Assessment Of Response To Heart Failure Therapy: Ventricular Volume Changes Versus Shape Changes

The prolate ellipsoid left ventricular geometry is crucial for its unique contraction and relaxation patterns. Perturbations in optimal cardiac function preceding overt heart failure ensue when this ellipsoid shape assumes a more spherical configuration. This stage of spherical configuration, prior to overt dilatation, is when therapy should be intensified. The dynamic shape changes during the cardiac cycle of systole and diastole in valvular regurgitations when ventricular volumes are within normal range have proved that shape changes are clearly dissociated from volume changes in the early stages. In the scenario of advanced heart failure, several therapeutic interventions have been tried with variable success. These therapies aim at decreasing the ventricular equator, and hence its volume. However, the ventricular shape may still be spherical leading to suboptimal function. The aim in any therapy for heart failure should be therefore to achieve near normal left ventricular anatomy and physiology, with shape assessment as the surrogate marker of therapeutic success

Characteristics of Uremic Cardiomyopathy with Reversible Systolic Dysfunction

Background: There exists a sub group of patients with uremic cardiomyopathy who experience resolution of heart failure following hemodialysis. It has been hypothesized that these patients are fluid overloaded, and following hemodialysis, show improvements in cardiac geometry and function. We wanted to study their clinical, biochemical and echocardiographic features to define any other additional characteristics.

Aim: To define characteristics of reversible systolic dysfunction.

Methods: We studied 72 patients with chronic kidney disease on hemodialysis of whom 52 presented with congestive heart failure, over a period of 190 days. We studied their echocardiographic profile and blood biochemistry parameters including troponin I and C reactive protein.

Results: There were 29 patients with systolic dysfunction (LVEF≤40%). Twenty three patients with preserved systolic function, had diastolic dysfunction. Of the 29 patients with systolic dysfunction, 10 patients had significant improvement in NYHA functional class, and left ventricular dimensions (LVIDd:59.8±2.6 mm to 55.9±2 mm and LVIDs:51.8±1.8 mm to 34±1.2 mm; p<0.001) with significant increase in left ventricular ejection fraction (30.5±5% to 50.1±4%; p<0.001). These patients had the highest serum levels of troponin I (p=0.024) which decreased significantly with recovery of cardiac function. In the patients with persistent systolic dysfunction and in the patients with diastolic function, the troponin I remained high. The troponin I was significantly lesser in the control group (p=0.002).

Conclusions: A sub group of patients with uremic cardiomyopathy demonstrated reversible left ventricular systolic dysfunction, and high levels of serum troponin I levels at presentation, which regressed with recovery of ventricular function

Percutaneous Angioplasty of the Sole Patent Cerebral Artery in Two Patients with Takayasu's Aortoarteritis

We report two female patients with Takayasu's aortoarteritis, who presented with symptoms of cerebral ischemia due to critical stenosis of the sole patent cerebral artery. Both had occlusion of both vertebral arteries and one carotid artery with critical stenosis of the other carotid artery and presented with hemiparesis contralateral to the patent but stenosed cerebral artery. They also had transient ischemic attacks attributable to the culprit vessel. In the first patient, balloon angioplasty alone was not successful, and hence, a self-expanding stent was deployed in the right common carotid artery. In the second patient, successful balloon angioplasty was performed for the left common carotid artery. Distal protection devices were not used, and neither patient experienced any periprocedural neurological event. Clinical follow-up at six months revealed no significant cerebral events

Use of coronary hardware in peripheral vascular interventions: Necessity fostered ingenuity-Is it solution enough?

In third world countries like India, where there is a paucity of dedicated interventional radiologists and training fellowships in peripheral interventions, it is the onus of the cardiologist to perform peripheral interventions. This coupled with logistic constraints of unavailability of medical insurance for majority of the population, makes it necessary to modify coronary hardware for use in peripheral interventions. Here, we discuss the modifications and simplifications performed to ensure optimal quality of clinical outcomes

Ventricular Geometry in Post-Myocardial Infarction AneurysmsImplications for Surgical Ventricular Restoration /

XVI, 152 p. 77 illus., 37 illus. in color.online