Assessment Of Cardiac Status Research Articles

To Identify Myocardial Changes in Severely Malnourished Children: A Prospective Observational Study.

The main purpose of this study is to identify the myocardial changes in severely malnourished children. This prospective, observational study, conducted for a period of 1 year, enrolled 200 children (120 males and 80 females) between 6 months and 5 years of age with severe protein-energy malnutrition, according to the criteria of the World Health Organization. The parents were duly informed, the study was explained and written consent was obtained. A random selection of cases was carried out, and they were further divided into five groups according to their age as follows: <1, 1-2, 2-3, 3-4, and 4-5 years. Electrocardiograms (ECGs) were taken at the time of admission for all the cases and the control group and were taken again after nutritional therapy either at the time of discharge or after a fortnight. The differences were then compared. On admission, 32% of cases had flat P-wave, out of which 75% reverted to normal with therapy. Similarly, 84% of cases had increased corrected QT interval at the time of admission. ST segment was depressed only in 8% of cases. 88% of cases had altered (flat to depressed) T wave at the time of admission. With the help of nutritional supplementation, all these abnormalities were back to a normal level at the time of discharge. Electrocardiographic changes may be of help in assessing the severity and prognosis of severe acute malnutrition. The reversibility of ECG changes with dietary treatment suggests that the cardiac changes are not permanent in nature and may not affect adult life if the malnutrition is corrected. The cardiac status as denoted by heart rate remained the same even after a fortnight, suggesting that prolonged therapy and assessment of cardiac status is warranted even after fortnight therapy.

Assessment of cardiac status in children with chronic kidney disease

Assessment of cardiac status in children with chronic kidney disease

Plasma neurohormone levels correlate with left ventricular functional and morphological improvement in LVAD patients 1

Brain natriuretic peptide (BNP) and endothelin-1 (ET-1) have been shown to be markers of left ventricular (LV) function. To determine the feasibility of using serial assays of these neurohormones in the assessment of cardiac status in the left ventricular assist device (LVAD) setting, we examined the relationship between LV function, myocardial morphology, and plasma levels of these hormones in LVAD recipients. Plasma BNP and ET-1 levels were serially assayed in 19 end-stage congestive heart failure (CHF) patients before and after LVAD implantation with various devices (i.e., MicroMed DeBakeyVAD/DVAD, Novacor/NVAD, TCI Heartmate/TCI, Thoratec/TVAD). Echocardiography performed correspondingly at the time points of the hormonal assays and immunohistochemical collagen staining of left ventricular tissue samples, derived from six non-failing hearts as well as from LVAD patients at the time of device insertion and removal, were then contrasted. Patients were grouped according to device used and etiology of heart disease (ischemic or dilated cardiomyopathy, ICM/DCM). LVAD therapy significantly improved LV ejection fraction (EF%: 21 +/- 3.8% to 28.11 +/- 3.57%), cardiac output (CO: 3.49 +/- 1.3 to 7.3 +/- 0.2 l/m), and left ventricular end-diastolic diameter (LVEDD: 6.68 +/- 0.92 versus 4.79 +/- 1.54 cm, P < 0.0001) in all patients. Absolute BNP and ET-1 plasma levels remained significantly lower in all patients after LVAD implantation (both P < 0.001). The NVAD group exhibited the most BNP reduction and EF% increase (P < 0.0004 and P < 0.038, respectively). Average collagen levels were reduced in all patients (P < 0.0005). Among the devices, the NVAD group demonstrated the most evident change (P < 0.0036), while there was comparable reduction in the DCM and ICM groups (both P < 0.03). In general, postoperative BNP and ET-1 trends exhibited a notable parallelism with both manifesting bi-phasic tendencies and an inverse proportionality to corresponding EF% measurements. Device selection appears to influence the cardiac morphological and neurohormonal expressive tendencies exhibited by recipients. Plasma BNP and ET-1 levels correlate with both LV function and myocardial morphological improvement. Alterations in the levels of these hormones during LVAD support may be real-time indicators of prevailing myocardial autocrine/paracrine activity and as such may be of potential use in future algorithms of cardiac assessment and therapeutic decision-making with regard to transplant urgency and/or possible device explantation.

Ambulatory blood pressure and cardiac rhythm disturbances in elderly hypertensives: relation to left ventricular mass and filling pattern.

In order to define cardiac hypertensive involvement a group of 25 consecutive elderly male hypertensive outpatients and 25 age-matched male normotensive controls underwent full non-invasive assessment of cardiac status by resting 12-lead electrocardiography, Doppler-echocardiographic examination and simultaneous ambulatory blood pressure and electrocardiographic monitorings. Elderly hypertensives showed a higher prevalence of electrocardiographic left ventricular hypertrophy, an increased echocardiographic left ventricular mass, an impaired left ventricular filling pattern and more frequent ventricular arrhythmias when compared with normotensive controls. In elderly patients, left ventricular mass was found to be correlated with 24-hour ambulatory blood pressure (r = 0.47, p < 0.01) and 24-hour ambulatory blood pressure variability (r = 0.52, p < 0.01), while ventricular arrhythmias were correlated with left ventricular mass (r = 0.52, p < 0.01), the Doppler synthetic index of diastolic function E/A ratio (r = -0.56, p < 0.01) and both 24-hour systolic (r = 0.54, p < 0.01) and diastolic (r = 0.59, p < 0.01) ambulatory blood-pressure variabilities. These data suggest that hypertension induces in elderly patients an impairment of cardiac structure and function comparable with that already shown in younger hypertensives. Therefore, the assessment of hypertensive target-organ damage currently employed in younger subjects should be also considered in elderly hypertensives, at least when no other relevant medical disease is present.

Echo-Doppler assessment of cardiac status in conjoined (thoraco-omphalopagus) twins

Cardiac status was assessed noninvasively in a case of thoraco-omphalopagus conjoined twins by two-dimensional and Doppler echocardiography which showed completely separate hearts and major arteries and veins. The twins were successfully separated surgically, without preoperative invasive cardiac investigation. Echocardiography can provide an accurate assessment of cardiac status in conjoined twins and may obviate the need for cardiac catheterization.

Left Ventricular Hypertrophy in Kidney Transplant Recipients in Sub-Saharan Africa

Background: Left ventricular hypertrophy (LVH) is present in 67-70% of patients on chronic dialysis and in up to 40-60% of kidney transplant recipients (KTRs) and is associated with graft dysfunction. We determined the prevalence of LVH and its association with graft function among KTRs in a South African transplant center. Materials and Methods: Adult recipients of kidney transplant at the Charlotte Maxeke Johannesburg Academic Hospital between January 2005 and December 2009 were recruited. Patients' records were assessed for information on their posttransplant follow-up. All patients had transthoracic echocardiography and carotid Doppler done for assessment of cardiac status and carotid intima-media thickness (CIMT) respectively. Graft dysfunction was defined as estimated glomerular filtration rate of <60 ml/min/1.73 m 2 based on the modification of diet in renal disease formula. Inferential and modeling statistics were applied as appropriate using SPSS, and P ≤ 0.05 considered significant. Results: One hundred KTRs underwent echocardiography. There were 63% males, and the mean age of the study population was 42.2 ± 12.42 with a range of 19-70 years. The mean duration posttransplant was 59.28 ± 18.59 months with a range of 36-84 months. LVH was present in 76% of the study population; 51% had concentric LVH, and 25% had eccentric LVH. Graft dysfunction was found in 52%. Risk factors for LVH were longer duration on dialysis P = 0.017, cigarette smoking P = 0.032, increased CIMT P = 0.05, higher cumulative steroid dose P < 0.0001 and increased waist circumference P = 0.03. LVH was associated with graft dysfunction, χ2 = 9.22, P = 0.008. Conclusion: LVH is prevalent in our KTRs and is associated with graft dysfunction.