AH jump as predictor for successful Ablation of atrioventricular nodal reentrant tachycardia (AVNRT)

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the commonest regular supraventricular tachyarrhythmia. Ablation in the area of slow pathway (SP) has been successfully implemented in every day clinical electrophysiological practice for more than 20 years. Although the procedure is generally regarded as effective and safe, data on long-term effects and predictors of success or failure are incomplete. Objectives: This study was designated to prove that AH interval is an electrophysiological parameter which serves as a predictor for successful AVNRT ablation. Methods: While performing an electrophysiological study using a programmed atrial stimulation, thirty nine (39) patients (25 female and 14 males) with a mean age 51 ± 16.7 years with AVNRT were assessed and underwent AVNRT radiofrequency ablation using diagnostic and ablation catheters inserted via the right femoral veins. This study was performed during the period from February, 2013 to march, 2014 at the unit of Electrophysiogy in Leipzig heart center. Results: Acute successful AVNRT ablation was achieved in 39 (100%) patients, including 23 (59%) with slow pathway (SP) ablation and 16 (41%) with SP modification. Patients with SP modification were younger male, had faster AVNRT cycle length, and had more frequent isoproterenol usage before ablation. During six months follow-up period, all patients experienced no AVNRT recurrences. . Conclusions: AH jump served as predictor for successful Ablation of atrioventricular nodal reentrant tachycardia with a better outcome

Delayed Recovery of Contrast Induced Kidney Injury Post Angiography: Rate and Risk Factors

Background: Exposure to Contrast media is the third leading cause of hospital acquired acute kidney injury. It follows a predictable time of onset and a less predictable scenario in recovery. This is related to certain factors, but at the end there will be asubstantial association with increased mortality, morbidity, and length of hospitalization. Objectives: To define the Incidence of persistent contrast induced renal impairment a month after angiography and to define the risk factors for such persistence Patients and Methods: One hundred and one patients (101) were enrolled in this study. All were referred to the Iraqi Center for Heart Diseases in Baghdad/ Iraq for coronary and/or peripheral vascular angiography from October 2009 to July 2010. All patients’ clinical and laboratory data including baseline renal function tests were ordered and recorded with subsequent risk categorization. Post procedure serum creatinine checked on regular intervals (48 hours, one week, and then weekly for three months for those with serum creatinine consistent with the contrast induced - acute kidney injury (CI-AKI) definition at 48 hours. Results: The mean age for the study group was 62±16.9 with 78 (77%) male. Twenty three patients (22.7%) had diabetes mellitus. Thirteen patients (12.7%)had a pre-existing renal impairment. Twenty one patients (20.7%) received extradoses of contrast. Thirty two patients (31.6%) developed CIN by the definition within 48 hours of the procedure with the mean serum creatinine of 1.8 mg/dl. Seven patients (6.8%) continued to have impaired renal function at week 4 and persisted to have such low GFR up to three months of the procedure. Baseline low GFR, Diabetes mellitus and extradoses of contrast were independent risk factors for the occurrence of CIN and delayed renal recovery. Conclusion: The risk of poor renal recovery after contrast cannot be overlooked. Preexisting renal function impairment, diabetes mellitus, and extra doses of contrast media are independent risk factors for such delay

The Ankle- Brachial Pressure Index AS A Predictor of Coronary Artery Disease Severity

Background: Atherosclerosis is a diffuse disease process, being present in one vascular bed predicts its presence in the others. Ankle –brachial pressure index (ABI) is a non invasive test proved to be sensitive and specific in detecting and assessing the severity of peripheral arterial disease. Patients and Methods: One hundred fifty patients (150) were enrolled in this study, from January - June 2007; all were referred to the Iraqi Centre for Heart Diseases (I.C.H.D.) for further evaluation, with request for further assessment of CAD or lower extremity peripheral arterial disease. Clinical data and physical examination were performed; ABI was calculated by measurement of systolic pressure on both ankles over both dorsalis pedis and posterior tibial arteries and on both arms over the brachial arteries by using a Doppler stethoscope. The Ankle –Brachial Pressure Index (ABI) calculation was made by taking the lowest value for the ankle pressure and the highest value for the brachial pressure. The normal value for the ABI range from (1-1.4), a cutoff value of < 0.90 was used to identify low ABI. All patients underwent diagnostic coronary angiography and quantitative coronary angiography (QCA) was used to identify the lesion length and severity of stenosis. The severity of CAD was quantified by GENSINI score, the number of diseased vessels and the number of significant lesions. Results: The mean Ankle-Brachial Pressure index (ABI) for the sample was 0.908±0.31 (range 0- 1.53), the mean GENSINI score was 44.02±40 (range 0-148), GENSINI score was zero in 30 (20%) patients, 40 (26%) were having no diseased vessel, 41(27%) having single, and 43 (28.7%) double and 26 (17%) triple vessel disease. ABI was inversely related to the extent of CAD assessed by GENSINI (p-value 0.015), number of diseased vessels (p-value 0.009), and number of significant lesions (p-value 0.021). ABI < 0.9 was recorded in 51 patients (34%) and a low ABI was an independent factor for a higher GENSINI scores (p-value 0.043) and a higher number of diseased vessels (p-value 0.0001). Patients who were referred with PAD were found to have significantly lower ABI than the rest of the sample (p=0.0001), and a coexisted CAD was detected in 15 out of 20 (75%) patients. Conclusions: ABI was a useful bedside clinical test that predicts the severity of the CAD in patients who are already suffering from or suspected to have ischemic heart disease

The effect of Valsalva maneuver on diastolic filling indices in patients with essential hypertension.

Background: Left ventricular hypertrophy and diastolic dysfunction are considered to be an important risk factor for cardiovascular morbidity and mortality in asymptomatic hypertensive patients. At the bedside, left ventricular geometric remodeling and diastolic dysfunction in hypertension can not be diagnosed without echocardiography which is a useful adjunct to the medical history, physical examination, ECG, and chest radiography. Hence, it provides an opportunity for good management and prognosis of what appears to be preclinical hypertensive complication.  Subjects and Methods: 127 subjects with essential hypertension of either sex attending echo unit were subjected to medical history, clinical examination, physical measurements, ECG, M-mode and Doppler echocardiography. They were classified as 46 treated hypertensives where they were on regular antihypertensive medication, and 81 untreated hypertensive patients. In addition, they were sex and age matched to 39 healthy subjects who served as control group.  Results: The results of this study revealed that hypertensive patients especially those with stage II hypertension were prone to develop left ventricular hypertrophy (LVH) of concentric geometric pattern and diastolic dysfunction. However, small percentage of those patients found to have diastolic dysfunction despite they were without LVH. In addition, Doppler echocardiography clarify that hypertensives with abnormal transmitral inflow profile; of left ventricular impaired relaxation pattern suffered left ventricular systolic dysfunction. Moreover, in this study there was no evidence of  pseudonormal transmitral inflow filling pattern which is excluded after Valsalva maneuver. Conclusion: There is a strong association between left ventricular hypertrophy and diastolic dysfunction which was more common in patients with stage II hypertension. However, left ventricular diastolic dysfunction is usually follows left ventricular hypertrophy, but it still may proceed especially in those patients with left ventricular hypertrophy (LVH) of concentric geometric pattern. In addition, left ventricle diastolic dysfunction is not necessary coincide with the development of systolic dysfunction, namely normal ejection fraction and fractional shortening