Ahmed Adel Elamragy

{Background: COVID-19 caused restrictions and re-allocation of medical resources among all healthcare services. During the peak of the pandemic, several unrelated–yet critical–conditions had silently taken their toll. Infective endocarditis (IE), owing to its non-specific clinical presentation, may have been largely mislabeled as COVID-19 in a number of cases. Results: This retrospective observational study reviewed all IE presentations at an IE unit in a university hospital during the peak of COVID-19. Patient characteristics, courses, and outcomes were compared with historical controls from our IE database published before the COVID era. We identified 30 IE cases [Group A] during the COVID-19 peak in our region (June 2021 to June 2022), with a 25% decrease compared to the usual annual rate. This is in contrast to the expected surge during the pandemic. Compared with group B (398 published IE cases from our database), group A had significantly longer symptoms-to-presentation intervals (60 [31–92] vs. 28 [14–72] days

BackgroundA major barrier for adult congenital heart disease (ACHD) services in developing countries is the insufficient data on the disease burden and specific needs of this population. Our goal was to the clinical profile and challenges of ACHD patients in Egypt who require further surgical correction. MethodsThe study comprised ACHD patients (above 14 years of age) scheduled for further surgical correction following a heart team discussion at a tertiary cardiac center in Egypt. Data on age, gender, presentation, functional capacity, resting oxygen saturation, diagnosis, previous intervention and its timing, and the type of planned surgery were collected.ResultsThroughout one year, 103 cases (49.5% males, mean age 23 years) were referred to surgery out of 134 cases discussed by the heart team. One-third (34%) were cyanotic. The majority presented in NYHA class II (44.7%) and III (35.95%) and had a previous surgical or trans-catheter intervention (56.3%) at a median age of four years. The most frequent diagnoses were Tetralogy of Fallot (ToF) (23.3%), atrial septal defect (ASD) (18.4%), double outlet right ventricle (11.6%), and transposition of great arteries (7.8%). The most common planned surgical procedures were Fontan (20.3%), ASD closure (18.4%), pulmonary valve replacement (14.5%), total ToF repair (9.7%), subaortic membrane resection (6.7%) and tricuspid valve surgery (5.8%).ConclusionACHD patients in our database who require additional surgical correction are heterogeneous, with highly variable presentations and surgical complexity. An efficient ACHD program mandates a multidisciplinary team that is familiar with this patient population’s unique demands and difficulties.

Background: The prognostic value of right ventricular (RV) function in chronic heart failure (HF) has lately been well established. However, research on its role in acute heart failure (AHF) is sparse. Results: This study comprised 195 patients, aged between 18 and 80 years, with acute left-sided heart failure (HF) and a left ventricular ejection fraction (LVEF) < 50%. Patients with LVEF ≥ 50%, mechanical ventilatory or circulatory support, poor echocardiographic windows, prosthetic valves, congenital heart diseases, infective endocarditis, and/or life expectancy < 1 year due to non-cardiac causes were excluded. The study participants’ mean age was 57.7 ± 10.9 years, and 74.9% were males. Coronary artery disease was present in 80.5% of patients. The mean LVEF was 31% ± 8.7. RV dysfunction (RVD), defined as tricuspid annular plane systolic excursion (TAPSE) < 17 mm, RV S' < 9.5 cm/s and/or RV fractional area change (FAC) < 35%, was identified in 48.7% of patients. The RV was dilated in 67.7% of the patients. RVD was significantly associated with a longer HF duration, atrial fibrillation, and idiopathic dilated cardiomyopathy. The primary outcome, a 6-month composite of cardiovascular death or hospitalization for worsening HF (HHF), occurred in 42% of the participants. Cardiovascular mortality and HHF occurred in 30.5% and 23.9% of the patients, respectively. The primary endpoint and longer CCU stays were significantly more common in patients with RVD than in those with normal RV function. RV dilatation was significantly associated with the primary outcome, whether alone or in combination with RVD. Multivariate regression analysis showed that only RV global longitudinal strain (GLS) independently predicted poor outcomes. Conclusions: RVD and RV dilatation strongly predict CV death and HHF in patients with AHF and LVEF < 50%. Multivariate analysis showed that RV GLS was the only predictor of a composite of CV death and HHF.

Multi-detector computed tomography (MDCT) is the gold standard non-invasive tool for evaluating aortic root dimensions. We assessed the agreement between 4D TEE and MDCT-derived aortic valve annular dimensions, coronary ostia height, and minor dimensions of sinuses of Valsalva (SoV) and sinotubular junction (STJ). In this prospective analytical study, we measured the annular area, annular perimeter, area-derived diameter, area-derived perimeter, left and right coronary ostial heights, and minor diameters of the SoV and the STJ using ECG-gated MDCT and 4D TEE. TEE measurements were calculated semi-automatically by the eSie valve software. We enrolled 43 adult patients (27 males, median age: 46 years). We found strong correlations and good agreement between the two modalities in annular dimensions (area, perimeter, area-derived diameter, and perimeter-derived diameter), left coronary ostial height, minimum STJ diameter, and minimum SoV diameters. Moderate correlations, and agreement, with relatively large differences between the 95% LOA, were demonstrated for the right coronary artery ostial height. 4D TEE correlates well with MDCT in measuring aortic annular dimensions, coronary ostial height, SoV minor diameter, and sinotubular junction minor diameter. Whether this can affect clinical outcomes is unknown. It could replace MDCT if the latter is unavailable or contraindicated.

{Objectives This study sought to evaluate the incidence and the mechanism of post-procedural cardiac biomarker (CB) rise following device implantation. Background A fully bioresorbable Absorb scaffold, compared with everolimus-eluting metallic stents (EES), might be associated with a higher incidence of periprocedural myocardial injury. Methods Prospective nonrandomized comparative study enrolled 52 patients with stable myocardial ischemia with diffuse/ long LAD lesion for either an everolimus-eluting bioresorbable vascular (BVS) scaffold (22 patients) or an EES (30 patients), 3 types of CB (creatine kinase (CK), creatine kinase-myocardial band (CK-MB), and troponin) were obtained before and after procedure. Per protocol, periprocedural myocardial infarction (PMI) was defined as CK rise >2 the upper limit of normal with CK-MB rise. Results Incidence of side branch occlusion (SBO) and any anatomic complications assessed by angiography was similar between the 2 treatment arms (SBO: Absorb: 4.5% vs. Xience: 6.7%