BACKGROUND AND OBJECTIVE: Diurnal variation in the onset of acute myocardial infarction with a peak in the morning has been demonstrated. Few data are available concerning about the left ventricular systolic dysfunction according to the infarct time. Regarding importance of onset of heart failure following acute myocardial infarction, this study was done to survey the effect of the time of acute myocardial infarction on left ventricular systolic dysfunction.METHODS: This prospective study was performed on 100 patients with acute myocardial infarction (AMI). Left ventricular systolic dysfunction (LVSD) was defined by echocardiography when ejection fraction (EF) was less than 55%. FINDINGS: Of these patients, 72 had EF<55% and 37% of them experienced myocardial infarction between 6 am and 5:59 pm (group 1) and 63 experienced their AMI between 6 pm and 5:59 am (group2). Left ventricular EF less than 55% occurred in 22 (59.5%) patients of group1 compared with 50 (79.4%) in group 2 (p=0.04). Mild, moderate and severe LVSD were also more frequent in group 2 patients (p=0.01).CONCLUSION: The risk of mild, moderate and severe left ventricular systolic dysfunction after AMI is higher among infarctions that begin at night.

Background: early diagnosis of left ventricular mass (LVM) inappropriateness and left ventricular hypertrophy (LVH) can result in preventing diastolic left ventricular dysfunction and its related morbidity and mortality. This study was performed to determine if diastolic dysfunction is associated with LVH and inappropriate LVM.Materials and Methods: one hundred and twenty five uncomplicated hypertension from Isfahan Healthy Heart Program underwent two-dimensional echocardiography. Inappropriate LVM was defined as an LVM index greater than 88 g/m2 of body-surface area in women and greater than 102 g/m2 in men. LVH-defined septal and posterior wall thickness greater than 0/9 cm in women and greater than 1 cm in men, respectively. Echocardiographic parameters, including early diastolic peak velocity (E) /late diastolic peak velocity (A), deceleration time (DT), and E/early mitral annulus velocity (E') were measured.Results: the mean systolic and diastolic blood pressure at the patients’ admission day were 142.87 ± 18.12 and 88.45 ± 9.18 mmHg, respectively. Totally, 21.7% of subjects had inappropriate LV mass that moderate and severe abnormal LV mass was revealed in 5.6% and 5.6%, respectively. The mean of age and BMI was significantly higher in patients with moderate left ventricular hypertrophy (P<0.05). Adjusted by age, gender, BMI, and systolic and diastolic blood pressures, both E/A ratio and deceleration time were higher in those with the severer ventricular hypertrophy. Subjects with severe showed significantly higher BMI 33.7 ± 3.7 (P< 0.001). There was a slight difference between the grade of diastolic dysfunction and the severity of inappropriate LV mass (P=0.065). But no significant difference was found between E/A, E/E', and deceleration time and the level of inappropriate LV mass (P>0.05). Spearman’s Rank test was used to test the correlation between diastolic dysfunction and LV mass (P=0.025).Conclusion: LVH is correlated with the severity of diastolic dysfunction manifested by the E/A value and deceleration time, but inappropriate LVM can slightly predict diastolic dysfunction severity in uncomplicated hypertension.

Primary aldosteronism is characterized by hypertension, suppressed plasma renin activity, increased aldosterone excretion, and hypokalemia with metabolic alkalosis. Ventricular arrhythmia is an uncommon finding. We report the case of a 46‑ year‑ old female who was referred to our center due to uncontrolled ventricular arrhythmia. The past medical history was positive for hypertension. On admission, echocardiography showed severe left ventricular (LV) dysfunction. Blood examination revealed severe hypokalemia. She had been diagnosed with acute coronary syndrome and decompensated heart failure elsewhere and was given diuretics. A diagnosis of primary aldosteronism due to adrenal adenoma was made according to laboratory findings and imaging modalities. The prompt management of bradycardia and correction of hypokalemia, along with surgical resection of adrenal adenoma, resulted in control of arrhythmias and improvement in LV function.

Background: Ischemic left ventricular (LV) dysfunction is one of the major causes of LV dyssynchrony. This is indicative of poor prognosis in patients with LV dysfunction and correction of ischemia by Coronary Artery Bypass Grafting (CABG) may resynchronize LV contraction. The aim of this study was to evaluate the effect of CABG on LV dyssynchrony, systolic and diastolic function.Patients: The present study comprised 31 patients with ischemic LV dysfunction with Ejection Fraction (EF:25- 50%). Echocardiography with Tissue Doppler Imaging (TDI) was performed to assess LV dyssynchrony (calculated by basal LV segment), to evaluate diastolic function by measurement of peak early diastolic mitral annular velocity (Em) ,systolic function by measurement of peak early systolic mitral annular velocity (Sm) and Ejection Fraction (EF) by Simpson method.Results: Mean LV dyssychrony before CABG was 30±16 ms that decreased to 22±14 ms after operation (P=0.04). There was also improved diastolic and systolic function after CABG (Em 0.04m/s versus 0.05 m/s, P=0.01 and Sm 0.06 m/s versus 0.08 m/s P=0.01).The mean ejection fraction rose from 40±8.6% to 42±8.2% (P=0.01). Conclusion: CABG is associated with improvement of LV dyssynchrony, systolic and diastolic function in patients with ischemic LV dysfunction.

This study assessed changes in global and regional systolic left ventricular function after successful percutaneous recanalization of coronary artery occlusions. A consecutive series of 110 patients with mean ± SD age of 53.6 ± 9.1 years, in whom a complete angiographic evaluation was available before angioplasty, underwent successful percutaneous recanalization of significant occlusions of coronary arteries. Left ventricular ejection fraction and wall motion score index were assessed by echocardiography at baseline, and 1, and 6 months after recanalization Left ventricular ejection fraction increased from a mean ± SD of 40.7 ± 4.52% at baseline to 50 ± 8.3% after one month (P < 0.001) and to 50.9 ± 8.5% after 6 months. There was no significant difference between left ventricular ejection fraction at the end of the first and the sixth month of treatment (P = NS). The wall motion score index decreased from 1.3 ± 0.2 at baseline to 1.1 ± 0.2 after one month (P < 0.01). There was no significant difference between 1 and 6 months results. Six-month follow-up of all patients showed significant improvement in both angina severity and NYHA class. The restoration of coronary potency of occluded coronary arteries by successful percutaneous recanalization is associated with significant improvement in regional and global left ventricular function and clinical outcome.

Background- Mechanical dyssynchrony is common in patients with heart failure and its presence predicts patient response to cardiac resynchronization therapy (CRT).The quantification of left ventricular dyssynchrony using tissue Doppler imaging (TDI) may improve the selection of these patients. We aimed to evaluate the prevalence of dyssynchrony in patients with heart failure and valvular heart disease with either normal or prolonged QRS durations.Methods- Patients with left ventricular (LV) systolic dysfunction and significant organic valvular heart disease were evaluated. Using conventional and tissue Doppler echocardiography, an interventricular mechanical delay >40 ms was defined as significant interventricular dyssynchrony. Intraventricular dyssynchrony was evaluated using the calculation of the septal-to-lateral wall delay, the SD of the time from the Q wave to the peak systolic wave of 6 basal and 6 mid segments, and the maximum difference in the time from the Q wave to the peak systolic wave of all 12 segments.Results- Forty-four patients (22 female, mean age 47 ± 15.2 years) were evaluated. Interventricular dyssynchrony was present in 12 (27%) patients. Intraventricular dyssynchrony was present in 17 (39%) to 19 (43%) patients, depending on the method used. Interventricular and intraventricular mechanical dyssynchrony had a significant association with LV volume and QRS duration (independent of the type of valvular heart disease). We found almost perfect agreement between maximum difference and total dyssynchrony index (kappa = 0.91), and the overall agreement among septum-to-lateral delay, maximum difference, and total dyssynchrony index was good (kappa = 0.72).Conclusion- Although ventricular dyssynchrony in patients with valvular heart disease and LV dysfunction is not highly prevalent, it has a significant association with QRS duration and LV size.

Background: Chronic kidney disease (CKD) affects multiple organs and is an established risk factor for cardiovascular disease and mortality. Impaired systolic function of the left ventricle is common in adult CKD patients. Objective: The main objective of the study is to determine the prevalence of left ventricular systolic dysfunction (LVSD) in children with CKD and its association with age, stage of disease, and history of dialysis. Subjects and Methods: This was a comparative cross‑ sectional descriptive study. Twenty‑ one children with CKD aged 3– 14 years and an equal number of age‑   and gender‑ matched apparently healthy controls were recruited. Outcome Measures: LVSD was considered present when ejection fraction (EF) <50%. Results: The mean EF of 63. 9% in the patients was not significantly lower than the 65. 3% recorded in the controls, but LVSD was detected in 5 (24%) and none of the controls (Fisher’ s exact; P = 0. 001). Patients with LVSD were older than those with normal left ventricular systolic function, but this difference was not statistically significant (P = 0. 067); however, they differed significantly with respect to the stage of CKD (P < 0. 001). LVSD was more common in patients who were never dialyzed (P < 0. 001). Conclusion: LVSD is more frequent in children with CKD compared with controls. Patients with LVSD were similar to those without it, with respect to age but had more advanced disease (CKD) and less likely to have ever been dialyzed.