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Article
Left Ventricular Dysfunction in Breast Cancer Patients Receiving Trastuzumab: An Observational Study in a Cohort of Iraqi Breast Cancer Patients
أنخفاض وظيفة البطين الأيسر لدى مرضى سرطان الثدي المعالجين بعقار التراستوزوماب

Author: Musaab R. Al-Bayati الدكتور مصعب راجي البياتي
Journal: Thi-Qar Medical Journal مجلة ذي قار الطبية ISSN: 19929218 Year: 2018 Volume: 15 Issue: 1 Pages: 105-113
Publisher: Thi-Qar University جامعة ذي قار

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AbstractBackground : Cardiotoxicity is a well recognized adverse event of trastuzumab. This study was designed to evaluate the frequency of decline in left ventricular ejection fraction (LVEF) to less than 50% in patients with breast cancer who have received trastuzumab in a daily practice setting. Methods : Retrospective observational study of 116 patients with HER2 positive breast cancer treated with trastuzumab in one center between May 2012 and January 2017. Results : Left ventricular ejection fraction decline to less than 50% was observed in 7 patients (6%). Patients above 70 years of age have the highest frequency of LVEF decline (33%). All events of LVEF decline was reported in the first six months of treatment. Prolonged administration of trastuzumab beyond one year was not associated with adverse cardiac events. Previous anthracycline exposure and chest irradiation was not found to be associated with LVEF decline. Conclusions : Events of LVEF decline to less than 50% associated with trastuzumab use seems to be slightly higher in general daily practice than in clinical trial setting, especially in patients above 70 years, calling for better patient selection. First year of trastuzumab therapy carries the highest risk of cardiac events which necessitates a close cardiac monitoring, thereafter, periodic LVEF measurements can be reduced to reduce the costs.


Article
FREQUENCY OF LEFT VENTRICULAR SYSTOLIC DYSFUNCTION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS
تواتر ضعف البطين الأيسر الأنقباضي المزمن عند مرضى انسداد مجرى المسالك التنفسية المزمن

Authors: SABAH H. IBRAHIM صباح ابراهيم --- HUSSEIN M. JUMAAH حسين جمعة --- DHAHER J. AL-HABBO ظاهؤ الحبو --- FAKHIR Y. HUSSEIN فخري حسين
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2011 Volume: 5 Issue: 2 Pages: 51-59
Publisher: University of Dohuk جامعة دهوك

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Abstract

Background and objectives To determine the frequency of left ventricular systolic dysfunction in chronic obstructive airway disease patients and its relation to age, gender, duration of smoking and other factors.Methods A case series study of forty two chronic obstructive airway disease patients (mean age 63.64±10.21 years) were studied for assessment of left ventricular systolic dysfunction using 2D and M-mode echocardiography with assessment of ejection fraction for all patients.Assessment of clinical parameters and biochemical parameters. The age and gender of the patients were assessed. Duration of smoking and the number of pack per year were also calculated. The study was carried out in the respiratory care unit and general medical units of Ibn-Sina Teaching Hospital.Results Forty two chronic obstructive airway disease patients 36 males (85.7%) and 6 (14.3%) females (mean age 63.64±10.21 years), were studied for assessment of left ventricular ejection fraction. Among the 42 patients only 9 (21.4%) had left ventricular ejection fraction with 2(22.2%) among females and 7 (77.8%) among males, (p= 0.382), The Mean age of left ventricular ejection fraction group was found to have no significant correlation at (p=0.442). Age compared with the groups of left ventricular ejection fraction, this correlation was not significant ( p=0.267). The mean duration of smoking and pack years showed no significant association with left ventricular ejection fraction (p=0.618 and p=0.348 respectively). Patients characteristics show no sensible statistical correlation to LVSF (p =0.338), (p =0.42, p =0.26), (p=0.163, p=0.288, p=0.463) in sequence.Conclusions The frequency of left ventricular systolic dysfunction in chronic obstructive airway disease patients was 21.4 %. Age, duration of smoking and pack years in addition to other patient’s characteristics didn't demonstrate a significant relation to left ventricular systolic function in chronic obstructive airway disease patient. More sophisticated tools should be used for evolution of left ventricular systolic dysfunction in chronic obstructive airway disease patients.

خلفية واهداف البحث: تحديد تواتر خلل البطين الأيسر الانقباضي في مرضى انسداد مجرى المسالك التنفسية المزمن، وعلاقته بالعمر والجنس للمرضى ودراسة تاثيرمدة التدخين وعوامل أخرى على هذا الفحص.طرق البحث: تم دراس ة 42 مريضا يعانون من مرض انسداد مجرى المسالك التنفسية المزمن ،متوسط أعمارهم مع تقييم معلمات (D2 and M Mode) 10.21 سنة)، لتقييم خلل البطين الأيسر الانقباضي، وذلك باستخدام ±63.64) الكيمياء الحيوية والفحوصات السريرية ومتغيرالعمر .جرى تقييم المرضى من الجنسين . وتم احساب تاثير مدة التدخين. أجريت الدراسة في وحدة العناية التنفسية والوحدات الطبية العامة لمستشفى ابن سينا،وقد تم احتساب تاثير هذه تم ( SPSS المتغييرات مع وظيفة البطين الأيسر الانقباضي . تم إجراء التحاليل الإحصائية بواسطة برنامج ( 16 ذات دلالة ( P < حسب الحاجة، وتعتبر قيمة ( 0.05 ANOVA استخدام اختبار كاي سكوير بالاضافة الى اختبار إحصائية معنوية.النتائج: تم دراسة اثنين وأربعين مريضا يعانون من مرض انسداد مجرى المسالك التنفسية المزمن. 36 ذكور 10.21 سنة. لتقييم خلل البطين الأيسر الانقباضي بين ± 14.3 %) إناث. متوسط اعمارهم 63.64 ) ٪85.7 ) و 6 ) 21.4 %) يعاني من خلل البطين الأيسر الانقباضي مع 2 ) المرضى بينت النتائج ان من بين 42 مريض سوى 9 متوسط اعمار . (P= 77.8 ) من بين الذكور وكانت قيمة الارتباط ( 0.382 %) ٪22.2 ) من بين الإناث و 7 ) العمرو مقارنة مع مجموعات .(P= مجموعة خلل البطين الأيسر الانقباضي ليست ذات ارتباط معنوي كبيرة ( 0.442 التدخين لم تظهر له أي .P= مرضى خلل البطين الأيسر الانقباضي ، ليست ذات ارتباط معنوي كبيرة 0.267 على التوالي . خصائص المرضى لم تظهر أي علاقة معنوية احصائية = (P= ارتباط معنوي ايظا مع ( 0.348على التوالي. (P = 0.463 ،P = 0.288 ، ع (= 0.163 ، ( P ، 0.26 = (ع = 0.42 ،(0.338 .٪ الاستنتاجات: تواتر خلل البطين الأيسر الانقباضي عند مرض انسداد مجرى المسالك التنفسية المزمن كان 21.4 من المرضى، مدة التدخين عمر المرضى بالاضافة الى عمر وجنس المرضى لم تثبت وجود علاقة معنوية كبيرة مع في LVSD عند مرضى انسداد مجرى المسالك التنفسية المزمن. وينبغي استخدام أدوات أكثر تطورا لفحص LVSF المرضى الذين يعانون من انسداد مجرى المسالك التنفسية المزمن.


Article
Effect of carvedilol on echocardiographic ejection fraction and fraction shortening in doxorubicin treated females with breast cancer

Authors: Hashim Mahdi Hashim هاشم مهدي هاشم --- Adeeb Ahmad Al-Zubaidy اديب احمد الزبيدي --- Sameer Hassan Abboud Al-Rekabi سمير حسن عبود
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2012 Volume: 8 Issue: 13 Pages: 133-142
Publisher: Al-Qadisiyah University جامعة القادسية

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Background : Doxorubicin based regimen is the most common treatment of breast cancer which is highly complicated by cardiotoxicity.Aim : To clarify the possible effects of carvedilol on echocardiographic ejection fraction and fraction shortening in doxorubicin based regimen in females with breast cancer.Patients and Methods : A total of 16 females with breast cancer were included in this study. The patients were randomized into 2 groups , 8 patients each. Group I included patients were treated with doxorubicin based regimen for 6 cycles with 21 day apart. Group II included patients were received doxorubicin based regimen with carvedilol 3.125 mg , orally , twice daily for 5 days , for 6 cycles. Echocardiography was done to measure ejection fraction and fraction shortening at zero time and 3 days after 2nd , 4th and 6th cycles.Results: Treatment with CAF regimen caused highly significant decrease in echocardiographic ejection fraction and fraction shortening after 2nd , 4th and 6th cycles in comparison to baseline readings ( P < 0.01 ). Combined CAF + Carvedilol 3.125 mg orally twice daily for 5 days caused highly significant increment in echocardiographic ejection fraction and fraction shortening compared with that of CAF regimen group ( P < 0.01 ).Conclusion: Carvedilol causes significant increase in echocardiographic ejection fraction and fraction shortening in doxorubicin treated patients.

يعتبر النظام العلاجي المعتمد على الدوكسوروبوسين من أكثر العلاجات استخداما لعلاج سرطان الثدي والذي قد يتسبب بتسمم القلب.هدف الدراسة هو لتوضيح أمكانية تأثير عقار الكارفيديلول على الجزء المقذوف والاختصار الجزئي في فحص صدى القلب لدى النساء المصابات بسرطان الثدي اللواتي يستخدمن عقار الدوكسوروبوسين.شاركت 16 امرأة تعاني من سرطان الثدي في هذه الدراسة . وزعت المريضات عشوائيا إلى مجموعتين , كل مجموعة تحوي على 8 مريضات . تضمنت المجموعة الأولى مريضات تم علاجهن بعقار الدوكسوروبيسين لست دورات مفصولة بواحد وعشرين يوما , أما المجموعة الثانية فقد احتوت على مريضات تم علاجهن بعقاري الدوكسوروبيسين + الكارفيديلول 3,125 ملغم عن طريق الفم , مرتان يوميا لمدة 5 أيام بعد كل جرعة من الدوكسوروبوسين لست دورات. تم قياس الجزء المقذوف والاختصار الجزئي عن طريق أجراء فحص صدى القلب لكل مريض قبل ( وقت صفر ) وبعد 3 أيام من وقت الجرعة الثانية والرابعة و السادسة.تم الحصول على النتائج التالية:1- سبب النظام العلاجي المعتمد على الدوكسوروبوسين نقصان معنوي عالي في الجزء المقذوف والاختصار الجزئي في فحص صدى القلب بعد الجرعة الثانية والرابعة والساسة مقارنة مع القراءات الأولية.P < 0.01 2- سبب استخدام الكارفيديلول مع الدوكسوروبوسين زيادة معنوية عالية في الجزء المقذوف والاختصار الجزئي في فحص صدى القلب مقارنة مع استخدام الدوكسوروبوسين فقط. P < 0.01 ,من هذه الدراسة , يمكن أن نستنتج بان عقار الكارفيديلول يسبب زيادة معنوية عالية في الجزء المقذوف والاختصار الجزئي لدى المريضات المصابات بسرطان الثدي اللواتي يستخدمن نظام علاجي المعتمد على الدوكسوروبوسين.


Article
The Effects of Ferrous Sulfate as an Iron Supplement on Ejection Fraction in Patients with Iron Deficiency Anemia Associated with Decompensated Heart Failure

Author: Mohammed Qasim Yahya Mal‑Allah Al‑Atrakji
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2018 Volume: 17 Issue: 1 Pages: 22-28
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Acute decompensated heart failure (HF) is a clinical syndrome that results when abnormalities in the structure and functionof the myocardium impair cardiac output or decrease filling of the ventricles. Anemia is a common comorbidity in patients with chronicHF (CHF), is associated with increased disease severity, and may contribute to a worse the outcome. Aim of the Study: To study the relationship between iron level and left ventricular function (LVF) in patients having acute decompensated HF and the effects of iron supplement on thisfunction. Patients and Methods: This cross‑sectional study was conducted in the medical wards of Baghdad Teaching Hospital at differenttimes during the period between October 1, 2016, and May 1, 2017. It included 60 patients diagnosed with CHF (9 patients with HF withpreserved ejection fraction [EF] and 51 patients with HF with reduced EF) and admitted to the medical wards due to acute decompensation.For all patients, history, cardiological examination, New York Heart Association classification, electrocardiogram, and chest X‑ray weredone. Body mass index was measured. Standard echocardiography was performed. Hematological parameters were measured includinghemoglobin (Hb), mean corpuscular volume, mean corpuscular Hb (MCH), MCH concentration, blood film, serum iron, erythrocyte count,total iron‑binding capacity, and transferrin saturation. Results: Serum iron was significantly lower in patients with impaired EF with medianserum iron 41 versus 94 mcg/dL in preserved EF (72.5% vs. 0%). Transferrin saturation was statistically and significantly lower in patientswith EF <50% (39.2% of the patients with impaired EF had low transferrin saturation [P < 0.001] compared to 0% in patients with preservedEF). EF had inverse significant correlation with total binding capacity of iron (r = −0.585, P < 0.001). Iron supplements as ferrous sulfatehave a highly significant effect (P < 0.001) on improving the LVF and EF, iron level and transferrin saturation in patients with decompensatedHF with low EF. Conclusions: Most HF patients with low EF in this study had reduced iron level and transferrin saturation comparing tothose with preserved EF. Iron supplement in a patient with low EF preserved the EF in them. Anemia still is founded in patients of HF withacceptable EF in the presence of normal iron status, and this is explained by other causes rather than iron deficiency


Article
The Prognostic Value of the Left Ventricular End Diastolic Volume, Ejection Fraction and the Development of Dyarrhythmia in Ischemic Heart Disease.

Author: Basil N. Saeed* MRCP, MD, FACC د. باسل نجيب سعيد
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2009 Volume: 51 Issue: 4 Pages: 345-347
Publisher: Baghdad University جامعة بغداد

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Summary:Background: Study the correlation between the left ventricular end diastolic volume (LVEDV), ejection fraction (EF) and the development of arrhythmia. Patients and methods: Two hundreds patients with documented acute coronary syndrome and myocardial infection with dysrhythmia documented by ECG and holter monitoring assessed at the cardiac department at Baghdad teaching hospital over the period Jan-Dec 2007. These dysrhythmias were corelated with left ventricular end diastolic volume and ejection fraction. Results: The patients were divided into 4 groups according to LVEDD and EF. The 1st group, 40 patients (20%) found to have non sustained ventricular tachycardia was associated with higher LVEDD (62-72mm) and low EF (30-39%) in comparison with other groups. A 2nd group of 80 patients (40%) have occasionally ventricular ectopic, their left ventricular end diastolic dimension is (52-58 mm) and ejection fraction in higher than the 3rd group 10 patients (5%) who had atrial fibrillation were having normal left ventricular end diastolic volume but ejection fraction was 45%. A 4th group of 40 patients (20%) were having occasional atrial ectopic have both normal ejection fraction and left ventricular end diastolic volume, the remaining 30 patients (15%) from the total did not develop any arrhythmia and their left ventricular end diastolic volume and ejection fraction were normal considered an control groups. Conclusion: It was found that the development of arrhythmia is very significantly correlated with the abnormal increased left ventricular end diastolic volume and more lowering of ejection fraction.Key wards: Arrhythmia left ventricular end diastolic volume, ejection fraction.


Article
Renal Dysfunction in Patients with Heart Failure

Author: Jawad K. Manuti جواد كاظم
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 2 Pages: 129-131
Publisher: Baghdad University جامعة بغداد

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Background: The coexistence of renal and heart failure carries an extremely bad prognosis. The exact cause of deterioration of kidney function and the mechanism underlying this interaction are complex, multifactorial in nature, and still not completely understood. Both the heart and the kidney act in tandem to regulate blood pressure, vascular tone, diuresis, natriuresis, etc.Patients and methods: Sixty patients mean age 65.5 year were complaining heart failure duo to different causes assessed for renal function (blood urea &creatinine) and cardiac function by echocardiography in day 0 and 10 day after treatment of heart failure.Results: The mean value (±S.D) of blood urea and serum creatinine on day 0 were 64.17mg/dL (±30.72) and 1.75mg/dL(±0.68) respectively. There is significant correlation between the severity of heart failure and the degree of renal impairment (P.value <0.05). after 10 days of treatment there was improvement in symptoms of heart failure but no significant correlation was found between the improvement of cardiac function and renal failure after 10 days treatment(51% patients has high blood urea>43mg/dL after 10 days&58% patients has high creatinine after 10 days although improvements in ejection fraction)(P.value >0.05).Conclusion: Renal dysfunction is common in heart failure and has strong prognostic value. the classical treatment of heart failure dose not improve renal dysfunction duo to intrinsic renal disease, renal vascular disease , nephron loss (age, renal disease), inadequate renal perfusion, hypovolemia, inadequate cardiac output ( vasoconstriction/pump failure), hypotension , abnormally high central venous pressure and by drug induced e.g.( ACEI, ARB). So patients were advice to take adenosine, A1receptor blocker, vasopressin antagonists, other intervention include earlier use of dialysis and ultrafiltration and left ventricular assist devices.Keywords: Renal impairment, heart failure, ejection fraction, urea, creatinine.


Article
Physiological and Biochemical Changes in Acute Heart Failure as A Sequent to Acute Myocardial Infarction

Author: Ghafil Saihood Hassan
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 1 Pages: 91-98
Publisher: Babylon University جامعة بابل

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Acute heart failures (AHF) can develop after acute myocardial infarction (AMI) early or later. It is a major cause of mortality especially in old age. The aim of current study was to detect the site of infarction in AHF patients, evaluation of parameter of AHF and comparison with control group. The present study was done in Marjan Medical City, Hilla, at cardiac center unit. Thirty (30) random patients of AHF sequent to AMI. They include (19male, 11female). The random control subjects include 30 healthy persons (20 male, 10 female) with matching age. The ages of both groups were 50 – 80 years. All patients were diagnosed by a specialist doctor. Medical history, physical examination, echocardiography, electrocardiography blood pressure measurement, body mass and laboratory tests (Serum troponin T and I, serum potassium, serum calcium and serum sodium) are performed to all subjects.The incidence of DM, HT, and smoking in AHF were 56.7%,60%, and 73% respectively. The serum troponin T, serum troponin I, serum calcium, were increased significantly while serum potassium, serum sodium and EF were decreased significantly in AHF compared to control group. The most common site of infarction in AMI with AHF was anterior infarction. Parameters of AHF were increased significantly (HR, serum troponin T, serum troponin I, and serum calcium)while other parameters were decreased significantly (serum potassium, serum sodium, and ejection fraction) were decreased significantly compared with control group.


Article
Early Detection of Left Ventricular Systolic Dysfunction in Asymptomatic Patients with Chronic Aortic Regurgitation by two Dimensional Speckle Tracking Echocardiography
الكشف المبكر للخلل الوظيفي لعمل البطين الايسر الانقباضي في المرضى المصابين بارتجاع الصمام الابهر المزمن غير ذوي الاعراض باستخدام صدى القلب ثنائي الابعاد ذي التتبع النقطي

Author: 1Amal N. Al-Marayati, 2Thamer I. Al-Jawahiri د.امال نوري المراياتي, د.ثامر الجواهري
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2018 Volume: 14 Issue: 2 Pages: 35-42
Publisher: Baghdad University جامعة بغداد

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Background: Early detection of subclinical left ventricular (LV) systolic dysfunction is crucial and could influence patients' prognosis by aiding the clinician to candidate patients for better management.Objective: To detect early LV systolic dysfunction in asymptomatic patient with chronic aortic regurgitation by two dimensional speckle tracking echocardiography. Methods: Sixty one asymptomatic patients with chronic aortic regurgitation, with no ischemic heart diseases (by coronary angiography) or conductive heart diseases, no diabetes mellitus, no hypertension, and no other valvular heart diseases (group 1) and fifty age and sex-matched healthy subjects (group 2) were enrolled into the study. Group (1) was further classified into 3 sub-groups according to 4 chosen parameters from the published guidelines of American Society of Echocardiography (ASE) into: Mild AR, Moderate AR, and Severe AR. All patients and controls underwent echocardiographic examination including conventional echocardiography, tissue Doppler study and Two Dimensional (2-D) Speckle Tracking Echocardiography.Results: GLS showed the highest sensitivity and specificity in detection of subtle LV systolic dysfunction in moderate AR. In moderate AR,a cut off value of > (-19.62) has sensitivity and specificity of 91.3% and 95.5% respectively, with Positive Predictive Value (PPV) and Negative Predictive Value ( NPV ) of 87.5% and 96.9% respectively, Area under curve (AUC) of 0.981. In all types of AR, GLS had higher NPV than PPV which makes it a powerful screening tool for early detection of subtle LV systolic dysfunction.Conclusion: Global Longitudinal strain measured by 2-D speckle tracking echocardiography is an excellent tool for early detection of subtle LV systolic dysfunction in asymptomatic patients with chronic AR.

خلفية الدراسة : ان الكشف المبكر للخلل الوظيفي لعمل البطين الايسر الانقباضي ذاو اهمية في مساعدة الاطباء لمعرفة حالة المريض المستقبليةالهدف : الكشف المبكر للخلل الوظيفي لعمل البطين الايسر الانقباضيطرق العمل: أجريت هذه الدراسة في المركز العراقي لأمراض القلب ، مسشفى اليرموك التعليمي و مستشفى بغداد التعليمي .لقد شملت الدراسة 61 مريضا ًيعانون من مرض ارتجاع الصمام الابهري المزمن غير ذوي الاعراض والعلامات، خالين من امراض القلب الاقفارية أو التوصيلية وخالين من داء السكري او إرتفاع ضغط الدم أو أمراض صمامات القلب الأخرى حيث أعتبرت هذه المجموعة رقم (1) وكذلك شملت الدراسة 50 شخصا سليما مطابقين من حيث العمر والجنس حيث اعتبرت هذه المجموعة رقم (2) ثم قسمت المجموعة رقم (1) الى ثلاثة مجاميع فرعية استناداً الى أربع خصائص لتحديد شدة الارتجاع مأخوذه من القواعد التوجيهية المنشورة للجمعية الامريكية لصدى القلب الى :-ارتجاع أبهري قليل الشدة ، ارتجاع أبهري متوسط الشدة وارتجاع أبهري كبيرالشدة. طرق العمل :تم اجراء فحص صدى القلب التقليدي ، فحص الدوبلر النسيجي وفحص صدى القلب ثنائي الابعاد من خلال تتبع النقط لجميع المرضى والاشخاص السليمين . النتائج: كان الاجهاد الطولي الشامل اكثر حساسية وخصوصية للكشف المبكر لاختلال عمل البطين الأيسر الأنقباضي .فبالنسبة للارتجاع الأبهري المتوسط الشدة فإن القيمة الفاصلة للاجهاد الطولي الشامل والتي مقدارها > -19.62% لديها قيمة حساسية وخصوصية قدرها 91.3 % و95.5% على الترتيب مع قيمة تنبؤية ايجابية وقيمة تنبؤية سلبية قدرها 87.5 % و96.9 % على الترتيب وقيمة مساحة تحت المنحني مقدارها 0.981% وقيمة احتمالية اقل من 0.0001. وفي جميع أنواع إرتجاع الصمام الأبهري كان للاجهاد الطولي الشامل قيمة تنبؤية سلبية أعلى من القيمة الايجابية مما يجعله أداة قوية لغربلة حالات إرتجاع الصمام الأبهري. كل ذلك يشير الى ان الاجهاد الطولي الشامل المقاس بواسطة صدى القلب ثنائي الابعاد ذوالتتبع النقطي هو وسيلة ممتازة لغرض الكشف المبكر عن خلل وظيفة القلب الانقباضية في المرضى الذين يعانون من ارتجاع الصمام الابهري المزمن غير ذوي الاعراض.


Article
Prevention of hypotension associated with the induction dose of remifentanil in open heart surgery for low ejection fraction patients, in Kurdistan region, Iraq

Author: Othman Ismat Abdulmajeed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2019 Volume: 23 Issue: 2 Pages: 283-289
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Hypotensive attacks commonly occur during induction of anesthesia and can result in irreversible ischemic damages to the vital body organs. This study aimed to assess the effect of using ephedrine at low doses in controlling hemodynamic changes induced by anesthesia.Methods: A single centered single-blinded, prospective comparative study was conducted in Erbil cardiac center in periods between January 2018 and July 2018. A total of 150 patients with left ventricular ejection fraction <40% and age younger than 80 years were included in this study. They were divided into three main groups; the 1st group was the placebo group, the 2nd group received ephedrine at a dose of 0.035mg/kg body weight, and the 3rd group received ephedrine at a dose of 0.07 mg/kg body weight. Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and heart rate were reported in three different phases; before induction, two minutes after induction, and five minutes after induction of anesthesia.Results: In the placebo group, induction of anesthesia by 3mcg/Kg of remifentanil significantly reduces diastolic, systolic, and mean arterial pressure with P <0.001. At two minutes after using ephedrine at the dose of 0.035 mg/kg in the induction of anesthesia significantly increases the diastolic, systolic, and mean arterial pressure with P = 0.002, <0.001, and 0.007, respectively, and at five minutes after induction with P = 0.02, 0.03, and 0.04, respectively. Using ephedrine at a dose of 0.07mg/kg induction of anesthesia was found to significantly increase the diastolic, systolic, and mean arterial pressure with P <0.001 for all the readings. The heart rate was not significantly affected by using remifentanil alone or in combination with ephedrine during induction of anesthesia.Conclusion: Using ephedrine at different doses during induction of anesthesia with remifentanil in patients with low ejection fraction significantly prevents hypotensive attacks.


Article
Study of Minor Echocardiographic Indices of Cardiac Systolic Function in Subjects with Normal Ejection Fraction and Correlation with Age

Authors: Ali Jasim Mhaimeed Al-Sultani --- Ali Jaber Al-Mamoori --- Basim Mohammed Madloom
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 1 Pages: 156 -161
Publisher: Babylon University جامعة بابل

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Abstract

Many echocardiographic parameters should be added to traditional cardiac examination beside the EF (ejection fraction) as some conditions are with subclinical systolic dysfunction in spite of normal EF. To study the minor echocardiographic cardiac systolic function indices in subjects with normal ejection fraction and correlation with age.Sixty five healthy subjects with normal resting ejection fraction were involved in this study. They were divided into two age groups, group1: 40 subjects with age range (20-39) year and group2: 25 subjects with age range (40-60) year. Measurement of stroke volume index, pre ejection period, left ventricular ejection time and pre ejection period / ventricular ejection time ratio were done. There were no significant difference of stroke volume index, pre ejection period, ventricular ejection time , and pre ejection period / ventricular ejection time ratio of the two age groups. Correlation study between stroke volume index and ventricular ejection time show significant positive correlation (r=0.5478, p<0.05) and negative correlation with pre ejection period but statistically nonsignificant (r=-0.0111,p>0.05) . Correlation study between stroke volume index and pre ejection period / ventricular ejection time ratio was negative correlation but statistically nonsignificant (r= -0.2139,p>0.05). Minor echocardiographic indices of cardiac systolic function (systolic time periods) during routine echocardiographic examination are effortless and informative and not affected by aging and should be added to traditional cardiac examination beside the ejection fraction as some conditions are with subclinical systolic dysfunction in spite of normal EF.

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