Impact of Body Mass Index on Left Ventricular Function

Background

Obesity is associated with increased cardiovascular morbidity and mortality. A direct effect of isolated obesity on cardiac function is not well established. The study was designed to determine the direct effect of various grades of isolated obesity on echocardiographic indices of systolic and diastolic left ventricular function.

Methods

Fifty one obese and 25 normal weight, serving personnel without any other pathological condition were studied. Group I (n=25) consisted of subjects with normal weight and body mass index (BMI <25kg/m²), Group II (n=34) of overweight subjects (BMI 25-29.9 kg/m²) and Group III (n=17) of obese subjects (BMI >30 kg/m²). Echocardiographic indices of systolic and diastolic function were obtained and dysfunction was assumed when at least two values differed by ≥ 2 SD from the normal weight group.

Result

Ejection fraction, fractional shortening were increased (p<0.05) in Group II and III. Left ventricular dimensions were increased (p< 0.001) but relative wall thickness was unchanged. Systolic dysfunction was not observed in any of the obese patients. The mitral valve pressure half time (p< 0.01), left atrial diameter (p < 0.01) and the deceleration time were increased (p< 0.01) in obese subjects, while other diastolic variables were unchanged. No difference were found between obesity subgroups. Subclinical diastolic dysfunction was more prevalent among obese subjects. BMI correlated significantly with indices of left ventricular systolic and diastolic function.

Conclusion

Subclinical left ventricular diastolic dysfunction was noted in all grades of obesity which correlates with BMI.Key Words: Obesity, Systolic function, Diastolic function, Echocardiography     

Cor triatriatum: the utility of cardiovascular imaging

A 44-year-old man with no known cardiac history presented with worsening dyspnea on minimal exertion. During follow-up, computed tomography angiography and echocardiography confirmed the incidental finding of cor triatriatum. As improvements in spatial and temporal resolution continue, cardiac computed tomography may become better suited to the dynamic imaging of anatomical defects in the heart, including, but not limited to, coronary artery disease.     

Multidetector computed tomography for the detection of left atrial appendage thrombus: a comparative study with transesophageal echocardiography

OBJECTIVE: To determine the diagnostic performance of multidetector computed tomography (MDCT) for the detection of left atrial appendage (LAA) thrombus as compared with transesophageal echocardiography. METHODS: Multidetector computed tomography was evaluated in 43 patients qualitatively for the presence or absence of a filling defect in the LAA and compared with transesophageal echocardiography. Additionally, a ratio of the mean computed tomographic attenuation in the LAA apex to the mean computed tomographic attenuation in the aortic root was used for quantitative evaluation. RESULTS: A filling defect visualized in the LAA by MDCT corresponded to a sensitivity of 70% (7/10), a specificity of 82% (27/33), and a negative predictive value of 90% (27/30) for detection of LAA thrombus. When using quantitative parameters, MDCT demonstrated a sensitivity of 80% (8/10), a specificity of 73% (24/33), and a negative predictive value of 92% (24/26). Multidetector computed tomography was not able to differentiate LAA thrombus from spontaneous echo contrast by either visual evaluation or by quantitative parameters. CONCLUSIONS: Multidetector computed tomography remains limited for the detection of LAA thrombus. However, a subgroup of patients at very high risk for LAA thrombus may benefit from the high negative predictive value of cardiac MDCT.     

Geriatric hemodialysis rehabilitation care

The 2 objectives of this review are to provide background information about functional status in older dialysis patients and to discuss the utility of geriatric dialysis rehabilitation. We performed a literature search using PubMed and MedLine. All relevant texts were reviewed for information on functional status and disability in the renal population and in the general population. Data pertaining to geriatric rehabilitation and geriatric dialysis rehabilitation were also reviewed. We show how disability and functional limitations are more prevalent in populations with advanced stages of chronic kidney disease (CKD) compared with those with only mild stages of CKD. We describe data showing that dedicated geriatric dialysis rehabilitation units, using interdisciplinary care models, result in more than 70% of patients meeting their rehabilitation goals and being successfully discharged home. Nephrologists increasingly will be faced with problems arising from functional decline. We conclude by offering suggestions for future changes that may help to stem the rising tide of dialysis disability.     

变价态唐松草新碱—PVC膜离子选择电极的研制及解离常数的测定

本文研制了以四苯硼—唐松草新碱缔合物为电活性物质的变价态唐松草新碱—PVC膜电极。电极膜按电活性物质:PVC:DBP为1:8:8组成。该电极在pH 5.0～6.0,Ⅰ=0.05的NaCl—HCl溶液中Nernst响应范围为1×10^-3～1×10^-5mol/L。电极斜率为58.2 mV/logc。检测限为2.5×10^-6mol/L。用直接电位法考察了TDH⁺,TDH₂CF⁺⁺共存时溶液pH和电极斜率S的关系。用S—pH关系,测定了25℃,Ⅰ=0.05时的Ka₁值为(2.5±0.2)×10^-4,用E—pH关系,测定了25℃,Ⅰ=0.05时的Ka₂值为(8.1±0.9)×10^-8。     

运动对铁吸收的影响及其作用途径

目的:综合分析运动对铁吸收的影响及其作用途径。资料来源:检索Pubmed1950-01/2006-04有关运动对铁吸收的影响及其作用途径的文献,检索词为“iron absorption,iron metabolism,exercise”。同时检索万方数据库1994-01/2006-03有关运动对铁吸收的影响及其作用途径的文献,检索词为“铁吸收,铁代谢,运动”。资料选择:初选后,有关铁吸收、运动对铁吸收影响及其调节机制的文献被选中。发表于2002年后的文献被优先选择,排除重复实验和Meta分析。资料提炼:检索到9000篇文献,大部分是关于铁吸收调节机制的文献,其中40篇有关运动和铁吸收及其调节机制,30篇作为代表性研究文献被引用。资料综合:运动可导致低铁状态,影响运动能力,这种低铁状态的形成及其调节与铁吸收相关。但是,对于运动如何影响铁吸收存在两种截然相反的观点,一种观点认为运动促进铁吸收;另一种观点认为运动降低铁吸收。最近的研究已经显示运动可能通过机体铁水平、一氧化氮、Hepcidin、促红细胞生成素、低氧以及基因突变(如HFE突变)调节铁吸收。结论:有关运动影响铁吸收的研究仍是初步的,在运动情况下如何调节铁吸收尚有待研究,这对于进一步分析运动诱导的低铁状态的本质以及运动员和运动健身人群是否需要以及如何补充铁具有重要意义。