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Background: In patients with ST-segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) tries to reestablish coronary flow and ensure effective cardiac reperfusion. An independent predictor of no-reflow is a large thrombus load. Objective: This investigation sought to determine if the red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) were reliable indicators of excessive thrombus load on coronary angiography. Patients and methods: Two-hundred patients, with STEMI managed by primary PCI within 12 hours from chest pain onset, were divided into group A with high thrombus burden (Thrombolysis in myocardial infarction (TIMI) thrombus grade 4-5) and group B with low thrombus burden (TIMI thrombus grade 1-3). Results: One-hundred and seventeen patients (58.5%) had a high thrombus burden (group A). They had more mean number of cardiovascular disease (CVD) risk factors (2.4 ±0.99 versus 2.06 ±1.06, p=0.02), longer pain to balloon time (PTB) (151.28 ±42.05 versus116.99 ±43.16 minutes, p<0.001), higher mean Killip class (1.49±0.73 versus 1.28±0.6, p=0.03), higher RDW (18.99±1.55 versus 14.03±1.52, p<0.001), and higher NLR (5.93±1.39 versus 4.08±0.93 p<0.001) compared to group B. Independent predictors of high thrombus burden were RDW (OR: 4.06, p<0.001), NLR (OR: 1.35, p= 0.04), number of CVD risk factors (OR: 1.62, p= 0.01), and PTB time (OR: 1.02, p<0.001). Cut-off values to predict high thrombus burden were 16% for RDW and 4.55 for NLR. Conclusions: Rapid identification of RDW more than 16% or NLR more than 4.55, could predict a high thrombus burden. [ABSTRACT FROM AUTHOR]

Introduction: Acute STEMI is the most serious presentation of CAD. Restoration of the coronary flow facilitates cardiomyocyte salvage and decreases cardiac morbidity and mortality. However, reperfusion may result in paradoxical cardiomyocyte dysfunction, a phenomenon termed reperfusion injury. Trimetazidine is a metabolic anti-ischemic drug which is beneficial in reducing periprocedural myocardial reperfusion injury. The aim of the work is to study the effect of trimetazidine on myocardial salvage index in patients with acute STEMI who underwent primary PCI. Methods: Forty patients presented with acute STEMI, underwent primary PCI with injection of an intravenous dose of Tc-99m labeled Sestamibi before primary PCI then first set of SPECT images were taken within 6 h from injection time to assess the initial size of the perfusion defect. Prior to discharge the patients received another dose of Tc-99m labeled Sestamibi and follow up SPECT images were taken to assess the final perfusion defect and to calculate myocardial salvage and myocardial salvage index. Twenty patients of them received trimetazidine before primary PCI (study group) and the other twenty patients did not receive trimetazidine (control group). Results: (1) Patients with acute STEMI undergoing primary PCI who received trimetazidine before primary PCI had better myocardial salvage index, however it was statistically non significant. (2) Statistically significant better myocardial salvage index with post procedural TIMI 3 flow than with post procedural TIMI 2 flow among patients who received trimetazidine before primary PCI. Conclusion: In the presence of post procedural TIMI3 flow trimetazidine is beneficial in improving myocardial salvage index in patients presented with acute STEMI who underwent primary PCI.

Background: No reflow is linked to worse prognosis post revascularization, so preventing no reflow is better than treating it. Objective: this study aims to evaluate the effect of adding high-dose allopurinol and atorvastatin in preventing NRP when given before undergoing primary PCI in patients presenting with STEMI. Patients and Methods: This study recruited 300 patients who were classified into 3 groups (100 each), Group A: patients were preloaded with high dose Allopurinol and Atorvastatin on top of the standard of care treatment according to the European society of cardiology guidelines. Group B: patients were preloaded with high dose Atorvastatin only on top of the standard of care treatment, Group C: were only preloaded with the standard care treatment according to the European society of cardiology guidelines, each group was subjected to the same pre procedural laboratory tests, primary percutaneous coronary intervention was done by the most experienced operator available according to the European society of cardiology guidelines. Results: Percentage of post procedural no reflow was significantly lower in patients who were preloaded with high dose Allopurinol and Atorvastatin compared to the other 2 groups (highest with group C) (Group A: 11%, Group B: 23%, Group C: 39%). Conclusion: preloading patients before primary percutaneous coronary intervention in patients presenting with ST elevation myocardial infarction with high dose Allopurinol and Atorvastatin significantly decreases incidence of post procedural no reflow. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) insidiously affects the myocardium with subsequent cardiomyopathy and induces microvascular damage in the kidneys reflected by albuminuria. We aimed to investigate the relationship between albuminuria and subclinical left ventricular (LV) systolic dysfunction in asymptomatic normotensive patients with T2DM assessed by two-dimensional speckle-tracking echocardiography. Materials and Methods and Results: Sixty normotensive patients with T2DM were included and subdivided into two subgroups, each including thirty patients according to the presence of albuminuria, together with thirty control subjects. All underwent echocardiographic examination, including LV regional and global longitudinal strain (GLS) measurements. Laboratory tests were withdrawn, including serum glycated hemoglobin (HbA1C) and albumin–creatinine ratio (ACR). When compared to the control group, patients with T2DM had a significantly lower average peak systolic LV GLS (−16.18% ± 2.78% vs. −18.13% ± 2.86%, P < 0.001), however, there was no significant difference in average peak systolic LV GLS between both diabetic subgroups (−15.57% ± 2.77% in the albuminuric subgroup vs. −16.79% ± 2.70% in the nonalbuminuric subgroup, P = 0.077). Moreover, there was a significant correlation between ACR and reduction of GLS in patients with T2DM and albuminuria (r = 0.55, P = 0.002). However, this correlation was absent in patients with T2DM without albuminuria (r = 0.107, P = 0.573). Conclusions: Patients with T2DM have subclinical LV systolic dysfunction with a reduction of average LV GLS that correlates with ACR in patients with T2DM and albuminuria. [ABSTRACT FROM AUTHOR]

Introduction: Duchenne muscular dystrophy (DMD) is considered the most common inherited neuromuscular disorder that shows an X-linked recessive pattern of inheritance. Cardiac manifestations are the most common causes of death in DMD patients.[1,2] Several studies discussed the effect of the genetic diagnosis on the progression of cardiomyopathy. There is a conflict regarding specific mutations as being either cardioprotective or being risk factor for development of cardiomyopathy. Methodology: In this study, 30 genetically diagnosed patients and 26 genetically diagnosed carriers were subjected to history taking, clinical examination, ECG and echocardiography. Results: DMD patients with exon 65 mutation appeared to have a better LV EF compared to patients who don’t have this mutation. Female carriers of DMD mutations located 3-6 had larger LV dimensions compared to patients who don’t have these mutations. Conclusion: There is still a conflict regarding relation between different exon mutations and cardiac affection. Exon 65 appeared to have a cardioprotective effect in DMD patients. Female carriers with mutations in exon 3-6 tended to have larger LV internal dimensions. [ABSTRACT FROM AUTHOR]