, TGL, VLDL, LDL, TC/ HDL, LDL/HDL were significantly elevated in hypertensive group as compared to healthy controls. Serum HDL was low in patients with hypertension as was compared with controls, which was statistically significant. The LDL was raised in obese compared to non-obese patients, which is statistically very significant. TC/ HDL and LDL /HDL were also raised in obese patients which is statistically significant. TC is raised in CVA group, which is statistically highly significant. LDL is raised in CVA group, which is statistically very significant. TC/ HDL and LDL/HDL are raised in CVA group compared to non-CVA group, which is statistically very significant. TC is raised in IHD group, which is statistically significant. LDL is raised in IHD group, which is statistically very significant. LDL/HDL is raised in men, which is statically significant. Conclusion:There is significant alteration of lipid profile in hypertensive patients as compared to controls. Total cholesterol, LDL cholesterol, triglycerides, VLDL, TC/HDL and LDL/HDL ratios are significantly elevated in patients with hypertension. HDL is significantly reduced in hypertensive patients. Hyperlipidemia is seen in majority of cases of hypertension with Type IIa pattern being the most frequent. Mean TC, LDL, TC/HDL, LDL/HDL were higher in obese. Mean TC, LDL, TC/HDL and LDL/HDL ratios are raised in CVA group. Mean TC and LDL are raised in IHD group.
BACKGROUND: Organophosphorus (OP) poisoning is a major public health problem in developing world. OP pesticides inhibit carboxylic esterase enzymes including plasma cholinesterase (PChE). Clinical manifestations following OP poisoning can be associated with the extent of decrease of PChE. This study was designed to investigate the relevance of diastolic function of the heart, severity of diastolic dysfunction and the reversibility of dysfunction in organophosphorus compound poisoning patients in relation to plasma cholinesterase (PChE) levels with the treatment. MATERIALS AND METHODS: 76 patients admitted with organophosphorus compound poisoning were evaluated for diastolic dysfunction by echocardiography. Clinical features and the nature of compound involved were recorded. Severity of diastolic dysfunction was assessed. Cholinesterase levels were assessed. Initially there was worsening of diastolic function. As the treatment progressed, there was improvement in the pattern of diastolic dysfunction with the corresponding improvement in cholinesterase level and clinical improvement. This was a cross-sectional study which was conducted from 1st January 2014 to February 2015. RESULTS: In total, mean age of patients were 31.2 (range: 19-46) years. Majority of patients were females (68.4%), and agricultural workers (75%). Main clinical findings at the time of admission were congested conjunctiva (83%), pin point pupil (89%), lacrimation (78%), vomiting (69%), non-reactive pupil (85%), respiratory distress (65%) and abdominal pain (45%). Mean (SD) PChE at 6 hours post-exposure was 3242.6 IU/L. At presentation, cyanosis, muscle weakness, convulsion, respiratory distress and fasciculation were related to cases with >75%reduction of PChE, while, constricted and nonreactive pupil, lacrimation and congested conjunctivae were related to cases with 50-75% reduction and abdominal pain, dryness of conjunctiva, vomiting and diarrhea were related to <50% reduction. 11.8% of patients had normal diastolic function. 88.1% patients were found to have diastolic dysfunction. 15.7% had grade I diastolic dysfunction which persisted in same level throughout treatment. In 72.3 % patients there was gradual worsening of diastolic function. With the treatment there was gradual improvement in diastolic function from grade III to grade I. At the end of 5 days, 19.7% patients had complete reversal of dysfunction. 68.4% patients had persistent mild dysfunction even at the time of discharge. CONCLUSIONS: Patchy myocardial involvement as a result of direct cardiac toxicity could be one of the factors responsible for cardiac complications. Continuous cardiac monitoring should be undertaken to detect dynamic cardiac changes. These findings can assist health professionals to better evaluate patients' prognosis and improve their treatment plan. KEYWORDS: Organophosphorus compound, Diastolic dysfunction, Plasma cholinesterase (PChE). The replacement of an oxygen atom in the organophosphorus structure by sulfur leads to the formation of organo...
OBJECTIVES:To assess the effect of obesity and hypertension on left ventricular (LV) diastolic function. BACKGROUND: Obese and overweight individuals are at increased risk of heart failure. LV diastolic dysfunction is an asymptomatic condition associated with future heart failure. It is unclear whether obesity and overweight are independently associated with LV diastolic dysfunction. Obesity is associated with heart failure, but an effect of weight, independent of comorbidities, on cardiac structure and function is not well established. Severe prolonged obesity in adults results in increased plasma volume, eccentric LV hypertrophy, and diastolic dysfunction. Obese people are at increased risk for the development of heart failure. METHODS: A total of eighty subjects of either gender, coming from rural background admitted in a tertiary care hospital in South India, were enrolled in this cross sectional case control study. Patients were enrolled from March 2014 to May 2015. The study sample was divided into three groups: normal weight [body mass index (BMI) <25.0], overweight ) and obese (BMI≥30). Diastolic dysfunction in each category of patients was assessed with standard methods. RESULTS: BMI was independently associated with higher E, A, and E/E′, an indicator of LV filling pressure (all p≤0.01). Overweight and obese had lower E′ (both p<0.01) and higher E/E′ (both p<0.01) than normal weight participants. E/A was lower in obese than normal weight subjects (p<0.01). The risk of diastolic dysfunction was significantly higher in overweight and obese compared to normal weight individuals. Hypertensive patients were found to have worse diastolic function as compared to those having normal blood pressure. CONCLUSIONS: Increased BMI was associated with worse LV diastolic function. The increased risk of LV diastolic dysfunction in both overweight and obese individuals may partially account for the increased risk of heart failure associated with both conditions. Overweight subjects without overt heart disease have subclinical changes of LV structure and function. These abnormalities in LV function may have important implications for explaining the myocardial dysfunction that is associated with increased cardiovascular morbidity and mortality caused by obesity. Hypertension adds to the worsening of diastolic dysfunction.
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