BACKGROUND:The expanding utilization of extraplaque (EP) strategies has led to increasing success rates in coronary chronic total occlusion (CTO) recanalization. The contemporary EP techniques have shown mid-term outcomes comparable to intraplaque (IP) recanalization approaches. Differential neointimal healing after CTO recanalization by various approaches remains to be identified. AIM:This study aimed to assess the vascular healing response across different CTO recanalization techniques using optical coherence tomography (OCT)-derived Neointimal Healing Score (NIHS). METHODS:This was a prospective, observational, analytic, single-center study recruiting 50 consecutive patients who underwent successful recanalization of 51 coronary CTOs. The recanalization technique (EP vs. IP) was according to the operator's discretion based on the CTO anatomical characteristics. The study aimed to compare the impact of the EP versus IP recanalization technique on the vascular healing assessed by OCT-derived NIHS (evaluating the presence of uncovered and/or malapposed stent struts and intraluminal filling defects), 6 months after the index procedure. RESULTS:The mean age was 58 ± 8 years, and 35 (70%) were males. EP and IP techniques were used in 15 and 36 of the recanalized CTOs, respectively. At 6 months, clinical and angiographic follow-ups were completed for all patients, while interpretable OCT imaging was available for 39 patients (77%). The mean NIHS for all patients was 14.3 ± 9.7. The NIHS was comparable between EP and IP techniques (18 ± 7.4 vs. 14.1 ± 8.4; p = 0.51). Target vessel failure (TVF) occurred in 23.5% of all patients with a numerically nonsignificant higher rate in the EP compared to the IP technique (27% vs. 22%; p = 0.73). CONCLUSION:CTO recanalization using EP techniques is associated with a nonsignificant numerical increase in NIHS without leading to a significant difference in TVF compared to IP techniques at mid-term follow-up.

Background The CHA 2 DS 2 -VASc score is an established tool for thromboembolic risk assessment in atrial fibrillation (AF). Individual components of the score may affect left atrial function. Speckle-tracking echocardiography (STE) enables detection of early, subtle changes in the left atrium. Aim This study aimed to test whether left atrial function, as assessed by speckle-tracking echocardiography, differs among patients with sinus rhythm according to their CHA 2 DS 2 -VASc score. Methods This study included 150 patients with sinus rhythm. They were grouped by CHA 2 DS 2 -VASc score: low (1 for females, 0 for males), moderate (2 for females, 1 for males), and high (≥ 3 for females, ≥ 2 for males), with 50 patients per group. All participants gave written consent, provided medical histories, underwent a 12-lead ECG, and received standard and STE echocardiography. Results The high-risk group had significantly lower left atrial strain during both the reservoir (33.2 ± 7.1) and conduit phases (20.3 ± 5.7) compared to the moderate-risk group (36.9 ± 6.1, 23.5 ± 4.8) and low-risk group (40.6 ± 5.6, 26.9 ± 3.9), with all p-values < 0.01. Moderate-risk patients also showed lower strain values than low-risk patients. In contrast, left atrial maximal volume index did not differ among the groups (p = 0.536). Conclusion Increased CHA 2 DS 2 -VASc scores correlated with reduced left atrial strain in reservoir and conduit phases, suggesting early atrial dysfunction prior to enlargement. Further research should assess the clinical relevance of these echocardiographic findings for risk stratification in patients with high CHA 2 DS 2 -VASc score.

Background ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) are at increased risk for contrast-induced nephropathy (CIN) than elective PCI procedures. Routine calculation of Mehran’s score is limited by its complexity and difficulty to memorize. This study evaluated CHA 2 DS 2 -VASc score predictive utility for CIN in STEMI patients before pPCI. Results Consecutive 500 acute STEMI patients presenting to two Egyptian pPCI centers were recruited. Exclusion criteria included cardiogenic shock or known severe renal impairment (baseline serum creatinine ≥ 3 mg/dL) or current or previous indication of hemodialysis. CHA 2 DS 2 VAS C score , Mehran’s score, baseline estimated glomerular filtration rate (eGFR), contrast media volume (CMV) and CMV/eGFR ratio were collected for all patients. Post-pPCI CIN (defined as 0.5 mg/dL absolute increase or 25% relative increase of serum creatinine from baseline) and predictive accuracy of CHA 2 DS 2 VAS C and Mehran’s scores were evaluated. CIN occurred in 35 (7%) of the study group. Values of CHA 2 DS 2 VAS C score , Mehran’s score, baseline eGFR, CMV and CMV/eGFR ratio were significantly higher in those who developed CIN compared to those who did not. CHA 2 DS 2 VAS C score , Mehran’s score and CMV/eGFR were found to be independent predictors for CIN ( P < 0.001 for all). ROC curve analysis revealed that CHA 2 DS 2 VAS C ≥ 4 had a superb predictive ability, comparable to Mehran’s score, for post-pPCI CIN. Conclusions Being practical, easily memorizable and applicable before proceeding to pPCI, routine CHA 2 DS 2 VAS C score calculation in STEMI patients can effectively predict CIN risk and guide preventive and/or therapeutic interventions.

Objective: Hypertension is considered the third leading killer over the world. Non-pharmacological therapy to prevent and to manage hypertension gained more popularity worldwide. Low frequency transcutaneous electrical nervous stimulation (TENS) was found to be beneficial in decreasing systolic and diastolic blood pressures. The aim of the study was to assess the effectiveness of TENS-based device in reducing blood pressure in hypertensive patients. Design and method: This was a prospective interventional paired study which examined the effect of low frequency TENS device (Inferum-050) on the 24-hour ambulatory blood pressure in a cohort of 50 patients with mild and moderate hypertension (based on the European Society of Cardiology definition). The device looks like a digital watch and in the baseline visit, patients were taught to use. They were told to wear the device on the ventral aspect of the distal left forearm. turn it on and just sit and relax as the device acts automatically. Patients were instructed to use the device for 6 minutes/session, twice daily, for 14 consecutive days at home. Office and Ambulatory blood pressures were evaluated at baseline and after 14 days of device use. Results: The mean age of patients was 51.8 ± 15.0 years and almost half were females (n = 26, 52%). Baseline office measurements showed that 28 patients (56%) had moderate hypertension. There were statistically significant reductions of office systolic (147.9 ± 14.4 vs 159.2 ± 8.6mmHg, p < 0.001), office diastolic (88.5 ± 8 vs 96.7 ± 6.6 mmHg, p < 0.001), 24-hours ambulatory systolic (147.7 ± 14.5 vs 158.4 ± 8.2mmHg, p < 0.001) and 24-hours ambulatory diastolic blood pressures (89.1 ± 8.1 vs 95.1 ± 7.1 mmHg, p < 0.001) in follow up as compared to baseline values. Nineteen patients (38%) complained of symptoms, mostly headache and fatigue, at baseline, and most of them (n = 15, 79%) reported improvement of these symptoms at follow up. Conclusions: Inferum ABP-050 device could be used as a non-pharmacologic adjuvant therapy to help further reduction of blood pressure in patients with mild and moderate hypertension. Most of the symptomatic patients reported improvement of their symptoms after device use. However, further studies and larger number of patients are needed to validate these results.

Background: Left ventricular (LV) dyfunction with preserved ejection fraction has been associated with increased mortality. Left atrium (LA) modulates LV filling and plays a role in maintaining cardiac function. Cardiovascular disease is a leading cause of death in rheumatoid arthritis (RA). Aim of the work: To study the left atrium modulating the left ventricular filling and to investigate its relation with disease activity to detect subclinical early cardiac affection in RA patients. Patients and methods: 45 RA patients and 30 control were studied. The disease activity score (DAS28) was calculated. Conventional and tissue Doppler imaging (TDI) and strain (S) and strain rate (SR) analysis by two-dimensional speckle tracking of LA were conducted. Results: The 45 female patients mean age was 38.8 +/- 8.7 years, disease duration was 7.3 +/- 6.2 years and mean DAS28 was 4.1 +/- 0.9. Regarding the LA emptying fractions, only the 2 LA passive emptying fraction (PEF) and total emptying fraction (TEF) were significantly lower in patients compared to control (p = 0.01 and p = 0.025 respectively). The LA expansion index (EI) was significantly reduced in patients compared to control (p = 0.009). Regarding TDI-derived mitral annular velocities, lateral e' and s as well as SRe (l/s) were significantly slower in patients compared to control (p = 0.001, p = 0.02 and p < 0.0001 respectively). Rheumatoid factor (RF) was significantly inversely related to TDI laterale, TDI laterals, and strain rate e, LA-PEF, LA-EI and LA-TEF. Conclusion: RA patients had alteration in LV longitudinal myocardial function and more LA stiffness. Cardiac affection is more in seropositive patients. (C) 2020 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V.

The correlation of P wave indices on surface ECG and phasic LA dysfunction in patients with significant primary mitral regurgitation (MR) due to the adverse LA adaptive structural and functional changes needs to be more studied. This study aims to investigate the diagnostic value of P wave indices to predict LA function assessed both by volumetric analysis using 3-dimensional (3D)echocardiography, and by strain analysis using speckle tracking echocardiography. (STE). The study included 107 subjects, we measured maximum P-duration (Pmax), P dispersion (PD), and V1 negative terminal force (V1-NTF) (negative duration x negative amplitude) on surface ECG. Both Basic and Dynamic LA volumes (LAV) during reservoir, conduit, and contractile phases were measured. The global LA strain and strain rate parameters were calculated By STE. LA ejection fraction (LAEF) and ejection force were also calculated.V1-NTF showed a significant positive correlation while P-max a significant negative correlation with global peak atrial longitudinal strain (GPALS) (r = 0.75; P < 0.001 and r = − 0.72; P < 0.001 respectively). Using ROC curve analysis, Pmax > 110 ms, 1-NTF ≥ 4 ms.mV and P notching > 40 ms had a sensitivity of 90%, 95% and 50% and a specificity of 87.4%, 94.3% and 100% respectively in predicting GPALS ≤ 30%. P notching > 40 ms was associated with severe LA dysfunction. ECG P wave indices represent a simple bedside tool that could have an incremental role in predicting LA dysfunction as well as size in patients with significant primary MR.

Abstract Introduction Smoking and obesity are recognized as important modifiable risk factors for coronary artery disease (CAD). However, the general perception that smoking protects against obesity is a common reason for starting, and/or not quitting smoking. Purpose To detect the quantity, quality and relative distribution of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) estimated by abdominal computed tomography in smokers versus non- smokers. Methods The abdominal muscular wall was traced manually to calculate SAT and VAT areas (cm2) (outside and inside abdominal muscular wall respectively) as well as SAT density [Hounsfield units (HU)] at L4-L5 in 409 consecutive patients referred for evaluation of chest pain by multi-slice computed tomography coronary angiography (MSCT-CA). Results 26% of the studied patients (n=107) were current smokers, while the remaining 74% (n=302) never smoked. Coronary artery atherosclerosis was more prevalent in smokers compared to non-smokers (64.5% vs 55.0%; p=0.09). Smokers had statistically significantly lower body mass index (BMI) (31.2±4.3 vs. 32.5±4.7 kg/m2; p=0.015), hip circumference (HC) (98.6±22.5 vs. 103.9±20.9 cm; p=0.031), total fat area (441.62±166.34 vs. 517.95±169.51cm2; p<0.001), and SAT area (313.07±125.54 vs. 390.93±143.28 cm2; p<0.001) as compared to non-smokers. However, smokers had statistically significantly greater waist-to-hip ratio (0.98±0.08 vs. 0.96±0.08; p=0.010), VAT/SAT area ratio (0.41±0.23 vs. 0.35±0.20; p=0.013), and denser SAT depot (−98.91±7.71 vs. −102.08±6.44 HU; p<0.001). Conclusion Smoking contributes to CAD and to the pathogenic redistribution of body fat towards VAT, through limiting SAT potential to expand. Funding Acknowledgement Type of funding source: None

Background Xanthelasma palpebrarum are yellow plaques that are found near the inner canthus of the eyelid. However, it is still controversial whether such lesions are marker for coronary artery disease.Aim The aim of the study was to investigate the association between xanthelasma and severity of coronary artery disease using coronary angiography.Settings and design A prospective, case–control study was conducted on 86 patients scheduled for coronary angiography to diagnose coronary artery disease. The study population included two groups. Groups A and B were formed of 43 patients each with and without xanthelasma, respectively.Patients and methods The day before diagnostic coronary angiography, all patients were subjected to full medical history taking; clinical examination; laboratory investigations, including lipoprotein (a) [Lp (a)], serum creatinine, and lipid profile; 12-lead electrocardiogram; and transthoracic echocardiography. A written informed consent was taken from all included patients, and approval of the CMREC (Cairo Medical Research Ethics Committee) was obtained.Results Waist circumferences were increased in patients with xanthelasma compared with those without. Low-density lipoprotein and Lp(a) levels were significantly increased in patients with xanthelasma. The severity of coronary artery disease was significantly increased in patients with xanthelasma.Conclusion Hypertension, diabetes, and dyslipidemia were common in patients with xanthelasma palpebrarum. The presence of xanthelasma and Lp(a) were independent predictors of coronary artery disease. The severity of coronary artery disease was significantly increased in patients with xanthelasma.

Introduction: Distribution of abdominal fat is more detrimental in the pathogenesis of coronary artery atherosclerosis (CAA) than its amount. Purpose: To detect the value of the amount of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and their distribution by abdominal computed tomography in the detection of CAA as assessed by multi-slice computed tomography coronary angiography (MSCT-CA). Methods: The abdominal muscular wall was traced manually to calculate SAT and VAT areas (cm²) (outside and inside abdominal muscular wall respectively) at L4-L5 in 63 consecutive patients with no risk factors for coronary artery disease (CAD) referred for evaluation of chest pain by MSCT-CA. Results: 40% of the studied patients (n=25) had CAA (Group 1), while the remaining 60%(n=38) had no CAA (Group 2). There was no statistically significant difference between both groups as regards weight, body mass index (BMI), waist circumference (WC), waist-to hip ratio (W/H ratio), VAT area, SAT area, and total fat area. Group 1 patients were predominantly males (53% vs 24%; p=0.023), with statistically significantly increased VAT/SAT area ratio (0.40 ± 0.23 vs 0.29 ± 0.16; p=0.028), and increased age (55.7 ± 7.9 vs 44.0 ± 11.1; p<0.001) as compared to Group 2 patients. Conclusion: VAT/SAT area ratio can be used in the detection of CAA in patients with no CAD risk factors.

Background: Cardiovascular disease is the most common, complication and principal cause of death in type 2 diabetes mellitus, (T2DM). Testing atherosclerotic burden using markers such as coronary, artery calcium score (CACS), and newer emerging techniques such as, pericardial fat volume (PFV) is needed. Methods: This prospective study was conducted on 1032 patients. Using, multidetector computed tomography (MDCT), we assessed CACS and PFV for, 402 patients with T2DM included in the study. Diabetic patients with, measured PFV (204 patients) were divided into 2 groups; patients with PFV >= 100 cm(3) and patients with PFV < 100 cm(3). The severity of coronary, artery disease (CAD) was quantified using the Gensini Score. Correlation, between CACS and PFV and severity of CAD was studied. Results: CACS, PFV and Gensini score were higher in diabetic patients. Linear correlation of CACS with Gensini score was significant whereas, linear correlation of PFV with Gensini score was not significant. Logistic regression analysis was applied; only the male gender and CACS, were the significant predictors for CAD. Conclusion: Quantification of CACS by MDCT is an effective method to, predict atherosclerotic CAD in type 2 DM. Quantification of PFV remains, uncertain for prediction of presence or severity of CAD.

Background: Closure of atrial septal defect (ASD) among adults under transthoracic echocardiography (TTE) guidance using devices other than the Amplatzer Septal Occluder has not been extensively tested. Aim of work: Assessment of the safety and efficiency of secundum ASD closure using the Occlutech Figulla ASD Occluder under TTE guidance in adult patients with hemodynamically significant secundum ASD. Methods: Twenty patients (mean age, 32.9 p 9.7, 75% of them females) were enrolled in the study. All patients underwent TTE and transoesophageal echocardiography (TEE) to assess the characteristics of the ASD prior to percutaneous closure. Procedures were performed using the Figulla Occluder device under both fluoroscopic and TTE guidance. Follow-up clinical and TTE examinations were done at 1, 3, and 6 months following the procedure. Results: TTE estimated mean ASD size was 21.7 p 7.3 mm with adequate rims except for the aortic rim (deficient in one third of cases). Mean device size was 28.1 p 8.6 mm with mean procedure and fluoroscopic times of 46.2 p 16.4 and 15.7 p 5.4 minutes respectively. ASD was successfully closed in all patients. Two patients showed a small residual shunt immediately after the device placement that disappeared by the end of the 2nd followup TTE examination. Transient complications were detected in 2 patients. All patients were asymptomatic during the follow-up period. Conclusion: Transcatheter closure of secundum ASD in adults under TTE guidance using the Occlutech Figulla ASD occluder device is safe and effective when performed in a tertiary center and by expert echocardiographers and interventional cardiologists. (C) 2017 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University.

Results:We used coronary MDCT scan to evaluate 120 patients of mean age 55.92±9.89.We found that total serum cholesterol, LDL-C, non-HDL and serum triglycerides were significantly higher in the subgroup having non-calcified plaques than those with calcified ones.These lipid parameters were significantly higher in patients with significant stenosis (higher SIS, SSS, ABOS and modified Gensini Scores) than those with non-significant stenosis.Total serum cholesterol, LDL-C, non-HDL and serum triglycerides were significantly positively correlated with calcium score and the extent of atherosclerosis, while HDL was significantly negatively correlated with calcium score and the extent of atherosclerosis.Conclusion: This is the first study using MDCT to find the relation between lipogogram parameters and the plaque criteria.Total cholesterol, LDL-C, non-HDL and triglycerides are positively correlated with the extent of plaque, calcium score and the significance of the stenosis in patients with low to intermediate propability of CAD.

Background Percutaneous transcatheter closure of atrial septal defect (ASD) among children using devices other than the Amplatzer septal occluder has not been extensively tested. Objectives We evaluated the efficiency and safety of secundum ASD closure using the Occlutech Figulla ASD occluder in children and the efficiency and safety of secundum ASD closure under transthoracic echocardiography (TTE) guidance in children with less than 12 kg body weight. Patients and methods Forty-two patients (19 girls and 23 boys; mean age 4.8±2.0 years) were enrolled in a prospective cohort study. All patients underwent TTE and transesophageal echocardiography (TEE) to assess the characteristics of the ASD before transcatheter closure. Procedures were performed under fluoroscopic and TTE or TEE guidance. Follow-up was done at 1, 3, and 6 months following the procedure by clinical and TTE examination. Results The mean defect size was 14.9±4.2 mm on TTE and 16.1±4.7 mm on TEE. The mean device size was 17.9±4.9 mm (range 10.5–27 mm). The mean procedure time was 59.6±19.5 min. Thirty-one cases were performed under general anesthesia and TEE guidance, whereas the other 11 cases were performed under general anesthesia and TTE guidance. The device was placed successfully in all 42 patients. A small residual flow was seen immediately after device placement in three (7.1%) patients, which disappeared at 6 months. No complications occurred during the procedure. All patients were asymptomatic during the follow-up period. Conclusion Transcatheter closure of secundum ASD is generally safe and efficient in children younger than 12 years old, and ASD closure under TTE guidance in children less than 12 kg body weight is considered safe and efficient when performed in a tertiary center in the presence of an expert echocardiographer and interventional cardiologist.

Background: The effect of type 1 diabetes mellitus (T1DM) on myocardial function is still controversial.\Aim: To examine the usefulness of speckle tracking echocardiography (STE) in detecting subclinical left ventricular (LV) dysfunction in asymptomatic T1DM patients and detect whether any LV abnormalities are related to duration or control of DM.Methods: Sixty young T1DM patients and 30 controls were subjected to conventional echocardiography and STE. The left ventricular (LV) peak systolic (PS) global longitudinal strain (GLS)/strain rate (GLSR) and diastolic global strain rate during the isovolumic relaxation period (GSRivr), early diastole (GSRe) and late diastole (GSRa) were calculated as the average of the 12 myocardial segments of the four and two- chamber views while the mid circumferential strain (MCS) was calculated as the average of strains of the 6 LV segments of the mid LV cavity.Results: In diabetic patients, the LV end diastolic dimension (LVEDD) was significantly lower (p = 0.000) while the LV myocardial performance index (LVMPI) and E/lateral E' ratio were significantly higher (p = 0.000 and p = 0.02 respectively) compared to controls. By STE, only the GLS was significantly lower in diabetic patients compared to controls (p = 0.000). A significant negative correlation was detected between LDL-C and GLS (r = -0.4; p =0.002). Multivariate logistic regression analysis identified HbA1c as the only independent predictor of GLS in patients (beta = -0.34, 95% CI: -0.67 to -0.19; p =0.001).Conclusion: STE is useful to detect subclinical LV dysfunction in asymptomatic patients with T1DM. Control of DM but not duration of disease was an independent predictor of LV systolic dysfunction. (C) 2016 Egyptian Society of Cardiology. Production and hosting by Elsevier B.This is an open access article under the CC BY-NC-ND.

Background: Myocardial deformation assessed by two dimensional speckle tracking echocardiography (2D-STE) allows accurate evaluation of regional and global left ventricular (LV) function and is sensitive to detect abnormalities induced by ischemia.Aim: To examine the value of LV strain (S) and strain rate (SR) assessed by STE to detect the presence, and extent of coronary artery affection in patients with suspected stable coronary artery disease (SCAD).Methods: 81 patients with suspected SCAD and normal resting echocardiography were subjected to 2DSTE and coronary angiography. The peak systolic (PS) global longitudinal strain (GLS)/strain rate (GLSR) and PS global radial strain (GRS)/strain rate (GRSR) were calculated as the average of S/SR of the 18 LV segments of the 3 apical views. The PS mid circumferential strain (MCS)/strain rate (MCSR) was calculated as the average of S/SR of the 6 LV segments of the mid LV cavity short axis view.Results: 20 patients (24.7%) represented the normal coronaries group (NCG), and 27 patients (33.3%) with one/two vessel-CAD represented the low risk group (LRG) while 34 patients (42%) with three vessel/left main-CAD represented the high risk group (HRG). GLS, GLSR, GRS, GRSR, MCS and MCSR were significantly lower in patients with significant CAD compared to NCG (all p = 0.000). GLS, GLSR, GRSR, MCS and MCSR were significantly lower in HRG compared to LRG (p = 0.030, p = 0.009, p = 0.000, p = 0.000, and p = 0.004 respectively).Conclusion: Myocardial deformation analysis by STE is not only useful to diagnose CAD, but also predicts the extent of CAD affection in patients with suspected SCAD. (C) 2016 The Authors. Production and hosting by Elsevier B.V.

Endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) are mobilized from the bone marrow and increase in the early phase after ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the prognostic significance of CECs and indices of endothelial dysfunction in patients with STEMI. In 78 patients with acute STEMI, characterization of CD34+/VEGFR2+CECs, and indices of endothelial damage/dysfunction such as brachial artery flow mediated dilatation (FMD) were determined. Blood samples for CECs assessment and quantification were obtained within 24 hours of admission and FMD was assessed during the index hospitalization. At 30 days follow up, the primary composite end point of major adverse cardiac events (MACE) consisting of all-cause mortality, recurrent nonfatal MI, or heart failure and the secondary endpoint of early adverse left ventricular (LV) remodeling were analyzed. The 17 patients (22%) who developed MACE had significantly higher CEC level (P = 0.004), von Willebrand factor (vWF) level (P = 0.028), and significantly lower FMD (P = 0.006) compared to the remaining patients. Logistic regression analysis showed that CECs level and LV ejection fraction were independent predictors of MACE. The areas under the receiver operating characteristic curves (ROC) for CEC level, FMD, and the logistic model with both markers were 0.73, 0.75, and 0.82, respectively, for prediction of the MACE. The 16 patients who developed the secondary endpoint had significantly higher CEC level compared to remaining patients (P = 0.038). In conclusion, increased circulating endothelial cells and endothelial dysfunction predicted the occurrence of major adverse cardiac events and adverse cardiac remodeling in patients with STEMI.

Background: Systemic lupus erythematosus is an autoimmune disease associated with reduced number and impaired function of endothelial progenitor cells (EPCs) responsible for vascular regeneration.Aim of the work: to assess left ventricular (LV) function of SLE patients using relatively new speckle tracking echocardiography (STE) and examine the relation of any detected abnormalities with peripheral circulating EPC level.Patients and methods: Fifty SLE patients and 25 healthy controls were subjected to quantification of peripheral circulating Cluster of differentiation 133(+)/vascular endothelial growth factor receptor2(+)(CD133(+)/VEGFR2(+)) and CD34(+)/VEGFR2(+) EPCs, transthoracic echocardiography (TTE), tissue Doppler imaging (TDI) and STE.Results: Patients showed a significantly lower CD133(+)/VEGFR2(+) EPCs (p=0.009) and CD34 +/VEGFR2 + EPC counts (p=0.0001) compared to controls. TTE/TDI revealed a significantly lower LV ejection fraction (EF) (p=0.007), higher LV end systolic dimensions (p=0.02), myocardial performance index (MPI) (p=0.0001) and mitral flow E/lateral annulus E0 ratio (p=0.002) in patients compared to controls. STE showed a significantly lower global longitudinal strain (GLS) (p<0.001), global circumferential strain (GCS) (p<0.001) and global strain rate during isovolumic relaxation period (GSRivr) (p=0.01) in patients compared to controls. By multiple logistic regression analysis, the independent variables affecting GCS and GSRivr were the prednisolone dose and the LVEF respectively. (95% CI=-0.46 to -0.03; p=0.03 and 95% CI=0.001-0.01; p=0.021; respectively). There was no significant correlation of the GLS, GCS or GSRivr with the EPCs.Conclusion: STE detected subclinical systolic and diastolic abnormalities of LV function in SLE patients. These abnormalities of LV function did not show however any relation with the significantly lower EPC count detected in patients. (C) 2015 The Authors. Production and hosting by Elsevier B. V. on behalf of Egyptian Society of Rheumatic Diseases. This is an open access article under the CC BY-NC-ND license.

Background: Several studies showed that ST-segment elevation myocardial infarction (STEMI) patients with high body mass index (BMI) have better in-hospital outcomes. Aim: This study examined the impact of waist circumference (WC) on the hospital outcome and coronary angiographic extent of STEMI patients.Methods: We evaluated 142 consecutive patients with STEMI. Patients were classified into 2 groups according to WC. Group A (n= 72) had increased WC (WC > 88/102 cm for women/men). Group B (n= 70) had normal WC. A primary composite outcome of in-hospital mortality and cardiovascular complications namely heart failure, cardiogenic shock, serious arrhythmias, re-infarction, post infarction angina, a secondary outcome of in-hospital mortality and coronary angiographic findings were compared between the 2 groups.Results: Group A patients were significantly older, had a significantly higher prevalence of hypertension (HTN), diabetes mellitus (DM) and were significantly less likely to be smokers compared to group B. There was no statistically significant difference in the primary outcome between the 2 groups. WC as a categorical or as a continuous variable did not have any significant influence on the secondary outcome of in-hospital mortality even after adjustment for other predictors of death. Age was the only statistically significant predictor for mortality (p= 0.01). Coronary angiography revealed no statistically significant difference in the number of diseased coronary vessels, number of coronary lesions or Gensini score between the 2 groups.Conclusion: A high WC, had no favorable impact on in-hospital mortality, cardiovascular complications or coronary angiographic extent in STEMI patients. (C) 2014 Production and hosting by Elsevier B. V.