Background: Gestational hypertension exerts a great challenge on the maternal cardiovascular system, inspite of this fact, there is lack of reports regarding the maternal diastolic function in gestational hypertensionwhich precedes systolic dysfunction in any cardiovascular complications.Objectives: To evaluate the maternal left ventricular diastolic function in gestational hypertensive women in thethird trimester by measuring the mitral inflow parameters with pulse wave Doppler and Tissue DopplerImaging.Patients and Methods: This studywas conducted in Baghdad teaching hospital from November 2015 to June2016. Sixty gestational hypertensive womenwith singleton pregnancy in the third trimester, aged 29.7 ± 5.9year, gestational hypertension was defined as systolicblood pressure that is equal or more than 140 mmHg ordiastolic bloodpressurethatequals or exceeds 90 mmHg and starts after 20 weeks of gestation withoutproteinuria were enrolled in this study. Another 50 Normal pregnant womenaged 28 ± 3.18year served ascontrols. The left ventricular diastolic function was studied using two transthoracic echocardiographicmethods: Pulsed wave Doppler (PWD) to measure the transmitral flow velocity including the early maximumvelocity of mitral inflow(E wave), the late maximum velocity of mitral inflow (A wave), and E/A ratio wasrecorded. Tissue Doppler imaging (TDI) to measure thelateralmitral annular velocity (lateral é), the septalmitral annular velocity (septal é) and their average (é) was calculated. The ratio of E/é was recorded.Results: Gestational hypertensive women hadsignificant lower E wave velocity compared tonormal pregnantwomen (P value was 0.001). “A”wave velocity was higher in gestational hypertensive women with statisticaldifference(P value 0.002) and E/A was significant low in gestational hypertension with P value <0.05. TissueDoppler imaging showed significant difference in é velocity which was lowerin gestational hypertensive women(P value 0.001). E/éin gestational hypertension showed significantly higher value than controls with Pvalue<0.05.Conclusion: Gestational hypertension puts the maternal heart under pressure and volume overload associatedwith impaired relaxation as manifested by the changes inthe left ventricular diastolic function measured bytransthoracic echocardiography
 

Background: Gestational hypertension represents a transient period of elevated blood pressure with special effects on the maternal left ventricle that is different from the effects observed in chronic essential hypertension; it affects a previously normal heart and lasts for a maximum of nine months associated with volume and pressure overload on the maternal heart. Tei index (also called myocardial performance index) was found to be a dependent combined index evaluating the systolic and diastolic function of the left ventricle and represents a sensitive indicator for many types of heart diseases. Objective: to evaluate the effects of gestational hypertension on the maternal myocardial function during the third trimester by measuring the Tie index using transthoracic echocardiography. Method: This study was performed in Baghdad teaching hospital in the time period from November 2015 to August 2016. The study included a total of 150 women; 100 women had gestational hypertension, in the third trimester of a singleton pregnancy and with a mean age (29.83 ± 5.33 year), gestational hypertension was identified as elevated systolic or diastolic blood pressure over 140/90 mmHg that emerges after the 20th week of gestation with proteinuria level lower than 300 mg/dl. Another 50 normotensive pregnant women with singleton pregnancy and mean age (28 ± 3.18 year) were used as controls. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured to find the type of hypertrophy in gestational hypertension. Ejection fraction (EF) was measured with 2D directed M mode echocardiography, and isovolumic relaxation time (IVRT), isovolumic contraction rime (ICT) and ejection time (ET) were measured for both groups using pulse wave Doppler echocardiography in order to calculate the myocardial performance index which is also called “Tei index” and equals the sum of IVRT and IVCT divided by the ET (Tei index = IVRT+IVCT/ET). Results: Left ventricular mass index and relative wall thickness were significantly higher in gestational hypertensive women, 41% of gestational hypertensive women had normal geometry and 59% had abnormal geometry (34% eccentric hypertrophy, 19% concentric hypertrophy and 6% concentric remodeling). IVRT and IVCT were significantly higher in gestational hypertensive women with p value of 0.0001 and P = 0.003. ET showed a non-significant lower values (p= 0.34) in gestational hypertensive women. Tei index was significantly higher in Gestational hypertension (P=0.011). Conclusion: Women with gestational hypertension had altered myocardial function characterized by the higher Tei index values associated with eccentric hypertrophy which can be explained by the fact that gestational hypertension poses higher afterload on the left ventricle instead the state of low peripheral resistance that is ysually expected during normotensive pregnancy. 

ABSTRACT : Ideal cardiac performance is dependent on coronary circulation. Which can be determined by measuring the coronary sinus blood flow (CSBF); as it provides a good estimation on global LV perfusion. Hypertension is a major risk factor for coronary artery disease, yet, still there is some debate about coronary sinus blood flow in hypertension. Evaluate the relation between CSBF and left ventricular (LV) mass in individuals with hypertension and coronary artery disease. In the time between January 2020 and March 2021, a total of 70 patients referred for diagnostic cardiac catheterization at Baghdad Teaching Hospital for suspected coronary artery disease and potential PCI were included in this study. All PCIs were successful, with good angiographic results. Transthoracic two-dimensional and Doppler flow imaging was used to determine CSBF. Among the selected patients 33 were hypertensive with coronary artery disease, while, 17 patients were normotensive with coronary artery disease. 20 patients were normotensive without coronary artery disease and served as controls. LV internal dimensions, interventricular septum, posterior wall thickness and LV mass were recorded. Regarding the coronary sinus, the peak and mean velocity, the peak and mean pressure gradient and the velocity time integral VTI were recorded. The Coronary sinus blood flow (CSBF) was calculated according to the formula: [(CSVTI) × (cross-sectional area of the CS) × (heart rate)). In comparison with controls, hypertensive patients without CAD had significantly higher VTI and mean gradient (20.48±1.8 cm and 0.935±.108mmHg vs 18.63±1.5 cm and 0.53±0.2). They also had significantly higher CSBF (554.653±70 mL/min compared to 501.64±63.8 mL/min, p value <0.05). On the other hand, they had significantly lower global LV perfusion 2.71±.7 mL/min/g compared to 3.04±0.7 mL/min/g in normotensive patients). Compared with normotensive patients with CAD, those who were hypertensive with CAD had significantly lower CS diameter (0.65±11.3 cm compared to 0.7±12.8 cm), significantly higher VTI and CSBF (13.81±2 cm and 338.57±43.9 ml/min in hypertensive with CAD, compared to 11.28±1.1 cm and 259.42±35.5 ml/min in normotensive ones). LV mass was significantly higher (244.95±36.26 g/m2) than (170±57.7 g/m2) in normotensive patients with CAD. As a result, hypertensive patients with CAD had significantly lower LV perfusion than the normotensive patients (1.042± 0.27 mL/minute compared to 1.58±0.53mL/minute). In conclusion, hypertension is associated with an increase in CSBF; attention should be taken while assessing hypertensive patients with coronary artery disease. There is highly important inverse relationship between global perfusion and LV mass.

ABSTRACT : Reperfusion therapy for symptomatic patients with chronic stable angina enhances coronary artery flow and therefore the left ventricular perfusion. Transthoracic echocardiography, a simple, non-invasive and cost-effective technique, may provide a reliable method for measuring coronary sinus blood flow. To find the correlation of coronary sinus blood flow (CSBF) to left ventricular function using 2D and Doppler transthoracic echocardiography in patients with chronic stable angina who were eligible for percutaneous coronary intervention (PCI) before and after the procedure. Ninety-two (92) patients with stable chronic coronary artery disease chosen after admission for diagnostic (and/or therapeutic) catheterization have been enrolled in the current study at the Department of Catheterization and Echocardiography in Baghdad Teaching Hospital, they were listed as the cases group, after admission for PCI they were divided into the positive and the negative group based on their results. Standard 2D and Doppler echocardiography was performed and CSBF, CSVTI, CSPG, RWMSI, LV mass and LV perfusion were registered. Among the cases; the negative group had significantly higher global LV perfusion compared to the positive group (2.98±1.06 ml/min/g vs 1.02± 0.56± 0.56 ml/min/g) with P value less than 0.001. The correlation between CSBF and RWMSI severity was assessed before and after treatment, the positive group showed negative correlation (inverse; r = .238 and p = .34) that changed into no correlation after the treatment. The positive group also showed significant increase in CSBF 460.09±74.9 ml/min (p value less than 0.05) after successful PCI. The same applied for the global LV perfusion, which increased to 2.331±0.98 mL/min/gm. In conclusion, this study revealed that the coronary sinus blood flow measured by transthoracic echocardiography had strong correlation with results obtained by angiography. It can be used as a functional and reproducible method to track improvements in cardiac perfusion before and after percutaneous coronary intervention in patients with chronic stable angina.

Background: percutaneous coronary intervention for symptomatic patients with chronic stable angina improves coronary artery blood flow and hence the le ventricular perfusion. Transthoracic echocardiography that is simple, non-invasive and cost effective technique, can provide an efficient procedure for measuring coronary sinus blood flow. Objectives: to assess coronary sinus blood flow (CSBF) and global LV perfusion in the coronary sinus using 2 D and Doppler transthoracic echocardiography in patients with chronic stable angina before and aer Percutaneous Coronary Intervention. Patients and methods: Ninety-two (92) patients with stable chronic coronary artery disease chosen aer admission for diagnostic (and/or therapeutic) catheterization have been enrolled in the current study at the Department of Catheterization and Echocardiography in Baghdad teaching hospital. Aer admission for coronary angiography, 63 patients had positive coronary lesions and proceeded to percutaneous coronary intervention (PCI). Fiy 50 normal healthy adults with no coronary artery disease CAD or CAD risk factors served as the control group. Standard 2D and Doppler echocardiography was performed and CSBF, CSVTI, CSPG LV mass and LV perfusion were registered.Results: Basic parameters were the same between the two groups (P#0.05). Controls had significantly higher CSBF, global LV perfusion and lower LV mass than the cases group (3.04±0.7 mL/min/gm, 501.64±63.8 mL/min and 99.97±9.4gm/ m. in controls vs 2.11±1mL/min/gm, 223.15±55.7 mL/min and 195.74±68.6 gm/m. in the cases group). e positive group also showed significant increase in CSBF 438.09±89.9 ml/min (p value less than 0.05) aer successful PCI. e same applied for the global LV perfusion which increased to 2.537±1.06 mL/min/gm. Conclusion: is study revealed that the transthoracic echocardiographic measurement of the coronary sinus blood flow is a valuable tool to assess the results obtained by angiography and it can be used as a practical and reproducible method for observing the changes in cardiac perfusion before and aer percutaneous coronary intervention in patients with chronic stable angina.