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 TISSUE DOPPLER QUANTIFICATION OF LEFT
 VENTRICULAR ASYNCHRONY IN CORONARY
ARTERY DISEASE : AN EARLY ASSESSMENT OF
         MYOCARDIALISCHAEMIA
                      THESIS
       Submitted in partial Fulfillment Of
         Master Degree in Cardiology

                        BY
        Dalia Ali Mohamed Shehata
                   M. B.. B. CM..

          UNDER THE SUPERVISION Of

                      Prof. Dr.
       Mesbah Taha Hassanin
              Professor of Cardiology
                Faculty of Medicine
                Zagazig University

                      Prof. Dr.
    Laila Mohamed El Maghawry
          Assistant Professor of Cardiology
                 Faculty of Medicine
                 Zagazig University

                        Dr.
   Khaled Mohamed Abd El Salam
               Lecturer of Cardiology
                Faculty of Medicine
                Zagazig University


                       2005
                   SUMMARY AND CONCLUSION


      In our study, patients were selected from the Cardiology
Department of Zagazig University Hospital during the period between
October 2003 to October 2004, who were undergoing coronary
angiography at least one month post MI.
      The study included 45 patients. The patients were divided into
three groups:
Group 1: Included non-diabetic patients with normal glucose tolerance
and no history of diabetes mellitus.
Group 2: Included IDDM patients with history of diabetes mellitus since
birth and treated with insulin.
Group 3: Included NIDDM patients with history of diabetes mellitus and
treated with oral hypoglycemic agents.


      All the patients underwent thorough history taking and full clinical
examination with special stress on cardiac related manifestations, random
and   postprandial    blood       sugar   level,   resting   12-lead   E.C.G,
echocardiography and lastly cardiac catheterization and coronary
angiography.


      The aim of the study is to compare the angiographic characteristics
of coronary artery lesion in diabetic patients (IDDM and NIDDM ) with
that of non-diabetic patients post MI.
      It was found that the extent and the severity of coronary artery
disease is more in diabetic patients both groups (IDDM and NIDDM )
than in non-diabetic patients. More severe in BDDM than in non-diabetic,
also, than NIDDM, Diabetic patients ( IDDM and NIDDM) had more
incidence of three-vessels disease and less incidence of single-vessel
disease than non-diabetic patients, IDDM patients had more incidence of
three-vessels disease than NIDDM. LMCA affection had more incidence
in IDDM than both NEDDM and non-diabetic. Proximal lesions and
distal lesions were more prevalent in diabetic patients (IDDM and
NIDDM) while middle lesions were more prevalent in non-diabetic
patients.
      Long lesions and eccentric lesions were more prevalent in diabetic
(IDDM and NIDDM) than in non-diabetic patients while short lesions
and concentric lesions were more prevalent in non-diabetic patients.
      Total coronary artery occlusions were significantly higher in
diabetic (IDDM and NIDDM) than in non-diabetic patients. IDDM had
more incidence of total occlusion than NIDDM.
      According to Gensini score, coronary artery lesion score was
significantly higher in diabetic (IDDM and NIDDM) than in non-diabetic
patients.
      Smoking cigarettes incidence was equal in both diabetic (IDDM
and NIDDM) and non-diabetic patients. Coronary artery score was
significantly higher in smokers than in non-smokers in both diabetic
(IDDM and NIDDM) and non-diabetic groups of patients.
      Echocardiographic    parameters    showed    that,   E/Aratio    was
significantly lower in diabetic than in non-diabetic patients (IDDM and
NIDDM) with more incidence of reversed E/A ratio among diabetics.
FVRT was significantly higher in diabetic (IDDM and NIDDM) than in
non-diabetic patients. These data suggest impaired diastolic function in
diabetic patients(IDDM and NIDDM).
      Regarding MI site, and size, IDDM patients had more incidence of
ant MI, also, more incidence of extensive MI. than non-diabetic and
NIDDM.
Recommendations:
      We recommend that coronary artery risk factors must be managed
aggressively in diabetic patients both types. Intensive multifactorial risk
factors modification include: dietary modification, light to moderate
exercise three to five times per week, smoking cessation , multivitamins,
aspirin, intensive glucose control, lipid modification, and aggressive
blood pressure control.
      Any symptom that could be due to coronary artery disease in
diabetic patients must be investigated thoroughly by non-invasive and/or
invasive means.


Conclusion:-

Finally, we conclude that:
 IDDM patients had more greater size MI that reflect the increased
   prevalence of CAD and diffuse vascular lesion.
 Coronary artery lesion is not only more prevalent, but also more
   extensive in IDDM patients with more three- vessels disease, more
   affection of LMCA , more total occlusion, and more coronary artery
   score than NIDDM and. non-diabetic.

				
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