Background The occurrence of in-hospital heart failure in the acute phase of myocardial infarction carries an ominous prognosis and is often preceded by abrupt loss of functioning myocardium. However ,In hospital heart failure may occur in patients with apparently only minor myocardial injury and preserved or only moderately reduced left ventricular ejection fraction and still carries a significantly increased risk of adverse outcome. In patients with clinical symptoms of heart failure despite preserved left ventricular ejection fraction(heart failure with preserved ejection fraction), abnormalities in longitudinal myocardial mechanics have been reported suggesting that the discrepancy between near normal left ventricular ejection fraction and clinical symptoms may be partially explained by theses indices. Purpose Evaluation of the role of global longitudinal strain in prediction of the occurrence of in hospital heart failure in patients presenting with acute myocardial infarction particularly in patients with normal ,or moderately impaired ejection fraction. Methods forty patients with first attack of acute myocardial infarction were ranked according to killip class during their hospital admission and course. The patients were divided into two groups: Group 1: patients having in-hospital heart failure (killip class > 1).Group2: Patients not having in–hospital heart failure (killip class = 1). Echocardiogaraphic examination was done for them including global longitudinal strain within 72 hours after successful reperfusion .Comparison of different echocardiographic parameters between the two groups was done. Patients with mildly impaired ejection fraction (Ejection fraction > 40%) were studied for echocardiographic parameters correlated significantly with the occurrence of in-hospital heart failure . Results Patients with in-hospital heart failure had significantly impaired global longitudinal strain(-8.63%+1.57% vs -12.41%+1.31%, p = 0.000), lower left ventricular ejection fraction (34.17%+8.17% vs 42.92 %+7.98%,p < 0.001) and higher wall motion score index (1.57 + 0.32 vs 1.31 +0.24 ,p < 0.006). In patients with left ventricular ejection fraction >40% experienced in-hospital heart failure also exhibited significantly impaired global longitudinal strain p= 0.035 . Conclusion Global longitudinal strain can offer accurate, feasible, and non invasive predictor of hemodynamic deterioration in patients with myocardial infarction. Global longitudinal strain was superior to left ventricular ejection fraction , wall motion score index in evaluation of myocardial dysfunction specially in those with preserved left ventricular ejection fraction(EF > 40%).Global longitudinal strain was also superior to left ventricular ejection fraction , wall motion score index in detection of patients with Killip class II ( those without overt heart failure ,and who can be easily missed).

Background:The most common causes of severe mitral regurgitation (MR) in developing countries are rheumatic heart disease. The plasma level of B-type natriuretic peptide (BNP) is known to increase with left ventricular (LV) dysfunction.Aim of the Work:To study BNP level as an index of symptoms and severity of chronic rheumatic MR.Patients and Methods:One hundred and forty patients with rheumatic MR and LV ejection fractions (EFs) of >55% underwent assessment of symptoms, transthoracic echocardiography, and measurement of BNP. Results: The level of BNP rose with increasing left atrium (LA) dimensions and volumes, LV dimensions and volumes, echocardiographic parameters of MR severity (width of the vena contracta, regurgitation jet area, effective regurgitation orifice area, and regurgitant volume), and E waves.Results:BNP was significantly higher in patients with severe MR compared with moderate and mild MR (P < 0.001), and using cutoff point of 61 pg/mL mm had 97% sensitivity and 89% specificity for predicting patients with severe MR (0.99, 95% confidence interval [CI] 0.9–1). BNP was significantly higher in patients with New York Heart Association (NYHA III) compared with NYHA II, I and asymptomatic patients (P < 0.001) and using cutoff point of 53 pg/mL had 97% sensitivity and 87% specificity for predicting symptomatic patients with symptomatic MR (0.81, 95% CI 0.70–0.92).Conclusions:BNP level increase with increasing severity of rheumatic MR and are higher in symptomatic compared to asymptomatic patients, even in the presence of normal EF%.

We aimed to Evaluation of left ventricular function by Echocardiography post Percutaneous Coronary Intervention to totally occluded coronary arteries. Methods: In 100 consecutive patients with chronic totally occluded coronary vessel, LV systolic function were measured by transthoracic Echocardiograrphy before and after successful CTO PCI. Results: The study was conducted on 100 patient collected from department of cardiology , Fayoum University all patients were diagnosed as chronic total occlusion of coronary arteries , L.V systolic function was compared between pre-procedural echocardiographic study and that done within 6 months after the procedure. L.V. Function Improvement was observed in 76% of patients. With no change in 14% and worsening in 10% of studied patints. Conclusion: PCI for a CTO has a beneficial effect on LV functions, myocardial contractility .