Rania Gaber

Clinical and biochemical predictors of increased carotid intima-media thickness in overweight and obese adolescents with type 2 diabetes.

Objective: To identify the clinical parameters associated with increased carotid intima-media thickness (CIMT) in overweight and obese adolescents with type 2 diabetes. Methods: We studied 27 patients (11 males) with type 2 diabetes. Criteria for selection were age (12–19 years), body mass index above the 95th percentile for age and gender, a positive family history of diabetes, normal or high C-peptide, and negative studies for islet cell antibodies. Age- and gender-matched healthy subjects were selected as the control group. Measurements of CIMT, lipid profile, hypersensitive C-reactive protein, hemoglobin A1C (HbA1C), and insulin resistance by homeostasis model of assessment (HOMA) were obtained for all participants. Results: CIMT was higher in diabetic patients than in healthy subjects (0.68 ± 0.16 vs. 0.58 ± 0.1, p < 0.01). The range of HbA1C in the 15 patients with uncontrolled diabetes was 7.6–10.4 (mean: 8.9 ± 0.9). CIMT, HbA1C, systolic blood pressure, triglycerides, HOMA, and C-reactive protein were significantly higher in patients with uncontrolled than with controlled diabetes. In diabetic patients, CIMT correlated positively with body mass index (p < 0.001), duration of diabetes (p < 0.001), systolic (p < 0.001) and diastolic blood pressure (p < 0.01), HbA1C (p < 0.001), HOMA (p < 0.01), and C-reactive protein (p < 0.01). Conclusions: CIMT is increased in adolescents with type 2 diabetes. Poor glycemic control, HOMA, increased C-reactive protein, body mass index, duration of diabetes, and elevated blood pressure are associated with early atherosclerosis in these patients.

The impact of total bile acid levels on fetal cardiac function in intrahepatic cholestasis of pregnancy using fetal echocardiography: a tissue Doppler imaging study

Abstract Aim: The aim of this study was to assess total bile acid (TBA) levels and its impact on systolic and diastolic functions in fetuses of mothers with intrahepatic cholestasis of pregnancy (ICP) using tissue Doppler imaging (TDI), and to explore the correlation between TBA levels and fetal cardiac function. Subjects and methods: The study employed 98 pregnant women with ICP who were divided into two groups according to their bile acid levels. Fifty pregnant women without ICP represented the control group. Results: Significant differences in the myocardial tissue velocities of both mitral and tricuspid valves were found between the fetuses of mothers with ICP and TBA levels of <40 mmol/L and the control group, versus fetuses of mothers with ICP and TBA levels >40 mmol/L. There was a significant increase in neonatal respiratory distress, meconium staining and neonatal TBAs in group II compared to the control group and group I. There was a correlation between maternal TBA levels and preterm delivery, APGAR scores and neonatal TBA levels at birth. There was also a positive correlation between maternal TBA and fetal myocardial tissue velocities of both mitral and tricuspid, and fetal diastolic myocardial tissue Doppler velocities. Conclusion: ICP is a very serious condition especially when maternal TBA levels are >40 mmol/L. Fetal echocardiography with tissue Doppler is a useful tool for fetal assessment in patients with ICP. It could be an indication of induction of labor in cases of ICP and bile acid levels ≥40 mol/L. Neonatal echocardiography is mandatory for follow-up and management of these neonates.

Value of serum tenascin-C in patients with acute myocardial infarction

Abstract Background Myocardial infarction (MI) is defined as myocardial cell necrosis due to significant and sustained ischemia. TN-C is an extracellular matrix glycoprotein that is expressed in several important steps during the very early stage of cardiogenesis. TN-C is not normally expressed in the adult heart, but transiently appears during pathological conditions and plays important roles in tissue remodeling. Aim To study the role of TN-C in myocardial infarction patients and to evaluate its role as a predictor of HF in these patients. Methods This study was conducted on 45 cases uniformly divided into 3 closely matched (in age and sex) groups as follows: Group (I) includes 15 patients who were suffering from AMI; Group (II) includes 15 patients who were suffering from HF on top of MI; and Group (III) includes 15 healthy volunteers coming for regular annual checkup. 3–6 ml venous blood was collected on the day of admission under complete aseptic conditions and stored at −70 °C until assayed by ELISA. Results TN-C levels in the sera of patients with AMI Group (I) were significantly higher than those of healthy volunteers. Moreover, in Group I of AMI, a positive correlation between TN-C level on one side and CK, CK-MB and troponin T level on the other side was found. TN-C levels in the sera of patients with congestive heart failure on top of acute MI Group (II) were significantly higher than those of healthy volunteers. Pro-BNP levels in patients with heart failure Group (II) were significantly higher than those with AMI not complicated with heart failure Group (I). Levels of pro-BNP were also positively correlated with those of TN-C in patients with heart failure on top of AMI Group (II). Conclusions Serum TN-C might be a novel marker reflecting active structural remodeling in the myocardium following infarction, with high TN-C levels at acute stages possibly predicting progression of LV remodeling. Also, the incorporation of a combination of serum TN-C and plasma BNP levels may improve risk stratification for congestive heart failure after AMI. Further studies on large scale are needed for more evaluation of TN-C role in HF.

Detection of early left ventricular dysfunction in patients with maternal placental syndrome using tissue Doppler and strain rate imaging

Background: Maternal placental syndromes (MPS) occur as a consequence of abnormal placental vessel formation and refer to hypertensive pregnancy disorders and related placental abnormalities. The aim of this study is to investigate early alterations in left ventricular function in patients with history of MPS using tissue Doppler and strain rate imaging. Methods: We enrolled 122 females who were 6 months after delivery. Group 1 included 72 patients who experienced MPS. Group 2 included 50 women with normal pregnancy as control. Results: There was no significant difference between both groups with regard to ejection fraction, deceleration time, isovolumetric relaxation time, or E/A ratio. Deterioration of left ventricular systolic and diastolic function was evident in the MPS group, by TDI parameters (significantly lower values of Sm 7.5 ± 1.2 vs. 9.1 ± 1.3, p < 0.001; Em 7.0 ± 0.8 vs. 10.0 ± 1.4, p = 0.02; and Em-to-Am ratio 0.84 ± 0.14 vs. 1.2 ± 0.18, p < 0.001). Systolic strain, peak systolic strain rate, and early and late diastolic strain rates were also significantly lower in patients who had MPS than in the control group (−18.7 ± 2.6 vs. −20.8 ± 1.5, p < 0.001; −0.92 ± 0.14 vs. −1.01 ± 0.23, p < 0.001; 1.05 ± 0.11 vs. 1.29 ± 0.24, p < 0.001; 1.8 ± 0.3 vs. 1.2 ± 0.4, p < 0.001, respectively) and in patients who had severe pre-eclampia than mild pre-eclampsia. Pre-eclamptic women who had preterm delivery showed significantly higher left diastolic dysfunction. Conclusion: Left ventricular systolic and diastolic dysfunction occur in patients with history of MPS. These abnormalities are evident on tissue Doppler and strain imaging even in the absence of changes in ejection fraction or standard diastolic parameters.

Right ventricular function assessment in single LAD lesion patients using strain and strain rate imaging

Abstract Background Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage, and data are not available on this imaging method with regard to assessing right ventricular involvement in single LAD lesion. Aim To evaluate right ventricular regional functions using strain and strain rate imaging tissue Doppler method in patients with single LAD lesion. Methods The patient group was composed of 60 patients who had experienced first anterior myocardial infarction and had undergone successful percutaneous coronary intervention for LAD lesion. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained. Results The right ventricular tissue Doppler parameters (Sm, E, A, E/A ratio, IVA, E/E″) of the patients group were significantly decreased than controls. In addition, changes in the right ventricular mean strain and strain rate values were significantly lower in patient group than controls. Conclusion Right ventricular involvement in LAD lesion patient is significant even after PCI and recanalization of LAD. TDI, strain and strain rate are new, useful imaging techniques for detection of subclinical RV dysfunction in patients with LAD lesion.