Real-time three-dimensional transthoracic echocardiography for predicting mitral annuloplasty ring size.

BACKGROUND AND AIM OF THE STUDY: Despite advances in mitral valve repair techniques, including robotic surgeries, few studies are available on predicting mitral annuloplasty ring size using echocardiography. Furthermore, these studies either had limited accuracy or else required the use of three-dimensional transesophageal echocardiography (3D-TEE), an expensive and semi-invasive tool. The study aim was to predict the mitral annuloplasty ring size preoperatively using real-time, three-dimensional transthoracic echocardiography (RT3D-TTE), which is a cheaper, non-invasive technique. METHODS: This prospective study included 47 consecutive patients scheduled for elective mitral valve surgery. All participants underwent preoperative RT3D-TTE. The mitral annular transverse diameter during early systole and the maximum height of the A2 scallop were measured in the multiplanar reconstruction mode. The surgeon, who was blinded to the echocardiographic measurements, also measured these two variables intraoperatively. A Pearson correlation coefficient was used to assess the association between the echocardiographic and operative measurements. A linear regression analysis was used to predict the annuloplasty ring size. RESULTS: A total of 34 patients (72.3%) underwent mitral valve repair. The echocardiographic measurements of the mitral annular transverse diameter were well correlated with the operative measurements (r = 0.64, p < 0.001). A moderate correlation was observed between the echocardiographic and operative measurements of A2 height (r = 0.59, p < 0.001). Linear regression analysis yielded an equation that predicted the annuloplasty ring size (R = 0.828, p < 0.001). CONCLUSION: RT3D-TTE was used successfully to predict the mitral annuloplasty ring size. This technique may potentially aid surgical planning, particularly before robotic procedures are performed.

Management of Diabetes and Hypertension within the Gulf Region: Updates on Treatment Practices and Therapies.

Cardiovascular disease (CVD) is a leading cause of death globally, driven by the high rates of risk factors, such as diabetes and hypertension. As the prevalence of these risk factors is particularly high in the Gulf region, better diagnosis and management of type 2 diabetes (T2D) and hypertension has the potential to dramatically reduce adverse cardiovascular outcomes for individuals in that part of the world. This article provides a summary of presentations made during the EVIDENT summit, a virtual symposium on Evidence in Diabetes and Hypertension, held in September 2021, including a review of the various guidelines for both T2D and hypertension, as well as recent findings relevant to the safety and efficacy for therapies relating to these conditions. Of relevance to the Gulf region, the risk of hypoglycaemia with sulfonylureas during Ramadan was reviewed. For the management of T2D, sulfonylureas have been a long-standing medication used to achieve glycaemic control; however, differences have emerged between early and later generations, with recent studies suggesting improvements in the safety profiles of late-generation sulfonylureas. For patients with hypertension, incremental therapy changes are recommended to reduce the risk of cardiovascular complications that are associated with increasing blood pressure. For first-line therapy, angiotensin-converting enzyme inhibitors (ACEi), such as perindopril, have been demonstrated to reduce the risk of cardiovascular and all-cause mortality. The addition of calcium channel blockers and diuretics to ACEi has been shown to be effective in patients with poorly controlled hypertension. The different renin-angiotensin-aldosterone system inhibitors are reviewed, and the benefit of combination therapies, including amlodipine and indapamide in patients with difficult-to-control hypertension, is investigated. The benefits of lifestyle modifications for these patients are also discussed, with important clinical considerations that are expected to inform patient management in daily clinical practice.