Systolic and diastolic heart function in SLE patients.

Cardiovascular pathology is frequent in systemic lupus erythematosus (SLE). Left ventricular (LV) diastolic dysfunction is its common findings. The aim of the study was to assess the systolic and diastolic function of the left ventricle (LV) in SLE patients without clinically evident cardiovascular disease, using pulsed Doppler echocardiography. Another purpose was to estimate whether there is a correlation between the duration and severity of SLE and the degree of LV diastolic dysfunction. A comparison of the average values of echocardiographic measurements was made between the SLE group and control group, which constituted healthy volunteers. No statistically significant differences in systolic heart function between groups were observed, except for lower values of the fractional shortening (SF 35.9 +/- 1.2 and 37.1 +/- 0.9, P = 0.01) in SLE patients, particularly in long (more than 10 years) disease duration (34.9 +/- 0.6 vs. 37.0 +/- 0.8, P < 0.005) and the value of SLE Disease Activity Index (SLEDAI) higher than six points (35 +/- 0.9 vs. 37.1 +/- 0.5, P < 0.01) Left atrial end-systolic diameter (LA) was greater (3.69 +/- 0.37 vs. 3.5 +/- 0.28, P < 0.05) and the ejection fraction (EF) was lower (64.6 +/- 1.5 vs. 66.3 +/- 1.3, P < 0.05) in SLE subjects of long disease duration than in the controls. SLE patients demonstrated significantly higher late diastolic velocity (A') and lower E'/A' ratio than the control group. No differences were observed in A' values between SLE subset of short disease duration and the controls. Isovolumetric relaxation time in turn was significantly longer and E/A ratio as well as E'/A' ratio lower in SLE of long disease duration versus the short one. In older patients, peak velocity at the time of atrial contraction (A) and A' values were higher and peak early velocity wave (E), early diastolic velocity (E'), E/A ratio and E'/A' ratio lower than in the younger subset. Increased the value of SLEDAI correlated with increased A' and decreased E, E/A ratio and E'/A' ratio in SLE subjects. Further analysis concerning the strong connection of these parameters with patients' age, however, revealed no statistically significant correlation between SLEDAI values and LV diastolic function parameters. In long (>10 years) disease duration LV diastolic properties were worse.

Diastolic heart function in RA patients.

The results of some epidemiological studies point to the presence of an increased risk of cardiovascular disease (CVD), particularly atherosclerosis and congestive heart failure (CHF) in rheumatoid arthritis (RA). At least 50% of abnormalities remained asymptomatic. Pathological conditions contributing to myocardial dysfunction such as high serum levels of IL-6, C-reactive protein (CRP) and TNF alpha are present both in RA and CHF patients. The most common pathological mechanism leading to the development of heart failure is left ventricular (LV) diastolic dysfunction, which remains clinically asymptomatic for a long time. The aim of this study was to assess the systolic and diastolic functions of the LV in RA patients without clinically evident cardiovascular disease, using pulsed Doppler echocardiography. Our purpose was also to estimate whether there is a correlation between the duration and severity of RA and the degree of LV diastolic dysfunction. A comparison of the average values of echocardiographic measurements was made between the RA group and control group, which constituted healthy volunteers. Left ventricular mass index in RA group was significantly greater than in the control group (105.2 +/- 32.6 vs. 87.9 +/- 16.8; p < 0.05) so were the interventricular septum end-diastolic thickness (1.01 +/- 0.33 vs. 0.86 +/- 0.12; p < 0.05), the LV posterior wall end-diastolic thickness (0.94 +/- 0.08 vs. 0.83 +/- 0.11; p < 0.0001) and the aortic root diameter (3.18 +/- 0.31 vs. 3.10 +/- 0.63, p < 0.001). The ejection fraction in RA group was significantly lower than in the control group (64.4 +/- 1.3 vs. 66.3 +/- 1.3; p < 0.0001). The assessment of diastolic function parameters revealed significantly longer isovolumetrc relaxation time (IVRT) and shorter deceleration time (DT) in RA patients compared to the control group. Patients in stage II or III revealed significantly lower LV mass index (99 +/- 17 vs. 131 +/- 42; p < 0.05) and the interventricular septum end-diastolic thickness (0.94 +/- 0.10 vs. 1.28 +/- 0.5; p < 0.05) than those in stage IV. Mean aortic diameter was significantly greater in individuals in stages III and IV (3.73 +/- 0.28) than in the stage II of the disease (2.77 +/- 0.21), p < 0.05. No differences in echocardiographic parameters' values were observed between seropositive, seronegative, nodule-present and nodule-absent persons. Echocardiographic examination revealed valvular heart disease in 24 (80%) RA and 6 (20%) control patients (p < 0.0001).

Echocardiographic findings and 24-h electrocardiographic Holter monitoring in patients with nodular and non-nodular rheumatoid arthritis.

Echocardiographic examination and 24-h electrocardiographic Holter monitoring were carried out on 35 patients with nodular rheumatoid arthritis (RA) and 35 with non-nodular RA, who were matched with the nodular RA group regarding age, sex and BSA. A further 35 patients with osteoarthrosis and spondyloarthrosis matched, with both RA groups, constituted a control group. Patients with a history of myocardial infarction, hypertension, rheumatic fever and diabetes were excluded from the study. Cardiac involvement, evaluated using echo-Doppler cardiography, 24-h electrocardiographic Holter monitoring and ECG at rest, occurred in 25 (71.9%) patients with nodular RA and in 15 (42.9%) with non-nodular RA in comparison to 8 (22.9%) control group patients (P < 0.0002). Holter electrocardiographic monitoring over 24 h did not present any essential differences in frequency of rhythm disorders between the examined groups and the control group. However, it revealed more patients with 1-mm ST depression in the nodular RA group than in the non-nodular and control groups. Echocardiographic examination revealed more cases of valvular heart abnormalities, especially those of mitral insufficiency, in nodular RA patients than in non-nodular and control patients. Both a mitral valve prolapse and a pericardial effusion were noted in 8.6% of nodular RA patients. Patients with nodular RA were noted to have a bigger aortic root diameter, but smaller ejection fraction, mean velocity of circumferential fibre shortening and fractional shortening in comparison to non-nodular and to control group patients.

Echocardiographic findings, 24-hour electrocardiographic Holter monitoring in patients with rheumatoid arthritis according to Steinbrocker's criteria, functional index, value of Waaler-Rose titre and duration of disease.

Electrocardiographic (ECG) and echocardiographic examinations and 24-h ECG Holter monitoring were carried out in 100 patients (age < 65 years) with rheumatoid arthritis (RA) of stages II-IV according to Steinbrocker's criteria. One hundred patients with osteoarthrosis, spondyloarthrosis and painful shoulder matched for age, sex and body surface area constituted the control group. All patients with myocardial infarction, hypertension, rheumatic fever or a history of diabetes were excluded. Cardiac involvement, evaluated by echo-Doppler cardiography, 24-h ECG Holter monitoring and an ECG at rest, occurred in 52 (52%) patients with RA and in 23 (23%) control group patients (p < 0.0005). In the RA group ECG examination, 1 mm ST depression in at least two consecutive leads was observed more frequently, and occurred statistically more frequently for the highest stage of RA according to Steinbrocker's criteria, highest level of functional index and longer duration of disease. The 24-h Holter ECG monitoring did not show any differences in frequency of rhythm disorders between the RA group and the control group. However, silent myocardial ischaemia episodes appeared more often in the RA group. An ECG examination revealed more cases of valvular heart disease, especially mitral insufficiency, in RA patients than in the control group. A mitral valve prolapse was noted in 6% of patients and a pericardial effusion in 4% of patients. Patients with RA were noted to have a larger diastolic left ventricular diameter and aortic root diameter, and smaller ejection fraction, mean velocity of circumferential fibre shortening and fractional shortening. The results of the examinations show that RA is associated with cardiac involvement in a significant proportion of cases.

The long term results of treatment of heart myxomas with special attention to very rare myxoma of the right ventricle.

Fifteen patients with cardiac myxomas, 13 in the left atrium, one in the right atrium and one in the right ventricle were treated surgically during a 15 years period with no hospital and no late deaths. Left atrial myxomas revealed symptoms of obstruction to blood flow in 100%, symptoms of constitutional effects in 55% and thromboembolic events in 23%. Diagnosis of left atrial myxomas was made before operation in eleven patients by echocardiography or angiography or by both methods. In two patients diagnosis of left atrial myxoma was made incidentally during cardiac surgery for mitral stenosis. 8 left atrial myxomas originated from septum and 5 from the wall. Removal of the myxoma with the portion of the septum or the wall was performed in 11 patients and direct suture was satisfactory in 9 cases. In 2 patients septum was repaired by pericardial patch. Septum was left intact in 2 patients. Follow-up period varied from 1/2 to 15 years, mean-above 8 years. Estimation of late results was achieved by 2-D echocardiography in every patients. Results remain very good, patients are in the NYHA class 1, examinations revealed no recurrences. Special attention was paid to very rare case of huge right ventricular myxoma demonstrating wide infiltration of the endocardium and involvement of the tricuspid valve, which was completely destroyed. The technique of endocardial decortication was used for removal of the myxoma and tricuspid valve had to be replaced. Three months after operation extreme obstruction of the artificial valve was recognized. During second operation valve was cleaned from the thrombus but also fragments of the myxoma probably left during first operation were removed by wider technique of endocardial decortication. Results after 15 years remains very good. Right ventricular myxoma being on the border of operability needs more aggressive technique than simple removing.

[Thrombi of the left ventricle, infarction location and method of treatment]. / Skrzepliny w lewej komorze a lokalizacja zawalu i sposób leczenia.

A study is reported of 63 patients treated in the Cardiology Department, Institute of Internal Diseases, MSW for acute myocardial infarction. They were divided into two groups: 21 patients w treated with intravenous streptokinase infusion and then with intravenous heparin, with simultaneous administration of nitroglycerin. The other group comprised 42 patients treated with nitroglycerin alone. On the basis of the mass of the infarcted tissue calculated from the curves of CK-MB levels, and echocardiography for assessment of the presence of left-ventricular clots and degree of impairment of cardiac wall contractility according to Heger a much more frequent occurrence was noted of clots in the left ventricle in patients treated with nitroglycerin only, but the volume of the infarcted tissue was not statistically significantly different between both groups.