Association between Serum Asymetrical Dimethylarginine Level and Cardiac Functions in Chronic kidney Disease Patients

Background Chronic kidney disease (CKD) is a major public health problem worldwide and is associated with a considerable increase in morbidity and mortality, cardiovascular disease is most common cause of death among chronic kidney disease patients. Objectives The aim of study was to determine the association between serum ADMA level and cardiac functions assessed by tissue Doppler imaging in chronic kidney disease patients. Patients and Methods our study conducted on 90 patients from outpatient clinic or inpatient department of national institute of nephrology and urology. Results All patients were subjected to full history, full clinical examination, laboratory investigations including: serum urea, serum albumin, complete blood picture, serum electrolytes (calcium and phosphorus), PTH, serum ADMA, lipid profile and echocardiography and Tissue Doppler imaging. Conclusion Serum ADMA is negatively correlated with diastolic function among CKD patients, tissue Doppler imaging is more accurate than echocardiography to estimate diastolic function.

Prevalence of Left Ventricular Diastolic Dysfunction by Tissue Doppler Imaging in Patients with End Stage Renal Disease undergoing Regular Dialysis with Preserved Systolic Function

Background Left ventricular hypertrophy (LVH) is the principal myocardial alteration in patients with ESRD due to multiple preload and afterload factors related to hemodialysis leading to left ventricular diastolic dysfunction manifested by signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The use of echocardiography and tissue Doppler imaging is essential to detect diastolic dysfunction in ESRD patients undergoing hemodialysis as the prevalence of diagnosing HFpEF in ESRD patients is under-estimated. Objective To evaluate the possible impact of renal replacement therapy in the form of regular dialysis provided to end stage renal disease patients on left ventricular diastolic function by implementing tissue doppler imaging. Patients and Methods The study included 100 ESRD patients on regular dialysis presenting to the dialysis unit in Ain Shams University Hospitals. The inclusion criterion was end stage renal disease patients with GFR < 15 ml/min/1.73 m2 on regular dialysis for more than 6 months. Excluded patients were those above than 80 yrs old, with hemodynamic instability, arrhythmias, valvular diseases, ischemic conditions, and LV systolic dysfunction. After the hemodialysis session, ECG gated echocardiography was done applying pulsed wave Doppler on mitral valve to detect E/A ratio, continuous wave Doppler on tricuspid valve to calculate TR vmax, and tissue Doppler on lateral mitral annulus to detect e’ and E/e’ ratio. Moreover, left atrial volume index (LAVI) and other standard echocardiographic parameters were measured. Full history and clinical examination including ECG recording was done and blood samples were taken to measure hemoglobin levels. Patients were then stratified according to their diastolic dysfunction grading. Results Seventy eight percent (78%) of the patients showed diastolic dysfunction including 46 % showed grade I diastolic dysfunction, 26 % showed grade II diastolic dysfunction and 6% showed grade III diastolic dysfunction. Hemoglobin levels showed significant negative correlation with E, E/A, E/E’, LAVI and TR Vmax (r = -0.25, -0.37, -0.29, -0.23 and -0.31 with p 0.012, <0 .001, < 0.003, 0.002 & <0 .001 respectively). Multiple regression analysis revealed smoking, DM, Hb, LVPWd, EF, E/A, LAVI and TR Vmax presented the important determinants of diastolic filling (β = -0.16, 0.15, -0.20, -0.27, -0.25, 0.16, 0.39 & 0.27 and p = 0.002, 0.045, < 0.001, 0.022, < 0.001, 0.039, < 0.001 & < 0.001 respectively). Comparing E/A ratio with E/e’ ratio sensitivities revealed E/A ratio was 28.2% while E/e’ ratio was 74.3%. This was statistically significant showing a difference between the two modalities (χ2 = 33.2526 and p = < 0 .0001). Conclusion In ESRD patients, maladaptive events leading to LVH and diastolic dysfunction occur frequently. Thus, early identification and treatment of factors involved in order to prevent this devastating process. Now it seems that TDI and E, E/A and E/E’ parameters are good instruments for the early detection of LVH and diastolic dysfunction as they are important risk factors for cardiovascular morbidity and mortality in CKD. In comparison with the conventional Doppler techniques, tissue Doppler is a vital tool in diagnosing diastolic dysfunction.

Association between Serum 25-Hydroxyvitamin D Level and Cardiac Functions in Chronic kidney Disease Patients

Background Chronic kidney disease (CKD) is a major public health problem worldwide and is associated with a considerable increase in morbidity and mortality, cardiovascular disease is most common cause of death among chronic kidney disease patients. There is an increasing interest in using vitamin D levels as a novel marker for CVD, because epidemiological data have shown a strong correlation between the risk of CVD and vitamin D deficiency. Objectives The aim of study was to determine the association between serum vitamin D level and cardiac functions assessed by tissue Doppler imaging in chronic kidney disease patients. Patients and Methods Our study conducted on 90 patients from outpatient clinic or inpatient department of national institute of nephrology and urology. All patients were subjected to full history, full clinical examination, laboratory investigations including: serum urea, serum albumin, complete blood picture, serum electrolytes (calcium and phosphorus), PTH, serum vitamin D, lipid profile and echocardiography and Tissue Doppler imaging. Conclusion Serum vitamin D is positively correlated with diastolic function among CKD patients, increased incidence of left ventricular hypertrophy in CKD patients especially with vitamin D deficiency, Tissue Doppler imaging is more accurate than echocardiography to estimate diastolic function.

TO STUDY RIGHT VENTRICLE (RV) AND LEFT VENTRICLE ( LV) DYSFUNCTION IN TRANSFUSION DEPENDENT BETA THALASSEMIA CHILDREN AT TERTIARY CARE HOSPITAL IN NORTH WEST RAJASTHAN

Background- Regular blood transfusions used for long term survival in ß-thalassemia major patients cause a secondary state of tissue iron overload. Myocardial iron deposition can result in cardiomyopathy, and heart failure remains the leading cause of death. This study was planned to see the Right Ventricle (RV) and Left Ventricle(LV)dysfunction in beta thalassemia transfused patients. Method- Patients of ß thalassemia major above 2 years of age received regular blood transfusions at least for 1 year duration, attending OPD in the Department of Pediatrics, S P Medical College, Bikaner were included.Echo was correlated with serum ferritin Level(SFL). Results- Tissue Doppler imaging(TDI) parameters of 50 patients at mitral annulus e.g. Em septal, Em Lateral, Am septal, Am lateral, Sm Septal and Sm Lateral were abnormal(<2SD and >2SD)in 70% & 0%, 50% & 4%, 10% & 46%, 34% & 24%, 40% & 22% and 60% & 10% patients respectively.TDI parameters at tricuspid valvee.g. Et, At and St were abnormal(<2SD)in 98%, 96% and 98% patients respectively. The differences in mean values of Et, At and St, when compared in the SFL groups <2500,2500-5000 and>5000, was non significant(p>0.05). Conclusion- TDI is superior to conventional echocardiography in giving an early evidence of diastolic myocardial dysfunction in asymtopmatic and normal LV function patients.TDI can be applied as an integrated part of assessment of children & adolescents with ß-thalassemia. Septal Sm, Em & lateral Em, Sm, Am and RV Et, At, St were reduced early in majority of patients. Our study showed early involvement of septum and RV in thalassemic patients. Key Words: ß-thalassemia major ;Right Ventricle (RV) and Left Ventricle ( LV) dysfunction; Echocardiogram ;Tissue Doppler Imaging

Case Report: An Unusual Case of Biventricular Thrombosis in a COVID-19 Patient With Ischemic Dilated Cardiomyopathy: Assessment of Mass Mobility and Embolic Risk by Tissue Doppler Imaging

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein binds to angiotensin-converting enzyme 2 (ACE2) receptor on vascular cells. As a consequence, patients with COVID-19 have an increased incidence of thromboembolic complications of the SARS-CoV-2 infection and subsequent endothelial cell damage with consequence of development of systemic vasculitis and diffuse intravascular coagulation. The present case describes a COVID-19 female patient with ischemic dilated cardiomyopathy, who presented with congestive heart failure and echocardiographic evidence of biventricular apical thrombi. The peak antegrade longitudinal velocity (Va) of each thrombotic mass was measured by pulsed wave tissue Doppler imaging (PW-TDI). Both left ventricular and right ventricular apical thrombi were found with a TDI-derived mass peak Va &lt; 10 cm/s. There was no clinical evidence of neither systemic nor pulmonary embolization, probably due to the hypomobility of both left and right ventricular masses.

Tissue Doppler Imaging: An Overview

Tissue Doppler Imaging (TDI) is a non-invasive, echocardiographic imaging technique that measures myocardial motion velocity throughout the cardiac cycle using Doppler principles. While conventional Doppler techniques assess blood flow velocity by sensing high-frequency, low amplitude signals from small, fast-moving blood cells, TDI uses the same Doppler principles to instead measure high-amplitude, lower-velocity signals of myocardial tissue. Methods A literature review was conducted to survey and review studies investigating the limitations, strengths, physical principles, novel methods, applications in diseased states, and prognostic capabilities of TDI. These articles were further screened for inclusion, and those deemed ineligible or irrelevant to the scope of the review were discarded. In total, 19 studies were included in the qualitative synthesis. Results TDI is shown to be an effective method for detailed quantification of cardiac function. It provides an early means of diagnosing cardiac dysfunction and is a valid prognostic indicator for various forms of heart disease. TDI's versatility and precision allows clinicians to predict the clinical course of disease, leading to early intervention and the selection of targeted care management plans for many cardiac pathologies. Despite imaging limitations like angle dependence and incapacity for passive and active motion differentiation, further investigation continues to reveal novel TDI methodologies that advance the scope of this imaging technique.