Hanan Ibrahim Radwan

This study hypothesized that imaging provides information indicating the right ventricular (RV) involvement after anterior or inferior ST-elevation myocardial infarction (STEMI), beyond standard electrocardiogram (ECG) due to the increasing interest in RV function and assessment techniques. This study aimed to compare RV function between anterior and inferior MI without RV involvement using different echocardiographic modalities. This study included 100 patients with anterior (50 patients) and inferior (50 patients) STEMI, who underwent primary percutaneous coronary intervention (PPCI) and two-dimensional echocardiographic imaging within 24 h after PPCI with RV function analysis by left ventricular (LV) infarct size, LV filling pressure, and RV strain rate. Our primary endpoint was the subclinical RV dysfunction in anterior or inferior MI using tissue Doppler and speckle tracking (STE). The study population included 80 (80%) males and 20 (20%) females. Patients with the anterior STEMI had higher mean creatine kinase-MB (CKMB) and troponin than those with inferior STEMI. This study revealed worse RV dysfunction in patients with anterior than those with inferior STEMI, as reflected by significantly lower RV systolic function, tricuspid annular plane systolic excursion (p ≤ 0.0001), tissue Doppler-derived velocity (p ≤ 0.0001), and STE-derived strain magnitude and rate (p ≤ 0.0001). RV dysfunction occurs in patients without ECG evidence of RV STEMI. RV dysfunction is worse in anterior than inferior MI. Moreover, RV systolic functions were affected by declined LV ejection fraction irrespective of the infarction site, which clinically implies prognostic, treatment, survival rate, and outcome improvement between both conditions. (Trial registration ZU-IRB#:4142/26–12-2017 Registered 26 December 2017, email: IRB_123@medicine.zu.edu.eg).

BACKGROUND The relationship between diabetes mellitus and a higher incidence of coronary artery disease is clinically established. Diabetic patients with acute coronary syndrome appeared to have worse prognosis than nondiabetic patients 1. During hospitalization of diabetic and non-diabetic patients with Non-ST elevation myocardial infarction, the incidence of heart failure was twice in diabetic versus nondiabetic ones 2. There is positive correlation between diabetes mellitus duration and the risk of developing acute coronary syndromes 3. An independent relation between the duration of diabetes mellitus and critically and fatal coronary artery disease has been shown in men 4. Some studies suggest that coronary artery disease and HbA1c level are predictors of cardiovascular morbidity and mortality 5. OBJECTIVES To study the interventional outcomes of high-risk non-ST elevation acute myocardial in diabetic and non-diabetic patients PATIENTS AND METHODS This prospective study was conducted in Cardiology Department, Zagazig University Hospitals, during the period from January 2016 to January 2019 , it included 480 patients , admitted to the cardiac care unit, diagnosed by ECG, cardiac biomarker and Grace Score as high risk NSTE-ACS , divided into two groups: 272 Diabetic and 208 Nondiabetic , All patients underwent complete history taking, thorough clinical examination. 12-lead ECG, laboratory tests (CK-MB, Tropinin I, lipid profile & HbA1c, GRACE score was calculated. Patients were classified according to GRACE score into 3 categories high (>140), intermediate (70-140), and low (1-70), the patients underwent early emergency, or elective coronary angiography within 3 days of admission. evaluating the extent and the severity of coronary lesions were assessed by using Gensini score 6. DISCUSSION The current study attempted to pierce out risk factors, clinical presentation and coronary angiographic picture in patients with diabetes mellitus compared with other non-diabetic patients. In this study there was no statistically significant difference between the two groups as regard age and hypertension in this result was in ABSTRACT Introduction: Patients with Non ST elevation myocardial infarction , the incidence of heart failure was twice in diabetic versus non diabetic ones 1,2 .There is positive correlation between diabetes mellitus duration and the risk of developing acute coronary syndromes 3 , An independent relation between the duration of diabetes mellitus and critically and fatal coronary artery disease has been shown in men 4 , Some studies suggest that coronary artery disease and HbA1c level are predictors of cardiovascular morbidity and mortality 5. Aim of the study: To study the interventional outcomes of high-risk non-ST elevation acute myocardial in diabetic and non-diabetic patients. Patients and methods: a prospective study was conducted in, Zagazig University Hospitals , it included 480 patients , diagnosed by ECG, cardiac biomarker and Grace Score 6 as high risk NSTE-ACS , divided into (272 Diabetic and 208 Non-diabetic).Patients were classified according to GRACE score into 3 categories high (>140), intermediate (70-140), and low (1-70), the patients underwent early emergency, or elective coronary angiography within 3 days of admission. After intervention (PCI) , followed up for 48 hours to detect complications and death. Results: There was no significant difference between the two groups as regard age and hypertension. Gensini and Grace scores were significantly higher in diabetes. In patients of high Gensini and syntax scores only diabetes was an independent predictor of the extent and severity of coronary artery obstruction. Conclusion: Diabetes Mellitus has a significant correlation with angiographic complexity and interventional outcome in patients with Non-ST elevation myocardial infarction.

Background: To detect the potential in hospital prognostic value of fQRS complex in patients with acute coronary syndrome (ACS) & investigate whether FQRS complex can be used to distinguish patients with early NSTEMI from those with unstable angina. Methods: It included 150 patients with acute NSTEMI and unstable angina. All patients were subjected to Grace score calculation, ECG to detect ischemic changes and detect presence or absent of fQRS, transthoracic echo to detect LV ejection fraction and recording in-hospital outcome. Results: Patients with fQRS have significant higher Killip class>2, higher troponin &CKMB levels, higher grace score, increased LVEDD & LVESD and significantly lower LVEF%. LVEF is significantly lower among patients with fQRS than patients with not fQRS in NSTEMI patients while there is no significant difference of LVEF % between both groups in unstable angina patients. There is significant association between fQRS and higher prevalence of NSTEMI and higher incidence of heart failure, arrhythmia and bad outcome. By multivariate analysis, NSTEMI (p =0.003) and high HR (p =0.004) and fragmented QRS (p =0.00) were the only significant predictors for bad outcome. FQRS have the ability to diagnose NSTEMI in 47.9% of cases, fQRs can truly exclude NSTEMI in 72.7% of case. Conclusion: Among patients with ACS, the presence of fQRS was associated with an increase incidence of complication, worse outcome, larger LV dimensions, and lower LVEF. The presence of fQRS in acute coronary syndrome patients could predict the presence of NSTEMI with fair diagnostic value.

Background: To assess the extent of transmurality in non-ST elevation myocardial infarction (NSTEMI) patients using speckle-tracking echocardiography (STE) in relation to their risk categorization to improve the risk stratification of NSTEMI patients through detecting the presence of transmural infarction. Patients and Methods: It included 96 patients with NSTEMI. All patients were subjected to GRACE score (GS) calculation, transthoracic and speckle-tracking echocardiography (STE): To detect left ventricular ejection fraction and myocardial global longitudinal strain [GLS]and circumferential strain [CS]. Results: As compared to low-GS group; high-risk group was older with the increased prevalence of hypertension (HTN), diabetes, and smoking. There was no significant difference between both groups regarding LS and CS of all 17 segments except for apex where longitudinal strain (LS) was significantly decreased in low-risk group (−17.2 ± 1.1) as compared to high-risk group (−18.6 ± 1.4). GLS was significantly decreased in high-risk group (15.4 ± 0.6) as compared to low-risk group (16 ± 0.8), P = 0.02 with no significant difference in the global CS (P = 0.8). Transmural infarction constitutes 37.5% of all patients. The prevalence of transmural infarction was increased in the low-risk group without significant difference. GS showed a positive correlation with age, male, HTN, diabetes, and smoking and negative correlation with GLS. There was no significant correlation between GS and global CS. Age, GS, and LS were significantly related to transmural infarction. None was found to predict the occurrence of transmural infarction. Conclusion: Transmural extent as detected by STE had been found in a relatively substantial number of patients with NSTEMI, and it may serve as a tool in conjunction with risk stratification scores for the selection of high-risk patients.

Objective: Evaluate the diagnostic accuracy of 256 slices computed tomography (CT) coronary angiography (CA) (multidetector CT [MDCT]) in the assessment of native coronary arteries and grafts in post-coronary artery bypass graft (CABG) surgery Egyptian patients. Patients and Methods: It included 70 patients with a history of isolated CABG with recurrent chest pain. We excluded patients with a history of redo CABG or other open-heart surgeries, renal impairment, severe claustrophobia, chronic liver disease, dye allergy, tachycardia with contraindication to beta blockers (BB), pregnancy. All patients were subjected MDCT and CA. Both examinations were done within 3 months. Results: In our study, 161 grafts evaluated (63 left internal mammary artery [LIMA] in situ grafts, 5 right internal mammary artery (RIMA) and 2 radial grafts, and 91 venous grafts). CA failed to detect 3 LIMA and 7 venous grafts. All were seen only by MDCT. For grafts CT compared to CA has sensitivity (91.5%, 84.8%), specificity (98%, 100%), accuracy (95.65%, 96.9%), positive predictive value (PPV) (96.43%, 100%), and negative predictive value (NPV) (95.24%, 96.2%) in the assessment of significant stenosis and total occlusion of grafts, respectively. For grafted vessels CT has sensitivity (94%, 100%), specificity (98%, 100%), accuracy (96.94%, 100%), PPV (95.92%, 100%), and NPV (97%, 100%) in the assessment of significant stenosis and total occlusion of grafted vessel, respectively. For native vessels CT has sensitivity (100%, 97.7%), specificity (84.2%, 98.4%), accuracy (97.14%, 98.1%), PPV (96.6%, 97.7%), and NPV (100%, 98.37%) in the assessment of significant stenosis and total occlusion of native vessels, respectively. Conclusion: Our study demonstrated a high diagnostic accuracy of MDCT for the assessment of bypass grafts and grafted or native coronary arteries compared with CA. Detection of grafts or native vessels occlusion was better than detection of substantial stenosis. MDCT is a good negative test for native vessels as it has a high sensitivity since it tends to overestimate stenosis degree, so patients with negative MDCT angiographic results mostly have patent vessels.

Significant coronary artery stenosis might cause persistently impaired longitudinal left ventricle (LV) function at rest. LV global longitudinal strain (LVGLS) can be accurately assessed by 2D speckle-tracking strain echocardiography(2D-STE). We aimed to evaluate the diagnostic accuracy of LV global longitudinal strain obtained by 2D-STE in prediction of severity of CAD. Eighty patients with suspected stable angina pectoris were included. They underwent transthoracic echocardiography (TTE) to measure LV ejection fraction, 2-D-STE to measure GLS and coronary angiography (CA). The patients were divided into two groups: group 1 (58 patients) with significant (>70%) CAD, and group 2 (22 patients) with non-significant (<70%) CAD. Images were obtained in the apical long-axis, four-chamber, and two chamber views. Regional longitudinal systolic strain was measured in 17 myocardial segments and averaged to provide global longitudinal strain (LVGLS). There was significant decrease in GLS in group 1 compared to group 2 (-11.86 ± 2.89% versus -18.65 ± 0.79%, P < 0.000). The optimal cutoff value of GLS for prediction of significant CAD was -15.6% [AUC 0.88, 95% CI 0.78-0.96 p < 0.000]. The sensitivity, specificity and accuracy of GLS for detecting significant CAD were 93.1%, 81.8%,and 90% respectively.There was a significant positive correlation between GLS and EF (r = 0.33; p = 0.036).There was incremental significant decrease in GLS with increasing number of coronary vessels involved. Measurement of global longitudinal strain using 2D speckle tracking echocardiography is sensitive and accurate tool in the prediction of severe CAD.

The reported incidence of AF after CABG surgery varies from 20 to 40%, with the arrhythmia usually occurring between second and fourth postoperative days. Postoperative AF after CABG was associated with greater in-hospital mortality and worse survival at long-term follow-up. Therefore, intensive attention has focused on the prevention of AF in high-risk patients. Many perioperative factors have been suggested to increase the incidence of postoperative AF after conventional CABG. In this study we are trying to examine some of these risk factors as predictors for Post-operative AF in our patients. In this study, our aim was to identify the perioperative predictors of AF in our patients who underwent Coronary Artery Bypass Grafting. Our Patients were divided into two groups; Group A included patients who did not develop PO AF (168 patients) and Group B patients who developed PO AF (84 patients). Perioperative Data, including gender, age, demographic variables and postoperative morbidity and mortality were extracted from the medical records. This retrospective cohort study was conducted on 252 consecutive adult patients underwent CABG, in King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia. The mean age for patients with PO AF was 65 years (P = .0001). Eight-three patients (49.4%) were diabetics in group A and 56 patients (66.7%) in group B (P = .0001). Patients who developed POAF had a lower ejection fraction (44.8 ± 5.7%) (P = .0001), diastolic dysfunction (P = .0001), Larger Left atrial volume (P = .0001). Bleeding requiring re-opening for exploration and Postoperative shock were identified as significant predictors for POAF. Multivariate logistic regression (odds ratio, ±95% CI, P value) was performed to identify the effect of age, preoperative heart rate, ejection fraction, postoperative bleeding, Shock, ventilator time, Sensitivity was 89.5%, specificity was 94.6%, positive predictive value was 89.5%, and negative predictive value was 94.6%. In our study, advanced age, enlarged LA volume, low ejection fraction, combined surgeries and prolonged ventilation time were found to be predictors of atrial fibrillations after coronary artery bypass grafting.