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The changes in the MVR can be used as a DSE parameter for expression of stenosis severity and to describe discrepancy in symptom status in patients with mild-to-moderate mitral stenosis.

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Background Skin acts as a mirror to the internal state of the body. Hypothesis We tried to find the relation between skin aging parameters and the incidence of degenerative AV block. Methods This study included 97 patients divided into 2 groups; group D comprised 49 patients with advanced‐degree AV block, and group C comprised the 48 matched control group. All were subjected to full history taking, thorough clinical examination, calculation of intrinsic skin aging score, and resting 12‐lead surface electrocardiography (ECG). ECG for all patients assessed left ventricular end‐systolic diameter, left ventricular end‐diastolic diameter, ejection fraction, left atrium (LA) diameter, aortic root diameter, mitral annular calcification, aortic sclerosis. Coronary angiography was also performed when indicated for patients in group D. Results Patients in group D had a higher percentages of uneven pigmentation, fine skin wrinkles, lax appearance, seborrheic keratosis, total score > 7 (38 [77.55%] vs 10 [20.83%]), mitral annular calcification score of 33 (67.34%) vs 5 (10.41%), aortic sclerosis score of 21 (42.85%) vs 4 (8.33%), and mean LA diameter of 39.98 ± 5.52 vs 36.21 ± 3 mm (P < 0.001). Total score > 6 is the best cutoff value to predict advanced‐degree heart block with 89.79% sensitivity and 64.58% specificity. Seborrheic keratosis was the strongest independent predictor. Conclusions Any population with a total intrinsic skin aging score of >6 is at high risk for developing advanced‐degree AV block and should undergo periodic ECG follow‐up for early detection of any conduction disturbance in the early asymptomatic stages to minimize sudden cardiac death.

Background It is important to diagnose right ventricular (RV) infarction in the setting of acute inferior myocardial infarction (MI). We aimed to improve the diagnostic accuracy of RV infarction and identify a high‐risk subset of inferior MI patients with proximal RCA lesions. Hypothesis We tried to find the link between speckle tracking and coronaries in high risk inferior infarction Methods This study included 68 patients within 24 hours of first acute inferior MI. Group 1 (n = 49) isolated inferior MI; group 2 (n = 19) inferior and RV MI. echocardiography for RV free wall longitudinal strain (FWLS), RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI) and peak systolic velocity (S′). Results Group 2 had higher MPI by tissue Doppler and 2D‐RV average FWLS, whereas RV FAC, S′, and TAPSE were lower (P < 0.001). In group 1, 14.4% had a significant proximal RCA lesion with impaired RV function. RV average FWLS at a cutoff value ≥ − 19.7% can predict proximal RCA culprit lesion with 91.7% sensitivity and 70.5% specificity, which was detected as an independent predictor in multivariate logistic regression (odds ratio: 37.75, P = 0.036). Conclusions 2D RV average FWLS at a cutoff of ≥ − 19.7% is a useful added tool for diagnosis of RV involvement and an independent predictor to rule in proximal RCA culprit lesion in inferior‐wall MI patients in the emergency department.

ObjectiveTo assess the relationship between serum endostatin (ES) and coronary artery calcification (CAC) in type 2 diabetic (T2DM) patients.MethodsThe study included 110 participants with coronary artery disease (CAD); 55 with T2DM, for serum ES levels by enzyme-linked immunosorbent assay and CAC by contrast-enhanced spiral computed tomography (CT).ResultsMean serum ES value was 66.54 ng/mL [95% confidence interval (CI), 61.77–71.32 ng/mL]. Serum ES levels positively correlated with Agatston score index [ASI; r = 0.701, p < 0.001; high sensitive C-reactive protein (hs-CRP) r = 0.783, p < 0.001]. On multiple regression analysis, the highest three ES quartiles (2, 3, and 4) were related to ASI in diabetic patients, adjusted ES level was an independent predictor of CAD [odds ratio (OR) = 1.065; 95% CI, 1.008–1.126; p = 0.026] and for the number of coronary vessels affected (OR = 1.089; 95% CI, 1.018–1.164; p = 0.013) in T2DM patients. Receiver operating characteristics (ROC) analysis showed serum ES at a cutoff value of 86.5 ng/mL can predict the risk of CAC in T2DM, with a sensitivity of 74.1%, specificity of 71.4%, p < 0.001 and area under curve (AUC) of 0.776.ConclusionMeasurement of serum ES levels can improve diagnosis of CAC and could be useful as a high sensitive marker for the presence and progression of atherosclerosis in T2DM patients.

Background The dramatic increase in the use of cardiovascular implantable electronic devices (CIED) was associated with an increased rate of CIED infection, which has a high management cost. Aim of the Study To test the safety and efficacy of a single‐session protocol, aiming to reuse the infected pocket side and the same device and leads in patients with CIED pocket infection. Patients and Methods We included patients with isolated pocket infection between January 2015 and November 2019. The Patient was prepared by taking a swab for culture and sensitivity before the procedure. The pocket was debrided and the capsule was removed, the pocket was rinsed with povidone‐iodine and hydrogen peroxide mixture, then packed with gauze sponge soaked with povidone‐iodine. The device was debrided using ultrasonic irrigation and sterilized using gas plasma. The device was reimplanted and the wound was closed in layers. Results During the period of the study, we had 12 patients with isolated pocket infection. Nine presented with erosion, two with impending erosion, and one with a chronic sinus. Patient's age was 61.5 ± 7.64 years. The infection was diagnosed 14.2 ± 8.22 weeks post device implantation. They were admitted for 7.6 ± 1.54 days postprocedure. The follow‐up duration was 26.5 ± 15 (1.7–52) months. Only one patient (8%) had a recurrence of the infection after 50 days of the procedure. Conclusion Our protocol was successful in treating 92% of device‐related pocket infection without the need to replace the device or the pocket side.

Background: Accurate diagnosis, characterization, and quantification of myocardial infarction (MI) are essential to assess the impact of therapy and to aid in predicting prognosis of patients with ischaemic heart disease.Objective: This study aimed to define different parameters regarding prediction of myocardial functional recovery following successful reperfusion of acute ST segment elevation myocardial infarction (STEMI). Patients and methods: This prospective study was carried out in Zagazig University and National Heart Institute (NHI) of Egypt during the period from June 2020 to June 2021. The study included 48 patients admitted with first acute STEMI. All patients were subjected to demographic data taking, electrocardiography and echocardiography examination (two examinations were done, the first was immediately after reperfusion and the second was 3 months from primary percutaneous coronary intervention (PCI). Results: There was no statistically significant difference between demographic data and risk factors except smoking habit. Regarding laboratory findings there were significant lower troponin value, peak CKMB value compared to patients had remolding (p=0.0001, p=0.027 respectively). Regarding ECG parameters, there was no statistical significant difference between the study groups regarding sum ST elevation and MI territory (p value > 0.05), but there was highly statistically significant difference between the study groups regarding 90 min ST resolution among contractile recovery (group I) p=0.0001. Conclusions: In this study patients affected by AMI with ST segment elevation and treated by primary PCI showed contractile recovery in 60.4% of the patients, while the remodeling of the LV has been observed in 39.6%.