جستجوی مقالات مرتبط با کلیدواژه « Ventricular Dysfunction » در نشریات گروه « پزشکی »

Subclinical left ventricular dysfunction is an important predictor of cardiovascular death, detected via the global longitudinal strain (GLS) echocardiographic parameter. While T2DM is associated with a worse GLS, it is not cost-effective to perform 2D speckle tracking echocardiography for all asymptomatic T2DM patients to screen for early signs of subclinical left ventricular dysfunction.

We aimed to investigate the association of possible risk factors with subclinical left ventricular dysfunction assessed by 2D speckle tracking echocardiography in T2DM patients with normal ejection fraction, excluding patients with comorbidities associated with left ventricular dysfunction such as hypertension or any cardiovascular disease.

This cross-sectional study involved patients aged >18 with type 2 diabetes mellitus (T2DM) and EF ≥ 50% referred to Shohada-e-Tajrish Hospital, Tehran, Iran, from May 2, 2023, to June 21, 2023. Patients with any history or signs and symptoms of heart disease and hypertension were excluded. The correlation of GLS with age, BMI, duration of diabetes, systolic (SBP) and diastolic blood pressure (DBP), and laboratory parameters was assessed using Pearson’s correlation test, with P < 0.05 denoting significance.

In this cross-sectional study, 118 patients consisting of 70 women (59.32%) and 48 men (40.68%) with T2DM were enrolled. The mean age of the participants was 49.61 ± 5.10 years. The mean GLS was -16.71 ± 2.14%. The GLS correlated positively with BMI (P = 0.038 and r = 0.197), SBP (P = 0.003 and r = 0.268), DBP (P = 0.023 and r = 0.209), homocysteine (P = 0.001 and r = 0.310), HbA1C (P = 0.046 and r = 0.184), LDL (P = 0.034 and r = 0.203), and TG (P < 0.001 and r = 0.375), and negatively with GFR (P < 0.001 and r = -0.363).

BMI, SBP, DBP, homocysteine, HbA1C, LDL, TG, and GFR correlated with subclinical left ventricular dysfunction assessed by GLS in patients with T2DM; these markers may offer value in selecting T2DM patients for cost-effective 2D speckle tracking echocardiography screening of subclinical left ventricular dysfunction.

Significant cardiac sequelae may be considered as one of the principal causes of death in COVID-19 individuals; however, very few publications are available that address these complications and their treatment strategies in the pediatric age group.

A 4-month-old male infant was admitted to the PICU with sudden tachycardia, tachypnea and low oxygen saturation after surgery. Laboratory tests and echocardiography revealed elevated troponin-I (Trop I) levels and myocardial dyskinesia with decreased left ventricular ejection fraction (LVEF= 50%) and pulmonary hypertension (30 mmHg) consistent with cardiac injury. In spite of a normal chest x-ray, Chest CT-Scan disclosed ground glass opacities in the periphery of the left lower lobe indicative of viral infection. The patient fulfilled the diagnostic criteria of the Chinese expert consensus statement for clinical myocarditis. Viral tests for COVID-19 obtained on the first day of admission were found positive a few days later. The patient successfully recovered clinically after receiving anti-failure therapy and IVIG. Trop I level reduced to 0.10 g/L and the LVEF eventually recovered to 68%.

COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. Myocarditis in this patient can be treated without antiviral drugs and only needing supportive therapies.

The antiepileptic Valproic acid (VPA) changes the oxidative/ anti-oxidative balance that results in oxidative stress and maybe an increased risk of cardiac dysfunction. The aim of this study was to investigate the effect of VPA on ventricular function in epileptic children. We designed a study to evaluate ventricular function in epileptic children who had received VPA for at least one year. All subjects were evaluated using standard echocardiography, pulsed wave Doppler (PWD), and tissue Doppler imaging (TDI). This study consisted of 60 patients with epilepsy (mean age 10.30±3.21 years) and 60 healthy subjects in the control group (mean age 10.28±3.18 years). The duration of antiepilepsy medication ranged from 1.4 to 10 years, and the dose of VPA was 5-30 mg/kg. The ejection fraction and fractional shortening (P=0.841 and 0.064, respectively) were not significantly different between the two groups. The present study reports subclinical right and left ventricular systolic and diastolic dysfunction along with longitudinal ventricular motion disorder. It is recommended the evaluation of subclinical cardiac dysfunction in children treated by VPA.

Ankylosing spondylitis (AS) is a chronic inflammatory condition associated with more cardiac manifestations than those in the normal population. In this study, we sought to determine the prevalence of cardiac involvement in patients suffering from AS without cardiovascular risk factors.

The present case-control study, conducted in 2 university hospitals in Tehran from January 2016 to December 2017, recruited 67 patients with AS and 40 age- and sex-matched healthy controls. The diagnosis of AS was based on the classification criteria of the Assessment of SpondyloArthritis International Society. All the participants were examined using transthoracic echocardiography and a standard 12-lead ECG. Baseline characteristics, echocardiographic findings, and ECG features were compared between the AS and control groups using univariate analyses. 

The median age was 33.5 (IQR25-75%: 20.5–59) years in the AS group and 35 (IQR25-75%: 26–59) years in the control group (P=0.301). The number of patients with left ventricular systolic and diastolic dysfunction was significantly higher in the patients with AS than in the controls (7.5% vs. 20.9%; P=0.067, and 22.9% vs. 5.0%; P=0.026, respectively). The number of individuals with a left-axis deviation and a left anterior fascicular block was significantly higher in the patients suffering from AS than in the control group. The number of patients with aortic valve involvement was comparable between the groups (P=0.332).  

The most common cardiac involvement in our patients with AS was left ventricular dysfunction, followed by rhythm disturbances and aortic valve insufficiency. These findings were independent of age, AS severity, and disease duration. Therefore, the implementation of cardiovascular screening can be recommended for patients with AS.

Regarding the progress in surgeries, the mortality rate of coronary artery bypass grafting surgery is still low, despite advanced age and comorbidities. One of the independent causes of mortality rate is low ejection fraction (EF). This study aimed to assess mortality after coronary artery bypass grafting (CABG) operation in patients with ejection fraction under 30%. In the present study the experience of 20 patients with an EFbelow 30% and 20 patients with an EF above 30% was investigated in Birjand in which only three of the patients died within 2 years after the operation. This crross-sectional descriptive study was conducted on 40 patients in Birjand Vali-e-aser Hospital. Out of the 40 cases, 20 patients had EF below 30% and 20 subjects had EF above 30 %. The files of all the cases undergoing heart surgery with an EF were obtained since 2015 to 2017, and then their demographic features, such as addresses and phone numbers were collected. Afterwards, they were called and their mortality was checked and the data were analyzed with independent-samples t-test. In addition, the ratios were examined in SPSS Software (version 22) and P-value considered higher than 0.05. From 2015 to 2017, the two groups, including 20 patients with EF<30% and 20 patients with EF>30%, undergone CABG surgery in Birjand University of Medical Science, 65% of which were men and 35 % were women with the age range of 64.7 for the cases with EF<30 and 62.5 for the subjects EF>30. One of the patients died with an EF above 30% and two subjects died with EF below 30%. The mortality rate can be reduced with providing appropriate care despite the fact that an EF<30% is an independent cause of mortality and according to the results of the present study which showed three patients died after the CABG operation.

The purpose of this study was to investigate efficacy of high dose vitamin D in improving left ventricular ejection fraction (LVEF) in thalassemia patients with heart failure and vitamin D deficiency. This clinical trial study was conducted on 16 chronically transfused thalassemia patients and ventricular dysfunction with vitamin D deficiency between December and Jun 2018 in Thalassemia clinic, Tabriz Children Hospital. Mean age of the patients was 11.15 ± 3.61 years ranged from 8 to 18 years old. A serum 25-hydroxy vitamin D3 (25-OHD3) level less than 30ng/dl was considered vitamin D deficiency in this study. LVEF less than 55% was indicated as poor pump function. The patients received 50,000 IU of vitamin D3 weekly for 8 weeks. Data on LVEF and serum 25-OHD3 were compared before and after completing the treatment. Moreover, adverse effects were recorded during the study. Means of serum 25-OHD3 levels, before and after the study, were 13.10±5.91ng/ml and 51.03±4.31ng/ml, respectively (p=0.01). Means of LVEF were13.10±5.91% and 50.27±11.93% before and after the study, respectively (p=0.03). Means of serum ferritin levels were 3913±2229 ng/ml (ranged from 1246 to11000ng/ml). Mean of cardiac magnetic resonance imaging (MRI) T2* of the patients was 11.51±5.34ms. Serum parathyroid hormone (PTH) levels of the patients decreased from the beginning of the study to the end of the eighth week (94.28 ± 18.35 vs 43.66 ± 17.31ng/ml) (p=0.03). There was a positive correlation between mean of serum 25-OHD3 level and cardiac MRI T2* parameter at the beginning of the study (r=0.001). There was a positive correlation between in the increase of mean serum 25-OHD3 and LVEF percent at the end of study (r=0.001). Results showed that vitamin D3 was effective and safe in improving LVEF and cardiac dysfunction in transfusion-dependent thalassemia patients with vitamin D deficiency.

We report an unusual visceral complication of intra-aortic balloon pump (IABP) due to the malpositioning of the catheter in the aorta.
CASE REPORT: A 55-year-old man with severe left ventricular dysfunction underwent coronary artery bypass grafting (CABG) with the preoperative use of an intra-aortic balloon pump. Postoperative course was complicated by renal and hepatic failure. The early occurrence of complications during 36 hours after operation exhibited a serious vascular complication. The combination of acute renal and hepatic failure led to the suspension to occlusive effect of intra-aortic balloon pump catheter on ostium of the aforementioned organs. The intra-aortic balloon pump was removed, and urine output immediately restored. Thereafter, daily slop dawn serum levels of aminotransferases were started, and became normal at the 10th day of operation.
This is an exceptional case that shows how intra-aortic balloon pump may be contributed to mechanical aortic side branches obstruction. A high index of suspension is mandatory in the diagnosis of such bizarre complications.

The dramatic increase in the prevalence of metabolic syndrome is associated with more increased cardiovascular morbidity and mortality in this group. Some recent studies suggested that metabolic syndrome is associated with increased risk of subclinical left ventricular (LV) systolic dysfunction. In the present cross-sectional case–control study, the utility of two-dimensional speckle tracking echocardiography (STE) was examined to detect early LV systolic dysfunction in this population.
A total of 75 clinically asymptomatic subjects with LV ejection fraction (LVEF) ≥ 55%, 39 without metabolic syndrome and 36 with metabolic syndrome, matched for gender and age, were enrolled in this case–control study. Metabolic syndrome was diagnosed using the National Cholesterol Education Program/Adult Treatment Panel III criteria. LV systolic function was assessed by STE-derived global and segmental longitudinal strain (εLL).
Global εLL was significantly lower in patients with metabolic syndrome compared with normal population (−18.41 ± 2.20% vs. −21.2 ± 2.1%, P STE-derived longitudinal LV strain (εLL), a marker of subclinical cardiovascular disease, is impaired in asymptomatic individuals with metabolic syndrome and normal LVEF.

N-terminal pro-brain natriuretic peptide (NT-proBNP) is a sensitive biomarker for the detection of asymptomatic left ventricular (LV) dysfunction. Since β-thalassemia major patients suffer from early diastolic dysfunction due to iron deposition of chronic blood transfusion, we tried to evaluate the correlation between the serum NT-proBNP level and the severity of LV diastolic dysfunction determined by echocardiography in these patients.
Fifty β-thalassemia major patients with normal LV systolic function were studied by tissue Doppler echocardiography, and blood samples were taken at the same time to measure the serum NT-proBNP level. Using flow velocity through the mitral valve on the tissue velocity of the mitral annulus in early ventricular filling (E/E') as an LV diastolic function indicator, the patients were divided into 3 groups: group 1) no diastolic dysfunction (E/E' 15). Other variables assessed included sex, age, method of chelator therapy, and mean hemoglobin and ferritin levels for the past 2 years.
According to the echocardiographic findings of all the 50 patients (29 male and 21 female) with an age range of 11-35 years (mean = 17.98 y), 46% were classified in group 1, 54% in group 2, and none in group 3. The NT-proBNP level was 1070 ± 566 ng/mL in group 1 and 974 ± 515 ng/mL in group 2. The t-test showed no significant difference between groups 1 and 2 in the NT-proBNP level (p value = 0.536).
Due to specific conditions in thalassemia major patients, the correlation between the serum NT-proBNP level and the severity of diastolic dysfunction seems to be not meaningful.

Tachycardia-induced cardiomyopathy (TIC) is a ventricular dysfunction secondary to chronic and persistent tachycardia that can regress partially or completely following heart rate normalization. Paroxysmal atrial tachycardia and permanent junctional reciprocating tachycardia are two types of frequent arrhythmias that can cause cardiomyopathy in children..
A 12-year-old child with obesity (body mass index > 26.8) was admitted with fatigue, pallor and tachypnea to the clinic. He had palpitation for the past 24 hours. On the cardiac auscultation, holosystolic 2/6 murmur was heard in the apex as well as gallop rhythm. Electrocardiogram revealed heart rate of 150 - 160 bpm and negative P waves in II, III and AVF leads. The echocardiography revealed dilated cardiomyopathy with an ejection fraction of 30%..
Diagnosis of tachycardia-induced cardiomyopathy in children is important, since appropriate treatment improves the prognosis. Every child with recurrent and persistent palpitation with the first episode of congestive heart failure should be evaluated for tachycardia- induced cardiomyopathy..

The prevalence of patients with severe left ventricular dysfunction (LVD) referred for coronary artery bypass grafting (CABG) is increasing. Preoperative LVD is an established risk factor for early and late mortality after revascularization. The aim of the present study was to assess the early outcome of patients with severe LVD undergoing CABG.
Between December 2012 and November 2014, 145 consecutive patients with severely impaired LV function (ejection fraction ≤ 30%) undergoing either on-pump or off-pump CABG were enrolled. The primary end point was all-cause mortality. Different variables (preoperative, intraoperative, and postoperative) were evaluated and compared.
The mean age of the patients was 58.7 years (range, 34 to 87 years), and 82.8% of the patients were male. The mean preoperative LV ejection fraction was 25.33 ± 5.07% (10 to 30%), which improved to 26.67 ± 5.38% (10 to 40%) (p value CABG in patients with severe LVD can be performed with low mortality. CABG can be considered a safe and effective therapy for patients with a low ejection fraction who have ischemic heart disease and predominance of tissue viability.

Takotsubo cardiomypathy is a very rare cardiovascular syndrome leading to myocardial infarction and left ventricular dysfunction in the absence of a detectable coronary artery lesion. It is accepted as reversible left ventricular asynergy occuring typically after an intrinsic adrenergic hyperstimulation. In this report we present Takotsubo cardiomyopathy in a 75-year-old patient with multiple autoimmune disorders..