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Rasheed Ibdah,1,* Omar Obeidat,1,* Yousef Khader,2 Jowan Al-Nusair,1 Obada Abusurrah,1 Abedallah Obeidat,1 Ali Obeidat,1 Sukaina Rawashdeh,1 Nasr Alrabadi,3 Abdelrahman F Obiedat,4 Naseem N Alnadi,4 Ayman Hammoudeh4 1Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan; 3Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Cardiology, Istishari Hospital, Amman, Jordan*These authors contributed equally to this workCorrespondence: Rasheed Ibdah, Division of Cardiology, Department of Internal Medicine, Jordan University for Science and Technology, Irbid, 22110, Jordan, Email rkibdah@just.edu.joBackground and Purpose: CHA2DS2-VASc score is one of the most widely used scoring systems to assess the risk of systemic embolization and stroke in patients suffering from atrial fibrillation (Afib); furthermore, it is important in guiding their treatment. This study aimed to evaluate the predictivity of this score in the Jordanian population, build a deeper understanding of patients’ demographic and risk factors, and assess the usefulness of anticoagulation as a preventive measure.Methods: A total of 2020 patients with Afib registered in the Jordanian Atrial Fibrillation (JoFib) registry were enrolled in this study. All patients were followed up for 1 year to assess their susceptibility to develop cerebrovascular accident (CVA) and systemic embolism (SE). The association between CHA2DS2-VASc score and risk of development of stroke or systemic embolization was analyzed based on bivariate and adjusted multivariate analyses. The ROC curve was used to assess the predictivity of the CHA2DS2-VASc score.Results: The mean age of the study population was 67.8 years; 45.8% were males, and 81.8% were on anticoagulants. And, 71.8% had a CHA2DS2-VASc score of ≥ 3. During the follow-up period of 1 year; 69 developed new CVA (mean age, 72.8 years), and 9 developed SE. A total of 276 patients died; 18 patients died (6.5% out of all deceased)% from CVA. A moderate predictive power of the CHA2DS2-VASc score was demonstrated through ROC curve analysis with C statistics of 0.689 CI (0.634 to 0.744) for predicting the development of SE or CVA at 1 year.Conclusion: CHA2DS2-VASc showed a moderate predictivity of stroke, SE, and all-cause mortality at 1 year. The study suggested disregarding gender differences in deciding to initiate anticoagulant therapy.Keywords: atrial fibrillation, Jordan, CHA2DS2-VASc, stroke, risk

Kassahun Cherkos, Gashaw Jember, Tewodros Mihret, Molla Fentanew Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Molla Fentanew, University of Gondar, P.O. Box. 196, Gondar, Ethiopia, Tel +251935686860, Email molefentapt@gmail.comBackground: Deficit in cognitive impairment is the most serious of the stroke sequelae. Post-stroke cognitive impairment is associated with impaired daily living activities and decreased capacity for independent living and functional performance. As a result, the purpose of this study was to determine the prevalence and associated factors of cognitive impairment among stroke survivors at comprehensive specialized hospitals in Ethiopia’s Amhara region by 2022.Methods: A multi-centered cross-sectional study was designed at an institution. During the study period. Data was gathered by conducting structured questionnaire interviews with participants and reviewing medical charts with trained data collectors. The participants were chosen using a systematic random sampling technique. The Montreal cognitive assessment basic was used to assess cognitive impairment. Descriptive statistics, binary and multivariate logistic regression methods were used to analyze the data. The Hosmer-Lemeshow goodness-of-fit test was used to assess the fitness of the model. The AOR with a P value of 0.05 at 95% CI was reported, and variables were considered statistically significant.Results: This study enrolled 422 stroke survivors. Overall, 58.3% of stroke survivors had cognitive impairment (95% CI 53.4– 63.0%). The study participants’ age with AOR; 7.12 (4.40– 11.45), being hypertensive with AOR; 7.52 (3.46– 16.35), arriving at the hospital after 24 hours with AOR; 4.33 (1.49– 12.05), less than three months after stroke with AOR; 4.83 (3.95– 12.19), dominant hemisphere lesion with AOR; 4.83 (3.95– 12.19) and being illiterate with AOR; 5.26 (4.43– 18.64) were found significant factors.Conclusion: Cognitive impairment was discovered to be relatively common among stroke survivors in this study. More than half of stroke survivors who attended comprehensive specialized hospitals during the study period were found to have cognitive impairment. Age, hypertension, arriving at the hospital after 24 hours, less than three months after stroke, dominant hemisphere lesion, and illiterate educational status were all significant factors in cognitive impairment.Keywords: - cognitive impairment, prevalence, stroke survivors, Ethiopia

Fernando M Clara,1,2 José Alfie,3 Adriana Scandurra,1 Mariana Fita2 1Instituto de Investigaciones Científicas y Tecnológicas en Electrónica, Universidad Nacional de Mar del Plata/ CONICET, Mar del Plata, Argentina; 2Unidad Cardiometabólica, Centro de Especialidades Médicas Ambulatorias, Mar del Plata, Argentina; 3Unidad de Hipertensión Arterial, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, ArgentinaCorrespondence: Fernando M Clara, ICyTE, UNMDP/CONICET, Av. Juan B. Justo 4302, Mar del Plata, B7600, Argentina, Tel +54 0223 481-0046, Email fermclar@gmail.comIntroduction: The compliance of the distal arteries depends on their vasoconstrictor tone and distensibility and is sensitive to endothelial function and aging. C2, a component of the Windkessel model, is a measure of distal arterial compliance, and establishes the magnitude of the pressure rise during early diastole. It is calculated from the diastolic portion of the radial pulse wave using sophisticated analyses. C2 is used as a cardiovascular risk indicator since it decreases with aging, high blood pressure, and diabetes. Here, we propose an alternative method to assess the distal arteries distensibility by measuring the amplitude of the oscillation that occurs at the beginning of diastole.Methods: Peripheral pulse wave was evaluated noninvasively by applanation tonometry in 511 individuals (264 women) aged between 13 and 70 years. Diastolic amplitude (DA) was measured as the peak-to-peak amplitude of the diastolic oscillation. Radial augmentation index (RAIx) and pulse wave velocity (PWV) were also calculated.Results: DA decreased approximately 2% per decade of life between 16 and 70 years from 19% to 7%, and was higher in men than in women (p< 0.0001). Linear regression analysis identified RAIx as the strongest predictor of AD (p< 0.0001), followed by age and height. Sex modified the age-related decrease in DA (p< 0.001). By applying the method to measure DA from previously published data, we found a strong linear correlation with C2.Conclusion: DA decreased linearly with age in a reciprocal manner to the increase in radial augmentation index, was greater in men than women, and was independent of blood pressure and heart rate, as previously reported for C2. We propose that measuring DA could provide an alternative index to evaluate distal arterial compliance and aging.Keywords: pulse wave analysis, diastole, distal arteries, ageing

Ahmed Hussein,1 Ahmed M Khalaf,2 Laila A Alsharawy,3 Gomaa Abdelrazek,4 Mohammad Shafiq Awad5 1Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt; 2Department of Internal Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt; 3Department of Chest Diseases, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt; 4Cardiology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt; 5Cardiology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, EgyptCorrespondence: Ahmed Hussein, Sohag University, Faculty of Medicine, Nasser City, Sohag, 82524, Egypt, Tel +2 01011145537, Fax +2 0934600349, Email ahmed_hussien@med.sohag.edu.egBackground: A little is known about the risk factors and predictors of pulmonary embolism (PE) in Coronavirus disease 2019 (Covid-19) infected patients. Therefore, we directed this study to investigate the predictors of PE in patients infected with Covid – 19 in Upper Egypt.Methods: We conducted a retrospective cohort study on 297 patients infected with COVID-19, aged ≥  18 years old. Suspicion of COVID-19 infection was based on the World Health Organization (WHO) criteria and confirmed by nasal and pharyngeal swab for real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. The patient was also determined to have COVID-19 when CT results that were thought to be typical for COVID-19 and clinical data that were compatible were present.Results: PE was diagnosed in 18.2% of patients. We found that the incidence of PE was significantly higher in older patients, females, those with higher BMI, hypertensive patients, diabetics, and patients with co-morbidities. Also, PE was significantly higher in patients presented with dyspnea, chest pain, longer duration of symptoms at hospital admission, and lower oxygen concentration. The mean serum Hb level, platelet count, TLC and absolute lymphocytic count were markedly reduced in those who had PE. All the patients who developed PE had a CO-RADS scale five on their CT chest scan. Age > 65, BMI > 25, DM, and associated co-morbidities were the independent patients’ characteristics associated with the development of PE after the multivariate regression analysis.Conclusion: PE is a common complication of Covid 19 infection. PE is associated with a variety of clinical and laboratory parameters in univariate analysis, but age > 65, BMI > 25, DM, and associated co-morbidities were the independent patients’ characteristics associated with the development of PE in those infected with Covid-19.Keywords: Covid-19, SARS-CoV-2, CO-RADS, pulmonary embolism

Mahasen Al-Najar,1 Mohammed Al-Nusair,2 Nasr Alrabadi,3 Ibrahim Alawaisheh,4 Tuqa Alawaisheh,4 Mohamad Jarrah,5 Karem H Alzoubi,6,7 Sumaya Njem,3 Ayman Hamoudeh8 1Department of Radiology, Faculty of Medicine, The University of Jordan, Amman, Jordan; 2Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 4Faculty of Medicine, The University of Jordan, Amman, Jordan; 5Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 6Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates; 7Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; 8Cardiology Department, Istishari Hospital, Amman, JordanCorrespondence: Mohamad Jarrah; Nasr Alrabadi, Correspondence: Tel +962795994247, Email jarrahmohammad16@gmail.com; nnalrabadi@just.edu.joAim: The risks of thromboembolism and major bleeding in atrial fibrillation (AF) patients were assessed according to the “Evaluated Heartvalves, Rheumatic or Artificial” (EHRA) classification. Additionally, the safety and efficacy of vitamin K antagonists (VKAs) and non-VKA oral anticoagulants (NOACs) were compared in AF patients with EHRA type 2 valvular heart disease (VHD) versus those with no VHD.Methods: AF patients enrolled in the “Jordan Atrial Fibrillation (JoFib)” study were followed up for thromboembolic events and major bleeding at 30, 180, and 365 days. Patients in the EHRA type 2 VHD and non-VHD groups were sub-grouped to compare different OACs.Results: 2020 AF patients were recruited. The thromboembolic risk was higher in EHRA type 2 VHD patients compared to non-VHD controls. Major bleeding also occurred at higher rates in EHRA type 2 patients. In addition, NOACs were more effective in preventing thromboembolic events than VKAs and non-anticoagulation in EHRA type 2 VHD patients. Furthermore, EHRA type 2 VHD patients taking rivaroxaban had significantly less thromboembolic risk than their non-anticoagulated counterparts. At the same time, apixaban and warfarin did not significantly lower the risk of thromboembolism compared to non-anticoagulation.Conclusion: AF patients with EHRA type 2 VHD are at significant risk of thromboembolism and major bleeding. Furthermore, NOACs were more effective than VKAs in preventing thromboembolic events in this group of patients without conferring an added risk of major bleeding. Moreover, rivaroxaban appears to be particularly efficacious.Keywords: thromboembolism, bleeding, atrial fibrillation, EHRA type 2 valvular heart disease, Jordan

Nicolas W Shammas, Gail Shammas, Lori Christensen, Sue Jones-Miller On behalf of the JET-RANGER InvestigatorsMidwest Cardiovascular Research Foundation, Davenport, IA, USACorrespondence: Nicolas W Shammas, Research Director, Midwest Cardiovascular Research Foundation, 630 E 4th Street, Suite A, Davenport, IA, 52801, USA, Email shammas@mchsi.comBackground: The JET-RANGER study (NCT03206762) was a multicenter (11 US centers) randomized trial, core lab adjudicated, designed to demonstrate the superiority of Jetstream + Paclitaxel coated balloon (JET+PCB) versus angioplasty (PTA) + PCB in treating femoropopliteal (FP) arterial disease. The one-year primary endpoint of JET-RANGER has been recently published. The 2-year outcome data are presented in this report.Methods: There were 43 patients who completed the 1-year follow-up. Two were lost to follow-up and one died prior to the 2-year follow-up, resulting in 40 patients. Fifteen patients were randomized to PTA+PCB and 25 patients to JET +PCB. Kaplan Meier Survival analysis was performed to estimate the freedom from TLR. Bailout stenting was not considered a TLR in this analysis. Statistical significance was determined by a p-value < 0.05.Results: Freedom from TLR was similar between the 2 groups at 2 years. There was also no significant difference in the change of ABI between the PTA + PCB and JET + PCB from baseline at 6-months, (p-value = 0.7890), 1-year (p-value = 0.4070), and 2-year (p-value=0.7410). There was also no statistical difference between the JET + PCB and PTA + PCB arms for RCC improvement by one or more category, (p-value= 1.000). There were no minor or major amputations for either arm throughout the 2-year follow up. One JET + PCB patient died before the 2-year specified window.Conclusion: JET + PCB had similar freedom from TLR and improvement in ABI and RCC at 2-year follow-up when compared to PTA + PCB with no difference in amputation or mortality between the 2 arms.Clinical Trial Registration: NCT03206762.Keywords: Jetstream, atherectomy, femoropopliteal, vessel prepping, drug coated balloons, Ranger, In.PACT, randomized trial, dissections, bailout stenting

Cynthia Al Hageh,1,* Stephanie Chacar,2,* Michella Ghassibe-Sabbagh,3 Daniel E Platt,4 Andreas Henschel,5 Hamdan Hamdan,2 Dominique Gauguier,6,7 Yara El Murr,3 Eman Alefishat,8,9 Elie Chammas,10 Siobhán O’Sullivan,1 Antoine Abchee,11 Moni Nader,2,9 Pierre A Zalloua1,9,12 1Department of Molecular Biology and Genetics, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; 2Department of Physiology and Immunology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; 3Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon; 4Computational Biology Center, IBM TJ Watson Research Centre, Yorktown Hgts, NY, USA; 5Department of Electrical Engineering and Computer, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; 6Université Paris Cité, INSERM UMR 1124, Paris, 75006, France; 7McGill University and Genome Quebec Innovation Centre, Montreal, QC, H3A 0G1, Canada; 8Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; 9Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates; 10School of Medicine, Lebanese University, Beirut, Lebanon; 11Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; 12Harvard T.H. Chan School of Public Health, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Pierre A Zalloua; Moni Nader, College of Medicine and Health Sciences, Khalifa University for Science and Technology, PO Box 127788, Abu Dhabi, United Arab Emirates, Email pierre.zalloua@ku.ac.ae; moni.nader@ku.ac.aeBackgrounds and Aims: The role of Lipoprotein(a) (Lp(a)) in increasing the risk of cardiovascular diseases is reported in several populations. The aim of this study is to investigate the correlation of high Lp(a) levels with the degree of coronary artery stenosis.Methods: Two hundred and sixty-eight patients were enrolled for this study. Patients who underwent coronary artery angiography and who had Lp(a) measurements available were included in this study. Binomial logistic regressions were applied to investigate the association between Lp(a) and stenosis in the four major coronary arteries. The effect of LDL and HDL Cholesterol on modulating the association of Lp(a) with coronary artery disease (CAD) was also evaluated. Multinomial regression analysis was applied to assess the association of Lp(a) with the different degrees of stenosis in the four major coronary arteries.Results: Our analyses showed that Lp(a) is a risk factor for CAD and this risk is significantly apparent in patients with HDL-cholesterol ≥ 35 mg/dL and in non-obese patients. A large proportion of the study patients with elevated Lp(a) levels had CAD even when exhibiting high HDL serum levels. Increased HDL with low Lp(a) serum levels were the least correlated with stenosis. A significantly higher levels of Lp(a) were found in patients with > 50% stenosis in at least two major coronary vessels arguing for pronounced and multiple stenotic lesions. Finally, the derived variant (rs1084651) of the LPA gene was significantly associated with CAD.Conclusion: Our study highlights the importance of Lp(a) levels as an independent biological marker of severe and multiple coronary artery stenosis.Keywords: lipoprotein(a), cardiovascular diseases, stenosis

Abdullah Al-Kasasbeh,1 Ahmad Abdalmajeed Alghzawi,2 Khalid S Ibrahim,3 Muhannad J Ababneh,1 Rasheed Ibdah,1 Obada Abusurrah,1 Khaled Dweik,1 Khalid A Kheirallah2 1Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Division of Cardiac Surgery, Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Abdullah Al-Kasasbeh, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan, Tel +962798339500, Email ahkasasbeh@just.edu.joBackground: During COVID-19 lockdown periods, several studies reported decreased numbers of myocardial infarction (MI) admissions. The lockdown impact has not yet been determined in developing countries. The aim of this study was to investigate the impact that of the lockdown measures might have had on the mean number of MI hospital admissions in Northern Jordan.Methodology: A single-center study examined consecutive admissions of MI patients during COVID-19 outbreak. Participants’ data was abstracted from the medical records of King Abdullah University Hospital between 2018 and 2020. Mean and percentages of monthly admissions were compared by year and by lockdown status (pre-lockdown, lockdown, and post-lockdown time intervals).Results: A total of 1380 participants were admitted with acute MI symptoms: 59.2% of which were STEMI. A decrease in number of MI admissions was observed in 2020, from 43.1 (SD: 8.017) cases per month in 2019 to 40.59 (SD: 10.763) in 2020 (P < 0.0001) while an increase in the numbers during the lockdown was observed. The mean number during the pre-lockdown period was 40.51 (SD: 8.883), the lockdown period was 44.74 (SD: 5.689) and the post-lockdown was 34.66 (SD: 6.026) (P < 0.0001 for all comparisons). Similar patterns were observed when percentages of admissions were used.Conclusion: Upon comparing the lockdown period both to the pre- and post-lockdown periods separately, we found a significant increase in MI admissions during the lockdown period. This suggests that lockdown-related stress may have increased the risk of myocardial infarction.Keywords: COVID-19, myocardial infarction, lockdown, hospital admissions, Jordan, STEMI, NSTEMI

Sagarika Majhi,1 Lubhan Singh,2 Mohd Yasir3 1Department of Pharmacology, I. T. S College of Pharmacy, Ghaziabad, UP, India; 2Department of Pharmacology, Kharvel Subharti College of Pharmacy, Swami Vivekanand Subharti University, Meerut, UP, India; 3Department of Pharmacy, College of Health Sciences, Arsi University, Asella, EthiopiaCorrespondence: Mohd Yasir, Department of Pharmacy, College of Health Sciences, Arsi University, Asella 396, Oromia Region, Ethiopia, Tel +251-904748369, Email mohdyasir31@gmail.comBackground: Several mechanisms have been explored for the anthracycline myocardial toxicity. These are free-radical generation, myocyte apoptosis, lipid peroxidation, mitochondrial deterioration, and direct repression of muscle-specific gene expression. Adriamycin (Doxorubicin) is a potent anti-cancer agent. Adriamycin in prolonged use is fatal and generates free radicals that lead to dose-dependent cardiac toxicity.Objective: The intent of the study was to explore the protective activity of candesartan and quercetin in cardiomyopathy induced by doxorubicin in rats.Methods: To induce cardiac toxicity, rats were intraperitoneally treated with doxorubicin (06 equivalent injections of 2.5 mg/kg, i. p. at 48 hour interval for 02 consecutive weeks to achieve a cumulative dose of 15 mg/kg). Individual and combined oral treatment of candesartan (5 mg/kg/day) and quercetin (10 mg/kg/day) was administered for four weeks.Results: Following cardiomyopathy, heart/body weight ratio (3.526 × 10− 3), serum creatine kinase (352.4± 16.99 IU/L), lactate dehydrogenase (661.7± 20.45 IU/L) levels were elevated in addition to altered lipid profile (TC – 118.4± 4.25 mg/dL, TG – 263.3± 9.99 mg/dL, VLDL – 52.66± 1.99 mg/dL, LDL – 52.99± 5.80 mg/dL and HDL – 12.78± 0.36 mg/dL). The pre-cotreatment of candesartan and quercetin significantly restored the values to normal. The increased level of lipid peroxides (33.12± 1.63 μmol/mg protein), serum troponin-T (1.82 ± 0.11 pg/mL) and nitric oxide (13.33± 0.73 nmol/mg protein) level along with attenuating antioxidant profile, ie catalase, glutathione and superoxide dismutase (1.43± 0.12 nmol/mg protein, 8.48± 0.42 nmol/mg protein and 2.09± 0.031 U/mg protein) were reversed to normal. Morphometry and histopathologic changes represented a beneficial effect of single and combination pre-cotreatment of drugs which significantly decreases adriamycin cardiac toxicity.Conclusion: The overall result depicts more beneficial and cardioprotective effect of quercetin and candesartan combination as compared to their individual effects in doxorubicin treated animals. Therefore, this combination might be a suitable option to treat the cardiotoxic effect of doxorubicin.Keywords: cardiotoxicity, candesartan, quercetin, doxorubicin/adriamycin

Elizabeth do Espirito Santo Cestario,1,&ast; Jose Fernando Vilela-Martin,1,&ast; Luciana Neves Cosenso-Martin,1 Tatiane Azevedo Rubio,1 Jessica Rodrigues Roma Uyemura,1 Valquiria da Silva Lopes,1 Letícia Aparecida Barufi Fernandes,1 Lucia Helena Bonalume Tacito,2 Heitor Moreno Junior,3 Juan Carlos Yugar-Toledo1,&ast; 1Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil; 2Endocrinology Division, Internal Medicine Department, Medical School in São José Rio Preto (FAMERP), São Paulo, Brazil; 3Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil&ast;These authors contributed equally to this workCorrespondence: Jose Fernando Vilela-Martin, Ave Brig Faria Lima 5416, Sao Jose do Rio Preto, São Paulo, SP, 15090-000, Brazil, Tel +55 17 32015727, Email vilelamartin@uol.com.brIntroduction: Hypertension is the most important modifiable risk factor for cardiovascular disease and a leading public health concern.Objectives: The primary aim was to compare sequential nephron blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment.Material and Methods: This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug up-titration. Participants were evaluated during five visits at 28-day intervals.Results: The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5± 21.0 to 127.0± 14.74 mmHg (p< 0.0001), and DBP decreased from 105.3± 15.5 to 78.11± 9.28 mmHg (p< 0.0001). DRASB group, SBP decreased from 178.4± 21.08 to 134.4 ± 23.25 mmHg (p< 0.0001) and DBP decreased from 102.7± 11.07 to 77.33± 13.75 mmHg (p< 0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p< 0.0001).Conclusion: In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction.Keywords: resistant hypertension, natriuretic agents, dual blockade of the renin-angiotensin system, bisoprolol

Carolina Hungaro Cunha,1 Debora Yuri Sato,1 Jose Maria Pereira de Godoy,2 Gleison Juliano da Silva Russeff,1 Desirée Franccini Del Frari Silva,1 Henrique Jose Pereira de Godoy,3 Mariana Orate Menezes da Silva,4 Henrique Amorim Santos,4 Maria de Fatima Guerreiro Godoy5 1Ecography Service in Hospital de Base-FUNFARME/FAMERP, Sao Jose do Rio Preto, Brazil; 2Cardiology and Cardiovascular Surgery Department Sao Jose do Rio Preto School Medicine-FAMERP, Sao Jose do Rio Preto, Brazil; 3General Surgery Department São Jose do Rio Preto School Medicine-FAMERP, Sao Jose do Rio Preto, Brazil; 4Vascular Surgery Service São Jose do Rio Preto School Medicine-FAMERP, Sao Jose do Rio Preto, Brazil; 5Post-Graduate Program São José do Rio Preto-FAMERP, Sao Jose do Rio Preto School Medicine-FAMERP, Sao Jose do Rio Preto, BrazilCorrespondence: Jose Maria Pereira de Godoy, Cardiology and Cardiovascular Surgery Department São Jose do Rio Preto School Medicine-FAMERP, Rua Floriano Peixoto, São Jose do Rio Preto, SP, 2950, Brazil, Tel/Fax +551732326362, Email godoyjmp@gmail.comPurpose: The SARS-CoV-2 disease predisposes infected individuals to thrombosis, the underlying mechanisms of which are not fully understood. The balance between pro-coagulant factors and natural coagulation inhibitors in critically ill patients with Covid-19 is fundamental to the prevention and treatment of complications. The aim of the present study was to investigate the pulmonary injury patterns in Covid-19 having higher mortality in the presence of deep vein thrombosis in comparison to patients without venous thrombosis and determine the Gamma variant.Methods: A retrospective study was conducted involving the evaluation of 200 medical records of patients with Covid-19 and a clinical suspicion of deep vein thrombosis (DVT) at the intensive care unit of a public hospital. The sample was divided into two groups of patients were formed – those positive and those negative for DVT. Statistical analysis involved the use of Fisher’s exact test, the paired t-test and chi-square test.Results: Patients with DVT had more severe lung injuries (greater than 70%) compared to those without DVT (p = 0.003). Lesions affecting 50% to 70% of the lung area occurred in little more half of the group with DVT and just under half in the group without DVT (p = 0.5). Pulmonary lesions affecting less than 50% of the lung occurred more in patients without DVT (p = 0.0001). The Gamma variant increased prevalence of the both DVT and mortality (p=0.0001).Conclusion: Deep vein thrombosis is an aggravating factor of mortality in patients with SARS-CoV-2, and the Gamma variant is an aggravating factor of both thrombotic events and mortality.Keywords: Covid-19, deep vein thrombosis, pulmonary thrombosis, mortality

Temirkhan Begisbayev,1 Lyazzat Kosherbayeva,2,3 Kamilla Gaitova,4 Marzhan Brimzhanova1 1Kazakhstans Medical University “KSPH”, Almaty, Kazakhstan; 2Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; 3Al-Farabi Kazakh National University, Almaty, Kazakhstan; 4Health Technology Assessment Department, Republican Center for Health Development, Nur-Sultan, KazakhstanCorrespondence: Lyazzat Kosherbayeva, Asfendiyarov Kazakh National Medical University, 88 Tole bi Street, Almaty, Kazakhstan, Tel + 7 705 120 46 52, Email lyazzat.k@mail.ru; kosherbaeva.l@kaznmu.kzAbstract: Cardiovascular disease is the leading cause of morbidity and mortality worldwide. The implementation of effective technologies such as Implantable cardioverter-defibrillator (ICD) for patients at risk of sudden cardiac death requires additional health system resources.Objective: To assess the economic effectiveness of ICD in comparison with conservative tactics for preventing life-threatening rhythm disturbances in Kazakhstan.Methods: A Markov model was built with a time horizon of 35 years. Mortality and utility data were obtained from the available literature. The economic parameters of the model are based on the approved tariffs for medical services in Kazakhstan and clinical protocols. Following WHO recommendations, a willingness to pay threshold of three times gross domestic product per capita was used to assess cost-effectiveness. A discount rate of 3.5% was applied to both costs and benefits. To deal with parameter uncertainties and to provide robust analysis, a probabilistic sensitivity analysis was performed, randomly varying all inputs subject to uncertainty assuming a statistical distribution.Results: The total costs in the primary prevention (PP) group by ICD implantation and in the control group were 8,903,786 tenges and 3,194,414 tenges, respectively. The discounted total quality-adjusted life-years saved (QALYs) in the ICD and control groups were 6.48 and 4.98, respectively. The indicator of incremental cost-effectiveness ratio amounted to3791604 tenge, which is below the willingness to pay threshold and indicates the cost-effectiveness of using ICD as a PP strategy in patients with sudden cardiac death risk factors in the health care of Kazakhstan.Conclusion: The ICD for the primary prevention of the development of life-threatening rhythm disturbances and sudden cardiac death is a cost-effective health technology from the position of a payer in the health care system of Kazakhstan.Keywords: cardioverter-defibrillator implantation, cost-effectiveness, Markov model, reimbursement of ICD in Kazakhstan

Khalid S Ibrahim,1 Khalid A Kheirallah,2 Mahmoud A Megdadi2 1Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health and Community Health, College of Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Khalid S Ibrahim, Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan, Tel +962 79 6 42 77 00, Email Ksibrahim@just.edu.joBackground: Enlargement of the left atrium has been thoroughly studied in many clinical situations, especially its association with mortality and morbidity.Patients and Methods: The study cohort included patients with rheumatic valve pathology such as stenosis and regurgitation. All patients underwent valvular surgical procedures including mitral valve replacement (MVR), aortic valve replacement (AVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with or without CABG. This study included patients who underwent surgery between 2002 and 2017.Results: Three hundred and forty-six patients were included in this study. The mean patient age was 51.6± 16.1 years; 37% of the patients underwent AVR, 28% underwent MVR, and 13% underwent a combination of MVR with AVR, AVR with CABG in 6%, and MVR with CABG in 10%. The operative mortality rate was 5.8% (n=20). Univariate analysis revealed that the predictors of mortality included age (P < 0.001), body mass index (BMI) (P = 0.003), type of surgery performed (P = 0.007), hypertension (P = 0.005), emergent surgeries (P = 0.018), left atrial diameter (P = 0.003), cross-clamp time greater than 90 minutes (P = 0.007), postoperative acute kidney injury (AKI) (P = 0.044), postoperative stroke (P = 0.049), and surgical site infection (P = 0.047). Multivariate analysis revealed that predictors of mortality included age (P = 0.028, AOR=10.6), BMI (P = 0.003, AOR=3.12), re-exploration (P = 0.006, AOR=8.38), length of intensive care unit stay (P ≤ 0.002, AOR=4.55), and left atrial diameter (P = 0.003, AOR=10.64).Conclusion: Enlargement of the left atrium has been studied extensively as a predictor of mortality and morbidity in different clinical situations, to the extent that some authors suggest adding it to risk stratification models. In this study, left atrial size > 4 cm was found to strongly predict mortality after rheumatic heart valve surgery.Keywords: valve surgery, mortality, mitral, aortic, left atrial size

Mingfang Li,1 Jiaojiao Shi,1 Ming Chu,1 Youmei Shen,1 Shimeng Zhang,1 Xingxing Sun,1 Hengli Zhang,1 Qing Yan,1 Jinlong Gong,2 Gregory YH Lip,3,4 Minglong Chen1,5 1Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; 2Division of Cardiology, Jiangdu People’s Hospital, Yangzhou, People’s Republic of China; 3Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; 4Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 5Division of Cardiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of ChinaCorrespondence: Minglong Chen, Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People’s Republic of China, Tel +86-25-68303115, Fax +86-25-6813-6479, Email chenminglong@njmu.edu.cnAbstract: China has a large population of elderly in rural areas. Village doctors are acting as health-care gatekeepers for the rural elderly in China and are encouraged to provide more long-term care for patients with chronic diseases such as atrial fibrillation (AF). The data of AF registries from the rural elderly are limited. The present registry aims to provide contemporary data on the current AF-related health status of the rural elderly and the gaps in management of AF by village doctors. This study has two phases. The first phase is a cross-sectional study of AF screening in two rural towns of eastern China. All the residents aged ≥ 65 years are eligible and will be invited to attend a government-led health examination or an in-house AF screening program. The AF detection rate, the awareness of AF and the usage of oral anticoagulants and smartphones by AF patients, and the ability to diagnose and manage AF by village doctors will be assessed. Participants with AF detected in the first phase are eligible for the second phase. A variety of modes of intensified education will be provided to all AF patients and their family members to enrich their AF-related knowledge. Their village doctors will be offered a lecture-based training program focusing on Atrial fibrillation Better Care (ABC) pathway. Follow-up will be conducted for 1 year. The primary endpoint is the composite of all stroke and all-cause mortality. The first phase of AF screening was conducted between April 2019 and June 2019, and 18,712 participants with the mean age of 73.1± 5.8 years were enrolled. The second phase that includes 810 patients with AF, started on 1 May 2019. This study will provide a perspective of primary care system and would indirectly reflect the current status of chronic disease care in rural China.Keywords: atrial fibrillation, elderly, village doctors, rural China

Michal Chudzik,1,2 Anna Cender,1 Robert Mordaka,1 Jacek Zielinski,3 Joanna Katarzynska,4 Andrzej Marcinek,4,5 Jerzy Gebicki4,5 1Medical Center, Saint Family Hospital, Lodz, Poland; 2Department of Internal Medicine and Geronto-Cardiology, Medical Centre for Postgraduate Education, Warsaw, Poland; 3Department of Athletics, Strength and Conditioning, Poznan University of Physical Education, Poznan, Poland; 4Angionica Ltd., Lodz, Poland; 5Institute of Applied Radiation Chemistry, Lodz University of Technology, Lodz, PolandCorrespondence: Jerzy Gebicki, Institute of Applied Radiation Chemistry, Lodz University of Technology, Lodz, 90-924, Poland, Tel +48 42 631 31 71, Email jerzy.gebicki@p.lodz.pl; jerzy.gebicki@angionica.com.pl Michal Chudzik, Department of Internal Medicine and Geronto-Cardiology, Medical Centre for Postgraduate Education, Warsaw, Poland, Tel +48 691 941 814, Email michalchudzik@wp.plPurpose: The pathophysiology of chronic fatigue associated with post-COVID syndrome is not well recognized. It is assumed that this condition is partly due to vascular dysfunction developed during an acute phase of infection. There is great demand for a diagnostic tool that is able to clinically assess post-COVID syndrome and monitor the rehabilitation process.Patients and Methods: The Flow Mediated Skin Fluorescence (FMSF) technique appears uniquely suitable for the analysis of basal microcirculatory oscillations and reactive hyperemia induced by transient ischemia. The FMSF was used to measure vascular circulation in 45 patients with post-COVID syndrome. The results were compared with those for a group of 26 amateur runners before and after high-intensity exercise as well as for a control group of 32 healthy age-matched individuals.Results: Based on the observed changes in the NOI (Normoxia Oscillatory Index) and RHR (Reactive Hyperemia Response) parameters measured with the FMSF technique, it was found that chronic fatigue associated with post-COVID syndrome is comparable with transient fatigue caused by high-intensity exercise in terms of vascular effects, which are associated with vascular stress in the macrocirculation and microcirculation. Acute and chronic fatigue symptomatology shared similarly altered changes in the NOI and RHR parameters and both can be linked to calcium homeostasis modification.Conclusion: The NOI and RHR parameters measured with the FMSF technique can be used for non-invasive clinical assessment of post-COVID syndrome as well as for monitoring the rehabilitation process.Keywords: COVID-19, post-COVID syndrome, chronic fatigue, vascular circulation, FMSF technique

Maciej Antkiewicz,1 Marcin Protasiewicz,2 Wiktor Kuliczkowski,2 Tomasz Zubilewicz,3 Piotr Terlecki,3 Magdalena Kobielarz,4 Dariusz Janczak1 1Department and Clinic of Vascular, General and Transplantation Surgery, Wroc&lstrok;aw Medical University, Wroc&lstrok;aw, Poland; 2Department and Clinic of Cardiology, Wroc&lstrok;aw Medical University, Wroc&lstrok;aw, Poland; 3Department and Clinic of Vascular Surgery and Angiology, Medical University of Lublin, Lublin, Poland; 4Department of Mechanics, Materials Science and Biomedical Engineering, Wroc&lstrok;aw University of Science and Technology, Wroc&lstrok;aw, PolandCorrespondence: Maciej Antkiewicz, Department and Clinic of Vascular, General and Transplantation Surgery, Wroc&lstrok;aw Medical University, Borowska 213, Wroc&lstrok;aw, 50-556, Poland, Tel +48 71 733 2003, Fax +48 71 733 2009, Email maciej.antkiewicz@gmail.comPurpose: Numerous cases of abdominal aortic aneurysm (AAA) enlargement, and even rupture, despite endovascular aneurysm repair (EVAR), have been documented. This has been linked to increased aneurysm sac pressure (ASP). We decided to conduct further research with the aim to identify correlations between ASP during EVAR and subsequent aneurysm enlargement.Patients and Methods: This experimental prospective study included 30 patients undergoing EVAR of infrarenal AAAs. Invasive ASP measurements were done using a thin pressure wire. Aortic pressure (AP) was measured using a catheter placed over the wire. Systolic pressure index (SPI), diastolic pressure index (DPI), mean pressure index (MPI), and pulse pressure index (PPI) were calculated both for ASP and AP. The results of follow-up computed tomography angiography (CTA) at 3 months were compared with baseline CTA findings.Results: During EVAR, a significant reduction was observed for SPI (from 98% to 61%), DPI (from 100% to 87%), MPI (from 99% to 74%), and PPI (from 97% to 34%). There were no significant correlations of pressure indices with an aneurysm diameter, cross-sectional area, velocity, thrombus shape and size, number of patent lumbar arteries, length and diameter of aneurysm neck, diameter of the inferior mesenteric artery, as well as diameter and angle of common iliac arteries. On the other hand, aneurysm neck angulation was significantly inversely correlated with reduced PPI. After combining CTA findings with pressure measurements, we identified a positive correlation between PPI and aneurysm enlargement (ratio of the cross-sectional area at the widest spot at baseline and at 3 months after EVAR).Conclusion: The study showed that ASP can be successfully measured during EVAR and can facilitate the assessment of treatment efficacy. In particular, PPI can serve as a prognostic factor of aneurysm enlargement and can help identify high-risk patients who remain prior monitoring.Keywords: abdominal aortic aneurysm, aneurysm sac pressure, endovascular surgery, endoleak

Nawaphan Taengsakul Surgical Unit, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, ThailandCorrespondence: Nawaphan Taengsakul, Surgical Unit, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, 906 Kamphaeng Phet 6 Road, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand, Tel/Fax +66-2-576-6791, Email nawaphan.tan@cra.ac.thIntroduction: The prevalence of chronic venous disease (CVD), a common health care problem, is still underestimated. A few previous epidemiologic studies have report Asian patients with this condition in western countries, but not in Asian countries. The aim of this study was to determine risk factors for CVD and its treatment in Thai individuals.Methods: In this cross-sectional study, we collected data of patients with CVD visiting Chulabhorn Hospital Vascular Clinic from 1 December 2018– 1 October 2021. We reviewed medical records for patient characteristics, comorbidities, Clinical, Etiology, Anatomy, Pathophysiology (CEAP) categories, Venous Clinical Severity Score (VCSS), ultrasound findings and treatment.Results: The study cohort comprised 260 CVD patients with CVD of mean age 61.92 ± 12.82 years. Almost 80% of participants were female. A history of deep vein thrombosis (DVT) was the strongest risk factor for severe CVD. Other identified risk factors comprised body–mass index (BMI) > 30 kg/m2, and older age. The most common CEAP categories were C2 (39%) and C1 (33.8%). Superficial venous reflux was the most common location of venous reflux in this study, 67.32% of participants having great saphenous vein reflux and 16.99% small saphenous vein reflux. Only 4.76% of our cohort had both reflux and obstruction. Most of the participants had undergone compression therapy, approximately half of them complying well with wearing of stockings. Nineteen percent of our cohort had undergone sclerotherapy and 14% surgery, which comprised radiofrequency ablation in 97% of them.Conclusion: The major risk factors for severe CVD identified in this study were deep vein thrombosis, body mass index> 30 kg/m2 and older age. The most common CEAP category was C2 (39%). GSV was the most commonly involved venous system. Involvement of numerous venous systems was a risk factor for severe CVD.Keywords: chronic venous disease, chronic venous insufficiency, CEAP classification, risk factor, Thailand

Abdulaziz Mohammad Al-Sharydah,1 Hussain Khalid Al-Arfaj,2 Sari Saleh Al-Suhibani,1 Fahad Safran Al-Safran,2 Abdulrahman Hamad Al-Abdulwahhab,1 Saeed Ahmad Al-Jubran,1 Abdulhadi Ahmad AlSaflan3 1Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar City, Eastern Province, Saudi Arabia; 2Medical Imaging Department, King Fahd Specialist Hospital, Dammam City, Eastern Province, Saudi Arabia; 3Anesthesia Department, King Fahd Hospital of the University, Khobar City, Eastern Province, Saudi ArabiaCorrespondence: Abdulaziz Mohammad Al-Sharydah, Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 31952 (4398), Khobar City, Eastern Province, Saudi Arabia, Tel +966 566473111, Fax +966 13-8676697, Email Amsharydah@iau.edu.saPurpose: Stroke is a leading cause of severe long-term disability and death worldwide. This study aimed to determine the genetic background, causative factors, and diagnostic and outcome measures of pediatric stroke in an area endemic to sickle cell disease (SCD).Patients and Methods: This retrospective review analyzed pediatric patients with acute stroke who were admitted to King Fahd Hospital of the University, Eastern Province, Saudi Arabia, between January and June 2019. We assessed 49 cases based on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Patients with incomplete records or unavailable radiological images were excluded.Results: A high likelihood of familial coexistence of stroke was detected in patients with affected siblings (33%). Among various central nervous system manifestations, motor weakness (28.6%) and headache (20.4%) were the most common symptoms/signs. Hypoxic-ischemic encephalopathy (HIE) (28.6%), SCD (22.5%), and moyamoya disease (14.3%) were the most prevalent underlying etiologies. CT without intravenous contrast was the most used initial imaging technique (92.5%). An arterial blockage was more prevalent (53.4%) than a venous infarct (46.6%) (p = 0.041), while arterial ischemic stroke was more prevalent (56.5%) than hemorrhagic stroke (43.5%). The middle cerebral artery (MCA) was most affected (63.5%), followed by the anterior cerebral artery (22.7%) and posterior cerebral artery (13.6%). Most patients were managed with medical treatment (86.1%). No mortalities occurred during the initial hospital stay. The mean length of hospital stay was 12 days.Conclusion: HIE was the most prevalent etiology of pediatric stroke. Motor weakness and headache were the most common initial manifestations. Arterial ischemic stroke was more prevalent than venous or hemorrhagic stroke. Considering the rarity of pediatric stroke, future studies should be performed with a aborative effort nationally and internationally.Keywords: magnetic resonance imaging, computed tomography, ischemic stroke, hemorrhagic stroke, paediatric

Stéphane Yanda Tongo,1 Benjamin Longo-Mbenza,2,3 Antoine Molua Aundu,1 Raoul Gombet,4 Jean Robert Makulo Risasi,5 Christian Kisoka Lusunsi,3 Héritier Mawalala Malengele,1 Augustin Nge Okwe3 1Radiology Service, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of Congo; 2Cardiology Service, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of Congo; 3Department of Public Health, Lomo University for Research, Kinshasa, Democratic Republic of Congo; 4Marien Ngouabi University, Brazzaville, Democratic Republic of Congo; 5Nephrology Service, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of CongoCorrespondence: Benjamin Longo-Mbenza, Faculty of Health Science, Private Bay XI, Mthatha, Eastern Cape, 5117, South Africa, Tel +243 814396257, Email longombenza@gmail.comBackground: Several classic/traditional risk factors are associated with intima–media thickness (IMT), a novel risk of cardio metabolic risk (CMR) in the literature but not in Kinshasa, a megacity prone to CMR. Thus, the objective of this study was to evaluate potential correlations between inflammation, kidney function, psychological stress, hemodynamics, and changes in IMT.Methods: This cross-sectional study was carried out between 2018 and 2021 within Monkole and Biamba Marie Mutombo Hospitals, respectively, and randomly selected from 10 health structures from East and West of Kinshasa, Capital of Democratic Republic Congo (DRC). A random sample of adult hypertensive Bantu Central Africans was examined after bivariate correlations and multiple linear regression.Results: Out of 280 patients with 140 men and 140 women aged 62 ± 11 years, the mean carotid intima–media thickness (CIMT) was 1.06 ± 0.5 mm and 73% (n = 204) patients had uncontrolled hypertension. After controlling for confounders, 52.9% variations (R2) of CIMT were independently and significantly (P = 0.037) predicted by CRP, 24-hour proteinuria, urinary albumin/creatinine ratio, duration of hypertension, heart rate, hip circumference, and psychological stress with Equation Y = 0.717 + 0.87 × CRP + 0.02 × 24 H – proteinuria + 0.005 × urinary albumin/creatinine ratio + 0.05 × duration of hypertension + 0.001 × heart rate + 0.006 × hip circumference + 0.017 × psychological stress.Conclusion: There is an urgent need to control inflammation, impaired renal function, cardiac rhythm, peripheral obesity, longer duration of hypertension management, and stress, which are emerging as specific novel determinants of the subclinical atherosclerosis for those Bantu Central African hypertensive patients.Keywords: carotid intima–media thickness, subclinical atherosclerosis, Central Africans

Marc Machaalani,1 Houssam Seifeddine,1 Abdallah Ali,1,&ast; Hassan Bitar,1,&ast; Oukba Briman,1,&ast; Mirna N Chahine1– 4 1Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon; 2Basic Sciences Department, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon; 3Foundation-Medical Research Institutes (F-MRI®), Beirut, Lebanon; 4Foundation-Medical Research Institutes (F-MRI®), Geneva, Switzerland&ast;These authors contributed equally to this workCorrespondence: Mirna N Chahine, Basic Sciences Department, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon, Tel +961 76 053292, Email mirnachahine01@gmail.comBackground and Objectives: Hypertension (HTN) is a major health concern that leads to cardiovascular disease and premature death. Assessing HTN knowledge, attitude, and practice (KAP) is crucial for controlling HTN. This study aimed to determine HTN KAP among hypertensive patients residing in Lebanon.Methods: This cross-sectional study involved 342 hypertensive patients. A questionnaire form was used to collect data related to patients’ characteristics. SPSS was used to determine KAP scores, descriptive statistics, and correlations.Results: Data from HTN patients was analyzed of whom 98.2% were Lebanese and 51.2% were males. The median age was 59.15 ± 13.55 years old. A proportion of 40.4% had HTN duration for at least 10 years and 67.3% had HTN family history. Patients had fair HTN knowledge and practice, but good attitude toward HTN. Only 45.3% regularly checked their blood pressure. Positive correlations were observed between HTN attitude and each of knowledge and practice. HTN knowledge and attitude were associated with many studied factors, whereas no relationship was found regarding practice.Conclusion: Hypertensive patients had fair levels of knowledge and practice, and a good level of attitude concerning their disease. We provided a model for predictors of HTN KAP scores that will allow the development of efficient campaigns related to HTN.Keywords: hypertension, KAP, Lebanon, hypertensive patients

Bushra HA Abdelmalik,1 Musleh Mohammed Ali Leslom,2 Moawia Gameraddin,3,4 Qurain T Alshammari,1 Rehab Hussien,1 Mansour Hussain Alyami,5 Mohammed Salih,1 Mohamed Yousef,6 Elgeili Yousif1 1Diagnostic Radiology Department, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia; 2Najran-Hubuna Thar General Hospital, Ministry of Health, Najran, Saudi Arabia; 3Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah, Saudi Arabia; 4Department of Diagnostic Radiology, Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum, Sudan; 5King Khalid Hospital, Health Affairs of Najran Region, Najran, Saudi Arabia; 6Radiological Sciences Program, Batterjee Medical College, Jeddah, 21442 Saudi ArabiaCorrespondence: Moawia Gameraddin, Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah, Saudi Arabia, Email gameraldinm@gmail.comBackground: Deep vein thrombosis (DVT) is a common health problem. Accurate diagnosis of DVT is essential to avoid potentially fatal acute consequences of pulmonary embolism.Aim: The study aims to assess deep venous thrombosis (DVT) of the lower limbs and to analyze the related risk factors.Methods: This is a retrospective study including 60 patients who were examined using Triplex Doppler imaging. The patients were referred to the imaging departments with symptoms of lower limb DVT. The risk of DVT was expressed as an odds ratio (OR) with 95% confidence interval. Multiple logistic regression analysis was used to detect the independent risk factors. P value < 0.05 was considered a significant statistic.Results: Among the Saudi patients in Najran, acute DVT was more prevalent than chronic one (56.7% vs 38.3%), while subacute is less frequent (5%). DVTs are more prevalent in females than males (60% vs 40%) and most commonly affect patients older than 40. DVTs affect the left lower limb veins more than the right limb (75% vs 15%) and are less frequent on both sides (10%). The left popliteal vein (PV) and left common femoral vein (CFV) were the most common sites for acute DVTs. Binary logistic analysis revealed the independent risk factors for developing lower extremity DVT; malignancy (OR = 2.84, 95% CI = 0.518– 15.513), surgery (OR = 2.66, 95% CI = 0.411– 17.281), trauma (OR = 2.30, 95% CI = 0.452– 11.658), and diabetes and hypertension (OR = 1.53, 95% CI = 0.335– 6.969).Conclusion: Acute lower limb DVT was more prevalent than chronic one. Malignancy, surgery, trauma, diabetes mellitus, and hypertension were the most common risk factors for lower limb DVTs. Left popliteal and left common femoral veins were the most common sites of acute DVTs.Keywords: DVT, malignancy, pregnancy, popliteal vein, acute, surgery

Aychew Kassa Belete,1 Abebe Tarekegn Kassaw,2 Bantie Getnet Yirsaw,3 Birhan Ambachew Taye,3 Samueal Nigatie Ambaw,1 Biset Asrade Mekonnen,4 Ashenafi Kibret Sendekie5 1Department of Sport Science, Faculty of Natural and Computational Science, Woldia University, Woldia, Ethiopia; 2Department of Pharmacy, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia; 3Department of Statistics, Faculty of Natural and Computational Science, Woldia University, Woldia, Ethiopia; 4Department of Pharmaceutical Analysis, School of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 5Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Ashenafi Kibret Sendekie, Email ashenafikib0960@gmail.comBackground: Unhealthy lifestyles and physical inactivity are among the contributing factors of hypercholesterolemia. This study assessed the prevalence, awareness of risk factors, and prevention and treatment of hypercholesterolemia among adults who visited Woldia referral hospital, Northeast Ethiopia.Methods: A cross-sectional survey was conducted among adults who visited Woldia referral hospital from May to August 2022. Data was collected using a structured questionnaire through a face-to-face interview and patient medical record review. Logistic regression analysis was employed to determine the association between hypercholesterolemia and other variables. A p-value at a 95% confidence level was statistically significant.Results: A total of 1180 eligible adults were included in the study. The magnitude of hypercholesterolemia was 26.4%. The majority of the respondents were aware of some risk factors, such as higher fat intake (82.3%), obesity (67.2%), and lack of adequate exercise (56.1%). However, the majority of the respondents were not aware that smoking, alcohol consumption, and age (86.8% for all) had cardiovascular risk. The majority of the respondents were aware that eating a limited amount of saturated fat (56.5%), maintaining a healthy weight (67.2%), and taking prescribed medications properly (86.8%) can prevent the risk of hypercholesterolemia. However, a larger proportion of respondents were unaware that smoking cessation (86.8%), exercise (55.3%), alcohol restriction (86.8%), and stress avoidance (75.3%) can prevent cardiovascular risks. Age (p = 0.036), smoking (p = 0.007), alcohol use (p = 0.013), fruit consumption (p = 0.019), saturated oil use (p = 0.031), level of physical activity (p < 0.001), and body mass index (p = 0.03) were significantly associated with hypercholesterolemia.Conclusion: This study concluded that more than one-fourth of adults had hypercholesterolemia. The majority of the respondents did not have an awareness of common cardiovascular risk factors and prevention and treatment techniques regarding unhealthy lifestyles and physical inactivity.Keywords: hypercholesterolemia, cholesterol, dyslipidemia, awareness, prevention, risk factors

Manuel E Machado-Duque,1,2 Andrés Gaviria-Mendoza,1,2 Juan Manuel Reyes,3 Alejandro Mesa,3 Natalia Castaño-Gamboa,3 Luis Fernando Valladales-Restrepo,1,2 Jorge Enrique Machado-Alba1 1Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia; 2Grupo de Investigación en Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia; 3Pfizer Colombia, Bogotá, ColombiaCorrespondence: Jorge Enrique Machado-Alba, Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, Pereira, Risaralda, 660003, Colombia, Tel +57 3108326970, Fax +57 63137822, Email machado@utp.edu.coPurpose: The aim was to analyze the characteristics, treatment patterns, and clinical outcomes of Colombian patients with non-valvular atrial fibrillation (NVAF) under treatment with oral anticoagulants (OAs).Patients and Methods: Retrospective cohort in patients with NVAF identified from a drug dispensing database, aged ≥ 18 years, with first prescription of an OA (index) between January/2013 and June/2018, and a follow-up until June/2019. Data from the clinical history, pharmacological variables, and outcomes were searched. International Classification of Diseases-10 codes were used to identify the patient sample and outcomes. Patients were followed until a general composite outcome of effectiveness (thrombotic events), bleeding/safety or persistence (switch/discontinuation of anticoagulant) events. Descriptive and multivariate analyzes (Cox regressions comparing warfarin and direct oral anticoagulants-DOACs) were carried out.Results: A total of 2076 patients with NVAF were included. The 57.0% of patients were women and the mean age was 73.3± 10.4 years. Patients were followed for a mean of 2.3± 1.6 years. 8.7% received warfarin before the index date. The most frequent OA was rivaroxaban (n=950; 45.8%), followed by warfarin (n=459; 22.1%) and apixaban (n=405; 19.5%). Hypertension was present in 87.5% and diabetes mellitus in 22.6%. The mean CHA2DS2-VASc Score was 3.6± 1.5. The 71.0% (n=326/459) of the warfarin patients presented the general composite outcome, and 24.6% of those with DOACs (n=397/1617). The main effectiveness and safety outcomes were stroke (3.1%) and gastrointestinal bleeding (2.0%) respectively. There were no significant differences between patients with warfarin and DOACs regarding thrombotic events (HR: 1.28; 95% CI: 0.68– 2.42), but warfarin was associated with higher bleeding/safety events (HR: 4.29; 95% CI: 2.82– 6.52) and persistence events (HR: 4.51; 95% CI: 3.81 − 5.33).Conclusion: The patients with NVAF in this study were mainly older adults with multiple comorbidities. Compared to warfarin, DOACs were found to be equally effective, but safer and had a lower probability of discontinuation or switch.Keywords: anticoagulation, direct oral anticoagulant, non-valvular atrial fibrillation, warfarin, real-world study, pharmacoepidemiology

Teuku Heriansyah,1 Herlina Dimiati,1 Tjut Farahiya Hadi,1 Dimas Arya Umara,1 Lian Varis Riandi,2 Fauzan Fajri,3 Sukmawan Fajar Santosa,4 Titin Andri Wihastuti,5 Kumboyono Kumboyono6 1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 2Department of Parasitology, Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 3Department of Animal Model, Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 4Integrated Research Laboratory, Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 5Department of Basic Nursing, Faculty of Health Sciences, Universitas Brawijaya, Malang, Jawa Timur, Indonesia; 6Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Malang, IndonesiaCorrespondence: Tjut Farahiya Hadi, Email tjut@mhs.unsyiah.ac.idIntroduction: Ascorbic acid and calcitriol were frequently utilized in conjunction as therapy during the COVID-19 pandemic, and individuals with minor symptoms had notable improvements. There have been a few studies, often with conflicting findings, that examine the use of them for endothelium restoration and numerous clinical trial studies that failed to establish the efficacy. The aim of this study was to find the efficacy of ascorbic acid compared to calcitriol on the inflammatory markers monocyte chemoattractant protein-1 (MCP-1), nitric oxide (NO), and superoxide dismutase (SOD), as protective agents which play an important role in the early stages of atherosclerosis formation. This study was an experimental in vivo study.Methods: The total of 24 male Rattus norvegicus strain Wistar rats were divided into 4 groups, namely: control/normal group (N), atherosclerosis group (DL) given atherogenic diet, atherosclerosis group given atherogenic diet and ascorbic acid (DLC), and atherosclerosis group given atherogenic diet and calcitriol (DLD) treatment for 30 days.Results: Ascorbic acid and calcitriol treatment was significantly effective (P< 0.05) in lowering expression of MCP-1 and increasing NO and SOD level. Calcitriol was superior to ascorbic acid in increasing SOD (P< 0.05). There was no significant difference between ascorbic acid and calcitriol in decreasing MCP-1 and increasing NO (P> 0.05).Discussion: Both treatments could reduce MCP-1, and increase NO and SOD by increasing antioxidants. In this study calcitriol was superior to ascorbic acid in increasing SOD, but not NO and decreasing MCP-1. According to the theory, it was found that calcitriol through nuclear factor erythroid 2-related factor 2 (Nrf2) causes a direct increase in the amount of SOD. Nrf2 is an emerging regulator of cellular resistance to oxidants.Conclusion: Ascorbic acid and calcitriol treatment was able to reduce MCP-1 and increase NO and SOD in atherosclerosis rat. Calcitriol was significantly superior in increasing SOD levels compared to ascorbic acid.Keywords: ascorbic acid, calcitriol, monocyte chemoattractant protein-1, nitric oxide, superoxide dismutase, atherosclerosis

Juan Mundisugih,1,2 Caroline X Gao,1,3 Jillian F Ikin,1 Michael J Abramson,1 David Brown,1 Sinjini Biswas,1,2 Elizabeth M Dewar,2,4 Danny Liew,1 Dion Stub1,2,4 1School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; 2Department of Cardiology, Alfred Health, Melbourne, VIC, Australia; 3Centre for Youth Mental Health (Orygen), University of Melbourne, Melbourne, VIC, Australia; 4Baker Heart and Diabetes Institute, Melbourne, VIC, AustraliaCorrespondence: Jillian F Ikin, Tel +61 3 9903 0308, Email jill.blackman@monash.eduBackground and Aims: Mega-wild fires are exposing large communities to weeks or months of high concentration smoke-related fine particulate air pollution (PM). However, little research has examined the long-term vascular responses from exposure to PM of this concentration and duration. We investigated whether level of exposure to 6 weeks of PM from the 2014 Hazelwood coal mine fire was associated with abnormal vascular responses approximately four years later.Methods: A cross-sectional analysis was undertaken of 387 participants (225 exposed, 162 unexposed) aged 55– 89 years, 3.5– 4 years after the mine fire. The primary outcome was flow-mediated dilatation (FMD), with time to reach peak diameter as the secondary outcome. Other secondary markers included high-sensitivity C-reactive protein (hsCRP) and ischaemic Electrocardiogram (ECG) changes.Results: There was no evidence of a difference in FMD between participants with high, medium, low or no mine-fire related PM2.5 exposure (4.09% vs 4.06% vs 4.02% vs 3.98%, respectively, p=0.99). Likewise, there was no difference in hsCRP or ischaemic ECG changes. In contrast, there was evidence of a difference in time to peak diameter (p=0.002) with more unexposed participants reaching peak diameter within 30 seconds (36%) compared to those who had high, medium, or low exposure (23%, 22%, 13%, respectively). Multivariate ordinal logistic regression analysis suggested that township, Morwell (exposed) vs Sale (unexposed), but not level of PM2.5 exposure, was associated with delayed time to peak diameter (OR 2.71; 95% CI 1.56, 4.69). Smokers also had delayed time to peak diameter.Conclusion: There was no association between level of exposure to PM2.5 from the 6-week Hazelwood coal mine fire smoke event and reduced FMD, elevated hsCRP or ischaemic ECG four years later. Evidence of delayed time to peak diameter observed in adults from the exposed town, compared to an unexposed town, requires further investigation.Keywords: vascular responses, flow mediated dilatation, time to peak diameter, particulate matter, epidemiology, air pollution

Nicolas W Shammas The Midwest Cardiovascular Research Foundation, Davenport, IA, USACorrespondence: Nicolas W Shammas, Research Director, Midwest Cardiovascular Research Foundation, 630 E 4th Street, Suite A, Davenport, IA, 52801, USA, Email shammas@mchsi.comAbstract: Atherectomy is an effective vessel prepping device but not all atherectomy devices are equal. The depth of vessel injury and residual narrowing vary considerably among atherectomy devices with significant implications on outcome. Precision imaging is critical to optimize outcome using atherectomy as a vessel prepping technique. Prospective trials need to test the hypothesis that precision imaging has a significant impact on how operators approach the treatment of infrainguinal arterial disease.Keywords: atherectomy, aggressive debulking, vessel prepping, dissections, residual narrowing, complications, adventitial injury

Juni Kurniawaty,1 Budi Yuli Setianto,1 Supomo,1 Yunita Widyastuti,1 Cindy E Boom2 1Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 2Harapan Kita National Heart Center, Jakarta, IndonesiaCorrespondence: Juni Kurniawaty, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia, Tel +62 274 514495, Email juni.kurniawaty@ugm.ac.idBackground: Among cardiac surgery patients, low preoperative left ventricular ejection fraction (LVEF) is common and has been associated with poor outcomes. The objective of this study was to assess the association between LVEF and postoperative mortality in patients undergoing open-heart surgery in several hospitals in Indonesia.Methods: We conducted a multicenter study with the retrospective design using data from patients undergoing open-heart surgery in 4 institutions in Indonesia. Data regarding LVEF and other potential risk factors were extracted from medical records and compiled in one datasheet. Statistical analyses were performed to assess if low LVEF was associated with postoperative mortality and identify other potential risk factors.Results: A total of 4789 patients underwent cardiac surgery in participating centers during the study period. Of these, 189 subjects (3.9%) had poor preoperative LVEF. Poor LVEF was associated with postoperative mortality (adjusted OR 2.761, 95% CI 1.763– 4.323, p < 0.001). Based on types of surgery, LVEF had a significant association with mortality only in CABG patients, while there was no such association in valve surgery and inconclusive in congenital surgery patients. Other significant independent predictors of in-hospital mortality included age more than 65 years old, non-elective surgery, the complexity of procedures, history of cardiac surgery, organ failure, CARE score ≥ 3, NYHA class ≥ III, and poor right ventricular function.Conclusion: Patients with low preoperative LVEF undergoing open-heart surgery had a higher risk of postoperative mortality. Cardiac surgery can be performed with acceptable mortality rates. Accurate selection of patients, risk/benefit evaluation, and planning of surgical and anesthesiological management are mandatory to improve outcomes.Keywords: open cardiac surgery, left ventricular ejection fraction, mortality, retrospective study

Jirar Topouchian,1 Parounak Zelveian,2 Zoya Hakobyan,2 Heghine Gharibyan,2 Roland Asmar3 1Diagnosis and Therapeutic Center, Hôtel Dieu Hospital, Paris, France; 2Preventive Cardiology Dept, Institute of Cardiology Named After Levon Hovhannisyan, Yerevan, Armenia; 3Foundation-Medical Research Institutes (F-MRI)®, Geneva, SwitzerlandCorrespondence: Roland Asmar, Foundation-Medical Research Institutes ®, Place St Gervais 1, Geneva, Switzerland, Tel +33640142239, Email ra@cmcv.orgBackground: As recommended by various authorities and scientific societies, electronic devices for blood pressure (BP) measurements must undergo independent clinical validations for accuracy assessment.Objective: To assess the accuracy of the Withings BPM Connect device in the general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization “AAMI/ESH/ISO Universal Standard (ISO 81060– 2:2018)”.Methods: The Withings BPM Connect device measures BP at the brachial level using the oscillometric method. According to this protocol using the same-arm sequential BP measurement method, subjects (n ≥ 85) fulfilling the age, gender, BP and cuff distribution criteria must be included. Two criteria are used for the analysis: Criterion 1: differences between observers’ mercury sphygmomanometer reference measurements and test device BP values (test versus reference) and their standard deviation (SD) must be ≤ 5 ± 8 mmHg for both systolic (SBP) and diastolic BP (DBP). Criterion 2: the SD of the mean BP differences between the test device and reference BP per subject must be ≤ 6.91/6.62 mmHg for SBP/DBP.Results: Ninety-two subjects were selected, 85 of whom were included. For validation criterion 1, the mean difference ± SD between the reference and device BP values was 0.6 ± 5.3 mmHg for SBP and 2.1 ± 4.3 mmHg for DBP. For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 4.2/3.6 mmHg (SBP/DBP). These results fulfilled the AAMI/ESH/ISO Universal Standard (ISO 81060– 2:2018) protocol requirements.Conclusion: The Withings BPM Connect oscillometric device for home BP measurement fulfilled all of the accuracy requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060– 2:2018) in general population and consequently can be recommended for home BP measurements.Keywords: blood pressure measurements, accuracy, validation, home blood pressure, oscillometric, Withings

Syed Sajid Hussain Kazmi,1,2 Nathkai Safi,1,2 Simen Tveten Berge,2,3 Marryam Kazmi,1,4 Jon Otto Sundhagen,1 Jonny Hisdal1,2 1Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway; 2Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; 3Department of Vascular Surgery, Innlandet Hospital Trust, Hamar, Norway; 4Faculty 2, Poznan University of Medical Sciences, Poznan, PolandCorrespondence: Syed Sajid Hussain Kazmi, Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Kirkeveien 166, Oslo, 0450, Norway, Tel +47 92468309, Email sshkazmi@gmail.comBackground: The selection of patients with MALS for surgical treatment depends upon the reliability of the symptom interpretation and the diagnostic work-up. We aimed to follow up the results of the laparoscopic decompression of the patients with MALS.Patients and Methods: In a single-center, 52 consecutive MALS patients were followed-up, prospectively, after transperitoneal laparoscopic decompression. MALS was diagnosed with a computed tomography angiography (CTA) verified stenosis, ≥ 50% of the celiac artery (CA), and with duplex ultrasound, a peak systolic velocity (PSV) ≥ 2.0 m/s. Postoperative, CTA, and duplex ultrasound were performed, and the patients were followed-up at 3, 6, 12 months, and yearly after that.Results: Mean age of the patients was 47 ± 21 years, and 65% were females. The patients had a mean weight loss of 8.4 ± 7.2 kg. Fifty-one patients had the laparoscopic operation with a mean operation time of 102 ± 28 minutes. Forty-seven patients (90%) achieved relief from the symptoms either completely (67%) or partially (23%) at 3– 6 months of follow-up. Significant improvement in postoperative PSV was found compared to the preoperative values, p< 0.001. Five patients (10%) with no immediate effect of the operation, but two of them became free from symptoms during the mean study follow-up of 2.4 ± 2 years. Five patients (10%) had operative complications, including one trocar injury to the liver, one pneumothorax, and three cases of bleeding from the branches of CA. Two patients died of cancer disease during the study period. Only two patients (4%) had symptoms relapse, both later treated successfully.Conclusion: Laparoscopic transperitoneal decompression provides most of the patients a persistent relief from MALS symptoms.Keywords: median arcuate ligament syndrome, postprandial pain, laparoscopy, mesenteric ischemia

Parounak Zelveian,1 Jirar Topouchian,2 Zoya Hakobyan,1 Jennifer Asmar,3 Heghine Gharibyan,1 Roland Asmar4 1Preventive Cardiology Dept, Institute of Cardiology Named After Levon Hovhannisyan, Yerevan, Armenia; 2Diagnosis & Therapeutic Center, Hôtel Dieu Hospital, Paris, France; 3Gynecology-Obstetric Dept, Foch Hospital, Suresnes, France; 4Foundation-Medical Research Institutes (F-MRI)®, Geneva, SwitzerlandCorrespondence: Roland Asmar, Foundation-Medical Research Institutes (F-MRI) ®, Place St Gervais 1, Geneva, Switzerland, Tel +33640142239, Email ra@cmcv.orgBackground: Electronic devices for blood pressure (BP) measurements require independent clinical validation as recommended by various authorities/societies, both in general and special populations such as pregnancy.Objective: To assess the accuracy of the Withings BPM Connect device in pregnancy and pre-eclampsia according to the Universal Standard Validation Protocol.Methods: The Withings BPM Connect device measures BP at the brachial level using the oscillometric method. The study was performed according to the so-called “modified AAMI/ESH/ISO (ISO 81060-2:2018) protocol” or the “Universal Standard Protocol”. The validation study included 45 pregnant women in the second and third gestational trimester: 15 with pre-eclampsia, 15 with gestational hypertension and 15 normotensives. Differences between mercury sphygmomanometer BP measurements (reference) and device BP values (test) and their standard deviation (SD) were calculated.Results: The mean differences between the mercury standard and device BP values in pregnancy (n = 45) were − 0.5 ± 5.7 mmHg for systolic BP (SBP) and − 0.8 ± 3.8 mmHg for diastolic BP (DBP). In the preeclamptic patients (n = 15), the mean differences were 0.14 ± 5.5 mmHg for SBP and 0.39 ± 3.7 mmHg for DBP. These results fulfilled the protocol requirements (< 5 ± 8 mmHg).Conclusion: The Withings BPM Connect fulfills the validation protocol criteria in pregnancy and pre-eclampsia. Consequently, this device can be recommended for home BP measurements in this specific pregnancy population.Keywords: blood pressure measurements, accuracy, validation, pregnancy, pre-eclampsia, home blood pressure, Withings

Peter L Latchman,1 Qin Yang,2 Lingsong Kong,3 Hengbo Zhang,4 Josephine Sebagisha,5 Ronald E De Meersman6 1Department of Health and Movement Sciences, Southern Connecticut State University, New Haven, CT, USA; 2School of Health Promotion and Kinesiology, Texas Woman’s University, Denton, TX, USA; 3Department of Kinesiology, University of Massachusetts, Amherst, MA, USA; 4College of Physical Education, Hunan First Normal University, Changsha, People’s Republic of China; 5Clinical Department St. James School of Medicine, Chicago, IL, USA; 6Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USACorrespondence: Peter L Latchman, Department of Health and Movement Sciences, Southern Connecticut State University, 501 Crescent Street, New Haven, CT, 06515, USA, Tel +1 203-392-6081, Fax +1 203-392-6093, Email latchmanp1@southernct.eduPurpose: Measuring heart rate recovery (HRR) holds valuable cardiovascular information and requires minimal technical skill and cost. Understanding the associations between HRR and more robust cardiovascular indicators, such as central systolic blood pressure (CSBP), can provide valuable cardiovascular information with less involvement. CSBP is a strong predictor of certain cardiovascular diseases. The study aims to examine the association between measures of HRR and CSBP and the augmentation index (AIx) in a group of young, healthy individuals and based on sex.Participants and Methods: One-hundred and seven participants (men – 55, women – 52) were measured for HRR at one minute (HRR1) and two minutes (HRR2) after maximum oxygen consumption (VO2max) testing, CSBP, and the AIx at a heart rate of 75 beats∙min− 1 (AIx@75).Results: The Pearson correlation indicated no association between HRR1, HRR2, and CSBP in men and women combined: r = 0.06, P = 0.53; r = 0.05, P = 0.59, respectively, or based on sex: men = r = 0.01, P = 0.95; r = 0.04, P = 0.79, respectively, and women = r = − 0.05, P = 0.75; r = − 0.09, P = 0.52, respectively. However, there were associations between HRR1 and AIx@75 in men and women combined: r = − 0.37, P < 0.001, and based on sex: men = r = − 0.31, P = 0.02, and women = r = − 0.38, P < 0.01.Conclusion: Measures of HRR were not associated with CSBP in a combined group of young men and women or based on sex. Most measures of HRR, especially those established by parasympathetic nervous activity, were associated with lower AIx@75. Though measures of HRR might be good indicators of cardiovascular disease, they might not be good indicators of CSBP in young, healthy individuals.Keywords: heart rate recovery, central blood pressure, central systolic blood pressure, augmentation index, sex

I Made Adi Parmana,1 Cindy Elfira Boom,1 Lisnawati Rachmadi,2 Dudy Arman Hanafy,3 Yunita Widyastuti,4 Muchtaruddin Mansyur,5 Bambang Budi Siswanto6 1Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 3Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia; 4Department of Anesthesiology and Intensive Care, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia; 5Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 6Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, IndonesiaCorrespondence: I Made Adi Parmana, Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, LetJen S. Parman St No. Kav. 87, West Jakarta, Jakarta, Indonesia, Email adiparmana13@gmail.comPurpose: On-pump coronary artery bypass graft (CABG) causes myocardial ischemia, through the cardiopulmonary bypass (CPB) and aortic cross-clamping (AoX). Glutamine supplementation protects cardiac cells during cardiac ischemia. This study analysed the correlation between cardiac index (CI), plasma troponin I, myocardial histopathology, CPB and AoX duration in low ejection fraction patients receiving glutamine and no glutamine undergoing elective on-pump CABG.Material and Methods: This was a secondary analysis of a double-blind, randomised controlled trial of 60 patients, split into control and intervention (glutamine) groups. Glutamine was administered at a dose of 0.5 g/kg/24 hours. There were 29 patients in each respective groups after a total of two patients dropped out.Results: A negative correlation (p = 0.037) was observed between CPB duration and CI at 6 hours after CPB in the glutamine group. A positive correlation (p = 0.002) was also observed between AoX duration and plasma troponin I at 6 hours after CPB in the control group. However, no correlation was observed between myocardial histopathology and plasma troponin I level at 5 minutes after CPB.Conclusion: Significant negative correlation between CPB duration and CI at 6 hours after CPB in the glutamine group, along with significant positive correlation between AoX duration and plasma troponin I level at 6 hours after CPB in the control group demonstrated the myocardial protection qualities of intravenous glutamine administration in patients with low ejection fraction undergoing elective on-pump CABG surgeries.Keywords: glutamine, myocardial protection, coronary artery bypass grafting, cardiopulmonary bypass, low ejection fraction, myocardial injury

Cynthia Al Hageh,1,&ast; Stephanie Chacar,2,&ast; Thenmozhi Venkatachalam,2 Dominique Gauguier,3,4 Antoine Abchee,5 Elie Chammas,6 Hamdan Hamdan,2 Siobhan O’Sullivan,1 Pierre Zalloua,1,7,8 Moni Nader2,7 1Department of Molecular Biology and Genetics, College of Medicine and Health Sciences, Khalifa University for Science and Technology, Abu Dhabi, United Arab Emirates; 2Department of Physiology and Immunology College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, UAE; 3McGill University and Genome Quebec Innovation Centre, Montreal, QC, H3A 0G1, Canada; 4Université Paris Cité, INSERM, Paris, France; 5Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; 6School of Medicine, Lebanese University, Beirut, Lebanon; 7Biotechnology Center, Khalifa University for Science and Technology, Abu Dhabi, United Arab Emirates; 8Harvard T.H. Chan School of Public Health, Boston, MA, USA&ast;These authors contributed equally to this workCorrespondence: Pierre Zalloua; Moni Nader, College of Medicine and Health Sciences, Khalifa University for Science and Technology, PO Box 127788, Abu Dhabi, United Arab Emirates, Email pierre.zalloua@ku.ac.ae; moni.nader@ku.ac.aeBackground and Objective: Coronary artery disease (CAD) is a major cause of death worldwide. Revascularization via stent placement or coronary artery bypass grafting (CABG) are standard treatments for CAD. Despite a high success rate, these approaches are associated with long-term failure due to restenosis. Risk factors associated with restenosis were investigated using a case-control association study design.Methods: Five thousand two hundred and forty-two patients were enrolled in this study and were assigned as follows: Stenosis Group: 3570 patients with CAD > 50% without a prior stent or CABG (1394 genotyped), and Restenosis Group: 1672 patients with CAD > 50% and prior stent deployment or CABG (705 genotyped). Binomial regression models were applied to investigate the association of restenosis with diabetes, hypertension, and dyslipidemia. The genetic association with restenosis was conducted using PLINK 1.9.Results: Dyslipidemia is a major risk factor (Odds Ratio (OR) = 2.14, P-value < 0.0001) for restenosis particularly among men (OR = 2.32, P < 0.0001), while type 2 diabetes (T2D) was associated with an increased risk of restenosis in women (OR = 1.36, P = 0.01). The rs9349379 (PHACTR1) and rs264 (LPL) were associated with an increased risk of restenosis in our patients. PHACTR1 variant was associated with increased risk of restenosis mainly in women and in diabetic patients, while the LPL variant was associated with increased risk of restenosis in men.Conclusion: The rs9349379 in PHACTR1 gene is significantly associated with restenosis, this association is more pronounced in women and in diabetic patients. The rs264 in LPL gene was associated with increased risk of restenosis in male patients.Keywords: PHACTR1, LPL, diabetes, restenosis

Jerzy Gebicki,1,2 Joanna Katarzynska,2 Andrzej Marcinek1,2 1Institute of Applied Radiation Chemistry, Lodz University of Technology, Lodz, Poland; 2Angionica Ltd, Lodz, PolandCorrespondence: Jerzy Gebicki, Institute of Applied Radiation Chemistry, Lodz University of Technology, Lodz, 90-924, Poland, Tel +48 42 631 31 71, Email jerzy.gebicki@p.lodz.pl; jerzy.gebicki@angionica.com.pl

Solomon Getawa, Biruk Bayleyegn Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Solomon Getawa, Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O.Box: 196, Gondar, Ethiopia, Tel +251-914-665-736, Email solomon2525geta@gmail.comBackground: Heart failure pathophysiology and its clinical symptoms are characterized by inflammation. Elevated levels of leukocyte subpopulations are a well-known indicator of inflammation and play a predictive role in determining the prognosis of patients with cardiovascular diseases. Besides, platelets are essential mediators of inflammation, especially when they interact with leukocytes. Platelet synthesis, activation, and function are all impacted by heart failure. Thus, the study was aimed at determining the magnitude of platelet, neutrophil, and lymphocyte abnormalities in patients with heart failure.Methods: A retrospective cross-sectional study was conducted from June to July 2022 at the University of Gondar comprehensive specialized hospital. A total of 245 medical records of heart failure patients were included. Data regarding socio-demographic, clinical, and some hematological and biochemical parameters were collected from medical records. Data was entered into Epi-Data 4.6.0.2 and then exported to Stata 11.0 statistical software for analysis. A binary logistic regression analysis with its odds ratio was calculated to identify factors associated with the outcome variables. P-value < 0.05 was considered statistically significant.Results: The most frequent leukocyte abnormality among adults with heart failure was neutrophilia, which was detected in 17.55% (95% CI: 13.26– 22.87). Besides, lymphocytosis was observed in 10.20% (95% CI: 6.97– 14.70) of patients. The magnitude of thrombocytopenia and thrombocytosis among patients with heart failure was 12.24% (95% CI: 8.67– 17.01%) and 2.86% (95% CI: 1.36– 5.90%), respectively. Only being female was significantly associated with neutrophilia in patients with heart failure (AOR = 2.33; 95% CI: 1.05– 5.16). However, none of the variables were significantly associated with platelet and lymphocyte abnormalities.Conclusion: Neutrophilia, lymphocytosis, and thrombocytopenia are the common leukocyte and platelet abnormalities in heart failure patients. Therefore, early detection and management of the underlying causes of those abnormalities may be important to improve patients’ outcomes and prevent further complications.Keywords: heart failure, platelet, neutrophil, lymphocyte, neutrophilia, lymphocytosis, thrombocytopenia

Rakhmad Hidayat,1– 3 Al Rasyid,2,3 Salim Harris,2,3 Alida Harahap,2 Herqutanto,2 Melva Louisa,2 Erlin Listiyaningsih,4 Aldy Safruddin Rambe,5 Tonny Loho6 1Doctoral Program in Medical Sciences Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 2Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 3Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 4Harapan Kita Hospital, Jakarta, Indonesia; 5Sumatera Utara University, Medan, Indonesia; 6Faculty of Medicine and Health Science, Kristen Krida Wacana University, Jakarta, IndonesiaCorrespondence: Rakhmad Hidayat, Tel +62 813 88756299, Email rhidayat.md@gmail.comBackground: Stroke is one of the highest causes of disability and mortality in several countries worldwide. Secondary prevention is important in the management of stroke. Clopidogrel is widely used in Asia as secondary prevention for ischemic stroke, even though several studies in Western show limited data related to clopidogrel resistance in Asia. This study aims to determine the correlation between P2Y12 genetic polymorphism and clopidogrel resistance in Indonesia.Methods: This study was conducted on one-year duration, the subjects were chosen through the consecutive sampling method, all subjects were examined for genetics and resistance to clopidogrel. The data were analyzed through statistical analysis, a bivariate analysis was conducted to determine the correlation between several variables and the resistance variable. This study employed resistance diagnostic methods with VerifyNow. Polymorphism of receptor P2Y12 was tested with the Polymerase Chain Reaction method (PCR) and analysis of restriction fragment length polymorphism (RFLP). The genes tested in this study were G52T and C34T.Results: The number of participants in this study was 112. Examination of gene P2Y12 showed that the majority was homozygote, wild-type C34T allele (67%), and G52T (66.1%). There was no significant correlation between clopidogrel resistance and gene G52T and C34T of P2Y12 (p > 0.05). Hb levels significantly correlated with P2Y12 G52T (p = 0.024). Meanwhile, Fatty Liver significantly correlated with P2Y12 C34T (p = 0.037).Conclusion: Indonesia showed a low clopidogrel resistance rate and a very low C34T and G52T allele P2Y12 gene mutation, meaning that Indonesia had low mutations in the P2Y12. This is the cause of clopidogrel resistance in this study only 15%. Therefore, in a region with less clopidogrel resistance, examination of the P2Y12 gene would not give significant results.Keywords: clopidogrel resistance, P2Y12, stroke, antiplatelet

Mihret Melese, Ayechew Adera, Adugnaw Ambelu, Yibeltal Yismaw Gela, Mengistie Diress Department of Human Physiology, School of Medicine, University of Gondar, Gondar, EthiopiaCorrespondence: Mengistie Diress, University of Gondar, P. O. Box 196, Gondar, Ethiopia, Email mengistiediress@gmail.comIntroduction: Cardiovascular disorders are one of the commonly recognized occupational diseases in the developed world. Individuals chronically exposed to noise at workplaces had a higher risk of developing elevated arterial blood pressure. There are limited studies in Ethiopia regarding this topic and thus this study determined the prevalence and determinant factors of occupational noise-induced pre-hypertension among metal manufacturing workers in Gondar city administration, Northwest Ethiopia.Methods: An institution-based cross-sectional study design was carried out. In this study, 300 study participants were recruited by census sampling method. A sound level meter was used to measure the working area noise level. A semi-structured pre-tested interviewer-administered questionnaire was used to collect sociodemographic and clinical data. Blood pressure was measured in a quiet room in the morning using a mercurial sphygmomanometer. Both bivariable and multi-variable binary logistic regressions were used to identify factors associated with noise-induced prehypertension. Adjusted odds ratio with 95% confidence interval was reported, and variables with p < 0.05 were considered as statistically associated factors with pre-hypertension.Results: The prevalence of noise-induced pre-hypertension was 27.7% (95% CI: 22.7– 32.7). In multivariable logistic regression, working area noise level (AOR = 3.8, 95% CI: 6.8– 8.9), 45– 65 years’ age (AOR = 9.8, 95% CI: 5.4– 12.9), years of work experience ((6– 10 years (AOR = 2.8, 95% CI: 1.98– 5.90 and > 10 years (AOR = 4.8, 95% CI: 7.8– 9.75)), being a cigarette smoker (AOR = 3.6, 95% CI: 1.36– 9.77), and alcohol consumption (AOR = 2.4, 95% CI: 1.06– 1.04) were significantly associated with noise-induced prehypertension.Conclusion: Workers in metal manufactures who were exposed to noise levels > 85 dB developed elevated blood pressure. The odds of having prehypertension were increased by years of work experience, advanced age, smoking, and alcohol consumption. Our findings recommended that the real-world preventive strategies should be taken to lower the risk of noise-induced pre-hypertension hastened by occupational noise exposure.Keywords: noise, pre-hypertension, metal manufacturing workers, Ethiopia

Ahmed Hussein,1 Mohamed Eid,1 Sharaf E D Mahmoud,1 Mohamed Sabry,2 Ali Altaher1 1Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt; 2Department of OB/GYN, Faculty of Medicine, Sohag University Egypt, Sohag, EgyptCorrespondence: Ahmed Hussein, Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University, Nasser City, Sohag, 82524, Egypt, Tel +2 01011145537, Fax +2 0934600349, Email ahmed_hussien@med.sohag.edu.egBackground: Percutaneous balloon mitral valvuloplasty (PBMV) is considered the most suitable option for managing symptomatic severe mitral valve stenosis (MS) during pregnancy with favorable anatomy. We do not know the best time to perform PBMV during pregnancy to achieve the best maternal and fetal outcomes. Therefore, we conducted this study to clarify the best procedure timing.Methods: This prospective, observational, single-center study involved 44 pregnant patients suffering from symptomatic MS who underwent PBMV from May 2017 to May 2020. A detailed history is taken, full clinical examination, laboratory assessment, 2 D echocardiography, and follow-up during the hospital stay and monthly until labor.Results: We found that the mean mitral valve area (MVA) had significantly increased from 1.12 ± 0.24 to 2.09 ± 0.46 cm2 (P < 0.001). The mean pressure gradient across the mitral valve reduced from 17.22 ± 5.55 to 8.94 ± 3.75 mmHg (P < 0.001). The procedures were successful in 91% of the patients. Regarding obstetric outcomes, the incidence of preterm labor, fetal death, and composite adverse outcomes was significantly lower in patients who had the procedure during the second trimester than those who had the procedure during the third trimester. All preterm deliveries and intrauterine fetal deaths occurred at least 21 days after PBMV. The patients showed a statistically significant improvement in NYHA functional classification.Conclusion: We can conclude that PBMV performed in pregnant patients is an effective and safe treatment modality, and we observed better obstetric outcomes achieved with early intervention during the second trimester.Keywords: rheumatic heart disease, mitral stenosis, PBMV, pregnancy, obstetric outcomes

Lubna Al Asoom,1 Maha A Alassaf,2 Najd S AlSulaiman,3 Dhuha N Boumarah,4 Aldana M Almubireek,2 Gaeda K Alkaltham,2 Hussain A Alhawaj,5 Taleb Alkhamis,5 Nazish Rafique,1 Ahmed Alsunni,1 Rabia Latif,1 Seham Alsaif,1 Dana Almohazey,6 Sayed AbdulAzeez,7 J Francis Borgio7 1Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2King Fahd hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Internal Medicine, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 5Animal House, Environmental Health Department, Institute for Research and Medical Consultation, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 6Department of Stem Cell Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 7Department of Genetic Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Lubna Al Asoom, Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O Box 2004, Dammam, 31541, Saudi Arabia, Tel +966505846344, Email lasoom@iau.edu.saBackground: Obesity is a global pandemic that is associated with high morbidity and mortality. Natural herbs are commonly used for weight reduction and appetite suppression. Therefore, we aim to investigate the role and mechanism of Nigella sativa (NS) and ginger on weight reduction and appetite regulation.Methods: This experimental study was performed at Imam Abdulrahman Bin Faisal University. Twenty-five female rats were distributed into 5 groups: NS (oral 1000mg/kg), Ginger (500 mg/kg), NS-ginger (both interventions), a positive control (intraperitoneal 50 μg/kg Liraglutide), and a negative control. Each intervention was given for 9 weeks. Food intake and body weight were assessed weekly. Serum lipid profile and peptides involved in appetite control (cholecystokinin (CCK), glucagon-like peptide 1(GLP-1), gastric inhibitory polypeptide (GIP), ghrelin, peptide YY, and orexin) were assayed at the end of the experiment.Results: None of the interventions showed a statistically significant difference regarding food consumption or weight gain (p > 0.05). However, the three interventions significantly reduced total cholesterol (TC), NS and NS-ginger significantly increased HDL, NS increased ghrelin and ginger increased orexin.Conclusion: The present dose and duration of NS, ginger, or in combination did not demonstrate a significant change in body weight or food consumption in comparison to the negative or positive controls. However, NS or ginger has improved the lipid profile by reducing TC and increasing HDL. In addition, NS or ginger can influence some of the peptides involved in appetite regulation such as the increase in ghrelin induced by NS and the reduction of orexin induced by ginger. We believe that these latter effects are novel and might indicate a promising effect of these natural products on appetite regulation.Keywords: Nigella sativa, ginger, body weight, appetite, Liraglutide

Alexandra Kasim,1,&ast; Gabby Elbaz-Greener,2,3,&ast; Amjad Shalabi,4– 6 Erez Kachel,4– 6 Liza Grosman-Rimon,4,5 Michael Jerdev,4 offer amir,2– 5 Shemy Carasso2– 5 1Department of Radiology, B Padeh Medical Center, Poriya, Israel; 2Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel; 3Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; 4Cardiovascular Institute, B Padeh Medical Center, Poriya, Israel; 5The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; 6Department of Cardiac Surgery, B Padeh Medical Center, Poriya, Israel&ast;These authors contributed equally to this workCorrespondence: Gabby Elbaz-GreenerDepartment of Cardiology, Hadassah Medical Center, Room Number 114, Jerusalem, IsraelTel +97226776564Fax +97226411028Email Gabby@hadassah.org.ilBackground: Severe mitral annulus calcification (MAC) is believed to bear high operative and post-operative risk during mitral valve replacement (MVR) surgery, including longer surgery time, post-surgical valvular leaks and increased rate of embolic phenomena. We hypothesized that quantification of mitral calcium in pre-operative chest computerized tomography (CCT), performed to assess aortic root before cross-clamping may help in risk assessment of adverse intraoperative and postoperative outcomes in patients undergoing MVR.Methods: We included patients who underwent MVR between the years 2015 and 2018 at Poriya medical center. Preoperative CCT was performed using Philips iCT 256 and Agatston mitral annulus calcium score (MACS) was retrospectively calculated using Philips Intellispace portal version 8.0. Patients were divided into MACS quintiles; 1– 3 quintiles were grouped (Low MACS) and compared to the 4– 5 quintiles (High MACS) group for demographic, clinical operative and post-operative parameters.Results: A total of 66 patients had MVR, out of which 61% were males, with mean age of 64± 9. Concomitant coronary or valvular procedures were done in 60% of patients. The median MACS was 43. High MACS (≥ 854) was not associated with longer bypass or cross clamp times. No differences in the MVR results were found between the groups. There were 6 post-operative embolic events; 1 mesenteric and 5 cerebral, which were not associated with MACS.Conclusion: MACS did not seem to be related to adverse outcomes in MVR. Due to a low event rate and probable pre-selection of patients without extreme mitral annulus calcifications our results should be confirmed in larger prospective study.Keywords: mitral annulus calcification, MACS, mitral valve replacement, MVR

Kouichi Murakami,1 Emi Inayama,1 Yukiko Itoh,1 Shoji Tuchiya,1 Masashi Iwasaki,2 Nobuko Tamura,1 Toshihiko Suzuki,3 Noriko Iwai,1 Junji Utino,4 Motoyuki Masai,4 Daiji Nagayama,5,6 Kohji Shirai4,6 1Seijinaki Mihama Narita Clinic, Narita City, Chiba, 286-0041, Japan; 2Seijinkai Mihama Katori Clinic, Katori City, Chiba, 287-0041, Japan; 3Seijinkai Mihama Sakura Clinic, Sakura City, Chiba, 285-0841, Japan; 4Seijinkai Mihama Hospital, Chiba City, Chiba, 261-0013, Japan; 5Nagayama Clinic, Oyama City, Tochigi, 323-0032, Japan; 6Sakura Hospital, School of Medicine Toho University, Sakura City, Chiba, 285-8741, JapanCorrespondence: Daiji NagayamaNagayama Clinic, 2-12-22, Tenjin-Cho, Oyama City, Tochigi, 323-0032, JapanTel/Fax +81-285-22-0219Email deverlast96071@gmail.comAim: Mortality rate of maintenance hemodialysis patients is known to be high. Cardio-ankle vascular index (CAVI) is an index reflecting the proper stiffness of the arterial tree from the origin of the aorta to the ankle. We aimed to clarify the utility of CAVI as a predictor of mortality in hemodialysis patients. The roles of age and nutritional conditions on survival were also examined.Methods: We followed 242 patients undergoing hemodialysis for 6 consecutive years. Data from 209 patients (mean age was 60 ± 11 years) excluding those with ankle-brachial index < 0.90 were then analyzed. CAVI and heart to ankle pulse wave velocity (haPWV) were measured using Vasera 1500.Results: Thirty-eight hemodialysis patients who died during the 6-year period had higher age, cardiothoracic ratio (CTR), CAVI, and haPWV, and lower diastolic blood pressure, albumin, phosphate, and calcium phosphate product. The Kaplan–Meier curves for cumulative survival among the tertile groups showed that the mortality rate was higher in the highest tertile (T3) compared to T1/T2 for both CAVI and haPWV. Receiver operating characteristic (ROC) analysis revealed that CAVI had better discriminatory power for all-cause mortality compared to haPWV. In the Cox-proportional hazards analyses, 1 SD increase in both parameters contributed independently to all-cause mortality [CAVI: HR 1.595 (95% CI 1.108– 2.297), haPWV: HR 1.695 (95% CI 1.185– 2.425)], as well as age and CTR. Both parameters above the cut-offs estimated in the ROC analysis (CAVI ≥ 9.2, haPWV ≥ 8.9) also had independent contributions to mortality.Conclusion: Through the 6 consecutive years of follow-up in 209 HD patients, increased CAVI might represent a major modifiable risk factor for all-cause mortality. Further research is needed to examine whether CAVI-lowering interventions contribute to improved prognosis.Keywords: hemodialysis patient, mortality, cardio-ankle vascular index, phosphorus

Ganna Dmytrivna Radchenko, Yurii Anatoliiovych Botsiuk, Yuriy Mykolaiyovich Sirenko State Institution “National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, UkraineCorrespondence: Ganna Dmytrivna Radchenko, State Institution National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Science of Ukraine”, 5, Svyatoslava Khorobroho str., Kyiv, 03151, Ukraine, Tel +38-0667128405, Email rganna@bigmir.netAbstarct: Aim: This study aims to evaluate the left ventricle (LV) systolic and diastolic function in patients with idiopathic pulmonary arterial hypertension (IPAH) and its correlation with systemic arterial stiffness assessed by cardio-ankle vascular index (CAVI).Patient and methods: We included 37 patients with IPAH and 20 healthy people matched by age. All patients were assessed: vital signs, 6-minute walk test, NT-proBNP level, the CAVI, the right ventricular (RV) and LV function parameters, including ejection time (ET), tissue speckle-tracking values – global longitudinal strain (GLS) and strain rate (SR).Results: The groups were matched by age, gender, BMI, office SBP and DBP. Patients with IPAH had higher heart rate, NT-proBNP level and lower ferritin level, GFR (CKD-EPI), SaO2 than healthy people. The mean CAVIleft was higher in IPAH patients than in the control group- 8.7± 1.1 vs 7.5± 0.9, P=0.007. Healthy people had significantly less E/e’ and lower IVRT. LVET and RVET were shorter in IPAH patients. Patients with IPAH had mean LVGLS –(− 17.6± 4.8%) and 35.1% of them were with LVGLS ≤ 16% compared to healthy people –(− 21.8± 1.4%) and 0%, respectively. LVSR was significant less in IPAH patients, but in the normal range. We found significant correlations of CAVI with age, history of syncope, bilirubin, uric acid, total cholesterol, cardiac output, cardiac index, RVET, LVET and E/A. Multiple linear regression confirmed the independent significance for age (β=0.083± 0.023, CI 0.033– 0.133) and RVET (β=-0.018± 0.005, CI -0.029 to − 0.008) only. The risk to have CAVI ≥ 8 increased in 5.8 times in IPAH patients with RVET

Kazuhiro Shimizu,1 Mao Takahashi,1 Shuji Sato,1 Atsuhito Saiki,1 Daiji Nagayama,1,2 Takashi Hitsumoto,3 Akira Takahara,4 Kohji Shirai1,5 1Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan; 2Department of Internal Medicine, Nagayama Clinic, Oyama, Tochigi, Japan; 3Hitsumoto Medical Clinic, Shimonoseki, Yamaguchi, Japan; 4Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Chiba, Japan; 5Department of Internal Medicine, Seijinkai Mihama Hospital, Chiba, Chiba, JapanCorrespondence: Kazuhiro Shimizu, Department of Internal Medicine, Toho University Sakura Medical Center, 561-4 Shimoshizu, Sakura, Chiba, 285-8741, Japan, Tel +81-43-462-8811, Fax +81-43-462-8820, Email k432@sakura.med.toho-u.ac.jpAbstract: Predictive factors for vascular events have not been established. The vasculature of the atheroma is supplied by penetration of the vasa vasorum through the smooth muscle cell layer from the adventitia. Smooth muscle cell contraction induces compression of the vasa vasorum, resulting in ischemia in intimal atheromatous lesions. Cardio-ankle vascular index (CAVI) has become known as an index of arterial stiffness of the arterial tree from the origin of the aorta to the ankle. CAVI reflects the progress of arteriosclerosis, and a rapid rise in CAVI indicates arterial smooth muscle cell contraction. We hypothesized that rapidly increased arterial stiffness evaluated by CAVI may be a predictor of impending cardiovascular events.Keywords: arterial stiffness, stress, plaque rupture, CAVI

Bai Yi Song1 &ast;, Chen Chen2 &ast;, Wen Hu Xu,1 Bai Lin Cong,3 Zheng Yi Guo,1 Zai Hao Zhao,4 Lan Cui,1 Yin Hua Zhang1,4,5 1Cardiovascular Medicine Department, Yanbian University Hospital, Yanji, 133000, People’s Republic of China; 2Department of Emergency Medicine, Yanbian University Hospital, Yanji, 133000, People’s Republic of China; 3Cardiovascular Medicine Department, Jilin City Central Hospital, Jilin, 132011, People’s Republic of China; 4Research Center, Yanbian University Hospital, Yanji, 133000, People’s Republic of China; 5Department of Physiology & Biomedical Sciences, Ischemic/Hypoxic Disease Institute, Seoul National University, College of Medicine, Seoul, 03080, Republic of Korea&ast;These authors contributed equally to this workCorrespondence: Yin Hua Zhang; Lan Cui, Yanbian University Hospital, Yanji, 133000, People’s Republic of China, Tel +86 433 2660129, Email yinzhang87@gmail.com; lancui@ybu.edu.cnBackground: There are clear gender differences in the pathological process and outcome in acute myocardial infarction (AMI) patients but inflammatory responses remain clarified. Here, we aimed to analyse the correlations between inflammatory cells and organ injury parameters in AMI patients and compared between male and female groups.Methods: A total of 603 AMI patients who underwent percutaneous coronary intervention (PCI) within 24 hours of the onset were analysed retrospectively. Basic information and hematological parameters detected 6 hours before the PCI were collected, neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) were calculated. Renal, liver function indicators, and myocardial enzymes were measured. Left ventricular ejection fraction (EF) and fractional shortening (FS) on days 5– 7 after PCI were obtained. Western blot was performed to detect iNOS, eNOS and nNOS expression in H9C2 rat cardiomyocytes treated with IL-6 with and without estrogen and testosterone.Results: WBC, NEU, MON, MLR, CK, ALT and CREA of male patients were significantly higher than females, but FS was lower in females. NEU, MON and MLR were positively correlated with CK, CK-MB, AST, and ALT in males, whereas LYM were correlated with these parameters in female. NEU and NLR were inversely correlated with EF or FS only in female. Estrogen and testosterone reduced IL-6-induced iNOS protein expression in H9C2 cardiomyocytes, estrogen enhanced IL-6-induced nNOS protein expression.Conclusion: NEU, MON, MLR in male AMI patients, and LYM in female patients were associated with organ injury parameters. Estrogen regulation of nitric oxide pathway may mediate the protective effects in female.Keywords: acute myocardial infarction, gender differences, immune cells, renal function indicators, liver function indicators, nitric oxide synthases

David Corredor-Orlandelli,1,* Santiago Sambracos-Parrado,1,* Santiago Mantilla-García,1 Josué Tovar-Tirado,1 Valentina Vega-Ramírez,1 Santiago David Mendoza-Ayús,1 Laura Catalina Peña,1 María Fernanda Leal,1 Juliana Rodríguez-Carrillo,1 Juanita León-Torres,1 Juan Mauricio Pardo-Oviedo,2 Katherine Parra Abaunza,3 Nora Contreras Contreras Bravo,1 Oscar Ortega-Recalde,1 Dora Janeth Fonseca Mendoza1 1Center for Research in Genetics and Genomics – CIGGUR, GENIUROS Research Group, School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Colombia; 2School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; 3Hospital Universitario Mayor – Méderi, Universidad del Rosario, Bogotá, Colombia*These authors contributed equally to this workCorrespondence: Dora Janeth Fonseca MendozaCenter for Research in Genetics and Genomics (CIGGUR), GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Cra 24 # 63C69, Bogotá, 112111, ColombiaTel/Fax +57 12920200Email dora.fonseca@urosario.edu.coBackground: Paraoxonase-1 (PON1), a glycoprotein associated with serum high-density lipoprotein (HDL), has a central role in metabolizing lipid peroxides, exhibiting antiatherogenic properties. The polymorphism p.Q192R has been previously associated with coronary artery disease (CAD) susceptibility and clopidogrel response.Purpose: We aimed at investigating the association of PON1 p.Q192R with CAD and clopidogrel response in Colombian population.Patients and Methods: The study was conducted among 163 patients diagnosed with CAD and treated with clopidogrel. The allele frequencies for the PON1 192Q and 192R alleles were determined in cases and Latin-American controls obtained from the public database gnomAD (n = 17,711). Response to clopidogrel was determined by assessing the platelet function using the INNOVANCE PFA-200 System. We determined the association between PON1 p.Q192R polymorphism, increased susceptibility to CAD and high on-treatment platelet reactivity (HPR) by using odds ratio (OR) and 95% confidence interval (CI) on four genetic models.Results: The allele frequencies for the PON1 192Q and 192R alleles were 0.60 and 0.40, respectively. The allele distribution was found to be statistically different from the control group and other ethnic groups. The allele 192R was positively associated with decreased susceptibility to CAD under a dominant model (OR, 0.58; 95% CI, 0.42– 0.8; P < 0.01). We found no association between the polymorphism and HPR.Conclusion: We propose that PON1 p.Q192R is a potentially useful marker for CAD susceptibility in the Colombian population and lacks association with HPR under clopidogrel treatment.Keywords: PON1, genetic risk, cardiovascular disease susceptibility, platelet reactivity, clopidogrel

Jacques Blacher,1 Virginie Femery2 On behalf of the VIVOPTIM medical committee1Diagnosis and Therapeutic Center, Hôtel-Dieu Hospital; Université de Paris; AP-HP, Paris, France; 2Department of Executive Management, VIVOPTIM Solutions, Paris, FranceCorrespondence: Jacques BlacherUniversité de Paris; Assistance Publique-Hôpitaux de Paris; Unité HTA, Prévention et Thérapeutique Cardiovasculaires, Centre de Diagnostic et de Thérapeutique, Hôpital Hôtel-Dieu, Place du Parvis Notre-Dame, Paris 75004, FranceTel +33 1 42 34 89 66Fax +33 1 42 34 86 32Email jacques.blacher@aphp.fr

Natalia Kirsten,1 Nicole Mohr,1 Franziska Gensel,1 Aminah Alhumam,1,2 Guido Bruning,3 Matthias Augustin1 1Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; 2Department of Dermatology, College of Medicine, King Faisal University, Hofuf, Al Ahsa, Saudi Arabia; 3Department of Vein and Dermatosurgery, Tabea Hospital GmbH and Co KG, Hamburg, GermanyCorrespondence: Natalia KirstenInstitute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, Hamburg, D-20246, GermanyTel +49-40-7410-55428Fax +49-40-7410-55348Email n.kirsten@uke.deIntroduction: Data on the prevalence of chronic venous disorders (CVD) at the national level in Germany are scarce.Methods: We performed a population-based observational study based on clinical examinations, personal history, and technical examinations. Data were collected from 2006 to 2015. Descriptive data analysis was done to determine CVD and chronic venous insufficiency (CVI) prevalence and occurrence of potential risk factors. Chi-squared tests were performed to estimate the influence of risk factors on the prevalence of CVD.Results: In total, 19,104 employees from different branches were included. The majority of the examined people were doing office work (n = 8157; 80.2%). A total of 4038 persons (21.1%) show at least one sign of CVD. At least one sign of CVI could be found in 679 persons (3.6%). Being female was found to be protective with an odds ratio of 0.66 (95% CI 0.59– 0.73).Conclusion: There is clear indication for active venous treatment in 22.3% of the adult working population in Germany.Keywords: venous insufficiency, epidemiology, prevalence

Masho Tigabe,1 Abaynesh Fentahun,1 Solomon Getawa,2 Kassahun Alemu Gelaye,3 Eyob Alemayehu Gebreyohannes1,4 1Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 4Division of Pharmacy, School of Allied Health, University of Western Australia, Nedlands, AustraliaCorrespondence: Solomon GetawaDepartment of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, EthiopiaTel +251 914-665-736Email solomon2525geta@gmail.comBackground: Despite the growing burden of heart failure in developing countries, data describing the clinical characteristics and in-hospital outcomes of acute heart failures are limited. Therefore, this study aimed at describing the clinical characteristics and in-hospital outcomes of acute heart failure patients admitted to the medical ward of University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.Methods: A prospective observational hospital-based cross-sectional study was conducted on 226 patients with acute heart failure at the University of Gondar Comprehensive Specialized Hospital from November 2019 to October 2020. Data were collected by using a pretested data abstraction format and analyzed with Statistical Package for Social Sciences version 21. Bivariable and multivariable binary logistic regression model were fitted to identify factors associated with in-hospital outcome and reported with 95% confidence interval (CI). P-value < 0.05 was considered as statistically significant.Results: The mean (± standard deviation) age of the study participant was 51.17± 19.03 years and 59.3% were females. Majority, 60.6% of patients were admitted with new onset heart failure. Dyspnea (88.05%) and peripheral edema (80.5%) were the most frequent clinical findings. The in-hospital mortality was 10.6% (95% CI: 7.1– 14.7). Atrial fibrillation (AOR=9.46; 95% CI: 1.49– 60.29), concurrent ischemic heart disease (AOR=8.23; 95% CI: 1.15– 58.89), being admitted with reduced left ventricular ejection fraction (AOR=5.36; 95% CI: 2.81– 35.52), presence of orthopnea (AOR=6.63; 95% CI: 2.94– 46.76), and using intranasal oxygen therapy (AOR=9.41; 95% CI: 1.35– 65.82) were significantly associated with in-hospital mortality in patients with acute heart failure.Conclusion: The in-hospital mortality of acute heart failure patients was relatively higher in the study area. Therefore, specific preventative and therapeutic strategies focusing on heart failure patients with reduced left ventricular ejection fraction, atrial fibrillation, ischemic heart disease, orthopnea, and intranasal oxygen therapy are required to reduce the mortality rate.Keywords: heart failure, clinical characteristics, in-hospital mortality, Ethiopia

Khaled Z Alawneh,1 Liqaa A Raffee,2 Musa Ahmed Mohammed Alshehabat,3 Hazem Haddad,4 Saied A Jaradat5 1Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Clinical Veterinary Medical Sciences, Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid, Jordan; 4Haya Biotechnology Center, Jordan University of Science and Technology, Irbid, 22110, Jordan; 5Princess Haya Biotechnology Center, Jordan University of Science and Technology, Irbid, 22110, JordanCorrespondence: Liqaa A RaffeeDepartment of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, JordanEmail laraffee5@just.edu.joPurpose: Ischemic stroke of the brain is still considered one of the most common causes of disability and death in developed and developing countries in human beings despite advances in medicine and technology. This study was conducted to characterize and profile tens of induced biomarkers (microRNAs) after experimentally inducing regional ischemic stroke of the brain by occluding the middle cerebral artery under fluoroscopic guidance using an autologous blood clot.Patient and Methods: A total of six healthy dogs were recruited for this study. The microRNAs were profiled in the blood and urine before and after occluding the middle cerebral artery using genetic techniques.Results: The very highly expressed genes were comprised within cluster A, followed by cluster D in both 24 and 48-hour brain samples. Clusters B and C revealed down-regulated genes, while miRNAs remained up-regulated in the 24-hour samples merely in cluster F. Upregulated genes at 48 hours of reperfusion were included in cluster E. On the other hand, changes were observed after a day on the cluster G genes. Exclusive upregulation was notified after 2 days due to the changes in mIR-138. The normalized gene expression in the test sample is witnessed through Fold-Change, which divides the control sample’s normalized gene expression. Moreover, fold-change has emerged as a significant approach for representing fold-regulation.Conclusion: The microRNAs expression in blood and urine may have a potential role in the diagnosis, prognosis, and assessment of therapy associated with cerebral artery occlusion under fluoroscopic guidance.Keywords: dogs, fluoroscopic induced ischemic brain, microRNAs, middle cerebral artery stroke

Abdallah Damin Abukhalil Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, PalestineCorrespondence: Abdallah Damin Abukhalil, Email adkhalil@birzeit.edu