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Background and Aims: Little is known about the clinical relevance of pericardial fat volume (PFV), compared to other conventional cardiovascular risk factors, as predictors of coronary atherosclerosis severity among postmenopausal women. Our main aim was to assess the association of PFV and cardiovascular risk factors with coronary atherosclerosis burden, including occlusive coronary artery disease (CAD) (luminal stenosis >50%), coronary artery calcium score (CAC) >100, and plaque types in postmenopausal women. Methods: Patients who had chest pain of angina and referred for 64‐slice multi‐detector CT (MDCT) angiography examination to exclude occlusive CAD presence were enrolled in this retrospective study. Results: A total of 241 women with absence of menses for more than 2 consecutive years and not taking hormone replacement therapy were enrolled in the present study. Increased PFV (OR [CI] = 1.1 [1−1.3], p = 0.004), age (OR [CI] = 1.1 [1−1.4], p = 0.002), and diabetes mellitus (OR [CI] = 2 [1−4], p = 0.025) were significant predictors of occlusive CAD presence. Increased PFV (OR [CI] = 1.1 [1−1.4], p = 0.017) and increased age (OR [CI] = 1.2 [1.1−1.4], p < 0.001) were better predictors of CAC >100 than other cardiovascular risk factors. Regarding coronary plaque types, increased age (OR [CI] = 1.1 [1.1−1.3], p = 0.001) showed a significant association with coronary calcified plaque presence while increased body mass index(OR [CI] = 1.2 [1−1.4], p = 0.018) showed a significant association with coronary non‐calcified plaque presence. Conclusion: Higher PFV values showed an independent association with occlusive CAD and significant coronary calcification. This may imply that increased PFV is likely associated with the development of advanced and severe phenotype of coronary atherosclerosis among postmenopausal women with suspected CAD. [ABSTRACT FROM AUTHOR]

Background and Aims: There are gaps in knowledge regarding the association between the ABO blood group and coronavirus disease 2019 (COVID‐19) immediate and long‐term outcomes. We aimed to investigate the association of ABO blood group with COVID‐19 in‐hospital adverse outcomes and to determine whether ABO blood group is associated with post‐COVID‐19 persistent symptoms. Methods: This was a single‐center longitudinal observational study that included patients who presented with symptoms suggestive of COVID‐19 infection and a positive test for COVID‐19 and were able to attend the out‐patient clinic after 6 months following acute COVID‐19. The main outcomes were intensive care unit admission, the requirement for respiratory support, in‐hospital death, and persistent symptoms. χ2 test and regression analysis were used to analyze the collected data. Results: A total of 169 patients were enrolled for the assessment of in‐hospital adverse outcomes of whom 86 patients were included for the assessment of persistent symptoms after the exclusion of deceased patients or patients not attended the out‐patient clinic. Patients with blood group B had higher prevalence of in‐hospital death compared to blood group O (39% vs. 13%, p = 0.01) and this persisted after adjusting for sex (odds ratio, OR [confidence interval, CI] = 1.4 [1.1–2.1], p = 0.04), while patients with blood group AB had higher prevalence of requiring respiratory support than blood group O (54% vs. 10%, p = 0.02) and this persisted after adjusting for age (OR [CI] = 1.5 [1.1–2.3], p = 0.02). Concerning the association of ABO blood group and long‐term symptoms, blood group AB showed a higher prevalence of palpitation (p < 0.001) and dizziness (p = 0.02) than other blood groups. Conclusions: Blood groups AB and B are significantly associated with respiratory support use and in‐hospital death, respectively, compared to blood group O. Blood group AB is significantly associated with persistent palpitation and dizziness compared to other blood groups. [ABSTRACT FROM AUTHOR]

Background: The are conflicting reports on the effects of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) continued treatment on clinical outcomes in COVID-19 patients. Material and methods: Patients presented with symptoms suggestive of COVID-19 infection were enrolled between 5 April 2021, and 5 June 2021. Patients who survived acute stage of the disease were asked to attend out-patient clinic after six months following COVID-19 infection diagnosis. Results: A total of 162 patients were enrolled in this study. ARB users showed significant independent association with lower fatality rate as compared to ACEI/ARB-naïve patients [OR (CI) = 0.1(0.0-0.5), p = 0.01]. The prevalence of respiratory support use and intensive care unit (ICU) admission was numerically, but not statically significant, lower among ARB users than non-ARB users. The distribution of in-hospital adverse outcome was numerically lower among ACEI users than in non ACEI users, though the association did not reach statistical significance. ARB users showed significant independent association with persistent cough [OR (CI) = 2 (1.1-10), p = 0.02]. No significant differences in other long term symptoms were found between ARB users and nonusers. On the other hand, chest pain showed higher prevalence among ACEI users than in non-ACEI users. After adjusting for baseline comorbidities, chest pain association with ACEI user was not persisted. No significant differences in other long term symptoms were found between ACEI users and nonusers. Conclusion: ARB and ACEI users showed low prevalence of in-hospital adverse outcome compared to ARB/ACEI nonusers. ARB showed significant and independent association with persistent cough. [ABSTRACT FROM AUTHOR]

Background: The available data on gender differences in a) markers of cardiac involvement, b) peripheral blood parameters, and c) clinical adverse outcomes related to COVID-19 pneumonia severity are limited in the literature. Objectives: To investigate gender differences in ECG markers of increased risk for malignant arrhythmias. This includes T from peak to end (Tp-e) interval, corrected QT (QTc), transmural dispersion of repolarization (TDR)(Tp-e/QTc), and index of cardiac electrophysiological balance (iCEB)(QTc/QRS), peripheral blood parameters, and in-hospital adverse outcomes in patients with COVID-19 pneumonia. Methods: A cross sectional study enrolled patients with COVID-19 pneumonia admitted to hospital from August 20th, to September 30th, 2020. Results: A total of 197 patients were included. Ninety-six (47%) were men and 101 women. There were no significant gender related differences concerning comorbidities. Men had higher QRS values, Tp-e interval and TDR, and lower values of iCEB. No significant gender differences were observed in the distribution of QTc interval. Men stayed longer in the hospital and had more extensive lung injury than women. In men, prolonged QTc interval, low lymphocytes %, high platelet distribution width (PDW), and low hemoglobin (Hb) were the main predictors of adverse in-hospital outcome, while prolonged QTc interval, high PDW, and low platelet count were the main predictors of adverse in-hospital outcome for women. Conclusions: Men had higher TDR values, lower iCEB, stayed longer in the hospital, and had more extensive lung injury than women, suggesting that, despite that there was no significant difference in mortality incidents between the two genders, the difference in surrogate markers may indicate that men are at a higher risk for adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Little is known about the role of ECG markers of increased risk of sudden cardiac death during the acute period of coronavirus disease 2019 (COVID‐19) pneumonia. Objectives: To evaluate ECG markers of sudden cardiac death on admission, including the index of cardiac electrophysiological balance (iCEB) (QTc/QRS) and transmural dispersion of repolarization (TDR) (T from peak to end (Tp‐e) interval and Tp‐e/QTc), in patients with COVID‐19 pneumonia. Patients and methods: This cross‐sectional study included 63 patients with newly diagnosed COVID‐19 pneumonia who presented to the outpatient clinic or admitted to the respiratory care unit between August 20 and September 15, 2020. Forty‐six persons matched for sex and age were selected from data collected before COVID‐19 pandemic. Results: QRS and QTc showed a significant prolongation in patients with COVID‐19 pneumonia compared to the controls (87 vs. 78, p <.00, and 429 versus. 400, p <.00, respectively). After categorization of patients with COVID‐19 pneumonia into 3 groups according to the severity of pneumonia as mild‐moderate, severe, and critical groups, a decreased values of QRS were observed in the critical COVID‐19 pneumonia group compared to severe and mild‐moderate COVID‐19 pneumonia groups (p =.04) while increased values of QTc and iCEB(QTc/QRS) were noted in critical COVID‐19 pneumonia group compared to other 2 groups(p <.00). Conclusions: Patients with COVID‐19 pneumonia showed significant changes in repolarization and conduction parameters compared to controls. Patients with mild to severe COVID‐19 pneumonia may be at low risk for torsades de pointes development. [ABSTRACT FROM AUTHOR]

Background: ECG abnormalities associated with COVID‐19 pneumonia and adverse outcome are undefined and poorly described in prior studies. Objectives: To assess the predictive role of baseline ECG markers of increased risk of malignant arrhythmias and cardiac death for adverse in‐hospital outcomes. Patients and methods: A retrospective study included 93 patients of newly diagnosed COVID‐19 with features consistent with pneumonia who were admitted to the hospital from August 20 to September 20, 2020. The main outcomes were defined as receiving mechanical ventilation, in‐hospital cardiac arrest, length of ICU stay, and degree of lung damage according to computed tomography (CT) score. Results: Increased QTc (QT corrected) interval, Tp‐e (T from peak to end) interval, and transmural dispersion of repolarization (TDR) were independent predictors of prolonged ICU stay (P <.0001) after adjustment for baseline clinical characteristics. Increasing age (P <.0001) followed by increased QTc interval (P =.02) and history of chronic lung disease (P =.04) were independent predictors of extensive lung damage. The independent predictors for in‐hospital cardiac arrest were increased QTc (P =.02) followed by increasing age (P =.04) and increased Tp‐e interval (P =.04). Conclusion: Repolarization abnormalities on baseline ECG may be useful prognostic markers in patients with COVID‐19 pneumonia. [ABSTRACT FROM AUTHOR]

The predictive role of blood indices in coronavirus disease 2019 (COVID-19) related in-hospital adverse outcomes and post-recovery status is not fully defined. The main aim was to assess the association of complete blood indices measured at baseline with COVID-19 related in-hospital clinical outcomes, including length of hospital and intensive care unit (ICU) stay, receiving mechanical ventilation, degree of lung injury and in-hospital death, and postrecovery status. This retrospective study included patients with newly diagnosed COVID-19 infection from August 20, to September 25, 2020. The initial study cohort included 127 patients with newly diagnosed COVID-19. Of whom 26 patients were excluded, leaving 101 patients for final analysis. low lymphocytes % [Odds ratio and confidence intervals = OR (CI)] [0.2(0.0-0.2, p=0.03] increased the odds of ICU stay length while high platelet mean volume (PMV) [0.9(1.1-5, p<0.00], high platelet distribution width (PDW) [0.3(0.4-1.9), p<0.00], and low lymphocytes % [0.2 (0.0-0.2), p=0.02] increased the odds of length of hospital stay. Decreased lymphocytes % showed significant independent association with increased risk for mechanical ventilation use [0.9 (0.9-1), p=0.04], extensive degree of lung injury [0.2 (0.1-0.7), p<0.00], and in-hospital death [0.5 (0.3-0.8), p=0.01]. High lymphocytes %[0.9 (0.9-1), p<0.00] and high PMV [0.3 (0.3-0.8), p=0.02] were significantly associated with complete recovery while increased neutrophil % [1 (1-1.1), p=0.04] was associated with increased risk for post recovery fatigue. In conclusion, low lymphocytes % and high neutrophil % are useful markers for predicting adverse in-hospital outcome and post-recovery persistent fatigue, respectively. High PMV and lymphocyte % showed significant association with favorable short term prognosis. [ABSTRACT FROM AUTHOR]

We assessed sex-related differences in the association of pericardial fat volume (PFV) and obesity measured by body mass index (BMI) with coronary atherosclerotic markers (coronary artery calcium score [CAC], coronary luminal stenosis severity, and coronary plaque) in young patients. Patients (n = 174; age <50 years) with suspected coronary artery disease who underwent 64-slice multidetector computed tomography angiography were enrolled. Females tended to have a younger age and increased BMI, normal coronary arteries (free from luminal stenosis), and increased percentage of absent coronary plaque compared with males. There was a significant independent association between PFV with coronary luminal stenosis and between PFV and BMI with coronary noncalcified plaque presence after adjustment for conventional cardiac risk factors. On the other hand, males showed a more increment in PFV, CAC, percentage of calcified plaque, and percentage of significant coronary luminal stenosis compared with females. There was a significant independent association of PFV with CAC, significant coronary stenosis, and calcified plaque presence, while no association was observed between BMI with coronary markers in young males. In conclusion, PFV, but not BMI, showed a significant independent association with advanced coronary atherosclerosis in young male patients. [ABSTRACT FROM AUTHOR]

The link between obesity and hypertension with coronary atherosclerosis is complex. We aimed to assess the association of cardiac fat deposition measured by pericardial fat volume(PFV) using by multi-detector CT(MDCT) and general obesity measured by BMI with subclinical coronary atherosclerotic markers (coronary artery calcium score (CAC), coronary plaque and stenosis) in patients with hypertension and suspected coronary artery disease. Among 496 patients presenting with chest pain who underwent 64-slice MDCT angiography to exclude occlusive coronary disease, 261 patients with hypertension (age: 57 ± 8 years, 45% males) enrolled in the present study. PFV showed a significant association with CAC(r = 0.2,P =.001),coronary stenosis severity(PFV median(IQR) 88(63–161) in patients with coronary stenosis<50% compared to PFV median(IQR) 125(85–140) in patients with coronary stenosis ≥ 50%, P =.001) and coronary plaque presence (PFV median (IQR) 89(65–128) in patients without plaque compared to PFV median (IQR) 115(74–150) in patients with plaque presence = 0.03).the significant association of PFV with CAC[odds ratio(95% confidence interval = 0.5(0.19–0.97),P =.001] and coronary stenosis severity [odds ratio(95% confidence interval = 1.1(1.00–1.01),P =.01]persisted after adjustment for conventional cardiac risk. BMI showed a significant association with significant coronary stenosis presence (P =.02).The association of BMI with significant coronary stenosis presence after adjustment for conventional cardiac risk factors (P =.03).BMI showed no significant association with CAC and coronary plaque presence (P >.05). PFV showed a significant independent association with coronary calcification and significant coronary stenosis in patients with hypertension rather than BMI. [ABSTRACT FROM AUTHOR]

Background: We aimed to explore the association of clinical symptoms of COVID-19 pneumonia, blood parameters on admission, and anti-hypertensive drugs with in-hospital outcomes, including length of hospital and intensive care unit (ICU) stay, receiving mechanical ventilation, degree of lung injury, and in-hospital death among patients with hypertension. Material and methods: This retrospective study conducted in patients with newly diagnosed COVID-19 pneumonia from August 20, 2020 to September 25, 2020. Results: A total of 182 patients with COVID-19 pneumonia were included in the present study. The patients were categorized into those with hypertension (n = 82) or without hypertension (n = 100). Patients on angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) showed no significant increase in the risk for all in-hospital outcomes. Old age [0.6 (0.5-2) p < 0.00], fever [0.3 (0.2-1.8), p < 0.00] and low lymphocytes percentage [0.3 (0.2-1.2), p < 0.00] were associated with increased risk for extensive lung injury. Old age [0.4 (0.1 = 0.7) p < 0.01], high neutrophil count [0.3 (0.2-2), p = 0.02] and low lymphocyte percentage [0.3 (0.1-0.7), p = 0.01] were associated with prolonged hospital stay while low lymphocytes percentage [0.7 (0.6-0.9), p < 0.00], old age [1.2 (1-1.4), p = 0.01] and fatigue [2 (1-4), p = 0.04] showed significant association with prolonged length of ICU stay. Low lymphocytes percentage [0.7 (0.6-1), p < 0.00], old age [1.1 (1-1.2), p = 0.01] and fatigue [2 (1.7-4), p = 0.02] were associated with increased risk for receiving mechanical ventilation. Risk for in-hospital death was associated with increased neutrophil percentage [1.2 (1-1.5), p = 0.01] and old age [1.1 (1-1.2), p = 0.03]. Conclusions: ARBs and ACEIs showed no significant association with adverse in-hospital outcomes. Old age, low lymphocytes percentage and high neutrophils percentage on admission were independent predictors for increased risk of in-hospital mortality and morbidity among COVID-19 pneumonia patients with hypertension. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the association between body phenotype markers and coronary atherosclerosis markers. Methods: Eighty-nine patients (mean age 57 ± 9 years, 50.5% male) who were assessed for coronary artery disease by 64-slice multidetector computed tomography angiography were enrolled in the study. Results: A significant positive association was observed between coronary artery calcification and the second to fourth digit ratio (r = 0.2, p = 0.00); more notably in males compared to females (p = 0.03 vs. p = 0.08). There was a significant association between coronary artery calcification and pure white hair (p = 0.00). There was no significant association between pericardial fat volume and second to fourth digit ratio (p = 0.8). Pericardial fat volume was significantly associated with pure white hair (p = 0.02). A significant association was observed between coronary plaque and a higher second to fourth digit ratio (p = 0.01) and this was more notable in males (p = 0.04). A significant association was observed between pure white hair and coronary plaque (p = 0.00). After adjustment for conventional cardiac risk factors, the association of coronary artery calcification and coronary plaque with the second to fourth digit ratio did not persist, whereas the association of pericardial fat volume and coronary artery calcification with pure white hair remained significant (p = 0.01 and p = 0.00, respectively). Conclusion: These results suggest a possible predictive value of hair color, rather than digit ratio, in assessing increased risk of coronary atherosclerosis and cardiac fat deposition. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the effect of body mass index (BMI) on the relationship between pericardial fat volume (PFV), aortic root calcification (ARC) and coronary artery calcification (CAC) among patients with suspected coronary artery disease (CAD). Methods: This cross-sectional study took place between January and December 2014 at the Kufa University Teaching Hospital, Najaf, Iraq. A total of 130 consecutive patients with an intermediate pretest probability of ischaemic heart disease who underwent 64-slice multidetector computed tomography (CT) angiography during the study period were recruited. Of these, 111 were included in the study and divided into groups according to BMI. Imaging markers were measured on CT angiography. Results: A total of 28 patients were obese, while 42 and 41 were overweight and normal weight, respectively. The median PFV, CAC and ARC was 109 cm³ (interquartile range [IQR]: 52-176 cm³), 0 Agatston score (IQR: 0-52 Agatston score) and 0 Agatston score (IQR: 0-15 Agatston score), respectively, in the normal weight group in comparison to 79 cm³ (IQR: 43-138 cm³), 0 Agatston score (IQR: 0-54 Agatston score) and 0 Agatston score (IQR: 0-0 Agatston score), respectively, in the obese group. Significant correlations were observed between PFV and CAC (r² = 0.22; P = 0.002) and ARC and CAC (r² = 0.37; P <0.001) in the normal weight group. However, no significant correlations were observed for obese and overweight patients. Conclusion: These findings indicate that BMI may not be an accurate tool for measuring adiposity or assessing subclinical coronary atherosclerosis in patients with suspected CAD. [ABSTRACT FROM AUTHOR]

Background The true role of thymic function in children with congenital heart defects is largely unknown. Aim To study the possible role of thymic CD3 (T-lymphocyte marker) and CD20 (B-lymphocyte marker) expression and thymic histopathological changes in complications after surgery for congenital heart defects. Methods Between January and July 2014, thymic tissue samples were obtained from 13 (69% male, 31% female, mean age 10.9 ± 2 years) of 25 Iraqi patients who underwent open heart surgery with partial thymectomy for correction of congenital heart defects. The samples were evaluated for thymic expression of CD markers (CD3 and CD20) and histopathological changes. For up to 6 months after surgery, data on complications were collected from each patient, including wound infection, cardiac arrhythmias, heart failure, rehospitalization, chest infection, and death. Results The prevalence of thymic hypoplasia was 15% and it occurred more frequently in patients with absent thymic CD3 expression (p = 0.005). Only wound infection (n = 2) and atrial fibrillation (n = 1) comprised the postoperative complications in our patients. Absence of thymic CD20 expression correlated significantly with postoperative complications and obstructive cardiac defects (p = 0.04), whereas no significant correlations were found between thymic hypoplasia with CD3 expression and postoperative complications (p > 0.05). Conclusion Patients with absent thymic CD20 expression had significantly more postoperative complications and cardiac obstructive defects than those with positive CD20 expression. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the impact of hypertension on angiographic results in Iraqi patients with coronary artery disease. Six hundred and fifty seven patients with coronary artery disease (CAD) were submitted to routine coronary angiography in the period from January 2008 to December 2010. A comparison and evaluation have been divided into 2 stages. There was no significant association between patients with CAD who had a history of hypertension only with the number and distribution of coronary artery vessels involvement, as well as with morphological severity of coronary lesions. But, there was a statistically significant association between hypertension associated with other cardiac risk factors with multiple coronary lesions. Hypertension was significantly associated with multiple coronary artery lesions when combined with other cardiac risk factors. [ABSTRACT FROM AUTHOR]