Presence Of Cardiac Dysfunction Research Articles

Left ventricular dysfunction in patients with HIV/AIDSon HAART in correlation with CD4 count

According to World Health Organization (WHO) global HIV report 2019, people living with HIV is about 38 million. Especially after the advent of antiretroviral therapy (ART), in PLHIV, cardiovascular complications signify an increasingly important health concern. This vastly active HAART regimen has provided more efficient prophylactic treatment. With the increased duration of survival, this has progressed to an increased episodes of cardiovascular complications associated with PLHA. The following review overviews the left ventricular dysfunction in patients with HIV infection on HAART focusing on early diagnosis, therapy and prognosis. It is a Cross sectional study conducted on HIV infected patients attending ART clinic and admitted in medicine wards of MKCG medical college & Hospital from MARCH 2017 to OCTOBER 2018 were included in the study. Maximum patients were in the age group 25 – 49 years (68.44%) in our study. Mean age of the study group 41.32 + 11.24 years. Gender distribution shows that 82.46% of the patients were males and 14.04% were females. 4 (7%) patients have cardiac disorder. All the patients having cardiac disorders are male. Only 2 patients (3.5%) had left ventricular dysfunction with reduced ejection fraction. Males are involved more than females. Most patients are in the middle age group between 25 – 49 years. Heterosexual mode was the most common mode of transmission. Most of the study population belonged to rural area 61.4%. Three patients (5.3%) were on anti tubercular drugs. The systolic LV dysfunction was found in 50% of PLHA patients with cardiac disorders. CD4 count was positively correlated with fractional shortening. Presence of cardiac dysfunction was significantly associated with the adherence to ART treatment.

CardiOvaScular Mechanisms In Covid-19: methodology of a prospective observational multimodality imaging study (COSMIC-19 study)

Background8–28% of patients infected with COVID-19 have evidence of cardiac injury, and this is associated with an adverse prognosis. The cardiovascular mechanisms of injury are poorly understood and speculative. We aim to use multimodality cardiac imaging including cardiac magnetic resonance (CMR) imaging, computed tomography coronary angiography (CTCA) and positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-d-glucose integrated with computed tomography (18F-FDG-PET/CT) to identify the cardiac pathophysiological mechanisms related to COVID-19 infections.MethodsThis is a single-centre exploratory observational study aiming to recruit 50 patients with COVID-19 infection who will undergo cardiac biomarker sampling. Of these, 30 patients will undergo combined CTCA and 18F-FDG-PET/CT, followed by CMR. Prevalence of obstructive and non-obstructive atherosclerotic coronary disease will be assessed using CTCA. CMR will be used to identify and characterise myocardial disease including presence of cardiac dysfunction, myocardial fibrosis, myocardial oedema and myocardial infarction. 18F-FDG-PET/CT will identify vascular and cardiac inflammation. Primary endpoint will be the presence of cardiovascular pathology and the association with troponin levels.DiscussionThe results of the study will identify the presence and modality of cardiac injury associated COVID-19 infection, and the utility of multi-modality imaging in diagnosing such injury. This will further inform clinical decision making during the pandemic.Trial Registration: This study has been retrospectively registered at the ISRCTN registry (ID ISRCTN12154994) on 14th August 2020. Accessible at https://www.isrctn.com/ISRCTN12154994

Abstract 13910: Importance of Non-invasive Estimates of Left Ventricular Filling Pressures in Critically Ill Patients

Introduction: The presence of cardiac dysfunction predicts adverse outcomes in the intensive care unit (ICU). We explored the relationship of cardiac injury and left ventricular (LV) systolic and diastolic dysfunction (LVDD) to outcomes in critically ill patients. Methods: This is a retrospective analysis of adult medical ICU admissions from May, 2018 through October 2019. Patients with elevated high-sensitivity troponin T (hs-cTnT) and an echocardiogram performed within 72 hours of admission were included. Patients were classified as having normal LV diastolic function, isolated LVDD, concomitant LV diastolic and systolic dysfunction (LVDDSD) or indeterminate LV diastolic function based on American Society of Echocardiography 2016 guidelines. LV systolic dysfunction was defined as an ejection fraction (EF) < 50%. Results: Overall, 222 patients were included. LVDD was seen in 123 patients (55.4%). Thirty patients (13.5%) were classified with indeterminate diastolic function and 56 normal diastolic function (25.2%). Of those with LVDD , 59.3% had LVDDSD while isolated LVDD was seen in 40.7%.Patients with LVDDSD had a higher median hs-cTnT at baseline compared to patients with isolated LVDD [102ng/L IQR (50-257) vs. 77 ng/L (33.5-166); p=0.047]. Medial e’ velocity and tricuspid valve systolic regurgitant velocity were often associated with LV systolic dysfunction (p=0.0172 and 0.0013, respectively). LVDDSD was associated with a longer length of stay than patients with isolated LVDD [2.9 (1.6-4.0) vs.1.8 (1.1-3.3); p-value 0.03].Twenty-nine patients died during their ICU stay (13%). Patients with LVDDSD had 9.6-fold higher odds of dying in the ICU than patients with isolated LVDD (p=0.0048). Reduced medial e’ velocity (OR 0.63, CI 0.4-1.0, p=0.0285) and increased E/e’ (OR 1.08, CI 1.01-1.15, p=0.0192) were associated with ICU mortality. The association between LVEF<50% and ICU mortality was less pronounced (OR 0.95, CI 0.01-0.98; p=0.0023). Conclusions: Concomitant LV systolic and diastolic dysfunction and measures of increased cardiac filling pressures are strong predictors of mortality.

Role of Oxidative Stress in Metabolic and Subcellular Abnormalities in Diabetic Cardiomyopathy.

Although the presence of cardiac dysfunction and cardiomyopathy in chronic diabetes has been recognized, the pathophysiology of diabetes-induced metabolic and subcellular changes as well as the therapeutic approaches for the prevention of diabetic cardiomyopathy are not fully understood. Cardiac dysfunction in chronic diabetes has been shown to be associated with Ca2+-handling abnormalities, increase in the availability of intracellular free Ca2+ and impaired sensitivity of myofibrils to Ca2+. Metabolic derangements, including depressed high-energy phosphate stores due to insulin deficiency or insulin resistance, as well as hormone imbalance and ultrastructural alterations, are also known to occur in the diabetic heart. It is pointed out that the activation of the sympathetic nervous system and renin–angiotensin system generates oxidative stress, which produces defects in subcellular organelles including sarcolemma, sarcoplasmic reticulum and myofibrils. Such subcellular remodeling plays a critical role in the pathogenesis of diabetic cardiomyopathy. In fact, blockade of the effects of neurohormonal systems has been observed to attenuate oxidative stress and occurrence of subcellular remodeling as well as metabolic abnormalities in the diabetic heart. This review is intended to describe some of the subcellular and metabolic changes that result in cardiac dysfunction in chronic diabetes. In addition, the therapeutic values of some pharmacological, metabolic and antioxidant interventions will be discussed. It is proposed that a combination therapy employing some metabolic agents or antioxidants with insulin may constitute an efficacious approach for the prevention of diabetic cardiomyopathy.

Critical Illness and Cardiac Dysfunction in Anthracycline-Exposed Pediatric Oncology Patients.

To determine if the presence of cardiac dysfunction in anthracycline-exposed pediatric oncology patients is associated with an increased frequency of PICU admission or mortality. Retrospective parallel cohort study. PICU at an academic freestanding children's hospital. Children with oncologic diagnoses who received anthracyclines between January 2006 and December 2014 and were admitted to the hospital within 1 year of completion of therapy. None. Charts of 734 patients were reviewed and 545 were included in analysis. Anthracycline-exposed pediatric oncology patients with cardiac dysfunction were more likely to be admitted to the PICU than those without cardiac dysfunction (87% vs 37% rate of PICU admission). PICU admission was also associated with identified infection and higher cumulative anthracycline dose. Once admitted to the PICU, those anthracycline-exposed patients with cardiac dysfunction had significantly higher mortality (26% vs 6%) and longer length of stay (7 vs 2 d) than children without cardiac dysfunction. Patients with cardiac dysfunction were more likely to require mechanical ventilation (59% vs 18%), required more vasoactive medications for longer, and were more likely to develop fluid overload. Death within 1 year of ICU admission was associated with higher cumulative anthracycline dose. Children with cancer who received anthracyclines, especially at higher doses, and who develop cardiac dysfunction are at higher risk of critical illness, have higher rates of multiple organ dysfunction and higher rates of mortality than anthracycline-exposed patients without cardiac dysfunction.

Lung ultrasound as a translational approach for non-invasive assessment of heart failure with reduced or preserved ejection fraction in mice.

Heart failure (HF) has become an epidemic and constitutes a major medical, social, and economic problem worldwide. Despite advances in medical treatment, HF prognosis remains poor. The development of efficient therapies is hampered by the lack of appropriate animal models in which HF can be reliably determined, particularly in mice. The development of HF in mice is often assumed based on the presence of cardiac dysfunction, but HF itself is seldom proved. Lung ultrasound (LUS) has become a helpful tool for lung congestion assessment in patients at all stages of HF. We aimed to apply this non-invasive imaging tool to evaluate HF in mouse models of both systolic and diastolic dysfunction. We used LUS to study HF in a mouse model of systolic dysfunction, dilated cardiomyopathy, and in a mouse model of diastolic dysfunction, diabetic cardiomyopathy. LUS proved to be a reliable and reproducible tool to detect pulmonary congestion in mice. The combination of LUS and echocardiography allowed discriminating those mice that develop HF from those that do not, even in the presence of evident cardiac dysfunction. The study showed that LUS can be used to identify the onset of HF decompensation and to evaluate the efficacy of therapies for this syndrome. This novel approach in mouse models of cardiac disease enables for the first time to adequately diagnose HF non-invasively in mice with preserved or reduced ejection fraction, and will pave the way to a better understanding of HF and to the development of new therapeutic approaches.

Relation of Echocardiographic Parameters to Outcome of Patients with Severe Sepsis and Septic Shock

Background: Myocardial dysfunction is one of the most important features of sepsis. The presence of cardiac dysfunction in sepsis has been associated with high mortality rate in septic patients Material & Methods: This was prospective, observational cohort (patient with severe sepsis and septic shock) study conducted over period of one year in medical intensive care unit. Patients with an initial diagnosis of severe sepsis or septic shock were enrolled. Aims & Objectives: To study demographic profile, APACHE-II score and echocardiographic parameters in patients with severe sepsis and septic shock and to find out relation of echocardiographic parameters to variables of sepsis and outcome. Study Population: All patients underwent laboratory investigations, APACHE-II score and Transthoracic 2- Dimensional echocardiogram. Statistical analysis: Data was analysed by trial version SPSS-16 for mean, SD, chi-square test with ‘p’ Results: Of total 51 patients with sepsis and septic shock 32 were males and 19 were females with mean age of 51.48 (±13.11) years and 59.66(±16.93) respectively. The mean LVEF was 35.70% (±7.47608). APACHE-II score had negative correlation with LVEF and positive with DD. Total 17.64% had normal LV diastolic function, 47.05% had grade-I diastolic dysfunction and 35.29% had grade-II diastolic dysfunction [‘p’=0.082]. Overall mortality was 29.41% in patient with sepsis. Overall diastolic dysfunction was significantly more in patients with death compared to survived population [‘p’= 0.0218 and 0.0329]. Conclusion: Diastolic dysfunction was common and a major predictor of mortality and outcome in severe sepsis and septic shock and was well correlated with APACHE-II score. Present study favors to use echocardiography as an ideal monitoring, tool in the septic patient for goal-oriented therapy for better outcome. Key words: Myocardial dysfunction, Sepsis, APACHE-II score, Echocardiographic parameters, Septic shock.

Evaluation of cardiac functions of cirrhotic children using serum brain natriuretic peptide and tissue Doppler imaging.

Background:Cirrhotic cardiomyopathy (CCM) is described as the presence of cardiac dysfunction in cirrhotic patients. In children with chronic liver disease, CCM has been very rarely investigated.The Aim of the Study:Is to evaluate the cardiac function of cirrhotic children to identify those with CCM.Patients and Methods:Fifty-two cirrhotic patients and 53 age and sex matched controls were assessed using serum brain-type natriuretic peptide (BNP), conventional echocardiography, and tissue Doppler imaging.Results:Patients’ mean ages were 7.66 ± 4.16 years (vs. 6.88 ± 3.04 years for the controls). The study included 27 males and 25 females (28 and 25 respectively for the controls). Patients had larger left atrium and right ventricle (RV) (P value 0.05) and increased LV posterior wall thickness than controls (P value 0.04). They had higher late atrial diastolic filling velocity (A) of tricuspid valve (TV) inflow (0.59 ± 0.17 vs. 0.5 ± 0.1 m/s, P < 0.001) and lower ratios between the early diastolic filling velocity (E) and A wave velocity (E/A) of both mitral valve and TV inflow (1.7 ± 0.35 vs. 1.87 ± 0.34 and 1.3 ± 0.3 vs. 1.5 ± 0.3, P < 0.005 and 0.0008, respectively). Patients had significantly longer isovolumic relaxation time of LV (45.5 ± 11.1 vs. 40.5 ± 7.7 ms P 0.008), higher late diastolic peak myocardial velocity (A’) (11.8 ± 3.6 vs. 9.5 ± 2.7 ms, P 0.0003) and systolic velocity (S’) of the RV (14.5 ± 2.7 vs. 13.2 ± 2.9, P 0.01) and significantly higher myocardial performance index of both LV and RV (P 0.001 and 0.01). BNP levels were significantly higher in cases than controls (5.25 ng/l vs. 3.75 ng/l, P < 0.04) and was correlated with the E wave velocity of the TV (r 0.004) and the E/E’ ratio of the RV (r 0.001). None of the clinical or laboratory data were correlated with the BNP level.ConclusionCirrhotic children have cardiac dysfunction mainly in the form of diastolic dysfunction. There is a need that CCM be more accurately described in children.

Imaging of cardiac and renal perfusion in a rat model with 13N-NH 3 micro-PET.

Cardiac dysfunction leads to decreased organ perfusion. We aimed to measure cardiac and renal perfusion simultaneously with the use of (13)N-NH3-microPET in different rat models. Ten male Wistar rats underwent sham surgery (n=5) or permanent coronary artery ligation to induce myocardial infarction (MI, n=5). Eleven weeks later (13)N-NH3-microPET scan was performed to study the cardiac and renal perfusion. Cardiac perfusion was significantly reduced in MI group, directly correlated with ejection fraction and inversely correlated with MI size (r=0.89; p<0.001 and r=-0.86; p<0.001 respectively). Renal perfusion showed a notional 17% non-significant reduction in MI group when compared to sham (3.44±0.40 vs. 4.12±0.48ml/g/min). There was a trend towards greater reduction of perfusion in cortical than medullar region. Cortex perfusion was negatively correlated with histological changes. (13)N-NH3-microPET may be a potential tool for evaluation of cardiac and renal functional and perfusion changes in presence of cardiac dysfunction in rat models.

Relationship between NT-proBNP and Cardio-Renal Dysfunction in Patients with Advanced Liver Cirrhosis

Background &amp; Aims: ProBNP is a sensitive marker of cardiac dysfunction. We assessed the concentration of circulating NT-proBNP in patients with liver cirrhosis in various stages of the disease and its correlation with markers of cardiac and renal dysfunction and with markers of liver disease severity.Patients and methods: A number of 88 patients with liver cirrhosis were included in the study, divided into 3 groups: group 1 - 18 control patients without ascites; group 2 - 35 non-azotemic patients with ascites; group 3 - 35 patients with hepatorenal syndrome. The cardiac dysfunction was assessed by measuring the NT-proBNP serum levels and the QTc interval. The markers of renal dysfunction were the estimated glomerular filtration rates - formulas involving creatinine and serum cystatin C. The Child-Pugh score was used to assess the liver disease severity.Results: The median NT-proBNP serum levels significantly increased in patients with advanced liver cirrhosis (group 3: 960 fmol/ml and group 2: 660 fmol/ml) as compared to group 1 (435 fmol/ml) (p&lt;0.05). A significant direct correlation was found between the NT-proBNP concentration and the QTc interval (r=0.540, p&lt;0.001). The NT-proBNP levels also correlated with the Child-Pugh score (r=0.501, p&lt;0.01), proving the link between the cardiac dysfunction and the liver disease severity. The cardio-renal interrelation is supported by the relationship between the NT-proBNP concentration and the estimated clearances.Conclusion: The high NT-proBNP levels in patients with advanced cirrhosis indicate the presence of cardiac dysfunction, which has a role in the pathogenesis of the hepatorenal syndrome.Abbreviations: DP: diastolic pressure; GFR: glomerular filtration rate; HRS: hepatorenal syndrome; MAP:mean arterial pressure; NT-proBNP: N-terminal fragment of the prohormone B-type natriuretic peptide; proBNP: prohormone brain natriuretic peptide; SBP: spontaneous bacterial peritonitis; SP: systolic pressure; TIPS: tranjugular intrahepatic portosystemic shunt.

Crisis epiléptica complicada con un síndrome de takotsubo

Takotsubo syndrome is a disorder characterised by a reversible ventricular dysfunction, angina-like precordial pain and electromyographic changes with no evidence of coronary obstruction in examinations performed by coronary catheterisation. It is triggered by stress and is frequent following bouts of epileptic seizures. We report the case of a patient who began with this cardiomyopathy following epileptic seizures suffered after one of her haemodialysis sessions. We report the case of a 55-year-old female on haemodialysis due to chronic renal failure, with epilepsy secondary to a residual lesion in the right frontoparietal area due to a haematoma that required surgical evacuation. After her haemodialysis session she suffered an attack of focal epilepsy with secondary generalisation and, some hours later, pain in the middle of her chest. Serial enzymes revealed increased levels of troponin I and, electrocardiographically, negative T waves were observed in precordial derivations (V2-V6). Coronary catheterisation was performed, with normal results, and alterations were noted in contractility, which were confirmed as being transient in a serial echocardiography study. All the previous data lead us to a suspected diagnosis of Takotsubo syndrome. Cardiac complications are one of the causes of morbidity and mortality in epilepsy, and Takotsubo syndrome is an example of them. The real incidence of this syndrome is unknown, but given its involvement in mortality caused by heart problems in epilepsy it is important to suspect it in the presence of cardiac dysfunction following epileptic seizures.

Diastolic and autonomic dysfunction in early cirrhosis: a dobutamine stress study

Objective. Presence of cardiac dysfunction in patients with advanced cirrhosis is widely accepted, but data in early stages of cirrhosis are limited. Systolic and diastolic functions, dynamics of QT-interval, and pro-atrial natriuretic peptide (pro-ANP) are investigated in patients with early stage cirrhosis during maximal β-adrenergic drive. Material and methods. Nineteen patients with Child A (n = 12) and Child B cirrhosis (n = 7) and seven matched controls were studied during cardiac stress induced by increasing dosages of dobutamine and atropine. Results. Pharmacological responsiveness was similar in cirrhosis and controls and the heart rate (HR) increased by 66 ± 15 versus 67 ± 8 min−1. HR-blood pressure product increased equally by 115% in both cirrhotic patients and controls. However, time to resume HR of 100 beats/min was significantly longer in cirrhosis, p < 0.01. The QTc interval increased after dobutamine infusion in cirrhosis (0.41 ± 0.02 vs. 0.43 ± 0.02 s, p = 0.001) but similar electrophysiological changes were seen in controls. Cardiac volumes increased with the severity of disease. The increased cardiac output was primarily attributed to increased stroke volume. The ejection fraction was similar in patients and controls. Peak filling rate was longer in cirrhosis compared to controls (1.8 ± 0.4 and 1.4 ± 0.2 end-diastolic volume/s, p < 0.01). Pro-ANP was higher in cirrhosis and increased during stress by 13% compared to 0% in controls, p < 0.01. Conclusions. These findings indicate that patients with early stage cirrhosis exhibit early diastolic and autonomic dysfunction as well as elevated pro-ANP. However, the cardiac chronotropic and inotropic responses to dobutamine stress were normal. The dynamics of ventricular repolarization appears normal in patients with early stage cirrhosis.

Assessing mean and median filters in multiple testing for large-scale imaging data

ProBNP is a sensitive marker of cardiac dysfunction. We assessed the concentration of circulating NT-proBNP in patients with liver cirrhosis in various stages of the disease and its correlation with markers of cardiac and renal dysfunction and with markers of liver disease severity. A number of 88 patients with liver cirrhosis were included in the study, divided into 3 groups: group 1--18 control patients without ascites; group 2--35 non-azotemic patients with ascites; group 3--35 patients with hepatorenal syndrome. The cardiac dysfunction was assessed by measuring the NT-proBNP serum levels and the QTc interval. The markers of renal dysfunction were the estimated glomerular filtration rates--formulas involving creatinine and serum cystatin C. The Child-Pugh score was used to assess the liver disease severity. The median NT-proBNP serum levels significantly increased in patients with advanced liver cirrhosis (group 3: 960 fmol/ml and group 2: 660 fmol/ml) as compared to group 1 (435 fmol/ml) (p<0.05). A significant direct correlation was found between the NT-proBNP concentration and the QTc interval (r=0.540, p<0.001). The NT-proBNP levels also correlated with the Child-Pugh score (r=0.501, p<0.01), proving the link between the cardiac dysfunction and the liver disease severity. The cardio-renal interrelation is supported by the relationship between the NT-proBNP concentration and the estimated clearances. The high NT-proBNP levels in patients with advanced cirrhosis indicate the presence of cardiac dysfunction, which has a role in the pathogenesis of the hepatorenal syndrome.

Mortality and Sudden Death in Pediatric Left Ventricular Noncompaction in a Tertiary Referral Center

Left ventricular noncompaction is a cardiomyopathy characterized by excessive trabeculation of the left ventricle, progressive myocardial dysfunction, and early mortality. Left ventricular noncompaction has a heterogeneous clinical presentation that includes arrhythmia and sudden cardiac death. We retrospectively reviewed all children diagnosed with left ventricular noncompaction at Texas Children's Hospital from January 1990 to January 2009. Patients with congenital cardiac lesions were excluded. Two hundred forty-two children were diagnosed with isolated left ventricular noncompaction over the study period. Thirty-one (12.8%) died, and 13 (5.4%) were received a transplant. One hundred fifty (62%) presented with or developed cardiac dysfunction. The presence of cardiac dysfunction was strongly associated with mortality (hazard ratio, 11; P<0.001). ECG abnormalities were present in 87%, with ventricular hypertrophy and repolarization abnormalities occurring most commonly. Repolarization abnormalities were associated with increased mortality (hazard ratio, 2.1; P=0.02). Eighty children (33.1%) had an arrhythmia, and those with arrhythmias had increased mortality (hazard ratio, 2.8; P=0.002). Forty-two (17.4%) had ventricular tachycardia, with 5 presenting with resuscitated sudden cardiac death. In total, there were 15 cases of sudden cardiac death in the cohort (6.2%). Nearly all patients with sudden death (14 of 15) had abnormal cardiac dimensions or cardiac dysfunction. No patient with normal cardiac dimensions and function without preceding arrhythmias died. Left ventricular noncompaction has a high mortality rate and is strongly associated with arrhythmias in children. Preceding cardiac dysfunction or ventricular arrhythmias are associated with increased mortality. Children with normal cardiac dimensions and normal function are at low risk for sudden death.

Prognostic factors in critically ill patients with hematologic malignancies admitted to the intensive care unit

ObjectiveDespite an improvement in the prognosis of patients with hematologic malignancies, the mortality of such patients transferred to the intensive care unit (ICU) is high. This study determined the predictors of mortality in a cohort of critically ill patients with hematologic malignancies admitted to the ICU. MethodsWe studied 227 critically ill patients with hematologic malignancies who were admitted to the ICU between April 2009 and December 2011. A cohort of consecutive patients with hematologic malignancies was reviewed retrospectively to identify clinically useful prognostic factors. ResultsThe ICU mortality rate was 84.1%, and the in-hospital mortality rate was 89.9%. The ICU mortality was significantly higher in patients with acute leukemia than in those with other malignancies. A significant difference between survivors and nonsurvivors was found in neutropenia and its recovery during the ICU stay, presence of cardiac dysfunction, the need for an invasive mechanical ventilator, use of inotropic/vasopressor agents, platelet count, aspartate transaminase level, pH, and Acute Physiology And Chronic Health Evaluation II score. In the multivariate analysis, acute leukemia, need for invasive mechanical ventilator, use of inotropic/vasopressor agents, and Acute Physiology And Chronic Health Evaluation II scores were independently associated with a worse outcome in patients with hematologic malignancies admitted to the ICU. ConclusionHigher mortality in patients with hematologic malignancies admitted to the ICU is associated with more severe illness, as reflected by higher organ failure scores or respiratory or hemodynamic instability. Mortality is higher in patients with acute leukemia as compared with other hematologic malignancies.

Cardiac dysfunction in cirrhosis is not associated with the severity of liver disease

BackgroundCirrhotic cardiomiopathy is described as the presence of cardiac dysfunction in cirrhotic patients. The aim of the study was to investigate factors associated with cardiac dysfunction in cirrhotic patients. Patients and methodsSeventy-four cirrhotic patients and twenty-six controls performed a conventional echocardiography and Tissue Doppler Imaging (TDI) for systolic and diastolic function. Results were analyzed by using the Guidelines of American Society of Echocardiography. ResultsIn patients with cirrhosis, left ventricular end-diastolic diameter was increased (p<0.001) , peak systolic velocities were decreased (11.3±2.7 vs 13.9±1.4cm/s; p<0.001) and left atrial volumes were increased (32.7±8.3 vs 24±8.5ml, p<0.001) as well as cardiac mass (90.6±23 vs 70.5±22g/m2, p<0.001). Forty-seven cirrhotic patients (64%) showed diastolic dysfunction at rest: grade I in 37 and grade II in 10 patients. Systolic and/or diastolic dysfunction were not influenced by a more severe liver impairment. Diastolic dysfunction was more prevalent in patients with ascites vs those without (77% vs 56%; p=0.04). ConclusionA mild diastolic dysfunction at rest is frequent in cirrhotic patients but cardiac load conditions are confounding factors in this diagnosis. We did not identify an association between severity of liver disease and cardiac dysfunction.

Risk factors associated with preterm delivery in women with cardiac disease

The purpose of this study was to identify clinical characteristics of preterm delivery at less than 37 weeks of gestation (PD37G) and prenatal events associated with preterm delivery at less than 35 weeks of gestation (PD35G) in women with cardiac disease (WCD). A case-control study was conducted of 599 pregnancies in 479 single pregnant women with congenital or acquired cardiac lesions or cardiac arrhythmias. The relevant variables were compared between women who had PD35G (n=37) and the controls (n=562). Cardiac dysfunction was defined as the appearance of clinical symptoms of heart failure, abnormal electrocardiogram, or cardiac ultrasonography. PD37G occurred in 77 cases (12.9%). The spontaneous and indicated preterm delivery was 26 (33.8%) and 51 (66.2%) cases, respectively. The presence of cardiac dysfunction [odds ratio (OR) 21.82, 95% confidence interval (CI) 8.3-57.49], New York Heart Association class II (OR 3.96, 95% CI 1.05-14.93), cardiomyopathy (OR 7.74, 95% CI 1.69-35.45) and pregnancy-induced hypertension (PIH) (OR 3.15, 95% CI 1.37-7.24) was significantly associated with an increased risk of PD35G. No maternal death was seen within one year after delivery. Although pregnancy and delivery are generally safe in WCD, it is necessary to be aware of the risk factors of cardiac dysfunction, cardiomyopathy, and PIH from the aspect of PD35G.

Ultrasonographic Prevalence and Factors Predicting Left Ventricular Diastolic Dysfunction in Patients with Liver Cirrhosis: Is There a Correlation between the Grade of Diastolic Dysfunction and the Grade of Liver Disease?

Presence of cardiac dysfunction has been associated with an unfavorable prognosis in patients with liver cirrhosis. In the present study, 92 consecutive, newly-diagnosed patients with liver cirrhosis were prospectively evaluated. Liver disease was graded according to the modified Child-Turcotte-Pugh (CTP) score whereas left ventricular diastolic function was assessed by Doppler-echocardiography and graded (Stage 0 to 4) according to current guidelines. Overall, DD was diagnosed in 55/92 (59.8%) patients [DD-stage-1: 36/92 (39.1%), DD-stage-2: 19/92 (20.6%)]. Prevalence of DD-stage-1 among the different stages of liver cirrhosis was: CTP-class A: 11/29 (37.9%), B: 15/39 (38.5%), C: 10/24 (41.6%), (P > 0.05 in all comparisons), whereas for DD-stage-2 the corresponding proportions were CTP-class A: 3/29 (10.3%), B: 5/39 (12.8%), C: 11/24 (45.8%), (P = 0.0009 between CTP-class C versus A and B). Age > 53 years (Odd's Ratio [OR]: 4.2; 95% confidence interval [CI]: 1.5–12.1) and CTP-class C (OR: 4.6; 95% CI: 1.1–20) could independently predict DD. No relation between presence of DD and the etiology of the liver disease was found. We conclude that DD is a common feature in liver cirrhosis. DD-stage-1 is fairly prevalent among all CTP-classes whereas DD-stage-2 seems to be characteristic of the advanced liver disease (CTP-class C). A high level of awareness for the presence of the syndrome is required, especially if cirrhotic patients are CTP-class C and/or of older age.

Antenatal and Postnatal Diagnosis of Coxsackie B4 Infection: Case Series

Enteroviruses are a common cause of neonatal infection. In particular, Coxsackie B viruses are often associated with severe, fatal disease. The antenatal diagnosis of Coxsackie B viral infections is uncommon. We present a unique case of Coxsackie B4 virus ventriculitis and myocarditis causing fetal hydrops at 22 weeks gestation. Transmission was inferred by viral isolation from the amniotic fluid and by placental pathology. We also describe two additional cases of fatal neonatal Coxsackie B4 infection complicated by myocarditis and encephalitis with cerebral necrosis in a 4-day-old female and by myocarditis, spinal leptomeningitis, and hepatitis in a 4-day-old male. Transplacental acquisition of infection carries a poor prognosis. We propose that Coxsackie B virus should be considered in the investigation of nonimmune hydrops, particularly in the presence of cardiac dysfunction.

12. Factors associated with effectiveness of CPAP therapy on central sleep apnea – Influence of body position during sleep and underlying cardiac dysfunction

The effectiveness of CPAP therapy on central sleep apnea (CSA) remains controversial and factors associated with such effectiveness are still unclear. We investigated effectiveness of CPAP on CSA and related factors, focusing on body position during sleep and presence or absence of underlying cardiac dysfunction. Among 7268 subjects who underwent polysomnography, 115 patients who had central apnea hypopnea index (CAHI) P15 were analyzed. We excluded 47 patients who had rarely lateral position during sleep ( 80% reduction from the diagnostic AHI) whereas residual 34 subjects did not show such reductions (i.e. ineffective group). Ineffective group showed significantly greater AHI on lateral position (L-AHI) and lower % of slow wave sleep (%SWS) on diagnostic study, and more frequently had cardiac dysfunction as compared with effective group. Multivariate logistic regression analysis showed greater LAHI, lower %SWS and presence of cardiac dysfunction are independently associated with the CPAP-ineffectiveness. Our findings suggest that in addition to the underlying cardiac dysfunction, CSA on lateral position may play a role to determine CPAP effectiveness on CSA.