BACKGROUNDThe prevalence of hepatitis C virus (HCV) in Egypt is quite high, and the combined oral direct-acting antiviral agents (DAAs) may have impressive results.OBJECTIVETo assess the cardiovascular effects of DAAs in patients with HCV.METHODSA total of 170 patients with HCV were divided into 2 groups: first group (100 patients) received triple combination therapy (pegylated interferon alfa, sofosbuvir, and ribavirin, whereas the second group (70 patients) received dual combination therapy (sofosbuvir and simeprevir). Group 1 patients were followed up for 1 year more than 3 visits, whereas group 2 patients were followed up for 6 months more than 2 visits; and the end point of the study was the development of a major cardiovascular event (eg, congestive heart failure, echocardiographic evidence of left ventricular dysfunction, occurrence of significant arrhythmias, or acute coronary syndrome). The following parameters were accomplished: medical history and clinical examination, electrocardiogram, echo-Doppler study, and laboratory investigations.RESULTSNo significant differences were found between the 2 study groups regarding demographic criteria. None of the both group patients had developed any major cardiac event. No significant changes were observed regarding ST-T wave abnormalities, arrhythmias, or QT interval. None of the both group patients developed echocardiographic regional wall motion abnormalities at baseline or at study end. Systolic function parameters showed minute nonsignificant changes over study visits. Diastolic function parameters showed nonsignificant changes between baseline and 6-month and 12-month visits.CONCLUSIONSThe DAAs used in combination regimen with interferon or used orally in combination do not significantly affect the cardio-vascular system.

Background: This study aimed to investigate the correlation between the functional parameters of the left atrium (LA) derived from deformation imaging, two-dimensional (2D) speckle tracking echocardiography (STE), and tissue Doppler imaging (TDI) strain and strain rate (SR) and the function of the left atrial appendage (LAA) as measured by transesophageal echocardiography (TEE) in patients with primary valvular heart disease. Methods: This cross-sectional research included 200 primary valvular heart disease cases, categorized into Group I (n = 74) with thrombus and Group II (n = 126) without thrombus. All patients were subjected to standard 12 lead electrocardiography, transthoracic echocardiography (TTE), strain and SR imaging of the LA by TDI and 2D speckle tracking, and TEE. Results: At a cut-off value of <10.50%, peak atrial longitudinal strain (PALS) is a predictor of thrombus with an area under the curve (AUC) of 0.975 (95% CI: 0.957-0.993), sensitivity of 94.6%, specificity of 93.7%, positive predictive value (PPV) of 89.7%, negative predictive value (NPV) of 96.7%, and accuracy of 94%. At a cut-off value of <0.295 m/s, LAA emptying velocity is a predictor of thrombus with an AUC of 0.967 (95% CI: 0.944-0.989), sensitivity of 94.6%, specificity of 90.5%, PPV of 85.4%, NPV of 96.6%, and accuracy of 92%. The PALS (<10.50%) and LAA velocity (<0.295 m/s) are significant predictors of thrombus (P = 0.001, β = 2.745, SE = 0.804, OR = 15.56, and 95% CI: 3.219-75.245; and P = 0.002, β = 2.499, SE = 0.799, OR = 12.17, and 95% CI: 2.543-58.201, respectively). Peak systolic strain < 12.55% and SR < 1.065/s are insignificant predictors of thrombus (β = 1.167, SE = 0.996, OR = 3.21, and 95% CI: 0.456-22.631; and β = 1.443, SE = 0.929, OR = 4.23, and 95% CI: 0.685-26.141, respectively). Conclusions: Among LA deformation parameters derived from TTE, PALS is the best predictor of reduced LAA emptying velocity and LAA thrombus in primary valvular heart disease, regardless of the rhythm.

Gender specific coronary angiographic findings in patients with coronary artery disease in the age year group 40 to 60. The aim was to identify gender differences between both sex regarding risk factors and coronary vessels affected by coronary angiography. Methods: A study of 100 patients (50 male & 50 female) underwent diagnostic coronary angiography in our catheterization laboratory in cardiovascular department in Benha University hospital from April 2014 to April 2015. Results: A total of 100 patients with age range 40-60 years old were studied, 50 female patients with mean age (53.72±5.9) and 50 male patients with mean age (50.6±9.77).Females were significantly more obese than males. Males were significantly higher than females in smoking, DM & family history of IHD .The clinical presentation was significantly different in both groups. STEMI & NSTEMI were significantly higher in males than females while atypical chest pain was significantly higher in females than males .There was no significant differences between both groups regarding the number of vessels affected while the LAD was the most frequently affected vessel and the left main was the least. Conclusion: We documented gender difference in clinical presentation between males & females with no significant difference regarding the number of vessels affected while the LAD was the most frequently affected vessel while the left main was the least in both group.

Introduction: Balloon angioplasty has been proposed as an alternative way to surgery in primary treatment of aortic coarctation (Co A) for both children and infants. Objective: The purpose of this study is to assess the immediate and intermediate term effectiveness and safety of balloon angioplasty in infants and children with native discrete membranous Co A. Patients and Methods: Forty consecutive patients with native discrete coarctation of the aorta were treated with balloon angioplasty. They were 8 infants and 32 children; with ages ranged from 2 months to 10 years and all weighted below 35 Kg. All patients were clinically evaluated immediately after and at 6 to 12 months and 18 to 24 months after the procedure. Follow up data were collected and Doppler echocardiography was done before intervention to confirm diagnosis and to plan management and post interventional to follow-up patients and estimate the outcome and complications. Results: Immediate successful relief of native Co A was obtained in 92.5% of the population study, while 7.5% recorded immediate suboptimal results with pressure gradient above 20mmHG. The peak systolic gradient across the coarcted segment was reduced significantly with 82.5% immediately after balloon angioplasty, 75% and 73.2% at the end of first and second follow up period respectively. Pressure gradient decreased significantly from 57 ± 15.7 mmHg before balloon angioplasty to 14.23 ± 11.30mmHg 9 to 12 months after, but it was increased slightly to reach 15.15 ± 11.80 mmHg at the end of the second year. The systolic ascending aortic pressure decreased significantly (19%) and the systolic descending aortic pressure increased significantly (11.4%) at the end of the study. Recoarctation occurred in 17.5% at the end of the 1st year and balloon angioplasty was repeated for all patients successfully. At the end of the 2nd year restenosis was evidenced in 10% of the whole study population. Aneurysm formation at the site of coarcted segment occurred in (5%). Conclusion: Balloon angioplasty is an effective and safe alternative to surgery for treatment of Co A in infants older than 2 months and children10 years of age or younger.

Background: Emerging evidence supports a cardiovascular protective role of Cooled Dialysis (CD) in incident Hemodialysis (HD) patients. Whether this benefit can be extended to maintenance HD patients remains to be established. Objective:The aim of the present study was to assess the impact of CD by lowering Dialysate temperature (dt) 0.5 o C below Core Body Temperature (CBT), on minimizing myocardial ischemia in maintenance HD patients (>1 year on HD). Patients and Methods: from March 2019 to January 2021, we randomized one hundred maintenance HD patients to receive either Cooled Dialysis (dt -0.5 o C below CBT, intervention) or Standard Dialysis (dt= CBT, control) for 12 months. Over the study period, serial measurements of ECG, echocardiography, and myocardial enzymes (CK-MB and Troponin-T) were performed for the whole study population as surrogates for myocardial ischemic injury. Results: By the end of 12-months, compared to Standard Dialysis (ST) patients, Cooled Dialysis (CD) patients had overall less incidence of new myocardial ischemia (composite surrogate outcomes: ECG, Echo and CK-MB) (p=0.032). In logistic regression analysis, CD was found to be independently protective against myocardial ischemia (OR 0.54, p-value 0.033, CI: 0.3-0.95). Conclusion: In maintenance HD patients, Cooled Dialysis might help decrease myocardial ischemia with a reasonable safety profile. Further studies are warranted to explore these findings.