Presystolic Wave is Associated with Subclinical Left Ventricular Dysfunction Assessed by Myocardial Performance Index in Type 2 Diabetes Mellitus.

BACKGROUND: Myocardial performance index (MPI), demonstrates both systolic and diastolic functions of the left ventricle. Presystolic wave (PSW) is frequently detected on Doppler examination of the left ventricular outflow tract and possible mechanism of PSW is impaired LV compliance and left ventricular stiffness. OBJECTIVE: To investigate the relationship between PSW and MPI in type 2 diabetic patients. METHOD: A total of 129 type 2 diabetic patients were included in this study. Patients were divided into two groups according to the presence of PSW on Doppler echocardiography. There were 90 patients (38 male, mean age 57.77 ± 10.91 years) in the PSW-positive group and 39 patients (13 male; mean age: 55.31 ± 11.29 years) in the PSW-negative group. The p values of < 0.05 were considered statistically significant. RESULTS: MPI was higher in PSW- positive group (0.63 ± 0.17vs 0.52 ± 0.13, p < 0.001). In addition, subclinical left ventricle dysfunction (LVD) was higher in the PSW- positive group (p = 0.029). Univariate analysis showed that the presence of PSW associated with abnormal MPI (p = 0.031). Pearson correlation analysis showed that PSW velocity correlated with MPI (r: 0.286, p = 0.006). CONCLUSION: Presence of the PSW on Doppler examination was associated with subclinical LV dysfunction in patients with DM type 2. This easy-to-perform echocardiographic parameter may be related to subclinical LVD among patients with type 2 DM.

Presystolic Wave is Associated with Subclinical Left Ventricular Dysfunction Assessed by Myocardial Performance Index in Type 2 Diabetes Mellitus / Onda Pressistólica Associada à Disfunção Ventricular Esquerda Subclínica e Avaliada com Base no Índice de Performance Miocárdica em Pacientes com Diabetes Mellitus Tipo 2

Abstract Background: Myocardial performance index (MPI), demonstrates both systolic and diastolic functions of the left ventricle. Presystolic wave (PSW) is frequently detected on Doppler examination of the left ventricular outflow tract and possible mechanism of PSW is impaired LV compliance and left ventricular stiffness. Objective: To investigate the relationship between PSW and MPI in type 2 diabetic patients. Method: A total of 129 type 2 diabetic patients were included in this study. Patients were divided into two groups according to the presence of PSW on Doppler echocardiography. There were 90 patients (38 male, mean age 57.77 ± 10.91 years) in the PSW-positive group and 39 patients (13 male; mean age: 55.31 ± 11.29 years) in the PSW-negative group. The p values of < 0.05 were considered statistically significant. Results: MPI was higher in PSW- positive group (0.63 ± 0.17vs 0.52 ± 0.13, p < 0.001). In addition, subclinical left ventricle dysfunction (LVD) was higher in the PSW- positive group (p = 0.029). Univariate analysis showed that the presence of PSW associated with abnormal MPI (p = 0.031). Pearson correlation analysis showed that PSW velocity correlated with MPI (r: 0.286, p = 0.006). Conclusion: Presence of the PSW on Doppler examination was associated with subclinical LV dysfunction in patients with DM type 2. This easy-to-perform echocardiographic parameter may be related to subclinical LVD among patients with type 2 DM.

Resumo Fundamento: O índice de performance miocárdica (IPM) avalia as funções sistólica e diastólica do ventrículo esquerdo. A onda pressistólica (OPS) é geralmente detectada no exame Doppler da via de saída do ventrículo esquerdo e seus possíveis mecanismos são complacência prejudicada e rigidez do ventrículo esquerdo. Objetivo: Investigar a relação entre OPS e IPM em pacientes com diabetes tipo 2. Método: 129 pacientes com diabetes tipo 2 foram incluídos no estudo. Os sujeitos foram alocados em dois grupos, com base na presença de OPS no exame ecocardiográfico com Doppler. Foram incluídos 90 pacientes (38 homens, idade média 57,77 ± 10,91 anos) no grupo OPS-positiva e 39 pacientes (13 homens; idade média 55,31 ± 11,29 anos) no grupo OPS-negativa. Valor de p < 0,05 foi considerado para significância estatística. Resultados: O IPM foi mais alto no grupo OPS-positiva (0,63 ± 0,17 vs 0,52 ± 0,13, p < 0,001). Além disso, a disfunção ventricular esquerda subclínica (DVE) foi maior no grupo OPS-positiva (p = 0,029). Análise univariada mostrou associação de OPS com IPM anormal (p = 0,031), assim como o coeficiente de correlação de Pearson mostrou correlação entre velocidade de OPS e IPM (r: 0,286, p = 0,006). Conclusão: Presença de OPS na ecocardiografia com Doppler foi associada à DVE subclínica em pacientes com diabetes tipo 2. Esse exame ecocardiográfico de fácil execução pode ser relacionado à DVE subclínica entre pacientes com diabetes tipo 2.

Presystolic Wave is Associated with Subclinical Left Ventricular Dysfunction Assessed by Myocardial Performance Index in Type 2 Diabetes Mellitus / Onda Pressistólica Associada à Disfunção Ventricular Esquerda Subclínica e Avaliada com Base no Índice de Performance Miocárdica em Pacientes com Diabetes Mellitus Tipo 2

Abstract Background: Myocardial performance index (MPI), demonstrates both systolic and diastolic functions of the left ventricle. Presystolic wave (PSW) is frequently detected on Doppler examination of the left ventricular outflow tract and possible mechanism of PSW is impaired LV compliance and left ventricular stiffness. Objective: To investigate the relationship between PSW and MPI in type 2 diabetic patients. Method: A total of 129 type 2 diabetic patients were included in this study. Patients were divided into two groups according to the presence of PSW on Doppler echocardiography. There were 90 patients (38 male, mean age 57.77 ± 10.91 years) in the PSW-positive group and 39 patients (13 male; mean age: 55.31 ± 11.29 years) in the PSW-negative group. The p values of < 0.05 were considered statistically significant. Results: MPI was higher in PSW- positive group (0.63 ± 0.17vs 0.52 ± 0.13, p < 0.001). In addition, subclinical left ventricle dysfunction (LVD) was higher in the PSW- positive group (p = 0.029). Univariate analysis showed that the presence of PSW associated with abnormal MPI (p = 0.031). Pearson correlation analysis showed that PSW velocity correlated with MPI (r: 0.286, p = 0.006). Conclusion: Presence of the PSW on Doppler examination was associated with subclinical LV dysfunction in patients with DM type 2. This easy-to-perform echocardiographic parameter may be related to subclinical LVD among patients with type 2 DM.

Resumo Fundamento: O índice de performance miocárdica (IPM) avalia as funções sistólica e diastólica do ventrículo esquerdo. A onda pressistólica (OPS) é geralmente detectada no exame Doppler da via de saída do ventrículo esquerdo e seus possíveis mecanismos são complacência prejudicada e rigidez do ventrículo esquerdo. Objetivo: Investigar a relação entre OPS e IPM em pacientes com diabetes tipo 2. Método: 129 pacientes com diabetes tipo 2 foram incluídos no estudo. Os sujeitos foram alocados em dois grupos, com base na presença de OPS no exame ecocardiográfico com Doppler. Foram incluídos 90 pacientes (38 homens, idade média 57,77 ± 10,91 anos) no grupo OPS-positiva e 39 pacientes (13 homens; idade média 55,31 ± 11,29 anos) no grupo OPS-negativa. Valor de p < 0,05 foi considerado para significância estatística. Resultados: O IPM foi mais alto no grupo OPS-positiva (0,63 ± 0,17 vs 0,52 ± 0,13, p < 0,001). Além disso, a disfunção ventricular esquerda subclínica (DVE) foi maior no grupo OPS-positiva (p = 0,029). Análise univariada mostrou associação de OPS com IPM anormal (p = 0,031), assim como o coeficiente de correlação de Pearson mostrou correlação entre velocidade de OPS e IPM (r: 0,286, p = 0,006). Conclusão: Presença de OPS na ecocardiografia com Doppler foi associada à DVE subclínica em pacientes com diabetes tipo 2. Esse exame ecocardiográfico de fácil execução pode ser relacionado à DVE subclínica entre pacientes com diabetes tipo 2.

Percentage of Memory B Lymphocytes and Regulatory T Lymphocytes in Peripheral Blood are Low but Not Predictive of Therapy outcomes in Newly Diagnosed Adult Patients with Primary Immune Thrombocytopenia.

Although changes in the number and function of regulatory T lymphocytes have been reported in primary immune thrombocytopenia (ITP), no study has investigated whether quantification of these cell types in peripheral blood could be used as early predictive marker of treatment outcome. And, it is not clear whether any change occurs in peripheral blood memory B lymphocyte levels in ITP. Hence, the aim of this study was to investigate the percentage of regulatory T lymphocytes and memory B lymphocytes in peripheral blood of ITP patients compared to controls, and also examine whether these levels have any significant predictive value for therapy outcome. A total of 20 newly diagnosed, untreated patients with ITP and 20 healthy controls were included. Flow cytometric analyses of lymphocyte subtypes in the peripheral blood were performed in specimens obtained from patients at the time of diagnosis and one month after the therapy initiation. First line corticosteroid (1 mg/kg/day methylprednisolone) therapy or splenectomy as second line treatment was performed, and patients were followed up for 3 years. Percentage of regulatory T lymphocytes (0.25 ± 0.17% vs. 1.14 ± 0.77%, P < 0.0001, n = 20) and percentage of memory B lymphocytes (1.57 ± 1.24% vs. 4.38 ± 2.41%, P < 0.001, n = 20) was significantly lower in ITP patients than healthy controls, at baseline. After one month therapy, the percentage of memory B lymphocytes of ITP patients significantly increased (from 1.66 ± 1.31% to 3.0 ± 1.7%, P < 0.009, n = 17). The initial value of regulatory T (0.33 ± 0.30%, n = 10 vs. 0.16 ± 0.05%, n = 7, P > 0.05) and memory B lymphocytes percentages (2.1 ± 1.8%, n = 10 vs. 1.1 ± 0.75%, n = 7, P > 0.05) were not significantly different for those who had complete response to first line therapy than those required splenectomy. These results indicate that regulatory T lymphocytes and memory B lymphocytes percentages are not useful for predicting treatment outcome in patients with newly diagnosed adult patients with ITP.

Evaluation of epicardial fat tissue thickness in patients with Hashimoto thyroiditis.

OBJECTIVE: Hypothyroidism, whether overt or subclinical, has multiple effects on the cardiovascular system. Epicardial fat tissue (EFT) is closely related to cardiovascular disorders and atherosclerosis. Our study aimed to assess EFT thickness and carotid artery intima-media thickness (CIMT) in patients with Hashimoto's thyroiditis (HT) displaying overt and subclinical hypothyroidism (SCH). DESIGN AND PATIENTS: The study included 33 patients with SCH and 24 patients with overt hypothyroidism (OH) with HT as well as 32 healthy controls. EFT thickness, CIMT, thyroid hormone levels and lipid parameters were measured in all subjects. Correlation analysis and linear regression analysis were performed for EFT thickness. RESULTS: Mean EFT thickness was 2·89 ± 0·38, 3·53 ± 0·92 and 4·56 ± 1·61 mm in control, SCH and OH groups, respectively (P < 0·001). EFT thickness of OH patients was high compared with SCH and control subjects (P < 0·01 and <0·001, respectively). CIMT of OH patients was high compared with SCH and control subjects (P < 0·01 and <0·001, respectively). In addition, EFT was significantly thicker in SCH patients than in controls (P < 0·05). Correlation analysis showed that EFT thickness was significantly positively correlated with CIMT, age, body mass index, systolic blood pressure, thyroid-stimulating hormone, total and LDL cholesterol and triglyceride and negatively correlated with free T4. In the regression analysis, EFT thickness retained its independent and positive association with CIMT, patient group (particularly OH) and systolic blood pressure. CONCLUSIONS: Epicardial fat tissue thickness may be a useful indicator of early atherosclerosis in SCH and OH patients with HT.