ObjectivesDisease activity has been considered as independent cardiovascular risk factor in rheumatoid arthritis (RA) patients. We aimed to evaluate the effect of RA disease activity on left ventricular (LV) and right ventricular (RV) functions by speckle tracking echocardiography (STE).Methods120 patients with RA without evidence of cardiovascular disease and 40 healthy control subjects were included. Disease activity was evaluated according to Simplified Disease Activity Index (SDAI) score and Disease Activity Score 28 (DAS28). LV and RV functions were assessed using conventional echocardiography and global longitudinal strain (GLS) technique measured by STE.Results81 patients had active disease while 39 patients were in remission. The LV and RV GLS value for active RA patients was reduced compared to RA patients in remission and control group (p = <0.001). There was a significant correlation between RA disease activity scores level and LV GLS value, increasing levels of disease activity was associated with worse LV GLS (r = −0.802, p value = <0.001) and r = −0.824, p value = <0.001) for SDAI and DAS28 scores respectively. Also, there were significant correlations between RA disease activity scores level and RV GLS value as the disease activity level increases the RV GLS value become worse (r = −0.682, p value = <0.001) and r = −0.731, p value = <0.001) for SDAI and DAS28 scores respectively Receiver operating characteristic (ROC) curve analysis showed that SDAI score and DAS28 were predictive for reduced LV GLS with a cut off value of >7 and >2.8 respectively with sensitivity of 77.6%, specificity of 85.0% and area under ROC curve = 90.4 for SDAI score and with sensitivity of 89.7%, specificity of 71.7% and area under ROC curve = 89.4 for DAS28 score. Also, SDAI score and DAS28 were predictive for reduced RV GLS with a cut off value of >11 and >3 respectively with sensitivity of 73.1%, specificity of 93.5% and area under ROC curve = 91.6 for SDAI score and with sensitivity of 84.6%, specificity of 80.4% and area under ROC curve = 90.8 for DAS28 score.ConclusionDisease activity in patients with rheumatoid arthritis is associated with lower left and right ventricular function. Disease activity scores can predict subclinical left and right ventricular dysfunction.
Background: The CHA2Ds2-VASC was was revealed to be a predictor for thromboembolism event in patients who do not have atrial fibrillation or who have supra ventricular arrhythmia. The aim of this work was to evaluate the role of CHA2DS2 – VASC score in prediction of coronary artery disease. Methods: This cross sectional observational study included 150 patients underwent coronary angiography for diagnosis and treatment of CAD. There were 59 patients with ACS (including STEMI and Non-STEMI) and 91 patients with no ACS. All patients were subjected to complete history taking, clinical, general examination and local cardiac examination. Standard 12-lead ECG was obtained within 10 minutes of first medical contact (FMC) according to ESC guidelines. Baseline laboratory tests were done including serum creatinine, INR, hemoglobin, platelets, cholesterol and triglycerides. Arterial coronary angiography (Femoral approach), right and left coronary imaging and echocardiographs were performed. Results: The incidence of HTN, CHF, DM and Vascular disease was statistically significantly higher in the cases with ACS as compared with the cases with no ACS. The total mean Gensini score was significantly higher in the cases with ACS as compared with the cases with no ACS. There was a statistically significantly strong positive correlation between CHA2DS2‐VASc Score and Gensini score. The best cut-off point of CHA2DS2‐VASc Score to differentiate between cases with ACS and no ACS WAS > 2 with 79.7% sensitivity and 56% specificity. With univariate regression analysis, increasing age, CHF, DM, previous stroke, vascular disease and increasing CHADS-VASC score were reported as risk factors for vessel affection, however with multivariate regression analysis CHF, DM and increasing CHADS-VASC score were shown as independent risk factors of vessel affection Conclusions: CHA2DS2-VASc score could be utilized as a useful diagnostic and predictor tool in cases with CAD. Patients with higher CHA2DS2-VASc scores had higher risks of cardiovascular disease severity.
Background: Left ventricular dysfunction is the single strongest predictor of mortality and one of the most frequent and deadly complication following coronary artery diseases. Aim: This work aims to study and explore the left ventricle ejection fraction improvement after revascularization with percutaneous coronary intervention (PCI) and the predictive factors for left ventricle ejection fraction improvement. Methods: One hundred patients with ischemic (HFrEF) who had complete revascularization with percutaneous coronary intervention (PCI), had survived at least 90 days and had undergone echocardiography review. The study duration was 1 year from April 2019 to May 2020. Result: We focused on a group of the common possible predictive factors affecting left ventricular improvement. Gender (male), CKD, DM, number of affected vessel(single vessel disease), CTO lesion, heart rate, ECG findings, presence of anginal pain, presence of dyspnea , usage of medications ( ACEI and Clopidogrel),hyper urecemia and the time between presentation of complaints and PCI were correlated with improvement of left ventricular function after revascularization by PCI. Conclusion: Time between appearance of symptoms and PCI was found to be independent predictor of LV EF improvement after revascularization. Other predictors were Male gender, DM, CKD, normal ECG finding ,absence of hyper urecemia, slower heart rate ,presence of chest pain and dyspnea , absence of CTO lesion , single vessel affection and administration of ACEI and Clopidogrel.
Background: Ischemic heart disease is considered the most common cause of death, worldwide. It accounts for 1.8 million deaths annually in Europe alone. According to the center for disease control (CDC) it’s the most common cause of deaths in Egypt accounting for more than one fifth of the total death count per year (21%), followed by stroke, then cancer. Aim: This work aimed to study and assess the efficacy of a pharmacoinvasive strategy compared with a primary PCI strategy on the left ventricle function in treatment of patient with myocardial infarction. Methods: Our study was prospective non randomized which compares between two groups, both of which had first time acute STEMI admitted to our Tanta University Hospital within the accepted time, which are (group 1) patients who had primary PCI for the infract related artery as a reperfusion therapy and (group 2) patients who had thrombolytic followed by coronary angiography with a window to PCI (pharmacoinvasive technique). Coronary angiography was performed either immediately in case of failed thrombolytic therapy or within 3-24 hrs. Following thrombolytic in case of successful thrombolytic. Both groups presented to the hospital within the accepted time window for reperfusion therapy either (thrombolytic or primary PCI), within 12 hrs. Results: The study compared between the two groups in the acute stage during hospitalization of the patients and after discharge according to Clinical outcomes: (mortality, major adverse cardiac events (MACE) as heart failure symptoms, re-infarction and Cardiac death),angiographic findings (base line TIMI flow score and final TIMI score, single or multi-vessel disease), angiographic complications as dissection and no-reflow, occurrence of contrast induced nephropathy and cerebrovascular events and LV systolic function assessment by echocardiography. Conclusion: In this study, we highlighted the importance of total ischemic time and importance of patient and system related delays in influencing outcomes of STEMI.
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