Objectives: To investigate the clinical profiles and outcomes of young adults presenting with ST-segment elevation myocardial infarction (STEMI). Methods: We retrospectively reviewed King Saud Medical City, Riyadh, Saudi Arabia, registry between January 2016 and November 2017 for all patients younger than 45 years old who were admitted with STEMI. We compared this study population to a control group of patients aged 45 years and older who were enrolled in the same period. Results: In total, 402 patients were enrolled; 197 were younger than 45 years. The incidence of newly diagnosed dyslipidemia was higher in younger patients (44% vs. 32%, p =0.01). Smoking was significantly more prevalent in the younger group (52% vs. 35%, p =0.001). The prevalence of pulmonary edema and cardiogenic shock on presentation was significantly higher in the older group (3% vs. 10; odds ratio, 4.43; 95% confidence interval, 1.750-10.94; p =0.002). Hospital stay was also longer in the older group (4±2 vs. 5±2 days, p =0.03). Conclusion: ST-segment elevation myocardial infarction in young patients has a favorable outcome. Smoking and dyslipidemia are the main risk factors for STEMI in young individuals. The majority of young patients with dyslipidemia were not aware of their pre-existing condition. Our findings recommend local adaptation and implementation of screening programs for dyslipidemia in the young and the reinforcement of smoking prevention programs.

Objectives:To investigate the effect of Ramadan fasting on the symptoms of chronic heart failure with a reduced ejection fraction (HFrEF). Globally, more than one billion Muslims fast during Ramadan. Data regarding the effect of fasting in heart failure patients with a reduced ejection fraction are limited.Methods:We prospectively studied 249 outpatients with HFrEF who undertook Ramadan fasting at tertiary care cardiac center in Saudi Arabia in 2017. We obtained information regarding the clinical assessment, diagnosis, emergency department visits, and hospitalization during and in the month preceding Ramadan.Results:We enrolled 249 patients, 227 (91%) undertook the fast for the entire month. During Ramadan, 209 (92%) patients remained hemodynamically stable, whereas 18 (8%) developed instability. The mean New York Heart Association (NYHA) functional class was significantly lower in the stable than in the unstable group (1.46±0.7 vs. 3.22±0.55, p<0.0001), although no intergroup differences were observed before Ramadan. Patients from the unstable vs. the stable group showed significantly less adherence to medications (67% vs. 94%, p<0.0001) and to diet (39% vs. 79%, p<0.0001), and a lower likelihood of demonstrating ischemic cardiomyopathy as an underlying etiology of HFrEF (33% vs. 57%, p=0.046). Dependent t-test analysis including all patients showed that the NYHA classification before Ramadan was significantly higher than during Ramadan (2.19±0.9 vs. 1.6±0.8, t-value 8.5, p<0.0001).Conclusion:In most patients with chronic HFrEF, Ramadan fasting is considered safe. Non-adherence to medication and diet are significantly associated with decompensated heart failure during Ramadan.

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Objectives: To assess left ventricular (LV) dyssynchrony in patients with ST elevation myocardial infarction (STEMI). Background: Mechanical synchronization disorder leads to a decrease in LV ejection fraction (LVEF) and stroke volume, an abnormal distribution of wall tension, and increase in workload during cardiac contraction. Methods: We enrolled 56 participants, 36 with acute STEMI and 20 healthy controls. The automatically color-coded time to peak myocardial velocity was measured using a 6mm sample volume, manually positioned within the two-dimensional-tissue strain image of the 12 basal and middle LV segments. Results: A significant delay was found between the septal-lateral and septal-posterior walls in patients with STEMI compared to patients in the control group (36.36 vs. −6.0ms, P = 0.036; and 42.7 vs. 23.94ms, P = 0.042, respectively). Furthermore, all segment maximum differences and all segment standard deviation (SD; dyssynchrony index) were found to be significantly higher in the STEMI group (131.28 vs. 95.45ms, P = 0.013; and 44.47 vs. 26.45ms, P = 0.001, respectively). A significant delay between the septal-lateral walls and septal-posterior walls, all segment maximum difference, and all segment SD (dyssynchrony index) were found in patients with complicated STEMI (70.89 vs. 15.83ms, P = 0.038; 57.44 vs. 19.06ms, P = 0.040; 138.11 vs. 100.0ms, P = 0.035; and 45.44 vs. 32.50ms, P = 0.021, respectively). There was a significant negative correlation between tissue synchronization imaging parameters and LVEF, and a positive correlation with LV end systolic dimension. Conclusion: Patients with acute STEMI showed significant LV dyssynchrony, which was an independent predictor of inhospital complications.

Objective: The arteriovenous fistula (AVF) is the preferred access type for hemodialysis, owing to its better patency rates and fewer complications. This study aimed to evaluate the outcome of percutaneous transluminal angioplasty in a failing arteriovenous fistula and arteriovenous graft in hemodialysis patients. Methods: Clinical data of patients who underwent percutaneous transluminal angioplasty in the vascular department of Aseer Central Hospitals, KSA, from January 2017 to May 2018 and with follow-up of >12 months were analyzed in retrospective cohort study. Results: Angioplasties were performed in 55 patients with fistulae, of which 18 patients had venous hypertension on dialysis and the remaining patients had weak or poor flow. Conclusions: Percutaneous transluminal angioplasty is an efficacious method for the correction of stenosis of arteriovenous fistulae for patients on hemodialysis, prolonging the patency of the fistula and enabling new interventions. Highlights:

Background: Thoracic endovascular aortic repair (TEVAR) is superior to open techniques, as it is a minimally invasive procedure with low morbidity and mortality rates. The aortic isthmus is usually the rupture site in aortic thoracic injuries. Therefore, the distance from the left subclavian artery (LSA) usually allows proximal stent graft fixation. The main challenge is the intentional coverage of the LSA without revascularization, which is necessary to expand the proximal landing zone and to achieve an adequate seal. Acute arm ischemia, claudication, stroke, and/or left subclavian steal syndrome may occur during intentional occlusion of the LSA without revascularization when performing thoracic aorta lesion endovascular repair. The present study was conducted to analyze the safety of coverage of the LSA without revascularization during the endovascular treatment of traumatic thoracic aorta injuries. Methods: A retrospectively collected data set from two trauma centers in Saudi Arabia was reviewed between April 2007 and January 2018 to analyze the safety of LSA coverage during TEVAR performed for traumatic thoracic aorta transection. In this data set, 69 patients presented with descending thoracic aortic injuries. All were treated urgently with TEVAR with intentional LSA occlusion without revascularization during aortic injury endovascular repair. Those who underwent thoracotomy and pre-TEVAR patients who died were excluded from this study. Results: A total of 69 patients underwent intentional left subclavian artery (LSA) coverage without revascularization during the procedure; the primary technical success reached 94.2% for patients who underwent TEVAR for traumatic aortic transection. The clinical success rate was 98.6%. Only 1 of 69 patients with LSA coverage developed a localized ischemic stroke (1.4%). The 30-day mortality rate was 4.3% due to multiple organ failure. Conclusion: Revascularization of LSA is not mandatory with TEVAR for treating traumatic thoracic aortic injury with an inadequate proximal landing zone. Extending the landing zone to zone 2 and coverage of LSA is considered safe and non-time-consuming, especially in urgent situations. It provides better fixation and a good sealing zone. Highlights:

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Highlights The treatment paradigm for aortic dissection is complex and dependent on acuity of presentation with clinical and anatomical considerations. Endovascular treatment of supraceliac IAADs represents a feasible and safe. The long-term outcome data suggest that endovascular repair.