Rationale, design, methodology and hospital characteristics of the first gulf acute heart failure registry [gulf care]

There is paucity of data on heart failure [HF] in the Gulf Middle East. The present paper describes the rationale, design, methodology and hospital characteristics of the first Gulf acute heart failure registry [Gulf CARE]. Gulf CARE is a prospective, multicenter, multinational registry of patients >18 year of age admitted with diagnosis of acute HF [AHF]. The data collected included demographics, clinical characteristics, etiology, precipitating factors, management and outcomes of patients admitted with AHF. In addition, data about hospital readmission rates, procedures and mortality at 3 months and 1-year follow-up were recorded. Hospital characteristics and care provider details were collected. Data were entered in a dedicated website using an electronic case record form. A total of 5005 consecutive patients were enrolled from February 14, 2012 to November 13, 2012. Forty-seven hospitals in 7 Gulf States [Oman, Saudi Arabia, Yemen, Kuwait, United Gulf Emirates, Qatar and Bahrain] participated in the project. The majority of hospitals were community hospitals [46%; 22/47] followed by non-University teaching [32%; 15/47 and University hospitals [17%]. Most of the hospitals had intensive or coronary care unit facilities [93%; 44/47] with 59% [28/47] having catheterization laboratory facilities. However, only 29% [14/47] had a dedicated HF clinic facility. Most patients [71%] were cared for by a cardiologist. Gulf CARE is the first prospective registry of AHF in the Middle East, intending to provide a unique insight into the demographics, etiology, management and outcomes of AHF in the Middle East. HF management in the Middle East is predominantly provided by cardiologists. The data obtained from this registry will help the local clinicians to identify the deficiencies in HF management as well as provide a platform to implement evidence based preventive and treatment strategies to reduce the burden of HF in this region

Color M-mode for the assessment of left ventricular diastolic function

During the last two decades, Doppler echocardiography has emerged as the principal clinical tool for the assessment of left ventricular [LV] diastolic function. Trans-mitral and pulmonary venous Doppler flow indices have been used to evaluate different parameters of diastolic function, but it is difficult to use these modalities in differentiation between a normal filling pattern and a pseudo-normal filling pattern. Recently, color M-mode [CMM] of LV inflow and tissue Doppler imaging [TDI] of mitral annulus have provided additional insights in the assessment of diastolic function. Aim of the work: was to correlate the new parameter CMM of LV inflow with trans-mitral flow [TMF] in different patterns of diastolic performance to evaluate its clinical utility. 70 patients [46 males, and 24 females] who are having diseases known to affect diastolic function and 10 normal individuals as a control group were included in the study. The 70 patients were divided into 3 groups according to their LV diastolic filling pattern based on the conventional TMF pattern and included, group I [impaired relaxation pattern, IR], group 2 [pseudo-normal pattern, PN] and group 3 [restrictive filling pattern. RFP]. All of them were subjected to trans-thoracic Doppler echocardiography [TTE] with TMF and CMM examinations. In group I [IR], flow propagation velocity [VP] was lower than that in PN and control groups but higher than that in RFP group. Time delay [TD] and E/VP ratio were lower than those in PN and RFP groups but higher than those in control group. In group 2 [PN], VP and TD were higher than those in IR and RFP groups but lower than those in control group. E/VP was higher than that in IR and control groups but lower than that in RFP. In group 3 [REP], VP was lower than that in all other groups. TD and E/VP were higher than those in all other groups. Tei index was significantly higher in group 2 and 3 as compared to the control group but did not show significant change between group 1 and the control group. Also there was statistically significant correlation between E/VP ratio with, E, TD and Tei index. While statistically significant negative correlation was recorded between E/VP ratio with EDT, IVRT and VP. The new modality CMM is helpful in differentiation of PN pattern from normal pattern and can be complementary to TMF to give an idea non-invasively about diastolic parameters