Prediction of Cardiac Resynchronization Therapy Response Using Quantitative Gated Myocardial Perfusion Imaging.

Conventional selection criteria are not consistently able to discriminate between responders and non-responders to cardiac resynchronization therapy (CRT). The objective of this study was to evaluate the usefulness of quantitative gated single-photon emission computed tomography (SPECT) in predicting the response to CRT. This prospective cross-sectional study included 25 patients with advanced congestive heart failure who underwent quantitative gated SPECT before and after CRT implantation. Patients with the left ventricular (LV) lead positioned at the latest activation segment away from the scar had a significantly higher chance of responding than those with the lead positioned at a different area. Responders were likely to have a phase standard deviation (PSD) value of >33°, with 86.6% sensitivity and 90% specificity, and a phase histogram bandwidth (PHB) value of >153°, with 100% sensitivity and 80% specificity. Quantitative gated SPECT can help refine patient selection for CRT implantation, using PSD and PHB cutoff points, in addition to guiding the positioning of the LV lead.

Renoprotective effect of febuxostat on contrast-induced acute kidney injury in chronic kidney disease patients stage 3: randomized controlled trial.

INTRODUCTION: Contrast-induced acute kidney injury (CI-AKI) is known to be a complication of using intravascular contrast injection. Unfortunately, it is associated with adverse outcomes such as prolonged length of hospitalization and increased burden of health care costs. So, we aimed to determine the efficacy of febuxostat in the prevention of contrast-induced acute kidney injury among patients with chronic kidney disease Stage 3 performing percutaneous coronary intervention (PCI). METHODS: In a randomized controlled trial we enrolled 120 CKD stage 3 Patients with acute coronary syndrome referred to the cardiology department Ain-Shams University hospital for performing PCI and stenting. Patients were randomly assigned to two arms: Group I (study group): Included 60 patients who received Febuxostat added to the traditional treatment (IV hydration and N-acetylcysteine). The patients received Feburic 80 mg within 6-18 h before and within 6-18 h after the coronary intervention (a time gap of 24 h between two doses). Group II (control group): included 60 patients who received only traditional treatment. RESULTS: The incidence of AKI was higher in the control group with a statistically significant difference. We found that Independent Significant risk factors that led to AKI were febuxostate avoidance, DM, high urea level, high creatinine level, CKD stage 3B, high Mehran score and high AKI risk. CONCLUSION: We demonstrated that febuxostat has a Reno protective effect and it can help to reduce the incidence CI-AKI in CKD patients stage 3 performing PCI.

Percutaneous coronary artery intervention in unprotected left main coronary artery disease: one-year outcome Egyptian registry.

BACKGROUND: Left main coronary artery lesions are associated with jeopardy of an outsized area of the myocardium, causing a high incidence of morbidity and mortality. Optimal treatment of coronary bifurcation anatomy remains highly debatable, whether by provisional or two-stent technique. This prospective observational study was designed to investigate the one-year clinical outcomes of unprotected left main coronary artery disease revascularization by percutaneous coronary intervention in a "real-world" setting among Egyptian patients in a prospective single-center registry (at Ain Shams University Hospitals). RESULTS: This study included 163 patients who underwent PCI to LM lesions between May 1, 2020, and the end of April in Ain Shams University hospitals. Patients were dichotomized into two groups according to their intended stenting technique, whether provisional or two-stent technique. A total of 142 underwent provisional stenting while 21 were designated for the two-stent technique, mainly DK crush (double kissing). Among the patients with intended provisional stenting, 34 patients underwent the TAP technique. Patients were followed up for the primary endpoints, at the in-hospital setting, at 30 days, and after 1 year. In-hospital death was encountered in 6.34% of cases undergoing provisional stenting, among which 5.36% were due to a cardiovascular cause. Total MACCE was found to be 2.96% in the provisional stenting group versus 4.76% in the two-stent group. Overall, MACCE at 1 year was found to be 22.31% in the provisional group and 30% in the two-stent group (p-value0.57). TVF was recognized in 10% of cases treated by provisional stenting and 30% of cases treated by the two-stent technique (p-value 0.023). CONCLUSIONS: LM coronary artery lesions treatment by PCI is considered a safe and beneficial solution. Provisional stenting is the preferred approach bearing in mind that bail-out procedures may be sought in case the SB needs further treatment. Adjunctive assessment by IVUS or FFR may help achieve better outcomes, and efforts should be performed to facilitate their feasibility.

Myocardial Contraction Fraction is Superior to Ejection Fraction in Predicting Functional Capacity in Patients with Heart Failure with Reduced Ejection Fraction.

Objectives: In this study, we aimed to evaluate the relationship between three-dimensional echocardiography (3DE)-determined myocardial contraction fraction (MCF) and functional capacity in heart failure with reduced ejection fraction (HFrEF) patients. The MCF is a volumetric index of myocardial function, defined as stroke volume ratio to myocardial volume (MV). Functional capacity was evaluated by a 6-min walk test (6MWT), and health-related quality of life (HRQOL) was assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). In view of cardiac remodeling, we hypothesized that MCF would be superior to left ventricular ejection fraction (LVEF) in predicting functional capacity in HFrEF patients. Methods: The study was conducted on thirty HFrEF patients with an LVEF of no more than 40% with NYHA functional class I-III. Each patient performed, on the same day, the MLHFQ, 6MWT (to calculate the 6-min walk distance "6MWD"), and an ECG gated echocardiographic study including 3DE-determined MCF. MV was calculated as 3DE determined LV mass divided by the specific gravity of the myocardium. Results: Our results showed that MCF is inversely correlated with the Minnesota score (r 0.6, p < 0.001) and positively correlated with 6MWD (r 0.65, p < 0.001). However, no significant relationship existed between LVEF and MLHFQ score or 6MWD. In a multivariate model, MCF was shown to be an independent echocardiographic predictor (besides pulmonary artery systolic pressure) of 6MWD; however, LVEF failed to offer such potential. Conclusion: Among various echocardiographic parameters, MCF can be considered a volumetric index superior to LVEF in predicting functional capacity in HFrEF patients.

A Subtle Decline in Cardiac Mechanics is correlated with Albuminuria in Asymptomatic Normotensive Patients with Type 2 Diabetes Mellitus: A Two Dimensional Strain Echocardiography Study.

Background: Type 2 diabetes mellitus (T2DM) insidiously affects the myocardium with subsequent cardiomyopathy and induces microvascular damage in the kidneys reflected by albuminuria. We aimed to investigate the relationship between albuminuria and subclinical left ventricular (LV) systolic dysfunction in asymptomatic normotensive patients with T2DM assessed by two-dimensional speckle-tracking echocardiography. Materials and Methods and Results: Sixty normotensive patients with T2DM were included and subdivided into two subgroups, each including thirty patients according to the presence of albuminuria, together with thirty control subjects. All underwent echocardiographic examination, including LV regional and global longitudinal strain (GLS) measurements. Laboratory tests were withdrawn, including serum glycated hemoglobin (HbA1C) and albumin-creatinine ratio (ACR). When compared to the control group, patients with T2DM had a significantly lower average peak systolic LV GLS (-16.18% ± 2.78% vs. -18.13% ± 2.86%, P < 0.001), however, there was no significant difference in average peak systolic LV GLS between both diabetic subgroups (-15.57% ± 2.77% in the albuminuric subgroup vs. -16.79% ± 2.70% in the nonalbuminuric subgroup, P = 0.077). Moreover, there was a significant correlation between ACR and reduction of GLS in patients with T2DM and albuminuria (r = 0.55, P = 0.002). However, this correlation was absent in patients with T2DM without albuminuria (r = 0.107, P = 0.573). Conclusions: Patients with T2DM have subclinical LV systolic dysfunction with a reduction of average LV GLS that correlates with ACR in patients with T2DM and albuminuria.

Muscle-specific GSTM2-2 on the luminal side of the sarcoplasmic reticulum modifies RyR ion channel activity.

We show that a glutathione transferase (GST) protein, which is recognised by an antibody against the muscle-specific human GSTM2-2 (hGSTM2-2), is associated with the lumen of the sarcoplasmic reticulum (SR) of cardiac muscle, but not skeletal muscle. We further show that hGSTM2-2 modifies both cardiac and skeletal ryanodine receptor (RyR) activity when it binds to the luminal domain of the RyR channel complex. The properties of hGSTM2-2 were compared with those of the calsequestrin (CSQ), a Ca(2+) binding protein also present in the lumen of the SR which, like GSTM2-2, contains a thioredoxin-fold structure and modifies RyR activity (Wei, L., Varsanyi, M., Dulhunty, A. F., Beard, N. A. (2006). The Biophysical Journal, 91, 1288-1301). The glutathione transferase activity of hGSTM2-2 is strong, while CSQ is essentially inactive. Conversely CSQ is a strong Ca(2+) binder, but hGSTM2-2 is not. The effects of luminal hGSTM2-2 on RyR activity differ from those of CSQ in that hGSTM2-2 activates RyRs by increasing their open probability and conductance and the effects are independent of luminal Ca(2+) concentration. The results suggest that GSTM2-2 can interact with specific luminal sites on the RyR complex and that the interaction is likely to be within the pore of the RyR channel. The differences between the effects of CSQ and hGSTM2-2 suggest that the thioredoxin fold is not a major determinant of the luminal actions of either protein. The results indicate that GSTM2-2 is a novel luminal regulator of the RyR channels in the heart.