اسعد حسن نعمان العبودي

Abstract: Hypertension is an elevation of systolic blood pressure (SBP) ≥140 mm Hg, or a diastolic blood pressure (DBP) ≥90 mm Hg, or using antihypertensive drugs. Arterial hypertension causes high morbidity and mortality because its harmful impact on many systems, specially the cardiovascular system. Despite good control of their blood pressure, young patients with non-complicated hypertension are usually presented with exercise intolerance which necessitate the search for possible causes. Aim: The present study is targeted to discover possible subtle systolic dysfunction and its correlation with exercise capacity among young age patients with chronic non complicated hypertension as well as to assign the main factors affecting exercise capacity in those patients. Methods: A total of 80 young age participants involved in this study. They are grouped as group I (control subjects) , n= 40 (female: 17, male: 23) and group II (hypertensive patients), n= 40 (male: 27, female: 13) with different BMI levels. Group II further subdivided into group A (exercise capacity > 7 MET) and B (exercise capacity≤7 MET). Strain analysis was performed using propriety software on the echocardiograph. TDI and PWD are used to measure E/e, and PCWP. All participants are subjected to treadmill test using Bruce protocol in order to obtain exercise capacity and to exclude IHD. Results: Compared to normal subjects, non-complicated hypertensive patients have significantly reduced GLS (P value: 0.00) and increased PSI (P value: 0.00) as well as significant increase in E/e, (P value: 0.00), PCWP (P value: 0.00) and significant reduction in exercise capacity (P value: 0.00). In hypertensive patients with exercise capacity ≤7 MET versus those with exercise capacity >7 MET, there is no statistical difference between the average GLS (P value:0.6), average PSI (P value: 0.07) while significant elevation of E/e, (P value: 0.01) and PCWP (P value: 0.01) are observed in hypertensive patients with lower exercise capacity. Conclusion: Though significant changes in GLS, PSI and lower exercise capacity are evident in hypertensive patients in relation to healthy control subjects, Low exercise capacity in those patients is related to significant diastolic changes rather than subclinical systolic dysfunction.

BACKGROUND: Notwithstanding its clinical use as a reliable measure of left ventricular performance, little is known about whether myocardial performing index (MPI) is influenced by increased left ventricular mass (LVM) in healthy obese individuals. AIM: The present study was targeted at investigating the impact of increased LVM on the LV MPI in healthy obese men. SUBJECTS AND METHOD: Sixty-six normal male subjects were involved in this study. The subjects were divided according to their body mass index (BMI), into group I (BMI=20-24.9, n=37, mean age 33.405±10.277 years) which served as the control group, and group II (BMI=≥ 30, n=29, mean age 39.208±10.214 years). The MPI was determined in all subjects using the following formula proposed by Tei: MPI=IVCT+IVRT/ET. LVM was calculated according to the following Devereux formula as: LVM=0.8[1.04(IVSd+PWTd+LVIDd)-(LVIDd)] +0.6. RESULTS: There were no significant differences in MPI between control subjects and obese subjects with increased LVM (p>0.05). Additionally, there was no linear correlation between MPI and LVM (R(2)=0.0003, p=0.89). CONCLUSION: MPI is a simple and accurate tool for the quantitative assessment of left ventricular function. Because of its ease of application, cost effectiveness, and reproducibility, this tool could be regarded as a principal measurement for comprehensive hemodynamic studies. MPI values (according to the Tei index) did not vary significantly between healthy obese and morbidly obese individuals, and therefore may have limited utility for predicting cardiac diseases in at-risk obese individuals.

Abstract Background: Despite its clinical use as a sensitive measure of left ventricular performance, little is known about whether MPI is influenced by increasing BMI or WHR. Aim: The present study is targeted at investigating the impact of different grades of BMI and WHR on left ventricular myocardial performance index in normal men. Method: 82 normal male subjects were involved in this study. The subjects were divided as per BMI groups into group Ia (BMI= 20-24.9, n=34, mean age 32.315±10.179 as a control group) and group IIa (BMI= >24.9, n=44, mean age 38.181±11.501); as well as, by dividing the subjects in to two groups according to Waist-Hip ratio, group Ib (WHR <0.8-0.9, n=45, mean age 31.8±8.91) and group IIb (WHR >0.9, n=37, age 39.918±12.239). MPI was determined in all these subjects using the formula proposed by Tie as MPI=IVCT+IVRT/ET. Results: There were statistically no significant variations in MPI with increased BMI (p>0.05) or WHR (p>0.05). There was no linear correlation between MPI and BMI (r= 0.0023), and MPI and WHR (r=0.0007). Conclusion: MPI is a simple and accurate tool for quantitative assessment of left ventricular functions and because of easy application, cost effectiveness, and reproducibility; it could be regarded as an important measurement in a comprehensive hemodynamic study, especially in those with increased BMI or WHR, in whom the increased BMI or WHR was found to have no effect on MPI. خلفية الدراسة: على الرغم من استعمال مؤشر كفاءة البطين الأيسر كقياس حساس لمعرفة كفاءة البطين الأيسر,القليل من المعلومات متوفرة فيما إذا كان هذا المؤشر يتأثر بزيادة مؤشر كتلة الجسم أو زيادة نسبة الخصر إلى الورك. الهدف من الدراسة: تحرّت الدراسة الحالية عن تأثير الدرجات المختلفة لمؤشر كتلة الجسم ونسبة الخصر إلى الورك على مؤشر كفاءة البطين الأيسر في الرجال الطبيعيين. الطريقة: الدراسة تضمنت 82 متبرع من الذكور الطبيعيين, قسّموا حسب دليل كتلة الجسم إلى مجموعتين, مجموعة 1أ (مؤشر كتلة الجسم 20-24,9, العدد=34, متوسط العمر=32,315±10,179) ومجموعة 2أ (مؤشر كتلة الجسم أكثر من 24,9, العدد= 44, متوسط العمر=38,181±11,501). كذلك قسموا إلى مجموعتين حسب نسبة الخصر إلى الورك, مجموعة 1ب (نسبة الخصر إلى الورك= اقل من 0,8 إلى 0,9, العدد=45, متوسط العمر=31,8±8,91 ) و مجموعة 2ب (نسبة الخصر إلى الورك= اكثرمن0,9, العدد=37, متوسط العمر=39,918±12,239). النتائج: إحصائيا لا توجد هناك اختلافات معنوية بين مؤشر كفاءة البطين الأيسر مع زيادة مؤشر كتلة الجسم أو نسبة الورك إلى الخصر. كذلك لاتوجد هناك علاقة خطية بين مؤشر كفاءة البطين الأيسر مع مؤشر كتلة الجسم أو نسبة الورك إلى الخصر. الاستنتاج: مؤشر كفاءة القلب أداة بسيطة ودقيقة للتقييم الكمي لوظائف البطين الأيسر,وبسبب التطبيق السهل لهذا المؤشر لذا يمكن استخدامه في دراسات جهاز الدوران الشاملة خصوصا أولئك الذين لديهم زيادة في مؤشر كتلة الجسم أو نسبة الورك إلى الخصر حيث إن هذه الزيادة لا تؤثر بشكل ملحوظ عليه

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