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Background: Most of cardiovascular (CV) events in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) are linked to the progression of non-culprit coronary lesions (NCCLs) during the follow-up period. Yet, the clinical and angiographic risk factors of non-culprit coronary lesion (NCCL) progression are not well known. Objectives: To assess the clinical risk profile and angiographic features that can be related to the progression of non-culprit lesions (NCLs) of patients with STEMI undergoing PCI over 24 months duration.Subjects and methods: The present cohort study evaluated 200 patients with STEMI underwent PCI to the culprit lesion and have mild non culprit lesion (NCL) 1.4mmol/L) (OR:54.656, 95% CI: 4.052 to 737.256; p= 0.003), Complex culprit lesion(OR:296.112, 95% CI: 13.673 to 6412.728; p < 0.001), and presence of more than one NCL (OR:22.447, 95% CI: 2.521 to 199.849; p= 0.005). Conclusion: The underlying clinical and angiographic characteristics can predict NCLs progression. Complex morphology of culprit lesion is the strongest independent predictor for progression of NCLs.

Background: Echocardiography can provide comprehensive information concerning thromboembolic risk in patients with atrial fibrillation (AF). Global LA strain associated with a higher prevalence of left atrial stasis and is superior to conventional parameters of LA analysis as thromboembolic risk stratification of AF. The aim of this work is to demonstrate the importance of global LA Strain as predictor of stroke risk in patients with AF after PCI.Patients and methods: This work included 63 consecutive coronary artery disease patients who were admitted for elective PCI (42 with permanent AF as case group & 21 with sinus rhythm as control group). All patients were evaluated by history, examination, 2D and Doppler echocardiography and 2D-speckle tracking echocardiography (2D-STE). Patients with permanent AF only were evaluated by CHA2DS2-VASc Risk Score calculation, INR & TEE to detect echocardiographic features of high stroke risk.Results: The results showed that the global LA strain was highly statistically significantly lower in patients in case group than patients in control group (16.01±7.43 vs. 33.25±11.21, P< 0.001). 9 patients had abnormalities on TEE. The global LA strain was highly statistically significantly lower in patients with high risk features of stroke than patients without these features (6.8 ± 1.1 vs. 18.2 ± 6.5, P

Background We thought that the early diastolic driving force (DF) can offer a clinically reliable method to determine left ventricular end diastolic pressure (LVEDP). Material and methods One hundred patients were scheduled for estimation of LVEDP by left-sided heart catheterization (LVEDPcath) and Echocardiography, via estimation of the mitral E wave velocity and its deceleration time (DT), to calculate the DF=density×volume×acceleration=1.055×(mitral valve area×velocity time integral)×peak E/acceleration time (AT) =1.055×{(220/P1/2)×(E×AT)/2}×E/AT, if P1/2=0.29 DT, and hence DF=400 E 2 /DT=0.004 E 2 /DT Newton. Tissue Doppler estimation of the mitral annular E′ for the E/E′ ratio and septal (E/E′-S) and lateral (E/E′-L) was done. Results DF had a negative correlation ( r =−0.63, P r =0.87 and 0.85 respectively, P 16. E/E′-L is more sensitive and more specific than E/E′-S (72.9% and 93.3% vs. 58.8% and 86.7%) in prediction of LVEDPcath. DF is the almost powerful independent predictor of LVEDPcath ( P =0.002). DF had a coefficient=0.619 ( P Conclusion Early diastolic DF could be used as a reliable index for elevated LVEDP, especially in the gray zone.

Echocardiographic predictors of redo-percutaneous balloon mitral valvuloplasty (redo-PBMV) have not been well studied, and indications are based mainly on Wilkins score. The study aim was to evaluate the immediate results of redo-PMBV and to introduce a simplified redo-score to predict the success of redo-PBMV.Two cohorts of symptomatic patients (derivation group, n = 218; validation group, n = 100) who had undergone redo-PBMV at a mean of 8.1 ± 2.9 years after a first successful PBMV were enrolled in the study. The mean Wilkins scores were 8.5 ± 1.7 in the derivation group and 8.4 ± 1.8 in the validation group. PBMV was performed using a multi-track technique. Independent echocardiographic predictors of outcome were assigned a points value: mitral valve area ≤1.0 cm2 (2 points), posterior mitral valve leaflet length (PMVL)/anterior mitral valve leaflet length (AMVL) ratio ≤1/2 (2 points), doming distance ≤12 mm (3 points), mitral annular calcification (mild = 1 point; moderate = 2 points; severe = 3 points), commissural status (no fusion = 0 points; uni-fusion = 2 points; bi-fusion = 3 points) and chordal length ≤10 mm (2 points).The minimum score was 5 and the maximum was 13. A receiver operating curve analysis showed the redo score to be highly significant in predicting redo-PBMV immediate results. The cut-off value of redo score to predict a favorable outcome was ≤8, with a sensitivity of 96% and specificity of 85% in the derivation cohort, and a sensitivity of 95% and specificity of 83% in the validation cohort. A Wilkins score ≤8 had a sensitivity of 71% and a specificity of 59% in the derivation cohort, while sensitivity was 70% and specificity 62% in the validation cohort.The described scoring system was significantly more predictive than the Wilkins score, and was particularly valuable in predicting outcome in patients with a prior PBMV. It may serve as a satisfactory scoring system for correctly selecting patients with mitral restenosis for PBMV.

The aim of the study was to assess the left ventricular (LV) synchronicity in pregnant women and to identify the main determinants of LV dyssynchrony in asymptomatic pregnant women.One hundred sixty-seven pregnant women consecutively and 48 age-matched nonpregnant controls were enrolled. For the assessment of LV systolic dyssynchrony, the standard deviation of the time from QRS onset to peak systolic (Tps-LV- standard deviation [SD]) velocity and the maximal difference of the time from QRS onset to peak systolic velocity (Tps-LV) from 12 segments at the apical views. For the LV diastolic dyssynchrony, the standard deviation of the time from QRS onset to peak diastolic (Tpe-LV-SD) velocity and the maximal difference of the time from QRS onset to peak diastolic velocity (Tpe-LV) were calculated.Both systolic and diastolic dyssynchrony indexes were significantly higher in pregnant women than in the normal controls (Tps-LV; P.01, Tps-LV-SD; P.03, Tpe-LV, P.05 and Tpe-LV-SD; P.02). A total of 28 (16.8%) of the pregnant women had a dyssynchrony index above the accepted value for LV dyssynchrony (34.4 msec). There was a significant correlation between LV dyssynchrony indexes with, multiparty, multifetal pregnancies, systolic blood pressure in pregnant women with LV dyssynchrony. Additionally LV dyssynchrony was significantly associated with elevated E/e" and brain natriuretic peptide (BNP).Both systolic synchronicity and diastolic synchronicity were affected in pregnant women compared to nonpregnant women. LV dyssynchrony was significantly correlated with age, multiparity, and BNP level. Early detectable changes in systolic and diastolic synchrony may be present in pregnant women at higher risk of peripartum cardiomyopathy.

Background: We aimed to assess the relation of fractional pulse pressure (PPf) to aortic stiffness index and their impact on coronary flow reserve (CFR) and left ventricular diastolic function in asymptomatic diabetic patients. Methods: One hundred and thirty five consecutive asymptomatic diabetic patients (aged 48.8 ± ± 7.84 years), were included. CFR was calculated noninvasively using transthoracic echo-Doppler assessment with hyperemia induced by infusion of dipyridamole at a rate of 0.56 mg/kg over 4 min. PPf was calculated as pulse pressure divided by mean arterial pressure (SBP – DBP/ /MAP), while diastolic function was evaluated by means of transmitral flow and tissue Doppler imaging. Aortic stiffness indices (ASI) were measured as previously described. Results: Diabetic patients with low CFR (n = 52) compared with those with normal CFR (n = 83) exhibited significantly increased PPf (75.2 ± 11.4 vs. 64.5 ± 6.7, p < 0.001). PPf was significantly correlated with ASI (r = 0.520, p < 0.001), E/Em ratio (r = 0.425, p < 0.001) and left atrial volume index (r = 0.462, p < 0.001). CFR was negatively correlated with both PPf (r = –0.68, p < 0.0001). After applying multivariate linear regression analysis, after correction for cardiovascular risk factors, importantly, PPf and ASI remained significant predictors of CFR (p < 0.0001 and p < 0.001, respectively). Conclusions: PPf was significantly correlated to ASI in asymptomatic diabetic patients. Likewise, increased PPf was associated with impaired CFR and subclinical diastolic dysfunction in diabetic patients. PPf could be utilized as a simple non-invasive predictor of occult atherosclerosis and diastolic dysfunction in diabetic patients. (Cardiol J 2013; 20, 6: 605–611)

Background and Aim: In patients with stable coronary artery disease aortic rigidity may contribute to exercise intolerance and impaired left ventricular (LV) function after coronary intervention. However, this relationship has not yet been investigated. We aimed to assess the impact of aortic stiffness on both exercise tolerance and left ventricular diastolic filling pressure after percutaneous coronary intervention (PCI). Methods: A percutaneous coronary intervention and stenting was performed in 98 consecutive patients with stable coronary artery disease (CAD) and positive exercise ECG. Before and after PCI, echocardiographic study, exercise stress test and aortic stiffness indices were calculated. Results: Aortic stiffness index was significantly higher in patients with CAD (19.5 ± 4.9vs 5.6 ± 2.1; P

Background There is a suggestion that increased aortic stiffness can be the early manifestations of the atherosclerosis process and is related to decrease coronary flow after coronary stenting. We aimed to evaluate whether aortic stiffness could predict occurrence of in-stent restenosis (ISR) and its relation to coronary flow reserve (CFR) after coronary artery stenting. Methods and Results The study population included 126 patients with single vessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) with bare-metal stenting and at least 12 months of follow-up. All patients underwent noninvasive aortic stiffness index (ASI) assessment before stenting and coronary flow assessment 1 month after stenting. Clinical ISR was observed in 29 (23%) patients, whereas 97 patients remained free of signs or symptoms of recurrent ischemia. ASI was significantly higher in patients with coronary artery disease versus control subjects, and it is significantly increased in patients with restenosis versus those without restenosis (P

Background: We aimed to create a novel modified score by combining anatomic and hemodynamic Doppler-echocardiographic measures for selection of suitable patients with mitral stenosis for percutaneous balloon mitral valvuloplasty (PBMV) and its impact in prediction of outcome. Methods: 262 consecutive patients candidate for PBMV were enrolled. Wilkins score and a global score based on anatomical parameters (Wilkins score, posterior to anterior mitral leaflet ratio [PMVL/AMVL ratio]; left atrial diameter [LAD]) and hemodynamic parameters (mitral regurgitation [MR]; atrioventricular compliance [CN]; systolic pulmonary artery pressure [SPAP]) were assessed. Patients were classified into two groups according to their outcomes. Results: Global Echo-Doppler Score (GEDS) for patients with favorable vs. those with unfavorable outcomes was (5.0 ± 0.9 vs. 8.9 ± 1.3; p < 0.001). Sensitivity, specificity, and accuracy of a GEDS ≥ 7 for prediction of cardiac events were 97.5%, 88%, and 97.5%, respectively. The area under the receiver operating characteristic curve was 0.95 (p < 0.001). The correlation coefficient was 0.852 (p < 0.0001) for GEDS 0.531 (p < 0.002), for Wilkins score 0.315 (p < 0.02), for PMVL/AMVL 0.460 (p < 0.01), for LAD; MR: Pre-PBMV (r = 0.348, p < 0.03); CN [mL/mm Hg] (r = 0.579, p < 0.01) and SPAP [mm Hg] (r = 0.499, p < 0.01). In the regression analysis, GEDS, Wilkins score, and LAD were entered into the model. The regression coefficient (r = 0.695) of GEDS was much higher than those of the other 2 factors. Conclusions: GEDS is an independent predictor of PBMV success and clinical outcome and may be formulated in a scoring system that would help to identify the proper timing and best candidates for PBMV.