No abstract

Background: Coronary artery bypass grafting (CABG) continues to be the best standard in the management of severe coronary artery disease (CAD), providing good symptom management and life extension. Although CABG was first performed by reversed saphenous veins (SVGs), surgeons have increasingly adopted arterial conduits because of their longer-term patency and resistance to atherosclerosis. CABG's efficacy may potentially be affected by the extension of atherosclerosis in the native coronary arteries. Few researches have investigated the long-term angiographic disease progression of native coronary arteries after surgical revascularization, or the variables that may impact this progression. Proximal native disease progression was presented to be two to six times more common than distal disease progression, with greater rates of progression in coronaries bypassed by SVGs than arterial grafts. The goal of this research was to determine influence of CABG on the extension of native coronaries atherosclerosis. Methods: This prospective study was established on 25 patients who were diagnosed to have ischemic heart disease in cardiothoracic surgery department in Faculty of Medicine Menoufia University. Results: The study showed that according to the risk factors among the studied cases, smoking was (60%), Dyslipidemia was (32%), HTN was (32%) and Diabetes was (32). According to grafts in proximal lesions, there was progression of atherosclerosis up to total occlusion, but in Distal lesions, there was significant regression of atherosclerosis. As result, there was statistically significant difference between proximal with distal lesions. Also, study showed that there was a significant difference between left system (LAD, D, OM) in comparison with right system (PDA) regarding distal lesion. Our results showed that univariate logistic regression analysis for progression in distal lesion regarding Dyslipidemia and Diabetes. Conclusion: Progression of disease is more evident in coronary segment proximal to anastomosis, while regression of disease is more evident in coronary segment distal to anastomosis with statistically significant difference between them, also the risk of disease progression post CABG was found to be multifactorial, as certain risk factors can affect progression of the disease as Diabetes mellitus and dyslipidemia that were of statistically significance.

This study aims to evaluate the torsional dynamics and 2D speckle tracking in heart failure with reduced ejection fraction on patients taking angiotensin receptor neprilysin inhibitors (ARNI) and none. ARNI has been shown to be superior to enalapril in the long term reducing the mortality and hospitalization of heart failure (HF). However short-term effects on diastolic function remain unclear. We sought to evaluate 6 months' effects of ARNI on left ventricular (LV) diastolic parameters determined by speckle tracking and tissue Doppler imaging. This study was carried out in Menoufia University Hospitals including 60 patients of HFrEF during the period from August 2019 to January 2020. (50%) of patients were treated with traditional treatment of heart failure and the remaining were treated with ARNI. Data were collected including history and clinical examination. ECG and speckle tracking and tissue Doppler imaging were done to evaluate the diastolic function. Our results showed no significant difference between the two groups at baseline. There was a significant improvement in the LV diastolic function parameters. Untwisting time and untwisting onset showed the highly significant parameters of improvement. This study concluded that ARNI showed short term improvement of diastolic function of the left ventricle that could be detected by STE.