It is frequent to see pulmonary hypertension (PH) in patients with mitral stenosis (MS) secondary to increased pulmonary vascular resistance (PVR), data about the effect of PVR on the results of percutaneous balloon mitral valvotomy (PBMV) are insufficient. To detect the role of PVR in predicting residual PH immediately after PBMV. This prospective study comprised 49 consecutive patients with moderate to severe MS who were investigated pre and within 48 h post a successful PBMV for the first time. Echocardiography was used to assess the mitral valve area (MVA), mean transmitral pressure gradient (MPG), mitral valve resistance (MVR), right ventricular systolic pressure (RVSP) and PVR. Patients were classified into two groups according to the pre PVR (≥ 1.6 WU as group I and < 1.6 as group II). At baseline compared to group II (32 patients), Group I (17 patients) had higher MPG (13.6 ± 5.2 vs. 11.7 ± 3.7 mmHg, P < 0.05), RVSP (45.6 vs. 37.9 mmHg, P < 0.001) and PVR (2.2 ± 0.1 vs. 1.2 ± 0.1WU, P < 0.001) with no significant difference regarding age, gender, MVS, MVA and MVR. Patients of group I had comparatively lower improvement immediate post procedural of RVSP and PVR with no significant difference in immediate post procedural improvement in NYHA classification, MVA, MPG and MVR. Basal PVR > 1.8WU was proved to be a highly specific (91%), a good predictor (AUC 0.78) of persistent elevation of RVSP > 50 mmHg post PMV. Pathological rise of PVR that associates MS had provided a strong and an independent predictor of persistent pulmonary hypertension post PBMV and by this aspect it could be used as a valuable tool as MVA and MPG to send patients earlier for PBMV even with less severe MS. PVR > 1.81 WU could be used as a noninvasive parameter for predicting regression of PH immediately after PBMV.

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.

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.

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: The aim of this study is to point out timing of left atrium and its appendage functional recovery after cardioversion (CV) in recent onset atrial fibrillation (AF 30 and 90 days post CV in groups I and II, respectively. IACT1 and IACT2 correlated with LA diameter (r = 0.2778 and r = 0.227, respectively, p < 0.01 LA and LA appendage. (Cardiol J 2015; 22, 6: 699-707)

Background and aim:Interferon-based therapy is associated with significant side effects, including the cardiac complications; these may affect the patients' adherence to therapy and consequently the response rate. The aim of this study was to detect the types and predictors of interferon induced cardiac complications in the Egyptian hepatitis C virus infected patients treated with pegylated interferon/ribavirin combination therapy. Patients and Methods: A total of 194, chronic HCV patients were followed up from the time of receiving treatment till 6 months after the end of treatment, to detect cardiac disorders and to determine the response status. Patients were assessed by through history taking, full clinical examination, full laboratory parameters and cardiac assessment using the standard 12 lead ECG and Transthoracic Doppler Echocardiography. Patients in the final analysis were divided into: Group A (who developed cardiac disorders) and group B (who did not develop cardiac disorders). Results:The baseline clinical features (cardiovascular risk factors and hemodynamics) were comparable in both groups. Patients who developed cardiac disorders had higher baseline ALT level, hepatic fibrosis and histologic activity in the liver biopsy than patients without cardiac disorders (P<0.05). The confirmed cardiac complications represented 18% (n=35) and included left ventricular systolic and diastolic dysfunction, pericardial effusion, arrhythmia and myocardial ischemia. Histological activity in the liver biopsy, ejection fraction (EF) and left ventricular end diastolic dimension (LVEDD) were independent predictors for cardiovascular complications. Conclusion: Pegylated interferon therapy of chronic HCV is associated with many types of cardiac complications, predictors of which were histological activity in the liver biopsy, EF and LVEDD.

fQRS is a good, simple, applicable positive test to predict the presence of significant CAD in acute coronary syndrome (ACS), even without enzyme elevation.

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