The effect of right ventricle septal pacing versus apical pacing in dual-chamber pacemakers on patients' anxiety and depression: a one-year follow-up study.

BACKGROUND: Anxiety and depression are potentially harmful outcomes of permanent cardiac pacemakers. Dual-chamber P.P.M. is frequently used to treat life threatening bradycardia. The study aims to estimate the effect of the right ventricular PM lead position on recipients' anxiety and depression before, 6 months, and 1 year after implantation. RESULTS: A statistically significant correlation was discovered between the studied groups regarding HADS depression score after 6 months (p 0.013) and 1 year (p 0.013). A statistically non-significant difference was found among the studied groups at any point of time regarding baseline (p 0.063), after 6 months (p 0.054), or after 1 year (p 0.099). Significance was found between HADS anxiety score (p 0.015) or depression score after 1 year and the incidence of complications (p 0.001). CONCLUSIONS: A strong relationship was found between the level of depression and the R.V. site of implantation, as patients with the apical group had higher levels of depression post-implantation. The septal position has less stress and depression on the patient's well-being than the apical one.

Three-Dimensional Echocardiography As A Predictor Of Positive Response To Cardiac Resynchronisation Therapy.

Objectives: To assess patients with three-dimensional echocardiography before cardiac resynchronisation therapy device implantation to predict the responders, and to determine the response 3 months post-intervention. Method: The descriptive study was conducted at Kafrelsheikh University Hospital, Egypt, from January 2020 to March 2022, and comprised patients of either gender who underwent cardiac resynchronisation therapy device implantation. The patients were assessed clinically and with three-dimensional echocardiography using 16-segment systolic dyssynchrony index asthe main parameter compared at baseline and 3 months after implantation. The patients were classified as non-responders, clinical responders, and clinical and echocardiographic responders. Data was analysed using SPSS 23. RESULTS: Of the 40 patients, 23(57.5%) were males and 17(42.5%) were females. The overall mean age was 57.43±10.47 years, mean body weight was 81.30±11.33kg, mean height was 171.15±10.56cm), and mean body surface area was 1.93±0.17m2. Of the total, 14(35%) patients were hypertensive, 10(25%) diabetic, 15(37.5%) ischaemic and 2(5%) patients had atrial fibrillation. There were 8(20%) non-responders, 8(20%) clinical responders, and 24(60%) clinical and echocardiographic responders to therapy. Mean systolic dyssynchrony index at baseline was a positive highly significant predictor of post-therapy response (p<0.01). A positive highly significant correlation was also found between post-therapy response and end-systolic volume, three-dimensional ejection fraction, New York Heart Association class and QRS width (p<0.01). CONCLUSIONS: Three-dimensional 16-segmentsystolic dyssynchrony index wasfound to be a significantly effective tool to predict response to cardiac resynchronisation therapy device implantation.

Effect Of Left Ventricular Hypertrophy On The Outcome Of Coronary Artery Bypass Grafting.

Objectives: To evaluate the relationship between left ventricular hypertrophy (LVH) and coronary artery bypass grafting (CABG) procedure especially on the early outcome during the first 6 months following surgical intervention. Method: This prospective cohort study included 82 patients with coronary artery disease indicating CABG. These patients were admitted, operated and followed -up in cardiothoracic surgery departmentsin the faculty of medicine, Kafrelsheikh university hospitals in the period from April 2019 till November 2021.The patients included in this study were divided into two groups according to presence or absence of left ventricular hypertrophy, Group I had 38 (46.34%) patients with LVH and Group 2 had 44 (53 .65%). patients without LVH. RESULTS: The time to regain mechanical activity waslonger (5.76±1.82) minutesin LVH patients(p <0.001). LVH group had a significantly longer period of mechanical ventilation 16.50±4.25 hours (p <0.001) compared to non LVH group which was 9.61±3.78 hours. Also, the mean duration of ICU stays in the LVH group compared to the non LVH group was 3.81±1.20 days versus 2.56±0.81 daysrespectively. The ICU follow up showed a statistically significant relationship of arrhythmias with LVH (p =0.022), infections (p =0.005) and wound infections (p<0.001). CONCLUSIONS: In patients undergoing CABG surgery, LVH has been associated with increased morbidity and poor outcome.

Role Of Speckle Tracking Echocardiography In Prediction Of Responders To Cardiac Resynchronization Therapy.

Objectives: To assess heart failure patients by speckle tracking echocardiography before cardiac resynchronisation therapy implantation to predict the outcome. Method: The descriptive follow-up study was conducted at Kafrelsheikh and Mansoura University Hospitals, Egypt, from January 2020 to May 2022, and comprised heart failure patients of either gender who had ejection fraction ≤35%, QRS width ≥130msec and symptomatic even on optimal medical therapy. They were subjected to full clinical evaluation, electrocardiogram, basic and speckle tracking echocardiography with calculation of maximal septal to lateral delay at baseline and 3 months after cardiac resynchronisation therapy implantation. The patients were classified according to response into group I having non-responders, group II having patients who improved clinically only, and group III having responders both in clinical and echocardiographic terms. Data was analysed using SPSS 23. RESULTS: Of the 38 patients with mean age 55.24±11.23 years, 16(42%) were females and 22(57.9%) were males. There were 7(18.4%) patients in group I, 7(18.4%) in group II and 24(63.2%) in group III. There was a positive significant correlation between response to cardiac resynchronisation therapy CRT and increase in maximalseptal to lateral delay at baseline (p<0.01). There was an inverse significant correlation between response to cardiac resynchronisation therapy and decrease in maximal septal to lateral delay 3 months after the implantation (p=0.036). CONCLUSIONS: Maximal septal to lateral delay was found to be a good tool to predict the response to cardiac resynchronisation therapy before implantation.

Evaluation Of Left Ventricular Function After Sofosbuvir And Daclatasvir Regimen For Chronic Hepatitis C.

Objectives: To assess left ventricular functions by echocardiography after 12 weeks of sofosbuvir-daclatasvir combination therapy. Method: The prospective cohort study was conducted from December 2019 to December 2021 at Kafrelsheikh University Hospital, Egypt, and comprised adult patients of either gender who had been referred to the Cardiovascular Department for cardiac evaluation and were found to be eligible forsofosbuvir-daclatasvir combination therapy. The patients were classified into five groups according to cardiovascular risk factors. Group 1 had no risk factors; Group 2 had many risk factors; Group 3 had only hypertension; Group 4 had diabetes only; and Group 5 had smoking as the only risk. All patients were assessed at baseline and at the end of the 12-week of antiviral combination therapy sofosbuvir 400 mg once daily dose and daclatasvir 60 mg once daily dose. Parameters checked were left ventricular ejection fraction, global longitudinalstrain, wall motion abnormalities and diastolic function. Data was analysed using SPSS 23. RESULTS: Of the 200 patients, 104(52%) were females and 96(48%) were males. The age range was 34-81 years, and 18(9%) patients were aged >70 years. There were 78(39%) patientsin Group 1, 60(30%) in Group 2, 25(12.5%) in Group 3, Group 4 had 13(6.5%) and Group 5 had 24(12%) patients. There were no significant changes in mean ejection fraction, global longitudinal strain and wall motion abnormalities (p>0.05). Diastolic function had some significant parameters in each of the 5 groups (p<0.05). CONCLUSIONS: Sofosbuvir-daclatasvir combination therapy did not affect or impair left ventricular systolic or diastolic functions.

Cardiovascular Risk Assessment After Sofosbuvir And Daclatasvir Regimen For Chronic Hepatitis C Virus Infection.

Objectives: To assess cardiovascular risk after sofosbuvir and daclatasvir antiviral combination therapy in chronic hepatitis C virus patients. Method: The prospective cohortstudy was conducted at the Kafrelsheikh University Hospital, Egypt, from December 2019 to December 2021, and comprised adult patients of either gender with chronic hepatitis C virus and with minimum ejection fraction 40%. They were classified into groups according to their cardiovascular risk. Group 1 had individuals with no risk factors, Group 2 had patients with many risk factors, Group 3 had patients with only hypertension, Group 4 had those with diabetes alone, and Group 5 comprised smokers. All the patients were evaluated for the risk of major cardiovascular events at baseline and at the end of 12-week of antiviral combination therapy of sofosbuvir 400 mg once daily dose and daclatasvir 60 mg once daily dose. Data was analysed with SPSS version 23. RESULTS: Of the 200 patients, there were 96(48%) males and 104(52%) females. The age ranged 34-81 years. There were 78(39%) patients in Group 1; 20(25.6%) males and 58(74.4%) females with mean age 54.4±10.45 years. Group 2 had 60(30%) patients; 40(66.6%) males and 20(33.3%) females with mean age 59.57±9.1 years. Group 3 had 25(12.5%) patients; 3(12%) males and 22(88%) females with mean age 61.4±7.8 years. Group 4 had 13(6.5%) patients; 10(77%) males and 3(23%) females with mean age 55.4±10.4 years. Group 5 had 24(12%) patients who were all (100%) males with mean age 60.7±5.7 years. There were non-significant changes in the incidence of angina, arrhythmias or progression of dyspnoea (p>0.05). Echocardiography follow-up results showed non-significant changes in mean ejection fraction, global longitudinal strain and pulmonary artery pressure (p>0.05). CONCLUSIONS: Sofosbuvir and daclatasvir combination therapy wasfound to be safe in chronic hepatitis C virus patients regarding cardiac risks.

Left Atrial Function Assessment By Speckle Tracking Echocardiography In Low-Risk Atrial Fibrillation Patients.

Objectives: To compare the left atrial function utilising speckle tracking echocardiography in patients with low-risk and high-risk non-valvular atrial fibrillation. Method: The descriptive, cross-sectional study was conducted at the cardiology department of Kafrelsheikh University Hospital, Egypt, from January 2021 to January 2022, and comprised low-risk atrial fibrillatin participants in group I, high-risk atrial fibrillatin patients in group II, and healthy controls in group III. After detailed medical history, the subjects underwent 12-lead electrocardigram, and echocardiographic assessment, including two dimensional, M-mode, tissue doppler, and speckle tracking of the left atrium. The association of left atrial strain with Congestive heart failure, hypertension, age ≥75 (doubled), diabetes,stroke (doubled), vascular disease sex category (female)score was explored. Data was analysed using SPSS 28. RESULTS: Of the 90 subjects, there were 30(33.3%) in each of the 3 groups. The mean age among the groups was significantly different among the groups (p=0.014). Left atrial ejection fraction and left atrial strain had an overall significant difference among the groups(p<0.001). Congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease sex category (female)score was negatively correlated with Left atrial ejection fraction and (p<0.001) and left atrial strain (p<0.001). CONCLUSIONS: In individuals with atrial fibrillatin, there was a significant decrease in left atrial strain and left atrial function. The use of speckle tracking echocardiography allowed for a more detailed analysis of left atrial mechanics. The correlation of left atrialstrain and left atrial ejection fraction with Congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease sex category (female) score was significantly negative.

Tissue Doppler Echocardiography As A Predictor Of Early Subclinical Right Ventricular Diastolic Dysfunction In Asthmatic Children.

Objectives: To assess the effect of asthma in children on systolic and diastolic functions of the heart, and to explore the relationship between the two. Method: The case-controlstudy was conducted at Kafrelsheikh University Hospital, Egypt, from September 2019 to May 2022, and comprised asthmatic children of either gender aged 5-15 years and healthy controls matched for age and gender. The participants were subjected to detailed history, complete examination, spirometry evaluation and conventional and tissue Doppler echocardiography. Myocardial performance index was calculated and compared. Data was analysed using SPSS 22. RESULTS: Of the 120 subjects, 60(50%) were cases; 33(55%) boys and 27(45%) girls with mean age 9.4±2.9 years(range: 5-15 years). The remaining 60(50%)subjects were controls; 34(56.6%) boys and 26(43.3%) girls with mean age 9.7±2.9 years (range: 5-15 years). Left ventricular dimensions, estimated pulmonary artery pressure, and right ventricular dimensions showed no significant inter-group differences (p>0.05), but right ventricular end diastolic diameter was significantly higher in the cases than the controls (p=0.046). Tissue Doppler showed that lateral annular peak Ê, Â, isovolumetric relaxation time and myocardial performance index values were significantly different between the groups (p<0.05). CONCLUSIONS: Tissue Doppler echocardiography could detectsubtle right ventricular diastolic dysfunction in asthmatic children even with no clinical symptoms and normal findings on conventional echocardiography.

Can Speckle Tracking Of Right Ventricle Add Value For Evaluation Of Asthma Severity In Children?

Objectives: To investigate myocardial deformation by tracking speckles along with evaluation of cardiac function using conventional and tissue Doppler imaging. Method: The case-control study was conducted at Kafrelsheikh University Hospital, Egypt, from September 2019 to May 2022, and comprised asthmatic children and healthy controls matched for age and gender. After taking family history of asthma, assessments were made for bronchial asthma treatment and severity. Clinical examination and pulmonary function tests were performed along with tissue Doppler imaging and speckle tracking. Global left ventricular and right ventricular strains were measured. Data was analysed using SPSS 22.. RESULTS: Of the 120 subjects, 60(50%) were cases; 33(55%) males and 27(45%) females with mean age 9.4±2.91 years. The remaining 60(50%) were controls; 34(56.7%) males and 26(43.3%) females with mean age 9.7±2.99 years(p>0.05). Among the cases, 36(60%) had moderate severity and 24(40%) had mild asthma. Family history was positive in 11(18.3%) cases and negative in 49(81.7%). There was no significant difference in terms of conventional echocardiography between the groups (p>0.05). There was impairment in right ventricular diastolic function in the cases, with lateral tricuspid E` velocity significantly lower (p<0.05) and isovolumetric relaxation time significantly higher than the controls(p=0.001). There wasimpairment ofsystolic function of the right ventricle in the cases compared to the controls(p=0.001). Right ventricular peak longitudinalsystolic stress cut-off value distinguishing the controlsfrom the cases was -20.4 with sensitivity 85% and specificity 63%. The cut-off value distinguishing mild from moderate asthmatic cases was -19.8 with sensitivity 83% and specificity 91%. CONCLUSIONS: Speckle tracking echocardiography could detect very early subtle right ventricular systolic dysfunction. Right ventricle dysfunction worsened with the severity of asthma.

Echocardiographic Assessment Of Left Ventricular Function After COVID-19 Vaccination In Adults.

Objectives: To assess left ventricular function by conventional and speckle tracking echocardiography in subjects having received coronavirus disease-2019 vaccine. Method: The cohortstudy was conducted from April 2021 to April 2022 at the Department of Cardiology, Kafrelsheikh University Hospital, Egypt, and comprised adults of either gender who had received coronavirus disease-2019 vaccine. Detailed history was noted before clinical assessment, electrocardiogram and echocardiography, which were done at baseline and after two weeks of the last vaccine dose. Apical 4, apical 3 and apical 2 strains were obtained to get the global longitudinal strain. Data was analysed using SPSS 20. RESULTS: Of the 100 subjects, 50(50%) each were males and females. The overall mean age was 39.20±14.57 years. There were 16(16%) subjects with diabetes mellitus and 21(21%) with hypertension. Regarding vaccine distribution, 34(34%) had received AstraZeneca AZD1222, 31(31%) had BioNTech Pfizer vaccine BNT162B2 and 35(35%) had Sinopharm Beijing Institute of Biological Products BBIBP-CorV. The global longitudinal strain before and after vaccination did not show a significant difference (p<0.063). There was no significant variation in global longitudinal strain between the various vaccination types (p=0.584). CONCLUSIONS: The studied vaccines had similarly acceptable safety profiles regarding left ventricular functions.

Coronary Plaque Morphology And Characteristics In Patients With Raised Haemoglobin A1c: An Intravascular Ultrasound Study.

Objectives: To identify coronary plaque morphology using grey scale and virtual histology intravascular ultrasound in patients with and without elevated glycated haemoglobin. Method: The cross-sectional study was conducted at the Cardiology Department of Kafrelsheikh University, Egypt, from November 2019 to January 2022, and comprised adult patients of either gender suffering from acute coronary syndrome admitted for catheterisation. The patients were divided into three groups.Diabetic patients were in group A, prediabetic patients with elevated glycated haemoglobin in group B, and patients with normal glycated haemoglobin in group C. All patients were subjected to clinical examination, 12-lead electrocardiogram, coronary angiography and multimodality intravascular ultrasonography scan of proximal segments 3-6cmof non-culprit coronary arteries intra group differences were compared using the analysis of variance (ANOVA) test. RESULTS: Of the 52 patients, 18(34.7%) were females and 34(65.3%) were males. Group A had 18(34.6%)patients; 13(72%) males and 5(28%) females with mean age 57.9±6.9 years. Group B had 17(32.7%) patients;11(64.7%) males and 6(35.3%) females with mean age 56.5±5.5 years. Group C had 17(32.7%) patients; 10(59%) males and 7(41%) females with mean age 59.5±5.1 years(p>0.05). Thin-cap fibroatheroma wassignificantly higher in groups A and B compared to group C (p=0.045). CONCLUSIONS: Patients with raised glycated haemoglobin presenting with acute coronary syndrome were found to have more vulnerable plaque types than those with normal levels.

Clinical Presentation And Outcome In Acute Coronary Syndrome Patients In Relation To Plaque Morphology Identified By Intra Vascular Ultra Sound.

Objectives: To evaluate plaque morphology in non-culprit coronary arteries using intravascular ultrasound in patients with acute coronary syndrome with and without elevated glycated haemoglobin and its assocaition with patient outcome. Method: The cross-sectional study was conducted at the Cardiology Department of Kafrelsheikh University, Egypt, from November 2019 to January 2022, and comprised adult patients of either gender suffering from acute coronary syndrome. The patients were divided into three groups. Diabetic patients were in group A, prediabetic patients with elevated glycated haemoglobin in group B, and patients with normal glycated haemoglobin in group C. The patients were subjected to coronary angiography and percutaneous coronary intervention. Intravascular ultrasound scan was done after succcessful intervention. Lesions were classified according to ultrasound findings. Patients were followed up for one year to observe subsequent events to the morphology of the lesions detected at baseline. Data was analysed using SPSS 20. RESULTS: Of the 52 patients, 18(34.7%) were females and 34(65.3%) were males. Group A had 18(34.6%)patients; 13(72%) males and 5(28%) females with mean age 57.9±6.9 years. Group B had 17(32.7%) patients; 11(64.7%) males and 6(35.3%) females with mean age 56.5±5.5 years. Group C had 17(32.7%) patients; 10(59%) males and 7(41%) females with mean age 59.5±5.1 years(p>0.05). Thin-capped fibro-atheroma wassignificantly higher in groups A and B compared to group C (p=0.045). Significant direct correlation between major adverse cardiac events and prevalence of thin-capped fibro-atheroma wasfound between groups A and C (p=0.033), and between groups B and C (p=0.047) regarding prevalence of necrotic plaque and subsequent myocardial infarction. CONCLUSIONS: Thin-capped fibro-atheroma was the more common plaque type in patients with raised glycated haemoglobin, and the subsequent rate of major adverse cardiac events was significantly higher in such patients compared to the non-diabetic population.

Association of Left Atrial Deformation Analysis by Speckle Tracking Echocardiography With Left Atrial Appendage Thrombus in Patients With Primary Valvular Heart Disease.

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, ß = 2.745, SE = 0.804, OR = 15.56, and 95% CI: 3.219-75.245; and P = 0.002, ß = 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 (ß = 1.167, SE = 0.996, OR = 3.21, and 95% CI: 0.456-22.631; and ß = 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.

Effect of Chronic Hepatitis C Virus Treatment by Combination Therapy on Cardiovascular System.

BACKGROUND: The prevalence of hepatitis C virus (HCV) in Egypt is quite high, and the combined oral direct-acting antiviral agents (DAAs) may have impressive results. OBJECTIVE: To assess the cardiovascular effects of DAAs in patients with HCV. METHODS: A 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. RESULTS: No 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. CONCLUSIONS: The DAAs used in combination regimen with interferon or used orally in combination do not significantly affect the cardio-vascular system.