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Our aim was to investigate the changes in the myocardium stiffness index for patients suffering from systemic hypertension, and to assess their left ventricular performance. We studied 263 hypertensive patients and 166 healthy subjects as a control group. By using conventional Doppler echocardiography, the following parameters were measured-Left ventricular end diastolic diameter, left ventricular end systolic diameter, transmitral early velocity, isovolumic relaxation time, and isovolumic contraction time. Tissue Doppler imaging (TDI) was used in the measurements of the early mitral annular velocity (Ea) and the diastolic stiffness was obtained by calculating the ratio E\Ea\LVIDd. Index myocardial performance (IMP) was calculated according to following equation (IVCT + IVRT)/ET for both the control group and hypertensive group. Results reveal that the differences in the average value of transmitral early filling velocity (E) between patients and control groups for age range (20 -49) and (50 -80) were (−1.91%) and (−3.69%) respectively with p value >0.05 for both groups, and the changes in LVIDd between patients and control groups were 0.42% and 1.29% for age ranges (20 -49) and (50 -80) respectively with p value >0.05 for both age groups. A significant difference in IMP between patients and controls has also been observed and the changes were 29.54% and 30.43% for age range (20 -49) and (50 -80) respectively with p value <0.05 for both groups. The mean values for E/Ea ratio and for the measured LV stiffness index were significantly higher in hypertensive patients compared with control group (p value < 0.05) for both age groups. In conclusion, LV myocardial diastolic stiffness index and IMP are increased in hypertensive patients.M. F. Hussein et al.

Diabetes (DM) and hypertension (HT) cause changes in cardiac performance. Long-term diabetes and hypertension can lead to changes in cardiac contractility, reduced left ventricular efficiency and heart failure. The aim of this study is to evaluate the effect of the coexistence of diabetes mellitus and hypertension on left ventricular myocardial performance and structural changes. The study involved 45 patients with essential hypertension and type 2 diabetes (14 males and 31 females, their mean age was 53.28 ± 13.28 years), and 45 healthy subjects (10 males and 35 females, their mean age was 48.11 ± 13.07 years) as a control group. Transthoracic echocardiography was done for all patients. The echocardiographic measurements included: left ventricle internal diameter at end diastole (LVIDd), left ventricle internal diameter at end systole (LVIDs), peak velocity of early transmitral flow (E), peak velocity of late transmitral flow (A), ejection fraction (EF%), isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT) and ejection time (ET) from which the ındex of myocardial performance (IMP) was calculated. Results revealed a significant change in the ratio (E/A) between patients and controls (−32.45%) with p value < 0.05, and the change in (LVIDd) and (LVIDs) between patients and control groups were (4.61%) and (0.754%) respectively with insignificant p value. The change in IMP was (44.65%), with p value < 0.05, and the change in ejection fraction (EF%) was (−1.49) with p value > 0.05. İn conclusion, diabetic patients with hypertension had an increase in IMP and reduced E/A indicating deterioration in cardiac performance despite normal ejection fraction and insignificant change in LV dimensions.

Background: Coronary artery disease remains the main cause of death despite several preventive programs. Epicardial adipose tissue is a visceral fat depot of the heart located along the large coronary arteries and on the surface of ventricles and apex. Intima media thickness is commonly recognized as the initial stage in the development of atherosclerosis. The development of ultrasound machines, advances in echocardiographic devices and high resolution transducers facilitate comprehensive analysis of epicardial fat thickness (EFT) and carotid –intima media thickness (C-IMT).Aim: To investigate the relationship of echocardiographic epicardial fat thickness (EFT) and carotid –intima media thickness (C-IMT) with the severity of coronary artery disease.Methods: A cross sectional multicenter diagnostic accuracy study carried out at Ibn Al-Nafis Cardiovascular Hospital, Ibn Al- Bitar Cardiology Center and Ghazi Al-Hariri Hospital –Iraqi Center for Cardiology during the period between October 2016 and May 2017 assessing. History regarding demographic data and risk factors was taken. Two dimensional transthoracic echocardiographic measurements were done. EFT was measured from parasternal long axis view perpendicular to the right ventricular free wall. C-IMT was measured according to that recommended by the American society of echocardiography (ASE).Results: The current study demonstrated that the EFT has a direct and significant correlation with the number of involved vessels (P value ˂ 0.001, r= 0.770). The validity of EFT to discriminate between multiple vessels disease and no vessel involvement is excellent (AUC= 0.984, cut point > 8mm, sensitivity=92.9%, specificity= 93.3%). There is inverse and significant correlation between ejection fraction (EF) and three vessels disease (P value ˂ 0.001, r= -0.507). Also there is a direct and significant correlation between C-IMT and severity of CAD. ROC analysis for validity of C-IMT to discriminate between multiple vessels disease and no vessel involvement is excellent (AUC= 0.961, cut point > 1.04mm, sensitivity=92.9%. specificity=86.7%). C-IMT is fair to discriminate between single vessel disease and no vessel involvement (AUC=0.738, cut point ˃ 0.84mm, sensitivity 100%), so if correlated with age, C-IMT above 0.84 can be used as a cut off point for the prediction of CAD. Finally, EFT and C-IMT are more likely to reflect severity of CAD than their ratio.Conclusions: C-IMT and EFT are simple and reproducible parameters that can be used as a screening tool for the presence and severity of CAD especially before symptoms appearance in high risk patients