BackgroundIvabradine is approved to improve exercise tolerance and quality of life in patients with chronic heart failure; its use in acute heart failure (AHF) has not previously been studied.MethodsForty adult patients admitted with AHF were randomized into two groups; Group 1 patients were prescribed beta-blockers (BBs) and Group 2 patients were prescribed ivabradine. Both groups were given optimum anti-failure treatment for AHF. All patients were assessed for heart rate (HR), 6-minute walk test (6MWT), New York Heart Association (NYHA) classification, and Minnesota Living With Heart Failure Questionnaire (MLWHFQ) before and after 1 month of therapy.ResultsBBs or ivabradine among optimum medical therapy for AHF resulted in a significant improvement in all the studied parameters (NYHA class; 6MWT distance; HR and Borg scale dyspnea/fatigue score before and after the walk). The MLWHFQ was significantly worse during the follow-up in both groups. At the end of follow-up, there was a comparable beneficial effect attributed to the significant HR reduction observed in both groups.ConclusionThe results of this pilot study demonstrated the safety of the early use of ivabradine alone versus BBs when tolerated in patients admitted with AHF (both acutely decompensated as well as de novo). Both groups achieved comparable reduction in HR with improvement in functional capacity and exercise tolerance.

Aim: The purpose of the study is to evaluate the relationship between red blood cell distribution width (RDW) and coronary calcium score in diabetic patients. Methods: Hematological parameters of 100 diabetic (Type II) patients were assessed. Computed tomographic angiography was used to asses coronary artery calcium (CAC) score. Results: Mean age of the study cohort was 55 years (males: 60%). Mean RDW was 12.7%. Mean CAC score was 243. There was a significant correlation between RDW and each of: CAC scores (r = 0.53; p < 0.001) and severity of coronary artery disease (CAD; r = 0.25; p = 0.047). A cut-off value >14.2% (receiver operating characteristic curves) predicted CAC score >400. A cut-off value >-14.6% predicted the presence of significant CAD. Conclusion: Diabetic patients with high-CAC scores and significant CAD had higher RDW.

Hypertension is an important non-communicable disease in Africa. It is the most important cardiovascular risk factor. The effect of hypertension on left ventricle has been documented for long time, but sparse and consistent evidence shows an impact of hypertension on the right ventricle. The RV can be studied with many imaging and functional modalities. In clinical practice, echocardiography is the mainstay of evaluation of RV structure and function. Aim of this study was to analyze impact of presence and severity of systemic arterial hypertension (HTN) on right ventricular function measured by tissue Doppler echocardiography. For this aim we included sixty consecutive patients from outpatient clinics and thirty healthy age and sex matched individuals and made a full 2D and tissue doppler study for the RV and compared results for non-hypertensives, stage 1 and stage 2 hypertensives. Doppler data obtained at the tricuspid valve showed statistically significant results regarding E, E/A, DT and IVRT correlating the presence and degree of hypertension with RV diastolic function (p<0.001). The current study demonstrated that RV diastolic dysfunction not only is an early marker that is correlated to presence of systemic arterial hypertension but also showed it to be a marker of its severity and degree of control as conveyed by stage of hypertension.

Background Right ventricular (RV) involvement in acute left ventricular (LV) myocardial infarction (MI) is frequently underestimated in the clinical setting owing to the diagnostic limitations of the electrocardiogram and echocardiography. Objective To assess RV function in patients presented with first acute anterior ST elevation myocardial infarction (STEMI) who underwent successful primary percutaneous coronary intervention (PCI) and factors affecting it. Methods Forty consecutive patients with anterior STEMI who underwent successful primary PCI were enrolled in the study. Presence of a coexisting clinical condition that might affect RV function, patients with RV infarction or those having significant stenosis (>50%) affecting RV branch or right coronary artery proximal to RV branch were excluded. Echocardiography was performed during the hospital stay to assess the LV and RV systolic and diastolic function with special focus on tricuspid annular plane systolic excursion, RV end-diastolic dimension, right atrial area, RV fractional area change, and tissue Doppler-derived myocardial performance index. Results and Conclusion RV dysfunction according to our definition in the first anterior MI occurred in (55%) of the study population. Independent predictors for abnormal RV function were left circumflex artery mid or proximal affection, eventful procedure, occurrence of no reflow, glucose level, LV end-systolic dimension, LV end-diastolic dimension, and LV ejection fraction.

Background: Cardiovascular disease (CVD) has emerged as the leading cause of death worldwide. Multiple meta-analyses have demonstrated that cardiac rehabilitation (CR) reduces mortality in patients with coronary artery disease. Despite guidelines recommending the use of CR programs for patients with ST segment elevation myocardial infarction (STEMI) participation in these programs continues to be low which had led to the development of alternative models of CR. Objective: To evaluate the efficacy of home-based cardiac rehabilitation (HBCR) program in patients presenting with STEMI in a comparison with the standard inhospital CR program. Methods: The study included 70 Patients referred for cardiac rehabilitation unit at Ain shams university hospitals after STEMI successfully treated by primary PCI. Patients were subdivided into two (2) groups according to patients' preference to different modalities of cardiac rehabilitation: a. Group (A): 35 patients who underwent regular in-hospital cardiac rehabilitation b. Group (B): 35 patients who couldn't undergo regular in-hospital cardiac rehabilitation and preferred to undergo home-based cardiac rehabilitation Outcome measures were assessed at baseline and after completion of the CR program in the form of: a. 12 hr fasting lipid profile (TC, HDL, LDL and TGs). b. Transthoracic echocardiographic examination for assessment of Ejection fraction (EF%) by 2D modified biplane Simpson's method c. Symptom limited treadmill exercise stress test using Modified Bruce protocol: The following parameters were recorded: Resting blood pressure, resting heart rate (HR) and maximum achieved HR, HR recovery at 1 minute (HRR1), HR reserve and metabolic equivalents of task (METs) achieved. Results: No significant differences between both groups regarding baseline lipid profile, EF% and Exercise test parameters before starting the CR program. There was a statistically significant improvement in Lipid profile, EF% and Exercise test parameters (METs, Exercise time, peak HR, HR reserve and HRR) after completion of the CR program in both groups with no statistically significant difference between both groups regarding delta changes in the studied parameters. Conclusion: Home-based cardiac rehabilitation does not have inferior outcomes compared to hospital-based supervised program in post MI patients and may offer an alternative model of CR for individuals less able to access center-based cardiac rehabilitation.