There is a strong association between pre-operative diastolic dysfunction and difficulty in weaning from cardiopulmonary bypass. We compared the effects of propofol and isoflurane on left ventricular diastolic function in patients with pre-existing diastolic dysfunction undergoing coronary artery bypass grafting. We randomly allocated 60 patients to receive either propofol or isoflurane anaesthesia, and assessed left ventricular diastolic function using transoesophageal echocardiography. We measured early (E), late (A) diastolic velocities, E/A ratio, A-wave duration and deceleration time using pulsed wave Doppler, and early (Em), late (Am) diastolic velocities of the mitral annulus, Em/Am ratio and isovolumetric relaxation time using tissue Doppler. We measured pulmonary venous flow velocity and recorded values for the peak systolic flow velocity (S), peak diastolic flow velocity (D), S/D ratio, peak reverse atrial flow velocity and duration of reverse atrial flow. All data were recorded immediately after tracheal intubation as a baseline, 5 min before sternotomy (T ), 5 min before aortic cannulation (T ) and 15 min after weaning from cardiopulmonary bypass (T ). Both propofol and isoflurane improved left ventricular diastolic function as evidenced by significant increases in E/A ratios, and significant decreases in deceleration time and isovolumetric relaxation time; the improvement was greater in the isoflurane group (between groups, p = 0.001 for both E/A ratio and deceleration time at T and T and p = 0.006 for isovolumetric relaxation time at both T and T ). Furthermore, Em/Am ratio, S, D and S/D ratios were significantly better in the isoflurane group. The administration of isoflurane during cardiac surgery improves diastolic function comparatively more than propofol.

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Background The current expert view of the PCSK9 inhibitors’ use in Egypt is still ambiguous. Main body Hyperlipidemia is an important, if not the most important, risk factor for the occurrence of atherosclerosis worldwide. Egypt is the most populous country in the Middle East and North Africa and has > 15% of the cardiovascular deaths in the region. The burden of dyslipidemia as seen in the recently published CardioRisk project conducted throughout Egypt shows a high prevalence of dyslipidemia as a risk factor that is still reaching up to 71% in female participants. Reaching the targets for LDL lowering, and thus control of hyperlipidemia, is quite often very difficult especially with the update of the last ESC guidelines. With the advent of PCSK9 inhibitors, the control rate of patients, reduction of cardiac major adverse events, and mortality have been improved. However, Egypt is not considered a rich country on the grounds of annual income, and this raises a concern on which patients would benefit from these expensive medications. Revising the randomized control trials, we analyzed the data that would enable us to control LDL in those patients, at risk, to obtain simple clear indications for the use of these rather expensive medications. Conclusion We recommend the use of PCSK9 inhibitors in addition to statins ± ezetimibe in patients with ASCVD, by definition at very high risk; patients with ASCVD at very high risk who do not tolerate appropriate doses of at least three statins; and familial hypercholesterolaemia patients with clinically diagnosed ASCVD, at very high cardiovascular risk.