Mohamed Sadaka

Serum chemerin and high-sensitivity C reactive protein as markers of subclinical atherosclerosis in Egyptian patients with type 2 diabetes

Context: Chemerin is one of the adipokines that regulate fat metabolism. High-sensitivity C-reactive protein (hs-CRP) may be considered as a cardiovascular risk predictor. Measuring intima-media thickness of the CCA (C-IMT) is a well-evidenced tool for the detection of early stages of atherosclerosis. We aimed here to study both serum chemerin and hs-CRP as markers of subclinical atherosclerosis in Egyptian patients with type 2 diabetes, who are angiographically free of coronary artery disease (CAD). Subjects and methods: This cross-sectional study was conducted on 180 subjects divided into two groups: Group A included 90 type 2 diabetic patients without CAD and group B including 90 nondiabetic control subjects. All study subjects were having normal coronary angiography. Serum chemerin, homeostasis model assessment for insulin resistance (HOMA-IR), glycated haemoglobin (HbA1c), lipid profile, hs-CRP as well as C-IMT were assessed in all study subjects. Results: There was a statistically significant difference between the 2 groups regarding serum chemerin level, HOMA-IR, hs-CRP and C-IMT; being higher in the diabetic patients than in the control group (p = 0.006, 0.024, 0.040 and <0.001, respectively). There was positive correlation between serum chemerin level and waist-to-hip ratio (WHR), HOMA-IR, hs-CRP and C-IMT. Carotid intima-media thickness was positively correlated with patients’ WHR, blood pressure, HbA1c, diabetes duration as well as hs-CRP, and negatively correlated with ankle-brachial index (ABI). Linear regression analysis showed that HbA1c, serum chemerin and hs-CRP were independently affecting C-IMT. Serum hs-CRP was positively correlated with HbA1c and HOMA-IR (p = 0.006 and 0.032, respectively), and negatively correlated with HDL-cholesterol level (p = 0.018). Conclusion: Both serum chemerin and hs-CRP could be considered as markers of subclinical atherosclerosis, and hence, may be utilized for the early detection of macrovascular disease, in Egyptian patients with type 2 diabetes.

Electrocardiogram as prognostic and diagnostic parameter in follow up of patients with heart failure

Abstract Introduction Most patients with HF due to systolic dysfunction have a significant abnormality on ECG. It is a widely available tool relatively inexpensive, simple to perform, and yields an instant result. Aim To determine whether heart failure (ECG) conveys prognostic and diagnostic information in patients with HF. Methods The study was carried out on 100 heart failure patients. All patients were subjected to history taking, clinical examination, standard 12 lead ECG (at admission, discharge, and 3 month follow up) for assessment of the following: (QRS voltage amplitude: in limb leads and in chest leads, total QRS voltage and transthoracic echocardiography were done for all patients (at discharge and at 3 month follow up (FU). Results There were 75 males and 25 females, aged between 21 and 86 years (mean = 59.14 ± 13.41 years). Total QRS voltage, limb leads voltage and chest leads voltage; all significantly increased from admission values (98.54 ± 20.64, 37.87 ± 11.06, and 60.67 ± 15.26 mm) to (110.72 ± 21.28, 43.01 ± 11.92, and 67.71 ± 15.22) at discharge (p < 0.001 for all). Also there was a significant increase in voltage at FU (111.72 ± 21.28, 43.30 ± 11.96, and 68.61 ± 16.61 mm) (p < 0.001 for all). There was a negative correlation found between left ventricular end diastolic and systolic dimensions (LVEDD and LVESD) with total QRS voltage, chest leads voltage and limb leads voltage, both at discharge and at FU. The total QRS Voltage was significantly higher in patients having no lower limb (LL) edema than those with edema on admission, at discharge and on FU (p < 0.001). Conclusion Voltages of ECG are considered one of the most important parameters in diagnosis and FU of patients with heart failure. Voltage of chest leads well correlated with LVEDD and LVESD. Voltage of limb leads has important inverse correlation with LL edema.

Albumin to creatinine ratio as a predictor to the severity of coronary artery disease

Abstract Introduction Microalbuminuria (MA) is a well-known risk factor for coronary artery disease (CAD). It is associated with higher cardiovascular mortality, especially in diabetics. However, there are few data linking angiographic severity of CAD to MA. Aim The aim of the present study was to assess the albumin to creatinine ratio as a new predictor for CAD and to correlate with its severity apart from other traditional CAD risk factors. Methods Our study included 100 patients with documented CAD by coronary angiography in Alexandria main university hospital. The severity of CAD was scored on the basis of the number and the extent of lesions within the coronary arteries by using Syntax score. Urine albumin excretion was measured for all patients in morning spot urine samples by immune precipitation technique. We correlate between MA and severity of CAD. Results In a total of 100 patients (74 males and 26 females), (mean age 55.71 ± 8.99 y) MA was present in 34 patients only. Patients were divided into two groups; group I included those without MA and group II with MA. CAD occurred more frequently in males than in females and in smokers than in non-smokers. There were no significant differences in the prevalence of hypertension and hypercholesterolemia between the two groups. A direct relationship between MA and extension of atherosclerotic coronary lesions was noticed (P = 0.009). Conclusion Patients with MA having more severe angiographic CAD were compared to those without MA. This relation is independent of other risk factors. MA could be utilized as an independent risk factor for CAD.

Outcomes of DES in Diabetic and Nondiabetic Patients with Complex Coronary Artery Disease after Risk Stratification by the SYNTAX Score

Diabetes mellitus (DM) increases the risk of adverse outcomes after coronary revascularization. Controversy persists regarding the optimal revascularization strategy for diabetic patients with multivessel coronary artery disease (MVD). Aim The aim of this study was to assess the outcomes of drug-eluting stent (DES) insertion in DM and non-DM patients with complex coronary artery disease (CAD) after risk stratification by the percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. Methods and Results We performed multivessel percutaneous coronary intervention (PCI) for 601 lesions in 243 DM patients and 1,029 lesions in 401 non-DM patients. All included patients had MVD and one or more lesions of type B2/C. The two-year outcomes and event rates were estimated in the DM and non-DM patients using Kaplan–Meier analyses. The baseline SYNTAX score was ≤22 in 84.8% vs. 84%, P = 0.804, and 23-32 in 15.2% vs. 16%, P = 0.804, of the DM and non-DM patients, respectively. The number of diseased segments treated (2.57 ± 0.75 vs. 2.47 ± 0.72; P = 0.066) and stents implanted per patient (2.41 ± 0.63 vs. 2.32 ± 0.54; P = 0.134) were similar in both groups. After a mean follow-up of 642 ± 175 days, there were no differences in the major adverse cardiac and cerebrovascular events (MACCE; 26.7% vs. 20.9%; P = 0.091), composite end point of all-cause death/myocardial infarction (MI)/stroke (12.3% vs. 9%; P = 0.172), individual MACCE components of death (3.7% vs. 3.2%; P = 0.754), MI (6.6% vs. 4%; P = 0.142), and absence of stroke in the DM and non-DM patients. An increased need for repeat revascularization was observed in DM patients (18.5% vs. 10.2%; P = 0.003). In the multivariate analysis, DM was an independent predictor of repeat revascularization (hazard ratio: 1.818; 95% confidence interval: 1.162-2.843; P = 0.009). Conclusions DES implantation provides favorable early and mid-term results in both DM and non-DM patients undergoing PCI for complex lesions. After a mean follow-up of two years, DM and non-DM patients with complex CAD treated by PCI using new-generation DES showed no differences with regard to MACCE and other secondary end points. However, higher rates of ischemia-driven repeat revascularization were observed in DM patients.

Prognostic value of area flow index in patients with acute ST elevation myocardial infarction: clinical and echocardiographic outcomes

Background: Early restoration of patency of infarct related artery is a universally accepted goal in the treatment of acute myocardial infarction. These could be achieved by Primary PCI or fibrinolysis. Primary PCI is preferred reperfusion strategy over fibrinolysis. Identifying initial area at risk in patients with acute myocardial infarction had been shown to have a direct impact on patients adverse clinical outcomes as well as prediction of systolic dysfunction. Area flow index (AFI) calculation in patients with acute myocardial infarction may predict initial area at risk during primary PCI. Aim: To investigate the clinical utility of Area flow index to predict systolic dysfunction and adverse clinical outcomes in patients with acute anterior ST elevation myocardial infarction Patients: 250 consecutive patients with acute anterior ST elevation myocardial infarction treated with primary PCI presenting to Alexandria main university hospital and ICC hospital from June 2013 till December 2014. Methods: Echocardiographic assessment of LV systolic function 5-7 days after myocardial infarction by calculation of ejection fraction using modified simpson method. Area flow index was calculated by dividing culprit segment cross sectional area to total coronary cross sectional area. Where DC is the culprit segment diameter, D1 left anterior descending diameter, D2 left circumflex diameter, D3 right coronary diameter. All patients were followed one month for the occurrence of MACE. Results: Patients were grouped according to their ejection fraction following myocardial infarction into 3 groups: -Group I: severe LV systolic dysfunction EF <30%. -Group II: moderate LV systolic dysfunction EF 30-45%. -Group III: mild LV systolic dysfunction EF>45% There was a significant negative correlation between AFI and LVEF (r=-0. 58, P<0. 001). The mean AFI for patients in group I was 33. 1 ± 7.4, patients in group II was 26. 6 ± 7.4, and those in group III was 20.0 ± 6. 1. AFI>28.4% had a 75.6% sensitivity and 78.1% specificity in predicting severe LV systolic dysfunction. Also the composite one month MACE was higher in the group with AFI>28.4% (p<0. 001). Conclusion: Area flow index calculated from coronary angiography at time of primary PCI is a new strong independent predictor of LV systolic dysfunction and 1month MACE in patients with acute anterior myocardial infarction. Ayad et al., Pigmentary Disorders 2016, 3:2 DOI: 10.4172/2376-0427.1000236 Research article Open Access Pigmentary Disorders ISSN:2376-0427 JPD, hybrid open access journal Volume 3 • Issue 2 • 1000236 Jo ur na l of Pigmentary Dirders World Health Academy ISSN: 2376-0427 Journal of Pigmentary Disorders

TCT-651 Feasibility and clinical outcomes of ≥38 mm long drug eluting stent treatment for diffuse coronary artery disease in Egyptian population

Diffuse long lesions are commonly encountered in routine clinical practice and often lead to use long or overlapping stents. Limited data are available on the long-term efficacy and safety of long drug-eluting stents (DES) in this complex lesion subset. We investigated the long-term efficacy and