Background Nicorandil in conjunction with primary percutaneous coronary intervention (PPCI) has been reported to exert cardioprotective effect in patients with ST segment elevation myocardial infarction (STEMI). Intravenous and intracoronary Nicorandil administration with PPCI have been reported to reduce reperfusion injury consequences and improve cardiac function in patients with STEMI even on the long term .However, there is limited information on the cardioprotective effect of oral Nicorandil in STEMI patients . Objective The Aim of this study was to evaluate Cardioprotective effect of a single oral dose of Nicorandil 20 mg given before primary PCI in patients presenting with a first anterior STEMI within 6 hours from symptoms onset. Material and Methods This study is a Prospective multicenter Study that included 80 Patients who were presenting with first anterior STEMI and undergone primary PCI as a myocardial reperfusion method in the period between June 2016 and May 2018. Patients were divided into two groups: Group A (40 patients) was the Study group which received Nicorandil 20mg single oral dose immediately on admission with the loading doses of aspirin and clopidogril prior to the PPCI procedure and Group B (40 patients) was the Control group that did not receive Nicorandil . Results There were no statistically significant differences between two groups as regards demographic data, risk factors for coronary artery disease and procedural data . There was statistically significant lower peak levels of cardiac enzymes and higher left ventricle ejection fraction (LVEF%) in group (A) compared to group (B). The peak level of CKT in group (A) was 1899.1± 601.000 compared to 2386.300 ± 844.318 in group (B), (P = 0.004) .The peak level of CK MB in group (A) was 264.100 ± 86.982 compared to 329.325 ± 147.404 in group (B), (P = 0.018) .The LVEF% in group (A) was (43.550±5.114) compared to (40.325±5.753) in group (B), (P = 0.010). Conclusion Single dose of Nicorandil 20 mg administered orally and given to patients who were presenting with a first anterior STEMI within 6 hours from symptoms onset prior to reperfusion with primary PCI had a significant cardioprotective effect in the form of higher left ventricular ejection fraction and lesser release of cardiac enzymes (CKT and CK MB) compared to control group which reflects more myocardial salvage of the area at risk and lesser reperfusion induced myocardial damage.

Background: The right ventricle (RV) shows good long-term recovery in STEMI patients treated by primary PCI (PPCI), but, in the short term, RV involvement has a worse prognosis. Acute cardiogenic shock due to acute RV failure is equal in mortality to that due to acute left ventricular failure. The assessment of RV structure and function by echocardiography improved by advances including tissue doppler, strain, and three-dimensional (3D) imaging techniques. Methods: In PPCI treated patients, the early recovery of the RV was studied using 2D speckle tracking Echocardiography. Results: The study enrolled 120 patients, 40 anterior STEMI patients, 40 inferior STEMI patients and 40 adult healthy controls. All patients presented to Ainshams University hospitals cath. lab for PPCI as per guidelines. We excluded patients with known history of any disease affecting the RV. 102 males (85%) and 18 females (15%) were studied. The mean age of the anterior group was (53 ± 9 years) and of the inferior group was (54 ± 10 years). Full transthoracic echocardiography (TTE) examination including assessment of the RV systolic function by fractional area change (FAC), tricuspid annulus plane systolic excursion (TAPSE), Systolic TV annular velocity (S’) and RV free wall longitudinal strain. All echocardiographic measures were repeated after 3-6 months. Nine patients died during the follow up period. 54 (67.5%) patients had an impaired left evntricular ejection fraction (LVEEF) in the baseline study which significantly improved in the follow up (39.4%), (p value 0.001). A significant deterioration of the diastolic function was detected, (p value 0.002). A significant reduction of the Left atrial volume index (LAVI) was detected (p value 0.006). Also, a significant improvement of the RV FAC (p value 0.01) and TAPSE (p value 0.047). There was a significant deterioration of the apical RV free wall strain (P value 0.018). Conclusions: Right ventricular systolic function may be normal after acute STEMI treated by PPCI, but with 2D strain echocardiography, subclinical RV systolic dysfunction can be detected. So, it’s recommended to assess the global & segmental RV functions after acute MI with the conventional parameters as well as by 2D speckle tracking derived strain. Keywords: Acute MI; TTE; FAC; TAPSE S’; RV free wall GLS

Background Dyslipidemia is one of the most important factors for CAD. Atherogenic index of plasma (AIP) is a new indicator involved in dyslipidemia. However, its relation with CAD severity in diabetic patients is not well established yet. Aim of the Study To study the relationship between atherogenic index of plasma and severity of coronary artery disease (CAD) in the diabetic patients. Methods Our study was conducted on 150 diabetic patient with stable CAD undergoing elective coronary angiography in Al-Agoza Hospital from april 2016 to august 2018. Atherogenic index was calculated from the logarithmically transformed ratio of concentrations of TGs to HDL-C obtained from the patient’s lipid profile. correlation of the AIP and the severity of CAD according to Gensini scoring system was done. Results AIP had a statistically significant positive relation with IDDM (p = 0.033), NIDDM (p = 0.033), HTN (p = 0.024), dyslipedemia (p = 0.042). And a highly significant positive correlation with FBS (p < 0.001, r = 0.479) and HbA1c (p < 0.001, r = 0.538), proximal LAD lesions (p = 0.002), LCX (p < 0.001), and the number of vessls affected (p = 0.005). AIP Also had a highly significant positive correlation with severity of CAD in terms of Gensini score (p < 0.001, r = 0.692). Conclusion AIP is considered a good predictor of CAD severity and multivessel affection in diabetic patients.