Subclinical RV dysfunction-as estimated by TDI derived MPI-is highly prevalent among ESRD patients even before starting dialysis therapy. Pulmonary hypertension is not significantly associated with RV dysfunction in these patients.

Background and Purpose: The prevalence of carotid artery stenosis has been studied in several cohorts and groups of populations. Prevalence estimates were mostly based on ultrasound studies, because duplex ultrasound is accurate, reproducible and inexpensive to diagnose and follow up patients with arterial disorders. The purpose of our study was to describe the pattern of carotid artery disease in a large sample of Egyptians. Methods: We analyzed the data of 4,733 Egyptian subjects, who underwent extracranial carotid duplex scanning at the vascular laboratories of Cairo University Hospitals from January 1, 2003, to January 1, 2008. Demographic, clinical data and causes of referral were correlated with ultrasound findings. Results: Atherosclerotic carotid artery disease was present in 41% of the study population in the form of intimal thickening in 835 (17.6%), <50% stenosis in 983 (20.8%), 50–69% stenosis in 81 (1.7%), ≧70% stenosis in 38 (0.8%) and occlusion of internal carotid artery in 3 (0.06%) patients. Nonatherosclerotic disease was detected in 9 (0.2%) patients only. Significant and clinically relevant stenosis ≧50% was detected in 19 (2.5%) of the atherosclerotic symptomatic subjects. Multivariate stepwise logistic regression analysis selected age, diabetes mellitus, hypertension, smoking and dyslipidemia as independent predictors of the presence of carotid atherosclerotic disease. Conclusion: Hemodynamically significant and clinically relevant extracranial atherosclerotic carotid disease is rare among Egyptians. Risk factors for carotid atherosclerosis are the same as in societies where carotid disease is more prevalent.

The prevalence of LV diastolic dysfunction in patients with COPD varies according to the used echocardiographic approach. Further studies are recommended to determine which approach is the most accurate in estimating the true prevalence of LV diastolic dysfunction among this group of patients.

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Increased sympathetic tone and use of bronchodilators increase heart rate and this may worsen functional capacity in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to look at the short-term effect of the heart rate lowering drug ivabradine on clinical status in COPD patients. We randomised 80 COPD patients with sinus heart rate ≥90 bpm into either taking ivabradine 7.5 mg twice per day or placebo for two weeks. We assessed all patients using the modifi ed Borg scale and 6-minute walk test at baseline and then again 2 weeks after randomisation. There were no signifi cant differences in age, sex, severity of airway obstruction (measured using forceful exhalation), severity of diastolic dysfunction or pulmonary artery systolic pressure between the two groups. The ivabradine group showed signifi cant improvement in 6-minute walk distance (from 192.6±108.8 m at baseline to 285.1±88.9 m at the end of the study) compared with the control group (230.6±68.4 at baseline and 250.4±65.8 m at the end of study) (p<0.001). This improvement in the drug group was associated with signifi cant improvement of dyspnea on modifi ed Borg scale (p=0.007). Lowering heart rate with ivabradine can improve exercise capacity and functional class in COPD patients with resting heart rate >90 bpm.