International Cardiovascular Research Journal
Volume:3 Issue: 1, Mar 2009

LVNC is a genetic cardiac disease of emerging importance with a distinct clinical and pathophysiological presentation.The diagnosis of LVNC, however, is often missed, most often as a consequence of ignorance of the condition. Echocardiography is considered the reference standard for the diagnosis of LVNC. Prognosis remains poor for patients with impaired systolic left ventricular function, as treatment options are very limited. Because of the familial association of LVNC, first-degree relatives should be screened by Echocardiography.

To study the occurrence of left ventricular (LV) diastolic asynchrony in patients with systolic heart failure (HF) and its relationship to diastolic function regardless of QRS duration.Recent work has demonstrated that intraventricular asynchrony is a common finding in patients with systolic heart failure. Little attention has been paid to diastolic asynchrony in patients with systolic heart failure. We have therefore decided to determine the extent to which patients with systolic heart failure have evidence of diastolic asynchrony and whether or not diastolic asynchrony is correlated with diastolic dysfunction. Patients and Tissue Doppler echocardiography was performed in 50 HF patients (LV EF=23 ± 8%). Diastolic and systolic asynchrony was determined by tissue synchronization imaging using a 6 basal, 6 mid-segmental model. Systolic and diastolic asynchrony were assessed by the maximal difference in time to peak systolic and early diastolic velocities between any two of 12 LV segments, and the standard deviation of time to peak systolic and early diastolic velocities of the 12 LV segments. The mean ± SD maximal difference in time to peak systolic velocity (controls: 17.2± 9.6 ms versus narrow QRS: 66.7 ± 38.0 ms versus wide QRS: 76.5± 34.6 ms, both P<0.05 versus controls) and in standard deviation of time to peak systolic velocity of 12 LV segments (controls: 15± 6.1 ms versus narrow QRS: 25.9± 15.3 ms versus wide QRS: 28.6±14.4ms, both P<0.05 versus controls) was prolonged in both the narrow and wide QRS groups compared with normal controls. Similarly, the maximal difference in time to peak diastolic velocity (controls: 39± 16.8 ms versus narrow QRS: 73.1± 58ms versus wide QRS: 108.5± 168 ms, both P<0.05 versus controls) and in standard deviation of time to peak early diastolic velocity of 12 LV segments (controls: 15.3±5.8ms versus narrow QRS: 25.1±. 13.8ms versus wide QRS: 25.5± 14.9ms, both P<0.05 versus controls) was prolonged in both the narrow and wide QRS groups. The respective prevalence of systolic and diastolic asynchrony was 31.4% and 20%, in the narrow QRS group, and 40% and 28.6%, in the wide QRS group respectively.Stepwise multiple regression analysis showed that low ejection fraction and low mitral annular early diastolic velocity were independent predictors of both systolic and diastolic asynchrony. QRS complex duration was found to correlate only with diastolic asynchrony. LV systolic and diastolic mechanical asynchrony is common in patients with HF regardless of QRS duration. Selection for cardiac resynchronization treatment should also be based on information about systolic and diastolic synchronicity.

Essential hypertension is characterized by endothelial dysfunction, arterial stiffness, and increased oxidative stress. We evaluated the effect of short-term treatment with the antioxidant vitamin C on blood pressure in essential hypertensive patients. Patients and A total of 50 participants with essential hypertension were evaluated before and after the study. They received 250 mg vitamin C twice daily for one month. Blood pressure, weight and height were measured before and after intervention. Body mass index was calculated and dietary pattern was assessed by using food frequency questionnaire and 24 dietary recalls. We observed a significant decline in both systolic blood pressure (138.1±12.7 vs 134.2±11.5 mmHg, p<0.005) and diastolic blood pressure (87.2±10.1 vs 85±8.8 mmHg, p<0.005) of the participants after one month of vitamin C intake. These effects were independent of patient’s BMI. Our results indicates that daily intake of 500 mg supplementary vitamin C (250mg twice daily) may have beneficial effects on blood pressure and thus reducing the risk of complications.

Little information is available regarding the effects of strenuous exercise on cardiac function. We evaluated the effect of severe prolong exercise on ventricular performance. Army rangers were invited to participate in this study. All patients underwent transthoracic echocardiographyusing tissue Doppler imaging. A total of 45 consecutive male rangers who completed ranger training program were included in this study. Peak systolic myocardial velocity (S) decreased significantly after training (12.46 ± 0.54 vs. 9.93 ± 0.45 cm/s; P< 0.001). In the right ventricle, tissue Doppler measures of systolic and early diastolic function decreased significantly after training. In conclusion, strenuous prolonged exercise may result in depressed left ventricular contractile function.

Non-invasive quantitative analysis of the heart wall thickness is a fundamental step in diagnosis and discrimination of heart disease. Thickness measurements in 2D echocardiographic images have many applicationsin research and clinic for assessment of wall stress, wall thickening and viability parameters. The measurement of interventricular septum wall thickness by conventional manual method is more dependent on sonographer’s experiment.This encouraged researchers to develop a semi-automatic computer algorithm to access interventricular septum segments thickness. Patients and We proposed and developed a computerized algorithm for wall thickness measurements in 2D echocardiographic image frames. In this program, wall thickness measurement is based on intensity profilefunction and adaptive bilateral thresholding operation. For validation, thicknesses of septum base and mid segments were estimated in constituent image frames using proposed technique followed by comparing them with conventional manual results from same images of the cardiac cycle by statistical methods. In our sample image frames (240 corresponding segments; with different range of image quality), a bias of 0.10 mm and 0.12 mm with SD differences of ±0.81 mm and ±0.72 mm and correlation coefficients of 0.87 and 0.89 were found in base and mid segments, respectively. Interobserver variability using the computer-assisted method (CAM) and conventional manual technique (CMM) were 4.0% and 4.7% for the basal and 2.8% and 3.9% for the middle segments. The method introduced in the present study permits precise hickness assessment of base and mid segments of the interventricular septum wall with high concordance with CMM

This study was carried out to appraise the usefulness of second dose thiopental for hemodynamic response to laryngoscopy and intubation.Patients and The present study comprised 120 patients aged 15 to 65 years who were divided into four groups each of 30 patients. Patients in each group were given 2 µg/kg fentanyl iv, 4 mg/kg thiopental for induction of anesthesia, followed by 0.5 mg/kg atracurium for muscle relaxation and a second dose of thiopental (1mg/kg in group I, 2mg/kg in group II) immediately prior to laryngoscopy and intubation, lidocaine 1.5 mg/kg (group III) or normal saline 5 ml (group IV) 2 minutes prior to larygoscopy and intubation. The heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and rate pressure product (RPP) were determined before induction of anaesthesia and laryngoscopy (baseline), and at 1min (T1), 3min(T3), 5min(T5), and 10min (T10) after laryngoscopy and intubation. Our findings demonstrated similar effects of lidocaine and second dose thiopental 2mg/kg on attenuation of DAP, MAP, RPP, and HR changes at 1, 3, and 5 min after endotracheal intubation (EI). Second dose thiopental can be employed as a substitute for lidocaine in attenuation of cardiovascular response to intubation in patients devoid of ischemic heart disease.

The aim of this study was to determine the clinical course and outcome of coronary artery anomaliesincluding anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) diagnosed by coronary artery angiography (CAA) at our institution. The term coronary artery anomaly refers to a wide range of congenital abnormalities, involving the origin, course and the structure of epicardial coronary arteries. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an extremely rare, but potentially fatal congenital coronary anomaly. Patients and The review included 21280 patients undergoing CAA at Medical Centers of Shiraz University between years 1997 -2006. The hospital records of all patients with diagnosis of ALCAPA reviewed for analysis. Data were expressed as percentages. There were 149 (0.7 %) cases of coronary anomalies, including 9 (6.04%) proven cases of ALCAPA. In ALCAPA group, five patients presented with congestive heart failure (CHF) and a non-specific systolic murmur on examination. Isolated mitral valve regurgitation (MR), cerebrovascular accident due to embolization of a mural thrombus, and chest pain were the main presentations in three patients. Two of the patients were under follow up with presumptive diagnosis of coronary artery fistula. The patients aged between 4 months and 35 years. Surgical correction done for all the patients with ALCAPA by direct reimplantation in 8 patients and Takeuchi technique in one. We had one early hospital mortality in our group. ALCAPA should be considered in differential diagnosis of any patient presenting with dilated cardiomyopathy, CHF, MR or chest pain syndrome. Awareness of such pathology can prevent or decrease the morbidity and mortality of a potentially fatal congenital heart disease.

It has been established that intense emotions can affect the development and course of cardiac arrhythmias. This study sought to convey that a lack of expression of emotion can also have an effect on arrhythmias. A psychotherapist with Idiopathic Ventricular Fibrillation and an Implantable Cardioverter Defibrillator measured his rate of Premature Ventricular Contractions using a Holter monitor during three separate six-week periods and in three domains: A) work days vs. off days, B) a 27 hour work week vs. 22 hour work week, and C) in 5 different modalities including 1) Meeting with department head 2) Individual psychotherapy with patients 3) Group therapy with patients 4) Supervision of residents 5) Personal psychoanalysis. The results showed more than a 3-fold increase of arrhythmogenic activity during the 27-hour work week vs. 22 and a 5-fold increase in arrhythmogenic activity on work days compared to days off. Department Head meetings were found to be most arrhythmogenic and personal psychoanalysis was least. The data suggest that the psychiatrist’s lack of emotional expression in his clinical work has been demonstrated to markedly worsen his arrhythmia. The results also point to the potential ameliorating effects of the therapist’s own psychotherapy.

A 24-year-old man, referred to our center with generalized body edema and hypotension. He had a complex congenital heart disease that finally discharged after konno operation.