Clinical and experimental observations have long suggested that elevated levels of estrogen associate with increased serum iron availability. Additionally, recent work has shown that estrogen can downregulate hepcidin synthesis in vitro. This study aims at assessing whether the ability of estrogen to downregulate hepcidin synthesis translates into changes in serum iron status. Hepcidin synthesis was evaluated in MCF-7, Hep-G2 and SKOV-3 cells treated with increasing concentrations of estrogen and cultured for up to 24 h post treatment. The correlation between levels of serum estrogen, hepcidin and iron was assessed using serum samples collected from 153 premenopausal women at random and samples collected from 6 women at days 1, 5, 10, 16, 21 and 28 of the monthly cycle. Estrogen-treated MCF-7 cells showed a significant reduction in hepcidin synthesis, especially at 20 nM/24 h E2 treatment. Hepcidin synthesis was also significantly reduced in Hep-G2 and SKOV-3 cells at 20 nM/24 h E2 treatment. In serum samples collected at random, estrogen (P=0.022; R=-0.213) and iron (P=0.028; R=-0.316) correlated negatively with hepcidin and positively with each other (P=0.033; R=0.319). An overall similar pattern was also observed in monthly cycle-timed samples. These findings suggest that elevated levels of estrogen reduce hepcidin synthesis as means of enhancing serum iron content in menstruating women.

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BackgroundContrast-induced nephropathy (CIN) is the acute deterioration of renal function after parenteral administration of radio contrast media in the absence of other causes. The true incidence of CIN varies because of differences among the published studies in the definition of CIN, the proportion of high-risk patients, the types of contrast media, and the use of preventive measures. Remote ischemic preconditioning (IPC) may offer a non-pharmacological prevention strategy for lowering CIN in patients undergoing coronary procedures. The assumption that IPC produces protective effects on tissues or organs by multiple brief cycles of ischemia and reperfusion applied to another remote tissue or organ.AimTo investigate the effect of ischemic preconditioning in prevention of CIN in patients with renal impairment undergoing percutaneous coronary angiography.ResultsIn this study, 100 patients undergoing elective PCI with a base line creatinine clearance <60 ml/min were studied. Patients were divided into two equal groups (ischemic preconditioning group and control group). The incidence of CIN was markedly lower in ischemic preconditioning group 14% VS 38% in control group. The incidence of CIN difference as was found to be (24%). Amount of dye used, decreased LVEF and presence of a significant LAD lesion were significant risk factors for occurrence of CIN.ConclusionsThe current study showed that remote ischemic preconditioning plays an important role in prevention of CIN in patients undergoing PCI with renal impairment GFR < 60 ml/min. The amount of contrast, decreased LVEF, and presence of LAD significant lesion were significant risk factors for developing of CIN and these subgroups benefited from application of ischemic preconditioning.

Background: Diabetes is a chronic disease that is responsible for a high rate of morbidity and mortality which can be attributed to atherosclerosis and cardiovascular disease. Diabetes is heralded by prediabetes which not only indicates a higher risk of developing diabetes but also increases the burden of cardiovascular disease. The objective was to observe the effect of prediabetes on the severity of coronary artery disease in patients undergoing elective coronary angiography. Seven hundred and thirty-one patients were admitted for elective coronary angiography and/or PCI starting from September 2017 to August 2018. Patients were divided into group A (normoglycemic group, N = 228), group B (prediabetes group, N = 177), and group C (diabetic group, N = 326). Coronary artery disease (CAD) severity including number of vessels affected and atherosclerotic burden by Gensini score were compared among different groups. Results: The number of vessels affected as well as left main (LM) disease was higher in the prediabetes group when compared to the normoglycemic group (P,=0.001, P = 0.009, respectively) and was comparable to the diabetes group (P = 0.4, P = 0.6, respectively). Prediabetes showed a Gensini score higher than the normoglycemic group (P = 0.0001) with no significant difference when compared to the diabetic group (P = 0.9). Conclusion: Prediabetes is associated with high atherosclerotic burden and coronary artery disease complexity that is similar to diabetic than normoglycemic individuals.

BackgroundRight ventricular involvement in ST segment elevation myocardial infarction (STEMI) entails an increased morbidity and mortality. However, very scarce data is present on its affection in the setting of non-ST segment elevation myocardial infarction (NSTEMI).AimTo assess the affection of right ventricular function in patients presenting with NSTEMI undergoing an invasive procedure.Subjects and methodsOne hundred and fifty patients admitted with a first NSTEMI and eligible for reperfusion therapy via invasive percutaneous coronary intervention. These patients were divided in two groups; group A including patients with normal RV function, and group B including patients with impaired RV function as diagnosed by tricuspid annular plane systolic excursion (TAPSE) cutoff value < 17 mm. All patients underwent angioplasty and were followed up in-hospital and for 3 months.ResultsRV dysfunction occurred in ninety-five (61.3%) patients of the study population. Significant improvement occurred to TAPSE after 3 months in comparison to TAPSE at baseline (15.45 ± 3.21 versus 17.09 ± 4.17 mm). Those with impaired RV function showed improvement of TAPSE after three months as compared to baseline (13.62 ± 2.58 vs 17.16 ± 3.64 p = 0.008). Multivariate analysis determined the independent predictors of RV dysfunction as RVEDD > 26 mm, RVFAC < 35%, RAA > 20 cm2, and TAPSE < 17 mm.ConclusionRV dysfunction is not uncommon in NSTEMI when using the definition of TAPSE < 17 mm. Following up RV function by TAPSE, showed significant improvement after 3 months with successful PCI as compared to baseline. We recommend assessing and following up RV function in all patients admitted with a NSTEMI.

BackgroundNo-reflow is an important factor as it predicts a poor outcome in patients undergoing primary angioplasty. In comparison with patients attaining TIMI 3 flow, patients with no-reflow have an increased incidence of ventricular arrhythmias, early congestive cardiac failure, cardiac rupture and cardiac death. As such, it is of paramount importance to consider strategies to prevent the occurrence of no-reflow phenomenon. Previous evidence suggests that Beta (β) blockers have multiple favorable effects on the vascular system not directly related to their effect on blood pressure. However, there are insufficient data regarding the effects of prior Beta blocker use on coronary blood flow after primary PCI in patients with AMI.AimThe aim of this study was to test the hypothesis that Beta blocker treatment before admission would have beneficial effects on the development of the no-reflow phenomenon after acute myocardial infarction.Methods and resultsThe study included 107 diabetic patients who had presented with acute STEMI within 12 h from the onset of chest pain. All of them have undergone primary angioplasty at Ain Shams University hospitals or National Heart institute. The incidence of no-reflow phenomenon was 21%. No-reflow phenomenon was significantly lower in patients on chronic B-blocker therapy (12% vs. 28%; P = 0.04). The heart rate was significantly lower in the normal reflow group than in the no-reflow group (P = 0.03). The study also showed that B-blocker pretreatment is an independent protective predictor for the no-reflow phenomenon (P = 0.045).ConclusionChronic pre-treatment with B-blocker in diabetic patients presenting with STEMI, is associated with lower rate of occurrence of no-reflow phenomenon after primary PCI.

Background The current expert view of the PCSK9 inhibitors’ use in Egypt is still ambiguous. Main body Hyperlipidemia is an important, if not the most important, risk factor for the occurrence of atherosclerosis worldwide. Egypt is the most populous country in the Middle East and North Africa and has > 15% of the cardiovascular deaths in the region. The burden of dyslipidemia as seen in the recently published CardioRisk project conducted throughout Egypt shows a high prevalence of dyslipidemia as a risk factor that is still reaching up to 71% in female participants. Reaching the targets for LDL lowering, and thus control of hyperlipidemia, is quite often very difficult especially with the update of the last ESC guidelines. With the advent of PCSK9 inhibitors, the control rate of patients, reduction of cardiac major adverse events, and mortality have been improved. However, Egypt is not considered a rich country on the grounds of annual income, and this raises a concern on which patients would benefit from these expensive medications. Revising the randomized control trials, we analyzed the data that would enable us to control LDL in those patients, at risk, to obtain simple clear indications for the use of these rather expensive medications. Conclusion We recommend the use of PCSK9 inhibitors in addition to statins ± ezetimibe in patients with ASCVD, by definition at very high risk; patients with ASCVD at very high risk who do not tolerate appropriate doses of at least three statins; and familial hypercholesterolaemia patients with clinically diagnosed ASCVD, at very high cardiovascular risk.

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