Background: QT dispersion (QTd) varies according to heterogeneity of recovery time in the myocardium, and the impact of iron overload on the QTd in adult patients with Sickle Cell Disease (SCD) is not clear. Aim: This...Background: QT dispersion (QTd) varies according to heterogeneity of recovery time in the myocardium, and the impact of iron overload on the QTd in adult patients with Sickle Cell Disease (SCD) is not clear. Aim: This cross-sectional study was designed to evaluate corrected QTc interval and QTd on 12 leads ECG in patients with SCD, and assess the LV systolic and diastolic function using Pulsed Doppler Echocardiogram. Method: All patients were evaluated clinically with pulse Doppler echocardiography. Twelve leads ECG were taken to measure QTd and QTc. Blood samples withdrawn to assess the blood level of ferritin and hemoglobin. Pearson correlation coefficient was used to measure the linear relationship between serum ferritin and QTd. Results: The study included patients with SCD (n = 70, age 15.7 ± 8.9 years), compared with age-matched healthy control group (n = 70, age 15.9 ± 8.9 years). In patients with SCD compared with healthy control group the QTc (msec) 416 ± 23.21 ms vs. 401 ± 24.12 (p = 0.75), and the QTd were slightly longer in SCD compared with the control of 43 ± 22.1 vs. 38 ± 20.16 msec, (p = 0.071) with no significant difference. M mode echo showed that SCD patients compared with control had higher LVMI gm/M2 of 105 ± 10.3 vs. 83 ± 7.1, P = 0.001, larger LV end diastolic dimension (cm) of 5.5 ± 0.32 vs. 4.72 ± 0.35, p = 0.03, RV diameter (cm) of 2.8 ± 0.42 vs. 2.4 ± 0.31, (p = 0.041) and RV wall thickness (mm) of 0.31 ± 0.06 vs. 0.28 ± 0.03, (p = 0.024). Pulsed Doppler showed high LV transmitral E wave velocity of 85.23 ± 1.92 vs. 62.43 ± 1.67 m/s (p = 0.001), A wave (msec) 46.26 ± 4.7 vs. 56.24 ± 3.2 m/s, p = 0.032, with E/A ratio of 1.86 ± 0.01 vs. 1.10 ± 0.03, (p = 0.024) and DT of E wave (msec) of 156.43 ± 23.5 vs. 189.87 ± 19.5, (p = 0.031). Left ventricle ejection fraction percentage was similar between both groups, but SCD had significantly higher right ventricle tricuspid annular plane systolic excursion TAPSE (cm) of 1.23 ± 0.21 vs. 1.11 ± 0.23 cm (p = 0.02), and the tricuspid valve velocity showed significant higher velocity (m/s) in the SCD patients of 2.9 ± 0.14 vs. 1.7 ± 0.09, p = 0.004 indicating higher pulmonary artery pressure with calculated right ventricle systolic pressure of 38.64 vs. 16.56 mmHg. Conclusion: SCD patients compared with control have higher but not significant QT dispersion and corrected QT interval with a significantly larger LV mass and LV diastolic filling indices suggestive of restrictive diastolic pattern. These data indicate that LV diastolic abnormalities compromised initially in patients with SCD.展开更多
Background: Adrenal and parathyroid insufficiency are uncommon in patients with transfusion dependent Beta Thalassemia (β-TM). Further, myocardial echocardiographic abnormalities are recognized but with a variable ou...Background: Adrenal and parathyroid insufficiency are uncommon in patients with transfusion dependent Beta Thalassemia (β-TM). Further, myocardial echocardiographic abnormalities are recognized but with a variable outcomes Aim: The aim is to determine the prevalence of adrenal and parathyroid insufficiency in patient with transfusion dependent β-TM. And to assess left ventricle systolic and diastolic function using Pulsed Doppler (PD) and Tissue Doppler (DT) echocardiogram. Methods:The study was conducted on patients with β-TM (n = 99, age 15.92 ± 8.92 years) and compared with an age-matched controls (n = 98 age 15.79 ± 8.94 years). In all participants echocardiographic indices of M mode and PD and TD were performed. Blood samples were withdrawn for measuring the serum cortisol, parathyroid and Ferritin. Correlation between the level of cortisol and ferritin level was evaluated. Results: Patients with β-TM compared with controls, had significantly thicker LV septal wall index of 0.65 ± 0.26 vs 0.44 ± 0.2190, p 0.001 and LV posterior wall of 0.65 ± 0.235 vs 0.43 ± 0.214, p ± 5.5 vs 5.0 ± 5.6, p = 0.23. Furthermore patients with β-TM had higher E/A ratio (1.54 ± 0.18 vs 1.23 ± 0.17, p 0.01) and shorter deceleration time (DT) (170.53 ± 13.3 vs 210.50 ± 19.20 m sec, p 0.01). The ratio of transmitral E wave velocity to the tissue Doppler E wave at the basal septal mitral annulus (E/Em) was significantly higher in β-TM group (19.68 ± 2.81 vs 13.86 ± 1.41, p 0.05). The tissue Doppler systolic wave (Sm) velocity and the early diastolic wave (Em) were significantly lower in β-TM group compared with controls with Sm, of 4.82 ± 1.2 vs 6.22 ± 2.1 cm/sec, p 0.05 and (Em) of 3.51 ± 2.7 vs 4.12 ± 2.5 cm/sec p 0.05, respectively). The tricuspid valve velocity was significantly higher in β-TM patients compared with controls (2.85 ± 0.56 vs 1.743 ± 0.47 m/sec, respectively, p 0.01). The prevalence of adrenal insufficiency in patients with β-TM was 16%, hypoparathyroidism of 4.5% weak negative correlation between serum level of cortisol and the serum Ferritin. Conclusion: Patients with β-thalassemia major had a high prevalence of subclinical adrenal insufficiency of 16%, hypoparathyroidism of 4.5% with weak negative correlation between the low level of cortisol ≤160 nmol/L and high serum ferritin. Echocardiographic Pulsed Doppler showed a restrictive LV diastolic pattern suggestive of advanced diastolic dysfunction but preserved left ventricle systolic function.展开更多
Background: Heart failure (HF) is a common clinical syndrome mostly due to the impaired ability of the Left Ventricle (LV) to eject blood with reduced cardiac output. Heart failure is called systolic (SHF) if left ven...Background: Heart failure (HF) is a common clinical syndrome mostly due to the impaired ability of the Left Ventricle (LV) to eject blood with reduced cardiac output. Heart failure is called systolic (SHF) if left ventricle ejection fraction on echo-cardiogram is low (LVEF of ≤50%). Aim: To assess the echocardiographic characteristics of patients with SHF with Atrial Fibrillation (AF) and compare with those with Sinus Rhythm (SR) on 12 leads ECG. Furthermore, to evaluate the clinical and biochemical markers for the prediction of AF in SHF. Method: Over two years duration, each patient diagnosed with SHF was enrolled in the study (n = 354) based on admission code. AF or sinus rhythm on 12 leads ECG was documented on each patient. Multiple logistic regression analysis was applied to assess the risk ratio of different clinical and Doppler derived variables for the development of AF in SHF. Results: Out of the total hospital medical admissions of 14,674 patients, there were 354 patients with diagnosis of SHF, a prevalence of 2.4%. The incidence of AF on ECG was 109 (31%) patients in the whole study population and 245 (69%) in SR. M Mode echocardiogram in patients with SHF and AF compared with those in SR showed significant dilation of LV cavity in systole with LVESD of 5.72 ± 0.63 vs. 5.23 ± 0.76 cm, P < 0.001 and in Diastole LVEDD of 6.83 ± 0.51 vs. 6.58 ± 0.63 cm, P < 0.001. Pulsed Doppler echocardiogram showed a severe restrictive-pattern with shorter Decellration Time (DT) of 163.73 ± 7.42 vs. 214.9 ± 31.81msec, P < 0.001 and higher Pulse to Tissue Doppler ratio of E/Em of 14.26 ± 1.34 vs. 9.99 ± 1.27, P , and the serum level of Brain Natriuretic Peptide (BNP) hormone of 723.72 ± 13.45 vs. 686.98 ± 72.57 pg/ml, P < 0.001. The predictive risks (odd ratio) of different clinical variables for the development of AF in SHF were positive for high BNP > 500 pg/ml of 2.8, history of hypertension of 1.8, history of DM of 1.7, BMI > 28 of 1.4, LV hypertrophy on ECG of 1.3. Conclusions: The prevalence of Systolic Heart Failure in the study population was 2.4%. The prevalence of AF in the study population was 31%. The best predictors of AF in SHF were high BNP > 500 pg/ml, history of hypertension, Diabete Mellitus and LV Hypertrophy on ECG.展开更多
文摘Background: QT dispersion (QTd) varies according to heterogeneity of recovery time in the myocardium, and the impact of iron overload on the QTd in adult patients with Sickle Cell Disease (SCD) is not clear. Aim: This cross-sectional study was designed to evaluate corrected QTc interval and QTd on 12 leads ECG in patients with SCD, and assess the LV systolic and diastolic function using Pulsed Doppler Echocardiogram. Method: All patients were evaluated clinically with pulse Doppler echocardiography. Twelve leads ECG were taken to measure QTd and QTc. Blood samples withdrawn to assess the blood level of ferritin and hemoglobin. Pearson correlation coefficient was used to measure the linear relationship between serum ferritin and QTd. Results: The study included patients with SCD (n = 70, age 15.7 ± 8.9 years), compared with age-matched healthy control group (n = 70, age 15.9 ± 8.9 years). In patients with SCD compared with healthy control group the QTc (msec) 416 ± 23.21 ms vs. 401 ± 24.12 (p = 0.75), and the QTd were slightly longer in SCD compared with the control of 43 ± 22.1 vs. 38 ± 20.16 msec, (p = 0.071) with no significant difference. M mode echo showed that SCD patients compared with control had higher LVMI gm/M2 of 105 ± 10.3 vs. 83 ± 7.1, P = 0.001, larger LV end diastolic dimension (cm) of 5.5 ± 0.32 vs. 4.72 ± 0.35, p = 0.03, RV diameter (cm) of 2.8 ± 0.42 vs. 2.4 ± 0.31, (p = 0.041) and RV wall thickness (mm) of 0.31 ± 0.06 vs. 0.28 ± 0.03, (p = 0.024). Pulsed Doppler showed high LV transmitral E wave velocity of 85.23 ± 1.92 vs. 62.43 ± 1.67 m/s (p = 0.001), A wave (msec) 46.26 ± 4.7 vs. 56.24 ± 3.2 m/s, p = 0.032, with E/A ratio of 1.86 ± 0.01 vs. 1.10 ± 0.03, (p = 0.024) and DT of E wave (msec) of 156.43 ± 23.5 vs. 189.87 ± 19.5, (p = 0.031). Left ventricle ejection fraction percentage was similar between both groups, but SCD had significantly higher right ventricle tricuspid annular plane systolic excursion TAPSE (cm) of 1.23 ± 0.21 vs. 1.11 ± 0.23 cm (p = 0.02), and the tricuspid valve velocity showed significant higher velocity (m/s) in the SCD patients of 2.9 ± 0.14 vs. 1.7 ± 0.09, p = 0.004 indicating higher pulmonary artery pressure with calculated right ventricle systolic pressure of 38.64 vs. 16.56 mmHg. Conclusion: SCD patients compared with control have higher but not significant QT dispersion and corrected QT interval with a significantly larger LV mass and LV diastolic filling indices suggestive of restrictive diastolic pattern. These data indicate that LV diastolic abnormalities compromised initially in patients with SCD.
文摘Background: Adrenal and parathyroid insufficiency are uncommon in patients with transfusion dependent Beta Thalassemia (β-TM). Further, myocardial echocardiographic abnormalities are recognized but with a variable outcomes Aim: The aim is to determine the prevalence of adrenal and parathyroid insufficiency in patient with transfusion dependent β-TM. And to assess left ventricle systolic and diastolic function using Pulsed Doppler (PD) and Tissue Doppler (DT) echocardiogram. Methods:The study was conducted on patients with β-TM (n = 99, age 15.92 ± 8.92 years) and compared with an age-matched controls (n = 98 age 15.79 ± 8.94 years). In all participants echocardiographic indices of M mode and PD and TD were performed. Blood samples were withdrawn for measuring the serum cortisol, parathyroid and Ferritin. Correlation between the level of cortisol and ferritin level was evaluated. Results: Patients with β-TM compared with controls, had significantly thicker LV septal wall index of 0.65 ± 0.26 vs 0.44 ± 0.2190, p 0.001 and LV posterior wall of 0.65 ± 0.235 vs 0.43 ± 0.214, p ± 5.5 vs 5.0 ± 5.6, p = 0.23. Furthermore patients with β-TM had higher E/A ratio (1.54 ± 0.18 vs 1.23 ± 0.17, p 0.01) and shorter deceleration time (DT) (170.53 ± 13.3 vs 210.50 ± 19.20 m sec, p 0.01). The ratio of transmitral E wave velocity to the tissue Doppler E wave at the basal septal mitral annulus (E/Em) was significantly higher in β-TM group (19.68 ± 2.81 vs 13.86 ± 1.41, p 0.05). The tissue Doppler systolic wave (Sm) velocity and the early diastolic wave (Em) were significantly lower in β-TM group compared with controls with Sm, of 4.82 ± 1.2 vs 6.22 ± 2.1 cm/sec, p 0.05 and (Em) of 3.51 ± 2.7 vs 4.12 ± 2.5 cm/sec p 0.05, respectively). The tricuspid valve velocity was significantly higher in β-TM patients compared with controls (2.85 ± 0.56 vs 1.743 ± 0.47 m/sec, respectively, p 0.01). The prevalence of adrenal insufficiency in patients with β-TM was 16%, hypoparathyroidism of 4.5% weak negative correlation between serum level of cortisol and the serum Ferritin. Conclusion: Patients with β-thalassemia major had a high prevalence of subclinical adrenal insufficiency of 16%, hypoparathyroidism of 4.5% with weak negative correlation between the low level of cortisol ≤160 nmol/L and high serum ferritin. Echocardiographic Pulsed Doppler showed a restrictive LV diastolic pattern suggestive of advanced diastolic dysfunction but preserved left ventricle systolic function.
文摘Background: Heart failure (HF) is a common clinical syndrome mostly due to the impaired ability of the Left Ventricle (LV) to eject blood with reduced cardiac output. Heart failure is called systolic (SHF) if left ventricle ejection fraction on echo-cardiogram is low (LVEF of ≤50%). Aim: To assess the echocardiographic characteristics of patients with SHF with Atrial Fibrillation (AF) and compare with those with Sinus Rhythm (SR) on 12 leads ECG. Furthermore, to evaluate the clinical and biochemical markers for the prediction of AF in SHF. Method: Over two years duration, each patient diagnosed with SHF was enrolled in the study (n = 354) based on admission code. AF or sinus rhythm on 12 leads ECG was documented on each patient. Multiple logistic regression analysis was applied to assess the risk ratio of different clinical and Doppler derived variables for the development of AF in SHF. Results: Out of the total hospital medical admissions of 14,674 patients, there were 354 patients with diagnosis of SHF, a prevalence of 2.4%. The incidence of AF on ECG was 109 (31%) patients in the whole study population and 245 (69%) in SR. M Mode echocardiogram in patients with SHF and AF compared with those in SR showed significant dilation of LV cavity in systole with LVESD of 5.72 ± 0.63 vs. 5.23 ± 0.76 cm, P < 0.001 and in Diastole LVEDD of 6.83 ± 0.51 vs. 6.58 ± 0.63 cm, P < 0.001. Pulsed Doppler echocardiogram showed a severe restrictive-pattern with shorter Decellration Time (DT) of 163.73 ± 7.42 vs. 214.9 ± 31.81msec, P < 0.001 and higher Pulse to Tissue Doppler ratio of E/Em of 14.26 ± 1.34 vs. 9.99 ± 1.27, P , and the serum level of Brain Natriuretic Peptide (BNP) hormone of 723.72 ± 13.45 vs. 686.98 ± 72.57 pg/ml, P < 0.001. The predictive risks (odd ratio) of different clinical variables for the development of AF in SHF were positive for high BNP > 500 pg/ml of 2.8, history of hypertension of 1.8, history of DM of 1.7, BMI > 28 of 1.4, LV hypertrophy on ECG of 1.3. Conclusions: The prevalence of Systolic Heart Failure in the study population was 2.4%. The prevalence of AF in the study population was 31%. The best predictors of AF in SHF were high BNP > 500 pg/ml, history of hypertension, Diabete Mellitus and LV Hypertrophy on ECG.
