الفهرس 
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Abstract
Summary:
The aim of our work was to evaluate the cardiac and vascular function in patients with relapsing-remitting Multiple Sclerosis and to correlate those functions with clinical and radiological findings. Our work also aimed at the early detection of patients with Multiple Sclerosis who are at high risk of developing cardiovascular disease and helping them to improve their cardiovascular health.
In our study, we recruited 50 patients with definite MS diagnosis, according to MacDonald’s criteria, from the neurology clinic and 50 age- and sex-matched control subjects. All participants were free of any CV risk factors like obesity, diabetes, or hypertension. They were all free of any history of cardiovascular disease. They all underwent general and cardiac assessment. Neurological history taking and assessment were also done for all MS patients, to assess their disability score (EDSS), disease duration, total number of relapses and disease-modifying drugs. Radiological assessment was done for all patients to determine their MRI lesion load. The cardiac function of all participants was assessed by three echocardiographic modalities; conventional two-dimensional echocardiography, tissue Doppler imaging, and speckle tracking technique. Their arterial function was also assessed, by measuring peripheral PWV and augmentation index, using Brachial Cuff Based Method via Mobil-O-Graph device. Arterial remodeling was also assessed by measuring carotid IMT and screening for carotid plaques, using carotid ultrasound. Serum lipids were measured in all participants.
Our results revealed that patients with Multiple Sclerosis had significantly impaired cardiac and arterial functions, compared to control subjects. MS patients had significantly higher mean values of left ventricular dimensions, volumes and mass. They had a significantly impaired LV systolic function, confirmed by significantly lower two-dimensional left ventricular ejection fraction, lower mitral annular plane systolic excursion, lower mitral annular longitudinal systolic velocity, higher LV myocardial performance index, and lower LV global longitudinal strain, compared to control subjects. We also found a significantly impaired LV diastolic function in MS patients, confirmed by significantly lower mitral inflow E/A ratio, longer mitral E-wave deceleration time, higher TR velocity, lower mitral annular early diastolic velocity, higher mitral E/E` ratio, and longer LV isovolumetric relaxation time. Moreover, we found a significantly impaired RV systolic and diastolic function, confirmed by significantly lower tricuspid annular plane systolic excursion, lower tricuspid annular longitudinal systolic velocity, lower tricuspid annular early diastolic velocity, higher RV myocardial performance index, and higher pulmonary artery systolic pressure in MS patients, compared to control subjects. No significant correlation was found between cardiac function, and disease duration or disability (EDSS) score, apart from a significant positive correlation between LV end-systolic dimension and disease duration, EDSS score, and the total number of relapses in addition to a significant positive correlation between LV end-diastolic dimension and the EDSS score.
Furthermore, we found a significantly impaired arterial function, confirmed by significantly lower peripheral pulse wave velocity and augmentation index in MS patients, compared to controls. On the other hand, no significant difference in CCA IMT was found between the two groups and none of our patients had a carotid plaque. A significant positive correlation was found between PWV and both disease duration and disability score (EDSS). Meanwhile, we found significantly higher serum levels of total cholesterol and triglycerides, insignificantly higher serum levels of low-density and very-low-density lipoprotein cholesterol in addition to a significantly lower serum level of HDL-cholesterol in patients with MS, compared to control subjects. We did not find a significant correlation between T-cholesterol, triglycerides, LDL-cholesterol, and both disease duration and disability. Only HDL-cholesterol was found to be positively correlated with the disease duration. Also, there was no statistically significant difference between treated and non-treated MS patients, regarding either cardiac or vascular function.