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The prediction of pulmonary arterial hypertension documented by echocardiography in patients with dilated cardiomyopathy at Chris Hani Baragwanath HospitalNaidoo, Krinesh January 2011 (has links)
Submitted in fulfillment of the Degree of Masters in Technology: Clinical Technology, Durban University of Technology, 2011. / Background: Idiopathic dilated cardiomyopathy (IDC) is a primary myocardial disease of unknown cause characterized by left ventricular or biventricular dilatation and impaired myocardial contractility. Idiopathic dilated cardiomyopathy (IDC) is the second commonest cause of heart failure in Africa. Some patients with idiopathic dilated cardiomyopathy present with significant pulmonary hypertension (PHT) which maybe out of keeping with the usual degree of PHT seen in patients with this disorder.
Methods and Material: This is a prospective and longitudinal follow-up study of 66 patients with IDC who were evaluated after satisfying the inclusion and exclusion criteria of this study. The clinical evaluation of each patient included a complete medical history, physical examination, 12 lead electrocardiogram, 2D-echocardiography, continuous wave (CW), pulsed wave (PW), and tissue Doppler imaging (TDI).
Results: The mean age of all patients was 48.5 ± 12.8, with 39/66 (59.1%) patients being male. The prevalence of pulmonary arterial hypertension (PAH) was documented in 47 patients (71.2%, 95% CI: 59 - 83%). Mean left ventricular ejection fraction (LVEF) was 25.3 ± 8.8%, and mean left atrial volume index (LA volume) was 44.5±19.8 ml/m2. Mitral regurgitation (MR) occurred in 56/66 (84.8%) of patients with moderate or severe MR detected in 60.6% of all cases of IDC. The presence of a tricuspid regurgitant jet was found in 56/66 (84.9%), with (95% CI: 75 -93%). Right ventricular dilatation was found in 65/66 (98.5%), with (95% CI: 95 - 101%).
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Age, LA volume, LVEF and MR were included into a multivariate logistic regression model to predict PAH. Only MR presence was independently associated with PAH adjusted (OR 6.02, 95% CI: 1.15- 31.47) (p= 0.03). Conclusion: The study has shown that there is a significant prevalence of pulmonary arterial hypertension (PAH), right heart involvement and tricuspid regurgitant jet in IDC patients. The present study also showed that in patients with dilated cardiomyopathy, the degree of mitral regurgitation was a good predictor of PAH.
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The use of echocardiography in predicting left ventricle thrombus in patients with idiopathic dilated cardiomyopathy at Chris Hani Baragwanath HospitalFerreira Dos Santos, Claudia Marisa Goncalves 21 January 2013 (has links)
Submitted in fulfillment of the requirements for the Degree of Masters in Technology: Cardiology, Durban University of Technology, 2012. / Cardiomyopathies and their resultant heart failure (HF) remain a
major cause of cardiovascular morbidity and mortality (Wood and Picard, 2004).
Idiopathic dilated cardiomyopathy (IDCMO) is a primary myocardial disease of
unknown cause, characterized by left ventricular (LV) or biventricular dilatation
and impaired myocardial contractility. Dilated cardiomyopathy (DCMO), along
with rheumatic heart disease and hypertension (HPT), is one of the leading
causes of HF in Africa. In fact, in an epidemiology study of 884 patients in
Soweto, IDCMO was the second major cause of HF. Thirty five percent of
patients in the study, with HF, had IDCMO (Sliwa, Damasceno, Mayosi, 2005).
Methodology: Patients referred to the cardiomyopathy (CMO) clinic at Chris
Hani Baragwanath hospital, situated in the echocardiographic lab, were recruited,
provided they satisfied the exclusion and inclusion criteria and were enrolled after
obtaining voluntary informed consent. From May 2009 to September 2010, 70
patients with IDCMO were recruited for this trial. Patients with DCMO were
identified by means of echocardiographic criteria which included a left ventricular
ejection fraction (LVEF) of less than 45% and an end diastolic dimension (EDD)
of greater than of 52 mm (2D in long parasternal axis).
Results: In the present study the prevalence of left ventricular (LV) thrombus in
patients with IDCMO was 18.6%. When using Univariate logistic regression, the
only independent predictors of LV thrombus formation was LVEF and age.
However, when multivariate logistic regression analysis was applied to the data,
the only predictor with a significant association was age. The reason for this is
not clear. It is postulated that perhaps younger patients have differences in the
pathophysiology of their disease such as a greater smoldering inflammatory
component which may therefore predispose them to thrombus formation. For
example the presence of IL-6 may be important in the formation of LV clot in
cases of LV dysfunction (Sosin, Bhatia, Davis, Lip, 2003). The association
between LVEF and LV thrombus was borderline significant.
Conclusion: The prevalence of LV thrombus formation in this cohort of patients
with IDCMO was 18.6%. Echocardiographic parameters alone cannot predict
which patients are more likely to develop thrombus formation. / National Research Foundation
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The use of echocardiography in predicting left ventricle thrombus in patients with idiopathic dilated cardiomyopathy at Chris Hani Baragwanath HospitalFerreira Dos Santos, Claudia Marisa Goncalves 21 January 2013 (has links)
Submitted in fulfillment of the requirements for the Degree of Masters in Technology: Cardiology, Durban University of Technology, 2012. / Cardiomyopathies and their resultant heart failure (HF) remain a
major cause of cardiovascular morbidity and mortality (Wood and Picard, 2004).
Idiopathic dilated cardiomyopathy (IDCMO) is a primary myocardial disease of
unknown cause, characterized by left ventricular (LV) or biventricular dilatation
and impaired myocardial contractility. Dilated cardiomyopathy (DCMO), along
with rheumatic heart disease and hypertension (HPT), is one of the leading
causes of HF in Africa. In fact, in an epidemiology study of 884 patients in
Soweto, IDCMO was the second major cause of HF. Thirty five percent of
patients in the study, with HF, had IDCMO (Sliwa, Damasceno, Mayosi, 2005).
Methodology: Patients referred to the cardiomyopathy (CMO) clinic at Chris
Hani Baragwanath hospital, situated in the echocardiographic lab, were recruited,
provided they satisfied the exclusion and inclusion criteria and were enrolled after
obtaining voluntary informed consent. From May 2009 to September 2010, 70
patients with IDCMO were recruited for this trial. Patients with DCMO were
identified by means of echocardiographic criteria which included a left ventricular
ejection fraction (LVEF) of less than 45% and an end diastolic dimension (EDD)
of greater than of 52 mm (2D in long parasternal axis).
Results: In the present study the prevalence of left ventricular (LV) thrombus in
patients with IDCMO was 18.6%. When using Univariate logistic regression, the
only independent predictors of LV thrombus formation was LVEF and age.
However, when multivariate logistic regression analysis was applied to the data,
the only predictor with a significant association was age. The reason for this is
not clear. It is postulated that perhaps younger patients have differences in the
pathophysiology of their disease such as a greater smoldering inflammatory
component which may therefore predispose them to thrombus formation. For
example the presence of IL-6 may be important in the formation of LV clot in
cases of LV dysfunction (Sosin, Bhatia, Davis, Lip, 2003). The association
between LVEF and LV thrombus was borderline significant.
Conclusion: The prevalence of LV thrombus formation in this cohort of patients
with IDCMO was 18.6%. Echocardiographic parameters alone cannot predict
which patients are more likely to develop thrombus formation. / National Research Foundation / M
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