Objective: To evaluate the relation between epicardial adipose tissue (EAT) thickness and also pericoronary fat assessed by Multidetector Computed Tomography (MDCT) with both calcium score and significance of coronary artery disease. Background: Epicardial adipose tissue (the visceral fat of the heart present under the visceral layer of the pericardium) has the same origin of abdominal visceral fat, which is known to be strongly related to the development of coronary artery atherosclerosis. Multidetector CT (MDCT) provides an accurate and reproducible quantification of EAT due to its high spatial and temporal resolution. Patients and Methods: The current study included 70 patients with low-intermediate probability of coronary artery disease. All patients were subjected to 256 Multidetectors CT to assess EAT thickness, the mean thickness of the pericoronary fat surrounding the three coronary arteries and coronary calcium score. Also coronary CT angiography was done and patients were then divided into 3 groups according to significance of coronary atherosclerosis: Group 1: No atherosclerosis (20 patients), Group 2: Non obstructive atherosclerosis (luminal narrowing less than 50% in diameter) (25 patients), Group3: Obstructive atherosclerosis (luminal narrowing ≥ 50%) (25 patients). Results: The mean EAT thickness and the mean pericoronary fat thickness were significantly higher in patients with obstructive coronary artery disease (CAD) with stenosis > 50% (group 3) compared to other groups with normal coronaries or non obstructive (CAD). ROC curve was used to define the best cut off value of the thickness of both EAT and pericoronary fat in predicting the obstructive CAD group which was ≥7.2 and 12.6 mm for epicardial and pericoronary fat respectively. Also there is a How to cite this paper: Samy, N.I., Fakhry, M. and Farid, W.

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Background: ST-elevation myocardial infarction (STEMI) is one of the leading causes of mortality and morbidity worldwide. However, survival after acute STEMI has considerably improved due to increasing symptom recognition, accurate diagnosis and effective timely reperfusion. This study aimed to investigate the relation between the level of oxidative stress markers and coronary no-reflow after primary percutaneous coronary intervention for patients with acute myocardial infarction. Patients & Methods: This prospective cohort study included 90 patients admitted with acute STEMI at cardiovascular medicine department Naser Institute hospital, during the period from June 2018 till 12 months. Patients were divided into 2 groups according to the post primary PCI thrombolysis in myocardial infarction (TIMI) flow score into: Group I: 45 patients with noreflow phenomenon. Group II: 45 patients with TIMI flow ≥ 2 after primary PCI. They all underwent primary PCI within 24 hours of presentation. Results: This study showed increased concentrations of Malondialdehide (MDA) in the circulation of patients with no-reflow indicating increased lipid peroxidation which could be attributed to a deficiency of antioxidant defense mechanism. In group I, pt with coronary no-reflow MDA level ranged from 2.8-4.5 nmol/mL with mean 3.9±1.5 nmol/mL, while in group II control group, MDA level ranged from 1.1 -2.1 nmol/mL with mean 1.55±0.4 nmol/mL, there was statistically significant difference between the two groups (P value<0.004). Conclusions: no-reflow phenomenon after primary PCI can be predicted using the oxidative stress markers.

Background: . Valsalva maneuver was used to differentiate normal from pseudonormal mitral flow pattern. Doppler tissue imaging (DTI), differentiates normal from abnormal diastolic function. Aim of the Work: Assessment of Valsalva maneuver as a mean to differentiate pseudonormal from normal mitral flow pattern (MFP), using pulsed-wave DTI Patients and Methods: sixty patients with dilated cardiomyopathy (EF<40%), sinus rhythm and pseudonormalized MFP were selected. Transmitral flow velocity curve (MFVC), before and during Valsalva maneuver was recorded. Peak early mitral filling (Em), peak atrial filling (Am) and Em/Am were measured before and during Valsalva. After Valsalva patients were classified into two groups. Group I included 24 patients with Em/Am <1 and group II, 36 patients with Em/Am >1. Pulsed-wave DTI was recorded at septal, lateral, inferior and anterior aspect of the mitral annulus from apical 4 and 2 chamber views. The mean peak early velocity (Ea), Peak atrial (Aa), and Ea/Aa of the 4 sites were measured from DTI derived velocity curve for each patient. The results were compared with the MFP. Results: Valsalva maneuver was able to detect a hidden relaxation abnormality in 40% of patients where Em/Am became <1 with significantly prolonged deceleration time (DT), and isovolumetric relaxation time (IVRT). However, 60% of patients the Em/Am remained >1 with slightly prolonged DT and IVRT. Pulsed-wave DTI detected relaxation abnormality in all patients. They had Ea/Aa 0.79±0.11, prolonged DT and IVRT. Group 1 had higher EF (36.71% vs. 32.87%), higher Ea (6.1±0.68 vs 5.3±0.1cm/s), lower Aa (7.9±2.012 vs 8.1±1.91 cm/s) and higher Ea/Aa ratio (0.77 vs 0.65) than group II patients. These data may denote that it was a progression of diastolic dysfunction with or without a hemodynamic factor that was responsible for the persistence of pseudonormalized pattern during Valsalva. Conclusion: Patient uncoperation, less sensitivity, and specificity are the major limitations Valsalva maneuver in assessment of patients with pseudonormalized MFP.Doppler tissue imaging is a simple noninvasive bedside technique with less load dependence. it can be used in combination with MFP for better understanding and assessment of diastolic dysfunctionin those patients.