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Blood cysts are rarely found during an echocardiogram in adults. They are benign lesions most often seen on the cardiac valves, mainly on the atrial side of the anterior mitral leaflet (AML). They occasionally cause symptoms and complications. Here, we report a patient with non-ST-elevation myocardial infarction, who on echocardiogram was found to have an AML mass suggestive of mitral valve blood cyst; the cyst was seen on the ventricular aspect of the AML. [ABSTRACT FROM AUTHOR]

Background: The Program for the Evaluation and Management of Cardiac Events in the Middle East and North Africa (PEACE MENA) is a prospective registry program in Arabian countries that involves in patients with acute myocardial infarction (AMI) or acute heart failure (AHF). Methods: This prospective, multi-center, multi-country study is the first report of the baseline characteristics and outcomes of inpatients with AMI who were enrolled during the first 14-month recruitment phase. We report the clinical characteristics, socioeconomic, educational levels, and management, in-hospital, one month and one-year outcomes. Results: Between April 2019 and June 2020, 1377 patients with AMI were enrolled (79.1% males) from 16 Arabian countries. The mean age (± SD) was 58 ± 12 years. Almost half of the population had a net income < $500/month, and 40% had limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia; 53% had STEMI, and almost half (49.7%) underwent a primary percutaneous intervention (PCI) (lowest 4.5% and highest 100%). Thrombolytics were used by 36.2%. (Lowest 6.45% and highest (90.9%). No reperfusion occurred in 13.8% of patients (lowest was 0% and highest 72.7%).Primary PCI was performed less frequently in the lower income group vs. high income group (26.3% vs. 54.7%; P<0.001). Recurrent ischemia occurred more frequently in the low-income group (10.9% vs. 7%; P = 0.018). Re-admission occurred in 9% at 1 month and 30% at 1 year, whereas 1-month mortality was 0.7% and 1-year mortality 4.7%. Conclusion: In the MENA region, patients with AMI present at a young age and have a high burden of cardiac risk factors. Most of the patients in the registry have a low income and low educational status. There is heterogeneity among key performance indicators of AMI management among various Arabian countries. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a prevalent condition in our society, frequently accompanied by various interacting comorbidities. Among these, brain-related comorbidities such as stroke and transient ischemic attack (TIA) play a crucial role in exacerbating the severity of HF. The relationship between cerebrovascular accidents (CVAs) and HF across different left ventricular ejection fraction (LVEF) levels is not well understood. Objectives: This study aims to assess the impact of CVA including stroke and TIA on mortality and morbidity in patients with acute heart failure (AHF) stratified by LVEF. Methods: We conducted an analysis of consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in a multinational registry of patients with HF. The study population consisted of patients with CVA and AHF, categorized into three groups based on EF: HF patients with preserved EF (HFpEF) (250%), HF patients with reduced EF (HFrEF) (<40%), and HF patients with mid-range EF (HFmrEF) (40%-49%). Univariate and multivariate statistical techniques were employed for the analysis. Results: Our study involved 370 patients, averaging 66.4 ± 13.2 years. In-hospital mortality for CVA and AHF patients was 8.4% (n = 31). Patients in different ranges of LVEF experienced comparable rates of hospitalization and mortality at both the 3-month and 12-month intervals. Left atrial enlargement (odd ratio [OR]: 3.27, 95% confidence interval [CI]: 1.33-9.32, P = 0.015) and noninvasive ventilation (OR: 6.17, 95% CI: 2.71-14.07, P < 0.001) were associated with a higher mortality rate while discharging on digoxin (OR: 0.14, 95% CI: 0.02-0.52, P = 0.011) was linked to lower mortality. The sole distinction among HF groups was observed in 12-month survival, with HFpEF patients having a superior survival rate of 91.7% compared to HFIEF patients at 77.5% and HFmrEF at 77.8% during this perio Conclusions: This study found significant differences in all-cause mortality at 12 months. Further research is warranted to better understand the mechanisms underlying these associations. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, mitral valve (MV) repair has become the procedure of choice for treating isolated mitral regurgitation (MR). The aim of this study was to evaluate immediate and long-term clinical and echocardiographic results of MV repair performed at a tertiary hospital in Oman. Materials and Methods: The study population consisted of patients with severe MR above 18years of age who had isolated MV repair between 2006 and 2016 at Royal Hospital, Oman. Retrospective observational study. Primary Endpoints: 1-year freedom from reoperation, recurrence of severe MR and mortality. Secondary Endpoints: Five-year echocardiographic recurrence of severe MR, ejection fraction (EF), NYHA class and mortality. Results: The case records of 351 patients with MR who had MV surgery in Royal Hospital were reviewed. A total of 89 patients had isolated MV repair surgery with follow up 1 year. The etiology of mitral disease was degenerative in 58.42%, rheumatic in 20.22%, post endocarditis in 12.35%, congenital 5.61% and ischemic MR in 3.37%. Operative mortality was 2.24% (2/89). Pre-operative NHYA class III/IV was noted in 62.92% of patients (56/89). All the patients had an EF of > 60%. Among the 87 patients followed up for one-year, 95.40 % (83/87) of patients were free from reoperation. Four patients (4.59%) had recurrence of severe MR needing MV replacement surgery. Of the 87 patients, 56 patients were followed in our institute for 5 years had demonstrated trivial to mild MR in 73.2% (41/56) moderate MR in 16.07% (9/56), and severe MR in 10.07% (6/56) of patients though 83.92% (47/56) patients were in NYHA class I. Majority of grade 3 (10.71%) and 4 MR (8.92%) occurred in patients with rheumatic etiology who underwent MV repair. Ejection fraction remained > 60% in 89.28% patients. There was no mortality at 5 years among the 56 patients followed-up. Conclusions: MV repair in a tertiary center in Oman showed favorable early and one-year results as regards mortality, freedom from reoperation and recurrence of significant MR. Those followedup at five years, majority of patients were asymptomatic though echocardiographic recurrence of moderate and severe MR was high predominantly in patients with rheumatic etiology. [ABSTRACT FROM AUTHOR]

Background: Clinical characteristics and outcomes in patients with type 2 diabetes mellitus (T2DM) and acute heart failure (AHF) patients with idiopathic cardiomyopathy are not well known. Objective: The objective of our study is to determine all-cause mortality in patients with idiopathic cardiomyopathy presenting with AHF. Methods: We analyzed the data from 509 consecutive patients with idiopathic cardiomyopathy presenting with AHF to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) between February and November 2012. All patients were stratified according to T2DM. The analyses were performed using the univariate and multivariate statistical techniques. Results: The mean age of the cohort was 52.0 ± 14.8 years. Of the 509 patients, 123 (24.2%) had T2DM and had a higher incidence of major stroke than the nondiabetic group (11.4% vs. 2.8%; P = 0.001). Diabetic patients were also more likely to be associated with hypertension than those without diabetes mellitus (78.9% vs. 21.8%; P < 0.001). Multivariate logistic regression demonstrated that those with cardiogenic shock (adjusted odds ratio [aOR], 59.3; 95% confidence interval [CI]: 20.1-207; P = 0.001) and noninvasive ventilation (NIV) (aOR: 4.19; 95% CI: 1.33-13.1; P = 0.013) were associated with higher odds of all-cause in-hospital mortality. However, age (aOR: 1.00; 95% CI: 0.96-1.03; P = 0.792), T2DM status (aOR: 0.43; 95% CI: 0.10-1.51; P = 0.207), and atrial fibrillation (aOR: 3.95; 95% CI: 0.82-17.2; P = 0.07) were not associated with higher odds of all-cause inhospital mortality. Conclusions: In AHF patients with idiopathic cardiomyopathy, T2DM was not associated with higher odds of all-cause inhospital mortality. Patients on NIV and cardiogenic shock were demonstrated as the independent predictors of increased inhospital mortality. [ABSTRACT FROM AUTHOR]

It is known that a dynamic left ventricular outflow tract (LVOT) obstruction exists in patients, following aortic valve replacement (AVR) and is usually considered to be benign. We present a patient with dynamic LVOT obstruction following AVR, who developed refractory cardiogenic shock and expired inspite of various treatment strategies. This phenomenon must be diagnosed early and should be considered as a serious and potentially fatal complication following AVR. The possible mechanisms and treatment options are reviewed.