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Background: Heart failure (HF) is a major and growing public health problem, as 21 million adults worldwide are living with heart failure and this number is expected to rise due to aging population, increasing prevalence of risk factors and improved post myocardial infarction (MI) survival. Objective: This study was discuss the effect of modern versus standard of care anti failure medications on LV function in heart failure patients with reduced ejection fraction using 2D speckle tracking echocardiography. Patients and methods: The study population includes 100 heart failure patients with reduced ejection fraction 50 on modern anti-failure medications including angiotensin receptor neprilysin inhibitor (ARNI) and 50 controls on standard anti-failure medications including angiotensin I-converting enzyme inhibitor (ACEI) or angiotensin II receptor blockers (ARBs). All patients attended the outpatient clinic of the Cardiology Department at Al-Azhar University Hospital (Cairo) from March 2020 to March 2021. Results: There was no significant statistical difference between groups also regard sex distribution there was no significant difference between groups and male were majority in both groups. There was no significant difference between the two studied groups regarding levels of serum creatinine and serum K. Results of comparison of end systolic, end diastolic diameters of left ventricle and diameter of left atrium showed no significant difference between both groups at pre medication assessment but there was a highly significant after medications in both groups (p= 0.00, 0.038 and 0.035 respectively) also in group A there was a significant decrease from pre to post assessment (p=0.003, 0.012 and 0.004 respectively). There was a statistically significant improve in mitral regurgitation after medication in group A than in group B (p=0.00) but was of no significant in pre medication assessment (p=0.48). Conclusion: In HFrEF patients, sacubitril/valsartan significantly improves the mitral regurgitation LV remodeling and with a significant effect on LV diastolic and systolic echo parameters. Accordingly, sacubitril/valsartan could be used at an earlier time in HFrEF patients in order to further limit LV remodeling.

Background: Diabetes mellitus (DM) is considered as a major risk factor for heart failure with preserved Ejection fraction (EF). Using M-Mode echocardiographic method may be useful in prediction of early LV systolic dysfunction in patient with type II diabetes mellitus by measurement of mitral annular plane systolic excursion (MAPSE) in correlation to global longitudinal strain (GLS) and to tissue Doppler imaging (TDI). Objective: To emphasize on the usefulness of M-mode echocardiographic methods like the mitral annular plane systolic excursion (MAPSE) correlated to speckle tracking by 2 dimensional (STE) and tissue Doppler imaging in prediction of subclinical LV systolic dysfunction in patients with type 2 diabetes. Patients and methods: The study included 100 asymptomatic patients with type II DM and 50 healthy subjects as a control group. Echocardiography was performed to all of them All cases were recruited from the outpatient clinic in Maadi military Hospital in Cairo. Results: The study included 100 asymptomatic patients with type II DM, 65 of them were females, and 50 healthy subjects as a control group, 27 of them were females. MAPSE were significantly lower in DM group [1.2 (1.1 – 1.25) cm] compared to control group [1.4 (1.3 – 1.5) cm] (p < 0.001). MAPSE linearly had a significant positive correlation with EF, GLS and Sa wave [r= 0.565, 0.723, 0.595 respectively], (p < 0.01). MAPSE linearly had a significant negative correlation with DM duration and HbA1C Level [r= -0.495, -0.776 respectively], (p < 0.01). Average MAPSE at a cut-off point (≤1.2cm) with good (82%) accuracy, sensitivity= 68% and specificity= 82% (p < 0.01). Conclusions: MAPSE is a useful M-mode method in prediction of subclinical LV systolic dysfunction in asymptomatic type II diabetic patients, and it has a positive correlation to GLS and Sa wave of TDI. It has a negative correlation with duration of DM and HbA1C level.

Background: Echocardiography-derived calcium score (ECS) was able to predict the presence of extensive coronary calcium and obstructive Coronary artery disease(CAD), assessed using Multi slice CT (MSCT) coronary angiography. Furthermore, significant linear trends were observed between ECS and extent and severity of coronary atherosclerosis and number of calcified coronary artery lesions. Objective: To correlate an echocardiography-derived calcium score (ECS), obtained using coronary artery calcium Score (CACS) and the presence of obstructive CAD. Patients and Methods: The study comprised 100 patients (males and females) presented with symptoms suspected of stable CAD. All cases were recruited from the outpatient clinic in Agouza police Hospital in Cairo and Islamic center of Al-Azhar University during a period of fourteen months from 1/11/2018 to 30/12/2019. Results: Linear regression analysis identified that the most independent variables that can predict AVC were CAC score, dyslipidemia, and the most independent variable that can predict obstructive coronary artery disease was the presence of coronary artery calcification and higher CAC score. ROC curve analysis was used to test the predictive value of aortic valve calcification (AVC), Mitral annulus calcification (MAC) and CAC scores for the presence or absence of obstructive CAD. This analysis showed that AVC and MAC scores were inferior to CAC score which was found to have the highest predictive value evidenced by an area under the curve of 0.763 (95%CI: 0.781, 0.913). MAC score was inferior to AVC score which was found to have the highest predictive value evidenced by an area under the curve of 0.815 (95%CI: 0.758, 0.879). Conclusion: The echocardiographic calcium scores specifically the MVC and AVC was correlated to be CAC. ECS can predict the CAC score. ECS can predict the presence or absence CAD.