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QT interval prolongation on surface ECG shows significant association with mechanical dyssynchrony and LV dysfunction in HCM. This may add pathophysiological insight into understanding ECG changes in such myocardial disease.

Objectives: Our study aimed to demonstrate the early negative impact of right ventricular apical pacing induced by single (VVI) and dual chamber (DDD) pacemakers on LV functions in patients with preserved EF. And to assess that single brain natriuretic peptide (BNP) after 2 months of implantation is correlated to ventricular dyssynchrony. Methods: 40 patients with implanted VVI and DDD pacemakers were examined before implantation and again after 2 and 6 months of implantation for BNP, left ventricular (LV) systolic and diastolic functions by echocardiography and pulsed tissue Doppler. After 6 months, patients with DDD pacemakers were crossed over to VVI mode of pacing for 2 weeks with lower rate programed to 60 beat per minute then sample for BNP was collected again. Results: There was no statistically significant difference in LV systolic and diastolic functions except for myocardial performance index (MPI) with (P value of 0.03). Mean BNP level in VVI pacing was higher than DDD pacing after two months with P value = 0.001 while comparison after 6 months showed P value = 0.023. There was a statistically significant difference between both groups in results of aortic preejection delay (APED) (P value of <0.05). BNP was correlated to APED (r = 0.651 and P value = 0.001) and pacing percentage (r = 0.687 and P value = 0.00). Conclusion: Loss of atrioventricular synchrony in VVI mode leads to a significant difference in LV dyssynchrony between both groups. BNP level is correlated to LV dyssynchrony and pacing percentage. ª 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Cardiology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Background: Coronary no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) is associated with a poor clinical outcome. Although its pathophysiology is not fully understood, a deregulated systemic inflammatory response plays an important role. We aimed to explore the relationship between platelet\lymphocyte ratio (PLR) and no-reflow in patients with acute STEMI who were treated with a primary percutaneous coronary intervention (PPCI). Methods: A total of 200 patients with STEMI undergoing PPCI were included in the study. Transthoracic echocardiographic examination was performed to assess left ventricular (LV) ejection fraction (EF) and wall motion score index. Blood samples were assayed for platelet and lymphocyte count before PPCI. No-reflow was defined as coronary blood flow thrombolysis in myocardial infarction grade ≤II. Results: No-reflow was observed in 58 (29%) of STEMI patients following PPCI. PLR was significantly higher in hypertensive patients compared to normotensive patients (144.7±91.6 vs. 109.1±47.1, respectively, P <0.001) and in the no-reflow group compared to the normal reflow group (214±93 vs. 101.6±51.3, respectively, P <0.0001). Logistic regression analysis revealed that PLR (β: 0.485, 95% CI: −0.006-0.001, P <0.002) and LV EF (β: 0.272, 95% CI: 0.009-0.034, P <0.001) were independent predictors of no-reflow after PPCI. Conclusion: Pre-procedural increase in PLR is predictive of the no-reflow phenomenon following PPCI in STEMI patients. Relevance for Patients: No reflow phenomenon is an unfavorable complication following PPCI in patients with acute STEMI. High pre-procedural PLR is an independent predictor of reperfusion failure and helps to identify patients who require prophylactic treatment.

BackgroundLeft ventricular (LV) diastolic dysfunction is a prominent feature of hypertrophic cardiomyopathy (HCM). Prediction of LV filling pressure using the ratio between early diastolic transmitral flow and mitral annular velocity (E/e') had proved a good accuracy.Aim of this studyWe investigated the value of E/e' to predict cardiovascular (CV) mortality in patients with HCM.MethodsA total of 243 patients with HCM had E/e' measured in combination with clinical evaluation, conventional echocardiographic measurements, cardiopulmonary exercise evaluation, and Holter monitoring.ResultsDuring a mean follow‐up of (3.2 ± 1.2 years), 17 (7%) patients died. Non survivors had significantly higher SBP, DBP, left ventricular outflow tract obstruction (LVOTO) gradient, mitral E, and E/e', but lower e' of mitral annulus and more prevalent restrictive filling pattern. E/e' was directly correlated with age (r = .24, P < .005), left atrial volume index (r = .44, P < .0001), LVMI (r=0.23,P<.005), LVOT gradient (r = .43, P < .0001), NYHA class (r = .19, P < .006), pulmonary artery pressure (r = .24, P < .005), positive family history of HCM (r = .22, P < .005), and inversely related to peak systolic velocity (S) (r = .44, P < .0001). By multivariate analysis, only LVOTO ([RR] 4.11, 95% CI 1.002 to 1.148, P < .04) and E/e' were independent predictors for overall mortality in HCM (relative risk [RR] 5.27, 95% CI 1.002 to 1.024, P < .02). The risk of dying increased with increasing E/e' ratio, being approximately 4 times higher for patients in the highest quartile (HR 3.8 (CI 1.38‐5.12, log‐rank < 0.002)).ConclusionsIn hypertrophic cardiomyopathy, the E/e' ratio remains a powerful predictor of all‐cause mortality, particularly if it is associated with LVOT obstruction.