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Introduction Coronary revascularization is associated with better prognosis in multivessel coronary artery disease (MV-CAD) chronic kidney disease (CKD) patients. However, whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is better remains unknown. Aim of the study To compare outcome of multi-vessel PCI versus CABG in the group of patients with CKD regarding in-hospital and one-year major adverse cardiovascular and cerebrovascular events (MACCE). Methods A retrospective analysis of the data of patients with established CKD with eGFR less than 60 ml/min with MV-CAD who underwent PCI or CABG were compared as regards in-hospital and one-year MACCE. Results A total number of 565 patients were reviewed, 230 patients had PCI while 335 patients had CABG. Comparing both groups regarding in-hospital MACCE, patients who had mutli-vessel PCI had significantly lower in-hospital death, cerebrovascular events and total MACCE than patients who had CABG (P-value = 0.03, 0.01, 0.04 respectively). While comparing both groups regarding 1-year MACCE, patients who had mutli-vessel PCI had significantly lower cerebrovascular events and total MACCE than patients who had CABG (P-value = 0.02, 0.03 respectively). Conclusion On the contrary to previously published data, in a retrospective study to determine which is better in CKD MV-CAD patients, Multi-vessel PCI for CKD patients and MVCAD had advantages over CABG as regards in-hospital and 1-year cerebrovascular accidents (stroke/TIA) and total MACCE. Large randomized controlled trials are needed to confirm our findings. Funding Acknowledgement Type of funding source: None

Background Left atrial appendage closure (LAAC) during cardiac surgery in atrial fibrillation (AF) patients has been investigated in multiple studies with variable safety and efficacy results. Methods A comprehensive review was performed of all studies comparing LAAC and placebo arm during cardiac surgery in AF patients. A random-effect model was used to calculate risk ratios, mean differences, and 95% confidence intervals. Results Five randomized controlled trials and 22 observational studies were included with a total of 540,111 patients. The LAAC group had significantly decreased postoperative stroke/embolic events as compared to the no LAAC group with all cardiac surgeries (3.74% vs 4.88%, p = 0.0002), isolated valvular surgery (1.95% vs 4.48%, p = 0.002). However, CABG insignificantly favored the LAAC group for stroke/embolic events (6.72% vs 8.30%, p = 0.07). There was no difference between both groups in all-cause mortality in the perioperative period (p = 0.42), but was significantly lower in the LAAC arm after two years (14.1% vs 18.3%, p = 0.02). There was no difference in major bleeding, all-cause rehospitalizations, or cross-clamp time between both groups (p = 0.53 and p = 0.45). The bypass and the cross-clamp time were longer in the LAAC group (4 and 9 min, respectively). Conclusion In AF patients, LAAC during cardiac surgery had a decreased risk of stroke and long-term all-cause mortality. Additionally, there was no difference in major bleeding, all-cause rehospitalizations, or cross-clamp time.

Direct oral anticoagulants (DOACs) have a well-established role in the treatment of deep vein thrombosis and pulmonary embolism and in the reduction of thromboembolism in nonvalvular atrial fibrillation. However, limited evidence supports their role in patients with left ventricular thrombi. The PubMed, EMBASE, and Cochrane databases were searched for relevant articles published from inception to 1 August 2020. We included studies evaluating the effect of DOACs versus vitamin K antagonists (VKAs) in patients with left ventricular thrombi. The primary outcome was thrombus resolution, and the secondary outcomes were major bleeding and stroke or systemic embolization (SSE). Five retrospective observational studies were included, with a total of 857 patients. VKAs and DOACs had a similar rate of thrombus resolution (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.57–1.65; p = 0.90). Our analysis also demonstrated a similar rate of major bleeding (OR 0.62; 95% CI 0.27–1.44; p = 0.27) and SSE (OR 1.86; 95% CI 0.99–3.50; p = 0.05) between the two treatment groups. In patients with left ventricular thrombi, DOACs and VKAs are associated with similar rates of thrombus resolution, major bleeding, and SSE.

A single coronary artery is an exceedingly rare anomaly. Hereby, we present an unusual case of a young patient with an acute coronary syndrome who was found to have a single coronary artery originating from a single ostium in the right sinus of Valsalva with dual left anterior descending (LAD) arteries arising from the right coronary artery with two different anatomical courses, and additionally one of those LADs running a malignant intra-arterial course.

Left ventricular thrombi form due to the presence of Virchow's triad in patients with left ventricular systolic dysfunction. This complication increases the incidence of systemic embolization, hence anticoagulation is recommended to decrease this risk. Up to the present time, vitamin K antagonists are recommended by all societal guidelines for patients with left ventricular thrombi. Recently, several studies have investigated the role of different anticoagulants and yielded promising outcomes. This opinion article focuses on the evidence supporting vitamin K antagonists and direct oral anticoagulants in patients with left ventricular thrombi.

Introduction The incidence of acute cardiac injury in COVID-19 patients is frequently subclinical and can be identified by cardiac magnetic resonance imaging. Left ventricular global longitudinal strain (LV-GLS) using two-dimensional speckle-tracking echocardiography (2D-STE) provides an accurate validated method for early detection of subclinical myocardial dysfunction. So far, long-term cardiovascular complications of COVID-19 are undetermined therefore several validated methods should be used for early diagnosis and intervention in those patients. Purpose The aim of this work was to describe GLS as an indicator of myocardial injury in a case series of non-hospitalized COVID-19 patients complaining of persistent dyspnea after resolution of COVID-19 infection. Methods A total number of 18 patients who were diagnosed with COVID-19 and were not indicated for hospital admission due to mild symptoms presenting with residual persistent dyspnea following COVID-19 infection resolution. Through clinical examination and standard 2D transthoracic echocardiography with STE emphasizing on LV-GLS was performed using Philips Epic - Qlab 10 software. Results The mean age of the included patients was 37.44±6.33 years, the mean time from COVID-19 diagnosis was 48.1±15.45 days, all patients (100%) had persistent dyspnea grade II. The mean left ventricular ejection fraction (LVEF) was 62.9±3.46% while the mean LV-GLS was −15.55±2.16%. Clinical and echocardiographic data is presented in Table 1. Conclusion In a case series of non-hospitalized COVID-19 survivors who complained of persistent dyspnea, GLS was low in comparison to the normally reported values of LV-GLS although they had normal LVEF indicating the persistence of myocardial injury even in mild cases of COVID-19 long after infection resolution. Further close follow-up of even mild and moderate COVID-19 survivors is certainly required to detect long-term cardiovascular sequelae. 2D STE with LV-GLS can be used as a readily available validated technique to detect early or persistent myocardial dysfunction succeeding COVID-19 infection. Funding Acknowledgement Type of funding sources: None.

Introduction Coronary bifurcation lesions are considered one of the challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. However, there is limited data about the proper management of such lesions in the setting of myocardial infarction as most bifurcation lesion studies excluded patients with acute coronary syndrome (ACS). Aim To compare in-hospital and mid-term outcomes of single-stent and two-stents strategy in the management of bifurcation culprit lesions in patients presenting with anterior STEMI Methods This retrospective multi-center study included all consecutive patients presented with anterior STEMI who underwent primary PCI between January 2017 and December 2019, coronary angiography showed true bifurcation lesion with sizable side branch that can be managed by stenting. Patients with left main bifurcation lesion, patients indicated for urgent CABG, or patients in cardiogenic shock were excluded. Included patients were divided into two main groups according to the stenting strategy either single or two stents strategy. Six months of follow up data were collected by telephone calls and the examination of medical records Results Out of 1355 anterior STEMI patients presented between January 2017 and December 2019, 158 patients (11.6%) were identified to have bifurcation culprit lesions with a sizable diagonal branch. The baseline characteristics and angiographic findings were similar in both groups except for higher side branch involvement in the two stents group (83.31%± 11.20 and 71.88%±15.05, t=−5.39, p Conclusion Although two stents strategy in the setting of STEMI is much complex with more fluoroscopy time and contrast volume, the procedural success rate and the incidence of complications between two groups were comparable on the medium-term follow up Funding Acknowledgement Type of funding sources: None.

Ivabradine is a heart rate-lowering agent that inhibits pacemaker funny current (If). It has been approved by the European Medicines Agency and the US Food and Drug Administration for patients with stable angina and heart failure (HF). AF is a common issue especially in ischaemic heart disease and HF patients. In contrast to experimental findings and a limited number of clinical trials that demonstrate the emerging role of ivabradine for heart rate control in AF or maintenance of sinus rhythm, there is accumulating contradictory data indicating that there is, in fact, an increased incidence of new-onset AF among people who are taking ivabradine in clinical practice. This article reviews the most recent evidence highlighting the diversity of data in relation to the use of ivabradine and the onset of AF and whether it has a legitimate role in AF treatment and the maintenance of sinus rhythm.

Introduction: A critical mechanism of how hypoxia/ischemia causes irreversible myocardial injury is through the exhaustion of adenosine triphosphate (ATP). Cyclocreatine (CCr) and its water-soluble salt Cyclocreatine-Phosphate (CCrP) are potent bioenergetic agents that preserve high levels of ATP during ischemia. Areas covered: CCr and CCrP treatment prior to the onset of ischemia, preserved high levels of ATP in ischemic myocardium, reduced myocardial cell injury, exerted anti-inflammatory and anti-apoptotic activities, and restored contractile function during reperfusion in animal models of acute myocardial infarction (AMI), global cardiac arrest, cardiopulmonary bypass, and heart transplantation. Medline and Embase (1970 - Feb 2019), the WIPO databank (up to Feb 2019); no language restriction. Expert opinion: This review provides the basis for a number of clinical applications of CCrP and CCr to minimize ischemic injury and necrosis. One strategy is to administer CCrP to AMI patients in the pre-hospital phase, as well as during, or after Percutaneous Coronary Intervention (PCI) procedure to potentially achieve protection of the myocardium, reduce infarcted-size, and, thus, limit the progression to heart failure. Another clinical applications are in predictable myocardial ischemia where pretreatment with CCrP would likely improve outcome and quality of life of patients who will undergo cardiopulmonary bypass for coronary revascularization and end-stage heart failure patients scheduled for heart transplantation.

Background Despite the marked improvement in the aortic dissection repair techniques, residual dissected aorta with a patent false lumen remains an issue. So, the aim of our study is to observe the effect of inserting the Thoraflex Hybrid Graft on the aortic diameters in patients with type A aortic dissection involving the arch and descending aorta. Patients with type I aortic dissection who had aortic dissection repair using the Thoraflex Hybrid Graft in University Hospitals Birmingham were studied. Radiological assessment with computed tomography of the aorta was done at the level of the diaphragm to measure the true lumen, false lumen and total aortic diameters. Significance of change of diameters at early post-operative as compared to the pre-operative period was analysed. Results Eight cases were done in the acute setting, while 14 cases were done in the chronic setting. The ratio of true lumen to the total aortic diameter has significantly increased in the follow-up period as compared to the pre-operative period (P = 0.031). Whereas false lumen to total aortic diameter ratio has significantly decreased (P = 0.024). Subgroup analysis revealed that these changes were not significantly altered by whether the dissection was acute or chronic. Conclusions The Thoraflex Hybrid Graft will induce positive aortic remodelling with expansion of true lumen and will diminish the false lumen. But we could not find a significant difference between acute or chronic cases due to small sample size.

Background Novel coronavirus disease 2019 (COVID-19) is known to lead not only to severe acute respiratory syndrome, but also can result in thromboembolic events in both the venous and the arterial circulation by inducing coagulation disorders. The potential causes of coagulopathy are inflammation, platelet activation, endothelial dysfunction, and stasis. The thrombotic events including pulmonary embolism, deep venous thrombosis as well as intracatheter thrombosis are more likely to develop in patients infected with severe form of SARS-CoV-2 who are admitted to ICU. Furthermore, these events contribute to multi-organ failure. Case presentation Herein, we report a case of an immunocompromised COVID-19 elderly patient with acute lymphocytic leukemia who developed myocardial infarction with ST elevation in the setting of acute pulmonary thromboembolism in the presence of zero platelet count. Despite successful urgent coronary revascularization and platelet transfusion, the patient eventually died after failed resuscitation efforts. Conclusion Patients with COVID-19 infection are at a greater risk of developing cardiovascular complications, but their appropriate management can decrease the risk of fatal events. Coronary thrombosis associated with pulmonary thromboembolism in the setting of thrombocytopenia is a rare and a complex to manage condition. Significance of single antiplatelet agent in STEMI with thrombocytopenia merits further studies. According to expert opinions and literature reviews, we must avoid dual antiplatelet therapy in these patients and keep platelet transfusion as a standard therapy to avoid drastic bleeding complications.

Background Subaortic obstruction by a membrane or systolic anterior motion of the mitral valve leaflets is usually suspected in young patients, especially if the anatomy of the aortic valve is not clearly stenotic and unexplained left ventricular hypertrophy exists in the context of high transaortic gradients. Main body In certain circumstances, some patients show both aortic and subaortic stenotic lesions of variable severity. Doppler echocardiography can help in grading severity in the case of single-level obstruction but not in patients with multilevel obstruction where the continuity equation is of no value. Three-dimensional (3D) echocardiography allows "en-face" visualization of each level of the aortic valve and subaortic tract; in addition, direct planimetry of the areas can be done using multiplanar reformatting. Conclusions Accordingly, 3D echocardiography plays a crucial role in the assessment in patients with multilevel left ventricular outflow tract obstruction as it can accurately delineate the location and size, and severity of the stenosis.

A 60-year-old woman was referred to our clinic for evaluation of her rapidly progressive dyspnea, and she had no previous history of heart disease. A murmur was noted on her examination, and transthoracic echocardiography was so difficult to be performed due to poor acoustic windows so she was referred to do a transesophageal echocardiography that showed an ostium primum atrial septal defect (ASD) with left-to-right shunt and a quadrileaflet mitral valve with severe regurgitation. Later on, she underwent surgery with ostium primum ASD closure by a patch and double cleft repair by suture after right heart catheterization. WOS:000634144200001 33778991 Q4

BackgroundAtrial fibrillation (AF) affects millions of people worldwide and can remain undiagnosed for years. It is a major cause of cerebrovascular stroke (CVS); hence, early detection is extremely important in order to decrease the risk of CVS. We conducted a retrospective observational study looking into the prevalence of silent AF in 3299 patients admitted from January 2014 to December 2017 in a tertiary care stroke specialized center. Ischemic CVS was confirmed either by using multislice computed tomography (MSCT) or magnetic resonance imaging (MRI) of the brain. AF was diagnosed by electrocardiography (ECG) at the time of admission or during the hospital stay. Patients with a history of AF were excluded from the study.ResultsOf the 3299 patients admitted by acute ischemic CVS, 707 (21.43%) had a history of AF and thus were excluded from the study. Of the remaining 2592 patients eligible for the study, 1666 (64.27%) were males with a mean age of 56.06 years (± 16.01). A total of 2313 (89.24%) patients remained in sinus rhythm throughout the hospital stay, 211 (8.14%) patients were in AF on admission, and 68 (2.62 %) patients developed AF during their hospital stay. The total number of newly diagnosed patients with AF was 279 (10.76%).ConclusionThe prevalence of de novo atrial fibrillation in patients presented with acute cerebrovascular stroke is high. The implementation of good screening programs can significantly reduce the risk of disabilities and morbidities.

Carney complex is a rare autosomal dominant disorder characterized by multiple tumors, including cardiac and extracardiac myxomas, skin lesions, and various endocrine disorders. We are reporting a 21-year-old female patient with past surgical history significant for excision of a cutaneous myxoma who presented with multicentric cardiac myxomas involving the four cardiac chambers. She also presented with endocrinal disorders in the form of an enlarged right lobe of the thyroid, hyperthyroid state, and an incidentally noted adrenal cyst; hence, she was diagnosed with carney complex syndrome.

Objectives To evaluate diagnostic yield of coronary artery calcium (CAC) scoring using multidetector CT imaging in rheumatoid arthritis (RA) patients presented with chest pain. Patients and methods Seventy RA patients evaluated using the 28 joint disease activity (DAS-28) score, Disability Index (DI) and radiologically for Larsen–Dale index. Patients underwent assessment for coronary artery disease (CAD) risk factors and coronary risk stratification using the Framingham Risk Score (FRS). Patients were clinically categorized according to criteria for typical anginal pain (TAP) and were scanned using a 64-row spiral CT scanner for CAC scoring and were stratified according Agatston CAC scores for calculation of total Agatston score (TAS). Results Clinically, 32 patients had full criteria of TAP, 27 patients showed a picture of atypical anginal pain, while 11 patients had non-anginal chest pain. FRS predicted low, intermediate and high risk of CAD in 34, 18 and 18 patients, respectively. TAS defined no CAC in 4 patients, while mild, moderate and severe CAC was detected in 24, 36 and 6 patients, respectively. Regression analysis defined low HDL blood level, current smoking and high TAS, DAS-28 and FRS as significant predictor for TAP in decreasing order of significance. Receiver operating characteristic (ROC) curve analysis defined low HDL blood level and high TAS as the significant sensitive and specific tests, respectively. There was positive significant correlation between FRS and both of TAS scores and extent of coronary stenosis. However, FRS was the least significant predictor for TAP. Conclusion Screening of RA patients with combination of clinical scoring using FRS and CAC using non-invasive multidetector CT could allow early detection of patients at risk for acute cardiovascular events. However, TAS acts better for the prediction of TAP.

Unguarded tricuspid orifice is the most extreme of tricuspid valve dysplasia with a very variable natural history. They can tolerate tricuspid regurgitation well, and they become symptomatic only if significant right ventricular dysfunction or atrial fibrillation occurs. Patients with a mild degree of right ventricular dysfunction can survive to adulthood and even reach old age. Surgical treatment is a difficult option due to variable natural history, and surgical results are not too encouraging.

Although there are abundant data highlighting the safety and efficacy of direct oral anticoagulants, to date, recent guidelines have limited their use to stroke prevention in patients with non-valvular AF, as well as in the prevention and treatment of venous thromboembolism and pulmonary embolism. Encouraging data about the off-label use of direct oral anticoagulants have been shown in several other indications, such as intracardiac thrombi, left ventricular thrombi and left atrial appendage, but a large sector of patients are still not addressed, such as valvular and prosthetic patients.

Background Tetralogy of Fallot (TOF) represents approximately 7%-10% of congenital heart diseases (CHDs), and it is the most common cyanotic CHD, with 0.23-0.63 cases per 1,000 births. In our case report we are reviewing the added value of three dimensional echocardiography in the assessment of degree of infundibular and valvular stenosis in tetralogy of Fallot. Case report A 29-year-old female patient with history of congenital heart disease (Fallot’s tetrology) and history of total surgical correction at the age of 10 presented to our facility by dyspnea grade III that started 1 month before presentation .On examination; an ejection systolic murmur was heard over the pulmonary area with palpable thrill. Electrocardiogram (ECG) revealed normal sinus rhythm with a heart rate of 75bpm with right axis deviation and right ventricular hypertrophy voltage criteria. Transthoracic two dimensional echocardiography revealed increased thickness of the right ventricle (RV) free wall , and aliasing of the color Doppler flow across the right ventricular outflow tract (RVOT) with a peak systolic gradient across the RVOT 69mmHg . By performing three dimensional transesophageal echocardiography we were able to demonstrate the RVOT narrowing in RVOT enface view and by using specific software we were able to demonstrate the morphology of the pulmonary valve and the pulmonary valve orifice area and we found that the pulmonary valve is a bicuspid valve as shown and the pulmonary valve orifice area was 3.8cm2 signifying the absence of significant valvular stenosis. Conclusion 3D echocardiography in adult congenital heart disease provides unique projections from the living complex anatomy (such as en face views) and true volumetric quantification without geometric assumptions Abstract P696 Figure. Infundibular stenosis

OnBehalf YIG-CVR Introduction Thromboembolic events or bleeding are by far the most frequent complications of prosthetic heart valves. Cerebrovascular stroke is one of the major thromboembolic complications of anticoagulation-related issues of prosthetic heart valves. Aim of the work To determine the pattern and risk factors of acute stroke in patients with prosthetic heart valves. Methods and Patients A retrospective single-center analysis of the database registry of consecutive acute stroke patients with mitral or aortic heart valve prostheses admitted to a tertiary care stroke specialized center from 01/01/2012 to 01/12/2017. All patients were examined by a certified neurologist and underwent a complete work-up evaluation (Computed Tomography or Magnetic Resonance Imaging, Carotid Doppler ultrasound examination, complete blood tests, and electrocardiogram) and a transthoracic echocardiography (TTE) examination as well as transesophageal echocardiography (TOE) if valve dysfunction or thrombosis were suspected. Results 214 patients with mitral or aortic valve prostheses were admitted by acute stroke in the duration from 01/01/2012 to 01/12/2017 with a mean age of 44 ± 15 years, 132 were males (61.7%) and 178 patients had mechanical valves (83.2%). 135 patients had mitral prosthesis (63.1%) and ischemic stroke was encountered in 151 patients (70.6%). Conclusion In a single center experience, mechanical prosthesis at the mitral valve position was associated with higher incidence of ischemic stroke. Proper close follow-up of INR levels as well as the surgical shift to biological instead of mechanical valve should decrease significantly the incidence of prosthetic valve related strokes. Baseline, clinical and other parameters Patients (n = 214) Age (years) 44 ± 15 Mechanical valve 178 (83.2%) Atrial Fibrillation 101 (47.2%) Rheumatic Heart Disease 175 (81.8%) Left ventricular ejection fraction (%) 54 ±13 Mitral Only 135 (63.1%) Aortic Only 51 (23.8%) Double Valve Prosthesis 28 (13.1%) Ischemic stroke 151 (70.6%) Hemorrhagic stroke 47 (22%) Both ischemic and hemorrhagic stroke 16 (7.4%) Data are represented as mean(±SD) or number (Percentage) Abstract P1521 Figure. Valve sites

Introduction Acute ischemic cerebrovascular stroke (CVS) can be the first clinical manifestation of atrial fibrillation (AF), that is why large-scale screening programs for AF are currently implemented especially in individuals more than or equal 65 years old. Yet, to date, cost-effectiveness data have relied on assumptions of stroke rates observed in patients with established AF, while the true incidence rates of undiagnosed AF presenting as a stroke remain unknown. Purpose To estimate the incidence of patients with no history of AF who are presented with acute ischemic CVS and are found to be in AF at the time of presentation or developed atrial fibrillation during the hospital stay. Methods A retrospective analysis of all patients admitted with acute CVS to a tertiary care stroke specialized center in the period from 01/01/2014 till 31/12/2017. Ischemic CVS is confirmed by either multislice computed tomography (MSCT) or magnetic resonance imaging (MRI) of the brain. AF is documented by electrocardiography (ECG) that is made at admission or during hospital stay. Patients with history of AF on rate or rhythm-control therapy were excluded from the study. Results Of the 3299 patients admitted by acute ischemic CVS, 707 (21.43%) patients had history of AF and they were on medical rate or rhythm control therapy and thus were excluded from the study. Of the remaining 2592 patients eligible for the study, 1666 (64.27%) were males with a mean age of 56.06 years (±16.01). Regarding ECG, 2313 (89.24%) patients were in sinus rhythm and other non-AF rhythms and 211 (8.14%) presented with AF rhythm and 68 (2.62%) developed AF during their hospital stay with a cumulative incidence of (10.76%). Table 1. Baseline patient characteristics and ECG data (n=2592) Risk factors n=2592 Hypertension 1849 (71.33%) Diabetes Mellitus 925 (35.69%) Smoking 1445 (55.75%) ECG data Non-AF 2313 (89.24%) AF on admission 211 (8.14%) AF in hospital 68 (2.62%) Total AF 279 (10.76%) Undiagnosed AF in acute ischemic CVS Conclusion The incidence of undiagnosed atrial fibrillation in patients presented with acute cerebrovascular stroke is significantly high. Implementation of good screening programs can significantly reduce the risk of disabilities and morbidities.

Background SYNTAX score II (SSII) is an update of the established SYNTAX score (SS) that uses clinical variables such as age, sex, creatinine clearance, left ventricular ejection fraction, chronic obstructive pulmonary disease, and peripheral arterial disease. Furthermore, SSII has been proven to be a more powerful predictive tool than SS in patients with complex coronary artery disease (CAD). Carotid intima-media thickness (CIMT) is a widely used noninvasive evidence for subclinical or early atherosclerosis, and it was proved to be an independent predictor for cardiovascular events. Most of the previously published articles studied the association between the CIMT with old cardiovascular scoring systems such as SSI and Gensini score with debatable data about their correlation. Aim To study the correlation between SSII and CIMT in stable CAD patients undergoing elective coronary angiography (CA). Method and patients A prospective study including 155 patients undergoing elective CA for stable CAD excluding patients with history of acute coronary syndrome, previous coronary revascularization either by percutaneous coronary intervention or coronary artery bypass grafting, and previous cerebrovascular stroke. Results The mean age of patients was 58.25 ± 16.46 years, and 79 patients (50.96%) were men. The mean SSII score was 10.23 ± 11.36 and mean CIMT was 0.85 ± 0.24. The correlation between SSII and CIMT using Spearman correlation showed a strong correlation between SSII score and CIMT with correlation coefficient r = 0.752. Conclusion The study showed a strong positive correlation between SSII and CIMT in stable CAD patients undergoing elective CA.

A 17-year-old male patient with Gaucher disease was presented to our institution complaining of rapid irregular palpitations. Echocardiography showed the presence of critical aortic stenosis due to Gaucher disease.

Contrast-induced acute kidney injury (CI-AKI) is an underdiagnosed complication of percutaneous coronary intervention (PCI). Midkine (MK) is a heparin-binding growth factor that regulates cell growth, survival and migration. Serum MK is considered an early predictor of CI-AKI. The study aimed to

Pulmonary embolization (PE) carries a high mortality risk if not suspected and treated properly. Systemic embolization is quite common especially in cases of mobile left ventricular (LV) thrombi. We were encountered with a catastrophic case of thromboembolism with simultaneous massive PE and bilateral lower limb ischemia in a patient with biventricular systolic dysfunction and multiple LV thrombi. Tissue plasminogen activator (tPA) was given and the patient’s hemodynamics started to be stable. Unfortunately, he developed left lag, bilateral lower limb dry gangrene and subsequently he passed away despite all trials to resuscitate.

Left ventricular (LV) thrombus is usually seen in patients with significantly reduced LV systolic function especially those surviving a large ST-elevation myocardial infarction (STEMI). It usually occurs when the STEMI is anterior, anterolateral or anteroseptal with a large area of akinesia or dyskinesia involving the apex. It may occur following an inferior or a posterior STEMI with large akinetic segments in the inferior or posterior walls in rare occasions (1). The main risk associated with LV thrombi is distal systemic embolization that usually occurs during the first 3 - 4 months after infarction (2, 3). The main clinical consequence of thromboembolism is the occurrence of stroke, and the current guidelines do recommend the use of vitamin K antagonists (VKAs) as a preventive measure in patients with LV thrombus. Non-VKA direct oral anticoagulants (DOACs) are currently replacing VKA in several clinical indications, such as in patients with non-valvular atrial fibrillation (AF) where they were found to be either non-inferior or superior to VKAs. However, to our knowledge, there are no robust data on the use of DOACs for the treatment of LV thrombi, and all the available data are limited to individual case reports (4, 5). We present the effect of rivaroxaban, a DOAC, in the dissolution of LV thrombi in a series of patients presenting with acute coronary syndrome (ACS) and receiving dual antiplatelet therapy (DAPT) without valvular heart disease.

Left ventricular free wall rupture (LVFWR) is a rare, yet lethal, complication of acute myocardial infarction (AMI), occurring in approximately 2% of cases. In the era of percutaneous coronary intervention, however, it is less frequently encountered. We were confronted with a case of AMI complicated with LVFWR after receiving thrombolytic therapy. The diagnosis was established using transthoracic echocardiography (TTE). Unfortunately, the patient passed away before surgical intervention. This case demonstrates the importance of prompt diagnosis and management of such a lethal complication.

Cryptogenic stroke represents one third of ischemic strokes, initial work up includes Computed Tomography (CT), Magnetic resonance imaging (MRI), laboratory investigations, Electrocardiogram (ECG) and Echocardiography either transthoracic (TTE) or Transesophageal (TEE). Patent foramen ovale (PFO) which is seen in between 15% and 25% of adults has been identified as a source for cryptogenic ischemic stroke.

Type Clinical Research. Presentation Type Oral Presentation. Introduction Nowadays, there are many methods for detection of significant coronary artery stenosis and myocardial ischemia either by imaging the coronaries or detecting myocardial perfusion abnormalities, but the majority of these methods needs either stress imaging or injection of contrast especially in patients with stable coronary artery disease (SCAD) where there is no resting electrocardiogram (ECG) changes or resting echocardiography wall motion abnormalities. With the development of tissue Doppler imaging, new methods like strain and strain rate imaging were developed followed by the development of the speckle tracking imaging. Strain and strain rate imaging can detect myocardial deformation which is the basis of myocardial function, thus with impaired myocardial perfusion the amount and rate of deformation decreases. Methodology Thirty patients with SCAD and significant single vessel left anterior descending (LAD) coronary artery stenosis, diagnosed by invasive coronary angiography, undergoing elective percutaneous coronary intervention (PCI) of the LAD lesion with no significant lesions in the other coronary vessels, left circumflex (LCX) and right coronary artery (RCA). Patients with diabetes, regional wall motion and reduced left ventricular systolic function were excluded. Regional systolic strain and strain rate was measured in the ischemic LAD segments which are six, apicoseptal, mid anteroseptal, basal anteroseptal, apicoanterior, mid anterior and basal anterior, and measured in the non-ischemic LCX and RCA segments, before elective PCI of LAD and three months later. Results By comparing the strain and strain rate of the ischemic segments before and after PCI there was significant improvement of the systolic strain while there were non-significant changes in the non-ischemic segments. Conclusion Tissue Doppler strain and strain rate imaging during resting echocardiography can be used to detect regional myocardial ischemia in patients with significant coronary artery stenosis.

Thrombus burden (TB) in patients presenting with acute ST-elevation myocardial infarction (STEMI) can be reliably estimated in occluded infarct-related arteries (IRAs). High thrombus burden is a significant independent predictor for mortality and major adverse cardiovascular and cerebrovascular