Sameh Bakhoum

Background Systemic lupus erythematosus (SLE) is an autoimmune disease associated with reduced number and impaired function of endothelial progenitor cells (EPCs) responsible for vascular regeneration. Aim The aim of this study was to assess left ventricular (LV) function of SLE patients using the relatively new speckle tracking echocardiography (STE) and examine whether any detected abnormalities of LV function have any relation with peripheral circulating EPCs level. Methods Fifty SLE patients and 25 healthy controls were subjected to quantification of peripheral circulating VEGFR2+/CD133+ and VEGFR2+/CD34+ EPCs, transthoracic echocardiography (TTE), tissue Doppler imaging (TDI) and STE. Results Patients showed a significantly lower CD133+/VEGFR2+ EPCs (p= 0.009) and CD34+/VEGFR2+ EPCs counts (p= 0.0001) compared to controls. TTE/TDI revealed a significantly lower LV ejection fraction (EF) (p=0.007), higher LV end systolic dimensions (p=0.02), myocardial performance index (MPI) (p=0.0001) and mitral flow E/lateral annulus E' ratio (p=0.002) in patients compared to controls. STE showed a significantly lower global longitudinal strain (GLS) (p value <0.001), global circumferential strain (GCS) (p<0.001) and global strain rate during isovolumic relaxation period (GSRivr) (p=0.01) in patients compared to controls. No correlation was detected between age of the patients, duration of disease, prednisolone dose or intake duration, use of azathioprine vs. cyclophosphamide, SLE disease activity index, LV MPI, LV EF, CD133+/VEGFR2+ EPCs or CD34+/VEGFR2+ EPCs count and GLS. By multiple logistic regression analysis, the independent variables affecting GCS and GSRivr were the prednisolone dose and the LVEF respectively. (95% CI = -0.46 to -0.03; p= 0.03 and 95% CI = 0.001 to 0.01; p=0.021; respectively). Conclusion
STE detected subclinical systolic and diastolic abnormalities of LV function in SLE patients. These abnormalities of LV function did not show however any relation with the significantly lower EPCs count detected in patients.
 

Abstract Background: Several studies showed that ST-segment elevation myocardial infarction
(STEMI) patients with high body mass index (BMI) have better in-hospital outcomes.
Aim: This study examined the impact of waist circumference (WC) on the hospital outcome and
coronary angiographic extent of STEMI patients.
Methods: We evaluated 142 consecutive patients with STEMI. Patients were classified into 2
groups according to WC. Group A (n=72) had increased WC (WC > 88/102 cm for women/
men). Group B (n= 70) had normal WC. A primary composite outcome of in-hospital mortality
and cardiovascular complications namely heart failure, cardiogenic shock, serious arrhythmias,
re-infarction, post infarction angina, a secondary outcome of in-hospital mortality and coronary
angiographic findings were compared between the 2 groups.
Results: Group A patients were significantly older, had a significantly higher prevalence of hypertension
(HTN), diabetes mellitus (DM) and were significantly less likely to be smokers compared to group B. There was no statistically significant difference in the primary outcome between the 2
groups. WC as a categorical or as a continuous variable did not have any significant influence
on the secondary outcome of in-hospital mortality even after adjustment for other predictors of
death. Age was the only statistically significant predictor for mortality (p= 0.01). Coronary angiography
revealed no statistically significant difference in the number of diseased coronary vessels,number of coronary lesions or Gensini score between the 2 groups.
Conclusion: A high WC, had no favorable impact on in-hospital mortality, cardiovascular complications
or coronary angiographic extent in STEMI patients.

Abstract Introduction: High quality cardiopulmonary resuscitation (CPR) performed according
to international guidelines has a vital impact on survival of cardiac arrest.
Objective: To investigate different variables affecting return of spontaneous circulation (ROSC)
and survival to discharge (STD) after in-hospital cardiac arrest (IHCA) and evaluate adherence
to CPR guidelines using a modified Utstein-style template.
Methods: A prospective observational study of 126 IHCA out of 5479 admissions to cardiology
units of 3 Cairo University hospitals.
Results: CPR was not attempted in 7 futile cases. ROSC was achieved in 50.4%, while STD was
achieved in only 7.6% of 119 attempted resuscitations. CPR was started by a physician in 114 cases
(95.8%) and by the on duty nurse in only 5 cases. The initial rhythm was shockable rhythm (SR) in
19 cases; 13 (68.4%) of whom achieved ROSC and 6 (31.6%) STD and non SR (pulseless electric activity/asystole) in 100 cases; 47 (47%) of whom achieved ROSC and 3 (3%) STD. Chest compressions
were observed appropriate P100/min, P2 inches deep and interrupted <10 s in 99.2%,
92.4% and 48.7% of cases respectively. Initial SR and duration of CPR were independently associated
with ROSC (both P =0.01) and STD (P= 0.008 and 0.02 respectively). A cut-off value for
CPR duration of 22.5 min had a sensitivity of 86.7% and a specificity of 81.4% in predicting ROSC
by receiver-operator characteristics analysis.
Conclusion: The poor STD despite a relatively good ROSC calls for improvement of CPR education
and training for hospital personnel and better post CA care.

Cardiovascular complications are the major cause of diabetes-associated morbidity and mortality. However,
not all patients with diabetes are at increased risk for cardiovascular disease (CVD). Coronary artery calcification was found to be a powerful predictor of coronary artery disease (CAD). The presence of extracoronary cardiac calcification as a useful predictor of CAD is not yet established, especially in type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the relation between extracoronary
calcification and extent of CAD in a group of T2DM patients who were scheduled for computed tomographic coronary angiography (CTCA). We prospectively studied 380 patients(151 had T2DM) under the age of 60 years who were scheduled for CTCA because of suspected CAD. Severity of CAD was assessed by Gensini score. Coronary artery calcium score (CACS) as well as calcium score in the aortic valve, mitral annulus, ascending aorta, and descending aorta were measured by a 256-row multidetector computed tomography
scanner with dedicated software for calcium calculation. Patients with known CAD were excluded. Diabetic and
nondiabetic patients had comparable age and gender distribution. However, the diabetic group had higher Gensini score,CACS, and extracoronary calcium score (ECCS). Logistic regression analyses identified male gender and ECCS as significant predictors for the presence of CAD in diabetic patients. Age, smoking, and ECCS were the significant predictors of CAD in nondiabetic patients. Type 2 diabetic patients had increased coronary and extracoronary calcification. ECCS was found to be a significant predictor of CAD in diabetic and nondiabetic patients only when CACS was not taken into account.

Psoriasis, recently considered a systemic inflammatory disease, is associated with increased
cardiovascular morbidity and mortality. Inflammation can affect left ventricular function via
multiple mechanisms.
Objective Our aim was to determine the usefulness of using the relatively new tissue Doppler imaging
(TDI) in detecting left ventricular (LV) function abnormalities which may be underestimated
by conventional Doppler echocardiography (DE) in psoriasis patients.
Methods Thirty young patients with psoriasis (mean age36.9±9.2 yrs), without cardiovascular risk
factors or clinically evident cardiovascular disease and 30 healthy age and sex-matched
controls were subjected to DE and TDI. High-sensitivity C-reactive protein (hs-CRP), serum
homocysteine (Hcys) were also measured.
Results The serum hs-CRP and Hcys levels were significantly higher in patients compared to controls
(10.6±5.2 vs. 1.1±0.6mg/dl and 21.8±13.4 vs. 13.6±6.0μmol/l; both p <0.0001; respectively).
As regards DE, there was no statistically significant difference in LV dimensions, ejection
fraction, mitral Doppler flow E, A wave peak velocities, E/A ratio, or isovolumic relaxation time
(IVRT). As regards TDI, the peak systolic annular velocity (S), the early peak e’ and the late
peak a’ diastolic annular velocities were significantly lower in patients compared to controls
(9.6±1.6 vs. 10.9±1.0cm/sec; p <0.007; 12.6±2.6 vs. 14.6±1.2cm/sec; p <0.001 and 10.1±2.3 vs.
12.5±2.2cm/sec; p <0.002; respectively). The TDI derived IVCT and IVRT were significantly
prolonged in patients compared to controls (78.9±15.3 vs. 68.8±9.5msec; p <0.01 and 83.6±17.8
vs. 69.2±6.1msec; p <0.001 respectively). Significant negative correlations between hs-CRP
(r= -0.47; p= 0.017), Hcys (r= -0.61; p= 0.001) levels and e’ peak velocity, and between Hcys
level and S peak velocity (r= -0.52; p= 0.008) and a significant positive correlation between Hcys
level and TDI derived IVRT (r= 0.48; p= 0.014) were noted in patients.
Conclusions Mitral annular systolic and diastolic abnormalities detected by TDI, in patients with psoriasis
may be a useful marker for early heart failure in this group of patients.

Background In subjects with coronary artery disease (CAD), the angina induced by initial exercise is
attenuated with re-exercise after a brief rest. This warm-up phenomenon believed to be due
to ischemic preconditioning is related to the opening of cardiac ATP-sensitive K channels (K
ATP). Blockers of these K ATP channels such as the sulphonylurea drugs can lead to loss of
ischemic preconditioning.
Objective This study aimed to examine the effects of three different sulfonylureas: glibenclamide,
gliclazide and glimepiride, on the warm-up phenomenon by analyzing the results of 2
consecutive exercise tests in diabetic patients with coronary artery disease (CAD).
Methods Forty patients with chronic stable angina: 30 patients having type 2 diabetes mellitus (DM)
and 10 non diabetic patients (group D) were enrolled in the study. The DM patients were
divided into 3 groups according to the type of sulfonylurea drug they are receiving: Group
A (glibenclamide), Group B (gliclazide) and group C (glimepiride). All the patients were
subjected to 2 consecutive exercise tests with a 15-minute recovery period between the 2 tests..
Results There was no significant increase in peak heart rate, systolic blood pressure and rate pressure
product during test 2 compared to test 1 in groups B, C and D but not in group A patients. There
was a statistically significant increase in the time to onset of chest pain (p <0.007 for B, C and
p <0.005 for D), time to onset of 1 mm ST segment depression (p <0.007 for B, C and p <0.03 for
D) and exercise duration (p <0.01 for B; p <0.008 for C and p <0.02 for D) in test 2 compared to
test 1 in groups B, C and D but not in group A. There was also a significant decrease in time to ST
segment recovery to baseline in test 2 compared to test 1 in groups B,C and D (p <0.005 in the 3
groups) but not in group A.
Conclusions Glibenclamide, but not gliclazide or glimepiride abolished the warm-up phenomenon, the
clinical counterpart of ischemic preconditioning in type 2 DM patients with CAD.