The association between tissue doppler-derived E/(e's') ratio and coronary atherosclerosis severity measured by the SYNTAX score in patients with non-ST elevation-acute coronary syndrome.

BACKGROUND: The prognosis of patients hospitalized with non-ST elevation-acute coronary syndrome (NSTE-ACS) is typically determined by the existence and severity of myocardial necrosis and left ventricular (LV) remodeling. AIM: The present study was to assess the association between the E/(e's') ratio and the coronary atherosclerosis severity, measured by the SYNTAX score, in patients with NSTE-ACS. METHODS: Utilizing a descriptive correlational research design, this study was prospectively conducted on 252 patients with NSTE-ACS, undergoing an echocardiography to determine the left ventricular ejection fraction (LVEF), the left atrial (LA) volume, the pulsed-wave (PW) Doppler-derived transmitral early (E) and late (A) diastolic velocities, and the tissue Doppler (TD)-derived mitral annular early diastolic (e') and peak systolic (s') velocities. After that, a coronary angiography (CAG) was performed, and the SYNTAX score was calculated. RESULTS: The patients were divided into two groups, viz., those with the E/(e's') ratio < 1.63 and the cases with the ratio ≥ 1.63. The results revealed that the patients with a high ratio were older, had a higher prevalence of females, a SYNTAX score ≥ 22, and a lower glomerular filtration rate than those with a low ratio (p-value < 0.001). Besides, these patients had larger indexed LA volume and lower LVEF than others (p-value: 0.028 and 0.023, respectively). Furthermore, the multiple linear regression outcomes established a positive independent association between the E/(e's') ratio ≥ 1.63 (B = 5.609, 95% CI 2.324-8.894, p-value = 0.001) and the SYNTAX score. CONCLUSION: The study results demonstrated that the patients hospitalized with NSTE-ACS and the E/(e's') ratio ≥ 1.63 had worse demographic, echocardiographic, and laboratory profiles and a higher prevalence of a SYNTAX score ≥ 22 than those with a lower ratio.

Correlation between albuminuria and tissue Doppler-derived left ventricular myocardial performance index in patients with type 2 diabetes.

BACKGROUND: Albuminuria is considered as a significant predictor of cardiovascular morbidity and mortality in patients with diabetes mellitus. The main purpose of this study was to determine the correlation between albuminuria and global left ventricular (LV) function in patients with type 2 diabetes (T2D). METHODS: This observational study was conducted on 80 consecutive asymptomatic patients with T2D and an LV ejection fraction ≥55%. The patients were divided into two groups depending on the presence or absence of albuminuria. Echocardiography-derived indices of the LV function were then compared between these groups. RESULTS: The patients with albuminuria were older (mean ± SD: 60.37 ± 9.05 vs 54.52 ± 10.26 years of age, P = .01) and had higher hemoglobin A1c (HbA1c) levels (8.45 ± 1.97 vs 7.25 ± 1.93 mg/dL, P = .012) than those without albuminuria. Among the echocardiographic variables, the patients with albuminuria had higher LV Tei-index (median [lower-upper quartile]: 0.620 [0.455-0.824] vs 0.441 [0.336-0.586], P < .001), more prolonged early filling (E)-wave deceleration time (274.87 ± 75.97 vs 239.40 ± 61.35 ms, P = .032), increased interventricular septal wall thickness (1.11 ± 0.31 vs 0.95 ± 0.21 cm, P = .012), and lower mean early diastolic mitral annular velocity (7.57 ± 2.34 vs 8.68 ± 2.46 cm/s, P = .046) than those without albuminuria. Among risk factors, only albuminuria and HbA1c levels were associated with a significant increase in LV Tei-index (Beta = 0.426 and P < .001, Beta = 0.226 and P = .042, respectively). CONCLUSION: The LV Tei-index was significantly higher in diabetic patients with than without albuminuria. Low HbA1c levels were correlated with a decrease in LV Tei-index.

Postsystolic index for distinguishing coronary artery disease in left bundle branch block.

BACKGROUND: Left bundle branch block (LBBB) is associated with a high risk of death, particularly from ventricular tachyarrhythmia and myocardial infarction. It is difficult to clinically differentiate between ischemic and nonischemic LBBB. In this study, we investigated whether advanced echocardiographic variables, such as strain delay index (SDI) and postsystolic index (PSI), can be used to distinguish coronary artery disease (CAD) in patients with LBBB. METHODS: Our study included 102 patients with LBBB. All patients underwent echocardiography. The left ventricular ejection fraction (LVEF), left ventricular mass, PSI, SDI, global longitudinal strain (GLS), and time-to-peak longitudinal strain were then calculated. Coronary angiography was performed, and the patients were divided into groups with significant CAD and without significant CAD. RESULTS: Patients in the group with significant CAD were older than the patients in the group without significant CAD. The group had a higher prevalence of diabetes mellitus, hypertension, hyperlipidemia, and family history of CAD than the group without significant CAD. The group with significant CAD also had lower LVEF and GLS than the group without significant CAD. The group without significant CAD showed a direct correlation between LVEF and SDI and an inverse correlation between LVEF and PSI: P value = 0.040 and r = 0.255, and P value = 0.001 and r = -0.427, respectively. However, the group with significant CAD did not show any significant correlation between LVEF and SDI or PSI. CONCLUSION: Strain delay index and PSI may be useful markers in distinguishing CAD in patients with LBBB and preserved LVEF.

The association between myocardial early systolic lengthening and high risk angiographic territory involvement in patients with non-ST-segment elevation myocardial infarction.

BACKGROUND: Non-ST-segment elevation myocardial infarction (NSTEMI) is more common than ST-segment elevation myocardial infarction (STEMI), consisting of 60-70% of myocardial infarctions. When left ventricular (LV) pressure increases during early systole, regionally ischaemic myocardium with a reduced active force exhibit stretching. The aim of this study was to evaluate the role of this parameter in determining high risk angiographic territory involvement in NSTEMI patients. RESULTS: This study was a descriptive correlational research that was conducted on 96 patients with NSTEMI and a left ventricular ejection fraction ≥ 50% who underwent coronary angiography (CAG). Patients were divided into two groups based on having or not having high risk angiographic territory involvement in CAG. All patients underwent a transthoracic echocardiography during the first day of hospitalization and early systolic lengthening (ESL), duration of ESL (DESL), left ventricular global longitudinal strain (LVGLS), pulsed-wave Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. The results of this study showed DESL, DESLLAD, and DESLLCX were longer in high risk angiographic territory group than other one (P value 0.016, 0.044, and 0.04, respectively). The logistic regression analysis showed among different variables, only age and ESLLAD had an independent association with high risk angiographic territory involvement (P = 0.01, odds ratio [OR] 1.09, 95% CI 1.021-1.164, and P = 0.024, odds ratio [OR] 1.243, 95% CI 1.029-1.50, respectively). CONCLUSIONS: Assessment of myocardial ESLLAD by speckle-tracking echocardiography may be helpful in predicting high risk angiographic territory involvement in patients with NSTEMI. Indeed, a higher value can be considered as a high risk parameter which may show benefit of an early invasive strategy versus a conservative approach.

The correlation between epicardial fat thickness and longitudinal left atrial reservoir strain in patients with type 2 diabetes mellitus and controls.

BACKGROUND: Diabetes mellitus (DM) has been documented among the strongest risk factors for developing heart failure with preserved ejection fraction (HFpEF). The earliest imaging changes in patients with DM are the left atrial (LA) functional and volumetric changes. The aim of this study was to determine the correlation between epicardial fat thickness (EFT) and longitudinal LA reservoir strain (LARS) in patients with type 2 DM (T2DM), as compared with non-diabetic controls. RESULTS: The study samples in this case-control study comprised of consecutive patients with T2DM (n=64) and matched non-diabetic controls (n=30). An echocardiography was performed on all patients and EFT, volumetric and longitudinal LARS, left ventricular (LV) global longitudinal strain (LVGLS), pulsed-wave Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were obtained. The study results demonstrated that the patients with T2DM had thicker EFT (5.96±2.13 vs. 4.10±3.11 mm) and increased LA volume index (LAVI) (43.05± 44.40 vs. 29.10±11.34 ml/m2) in comparison with the non-diabetic ones (p-value: 0.005 and 0.022, respectively). On the other hand, a direct association was observed between EFT and the E/e' ratio, and an inverse correlation was established between EFT and LARS in patients with T2DM (r=0.299, p-value=0.020 and r=- 0.256, p-value=0.043, respectively). However, regression analysis showed only LV mass index (LVMI) (ß=0.012, 95% CI 0.006-0.019, p-value<0.001), LAVI (ß=- 0.034, 95% CI - 0.05-0.017, p-value<0.001), and EFT (ß=- 0.143, 95% CI - 0.264-- 0.021, p-value=0.021) were independently correlated with LARS. CONCLUSIONS: LARS is considered as an important early marker of subclinical cardiac dysfunction. Thickened epicardial fat may be an independent risk factor for decreased LA reservoir strain. Diabetics are especially considered as a high risk group due to having an increased epicardial adipose tissue thickness.

Potential Cardiotoxic Effects of Remdesivir on Cardiovascular System: A Literature Review.

Corona disease 2019 (COVID-19) pandemic continues to spread around the world with no efficacious treatment. Intravenous remdesivir is the only authorized drug for treatment of COVID-19 disease under an Emergency Use Authorization. Remdesivir is a 1'-cyano-substituted adenosine nucleotide prodrug which inhibits viral RNA synthesis. This metabolite is an adenosine analog but with a significantly longer half-life than adenosine. Adenosine is a powerful vasodilator that can cause profound hypotension which is followed by the compensatory release of catecholamines. It can also shorten atrial action potential and refractoriness and lead to atrial fibrillation (AF). These effects may also occur in ventricular cells and predispose patients to ventricular fibrillation. Remdesivir can also induce significant cytotoxic effects in cardiomyocytes that is considerably worse than chloroquine cardiotoxic effects. Remdesivir-induced cardiotoxicity is due to its binding to human mitochondrial RNA polymerase. On the other hand, remdesivir can increase field potential duration with decreased Na+ peak amplitudes and spontaneous beating rates in a dose-dependent manner that might induce prolonged QT interval and torsade de point. There are some reports of sinus bradycardia, hypotension, T-wave abnormalities, AF, and a prolonged QT interval and few cases of cardiac arrest and complete heat block following remdesivir infusion. It seems remdesivir have some cardiotoxic and proarrhythmic effects that are especially more pronounced in patients with previous cardiovascular diseases. The current safety profile of remdesivir is still not completely known and further prospective clinical trials are needed to assess its safety profile and potential adverse cardiovascular effects.

Correlation Between Glycated Hemoglobin (HbA1c) and Post-Systolic Index Measured by Speckle-Tracking Echocardiography in Patients with Non-apparent Coronary Artery Disease.

Glycated hemoglobin (HbA1c) is a useful biomarker for the diagnosis of diabetes and also for determination of individuals with an increased risk of a severe disease. Some subtle changes in myocardial contractile function is measurable by post-systolic index (PSI) which is defined as late systolic shortening after aortic valve closure. The aim of our study was to determine the relationship between HbA1c and PSI in patients with non-apparent coronary artery disease (CAD) on angiograms. This study was a historical cohort study on 85 consecutive patients with a left ventricular ejection fraction ≥ 50% and non-apparent CAD on angiogram. Patients were divided into two groups based on their HbA1c levels, regardless of the diagnosis of diabetes in these patients, to patients with an HbA1c level of equal or higher than 5.7% and those with an HbA1c of less than 5.7%. A speckle-tracking echocardiography was performed for all patients and global longitudinal strain, PSI, left ventricular diameters, left atrial volume, pulsed-Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. PSI, E/e' ratio, and A wave were higher and e' velocity was lower in patients with HbA1c ≥ 5.7% than those with a level of < 5.7% (P value = 0.04, 0.001, 0.014, and 0.004, respectively). Other echocardiographic variables were not different between two groups. Multiple linear regression analysis showed the association between HbA1c and PSI was independent of other demographic, biochemical, and echocardiographic variables (B = 35.674, 95% CI 10.741-60.606, P value = 0.006). Our study showed PSI is more pronounced in individuals with an HbA1c > 5.7% than those with a lower value in the absence of CAD. Because PSI is an important indicator of adverse outcome and increased mortality, these data can underline the importance of an abnormal HbA1c level and its association with subtle cardiac dysfunction, irrespective of the diagnosis of diabetes in patients with non-apparent CAD.

Semi-mobile rudimentary tissues attached to a congenital intramitral ring in a woman with previous history of embolic stroke: A rare case report.

Isolated congenital mitral ring is a very rare subtype of congenital mitral valve malformation, which accounts for about one-third of congenital cardiac anomalies associated with left ventricular inflow obstruction. A mitral ring may be easily missed unless the disease is suspected. The mitral valve repair should be considered in symptomatic patients with mitral stenosis. We report a rare case of a 43-year-old woman with an intramitral ring who experienced previous embolic stroke with left hemiplegia. However, stroke happened several years ago and it does not completely prove causality.

Epicardial adipose tissue and its association with cardiovascular risk factors and mitral annular calcium deposits.

INTRODUCTION: Epicardial fat is a variety of visceral adipose tissue that secretes pro-inflammatory cytokines that can lead to progression of atherosclerosis. Previous studies have shown a correlation between cardiovascular risk factors and severity of mitral annular calcification. The aim of our study was to assess the correlation between epicardial fat thickness and mitral annular calcification. METHODS: This study recruited 188 patients who were considered for coronary angiography and underwent echocardiography within 24 hours of admission. Epicardial fat thickness was measured in the parasternal long axis view at the end-systole. Mitral annular calcification was visualized in the parasternal short-axis view and was grade as none, mild, moderate, and severe. Furthermore, left atrial diameter, severity of mitral regurgitation, left ventricular ejection fraction, and early diastolic velocities (E wave) determined by transmitral pulsed Doppler, the early mitral annular velocities measured by tissue Doppler (e'), and E/e' were obtained. RESULTS: Patients with an epicardial fat thickness ≥7 mm had higher prevalence of hypertension and higher SYNTAX score (p value = 0.002 and 0.0014, respectively). Also, mitral annular calcification was both more prevalent and more extensive (p value = 0.007 and <0.001, respectively) and left atrial diameter was larger in these patients compared with patients with epicardial fat thickness <7 mm (p value = 0.001). CONCLUSIONS: Our study showed significant association between increased epicardial fat thickness and calcium deposits in the mitral valve annulus that is a degenerative process associated with cardiovascular risk factors.