الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Diastolic dysfunction is an abnormality in elastic properties of the myocardium or in the process of active relaxation. Ischemia is a major cause for both systolic and diastolic dysfunction with or without heart failure. So after cardiac revascularization surgery there is a good chance for improvement in both systolic and diastolic dysfunction and hence on the overall outcome.
Doppler echocardiography can be helpful in the assessment of diastolic function. Also, Tissue Doppler imaging give good data about diastolic dysfunction which is less sensitive to preload than are standard Doppler approaches and permits more accurate estimation of the filling pressures.
The benefit of ivabradine over other negatively chronotropic agents is its absence of negative inotropy and also did not exert any negative lusitropic effect. Also ivabradine may improve endothelial function and reduce fibrosis which improve diastolic dysfunction.
We have found that the diastolic dysfunction post CABG had not been studied well till now and the ivabradine effect on diastolic dysfunction is still under investigation and need to be more clarified.
This study included 60 patients had been randomized into two groups by admission order. First group constituted 30 patients from whom 5 patients were dropped out after the 3 months of the study and second group constituted also of 30 patients from whom another 2 patients were also dropped out. A prospective cohort study have been performed on patients fulfilling the inclusion and exclusion criteria.
group I patients have had standard postoperative medical treatment and supplemental therapy with Ivabradine. group II have had standard postoperative medical treatment only.
During the time of the study the following data regarding every patient in both groups have been collected and recorded:
Initial history regarding past medical history, smoking and previous cardiac surgery. Initial and serial physical examination for any sign and symptoms of heart failure or ischemia , valvular or pericardial affection, vital signs, rhytm changes or any electrocardiography (ECG) changes or any new complains have been recorded.
ECG, chest x- ray , routine laboratory tests, cardiac enzymes and troponin have been checked before , immediately postoperative, 7 days and 3 months after surgery.
Echo have been done before , 7 days after and 3 months after surgery Transthoracic M-mode, two-dimensional and spectral Doppler (pulsed (PW) and continuous wave(CW)) and Doppler tissue imaging (DTI) echocardiographic studies were performed in all patients in both groups.
The following echocadiographic criteria for diastolic function evaluation were used: 1- LA dimension in mm, LA Volum in mL/m2, E in m/s and A in m/s, E/A, DTE in ms, e’ in cm/s and a’ in cm/s, E/e’, Ar – A dur in ms, IVRT in ms and S/D.
All patients have been classified by these parameters into normal and 3 abnormal grades of diastolic dysfunction.
After classifying patients by diastolic dysfunction parameters into grades it was observed that:
Normal function was 0% versus 44% in first group and 0% versus 10.7% in second group preoperatively and 3 months postoperatively respectively. Grade 1 diastolic dysfunction was 68% versus 28% in first group and 67.9% versus 53.6% in second group preoperatively and 3 months postoperatively respectively. Grade 2 diastolic dysfunction was 28% versus 20% in first group and 25% versus 25% in second group preoperatively and 3 months postoperatively respectively. Grade 3 diastolic dysfunction was 4% versus 8% in first group and 7.1% versus 10.7% in second group preoperatively and 3 months postoperatively respectively.