Ahmed Adel Elamragy

Background: There is growing evidence for the diagnostic value of the global longitudinal myocardial deformation indices in predicting the presence of significant coronary artery disease (CAD). However, the significance of regional myocardial deformation analysis is still unknown. Aim: To study the diagnostic accuracy of 2D speckle tracking echocardiography (STE)-derived regional longitudinal strain and strain rate during dobutamine stress echocardiography (DSE) in predicting the culprit coronary artery territory in patients with moderate pretest probability for CAD. Methodology: 101 patients suspected to have stable CAD were prospectively studied by DSE, followed by coronary angiography within one month. The 3 standard apical views were acquired at rest and peak stress (average frame rate was 70/sec). Each segment of the 17 segment model was analyzed for the following 2D STE derived indices: longitudinal peak systolic strain (LS), longitudinal peak systolic strain rate (LSRs), longitudinal early diastolic strain rate (LSRd) and post systolic index (PSI). Regional strain was obtained by calculating the mean of strain parameters of all segments supplied by either the left anterior descending artery [10 segments representing the anterior coronary circulation (ACC)] or the right coronary, left circumflex or both arteries [7 segments representing the posterior coronary circulation (PCC)]. Luminal diameter stenosis ≥ 70% on coronary angiography was considered significant. Results: Group 1 (n= 52 patients) had normal or mild CAD while group 2 (n=49 patients) had significant CAD and was further classified into group 2A (n=21, ACC territory disease), and 2B (n=11, PCC territory disease). Those with mixed territory disease (n=17) were excluded from final analysis. At rest, PSI of ACC segments was marginally higher in group 2A than group 1 (0.015±0.01 vs 0.008±0.01, p:0.05), while LS & LSRs of PCC segments were lower in group 2B than group 1 (-19.4±2.6 vs -21.7±2.5, p:0.007 and -1.23±0.17 vs -1.49±0.33, p: 0.015 respectively). At peak stress, all strain parameters were significantly different between the two groups regardless of the involved territory. In Receiver Operator Characteristics analysis, peak stress LS in either ACC and PCC territories showed the largest area under the curve: 0.9 (p<0.001) and 0.88 (p<0.001) respectively. In ACC, LS cutoff value of -21% had 90.5% sensitivity and 88.5% specificity for detecting significant ACC disease, while in PCC, LS cutoff value of -20% had 81.8% sensitivity and 79% specificity for detecting significant PCC disease. Conclusion: Regional strain analysis at rest (LS and LSRs) could detect significant CAD in PCC territory. At peak stress, LS of -21% in ACC segments and -20% in PCC segments can detect significant disease in the corresponding coronary territory with high sensitivity and specificity.

AIMS: To establish a clinical registry for adult patients with congenital heart disease (CHD) managed in Cairo University Hospitals, aiming at description of the pattern and clinical profile of such patients.\n\nMETHODS: Patients were recruited from both Cardiovascular Medicine Department Outpatient Clinic and inpatient wards of Cairo University Hospitals. Clinical data were collected from hospital records and directly from patients by treating cardiologists. Collected data were then registered in a dedicated database system and subsequently analyzed.\n\nRESULTS: Patients (49% males) ranged in age from 16 to 63 years, with a median of 25 years. Fifty-one patients were in the age-group from 20 to 30 years, with only 9% aged 50 years or older. Seventy-eight patients had acyanotic lesions, with atrial septal defect being the most common primary diagnosis (20% of total lesions). The remaining 22 patients had cyanotic heart disease, with tetralogy of Fallot being the predominant diagnosis (45% of cyanotic lesions). Six patients presented with infective endocarditis in the setting of CHD. Four women (8% of females) presented during pregnancy. Forty-six patients were sent for surgical correction/repair, while percutaneous intervention was planned in 20 patients.\n\nCONCLUSIONS: A new registry of adult patients with CHD managed in Cairo University Hospitals provides useful information, including the extent to which congenital heart defects are underdiagnosed and undertreated during infancy and childhood. In addition, those who were previously treated early in life require long-term follow-up in specialized centers. Establishment of a multidisciplinary team with expert physicians (cardiologists, dentists, obstetricians, and psychiatrists), cardiac surgeons, and nurses may be facilitated by development of a dedicated database system. Continuous financial support is a major challenge.

AIMS: To establish a clinical registry for adult patients with congenital heart disease (CHD) managed in Cairo University Hospitals, aiming at description of the pattern and clinical profile of such patients. METHODS: Patients were recruited from both Cardiovascular Medicine Department Outpatient Clinic and inpatient wards of Cairo University Hospitals. Clinical data were collected from hospital records and directly from patients by treating cardiologists. Collected data were then registered in a dedicated database system and subsequently analyzed. RESULTS: Patients (49% males) ranged in age from 16 to 63 years, with a median of 25 years. Fifty-one patients were in the age-group from 20 to 30 years, with only 9% aged 50 years or older. Seventy-eight patients had acyanotic lesions, with atrial septal defect being the most common primary diagnosis (20% of total lesions). The remaining 22 patients had cyanotic heart disease, with tetralogy of Fallot being the predominant diagnosis (45% of cyanotic lesions). Six patients presented with infective endocarditis in the setting of CHD. Four women (8% of females) presented during pregnancy. Forty-six patients were sent for surgical correction/repair, while percutaneous intervention was planned in 20 patients. CONCLUSIONS: A new registry of adult patients with CHD managed in Cairo University Hospitals provides useful information, including the extent to which congenital heart defects are underdiagnosed and undertreated during infancy and childhood. In addition, those who were previously treated early in life require long-term follow-up in specialized centers. Establishment of a multidisciplinary team with expert physicians (cardiologists, dentists, obstetricians, and psychiatrists), cardiac surgeons, and nurses may be facilitated by development of a dedicated database system. Continuous financial support is a major challenge.

Background The hemodynamic disorders of preeclampsia (PE); represent a very interesting model in which a pressure overload develops in a few weeks may induces cardiac changes similar to that detected in chronic arterial hypertension (CAH), which is characterized by a long-lasting pressure overload. Our aim is to assess the left ventricular geometry, systolic and diastolic function in PE in comparison to CAH pregnant patients. Methods Twenty five consecutive pregnant women with preeclampsia (PE group) and 25 with chronic arterial hypertension (CAH group) were enrolled in their third trimester of gestation. Conventional M-Mode, 2D and Doppler echocardiography were performed for all patients. Left ventricular mass (LVM), relative left ventricular mass (rLVM), left ventricular mass index (LVMI), as well as relative wall thickness (RWT) were calculated to define the LV geometric pattern. Ejection fraction, fractional shortening, stroke volume and cardiac output were measured to evaluate the LV systolic function. Mitral inflow velocities were used to evaluate the diastolic function. Results Both groups were well matched for their baseline characteristics apart from the age, weight and parity that were higher in (CAH) group (p <0.0001). There were significant increase of LVM; 200.3±72.73vs. 153.6±34.26g, rLVM; 121.4±42.39vs. 95.6±21.84g, LVMI; 108.8±36.49vs. 86±19.19g/m 2 , as well as RWT; 0.46±0.1vs. 0.35±0.1 (P <0.01) in CAH group as compared to PE group. Concentric hypertrophy was the most common geometric abnormality detected in CAH group 44% vs. 12% (p= 0.012) while normal pattern was more evident in PE group 68% vs. 36% (p= 0.024). The concentric remodeling and eccentric hypertrophy pattern were similar in both groups. The ejection fraction, fractional shortening, stroke volume and the cardiac output were high but similar in both groups (p= N.S). The E/A ratio was >1 in both groups but it was statistically lower in CAH group, (p= 0.01). Conclusions Preeclamptic pregnant women have evidence of abnormal left ventricle geometry but less than that detected in CAH with enhanced left ventricular systolic function. These structural and functional cardiac changes justify routine cardiologic assessment, even in the absence of cardiopulmonary symptoms.

Background The hemodynamic disorders of preeclampsia (PE); represent a very interesting model in which a pressure overload develops in a few weeks may induces cardiac changes similar to that detected in chronic arterial hypertension (CAH), which is characterized by a long-lasting pressure overload. Our aim is to assess the left ventricular geometry, systolic and diastolic function in PE in comparison to CAH pregnant patients. Methods Twenty five consecutive pregnant women with preeclampsia (PE group) and 25 with chronic arterial hypertension (CAH group) were enrolled in their third trimester of gestation. Conventional M-Mode, 2D and Doppler echocardiography were performed for all patients. Left ventricular mass (LVM), relative left ventricular mass (rLVM), left ventricular mass index (LVMI), as well as relative wall thickness (RWT) were calculated to define the LV geometric pattern. Ejection fraction, fractional shortening, stroke volume and cardiac output were measured to evaluate the LV systolic function. Mitral inflow velocities were used to evaluate the diastolic function. Results Both groups were well matched for their baseline characteristics apart from the age, weight and parity that were higher in (CAH) group (p {\textless}0.0001). There were significant increase of LVM; 200.3±72.73vs. 153.6±34.26g, rLVM; 121.4±42.39vs. 95.6±21.84g, LVMI; 108.8±36.49vs. 86±19.19g/m 2 , as well as RWT; 0.46±0.1vs. 0.35±0.1 (P {\textless}0.01) in CAH group as compared to PE group. Concentric hypertrophy was the most common geometric abnormality detected in CAH group 44{%} vs. 12{%} (p= 0.012) while normal pattern was more evident in PE group 68{%} vs. 36{%} (p= 0.024). The concentric remodeling and eccentric hypertrophy pattern were similar in both groups. The ejection fraction, fractional shortening, stroke volume and the cardiac output were high but similar in both groups (p= N.S). The E/A ratio was {\textgreater}1 in both groups but it was statistically lower in CAH group, (p= 0.01). Conclusions Preeclamptic pregnant women have evidence of abnormal left ventricle geometry but less than that detected in CAH with enhanced left ventricular systolic function. These structural and functional cardiac changes justify routine cardiologic assessment, even in the absence of cardiopulmonary symptoms.

BACKGROUND: Recent guidelines stressed the need to adopt different values of waist circumference (WC) measurements to define abdominal obesity in different ethnic groups. The aim of this study is to identify WC cutoff points in normotensive and hypertensive subjects which are diagnostic of abdominal obesity in a Middle Eastern population and the prevalence of abdominal obesity in a nationwide sample. METHODS: Data were collected during phase-2 of the Egyptians National Hypertension Project survey. Blood pressure, anthropometric measurements and laboratory studies were performed according to a standardized protocol by trained personnel. To derive the cutoff points for WC, we applied the factor analysis on CV risk factors: diabetes mellitus, decrease in HDL-C and increase in LDL-C, triglycerides and left ventricular mass index by echocardiography. RESULTS: The sample included 2313 individuals above the age of 25 years. WC values (mean ± SD) were 88 ± 14 cm and 95 ± 14 cm for normotensive (NT) and hypertensive (HT) men respectively, and 89.6 ± 14.7 cm and 95.7 ± 15.9 cm for NT and HT women respectively. Applying factor analysis, the weighted average cutoff points were 93.5 cm for both NT and HT men and 91.5 and 92.5 cm for NT and HT women respectively. Based on these thresholds, the prevalence of abdominal obesity was 48% in men and 51.5% in women. CONCLUSION: This is the first report of specific abdominal obesity cutoff points in a Middle Eastern country. The cutoff points were different from the Europid standards. There is a high prevalence rate of abdominal obesity among Egyptians which is associated with increased prevalence of cardiometabolic risk factors.