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Abstract We investigated the impact of trimetazidine treatment on left ventricular (LV) functions and cardiac biomarkers in diabetic patients with diastolic dysfunction as an early stage of diabetic cardiomyopathy. Sixty-three patients were randomly assigned to receive either trimetazidine or a placebo for 3 months. At baseline and after 3-months of treatment, measurements of serum levels of glycemic control parameters, lipid profile, tumor necrosis factor alpha, transforming growth factor beta 1, n-terminal pro brain natriuretic peptide and assessment of modified Medical Research Council (mMRC) dyspnea score, echocardiographic indices of LV functions and LV global longitudinal strain (GLS) were performed. After 3-months, trimetazidine group exhibited a significant reduction in left atrial volume index by 6.99% versus an increase by 0.66% in placebo group, p = 0.034. Moreover, average e’ increased by a significantly higher percentage in trimetazidine versus placebo group (8.46 ± 18.64 vs. -2.49 ± 14.52, respectively. p = 0.015). Trimetazidine treatment resulted in a significant increase in LVGLS by 6.66% versus LVGLS reduction by 2.79% in placebo group (p = 0.004). Trimetazidine group had a significantly lower median mMRC dyspnea score compared to placebo (0 vs. 1, respectively, p = 0.015) and a significantly lower low-density lipoprotein (LDL-C) (103.43 ± 28.31 vs. 125.34 ± 45.27, respectively, p = 0.032). There was no significant difference between both groups in levels of other biomarkers. Three-months treatment with trimetazidine improved diastolic function parameters, LVGLS, dyspnea severity and LDL-C levels in diabetic patients with diastolic dysfunction.

Background: Vascular access for hemodialysis (HD) with an inappropriately high flow may underlie the onset of high output heart failure (HOHF).The aim of this study was to determine the prevalence of high flow access (HFA) in chronic HD patients, and to determine its effects on cardiac functions. Methods: This cross sectional study was conducted on 100 chronic hemodialysis patients through arteriovenous fistula (AVF). The study cohort was subdivided into 2 groups based on AVF flow: Group A (Non-HFA group with Qa

Background: The main focus of most of the studies in heart failure (HF) is the assessment of the left ventricular functions, while the right ventricle was much less studied. Much of this neglect is due to the complexity of anatomy and physiology of the right ventricle which are considered challenges during assessment of RV. Objective: [1] To review the alterations of right ventricular dimensions & function associated with chronic heart failure. [2] To predict the prevalence of right ventricular systolic dysfunction in patients with chronic heart failure, based on echocardiographic parameters. Methods: 100 chronic left sided heart failure patients with LVEF less than 40% were evaluated in Ain Shams University hospitals from April 2015 to March 2016. All patients were subjected to full history taking & clinical evaluation. ECG was done mainly to exclude presence of ischemic heart disease. Complete trans-thoracic echocardiography study was done for assessment of [B] Left ventricular dimensions, systolic and diastolic functions [B] Assessment of the right side of the heart: [1] Measurement of the right ventricular dimensions [basal – mid cavity and the longitudinal diameters]. [2] Right ventricular area and calculation of the fractional area change (FAC). [3] Tricuspid annular plane systolic excursion (TAPSE). [4] Tissue Doppler derived tricuspid lateral annular systolic velocity (S′ wave velocity). [5] Tissue Doppler derived Myocardial Performance Index (MPI) (Tei index). [6] Grading of tricuspid regurgitation severity, and assessment of right ventricular systolic pressure. Results: Right ventricle was dilated at the basal level in 36% of the studied patients & at the mid cavity level in 23% of the patients. Longitudinal RV diameter was enlarged in 20% of the patients.Right ventricular systolic dysfunction was found in 36% of patients with DCM in the current study. Patients who had right ventricular systolic dysfunction had significantly higher incidence of elevated JVP, significantly lower EF and significantly higher grade of LV Diastolic dysfunction. They showed significantly larger RV dimensions at different levels, significantly worse degree of TR and significantly higher mean value of RVSP. Conclusions: The occurrence of right ventricular systolic dysfunction in patients with DCM is common [Approaching 40% in this study] and is independent of age and sex, and is proportionate to the degree of LV dilatation, and EF impairment. Keywords: RV, Heart failure, Fractional Area Change (RVFAC), TAPSE, Tissue Doppler derived tricuspid lateral annular systolic velocity (S′ wave velocity), MPI index right ventricular dimensions

Background: A substantial fraction of patients with non ST-elevation acute coronary syndrome have an occluded culprit vessel on coronary angiography. Acute coronary occlusion often results in myocardial infarction and loss of systolic function. Identification of these patients may have considerable impact on treatment and prognosis. Aim: The study aims at investigating role of 2D speckle tracking echocardiography as a non-invasive predictor of acute coronary artery occlusion in patients with non ST-segment elevation myocardial infarction. Patients: This study was carried on 60 patients with first attack non ST segment elevation myocardial infarction who were admitted to coronary care unit of Ain Shams University Hospitals. All patients underwent thorough history taking, full clinical examination, 12 leads surface ECG, full 2D, M-mode and Doppler echocardiographic study, two-dimensional speckle tracking strain study and coronary angiography. Results: 2D derived peak global longitudinal strain had a highly significant relationship in prediction of the presence of total occlusion, and also number of segments with reduced strain (functional risk area by strain) had a highly significant relationship in prediction of the presence of total occlusion. In this study, 2D derived peak longitudinal strain sensitivity and specificity were 68.9% and 77.7% respectively at a cutoff value of −15.5 while number of segments with reduced longitudinal strain sensitivity and specificity were 63.6% and 77.7% respectively at a cutoff value of 5 segments. Conclusion: Both global and regional peak longitudinal systolic strain can offer accurate, feasible, and non-invasive predictor for acute coronary artery occlusion in patients with non ST elevation myocardial infarction who may benefit from early revascularization.

Aim: This study aims at using peak lateral tricuspid annular systolic velocity (ST) and right ventricular myocardial performance index (RV-MPI) as predictors of RV infarction (RVI) and subsequently localizing the culprit lesion in the proximal right coronary (RCA) rather than other locations [the distal RCA or dominant left circumflex (LCX) artery]. Patients: 30 patients suffering from acute inferior infarction, were subjected to early conventional and pulsed wave tissue Doppler echocardiographic examinations, measuring (ST) and calculating RV-MPI. Half of the patients had the culprit lesion proximal to the RV branch of the RCA and the other half had non-proximal RCA occlusion. Results: ST values were significantly reduced in patients with RVI. Cutoff value of ST was found to be 11.9 cm/s with a sensitivity 80.0%, specificity 93.3%, positive predictive value 92.3% and negative predictive value 82.4% in the identification of proximal RCA lesion as the culprit lesion. The calculated RV-MPI was significantly different; its mean value was 0.666 ± 0.118 in the proximal RCA vs. 0.524 ± 0.133 in the non-proximal RCA patients. RV-MPI cutoff value proved to be 0.50 with sensitivity 80%, specificity 66.7%, negative predictive value 76.9% and positive predictive value 70.6%. Conclusion: RVI caused by a proximal RCA lesion could be predicted using TDI to assess ST and RV-MPI from the tricuspid annulus. Patients with ST

Background: CAD is a significant cause of mortality and morbidity, Noninvasive imaging techniques are crucial in the diagnosis and risk stratification of patients with suspected stable angina pectoris. However, invasive coronary angiography remains the gold standard for CAD diagnosis. To enhance patient selection for this procedure, myocardial deformation imaging using strain echocardiography provides a simple and noninvasive method to evaluate LV deformation during myocardial ischemia. Strain echocardiography improves the identification of patients who would benefit from invasive coronary angiography. Objective: To correlate between severity of coronary artery disease using Gensini score and 2D speckle-tracking derived LV global longitudinal strain. Patients and Methods: The study included 100 patients with symptoms of chronic stable angina. History taking, cardiac examination, full transthoracic echocardiographic study including assessment of left ventricular global longitudinal strain (GLS) using 2D speckle tracking echocardiography and coronary angiography were done for all patients. Results: The study concluded that a GLS value of -15% was the optimal cut-off for predicting the presence of significant coronary artery lesions, with a sensitivity of 55.81% and specificity of 82.46%. Correlation analysis revealed a positive correlation between GLS and the Gensini score, indicating that as the Gensini score increased (indicating more severe coronary artery disease), the GLS became less negative. Conclusion: GLS has significant correlation with Gensini score and aids in detection of significant CAD in patients with chronic stable angina. Myocardial strain by 2-D speckle tracking echocardiography together with Gensini score assessment correlates with the angiographic severity evaluated by coronary angiography in patients with stable angina with good sensitivity and specificity thus facilitating prediction of presence of significant CAD. Accordingly, this promises to be an efficient, non-invasive diagnostic tool that may facilitate early intervention for patients with CAD and application of preventive or treatment measures for patients with chronic coronary syndrome. [ABSTRACT FROM AUTHOR]

Background: Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders. CAE is one of the known risk factors for acute coronary syndrome, its incidence ranges from 1.5%-5% of patients undergoing coronary angiography, with predominance in males. Coronary artery ectasia (CAE) is defined as dilatation of an arterial segment to a diameter at least 1.5 times that of an adjacent normal artery and involves at least one third of the affected artery (1)(1). The exact pathogenesis of CAE is not well established; however, Coronary atherosclerosis is detected in more than 50% of the patients. Objective: To evaluate global left ventricle longitudinal strain by 2D speckle tracking echocardiography in patients with coronary artery ectasia and without significant (>50%) coronary artery stenosis. Patients and Methods: This study carried on sixty patients referred to cath lab of Ain Shams university hospital for elective coronary angiography during period between January 2018 and Augest 2019. The patients were divided in to two groups (Group A) included thirty patients with ectasia in one or more of the coronary arteries without any significant coronary artery stenosis and (Group B) included thirty patients with normal coronary angiographic findings serving as control group. Results: The present study showed a statistically significant decrease in EF comparing CAE group to control group .As regards other echocardiography parameters, there was a highly significant difference of LVEDD, LVEDD index, LVESD,, LVESD index, LV mass, LV mass index, LA volume and LA volume index between the two groups. Global peak longitudinal strain showed highly significant difference between two groups as its mean value was significantly lower in the CAE group. Conclusion: In our study, we have concluded that global peak longitudinal strain was significantly impaired in patients with coronary artery ectasia without significant coronary artery lesion denoting subclinical LV systolic dysfunction .LV diastolic dysfunction was more prevalent in coronary artery ectasia patients compared to control subjects. [ABSTRACT FROM AUTHOR]

Background: Chronic Heart Failure (CHF) patients have marked functional limitations causing a significant impact on Health Related Quality of Life (HRQoL) in these patients. Iron Defeciency is very common in Heart Failure patients & it is suggested that it affects HRQoL in CHF patients regardless of the Anemia status . Objective: To evaluate the impact of iron deficiency (ID) on health-related quality of life (HRQoL) in chronic heart failure (CHF) patients using Minnesota Living with Heart Failure questionnaire (MLHFQ) in patients with normal hemoglobin levels . Methods: From October 2018 to August 2019,100 patients with CHF from out- patient clinics in ASU university hospitals were subjected to history taking, examination, Echocardiography, measurement of Iron status using serum ferritin, Assessment of Health Related Quality of Life (HRQoL) using Minnesota Living with Heart Failure Questionnaire (MLHFQ) . Patients then were divided into 2 equal groups depending on their serum ferritin level & comparison of MLHFQ score between the 2 groups was done . Results: The study population was divided into 2 groups: Iron Defecient (ID) (n = 50) & non Iron Defecient (non ID) (n = 50), 61 patients were males & 39 were females. The MLHFQ scores were 66.9 ± 9.1 among ID patients vs 46.9 ± 7.3 in non ID patients (p value < 0.001) indicating worse HRQoL in ID group . The physical domain (p value < 0.001) was markedly affected than the emotional domain (p value 0.006) of the MLHFQ score . Conclusion: In CHF patients, HRQoL was markedly affected among ID patients than non ID patients with physical factors more affected than the emotional factors . [ABSTRACT FROM AUTHOR]