Yehia Taha Kishk

Circulating Endothelial Cells and Platelet Microparticles in Mitral Valve Disease With and Without Atrial Fibrillation

Hypercoagulability in mitral valve disease (MVD), a cause of atrial fibrillation (AF) and stroke, is potentially due to endothelial damage/dysfunction (marked by circulating endothelial cells [CECs]), platelet activation (soluble P-selectin [sPsel], platelet microparticles [PMPs], and soluble CD40 [sCD40]), and oxidized low-density lipoprotein (oxLDL) cholesterol. We measured these variables in 24 patients with MVD as well as in 21 with MVD + AF and compared them with 20 healthy controls (HCs). The CECs and PMPs were measured by flow cytometry; sPsel, oxLDL, and CD40 by enzyme-linked immunosorbent assay. Compared with HCs, sPsel and PMPs were equally higher in MVD and MVD + AF; sCD40 and oxLDL were higher in MVD + AF than in HCs and MVD; and CECs were higher in MVD than in the HCs, with further increases in MVD + AF (all P < .001). We conclude that excess platelet activation is present in MVD regardless of AF, and that increased endothelial damage in MVD is greater when compounded by AF.

Predictors of no-reflow in patients undergoing primary percutaneous coronary intervention. Thrombus aspiration was protective

Primary percutaneous coronary intervention (P-PCI) is the best available reperfusion strategy in patients with acute ST-segment elevation myocardial infarction (STEMI).1 However establishing myocardial reperfusion by P-PCI is associated with a serious complication called no reflow (NR); defined as final Thrombolysis in myocardial infarction (TIMI) flow <3 or TIMI 3 flow with TIMI myocardial blush grade (TMBG) 0 or 1 in absence of mechanical obstruction.2 NR is considered to be an under-reported complication with a low incidence (1–3%) in large registries, based on TIMI flow grade, MBG and ST resolution.3 Modern more sensitive methods of assessing NR and microcirculatory dysfunction, including myocardial contrast echocardiography (MCE) and cardiac magnetic resonance imaging (CMR), have recorded a higher incidence (10–30%).4 Although these techniques have greater accuracy for detecting post-PCI suboptimal reperfusion, TIMI flow grade is the easiest and most commonly used method of evaluating P-PCI success.5, 6 The objective of the present trial was to identify the prevalence of NR in patients with STEMI undergoing P-PCI in the current era and its predictors with short term outcome.

Incidence of Impaired Glucose Tolerance Assessed by Glycated Hemoglobin and Fasting Plasma Glucose in Patients with Acute Coronary Syndromes and its Impact on Clinical and Angiographic Outcomes

Impaired glucose tolerance (IGT); diabetes and prediabetes, is common among patients with CAD. Diabetic patients usually have a worse clinical course, so it is important to detect diabetes and even prediabetes, since progress to T2DM can be retarded by lifestyle interventions. It is known that OGTT is recommended in patients with CAD, but still HbA1c and FPG are more clinically applicable. Our study aimed to assess the incidence of IGR in patients with ACS using HbA1 and FPG as most of previous studies used OGTT and to study the impact of IGR on in hospital clinical outcomes and severity of coronary arteries lesions using Syntax score.

Correlation of corrected QT dispersion with the severity of coronary artery disease detected by SYNTAX score in non-diabetic patients with STEMI

Introduction Determination of the QT interval dispersion by means of a standard ECG at rest has been widely used for cardiovascular risk assessment during the last 15 years as one of the recent explanations for the development of life threatening ventricular arrhythmias. However, little is known about the relation between QT dispersion and the severity of coronary artery atherosclerosis as defined by SYNTAX score. Aim of work: The present study was done to assess the correlation between QTc dispersion and the severity of coronary artery disease in acute ST elevation myocardial infarction (STEMI) detected by SYNTAX score. Patients and methods It included 50 patients who were non-diabetic, non-hypertensive and diagnosed as acute STEMI within 6 months undergoing coronary angiography in the cath. lab. of Assiut University Hospital. QT dispersion was calculated as the difference between the longest (QT max) and the shortest QT (QTmin) interval recorded by standard 12 lead ECG. The QT interval was corrected by using Bazett’s formula (QTc = QT/square root of R-R interval in seconds). Corrected QT dispersion (QTcd) was defined as the difference between the maximum and minimum QTc for a given heart rate. The SYNTAX score is calculated by syntax calculator, a new tool to grade the complexity of coronary artery disease. Results Out of 50 participating patients, there were 43 (86%) males with mean age 53.9 ± 12.1 years. The mean QTc dispersion was 83.1 ± 20.3 ms, while mean SYNTAX score was 11.6 ± 6.1. There is a strong positive correlation between QTc dispersion and SYNTAX score. This was not related to age, gender, risk factors or family history of ischemic heart disease. Of note, there was a relationship between QTc dispersion and serum creatinine. Conclusions Our study concluded that there is a significant positive correlation between corrected QT dispersion and severity of coronary artery disease as assessed by SYNTAX score.