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Background: obesity is defined as body mass index (BMI) ≥30 kg/m 2 . Obesity is currently the most common metabolic disease. It is associated with many metabolic and cardiovascular diseases, thereby contributing to increased morbidity and mortality. Recent studies have described a better outcome of obese patients in the setting of acute ST segment elevation myocardial infarction (STEMI).Objectives: to study the impact of BMI on the presentation and in-hospital outcome of acute STEMI.Methods: a total of 140 STEMI patients were enrolled in our study, those patients were treated mainly by primary PCI. Patients were classified into two groups according to BMI; obese group with BMI ≥ 30kg/m 2 and non obese group with BMI < 30kg/m 2 . Both groups were compared regarding presentation and inhospital outcome.Results: seventy six patients (54.3%) were obese; they were significantly younger, more hypertensive, diabetic and dyslipidemic. Obese patients presented earlier (P= 0.001) and in better Killip class than non obese (P= 0.017). 37 non obese patients (57.8%) had post MI complications compared to 18 obese patients (23.7%) (P= 0.000), mainly heart failure, tachyarrhythmias, heart block and post MI angina. Patients with low BMI had complications 4 times more than patients with high BMI (Odds ratio = 4.416, 95% C.I. from 2.138 to 9.118, P< 0.001).Conclusion: the current study highlights an apparent obesity paradox showing that the non-obese STEMI patients were found to have complications 4 times more than the obese patients. Caution should be taken to prevent confusion between risk marker and risk factor.

Background: Atrial septal defects (ASDs) are the second most common congenital lesion in adults. ASD closure is followed by symptomatic improvement and regression of pulmonary artery pressure (PAP), reduction in right heart volume overload and hence the prevalence of arrhythmias, thus quantification of the RV function is an important prognostic factor. Tissue Doppler and strain imaging are helpful tools for the assessment of RV systolic and diastolic function. Results:At the 1 year follow up of transcatheter ASD closure, the RVEDD had decreased from 22.93±5.889 mm to 18±4.06 mm(P=0.000), and the LVEDD had increased from 33.23±5.393 mm to 36.27±6.75 mm(P=0.001). Mean PAP decreased from 18.37±4.796 mmHg to 14.77±4.75 mmHg (P=0.022). RVSP decreased from 28.9±4.425 mmHg to 15.83±4.17 mmHg (P=0.000). Regarding electrocardiography, the P wave duration decreased from 107.13±19.62 ms to 77±14.18 ms (P=0.000) and the PR interval decreased from 177.97±21.932 ms to 160.33±26.06 ms (P=0.000).The QRS duration decreased from 134.40± 4.97 ms to a mean of 119.87±4.12 ms (P=0.000). All the patients had normal sinus rhythm before closure and no one developed arrhythmia until 1 year after closure. 50 % of the patients had normal RV size at the 1-year follow up. Tricuspid annular velocities, longitudinal strain, and strain rate measurement showed no significant difference as compared to normal values, which suggest improvement of the RV systolic and diastolic function after transcatheter closure. Conclusion:Transcatheter ASD closure leads to a significant improvement in heart cavity dimensions and RV function and reversal of electrical and mechanical changes. Novel parameters for assessment of RV function are promising and appear to be helpful for the assessment of RV function and its response to correction of volume

Background: In patients with ST-segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) tries to reestablish coronary flow and ensure effective cardiac reperfusion. An independent predictor of no-reflow is a large thrombus load. Objective: This investigation sought to determine if the red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) were reliable indicators of excessive thrombus load on coronary angiography. Patients and methods: Two-hundred patients, with STEMI managed by primary PCI within 12 hours from chest pain onset, were divided into group A with high thrombus burden (Thrombolysis in myocardial infarction (TIMI) thrombus grade 4-5) and group B with low thrombus burden (TIMI thrombus grade 1-3). Results: One-hundred and seventeen patients (58.5%) had a high thrombus burden (group A). They had more mean number of cardiovascular disease (CVD) risk factors (2.4 ±0.99 versus 2.06 ±1.06, p=0.02), longer pain to balloon time (PTB) (151.28 ±42.05 versus116.99 ±43.16 minutes, p<0.001), higher mean Killip class (1.49±0.73 versus 1.28±0.6, p=0.03), higher RDW (18.99±1.55 versus 14.03±1.52, p<0.001), and higher NLR (5.93±1.39 versus 4.08±0.93 p<0.001) compared to group B. Independent predictors of high thrombus burden were RDW (OR: 4.06, p<0.001), NLR (OR: 1.35, p= 0.04), number of CVD risk factors (OR: 1.62, p= 0.01), and PTB time (OR: 1.02, p<0.001). Cut-off values to predict high thrombus burden were 16% for RDW and 4.55 for NLR. Conclusions: Rapid identification of RDW more than 16% or NLR more than 4.55, could predict a high thrombus burden.